The 20th World Congress on

Controversies in Obstetrics,
Gynecology & Infertility (COGI)
All about Womens Health

Paris, France, December 4-7, 2014

Abstract Book

A comprehensive Congress fully devoted to clinical controversies, debates and consensus

on a wide spectrum of topics in Obstetrics, Gynecology and Infertility

www.congressmed.com/cogiparis
[email protected]

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

Timetable
Thursday, December 4, 2014
09:30-16:00

Pre Congress Workshop:

VITRIFICATION HANDS-ON WORKSHOP OOCYTE AND EMBRIO VITRIFICATION

18:30-19:30

OPENING SESSION

19:30-20:30

NETWORKING COCKTAIL

Friday,December 5, 2014
Hall A
Infertility

08:30-10:00

Hall B
Fetomaternal

INDUSTRY SYMPOSIUM

INDUSTRY SYMPOSIUM

See page 61

See page 62

INDUSTRY SYMPOSIUM
See page 61

NON-INVASIVE PRENATAL
TESTING (NIPT)

Hall E
Free Communications

MANAGING THE
MENOPAUSAL SYMPTOMS

INFERTILITY

LABORATORY MISTAKES AND

PATIENT SAFETY

HRT: WHO SHOULD BE

TREATED?

FETOMATERNAL

Poster Viewing

11:50-12:10
12:10-13:40

RISK MANAGEMENT IN IVF

LABORATORIES

Hall D
Gynecology

Coffee Break

10:00-10:20
10:20-11:50

Hall C
IFV Laboratory Workshop

ANTI-MULLERIAN HORMONE
(AMH) & INDIVIDUALIZED
DOSING FOR OVARIAN
STIMULATION FOR IVF

INDUSTRY SYMPOSIUM
See page 62

IMPROVING EMBRYO QUALITY

NEW COMBINATION IN THE
AND SELECTION
MARKET

GYNECOLOGY

Lunch Break

13:40-14:30

INDUSTRY SYMPOSIUM
14:30-16:00

STIMULATION OR MILD
STIMULATION?

INDUSTRY SYMPOSIUM

See page 63

See page 63

CONTROVERSIES IN IVF
LABORATORIES PRACTICE I
Coffee Break

16:00-16:30
16:30-18:00

TREATMENTS OF MENOPAUSE GYNECOLOGY

The Ovarian Zone Workshop:

RECONSTRUCTING THE
OVARIAN STORY: TOWARDS A
NEW CLINICAL SOLUTION

METHOD VALIDATION
FETAL MONITORING

CONTROVERSIES IN IVF
LABORATORIES PRACTICE II

MANAGING THE
MENOPAUSAL SYMPTOMS

INDUSTRY SESSION:
MEET THE EXPERT
See page 64

Saturday,December 6, 2014
Hall A
Infertility

08:30-10:00

Hall B
Fetomaternal

PERICONCEPTIONAL
MEDICINE: WHERE
REPRODUCTIVE AND FETALMATERNAL MEDICINE MEET

PRE-GESTATIONAL WEIGHT
AND WEIGHT GAIN DURING
PREGNANCY: AN OLD
DILEMMA REVISTED

THE UTERUS
TRANSPLANTATION
WORKSHOP- PART I

PROGESTERONE SUPPORT
DURING PREGNANCY

THE UTERUS
TRANSPLANTATION
WORKSHOPPART II

DECREASED OVARIAN
RESERVE (DOR)

TIME-LAPSE TECHNOLOGY
POSTPARTUM HEMORRHAGE

INDUSTRY LECTURE
See page 65

See page 65

PRENATAL DIAGNOSIS OF
MULTIPLE PREGNANCIES

FREEZING GAMETE FOR

FERTILITY PRESERVATION

CMV SCREENING AND

BEYOND

INDUSTRY SYMPOSIUM

FETOMATERNAL

Workshop in HPV and

adolescence gynecology:
HPV SCREENING

GYNECOLOGY

INDUSTRY SYMPOSIUM
See page 65

HPV VACCINATION AND

COMBINED PROTOCOLS

INFERTILITY

OPERATIONS BEFORE IVF

TREATMENT

A MULTI-DIMENSIONAL
GYNECOLOGICAL CARE OF
ADOLESCENTS

FETOMATERNAL

CONTRACEPTION AND
FAMILY PLANNING

GYNECOLOGY

Coffee Break

16:00-16:30
16:30-18:00

OVARIAN CANCER

Lunch Break

13:40-14:30
14:30-16:00

Hall E
Free Communications

Poster Viewing

11:50-12:10
12:10-13:40

Hall D
Gynecology

Coffee Break

10:00-10:20
10:20-11:50

Hall C
Reproduction

ENDOMETRIOSIS

Sunday, December 7, 2014

Hall A
Infertility

08:30-10:00

CONTROVERSIAL ISSUES IN BASIC CLINICAL

ASPECTS OF ART

PRENATAL DIAGNOSIS AND ULTRASOUND

Hall C
Free Communications
GYNECOLOGY

Coffee Break

10:00-10:20
10:20-11:50

Hall B
Fetomaternal

NEW PARADIGMS IN PCOS

BEWARE OF THE LAWYERS: ISSUES IN PERINATAL

LITIGATION

GYNECOLOGY

Abstract Book

Table of Contents
Welcome Letter

Invited Speakers

Oral Presentations

21

Posters

67

book only

153

Index

161

3
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The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

Welcome letter
Dear Colleagues,
We would like to personally welcome each of you to the 20th COGI Congress in Paris,
France. As COGI continues to grow, the Organizing Committee is motivated to bring you current
controversies we are facing today in gynecology, infertility and obstetrics.
We would like to give you an idea of what you can expect and what we hope to achieve over the
next few days. 150 invited speakers will debate, discuss and lecture in 5 parallel halls including
the Annual Robert G. Edwards Nobel Prize Laureate Lecture which will be delivered
in the opening session. The program will also include a IVF Laboratory Workshop, Uterus
Transplantation Workshop, and an HPV and Adolescence Gynecology Workshop.
A total of 650 abstracts were accepted, out of which 100 were selected for oral presentation.
The number of participants has grown to over 2,000 delegates. 21 pharmaceutical and medical
equipment companies are sponsoring and/or exhibiting at the Congress.
We thank each of you for attending the COGI Congress and for bringing your own expertise to our
gathering. We are happy to be associated with you, as leaders in your communities, to teach and
learn, and to pave the way to a better future in the field of Ob/Gyn.
Sincerely,

Zion Ben-Rafael, Rene Frydman, Bart C.J.M Fauser

Congress Co-Chairpersons

4
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The 20th World Congress on

Controversies in Obstetrics,
Gynecology & Infertility (COGI)
All about Womens Health

Invited Speakers

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

Notes

Abstract Book

INVITED SPEAKERS ABSTRACTS

Thursday, December 5, OPENING SESSION
S01
THE RW GENOME, EPIGENETICS, EVOLUTION AND PREGNANCY
J.A. Shapiro
University of Chicago, USA
60 years of molecular biology have changed our view of the genome. Instead of
a ROM (read-only memory), we now realize that the genome is a RW (readwrite) data storage system. The relevant discoveries included:
(1) The elucidation of "natural genetic engineering, biochemical systems
responsible for genome changes at all levels of DNA structure;
(2) The recognition of cells' ability to control genome function and expression
by transcription factor complexes and epigenetic chromatin modifications.
These discoveries allow us to see evolutionary processes as active cell-mediated
changes to genome structure. Among the main agents of natural genetic
engineering and inscription of epigenetic signals are viruses and mobile genetic
elements, including retroviruses. Endogenous mammalian retrovirus has played
a major role in placental evolution, and epigenetic regulation is key to
understanding the development of the placenta and the embryo. The lecture will
outline connections between molecular evolution science and real-world
influences on fetal health.
CAPSULE BIOSKETCH: James A. Shapiro, author of the 2011 book Evolution: A
View from the 21st Century, is Professor of Microbiology at the University of
Chicago. He has a BA in English Literature from Harvard (1964) and a PhD in
Genetics from Cambridge (1968). During a postdoctoral at the Institute Pasteur
in 1968, he established insertion mutations in bacteria. In 1969, he and
colleagues at Harvard Medical School used in vivo genetic manipulations to
clone and purify the lac operon. With Bukhari and Adhya in 1976, he organized
the first conference on DNA insertion elements. In 1979, Shapiro formulated a
molecular model for transposition. In 1984, he showed that selection stress
triggers transposon action. Since 1992, he has been writing about the
importance of biologically regulated natural genetic engineering.
READINGS: Shapiro, J.A. 2011. Evolution: A View from the 21st Century. FT
Press Science. http://www.amazon.com/Evolution-View-21st-Centurypaperback/dp/0133435539/
Shapiro JA 2013. How Life Changes Itself: The Read-Write (RW) Genome. Physics
of Life Reviews 10:287-323.
http://www.sciencedirect.com/science/article/pii/S1571064513000869
Friday, December 5, Hall A
S02
CAN AMH PREDICT PREGNANCY RATES BETTER THAN OTHER MARKERS?
S. Nelson
University of Glasgow
The age-related decline in oocyte quantity and quality underpins the decline in
success rates and prospect of live birth after assisted conception with advancing
maternal age. Age alone however is of limited accuracy in predicting live birth;
thus there is a need for improved prediction. The substantial heterogeneity in
the size of the ovarian reserve at any given age results in marked inter-individual
variation in ovarian response despite optimal ovarian stimulation. Analysis of
this heterogeneity may provide insights into understanding individual fertility
and how it changes with age, and it is also a likely source of clinically useful
biomarkers. A variety of ovarian reserve tests have been developed and their
predictive capacity for ovarian response examined. In recent systematic reviews,
individual patient data meta-analysis and international multicentre trials, antiMllerian hormone (AMH) has been confirmed as the current best biomarker for
prediction of oocyte yield and poor and excessive ovarian response.
Given the strength of the relationships with oocyte yield, the association of AMH
with pregnancy after assisted conception has been examined, but results have
been inconclusive. Some studies have concluded that AMH is not associated with
pregnancy while others have found a positive association. An individual patient
data meta-analysis in 1008 patients undergoing fertility treatment

demonstrated a weak association of AMH with ongoing pregnancy. To further

clarify the role of AMH for prediction of live birth we undertook a meta-analysis
of 6306 women. This suggested that although AMH has some association with
predicting live birth independent of age in women undergoing IVF, its predictive
accuracy was poor. Consequently given this poor diagnostic accuracy for live
birth we suggest that it should not be used to exclude couples from IVF/ICSI
based on a low AMH. In addition, these data do not justify adoption of an AMH
threshold for access to such treatments and further studies are needed to
investigate whether a universal AMH threshold is possible, or appropriate.
S03
IS LOW INTENSITY ("MILD" OR "MINI") OVARIAN STIMULATION PREFERABLE?
NO
N.H. Zech
IVF Centers Prof. Zech, Bregenz, Austria
The main argument for mild stimulation is that it requires relatively low doses of
hormones. Thereby the likelihood of the occurrence of side effects is thought to
be reduced. Additionally, per stimulation cycle, the costs for medication are
lower as compared to classic stimulation protocols. This is said to reduce overall
costs per treatment. The terms mild, light, soft, mini or low-dose
stimulation are usually used synonymously and express that only few follicles
should grow resulting in few, mostly not more than 1-3 oocytes per ovarian pickup (OPU). However, with such low numbers of oocytes, several cycles are likely
to be necessary to achieve one live birth. Concluding, overall costs per baby will
accumulate with the number of stimulation cycles and OPUs needed due to
physics of nature.
In contrast, when applying conventional ovarian stimulation protocols followed
by single embryo transfer (SET) at the blastocyst stage in combination with
optimal aseptic vitrification protocols (e.g. Vitrisafe), we may expect the birth of
several consecutive babies per OPU. To minimize the risks and inconvenience of
OHSS, a primary embryo transfer in a consecutive cryo-cycle is nowadays
regarded as the best option without compromising pregnancy rates.
In this regard our target should be to reach the highest possible individual EGP
(expected gametes performance) for the couples in means of obtaining several
good quality blastocysts after only one stimulation cycle. To reach this goal, we
need a good number of oocytes to work on the target EGP. With this in mind we
have to ask following question: what is the least harmful and most cost effective
approach for patients? Several mild stimulation cycles to obtain one baby, or
one classical stimulation cycle with a high probability to obtain more than one
child, one at a time.
S04
MITOCHONDRIAL REPLACEMENT THERAPY.
A. Murdoch
Newcastle Fertility Centre at Life, UK
It is important at the start of this review to be clear about the scope and
limitations of the procedures that will be described. Firstly, these are techniques
that are being developed to help women who carry abnormal mitochondrial
DNA. It is not a technique that is relevant to the subfertile population as there is
no evidence that mitochondrial abnormalities are related to fecundity. Secondly,
at the time of writing, mitochondrial replacement is not a legal therapy in the
UK. The work that is described relates to basic research although the current
legal and ethical debate will be summarised. The required Regulations in the UK
have been prepared but are still subject to Parliamentary debate.
Mitochondria within the cytoplasm provide the energy required for normal cell
function. Each cell in the body may contain up to several thousand mitochondria
depending on the energy requirements of that cell. The mitochondria contain
DNA (mtDNA) which contain 37 genes (0.01% of the total DNA in cells). Unlike
nuclear DNA, the mtDNA is inherited entirely through the maternal line. 1 in
6500 children will inherit significantly abnormal mtDNA.
Most individuals are homogeneous for normal mtDNA, some carry mostly
abnormal mtDNA and some are heterogenous. The phenotypes associated with
abnormal mtDNA are highly variable because there may be different proportions
of abnormal mtDNA in different cells. Thus an apparently healthy woman may

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

have a very high risk of passing abnormal mtDNA to her child if there is a high
number of abnormal mtDNA in her oocytes. Disorders caused by mutated
mitochondrial DNA are progressive and can appear at any time from birth
onwards. The spectrum of associated health problems includes heart and other
major organ failures, stroke, dementia, blindness, deafness and premature
death. There is currently no cure for disorders related to abnormal mtDNA. It is
not surprising therefore that the leading supporters of the research to develop
mitochondria transfer techniques are the patient groups.
The current fertility options available for this patient group include remaining
childless, adoption, egg donation or PGD. Any future therapy will be placed
alongside these options. The techniques being developed use the skills and
knowledge acquired from the clinical and research studies within the IVF setting
to help those with abnormal mtDNA. A simple description of the technique is
that an egg is donated by a healthy woman, her nuclear DNA is removed and
replaced with the DNA from the egg of the patient with abnormal mtDNA. This
could be done before or after fertilisation. The optimal technique is still to be
determined.
Studies to develop these techniques have been ongoing for over 10 years. They
have been shown to be successful in producing live mice. Others have carried
out the techniques successfully in primates. Translating this to humans has been
more complicated because of the relatively poor reproductive potential of
humans and the ethical and legal considerations. Our studies using abnormally
fertilised human oocytes (from the IVF clinic) confirmed the proof of principle
of the procedures e.g. the low mitochondrial carry over and potential for onward
development of reconstructed embryos. This work is ongoing using eggs
donated by healthy volunteers and aims to optimise the techniques and evaluate
the subsequent embryo quality.
A more detailed review of the mitochondria and the relevant research is given
in the HFEA Scientific Reviews Alongside the scientific development of the
techniques, there is a need to engage the public, the legislators and the
regulators. There are several issues that are raised. The ethical issues were more
widely discussed in the Nuffield Council Report. A summary of their main areas
for consideration is given below.
Implications for identity: whilst nuclear DNA clearly relates to individual identity,
the role, if any, of mtDNA is debatable. It is arguable that our health (or unhealth) is a determinant of identity. Germline therapies: since the transferred
normal mitochondria are passed on to the next generation, this is germline
therapy. Whilst clearly unacceptable for nuclear DNA, this is arguably the desired
benefit for families who carry abnormal mtDNA.
The introduction of novel techniques and follow-up of children: Whilst it is
obviously vital that the outcome of these techniques is monitored over future
generations, this in itself presents ethical problems. Parentage of the child: the
significance of mitochondrial donation techniques in the biological, social and
legal context of the relationship between the donor and the child requires
consideration.
The status of the mitochondrial donor: there are practical issues relating to the
regulations in the UK about egg donation that have ethical considerations e.g.
should the donor remain anonymous? Implications for wider society and future
generations: If there is concern about future generations, the techniques could
be limited to the birth of boys only. This would resolve one problem whilst
introducing others.
In the UK, the HFEA carried out a public consultation and subsequently the
government has responded. In addition the HFEA has carried out a further
Scientific Review of the procedures in 2014. As a result of this, the UK
government is preparing Regulations that, if approved, would permit these
techniques to be licensed by the HFEA for treatment if the HFEA consider that
this scientific evidence supplied with an application is acceptable. In anticipation
of the debate on Regulations, Parliament is being briefed. The UK is not the only
country working on these techniques but it is leading on the regulatory and
ethical issues. It is hoped therefore that when the scientific evidence is
compelling, there will be no barrier to translating this into treatment.
The research in Newcastle is supported by The Wellcome Trust

Friday, December 5, Hall B

S05
EFFECT OF PRE-PREGNANCY WEIGHT AND GESTATIONAL WEIGHT GAIN ON
THE INCIDENCE OF PREECLAMPSIA AND GESTATIONAL DIABETES
Natasa Tul, MD, PhD1 ; Miha Lucovnik, MD, PhD1; Isaac Blickstein, MD2; Lili
Steblovnik, MD1; Ivan Verdenik, PhD1; Andreja Trojner Bregar, MD1 , Vesna
Fabjan Voduek MD1
1Department of Perinatology, Division of Obstetrics and Gynecology, University
Medical Centre Ljubljana, Slovenia; 2Department of Obstetrics and Gynecology,
Kaplan Medical Center, Rehovot, affiliated with the Hadassah-Hebrew University
school of Medicine, Jerusalem, Israel
Number of obese women of reproductive age is increasing. These women are at
increased risk of several pregnancy complications, among which preeclampsia
and gestational diabetes mellitus (GDM). Excessive gestational weight gain has
also been demonstrated to be associated with an increased risk of both
preeclampsia and GDM. It is important, however, to differentiate between the
effect of pre-pregnancy body mass index (BMI) and gestational weight gain on
the incidence of these two conditions, since weight gain is amenable to
interventions during pregnancy while high pre-pregnancy BMI is not.
Conclusions of two studies on Slovenian population of pregnant women are that
pre-pregnancy BMI is strongly associated with preeclampsia and GDM in both
twin and singleton pregnancies. Gestational weight gain is also associated with
risk of preeclampsia, although seemingly less so than pre-pregnancy BMI.
Smaller gestational weight gain noticed in patients with GDM may reflect the
importance of dietary counseling after GDM diagnosis.
References
Lucovnik M, Blickstein I, Verdenik I, Trojner-Bregar A, Tul N. Maternal obesity in
singleton versus twin gestations: a population-based matched case-control
study. J Matern Fetal Neonatal Med. 2014
Lucovnik M, Blickstein I, Verdenik I, Steblovnik L, Trojner Bregar A, Tul N. Impact
of pre-gravid body mass index and body mass index change on preeclampsia and
gestational diabetes in singleton and twin pregnancies. J Matern Fetal Neonatal
Med. 2014
Friday, December 5, Hall C
S06
PERSONAL QUALIFICATION AND COMPETENCY MAINTENANCE
V. de Larouziere,
Hpital Tenon, France
IVF laboratory work requires high precision and technology. Therefore the
personal qualification and competency maintenance according to ISO 15189 is a
major subject in an ART laboratory.
Then 3 different aspects have to be defined:
-the personnel concerned (embryologists, biologists, technicians, trainees),
-the critical activities in laboratory work
-qualitative and quantitative criteria of personal competency for these activities,
Finally, once a person is qualified, his competency has to be maintained (internal
and external evaluation programs...). All the criteria will be defined according to
the 15189 requirements and the embryologist experience.
S07
FRANCE ORGANISATION: AMP VIGILANCE
G. Lemardeley, J-O Galdbart; F. Merlet, D. Royre
France organisation : ART vigilance
Introduction: In France, ART (assisted reproductive technology) vigilance is a
recent mandatory vigilance system which has been set up to monitor adverse
reactions and adverse events in the field of reproductive cells (eggs, sperm) and
reproductive tissues, in order to improve safety and quality of the practices. The
whole system became fully operational in June 2008 through a ministerial
decree, after the transposition of the European directive, i.e. Directive
2004/23/EC of the European Parliament and of the council of March 31, 2004
which set standards of quality and safety for the donation, procurement, testing,
processing, preservation, storage and distribution of human tissues and cells.

Abstract Book

The "Agence de la biomedecine" (ABM) is responsible for the management of

this system at the national level.
Material and methods: In France, a total of about 200 ART centres are spread all
over the country. These centres develop clinical and/or laboratory activities in
the field of ART. Each center must appoint a local correspondent for ART
vigilance. Up till now, 96 % of the ART centres have appointed one
correspondent. The correspondent should carry out specific tasks particularly to
report all ART adverse reactions and adverse events to the Agence de la
biomedecine and to coordinate the investigations.
Each reported incident is analyzed on the basis of its seriousness and frequency.
An assessment is carried out by the Agence de la biomedecine with ART
external experts to evaluate the impact in terms of safety at the national level.
Based on the assessment results, the ABM develops specific actions to inform
health professionals and recommends corrective measures when necessary.
France took part of the two European projects funded by the European
commission, Eustite and Soho whose aim was to define standardization and
common tools in the fields of biovigilance, ART vigilance and inspection
throughout European countries.
Results: In 2013, a total of 469 notifications have been reported to the "Agence
de la biomedecine" by the ART centres. Among these 469 incidents, 107 adverse
events and 362 adverse reactions were reported by 86 centres. Nearly 80 % were
serious incidents. The average time of notification to the agency is about 2
months. Most of the adverse reactions were related to an ovarian stimulation.
Among reported cases, we observed ovarian hyperstimulation syndrome which
accounted for around 50 % of the notifications, thromboembolic accidents,
adnexal torsions, surgical or anaesthetic complications, or infectious events.
Most of the adverse events were related to the loss of gametes or embryos at
different stages of the process. Those events were most often linked to a human
error or an equipment failure (ex: misidentification, fall of the culture dish) or
in some cases, to an environmental problematic (ex: contamination of
cultures...). Part of the reports collected through the ART vigilance system also
concerned other vigilance systems (pharmacovigilance, medical devices
vigilance, biovigilance).
Conclusion: ART vigilance is a new regulatory vigilance that contributes to
enhance the quality of care for patients who need assisted reproductive
technology. This system should be coordinated with other vigilance systems in
order to increase its efficiency both at the national and the European levels.
Feedback to the ART professionals is essential to develop the system in a
confident way. Further cooperation through EU member states should be
developed.
S08
HOW TO AVOID LABORATORY MISTAKES?
R. Lvy
Service dHistologie-Embryologie-Cytogntique-CECOS, Hpital Jean Verdier
(AP-HP), Bondy, France; Service de Mdecine de la reproduction, Hpital Tenon,
4 rue de la Chine, 75020, Paris (AP-HP), France
According to European and national guides and recommendations (Guide for
good analysis (GBEA), rules of good practice for ART (arrt du 3 aot 2010
modifiant l'arrt du 11 avril 2008), transposition of European standard (dcret
n2008-588 du 19 juin 2008), report form for ART vigilance (arrt du
18/12/2008), Accreditation ISO15189, risk assessment) and specific
recommendation from Biomedecine Agency Director (14/01/2010), centres
must have in place continuous quality improvement with robust and effective
processes to ensure that no laboratory mistakes occur, including
misidentifications of gametes or embryos or identification errors.
Centres must carefully check the identification of all samples and the patients,
or donor, to whom they relate at all critical points of the clinical and laboratory
process. These checks must be completed and recorded at the time of the
relevant clinical or laboratory process/procedure takes place. A record must be
kept in each patients/donors medical record. Manual double witnessing
(MDW) for all IVF laboratory processes involving gametes or embryos has been
mandated by HFEA to reduce the risk of misidentification of patient samples.
Electronic witnessing systems to track samples at predefined procedural steps
in IVF laboratories worldwide to prevent mix-ups and provide an automated

solution for mandatory double-witnessing are now available, using for example
Radio Frequency Identification (RFID) technology.
Clinical and laboratory procedures: The identified critical steps are:
- Collecting eggs: pick up and retrieval, collecting sperm / surgical spermatozoa,
preparing sperm
- Mixing sperm and eggs or injecting sperm into eggs, transferring gametes or
embryos between tubes or dishes, embryo transfer and intra uterine
insemination with sperm prepared in the laboratory
- Freezing gametes or embryos and placing gametes or embryos into
cryopreservation container
- Removing gametes or embryos from cryopreservation and thawing
- Disposing of gametes or embryos, transporting gametes or embryos
- Centres performing embryo biopsy should have protocols in place to ensure
that embryos and the material removed from them for analysis are labeled
Keeping a record: The checking of identifying samples, patients and donors
should be recorded, the record stating:
- The control check (name, first name, birth date), the date and time of the check,
the signature of the person doing the check
- If available, the signature of the witness or patient (sperm sample)
Training: centres should have an induction programme for new staff to ensure
they understand the principles of check and follow the centres protocol. Staff
should also receive refresher training as the centre decides is appropriate.
Interruptions and distractions in the clinic and laboratory: the centre should
consider the implications of distractions in the clinic and laboratory, such as from
phones and external noise, and ensure they are minimized. Interrupting and
returning to a task is a common source of human error.
In case of laboratory mistake, a clinic-biological staff will analyze each situation
(risk analysis, corrective action, and eventual procedure optimization) and a
statement to Biomedecine Agency will be addressed.
Conclusion: strict procedures must be implemented to avoid laboratory
mistakes, part of accreditation. Identification mismatches reflect the specificity
of ART procedure (couples, gametes, embryos, and donor). In case of rare bur
inevitable error, there is a clear need for transparency.
S09
IMPROVING EMBRYO QUALITY AND SELECTION - EMBRYOS GROUPING TO
IMPROVE DEVELOPMENT
R. Lvy1, 2, P.-Villard2
1
Service dHistologie-Embryologie-Cytogntique-CECOS, Hpital Jean Verdier
(AP-HP), Bondy, France; 2Service de Mdecine de la reproduction, Hpital
Tenon, 4 rue de la Chine, 75020, Paris (AP-HP), France
Embryo culture conditions are key determinants of ART procedures efficacy. In
routine IVF procedures, droplets of medium may contain one or more than one
embryos, depending on the embryologists choice or specific requirements such
as mandatory individual embryo traceability: e.g. PGS/PGD procedures, timelapse embryo development analysis, research protocols). The latter is generally
referred as individual embryo culture, whereas cultivating more than one
embryo in one drop is referred as group embryo culture.
It has been hypothesized that preimplantation-stage human embryos were able
to produce and secrete trophic factors into their culture medium. Candidates
factors include several embryotrophic ligand with mitotic stimulating abilities,
such as PAF or IGF1 and IGF2.The possibility that these factors could act in a
autocrine/paracrine way has led to the hypothesis that cultivating more than
one embryo in the same drop of media or reducing drop volume could improve
in vitro embryo development and consequently IVF procedures outcomes. On
the other hand, increasing embryo density by multiplying the number of embryo
in one drop or by diminishing drop volume could result in a potentially harmful
accumulation of toxic substances such as ammonium or oxygen derived free
radicals in the vicinity of the embryos, which could in return negatively influence
IVF outcomes (Virant-Klun et al., 2006). Ultimately, the use of such trophic agent
in embryo culture could improve IVF outcomes (Jin et Oneill 2014).
Animal models suggested an increased blastocyst development when group
culture is applied. Group culture at an optimum density of 9 murine embryos in
50l droplets of volume media was superior in terms of blastulation rate and
good quality blastocysts number to individual embryo culture or group culture

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

with greater or lower embryo density (Dai et al 2012). Interestingly, when

individual embryo culture was considered, a significant increase in blastocyst
quality was found when embryos were placed in a microwell carved on the
bottom of the Petri dish, although it was not the case for group culture embryo.
The same modified microwell dishes were used to evaluate the effect of embryo
density on in vitro development and gene expression in a bovine model
(Sugimura et al 2013). An optimal density of embryo for blastocyst formation
was described and differential expression of IFN tau and IGF2R gene was
reported. In the group of maximum embryo density and blastocyst formation,
these two genes were respectively up and down regulated compared to a group
with less embryo density. These results were not reproduced when embryo
where cultured into microwell. Animal models suggest that an optimal embryo
density exist and that microwell culture could rescue the detrimental effect of
an eventual suboptimal embryo density, possibly by concentrating autocrine
factors around the developing embryo.
However, no significant statistical differences in terms of in vitro embryo
development or pregnancy rates were initially found in prospective human
studies. These results, and the fact that individual culture allows individual
assessment and embryo traceability, explain the popularity of this practice
among ART facilities.
In a recent randomized prospective study (Ebner et al 2010) including 936
zygotes from 72 patients, Ebner and colleagues were able to demonstrate a
statistically significant improvement in compaction and blastulation rates, as
well as blastocyst quality, when group culture in sequential medium was applied.
Ultimately, the fact that the best in vitro embryo development occurred in the
subgroup of maximum embryo density and contact raises the question of a
possible beneficial physical effect of close vicinity between embryo such as
optimum space between embryo, or even mechanical interaction between
embryos in the same droplet. Such optimal space between embryos has
previously been described in bovine model (Gopichandran and Leese, 2006) and
a beneficial effect of mechanical stimulation of embryo during in vitro culture
has recently been demonstrated (Isachenko et al 2011)
Grouping 2 to 5 embryos in 50l droplets from day 3 today 5/6 after individual
culture from day 1 to day 3, (Tao et al 2013), the authors found a significantly
higher blastulation and blastocyst utilization rate when good and poor
morphological quality day 3 embryos were separately grouped, compared to
random grouping, regardless of embryo quality.
An Italian team (Restelli et al 2014) recently tried to improve Ebners group
culture strategy by grouping good quality zygotes in separate drops from
morphologically non-optimal zygotes. They compared pronuclear morphology
based grouping versus random zygotes grouping in an observational time-course
study. As previously described, blastulation rate was higher when symmetrical
zygotes were grouped together, compared to unsymmetrical ones. But
surprisingly, significantly better clinical outcomes were observed after fresh
blastocyst transfer in the random zygote grouping cohort (n=594) compared
to the other cohort where grouping was based on pronuclei morphology
(n=649). Interestingly, the mean number of zygotes per drop was significantly
lower in the latter cohort (2,9+/-0,9 Vs 3,3+/-0,5, p<0,001), due to the selection
process.
The underlying mechanisms of embryo cross talk are largely unknown, even if
previously described trophic factors have been identified. Recently, it has been
suggested that human embryo could secrete miRNAs into culture media, and
that their differential expression could be related to implantation potential of
the embryo (Rosenbluth et al, 2014) Exosome/microvesicles could also play a
part in paracrine regulation of embryo development. The fact that exosome can
be associated with RNA molecules and be incorporated into porcine embryos
open new perspectives for embryo group culture methods (Saadeldin et al
2014).
To conclude, even though it has to be confirmed by prospective randomised
clinical trials, these recent findings may indicate that embryo density or
proximity rather than embryo quality may influence IVF outcome when
considering group culture, especially in blastocyst transfer programs. Finally,
large scale multicentric prospective studies should be promoted to better
understand the influence of culture conditions on IVF conceived childrens
health.

10

S10
SPERM DNA DAMAGE: NEW STRATEGIES OF INTERVENTION BASED ON
INDIRECT ANTIOXIDANTS
M. Dattilo1, M. Cohen2, Y. Menezo3
1Parthenogen, Via F. Pelli 1, Lugano 6900, Switzerland; 2Procrelys Association
de recherche en Infertilit, Lyon 69008, France; 3Laboratoire Clment, 17
avenue dEylau, Paris 75016, France
Problem statement: Sperm chromatin structure is often impaired by oxidative
damage and has been related to poor reproductive outcomes in both natural
and assisted reproduction. We aimed to test a new intervention based on the
administration of indirect antioxidants acting within the frame of cellular
homeostasis1.
Methods: 84 male partners of couples with at least 2 ART failures (range 2-6,
mean 2.4) and with a sperm DNA fragmentation index (DFI) and/or a sperm
nuclear decondensation index (SDI) > 20% were recruited irrespective of their
spermiogram (1 out of 4 normospermic) and of female factors (present in 28 out
of 84). They took a 4 month nutritional support with indirect antioxidants in
preparation of a new ART attempt. The support contained a methyl donor (folic
acid) to feed transmethylations, a cysteine donor to feed GSH synthesis and all
the rate limiting co-factors for the concerned enzymes (Vit. B2, B6, B12, zinc).
The product of concern, CondensylTM, also contained small amounts of Vit. E
and of quercetine and betalaines. The DFI was measured by TUNEL and the SDI
by blue aniline staining both before and after the treatment.
Results: 18 out of 84 couples experienced a spontaneous pregnancy and a live
birth before the time for the planned ART. The remaining 66 couples underwent
ART (4 IUI; 18 IVF; 44 ICSI) resulting in 22 further clinical pregnancies and 15 live
births. The positive pregnancy outcome was related to the decrease of the SDI.
DFI and SDI response according to the occurrence of a clinical pregnancy, mean
values
DFI
Groups
n (%)
%
Pre
Post
change
Any
pregnancy
40
YES
29.4% 20.1%
-9.3%
(47.6)
44
NO
30.1% 25.9%
-4.2%
(52.4)
Spontaneous
pregnancy
18
YES
23.2% 18.4%
-4.8%
(21.5)
66
NO
31.5% 24.4%
-7.2%
(78.5)
ART
pregnancy
22
YES
34.4% 21.4%
-13.0%
(33)
44
NO
30.1% 25.9%
-4.2%
(67)
SDI
p
Pre
Post
% change
p
0.168

40.6%
39.6%

29.3%
42.6%

-11.3%
3.0%

0.000

0.571

44.8%
38.8%

29.8%
38.0%

-15.0%
-0.7%

0.000

0.046

37.2% 29.0%
-8.2%
0.001
39.6% 42.6%
3.0%
Mann-Whitney test
Conclusion: Nutritional support with indirect antioxidants (Condensyl) may
improve the clinical outcomes in couples infertility due to a male factor. The

Abstract Book

strong correlation between the pregnancies and the SDI decrease supports a
positive effect on the sperm chromatin architecture.
1Dattilo et al. Reproductive Biology and Endocrinology 2014, 12:71
S11
DO WE GO DIRECTLY TO BLASTOCYST WITHOUT CLEAVED EMBRYO
EXAMINATION?
G. Cassuto
Art Unit, Drouot Laboratory, Drouot Street, Paris, France.
At the beginning we thought that embryo culture must mimic the nature with
the sequential media systems. Today most of IVF center have evolved in their
practice from sequential to one single step culture medium. Let the embryo
choose and select which nutrients it needs to metabolize. Let it eat all it
can.Going ahead we decide to put all the embryos together in the same culture
media and in the well dish. We present here a comparison of blastocyst rates,
which were grown in a same CSC media (Irvine Scientific) but with a follow up
and different culture conditions.
The study included in 2014, 20 couples programmed for ICSI or IMSI with 8 and
more oocytes. Sibling injected oocytes were randomly split between Galaxy
(Group 1) and Miri incubator (Group 2); cultured for the two groups in 250 l
CSC medium + 10% SSS covered with 150 l mineral oil. The Group 1 was
performed in 6% CO2, examined at day 1 to assess fertilization, cleavage,
embryo quality and transferred to fresh media on day 3. In opposite Group 2 was
in static environment, reduced oxygen 5%, 6% CO2 and 89% N2; without
examined microscopically, without any change and medium renewal and
without any disturbances. We previously calculated during 2 years the triploids
number after injection: 4 out of 13 886 injected oocytes were triploids (0.0003%)
and the ammonium levels in the presence of embryos did not compromise their
development.
The blastocyst rate between the Group 1 and 2 show a statistically significant
difference: 34 out of 141 (24%), and 55 out of 138 (40%), respectively. (p< 0.04;
chi square= 4.12)
Several factors affect the morpho kinetics of the embryo development and the
blastocyst rate is dependent on the in-vitro culture environment. Do not disturb
them!
S12
DO WE GO DIRECTLY TO BLASTOCYST WITHOUT CLEAVED EMBRYO
EXAMINATION?
I. Koscinski
Laboratory of Biology of Reproduction, CHRU Strasbourg, CMCO, 1 place de
lHpital, 67000 STRASBOURG, FRANCE.
Pregnancy results of implantation of a normal embryo in an appropriate
endometrium. The morphology of the embryo is historically a usual method to
appreciate the evolutive parameter. The high miscarriage rate observed after
ART has been largely explored and partially explained by the DNA state of the
embryo. Several studies have demonstrated that chromosomal abnormalities
are one of the most common causes of abnormal embryos in IVF, and PGS is
probably the most effective method to selection normal embryo (s). When this
practice is forbidden as in France, some other tools have been developed to
explore the embryo DNA and try to select the embryo(s). On the other hand, the
transfer of a vitrified embryo offering the same chances of pregnancy as the
transfer of a fresh embryo, the risk of no transfer of a normal embryo of the
cohort is reduced. Of course, this theoretical consideration should be modulated
by the emotional impact for the couple exposed to the attempt failure and by
the cost of frozen embryo procedures.
That is why the embryo culture to blastocyst stage is regularly used as selection
tool of normal embryos even if a recent study showed around 45% of blastocysts
with aneuploidy. In this context, it is of the greatest importance for the ART lab
to offer the best culture conditions, ensuring the best embryo development. The
daily human observation of embryos as practiced in a lot of ART labs unequipped
with a Time-lapse system is limited since the embryo morphology is linked to its
kinetics which is affected by the culture conditions. Animal studies highlighted
that culture conditions can affect pre and post natal phenotype. As already

exposed, all culture conditions like hypoxia, PH, temperature, light result in a
culture system impacting on the blastulation rate. We expose here another
important condition of the human embryo culture system: the culture medium.
Two types of media are available: single media used for the whole culture or
sequential media whose composition varies according with the stage of embryo
development.
Material and methods: The prospective study reported here compares embryo
development obtained in 300 couples either with a unique medium (Global ,
Global life, JCD) either with sequential media of the COOK company (5 different
media from the Gamete Buffer , to the Blastocyst Medium ). Inclusion criteria
were the first and second attempts at IVF, ICSI or IVF half - half ICSI performed
in couples where women were under 37 years. Elective transfer of an embryo
was systematic at Day3 stage as well as at blastocyst stage. Exclusion criteria
were couples beneficing of a pre- implantation genetic diagnosis or a oocyte
donation. In addition to pregnancy rates and embryo freezing at day 3 and at
day 5, we focused our attention on development events like compaction of
embryos on Day3 and embryo kinetic. The recording the birth weight in each
group is still in progress.
Results: no difference in the pregnancy rate per retrieval and transfer between
the two groups: 39.6% per oocyte retrieval and 49.6% per transfer (of fresh or
frozen embryo) in the Global group and 44.5% per oocyte retrieval and 51.2%
per transfer of a fresh embryo or 53% per transfer of a frozen embryo in the
sequential group. We observed more good quality embryos, a greater
blastulation rate and we froze more blastocysts in the group of sequential
media. The kinetics of early embryo development was significantly accelerated
with the Global medium: 28% of embryos with more than 8 cells J3, versus 17%
with the sequential media. The embryos are more frequently compact J3 in the
Global group (16% versus 10%). It is still too early to compare the birth weight
in both groups since a lot of pregnancies obtained after transfer of frozen
embryo are still ongoing. The results will be compared with the literature,
pointing the impact of media culture as well as other in vitro culture conditions
affecting the embryo development in the pre-implantation, post-implantation
and post natal stages.
Friday, December 5, Hall D
S13
PHARMACEUTICAL INTERVENTIONS AT THE TIME OF THE MENOPAUSE THAT
REDUCE THE INCIDENCE OF BREAST CANCER.
M.P. Brincat, A. Calleja J, M.F.J. Brincat, J. Gambin
Dept of O&G, Mater Dei Hospital, Malta.
Breast cancer is the most frequently diagnosed cancer in women in both
developed and developing countries. In this regard, the identification of primary
chemoprevention strategies targeting breast cancer is an important priority in
healthcare. Chemoprevention refers to the use of agents, both pharmacologic
and natural, with the aim of inhibiting the development of invasive breast
cancer. This may be achieved either by blocking an existing carcinogenic
mutation, or through the reversal of any cellular oncogenic processes. This can
permit the development of therapeutic agents aimed at preventing cancer in
individuals, either before having any encounter with cancer (primary
chemoprevention), or else to prevent recurrence of a previous instance of
cancer (secondary chemoprevention).
Overall evidence points to accumulation of risk through the life course. Selective
estrogen receptor inhibitors (SERMs) may offer potential to inhibit the final
stages of progression to cancer, with prevention being greatest among those
with high estrogen levels. There is evidence that lifestyle contributes to
cumulative risk. Other forms of medication ranging from Asprin to Vit D have
also been suggested as agents that reduce the incidence of breast cancer.
Aromatase Inhibitors have been shown to also be useful in this regard. In
conclusion, although there is no one single intervention which, in isolation, will
prevent breast cancer, there is much that can be done to reduce its incidence,
and strategies to ascertain just by how much and which therapeutic maneuvers
are necessary and when, are being established.

11

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

S14
BENEFICIAL ACTIONS OF PROGESTERONE INCLUDING ON THE BRAIN
R. Sitruk-Ware1, N. Kumar1, M. El-Etr2, M. Schumacher2
1Population Council and Rockefeller University, New York, and 2INSERM 788,
University Paris-Sud 11, Kremlin-Bictre, France
Progesterone is a steroid hormone essential for the regulation of reproductive
function. The natural hormone has been approved for contraception during
lactation, maintenance of pregnancy, and prevention of premature labor.
Progestogens including natural progesterone and synthetic progestins have
been approved for a number of indications including the treatment of an
ovulatory cycles, and, when combined with estrogen, for contraception, and the
prevention of endometrial hyperplasia in hormonal replacement therapy (HRT).
There is strong evidence of specific differences between natural and synthetic
molecules without any progestin class-effect, with regard to beneficial or
adverse effects.
In addition to its main role in reproduction, progesterone regulates a number of
biologically distinct processes in other tissues, particularly in the nervous
system. Recently, we showed in animal experiments that progesterone and the
synthetic progestin Nestorone, trigger neuroregeneration and brain damage
repair, as well as myelin repair. In addition, both progesterone and Nestorone
were shown to promote the remyelination of axons by oligodendrocytes after
demyelination in mouse models. Also, Progesterone and Nestorone induced
positive effects on hippocampal neurogenesis and cell viability, leading to
possible memory benefits. These protective effects were mediated via
progesterone receptors (PR). Thus progestins such as Nestorone which target PR
with high specificity may prove useful to promote myelin regeneration and open
new therapeutic options for women with multiple sclerosis or other
neurodegenerative disorders.
The potential benefits of natural progesterone and its related derivatives
warrant further investigation and may lead to better future therapies for men
and women.
S15
HORMONE THERAPY AND FRACTURE
R.D. Langer
University of Nevada School of Medicine,Las Vegas, USA
Throughout the world, postmenopausal fractures due to osteoporosis,
particularly hip and vertebral fractures, are a major cause of morbidity, with a
high rate of accelerated downstream mortality. In the U.S., a woman's risk of hip
fracture is equal to her combined risk of getting breast, uterine and ovarian
cancer.
Hip fracture is not a trivial event, approximately 1 in 4 hip fracture patients over
the age of 50 die in the year following the fracture. Hormone therapy promotes
both preservation of bone, and increases in bone density, in a physiologic
manner.
Clinical trial evidence demonstrates that Hormone Therapy (HT) is effective in
reducing fracture rates in postmenopausal women. The most definitive evidence
comes from the Women's Health Initiative (WHI) clinical trial. In contrast to the
populations studied in most clinical trials of interventions to prevent fractures,
participants in the WHI hormone trials were not selected for increased fracture
risk. And, because their average body mass index was somewhat higher than
average for women of similar ages worldwide, their baseline fracture risk was
lower. Nonetheless, even within that more challenging design, the WHI
demonstrated significant reductions in hip, wrist, vertebral and total fractures.
Other clinical trials have demonstrated significant improvements in bone
mineral density (BMD) in women taking HT, and increased BMD correlates
strongly with reduced fracture risk.
However, in the aftermath of the early stopping of the WHI for a marginal
increase in breast cancer and a lack of coronary benefit driven by the fact that
the average participant was more than a decade past menopause there has
been a dramatic shift away from the use of HT for the prevention of
osteoporosis, although it remains licensed for this indication in most countries.
Longitudinal studies conducted since the end of the WHI clinical trials have
demonstrated that the flight from HT has been associated with a reduction in

12

BMD and an increase in fractures, including the most devastating type, hip
fracture.
As these trends have become more obvious, major professional organizations,
including the International Menopause Society and the North American
Menopause Society have published recommendations supporting the use of HT
for the prevention of osteoporosis, particularly in women below the age of 60.
While other therapeutic modalities are also available, including
bisphosphonates, HT remains an important option.
The World Health Organization Fracture Assessment Tool, known as the FRAX, is
a simple and critically important element in the assessment of disease risk in
postmenopausal women. Versions optimized for most nations are available
online. FRAX assessments should be conducted for all menopausal women and
appropriate interventions, potentially including HT, should be initiated for any
woman with risk above the intervention threshold.
S16
WHY DON'T WE GIVE COC USERS THEIR ANDROGENS BACK?"
R.H.W. van Lunsen*, E. Laan*, X.Y Zimmerman**, H.J.T.Coelingh Bennink**
*Dept Sexology & & Psychosomatic Ob/Gyn, Division Obstetrics & Gynaecology;
Academic Medical Center, University of Amsterdam, ** Pantarhei Bioscience,
Zeist, The Netherlands.
In women androgens, and especially testosterone (T), are not only essential for
the sensitivity for sexual stimuli and some other aspects of sexual functioning,
but for general wellbeing and long-term general health as well (Davis 2013).
Treatment with testosterone of perimenopausal women with low levels of free
testosterone significantly increases sexual desire, orgasm frequency and sexual
pleasure. Nevertheless, studies on the relationship between androgen levels and
sexual functioning in women show contradictory results. The main explanation
for the absence of evidence is that the effects of androgens on sexuality are
rather discrete. In general, androgens do not directly influence sexual responses,
but they modulate the sensitivityreceptivity to sexual stimuli. Moreover, there
may be large interindividual differences in womens sensitivity for changes in
androgen levels. There are indications that this sensitivity is related to prenatal
exposure of androgens, and is reflected in the 2D-4D ratio; lower ratios are
indicative of sensitivity being more androgen dependent. (Oinonen 2009) Also,
dependency on androgen levels depends on the preferential pathways of sexual
processing. In several psychophysiological studies, for instance, fantasyprovoked sexual responses showed to be androgen dependent, while responses
provoked by visual stimuli are not (Bancroft & Wu, 1986; Laan & van Lunsen,
1997).
T in women arises from three sources: Approximately 5060% is derived from
the peripheral conversion of the ovarian and adrenal pro-hormones
androstenedione (AD) and dehydroepiandrosterone (DHEA) and its sulphate
(DHEA-S), whereas 25% is secreted by the ovary and 25% by the adrenal gland.
Around 6570% of circulating T is bound and inactivated by sex-hormonebinding globulin (SHBG). Most of the remaining 3035% is bound by albumin and
only 0.53% represents freely circulating T (free T). Since the binding of T to
albumin is rather weak, the free- and albumin-bound T together are defined as
the bioavailable T.
Combined oral contraceptives (COCs) reduce levels of bioavailable T, by
inhibiting ovarian and adrenal androgen synthesis and by increasing levels of sex
hormone-binding globulin (SHBG). Due to this combination of suppression of T
synthesis and SHBG binding, free T levels decrease during COC use by a mean of
61%. (2)
Androgen deprivation therefore should be considered as a side effect of the
negative feedback of COCs on the hypothalamic pituitary gonadal axis. The
estrogen deprivation is restored by the estrogen in the COC and the T
suppression and SHBG increase, which occurs in most COCs, is partly
counteracted by the androgenic properties of some progestagens (e.g.
levonorgestrel). We hypothesized that restoring androgen levels in COC users to
a physiological level would improve sexual functioning and general well-being of
women on COCs. We studied the effects on endocrine parameters and sexual
function when testosterone concentrations are normalized during combined
oral contraceptive (COC) use by co-administration of dehydroepiandrosterone
(DHEA).

Abstract Book

A randomized, double-blind, placebo-controlled, comparative, two-way

crossover study was conducted in healthy COC users aged 20-35 years, with a
stable and satisfactory sexual relationship, who stopped taking their usual COC
for one month. Women were subsequently treated with either 5 cycles COC
(ethinylestradiol (EE)/levonorgestrel (LNG) or EE/drospirenone (DRSP)) and 50
mg/day DHEA followed by 5 cycles COC and placebo, or treatment was received
in the reverse order. Endocrine parameters and sexual function (physical &
psychological aspects) were assessed at baseline and after each of the 5
treatment cycles.
In total 81 women were randomized and treated. Seven women discontinued
early (3 during DHEA and 4 during placebo). Results showed that:
1)
COC use significantly suppresses androgens. (P<0.0001) In the
placebo condition free T is reduced with 68% in the EE/LNG and with 76% the
EE/DRSP group.
2)
COC use has unfavorable effects on sexual function (lower FSFI and
diary scores; P<0.05)
3)
By adding DHEA to an LNG/EE COC, the loss of androgens, especially
free T, can be restored (P<0.0001) without inducing side effects, but the
favorable effects of COCs on acne are lost
4)
Favorable clinical effects were observed on several aspects of sexual
function. Women on COCs with DHEA reported more frequent partnered
sexual activity and more responsivity to partner initiative (P<0.05)
These data confirm that COCs suppress androgen concentrations and provide
evidence that COCs interfere with optimal sexual function. Addition of DHEA
restores free T when combined with an LNG pill, but this does is too low for a
DRSP pill. Several aspects of sexual function can be improved by restoring
androgen levels through concomitant DHEA treatment. An EE/ LNG COC with 50
mg DHEA is suitable as a first choice preparation for all women, except for
women who use the pill with the additional objective to treat androgen-related
skin symptoms.
Literature:
Bancroft J, Wu, FCW. Changes in erectile responsiveness during androgen
therapy. Archives of Sexual Behavior 1983;12 :59-66.
Davis SR. Androgen therapy in women, beyond libido. Climacteric
2013;16(Suppl 1):1824
Laan E, van Lunsen RHW. Hormones and sexuality in postmenopausal women:
a psychophysiological study. J Psychosom Obstet Gynecol 1997;18;126-133
Oinonen KA . Putting a finger on potential predictors of oral
contraceptive side effects: 2D:4D and middle-phalangeal hair.
Psychoneuroendocrinology 2009;34,713726
Zimmerman Y et al. The effect of combined oral contraception on testosterone
levels in healthy women: a systematic review and meta-analysis. Hum Reprod
Update. 2014; 20 : 76105.
S17
MENOPAUSE, HORMONES, WELL-BEING AND SEXUALITY - A PSYCHOSOMATIC
APPROACH IN "REAL" LIFE
M. Lachowsky
Consultant Psychosomatic Gynecology, President AFEM (French Menopause
Association), Founder and Vice-President SeFGOP (French Society of
Psychosomatic OBS/GYN) Paris, France
The menopause that turn of life, seems to be, in our patients mind, a wellknown if troublesome event, where evidence based medicine adds its value to a
personal and almost historical knowledge. It is part of an expected program,
physiological and biological, a normal if unpleasant part of femininity, as even
the Talmud acknowledges it! But it is still considered a difficult and even risky
period by most women, paradoxically made sometimes even riskier by medical
intervention, but that is another discussion, and a tumultuous never-ending one!
It has long been a private and intimate moment. To-day it has become a public
issue, a red question mark in our patients minds, exposed and discussed on
Internet and other media.
Two major reasons, two major trends: Age and ageing, what it means for our
present society, and quality of life with/without medical help. A womans life
expectancy means that almost half of her lifespan will be spent after
menopause, so how to get old without getting older, how to advance without

ages marks and failings, how to use medicine with no adverse but only positive
effects, that is the question! Beautiful people, slim, sun-tanned, bearing
children whenever they desire, without any financial problems, that is the image
our young century wants to promote, rather than that simple reality: we are not
equal before health and age. Why not try and help our patients to live their postmenopausal time as an Indian summer rather than an icy winter?
In the 21st century, sexuality and age is still an unusual topic, even in medical
circles. If sexuality is nowadays a recurrent subject of discussion, especially in
everyday conversation and media, our society seems much less at ease with age
and aging. Danger is lurking, our longevity is adding year after year to our life
expectancy, but what about our expectations? Getting old, older, has become
one of the major anguish of our society and how to bear with that gift of science
is the to be or not to be of our time. Seniors, 3rd and now 4th age, anything
but old and elderly, anything to avoid the unmentionable.
This presentation will of course work on those problems, on quality of life and
one of its parameter, quality of sexuality. Rather than expanding on how postmenopausal women may experience dyspareunia mostly due to vaginal dryness,
or shame because of the changes in their bodies, how older men may fear and
experience erection difficulties, how these situations may have disastrous
consequences on a couples quality of life, how a good gynecologists should
be of assistance not only with effective drugs but also with tactful indiscreet
questions and empathic counselling, I would like to share with you some
thoughts about that entity, the elderly couple, as seen by a psychosomatic
gynecologists. That does not mean the psychology of the elderly couple, as this
heading would imply two capital prerequisites. One is scholarly and theoretical
: Is there such a thing as a psychological profile?, the other sociological :How
long will such a concept as an elderly couple, two people having stayed together
long enough to reach old age, be a relevant issue in the 21st century? Last but
not least, the semantic question we already mentioned: from what age on is one
elderly, when is the word old more appropriate, or is it simply a delicate way to
express the hard facts of life? And now a more down-to-earth question: what
about their past life together, what about memory and souvenirs, what about
their real life?
Let us work on those apparently- rhetoretical questions to understand the
implications of age and aging in body and mind, not similar in man and woman,
as well as their impact on each other in that particular situation, being a couple.
An elderly couple, meaning two individuals of opposite gender having wanted hopefully still wanting,-to create a separate unit, with an eye on their future on
the genealogical tree, all this by way of sharing a special intimacy, their own
private and somewhat secret blend of love, sex and mutual investment. Let us
imagine the most common situation: a man and a woman meet during the socalled golden years of youth, they chose to join hands, bodies and lives. Born by
the hope and glory of mutual desire and similar dreams, they decide to build an
ideal future, with perfect children and sound jobs as common aims. Be they
beautiful people or ordinary Mr. and Mrs. Jones, be it ages ago or to-day, the
beginning of that story is almost always the same. But a notable change has
occurred, dating already from the last century: the new status of women. Status?
Maybe more of a great shift in womans place and image, endowing her with a
new role in her couple and modifying its evolution. One could well argue that
apart from their new longevity, still to womans advantage, no known mutation
has happened to human beings whatever their gender, nothing new. Nothing?
What about contraception, and the complete change of life it brought to
women? What about that famous infamous?- time, that turn of life, the
menopause and its medical approach, what about the roads and rights to
feminine sexuality, all those new acquisitions in the wedding presents of todays
woman? True, all those openings concern the womenfolk, no such thing
happened to the other half. Was that half as much in dire need of support and
amelioration, that is another question, but those considerations should help us
to understand how the elderly couple of the 3rd millennium, surfing on the crest
of that new wave (did they meet on the barricade of May 1968 in Paris?) may
well be a different one, opening a new era in man and woman relationship. For
better or for worse, depending what one looks for, from what time, place or
point of view, anyway the answer stays open.
Being fifty or sixty today is different for both genders, as well as between them.
There is neither actual nor social equivalence for men and women: age and aging
are weighed on different scales: wrinkles are rarely called interesting and silvery

13

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

temples do not enhance womans seduction, neither does that specific endpoint, the menopause. This is why the role of man is capital, he is the one able
to soften the blow if he accepts his own aging image when reading the passing
of time on his companions face and body. But if he cannot bear what her body
tells him, and what he sees and feels in his own body, it is HER self-esteem which
will be the victim of his wish to deny reality. Love and libido are a troublesome
pair, both are necessary in a couple to keep the flame burning, even if it is not
an Olympic one anymoreAnd this is where we might be needed, we doctors
and gynecologists, with both hormonal and psychological bolstering, helping
man and woman to focus things differently, to readjust to that new deal. It is not
only an estrogen/androgen replacement which is expected of us, but almost a
way-of-life replacement. No wonder those elderly women chose to come to us
gynecologists: We are partners of all their life-events, ours being a medicine of
life and not concerned with disease alone. She lets us know she is still a woman,
still in her rightful place whatever her age, with no abdication of her femininity.
Far from denying ageing, she defies it with her new demands about quality of
life, including her sexuality. There arises a new question: are we prepared, are
we trained for that approach? Why is it still so difficult to talk sexuality with our
patients, even more so with the elderly ones? Let us summarize, as you
certainly experienced that feeling of uncertainty on both sides:
On the PATIENTs side:
*fear of the lack of right words
*Fear of ridicule (at my age!)
*Fear of embarrassing the doctor
* Fear of taking too much of the doctors
valuable time
*Not a medical problem, what can the Dr.
do about it?
On the DOCTORs side
*Unease, the right words for each patient
*Own personal problems about sex and
sexuality
*Mixed feelings: indiscretion
lack of tact
violation of intimacy
Sexuality and its troubles need to be addressed with as much knowledge and
know-how as any part of our medical science and art. Time, the time, is not
always easy to define, the right moment as well as the right setting are of the
utmost importance, the right distance not to near, not too far- also plays an
important part in the success of our relationship to that particular woman, that
particular patient.
But let us come back to our couple. What makes it all the more complicated is
that both partners may not always be in the best of health. As age blends into
old age, small problems, arthritic joints or bad digestion, will rather help the
couple, giving them common preoccupations as well as conversation topics,
especially useful when children's illnesses or job's difficulties have long
disappeared from the agenda. As often as not, there may have been a bad
period, the retirement of the husband, with the wife either still working or
having long ago arranged her own life. The man's permanent presence in a home
he did not really know during his usual working day, that free time so coveted,
how can it have turned into that feeling, into that empty time-table with nothing
worth telling about?.Some have given thought soon enough to those years after
the officially active ones, and have carefully arranged their lives around new
interests, or old cherished ones, some couples have also taken care not to leave
their usual environment to rashly, for fear of losing their circle of friends, losing
all that social web independent of the professional one, as this one usually does
not survive very long after one's departure from the office. There is another
deep gender difference and that is friends: with small talk, healthy laughter or
murmured confidences helping to bear day to day troubles, women are the great
sweet cocoon for women whatever their age or way of life. Men seem to be less
lucky in that domain. Apart from the one childhood inseparable friend, men
seem to establish most of those relations in their working background and often
lose contact after a few months, leaving them deprived and disappointed.
All this should teach us to enlarge our vision: not to take into account their
family, their colleagues, the small or large world in which they live, would
deprive us of an important level of responses, those reactions to society which

14

mould at least part of everybody's way and quality of life. The influence of time
is to be read not only on the skin but also deeper, where it cannot always be
expressed. Imagination and images sometimes collide and superimpose
themselves on a past which may be either exaggeratedly enhanced or
reproachfully devaluated. Sexuality is one of the best examples, age may be used
as an excuse for putting an end to something which was never satisfactory for
one of the partners or for both. This is true for women who hide behind
hormonal explanations, and for men who consider erectile dysfunction too
humiliating for words. Man often accepts even less than woman the treasons of
the mind coupled or revealed by the lapses of the body. Maybe we
gynaecologists should remember that sex is always present in our consultations,
whatever the official cause for consulting and the age. Sexuality is a language,
maybe the first one between human beings, why should one forget or forsake
it? It may be different for our elderly couple, coping with changes of pace,
arrangements for less lithe bodies and with the possibility of a revival of desire
after troubled waters finally crossed. But sexuality needs intimacy, and the
privacy one is entitled to hope for in later years is nowadays often torn open
either by offsprings coming back with their own children after a divorce or by
declining parents needing day and night attention. Crowded, but what about the
other side of the problem, what is better, too many or too few people around?
With, in the background, the conscious or unconscious anxiety of being left
alone, what if one of us is too sick to take care of the other, and what if we lose
our autonomy? Coping with one's own difficulties, coping with the partner's
approach to his/her problems and coping with what each one sees -or believes
to see- in the other's eyes, all this does apply to any couple but how much more
do elderly spouses have to work on it, that is the question.
Sexuality and its troubles are not on the agenda of most medical universities,
although there is scarcely a consultation where we are not talking sex, whatever
the official cause of the referral or the age. Be it contraception at menopause,
late pregnancy or Pap smears, sexuality is always in the background, there is no
gynecological practice that does not refer to a persons ability to experience
sexual feelings as the Collins Cobuild English Dictionary defines sexuality
in1988. In 2009, we still have to take individual steps to learn how to avoid the
many pit-falls threatening our relationship with some patients, in order to help
them with the answers they are seeking. We may also help them discover that
tender and warm companionship is one of the best links, sustaining the
acceptation of nature's toll. What with empathy and attention, time to listen
and to counsel, hormonal systemic and local treatments, we do have ways and
means to make our patients life a life of quality, although they sometimes forget
we have no magical wand to give them their youth back!

Abstract Book

S18
UPDATE ON VAGINAL LACTOBACILLI AND BIOFILM FORMATION
G. Ventolini
School of Medicine at Texas Tech University Health Sciences Center, Odessa,
USA
A German physician, Albert S. Dderlein, described in 1892 a micro-organism
that he isolated from a vaginal sample of a pregnant patient that he named:
Dderleins bacillus. This bacterium was far along renamed Lactobacillus.
Dderlein studied and classified the bacterial groups into normal (Grade A:
dominated by the vaginal Dderleins bacillus) and abnormal (Grade C:
dominated by other micro-organisms). He also contended a fundamental
concept: that the Dderleins bacilli in addition to the vaginal acidity were
necessary to maintaining the normal vaginal secretions free of harmful bacteria.
Recent introduction of modern technologies like high-throughput sequencing
(Pyrosequencing), software for computational analysis and genus-specific
quantitative PCR (qPCR) assays have weighty corroborated the interpretations
made by Dderlein and his colleagues. Today it is recognized by most
investigators that the majority of normal flora of fertile womens vagina are
populated, with a small number of exceptions, by mainly 4 groups of lactobacilli:
L. crispatus, L. iners, L. jensenii, and L. gasseri. Healthier vaginas include L.
crispatus and L. jensenii.
Lactobacilli found in women are primarily derived from the intestinal microflora, they colonize the nutrient-rich vaginal environment therefore they
maintain a steady environment. Vaginal epithelium, which is glycogen rich and
ovarian dependent, when degrades makes glucose available. Lactobacilli are
obligate homo-fermenters of glucose and produce lactic acid. Additionally they
also produce hydrogen peroxide and both are responsible for conserving a
vaginal pH between 3.8 and 4.2. Furthermore lactobacilli secrete bacteriocins,
organic acids, bio-surfactants and other products that consent receptors
attachment to vaginal epithelial cell and co-aggregate to form biofilms.
The majorities of lactobacilli possesses small genomes, and have acquired new
protein transporter gene systems that enable vaginotropism.
Biofilm formation by lactobacilli: Biofilms are particularly complex biological
conglomerates structures were bacteria commonly thrive. The formation of
biofilm is a refined procedure that usually involves two foremost divided steps:
first the adhesion and second. Embraces: first, the recognition of surface-related
stimuli that enables the adhesion of the micro-organism to a surface and second,
a matrix biofilm and buildup production. This matrix is known as the extracellular
polymeric substances (EPS) and inside it the micro-organisms are entangled.
Biofilm is species-specific for each group of micro-organisms.
In recent times research has developed to analyze the influence of genetic
determinants in the formation of biofilms. Also we have learned more about the
ecological conditions that affect this complex process. Biofilm formation is a very
important clinical issue. The complete knowledge of it will allow us to
understand and identify which micro-organism bacteria exhibit biofilm-linked
traits. Therefore we will be better equipped to discriminate which microorganism exhibit tolerance to a specific antibiotic therapy and which to a precise
host defense.
Lactobacilli were studied by a few researchers regarding biofilm formation
utilizing different growth media. The conclusion of those studies showed that
almost all lactobacilli isolates produce biofilm on a polystyrene surface. L.
acidophilus was the one lactobacillus that demonstrated the uppermost biofilm
formation.
Last year, Ventolini verbally presented at COGI in Vienna findings regarding
biofilms produced by human vaginal lactobacilli (manuscript under
consideration by Medical Hypothesis Journal). Follow-up with qPCR research he
and his work group has further categorized these lactobacilli as L. jensenii (the
topic of this presentation at COGI here in Paris that will include
microphotography pictures and motion pictures).
Conclusions: Lactobacilli are accountable for sustaining healthy micro-flora
equilibrium in womens vagina. Our knowledge and understanding of the biofilm
formation process has greatly progress. Today we have a more comprehensive
understanding and clarification of the complexities and relations between the
assorted vaginal micro-flora and lactobacilli. Clinical research is still ongoing to
identify the influences that lactobacilli biofilm could make regarding protection

against bacterial and fungal infections recurrences but more important

regarding prevention of preterm labor.
S19
PATHOGENIC BIOFILMS: LEADING CONTRIBUTORS TO RECURRENT VAGINITIS
AND CYSTITIS
A. Graziottin1, P. Paolo Zanello2
1Center of Gynecology and Medical Sexology, San Raffaele Hospital, Milan,
2
University of Parma, Parma, Italy
Problem Statement: Recurrent cystitis and vaginitis have an increasing relevance
in gynecological practice. They are a major health issue for women and their
sexual life, with a specific impact on vaginal and bladder pain associated with
intercourse (Graziottin A. 2014; Graziottin A. et al., 2014 a). At the same time
recidivism of cystitis and vaginitis may cause frustration to the practitioner,
whose therapeutic expertise appears to be too often significantly jeopardized.
Significant data on both the dramatic increase of bacterial resistance and
common escalation of microbial aggression in urology and gynecology diseases
suggest a connection with the frequent, and sometimes indiscriminate, use of
antibiotics.
Methods: This abstract focuses on pathogenic biofilms, as they may lead to a
new understanding of the pathogenesis of recurrent urogynecological
infections.
Results: In the urogynecological field, biofilms can be: extracellular, usually in
the vagina, and intracellular, in urothelium.
An extracellular biofilm is composed by pathogenic microorganism-secreted
polysaccharides, with a primitive circulatory system, and a complex assembly of
synergistic micro-organisms. The polysaccharides network acts as a protection
system that prevents drugs penetration and action and immune response
effectors. Increasing evidence proves that the majority of urogynecological
infections are supported by pathogenic biofilms. This evidence parallels the
same pathophysiologic mechanisms operating in recurrent nose, sinus,
bronchial or lung infections thus underlying a general microbiologic aggressive
and survival-oriented strategy. It may explain the:

incomplete or absent response to common drugs

high presence of co-morbid forms of urogynecological antibiotic-resistant

infections and diseases

the increasing bacteria resistance to immune response effectors

the infections tendency to become chronic

Extracellular biofilm grows close to the vaginal vestibule, and all along the
vaginal wall. They usually reside near the apical cell surface of the vaginal
mucosa and protrude towards the cavity. They can also be found on the surface
of mucous membranes or different inert supports such as all kind of medical
devices (Aparna M.S. and Braz Y.S., 2008; Leonhard M. et al., 2013). Inside the
biofilm, bacteria have a gradient of metabolic activity, the higher at the surface,
the lower in the deeper part of the biofilm, close to the vaginal mucosa. In the
deeper part of biofilms, reduced levels of oxygen and nutrients facilitates the
growth of a sub-population (0.1-1%) of quiescent bacterial cells called persisted
cells, dormant phenotypic variants of regular cells whose slow metabolism fits
perfectly into the habitat. Thanks to their minimal metabolic activity, persisted
cells are the most resistant to antibiotics and to immune system attacks.
Intracellular biofilm resides inside the urothelium that covers the inner
bladder/wall bladder. They are characterized by a specific pathogenic strain of
Escherichia coli, carrier of the antigen K. This strain is responsible for 75-85% of
recurrent cystitis and intracellular biofilm formation, (Rosen D.A. et al., 2007).
Conclusion: Understanding the pathophysiology of pathogenic biofilms, and the
most effective modulation of their role, may add a new potentially effective
arrow in the physicians arms. Controlled prospective studies are needed to
substantiate the impact and limits of this new approach.
Disclosure of Interest: A. Graziottin Consultant for: Bayer, Deakos, Epitech,
Janssen-Cilag, Menarini, Palatin, Pfizer, Speaker Bureau for: Deakos, Epitech,
Lo.Li.Pharma, Menarini, Sanofi, P. P. Zanello Consultant for: Deakos

15

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

S20
NON HORMONAL TREATMENT OF THE MENOPAUSE
S. Palacios
Director of Palacios Institute of Womens Health. Madrid. Spain
Hormone therapy (HT) is the gold standard treatment for the control of
vasomotor symptoms (VMS). However, with the first publications and
interpretations of the WHI study and the negative reaction that brought, many
doctors and women reconsidered the use of HT. Although in recent years we
have seen the windows of opportunity, in terms of cardiovascular risk, posed by
his administration in women younger than 60 years and using low doses since
the adverse effects are minimized. But, many doctors and women think that are
unacceptable risks and they are asking for non-hormonal treatments for the
management of vasomotor symptoms.
That is why we are looking for new therapeutic products that have less side
effects than Traditional Hormone Therapy ones. Many treatments have been
tested, among which are:

Antihypertensives (clonidine): Clonidine is an antihypertensive that has

been used for the treatment of hot flashes, with modest results and a clear
increase in side effects, highlighting dry mouth, drowsiness, constipation
and sedation. Moreover, decreasing blood pressure and heart rate, and
high doses were observed arrhythmias.

Anticonvulsants (gabapentin): In a review of 4 clinical trials, gabapentin

reduces the frequency of hot flashes by 45-71% after 8-12 weeks of
administering 600-2400 mgr/day repeated dose. The most common side
effects found, especially in the first two weeks, were somnolence, dizziness
and instability.

Antidepressants (fluoxetine, paroxetine, venlafaxine, desvenlafaxine):

With adaptable results. Mechanism of action in VMS thought to be related
to potentiation of CNS neurotransmitters which impact regulation of body
temperature.

Phytotherapic Products (black cohosh, dong quai, ginseng, and soy

isoflavones among others): though their mechanisms of action are not
exactly known and the studies conducted have mostly inconsistent results.
We reviewed the results published in Medline during 1993 to April of 2013 on
the efficacy and safety of soy isoflavones and SSRIs and SNRIs, especially,
paroxetine and desvenlafaxine for VMS.
Saturday, December 6, Hall A
S21
PRECONCEPTION CARE; AN ESSENTIAL NEW STRATEGY TO IMPROVE
WOMENS AND CHILDS HEALTH
E.A.P. Steegers
Department of Obstetrics and Gynaecology, Erasmus MC, Erasmus Medical
Center Rotterdam, the Netherlands
Having a healthy child is one of the highest values in almost every parents life.
However, 15% of the couples with a child wish remain subfertile and more than
50% of the pregnancies results in adverse pregnancy outcomes (congenital
malformation, miscarriage, premature birth, stillbirth, low birth weight, fetal
growth restriction). All those conditions originate in the periconception period
(14 weeks before up to 10 weeks after conception), in which gene-environment
interactions play an important role. These experiences have a great impact on
the health and the quality of life of parents, children, and families and even of
the health of future generations. Moreover, the lifetime costs for care and
medical treatment of subfertility and adverse pregnancy outcomes are
substantial.
During the last decade, the Erasmus MC Preconception Expert Centre,
embedded in the Department of Obstetrics and Gynaecology gained knowledge
and expertise in preconception health and health care. Preconception health is
determined by multiple factors ranging from constitutional and genetic factors
to (none) modifiable environmental factors. To primary and secondary prevent
subfertility and adverse outcome in the short and long term, preconception care
warrants a multidisciplinary approach in which evidence based screening and

16

(tailored) interventions are needed. The periconception period can be

considered as a window of opportunity to change the poor health of couples as
a consequence of medical problems, poor nutrition, lifestyle, housing and
working circumstances.
So far, the following projects and programs have been initiated:
1) Development of protocols for preconception care targeted on medical,
nutrition and lifestyle risk assessment.
2) International textbook on preconception care for health care providers.
3) Book on preconception care for the general population.
4) Development of outpatient preconception care clinics:
a) Specialized preconception care for (chronic) medical conditions and
pregnancy complications.
b) Preconception care clinic tailored on nutrition and lifestyle (called clinic for
achieving a healthy pregnancy).
5) Development of preconception E-health tools:
a) www.zwangerwijzer.nl (preparing for pregnancy), a screening instrument to
identify medical, genetic, environmental, nutrition and lifestyle risk factors to be
used by couples planning pregnancy. The identification of risk factors results in
recommendations and referral to the midwife, general practitioner or
obstetrician.
b) www.preconceptiewijzer.nl (Preconception guide), an instrument developed
for health care providers to be used together with www.zwangerwijzer.nl.
Individual risks of a couple identified in Zwangerwijzer.nl can be linked to
protocols regarding preconception advice and suggestions for referral patterns
in case of high risks. In this way preconception care can be offered in a
structured, protocolized way as part of chain care.
c) www.slimmerzwanger.nl (Smarter Pregnancy), a personal coaching program
of 26 weeks on the mobile phone tailored on improvement of nutrition and
lifestyle to be used by couples before and during pregnancy. This program
consists of a website in combination with SMS and Email messages, through
which personal support is given at any time, at any place and at very low costs.
The screenings module on nutrition and lifestyle can be used in preconception
care by health care providers.
6) Organization of campaigns to increase the awareness of the importance of
preconception health and care. The Erasmus MC, together with the Star-Medical
Diagnostic Centre and the municipal health authority conducted a
comprehensive field study at the end of 2006 to examine the interest for
organized, chain-oriented preconception care. We conducted a small campaign
in the North of Rotterdam: posters along the road and in offices of care
providers, and a house-to-house information leaflet were distributed. The short
campaign resulted in a temporary increase in the use of Zwangerwijzer.nl of 250
percent (the last two years, the average number of visitors per day is 400).
People thus seem to be interested in preconception and subsequently start to
look for information.
7) Program based Preconception Care in Primary Care. In January 2009, an urban
perinatal health program, entitled Ready for a baby, officially started in
Rotterdam. The aim of the 10-year program is to improve perinatal health
outcome in Rotterdam. The program consists of projects that are based on
standard care in the obstetrical chain of care and supplemented by a number of
non-medical measures. Within the program Ready for a baby, we have invested
a great deal in the development and organization of program based PC in
primary care (midwifes and GPs). Major challenges are not only to raise public
awareness for the concept of PC but also to reach the most vulnerable
population groups (such as immigrants and those with a low socio-economic
status). One very important aspect is to combine PC with public health and social
welfare services.
Since 2011, funded by the Dutch Government, the Erasmus MC coordinates a
national program entitled Healthy Pregnancy 4 Al in which experiments are
being conducted regarding preconception care and broadened atenatal risk
assessment with respect to non-medical risks during pregnancy. The
preconception care experiments are carried out in 14 cities in the Netherlands.
Women contemplating pregnancy, between eighteen to forty-two years of age
are recruited for individual preconception care consultations at a midwife- or
GPs practice. Via different recruitment strategies women are invited to attend
PC. Firstly, the municipal health care service sends invitations by mail. Secondly
GPs send invitations to women enlisted in their practice. Thirdly, women are

Abstract Book

recruited for interconception care by infant and children health welfare centers.
Fourthly, peer educators perinatal health forms a bridge between the women
that they recruit for educational programs on preconception/ perinatal health
and caregivers.
8) Education about Preconception Care. The Midwifery Academy Rotterdam
together with the Erasmus MC has developed a preconception education
curriculum for midwives. The Erasmus MC has also developed such curriculum
for GPs. Furthermore, a Peer Educator Perinatal Health course was developed.
High-risk groups are difficult to reach by the regular care. Not only linguistic and
cultural differences may constitute barriers, but also low training and lack of
specific knowledge. 16 bilingual women of immigrant origin with a high school
diploma were trained full time in six months time. Since May 2011, they are
available for professional support. Tailored made products are developed to
provide group education for high risk difficult to reach groups. The peer
educators also play a bridging function between caregiver and clients. They are
able to translate the (medical) message in their own language and culture.
9). A Dutch national summit was organized in 2012 to achieve consensus about
(I) the definition and categories of preconception care, target groups,
prepregnancy risk factors and interventions and risk assessment instruments
(Temel et al. Journal of Community Genetics, in press).
S22
CAN WE IMPROVE RESPONSE BY INCREASING THE DOSE OF MENOTROPINS?
YES: HIGHER DOSE CAN STIMULATE OOCYTES WHICH NEED HIGHER FSH
THRESHOLD
J. A Garcia-Velasco
Obstetrics and Gynecology, Director IVI Madrid, Spain
Although natural cycle is an option to practice ART, it is a common practice to
stimulate the ovaries to obtain multiple follicular growth in order to make the
cycle and the treatment- more efficient. Just one oocyte may be obtained after
a non-stimulated cycle, but how many do we need in IVF? How much should we
stimulate the ovaries to be successful in IVF? Today we do know that more is
not always better. More oocytes means that healthy embryos might be
obtained even if some are immature, some do not fertilized, a few do not cleave
and part of them are not good quality embryos. But too many follicles do bring
along well known risks, very specially OHSS. On top of that, a too aggressive
ovarian stimulation may retrieve oocytes that do not have enough quality to
progress to healthy embryos. Thus, an adequate stimulation seems to be
optimal. But what is adequate? Is it the same for all patients? Does it only
depend only on age or ovarian reserve makers? It seems that not all patients
respond to COS similarly. And in fact, some patients do need significantly higher
dose of gonadotropins than other patients of similar age or ovarian reserve
markers. We will try to reinforce the concept that mild stimulation is not the
best option for these particular subgroup of patients.
S23
HOW TO ASSESS THE POLYCYSTIC OVARY; AN ULTRASOUND AND AMH
UPDATE
D. Dewailly
Department of Endocrine Gynaecology and Reproductive Medicine, Hpital
Jeanne de Flandre, Centre Hospitalier de Lille, France
Given its strong involvement in the pathophysiology of polycystic ovary
syndrome, measurement of serum AMH is a topic of interest to clinicians
involved in this field. Some would even make the plasma concentration of this
hormone the "Gold Standard" for the diagnosis of PCOS. This position is at least
premature and excessive.
Certainly, the concentration of serum AMH is increased in most patients with
PCOS and the strong association between AMH and number of follicles at
ultrasound (U/S) has led some to compare the performance of serum AMH and
antral follicle count (AFC) for the diagnosis of PCOS. However, the results of the
current literature are not consistent across studies as demonstrated in recent
reviews. Part of this heterogeneity is due to the absence of well-defined
populations. It should be noted in particular that many authors have used the
threshold established in 2003 at the Consensus Conference Rotterdam, i.e. 12

follicles 2-9 mm in diameter per ovary to define polycystic ovaries. We know that
this threshold is now obsolete. With the latest generation of ultrasound devices
and from well-defined populations, recent studies have suggested increasing the
threshold to 19 or even 25. This threshold is likely to continue to evolve in
parallel with the technical improvements in equipment and in particular
ultrasound probes.
Besides the difficulty of defining patients by ultrasound criteria, the variability of
results is also explained by the problem of different serum AMH assays. Until
2010, about half of all published studies using the DSL assay (Diagnostic Systems
Laboratories) while the other half used the Immunotech assay. Both tests used
two different standards and different antibodies with corresponding values of
problem (Iliodromiti, Kelsey et al. 2013). More recent studies using the Gen II kit
(which uses the DSL antibodies Gen I with standards Immunotech assay) should
be interpreted with great caution, because this kit suffered until July 2013 from
an underestimation of the values due to interference with serum complement
in undiluted patient samples. It is now replaced by a new kit from the same
company and other kits from other companies are emerging, including
automated assays that should minimize the inter-center variability of results. It
is however impossible to date to propose a consensual and universal threshold
of serum AMH for the diagnosis of PCOS. However, in our experience, with the
Immunotech test, serum AMH was considered more powerful than the number
of follicles with excellent sensitivity and specificity for a threshold of 35 pmol L
(4.9 ng/ml). Unlike other studies, the specific thresholds for AMH and number of
follicles were calculated concurrently without using present values for the
number of follicles, through a complex statistical method called "clusters." In
addition, women with polycystic ovaries were excluded from the asymptomatic
control group of menstruating women regularly. These results have been
recently replicated with another AMH assay in a totally independent large
population. Therefore, we are close to get an accurate and reliable marker of
PCO that will eventually replace the AFC that also suffers from a great
controversy in the current literature. It seems reasonable to propose the
elevation of serum AMH levels as a substitute for the item "polycystic ovary
morphology" in the Rotterdam classification. Also, since we now have at our
disposal two different markers, one being morphological (AFC) and the other
biochemical (increase in serum AMH), we suggest using instead the term "PCOlike anomalies" as the third element of the Rotterdam classification. It must be
emphasized, however, that the threshold of follicle excess and serum AMH levels
should be reviewed and validated around the world in different ethnic
populations, as recent technical developments in ultrasound procedures and
AMH assays can lead to a change in thresholds previously proposed. Until then,
we recommend clinicians to define their own thresholds fitting their
populations.
Saturday, December 6, Hall B
S24
EFFECT OF PRE-PREGNANCY WEIGHT AND GESTATIONAL WEIGHT GAIN ON
THE INCIDENCE OF PREECLAMPSIA AND GESTATIONAL DIABETES
N. Tul1; M. Lucovnik1; I. Blickstein2; L. Steblovnik1; I. Verdenik1; A. Trojner
Bregar1, V. Fabjan Voduek1
1Department of Perinatology, Division of Obstetrics and Gynecology, University
Medical Centre Ljubljana, Slovenia
2Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot,
affiliated with the Hadassah-Hebrew University school of Medicine, Jerusalem,
Israel
Number of obese women of reproductive age is increasing. These women are at
increased risk of several pregnancy complications, among which preeclampsia
and gestational diabetes mellitus (GDM). Excessive gestational weight gain has
also been demonstrated to be associated with an increased risk of both
preeclampsia and GDM. It is important, however, to differentiate between the
effect of pre-pregnancy body mass index (BMI) and gestational weight gain on
the incidence of these two conditions, since weight gain is amenable to
interventions during pregnancy while high pre-pregnancy BMI is not.
Conclusions of two studies on Slovenian population of pregnant women are that
pre-pregnancy BMI is strongly associated with preeclampsia and GDM in both
twin and singleton pregnancies. Gestational weight gain is also associated with
risk of preeclampsia, although seemingly less so than pre-pregnancy BMI.

17

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

Smaller gestational weight gain noticed in patients with GDM may reflect the
importance of dietary counseling after GDM diagnosis.
References
Lucovnik M, Blickstein I, Verdenik I, Trojner-Bregar A, Tul N. Maternal obesity in
singleton versus twin gestations: a population-based matched case-control
study. J Matern Fetal Neonatal Med. 2014
Lucovnik M, Blickstein I, Verdenik I, Steblovnik L, Trojner Bregar A, Tul N. Impact
of pre-gravid body mass index and body mass index change on preeclampsia and
gestational diabetes in singleton and twin pregnancies. J Matern Fetal Neonatal
Med. 2014
S25
THEORETICAL REASONS TO CHOOSE NATURAL PROGESTERONE
F. Facchinetti, L. Pignatti
Unit of Gynecology and Obstetrics, Mother-Infant Dept, University of Modena
and Reggio Emilia
Progesterone received its name due to its role as a pro-gestational agent and it
is responsible for a variety of effects that help maintain pregnancy. The use of
progesterone may be important in maintaining uterine quiescence in the latter
half of pregnancy by limiting the production of stimulatory prostaglandins and
inhibiting the expression of contraction-associated protein genes (ion channels,
oxytocin and prostaglandin receptors, and gap junctions) within the
myometrium.
Progesterone stimulates morphological changes to the cervix and other tissues
that help to maintain pregnancy. Throughout pregnancy, progesterone inhibits
the immune system. Such immunosuppression prevents the maternal immune
system from rejecting the fetus and ensures that the pregnancy goes to term.
Parturition is widely accepted to be an inflammatory event, as it is largely driven
by inflammatory cytokine and prostaglandin signalling. Inflammatory pathways
stimulate the various events that lead to parturition, such as cervical ripening,
rupture of membranes, and uterine contractions. Progesterone holds off these
inflammatory events until pregnancy reaches term. Progesterone also inhibits
uterine contractions, both through suppression of prostaglandin production and
by reducing the contractility of the smooth muscle cells. Progesterone due to its
effects is widely used for preterm birth (PTB) prevention. Evidence seems to
favour two mechanisms that explain the beneficial effect of progesterone
administration in PTB prevention: an anti-inflammatory effect that counteracts
the inflammatory process leading to delivery, and a local increase in
progesterone in gestational tissues that counteracts the down-regulation
leading to PTB.
Two pharmacological approaches are extensively used to prevent labour:
progesterone itself or the synthetic progestin 17-alpha-hydroxy-progesteronecaproate (17P). Administration of progesterone instead of its derivatives has the
advantage of ensuring that all the pathways activated by endogenous
progesterone will be activated. It has been described that progesterone
activates also non-genomic or yet unknown pathways. Progesterone is more
likely to replicate the endogenous pregnancy maintaining activation of uterine
membrane receptors. Progesterone, but not 17P, inhibits the contractions of
human myometrial cells, apparently acting through non-genomic receptors.
There are many progesterone metabolites that have some activities that are not
still understood and that are unlikely to be mimicked by a progesterone
derivative, particularly one designed to be resistant to metabolism. Indeed, 5beta-reduced progesterone metabolites are important in maintaining pregnancy
and these effects are unlikely to be replicated with 17P or other synthetic
derivatives. Exogenous progesterone is rapidly metabolized by kidneys and liver.
Due to this rapid decay, progesterone is usually administered vaginally during
pregnancy to ensure that as much progesterone as possible reaches the target.
For the same reasons, progesterone must be administered frequently, typically
once daily when administered vaginally. However it is still debated how much
exogenous progesterone reaches its receptor in target tissues. On the other
hand, 17P is not metabolized by traditional steroid transforming enzyme and is
not a prodrug. The only known metabolism observed with 17P is oxidation by
cytochrome p450 enzymes. This metabolic stability causes 17P to have a longer
half-life that allows for its weekly administration. Different metabolism pathway
between progesterone and 17P also means that the latter is not subject to

18

regulation via progesterone metabolizing enzymes and may behave differently

in target tissues.
Vaginal progesterone is associated with reduction in PTB and composite
perinatal morbidity and mortality, in women with singleton gestations, no prior
spontaneous PTB, and short cervix at ultrasound (< 20mm identified at 24
weeks). 17P administration is beneficial in preventing PTB in singleton gestation
with prior spontaneous PTB, and unknown cervical length. There is at present
stronger evidence of effectiveness for 17P rather than for vaginal progesterone.
In this subgroup of patients. 17P should be recommended to women with prior
spontaneous PTB starting at 16 weeks. There are no data comparing the
different preparations of progestogens. In multiples, progestogen treatment,
regardless if vaginal progesterone or 17P, have no significant effect on adverse
perinatal outcome and time to delivery, compared with controls. However, in a
subgroup of women with a short cervical length (<25mm before 24 weeks),
vaginal progesterone treatment seems beneficial.
It has often been assumed that vaginal progesterone and i.m. 17P are
interchangeable. However, differences in the chemistry and biochemistry of the
two molecules suggest that this is probably not the case as also supported by
clinical trials.
Byrns M.C., Regulation of progesterone signaling during pregnancy:
Implications for the use of progestins for the prevention of preterm birth. J
Steroid Biochem Mol Biol 2014 Jan;139:173-81.
Martinez de Tejada B. et al, Prevention of preterm delivery with vaginal
progesterone in women with preterm labour (4P): randomised double-blind
placebo-controlled trial. BJOG 2014 Sep 11.
Parzek A. et al., Progesterone, inflammation and preterm labor. J Steroid
Biochem Mol Biol. 2014 Jan;139:159-65.
Schuit E. et al, Effectiveness of progestogens to improve perinatal outcome in
twin pregnancies: an individual participant data meta-analysis. BJOG 2014 Aug
22.
Society for Maternal-Fetal Medicine Publications Committee, with assistance of
Vincenzo Berghella, Progesterone and preterm birth prevention: translating
clinical trials data into clinical practice. Am J Obstet Gynecol. 2012 May;206
(5):376-86
S26
SURGICAL TREATMENT OF PPH
L. Sentilhes
Department of Obstetrics and Gynecology, Angers University Hospital, 4, rue
Larrey, 49933 Angers Cdex 9. [email protected]
Peripartum hysterectomy remains the gold-standard to control severe PPH and
is the final option when the other procedures failed. However, uterine-sparing
sparing procedures have been developed during this last decade. The two
possible options are (1) vessel ligation, including bilateral uterine artery ligation
as described by OLeary (1995), stepwise uterine devascularization as described
by AbdRabbo (1994), triple ligation as described by Tsirulnikov (1974), and/or
bilateral internal artery ligation; and/or (2) uterine compression suture, of which
the B-Lynch procedure (1997) is very likely the most frequently used. Bilateral
internal artery ligation has been found to be considerably less successful (about
60-70%) than previously thought, and many practitioners are only slightly
familiar with this technique. Bilateral uterine artery ligation and stepwise uterine
devascularization procedures present the main advantage, similarly to B-Lynch
suture, of being quicker and easier to perform than internal artery ligation. The
success rate and morbidity do not seem to differ between vessel ligation
involving the uterine arteries (about 75-90%) and uterine compression sutures
(about 75-90%). However, the methodological quality of these studies remains
limited, and there is no controlled trial regarding these different procedures
reported in the literature. Therefore, at present there is no strong evidence to
suggest that any one method is better for the management of severe PPH.
Uterine or hypogastric artery ligation does not appear to compromise a womans
subsequent fertility and obstetric outcome. Uterine compression sutures do not
also appear to compromise a womans subsequent fertility and obstetric
outcome. Nevertheless, there are limited but alarming data suggesting that
uterine compression suture may increase the risk of subsequent intrauterine
synechia.

Abstract Book

The highest cause of uterine-sparing procedure failure is placenta

accreta/percreta. The cesarean hysterectomy is generally considered the
standard treatment for placenta accreta. This option may reduce maternal
morbidity, but by definition it leaves women sterile. Accordingly, conservative
treatment may be applied for some women who want to be able to have more
children. In this approach, the placenta adhering either partially or totally to the
myometrium is left in situ. Conservative management is an option with a success
rate of 78% for patients who are properly counselled and motivated. Moreover,
successful conservative treatment for placenta accreta does not appear to
compromise the patients subsequent fertility or obstetrical outcome, although
these patients should be advised of the high risk that placenta accreta may recur
during future pregnancies (30%). Nevertheless, there are significant risks of
serious immediate and delayed morbidity (6%) associated with conservative
management requiring a close follow-up monitoring after delivery.
B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique
for the control of massive postpartum hemorrhage: an alternative to
hysterectomy? Five cases reported. Br J Obstet Gynaecol 1997; 104:372-5.
OLeary JA. Uterine artery ligation in the control of postcesarean hemorrhage. J
Reprod Med 1995;40:189193.
Poujade O, Grossetti A, Mougel L, Ceccaldi PF, Ducarme G, Luton D. Risk of
synechiae following uterine compression sutures in the management of major
postpartum haemorrhage. BJOG 2011;118:433-9.
Sentilhes L, Trichot C, Resch B, et al. Fertility and pregnancy outcomes following
uterine devascularization for postpartum haemorrhage. Hum Reprod
2008;23:1087-92.
Sentilhes L, Gromez A, Caroline Trichot, Aude Ricbourg-Schneider, Philippe
Descamps, Loc Marpeau. Fertility after B-Lynch suture and stepwise uterine
devascularization. Fertil Steril 2009;91:934.e5-9.
Sentilhes L, Ambroselli C, Kayem G, et al. Maternal outcome after conservative
treatment for placenta accreta: Obstet Gynecol 2010;115:526-34.
Sentilhes L, Kayem G, Ambroselli C, et al. Fertility and pregnancy outcomes
following conservative treatment for placenta accreta. Hum Reprod
2010;25:2803-10.
Tsirulnikov MS La ligature des vaisseaux utrins au cours des hmorragies
obsttricales. J Gyn Obst Biol Reprod 1979;8:751-753.
S27
EFFECT OF PRE-PREGNANCY WEIGHT AND GESTATIONAL WEIGHT GAIN ON
THE INCIDENCE OF PREECLAMPSIA AND GESTATIONAL DIABETES
N. Tul1, M. Lucovnik1; I. Blickstein2; L. Steblovnik1; I. Verdenik1;
A. Trojner Bregar1, V. Fabjan Voduek1
1
Department of Perinatology, Division of Obstetrics and Gynecology, University
Medical Centre Ljubljana, Slovenia
2Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot,
affiliated with the Hadassah-Hebrew University school of Medicine, Jerusalem,
Israel
Number of obese women of reproductive age is increasing. These women are at
increased risk of several pregnancy complications, among which preeclampsia
and gestational diabetes mellitus (GDM). Excessive gestational weight gain has
also been demonstrated to be associated with an increased risk of both
preeclampsia and GDM. It is important, however, to differentiate between the
effect of pre-pregnancy body mass index (BMI) and gestational weight gain on
the incidence of these two conditions, since weight gain is amenable to
interventions during pregnancy while high pre-pregnancy BMI is not.
Conclusions of two studies on Slovenian population of pregnant women are that
pre-pregnancy BMI is strongly associated with preeclampsia and GDM in both
twin and singleton pregnancies. Gestational weight gain is also associated with
risk of preeclampsia, although seemingly less so than pre-pregnancy BMI.
Smaller gestational weight gain noticed in patients with GDM may reflect the
importance of dietary counseling after GDM diagnosis.
References
Lucovnik M, Blickstein I, Verdenik I, Trojner-Bregar A, Tul N. Maternal obesity in
singleton versus twin gestations: a population-based matched case-control
study. J Matern Fetal Neonatal Med. 2014

Lucovnik M, Blickstein I, Verdenik I, Steblovnik L, Trojner Bregar A, Tul N. Impact

of pre-gravid body mass index and body mass index change on preeclampsia
and gestational diabetes in singleton and twin pregnancies. J Matern Fetal
Neonatal Med. 2014
Saturday, December 6, Hall C
S28
Strategies of management of genital endometriosis
L.V. Adamyan
Russian Scientific center for obstetrics, gynecology and perinatology named
after V.I. Kulakov, Moscow, Russia
Endometriosis is classically defined as the presence of endometrial glands and
stroma in ectopic locations. Affecting from 6% to 10% of reproductive-aged
women, endometriosis may result in dysmenorrhea, dyspareunia, chronic pelvic
pain, and subfertility. The prevalence of this condition in women experiencing
pain, infertility, or both is as high as 50%.
Endometriosis is a debilitating condition, posing quality-of-life issues for the
individual patient. The significant individual and public health concerns
associated with endometriosis underscore the importance of understanding its
pathogenesis. Despite the passage of time and extensive investigation, the exact
pathogenesis of this enigmatic disorder remains unknown.
Endometriosis is a progressive disease that does not regress spontaneously and
tends to aggravate with time, suggesting early surgical intervention. One of the
challenges of endometriosis is the prompt and accurate diagnosis of the disease,
which is of great importance in order to avoid long delay before possible surgical
management.
Saturday, December 6, Hall D
S29
CONSULTATION WITH THE ADOLESCENT: MORE THAN A GYNECOLOGICAL
EXAMINATION
G. Creatsas G
University Of Athens, Greece
Pediatrics and adolescent gynecology deals with the gynecological pathologies
during childhood and adolescence, adolescent pregnancies and contraception.
Early diagnosis, with clinical and laboratory evaluation as well as prevention and
consultation are the important tools for the management of the above
conditions. The evaluation of the paediatric and adolescent gynaecological
patients also includes the clinical history, the gynecological examination, the
pelvic ultrasonography and occasionally the laparoscopy and hysteroscopy.
Consultation is related to the relative pathology itself, and includes: discussion
on the menstrual disorders, (i.e. the dysfunctional uterine bleeding [DUB], the
amenorrhea, the dysmenorrhea, the premenstrual tension syndrome) and other
pathologies as: the ectopic pregnancy, the termination of unwanted
pregnancies, the miscarriages, the polycystic ovarian syndrome)- (PCO), the
short stature and the primary hypogonadism, the congenital uterovaginal
anomalies, the hermaphroditism, as well as the injuries of the external genitalia.
The young girl and the family, mainly the mother, should know that DUB is a
painless endometrial bleeding that is prolonged, excessive, and irregular, which
is not attributable to any underlying structural or systemic disease.
Furthermore consultation is related to the prevention of undesired pregnancies
(the use of the new generation oral contraceptives), the adolescent sexuality and
the prevention of the sexually transmitted diseases, including information on the
vaccination against the human papilloma viruses. It is recommended to the
health care professionals (HCPs) to avoid, during the discussion, medical terms
related to the pathophysiology and the management of the disease. On the
contrary they should provide information in simple words and reassurance, as
many families and especially their young children may be easily afraid or over
worried after the first appointment.
Unfortunately the problem of communication is getting worst when the family
or the child has already received information through other sources as the
Internet and the peers. A study presented by our Institution showed that
adolescents rely on information received through the media and secondly
through the HCPs and the family.

19

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

Stress, anorectic and athletic amenorrhea are strongly related to the psychology
of the girl. Consultation in these cases should be also provided by experts
focusing on the positive and negative effects of the physical exercise and the
importance of healthy and balanced nutrition. The discussion also includes
information on the fertility issues and the quality of life, especially in cases of
PCO, obesity, hirsutism and /or acne, congenital anomalies, amenorrhea and
oligomenorrhea.
In the preparation for the first gynecological examination, the role of the
midwifes and the trainees of the Unit, is of major importance, as it affects the
attitude of the child and especially the cooperation and the follow up. The
mother should accompany the girl while an informed consent should be signed,
in all cases, according to the law.
The International Federation of Pediatrics and Adolescent Gynecology (FIGIJ)
presents through the Word Congresses, the latest information for consultation
and management related to the above mentioned pathologies. Relative
meetings are organized by the European Pediatrics and Adolescent
Gynecological Society as well as by the Hellenic Society of Pediatrics and
Adolescent Gynecology.
S30
DEFICIENCIES IN THE ADOLESCENT: KEY SUPPLEMENTATIONS
S. Palacios
Director of Palacios Institute of Womens Health. Madrid. Spain
Adolescence is that period of life when children grow into young adults physically, mentally and socially. During this phase of life, approximately 20% of
final adult height and 50% of body weight are attained. This period of rapid
growth and development requires proper nutrition and, as a consequence, it is
a time of risk for the individual since nutritional status can impact their general
health, cognition and subsequently their academic achievement. There are
many factors and conditions which affect nutrient needs during adolescence
including pregnancy, lactation, level of physical activity, and chronic illnesses.
There are also many other considerations relating to general health (food supply,
underweight, overweight, eating disorders, etc.), personal choice (eg.
vegetarianism), and special circumstances (perioperative care and celiac
disease), which the health practitioner needs to be aware. Iron deficiency is the
most prevalent nutrient deficiency, and it is most common during infancy and
adolescence because of the increased need for iron to support rapid growth. As
a consequence, adolescents are especially vulnerable to anaemia, particularly
girls. Management of individuals with anaemia comprises three possible steps:
Increasing the diversity of foods consumed (this may not always resolve anaemia
since the diet may include insufficient amounts of iron or poorly bioavailable
iron); Food fortification (addition of micronutrients to processed foods - useful
for calcium and iodine but not so useful for iron because of the poor
bioavailability of iron from food sources; Pharmacological supplementation
(many iron preparations are available).
S31
ADOLESCENT CONTRACEPTION
G. Creatsas
University of Athens, Greece
Adolescent sexuality and contraception is related to the prevention of
adolescent pregnancies, termination of undesired pregnancies, prevention and
treatment of sexually transmitted diseases and other gynecological pathologies.
Next table presents the contraceptive methods available for adolescents (table
1).
Table 1. Contraceptive methods for adolescents
HORMONAL

COCs

Emergency
contraception

20

LARCs
Injectable
Mini IUDs

NON HORMONAL

The condom

The double
method
Mini IUDs
The sponge
Abstinence?

douthce

COCs: Combined oral contraceptives

LARCs: Long acting reversible contraceptive methods
IUDs: Intrauterine devices
SI: Sexual intercourse
The condom and the new generation combined oral contraceptives (COCs) are
the recommended methods for the prevention of unwanted pregnancies. The
combination of these methods also prevents the sexual transmitted diseases
including the papilloma virus infections. The failure rate of (COCs) during
adolescence is reported between 5%- 15%. Recently, research was directed
towards the development of new COCs with 17 estradiol (17- COCs) and new
progestings as the dienogest, drospirenone, nomegestrol acetate and others. An
emphasis was also given to the development of new progestins with both
progestagenic and antiandrogenic efficacy. During the last years an effort was
undertaken to reduce the dose of ethinylestradiol in COCs. However the
decrease of the dose had negative effect on the regulation of the menstrual
cycle. On the other hand early attempts to develop 17- COCs, accompanied
with a prolonged or heavy uterine bleeding and high discontinuation rates.
The new generation COCs cater for several effects especially during adolescence,
including: the regulation of the menstrual cycle, the improvement of acne,
hirsutism and endometriosis, as well as the prevention of the ovarian and
endometrial cancers. The 17 COCs also provide beneficial effects on the lipid
and the carbohydrate metabolism, as well as on and the liver and thyroid
function. Adolescents should be informed that COCs are effective if taken
regularly. If not, another contraceptive method should be proposed. The use of
the long acting reversible contraceptive methods is also recommended as they
provide better compliance, especially for adolescents.
The emergency contraception is recommended in cases of no contraception use,
condom breakage or incorrect use of the condom and failed coitus interrupts.
The following products may be used: the estrogen and progestin emergency
contraception kit, the progestin only tablets, the single dose of RU 486
mifepristone and the 19 nor progestagenic derivative.
The levonorgestrel intrauterine devices (IUDs) are still not in use during
adolescence, until further data is presented on the mini IUDs.
Consultation and sexual education are very important tools for the prevention
of unwanted pregnancies. Information should be provided by experts in
Pediatrics and Adolescent Gynecological Centers and Family Planning Units.
During the discussion with the young girl it is recommended to avoid medical
terms to overcome psychosocial problems.

Abstract Book

The 20th World Congress on

Controversies in Obstetrics,
Gynecology & Infertility (COGI)
All about Womens Health

Oral Presentations

21

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

Notes

22

Abstract Book

ORAL ABSTRACTS
O01
ARE DIFFICULTY OF BECOMING PREGNANT AND FERTILITY TREATMENTS
ASSOCIATED WITH CHILDHOOD ACUTE LEUKEMIA? RESULTS FROM THE
ESTELLE STUDY.
R. Ajrouche 1,*, J. Rudant 1, L. Orsi 1, D. Hmon 1, J. Clavel
Inserm, Villejuif, France
Problem Statement: The number of couples who are finding difficulty in
becoming pregnant and seeking treatment for infertility has dramatically
increased over time. The consequences of such exposures on the outcomes of
pregnancies are unclear. In addition, there have been little investigations
regarding childhood cancer risk, especially Childhood leukemia (CL), which has
in utero origin in most cases. If a recent cohort study did not show any increase
in the leukemia risk of children who were born after non-donor assisted
conception, only a few other studies reported on the associations between other
fertility treatments, infertility and CL, with inconsistent results. We investigated
the potential involvement of fertility treatments and infertility in the etiology of
CL.
Methods: The ESTELLE study included 747 cases of CL (636 cases of acute
lymphoblastic leukemia (ALL) and 100 of acute myeloblastic leukemia (AML))
diagnosed in France in 2010-2011 and 1421 population controls frequencymatched with the cases on age and gender. Data were obtained from structured
telephone questionnaires administered to mothers. In particular, mothers were
asked whether they had difficulty becoming pregnant, which was defined as
taking more than a year to conceive the index child and/or the need to consult
a doctor and/or the need for the mother or father to undergo fertility treatment.
In the latter case, the mothers were asked to specify the type of treatment: In
vitro fertilization (IVF), IVF with intracytoplasmic sperm injection (ICSI), artificial
insemination (AI), zygote intrafallopian transfer (ZIFT), gamete intrafallopian
transfer (GIFT) or hormonal treatment (clomiphene, gonadotropin, dopamine
agonist or other). The odds ratios (OR) and their 95% confidence intervals were
estimated using unconditional regression models adjusted for potential
confounders.
Results: Difficulty becoming pregnant was reported by 18% of the control
mothers and 16% of the CL mothers. CL was not associated with infertility or the
use of a fertility treatment for the index pregnancy (table1), even after taking
into account folic acid supplementation and other conditions of becoming
pregnant (getting pregnant on contraception and maternal reproductive
history). The present study is the first study to investigate the specific types of
fertility drugs; it showed no association with the various types of drug.
Table 1: Difficulty for becoming pregnant with the index child and childhood
acute leukemia, the ESTELLE study, France, 20102011

Difficulty
for
becoming pregnant
No
Yes
Mother
fertility
treatment
No
Yes
In vitro fertilization
Artificial insemination
Ovulation
induction
drug only

Controls
(N=1421)

CL
cases
(N=74
7)

OR

95%CI

1167
254

627
120

1.0
0.9

ref
0.7-1.2

1323

706

1.0

ref

98
23
16
30

41
7
4
16

0.8
0.6
0.5
1.0

0.5-1.1
0.3-1.5
0.2-1.4
0.6-1.8

AORs and 95%CI estimated by unconditional logistic regression adjusted for age,
gender, last professional category and maternal age at child's birth
Conclusion: The results are reassuring for mothers seeking infertility treatments;
the findings support the absence of increasing risk of CL after IVF, as recently
reported in a 17-year period UK cohort study, and more generally, after any
fertility treatments.
Disclosure of Interest: None Declared

O02
LATE FOLLICULAR VERSUS LUTEAL PHASE RANDOM START OVARIAN
STIMULATION FOR DONOR EGG IVF CYCLES
N. K. Duru 1,*, T. Isidan 1, M. Haxhia 1, B. Ferhati 1, L. Kansiz 1, A. Sula 1, J. Gjoshe 1
1Obstetrics and Gynecology, IVF Unit, American Hospital, Tirana, Albania
Problem Statement: Random start emergency ovarian stimulation for
reproductive age cancer patients has been reported to result in cryopreservation
of mature eggs and embryos. The objective of this study is to perform oocyte
donation cycles using random start ovarian stimulation of the donor, instead of
donor-recipient cycle synchronization, and to transfer fresh embryos.
Methods: In a private hospital IVF clinic setting, 15 oocyte donation cycles were
prospectively done using GnRH-antagonist/Recombinant FSH. Donor ovarian
stimulation was started randomly during either late follicular (n:7) or luteal (n:8)
phase, according to recipient's cycle start for endometrial preparation. For the
late follicular versus luteal start groups respectively, the age of the donors (28.3
vs 28.6 years) and recipients (42.3 vs 45.3 years) did not differ significantly.
Results: Mean duration of stimulation (9.6 vs 10.0 days) and mean amount of
recombinant FSH used (2858 vs 2925 IU) did not differ significantly in the late
follicular versus luteal start groups, respectively. Mean number of mature
oocytes retrieved (10.6 vs 11.3), embryos transferred (1.6 vs 1.5), and clinical
pregnancy rates (71 % vs 62%) did not differ significantly in the late follicular
versus luteal start groups, respectively.
Conclusion: Ovarian stimulation of the donor can be started randomly either at
the late follicular or luteal phase, as an easy and convenient method for oocyte
donation cycles. This finding may be evaluated further for the future setting of
oocyte banking.
Disclosure of Interest: None Declared

O03
PREDICTIVE VALUE OF SERUM BETA- HUMAN CHORIONIC GONADOTROPHIN
(B-HCG) FOR THE PREGNANCY OUTCOME IN INTRAUTERINE INSEMINATION
(IUI) CYCLES
H. Grigoryan,*, E. Hambartsoumian
Fertility Center, Yerevan, Armenia
Problem Statement: As there were a number of study concerning predictive
value of betta-Human Chorionic Gonadotrophin (b-HCG) after Invitrofertilization (IVF) cycles and embrio transfer , we`ve decided to determine if
there is a relation between pregnancy outcome and betta-human chorionic
gonadotrophin (b-HCG) level on day 15 after ovulation in Intrauterin inseminatin
cycles. The main objective of this study was to evaluate the predictive value of
beta- Human Chorionic adotrophin (-HCG) for the successful outcome in
Intrauterine Insemination (IUI) cycles on day 15 after ovulation.
Methods: It was the prospective study 230 pregnant patients ages 19-40 with
positive -HCG after intrauterine insemination (IUI) cycles were studied from
Januanry 2010 to Januanry 2014 in << Fertility Center>> Yerevan.
Results: Patients were assigned two groups on the basis of the -HCG level on
day 15 after ovulation. Group A if the betta- human chorionic gonadotrophin (HCG) level was more than 130 mIU/mL, and Group B if betta- human chorionic
gonadotrophin (-HCG) level was less than 130 mIU/mL. There were 96.7%
normal pregnancies in group A vs. 26% in a group B. There were 1.7 % ectopic
pregnancies and 1.6% spontaneous abortions in group A vs. 52% and 22% in a
group B.
Conclusion: A betta- human chorionic gonadotrophin (-HCG) value of 130
mIU/mL on 15th day after the ovulation in intrauterine insemination cycles (IUI)
appeares to be a suitable cut-off point to predict viable pregnancy.
Disclosure of Interest: None Declared

O04
CLOMIPHENE BASED OVARIAN STIMULATION IN A COMMERCIAL DONOR
PROGRAM.
S. Gupta 1,*, R. Satwik 2, A. Majumdar 1, S. Mittal 2, N. Tiwari 1
1Sir Ganga Ram Hospital, New Delhi, India, 2Centre for IVF and Human
Reproduction, Sir Ganga Ram Hospital, New Delhi, India

23

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

Problem Statement: Clomiphene has proven efficacy for minimal-stimulation in

PCOS patients. Its isomer en-clomiphene effectively suppresses LH and can
eliminate the use of high dose gonadotropins. Donor recipient cycle provides a
unique setting to test a clomiphene based stimulation regimen, as the recipients
endometrium remains unaffected of its antagonistic effect. The present study
was conducted at a tertiary care centre in New Delhi, India to compare a
clomiphene-based ovarian stimulation regimen with the conventional
antagonist protocol applied to donor-recipient cycles.
Methods: A total of 170 donors were stimulated between January 2013 and
December 2013. Conventional antagonist protocol (group I) was employed in
139 cycles, and clomiphene was used in 31 donor cycles (group II). 50mg
Clomiphene was given simultaneously with gonadotropins from day 2 of the
cycle till the day of trigger. Analysis was performed retrospectively for pregnancy
rates, fertilization rates, cycle cancellation and blastocyst formation. The
dosages, cost, terminal E2 (Estradiol) were also compared between the two
groups.
Results: The donor age groups were comparable in both the groups. There were
no unsuccessful egg retrievals with clomiphene. The pregnancy rate (positive
beta HCG) was significantly higher in the clomiphene group (odds ratio: 2.453;
p=0.02). Similarly, fertilization rate was significantly higher in the clomiphene
group (59.5/50.5, p=0.04). Eggs retrieved were similar in both groups, but the
terminal E2 was significantly lower in the clomiphene group (p=0.001). Average
gonadotropin used was also significantly lower in clomiphene group (p<. 001).
Conclusion: Clomiphene alone can effectively prevent LH surge and limit the
dose of gonadotropins thus bringing down the costs and negative impact of high
dose gonadotropin on the endometrium and oocyte quality.
Disclosure of Interest: None Declared

O05
CLINICAL AND REPRODUCTIVE OUTCOMES FOLLOWING HYSTEROSCOPIC
ADHESIOLYSIS FOR ASHERMAN SYNDROME
C. Hui 1,*, M. Lau 2, G. Ng 1, H. H. Tan 2
1
Obstetrics and Gynaecology, 2Reproductive Medicine, KK Women's and
Children's Hospital, Singapore, Singapore
Problem Statement: Women with Asherman Syndrome have intrauterine
adhesions and present with menstrual abnormalities, infertility or recurrent
pregnancy loss. It is now recognized that the prevalence of Asherman Syndrome
varies geographically because of the different laws and methods of abortions in
the world. To date, there is paucity of data looking at the clinical characteristics
and reproductive outcomes of women with this condition in our population.
Methods: This is a retrospective case series analysis of 76 patients diagnosed
with Asherman Syndrome in a tertiary womens hospital in Singapore from
January 2008 to December 2009. All patients underwent hysteroscopic
evaluation and treatment of intrauterine adhesions. Our center uses a modified
classification based on that by the European Society of Gynecological Endoscopy
to grade adhesions into mild, moderate or severe. The demographics,
predisposing factors and the menstrual symptoms and reproductive outcomes
following treatment at two-year follow up were recorded.
Results: The median age of the 76 patients was 35 years, with age ranging from
24 to 45 years. The racial ethnicity of our study population were 71% (54/76)
Chinese, 13.1% (10/76) Malay, 7.9% (6/76) Indian and other races constituted
the remaining 7.9% (6/76). 81.6% of patients with Asherman Syndrome had prior
trauma to the gravid uterus, making this the main predisposing factor. Other
factors documented included trauma to the non gravid uterus (hysteroscopy/
polypectomy), infection and uterine manipulation during hysteroscopy. No
obvious predisposing factor was found in 5.3% of our study group. 65.8% of the
patients in our study had presented purely with subfertility, of which 50% had
mild adhesions. In contrast, 60.8% of the patients who presented with menstrual
abnormalities had moderate to severe adhesions.
Mild
adhesion
s
Moderat
e

24

Number
of
Patients
24

Clinical
pregnancy

Live birth

14/24
(58.3%)

11/14 (78.5%)

17

9/17
(52.9%)

7/9 (77.8%)

adhesion
s
Severe
adhesion
s
Total

5/6 (83.3%)

1/5 (20%)

47

28/47
(59.6%)
p=0.503

19/28 (67.8%)
p=0.0566

There was a return of normal menses in 20/23 (87%) of patients presenting with
menstrual abnormalities. Of the 56 patients who presented with subfertility, 9
were lost to follow up for the two-year period. Clinical pregnancy was achieved
in 59.6% of patients. When comparing mild and severe adhesions, the live birth
rate was significantly higher (78.5%) in the mild adhesions group when
compared to the group with severe adhesions (20%), p=0.038. When comparing
the patients presenting with subfertility who had prior trama to a gravid uterus,
there was no significant difference in the conception and live birth rate when
comparing groups with increasing number of procedures to the gravid
uterus. For 19 patients who achieved live births in our study population, 21%
(4/19) had preterm deliveries while 10.5% (2/19) had abnormal placentation
(one placenta accreta and one placenta praevia major).
Conclusion: The most common predisposing factor for developing Asherman
syndrome in our population was trauma to the gravid uterus. The severity of
adhesions has an impact on the prognosis of reproductive outcomes, with
patients diagnosed with mild adhesions achieving a significantly higher live birth
rate than patients with severe adhesions. Successful pregnancies after
hysteroscopic adhesiolysis should be monitored closely antenatally due to the
high rates of obstetric complications reported in this population.
Disclosure of Interest: None Declared

O06
EXPRESSION PATTERNS OF HOXA-10, HOXA-11 AND LIF IN THE ENDOMETRIUM
OF FERTILE AND INFERTILE WOMEN: PILOT RESULTS.
C. MARGIOULA-SIARKOU 1 2,*, S. PETOUSIS 1 2, S. MILIAS 3, K. HAITOGLU 4, G.
MAVROMATIDIS 1, Y. PRAPAS 1 2, D. ROUSSO 1, N. PRAPAS 1 2
13rd Department of Obstetrics and Gynaecology, Aristotle University of
Thessaloniki, 2IAKENTRO, Infertility Tretament Center, 3Division of Pathology,
424 General Army Hospital, 4Laboratory of Biochemistry, Aristotle University of
Thessaloniki, Thessaloniki, Greece
Problem Statement: -10, HOXA-11, as well as Leukemia Inhibitory Factor
(LIF) have been indicated to have an important role in endometrial receptivity.
Nevertheless, the possible relationship between their expression patterns and
cause of infertility has not yet been clarified. Main objective of the present study
was to analyze expression patterns of -10, HOXA-11 and LIF in the
endometrial tissue of fertile and infertile women, during the window of
implantation.
Methods: : A prospective PhD research study was conducted during 1/20133/2014 in 3rd Department of Obstetrics and Gynecology of Aristotle University of
Thessaloniki and Iakentro, Infertility Treatment Center. Women having delivered
at least one alive newborn and without signs of potential infertility were the
studys control group (fertile women, group 1) while those with diagnosed
infertility were the patients group (infertile women, group 2). An endometrial
biopsy was obtained by Pipelle on 7th-8th day after ovulation confirmation in each
woman. Immunohistochemistry was performed to assess expression of HOXA10 and HOXA-11 in stromal cells as well as expression of LIF in both epithelial
and stromal cells. Primary outcomes were defined to be positive nuclei
percentage (expressed as % percentages) as well as intensity of staining and the
combined rate of h-score (expressed as mean SEM). The former parameters
were compared between fertile and infertile women. Statistical significance was
defined as P<.05 while statistical trend as P<.20.
Results: There were overall 25 women (10 fertile and 15 infertile) meeting the
inclusion criteria during the studys period, of which endometrial sample was
successfully obtained by 7 fertile and 14 infertile women. Mean age was 30.7
0.8 years for group 1 and 37.3 3.5 for group 2 (P=.002). Endometrial staining
was out-of-phase in 1 out of 7 controls (14.3%) while in 7 out of 14 infertile
women (50.0%) (P=.16). HOXA-11 staining was significantly increased in the
endometrium of infertile women (P=.02). Similarly HOXA-11 h-score was 0.7
0.3 in fertile vs. 1.4 0.2 in infertile women (P=.08). In contrary, LIF positive

Abstract Book

nuclei percentage in epithelial cells was 50.7% in group 1 vs. 27.3% in group 2
(P=.16), while h-score was respectively 1.3 0.4 vs 0.6 0.2 (P=.18),
demonstrating a statistical trend of higher expression in fertile women. No
significant difference or trend was detected regarding the expression of HOXA11 and LIF in stomal cells between the two groups (P>.20).
Conclusion: Pilot results of our study indicate that HOXA-11 expression is
significantly higher in the endometrium of infertile women. LIF expression in
epithelial endometrial cells may also be impaired in the infertile group.
Conversely, HOXA-10 and LIF expression in stromal cells may not differ
significantly between fertile and infertile women.

Progesterone receptors impaired expression may potentially present an

important aitopathogenetic factor of causing implantation failure.

O07
PROGESTERONE RECEPTORS EXPRESSION IS SIGNIFICANTLY DECREASED IN
THE ENDOMETRIUM OF INFERTILE WOMEN AND PRESENTS SIGNIFICANT
DIFFERENCES AMONG VARIOUS SUB-CATEGORIES OF INFERTILITY: PILOT
RESULTS.
S. PETOUSIS 1 2,*, C. MARGIOULA-SIARKOU 1 2, S. MILIAS 3, K. RAVANOS 2, K.
HAITOGLU 4, Y. PRAPAS 1 2, D. ROUSSO 1, N. PRAPAS 1 2
1
3rd Department of Obstetrics and Gynaecology, Aristotle University of
Thessaloniki, 2IAKENTRO, Infertility Treatment Center, 3Division of Pathology,
424 General Army Hospital, 4Laboratory of Biochemistry, Aristotle University of
Thessaloniki, Thessaloniki, Greece

Problem Statement: Controlled ovarian hyperstimulation (COH) is one of the key

steps of assisted reproductive technology (ART). Safe and cost-effective COH
protocols with good patient compliance play a pivotal role in improving the
success rate for in vitro fertilization/embryo transfer (IVF/ET). In recent
years, GnRH antagonist (GnRH-ant) is increasingly being used in China. It can
induce a rapid decrease in LH and FSH, preventing and interrupting the
premature LH surge. For women of advanced reproductive age with relatively
poor ovarian function, whether GnRH-ant protocols can provide good quality of
embryo and high pregnancy rate? In this study, we compared the effect of
different ovarian stimulation protocols with GnRH antagonist and agonist on the
oocyte and embryo quality. Our aim was to select personalized COH protocols
with improved softy, efficiency and cost-effectively.
Methods: This study was approved by the local ethics review committee.
Retrospective analysis of the 844 cycles of IVF data between the period of
January 2012 and December 2012 from patients (38~42 years of age) with an
indication for IVF in our center was performed. Patients with the following
conditions were enrolled: cycle number 2, FSH 12, and retrieved oocyte
number 4. Patients with mini-stimulation protocol and natural cycles were
excluded. The patients were divided into four groups: GnRH-ant group (n=212),
GnRH agonist short protocol group (n=367), GnRH agonist long protocol group
(n=126), and GnRH agonist ultra-long protocol group (n=139). The data of FSH,
E2, LH, HCG, serum LH, serum E2, Gn days, Gn dosage, retrieved oocyte number,
cycle available embryo number, oocyte maturation rate, fertilization rate, low
fertilization rate, fertilization failure rate and implantation cancelling rate of
different groups were collected, respectively. Data were analyzed using
SPSS18.0 software package. P<0.05 was considered significantly different.
Results: In women of advanced reproductive age, the retrieved oocyte number
and cycle available embryo number in the GnRH-ant group was significantly
higher than that in the short protocol group (10.5005.224 vs. 18.6034.427,
P<0.05;4.5153.668 vs. 3.5573.403; P<0.05); P<0.05); the implantation rate
and pregnancy ratein the GnRH-ant group was significantly higher that of the
short protocol group (12.62% vs. 8.85%, P<0.05;28.35% vs. 16.81%;P<0.05), the
abortion rate in the GnRH-ant group was significantly lower than that in the
short protocol group (26.92% vs. 47.37%;P<0.05); the live birth rate in the GnRHant group was significantly higher than that of the short protocol group (18.04%
vs. 6.98%;P<0.05).
Conclusion: In our studies, it shows GnRH-ant protocol is advantageous in the
aspects of being simple and quickly enrolling in the treatment period. The Gn
doses and Gn days in the GnRH-ant protocol were less than that in the long
protocol. Compare with the agonist protocols, the GnRH-ant protocol was more
suitable for the elderly patients. The laboratory data and clinical outcomes of
the GnRH-ant protocol are comparable to that of the GnRH agonist long and
ultra-long protocols, whereas are better than that of the agonist short protocol.
Compared with the short protocol, the embryo quality as well as the clinical
pregnancy rate and live birth rate were significantly improved and the aborting
rate was significantly reduced in the GnRH-ant protocol group.
Disclosure of Interest: None Declared

Disclosure of Interest: C. MARGIOULA-SIARKOU Grant / Research support from: IKY

FELLOWSHIPS OF EXCELLENCE FOR POSTGRADUATE STUDIES IN GREECE, S. PETOUSIS: None
Declared, S. MILIAS: None Declared, K. HAITOGLU: None Declared, G. MAVROMATIDIS: None
Declared, Y. PRAPAS: None Declared, D. ROUSSO: None Declared, N. PRAPAS: None Declared

Problem Statement: The expression of progesterone receptors type A and B is

involved in the normal implantation procedure of blastocyst. Main objective of
the present study was to compare the expression of total progesterone
receptors (A+B), as well as type-B receptors between fertile and infertile women
as well as between the various categories of infertility.
Methods: These are the pilot results of a PhD research performed since 1/2013
in 3rd Department of Obstetrics and Gynecology of Aristotle University of
Thessaloniki and Iakentro, Infertility Treatment Center. Women having
delivered at least one alive newborn and without signs of infertility consisted the
studys control group (fertile women, group 1) while infertile women the
patients group (group 2). Infertile women were also categorized according to
their infertility cause to those with ovarian failure (group 2a), tubal factor
infertility (group 2b) or with recurrent pregnancy loss and multiple IVF failures
(group 2c). All women recruited in our analysis were set on daily ultrasound
examination from 7th menstrual day in order to detect ovulation day and were
afterwards performed an endometrial biopsy by Pipelle on 7th-8th menstrual day
after ovulation. Immunohistochemistry was performed to measure expression
of total progesterone receptors (TPR) as well as type-B receptors (PR-B) in both
epithelial and stromal cells. Primary outcomes were positive nuclei staining,
intensity of staining and their combined rate h-score. The former outcomes
were compared between groups 1 and 2 as well within the different sub-groups
of infertility.
Results: There were overall 30 women (10 fertile and 20 infertile) meeting the
inclusion criteria during the studys period. Endometrial sample was successfully
obtained by 7 fertile and 19 infertile women, 8 of which were diagnosed with
ovarian failure, 5 with tubal infertility and 6 with RPL or multiple IVF failure.
Mean age was 30.7 0.8 years for group 1 and 37.3 3.9 for group 2 (P=.001).
TPR and PR-B expression was significantly decreased in the epithelial cells of
infertile women compared with fertile controls. Specifically, TPR h-score was 2.2
0.3 for group 1 vs. 1.0 0.3 for group 2 (P=.05), while PR-B h-score was 1.5
0.4 for group 1 vs. 0.7 0.2 for group 2 (P=.05). No significant difference was
observed regarding their expression in stromal cells. Finally, when comparing
within the different sub-categories of infertility, both TPR and PRB expression in
epithelial cells presented significant differences among groups (P=.05 and P=.02
respectively), the lower rates being observed in group 2c (1.1 0.3 for TPR and
0.2 0.1 for PRB).
Conclusion: Pilot results of our study indicate that progesterone receptors
expression in epithelial cells is decreased in infertile women, the lower
expression being observed in women with recurrent pregnancy loss.

Disclosure of Interest: S. PETOUSIS Grant / Research support from: STATE SCHOLARSHIP

FOUNDATION OF GREECE, C. MARGIOULA-SIARKOU: None Declared, S. MILIAS: None
Declared, K. RAVANOS: None Declared, K. HAITOGLU: None Declared, Y. PRAPAS: None
Declared, D. ROUSSO: None Declared, N. PRAPAS: None Declared

O08
COMPARISON OF OVARIAN STIMULATION PROTOCOLS WITH GNRH
ANTAGONIST AND AGONIST: A LARGE RETROSPECTIVE STUDY IN WOMEN OF
OVER 38 YEARS OLD
X. Shi 1,*, P. Liu 2, J. Qiao 2
1Medical Center for Human Reproduction, Beijing University Third Hospital,
2Beijing University, Beijing, China

25

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

O09
A NOVEL METHOD OF PRIMING WITH A GNRH AGONIST BEFORE IMMATURE
OOCYTE RETRIEVAL MAY IMPROVE MATURITY OF OOCYTES AND OUTCOME IN
IN VITRO MATURATION (IVM) CYCLE: A CASE REPORT
A. Smirnova 1,*, M. Anshina 1, A. Ellenbogen 2
1
IVF&Genetics Center "FertiMed", Moscow, Russian Federation, 2Department of
Obstetrics and Gynecology, IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel
Problem Statement: IVM of oocytes technique was introduced into clinical
practice more than 20 years ago. It was demonstrated that HCG priming has an
important value in IVM outcome. It was shown in an antagonist cycle that GnRH
agonist (GnRHa) is as effective as HCG to induce adequate follicular maturation.
The possible mechanism is simultaneous induction of FSH surge, comparable to
the surge of natural cycle which promote development of LH receptors in
granulosa cells and oocyte nuclear maturation and cumulus expansion. Two
RCTs reported the retrieval of more mature oocytes after GnRHa trigger, which
might be attributed to the presence a FSH surge as well as LH.
Methods: The purpose of this report was to examine the effect of GnRHa
priming, instead of HCG, before immature oocytes retrieval in an IVM cycle.
Methods: A 38 years old woman was referred to IVF&Genetics Center for fertility
preservation. She underwent adnexectomy from the right side because of large
papillar mucinous ovarian cystadenoma and cystectomy of the left ovary
because of mucinous cystadenoma. The recurrence of cystadenoma of the left
ovary was diagnosed 3 years after last surgery and present up to her admittance
in our unit. Basal FSH was 6.9 IU/l, AMH 0, 35 ng/ml, AFC 5.
Results: Results: In accordance with Russian legislation ovarian stimulation
including HCG is forbidden in women with ovarian tumors. Therefore triggering
of ovulation with a GnRHa was conducted. A first IVF attempt was performed in
a natural cycle. No oocyte was obtained. In order to maximize the number of
oocytes obtained without stimulating the ovaries, three IVM attempts were
performed.
1st attempt: Decapeptyl 0, 2 mg was given on day 8, when leading follicle
achieved 9,5 mm in diameter. OPU was performed 39 hours later, 3 oocytes
were retrieved. All of them were cultured for 5 hours in maturation medium
(SAGE), stripped and fertilized by ICSI on the day of follicle aspiration. Three good
quality embryos were vitrified on day 3.
2nd attempt: Same trigger was given on day 10, leading follicle = 10,5 mm. OPU
was performed 39 hours later, 6 oocytes were retrieved, all MII after 4 hours
of culture in proper medium. Five oocytes developed in 2pN 19 hours after ICSI.
One good quality embryo was vitrified on day 3, other were cultured till day 6,
and two poor quality blastocyst were obtained.
3rd attempt: Decapeptyl 0, 2 mg was given on day 10, leading follicle = 10 mm.
OPU was performed 39 hours later. 3 oocytes were retrieved, cultured for 5
hours, denudated and fertilized by ICSI on the day of follicle aspiration. Two good
quality embryos were vitrified on day 3.
In summary, six good quality embryos were vitrified on day 3. After performing
cystectomy in order to rule out malignancy frozen embryo transfer is planned.
Conclusion: In an IVM cycle the percentage of MII oocytes after 6-48 hours of
maturation in IVM media usually dont exceed 70%. In our case all retrieved
oocytes became MII on the day of follicle aspiration. It is possible that the high
early maturation rate obtained is due to GnRHa-induced surge of FSH which may
promote nuclear and cytoplasmic maturation of oocyte.
Disclosure of Interest: None Declared

O10
CAN INTRA CYTOPLASMATIC MORPHOLOGICALLY SELECTED SPERM INJECTION
(IMSI) TECHNIQUE IMPROVE OUTCOME IN PATIENTS WITH REPEATED IVF/ICSI
FAILURE- A COMPARATIVE STUDY
E. Adrian 1,*, S. P. Einat 1, M. Medeia 1
1IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel
Problem Statement: Spermatozoal morphology was reported to effect
fertilization, embryo quality and pregnancy results in spontaneous conception
and ART. IMSI is an innovative, not invasive technique, which examines the
sperm with no harm at a magnification of x6000 in order to obtain optimal sperm
to perform ICSI. We evaluated the efficiency of IMSI technique in patients with

26

repeated IVF/ICSI failure of at least 3 cycles with no viable pregnancy and /or
very poor sperm quality.
Methods: All couples that performed IMSI between the years 2009 to 2012 were
enrolled retrospectively to the study. Couples with male infertility who were
treated with IMSI were included in the study. All their treatments were
evaluated and divided into 2 subgroups: conventional IVF-ICSI treatment and
their subsequent IMSI treatment. Demographic data, clinical parameters and
outcome were recorded. The IMSI treatments were compared to previous nonIMSI treatments in terms of fertilization rates, cleavage rates, number of
embryos and their quality, number of embryos transferred and pregnancy
outcome.
Results: Forty two couples were reviewed. Basic characteristics of the groups
were comparable. Fertilization and cleavage rates of the two groups were
comparable. The embryos quality demonstrated a trend towards superior
quality (grade 1-2) embryos in the IMSI vs. ICSI (60% vs. 47%; P=0.07 and 53% vs.
40%; P=0.07) respectively. Implantation and clinical pregnancy rates were
significantly superior in IMSI group (19.2% vs. 7.8%; P=0.042 and 41.3% vs.
10.5%; P=0.02 respectively). Miscarriage rate was significantly higher in
conventional IVF-ICSI group (100% vs. 15.8%; P=0.04) and live birth rate was
significantly higher in IMSI group (0 in conventional IVF-ICSI and 34.7% per
transfer in IMSI group; P=0.003)
Conclusion: IVF outcome of IMSI resulted in a higher implantation rate,
pregnancy rate and most importantly delivery rate compare to non IMSI treated
cycles.
Disclosure of Interest: None Declared

O11
DOES BMI INFLUENCE OOCYTE VOLUME IN IN VITRO FERTILIZATION-INTRA
CYTOPLASMATIC SPERM INJECTION CYCLES?
E. Adrian 1,*, S. P. Einat 1, M. Medeia 1
1IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel
Problem Statement: Oocytes from animal models with insulin- resistant and
obese mice showed delayed maturation, smaller oocyte size, and increased
granulosa cell apoptosis. These findings are linked to adverse embryonic and
fetal outcomes including delayed embryonic development, growth restriction,
anatomic defects, and smaller fetuses. In humans, excess body fat is associated
with chronic oligo-anovulation and infertility due to hyperinsulinemia and
ovarian hyperandrogenemia.Obesity is also associated with higher miscarriage
rates, a higher prevalence of gestational diabetes as well as pregnancy induced
hypertension. Obesity induced elevations in insulin, glucose, and free fatty acids.
It appears to impact the developmental competence of the oocyte as well as
other tissues: sperm, embryo, placenta, or uterine environment. Negative
environmental exposures may affect the developmental competence of the
oocyte; defined as the ability of the oocyte to be fertilized and support embryo
development. The aim of the study was to evaluate the effect of BMI on oocyte
volume and treatment cycle outcomes
Methods: Prospective, cohort study - Women undergoing IVF-ICSI cycles were
divided into two subgroups according to their BMI: Obese BMI > 30; Lean BMI <
25. We evaluated the effect of BMI on the number of oocytes retrieved,
fertilization and cleavage rates, number of top quality embryos, pregnancy rate
and oocytes diameter and volume. All oocytes were captured after denudation
of the granulosa cells before ICSI by an Olympus camera in the inverted
microscope. A Zilos laser and software allowed the measurement of computercaptured digital images by using built-in tools that automatically calculated the
mean and standard deviation of each measurement. We measured the diameter
of each mature oocyte, zona pellucida and oolema and calculates the oocyte
volume.
Results: 26 cycles of IVF-ICSI were analyzed. 10 obese patients (77 oocytes) and
16 lean patients (149 oocytes). FSH, LH, Estradiol and number oocytes retrieved
were comparable between the two groups. The oocytes obtained from obese
patients were significant smaller in total oocytes diameter and volume
(162.55.2 vs. 164.55.1, P=0.01; 2.2*10^60.2 vs. 2.3*10^60.2, p=0.01).
However, oolema diameter and volume were comparable. Significantly higher
percent of top quality embryos and higher pregnancy rate was obtained in the
lean group (49% vs 33% and 50% vs 37.7% respectively, p<0.04).

Abstract Book

Conclusion: Oocytes from obese patients have lower volume than from lean
patients. A direct correlation was found between smaller oocyte volume and
oocytes function in terms of less TOP quality embryos.and lower pregnancy rate.
It is possible that this finding may be caused by an abnormal metabolism of fat
in oocytes of obese patients causing a decrease in vital elements needed for
energy buildup into the oocytes. Our study suggests that the results of In Vitro
Fertilization treatment are correlated with body mass index.
Disclosure of Interest: None Declared

O12
SIGNIFICANCE OF HYSTEROSCOPIC EVALUATION AND TREATMENT OF UTERINE
ANOMALIES BEFORE ASSISTED REPRODUCTIVE TECHNOLOGIES
A. Fazekas *, Z. Benedek, A. Vereczkey
Versys Clinics Human Reproduction Institute, Budapest, Hungary
Problem Statement: Uterus anomalies (e.g. septum, subseptum, arcuatus, and T
shaped endometrium) with different severity may be the reason of infertility in
20-40 % of cases. It has been known already that operative treatment of these
anomalies significantly increases the pregnancy and live birth rates and reduces
miscarriage rate and preterm birth. Currently it has been proven that surgerical
correction of smaller variances (e.g. uterus arcuatus) may be reasonable as well
in case of infertility or recurrent misscarriages.
Methods: Our aim was to retrospectively analyse the experiences of
hysteroscopic septum/subseptum resection and its possible effect on infertility
treatment on patients appearing at our clinic between October 2010 and March
2014. We were interested in the average age of the women, the success of the
IVF (in vitro fertilization) treatment (pregnancy and live birth rates).
Results: Average age of the patients was 36.2 years old. We performed 155
hysteroscopy during the examined time period. In 132 cases we executed
hysteroscopy only, while in 23 cases hysteroscopy was performed together with
laparoscopy. In total, we fulfilled 62 hysteroscopic septum/subseptum
resections. Out of these, follow-up of 54 cases was possible. All of these patients
obtained clinical pregnancy (41 spontaneous and 13 after IVF treatment), but in
four cases the pregnancy ended in misscarriage (1 spontaneous and three after
IVF treatment). In summary, after surgical treatment of uterus
septum/subseptum the clinical pregnancy rate was 100 %, while the live birth
rate was 92 %.
Conclusion: The results obtained at our clinic fit well in international trends and
support recent data in literature, as uterus septum with different severity
treated by hysteroscopic septum resection is necessary to obtain successful
pregnancy in infertile patinets. Further prospective trials would be needed
though with higher number of cases to prove its exact role in the treatment of
infertile patients.

Disclosure of Interest: None Declared

O13
ARE PROTEASE INHIBITORS ASSOCIATED WITH IMPAIRED GLUCOSE
METABOLISM IN HIV-INFECTED PREGNANT WOMEN?
H. Adler 1,*, R. Moore 2, V. Jackson 3, M. Eogan 2, M. Byrne 4, M. Lawless 5, J.
Lambert 1 5 6
1Infectious Diseases, Mater Misericordiae University Hospital, 2Obstetrics and
Gynaecology, 3Clinical Audit & Surveillance Scientist, Rotunda Hospital,
4Endocrinology, Mater Misericordiae University Hospital, 5Infectious Diseases,
Rotunda Hospital, 6School of Medicine and Medical Sciences, University College
Dublin, Dublin, Ireland
Problem Statement: Metabolic complications including diabetes mellitus have
been increasingly recognized in HIV-infected individuals since the introduction
of antiretroviral therapy (ART). Protease inhibitors (PIs) are a particular concern
in this regard. PI-based ART regimens are frequently employed in pregnant HIVinfected women and previous studies have given conflicting results regarding
the contribution of PIs to impaired glucose tolerance (IGT) and gestational
diabetes mellitus (GDM) in such patients. An association with GDM has the
potential to limit the choices of ART regimens in pregnant women.
Methods: This study was a retrospective review of all HIV-infected women
attending a combined infectious disease and antenatal clinic between 2007 and

2013 who underwent a 100g oral glucose tolerance test (OGTT) at 24-28 weeks
gestation with blood glucose levels measured at 0, 1, 2 and 3
hours. Carpenter/Coustan thresholds were used for diagnosis of GDM. Test
results, baseline demographics, ART regimens and obstetric outcomes were
collated.
Results: 141 women with HIV underwent an OGTT in our clinic over the time
frame of the study. The average age was 31 years, all women were of European
or African origin and 33% had a body-mass index >30kg/m2. 93.6% were on
protease-inhibitor based regimens. The prevalence of IGT was 2.84%, while the
prevalence of GDM was 2.13%; this is similar to the rates of GDM in our general
pregnant population. 71.4% (n = 5) of women with abnormal glucose
metabolism were taking PIs, versus 94.8% (n = 127) of normoglycaemic women
(p = 0.06). No differences in obstetric outcomes were observed.
Conclusion: This study did not detect an increased rate of GDM in HIV-infected
women in our patient population and found no association between PI use and
GDM. The ethnic makeup of our study population may partially explain the low
rates of GDM compared with previous studies. Glucose tolerance in pregnant
women infected with HIV should remain a priority for future research, but our
study does not suggest any linkage between PI use and GDM.
Disclosure of Interest: None Declared

014
EFFECTS OF CONTINUOUS USE OF ENTONOX IN COMPARISON WITH
INTERMITTENT METHOD ON MATERNAL OUTCOMES: A RANDOMIZED
CLINICAL TRIAL
J. Agah 1,*, R. Baghany 1, S. H. Safiabadi Tali 2, Y. Tabarraie 3
1gyn&obstetrics, SABZEVAR MEDICAL UNIVERSITY, sabzevar, 2Internal medicine,
Ghazvin medical university, Ghazvin, 3Biostatics, SABZEVAR MEDICAL
UNIVERSITY, sabzevar, Iran, Islamic Republic Of
Problem Statement:
Background: Entonox is commonly used intermittently. Practically,
synchronization of using Entonox and uterine contractions in this method, is
difficult. So, some laboring women are interested in breathing in face mask
continuously. On the other hand, health staff remind them to put the mask
aside between contractions strictly. In such situation, the intermittent method
can be associated with anxiety and fatigue for both mothers and midwives. So
we decided to compare the maternal complications induced by two methods to
find out whether it is safe to permit the mothers using Entonox continuously or
not?
Methods: This randomized clinical trial was performed in Mobini Hospital,
Sabzevar, Iran. 50 parturients used Entonox intermittently and 50 persons used
it continuously during labor. Then maternal obstetrical
outcomes were
compared in two groups. Statistical Analysis was performed by spss17 software,
t-test and chi square test.
Results: This study showed maternal collaboration during delivery was more in
continuous group significantly (p=0.03). Perineal lacerations was less in the
continuous group significantly (p=0.04). Assisted vaginal birth was not different
significantly (0.4). Uterine atony had no significant difference in two groups
(p=0.2). Satisfaction rate was higher in continuous group significantly (0.000).
Conclusion: Our study showed that parturiens in continuous group had less
obstetric complications than the intermittent group. Also, they were more
satisfied by this method significantly. It seems by further researches, we can
suggest continuous method of Entonox to laboring women.

Disclosure of Interest: None Declared

O15
POSTPARTUM UNFORESEEN CONVULSION: A RARE CASE OF POSTERIOR
REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES)
J. Agah
Department of obstetrics & gynecology, Faculty of medicine, Sabzevar university
of medical sciences, Sabzevar, Iran
Gyn&obstetrics, SABZEVAR MEDICAL UNIVERSITY, sabzevar, Iran, Islamic
Republic Of

27

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

Problem Statement: One of the causes of peripartum convulsion is posterior

reversible encephalopathy syndrome (PRES).The symptoms are including:
headache, nausea and vomiting, confusion, blurred vision, blindness and seizure.
Some situations can predispose the mother to this syndrome including;
hypertensive encephalopathy, preeclampsia and eclampsia, lupus
erythematous, thrombotic thrombocytopenic purpura, renal failure and long
use of immunosuppressive drugs like cyclosporine.Usually it is accompanied by
other events mostly hypertensive disorders. The following case is a pure rare
case of "pres" without any associated factors.
Methods: A postterm primigrvida woman aged 25 years admitted for induction
of labor in Mobini hospital, Sabzevar, Iran. After an uneventful vaginal delivery.
She suddenly involved in a generalized tonic-clonic seizure. Her blood pressure
was normal and the tests rolled out eclampsia and brain CT-scan was normal.but
MRI revealed hyperintensive T2 signals in cortical part of parietooccipital lobes
indicating PRES. The convulsion was controlled and did not appear by
administration of anticonvulsant drug.
Results: She was discharged with Phenytoin and showed healthy status in several
months follow up.
Image / Graph:

Conclusion: PRES is a dreadful but reversible phenomenon, if the approach in

acute phase is prompt and proper, the patient will recover completely.

Disclosure of Interest: None Declared

O16
SCREENING FOR GESTATIONAL DIABETES: DOES A FALSE POSITIVE GLUCOSE
CHALLENGE TEST PREDICT ADVERSE PREGNANCY OUTCOME?
R. H. Al-Haddabi 1,* and Rahma Al-Hadabbi, Heather Scott, Colleen OConnell,
Krista Jangaard, B. Anthony Armson.
1Obstetrics and gynecology, Sultan Qaboos University Hospital, MUSCAT, Oman
Problem Statement: To determine if women with a positive glucose challenge
test (GCT) and negative oral glucose tolerance test (OGTT) are at greater risk for
pregnancy complications than women with a negative GCT.
Methods: : A retrospective cohort of all pregnant women who underwent a GCT
from 1998 to 2005 at the IWK Health Centre was divided into four groups: 1)
negative GCT (control); 2) positive GCT, negative OGTT (false positive GCT); 3)
impaired glucose tolerance (IGT); 4) gestational diabetes (GDM). The primary
outcome was neonatal macrosomia. Demographic and pregnancy outcome
information was obtained from the Nova Scotia Atlee Perinatal Database. SPSS
statistical software was used for univariate and regression analysis.
Results: Among the cohort of 23,801 parturients, 89.2% were GCT negative, 6.3%
had a false positive GCT, 2% had IGT and 2.5% had GDM. Women with a false
positive GCT were more likely to be older, nulliparous, obese and have a past
history of GDM than controls. The risk of neonatal macrosomia > 4500g, was
increased in women with a false positive GCT compared to controls (OR1.43 95%
CI 1.08 1.88) as was the risk of other adverse outcomes associated with GDM.
Only neonatal hypoglycemia, hyperbilirubinemia and preterm birth remained
significant after controlling for other risk factors for adverse perinatal outcome
including maternal obesity.
Conclusion: Women with a false positive GCT are at risk for adverse pregnancy
outcomes commonly associated with GDM. The magnitude of this risk is
mitigated by other risk factors, particularly maternal obesity.
Disclosure of Interest: None Declared

28

O17
EARLY VERSUS LATE INTRAUTERINE FETAL DEATH: A COMPARAISON OF THE
ETIOLOGY FROM SINGLE HEALTH CENTRE
H. Al-Mandeel,*, S. Al-Mutairy, A. Alhazzaa, M. Bukhari, A. Al-Badr
Obstetrics & Gynecology, King Saud University, Riyadh, Saudi Arabia
Problem Statement: intrauterine fetal death is one of the major obstetrics
complications that remain a significant and understudied.
Objectives: to compare etiologies in early versus late Intrauterine fetal death
(IUFD).
Methods: A retrospective cohort study of all cases of intrauterine fetal death
presented to a university hospital from 2006 to 2013. Study population was
based according to WHO as a baby born with no signs of life at or after 20 weeks
of gestation. Cases were classified in to two groups early IUFD (20weeks33weeks) and late IUFD (34 weeks and above).
Results: Total number of births during the study period was 26539 births
including 304 cases (1.14%) of IUFD. 24 cases were excluded from analysis, due
to missing records or being incorrectly coded, leaving 280 cases (92.1%) for
analysis. The cases included130 cases (46.4%) in group 1 (from 20 weeks to33
weeks) and 150 cases (53.6%) in group 2(34 weeks and more). 46.4% of group 1
and 68% of group 2 were not having regular antenatal care. There were no
significant difference in the etiology of IUFD such as obstetrics complications,
maternal medical diseases, fetal congenital anomalies, umbilical cord
abnormalities, and maternal/fetal infections between the 2 groups except for
IUGR and GDM which were significantly higher in late IUFD group (41% vs.18.4%
and 20.7% vs. 7.7%, respectively). Placental abnormalities were also higher in
both IUFD groups though; there was no significant difference between two
groups.
Conclusion: Intrauterine feral death is not a rare incidence. Intrauterine growth
restriction and GDM are associated with late IUFD in comparison to early IUFD.
Disclosure of Interest: None Declared

O18
RISK FACTORS FOR MATERNAL AND NEONATAL MORBIDITIES ASSOCIATED
WITH OPERATIVE VAGINAL DELIVERIES
M. R. C. Arcilla*, B. Zamora
OB GYN, St. Luke's Medical Center, Quezon City, Philippines
Problem Statement: Risk Factors for Maternal and Neonatal Morbidities
Associated with Operative Vaginal Deliveries.
Objective: To determine the risk factors for maternal and neonatal complications
associated with operative vaginal deliveries.
Methods: A retrospective chart review of 435 patients who underwent operative
vaginal deliveries was done. Patient profiles age, parity, AOG, duration of labor
and outcomes birthweight, maternal and neonatal complications - were
tabulated and multivariable analysis and logistic regression were performed
using SPSS Statistics Base.
Results: Results and Conclusion: There was no significant difference in the
incidence of maternal and neonatal complications between those that
underwent vacuum and forceps extraction. Among the variables analysed, parity
and duration of labor reached statistical significance. The odds of maternal
complications were 3 times higher among nulliparous patients. Neonatal
complications were seen in those whose labor lasted more than 9 hours.
Conclusion: This study concludes that in a tertiary-hospital setting, instrumental
vaginal delivery is a relatively safe alternative for effecting vaginal delivery. The
choice of instrument, whether silicone rubber cups or forceps, does not impact
the possibility of morbidities. However, if vaginal delivery in a nullipara is
predicted to be difficult and complex, after more than 9 hours of labor, then
maternal and neonatal complications must be anticipated and outweighed.
Operative vaginal delivery should only be performed if there is an appropriate
indication. No indication is absolute because the option of cesarean delivery is
always available.

Disclosure of Interest: None Declared

Abstract Book

019
INTRAVENOUS TRANEXAMIC ACID- CAN IT REDUCES BLOOD LOSS IN
CAESAREAN SECTION CASES?
S. S. M. Aris 1 2 3,*, A. azizi 3, S. Khalid 1, N. naim 2 2
1O&G, Universiti Sains Islam Malaysia (USIM), NILAI, 2O&G, PPUKM, Cheras,
3O&G, SGH, Kuching, Malaysia
Problem Statement: To study the effectiveness of tranexamic acid in reducing
blood loss during and after caesarean section in Sarawak General Hospital.
Methods: A prospective, randomised, case-controlled clinical trial was
conducted on 174 patients who underwent caesarean section. The study group,
93 patients received intravenous Tranexamic Acid 1Gm immediately before
caesarean section whereas the control group, 81 patients did not receive any.
Blood losses were measured in two periods; the intra-operative loss (from
placental delivery to the end of caesarean section) and the post-operative loss
(from the end of caesarean section to 6 hours post-partum). Full blood count
was tested 24 hours after caesarean section. It was then compared between the
two groups. Any adverse effects and complications during the study also
evaluated.
Results: Tranexamic acid significantly reduced the blood loss during and after
caesarean section. Median blood loss was significantly less in the study group
compared with control group in intra-operative loss 302.38 ml (202.85-501.19)
vs 402.85ml (302.38-503.09) ) and post-operative loss 150.00 ml (90.00-180.00)
vs 180.00ml (150.00-270.00) ) with p=0.001 respectively. Median haemoglobin
level 24 hours post-operation was significantly greater in study group compared
to control group 11.10g/dL (10.15-12.05) vs 11.00g/dL (9.60-11.90) with p=0.02.
No complications or adverse effects of tranexamic acid were reported in both
groups.
Conclusion: Intravenous Tranexamic acid significantly reduced intra-operative
and post-operative blood loss during Caesarean Scetion. It can be use safely and
effectively in women undergoing caesarean section.
Disclosure of Interest: None Declared

020
PRENATAL DIAGNOSIS OF FETAL ANEUPLOIDIES USING QF-PCR: THE EGYPTIAN
STUDY
S. H. Atef 1
1Clinical Pathology, AIN SHAMS UNIVERSITY, FACULTY OF MEDICINE, Cairo, Egypt
Problem Statement: The most common chromosomal abnormalities identified
at birth are aneuploidies of chromosome 21, 18, 13, X and Y. Prenatal diagnosis
of fetal aneuploidies is routinely done by traditional cytogenetic culture, a major
drawback of this technique is the long period of time required to reach a
diagnosis. In this study we evaluated the QF-PCR as a rapid technique for
prenatal diagnosis of common aneuploidies
Methods: This work was carried out on Sixty amniotic fluid samples taken from
patients with one or more of the following indications: Advanced maternal age
(3 case), abnormal biochemical markers (6 cases), abnormal ultrasound (12
cases) or previous history of abnormal child (39 cases).Each sample was tested
by QF-PCR and traditional cytogenetic. Aneuploidy screenings were performed
amplifying four STRs on chromosomes 21, 18, 13, two pseudoautosomal, one X
linked, as well as the AMXY and SRY; markers were distributed in two multiplex
QFPCR assays (S1 and S2) in order to reduce the risk of sample mishandling
Results: All the QF-PCR results were successful, while there was two culture
failures, only one of them was repeated. No discrepancy was seen between the
results of both techniques. Fifty six samples showed normal patterns, three
sample showed trisomy 21, successfully detected by both techniques and one
sample showed normal pattern by QF-PCR but could not be compared to the
cytogenetics due to culture failure, the pregnancy outcome of this case was a
normal baby
Conclusion: Our study concluded that QF-PCR is a reliable technique for prenatal
diagnosis of the common chromosomal aneuploidies. It has the advantages over
the cytogenetic culture of being faster with the results appearing within 24-48
hours, simpler, doesn't need a highly qualified staff, less prone to failure and
more cost effective.

Disclosure of Interest: None Declared

O21
PREGNANCY OUTCOMES IN SYSTEMIC LUPUS ERYTHEMATOSUS WITH
PREVIOUS NEPHRITIS: STUDY OF 28 PREGNANCIES FROM A PORTUGUESE
UNIVERSITY HOSPITAL
A. Braga 1,*, C. Vasconcelos 2, J. Braga 1
1Obstetrics and Gynecology, 2Unidade de Imunologia Clnica, Centro Hospitalar
do Porto, Porto, Portugal
Problem Statement: Systemic lupus erythematosus (SLE) affects women in
childbearing age, so its association with pregnancy is not a rare event. These
pregnancies are associated with an increased risk of preeclampsia, fetal growth
restriction, and preterm delivery, and fetal demise, neonatal and maternal
death. Nephritis is known to be one of the most serious complications of SLE,
and traditionally an important predictor of poor obstetric outcome. Our
objective is to analyze the maternal and embryo-fetal outcomes in a group of
Portuguese pregnant women with previous lupus nephritis.
Methods: Retrospective study of all pregnant women with previous or present
histologically proven lupus nephritis followed in a Portuguese University
Hospital between 1999 and 2013.
Results: 28 pregnancies in 24 patients were included in our study. 71,4% were
nulliparous, the average age at delivery was 29,1 years and the mean time
between lupus nephritis and the first pregnancy was 6,4 years. Diffuse
proliferative nephritis was the most frequent histological type. 3 patients had
antiphospholipid antibodies but only one had criteria for antiphospholipid
syndrome before the first pregnancy. At time of conception 88% of patients
were under treatment with immunosuppressive medication, 78,5% were
treated with corticosteroids, 46,4% with hydroxychloroquine and 23% of
patients were treated with anti-hypertensive drugs. 78,6% of pregnant women
were also medicated with acetylsalicylic acid and 7,1% with low molecular
weight heparin. During pregnancy, 23% of patients experienced an exacerbation
of renal function, and 25% an increment on proteinuria. Lupus flare was
diagnosed in 23% of patients during pregnancy and postpartum. Obstetric
complications were found in 46,4% of these patients. The most frequent was
gestational hypertension (28%), followed by preeclampsia (20%), fetal growth
restriction (12%) and preterm delivery (12%). We also report 2 miscarriages, 2
cases of HELLP syndrome and 1 case of medical pregnancy termination during
the 20th week of gestation in a case of aggressive renal flare resistant to medical
treatment. In our study we found a positive association between the renal
function deterioration and the development of obstetrics adverse outcomes,
especially development of pre-eclamspia. There were a cesarean rate of 52% in
this group of patients. There were 1 neonatal death to report, secondary to
extreme permaturity. There were no cases of maternal deaths or congenital
malformations to report.
Conclusion: Pregnant SLE patients are a group of high risk pregnancies. Previous
or actual lupus nephritis is traditionally associated with poor obstetrics
outcomes. In our study we confirm that a deterioration of renal function during
pregnancy is an important risk factor for the development of obstetric adverse
outcome, especially preeclampsia. We also find a high rate of HELLP syndrome
and cesarean delivery in this group of patients.
Disclosure of Interest: None Declared

O22
OBSTETRICS AND GYNAECOLOGY EMERGENCY TRIAGE THE EXPERIENCE
USING MANCHESTER TRIAGE SYSTEM
D. Bruno 1 2 3,*, D. Ermida 1, P. Freitas 3, F. Matos 2
1Centro de Investigao e Criatividade em Informtica, 2Obstetrics Department,
HOSPITAL PROF. DR. FERNANDO FONSECA, 3Portuguese Triage Group, Amadora,
Portugal
Problem Statement: Most emergency departments (ED) worldwide use triage
tools to prioritise patients in need of acute evaluation and determine those who
can safely wait. Obstetrics and gynaecology (OB/GYN) ED face similar challenges
leading to the implementation of those triage tools. Nevertheless, the evidence
of any triage tool in OB/GYN ED is sparse, with most well-known systems not
being validated in this setting. The aim of this study was to study the usage of a

29

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

well-established five-category triage scale Manchester Triage System in

OB/GYN ED setting.
Methods: We conducted a retrospective study of all patients admitted to our
OB/GYN ED from January to December 2013. Patient age and pregnancy status,
triage data and priority, delay to specialist evaluation, diagnostic studies,
treatment approaches and discharge outcomes were studied. Statistical analysis
was performed using STATA 12.1.
Results: A total of 14869 patients were triaged, 62.8% of which were pregnant.
Mean patient age was 31.4 10.7. 0.1% were allocated to immediate (red)
priority, 10.3% to very urgent (orange), 61.7% to urgent (yellow), 25.6% to
standard
(green)
and
2.4%
to
non-urgent
(blue).
Time to secondary health provider was 7.2, 31.3, 50.9, 61.4 and 64.3 minutes
respectively. These times were significantly different between immediate, very
urgent, urgent and standard subgroups (p<0.05); that was not the case between
standard
and
non-urgent
patients
(p>0.05).
Any type of therapy was used in 25.0%, 15.0%, 16.2%, 8.0% and 2.0%
respectively. The utilisation rate was significantly lower in the standard and nonurgent
groups
compared
to
higher
priority
groups.
Hospital admission rate was 75.0%, 69.6%, 15.7%, 6.0% and 0.8% respectively.
The rate difference was not significant between immediate and very urgent
priority patients (p>0.05), but it was significant among all other priority changes
(p < 0.0001). Total death cases were 6, with no tendency among priority
subgroups.
Conclusion: The MTS can be effectively used in OB/GYN ED and priority
allocations are related both to resource utilisation and hospitalisation rate,
which are indirect markers of disease severity.
Disclosure of Interest: None Declared

O23
CLINICAL AND SUBCLINICAL HYPOTHYROIDISM DURING PREGNANCY:
PREVALENCE AT THE NATIONAL INSTITUTE OF PERINATOLOGY. SCREENING IS
JUSTIFIED?
E. A. Cruz 1,*, A. Ramirez 2, R. Pelaez 3, R. Zamora 4
1Human Reproduction Biology, 2Endocrinology, 3Gynecology and Obstetrics,
4Medical Director, National Institute of Perinatology, Mexico, Mexico
Problem Statement: The prevalence of overt and subclinical hypothyroidism
during pregnancy is 0.3% to 0.5% and 3 to 5% accordingly. No prevalence studies
in Mexico of thyroid disease during pregnancy exist. Evidence on thyroid disease
screening during pregnancy is controversial. Several studies show the
association of thyroid hormone deficiency with adverse effects during
pregnancy, childbirth and postpartum. Clarification of this controversy could
lead changes in regards to antenatal care.
Methods: This was a transverse study conducted at the National Institute of
Perinatology in Mexico City from October 2012 to March 2013. Pregnant
patients attending their first time consultation at the National Institute of
Perinatology were invited to participate. Inclusion criteria were: singleton
pregnancy without preexisting thyroid disease or autoimmune diseases. Patients
of all gestational ages could be included. Informed consent was obtained for all
participants. A questionnaire was applied to participants in order to classify
them as high or low risk for thyroid disease according to American Thyroid
Association recommendations. Determination of serum thyrotropin (TSH),
triiodothyronine (T3) and free thyroxin (FT4) was performed to all patients.
Treatment was initiated with levothyroxine to achieve normal levels of
thyrotropin (TSH).
Results: 123 patients were included. Subsequent follow-up of 14 of them (11.4%)
no thyroid function tests were performed. Monitoring was performed in 109
patients. Fifty-eight patients (53.2%) were euthyroid. Thyroid disease during
pregnancy was 33.9% (n=37); with 12.8% (n=14) having overt hypothyroidism
and 21.1% (n=23) subclinical hypothyroidism. Isolated hyptohyroxinemia was
present in 12.8% (n=14). In regards to gestational age: 5.5% (n=6) of patients
were enrolled in the first trimester of pregnancy, 60.6% (n=66) second trimester
and 33.9% (n=37) in the third trimester. The biochemical diagnosis of thyroid
disease according to each trimester was as follows: 6 patients in the first
trimester (83.3%, n=5) were euthyroid, 6.6% (n=1) had subclinical
hypothyroidism. During the second trimester: 51.5% (n=34) were euthyroid,

30

13.6% (n=9) had overt hypothyroidism, 19.6% (n=13) were diagnosed with
subclinical hypothyroidism, and 15.1% (n=10) with isolated hypothyroxinemia.
In the third trimester of pregnancy 51.3% (n=19) were euthyroid, 13.5% (n=5)
with overt hypothyroidism, 24.3% (n=9) diagnosed with subclinical
hypothyroidism, and the remaining 10.8% (n=4) with isolated hypothyroxinemia.
Therefore it can be concluded that only 12.8% (n=14) of patients had no
screening indication, of where 57.1% (n=8) had some alteration in thyroid
profile. On the other hand, 87.1% (n=95) of the patients had a risk, history or
symptoms of thyroid disease. Modifications in thyroid function were present in
45.2% (n=43), while the remaining 54.7% (n = 52) had a normal result.
Conclusion: The prevalence of both overt and subclinical thyroid disease was
higher in our population than reported in literature. The presence of thyroid
disease symptoms or risk factors has no relation in regards to development of
clinical or subclinical thyroid disease during pregnancy. Detection of thyroid
disease during pregnancy would increase 100% if universal screening were
performed. This is in order to prevent adverse perinatal outcomes and prompt
treatment.
Disclosure of Interest: None Declared

O24
EFFECT OF DELAYED CORD CLAMPING ON HEMOGLOBIN LEVEL AMONG
NEWBORNS IN RAJIV GANDHI GOVERNMENT WOMEN & CHILDREN HOSPITAL,
PUDUCHERRY
M. B. Dash
Nursing, Mother Theresa Post Graduate and Research Institute of Health
Sciences, Puducherry, India, Puducherry, India
Problem Statement: EFFECT OF DELAYED CORD CLAMPING ON HEMOGLOBIN
LEVEL AMONG NEWBORNS IN RAJIV GANDHI GOVERNMENT WOMEN &
CHILDREN HOSPITAL, PUDUCHERRY
Objectives of the Study
1. To estimate the cord blood hemoglobin among the Group I newborns, where
the cord was clamped within 15 seconds of birth.
2. To estimate the cord blood hemoglobin among the Group II newborns, where
the cord was clamped at 3 minutes after birth or immediately after cessation of
cord pulsation.
3. To estimate the hemoglobin level at 24 hours after birth in both Group I (cord
clamped within 15 seconds) and Group II newborns (cord was clamped at 3
minutes after birth or immediately after cessation of cord pulsation).
4. To compare the level of Hemoglobin among the study groups (I, II)
5. To correlate the cord clamping time with Hemoglobin level of the term
newborns.
6. To associate the Hemoglobin level of term newborns of study groups (I, II)
with their selected demographic variables.
Methods: Quantitative research approach and true Experimental Design with
two groups was adopted for this study. The total sample size was 61 term
infants- 30 in group I (cord clamped within 15 seconds of birth) and 31 in group
II (cord clamped at 3 minutes of birth or immediately after cessation of
pulsation). The inclusion criteria were, term newborns born, babies having
APGAR 8/10 or above at birth, Mothers having Hemoglobin greater than or equal
to (>) 10 gm/dl at the time of delivery. The sampling technique was Simple
random sampling. The tool had two sections: Section A had 2 parts for collecting
demographic variables of mother and baby. Section B had checklist for mean
hemoglobin and timing of cord clamping Hemoglobin level at birth and 24 hours
was estimated by using standardized sahlis hemoglobin meter.
Results: The distribution of demographic variables of the mothers shows that
majority of the mothers 25 (83.33%) and 26 (83.87%) were in the age group of
18-25 years, 23 (76.66%) and 21 (67.74%) were completed secondary/higher
secondary level of education, 21 (70%) and 20 (64.52%) gave birth for the first
time, 12 (40%)and 13 (41.94%) mothers had more than 12gms% Hb from Group
I and Group II respectively. With regard to demographic distribution of the
newborn highlights that 15 (50%) and 19 (61.29%) subjects were males and
about 15 (50%) and 12 (38.71%) of samples were females, 12 (40%) and 17
(54.84%) samples had birth weight of 2.5-3 kg, in Group I and Group II
respectively (Table 2).

Abstract Book

Conclusion: Clamping and cutting of the umbilical cord at birth is the oldest and
most prevalent intervention in humans. In spite of that, the optimal timing of
cord clamping has been a controversial issue for decades (Eileen K. Hutton &
Eman S. Hassan, 2007). It is a safe, simple and low cost delivery procedure that
should be incorporated in integrated programs that are aimed at reducing iron
deficiency anemia in infants in developing countries. Vaginal delivery facilitates
this action.
Disclosure of Interest: None Declared

O25
CIRCULATING LEVELS OF OBESTATIN AND COPEPTIN IN OBESE AND NONOBESE WOMEN WITH POLYCYSTIC OVARY SYNDROME.
M. Islimye Taskin 1,*, E. Bulbul 2, A. Hismiogullar 3, E. Adali 1, U. Inceboz 1
1
Obstetrics and Gynecology, 2Radiolgy, 3Biochemistry, Balkesir University School
of Medicine, Balikesir, Turkey
Problem Statement: Polycystic ovary syndrome (PCOS) is one of the most
common endocrinopathy which affects 5-8% of reproductive-age women.
Although PCOS is actually considered as reproductive disease because of chronic
oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism and
related fertility problems, it is also associated with insulin resistance, central
obesity, type 2 diabetes mellitus, dyslipidemia, and cardiovascular diseases. The
current study was undertaken to evaluate plasma copeptin, obestatin levels,
carotid arter intima-media thickness and brachial arter flow mediated dilatation
in obese and non-obese women with PCOS and age matched healty controls and
to investigate their relationship with each other and with clinical, metabolic, and
hormonal parameters and cardiovascular risk factors.
Methods: This was a cross sectional controlled study setting in a university
hospital. In the study population, we analyzed 60 patients with PCOS and 30 agematched healthy women as controls. The patients with PCOS were divided into
two groups based on body mass index (BMI): an obese (BMI>30 kg/m2, n=30) or
non-obese group (BMI<30 kg/m2, n=30). History and physical examination,
peripheral venous blood sampling, carotid and brachial artery ultrasonography
were performed. Serum copeptin, obestatin levels, follicle-stimulating hormone
(FSH), luteinizing hormone (LH), estradiol (E2), total testesterone, C-reactive
protein (CRP), glucose, total cholesterol, low-density lipoprotein (LDL)
cholesterol, high-density
lipoprotein (LDL) cholesterol, triglycerides,
homeostasis model assessment for insulin resistance (HOMA-IR, ), carotid arter
intima-media thickness (CIMT), brachial artery flow-mediated vasodilation
(FMD) were determined and compared among groups.
Results: Our results have shown that women with PCOS especially obese PCOS
have higher triglyserides, HOMA-IR, total testesterone, CRP, sistolic and diastolic
blood pressure, WHR, and lower HDL. Serum obestatin levels were significantly
lower in the obese PCOS group than those in the non-obese and control groups
(p<0,001). Serum copeptin levels were significantly higher in obese PCOS group
than non-obese PCOS and control group (p<0,001). CIMT were similar among
groups (p>0,05). Brachial artery FMD has been found lower in PCOS groups than
the control group (p<0,001). Obestatin and FMD values have been negatively
correlated with cardiovascular risk factors; whereas copeptin has been positively
correlated. A significant positive correlation was found between copeptin, BMI,
WHR, hirsutism score, total testesterone and HOMA-IR. There was no
correlation between CIMT, copeptin, obestatin and FMD. Positive correlation
was shown between CIMT, BMI, triglycerides and HOMA-IR.
Conclusion: Copeptin and obestatin may provide useful information for future
cardiovascular risk in PCOS patient as copeptin was found positively correlated
with cardiovascular risk factors; whereas obestatin was found negatively
correlated with cardiovascular risk factors.
Disclosure of Interest: None Declared

O26
UTERINE NECROSIS FOLLOWING UTERINE FIBROID EMBOLIZATION: A CASE
SERIES
A. D. Knoll 1,*, S. Pham 1, N. Astill 2, N. J. Resnick 3, M. Elmadijan 4, J. Arampulikan

1Radiology, Columbia University/Harlem Hospital Center, 2Obstetrics and

gynecology, Cornell University/Lincoln Medical Center, 3Columbia

University/Harlem Hospital Center, 4Cornell University/Lincoln Medical Center,

New York, United States, 5Radiology, Cornell University/Lincoln Medical Center,
New York, United States
Problem Statement: Uterine fibroid embolization (UFE) is a common primary
treatment for symptomatic uterine fibroids, and can often replace the need for
hysterectomy. Uterine necrosis is a rare complication following UFE. We present
a case series of two patients who underwent UFE and developed subsequent
uterine necrosis.
Methods: We retrospectively reviewed patients in our institution who
underwent UFE. We identified patients who developed uterine necrosis and
reviewed the medical history, imaging, and operative reports.
Results: Our center performed 67 UFE procedures during the study period from
July 2013July 2014. The overall clinical success rate of the procedure was 97%
(65/67). The most frequently reported indication for the procedure was
moderate to severe pelvic pain, which was reported in 80% of patients (54/67).
Forty eight percent of patients reported menorrhagia (32/67).
We observed post embolization syndrome (PES) as the most common adverse
outcome following the procedure, which occurred in 12% of patients (8/67),
which was treated and resolved with supportive care. Additional postprocedural complaints which occurred in nearly all patients included mild vaginal
bleeding, mild pelvic pain, and nausea, all of which resolved with supportive care
alone. Two patients (2/67) experienced uterine necrosis following the
procedure. Both of these patients reported a history of severe pelvic pain and
menorrhagia. Patient A had extensive medical co-morbidities including HIV,
hypertension, dyslipidemia, trichomoniasis, and morbid obesity. Patient B had a
surgical history notable for failed myomectomy due to abdominal adhesions
from prior abdominal surgery. Pre-procedural imaging assessment noted the
uterus to be markedly enlarged for both patients. Following the procedure, both
patients continued to complain of severe pain and vaginal bleeding. Eventually,
both patients were subsequently found to have radiographic evidence of uterine
necrosis. Patient A had a hysterectomy 72 days post UFE. Patient B had a
hysterectomy 22 days post UFE.
Conclusion: UFE can achieve high success rates and is a primary treatment for
symptomatic uterine fibroids. Serious and rare complications such as uterine
necrosis and pyomyoma were observed in a minor percentage of our patients.
We surmise the immunocompromised state of patient A and the recent surgical
interrogation of patient B may have predisposed them to the negative
outcomes. With the rising ubiquity of UFE for symptomatic fibroid treatment,
interventional radiologists should be mindful of the rare, but serious risks which
can be associated with UFE in select patient populations. Knowledge of specific
imaging findings associated with post-procedural complications is crucial for
proper assessment and management. Finally, a detailed medical and surgical
history may aid in risk stratification for post-procedural complications.
Disclosure of Interest: None Declared

O27
FERTILITY-SPEARING TREATMENT OF WOMEN WITH CERVICAL PREGNANCY
A. Kozachenko *, L. Adamyan
Operative gynecology, Russian Scientific center for obstetrics, gynecology and
perinatology named after V.I. Kulakov, Moscow, Russian Federation
Problem Statement: To evaluated the effectiveness of modern approaches and
technologies for preserving fertility in young nulliparous patients with cervical
pregnancy
Methods: 31 women with cervical pregnancies (ages 25-43 years) were treated
in Operative Gynecology department during 8 recent years. 20 of them
underwent combined therapy with preoperative methotrexate chemotherapy
and minimal invasive surgery (ligation of cervical branches of uterine arteries
and resectoscopic removing of cervical pregnancies) for preserving fertility.
Results:
Clinical
protocol
included
transvaginal
ultrasound
investigation with transducer for color Doppler mapping, magnetic resonance
imaging to visualize gestational sac, definition of the boundaries between the
chorion and stroma of the cervix; definition of the blood flow intensity in the
chorion, the definition of -subunit of human chorionic gonadotropin (-hCG) in
serum in dynamics, general clinical research: clinical parameters, biochemical

31

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

blood tests and hemostasis in the dynamics, diagnostic hysteroscopy and

followed resectoscopy with material removed. The term of pregnancy on
admission ranged from 5 to 9 weeks of gestation and the average term was 6,1
0,9 weeks. Patients with cervical pregnancy received methotrexate at an
average of 50 mg/every 48 hours, leucovorin administered at a dose of 6 mg
after 28 hours after methotrexate injection. The total dose of administered
methotrexate ranged from 200 to 300 mg and depended on the patient's body
weight, week of gestation and intensity of chorion blood flow. Surgical
procedure started at decreased level of -hCG about 4000-7000 IU/l.
Conclusion: The results of this study suggest that resectoscopic removing of
embryo with previous cytostatic therapy with methotrexate in combination with
leucovorin allows to save fertility in young women with early cervical pregnancy.
Disclosure of Interest: None Declared

028
THE SAFETY AND DIAGNOSTIC VALUE OF HYSTEROSCOPY BEFORE ART
I. F. Kozachenko 1,*, L. Adamyan 1
1operative gynecology, RUSSIAN SCIENTIFIC CENTER FOR OBSTETRICS,
GYNECOLOGY AND PERINATOLOGY, Moscow, Russian Federation
Problem Statement: Hysteroscopy is the gold standard test for assessing
the uterine cavity. Hysteroscopy not only provides accurate visual assessment of
the uterine cavity, but also provides a chanceto treat any pathology detected
during the examination. Currently, there is evidence that performing
hysteroscopy before starting IVF treatment could increase the chance of
pregnancy in the subsequent IVF cycle in women who had one or more failed IVF
cycles. However, recommendations regarding the efficacy of routine use of
hysteroscopy prior to starting the first IVF treatment cycle are lacking.
Methods: The safety and diagnostic value of hysteroscopy before ART was
examined in 600 patients seeking treatment for subfertility. The following
parameters were analyzed: the presence of minor and major pathology of the
endometrium, type of anesthesia, technique of operative work, instruments and
energy used during hysteroscopy and complications.
Results: Seventy-eight percent of all procedures were done under intravenous
anesthesia. Diagnostic hysteroscopy was performed successfully in all
women. The most common operative procedure was polypectomy and the most
complicated one was myomectomy. The combination of mechanical instrument
and bipolar energy were used in most of the cases, while the percentage of
complications was extremely low. Diagnysteroscopy was performed successfully
in all women. 53.7% had a history of ART failures. In 36% findings at hysteroscopy
were normal, whereas in 64%, hysteroscopy revealed intrauterine lesions
(polyps, septa, submucosal leiomyomas, or synechiae) that led to operative
hysteroscopy. The total percentage of abnormal intrauterine findings was higher
in women with a history of repeated ART failures in comparison with those with
no history of ART attempts.
Conclusion: Hysteroscopy is a safe, highly sensitive, precise diagnostic and
operative endoscopic procedure. Diagnostic hysteroscopy should be performed
after all ART failure and maybe before ART in all patients, because a significant
percentage of them have undiagnosed uterine disease that may impair the
success of fertility treatment.
Disclosure of Interest: None Declared

O29
THE VIVEVE PROCEDURE IS A NONSURGICAL TREATMENT WITH
RADIOFREQUENCY THERMAL THERAPY FOR VAGINAL INTROITAL LAXITY AFTER
CHILDBIRTH THAT HAS DEMONSTRATED SUSTAINED 12-MONTH
EFFECTIVENESS AND IMPROVED SEXUAL FUNCTION.
M. L. Krychman
Southern California Center for Sexual Health, Newport Beach, United States
Problem Statement: Childbirth may result in trauma to the pelvic floor and
vagina with laxity of the introitus that may alter genital sensation and reduce
sexual satisfaction. There are either behavioral exercises or surgical
interventions to correct this problem- no intermediate non-invasive non-surgical
procedures exist to correct this problem

32

Methods: Prospective, single-arm study to treat 30 Japanese women with an

office procedure using RF energy (90 joules/cm2) applied to the vaginal introitus
occurred. Main outcome measures included: The linguistic validated Japanese
versions of the Female Sexual Function Index (FSFI) and Female Sexual Distress
Scale-Revised (FSDS-R) and the vaginal laxity and sexual satisfaction
questionnaires.
Results: Sexual function improved significantly: the mean total FSFI score
improved from a baseline mean of 22.4 6.7 to a mean of 26 5.8 (P=0.005) at
6 months post treatment. In 22 of 30 subjects, at 12 months, the mean was 26.0
5.2 (P=0.055). The orgasm and satisfaction domains of the FSFI also showed
significant improvements from baseline means of 3.4 1.5 and 3.6 1.5 to 4.2
1.3 and 4.2 1.3, respectively at 12 months (P=0.006 and 0.047). Distress
related to sexual activity reported on the FSDS-R significantly decreased: from a
mean score of 15.8 11.7 at baseline to a mean of 10.3 8.7 (P<0.001 0.003)
at one month and was sustained through 12 months. Subjects perceived
increased feelings of decreased laxity was maintained at this level out to 12
months. No significant treatment-related adverse events were reported.
Conclusion: A single, low-dose RF treatment as a non-surgical office-based
medical procedure for vaginal introital laxity achieved significant and sustained
12-month improvements in reported tightness of the vaginal introitus and
improved sexual satisfaction. Treatment was well-tolerated with no adverse
events. This procedure had a positive impact on the condition of vaginal laxity
and on sexual health and function in this cohort of Japanese women. Research
supported by Viveve, Inc., Sunnyvale, CA.
Disclosure of Interest: M. Krychman Consultant for: Bayer, Shionogi Inc, Pfizer, Palatin,
Noven Therapeutics, Viveve, Sprout Pharmaceuticals, Speaker Bureau for: Pfizer, Noven,
Shinogi

030
NEW LAPAROSCOPIC PERITONEAL PULL-THROUGH VAGINOPLASTY
TECHNIQUE
P. Mhatre 1,*, J. Mhatre 2
1Obstetrics and Gynecology, Seth G.S. Medical college, Mumbai India, 2Obstetrics
and Gynecology, Kedar Hospital, Mumbai, India
Problem Statement: Many reconstructive surgical procedures have been
described for vaginal agenesis. Almost all of them are surgically challenging,
multi-staged, time consuming or leave permanent scars on abdomen or skin
retrieval sites. New simple technique using laparoscopic peritoneal pull-through
in creation of neo vagina in 39 patients has been described.This technique has
given excellent results over a period of 1 to 8 years of follow-up. The peritoneal
lining changes to stratified squamous epithelium resembling normal vagina and
having acidic Ph.
Methods: 39 patients with congenital absence of vagina (MRKH syndrome) were
treated with laparoscopic peritoneal pull through technique of Dr.
Mhatrebetween 2003 till 2013. Dr. Mhatre has described 3 different
techniques of peritoneal vaginoplasty thin peritoneal graft, thick peritoneal graft
with substratum,Combined use of peritoneum with amnion grafts.(patients with
pelvic kidney peritoneum retrieval is difficult) The technique describes
laparoscopic application to modify original Davydov procedure. 1) Neovaginal
space was created by surgical dissection. 2) The anterior and posterior flaps were
created laparoscopically. Usuallythin flaps of peritoneum are created. In 6 cases
thick peritoneal flaps were obtained. 3) Top of the neo-vaginal space is
divided.Peritoneal flaps are drawn through this opening and are attached to
introitusNeo-vaginal top is closed. 4) Glass dilators are used to maintain the
desired length till sexual activity is resumed.
Results: 1) The patients were between 16 to 27 years of age. 2) Marital Status 9
out of 39 were married and 18 patients married post vaginoplasty. 3) PreOperative Laparoscopic findings All had small bilateral rudimentary horns and
normal ovaries.9 patients had associated renal anomalies, 4 having pelvic
kidney, 3 with single kidney,1 with horseshoe kidney and 1 having double ureter.
4) Pre-operative vaginal length varied between 0.5 to1 cm. 5) Operative time
average was 60-90 minutes. 6) Hospitalization average was 3 days except 2
patients required 5 days 7) Complications There were no major complications
except 1 with small rectal damage which was sutured with uneventful recovery
and 1 patient had voiding difficulty requiring 3 days of catheterization. 8) Sexual

Abstract Book

satisfaction Of 39 patients 9 were married and 18 patients married later. All 27

patients reported no difficulty to either partner. Nine patients had vaginal biopsy
after 6 to 12 months of surgery and showed normal stratified vaginal lining All
39 patients had vaginal cytology done after 6 months showing normal pattern.
9) As the ovary became accessible per vaginum 3 patients underwent ovum
retrieval and pregnancy using surrogate mother.
Conclusion: In conclusion the new laparoscopic peritoneal pull-through
vaginoplasty offers a relatively easy surgical procedure with excellent results on
long term follow up. This procedure is practically devoid of morbidity. Peritoneal
lining having the same parentage of mullerian duct undergoes metaplasia and
transforms itself in to stratified squamous epithelium resembling normal vagina.
This transformation has been documented in 9 patients. As the ovary became
accessible per vaginum 3 patients underwent ovum retrieval and pregnancy
using surrogate mother, making this a fertility enhancing procedure.
Disclosure of Interest: None Declared

O31
TROCHANTERIC CORTICAL THICKNESS AND SOFT TISSUE THICKNESS AT THE HIP
IN VARIOUS GROUPS OF WOMENNEW MARKERS FOR POSTMENOPAUSAL
OSTEOPOROTIC HIP FRACTURE
Y. Muscat Baron
Department of Obstetrics and Gyanecology, Mater Dei Hospital, Mosta, Malta
Problem Statement: The assessment of the greater trochanter cortical thickness
and soft tissue thickness on the lateral aspect of the left hip in various groups of
women.
Methods: One hundred and sixty-two women were recruited sequentially to
have the outer cortical thickness of the left lower limbs greater
trochanter measured ultrasonically. Sixty-two women were young menstrual
(under the age of 35 years) while there were 25 women in the older menstrual
group (35+ years). The other groups were perimenopausal women (17) and
treated (30) and untreated postmenopausal women (28). The woman would be
placed on the right flank with both lower limbs extended. The greater trochanter
would then be palpated and a 3.5 MHz ultrasound sector probe Aloka (SD 500)
would be placed at right angles to the point where the trochanter could be felt.
Under the sonolucent subcutaneous tissue, a /\ shaped hyperechoic signal
could be seen representing the greater trochanter and is consistently noted to
be thinnest point of outer cortical bone in this region. The inner and outer
hyperechoic edges at the obtuse angle of the trochanteric/\ could be
consistently delineated allowing the accurate measurement of the cortical
thickness.
Results: The lowest cortical thicknesses were registered for the untreated
menopausal group (0.776 +/-0.2cm) and the perimenopausal group (0.878 +/0.15 cm). The oestrogen replete group were consistently higher young and old
menstrual group (0.943+/- 0.19 cm and 0.928 +/- 0.16 cm) respectively and
0.936 +/-0.18 cm in the hormone treated group. The trochanteric thickness of
menopausal group was significantly lower than all the other groups of women.
The lowest fat pad thicknesses were registered for the untreated menopausal
group (2.04+/-0.69 cm), the perimenopausal group (2.06 +/-0.86 cm) and young
menstrual group (2.09+/-0.64 cm). The oestrogen replete group were
consistently higher old menstrual group and 2.3 +/- 0.76 cm) respectively and
2.33 +/-0.72 cm in the hormone treated group. These differences did not reach
statistical significance except between the hormone treated group and the
untreated postmenopausal group. However significant correlations were noted
between the fat pad thickness and trochanteric cortical thickness all groups of
women.
Conclusion: The low cortical thicknesses of the greater trochanter may represent
a weak point where postmenopausal fracture of the hip may initiate. This area
may be most vulnerable as it experiences significant shearing forces from all
directions. Moreover possibly with less mobility related to the ageing process,
osteoporosis may set in at a faster rate in this region due to the diminished strain
applied through the ligamental insertions. Measurement of this region is easily
performed and reproducible. This may be another marker for women at risk of
the classical postmenopausal osteoporotic fracture of the hip.
Disclosure of Interest: None Declared

O32
MICRO RNA 135A AND 135B ARE PRESENT IN THE ENDOMETRIOSIS LESIONS
AND DOWN REGULATED IN THE SECRETORY PHASE
R. Petracco 1,*, A. C. Dias 2, F. Heldt 3, H. Taylor 4, J. Michelon 5, A. Petracco 5, M.
Badalotti 5, D. Machado 1
1Pos Graduacao em Medicina e Ciencias da Saude, Pontificia Universidade
Catolica do Rio Grande do Sul, 2Quatro G Pesquisa e Desenvolvimento, 3Instituto
de Pesquisa Biomdica, Pontificia Universidade Catolica do Rio Grande do Sul,
Porto Alegre, Brazil, 4Department of Obstetrics, Gynecology and Reproductive
Sciences, Yale University, New Haven, United States, 5Departamento de
Obstetricia e Ginecologia, Pontificia Universidade Catolica do Rio Grande do Sul,
Porto Alegre, Brazil
Problem Statement: Endometriosis is a well know estrogen dependent disease
and its most common symptoms are severe pelvic pain and infertility. It affects
up to 15% of patients on reproductive age and up to 50% of infertile patients. Its
pathogenesis still unclear and there is evidence for a role of genetic components.
The microRNA 135a and 135b (miR 135) silence gene expression and increased
miR 135 down-regulated HOXA 10, a key mediator of endometrial receptivity
and implantation. MiR are aberrantly regulated in the endometrium of women
with endometriosis when compared to the endometrium of disease free
women. Considering that several genes are known to be differentially expressed
in eutopic and ectopic endometrium of women with endometriosis, we analyzed
the expression of miR 135 in the ectopic endometrium, compared with the
expression in the eutopic from the same patients in different phases of the
menstrual cycle.
Methods: Thirty one subjects who underwent surgery from March 2013 through
May 2014 for diagnosis or treatment of endometriosis had endometrium and
endometriosis lesions biopsies taken. Approval was obtained from the PUCRS
and Santa Casa Hospital Investigations Committee. Eight subjects were excluded
due to low levels of mRNA. The samples were divided according to the menstrual
cycle as follows: proliferative, day 1-14 (n=11) and secretory, day 15-28 (n=12).
For miRNA detection, we used the poly (A) RT-PCR method using Invitrogen
NCode miRNA first-strand cDNA synthesis MIRC-50 kit (Invitrogen, California,
USA). Gene transcripts were amplified by real-time PCR using the Bio-Rad iCycler
iQ system (Bio-Rad Laboratories) with the forward specific primers to miR135a
and miR 135b and the universal reverse primer complementary to the anchor
primer. U6 small nuclear RNA was used as a control to determine relative miRNA
expression. Relative mRNA level was presented using the formula 2Ct.
Statistical analysis was performed using unpaired Mann Whitney test for the
ectopic vs.eutopic endometrium samples between different phases of the
menstrual cycle. All the analyses were considered a p< 0.05 as significant.
Results: Tweenty three patients submitted to laparoscopic surgery for diagnosis
or treatment of endometriosis had endometrium biopsy taken and excision of
endometriosis lesions. When the subjects were divided by the menstrual cycle
phase, during the secretory phase the expression of mir135a and 135b was
lower in the ectopic endometrium comparing to the proliferative phase.
Conclusion: Micro RNA is involved in endometrial receptivity, and there is
evidence of a relation between miR 135a and miR 135b with HOXA10, a well
know gene that is down regulated in women with endometriosis and has a
strong influence on embryo implantation. Here we detected a lower expression
of miR 135 during the secretory phase that is likely due to physiological lower
levels of estrogen and higher levels of progesterone during this phase.
Disclosure of Interest: None Declared

O33
SURGICAL OR MEDICAL TREATMENT FOR UNRUPTURED INTERSTITIAL
(CORNUAL) ECTOPIC PREGNANCY? THAT IS THE QUESTION.
(INTRODUCING A NEW SIMPLE, SWIFT AND SAFE LAPAROSCOPIC TECHNIQUE
FOR TREATMENT OF CORNUAL GESTATION).
M. A. Rahimi
Obstetrics and Gynaecology, Wyong Hospital - CCLHD, Gosford, Australia
Problem Statement: Cornual pregnancy is a rare and most dangerous form of
ectopic pregnancy which is usually treated by cornual excision or hysterectomy.
The consequence of cornual location of gestation is usually massive

33

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

intraperitoneal haemorrhage, necessitating blood transfusion. Controversies

exist between the group of gynaecologists who excise the corneum via
laparoscopy or laparotomy and the group of gynaecologists who leave the
corneum intact and use drugs (i.e., Methotrexate) for treatment of cornual EP.
Expectant management of this type of ectopic pregnancy is suitable only for
woman with low and diminishing levels of hCG. Each group claim their way of
managing unruptured EP is preferable over the other method. There are
advantages and disadvantages in each mode of treatment. (This will be the
subject of discussion at the presentation of this paper at the congress). Patients
with cornual EP usually have signs and symptoms of ectopic gestation later in
the first trimester of pregnancy. This is because the location of the gestation
allows more room for the growing EP. Therefore the size and the level of hCG
are higher than other types of EP. In fact there are anecdotal reports of term
interstitial EP. In view of this fact, these patients with high levels of hCG are not
suitable for medical therapy. Currently laparoscopic surgery is the preferred
treatment for EP. But wedge resection and repair of the cornual needs
experienced gynaecologist laparoscopists whom are capable of performing
advanced laparoscopic surgery. This technique was developed in New Zealand
in 1995 on an unexpected cornual EP undergoing emergency laparoscopy. This
case was presented at the 26th annual meeting of the American Association of
Gynaecologic Laparoscopists in Seattle, (September 23-28 1997) and published
in the Journal of the American Association of Gynaecologic Laparoscopists (May
1999, vol. 6, No 2).
Methods: A simple, swift and safe (SSS) laparoscopic technique for the
treatment of interstitial pregnancy is applying 2-3 Vicryl endoloops below the
corneum incorporating the proximal third of the tube, mesosalpinx and portion
of the myometrium adjacent to the cornual EP. This should be done after
cornuostomy and suction evacuation of the product of conception in the
corneum. This technique is easy to perform by any gynaecologists whom have
some experience in laparoscopy.
Conclusion: In the authors opinion the above laparoscopic technique is preferred
to the medical treatment because it ends the EP and anxiety in one session.
Methotrexate may be a reasonable option in selected women with a low betahCG level but is not successful in every interstitial pregnancy.
Disclosure of Interest: None Declared

O34
INTRAVENOUS LEIOMYOMATOSIS: A RARE CONDITION - ABOUT A CASE
A. J. P. Rocha 1,*, A. Castro 2, P. Correia 3, D. Freitas 3, C. Carnide 3, O. Moutinho 3
1Gynecology, CENTRO HOSPITALAR SO JOO, Porto, 2Centro Hospitalar Trs-osMontes Alto Douro, Vila Real, Portugal, 3Gynecology, Centro Hospitalar Trs-osMontes Alto Douro, Vila Real, Portugal
Problem Statement: Intravenous Leiomyomatosis (IVLM) is a rare condition
associated to uterine leiomyomatosis and is a differential diagnosis of Benign
Leiomyomatosis metastization and disseminated peritoneal leiomyomatosis.
IVLM consists on benign proliferation of smooth muscle cells that starts in
uterine or gonadal veins and extends to the venous drainage system of pelvis
and abdomen. This condition could reach the right heart and the pulmonary
arteries and despite non-malignant could be a life-threatening condition.
Methods: A 46-year-old woman, gravida 5, para 5, regular cycles, with abundant
menses, and non-cyclic pelvic pain. She denied any important pathologic event.
The physical/gynaecological examination revealed a 12 weeks uterus, without
any other palpable masses. The transvaginal ultrasound showed a uterus with
augmented dimensions, with external limits deformed by multiple leiomyomas,
the bigger with 33x28x16mm, in intramural/subserous (IM/SS) localization,
heterogeneous myometrium and endometrium with 8mm. Right adnexial area:
complex heterogeneous mass, with cystic bilobulated component, measuring
100x91x52, the major loca measure 67x46mm, and two solid components with
50x17mm and 18x10mm, respectively, without vascularisation. Left adnexial
area was normal. There was no ascites. It was performed tumoral marker, Ca
125 that was normal. It was proposed surgical treatment, with explorer
laparotomy.
Results: Surgery findings: large uterus, with 3 SS fibroids, ovaries and fallopian
tubes were macroscopically normal. It was identified a 100mm para-ovaric mass,
both cystic and solid, extending from infundibulopelvic ligament to the

34

paracervix. This white-gray elastic mass was enucleated and removed. Smaller
pieces were extracted from uterine and ovaric veins. Hysterectomy and bilateral
adnexectomy was made. Pathological analysis confirmed intravenous
leiomyomatosis. The patient had an uneventful post-operative recovery. Further
investigation with MRI was done (exam results are not available yet), and it was
initiated continuous progestative, as adjuvant hormonal treatment. (We have
images to document this case)
Conclusion: We present this case to illustrate how important is to be alert for
such a rare condition, because the anticipation of diagnosis could prevent
surgical and potential fatal complications. The follow up of these women could
prevent thrombotic events by early recurrence diagnosis.
Disclosure of Interest: None Declared

O35
NOVEL SERJURY METHOD NAMED CORNOPLASTY FOR RECONSTRUCTION OF
UTERUS UNICORNUATE UTERUS WITH RUDIMENTARY HORN
A. Saremi *, M. Rasekhi
Gynecology, Sarem Women's Hospital & Sarem Cell Research Center (SCRC),
Tehran, Islamic Republic of Iran
Problem Statement: Unicornuate uterus with rudimentary horn is one of the
uterus abnormalities that formed during the embryogenesis, as the alteration
happened due to developing of one of the Mllerian/Paramesonephric
ducts and the other one is developrd only in a rudimentary fashion. In these
patients, pregnancy may implant into such a horn setting up a dangerous
situation as such pregnancy can lead to a potentially fatal uterine rupture.
Surgical resection of the horn is indicated. In the following case report, we
performed a novel surgery methd for a patient by reserving her
uterine rudimentary horn and reconstruction of her uterus and build a relative
normal uterine.
Methods: In this paper, we report a woman with infertility presentation and a
history of the IUFD, base on her histrosalpingography, she candidate for
laparoscopic surgery and discovered a Unicornuate uterus with rudimentary
horn & unlike the sugessted treatments for resection of the rudimentary horn,
we repaire it and linked it to the main uterus, by this method the uterus be
reconstructed and a relative normal uterine has been performed, with increase
the chance of fertilization and reduction in abnormal pregnancy in uterine
rupture risk. In this laparotomy, connective stalk was removed in wedge shape.
Results: In this case, the patients histrosalpingography became normal after 3
months with one uterus cavity and two open fallopian tubes.
Conclusion: The mentioned surgical method named by the authors as
"Cornoplasty".

Disclosure of Interest: None Declared

O36
C DUBLINIENSIS IN PATIENTS WITH RECURRENT VAGINAL CANDIDIASIS
G. Ventolini 1,* and Cendrowski E, MS III; Graham G, MS IV; Meachum W, BA.
1Regional Chair and Professor, Texas Tech University Health Sciences Center
Permian Basin, Odessa, United States
Problem Statement: The prevalence of vaginal candidiasis (mostly C. albicans)
has dramatically increased in recent years. Also, other pathogenic species that
are resistant to commonly used antifungal agents began to emerge. Among
these is Candida dubliniensis (described in 1995 on HIV positive patients in
Dublin, Ireland). It is dimorphic yeast of the genus Candida, phenotypically
similar but genotypically distinct to C. albicans with a unique phylogenetic
cluster in DNA fingerprinting. These fungi form dark green colonies on
chromogenic Candida agar plates and are identified by the Bichro-Dubli latex
agglutination test and by not surviving cultures above 42 C.
C. dubliniensis has a decreased ability to form hyphae, but the species does form
chlamydospores (in pairs, chains, and clusters). Additionally, an enhanced
adherence to vaginal epithelial cells and an increased production of aspartic
proteinases explains why is associated with vaginal candidiasis. C. dubliniensis
has the ability to rapidly develop resistance to fluconazole (resistance mediated
by a multidrug transporter that is rapidly mobilized in vitro after fluconazole
exposure). Retrospective studies have revealed that C. dubliniensis had been

Abstract Book

commonly misidentified as Candida albicans; therefore, a proper identification

is mandatory in patients with recurrent vaginal candidiasis.
Methods: To report the prevalence of C. dubliniensis in West Texas, USA we
reviewed a database of 60 patients with recurrent vaginal candidiasis (positive
fungal culture and microscopic photograph of wet mount). Each patient had a
wet mount photograph obtained at the time their fungal culture was submitted.
Reviewing and reporting de-identified microscopic photographs was not
considered to require IRB approval by TTUHSC IRB guidelines.
Results: Six microphotographs from 6 different patients were identified and
matched as positive cultured C. dubliniensis. The microphotographs
demonstrated abundance of chlamydospores in pairs, chains, and clusters, and
at the tip of short pseudohyphae.
Image / Graph:

Conclusion: We are reporting a high prevalence (10%) of C. dubliniensis in nonimmunocompromised patients with recurrent vaginal candidiasis in West Texas,
USA. Since other countries in the world are increasingly reporting this resistant
yeast, a proper identification is mandatory in patients with recurrent vaginal
candidiasis.
Disclosure of Interest: None Declared

O37
TREATMENT OF VAGINAL ATROPHY - COMPARISON OF NEW MINIMALLY
INVASIVE ER: YAG LASER TREATMENT AND HORMONAL REPLACEMENT
THERAPY
A. Gaspar 1, Z. Vizintin 2,*
1Gynecology Department Faculty of Medicine, Mendoza University, Mendoza,
Argentina, 2FOTONA, Ljubljana, Slovenia
Problem Statement: The objective of this study was to compare the efficacy and
safety of two minimally invasive procedures for treatment of vaginal atrophy; a
new Er: YAG laser procedure and hormonal replacement therapy with estriol.
Methods: 50 vaginal atrophy patients were randomly divided in two equal
groups. Group A patients were submitted to long term estriol therapy: 0.5
mgr/day 3 times a week during 2 weeks, followed with the same estriol dosage
twice a week for 4 weeks. B group patients firstly got the same short term estriol
therapy for 2 weeks, followed with 3 sessions of ErYAG laser treatment, with 3
weeks interval between the sessions. Therapy efficacy was measured using
maturation value, pH value, VAS scores for atrophy symptoms: Dyspareunia,
Dryness, Irritation and Leukorrhea. On 6 patients from each group biopsies were
taken (before and 3 months post-op). Follow-ups were at 1 month, 3 months
and 6 months after the therapy.
Results: Both groups showed improvement in atrophy, but laser therapy showed
better and longer lasting effects. Maturation value in A group improved from
22,5 points to 24,7 points at 6 months follow-up. In comparison to that B group
improvements was from 20,8 points to 47,9 points. pH value improved at 3
months for 7,2% in A group, and for 17,6% in B group. Dyspareunia in A group
improved for 48%, and in B group for 72%; Dryness in A group for 68%, in B group
for 76%; Irritation in A group for 48%, in B group for 60% and Leukorrhea in A
group for 81%, while in B group for 94%. Both groups tolerated the therapy well
and adverse effects were mild and transient.
Conclusion: Hormonal replacement therapy is considered to be the first choice
for vaginal atrophy, but this new minimally invasive Er: YAG laser procedure
seems to be safe and efficacious alternative with potential to offer to vaginal
atrophy patients longer period of symptom free life.

Disclosure of Interest: A. Gaspar: None Declared, Z. Vizintin Consultant for: Application

Development

O38
AROMATASE INHIBITORS IS AN EFFECTIVE WAY OF TREATMENT OF EXTENSIVE
FORMS OF GENITAL ENDOMETRIOSIS
M. I. Yarmolinskaya 1,*, A. Molotkov 2, V. Bezhenar 2
1
Gynecological endocrinology, .O. Ott Research Institute of Obstetrics and
Gynecology, 2operative gynecology, D.O. Ott Research Institute of Obstetrics and
Gynecology, Saint-Petersburg, Russian Federation
Problem Statement: Problem statement: taking into consideration the fact that
endometriosis is a chronic progressive and recurrent disease, its combined
treatment (surgery and postoperative hormonal therapy) is considered to be the
most effective way of therapy. The choice of effective therapeutic scheme for
patients with recurrent genital endometriosis (GE) and reduced ovarian reserve
who previously received GnRH agonists (aGnRH), is an unsolved problem. The
aim of the study was to examine the effectiveness of therapy and severity of side
effects of aromatase inhibitor letrozole in combined treatment of GE.
Methods: Materials and methods: we examined 127 patients aged from 22 to 43
years with GE. The diagnosis in all the patients was stated during laparoscopy
and was confirmed by histological examination. 93 (73.3%) patients complained
on peri - and intermenstrual bleeding. Chronic pelvic pain was observed in 86
(67.7%) women, dyspareunia - in 39 (30.7%) patients, infertility in 71 (55.9%)
cases. In 22.8 % of patients GE was diagnosed for the first time, in 77.2% of
patients it was a recurrence of the disease. Reduced ovarian reserve was
observed in 103 (81.1%) patients, history of treatment with aGnRH - in 63% of
patients. When assessing the prevalence of GE on R-AFS classification, I stage
was diagnosed in 2 patients (1.6%), II stage- in 8 females (6.3%), III stage - in 33
(26.0%) and IV stage of the disease was diagnosed in 84 patients (66.1%),
respectively. After surgery patients were prescribed aromatase inhibitor
(letrozole 5 mg/day) in combination with progestogen, derivative of 19nortestosterone (orgametril 5 mg 2 times/day) daily continuously for 6 months.
Results: Results: within the course of treatment with aromatase inhibitors in
combination with progestogens, pain syndrome was absent in almost all the
patients (97.6%). None of the patients had symptoms and findings of recurrence
of the disease, based on laboratory tests and pelvic ultrasound examination.
Control laparoscopy was performed in 9 (7.1%) cases. Regression of
endometriotic lesions was confirmed. One of the most frequently observed sideeffects was spotting from genital tract (32.3% of patients), 22.1% of patients had
a slight increase of body weight, 2.60.6 kg in average, and 13.4% of women had
acne. None of the above side effects were the reason for early termination of
therapy. After treatment with aromatase inhibitors and progestogens 22
patients with infertility (31%), repeated courses of ineffective hormonal therapy,
extensive GE, became pregnant. In 18.2% of patients pregnancy occurred
spontaneously, in 22.7% after ovulation induction with gonadotropins, in 59%
of patients after IVF procedure (using own (27.2%) or donor (31.8%) oocytes).
14 patients (63.6%) to the present time delivered healthy babies in time, 4 of
them were natural deliveries, others Cesarean section. The rest of the
pregnancies are still in progress.
Conclusion: Conclusion: Therapy of extensive forms of GE with the use of
aromatase inhibitors appears to be effective for patients with recurrence of the
disease and reduced ovarian reserve, but certainly it requires further study.
Disclosure of Interest: None Declared

O39
OUTCOMES OF COLD COAGULATION (CC) FOR TREATING CERVICAL
INTRAEPITHELIAL NEOPLASIA (CIN) IN THE UNDER 25 POPULATION.
M. Aref-Adib 1,*, S. Kingdon 2, J. Rains 2, T. Adib 2, F. Bano 2, A. Ahmed 3
1Obstetrics and Gynaecology, QUEENS HOSPITAL, London, 2Obstetrics and
Gynaecology, QUEENS HOSPITAL, Romford, 3Medical school, Liverpool
University, Liverpool, United Kingdom
Problem Statement: The overtreatment of women aged under 25 with high
grade CIN presents a dilemma for clinicians as it is well known that over half of
these cases will regress or will still be of a treatable precancerous stage at 25

35

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

when they can join a screening program. Excisional treatment (eg large loop
excision of the transformation zone (LLETZ)) is associated with an increased risk
of obstetric complications. CC (100 degrees celcius for 120 seconds) is an
alternative, ablative therapy with fewer risks and no evidence of inferiority to
LLETZ. We set out to review the outcomes of women under 25 with CIN treated
with cold coagulation.
Methods: A retrospective study of all women treated for CIN1 or above with CC.
Data from 01/201010/2011 was gathered from treatment diary, clinical failsafe
books, Cyberlab and CIMS database for Colposcopy. Women treated for
symptomatic ectropion (SE) were excluded. The women were then followed up
to review smear outcomes and pregnancy.
Results: Between January 2010 and December 2011- 38 patients received cold
coagulation and were included in the study. Following treatment, no further
follow up was available for 6 patients who did not undergo repeated smear tests
in our unit. 32/38 patients attended for follow up smear tests with a mean length
of follow-up of 16 months. Over the study period 5/38 patients became
pregnant. 26/38 patients had negative smear result at the last available smear.
1/38 patients had a borderline smear at the last smear.
Conclusion: The data suggests that CC may be a good option in the treatment of
CIN in women under 25, however longer data term are needed.
Disclosure of Interest: None Declared

O40
OOCYTES CRYOPRESERVATION IN ONCOLOGICAL PATIENTS: EXPERIENCE OF
A TERTIARY CARE REFERRAL CENTER
A. Baggiani 1,*, E. Albani 1, C. Specchia 1, A. Smeraldi 1, C. Tinterri 2, A. Santoro 2, P.
E. Levi Setti 1
1Department of Gynecology, Division of Gynecology and Reproductive Medicine,
Fertility Center, 2Humanitas Cancer Center, Humanitas Research Hospital,
Rozzano, Milan, Italy
Problem Statement: The cryopreservation of female gametes in order to
preserve fertility is a therapeutic strategy that a modern center of Reproductive
Medicine should be able to offer. Around 1 in 10 of all cancer diagnosis occurs
in reproductive age and modern oncologic treatments have increased survival
rates. However these various treatments can cause long-term effects, such as
loss of fertility, so the demand for effective and individualized fertility
preservation options has increased.
Methods: Aim of this work is to report all patients who have undergone a female
gametes (oocytes) cryopreservation from July 2001 to September 2014 at our
Institute. In 2012 a cooperation was established between Cancer Center and
Fertility Center. This project grew gradually until the establishment of a service
with a multidisciplinary team (gynecologists, oncologists, psychologists). We
routinely evaluate in all patients ovarian reserve, based on age, clinical and
biochemical parameters (Antimullerian Hormone, Follicular Stimulating
Hormone and Antral Follicular Count). Patients are fully informed and counselled
about the risks of ovarian depletion related to the type of cancer therapies
proposed, the chances of drug-protection, the procedure of oocytes freezing,
the feasibility of the procedure focused on risks and prognosis of pregnancy. The
growing strict relation between oncologists and reproductive care specialists
and awareness of fertility preservation options are the reasons of a yearly higher
number of performed procedures.
Results: Between 2001 and 2014 78 women underwent ovulation induction for
oocytes cryopreservation and 1 ovarian tissue cryopreservation was performed.
One patient has cryopreserved oocytes in two different cycles; 6 stopped
therapy of ovulation induction cause inadequate response. The most prevalent
cancers in the female cohort were breast cancer (67%), lymphomas (17%) and
sarcomas (6%). Others diagnosis (10%) included colorectal, cervix and ovarian
border-line carcinomas. All patients underwent ovulation induction used
recombinant gonadotropins in association with GnRH antagonists. We used
GnRH agonist analogues as a trigger to prevent ovarian hyperstimulation
syndrome. Recently, on the basis of scientific evidence, for patients with breast
cancer we have added an aromatase inhibitor in order to reduce the exposure
to high levels of estrogen in cases of hormone-sensitive tumours. Only 2 female
patients out of 78 attempted to conceive utilizing cryopreserved oocytes after
in vitro fertilization and embryo transfer with a negative outcome.

36

Conclusion: The early diagnosis of cancer and modern cancer therapies, allow us
to improve survival rate and quality of life of these patients. Fertility
preservation should therefore be offered. The number of cancer long survivors
that have been treated during the first decades of life is growing every year and
their desire to have a child needs to be approached even before a therapeutic
strategy is offered. Only a multidisciplinary work and an integrated team of
gynaecologists, oncologists and other specialists is the basis for a correct
approach to these patients
Disclosure of Interest: None Declared

O41
STAGE I OVARIAN CARCINOMA: A HISTOLOGICAL, MOLECULAR AND CLINICAL
STUDY
L. Deligdisch, A. Mares *, M. Castillo-Martin, J. de la Iglesia-Vicente, C. CordonCardo
Pathology, MOUNT SINAI HOSPITAL, New York, United States
Problem Statement: Ovarian carcinoma (OC) are the most lethal gynaecological
tumors due to their diagnosis in late stages. OC are rarely diagnosed in stage
one, when confined to the ovaries, with a 5-year survival of 80-90% as compared
to 32% for all stages. Stage I OC are a heterogeneous group of tumors with a
different histological distribution, requiring different therapeutic approaches as
compared to all stages OC.
Methods: Representative histological slides of ovarian tumors from 50 patients
diagnosed with stage I OC were reviewed and classified into serous (OSC) and
nonserous (NSOC): endometrioid (OEC), clear cell (CCC), mucinous (OMC) and
mixed carcinoma (MC). Paraffin sections were stained routinely with H&E and
with special immunohistochemical stains for molecular markers: AE1/AE3, HLA,
Notch and beta-catenin.
Results: The histological distribution of stage I OC was different from that of OC
in all stages, in which OSC predominate. In our group of 50 stage I OC, there were
13 OSC (26%) and 37 NSOC (74%): OEC 13 (26%), CCC 10 (20%), OMC 9 (18%)
and MC 5 (10%). As in our previous studies of stage I OC, the NSOC were seen in
younger women, most presenting with symptomatic pathology, such as
endometriosis and uterine neoplasias. Immunohistologic stains (see Table 1)
showed a positivity of >80% for cytokeratins AE1/AE3 in all histologic groups,
except for 5 cases of OSC (with 70-75% positivity). HLA stains showed a wide
spectrum of immunoreactivity; NOTCH and beta-catenin immunoreactivity
exhibited low values in all histological groups, the highest being 5% positivity in
one OEC.
Table 1:
Serous
Endomet
Clear cell Mucinou
Mixed
carcinom rioid
carcinom s
carcino
a
carcinom a
carcinom mas
(n = 13)
a
(n = 10)
a
(n = 5)
(n = 13)
(n = 9)
AE1/A
>80
% >80%
>80%
>80%
>80%
E3
(n=8)
<80% ( n
= 5)
HLA
1-30%
Negative
1-2%
Negative
10-20%
(n=9)
(n=2)
(n=1)
(n=2)
(n=3)
60-75%
1% (n=1)
5-10%
1-2%
60%
(n=4)
15-30%
(n=2)
(n=1)
(n=1)
(n=2)
50%
10-20%
60-90%
(n=1)
(n=5)
(n=8)
60-90%
90%
(n=6)
(n=1)
Notch
Negative
Negative
Negative
Negative
Negati
or 1-2% or 1-2% or 1-2% or 1-2% ve or 1positive
positive
positive
positive
2%
positiv
e
BetaNegative
Negative
Negative
Negative
Negati
cateni
to
1% to
5% to
1% to
1% ve to
n
positive
positive
positive
1%

Abstract Book

positive
positiv
(n=1)
e
Conclusion: The study confirmed our previous finding of a major shift in the
histological distribution of stage I OC versus all stage OC, with OSC representing
a minority of cases (26%) and NSOC predominating (for example, CCC represents
only 6% of all stage OC and 20% of stage I OC). This stage I histologically
heterogenous group of tumors also displays a heterogeneous molecular
composition. The immunoreactivity to cytokeratin is high in most of the tumors.
There is a wide variability in the reactivity to HLA, possibly related to the degree
of tumor differentiation; Notch and beta-catenin reactivity is low or absent.
Stage I OC require a different management than late stage OC. Chemotherapy is
not indicated in some cases and there is a need for chemotherapeutic agents
different from those used for advanced OC, as is the case of the more commonly
diagnosed in stage I CCC. The identification of the various phenotypical and
genotypic characteristic of stage I OC offers an insight into their early
carcinogenesis and can have an impact on early diagnosis and therapeutic
choices.
Disclosure of Interest: None Declared

O42
USE OF ROY ADAPTATION MODEL IN NURSING CARE FOLLOWING
HYSTERECTOMY
A. Kacaroglu Vicdan 1, T. Demirel 2,*
1
Nursing, Seluk University Akehir Kadir Yallagz School of Health, 2Public
Health Nursing, Selcuk University, Konya, Turkey
Problem Statement: Hysterectomy affects women in physiological, psychological
and social aspects. A patient whose organ will be removed in a surgical operation
experiences such fears and anxieties as pain, danger of death, possibility of
injury, leaving the beloved ones and quitting the hobbies and change in the
bodily image. The women who will undergo hysterectomy, on the other hand,
are afraid of losing sexual function, reproductive potential and femininity in
addition to the afore mentioned fears and anxieties and feel anxious about a
breakdown in the relationships with their husbands, suffering from the negative
impacts of the menopause and losing physical strength. Nursing is a health
discipline which is built on philosophy, theory, application and research. Basic
purpose of a professional discipline is to reveal the scientific knowledge content
that could be used in the practices of the profession. This basic knowledge is
expressed with concepts and theories specific to the profession.This research
was conducted in an attempt to attract attention to the necessity of using the
nursing models and to enable the widespread use of these models by explaining
the utilization of Roys Adaptation Model with a sample.
Methods: Data of Mrs. Y.T. who underwent hysterectomy surgery were collected
through Roy Adaptation Model between 01 September and 10 September 2014.
At the end of the data, NANDA nursing diagnoses were determined and nursing
interventions
specific
to
the
patient
were
planned.
Results: Physiological Assessment: Mrs. Y.T. who is aged 40 underwent total
hysterectomy two days ago. She is married and has two daughters. She
experience insomnia, pain and pain around the stitches.
Self-Concept Assessment: She thinks that she is no more a woman. She perceives
herself as a half person. She feels anxious and nervous.
Role Function Assessment: She states that the most important role of femininity
no longer exists. Mutual Attachment Assessment: Mrs. Y.T. thinks that her
relations with her husband are not like before and will never be and her sexual
functions have come to an end.
Conclusion: It was concluded that the care plan applied according to Roy
Adaptation Model increased the physiological, psychological and social
adaptation of Mrs. Y.T. after the hysterectomy surgery.
Disclosure of Interest: None Declared

O43
BREAST CANCER SCREENING AMONG ARABIC WOMEN LIVING IN THE STATE
OF QATAR: RECOMMENDATIONS FROM WOMEN, MEN AND HEALTH CARE
PROVIDERS
T. T. Donnelly 1,*, A.-H. Al-Khater 2, S. B. Al-Badar 2, M. G. Al-Kuwari 3, M. A. Malik
4, N. Al-Meer 5, R. Singh 6, S. Sharara 7
1Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary,
Canada, 2Department of Hematology and Oncology, Hamad Medical
Corporation, 3Sport Medicine, Aspetar, 4Primary Health Care, 5Nursing Affairs,
Qatar Supreme Council of Health, 6Research, Hamad Medical Corporation,
7Research, University of Calgary-Qatar, Doha, Qatar
Problem Statement: Breast cancer is the most common cancer among women
in Qatar, and the incidence rate is rising. Arab women are at a significant risk due
to being diagnosed at advanced stages of breast cancer. This study investigates
breast cancer screening (BCS) practices among Arab women in Qatar and
recommendations for increasing BCS uptake.
Methods: Data was collected from two studies; a quantitative cross-sectional
survey conducted with 1,063 Arabic women 35 years of age or older, and a
qualitative study conducted with 135 men, women and health care providers
living in Qatar.
Results: 13.8% of the female participants performed BSE monthly, 31.3% had a
CBE once a year or once every two years, 26.9% had a mammogram every 1-2
years (40+ years old). Recommendations included expansion of health care
facilities and availability of providers; raising awareness among men, women
and the younger generation on the benefits of early detection; promoting
awareness through extensive participation of health care professional, media
campaigns, at health centers and educational facilities; working with influential
religious and community leaders; implementing a population-based national
screening program.
Conclusion: Qatari women are at risk for lack of early detection and treatment
of breast cancer in its early stages. It is vital to establish a culturally appropriate,
socially-acceptable, and effective intervention program to promote BCS. The
results of this research will impact health care policy and provision of BCS to
women in Qatar. Findings may also be applicable and benefit other female
populations in the Middle East and women of similar ethnocultural backgrounds
worldwide.
Disclosure of Interest: None Declared

O44
MORCELLATION OF A SARCOMA IN PLACE OF A FIBROID BY MINIMALLY
INVASIVE TECHNIQUES: IS IT AVOIDABLE?
A. Fazel
Obstetrics and Gynecology, Hopital Lariboisiere, Paris, France
Problem Statement: Recent controversies over sarcoma morcellation ended up
with the retrieval of laparoscopic morcellation devices and controversial FDA
statements on one hand, and scientific statements (AAGL, ISGE, and ESGE) on
the other hand. To follow up with this debate we present our experience of
uterine sarcomas diagnosed among a continuous cohort of 2824 patients
referred for fibroid treatment in an academic setting with minimally invasive
procedures.
Methods: Prospective study (Canadian Task Force classification II-3)
2824 patients were referred for treatment of uterine fibroids between
01.01.2002 and 31.12.2013. Patients were from over 20 different ethnical
origins. All patients had an ultrasound, MRI, and a multidisciplinary discussion
prior to surgical treatment (laparoscopy, vaginal surgery, and laparotomy) or
Uterine Artery Embolization (UAE). Endometrial sampling and hysteroscopy
were performed when needed and on all women over 40. All suspected cases
were thouroughly reviewed prior to surgery or UAE by a specific panel of
oncologic radiologists. All specimens operated had pathology examination and
all sarcomas were reviewed by a panel of pathologists specialized in sarcomas.
Results: 579 patients were treated by laparoscopy, 263 patients by a vaginal
procedure, and 262 patients by UAE. Six patients had a final diagnosis of uterine
sarcoma. None of them was treated by a minimally invasive procedure nor had
a uterine morcellation. One patient had a ruptured uterine sarcoma and

37

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

operated in emergency. No hazard due to uterine or myoma morcellation by

laparoscopy or vaginal route with an unrecognized sarcoma was reported.
Conclusion: The incidence of uterine sarcoma in a continuous population of 2824
patients of diverse ethnical origins referred for treatment of fibroids in a tertiary
center was 0.21%. All sarcomas had a suspected diagnosis of malignancy or
cellular fibroid prior to surgery. No hazard was reported due to the morcellation
of an unrecognized sarcoma. A thourough workup prior to surgery including MRI
and office hysteroscopy could help in counseling and preventing from accidental
morcellation of a malignancy.
Disclosure of Interest: None Declared

O45
PATIENTS WITH EARLY ENDOMETRIAL CANCER IN SINGAPORE HAVE A BETTER
QUALITY OF LIFE AFTER ROBOTIC HYSTERECTOMY COMPARED TO OPEN
HYSTERECTOMY
J. Liu
Obstetrics and Gynecology, National University Health System, Singapore,
Singapore
Problem Statement: Total hysterectomy bilateral salpingo-oopherectomy
(THBSO), is the mainstay of treatment for early endometrial cancer. Robotic
assisted hysterectomy (RAH) has been reported to have better surgical
outcomes than total abdominal hysterectomy (TAH) [1, 2]. However, there is
limited data on the quality of life (QOL) after RAH compared to TAH. This study
aims to evaluate the post-operative QOL in patients with early endometrial
cancer who underwent RAH and TAH.
Methods: A DSRB-approved retrospective study of Singaporean patients who
underwent surgical treatment for FIGO stage 1 endometrial cancer between
January 2006 and December 2011 at the National University Hospital was
conducted. The patients post-operative QOL was assessed using a questionnaire
based on the validated SF-36 health questionnaire, administered via direct
teleconference. All data were analyzed using the SPSS version 20.
Results: A total of 82 patients were called and 71 (86.6%) responded. 34 (47.9%)
patients had TAH and 37 (52.1%) had RAH. In terms of primary outcomes,
patients in the RAH group reported experiencing less activity limitation
(p=0.044), better health perception (p=0.029) and reported better general
health (p=0.053) compared to patients in the TAH group. The RAH group also
had significantly better results in all secondary outcomes such as shorter postoperative hospital stay (p<0.001), shorter time to return to normal activities
(p=0.009), greater satisfaction with scar appearance (p<0.001) and lower postoperative pain scores (p<0.001).
Conclusion: Singaporean women with early endometrial cancer are more likely
to report better quality of life indices after robotic hysterectomy than with open
hysterectomy
Disclosure of Interest: None Declared

O46
PRIMARY NON-HODGKIN LYMPHOMA OF VAGINA - REPORT OF A RARE
CLINICAL ENTITY
V. C. Silva 1,*, P. Correia 2, N. Oliveira 2, M. Gomes 3, M. C. Coelho 2, L. S 2
1Obstetrics and Gynecology, Tondela-Viseu Hospital Center, Viseu, 2Gynecology,
3Clinical Pathology, Portuguese Institute of Oncology, Coimbra, Portugal
Problem Statement: Primary lymphomas of the female genital tract represent
about 1% of all primary extranodal lymphomas. Lymphomas of the vagina are
extremely rare and can occur at any age. They are infiltrative tumors which affect
the vaginal wall thickening. The most frequent clinical presentation is vaginal
bleeding, but may also present as a mass, symptoms of dyspareunia or vaginal
discharge or irritative urinary symptoms.
Methods: The authors report a case of primary lymphoma of the vagina and do
a review of the literature about similar published cases.
Results: Clinical case - 52 years woman, with no personal history of relief and a
family history of breast cancer (mother), who referred bleeding with intercourse
since 2 months ago. Gynecological examination revealed traces of blood in the
vagina, no visible lesions in the cervix and a hardened plaque on the posterior
vaginal wall invading the posterior vaginal fornix up to 2 cm from the introitus;

38

on digital rectal examination a 6cm tumor was evident but not invading the
rectal mucosa; fresh excisional biopsy revealed it was a malignant non-Hodgkin's
lymphoma of large cells; it was excluded marrow or lymph node disease; the
patient had a good response to chemotherapy with anthracyclines with
complete tumor regression and currently have a disease-free survival of 72
months.
Conclusion: A high degree of suspicion is required to diagnose this rare entity
since these tumors may have a nonspecific presentation, may mimic squamous
cell carcinoma and colposcopic biopsy may have a false-negative result. A review
of the literature revealed that a good response to treatment and a good
prognosis are frequent when the disease is still localized.
Disclosure of Interest: None Declared

O47
THE OBSTETRICIAN BEFORE COURT: A CRITICAL CASE STUDY ON (SUB)
STANDARD PERI-AND POSTNATAL CARE
M. Eggermont
Law, Ghent University, Melden, Belgium
Problem Statement: In case of birth injuries, such as brain damage or even
death, parents are often incited to lodge a complaint, with civil, criminal, or
disciplinary suits following. Through a case study of judicial proceedings of
Belgium, the Netherlands and France related to the delivery process, this paper
addresses the risks of liability for the obstetrician during peri-and postnatal care.
Every medical malpractice law suit necessitates an individual analysis, but
similarities are frequent. These commonalities allow us to draw some
conclusions. By assessing the risks involved in intrapartum care, juridical
recommendations for avoiding medical liability can be developed.
Methods: A 118 closed cases (facts from 1975-2008) on medical negligence in
maternity care in Belgium, the Netherlands and France, were analyzed in depth.
The legal databases used were Jura and Judit (Belgium), Legifrance, Juricaf and
Dalloz (France) and Recht, Rechtspraak (the Netherlands). A minority of the
cases were retrieved through contacts with insurance companies (Belgium only)
and courts. The first juridical analysis concerned the procedural aspects such as
time of facts, place of facts, civil/criminal procedure and the involved health care
professional and qualification of liability (personal/vicarious). After the analysis
of the medical aspects, the cases were categorized in domains of expertise and
then subdivided into types of pathologies. The last analysis concerned the type
of damage.
Results: Most cases involved the performance of the obstetrician in recognizing
a specific pathology in time. Two obstetric complications were well documented:
uterine rupture and placental abruption. The highest liability rate (more than
eighty percent) was reflected in the category of interpreting fetal monitoring.
Failure to identify a pathological fetal heart rate (suggesting fetal distress) was
without exception medical negligence on the part of the obstetrician. In some
cases in instrumental delivery - though life-saving on some occasions - was the
direct cause of the obstetricians liability. The medical indication, the positioning
of the instrument and the duration of the intervention were assessed. In cases
without medical risk factors, shoulder dystocia was considered an obstetric
complication, if maneuvers were performed to relieve the shoulders. Not
correctly performing a caesarean section or not addressing a haemorrhaghia
post partum also involved the liability of the obstetrician.
Conclusion: Although this is not an exhaustive quantitative study, a liability rate
of more than sixty percent is high. The two most important juridical
recommendations, which may reduce this rate, are: respond to the first
symptoms of obstetric complications and recognize abnormal fetal heart rate
patterns. Cardiotocograph interpretation skills are important to implement
appropriate clinical decisions. Also consider the risk of failed instrumental
delivery when choosing an instrument. In relation to shoulder dystocia, be aware
of the risk factors and order examinations to purchase a diagnosis.
Disclosure of Interest: None Declared

Abstract Book

O48
BRAIN NATRIURETIC PEPTIDE LEVELS IN LABOR AND POSTPARTUM
A. Hamaoui *, C. M. Santiago, R. Upadhyay, E. Chadwick, C. Henderson, R.
Mercado
Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health
Center, Weill Cornell Medical College, Bronx, United States
Problem Statement: Brain Natriuretic Peptide (BNP) is an important marker for
heart failure. Recently studies have shown that elevated values are found
associated with hypertension in pregnancy (Resnick et al, Hamaoui et al).
However, the difference or similarity in the range of levels of BNP in these clinical
entities has not been established.
Methods: This is a chart review of women admitted from January 2013 to August
2014 to the surgical intensive care and/or to the obstetric labor service and
found to have elevated BNP levels equal to or above 100 pg/mL. Women with at
least two elevated blood pressures equal to and/or above 140/90 mmHg and
proteinuria defined by an albumin to creatinine ration above 30 mg/g were
classified as preeclamptic.
Results: Most women, 91.8%, admitted to the intensive care with elevated BNP
were over 50 years old, and 77.1% were over 60 years old. The range of
maximum measurable values was 101 to 2980 pg/mL, a third of which (29.5%)
were above 1000 pg/mL; and more than a half (54.1%) of which were above
500 pg/mL. Diagnoses involved some level of heart failure (66.7%), multi-organ
failure (30%) and/or sepsis (46.7%) compounding the surgical condition.
Most women, 82.3%, admitted without cardiac involvement or other underlying
disease, other than hypertension, and in labor who had elevated BNP were
younger than 35 years old; and 41.4% were younger than 25 years old. The range
of maximum measurable values was 100 to 1060 pg/mL, of which only 0.6% were
above 1000 pg/mL and only 6.2% were above 500 pg/mL; most, 53.1%, were
below 200 pg/mL. After at least 24 hours into the postpartum, the range of
maximum measurable BNP values was 101 to 994 pg/mL, of which only 1.6%
were above 500 pg/mL, and 65.8% were below 200 pg/mL.
The majority of parturients with elevated BNP beyond 100 pg/mL, 96.5%, had
some form of hypertension. Almost three quarters of women, 73.4%, with
elevated BNP, met the criteria for preeclampsia, while 23.0% had gestational
hypertension.
Conclusion: The BNP levels of hypertensive women in pregnancy are associated
with lower maximum levels than in women with cardiac events and/or severe
disease (P 0.0001). A possible criticism to this conclusion is that there was a
huge difference in age between the cohorts. Nonetheless, healthy women at all
ages do not have elevated BNP of such magnitude. Levels higher than 500mg/mL
in hypertensive parturients should lead to consideration of compounding
conditions whether sepsis, pulmonary emboli, cardiac stress or some other
serious condition.
Disclosure of Interest: None Declared

O49
DIAGNOSTIC VALUE OF 3T MRT FOR SUSPECTED UTERINE DEFECT IN PATIENTS
WITH PREVIOUS CESAREAN SECTION - 2 CASES
J. Hoffmann 1,*, P. Stumpp 2, T. Kahn 2, H. Stepan 1
1Obstetrics, 2Radiology, University of Leipzig, Leipzig, Germany
Problem Statement: A scar defect/uterine rupture in a new pregnancy is a rare
but threatening secondary complication of a previous cesarean section. Scar
dehiscences or covered ruptures are often low or not symptomatic and raise the
risk for uterine rupture during the delivery. For that reason, 2D-sonography is
used for prenatal diagnosis by measuring the lower uterine segment. Because of
methodical limitations of ultrasound examinations with regard to dependency
on the examiner and patients constitution different accessory techniques are
needed for a more detailed prenatal diagnostic. These case reports of two
patients demonstrates the usefulness 3T MRI in case of suspected uterine
dehiscence.
Methods: Two pregnant women presented with lower abdominal pain after
previous cesarean section with 31+1 and 26+1 gestational weeks.
Transabdominal 2D sonografie (GE Healthcare, Voluson E8 Expert) was used for
primary diagnostics of the lower uterine segment. T2 weightend sequences in

sagittal and axial orientations were performed on a 3 Tesla MRI scanner

(Magnetom Trio, Siemens HealthCare) for advanced diagnostics.
Results: In both cases the lower uterine segment sonographically (GE
Healthcare, Voluson E8 Expert) appeared very thin. In the first case a uterine
dehiscence was suspected and likewise could not be safely excluded by
ultrasound in the second case. In the first case a uterine rupture was confirmed
by additional MRI examination and the women was delivered by caesarean
section with 31+3 weeks of gestation. In the second case, MRI examination could
definitively exclude a uterine rupture and pregnancy could be prolonged to 37+0
weeks of gestation. This patient was delivered by cesarean section as well. In
both cases MRI findings were verified intraoperatively.
Image / Graph:

Conclusion: These two cases demonstrate the use of additional MRI examination
in case of a sonografically suspected uterine dehiscence or symptomless uterine
rupture after previous uterine section. Since MRI is noninvasive and applicable
without contrast agents or any premedication, it can be performed safely in
pregnancy. Additional MRI findings can be helpful to classify sonographic
findings more accurately and to decide about the following management. MRI
findings and intraoperative findings correlated well in the presented cases.
Disclosure of Interest: None Declared

O50
PRENATAL DIAGNOSIS OF DIFFUSED DILATED BOWEL LOOPS: FETAL
CHARACTERISTICS AND NEONATAL OUTCOME
G. Katz 1 2,*, B. Pode-Shakked 3, M. Berkenstadt 4, R. Bilik 5, R. Achiron 1, Y. Gilboa
1

1Department

of Obstetrics and Gynecology, 2Pinchas Borenstein Talpiot Medical

Leadership Program, Sheba Medical Center, Tel-Hashomer, 3Department of
Pediatrics, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, TelHashomer, Ramat Gan, Israel., 4The Danek Gertner Institute of Human Genetics,
Sheba Medical Center, Tel-Hashomer, Ramat Gan, 5Department of Pediatric
Surgery, Edmond and Lily Safra Childrens Hospital, Sheba Medical Center, TelHashomer, Ramat Gan, Israel, Israel
Problem Statement: The purpose of this study was to describe the
characteristics and outcomes of fetuses prenatally diagnosed with diffused
dilation of bowel loops.
Methods: We conducted a retrospective study of all pregnancies with fetal
diagnosis of diffuse dilated bowel loops (DDBL) during a period of 14 years in a
large tertiary referral center. By assessing the electronic medical records of all
patients referred for dilated bowel loops we selected those diagnosed with
DDBL. After confirming the diagnosis by evaluating the recorded ultrasound
examination, we assessed the pregnancy, delivery and neonatal outcomes.
Results: Forty two patients were referred for counseling due to dilated bowel
loops. All were assessed for other structural malformations, were counseled by
a pediatric surgeon and underwent genetic counseling. Six cases were ultimately
diagnosed with DDBL. The mean gestational age at diagnosis was 31 weeks and
4 days (18 days). In 3 patients a normal karyotype was confirmed. The mean
gestational age at delivery was 36+0 weeks (18 days), all but one delivered by
normal vaginal delivery. Four cases had a premature rupture of membranes
beyond 33 weeks. The mean birth weight was 2530 401 g, and Apgar score was
8.7 (0.5) and 9.7 (0.5) at 1 and 5 minutes, respectively. The mean length of
hospitalization was 27 (27) days. All cases but one, who was operated for ileal
atresia, were managed conservatively. Two cases were presented with
hematochezia in the early hours after delivery, following admission to the
preterm ward and were treated by a special dietary formula. One case required

39

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

repeated packed RBC transfusions. Hematochezia resolved spontaneously and

the neonates were discharged home without apparent anomaly following a
thorough investigation. After a follow-up of up to 8 months, both cases were
developing well with no gastrointestinal complications.
Conclusion: DDBL diagnosed in the second half of pregnancy is associated with
premature rupture of membranes and newborn hematochezia, and therefore
requires special neonatal care, after which a favorable outcome is expected.
Disclosure of Interest: None Declared

O51
IMMUNOHISTOCHEMICAL STUDIES IN CASES OF PLACENTA PREVIA
Z. S. Khodzhaeva 1 1 1,*, A. Safonova 1, E. Dubova 2, N. Klimenchenko 1, A.
Tschegolev 2, G. Sukhikh 3
1
Maternal-Fetal Medicine, 2Pathomorphologic Laboratory, 3Director, Federal
Research Center for Obstetrics, Gynecology&Perinatology, Moscow, Russian
Federation
Problem Statement: Placenta [z.kh.1] previa is known to cause significant
maternal and perinatal morbidity and mortality and occurs in approximately
0.30.5% of all pregnancies at term. With the increasing incidence of both
cesarean delivery and poor obstetric history, this pathologic condition is
becoming more common.
Most studies investigated the role of
metalloproteinases and their inhibitors in the placenta, but their expression and
potential role in cases of placenta previa regardless of the presence of a uterine
scar have not been investigated adequately.
Objectives: Immunohistochemical study of the matrix metalloproteinases
(MMP-2 and MMP-9) and their inhibitors (TIMP-2 and TIMP-3) expression in
cases of placenta previa.
Methods: 40 placentas obtained by Cesarean Section at term were studied:
Group 1 - placenta previa, in the absence of a uterine scar (n = 12), 2 - placenta
previa in women with a uterine scar (n = 14), group 3 as a control (n = 14).
Clinical, morphological and special immunohistochemical methods used.
Results: In the control group, the maximum values of MMP and TIMP expression
were observed in the trophoblast and decidual cells of the basal lamina. Reaction
intensity in the terminal villi was higher than in endothelial cells of capillaries:
syncytio-endothelial rate for MMP-2 was 1,44; MMP-9 - 1,41; TIMP-2, - 2,59;
TIMP-3 - 2 12. In group 1 the expression levels of MMP-2 and MMP-9 in cells of
basal lamina was higher than in control group: 15.9% and 17.2% more in
trophoblast, 11.6% and 21.3% in decidual cells respectively. These changes
indicate the severity of proteolysis in the adjacent tissues and thus contribute to
the excessive trophoblast invasion and placenta previa. Expression of MMP-9
was 6.1% higher in the syncytiotrophoblast and 5.1% higher in the endothelial
cells. But MMP-2 was lower than the control values (13.6% and 2.0%
respectively). Significant reduction of TIMP-2 levels detected in the
syncytiotrophoblast (by 20.6%) and EVT (by 17,5%), and TIMP-3 - in
sincitiothrofoblast (by 7.7%) compared with the control group. In group 2, the
levels of MMP-9, TIMP-2 and TIMP-3 were lower than in women without a
uterine scar (group 1): MMP-9 in the decidual cells- by 15.5% and in the
trophoblast of basal lamina by 9.9%. In the sinciothrofoblast and in villi capillary
endothelial cells the levels of TIMP-2 were higher by 5.3% and 15.4%
respectively, which indicates a violation of the relationship between MMPs and
their inhibitors in women with a uterine scar. Syncytio-endothelial rate for MMP2 was 1,31, MMP-9 - 1,44, TIMP-2, - 2,11, TIMP-3 - 1.96.
Conclusion: Identified abnormalities in MMP-2,9 and their inhibitors TIMP-2,3
activity are accompanied by increased proteolysis of extracellular matrix, which
contributes to violations of the structure and function of the placenta. The
imbalanced expressions of MMP-2 and MMP-9 and TIMP-2,3 in placenta previa,
regardless of the presence of a uterine scar is likely to result in a pathological
invasion. Further researches based on the molecular genetic studies will
contribute to a better understanding of the mechanisms of pathological
placentation and development of preventive measures.
Disclosure of Interest: None Declared

40

O52
ESTIMATING TRENDS IN THE MEAN AND OPTIMAL BIRTH WEIGHT IN JAPAN,
1979 - 2010
M. Kita 1,*, S. Gilmour 1, E. Ota 2
1Department of Global Health Policy, Graduate School of Medicine, The
University of Tokyo, 2Department of Health Policy, National Center for Child
Health and Development, Tokyo, Japan
Problem Statement: Low birth weight (LBW) is an important indicator of
perinatal mortality, and long-term negative health outcomes such as premature
adolescence, low cognitive functioning, respiratory problems and increased
prevalence of non-communicable diseases (NCDs) in adulthood. Compared to
other industrialized nations, the proportion of LBW neonates has been
increasing in Japan in recent years, reversing a post-world war two decrease. In
2007 Japan reported the highest proportion of LBW infants in the OECD,
reaching 9.7% of newborns, which is 2.9% higher than the OECD average. The
proportion of LBW infants has increased by 86.5% from 1980 to 2007, and the
mean birth weight among singletons has fallen more than 150g from 1980 to
2003. Estimation of prevalence of and trends in LBW and optimal birth weight is
essential for understanding future changes in perinatal mortality risk and adultonset NCDs.
Methods: We analyzed vital statistics of births, deaths, and stillbirths from 1979
to 2010, which were obtained from the Ministry of Health, Labour and Welfare.
The outcomes of this study were birth weight, perinatal mortality rate (PMR),
and LBW. The trend in birth weight was analyzed from 1979 to 2010, as these
years had consistent measurements of gestational age, using a monthly timeseries analysis. Splines were used to fit perinatal mortality to birth weight in 100g
increments, and the optimum of the derivative of the spline was estimated to
calculate the optimal birth weight. The predicted perinatal mortality rate
corresponding to the mean birth weight and the optimal birth weight was
obtained from the smoothed spline for every year.
Results: The proportion of LBW babies has increased from 6.2% in 1979 to 8.5%
in 2010. There has been a decline in mean birth weight of 200 grams among
preterm neonates, and 170 grams among neonates born during term. The
optimal birth weight decreased by year from 3662 g (95% CI: 3584 3730) in
1979 to 3481 g (95% CI: 3421 3545) in 2010, while the optimal birth weight
range has increased and the perinatal mortality rate at the optimal birth weight
has also decreased. The mean birth weight has been less than the optimal birth
weight during the entire time period. The perinatal mortality rate could be
reduced by elevating the mean birth weight closer to the optimal birth weight.
Conclusion: The mean birth weight in Japan has decreased, especially among
premature and term neonates. Some perinatal mortality could be averted, by
increasing birth weight so that it is closer to the optimal birth weight. Policies
that drive birth weight further from the optimal birth weight such as strict
restriction of weight gain among pregnant women need to be revised, if Japans
past gains in perinatal mortality reduction are to be maintained in the future.
Disclosure of Interest: None Declared
O53
REPEATED CONTROLS OF GESTATIONAL ANGIOGENIC BIOMARKERS IN HIGHRISK PREGNANCIES- DO THEY DERIVE A CLINICAL BENEFIT?
V. Kolovetsiou-Kreiner 1,*, E.-C. Stern 1, K. Mayer-Pickel 1, I. Lakovschek 1, U. Lang
1
, M. Cervar-Zivkovic 1
1Department of Obstetrics and Gynecology, Medical University of Graz, Austria,
Graz, Austria
Problem Statement: Pathogenesis of severe placenta mediated gestational
complications (preeclampsia, eclampsia, HELLP-Syndrome, abruption of
placenta, IUGR) are associated with altered angiogenic biomarker levels. Aim of
this study is to determine if maternal serum angiogenic biomarker ratio (sFlt1/PIGF) can predict maternal and/or fetal, neonatal complications during
pregnancy.
Methods: We prospectively studied 58 women with high-risk pregnancies
(previous preeclampsia/eclampsia/HELLP-Syndrom, preexisting hypertension,
thrombophilia, and antiphospholipid-syndrom). We measured serum levels of

Abstract Book

sFlt-1 and PLGF by ELISA and calculated sFlt-1/PLGF-ratio every 4-6 weeks from
week 10 until the end of pregnancy. Maternal and fetal/neonatal complications
were analyzed subsequently. We also evaluated effects of applied medication
(acetylsalicylic acid, low molecular heparin) on gestational biomarker levels.
Results: sFlt-1/PLGF ratio was higher in women with adverse pregnancy
outcome, even without preeclampsia, i.e. early placenta abruption at 24th week
of pregnancy. Application of acetylsalicylic acid and/or heparin was associated
with an immediate and constant strong decrease of the ratio after
administration.
Image / Graph:

Conclusion: Women with high risk to develop severe complications during

pregnancy like abruption of placenta or severe preeclampsia showed strong
increase of sFlt-1/PIGF ratio up to twelve weeks before clinical manifestation of
these events. Protective effects of acetylsalicylic acid can be demonstrated once
again by a decrease of sFlt-1/PLGF ratio levels in our study.
Disclosure of Interest: None Declared

c.*465A>T were found in 5-UTR. The frequency of each variation in GH and PE

groups were compared to controls (Table 1).
dbSNP ID

HGVS name

rs5479

c.468C>A

rs4548329
3

c.534G>A

rs5640687
0

c.*197C>T

rs7265012
8

c.*465A>T

genotype

genotype frequency
GH

PE

controls

CC

0.857

0.941

0.897

CA+AA

0.143

0.059

0.103

GG

0.857

0.941

0.897

GA+AA

0.143

0.059

0.103

CC

0.905

1.000

0.917

CT+TT

0.095

0.000

0.083

AA

1.000

1.000

0.949

AT+TT

0.000

0.000

0.051

p value
Fishers
exact
test
1.000a
0.657b
1.000a
0.657b
1.000a
0.546b
0.526a
1.000b

Table 1. Frequencies of genotypes and their associations with GH and PE

a GH vs. controls; b PE vs. controls
Conclusion: Preliminary studies indicate several variants of HSD11B2, however
the relevance of the observed SNPs to the development of GH or PE has to be
further analyzed involving more subjects. On the other hand, the impaired
activity of 11-HSD2 may be a result of changes in DNA methylation and gene
expression in placenta instead of mutations having impact on amino acid
sequence in the protein [7].
References
1. Arulkumaran N, Lightstone L. Clin Obstet Gynaecol 2013, 27:877
2. Wallis AB et al. Am J Hypertens 2008,21:521
3. Causevic M, Mohaupt M. Mol Aspects Med 2007, 28:220
4. Harris A, Seckl J. Horm Behav 2011, 59:279
5. Reynolds RM. Psychoneuroendocrinol 2013,38:1
6. Mukherjee S et al. Placenta 2011,32:687
7. Baserga M et al. Am J Physiol Regul Integr Comp Physiol 2010, 299: R334
Disclosure of Interest: None Declared

O54
SEQUENCE VARIATIONS IN HSD11B2 GENE IN GESTATIONAL HYPERTENSION
AND PRE-ECLAMPSIA - PRELIMINARY STUDIES
K. Kosicka 1,*, A. Siemitkowska 1, A. Pkal 1, G. Brborowicz 2, M. Krzycin 2, A.
Majchrzak-Celiska 3, W. Baer-Dubowska 3, M. Resztak 1, F. Gwka 1
1Department of Physical Pharmacy and Pharmacokinetics, 2Department of
Perinatology and Gynecology, 3Department of Pharmaceutical Biochemistry,
Poznan University of Medical Sciences, Poznan, Poland

O55
ASSOCIATION OF LOW MATERNAL SERUM CONCENTRATIONS OF PREGNANCYASSOCIATED PLASMA PROTEIN A (PAPP-A) AND FREE BETA-SUBUNIT HUMAN
CHORIONIC GONADOTROPIN (F-HCG) WITH ADVERSE NEONATAL OUTCOME
J. Liu 1
Obstetrics and Gynecology, Singapore General Hospital, Singapore, Singapore

Problem Statement: Hypertension is observed in 3-10% of pregnancies, but the

incidence of gestational hypertension (GH) and pre-eclampsia (PE) in recent
years is increasing steadily [1,2]. The etiology of GH and PE has not yet been fully
elucidated. One of the hypotheses assumes that they develop as a result of
placenta malfunctioning at the early stage of pregnancy. Placental dysfunction
is associated with decreased activity of 11-hydroxysteroid dehydrogenase 2
(11-HSD2), which catalyzes the conversion of cortisol (F) to biologically inactive
cortisone in placenta. It constitutes a barrier reducing the impact of maternal F
on the developing fetus and protecting it from the excess of maternal GC. It was
shown that 11-HSD2 activity is reduced in GH, so that the baby is overexposed
to F, which at high concentrations has pro-apoptotic effects, leading to abnormal
development of the child and low birth weight [3-6].
The aim of the study was to analyze the sequence of HSD11B2 gene encoding
11-HSD2, searching for mutations that could be associated with the increased
risk of GH or PE. The variations in coding fragments of HSD11B2 may lead to
abnormal structure of enzyme protein with impaired activity.
Methods: The study included 77 women with a singleton pregnancy after 20
week of gestation: 39 normotensive (controls), 21 with GH and 17 with PE. The
research comprised DNA sequencing of coding regions of HSD11B2, followed by
restriction analysis (PCR-RFLP).
Results: The study indicated 4 sequence variations in HSD11B2 that occurred
most commonly. Two synonymous mutations were observed in coding region:
c.468C>A in exon 2 and c.534G>A in exon 3, the other two: c.*197C>T and

Problem Statement: Low maternal serum concentrations of pregnancyassociated plasma protein-A (PAPP-A) and free -human chorionic
gonadotrophin (-hCG) used in the First Trimester Screening have been
associated with adverse obstetric outcomes. However, there is limited literature
on their associations with adverse neonatal outcomes. This study aims to
evaluate low maternal serum PAPP-A and f-hCG concentrations in relation to
adverse neonatal outcomes.
Methods: A retrospective cohort study of 962 patients who underwent first
trimester screening during 11-14 weeks of gestation between January and
December 2010 at the Singapore General Hospital was conducted. Pregnancies
with fetal anomalies, multiple fetuses, miscarriages before gestational age of 24
weeks, and patients with incomplete obstetric and neonatal data were excluded.
Concentrations of maternal serum PAPP-A and f-hCG were converted to
gestational age-adjusted multiples of the medians (MoM), and low levels were
defined by less than 10th percentile. Outcome variables included Neonatal
Intensive Care Unit (NICU) admission, neonatal jaundice, neonatal
hypoglycemia, neonatal infection and poor Apgar scores. Neonatal information
was obtained via electronic records.
Results: A total of 649 patients were included. 35 (4.5%) had low PAPP-A levels
and 51(7.9%) had low f-hCG levels. Incidence rates of all the adverse neonatal
outcomes in the groups with low PAPP-A and f-hCG levels were higher than the
control group. Both PAPP-A and f-hCG, at low levels, were significantly
associated with neonatal hypoglycemia (OR 3.72, 95% CI 1.17-11.8; OR 3.69, 95%
CI 1.36-10.0). Low PAPPA-A levels were also associated with neonatal jaundice
(OR 2.59, 95% CI 1.06-6.34) and low birth weight (OR 3.49, CI 1.55-7.85). Preterm

41

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

delivery (<37 weeks) was found to be a significant risk factor for neonatal
hypoglycemia and neonatal jaundice (OR 4.07, 95%CI 1.44-11.5; OR 3.01, 95% CI
1.03-5.08).
Conclusion: Low serum levels of PAPP-A and f-hCG are significantly associated
with higher incidence of some adverse neonatal outcomes but not NICU
admission. However, other possible risk factors such as maternal smoking were
not included and hence should be investigated in future studies.
Disclosure of Interest: None Declared

O56
THE NEED FOR SCIENTIFIC RESEARCH OF CLINICAL PREDICTORS OF STROKE RISK
IN PREGNANCY
V. Novikova1, G. Penzhoyan1
1Department
of Obstetrics, Gynecology and Perinatology Faculty of
Postgraduate Education, Kuban State Medical University, Krasnodar, Russian
Federation
Problem Statement: Objective: identify clinical predictors of stroke risk in
pregnancy.
Methods: The study was conducted on the bases of the territorial Perinatal
Center of Krasnodar territorial Hospital 2. were analyzed 7 cases of stroke in
women during pregnancy. The average age 30,675,27 years (24-38). In the
anamnesis number of labor 1,331,51 (0-4), pregnancies 2,332,42 (0-6),
pregnancy was desired, occurred spontaneously.
Results: BMI was 22,172,64 (20-27). All women have no complications by
cardiovascular and cerebrovascular disorders in hereditary and own anamnesis.
2 women identified inherited thrombophilia. 1woman smoked up to 20
cigarettes per day. Only 1 woman from 26 weeks of pregnancy complicated by
mild preeclampsia, other was without major complications. Stroke occurred in
gestational age 353,48 (30-39) weeks. In 6 cases diagnosed ischemic stroke (in
the basins of the right posterior cerebral artery, the right middle cerebral artery,
the right common carotid artery or cortical branches of the left middle cerebral
artery). In one case there was a thrombosis of the right transverse and sigmoid
sinus with areas of secondary ischemia left temporo-occipital and right occipital
areas. In 5 cases of stroke occurred against a background of well-being, in 2
cases, during a brief headache. ADsist 12921,9 (120-140) mm Hg, ADdiast
8015,81 (70-90) mm Hg. 2 women revealed distinctive features of ultrasound:
signs of a small diameter of the vertebral artery (2.8 mm) in spinal canal (CIV).
Delivery is made by caesarean section at 37,83 (35-39) weeks of gestation with
living fetus and physiological blood loss. Postpartum without obstetric
complications. In one case, Pregnant V., 33 years old, expected second delivery
of the second pregnancy. Heredity, extragenital, obstetric anamneses
unremarkable. Regularly observed in the present pregnancy by obstetrician. At
30 weeks of pregnancy appeared moderate arching growing headaches, there
was disorientation, confusion, speech disorder. Immediately taken to the
Perinatal Center, where revealed thrombosis of the transverse and right sigmoid
sinus. Also installed progressively increasing signs of fetal hypoxia, performed a
cesarean section (CS), fetus were alive with signs of prematurity with satisfactory
Apgar scores. At the time CS for the first time found a solid inclusion in the
tissues of one of the ovaries, immediately histological diagnosed as metastasis
of breast cancer. In the future, was diagnosed with breast cancer with
metastases to the liver, lungs, brain, mediastinal lymph nodes, the kidneys,
adrenal glands, lymph nodes of abdomen, ovaries.
Conclusion: Uniquely clinical predictors of stroke is not revealed. Clinically
normal pregnancy in the absence of significant risk factors can be complicated
by stroke. Multicenter studies are needed to assess women cerebrovascular
disorders during pregnancy and the postpartum period, in order to prevent
stroke, able to significantly affect a woman's health, lead to her disability,
mortality. It is necessary to create an international registry of cases of stroke
during pregnancy to be able to organize and analyze data.
Disclosure of Interest: None Declared

42

O57
PREGNANCY OUTCOMES IN HIV-INFECTED WOMEN 5-YEAR EXPERIENCE IN
MATERNAL FETAL UNIT
J. M. Raimundo 1 2,*, L. Pinto 2, A. Zagalo 3, F. Prata 4
1Obstetrics and Gynecology, Centro Hospitalar de Setubal, Setubal, 2Obstetrics
and Gynecology, 3Infectious Diseases , 4Pediatric , Centro Hospitalar Lisboa Norte
- Hospital Santa Maria, Lisbon, Portugal
Problem Statement: HIV infected pregnant women require multidisciplinary
care. Prevention of mother-to-child transmission is of paramount concern but
we must be aware of obstetric and perinatal complications related to the
underlying disease.
OBJECTIVE: To evaluate obstetric outcomes of HIV-infected pregnant woman in
a Maternal Fetal Unit of a tertiary hospital.
Methods: Retrospective observational study of the HIV-infected pregnant
women, submitted to highly active antiretroviral therapy, whose surveillance
and delivery occurred at Hospital Santa Maria, between January 2009 and
December 2013. The maternal and neonatal clinical records were reviewed.
Results: 102 pregnant women, mean age of 29,3 years. The major risk factors for
HIV infection were heterosexual transmission (68.62%) and intravenous drug
use (31.3%). The diagnosis of HIV-infection was made during pregnancy in
18.6%. Obstetrics outcomes: 24.48% (24/102) gestational diabetes, 9.18%
(9/102) obstetric hemorrhage, 6.12% (6/102) preeclampsia, 3.06% (3/102)
pregnancy hypertension, other 14.7% (15/102). Segmentary cesarean rate was
40.1% (41/102) (elective cesarean: 87.8% 36/41). The mean birthweight was
2.290g with 18,6% having low birthweight. There were 16 preterm births
(15.7%). Preliminary data show a mother-to-child transmission rate of 0.98%
(1/102).
Conclusion: These results highlight the importance of prenatal screening for HIV
infection and the need for a multidisciplinary approach in order to minimize
obstetric and neonatal complications.

Disclosure of Interest: None Declared

O58
PREGNANCY IN WOMEN >40 YEARS: EGG DONATION VS. IVF/ICSI VS.
SPONTANEOUS CONCEPTION
M. Langer 1,*, A. Perricos 2
1Dept. of Obstetrics and Fetomaternal Medicine, Medical University of Vienna,
2Dept. of Obstetrics and Fetomaternal Medicine, Dept. of Obtetrics and
Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
Problem Statement: The age of women at their first pregnancy rose continually
and now lies above 30 years. It has been shown that advanced maternal age and
certain procedures of reproductive medicine correlate with increased morbidity
in pregnancy. We therefore studied the influence of the mode of conception
upon the course of pregnancy and birth.
Methods: In a retrospective design we analyzed all pregnancies of women <40
years at birth who attended the Department of Obstetrics and Fetomaternal
Medicine, Medical University of Vienna between Jan 1st, 2011 Dec 31st, 2013.
Patients were allocated according to mode of conception to one of 3 groups: egg
donation (ED), autologous IVF/ICSI (IVF) and spontanous conception (SC).
Outcome parameters were: multiple pregnancies, preeclampsia, gestational
diabetes, hospitalization during pregnancy, mode of birth and fetal outcome.
Results: 736 women >40 years at conception were treated in our department;
618 births resulted of these pregnancies. 260 patients were included in the
study: ED 47, IVF 71, spontanous 140. The group EDdiffered in several clinically
relevant parameters from the IVFand the SCgroups. The following were higher
in the ED group: age (45,0 vs. 41,6 vs. 41,6), percentage of multiple pregancies
(53,3% vs. 40% vs. 5.9% p<0,001), preeclampsia (24,4% vs. 11 vs. 4,4%),
caesarean section rate (97,6% vs. 79% vs. 59%) , whereas gestational age (34,2
vs. 36,8 wks, p<0,01) and birth weight (2349g vs. 2627g vs. 2971g, p<0,01) were
significantly lower. There was no maternal or fetal mortality; one patient of the
ED group had to be transferred to the Intensive Care Unit because of postpartum myocardiopathy and recovered after 9 days of treatment.

Abstract Book

Conclusion: Mode of conception had a decisive impact upon the course of

pregnancy and on fetal outcome. These results may be used for counselling of
women before IVF or ED.

Image / Graph:

Disclosure of Interest: None Declared

O59
COGIParis-1069
LAPAROENDOSCOPIC SINGLE-SITE SURGERY (LESS) FOR HUGE OVARIAN CYSTS
A. Alobaid
King Fahad Medical City, Riyadh, Saudi Arabia
Problem Statement: Many patients with huge ovarian cysts are managed by
laparotomy. We present our experience with 9 Patients who had
Laparoendoscopic single-site surgery (LESS) for huge ovarian cysts ranging
between 20 to 30 cm in diameter. The objective of this review is to assess the
feasibility, safety and operative outcome of the management of huge ovarian
cysts by LESS.
Methods: We performed a retrospective chart review for all patients who
underwent LESS for huge ovarian cysts that were 20 cm or more in diameter at
our hospital. We analyzed the patients age, body mass index (BMI), tumor
maximum diameter as measured by ultrasound, operative time, estimated blood
loss (evaluated by the hemoglobin drop after the surgery), amount of fluid
drained from the cyst and the histopathology result. All patients had normal
tumor markers and the radiologic evaluations were in favor of a benign nature
of the cysts (figure 1). The procedures were performed through a 2.5 cm
umbilical incision. Using the open technique, initially the cyst surface was
evaluated, that was followed by drainage of the cystic fluid if the initial
evaluation supports a benign nature of the cyst. The surgery was then done
similar to procedures performed using the conventional technique. The
specimens were retrieved through the umbilical incision.
Results: The patient's chracteristics and the results are shown in the below table.
All patients had benign cysts. The median patients age was 25 years. The mean
BMI was 26.96 (21.9-29.6). The mean tumor size was 22.3 cm (20-30). The mean
mount of fluid aspirated from the cysts was 3644 ml (500-8500). The mean
operative time was 78.4 minutes (56-109) and the mean drop in hemoglobin was
0.5 gm/dl (0- -1.7). There were no operative complications. Figures 2 and 3 show
the images of a patient with a huge cyst before and after the surgery with no
visible scars.
BMI
(cm/m2)

Cyst
maximum
diameter
(cm)

Operativ
e time
(min)

Hgb
drop
(gm/
dl)

flui
d
drai
ned
(ml)
850
0

procedu
re
perform
ed

pathol
ogy

22

25.7

30

109

-1.3

Salpingo
oophere
ctomy

-0.1

500

-1.4

540
0

56

NA

250
0

Cystecto
my
Salpingo
oophere
ctomy
Cystecto
my

Mucino
us
Cystade
noma
Terato
ma
Terato
ma

24

29.6

20

76

25

26.2

28

88

25

28.2

20

27

21.9

23

71

200
0

Cystecto
my

27

27.6

27

95

0.1

800
0

Salpingo
oophere
ctomy

24

27

20

88

0.2

31

28.2

20

58

-1.7

130
0
110
0

Cystecto
my
Salpingo
oophere
ctomy

34

28.3

22

65

-0.2

350
0

Salpingo
oophere
ctomy

(years)

age

Mucino
us
Cystade
noma
Serous
Cystade
noma
Serous
Cystade
nofibro
ma
Terato
ma
Mucino
us
Cystade
noma
Mucino
us
Cystade
noma

Conclusion: With proper patient selection and expertise, we believe that LESS
may be a safe and favorable surgical option for the management of patients with
huge ovarian cysts and provides a great cosmetic benefit. The short-term
outcome evaluated by the operative time, complications and blood loss was
satisfactory.
Disclosure of Interest: None Declared

060
DO SONOGRAPHIC FINDINGS OF RESIDUA TWO WEEKS AFTER PREGNANCY
TERMINATION WITH MIFEPRISTONE INDICATE FAILURE?
J. Amer - Alshiek 1,* and Jonia Amer-Alshiek, MD, MSc;1 Osama Shekh, MD2
Arnon Agmon, MD;1 Yifat Ochshorn, MD;1 Dan Grisaru, MD, PhD1
1Obsteterics and gynecology, Tel Aviv medical center, Tel Aviv, Israel
Problem Statement: The objective of the study was to determine if uterine
transvaginal sonographic (TVS) findings suspicious for residua 2-4 weeks after
medical termination of pregnancy (MTOP) with mifepristone indicate a failure of
the procedure as determined by the pathology results of surgical intervention
by hysteroscopy/curettage.
Methods: The records of 301 consecutive women undergoing MTOP with
mifepristone (600 mg orally) followed by misoprostol (400 mcg orally) 36-48
hours later between 7/2010-7/2011 were studied retrospectively. The imaging
protocol included a TVS study at two weeks following MTOP. Surgical TOP was
offered when pregnancy was found to be ongoing, and either
hysteroscopy/curettage or a repeat TVS two weeks later was offered when the
endometrium appeared to be thick and irregular with a positive Doppler flow.
The rate of women positive for residua was calculated, and TVS results were
compared to the pathology findings following hysteroscopy/curettage.
Results: The highest rate of women who had TVS findings suspicious for residua
was observed at two weeks following mifepristone/misoprostol administration.
This rate declined as the interval between the imaging evaluation and
mifepristone/misoprostol administration was longer (i.e., up to 10 weeks).
Conclusion: TVS findings suspicious for residua two weeks following MTOP by
mifepristone/misoprostol administration do not conclusively indicate a failure of
the pregnancy termination procedure. It is recommended that imaging studies
should be done two weeks following mifepristone administration to rule out
ongoing pregnancy, and again after another four weeks for women with
suspicious residua before diagnosing procedural failure.
Disclosure of Interest: None Declared

O61
WHICH HORMONE REPLACEMENT THERAPY (HRT) AFTER HYSTERECTOMY?
M. Aref-Adib 1,*, F. Bano 2, B. Lamb 3, A. Ahmed 4, J. Barrington 5
1Obstetrics and Gynaecology, QUEENS HOSPITAL, Romford, 2Obstetrics and
Gynaecology, QUEENS HOSPITAL, 3Centre for patient safety and service Quality,
Dept of Surgery,, Imperial College, London, 4Liverpool University Medical School,
Liverpool University, Liverpool, 5Obstetrics and Gynaecology, Torbay Hospital,
Torquay, United Kingdom
Problem Statement: The role of HRT in womens health is controversial. Evidence
is lacking in the use of HRT following TH/SH/BO for benign conditions including
endometriosis. Current practice in the UK has not previously been defined. We
set out to ascertain the preferences of UK gynaecologists regarding the type and
the route of HRT prescribed after total hysterectomy (TH), subtotal
hysterectomy (SH) and bilateral oophorectomy (BO) for benign condition
including endometriosis.
Methods: A questionnaire to assess the type and route of HRT prescribed
following TH/SH/BO for benign conditions and endometriosis was sent out to

43

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

400 UK O&G Consultant, randomly selected from the RCOG Members and
Fellows Database. Postal surveys were sent with a covering letter informing
participants about the nature of the study. Participation was opt-in, and consent
was implied by participation.
Results: 212 (53%) UK O&G consultants responded; 81% from district general
hospitals, 19% from teaching hospitals. Regarding benign conditions (nonendometriosis) 96% would prescribe oestrogen only HRT following TH/BO, 2%
favour combined oestrogen and progesterone preparations, 2% prescribe
different combinations. Following SH/BO 55% would prescribe oestrogen only
HRT, 32% favoured combined oestrogen and progesterone, and 13% other
combinations. Regarding TH/BO for endometriosis, 42% would prescribe
oestrogen only HRT, 39% combined oestrogen and progesterone preparations,
9% preferred Tibolone, 7% other combinations, and 2% would not offer HRT.
Following SH/BO for endometriosis, 42% would prescribe combined oestrogen
and progesterone preparation, 29% oestrogen only, 17% Tibolone, 7% other
combinations and 5% would not prescribe HRT.
Conclusion: Our results suggest that prescribing practice in the UK for HRT
following hysterectomy are varied, reflecting the lack of available evidence.
Decision-making should be shared between patients and health care providers,
and should take account of benefits and risk and a patients individual
circumstances.
Disclosure of Interest: None Declared

O62
THE INNOVATIVE APPROACH TO PI3K/ACT-SIGNALLING PATHWAY
UNBALANCE IN ENDOMETRIAL HYPERPLASIA AND ITS MODULATION WITH
MICRONIZED PROGESTERONE
A. Asaturova 1,*, M. Dumanovskaya 2, G. Chernukha 2, E. Kogan 1, N. Fayzullina 1
1
2
pathology,
gynecological
endocrinology,
Federal
State
Budget
Institution"Research Center for Obstetrics, Gynecology and Perinatology",
Moscow, Russian Federation
Problem Statement: Molecular and biological implications of endometrial
hyperplasia (EH) development and treatment impact are very important and at
the same time are poorly investigated. Therefore the purpose of our research is
to investigate PI3K/Act -signalling pathway disbalance in endometrial
hyperplasia (EH) and endometrial endometrioid adenocarcinoma (EEA) and
possibility to modulate them with micronized progesterone in simple EH.
Methods: 113 patients with simple EH (n=64), complex EH (n=15), atypical EH
(n=8), EEA (n=11) and control group (proliferative endometrium, n=8) were
examined morphologically and immunohistochemically (patients with simple EH
before and after treatment). The patients with simple EH were treated with
MP (400 mg/day) and subdivided into 2 groups: the group A was treated during
14 days (n=31), the group B during 21 days (n=33). Expression of estrogen and
progesterone receptors (ER and PgR), Ki-67, NDRG1, PTEN and BIRC 5 was
investigated in endometrial glands.
Results: Non-atypical EH into atypical EH transformation results in 1.1-fold Pg/ER
correlation increase, 1.6-fold proliferative activity increase, tumor
suppressor expression decrease (1.1-fold on the basis of both NDRG1 and
PTEN). Atypical EH into EEA transformation involves 1.1-fold Pg/ER correlation
increase, 1.4-fold proliferative activity increase, tumor suppressor expression
decrease (1.3-fold on the basis of PTEN and 1.1-fold both NDRG1 and PTEN).
After MP treatment simple EH regression was observed in both groups (group A
75%, group B 84,6% (>0,05),secretory transformation of endometrium (STE)
developed in 47,2% and 38,5% accordingly, endometrial decidualization (ED)
in 46,1% and 27,8% accordingly. Because either STE or ED was registered in both
groups, immunohistochemical results depended only on the endometrial
reaction, but didnt depend on MP regimen. Thus, ER expression was 137.545.5
in simple EH, 6510 in STE, 39.5 8.4 in DE (the control group 175.112.2). PgR
expression was 139.444.3 in simple EH, 797.4 in STE, 80.76.7 in ED (the
control group: 236.41.9). Ki-67 expression was 25.610.5 in simple EH, 7.61.3
in STE, 2.70.8 in ED (the control group: 73.50.7). BIRC 5 expression was
75.917.8 in simple EH, 6010 in STE, 37.24.5 in ED (the control group:
75.716.3). PTEN expression was 98.12.9%, in simple EH, 100% in STE and DE
(the control group 100%). NDRG1 expression was 81.523.6% in simple EH,
82.120.1 in STE, 32.112.1 in DE (the control group 957.1)

44

Conclusion: Transition from less to more severe types of EH and further to EEA
induces changes in ER/PgR correlation, proliferation, apoptosis and tumor
suppressors activity. Differences between non-atypical EH and atypical EH and
between atypical EH and EEA were statistically significant for all markers,
p<0,05). It is PI3K/Act -signalling pathway unbalance that plays the key role in
pathologic changes progression in endometrium (BIRC5, PTEN and NDRG1 are
the components of this pathway). Simple EH treatment with MP leads to ER, PgR,
Ki-67, BIRC5, NDRG1 and PTEN expression decrease and differences between
endometrial samples before and after the treatment were statistically significant
for all markers except NDRG1, p<0,05). These changes were twofold-fourfold
more evident in ED than in STE. Thus, 21-days regiment suppresses proliferation,
activates apoptosis and may impact PTEN expression more powerfully than 14days regimen.
Disclosure of Interest: None Declared

O63
COST EFFECTIVENESS OF MINIMALLY INVASIVE VAGINAL HYSTERECTOMY
USING ERBE BICLAMP FORCEPS: ENOUGH TO INCENTIVISE CHANGE FROM
CONVENTIONAL COUNTERPARTS?
G. Blayney 1,*, J. Beirne 1, L. Hinds 1, D. Quinn 1, G. Dorman 1
Obstetrics and Gynaecology, Antrim Area Hospital, Antrim, United Kingdom
Problem Statement: Hysterectomy is a common gynaecological procedure. The
vaginal approach has fewer complications than its abdominal counterpart. Yet
difficulties regarding technique, access and ease of surgery have previously
hindered the use of the vaginal approach. In addition, recent significant
advances in electro-surgery, coupled with ever-increasing time pressures and
demands for cost reduction have resulted in a vast increase in electro-surgery.
The ERBE BiClamp bipolar vessel sealing system (BVSS) is helping to increase
the preference for vaginal hysterectomy through its ease of access and
simplified, yet similar technique, thus reducing the learning curve. It is a safe,
effective alternative to conventional methods of suture ligation and confers
better outcomes on post-operative complications, hospital stay and analgesia
requirements. However, little literature is available on its economic value over
alternatives. Accordingly, we investigated the cost effectiveness of Biclamp
vaginal hysterectomy.
Methods: We conducted a retrospective 200-case review of vaginal
hysterectomy using the ERBE BiClamp BVSS performed by a single surgeon over
a 7-year period. Data was collected on patients undergoing Biclamp Vaginal
hysterectomy (VH) +/- Bilateral Salphingoophrectomy (BSO) (vaginal or
laparoscopic) or pelvic floor repair (PFR). Data obtained included surgery
duration, post-operative analgesia requirements, length of hospital admission
and complication rate. Estimated costs provided by Hospital Procurement were
obtained for hospital admission and BiClamp vaginal hysterectomy.
Results: Operating time, defined as time from knife-to-skin to close (or GA time
where knife-to-skin time was not available) was available for 98% of patients:
64% of operations took < 60 minutes - 78% of Biclamp VH +/- vaginal BSO/PFR
and 27% of Biclamp VH + Laparoscopic BSO. The median was 55 minutes (range
23 - 157minutes) 76.5% of patients required simple analgesia postoperatively:
an average of 2.58 doses/day of paracetemol or codeine and 0.8 doses/day of
non-steroidal anti-inflammatories. Of those requiring opioid analgesia 77%
needed >/= 5mg morphine/day. Mean post-operative stay was 2.1 days; 89%
were discharged on post-operative Day 3 or earlier; 37% on Day 1. Complications
were minimal: bladder injury 2.5%; ureteric injury 0.5%; bowel injury 0%;
conversion to open 2%; blood transfusion 1%; return to theatre 2.5%; and
readmission 2%. Long term complication rate was 2.5%: persistent pelvic pain
and prolapse. The average cost for Biclamp VH was 3145, 29% cheaper than
LAVH/TLH, with 1 night admission to the gynaecology ward costing 1346.
Conclusion: These findings, we believe to be the largest documented for a single
surgeon, highlight the ERBE Biclamp BVSS in vaginal hysterectomy as a safe and
effective alternative to conventional methods. In comparison to published data
on its alternatives, Biclamp confers quicker operation times, quicker recovery,
with less analgesic requirements resulting in shorter post-operative hospital
admission, and without compromising on safety or long-term outcome. The use
of Biclamp forceps is an innovative technique which should be considered as
first line in minimally invasive hysterectomy and overcomes obstacles that have

Abstract Book

previously hindered the vaginal approach. Biclamp confers greater benefit to

the patient, surgeon and hospital.
Disclosure of Interest: None Declared

O64
WAYS OF COPING WITH STRESS AND GIVING SOCIAL SUPPORT FOR
CAREGIVERS OF PATIENTS WITH GYNECOLOGIC CANCER
M. Demirgoz Bal 1, S. Dereli Ylmaz 2,*, N. Kzlkaya Beji 3, M. Arvas 4
1
Obstetric and Gynecological Nursing, School of Nursing, Karaman, 2Department
of Midwifery, Selcuk University Health Sciences Faculty , Konya, 3Florence
Nightingale Nursing Faculty, Istanbul University, 4Obstetri and Gynecology,
Istanbul University Cerrahpasa Health Faculty , Istanbul, Turkey
Problem Statement: Cancer affects not only the patients but also their
caregivers. The aim of this study was to determine whether ways of coping with
it are related to social support given to caregivers of patients with gynecologic
cancer, or not.
Methods: The descriptive study was performed in The Gynecological Oncology
Department of Cerrahpasa Medical School of Istanbul University. Approval was
obtained from the ethical board of the institution.
The study was performed as a cross-sectional design in a university hospital in
Istanbul, Turkey, with 200 caregivers the data were collected via 3
questionnaires, the first with socio-demographic features, the second with
multidimensional scale of perceived social support, and the third with the scale
of ways of coping with stress.
Results: The characteristics of participants have been summarized in Table 1.
n
%
Marital status
Educational status

Professional status
Relative Level

Unmarried

52

26.0

Married

148

74.0

Primary school and

under
Secondary school and
over
Employed

102

51.0

98

49.0

55

27.5

Unemployed

145

72.5

First level

135

67.5

Second level
65
32.5
Mean age rate and care duration of our participants were 41.06 (SD, 11.5) years,
14.0 (SD, 36.5) months, and 2.4 (SD, 2.7), respectively. The ECW and ICW mean
scores of women were 30.13 (SD, 7.74) and 14.44 (SD, 7.06), and the total score
of the MSPSS was 58.59 (SD, 20.46).
Conclusion: Social support is the basic of coping with stress for caregivers of
patients with gynecologic cancer. In line with these findings, it is recommended
that caregivers should be given a social support. Such caregiver should be backed
up further in order to increase social support by family and friends, and
governmental and non-governmental organizations.
Disclosure of Interest: None Declared

O65
ATOSIBAN: THE CLINICAL EXPERIENCE IN PREVENTION OF PRETERM DELIVERY
B. Dewan
Medical Department, Zuventus Healthcare Limited, Mumbai, India
Problem Statement: Preterm birth is one of the major causes of perinatal
morbidity and mortality. India has the highest number (3.5 million) of preterm
births in the world. Management of preterm labor thorough tocolysis is an
established clinical strategy. Most of the tocolytics are not utero-specific;
therefore, multi-organ fetomaternal side effects are expected. Atosiban, an
oxytocin receptor antagonist, is a uterine specific tocolytic with more favorable
safety profile. The current study was conducted to establish the efficacy and
safety of atosiban (7.5 mg/ml) in Indian population
Methods: This was a prospective, open label, non comparative study conducted
at Lokmanaya Tilak Municipal Medical College Mumbai, India. The study was
performed in accordance with the Declaration of Helsinki, Good Clinical Practice

(GCP) guidelines and the protocol was approved by the institutional ethics
committee of the hospital. Pregnant Indian women (n=110) between the
gestational age of 24 to 34 weeks, presenting preterm labour were enrolled in
the study. Atosiban was administered as intra venous (i.v.) infusion for 48 hrs.
The treatment was initiated by an initial bolus dose (6.75mg), then continuous
high dose infusion (300g/min) for a period of 3 hours followed by 100g/min
up to 48 hrs. Efficacy was assessed by the proportion of women remaining
undelivered for a period of 72 hrs and not requiring an alternative tocolytic
within 48 hrs post administration of study medication. Safety and tolerability of
atosiban was assessed in terms of maternal and fetal side effects. The study was
registered with Clinical Trial Registry of India with the registration
number: CTRI/2013/11/004166 [Registered on: 22/11/2013]
Results: Out of 110 patients enrolled in the study, 98 patients (89.09%) remained
undelivered up to 72 hrs after completion of 48 hrs treatment phase. Ninety
seven patients (88.18%) remained undelivered till the end of their hospital stay
(upto 7 days). There were 7 patients with multiple birth pregnancy. Atosiban
therapy was successful in delaying labor for 72 hrs in all the 7 patients who had
multiple birth pregnancy. None of the patients required any alternative tocolytic
agent or retreatment with atosiban throughout the study period. The study
medication was well tolerated as no adverse events were observed throughout
the study duration.
Conclusion: Atosiban, an oxytocin receptor antagonist, has proven to be an
effective tocolytic drug in Indian pregnant females for the management of
preterm labour with a better safety profile.
Disclosure of Interest: B. Dewan Employee of: Zuventus Healthcare Limited

O66
FOLIC ACID SUPPLEMENTATION IN THE MANAGEMENT OF MENOPAUSAL
SYMPTOMS IN CANCER SURVIVORS AND HEALTHY POSTMENOPAUSAL
WOMEN (FOAM TRIAL) LAUNCHING A NEW RCT
A. Ewies
Gynaecology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham,
United Kingdom
Problem Statement: Hot flushes are experienced by 75% of menopausal women.
Oestrogen was shown to ameliorate hot flushes by reducing noradrenaline and
increasing serotonin in the brain. Hormone replacement therapy (HRT), the first
treatment option, causes concerns over possible increased risks particularly
breast cancer. There is emerging evidence that folic acid supplementation
ameliorates hot flushes by the same mechanism as oestrogen.
Methods: To explore this hypothesis, we designed a national multi-centre (8
centres in the UK), phase III, double-blind, placebo-controlled randomized to
primarily compare the effect of 5 mg folic acid capsule daily for 12 weeks v
placebo (randomized on 1:1 basis) in reducing the frequency and severity of hot
flushes (using the validated Hot Flush Score) in postmenopausal women (both
healthy and breast and endometrial cancer survivors). The secondary objectives
are to study the efficacy on other menopausal symptoms (using Greene
Climacteric Scale) and quality of life domains (using Utian Quality of Life Scale).
The exploratory translational objectives are to assess the effect on the blood
levels of serotonin and nor-adrenaline, and to measure the correlation between
clinical improvement, serum folic acid levels and blood levels of serotonin and
nor-adrenaline.
Results: Not available yet.
Conclusion: I would like to present as the chief investigator, for the first time in
a scientific international meeting, the hypothesis, rational, methodology of this
important RCT. If folic acid supplementation is demonstrated to be effective, it
will be a turning point in the clinical practice since it represents a cheap, safe,
easily deliverable and well-tolerated alternative to the conventional HRT.
Disclosure of Interest: None Declared

O67
THE ASSOCIATIONS BETWEEN THE CODON 72 POLYMORPHISM OF TP53 GENE
AND THE RISK OF ENDOMETRIOSIS: A COMPREHENSIVE META-ANALYSIS
Y. Feng 1,*, Y. Wu 2, Z. Luo 2, Z. Lin 2, X. Zhao 1
1Department of Gynecology and Obstetrics, West China Second University
Hospital, Sichuan University, Chengdu, 2Department of Gynecology and

45

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

Obstetrics, Affiliated Ruikang Hospital, Guangxi University of Chinese Medicine,

Nanning, China
Problem Statement: Endometriosis is a chronic, inflammatory and one of the
most common gynecological diseases that characterized by the presence of
functional endometrial glands and stroma outside of the uterine cavity, which
affects approximately 6-15% of women in reproductive age. The TP53 codon 72
polymorphism has been implicated in susceptibility to endometriosis, but many
researchers
have
reported
inconclusive
results.
The aim of this article is to investigate the associations between TP53 codon 72
polymorphism and the risk of endometriosis.
Methods: A comprehensive search for relevant articles was conducted in
PubMed, Embase, CNKI, Wanfang, and Weipu database, and Google Scholar
until August 13, 2014. The odds ratios (ORs) and 95% confidence intervals (CIs)
for CC + GC vs. GG genotype, CC vs. GC+GG genotype, CC vs. GG genotype, GC
vs. GG genotype, and for C vs. G allele were estimated. Publication bias and
sensitivity analysis were explored. Statistical analyses were performed using the
RevMan 5.2 software and Stata 11.0 software.
Results: A total of 13 case-control studies in 12 articles with 2552 endometriosis
cases and 2749 controls were included. Overall random-effect OR of 1.49 (95%
CI, 1.161.90) in the dominant model (CC + GC vs. GG) was found. The results
suggested that individuals who carried CC homozygote and heterozygote GC
might have a 49% increased endometriosis risk compared with the homozygote
GG. In the subgroup analysis by ethnicity, significantly increased risk was
observed among Asians (OR, 1.97; 95% CI, 1.392.80; P = 0.0002) and Latin
American (OR, 1.66; 95% CI, 1.142.42; P = 0.009) but not in Caucasians (OR,
0.99; 95% CI, 0.77-1.28; P = 0.93) in the dominant model.
Image / Graph:

application was performed to women in the intervention and placebo groups for
a period of 6 weeks, twice a week for 25 minutes for each session, totally 12
sessions. The reflexology, applied to ntervention group was performed by the
researcher and non-spesific foot massage in the plasebo group were performed
by trained assistant researcher. The data were collected by using identification
and evaluation form, visual analog scale, menopause-specific quality of life scale
and hot flash diaries. Data obtained were evaluated by Chi-Square test, t-test
and Mann Whitney U test. In all tests, the level of statistical significance was
taken as 0.05.
Results: It was detected that prior to intervention the hot flashes, sweating and
night sweats VAS score means of respectively, 8.1, 6.9 and 7.1 on the other hand
after the intervention, 5.7, 4.3 and 5.0 on the women in the placebo group.
Additionally It was detected that prior to intervention the hot flashes, sweating
and night sweats score means of respectively 7.5, 7.3, and 6.9 on the other hand
after the intervention, 3.3, 3.2 and 2.3 on the women in the intervention group.
The hot flashes, sweating and night sweats score avarage was decreased after
intervention in both group (p<0.05). However, after the application score
average in the intervention group was found lower than that in the placebo
group and, the difference between groups was determined to be statistically
significant (p<0.001). The mean scores of the vasomotor, psychosocial and
physical area which is the sub-group of Menopause-specific Quality of Life Scale,
improvement was detected on the both groups after the application (p<0.001).
In the sexual area while there was significantly improvement for intervention
group (p<0.05) no any improvement detected for placebo group (p>0.05).
Conclusion: The result of this study showed that reflexology was effective to
reduce vasomotor symptoms and to increase quality of life in menapousal
women.
Disclosure of Interest: None Declared
O69
ECHOGRAPHIC ASPECTS OF CESAREAN SCARS IN NON-PREGNANT UTERUS
AFTER SINGLE OR MULTIPLE CESAREAN SECTIONS
C. A. Ionescu 1,*, I. Pacu 1, D. Gheorghiu 2, H. Haradja 1, M. Banacu 2, C. Coroleuca2
1Obstetrics Gynecology, UMF Carol Davila,Clinical Emergency Hospital Sf
Pantelimon,Bucharest, 2Obstetrics Gynecology, Clinical Emergency Hospital Sf
pantelimon, Bucharest, Bucharest, Romania

Conclusion: This meta-analysis shows that the TP53 codon 72 polymorphism was
associated with the endometriosis risk, especially in Asian and Latin American
populations.

Disclosure of Interest: None Declared

O68
THE EFFECT OF FOOT REFLEXOLOGY APPLIED TO WOMEN AGED BETWEEN 40
AND 60 ON VASOMOTOR COMPLAINT AND QUALITY OF LIFE
E. Gozuyesil 1,*, M. Baser 2
1Cukurova University, Vocational School of Health Services, Adana, 2Erciyes
University, Nursing department, Kayseri, Turkey
Problem Statement: The hot flushes that common symptoms of menopause are
negatively affects the quality of the womens life. Althought Horman therapy
reduces hot flushes, it is not preferred by women for some risk factors. In order
to reduce vasomotor symptoms, non-hormonal method of treatment preferred
by women and in this regard refers to methods outside of modern medicine. This
method is generally called complementary or alternative medicine (TAT). The
Reflexology that is one of the applications of T.A.T, is one of the
nonpharmacological methods used in the treatment of diseases.
Methods: This is a randomized, placebo-controlled study which was performed
in order to determine the effect of foot reflexology applied to women aged
between 40 and 60 on vasomotor complaint and quality of life. This study was
performed with 120 women who presented to Balcal Hospital of Cukurova
University, Menopause Policlinic between 22.02.2013 22.02.2014. The ethical
approval was taken from Ethics Committee in order to perform the study. The

46

Problem Statement: The objectives of our study was to establish an association

between echographic parameters of the cesarean scar in non-pregnant uterus
and the number of previously performed Cesarean sections. Some studies have
proposed that thinning of lower uterine segment diagnosed by vaginal
ultrasound can predict the uterine rupture during labour.
Methods: The study group include 110 nonpregnant women with a history of
low transverse Cesarean section with single or 2 layer uterine closure. The
transvaginal ultrasound was performed to establish the parameters of the
cesarean scar: the thickness of the tissue scar segment, the triangular shaped
anechoic scar defect.
Results: The cesarean scar section was evidence with transvaginal ultrasound. In
98,4% of cases the scar was identified. In 24,4 % of cases the completely
hysterotomy scar tissue was identified. In 75,5 % of cases an anechoic triangle
identified as scar defect , was observed.
The thickness of the tissue scar segment varies with the number of cesarean
section. So the mean thickness after a single Cesarean section was 10,1 mm,
after two cesarean section was 8,1 mm and after 3 cesarean section was 4,4 mm.
We identified the basis of the triangle (P) and the height of the triangle (W) and
we made the the index Thickness/basis and thickness/height of triangle.
Conclusion: The thickness of the scar tissue segment and the index
thickness/height decrease with the number of cesarean section. Also there is no
diference according to single layer closure or two layer closure

Disclosure of Interest: None Declared

O70
A LARGE DOUBLE-BLIND EFFICACY AND SAFETY TRIAL OF CORIFOLLITROPIN
ALFA VERSUS DAILY RECOMBINANT FSH IN WOMEN 35 TO 42 YEARS OF AGE
UNDERGOING OVARIAN STIMULATION PRIOR TO IVF OR ICSI (PURSUE TRIAL).
B. Stegmann 1,*, R. Boostanfar 2, T. Yeko 3, B. Shapiro 4, J. Elbers 5, H. Witjes 5

Abstract Book

1Merck

& Co., Inc., Whitehouse Station, 2Huntington Reproductive Center,

Encino, 3The Reproductive Medical Group, Tampa, 4The Fertility Center of Las
Vegas, Las Vegas, United States, 5MSD, Oss, Netherlands

Problem Statement: To examine the efficacy and safety of a single injection of

corifollitropin alfa vs daily rFSH for ovarian stimulation in women aged 35-42
years.
Methods: In this phase 3, double-blind trial (noninferiority margin -8%), 1390
women were randomized to a single injection of 150 g corifollitropin alfa
(n=694) or daily 300 IU rFSH. (n=696) during the first 7 days of ovarian
stimulation. When required, they continued the cycle with daily rFSH (maximally
300 IU) until 3 follicles reached 17 mm. Ganirelix (0.25 mg) was started on
stimulation day 5. Recombinant human chorionic gonadotropin was given for
oocyte maturation. 2 embryos were transferred on day 3.
Results: Vital and ongoing pregnancy rates per started cycle were 23.9% and
22.2% in the corifollitropin alfa group and 26.9% and 24.0% in the rFSH group.
The estimated differences (95% confidence intervals) were -3.0% (-7.4 to 1.4) for
the vital pregnancy rate and -1.9% (-6.1 to 2.3) for the ongoing pregnancy rate.
The mean (SD) number of recovered oocytes was 10.7 (7.2) and 10.3 (6.8) in the
corifollitropin alfa and rFSH groups, respectively, with an estimated difference
of +0.5 (-0.2 to 1.2) oocytes. The incidence of serious adverse events (SAEs) was
0.4% vs 2.6% in the corifollitropin alfa and rFSH groups, respectively. The
incidence of AEs (SAEs) of moderate/severe ovarian hyperstimulation syndrome
was 0.7% (0%) vs 1.4% (0.7%), respectively.
Conclusion: Corifollitropin alfa was proven noninferior to rFSH in terms of
efficacy and was well tolerated in women aged 3542 years. Financial support
for this study was provided by Merck & Co., Inc.
Disclosure of Interest: B. Stegmann Shareholder of: Merck, Employee of: Merck, R.
Boostanfar Grant / Research support from: Merck, T. Yeko: None Declared, B. Shapiro: None
Declared, J. Elbers Shareholder of: Merck, Employee of: Merck, H. Witjes Shareholder of:
Merck, Employee of: Merck

071
THE EFFICACY OF A NEW REGIMEN OF DAILY GNRH ANTAGONIST
ADMINISTERED FROM DAY 6 OF MENSES FOR CONTROLLED OVARIAN
STIMULATION IN IVF/ICSI.
K. J. Thong 1,*, F. Shakur 1, R. Bano 1, S. Pickering 1
1Reproductive Medicine, Edinburgh Royal Infirmary, Edinburgh, United Kingdom
Problem Statement: The efficacy of a new regimen of daily GnRH antagonist
administered from day 6 of menses for controlled ovarian stimulation in IVF/ICSI.
The primary objective was to see the efficacy of this new regimen of daily GnRH
antagonist Cetrorelix/Ganirelix) administered from day 6 of menses for
controlled ovarian stimulation. GnRH antagonists are increasingly used in IVF
treatment. GnRH antagonists result in down regulation of pituitary by binding to
GnRH receptors and prevent endogenous LH surge. The IVF clinical pregnancy
rate using GnRH antagonist is similar to GnRH agonist and is known to have a
lower incidence of OHSS. Although premature LH surge has been reported in
GnRH antagonist treatment cycles, there is no large study on the use of GnRH
antagonist using this new regimen.
Methods: This study is a retrospective analysis of consecutive GnRH antagonist
IVF /ICSI cycles over a period of nearly 6 years in a University teaching hospital.
Women with polycystic ovary syndrome (PCOS) were excluded from analysis and
the total number of treatment cycles was 408. Serum oestradiol/LH was
measured on day 6 of menses and every visit until ovulation trigger.
Women in the study had regular menses (25-35 days) and BMI < 32
kg/m2. Ovarian stimulation was started from 2 to day 3 of menses. The dose of
gonadotrophin for ovarian stimulation was individualised according to AMH
level and antral follicle count. The GnRH antagonist (Cetrorelix/Ganirelix) was
started from day 6 of menses in a daily dose of 0.25mg.
Results: Premature LH surge was observed in five (n=5/408), 1.2% of women
who had IVF/ICSI treatment. The median (range) age of women having
treatment was 34 (20-44) years. The median (range) of days of ovarian
stimulation and oocytes retrieved were 11 ((6-20) and 11(1-32) respectively.
Women had a maximum of two embryos replaced. The overall clinical pregnancy
rates were 37.8% (102/270) in women up to 35, 35.1% (39/111) in women 3639 and 11.1% (3/27) for women 40 and over. Of the five women who had

premature LH surge, 3 had clinical pregnancy (60%) and one had all embryos
electively frozen because of risk of OHSS and one failed to conceive. The
incidence of failed fertilisation was 0.9% (4/408) and a total of 19 (4.6%) women
had embryos electively frozen because of risk of OHSS.
Conclusion: This large study demonstrated the efficacy of using this GnRH
antagonist regimen for controlled ovarian stimulation. The incidence of
premature LH surge was low (1.2%) and the findings suggest that serum LH
measurement during treatment may be omitted with no detriment to clinical
outcome. Further studies should be carried out to confirm these findings.

Disclosure of Interest: None Declared

O72
REPRODUCTIVE HEALTH PROBLEMS IN WOMEN WITH DISABILITIES
M. Ugurlu 1,*, T. YAVAN 1
Obstetrics and Gynecology Nursing, GULHANE MILITARY MEDICAL ACADEMY,
Ankara, Turkey
Problem Statement: To determine the reproductive health problems of the
women with disabilities.
Methods: Data which is obtained by scanning databases (Ebscohost, Ovid,
Science Direct, and Google Scholar), magazines and related literature is
evaluated.
Results: World Health Organization determined disability rate of 12% for
developing countries. Women constitute the majority of people with disabilities.
They live the diffuculties of both being woman and disable. Disabled
womens health is affected negatively because of their physical limitations,
psychological problems, and economical problems, lack of education and
attitudes of social enviroment. These problems increase the risk of health
problems of women with disabilities. In society, sexual lives of disabled
individuals are treated as an unknown and ignored issue, and moreover it has
been assumed that they have no such needs. Whereas the sexuality of disabled
people is one of the important areas for quality of life. Disabled women look for
gynecological care but can not reach. Therefore, women with disabilities are
faced with reproductive health problems more often compared to other women.
Disabled womens reproductive health problems can be classified as menstruel
cycle, sexuality, family planning, pregnancy and parenting. Disability does not
affect usually menstruation, fertility or sexual response. Many women with
disabilities are considered asexual and sexual health are ignored. These women
are in need of information about family planning. Women with disabilities are
exposed to social pressures on parenting. Their family and friends, as well as
medical personnel tend to discourage them the desire to have a child.
Considering all these problems of women with disabilities, reproductive health
needs should not be overlooked.
Conclusion: Women with disabilities is a group that should be seriously
considered because of the importance reproductive health problems. Health
workers should be educated about their reproductive health problems and
awareness should be increased. Reproductive health programs should be
prepared training materials according to the needs of women with disabilities.
The education of women with disabilities should also be included their families
and husbands.
Disclosure of Interest: None Declared

073
SHOULD TUBAL PATHOLOGY BE SURGICALLY MANAGED PRIOR TO IVF - YES OR
NO?
S. Babu 1,*, Y. Beebeejaun 2, D. Rajeswari 3
1Imperial College Healthcare NHS Trust, 2Queen Elizabeth Hospital, London,
3Ashford & St. Peter's Hospital NHS Trust, Chertsey, United Kingdom
Problem Statement: Tubal disease is responsible for around 14% of cases of
subfertility in women. Hydrosalpinx, distorted tubal anatomy and pelvic
adhesions have been known to cause lower implantation rates and increase risk
of miscarriage after assisted reproductive techniques such as in-vitro fertilisation
(IVF). Hydrosalpinx is the most common form of tubal pathology. It is believed
that the excessive amount of fluid in this condition compromises transfer of the
embryo and implantation. Furthermore this fluid is thought to have detrimental

47

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

effects on the embryos growth and maturity. Performing a surgical procedure

prior to IVF is thought to increase its chances of success. Salpingectomy,
salpingostomy, surgical management of hydrosalpinx and tubal ligation are all
frequently performed before commencing IVF. In this presentation, we aim to
explore the various surgical options available and present the success rates of
each. Methods: We carried out literature searches on MEDLINE, PUBMED and
consulted the recent Cochrane Review which included five randomised
controlled trials in its analysis. This review analysed the success rates of IVF after
surgery in subfertile women. The primary outcome measure in the literature was
live birth. Secondary outcomes included an ongoing pregnancy, viable
pregnancy and a clinical pregnancy.
Results: We found that performing a laparoscopic salpingectomy prior to IVF was
associated with an increased chance of a successful pregnancy. This benefit has
been documented many times and the Cochrane review further supports it.
Laparoscopic occlusion of the tubes was also shown to improve the odds of
clinical pregnancy. In our presentation, we will outline the chances of a
successful pregnancy with each potential surgical procedure before IVF.
Conclusion: After statistical analysis of the probabilities of achieving a
pregnancy, we recommend women suffering from tubal pathology undergo
surgical management prior to commencing an IVF cycle. Through this poster we
aim to remind delegates on the current surgical managements available and the
success rates associated with each one.
Disclosure of Interest: None Declared

O74
CALCIUM GLUCONATE AS A PREVENTIVE THERAPY FOR OVARIAN
HYPERSTIMULATION SYNDROME
A. Salve
Srishti assisted fertility and advanced laparoscopy centre, Pondicherry, India
Problem Statement: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic
condition and potentially life threatening complication of ovarian stimulation. It
complicates almost 33% of stimulated ovarian cycles. It is categorized into mild,
moderate, severe and critical forms. Incidence of moderate form varies between
3-6% and severe form between 1-2% of stimulated cycles.
The treatment for OHSS is mainly supportive. Primary and secondary preventive
measures form the mainstay of management. Our study aims at evaluating the
effectiveness of intravenous infusion of calcium gluconate in reducing the
incidence of severe ovarian hypersimulation syndrome in high risk patients
undergoing assisted reproductive techniques.
Methods: We conducted an interventional study in our center from October
2013 to April 2014. Patients included were women attending our clinic between
20 and 40 years of age, with an antral follicle count exceeding 15 and an FSH
level between 3-10 mIU/ml; undergoing the long agonist protocol in whom more
than 20 oocytes were retrieved. They were given intravenous infusion with 10
ml of 10% calcium gluconate solution in 200 ml normal saline on the day of ovum
pick up and continued thereafter on day 1, day 2 and day 3, subsequently.
Results: The incidence of OHSS among stimulated cycles (n=63) after intravenous
infusion of calcium gluconate was 19 %( n=12)
Among them, there was not a single case of severe OHSS. Incidence of moderate
OHSS was less than 3%.
Conclusion: Conclusion OHSS is a well known complication of ovarian simulation.
This can lead to life threatening complications if not recognized early. Calcium
gluconate infusion can be an important preventive strategy to reduce the
occurrence of OHSS and its complications in high risk patients.
Disclosure of Interest: None Declared

O75
THE NEW METHOD OF TREATMENT OF THIN ENDOMETRIUM DURING THE
PREPARATION OF PATIENT TO IVF PROGRAM- AN ALTERNATIVE TO A
HORMONE THERAPY
M. Schneiderman 1,*, A. Kuzemin 1, K. Alieva 1, S. Pavlovich 1, E. Kalinina 1, V.
Smolnikova 1, L. Levkov 1, N. Mishieva 1
1RESEARCH CENTER OF OBSTETRICS, GYNECOLOGY AND PERINATOLOGY,
Moscow, Russian Federation

48

Problem Statement: Thin endometrium can be a cause of failed implantation and

reduction of pregnancy rates after IVF procedure during the treatment of
infertility. It is considered that the endometrium thickness less than 5-7 mm
(during the implantation window) provides minimal chance for successful
conception. We did not find in the literature any evidence about the treatment
of patients with thin endometrium by using the gas mixture (5% CO2 and 95%
N2) for stimulation of development of endometrium to enhance the blood
circulation and, as a result, to increase a thickness of basal and functional layers
of endometrium. Carbon dioxide in some concentrations is a great vasorelaxant.
It was shown that the local effect of the CO2 on the tissues is accompanied by
several mechanisms of action: an enhancement of blood flow, an increasing the
speed of oxygen consumption by tissue, an enhancement of metabolism in
organ tissue, a recovery of sensibility of some receptors, an increasing of
reparative processes, and the activation of fibroblasts.
Methods: In our study endometrium thickness (ultrasonography) was measured
three times repeatedly: first time before the inclusion of the patient into the
research program, second time during the treatment cycle and the third time
during the next cycle after the treatment. Ultrasonography was performed on
the 7th, 11th, 13th, 15th days of the menstrual cycle.Sixty five patients of the
fertile age with the diagnosed primary of secondary infertility with sign of thin
endometrium, which is not responding to medical treatment, participated in the
study. All patients were investigated by laboratory methods before infertility
treatment and transvaginal ultrasonography investigation.
Results: During the first ultrasonography before the gas ablution the thickness
of endometrium was in range between 3,1 mm and 5,9 mm in all patients. During
the second ultrasonographic investigation after 2 days after the first gas ablution
the endometrium thickness increased in different patients by 2,7-3,3 mm, and
after 2 days after the second ablution it was increased on additional 1,8-3,4
mm. After the third ablution endometrium thickness was in range of 7,3-10,8
mm.
Conclusion: In this study we demonstrated that in women with previous
repeated unsuccessful stimulation of endometrium by using hormone therapy
there is the evident trend of growth of endometrium thickness after treatment
with using ablution with gas mixture of Carbone dioxide and nitrogen.
Disclosure of Interest: None Declared

076
VERY RAPID SHRINKAGE OF LARGE UTERINE FIBROIDS BY ULTRASOUND
GUIDED HIGH INTENSITY FOCUSED ULTRASOUND ABLATION BASED ON
MAGNETIC RESONANCE IMAGING
J. H. Suh 1,*, S. H. Kim 2, P. J. Cho 2, K. J. Yoon 2
1Obstetrics and Gynecology, Gangnam St. Peter's Hospital, 2Obstetrics and
Gynecology, Gangnam St.Peter's Hospital, Seoul, Korea, Republic Of
Problem Statement: Noninvasive treatment of fibroids has recently emerged as
a highly desirable alternative to surgery. Although large fibroids are indicated for
laparotomy, increased risk of morbidity related to major surgery has led
physicians to seek minimally invasive treatment modalities. Since High Intensity
Focused Ultrasound (HIFU) ablation was first reported to be a feasible treatment
for uterine fibroids in 2003, numerous clinical studies were actively performed
worldwide revealing data that suggest HIFU may be an efficient nonsurgical
therapy, reducing the volume of fibriod by delivering intense acoustic sonication
energy to induce coagulative necrosis at a focused region of fibroid. We selected
patients diagnosed of large fibroids and evaluated the immediate therapeutic
effects of ultrasound-guided HIFU (USgHIFU) ablation on large fibroids not
feasible for pelviscopy based on MRI imaging.
Methods: Between June 2014 and August 2014, 30 symptomatic patients (mean
age, 437 years) underwent USgHIFU ablation for large uterine fibroids defined
as more than or equal to 8 cm mean diameter at Gangnam St. Peters Hospital,
Seoul, Korea. Under the guidance of dynamic real-time ultrasonographic
imaging, fibroids were ablated using acoustic sonication power output of
average 410 W. Exposure time, T1-weighted and T2-weighted MRI imaging of
fibroid volume at pre- and post-treatment 24 hours were assessed. Volume was
calculated using the ellipsoid formula: D1x D2 x D3 x 0.523 (D1: longitudinal, D2:
anteroposterior, D3: transverse). The percentage of decrease in fibroid volume

Abstract Book

was calculated by 100 x (pretreatment volume post treatment volume) /

pretreatment volume.
Results: USgHIFU ablation was well tolerated in all patients. The mean exposure
time was 1318779 sec. uterine fibroids ranged from 8 cm to 21 cm. Mean
pretreatment volume of fibroid was 525.3367.4 cm3. Post-treatment MRI
showed statistically significant volume reduction of fibroid. The mean volume of
fibroid at 24 hours after procedure was 406.2304.3 cm3 (P<0.001 compared
with pretreatment volume). The absolute difference was 119.288.1 cm 3 and
the percentage of decrease in fibroid volume was 24.19.0%. When we
performed subgroup analysis in patients with huge uterine fibroid (mean
diameter 10 cm, n=18), the treatment effect was consistent. Fibroid volume
decreased significantly by USgHIFU ablation (703.5379.8 cm3 to 548.4321.1
cm3, P<0.001). The absolute difference was 155.197.5 cm3 and the percentage
of decrease in fibroid volume was 23.110.1%.
Image / Graph:

Methods: This is a prospective audit of the pre-treatment of symptomatic

uterine fibroids using Ulipristal acetate, particularly large fibroids. There are
indications that this preparation is efficacious in the treatment of symptomatic
fibroids before hysterectomy or myomectomy irrespective of site and size (Pearl
Study). Institutional research and audit board approval was obtained prior to the
audit and consent was obtained for imaging and use of the images presented.
We audited the effects of this medication in inducing amenorrhoea in women
with excessively heavy menstrual bleeding secondary to fibroids, effect on pain
and pressure symptoms and size reduction in 52 women with fibroids of varying
sizes and sites. We also analysed the effects on the treatment modality blood
loss at surgery, requirement for blood transfusion, planned versus actual
treatment undertaken and immediate post-operative or post-treatment
complication.
Results: The selective Progesterone receptor modulator Ulipristal, shows
promise with beneficial effects in some of the parameters studied. The results
are as presented.
Conclusion: Currently recommended pre-treatment for symptomatic uterine
fibroids are the gonadotrophic hormone release hormone analogues. The
introduction of Ulipristal acetate provides another treatment option with
possibly less side effects and equal efficacy that may be of benefit.
Disclosure of Interest: None Declared

078
THE EFFICACY OF THE PPH SHELF TO FACILITATE UTERINE COMPRESSION
USING A MANNEQUIN MODEL: A RANDOMISED CROSS-OVER STUDY
N. Aflaifel 1 2,*, A. Weeks 3, J. Porter 4, P. Watt 5
1Sanyu Research Unit, Department of Womens and Childrens Health, University
of Liverpool, Liverpool Women's , University of Liverpool, Libverpool, United
Kingdom, 2Department of Obstetrics and Gynecology, University of Omer AlMukhtar , Al-Bayda, Libya, 3Sanyu Research Unit, Department of Womens and
Childrens Health, University of Liverpool, Liverpool Women's Hospital, Liverpool,
4Electronic Product Supplies Limited, Wirral, 5Department of Clinical Engineering,
University of Liverpool, Liverpool, United Kingdom
Conclusion: Noninvasive ultrasound-guided HIFU ablation efficiently reduces
large fibroids within 24 hours of treatment, and may be a promising therapeutic
modality in patients with large fibroids not suitable for minimally invasive
surgery.
Disclosure of Interest: None Declared

O77
PRETREATMENT OF UTERINE FIBROIDS USING A SELECTIVE PROGESTERONE
RECEPTOR MODULATOR - ULIPRISTAL ACETATE
M. Wong 1,*, M. O. Thompson 1
Obstetrics & Gynaecology, Barking Havering & Redbridge University Teaching
Hospitals, Romford, United Kingdom
Problem Statement: Uterine leiomyomas are common, benign tumours of the
female reproductive tract which when complicated, can present with problems
of heavy menstrual bleeding including severe anaemia requiring blood
transfusion, organ compression with pressure effects on bladder, bowel, ureters
and ultimately kidneys, abdominopelvic pain, and subfertility. They are
commoner in women of black or Asian ethnicity. Our centre serves a large multiethnic population and presentation with large symptomatic uterine fibroids is
common creating a significant healthcare burden from recurrent hospital
admissions for heavy bleeding requiring transfusion and other symptomatology
in a population of women who are acculturally keen to retain their fertility.
There are various treatment options available for symptomatic small to
moderate sized uterine fibroids > 3.0cm in diameter, including endoscopic or
open surgery, selective arterial embolisation, and magnetic resonance guided
focused ultrasound ablation, while pharmaceutical treatment has been
recommended for small fibroids < 3.0cm in the absence of structural or
histological uterine abnormality, where there is no cavity distortion (NICE
guidelines 2007). There are newer pharmaceutical agents that can be used either
for pre-treatment prior to definitive vascular interventions or surgery, including
the selective Progesterone receptor modulator Ulipristal acetate.

Problem Statement: Postpartum haemorrhage (PPH) remains the major cause

of maternal mortality worldwide. The treatment of PPH has for many years
focused on the provision of uterotonics. However, there are problems not only
with the provision of the drugs to low resource community settings, but also in
the escalation of care for those women who continue to bleed despite oxytocics.
For treatment of atonic PPH bimanual uterine compression and massage is an
appropriate procedure to initiate the management, followed by uterotonic
drugs. However, the technique of bimanual compression requires the insertion
of a fist into the vagina, an act that is both painful and has overtones of genderbased violence. It is therefore currently only used in extreme situations. If,
however, it could be performed in a less invasive manner, then it could act as a
low-cost complete treatment for PPH. The development of a simple, low cost,
treatment for PPH that can be easily used by low-level providers is therefore
crucial. The PPH shelf is a new device, invented by Professor Andrew Weeks,
designed to make uterine compression available for use at a much earlier stage
in the PPH process, and provide a treatment without the need for medicines or
advanced diagnostic skills. This study tested the use of the PPH shelf in a
mannequin model by delivery suite staff, with the hypothesis that using the PPH
shelf produces an equivalent amount of uterine pressure as standard bimanual
compression, but can be sustained for a longer time.
Methods: The study was carried out at Liverpool Womens Hospital. The
participants were 26 delivery experienced obstetricians, who are expert at
bimanual uterine compression, and 26 midwives, who had not done bimanual
compression before. Each participant conducted two forms of uterine
compression on a mannequin model: bimanually and using the PPH shelf. The
order in which they performed the test was randomly allocated. The mannequin
(Noelle, Gaumard, Florida) was supplied with an atonic uterus, modified to
facilitate bimanual compression and containing a pressure sensor. The sensor
assessed the amount of intrauterine pressure produced by compression of each
participant.
Results: Recruitment to the study is underway. We will compare the results
between the two methods, as well as examining the effect of experience on

49

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

uterine pressures. 32 participants have already taken part the study is

expected to be completed at the end of September 2014. The results will be
presented at the conference.
Conclusion: The results will be presented at the conference.
Disclosure of Interest: None Declared

O79
DETERMINING PREGNANT WOMENS KNOWLEDGE ON THE INVASIVE AND
NON-INVASIVE PRENATAL TESTS AND THEIR ANXIETY LEVELS
H. Alan 1,*, T. Demirel 2, S. Dereli Yilmaz 1
1Midwifery, 2Nursing, Selcuk University, KONYA, Turkey
Problem Statement: This study aimed at determining the pregnant womens
knowledge on the invasive and non-invasive prenatal tests and their anxiety
levels.
Methods: The study was descriptive and cross-sectional. Data were collected
from 350 pregnant women resorting to the pregnancy polyclinics of a hospital
between 3 April 2014 and 8 August 2014. In the collection of the data, the
questionnaire form assessing the socio-demographic features of the pregnant
women, current features of the pregnancy, foetal tests applied and knowledge
on these tests and the State-Trait Anxiety Inventory aiming at determining the
levels of anxiety were used. In the analysis of the data, percentage, mean,
Standard deviation and Mann Whitney U test were used. Prior to the study, local
ethical permission was received.
Results: Age average of the pregnant women participating in the study is
28.875.46 while the mean length of the married life is 5.764.91. 73 % of the
pregnant women and 63.4 % of their spouses are primary school-secondary
school graduates. 77 % of the participants classified their economic situations to
be moderate. While the mean of the gestational week is 34.896,372, the mean
number of pregnancies is 2.281.34. Pregnant women received prenatal care for
7.413,097 times on average during their pregnancies. Low level of anxiety was
detected among the pregnant women whose mean score in the State-Trait
Anxiety Inventory was 38.808.35. In 11 % of the pregnant women, the
pregnancy was accompanied by a chronic disease. While 76.6 % of the
participants got pregnant on purpose, 6.3 % of them had intended to terminate
their current pregnancies. 22 % of the participants did not experience any
problems in their current pregnancies. 11.4 % of the pregnant women
underwent the risk of preterm labour while 6.3 % of them suffered vaginal
bleeding. 25 % of the participants took NST while 15 % of them took double test,
triple test and oral glucose tolerance test together. 4 % of the pregnant women
had amniosynthesis done. When the participants were asked whether they were
provided with an adequate level of information on the tests evaluating the foetal
health, 55 % of them stated that they could not receive information sufficiently.
The most common sources of information among the participants were
physicians (35 %) and nurses (17 %). While 70.6 % of the pregnant women found
explanations made by the health professionals on the tests insufficient, only 27
% of them stated that the explanations helped them reduce their anxieties
concerning the health of the baby. 14 % of the pregnant women said that none
of the questions was answered. While a statistically significant relationship
(p<0.05) was found between the participants mean score in the State-Trait
Anxiety Inventory and having health problems during pregnancy, receiving
regular prenatal care and being informed sufficiently during pregnancy, no
statistically significant relationship (p0.05) was found among education level of
the woman, education level of the spouse, income level, presence of chronic
diseases in the pregnant woman.
Conclusion: It was determined in the study that pregnant women were not
informed sufficiently on the tests evaluating the foetal health and they were
unsatisfied with this situation. It is recommended that the pregnant women are
provided with information adequately by the health professionals during the
pregnancy which is stressful in nature and their questions are answered
properly.
Disclosure of Interest: None Declared

50

O80
DOES THE GENDER OF MEDICAL STUDENTS AFFECT THE ACQUISITION OF
KNOWLEDGE AND SKILLS DURING AN OBSTETRICS AND GYNAECOLOGY
ROTATION IN MEDICAL SCHOOL?
S. Babu 1,*, Y. Beebeejaun 2, D. Rajeswari 3
1
Imperial College Healthcare NHS Trust, 2Queen Elizabeth Hospital, London,
3Ashford & St. Peter's Hospitals NHS Trust, Chertsey, United Kingdom
Problem Statement: Over the last decade, Obstetrics and Gynaecology has
witnessed major changes in its workforce. We now work in a speciality that is
increasingly female. Data from the United States shows the percentage of
female Obstetricians and Gynaecologists has risen from 12% in the 1980s to over
40% in recent years. This gender shift has had a direct effect on the number of
male graduates entering higher speciality training. Indeed, a drop from 46% to
23% has been reported between 1998 and 2003. In the United Kingdom, third
or fourth year medical students are attached to an Obstetrics and Gynaecology
firm. Here they are expected to acquire the required medical knowledge and
surgical skills necessary for managing womens health. We designed a study to
analyse the effect medical student gender on their experience during their
Obstetrics and Gynaecology rotation. We focused on the effects of students'
gender on quality of teaching, amount of surgical exposure, patient interaction
and bedside teaching received. We also asked whether their medical school
experience affected their decision to pursue a career in this specialty. Our
hypothesis was that male students would have perceived an element of gender
discrimination and consequently obtained a different experience to their female
counterparts. This would translate to less patient interaction and exposure to
procedures, compromising the acquisition of knowledge and skills.
Methods: All medical students who rotated through an Obstetrics &
Gynaecology department were given an anonymous questionnaire. This
questioned whether they felt their gender had a positive, negative, or neutral
effect on their learning experience. We also asked students to list the number of
bedside procedures they performed and the surgical opportunities they had.
Furthermore we asked about how comfortable they felt in their ability to counsel
women in their future careers. Finally we assessed whether their medical school
experience had affected their desire to pursue a career in Obstetrics and
Gynaecology. Results: We observed that medical student gender did not affect
the quality of teaching male students received. However we did find that
patients were less likely to allow men to be actively involved in their medical and
surgical management. Therefore male students were unable to get as much
clinical experience as their female colleagues. This in turn dissuaded many men
from considering a career in Obstetrics & Gynaecology.
Conclusion: We therefore advise that educators actively encourage patients to
allow male and female medical students to participate in their care equally. This
is crucial to ensure that male medical students gain an interest in Obstetrics &
Gynaecology so the specialty does not miss out on talented individuals purely
because of their gender.
Disclosure of Interest: None Declared

O81
EVALUATION OF UNIVERSITY STUDENTS' KNOWLEDGE REGARDING
SEXUAL/REPRODUCTIVE HEALTH
T. Demirel 1,*, H. Alan 2
1Public Health Nursing, 2Midwifery, Selcuk University, Konya, Turkey
Problem Statement: Educational initiatives targeting young people is very
important in order to prevent their lack of knowledge regarding sexual health
(SH) and reproductive health (RH). It should not be forgotten that in the absence
of adequate information and counseling, young people may be at risk in this
context. The purpose of this research is to determine university students'
knowledge level regarding SH/RH matters
Methods: This study was conducted between February March 2014 in five
faculties of Konya Seluk University. For sample selection of the study, cluster
sampling, a probability sampling method was utilized. Sample size was
determined as 396 via sampling calculation of known universe method. Data was
collected via face to face interviews and a questionnaire form which consists of
demographic as well as SH/RH related questions. Necessary permits and

Abstract Book

permissions were obtained both from the university and from students
themselves prior to research. Data analysis were conducted using SPSS 20
program utilizing number, percentage, mean, standard deviation and chi square
tests
Results: 52.5% of students who participate in the research were male while 94%
were between ages 18-24. 60.6% of students have defined 'safe sex' as 'to be
protected from sexually transmitted diseases'. SPECIAL; 23% of all participants
stated that they have had at least one sexual intercourse before. A statistically
significant relationship between knowledge level and gender had been found
(p<0.05). It was observed that female students have more information about
sexual/reproductive health when compared to males (59.6%). A statistically
significant
relationship
between
experiencing
problems
about
sexual/reproductive health and gender had also been found (p<0.05). This
showed that female students had more health problems regarding SH/RH than
male students. The research also revealed that there is a statistically significant
difference between 'gathering information about SH/RH, having information
about institutions which provide counseling about SH/RH and faculties (p<0.05).
It was observed in our research that students who study in
departments/faculties affiliated with institute of health sciences have more
information regarding SH/RH than students who study in departments/faculties
that are not affiliated with institute of health sciences. SPECIAL; 72% of students
who don't receive any SH/RH counseling or service stated that they don't receive
these services because they don't need them while 10.7% of students said they
don't receive counseling because they are ashamed. When asked about family
planning methods that they are familiar with, the answer that was given the
most was birth control pills (84.2%). 78.3% of students stated that the
responsibility for using birth control/family planning methods during sexual
intercourse falls on shoulders of both genders/partners. SPECIAL; Students who
participate in the research stated that they gather information regarding
sexual/reproductive health from following sources: media (46.5%), books
(41.9%), school (42.3%), friends (27.8%) and relatives (21.6%).
Conclusion: It was found that students who study in departments/faculties
affiliated with institute of health sciences have more information about
sexual/reproductive health. It was also observed that female students
have/gather more information regarding sexual/reproductive health when
compared to males.
Disclosure of Interest: None Declared

O82
SEVERE PERINEAL LACERATION DURING PROLONGED SECOND STAGE OF
LABOR: THE IMPACT OF INSTRUMENTAL DELIVERY
M. Simic 1,*, S. Cnattingius 1, A. Sandstrm 1, O. Stephansson 1
Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet
and University Hospital, Stockholm, Sweden
Problem Statement: Severe perineal lacerations represent a significant
complication of vaginal delivery with a strong impact on quality of life. Previous
research has described various factors that contribute to the occurrence of
perineal lacerations. By separating different risk factors, we investigated how
maternal, fetal and delivery characteristics influence the risk for perineal
laceration. The aim or our study was to investigate the impact of duration of
second stage of labor on risk for severe perineal laceration.
Methods: We conducted a population based cohort study including primiparous
mothers undergoing vaginal delivery with cephalic presentation, at 37
completed gestational weeks or later, 2008- 2012 in Stockholm/Gotland region
in Sweden. Information on duration of second stage of labor were collected from
partograph data and categorised into 5 groups: 0-59 min (reference); 60-119;
120-179; 180-239; and 240 minutes. The outcome was define as perineal
laceration grade III and IV. Logistic regression models were adjusted for
maternal, delivery and fetal characteristics.
Results: The multivariate analysis found that the risk for perineal lacerations
increased with duration of second stage of labour from OR 1 at first hour till OR
1.36 (95% CI 1.19-1.56) at four hours. Factors associated with perineal laceration
included in multivariate analysis were: epidural analgesia (OR 0.98; 95% CI 0.871.10), oxytocin use for labor augmentation (OR 1.56; 95% CI 1.44-1.68),
increasing gestational age- week 42 compared to week 37 (OR 1.79; 95% CI 1.47-

2.19) induction of labor (OR 1.12; 95% CI 1.03-1.22), head circumference (OR
1.61; 95% CI 1.51-1.73) birth weight >4500 gr (OR 2.42; 95% CI 1.98-2.97),
occiput posterior position (OR 1.56; 95% CI 1.44-1.68), episiotomy (OR 1.39; 95%
CI 1.27-1.53) , maternal age > 35 years (OR 1,18; 95 % CI 1.07-1.30), BMI 25.029.9 (OR 1,12; 95 % CI 1.02-1.22), maternal height 130-154 cm (OR 1. 36; 95 %
CI 1.12-1.65) parental cohabitation (OR 1.14; 95 % CI 1.06-1.22), and smoking
(OR 0.65 CI 0.54-0.77) . The rate of perianal laceration at instrumental delivery
was approximately twice the rate at vaginal delivery (OR 2.49; 95% CI 2.34-2.67).
Stratification by mode of delivery indicated that occiput posterior position was
significantly associated with perineal laceration among instrumental, but not
among normal deliveries while episiotomy had an opposite effect. High birth
weight increased risk for perineal laceration among both groups. Duration of
second stage of labor had no significant influence on the risk for perineal
laceration among instrumental deliveries.
Conclusion: The risk for severe perineal laceration increases with time from
retracted cervix to birth. However, instrumental delivery is an independent risk
factor for perineal lacerations and is not correlated to duration of second stage
of delivery.
Disclosure of Interest: None Declared

O83
MATERNAL URIC ACID LEVELS AND PRE-ECLAMPSIA: A CAUSAL ASSOCIATION?
E. Staines Urias 1,*, C. C. Colmenares 2, N. C. Serrano 3 on behalf of GenPE, A.
Hingorani 4, J. P. Casas 1
1NCDE, London School of Hygiene and Tropical Medicine, London, United
Kingdom, 2Centro de Investigaciones Biomdicas, Universidad Autnoma de
Bucaramanga, 3Fundacin Cardiovascular de Colombia, Bucaramanga,
Colombia, 4Department of Epidemiology and Public Health, University College
London, London, United Kingdom
Problem Statement: Pre-eclampsia is a main cause of maternal and foetal
morbidity and mortality. Despite intensive research, the pathogenesis of this
complex disease remains unclear. The increase in maternal uric acid that
precedes pre-eclampsia onset has traditionally been viewed as a consequence
of decreased renal excretion, and so uric acid is considered a marker of disease
severity rather than having a role in pre-eclampsia pathogenesis. Current
evidence suggests that, in the general population, uric acid might be causally
related to two pathognomonic signs of pre-eclampsia: hypertension and
impaired renal function. It remains possible that uric acid is causally associated
with pre-eclampsia and could represent a therapeutic target for pre-eclampsia
prevention.
Methods: GenPE is a case-control study of women with first pre-eclampsia
(N=1365) and healthy pregnant controls (N=1886) from eight Colombian cities
recruited at the time of delivery between December 2000 and February 2012.
Maternal concentrations of uric acid were measured on serum samples.
Information on potential confounders was obtained through a verbal interview.
Adjusted odds ratios for uric acid levels were estimated.
A meta-analysis of reported measures of effect from prospective studies was
conducted.
Results: Uric acid levels were positively associated with increased risk of preeclampsia, with evidence of a linear effect across quintiles (linear trend p-value
<0.001). The adjusted odds ratio of pre-eclampsia was 1.45 (95%CI 1.23-1.71) for
a top vs. bottom quartile comparison. Three studies with uric acid measured
before 20 weeks gestation were identified (385 cases and 7006 non-cases), with
a pooled OR of pre-eclampsia of 1.46 (95%CI 1.22-1.75) for a top vs. bottom
quartile comparison.
Conclusion: This study provides large-scale evidence for elevated uric acid levels
being associated with increased odds of pre-eclampsia; this association followed
a linear shape without an observable threshold that was robust to adjustment
for a comprehensive set of possible confounders. Concordant results from a
meta-analysis of prospective studies supports that reverse causation is not likely
to entirely explain the observed association. The recent evidence from
randomised trials for a role of uric acid in the pathogenesis of hypertension and
endothelial and renal dysfunction, both characteristic features of pre-eclampsia,
favours the evaluation of an scenario in which uric acid is a causal contributor to
pre-eclampsia. Current knowledge of the genetics of uric acid metabolism and

51

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

the existence of potential sources of data from consortiums like the

InterPregGen Collaboration would support a Mendelian randomisation study
with multiple instrumental variables that could inform on the feasibility of an
RCT of uric acid lowering therapy for pre-eclampsia prevention.
Disclosure of Interest: None Declared

O84
ANGIOGENIC FACTORS AND UTERINE ARTERY BLOOD FLOW FOR PREDICTION
OF PREECLAMPSIA
V. Taraseviciene 1,*, D. Simanaviciute 1, R. Maciuleviciene 1
Obstetrics and Gynecology, Lithuanian University of Health Sciences, Kaunas,
Lithuania
Problem Statement: It is widely accepted that key proteins responsible for
endothelial dysfunction during preeclampsia are soluble fms-like tyrosine kinase
1 (sFlt-1) and placental growth factor (PlGF). Inadequate trophoblast invasion
into spiral arteries result in increased placental vascular resistance that can be
detected by uterine artery Doppler. There are number of studies investigating
those factors use for prediction of preeclampsia. However the data regarding
their effectiveness, timing of testing are controversial. The aim of our study was
to investigate the sFlt-1, PlGF and uterine artery Doppler for prediction of
preeclampsia.
Methods: 206 women having high risk for preeclampsia were examined
prospectively at 22+022+6 and 27+027+6 weeks of gestation. SFlt-1, PlGF and
uterine artery Doppler (mean pulsatility index (PI) and mean resistance index
(RI)) were performed and evaluated. All included women were followed until
delivery and the event of preeclampsia if occurred was recorded. Discriminant
function analysis was performed to determine significant predictors of
preeclampsia. Subsequently the cut-off point was established for each of them
by receiver operating characteristic (ROC) curve analysis. Logistic regression was
performed to calculate the combined prediction of preeclampsia.
Results: Preeclampsia developed in 17 cases. At 22+022+6 weeks of gestation
PlGF, mean uterine artery PI and RI were determined as significant predictors of
preeclampsia.If the values of these predictors surpassed the cut-offs,
determined by ROC curve analysis, the probability of preeclampsia and preterm
preeclampsia increased to 64.5% and 95.5%. Neither of tested variables or their
combination could predict late preeclampsia at this gestational age. At 27+027+6
weeks of gestation, the strongest preeclampsia predictors appeared to be sFlt-1
and PlGF ratio and mean uterine artery PI. Logistic regression showed that the
ratio of sFlt-1/PlGF more than 10.7 could predict preterm preeclampsia with
100% sensitivity and specificity. The most significant predictor of term
preeclampsia at 27+027+6 gestational weeks appeared to be mean uterine artery
PI.
Conclusion: We conclude that at 22 weeks of gestation best predictors of
preeclampsia are PlGF, mean uterine artery PI and RI. While at 27 weeks of
gestation best predictor was found to be sFlt/PlGF ratio.
Disclosure of Interest: None Declared

O85
RELATIONSHIP OF SUPPORTIVE CARE, PAIN AND SATISFACTION IN LABOR
S. Mete 1, E. Uluda 1,*, G. amaz 1
Dokuz Eylul University Nursing Faculty, Izmir, Turkey
Problem Statement: Labor is an important experience for women, which has
physical and emotional effects. Therefore, women's satisfaction in labor is
important. Womens satisfaction in labor decreases from labor pain. Supportive
care decreases labor pain and increases satisfaction in labor.
Aim: To determine the relationship between the supportive care, pain and
satisfaction in labor.
Methods: It was a descriptive study. A sample of the study 250 women who has
vaginal birth at one state hospitals participated. Written permission was
obtained from the Ethics Committee, hospital and participants. Data was
collected with the Womens Information Form, Visual analog scale (VAS),
Postpartum Self-Evaluation Scale Subscale of the Satisfaction with The Labor,
The Womens Perception For Supportive Care Given During Labor Scale. Sociodemographic and obstetric characteristics were evaluated by percentage.

52

Relationship between the supportive care in labor, labor pain and satisfaction
with the labor evaluated Pearson correlation coefficient.
Results: The average age of women was 26.56. The percentages of woman
unemployment rate were 93.6%. Illiterate rate were 10.8 %, primary school
graduates were 38 %, middle school graduates were 31.2 %, high school
graduates were 20% and university graduates were 2 %. There was very weak
positive correlation Supportive care point and satisfaction scores in the labor (r:
0.245, p<0.001). There was no correlation between first, second and third phase
pain score with supportive care and satisfaction with the labor.
Conclusion: Womans awareness levels can be increased when supportive care
increases from the care givers. By this way they can feel happiness from having
a new baby. There are no relationship between first, second and third phase pain
score and supportive care. In this research, woman's low educational levels and
their unemployment rate is being high can affect perceive in supportive care.
Woman who has low sociocultural level are known as their low expectations in
supportive care. For this reason, care givers similes and asking their needs is
enough for them. Also they are accepting care givers negative behavior. Having
a baby and birth has positive effect and also it gives a positive statue for woman
in Turkey. In additional to this, women are expected to having an intense pain
while give birth. That is why, even their birth process was painful they could still
state they pleasant from their labor experience.

Disclosure of Interest: None Declared

O86
PRECONCEPTION HEART RATE AND RISK OF PRETERM DELIVERY IN CHINESE
REPRODUCTIVE AGE WOMEN
Y. Yang 1,*, Y. Wang 1, Z. Peng 1, X. Ma 1
National Research Institute for Family Planning, Beijing, China
Problem Statement: Preterm delivery (PTD) is an important adverse pregnancy
outcome for pregnant women, which threaten maternal and child health. The
report of WHO in 2012 showed that around 1 million children die each year due
to complications of preterm birth. Many survivors face a lifetime of disability,
including learning disabilities and visual and hearing problems. Pregnancy is a
special physiological period for women, in which the maternal cardiac load
would significantly increase caused by volume expansion. Maternal cardiac
function may have a marked impact on pregnancy outcome, such as PTD.
Previous studies mostly focus on the effect of gestational maternal cardiac
function on PTD risk. However, the preconception cardiac function indicators on
PTD risk in women who prepare to get pregnant remain uncertain. In the present
study, we examined the relationship between preconception heart rate (HR)
level and the risk of PTD.
Methods: We conducted a historical cohort study which recruited 380848 rural
reproductive age women participated National Free Pre-pregnancy Checkups
(NFPC) in 2010-2012 in China. Data on preconception HR, blood pressure, history
of pregnancy and diseases, fasting glucose level and other variables were
obtained from the physical examination record in NFPC. Follow-up evaluation
was conducted from June 2010 to Oct 2013. Successful conception and
pregnancy outcomes were documented during the follow-up period. In the
present study, PTD which is defined as babies born alive within 28 to 37 weeks
of pregnancy are completed was the end point event of the cohort. Participants
who are failure to get pregnant, suffered from fetal death, still birth abortion,
and multiple gestation were excluded from the analysis. Multivariate logistic
regression models were undertaken to adjust baseline variables with PTD as the
outcome variable.
Results: Until Sep 30th 2013, 3503 PTD events were documented. The PTD
incidence rate was lowest in women with a heart rate of 70-89 bpm (incidence
rate=0.85%), while the PTD incidence rate was highest in women with a heart
rate<60 bpm (incidence rate=1.74%). Compared to the participants with a heart
rate of 70-79 bpm, women with a heart rate <60, 60-69, 80-89, 90-99, 100-109
and 110bpm had higher risk of PTD, and the corresponding multivariateadjusted RRs and 95% confidence intervals (CIs) were 2.02(1.15-3.44), 1.37(1.231.53)1.01(0.92-1.44), 1.20(1.00-2.04), 1.51(1.12-2.04) and 1.78(1.08-2.93).
Table 1. Incidences and RRs of PTD by preconception heart rate level

Abstract Book

HR
(bpm)
<60

PTD
incidence
(%)
1.74

60-69

1.18

70-79

0.86

80-89

0.85

90-99

1.06

100109
>=110

1.32
1.54

RRa (95%CI)

P-valuea

RRb (95%CI)

P-valueb

2.02(1.193.44)
1.37(1.231.53)
1.00

0.009

2.04(1.153.62)
1.36(1.201.54)
1.00

0.015

0.99(0.921.08)
1.24(1.051.46)
1.58(1.202.08)
1.85(1.162.95)

0.915

1.01(0.921.44)
1.20(1.002.04)
1.51(1.122.04)
1.78(1.082.93)

0.840

<0.001
-

0.011
0.001
0.010

<0.001
-

0.053
0.006
0.025

a adjusted for age.

b adjusted for age, BMI, smoking, alcohol consumption, diabetes, hypertension,
thyroid dysfunction, history of adverse pregnancy outcome, northern residents
and high school education.
Conclusion: Preconception heart rate level was significantly associated with risk
of PTD incidence. Either preconception heart rate too high or too slow can
increase the risk of PTD incidence.
Disclosure of Interest: None Declared

O87
EPIDEMIOLOGY OF INTRAUTERINE FETAL DEATHS: A 5 YEARS STUDY IN THE
HOSPITAL OF PORTIMO
A. F. Rafael 1,*, C. Paixo 1, S. Costa 1, P. Guedes 1, F. Guerreiro 1
Centro Hospitalar do Algarve - Hospital de Portimo, Portimo, Portugal
Problem Statement: Still birth is a tragic event for the parents and a great cause
of stress for the caregiver. Stillbirth incidence is 1 in 200 births. 2.6 million 3rd
trimester stillbirths occur worldwide every year. Portimo's maternity is a level
3 unit, without a neonatal intensive care department. The present study was
conducted to understand the characteristics of the pregnant population, and to
know the prevalence, socio-epidemiological and etiological factors of stillbirths
in the Hospital of Portimo, Portugal, in order to improve fetal and maternal
outcomes.
Methods: Stillbirth data was collected from doctors' records and maternity unit
birth statistics, including all the cases with more than 24 weeks of gestation.
Clinical notes were reviewed retrospectively to identify information relevant to
the study. Ante partum and intra partum events leading to fetal demise were
recorded, socio-demographic and clinical characters were noted, as well as post
mortem archives.
Results: 28 cases of stillbirth were identified between January 2009 and
December 2013 including 8 at term (> = 37 weeks). The stillbirth rate was 4.11
per 1000 births (national average of 2.5 per 1000 from 2009 to 2013).
Risk factors recognised were diabetes, maternal age over 40 years, being
overweight or obese, narcotic drug abuse and cigarette smoking in the 3 months
prior
to
pregnancy.
There was 2 cases (7%) of Abruptio placenta and 3 cases (10%) associated with
maternal diabetes, 1 presented in multiple gestation, 3 cases (10%) of umbilical
cord lesions, 2 cases had some malformation, fetal growth restriction was the
main cause of death in 4 cases (14%) and 3 had documented infection. 10 cases
(35%) had no relevant condition identified.
Conclusion: Advances in diagnostic and therapeutic modalities allow the rate of
still birth to be constant in Portugal. In the region of Portimo, the rate is higher
due to socio-cultural background, illiteracy, lack of adequate antenatal care and
inaccessible health care. Universal and improved antenatal care is needed to
continue to lower the stillbirth rate.
Disclosure of Interest: None Declared

O88
CAN ADVERSE CHILDHOOD EXPERIENCES AFFECT THE DEVELOPMENT OF PAIN
DURING PREGNANCY?
J. Drevin 1,*, T. Tydn 1, M. Larsson 2, J. Stern 1, E.-M. Annerbck 1, M. Petersson 1,
S. Butler 1, P. Kristiansson 1
1Department of Public Health and Caring Sciences, 2The Department of Women's
and Children's Health, Uppsala University, Uppsala, Sweden

Problem Statement: Experiencing pain is common during pregnancy, 46% of

Swedish women report having pelvic girdle pain and 78% report having back pain
sometime during pregnancy. Adverse Childhood Experiences (ACEs) include a
range of potential traumatic events during the first 18 years in life. These are
physicial, mental and sexual abuse and different forms of household
dysfunctions. Previous studies have shown that ACEs increase the risk for various
health problems in adulthood such as having sexually transmitted diseases,
obesitas and ischeamic cardiac diseases. It is unknown if ACEs affect
development of pain during pregnancy.
Methods: A prospective longitudinal cohort study was made as a pilot study.
Women were enrolled at 18 antenatal clinics in south Mid-Sweden and 232
(78%) women participated and answered to the first questionnaire in early
pregnancy. A follow-up questionnaire was distributed in late pregnancy and was
answered by 160 (72%) of the enrolled women. The questionnaires included
sociodemographic questions, pain drawings, visual analogue scales for pain
intensity and eight ACE categories, which were summed to a score. The
distribution of pain was coded in 41 predetermined areas.
Spearmans correlation coefficient and the 2 test were used to study
relationships. For regression analyses General Linear Model and logistic
regression were used.
Results: In late pregnancy 72% reported any pain and 62% any category of ACE.
Among
women
reporting experience of ACE the prevalence of any reported pain was not
different from that of women without such experiences whereas women
reporting child physical abuse category of ACE reported higher prevalence of
sacral and pelvic pain (p=0.0003 and p=0.02, respectively). Worst pain intensity
during the past week was significantly higher among women reporting any ACE
(p=0.01) but not among those reporting child physical abuse (p=0.3) as
compared to women without such experience. The number of pain locations was
positively associated to the ACE score (rs=0.19, p=0.02). This association
remained significant adjusting for factors measured in early pregnancy in a
multiple regression analysis (p<0.0001).
Conclusion: ACEs were commonly reported and might influence development of
pain with onset during pregnancy.
Disclosure of Interest: None Declared

O89
KIELLAND'S ROTATIONAL FORCEPS DELIVERY: IS IT A DYING ART?
S. Mukherjee 1,*, S. Umranikar 1, V. Perry 1, S. Slater 1
Obstetrics and gynaecology, University of Southampton, Princess Anne Hospital.,
Southampton, United Kingdom
Problem Statement: There has been a significant decline in the use of Kielland's
rotational forceps for malpositions, and also a rise in rate of second stage
Caesarean section.This is due to previous reports that their use results in
increased maternal and neonatal complications. However, most of these studies
date from more than 25 years ago, and there is a lack of recent data regarding
maternal and neonatal outcomes following Kiellands rotational forceps delivery
(KRFD). The aim of this study is to describe maternal and neonatal outcomes of
KRFD, to compare maternal complications with those of other modes of delivery,
and to examine whether more training and more senior involvement is needed
to improve the outcome of KRFD.
Methods: This is a Retrospective observational study from January 2013
December 2013 at Princess Anne Hospital, University of Southampton, which is
a very busy tertiary teaching Hospital in Southampton, UK and we collected data
mainly from our electronic database. We prepared the proforma to collect the
data and reviewed all the cases who had KRFD during the above time period.
Our standards were set from the Guideline of RCOG. The data were analysed to
get the result and recommendations were made for further improvement of the
local practice.
Results: Total births during the period were 5910. Forceps delivery rate
was 9.8%, Keilland was attempted in 129 (2.18%) cases with a Success rate of
63%. Majority of the successful KRFD were nulliparous (75%) and average age
group was 30-40 years. Average gestational age for successful KFD was 30-41
weeks and average birth weight of the babies were 3.5-4 kg. Rate of sequential

53

The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
Paris, France December 4-7, 2014

use of instruments 9.2%. Rate of emergency LSCS 28% (failed KF) .Rate of third
and fourth degree tear was 5.4 % and a significant number of the women (57%)
had PPH of less than 500ml. Rate of minor neonatal morbidity was 9.3 % and
there was very minimal neonatal complication rate. Majority of cord gases
results were within normal range. Rate of Low Apgar score was 13.6%. Adequate
analgesia was given in 100%cases and no Urinery retention was noted after
KFRD. This study shows that 86% of cases were done by the Consultant or Senior
Registrar.
Conclusion: Kielland forceps deliveries have not gotten serious complication rate
Majority of the babies were with good Apgar score and Cord Gases .Majority of
the deliveries were conducted by Senior Trainees. Kielland forceps deliveries
definitely contributed towards lowering Second Stage Section rate.
Risk of major PPH in KRFD is not high .Risk of third & fourth degree tear is also
comparable to overall rate of third & fourth degree tear. (5.4 % vs 4.1%)
There was no complication of urinary retention after delivery.
Hence, the result of our study suggest that in experienced hands, assisted vaginal
birth by Kielland Forceps is likely to be the most effective and safe method to
prevent the ever rising rate of Caesarean sections when malposition complicates
the second stage of labour.
Disclosure of Interest: None Declared

O90
EXAMINATION OF TRADITIONAL POSTPARTUM PRACTICES OF WOMEN AND
INFANTS IN KONYA/TURKEY
S. Cankaya 1,*, G. GUNEN 1, F. KARAKAS 1, A. ARI 1, S. SAHN 1, T. YLMAZ 1, B.
GORGULU 1
Midwifery, Health sciences faculty, Konya, Turkey
Problem Statement: To gain an understanding of traditional postpartum
practices for women and babies, and to investigate the factors inuencing such
practices.
Methods: The study was conducted with 302 voluntary mothers who had babies
aged 0-12 months and who accepted to participate in the study at three different
family health centers located in Konya city center. For the data collection; a
survey form about mothers socio-demographic characteristics and their babies
was administered.
Results: It was determined that mean age of the mothers was 26.35.8 years,
39.7% of them were graduated from primary school, 69.9% of them were
housewife. A number of women (37.4%) had their abdomen tightly wrapped and
more than half of the women (76.2%) avoided sexual intercourse for 40 days
after giving birth. It was determined that (19.5%) fed their babies with water
containing sugar just after the birth, 29.8% of them salted to the infant, 55.3%
of mothers were a bath to the infant after the umbilical cord had dopped, and
70.9% of women kept their babiesumbilical cord in a special place. Afterwards,
the mothers threw the cords into a river or they buried them in thegrounds of a
mosque or a school. Most of the mothers (62.9%) reported that they covered
their babies with a yellow cloth in order to protect them from jaundice.
Conclusion: It was result of the research, mothers were often applied of
traditional practices because of mothers were young and educational level low.
Postpartum care of women and their babies are important cultural practices.
Some of these practices may have harmful effects on women and their babies.
Midwives and nurses should discuss these ndings and their implications when
they educate new mothers and their families about contemporary methods of
postnatal maternal and infant care.
Keywords: Traditional practices in Turkey; Midwiferynursery; postpartum
period; Women; Infants
Disclosure of Interest: None Declared

O91
EFFECT PREGNANT WOMEN IN THE ACTIVE PHASE IN LABOUR PERFORMED
FOOT MASSAGE ON POSTPARTUM COMFORT
Y. Erkal Aksoy 1,*, S. Dereli Ylmaz 1
Midwifery, Faculty of Health Sciences, Konya, Turkey
Problem Statement: In the process of labor performed for 20 min head, neck,
back and foot massage has a positive effect such as anxiety, worry and pain levels

54

decrease significantly, shortening of the duration of labour. This research is the

intervention study in order to perform on determine the effect of postpartum
comfort of foot massage pregnant women in the active phase of delivery.
Methods: Research was carried out with primipara pregnant women who
admitted birth services in city of Konya maternity hospital. Sample size was
determined for suitability of parametric test as 30 controls and 30 experimental
groups. In this study, the standard of care was applied to both groups, in addition
the foot massage was applied experimental group the active phase until the
transition phase during period rest of the labour contractions. Foot massager
made through pressure the base of foot and thumb, massage time was
determined according to range of the contraction of every pregnant and was
continued massage until the transition phase. In addition was used in massage
oil. Collection of data were used socio-demographic question form and
Postpartum Comfort Questionnaire (PPCQ). Data was analyzed with percentage,
average, t-test.
Results: The average age of pregnants were 23.16 3.86 (min = 17, max = 35),
66.7% were primary education, 81.7% were housewives, montly income
expense was equivalent (medium) at 55.0% of pregnants, %81.7 of pregnants
have social insurance, 80% of pregnants willingly were conceived. 38.3% of
women experienced problems during pregnancy and 20,0% of pregnants faced
with the problem of nausea and vomiting. 90.0% of pregnant women were
controled prenatal care regular. 41.7% of pregnants were educated related to
the delivery on antenatal care and 48.3% were trained by midwives. Postpartum
Comfort Questionnaire total and subscale scores of pregnant women in the
between experimental and control groups were not significantly different
(p>0.05).
Conclusion: In this research was found that foot massage was conducted in the
active phase of labour have no effect on postpartum comfort. More studies are
needed to investigate relationship between the foot massage in the active phase
of labour with postpartum comfort.
Disclosure of Interest: None Declared

O92
EFFECTS OF ADOLESCENT PREGNANCIES ON MATERNAL AND NEONATAL
HEALTH
E. KIZILER 1,*, D. YILDIZ 1, D. SULUHAN 1
Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey
Problem Statement: To determine whether adolescent pregnancy is associated
with increased risk for maternal and neonatal health.
Methods: Data which is obtained by scanning databases (Ebscohost, Ovid,
Science Direct, and Google Scholar), magazines and related literature is
evaluated.
Results: Adolescent pregnancy which is a pregnancy at the age 19 or younger, is
associated with higher rates of illness and death for both the mother and infant.
Each year, approximately 16 million women give birth under 19 years old, about
11% of all births worldwide. Adolescents are twice as likely to die during
pregnancy or childbirth compared to women over 20 years of age. Adolescent
pregnancy is a complex issue with many reasons for concern. Pregnant teens are
at much higher risk of having serious medical complications and health
problems. These include anemia, sexually transmitted infections, postpartum
haemorrhage, toxemia, placenta previa, pregnancy- induced hypertension and
mental disorders, such as depression. Infant and child mortality is also highest.
Stillbirths and death in the first week of life are 50% more frequent among babies
if the mother is an adolescent. Additionally, adolescent mothers are more likely
to have low birth weight babies who are at risk of malnourishment and poor
development. The rates of prematurity, preterm birth, IUGR, low birth weight
and asphyxia are higher among the children of adolescents, all of which increase
the chance of death. Adolescent mothers are also more likely to have unhealthy
habits such as substance abuse and poor health care that can cause a greater
risk for inadequate growth, infection, or chemical dependence for the baby after
birth.
Conclusion: Adolescent maternal morbidity and mortality constitutes a major
public health problem on a global level. Research shows that low education
levels and socioeconomic status are closely associated with early pregnancies.
Education programs focus on teaching adolescents about their bodies,

Abstract Book

encourage teens to wait to have sex until marriage or until they are mature
enough to handle sexual activity. It also provides information about birth control
and how to prevent sexually transmitted infections to decrease complications.
Disclosure of Interest: None Declared

O93
CELL SAVER SAVES LIVES- A STUDY LOOKING AT THE USE OF CELL SALVAGE
TRANSFUSION DURING CAESAREAN SECTIONS IN A DISTRICT GENERAL
HOSPITAL IN MERSEYSIDE, ENGLAND.
E. Pye 1, A. Neville 2,*, C. Nwosu 2, M. Omar 2, P. Yoxall 3, N. Srivastava 2, S. Rao 2,
T. Idama 2
1
Student, Newcastle University, Newcastle, 2Obstetrics and gynaecology,
3Anaesthetics, Whiston hospital, Liverpool, England, Liverpool, United Kingdom
Problem Statement: Autologous blood replacement may be required at
caesarean section. Intra-operative cell salvage transfusion is used in cardiac,
orthopaedic and vascular surgery. It reduces the incidence of blood transfusions,
transfusion reactions and occasional difficulties with cross matching blood.
In obstetrics it is yet to be universally adopted due to the potential risks of
amniotic embolism and re-infusing fetal cells with the associated risk of future
development of haemolytic disease of the new born. Should we be using cell
salvage more frequently in both routine elective and emergency caesarean
sections? This audit aims to answer this question.
Methods: This was a year long retrospective study at Whiston Hospital in
Merseyside, England from 1/6/2013 31/05/2014. A list of patients given
autologous transfusion at caesarean section was identified from operating
theatre records and the department's electronic patient note system. Patient
details were then extracted including: ethnicity, age, body mass index, parity,
gestation, indication for cell saver, amount of red cells obtained and transfused,
post operative recovery and discharge, pre-operative and post-operative
haemoglobin and breastfeeding rates. The same information was obtained for a
group of randomly selected matched control patients that had no transfusion.
Comparisons were then made between the two groups.
Results: 56 patients with sufficient documentation who received an autologous
blood transfusion during the time period were identified. The same number
of matched controls were used. Average patient demographics between the
two groups (age/body mass index /ethnicity) showed no significant differences.
The average amount of blood recovered and transfused back to patients during
cell salvage (327mls) was in keeping with other studies. There was a positive
linear relationship between the estimated blood loss at caesarean section and
the amount of cell salvaged blood returned. The average post-operative drop
in haemoglobin value was significantly reduced in the cell salvage versus the
control group (11.4 g/l vs. 16.4g/l respectively). The patients transfused salvaged
blood were discharged earlier (2.6 vs. 2.9 days) although this was not statistically
significant. In rhesus negative cell salvaged patients 17% needed further AntiD
when the maternal blood kleihauer test showed >2mls of fetal cells. None of the
rhesus negative patients in the control group required extra AntiD. Patients
transfused salvaged blood suffered no immediate complications such as DIC,
hypothermia, anaphylaxis or infection. The amount of cell salvaged blood given
to patients would have depleted blood bank stores with significant cost. There
was not a significant difference in breastfeeding rates between the two groups.
Conclusion: Study numbers are too small to make a reliable conclusion. However
initial results are positive towards using cell salvage transfusion more readily at
elective and emergency caesarean sections because the benefits outweigh the
potential risks. A multidisciplinary team at Whiston hospital will draw up an inhouse protocol to reflect this.
Future
work
is
needed
on:
(1) A continuous rolling audit on this topic as more patient numbers are required
to prove significant outcomes.
(2) Long term future pregnancy follow up of rhesus negative women transfused
an autologous transfusion
Disclosure of Interest: None Declared

O94
ANTENATAL UTERINE ARTERY EMBOLISATION FOR MORBIDLY ADHERENT
PLACENTA THE EXPANDING ROLE OF INTERVENTIONAL RADIOLOGY IN
MODERN OBSTETRICS.
A. Obloza 1,*, A. M. Coady 2, P. Scott 3, P. Lesny 1, S. Lindow 4
1O&G, 2O&G Radiology, Women and Children's Hospital NHS trust,
3Interverntional Radiology, Hull Royal Infirmary NHS Trust, Hull, United Kingdom,
4Head Division Obstetrics, Sidra Medical and Research Centre, Doha, Qatar
Problem Statement: There is undisputed evidence that the rising incidence of
caesarean sections (CS) are associated with the increase of abnormal
placentation disorders, including morbidly adherent placentas and caesarean
scar pregnancies (CSP). Both carry high maternal morbidity and mortality risks
including uterine rupture, severe hemorrhage and hysterectomy. Fertility
preservation is, in these cases, one of the emerging challenges in modern
obstetrics when an obstetric hysterectomy has become increasingly obsolete.
Current literature describes different treatment modalities for uterine
preservation. Interventional radiology is already commonly used for treatment
of postpartum haemorrhage, placental attachment disorders and caesarean scar
pregnancies.
Methods: Antenatal use of interventional radiology with pelvic arteries
embolization appears to be a valid management option in selected cases. We
present a case illustrating such example. A 35 year old insulin dependent
diabetic patient, who had had two previous CS with only one living child,
attended the medical obstetrics team clinic at 17 weeks gestation with
ultrasound diagnosis of a hypoplastic left heart syndrome. Sadly, her first child
died of the same condition following surgery during neonatal period. Under
these circumstances the patient requested termination of pregnancy. To
complicated the situation a placental attachment disorder in form of placenta
accreta was confirmed by subsequent ultrasound scans (Fig.1). At 18 weeks of
gestation the patient underwent radiologically guided bilateral uterine artery
embolization (Fig.2) 2 hours prior to an operative delivery via a longitudinal
incision of the upper uterine segment. The fetus was dead at delivery. The
morbidly adherent placenta was left in situ, the umbilical cord and membranes
were carefully removed.
Results: She was followed up weekly for ten weeks with scheduled blood tests:
full blood count (FBC) and HCG (Graph 1). Serum HCG became undetectable after
nine weeks and placental tissue resolution occurred after twelve weeks.
Subsequent hysteroscopy showed a normal uterine cavity. The menstrual cycle
had also resumed by then.
Image / Graph:

Conclusion: Although there is still no uniform approach in the management of

placental attachment disorders our case demonstrates selective pelvic artery
embolization as a successful therapeutic modality for the management of
invasive placentation in the second trimester of pregnancy especially when
there is no concern with fetal survival. The effectiveness of the embolisation in
reducing placental perfusion was confirmed by the demise of the fetus. Whether
the procedure and placental absorption would have been as uneventful if no
embolisation had taken place is speculative. Furthermore, arterial embolization
is a safe alternative for women with placenta accreta who wish to preserve
fertility, with a 76.9% success rate and an 11% complication rate. Pre-operative

55

The 20th World Co