COGIParisAbstractBook 1

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
cogi@congressmed.com
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
-3-
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
-4-
Invited Speakers
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
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
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 preimplantation 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
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
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
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
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
17
References
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. loicsentilhes@hotmail.com
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
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
References

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
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
Oral Presentations
21
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.
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.
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
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.
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.
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: 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
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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
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.
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.
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".
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.
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.
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
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.
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
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.
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.
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.
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
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.
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
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.
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.
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.
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.
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
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.
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.
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.
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.
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
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
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.
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.
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.
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:
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.
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.
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
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.
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.
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.
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.
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.
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
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.
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.
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
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.
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.
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
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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
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.
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
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.
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.
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
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
selective artery embolization appears to reduce the risk of hemorrhage,

decrease morbidity and mortality, and increase the chance of fertility
preservation in patients with placenta accreta, increta, and percreta. It can be
used in selected cases only (at the cost of fetal demise) and wiith a long follow
up. We further propose it as a method that can be also utilized in cases of
caesarean scar, cervical and cornual pregnancies.
O95
HIGH-RISK HUMAN PAPILLOMAVIRUS AND RISK OF PREECLAMPSIA: A
POSSIBLE CONNECTION?
C. Dragosloveanu 1,*, R. Vladareanu 2
1Obstetrics and Gynecology, Clinical Hospital of Obstetrics and Gynecology
"Professor Dr. Panait Sarbu", 2Obstetrics and Gynecology, Elias University
Hospital, Bucharest, Romania
Problem Statement: Human papillomavirus (HPV) affects up to 80% of women
in their lifetime. There is growing evidence in literature of the high prevalence
of HPV trophoblast infection in both spontaneous abortions and spontaneous
preterm delivery; furthermore, defective trophoblast invasion in early
pregnancy may lead to other obstetric adverse outcomes, such as preeclampsia.
Our purpose was to determine whether there is a correlation between high-risk
human papillomavirus (HR-HPV) cervical infection in early pregnancy and
preeclampsia (PE).
Methods: We conducted a retrospective case control study carried out in
"Prof.Dr. Panait Sarbu Hospital in Bucharest over a one-year period.Women
who tested positive for HR-HPV at entry to prenatal care (n=108) were compared
with those who were HR-HPV negative (n=216). We used for reporting the
results of HR-HPV cervical infection the Hybrid Capture II system (Digene
Diagnostics Inc., Gaithersburg, MD, USA). We assessed the relationship between
the presence of HR-HPV and preeclampsia (as defined by clinical guidelines).
Unadjusted and adjusted analyses were performed. All patients delivered in our
clinic and signed an informed consent at admission according to the World
Medical Association Declaration of Helsinki regarding both delivery and
anesthesia. This study was approved by the Committee of Ethics and Research
in Humans of our institution.
Results: One hundred and eight women with HR-HPV were matched with two
hundred sixteen women HR-HPV negative. Patients carrying HR-HPV were
younger (mean age 25.03 3.42 years old vs. 27.083.14 years old, p< 0.001),
more likely to be nulliparous, had lower body mass index (mean value 22.58
3.01 Kg/m2 vs. 25.35 3.19 Kg/m2, p< 0.001) and more likely to develop
preeclampsia (13% vs 3.7%, p= 0.001; adjusted odds ratio 5.30; 95% confidence
interval, 2.03-13.84). We also observed a tendency of women in the exposed
group to develop severe preeclampsia compared with the unexposed group
(6.5% vs. 1.4%, p< 0.01).
Conclusion: We showed that HR-HPV infection was associated with an increased
risk of developing preeclampsia. The results obtained in our study could be
explained on a molecular basis by the growing evidence of the possible
transplacental transmission of human papillomavirus. Recently, it has been
revealed that HPV-16 is able to replicate its DNA de novo and produce progeny
in placental trophoblasts cultures. This is a surprising report taking into account
that HPV was previously believed to be an exclusively keratinocyte/skin-specific
virus. Further prospective studies or larger cohorts are needed to confirm our
findings and also to evaluate the mechanisms by which this association takes
place; if this is to happen, then HPV vaccination may prove to have additional
health benefits by possibly participating in the prevention of various adverse
pregnancy outcomes, including preeclampsia.
O96
KNOWLEDGE OF HPV, CERVICAL CANCER, AND PAP SMEAR AMONG TURKISH
WOMEN
V. Sava imke 1,*, G. Breki 2
1Nursing, HEALTH SCIENCES INSTITUTE, hatay, 2Nursing, HEALTH SCIENCES
INSTITUTE, Mersin, Turkey
56
Problem Statement: cervical cancer is one of the most widely seen cancer types.
Persistent infection with a human papillomavirus (HPV) is the main cause for
cervical cancer. However, cervical cancer is a preventable disease and Pap smear
screening is the best methods for prevention of the disease. But awareness of
womens about HPV, Pap smear test and cervical cancer for prevention is very
important. This study aims to find out the level of knowledge, behaviors of
women about HPV, cervical cancer and Pap smear test.
Methods: This study is conducted with 753 women who live in Hatay skenderun.
228 nurses, 135 teachers, 28 doctors, 20 academicians, 21 police officer, and 321
married house wife take part in this research. The data are collected by using
A questionnaire directed to determine socio-demographic characteristics and
obstetric story which contains knowledge about women and a questionnaire
used to determine the knowledge of HPV, Pap smear test, and cervical cancer.
The questionnaires are conducted with the face-to-face interview method. The
analysis of data collected between 1 November 2012 and 1 November 2013 is
made with chi square, student t-test, One-Way ANOVA test on SPSS 11.5
programme.
Results: 78,1% of women whose average age is 34,717,51 (min:18 max::64) are
married and 52,9% of them have middle income. 62,6% of them live in town.
32,9 % of them smoke. 57,4% of them have a job, and 42,6% of them are
housewife. 42,9% of them have a university degree whereas 58,6% of
housewives are primary school graduate. 75% of women have at least one
pregnancy story, 64,5% of them have 1 or 2 children. 51,4% of the women state
that they do not use family planning method. The most widely used family
planning method is preservative (39,9%). Although 69,2% of women get
gynecological examination, 27,8% of them state that they get pap smear. 1,3%
of women in the study state that they are vaccinated for HPV.
59,5% of the women in our study state that they have not heard HPV, 61,33% of
them states that they have no idea about HPV vaccination. 41,9% of them do
not know that HPV results in cervical cancer. 29,0% of whom have heard HPV
state that they have learned it from medical personnel. 33,1% of the participants
say that they will be vaccinated if the state finance it. The women who says they
will not be vaccinated state that they do not have enough knowledge about it.
(64,7%).
The level of knowledge of the women who live in city, have a good income and
educational level, is found to have high level of knowledge of HPV, HPV
vaccination, Pap smear test, and cervical cancer (p<0,05). The relationship
between the level of knowledge of Pap smear and cervical cancer and age is not
determined while the level of encountering with HPV decreases when the age of
women increases. 74,6% of nurses have heard HPV, but the nurses constitute
the group who gets the least gynecologic examination., and the doctors are the
ones who mostly get the gynecological examination.
Conclusion: It is seen that the vaccination and getting Pap smear test level of the
women in our study is very low, and their knowledge of HPV, Pap smear test and
cervical cancer is not enough. It is required multidisciplinary education and
consultancy services to be widened to protect against HPV infections and
cervical cancer.
O97
DETERMINATION OF THE ATTITUDES OF DISABLED WOMEN ABOUT FAMILY
PLANNING
R. Aydin 1,*, D. V. Ylmaz 2
1Nursing, Health Sciences Institute, Ankara, 2Nursing, Health Sciences Institute,
Mersin, Turkey
Problem Statement: This study is methodological and descriptive in character
and is based on a survey applied to disabled women at the age of 18-49 aiming
to assess their attitudes towards family planning (FP) and the factors that may
be thought to have a role in effecting these attitudes. The sample of the study
consists of a total of 108 disabled women at the age of 18-49 enrolled at Mersin
Disabled People Platform and six intitutions bound to it.
Methods: The collected data is collected by using the questionnaire form and
Family Planning Attitude Scale (FPAS). The questionnaire applied consisted of
two parts with the first part recording the socio-demographic characteristics of
the spouses of women and their families while the second part contained
Abstract Book
questions regarding the obstetric aspects of disabled women. The FPAS which is
developed by Orsal and Kubilay (2007) is a five point likert scale consists of 34
clauses and the scale has three sub-dimensions. The questionnaire and the FPAS
was applied between January 7th and June 21st in 2013. The collected data was
processed in MedCalc 12.3.0 packaged software and was analyzed with levels of
means, standard deviation, median, minimum and maximum values and
percentage points by means of t-test, One-way ANOVA test, Shapiro Wilk test,
Student t test, Levene test, Welch test and Games Howell test. The statistical
significance level was set at p<0,05. The collected data is collected by using the
questionnaire form and Family Planning Attitude Scale (FPAS). The
questionnaire applied consisted of two parts with the first part recording the
socio-demographic characteristics of the spouses of women and their families
while the second part contained questions regarding the obstetric aspects of
disabled women.The FPAS which is developed by Orsal and Kubilay (2007) is a
five point likert scale consists of 34 clauses and the scale has three subdimensions. The questionnaire and the FPAS was applied between January 7th
and June 21st in 2013. The collected data was processed in MedCalc 12.3.0
packaged software and was analyzed with levels of means, standard deviation,
median, minimum and maximum values and percentage points by means of ttest, One-way ANOVA test, Shapiro Wilk test, Student t test, Levene test, Welch
test and Games Howell test. The statistical significance level was set at p<0,05.
Results: The study results are determined as disabled womens average score of
FPAS is 116,72 points; the average score of the attitude of society about FP is
51,68 points, the average score of the attitude about the FP methods is 36,23
points and the average score of the attitude about birth is 28,80 points. The
average score of FPAS of the disabled women at the age of 26 and over is
indicated high and statistically significant and meaningful comparing to the
disabled women at the age of 19-25 and this is. (p<0,05). The disabled women
who have 1-2 pregnancy have higher average score of sub-dimension than the
ones who have 3 or more pregnancy and the difference between them is more
meaningful statistically.
Conclusion: The disabled womens positive attitude about FP and the aspects
that have a role in FP are designated and the suggestions are made in accordance
with these aspects. Keywords: Disability, Disabled Women, Family Planning,
Family Planning and Disabled Women, Family Planning and Attitudes Towards
Family Planning. The disabled womens positive attitude about FP and the
aspects that have a role in FP are designated and the suggestions are made in
accordance with these aspects.
O98
PATHOLOGICAL FINDINGS ASSOCIATED WITH PAIN IN TRANSVAGINAL MESHES
V. Iakovlev 1 2,*, E. Carey 3, G. Iakovleva 4, J. Steege 5, R. Bendavid 6
1Pathology, St. Michael's Hospital and the Keenan research Centre of the Li Ka
Shing Knowledge Institute, 2Laboratory Medicine and Pathobiology, University of
Toronto, Toronto, Canada, 3Department of Obstetrics and Gynecology, University
of Kansas, Kansas City, United States, 4Pathology, Markham Stoufville Hospital,
Markham, Canada, 5Department of Obstetrics and Gynecology, University of
North Carolina, Chapel Hill, United States, 6Surgery, Shouldice Hospital,
Richmond Hill, Canada
Problem Statement: Although effective in most patients, transvaginal meshes
present a steady complication rate of chronic pain, dyspareunia, urinary
symptoms and erosion. This leads to a proportion of meshes excised, however
the available material has been underutilized and no studies correlating
pathologic findings with clinical symptoms have been published.
Methods: 29 explanted transvaginal slings were assessed for morphological
features: bridging fibrosis as % of mesh pores with scar; foreign body reaction
on a scale of 3; chronic inflammation on a scale of 3; nerve density as
nerves/twigs in 200x microscopic fields, other parameters as +/-.
Results: Out of 29 explants 10 were retropubic and 19 transobturator. Reasons
for excision were: erosion - 38%; pain/dyspareunia - 57%; de novo urinary
symptoms - 33%.
Image / Graph:
Conclusion: The findings indicate that the degree of foreign body reaction, intramesh edema, involvement of smooth muscle and density of innervation likely
play a role in the development of pain and dyspareunia.
Disclosure of Interest: V. Iakovlev Consultant for: Medico-legal Consultations. E. Carey

Consultant for: Medico-legal Consultations. G. Iakovleva: None Declared, J. Steege
Consultant for: Medico-legal Consultations. R. Bendavid: None Declared
O99
SUBACUTE UTERINE INVERSION, UNEXPECTED HOSPITAL ENCOUNTER: A CASE
SERIES
R. Mizan 1,*, I. Hutagaol 2, S. Maryuni 3
1
Obstetric and Gynecology, University of Indonesia, Jakarta, 2Division of
Reproductive Endocrinology Fertility, 3Division of Reconstructive Urogynecology,
Arifin Achmad Regional Hospital, Pekanbaru, Indonesia
Problem Statement: Acute puerperal uterine inversion is a rare life threatening
case. The relatives prevalence is 2,6% compare to acute (83,4%) and chronic
(13,9%)1. It is the rarest, it is often less aware by clinicians since patient is usually
still in hospital care. Moreover it is a sad encounter for Health Provider if such
case present in Hospital where the patient is under close observation. It is said
that timing is the key for a successful management of uterine inversion. But even
in Hospital setting where immediate diagnosis can be made and immediate
management performed, subacute uterine inversion may appear in wide clinical
variation result in dramatically different outcome. The following manner are
performed to manage uterine inversion. Immediate manual repositioning of the
uterus (Johnson procedure) on conscious patient without tocolysis. If failed,
tocolysis is required or direcly sfift to general anesthesia. If manual repositioning
still fail surgical intervention is needed2.
Methods: We are reporting two unexpected hospital encounter of stage 3 sub
acute uterine inversion. The first case was a 45 yo parity four post spontaneous
delivery peurperal day 4. The second case was a 23 yo parity one post
spontaneous delivery peurperal day 3. Both case were refered to our Emergency
Room due to severe anemia. On our examination anteflexed uterus was
palpated below navel with good contraction. Normal portio was visualized with
no laceration nor active bleeding from inpeculo examination. Ultrasound
examination recorded normal involution of uterus. Both patient were then sent
to ward planned for blood transfusion to correct anemia. Both case develop
stage 3 uterine inversion in our ward. On both case immediate manual
repositioning of the uterus were fail, repositioning under general anesthesia
were then performed.
Results: On the first case such attempt was fail to correct the inversion due to
tight cervical ring and tissue oedema. The surgical Haulteins procedure was
performed successfully but uterine atony occured left the operator with no
choice but performed hysterectomy. On second case manual repositioning was
successfully done but uterine atony also then occured. The patient managed
with compression, uterotonics and condom tamponade. Whole blood were
transfused immediately as there was still continuous bleeding. The patient was
shifted to ICU for close observation. After 7 days of hospital stay both patients
were discharged from hospital in good condition.
Conclusion: This case series was reported as an eye opening for clinicians, as
such rare life threatening case may slipped from our attention. It is imperative
that the condition is recognized quickly and managed promptly in order to
minimize the potential for maternal morbidity and even mortality. It is crucial
for clinicians to have a heightened awareness of the condition and know how to
best manage it when such condition occurs as it will remain a big challenge for
every health care provider especially in developing country.
57
O100
EVALUATION OF ER: YAG LASER TREATMENT FOR HIGHER GRADE PELVIC
ORGAN PROLAPSES 1 YEAR FOLLOW-UP
S. Sencar 1,*, U. Bizjak-Ogrinc 1, Z. Vizintin 2
1Juna Clinic, 2FOTONA, Ljubljana, Slovenia
Problem Statement: The objective of this study was to evaluate new minimally
invasive, non-ablative Er: YAG laser technique for prolapse reduction.
Methods: During 15 months period (between March 2012 and June 2013) 61
patients (average age 54.9 yrs, parous status 2.2 and BMI of 25.5) with cystoceles
of grades IIIV were treated with new non-ablative Er: YAG laser treatment.
Preoperative evaluation included history and physical examination and
classification of cystocele grades using Baden-Walker scale. Patients received
between two and five treatment sessions with intervals of 2 months in between
the sessions. Pain during the treatment was measured at every session with 10
point VAS pain scale. Digital photographs of prolapses were obtained at every
visit. Follow-ups were performed at 3, 6 and 12 months. At each follow-up aside
of physical examination and prolapse photographing cystoceles grading by two
physicians were performed and patients were interviewed about post-op
adverse effects, degree of improvement of their cystocele and satisfaction.
Results: Before the treatment there were 40 patients with cystocele of grade II,
15 of grade III and 6 of grade IV. At last follow-up the large majority of patients
(58 or 95%) reduced their prolapse grades for at least one grade, 27 of them
(44%) for two grades and 8 (13%) even for three grades. At 12 months follow-up
85% of patients had either 0 or I grade of prolapse and the remaining 15% of
patients had II grade prolapses. One year after the treatment there were no
patients with III or IV grade prolapses. Treatment discomfort was very low
(average score of 0.4 on 10 grade scale) large majority of patients asses their
satisfaction as satisfied or very satisfied and their subjective assessment of
improvement was also very positive. There were no adverse effects of this
treatment reported.
Conclusion: New non-invasive Er: YAG laser treatment for higher-grade cystocele
demonstrated good efficacy in improvement of cystocele with minimal patients
discomfort during the treatment, at least 12 months lasting improvement and
no adverse effects.
Disclosure of Interest: S. Sencar: None Declared, U. Bizjak-Ogrinc: None Declared, Z. Vizintin
Consultant for: Application Development
O101
MINIMALLY INVASIVE NON-SURGICAL ERYAG LASER TREATMENT FOR FEMALE
STRESS AND MIXED URINARY INCONTINENCE- ONE YEAR FOLLOW-UP
U. Bizjak-Ogrinc 1,*, S. Sencar 1, Z. Vizintin 2
1Juna Clinic, 2FOTONA, Ljubljana, Slovenia
Problem Statement: The purpose of this study was to report the outcomes of
newly proposed minimally invasive laser therapy for female stress and mixed
urinary incontinence (SUI and MUI). There were two main objectives of our
study: to assess the efficacy of this therapy and to evaluate its safety.
Methods: This is a single arm prospective study performed in one medical center
from March 2012 to May 2013. Patients with stress and mixed urinary
incontinence were treated with new Er: YAG laser treatment. Prior to treatment
all patients were clinically inspected, and classified by incontinence types and
grades using ICIQ-UI and forming Incontinence Severity Index (ISI) upon Klovning
proposal. Patients received one to three treatment sessions with interval of 2
months in between the sessions. Treatment discomfort was measured at every
session with 10 point numerical pain scale. Follow-ups with repeated
measurements were performed at 2, 6 and 12 months.
Results: 175 patients (average age 49.7 years, average BMI of 24,7 and parity of
2,0) were treated. Of all patients 66,0% were diagnosed SUI and 34% MUI.
Average ISI score before the treatment was 5,7 points (moderate UI). Most of
the patients, 51% had severe UI, 27% moderate , 17 % mild and 5% very severe
UI before the treatment. At 12 months follow-up 82% of patients with SUI and
37% with MUI were cured, 25% of all patients remained with mild UI, 12% with
moderate and 2% with severe UI. There were no patients with very severe UI at
58
12 months follow-up. Treatment discomfort was very low (average grade 0.6 on
10 points scale). There were no significant differences (p<0.001) in UI
improvement among the age groups. However, there were statistically
significant differences (p<0.001) in the UI improvement among the severity (ISI)
groups. The largest ISI score decrease (of 8.4 points) was achieved in very severe
group, followed by 5,7 points decrease in severe group, 3.6 points in moderate
and 2.6 points in mild group. There were also no statistically significant
differences (p<0.001) in the UI improvement at 6 and 12 months follow-up.
Adverse effects were mild and transient: negligible discomfort, mild erythema
and edema. 11% of patients developed transient de-novo urge incontinence.
Conclusion: This clinical evaluation of a new non-invasive Er: YAG laser
treatment for stress and mixed urinary incontinence showed high efficacy in
improvement of UI with no major adverse effects noted. Transient urge
incontinence can appear as adverse effect. Patients discomfort during the
treatment was minimal and satisfaction very high. So far we can say that
treatment effects last for more than one year.
Disclosure of Interest: U. Bizjak-Ogrinc: None Declared, S. Sencar: None Declared, Z. Vizintin
Consultant for: Application Development
O102
ANTI-DIABETIC AND ANTIOXIDANT EFFECT OF WATER MELON SEEDS EXTRACTS
(CITRULLUS VULGARIS) ON SERUM TESTOSTERONE.
Khaki 1,*, E. Ouladsahebmadarek 2, A. A. Khaki 2, F. Fathiazad 3
1Department of Pathology, College of Vet Medicine, Tabriz Branch, Islamic Azad
University, Tabriz, Iran. 2Womens Reproductive Health Research Center, Tabriz
University of Medical Sciences, Tabriz, Iran, 33-Department of Pharmacognosy ,
Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Islamic Republic of Iran
Problem Statement: Citrullus vulgaris is an antioxidant and it has been shown to
reduce oxidative stress. Previous study confirmed antioxidants have essential
effect on infertility by their role on reactive oxygens spaces, chronic
hyperglycemia is known to cause infertility in diabetes disease.
Methods: Wistar male rat (n=40) were allocated into three groups, control group
(n=10) and citrullus vulgaris seeds extract (CVE) group that received 55mg/kg by
gavage method (n=10), and Diabetic group that received 55mg/kg (IP)
streptozotocin (STZ) (n=20) which was subdivided to two groups of 10; STZ group
and treatment group. Treatment group received 55mg/kg (IP) STZ plus55mg/kg
CVE, daily for,4 weeks, respectively; however, the control group just received an
equal volume of (0.9% NaCl) daily(gavage) . Diabetes was induced by a single
(IP) injection of streptozotocin (55mg/kg). Animals were kept in standard
condition. In 28day, 5 cc blood sample of each rat was taken for biochemical
analysis, sperm samples from epididymis were collected.
Results: sperm parameters suach as count,viability and motality, Testosterone
levels and TAC significantly were increased in groups that has received 55mg/kg
(CVE) in comparison to other groups (P<0.05).
Conclusion: Since in our study 55mg/kg (CVE) by increasing serum TAC cause to
significantly improving effect on testosterone levels, it seem using it in infertile
patients has beneficial antioxidant effects.
O103
APPLICABLE ROLE FOR URINARY LH SURGE KIT IN FROZEN EMBRYO TRANSFER
CYCLES.
E. Pourmatroud 1,*, P. Jelodaian 1
AHVAZ JUNDISHAPUR UNIVERSITY OF MEDICAL SCIENCE, Ahvaz, Islamic Republic
of Iran
Problem Statement: Embryo cryopreservation is an important progress in recent
decades adjust to in vitro fertilization (IVF) or intra cytoplasmic sperm injection
(ICSI) cycles, which means freezing the embryos at a temperature which all of
the metabolic cell function have been arrested To assess the effectiveness of
adding urinary LH surge kit to hormonal prepared frozen embryo transfer (FET)
cycles we design this study.
Methods: In this prospective clinical trial, 48 patients enrolled in two groups.
Endometrial hormone priming in both groups was similar; but in group A, from
day 10 of cycle, urinary LH surge detection was started embryo transfer (ET)
Abstract Book
scheduled after first positive test. In group B, ET was done after reaching
endometrium thickness to at least 7mm. The duration of cycle, the frequency of
sonographic monitoring, the total dosage of estrogen consumption and the
result of cycle were measured.
Results: The duration of cycle before ET in group A was shorter (8.791.14 VS
111.47 days, P Value: 0.0005), the number of sonography repetition also was
lesser (2.420.58 VS 3.670.86, P Value: 0.001). Respectively, in group A the total
dosage estrogen consumption was less than group B (35.585.2 VS 46.835.27
mg, P value: 0.0005). The pregnancy rate in group A was more than group B,
although it was not significantly different (37.5% VS 25%, P value: 0.52).
Conclusion: We suggested that prediction of LH surge and determination of
ovulation time. Neither in natural cycle but in hormonal primed FET cycle could
lead to better result due to most accurate time for transfer. We think if repeat
the study in larger population of patients the positive result of cycle would be
increased; in addition, it's obvious except endometrial characters, assurance
about the best time for implantation will be more important and applicative and
prevent wasting valuable frozen embryo by incorrect timing of thawing and
transfer. It seems except endometrial characters, assurance about the best time
for embryo implantation prevent wasting valuable frozen embryo by incorrect
timing of thawing and transfer.
Disclosure of Interest: E. Pourmatroud Grant / Research support from: AJUMS, P. Jelodaian:
None Declared
O104
CORRELATION BETWEEN DONOR SPERM PARAMETERS AND PREGNANCY
OUTCOME AFTER INTRAUTERINE INSEMINATION: A RETROSPECTIVE STUDY IN
CHINA
M. Rao 1,*, T. Meng 2, W. Xia 1, C. Zhu 1, C. Xiong 2, H. Guan 2
1Family Planning Research Institute, Tongji Medical College, 2Reproductive
Medicine Center, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
Problem Statement: The predictive value of sperm parameters on clinical
pregnancy outcome have been debated for several decades, and currently no
consensus has been reached regarding the optimal semen parameters necessary
for success with AID (artificial insemination by donor sperm). The aim of this
study was to investigate whether sperm parameters can affect the pregnancy
outcome of AID.
Methods: This study was conducted in the Reproductive Medicine Center of the
Tongji Medical College. A total of 1355 couples received 2821 AID treatment
cycles between January 2010 and December 2013, the data were collected and
retrospectively analyzed. The relationship between pre-freezing, post-thawing
as well as optimized sperm parameters and AID pregnancy outcome were
investigated through semen parameters in pregnant cycles and non-pregnant
cycles. Then we used multivariable logistic regression method to evaluate the
effect of these parameters on pregnancy outcome.
Results: A total of 728 cycles from 2821 treatment cycles achieved pregnancies
and clinical pregnancy rate was 25.81%. Pre-freezing progressive sperm motility
in pregnant cycles was higher than that in non-pregnant cycles (p=0.001); prefreezing progressive sperm motility could significantly, positively affect
pregnancy outcome (OR 0.97, 95%CI: 0.95-0.98; p=0.0001, table 1). Other
parameters seemed to be no obvious influence.
Table 1. Multivariable logistic regression model to evaluate the effect of
parameters on pregnancy outcome.
Seperm parameters
Pre-freezing sperm concentration (106ml)
Pre-freezing progressive sperm motility (%)
Post-thawing sperm concentration (106ml)
Post-thawing progressive sperm motility (%)
Optimized sperm concentration (106ml)
Optimized progressive sperm motility (%)
Optimized total progressive sperm count (106)
OR
1.00
0.97
1.01
1.00
1.01
1.00
1.00
95%CI
0.99-1.02
0.95-0.98
1.00-1.01
0.98-1.03
1.00-1.01
0.99-1.02
0.99-1.01
OR=odds ratio;
CI = confidence interval;
** :< 0.05.
Conclusion: Pre-freezing progressive sperm motility should be a valuable
predictor for AID pregnancy outcome. We put forward that donors with
relatively high value of motility whereas suboptimal value of concentration
compared with sperm bank criteria should not be rejected. This will be very
helpful to ease the tense situation of screening eligible sperm donors, and also
elevate the AID pregnancy rate.
Disclosure of Interest: M. Rao Speaker Bureau for: no competing interest, T. Meng Employee
of: no competing interest, W. Xia Employee of: no competing interest, C. Zhu Grant /
Research support from: no competing interest, C. Xiong Shareholder of: no competing
interest, H. Guan Consultant for: no competing interest
O105
RETROSPECTIVE ANALYSIS OF THE FIRST 1238 PREIMPLANTATION GENETIC
SCREENING DONE IN HUNGARY USING ARRAY COMPARATIVE GENOMIC
HYBRIDIZATION
A. Vereczkey 1,*, D. Debreceni 1, M. Csenki 1, J. Schnlber 1, G. Tgls 1, L. Nnssy
1, E. Gajdcsi 1, G. Bthori 1
1Versys Clinics Human Reproduction Institute, Budapest, Hungary
Problem Statement: Preimplantation Genetic Screening (PGS) with array
Comparative Genomic Hybridization (aCGH) is a widely spreading technique to
improve the outcome of assisted reproduction. It refers to the screening of the
chromosomes of embryos and oocytes for numerical chromosome errors. PGS is
dedicated to increase the success of in vitro fertilization (IVF) cycles in women
with advanced maternal age, or those who are suffering from recurrent
miscarriage or repeated implantation failure.
Methods: Retrospective analysis of data obtained from chromosome analysis of
1000 embryos was conducted between May 2011 and August 2014. Array
Comparative Genomic Hybridization was performed on single blastomeres using
24sure and 24sure+ microarrays from Bluegnome/Illumina.
Results: We diagnosed 365 euploid (29,48%), 275 single aneuploid (22,21%) and
499 complex aneuploid embryos (40,31%). Ninety-nine embryos (8%) could not
be diagnosed because of cell degradation or the failure of the embryo biopsy or
the whole genome amplification (WGA). Average maternal age/cycle was 37,86
years old. We have found the following numbers of viable single autosomal
aneuploidies: Down syndrome (Trisomy 21): 8, Edwardss syndrome (Trisomy
18): 2, Patau syndrome (Trisomy 13): 4.
Conclusion: Array Comparative Genomic Hybridization is a reliable and robust
technique utilizing a chip of DNA technology. The whole process can be
performed within 12-24 hours enabling fresh embryo transfer following cleavage
stage biopsy. Hopefully, further clinical trials will support the acceptance of PGS
in reproductive medicine and the method will make a significant positive
difference in clinical outcomes for couples who require IVF to establish a
successful pregnancy and ultimately a healthy live birth.
O106
ADJUVANT GROWTH HORMONE THERAPY IN POOR RESPONDERS: EFFECT ON
OVARIAN STIMULATION AND PREGNANCY
J. Rajendran 1,*, F. Louis 2, P. Gopinath 2, K. Gopinathan 2
1Reproductive Medicine, Shrishti Assisted Fertility and Advanced Laparoscopy
Center, Puducherry, 2Reproductive Medicine, Center for Infertility Management
and Assisted Reproduction, Cochin, India
Problem Statement: About 10 24% of women show poor ovarian response to
controlled ovarian hyperstimulation (COH), presenting a challenging and often
frustrating problem for the care giver. Several strategies are used to overcome
this challenge namely modifications of the pituitary down regulation or
stimulation protocols and adjuvant use of growth hormone,
dehydroepiandrostenedione sulphate (DHEAS), L- arginine etc. We aimed to
study the effect of adjuvant growth hormone (GH) therapy on COH and
pregnancy in poor responders
Methods: We studied a case series with historical controls. Cases were women
that were classified as poor responders (age 37 years, D2 FSH levels 8 IU/ mL
but 15 IU/mL, D2 antral follicular count < 5, or a history of poor response in
previous cycles characterized by less than 3 mature oocytes retrieved) and
received subcutaneous GH 2U/day along with stimulation protocol from D2 till
hCG injection during January 2010 through December 2011. Controls were
women treated in the preceding two years with the same protocol except for
adjuvant GH. The stimulation was done using human menopausal gonadotropin
59
(HMG) in both groups. Primary outcome was mature metaphase II oocytes

retrieved; secondary outcomes were peak estradiol (E2) serum levels and
pregnancy rate. Statistical analysis was carried out using SPSS version 20
Results: During the study period, out of 2559 couples undergoing fertility
treatment, 128 women (5%) were classified as poor responders receiving
adjuvant GH. In the preceding 2 years, 81 women fulfilled the same criteria and
had the exact same treatment protocol except adjuvant GH. Mean age was
lesser in the cases than controls (35.5 years vs. 37.4 years, p < 0.001); duration
of infertility, abnormal semen parameters, female factors such as tubal factor,
endometriosis, pelvic adhesion, poor ovarian reserve etc were similar between
the groups. The mean stimulation duration was similar between cases vs
controls (11.6 days vs 11.9 days, p = 0.3); total HMG dose in either group did not
differ significantly (999.8 IU vs 1229 IU). The total number of ripe follicles on the
day of hCG (5.5 vs 3.7; p < 0.001); mean peak estradiol levels achieved ( 2118 vs
1273 pg/mL; p < 0.001); number of women with peak estradiol level > 1000
pg/mL (109 vs 43; p < 0.001); mean number of metaphase II oocytes ( 6.3 vs 4.3;
p < 0.001); number of women achieving > 10 M II oocytes (20 vs 4, p < 0.048)
were all significantly higher in the cases than controls. The overall pregnancy
rates was higher in cases (32% vs 21%; p = 0.024); rates of pregnancy that
continued beyond first trimester were 24.2 % and 12.3 % (p = 0.048) in the cases
and controls respectively. Multivariate regression analysis established
independent effect of GH on the number of M II oocytes retrieved, peak E2 levels
achieved and rate of pregnancy beyond first trimester in women with poor
ovarian reserve
Conclusion: Addition of 2U of GH to COH long protocol resulted in significantly
more number of M II oocytes retrieved and higher levels of peak estradiol levels.
In women with poor ovarian reserve, adjuvant GH therapy improves the rate of
pregnancy that continue beyond first trimester.
O107
UTERINE ARTERY EMBOLIZATION FOR TREATING POSTPARTUM HEMORRHAGE
DOES IT HELP?
K. Aas-Eng 1,*, E. Qvigstad 1 2, N.-E. Klw 2 3, K. Hald 1
1Department of Obstetrics and gynecology, Oslo university hospital, 2Faculty of
medicine, Oslo University, 3Department of Radiology and interventional
medicine, Oslo university hospital, Oslo, Norway
Problem Statement: To evaluate the clinical effectiveness, safety, long-term
complications and fertility after uterine artery embolization (UAE) for
management of postpartum hemorrhage (PPH). Secondly, to find whether the
introduction of UAE influenced the incidence of postpartum hysterectomy.
Methods: Retrospective study in a Norwegian tertiary referral centre. Women
who underwent postpartum hysterectomy from January 2003 to December
2010 (n=20) and women that underwent embolization for PPH from January
2007 to December 2010 (n=34) were included. Patients were identified with
diagnosis-related group (DRG) coding system and their hospital records were
reviewed. Patients who were embolized were contacted by questionnaire to
evaluate long-term complications and fertility. Clinical success was defined as
not needing further intervention after embolization. Secondary outcome
measures were registered pregnancies and labors among those who were
embolized only. Additionally, incidence of postpartum hysterectomy in the
period before (2003- 2006) and after (2007- 2010) the introduction of UAE for
PPH was registered.
Results: Clinical success was achieved in 28 out of 34 patients (82 %) who
underwent UAE. Five needed subsequent hysterectomy; four due to continuous
hemorrhage, one because of uterus necrosis. There were nine reported
pregnancies and seven live births. Recurrent PPH occurred in 57 %. None
required repeat embolization. The incidence of postpartum hysterectomy was
unchanged since the introduction of UAE for postpartum hemorrhage (p=0.80).
Conclusion: UAE as treatment for PPH was effective and safe with preservation
of fertility in most cases. No statistically significant reduction in hysterectomy
rate was found. High recurrence rate of PPH after previous UAE was observed.
60
O108
PROSTATIC TISSUE, AN APPENDIX AND A MUCINOUS CYSTADENOMA, ALL IN
ONE MATURE CYSTIC TERATOMA.
W. M. Al Ghafri 1,*, M. Al-Shukri 1, M. Al Riyami 2, K. Al Amrani 3
1Obstetrics and Gynecology, Sultan Qaboos University Hospital, 22. Department
of
Emergency
of Pathology, Sultan Qaboos University, 33. Department
Medicine, Sultan Qaboos University Hospital, Al Seeb, Oman
Problem Statement: Mature cystic teratomas can contain tissue from any of the
three embryonic germ cell layers. The most common type of gastrointestinal
tissue found in mature teratomas is intestinal type epithelium usually of
duodenal type. Up to our knowledge no cases have been reported of finding
tissue resembling the appendix in such tumors. In addition to that we are
reporting a rare ovarian neoplasm composed of an admixture of mature
teratoma and a benign mucinous cystadenoma in an appendix in the teratoma
and presence of prostatic tissue
Methods: Mature cystic teratomas are the third most common benign tumors
next to serous and mucinous cystadenomas and the most common germ cell
tumor. They range in size but the majority is 5 to 10 cm in diameter. Most
commonly, they are filled with thick sebaceous material and hair. In 30 to 50%
of the cases formed teeth are present. The other cellular elements present are
skin with its appendages, gastrointestinal epithelium, salivary gland, thyroid
tissue, cartilage, bone, muscle, nervous tissue, choroid plexus, etc.
Results: Here we are reporting a 35 years old lady, Para 11 Abortion 1 Living 10
who undergone laparoscopic Bilateral ovarian cystectomy for bilateral dermoid
cysts. Operative findings were normal looking uterus and tubes, normal looking
bowel, appendix, liver and hemidiaphragm. The left Ovary was enlarged with
dermoid cyst around 8x7 cm and the right ovary was enlarged with dermoid cyst
around 3x 4 cm. postoperative course was uneventful and she was discharged
home on the next day.
On histopathologic examination of the right ovarian cyst it was largely lined by
keratinizing squamous epithelium with skin adnexa in its wall. In one area,
prostatic tissue including acinar glands and fibromuscular stroma is
noted. Mature glial tissue and ganglion cells are also present. A smaller locule
is lined by urothelium with squamous metaplasia. There was a cystic area filled
with mucoid material proven histologically to be reminiscent of an appendix with
an epithelial lining of a benign mucinous cystadenoma. The wall of this
appendicular structure has an inner and outer muscle coat with intervening
nerve bundles and ganglion cells identical to the architecture of a gastrointestinal appendix. There is no dysplasia or malignancy in any of the elements.
The other ovarian cyst was typical of a mature cystic teratoma.
Image / Graph:
Conclusion: Ovarian teratomas are the most common germ cell neoplasms and
accounts for 1020% of all ovarian tumors. These include: mature cystic
teratomas, immature teratomas and monodermal teratomas. They are
composed of tissue derived from the three pluripotential germ cell layers:
ectoderm (skin derivates and neural tissue), mesoderm (fat, bone, cartilage,
muscle) and endoderm (gastrointestinal and bronchial epithelium, thyroid
tissue). Gastrointestinal type epithelium is found on microscopy in 7-13% of
teratomas. Kwon et al and Nelson et al reported grossly visible loops of intestine.
Our patient represents an interesting combination of intestinal type epithelium
specifically identical to the appendix with a mucinous cystadenoma within that
structure in addition to prostatic tissue.
Abstract Book
O109
THE ROLE OF VITAMIN D IN THE PREVENTION OF OSTEOPOROSIS
M. Brincat 1,*, M. Brincat 1, J. Calleja Agius 1
Dept of Obstetrics and Gynaecology, Birkirkara, Malta
Problem Statement: It is known that circulating Vitamin D predominantly
orginates from cutaneous synthesis and therefore should be considered as a
hormone rather than a vitamin. Vitamin D deficiency (<50nmol/L) is a worldwide
epidemic with multiple implications on human health, due to its role in various
physiological systems.
Methods: Various studies have shown that with higher serum 25 hydroxyvitamin
D levels, there is a decrease in the incidence of non-vertebral and hip fractures.
Results: it is recommended that a deficiency in vitamin D should be treated with
pharmacological doses of vitamin D (for example 800 1000IU of vitamin D3
daily) to rapidly restore vitamin D levels and have minimal risk of toxicity. The
National Osteoporosis Guideline Group (NOGG) recommended a daily intake of
at least 1000mg of calcium, 800 U of vitamin D, and 1 g/kg body weight of protein
as a general measure for osteoporosis prevention [17]. Currently NOGG states
that Calcium and vitamin D supplementation is widely recommended in older
people who are housebound or living in residential or nursing homes, where
vitamin D deficiency and low dietary calcium intake are common.
Conclusion: There is limited research data on the management of vitamin D
deficiency using therapeutic doses.The majority of studies focus on lower
physiological doses rather than high pharmacological doses In order to reach
serum levels of 75nmol/L from a deficiency state, higher doses than 800 1000
IU/day are required. Future focus should be on the implications of a rise in
systemic 25 (OH) D3 levels from a deficiency state to 75nmol/L on bone density
and fracture risk, and the use of high doses in cases of vitamin D deficiency.
O110
MENOPAUSE-RELATED CHANGES IN THE MUSCULOSKELETAL SYSTEM,
CARTILAGES & JOINTS
J. Calleja Agius 1, M. Brincat 1,*
Dept of Obstetrics and Gynaecology, Birkirkara, Malta
Problem Statement: Postmenopausal osteoporosis is a silent systemic
progressive disease characterised by a decrease in bone mass per unit
volume. Osteoporosis and related fractures are a significant concern for the
global community. As the population continues to age, morbidity and mortality
from fractures due to osteoporosis will likely continue to increase.
Methods: The menopause has been shown repeatedly to have a negative effect
on the connective tissue in the bone matrix. Such an effect is prevented and in
some cases reversed with oestrogen therapy. Studies show that oestrogen
prevents osteoporosis partly by inhibiting bone resorption. In the wake of the
WHI trial, many dilemmas have yet to be resolved regarding the use of HRT in
postmenopausal women. Selective oestrogen receptor modulators (SERMs) act
through oestrogen receptors and are agonists for bone and antagonists for
breast and uterine tissue.
Results: The lumbar intervertebral disc height has been shown to be significantly
higher in the premenopausal group (height of three lumbar discs 2.16+/- 0.1cm)
and hormone treated group (disc height 2.2+/- 0.12cm), compared to the
untreated postmenopausal women (disc height 1.86+/- 0.06cm)
(p<0.0001). This has been confirmed by another study on a bigger cohort. The
premenopausal women and hormone treated women had disc heights of 2.01
+/- 0.09cm and 2.15 +/- 0.08cm respectively, the latter results being significantly
higher than the untreated postmenopausal group (height of three lumbar discs
1.82 +/- 0.06cm) and the osteoporotic fracture group (1.58 +/- 0.1cm)
(p=<0.0001). A new approach to menopausal therapy is the tissue selective
oestrogen complex or the pairing of a selective oestrogen receptor modulator
with oestrogens.
Conclusion: Novel bone-targeting Oestradiol delivery systems have the potential
to improve the safety profile of Oestradiol in the treatment of osteoporosis.
O111
BREAST SAFETY OF CONJUGATED ESTROGENS/BAZEDOXIFENE: POOLED
ANALYSIS
OF
RANDOMIZED,
PLACEBO-CONTROLLED
TRIALS
IN
POSTMENOPAUSAL WOMEN
J. H. Pickar 1, K. A. Ryan 2, M. Messig 3, S. Mirkin 2, B. S. Komm 2,*
1Columbia University Medical Center, New York, 2Pfizer Inc, Collegeville, 3Pfizer
Inc, New York, United States
Problem Statement: Clinical studies have shown that progestin-containing
hormone therapy (HT) is associated with an increased risk of unfavorable breast
effects. Conjugated estrogens/bazedoxifene (CE/BZA) is a tissue-selective
estrogen complex that combines the benefits of CE on menopausal symptoms
and bone with the protective effects of BZA on the breast and uterus. The breast
safety profile of CE/BZA was assessed using pooled data from the Selective
estrogens, Menopause, And Response to Therapy (SMART) clinical trial program.
Methods: Data for CE 0.45 mg/BZA 20 mg (n=1585), CE 0.625 mg/BZA 20 mg
(n=1583), CE 0.45 mg/medroxyprogesterone acetate (MPA) 1.5 mg (n=399
[SMART-4 and -5 only]), raloxifene (RLX) 60 mg (n=423 [SMART-1 only]), and
placebo (PBO; n=1241) were pooled from the randomized, double-blind, PBOand active-controlled, phase 3 SMART trials in postmenopausal women with a
uterus. Breast procedure incidence (biopsies, aspirations, nipple discharge
cytology), mammography data, breast pain/tenderness (measured by daily
diaries), and breast-related adverse events (AEs) were assessed; breast cancer
incidence was determined from cumulative meta-analysis with inverse variance
weighting.
Results: Overall incidence of breast cancer per 1000 woman-years was 1.00 (95%
confidence interval [CI] 0.003.21) for CE 0.45 mg/BZA 20 mg, 0.00 (0.001.54)
for CE 0.625 mg/BZA 20 mg, 1.05 (0.006.89) for CE/MPA, 0.00 (0.002.20) for
RLX, and 1.40 (0.004.17) for PBO (Table). Incidences of abnormal
mammograms were similar for both CE/BZA doses vs PBO and CE/MPA and
significantly lower vs RLX. Percentage of subjects who had follow-up breast
procedures was similar for CE 0.45 mg/BZA 20 mg (0.76%), CE 0.625 mg/BZA 20
mg (0.88%), and PBO (0.89%); percentage of subjects was numerically higher for
CE/MPA (1.50%) and RLX (1.33%). Incidence of breast pain/tenderness for CE
0.45 mg/BZA 20 mg (9.8-11.5%) and CE 0.625 mg/BZA 20 mg (9.8-10.2%) was
similar to PBO (8.1-11.2%) and RLX (6.2-8.7%) and significantly lower vs CE/MPA
(21.6-29.1%; P<0.001). The incidence of breast-related AEs was low (1% for
each AE) and similar among groups.
Table. Breast Cancer Incidence (SMART-1 to -5), Abnormal Mammograms
(SMART-1, -4, and -5) and Breast Pain/Tenderness (SMART-1, -2, -4, and -5a)
Treatment
Breast cancer incidence per

1000 woman-years (95% CI)
Women
with
abnormal
mammogram at month 12, n (%)
CE 0.45 mg/BZA 20 mg
1.00 (0.003.21)
20 (2.58)b
CE 0.625 mg/BZA 20 mg
0.00 (0.001.54)
20 (2.60)b
CE 0.45 mg/MPA 1.5 mg
1.05 (0.006.89)
3 (1.66)
RLX 60 mgf
0.00 (0.002.20)
16 (5.33)
PBO
1.40 (0.004.17)
20 (3.16)
aBreast
pain was not assessed in SMART-3.

bP<0.05 for CE/BZA vs RLX.
cP<0.001 for CE/BZA vs CE/MPA.
d
P<0.001 for CE/MPA vs PBO.
eP<0.001 for CE/MPA vs RLX.
fStatistical tests of RLX vs PBO and RLX vs CE/MPA were not done.
Conclusion: CE 0.45 mg/BZA 20 mg and CE 0.625 mg/BZA 20 mg were associated
with an acceptable breast safety profile with no increase in breast-related
tolerability concerns. CE/BZA provides a therapeutic alternative to conventional
HT for postmenopausal women, which may be particularly valuable for those
with safety or tolerability concerns with progestin-containing HT.
Disclosure of Interest: J. H. Pickar Consultant for: Wyeth/Pfizer, Ausio Pharmaceuticals,
Besins Healthcare, Shionogi, Depomed and TherapeuticsMD, Employee of: Former employee
of Wyeth Research, K. A. Ryan Employee of: Pfizer Inc, M. Messig Employee of: Pfizer Inc, S.
Mirkin Employee of: Former employee of Pfizer Inc, B. S. Komm Employee of: Pfizer Inc
61
O112
INFLUENCE OF HORMONAL CONTRACEPTION IN PATIENTS WITH
THROMBOEMBOLIC EPISODE UNDER THE AGE OF 40 YEARS
P. M. M. Figueiredo 1,*, D. Coelho 1, M. Mesquita 1, F. Queirs 2, L. Graa 1
1Ginecologia/Obstetrcia, 2ImunoHemoterapia, Centro Hospitalar do Alto Ave,
Guimares, Guimares, Portugal
Problem Statement: In the fifties, after the introduction of hormonal
contraception, it was early recognized and identified the association of
thromboembolic episodes and the use of contraceptives, particularly the ones
with estrogenic component. Nowadays, the occurrence of these events has been
declining with lower hormone dosages, but they are still occurring, even in young
women.
Methods: Retrospective analysis of all patients with thromboembolic events
with less than 40 years referred to the Centro Hospitalar do Alto Ave between
1st January 2010 and 31st December 2013. Variables such as age, type of
contraception used, relation between the start of contraception and the event,
presence of thrombophilia and risk factors were collected. Data were analyzed
using the SPSS application, version 22.0.
Results: A cohort of 141 patients from different specialities intra and extrahospital (all referenced to Immunohematology/ Thromboembolic Diseases)
were obtained. In almost 10% of the cases, the episode occurred after the
introduction of combined oral contraception; 30% of the patients had family
history of thrombosis. The most frequent risk factors encountered were
dyslipidemia, obesity and immobility. In the study, the etiology more frequent
were MTHFR and combination of gene modifications. We verified also the
presence of thromboembolic events in very young women, with one or more
risk factors but also cases without identified risk.
Conclusion: Combined hormonal contraception was one of the great revolutions
of the twentieth century, keeping a place in family planning today. However, and
despite lower estrogen dosages used, the contraceptive approach on an
individual basis, with the identification of risk factors and history of women,
continues to be fundamental in choosing the better method, with weighing the
risks / benefits.
O113
USE OF TRADITIONAL MEDICINE FOR THE TREATMENT OF INFERTILE WOMEN
WITH POLYCYSTIC OVARY SYNDROME (PCOS)
R. Ershadpour 1, M. Sahraeian 2, R. Jahromi 1,*, S. sobhaniyan 3
1Jahrom University of Medical Sciences, 2Jihad versity of Jahrom, 3Faculty of
Nursing and Para medicine, Jahrom University of Medical Sciences, Jahrom,
Islamic Republic of Iran
Problem Statement: Beside Pharmaceutical treatment, traditional medicine
could be an alternative way to induce ovulation and treat infertility due to
polycystic ovary syndrome. This study aimed to compare traditional medicine
with medical therapy in the treatment of infertile PCOS patients.
Methods: This study is a retrospective cohort, from June 2012 to March 2013. 32
of the patients were treated by prescribing drugs such as Apometformin,
Medroxy progesterone, metformin, letrozole, clomiphene and 32 patients by
taking the herbal drugs; vitex, nettles and over 15 sessions of cupping therapy.
The standard of PCOS improvement was ovarian follicular growth more than 10
millimeter. Data such as the results of the ultrasonic and ovary tests, duration of
the treatments, fertility creation and demographic information were entered in
standard statistic software.
Results: The mean duration of the treatment in medical therapy was 127.34
70.38 days and 81 47.09 days in traditional medicine. Indeed patients
recovered faster by using traditional medicine. On the other hand improvement
of PCOS in both methods had no significant difference (P 0/108), but fertility
creation after the course of treatment, in both groups, showed statistically
significant difference (P 0.003), which means by traditional medicine, ovarian
follicles were capable of fertilization more effectively.
Conclusion: Improvement of PCOS had no significant difference in growth of
ovarian follicles in both methods, that means increase in follicle size had been
seen in both groups, but this improvement allocated less time and the
62
probability of fertilization significantly increased in traditional medicine method,

compared to medical therapy. Traditional medicine could be an appropriate
method for the treatment of infertile PCOS patients. For appropriate decision
about the use of traditional medicine alongside classical treatments, further
studies are necessary in future.
O114
ULTRA-STRUCTURAL STUDY BY TRANSMISSION ELECTRON MICROSCOPY:
EFFECT OF OMEGA-3 ON OVARY CELL ORGANELLES AFTER EXPERIMENTAL
INDUCED POLY CYSTIC OVARY SYNDROME
A. Khaki 1,*, E. Ouladsahebmadarek 2, N. Ainehchi 3, Z. Ghanbari 2
1
Department of Pathology, College of Vet Medicine, Tabriz Branch, Islamic Azad
University, Tabriz, Iran. 2Womens Reproductive Health Research Center, Tabriz
University of Medical Sciences, Tabriz, Iran, 3Department of Pharmacognosy,
Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, and Islamic Republic of
Iran
Problem Statement: Polycystic ovary syndrome (PCOS) is the most frequent
cause of female infertility, affecting about 4% to 8% of women in the age of
procreation. For evaluation the protective effects of omega-3 polyunsaturated
fatty acid on ovarian structure in experimental PCO induced by estradiol-valerat,
this research was done.
Methods: Wistar female rats (n=40) were allocated into four groups, one control
(n=10) and three test groups (n=30), that one group received omega-3 (60
mg/rat/orally/daily), second and third groups were induced PCO by single
injection of estradiol-valerate (16mg/ kg/ i.m), third group also received omega3 (240 mg/kg) for 60 consequence days. Animals were kept in standard
conditions. On day 60, the ovarian tissue of Rats in whole groups were removed
and prepared for pathological analysis.
Results: vacuolated area and rough endoplasmic reticulum expanded, degranulated, disorganized were seen in PCO groups; however, these side effects
decreased in the groups that received omega-3 significantly (p<0.05) in
comparison to experiment groups and ovarian weights in PCO experimental
decreased significantly (p<0.05).
Conclusion: Results revealed that administration of omega-3 could significantly
treat PCO. This suggested that polyunsaturated fatty acid could diminish
negative side effects of PCO on ovary tissue.sugestion is take omega-3 in women
diet could be show good effect in thier ovariaon working.
O115
CIRCULATING ENDOMETRIAL CELLS: A BIOMARKERS IN ENDOMETRIOSIS?
V. Bobek 1, K. Kolostova 1,*
Dpt. of Laboratory Genetics, FNKV, Prague, Czech Republic
Problem Statement: Endometriosis is a common disorder amongst women of
reproductive age. Despite extensive research, no reliable blood tests currently
exist for the confirmation of endometriosis diagnosis. We report a new
noninvasive testing for enrichment and culturing of viable circulating
endometrial-like cells (CECs).
Methods: A size-based filtration method (MetaCell, Ostrava, Czech Republic)
has been used for the enrichment CECs out of peripheral blood (PB) and and
peritoneal endometrial cells (PECs) out of peritoneal washing (PW). Filtration
flow is driven by capillary action through polycarbonate membrane with
predefined pores sized 8mM.
Results: Together 17 patients with newly diagnosed endometriosis have been
enrolled into the study. The PECs were found in the PW in all of the tested
patients using the size-based filtration method, but circulating endometrial cells
(CECs) only in 23, 5% (4/17) cases in PB. Besides cytomorphological analysis to
confirm the origin of the captured cells following antibodies has been used: Pancytokeratin, Vimentin and CD10. In the 9 of the 17 cases we have successfully
cultured the PECs in vitro as well directly on the separating membrane. We
identified two cell types growing in PECs- fractions: glandular - and stromal -like
cells. Some of the CECs and PECS were able to grow through the membrane
Abstract Book
pores and set up new cell colonies on the culture flask- bottom. CECs proliferated
successfully in the two of the four positive cases.
Conclusion: The occurrence in CECs in peripheral blood is a very specific evidence
of endometrial disease. To date we are not able to describe the prognostic
information of the CECs, but we are able to use the captured cells for evidencing
endometriosis disease. We demonstrated efficient, quick and user friendly CECs
capture platform based on a different cells size. Furthermore, we demonstrated
the ability to culture the captured cells, a critical requirement for post-isolation
cellular and molecular analysis, which could improve significantly the
endometriosis management in future.
O116
CLINICAL AND MORPHOLOGICAL FEATURES OF PELVIC ADHESIONS IN
PATIENTS WITH UTERINE LEIOMYOMA
L. Kondratovich 1,*, A. Kozachenko 2, L. Adamyan 2, E. Kogan 3
1
Operative gynecology, 2Russian Scientific Center for Obstetrics, gynecology and
perinatology named after V.I. Kulakov, Moscow, Russian Federation,
3
pathomorfology, Russian Scientific Center for Obstetrics, gynecology and
perinatology named after V.I. Kulakov, Moscow, Russian Federation
Problem Statement: To study the clinical and morphological features of
formation of pelvic adhesions in patients with uterine leiomyoma after
laparoscopic myomectomy.
Methods: 110 patients with uterine leiomyoma included in this study. The
patients were divided into 2 groups. The first group - with pelvic adhesions (n =
34). The second group - without pelvic adhesions (n = 76). All 110 patients
underwent laparoscopic myomectomy in Operative Gynecology department
during last year. Clinical investigation, morphological method, morphometric,
immunohistochemical staining with detection of Ki67, C-KIT, VEGF, MMP2,
TIMP2, Col 1, Col 3 type expression in leiomyoma and adhesions were used.
Results: Dystrophic changes accompanying with growth foci in the uterine
leiomyomas prevailed in I group of patients. Markers of proliferative activity,
markers of intercellular interactions, and angiogenesis were overexpressed in a
fiber tissue. Morphological features of the adhesive fibers were characterized by
presenting of adipose tissue and cells with signs of steam cells.
Conclusion: Severe pain syndrome, high frequency of infertility, low pregnancy
rate were in a group of patients with pelvic adhesions. Existence of the steam
cells in adipose tissue in adhesive fibers in patients with uterine leiomyoma
needs to be investigated. Further studies of influence of steam cells in adhesive
fibers on pelvic adhesion formation and fertility in patients after laparoscopic
myomectomy are required.
0117
MENOPAUSE SYMPTOMS & IMPACT ON QUALITY OF SEXUAL LIFE
G. KURT 1,*, T. YAVAN 1, G. G. NIZAM 2
1
Obstetrics and Gynecologic Nursing, Gulhane Military Medical Academy, School
of Nursing, 2Gulhane Military Medical Academy, Ankara, Turkey
Problem Statement: Menopause appears as period during which many physical
and psychological symptoms are observed in middle aged women. Menopause
symptoms affect almost 70% of all women and can begin a long time prior to
menopause. While menopause is experienced differently by different women,
there are some commonly experienced physical and psychological menopausal
symptoms, one of which is loss of libido. Menopausal Symptoms must be
determined and intervened to improve quality of life of women. The aim of the
study was to determine the menopausal symptoms and the effects of
menopausal symptoms on the quality of sexual life in postmenopausal women.
Methods: This cross-sectional study was conducted in the menopause
outpatient clinic of a university hospital between January-March 2014. The
sample consisted of 178 postmenopausal women who had menopause term and
accepted to participate in the study. Data was collected by using a form which
was developed by the researcher in accordance with consulted relevant
literature. In addition Menopause Symptoms Rating Scale (MSRS) and Sexual
Quality of Life Questionnaire-Female (SQLQ-F) were used. Statistical analyses
were performed using the SPSS for the Windows version 15.0 program.
Categorical variables were reported as number and percent. Continuous
variables were reported as meanstandard deviation. The Pearson correlation
test was used for statistical analyses. A value of p<0.05 was considered
statistically significant.
Results: The mean age of women was 54.8368.26 years. The average of
menopause age was 45.853.78. The 14.0% of women took HRT. MSRS total
score of the women was found as 18.1712.07 which shows us menopausal
complaints of them were moderate and affected their quality of life adversely.
Approximately half of the women are experiencing urogenital (x=4.244.00),
one third of the women are experiencing somatic (x=7.004.68), and
pschological (x=6.934.38) symptoms violently. Most of the menopausal
complaints of them were sexual problems (81.6%), hot flashes and sweats
(63.0%), irritability and anger (34.0%). SQLQ-F total score of the women was
found as 62.3020.17. It shows that quality of sexual life of women were
moderate. 44.1% of women avoided from sexual intercourse. 39.3% of the
women experienced sexual dissatisfaction and 37.6% of the womens sexual
intercourse frequency decreased. There are significant statistically between
SQLQ-F and MSRS total score. When the intensity of menopausal complaints
increase, the quality of sexual life is reduced (p<0.001).
Conclusion: In this study, it was shown that womens SQLQ-F and MSRS total
score were moderate. Menopausal symptoms are affected sexual life of women
negatively. For this reason, nurses and health care institutions must give
information to women about sexual life and psychologic consultancy services
during menopause.
O118
TISSUE SELECTIVE ESTROGEN COMPLEXES: A NOVEL MECHANISM OF ACTION
FOR THE TREATMENT OF MENOPAUSAL SYMPTOMS
B. S. Komm 1,*, S. N. Jenkins 1, S. Mirkin 1
Pfizer Inc, Collegeville, United States
Problem Statement: Estrogens bind with and activate estrogen receptors (ERs)
to modulate gene transcription and signaling, impacting cellular processes in
various tissues, including bone, breast, and endometrium. ER-mediated activity
has shown benefits for menopause-related conditions in women; however,
estrogens are associated with proliferation in uterine tissue compartments.
Consequently, traditional estrogen therapy for postmenopausal women with a
uterus requires use of progestins, which, via the progesterone receptor, inhibit
cellular proliferation in the endometrium, counteracting estrogenic effects.
Progestins, however, are associated with tolerability issues including breast pain
and uterine bleeding. A newer approach to menopausal therapy, the tissue
selective estrogen complex (TSEC), pairs a selective estrogen receptor modulator
(SERM) with 1 or more estrogens. Because SERMs exhibit distinct profiles of gene
and target-tissue activity, TSECs maintain the benefits of estrogens on
menopausal symptoms without the stimulatory effects on breast and uterus.
Methods: A series of preclinical and clinical studies was conducted in the course
of the clinical development of the first TSEC, which combines conjugated
estrogens (CE) with the SERM bazedoxifene (BZA), to characterize the
mechanisms of action underlying the therapeutic effects of TSEC therapy.
Results: The components of a TSEC can form a heteroligand-ER complex with
distinct effects on gene expression and target tissues, compared with their
individual SERM or estrogen components. Preclinically, the TSEC CE/BZA is
associated with ER agonist effects on bone turnover and vasomotor function as
well as concurrent antagonist effects in breast and endometrium resulting from
the presence of the BZA SERM component. CE/BZA also promotes ER
degradation somewhat tissue-selectively, further minimizing endometrial and
breast estrogenic responses. In five phase 3 clinical trials, CE 0.45 mg/BZA 20 mg
and CE 0.625 mg/BZA 20 mg relieved vasomotor symptoms and some measures
of vulvar-vaginal atrophy related to menopause, increased bone mineral density,
and decreased bone turnover without increasing breast density or risk of
endometrial hyperplasia in nonhysterectomized postmenopausal women.
Conclusion: Via receptor-binding competition, variable gene transcriptional
activity associated with heteroliganded receptor dimers, and ER degradation,
CE/BZA is mechanistically and pharmacologically distinct from its individual
63
components. By blending estrogen and SERM activity, TSECs provide a unique

combination of attributes different from that of hormone therapy or SERMs
alone.
Disclosure of Interest: B. S. Komm Employee of: Pfizer Inc, S. N. Jenkins Employee of: Pfizer
Inc, S. Mirkin Employee of: Former employee of Pfizer Inc
O119
CLINICAL FEATURES AND MANAGEMENT OF PULMONARY ENDOMETRIOSIS: A
COMPREHENSIVE SINGLE CENTER ANALYSIS
J. H. Park 1
Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea,
Republic Of
Problem Statement: To analyze the diagnostic profiles and treatment outcomes
of pulmonary analysis including diagnosis surgical and medical treatment.
Methods: A comprehensive review of medical records was performed in a
retrospective manner for patients with pulmonary endometriosis at Gangnam
Severance Hospital, Yonsei Univerity College of Medicine from Jan, 2007 to July,
2014.
Results: A total of 15 patients with pulmonary endometriosis were evaluated.
With a median age of 35(23-48) years, 8 patients presented with catamenial
hemoptysis whereas 7 patients presented with catamenial pneumothorax. The
median age was 26 (23-36) years for catamenial hemoptysis group and 42(3548) years for catamenial pneumothorax group. Only 3 (20%) of the 15 patients
had coexisting pelvic endometriosis and all were pre-menopausal states. All
patient underwent chest CT scans, where the lesions predominantly influenced
the right lung (n=13, 86.7%) opposed to the lung (n=2, 13.3%) or bilateral lung
(n=0). Lesions were mainly distributed on the right upper lobe (n=9, 60%). 10 of
these patients underwent video assisted thoracoscopic surgery (VATS), one
patient received a thoracotomy. Intraoperatively, endometriosis specific
findings (red lesion, endometriotic spots) were observed in 8 of 11 (72.7%)
patients. 5 of 11 (45.4%) patients had detected endometriosis only upon
microscopic examination and staning. The mean follow up period was 18.4
months (range 2-65 months). Five patients (33%) had clinical signs of recurrence.
Recurrence was not detected in all of the five catamenial pneumothorax patients
that received adjuvant hormonal therapy after surgery.
Image / Graph:
Conclusion: Pulmonary endometriosis could only be diagnosed and treated

through a multidisciplinary approach based upon skillful differential diagnosis
through careful gynecologic evaluation and assessment of the cyclicity of
pulmonary symptoms. Although the imaging findings are non-specific, laterality
towards the right lung should be considered. Since recurrence of symptom is
more common in those with pneumothorax, extra caution is warranted, with a
strong recommendation for adjuvant medical therapy.
O120
INTRAOPERATIVE MONITORING AND EVALUATION OF MRI IN WOMEN OF
REPRODUCTIVE AGE AFTER PREVIOUSLY PERFORMED UTERINE ARTERY
EMBOLIZATION
I. Porotikova 1,*, T. Gavrilova 1, E. Kulabukhova 1, L. Adamyan 1
64
1Operative gynecology, Russian scientific center for obstetrics, gynecology and

perinatology, Moscow, Russian Federation
Problem Statement: Uterine fibroids is the most common disease among

women of reproductive age and consist of 10 to 30% of all gynecological
diseases. Despite the fact that quite often uterine fibroids have no symptoms, it
can become a cause of serious complaints such as menorrhagia, infertility and
miscarriage.Nowadays there are different methods of treatment of uterine
fibroids, one of them is the uterine artery embolization, but this method is not a
radical, and its efficiency depends on the patient's age and clinical manifestation,
size, localization of uterine fibroids. Many researchers suppose that the failure
of uterine artery embolization (UAE) may be due to the existence of an
additional blood supply to the fibroids from ovarian, bladder artery and
collateral arterial anastomoses from pelvis
Methods: We have examined a group of 23 patients. All of them previously
underwent UAE. Age of the women ranged from 22 to 40 years. The main
complaints were menorrhagia (80.2%), pelvic pain in the abdomen (70%),
absence of pregnancy (95%). The size of uterine fibroids ranged from 7 to 22
weeks of pregnancy. All patients underwent MRI with the magnetic field
strength of 1.5 Tesla. The study was conducted using T1 and T2-weighted
standard sequences. To estimate the size and location of fibroids sections
arranged along the axes of the uterus. The maximum diameter of leiomyoma
was 10 cm. Later all women underwent surgical treatment.
Results: Analysis of the MRI showed that 77.4% had significant degenerativedystrophic changes fibroids, varicose of pelvic and uterine wall found in 21.5%
of cases. During surgery in 100% of cases were multiple uterine fibroid, in 86%
patients multiple fibroids with secondary degeneration changes, in 17.2% - the
number of fibroids was more than 50. Increased diffuse bleeding tissue was
observed in 81, 7% of patients.
Conclusion: Further research including the development of clear indications for
embolization in patients with uterine leiomyoma in reproductive age is required.
O121
THE DETERMINATION OF OGTT (ORAL GLUCOSE TOLERANCE TEST) SENSITIVITY
IN DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS
M. Jaladat 1, A. Rasekh 1,*, M. Naseri 1, S. Pourshojae 1, M. Alborzi 1, F. Alipoor 1, S.
Mohammadzade 1
Jhrom University, Shiraz, Iran, Islamic Republic Of
Problem Statement: It is well documented that the pregnancy is the insulin
resistant state which can be tolerated by most of the women with normal
glucose metabolism. However, some pregnant women experience carbohydrate
intolerance with various degrees during their pregnancies. Although the certain
mechanism of this pregnancy dependent carbohydrate intolerance has not been
well known yet, excessive insulin resistance, which means reduced insulin
response to carbohydrates or low insulin sensitivity and beta cell dysfunction are
the common characteristics of the subjects. Diagnostic methods of this
heterogeneous group of pregnant women are also under debate. Gestational
diabetes mellitus (GDM) affects the 1 to 14 percent of the pregnancies according
to the diagnostic test which was performed by the physicians. Today, one-step
and two-step approaches are the common tests for the detection of gestational
diabetes At present, the status of carbohydrate metabolism of pregnant women
with high glucose levels, which exceeds the critical threshold value of GCT, but
normal 100-g, 3-hour OGTT have not been evaluated clearly yet. The aim of this
study to find the sensitivity of OGTT in diagnosis of GDM.
Methods: This study was performed on 460 pregnant women referred to
Dr.Rasekh clinic between 24 and 28 weeks of gestation in Jahrom city.
Gestational age was based on last menstrual period and according to a reliable
menstrual history confirmed by ultrasonography before 20 weeks of gestation.
All the pregnant women underwent 50-g glucose challenge test as our routine
antenatal screening protocol. Venous plasma glucose was measured at the first
hour of the glucose load. A value of plasma glucose 140 mg/dL as accepted as
the threshold value for the positive glucose challenge test. Pregnant women
with a positive challenge test underwent 3-hour 100-g OGTT within 7 days .At
least two plasma glucose levels exceeding the cut-off values following OGTT
Abstract Book
were essential for the diagnosis of GDM. Women with one abnormal value were
excluded from the study, and the pregnant women who had normal GTT
followed up with FBS and 2hr blood sugar test every two or three weeks until
the end of pregnancy .The value of FBS 105 and the value of 2hr GTT 120 as
accepted as the threshold value for GDM. OGTT
Results: The subjects with abnormal GCT were 125 pregnant women that were
classified into 3 groups according to the OGTT and GCT results: group 1 (n: 20)
pregnant women with abnormal GCT and abnormal GTT. group 2 (n: 92) women
with abnormal glucose challenge test but normal GTT who didnt have
gestational diabetes in the follow up., and group 3 (n: 10) pregnant women with
abnormal GCT but normal GTT but had gestational diabetes.
Conclusion: The sensitivity of GTT in finding gestational diabetes is 66 % that is
not good enough for detecting in this important disease in pregnancy. So, we
suggest, if GCT is positive, the patient must be followed carefully to rule out
gestational diabetes. So that we can prevent complications due to the timely
diagnosis of gestational diabetes. We were able to avoid maternal and fetal
complications with early detection of GDM in our patients.
O122
PROBIOTICS AND BACTERIAL VAGINOSIS: THE IMPORTANCE OF
AEQUILIBRIUM. USE OF LACTOBACILLUM RHAMNOSUS BMX 54 AS ADJUVANT
IN THE STANDARD TREATMENT OF BACTERIAL VAGINOSIS
N. Recine 1,*, L. Domenici 1, M. Giorgini 1, V. Marcone 2, E. Palma 1, P. Benedetti
Panici 1
1
Dept Gynecologic, Obtetrics and Urologic Sciences, University Sapienza of Rome,
2Italian Association for Prevention in Obstetrics and Gynecology, AIPOG, Rome,
Italy
Problem Statement: Bacterial vaginosis (BV) is the most common gynaecologic
disorder in the primary care setting. The prevalence of BV among girls and
women aged 14 to 49 years was about 29.2%. Although the aetiology of bacterial
vaginosis is not completely understood, research has confirmed that BV is a
synergistic, polymicrobial infection characterized by a shift in the bacterial flora
of the vagina, characterized by a decline in the concentration of lactobacilli and
an overgrowth of other microorganisms. A healthy vagina normally contains
many microorganisms, predominantly lactobacilli, and a natural host defence by
producing both lactic acid, which maintains the vaginal pH below 4.5, and
hydrogen peroxide, which inhibits the growth of non-catalase producing
microorganisms. The BV is characterized by a high rate of recurrence in sexual
active women, the patients having three or more relapses each year. The aims
of this work were to assess the effectiveness of intravaginal treatment with
Lactobacillus Rhamnosus BMX 54 (NORMOGIN) on the vaginal pH and on the
clinical symptoms in a group of 252 women affected by BV diagnosed by the
Amsel criteria.
Methods: We have evaluated the evolution of patients with bacterial vaginosis
who received the classical antibiotic therapy associated or not with an
intravaginal probiotic product (NORMOGIN). The study group consisted of 252
non-pregnant, sexually active patients, 18-45 years old, with no additional health
problems and no contraceptive undergoing treatment, which have been
admitted to the department of Gynecological Obstetrics and Urological Sciences
of the University Sapienza of Rome. Patients were randomized into two groups:
group A (126 treated with metronidazole 500 mg orally twice a day for 7 days)
and group B (126 patients treated patients treated with metronidazole 500 mg
orally twice a day for 7 days followed by vaginal tablets of Lactobacillus
Rhamnosus BMX 54 -NORMOGIN- once a day for 15 days, twice a week for 15
days months and then once a week for 1 month). The patients were valued four
times (at 0, 60, 90 and then after 4 months from the beginning of the tretment)
and returned to our department during the follow up only in the case of
worsening of the BV symptoms.
Results: After 60 days, 114 of group B patients (90.4%) showed a restore of
physiological vaginal microflora and 101 of group A (80.2%) a complete clinical
remission of BV (p<0.05). Vaginal pH was above the physiological value of 4.5 in
88% of all patients at the first visit. It returned under 4.5 value in 113 of group B
(89.6%) and 99 of group A patients (78.5%) after 2 months of treatment,
respectively (p<0.05). The gradual return to a vaginal physiological pH was
associated with a reduction of the intensity of symptoms as shown by the

decrease in the symptoms score. After 4 months, 15% of group B (19 pts) and
75.4% (95 pts) of group A showed a recurrence of BV (p<0.01).
Conclusion: The dominance of lactobacilli in healthy vaginal microbiota and its
depletion in bacterial vaginosis (BV) has given rise to the concept of treatment
of probiotic Lactobacillus strains for the management of this condition. We
demonstrate that the administration of vaginal tablets containing Lactobacillus
Rhamnosus BMX 54 (NORMOGIN) represents an effective and safe treatment
for restoring the physiological vaginal pH, controlling symptoms and reducing
recurrences of BV.
O123
PERCEPTIONS OF NURSING STUDENTS ABOUT HPV VACCINATION: A
PHENOMENOLOGICAL STUDY
G. Kurt 1, S. Aksz 1,*
School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey
Problem Statement: The human papillomavirus (HPV) vaccine provides an
effective strategy against HPV infection and cervical cancer. A greater
understanding of HPV disease and prevention among nursing students may lead
to greater reductions in the burden of cervical and other HPV-related diseases.
While the HPV vaccine represents substantial progress towards cervical cancer
prevention, little is currently known about nursing student's beliefs regarding
the HPV vaccine. Although young women are central to the HPV vaccination
programme, perceptions of nursing students as young women are
underrepresented in the qualitative literature.
Methods: The aim of this study was to identify the perceptions of nursing
students about HPV vaccination. The study was performed using the
phenomenological approach, a qualitative study design. The data were collected
by the investigators using the face-to-face in-depth interview technique. All
participants (n=23) were female nursing students of a university in Turkey. A
semi-structured interview form created as a result of a relevant literature
survey. The interviews were recorded after obtaining the consent of the
students. The interviews lasted about 30-45 minutes. Colaizzi's
phenomenological interpretation method was used to evaluate the data
collected through the interviews. The interviews were transcribed by
investigators at the end of the interviews, the relevant points were marked and
the main theme and sub themes arranged. Then the statements of the
participating students were evaluated and a report created.
Results: Two themes were identified in the qualitative content analysis:
information needs and vaccine anxieties. In this study, each participant showed
poor knowledge regarding to HPV vaccine and there were significant vaccinerelated knowledge gaps. The participants presented anxiety about the
effectiveness and side effects of the vaccines. The participants expressed
concerns with medical risks, such as side effects and unknown long-term effects
of the HPV vaccine. Health belief factors relating HPV vaccination included: cost
and availability of vaccine, and recommendations from others. The students
stated that they did not want as they did not have enough information about
HPV vaccines and they were more willing to receive the HPV vaccination if it was
recommended by clinicians. The high cost of the vaccine which was not covered
by health insurance were identified as an important barrier to provision of, and
access to the HPV vaccine.
Conclusion: This study highlights a need for more education to promote a
greater understanding of HPV vaccination among nursing students. Perceptions
towards the HPV vaccine appear to be an important contributing factor
in vaccination, to promote HPV vaccination, and to help young women make
informed decisions. In order to increase awareness and knowledge
about HPV vaccination and develop positive behaviors, young people should be
provided with accurate information through educational activities in the
community and health care services. Further quantitative and qualitative
research is needed to design educational activities targeting female students in
the health professions in order to create a positive effect and
improve HPV vaccination coverage levels in Turkey.
65
O124
MOLECULAR CHARACTERIZATION OF CIRCULATING TUMOR CELLS IN
GYNECOLOGICAL CANCER MANAGEMENT
K. Kolostova 1,*, V. Bobek 1
Dpt of Laboratory Genetics, FNKV, Prague, Czech Republic
Problem Statement: We present size-based enrichment protocol for CTCs
isolation, followed by in vitro culture of CTCs and cytomorphological
characterization. In parallel, gene expression profiling of tumor associated
markers and markers of chemoresistance is provided in CTCs.
Methods: To date, 75 patients with ovarian cancer and 59 with carcinoma of
endometria have been enrolled into the study. Peripheral blood (PB) (2 x 8 mL)
was collected within the disease management, mainly before adjuvant
chemotherapy treatment. The size-based separation protocol (MetaCellTM)
enabled to enrich viable cancer cells out of the peripheral blood and peritoneal
lavage, allowing their in vitro propagation on the separating membrane directly.
Immediately after the filtration process captured cells were evaluated by light
microscopy and subsequently by fluorescent microscopy using unspecific stains
(NucBlue, CellTracker) to identify viable cell morphology. A part of enriched
CTC fraction has been used for gene expression profiling immediately after
completing the separation process. The gene expression profiling of tumor
associated genes (cytokeratin (CK) CK7, CK19, MUC1, MUC16, EpCAM, CD45,
CD68) and chemoresistance associated genes (ERCC1, MDR1, MRP1, MRP2,
MRP4, MRP5, MRP7) was provided.
Results: We report successful isolation and cultivation of CTCs, characterized by
above mentioned approaches with CTC- positivity 43 % in ovarian cancer, 59%
in endometrial cancer. The chemoresistance profiles have to be reported for
each patient individually.
Conclusion: We believe that implementation of parallel cytomorphological and
molecular CTC- testing could help in process of more precise CTCcharacterization and subsequent clinical utility.
O125
SYNCHRONOUS PELVIC ORGAN PROLAPSE AND URODYNAMIC STRESS
URINARY INCONTINENCE: ONE - OR TWO - STEP SURGICAL MANAGEMENT?
C. Grigoriadis 1,*, P. Bakas 1, E. Liapis 1, A. Tympa 2, D. Hassiakos 1, A. Liapis 1, G.
Creatsas 1
12nd Department of Obstetrics and Gynecology, Aretaieion Hospital, 21st
Department of Anesthesiology, Aretaieion Hospital, University of Athens, Athens,
Greece
Problem Statement: Pelvic organ prolapse (POP) is a common gynecological
problem with an increased incidence of recurrence. It is often associated with
urodynamic stress urinary incontinence (USUI) and causes not only health but
quality of life issues as well. During the last decade, conflicting data concerning
the ideal therapeutic management of synchronous POP and USUI came into
light. Several studies support the therapeutic value of a two step management,
in which anti-incontinence procedure follows only if USUI persists. On the other
hand, the one step surgical treatment of synchronous POP and USUI is widely
accepted by the urogynecological community. The aim of this study was to
examine the outcome of the one - step surgical treatment of patients with
synchronous POP and USUI.
Methods: This was a 4-year prospective cohort clinical study. The study was
organized by the Urogynecology Unit of the University Hospital and received
approval by the Institutional Ethics Committee. All patients provided informed
consent. The study group included patients diagnosed with synchronous POP
(grade II or grader according to the POP-Q classification system) and USUI
between September 2010 and August 2011. Preoperative assessment included
patients history, gynecological and physical examination, as well as urodynamic
study (uroflow, filling and voiding cystometry). All study group patients
underwent synchronous surgical treatment of POP and USUI. The insideout
transobturator tension free vaginal tape (TVTO) method was selected for the
management of USUI in all cases. All operations were performed by the same
experienced urogynecological team. Patients were reassessed six weeks
66
postoperatively with clinical examination and urodynamic study and then every
12 months with only clinical examination.
Results: Totally, 32 women aged between 47 73 years old (mean age 61.1
years) were included in the study. Fourteen patients underwent vaginal
hysterectomy with synchronous anterior repair and TVT-O placement, 8 patients
underwent Manchester operation and TVT-O placement, while in 10 cases
anterior or posterior repair with synchronous TVT-O placement took place. No
severe intra- or postoperative complications occurred. No patients had urinary
tract injuries or required blood transfusion. No postoperative urinary retention
was diagnosed in any patient. Postoperative incomplete bladder
emptying (residual urine > 100 ml) was reported in 2 cases (6.3%) and was
effectively treated by a 7- day Foley catheter placement. Early postoperative
symptoms of frequency and urgency were reported in 3 cases (9.4%). No tape
rejection was diagnosed. During the 3-year follow-up, no recurrence of POP was
observed among the study group patients. The cure rate of USUI at 3-years
follow-up time was estimated at 81.3%. The improvement and failure rates at
the same follow-up period were 6.3% and 12.4%, respectively.
Conclusion: The one step surgical approach in cases of synchronous POP and
USUI seems to be a safe and effective method.
Posters
67
Notes
68
Abstract Book
POSTER ABSTRACTS
P01
ELECTIVE SINGLE-EMBRYO TRANSFER: TWO YEARS EXPERIENCE FROM A
PORTUGUESE CENTER
S. Aguilar 1,*, M. Rato 1, C. Julio 1, S. Figueiredo 1, T. Simes 1, G. Pinto 1
Maternidade Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central, Lisboa,
Portugal
Problem Statement: The purpose of elective single-embryo transfer (eSET) is to
reduce the ocurrence of multiple pregnancy in assisted reproduction
treatments, in order to avoid the resulting obstetrical and neonatal
complications. As such, eSET should be considered in selected cases. Our
objective was to characterize the population of women who underwent an
elective transfer of one fresh embryo (eSET group) and to compare the
reproductive outcomes of this approach to the ones associated with fresh
double-embryos transfers (DET). Methods: Retrospective analysis of fresh
transfers of one embryo - eSET group (group 1 G1) and of two embryos - DET
group (group 2 G2), performed at our centers Assisted Reproduction Unity,
between January/2012 and December/2013. Results: Fifty-three cases of eSET
(G1) and 590 cases of DET (G2) were included. Womans age, duration of
infertility and previous assisted-reproduction cycles were significantly lower in
G1; there were no significant differences between the two groups when it comes
to type and cause of infertility and assisted reproduction technique.
In G1 37,7% of women (n=20) were more than 35 years-old; in that subpopulation, eSET was performed because of: previous cervical conization in 3
cases; another uterine factor in 6 (3 with an uterine malformation and 3 with
clinical important myomatosis or adenomyosis masses); couples choice in 7; and
a particular favourable prognosis for an eSET cycle in the remaining 4 cases. The
rate of clinical pregnancy was inferior in G1 (36,5% vs 46,5% in G2), but this
difference didnt reach statistical significance (p=0.214); there were no multiple
pregnancies in G1 versus an incidence of 27% in G2. Regarding obstetrical
outcomes we analized the transfers performed until 31/7/2013: 32 in G1 and
488 in G2. Comparing G1 to G2, the rate of pregnancies that resulted in at least
one live birth (31,3% vs 38,2%), gestational age (GA) at birth, (36 weeks (wks) in
both groups), birth weight (2923grams (gr) vs 2589gr), births at a GA 32wks
(10% vs 9,2%) and newborns with less than 1500gr (10% vs 7,8%) were not
significantly different. Twenty-six frozen-embryos transfers were performed in
25 couples from G1: in 12 of them of a single frozen-embryo - G1.1 (46,2%) and
in the remaining 14 cases of two frozen-embryos G1.2. We registered 3
pregnancies in G1.1 (25%), all of them singletons, and 8 in G1.2 (57,1%), 4 of
which twins; the cumulative rate of clinical pregnancy was 57,7% in G1 (eSET
plus an additional frozen-embryo transfer); that rate equaled 42,3% when taking
into account only G1.1 (eSET plus an additional single frozen-embryo
transfer).Conclusion: Even though the rate of clinical pregnancy after a fresh
elective single embryo transfer was inferior, is was not significantly different
from the one resulting from the transfer of two fresh embryos. When eSET was
associated with an additional transfer of one or two frozen-embryos its clinical
pregnancy rate exceeded the one resulting from the transfer of two fresh
embryos, with a significantly inferior frequency of multiple pregnancy (7,7% vs
27%). The cumulative clinical pregnancy rate of eSET followed by the transfer of
one frozen-embryo was only 4% inferior to the the clinical pregnancy rate of
fresh double-embryos transfers.
P02
DECREASE MALE FERTILITY IN OBESE RATS IS ASSOCIATED WITH TESTICULAR
UP-REGULATION OF GHRELIN AND DOWN REGULATION OF STEM CELL
MRNAS: A PROTECTIVE ROLE OF REGULAR EXERCISE
F. Al-Hashem 1,*, M. Alshahrani 1, M. Alsunaidi 1, M. Alkhateeb 1
Physiology, King Khalid University, College of Medicine, Abha, Saudi Arabia
Problem Statement: Increased oxidative stress and hormonal imbalance have
been hypothesized to underlie infertility obese animals.
However, recent evidence suggests that Ghrelin and Stem Cell Factor (SCF) play
an important role in fertility, in lean individuals. Therefore, this study aimed at
investigating whether changes in the levels of Ghrelin and SCF in rat testes
underlie semen abnormal parameters observed in obese rats, and secondly,
whether endurance exercise or Orlistat can protect against changes in Ghrelin,
SCF, and/or semen parameters in diet induced obese rats.
Methods: Obesity was modelled in male Wistar rats using High Fat Diet (HFD)
12-week protocol. Eight week-old rats (n=40) were divided into four groups,
namely, Group I: fed with a standard diet (12 % of calories as fat); Group II: fed
HFD (40 % of calories as fat); Group III: fed the HFD with a concomitant dose of
Orlistat (200 mg/kg); and Group IV: fed the HFD and underwent 30 min daily
swimming exercise. The model was validated by measuring the levels of
testosterone, FSH, LH, estradiol, leptin, triglycerides, total, HDL, and LDL
cholesterol, and final change in body weight. Levels were consistent with
published obesity models
Results: As predicted, the HFD group had a 76.8 % decrease in sperm count,
44.72 % decrease in sperm motility, as well as 47.09 % increase in abnormal
sperm morphology. Unlike the control group, in the HFD group (i.e. obese rats)
Ghrelin mRNA and protein were elevated, while SCF mRNA and protein were
diminished in the testes. Furthermore, in the HFD group, SOD and GPx activities
were significantly reduced, 48.55.8 % (P=0.0012) and 45.64.6 % (P=0.0019),
respectively, while TBARS levels were significantly increased (112.78.9 %,
P0.0001). Finally, endurance exercise training and Orlistat administration
individually and differentially protected semen parameters in obese rats. The
mechanism includes, but is not limited to, normalizing the levels of Ghrelin, SCF,
SOD, GPx and TBARS.Conclusion: The present study showed that obesity is
inversely correlated with reproductive function in male rats namely sperm
count, motility and morphology; an effect that was observed to be concomitant
with
decreased
serum
levels
of
total
Testosterone,
and
gonadotropins. Interestingly, this effect was associated with down regulation
of testicular stem cell factor (SCF) levels and up own regulateion of Ghrelin
levels. The reproductive function and the levels of these proteins were
normalized effectively by exercise and to a lesser extent by Orlistat
administration, the results of which have direct implications for Phase-1
Translational Clinical Trial.
P03
THE IMPACT OF ZONA PELLUCIDA THICKNESS ON DAY-5 BLASTOCYSTS IN
CLINICAL PREGNANCIES.
V. Athanassiou 1,*, E. Timotheou 1, G. Ntoutsoulis 1, D. Kostomenos 1,
G. Nikolopoulos 1, M. Sakellariou 1
1IVF Athens Center, Marousi, Athens, Greece
Problem Statement: The aim of the study is to analyze if the zona pellucida
thickness (ZPT) in laser assisted hatching (L-AH) day-5 blastocysts impact the rate
of clinical pregnancies.
Since 1995 several reports are dealing with the ZPT regarding the fertilization
and pregnancy rate. On the other hand, many reports clearly indicate that L-AH
has beneficial effect in cases of increased ZPT. However, in our knowledge, there
is not any report to correlate the ZPT on L-AH day-5 blastocysts and the rate of
clinical pregnancies.Methods: A retrospective analysis of 43 cases including the
transfer of 86 L-AH day 5-blastocysts, 2 blastocysts/embryotransfer (ET), in the
period between January and October 2013 enrolled the study. A total of 86 day5 blastocysts were studied. In Group I (n=32) were cases with clinical pregnancies
and Group II (n=11) without. Both groups had similar age and sperm
characteristics. L-AH was performed 30 minutes before ET and ZPT was
measured with OCTAX Eyeware Software 115 hours post intracytoplasmic sperm
injection (ICSI).Results: Although L-AH was performed in all cases 30 minutes
before embryo transfer (ET), clinical pregnancies were observed only in Group I
with ZP 2.620.8 m (mean SD). No clinical pregnancies were found in Group
II with ZP 8.364.8 m (mean SD). The differences in zona pellucida thickness
between the two groups were significant (p<0.01).Conclusion: Our results
suggest that when the ZPT is more than 3.5 m the prognosis for clinical
pregnancy is poor. L-AH is of limited value in cases when the zona pellucida is
very thick.
69
P04
EFFECTIVENESS OF RECTAL NONSTEROIDAL ANTI-INFLAMMATORY DRUG IN
VAGINOSCOPIC OUTPATIENT HYSTEROSCOPY IN PRIMARILY INFERTILE
WOMEN
E. Karakas 1, H. Hassa 1, Y. Aydin 1,*, T. Oge 1, K. Cicek 1
Department of Obstetrics and Gynecology, Eskisehir Osmangazi University
School of Medicine, Eskisehir, Turkey
Problem Statement: To assess whether rectally administered nonsteroidal anti
inflammatory drug reduces pain during vaginoscopic diagnostic outpatient
hysteroscopy in nulliparous infertile patients.Methods: This was a randomized,
prospective, controlled paralel group study. Women who visited our infertility
department and required diagnostic outpatient hysteroscopy for investigation
of infertility were enrolled in the study group. In the control group, 51 patients
had rectal placebo 1 hour before the procedure. Indomethacin 100 mg were
administered to the second group of patients (n: 50) 1 hour before the
procedure by rectal route. Office hysteroscopy was performed with vaginoscopic
approach. Patients were asked to record the severity of pain, which was the
primary outcome of the study, during the procedure by using 10-cm visual
analog scale (VAS) ranging from 1(very favorable) to 10 (very unfavorable).
Secondary outcomes were time of the procedure, rate of the vasovagal
symptoms and requirement of analgesia after the procedure. Results: As a
primary outcome of our study, we evaluated VAS scores between groups. Mean
scores were 4.40 2.87, 4.91 2.51 for rectal placebo and rectal indomethacin
groups respectively. There was no significant difference between groups
according to VAS values (p: 0.681). Among medication groups; any analgesic
drug requirement and vasovagal symptoms are 5 (9.8%), 4 (8%) for analgesic
requirement and 2 (39.1%), 1 (19%) for vasovagal symptoms as rectal placebo
and rectal indomethacin respectively. There were no significantly difference
among groups. Conclusion: Pain relief is an important circumstance for patients
during invasive procedures like office hysteroscopy even if it is diagnostic. Thus
some medications are tested to reduce pain during and after the procedure.
According to our results, it seems that rectally administered indomethacin are
not effective in pain relief during diagnostic vaginoscopic hysteroscopy. New
interventions and/or drugs should be studied to decrease pain perception during
vaginoscopic diagnostic outpatient hysteroscopy in nulliparous infertile patients.
P05
ASSISTED REPRODUCTIVE TECHNIQUES- AN OVERVIEW OF THE CURRENT
METHODS AND TECHNOLOGY AVAILABLE
S. Babu 1,*, Y. Beebeejaun 2, G. Ho 3
1St Mary's Hospital, 2Women's Health, Guy's and St Thomas' Hospital, London,
3
Brighton and Sussex University Hospital, Brighton, United Kingdom
Problem Statement: Since the first test tube baby was born in the year 1978,
fertility treatments have advanced greatly. With the increasing age at which
women now desire to start a family, Assisted Reproductive Techniques (ART) are
becoming increasingly popular and it is currently estimated that a total of five
million children have now been conceived through ART. This number is expected
to rise and recent literature state that as many as one in six couple will now
encounter problems with experience subfertility. Fertility treatments are
complex and undergoing one cycle of ART involve various key steps from ovarian
stimulation, follicle maturation, egg collection, in-vitro fertilisation to embryo
transfer and eventual luteal phase support. These steps are highly complex and
understanding the key concepts behind each step is key to a successful clinical
pregnancy and eventual live birth. In this review, we aim to assess at the various
methods available for each step, compare them and summarise the evidence
behind them. We also compared the costs associated with ART and further
compare its cost globally. Methods: We performed a literature review of articles
looking at the current methods and technologies involved in ART. We also looked
at the published Cochrane reviews which analysed the efficacy of each method.
This included at a further 54 Cochrane reviews which analysed the various stages
of an ART cycle with primary outcome of these reviews being a live birth. We
also performed literature search and compared the cost benefit of various steps
in an ART cycle and looked at the extent of public funding for an ART cycle and
70
the factors that affect this. Results: This review allowed us to fully compare and
summarise the various modalities available through Assisted Reproductive
Technique. We reviewed various clinical review articles, analysed the results of
Randomised Controlled trials and compared the current methods available.
Through this poster, delegates will be able to learn about the ART, the methods
available and understand the various steps involved in an Assisted Reproductive
Technique cycle better. Conclusion: Subfertility is becoming a global issue with
more and more couple seeking ART as a way to complete their family. It is
therefore important for us to fully understand the various methods currently
available so as we can counsel our patients even better.
P06
INFERTILITY AND IVF: A SENTIMENT ANALYSIS WITH CASE STUDIES ON
TWITTER
E. M. Clark 1,*, C. Jones 2, R. Raj 3, P. Dodds 1, C. Danforth 1, D. Gaalema 4,
R. Redner 4, T. White 4, A. Schneider 5, M. Couch 2, M. Norotsky 2, E. Sills 6
1
Mathematics, 2Surgery, 3Gynecology, 4Psychiatry, 5Economics, University of
Vermont, Burlington, 6HRC-Fertility, HRC-Fertility, Newport Beach, United States
Problem Statement: Social Media provides a lens for data scientists to
investigate public sentiments regarding the health and social implications of
infertility. Twitter, a popular social media outlet, has become a useful tool for
the study of social behavior through user interactions called tweets. Case studies
regarding the emotional effects of patients participating in in vitro fertilization
(IVF) programs can be studied from the tweets of users who have identified
themselves as members of an IVF treatment regimen.Methods: Two
distributions of tweets were processed in this social experiment. All tweets with
geo-spatial coordinates spanning from May to August 2014 were salvaged from
millions of twitter-feeds, a collective sampling that represents approximately 1%
of the entire twitter- sphere, along with a 10% sample of all tweets collected
from the Twitter fire-hose spanning 2013. Pattern matching by key-words
relating to infertility (i.e. infertility, infertile, IVF, in vitro fertilization) yielded
~50,000 tweets from 2013 and ~2000 tweets from the 2014 Geo-Data set.
Tweets from 20 users who self-identified as undergoing IVF were also collected
to compare sentiments before and after the procedure. Emotionally charged
words that contribute to the positivity of various subsets of tweets were
quantitatively measured using hedonometrics. We then examined the density of
behavioral tweet indicators over time to illuminate public sentiments regarding
infertility issues as well as patients currently involved in IVF treatments.Results:
A word-shift graph comparing the emotionally charged words of patients before
and after participation in an IVF regimen over a six month period is presented
below. After undergoing IVF, the average happiness score of post-IVF binned
tweets grows due to an increase in the positive words
mom,gorgeous,thanks,congrats,excited,love,happy, along with a
decrease in negative words such as never,hate, and regret, among others.
We additionally evaluated a happiness and frequency time-series. The happiness
and frequency outliers help identify important events regarding infertility and
IVF sentiments over time.
Image / Graph:
Conclusion: We demonstrate the
potential of twitter to perform case
studies on patients undergoing IVF
treatment. Social Media can be
harnessed to help understand
public
sentiment
surrounding
health disparities. It is anticipated
that
understanding
these
sentiments
can
lead
to
improvements in patient centered
care.
Abstract Book
P07
CONTROLLED OVARIAN HYPERSTIMULATION AND IUI CYCLES IN PATIENTS
WITH MILD ENDOMETRIOSIS
M. Ebrahimi 1,*, F. akbari Asbadh 1, S. Esapoor 2
1Tehran Women General Hospital, 2Tehran University of Medical Science,
Tehran, Islamic Republic of Iran
Problem Statement: Sever endometriosis is one of cause of female infertility.
Association of between minimal or mild endometriosis and infertility has not
been completely established. The aim of this study was to compare the results
of COH-IUI cycles in minimal or mild endometriosis and unexplained
infertility.Methods: A prospective study, between October 2008 and October
2011 in academic reproductive endocrinology and infertility center. Two groups
of patients undergoing stimulated IUI cycles were compared, thirty-four
infertile couples with mild endometriosis as the sole cause of infertility in the
group (), and thirty-four couples with unexplained infertility in the group (II).
The patients underwent 3 consecutive ovarian hyperstimulation (Clomiphen
citrate and human Menopausal Gonadotropin) and IUI cycles. The main outcome
measures were cumulative pregnancy rates (CPR) per patient for 3 consecutive
stimulated IUI cycles. For statistical analysis Fisher exact test, Chi-squared test
and independent T -test were used.Results: Cycle characteristics were found to
be homogenous between the both groups. CPRs were similar in the group
(7/34, 23.5%) and the group II (8/34; 20.6%) (P =0.7) Conclusion: Both groups
with minimal or mild endometriosis and unexplained infertility did not have any
difference in response to COH-IUI. So, performing laparoscopy and other
invasive procedures, in order to differentiate between minimal or mild
endometriosis and unexplained infertility, is not recommended.
P08
CONTROLLED OVARIAN HYPERSTIMULATION AND INTRAUTERINE
INSEMINATION CYCLES IN PATIENTS WITH UNILATERAL TUBAL BLOCKAGE
DIAGNOSED BY HYSTEROSALPINGOGRAPHY
M. Ebrahimi 1,*, F. Akbari Asbagh 1, A. Rasekh Jahromi 2, M. Alborzi 2, S. Namazi 3
1IVF Ward/Tehran Women General Hospital, Tehran University of Medical
Science, Tehran, 2OB&GYN Ward, Jahrom University of medical science, jahrom,
3psychiatric ward, bushehr university of medical science, bushehr, Islamic
Republic of Iran
Problem Statement: Tubal pathology ranks among the most frequent causes of
subfertility, next to ovulatory disorders and sperm defects .The assessment
of
tubal
patency
is
a
fundamental
part
of
infertility
workup.Hysterosalpingography(HSG) is widely used as a first-line approach to
assess uterine anatomy and tubal patency in routine infertility workup.HSG has
65% sensitivity and 83% specificity for tubal obstruction. Controlled ovarian
hyperstimulation and intrauterine insemination cycle is an ideal protocol for
some subfertile patients. So, we decided to try this therapeutic protocol for the
patients with unilateral tubal blockage diagnosed by hysterosalpingography.
Methods: A Cross-sectional analysis, between October 2006 and October 2009
in an academic reproductive endocrinology and infertility center was done. Two
groups of patients undergoing stimulated IUI cycles were compared. Sixty-four
unfertile couples with unilateral tubal blockage diagnosed by HSG as the sole
cause of infertility in the group (I) and two hundred couples with unexplained
infertility in the group (II). The patients underwent 3 consecutive ovarian
hyperstimulation (Clmiphen citrate and human Menopausal Gonadotropin) and
IUI cycles. The main outcome measurements were the Cumulative
pregnancy rates (CPRs) per patients for 3 consecutive stimulated IUI
cycles.
Results: Cycle characteristics were found to be homogenous between the both
groups. CPRs were similar in the group (26.6%) and the group II (28%) (P =0.87;
OR=1.075; 95% CI: 0.57 -2.28). Conclusion: Unilateral tubal blockage (diagnosed
on HSG) has not effect on success rate of stimulated IUI cycles, so COH and IUI
could be recommended as the initial therapeutic protocol in these patients.
P09
PREGNANCY AFTER ENDOMETRIAL ABLATION: MIRACLE OR MINEFIELD?
J. Loganathan 1, R. Farah 1,*
Lister Hospital, East and North Hertfordshire NHS Trust, Chelsea, United
Kingdom
Problem Statement: Endometrial ablation is a widely used treatment for
menorrhagia after medical treatment has failed 1,2. It has been available since
the 1980s and acts by removing the endometrial lining and deep basal glands to
prevent regeneration2. Although conception after ablation is unlikely, it has
been reported, and often with disastrous consequences.Methods: A 36 yr old
para 2 presented at 29 weeks gestation with epigastric pain. She had 2 previous
vaginal deliveries then balloon endometrial ablation to treat menorrhagia. Five
years on she had intrauterine adhesiolysis in order to aid conception and she
conceived spontaneously 6 months later. Her anomaly scan was normal.At
presentation the CTG was reassuring, there was no vaginal bleeding and the pain
settled with codeine. During admission an MRI and ultrasound scan were done
to evaluate the placenta. Both modalities showed no features to suggest
abnormal placentation.Results: At 31 weeks the pain worsened and she became
haemodynamically unstable. The CTG remained reassuring, but given the clinical
suspicion of intra-abdominal bleeding, an ultrasound was done which showed
perihepatic and perisplenic fluid.At laparotomy a haemoperitoneum of 2000mls
was confirmed with the placenta seen breaching the serosa at the uterine
fundus. The live fetus was delivered by lower segment incision and a subtotal
hysterectomy was performed. Overall, a five unit blood transfusion was
required.
Image / Graph:
Conclusion: Pregnancy after endometrial ablation is rare, with a reported

incidence of 0.7%3. However it can occur and there are over 120 reported cases
in English literature so far4. Abnormal placentation is a significant risk and in a
case series by Yin et al, the incidence was 25%, compared to 0.017% amongst
women with no uterine surgery4. The risk of preterm delivery, premature
rupture of membranes and fetomaternal morbidity is also higher, and in a study
by Vinograd et al perinatal mortality in placenta accreta cases was reported at
6.7% compared to 0.9% in the control group5.Current screening with Doppler
ultrasound has a reported specificity of 89.6% and sensitivity of 82%6. Magnetic
resonance imaging is often used if ultrasound is equivocal. It detects features
such as uterine wall bulging and focal interruptions in the myometrial wall. In
cases of abnormal placentation delivery planning should involve a
multidisciplinary team. This can reduce emergency deliveries and blood loss,
which is critical as placenta accreta has a 40% chance of requiring more than 10
units blood transfusion7. In our case, delivery was by emergency caesarean
section with 5 units blood transfused and subtotal hysterectomy. Placenta
accreta is one of the leading causes of caesarean hysterectomy in the developed
world8 as placental removal can precipitate massive haemorrhage, and repairing
uterine rupture may not be possible. In the literature reviewed, caesarean
hysterectomy particularly for cases of placenta increta and percreta, is
recommended to reduce transfusion requirements and complication rates9,10.
In conclusion, pregnancy after endometrial ablation is a rare but important
occurrence. These pregnancies are high risk for abnormal placentation and
associated fetomaternal morbidity and mortality. Imaging is vital antenatally to
evaluate placentation and delivery planning requires a multidisciplinary
approach. Despite these precautions the risks are high, therefore thorough
counselling before endometrial ablation must include the need for reliable
contraception.
71
References: 1. Fergusson RJ, Lethaby A, Shepperd S, Farquhar C. Endometrial resection and

ablation versus hysterectomy for heavy menstrual bleeding. Cochranr Database Systematic
Review 2013 Nov 29;112. Lethaby A, Hickey M, Garry R, Penninx J. Endometrial
resection/ablation techniques for heavy menstrual bleeding. Cochrane Database of
Systematic Reviews 2009, Issue 4. 3. Lo J.S., Pickersgill A. Pregnancy after endometrial
ablation: English literature review and case report. J Minim Invasive Gynecol. 2006;13:88914. Yin C.S. Pregnancy after hysteroscopic endometrial ablation without endometrial
preparation: a report of five cases and a literature review. Taiwan J Obstet Gynecol. 2010
Sep;49(3):311-95. Vinograd A, Wainstock T, Mazor M, Weisel RB, Klaitman V, Dukler D et al.
Placenta accreta is an independent risk factor for late pre-term birth and perinatal mortality.
J Matern Fetal Neonatal Med. 2014 Aug;21:1-28 [epub ahead of print]6. Elhawary T, Dabees
L, Youssef M. Diagnostic value of ultrasonography and magnetic resonance imaging in
pregnant women at risk for placenta accreta. J Matern Fetal Neonatal Med. 2013
Sep;26(14):1443-97. Shamshirsaz A, Salmanian B, Fox KA, Diaz-Arrastia CR, Lee W, Baker
BW. Maternal morbidity in patients with morbidly adherent placenta treated with and
without a standardized multidisciplinary approach. Am J Obstetric Gynecol. 2014 Aug
27.pii:S0002-9378(14)00855-28. Flood KM, Said S, Geary M, Robson M, Fitzpatrick C, Malone
FD. Changing trends in peripartum hysterectomy over the last 4decades. Am J Obstet
Gynecol. 2009 Jun;200(6):6329. The American College of Obstetricians and Gynecologists.
Placenta accreta. Committee opinion. Number 529 July 2012. Reaffirmed 2014. 10. Siwatch
S, Chopra S, Suri V, Gupta N. Placenta percreta: rare presentation of haemorrhage in the
second trimester. BMJ Case Reports. 2013 Feb; doi:10.1136/bcr-2012-007782
P10
HYSTEROSALPINGOGRAPHY A THREE YEAR REVIEW IN UNIDADE LOCAL DE
SADE DO ALTO MINHO
S. C. Ferreira 1,*, J. Prata 1, A. P. Ferreira 1, G. Taketani 2, D. Ribeiro 1, P. Pinheiro 1
1Ginecologia/Obstetrcia, 2Imagiologia, Unidade Local de Sade do Alto Minho,
Viana do Castelo, Portugal
Problem Statement: Histerosalpingography (HSG) is a radiological exam that
evaluates the uterine cavity and the fallopian tubes after injection of radioopaque medium through the cervical canal. Its main propose is to study
infertility and recurrent miscarriage. A therapeutic effect has been described,
resulting in an increased rate of pregnancy in the months after the procedure.
The aim of this study was to characterize the population submitted to HSG in our
hospital (Unidade Local de Sade do Alto Minho) and to evaluate the
reproductive success after the exam.
Methods: Retrospective study that included all the HSG performed in Unidade
Local de Sade do Alto Minho in a three year interval, from January 2011 to
December 2013. The information was collected from the patients clinical files
and the exam reports.Results: in the study period, 147 HSG were performed in
our hospital. The median patients age was 32 years old. The main indication for
the procedure was the study of infertility (96%), most of the cases primary
infertility. Fourty-four of these women got pregnant after the exam procedure
and 54,5% (n=24) of this pregnancies were spontaneous. The time from the date
of exam realization until conception, in spontaneous pregnancies, was between
0 and fourty months, with 37,5% of this pregnancies occurring in the first 6
months after the procedure. Fifteen of this pregnancies referred to cases of
primary infertility, while 8 cases were in couples referred because of secondary
infertility. With the exception of one case of unilateral obstruction and one case
of inconclusive exam, all cases revealed tubar bilateral patency. Conclusion: the
results obtained seem to support the existent evidence that HSG has a
therapheutic efect, increasing the fertility in the months after the procedure.
The mechanism that results in this increased in fertility is not totally understood.
P11
ELECTIVE SINGLE BLASTOCYST TRANSFER AND CLEAVAGE STAGE DOUBLE
EMBRYO TRANSFER
P. L. Ho 1,*, T. Y. Tan 2, C. Melinda 3, H. H. Tan 4, S. Nadarajah 2
1Department of Obstetrics and Gynaecology, 2Department of Reproductive
Medicine, KK Women's and Children's Hospital, Singapore, 3Department of
Reproductive Medicine, KK Womens and Childrens Hospital, 4Department of
Reproductive Medicine, KK Womens and Childrens Hospital, Singapore,
Singapore
72
Problem Statement: In IVF treatment, the standard practice of transferring two

cleavage stage embryos (Double Embryo Transfer, or DET) is often associated
with risk of multiple pregnancy, which is also related to increased fetal and
maternal mortality and morbidity. This study examines the outcomes of using an
alternative approach, elective Single Blastocyst Transfer (eSBL), and whether it
reduces the above risks while maintaining pregnancy rates.
Methods: A prospective study was conducted between January 2011 to
December 2013 at the KK IVF centre. Samples were divided into the DET and
eSBL groups. The inclusion criterias for the DET group are participants with first
stimulated cycle, age 35 years and below, and have at least four good grade
embryos. For the eSBL group, inclusion criterias are participants with age 36
years and below and have at least 4 good grade embryos, or participants with
previous successful pregnancy regardless of age. The treatment outcomes are
measured in terms of clinical pregnancy rate, multiple pregnancy rate, live birth
rate for both groups under study.
Results: In 2011 and 2012, both groups were observed to have good clinical
pregnancy rate of 50% or more, and live birth rate of 40% or more. In 2013, as
more patients underwent eSBL our results show that clinical pregnancy rate was
still maintained at above 50%, without compromising pregnancy rate. In fact,
eSBL resulted in 100% singleton rate for all years observed. The DET group
results show an overall twin pregnancy rate of 25.1%, with a twin live birth rate
of 24.7%. For those who received DET, our results also show that younger
patients aged 30 years or below had higher multiple pregnancy rates (28.3%)
compared to older patients aged between 31-35 years old (22.8%).
Image / Graph:
Conclusion: Elective Single
Blastocyst transfer (eSBL)
produces a comparable
clinical pregnancy rate when
compared to the current
practice of Double Embryo
transfer (DET). Our study
also shown that eSBL
treatment resulted in 100%
singleton pregnancies, thus
achieving the aim of
reducing multiple pregnancy
and its associated risks in
reproductive treatment. In
fact, we observed that
younger
patients
who
underwent DET have an
increased risk of multiple
pregnancy.
Overall, our observations suggest that the adoption of elective single blastocyst
transfer could reduce the incidence of multiple pregnancies and associated fetal
and maternal complications while maintaining good pregnancy and live birth
rates.
P12
DO ENDOMETRIAL MOVEMENTS AFFECT THE ACHIEVEMENT OF PREGNANCY
DURING INTRAUTERINE INSEMINATION?
T. Kim 1,*, H. M. Park 2
1OBGYN, Korea University Anam Hospital, 2OBGYN, Chung-Ang University,
Seoul, Republic of Korea
Problem Statement: Although several studies have assessed endometrial
movements and pregnancy rates resulting from in-vitro fertilization (IVF) and
have concluded in negative correlation between the frequency of movements
and pregnancy outcomes, few have examined the relationship between
endometrial movements and pregnancy achievement after intrauterine
insemination (IUI). In IVF cycles, implantation is a key determinant of pregnancy,
whereas both processes of spermatozoa transport and implantation occur after
Abstract Book
IUI.This study was aimed to assess the effect of endometrial movements on

pregnancy achievement in intrauterine insemination (IUI) cycles.
Methods: The study population was composed of unexplained infertility couples
who undergo first-time IUI with clomiphene citrate between September 2010
and October 2013. Not only endometrial movements, but also thickness,
volume, pattern, and echogenic change of endometrium were analyzed
prospectively in prediction of pregnancy.
Results: The total number of 241 cycles of IUI with 49 intrauterine pregnancies
(20.3%) was analyzed. Pregnancy was not related to endometrial thickness and
endometrial volume, but significantly related to endometrial movements,
trilaminar pattern, and hyperechoic change (p < 0.05). Pregnant group showed
higher cervicofundal movement rate (89.8% vs 75.5%).
Conclusion: For IUI cycles stimulated by clomiphene citrate in unexplained
infertility women, endometrial movements on the day of IUI could be a predictor
of pregnancy.
P13
DETECTION OF ENDOMETRIAL SUBENDOMETRIAL VASCULATURE ON THE DAY
OF EMBRYO TRANSFER AND THE PREDICTION OF PREGNANCY DURING FRESH
IN VITRO FERTILIZATION CYCLES
T. Kim 1,*, H. Choi 2, H. Y. Kim 3, W. Y. Paik 4
1OBGYN, KOREA UNIVERSITY ANAM HOSPITAL, 2OBGYN, Inje University Sanggye
paik Hospital, Seoul, 3OBGYN, Kosin University, Busan, 4OBGYN, Gyeongsang
National University hospital, JinJu, Republic of Korea
Problem Statement: Successful implantation depends on a close interaction
between the blastocyst and the receptive endometrium. Endometrial
vasculature has been considered to play an important role in the early
endometrial response to blastocyst implantation, and vascular changes may
affect uterine receptivity. This study was aimed to investigate whether vascular
parameters measured using three-dimensional power Doppler ultrasound (3D
PD-US) can predict pregnancy following fresh in vitro fertilization and embryo
transfer (IVF-ET) with fresh GnRH agonist long protocol.
Methods: In this prospective observational study, the total number of 236
nulliparous women who underwent the first IVF-ET with GnRH long protocol
stimulated by recombinant FSH (rFSH) between May, 2009 and April, 2014 were
enrolled. Except two cases of tubal pregnancy, 234 cases were classified as the
pregnant group (n=113), and as the non-pregnant group (n=121). A color
Doppler ultrasound and 3D PD-US examination were performed on the day of
embryo transfer. Pulsatility index (PI), resistance index (RI), and systolic/diastolic
ratio (S/D) of uterine artery, and vascuarization index (VI), flow index (FI), and
vascularization flow index (VFI) of endometrium as well as those of
subendometrial region were obtained as main outcomes. These measurements
were analyzed in the relation to IVF-ET outcome (pregnant vs. non-pregnant
groups).
Results: There were no significant differences in patients age, infertility
duration, BMI, basal FSH levels, the number of retrieved oocytes and good
quality embryos, and endometrial thickness and volume between two groups.
The pregnant group had higher endometrial VI, FI, and VFI scores than the nonpregnant group (p = 0.001, 0.000, 0.021, respectively). In contrast, the
subendometrial region VI, FI, and VFI scores did not differ between the groups
(p = 0.770, 0.252, 0.451, respectively), nor did the uterine artery PI, RI, and S/D
scores (p = 0.256, 0.527, 0.365, respectively). Cut-off values of endometrial VI,
FI, and VFI scores for pregnancy achievement were 0.95, 12.94, and 0.15,
respectively.Conclusion: 3D PD-US was a useful and effective method for
assessing endometrial blood flow in IVF cycles. Good endometrial blood flow on
the day of ET in GnRH long protocol may be associated with high success in
pregnancy, which is indicative of endometrial receptivity in fresh IVF cycles.
P14
CLINICAL EFFICIENCY OF IVF CYCLES FOLLOWING EMBRYO CULTURE IN THE
PRESENCE OF GM-CSF IN PATIENTS WITH PREVIOUS IMPLANTATION FAILURE
S. N. A. Lee 1,*, M. N. Lim 1, C. F. To 1, S. L. Yu 1
1Obstetrics & Gynaecology, Singapore General Hospital, Singapore
Problem Statement: Our Centre reported the first pregnancy in Singapore with
EmbryoGen in November 2011. EmbryoGen, Origio, Denmark is the first culture
medium that contains a natural cytokine growth factor, GranulocyteMacrophage Colony-Stimulating Factor (GM-CSF), which is found in the female
reproductive organs during early pregnancy. GM-CSF has been documented to
stimulate cell growth, promote and regulate embryonic development from early
stage to implantation and placentation and prevent miscarriages. Since then, we
started using EmbryoGen routinely in women with previous implantation failure.
In this study, we evaluate the clinical pregnancy, implantation and miscarriage
rates of IVF cycles in which embryos were cultured and transferred in
EmbryoGen.Methods: This retrospective study includes a total of 93 patients
with antral follicle count between 4-29, aged between 30-46 years old with a
past history of failed IVF cycles. The oocytes were denuded using hyaluronidase.
Metaphase II (MII) oocytes, selected by the presence of the first polar body were
considered suitable for ICSI. The injected oocytes were cultured individually in
microdrops of EmbryoGen in 6% CO2, 5% O2 and 89% N2 atmosphere. A
maximum of three embryos were replaced three days after egg retrieval
between 2012-2013.Results: Clinical pregnancy rate per transfer was 34.4%
(32/93). Implantation rate was 21.6% (43/199) and miscarriage rate was 15.6%
(5/32). None of the patients had OHSS.
Conclusion: The results showed that the use of GM-CSF supplemented IVF
culture medium improves the chance of a baby who have previously failed. It is
concluded that GM-CSF helps to regulate cell division and viability. The addition
of growth factor, GM-CSF to an IVF culture medium has been shown to benefit
human embryo development, increasing the blastulation rate and increase in
blastocyst cell number. It enhances the composition of the medium to make it
more closely mimic the natural surroundings of the embryo and thereby increase
the chance of implantation and pregnancy and reduce the miscarriage rate in
assisted reproduction for patient. EmbryoGen may be an additional investment
for the couple in a state-of-the-art treatment to improve their pregnancy
chance. The pregnancy rate is promising and our Centre will continue to evaluate
the commercial medium.
P15
TRASNSDERMAL TESTOSTERONE ON POOR OVARIAN RESPONDERS
UNDERGOING IVF/ICSI EXPERIENCE OF A CENTER
B. G. Lopez 1,*, C. Tomas 1, I. Bravo 1, J. Metello 1, S. Ramos 1, P. Ferreira 1, P. S e
Melo 1
Centro de Infertilidade e Reproduo Medicamente Assistida, Hospital Garcia
de Orta, Lisboa, Portugal
Problem Statement: Poor response to controlled ovarian stimulation was first
described in 1983 and has an estimated incidence of 9-26%. There are several
studies testing interventions such as dehydroepiandrosterone, transdermal
testosterone, inhibitors of aromatase, recombinant LH and HCG, however, the
evidence is weak and controversial given the small numbers and the
heterogeneity of the studied population. In 2009, Fabregues et al published the
first randomized study demonstrating that pretreatment with transdermal
testosterone improved the ovarian response in patients with a previous cycle
canceled due to poor response. Our aim was to describe the results obtained
with the use of transdermal testosterone among poor ovarian responders in our
population. Methods: We conducted a single-center prospective observational
study of patients who performed a cycle with agonist and transdermal
testosterone prior to stimulation ovarian gonadotropin, from November 2012 to
July 2014. It was defined as inclusion criteria having had at least one previous
course with 300 IU/day of gonadotropins, one previously cancelled cycle or
with less than 3 oocytes, regular cycles of 25-34 days and BMI 19-30 kg/m2. The
presence of endocrine or metabolic disease and prior ovarian surgery were
exclusion criteria. We analyzed the following variables: number of oocytes and
embryos obtained per cycle; number of embryos transferred per cycle;
cancellation rate and pregnancy rate.Results: A total of 24 cycles were analyzed.
The mean age of patients was 35.2 years, day 2 FSH mean level was 11.4 mg/dL
and antral follicle mean count was 7. There were no cases of discontinued
therapy due to intolerance or adverse effects. In three cases the cycle was
73
canceled no retrieval was performed due to poor response. The average

number of oocytes collected and embryos obtained per cycle started was 4.62
and 2.82, respectively. In 19 cases there was embryo transference and in the
majority of cases (n=14) 2 embryos were transferred. Six clinical pregnancies
occurred, one of them resulted in a spontaneous abortion at 8 weeks, 3 in
healthy newborns and the remaining 2 are currently ongoing pregnancies. The
pregnancy rate per started cycle was 25% (28,5% per retrieval)Conclusion: The
testosterone treatment in this subgroup of patients, with previous cycles
canceled or with previous response with less than three oocytes obtained,
seems to improve the ovarian sensitivity to the gonadotropin and reduce the
likelihood of cancellation of the cycles for poor response. Although our study is
single-centered and with a relatively small sample, our findings are in agreement
with the results from a recent meta-analysis demonstrating that the use of
transdermal testosterone in poor responders patients increases the likelihood
of live birth using lower doses of gonadotropins. More randomized studies are
necessary to confirm these benefits.
P16
TRANSLOCATIONS INVOLVING THE Y NON- ACROCENTRIC CHROMOSOMES: A
PROPOSE OF A CASE
G-Y. G. Marta 1,*, A. Muoz Ledesma 1, A. B. Rodriguez Bujez 1 on behalf of 1,
Y. Pascual Arevalo 1, E. Mancha Heredero 1, B. Gonzalez Soto 1 on behalf of *
Embriologist
Obstetrics and Ginecology, Hospital Ro Hortega Valladolid, Valladolid, Spain
Problem Statement: In mammals, the Y chromosome is essential for sex
determination, early sexual differentiation and control of spermatogenesis. In
general population the incidence of Y- autosome translocations is 1:2000. In
particular, translocations involving the Y non- acrocentric chromosomes are
even rarer and may involve any segment of the Y chromosome.
Methods: We report a well- masculinised 39 year-old man who was referred to
our institution because of a history of two years of infertility. There was no family
history of infertility or other genetic disorders. Repeated Seminal analysis
showed azoospermia with an average seminal volume of 5 ml. Hormonal studies
revealed hypergonadotropic hypogonadism with serum levels of FSH at 64
IU/ml, LH at 22 IU/ml and testosterone at 222 ng/ml.2qThe Karyotype was
investigated by a cytogenetic study of peripheral blood. Chromosome analysis
revealed a 46 xx karyotype.
Results: G-banding analysis of 25 metaphases showed a 46, XX chromosome
constitution (46 chromosomes with XX sexual composition). Fluorence in situ
hybridation (FISH analysis) showed mosaic sex chromosome constitution:
X two crhomosomes in 96% of the peripheral blood cells and one X crhomosome
in 4%. In both lines an SRY translocation (locus Y p11.2) was found in X
crhomosome. An intra-uterine insemination using donor sperm was proposed.
Conclusion: This syndrome is a rare but important cause of hypergonadotropic
hypogonadism in which the diagnosis can be delayed or missed.
P17
ASSISTED REPRODUCTIVE TECHNOLOGY: ARE EMBRYO SCORES AND
PREGNANCY OUTCOMES RELATED?
A. T. Marujo 1,*, L. Correia 1, M. Rato 2, S. Pinto 2, G. Pinto 2, T. Simes 2
1Fetal-Medicine Department, 2Assisted Reproductive Technology Departement,
Maternidade Dr. Alfredo da Costa, Lisboa, Portugal
Problem Statement: The consensual opinion states that an optimal day-2
embryo should have four equally-sized mononucleated blastomeres in a threedimensional tetrahedral arrangement, with <10% fragmentation. The consensus
scoring system for cleavage-stage embryos is: Grade 1 <10% fragmentation,
stage-specific cell size, no multinucleation; Grade 2 10-25% fragmentation,
stage-specific cell size for majority of cells, no evidence of multinucleation;
Grade 3 Severe fragmentation (<25%), cell-size not stage-specific, evidence of
multinucleation. Several studies have focused on the predictive value of these
parameters on the implantation rate. In this study, we tried to evaluate the
74
correlation of these scores with the evolution of the pregnancy. Do good

embryos have better pregnancy outcomes?
Methods: We analyzed 826 IVF and ICSI cycles performed at Maternity Dr.
Alfredo da Costa in the Reproductive Medicine Unit between 2012 and 2013,
corresponding to the period during which the classification of embryos was done
using the Istambul consensus from the workshop on embryo assessment
classification. We selected the 406 with a positive Beta-hCG test and from this
subset we selected the 288 which had a transference of one single embryo or
two embryos with the same score (either G1 or both G2 or both G3). We then
compared pregnancy outcomes for the three groups.
SPSS version 13 (Chicago, IL) and True Epistat Software (Math Archives, Round
Rock, TX) were used for statistical analysis. P-values <0.05 were considered
significant.
Results: From the 288 cycles, 185 pregnancies (64.2%) resulted from G1 embryos
(G1); 94 (32.6%) from G2 embryos (G2) and 9 (3.1%) from G3 embryos (G3).
Maternal age was similar in all the groups (p=0.5): 33.33.8 (G1); 33.74.2 (G2);
33.84.2 (G3). Duration of infertility was also similar in all groups (p=0.2): 5.02.5
(G1), 5.12.5 (G2); 5.81.5 (G3). Agonists were used in 74.6% (G1); 69.1 %( G2)
and 66.7 % (G3), p=0.6. On average, higher doses of gonadotropins were used in
groups G2 and G3 (1939 735 IU and 2022802 IU) compared to group G1
1705613 IU (p=0.09).The average number of days of stimulation was similar
across the three groups: 10.21.9 (G1), 10.72.1 (G2) and 10.72.2 (G3), p=0.5.
Clinical pregnancy (ultrasound confirmation of fetal heartbeat) was not different
among the groups: 74.6% (G1); 72.3% (G2) and 66.7% (G3), p=0.8. We found
statistically significant differences with respect to delivery: 68.2% of G1 embryos
had delivery compared with 55.3% of G2 embryos and 42.9% of G3 embryos
(p=0.02). Group G1 had a higher rate of cryopreserved embryos: 58.9% (G1),
versus 33% (G2) and 11.1% (G3), p<0.001. We did not find statistically significant
differences with respect to mean gestational age at delivery: 36.83.1 (G1),
37.23.1 (G2) and 37.71.5 (G3) weeks of gestation, p=0.07 and to mean birth
weight 2700695 g (G1), 2838676 g (G2) and 2788252g (G3), p=0.3 There were
30 twin deliveries in group G1 (16%); 7 in group G2 (14.9%) and none in group
G3.
Conclusion: Top quality of embryos (G1) were associated with a higher rate of
delivery. However, differences between G1, G2 and G3 embryos were not
statistically significant with respect to gestational age at delivery and mean birth
weight.
P18
OVERWEIGHT AND PREVALENCE OF B-CLASS EMBRYOS APPARENTLY DO NOT
AFFECT PREGNANCY RATE
J. D. Micic 1,*, L. Surlan 1, J. Dotlic 1, V. Stankovic 1, M. Terzic 2
1
ART, 2Infertility, Clinic of Ob/Gyn, Clinical Center of Serbia, Belgrade, Serbia
Problem Statement: Overweight and obesity, as some of the biggest health
problems in the world, are evidenced to co-relate with an increased risk of
infertility. The effect of patients body mass index on IVF procedure still remains
a controversial subject, since published data demonstrated variety of conflicting
conclusions.
Methods: We subjected 445 patients from National funded IVF program at the
Clinic of Ob/Gyn, Clinical Center of Serbia. Female patients are viewed through
BMI (<25; 25-30), infertility background and age, stimulation protocol,
gonadotropin doses, number and quality of oocytes and embryos obtained, and
achieved clinical pregnancy rates.
Results: Women had 34.16 +/- 3.74y. The mean patients BMI was 22.49 +/- 2.79
with 16.2% having BMI over 25. The most frequent causes of infertility were
male and unknown factor (p=0.001). BMI positively correlated with age
(p=0.009) and used rFSH doses (p=0.031). On average, 9.47+/-6.63 oocytes were
retrieved and 4.96 +/- 4.08 embryos were achieved. There were 1.54 +/- 2.36
type A, 2.28 +/- 2.54 type B and 1.14 +/- 1.98 type C embryos. Overweight group
had higher proportion of type B embryos (p=0.022) and total number of embryos
(p=0.037). BMI had no influence on clinical pregnancy rate.
Conclusion: If BMI is below 30 kg/m2 it has no influence on IVF course and
procedure outcome. The fact that embryos are graded as B morphologic type
Abstract Book
does not necessarily mean their lower implantation capacity, but confirms high
dynamics and plasticity of early development.
P19
IMPORTANCE OF MULTIDISCIPLINARY TREATMENT OF INFERTILITY WITH
RESPECT TO PATIENTS' SATISFACTION
V. Nagy 1,*, . Margittai 1, A. Vereczkey 1
Problem Statement: High-quality care for patients faced with infertility should
be based on complex treatment offered by the fertility clinic and continuous
analyses of patients feedback reports. There is a new trend in the services of
infertility clinics worldwide: some centers give full range of medical services. The
so called multidisciplinary, or complex approach involve many specialties
besides gynecology and in vitro fertilization (IVF). In the present study, we aimed
to examine infertility care from the patients' viewpoint to obtain in-depth
insights into their perspective on infertility care.
Methods: Data were collected from 20 patients participating voluntarily in the
study who have already gone through at least one IVF cycle at our clinic. All
patients filled out a questionnaire containing issues about patients tendency to
participate on the offered consultations and examinations, and content analysis
with the multidisciplinary approach. The research was conducted in 2014.
Results: The average age of the participting women was 37, and 45 years old. All
of them had previously undergone at least one IVF program in our institute. 85%
of the participating women were fully satisfied with the information received
about the complex treatment of infertility. 100% of the respondents agreed to
be advised to more than one specialists during infertility treatment and thought
that an individual treatment should be developed by the collaboration of
different specialists. The great majority of patients did not consider infertility
only a gynecological problem and found advantegous that all the related
professions are represented at our clinic. Preimplantation genetic examinations
were found substantial by 95% of participating patients, while
andrological/urological checkups were important to 85% of them. Psychological,
genetic, endocrinological, immunological consultations were found equally
important to 100% of participating women. Dietetic consultation was found to
be the less important for them. Further results obtained from the filled out
questionnaires are going to be presented in the lecture.
Conclusion: The Versys Clinics Human Reproduction Institute was founded with
a purpose of giving a full range of services for patients suffering from infertility,
with a multidisciplinary approach being pioneer in Central Europe. Its central
idea is that infertility is not any more under the control only of gynecology; many
other specialties should be involved. According to our questionnaire, the vast
majority of patients is fully satisfied with the above concept and they participate
at all of the consultations proposed in order to elaborate the treatment.
Our experience shows that the complex infertility treatment is more successful,
precise and results highly satisfied patients, thus multidisciplinary approach
should have a central role in in infertility care worldwide.
P20
FIRST HUNGARIAN EXPERIENCES WITH PREIMPLANTATION GENETIC TESTING
USING ARRAY COMPARATIVE GENOMIC HYBRIDIZATION (ACGH) FOR
PATIENTS CARRYING BALANCED CHROMOSOMAL REARRANGEMENTS
L. Nanassy 1,*, E. Gajdocsi 1, A. Nemes 1, G. Teglas 2, A. Vereczkey 1
1Human Reproduction Institute, 2Reprogenex Genetic Diagnostic Laboratory,
Budapest, Hungary
Problem Statement: Chromosome rearrangements in a balanced form have a
frequency of ~0.2 % in newborns. In most cases affected individuals experiences
no obvious problems until they try to reproduce. Patients carrying chromosomal
rearrangement experience decreased fertility, increased rate of miscarriage and
in some cases it can lead to a birth of a child affected with congenital
abnormalities. Preimplantation genetic testing of embryos using aCGH provides
an effective tool for selecting embryos with no unbalanced chromosome
rearrangements.
Methods: Data from patients attending at our infertility clinic with chromosome
rearrangements were gathered and analyzed. Intracytoplasmic sperm injection
was used as fertilization technique in all cycles. Embryo biopsy was carried out
on day 3, one blastomere was removed and analyzed using aCGH (24 sure +,
Illumina, Cambridge, UK). Where normal/balanced embryo was available
embryo transfer was carried out on day 5. Positive chemical pregnancy was
considered if hCG level in blood serum was above 15. Clinical pregnancy was
noted when fetal heart beat was seen.
Results: Ten patients showed abnormal karyotype, 5 of them had reciprocal, two
of them had Robertsonian translocation, two of them had inversion on
chromosome 9 (1 homozygous) and one patient showed heterochromatin
variations. These 10 patients went through 13 IVF cycles. One hundred and
thirteen mature eggs was collected that resulted in 79 embryos having a
fertilization rate of 69,99%. Fifty one embryo was biopsied and 50 of them was
diagnosed (98,04%). A total of 16 embryo was diagnosed as euploid (32,00%).
Over forty percent of aneuploid embryos (15/34) was unbalanced or had a
chromosome involved in the aneuploidy that in the rearrangement. One patient
had no normal embryo after two cycles; the remaining patients had euploid
embryos at least in one cycle. Nine embryo transfer was carried out resulting in
5 (55,56%) chemical and 4 clinical (44,44%) pregnancies. Clinical pregnancy rate
calculated per cycles started was 30,77% (4/13).
Conclusion: Following its introduction in assisted reproduction aCGH quickly
replaced fluorescent in situ hybridization (FISH). However, FISH has been
successfully applied for patients with chromosome rearrangements in several
hundred cases, it suffers many limitations. Array based CGH is proved to be
efficient for selecting embryos for transfer for patients with balanced
chromosome rearrangements. In our setting pregnancy rates achieved were
similar to that currently available in the literature. We have concluded that our
clinic successfully adopted embryo selection with aCGH for patients with
structural chromosome abnormalities.
P21
COMPARISON OF FERTILIZATION RATES AND PREGNANCY OUTCOMES
AMONG THE INSEMINATION AND HALF INTRACYTOPLASMIC SPERM
INJECTION (HALF ICSI) VERSUS TOTAL ICSI IN IN-VITRO FERTILIZATION
PATIENTS WITH MODERATE MALE FACTOR INFERTILITY
E. J. Park 1,* Won IL Park, Jung Whan Shin, Yong Soo Seo
1Obstetrics and gynecology, Eulji Medical Center of Eulji University, Seoul, Korea
Problem Statement: To compare fertilization rates and pregnancy rates
among the insemination and half intracytoplasmic sperm injection (half ICSI)
versus total ICSI in in-vitro fertilization patients with moderate male factor
infertility.
Methods: 212 patients completed IVF cycles done for the tubal factor and
moderate male factor infertility (strict morphology of sperm is 4-10%, or high
variation of strict morphology of sperm between the 2-3 analyses of semen)
were included. 40 women (Group 1) underwent insemination after oocyte
aspiration. 31 women (Group 2) underwent insemination of half oocytes and ICSI
of half oocytes aspirated. 51 women (Group 3) underwent total ICSI after oocyte
aspiration.
Results: 3 patients (3 patients in Group 1) were cancelled by failed fertilization.
119 patients were evaluated. There was no difference in the mean age, aspirated
oocytes numbers, strict morphology of sperm. There was no difference
fertilization rates between three groups (74.1%, 70.8%, 66.1%, P=0.164). Group
1 and 2 was higher than Group 3 in ongoing pregnancy rate (43.2%, 41.9%/
27.5%, P=0.008) significantly.
Conclusion: The use of insemination or half ICSI in in-vitro fertilization patients
with moderate male factor infertility is superior to total ICSI in pregnancy rate.
Also, benefit of half ICSI in moderate male factor infertity is to prevent failure of
fertilization in using insemination, but half ICSI didn`t increase fertilization rate
significantly
75
P22
COMPARISON BETWEEN FRESH AND FROZEN BLASTOCYSTS TRANSFER
REGARDING TO PREGNANCY
R. Petracco 1,*, L. Okada 1, R. Azambuja 1, D. Kvitko 1, V. Reig 1, A. Tagliani-Ribeiro
1
,M. Badalotti 1, A. Petracco 1
Fertilitat- Centro de Medicina Reprodutiva, Porto Alegre, Brazil
Problem Statement: In vitro fertilization has become a widely method to achieve
pregnancy in infertile couples. Considering the advances regarding new drugs
and new laboratory techniques, the embryo quality and chance of pregnancy
have increased consistently. Recent studies have suggested that transferring
frozen embryos would have a higher chance of pregnancy considering that
hormonal stimulation that is present during the fresh cycle could impair
endometrial receptivity. This aspect is especially important considering patients
with risk for ovarian hyperstimulation syndrome (OHSS). Firstly because of hyper
estrogen levels that modify uterine contractility in these patients. Also due to
eventual use of agonist for triggering final oocyte maturation that due to its
shorter duration of the agonist-induced LH surge might not transform the
existing follicles efficiently to corpora lutea capable of supporting implantation
and consequently decreasing pregnancy rate. The aim of this study is to compare
the pregnancy rates of transferred blastocysts derived from fresh and frozen
cycles.
Methods: A retrospective study that included couples who underwent embryo
transfer at the blastocyst stage (fresh = 551 and frozen = 264), from January 2012
until July 2014. The results of pregnancy regarding to blastocyst transfer cycles
were evaluated. The method for cryopreservation used was vitrification
(according to Kuwayama et al 1998). Statistical analysis was performed using
Fisher's exact test (p <0.05).
Results: The mean age of patients in the fresh cycle and frozen embryo transfer
(FET) cycle was 34.7 and 34.6, respectively. The number of embryos transferred
in both groups (fresh and FET) were 1018 and 474, respectively, with an average
of 1.84 and 1.79 per patient. The rates of pregnancies and clinical pregnancies
were 46% and 39% for fresh embryos and 52% and 43% for frozen/thawed
blastocysts, respectively. No statistical difference (p> 0.05) was observed in any
of the results reported above.
Conclusion: Transfering frozen/thawed embryos is a good option considering
patients that could have their pregnancy rates decreased for different reasons
(for example, OHSS). Our results didn't find a reason to have the frozen/thawed
embryos transfer cycle as a routine, because the pregnancy rates dind't show
difference in both groups.
P23
PREGNANCY AFTER IN VITRO MATURATION OF OOCYTES IN A PATIENT WITH
REPEATED FERTILIZATION FAILURE IN IVF
A. Smirnova 1,*, M. Anshina 1, A. Ellenbogen 2
1IVF&Genetics Center "FertiMed", Moscow, Russian 2Department of Obstetrics
and Gynecology, IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel
Problem Statement: The incidence of fertilization failure decreased dramatically
since ICSI was successfully introduced into clinical practice. However even in very
successful units with high pregnancy rates there are couples who face repeated
IVF failure due to low or absence of fertilization attributable to various follicular
development abnormalities, oocyte incompetence or cytoplasmic immaturity in
which no embryos are available for transfer. Different stimulation protocols
were proposed in order to overcome this problem. Another option is in vitro
maturation (IVM) of immature oocytes retrieved from small antral follicles.
Methods: We presented a case of a 36 years old woman who was referred to
IVF&Genetics Center for infertility treatment after bilateral salpingectomy due
to two tubal pregnancies. Basal FSH level was 11,8 mIU/ml, AMH 0,5 ng/ml, LH
4,7 mIU/ml, E2 75 pg/ml, antral follicle count on day 3 was 6.
Results: First IVF attempt was performed using a short agonist protocol with
Decapeptyl 0,05 mg/daily and Pergoveris (300 IU of FSH daily) for 14 days.
Following routine HCG administration 5 MII oocytes were retrieved.
Nineteen hours after ICSI one oocyte developed in 3pN and other 4 oocytes
degenerated. Second IVF attempt was performed with a long agonist protocol
76
(Decapeptyl 0,05 mg/daily from day 21 of cycle and Merional 450 IU daily for 11
days started when ovarian suppression was achieved). Four follicles > 18 mm
were aspirated 35 hours after HCG triggering and no oocytes were retrieved. A
second aspiration of other 4 follicle > 17 mm was performed 40 hours after
triggering, 4 oocytes being obtained: 2 MII, 1 MI and 1 GV. No sign of fertilization
was found 24 hours after ICSI. Third attempt with ovarian stimulation by
clomiphene citrate 50 mg for 11 days resulted in single follicle growth and cycle
cancellation. Taking into consideration the repeated fertilization failure in
conventional IVF attempts IVM+IVF was performed with FSH priming (Merional
150 IU on day 2, 3 and 4 of cycle), hCG 10000 IU was given as a trigger on Day 7
of cycle. Six follicles 5-12 mm in diameter were aspirated 39 hours later and five
oocytes were obtained. All oocytes were cultured for 5,5 hours in maturation
medium (SAGE) and stripped for maturity assessment. Four oocytes were MII
and 1 GV. MII oocytes were fertilized by ICSI on the day of aspiration; three good
quality embryos were obtained. Two of them were transferred to the patient
and one was vitrified on day 3. Luteal phase support with Proginova 6 mg and
Utrogestan 600 mg vaginally was provided. Singleton ongoing pregnancy was
diagnosed by ultrasound scan six weeks after the embryo transfer.
Conclusion: IVM should be considered for patients with repeated fertilization
failure.
P24
TWIN PREGNANCY WITH SINGLE INTRAUTERINE FETAL DEMISED IN LIMITED
RESOURCE; A CASE REPORT
R. Agustine 1,*, N. Obgyn 2
1Obstetry and Gynecology Department of Indonesia University, University, East
jakarta, 2Obstetry and Gynecology Department of Indonesia University, Riau
University, Pekanbaru- Riau, Indonesia
Problem Statement: Single twin demise occurs in 2- 5% of twin pregnancies
occur during second and third trimester with potentially profound consequences
It is believed to be associated with increase risk of perinatal morbidity and
mortality for the surviving twin and risk of coagulopathy affecting mother. 4 The
occurence of single fetal death is 3 to 4 fold higher with loss rates up to 30- 50
% in monochorionic twins than in dichorionic twins. The exact rate of single
intrauterine fetal death (sIUFD) is difficult to define as the loss may occur before
the diagnosis of a multiple pregnancy. However, it emphasizes the importance
of first trimester scanning and the identification of sIUFD 1, 2, 13 In this report we
present two cases of single intrauterine fetal demised in twin pregnancy, the
first case ilustrates a 33 y.o woman with G4P3 with two live children, came to
Arifin Achmad General Hospital in Pekanbaru- indonesia on April 2014, reffered
from midwive in active phase of labour. This pregnancy is a twin gestation with
single intrauterine fetal dimised, other fetus was normal, mother with anemia
suspected iron deficiency, patients admitted she never done ultrasound (US)
examination during her pregnancy. 2nd case was 35 y.o woman with G1 at term
pregnancy, Patient came to ANC Clinic of Arifin Achmad General Hospital on July
2014, to control her pregnancy, and the other maternal complication was
gestational hypertension.
Methods: 1st patient got a twin pregnancy, with single intrauterine fetal dimised
and Monochorionic Diamniotic placentation type. Patient was planned to have
vaginal delivery and packed red cells transfussion. In 6 hours born 1st baby boy
1980 grams, 43 cm, Apgar score 8/9. 2nd baby boy 580 grams, 31 cm, died
macerated grade III. The placenta type was monochorionic diamnotic 2nd
patient's US examination result was Intrauterin twins with Single IUFD,
longitudinal lie breech-breech presentation, oligohidramnious, placenta type
was monochorionic diamniotic. Patient was planned to have a termination by
cesarean section. Under C-section Born 1st baby boy 2300 grams, 44 cm, Apgar
score 7/9, Balard score correspond to 36- 38 weeks of gestatonal age. Born 2nd
baby boy 1000 grams, died macerated grade III, diminished greenish amniotic
fluid, withered umbilical cord. We could not have additional examination such
as milk test to see whether there's vascular anastomoses of placenta to help
determine the possibility of SIUFD due to cultural problems.
Results: These two cases terminated atterm pregnancy with no any significant
difference. Vaginal delivery is not contraindicated in cases of sIUFD however
caesarean section may avoid the risk of acute TTTS due to vascular anastomoses.
Abstract Book
In these two cases we didn't find any significant difference of normal fetal
outcome between two modes of deliveries.
Conclusion: These cases illustrate the importance of antenatal care is well
supported by the possibility of early diagnosis of complications of twin
pregnancies. In monochorion diamniontic twin pregnancies management
guided by ultrasound in assessing fetal development, the type of placentation,
Doppler assessment, fetal surveillance and other investigations such as MRI,
blood tests are necessary needed in order to reduce morbidity and mortality of
the fetuses and the mother. In monochorionic twins the gestation of delivery
following a sIUFD is still debatable but most would suggest delivery by 38 weeks
and some as early as 32- 34 weeks. Vaginal delivery is not contraindicated in
cases of sIUFD
P25
CONJOINED THORACOPHAGUS TWIN WITH NON IMMIUNE HYDROPS FETALIS
- A CASE REPORT
L. Ahmad 1,*, S. Al-abri 1, J. Al-busaide 1
Gynae and Obs, Armed Forces Hospital, Muscat, Oman
Problem Statement: The incidence of conjoined twins is estimated at 1 in 50,000
births. Thoracopagus is the most common form, with fusion from the anterior
thorax to the umbilicus. Approximately half are stillborn, and a smaller fraction
of pairs born alive have abnormalities incompatible with life. The overall survival
rate for conjoined twins is approximately 25%. The condition is more frequently
found among females, with a ratio of 3:1.
Methods: A case report.Results: A 27-year-old, G2P1 woman with previous
cesarean section was referred to our hospital at 28 weeks gestation because of
a conjoined twin (thoracopagus) diagnosed by ultrasonography. She had no
personal or family history of twins. Sonography was performed and found two
fetuses with 2 heads, both fetuses were joined at the anterior chest wall with
two fused heart and liver, two spines, cord had multiple vessels, with 2 arms and
2 legs, Polyhydroamnios was also visualized. Abdominal ascites and pleural
effusion noted. The placenta was localized anteriorly. On the basis of these
findings, the diagnosis of thoracopagus conjoined twins with Hydrops fetalis was
made and the parents were informed about the malformation and the twins
poor prognosis of survival by the senior obstetrician in collaboration with senior
pediatrician. The parents decided to continue the pregnancy. After one-week
patient reported in accident and emergency with per vaginal leaking and mild
labor pain, speculum examination confirmed leaking. Patient proceeded with
emergency LSCS in next half an hour. J- Shaped incision made and plenty of thin
Meconium stained liquor drained, baby girls with Conjoined thoracophagus
delivered and weight of each baby was 1 kg with Apgar score 2 and 2. Babies
shifted to SCBU and both died in next 2 hours.
Conclusion: Conjoined twinning is one of the most fascinating human
malformations. Early diagnosis of conjoined twins with ultrasound, threedimensional ultrasound, computed tomography, or magnetic resonance imaging
is helpful in early termination of pregnancy. The surgical separation of conjoined
twins is a delicate and risky procedure, requiring extreme precision and care.
Therefore, the decision to separate twins is a serious one. Most cases of
separation are extremely risky and life threatening.
P26
EARLY FETAL ABDOMINAL CIRCUMFERENCE MEASUREMENT IN THE
PREDICTION OF FETAL MACROSOMIA
M. Alshebly 1
Ob/ Gyn, King Saud University, Riyadh, Saudi Arabia
Problem Statement: Abdominal circumference measurement (AC) was missed
out as an important predictor of fetal macrosomia especially in Saudi Arabia. This
study therefore was done to evaluate the value of early fetal AC measurement
in the prediction of fetal macrosomia in diabetic and non diabetic pregnant Saudi
mothers and the fetal outcome.
Methods: This is a retrospective study conducted at the Department of
Obstetrics and Gynecology, King Khalid University Hospital, Riyadh, Saudi Arabia.
The study includes 139 neonates who were born during the period of one year
with a birth weight of 4 kg or more. All ultrasonographic measurement of AC was
done during the antenatal period which were reviewed and analyzed using SPSS.
The mode of delivery and neonatal complications were also reviewed.Results:
AC measurement was found to be above 50th percentile in both ultrasound scans
done in 2nd and 3rd trimester. Only 36.4% of macrosomic infants were born to
mothers diagnosed to have gestational diabetes and most of these patients were
managed by diet restriction. 63.4% of macrosomic infants were delivered by
mothers who were normal and carried on with their pregnancy till spontaneous
delivery. Screening of gestational diabetes was carried only once in this group
and it was not repeated even when the ultrasound showed high AC
measurement.
Conclusion: High AC measurement in second and third trimester of gestation
was associated with fetal macrosomia. The antenatal measurement of fetal
abdominal circumference is an easy and practical method in the prediction of
fetal macrosomia. Fetomaternal complications can be reduced by adopting strict
screening and good planning if fetal macrosomia is suspected early during
antenatal follow up.
P27
ATTITUDES OF SAUDI MOTHERS TOWARDS BREAST FEEDING
M. Alshebly 1
Ob/ Gyn, King Saud University, Riyadh, Saudi Arabia
Problem Statement: Breastfeeding is very important to both mother and fetus
but nowadays most of mothers are not following the recommendations for
proper breastfeeding. This study was done to explore the practice and attitudes
of Saudi mothers towards breastfeeding. Methods: A cross-sectional survey
done on a total of 517 Saudi mothers using a questionnaire inquiring about their
demographic data, breastfeeding practice in the first 6 months after delivery and
longer, different reasons for stopping breastfeeding. Furthermore, their
impression on the relation between breastfeeding and breast cancer as well as
prevention of infants allergic and infectious diseases.
Results: Only 37.5% of the mothers practiced exclusive breastfeeding for 6
months. 31.9% of the mothers continued breastfeeding until 9-12 months, and
only 23% continued until 18-24 months. Insufficient breast milk was the
commonest reason for stopping breastfeeding (25.9%). The vast majority of the
mothers (95.2%) believe that breast milk can prevent allergy and infection to
their infants, and 88.4% agreed that breastfeeding may decrease the risk of
breast cancer. 30% of mothers with higher income and higher socio-economic
class tend to have less compliance with breastfeeding.
Conclusion: Exclusive breastfeeding in the first 6 months lag far behind the WHO
recommendation. There is a major problem with adequacy of breast milk
production in the majority of mothers in this study which might indicate the
need for proper awareness and teaching programs regarding breastfeeding in
our community.
P28
NON-REASSURING FETAL STATUS AND UMBILICAL CORD BLOOD GAS
ANALYSIS
. M. Alves 1,*, M. Morais 1, H. Fachada 1, R. Verissimo 1, N. Nogueira Martins 1,
F. Nogueira Martins 1
Departamento de Obstetrcia e Ginecologia, Centro Hospitalar Tondela-Viseu,
EPE, Viseu, Portugal
Problem Statement: Introduction: The umbilical cord blood gas analysis
represents a valuable marker of the metabolic status of the fetus in the peripartum period, and it must be included in the assessement of the obstetrical
practice.
Objective: To establish the relationship between peri-partum diagnoses of nonreassuring fetal status, based on cardiotocography; and the results of the
umbilical cord blood gas analysis after birth
Methods: Prospective study that included the umbilical cord blood gas samples
collected between 01.09.13 e 31.01.14; divided in two different groups. A study
77
group, which included the ones collected for singleton pregnancies and nonreassuring fetal status, prematurity, fetal growth restriction, and maternal
disease; and a control group, including those collected for operative vaginal
deliveries excluding the diagnosis of non-reassuring fetal status, and twin
pregnancies without associated patologies. The two groups were compared
regarding arterial pH at birth, bases excess and Apgar score at the first minute
of life. The authors used the IBM Statistical Package for the Social Sciences
(SPSS) 21 for the statistical analysis.
Results: During the five-month study, 136 umbilical cord blood gas samples were
collected according to protocol. Only 113 were valid for statistical analysis. The
average age of women was 30.1; and the average gestational age at birth was
38.5 weeks. None of these items had significant difference between groups. The
t-Student test for independent samples was used to compare the arterial pH at
birth, bases excess and Apgar score at the first minute of life. Authors
established a p value 0,005 for statistical significance. The difference between
the arterial pH resulted in p=0.343; the difference between the bases excess
resulted in p= 0.525; and only the difference between the Apgar score achieved
statistical significance, with p=0.037.
Conclusion: The diagnosis of non-reassuring fetal status can lead to early fetal
extraction, and the acid-base status after birth is not always in agreement with
the motive that lead to the fetal extraction. The sistematic review of the
umbilical cord blood gas analysis in a context of non reassuring fetal status may
represent a valuable contribution to the improvement of the accuracy of the
obstetrical practice.
P29
SELECTIVE EPISIOTOMY VS AN IMPLEMENTATION FOR A PROTOCOL OF NO
EPISIOTOMY: A RANDOMIZED CONTROLLED TRIAL
M. Amorim 1,*, L. Katz 2, I. Coutinho 2, I. Melo 2, A. H. Frana Neto 1
1
Obstetrics and Gynecology, UFCG AND IMIP, Campina Grande, 2Obstetrics and
Gynecology, IMIP, Recife, Brazil
Problem Statement: An episiotomy rate around 10% is recommended by World
Health Organization. However, the procedure is still routinely performed in
several regions and settings. Current rate of episiotomy in Brazil is 54%.
Episiotomies should be limited and physicians must use their clinical judgment
to decide when the procedure is necessary. There is no clinical evidence
corroborating any indication of episiotomy, so it is not yet known whether it is
in fact necessary in any context in modern obstetric practice. The objective of
this study was to compare the maternal and perinatal outcomes in women
undergoing a protocol of not conducting episiotomy versus selective
episiotomy.
Methods: A randomized open clinical trial was conducted in the maternity ward
at Instituto de Medicina Integral Prof. Fernando Figueira, from January 2013 to
February 2014. Clinically stable women in labor with term pregnancy with a live
fetus in vertex cephalic presentation and maximum cervical dilation between
6cm and 8cm were included. Women with bleeding disorders of pregnancy and
cesarean indication were excluded. Primary outcomes were frequency of
episiotomy, duration of second period of labor, frequency of spontaneous
lacerations, instrumental delivery and perineal trauma, postpartum blood loss,
need for perineal suturing, number of sutures used, Apgar scores in the first and
fifth minutes, need for neonatal resuscitation and pH in cord blood. Secondary
outcomes were assessed: frequency of severe perineal trauma, complications of
perineal suturing, postpartum perineal pain, maternal satisfaction, neonatal
morbidity and admission to the NICU. Data analysis was performed using EpiInfo statistical program version 7, adopting the principle of intention to treat.
Students t-test, the Mann-Whitney test, Pearsons chi-square test and Fishers
exact test were used in the statistical analysis. All p-values were two-tailed and
the significance level adopted was 5%. The study was approved by the Ethics
Committee in Research of IMIP (CAAE 114,993) and registered in the
ClinicalTrials.gov. Under number NCT02178111. All participants agreed to
participate and were included only after signing an informed consent.
Results: Nineteen of the 263 women approached were excluded for
cephalopelvic disproportion or failure to progress. Four women agreed to
participate and were excluded after randomization for non-reassuring fetal
78
heart rate and so 115 women were allocated for a protocol of not conducting
episiotomy (experimental group) and 122 to a group in which episiotomy could
be performed selectively (control group). There was no difference between the
two groups regarding maternal or perinatal outcomes. Episiotomy rate was
similar (two cases in each group, around 1.7% of total), as well as the duration
of second stage, frequency of perineal lacerations and blood loss at delivery.
Conclusion: A protocol of not conducting an episiotomy seems to be safe for
mother and child and points to the need of investigating if there is in fact any
indication of this procedure in current Obstetrics practice. Further research
should evaluate the need of episiotomies in the situations commonly described
as indications, like non-reassuring fetal heart rate, instrumental deliveries,
macrosomia, shoulder dystocia and prolonged second stage of labor. Until these
evidences are available obstetricians should try to reduce their rates of
episiotomy. We think that is possible to never perform an episiotomy: this is the
final cut.
P30
CLONIDINE VERSUS CAPTOPRIL FOR SEVERE POSTPARTUM HYPERTENSION
M. Amorim 1,*, S. Maia 2, C. Noronha 2, L. Katz 2, A. H. Frana Neto 1,
A. S. Rolland de Souza 2, I. Coutinho 2
1Obstetrics and Gynecology, UFCG AND IMIP, Campina Grande, 2Obstetrics and
Gynecology, IMIP, Recife, Brazil
Problem Statement: The choice of antihypertensive drugs both to control very
high blood pressure episodes and to keep blood pressure stable in postpartum
women remains controversial. Captopril plays an important role in the
treatment of very high blood pressure episodes and may be used postpartum
with no effect on breastfeeding. Nevertheless, in cases of acute renal disease or
drug reactions, captopril should be avoided. Clonidine has been used as an
alternative in pregnant or postpartum women with contraindications to
captopril, with satisfactory effects. The objective of the present study was to
determine the effectiveness and safety of clonidine compared to captopril for
treating severe postpartum hypertension.Methods: A randomized, triple-blind,
drug-controlled clinical trial was conducted to compare oral captopril (25 mg)
with oral clonidine (0.1 mg) for 90 postpartum women with hypertensive
disorders of pregnancy and very high blood pressure episodes. The study was
developed at the obstetric intensive care unit (ICU) of the Instituto de Medicina
Integral Prof. Fernando Figueira (IMIP). The study was approved by the
institutes internal review board. All patients agreed to participate and signed a
consent form. Students t-test, the Pearson chi-square test and Fishers exact
test were used in the statistical analysis. All p-values were two-tailed and
significance level was established at 5%.Results: A total of 90 women were
randomized to receive captopril (n=45) or clonidine (n=45). The baseline
characteristics of the women in the two groups were similar, with no statistically
significant differences. The frequency of the clinical parameters was also similar
in the two groups; however, there were fewer very high blood pressure episodes
during hospitalization (2.1 2.1 vs. 3.5 4.7; p = 0.08), a greater percentage
reduction in systolic pressure (14.0% 8.6% vs. 10.8% 8.8%; p=0.08) and less
need for sodium nitroprusside (2.3% vs. 13.3%; RR: 0.17; 95%CI: 0.021.39;
p=0.06) in the clonidine group compared to the captopril group. Repeated
measures analysis of variance for the first four days of hospitalization showed
no differences between the groups with respect to mean daily SBP (p = 0.20) or
DBP levels (p = 0.67). Nevertheless, mean SBP was lower on the third day in the
clonidine group (151.9 11.8 mmHg vs. 158.1 13.6 mmHg; p = 0.02). The same
was not found for DBP, which remained similar in both groups. Although not
statistically significant, adverse reactions were more common in the captopril
group (28.8%) compared to the clonidine group (18.6%).Conclusion: Clonidine
and captopril represent safe, effective treatments for severe postpartum
hypertension. We consider that antihypertensive treatment with clonidine may
constitute a safe, effective alternative for avoiding postpartum very high blood
pressure episodes, with certain advantages such as a shorter hospital stay and
lower treatment costs. In addiction, clonidine can be used in patients with acute
renal injury that cannot receive captopril. To define whether this
antihypertensive should be adopted in different services and regions, each
hospital or physician should take into consideration the characteristics of the
Abstract Book
population, the frequency of very high blood pressure episodes in postpartum

women and the confidence and ease of the medical team with the use of this
drug. The protocol of this study was registered at ClinicalTrials.gov
(NCT01761916)
P31
TEENAGE PREGNANCY DOES MARITAL STATUS AFFECTS THE OUTCOME?
S. S. M. Aris 1 2,*, S. khalid 1 2, M. A. Masri 1 2
1O&G, Universiti Sains Islam Malaysia (USIM), NILAI, 2O&G, Ampang hospital,
Ampang, Malaysia
Problem Statement: Teenage pregnancy is associated with poor obstetrics
outcome. However, whether this is attributable to deleterious socioeconomic
environments or biological immaturity remains controversial. This study aimed
to specifically compare the outcome of teenage pregnancy in those who are
married with those who are single.
Methods: A retrospective study of all pregnant teenagers delivered in Hospital
Ampang, Malaysia between January 2009 and June 2012 were reviewed. Data
about marital status, antenatal booking, and mode of delivery, birthweight,
Apgar score and neonatal intensive care unit (NICU) admission were collected
and analysed.
Results: There were a total of 752 teenage deliveries of whom 29.9% (173/579)
were single. 34.1% (59/173) of the single mothers were unbooked compared
with 2.6% (15/579) of the married mothers (P < 0.005). 18.5% (32/173) of single
mothers had preterm deliveries compared with 11.6% (67/173) of married
mothers (P < 0.05). The average birthweight among the single mothers was 2.7
kg (SD 0.513) compared with 2.86 kg (SD 0.514) among married mothers (P <
0.005). 19.1% (33/173) of the single mothers had low birthweight compared
with 15% (87/579) of married mothers (P > 0.05). 2.9% (5/173) babies had a low
Apgar score among the single mothers compared with 0.35% (2/579) of the
married mothers (P < 0.005). NICU admissions were 17.9% (31/173) in babies
delivered by single mothers compared with 15% (87/579) among married
mothers (P > 0.05).
Conclusion: In this study, being married had significantly changed the outcome
among the teenage pregnancies. It was associated with a booked pregnancy,
higher percentage of term deliveries and less likelihood of a low Apgar score.
However, there were no significant differences as regards to NICU admission and
preterm labour. This may suggest similar predisposing factors between the two
groups such as immaturity. Being married is associated with a better pregnancy
outcome among teenage mothers. Marriage can be seen as a means of providing
some form of socioeconomic stability.
P32
GESTATIONAL HYPERTENSION. MANAGEMENT AND TREATMENT IN AN
UNIVERSITARY CLINIC FROM ROMANIA
R. Botezatu 1,*, B. Raluca 1, T. Daia 1, G. Peltecu 1
Obstetrics and Gynecology, FIlantropia Clinical Hospital - Bucharest, Bucharest,
Romania
Problem Statement: Gestational hypertension is a major obstetrical
complication with unknown etiology which is life threatening for both mother
and fetus. Current trends are to resolve by Caesarian section the cases of
gestational hypertension in the third trimester of pregnancy.
Methods: Objective: Analysis of Filantropia Hospital experience regarding
pregnancies complicated by gestational hypertension between 2013-2014.
Retrospective observational study that followed the onset of hypertension,
treatment and outcomes of therapy, associated complications, duration of
hospitalization time until birth, way of delivery, birth and postpartum outcomes.
The study included 104 pregnant women with gestational hypertension,
preeclampsia and severe preeclampsia who gave birth in Filantropia Hospital.
Results: The vast majority of cases had favorable outcome under treatment and
the delivery occurred at more than 48 hours since admission. In 20 cases
hypertension was diagnosed before 35 weeks' gestation of which 9 cases the
birth was delayed 48 hours to perform corticosteroid therapy for fetal lung
maturation. In one case of severe preeclampsia unresponsive to treatment

ended with cesarean section at 27 weeks gestation.
Conclusion: Gestational hypertension is a major obstetric complication requiring
follow-up in a specialized medical center. The moment and way of delivery
should be decided after balancing clinical and laboratory findings in selected
cases and may be delayed in fetal benefit when blood pressure is controlled.
This paper was co-financed from the European Social Fund, through the Sectorial
Operational Programme Human Resources Development 2007-2013, project number
POSDRU/159/1.5/S/138907 "Excellence in scientific interdisciplinary research, doctoral and
postdoctoral, in the economic, social and medical fields -EXCELIS", coordinator The
Bucharest University of Economic Studies
P33
PREGNANCY WITH BEHETS DISEASE - THE EXPERIENCE OF 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: Behet's disease (BD) is a rare multisystem chronic disease
of unknown etiology characterized by oral and genital ulcers. BD has been
described worldwide with a higher prevalence in Turkey, Japan, Middle East and
Mediterranean "silk route" countries. In Portugal was reported an intermediate
prevalence of 5 cases per 100,000. This disorder is typically diagnosed during the
2nd decade of life, so, its association with pregnancy is not unlikely. It has been
described that BD adversely affects pregnancy so, our objective is to analyze the
maternal and embryo-fetal outcome in a group of Portuguese pregnant women
with BD.Methods: Retrospective study of all pregnant women with BD followed
in a Portuguese University Hospital between 2002 and 2013.Results: 28
pregnancies in 16 patients were included in our study. 13.6% of these patients
experienced clinical exacerbation during pregnancy and 22.7% at postpartum.
The most frequent symptoms were oral ulcers and cutaneous lesions. One
patient experienced a lower limb deep vein thrombosis that was treated with
low molecular weight heparin (LMWH). Obstetric complications were found in
32.1% of pregnancies, where the most frequent was first trimester miscarriage
(21.4%), followed by fetal growth restriction (13.6%) and preterm deliveries
(9.1%). There were no statistically significant association between the
development of obstetric complications and the presence of BD clinical
worsening, presence of autoantibodies or use of immunosuppressive
medication during pregnancy. The presence of antiphospholipid antibodies was
detected in 16.7% of miscarriage cases. None of the cases had criteria for
antiphospholipid syndrome. 32.1% of pregnant women were medicated with
acetylsalicylic acid and 14.2% with LMWH. Use of these medications were no
associated with a statistically significant reduction of obstetric complications.
However, there were no cases of miscarriage or fetal growth restriction in
pregnant women medicated with LMWH. Two newborns had congenital heart
malformations (1 case of ventricular septal defect, 1 case of pulmonary valve
stenosis) that were diagnosed during pregnancy and confirmed after delivery.
There were no cases of hypertensive disorders of pregnancy, maternal or
neonatal deaths. There were a cesarean rate of 50% in this group of
patientsConclusion: There are 279 pregnancies in BD patients described in the
literature. We found a high rate of miscarriage and a higher incidence of fetal
growth restriction in the population studied. There were no association between
the development of obstetric complications and the severity of the BD,
development of BD clinical worsening or use of immunosuppressive medication.
In our study the average gestational age at delivery was 37 weeks, with a low
rate of preterm deliveries, and a high incidence of cesarean deliveries in the
population studied.
P34
THE ROLE OF POLYMORPHISM F PROKONVERITINE GENE WITH THE
PATIENTS WITH RETROCHORIAL HEMATOMA
I. Bushtyreva 1,*, N. Kuznetsova 1, E. Pelageina 1, V. Kovaleva 1
Rostov state medical university, Rostov-on-Don, Russian Federation
79
Problem Statement: Chorion detachment is a common complication of

gestational process and according to different authors meets with from 3 to 18%
of all pregnancies. The purpose of this study is to evaluate the role of
polymorphisms of genes of hemostasis in the genesis of the development of
chorion detachment.
Methods: The present study was conducted in Rostov Perinatal Center (Russia)
in 2013-2014. The study included 43 pregnant women with chorion detachment
in the first trimester, verified by ultrasound research, the control group
comprised 43 pregnant with no signs of chorion detachment. The average age
of patients in the group with chorion detachment was 300,8, in the control
group 29of 0,9 years. The average duration of pregnancy, when retrohotel
hematoma was revealed 6,8of 1.3 weeks.
There was conducted genotyping of 7 polymorphisms of genes of hemostasis (F
2 (prothrombin KF II) G20210A, F5 (proaccelerin, labile factor KF V) G1691A
(Laden mutation), F VII (proconvertin, KF VII) G10976A, 13 F (Fibrinosa, KF XIII)
(G>T, FGB (beta-chain of fibrinogen) G455, ITGA2 (alpha-2integrin) C807T,
ITGB3 (platelet glycoprotein IIIA) TS, PAI-1 (inhibitor of plasminogen activator 1)
-675 5G/4G). Material for research peripheral blood. There has been used a
set of reagents CardioGenetics Thrombophilia DNA-Technology, Russia.
Statistical processing of the results was performed in accordance with HardyWeinberg tests on compliance of balance and identifying associations by the
method x2 with the help of DeFinetti program. For all statistical calculations pvalue <0.05 result was considered statistically significant.
Results: From the presented set of polymorphisms of genes on the basis of
statistical analysis there have been selected the options, the carriage of which
with the patients with chorion detachment in the first trimester was higher in
comparison with the patients in the control group. Frequencies of alleles and
genotypes of polymorphic loci FVII gene in the first trimester and their
association with the detachment of chorion is presented in Table 1.
Table1:
Frequencies of alleles and genotypes of polymorphic loci of polymorphism
353Gln (G10976A) FVII gene in the group of pregnant with detachment and in
the control group and their association with chorion detachment.
Group, n
Frequency of genotype (n)
Polymorphic locus G 10976 of the A gene F 7

GG
GA
AA
The
0,74
0,23
0,02
control
(32)
(10)
(1)
group
n=43
The
0,40
0,51
0,09
group
(17)
(22)
(4)
with
detachm
ent
n=43
Accordance to HardyWeinberg law, Chi-square
Revealed
association OR,
C.I., chi2, p
p=0,836193
For allele A
OR=3.131
chi2=10.29
p=0.00134
p=0,407961
Polymorphism of FVII gene leads to a decrease in the expression of the gene and
the lowering of the level of coagulation factor VII according to the literature by
30%. In the case of gipoproteinemia the formation of thrombin which catalyzes
the conversion of fibrinogen to fibrin slows down. This explains the development
of hemorrhagic complications. According to the results of our research with
carriers of allele 10976A FVII gene the risk of developing retromobile hematoma
increased 3.1 times (OR=3.131, chi2=10.29, p=0.00134).
Conclusion: Awareness of individual genetic defects in hemostasis allows
forecasting the development of the retrochorial hematoma, identifies
opportunities of pathogenetically substantiated therapy and prevention of late
gestational complications in this group of patients.
P35
LABOR INDUCTION AFTER A CESAREAN SECTION - A ONE-YEAR EXPERIENCE
AT A TERTIARY CARE HOSPITAL IN PORTUGAL
M. C. Cavazza 1,*, R. Teixeira Ribeiro 1, F. Santos 1, V. Veiga 1, G. Moura Ramos 1
Centro Hospitalar Leiria, Leiria, Portugal
Problem Statement: Labor induction (LI) during a trial of labor after cesarian
(TOLAC) is, according to the 2010 ACOG guidelines, of level B evidence. Studies
80
show that women with a previous cesarean section (CS) who undergo LI have a
two to three-fold increased risk of CS and a higher chance of uterine rupture.
The goals of this study were to caracterize the mode of delivery and analyze
possible predictive factors for successful vaginal delivery (VD) after LI in women
with a previous CS.
Methods: Retrospective analysis of 149 deliveries that occurred during a TOLAC
in a tertiary care unit during 2013. Multiple pregnancies were excluded.
Statistical analysis was performed with the use of the SPSS software system.
Results: Of the 149 deliveries, 37 (24.8%) occurred after LI. The indications for LI
were: prolonged gestation (15), premature rupture of membranes (8), nonreassuring fetal statuses (NRFS) (6), gestational diabetes (5) and maternal
pathology (3). Dinosprostone was the preferred method of LI (23; 62.2%). Only
2.7% of the women had a favorable Bishop index at admission compared to
41.1% in the spontaneous labor group. The success rate for VD was 37.8%
compared to 49.1% in the spontaneous labor group. Half (7) of the VD after LI
were vacuum-assisted. The most common indication for CS in TOLAC was failed
IL which occurred in 24.3%. Other indications included: stationary labor (6),
fetopelvic disproportion (4) and NRFS (4). The existence of a previous VD was
the only predictive factor for a successful TOLAC (p=0,047). There weren't any
cases of uterine rupture. There was no statistically significant difference in
perinatal morbimortality.
Conclusion: The decision to undergo TOLAC should be individualized and, if
indicated, LI can be performed. In the studied sample, it was offered to 37
women prior to spontaneous labor with VD occurring in 37.8% of them. A
previous VD was a predictive factor for a successful TOLAC. There were no
statistically significant differences in maternal and perinatal morbimortality.
P36
IN UTERO INFECTION BY SCHMALLENBERG VIRUS INDUCES ARTHROGRYPOSIS
MULTIPLEXA CONGENITA IN OVINE FETUSES
G. Boseret 1, F. Claine 2, D. Coupeau 2, B. Muylkens 2, C. Saegerman 1,
F. Chantraine 3,*, N. Kirschvink 2
1Mdecine vtrinaire, ULg, Liege, 2Mdecine vtrinaire, UnNamur, Namur,
3Obstetrics & Gynecology, CHR Citadelle, CHU, ULg, Liege, Belgium
Problem Statement: Some viral infections occurring during pregnancy are
reported to induce arthrogryposis multiplex congenita (AMC). In ruminants,
vector-borne Bunyaviruses, such as Akabane, LaCrosse, Cache Valley virus are
known to induce AMC syndromes in lambs and calves whose dams underwent
infection during early gestation. In 2011, Schmallenberg virus (SBV), a new
vector-borne Bunyavirus emerged in Europe and heavily affected ruminant
offspring born in late 2011 and 2012.
Methods: SBV-affected lambs of the Ovine Research Centre of the University of
Namur born in January 2012 underwent necropsy in order to compare lesions
with those reported in human AMC. Virological analyses were performed in
ewes and offspring order to confirm SBV infection.
Results: Among 99 pregnant ewes, 23 gave birth to lambs presenting an AMC
syndrome (n=28). In 11 cases, one healthy sibling was also born. All other lambs
were clinically healthy. The most severely affect lambs were stillborn (n=4), 18
lambs died shortly after birth due to breathing incapacity and 6 lambs were
euthanized. At necropsy, gender, body weight, macroscopic malformations
(scoliosis, torticolis, arthrogryposis, macroscopic central nervous system (CNS)
lesions and weight of gonads, lungs) were recorded. RTq-PCR was performed
on CNS tissue aiming at detecting SBV. 13 newborn lambs born in early 2012 and
that died from other causes than SBV were used as necropsy controls. Necropsy
results are shown in Table 1 and a representative case of an SBV-affected lamb
is shown in Figure 1. Serum samples of all lambing ewes were analyzed by
seroneutralisation test aiming at SBV antibody detection. Clinically healthy
lambs as well as SBV-siblings and underwent precolostral blood sampling aiming
at SBV antibody detection. 65% of SBV-affected lambs were positive at Rtq-PCR
and all tested sampled showed SBV antibodies. 86% percent of their clinically
healthy siblings as well as 44% of clinically healthy control lambs were positive
at SNT.
Abstract Book
Table 1: Necropsy results
Death due to
SBV
(n=28)
Death due to other causes

(n=13)
M/F ratio
21:7
8:5
Arthrogryposis
96%
0%
Scoliosis
75%
0%
Torticolis
64%
0%
Macroscopic CNS lesions
81%
0%
Brachygnathia
64%
0%
Cryptorchidism
86%
25%
Testicles weight (g)
3.60.25
6.150.27*
Lung weight (g)
55.48.5
11713*
*p<0.001
Figure 1: SBV affected lamb with severe front- and rear-limb arthrogryposis and
torticolis. Sagittal section of the head shows hypoplasia of cerebrum, brainstem
and cerebellum.
Image / Graph:
artery. Complete occlusion of the right ovarian artery being the only effective
treatment, laparoscopic ovariectomy of the right ovary was performed for
ovarian cryopreservation and in vitro maturation of the immature oocytes prior
to a second embolization of the right ovarian artery. Six weeks after this second
intervention computed tomography and Doppler US revealed complete
resolution of the AVM. Currently the patient is trying to conceive.
Results: UAVM is a rare condition consisting of a proliferation of high-flow
heterogenous-sized vascular channels with an arteriovenous fistula formation
and bypass the capillary system. Acquired UAVMs can be confined within the
myometrium and/or the endometrium. A direct connection between the
intramural branches of the uterine artery and myometrial veins is possible.
UAVM during pregnancy is even more exceptional and related to recurrent
pregnancy loss or abnormal bleeding. UAVMs can be detected with US and color
Doppler US as masses with multiple hypo- or anechoic tubular like structures of
varying sizes or as focal endometrial and myometrial thickenings. Diagnosis is
made with MRI or conventional angiography. Treatment by embolization is the
gold standard because it is minimal invasive, surgery is indicated when
embolization is not feasible. Obstetrical outcome after embolization of UAVM is
unclear. Some case-reports describe placental pathology.
Conclusion: Review of the literature reveals that UAVM during pregnancy
remains a rare entity yet in patients with a history of uterine surgery it should
be suspected if abnormal vascular structures are detected on US. Since UAVM is
related to recurrent pregnancy loss or abnormal bleeding during pregnancy and
delivery we conclude that AVM should be treated prior to conception.
Conclusion: These data show that fetal SBV infection is able to induce AMC in
lambs. Surprisingly, siblings could remain clinically healthy, although fetal
antibody production (assessed by procolostral blood sampling) demonstrated
that they underwent in utero infection. Similarly, clinically normal singletons also
demonstrated an active prenatal immune response.
P37
UTERINE ARTERIOVENOUS MALFORMATION DURING PREGNANCY: CASEREPORT AND REVIEW OF THE LITERATURE
N. Coryn 1,*, A. Vorsselmans 1, F. Van Tussenbroek 2, M. De Vos 3,
M. Breugelmans 1, M. Laubach 1
1Obstetrics, 2Interventional Radiology, 3Center for Reproductive Medcine, UZ
Brussel, Brussel, Belgium
Problem Statement: A uterine arteriovenous malformation (UAVM) is a rare and
potentially life threatening vascular disease. It can be congenital or acquired.
Acquired lesions are mainly related to previous uterine surgery such as
hysteroscopy frequently performed in patients during fertility treatment. High
index of suspicion and timely diagnosis are necessary in order to assure
uncomplicated outcome for the patient. The best treatment of this condition in
pregnancy is yet to be established.
Methods: We report a case of a 26-year-old gravida 3 para 0 with history of two
uterine curettages and diagnostic hysteroscopy. An AVM on the anterior wall of
the uterus was detected on 2-D ultrasonography (US) and power Doppler at 16
weeks gestation. There was no vascular communication with the placental side.
After counseling the patient choose to continue the pregnancy with follow up by
US and magnetic resonance imaging (MRI). However at 20 weeks gestation the
patient had a second trimester pregnancy loss, clinically suggestive for cervical
insufficiency. The patient had no abnormal bleedings. MRI post-expulsion
confirmed the persistence of the UAVM measuring three centimeter on the
anterior side of the uterus, the structure bulking the endometrium. On intraarterial angiography the AVM originated from three different arteries: the left
uterine artery, the left superior vesical artery and the right ovarian artery. The
AVM connects to the left ovarian vein. A therapeutic embolization was
performed from the left uterine artery and the right ovarian artery. Computed
tomography ten weeks after embolization revealed persistent arterial flow on
the AVM with wash-out in the venous phase originating from the right ovarian
P38
PERINATAL OUTCOMES IN WOMEN WITH ANTIPHOSPHOLIPID SYNDROME
DURING PREGNANCY TREATED WITH ACENOCOUMARIN IN THE NATIONAL
INSTITUTE OF PERINATOLOGY
R. Pelaez 1, E. A. Cruz 2,*, E. Reyes 3, R. Zamora 4, S. Vargas 5
1Gynecology and Obstetrics, 2Human Reproduction Biology, 3Endocrinology,
4Medical Director, 5Hematology, National Institute of Perinatology, Mexico
Problem Statement: The antiphospholipid syndrome (APS) during pregnancy is
associated with increased risk of preeclampsia, preterm delivery, intrauterine
growth restriction (IUGR), and venous thrombosis (VT). The recommended
treatment is unfractionated heparin (UFH), and/or low molecular weight heparin
(LMWH) plus low-dose aspirin. Few studies have evaluated the use of
acenocoumarin in pregnant patients with APS. The objective of this study is to
describe perinatal outcomes in pregnant women with APS using acenocoumarin
plus aspirin. The cost of acenocumarin in Mexico is 15.15 USD while LMWH cost
is 36.69 USD. Therefore we used this treatment in the National Institute of
Perinatology.
Methods: This is a retrospective cohort study. Patients with APS were recruited
from 20012013 and were following during their pregnancy. These patients
received acenocoumarin from the 12th until 37th week of pregnancy. Adverse
perinatal outcomes (APO) were analyzed.
Results: 48 women were included. Mean age was 29.54 5.9 years, parity 3.1
1.3, Body Mass Index (BMI) 27.4 3.8 kg/m2, and weigh gain (WG) 11.4 3.8.
The mean weekly dose of acenocoumarin was 13.8 5.1 mg, maintaining an
International Nationalized Ratio (INR) 2.4 0.5. The frequency of APO was:
preterm delivery (29.1%), preeclampsia (25.0%), miscarriage (8.4%), IUGR (6.9%)
thrombocytopenia (8.4%), VT (2.3%), gestational hypertension (2.3%), immature
birth (2.3%) and stillbirth (2.3%). No major malformations were reported.
Mean gestational age at resolution was 36.2 3 weeks. Newborn average weight
was 2,416 762 g.
Conclusion: The use of acenocoumarin plus aspirin from the 12th to 37th week
of gestation could be an alternative treatment in patients with APS, with similar
rate of APO as the use of UFH and / or LMWH plus aspirin.
81
P39
SOCIAL-CULTURAL PROFILE OF THE PREGNANT TEENAGERS FROM CHTVVISEU, PORTUGAL
A. H. B. Fachada 1,*, . Melo 1, C. Ferreira 1, R. Verssimo 1, S. Esprito Santo 1,
M. Santos 1
Departamento Obstetrcia e Ginecologia, Centro Hospitalar Tondela-Viseu,
Viseu, Portugal
Problem Statement: Adolescence encompasses dynamic changes in all the
spheres of the human development. The impact of an adolescence pregnancy
comprehends the management not only of internal resources, but also of
constraints imposed by the external environment, whereby the experiences of
pregnancy demand from the teenager an adaptive capacity which could still be
reduced. Therefore, it becomes relevant to enquire about the social, familiar and
cultural characteristics of the teenagers.
Objective: To evaluate the social-demographic (scholarity and age of the
pregnant and her partner), behavioral (first sexual intercourse, number of
partners), familiar (teen mother, acceptance of pregnancy) and cultural
(ethnicity) aspects of the adolescents.
Methods: A retrospective and analytical study of the adolescent pregnancies
observed in the Adolescent Pregnancy outpatient Unit between 2003 and 2013,
based on the outpatient questionnaire and in the computer records. Statistical
study performed with IBM Statistical Package for the Social Sciences (SPSS)
version 21.
Results: During the analyzed period 408 adolescents were followed, with ages
between 12 and 19 years old. 3 were unlettered and 178 had schooling below
the 9th grade. In our sample, 240 of the adolescents abandoned school, 55 of
those during the pregnancy, and the main reason for abandonment was
disinterest. As for family data, 139 of the adolescents had mothers who got
pregnant in the adolescence, most of them had the pregnancy accepted by the
family and the majority of them where supported by the own family. About the
relationship which gave rise to the pregnancy, most refer a serious relationship,
8 refer casual relationship and 57 were married (36 before and 21 during
pregnancy). Noteworthy of the married adolescents 20 of them were gipsy.
Conclusion: The identification of the circumstances and difficulties that influence
pregnancy in adolescence contribute to the better comprehension of the
specificity associated to this problem, necessary to the right answer to the real
needs of the future mothers.
P40
PENTALOGY OF CANTRELL WITH ABNORMAL POSTERIOR FOSSA IN THE FIRST
TRIMESTER ANOMALY SCAN
C. Ferreira 1, H. Fachada 1,*, R. Nogueira 2 3, N. Pereira 1, P. Manso 1
1Obstetrics and Gynecology Department, Tondela-Viseu Hospital Centre, Viseu,
2Pathology Laboratory CGC Genetics, Centro Genetica Clinica, Porto,
3
PhD Associated Life and Health Sciences Research Institute (ICVS), School of
Health Sciences, University of Minho, Braga, Portugal
Problem Statement: In the first trimester anomaly scan many major
abnormalities can already be diagnosed. Pentalogy of Cantrell is a rare form of
thoraco-abdominal-wall defect, consisting of the association of five features:
midline epigastric abdominal wall defect, lower sternal defect, anterior
diaphragmatic defect, diaphragmatic pericardium defect and intracardiac
defects. Pentalogy of Cantrell can also be associated with other abnormalities,
including craniofacial abnormalities, spine and limb defects, malrotation of the
colon and chromosomal abnormalities. Prognosis depends on the severity of
cardiac lesions and associated anomalies.
Methods: The authors report a case of Pentalogy of Cantrell associated with
abnormal posterior fossa and spine defect diagnosed at the 12 weeks scan.
Results: A 33 year-old pregnant woman gravida 1 para 0 was referred to our unit
at 12 weeks of gestation for first trimester screening. A live fetus with
supraumbilical exomphalos containg liver, stomach and bowel, a lower sternal
defect, ectopia cordis, and diafragmatic hernia was diagnosed on the scan. A
scoliosis with 90 rotation of the lumbar spine and abnormal posterior fossa
were also seen. NT was increased (7.39 mm). Umbilical cord appeared normal
82
and there was no amniotic band. These findings led to the diagnosis of Pentalogy
of Cantrell with abnormal posterior fossa and severe lumbar scoliosis. After
counselling, the parents opted for termination of pregnancy. The pregnancy was
terminated with misoprostol at 12 weeks. Pathological examination confirmed
the diagnosis, revealing enlargement of posterior fossa with cystic cerebellum,
lumbar scoliosis and cervical straightening in addition to Pentalogy of Cantrell.
Left ventricular noncompactation and limb defects as clubfoot, clinodactyly of
the right hand and arthrogryposis of the elbows were also diagnosed. Fetal
karyotype was normal (46 XX).
Conclusion: The improvement on ultrasound technologies and fetal maternal
medicine subspecialization with expertise in obstetric ultrasound enable the
evaluation of fetal anatomy systematically in the 11-13 weeks scan. Pentalogy of
Cantrell is a rare but easily feasible diagnostic in the first trimester. There are
reports of many other abnormalities associated to the condition, worsening the
prognosis, yet posterior fossa abnormality has not been previously described to
be associated to Cantrells complete form. Diagnosis of fetal abnormalities in the
first trimester gives the option of an earlier and safer termination of pregnancy.
P41
MANAGEMENT OF TWO PREGNANCIES WITH FETAL SACROCOCCYGEAL
TUMOR IN DIFFERENT SETTINGS:
A CASE SERIES
A. F. C. N. Fathoni 1,*, K. H. Hadi 1
Obstetric and Ginecology, University of Indonesia, Jakarta, Indonesia
Problem Statement: Obstructed labors due to fetal anomalies are rare. Fetal
ascites, fetal tumors, hydrocephalus, and conjoined twins are described as the
common causes.1 Antenatal ultrasonography can effectively screen these
conditions, thus decreasing the incidence of labor complications arising due to
such anomalies.1 SCT is the most common congenital neoplasm, usually
presenting as a large midaxial exophytic mass in the sacrococcygeal region.2 The
incidence of the disease is between 1:35,000 and 1:40,000 live births, and show
a female preponderance at a ratio of four to one3, 4 They are believed to originate
from pluripotent cells in Hensens nodule, which is located on the anterior
surface of the sacrum or coccyx.5 It is a neoplasm composed of tissue derived
from all three germinal layers and mostly arises from the fetal sacral area.1
Methods: We are reporting a case series of two dramatically different
approaches to labor management of two pregnancies with fetal sacrococcygeal
teratomas. First case of an arrested vaginal delivery baby whose birth was
complicated by an under-diagnosed SCT, referred from rural area to a regional
hospital with limited resources setting. The patient, a 28-years-old woman, was
presented with the complication of an arrested vaginal delivery to the level of
babys papilla mammae on her first pregnancy, and did not undergo routine
antenatal care. Second case affects a-24-years-old woman, who was presented
with premature rupture of membrane, with a better antenatal care gives better
outcome.
Results: Both tumors affect two baby girls that matched in the prevalence ratio
Male: Female=1:4, both rose from the coccyx where the greatest concentrations
of primitive cells exist for the longest period of time during development,
midline structured, located in the posterior portion fetus, attached in the fetal
rump that are most likely macroscopically sacrococcygeal teratoma, the second
baby undergone biopsy and confirmed.
Conclusion: The case histories described in this case will help clinicians,
especially in the limited resource settings to approach in the better way,
diagnose such case more appropriate, to enhance better treatment, patient
care, and better outcome. This will be a challenge for general practitioners and
obstetrician in developing countries, where pregnancies often remain under
supervised.
P42
EFFECTIVENESS OF LOADING DOSE OF ORAL VERSUS SUBLINGUAL NIFEDIPINE
FOR TOCOLYSIS: A RANDOMIZED CONTROLLED TRIAL
A. H. Frana-Neto 1,*, C. C. Leal-Junior 2, M. Amorim 3, A. S. Rolland de Souza 2
Abstract Book
1Obstetrics
and Gynecology, FCM and IMIP, Campina Grande, 2Obstetrics and

Gynecology, IMIP, Recife, 3Obstetrics and Gynecology, UFCG and IMIP, Campina
Grande, Brazil
Problem Statement: Nifedipine is currently considered to be the best tocolytic
agent as demonstrated in the Cochrane Review, but the ideal dose and route of
administration remains to be established. This study was conducted to
determine the effectiveness of oral versus sublingual loading dose of nifedipine
for tocolysis in women with preterm labor.
Methods: An open randomized controlled trial was carried out at Instituto de
Medicina Integral Prof. Fernando Figueira (IMIP) and Instituto de Sade Elpdio
de Almeida (ISEA), between March 2013 and May 2014. Patients in preterm
labor were randomized to receive sublingual or oral loading dose of nifedipine
for tocolysis. The study was approved by the institutes internal review board.
All patients agreed to participate and signed a consent form.
Results: A total of 80 patients were included, 40 randomized to receive 20mg of
sublingual and 40 to receive 20mg of oral nifedipine. This initial dose could be
repeated each 30 minutes until tocolysis, with a maximum dose of 60mg. The
time required for tocolysis was significantly lower with the use of sublingual
nifedipine (160 mm x 340 min, p = 0.0003). There was an inhibition of preterm
labor by up to 90 minutes more frequent with sublingual nifedipine (20,5%)
compared with oral nifedipine (2,5%). However, no significant difference
between groups in the first 12 to 48 hours was found. In the same way, the rate
of preterm delivery within 48 hours was similar between groups (only one case
in the sublingual group).
Image / Graph:
auscultation, the use of a partograph, emotional and physical support, freedom

in position and movement, respect for the womens choice of companions, the
inclusion of the women in decision making during labour and the use of nonpharmacological methods for pain relief. The acupuncture/acupressure is one of
the nonpharmacological methods during labour for support process.
Methods: The purpose of this study is to identify the effect of ice pressure
applied on Large Intestinal 4 (LI4) acupressure energy meridian area on womens
perceptions of labor pain as well as on the labor process. The study, designed as
pre-test post-test controlled, was conducted in the delivery room of Adana
Maternity and Children Hospital. Target population of the study is all pregnant
women at first stage labor who consulted to the hospital between 1st of
November 2012 and 1st of February 2013. The participants, who met the
research criteria according to the results of power analysis, were 72 healthy
pregnant women divided into one experiment (n=36) and one control group
(n=36).
The data were collected using Pregnant Women Identification Form,
Inspection Form about Labor, Visual Analogue Scale (VAS) and Partograph.
In the active phase of labor, the women in the experimental group were
provided with ice massage on the LI4 area on both hands throughout
contractions until the 80th minute. However, the women in the control group
were not provided with any interference except for the routine clinical
practices. At the beginning of the study, both experimental and control groups
were administered the forms; and the labor duration and progression were
identified using Inspection Form about Labor and Partograph. VAS was
administered to both groups before the ice practice, and in the 40th and 80th
minutes after practice.
Results: Results show that ice pressure applied on the LI4 point on pregnant
womens hands was not effective in reducing pain in the 40th minute, but it was
found to be effective in the 80th minute (p=0.001). Moreover, in terms of the
effect of ice pressure on labor duration, the practice was found to reduce the
labor duration of the women in the experimental group approximately one hour
on the average (p<0.05).
Conclusion: It was found that the ice pressure applied on the LI4 area by
midwives/nurses in the active phase of delivery could reduce pain and shorten
the delivery duration.
Conclusion: A loading dose of sublingual nifedipine was more effective than the
oral route to achieve faster tocolysis in patients with preterm labor. Although no
differences in rate of preterm delivery with 48 horas were found, the faster
effect can be desirable for women in preterm labor.
Register of protocol: Registro Brasileiro de Ensaios Clnicos (ReBEC):U111111566186
P43
IDENTIFICATION OF THE EFFECT OF ICE PRESSURE APPLIED ON LARGE
INTESTINAL 4 IN HANDS DURING THE FIRST STAGE OF LABOR ON THE LABOR
PAIN AND LABOR PROCESS
E. Yildirim 1, S. Alan 2, S. Gokyildiz 2,*
1Nigde University Zubeyde Hanim School of Health, Nigde, 2Cukurova University
Adana Health High School, Adana, Turkey
Problem Statement: The aim of intrapartal care in normal birth is to achieve a
healthy mother and child using the least possible number of interventions that
is compatible with safety. Instead of medical interventions, the WHO suggests
careful monitoring of labour progress and foetal well-being with intermittent
P44
CHANGES IN VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) AND
SOLUBLE FMS-LIKE TYROSINE KINASE-1 (SFLT-1, VEGFR-1) CORD SERUM
CONCENTRATIONS IN GESTATIONAL DIABETES MELLITUS (GDM)
O. Hadarits 1,*, Z. Al-Aissa 2, A. Zoka 2, D. Bancher-Todesca 3, J. Rigo 1,
G. Firneisz 2, A. Somogyi 4, K. Rosta 5
1
1st Dept of Ob/Gyn 22nd Dept of Internal Medicine, Semmelweis University,
Budapest, Dept of Obstetrics and Fetomaternal Medicine, Medical University of
Vienna, Austria, 42nd Dept of Internal Medicine, 5Dept of Obstetrics and
Fetomaternal Medicine, Medical University of Vienna, Austria
Problem Statement: Gestational diabetes mellitus is characterized by altered
fetoplacental angiogenesis and endothelial dysfunction. Angiogenic markers
including vascular endothelial growth factor (VEGF), and fms-like tyrosine kinase
1 (Flt-1) play important roles in the development of endothelial dysfunction. The
aim of our study was to measure the concentrations of the pro-angiogenic factor
VEGF and its soluble receptor sFlt-1 in cord blood serum samples of neonates
born to gestational diabetic mothers and non-diabetic controls.
Methods: One-hundred and sixty-three pregnant women (76 control, 87 GDM
cases) were enrolled into the study in Hungary and Austria after signing informed
consent. A standardized oral glucose tolerance test (OGTT) was performed at the
24-28th gestational week. Cord blood samples were obtained at delivery and
cord serum VEGF concentrations and sFlt-1 level were determined using a
Quantikine solid phase Elisa Kit (R&D Systems).
Results: Cord serum VEGF concentrations did not differ between GDM and
control groups. Cord serum sFlt-1 levels were lower in GDM than in controls
(p=0.00017). Cord serum sFlt-1 concentration negatively correlated with
maternal 2-hour serum glucose OGTT (p=0.0003, r2=0.18), and with maternal
preconceptional BMI (p=0.025, r2=0.07) respectively. Neither VEGF nor sFlt-1
83
levels correlated with fasting glucose values, HbA1c, birth weight, and birth
weight for gestational age.
Conclusion: Decreased sFlt-1 levels might contribute to the altered fetoplacental
angiogenesis in GDM. The association of sFlt-1 with 2-hour OGTT value
demonstrates that early changes in glucose metabolism may have long-term
effects on fetoplacental homeostasis. The association of cord serum sFlt-1 levels
with maternal BMI may show that obesity alters fetal metabolism and
angiogenesis.
P45
STILLBIRTHS - CAN WE PREVENT THEM? (A 3-YEAR SERIES)
E. Y. Huang 1,*, K. H. Tan 1 2
1Division of Obstetrics & Gynaecology, KK Women's & Children's Hospital,
2OBGYN Academic Clinical Program, SingHealth Duke-NUS Academic Medical
Centre, Singapore, Singapore
Problem Statement: With advances in perinatal care, the number of stillbirths in
the developed world has reduced significantly. However, there are cases which
may be potentially preventable. A critical analysis and audit of stillbirth cases can
highlight problems which can be corrected in the hope of further reducing
perinatal mortality. We aim to review all cases of stillbirths over a 3-year period,
based on epidemiological factors, possible causes and suboptimal factors.
Methods: Stillbirth is defined in our unit as a baby born without life at or after
28 weeks and weighing at least 500 grams. We collated a 3-year series of
stillbirths from 2006 to 2008, and the data were analysed and peer-reviewed by
two assessors. Consensus was reached regarding the cause and any suboptimal
factors leading to the stillbirth, and whether the case was preventable. We used
our units stillbirth classification system, known as KK Hospital Stillbirth
Classification as it is more robust compared to other standard classification
systems and it is more tailored towards an obstetricians perspective.
Results: The total number of stillbirths was 124 and total number of births was
36466, giving a stillbirth rate of 3.4 per 1000 births. 25.8% of the cases were
unexplained stillbirths, and majority (16/32) had no known risk factors. 8 cases
of unexplained stillbirths had cord abnormalities from placental and/or postmortem examination but not found as a cause of death. There were 1 case each
of hypertensive disease and diabetes, and 2 cases of multiple pregnancy, but no
suboptimal factors were detected. 4 cases of unexplained stillbirths were cases
of placental disease and included a case of incidental vasa praevia on placenta
histology in which there were no clinical evidence of bleeding complications.
Lethal malformations leading to stillbirths were due to multiple fetal
abnormalities (6/15), cardiac abnormalities (4/15), chromosomal abnormalities
(3/15) and central nervous system abnormalities (2/15). 52.4% (65/124) of cases
had suboptimal factors in their care. We identified the group primarily
responsible for each case of stillbirth with suboptimal care. Patients were
responsible in 57 of the cases (87.7%), and physicians were responsible for 12.3%
of the cases. Our analysis showed that 41.9% of stillbirth cases can be prevented.
Preventable causes include uncontrolled diabetes (6 cases (11.5%) where all
were grade 3, patient factor) and severe hypertensive disease (9 cases (13.8%)
of which 5 were grade 3, patient factor and 4 were grade 2, patient factor). We
also identified 1 case (1.5%) of an anencephalic fetus (grade 3, physician factor),
in which perinatal outcome could be improved if periconceptional folic acid was
prescribed. There were also 2 cases (3.1%) of poor management of fetuses with
intrauterine growth restriction (grade 2, physician factor).
Conclusion: A significant number of stillbirths can be prevented from this
analysis, in which patient factor is a major contributor. Patient education on
control of medical conditions and adherence to antenatal management and
follow-ups are therefore essential. Continual medical education for trainees and
physicians is vital to keep up-to-date with current knowledge and evidence of
antenatal management to reduce and prevent stillbirths.
P46
UNDIAGNOSED PHEOCHROMOCYTOMA MASQUERADING AS PREECLAMPSIA
K. Hyeon Ji 1,*, B. Ju Won 1
84
1Obstetrics
Korea
and gynecology, Chung-ang university hospital, Seoul, Republic of
Problem Statement: Pheochromocytoma in a pregnancy is rare condition with a

reported incidence of less than 0.2 per 10000 pregnancies. Diagnosis is often
delayed because pheochromocytoma produced signs and symptoms that mimic
preeclampsia or gestational hypertension. However maternal and fetal mortality
is around 50% if unrecognized antenatally. So we report a case of undiagnosed
pheochromocytoma masquerading as preeclampsia.
Methods: A 32-year-old woman, para 2 presented for severe headache,
palpitation and sweating at 37weeks gestation. At that time, the fetus had
intrauterine hypoxia and regular uterine contraction. Systolic blood pressure
(SBP) was 220mmHg even though we used labetalol. Cesarean section was
performed under general anesthesia immediately, baby was delivered with 8
and 9 of Apgar score. In recovery she was hypertensive (170mmHg systolic) and
had tachycardia at 160 beats/min with glyceryl trinitrate and magnesium
infusions. Even though patient did not have any symptoms or signs, she had still
tachycardia at 120 beats/min.
Results: We suspected that she might have thromboembolic lesion on chest or
pheochromocytoma. On chest and abdominal CT, patient had about 4cm sized
mass in left para-aortic space. Serum and urinary catecholamine levels were
obtained and increased significantly. Although she had tachycardia (120
beats/min), echocardiography revealed mild diastolic dysfunction. Therefore
she discharged with alpha blockade. She underwent laparoscopic mass removal
seven months later and pathology was confirmed as pheochromocytoma.
Conclusion: Typical paroxysmal hypertension with triad of headache, palpitation
and sweating during pregnancy, pheochromocytoma should be considered.
Early diagnosis and treatment based on the period of pregnancy can reduce the
maternal and fetal mortality rate.
P47
PERINATAL MORBIDITY ASSOCIATED WITH MATERNAL PREGNANCY INDUCED
HYPERTENSION IN SGA AND GROWTH RESTRICTED FAETUSES
C. A. Ionescu 1,*, G. Sardescu 1, I. Pacu 1, D. Gheorghiu 1, H. Haradja 1, M. Banacu 1
1Obstetrics Gynecology, UMF Carol Davila, Clinical Emergency Hospital Sf
Pantelimon, Bucharest, Bucharest, Romania
Problem Statement: Gestational hypertension is a severe pathology leading to
important maternal and neonatal effects. It represents one of the most
important causes of maternal morbidity and contributes to a high percentage
of perinatal mortality, determined by fetal hypoxia and especially by prematurity
and low birth weight. The objectives of the study was to compare perinatal
outcomes between SGA newborns and those with intrauterine growth
restriction from mothers with pregnancy induced hypertension
Methods: We included all foetuses with fetal weight below 10th percentile from
hypertensive mothers from January 2009 to December 2013 (62 foetuses). 48 of
these 62 gestations were complicated with intrauterine growth restricted (IUGR,
EFW <3rd percentile or <10th percentilewith Doppler alterations) and 14 with
small for gestational age (SGA, EFW <10th percentile but >3rd percentile without
Doppler alterations). We followed up the immediate postnatal
complications.Exclusion criteria were: twins, intrauterine infections,
chronic hypertension and major malformations
Results: We observed significant differences (p: 0.04) in prenatal nonreassuring
fetal heart rate status (electrocardiotocography) (32% IUGR vs. 2% SGA) and in
Caesarean section rate (p0.046) (93% IUGR vs. 68% SGA). We didnt find
significant differences referring to gestational age at diagnostic (33 weeks for
IUGR and SGA), to gestational age at birth (35 weeks for IUGR and SGA), birth
weight, umbilical artery pH. We found differences between Apgar scores form
the SGA with IUGR newborns and SGA without IUGR. Neonatal complications
were observed in some newborn admitted to neonatal intensive care unit: 9
respiratory distress syndromes (7 IUGR vs. 2 SGA), 5 pathological cerebral scans
(4 IUGR vs. 1 SGA), mechanical ventilation (2 IUGR vs. 1 SGA), 5 inotropic drugs
(2 IUGR vs. 1 SGA), 1 sepsis (1 IUGR vs. 0 SGA), and 1 cerebral hemorrhage
(IUGR). No neonatal deaths were recorded.
Abstract Book
Conclusion: Growth restricted foetuses have more probability of admission to

neonatal unit, as well as obstetrical (Caesarean section) and neonatal
complications.
P48
THE EFFECT OF PRE PREGNANCY BODY MASS INDEX (BMI) AND
INTRAPREGNANCY WEIGHT GAIN ON THE PREGNANCY OUTCOME AMONG
PRIMIGRAVIDA. A CROSSECTIONAL STUDY AT HOSPITAL TENGKU AMPUAN
AFZAN KUANTAN
H. Ismail 1,*, S. A. Mohamed @ Mohd Adnan 2, Z. Nusee 1
Obstetric and Gynaecology, International Islamic University Malaysia,
2Obstetric and Gynaecology, Ministry of Health Malaysia, Kuantan, Malaysia
Problem Statement: In 2006, 29.1% of Malaysian adult population was
overweight and the prevalence of obesity was 14.0%. Total population of
overweight and obese was 43.1%. Obesity in young women is a major public
health concern as it leads to major impact on pregnancy outcome.
The aim of the study was to measure the maternal and neonatal outcome among
primigravida as per body mass index (BMI). This study also aimed to determine
the optimum intra pregnancy weight gain which is associated with good
outcome.
Methods: This was a crossectional study on primigravida who delivered between
December 2011-June 2013. The study population include primigravida who
booked <14 weeks gestation. Mother with multiple="multiple" pregnancy,
underlying medical problem such as hypertension or diabetes mellitus before
pregnancy and no BMI data available at booking were excluded. The women
were categorized into five groups according to their BMI (WHO classification):
underweight (BMI 19.9kg/m2), normal (BMI of 20-24.9kg/m2), overweight (BMI
of 25-29.9kg/m2), obese (BMI of 30-34.9kg/m2) and morbidly obese (BMI
>35kg/m2). Normal BMI group was used as reference or comparison group for
the analysis. Data were analyzed using statistical package SPSS version 18.Chisquare (2), independent t-test, one-way ANOVA and simple logistic regression
were performed and p-value of <0.05 considered as statistically significant.
Results: Total of 500 women were enrolled: 130 (26%) underweight, 184 (36.8%)
normal, 100 (20%) overweight, 53 (10.6%) obese and 33 (6.6%) morbidly obese.
Overweigth, obese and morbidly obese group had increased risk of gestational
diabetes mellitus with the odd ratio of {OR2.199 (1.111, 4.352)}, {OR3.755
(95%CI 1.766, 7.986)} and {OR3.776 (95%CI 1.564, 9.114)} respectively.
The risk of gestational hypertension were {OR 1.965 (95%CI 1.007, 3.836)} for
overweight, {OR 2.272 (95%CI 1.034, 4.994)} for obese and {OR 5.719 (95% CI
2.503, 13.070)} for morbidly obese women. Underweight group had a protective
effect against gestational hypertension {OR 0.308(95%CI 0.113, 0.839)}.
Preterm delivery was highest in the underweight women {OR2.038 (95%CI
1.158, 3.586)}. Induction of labour were high for the overweight, obese and
morbidly obese women with odd ratio of {OR 1.945(95%CI 1.128, 3.354)}, {OR
2.440 (95%CI 1.268, 4.693)} and {OR 2.417(95%CI 1.105, 5.286)} respectively.
Morbidly obese women had increase risk of caesarean section {OR 2.339(95%CI
1.086, 4.993)}. Underweight women had significantly lower risk of caesarean
delivery {OR 0.616(95%CI 0.379, 1.001)}. Women who are overweight, obese
and morbidly obese also had higher incidence of augmentation of labour and
wound infection. For neonatal complication, underweight women faced higher
risk of low birth weight baby {OR 1.801(95%CI 1.055, 3.076)}. Women who were
overweight and obese had significantly low risk for low birth weight {OR
0.458(95%CI 0.081, 0.934)} and {OR 0.275(95%CI 0.081, 0.934)} respectively. As
for macrosomia, morbidly obese women had higher incidence compared to
normal BMI women.
Conclusion: High pre pregnancy BMI is associated with increased maternal risk
of gestational diabetes mellitus, gestational hypertension, induction and
augmentation of labour, caesarean delivery and macrosomic babies. However
the underweight women are associated with poor perinatal outcome namely
preterm labour and low birth weight baby.
P49
SECOND PREGNANCY IN PATIENT WITH PPCM IN FIRST PREGNANCY - CASE
REPORT
L. Jevdjic 1 1,*
Institute for Gyn/Obs, Clinical Centar of Serbia, Belgrade, Serbia
Peripartum cardiomyopathy (PPCM) is a rare but devastating form of heart
failure. Maternal mortality is high (30-60%). PPCM represent a unique syndrome
or a pregnancy related exacerbation of some other form of cardiomyopathy.
There are small numbers of patients who developed recurrent disease in a
subsequent pregnancy. Female 40 year old with PPCM diagnosed three months
after first delivery in September 2005. EF was 25% end LVEDD 7,2. During 2006
and 2007 she was often in hospital becouse of heart decompensation. She first
came to our clinic in November 2011 in fifth month of second pregnancy. Patient
was without dyspnea, cough, legs oedema and other signs of PPCM. On Echo we
found EF 30% and LVEDD 6, 4. Seven months before, she stop to take therapy.
Since there were no changes in results it was decided to continue the pregnancy
with regular monitoring of Echo and ECG in 15 days. In December we find
changes in ECG- VES. In therapy we included LMWH and Ca-antagonist.In
January 2012 it came to a deterioration of the general condition EF 26% LVEDD
6.9. Pregnancy ended at 34 weeks gestation with cesarean delivery.
Postoperative course was duly passed with out changes in the Echo end ECG
findings. EF was 25 % and LVEDD 7.2.With oral anticoagulant therapy was
discharged from hospital. By observing this patient we came to the conclusion
that second pregnancy, in this case, does not deteriorate heart function.
Methods: Female 40 year old with PPCM diagnosed three months after first
delivery in September 2005. EF was 25% end LVEDD 7,2. During 2006 and 2007
she was often in hospital becouse of heart decompensation.She first came to
our clinic in November 2011 in fifth month of second pregnancy. Patient was
without dyspnea, cough, legs oedema and other signs of PPCM. On Echo we
found EF 30% and LVEDD 6,4. Seven month before, she stop to take therapy.
Since there were no changes in results it was decided to continue the pregnancy
with regular monitoring of Echo and ECG on 15 days. In December we find
changes in ECG- VES.In therapy we included LMWH and Ca-antagonist. In
January 2012 is coming to a deterioration of the general condition EF 26% LVEDD
6.9. Pregnancy ended at 34 weeks gestation with cesarean delivery.
Postoperative course was duly passed with out changes in the Echo end ECG
findings. EF was 25 % and LVEDD 7.2.With oral anticoagulant therapy was
discharged from hospital.
Results: By observing this patient we came to conclusion that second pregnancy,
in this case, does not deteriorate heart function.
P50
MANAGEMENT OF TWIN REVERSED ARTERIAL PERFUSION (TRAP) SEQUENCE
BY ULTRASOUND GUIDED RADIOFREQUENCY ABLATION FOCUSING A
FEEDING ARTERY ON THE PLACENTAL SURFACE.
B. Ju Won 1,*, K. Hyeon Ji 1
Obstetrics and gynecology, Chung-ang university hospital, Seoul, Korea
Problem Statement: Radiofrequency ablation (RFA) has become widely accepted
as first line management for twin reversed arterial perfusion (TRAP) sequence.
Most RFA procedures have been performed using RFA needles of 14-17
gauge(G) focusing on an acardiac mass at an average age of 21 weeks of
gestation(17-24 weeks), In this case report, we describe treatment of TRAP
sequence using RFA with a 20G needle focusing artery on the placental surface
at gestational age 11-18 weeks.
Methods: The vascular connection site of the arterio-arterial anastomosis, which
showed arterial blood flow from the normal fetus to the acardiac member, was
detected on the placental surface using the color power Doppler setting. A 20G
150mm RFA needle (Cosman Medial, Burlingame, CA, USA) was introduced to
reach the anastomosis site through the placenta under the color power Doppler
setting. No anesthetic was employed. RFA was performed at the vascular
connection site on the placental surface under color flow mapping
guidance. RFA was performed in a cyclic manner, with 2min of ablation and 1min
of rest. The duration of RFA was 5min (two sets). Radiofrequency was generated
85
with an RFA-1A Generator (Cosman Medical) with the temperature set 90.
Immediate cessation of blood flow in the target vessel after RFA procedure was
detected. A normal fetal heart rate and normal movements were present in the
normal fetus following RFA.
Results:
Cases
Before
RFA
At time
RFA
After RFA
Delivery
7.3(11
weeks)
13
(38weeks)
40+2weeks,
Vaginal
delivery,
female 2.56Kg, Apgar score(A/S); 810
34
(18weeks
)
6.4(12
weeks)
12(22
weeks)
38+5weeks, Vaginal delivery, male

2.8Kg, A/S: 9-10
23
(15+1
weeks)
0.5
(9weeks)
4,2(11
+6weeks)
4
(16weeks)
35+6weeks, Cesarian
female 1.8Kg, A/S: 2-5
section,
Conclusion: Intrafetal RFA has been reported to be an uncomplicated and

effective treatment when compared with other methods. RFA has been
associated with lower rates of premature delivery and rupture of membranes
before 32weeks of gestation, and higher rate of clinical success than with cord
occulusion techniques. Intrafetal RFA for an acardiac twin was performed using
14G RFA needles at an average age of 21weeks of gestation. In the present cases,
we used a 20G RFA needle. We successfully treated the acardiac twin using RFA
on the communicating vessel at the gestational age of 11+6 18+0weeks. Early
RFA might have some advantages over the conventional RFA. First, early RFA
uses a small caliber needle, which makes the procedure safer and less painful.
Second, it can be done through the placenta without breakin fetal membranes.
In conclusion, if vascular anastomosis is seen on the placental surface on
ultrasound/Doppler examination, early vascular RFA can be an easy and safe
option compared with intrafetal RFA.
P52
IS CARDIOMEGALY MEANT HEART FAILURE AT TERM PREGNANCY: A
MEDIASTINAL TUMOR
K. Kim 1,*, Y. Lee 2, H. Kang 3
1
Obstetrics gynecology, Seonam University, 2Obstetrics gynecology,
presbyterian medical center, Jeonjusi, 3Nursing, kongju natioal university,
Kongju, Korea
Problem Statement: Is Cardiomegaly meant a heart failure at term pregnancy?
A 28 years-old Korean woman visited outpatient dispensary with dyspnea with
exertion. She was 38 weeks gestation with poor prenatal care. She had para 1
with previous cesarean section. Fetal ultrasonogram biometry revealed 2.8 Kg
baby with regular heart beat. For the preoperative evaluation, vital sign was
stable, chest X- revealed cardiomegaly. Hemoglobin was 11.6 mg/ml. We
performed echocardiography to evaluate cardiac function. The results revealed
large round homogenous mediastinal tumor displaced the heart.
Methods: Tumor marker studies were AFP 74.8 mg/ml, Beta-hCg 18.8mu/ml.
repeated cesarean section was done under spinal anesthesia. A healthy 2.8kg
male was delivered. After 6wrrks later of postpartum periods. Chest CT revealed
Lt Thorax was occupied by 2/3 involving large tumor with normal heart, Figure
showed the tumor and normal heart. The tumor excision was done under the
general anesthesia by chest surgern
Results: Histologic result was benign thymoma. Thymoma is found in 15% of
patients with myasthenia gravis. She had no symptom of myasthenis gravis. She
recovered well
Image / Graph:
P51
DOUBLE MARKER TEST AND UTERINE ARTERY DOPPLER IN CASES WITH
HYPEREMESIS GRAVIDARUM
A. Kholeif
Obstetrics & Gynecology, Faculty of Medicine, Alexandria University,
Alexandria, Egypt
Problem Statement: The objective of this work was to evaluate any correlation
between the double marker test (serum B-HCG and PAPP-a) and uterine artery
Doppler indices in cases with hyperemesis gravidarum at 11-13 weeks gestation.
Methods: The study was conducted on 60 cases, admitted to El-Shatby
Maternity University Hospital, Alexandria. They were divided equally into 2
groups; study and control groups. The study group cases were 11-13 weeks of
gestation, singleton pregnancy and with full picture of hyperemesis gravidarum.
The control group cases were with uncomplicated pregnancy and of the same
duration of pregnancy. Both groups were subjected to the assay of the double
marker test and the evaluation of uterine artery Doppler. The double marker
test was done using the Chemi-illuminescence (Siemens-Germany), PRISCA 4.0
for prenatal risk assessement. The uterine artery Doppler was done using the
machine Medison SonoAceX8.
Results: Analysis of the results revealed that serum level B-HCG and PAPP-a
showed no significant difference in cases with hyperemesis in comparison to
cases with normal pregnancy of the same duration. Also, Doppler indices
showed no significant difference as well between both groups.
Conclusion: Double marker test is not recommended for routine clinical
practice in cases with hyperemesis gravidarum.
Doppler indices results signify that hyperemesis gravidarum is not a risk factor
for the development of pre-eclampsia or IUGR later in pregnancy.
86
Conclusion: Cardiomegaly may be have various causes. Chest X-ray and cardiac
echocardiogram may be helpful to evaluate and verify cardiac function and
differentiate other causes. We can role out cardiomyopathy, and structural
abnormality with Chst computerized tomogram (CT) also. Our case was a
mediastinal thyoma.
P53
TRENDS IN PERINATAL MORTALITY AND ITS RISK FACTORS IN JAPAN
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: Perinatal mortality is an important indicator of quality in
obstetric care during pregnancy. There have been rapid past declines in perinatal
mortality rate (PMR). Assessing whether these declines can be sustained as total
mortality falls, and how to identify risk groups is important in order to sustain
PMR reductions in the future.
Methods: Data on deaths, live births and stillbirths were obtained separately
from the Ministry of Health, Labour and Welfare, and merged to obtain a
complete record of all birth outcomes in Japan between 1979 and 2010 in all 47
prefectures. The data included information on perinatal death, birth weight,
maternal age, gestational age, parity, nationality, and household occupation.
Multiple births were excluded because twins have very different PMR and risk
factors. Deaths were merged to births using a deterministic matching process;
Abstract Book
for those that did not match, probabilistic matching was applied based on the
highest predicted probability of mortality in a multilevel Poisson regression
model. An autoregressive moving average (ARIMA) model was fitted to the
differenced natural log of PMR separately by sex, after assessing its serial
dependence structure. A multilevel Poisson regression was conducted with a
prefecture-level random effect, to estimate the perinatal mortality risk ratio for
possible risk factors such as household occupation, birth weight, gestational age,
maternal age, and year.
Results: From January 1979 to December 2010, there were 41,073,669
pregnancies and 594,391 perinatal deaths. The PMR ranged from 21.8 per 1000
in 1975 to 3.9 per 1000 in 2010. A decreasing trend in the PMR was clearly seen
for both sexes. There was a significant continuous monthly reduction of PMR by
0.5 (0.4 -0.7) percent for males and 0.5 (0.3-0.7) percent for females among all
years. Compared to the reference group, perinatal mortality was 2.5 times
higher and on average 4.8 times higher for high birth weight (>4000g) and low
birth weight (<2500g) neonates, respectively. The risk was 2.7 times higher for
premature delivery, and 4.3 times higher for postmature delivery, more than 5.0
times lower for nulliparous mothers, 15.9 times higher for mothers who
experienced past neonatal mortality, and 1.6 times higher for mothers from
poorer or unemployed families.
Conclusion: A significant linear reduction in the logged PMR indicates that future
reductions in PMR can be expected, although future reductions in absolute
mortality numbers will become smaller. As the cost and challenge of maintaining
these gains increases, policies need to be targeted towards higher risk groups.
Health expenditure targeted to key indicators, and optimization of gestational
age and birth weight are necessary to further decrease the PMR in Japan in a
cost-effective way.
P54
PREOS (PREECLAMPSIA OPEN STUDY), A MULTICENTER, PROSPECTIVE, NONINTERVENTIONAL STUDY EVALUATING THE INFLUENCE OF THE SFLT-1/PLGF
RATIO ON PHYSICIAN DECISION-MAKING IN PREGNANT WOMEN WITH
SUSPICION OF PREECLAMPSIA
E. Klein 1,*, D. Schlembach 2, A. Ramoni 3, E. Langer 4, F. Bahlmann 5,
R. van der Does 6, D. Messinger 6, W. D. Verhagen-Kamerbeek 7, M. Reim 8,
M. Hund 9, H. Stepan 10
1Womens Clinic and Polyclinic, Munich Technical University Hospital, Munich,
2Vivantes Clinics Neuklln, Clinic of Obstetrics, Berlin,Germany 3University
Hospital of Innsbruck, Austria, 4Dept of Obstetrics, Leipzig University, Leipzig,
5Brgerhospital, Frankfurt, 6IST GmbH, Mannheim, 7Roche Diagnostics
International Ltd, Rotkreuz, 8Roche Diagnostics GmbH , Penzberg, Germany,
9Roche Diagnostics International Ltd, Rotkreuz, Switzerland, 10Dept of
Obstetrics, Leipzig University, Leipzig, Germany
Problem Statement: Preeclampsia is a major cause of maternal, fetal and
neonatal morbidity and mortality. Levels of serum sFlt-1 (soluble fms-like
tyrosine kinase-1) are increased and serum PlGF (placental growth factor)
decreased in pregnant women developing or having diagnosed
preeclampsia/eclampsia/HELLP syndrome. The sFlt-1/PlGF ratio is a valuable
tool in preeclampsia diagnosis. However, the clinical utility of the sFlt-1/PlGF
ratio in guiding physicians surveillance and treatment decisions for patients with
suspicion of preeclampsia has not yet been evaluated in routine clinical practice.
PreOS assessed the influence of the sFlt-1/PlGF test result on physicians clinical
decision-making for hospitalization, treatment and monitoring of patients with
suspicion of preeclampsia.
Methods: PreOS (multicenter, prospective, non-interventional) included
pregnant women (24+0 weeks) with suspicion of preeclampsia for whom the
physician considered that the sFlt-1/PlGF ratio should be determined. The Roche
Elecsys sFlt-1 and PlGF assays were used. Before the test result was known,
physicians documented intended clinical procedures using an iPad application.
Decisions were data locked, time stamped and transferred to an online data
center. After the sFlt-1/PlGF result was available, the decisions for clinical
procedures were confirmed or revised on the iPad. Investigators were free to
manage patients according to their own decisions. Primary objective: to assess
the influence of the sFlt-1/PlGF result on the decision-making of the physician to
hospitalize women with suspected preeclampsia. Secondary objectives focused

on the influence of the sFlt-1/PlGF result on decisions regarding induction of
delivery/ fetal lung maturation, additional laboratory measurements,
cardiotocography, Doppler sonography, change of intensity of patient
monitoring within one week and drug treatment. Maternal/neonatal outcomes
were documented at delivery and postpartum. An independent adjudication
committee evaluated the appropriateness of clinical decisions (based on
outcome). Primary endpoint: the proportion of appropriate decisions to
hospitalize/not to hospitalize patients with suspicion of preeclampsia before and
after knowledge of the sFlt-1/PlGF result.
Results: 118 of 209 enrolled patients comprised the per-protocol population. For
16.9% of patients in the per-protocol population, the sFlt-1/PlGF ratio influenced
the decision to hospitalize patients. For 11.0% of patients the sFlt-1/PlGF result
influenced the investigator towards not to hospitalize the patient. For 5.9% of
patients, the sFlt-1/PlGF result influenced the investigators to hospitalize the
patient after initially deciding not to hospitalize her. All changes regarding
hospitalization were assessed as appropriate by the independent adjudication
committee. Changed decisions on hospitalization and other clinical procedures
concurred with outcomes in mothers/neonates.
Conclusion: PreOS is the first study to demonstrate the influence of sFlt-1/PlGF
testing on physicians clinical decision making for pregnant women with
suspicion of preeclampsia in routine clinical practice. The test may be used to
guide appropriate intensity of patient management with respect to
hospitalization and diagnostic and therapeutic decisions in a clinically relevant
proportion of pregnant women with signs and symptoms of
preeclampsia/eclampsia/HELLP syndrome.
Disclosure of Interest: E. Klein: None Declared, D. Schlembach Consultant for: F. HoffmannLa Roche , A. Ramoni : None Declared, E. Langer : None Declared, F. Bahlmann : None
Declared, R. van der Does Employee of: CRO IST GmbH involved in the conduct and analysis
of the study, D. Messinger : None Declared, W. D. Verhagen-Kamerbeek Employee of: Roche
Diagnostics International Ltd., M. Reim Employee of: Roche Diagnostics GmbH, M. Hund
Shareholder of: F. Hoffmann-La Roche , Employee of: Roche Diagnostics International Ltd.,
H. Stepan Consultant for: Roche Diagnostics
P55
CESAREAN SECTION ON REQUEST OF THE PATIENT, CAN BE A LEGITIMATE
CHOICE OF THE WOMAN?
C. S. Laranjeira 1,*, C. H. Mascarenhas Silva 1, R. Lamaita 1, K. Moreira Lana 1,
B. Hermanny 1, D. Seixas 1, M. Salvador Geo 1
Obstetrics and Gynecology, Rede Mater Dei de Saude, Belo Horizonte, Brazil
Problem Statement:
A cesarean section is a surgical procedure originally designed to reduce the risk
of maternal and / or fetal complications during pregnancy and childbirth, and
should be avoided in the absence of a medical indication. Some authors report
that enhancements in surgical techniques, prevention of complications, and the
procedure is indicated to the satisfaction of the desires of the mother and / or
family. The main reasons found for the increases cesarean section rates are
social, cultural and economic factors associated with maternal request and
factors related to the health care model, involving aspects of medical assistance
and other professionals, preferences and economic interests of the actors this
process. In Brazil, cesarean rates are high and cesarean section for maternal
choice is a frequent point of discussion between managers and obstetricians. In
this context, the present study aims to evaluate neonatal and obstetric results
in women undergoing cesarean section by choice in term pregnancies.
Methods: A retrospective case series study, 297 women undergoing delivery in
a private hospital, quaternary care, from Jan to Sep/13. The women were divided
into two groups: group 1 with 140 women undergoing cesarean section by
choice in the absence of labor and group 2 with 157 women undergoing vaginal
delivery. Inclusion criteria: signed an informed consent according to the choice
made at admission, primiparous, greater than 37 weeks, cephalic presentation
and flexed, no fetal malformations. It was analyzed the type of anesthesia, the
weight of the newborn, the Apgar score less than 7 at 1 and 5 min, referral to
rooming and admission to neonatal intensive care unit, immediate
breastfeeding, maternal death and / or early neonatal, maternal readmission to
and / or neonatal increased uterine bleeding, maternal blood transfusion, use of
87
uterotonic and time of maternal hospitalization. We performed a statistical

study of the results obtained in both groups with the EpiInfo software.
Results: The average gestational age of group 1 and 2 was 275.67 and 274.04
days, respectively. The results showed that significant differences are described
in Table 1, the other evaluated variables showed no significant difference.
Table 1: Maternal and neonatal outcomes after cesarean by request and after
vaginal delivery
Outcomes
Use of uterotonic (N /%)

Maternal blood transfusion (N /%)
Maternal hospitalization time
(media) hours
Birthweight (mean) g
Apgar score <7 (1min) (N /%)
Group 1 (n =
140)
105 (80,7%)
1
46,1 (+ 11,6)
Group
2
(n=157)
139 (91,4%)
2
33,4 (+ 4,9)
3292
378,6)
7(5%)
3137 (+ 382,2)
29(19,1%)
(+
s
s
s
Conclusion: Considering that pregnancy and childbirth is a physiological event in

any woman's life, it is recommended that health professionals involved in the
birth of a child only when necessary. This study found that gestational age and
birth weight were higher in the group Cesarean by choice, and that maternal
and/or fetal complications were not higher in these women. The protocol
established in the institution where the study was conducted advocates
Cesarean by choice only if the patient has more than 39 completed weeks, is well
targeted and signing a consent form. Whereas the choice of the type of delivery
woman concerns the autonomy of your own body, to have a well established
protocol is crucial to have good results and not increase belated prematurity
rates. Further studies with a larger number of cases and include objective and
subjective evaluation of pre and postpartum women are needed.
P56
FETAL CYSTIC ADENOMATOID MALFORMATION OF THE LUNG: A CASE
REPORT
A. Castro 1, J. Lisboa 1,*, P. Alves 1, C. Carnide 1, O. Moutinho 1
CHTMAD, Vila Real, Portugal
Problem Statement: Congenital cystic adenomatoid malformation (CCAM) of the
lung is a rare anomaly of fetal development of terminal respiratory structures.
CCAM has a variable natural history that may result in hydrops in up to 40% or
regress in up to 15%.
Methods: We present a case of CCAM of the lung.
Results: Our patient was a 33 years-old pregnant woman, primigravida. Second
trimester ultrasonographic examination showed bilateral hyperechogenic
intrathoracal structures, occupying the middle and lower lung lobes of the right
hemithorax, measuring the largest cystic image 16,8x10,7mm. These
sonographic findings were compatible with type 2 CCAM. Fetal MRI confirmed
the initial diagnosis. Throughout pregnancy, the serial scans excluded the
presence of hydrops, polyhydramnios and other anomalies. . There was
regression of the CCAM and there was a decrease in the cyst larger. Delivery
occurred at 39 weeks of gestation without complications. Computed
tomography of the chest confirmed postnatal diagnosis of type 2 CCAM. Until
the 41st day of life, the child has no respiratory problems.
Conclusion: The importance of prenatal diagnosis of cystic intrathoracic
malformations is that these are responsible, at birth, by severe respiratory
failure and heart failure. However, as happened in this case presented, in 15%
of cases CCAM regresses and prognosis is better. The identification and
appropriate follow-up of these anomalies become essential for programming
specialized neonatal care
adverse pregnancy outcomes such as recurrent pregnancy loss, gestational

hypertension, fetal distress; and abnormalities in fetal growth and development
Methods: We report a case of a 31-year-old gravida 1 para 0 who presented at
34 weeks age of gestation with facial spasm and preterm labor. Work-up for
possible causes of facial spasm was done including serum electrolytes, which
revealed hypokalemia. Initial management include supplementation with
potassium chloride durules. There was persistent hypokalemia prompting
referral to a nephrologist. Work-up for persistent hypokalemia included random
urine potassium, random urine osmolality, arterial blood gas, serum
electrolytes, serum anion gap and urinalysis.
Results: Arterial blood gas and serum anion gap showed a normal anion gap
acidosis, which is a characteristic of RTA. Serum electrolytes showed a low level
of bicarbonate and high level of chloride. The combination of depressed serum
bicarbonate, hyperchloremia, acidemia, and a normal serum anion gap indicates
that the patient has hyperchloremic non-gap metabolic acidosis. Urinalysis
showed a high urine pH despite an abnormally low serum pH, relating to
impairment of urinary acidification, which confirmed the diagnosis of distal RTA.
Hypokalemia was corrected not just by potassium supplementation but also by
addressing the underlying acidosis.
Conclusion: Persistent hypokalemia in pregnancy despite adequate medical
management should prompt further search for possible etiologies. Possible
adverse maternal and fetal effects may be inevitable if accurate diagnosis is not
made.
P58
SONOGRAPHIC FINDING OF A CAUDAL APPENDAGE IN A SECOND TRIMESTER
GESTATION
N. F. B. B. Maciel 1,*, C. Frias 1, J. L. Borges 1, A. Sampaio 1, P. Melo 1, C. Ponte 1
Gynecology and Obstetrics, HOSPITAL DO DIVINO ESPRITO SANTO, Ponta
Delgada, Portugal
Problem Statement: The human tail has been categorized in true vestigial tail
and pseudotail, which include other forms of caudal appendages. The first one
contains adipose and connective tissue, striated muscle, blood vessels, and
nerves and is covered by skin. Bone, cartilages, notochord, and spinal cord are
not present. The pseudotail is composed of other tissues such as lipoma,
teratoma ou myelomeningocele. True tails are often associated with spinal
dysraphism such as spina bifida occulta.
Methods: Description of a clinical case.
Results: A 22-year-old Gravida I Para 0 woman was referred at 21week and 3
days gestation for second trimester sonogram. The patient was obese and
epileptic, treated with carbamazepine 200mg id. First trimester combined
screening was negative and there were no family records of malformations.
The authors report the finding of a 15mm caudal appendage in the lumbosacral
region with apparently no other associated malformations. The patient was sent
to a tertiary referral hospital for advanced diagnosis and is now waiting for fetal
MRI.
Image / Graph:
P57
RENAL TUBULAR ACIDOSIS IN PREGNANCY PRESENTING AS FACIAL SPASM: A
CASE REPORT
J. C. M. Macalintal,*, E. Tan
Obstetrics and Gynecology, St. Luke's Medical Center, Quezon City, Philippines
Problem Statement: Renal tubular acidosis (RTA) is rarely encountered in
pregnancy, and when it does, it is expected to be worse than in the general
population. Undiagnosed cases of maternal systemic acidosis have multiple
88
Conclusion: By 2013 there were over 30 cases of caudal appendages diagnosed

by sonography and this report provides some good images, which could help in
the study of this phenomenon. Such rare anatomic lesions can be seen in
isolation or with associated spinal abnormalities, additional congenital
anomalies or underlying genetic disease. For this reason fetal MRI is warranted
Abstract Book
for evaluation of associated anomalies and the position of spinal cord conus to
help guide counseling and prognosis.
P59
CELL-DERIVED MICROPARTICLES IN PREGNANT PATIENTS WITH
ANTIPHOSPHOLIPID SYNDROME: RELATIONSHIP WITH PREGNANCY
OUTCOME AND THROMBOSIS
M.-. Martnez-Zamora 1,*, D. Tssies 2, J. Munrs 1, J. C. Reverter 2,
G. Espinosa3, R. Cervera 3, F. Carmona 1, J. Balasch 1
1Institut Clnic of Gynecology, Obstetrics and Neonatology, 2Department of
Hemotherapy and Hemostasis, 3Department of autoimmune diseases, Hospital
Clnic of Barcelona., Barcelona, Spain
Problem Statement: Circulating microparticles (MP) are small membrane-coated
vesibles with a diameter of 0.1-1m delivered upon activation or apoptosis by
exocytic budding, by different cells. The most abundant originate from platelets,
but also from other cell types such as endothelial cells, leukocytes and red blood
cells. MP induce cell signaling that drives processes such as apoptosis, invasion,
and angiogenesis. Morevoer, exposure of new negatively charged phospholipids
in the outer membrane leaflet could easily explain the role of MP in the onset of
inflammation, thrombosis, and vascular dysfunction. Therefore, MP may play a
role in thrombotic pregnancy complications.
The antiphospholipid syndrome (APS) is a common acquired prothrombotic
condition characterized by vascular thrombosis and pregnancy morbidity in
association with persistently positive circulating antiphospholipid antibodies
(aPL). The association of aPL with pregnancy complications has increased the
frequency with which APS is diagnosed and has generated substantial interest in
elucidating its pathophysiology. Recent investigations have suggested that MP
levels correlated with the presence of aPL and thrombotic events in nonpregnant patients. This study evaluated MPs in pregnant patients with APS in
relation to pregnancy outcome and thrombosis.
Methods: A total of 60 patients were prospectively recruited in the third
trimester of pregnancy. The study group consisted of 30 pregnant patients that
had been previously diagnosed with primary APS (Group 1). These patients were
managed as having high-risk pregnancies and treated with low-dose aspirin
alone or associated with low-molecular weight heparin. The control group
(Group 2) comprised the next consecutive pregnant patient having a normal
term pregnancy and delivery after each patient of Group 1 was recruited. Other
thrombophilias, except from APS in Group 1, were excluded in all patients.
Venous blood samples were obtained at 28-32 weeks of pregnancy, and MP
were measured by capture on immobilized annexin V, which is the momst
common marker used to detect and quantify MP.
Results: Patients in Group 1 had more previous abortions and fetal deaths
compared with Group 2. There were more cesarean sections and lower neonatal
weight in Group 1. Seven patients of Group 1 had poor obstetric outcome: there
were two gestacional thromboses (1 arterial and 1 venous) and five severe
preeclampsias. Groups 1 and 2 had similar levels of MP (MP levels in mean SD:
Group 1: 7.8 3.8; Group 2: 7.06 4.7; p=0.5). MP were significantly higher in
patients of Group 1 with obstetric complications (severe preeclampsia o
thrombosis) compared with patients of Group 1 without complications (MP
levels in mean SD: Group 1 with complications: 11.9 3.5; Group 1 without
complications: 7.33.9; p=0.009).
Conclusion: MP levels do not present statistical differences between pregnant
patients with or withour APS in the third trimester of pregnancy. There were
statistically significant higher levels of MP in patients with the APS who
presented with thrombotic obstetric complications (severe preeclampsia or
maternal thrombosis), sugggesting a role of MP in the pathogenesis of these
complications in APS pregnant patients. Acknowledgements: Work supported in
part by Grant FIS PI11/01560 and the Agncia de Gesti dAjuts Universitaris i de
Recerca- Generalitat de Catalunya (2009SGR1099).
P60
TRIPLET PREGNANCY: ARE DICHORIONIC TRIPLETS A HIGH RISK EVENT?
A. T. Marujo 1,*, L. Correia 1, A. Queiroz 2, M. Rosal Gonalves 3, I. Periquito 3,
T. Simes 1
1Fetomaternal Department, 2Prenatal Diagnosis Department, 3Pediatric
Department, Maternidade Dr. Alfredo da Costa, Lisboa, Portugal
Problem Statement: The policy of transferring no more than two embryos in
assisted reproduction techniques (ART) and more judicious use of fertilityenhancing drugs have contributed to the decline of the incidence of triplet
gestations over the last few decades.
The vast majority of triplets after ART are trichorionic; however, spontaneous
conceptions may lead to dichorionic triplets and there are few studies focused
on this last entity. The aim of this study was to analyze obstetric and perinatal
outcomes in triplet pregnancies according to chorionicity.
Methods: This study is a retrospective analysis of all triplet pregnancies
diagnosed in a tertiary center between 1994 and 2012, at Maternity Dr. Alfredo
da Costa CHLC, Lisbon, Portugal. A total of 91 triplet pregnancies were followed
and delivered at this institution during that period. For this study, we identified
triplet pregnancies by chorionicity. We excluded 6 cases of monochorionic
triplets and compared only dichorionic with trichorionic triplets. Chorionicity
was established by standard ultrasonographic criteria performed by level III
ultrasonographers, confirmed by careful examination of the delivered placenta
by experienced obstetricians, and double-checked by pathologic examination of
the placentas. We evaluated maternal characteristics (age, parity, pre-gravid
mass index, mode of conception) and analyzed obstetric (incidence of feto-fetal
transfusion syndrome , premature contractions , hypertensive disorders,
premature rupture of membranes , gestational age at birth, mode of delivery,
days of hospitalization) and perinatal outcomes (incidence preterm births, birth
weight, Apgar score, major malformations, neonatal morbidity and death and
days of hospitalization). We used SPSS version 13 (Chicago, IL) and True Epistat
Software (Math Archives, Round Rock, TX) for statistical analyses. P-values <0.05
were considered significant.
Results: From the 85 pregnancies included, 41 were dichorionic (48.2%) and 44
(51.8%) trichorionic. We found no statistically significant differences in maternal
age (324.6 versus 313.8, p=0.18). Nulliparity was lower in the dichorionic
group (68% versus 84%, OR: 0.4, CI: 0.1-1.3) and spontaneous conception was
higher (51% versus 20.5%, OR: 4.0; CI: 1.4-11.9). Maternal complications were
similar between the two groups and we found an incidence of feto-fetal
transfusion syndrome of 14.6%; half of these cases required laser ablation of the
placental anastomoses. The dichorionic group had a lower mean gestational age
at delivery (31 weeks3.5 versus 322.6, p=0.05) with 48.7% of deliveries 32
weeks versus 31.8% in the trichorionic triplets (OR: 2.0; CI: 0.8-5.4). Although no
differences in the mean birth weight of the triplets were observed (1456 g versus
1604g, p=0.62), dichorionic triplets presented a higher risk of early neonatal
death (11.4% versus 4.5%, OR: 2.5; CI: 0.9-7.6) and a twofold risk of perinatal
mortality (15.4 versus 6.8, OR: 2.5; CI: 1.1-6.3). Both groups presented a similar
mean number of days in neonatal intensive care (8.3 6.513.5, p=0.41).
Conclusion: In our sample, despite good survival rate obtained in dichorionic
triplets group (84.6%), we found that this group had worse outcomes when
compared to trichorionic triplets with respect to risk of very preterm birth and
perinatal death.
P61
DIDELPHYS UTERUS AND UNCOMPLICATED PREGNANCY: CASE REPORT
V. Mourinha 1,*, A. Rodrigues 1, R. Martins 1, G. Abreu dos Santos 2, O. Viseu 1
Obstetrics Department, 2Faro's Hospital, Faro, Portugal
Problem Statement: It is estimated that uterine malformations affect 1 to 10%
of women. However it's difficult to know a true prevalence once in most cases
the diagnosis is made during the study of infertility causes, repeated
miscarriages or complications in pregnancy. Uterus didelphys is characterized by
a duplication of the uterus and cervix. It may coexist with other genitourinary
malformations.
89
Methods: 30 years-old woman diagnosed with didelphys uterus associated with

a longitudinal vaginal septum and history of a single miscarriage. After 10
months without contraception she got pregnant with no need of fertility
treatments. The pregnancy proceeded without complications and she was
submitted to elective caesarean section at gestational age of 38 weeks and 2
days, with a fetus in breach presentation. The newborn was female with 2865g
and Apgar score 10/10.
Results:
Image / Graph:
patient. Some literature explained that increased risk of preterm labor and low
birth weight is associated with chronic intake of oral corticosteroid such as
prednisolone or prednisone. On August 13, 2013, the patient conceived a boy at
34 weeks of gestation. His weight is 2,370 grams and the height is 18.5 inch. The
patients methylprednisolone therapy is still continued. Any history of
hypertension, diabetes mellitus, heart anomalies, and lung anomalies, as
preterm labor risk factors were denied. Other risk factors such as smoking,
caffeine consumption, low nutrition status, and history of previous premature
birth were also denied.
Methods: Case report of a patient with borderline lepromatous Morbus Hansen
with reversal reaction and erythema nodosum leprosum while pregnant.
Results: It is impressive that the preterm labor and low birth weight of patient's
baby can be associated with the long-term use of methylprednisolone in
pregnancy, although the use of dapsone which can lead to anemia needs to be
considered as well.
Conclusion: Administration of corticosteroids for Morbus Hansen patient with
pregnancy may indirectly affect fetal development. Research on this topic is
recommended.
Conclusion: Despite studies that evaluate outcomes of pregnancy in 2nd and 3rd
trimester in women with uterine malformations are still limited, the results have
been consensual with respect to an increased risk of complications such as
preterm delivery, fetal growth restriction, and premature preterm rupture of
membranes, abnormalities of placentation or even stillbirth. In the specific case
of the didelphys uterus, the most frequent complication appears to be preterm
delivery. Studies are limited and should mainly serve to guide clinicians in the
surveillance of these patients, to alert for early diagnosis of complications and
to assist in counseling the parents on making decisions regarding their current
and future pregnancies. However, there are exceptions. Alerting the womem
doesn't necessarily mean to alarm them. Despite the increased risk, there are
cases of uncomplicated pregnancies and it is important to remember that many
women with uterine malformations enjoy normal pregnancies and deliveries
without ever being diagnosed.
P62
PRETERM LABOR AS SIDE EFFECT OF METHYLPREDNISOLONE TREATMENT IN
MORBUS HANSEN PATIENT WITH PREGNANCY
N. N. Afifa *, F. A. Trinanda, A. C. Prasetyo
Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Problem Statement: Morbus Hansen, or leprosy, is a chronic granulomatous
infection that mainly attacks the skin and peripheral nerves. It is caused by
Mycobacterium leprae. Leprosy on women has been a complex health problem
because of some physiological changes of women such as hormonal changes,
pregnancy, lactation, and so on. On January 31, 2013, a 26-year-old female was
admitted to Dermatovenerology Department of Cipto Mangunkusumo Hospital
for BTA examination. When admitted, patient was having her first pregnancy at
2 months. Patient was diagnosed with borderline lepromatous Morbus Hansen
with reversal reaction and erythema nodosum leprosum while pregnant.
Patients primary complaints were fever, red bump on upper and lower limbs,
sore, and rash on her face since a week after taking her second MDT MB (multidrug therapy multi-basilar).Physical examination of face, abdomen, proximal left
upper extremity, bilateral upper, and lower extremity dermatological status
showed erythematous plaque to hyperpigmentation, multiple discrete,
lenticular-placate sized, clear border and half-diffuse, warm, and hypestation.
Bilateral upper and lower extremity showed lenticular-numular sized
erythematous plaque. A dilatation of right ulnar nerve was also found. BTA
examination showed bacterial index of 10/6 and morphological index of 0%.
At first, the patient was prescribed 4 mg 1x6 pills of methylprednisolone per day
for two weeks before the dose was lowered. Every time the methylprednisolone
dose is lowered to 4 mg 1x4 pills per day, a new bump appears accompanied by
soreness, and methylprednisolone dose is then returned to normal.
Methylprednisolone is one of corticosteroid drugs which has certain effects on
90
P63
POSTPARTUM VAGINAL HEMATOMA AS A RISK FACTOR FOR MASSIVE BLOOD
LOSS
V. Novikova1, G. Penzhoyan1
Dept of Obstetrics, Gynecology and Perinatology Faculty of Postgraduate
Education, Kuban State Medical University, Krasnodar, Russian Federation
Problem Statement: The reason for this study was the analysis of eight clinical
cases of postpartum hematoma with acute massive hemorrhage 1850± 239, 58 ml (500-3000 ml), identified in hospitals in Krasnodar
territory for 2006-2009. In all cases a hematoma formed without damage the
integrity of the vaginal mucosa; all women had varicose veins of various
locations; all women performed labor pain relief by continuous epidural
analgesia.
Methods: In 2009 - 2011 at the territorial Perinatal Center of Krasnodar
territorial Hospital 2 surveyed 120 women (Group I) with varicose veins of the
lower extremities. The control group consisted of 100 women without varicose
disease. Average age 24, 2± 5, 12 years; weight 74, 03± 11, 25
kg. Gestational age with the onset of labor 38, 20± 12, 09 weeks. In 26
(21.7%) of the women ahead for the first birth, 40 (78.3%) repeated (in history
2-8 delivery). Births were conservative, spontaneous. 2 hours after birth
underwent ultrasound study of the vagina, perineum by perineal access to
scanner PHILLIPS HD-11.
Results: The women in Group I were identified visceral phenotypic markers of
connective tissue dysplasia (CTD): mitral valve prolapse in 38 (31.7%) women
(p<0.05), atrial septal defect in 4 (3%), joint hypermobility in 31 (25, 8%)
(p<0.05), elastosis skin in 56 (46.7%) (p <0.05). In Group I, threatening
miscarriage occurred in various stages of pregnancy in 120 (100%) (p<0.01)
women, and 25 (20.8%) women ultrasound revealed Cervical incompetence.
Preeclampsia complicated pregnancy in 63 (52.5%) women in Group I
(p<0.05). Chronic placental insufficiency in 75 (62.5%) (p<0.05) in Group I.
A significant excess frequency anomalies of labor in women of Group I: the
weakness of labor in 28 (23.3%) of women (p <0.05), rapid delivery in 18 (15%)
women (p <0.05). Rupture of the vaginal walls of varying degrees was found
in 35 (29%) women (p<0.05), I degree perineal rupture in 24 (20%) (p<0.05)
women. Occasion careful surgical hemostasis with revision seams when
translated into maternity ward, a dynamic evaluation of clinical symptoms of
possible formation of hematomas. However, ultrasonography 2 hours after
vaginal delivery hematoma was detected in 31 (25.8%) women, with only 10
(8%) had a damage of the integrity of the mucosa, in 21 (17%) damage of the
vaginal mucosa was not . In any case, a woman did not show the characteristic
for the formation of hematomas. Diameter hematoma on ultrasound was
10,1±3,6 cm (5 to 15 cm).
Conclusion: Revealed, hematoma of vagina up to 15 cm in greatest
diameter in the early postpartum period may be asymptomatic. Presents a risk
of massive blood loss in the transfering to the postnatal ward without timely
Abstract Book
diagnosis of postpartum vaginal bruising, perineum or defects of hemostasis in

the area of suturing episiotomy suturing or breaks the soft tissues of the birth
canal, especially when coagulopathy due to pre-eclampsia, abruptio placentae,
hereditary defects hemostasis and others. Availability asymptomatic
postpartum vaginal hematoma may cause underestimation of additional blood
loss in women with early postpartum hemorrhage. This risk increases with use
of anesthesia. Especially be aware that even with the full surgical hemostasis
possible relapse formation of hematomas, especially in women with
undifferentiated CTD. That's why is necessary in the early postpartum period
with a view to the prevention of acute massive hemorrhage perform
transperineal ultrasound access to avoid bruising the vagina.
P64
THE EFFECTS OF MATERNAL SERUM LIPID ON MATERNAL BLOOD PRESSURE
AND FETAL BIRTH WEIGHT: A PROSPECTIVE COHORT STUDY AT PRIMARY
MATERNAL CHILD HEALTH CENTER
Z. Nusee 1,*, H. Kah Seong 1, H. Ismail 1, S. Abdullah 1
Obstetrics & Gynaecology, International Islamic University Malaysia, Kuantan,
Malaysia
Problem Statement: Pre-eclampsia (PE), a pregnancy specific condition, can be
fatal if left untreated. The purpose of the present study was to assess the sociodemographic characteristic and the maternal risk factors for PE, especially, the
maternal fasting serum lipids (FSL) between trimesters. In addition, we also
aimed to find out whether there is any association between FSL and fetal birth.
Methods: Pregnant women in their first trimester were prospectively studied at
a primary maternal child health center (KKIA) in Jalan Gambut Kuantan, Pahang,
Malaysia. The study involved measuring fasting serum lipids (FSL), blood
pressure (BP), and urine albumin in every trimester. The data were analyzed
using (SPSS) version 17.0, and p values < 0.05 were considered statistically
significant.
Results: We found increase in triglyceride (TG), low density lipoprotein (LDL),
high density lipoprotein (HDL) and total cholesterol (TC) as the gestational age
increased. The mean of TC surged from 5 mmol/L in the first trimester to 7.4
mmol/L in the third trimester (p<0.05). A similar trend was also observed with
TG, LDL, and HDL. There were no significant changes in blood pressure and urine
albumin throughout the pregnancy. Serum lipid did not statistically influence the
birth weight (P > 0.05). Meanwhile, serum triglyceride level was doubled (4.5
mmol/L) in one patient who developed eclampsia at 25 weeks gestation.
Conclusion: Serum lipid increased in parallel to increase in gestational age;
however, it did not influence the maternal blood pressure and birth weight.
Further study with larger sample size is required to confirm the factors
associated with PE.
P65
SPANISH COST-EFFECTIVENESS ANALYSIS OF INCORPORATING THE SFLT1/PLGF RATIO TEST INTO STANDARD CLINICAL PRACTICE FOR DIAGNOSIS OF
PRE-ECLAMPSIA AND/OR HELLP SYNDROME
N. Piella 1,*, D. Allegranza 2, M. Hund 3, E. Bertranou 4
1Roche Professional Diagnostics, Roche Diagnostics, Sant Cugat, Spain, 2Clinical
Operations, 3Medical and Scientific Affairs, Roche Diagnostics International
Ltd., Rotkreuz, Switzerland, 4Health Economic Modelling Unit, HERON
Commercialization - A PAREXEL Company, London, United Kingdom
Problem Statement: Pre-eclampsia affects 2% of pregnancies in Spain and is the
main cause of maternal and perinatal morbidity and mortality; thus, preeclampsia is a leading concern in pregnancy care. Uncertainty in diagnosis of preeclampsia may lead to unnecessary hospitalisation of women who do not
develop pre-eclampsia; thus, early diagnosis of pre-eclampsia may save costs.
The sFlt-1/PlGF ratio test accurately rules-out the onset of preeclampsia/Hemolyis, Elevated Liver enzymes, and Low Platelet count (HELLP)
syndrome within 1 week (sFlt/PlGF ratio 38), and rules-in pre-eclampsia/HELLP
syndrome within 4 weeks in women with suspected pre-eclampsia. Early
prediction of pre-eclampsia onset may lead to cost savings by reducing
unnecessary hospitalisation. The study aim was to evaluate the costeffectiveness of the test in clinical practice in Spain.
Methods: A decision tree model was developed from a Spanish payer
perspective to estimate costs associated with diagnosis and management of
pregnant women from first presentation with clinical suspicion of pre-eclampsia
until delivery. Two levels of management were defined: intermediate-intensity
(daily control visits and weekly to fortnightly outpatient appointment with a
specialist) and high-intensity (hospital inpatient care). Cost-effectiveness was
evaluated by comparing expected costs between two scenarios. In the 'no test'
scenario, current diagnostic criteria in Spain informed management decisions
(according to SEGO [Spanish Society for Gynaecology and Obstetrics] guidelines)
and the proportion of women hospitalised prior to diagnosis was taken from
PROGNOSIS, a prospective, non-interventional, blinded study of 1050 women
with suspected pre-eclampsia. In the 'test' scenario the proportion of women
assigned to each level of management intensity was determined by the test
result indicative of the patient's risk of pre-eclampsia diagnosis. Test results,
incidence of pre-eclampsia, and length of hospitalisation were available from
PROGNOSIS. The analysis conservatively assumed that neither the introduction
of the test, nor changes in management affected the incidence and severity of
pre-eclampsia. A proportion of women developing pre-eclampsia while not
hospitalised require emergency admission (EA), and/or neonatal ICU (nICU) stay
for the new-born. These costs were included in the analysis.
Results: The model predicts that introducing the test into clinical practice will
reduce the number of women hospitalised prior to pre-eclampsia by 50% from
368 to 183, in a cohort of 1050, leading to a cost saving of 228 per patient. The
model predicts that in the 'test' scenario, 37.1% of women hospitalised prior to
diagnosis will develop pre-eclampsia, compared with 26.9% in the 'no test'
scenario, indicating more targeted decision-making when the test is used. As
fewer women are hospitalised, there may be an additional 3 EAs and 1 nICU
admission.
Conclusion: Pre-eclampsia is a severe complication of pregnancy in Spain and
there is a need for improved diagnostic techniques to optimise management of
pre-eclampsia. The sFlt-1/PlGF ratio test enables more accurate identification of
patients most likely to develop pre-eclampsia, thereby reducing unnecessary
hospitalisation. As such, introduction of the test into clinical practice in Spain has
the potential to generate substantial cost savings, with a small increase in EAs
and nICU admissions.
Disclosure of Interest: N. Piella Employee of: Roche Diagnostics, D. Allegranza Employee of:
Roche Diagnostics Ltd., M. Hund Employee of: Roche Diagnostics Ltd., E. Bertranou
Consultant for: HERON Commercialization - A PAREXEL Company
P66
CERVICAL AND VAGINAL FLUID IL-6 AND IL-8 LEVELS IN PREGNANCIES
COMPLICATED BY PRETERM PRELABOR RUPTURE OF MEMBRANES
M. Kacerovsky 1, B. Jacobsson 2, M. Prochazka 3,*, P. Janku 4, C. Andrys 5
1Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine
Hradec Kralove, , Hradec Kralove, Czech Republic, 2Obstetrics and Gynecology,
Sahlgrenska University Hospital, Gothenburg, Sweden, 3Obstetrics and
Gynecology, Medical Faculty of Palack University, Olomouc, 4Obstetrics and
Gynecology, University Hospital and Masaryk University, Brno, Brno,
5Department of Clinical Immunology and Allergy, Charles University in Prague,
Faculty of Medicine Hradec Kralove,, Hradec Kralove, Czech Republic
Problem Statement: To determine the vaginal and cervical fluid interleukin (IL)6 and IL-8 concentrations in pregnancies complicated by preterm prelabor
rupture of membranes and their correlation to microbial invasion of the
amniotic cavity (MIAC) as well as histological chorioamnionitis (HCA)
Methods: Sixty-eight women with singleton pregnancies were included in this
study. Vaginal and cervical fluid was collected at the time of admission. IL-6 and
IL-8 concentrations in the vaginal fluid were determined using ELISA.
Results: Women with MIAC had higher vaginal fluid IL-6 levels compared to those
without MIAC (with MIAC: median 374 pg/mL vs. without MIAC: median 174
pg/mL; p = 0.03). IL-8 levels were higher in women with MIAC only in the crude
analysis but not after adjustment for gestational age. There was no difference
in the IL-6 and IL-8 concentrations between those with and without HCA.
Women with both MIAC and HCA had higher IL-6 vaginal fluid levels than those
91
without both MIAC and HCA (with MIAC and HCA: median 466 pg/mL vs. without
MIAC and HCA: median 178 pg/mL; p = 0.02). IL-8 levels were higher in women
with MIAC and HCA only in the crude analysis but not after adjustment for
gestational age. The women with MIAC had higher cervical fluid IL-6 and IL-8
levels than did the women without MIAC (IL-6: p=0.01; IL-8: p=0.003). There was
no difference in the cervical fluid IL-6 levels between women with and without
HCA (p=0.37). The women with HCA had higher IL-8 levels only in the crude
analysis (p=0.01) but not after adjustment for gestational age (p=0.06). The
women with both MIAC and HCA had higher cervical fluid levels of IL-6 and IL-8
than did the other women (IL-6: p=0.003; IL-8: p=0.001). The cervical fluid IL-8
level of 2653 pg/mL was found to be the best cutoff point in the identification of
PPROM pregnancies complicated by both MIAC and HCA with a likelihood ratio
of 24.
Conclusion: The presence of MIAC is the most important factor impacting the
local cervical inflammatory response, which is determined by IL-6 and IL-8 levels
in the cervical fluid. The cervical fluid IL-8 levels seem to be a promising noninvasive marker for the prediction of pregnancies complicated by the presence
of both MIAC and HCA.Vaginal fluid IL-6 but not IL-8 levels reflect the presence
of MIAC and both MIAC and HCA.
Supported by the grant of Min.of Health of the Czech Republic NT 14104-3/2013
P67
THE ROLE OF SCREENING TESTS DURING PREGNANCY AND NEONATAL
OUTCOME
A. Rasekh Jahromi 1,*, N. Davari 1, M. A. Nasseri Jahromi 2, N. pad 3,
S. pourshojaee 1, S. sobhanian 4, L. kalavani 3, F. gorgin 5
1dr rasekh clinic, Jahrom University of Medical Science , Jahrom, 2economic,
shiraz Azad university, shiraz, 3OB&GYN, 4nursery , Jahrom University of
Medical Science , 5physiology, Jahrom Azad university , Jahrom, Iran
Problem Statement: Nuchal translucency (NT) thickness is one of the major
screening markers during the first trimester that could be influenced by several
factors. A number of maternal serum markers have proven useful in screening
for Down syndrome and other chromosomal abnormality. Quad screening
performs better than triple screening with both lower false positive rates and
higher detection rates. They can be performed between 15 and 21 weeks. The
quad test is a better method of screening for Down's syndrome than use of
maternal age alone and is more effective than other screening tests.
Measurements of nuchal translucency (NT) contribute to improve screening
performance. Amniocentesis is the most extensively used fetal sampling
technique for detecting chromosome abnormality. The goal of first -trimester
prenatal screening is to provide risk information early in pregnancy, thereby
allowing for additional diagnostic testing and optimal pregnancy management
or early termination. The aim of this research is detection of association
between NT, Quad marker screening test, amniocentesis and neonatal outcome.
Methods: This clinical study was performed on 106 pregnant women that
referred to Dr.Rasekhs clinic during 12 months. Fetal nuchal translucency
measurements were performed on consecutive mothers attending the prenatal
diagnosis in 11-14 gestational weeks by ultrasonography. Then Quad screening
tests were performed at 15-18 weeks of gestational period.
Results: mean of nuchal translucency: 1.7 (max: 2.1 min: 1.4). The frequency of
the negative screening test for Down syndrome was 88.7% (94) and positive test
was 11.3 %( 12).In group with positive screening test, 25 %( 24 from 94 patients)
of them accomplished amniocentesis. All of them were reported normal and
without cytogenetic abnormalities and in follow up, all of their neonates were
normal. 8.3 %( from12pts (11.3%) of women with positive screening test, their
fetus were dead.Those who were not willing to amniocentesis were followed up
by ultrasononography and at last with mean of apgar scores 9, completely
normal neonate were born. In evaluation of relationship between positive quad
screening test and birth of neonate with Down syndrome, there was not virtual
association (p.value: 0.06), but with attention to different age group, the lowest
percent of the positive screening test was found in 19-25 years group(3%) and
highest percent of them in 35-40 years group(71.4%). Though in our study, the
most population of pregnant women were 25-35 years. The relation between
92
high maternal age and positive quad screening test is considerable (p.value:
0.005).
Conclusion: In our study, significant association between positive quad screening
test and birth of neonates with Down syndrome and was not seen.But there is
relationship between NT and amniocentesis and neonatal outcome. When NT is
normal range, amniocentesis is negative. Therefore, NT is important factor in
evaluating of the fetus. Factors which contribute in the false positive Quad
screening test should be considered in laboratory and to minimize that the
pregnant women are not undergone invasive and expensive procedures. In our
study, positive quad test was seen in pregnant women > 35 years significantly.
So by encourage the women to pregnancy at appropriate age and perform
required tests, the birth of Down syndrome and other chromosomal abnormality
will be decreased more and more.
P68
DIAGNOSTIC AMNIOCENTESIS - RESULTS AND COMPLICATIONS
L. M. Reis 1,*, M. Miranda 2, S. Nascimento 2, D. Bruno 2, C. Paixo 3
1Obstetricia, 2Obstetrica, Hospital Professor Doutor Fernando Fonseca EPE,
Amadora, 3Obstetrcia/Ginecologia, Centro Hospitalar do Barlavento Algarvio
EPE, Portimo, Portugal
Problem Statement: Amniocentesis is an invasive technique for withdrawing
amniotic fluid from the uterine cavity; the fluid can then be used for various
laboratory studies, including prenatal genetic studies. It is an invasive procedure
and, as such, there are risks. The major complications are rupture of membranes,
fetal injury, infection and fetal loss, the latter being the most feared by couples.
It is one of the most common used procedures for prenatal diagnosis, but a
precise assessment of the risks is difficult, because the rate of complications is
affected by several factors, and the true risk of fetal loss associated with the
procedure is still uncertain.
Our goal was to analise the diagnostic amniocentesis performed at the Prenatal
Diagnosis Department of Hospital Professor Doutor Fernando Fonseca (HFF),
and evaluate the results and complications of the procedure.
Methods: We conducted a retrospective observacional study of the diagnostic
amniocentesis performed at the HFF Prenatal Diagnosis Department in 2013,
using the information contained in the clinical files. Data analysis was performed
using Numbers 3.2 (Apple Inc., EUA).
Results: In 2013, 305 diagnostic amniocentesis were performed at our Prenatal
Diagnosis Department; 301 were single pregnancies and five were twin
pregnancies (three of them bichorionic); all procedures were performed under
ultrasound guidance. The average maternal age was 35.9 years. The most
common indications were: maternal age (65.9%), positive first trimester
screening (15.7%) and ultrasound with morphologic anomalies (11.1%). The
procedures were performed at a median gestational age of 16 weeks of
gestation; there were no amniocentesis performed before 15 weeks or after 32
weeks of gestation. There were two complications- one vaginal bleeding and one
fetal loss. The karyotype was normal in 289 cases; of the abnormal results (14),
there were seven cases of aneuploidy, of which three were Down syndrome and
two trisomy 18; in one case no karyotypo was obtained due to cell culture failure
and in other case the karyotype is unknown due to absent information in the
clinical file.
Conclusion: In 2013, at the HFF Prenatal Diagnosis Department unit, 305
diagnostic amniocentesis were performed. In 4.6% of cases there was an
abnormal karyotype, with a prevalence of aneuploidy of 2.3% (approximately 1%
of Down syndrome). The procedure-related fetal loss was 0.3%, which is in
accordance with the information cited by the American College of Obstetricians
and Gynecologists. Diagnostic amniocentesis is a safe procedure if performed by
trained professionals, but more studies are needed to asses the true rate of
complications.
Abstract Book
P69
PRE-PREGNANCY BODY MASS INDEX AND GESTATIONAL WEIGHT GAIN ROLE
ON BLOOD GLUCOSE AND BLOOD PRESSURE LEVELS DURING PREGNANCY
M. Romano 1,*, E. Lacaria 1, M. Rossi 1, M. Aragona 1, L. Battini 2, M. Corfini 1,
S. Del Prato 1, A. Bertolotto 1
1Department of Endocrinology and Metabolism, 2Department of Obstetrics and
Gynecology 2, University Hospital, Pisa, Italy
Problem Statement: The Institute of Medicine (IOM) defines guidelines for
gestational weight gain (GWG) based on Pre-pregnancy body mass index (PPBMI), in order to prevent maternal (hypertensive disorders, gestational diabetes
mellitus (GDM), non-elective cesarean delivery, post-partum weight retention
and obesity) and neonatal (large for gestational age and macrosomic infants,
obesity in offspring) adverse outcome. This study was undertaken to evaluate to
which extent the IOMs guidelines on GWG are followed and to determine the
effect of GWG on glucose values during the oral glucose tolerance test (OGTT)
screening for GDM and blood pressure (BP) values in pregnant women.
Methods: A total of 230 Caucasian pregnant women referred to Pisa University
Hospital, in Tuscany, underwent a 2 hr 75 g OGTT between the 24th-28th week of
gestation (WoG). Clinical, anthropometric, and laboratory data were recorded
on the screening test day by direct measurement, while PP-BMI was provided by
each woman. Based on PP-BMI the study population was sub-divided in normalweight (NW, n=78, 21,11,9 kg/m2), over-weight (OW, n=78, 26,91,2 kg/m2)
and obese (OB, n=74, 33,83,6 kg/m2 ). Weight gain was recorded again at
delivery. Statistical analysis was performed on StatView program using Anova,
LSD Fisher's test and Fisher exact test.
Results: The 3 groups were comparable for age (35,24,5 years), WoG (26,51,72
week), family history of type 2 diabetes (24,8%) and previous macrosomia
(3,5%). The percentage of women with previous GDM was significantly higher
(p=.0114) in OB women (9,5%) respect to NW an OW (both 1.3%). The OW and
OB women had an excessive GWG at delivery (+13,55,5 and +10,36,2 Kg,
respectively), particularly until the 24th-28th WoG (OW +8,55 Kg, OB +5,64,4
Kg) while NW women reached the target values (+8,52,7 kg at 24th-28th WoG,
+14,23,2 kg at delivery). At the OGTT screening OW and OB women had fasting
plasma glucose (FPG) and 1-hour glucose (1hG) significantly higher than NW
(FPG: OB 86,39 mg/dl, OW 85,78,7 mg/dl, NW 82,97,3 mg/dl; OB vs NW
p=.0212; OW vs NW p=.0497; 1hG: OB 14531 mg/dl, OW 141,930,7 mg/dl, NW
125,731,2; OB vs NW p=.0003, OW vs NW p=.0018), OB women had also 2-hG
values significantly higher than NW (OB 116,924,4 mg/dl, NW 10625 mg/dl;
p=.0072). The percentage of GDM was double in OB when compared to NW
(35,14 vs 17,95%) and greater than in OW (24,5%). Systolic (S) and diastolic (D)
BP values were significantly different between NW and OW (S 108,611,2 vs
115,613,8 mmHg p=.0011, D 66,87,8 vs 70,78,4 mmHg p=.0046), NW and OB
(S 108,611,2 vs 120,513,9 mmHg p<.0001, D 66,87,8 vs 74,69,4 mmHg
p<.0001), OW and OB (S 115,613,8 vs 120,513,9 mmHg p=.020, D 70,78,4 vs
74,69,4 mmHg p=.0051).
Conclusion: Our data demonstrates that the IOMs guidelines are no longer
being followed satisfactorily. OB an OW women had excessive GWG, glucose and
BP values significantly higher than NW women, and a greater prevalence of
GDM. It would be useful to have an effective pre-gestational counselling
program, and a strict GWG control during pregnancy, particularly during the 1st
and 2nd trimester to reduce the risk of developing metabolic diseases during
pregnancy and later in the life.
P70
ETHNICITIES AND POSTPARTUM MATERNAL REHOSPITALIZATION
C. M. Santiago 1,*, A. Hamaoui 1, A. Chadee 1, R. Mercado 1
Ob/Gyn, Lincoln Medical and Mental Health Center, Bronx, USA
Problem Statement: With the increasing number of cesarean deliveries
performed over the recent years, there has been a rise in maternal morbidity
and mortality. There have been few studies which evaluate complication rates
across ethnic groups. This study assesses the rates of maternal readmission, an
indicator of associated complications in the index admission, among women of
African and of Hispanic descent during the postpartum period.
Methods: The study reviewed the electronic medical records of all postpartum
women readmitted within 60 days of delivery over a five year period from 20072011. The dataset was collected from 11,333 deliveries, 66.89% of which were
of Hispanic and 26.67% of which were of African descent.
Results: Rehospitalization rates after vaginal deliveries for both groups were low,
0.44% for women of African descent and 0.60% for Hispanic women, and not
significantly different from each other. However, the patients who underwent
cesarean delivery had four times (1.95% vs. 0.52%, P <0.0001) (OR 3.80 95% CI
2.57 to 5.62 P<0.0001) the readmission rates when compared to patients who
had vaginal deliveries. This was similar to both ethnicities. Collectively, the
average time from delivery to rehospitalization was 12.16 8.89 days after
vaginal delivery and 15.36 10.73 days after a cesarean, with no differences in
these rates among the ethnic groups. On the other hand, considered separately,
the rate of readmission was twice as high in women of the African descent as
compared to women of Hispanic heritage (OR 2.30, 95% CI 1.42 to 3.74, P
0.0007). And when admitted, women of African descent tended to stay longer
(3.43% vs 1.52%, P 0.0009).
For both ethnicities (being similar the data were combined), the most common
causes of rehospitalization were: infection (75.23%), hypertensive disorders of
pregnancy (12.84%), and late postpartum hemorrhage (7.34%).
Conclusion: Cesarean delivery is associated with higher rates of maternal
morbidity for both groups; however, the more so among women of African
descent. The majority of postpartum readmissions occurred within the first two
weeks of discharge. Infections were a major challenge to both ethnicities,
postoperative wound infections following cesarean delivery, and endometritis
following vaginal deliveries. Notably paucity in readmissions for hypertensive
disorders of pregnancy and postpartum hemorrhage was found. Prevention of
maternal infections continues to be an important priority.
P71
IS IMPEDANCE CARDIOGRAPHY AN EFFICIENT METHOD TO EVALUATE
PREGNANT PATIENTS WITH MULTIPLE CARDIOVASCULAR RISKS? - CASE
REPORT
R.-M. Sima 1,*, I.-A. Badarau 2, C. Ciornei 2, R. Papacocea 2, C. Moisei 1, L. Ples 1
1Obstetrics-Gynecology, "Bucur" Maternity, 2Physiology, University of Medicine
and Pharmacy "Carol Davila", Bucharest, Romania
Problem Statement: Preeclampsia, gestational diabetes, or pregnancy-induced
hypertension identify a woman at risk for cardiovascular disease. Diabetic
women carry a 2-4 times increased risk of a hypertensive pregnancy compared
to non-diabetic people. Impedance cardiography (ICG) is a noninvasive
technology that can be used to assess cardiovascular function.
Methods: We present the case of 34 years old, obese and smoker, patient
investigated in our clinic and developed gestational diabetes in the third
trimester of pregnancy. She had normal blood pressure Patient underwent a
complete assessment including screening history, physical examination, blood
glucose level, blood pressure and body weight measurements, ultrasound and
impedance cardiography examination. All the results were compared with
similar findings of a smoker patient in the third trimester of pregnancy, non
obese, with normal blood pressure and without gestational diabetes.
Results: Here we report the hemodynamic parameters that we measured using
impedance cardiography in a diabetic, obese, normotensive third trimester
pregnant patient compared with a non diabetic, non obese, diabetic third
trimester pregnant patient. Using ICG we performed measurements in supine
position. Our findings were: diabetic patient has increased heart rate. Base
impedance was also elevated in this patient, but with no statistical significance.
Cardiac index was increased in the diabetic patient. Systemic vascular resistance
registered lower values for the diabetic patient.
The diabetic patient had a good outcome of pregnancy.
Conclusion: Impedance cardiography is a noninvasive method which provided us
the hemodynamic profile in a case of obesity and diabetes during pregnancy,
without associated gestational hypertension.
93
P72
DOPPLER PARAMETERS IN FETAL HYPOXIA-PERINATAL ASPHYXIA
T. Stefos
Ob-Gyn, University of Ioannina, Ioannina, Greece
Problem Statement: Fetal hypoxia-perinatal asphyxia is a complex phenomenon
and a complicated situation.It is very difficult to be given a precious definition
for these two conditions.Preeclampsia and gestational diabetes are two
conditions which could cause fetal hypoxia.Do we have methods to predict or to
detect the fetal hypoxia?
Methods: A variety of criteria has been used to characterize the fetal hypoxia
and perinatal asphyxia. Biochemical indices, acidosis, fetal monitoring methods,
Apgar score, neurologic signs or multiple organ dysfunctions are some of the
conditions which characterize the asphyxia in general. It is known that oxygen is
transfered across the placenta and it has a reversible binding to
fetal hemoglobin, in order to be achieved the growth and metabolism of the
fetus. Fetal hypoxia means oxygen deficiency in the tissues. It happens because
of reduced placental perfusion or reduced arterial blood oxygenation or
reduced blood flow to the fetal tissues, especially in cases of microangeiopathy
as pre-eclampsia or gestational diabetes are some of them.
Results: In such cases the fetus reacts with a brain-sparing phenomenon,
increasing the flow to the brain, heart, adrenals and decreasing the flow to the
fetal body, gut, and kidneys. It is observed an increased impedance to flow in
the uterine and umbilical arteries. So an increased resistance index and a
presence of an early diastolic notch are the characteristics in the
Doppler study of the uterine arteries. An increased resistance, absent end
diastolic flow or reversed end diastolic flow are the manifestations of
fetal impairment. The overall perinatal mortality is increased four times in cases
with absent end-diastolic flow and 10-11 times in cases with reversed flow. It
is also known that low cerebroplacental ratio increases fetal motrality.
The presence of enddiastolic pulsation in umbilical vein is a sign of acidemia
as also a reduction in umbilical venous flow with normal peak velocity in
ductus venosus is a significant manifestation of fetal hypoxemia.
Conclusion: In summary hypoxia is a severe stress for the fetus .The fetus reacts
with redistribution of the blood flow to the brain. So high resistance in
umbilical artery and simultaneously low flow restistance in middle cerebral
artery suggests fetal hypoxia.
P73
UK COST-EFFECTIVENESS ANALYSIS OF INCORPORATING THE SFLT-1/PLGF
RATIO TEST INTO STANDARD CLINICAL PRACTICE FOR DIAGNOSIS OF PREECLAMPSIA AND/OR HELLP SYNDROME
T. Strunz-McKendry 1,*, D. Allegranza 2, M. Hund 3, J. Posnett 4
1Health Economics, Roche Diagnostics Ltd., Burgess Hill, UK, 2Clinical
Operations, 3Medical and Scientific Affairs, Roche Diagnostics International
Ltd., Rotkreuz, Switzerland, 4Health Economic Modelling Unit, HERON
Commercialization - A PAREXEL Company, London, UK
Problem Statement: Hypertensive disorders, such as pre-eclampsia, affect
approximately 10% of pregnancies in the UK, resulting in substantial maternal
and perinatal mortality and morbidity. NICE guidelines recommend hospital
admission for women diagnosed with pre-eclampsia, but not for women with
mild/moderate gestational hypertension only. Uncertainty in diagnosis of preeclampsia may lead to unnecessary hospitalisation of women who do not
develop pre-eclampsia, and early prediction of pre-eclampsia onset may
therefore save costs. The sFlt-1/PlGF ratio test accurately rules-out the onset of
pre-eclampsia/Hemolysis, Elevated Liver enzymes, and Low Platelet count
(HELLP) syndrome within 1 week (sFlt-1/PlGF ratio 38), and rules-in preeclampsia/HELLP syndrome within 4 weeks. The study aim was to evaluate the
cost-effectiveness of the test in clinical practice in the UK.
Methods: A decision tree model was developed from a UK NHS payer
perspective to estimate costs associated with the diagnosis and management of
pregnant women from first presentation with clinical suspicion of pre-eclampsia
until delivery. Three levels of management intensity were defined: low (midwifeled, average weekly outpatient clinic appointment), intermediate (midwife-led,
94
average twice-weekly outpatient clinic appointment), and high (specialist-led,

hospitalisation). Cost-effectiveness was evaluated by comparing expected costs
between two scenarios. In the 'no test' scenario, current diagnostic criteria
informed management decisions, and the proportion of women hospitalised
prior to diagnosis was taken from PROGNOSIS, a prospective, noninterventional, blinded study of 1050 women with suspected pre-eclampsia. In
the 'test' scenario the proportions of women assigned to each level of
management intensity was determined by the test result indicative of the
patient's risk of pre-eclampsia diagnosis. Test results, incidence of preeclampsia, and length of hospitalisation were available from prognosis. The
analysis conservatively assumed that neither the introduction of the test, nor
changes in management affected the incidence and severity of pre-eclampsia. A
proportion of women developing pre-eclampsia while not hospitalised require
emergency admission (EA), and/or neonatal ICU (nICU) stay for the new-born.
These costs were included in the analysis.
Results: The model predicts that introducing the test into clinical practice will
reduce the number of women hospitalised prior to pre-eclampsia diagnosis by
50% from 379 to 188, in a cohort of 1050, leading to a cost saving of 399 per
patient. The model predicts that in the 'test' scenario, 41% of women
hospitalised prior to diagnosis will develop pre-eclampsia, compared with 26%
in the 'no test' scenario, indicating more targeted decision-making when the test
is used. As fewer women are hospitalised, there may be an additional 5-6 EAs
and 1-2 nICU admissions in the 'test' scenario.
Conclusion: The majority of women hospitalised with a suspicion of preeclampsia in the UK will not develop pre-eclampsia, indicating a need for
improved assessment of risk. The sFlt-1/PlGF ratio test enables more accurate
identification of patients most likely to develop pre-eclampsia, thereby reducing
unnecessary hospitalisation. As such, introduction of the test into UK clinical
practice has the potential to generate substantial cost savings, with a small
increase in EAs and nICU admissions.
Disclosure of Interest: T. Strunz-McKendry Employee of: Roche Diagnostics Ltd., D.
Allegranza Employee of: Roche Diagnostics Ltd., M. Hund Employee of: Roche Diagnostics
Ltd., J. Posnett Consultant for: HERON Commercialization - A PAREXEL Company
P74
WOMEN'S EXPERIENCE OF CERVICAL RIPENING BALLOON FOR INDUCTION OF
LABOUR
T. L. Tan 1,*, G. Y. H. Ng 1, S. E.-L. Lim 1, S. Tagore 1, G. S. H. Yeo 1
KK Women's and Children's Hospital, Singapore
Problem Statement: The Cochrane Database of Systematic Reviews concluded
that mechanical methods of induction of labour (IOL) were as effective as
prostaglandins (PGE) in achieving delivery with no change in caesarean section
or infection rates. It also concluded that mechanical methods were less likely to
lead to excessive uterine contractions and discomfort. The cervical ripening
balloon (CRB) is licensed for IOL. Its acceptability by women however is not well
studied. We aim to assess the pain and satisfaction scores of women undergoing
IOL with either CRB or PGE.
Methods: Women aged 21 40 years old with singleton term pregnancy and no
major fetal anomaly suitable for vaginal delivery were recruited unless they were
in labour, had cervical dilatation 3cm, confirmed ruptured membrane,
abnormal CTG or scarred uterus. Participants were randomized to receiving CRB
or PGE. If the woman was randomized to receive CRB, the CRB was inserted in
lithotomy position with the use of a bivalve speculum. The CRB was filled with
Trainer
Trainee
CRB insertion at 1st attempt (31)
87.5%
Help sought (31)
Time to insert CRB, min (31)
3:38
2:16
Pain score at IOL, 1-10 (83)
2.9
Pain score after IOL, 1-10 (83)
4.6
Satisfaction score, 1-5 (83)

Would recommend (31)
(7)
91.3%
(21)
8.7%
(2)
5:34
2:27
1.000
*
0.059
2.0
3.2
1.2
0.623
2.7
4.5
2.3
0.881
3.75
1.5
3.3
1.6
0.491
87.5%
(7)
65.2%
(15)
0.379
*
Abstract Book
normal saline over a period until both balloons contain 80 mls of normal saline.
If the woman was to receive PGE, the PGE would be inserted in the posterior
fornix of the vagina and repeated as necessary. Cardiotocogram was performed
before and after the IOL. After 12 hours of IOL, the CRB is removed if inserted,
and artificial rupture of membrane (ARM) performed with the use of oxytocin
infusion as indicated to augment labour. The characteristics of the women, as
well as their pain and satisfaction scores were obtained by interviewing the
women at IOL and after delivery. Pain scores were rated on a scale of 1 (no pain)
to 10 (most painful), while satisfaction score was rated on a scale of 1 (poor) to
5 (good). The data is analysed with SPSS version 19.
Results: A total of 87 women were recruited. Three cases were excluded for
preterm delivery, cervical dilatation >3 cm, breech in labour. One case of CRB
withdrew because of pain. The remaining 83 women were analysed and their
characteristics are shown below.
CRB
Maternal age, years

(83)
Ethnicity (83)
29.0
PGE2
5.3
29.5
5.0
0.649
0.222
Chinese
35.5%
(11)
42.3%
(22)
Malay
54.8%
(17)
36.5%
(19)
Indian
3.2%
(1)
15.4%
(8)
Primip (83)
61.3%
(19)
44.2%
(23)
0.174
BMI, kg m-2 (83)
25.5
5.2
25.2
5.2
0.817
Gestational age, wks

(83)
Cervical
dilatation,cm(83)
39.4
1.1
39.2
1.2
0.357
1.0
0.7
0.9
0.7
0.855
There was no difference in the pain score at IOL between the CRB and PGE group
(3.1 1.4 vs 2.6 1.9, p = 0.181). However, pain score in the CRB group was
lower than the PGE group subsequently (4.5 2.3 vs 5.6 2.4, p = 0.044). Women
were equally satisfied with both methods (3.4 1.5 vs 3.2 1.4, p = 0.465) and
were equally likely to recommend the method for IOL (71.0% vs 69.2%, p =
1.000).
Conclusion: The experience of women undergoing IOL with CRB or PGE were
equally satisfactory although the perception of pain after IOL was lower in the
CRB group. Both methods of IOL are acceptable to women and should be made
available to offer women choice.
P75
LEARNING CURVE IN THE USE OF CERVICAL RIPENING BALLOON
T. L. Tan 1,*, G. Y. H. Ng 1, S. E.-L. Lim 1, S. Tagore 1, G. S. H. Yeo 1
KK Women's and Children's Hospital, Singapore, Singapore
Problem Statement: Compared to prostin (PGE), cervical ripening balloon (CRB)
is equally acceptable and efficacious in induction of labour (IOL).
CRB is reported to have lower risk of excessive uterine contractions and is a
useful alternative in women where prostagladins are contraindicated or caution.
Its use is however less prevalent and training clinician may require undue
resources. Our literature search did not reveal any published study on the ease
of training. The aim of this study is to analyse the learning curve in the use of
cervical ripening balloon.
Methods: Trainees were given a lecture followed by hands-on session on models
in the use of CRB by an experienced trainer. Posters showing step-by-step
instructions are available for reference. When opportunity arises, trainees
observe a live insertion of CRB before being supervised for their initial insertion
of CRB in women aged 21 40 years old with uncomplicated singleton term
pregnancy suitable for vaginal delivery and induction of labour. Comparison
between trainer and trainee insertions were analysed.
Results: A total of 31 CRB insertion were analysed. There were no difference in
maternal age, weight, BMI, ethnicity, primiparity and cervical dilatation in
women with CRB insertion by trainer or trainee. The gestational age in the 2
groups were also similar. The outcome of CRB insertions by the trainer and
trainees are shown in the table below. The time taken to insert CRB by the
trainer was shorter compared to that by the trainees who had 2 previous
insertion experience (3:38 2:16 vs 8:59 5:39, p = 0.048). Trainees who had 3
or more previous insertion experience however similar timings had and do not
require help. We therefore conclude that after 3 insertion experience,
competency can be achieved.
Conclusion: The use of CRB can be easily taught with competency achieved
rapidly after about 3 insertions. Training and availability in the use of CRB should
be available to offer maternal choice in their birth plans.
P76
ANTENATAL DIAGNOSIS OF CYSTIC MASSES IN THE FETAL LUNG: THE
NATURAL HISTORY AND OUTCOMES - A SINGLE INSTITUTION'S EXPERIENCE
S. Thain 1,*, E. Thia 2, G. Yeo 2
1KK Women's and Children's Hospital, Singapore, Singapore, 2Maternal Fetal
Medicine, KK Women's and Children's Hospital, Singapore, Singapore
Problem Statement: Congenital cystic adenomatoid malformation (CCAM) and
bronchopulmonary sequestration of the lung are the most common lung lesions
to be identified by fetal ultrasound imaging. This study aims to look at the natural
history and outcomes of these fetal cystic lung masses detected in our centre.
Methods: This study was a retrospective observational case review of cases of
fetal cystic lung masses of CCAM and bronchopulmonary sequestration
diagnosed antenatally in KK Womens and Childrens Hospital from September
2006 to February 2013 looking at the pregnancy, fetal and paediatric outcomes
and natural history of antenatally diagnosed fetal cystic lung masses based on
our institutions management protocol. A secondary objective was to assess if a
method if using the mass: chest ratio to monitor progression of the mass
antenatally would be useful in the prediction of outcomes.
Results: Fetal CCAM and bronchopulmonary sequestration masses typically
plateaued in size between 26 and 30 weeks gestation. Antenatal ultrasound
features of initial mass size and mass: chest ratio, as well as largest mass size and
mass: chest ratio were not significantly associated with respiratory morbidity at
birth. There was also no significant relationship between trend of lung mass size
over gestation and respiratory morbidity at birth (p=0.2093). Two of three
fetuses with prenatal ultrasonographic regression of the cystic lung lesion had
persistent cystic lung mass on postnatal CT chest imaging.
Conclusion: The natural history of fetal cystic lung lesions generally follows a
benign course with excellent antenatal, neonatal and paediatric outcomes. Lack
of correlation between antenatal involution of cystic lung lesions and postnatal
imaging was observed, highlighting the need for postnatal imaging.
P77
PARTIAL PLACENTAL INSERTION ON INTRA UTERINE ADHESION CASE
REPORT AND REVIEW OF THE LITERATURE.
A. Wafi 1,*, L. De Catte 2, A. Vorsselmans 1, L. Monika 1
Obstetrics, UZ Brussels, Brussel, 2Obstetrics, UZ Leuven, Leuven, Belgium
Problem Statement: Uterine adhesions complicate up to 0.6% of pregnancies.
The increase in incidence during the last decades is attributed to increasing
numbers of uterine surgery in the fertile population. Mostly uterine adhesions
are considered benign during pregnancy. Placental insertion on uterine
adhesions is even more exceptional. Only 41 cases are described in the
literature. The obstetrical risks in these patients are unclear. Increased numbers
of placental abruption, PPROM and cord prolapse are found.
We report an unusual case of a 28-year-old patient with a partial placental
insertion on an intra-uterine adhesion diagnosed on 2-D ultrasound at 20 weeks
gestation. Amniotic band was excluded through maternal Dopplers signals in
the adhesion. Part of the placenta was implanted on the uterine adhesion with
a velamentous insertion of the umbilical cord. Magnetic resonance imaging
confirmed the placental implantation over the horizontally oriented adhesion
with signs of tension over the adhesion too. There was no argument for umbilical
cord prolapse or placental invasion in the myometrium. The patient was
admitted for close fetal observation as from 30 weeks of pregnancy and
delivered at 34 weeks by primary C-section from a healthy baby. The placental
95
implantation was confirmed during the intervention a resection of the adhesion

was carried out which allowed histological confirmation.
Methods: case report
Results: Post C-section Maternal and neonatal evolutions were uneventful.
Conclusion: We conclude that pregnancy in presence of intra uterine adhesions
is a high-risk situation. Prenatal diagnosed should prompt close feto-maternal
surveillance. Surgical resections should be offered if adhesions are found prior
to pregnancy.
P78
DETERMINANTS OF PSYCHOLOGICAL WELL-BEING IN WOMEN HOSPITALIZED
FOR HIGH-RISK PREGNANCY.
R. Watrowski 1,*, A. Rohde 2
1Obstetrics & Gynecology, St. Josefskrankenhaus, Teaching Hospital of the
University of Freiburg, Freiburg, 2Gynecologic Psychosomatics, Womens
University Hospital Bonn, Bonn, Germany
Problem Statement: Pregnancy is associated with a variety of positive and
negative mood states, which have been traditionally assessed separately (e.g.,
depression or anxiety). Recently, growing attention has been dedicated to the
holistic assessment of mood. The construct of psychological well-being is a
sum of negative and positive mood states. The recognition of positive
psychological well-being is in accordance with neurophysiological evidence that
positive and negative mood states are not only the other side of each other,
and that they are differentially mapped in the brain. In pregnant women,
maternal positive well-being was positively associated with length of gestation
and reduced risk of preterm delivery.
Methods: We studied factors influencing the psychological well-being and
overall negative affectivity in 126 women hospitalized for high-risk pregnancy at
the tertiary medical center in Poland (University of Medical Sciences, Poznan).
The women completed a questionnaire about their age, parity, education level,
marital status, pregnancy week, history of miscarriage, hospitalization reason,
perceived partners interest, familial support and material conditions (the last
three variables indicated on a four-point scale). The psychological well-being was
assessed with the 12-Item Well-being Questionnaire (W-BQ12), consisting of
three subscales (positive well-being, negative well-being and energy). The
negative mood was scored on the Hospital Anxiety and Depression Scale (HADS),
consisting of two subscales (depression, HADS-D, and anxiety, HADS-A).
Results: 126 patients responded to the W-BQ12, and 124 patients responded to
the HADS. The median age of the patients was 26 (1743) years. The mean
gestational age was 30.9 (SD 6.9) weeks of pregnancy. 43% of the patients were
primigravidae, whereas 67% were multigravidae. The most common diagnoses
were threatening preterm delivery and bleeding in pregnancy. In the univariate
analysis, the total scores of the W-BQ12 and HADS correlated significantly only
with self-perceived material conditions (p= 0.04 and p=0.03, respectively). The
scores for positive well-being (W-BQ12) correlated with familial support
(p=0.002), partners interest (p=0.02), and material conditions (p=0.005).
Planned pregnancy was associated with better scores for positive well-being
(p=0.01) and lower scores in HADS-D (p=0.03). The W-BQ12 score for negative
well-being was influenced by familial support (p=0.04) and history of miscarriage
(non-significant, p=0.09). In a multivariate analysis, only self-perceived material
conditions influenced significantly the W-BQ12 scores for general well-being
(p=0.02), positive well-being (p=0.04) and energy (p=0.03). As a strong predictor
of positive well-being (p=0.02) and energy (p=0.02) emerged also familial
support.
Conclusion: The studys main limitation was its reliance on self-reporting.
Therefore, the potential impact of pregnancy complication or related
medication (e.g. tocolytics) on psychological states could not be determined.
However, our study demonstrated that the perceived partners interest, familial
support and stable material conditions influenced the positive and negative wellbeing significantly more than the age, educational level, parity, pregnancy week,
or history of miscarriage.
P79
96
PREDICTION OF SHORT-TERM OUTCOME IN PREGNANT WOMEN WITH

SUSPECTED PREECLAMPSIA: THE PROGNOSIS STUDY
H. Zeisler 1,*, E. Llurba 2, F. Chantraine 3, M. Vatish 4, A. C. Staff 5, M. Sennstrm 6,
M. Olovsson 7, S. P. Brennecke 8, H. Stepan 8, D. Allegranza 9, P. Dilba 10,
M. Schoedl 11, M. Hund 11, S. Verlohren 10
1Medical University Vienna, Austria, 2Hospital Vall dHebron, Barcelona, Spain,
3University of Lige, CHR de la Citadelle, Lige, Belgium, 4University of Oxford,
UK, 5Oslo University Hospital and University of Oslo, Norway, 6Karolinska
University Hospital, Stockholm, 7Uppsala University, Uppsala, Sweden, 8The
University of Melbourne and Royal Womens Hospital, Melbourne, Australia,
9Dept of Obstetrics, Leipzig University , Leipzig, Germany, 10Roche Diagnostics
International Ltd, Rotkreuz, Switzerland, 11Roche Diagnostics GmbH, , Penzberg,
Germany
Problem Statement: Preeclampsia is a potentially life-threatening syndrome for
mother/fetus, diagnosed by hypertension and proteinuria. However, clinical
diagnosis is not straightforward and these signs are poor for predicting who will
develop preeclampsia/associated adverse outcomes. Where preeclampsia is
suspected, there is a need for reliable short-term prediction to optimize prenatal
care. An imbalance of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental
growth factor (PlGF) has been implicated in preeclampsia pathogenesis, with
high sFlt-1/PlGF ratio observed before onset. PROGNOSIS (sponsor: Roche
Diagnostics) investigated the sFlt-1/PlGF ratio for short-term prediction of
preeclampsia and maternal/fetal adverse outcomes in women with suspected
preeclampsia.
Methods: (multicenter/prospective/double-blind/non-interventional) enrolled
1273 pregnant women (gestational age 24weeks+0days to 36weeks+6days at
visit 1) with clinical suspicion of preeclampsia. A cutoff-based model for
preeclampsia prediction was derived from the first 500 evaluable subjects and
validated with data from a further 550 subjects. Primary objectives: to
demonstrate that low sFlt-1/PlGF ratio predicts absence of
preeclampsia/eclampsia/HELLP syndrome for 1 week after visit 1 (1-week ruleout),
and
high
sFlt-1/PlGF
ratio
predicts
diagnosis
of
preeclampsia/eclampsia/HELLP syndrome within 4 weeks of visit 1 (4-week rulein). Secondary objectives included correlation of low and high sFlt-1/PlGF with
absence and presence, respectively, of maternal/fetal preeclampsia-related
adverse outcomes within 1 and 4 weeks. Preeclampsia and adverse outcomes
were combined for an exploratory analysis. Subjects/investigators were blinded
to sFlt-1/PlGF data. Diagnostic criteria were protocol-defined from international
guidelines. SFlt-1 and PlGF were measured at an independent laboratory
(Elecsys system, cobas e platform, Roche Diagnostics).
Results: Preeclampsia prevalence was 19.0%. Feasibility cohort: a sFlt-1/PlGF
cut-off of 38 for all gestational ages was favorable. The validation cohort had
90% power to show: a negative predictive value (NPV) of >96%, with the cut-off
confirmed for 1-week rule-out of preeclampsia by a 95% CI of 97.999.9%; a
positive predictive value (PPV) of >25%, with the cut-off confirmed for 4-week
rule-in by a 95% CI of 28.445.7%. In the full evaluable dataset (n=1050), the sFlt1/PlGF cut-off showed promising NPV, PPV, sensitivity and specificity (Table/Fig);
primary objectives were met. Women with adverse outcomes (n=2; cerebral
hemorrhage plus preeclampsia; isolated cerebral thrombosis) had high sFLt1/PlGF ratios. sFlt-1/PlGF was correlated with fetal adverse outcomes and a
combined endpoint of maternal and/or fetal adverse outcomes and/or
preeclampsia. Low and high sFlt-1/PlGF ratios were associated with absence and
presence of combined outcomes, respectively.
Predictive value of sFlt-1/PlGF cut-off of 38 (n=1050)
% (95%
CI)
NPV
1-week rule-out of preeclampsia
4-week rule-in of preeclampsia
99.1 (98.299.6)
94.9 (93.196.3)
PPV
16.7 (12.321.9)
38.6 (32.645.0)
Sensitiv
ity
Specific
ity
85.7 (72.894.1)
70.3 (61.977.8)
79.1 (76.581.6)
83.1 (80.585.5)Image / Graph:
Abstract Book
Conclusion: A single sFlt-1/PlGF ratio cut-off value of 38 was validated to reliably

rule-out (within 1 week) and rule-in (within 4 weeks) preeclampsia in women
with suspicion of preeclampsia (gestational age 2437 weeks), and was
predictive of fetal adverse outcomes. The test may help optimize care by
improving management of suspected preeclampsia.
Disclosure of Interest: H. Zeisler Grant / Research support from: F.Hoffmann La Roche,
Consultant for: F.Hoffmann La Roche, E. Llurba: None Declared, F. Chantraine: None
Declared, M. Vatish: None Declared, A. C. Staff: None Declared, M. Sennstrm: None
Declared, M. Olovsson: None Declared, S. P. Brennecke Grant / Research support from: Cost
recovery financial support received from Roche Diagnostics GmbH for conduct of PROGNOSIS
study, H. Stepan Consultant for: Roche Diagnostics International Ltd., D. Allegranza
Shareholder of: F.Hoffmann La Roche, Employee of: Roche Diagnostics International Ltd., P.
Dilba: None Declared, M. Schoedl Shareholder of: Roche Diagnostics International Ltd.,
Employee of: Roche Diagnostics International Ltd., M. Hund Shareholder of: Hoffmann La
Roche, Employee of: Roche Diagnostics International Ltd., S. Verlohren Grant / Research
support from: Roche, Novartis, Consultant for: Roche, ThermoFisher
P80
ENDOMETRIAL PATHOLOGY IN TAMOXIFEN USERS: A RETROSPECTIVE STUDY
S. Aguilar 1,*, V. Ribeiro 1, S. Valadares 1
Maternidade Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central, Portugal
Problem Statement: Tamoxifen improves survival rates in hormonal receptor
positive breast cancer patients, but is associated with endometrial proliferation,
hyperplasia, polyp formation, carcinoma and uterine sarcoma. Regular
ultrasound endometrial surveillance in tamoxifen users is controversial since it
can lead to women overtreatment. Our objective was to determine the role of
gynaecological ultrasound screening for endometrial pathology in tamoxifen
treated women.
Methods: Retrospective analysis of gynaecological ultrasound, hysteroscopic
and endometrial histologic findings in breast cancer patients who started
tamoxifen (TAM) between 1990-2005. Inclusion criteria: a minimum of 5 years
of TAM use, regular gynaecological ultrasound and a follow-up for at least 5years after TAM treatment onset or until a hysterectomy was performed.
Exclusion criteria: endometrial pathology or hysterectomy previous to TAM use.
An endometrial thickness 10mm on ultrasound defined endometrial
thickening. Patients were considered symptomatic if they had abnormal uterine
bleeding (AUB).
Results: One-hundred and forty-five TAM users were included. Mean age at TAM
treatment onset was 53,7years; 13,9% were nulliparous, 59,2% post-menopause
and 66,7% had a body mass index 25. The mean duration of endometrial followup (from TAM treatment onset until a patients hysterectomy or last
appointment) was 9,6years. Endometrial pathology was suspected by
ultrasound and/or AUB in 48,3% (n=70): 41,4% (n=60) had endometrial
thickening, 4,8% (n=7) other atypical ultrasound endometrial pattern and 2,1%
(n=3) were symptomatic but had a normal endometrium on ultrasound. Based
on those suspicions 65 women were subjected to an invasive endometrial
evaluation: 62 had a diagnostic hysteroscopy and 3 endometrial aspiration
alone. Endometrial pathology was detected in 36,6% of TAM users (n=53): 33,1%
were diagnosed with polyps, 5,5% with hyperplasia without atypia and 2,1% with
cancer (n=3) 2 adenocarcinomas and 1 carcinosarcoma. 43% had more than 1
invasive procedure until diagnosis. Symptomatic patients had endometrial
pathology in 90% of the cases. Endometrial pathology incidence in the sub-group
of patients with asymptomatic endometrial thickening (n=43) was 79,1%, rising
to 88,2% if endometrial thickening was symptomatic (n=17). AUB was

significantly more frequent in the group with endometrial pathology compared
to women subjected to an invasive endometrial study but without a subsequent
diagnosis of endometrial pathology (32,7% versus 10%). All 3 endometrial cancer
subjects were obese; 2 were symptomatic; they were older at TAM treatment
onset and endometrial pathology diagnosis than individuals with other
endometrial pathologies; diagnosis was made 1 and 6 years after 5 years of TAM
treatment in two cases and in the other one during the second year of TAM use.
Conclusion: In our study endometrial pathology incidence in the group with
asymptomatic ultrasound endometrial thickness 10mm was 79,1%, rising to
88,2% if endometrial thickening was accompanied by abnormal uterine
bleeding. Using this clinical marker in association with gynaecological ultrasound
we detect endometrial pathology in 36,6% of tamoxifen users. Polys were the
most frequent entity. Three of the 53 endometrial pathology cases were
malignant (5,7%); they strongly correlated to older age, abnormal uterine
bleeding and obesity.
P81
MAYER-ROKITANSKY-KSTER-HAUSER SYNDROME WITH UNILATERAL RENAL
AGENESIS - A CASE REPORT.
L. Ahmad 1,*, S. Al-abri 1
Gynae and Obs, Armed Forces Hospital, Muscat, Oman
Problem Statement: Mayer-Rokitansky-Kster-Hauser (MRKH) syndrome is a
disorder that occurs in females and mainly affects the reproductive system. This
condition causes the vagina and uterus to be underdeveloped or absent. Women
with MRKH syndrome have a female chromosome pattern (46, XX) and normally
functioning ovaries, they also have normal female external genitalia, pubic hair
and normal breasts. Women with MRKH syndrome may also have abnormalities
in other parts of the body. The kidneys may be abnormally formed or positioned,
or one kidney may fail to develop (unilateral renal agenesis).
Methods: A case report
Results: A- 25-year-old female, married since 3 years, reported to infertility clinic
with complaints of unable to initiate menses since 12 years, severe dyspareunia
along with voiding difficulties and recurrent UTI, patient did not seek any
medical advice earlier. The patient undergoes puberty with normal thelarche
and adrenarche. Physical examination revealed normal secondary female sexual
characteristics with normal height, breast, axillary and pubic hairs. The vulva,
labia majora, labia minora, clitoris and urethra all were normal. Speculum
examination showed blind vagina around 1.5-2 cm and cervix was not visualized.
Hormonal profile showed FSH- 6.470m IU/ml, LH- 8 mIU/ml, estradiol 216.400,
testosterone 0.707 nmol/L. Imaging modalities used in which Ultrasonography
showed vaginal region with small tubal structure, aplastic uterus and both
ovaries were not visualized. MRI showed aplastic uterus, non-appreciable cervix,
and ovaries with no abnormality and thin vagina in the lower 1/3rd. Ultrasound
KUB showed normal right kidney however, left kidney was not seen. IVU showed
left renal agenesis. Informed consent obtained from the couple for vaginoplasty
and vaginal reconstruction. During Postoperative follow up, patient reported to
have satisfactory coitus. No vaginal scarring, infection and bleeding.
Conclusion: The cause of MRKH syndrome is unknown, although it probably
results from a combination of genetic and environmental factors. The goal of
treatment is to provide the patient with an unscarred vagina that allows sexual
functioning. Patients with Mayer-Rokitansky-Kuster-Hauser syndrome can
become pregnant by having oocytes harvested, fertilized, and implanted in a
surrogate.
P82
WOMEN'S ATTITUDES TOWARD EARLY DIAGNOSIS OF CERVICAL CANCER
M. Akbas 1,*, S. Gokyildiz 1, T. Ucar 1, N. Yalcin 1
Midwifery, Cukurova University Adana Health High School, Adana, Turkey
Problem Statement: Cancer is a major public health problem for both the world
and our country because of the burden of the disease, its lethality and the
increasing trend in its incidence. Women are at high risk throughout their lives
97
for the structural disorders related to the reproductive system and the formation
of tumor diseases. Screening programs have a significant impact on the
reduction of the cervical cancer. This study is conducted as descriptive and crosssectional in order to determine the attitudes of women towards early diagnosis
of cervical cancer.
Methods: The study population consists of all women between the ages of 20
and 64 applied to the obstetrics and pediatrics outpatient clinic of the hospital
for any reason between 14 July and 31 December 2014. Women who
participated in the survey are divided into "20-29", "30-39", "40-49", "50 and up"
age groups according to Adana female population data of Turkey Statistical
Institute in 2012. The study sample consists of 599 women who participated
voluntarily. Before the study, the hospital ethics committee approval, necessary
permits from the hospital management and written consent of women are
taken. Data were taken by a questionnaire, and a 30-item "Cervical Cancer Early
Diagnosis Attitudes Scale", which is developed by Ozmen.
Results: It is obtained that participants' mean age is 37.62 11.733, average
marriage age is 20:17 4.681, and average number of children is 2.95 1.818. It
is determined that of the participants, 74.8% (n = 448) had gynecological
examination, 53.8% (n = 322) of those who had gynecological examination goes
to gynecological examination due to illness complaint, 22.7% (n = 136) of those
who had not gynecological examination did not go to examination because of
lack of an illness complaint, 50.3% (n = 301) have cervical cancer related
knowledge, 32.1% (n = 192) obtained this information from health care
providers, 1.2% (n = 7) received cervical cancer diagnosis, 6.8% (n = 41) have
family member diagnosed with cervical cancer, 56.1% (n = 23) of those who have
family member diagnosed with cervical cancer have a second degree relative
diagnosed with cervical cancer, 41.7% (n = 250) have knowledge about pap
smear tests, 31.6% of the (189) have pap smear test, 54.5% (n = 103) have pap
smear test due to doctor recommendation when she went to a doctor for
gynecological examination, 90.5% (n = 371) of those who had not pap smear
screening test because of lack of an illness complaint. It is found that total score
average of the attitude scale towards early diagnosis of cervical cancer is 109.33
9.345, the distribution range is from 77 to 137; perceived sensitivity subscale
average of the scale is 31.96 3.837, perceived severity subscale average of the
scale is 31.62 4.709, perceived barriers subscale average of the scale is 24.29
4.160, perceived benefits subscale average of the scale is 21:47 2.522. The
relationship between the situations, having children, having a gynecological
examination, having information about cervical cancer, having a family member
diagnosed with cervical cancer, having information about pap smear, having a
pap smear test and total score average of the scale is statistically significant
(p<0.05).
Conclusion: In the light of these results, the regulation of educational programs
for women related to the importance of cervical cancer and Pap smear tests and
awareness-raising among women are recommended.
P83
THE ROLE OF DOPPLER ULTRASOUND IN PRE AND POST TREATMENT OF
UTERINE ARTERIOVENOUS MALFORMATION A CASE SERIES
R. Amster 1,*, J. Hartoov 1
Ob&Gyn, Lis Maternity Hospital, Tel Aviv, Israel
Problem Statement: Arteriovenous malformations (AVM) of the myometrium
are considered a rare entity. Data from recent studies suggest AVM are more
prevalent than previously believed. Pregnancy related uterine trauma is a major
risk factor for the development of acquired uterine AVM. It is believed that
acquired uterine AVM is fed from a solitary vessel while congenital lesions have
many feeding vessels. Intermittent torrential hemorrhage is the hallmark of
AVM. We now realize that some women with AVM are asymptomatic or may
present with variable bleeding pattern. Although Angiography is still the gold
standard in diagnosing AVM, Doppler Ultrasound is the most common first
diagnostic tool and acquired uterine AVM can be from more than soluitary
vessel.
Methods: Patiens reffered to our unit after ultrasound exam that revealed
myometrial hypo-echogenic mass raising the suspicion of an AVM. Doppler
Ultrasound imaging established the diagnosis of a uterine wall AVM. The patient
98
was treated with selective embolization treatment and than evaluated by post
treatment Doppler Ultrasound. Results: Doppler Ultrasound imaging established
the diagnosis of a uterine wall A-V Malformation in two suspected cases. The
patients was treated with consecutive selective embolization evaluated by
Doppler ultrasound.
Image / Graph:
Conclusion: Arterial venous malformation of the uterus should be suspected in

women presenting with Intermittent, torrential vaginal hemorrhage, especially
following abortion or delivery but can be found post pelvic gynecological
procedure like IVF. High index of suspicion is required when hypo echogenic
mass is observed in the myometrium. AVM can be reliably diagnosed and
followed using Doppler ultrasound.
P84
COMPARISON OF TWO DOSES OF MIFEPRISTONE IN COMBINATION WITH
SUBLINGUAL MISOPROSTOL FOR EARLY MEDICAL ABORTION
T. Belokrinitskaya 1,*, N. Frolova 1, D. Ananyina 1, E. Selesnyova 1, E. Hromykh 1,
I. Belokrinitskaya 2
1Obst/Gynec Department, Chita State Medical Academy, 2Obst/Gynec
Department, Medical Center Health plus, Chita, Russian Federation
Problem Statement: Medical methods of abortion have been proved to be safe
and effective (WHO, 2012). Combined regimens of mifepristone with
prostaglandins are more effective than single agents. In the combined regimen,
the oral dose of mifepristone can be lowered to 200 mg and the
subsequent misoprostol can be administered vaginally, sublingually or buccally.
Methods: The present study was prospective, randomized, and cohort; it was
approved by the Ethics Committee of the Chita State Medical Academy. In the
study, 1728 pregnant women with up to 9 weeks amenorrhoea received 600 mg
(group I, n=908) or 200 mg (group II, n=820) oral mifepristone (Pencrofton;
Pencroft Pharma, Russia), followed 24-48 h later by sublingval misoprostol 800
g (Mirolut; Stada Arzneimittel AG, Stada CIS, Russia), for the induction of first
trimester abortion. Efficiency was definded as the termination of pregnancy with
complete expulsion of pregnancy without the need for surgical evacuation.
Outcome measures were the need for surgical evacuation in patients with
bleeding or incomplete abortion, and the presence of an ongoing pregnancy.
Clinical history was obtained and physical examination was performed in all
cases. Post-abortion ultrasound scanning was used on 14 days. We have
analyzed the frequencies, 2 test, odds ratio (OR) and its 95% confidence interval
(CI) to compare the failure rate between the two groups.
Results: Efficacy rates were 99.34% (902/908, group I) and 99.88% (819/820,
group II) (2 >0.05). The overall frequencies of complications for the group I (600
mg mifepristone) and group II (200 mg mifepristone) are 2.31% (21/908) and
2.07%, respectively (OR=1.1; 95%CI 0.112.06) (Table). Continuing pregnancies
were more frequent in patients of group I than in group II (0.66% vs 0.12%,
OR=5.4, 95% CI 1.7010.37). All of these women (14) had a history of early
nondeveloping pregnancy. Six (0.66%) women of group I and eleven (1.34%) of
group II had required surgical intervention to resolve an incomplete abortion
(OR=0.5; 95%CI -0.710.77). This complication was associated with history of
Abstract Book
surgical abortion. Nine (52.9%) of those seventeen women had one and eight
(47.1%) two previous unsafe abortions. Vacuum aspiration was performed in all
cases of incomplete abortion (17). The incidence of severe bleeding with uterine
curettage were 1.6-times higher in women received 600 mg mifepristone (0.99%
vs 0.61%, OR=1.6; 95%CI 0.494.31).
Table: Complications of medical abortion in the comparison groups.
Complications
Continuing
pregnancy
Bleeding with
surgical
intervention
Incomplete
abortion
Total
Group I
(600
mg
mifepristone)
n=908
6 (0.66%)
Group II
(200
mg
mifepristone)
n=820
1 (0.12%)
OR
95% CI
5.4*
1.7010.37
9 (0.99%)
5 (0.61%)
1.6*
0.494.31
6 (0.66%)
11 (1.34%)
0.5
-0.70.77
21 (2.31%)
17 (2.07%)
1.1
0.112.06
* statistically significant associations.

Conclusion: Reduced dose of mifepristone (200 mg) with sublingual misoprostol
has been proven highly effective, safe and acceptable for abortions occurring up
to 9 weeks (< 63 days) since the last menstrual period.
P85
UP-REGULATION OF TRANSIENT RECEPTOR POTENTIAL VANILLOID 1 (TRPV1)
AND ANKYRIN 1 (TRPA1) ION CHANNELS IN THE EUTOPIC AND ECTOPIC
ENDOMETRIUM OF DEEP INFILTRATING ENDOMETRIOSIS AND
ENDOMETRIOMA PATIENTS
N. Bohonyi 1 2 3,*, B. Szalontai 2, K. Pohczky 1, K. Kovcs 4, B. Kajtr 4,
A. Hrn Perkecz 1, M. Koppn 3, Z. Helyes 1 2
1Pharmacology and Pharmacotherapy, University of Pcs Medical School,
2
Jnos Szentgothai Research Centre, University of Pcs , 3Obstetrics and
Gynaecology, 4Pathology, University of Pcs Medical School, Pcs, Hungary
Problem Statement: TRPV1 and TRPA1 receptors are non-selective cation
channels predominantly localized on peptidergic sensory nerves integrating a
variety of nociceptive stimuli and mediating neurogenic inflammation. Although
recent results indicate its localization on several non-neural cell types, its
physiological and pathophysiological roles are unclear. TRPV1 has been
described in the human endometrium, but its hormone-dependent alterations
and function has not been elucidated. However, TRPA1 expression has not been
investigated. Since both channels are activated by a lot of inflammatory
mediators and might play a role in pain initiation and maintenance, we analysed
their expression in the human endometrium, as well as its alterations in common
painful inflammatory gynaecologycal disorders, such as deep infiltrating
endometriosis (DIE) and endometrioma at mRNA and protein levels.
Methods: A total number of 35 patients undergoing laparoscopic surgeries due
to 1) DIE (n=15), 2) endometrioma (n=7), 3), uterine fibroid-induced
dysmenorrhea (n=7), or 4) endometrial pipelle biopsies (healthy controls, n=6)
were enrolled in this study. None of these women in reproductive age received
hormonal therapy. TRPV1, TRPA1 mRNA expression of the samples was
determined with quantitative real-time PCR in comparison with the
housekeeping gene Ribosomal Protein L9 (RPL9). Immunostaining was
performed on formalin-fixed paraffin-embedded sections to investigate TRPA1
and TRPV1 protein localization and distribution.
Results: Both TRPV1 and TRPA1 were detected at the mRNA level in the healthy
endometrium showing its non-neural expression. Immunostaining for these
channels showed scattered cytoplasmatic positivity for stromal and epithelial
cells, in turn no cycle-dependent changes were observed. Both TRPV1 and TRPA1
mRNA significantly, 1.5-2.5-fold and 5-7-fold increased in DIE lesions, as well as
in endometrioma samples, respectively. In DIE samples epithelium and stroma
were densely immunostained for both receptors, while plasmocytes presented
stronger reactivity for TRPV1. These cells, alongside with endothelia and
granulocytes had moderate staining for TRPA1. Colon epithelium appeared to be
weakly positive. Endometrioma samples stained intensely for TRPA1 in epithelia,
stroma and fibroblasts. The epithelium and plasmocytes were positive for
TRPV1. TRPV1, but not TRPA1 mRNA expression increased significantly (by 1.5-
2.5 folds) in the eutopic control endometrium of women suffering of

endometriosis.
Conclusion: We provide here the first evidence on TRPA1 expression in healthy
eutopic endometrium both at mRNA and protein levels. In addition, TRPV1 and
TRPA1 expressions significantly up-regulated in DIE and endometrioma lesions
in parallel with an increase of TRPV1, but not TRPA1 transcripts at the
autocontrol endometrium samples. These finding were confirmed by
immunohistochemistry describing important non-neuronal distribution for
these channels. Determining the functional significance of these results needs
further investigation.
Support: The work was funded by Hungarian GrantS SROP-4.2.2.A-11/1/KONV-20120024, SROP-4.2.2.A-11/1/KONV-2012-0053 and SROP-4.1.1.C-12/1/KONV-2012-0010
P86
METABOLIC FINGERPRINTING OF GRANULOSA CELLS FROM NORMAL AND
POLYCYSTIC OVARIES
M. F. J. Brincat *, J. Gamibin
Foundation Year 2, East of England Deanery, Cambridge, UK
Problem Statement: By comparing the metabolic profiles of granulosa cells from
normal ovaries and those from women with polycystic ovary syndrome (PCOS),
one should be able the see differences in the active pathways can be
demonstrated. Metabolomic techniques may permit pinpointing of metabolic
cycles which are inactive or active in the polycystic ovary.
Methods: PCOS Polycystic ovary syndrome is a common disease in premenopausal women. There is much debate as to whether PCOS is a single
disease or a combination of several disorders. Insulin resistance and
hyperinsulinaemia are well recognized characteristics of anovulatory women
with PCOS. Granulosa cells are somatic cells found closely associated with the
developing female oocyte gamete. Granulosa cells were extracted from follicular
fluids from normal and PCOS patients, then cultured and treated with insulin.
After 4 hours incubation with insulin, the cell extracts and media were stored,
freeze dried and MR spectra were obtained using a Bruker 600 MHz
spectrometer (pulse angle 45; repetition time, 3.5s)
Results: The results from this study show that metabolomics and the
examination of metabolic profiles of granulosa cells could be an important part
of an integrative approach for assessing the possible causes of PCOSpolycystic
ovary syndrome.
Conclusion: Metabolomics and the examination of metabolic profiles of
granulosa cells could be an important part of an integrative approach for
assessing the possible causes of PCOSpolycystic ovary syndrome.
P87
EXPERIENCE OF KNOTLESS WOUND CLOSURE DEVICE USED IN LAPAROSCOPIC
MYOMECTOMY OF UTERUS
C.-C. Chan
ObGyn, Taipei City Hospital, Taipei, Taiwan, Province of China
Problem Statement: Hemostatic control, suturing, and renovating leiomyoma
are the most important procedures associated with laparoscopic myomectomy.
When compared to the normal situation, suturing and tieing off using slender
instruments are more imprecise and more difficult. As a result, problems may
occur, such as when the joining of tissue is not strong enough and when there
are difficulties carrying out stypsis during suturing and cross-cutting. Knotless
wound closure device is a superior device that is equipped with an efficient barb
and welded loop design. This suture invention is able to help the surgeon to close
a wound, to stabilize the closure and to tie off rapidly.
Methods: We applied this wound closure device to laparoscopic myomectomy
with the aim of diminishing surgery time, reducing blood loss and reducing the
number of complication; such improvement ought to result in better uterus
recovery and pregnancy.This prospective study evaluated data on the efficacy of
treatment of 62 women who underwent laparoscopic myomectomy at Taipei
City Hospital Zhongxiao Branch from January 2010 through to August 2012. The
99
patients were randomly assigned to either the Knotless wound closure device
group or the 2-0 vicryl suture group.
Results: The two groups were similar in terms of age, body weight, delivery
number, hemoglobin and hematocrit before surgery. After surgery, blood loss,
operation time, change in hemoglobin, change in hematocrit and the presence
of uterus defects among the knotless wound closure device group were
significant less than among the vicryl group. There are 26 patients pregnant after
accepted surgery within 2 years. 12 of them are classified as Knotless wound
closure device group and the others are 2-O Vicryl. Among these 26 patients, 1
patient classified as 2-O Vicryl has received hysterectomy cause of uterine
rupture on the timing of the 24 week during her pregnancy, and the others have
taken Cesarean Section successfully for childbirth.
Conclusion: When compared with traditional suture material, the knotless
wound closure device, which is equipped with an efficient barb and welded loop
design, allows the surgeon to stably close any wound rapidly without having to
tie-off separately. The wound margin is held firmly together, which is especially
important during the critical stage of wound heal over and the stage of
pregnancy; furthermore, the sutures are absorbable in 180 days. In conclusion,
the knotless wound closure device brings a lot of benefits when used for
laparoscopic myomectomy.
P88
HISTOLOGICAL FINDINGS IN POST MENOPAUSAL WOMEN REFERRED FOR
ATYPICAL GLANDULAR CELLS IN THEIR PAP SMEARS.
V. Costa Ribeiro* and Aguilar S; Paula T.; Borrego J.
Gynecology, Alfredo da Costa Maternity, Lisbon, Portugal
Problem Statement: The aim of this study was to evaluate the histopathology
and the long-term follow-up outcome of post menopausal women who had
atypical glandular cells on Pap smears. Methods: We conducted a retrospective
study, at the Department of Colposcopy at Alfredo da Costa Maternity in Lisbon,
including all AGC cervical liquid-based cytology in post menopausal women
(ThinPrep) between January 2009 and December 2013. All specimens were
evaluated and reported using 2001 Bethesda System terminology. Age of
diagnosed AGC, parity, colposcopic-directed biopsies, endocervical curettage,
histological findings from cervical cones and endometrial sample studies were
analyzed. Statistic significance (p<0.05) was calculated using SPSS 20.0.
Results: The overall prevalence of post menopausal women in AGC ThinPrep was
26.7% (n=23 from a total of 86 identified AGC liquid-based cytology). The
medium age of AGC diagnose among the study group was 63.4. The average age
of first menses and menopause was 12.3 and 50 years respectively, women had
their first intercourse around 19.2 years and the group accounted for 69.6%
(n=16) of multiparous. When analyzing the different subtypes of AGC we found
an incidence of 65.2% (n=15) of AGC not otherwise specified (NOS), 21.7% (n=5)
of AGC in favor of neoplasia (FN), 8.7% (n=2) of concomitant AGC-NOS and
atypical squamous cells of undetermined significance (ASCUS) and 4.3% (n=1) of
AGC-FN in the presence of high-grade squamous intraepithelial lesion (HSIL).
Colposcopic-directed biopsies were performed in 17.4% (n=4) patients with
identification of 75.0% of squamous cervical intraepithelial neoplasia (CIN) (CIN
I= 1; CIN III=2). Endocervical curettage was performed in 39.1% (n=9) with an
11.1% identification of CIN (CIN III=1). A total of 13.0% (n=3) patients were
submitted to treatment by excisional cone with a 66.7% identification of CIN (CIN
III=2). Endometrial study was performed by ultrasound and hysteroscopydirected biopsies with the identification of 8 cases of endometrial pathology (2
cases of endometrial hyperplasia and 6 cases of endometrial neoplasia). In this
retrospective study of 23 post menopausal women who present with an AGC
liquid-base cytology we were able to identify 2 cases of CIN III, 6 cases of
endometrial neoplasia and 2 cases of endometrial hyperplasia. Conclusion:
Studies show that women with ACG cytology older than 50 or more commonly
have endometrial carcinoma. Our study identified 8.7% (n=2) of CIN III, 8.7%
(n=2) of endometrial hyperplasia and 26.1% (n=6) of endometrial carcinoma. In
our small sample the presence of endometrial pathology among post
menopausal women with AGC liquid based cytology is the most frequent
diagnose (p=0.038). Disclosure of Interest: None Declared
100
P89
ECTOPIC PREGNANCY ON INSTITUTO NACIONAL DE PERINATOLOGA ISIDRO
ESPINOSA DE LOS REYES, EVALUATION OF THE EXPERIENCES AND RESULTS
OBTAINED WITH CONSERVATIVE MANAGEMENT WITH METHOTREXATE
FROM JANUARY 2013 TO JUNE 2014
A. Garca Luna Vsquez , O. P. Cruz Orozco, A. Belmont Gmez,
E. A. Cruz Cruz *, R. E. Rodrguez Guerrero
Instituto Nacional de Perinatologa Isidro Espinosa de los Reyes, Mxico D.F.,
Mexico
Problem Statement: Ectopic pregnancy happens approximately in 1-2% of all
pregnancies. The prevalence of ectopic pregnancy in Mxico is reported to be 1
in 200 to 1 in 500 pregnancies. Cases of suspected or confirmed ectopic
pregnancy were admitted to the Instituto Nacional de Perinatologa Isidro
Espinosa de los Reyes, from January 2013 to June 2014. In the past, an ectopic
pregnancy was considered a surgical emergency, requiring open abdominal
surgery and post-operative hospitalization. With early diagnosis, the availability
of laparoscopy and conservative management with methotrexate has become
possible. Tubal pregnancy treatment with methotrexate has shown to be more
effective on early pregnancies where the risk of tubal rupture is small.
Methods: Asses the success and failure of conservative treatment with
methotrexate in the Instituto Nacional de Perinatologa from January 2013 to
June 2014, and include the related factors involved on the final outcome of
treatment. A retrospective cohort study of all cases that were admitted to our
institution through the emergency department with confirmed diagnosis or
suspected ectopic pregnancy from July 2013 to June 2014 was evaluated. From
these patients, the method used to make initial diagnosis was assessed by means
of using basal determinations of hCG and/or ultrasound. hCG was registered and
so posterior determinations. Other ultrasound variables were also evaluated
such as: extrauterine pregnancy location, gestational sac length, cardiac activity
presence, and free abdominal fluid. The information was taken directly from
clinical files, including physical as electronic. All data were obtained on the
gathering instrument and subsequently filled to an Excel data page.
Results: A total of 110 cases were registered with a confirmed or suspected
ectopic pregnancy. Ectopic pregnancy was localized to Fallopian tube on 93% of
the times and the rest on other regions. Of all patients, 45% required laparotomy
as definitive treatment, following laparoscopy. Only 12.7% (18 patients) received
conservative management with methotrexate. Mean gestational age was 6.58
+/- 1.41 weeks, with basal gonadothropin of 1203.5 +/- 1268.9mUI. Gestational
sac length was less than 3.5cm. Fetal activity was present in only 1 case. Free
abdominal fluid was reported in 7 cases. The success with methotrexate
treatment was 77.78%, and the rest of patients required some other
intervention. Therapeutic failure was considered as the necessity to realize some
other intervention to the patient apart from methotrexate administration.
Variables like gestational age, gestational sac length, and free abdominal fluid
are similar on all patients with therapeutic success and therapeutic failure,
though, basal values of quantitative hCG were greater on patients with failure
treatment than those with success. Both groups showed higher increments of
hCG on the second and fourth days following treatment. This increment was
greater than 50% on all cases associated with failure compared with success.
Conclusion: Different studies demonstrate that initial values of hCG possess
great predictive value for determining success or failure of methotrexate
treatment. Other values turn out to be important, such as cardiac fetal activity
or the following behavior of hCG.
P90
OFFICE GYNAECOLOGICAL SURGERY: PRELIMINARY RESULTS AT HOSPITAL
DEL MAR, BARCELONA
E. Del Amo*, K. Vellv, P. Nicolau, R. Carreras
Gynaecology and Obstetrics, Hospital del Mar, Universitat Autnoma de
Barcelona, Barcelona, Spain
Problem Statement: In January 2007 an office gynaecological surgery
programme was developed as a way to alleviate the waiting list for minor
surgical procedures. Given the positive results of diagnostic hysteroscopies and
Abstract Book
tubal occlusion it was agreed to outsource most of these procedures to primary

care from October 2010, keeping only patients of special consideration at the
hospital.
Methods: All office surgical records were reviewed from January 2007 to
December 2013 and the results are reported below. All patients were informed
about the technique potential complications and signed the informed consent.
None of the breast tumours removed had any malignancy suspicion prior to
procedure. The surgical team was composed of senior staff as well as supervised
residents.
COMMON OFFICE SURGICAL PROCEDURES: Diagnostic hysteroscopy +/- biopsy
16, tubal occlusion Essure 200, polypectomy/septoplasty 13, Bartholins gland
marsupialization 83, imperforate hymen 11, labioplasty 10, vaginal/vulvar
tumours 38, vaginal fibrosis/granulomas 22, cystoscopy and treatment of SUI 7,
remove stress incontinence devices 12, breast tumours 58, remove
contraceptive implants 35, cesarean scar granuloma 3.
Results: 508 office surgical procedures were performed under local anaesthesia
(either mepivacaine 2% or lidocaine 2% without vasoconstrictor) in 93.11% of
patients. Length of surgery was around 20 min (range: 7-46 min). 34
complications were detected (6.69 % of all procedures) (table 1). None of them
was considered to be a major event and no further hospital admission was
required in any case. Each office surgery average cost was 654.50 (range:
375.52-2474.94 ).
Table 1. Complications observed according to the proceduresImage / Graph:
Conclusion: Office gynaecological surgery could become an important tool to

reduce the surgical waiting list and save resources as it is less costly than hospital
admission. Only few and minor complications were observed, the whole
contributing to generate a smaller number of leaves. It is also a good opportunity
for residents to improve and master their surgical skills. Therefore, this kind of
programme should be encouraged always bearing in mind that its success
requires a careful scrutiny of all candidates.
P91
ZELESSE A NEW INTIMATE HYGIENE WASH SOLUTION FOR THE RELIEF OF
SYMPTOMS AND SIGNS OF ACUTE VULVOVAGINITIS
J.L. Delgado 1,*, R. Oliva 1, J. E. Blanco 1, R. San Martin 2, I. Muoz 2, I. Huerta 3, M.
Cuerva 4, J. Lazaro 5
1Dept of Ob/Gyn, University Hospital Virgen de Arrixaca, Murcia, 2 Dept of
Ob/Gyn, Specialist Medical Clinic, 3Medical Dept, Italfarmaco, 4 Dept of Ob/Gyn,
Hospital Quirn San Jos, 5 Dept of Ob/Gyn, University Hospital Ramn y Cajal,
Madrid, Spain
Problem Statement: Vulvovaginitis, an inflammatory disease of the vulvar and
vaginal area, is a highly prevalent condition -with diverse symptoms and signsaffecting women of all ages. The most annoying and relevant symptom, the
womens principal complaint, is itching. In many cases the genital area is shown
red and edematous, and increased vaginal discharge may occur. Zelesse an
intimate hygiene wash solution, based on Chamomile, Burdock and Aloe Vera,
with soothing, antipruritic and antiseptic properties may be beneficial for the
symptomatic relief of vulvovaginitis. The aim of this study was to evaluate the
effect and tolerability of Zelesse indicated alone or in combination with specific
pharmacological treatment in patients with symptoms suggestive of
vulvovaginitis.Methods: This is a prospective observational multicenter clinical
trial. 137women with symptoms of acute vulvovaginitis (mean age
38.611.1years) were included, 50women (SF group) with symptoms of
nonspecific vulvovaginitis (mean age 42.411.9years) received Zelesse once or
twice a day during 12 days. 87women (CF group) with vulvovaginal infection
(mean age 36.510.1years) were treated with specific pharmacological therapy
and also received Zelesse twice a day. At baseline and at the end of treatment,
symptoms and signs were evaluated with a validated numeric scale 0=absent,
1=mild, 2=moderate and 3=severe. A composite score of symptoms, the Global
Symptom Score (GSS), was obtained to assess the effect of treatment on all
individual symptoms taken as a whole.Results: At baseline, 93% of women
reported pruritus, erythema 80%, 59%edema, and 75% leucorrhoea. In the SF
group, 93% of women who afflicted pruritus at baseline experienced
improvement after treatment, reducing its intensity from 1.9 to 0.5 (p<0.0001,tstudent). Zelesse also showed beneficial effect on the rest of the evaluated
signs of vulvovaginitis. Zelesse improved erythema, edema and vaginal discharge
in 68%, 87% and 77% of women who had these signs at baseline, respectively.
Also, after treatment, 94%, 96% and 84% of women either did not show or only
presented mild erythema, edema or leucorrhea, respectively. In the CF group
89.6% of patients with moderate to severe pruritus decreased its intensity to
absent or mild, being reduced from 2.35 to 0.5 (p<0.0001,t-student). On the rest
of the evaluated signs, the effects of the combination therapy were also
beneficial, 95.2% of patients with moderate/severe erythema decreased its
intensity to absent/mild, as well as 97.3% of those with edema and 92.0% of
women with leucorrhoea. Interestingly after treatment, both groups showed
similar significant improvement of the GSS with respect to baseline: in the SF
group GSS decreased from 4.8 to 1.5 (p<0.0001,t-student) and in the CF group
the GSS decreased from 7.41 to 1.42 (p<0.0001,t-student). Finally, 84.5% of
women felt that the tolerability of the product was very good or excellent,
highlighting its soothing and refreshing properties.Conclusion: Zelesse is
effective for relieving symptoms and signs of acute nonspecific vulvovaginitis as
well as good adjuvant therapy in the management of vulvovaginal infection. The
similar final GSS after treatment also suggests the beneficial effects of Zelesse
on signs and symptoms of vulvovaginitis. The significant effect on pruritus, the
most disturbing symptom, is considered clinically relevant since pruritus is a very
distressing and persistent symptom which usually does not diminish without
treatment.
P92
OFFICE HYSTEROSCOPY IN THE MANAGEMENT OF INFERTILITY: PAST,
PRESENT AND FUTURE
M.Y. Eliseeva 1 2 3,*, L. Kindarova 2, I. Belokon 2, N. Danilova 3 4, A. Khachatryan 1,
O. Mynbaev 1 2 3 5 and The International Translational Medicine and
Biomodeling Research Team
1 Dept of Obstetrics, Gynecology and Reproductive Medicine, Peoples
Friendship University of Russia, 2Russian-German Center for Reproduction and
Clinical Embryology Genertion NEXT, Moscow, 3The International
Translational Medicine and Biomodeling Research Team, MIPT Center for
Human Physiology Studies, Laboratory of Cellular and Molecular Technologies,
Dept of Applied Mathematics, Moscow Institute of Physics & Technology (State
University), Dolgoprudny, Moscow, 4 Dept of Physiology & Basic Pathology,
Faculty of Fundamental Medicine, Lomonosov Moscow State University,
5Laboratory of Pilot Projects, Moscow State University of Medicine and
Dentistry, Moscow, Russian
Problem Statement: The role of office hysteroscopy in the management of
infertility has intensively debated. We present a systematic historical review
concerning an impact of basic sciences in improvements of an office
hysteroscopy as an effective diagnostic and surgical tool in the management of
infertility which has triggered an outpatient application of this
technique.Methods:
We searched the Medline and other electronic databases for appropriate
sources, including hand-search for cross references to find studies indicating an
impact of new technologies on hysteroscopy and also contacted experts in the
field for a consultation.Results:
Office hysteroscopy is a product of a translational medicine, which required
application of achievements of broad spectrum of basic sciences, such as
mathematics, optics, electrics, electronics, liquid resorption and conductivity
and other disciplines. Developments of technologies have had a crucial impact
on improvements of diagnostic and surgical abilities of hysteroscopy.
Most of hysteroscopic diagnostic and surgical techniques used today had been
described between 1980 and 2000, subsequently guidelines concerning
101
application of two stage hysteroscopy (the first step, as diagnostic outpatient

procedure and the second step, as inpatient procedure in the surgical theatre
with anesthesia) were formulated in terms of knowledge accumulated in that
period. Since then hysteroscopic technique has been miniaturizing owing to the
improvements of modern Hopkins telescopes, illumination, fibreoptics, digitalvideo, laser, electosurgery and other state-of-the-art technologies.
Subsequently today possibilities of surgical treatment of endometrial
pathologies by office hysteroscopy in the management of infertility are
dramatically extended and improved by an application of miniaturized
hysteroscopic technique, including thin mechanical instruments, laser and
bipolar electrosurgery and other innovative technologies with new working
principles. Nowadays an attitude of gynecologists and surgeons has been
metamorphosing taking into account implementations of new generation of thin
hysteroscopy with improved ergonomic handles, miniaturized surgical
instruments, when outpatient surgical procedures can be performed without
anesthesia with reduced costs and improved patients quality of life.Conclusion:
Developments of the state-of-the-art technologies have made an office
hysteroscopy as a reliable approach of modern medical service in the
management of infertility with appropriate tools and instruments. Further
applications of this approach with obtaining evidence based results of clinical
trials will open roads for widely implementations of this technology in the
management of infertility.
Conflict of interest: None declared.
Acknowledgments: We thank the International Translational Medicine and
Biomodeling Research Team members (Michael Stark, Andrea Tinelli, Antonio
Malvasi, Tahar Benhidjeb, Ioannis Kosmas, Mikhaylo Medvediev, Madina
Mazitova) and professor Bruno van Herendael from Antwerp for their
consultation. We cordially thank Professor Stefano Bettocchi from Bari
University for his special course, lessons in office hysteroscopy for ME, OM and
also for his consultation.
Funding: This work was supported by the Russian Science Foundation grant 1431-00024.
Disclosure of Interest: M. Eliseeva Shareholder of: none, Grant / Research
support from: none, Consultant for: none, Employee of: none, Paid Instructor
for: none, Speaker Bureau for: none, L. Kindarova Shareholder of: none, Grant
/ Research support from: none, Consultant for: none, Employee of: none, Paid
Instructor for: none, Speaker Bureau for: none, I. Belokon Shareholder of: none,
Grant / Research support from: none, Consultant for: none, Employee of: none,
Paid Instructor for: none, Speaker Bureau for: none, N. Danilova Shareholder of:
none, Consultant for: none, Employee of: none, Paid Instructor for: none,
Speaker Bureau for: none, A. Khachatryan Shareholder of: none, Grant /
Research support from: none, Consultant for: none, Employee of: none, Paid
Instructor for: none, Speaker Bureau for: none, O. Mynbaev Shareholder of:
none, Grant / Research support from: This work was supported by the Russian
Science Foundation grant 14-31-00024., Consultant for: none, Employee of:
none, Paid Instructor for: none, Speaker Bureau for: none
P93
UTERINE BLEEDING CONTROL WITH ULIPRISTAL ACETATE
T. Esteves 1,*, A. Codorniz 1, I. Matias 1, S. Mineiro 1, L. Caseiro 1, E. Pereira 1,
A. Regalo 1, F. Fernandes 1
1Hospital do Esprito Santo de vora - EPE, vora, Portugal
Problem Statement: Ulipristal acetate (UA) is a selective progesterone-receptor
modulator, currently approved for pre-operative treatment of moderate-tosevere symptoms caused by uterine leiomyomas in adult women in reproductive
age abnormal uterine bleeding (AUB), pelvic discomfort/pain and pressure
effects. The posology is 5 mg/day, for 3 months, and it can be repeated once.
UA has a direct effect in leiomyomas, reducing its volume through inhibition of
cellular proliferation and inducing apoptosis reducing the associated
symptoms within the first ten days of treatment. Therefore, besides the volume
reduction, it also provides better surgical conditions.Methods: Retrospective
study of 60 women with symptomatic uterine leiomyomas, who were proposed
to receive treatment with AU 5 mg/day, during 84 days. Subsequently, they had
scheduled appointments every three months (for 12 months), with evaluation
of treatment compliance, side effects, and uterine bleeding control.Results: Of
102
the 58 women that completed treatment, AUB was the main complain in 93,1%
(with anemia [hemoglobin <11.8 g/dL] in 35,2% of those). Four women didnt
return for any appointment; the remaining 54 had surveillance for an average of
7,54,3 months (23 are still being followed and 18 abandoned the study in
different stages). Of the patients whose main complaint was AUB, 94,4%
attained amenorrhea during treatment (74,4% within the first month); the
average duration of amenorrhea was 3,51,5 months (minimum 1, maximum 9).
The menstrual blood flow was subjectively diminished in 33,3% of the patients
that never had amenorrhea and in 60,8% of the patients who had at least one
month of amenorrhea (total of 59,3%). Non-serious adverse events occurred in
59,3% of the patients; the most common being hot flashes (22,5%),
worsening/beginning of urinary incontinence (15,5%), breast tenderness
(13,8%), irritability (8,2%) and flatulence (6,9%), most of them not needing
therapy. Endometrial thickness equal or greater than 16 mm in two subsequent
appointments was registered in 7,4% (half is still waiting for biopsy, half didnt
had pathological changes). Only 15,5% of the women needed additional therapy
for fibroids (55,6% of those had anemia that didnt improve) 6 hysterectomies
and 3 surgical hysteroscopies.Conclusion: Unlike previous medical therapies for
fibroids, that had limitations, AU appears to be an effective and safe treatment,
in controlling uterine bleeding, with acceptable non-serious adverse events. It
induces amenorrhea in most patients and, even after, subjectively diminishes
menstrual flow. Being a recent therapy and with the latest developments, there
may be potential benefits proven in futures studies.
P94
ENDOMETRIAL PATHOLOGY IN PRE-MENOPAUSAL, ASYMPTOMATIC WOMEN
I. Ferreira 1,*, E. Baptista 1, M. J. Carvalho 1, F. Falco 1, I. Torgal 1
1Centro Hospitalar e Universitrio de Coimbra, Coimbra, Portugal
Problem Statement: The aim of this study was to evaluate the type of
endometrial pathology diagnosed in asymptomatic women with abnormal
gynaecological ultrasound. Another objective is to evaluate the accuracy of
hysteroscopy in the prediction of endometrial pathology in these
patients.Methods: Retrospective study of 1103 premenopausal women that
performed office hysteroscopy between January 2009 and December 2013 at
Gynaecology A Service of Hospital and University Center of Coimbra. The
performance of hysteroscopy was described according to sensitivity (S),
specificity (E), positive predictive value (PPV) and negative predictive value
(NPV). The agreement between gynaecological ultrasound and hysteroscopic
findings with histology was evaluated using Cohen's test. Results: Concerning
premenopausal women, 68.2% (n=752) presented abnormal uterine bleeding
and 31.8% (n=351) were asymptomatic. The mean age of the premenopausal
asymptomatic group was 41.4 8.13 [20-58]; 25.1% (n=88) were nulliparous.
Analyzing the findings at ultrasonography in the asymptomatic women, 60.1%
(n=211) suggested endometrial polyps; 13.7% (=48) endometrial thickening and
9.1% (n=32) submucosal myoma. The most common diagnosis at hysteroscopy
were isolated endometrial polyps in 51.3% (n=180), isolated myomas in 6%
(n=21), anatomic malformations in 5.1% (n=18), diffuse endometrial thickening
in 3.1% (n=11), ovular remainings in 2.85% (n=10) and carcinoma in 1.1% (n=4)
patients. This exam showed no alterations in 17.7% (n=62). Regarding the
concordance between ultrasound and hysteroscopy, kappa values were
0.135, (p < .0005) for endometrial polyps; 0.265, (p < 0.0005) for myomas;
0.085, (p = n.s.) for endometrial thickening and 0.154 (p = .002) for endometrial
cancer. A histological exam was performed in 50.9% (179/351) patients. The
most common histological finding was endometrial polyp in 57.0% (n=102),
isolated myomas in 17.3% (n=31), endometrial hyperplasia without atypia in
6.1% (n=13), ovular remainings in 7.9% (n=11), carcinoma in 1.7% (n=3) and
atypical endometrial hyperplasia in 1.1% (n=2). The concordance between
hysteroscopy and histological findings was moderate, kappa values were 0.535
(p < 0.0005) for polyps; 0.509 (p < 0.0005) for myomas and 0.563 (p < 0.0005)
for carcinoma. When diagnosing polyps, hysteroscopy had a S of 86.3%, E of
66.3%, a PPV of 77.2% and a NPV of 78.5%. For myomas it presented a S of 45.2%,
E of 97.3%, a PPV of 77.8% and a NPV of 89.4%. For endometrial carcinoma, the
S was 66.7%; the E was 98.9%, the PPV was 50.0% and the NPV was
99.4%.Conclusion: Hysteroscopy detected endometrial cavity alterations in
Abstract Book
75.5% of asymptomatic women with abnormal ultrasound. Cancer diagnosis was

rare in this group (1.7%). Hysteroscopy had a good performance in predicting
the type of lesions. In general, hysteroscopy proved a good specificity and
negative predictive value, which emphasizes the utility of the exam in the
indication for surgical intervention.
P95
ADNEXIAL TORSION IN AN ADOLESCENT AGE: CASE REPORT
P.M.M. Figueiredo 1,*, C. Guerra 1, L. Gonzaga 1, M. Mesquita 1, P. Oliveira 1
1Ginecologia/Obstetrcia, Centro Hospitalar do Alto Ave, Guimares, Guimares,
Portugal
Problem Statement: The adnexal torsion is an infrequent condition but
significant cause of acute lower abdominal pain in women. Occurring mainly in
early reproductive years (changes in weigth of the adnexa) or postmenopausal
women (associated with adnexal pathology - cistadenoma). An early diagnosis
and appropriate management are important, to increase the ovarian saving
rate.Methods: We describe a case of adnexial torsion in an adolescent,
admitted in emergency room.
Results: S.R.C.S., 15 years, admitted to the emergency department with
abdominal pain in the right iliac fossa. Few days before, there was two previous
admissions of pain with lower intensity, associated with nausea and vomits. In
pelvic suprapubic sonography it was documented normal uterus, with regular
contours and homogeneous structure, normal characteristics of left ovary; retrouterine region occupied by solid, heterogeneous formation, about 70 x 85 mm
in the probable dependence of right adnexa. Analitic investigation presented
without remarks, negative PCR, -hCG and tumoral markers (AFP, CA 125, CA
19.9). In this episode, she presented with intense right abdominal pain, signs of
peritoneal irritation and was proposed to laparoscopic exploration. During the
surgery, was observed torsion of right adnexial cyst, with above 80 mm on
diameter, with congestive surface and three circunvolutions. Attempt to
untwist of the cyst and preservation of the adnexa was unsuccessful. Thus, it
was proceeded to right adnexectomy (the cist involved the entire ovary). The
uterus and left adnexa were normal. The histopathological exam revealed right
adnexa constituted by Falopian tube (with 7cm length), and ovary (with weight
of 80 g and 80 mm of major length) both showing congestive signs, with
hemorragic cystic lesions in the surface of the ovary; findings compatible with
adnexal torsion.Conclusion: The adnexal torsion of a cyst is a rare condition but
remain a differential diagnosis to consider. The arousal of acute abdominal pain
or repeated visits are some clues to the diagnosis. It must be made early as
possible, to decrease damages and aime to spare the adnexa, mainly in young
women. When not possible, a fast intervention will be extremely helpful,
reducing the spreading of the inflammatory process.
P96
THE ASSESSMENT OF QUALITY OF LIFE IN WOMEN WITH ENDOMETRIOSIS
LITERATURE REVIEW
N. Gica 1,*, G. Iancu 2, G. Peltecu 3
1Dept of Ob/Gyn, Filantropia Clinical Hospital, Dept of Ob/Gyn, "Carol Davila"
University of Medicine and Pharmacy Filantropia Clinical Hospital, Dept of
Ob/Gyn, Carol Davila University of Medicine and Pharmacy Filantropia Hospital,
Bucharest, Romania
Problem Statement: Endometriosis affects approximately 10% of
premenopausal women. We conducted a literature review aiming to evaluate
the quality of life in women with endometriosis.Methods: We specifically
assessed the impact of endometriosis on health-related quality of life, mental
and social wellbeing. PubMed/Medline, Cochrane Clinical Trials, Embase and
other online resources were search for studies published between January 2008
and January 2014. Only the studies using standardized instruments
(Questionnaires WPAI, EHP-5, EHP, SF-12, SF-36v2) were considered. We found
sixteen studies of whom only ten satisfied the inclusion criteria.Results: Healthrelated quality of life was decreased in all dimensions of the generic (SF-12,
WPAI) and specific (EHP-5) instruments. The present review confirms that
endometriosis has a significant impact on education, work, mental and social

wellbeing of affected women, despite its complex management in tertiary care
centers.Conclusion: Many studies, conducted in diferent countries, on women
with endometriosis demostrate that this pathology has a negative impact on
work productivity and health-related quality of life in affected women. In
conclusion women with endometriosis have impaired quality of life and
continue to bear the consequences of this pathology; the best instrument to
assess their quality of life and its influence on the optimal management of
endometriosis needs to be defined in future research.
P97
CORRELATION AND SIGNIFICANCE OF ATYPICAL GLANDULAR CELLS OF
UNDETERMINED SIGNIFICANCE (AGUS) PAPANICOLAU SMEAR IN AN ASIAN
POPULATION
J.C.G. Goh 1,*, R. Nadarajah 1, W. W. Lim 1, W. Cheng 1
1
Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore
Problem Statement: AGUS is a rare diagnosis, representing <1% of all
Papanicolaou smears. Compared to its squamous counterpart (ASCUS), where
the evaluation and treatment is usually straightforward, glandular lesions of the
cervix are more challenging both diagnostically and therapeutically because of
their relative rarity, lack of colposcopic findings, endocervical origin and broader
differential diagnosis. The aim of this study is to determine the clinical
implications of AGUS in our Asian population, with the intention to establish
appropriate evaluation and treatment guidelines at our institution.Methods: In
this 3-year retrospective review of all pap smears performed in our institute
from 2011 to 2013. We identified women with a cytologic diagnosis of AGUS.
Medical records were reviewed to identify patient demographic characteristics,
including age, ethnicity and menopausal status. We correlated the final
histologic correlations and performed subgroup analysis based on menopausal
status and age. Results: A total of 124 women who were diagnosed with AGUS
on Papanicolaou smear were included in our study. The mean age of our study
population was 53.4 years. The majority of women were post-menopausal
(61.3%). Final pathological diagnoses for our subjects with diagnosis of AGUS
were as follow: benign in 58.9% (n=73), pre-cancerous in 10.5% (n=13) and
malignant in 30.6% (n=38). Our analysis showed that there was a significant
relationship between postmenopausal status and final histopathological
diagnosis of malignant lesions in our subjects (RR 2.79, p=0.005). However, when
subgroup analysis was performed based on age groups, the relationship did not
prove to be statistically significant.Conclusion: Close to a third of women with
Papanicolaou smears reporting AGUS will be found to have a malignant lesions
on eventual histopathological diagnosis. Women who have post-menopausal
have higher risk of glandular lesions. The finding of AGUS on Papanicolaou
smears is significant and should be investigated further.
P98
EFFECTS OF MENOPAUSE ON THE LIFE OF WOMEN WHO EXPERIENCE HOT
FLASHES AND THEIR HEALTH-SEEKING BEHAVIOURS
S. Alan, E. Gozuyesil*, S. Gokyildiz
Cukurova University, Adana, Turkey
Problem Statement: Menopause is a natural and inevitable phenomenon which
affects all women. The menopausal period is characterized by different features
in every woman. The combination of hot flashes and night sweats, the most
typical indications of this period, are defined as vasomotor symptoms.
Vasomotor symptoms affect from 60 to 90 % of women in the menopausal and
early postmenopausal period and cause serious physical complaints. Having a
healthy menopausal period is of great importance for women. A lot of women
who do not get sufficient health care in this period develop chronic illnesses; and
inability to cope with the menopausal complaints causes negative effects on
their quality of life. Hot flashes, one of the most common menopausal
complaints, affect womens quality of life negatively. Methods: The purpose of
this study is to identify what health seeking behaviours women who experience
hot flashes use with a view to eliminating these complaints. The target
103
population of this study which is qualitative in nature is the women who applied
to Cukurova University Balcal Hospital Department of Obstetrics and
Gynaecology Menopause polyclinic. The participants were 40 women who
volunteered to participate in the study, who had the complaint of hot flashes,
and who went through menopause naturally. The data collection phase
continued until data saturation was achieved; and this phase was finished when
information repetition started. Data were collected using semi-structured
interview forms through an in-depth interview method conducted face-to-face.
The interviews were tape-recorded with the consent of the participants. Data
collected from the participants who did not want to be involved in voice and/or
image recording were written down. The data obtained from the semistructured interview form were analysed using the content analysis method, one
of the qualitative data analysis methods. Interview transcriptions were created
by transferring the interviews onto the computer. Similar groups were coded so
as to create themes; and then the data were analysed. Results: Results showed
that the quality of life of the women with the complaint of hot flashes in the
menopausal period was affected significantly; the women displayed various
health seeking behaviours, and they had expectations from both their relatives
and health professionals. In line with the data obtained, the themes emerging
from the study included negative perceptions about menopause, decrease in
quality of life, preparedness for menopause, complaints, coping, expectations
from health professionals, and expectations from family. Conclusion: This study
revealed that the quality of life of the women with the complaint of hot flashes
decreased considerably, that they made use of various practices in order to cope
with the complaints in this period, and that they could not cope with the
complaints effectively due to their lack of knowledge on the issue. It is
recommended that health professionals who provide womens health services
should help women to increase their quality of life and to cope with the
complaints effectively by providing them with the training and guidance
regarding the menopausal period and dealing with complaints during this
period.
P99
FACTORS AFFECTING ISRAELI WOMEN'S DECISION WHETHER TO DONATE
CORD BLOOD
K. Grinberg 1,*, M. Ben Natan 1 2
1Nursing, Ruppin Academic Center, Emelk Hefer, 2Nursing, Hillel Yaffe Medical
Center, Hadera, Israel
Problem Statement: Women's consent to donate cord blood is rarely obtained.
Despite Israel's high ranking in the world with regard to the number of donations
its ethnic diversity is a barrier to locating matching donations and therefore
there is still a significant lack of cord blood in Israel. Donations of cord blood may
be banked at either a public bank or a private bank. The current study will focus
on donations to the public bank in Israel. The aim of the study is to analyze
willingness to donate cord blood and the factors motivating one to donate cord
blood.
Methods: A descriptive, correlational study, employing the TPB. A questionnaire
constructed based on a literature review of research on cord blood donation and
on the TPB was administered to 207 Israeli women of childbearing age. Results:
Behavioral attitudes (womens total appraisal of cord blood donation),
subjective norms (womens perception of the opinion of significant others
regarding the specific behavior), and perceived behavioral control (womens
total appraisal of their control of the behavior and perceived ease or difficulty of
cord blood donation) were found to predict womens intention to donate cord
blood.Conclusion: It is important for the medical and nursing staff to cooperate
and to take part in workshops on the subject .Increasing the awareness of
obstetricians regarding the significance of consultations with women on
donating cord blood may lead to a significant rise in such donations in the future.
Obstetricians must be required to hold a joint consultation with both the mother
and spouse in order to explain to them about the option of donating cord blood.
104
P100
UTERINE ARTERY EMBOLIZATION AND FERTILITY, OUR EXPERIENCE
I.-A. horhoianu 1,* on behalf of "Excelis" postdoctoral individual research
project, B. Dorobat 1, R. Scaunasu 2, V. V. Horhoianu 1
1Obstetrics and Gynecology, University Emergency Hospital Bucharest, 2general
surgery, Coltea Hospital, Bucharest, Romania
Problem Statement: Uterine artery embolization is a minimally invasive
interventional radiology technique with large therapeutic aplicability in the
gynecological pathology of the fertile female patient ranging from the treatment
of fibroids, ectopic pregnancy to uterine bleeding remission. According to
general literature low level evidence has showed an increased rate of fertility
and pregnancy related complications following uterine artery embolization such
as small for gestational age infants, stillbirths, early miscarriages or postpartum
hemorrhages. Thus, it is very important to assess in a precise manner all the
uterine artery embolization consequences which might impair future fertility as
this kind of occlusion is considered a useful fertility sparing technique in many
circumstances.Methods: We conducted a retrospective evaluation of 7 such
cases gathered in our hospital during a period of time of 8 years (2006-2014)
who underwent uterine artery embolization. All the above found patients
delivered after uterine artery embolization. All necessary information regarding
the complications following embolization, the pregnancy outcome and the
pregnancy related pathology was gathered.Results: Out of the 7 cases
registered, 5 underwent uterine artery embolization for leiomyomas and 2 for
ectopic pregnancies. All the patients became pregnant and delivered in a period
of time ranging from 1 to 4 years after uterine artery embolization. The
pregnancies were uneventful with delivery by cesarian section of healthy
neonates. We discovered only one mild intrauterine growth restriction and one
low lying placenta. None of the following feto-maternal complications
mentioned in literature such as preterm delivery, postpartum hemorrhage,
malpresentations, early miscarriages, stillbirths or severe small for gestational
age infants were found.Conclusion: Associated with correct use and careful
reevaluation, embolization is an efficient conservative treatment technique
which can be used in patients without severely compromising the fertility and
pregnancy outcome. Still, higer level evidence is needed in order to attain
certainty regarding this subject as conflicting evidence is presented in literature.
P101
SEXUAL ORIENTATIONS OF WOMEN WITH POLYCYSTIC OVARY SYNDROME:
CLINICAL OBSERVATION IN TAIWAN
C.-H. Chen 1, M.-T. Hsieh2,*, C.-R. Tzeng 1, H.-Y. Chang 1
1Dept of Obs/Gyn, School of Medicine, College of Medicine, , 2Taipei Cancer
Center, Taipie Medical University Taiwan, Taipei, Taiwan
Problem Statement: Polycystic ovary syndrome (PCOS) is a commone endorcrine
disorder and a complex problem for women of various ages. The current study
aim to explore the association between sexual orientations and polycystic ovary
syndrome (PCOS)-related parameters.Methods: A cross-sectional study method
with participants recruited from the regular outpatient clinic at the department
of Obstetrics and Gynecology at Taipei Medical University Hospital Taiwan
between July 2012 and December 2013 was carried out. A total of 97 women
met the criteria to diagnose PCOS. Among these 97 women, 89 were
heterosexual and 8 were self-identified as lesbians. At the same time, 78 women
without PCOS were collected for the control group. Participants were given a
standard questionnaire and had blood withdrawn for the biochemistry
measurement on androgen parameters (including total testosterone [T],
androstenedione [A4], sex hormone binding globulin [SHBG], and free androgen
index [FAI]), 17-estradiol (E2), luteinizing hormone (LH), and follicularstimulating hormone (FSH). Biochemistry data was measured to compare the
PCOS clinical parameters present in people of different sexual orientations
(lesbians and heterosexuals). Results: PCOS women, regardless of sexual
orientations had higher percentages and serum levels of hyperandrogenismrelated clinical (acne [87.5% and 60.7% vs. 23.1%], p <0.001) and hirsutism
[62.5% and 57.3% vs. 15.4%, p0.001]) and biochemical parameters (total T,
p<0.05 or 0.001, and LH/FSH ratio, p0.001) than non-PCOS controls did. Sexual
Abstract Book
orientations in women with PCOS affected womens body mass index (BMI),
since lesbians with PCOS possessed higher BMI than PCOS women with
heterosexuality did (26.51.9 vs. 22.50.55; p<0.05), although
hyperandrogenism-related clinical and biochemical parameters were not
statistically significantly different between these 2 different sexual orientations
of women with PCOS.Conclusion: Our preliminary data showed that high rates
of lesbian were found among the PCOS patients collected at this study and sexual
orientations influenced on the BMI of women with PCOS, but did not
significantly affect hyperandrogenism-related clinical or biochemical
characteristics in Asian.
P102
THYROID STIMULATING HORMONE IS THE MAJOR PREDICTOR FOR INSULIN
RESISTANCE IN NON-OBESE WOMEN
M.-I. Hsu 1,*, S.-H. Shen 2
1OIbs/Gyn, 2Taipei Medical University - Wan Fang Hospital, Taipei, Taiwan,
Province of China
Problem Statement: Body mass index (BMI) is the major indicator to predict
insulin resistance in obese women, however, the risk factors of insulin resistance
in non-obese women remains debatable.Methods: The homeostasis model
assessment insulin resistance index (HOMA) was used as indicator of insulin
resistance. A total of 268 non-obese women (BMI <25) were classified as two
subgroups, 99 women with insulin resistance (IR (+); HOMA >2.14) and 169
women without insulin resistance (IR (-); HOMA <=2.14) were evaluated and
compared. Results: There is no difference in age (26.97.0 vs. 26.85.9; p=0.929)
and BMI (20.71.9 vs. 20.51.7; p=0.293) between IR (+) group and IR (-) group.
Although IR (+) group associated with higher risk of metabolic syndrome than IR
(-) group, the prevalence of polycystic ovary syndrome (PCOS), premature
ovarian failure (POF), and hyperprolactinemia were no difference between IR (+)
and IR(-) group. IR (+) group presented with higher serum triglycerides (mmol/L;
0.850.69 vs. 0.670.31 p=0.003), LDL (mmol/L; 2.830.77 vs. 2.580.75,
p=0.008) and lower serum HDL (mmol/L; 1.540.34 vs. 1.680.39; p=0.003)
levels than IR (-) group. Sex Hormone-binding globulin (SHBG), high sensitivity Creactive protein (hs-CRP), Anti-Mllerian hormone (AMH), serum total
testosterone,
androstenedione,
free
androgen
index,
and
dehydroepiandrosterone sulfate (DHEA-S) were no difference between IR (+)
group and IR (-) group. Multivariate regression was used to evaluate the
association of HOMA with age, BMI, testosterone, AMH, hs-CRP, SHBG, and
thyroid stimulating hormone (TSH); results revealed that TSH is the only
predictor of insulin resistance in non-obese women.Conclusion: Non-obese
women with insulin resistance presented with higher prevalence of metabolic
syndrome and lipid dysfunction. However, the prevalence PCOS, POF and
hypderprolactinemia did not significantly differ in non-obese women with or
without insulin resistance. Serum TSH level is the major predictor for insulin
resistance in non-obese women.
P103
THE APPROACHES OF EFFECTIVE ANTIRECURRENT TREATMENT OF UTERINE
FIBROIDS
V. Radzinsky 1, V. Khorolsky 2,*
1Peoples friendship university of Russia, Moscow, 2Kuban State Medical
University, Krasnodar, Russia
Problem Statement: Uterine fibroids are the most common nonmalignant
hyperplastic diseases in women during the reproductive period. Before fibroids
was the most common indication for hysterectomy. Modern surgical techniques
provides reservation of reproductive organ, save fertility. Fibroids can
complicate by menorrhagia, different menstrual disorders, but at least 50%
remain asymptomatic. Despite of symptoms fibroids may impair fertility or cause
miscarriage. Conservative myomectomy is the unique treatment for women of
reproductive period. Therefore its very important to prevent recurrence of
fibroids by individual antirecurrent treatment. To evaluate efficiency of
antirecurrent pharmacotherapy of fibroids in women of reproductive period

after conservative myomectomy the comparative investigation were performed.
Objective: To compare the effectiveness of different pharmacological
antirecurrent treatment of uterine fibroids after conservative myomectomy in
women of reproductive age.Methods: Were examined 75 women, average age
32,43,1 years, duration disease (fibroids) 4,291,5 years (2-7 years). Before
conservative myomectomy diameter of fibroids 45,8220,76 mm, after
16,552,56 cm. Number of fibroids/per woman 5,182,5. Pharmacotherapy
were provided with agonists of GnRH agonists, levonorgestrel intrauterine
device (LNG-IUD), antigestagens.Results: GnRH agonists provide decrease of
volume of uterus on 30% (from 325,416,2 cm3 to 227,810,1 cm3), number of
fibroids nodes (from 5,452,53 to 2,541,36), diameter of dominant node (from
18,140,45 cm to 12,290,28 cm). LNG-IUD provide decrease of volume of
uterus on 20% (from 312,415,0 to 252,58,8 cm3), number of fibroids
nodes (from 4,872,7 to 2,271,9), diameter of dominant node (from15,570,4
m to 11,570,22 m). Antigestagens provide decrease of volume of uterus on
20% (from 315,09,0 to 250,610,0 cm3), number of fibroids nodes (from
4,872,7 to 2,271,9), diameter of dominant node (from16,220,55 m to
12,870,5 m).Conclusion: No significant deferens of efficiency depended from
type of pharmacotherapy was found. During the ntirecurrent treatment of
uterine fibroids required noninvasive (ultrasound) monitoring the effectiveness
of treatment: rectovaginal examination; transabdominal and transvaginal pelvic
ultrasound; blood flow study of the myometrium and fibroid (IR, MAC, V1, F1,
VF1, uterine volume, the amount of nodes). When the negative dynamics or lack
of positive dynamics in the first month necessary to decide to change of
pharmacotherapy.
P104
THE VIVEVE PROCEDURE IS A NON INVASIVE INTERMEDIATE OFFICE BASED
INTERVENTION THAT IMPROVES VAGINAL INTROITAL LAXITY AND IMPROVES
SEXUAL FUNCTION.
M. L. Krychman*
Southern California Center for Sexual Health, Newport Beach, USA
Problem Statement: Many women report sexual complaints as a direct result of
changes in the integrity of vaginal introitus. This may happen as a direct result
of genital aging, childbirth or other pelvic trauma. Present treatment options
include behavioral pelvic floor muscle training, which has limited success, and
invasive surgical intervention, which is costly, and has serious complications with
variable success rates in improving sexual function. An intermediate, noninvasive, non-surgical procedure, such as the Viveve Procedure, offer women
reporting this condition an alternative to less successful and highly invasive
procedures. Methods: The Viveve System is a safe, effective, office based
treatment for Vaginal Introital laxity that has demonstrated the ability to
improve laxity and sexual function in adult female subjects. The Viveve System
is a monopolar radiofrequency (RF) system that uses surface cooling and (RF)
energy delivery to provide a non-surgical and minimally invasive approach.
During the Viveve Procedure, coolant is delivered to the membrane of the Viveve
treatment tip. Then the application of RF energy create a reverse thermal
gradient, which gently heats the deeper tissue while the coolant protects the
surface epithelium.Results: To date, over 300 procedures have been performed
in the US, Canada, Japan and Hong Kong). Two clinical studies and multiple preclinical and histological studies have demonstrated safety and efficacy. Further
randomized, sham-controlled trials are planned for this office-based, 20-30
minute procedure which is gaining popularity amongst health care professionals
and womenConclusion: The Viveve Treatment is a viable non surgical
treatment for women who have sexual complaints as a result of vaginal introital
changes in the genitopelvic matrix. Research supported by Viveve, Inc.,
Sunnyvale, CA
Disclosure of Interest: M. Krychman Consultant for: Bayer, Shionogi Inc, Pfizer,
Palatin, Noven Therapeutics, Viveve, and Sprout Pharmaceuticals, Speaker
Bureau for: Noven, Pfizer and Shionogi
105
P105
ATYPICAL PELVIC MASS - AN INCIDENTAL FINDING DURING ROUTINE
EVALUATION
J. Lisboa*, D. Freitas, P. Alves, O. Soares
Centro Hospitalar Trs-os-Montes e Alto Douro, Vila Real, Portugal
Problem Statement: Pelvic masses are common in women of all ages. These, may
be gynecologic as well as non-gynecologic in origin and may be detected during
a routine gynecologic exam, found upon examination of a specific complaint, or
found incidentally during radiologic evaluation of the pelvis.
Pathology in this area may arise from the uterus, adnexa, bowel,
retroperitoneum or metastatic disease.
The principal goals of the evaluation are to address acute conditions and to
determine whether a mass is malignant.Methods: During a routine gynecologic
evaluation of a 41-year-old female, with no relevant medical history, was
performed a pelvic ultrasound that revealed a 4cm, solid well defined pelvic
mass with mixed echogenicity in the paraspinal region with no further
pathology. The CT scan showed a 44mm pre-sacral mass, with no apparent
relationship with the uterus, in intimate relation with the left S2 foramen.
The patient was operated with extemporaneous examination, with total excision
of the mass. Histology showed a well circumscribed spindle-cell tumor, S100
immunohistochemistry was positive.Results: The final diagnosis was
Schwannoma.Conclusion: The goal of the evaluation of a patient with an adnexal
mass is to determine the most likely etiology of the mass. This process is often
challenging and a definitive diagnosis often requires a surgical evaluation.
With this case report the authors aim to demonstrate that in the gynaecologic
evaluation of a patient with a pelvic mass is important to exclude rarer cases
such a Schwannoma.
P106
THE IMPLEMENTATION OF ROBOTIC SURGERIES IN ISRAEL.
A. F. Matanis *, S. Bolous
OB/GYN, Rambam Healt Care Campus, Haifa, Israel
Problem Statement: Introduction: During the last decade the numbers of robotic
devices and of the medical procedures utilizing them have increased significantly
around the world.
Aims: To evaluate the implementation of robotic surgeries in Israel in various
surgical disciplines.Methods: A retrospective study accessing information about
the annual purchases of robots, the number of physicians trained for their use,
and the number of robotic surgeries performed each year, according to
indications of surgery and the disciplines of the operating medical staff. The data
were taken from the database of Intuitive Surgical Inc.Results: Six robots were
purchased by six medical centers in Israel during the years 2008-2013. There are
currently 150 doctors trained to use the robot in one of the simulators of
Intuitive Surgical Inc. Of them, 104 are listed as active robotic surgeons. Most
are urologists, gynecologists, or general surgeons. The number of robotic
surgeries increased each year in all fields in which it has been implemented. In
2013, 975 robotic surgeries were performed in Israel. Of them, 52% were
performed by urologists; 80% of which were radical prostatectomy.Conclusion:
The use of robotic surgery increased considerably in Israel over recent years, in
urology, gynecology, general surgery, and otolaryngology. Despite the lack of
conclusive evidence of the advantages of robotic surgery over the laparoscopic
approach, the market power and the desire to be at the technological forefront,
drive many medical centers to purchase the robot and to train physicians in its
use.
P107
EXTRA-PULMONARY TUBERCULOSIS A CLINICAL CASE OF GENITAL DISEASE
B. S. Melo*, N. Maciel, A. Pereira
Ginecologia/Obstetrcia, Hospital Divino Esprito Santo - Ponta Delgada, Ponta
Delgada, Portugal
106
Problem Statement: Tuberculosis is an infectious disease associated to an

elevated morbility and mortality, especially in developing countries.
Pulmonary affection is the usual form of presention, but it can be manifest as
extra-pulmonary.Methods: Description of a clinical case of genital
tuberculosisResults: 34 years-old women, admitted to the urgency with
asthenia, fever, dry cough with three weeks of evolution. In her personal history
there was a secondary infertility that was studied three months earlier by
hysterossalpingography, revealing tubal obstruction. On examination, she was
emaciated, pale, sub-febrile, and tachycardic, with decresead breath sounds on
the right. Abdominal palpation identified a bulky abdominal mass occupying
hypogastric and periumbilical areas. Laboratory tests showed leukocytosis and
elevated C-reactive protein. The CT scan revealed a large mass with 13*11*8 cm
in size and tubular images filled by water content and gas, suggesting tuboovarian abscess. An exploratory laparotomy was performed and revealed a
pelvic mass with spontaneous purulent discharge. During the surgery the right
ovary and tube were removed and sent to pathological examination. The
hospitalization lasted 15 days, under antibiotics. Blood cultures, urine and pus
results were negative. The pathological examination revealed necrotizing
epithelioid granuloma of tuberculoid type. Molecular biology was positive for
Mycobacterium tuberculosis complex DNA. Due to this result the patient was
referred to infectious diseases consultation.Conclusion: Genital tuberculosis
accounts for about 15-20% of extra-pulmonary tuberculosis. The hematogenous
pathway is the main form of spread. Clinically it can be manifested by infertility,
pelvic pain, amenorrhea or vaginal bleeding. The most affected organ is the
fallopian tube, but all female genital tract can be affected. Presentation as tuboovarian abscess is extremely rare. The diagnosis is difficult and, in this case, it
was suspected based on pathological features. The introduction of molecular
biology tecnics with elevated sensivity and specificity came to improve and to
accelerate this diagnosis. The patients are treated with anti-bacilary drugs for a
period of 6-9 months. Surgical treatment is reserved to particular cases.
P108
SURGICAL MANAGEMENT OF INTRA-UTERINE DEVICE COMPLICATIONS
T. Meneses 1,*, A. I. Machado 2, C. Marques 2
1
Gynecology, Maternidade Dr. Alfredo da Costa, Lisbon, 2Gynecology,
Maternidade Dr. Alfredo da Costa, Lisbon, Portugal
Problem Statement: IUDs are one of the most effective and long-lasting
contraception methods available. They can, however, lead to complications
including non-visible strings, dislocation or uterine perforation. All of these
require surgical intervention, with previous determination of IUD location by
ultrasound or pelvic X-Ray. Methods: This was a retrospective study of 32 cases
of IUD complications requiring surgical intervention in our Center, between
January 2007 and December 2013. Clinical databases were searched to assess
age at diagnosis, time elapsed between placement and diagnosis, type of IUD,
presence of complications and chosen procedure for removal.Results: We
identified 17 cases regarding copper IUDs and 15 cases envolving levonorgestrelreleasing intrauterine systems. Mean age at diagnosis was 40,5 years (10,43),
with most patients being multiparous (90,9%). In 75% of patients, diagnosis was
suspected to due IUD strings not being visible on speculum examination in
asymptomatic women. Mean time elapsed between placement and removal of
IUD was 5 years and 4 months, with greater intervals for copper IUD when
compared to LNG-releasing IUS (8 years vs. 1 year). In cases of suspected uterine
perforation, mean time elapsed was significantly shorter than in cases without
this complication (51 days vs. 6.8 years). The procedure of choice for removal
was hysteroscopy (66,7%), followed by exploratory laparoscopy (30,3%). There
were no cases of pregnancy or severe complications.Conclusion: With little or no
symptoms for IUD complications, a high suspicion ndex remains the key to
correct diagnosis. Time elapsed between IUD placement and diagnosis of
complications depends on the type of IUD, presence of symptoms and final IUD
location (uterine cavity vs. abdominal cavity). In most cases hysteroscopy is the
best procedure for retrieving IUD, but laparoscopy will be necessary in cases of
confirmed uterine perforation. Disclosure of Interest: None Declared
Abstract Book
P109
PREGNANCY AFTER TUBAL STERILIZATION 14 YEARS AGO: A PAINFUL
SURPRISE
S. Mineiro 1,*, A. Toller 2, A. Codorniz 3, J. Carvalho 3
1
Gynecology and Obstetrics, Esprito Santo Hospital, vora, 2Hospital de
S. Francisco Xavier, Lisboa, 3Hospital Esprito Santo vora, vora , Portugal
Problem Statement: Surgical sterilization is a safe, highly effective, permanent,
and convenient form of contraception. It can be performed postpartum,
postabortion or in conjunction with another surgical procedure. Performance of
the procedure postpartum or during the menstrual or proliferative phase of the
cycle reduces the chance of pregnancy at the time of the procedure. The
technique differs and can be achieved by laparoscopy and postpartum
sterilizations are done by minilaparotomy or per caesarean section. The
advantages of the laparoscopic procedure include decreased operative time, less
postoperative pain, shorter hospital stay, and more rapid return to normal
functional activities.Methods: The authors report a case of a healthy 42 aged
woman that went to the Hospital emergency department due to acute severe
abdominal pain in lower quadrant, more precisely in the right iliac fossa. The last
menstruation has been two months ago (68 days of amenorrhea) and sparse
vaginal bleeding was present. Despite the patient has undergone tubal ligation
during caesarean section 14 years ago (modified Pomeroy technique), the
immunological pregnancy test was surprisingly positive. The clinical
presentation revealed a painful abdomen, left shoulder pain and dolorous culde-sac assessment at gynecological examination.Results: Clinical suspicion of
ectopic pregnancy was raised and the diagnosis was confirmed by transvaginal
sonography. The main findings were thick endometrium, hemoperitoneum and
right adnexal Doppler ring containing a yolk sac and embryo with cardiac activity
(Crown Rump Length-7.2 mm). Surgery block was immediately informed about
laparotomy approach.During surgery we could state a great hemoperitoneum
with an ectopic pregnancy in the right ampullary portion. Right partial
salpingectomy and peritoneal toilette were performed.Conclusion: Pregnancy is
uncommon after tubal sterilization but when it does occur, the risk that it will be
an ectopic pregnancy is increased over that in the general population. Resection
methods failed most frequently because of spontaneous reanastomosis or
fistula formation. Operator failure occurred when the occluding device was
placed on the round ligament or mesosalpingeal veins. It also can be associated
with a suboptimal location of the tubal occlusion, incomplete closure of a clip or
incomplete encapsulation of the tube and lumen, increasing the likelihood of
spontaneous regeneration of the tubal lumen.
P110
MYOMA FIBROID EXPULSION AS FLESHY TISSUE DEBRIS AFTER THE UTERINE
ARTERY EMBOLIZATION: A CASE REPORT AND LITERATURE REVIEW
O. A. Mynbaev 1,*, M. Medvediev 2 and The International Translational
Medicine & Biomodeling Research Team
1Laboratory of cellular and molecular technologies, Moscow Insririute of Physics
and Technology, Dolgoprudny, Russia, 2Obstetrics and Gynecology, State
Establishment Dnepropetrovsk Medical Academy of Health Ministry of
Ukraine, Dnepropetrovsk, Ukraine
Problem Statement: The uterine artery embolization (UAE) has become as an
accepted minimally invasive treatment with established safety, and efficacy as
well as outcomes with adverse events. We report a case presenting UAE with
repeated sloughing of fibroid as fleshy tissue debris followed successful
spontaneous pregnancy and term delivery with healthy newborn without
complications supplemented with a literature review.Methods: Case report. The
review inclusion criteria were as follows: all articles described repeated
sloughing of fibroid as fleshy tissue debris following UAE or case reports with
confirmed diagnosis of this condition from PubMed and other
databases.Results: Case report: A 34-year-old woman G2P0A2 was admitted to
the hospital because of severe regular painful uterine bleedings with
pronounced hemorrhagic anemia (Hb 7-8 g/dl). Her periods have lasted 7-10
days with average menstrual blood loss 1(MBL) 028 points according to the
pictorial blood assessment chart (PBAC) for 12 months. Bimanual examination
revealed a slightly enlarged painful uterus. The submucous fibroid (D6 cm)
localized within posterior uterine wall (type 2 by Wamsteker classification) was
registered by US and confirmed by MRI (Fig 1). The selective bilateral UAE was
performed by the standard technique through right femoral artery (Fig. 2). The
efficacy of UAE was monitored by injection of contrasting solution into the
internal iliac arteries which presented a stagnation of embolization particles into
the uterine blood vessels and capillaries with blocking them. The patient has
complained on fever up to t 38,5 C, lower abdomen pain and mild nausea during
first two days after surgery, which was treated symptomatically with intravenous
infusion of Ringer's lactate solution, oral hydration therapy and meloxicam 7,5
mg. Patient was discharged on postoperative day 2. MBL has dropped
sufficiently after the procedure. Patient reported progressively decreased
menorrhagia from baseline to 3, 6 and 12 months after UAE respectively 1028,
256, 124 and 88 according to PBAC score. A decreased MBL was accompanied
by significantly increased values of blood parameters: hemoglobin, hematocrit,
mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular
hemoglobin concentration. In 3 months after UAE patient started to complain
on vaginal discharge as fleshy tissue debris with larger size up to 2 cm with an
unpleasant odor irrespectively of menstruations and during menses, which had
lasted during 6 months of follow-up. Histological examination of tissue
debris confirmed purulent necrotic leiomyoma tissue residues. A slight
deformation of posterior uterine wall was noted in sagittal MRI after 6 months,
whereas uterine wall was completely free from fibroids on US during both follow
up evaluation at the 6th and 12th months after UAE. Patient conceived
spontaneously at the 18th month after UAE. Her pregnancy was ended by a
vaginal term delivery with 3340 g male newborn. A postpartum hemorrhage
volume was 200 ml, without further complications. Fig. 1. MRI, T2: Submucous
6 cm fibroid, type 2, located within posterior wall. a). An axial view in T2. b). A
sagittal view in T2. Angiography of pelvic left uterine artery embolization (UAE)
through catheterization of a right femoral artery. c). before; d). after.Image /
Graph:
Conclusion: In conclusion, more cases need to be collected and analyzed

regarding this type of rare post-UAE outcomes to make the appropriate
treatment options of this condition.
Disclosure of Interest: O. Mynbaev Shareholder of: none, Grant / Research
support from: This work was supported by the Russian Science Foundation grant
14-31-00024, Consultant for: none, Employee of: none, Paid Instructor for:
none, M. Medvediev: None Declared
P111
THE EFFECT OF VAGINAL DOUCHING CESSATION ON VAGINITIS
F. Okumu 1,*, N. Demirci 2
1Department of Midwifery, Istanbul Medipol University, 2Department of
Nursing, Marmara University, Istanbul, Turkey
Problem Statement: Vaginal Douching (VD) to the practice of washing the vaginal
canal with a fluid by using a finger, hose or cloth. Various contribution of the
literary wealth in this field point it out that vaginal douching has many negative
effects, such as the increasing of the risk of PID, infertility, ectopic pregnancy and
premature birth. These negative effects are known to be the complications of
vaginal infections. This study was carried out to determine the effect of vaginal
107
douching cessation in women with vaginitis on the recovery.Methods: This is a

follow-up research conducted in southern Turkey. It focused on women
diagnosed with vaginitis. The participating women were divided into two groups,
one of which performed vaginal douching while the other did not. A subgroup of
the douching women were informed on the subject and instructed to stop VD.
Women were asked to undergo a vaginal examination 3 months later. The
women that had ceased performing vaginal douching were considered as the
experimental group of this study, the ones continuing to perform VD as the 1 st
Control Group and those non-douching as the 2nd Control Group.
The Patient Monitoring Form (PMF) and Inventory of Genital Hygiene Behaviors
(IGHB) were used to collect data. The vaginal examination was performed
through a speculum and a smear was taken for Pap-test. Consent of the Faculty
of Medicine's Ethical Commission was taken for this study.Results: The study
subjects presented to the outpatients with symptoms of vaginal discharge,
dyspareunia, itching, lower abdominal pain, bad vaginal odor, dysuria and
irritation. 62.2% of the women had grayish-white discharge and 14.2% had curdlike discharge on pelvic examination. The Pap-smear slides showed mild
inflammation in 33.8%, moderate inflammation in 48% and severe inflammation
in 18.2%. There was no statistically significant difference between the
experimental and control groups in terms of the participants vaginal symptoms,
or pelvic examination and microscopic examination results in phase 1.
In our study, 86% of women who were trained stopped performing VD. A
statistically significant decrease was found in all groups regarding the itching,
irritation, and dyspareunia symptoms (p<0.05). Although there was a statistically
significant decrease regarding bad vaginal odor and lower abdominal pain
symptoms in douching observation and douching cessation groups (p <0.05), no
change was present in the non-douching group when compared to phase I
(p>0.05).
Females with no inflammation on microscopic examination were concluded to
have recovered. A statistically significant difference was found between the
experimental group and 1st control group in terms of improvement (p=0.018)
while there was no statistically significant difference with the 2 nd control group
(p>0.05).Image / Graph:
P112
POSSIBILITYTOPRESERVEREPRODUCTIVNESS OF THE WOMAN WITH BIG SIZES
UTERINE FIBROID
G. Omarova *
Department of Obstetrics and Gynecology #1, Asfendiyarov Kazakh National
Medical University, Almaty, Kazakhstan, Almaty, Kazakhstan
Problem Statement: In literature they constantly keep discussing the subject
about the size of fibroidnodes under which it is possible to do myomectomy by
laparoscopic method. According to the majority authors opinion, the size of
node shouldnt exceed 8-10 cm.Methods: The surgery of 25.04.2013:
Laparoscopy, myomectomy, dranaigeofabdominalcavity.
The uterus is enlarged up to 14 weeks due to multiple subserous-interstitial
fibroid lesions. From the bottom of uterus closer the left corner there is visible
subserous fibroid node, size 11x12x13cm on the wide base, on the front wall of
the uterus there are 2 interstitial nodes, diameters 2 cm and 4 cm, on the back
surface of the upper one-third of uterus there is 1 interstitial node, diameter 6
cm.Fallopian tubes are without any pathology, ampulla parts are free. The
ovaries are of the regular sizes, without peculiarities.The myomectomy of 4
nodes was carried out. The vicryl sutures were put in on the myoma nodes bed.
Full hemostasis. Blood loss 250,0 ml.Morcellum: myoma nodes were removed.
The small pelvis drainage.Removedmorcellatedsubserosalfibroidlesions. Total
weight 1080 g.Results: Leiomyoma, fibroidThe pregnancy occurred after 9
monthsagaist the background of pre-gravidal preparation with gestagens
(didrogesteron).Ultrasound examination of 08.08.2014- Making progress
pregnancy of 32 weeks.Image / Graph:
Conclusion: The results indicate that VD cessation reduces the risk of vaginal
inflammation. Raising the awareness of women by informing them about the
negative effects of VD will decrease the performing of this practice. The
development of education programs that focus on the practices of female
genital hygiene habits and instruct on the abandonment of harmful practices like
VD as well as the adoption of appropriate behaviors may decrease the rates of
vaginitis. Disclosure of Interest: None Declared
Conclusion: This clinical case demonstrates the fact that the laparoscopic
myomectomy allows to preserve the reproductive function even with big sizes
fibroid nodes.
108
Abstract Book
P113
POSSIBILITY TOP RESERVE REPRODUCTIVNESS OF THE WOMAN WITH BIG
SIZES UTERINE FIBROID
G. Omarova,*
Kazakh State Medical University Asfendiarova, Almaty, Kazakhstan
Problem Statement: Inliteraturetheyconstantlykeepdiscussing the subject about
the size of fibroidnodes under which it is possible to do myomectomy by
laparoscopic method. According to the majority authors opinion, the size of
node shouldnt exceed 8-10 cm.Patient S., 31 years, was hospitalized
routinely24.04.2013 (ase report7112). She had complaints on the heavy
vaginal bleeding, dragging pain in the lower part of abdomen,secondary
infertility during the last 2 years.GTPAL score is 21102: G - number of pregnancy,
T number of full term pregnancies, P premature birth, A - number of
spontaneous or induced abortions, L - number of children (born alive or
living).2002 premature birth, baby body mass 1500,0 g, died.2005 delivery
at term, baby body mass 4200,0 g.Uterine leiomyoma was diagnosed in 2011,
the patient refused from hysterectomy many times, wishing to keep the
reproductive function.Ultrasound examination (20.03.2013): the uterus is ball
shaped, length 7,2 cm, thickness 7,9 cm, width 9,2 cm. The thickness of
functional layer is 3 mm. There were several nodes visualized, including 1
subserous node with sizes 11,3x12,1x13,0 cm at the bottom of the uterus, and 3
interstitial nodes, 2 of them on the front-side wall of the uterus and 1 node on
the back surface,sizes: 5,7x4,7; 1,8x2,2 and 4,2x4,0 cm respectively.
Methods: The surgery of 25.04.2013: Laparoscopy, myomectomy,
dranaigeofabdominalcavity.The uterus is enlarged up to 14 weeks due to
multiple subserous-interstitial fibroid lesions. From the bottom of uterus closer
the left corner there is visible subserous fibroid node, size 11x12x13cm on the
wide base, on the front wall of the uterus there are 2 interstitial nodes,
diameters 2 cm and 4 cm, on the back surface of the upper one-third of uterus
there is 1 interstitial node, diameter 6 cm.Fallopian tubes are without any
pathology, ampulla parts are free. The ovaries are of the regular sizes, without
peculiarities.The myomectomy of 4 nodes was carried out. The vicryl sutures
were put in on the myoma nodes bed. Full hemostasis. Blood loss 250,0
ml.Morcellum: myoma nodes were removed. The small pelvis drainage.
Results: Leiomyoma, fibroid. The pregnancy occurred after 9 monthsagaist the
background
of
pre-gravidal
preparation
with
gestagens
(didrogesteron).Ultrasound examination of 08.08.2014- Making progress
pregnancy of 32 weeks.Conclusion: This clinical case demonstrates the fact that
the laparoscopic myomectomy allows to preserve the reproductive function
even with big sizes fibroid nodes.
P114
EVALUATION OF THE RELATIONSHIP BETWEEN FOOD CRAVING AND
DEPRESSION IN PREGNANT WOMEN
K. Ozdemir 1,*, S. Sahin 2, A. Unsal 3
1Sakarya University, School of Health, Sakarya, 2Yildirim Beyazit University,
Faculty of Health Sciences, Ankara, 3Eskisehir Osmangazi University, Public
Health, Eskisehir, Turkey
Problem Statement: This study was conducted to determine frequency of food
craving in pregnant women, to review some factors that are believed to be
associated and to evaluate depression level.Methods: This is a cross-sectional
study conducted on pregnant women who applied to Sakarya Training and
Research Hospital from 25 March 2013 to 25 May 2013. The study group
consisted of 363 women (46%) who agreed to take part in the study out of 782
pregnant women who applied to pregnancy follow-up polyclinic of the hospital
based on the records of Sakarya Training and Research Hospital. A questionnaire
form prepared by using the literature in line with the study objective was used
to collect data. The questionnaire consisted of the questions of depression scale,
some socio-demographical characteristics, presence of food craving and some
factors that are believed to be associated. The women who agreed to take part
in the study were discussed in the waiting room of the pregnancy follow-up
polyclinic. Previously prepared questionnaires were completed by the pregnant
women under supervision. In this study, those who replied yes to the question
"Have you craved/do you crave for any food during your pregnancy?" were
regarded to have a history of food craving. Beck Depression Inventory was used
to evaluate the presence of suspected depression. Individuals with a score of 17
and above from this inventory were regarded to have suspected depression. Chisquare test was used for data analyses. Statistical significance level was accepted
as p < 0.05.Results: The age of women in the study group ranged from 17 to 49
with a mean age of 29.10 6.14 years. The number of pregnant women with a
history of food craving was found to be 260 (71.6%) in our study. Of the pregnant
women with a history of food craving, 38 (14.6%) reported craving for clay/soil,
79 (30.4%) reported craving for pickle/lemon, 20 (7.7%) reported craving for
chocolate, 71 (27.3%) reported craving for desserts, 11 (4.2%) reported craving
for pastry and 41 (15.7%) reported craving for other foods. More than half of
pregnant women (n=177; 68.1%) reported that they craved in the evenings and
at night. Food craving was most frequently reported in third month of pregnancy
and least frequently reported in first month of pregnancy (p < 0.05). In our study,
frequency of food craving was determined to be higher in those working actively
in an income-generated job, with good family income level, who consume
chocolate, who used drug during pregnancy, who used no contraceptive method
before pregnancy, with a history of chloasma in pregnancy, with a history of food
craving in previous pregnancies, with a history of food craving in before
pregnancy, with a family history of food craving in pregnancy and with obesity
(p < 0.05 for each). The number of women with suspected depression was found
to be 72 (19.8%) in this study. Frequency of food craving was determined to be
higher in those with suspected depression (p < 0.05).Conclusion: Food craving is
a common problem in pregnant women. The food which is the most craved
during pregnancy was pickle/lemon followed by desserts and clay/soil.
Frequency of suspected depression was higher in those with a history of food
craving. It may be advantageous to perform depression screens in pregnant
women and to refer suspected cases to advanced centers for definitive diagnosis
and treatment.
Key words: Pregnancy, food craving, depression
P115
XANTHOGRANULOMATOUS SALPINGO-OOPHORITIS MIMICKING AN
OVARIAN MALIGNANCY A SERIES OF 3 CASES AND REVIEW OF LITERATURE
S. Y. Pang*, I. Madan
Department of Obstetrics & Gynaecology, KKH, Singapore, Singapore
Problem Statement: Xanthogranulomatous salpingo-oophoritis is an uncommon
form of chronic inflammation manifesting in the genito-urinary tract with
symptoms and radiological finidings which mimic ovarian malignancy or severe
pelvic inflammatory disease (PID).
Methods: We describe three cases of xanthogranulomatous salpingo-oophoritis
diagnosed in our hospital and explore available literature on the risk factors,
clinical features, diagnostic pitfalls and treatment of this condition.
Results: There are three cases of salpingo-oophoritis identified in literature and
a total of 23 cases with the inclusion of isolated salpingitis or oophoritis. The age
of patients range from 19-84. Risk factors described include endometriosis,
leiomyoma, inadequately treated PID, IUCD in situ, and previous abdominal
surgery. Most women had abdominal pain, fever and adnexal mass on
examination. Ultrasound and radiological findings suggested the presence of
complex cystic adnexal masses for nearly all cases. One report suggested that
there may be characteristic findings on magnetic resonance imaging (MRI). Most
women were treated based on the working diagnosis of malignancy or PID
disease and underwent staging surgery, often with bilateral salpingooophorectomy. Intra-operative frozen-section was performed for two patients.
In three patients, immunohistochemical stains were performed on
postoperative histological samples. Our first patient is a 45-year-old nulliparous
lady with diabetes mellitus, previous appendicectomy and uterine leiomyoma
who presented with abdominal pain and fever. She was treated as having PID
and underwent total hysterectomy with bilateral salpingo-oophorectomy. The
second patient is a 51-year-old lady who had 2 previous Caesarean sections, who
presented similarly. She underwent total hysterectomy with bilateral salpingooophorectomy. The last patient is a 35-year-old nulliparous lady who had
dysfunctional uterine bleeding with a complex adnexal mass. She underwent a
109
diagnostic laparoscopy which resulted in left salpingo-oophorectomy.

Intraoperative frozen section was performed for all three women.
Conclusion: Xanthogranulomatous salpingo-oophoritis is a rare condition that is
often mistaken for ovarian malignancy clinically and radiologically. Salpingooophorectomy is the recommended treatment but most women are over
treated with operations such as hysterectomies that render them infertile. The
presence of fever, abdominal pain, identifiable risk factors, MRI characteristics
and the use of intra-operative frozen-section may aid in the diagnosis.
P116
SINGLE-PORT (GROVE PORT) LAPAROSCOPIC HYSTERECTOMY WITH
EXTRACORPOREAL VAGINAL CUFF CLOSURE VERSUS CONVENTIONAL
LAPAROSCOPIC HYSTERECTOMY WITH INTRACORPOREAL VAGINAL CUFF
CLOSURE
Y. S. Lee, I. Jung, E. Park,*
Obstetrics and Gynecology, The catholic university, Daejeon ST. Mary's
Hospital, Daejeon, Korea
Problem Statement: The objective of this study was to evaluate surgical
outcomes and complication rates between single-port and three-port
laparoscopic hysterectomy with different suture technique of vaginal cuff using
conventional straight instruments.Methods: 75 patients who underwent singleport laparoscopic hysterectomy with extracorporeal suture technique and 75
patients who underwent conventional laparoscopic hysterectomy with
intracorporeal suture technique from September 2010 through December 2012
were included in the study. The operative video and electronic chart reviews of
the 150 patients were done retrospectively. We analyzed the following variables
for all the patients : age, body mass index, adhesion, weight of uterus, operative
time, vaginal cuff suture time, estimated blood loss, complications, length of
hospital stay and postoperative pain.Results: Both group have no statistically
significant differences in estimated blood loss., complication, length of hospital
stay and postoperative pain. However, the mean operative time in single-port
group was significantly longer than conventional group ( 98.2 26.0 min VS.
80.220.3 min:P=0.02). Vaginal cuff suture time was decreased with experience
in both group Conclusion: Surgical outcomes and complication rates seems to be
similar in both group. Vaginal cuff suture time wasnt cause of increased total
operative time in single port group. Single port group needs more patients than
conventional group for decrease of total operative time.
P117
STUDY FOR USEFULNESS AND SAFETY OF SONOGRAPHY-GUIDED HIGHINTENSITY FOCUSED ULTRASOUND ABLATION OF UTERINE MYOMA
C. Pil Je*, Y. Kang Jun, S. Gi Hyun, K. Sang Hun
Department of Obstetrics and Gynecology, St.Peters Hospital, Seoul, Korea,
Problem Statement: The Objective of this study is to evaluate the usefulness and
safety of US-guided high-intensity focused ultrasound (HIFU) ablation of uterine
myoma.Methods: The study group designed by 27 patients who underwent USguided HIFU ablation due to uterine myoma between April and October 2013 in
St. Peter's Hospita with Model JC Focused Ultrasound Tumor Therapeutic
System. We assessed the differences volume at baseline and 6 months after
treatment based on contrast-enhanced T1-weighted image on MRI. Also we
evaluated safety of HIFU by presence of complications.Results: Mean age of
patients was 40.11 years. We divided 3 groups, below 100, 100-200, above
200 on volume of myoma at baseline (). Mean volume of contrast-enhanced
T1-weighted image on MRI was 225.55(35.81-834.43) before HIFU treatment
and 84.64(9.19-343.90) 6 months after HIFU treatment. Reduction rate was
62.47(%). No severe complications like bowel injury, bladder injury, infection
was not observed.
Table 2. Changes in Myoma Volume Before and 6 months After HIFU Treatment
on
110
Contrast-enhanced T1-weighted image of MRI

Characteristics
Before
6 months after
Mean contrastenhanced
225.55(35.81-834.43)
84.64(9.19-343.90)
Reductio
n Rate (%)
62.47
Below 100 (n=5)
66.19(35.81-84.26)
16.33(9.19-24.29)
75.53
100-200 (n=11)
149.80(109.94-195.35)
58.74(19.54-147.88)
60.78
Above 200 (n=11)
373.90(201.93-834.43)
141.59(37.58-343.90
62.15
Volume(range),
(n=27)
Figure. Contrast-enhanced T1-weighted images, baseline and after 6 Months:
Conclusion: US-guided HIFU treatment appears to be a safe and useful to ablate

uterine myoma.
P118
SYMPTOMATOLOGY OF ENDOMETRIOSIS- A PROSPECTIVE STUDY
R. D. Rajkumaralal*, H. Rajesh, S. L. Yu
Obstetrics and Gynaecology, Sinapore General Hospital, Singapore
Problem Statement: Endometriosis is a common gynaecological condition often
diagnosed at surgery and by histology. Efforts to develop a nonsurgical method
of diagnosing endometriosis have focused on imaging, biomarkers and patientreported symptoms. Raised serum CA-125 is advocated for diagnosing
endometriosis but is also elevated in ovarian cancer, pelvic inflammatory disease
and fibroids. Transvaginal ultrasonography and MRI are useful in diagnosing
ovarian endometriosis but cannot image small peritoneal lesions. Utilisation of
symptoms typical of endometriosis like dysmenorrhoea, pelvic pain,
dyspareunia etc is a simple, cost effective and noninvasive method in diagnosing
endometriosis. Hence this study was conducted to analyse all the possible
symptoms associated with endometriosis and the strength of
association.Methods: This prospective questionnaire based study was
conducted in the department of Obstetrics and Gynaecology, Singapore General
Hospital, Singapore between July 2011 and September 2012. A total of 200
women of 21-55 years undergoing surgery for nonmalignant gynaecological
conditions were recruited. Women undergoing surgery for acute conditions
such as ectopic pregnancy, cyst accidents and malignant gynaecological
conditions were excluded. The patients were asked to complete a questionnaire
related to symptoms experienced by the patient in the past 12 months. Later the
participant's surgical notes were reviewed and histology reports were traced. All
patients with either a surgical or histological diagnosis of endometriosis were
allotted to the study group and the rest were allotted to the control group. Data
analysis was done and statistical comparisons were made on various symptoms
of endometriosis between the two groups.Results: Out of the 200 participants
enrolled in the study, 66 (33%) women were found to have endometriosis and
134 (67%) did not have endometriosis. The patients in both groups were
homogenous in characteristics. The symptoms recorded for endometriosis and
nonendometriosis group are given in Table 1. In comparison with women who
did not have endometriosis, more women with endometriosis had significant
pain symptoms like dysmenorrhoea (P value .006), pelvic pain (P value .003) and
abdominal pain (P value .002). Back pain, dyspareunia and dyschezia were more
seen in the endometriosis group but the difference was not statistically
Abstract Book
significant. Women with endometriosis had less menorrhagia than the other
group as the majority of patients in that group were operated for fibroids and
menorrhagia being a predominant symptom in them.
Table 1: Distribution of symptoms in patients
Symptoms
Endometriosis
(n=66)
Dysmenorrhoea
Pelvic pain
Abdominal pain
Back pain
Dyspareunia
Menorrhagia
Dyschezia
46
27
26
32
12
31
9
69.7
40.9
39.4
48.5
18.2
47.0
13.6
NonEndometriosis
(n=134)
66
28
26
48
18
84
8
PValue
49.3
20.9
19.4
35.8
13.4
62.7
6.0
.006
.003
.002
.086
.376
.034
.068
Conclusion: The importance of this research lies in identifying strong predictive

symptoms of endometriosis like dysmenorrhoea, pelvic pain and abdominal pain
and the use of this information for patients attending gynaecological
consultation to prompt further investigation to diagnose or exclude
endometriosis and treat accordingly.
P119
HORMONAL ASSAY IN DETECTION OF EARLY OVARIAN FAILURE IN WOMEN
WITH ABNORMAL UTERINE BLEEDING
A. Rasekh Jahromi 1,*, R. Javidalsadi 1, M. Maalhagh 1, A. Nasseri Jahromi 2,
S. Pourshojaee 3, F. Alipour 1, M. Alborzi 1
1OB&GYN, Jahrom University of Medical Science , Jahrom, 2Economic, Azad
University, shiraz, 3dr Rasekh Clinic, Jahrom University of Medical Science ,
Jahrom, Iran
Problem Statement: AMH could indicate ovarian number of antral follicles and
ovarian age. Low levels of AMH in the blood is indicative of low ovarian reserve,
that could be a sign of early menopause.POF disease is determined with
decreased estrogen and increased FSH before the age of 40 years and it can be
detected by measurement of the FSH or AMH. Measurement of AMH many years
before the increase of FSH may be realized Impending POF. In this study, the
sensitivity and specificity of AMH and FSH were compared for the diagnosis of
early POF. Methods: 96 samples referred to Dr. Rasekh clinic were selected for
AMH and FSH testing that they were not exclusion criteria. After obtaining serum
levels hormones in patients referred, this information along demographic
information including age was entered in SPSS program then statistic analysis
was performed for evaluation of diagnostic accuracy of AMH and FSH
tests.Results: The sensitivity and specificity of AMH is specified
respectively 80%, ,78.89% in diagnostic POF in women suffering menstrual
disorders(AUB) in this study that the response rates for FSH is
obtained respectively 28.57%, 78.65% .The positive and negative predictive
value of AMH test is specified in diagnosis of POF in women suffering menstrual
dysfunction, respectively ,17.39, 98.61 percent that the rates for FSH is
obtained respectively 17.39 , 87.5 percent.Conclusion: : Anti-Mullerian
hormone(AMH) due to higher sensitivity and negative predictive value greater
than follicle stimulating hormone(FSH),It can be said that the use of this
hormone for the diagnosis and prediction of reduced ovarian reserve early
menopause appear to be useful.
As AMH levels is constant during the cycle, but FSH levels varies on cycle length,
so it can be measured at the same time of patient visit.
P120
THE ROLE OF LACTOBACILLUS RHAMNOSUS-BMX 54 IN RESTORING
PHYSIOLOGICAL VAGINAL ECOSYSTEM AND PREVENTING INFECTIONS. A
PILOT STUDY
N. Recine1,*, L. Domenici 1, M. Giorgini 1, V. Marcone 2, R. Tripodi 1, E. Palma 1,
P. Benedetti Panici 1
1
Dept Gynecologic, Obtetrics and Urologic Sciences, University Sapienza of
Rome, 2Italian Association for Prevention in Obstetrics and Gynecology, AIPOG,
Rome, Italy
Problem Statement: Lactobacilli are of crucial importance for the maintenance

of the vaginal ecosystem. Through the production of lactic acid, lactobacilli lower
vaginal pH and help prevent the development of potentially pathogenic
microorganisms. Other mechanisms of lactobacilli action are production of
oxygen peroxide, bacteriocins and surface-binding proteins that inhibit adhesion
to uroepithelial cells. Altogether, these actions contribute to inhibit the growth
of pathogenic microorganisms. Disturbance of this delicate ecosystem by
hormonal changes, sexual behavior, pregnancy or antibiotic therapy can
diminish the levels and activity of the lactobacilli, rendering the vagina more
susceptible to infection by pathogens, in particular to bacterial vaginosis.
Alteration of normal vaginal flora sometimes remains untreated, predisposing to
recurrence of vaginal infections (for example by E. Coli, Gardnerella spp,
Chlamydia, Ureaplasma spp, Streptococcus spp, etc). Infact, exogenous vaginal
lactobacilli can produce lactate and lower the vaginal pH, inhibiting the growth
of pathogens, while concomitantly favoring the development of the lactobacilli.
The aim of the present study was to assess the potential value of vaginal tablets
containing viable Lactobacillus Rhamnosus BMX 54 (NORMOGIN ) in the
treatment of abnormal vaginal flora (AVF), preventing new vaginal infections or
their recurrences.Methods: A total of 60 patients with abnormal vaginal flora
(AVF), were enrolled. Diagnosis of AVF was performed through microscopy of
vaginal content, indicating the proportion between Lactobacilli and other
microorganisms determine the type of vaginal microbiota. PAP smear and
cultures were performed at the first visit. All women were treated with
Lactobacillus Rhamnosus BMX 54 vaginal tablets (NORMOGIN ) according to
the following protocol: 1 tablet/day for 15 days, than two tablets per week for
1month and then one tablet once a week till 4 months. Patients were evaluated
after 2 and 4 months. Results: After 2 months, 54 patients (90%) showed a
restore of physiological vaginal microflora (p<0.05). After 4 months, 48 patients
(80%) maintained the natural healthy balance of the vaginal flora while 12
patients (20%) showed a recurrence of AVF with a vaginal documented
infection.Conclusion: Considering the low recurrence rate of vaginal infections,
in particular of bacterial vaginosis during follow-up it seems that treatment with
vaginal tablets of Lactobacillus Rhamnosus BMX 54 could reduce recurrence of
vaginal infections. Antibiotic treatment should be always performed in case of
documented vaginal infections, such as Chlamydia or Ureaplasma spp.
P121
TUBERCULOSIS OF THE CRVIX A RARE CASE PRESENTATION
C. F. Paixao 1, L. Reis 2,*, V. Mourinha 3
1Gynecology , Centro Hospitalar do Algarve - Portimo, Portimo, 2Obstetrics,
Hospital Fernando Fonseca, Amadora, 3Gynecology , Centro Hospitalar do
Algarve - Faro, Faro, Portugal
Problem Statement: The incidence of genitourinary tuberculosis is increasing,
being more common in 20-40 years of age group in developing countries Genital
organs most frequently affected include fallopian tubes (95-100%),
endometrium (50-60%), and ovaries (20-30%). Tuberculosis of the cervix is rare
and accounts for 0.1-0.65% of all cases of tuberculosis (TB) and 5-24% of genital
tract TB.Methods: A review of literature and presentation of a rare clinical
caseResults: 35-years-old multiparous, black race, with story of chronic hepatitis
B and right adnexectomy for a benign cyst, was referred to our colposcopic unit
with reapeted inflammation on cytology and vaginal bleeding. On examination,
she had an abnormal cervix, with ulceration, bleeding, and a friable papillary
growth.
The colposcopic exam showed increased vascularity without any acetowhite or
iodine negative areas. A clinical diagnosis of high grade cervical dysplasia was
made and a cervical cytology and punch biopsy were taken. The PAP smear
revealed an inespecif inflammation and the histological examination showed
ulcerated fragments of cervix with severe chronic active inflammation with
granuloma formation. The test for acid-fast bacilli and mycobacterium culture
failed but the tuberculin skin test was positive. The pulmonary X-ray was normal.
The patient was a non-smoker, non-alcoholic and did not have any other
significant medical conditions in the past. There was a story of a pelvic surgery,
when a suspicious right ovary tumor with associated ascites was operated, but
111
the anatomopathological exam didnt revealed granulomatosis desease. Patient

started on antitubercular treatment and now its on follow up.Conclusion:
This case emphasizes that though uncommon, tuberculosis is an important
alternative in the differential diagnosis of a malignant appearing lesion of the
cervix. The macroscopic findings of cervical TB are illustrated by this case. There
may be papillary or vegetative growths, a miliary appearance, and/or ulceration
present thus simulating invasive cervical cancer. The diagnosis of cervical
tuberculosis is usualy made by histologic examamination of the cervical biopsy,
witch reveals caseating granulomas and Isolation of the mycobacterium is the
gold standard. Because a third of cases are culture negatives, the presence of
typical granulomata is suficiente for diagnosis if other causes of granulomatous
cervicitis are excluded or a primary focus is identified.
P122
A RARE CASE OF A GIANT RETROPERITONEAL LEIOMYOSARCOMA IN YOUNG
AGE
C. F. Paixao 1, L. Reis 2,*, F. Rafael 3, P. Guedes 1
1Gynecology , Centro Hospitalar do Algarve - Portimo, Portimo, 2Obstetrics,
Hospital Fernando Fonseca, Amadora, 3Obstetrics, Centro Hospitalar do Algarve
- Portimo, Portimo, Portugal
Problem Statement: Sarcomas are rare malignant tumors that arise from
mesenchymal tissue at any body site. They represented only 0.64 percent of all
new cancers in United States in 2006. Ten to twenty percent of soft tissue
sarcomas occur in the retroperitoneum, typically in the fifth to seventh decade
of life. Liposarcoma, leiomyosarcoma and fibrosarcoma are the most common
histologic types of retroperitoneal sarcomas. The retroperitoneum provides a
widely expansible anatomic location for tumors arising there and these tumors
often become very large before symptoms manifest. We report a rare case of a
gigant retroperitoneal leyomisarcoma occurring in young age.Methods: Report
of a rare clinical case and review of the literature.Results: 29-year-old healthy
nuliparous, appealed to our hospital for a chronic states of pain and bloating. At
physical exame we observed a good general sate of health and, during
abdominal palpation,we identified a palpable pelvic hard mass, about 10-12 cm,
well delimited, extending to left iliac fossa. Gynecological examination without
other changes. The ultrasound revealed a masse similar to uterine tissue. She
was admitted to undergo complementary imaging studies. The magnetic
ressonance (MRI) suggested a primitive giant tumor of the left ovary,
compressing the ureters and no obvious cleavage plane. By a clinical state of
hypovolemic shock we performed an urgent exploratory laparotomy, where we
identify a bulky retroperitoneal tumor about 20 cm, with rupture of the capsule
and extensive hemoperitoneum. The uterus and adnexa were normal.
Lumpectomy was performed. The hystological exam revealed a necrotic mass
with 1200g, compatible with leyomiosarcoma grade II. The patient was
discharged on the 12th day post surgery, with indications for follow-up in
oncology consultation and start of radiotherapy. She is currently alive 6 months
after diagnosis without recurrence or metastasis. TConclusion: The most
common clinical picture in reported cases occurs late in life and includes back
pain, weight loss, and in-crease abdominal girth. This case is an atypical
presentation of, in the 3rd decade of life, with acute symptons associated to
tumor rupture.
Complete surgical resection is the treatment of choice. Adjuvant therapy with
radiation is commonly recommended for patient with highgrade resected
tumors. The benefits of adjuvant chemotherapy remain controversial.
Treatment of this rare neoplasm is complicated by the large size of the tumor at
diagnosis and frequent presence of metastases; therefore, prognosis is poor.
The overall 5-year survival rate of retroperitoneal sarcomas 36%58% and is
dependent on tumor histology and extent of tumor invasion. Early recognition
and aggressive surgery are the keys to long-term survival of patients with
retroperitoneal sarcomas, but the mainstay of treating advanced disease is yet
to be determined and needs further research as the overall prognosis of
advanced disease is relatively poor.
112
P123
LARGE FIBROTHECOMA IN A WOMAN WITH MAYER-ROKITANSKY-KUSTERHAUSER SYNDROME
F. A. Santos on behalf of Author, R. Ribeiro*, V. Veiga, C. Cavazza, M. Ponte,
A. Claudia, G. Ramos
Gynecology , Centro Hospitalar Leiria - Hospital Santo Andr, Leiria, Portugal
Problem Statement: We described a rare case of an ovarian fibrothecoma in a
woman with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome.Methods:
Data were obtained by analysis of clinical file and a brief review of the literature,
using Pubmed and key words Mayer-Rokitansky-Kuster-Hauser (MRKH)
syndrome and Ovarian fibrothecoma.Results: Mayer-Rokitansky-KusterHauser (MRKH) syndrome is a rare congenital aplasia or hypoplasia of uterus and
upper vagina with normal outer genitalia, productive ovaries, normal
development of sexual secondary characters and a 46, XX karyotype. Ovarian
fibrothecoma is a relatively new term that is used to describe an ovarian sex cord
stromal tumor that has mixed features of both fibroma and thecoma. The
prevalence of this tumors is very rare and is reported to be about 1,2% of all
ovarian tumors.
We report a case of 50 year-old woman with MRKH syndrome and an ovarian
fibrothecoma. Patient presented with a pelvic-abdominal mass and pain in the
lower abdomen for three months, with no other symptoms.
Medical records of a laparoscopy at age 19 years, which report two rudimentary
hemi-uterus with normal bilateral fallopian tubes and ovaries. At this age was
submitted to vaginoplasty.
Physical examinations revealed normal sexual secondary characters with a blind
vaginal pouch of 2 cm length. Her abdominal examination revealed a large
mobile mass of approximately 15 cm size. Ca 125 was normal as other laboratory
analysis. Transabdominal ultrasonography revealed a large pelvic mass with
solid predominance and central liquid areas, no ovary stromal visible. MRI
showed a pelvic mass with heterogeneous T2 signal, pseudocapsule and welldefined central cystic lesions, suggestive of fibroma. It was made biopsy guided
by CT scan that reveled fibrothecoma.
Patient was taken up for laparotomy being excised the mass with 15 cm of large
diameter. The histology confirms an ovarian fibrothecoma. Patient had good
recoveryConclusion: Ovarian fibrothecomas and MRKH syndrome are both rare
conditions. Ovarian fibrothecoma should be considered in women presenting
with pelvic pain and a large pelvic mass. Surgical excision is the preferred
treatment and is associated with a good prognosis.
P124
CARDIOVASCULAR SURROGATE MARKERS DURING ESTRADIOL/PROGESTIN
THERAPY COMBINED WITH STATIN THERAPY IN POSTMENOPAUSAL WOMEN
WITH KNOWN CORONARY HEART DISEASE
X. Ruan 1,*, H. Seeger 2, A. Mueck 2
1
Department of Gynecological Endocrinology, Beijing Obstetrics and
Gynecology Hospital; Capital Medical University, Beijing, China, 2Endocrinology
and Menopause, University Women's Hospital, Tbingen, Germany
Problem Statement: Statins play an important role in the secondary prevention
of coronary heart diseases. Combined hormone therapy in the postmenopause
may not reduce the risk of coronary heart disease although favourite effects on
lipid parameters have been shown. In the present study the combination of
estrogen/progestin plus statin therapy was investigated in comparison to a
statin monotherapyMethods: Twenty postmenopausal women with known
coronary heart disease were included in this study. The patients received either
Locol combined with Merigest or Locol alone in a randomised cross-over
study design. Blood flow measurement was conducted before, after 6 weeks
and after 12 weeks of treatment. Urinay vasoactive parameters (cGMP,
metabolites of prostacyclin and thromboxane) and serum parameters (lipids, Pselectin, ICAM-1, MCP-1 and homocysteine) were also measured basal and after
6 and 12 weeks of treatment.Results: Mean age of the patients was 62.3 years
(SD 6.6). In the intention-to-treat analysis no significant difference was found in
terms of blood flow measurements. A significant difference in total-Chol and LDL
was found between both treatment groups favouring the hormone/statin group
Abstract Book
(p<0.001), whereas no significant differences were found for LDL, HDL and Lp(a).
For the vasoactive surrogate marker in serum and urine no significant
differences between both treatment groups were observed.Conclusion:
Combined hormone/statin therapy may have beneficial effects on
cardiovascular risk factors beyond the effect of a statin monotherapy. However
it is very difficult to assess as to whether the observed benefits of a
hormone/statin therapy elicit a significant influence on the risk of coronary heart
desease.
P125
REVIEW OF VAGINAL DOUCHING AND ASSOCIATED FACTORS AND
ASSESSMENT OF QUALITY OF LIFE AMONG MARRIED WOMEN
S. Sahin 1,*, S. Kaplan 1, A. Unsal 2, H. Abay 1, N. Yzbasoglu 3, G. Pnar 1
1Yildirim Beyazit University, Faculty of Health Sciences, Ankara, 2Eskisehir
Osmangazi University, Public Health, Eskisehir, 3Dr. Nafiz Krez Sincan State
Hospital, Ankara, Turkey
Problem Statement: This study intended to review vaginal douching and
associated factors and to assess quality of life among married women admitted
to Ankara Dr. Nafiz Krez Sincan State Hospital.Methods: This is a cross-sectional
study conducted on married women admitted to Ankara Dr. Nafiz Krez Sincan
State Hospital between 01/03/2014 and 01/06/2014. Based on the records of
Ankara Dr. Nafiz Krez Sincan State Hospital, the study group consisted of 221
women (37%) out of 601 patients who applied to the gynecology polyclinic of
the hospital throughout the study and agreed to take part in the study. The
questionnaire form prepared in line with the literature to collect data included
some socio-demographic characteristics of women, vaginal douching practice,
some variables believed to be associated and questions of SF-36 quality of life
survey. The women who agreed to take part in the study were discussed in the
waiting room of the gynecology polyclinic. Previously prepared questionnaires
were completed by the women under supervision. The women who replied
Yes to the question Do you perform vaginal douching? were considered to
perform VD. The women with diagnosed genital and urinary infection within last
1 year were regarded to have genital and urinary infection history in this study.
SF-36 Health-related quality of life survey was used to assess quality of life. Chisquare test and Mann-Whitney U test were used to analyze the data. Statistical
significance level was accepted as p < 0.05.Results: The ages of women in the
study group ranged from 18 to 55 with a mean age of 32.937 9.37 years. The
number of women performing VD was determined to be 100 (45.2%) in this
study. VD is mostly performed for cleaning and feeling comfortable (29.9%),
most frequently after sexual intercourse (16.7%) and approximately half of the
women performing VD (45.0%) use soap and water for VD. Frequency of VD was
determined to be higher in women who had no pregnancy before, with
dyspareunia history, with urinary incontinence, with genital infection history and
with frequently recurring urinary infection history (p < 0.05 for each). Frequency
of VD was not associated with age, education level, working status, family type,
family income level, marriage period, menopause, number of birth, menstrual
regularity, dysmenorrhea, chronic pelvic pain, frequency of sexual intercourse,
use of contraceptive methods and urinary system infection history (p > 0.05 for
each). No difference was observed between women performing VD and women
not performing VD in terms of scores obtained from all domains of SF-36 quality
of life survey (p > 0.05 for each domain).Conclusion: Almost half of the women
in our study perform VD. Genital infections and frequently recurring urinary
infections were found to be higher in women performing VD. There is no
difference with regard to health-related quality of life between women
performing and not performing VD. It would be advantageous for healthcare
professionals to support women in acquiring proper behavior about VD and for
educating them about the fact that VD is unfavorable. More extensive studies
are required to demonstrate the relationship between VD and quality of life.
Key words: Married women, vaginal douching, health-related quality of life
P126
THE EFFECT OF PERIOVULATION ADMINISTRATION OF ESTROGEN ON
ONGOING PREGNANCY OUTCOME
M. Sayyah-Melli 1,*, S. Taghavi 2, M. Kazemi-shishvan 2
1
Women's Reproductive Health Research Center, Tabriz University of Medical
Sciences, 2Tabriz University of Medical Sciences, Tabriz, Iran
Problem Statement: For successful implantation, embryo needs a receptive state
which in turn needs a preprepared tissue to respond to progesterone postovulation. Ignoring this processes and complex events that occur in the human
endometrium during the menstrual and proliferative phase will result pregnancy
failure. A randomized clinical trial was conducted to compare response to
treatment protocol with ethinyl estradiol (EE) in infertile women with poly cystic
ovaries (PCO).Methods: From Sep. 2011 to Oct. 2012, sixty consecutive patients
20-34 years with infertility and PCO (as the only known factor), with thin
endometrium at the time of follicle maturation (<7 mm), in two consecutive
cycles induced ovulation with clomiphene citrate (CC), were included and
examined in three equal groups. Group one received EE for three courses, day
from 13-17 for three months and then underwent induction ovulation with CC
(100mg/d), started from day 3 for 7days and in group two, the EE, 0.25mg was
administrated in CC induced cycles for four days, after the size of follicles
reached 18-28mm, and the same protocol used for group three as controls
without EE. All groups received HCG to induce ovulation. Pregnancy rates and
early pregnancy outcomes were evaluated. Participants were evaluated for 3
courses of intervention. Statistical analyses were carried out using SPSS17.0/Win
statistical software. Values were given as median (range) or means (SD). Analysis
was performed with one- way analysis of variance (ANOVA) to compare variables
in three groups. Chi-Square test () was used to examine differences between
groups. For all analyses P<0.05 was considered statistically significant.Results:
Administration of EE, improved pregnancy outcome in group one and two, and
the rate of pregnancy was comparable and was not significantly different
(p>0.05). Cumulative ongoing pregnancy rates in group three was low (21%),
compared to 58% and 62% in group one and two. Live birth rates were 63% vs.
66% and 30% in group 1-3, respectively, which the difference was significant (p
<0.001).Conclusion: Periovulatory ethinyl estradiol administration improved the
conception rate and the outcome of pregnancy in patients with PCO and thin
endometrium. Prior to ovulation, the role of estrogen is considered to be
important in the regeneration and growth of the endometrium and to prepare
the tissue to respond to progesterone post-ovulation. These results opposing
the hypothesis that mid-luteal rise in estrogen is not essential for successful
implantation in the human.More studies are necessary to clarify the importance
of these findings.
P127
CLINICAL SIGNIFICANCE OF ATYPICAL GLANDULAR CELLS ON PAP SMEARS
SEEN IN SINGAPORE GENERAL HOSPITAL FROM 2005-2012
C. Sim 1,*, Y. Pang 1, C. Goh 2, F. Siddiqui 3
1O&G, 2Pathology, Singapore General Hospital, 3Public Health, Duke-NUS,
Singapore
Problem Statement: Cervical cancer is ranked the 8th most frequent cancer death
in Singapore. National cervical cancer screening programme in Singapore
encourages women aged 25 years old and above, who have ever had sex or
sexually active to go for Pap smears once every three years.
Pap smear provides a cytological diagnosis from cells obtained from the
endocervix. Cervical cytology uses the Bethesda system, with the latest revision
in 2001 that renamed Atypical Glandular Cells of Unknown Significance (AGUS)
to Atypical Glandular Cells (AGC), with further subcategories. The incidence of
AGC ranges from 0.1 to 2.1%. Due to small sample sizes, correlation between
AGC and a clinically significant histological diagnosis are widely varied among
different institutions.
A diagnosis of AGC on pap smears has a high correlation with a clinically
significant histological diagnosis. National guidelines in Singapore recommend
for all cases of atypical glandular cells (AGC) to undergo colposcopy, regardless
of the subcategory.
113
The study aims to identify the incidence of clinically significant histological

diagnosis in a Singapore population with AGC.Methods: A retrospective review
of patients with cervical cytological diagnosis of AGUS or AGC will be identified
via a computerized database between 1 January 2005 to 31 December 2012. Any
subsequent histological diagnosis and evaluation will also be retrieved and
analysed. For the purpose of this study, patients were followed up for a
maximum of 1 year. The pap smears were all reported by the pathologists using
the Bethesda System criteria and classified as "Atypical Glandular Cells of
Unknown Significance (AGUS)" then subdivided into "favour reactive", "favour
neoplastic" or "not otherwise specified". For the purpose of this study,
histological findings were subdivided into "benign lesions" or "clinically
significant lesions". Patients were excluded from the study if they had a previous
history of cancer.Results: A total of 249 patients were classfied as AGC on Pap
smear from 2005 2012. The majority of patients were aged between 50-59
years old, forming a total of 36.1% of all AGC cases. Only 6.4% of cases had no
documented follow up subsequently.
Benign findings include proliferative endometrium, polyps, cervicitis, and
endometriosis, forming 43.6% of the AGC cases. Malignant findings formed
40.6% of the cases. Endometrial cancer formed the highest proportion of the
malignant cases with 68.3%. The next highest group were extra-genital
maligancies, forming 11.9% of the cases. Conclusion: Our study is consistent with
previous studies demonstrating that AGC is often associated with a clinically
significant lesion more than 50% of the time. Based on current guidelines,
majority of AGC cases were correctly referred for further colposcopy to obtain a
histological diagnosis. It is interesting to note that a significant number of extragenital malignancy cases were detected from the histological diagnosis. While
these findings may be considered to be incidental, it further highlights the
importance of obtaining histology for AGC cases.
Our study showed that the majority of the AGC Pap smear diagnosis were
classfied under the not otherwise specified category, which may suggest that
a cytology diagnosis is almost always insufficient to accurately classify AGC cases.
As such, the term favour reactive was dropped from the 2001 Bethasda
classification of atypical glandular cells as it may potentially lead to a false
negative diagnosis.
P128
HOPELESSNESS AND ANXIETY AMONG INFERTILE WOMEN
S. Sahin 1, K. Ozdemir 2, A. Unsal 3, O. Simsek 4,*
1Yildirim Beyazit University, Faculty of Health Sciences, Ankara, 2SAKARYA
Universiyt, School of Health, Sakarya, 3Eskisehir Osmangazi University, Public
Health, Eskisehir, 4Sakarya University, School of Health, Sakarya, Turkey
Problem Statement: Aim of the study is to assess hopelessness and anxiety level
among infertile women.Methods: This is a descriptive study conducted on
women who applied to Sakarya Training and Research Hospital Infertility
Polyclinic between 01 March 2013 and 01 July 2013. The study group consisted
of a total of 774 women (88.1%) admitted to the infertility polyclinic of the
hospital and agreed to take part in the study. The questionnaire forms prepared
by using the literature in line with the study objective were completed by the
investigators with face-to-face interview method. Beck Hopelessness Scale was
used to assess hopelessness and Beck Anxiety Inventory was used to assess
anxiety level. Data analysis was made with Mann-Whitney U test, Kruskal-Wallis
test and Spearmans Correlation Analysis. Statistical significance was accepted
as p 0.05.Results: The age of women in the study group ranged from 17 to 48
with a mean age of 28.27 5.45 years. The scores obtained by women from
Hopelessness Scale ranged from 0 to 15 with a mean score of 4.70 3.66
whereas the scores obtained from Anxiety Inventory were between 1 and 48
with a mean score of 12.86 9.64. In this study, hopelessness level was found to
be higher in women aged 30 and above, with education level of primary school
and below, with Type B personality, married more than once, whose age of
menarche is 12 and below, with irregular menstruation, with secondary
infertility, whose infertility period is 5 years and more and with family infertility
history whereas hopelessness level was lower in women with alcohol addiction,
with gynecological surgical operation history and having love marriage (p < 0.05
for each). Hopelessness levels increase with longer marriage period (p < 0.05).
114
There is a positive relationship between hopelessness and anxiety levels (r =

0.277; p = 0.000). Conclusion: Hopelessness is an important mental health
problem in infertile women. Hopelessness level rises with anxiety level. It would
be beneficial to refer the women with increased hopelessness and anxiety level
to advanced centers for definitive diagnosis and treatment, if any.
Keywords: Infertility, hopelessness, anxiety, Turkey
P129
SUCCESSFUL TREATMENT FOR NECROTIZING FASCIITIS OF THE VULVA WITH
ADEQUATE DEBRIDEMENT PLUS HYPERBARIC OXYGEN: A CASE REPORT
P. Sutchritpongsa 1,*
1
Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol
University, Bangkok, Thailand
Problem Statement: Necrotizing fasciitis was an uncommon soft-tissue infection
and associated with severe systemic toxicity and high mortality rate unless
promptly recognized and aggressively treated. The author reported a case of
vulva necrotizing fasciitis with successful treatment by aggressive debridement,
proper antibiotics combined with hyperbaric oxygen therapy.Methods: A 56year-old Thai woman with history of type II Diabetes mellitus, was admitted due
to vulva ulcer. She had localized edema, induration, and exquisite pain at left
labia majora for 10 days. Seven days later, the lesion became pustule and then
burst out by itself, leaving to a raw area with yellowish, foul smelling sticky
discharge. On examination revealed swelling and redness of entire left labia
majora with extension to buttock. Ulcerative lesion with necrotic subcutaneous
tissue size 2 x 5 centimeters was noted. After initial resuscitation, controlled
blood sugar, she was given IV broad spectrum antibiotics, and scheduled for
surgical debridement within 6 hours after admission. The necrotic subcutaneous
tissue was found on surgical exploration with extension to entire left labia
majora and also to the left groin and buttock. The initial debridement was
performed to get rid of necrotic tissue as much as possible. Repeated
debridement was performed every 24-48 hours for totally 6 times. After area of
necrosis was controlled, hyperbaric oxygen (HBO) therapy was scheduled. The
patient received HBO in 90-minute daily session of 100% oxygen breathing in
hyperbaric chamber for 4 consecutive days. After HBO therapy, the condition of
the vulvar lesion improved dramatically and finally the suture was successfully
made at day 25th after initial debridement. The patient was discharged from the
hospital and the vulva lesion was completely healed at one month follow up
period.Results: Necrotizing fasciitis was characterized by widespread necrosis of
the subcutaneous tissue and fasciae without invade the deep fascia and muscle
due to invasion by microorganisms that lead to angiothrombosis and impairment
of microcirculation. The incidence was rare but the mortality rate was
approximately 40%. Vulva area involvement was extremely rare. The most
common risk factor was diabetes mellitus. Early diagnosis, broad spectrum
antibiotics and emergency comprehensive debridement of all dead tissue was
essential. Further debridement should be repeated every 24 to 48 hours until
the infection and area of necrosis was controlled. Delay or inadequate surgical
debridement was responsible for the high mortality rates. Hyperbaric oxygen
therapy was used to treat in this condition due to its therapeutic efficacy:
hyperoxia (elevated partial pressure of oxygen in tissues). The physiologic effects
of HBO at the tissue level have been shown to include increased killing ability of
leukocytes, killing of certain anaerobes, reduction of tissue edema, stimulation
of fibroblast growth, and increased formation. Several studies had shown
decreased morbidity and mortality when HBO is used postoperatively as
adjuvant therapy. HBO therapy significantly reduced the time to wound
stabilization and fresh granulation production, as well as the occurrence of
wound complications Image / Graph:
Abstract Book
Conclusion: This case report demonstrated a classic clinical manifestation of

vulva necrotizing fasciitis and also described the successful treatment modality
with adjuvant hyperbaric oxygen therapy to facilitate better outcome.
P130
LITERATURE REVIEW OF SPONTANEOUS HEMOPERITONEUM IN PREGNANCY
ASSOCIATED WITH ENDOMETRIOSIS
P. Tan*, M. Mathur
KK women's and cildren's hospital, Singapore, Singapore
Problem Statement: Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare
but life threatening condition. Perinatal mortality remained high (31%), with
44% of the deaths attributable to maternal shock. Recent literature has
identified increasing cases of ShiP associated with endometriosis.Methods: A
search of Pubmed for all cases of SHiP published associated with endometriosis
was carried out for publications in peer-reviewed journals with the following key
words: spontaneous hemoperitoneum, pregnancy, and endometriosis. 21
suitable publications, reporting a total of 25 cases, were retrieved.Results: 17
(74%) out of 23 cases were nulliparous. The mean age was 32 (SD 4.6) years. In
15 (60%) out of 25 cases, there was a prior diagnosis of previous endometriosis
with surgery performed and in 9 (36%) cases, the endometriosis was described
as severe or r-AFS stage 4. 10 (40%) of the 25 cases had endometriosis unknown
prior to pregnancy There were 12 (48%) pregnancies conceived after IVF of
which 7 (28%) were twin pregnancies. 3 (12%) cases of SHiP occurred prior to 24
weeks of gestation, 16 (64%) occurred between 24 and 33 weeks, 2 (8%)
between 33 and 37 weeks, 2 (8%) occurred at term and 2 (8%) occurred post
natal (day 7 and 14 post delivery). All presented with abdominal pain, 13 (52%)
cases were reported to have severe or progressive anemia and 15 (60%) cases
had evidence of hypovolemic shock. Free intraperitoneal fluid was detected on
imaging in 15 (60%) cases of which ultrasound was the main modality of imaging
used. 4 cases had a non-reassuring trace on fetal cardiotocography. 3 cases of
bradycardia with resultant fetal demise of both twins and 5 cases of intrauterine
fetal demise of singletons were detected on ultrasound. Laparotomy was
performed in all but one case where there was uneventful recovery with
conservative management. 4 (16%) cases of supracervical hysterectomy were
performed. In 5 (20%) cases, adnexectomy was performed for hemostasis and
histological diagnosis of suspicious adnexal lesions.Concurrent caesarean
section or hysterotomy for delivery of the fetus was performed in 18 (82%) cases
out of the 22 cases with existing intrauterine fetus/fetuses. Actively bleeding
endometriotic deposits were the source of hemorrhage in 11 (61%) out of 18
cases where SHiP was directly attributed to endometriosis and this was
confirmed on histology in 7 of the cases. 4 (22%) cases of hemoperitoneum were
secondary to a ruptured ovarian cyst showing decidualised endometriosis of
which 3 were confirmed on histology. No maternal deaths were reported.
Excluding 3 cases where spontaneous hemoperitoneum occured post-delivery
and 2 cases where neonatal outcome was not reported, 9 (45%) out of 20 cases
had good neonatal outcome in spite of morbidity associated with earlier pre
term delivery, of which 3 (15%) were twin pregnancies. 3 (15%) cases of poor
neonatal outcome resulting in severe asphyxia and pregnancy termination,
cerebral palsy or neonatal death occurred. 5 (25%) cases of intrauterine fetal
demise of singletons and 3 (15%) cases of fetal demise of twin pregnancies
occurred making the perinatal mortality rate 40%.Conclusion: With the advent
of assisted reproductive techniques, patients with infertility from severe
endometriosis have a higher chance of pregnancy. Increased incidences of SHIP
may occur. There should be no hesitation to perform an exploratory laparotomy
for hemostasis and maternal survival always takes precedence over fetal
viability.
P131
BENIGN TUMORS OF THE VULVA, A DESCRIPTIVE EPIDEMIOLOGICAL STUDY
L. Tinoco 1,*, A. Nicolalde 2, S. Carrillo 3, R. Tinoco 4, D. Tinoco 3, P. Avils 5
1Lower Genital Tract Pathology, 2Dept of Pathology, Oncology Hospital Soln
Espinosa Ayala "Solca", 3Gynecology & Obstetrics, Ginecomast, 4Dept of
Gynecology & Obstetrics, Ecuadorian Institute of Social Security , 5Postgraduate

Obstetrics and Gynecology , Catholic University of Ecuador, Quito, Ecuador
Problem Statement: The vulva corresponds to the female external genital
organs; includes the labia majora, labia minora, clitoris and mons Venus. The
vulva is continued with the vagina from the vestibule and behind it is limited by
the anus. Above mons Venus there is the abdominal skin and laterally reaches
the inguinal-femoral folds. Due to the controversy between classifications of
dermatological and vulvar lesions, in this study we followed the histologic
classification of WHO CLASSIFICATION OF TUMORS.Methods: It is a descriptive
epidemiological study of case series with collection cases 10 years, in which he
found 170 cases of benign tumor of the vulva lesions histologically diagnosed
and treated surgically, GINECOMAST and SOLON ESPINOSA AYALA SOLCA
HOSPITAL QUITO-ECUADOR.
OBJECTIVE: Identify benign tumor lesions of the vulva that occur in the
gynecological consultation, diagnose and properly treat them.Results: AGE
RANGE: Between 5-83 years.
The most common benign tumor was fibroepithelial polyp 22(12.96%) cases,
followed by 21 condylomata acuminate (12.35%), Squamous Papilloma 20
(11.76%), Nevus 16 (9.41%), Epidermal Inclusion Cyst and Hidradenoma
Papilliferum 8 (4.70%) each one, Lichen Simplex Chronicus 7 (4.11%), Syringoma
6 (3.52%), Molluscum Contagiosum 5 (2.94%), Lichen Planus and Aggressive
angiomyxoma 4(2.35%) each one. Angiokeratoma, Capillary Hemangioma and
Seborrheic Keratosis 3 (1.76%) each one. Subcutaneous Lipoma, Lichen
sclerosus, Hidradenitis suppurativa, Juvenile Xanthogranuloma, Leiomyoma and
Hymenal Caruncle Hypertrophy 2(1.17%) each one. Submucosal
Angioleiomyoma,
Angiomyofibroblastoma,
Lipofibroma,
Mucinous
cystadenoma, Cysts of the canal of Nuck, Skene duct cyst, Keratocyst, Verrucous
Dyskeratoma, Eccrine Spiradenoma, Pemphigus Vegetans, Lentigo, Intraductal
papilloma 1(0.58%) each one.Image / Graph:
Conclusion: Benign tumors of the vulva are associated with tumors of the skin
and may be peculiar to the vulva as systemic injury as in the case of Von
Recklinghausen Disease and Xanthoma.
Biopsy is mandatory for diagnosis, papilloma squamous followed by
fibroepithelial polyp and condylomata acuminata are the most frequent, the
latter which can be treated by chemical methods such as imiquimod and
physical, as laser.
The gynecologist must get used to the terminology used by dermatologists and
pathologists, it is little known in our specialty.
P132
EISENMENGER SYNDROME: WHY CONTRACEPTION IN THESE WOMEN?
C. Toms 1,*, B. Lopez 1, S. Couto 1, . Vieira 1, F. Romo 1
1Dept of Gynecology and Obstetrics , Hospital Garcia de Orta, Almada, Portugal
Problem Statement: Eisenmenger syndrome (ES) is the triad of systemic-topulmonary cardiovascular communication, pulmonary arterial disease causing
115
severe pulmonary hypertension and cyanosis. It requires the presence of

congenital heart disease and, in some cases, the diagnosis is not established until
adulthood.
Actually, the therapies are designed to improve patient survival and functional
capacity. Pulmonary vasodilator therapy may improve hemodynamics and other
important aspects of management include avoidance of high-risk situations such
as pregnancy, among others, and a specific attention to hematologic issues.
Pregnancy is absolutely contraindicated in women with ES. The reported rate of
mortality has ranged from 30 to 50 percent. The fixed pulmonary arterial
resistance cannot accommodate the hemodynamic fluctuations of labour,
delivery and the puerperium. Most deaths are due to thromboembolism,
volume depletion, which can augment the right-to-left shunt and precipitate
intense cyanosis and preeclampsia. On order of this, the women and her partner
should be educated regarding safe and appropriate method of contraception.
Hysteroscpic sterilization is the ideal method, but, in a patient that declines
nonreversible methods, other options are progestin-only contraception with
depot medroxyprogesterone acetate injections, etonogestrel implant or an
intrauterine device. This last one is an option for acyanotic or mildly cyanotic
women who are at low risk of acquiring a sexually transmitted infection and is
the preferred method because it reduces menstrual blood loss by 40 to 50
percent and may induce amenorrhea. A copper-containing IUD is not
recommended and estrogen-progestin contraceptives are contraindicated
because of the increased risk of thromboembolism.Methods: The authors
pretend to report a case of a 47 year-old women with ES, due to an
auriculoventricular sept defect, with severe menorrhagia and consequent
hemodynamic repercussion. In our case, contraception wasnt the primary gold.
The main issue was to control the menorrhagia in order to avoid volume
depletion and institute anticlotting agents. The menorrhagia were refractory to
the use of desogestrel. Then, it was tried a levonogestrel-realising intrauterine
device, which, however, was expelled after one week. Subsequently an
etonogestrel implant was applied, that was effective in the control of
menorrhagia and subsequent recovery to normal hemoglobin levels.Results:
Conclusion: Patients with cyanosis develop secondary erythrocytosis, a
physiologic response in attempt to improve tissue oxygenation. Menorrhagia is
a common problem in women with cyanotic heart disease and, if severe, can
lead to iron deficiency and its suppression is often helpful.
P133
A RARE CASE OF POSTCOITAL BLEEDING: CAN IT BE AIS?
A. Unipan 1*, M. Kingsley 2, F. Bano 2, I. Opemuyi 2
1Obstetrics&Gynaecology, 2O&G, Barking, Havering and Redbridge University
Hospitals NHS Trust, Romford, United Kingdom
Problem Statement: Androgen insensitivity syndrome (AIS) is an X-linked
recessive condition with an incidence of 1 case per 20,400 liveborn males. AIS
represents the failure of masculinization of the external genitalia in
chromosomally male individuals. It was first described in 1953 by John Morris at
Yale and is also known as Testicular Feminization Syndrome. It can be complete
or incomplete with the same 46XY karyotype. The etiology of AIS is a loss-offunction mutation in the androgen receptor (AR) gene, localized to the long arm
of the X chromosome. Most patients with complete androgen insensitivity
syndrome have a female gender.Methods: Case report:
An 18 years old black African patient presented to A&E department with profuse
postcoital bleeding and was referred to gynecological team for the suturing of
vaginal tear. On examination she had feminine outlook, her face was clean with
no signs of acne. Breasts were developed but pubic and auxiliary hair were
absent. Examination of the external genitalia showed well-developed labia
majora, minora and clitoris. Each inguinal region presented with a 3 cm long scar.
Vaginal examination revealed a 5.5cm long vagina, with a 3 cm lateral wall tear,
active bleeding. No cervix was visualized. Further discussion with the patient
revealed that she was diagnosed with AIS as a child. She has never had a
menstruation, and she was aware of the absence of the uterus and ovaries.
Following diagnosis she suffered gonadectomy and she was prescribed hormone
replacement therapy. She received counseling and she was using vaginal
dilatators.
116
Results: Patient was consented for vaginal repair under general anesthetic. The
vagina wall was reconstructed during the procedure and haemostasis was
achieved. Patient had an uneventful recovery and wasdischarged on the 2nd
postoperative day.Conclusion: Conclusion
Androgen insensitivity syndrome requires sensitive handling once diagnosed.
AIS is responsible for 10% of all cases of amenorrhea. Medical care is complex
and consists in hormone replacement therapy and physiological support.
Appropriate treatment with estrogen is required to prevent osteoporosis. Many
patients require long-term psychotherapy to resolve psychosexual identity
issues. Therapy should be provided from the time of diagnosis. These are rare
cases that present to emergency department and generally good
communication with the patient is vital for further treatment and management.
P134
THE EFFECT OF APPLYING ICE ON THE PERINEUM FOLLOWING AN
EPISIOTOMY ON PAIN REDUCTION AND WOUND HEALING
E. Veliolu*, N. Demirci
Marmara University, Istanbul, Turkey
Problem Statement: The most frequently employed surgical procedure to
facilitate vaginal delivery is an episiotomy (Duran, Erolu and Sandk 2002). The
application of ice after an episiotomy to eradicate episiotomy-related perineal
pain(Ghosh, Mercier, Couaillet, Benhamou 2004) that hinders the puerpera from
going about her daily activities causes vasoconstriction, which in turn prevents
the development of edema, stops bleeding, slows down the inflammatory
process and it also dispels pain by producing an anesthetic effect (Kozier et al.
2008). This study was planned as experimental research to examine the effect
on pain reduction and wound healing of applying ice on the perineum of women
undergoing an episiotomy during vaginal delivery.Methods: The sample
comprised women who had vaginally delivered with a mediolateral episiotomy
between the period August 1-October 1, 2013 at the Bursa ekirge State Hospital
Obstetrics and Gynecology Clinic; of the mothers, 73 were recruited into the
study group and 75 into a control group.
A Data Collection Form, the REEDA(evaluating the healing of the
episiotomy/wound) and the Visual Analogue Scales(VAS) were administered to
the mothers immediately after delivery.The REEDA and VAS were readministered at the 1st, 3rd, 24th hour and on the 7th day. Ice was applied to
the mothers in the study group for 20 minutes in the first 3 hours at 10 minute
intervals. No ice was applied to the mothers in the control group. The Wilcoxon
test was used in the analysis.Results: At the end of the research, it was found
that the mothers in the control group displayed no significant difference
between their VAS, REEDA and Edema baseline (0 min.) and 1st hour scores
(p>0.05), whereas the mothers in the study group did exhibit significant
differences between their VAS, REEDA and Edema baseline and 1st hour scores
(p<0.001). The mothers in the study group experienced an immediate reduction
in their pain as soon as the ice was applied, after which accelerated healing of
the wound was observed. The mothers in the control group, however, felt a
reduction in their pain after the 3rd hour with ensuing accelerated healing of the
wound (Table 1).
There was a significant difference between the study and control groups in terms
of the difference in their VAS, REEDA and Edema scores (p<0.001). In addition, a
positive correlation was found between the length of labor and the newborn's
birth weight and pain, edema and wound healing.
Table-1. Comparison of VAS and REEDA values of the Study and Control Groups
at the 1st, 3rd, 24th hour and 7th day
Abstract Book
Study Group
Median(min-max)
n=70
7(5:8)
5(4:7)
3(1:4)
0(0:0)
Median (min-max)
n=70
7(5:9)
7(4:9)
5(2:6)
1(0:2)
VAS p-values
compared to 0
<0.001
<0.001
<0.001
<0.001
VAS p-values
compared to 0
1.000
0.004
<0.001
<0.001
REEDA 1st hour
Median (min-max)
n=70
9(9:11)
REEDA p-values
compared to 0
<0.001
REEDA 3rd hour
8(7:10)
<0.001
REEDA 24th hour
7(5:9)
<0.001
REEDA 7th day
3(2:5)
<0.001
Control Group
REEDA 1st hour
Median (min-max)
n=70
11(9:13)
REEDA p-values
compared to 0
1.000
REEDA 3rd hour
10(9:13)
<0.001
REEDA 24th hour
8(7:12)
<0.001
REEDA 7th day
6(4:8)
<0.001.
VAS 1st hour

VAS 3rd hour
VAS 24th hour
VAS 7th day
Control Group
VAS 1st hour
VAS 3rd hour
VAS 24th hour
VAS 7th day
Study Group
Conclusion: The conclusion was drawn that ice applied to the perineum area
following an episiotomy reduces pain and edema and hastens wound healing.
The application of the ice in the first hour in particular was seen to produce the
greatest effect on pain, edema and wound healing
P135
PROFILE OF ESTROGEN METABOLISM IN ENDOMETRIOSIS PATIENTS
T. Verani*, K. Sumapraja
Obstetrics and Gynecology, Faculty of Medicine University of Indonesia,
Jakarta, Indonesia
Problem Statement: Background: The role of estrogen in the pathophysiology of
endometriosis has been well known. However, no study has observed the ratio
of estradiol, estrone, and estriol between women with endometriosis and
without endometriosis. Objectives: To assess the estrone (E1), estradiol (E2) and
estriol (E3) blood level and its ratio (E2:E1, E2:E3 and E1:E3) between women
with and without endometriosis.
Methods: An analytical cross sectional study with 27 women with endometriosis
and 27 women without endometriosis who met the inclusion criteria. The
samples were recruited in Cipto Mangunkusumo hospital and other satellite
hospitals from October 2012 to April 2013. The blood level of estrogen
metabolites was examined by enzyme-linked immunosorbent assay (ELISA). The
data comparison between two groups was analyzed by using Mann-Whitney
test. Results: The level of Estrone was found to be lower in endometriosis group
compared to this in control group (54,66 pg/ml vs 73,52 pg/ml, p 0.229).
Similarly, the level of estradiol and estriol were lower in endometriosis group (29
pg/ml vs 35 pg/ml, p 0.815 and 1,11 pg/ml vs 1,67 pg/ml, p 0.095, consecutively).
The E2:E1 ratio was higher in endometriosis group (0,51 pg/ml vs 0,38 pg/ml, p
0.164), as well as E2:E3 ratio (26,53 pg/ml vs 21,11 pg/ml, p 0.223) and the E1:E3
ratio (58.55 vs 50.28, p 0.684). However, all those differences were not statistical
significant.
Conclusion: The estrone, estradiol and estriol level in women with endometriosis
group was lower compared to these in women without endometriosis group.
The ratio E2:E1, E2:E3 and E1:E3 was higher in endometriosis group. However,
all those differences were statistically insignificant.
P136
VAGINAL DELIVERY IN PATIENTS WITH PREVIOUS CESARIAN SECTION.
SELECTION CRITERIA.
R. Victor*, G. Tatiana, M. Nara, G. Anna
Department of obstetrics and gynecology, PFUR, Moscow, Russian Federation
Problem Statement:
According to the last randomised multicentral trials of
ACOG and RCOG in 2011 the majority of women with one or two previous
cesarean sections (CS) with normal pregnancy are strong candidate for vaginal
delivery. Russian obstetrics allows to provide vaginal delivery in 30,6% of women
with surgically operated uterus.Methods:
The research has been performed
on the clinical site of the department of obstetrics and gynecology of PRFU.
The research covers 100 women with previous Misgav-Ladach -section who
have been admitted to vaginal delivery. All patients have been divided into 2
groups, one of which included 50 patients who underwent cesarean section
repeatedly (Group I), and the other group including 50 patients after vaginal
delivery (Group II). All pregnancies were singleton and full-term.
The average patient age was 34 years.Results: In Group I 6 women had 2
previous cesarean sections, 44 women had only one previuos operation.
Programmed labor with Foley catheter and amniotomy has been arried in 26
patients. Amniotomy with mature uterine cervix was produced in 16 women,
premature rupture of membranes occurred in 8 patients. Ultrasound uterine
scar assessment in patients of 1 group indicated: 30 patients had scar 2,0-2,4
mm (4 of them had 2 previous CS), 18 patients has scar 3-3,5 mm(2 of them had
2 CS); 2 patients 4-5 mm. Placenta was located on the front uterine wall in 18
women, on the back uterine wall 24, in the uterine fundus 8. Indications
for emergency cesarean section in Group I included poor uterine contraction
strength 36 cases (31 with failed oxytocine stimulation, 15 of with the
imperfect uterine scar), acute hypoxia 5 patients, contracted pelvis 2
insufficiency of imperfect scar 7. In Group I 4 neonates had weight over 4000
g. In Group II one woman had 2 previous CS, 49 had only one CS. 5 patients had
spontaneous uterine contraction. Programmed vaginal labor with Foley catheter
and amniotomy has been arried in 17 patients. Amniotomy with mature
uterine cervix was produced in 20 women, premature rupture of membranes
occurred in 8 patients. Ultrasound uterine scar assessment in patients of gGroup
II indicated: 3 women had scar less than 2,0 mm, 16 patients had scar 2,0-2,4
mm (1 of them had 2 previous CS), 21 patients has scar 2,5-3,0 mm; 10 patients
more than 3,0 mm. Placenta was located on the front uterine wall in 25
women, on the back uterine wall 19, in the uterine fundus 4, on the side
uterine wall 2. Epidural analgesia has been performed in every delivery in
group 2. In 5 cases poor uterine contractions have been corrected with
oxytocine. Only 1 neonate had weight over 4000 g.Conclusion: Favorable signs
for conservative delivery included placenta location on the front uterine wall
over the uterine scar and the thickness of the scar more than 2,5 mm.
Unfavorable signs included large birth weight. The most frequent indication for
emergency CS was a poor uterine contraction strength caused by imperfect
postoperative scar.
The research is currently in progress.
P137
THE MANAGEMENT OF TUBAL ECTOPIC PREGNANCY IN LINE WITH NICE
CLINICAL GUIDELINES
M. Vogiatzi*, J. Allsop
Obstetrics and Gynaecology, Royal Derby Hospital, Derby, United Kingdom
Problem Statement: Tubal ectopic pregnancies comprise over 90% of all
ectopics.Ectopic pregnancy remains the commonest cause of maternal mortality
in early pregnancy.The diagnosis of ectopic pregnancy is largely based on the use
of transvaginal ultrasound scan. Serial -chorionic gonadotrophin (HCG)
measurements are used as an adjunct.The management of an ectopic pregnancy
may include:Surgical treatment, medical treatment and expectant
managementMethods: We reviewed retrospectively the notes of all women
diagnosed with an ectopic pregnancy in our hospital over a period of 12
months between January to December 2013. 54 women were included in our
study. We analyzed the time from presentation to diagnosis,the number of visits
117
to the Gynaecology Assessment Unit (GAU), the number of hCG measurements

necessary to reach a diagnosis, the type of treatment offered, and the level of
seniority of doctor at which both the diagnosis was made and the treatment
offered.Results: 3 out of 54 women had a previous ectopic pregnancy. One had
3 previous ectopics (treated by salpingectomy, methotrexate administration and
salpingostomy), whereas the other 2 were treated by laparoscopic
salpingectomy. Many patients only attended once in GAU (20/54), most needed
only one transvaginal ultrasound scan (40/54) and required 1-2
hCG measurements before the diagnosis of ectopic pregnancy was reached.
34/54 women had treatment offered within 48 hours of admission (half of them
within 24 hours).43/54 women underwent surgical treatment, 8 had systemic
methotrexate, one was treated expectantly, one had surgical therapy following
failed medical management and another one required methotrexate treatment
post-surgery, as histology did not confirm the diagnosis of ectopic. There were 2
cases of laparoscopic salpingectomies converted to an open procedure (one due
to extensive pelvic adhesions and the other due to significant bleeding). 5
women had laparotomy and salpingectomy as they presented with ruptured
ectopic and were haemodynamically unstable.Seniors were involved in the
management of most cases. All operative procedures were preformed by either
Consultant or experienced trainees.Conclusion: The diagnosis of ectopic
pregnancy occurred within 48 hrs in the vast majority of cases. Most patients
required 1-2 -HCG measurements and only one transvaginal ultrasound
scan.However, there were cases where the management was suboptimal.The
lack of Consultant input played an important role in those case.senior input is
highly recommended and all cases ought to be discussed with a Consultant prior
to offering any treatment.
P138
GENTLE BUT EFFECTIVE: HEMOSTATIC GELATIN-THROMBIN MATRIX
(FLOSEAL) IN LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY
R. Watrowski*
Obstetrics & Gynecology, St. Josefskrankenhaus, Teaching Hospital of the
University of Freiburg, Freiburg, Germany
Problem Statement: Ectopic pregnancy (EP), resulting from implantation and
development of the blastocyst outside of the uterine cavity, occur in 1.5-2% of
all pregnancies. The most frequent localization of EP is the Fallopian tube (95%).
Non-tubal EP localizations (e.g. ovary, peritoneal cavity or uterine wall) are rare,
but not less insidious. The incidence of EP has increased in the last 30 years,
accompanying the widespread use of infertility treatments, increasing maternal
age, popularization of intrauterine devices, or rising number of surgeries. EP
remains the leading cause of death in early pregnancy, mostly due to intraabdominal hemorrhage. The current "state of the art" in EP treatment is
laparoscopic surgery with organ preservation (expectant or medical
management can be considered in early and asymptomatic cases). The main
challenge in the surgical treatment of EP is the hemostasis. The bleeding from
tubal mucosa, salpingotomy incisions or a peritoneal defect after trophoblast
removal can cease spontaneously. However, if the trophoblast grows deep into
surrounding tissues, the bleeding after trophoblast removal can become
uncontrollable. In those cases, the surgeon has to manage a balance act between
local bleeding control and organ preservation on the one hand, and patients
safety on the other hand. During laparoscopy, the common hemostatic
manoeuvres like sutures, clamping or thermal coagulation can be impractical or
unsafe (e.g. impairment of tubal integrity or functionality; proximity to fragile
intra-abdominal structures in non-tubal pregnancies). Therefore, agents
providing quick and tissue-preserving hemostasis deserve interest.Methods: We
demonstrate on a sequence of cases how quick and sufficient hemostasis can be
achieved with the hemostatic matrix (Floseal, Baxter), a locally applicable agent
consisting of bovine-derived gelatin and human thrombin. The drug is prepared
directly at the operating table within approximately 1 minute and can be applied
with a 5-mm endoscopic applicator directly on the bleeding tissue (e.g. bleeding
area after trophoblast removal). All excess hemostatic matrix (not incorporated
in the clot) should be irrigated after two minutes, since cases of intra-abdominal
granuloma formation or bowel obstruction have been reported after
inappropriate Floseal use.Results: We used Floseal in four laparoscopic
118
surgeries for EP. In each case, the hemostasis was achieved by application of one
unit (5 ml) of the hemostatic matrix. Our experiences with Floseal applications
during EP surgeries are illustrated on intra-operative pictures. None of the
patients required salpingectomy, laparotomy, or blood transfusions. We did not
observe any short term complications within 24-48h postoperative hospital stay.
Unfortunately, we do not know about the long term follow up of these
patients.Conclusion: The ideal treatment of EP should prevent maternal
mortality and morbidity without impacting the reproductive function. Our data
present a new way towards tissue-preserving bleeding control. It could be
particularly important in patients with fertility-reducing factors. Our case series
demonstrates that Floseal can be a valuable option for achieving hemostasis,
especially if conventional thermal coagulation, modern sealing devices or
ligatures are of limited value.
P139
EXPRESSION OF AROMATASE AND STEROID HORMONE RECEPTORS IN
ENDOMETRIOTIC HETEROTOPIES
M. I. Yarmolinskaya 1,*, V. Denisova 2, A. Molotkov 2, I. Kvetnoy 2, V. Bezhenar 2
1Gynecological endocrinology, 2D.O. Ott Research Institute of Obstetrics and
Gynecology, Saint-Petersburg, Russian Federation
Problem Statement: Problem statement: Genital endometriosis (GE) is still
considered to be one of the unsolved problems of modern gynecology. Despite
new data on the etiology and pathogenesis of GE, effective treatment, that
guarantees recovery or absence of recurrence of the disease, doesnt exist. Of
course, hyperestrogenemia influences on the development of the disease,
however, the synthesis and reception of steroid hormones in endometriotic foci
are still a mystery. Investigation of the change in steroid hormones and their
enzymes synthesis, as well as a violation of their reception will give an
opportunity to clarify some aspects of pathogenesis and development of the
disease. It could also be a promising therapeutic target in the combined
treatment of GE. The aim of this study was to evaluate expression of aromatase,
estrogen receptors- (ER) and progesterone receptors (PR) in endometrioid
heterotopies.Methods: Methods: we examined 81 patients of reproductive age
with GE. In all the patients the diagnosis was stated by laparoscopy and was
confirmed by histological examination. The control group consisted of 21 healthy
women who underwent laparoscopy and hysteroscopy and during these
surgeries no gynecological diseases were revealed. For immunohistochemical
studies in patients with GE we performed excision of endometrioid heterotopies
and endometrial biopsy, in women of the control group endometrial biopsy.
We assessed the expression of aromatase in 45 patients with GE, and
determined the expression of ER and PR in 36 patients. We used primary
monoclonal antibodies to the aromatase, ER and PR; as secondary antibodies
we used antibodies, labeled with peroxidase. For evaluation of the results we
performed morphometric study with computer analysis of microscopic images
with determination of relative surface expression, average brightness and
optical density.Results: Results: In endometrioid heterotopies square of
aromatase expression was increased in all the samples (averaged 11.942.11%),
which was significantly higher (p<0.01) than square of aromatase expression in
endometrium of healthy women (average size equal to 0.350.35%). We
determined significant decrease (p<0.05) of the expression of ER and PR in
endometrioid heterotopies as well as in eutopic endometrium of patients with
GE compared with the endometrium of healthy women. The relative surface
expression of ER in endometrioid heterotopies was 0.70.2% in average, in
eutopic endometrium of patients with GE it was 0.90.3% and in the
endometrium of healthy women of 4.91.5%. The relative surface expression of
PR was also minimal in endometrioid heterotopies and was 4.80.9% in average,
in eutopic endometrium of patients with GE - 8.61.7%, and in the endometrium
of healthy women - 10.22.2 %. We didnt receive statistically significant
difference in the average brightness and the optical density of the expression of
aromatase, as well as receptors of sex steroid hormones among patients with GE
and patients of the control group.Conclusion: Conclusion: with the use of
immunohistochemical method, the most informative indicator of aromatase and
receptors of sex steroid hormones expression is relative density. Increased
expression of aromatase and reduced expression of ER and PR in endometrioid
Abstract Book
heterotopies may contribute to progression, recurrence of the disease and
resistance of GE to different schemes of hormonal therapy.
P140
METHOTREXATE IN COMBINATION WITH VASOPRESSIN AND MISOPROSTOL
A NOVEL THERAPEUTIC APPROACH TO CERVICAL ECTOPIC PREGNANCY
S. Yeo 1,*, S. Teo 2
1
Obstetrics & Gynaecology, Singhealth, 2Reproductive Medicine, KK Women's
and Children's Hospital, Singapore
Problem Statement: Our patient was a 35-year-old Gravida 0 Para 0 lady with an
8-year history of subfertility, including failed Clomiphene therapy and intrauterine insemination. She underwent a fresh cycle of Intracytoplasmic Sperm
Injection (ICSI) at our centre, with uncomplicated transfer of two fresh embryos.
On day 19 post embryo transfer (ET), she complained of vaginal bleeding, with
fresh blood seen from the cervical os on speculum examination. The b-hCG
trend is presented in table 1.
Pelvic ultrasound on day 20 reported a 1.4 x 0.4 x 0.9cm gestational sac with a
0.1cm yolk sac within the lower endometrial / endocervical canal, corresponding
to 5 weeks and 5 days. A cervical ectopic was suspected. Our patient was
counseled on treatment options, and chose Methotrexate.Methods: Under
general anaesthesia, we injected intracervical (stromal) vasopressin on her
cervix. An IVM needle was introduced into the gestational sac under ultrasound
guidance, and the sac contents were aspirated. Methotrexate (at a dosage of
1.2mg/kg) was injected into the sac, advanced beyond the visible trophoblastic
rim, and injected into the cervical stroma. She was discharged the next day.
Our patient was readmitted to the high dependency ward one week later for
heavy vaginal bleeding with passage of clots and tissue. A single dose of
Misoprostol (400 mcg) was administered vaginally. The bleeding subsided, and
a >50% drop in her b-hCG levels was seen. Histology confirmed products of
conception. Transvaginal ultrasonography demonstrated heterogenous clots in
place of the previous cervical ectopic. (Figure 1). She was monitored outpatient
with spontaneous resolution of the clots.Results: Our case demonstrates a
conservative, fertility-sparing approach to an early cervical ectopic, using single
a dose of intra-sac Methotrexate and vaginal Misoprostol.
Table 1: b-hCG Trend
Post ET Day
Event
D17
D17
post ET
b-hCG level
2379.9
D24
D30
Re-admitted
with bleeding
18940.7
23960.8
D19
1st
presented
with PV
bleeding
6828.7
D31
Re-solution
of ectopic on
scan
10561.2
D21
11343.0
D23
Intra-sac
Methotrexate
injection
14328.0
D40
Clinic
follow-up
D61
Clinic
follow-up
1340.0
1.8
Figure 1:(Clockwise from top left) Cervical EP before passage; cervical EP before
passage (sagittal / coronal); endocervix after passage of EP (coronal / sagittal);
normal uterus and cervix; endocervix healed; resolving endocervical clot.Image
/ Graph:
Conclusion: Termination with local Methotrexate has reported success rates

approaching 100%, either alone or in combination with repeat local therapy or
cervical curettage. No official guidelines exist due to the rarity of experience
with cervical ectopics. However, multiple studies have found that Methotrexate
can be offered in the absence of fetal cardiac activity, and if ultrasound dating
of the pregnancy is less than nine weeks.
Conservative therapy with single dose intra-sac Methotrexate and vaginal
Misoprostol is an effective treatment option, and should be offered to patients
with early cervical ectopic pregnancies who desire future fertility.
P141
HUMAN PAPILLOMAVIRUS TESTING IN THE MANAGEMENT OF ATYPICAL
GLANDULAR CELLS ON CYTOLOGY.
V. Costa Ribeiro,* and Aguilar S.; Paula T.; Borrego J.
Gynecology, Alfredo da Costa Maternity, Lisbon, Portugal
Problem Statement: the aim of this study was to evaluate the presence of human
papillomavirus (HPV) deoxyribonucleic acid (DNA) in patients with atypical
glandular cells (AGCs) from cervical liquid-based cytology (ThinPrep) and to
report the relationship between the presence of HPV DNA and cervical
histological abnormalities.Methods: we conducted a retrospective study, from
2010 to 2013 at the Colposcopy Department in Alfredo da Costa Maternity in
Lisbon, including all AGC cervical liquid-based cytology with a concomitant HPV
DNA study. Age of diagnosed AGC, parity, colposcopic-directed biopsies,
endocervical curettage and histological findings from cervical cones were
compared between group A (n=9): HPV DNA positive and group B (n=21): HPV
DNA negative group.
Statistic significance (p<0.05) was calculated using SPSS 20.0.Results: The overall
prevalence of HPV DNA was 30% among the total 30 AGC cervical liquid-based
cytology included in this study. The medium diagnosed age of AGC was similar
between groups (Group A=43.3, Group B=45.7; p=0.790). We also found no
differences in what concerns the age of first menses (Group A=13.2, Group
B=12.1; p=0.193), the age of first intercourse (Group A=18.3, Group B=17.1;
p=0.283) or parity. Colposcopic-directed biopsies identified squamous cervical
intraepithelial neoplasia (CIN) in 33.3% (n=3) on Group A. The same procedure
detected one case of cervix glandular dysplasia on Group B, there were no
reports of CIN in this group.
119
Endocervical curettage indentified 2 patients with CIN in Group A. No

malignancies were reported in group B.
When submitted to treatment by excisional cone we identified CIN in 55.5%
(n=5) of Group A patients (n=1 case of CIN I and n=4 cases of CIN III). There was
one case of in situ adenocarcinoma identified in cone on Group B, there were no
reports of CIN in this group.
When testing positive for HPV DNA the risk of underlining cervical malignancy,
in AGC ThinPrep cytology, is showed to be higher (Group A: n=5, Group B: n=1;
p=0.005)Conclusion: Our study shows that the concomitant use of HPV DNA
testing in AGC cervical liquid-based cytology has a positive predictive value of
83% with a 55% of sensibility and 95% of specificity. The accuracy of this
diagnose test in our study rounds 83%. This study, although small in sample
agrees with the existing literature that states that when having an AGC cytology
the risk of cervical malignancy becomes higher when patients test positive for
HPV DNA.
P142
FACTORS ASSOCIATED WITH UTERINE CERVICAL ADENOCARCINOMA
A. H. Frana-Neto 1,*, M. Amorim 2, A. S. Rolland de Souza 3, T. M. Lubambo 3,
S. Herclio 3, P. R. Eleutrio Souza 4, N. Lubambo 3, A. Paulino da Silva 3
1Obstetrics and Gynecology, FCM and IMIP, 2Obstetrics and Gynecology, UFCG
and IMIP, Campina Grande, 3Obstetrics and Gynecology, IMIP, 4Gentica,
UFRPE, Recife, Brazil
Problem Statement: Cervical adenocarcinoma is a type of malignant tumor
originating from epithelial cells with glandular growth pattern. This type is much
less frequent than squamous cell carcinoma, but more difficult to diagnose, with
a greater number of false negative cytology and a worse prognosis due to failure
in therapeutic response. Identification of factors associated with cervical
adenocarcinoma in our setting can contribute to the development of
appropriate preventive strategies. This study was conducted to determine the
factors associated withadenocarcinomaof the cervix and the genotyping of
Human Papilloma Virus (HPV). Methods: A case-control study was carried out at
Institute of Integral Medicine Prof. Fernando Figueira (IMIP), located in Recife,
Pernambuco, Brazil, in the period of February 2001 to February 2014. Were
included 64 pacients with histopathological diagnosis of uterine cervical
adenocarcinoma (case) and 260 women without the disease (controls). Women
of the control group women had normal cytology and colposcopy and their data
were available in a database of other study previously carried out in IMIP. For
the collection of information of cases the medical records were used and the
extraction of HPV DNA for genotyping was performing using the blocks of
biopsies and surgical pieces. Statistical analysis was performed using the
statistical program Epi- Info 7.1.4. Chi-square test of association (Pearson) and
Fisher's exact tests were used, when indicated, for the categorical variables.
Odds ratio (OR) and its 95% confidence interval (95% CI) were calculated as an
estimative of relative risk. Logistic multivariable regression analysis was
performed to determine the adjusted risk factors associated with uterine
cervical adenocarcinoma. A significance level of 5% was adopted. Results:
Among the patients with adenocarcinoma, 98,4% (n=63) had a diagnosis of
invasive adenocarcinoma. It was observed that adenocarcinoma was associated
with age greater than or equal to 40 years (OR 2.34; 95% CI 2.02 5.37) ,
schooling less than or equal to three years (OR 2.34; 95% CI 1.02- 5.37), presence
of HPV (OR 6.75; 95% CI 2.41 18.91), women in menopausal status (OR 4.76;
95% CI 1.70- 13.31) , black race (OR 6.71; 95% CI 2.11-21.32), and never have
done Pap smears (OR 9.92; 95%; CI 2.41- 40.81. Among the types of HPV found
in the analysis, it was observed that HPV18 showed a strong expression of
association with uterine cervical adenocarcinoma (OR=99.1; 95% CI 12.96757.78) only when associated with one or more types of HPV. Similarly, HPV 31
was only associated with adenocarcinoma when associated with one or more
types of HPV in the same women (OR 4.76; 95% CI 2.62-8.66). However, HPV 16,
isolated (OR 0.71; 95% CI 0.36-1,39) or associated to one or more types of HPV
(OR 1.62; 95%; 95% CI 0.93- 2.84) had no expression of significant association
with adenocarcinoma. Conclusion: The main factors associated with
adenocarcinoma were age greater than or equal to 40 years, schooling less than
or equal to three years of age, black race, menopausal status, never have done
120
Pap screening and present of any HPV type studied. HPV 18 was associated with
adenocarcinoma when associated with other types of HPV in the same patient,
while HPV 16 was not associated with adenocarcinoma isolated or associated
with other types. These findings suggest that not only the types of HPV are
involved in the genesis of uterine cervical adenocarcinoma but the types of
associations can be a risk factor even more.
P143
CERVICAL CANCER SCREENING UPTAKE AND AWARENESS AMONGST RURAL
MALAYSIAN WOMEN
C. Lake *
Acute Medicine, Hammersmith Hospital, London, United Kingdom
Problem Statement: Cervical cancer is one of the most common cancers in
women worldwide and there is a huge global disparity in the uptake of screening
programmes to detect it. The uptake of cervical cancer screening (Pap smear) in
Malaysia has been low since its introduction in the 1960s and promoting uptake
remains a challenge. This study was conducted whilst on a medical elective in
Malaysia to determine the uptake of cervical cancer screening amongst women,
to assess awareness and to evaluate the factors affecting uptake.Methods: The
study was qualitative and adopted face-to-face interviews with 35 Malaysian
women aged 21-45 years attending their first antenatal appointment. Structured
questions were asked with the help of a local translator were asked to
investigate uptake of screening and analyse awareness of the methods and
purpose of screening. Questions were also posed to assess knowledge of cervical
cancer (risk factors, symptoms) to determine whether there was a correlation
between knowledge and uptake.Results: Among the 35 respondents, 89% were
aware that a screening programme for cervical cancer existed. However, only
54% had attended previously for a Pap smear. There was confusion amongst the
respondents about the need for a Pap smear and its use as a screening rather
than diagnostic tool was often misunderstood. Furthermore, many of the
respondents did not understand the importance of cervical cancer screening as
a tool to detect early changes that could progress to cancer. Those respondents
who had previously attended for a Pap smear demonstrated better knowledge
of the symptoms and risk factors for cervical cancer than those who had not. A
5 point Likert Scale indicated that 54% of respondents would be very likely and
37% would be likely to undergo further screening if their doctor suggested this
was important. Conclusion: The findings demonstrate that there is good overall
awareness that the Pap smear exists in Malaysia, however there is continued
poor uptake. The study highlighted that there is a general lack of awareness
about the importance of screening for cervical cancer amongst Malaysian
women. The findings also emphasised the importance of doctors in advising
women about the importance of screening. Future interventions aimed at
increasing uptake should aim to emphasise accurate information about cervical
cancer screening and the purpose of the Pap smear.
P144
THE ROLE OF CULTURAL FACTORS IN MAMMOGRAPHY SCREENING:
SYSTEMATIC REVIEW
S. Z. Akar 1,*, I. yeilnar 2, H. bebis 1, T. yavan 2
1Department of Public Health Nursing, 2 Obstetrics and Gynecology Nursing,
Gulhane Military Medicine Academy, Ankara, Turkey
Problem Statement: Breast cancer appears to be a significant disease of both
the developing and developed countries. Among Turkish women, breast cancer
is the second leading cause of cancer-related deaths. Cancer screening tests such
as mammography play a pivotal role in reducing breast cancer related
mortalities. It is broadly accepted that breast cancer prevention efforts should
consider cultural factors when addressing the needs of diverse populations, yet
there is surprisingly little evidence that doing so boosts effectiveness. The aim
of this literature review is to present cultural factors that affect mammography
screening.Methods: A literature search of six electronic databases (Wiley,
Medline, Springer Link, Ovid, EBSCOhost and PubMed) was conducted using the
terms breast cancer, mammography, culture, and nursing. Articles published in
Abstract Book
English and Turkish, from January 2009 to April 2014, were searched. 155
literatures founded and 50 literatures were related with our topics.Results:
Nurses need to understand the reasons behind why women dont practice
mammography, especially cultural factors. According to literature, despite the
increasing incidence of and mortality from breast cancer, Asian women in the
United States of America and Turkey report consistently low rates of
mammography screening. A number of health beliefs and socio demographic
and cultural characteristics have been associated with mammogram
participation among women. However, studies systematically investigating
cultural factors in relation to mammogram experience have been scarce around
Turkey and some countries. While rates of participating mammogram show
differences in terms of rural and urban areas in Turkey, rates show differences
in terms of age in Jordan. For example, Social norms and self-efficacy highly
influenced these womens intention to engage in mammography screening and
younger women were more willing to indicate intention to engage in
mammographic screening.Conclusion: Nurses are important persons to
increase the rates of mammogram participating and they must know cultural
factors of women. Nurses should consider the inclusion in culturally variety
interventions of more targeted outreach and health care system navigation
assistance for promoting mammography screening since mammography is very
important for early diagnosis of breast cancer.
P145
DETERMINATION OF KNOWLEDGE ABOUT CERVICAL CANCER AND EARLY
DIAGNOSIS OF UNIVERSITY STUDENTS
B. Altinel *
Selcuk University, Konya, Turkey
Problem Statement: This study of university students and early diagnosis oof
cervical cancer was conducted to determine the level of knowledge
about.Methods: Kastamonu University, studying in the part of the 4-year girl
students are studying in 1588. Planned as a descriptive study of these students
are pov-probability sampling method was used to analyze the work was
completed by 381 students. Statistical analysis of the data, SPSS 20.0 package
programwas carried out using. Percent statistical evaluation, correlation and chisquare tests were conducted.Results: The mean age of the 19 students who
participated in the study and 99.7% are single. Of these students, 70.8% have
social security, 90.6% have heard the diagnosis of cervical cancer. Students
accounted for 3.4% of the individuals in the family are diagnosed with cervical
cancer. The students who enrolled in the study 45.1% of early diagnosis of
cervical cancer is feasible, 8.4% have heard of the pop smear test. 11.5% is a
vaccine for prevention of cervical cancer is to know.
Surveyed students with ages cervical cancer control how often should be made
aware of marital status with cervical cancer early detection inquire about want
of social security and not the situtaion with the pop-smear hear the case of a
statistically significant relationship was found.Image / Graph:
Conclusion: In our study of university students and for the early diagnosis of
cervical cancer was found to be insufficient information
P146
NEUROENDOCRINE CARCINOMA ARISING FROM A MATURE CYSTIC
TERATOMA: A CASE REPORT
M. R. C. Arcilla *
OB GYN, St. Luke's Medical Center, Quezon City, Philippines
Problem Statement: Neuroendocrine tumors (NETs) are often characterized by
excessive hormone production localized more commonly in the gastrointestinal
and respiratory tract. Only 500 cases of ovarian origin have been reported and
often, diagnosis is retrospective. Excessive hormone production by the tumor
occurs less frequently with rare NETs.
Methods: However, immunohistochemical staining may still be positive, and
thus, aids in characterizing the neoplasm. Here we describe a case of a
neuroendocrine carcinoma of the ovary found incidentally after
oophorocystectomy for a mature cystic teratoma.Results: The specimen was
sent for histopathology. The left ovarian cyst wall consisted of two previously
opened cystic tissues measuring 4x3x3 cm. and 7x6x5 cm. The larger tissue was
multiloculated while the smaller tissue was uniloculated. Both were filled with
tan, pasty material, fibrofatty tissues and hair (APPENDIX B, Figure 2). A
yellowish ovoid, solid nodule measuring 2.3 cm in widest dimension was seen
attached to one of the locule walls of the larger tissue (APPENDIX B, Figure 3).
Histopathology revealed a neuroendocrine carcinoma arising in a mature cystic
teratoma of the left ovary. The tumor was 2.3cm in widest dimension. There
were no lymphovascular invasion. The tumor stained positive for synaptophysin
and calretinin, and negative for chromogranin A and inhibin (APPENDIX B). A
baseline
vanillylmandelic
acid
was
obtained
for
monitoring
purposes. Conclusion: Neuroendocrine tumor of the ovary is a rare neoplasm
that may be seen in women in the reproductive as well as postmenopausal age.
The functionality of such tumors, mass effect, and/or as an incidental finding
during imaging or on histopathology leads to diagnosis. Excessive hormone
production by the tumor occurs less frequently with rare NETs, thus may not be
seen. However, immunohistochemical staining may still be positive, and thus,
aids in characterizing the neoplasm.6 when detected early, surgical resection
leads to high survival rates. However, with aggressive histopathologic types,
adjuvant treatment may or may not halt disease progression.
P147
COMPARISON OF RECURRENCE RATE, DISEASE-FREE SURVIVAL AND OVERALL
SURVIVAL AFTER SENTINEL LYMPH NODE BIOPSY OR INGUINAL LYMPH NODE
DISSECTION IN PATIENTS WITH NODAL-NEGATIVE VULVAR CANCER
A. Beyer 1,*, T. W. Friedl 1, N. Degregorio 1, E. Vorwerk 1, T. Blankenstein 2, A.
Rempen 3, W. Janni 1, F. Ebner 1
1
Obstetrics & Gynecology, University of Ulm, Ulm, 2Obstetrics and gynecology,
LMU munich, Munich, 3Obstetrics and gynecology, Diak SHA, Schwbisch Hall,
Germany
Problem Statement: Sentinel lymph node biopsy (SNB) has been shown to
reduce the postoperative morbidity in women with vulvar cancer. However, data
on long-term outcome of SNB in vulvar cancer in terms of recurrence rates,
disease-free survival (DFS) and overall survival (OAS) as compared to women
with complete inguinal lymph node dissection (ILND) are scarce.Methods: Data
of women diagnosed with T1/T2 and histologically confirmed nodal-negative
vulvar cancer (pN0 or pN0sn) at three different hospitals (O&G Department
University Ulm, O&G Department University Munich, O&G Department Diakonie
Schwbisch Hall) between 1992 and 2011 were retrospectively analyzed. Based
on a median follow-up of 72 months, recurrence rates, DFS and OAS were
calculated and compared between patients who had undergone either SNB or
ILND. Women with a secondary tumor were excluded.Results: A total of 122 (60
SNB; 62 ILNE) patients with T1/T2 nodal-negative vulvar cancer were analyzed.
Patients in the ILND group had a significantly higher proportion of T2 tumors
(57% vs. 14%; p < 0.001) and received more often a complete vulvectomy (39%
vs. 3%; p < 0.001) as compared to the SNB group. During the follow-up period
(median 57 months for the SNB group and 92 months for the ILND group), 17
out of 60 (28%) patients in the SNB group had a recurrence; this includes 8 (13%)
patients with an inguinal lymph node recurrence. In the ILND group 29 out of 62
121
(47%) patients had a relapse, including 6 (10%) with an inguinal recurrence; the
rate of inguinal recurrences did not differ between the SNB and ILND group
(p=0,526). 5 out of 60 (8%) women died in the SNB group, and in 4 of these 5
cases (80%) death was due to vulvar cancer. In the ILND group 19 out of 62 (31%)
women died, with 9 of these deaths (47%) because of vulvar cancer. Multivariate
survival analyses accounting for tumor stage (T1, T2) and type of surgery
(complete vulvectomy, partial vulvectomy, wide excision) using cox regressions
revealed no significant effect of treatment group (SNB vs. ILND) on DFS (hazard
ratio 1.619; 95% confidence interval 0.828 3.165; p = 0.159) and OAS (hazard
ratio 1.167; 95% confidence interval 0.363 3.747; p = 0.796).Conclusion: In our
investigation no difference between SNB and ILND was found concerning DFS
and OAS. SNB seems to be a safe treatment in women with T1/T2 nodal-negative
vulvar cancer not only short-term but also long-term.
P148
BASAL CELL CARCINOMA IN OVARIAN MATURE TERATOMA - A CLINICAL CASE
F. Caeiro*, V. Santos, T. Diniz-Costa, J. Silva Pereira
Women's Health, Prof. Dr. Fernando Fonseca's Hospital, Lisbon, Portugal
Problem Statement: Introduction: Ovarian teratomas are the most common
type of germ cell tumors. They correspond to a neoplasm that differentiates
toward somatic-type cell populations (typically including cell populations that
would normally derive from ectoderm, endoderm, and mesoderm) that can be
found in either adult or embryonic development. The component tissues in a
teratoma range from immature to well differentiated, and are foreign to the
anatomic site in which they are found representing somatic cell type
differentiation, the majority of them benign. They are classified in 4 categories:
mature, imature, malignant due to a component of another somatic malignant
neoplasm, and monodermal or highly specialized. Mature teratomas correspond
to 95% of all teratomas, with a 0,2 to 2% of malignant transformation (in any of
their components). Risk factors to malignant transformation include: age over
45 years (mean age 50 years versus 33 years for benign teratomas), tumor
diameter greater than 10 cm, rapid growth, and findings on imaging suggesting
malignancy.Methods: The authors describe a case of malign transformation of a
mature teratoma, with basal cell carcinoma. Results: Clinical Case: A 48-year old
black woman, with irrelevant gynecological and personal antecedents, comes to
the Urgency Service with abdominal pain associated a rapid volume growth. At
clinical examination it was described an voluminous, distended and globally
painful abdomen, with higer intensity of pain in left quadrants. Bimanual
observation defined a giant pelvic mass difficult to delimitate. An abdominopelvic computerized tomography was performed describing an adnexal
heterogeneous mass with 14x9x9,5cm, compatible with a teratoma with
malignant characteristics, with ascites and no large lymph nodes. Tumor marker
CA125 (cancer antigen 125) was elevated (68,9). It was performed a unilateral
adnexectomy and a contralateral prophylactic salpingectomy and the pathologic
evaluation of the surgical piece was basal cell carcinoma in mature teratoma.
The case was discussed in multidisciplinary meeting and was decided to follow
up with seriated SCC (squamous cell carcinoma) tumor marker and no further
treatments were performed. Up till now the patient is in good clinical
condition.Conclusion: Though rare, malignant teratomas may appear, and there
are some characteristics that may create a clinical suspition of the malignancy,
that are described in the literature and were present in our patient: age over 45,
rapid growth, diameter greater than 10cm and imaging findings suggestive of
malignancy.
P149
COULD HISTOLOGIC AND IMMUNOHISTOLOGICAL STUDIES PERSONALIZE
MANAGEMENT OF PRIMARY MELANOMA OF THE UTERINE CERVIX?
N. V. Danilova 1 2 3,*, S. U. Davidova 3, G. A. Frank 2, Y. Y. Andreeva 2, E. V.
Petersen 1, N. A. Nefedova 2 3, P. G. Malkov 2 3, O. A. Mynbaev 1
1Dept of Applied Mathematics, Laboratory of Cellular and Molecular
Technologies, Moscow Institute of Physics And Technology, 2Dept of Pathology,
Russian medical academy of postgraduate education, 3Dept of Physiology &
122
Basic Pathology, Faculty of Fundamental Medicine, Lomonosov Moscow State

University, Moscow, Russian Federation
Problem Statement: Primary malignant melanoma (PMM) of the uterine cervix
(UC) is a rare and aggressive neoplasm and associated with a poor prognosis.
The diagnosis of PMM of UC is difficult due to morphological unpredictability
and tendency to mimic wide range of tumours, in particular, in the case of
amelanotic neoplasm. We report histologic, immunohistochemical (IHC)
features and clinical course of PMM of UC supplemented by literature review
aimed to clarify possibilities of personalized management of this condition in
future.Methods: In order to identify type of PMM a hematoxilin eosin (HE)
staining and an IHC assay with antibodies against 22 proteins were applied.
Sources of literature concerning cases of PMM were searched by 4 researchers
(ND, SD, NN, OAM) in Medline, Pubmed and other databases with subsequent
analysis and discussion. Finally signaling pathways of positively stained proteins
in PMM of UC behavior were also analyzed.Results: A 60-year-old woman
presented with an episode of post-menopausal genital bleeding. The punch
biopsy from the cervix revealed poorly differentiated carcinoma. MRI of the
pelvis revealed a cervical tumour stage 2B without any signs of dissemination.
Radical hysterectomy with bilateral salpingo-oophorectomy and lymph node
dissection type III were performed. Macroscopically: fleshy and pale polypoid
mass (2 1,5 0,7 cm) was originated from the vaginal part of the cervix,
extending into the lower part (2/3) of endocervical canal. HE slides showed
malignant spindle-cell amelanotic tumour of the cervix with high mitotic activity
and severe nuclear atypia (Fig. 1a). Junctional changes in cervical epithelium
were seen. IHC-assay for PCK, CD45 LCA, EMA, h-caldesmon, desmin,
synaptophysin, chromogranin, CD117, inhibin, calretinin, actin (sarcomeric),
myogenin, CD34, SMA and CD10 was negative, whereas staining for HMB45 (Fig.
1b), CD57 and tyrosinase (Fig. 1c) - partly positive. S100-protein, Melan A (Fig.
1d) and CD56, demonstrated diffuse positive reaction in tumour cells. Finally,
amelanotic PMM of UC was determined by combination of HE and IHC with
subsequent recommendations for clinicians. A broad-spectrum of antibodies
allowed us to carry out differential diagnosis of PMM from a wide range of
tumours, including poorly differentiated carcinoma, leiomyosarcoma,
rhabdomyosarcoma, malignant shwannoma, germ cell tumor, stromal sarcoma
and others. All pelvic and paraaortic lymph nodes were free of neoplasia
subsequently this tumour was corresponded to the FIGO stage IB1. Patient died
in 2,5 years after surgery. Detailed description of clinical manifestations and
morphological features of 90 cases of PMM of UC, as well as underlying signaling
pathways will be presented in the poster.
Fig. 1. a - tumour cells with severe nuclear atypia (HE, x200); b - tumour cells
positive for HMB45, c - tyrosinase, d - melan A (IHC staining, x200).Image /
Graph:
Conclusion: PMM of the UC in our case is amelanotic. An application of IHCstaining with antibodies against HMB45, CD57, tyrosinase, S100-protein, Melan
A and CD56 could distinguish it from a wide range of tumors simulating this
condition. Therefore an IHC assay is recommended as the key diagnostic tool for
PMM of UC. Further investigations are called for accumulation of similar cases
and creation of database with results of the state of the art methods in order to
build the framework for personalized management of patients with a PMM of
the UC.
Abstract Book
Disclosure of Interest: N. V. Danilova Shareholder of: None, Grant / Research support from:
ND was supported by postdoc program, Moscow Institute of Physics and Technology MIPT
(State University), Consultant for: None, Employee of: None, Paid Instructor for: None,
Speaker Bureau for: None, S. U. Davidova Shareholder of: None, Grant / Research support
from: None, Consultant for: None, Employee of: None, Paid Instructor for: None, Speaker
Bureau for: None, G. A. Frank: None Declared, Y. Y. Andreeva Shareholder of: None, Grant
/ Research support from: None, Consultant for: None, Employee of: None, Paid Instructor
for: None, Speaker Bureau for: None, E. V. Petersen Shareholder of: None, Grant / Research
support from: EP was supported by the MIPT research and educational programs,
Consultant for: None, Employee of: None, Paid Instructor for: None, Speaker Bureau for:
None, N. A. Nefedova Shareholder of: None, Grant / Research support from: None,
None, P. G. Malkov Shareholder of: None, Grant / Research support from: None, Consultant
for: None, Employee of: None, Paid Instructor for: None, Speaker Bureau for: None, O. A.
Mynbaev Shareholder of: None, Grant / Research support from: OM was solely supported
by a grant from the Russian Scientific Foundation grant No 14-31-00024 for the Institute of
Applied Mathematics of the Russian Academy of Sciences and the MIPT, Consultant for:
None, Employee of: None, Paid Instructor for: None, Speaker Bureau for: None
P150
LOW IMMUNOHISTOCHEMICAL EXPRESSION OF COX-2 IN ATYPICAL
ENDOMETRIAL HYPERPLASIA AND LOW GRADE ADENOCARCINOMA
PREDICTS RESULTS OF HORMONAL TREATMENT
N. V. Danilova 1 2,*, A. A. Makovsky 2, P. G. Malkov 1 2, Y. Y. Andreeva 1,
G. A. Frank 1, O. V. Novikova 3
1Dept of Pathology, Russian Medical Academy of Postgraduate Education,
2
Dept of Physiology and Basic Pathology, Faculty of Fundamental Medicine,
Lomonosov Moscow State University, 3Dept of Gynaecology, Moscow Research
Institute of Oncology by P.A. Hertsen, Moscow, Russia
Problem Statement: Endometrial cancer is the most common malignant cancer
of the female reproductive system in Russian Federation among women of all
ages. Every year 142,000 new cases of disease are registered. Uterine cancer
usually progress while the atypical endometrial hyperplasia (AEH) exists.
Estimated risk of progression of AEH to invasive endometrial cancer is 47%.
Thats why AEH is considered as a precancerous process for endometrial cancer.
Depending on the age the treatment strategy of patients with AEH and well
differentiated adenocarcinoma can vary significantly. At a young age, and in the
presence of the patient's desire to preserve reproductive function, hormone
therapy by progestins preferred. In the absence of these conditions simple
hysterectomy is performed or hysterectomy with appendages. However, the
application of hormone therapy has a risk of relapse or insensitivity.
Immunohistochemical markers, such as ER, PgR and others used to determine
sensitivity to hormone therapy of well differentiated adenocarcinoma and
AEH. However, the data for the prognostic significance of these markers are rare
and contradictory. The aim of the study was to determine prognostic significance
of IHC-study with antibodies to PTEN, Ki67, COX-2, PgR, ER in hormonal
treatment of AEH and early endometrial cancer.Methods: We used biopsy
samples from the 25 patients with early well differentiated adenocarcinoma of
the endometrium (9 patients) and AEH (16 patients) who receive hormonal
treatment from 2005 to 2012. Treatment was held by Zodalex 3.6 mg per month
and intrauterine device (IUD), with levonorgestrel. All patients were divided into
2 groups: group with good prognosis and group with a bad prognosis. In the
group with good prognosis age varied from 27 to 46 years (average age was 34
years). Selection criterion was the absence of cytologic atypia in the endometrial
biopsy in 6 months after initiation of treatment (average time of observation 19 months). In the group with a bad prognosis age varied from 26 to 46 years
(average age was 37 years). Group consisted of patients with histologically
confirmed incurability and relapses after treatment. Incurability defined as
presence of cytologic atypia in the biopsy in 6 months after starting the
treatment. Relapses were defined as the emersion of cytological atypia in
endometrial biopsy in 3 months after stated cure. In each case evaluation of
immunohistochemical markers PTEN, Ki-67, COX-2, RgP, ER was made before
treatment started and and 6 months after initiation of treatment. Results: The
expression level of estrogen receptor is higher in a group with a good prognosis
(p <0.05) and the level of COX-2 was significantly lower (p <0.05). PTEN, Ki67 and
PgR demonstrated no prognostic value.Conclusion: Thus the level of ER and COX-
2 expression can be used to evaluate the prognostic effectiveness of

conservative therapy before treatment started.
Disclosure of Interest: N. V. Danilova Shareholder of: None, Grant / Research support from:
None, Consultant for: None, Employee of: None, Paid Instructor for: None, Speaker Bureau
for: None, A. A. Makovsky Shareholder of: None, Grant / Research support from: None,
None, P. G. Malkov Shareholder of: None, Grant / Research support from: None, Consultant
for: None, Employee of: None, Paid Instructor for: None, Speaker Bureau for: None, Y. Y.
Andreeva Shareholder of: None, Grant / Research support from: None, Consultant for:
None, Employee of: None, Paid Instructor for: None, Speaker Bureau for: None, G. A. Frank
Shareholder of: None, Grant / Research support from: None, Consultant for: None,
Employee of: None, Paid Instructor for: None, Speaker Bureau for: None, O. V. Novikova
Shareholder of: None, Grant / Research support from: None, Consultant for: None,
Employee of: None, Paid Instructor for: None, Speaker Bureau for: None
P151
A STUDY TO EVALUATE THE EFFECTIVENESS OF VISUAL INSPECTION OF
ACETIC ACID (VIA) IN THE INCIDENCE AND PREVALENCE OF CANCER CERVIX
AMONG WOMEN IN THE SELECTED VILLAGES OF PUDUCHERRY
M. B. Dash *
Nursing, Mother Theresa Post Graduate and Research Institute of Health
Sciences, Puducherry, India, Puducherry, India
Problem Statement: A study to evaluate the effectiveness of visual inspection of
acetic acid (via) in the incidence and prevalence of cancer cervix among women
in the selected villages of puducherry
Objectives of the Study: To assess the Risk factors, Incidence and Prevalence of
cervical cancer by Visual Inspection of Cervix with Acetic Acid among women of
reproductive age. To estimate the sensitivity and accuracy of the VIA in detection
of Cancer Cervix. To associate the Post test scores with the selected
demographic variables and risk factors. To prepare a module based on risk
factors.
Methods: Research approach & Design- Quantitative approach and one group
only post test design
Setting- Gynaec OPD, RGGW&CH, Puducherry; Population- All women of
reproductive age group; Sample- Women who were attended Gynaec OPD;
Sample Size - 200 samples; Sampling Technique - Purposive sampling technique;
Sampling criteria; Inclusion Criteria; Women who were in the age group of 2060 yrs; Attending Gynaec OPD in RGGW & CH, Puducherry during the period of
data collection; Willing to participate in the study
Exclusion Criteria: The woman those who were bleeding PV; Woman who had
undergone hysterectomy; Women who were pregnant.
Description of Tool: Section: A-Demographic & Obstetrical variables, Sec -B Check listResults: There is a significant association found with the demographic
variables like occupation, family income and age at marriage towards the Post
test scores.
VIA test results
VIA test-negative
VIA test-positive
Suspicious for cancer
Mean
0.99
1.93
2.67
S.D
12.84
4.81
2.00
Conclusion: Screening for cervical precancerous and cancerous lesions using

Visual Inspection aided by Acetic Acid is a suitable low-cost and a feasible
alternative modality for early detection of cervical cancer in a poor resource
setting
P152
THE INFLUENCE OF SOCIOECONOMIC FACTORS ON BREAST CANCER
SCREENING PRACTICES AMONG ARAB WOMEN
T. T. Donnelly 1 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,
123
Qatar Supreme Council of Health, 6Research, Hamad Medical Corporation,

7Research, University of Calgary-Qatar, Doha, Qatar
Ob/Gyn, Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade,

Serbia
Problem Statement: Breast cancer incidence rates are rising in Qatar. Although
the Qatari government provides subsidized health care and screening programs
that reduce cost barriers for residents, breast cancer screening (BCS) practices
among women remain low. This study explores the influence of socioeconomic
status on BCS among Arab women in Qatar.Methods: A multicenter, crosssectional quantitative survey was conducted with 1,063 Arab women (87.5%
response rate) in Qatar from March 2011 to July 2011. Women who were 35
years of age or older, had lived in Qatar for at least 10 years, were recruited from
seven primary health care centers and womens health clinic in urban and semiurban regions of Qatar. Associations between socioeconomic factors and BCS
practice were estimated using chi-square tests and multivariate logistic
regression analyses.Results: Findings indicate that less than one-third of the
participants practiced BCS appropriately, whereas less than half of the
participants were familiar with recent BCS guidelines. Married women and
women with higher education and income levels were significantly more likely
to be more aware of and to practice BCS than women who had lower education
and income levels.Conclusion: Findings indicate low levels of awareness and low
participation rates in BCS among Arab women in Qatar. Socioeconomic factors
influence these womens participation in BCS activities. The strongest predictors
for BCS practice are higher education and higher income levels. Promotion of
BCS and intervention strategies in the Middle Eastern countries should focus on
raising awareness about breast cancer, the cost and benefit of early screening
for this disease, particularly among low-income women.
Problem Statement: Endometrial carcinoma is one of the most usual female

malignancies. The study aim was to determine which preoperative diagnostic
methods optimally predict the grade and stage of endometrial cancer. Methods:
Study involved 213 patients operated due to endometrial carcinoma at the Clinic
of Gynecology and Obstetrics Clinical Center of Serbia during three years (20112013). Preoperatively, standard anamnestic data (age, parity, comorbidities,
BMI, etc.) were taken. We preformed detailed ultrasound examination, with
endometrial thickness measurement. Pelvic MRI scan assessed ascites presence
and tumor expansion to cervics, myometrium and lymph nodes. Postoperatively,
tumor grade and stage were determined based on histolpathological
findings. Results: The majority malignancies were Endometrioid
adenocarcinomas mostly in FIGO stages I and II. Over 60% of cancer had grade
G1, NG1, but 15% were G2, NG2. Tumor FIGO stage was positively correlated
with cervical involvement, myometrial invasion depth, presence of ascites,
endometrial thickness found on ultrasonographic or MRI scan (p=0.001).
Ultrasound measured endometrial thickness was significantly positively
correlated with tumor expansion into the uterine cavity, cervix and myometrium
as well as stage and grade of disease (p=0.001). Myometrial infiltration depth
positively correlated with presence of lymph node metastases
(p=0.001).Conclusion: Ultrasound and MRI are adequate methods for
preoperative diagnosis and prediction of endometrial carcinomas expansion
especially into cervix. Ultrasonographically measured endometrial thickness and
myometrial infiltration depth clearly indicate tumor grade and stage.
P153
ULTRASOUND PARAMETERS RELIABLE IN PREOPERATIVE ASSESSMENT OF
ADNEXAL TUMORS
J. Dotlic*, M. Terzic, J. Bila, I. Pilic, D. Kocijancic, S. Andrijasevic, J. Micic,
J. Atanackovic
Ob/Gyn, Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade,
Serbia
P155
IDENTIFICATION OF THE LEVEL OF HOPE AND PERCEIVED SOCIAL SUPPORT IN
CANCER PATIENTS AND THEIR FAMILIES
S. Gokyildiz 1,*, M. Ozturk 1, S. Alan 1, F. T. Ozgunen 2, S. Soydan 2, E. Yildirim 3
1Midwifery, Cukurova University Adana Health High School, 2Obstetric and
Gynecology, Cukurova University Faculty of Medicine, Adana, 3Midwifery, Nigde
University Zubeyde Hanim School of Health, Nigde, Turkey
Problem Statement: Malignant ovarian tumors are usually diagnosed at an

advanced stage because all current diagnostic methods have low reliability in
evaluation of adnexal masses. The aim of this study was to determine which
ultrasound parameters can predict the adnexal tumors nature. Methods: Study
involved all women that were operated due to adnexal tumors throughout a
period of 36 months in the Clinic for Gynecology and Obstetrics, Clinical Center
of Serbia. On admission expert ultrasound scan was performed for every woman.
We evaluated if the tumor was multilocular, bilateral, had solid parts, septa,
mixed consistency and papillae. Also, tumor diameter (<5cm, 5-10cm, >10cm)
and Doppler Resistance and Pulsatility Index were evaluated, and the presence
of ascites was noted. Obtained data were compared with histopathological
findings of tumors (malignant, benignant, borderline), and statistically
analyzed. Results: The study included 609 women out of which 126 (20.7%) had
malignant, 449 (73.7%) benignant and 34 (5.6%) had borderline tumors. There
were significantly more positive US parameters in malignant than in benignant
tumors (p<0.001). There were significant differences (p<0.05) between
malignant, benignant and borderline tumors regarding all examined parameters
except multilocularity (p=0.060) of the tumors. Resistance Index was more
sensitive than Pulsatility. Sensitivity of US characteristics was 94.34%, specificity
30.62%, positive predictive value 22.27% and negative predictive value
96.25%. Conclusion: Ultrasound parameters are proven as good predictors of
tumors nature, and therefore, detailed ultrasonografic examination should
always be performed in all patients with adnexal masses.
Problem Statement: A systematic and holistic identification of the level of hope

and perceived social support in cancer patients and their families is of great
importance. This kind of an approach can help to reach results which help
patients to accept the treatment more easily, accelerate the healing process,
and improve patients quality of life by recovering their morale and
motivation. Methods: The purpose of this study is to identify the level of hope
and perceived social support in cancer patients and their families. This
descriptive and cross-sectional study was conducted between March, 2013 and
March, 2014 in the gynaecology service of a university hospital located in Adana,
Turkey. The participants were 69 cancer patients who volunteered to participate
in the study, who were not in the terminal period, and who did not have any
surgical operation during the time the study was conducted and 69 cancer
patients families. The data were collected through Patient Identification Form
developed by the researchers and Interview form for the relatives of the cancer
patients which aim to identify socio-demographic features of the participants,
Beck Hopelessness Scale developed by Beck et al. (1974) with a view to
identifying hope levels, Social Support Patient Form developed by Eylen (2001)
with a view to identifying the perceived social support of cancer patients and
their families, and Social Support Scale for the relatives of Cancer Patients. The
data were analysed using SPSS 13.5. Results: Average age of the participants
was found 56.4111.65 (min20-max84) years, average duration for the period
after they were diagnosed with cancer was 25.6734.029 (min1-max101)
months. Of all the participants, 72.5% was married, 49.3% was illiterate, 79.7%
had social security, 62.3% had over ca diagnosis, and 63.8 % received
chemotherapy. Mean score for social support of the patients was found
140.2817.260 while that of patients families was 124.9715.193. Hopelessness
mean score of the patients was found 3.78 3.702 and that of families was
3.413.21.Conclusion: The present study has detected a strong relationship
between the perceived social support of cancer patients and their families. The
patients perceived social support was found to be affected by such variables as
P154
ASSESSMENT OF CLINICAL DIAGNOSTIC PARAMETERS IN PREDICTION OF
ENDOMETRIAL CARCINOMA STAGE AND GRADE
S. Pantovic, A. Stefanovic, J. Dotlic*, K. Jeremic, S. Kadija, B. Milosevic, S. Milic
124
Abstract Book
education and the degree of the relationship. The patients and their families
hope levels was found to be very high. These findings indicate the importance of
maintaining social support and hope levels that support positive prognosis in
cancer patients in the process of coping with cancer and thereby of planning
approaches accordingly.
P156
THE IMPACT OF STAGING LAPAROSCOPY ON TREATMENT STRATEGY IN
ADVANCED OVARIAN CANCER
B. Kobal 1,*, B. Cvjetianin 1, M. Barbi 1, L. Megli 1, E. kof 2, O. Cerar 2
1Gynecology, university medical centre Ljubljana, 2chemotherapy, institute of
oncology, Ljubljana, Slovenia
Problem Statement: Optimal cytoreduction remains the most important
prognostic factor for disease free interval and overall survival in patients with
advanced ovarian cancer. in cases with absent adnexal masses but marked
peritoneal form of disease including metastases to intestinal mesenterium and
serosa , primary cytoreduction is difficult to achieve. This pattern of abdominal
disease spread represent biological aggressiveness with poor prognosis and
demands visual evaluation before planning treatment strategy. In such cases,
laparoscopy was proposed to be included in pretreatment evaluation of disease
spread.Methods: 2 years retrospective analysis (2011-2013) of 42 patients with
clinical signs of advanced ovarian malignancy, where according to gynecologiconcology consultative team, laparoscopy was proposed as a diagnostic and
staging procedure. After laparoscopic evaluation of respectability, primary
cytoreduction by laparotomy was performed. Metastatic process of intestinal
masenterium and/or serosa was considered as inoperable and neoadjuvant
chemotherapy was started followed by interval cytoreduction. Evaluation of
laparoscopic procedure and and impact on treatment strategy is
presented.Results: Ascites together with elevated tumour markers, with or
without pelvic or abdominal mass were the most the most common clinical sign
in population studied. 32 patients presented in Stage IIIC and 9 in stage IV.
Laparoscopic staging included evaluation of omental infiltration, peritoneal and
diaphragmatic carcinosis, intestinal mesenteric or serosal involvement, bowel
infiltration, and liver superficial metastasis as well as amount of pelvic disease.
In all stage IV patients only laparoscopy was performed.
According to laparoscopic staging in stage III patients, conversion to laparotomy
for debulking and adjuvant chemotherapy was performed in 21 patients; while
in 12 neodjuvant chemotherapy was started. Laparoscopic procedures in
neoadjuvant subgroup were: unilateral or bilateral adnexectomy (N=18);
omental biopsy (N=21), peritoneal biopsy (N=21); and cytology specimen
(N=15). Average start of chemotherapy was 10days (7-14) after surgery No
major intraoperative complications were registered. In 2 patients laparotomy
was performed because of obstructive ileus on day 3 and 5 after laparoscopy.
During the mean follow up of 21 (9-33) months 3/21 patients died in
cytoreductive subgroup and 5/12 in neoadjuvant subgroup; all in the first 8
months after surgery .Conclusion: According to our results, laparoscopy as a
staging procedure can have a certain impact on treatment strategy in advanced
ovarian cancer patients especially in those with aggressive peritoneal form of
disease, where optimal cytoreduction is difficult to achieve. Beside visual
evaluation of disease spread, neoadjuvant chemotherapy can be started early in
these selected cases.
P157
PREMATURE HEPATIC METASTASIS OF OVARIAN YOLK SAC TUMOR
D. W. Lee *, H. N. Lee, S. Y. Shin
Department of obstetrics and Gynecology,, Bucheon St. Marys Hospital,
College of Medicine, The Catholic University of Korea., Bucheon-si, Korea
Problem Statement: Yolk sac tumor also known as endodermal sinus tumor is
the second most common germ cell malignancy of the ovary accounting for 20
25% of malignant germ cell tumors. It most commonly occurs in children and
young women and it is characterized by high malignancy given its
premature metastasis. The most common presenting symptoms for patients
with yolk sac tumors are a rapidly enlarging mass and pain. Preservation of
fertility is one of the principal objectives of surgical management.Methods: A 18year-old woman presented with abdominal distension and pain of a month's
duration. A computed tomography scan reported unilateral large, multiseptated
ovarin mass of 23*20*15 cm size with ascites. Explorative laparotomy findings
revealed a large friable solid ovarian mass with a omental implantation. The
patient was treated with leftl salpingo-oophorectomy and infracolic
omentectomy.Results: Histological evaluation of the specimen after surgery
exhibited typical patterns of yolk sac tumor. On preparing for first cycle
chemotherapy, PET-CT scan showed multiple hepatic, bone and lymph node
metastases. The patient underwent 5 cycles of bleomycin, etoposide, and
cisplatin combination chemotherapy. She has remained free of the disease for
ten months after completion of therapy.Conclusion: Yolk sac tumors are rare
diseases, with a high potential for malignancy but also highly sensitive to
chemotherapy. Multidisciplinary management makes it possible to organize
appropriate surgery that should maximize the possibility of fertility preservation.
P158
MALIGNANT STRUMA OVARII COMBINED WITH BRENNER CELL TUMOR: A
CASE REPORT
D. W. Lee *
Department of obstetrics and Gynecology,, Bucheon St. Marys Hospital,
College of Medicine, The Catholic University of Korea., Bucheon-si, Korea
Problem Statement: Ovarian tumor composed only of Brenner tumor and
struma ovarii is very rare. It is generally accepted that Brenner tumors are
derived directly from ovarian surface epithelium, which undergoes metaplasia
to form the typical urothelial-like components, whereas some investigators
assume that Brenner tumors arise from immature germ cells.Methods: Our
patient had unilateral, large, multiseptated adnexal mass of 17*13*11 cm size
without thyroid dysfunction. Staging laparotomy including total abdominal
hysterectomy and bilateral salpingo-oophorectomy, pelvic and para-aortic
lymphnode dissection and omentectomy was performed.Results:
Macroscopically, the left ovary noted hemorrhagic necrosis with and measured
17x13x11cm. The proportion of cysts to the solid part was about 1:1. Most of
the cysts were about 12 cm in diameter and contained green or yellowish
colloid-like material in the lumen. Microscopic histological examinations
revealed the cysts were covered with non-specific flat to cuboidal epithelia.
Tumor necrosis and capsule invsion was noted. In the solid part, two patterns of
epithelial structures with abundant fibrous stromal backgrounds were found.
one was of thyroid-like micro- to macro-follicles that appeared as pores to the
naked eye, and the other was of medium-sized insular nests formed by a
transitional cell-like epithelium. The patient recovered well, and was discharge
from hospital without complication. She had no adjuvant therapy and no
evidence of disease at follow-up 20 months after surgery Conclusion: Struma
ovarii is a rare type of ovarian teratoma, consisting mainly of thyroid tissue. The
incidence of malignant struma ovarii is below 1%. While there is strong evidence
that pure Brenner tumors originate mostly from the ovarian surface, at
least Brenner tumors associated with teratomatous elements may have a germ
cell origin.
P159
AUTOTRANSPLANTATION OF OVARIAN TISSUE: A NEW POSSIBILITY FOR
FERTILITY PRESERVATION IN PATIENTS WITH MALIGNANCIES
. Margittai*, A. Vereczkey
Problem Statement: In the last decades cancer therapy went through a large
development; due to the early diagnosis, state-of-the-art surgical treatments
combined with chemo- and radiotherapy, and the pronounced aftercare the
number of cancer survivors is continuously increasing. Besides single therapy,
much effort has been made to improve quality of life of cancer patients. Women
suffering from a cancer that requires treatment with gonadotoxic drugs or
pelvic/whole body irradiation may experience amenorrhea and infertility as a
125
side effect due to destruction of the ovarian pool of follicles, and their hormone
synthesizing capacity. Techniques are now available to preserve fertility, which
are getting increased attention. In line with these efforts, we initiated a program
uniquely applied in Hungary, i.e. ovarian tissue cryopreservation and future
autotransplantation, the most up-to-date, but still experimental technology to
preserve fertility.Methods: We aimed to examine in a prospective, nonrandomized study the efficacy and safety of cryopreservation and
autotransplantation of ovarian cortex. Inclusion criteria involved age <38, ECOG
Performance Status = 0, signature of the written informed consent and normal
ovarian function and reserve capacity. The program aimed to include patients
only with stage I-III malignant disease confirmed by histological diagnosis with a
high risk for post-treatment infertility.Results: The study has started in
December 2013 and the first results are presented here. Till now, 7 patients
presented themselves at our clinic with the aim of fertility preservation. 57 % of
them met our inclusion criteria and were enrolled in the study (mean age was
29.5 3.8). Indications for fertility preservation were gonadotoxic
chemotherapy or irradiation of the pelvic area due to rectum adenocarcinoma
(two cases), breast cancer and uterus leiomyosarcoma. In all cases exclusion
from the study was based on passing the age limit. Cryopreservation of ovarian
tissue was performed promptly prior the initiation of cancer treatment, except
the leiomyosarcoma case where the patient already received one cycle of
chemotherapy. Conclusion: Cryopreservation of ovarian tissue - and its future
autotransplantation is a new strategy for fertility preservation in various
diseases, in which patients face the risk of ovarian failure. Although the
procedure is still experimental, this is the single option in prepubertal girls, and
the only procedure having the ability to restore natural fertility. Indeed, ovarian
tissue autotransplantation resulted around 35 live birth worldwide.
The general low number of patients appearing at our clinic indicates the
insufficient flow of information between oncologist, cancer patients and
fertility specialists, though early referral to reproductive specialists would be
crucial to increase fertility preservation outcomes. Future aims should include
better orientation of oncological patients to benefit the most from fertility
preservation techniques.
P160
CLINICAL, ULTRASOUND AND PATHOLOGICAL CORRELATION OF CLEAR CELL
ADENOCARCINOMA ARISING FROM ENDOMETRIOTIC CYSTS
Q. J. Ng 1,*, N. R. Padmavathi 2, Y. K. Lim 2
1Ob/Gyn, KK Women's and Children's Hospital, 2Dept of Gynaecological
Oncology, KK Womens and Childrens Hospital, Singapore
Problem Statement: Ovarian cancer is the 5th most common gynaecological
cancer in Singapore, affecting approximately 5.5% of the population. It has the
7th highest cancer mortality in females in Singapore. There has been an
increasing number of clear cell carcinoma in Singapore which has increased from
5.2% in 1988 to 13.4% in 2006. As ovarian clear cell carcinoma is often associated
with endometriosis and may arise from endometriotic cysts, our aim is to
compare the clinical, radiological and histopathological features between clear
cell carcinoma arising from endometriotic cysts and those not arising from
endometriotic cysts so as to improve the early detection rate of clear cell
carcinoma.Methods: From February 2000 to October 2008, there were 129
patients who underwent surgery and adjuvant therapy for clear cell
adenocarcinoma. A retrospective study was performed and we utilized a
prospectively maintained database to obtain the demographic data, past
medical and surgical history, past history of known endometriosis, ovarian
tumour markers and radiological features on ultrasound pelvis. We divided them
into 3 cohorts Cohort 1 comprised 56 patients with clear cell adenocarcinoma
arising from endometriotic cysts, Cohort 2 comprised 31 patients with clear cell
adenocarcinoma not arising from endometriosis but had other areas of
endometriosis, Cohort 3 comprised 42 patients with clear cell adenocarcinoma
without any history of endometriosis.Results: The mean CA 125 level was
significantly higher for patients with clear cell adenocarcinoma and
endometriosis where the mean value was 642.97 for Cohort 2 and 441.88 for
Cohort 3 as compared to 99.98 for Cohort 1 [P <0.05] but there was no significant
difference when Cohort 2 was compared to Cohort 3 [P =0.433]. The majority of
126
patients with clear cell adenocarcinoma arising from endometriotic cysts

(51.8%) had a CA 125 level of less than 50 as compared to 38.7% in Cohort 2 and
28.6% in Cohort 3 [P=0.201]. There was no significant difference in the levels of
the other ovarian tumour markers (carcinoembryonic antigen, beta-hCG and
alpha foetal protein). Regarding the radiological features, there was no
significant difference in the size between all 3 groups. The mean size of the cyst
ranged from 12.5cm in Group 1 to 13.4 cm in Group 2 and 13.6cm in Group 3
[P=0.335, 0.929]. Approximately 80% of the patients in each group had solid
areas noted on ultrasound pelvis [P=0.979]. 30.8% of patients in Cohort 1 and
42.4% of patients in Cohort 3 have ultrasound findings of septations or
loculations and this was significantly different from Cohort 2 where 11.5% of
patients do not have septations or loculations [P =0.035]. About 30-34% of
patients in each cohort had vascularity noted on ultrasound but this was not
statistically significant [P=0.857].Conclusion: Clear cell adenocarcinoma arising
from endometriotic cysts tend to have a lower CA 125 level as compared to those
not arising from endometriotic cysts and radiological features of solid areas,
septations or loculations tend to suggest a malignant transformation. Hence, we
suggest doing a frozen section during cystectomy of endometriotic cysts if there
is a high index of suspicion for malignancy.
P161
SOCIAL SUPPORT AND HOPELESSNESS IN PATIENTS WITH BREAST CANCER
G. Oztunc 1,*, P. Yesil 1, S. Paydas 2, S. Erdogan 3
1
Nursing Department, Cukurova University Adana Health High School,
2Oncology, Cukurova University Faculty of Medicine, Adana, 3Biostatistics and
Medical Informatics, Mersin University Faculty of Medicine, Mersin, Turkey
Problem Statement: Patients with breast cancer can experience a feeling of
hopelessness very deeply in the adjustment process, and the social support
provided during this period can be effective in increasing the level of hope. The
present study aimed to identify breast cancer patients social support and
hopelessness level. Methods: The target population of this analytical study was
all breast cancer patients (total of 85) who had treatment in the oncology
department of a university hospital located in Adana/Turkey and who met the
inclusion criteria. Data were collected through Personal Information Form,
Beck Hopelessness Scale (BHS) and Multidimensional Scale of Perceived
Social Support (MSPSS). Analysis was performed using Shapiro Wilk, One Way
ANOVA Welch, Student t-test, Mann Whitney U, and Kruskall Wallis tests.
Homogeneity of variance was tested with the Levene, Bonferroni and Games
Howell tests. Mean scores and standard deviation values are given as descriptive
statistics.Results: Average age of the participants with breast cancer is
48.610.6. Of all the participants, 84.7% are married, 49.4% graduated from
primary school, 81.2% are housewives, and 82.4% had children. The participants
multidimensional perceived social support total scores were found to be high
(57.4113.97) and hopelessness scale scores low (5.493.80). There was a
reverse, linear relationship between hopelessness scale scores and social
support total scores (r=-0.259, p=0.017). A statistically significant relationship
was found between hopelessness scores and education level and having
children, occupation, income status, and education level of spouses
(p<0.05).Conclusion: The present study indicates that hopelessness of the
patients with breast cancer decreased with the increase in their social support.
Therefore, activating patient social support systems is of importance in
increasing their level of hope.
Note: This research published as a manuscript in Asian Pacific J Cancer Prev,
2013; 14 (1):571-578 and presented as a poster in National Congress in Turkey
Disclosure of Interest: G. Oztunc Grant / Research support from: This study is funded by
ukurova University BAPKOM with the Project number ASYO2012BAP3, P. Yesil: None
Declared, S. Paydas: None Declared, S. Erdogan: None Declared
Abstract Book
P162
SINGLE SITE LAPAROSCOPIC VAGINECTOMY USING GLOVE PORT AND
CONVENTIONAL INSTRUMENTS IN A PATIENT WITH RECURRENT CERVICAL
CANCER OF VAGINAL STUMP (SURGICAL FILM)
Y. S. Lee, M. J. Song, E. Park*
Obstetrics and Gynecology, The catholic university, Daejeon ST. Marys
Hospital, Daejeon, Korea
P164
BIO-MOLECULAR MARKERS CONFIGURATION IN CANCERS OF THE UTERINE
CERVIX. PERSONALISED THERAPY .MONITORING AND PROGNOSIS
V. M. Prunoiu1,*, M. Marincas 1, S. Ionescu 1, S. Zurac 2, E. Bratucu 1
1
I st Clinic of Oncologic and General Surgery, Al. Trestioreanu Bucharest
Oncology Institute, 2Pathology Department, Colentina Clinical Hospital,
Bucharest, Romania
Problem Statement: Recent literature described in preliminary study

laparoscopic radical vaginectomy in patients with early stage vaginal cancer
seems to be safe and feasible. LESS (Laparoendoscopic Single Site Surgery) is
now being used in field of gynecologic oncology. We applied our expertise to
study the technical feasibility of single site laparoscopic vaginectomyMethods:
A 44-year-old women had been performed laparoscopic hysterectomy by
microinvasive squamous cell carcinoma of cervix (depth of invasion:1mm) in
2010. Follow up check after 4 years was ASCUS and HPV 16 positive. Colposcopic
biopsy appeared to be recurred in vaginal stump. We performed Single site
laparoscopic vaginectomy using Glove port and conventional instruments
through 1.5 centimeter (cm) umbilical incision.Results: Total operative time was
210 min and estimated blood loss was 50 ml. Final pathology revealed multifocal
microinvasive squamous cell carcinoma with a depth of invasion of 1mm and no
lympho vascular space invasion. All margins of 4 cm vaginal stump was clear
from tumor. No intraopeative complications was occurred and Urinary catheter
was removed at POD 7 and no significant voiding difficulties. She is without
evidence of disease 4 months after surgery.Conclusion: Single site laparoscopic
vaginectomy seems to be feasible and safe in select women with vaginal cancer.
We need more cases for optimizing operative and long term outcomes
Problem Statement: Genital neoplasms benefit from standard treatment such as

surgery and radio/chemotherapy. Nevertheless, there are aggressive cancer
forms which are resistant to radio/chemotherapy and which could be detected
with the help of bio-molecular markers. Lately, for stages IB-IIIB, procedures
involving thermic ablation have entered the therapeutic armamentarium, as
they also perform tumour destruction. The purpose of this paper is to establish
the place that radiofrequency ablation (RFA) holds in current treatment
protocols of cancers of the uterine cervix.Methods: We performed a 5-year
retrospective study (2008-2013) in which we analysed the use of RFA, with
selective criteria for aggressive tumours of the uterine cervix which bled and
associated acute secondary anaemia (Hb=7-11g/dl). 61 applications were done.
Using our own personal experience and literature study, we have arrived at the
conclusion that markers: Ki67, p53 and Bcl-2 can be identified in some aggressive
cancer forms with resistivity to radio/chemotherapy, all of these markers being
in correlation also with oncogenic human papilloma viruses (HPV).Results: The
results obtained underlined the haemostatic qualities of the procedure, RFA
being the only non-surgical method which can achieve quicker bleeding control
(20 min.), in comparison with either external irradiation or brachytherapy (which
obtain the same effects, but in no sooner than 12/48 hours). 61 patients were
evaluated, all in stages from IB-IIIB, with ages between 39 and 73 and a total of
61 procedures was performed. Secondary, we obtained locally reducing tumor
volume and enhanced effects of radio/chemotherapy
Conclusion: RFA is useful in cancers of the uterine cervix, in achieving emergency
haemostasis, and it can be considered a minimally invasive technique of neoadjuvant complementary treatment (in the context of tumour palliation) and it
has low morbidity (1.6%) and mortality (0%) rates. We consider that RFA can
hold an important place in oncology treatment protocols.
Therefore, we suggest:
- To add to the current treatment protocol a simple and quick hameostatic
technique (RFA) in bleeding tumors of the uterine cervix which associate acute
anemia
- To establish bio-molecular criteria as predictors of tumor aggressivity and
treatment response.
Once established the diagnosis of an aggresive neoplasm, resistant to
radio/chemotherapy, the molecular markers could influence personalised
treatment implementation (radiofrequency, neo-adjuvant chemotherapy), all of
which, on the long run, may equal longer patient life expectancy and
improvement in the quality of life.
P163
PERSPECTIVES AND LIMITS OF CYTOREDUCTIVE SURGERY IN ADVANCED
OVARIAN CANCER
V. Prunoiu*, S. Ionescu, M. Marincas, E. Bratucu
Surgical Oncology, Al. Trestioreanu Bucharest Oncology Institute, Romania
Problem Statement: Surgery still is the main feature in the treatment of
advanced ovarian cancer and the purpose of surgical cytoreduction is to remove
as much as possible of the tumour and its metastases, so that the residual
neoplastic mass is 1 cm. In this way, chemotherapy is more efficient and
patient survival increases. The known benefits of cytoreductive surgery are: the
removal of the tumour mass, the modification in cellular kinetics and the
improvement in the action of the chemotherapy agent.Methods: We made a 4year retrospective study (2008-2012) on the patients from the I -st Clinic of
General Surgery and Surgical Oncology of the Bucharest Oncology Institute,
study in which we monitored 106 patients with stages III and IV of ovarian
cancer, and ages between 28-79. In 51 patients (48,11%), we also performed
(apart from: hysterectomy, bilateral adnexectomy, and omentectomy): 57
multiple visceral resections, such as: enterectomy, segmental colectomy,
appendectomy, cystectomy, radiofrequency ablation, metastasectomy,
abdominal wall resection, pelvic lymphadenectomy and inter-aortico-caval
lymphadenectomy.Results: Patient survival varied between 6 and 48 months,
and the follow-up of was of 4 years. Although these patients presented in
advanced stages of disease, with short life expectancy (after 5 years: 30% in IIIA,
20% IIIB, 5%IIIC and IV), cytoreductive surgery - in association with adequate
chemotherapy- allowed the increase in quality of life and in survival to: 13
months for suboptimal surgery, 31 months for optimal surgery and 40 months
for cases without any residual tumour left. In 33% of the patients, secondary/or
even tertiary cytoreductive surgery was performed.Conclusion: Extensive
cytoreductive surgery in advanced ovarian cancer is justified by the increase in
patient survival and quality of life. These accomplishments were achieved
through the decrease in tumour volume, without any further complications and
without any increase in hospital stay.
P165
ESTRADIOL METABOLITES AS POSSIBLE PREDICTOR FOR BREAST CANCER RISK
IN PRE- AND POSTMENOPAUSAL WOMEN
X. Ruan 1,*, H. Seeger 2, A. Mueck 2
1Department of Gynecological Endocrinology, Beijing Obstetrics and
Gynecology Hospital; Capital Medical University, Bejing, China, 2Endocrinology
and Menopause, University Women's Hospital, Tbingen, Germany
Problem Statement: Two main estradiol metabolites have different biological
behaviour with tumorigenic features of 16OHE1 and antiproliferative
characteristics of 2OHE1. We investigated the ratio of these estradiol
metabolites in patients with breast cancer (BC) and with benign
diseases.Methods: From 41 premenopausal pts. with (cases) and without
(controls n=211) BC and 207 postmenopausal pts with and without BC (n=206)
urine samples were collected at the University womens clinic of Tuebingen. The
control group comprised following diagnoses: fibroadenoma, mastopathy,
hysteromyoma, urinary incontinence, benign ovarian cysts. Urine samples were
collected prior to surgery and stored at 20C until measurement. 2OHE1 and
127
16OHE1 were measured by ELISA (Estramet, Immuna Care, Bethlehem, USA).

Absolute values expressed in ug steroid hormone/mg creatinine were compared
after logarithmic transformation (log ratio 2OHE1 to 16OHE1) by t-test. The
multiple linear regression test with two interactions was performed to evaluate
the influence of different factors on the metabolic ratio.Results: In
premenopausal pts. log ratio was 0.25 (CI 0.20;0.29) and 0.21 (CI 0.11;0.31) for
controls and cases without significant difference. In postmenopausal pts log
ratio was 0.22 (CI 0.17;0.26) and 0.11 (CI 0.07;0.15) in controls and cases
respectively and was statistically significant lower (p= 0,0002). In multiple linear
regression test log ratio was significantly influenced by BMI, but only in
postmenopausal pts. In these pts an increased BMI resulted in a significantly (p<
0,042) decreased ratio of 2OHE1 to 16OHE1.Conclusion: The data of our case
control study suggest that in postmenopausal women a different metabolism of
estrogens may play an important role in the tumorigenesis of breast cancer. This
genetically determined metabolism could be influenced by the exogenic factor
BMI. In premenopausal women different hormone levels at different time points
of the menstrual cycle may be an explanation that we could not find an influence
of estrogen metabolism in this population.
P166
THE EVALUATION OF THE ATTITUDES OF TURKISH WOMEN TOWARDS EARLY
DIAGNOSIS OF CERVICAL CANCER
V. Savas imke 1,*, G. Breki 2
1
Institute of Health Sciences, Department of Nursing, 2Health School, Mersin
University, Mersin, Turkey
Problem Statement: Cervical cancer is on the tops among the types of cancers
mostly seen among the women in the World. Cervical cancer screening is an
effective method for reducing the incidence and mortality of cervical cancer, but
the screening attendance rate is far from satisfactory although cervical screening
is conducted throughout the country. It is important to determine the
differences among women and their perceived risk of cervical cancer to
determine target groups to increase cervical cancer screening. This study aims
to determine the attitudes of Turkish women towards the early diagnosis of
cervical cancer.Methods: The research is conducted in Iskenderun-Hatay
between 1 November 2012 and 1 November 2013 and includes 753 women over
18 who can communicate and accept the study. The data of the study are
collected by using socio-demographic characteristics and obstetric knowledge
questionnaire developed by the researchers and including the subjects such as
age, marital status, education level, smoking, the number of children, chosen
family planning method, the educational level of parents and the attitude scale
about the early diagnosis of cervical cancer (SAEDCC) developed by zmen et
all. The questionnaires are conducted by talking face to face with the
participants in hospitals, schools and family health center. The data are analyzed
by using pearson chi-square, t-test, one-way ANOVA, tukey test.Results: The
average age of the women is 34,717,51 (min:18 max::64). It is found that 21,9%
of the women in our study are single, 30,3% of them are nurses, 3,7% of them
are doctors, 17,9% of them are teachers, 2,7% of them are academicians, 2,8%
of them are police, and most of them are housewives (42,6%). While 6,4% of the
women are illiterate, 42,9% of them are university graduate. 52,9% of them have
a medium income, and 75% of them have at least one pregnancy experience.
48,6% of the women use a family method and the most widely used method is
preservative (39,9%). 69,2% of the women state that they get gynecological
experience, whereas the percentage of the ones who get pap smear is 27,8%. It
is found that the average point of the early diagnosis of cervical cancer is 101,91
10,77. The highest point of the attitude scale of early diagnosis is 150 and
the lowest one is 30.
When the age of women increases, the points of SAEDCC increases too and this
is evaluated as significant. The average point of SAEDCC and being familiar with
HPV is found to be significant and the level of education does not affect the
SAEDCC total point. Moreover, a significant relationship between marital status,
income rate, using family planning methods, smoking and SAEDCC is not
observed when they are compared. The average point rate of doctors and the
nurses taken from SAEDCC is high, and the lowest attitude belongs to the
policemenConclusion: According to the research, it is concluded that the higher
128
educational level they have, the more positive attitudes the women have
towards the early diagnosis of cervical cancer and the nurses and the doctors
have the highest attitude points. It can be clearly seen that the points of Turkish
women from the attitude scale about the early diagnosis of cervical cancer is
positive but not on a desired level
P167
INVASIVE VULVAR CANCER AND VULVAR INTRAEPITHELIAL NEOPLASIA IN
ONCOLOGIC HOSPITAL SOLN ESPINOSA AYALA "SOLCA QUITO-ECUADOR.
L. Tinoco 1,*, E. Carrasco 2, A. Nicolalde 3, V. Tapia 3, V. Tinoco 4, L. De los Reyes 5
1Lower Genital Tract Pathology, 2Surgery, 3Pathology, Oncology Hospital Soln
Espinosa Ayala "SOLCA", Quito, 4Gynecology & Obstetrics, General Hospital
Rodrguez Zambrano", Manta, 5Radiotherapy, Oncology Hospital Soln
Espinosa Ayala "SOLCA", Quito, Ecuador
Problem Statement: Invasive vulvar cancer disease that accounts for about of
gynecological cancer, it is a rare entity, the standardized incidence rate in
Ecuador is 0.7 per 100,000 women worldwide and ranges from 0.5 to
1.5. Invasive vulvar cancer (IVC) has been declining because of early diagnosis
and treatment of vulvar intraepithelial neoplasia (VIN). The relationship of these
entities with HPV are histologically confirmed of 39 countries gathered at the
Catalan Institute of Oncology (ICO), ranging from 25.1% in the IVC and 86.7% in
the VIN.
OBJECTIVE:Identify the frequency of invasive vulvar cancer and vulvar
intraepithelial neoplasia and encourage gynecologists to establish an early
diagnosis and treatment.Methods: Overall descriptive epidemiological study in
which 91 patients attending the Oncology Hospital Solon Espinosa Ayala
"SOLCA in Quito, during the years 2003 to 2014, carrying IVC and VIN with
histopathological results in conclusive biopsy and/or surgical specimen was
considered.Results: We studied 91 patients with an age range of 14 to 92 years
of which 63 cases (69.23%) were IVC and 28 (30.76%) VIN.
VULVAR INVASIVE CANCER: Age range 14 to 92 years. Was identified: Squamous
invasive 48 cases (76.1%); Basal 6 (9.52%), malignant melanoma 2 (3.17%); then
a series of 7 (11.6%) tumors with a single case: Eccrine Adenocarcinoma
1(1.58%), undifferentiated malignant tumor, mucinous, leiomisarcoma,
embryonal rhabdomyosarcoma, epithelioid sarcoma, and neuroendocrine
tumor. Variants of Squamous Carcinoma: keratinizing 41 (85.4%),
nonkeratinizing 3 (6.25%), Warthog (6.25%), basaloid 1(2.08%).
VULVAR INTRAEPITHELIAL NEOPLASIA: 30 Age range to 88 years. We found:
Bowen's Disease cases 8 (28.57%), VINIII 10 (35.71%), VINII 8 (28.57%), Paget
disease 2 (1.14%).Image / Graph:
Conclusion: In the study we added VIN, Paget's disease, which is a vulvar cancer
but it is not invasive and suppress the VIN I that does not contain this entity in
the protocols. Like invasive vulvar cancer, the intraepithelial neoplasia have a
Abstract Book
wide age range of appearance, so it is important not to underestimate this

diagnosis. The diagnosis on vulvar pathology only makes histopathology that
means biopsy is essential for proper treatment.
P168
PELVIC AND PARA-AORTIC LYMPHADENECTOMY IN PATIENTS WITH
ENDOMETRIAL CANCER: OUR EXPERIENCE
D. Vaidakis*, D. P. Karrer, C. Tatsi, J. Paraoulakis, C. Goudeli, E. Terzakis
Gynecological department, Anticancer Oncology Hospital of Athens St. Savas,
Athens, Greece
Problem Statement: Endometrial cancer is the commonest gynecological
malignancy in Europe. It is still under controversies whether or not pelvic and
para-aortic lymphadenectomy should routinely perform for early stage
endometrial cancer. Aim of the study was to compere the overall survival and
the recurrence rate in patients operated for endometrial cancer with and
without lymphadenectomy. Methods: For the purpose of the present study we
prospectively follow up for 60 months, 100 patients with similar characteristics
diagnosed with endometrioid adenocarcinoma. The patients were divided
equally in 2 groups. Group A: patients which total abdominal hysterectomy with
bilateral oophorectomy was performed and Group B which Pelvic and paraaortic lymphadenectomy was also performed. The Kaplan-Meier method was
used to generate overall survival (OS) data. Factors predictive of outcome were
compared using univariate analysis.Results: The mean age of the patients was
64 years. The demographic characteristic in both groups were similar. FIGO
Stage I endometrial cancer had 73% in group A and 69% in group B. From D&C
data nuclear grade I had 89% in group A and 79% in group B while grade II had
11% in group A and 21% in group B. Overall survival and recurrence rate (per
stage) in both group were similar. The mead number of lymph nodes removed
was 14. Positive lymph nodes were found in 3 patients.Conclusion: Even though
Pelvic and para-aortic lymphadenectomy doesnt affect overall survival or
recurrence rate and increase the morbidity of the operation, it is mandatory for
complete staging in endometrial cancer patients. Sentinel node biopsy can be
used in order to decrease morbidity
P169
VULVAR CANCER RECURRENCE RATE IN PATIENTS WITH LOCALIZED DISEASE
D. Vaidakis*, C. Goudeli, D. P. Carrer, C. Tatsi, E. Terzakis
Athens, Greece
Problem Statement: Vulvar cancer is a rare neoplasm with high recurrence rate
and poor prognoses in patients with affected groin lymph nodes. Even though
59% of the cases are diagnosed in early stages, approximately 20% of them will
recur in less than 5 years. Aim of the study was to identify predictive factors for
vulvar cancer recurrence in patients with localized disease.Methods: We
retrospectively study 64 patients, operated for squamous cell carcinoma of the
vulva from 2004-2010. In all patients 3 incisions radical vulvectomy with bilateral
groin lemphadenectomy were performed. All patients had negative groin lymph
nodes and no evidence of distanced metastasis at the time of the operation. The
mean follow up time was 7 years. Results: The mean age of the patients at the
time of diagnosis was 68 years. In 6% the tumor located at clitoris, while 45%
and 49% were at the left and right labia respectively. Urethra was involved in X
patients. Tumor size <2cm had 64% and the depth of invention was >3mm in
25%. Nuclear grade I had 72% of the patients. In 21 patients groin recurrence
was detected. The overall disease free survival was 47 months among patient
who relapse, and the 5year survival rate was 69%.Conclusion: Nuclear grade,
depth of invention, tumor size and location are identified as negative predictive
factors, while we couldnt identify any clinical characteristics as predictive factor
for recurrence. Vulvar cancer had, in general, poor prognosis so early diagnosis
is the goal of treatment.
P170
FERTILITY PRESERVING IN A 25 YEARS OLD NULLIPAROUS WOMEN WITH
ENDOMETRIAL CANCER: CASE REPORT
C. Tatsi, D. P. Carrer, M. Chrysi, D. Vaidakis*, E. Terzakis
Athens, Greece
Problem Statement: Endometrial cancer in the commonest gynecological
malignancy, in developed countries. Usually it is affect women after menopause,
while only 1.6% of the cases affect women younger than 30 years old. In this
cases if endometrial cancer is localized and if patients desire, it can be treated
conservatively in order to preserve fertility.Methods: In September 2012,
patient K.A. 25 years old, with free medical history, come at the outpatient
department of the hospital for her regular yearly examination. The U/S show an
endometrial polyps approximately 1cm. The patient didnt report any menstrual
disturbances or abnormal uterine bleeding. After counseling the patient, was
decided to remove the polys hysteroscopicaly and to perform D&C. Histology
report show endometrioid adenocarcinoma of the endometrium GR I, who cover
all the length of the polyps but with free surgical margins. The protocol we used
for fertility preserving was: per os megestrol oxide 360 mg per day, every
3mounths D&C with simultaneous placement of IUD MIRENA. Results: Till
December 2013 we perform 4 D&Cs which all were negative for malignances. In
December 2013 we stop the treatment, after patients demand in order to
childbearing. Approximately after one month she spontaneous conceives. She
had an uncomplicated pregnancy and in 9th of September she delivered a healthy
boy (BW:3100gr, APRAR:10/10, pH: 7,37). The placenta was sent for histological
examination which was negative for malignance. Conclusion: The protocol used
provides a sufficient protection for the patients with endometrial cancer who
wishes to preserve fertility. Women should be encouraged, by the attending
physician, to try to conceive automatically and only if it is not possible to resort
to the option of IVF. More research is needed for the patients options after
delivery.
P171
SEASONAL CHANGES IN SEMEN QUALITY FROM A UK FERTILITY CLINIC
POPULATION
J. Adams*, F. Mathews
Biosciences, University of Exeter, UK
Problem Statement: In humans, semen parameters are highly heterogeneous,
with conventional parameters changeable between men, countries, regions and
between samples from the same individual. Some heterogeneity within
individuals may be due to seasonal changes. In adult rhesus monkeys, under
controlled laboratory conditions, spermatogenesis varied in response to
circannual changes in the length of daylight. Previous studies have found
human semen parameters to be at their lowest in summer. However, results
have been inconsistent across regions, and little work has been carried out in
the UK. This study aims to investigate the effect of season on sperm motility,
morphology and concentration in the UK. Methods: Data were collected from
men referred for semen analysis at a UK based fertility clinic between 20082012. 1932 samples were included in our analyses. Seasonal trends were
evaluated for three commonly used sperm parameters: motility, morphology
and concentration. Statistical analyses were undertaken using R (i386 3.0.2)
packages season and phia. General Additive Models (GAMs) were used to
explore monthly variations in sperm quality, with month specified as a smoothed
and circular term. Generalised Linear Models (GLMs) with appropriate error
structures (binomial for sperm motility and morphology; Gaussian for
concentration) were then built. Data on sperm concentration were log
transformed in order to conform to assumptions of normality. The models were
refined using manual backwards-stepwise deletion. Comparisons between levels
of seasons were carried out in the phia package, which accounted for multiple
testing.Results: Seasonal trends were found for all three sperm parameters.
Sperm motility and morphology were significantly higher in summer than all
other seasons. Motility decreased from 54.3% to an average of 51.4% (p<0.001),
whilst morphology decreased from 7.5% to 6.8% (p<0.001). This resulted in an
129
overall significant seasonal effect (GAM p<0.001; p=0.005, respectively).

Seasonal changes were also found for sperm concentration (GAM p=0.04),
peaking in spring (65.46x106/ml) and dropping to its lowest in autumn
(56.25x106/ml) (p=0.027). Conclusion: Our study found significant seasonal
trends for sperm quality parameters in men from a UK fertility clinic population.
Results for sperm motility and morphology were different from previously
reported studies. However, the summer increase in these two parameters were
highly significant. Our findings for a seasonal trend for sperm concentration
were identical over the study period, suggesting a consistent seasonal increase
in spring.
Whilst the clinical implications of small fluctuations in sperm motility and
morphology are limited, the impact of a substantial seasonal decrease in sperm
concentration may be important in cases of limited sperm production. Further
work in other locations across the UK will clarify the seasonal impact on sperm
quality for men in the general population.
P172
INFORMATION, THOUGHTS AND PRACTICES OF HEALTH PERSONNELS IN
RELATION TO MATERNITY BLUES
S. Trkylmaz, N. Akdolun Balkaya*
1Adnan Menderes University, Aydn, Turkey
Problem Statement: This descriptive study has been carried out in order to
determine health personals information, thoughts and practices in relation to
the maternity blues. Methods: he study was conducted on health care workers
in Family Health Centers and Obstetrics and Gynecology Services of 2nd Health
Care Institutions in Ske, Aydin. The sample included 125 participants. Selfreported data were collected via a questionnaire prepared by the researcher,
after official permissions, approvals of the institutional ethics committee and
oral-written informed consent. The questions about knowledge were evaluated
according to the literature by grouping them as true (1 points) and false (0
points) out of 45 points. Data were evaluated with Chi-square, Fisher Exact Chisquare, Kruskal Wallis H and Mann Whitney-U tests. P< 0.05 was accepted as
significant in all analyses.Results: Participants mean age and average working
years in the profession were 39.787.31 and 17.407.81 years, respectively. Of
participants 81.6% were females and 44.8% had bachelor's degree. 70.0% of
participants who reported having a moderate knowledge of maternity blues
(56.0%), and got it during professional training (67.1%) hade a moderate
knowledge of maternity blues. Samples 76.0% wanted maternity blues training.
Of the sample 66.4% think maternity blues as a health problem, 63.0% care
about helping mothers and 80.0% think that education of healthcare staff is
necessary. Of participants faced with the maternity blues (45.6%) 77.2%
explained that the process is normal/temporary, 56.1% provided the expression
of mothers feelings, 61.4% of them with spouse and family support. However,
they saw themselves in this regard insufficient (79.2%). The information and
practices of nurses, midwives and personnel working in community health
centers and children's clinics were inadequate (p<0.005).Conclusion: As a result,
although health personals have a positive attitude to the maternity blues, their
knowledge and practices are inadequate. It is determined that this is affected by
a variety of institutional, professional and individual factors. Therefore,
supporting all health personals caring mothers before and after graduation with
planned and continuous trainings and institutional and legal arrangements in
order to increase their awareness would be very important.
P173
RECURRENT MISCARRIAGE AND CONSANGUINITY AMONG OMANI WOMEN
A CASE CONTROLLED STUDY
W. M. Al Ghafri 1,*, F. Al Hoqania 2, S. El tayeb 3, V. Gowri 1, Y. Al Farsi 4
1Obstetrics and Gynecology, Sultan Qaboos University Hospital, 2Medical
Student, Sultan Qaboos University, 3Obstetrics and Gynecology, Army Forces
Hospital, 4d.Department of Family Medicine and community Health, Sultan
Qaboos University, Al Seeb, Oman
130
Problem Statement: Recurrent miscarriage (RM) is defined as spontaneous loss

of three or more pregnancies consecutively prior to 20 weeks from the last
menstrual period, before the fetus has reached viability. It affects approximately
1% of women, and around 50% of these cases remain unexplained. Many studies
have demonstrated the detrimental effects of consanguinity on child health.
However research findings regarding the risk of consanguineous marriage on RM
are still controversial. The practice of consanguineous marriage has been the
culturally preferred form of marriage in most Arab and the Middle Eastern
countries, including Oman ((Islam 2012). The consanguineous marriage among
Arab population is about 20-50% of overall marriages with first cousin marriage
as the most common 25-30%.
Although there are many identified causes for RM, a large portion of RM are due
to unexplained reasons. Therefore, further research is needed in order to
discover these unexplained reasons, and with the mixed findings regarding
consanguinity as a risk factor it is important for research to be conducted on
consanguinity and RM to establish or eliminate it as a risk factor. The purpose of
this study was to determine the prevalence of unexplained RM and to find out if
there was a significant relationship between RM and consanguinity.Methods:
Case controlled study in which the cases group included all women with
unexplained RM attending the outpatient clinic at Sultan Qaboos University
Hospital from July 2006 to April 2012 and the controls group included women
with no history of RM after matching them with cases for age and parity (case to
control ratio was 1:2).the main outcome measures was the prevalence of
consanguinity in women with or without recurrent miscarriagesResults: During
study period a total of 290 women with RM were seen. Of which, 150(51.7%)
women had unexplained RM. Consanguinity rate among cases (60.7%) was
higher than the controls (53.7%). Consanguineous couples were 1.39 times more
likely to have RM compared to non-consanguineous couples. However this
observed increase in risk of RM was not statistically significant (95% confidence
interval [CI] 0.93-2.07; p=0.11).
Association between RM and consanguinity before and after adjustment for
confounding factors (age and parity)
Before adjustment for confounding factors
Risk factor
OR
95% CI
P- value
Consanguinity
1.39
0.93-2.07 0.11
After adjustment for
confounding factors
Risk factor
OR
95% CI
P- value
Consanguinity
1.38
0.92-2.09 0.12
Age
1.10
0.77-1.58 0.61
Parity
0.91
0.65-1.27 0.58
Conclusion: In this study we found that more than half of RM cases were
unexplained and there was no significant association between RM and
consanguinity.
P174
THE RELATIONSHIP BETWEEN ANXIETY/HOPELESSNESS AND DATING
VIOLENCE AMONG TURKISH YOUTH IN UNIVERSITY
H. Alan 1,*, T. Demirel 2, S. Dereli Yilmaz 2
1Midwifery, 2Selcuk University, KONYA, Turkey
Problem Statement: The aim of this research is to try and identify the correlation
between dating violence against women who study in university and their
anxiety/hopelessness levels.Methods: This is a descriptive and cross-sectional
research. Data were obtained from a total of 500 female university students who
have romantic relationships and agree to participate in the study by self
reporting method and between December 1, 2013-May 15, 2014. For data
collection, a questionnaire form which evaluates social-demographic
characteristics of participants along with their exposure to violence is used. The
study also utilized Beck Hopelessness Scale and Beck Anxiety Inventory. For data
analysis; percentage, mean, standard deviation and Mann-Whitney U test were
used. All local, ethical permissions were obtained prior to research.Results: The
mean age of female students participated in the study is 21.05 1.818 while
mean age of their partners is 22.99 2.910. 68% of participants have moderate
income. 2% of them share the same house with their partners. 15.6% of students
Abstract Book
are smokers while 6.4% of them consume alcohol while 46.6% of their partners
are smokers and 20.2% of their partners consume alcohol. 88% of female
students had been subjected to emotional violence, 22.2% of them had been
subjected to verbal abuse, 21.4% of them had been economically abused, 16.4%
of them have been subjected to physical violence and 7.2% of them had been
subjected to sexual violence by their partners. When asked about the reasons
for violence/abuse, 40.2% of them have answered "Jealousy". 56% of
participating female students said that their primary reaction to violence is
crying. When asked about why they choose to continue the relationship", 45%
of them answered "they endure the violence because they love their partners".
Average Beck Anxiety Inventory Score of students was found to be 14.1 12.0
and average Beck Hopelessness Scale Score was found to be 5.9 3.8,
respectively. These numbers show that students have clinically mild anxiety
levels and low hopelessness/despair levels. While there is a statistically
significant correlation between Average Beck Anxiety Inventory Score of
students and them being subjected to emotional, verbal, sexual and economical
abuse/violence (p<0.05), no statistically significant relationship was found
between Average Beck Anxiety Inventory Score of students and them being
subjected to physical violence (p0.05). Also, while there is a statistically
significant correlation between Average Beck Hopelessness Scale Score of
students and them being subjected to verbal, physical, sexual and economical
abuse/violence (p<0.05), no statistically significant relationship was found
between Average Beck Hopelessness Scale Score of students and them being
subjected to emotional violence (p0.05).Conclusion: All types of violence
against female students were observed to be quite common and this causes the
anxiety levels of students to increase. Despite the violence, hopelessnes of
students seems low. This suggests that violence may not have too much
influence regarding hopelessness levels of young, single individuals. Research
shows that most students' reaction towards violence is crying, which is
ineffective. It is suggested that students should be given necessary education
regarding protection from violence and combating violent behavior.
P175
HAS EXTERNAL CEPHALIC VERSION REDUCED THE INCIDENCE OF CAESARIAN
DELIVERY FOR BREECH PRESENTATION AT SQUH
R. H. Al-Haddabi*, N. Al_Maamari, N. Al-Maamarri, T. Al-Dugashi
Obstetrics and gynecology, Sultan Qaboos University Hospital, Muscat, Oman
Problem Statement: To assess the outcome of external cephalic version for
management of breech fetuses at term in terms of: Success rate of ECV and Fetomaternal complications.Methods: Design: Retrospective, cross sectional study.
Setting: Department of Obstetrics and Gynaecology, Sultan Qaboos Unviversity
Hospital, a tertiary care centre in Muscat, Oman. Patients: From June 2004 to
May 2014, the study was conducted involving pregnant women with breech
presentation at term who underwent external cephalic version. Data was
collected for identifying the success or failure of external cephalic version and
feto maternal complications. Main Outcome Measures: Maternal and fetal
outcome measures assessed in terms of: Success rate of external cephalic
version and maternal and fetal complications. Statistical Data Analysis: Collected
Data was entered into SPSS (Statistical Package for Social Sciences) version 19.0
and analyzed descriptively. Mean and SD was calculated for quantitation
variable like gestational age and percentages were calculated for qualitative
variables like gravida, complication etc.Results: fifty two women were included
in the study. External cephalic version was successful in ( ) patients. The majority
( ) of this group achieved the vaginal delivery. The rate of caesarean section was
( ). The most common indication for caesarean section was ( ). There was no
fetal adverse outcome and no major maternal complications. However the
procedure was stopped in ( ) patients due to maternal intolerance of pain.
Conclusion: External cephalic version has good success rate. External cephalic
version is relatively safe. Well equipped Obstetrics Units should routinely offer
the procedure in selective cases. ECV helps to avoid a significant number of
caesarean sections.
P176
COMPARISON OF HIGH HEAT SHOCK PROTEINS AND INFLAMMATORY
CYTOKINES LEVELS IN A PHYSIOLOGICAL LABOR AND PREECLAMPSIA
DEVELOPED.
M. D. C. Alvarez 1,*, A. Barrera 2, M. Osorio 3, A. Molina 4, N. Diaz 4, J. Acevedo 5,
H. Flores 1
1Biochemistry & Molecular Biology, 2Emergency, 3Obstetric & ginecology,
4Cellular Biology, Instituto Nacional de Perinatologa, Mexico City, Mexico,
5Obstetric and ginecology, University of Texas Southwestern Medical Center,
Texas, USA
Problem Statement: Preeclampsia (PE) is a multisystemic syndrome which
etiology is unknown, important cause of motherhood and perinatal mortality at
a worldwide level. About its physiopathology outstands the discovery of
immunology, genetics and environmental facts related with the bad placenta
implantation. Actually there are not biomedical markers for its early detection.
The heat shock proteins (Hsp) have been detected in different scenes in
pregnancy as long as labor, hypertensive disease and systemic illness. In PE the
Hsp have been associated with the increases of the immunology
response. Methods: Ethics statement. This study was reviewed and approved by
the National Institute of Perinatology Ethics and Research Committees. All
patients were explained the purpose of the study and informed consent was
obtained. Patients. This case control study was performed at the Perinatology
National Institute. Preeclampsia was defined according to the ACOG criteria. Five
milliliters of peripheral maternal blood was obtained from 3 groups of patients:
pregnant women with symptomatic preeclampsia diagnosis (n=60), women with
a healthy pregnancy who developed physiological labor (n=50) and women with
healthy pregnancy and without labor (n=28). The blood was centrifuged at 1500
rpm to obtain the plasma. Hsp and inflammatory cytokines quantification. The
plasma was recuperated for the total proteins quantification by Bradford
method and after that, to quantify Hsp-60, -70, IL-1 and TNF- using ELISA
method. The results are presented as mean deviation and statistical analysis
was performed using the Mann-Whitney test with a significant difference of
p<0.05.Results: The IL-1b, TNFa, Hsp-60 and -70 secretion in PE group increased
in 42.2 (p=0.003), 2.7 (p=0.05), 2.5 (p=0.002), and 2.8 (p=0.003) times
respectively over the group without labor. The group PE also showed higher
secretion of IL-1b, TNFa and -70 in 1.3 (p=0.099), 5.4 (p=0.05) and 1.3 (p=0.071)
times than the group with active labor, and a lower secretion in 1.3 times
(p=0.65) of Hsp-60. Image / Graph:
Conclusion: The findings in this study showed that the Hsp -60 and -70, and the
inflammatory citokynes IL-1b and TNF-a have higher secretion in women with PE
diagnosis than in women with normal pregnancy, and these biomarkers showed
a similar pattern in physiological inflammatory scenes like active labor.
131
P177
EVALUATION OF THE FEATURES OF CHILDBIRTH ON THE BACKGROUND
ANALGESIA
R. Svetlana 1, B. Oleg 2, S. Anna 3,*
1linic of family doctors Dobromed, 2Federal State Budget Institution
"Research Center for Obstetrics, Gynecology and Perinatology", 3Pirogov
Russian National Research Medical University, Clinical City Hospital 52,
Moscow, Russia
Problem Statement: Epidural analgesia (EA) is a widespread method of labour
pain relief. Frequency of its application reaches 50-90%. Data about influence of
EA on labour are contradictory. Purpose: To analyse features of a clinical course
and outcomes of labour under EA.
Methods: Materials and methods: The retrospective analysis of 300 case
histories of childbirth from 2008 till 2009 was carried out. Women were divided
into two groups: I group-128 (42.7%) didnt receive EA during labour, the II group
- 172 (57.3%) received EA for anaesthesia during labour. All women had vaginal
delivery at the full-term period of pregnancy. EA was started in an active phase
of childbirth with established labour activity. Fentanyl and naropin 0.2% were
used for EA.Results: Results: Comparative analysis revealed that in the group I
duration of childbirth was 399.58 109.77 min, while in the group II the duration
was 489.26 135.79 min (p<0.05). In the group I duration of the first period of
childbirth was 369.55 110.75 min, while in the group with EA 458.62 133.04
min (p<0.05). Duration of the second period of childbirth was also significantly
longer in the group with EA. Duration of the third period of childbirth didn't
exceed physiological values, however the tendency of shortening of the period
in women under EA was noted. Apgar scores and weight of newborns didnt
differ significantly in the groups I and II. Thus the general duration of labour
under EA was 22.4% longer. Duration of the first and second period of labour
was 24.1% and 13.5% longer under EA. It should be noted that 11 women under
EA and only 1 women in group I developed powerless labour (p<0.01). Acute
hypoxia of foetus was developed in 2 and 14 cases of the groups I and II
accordingly (p<0.01).Conclusion: Conclusion: EA increases duration of the first
and the second periods of labour and the risk of development of powerless
labour and acute hypoxia of foetus.
P178
NEW DEVICE FOR MEASURING ELECTRICAL IMPEDANCE IN MOUSE UTERINE
ENDOMETRIUM AND ITS APPLICATIONS
M. Arakawa*, M. Yamamoto, M. Nakamoto, K. Akasaka, Y. Nishimura,
T. Hosono
Department of Biomedical Engineering, Osaka Electro-Communication
University, Shijonawate, Osaka, Japan
Problem Statement: The uterine endometrium changes its histological
characteristics in each menstrual phase. Recently biological electrical
impedance has been widely used as a method to assess body constituents, such
as a body fat rate calculator. However, the technique of impedance
measurement has been seldom applied to gynecology. These are two ways of
measuring electrical impedance: a four-electrode method (FEM) and a twoelectrode method (TEM). The FEM involves two pairs of electrodes, an outer
pair (current-electrodes) and an inner pair (voltage-electrodes). Electrical
impedance is calculated by measuring the voltage between the voltageelectrodes produced by AC currents passing between the currentelectrodes. The TEM, involving only a pair of electrodes, measures parameters
similar to a circuit tester. The accuracy of the FEM is far higher than that of the
TEM. The aim of this study was to test the usefulness of a new device using the
FEM for measuring impedance in the uterine endometrium of mice.Methods:
Study 1. Thirty-five adult female mice were used in this study. We performed
cytological evaluations with Giemsa staining of vaginal smears and identified
estrous phases as proestrus (n=12), estrous (n=9), metestrus (n=9), and diestrus
(n=5). The intrauterine probe was composed of a core of tungsten wire of 0.3
mm in diameter and two pairs of electrodes. We rolled platinum wire on the
core wire as current electrodes and voltage electrodes at four sites within 10.0
mm from the tip end. We measured electrical impedance, that is, resistance and
132
reactance between 2.5 and 350 kHz, using an impedance checker. The
characteristic parameters such as impedance at 0 Hz (R0), infinity Hz (Ri), critical
frequency (Fc) at which resistance becomes a minimal value, resistance (Rfc) and
reactance (Ifc) values at Fc, and membrane capacitance (Cm) of the equivalent
circuit were automatically calculated. We exposed the mouse uterus under
inspired anesthesia and inserted the intrauterine probe into the vagina,
advanced it into the uterine cavity, and measured uterine endometrial
impedance. After the measurement, we pulled the probe out and checked it for
blood by wiping it with white paper. Study 2. We developed new probes using
thinner core wire and piling up platinum wires for electrodes by coiling up once
(probe A), twice (probe B), and three times (probe C). We used four female mice
in study 2. The experimental procedures were the same as mentioned in study
1.Results: Study 1. The resistances at 210 kHz for proestrus, estrus, metestrus,
and diestrus were 1,948 701, 707 339, 1,819 718, and 3,068 385 (mean
SEM), respectively with a significant difference between those at estrus and
diestrus (p<0.05). We noticed blood adhesion to the probe on every
measurement. We sometimes had to stop the measurement because we
penetrated the probe through the uterine wall because of the marked stiffness
of the probe. Study 2. The Rfc values measured using probes A, B, and C were
1,819 155, 803 98, and 658 581 , respectively. The deviation of
measurement values was minimal with probe B. Error codes were generated by
the impedance checker on measurement using probes A and C, indicating
inappropriate contact between the electrodes and uterine endometrium. There
was no blood adhesion with probe B.Conclusion: Our new device for measuring
uterine endometrial impedance using probe B may be useful for evaluating the
characteristics of the uterine endometrium.
P179
THE EFFECT OF RELAXATION EXERCISES ON SLEEP QUALITY IN PREGNANT
WOMEN
S. Aydin Ozkan 1,*, G. Rathfisch 2
1Nursing, Adiyaman University School of Health, Adiyaman, 2Nursing, Istanbul
University Florence Nightingale Nursing Faculty, Istanbul, Turkey
Problem Statement: Hormonal and physical changes during pregnancy causes
significant changes in regular sleep routine and sleep quality. The increasing
number of weeks of pregnancy is seen an increasing sleep problems and sleep
quality of pregnant women is negative affected. Studies on sleep quality show
that poor sleep quality in pregnancy has negative effects on labor as well as on
fetal health. This research was conducted to investigate the effect of relaxation
exercises on sleep quality in pregnant women.Methods: This study is a
randomized controlled trial one with a prospective pre-test post-test
experimental design. The study sample consisted of 84 pregnant women who
consulted to Republic of Turkey Ministry of Health (RTMH) Zeynep Kamil Training
and Research Hospital, Pregnant Women Monitoring Policlinic, pregnancy
training class between September 2012 and July 2013, applied pregnant women
in the third trimester and met inclusion criteria. Research ethics committee
approval was obtained from Zeynep Kamil Training and Research Hospital where
the study was conducted (Ethics Committee protocol no: 12353). All pregnant
women are assessed at pre-test with Pitsburg Sleep Quality Index (PSQI). The
pregnant women in the experimental group were asked to conduct the
relaxation exercises CD developed by Turkish Psychological Association in the
evening throughout four weeks. The pregnant women in the experimental group
and control group are assessed with PSQI after the four weeks again. The data
were analyzed using Statistical Package for Social Sciences (SPSS) 15.0
program.Results: The study has found that average age of the participants is
27,864,22 (20 - 39); and 64,3% of them are aged between 20 and 29. Of all the
participants, 54,8% (n=46) are university graduates and 50,0% (n=42) work;
75,0% planned their pregnancy (n=63), 60,7% are in their 28th-30th week of
pregnancy, and 39,3% are between their 31st and 34th week of pregnancy. BMI
values of the pregnant women before pregnancy were found to range between
15,92 and 24,97 kg/m2, and 22,022,27 kg/m2on the average. Measurements
regarding neck circumference range between 29 and 36, and 32,672,15 cm on
the average. The study has found that with a 60,7% pre-test PSQI scores the
pregnant women participating in the study had poor sleep quality. The mean
Abstract Book
score of the global PSQI was 7,123,66. After relaxation exercises, pregnant
women in the experimental group have increased sleep quality, subjective sleep
quality as very good is shortened sleep latency, increased sleep duration and
habitual sleep efficiency, decreased sleep disturbance and daytime dysfunction.
The difference between the two groups was found to be statistically significant
(p<0,001).Conclusion: This study has found that relaxation exercises have
increased sleep quality of the pregnant women in the third trimester. To
improve the quality of sleep of pregnant women in prenatal care practices
suggest that given relaxation exercises.
P180
HOW GOOD ARE WE AT CONSENTING PATIENTS FOR CAESAREAN SECTION?
S. Babu 1,*, M. Esan 2, G. Ho 3, Y. Beebeejaun 4
1St Mary's Hospital, 2Medical Education, King's College London, London,
3Brighton and Sussex University Hospital, Brighton, 4Women's Health, Guy's and
St Thomas' Hospital, London, UK
Problem Statement: Caesarean section is one of the most common operation
performed in Obstetrics Medicine. Whether it is part of an elective management
plan or as an emergency measure, the need for women to be appropriately
counselled about this procedure and its future implications is vital. With the
rising age of our average patient, appropriate and adequate consent about
caesarean section such as the nature ofhe procedure, the risks and benefits as
well as the important complications associated with the operation is a vital
discussion for obstetricians and midwives involved in the care of pregnant
mothers Methods: We performed a retrospective analysis of the pregnant
women who underwent Caesarean Section in our unit. The inclusion criteria was
for women who underwent either an elective procedure or a semi- elective
caesarean section. Category 1 Caesarean section or failed instrumental
deliveries that lead to an emergency procedure were excluded as these usually
proceed on verbal consent. We analysed the documentation of the consent
forms across our patient population and compared it to the guidelines set by the
Royal College of Obstetrician and Gynaecologist. Since our department was a
District General Hospital, we extended this quality assessment project to a
tertiary unit as well. This enabled us to complete a double centre project
allowing a fair and solid assessment at the ability of obstetricians to consent
women for caesarean sections. Using STATA statistical software, we analysed
the data recorded and found our findings to be statistically significant
(p<0.005). Results: After analysing the data, the results showed that
obstetricians were failing at consenting patients for caesarean specific
complications such as emergency hysterectomy, ureteric injury, or injury to the
fetus. General complications associated with all major surgeries such as
bleeding, infection and scaring were recorded in 100% of cases. A similar result
was obtained in our fellow tertiary level delivery suite, Conclusion: This quality
assessment project highlights areas of documentation which are not only noncompliant with the RCOG guidance, but also non-compliant with various aspects
of the General Medical Council of the United Kingdom document which advises
about what is deemed to be informed consent and the risks that patients should
be aware of. We therefore recommend delivery units to adopt a pre-filled
consent forms which would highlight to clinicians and patient about all the
common risks and complications associated with Caesarean sections.
P181
GESTACIONAL DIABETES MELLITUS INFLUENCES IN PREGNANCY SEXUAL
RESPONSE
A. M. P. Barbosa*, A. P. Machado de Almeida, G. Vesentini, F. Piculo,
G. Marini 1, J. Lara Padovani 2, M. Rudge 1
1Gynecology, Obstetrics and Mastology, 2Pathology, Unesp, Botucatu, Brazil
Problem Statement: Pelvic floor muscles (PFM) are very important to vaginal
mobility, pelvic organ maintenance, urethral and anal sphincter closure, urinary
continence and normal sexual function. The PFM integrity can be changed in
different phases of women life, especially in pregnancy and delivery.
Furthermore, these alterations can be highlighted with Gestational Diabetes
mellitus (GDM). GDM is a medical complication with higher occurrence during

pregnancy and can lead to higher frequencies of abnormalities when compared
with normoglycemic pregnancy. Studies have showed us that GDM altered the
structure of PFM, and it was associated with higher incidence of urinary
incontinence. Therefore, PFM alterations can affect the sexual function and
consequently can to worsen quality of life. Therewith, our objective was to
analyze the effects of GDM in pregnancy sexual response.Methods: This crosssectional study were performed from 2013 to 2014. 134 pregnant women with
thirty four or more pregnancy weeks or women who underwent childbirth in the
last two years were selected and recruited for this study. The women were
divided into 2 groups: Diabetic group (39) and Normoglycemic group (95) and
they answered the Pregnant Sexual Response Inventory (PSRI).
All experimental procedures were approved by the Ethics Committee of the
Botucatu Medical School UNESP (Protocol Number n161/12).Results: 43
(45,26%) women were primiparous and 52 (54,74%) were multiparous. The Body
Mass Index in groups are demonstrated at Table 1.
Table 1. Clinical characteristics of the groups normoglycemic (NG) and Diabetic
(DG)
Initial Body Mass Index
Underweight
Adequate
Overweight
Obesity
Final Body Mass Index
Underweight
Adequate
Overweight
Obesity
NG (n=95)
3
43
25
24
%
3,16
45,26
26,32
25,26
DG (n=39)
0
2
13
24
%
0,00
5,13
33,33
61,54
15
24
22
34
15,79
25,26
23,16
35,79
0
3
7
29
0,00
7,69
17,95
74,36
No difference between groups was found in PSRI questions about Sexual

Intercourses Number, Sexual Quality Score, Desire and Pleasure (p>0,05).
However, both of groups reported sexual difficulties when compared before
pregnancy and during pregnancy: 94 (70,1%) women reported decreased in
Sexual intercourses number, 102 (76,1%) reported decreased in sexual quality,
83 (61,9%) reported decreased in desire and 83 (61,9%) reported decreased in
pleasure. Conclusion: This data showed us that GDM not influenced in sexual
response during pregnancy but pregnancy has negative impact in sexual
response. Therefore, we concluded that actions are necessary to prevent PFM
impacts during pregnancy.
P182
ONTRACEPTIVE ADHERENCE TO THE INJECTABLE DEPOT
MEDROXYPROGESTERONE ACETATE (DMPA) AMONG HEALTHY WOMEN OF
DIFFERENT SOCIAL GROUPS
T. Belokrinitskaya 1,*, N. Frolova 1, L. Anohova 1, S. Anohov 2, B. Zhalsapova 2
1Obst/Gynec Department, Chita State Medical Academy, 2Polyclinic Dept,
Health care City hospital No 2, Chita, Russian Federation
Problem Statement: Acceptability of a contraceptive method depends upon
many interacting factors, like: characteristics of the method, demographic and
socioeconomic variables pertaining to the population of clients (WHO, 2009).
Injectable contraception reduces the need of daily consumption or depends
upon sexual intercourse. However, intolerable side effects and changes in
menstrual pattern are the most frequently indicated reasons for discontinuing
DMPA use. The objective of this study was to assess the prevalence of side
effects of injectable contraceptive DMPA in women of different social
groups.Methods: This prospective cohort study was approved by the Ethics
Committee of the Chita State Medical Academy (Russia). The inclusion criteria
were women aged 18-36 years and no contraindication for using of DMPA
according to WHO criteria. The exclusion criteria were: breast feeding, previous
injectable contraceptive, and history of gynecological or other diseases
(diabetics, blood pressure, etc). In accordance with the National criteria of living
standard (education, job, number of unemployed members of the family, quality
of housing, food, water, etc) 73 women were classified as a low-income social
group (group 1) and 12 female as a middle-income social class (group 2). DMPA
was given as 150 mg by deep intramuscular injection First injection was given
during the first five days of a menstrual cycle and then every 12 calendar weeks
133
(84 days+5 days). The volunteers were examined three, six and twelve months
after using contraceptive, and they were asked about side effects. Results: No
differences in median age, frequencies of parity and abortions were found
between both groups. As shown in table, significant association between side
effects of an injectable contraceptive DMPA and social class of women was
found. The overall frequency of DMPA side effects was 1.8-times higher in
women of middle-income social class (66.7% vs 37.8%; p=0,049). Female of
middle-income social class using DMPA versus a low-income social group had
increase risks of breast tenderness (OR=7.8), nausea (OR=6.6), depression and
nervousness (OR=3.6), headache (OR=3.1), weight gain (OR=2.2), spotting
(OR=1.6). Reduction in libido was observed only in four (33.3%) of middleincome social class women. Amenorrhea occurred only in two (2.7%) patients of
lower-income social group. Three or more side effects associated with prolonged
DMPA contraception were the cause of the discontinuing DMPA use (1.4% vs
33.3%, respectively 1-st and 2-nd group).
Table. Comparison of DMPA side effects in different social groups.
Variable
Breast tenderness
Nausea
Depression,
nervousness
Headache
Weight gain
Spotting
Reduction in libido
Amenorrhea
Number of patients
with side effects
Group 1
(low-income
social class)
n=73
2(2.7%)
1(1.4%)
9(12.3%)
Group 2
(middle-income
social class) n=12
95 % CI
3(25%)
1(8.3%)
4(33.3%)
7.8*
6.6*
3.6*
2.0510.32
1.8812.84
1.277.22
7(9.6%)
6(8.2%)
4(5.5%)
0
2(2.7%)
27(37.0%)
3(25.0%)
2(16.7%)
1(8.3%)
4(33.3%)
0
8(66.7%)
3.1*
2.2*
1.6*
3.4*
1.157.25
0.806.89
0.457.43
1.226.84
* statistically significant associationsConclusion: Side effects associated with

prolonged contraception with DMPA occurred 1.8 times less, and adherence to
treatment was up to 23.8 higher in women of low-income social group than
among women of middle-income social class, that perhaps influenced by the
lifestyle and standard of living, nutrition and physical activity of women.
P183
FREQUENCY OF PREGNANCY-INDUCED SYMPTOMS AMONG PREGNANT
WOMEN AND EFFECTS ON ACTIVITIES
D. Bilgic 1,*, G. Daglar 1, N. Nur 2, F. Evcili 1, G. Demirel 1
1Cumhuriyet University Faculty of Health Science, Sivas, Turkey, 2Cumhuriyet
University, Faculty of Medicine, Sivas, Turkey
Problem Statement: Symptoms experienced in pregnancy can be considered as
discomfort by the pregnant due to its effects. This may increase possibility of the
pregnant change her life style, restrict her activities, develop negative attitude
towards pregnancy, experience negative emotions and obstruct
physical/psychological adaptation to pregnancy. Therefore it is important to
determine effects of symptoms experienced during pregnancy on activities. The
study was carried out in order to determine frequency of pregnancy-induced
symptoms and their effects on activities.Methods: The descriptive study was
carried out between April-August 2014. It was aimed to include 20% of 62 streets
in total which are located in Sivas city center, 12 streets were chosen with
random sampling method and 418 pregnants participated in the study. The
study was carried out with home visits. Visit appointment was made before visits
via telephone call, women who accepted to participate in the study were asked
to fill in pregnants question form and question form about pregnancyinduced symptoms which was prepared according to literature. Data were
evaluated in SPSS 16.0 program; descriptive statistical criteria, chi square-test,
Variance Analysis, Correlation Coefficient were used, significance was taken as
p<0.05.Results: Mean age of pregnant women was 27.465.47 years. It was
determined that education period of 2.9% of pregnant women is 12 years and
less, 72.7% live in nuclear family, 74.9% regard their economic status as their
income is equal to their expense. 37.6% of pregnant women experience their
third or more pregnancy, 17.9% are in the I., 25.8% are in the II. and 56.2% are
in the III Trimester. Nearly all of the pregnant women (90.2%) stated they do not
134
smoke cigarette, most of them (84.2%) have healthy pregnancy period and
90.7% of them stated they wanted pregnancy. It was observed that the
most common symptom groups among pregnant women are
neurological/psychological (96.7%), genitourinary (90.2%) and dermatological
symptoms (89.2%). It was determined that symptoms of urinary incontinence
%74.3, fatigue %69.8, hemorrhoid %67.5, back pain %66.4, pelvic pain %64.4,
vomiting 60.7, pain down the back of leg %60.5 influence activities of pregnant
women. Symptoms about musculoskeletal systems were significantly high
among pregnant women in 3. Trimester (p=0.045).Conclusion: Pregnant women
mostly experience neurological/psychological, genitourinary and dermatological
symptoms. Activities of pregnant women who experience symptoms about
cardiovascular, musculoskeletal and gastro intestinal systems are more
influenced. Pregnant women in 3rd trimester experience symptoms especially
about musculoskeletal system more. Nurses and midwives who take care of the
pregnant women can help the pregnant cope with symptoms ideally by
evaluating frequency of symptoms and their effects on activities.
P184
DETERMINATION OF RELATION BETWEEN LIFE QUALITY AND LEVEL OF
MOTHER-INFANT ATTACHMENT IN PREGNANCY AND POSTPARTUM PERIOD
G. Daglar 1, N. Nur 2, D. Bilgic 1,*
1Cumhuriyet University Faculty of Health Science, Sivas, Turkey, 2Cumhuriyet
University Faculty of Medicine, Sivas, Turkey
Problem Statement: Physiological, psychosocial changes during pregnancy and
relation of these changes with life events may have effect on life quality of
pregnant. Maternal attachment is one of the most important factors which
promotes healthy growth and development of child. In the study, it was aimed
to determine relation between life quality in pregnancy and postpartum period
and mother-infant attachmentMethods: The descriptive study was carried out
between March-August 2014 with 174 pregnant women who have completed
35th gestational week. It was aimed to include 20% of 62 streets in total which
are located in Sivas city center, 12 streets were chosen with random sampling
method. The study was carried out with double home visits. Visit appointment
was made before visits via telephone call, women who accepted to participate
in the study were asked to fill in Pregnancy Description Form, The Prenatal
Attachment Inventory (PBI) and The Turkish version of the World Health
Organization Quality of Life Instrument (WHOQOL-BREF (TR)) in the first
visit. The second visit was made in the postpartum 7th or 8th day, in this period
women were asked to fill in Mother-to-Infant Bonding Scala (MIBS), the Turkish
version of the World Health Organization Quality of Life Instrument (WHOQOLBREF(TR)). Data were evaluated in SPSS 16.0 program; descriptive statistical
criteria, t-test, Variance Analysis, Mann-Whitney U Test, Kruskal Wallis Variance
Analysis and Correlation Coefficient were used, when p<0.05.Results: Mean age
of pregnant women was 27.335.64 years. It was determined that education
period of 46.6% of pregnant women is 12 years and more, 37.9% experience
their third or more pregnancy, 94.3% made regular inspections. It was
determined that there is meaningful and positive relation between subdimensions of life quality in pregnancy and average score of PBI (physical domain
r=0.179, p=0.018; mental domain r=0.343, p=0.000; social domain r=0.172,
p=0.023; environmental domain r=0.358 p=0.000; national environmental area
r=0.344, p=0.000), there is meaningful yet negative relation with MIBS average
scores (physical domain r=-0.184, p=0.015; mental domain r=-0.366, p=0.000;
social area r=-0.229, p=0.002; environmental area r=-0.284 p=0.000; national
environmental area r=-0.277, p=0.000).Conclusion: It was determined that PBE
mean score was 58.0011.60 (min-max:24-84) 58.0011.60 (min-max:24-84)
and MIBS mean score was 1.001.36 (min-max:0-6) Since the increase of score
obtained from MIBS shows that attachment is negative, as the prenatal
attachment increases so does the postpartum attachment. As the life quality in
pregnancy increases so does the mother-infant attachment in pregnancy and
postpartum period. As the score obtained from mental domain and
environmental domain sub-dimensions of postpartum life quality increases so
does the postpartum mother-infant attachment. In the attachment of mother-
Abstract Book
infant, it is important that health personnel support mother in ideally in

pregnancy, birth-giving and postpartum period.
P185
IMPACTS OF KANGAROO CARE WHICH IS APPLIED TO THE INFANTS IN
NEONATAL INTENSIVE CARE UNIT ON THE INFANTS PAIN LEVELS
S. Tazegul, S. Cetinkaya*
Adana School of Health, ukurova University, Adana, Turkey
Problem Statement: Kangaroo Mother Care (KMC) was developed in Colombia
in the 1970s. Low birth weight and preterm infants were cared for by their
mothers using continuous skin-to-skin contact 24 hours a day. They were
exclusively breastfed or fed with breast milk, whenever possible, and discharged
home early with a scheduled follow-up programme. Methods: This study is
experimentally planned to analyze the impacts of kangaroo care (KC) which is
applied to the premature infants stayed in Neonatal Intensive Care Unit (NICU)
on reducing the pain occurred while drawing blood from the toe. The population
were the premature neonatals and their mothers stayed in Neonatal Intensive
Care Unit of Cukurova University the Faculty of Medicine (TF) Balcal Research
and Application Hospital between June 2012November 2012. The study is
done on totally 45 premature infants who stayed anytime between and
complied with the case selection criteria. These infants were casually appointed
to experimental (n:21) and control groups (n:24). The Premature Infant Pain
Profile (PIPP) was utilized oncollecting data on the purpose of
assessing behavioural and physiological responses of the infant in the process of
survey, video camera, monitor and phlebotomization. The package of Statiatical
Package for Social Sciences 18.0 (SPSS) was utilized on the statistical analysis of
the data. Categorical measurements were summarized numerically and by
percentage; numerical measurements were summarized averagely and by
standard deviation. Chi square, Mann Whitney U and T tests were utilized on
assessing the data.Results: Most of the studied neonatals were between 32-36
weeks born; 58% of the neonatals in the control group and 67% of the neonatals
in the experimental group were girls and both groups were found similar when
introductory features of the experimental and control groups were
compared. On the study, PIPP score was found similar before the invasive
initiative (p=0.897), PIPP score in the experimental group was found statistically
significant (p<0.001) compared with the control group during the invasive
initiative and PIPP scores were found statistically similar in both groups after the
invasive initiative (p=0.195).Conclusion: Consequently; our findings have
showed that KC is an effective method on reducing the premature infants pains
in the invasive initiatives and PIPP is effective on assessing the premature
infants pain.
P186
THE COSTS OF THE DIAGNOSIS AND TREATMENT OF RESPIRATORY,
CARDIOVASCULAR AND FETAL GROWTH DISORDERS IN A NEONATAL
INTENSIVE CARE UNIT (NICU).
E. L. D. Costa*
Departamento de Obstetrcia e Ginecologia da Escs Braslia- Brasil, Escola
Superior de Cincias da Sade (Escs), Braslia, Brazil
Problem Statement: Objective: Theobjective of thisstudy is to accessthe cost,
paidby the UnifiedHealth System (SUS), of the hospitalization ofnewborns (RN)
in theNICU ofthe Hospital MaternoInfantil deBraslia (HMIB) in the period
from01/01/2013 to31/12/2013. The costs referred arerelatedto treatmentsof
disorders involving fetal growth, length of the pregnancy, and respiratory and
cardiovascular diseases of the neonatal periodMethods: Method: This was a
retrospective, cross-sectional study ofthe diagnosis and treatment of
hospitalized infants, inHMIBs NICU, in the periodof01/01/2013to 31/12/2013,
in relation to the amountof daily costsof the hospitalization forthe
diseasesmentionedabove. There are 40 beds in HMIBs NICU, andthe daily
costof a NICU, paid bySUS, is$223.08Results: . Results: InHMIBsNICU, in the
period mentioned above, a total cost of $146.928.026 was spent by SUS. Daily,
the cost was $5.534. In regard to the diseases analyzed, the cost was $3.434
daily, resulting in a percentage of 62.05% of the total of costs, corresponding to

total value of $919,495.11. The daily cost of treatments to diseases related to
length of pregnancy and fetal growth disorders was $1728, corresponding to a
total value of $462,729.47, and associated with a percentage of 31,22%. The
therapeutic of respiratory and cardiovascular diseases in the neonatal period is
related to a percentage of 30, 83% of the costs and thatinclude $1706 daily and
$456,695.64 in total. The daily rate charged by HMIB in the SUS, in all diseases,
was $267.70.
Image / Graph:
Conclusion: Conclusions: The
cost of hospitalization, in a
daily basis, in HMIBs NICU is
very high. Although, that isnt
a difference in costs between
newborns with more severe
diseases than with the one
with less severe ones. It is
known, in another hand that
the therapeutic arsenal used
in newborns with more
severe diseases is much
more sophisticated, speaking
both in quantity and in
quality terms.
A better analysis of the amount of money spent by SUS daily in HMIB should be
made, since patients with diagnosis related with length of gestationand fetal
growth disorders may use medications that cost, for example, one hundred
dollars a vial.
P187
WHY ARE THE RATES OF MATERNAL REQUEST CAESAREAN SECTION RISING IN
A LONDON TEACHING HOSPITAL AND WHAT ARE THE FINANCIAL
IMPLICATIONS?
L. Curran*, S. Subair
Obstetrics and Gynaecology, University College Hospital, London, London, UK
Problem Statement: Maternal request Caesarean sections are rising in our unit
with associated clinical and financial implications.
Caesarean Section (CS) performed at maternal request can be defined as the
primary caesarean section delivery of a fetus, in the absence of contraindications
to vaginal birth, at the mothers request. Whilst the risks and benefits of a
planned CS can be debated, undoubtedly the procedure carries a greater
financial cost than a vaginal delivery. The UK national institute for health and
care excellence (NICE) issued guidance in 2011 allowing maternal request CS.
At the same time, there has been a change in the NHS maternity tariffs since
2013. Intrapartum care now attracts 2 tariffs; delivery with complications and
delivery without complications. Trusts now receive the same tariff for a vaginal
delivery or Caesarean section with complications or without complications. i.e.
with complications (2161) (2804 + MFF) or without complications (1477)
(1917+ MFF). The uplift in our case is due to market forces factors in central
London.
The average UK cost of a CS is 2369, whilst the cost of a SVD is 1665. At
University College Hospital in London, the annual CS rate is approximately 31%
of all deliveries, compared to the national average of 25%. In 2011, 0.56% of all
deliveries were maternal request CS, increasing to 1.74% in 2013. Methods: This
study reviewed all maternal request CS performed at University College Hospital
over a 6-month period in 2013. Suitable cases were identified through the
Microsoft Outlook centralized CS booking diary and Medway Maternity EPR
records. A pro-forma was designed to record data for each maternal request CS,
with the aim of understanding factors contributing to the rising rate. Results:
Over the 6-month period (July 2013-December 2013), 51 cases of maternal
request CS were identified, 9 cases were excluded. Analysis of all cases (n=42)
showed that 9% of these women did not book their pregnancy until after 20
135
weeks gestation, 7% had transferred care from another hospital and in 28% of
cases mode of delivery was discussed with the mother by a consultant
obstetrician or consultant midwife prior to 20 weeks gestation.
There was clear documentation that the mother had been offered appropriate
referral for psychological support in 64% of cases. Of this proportion that were
referred, 89% (n=24) of the group were documented as having undertaken this
psychological support. Additionally, 75% of women first seen by a consultant
obstetrician or midwife after 30 weeks gestation did not partake in psychological
counseling. Of the group who had transferred their care from another institute,
they did so after 20 weeks gestation and none underwent
counseling.Conclusion: In those cases where the mother was not seen by a
consultant until the last 10 weeks of gestation, the proportion referred to
appropriate psychological counseling services, as recommended by our current
national guidance, was greatly reduced. There is an assumption that women
know their preferred method of delivery at booking whereas this is not always
so. Are we therefore able to deny late requests simply because they havent
engaged with the pathway or due to cost? Maternal choice has to be taken into
consideration.
Our consultant midwife had approximately 768 appointments in 2013 related to
maternal request CS and 55% attempted vaginal birth.
P188
THE IMMUNOLOGIC EFFECTS OF PREGNANCY ON ATOPIC DERMATITIS AND
PSORIASIS
M. J. Danesh 1,*, J. Murase 2
1
Dermatology, University of California, San Francisco School of Medicine,
2Dermatology, University of California, San Francisco; Palo Alto Foundation
Medical Group, San Francisco, USA
Problem Statement: Immunological changes in pregnancy are associated with
improvements in some pre-existing autoimmune skin diseases and
exacerbations in others. Estrogen is hypothesized to be partially responsible for
these changes by creating a shift from Th1 to Th2 immunity. As predicted,
psoriasis (a primarily Th1 mediated disease) tends to improve in pregnancy
whereas atopic dermatitis (a primarily Th2 mediated disease) tends to worsen.
However, the precise mechanism by which estrogen induces immunological
change in cutaneous autoimmune disease remains poorly understood. Our
objective in this review was to evaluate the immunologic effect of estrogen in
patient's psoriasis and atopic dermatitis during pregnancy.Methods: We
performed an English-language PubMed search of articles from September 2004
to September 2014 combining key terms including "atopic dermatitis,"
"psoriasis," "estrogen," "autoimmune disease," "pregnancy." Results: The effect
of estrogen on cutaneous autoimmune diseases, specifically psoriasis and atopic
dermatitis, will be described in this presentation with a focus on the mechanism
of improvement/exacerbation and the role of cell mediated
immunity. Conclusion: Estrogen appears to up-regulate Th2 cytokines (IL-4 and
IL-10) and down-regulate Th1 cytokines (IL-2, interferon gamma, IL-12). The
down-regulation of Th1 cytokines serve to prevent fetal rejection while upregulation of Th2 cytokines serve to promote passive transfer of antibodies to
the fetus. It has been shown in mice and humans that failure to shift from a Th1
to a Th2 system results in an increased rate of spontaneous abortion. This shift
was initially shown in murine systems by decreased mixed lymphocyte reactions
of splenocytes and increased antibody production during pregnancy. Antigen
stimulated splenocytes were then shown to produce less Th1 cytokines and
more Th2 cytokines when derived from pregnant mice. Additionally, antigen and
mitogen stimulated peripheral blood mononuclear cells derived from patients
with normal pregnancies demonstrated a decrease in the production of IL-2 and
IFNg and an increase in production of IL-4 and IL-10. Together these
observations support the shift from a Th1 to Th2 mediated immunity, which may
explain the exacerbation of atopic dermatitis, which is primarily a Th2 mediated
disease. It also supports the improvement of Th1 mediated diseases like
psoriasis. In fact, the phenomenon of an improvement in psoriasis during
pregnancy provides a unique opportunity to gain insight into autoimmune
disease pathogenesis and may encourage new future, inexpensive treatment
strategies involving hormonal therapy. Disclosure of Interest: None Declared
136
P189
REASONS FOR FEMALE UNIVERSITY STUDENTS START AND CONTINUE TO
SMOKE: A QUANTITATIVE AND QUALITATIVE ANALYSIS
A. Koyun 1, T. Demirel 2,*
1Obstetric and Women Disease Nursing, Afyon Kocatepe University,
Afyonkarahisar, 2Public Health Nursing, Selcuk University, Konya, Turkey
Problem Statement: Smoking is a very common addiction type which has
adverse effects on human health. While smoking cigarettes have various effects
on reproductive health of both sexes, it is known that it has more negative
effects on women's reproductive functions. In order to prevent these effects,
the reasons for young women start and continue to smoke should be identified
and services that help smoking cessation should be popularized. The aim of this
study is to identify the reasons for female university student start and continue
to smoke.Methods: Both quantitative and qualitative research methods were
used in this study. Features related to female students' smoking habits were
examined by cross sectional research methods while reason for them to start
and continue smoking were examined using Miles and Huberman's (1994)
quantitative data analysis method. This research conducted in Afyon Kocatepe
University between May 2, 2014 and June 1, 2014. A total of 148 randomly
selected, smoking female students from the university campus were included in
the quantitative research. Data were collected using the questionnaire form
prepared by the researches and Fagerstrom Test for Nicotine
Dependence (FTND). Two semi-structured focus group interviews were
conducted for 11 (5+6) randomly selected female students who participated in
the quantitative study and research was completed. Frequency and percentage
distributions of quantitative data were examined. Data reduction method was
used for analysis of qualitative data.Results: The average period for students to
continue smoking is 3.82.4 years. 37.2% of students are found to start smoking
cigarettes before they are 18 years old and 13% of them are found to smoke
more than half a pack. 40% of students scored medium and high on FTND. The
reasons for students to start smoking are wannabe / curiosity (36.5%), alleviating
distress (26.4%) and recommendation from friends (20.3%) while the reasons for
them to continue smoking are addiction / dependency (42.6%) and pleasure /
joy (38.6%). The reasons for students who participate in focus group study to
start and continue smoking was found to be to alleviate stress. Students have
stated that they want to quit smoking mostly because its negative effects to their
health. They've also stated that in case of family pressure or pregnancy, they
would definitely quit smoking.Conclusion: Study results show that female
students start smoking mostly due to peer influence and continue to smoke
because they believe it helps relieving and controlling stress. It is recommended
that behavioral therapy studies that takes especially peer influence into account
should be conducted in order to fight smoking.
P190
ACUTE POST-PARTUM UTERINE INVERSION TREATED BY MODIFIED
HAULTAINS PROCEDURE.
J. S. Dhannapuneni 1,*, J. L. S. Amma 2, P. Morgan 3
1Obstetrics and Gynaecology, St Helens and Knowsley Teaching Hospitals NHS
Trust, 2Obstetrics and Gynaecology, St Helens and Knowsley Teaching Hospitals
NHS Trust, Warrington Road, 3St Helens and Knowsley Teaching Hospitals NHS
Trust, Whiston, UK
Problem Statement: Acute uterine inversion is rare but life threatening
emergency in 3rd stage of labour. Prompt recognition and immediate
management is the key to saving the patients life.
Traditional management options involve immediate manual replacement with
or without hydrostatic pressure. When unsuccessful, surgical correction using
Huntington and Haultains procedures are used. Recently more conservative
surgical techniques have been reported. We would like to heighlight a simillar
coservative surgical technique used by minor modification to the originally
described Haultain's procedure in the sucessful managemesnt of an acute
postpartum uterine inversion associated with massive PPH.Methods: A 25 year
old para G3 P2 delivered a healthy male infant spontaneously after
Abstract Book
uncomplicated labour. She received 10 IU of Syntocinon with delivery of anterior

shoulder. After three unsuccessful attempts at delivering the placenta by a
midwife, she started bleeding heavily and medical assistance was summoned.
On arrival, the placenta and membranes filled with blood was found at the vulva.
The loosely attached placental membranes came off easily revealing complete
uterine inversion. Immediate attempt at digital replacement of uterus was
unsuccessful. She was transferred to theatre swiftly. Under general anaesthesia
further attempt at manual replacement followed by hydrostatic pressure
method were tried but unsuccessfully.
Laparotomy was performed and 3 cm partial thickness vertical incision was
made in the posterior uterine wall over the constriction ring and gentle upward
traction exerted with Littlewood forceps on either side of incised edges. The
incision was extended downwards as the fundus was advancing and two further
Littlewoods applied below previous application in a stepwise manner until the
uterus was returned to normal anatomical position. Results: we have managed
to replace the inverted uterus back to its anatomical position successfully by
using a partial thickness vertical incision over the constriction ring posteriorly
and by applying traction on the incised edges using littlewood forceps in a
stepwise manner.
This appears to be a simpler procedure with its associated advantages compared
to using a full-thickness incision leading to hysterotomy that was described in
original Haultain's procedure. Conclusion: Surgical correction of uterine
inversion is required in minority of cases of uterine inversion. While Huntingtons
procedure involves application of traction on round ligaments, Haultains
procedure involves hysterotomy (full thickness incision) over the constriction
ring to facilitate uterine replacement.
In this case, a partial vertical incision was made in the posterior uterine wall as
opposed to full thickness. This has advantages of not entering the uterine cavity
thereby reducing risk of uterine rupture in future pregnancies; reducing the risk
of infection and reducing surgical time with associated operative blood loss.
P191
CHILDBIRTH AND LUNAR CYCLE: SUPERSTITION ONLY?
T. Esteves*, A. Codorniz, A. Ramos, J. Carvalho
Hospital do Esprito Santo de vora - EPE, vora, Portugal
Problem Statement: Even in todays evidence based medicine, some
superstitions persist. One is the influence of lunar cycle in childbirth.
Previous studies indicate that there may be a connection between lunar phase
and delivery volume. However, theres a controversy of which lunar phase is
more influential and causes a peak volume, and if its a raise in all types of
deliveries or a subgroup (for example, only vaginal deliveries or in
multiparous).Methods: Retrospective study of the total deliveries (1300) in a
Portuguese District Hospital, in 2012. The clinical charts were analyzed; only the
spontaneous deliveries (not planned) were considered. The primary outcome
was to evaluate the influence of the moon in the volume of deliveries, duration
of the active phase, and the reason for both cesareans and hospitalization in
parturients. The secondary outcome was to assess the influence of the lunar
cycle in other variables (such as maternal age and parity, neonatal
characteristics, prematurity rate).Results: Of the 1300 deliveries, only 820 were
spontaneous deliveries.
The maternal and neonatal characteristics did not show variations with the lunar
cycle; neither did the duration of labor or the rate and reasons of prematurity.
Analyzing the four main lunar phases, none had association with the volume of
deliveries. However, two days before the first quarter and three days after full
moon, there was an increment in the total of births, which was mainly due to
eutocic deliveries, as only those showed to be statistically related to the lunar
cycle. Contractility was always the main reason for hospitalization, except
between the first quarter and full moon, and immediately after the new moon
when premature rupture of membranes was the main reason (with statistical
significance). The causes of cesareans were also related to the lunar cycle
although both no progression of labor and fetal distress were always the two
main reasons for cesarean, there were cyclic changes in the most
frequent. Conclusion: Supporting other studies, there was some relation
between the number and type of deliveries and the lunar cycle. Other labor
characteristics, such as reasons for hospitalization and for cesareans also

showed relation. Nevertheless, there is discrepancy with other studies,
particularly in the lunar phase with more influence other factors (such as
barometric pressure) should be considered in future studies.
P192
EFFECTS OF MAXIMUM EXERCISE ON IMMUNOLOGIC FACTORS IN BREAST
MILK
F. Fallah Rostami*, M. mehrizi
Pediatric Neuro rehabilitation Research Center, University of Social Welfare &
Rehabilitation Sciences, Tehran, Iran, Tehran, Iran
Problem Statement: The purpose of this study is to investigate the effects of
maximum exercise on immunologic factors in breast milk.
Methods: Subjects of the study were 17 lactating women 2 6 months
postpartum, with the mean age of (26.354.37), mean height (157.415.87 cm.),
and mean weight of (65.058.97 kgs). Each subject had completed two sessions
(control and experimental) with an interval of 5 to 7 days. Breast milk samples
were collected and immunologic factors were measured before warm up and
another sample were collected after warm up and also, after implementing the
modified bulk test in 10, 30 and 60 minutes until exhaustion. Data analysis was
done by Repeated Measure Test and results showed that milk concentrations of
sIgA and lactoferrin were intensively reduced immediately after exercise and
returned to normal one hour after the exercise.
Results: There was no significant difference noted between sIgA concentration
before exercise and 10 minutes after exercise (P>0.05) however, after 30
minutes of exercise, differences has been significantly noted (P=0.006). Also, the
concentration of lactoferrin 10 minutes (P=0.033) and 30 minutes after exercise
(P=0.001) was significantly different. Milk concentrations of lysozyme in the
control session, after exercise and after 10, 30 and 60 minute of exercise were
not significantly different (P>0.05).
Conclusion: Generally, the findings of this study showed that intense exercise
could influence changes on maternal secretions in the immune system resulting
in increase resistance against potential harm. More studies are needed in order
to clarify the mechanisms involved in the changes of the immune factors in
human breast milk.
P193
EMOTIONS, THOUGHTS AND EXPERIENCES OF WOMEN LIVING FERTILITY
PROBLEM IN TURKEY: A QUALITATIVE STUDY
S. Mete, S. Fata*, M. Alu Tokat
Dokuz Eyll University, Izmir, Turkey
Problem Statement: Infertility process is difficult for women. The study's aim
was to determine womens experiences, feelings, thoughts in the infertility
process in Turkey.Methods: Qualitative research design was used. The study
sample was performed from 26 women who commented in two internet forums
in April-June 2014. The data was analysed by using content analysis. Results:
Psychological changes
Emotions: -Suffering -Excessive love for children -Desperation -Worthlessness -Weakness Frustration -Missing Jealousy Concerns Unhappiness Anger Unlucky Burnout
Defeated Hope Hopelessness Shame Loneliness Deficiency -Feel that pregnant is
valuable, lucky
Lack of Coping with Stress: -Crying -Hiding Emotions -Self-blame -Inability to focus -Volatility
-Intolerance -Shouting, rebellion
Self-Esteem, Body Image: -Feel that everybody is sorry for her, ridicules with her -Selfdevaluation -Feel that she is not understood -Feel ugly
Changes in Social Life
Religion: -Believe in fate Praying -Praying for other pregnant women -Refuge in Allah
Relationship with spouse: -Impatience to like children and to child wish of husband
-Hiding feelings -Think that the husband is less affected by the process - Dissatisfaction in
marriage relations
Social Relations: -Not to want to be asked questions about infertility -Isolation -Anger to
love the children of others
Relations with Pregnant: - Cut off communication for avoiding to learn about the pregnancy
of married friends -Hiding the diagnosis of infertility
137
Cultural Values, Practices: -Not knowing how to relate with pregnant or women who gave
birth -Away from pregnant friends -Comparison herself and pregnant -Jealousy, rage to
pregnant and others pregnancy news -Thinking that pregnant spite her
-Fearing of whammy -Traditional practices Stigma -Thinking that infertility problems are
believed to women
Diagnosis, Treatment process
Diagnosis: -Reject the diagnosis of infertility Acceptance Uncertainty -Constantly thinking
about diagnosis
Treatment: -Constantly doing research -Search complementary therapies -Seeking different
doctor / treatment -Inability to accept the treatment process -Doubt the accuracy of
treatment decisions -The fear of treatment failure with advancing age -Always search
disease in herself -Frustration -Recantation from treatment -Fear of negative result -Fed up
from the same treatment cycle occurring each month
Relationship With The Person Receiving The Same Diagnosis: -Wish patience -Mutual
support Comparison -Curiosity, questioning -Be sorry for them Praying -Believe that
people with infertility problems only can understood each other -Share their diagnosis and
treatment process
Financial Difficulties: -Difficulties in meeting the costs of treatment -Wish for increase of
governmental support -Not to take qualified care because of economic difficulties
Future life
Uncertainty: -The uncertainty of how the future will look like -Be afraid of standing alone Be afraid about relationship with partner
Dream for Baby: -Longing for the smell of baby -To wonder how baby will look
New Health Problems
-Fatigue Prostration -DepressionConclusion: Womens experiences in the infertility
process in Turkey appear to be very complex. The health workers who will be working with
those women should require a holistic approach to address the problems, give appropriate
support and care.
P194
KK WOMENS AND CHILDRENS HOSPITAL: A CENTRES EXPERIENCE OF
MATERNAL CARDIAC ARREST AND PERIMORTEM CAESAREAN DELIVERY
(2009-2013)
S. A. Foo 1,*, M. Mathur 2
1Obstetrics & Gynaecology, KK Women's and Children's Hospital, 2Obstetrics &
Gynaecology, KK Women's & Children's Hospital, Singapore, Singapore
Problem Statement: Maternal cardiac arrest with resultant mortality or severe
morbidity is a rare but haunting event due to the devastation it carries. The
incidence rate of 1/30 000 is often quoted although a recent nationwide United
States study suggests the figure to be closer to 1/12000. It is difficult to ascertain
the global incidence due to lack of reliable data auditing maternal death in many
parts of the world. Maternal cardiac arrest requires immediate, coordinated
multi-disciplinary team response. But the rarity of such an event means teams
are often ill-prepared to delivery good quality maternal resuscitation and
perform perimortem caesarean delivery (PMCD) within the advocated 4mins
window from collapse. The latest meta-analysis on maternal cardiac arrest and
perimortem caesarean delivery between 1980-2010 yielded only 80 relevant
papers with 94 cases in total. With such limited data, it is difficult to draw
meaningful conclusions and optimise management guidelines for such events.
Methods: Our centre reports 3 cases of maternal cardiac arrest and perimortem
caesarean delivery over a period of 5years. We review the condition leading to
index event, response time of our specialist teams, management of the
resuscitation and time to PMCD. Maternal and neonatal outcomes in terms of
survival till hospital discharge are also reviewed. We measured our experience
against current recommendations in RCOG Maternal Collapse in Pregnancy and
the Puerperium Green-top Guideline No. 56 and European Resuscitation Council
Guidelines for Resuscitation 2010. Results: Our centre utilises a public call
announcement to activate obstetrics, anaesthesia and neonatology teams which
minimises the response time to a maternal collapse requiring immediate
delivery. PMCD was undertaken within the 5 minutes recommended window in
both cases of in-hospital collapse. The best outcome with survival till hospital
discharge of both mother and child happened in an in-hospital collapse in a term
pregnancy. Out-hospital collapse had the worst outcome with both maternal
and fetal demise.
Conclusion: As there are varied conditions leading to cardiac arrest in pregnancy,
there needs to be early recognition and appropriate management of the
underlying cause concurrently with resuscitation where possible. As poorer
138
outcomes are associated with out-hospital collapse with delay till presentation
to hospital, there needs to be a low threshold for admitting pregnant women
with high risk factors and early signs of cardiorespiratory decompensation for
close monitoring. There is a role for simulation training as the rarity and
complexity of such events make it difficult for teams to glean from hands-on
experience. All obstetricians and anaesthetists should receive regular training
and assessment to ensure good overall performance of cardiopulmonary
resuscitation (CPR) of pregnant women including familiarity with manual
leftward uterine displacement. Continuing audits and adaptation of current
hospital protocols are needed to identify lessons and improve clinical outcomes.
P195
COGIParis-1086
VITAMIN D STATUS AND THE IMPLICATION OF DEFICIENCY ON BONE HEALTH
M. F. J. Brincat, J. Gambin*
Foundation Year 2, East of England Deanery, Cambridge, United Kingdom
Problem Statement: It is known that Circulating Vitamin D predominantly
orginates from cutaneous synthesis and therefore should be considered as a
hormone rather than a vitamin. Vitamin D deficiency (<50nmol/L) is a worldwide
epidemic with multiple implications on human health, due to its role in various
physiological systems.
Methods: Various studies have shown that with higher serum 25 hydroxyvitamin
D levels, there is a decrease in the incidence of non-vertebral and hip fractures.
There is limited research data on the management of vitamin D deficiency using
therapeutic doses.The majority of studies focus on lower physiological doses
rather than high pharmacological doses In order to reach serum levels of
75nmol/L from a deficiency state, higher doses than 800 1000 IU/day are
required.
Results: Future focus should be on the implications of a rise in systemic 25 (OH)
D3 levels from a deficiency state to 75nmol/L on bone density and fracture risk,
and the use of high doses in cases of vitamin D deficiency.
Conclusion: In spite of ongoing debates on the precise role vitamin D in the
human body, there is general consensus that managing vitamin D deficiency may
in future reduce such health issues as fractures, falls, muscle power loss and
possibly more. The worldwide endemic of vitamin D deficiency is increasingly
being linked to having roles in various different conditions.
It has been shown that higher serum levels of 25 hydroxyvitamin D reduces non
vertebral and hip fracture rate, however there still isnt a wide spread consensus,
with some analysis contradicting the effects of vitamin D on fracture risk. It is
still not clear as to whether 25 hydroxyvitamin D alone or in conjunction is
calcium supplementation may be responsible for such reductions. In order to
achieve 25 hydroxyvitamin D levels of 75 nmol/L one would require high
pharmacological doses. The implications of such high doses requires further
future research, in order to ascertain whether there is a direct effect on health
issues such as fractures, and also to determine side effects of such doses.
P196
THE EFFECT OF ACCUPRESSURE APPLIED ON LI4 POINT ON LABOUR PAIN
Y. Hamlac 1,*, S. Yazc 2
1
Midwifery, Sakarya University, Sakarya, 2Midwifery, Istanbul University,
Istanbul, Turkey
Problem Statement: Labour pain marks its place on womens memories
physically, mentally and spiritually. Nonpharmacological and supportive
approaches does not slow labour, are not allergic and can be used on labour
safely. Acupressure is a type of massage that is applied on energy spots on the
body with palms and fingers.
Methods: The research is made experimental with randomly controlled
acupressure on LI4 point on the hand to detect the effect on labour pain. The
population of the research was women who applied to have normal labour (852
pregnant women) on TR Ministry of Health Bagclar Training and Research
Hospital between dates 1 June-30 September 2012. Samples of the research
were samples from 88 pregnant women (44 case, 44 control) who fit the
Abstract Book
research conditions. Acupressure was made first on 4-5cms of cervical

dilatation and the second acupressure was made on 7-8 cms of cervical
dilatation. Acupressure was applied first on right hand and the left hand after on
LI4 point for 4 contractions. The use of Visual Analogue Scale (VAS) made when
the patient arrived in the hospital, before-after the acupressure and 2 hours
after the labour (6 times). Nothing different from the routine was applied on the
control group.
The evaluation of the tests were made with percentage, standard deviation, one
sided varians analysis, t test, and chi-square test and Pearson correlation test.
Relevance of the test were accepted as p<0,05.
Results: It was found that the average age of the pregnant women (case/control)
were 24,64,58. When the mothers obstetric properties were examined,
pregnancy rate, miscarriage/curretage rate and the average labour rate were
found similar in both groups and first pregnancy age average was found
21,113,83(p>0,05).
Table 1: Average point of the perception of pain of labour before-after labour on
acupressure
Case Group n=44
OrtSS
MinMax
0,26,7
Control
n=44
OrtSS
Group
3,521,
6
MinMax
0,56,9
1-7
4,881,
37
0,87,8
0,36,5
6,221,
14
3,88,4
When it comes to hospital
3,421,
51
Before the first acupressure
4,651,
36
After the first acupressure
3,771,
3
0,0001
Before the second acupressure
7,371,
11
3,49,4
7,680,
85
5,79,3
After the second acupressure
7,571,
27
4-10
8,610,
71
7-10
0,062
Postpartum at 2 hours
0,580,
38
0,0001
0,0001
0,12,2
0,620,
4
0,21,8
0,
31
0,
81
9,
39
0,760
1,
47
4,
73
0,145
0,
51
0,610
offering an effective treatment for patients suffer from psychological distress

during IVF and pregnancy. According to them, this special psychological care can
reduce anxiety and psychological distress during the critical periods of IVF cycle
and the whole time of pregnancy.
Methods: We present the application of hypnotherapy and positive suggestion
voice records during the IVF treatment and pregnancy in two case reports - a 36
and 34 years old woman.
Results: According to the patients findings hypnotherapy and positive
suggestion voice records can successfully reduce patients anxiety and
psychological distress during the IVF treatment and pregnancy after IVF cycle.
Patients were highly satisfied with the hypnosis program, after a non-eventful
pregnancy, they finally gave birth to a healthy boy and a healthy girl.
Conclusion: According to previous studies, the use of hypnosis during embryo
transfer may significantly improve IVF outcomes in terms of increased
implantation and clinical pregnancy rates. Therefore clinical hypnosis may not
only reduce psychological distress and anxiety, but it could also increase success
rate. The case reports presented here are only based on the experience with two
of our patients. However it would be of great importance to expand our
investigations to a regular clinical study. Our clinical trial aiming to examine the
above effect will help us to obtain a comprehensive view of the effects of clnical
hypnosis in this special area.
0,421
0,0001
0,0001
It was found out that the VAS statistic points of case and control groups were
considerably different and the point of the case group was getting lower. After
the second acupressure VAS points were not found to be getting lower on case
group even though it was found a statistical difference between the two groups.
This situation can be explained with patients overwhelming pain that is gone
throught at that periof of pregnancy. On this note it can be considered that
acupressure can only lower the effects of mild and middle and middle scaled
pain. Conclusion: As a conclusion for this research it can be said that acupressure
on point LI4 is beneficient on labour pain and handling labour pain statistically.
Taking the results of the research into consideration;
-Larger scale of groups should be examined to evaluate the outcome of
acupressure on newborns and mothers
-Acupressure should be supported and used with other nonpharmacological
practices.
P197
CLINICAL HYPNOSIS AND POSITIVE SUGGESTION VOICE RECORDS AS A
SUCCESSFUL TOOL TO REDUCE ANXIETY DURING PREGNANCY AFTER IVF A
CASE REPORT.
V. Higi*, . Sli, Z. Ksa, A. Vereczkey
Problem Statement: Although the success rate is the most important index of
the in vitro fertilization (IVF), the patients satisfaction largely depends on other
factors as well, including psychological stress and discomfortable physical
interventions which always accompany the IVF treatment. The Versys Clinics
Human Reproduction Institute is an infertility clinic with a complex, holistic
approach where psychological care is one of the most significant resorts. Since
2013, clinical hypnosis is a new opportunity within the psychological care,
P198
MOTOR PERFORMANCE OF RAT MODELS AFTER NEONATAL HYPOXIC
ISCHEMIC ENCEPHALOPATHY WITH DIFFERENT PERIODS OF BRAIN INSULT
ASSESSED USING ROTAROD AND TRACTION TESTS
T. Hosono*, Y. Nishimura, M. Ishida, M. Arakawa, M. Nakamoto, K. Akasaka
Problem Statement: Hypoxic-ischemic (HI) encephalopathy (HIE) in neonates is
one of the most serious clinical problems since it is associated with long-term
neurological impairment. It is well known that maternal hyperthermia worsens
neonatal HIE. For studies on neonatal HIE, rat/mouse models using 7-day-old
animals developed by unilateral carotid artery (CA) ligation followed by 8%
oxygen exposure at an ambient temperature (Ta) of 37C for 1 2 hrs have been
widely used (Rice, 1981). Recently we successfully produced neonatal HIE brain
insults in rats after 8% oxygen exposure only for 15 min at a hyperthermic Ta of
40C (Hosono, 2010). However, the effects of the period of hyperthermic brain
insult remain unknown. The aim of this study was to clarify the effects of the
peiod of neonatal hyperthermic HIE insult on adult motor ability after growth
using a behavioral and anatomical study.
Methods: We anesthetized 7-day-old neonatal Wistar rats and ligated the left
CA (n=31, hyperthermic group, HG). The pups were returned to their dams for
1 hr. We divided all rats in the HG into four groups, and placed them in a
chamber at Ta of 40C with humidified 8.0% oxygen for: 30 min (n=10, HG30),
20 min (n=7, HG20), 10 min (n=7, HG10), and 5 min (n=7, HG5). Then, all the
pups were returned to their dams and raised until measurements were
conducted. Traction test (TT). We hung a 21-day-old rat from its forepaws from
a horizontal bar placed 30cm over a soft floor and supported its body. Then, we
released the support, and measured the time period from its release until it fell
to the floor (upper limit, 600 sec). We performed measurements three times
per day for five consecutive days. Rotarod test (RT). A 7-week-old rat was placed
on a rotating rod, and the interval until falling to the floor was measured twice
a day for five consecutive days. The rotational frequencies of the rod were 5, 5,
7, 9, and 11 rpm on the first to fifth days, respectively. Anatomy. After all
measurements, we removed rat brains after perfusing them with saline buffer
containing 10% formalin under deep anesthesia. We measured the longest
widths of the left (LW, insulted) and right (RW, intact) cerebral hemispheres, and
obtained the brain width index (BWI), defined as the LW/RW ratio.
Results: TT revealed that the mean time period of the rats hanging on the 5th
day for HG30 (513 36 sec, mean SE), HG20 (552 67 sec), and HG10 (355
68 sec) were significantly (p<0.05) shorter than that for HG5 (590 77 sec),
although that for HG30 (411 56 sec) on the first day was significantly longer
than those for HG10 (146 31 sec), and HG5 (199 77 sec). RT revealed that
139
the interval on the 5th day of HG30 (68 32 sec) was significantly shorter than
those of HG10 (224 30 sec) and HG5 (106 33 sec), although there was no
significant difference in the interval among all HG on the first day. Average BWI
values for HG30, HG20, HG10, and HG5 were 0.87, 0.87, 1.0, and 0.95,
respectively.
Conclusion: TT and RT revealed that longer hyperthermia during neonatal HIE
insult caused reduced motor ability. BWI revealed a decrease of the brain
hemisphere width in HG. Hyperthermic hypoxia for more 10 min may cause
brain impairment in the rat HIE model.
P199
EFFECTS OF ABDOMINAL WARMING USING A HEAT- AND STEAM-GENERATING
SHEET ON INTELLECTUAL CAPACITY AND AUTONOMIC NERVE ACTIVITY OF
FEMALE UNIVERSITY STUDENTS WITH DYSMENORRHEA
T. Hosono 1,*, C. Igi 1, M. Nakamoto 1, M. Arakawa 1, K. Akasaka 1, Y. Nishimura 1
1Department of
Biomedical Engineering, Osaka Electro-Communication
Problem Statement: Warming the abdomen during menstruation has been
widely used as a non-pharmacological treatment for dysmenorrheal pain
relief. The heat- and steam-generating (HSG) sheet measuring 54 cm2 (5.4 x 10.0
cm), which is attached to a skin area at around 40 C for 8 hrs, relieves
dysmenorrheal pain with comfort, and may promote subjects intellectual
capacity (Hosono, 2010). The aim of this study was to clarify the effects of
abdominal warming using the HSG sheet on intellectual performance employing
simple 1-digit addition calculations in different menstrual phases. The protocol
of this study was approved by the local ethics committee.
Methods: Sixteen female university students (age: 22.0 0.8, mean SD) were
included in this study. A subject sat in a room at an ambient temperature of 25
1C and attached an HSG sheet to the lower abdomen and warmed once during
her menstrual (WM), follicular (WF), and luteal (WL) phases, respectively. We
also applied a non-warming sheet (NHSG) of the same size as the HSG sheet in
the corresponding phases, that is, non-warming during menstrual (NM),
follicular (NF), and luteal (NL) phases, as a control, respectively. For the
evaluation of subjects intellectual performance, each solved simple, randomly
generated, single-digit additions similar to the Kraepelin psychodiagnostic test,
as many as possible in 15 min. Each subject underwent the test twice, just
before and one hr after attaching the HSG or NHSG sheet. We counted the
number of correct answers (A) per total number of answered questions (B) and
obtained the solution rate (SR), defined as A/B (%). We defined SR as SRB and
SRA before and after the HSG or NHSG sheet application, respectively, and
evaluated the increased rate of SR (SRI), defined as (SRA SRB)/SRB (%). Each
subject also recorded her lower abdominal pain levels using an integral score of
zero (no pain) to three (severe pain) only in WM and NM. We measured the
thumb temperature (Tt) every ten min for evaluating sympathetic nerve
activities (SNS). Furthermore, we measured the ear drum temperature (Ted),
heart rate (HR), and systolic (SBP) and diastolic (DBP) blood pressures.
Results: The rate of subjects with pain scores of more than two after HSG
warming was significantly lower in WM (50%) than that in NM (71%). The SRI in
WM (0.3 0.3%) was significantly greater than that in NM (0.0 0.1%) (p<0.05,
Wilcoxon signed-rank test). The SRI of four subjects with pain scores of zero or
one in WM was also greater than that in NM. However, no significant difference
was observed between the SRI in WF (-0.1 0.2%) and NF (0.0 0.0%) as well as
that between WL (-0.1 0.3%) and NL (0.0 0.4%). No marked changes were
observed in Ted, HR, SBP, or DBP.
Conclusion: Lower abdominal warming using the HSG sheet was effective for
promoting the intellectual capacity. The improved capacity may not be solely
due to relief from dysmenorrheal pain, but may also be related to the SNS
decrease.
140
P200
IS IT NECESSARY FOR ROUTINE ANTENATAL CLINICAL BREAST EXAMINATION
BY THE POINT OF PREGNANCY ASSOCIATED BREAST CANCER INCIDENCE?
Y.-H. Hsiao 1,*, Y.-Y. Chen 2, H.-D. Tsai 1, S.-J. Kuo 3
1Department of Obstetrics and Gynecology, 2Changhua Christian Hospital,
Changhua, Taiwan, Province of China, 3Comprehensive Breast Cancer Center,
Changhua Christian Hospital, Changhua, Taiwan, Province of China
Problem Statement: Is it necessary for routine antenatal clinical breast
examination? We evaluate it at the point of pregnancy associated breast cancer
incidence.
Methods: The incidence of pregnancy associated breast cancer (PABC) could be
a point to the problem. The data came from the Taiwan National Health
Insurance Research Database (TNHIRD) and the population-based study using
1,000,000 random samples from TNHIRD. PABC cases were retrieved based on
The International Classification of Diseases, 9th Revision, Clinical Modification
(ICD-9-CM) code 174 (174.0-174.9, Malignant neoplasm of female breast) and
insurance claim code 41-60 for antenatal care from Taiwan Medical Services
Payment Project between 1999 and 2008.
Results: Fifteen PABC women (age between 27-40 years), including 4 cases
during pregnancy and 11 postpartum cases, were identified in the period
between 1999 and 2008 (1999, two cases; 2000, two cases; 2001, one case;
2002, one case; 2003, two cases; 2005, three cases; 2006, one case; 2007, three
cases). During the period, the total number birth was 71,870 among the
1,000,000 populations. Therefore, the incidence rate of PABC for pregnant
women could be estimated as 0.02% (15/71870).
Conclusion: PABC is a challenging problem. Increasing awareness of performing
antenatal clinical breast examination among obstetrics doctors may help early
diagnose and reduce the mortality in women with PABC.
P201
THE GREAT CAESAREAN DEBATE: THE CONCEPT OF FEAR OF CHILDBIRTH AS A
POTENTIAL INDICATION FOR CAESAREAN DELIVERY
J. B. Imanoff*, C. Mannion, G. McCaffrey
Nursing, University of Calgary, Calgary, Canada
Problem Statement: Womens choice for caesarean delivery without a medical
indication is a recent phenomenon that is far from the original purpose of the
emergency procedure. With the rising caesarean rate, there has been increasing
debate on whether choice is a justifiable rationale for an operative delivery.
However, little guidance is provided on whether choice is a justifiable indication,
even less so in cases where fear of childbirth is present. In this concept analysis
I aim to provide a clear definition and explore factors leading to and stemming
from fear of childbirth in order to explore the notion of fear of childbirth as a
reasonable justification for caesarean deliveries.
Methods: A literature search was conducted using a variety of health related
databases in order to identify peer reviewed journal articles from a
variety of disciplines. The search terms included: fear, labour, childbirth,
tokophobia/tocophobia, and parity/nulliparous/primiparous/multiparous.
Inclusion in the final concept analysis required meeting one of the following
criteria: fear of childbirth was an outcome, was measured, or was the core
content of the article. Non-research articles were not included. A concept
analysis, as described by Walker and Avant (2005), was used to frame the literary
findings. This process included the sequential steps of: identifying uses of the
concept, determining the defining attributes, identifying a model case,
identifying additional cases, identifying antecedents and consequences, and
defining empirical referents.
Results: Fear of childbirth has proven to be a relevant and pertinent concept in
its practical application for clinical practice. In order to prevent the psychological
sequelae from traumatic childbirth experiences, some women either seek
psychological treatment in order to overcome their fear and have a positive birth
experience or aim to treat themselves by requesting a caesarean delivery. Both
these scenarios can contribute to a positive birth experience which is found to
be curative of debilitating fear of childbirth. Womens choice for caesarean
deliveries may be an alternative means to treat fear of childbirth. Until there is
Abstract Book
further research done on screening, therapies, and treatments for fear of

childbirth, health care providers should aim at providing the most supportive
care fort the individual woman.
Image / Graph:
Conclusion: Fear of childbirth is a serious concern for maternity care providers.

The potential negative psychological implications for women who experience
fear of childbirth can be devastating. As a preventative measure, caesarean
deliveries may be a justifiable indication; however, further investigation is
required to ensure women receive the support and help they need to have a
positive perinatal experience and transition into motherhood.
P202
VALIDATION AND RELIABILITY OF UTIAN QUALITY OF LIFE SCALE
H. Abay 1, S. Kaplan 1,*
Nursing, Yildirim Beyazit University, Ankara, Turkey
Problem Statement: This study was conducted descriptive and methadological,
in order to determine the quality of life of menopausal women and evaluate the
validity and reliability of Utian Quality of Life Scale in Turkish language.
Methods: The population of the study was composed of 250 women who applied
to Etlik Zbeyde Hanm Womens Health Education and Research Hospitals
Menapause Polyclinics. Personal information form and Utian Quality of Life Scale
are used for collecting data and SF-36 is used for the reliability of equivalent form
in the study. Language validity, content validity, construct validity methods are
used to assess the validity of the scale, Cronbach alpha reliability coefficient
calculation, equivalent form reliability methods are used to assess reliability of
the scale, frequencies, percentages, Mann Whitney U Test and Kruskal-Wallis H
Test with Bonferroni correction is used for data analysis.
Results: The Cronbach alpha reliability coefficient of Utian Quality of Life Scale is
calculated 0.88 and the scale is considered as a valid and reliable measurement
tool for Turkish population. The avarage age of the study population is
54.256.17, 54.8% of the study population are primary school graduate, 9.6%
are working in a wage-earning employment, 81.2% are married, 81.2% are living
in city centre and 79.6% describe themselves as middle income people.
Additionally, the Utian Quality of Life Scale attitude mean value is 75.4315.64,
professional/work, sexual, health and emotional quality of life attitudes mean
values are 26.754.13, 9.343.16, 20.436.59, 18.915.43 respectively.
According to these values it is determined that, the general professional/work,
sexual, health and emotional quality of life of menapousal women is in medium
level. Also when the Utian Quality of Life Scale attitude mean values are
compared according to the properties of women; it is found that the quality of
life of women is rising with increase of educational status, economical situation
perception, regular physical exercise, regular health controls by gynecologists,
positive menopause perception and with decrease of having chronical disease,
medication use, having menopause related health problems (p<0.05).
Conclusion: In this context, Utian Quality of Life Scale is considered
measurement tool for Turkish menopausal women, it is concluded that in order
to increase the quality of life of menopausal women disseminate menopause
policlinics where they can take education and consultation services and ensure
to perform nurses education and consultancy roles in the best way.
P203
TO ASSESS THE EFFECTIVENESS OF HEALTCARE SERVICES TRAININGS GIVEN IN
DIFFERENT METHODS DEALING WITH THE STRUGGLE CONDUCTED FOR THE
DOMESTIC VIOLENCE AGAINST WOMEN
S. Kaplan 1,*, N. Komurcu 2
1Obstetric & gynecology department, Yildirim Beyazit University, Ankara,
2Obstetric and gynecology department, marmara University, stanbul, Turkey
Problem Statement: This study, with a view to asses the effectiveness of
healthcare services trainings given in different methods dealing with the struggle
conducted for the domestic violence (DV) against women, being a single blind,
controlled and non-randomized intervention study, was carried out between
dates 01 to 30 December of 2009.
Methods: The intervention group consisted of 132 subjects against 249
healthcare personnel who constituted the control group. As a data collection
tool, we used five forms such as personal data form, data assessment form,
attitude scale related to violence and attitude scale of healthcare personnel
regarding their professional roles played in the course of violence. Both groups,
in regard with the struggle conducted for the DV against women, received a
training of healthcare services, and along with the given standard training, case
discussion and spot film demonstration was made for intervention group.
Results: At the end of this study, we reached a conviction that the knowledge
levels of subjects, in respect with the violence, were not quite low before the
start of training process. (M=10.01, K=9.89). Following the training course, while
an increase had been recorded in the average values of data score obtained by
both groups (M=16.02, K=12.88), we determined that such an increase, in total,
had occurred on the intervention group. This research served to indicate that
the subjects of both groups, in connection with the violence (M=36.30, K=34.25)
and their roles played in the course of violence (M=31.95, K=30.96) had displayed
a trend of modern attitude before the start of training. However, when
compared with the attitude trend of control group, the intervention group has
displayed a more traditional trend of attitude. Following the training course,
both groups, have displayed a positive attitude change in regard with the
attitudes assumed by them for violence (M=30.67, K=30.00) and their
professional roles (M=26.96, K=26.76). Although this difference is not considered
to be high, we detected that it originated from the intervention group.
Moreover, we also detected that the subjects of both groups, in regard with their
approaches for reporting the DV cases and effecting their interventions, had
followed a similar trend.
Conclusion: Within this scope, we reached a conclusion that the invention
training had yielded effective results at the levels of knowledge and attitude but
fell short of carrying the acquired knowledge into effect.
Keywords: Knowledge, training intervention, woman, violence, attitude.
P204
PREVELANCE OF PREMENSTRUAL SYNDROME IN UNIVERSITY STUDENTS AND
AFFECTING FACTORS
S. Kaplan*, S. Sahin, G. Pinar, A. Akalin, H. Abay
Department of Nursing, Yildirim Beyazit University, Ankara, Turkey
Problem Statement: Menstruation is a physiological process which covers an
important period of womans life and is repeated every month. Premenstrual
Syndrome (PMS) is described as psychological, physical and behavioral
symptoms which are seen in luteal phase of menstrual cycle and disappears
within a few days after the menstruation starts. This study was done to
determine the prevalence of premenstrual syndrome, which affects young girls
physically, mentally and behaviorally, and affecting factors among the students
of Yildirim Beyazit University.
Methods: In our study, the average age of students is found 19.831.43 and the
average age of menarche is found 13.191.20. In the study, the participants have
been identified as nonsmokers (90.7%) and not drinking alcohol (91.8%), doing
regular exercise (26.8%), having menstrual cycles regularly (74.4%). 46.3% of
them have mothers or sisters with PMS history. Lastly, almost half of the
participants (49.9%) have PMS complaints. In 20% of students complaints of
141
fatigue, insomnia, irritability and breast tenderness are seen in premenstrual

period. The PMS average score of students was 113.9336.15 and the
prevalence of PMS was 29.8%. When some some socio-demographic
characteristics of the students are compared in terms of presence of PMS, those
who have less educated father, mother and sister with PMS history and those
who do not have a proper diet were found to have PMS prevelance more. It is
also found that the participants who are aggressive and those who have more
bleeding during menstruation and consume a lot of coffee and salt were found
to have PMS prevelance more. A statistically significant difference was found
between the variables (p <0.05) However, according to education level of
mother, statistically significant difference wasnt found (p> 0.05).
Results: In our study, the average age of students is found 19.831.43 and the
average age of menarche is found 13.191.20. In the study, the participants have
been identified as nonsmokers (90.7%) and not drinking alcohol (91.8%), doing
regular exercise (26.8%), having menstrual cycles regularly (74.4%). 46.3% of
them have mothers or sisters with PMS history. Lastly, almost half of the
participants (49.9%) have PMS complaints. In 20% of students complaints of
fatigue, insomnia, irritability and breast tenderness are seen in premenstrual
period. The PMS average score of students was 113.9336.15 and the
prevalence of PMS was 29.8%. When some socio-demographic characteristics of
the students are compared in terms of presence of PMS, those who have less
educated father, mother and sister with PMS history and those who do not have
a proper diet were found to have PMS prevelance more. It is also found that the
participants who are aggressive and those who have more bleeding during
menstruation and consume a lot of coffee and salt were found to have PMS
prevelance more. A statistically significant difference was found between the
variables (p <0.05) However, according to education level of mother, statistically
significant difference wasnt found (p> 0.05).
Conclusion: In this research, it is found that almost a third of the students have
PMS. In order to determine the factors affecting menstrual period of the
students and improve the methods to deal with these symptoms, it is suggested
that the students should be assessed with multidisciplinary and biopsyco-social
approach.
Key Words: Premenstural Syndrome, University student, menstrual problems
P205
ATTITUDE TOWARD CERVICAL CANCER PREVENTION IN KOREAN STUDENTS
H. W. Kim,
College of nursing, Seoul National University, Seoul, Korea
Problem Statement: Young women have not focused a target group for cervical
cancer prevention in Korea. Information about cervical cancer prevention
among unmarried students of university could helpful for provision of primary
cervical cancer prevention.This study was performed to assess attitudes toward
cervical cancer prevention among sexually inexperienced students in Korea, and
finally to identify the factors associated with the intention of Pap test.
Methods: A total of 351 unmarried university students who had never
undergone a Pap test participated in a web-based survey. Awareness of the
importance of the Pap test, confidence in Pap testing, intention to undergo the
test, behavioral attitudes, subjective norms and perceived control were
assessed. Factors influencing intention of Pap test were analysed using
correlation and stepwise multiple regression.
Results: Majority answered that the need for regular Pap testing was less
important (score, 78.45) than other methods of cervical cancer prevention. They
were not confident that is was an effective method of cervical cancer prevention
for themselves (score, 61.85). Behavioral attitudes and subjective norms were
significant predictors of intention to undergo Pap Test.
Conclusion: Awareness of cervical cancer prevention among the students were
so low. Positive attitudes and social encouragement could be helpful to foster
cervical cancer screening behaviors.
Acknowledgments This research was supported by the Basic Science Research Program
through the National Research Foundation of Korea (NRF), which is funded by the Ministry
of Education, Science and Technology (2012-R1-A1-A3015525).
142
P206
EFFICACY OF MAXIMUM ELASTICITY AND MASS DIAMETER RATIO IN FEMALE
BREAST CANCER DETECTION
E. Kroi 1,*, R. Hasa 2, N. Manoku 3
1
Gynecogy department, Hygeia Hospital Tirana, 2Radiology department,
Diagnostic Orthodoxy Medical Center Evangelism, 3Gynecogy department,
Medicine faculty, Medicine University, Tirana, Albania
Problem Statement: Breast cancer is one of the most studied female pathology.
Grey scale ultrasound is one of the techniques with well-established role in
breast screening. Shear wave elastography is a new method of obtaining
quantitative tissue elasticity data during breast ultrasound examinations. The
aim of this study is to correlate the maximum elasticity and
ultrasound/elastography diameter ratio values of breast masses with
histological findings, so to compare the efficacy of former parameters.
Methods: This is a cross-sectional study among 76 consecutive patients
conducted in one medical center from January 2012 to April 2013. Patients
underwent standard breast US supplemented by quantitative SW elastography
using the Aixplorer ultrasound system (SuperSonic Imagine). For each lesion
was calculated maximum elasticity of the stiffest portion of the mass and the
ratio between the diameter of the lesion measured in grayscale ultrasound and
SW elastography. A maximum elasticity and diameter ratio respectively cut off
values of < 60 kilopascals (kPa) and < 1 were selected for benign/malignant
differentiation.
Results: 36 benign lesions and 43 malignant pathology were diagnosed by
histology. Mean ultrasound mass diameter were 16.677 mm, while mean
elastography mass diameter were 17.196. From 79 breast masses, 64 were
palpated, 15 were non-palpated revealed by other screening methods.
Maximum elasticity vs diameter ratio performance was: sensitivity 95.3 % vs
60.5%, specificity: 86.1% vs 72.2 %, positive predictive value (PPV): 89.1 % vs
72.2 %, negative predictive value (NPV): 93.9 % vs 60.5% ; misclassification rate
was 8.9% vs 34.2 %; accuracy was 91.1% vs 65.8 % respectively.
Conclusion: SW elastography gives quantitative information on female breast
lesions. Performance of maximum elasticity is better than
ultrasound/elastography mass diameter ratio.
P207
A RETROSPECTIVE CASE NOTE REVIEW ON OUTCOMES OF DELIVERY AFTER
PREVIOUS ANAL SPHINCTER INJURY
A. Langrish*, R. Roogi, M. Khadra
Poole maternity unit, NHS, Poole, UK
Problem Statement: To assess the mode of delivery after previous anal sphincter
injury (ASI) and to evaluate the outcome of recurrent perineal trauma. This
information will guide patient specific counselling antenatally.
Methods: Retrospective case note review of 28 patients sustaining previous anal
sphincter injury (ASI) between August 2007 and March 2014 under the care of
one of the obstetric consultants at Poole maternity unit. Results: 28 patients
notes were reviewed. Mean age of 31, majority being para one (24). Of the 28
previous ASIs 11 had 3a tears, 14 had 3b tears, 2 had 3c tears and 1 was not
recorded. Endo-anal ultra-sound of these patients only showed four persistent
defects. At booking of a subsequent pregnancy only four patients were
symptomatic (none of which had persistent anal sphincter defect). All patients
were offered elective caesarean section regardless of symptoms or persistent
anal sphincter defect. Of the 28 patients; 12 (43%) delivered via caesarean
section (10 elective and 2 emergency), 16 (57%) had vaginal deliveries. Of the 16
vaginal deliveries; 2 (12.5%) had recurrent anal sphincter injury, 6 had second
degree tear, 2 had first degree tear, 2 had episiotomies and 2 had no perineal
trauma. Conclusion: This retrospective review demonstrates that a personalised
antenatal assessment should be carried out for all patients with previous ASIs.
Patients may have a personal preference on mode of delivery. However 87.5%
of patients delivering subsequent pregnancies vaginally did not sustain a further
ASI, and therefore antenatal counselling is of high importance.
Abstract Book
P208
PREVALENCE OF VITAMIN D DEFICIENCY IN WOMEN OF PUSAN AND
GYEONGNAM PROVINCE IN KOREA
Y. J. Na*, Y. J. Song, J. E. Hong
Pusan National University Yangsan Hospital, Yangsan-si, Korea
Problem Statement: Vitamin D is a group of fat-soluble secosteroids which
stimulates intestinal calcium absorption. According to reports, low serum
vitamin D levels have been associated with fractutres and low bone mineral
density. However, there is few study about Vitamin D status in Korea. So we
investigate the vitamin D status of Pusan and Gyeongnam menopausal women.
Vitamin D is a group of fat-soluble secosteroids which stimulates intestinal
calcium absorption. According to reports, low serum vitamin D levels have been
associated with fractutres and low bone mineral density. However, there is few
study about Vitamin D status in Korea. So we investigate the vitamin D status of
Pusan and Gyeongnam menopausal women.
Methods: We recruited a total of 208 women who visited the Pusan National
University Yangsan Hospital from January 2011 to May 2012. We excluded 55
women who took medicine including vitamin D. The fasting blood serum were
analyzed for 25-Hydroxy vitamin D. The vitamin D deficiency was divided into 3
groups: mild (10 to 20 ng/mL), moderate (5 to10 ng/mL), severe (<5 ng/mL).
Results: The mean concentration of vitamin D was 20.9 ng/mL 9.6. The mean
concentration of vitamin D per age groups were as follows: 20-45 years, 22.4
16.6 ng/mL; 45-55 years, 19.4 11.4 ng/mL; > 55 years, 24.4 16.3 ng/ml.
Vitamin D deficiency affected 55.5% of all studied subject, which comprised
36.6% of mild, 15.1% of moderate and 3.9% of severe deficiency. Among all 3
groups, there were osteoporosis measured by BMD as follows: mild deficiency,
45.8%; moderate deficiency, 29.6%; severe deficiency; 56.5 %. The mean
concentration of vitamin D according to seasons were 16.24 9.1 ng/mL from
December to May and 22.5 11.0 ng/mL from June to November (p < 0.05).
Conclusion: Most of Pusan and Gyengnam women in Korea might be vitamin D
deficiency. Further large cohort study is needed to establish the nutritional
strategy.
P209
SEQUENTIAL ASSOCIATION BETWEEN UTERINE BLOOD FLOW AND
DYSMENORRHEAL PAIN RELIEF BY LUMBAR WARMING USING HEAT- AND
STEAM-GENERATING SHEET
M. Nakamoto*, M. Arakawa, K. Akasaka, Y. Nishimura, T. Hosono
Problem Statement: More than 80% of menstruating women complain of
dysmenorrheal pain. For a non-pharmacological treatment, warming the lower
abdominal or lumbar region has been widely known to relieve dysmenorrheal
pain. A heat- and steam-generating sheet (HSG) which warms the attached skin
area to around 40 for 8 hours is effective for dysmenorrheal pain relief
(Hosono, 2010). The cause of dysmenorrheal pain may be pain-producing
substances such as prostaglandins generated in the uterine endometrium before
and during menstruation. We hypothesized that the mechanism of pain relief
may be the washing out of pain-producing substances by increased uterine
blood flow which might be elicited by body warming. The aim of this study was
to investigate the effects of lumbar warming by HSG sheet application on
dysmenorrheal pain relief, and clarify the mechanism of dysmenorrheal pain
relief by lower lumbar region warming.
Methods: Seven female university students (21.7 0.3 yrs old, mean SEM)
were included in this study. On the second or third day of menstruation, each
subject applied an HSG sheet with a warming area of 54 cm2 to the lower lumbar
region for 60 min. The first day of menstruation was defined as the day when
the subject noticed menstrual blood. As a control, we also performed
measurements using a non-warming sheet (NWS) of the same size as the HSG
sheet. We measured the velocities of uterine blood flow by ultrasound Doppler
flowmetry before and 15, 30, 45, and 60 min after HSG or NWS sheet
application. We detected maximum (Vmax) and minimum (Vmin) velocities and
calculated the resistance index (RI), defined as (Vmax-Vmin)/Vmax, which
reflects peripheral vascular resistance. We also measured the finger-tip

temperature (Tf), eardrum temperature (Ted), heart rate (HR), and blood
pressure (BP) simultaneously with flowmetry. Each subject evaluated the
degree of pain and comfort using a numerical rating scale from zero to ten at the
same time as uterine blood flowmetry. The pain score was zero (no pain) to ten
(most painful), and the comfort score was also zero (most unpleasant) to ten
(most comfortable).
Results: Five of the subjects experienced dysmenorrheal pain relief during HSG
warming. The RI during HSG warming decreased in all subjects. The RI more
than 15 min after the start of sheet application was significantly lower than that
with NWS application. However, no marked correlations were observed
between the RI changes and pain scores. The decrease in the pain score
followed that in RI in three of the subjects, and vice versa in two of the
subjects. There were no significant changes in Tf, Ted, HR, or BP over all
measurements, irrespective of using HSG or NWS sheets. There were also no
significant differences in comfort scores between HSG and NWS warming.
Conclusion: Application of the HSG sheet to the lumbar region relieved
dysmenorrheal pain and also promoted a decrease in RI, indicating that uterine
vascular resistance decreased, and that the uterine blood flow
increased. However, the association between the decease in RI and pain relief
was not fully clarified in this study.
P210
STRUCTURAL ANALYSIS OF THE INTERACTIONS AMONG MIDWIFE, MOTHER,
AND BABY
M. Nishikawa*, T. Sameshima
Department of Nursing, Kyoto Koka Womens University, Kyoto, Japan
Problem Statement: There has recently been a gradual increase in the number
of reported cases of child abuse in Japan (59,603 cases in the fiscal year 2011
a 5.7% increase over the previous fiscal year). In 58.8% of these cases, the
victimizer was the childs mother, which highlights the importance of helping
mothers develop healthy relationships with their children during their
pregnancy and puerperium. We continuously observed midwives as they
performed their duties, noting that they were able to establish a support
environment responsive to the needs of the mother. We hypothesized that their
skills facilitated the development of intimate relationships between mothers and
midwives. In this study, we aimed to structurally analyze how relationships
among the expectant mother, baby, and family change as a result of interaction
between the expectant mother and midwife and to determine the significance
of the midwifes touch.
Methods: We observed five pregnant women and their interactions with
midwives from August 2013 to March 2014 and conducted semistructured
interviews. This study was approved by the research ethics review board of
Kyoto Koka Women's University (Approval No. 05).
Results: Mothers developed an attachment to the fetus by following its growth
and learning its appearance from ultrasound images at every prenatal
examination and by responding emotionally to its movements. Moreover,
expectant mothers often reported their health state to the fetus in a
conversational manner, as if the baby were lying next to them. They became
more confident and proud as mothers by calling the fetus my baby even before
birth, helping them find a new sense of value within themselves. In summary,
midwifeexpectant mother and midwifefetal interactions (labeled (1) and (1),
respectively, in Figure 1), in addition to the expectant mothers own senses, help
expectant mothers to perceive their fetus as real and establish a relationship
with it (2). When the expectant mother feels the fetus is real and builds a
relationship with it (2), the relationship between her and her family changes (4),
which in turn transforms the relationship between the fetus and the family (5).
Although the family may not feel that they personally know the fetus, they will
feel its invisible presence and accept the fetus as a real being through the
expectant mothers relationships with the fetus (2) and family (4). Thus, a change
in the expectant motherfetal relationship (2) leads to a change in the expectant
motherfamily relationship (4), and then the relationship between the fetus and
the family (5) finally emerges. In other words, when the babys presence
becomes more real in the expectant motherfetal relationship (2), the
143
relationship between the expectant mother and the family (4) must be
reconstructed, and a direct relationship between the fetus and the family (5) is
formed. Gradually, space for the invisible baby to be accepted is created within
the family (6).
Image / Graph:
between groups. Trials investigating the optimal time for vaginal misoprostol
premedication for pain relief in vaginoscopic outpatient hysteroscopy are
needed. New interventions and/or drugs should be studied to decrease pain
perception during vaginoscopic diagnostic outpatient hysteroscopy in
nulliparous infertile patients.
P212
MATERNAL OVERWEIGHT AND QUALITY OF LIFE DURING PREGNANCY PRELIMINARY RESULTS
M. C. Ribeiro 1,*, M. U. Nakamura 1, M. R. Torloni 2, P. E. Mancini 1, R. Mattar 1
1Obstetrics, 2Internal Medicine, So Paulo Federal University (UNIFESP), So
Paulo, Brazil
Conclusion: We developed Figure 1 based on our structural analysis of

interactions among midwife, expectant mother, and fetus.
P211
IS THERE ANY ROLE OF VAGINAL MISOPROSTOL FOR PAIN RELIEF IN
OUTPATIENT VAGINOSCOPIC OFFICE HYSTEROSCOPY?
H. Hassa, Y. Aydin, T. Oge*, E. Ozturk
Obstetrics and Gynecology Department-Reproductive Medicine Unit, Eskisehir
Osmangazi University, Eskisehir, Turkey
Problem Statement: Pain related to outpatient hysteroscopy is one of the most
important limitations in conventional and vaginoscopic procedures. Misoprostol
is a prostaglandin E1 analog that is primarily used as a cervical priming agent. In
obstetrics, it is frequently used in medical abortions and induction of labor.
Because it dilates and softens the cervix during hysteroscopy, it may reduce the
pain associated with the procedure. Cervical ripening using misoprostol may
facilitate the hysteroscopic procedure and may lower the risk of cervical
laceration. The objective of the present study was to assess the efficacy of
vaginal misoprostol therapy in reducing pain during vaginoscopic diagnostic
outpatient hysteroscopy.
Methods: This was a randomized, prospective, controlled parallel-group study.
Women who visited our infertility department and required diagnostic
outpatient hysteroscopy for investigation of infertility were enrolled in the study
group. In the control group, 51 patients had vaginal placebo 6-8 hours before
the procedure. 200 g vaginal misoprostol 6-8 hours before the procedure were
prescribed to the study group of patients (n:51). Patients were asked to record
severity of pain, which was the primary outcome of the study, during the
procedure by using a 10-point visual analog scale (VAS) ranging from 1(very
favorable) to 10 (very unfavorable) and also to indicate pain scores (VAS) from
previous hysterosalpingographic procedures. Secondary outcomes were; postprocedural analgesic requirements and vasovagal effects including nausea,
vomiting, sweating, syncope, hypotension, and bradycardia.
Results: No significant differences were observed in so far as age, body mass
index, duration of infertility, or recalled VAS pain score from a previously
performed hysterosalpingographic procedure. Among medication group any
analgesic drug requirement and vasovagal symptoms are 5 (9.8%), 8 (15.6%) for
analgesic requirement and 2 (3.9%), 5 (9.8%) for vasovagal symptoms as vaginal
placebo and vaginal misoprostol respectively. There were no significantly
difference among groups. There was no significant difference in the VAS pain
scores as a primary outcome between the groups (p=0.072). There was no
significant difference in the vasovagal symptoms and post-procedural analgesic
requirement.
Conclusion: Pain relief is an important circumstance for patients prior invasive
procedures like office hysteroscopy. Thus some medications are tested to
reduce pain during and after the procedure. In our study we compared
misoprostol with placebo and we didnt establish any significant difference
144
Problem Statement: Obesity is increasing worldwide. According to the latest

national demographic survey, 60% of reproductive age women (15-49 years) in
Brazil are overweight (body mass index - BMI > 24.9 Kg/m) and one third of these
women are obese (BMI > 30 Kg/m 2). Obese pregnant women are at higher risk
for several adverse obstetrics outcomes and may have worse quality of life than
normal weight pregnant women. We aimed to assess the possible association
between obesity and quality of life among Brazilian pregnant women.
Methods: Cross-sectional study conducted between August 2011 and February
2014 at the antenatal clinic of a public teaching hospital. Up to present, 206
healthy pregnant women between 14 and 40 weeks were recruited: 100 were
overweight and 106 were normal weight (pre-pregnancy BMI > 25.0 and 18.524.9 Kg/m2, respectively). The World Health Organization Quality of Life-Bref
(WHOQoL-Bref) questionnaire was used to assess quality of life; final scores
range from 0 to 100, with higher scores indicating better quality of life. The Chisquare and Students t tests were used to compare variables between the two
groups. P < 0.05 was considered significant.
Results: The main socio-demographic characteristics between the two groups
were similar. Most of participants were of mixed race, multipara, married,
catholic and employed. The overall total mean WHOQoL-Bref scores were similar
in the overweight and normal weight groups: 63.7 14.2 vs 64.1 12.4 (p=
0.830), respectively. The mean quality of life scores were very similar between
the two BMI groups in the 116 women in 2nd trimester of pregnancy (65.3 11.6
vs 65.2 11.1, p=0.963, normal vs overweight women) as well as in the 90
women in the 3rd trimester of pregnancy (62.0 13.5 vs 62.2 14.2, p= 0.946).
Conclusion: According to our preliminary results, being overweight does not
seem to affect the quality of life of healthy women between 14 and 40 weeks of
pregnancy, as measured by the WHOQoL-BREF questionnaire. The study is
ongoing.
This study was funded by a grant from FAPESP Fundao de Amparo Pesquisa do Estado
de So Paulo. Process n. 12/03670-4, 12/50225-6 and 12/11787-9.
P213
MATERNAL OVERWEIGHT AND DEPRESSIVE SYMPTOMS AMONG BRAZILIAN
PREGNANT WOMEN - PRELIMINARY RESULTS
M. C. Ribeiro 1,*, M. U. Nakamura 1, M. R. Torloni 2, M. D. T. Scanavino 3,
R. Mattar 1
1Obstetrics, 2Internal Medicine, So Paulo Federal University (UNIFESP),
3Psychiatric, So Paulo State University Medical School (FMUSP), So Paulo,
Brazil
Problem Statement: Depression is the most prevalent psychiatric disorder of
pregnancy affecting 4%> 25% of all pregnant women and up to 25% - 50% of
those in low socio-economic populations. The risk factors for depression in
pregnancy are still being investigated. Our aim was to access and compare the
prevalence of depressive symptoms in overweight and normal weight Brazilian
women in the 3rd trimester of pregnancy.
Methods: Cross-sectional study conducted between August 2011 and February
2014 at the antenatal clinic of a public Brazilian teaching hospital. So far, we have
recruited 90 healthy participants between 28 and 40 weeks gestation: 50
overweight and 40 normal weight women (prepregnancy BMI 25 and BMI 18.524.9 Kg/m2, respectively). The Beck Depression Inventory (BDI) questionnaire
Abstract Book
was used to assess depressive symptoms; final scores range from 0 to 63, with
total score 21 indicating risk for depression. The Chi-square and Students t
tests were used to compare the two BMI groups. P < 0.05 was considered
significant.
Results: Main socio-demographic characteristics between the two groups were
similar. Most of participants were of mixed race, multipara, married, catholic
and employed. Mean age was 28.1 5.6 years and mean gestational age was
34.1 3.3 weeks. There was a significantly higher rate of women with depressive
symptoms (total BDI scores 21) in the overweight than in the normal weight
group (26.0% versus 1.6%, p=0.045, respectively).
Conclusion: According to our preliminary results, overweight women in the 3 rd
trimester of pregnancy have a higher rate of depressive symptoms than normal
weight women of similar gestational age. The study is ongoing.
This study was funded by a grant from FAPESP Fundao de Amparo Pesquisa do Estado
de So Paulo. Process n. 12/03670-4, 12/50225-6.
P214
EVALUATION OF FREQUENCY OF DOMESTIC VIOLENCE AND ANXIETY LEVEL
AMONG INFERTILE WOMEN (SAKARYA, TURKEY)
S. Sahin 1,*, K. OZDEMIR 2, A. Unsal 3
1YildirimBeyazt Unversity, Faculty of Health Sciences, Ankara, 2Sakarya
Unversty, School of Health, Sakarya, 3Eskisehir Osmangazi Unversty, Eskisehir,
Turkey
Problem Statement: Aim of the study is to determine frequency of domestic
violence among infertile women, to review some associated variables and to
evaluate anxiety level.
Methods: This is a descriptive study conducted on women who applied to
Sakarya Training and Research Hospital Infertility Polyclinic between 01 March
2013 and 01 July 2013. The study group consisted of a total of 774 women
(88.1%) admitted to the infertility polyclinic of the hospital and agreed to take
part in the study. The questionnaire forms prepared by using the literature in
line with the study objective were completed by the investigators with face-toface interview method. The women who suffered from minimum one type of
domestic violence at least once within last 1 year were regarded to have
domestic violence history. Beck Anxiety Inventory was used to assess anxiety
level. Data were analyzed with Chi-square test and Mann-Whitney U test.
Statistical significance was accepted as p 0.05.
Results: The age of women in the study group ranged from 17 to 48 with a mean
age of 28.27 5.45 years. 116 (15.0%) infertile women in our study reported to
suffer from domestic violence. The most frequently reported domestic violence
type was emotional (56.1%) and sexual (21.9%). In our study, exposure to
domestic violence was determined to be higher in women aged 25 and above,
with an education level of high school and above, not working, with addiction of
smoking and alcohol, with obesity, married more than once, whose first
marriage age is 19 and below, married for 4 years or below, with primary
infertility, who is infertile for 2 years and less and have infertility family history
(p < 0.05 for each). No difference was found between marriage type, personality
type and exposure to domestic violence (p > 0.05 for each). Anxiety levels of
infertile women with domestic violence history were determined to be
significantly higher (p < 0.05).
Conclusion: Domestic violence against infertile women is an important issue
with regard to women health and in social terms. Treatment of infertile women,
if possible, enabling them to have children will affect their mental health
positively.
Key words: Domestic violence, infertile women, anxiety, Turkey
P215
DOMESTIC VIOLENCE, DEPRESSION AND ANXIETY DURING PREGNANCY
(SAKARYA, TURKEY)
S. Sahin 1,*, K. Ozdemir 2, A. Unsal 3
1Yildirim Beyazit University, Faculty of Health Sciences, Ankara, 2Sakarya
University, School of Health, Sakarya, 3Eskisehir osmangazi university, public
health, eskisehir, Turkey
Problem Statement: This study was conducted to determine frequency of

domestic violence among pregnant women, to review some variables that are
believed to be associated and to assess depression and anxiety levels.
Methods: This is a cross-sectional study conducted on the pregnant women who
applied to Sakarya Training and Research Hospital Gynecology Polyclinic
between 15 January 2013 and 15 July 2013. The study group consisted of a total
of 817 pregnant women (68.1%) admitted to the gynecology polyclinic of the
hospital and agreed to take part in the study. The questionnaire forms prepared
by using the literature in line with the study objective were completed by the
investigators with face-to-face interview method. The women who suffered
from minimum one type of domestic violence at least once throughout
pregnancy were regarded to have violence history during pregnancy. Beck
Depression Inventory was used to assess depression and Beck Anxiety Inventory
was used to assess anxiety level. Data were analyzed with Chi-square test and
Mann-Whitney U test. Statistical significance was accepted as p 0.05.
Results: The age of women in the study group ranged from 18 to 41 with a mean
age of 28.28 4.66 years. In our study, pregnant women reported verbal
violence most frequently (32.1%) and physical violence least frequently (1.3%).
In the study group, frequency of domestic violence was found to be higher in
pregnant women whose education level is secondary school and lower, who
have an extended family, whose spouse is drug/substance user, married twice
or more, whose first marriage age is 22 and below and whose number of
pregnancy is 3 and more (p < 0.05 for each). Frequency of suspected depression
among pregnant women was determined to be 16.8% (n=137). The scores
obtained from Beck Anxiety Inventory by the pregnant women in the study
group ranged from 0 to 51 with a mean score of 14.43 10.13.
Conclusion: Violence during pregnancy affects maternal and child health
negatively and causes important physical and emotional disorders, primarily
depression, in women. Accordingly, it is recommended to determine risk groups
during pregnancy follow-up and to provide spouses of pregnant women with
information on changes that occur during pregnancy in order to prevent
violence.
Key words: Domestic violence, pregnant women, anxiety and depression, Turkey.
P216
EARLY IDENTIFICATION AND EVALUATION OF HIGH-RISK PREGNANCY
S. Sahin 1,*, S. Kaplan 1, G. Pinar 1, A. Akalin 1, D. Ozgen 2, E. Inan 3, G. Kurnaz 2
1Faculty of Health Sciences, Yildirim Beyazit University, 2Department of Nursing,
Ankara Numune Training and Research Hospital, 3Department of Nursing, Zekai
Tahir Ankara Numne Training and Research Hospital, Ankara, Turkey
Problem Statement: Although, pregnancy is a natural and physiological event, it
affects the mother mentally and physically. A pregnancy is considered to be highrisk when there are potential complications that could affect the mother, the
baby, or both. The important thing for early detection of risky situations and
solving them so that it affects the mother and the fetus at least. It is necessary
to identify the mothers under risk to be able to raise the level of mother and
baby health by providing them with good prenatal care. This study was carried
to determine the early diagnostics of high-risk pregnancies and the assessment
of the effect of some variables on pregnancies
Methods: The study was conducted at the Pregnancy Polyclinic at Ankara
Numune Training and Research Hospital during January and September 2014.
Pregnant Women who applied the Pregnancy policlinic at the hospital, were
present at the clinic for routine checkup, applied to the study criteria and
accepted to participate in the study were included in the research. It is a
descriptive and cross-sectional study. In order to collect data, Personal
Information Form containing pregnant womens socio-demographic
characteristics and some variables associated with obstetric feature were used
in this study. The collected data was analysed using frequency, percentage,
mean, standard deviation, t-test, one way analysis of variance tests, Pearson's
correlation test and p < 0.05 was accepted statistically significant.
Results: Further analysis of this study is still continuing. According to the
estimates about our study, It has been analysed that only a small amount of the
pregnants deliveried successfully, and did not have any complications. But about
145
one out of ten pregnants had complications in their delivery, and more than half
of their pregnancy was planned. About one out of ten has low birth weight in
their babies, and one out of twenty of them have big babies. Almost of them
delivered in a hospital and under doctor control, and almost of them didnt have
alcohol. Whereas one out of fifteen pregnants kept smoking during the
pregnancies. About half of them has anemia during their pregnancies, and a
small group of them has blood pressure and edema problems. About one out of
ten have previous medical problems, and most of them go through regular
medical controls. About one out of three did not tetanus vaccine. This study will
prove that pregnant women frequently face these problems.
Conclusion: Its suggested that womens pre-conceptional process duration
assessment should be taken into consideration. During this period, it is also
important to identify the factors that affect the process of pregnancies, and to
recognize these potential risks. It is also advised that the pregnant women
should be assessed according to the multidisciplinary and biopsyco-social
approaches.
Key words: High-risk pregnancy, early detection, Risk assessment
P217
FULMINANT HEPATIC FAILURE IN PREGNANCY: CAN LIVER SUPPORT THERAPY
MAKE A DIFFERENCE?
D. Tomescu 1, M. Popescu 1, R.-M. Sima 2,*, L. Ples 2
1
Anesthesiology and Intensive Care Dept 3, Fundeni Clinical Institute,
2Obstetrics-Gynecology, "Bucur" Maternity, Bucharest, Romania
Problem Statement: Although fulminant liver failure is rare during pregnancy, it
has been associated with high mortality and morbidity for both mother and
child. When termination of pregnancy is not an option or when the severity of
liver disease threatens the mothers life, liver support therapies may represent
a feasible option.
Methods: We present the case of a 34 years old woman with 12 weeks
pregnancy admitted in the Obstetrics department for jaundice and fatigue for 3
days. The patient had no prior medical history except alcohol abuse for the last
2 years. She was diagnosed with fulminant liver failure and was admitted in to
Intensive Care Unit (ICU). Considering the risks for further severe complications
termination of pregnancy was performed. Two days after admission she
developed severe hepatic encephalopathy (grade 3) that required protective
intubation and mechanical ventilation, hepato-cytolysis and cholestasis
(bilirubin levels 25.1 mg/dL). Three consecutive sessions of hepatic dialysis
(Molecular Absorbent Regenerating System - MARS) were applied for 8 hours in
the first 3 consecutive days after ICU admission. Hepatic function, ammonia
levels and severity of coagulopathy were assessed after each session.
Results: The use of MARS was associated with an improvement of hepatic
encephalopathy: ammonia levels decreased from 186 mol/L to 170 mol/L
after the first session and then furthered decreased to 136 mol/L and to 125
mol/L after the second and third sessions. Each MARS session correlated with
a decresed in bilirubin levels from 25.1 mg/dL before the first session to 12.5
mg/dL after the third session. Although an improvement in hepatic function was
associated with the use of MARS, the patient developed severe respiratory
distress due to hospital acquired pneumonia and could not be weaned from
mechanical ventilation. The patient died 21 days after ICU admission due to
severe sepsis.
Conclusion: Fulminant liver failure in the first and second trimester of pregnancy
remains a rare complication of pregnancy. Liver support therapies, like MARS,
can help bridge selected patients to term in order to save both mother and child.
P218
WHAT DO WOMEN WITH MULTIPLE SCLEROSIS THINK ABOUT MARRIAGE
AND PREGNANCY?
S. D. Yilmaz 1,*, H. GUMUS 2, O. F. ODABAS 2, E. AKKURT 2, H. YILMAZ 2
1Midwifery, Selcuk University, 2Konya Education and Research Hospital, Konya,
Turkey
146
Problem Statement: Multiple sclerosis (MS) is an inflammatory, autoimmune,

relapsing, demyelinating and/or neurodegenerative chronic disease that usually
starts in young adults and is more frequently seen in women. It is important to
determine the perceptions of young women with MS on marriage and pregnancy
and to understand how their health condition affects them when planning their
future.
Methods: This study was planned to determine the feelings, thoughts,
experiences and perceptions of young women with MS and their opinions and
attitudes on marriage and pregnancy by using qualitative methods.
In the study performed via in-depth interviews, a semi-structured questionnaire
was used. 11 young and single women aged 18 years were invited to the study,
and interviews made with 9 of them were evaluated as 2 women didn't want to
participate in study. All participants were informed about the fact that the
interview would be taped, transcribed, and their names would be kept
confidential before collecting data. Transcribed interviews were qualitatively
and thematically analysed using content data analysis to code and categorize
emerging themes.
Results: Three main topics were established. The first one was "in the shadow of
MS". There was a dominant feeling amongst women that although there were
no serious sequelae of MS, people avoid and exclude them since they do not
have knowledge on the disease. The second topic was "feeling stigmatized".
Women particularly stated that they don't want people around them to know
their disease. Because they believed that people want to get marry with healthy
women, and when they meet with someone with the purpose of getting married,
he will give up from the beginning without giving any chance to get to know them
if he knows about their disease. The third topic was "against all odds". Although
there were women (5 women) who stated they want to leave a piece of
themselves in the world if they will get marry, some participants (4 women) were
worried about having attacks during pregnancy and unable to take care of their
baby in case of disease progression.
Conclusion: Young women with MS may have pessimistic and complex feelings
about future. Thus, it may be recommended particularly for healthcare providers
who treat single women with MS to determine the feelings of their patients on
marriage and pregnancy and provide training and consultancy services if
necessary.
P219
THIRD/ FOURTH DEGREE PERINEAL TEAR: DOES ANORECTAL SYMPTOMS
CORRELATE WITH MANOMETRY AND ENDO-ANAL SCAN RESULT?
D. F. Abdulwahab 1,*, A. Md Nor 2, Z. Nusee 1, H. Hussin 1, M. Awang 1
1
Obstetrics and Gynaecology, 2Surgery, International Islamic University
Malaysia, Kuantan, Malaysia
Problem Statement: Since the introduction of endoanal ultrasound in the early
1990s. It was found that obstetric anal sphincter injuries (OASIS) rather than
neurogenic injury was the leading cause of anal incontinence and can have a
devastating effect on a womans quality of life (QoL). OASIS is reported in
approximately 2.8% of primigravidae and 0.4 % of multigravidae. Despite
identification and immediate repair of OASIS, the outcome is suboptimal. Due to
that the follow up and subsequent management following OASIS remain
controversial. In this cohort study we assessed the short term outcome of OASIS
primary repair which include anorectal symptoms, QoL, sphincter integrity and
function and to find the correlation between anorectal symptoms and
investigations results.
Methods: Study population were all consented women complicated by 3rd /4th
perineal tear with immediate repair between June 2010 to December 2012. The
assessment made after 6 months post delivery using standardized and validated
questionnaire (Waxners score, UDI 6 and IIQ 7), anal manometry and endoanal
ultrasound (EAUS).
Results: Fourty eight out of 60 cases of OASIS with primary repair came for
assessment. There was 85.4% (41/48) third degree tear, of which majority were
type 3a and 3b (33.3% each) and 14.6% had 4th degree tear. Mean age of patient
was 27.4 (4.12) old, majority were Malay and para one 30 (62.5), follow up was
between 6-8 months. 12.5% (6/48) women had an abnormal Waxners score;
10.4% (5/48) on flatus, and 2.1 % (1/48) on solid of which 2.1% had altered life
Abstract Book
style. 39.58% (19./48) had abnormal EAUS, of which 25%(12/48) had both
internal anal sphincter (IAS)& external anal sphincter(EAS) defect, 12.5% (6/48)
and 2.08% (1/48) involved (EAS) and (IAS) alone respectively. However only 8.3
%(1/12) of those who have persistent defect in both EAS& IAS have both fecal
and flatus incontinence, 16.6% (1/6) of isolated abnormal EAS developed flatus
incontinence. Just one patient had persistent defect in IAS alone show normal
Waxners score. EAUS result does not correlate with Waxners score (P=0.705)
Total of 18.8% (9/48) showed abnormal manometry result of which 6.3% (3/48)
abnormal maximum resting pressure and 12.5% (6/48) abnormal maximum
squeeze pressure. None of them developed anal incontinence. There was no
significant correlation between manometry result and Waxners score. Neither
between manometry and EAUS (P=0.18)
Conclusion: Short term outcome showed 12.5% of OASIS clinically had
incontinence after primary repair despite of persistent defect in more than one
third by EAUS and 18.8% had abnormal manometry perineal study. Abnormal
manometry and EAUS does not reflect the anal incontinence symptoms. Routine
EAUS and monometry is not recommended in asymptomatic patient.
P220
VAGINAL PARAURETHRAL MYXOID LEIOMYOMA - A DIAGNOSTIC DILEMMA
S. Al Abri , L. Ahmad*
Obstetrics and gynecology, Armed Forces Hospital, Muscat, Oman
Problem Statement: Vaginal leiomyoma is a rare solid tumor of unknown
etiology, which usually develops in women between the ages of 35 and 50.
Methods: A Case Report.
Results: A 19 -year-old unmarried girl was seen in urogynaecology clinic with
complaints of vaginal mass and pain along with foul smelling vaginal discharge
since 3 years. Vaginal examination revealed, a 5x6 cm irregular hard mass arising
from anterior vaginal wall and was protruding through the Introitus. Mass was
ulcerated and pasted with thick mucopurulent discharge. Tumor markers were
normal. Imaging modalities used in which ultrasonography showed 4x5 cm mass
with some internal echoes seen anterior to vaginal canal. Both ovaries were
normal. MRI accurately defined the tissue planes between the lesion and the
adjacent structures and suggested its benign nature. There was a lobulated
superficial midline interlabial mass at the vaginal introitus, which extended
cranially and towards into the left pelvic area where it was seen to be on the left
side of distal urethra and anterior to the lower vagina. EUA and biopsy showed
same size of hard mass arising from anterior vaginal wall and the lesion
deformed the vagina and compressing the urethra, dislocating the external
urethral meatus upwards, urethra cannot be identified separately, different
dilators were used to identify urethral meatus without any success, therefore,
cystoscopy was not done. Vaginal orifice was admitting 1 finger only, posterior
vaginal wall felt normal. Per rectal examination was normal. Biopsy taken from
3 and 9O clock position. Biopsy result showed myxoid edematous stroma, no
mitotic active lesion seen. Surgery scheduled once biopsy result reviewed, the
mass was well circumscribed and it was completely resected by transvaginal
approach. Histopathology revealed tumor with no cytological atypia and had low
mitotic rate and the diagnosis was vaginal myxoid leiomyoma. After 1- year of
surgical removal, the patient is free of disease.
Conclusion: Vaginal Myxoid leiomyomas are rare, its recurrence and
transformation into sarcoma is very unlikely. Complete surgical excision is the
treatment of choice. Vaginal surgery is appropriate, however, resection can be
carried out with abdominal approach, if the lesion cannot resected vaginally.
P221
EFFICIENCY OF TREATMENT FOR FEMALE SUI (STRESS URINARY
INCONTINENCE) USING THE TVT-O (TENSION-FREE VAGINAL TAPE
OBTURATOR) TECHNIQUE
C. Alexandru*, L. A. Ivona, S. Demetra, S. Razvan
Obstetrics and Gynecology, UMF Gr.T.Popa Iasi Romania, Iasi, Romania
Problem Statement: The modern TVT-O technique is used worldwide to treat
SUI. The subject of the paper is timely and with a major practical potential. The
paper presents an ample retrospective study on a series of patients hospitalized

at the Second Clinic of Obstetrics Gynecology from Cuza-Voda Maternity
Hospital of Iasi, for a period of 3 years.
Methods: In the period January 2010 January 2013, 164 female patients were
subjected to surgical procedures to treat type II SUI, inserting TVT-O tapes.
Patients were selected based on anamnesis, clinical examination and positive
Bonneys test. When genital prolapse was associated with SUI, simultaneous
with strip insertion, other interventions were practiced, too. Cases were
followed in the immediate postoperative period, at 2 months, 6 months and 1
year, in order to analyze the efficiency of the method.
Results: 164 female patients aged between 38 and 65 were included in the study,
of which 60 cases had isolated SUI and in 104 of the cases SUI was associated
with genital prolapse. In 85% of the cases, the healing rate was satisfactory, and
in 15% of the cases, it was partially satisfactory, keeping the percentage at 6
months and 1 year. In respect of complications at 16 female patients, SUI was
improved, but persistent, in 14 cases the mictional imperiosity was described as
absent before intervention; in these cases we used oxybutynin, in 4 of them
tape sectioning and in 4 cases the exteriorization of the tape was relieved after
2 months, performing the secondary vaginal suture.Conclusion: The simple
operatory technique, the reduced hospitalization period, the short
convalescence and the immediate results support the TVT-O procedure in the
treatment of SUI. Postoperative complications are rare and do not compromise
results. The main goal of Sling interventions is the creation of a reliable closure
mechanism, supporting the passive urinary retention by urethral compression.
Our point of view with regard to the controversy of using TVT-O tapes is that the
technique does not have to be abandoned, being extremely efficient in academic
centers with ultra-specialized staff.
P222
FLUID INTAKE AND LOWER URINARY TRACT SYMPTOMS; HABITS AND
HEALTH KNOWLEDGE IN A YOUNG, HEALTHY POPULATION
S. Aydin Ozkan 1,*, N. Kzlkaya Beji 2
1Nursing, Adiyaman University School of Health, Adiyaman, 2Nursing, Istanbul
University Florence Nightingale Nursing Faculty, Istanbul, Turkey
Problem Statement: Health professionals commonly advise patients with
incontinence and other lower urinary tract symptoms about modifiable
contributing factors such as drinking and voiding habits. Poor drinking and
voiding habits may begin early in life, before symptoms emerge. However, little
is known about the habits and knowledge young people have regarding healthy
drinking and voiding habits. This research aimed to assess the habits and health
knowledge of young people regarding fluid intake and voiding.
Methods: This study design was observational cross-sectional survey. First year
university students in the Division of Health Sciences, Istanbul University and
Halic University, aged between 17 and 31 years were recruited via
questionnaires distributed during class. A questionnaire was used to assess the
drinking and voiding habits and The Urinary Symptom Profile-USP (USP structure
of 13 items in 3 dimensions: stress urinary incontinence, overactive bladder, and
low stream). The survey was completed by 602 participants. Data was entered
into a SPSS file and analyses undertaken using SPSS 16.0 for Windows.
Results: The average age of the participants were 19.191.48. The participants
were 79.1% female and 20.9% male. The average daily fluid intake was >2 L/day
for both genders. Overall median fluid intake was 2250 mL (lower [25th] to upper
[75th] quartiles; 17502750 mL). Males median fluid intake was 2500 mL
(interquartile range 1163 mL) whilst females was 2150 mL (inter-quartile range
1000 mL). The gender difference in fluid intake was significant (p < 0.05). Poor
drinking and voiding habits (such as high consumption of caffeinated drinks and
alcohol, or nocturia) were common. Especially male students were more than
consumption of caffeinated drinks and alcohol compared to female students.
USP score was stress urinary incontinence, overactive bladder, and low stream
0.160.69, 2.412.17, 0.280.83 respectively. The male students compared to
female students difference in stress urinary incontinence and low stream was
found to be statistically significant (p < 0.05).
147
Conclusion: More informed public education regarding healthy fluid intake, and
drinking and voiding habits, is required as part of the effort to reduce the
development of lower urinary tract symptoms, including incontinence.
P223
COLLAGEN TYPE 1 POLYMORPHISM AS A RISK FACTOR TO URINARY
INCONTINENCE IN PREGNANT WOMEN WITH GESTACIONAL DIABETES
MELLITUS
A. M. P. Barbosa 1,*, A. P. Machado de Almeida 1, G. Vesentini 1, F. Piculo 1,
G. Marini 1, J. Lara Padovani 2, M. Rudge 1
1
Ginecology, Obstetrics and Mastology, 2Patology, Unesp, Botucatu, Brazil
Problem Statement: Gestational Diabetes mellitus (GDM) is a medical
complication with higher occurrence during pregnancy and can lead to higher
frequencies of abnormalities when compared with normoglycemic pregnancy.
Studies have showed us that GDM altered the structure of pelvic floor muscle
(PFM), and it was associated with higher incidence of urinary incontinence. The
collagen has an essential role for organ pelvic support and for that, is very
important for PFM. Genetic alterations in collagen synthesis can result in tissue
fragility and it can lead to urinary incontinence too. Therefore, our objective was
to analyze the relationship with collagen type 1 polymorphism and urinary
incontinence in pregnant women with GDM.
Methods: This cross-sectional study were performed from 2013 to 2014. 134
pregnant women with thirty four or more pregnancy weeks or women who
underwent childbirth in the last two years were selected and recruited for this
study. The women answered the International Consultation on Incontinence
Questionnaire Short Form (ICIQ-SF) and then, were divided into 4 groups:
Diabetic continent (13), Diabetic incontinent (20), Normoglycemic continent (42)
and normoglycemic incontinent (59). The genomic DNA was extracted by saliva
sample and determination of the COL1A1 polymorphism was done by
polymerase chain reaction- real time. All experimental procedures were
approved by the Ethics Committee of the Botucatu Medical School UNESP
(Protocol Number n161/12).
Results: The patients presented average age 26 7 years old and the alleles are
demonstrated by groups in table 1.
GDI
GN
I
GN
C
Total (n)
G
D
C
0
TT
GG
14
0,0
1,5
0,0
10,4
4,5
47
35,1
28
95
4,48
5,2
10
7,5
14
20
14,9
1
3
9,7
59
44,0
3
42
20,
9
10,
4
31,
34
G/T
Total
37
134
Data show us that there was higher incidence of allele GG (71%) in general. In
separated groups, there were higher incidence of allele GG in groups DI, NI and
NC, but in the DC group, the higher incidence was polymorphic allele GT. But
there was no association between collagen polymorphism, diabetes and urinary
incontinence, as there was no difference in the genotype distribution
polymorphism COL1A1 between groups, different from Skorupski research
(2006), which found that G-T polymorphism at the SP1 binding site of the gene
encoding -1 chain of type 1 collagen is associated with increased risk of stress
urinary incontinence in women.
Conclusion: No difference between groups was found in the genotype
distribution polymorphism for COL1A1.
P224
EFFECTS OF SHORT-TERM SEVERE AND LONG-TERM MILD STZ-INDUCED
DIABETES IN URETHRAL TISSUE OF FEMALE RATS
A. P. Machado De Almeida 1,*, G. Marini 1, F. Piculo 1, A. Barbosa 1, D. Damaceno
1, S. Matheus 2, S. Felisbino 3, M. Rudge 1
Botucatu Medical School, 2Department of Anatomy, Institute of Biosciences,
3Unesp, Botucatu, Brazil
148
Problem Statement: Diabetes mellitus affects multiple organs including urinary

system either in diabetic or in prediabetic stages. Recent evidence strongly
suggests that urinary incontinence is a common complication among women
with diabetes. In additional to these studies, we and other investigators showed
that diabetes induced alterations of urethral tissue in rats. Our hypothesis was
that the intensity and number of alterations on urethral striated muscle and
extracellular matrix of short-term severe diabetes were higher compared to
long-term mild diabetes in rats.
Methods: For the induction of mild diabetes (blood glucose between 120-300
mg/dL), female newborns received streptozotocin (100 mg/kg body weight, sc
route) and to induction of short-term severe diabetes (blood glucose level >300
mg/d) adult animals received streptozotocin at 40 mg/kg, IV route. The rats were
killed on day 133 of the experimental by i.p. Thiopentax injection at 80 mg/kg
and the urethrovaginal tissues were harvested. Morphometric, pathological,
immunohistochemical to fast and slow fibers, and ultrastructural analysis were
conducted.
Results: In long-term mild diabetes were found collagen deposition, severe
fibrosis, lipid droplets and numerous subsarcolemmal and intermyofibrillar
mitochondria. The effect of STZ-induced short-term severe diabetes and longterm mild diabetes on urethral striated muscle and extracellular matrix of female
rats resulted in diabetic myopathy in both models which included decrease
number of fast fibers and loss of specific localization of fibers type I and type II.
Conclusion: Long-term mild diabetes amplifies the alterations found in urethral
tissue with severe fibrosis and has important implications for the monitoring and
treatment strategies implemented in patient with diabetes mellitus.
P225
COLLAGEN TYPE 1 AND METALOPROTEINASE 9 POLYMORPHISM AS A RISK
FACTOR TO URINARY INCONTINENCE IN PREGNANT WOMEN
A. P. Machado De Almeida 1,*, G. Vesentini 1, F. Piculo 1, G. Marini 1,
J. Padovani 2, A. Barbosa 1, M. Rudge 1
Botucatu Medical School, Botucatu, Brazil, 2Department of Pathology, Botucatu
Medical School, Botucatu, Brazil
Problem Statement: The urinary incontinence is defined by International
Continence Society as any involuntary urine loss and it can be occasioned by
many factors. The collagen type 1 has an important role in urinary continence
because is responsible to pelvic organs support and suspension. The
metalloproteinases has an important modular role in the development and
tendon remodeling and has influence on collagen degradation. Skorupski et al
found an association between the Sp1-binding site polymorphism and increased
risk of stress urinary incontinence and Chen et al found an association between
9 matrix metalloproteinase polymorphism and pelvic organ prolapsed. Thus,
changes in collagen type 1 synthesis or degradation can influence in the urinary
incontinence occurrence. The aim of this study was to analyze the relationship
between COL1A1 and MMP9 polymorphism with the urinary incontinence
occurrence in pregnant women.
Methods: This cross-sectional study was performed in 2013 to 2014. 118
pregnant women with thirty four pregnancy weeks or more, pregnant women
or women who underwent childbirth in last two years were selected and
recruited for this study. The women answered the International Consultation on
Incontinence Questionnaire Short Form (ICIQ-SF) and were divided into 2
groups: continent (48) and incontinent (70). The genomic DNA was extracted by
saliva sample and determination of the COL1A1 and MMP9 polymorphism was
done by polymerase chain reaction- real time. All procedures were approved by
the Ethics Committee of the Botucatu Medical School UNESP (Protocol Number
n161/12).
Results: 88 pregnant women were primiparous and 114 were multiparous and
the average age were 26 7 years old.13 pregnant women presented urge
urinary, 5 stress urinary incontinence and 52 mix urinary incontinence.The
genotype frequencies is presented in Table 1. The polymophic alleles COL1A1
(GT and TT) as MMP9 (AG and GG) were higher in the incontinent group, but
were not significantly associated with urinary incontinence.
Abstract Book
Table 1. Alleles frequencies
COL
1A1
MM
P9
GG
TT
G/T
GG
AA
A/G
Incontine
nt group
2
47
10
9
33
28
3,4
79,7
16,9
12,86
47,14
40,00
Contine
nt
group
0
28
14
5
20
23
Image / Graph:
0
66,7
33,3
10,42
41,67
47,92
Conclusion: There are not significant associated between

urinary incontinence and COL1A1 and MMP9 polymophism
P226
POSTPARTUM ANAL INCONTINENCE, AND URINARY
INCONTINENCE PREVALENCE AT 6 MONTHS AFTER
CHILDBIRTH
A. M. Muoz Ledesma*, M. Garcia-Yuste Gonzalez, M. Navarro
Monje,
C. Montoya Garcia, S. Del Olmo Bautista, A. Alvarez Gonzalez,
M. Azpeitia Rodriguez, A. Roman de la Pea, F. Vazquez
Camino
Obstetrics & Gynaecology, Hospital Universitario Ro Hortega,
Valladolid, Spain
Problem Statement: Study of the prevalence of urinary and anal
incontinence six months after childbirth
Methods: A cross-sectional study that included 490 women
who had spontaneous or operative vaginal delivery between
June 2012 and July 2013 at Ro Hortega University Hospital. We
collected clinical data from 720 patients including maternal age,
gestational age, type of delivery, type of anesthesia, use of
episiotomy, sphincter laceration and child birth weight.
At 6 months postpartum, we surveyed these women by
telephone using the Wexner Continence Grading Scale to
evaluate the presence and severity of anal incontinence. A
minimum score of 0 indicates perfect continence, and
maximum score of 20 indicates complete incontinence. These
results are stratified as mild (0-8 points), moderate (9-16
points) and severe (16-20 points) incontinence.Finally, 230
patients were not included in the study because they could not
be reached for the phone interview. We used the X squared
test, Fishers exact test and ANOVA for statistical analysis in
SPSS V15.
Results: The population study included 490 women 15 and 44
years-old with a mean age of 32.81 years-old. The mean
gestational age was 39.09 weeks and the mean bith weigh was
3192 gr. The Wexner scale mean result was 0.52. We foud 387
(79%) apontaneous deliveries and 103 (21%) operative vaginal
deliveries; 60 kielland forceps, 40 soft cup vacuums and 3
thierry spatulas. 458 patients received epidural analgesia
during labor, 26 received local injection analgesia, 3 received
spinal analgesia and 3 didnt receive any analgesia technique.
There isnt sifnificative results which link episiotomy and
urinary inconinence, but we find differences statistics between
women with normal vaginal delivery and instrumental delivery.
The higher prevalence of anal incontinence en patients with
spontaneos delivery compared with operative vaginal delivery
did noto achieve statistical significance
Conclusion: 1. According to other studies, anal incontinence

prevalence varies between 3% and 26%. The prevalence found
in our study was 15.7%, primarily mild anal incontinence. Anal
sphincter laceration is the most established and potentially
most modifiable risk factor for developing anal incontinence
after vaginal delivery. Primary sphincter repair is important to
minimize the risk of anal incontinence and more importantly,
the use of restrictive episiotomy results in fewer cases of
posterior trauma and fewer healing complications and should
be adopted as a routine practice. In the first medical visit after
childbirth, we advise that patients be asked specifically about
anal incontinence symptoms so as to improve the quality of life
for those who continue to experience anal incontinence in the
following months. 2. Urinary incontinence postdelivery is a
usual problem not only in the first days after that, also, in the
future with an important impact in women life. Because of that,
is very important to provide its apparition. A good diagnosis is
a good way to begin with the correct treatment, like Kegel
exercises and other kinds of treatments.
P227
THE EFFICACY AND COMPLICATION RATES OF TENSION FREE
VAGINAL TAPE OBTURATOR COMPARED WITH MINIARC(TM)
FOR THE TREATMENT OF STRESS URINARY INCONTINENCE
Thomas Niccol*, Susan Thomas
Faculty of Science, Medicine and Health, University of
Wollongong, Wollongong, Australia
Problem Statement: Stress urinary incontinence (SUI) is a
common condition in females. Curative treatment often
requires surgery. Two surgical procedures frequently
performed are Tension-free Vaginal Tape Obturator (TVT-O)
and MiniArcTM. To date, small-scale studies do not
demonstrate superiority of either technique. This study aimed
to determine if changing from TVT-O to the more modern
MiniArcTM for the treatment of SUI has an impact on efficacy
and complication rates.
Methods: One hundred and thirteen (MiniArcTM n=87, TVT-O
n=26) patients were retrospectively studied. Patients were of a
single practitioner at a single hospital site in regional Australia.
Patients were stratified into those who underwent the
procedure exclusively and those who underwent the procedure
in conjunction with other procedures (IOP). Pre-operative,
operative, hospitalization and post-operative review data was
collected from patients files.
Results: MiniArcTM/TVT-O exclusively: patients cured of SUI
when performing MiniArcTM versus TVT-O was 86% and 78%,
respectively, which is not statistically significant, p > .05. There
was one complication during a MiniArcTM procedure and no
intraoperative complications for TVT-O. The number of patients
149
P228
GYNECARE TVT VERSUS GYNECARE TVT EXACT: AN INSTITUTION'S 1 YEAR
FOLLOW-UP COMPARISON STUDY
S. Thain 1,*, H. C. Han 2
1O&G, 2Urogynaecology, KK Women's and Children's Hospital, Singapore
Problem Statement: Female stress urinary incontinence (SUI) is a common
condition worldwide, of which tension-free vaginal tape is widely used in its
treatment. Gynaecare introduced a new TVT prototype GYNECARE TVT EXACT in
the year 2010. The aim of this study was to examine and compare the perioperative complications and outcomes between patients undergoing TVT
retropubic approach versus patients who had the newer Gynaecare TVT-Exact
device.
Methods: The study was a retrospective case review of all cases of isolated
tension-free transvaginal tape procedures with cystoscopy using GYNECARE TVT
in 2011 and GYNECARE TVT EXACT in 2012. Baseline, 1 month, 6 month and 1
year post surgery outcomes and complication rates were extracted from
casenotes and phone follow up consultations and compared between the 2
groups.
Results: A total of 33 patients underwent isolated TVT procedure in 2011 and 31
patients underwent isloated TVT-Exact procedure in 2012. Mean age of the
subjects in the TVT and TVT-Exact group was 59.6 10.1 years and 54.2 8.8
years respectively. Subjective success rates were 84.8% and 100% in the TVT and
TVT-Exact group respectively (p=0.0564). Objective success rates were 92.0%
and 100% in the TVT and TVT-Exact group respectively (p=0.528). There was no
significant difference between the TVT and TVT-Exact group with regards to
intra-operative, peri-operative or long-term complications. Perforation rates in
our study were well within the above reported complication rates, with 12.1%
and 6.5% in the TVT versus TVT-Exact group respectively, and the difference
between the 2 groups was not statistically significant (p=0.673).
Conclusion: Our study shows that the use of both TVT and TVT-EXACT midurethral slings for treatment of female stress urinary incontinence have similar
results in terms of excellent cure rates and low complication rates over a followup period of 1 year. Further follow-up studies are required to assess the longterm cure rates and complication rates of the TVT EXACT sling.
P229
RECTUS ABDOMINIS MUSCLE ATROPHY INDUCED BY DIABETES IN PREGNANT
RATS
G. Vesentini 1,*, G. Marini 1, D. Damasceno 1, A. Barbosa 2, S. Matheus 3,
S. Felisbino 4, M. Rudge 1
1Gynecology and Obstetrics, UNESP - Univ. Estadual Paulista, botucatu,
2
Physiotherapy and Occupational Therapy, UNESP - Univ. Estadual Paulista,
Marlia, 3Anatomy, 4Morphology, UNESP - Univ. Estadual Paulista, botucatu,
Brazil
Problem Statement: The abdominal muscle, especially, the rectus abdominis,
takes part on the urinary continence mechanisms. It is well know that urinary
incontinence (UI) is a common symptom during pregnancy and
gestational Diabetes mellitus is associated with higher levels of UI. The aim of
this study was to investigate the effects of pregnancy and diabetes on the rectus
abdominis muscle in female rats.
Methods: Female Wistar rats were maintained under controlled conditions and
distributed into six experimental groups (n=8 rats/group): Control (C), Pregnant
(P), Mild Diabetic (MD), Severe Diabetic (SD), Mild Diabetic Pregnant (MDP) and
Severe Diabetic Pregnant (SDP). The SD groups was induced by streptozotocin
(40mg/Kg) to produce a severe hyperglycemic state (glycemia>300 mg/dL) in
adulthood, and the MD groups was induced by streptozotocin (100mg/Kg) on
the first day of life, to produce a hyperglycemic state between 120-300 mg/dL.
The rats were anesthetized with Thiopentax and killed for the harvesting of
maternal rectus abdominis muscle. All experimental procedures were approved
by the Ethics Committee on Animal Experiments (Protocol Number 1003/2013).
Transversal cross-sections of the rectus abdominais muscle were cut and
analyzed by immunohistochemistry to identify fast and slow muscle fibers and
transmission electron microscopy for ultrastructural analysis.
150
Results: Table 1. Proportion of type fiber and striated muscle area of rectus
abdominis muscle
The muscle area are
Control
Pregnant
Mild
Diabetic
expressed as mean
Fiber
Fast
79,5%
84,9%
83,2%
standard deviation (SD)
Type
Slow
20,5%
15,1%
16,8%
(m2). The fiber type
Striated
Fast
3761,5
3292,4
2653,3
muscle
1212,3
995,61
1272,31,2
proportion expressed as
area
Slow
871,4
1126,5
771,3
%. 1 p < 0.05 239,3
320,91
209,41,2
Significantly different
Severe
Mild
Severe
from control group, 2 p <
Diabetic
Diabetic
Diabetic
0.05 - Significantly
Pregnant
Pregnant
80,1%
77,2%
80,4%
different from pregnant
19,9%
22,8%
19,6%
group, 3 p < 0.05 2424,8
2819,1
1917,4
Significantly different
948,21,2,3
1248,11,2,3,4
756,31,2,3,4,5
818,9
1160,6
1006,4
from mild diabetic
212,72
304,51,3,4
247,21,2,3,4,5
group, 4 p < 0.05 Significantly different from severe diabetic group 5 p < 0.05 - Significantly
different from mild diabetic pregnant group. The morphometric analysis by
immunohistochemical staining showed a general expression of the fast myosin
heavy chain isoform in rectus abdominis muscle in all groups with lower
proportion of fast fibers in MDP group compared to other groups, lower total
area of fast fiber of all groups compared to control group, and higher total area
of slow fiber in the P, MD, MDP and SDP groups compared to control group. The
ultrastructural analysis in the control and pregnant groups was found wellorganized myofibrils forming intact sarcomere, abundant intermyofibrillar
mitochondria and with normal collagen distribution. The mild diabetic groups
caused an increased interstitial collagen, lipid droplets, numerous
subsarcolemmal and intermyofibrillar mitochondria and the glycogen granules
were dispersed in larger quantities in the striated muscle fyber. In the severe
diabetes groups centrally located myonuclei presence and sarcoplasmic
reticulum sparse T tubes was noted.Conclusion: Diabetes mellitus in different
levels causes structural and ultrastructural changes in the rectus abdominis
muscle in rats. Probably, these findings may suggest that these alterations are a
risk factor that contributes to the development of UI in women with gestational
Diabetes mellitus.
P230
DISRUPTION OF COLLAGEN AND GLYCOSAMINOGLYCANS STATUS IN THE
URETHRAL TISSUE OF PREGNANT RATS WITH STREPTOZOTOCIN INDUCED
SEVERE DIABETES
G. Vesentini 1,*, G. Marini 1, F. Piculo 1, D. Damasceno 1, A. Barbosa 2, S. Matheus
3
, S. Felisbino 4, M. Rudge 1
1
Gynecology and Obstetrics, UNESP - Univ. Estadual Paulista, botucatu,
2Physiotherapy and Occupational Therapy, UNESP - Univ. Estadual Paulista,
Marlia, 3Anatomy, 4Morphology, UNESP - Univ. Estadual Paulista, botucatu,
Brazil
Problem Statement: A positive relationship between gestational diabetes and
urinary incontinence was established by our group. The aim of this study was to
analyze the distribution and quantification of the key structural extracellular
matrix components, including total collagen, collagen I and III, collagen I/III ratio
and sulfated glycosaminoglycans, in urethra of severe STZ-induced diabetic
pregnant rats. Methods: One hundred and twenty female Wistar rats were
distributed in four experimental groups: virgin, pregnant, diabetic and diabetic
pregnant. In adult life, diabetes was induced in rats by streptozotocin
injection administered intravenously at 40 mg/kg to produce a permanent and
severe diabetic state (blood glucose level >300 mg/dL). At day 21 of the
experiment, the rats were lethally anesthetized and the urethra and vagina were
extracted as a unit. Urethral and vaginal sections were cut and analyzed by a)
histochemical staining for extracellular matrix and muscle structural
components and morphometric analysis, b) immunohistochemistry to identify
collagen I and III and Keratan sulfate, and c) Protein extraction and western
blotting analysis for Collagen I, Collagen III and Keratan sulfate. Results: The total
striated muscle is not only decreased but also this striated muscle is involved by
more connective tissue characterized by an increase in the relative ratio of the
Abstract Book
collagen I/III and a decrease in total GAGs and Keratan sulfate. Conclusion: The
importance of this study is that it provides the first line of experimental evidence
in support of a metabolic relationship between the elevated glycemic levels and
urethral dysfunction in diabetic pregnant rats.
P231
CD105 AND VEGFR2 PLACENTAL EXPRESSION IN DICHORIONIC-DIAMNIONIC
TWINS AFTER ASSISTED REPRODUCTIVE TECHNOLOGIES AND SPONTANEOUS
CONCEPTION: A COMPARATIVE STUDY
K.A. Pavlov, E.A. Dubova, N.V. Aleksandrova
Research Center for Obstetrics, Gynecology and Perinatology
Purpose: to compare molecular mechanisms of placental angiogenesis control in
the dichorionic-diamnionic placentas from assisted reproductive technologies
(ART) and spontaneous conception.
Material and methods: 20 dichorionic diamnionic full-term placentas were
studied morphologicaly and immunohystochemicalty (10 women with ART
pregnancies and 10 women after spontaneous conception). The expression level
of endoglin (D105) and vascular-endothelial growth factor-2 (VEGFR-2) were
studied in syncytiotrophoblast and endothelial cells of terminal villi. Exclusion
criteria were: women with IUGR or any severe obstetrical complications (such as
preeclamsia, hypertension etc.).
Results: no significant difference was observer between the assisted

reproductive technologies and spontaneous conception cases in birth weight
and placental weight (2463, 4341, 8 g and 2434, 7706, 2 g, p=0.53; 365, 490,
3 g and 300, 679, 9 g, p=0.72). Cytoplasmic and membranous VEGFR2
expression was revealed in syncytiotrophoblast, endothelial and mesenchymal
cells of terminal villi in both groups. No significant differences in VEGFR2
syncytiotrophoblastic and endothelial expression was revealed between the
groups of spontaneous conception and assisted reproductive technologies
(43,25,5 and 41,76,4 p=0.67; 22,13,9 and 20,35,3, p=0.39). The difference
in CD105 syncytiotrophoblastic and endothelial expression was also insignificant
(20,94,8 and 19,75,6, p=0.64; 11,13,3 and 10,33,6, p=0.81). Spontaneous
pregnancy group showed negative correlation between birth weight and CD105
endothelial expression (R= -0.74, p<0.05), as well as between placenta weight
and CD105 expression in syncytiotrophoblast (R=-0.73, p<0.05) and endothelial
cells (R=-0.68, p<0.05). In the ART group mild positive correlation between
placenta weight and VEGFR2 in endothelial cells VEGFR2 (R=0.63, p<0.05) was
found.
Conclusion: no differences in placental angiogenesis control provided by CD105
and VEGFR2 were found between the ART and spontaneous conception groups.
151
Notes
152
Abstract Book
Book Only
153
BOOK PUBLICATIONS
B1
GENETIC CAUSES OF MALE INFERTILE, VARIATIONS ACCORDING TO REGIONS
A. M. Muoz Ledesma 1,*, M. Garcia-Yuste Gonzalez 1, A. B. Rodriguez Bujez 1, Y.
Pascual Arevalo 1, E. Mancha Heredero 1, B. gonzalez Soto 2
1Obstetrics & Gynaecology, 2embryologist, Hospital Universitario Ro Hortega,
Valladolid, Spain
Problem Statement: About 20% of sterile couples are diagnosed with male
infertility. Infertile men require a thorough genetic study to assess whether
infertility may be caused by genetic factors, which accounts for 10% of male
infertility. Among all infertile men, 108 were diagnosed as azoospermic at
Hospital Universitario Ro Hortega de Valladolid (HURH) during a two-year
period (2011-2012) and therefore underwent a genetic study to test for
microdeletions at Y chromosome, chromosomal abnormalities and mutations at
CFTR Gene.
Methods: The study took place during 2011 and 2012. Azoospermia was the
condition in all cases (108). Kerotype as well as microdeletions at Y cromosome
and mutations at CFTR Gene were screened. Amplified Molecular Hybridization
technique was used to determine microdeletions at Y chromosome. In order to
deem a deletion as reliable, at least two consecutive STS had to be observed. Y
chromosome loci AZFa (STS sY86, sY625, sY84, M259), AZFb (STS sY127, sY131,
sY134), AZFc (STS sY254, sY255, sY157), YP11.3 Region (STS sY14, ZFY), Yp11.21
Region (STS sY81) and Yq11.221 Region (STS sY90) were examined.
Results: Incidence of microdeletions at Y chromosome (1.85%) was significantly
lower than what has been reported by other authors (3-7% oligospermic, 8-12
% azoospermic)*. Only two azoospermic men out of 108 had microdeletions at
Y chromosome. Chromosomal abnormalities (either numerical or structural)
were present in 6.48% of those diagnosed with azoospermia (7 patients out of
108). Incidence of heterozygous mutations at CFTR Gene was 5.55% (6 patients
out of 108), three of them associated with the 5T variant.
Conclusion: 12% of men from the West Area of Valladolid who underwent a test
for infertility during 2012 and 2013 suffered azoospermia, a percentage similar
to that found in other populations and studies.
- Incidence of microdeletions at Y chromosome (1.85%) was significantly lower
than what has been reported by other authors (8%>12%). Only two azoospermic
men out of 108 had microdeletions at Y chromosome.
- Chromosomal abnormalities (whether numerical or structural) were present in
6.48% of those diagnosed as azoospermic (7 patients out of 108).
- Incidence of heterozygous mutations at CFTR Gene was 5.55% (6 patients out
of 108), three of them associated with the 5T variant. The most frequent
genotype 7T/7T accounted for 76% of the sample, and no cases with 5T/5T
genotype were detected.
- If an 8% worldwide prevalence of microdeletions at Y chromosome is
considered, then p value = 0.0053. If a 12% worldwide prevalence of
microdeletions at Y chromosome is considered, then p value = 0.0001.
B2
VASCULAR ENDOTHELIAL GROWTH FACTOR AND SOLUBLE FMS-LIKE TYROSINE
KINASE: IS THERE A CORRELATION WITH CLINICAL MANIFESTATIONS OF
SEVERE PRE-ECLAMPSIA?
V. Aksenenko *, A. Dubovoy, L. Mozheyko, I. Nezhdanov, I. Vasilyev
Department of Obstetrics and Gynecology, Stavropol State Medical Univercity,
Stavropol, Russian Federation
Problem Statement: Hypertensive disorders complicate the course of 10% of
pregnancies. More than 60,000 women die each year because of complications
of pre-eclampsia (PE). Unfortunately, the vast majority of deaths caused by late
diagnosis and delayed treatment of this complication of pregnancy. Analysis of
more than 300 publications in the last 10 years has shown that so far for the
predicting the development of PE there is no single test with high sensitivity and
specificity.
154
Methods: We examined 34 pregnant women who were treated in the

Department of Pathology and Department of Intensive Care of the Stavropol
regional perinatal centre. These patients included in the main group. Inclusion
criteria were clinical manifestations of severe PE, singleton pregnancies, lack of
somatic pathology and informed consent for inclusion in the study. Two control
groups consisted of healthy pregnant women at term pregnancy (n = 30) and
non-pregnant healthy women (n = 30). Inclusion criteria were the absence of
disease with changes in angiogenic status, lack of PE during past pregnancies.
Material for the study was the serum. The concentration of the vascular
endothelial growth factor (VEGF-A) and soluble fms-like tyrosine kinase (sFlt-1)
was determined by enzyme immunoassay with a standard set of firm Bender
MedSystems GmbH. Statistical analyses were performed using Statistica 10 Rus
(S/n AXAR306F596204FA-J). The critical value of statistical significance when
testing the null hypothesis was assumed to be 0.05. Study of the correlation
between pairs of discrete qualitative characteristics was performed using paired
analysis of contingency tables.
Results: The age of pregnant women from the main group ranged from 19 to 43
years (mean 29,5; SD = 6,9), age of the patients in the control group was between
19 and 39 years (mean age 28,5; SD = 6,4). The average values and error of the
mean (m) of considered indicators are presented in the table. In women with
severe PE was to reduce concentration of VEGF-A and increase of concentrations
of antiangiogenic sFlt-1. Noteworthy entered into the study surrogate marker
that reflects the ratio of the studied factors sFlt-1/VEGF-A. In severe PE is an
increase in this index more than 6 times. A correlation analysis showed a
significant correlation between the concentration of factors and criteria that
characterize the level of women's health, objective research data, with
quantitative indicators of the pathologic process, gestational age, method and
timing of delivery. The strongest and most significant correlation was found
between the concentration of VEGF-A and the level of proteinuria (r = -0.68; p
<0.0001).
Groups
Severe PE
Healthy
pregnant
Non-pregnant
women
VEGF-A,
pg/ml
14,18
2,5
22,71
2,2
444,07
23,83
sFlt-1, pg/ml
sFlt-1/VEGF-A
436 30,12
503,37 67
1080 135
86,22 11,81
56,13 6,03
0,17 0,22Conclusion: The

observed correlation of VEGFA to the level of proteinuria,
severity of PE and sFlt-1 only in
the study group suggest that
the
decrease
in
the
concentration of this indicator
is a marker for the presence of
PE. Moreover, we can argue
about the feasibility of an
integrated assessment of the
angiogenic status of the
pregnant woman with the
detection of several markers.
B3
CLINICAL ANALYSIS OF PLACENTA PREVIA IN STAVROPOL (RUSSIA)
V. Aksenenko, L. Mozheyko, N. Zhernovaya, A. Dubovoy
Department of Obstetrics and Gynecology, Stavropol State Medical Univercity,
Stavropol, Russian Federation
Problem Statement: Antepartum haemorrhage is an important cause of
maternal and fetal morbidity and mortality. The most important causes are
placenta praevia and placental abruption which are more than half the cases.
Methods: We have analysed the incidence of placenta previa (PP) in the
Stavropol clinical perinatal centre (Russian Federation) from 2007 to 2013.
During this period, 33,975 births were registered, out of which 321 (0.95%) of
pregnant women revealed PP. There were 173 (54%) had a complete PP, in 58
(18%) partial placenta previa, and in 90 (28%) lower attachment of the
placenta. The main method for the diagnosis of PP is ultrasound. Up to 30 weeks
of pregnancy PP was diagnosed in 90% of patients.
Results: Method of delivery in PP was caesarean section. The main types of
anaesthesia were conductive methods (spinal and combined spinal-epidural
anaesthesia). The operative time ranged from 30 to 90 minutes. In case of low
Abstract Book
placental caesarean section was performed in 87% of women mainly under

indications that were not are connected to the type of PP (placental abruption,
uterine scar, functionally narrow pelvis, etc.). Caesarean section was performed
routinely in 78% of patients with complete PP, 50% of partial PP and 20% lower
attachment of the placenta. Placenta accreta was found in 37 (11.6%) patients
with placenta previa. We want to note that the total placenta previa occurred in
30 (81%) women. Ligation of the uterine arteries and internal iliac arteries was
performed in 72% in the case of a complete previa, 69% in the case of incomplete
previa and 7% in the low location of the placenta. In 63% of patients with
placenta previa during the operation area of the lower segment was stitched
with transverse sutures on the front and back walls of the uterus. Hysterectomy
was performed in 17 (5.3%) patients, most of whom (82%) are women with
complete placenta previa and placenta accreta. Amount of blood loss within the
1500-1800 ml was present in 74% with total placenta previa, 64% of incomplete
placenta previa and 100% in the low attachment of the placenta. It should be
noted that more than 2,000 ml of blood loss will occur only when full placenta
previa (7%). Maximum blood loss was 4800 ml. During the operation, 82% of
patients carried reinfusion of blood in a volume of 300 to 1800 ml unit Cell
Saver 5 (Haemonetics).
Conclusion: Postoperative complications were observed in 26.4% of patients
with a complete PP and in 16% with partial PP. Most often occurred anaemia,
the 2nd place was the parameterises and in one patient there was pulmonary
embolism.
B4
INFLUENCE OF GENETIC FACTORS ON THE INITIAL STAGE OF PRE-ECLAMPSIA
PATHOGENESIS
M. Kurochka 1, A. Milovanov 2, I. Bushtyreva 1,*, O. Gaida 1
1The Rostov State Medical University, Rostov-on-Don, 2Research Institute of
Human Morphology of the Russian Academy of Medical Sciences, Moscow,
Russian Federation
Problem Statement: To determine the influence of eNOS gene polymorphism on
the status of uteroplacental vascular system in pre-eclamptic gravidae, we
carried out genotyping, immunohistochemical testing of biopsy samples from
the placental site.
Methods: To study the eNOS gene polymorphism, genomic DNA was extracted
from 2 ml of venous blood using the QIAamp DNA Midi Kit ("Qiagen"). PCR was
performed
in
the
BIOMETRA
amplifier
using
the
NOS3
set. Immunohistochemical testing of biopsy samples from the placental site was
carried out using the polymer protein peroxidase method according to the
standard procedure, with the NOVOLINK (Novocastra, UK) staining system
and concentrates of mouse primary antibodies: Cytokeratin 8 (Abcam), antiNitric Oxide Synthase (Abcam). For the study we selected 15 uteroplacental
site bioptates taken during caesarean operation of patients with severe preeclampsia. For comparison we selected 10 control biopsy specimens taken from
conditionally healthy gravidae (with caesarean section performed during 38-40
weeks because of contracted pelvis, uterus scarring, abnormal fetus position). In
9 pre-eclamptic patients genotyping revealed .582+353_379 del polymorphism
in the endothelial NO synthase gene resulting in decreased production of
nitrogen oxide, 6 of the tested patients with pre-eclampsia demonstrated
normal genotype.
Results: During the study of uteroplacental morphology of conditionally healthy
gravidae, immunohistochemical staining of eNO synthase within the bioptates
of the placental site and in distant arteries of myometrium was especially
interesting. Immune expression of eNO synthase was revealed in endothelial
cells of capillaries, arterioles and venules, veins both within the endometrium
transition into myometrium, and in distant arteries and arterioles outside the
area of interstitial cytotrophoblast and multinucleated giant cells. Such eNOS
distribution in the endotheliocytes of all vessels confirms sufficient level of
nitrogen oxide (universal vasodilating factor) in all vessels. Study of eNO
synthase immune expression in the vascular endothelium of pre-eclamptic
patients with normal genotype revealed absence of positive reaction to the
presence of eNOS antibodies in the vascular endothelium of the invasion area
and visualized immune expression of varied intensity in vascular endothelium
outside the cytotrophoblast invasion area. The third stage of morphology

analysis included a study of morphological pattern in the uteroplacental biopsies
of 9 gravidae with severe pre-eclampsia and existing deletion of the pair 27 of
nucleotides in the intron 4 of the eNOS gene noncoding region (.582+353_379
del). Immunohistochemical testing using eNOS antibodies revealed no immune
expression both in the invasion area and in arteries distant from the process, or
just traces of it. We would note obvious endotheliosis, desquamation of vascular
endothelium in the invasion area and afar from it.
Conclusion: Collection of the immunohistochemical testing data resulted in
better understanding of pre-eclampsia pathogenesis. Together with abnormality
of cytotrophoblast invasion and remodelling of coiled and radial arteries, the
revealed deficit of nitrogen oxide and uteroplacental endotheliosis form the
base of the clinical picture of pre-eclampsia. In patients with polymorphism, the
deficit of nitrogen oxide in vessels has systemic nature.
B5
RETAINED PLACENTA TREATED BY ACUPUNCTURE-CASE REPORT
I. Djakovic 1,*, N. Bilic 2, S. Sabolovic Rudman 1, V. Kosec 1, K. Kuna 1, S. Radovic
Radovcic 1
1Department of Gynecology and Obstetrics, 2Department of Anesthesiology and
Intensive Care, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia
Problem Statement: The placenta is retained if it remains undelivered 30
minutes after delivery of the neonate despite active management of the third
stage of labour, or 60 minutes following physiological third stage of labour. The
incidence of retained placenta is 0.5-3%. Routine procedure for retained
placenta is manual removal, highly effective but associated with risks including
intrauterine palpation, puerperal infection and trauma to the cervix. Adequate
analgesia or anaesthesia is mandatory procedure whit its own complications and
risks. Therefore, there is a need for an alternative method of treatment.
Acupuncture methods in obstetrics are relative new in western medicine,
although they have been in used for thousands years in traditional Chinese
medicine. Acupuncture for third stage of labour is not widely accepted despite
growing number of reports on its success. The lack of randomized trials is a main
reason for the controversy of this specific topic.
Methods: We present a case of retained placenta and the influence of the
acupuncture in the third stage of labour. The protocol of our department
requires that the third stage of labour is actively managed by intravenous
administration of uterotonics, controlled traction of the umbilical cord and
transabdominal manual massage of the uterus. If these methods do not result in
placental delivery in the first 10 minutes, the bladder is catheterized and an antispasmodic drug is administered. If the placenta remains undelivered after a total
of 30 minutes have elapsed, then a manual removal of the placenta is performed
under general anaesthesia.
Results: Case: A 35-year-old women, para 2, in the 39th week of an
uncomplicated pregnancy gave birth to a male new-born weighting 3530 g and
Apgar score 10/10. Delivery of the placenta did not occur after 30 minutes with
the use of conventional procedures. We inserted acupuncture needles into
points KI16 (Huangshu, 0.5 cun lateral to the umbilicus) and SP6 (Sanyinjiao,
perpendicular insertion to 1.0-1.5 cun depth) and left in situ for 15 minutes
without stimulation. Following acupuncture treatment, spontaneous placental
delivery occurred in this case. The fourth stage of labour and the puerperium
were normal.
Conclusion: Acupuncture might be an alternative method for undelivered
placenta if all the risks of conventional methods are taken under consideration.
However, definitive conclusions are not possible because there are not enough
randomized trials.
B6
THREE SUCCESSFUL PREGNANCIES AFTER TUMOR COUSED PARAPLEGIA- CASE
REPORT
I. Djakovic 1, V. Gall, V. Koec, K. Kuna
Department of Gynecology and Obstetrics, University Hospital Center Sestre
milosrdnice, Zagreb, Croatia
155
Problem Statement: Pregnancy is a rare occurrence in patients with paraplegia.

There are very few reports of pregnancies in women with paraplegia. Integration
of disabled persons in the family and community is a goal and indicator for the
maturity of the society. Disability should not be the obstacle for parenthood. But
these pregnancies require multidisciplinary approach that includes neurologist,
neurosurgeon, anaesthesiologist, physiatrist, obstetrician and neonatologist.
Methods: We are reporting a case of 37-year-old woman with paraplegia at the
time of her fourth delivery. During her first pregnancy at age 22 legs weakness
was observed. She was diagnosed with astrocytoma of the thoracic part of spinal
cord. She had three more pregnancies after 8, 13 and 15 years. All three
pregnancies went without major complications and all ended by vaginal delivery.
Results: Fifteen years after operation of spinal cord astrocytoma patient gave
birth to 3340 g weighting and 51 cm long male new-born with Apgar score 10/10.
Delivery took place in an emergency vehicle 15 minutes before admission at our
department with no obstetrician or midwife present. Despite these
circumstances probably caused by neurological deficit and inability of the
patient to recognize the contractions in time delivery and post partal period
went without complications.
Conclusion: Successful pregnancies and parenthood is possible in paraplegic
women. Multidisciplinary approach is mandatory. Special care should be given
at the end of the pregnancy because of the neurological deficit and possibility of
recognizing the contractions by the patient.
B7
THE CHANGES OF SFLT-1 AND PLGF FOR PREDICTION OF PREECLAMPSIA IN
HIGH RISK PREGNANCIES
V. Taraseviciene 1, D. Simanaviciute, R. Maciuleviciene
Obstetrics and Gynecology, Lithuanian University of Health Sciences, Kaunas,
Lithuania
Problem Statement: The placenta and placental bed circulation play a central
role in the pathogenesis of preeclampsia. Abnormal remodelling of the spiral
arterioles result in placental ischemia and insufficiency, which in turn is thought
to lead to the secretion of soluble factors from damaged placental trophoblast
and endothelial cells into the maternal bloodstream inducing a widespread
endothelial dysfunction. The main proteins responsible for initiating endothelial
dysfunction are soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth
factor (PlGF) originating in these cells. An imbalance between angiogenic and
anti-angiogenic factors before the onset of preeclampsia has been described as
a promising predictive tool. Nevertheless studies for the best timing and
accuracy of these biomarkers are still needed for their use in clinical practice.
The aim of this study was to determine whether the change in maternal
angiogenic biomarkers between the 27th and 22nd gestational week can predict
preeclampsia in high risk pregnant women population.
Methods: This prospective study was conducted in the Department of Obstetrics
and Gynecology of Lithuanian University of Health Sciences Hospital, Kaunas
Clinics. Assays of maternal plasma of 206 pregnant women with high risk for
preeclampsia were collected at 22+022+6 and 27+027+6 weeks of gestation. Main
outcome measures were considered to be the changes in sFlt-1 and PlGF in the
period of 5 weeks in relation to preeclampsia.
Results: Preeclampsia complicated 17 pregnancies- there were 8 cases of
preterm and 9 cases of term preeclampsia. The rates of change of sFlt-1 and PlGF
between the 22nd and the 27th gestational week were significantly different in
women, who developed preeclampsia and early onset preeclampsia compared
with women, who remained normotensive throughout the pregnancy. Receiver
operating characteristics curves for the change in sFlt-1 and PlGF from the 22nd
to the 27th gestational week had areas under the curve of 0.886 (sensitivity
82.35%, specificity 84.13%) and 0.766 (sensitivity 70.59%, specificity 75.13%) for
overall preeclampsia and 0.999 (sensitivity 100%, specificity 98.94%) and 0.873
(sensitivity 100%, specificity 87.3%) respectively.
Conclusion: The change in maternal plasma sFlt-1 and PlGf of high risk
population between the 22nd and 27th gestational weeks can help predict
preeclampsia. Further studies for the establishment of the cut-offs with more
cases of preeclampsia are still needed.
156
B8
PELVIC ENDOMETRIOSIS AND URETERO-HYDRONEPHROSIS: CLINICAL,
IMAGISTIC AND SURGICAL IMPLICATIONS - CASE REPORT
C. Alexandru*, I. Ciprian, L. A. Ivona, S. Demetra, S. Razvan
Obstetrics and Gynecology, UMF Gr.T.Popa Iasi Romania, Iasi, Romania
Problem Statement: Endometriosis represent the presence and proliferation of
functional endometrial-like tissue outside the uterine cavity, and is a chronic,
recurrent, debilitating disease, in which kidney implications are rare, but
complex. Evaluation of clinical, imagistic and surgical implications of ureterohydronephrosis secondary to recurrent pelvic endometriosis are important
isues.
Methods: A 30 year old patient diagnosed with primary infertility and left
ovarian endometriosis (treated with classically conservative surgical procedure),
presented acute onset of obstructive urinary symptoms, requiring internal
drainage of the upper urinary straight path (Cook probe) for ureterohydronephrosis grade III. CT and MRI examination reveals the presence of an
imprecise pelvic mass incorporating right distal ureter and uretero-bladder
ostium.
Results: In this clinical and laboratory context, classic surgery is practicing with
right anexectomy and direct right uretero-vesical reimplantation, also with
psoas bladder-hitch. Histopathological examination confirmed the presence of
recurrent ovarian endometriosis with right distal ureteral invasion.
Conclusion: Recurrent endometriosis, although considered a benign condition,
often present invasive characters, determining considerable anatomical
destructions and severe symptoms. In this case, the patient went to two IVF
centres and both of them refused to perform ART techniques due to increased
vessel damage risk during the oocyte harvest. The urinary complications
reappeared and in the last six months the patient was treated with Diphereline
3,75 mg. The medical team had controversies about this case. What is better for
this patient? Removal of the uterus and the remaining adnexa or Diphereline
and other antiestrogens?
B9
ATTITUDE OF YOUNG PEOPLE TO FAMILY PLANNING.
G. OMAROVA, B. AMANZHOLOVA, S.ALIYEVA, A.MEIRMANOVA
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY #1, ASFENDIYAROV KAZAKH
NATIONAL MEDICAL UNIVERSITY, ALMATY, KAZAKHSTAN
B. Amanzholova 1,*, G. Omarova 2, A. Meirmanova 2
1Department of Obstetrics and Gynecology #1, Asfendiyarov Kazakh National
Medical University, Almaty, Kazakhstan, 2Department of Obstetrics and
Gynecology #1, Asfendiyarov Kazakh National Medical University, Almaty,
Kazakhstan, Almaty, Kazakhstan
Problem Statement: The aim of the study was to determine young people
awareness, attitudes and practices regarding the family planning.
Methods: An anonymous survey of 429 university students aged 18-24 years was
conducted to identify the awareness of students about family planning.
Results: The study showed that the majority of respondents (78%) wished to
postpone the birth of a child after the onset of sexual activity for 2 years or more,
but at the same time they did not have adequate knowledge on contraception.
34% of respondents indicated that their first sexual intercourse was
unprotected. Only 54% of sexually active respondents currently use
contraceptive methods, and the barrier method (condoms) was indicated as the
most popular contraception. The attitude of female and male respondents to
contraception varies considerably. The striking fact is that all female
respondents believed that contraception was the responsibility of both partners,
whereas only 24% of male respondents were ready to take responsibility for
contraception. The main source of information on contraception for adolescents
according to the survey of students is their friends, which leads to unreliable
information available for young people or misconceptions. Most adolescents
(81%) value the privacy when visiting family planning centres. The survey
revealed that the role of parents and teachers as a source of information on sex
Abstract Book
education and contraception is insignificant. It should be noted that 79% of

respondents considered it unacceptable to discuss such issues with their
parents.
Conclusion: To raise awareness level among young people on family planning
and increase the use of effective contraception it is critical to develop family
planning services on a confidential basis, to begin sex education before the start
of sexual activity, and to actively involve young men into family planning
programs.
B10
THE ASSOCIATION OF GENETIC MARKERS WITH THE RISK OF UTERINE FIBROIDS
V. Radzinsky 1, V. Khorolsky 2,*, I. Ordiyants 1, V. Kardanova 3, Y. Stykin 1
1
Peoples friendship university of Russia, Moscow, 2Kuban State Medical
University, Krasnodar, 3Medical Centre Women's Health, Moscow, Russian
Federation
Problem Statement: To evaluate the association of genetic markers with the risk
of developing uterine fibroids.
Methods: Were examined 64 women with uterine fibroids at the age of 40,10,8
(18-48) years. Genotyping was performed six molecular genetic markers
(polymorphisms -351A/G and -397 T/C gene ESR, gene polymorphisms of
tumour necrosis factor , tumour necrosis factor receptor 1-st and 2-nd type and
lymphotoxin ).
Results: In women with uterine fibroid uterus had the largest volume of
genotype CT (488 cm3), -351 AA (558.3cm3), -351GG (448.4 cm3), CC (307 cm3),
the estrogen receptor alpha and homozygotes 1/1 (362.8 cm3), tumour necrosis
factor receptor type 2. For other genotypes size and uterine volume did not
exceed 12 weeks of pregnancy. Both sites fibroids are much more common in
women with uterine fibroids in conjunction with adenomyosis: almost every
third woman identified heterozygotes CT and homozygotes TT, -351AA, -351GG,
+ 250GG, + 250AA, AA (+36 A/G ) and 2/2 (-322 VNTR). Interstitial fibroids found
in every woman. Homozygous genotypes TT and CC polymorphism -397 T / C,
GG polymorphism (-351 A/G), 2/2 (-322 VNTR), as well as heterozygotes +250
GA, -308GA and +36 AG are associated with the risk of the formation of multiple
fibroids with the rapid growth and large size. Genotypes + 250A, -308GG, + 36AA,
+36 GG and 2/1 may be associated with the development of single fibroids with
gradual growth. Genotypes ST, AA and GG (-308A/G), + 36 and GG 2/1 (-322
VNTR) may be responsible for slow and gradual growth of fibroids. Every second
woman with heterozygous alleles -308GA, + 36AG, every third heterozygotes
+250 GA had recurrent uterine fibroids after surgical treatment.
Conclusion: For prediction and early diagnosis of the uterine fibroids is
informative combined analysis of polymorphisms of genes estrogen receptor
alpha (ESR), tumor necrosis factor alpha (TNF), lymphotoxin alpha (Lt) and
tumor necrosis factor receptor 1 and type-2 (TNFR1, TNFR2). The study of the
molecular mechanisms of regulation of apoptosis and cell proliferation opens up
new prospects for the medical treatment of the most common diseases and
their prevention and rehabilitation.
B11
G.K. RAPILBEKOVA
PREVENTION OF RECURRENT MISCARRIAGE WITH THROMBOPHILIA
NATIONAL SCIENTIFIC CENTER OF MOTHERHOOD AND CHILDHOOD,
KAZAKHSTAN, ASTANA
G. Rapilbekova
National Scientific Centre of Motherhood and Childhood, Kazakhstan, Astana,
Astana, Kazakhstan
Problem Statement: In recent years in the development of the recurrent
miscarriage with thrombophilia important role of haemostasis disorders,
disruption of folate metabolism and the decrease in progesterone.
The aim of this research is the outcomes of pregnancy with recurrent miscarriage
with thrombophilia in history with the prevention of loss of the fetus during
pregnancy using injection: indirect anticoagulants, folic acid and
dydrogesterone.
Methods: 100 patients at risk for the development of miscarriage with the
identified acquired, inherited or multigene form of thrombophilia was
performed differentiated prevention of this pathology enoxaparin, folic acid and
dydrogesterone.
Results: The results of the study and discussion: We investigated the genotypes
frequencies of C677T mutation of MTHFR gene, G20210A mutation of
prothrombin gene and Leiden mutation at 100 kazakh patients with loss of fetus
in anamnesis and 200 healthy female for controls. The hereditary forms of
thrombophilies were founded at 53% patients. Thus C677T mutation was
founded at 41% patients, from them 35% women have heterozygous forms and
6% patients- homozygous forms. The isolate form of this mutation was founded
at 28% patients and in combination with other mutations at 13%. The C677T
mutation was founded at 22% patients of control group, from them at 21% are
heterozygous forms and at 1,5%> homozygous forms. The Leiden mutation was
founded at 9% patients and all are heterozygous forms. The isolate form was
founded at 4% patients and in combination with other mutations at 5%. Leiden
mutation was founded at 1,3% patients of controls. The G20210A mutation of
prothrombin gene was founded at 4% patients, and all are heterozygous forms.
The isolate form was founded at 2% patients and in combination with other
mutations at 2%. In controls this mutation was not founded. The combinations
two and even of three defects of thrombophilia were founded at 18% patients
and in control group were founded only isolated forms. The comparative analysis
showed that the application of our proposed therapy helped to reduce almost 2
times the frequency of early toxicity, threatened abortion, anaemia, placental
disorders, pre-eclampsia, premature delivery, fetal losses more than 3 times in
comparison with the comparison group.
Conclusion: Analysis of the features of childbirth has shown that such
complications generic act as premature rupture of water - in 8 and 14 cases
(16,7% and 33%), weakness of patrimonial activity - 2 and 4 cases (4.2% and
9,5%); premature detachment of normally located placenta - in 1 and 2 cases
(2% and 5%) more than 2 times less were observed in patients treated us
proposed therapy.
The use of preventive therapy contributed to the reduction in the incidence of
perinatal complications: the frequency of asphyxia fetus decreased by 24%,
delay the development of the fetus at 22%. Thus, the early use of
antithrombotic, folic acid and dydrogesterone of patients at risk for developing
pregnancy and thrombophilia contributes to a more favourable course and
outcome of pregnancy.
B12
EVALUATION OF PATHOHYSTOLOGICAL FINDINGS IN POSTMENOPAUSAL
WOMEN AFTER D&C
D. Z. Sretenovi*, B. Nikoli, S. Raki, A. Boovi
University Clinic of Gynecology and Obstetrics "Narodni front", Belgrade,
Gynecological, Belgrade, Serbia
Problem Statement: Uterine bleeding or pathological endometrial finding during
an ultrasound examination in postmenopausal women is a common situation in
everyday gynaecological practise. There are numerous possible reasons that
could provoke such response, from benign conditions such as endometrial
polyps to malignant conditions such as endometrial carcinoma.
Methods: The study includes 62 women who entered menopause and were
admitted to hospital with uterine bleeding or suspicious endometrial thickness
seen on ultrasound examination. Every patient had gynaecological examination,
trans-vaginal ultrasound examination (measurement of endometrial thickness)
and afterwards D&C.
Results: Endometrial thickness in patients with diagnosed endometrial
carcinoma was significantly higher compared to the patients with other
diagnosis (endometrial polyp, atrophy of endometrium, endometrial
hyperplasia, inactive endometrium) (median endometrial thickness 20 mm:
median endometrial thickness 10 mm, p = 0.021). The least endometrial
thickness with diagnosed endometrial carcinoma was 4mm. The thickest
endometrium without malignant finding was 19mm.
The incidence of endometrial carcinoma was significantly higher in group with
uterine bleeding compared to the patients without uterine bleeding and it was
157
independent on uterine thickness (28%: 5.4 %, P = 0.013). There wasn't

significant difference between the age of patients, age of entering menopause
and the length of menopause with development of endometrial carcinoma.
There wasn't significant difference between the length of menopause and
development of endometrial carcinoma.
Conclusion: Ultrasound examination of endometrial thickness alone is not a
reliable method for diagnosing endometrial condition as it can't distinguish
which type of change is happening. Uterine bleeding associated with abnormal
endometrial thickness is a sensitive predictor of endometrial cancer.
after surgery, she was admitted due to anorexia and fatigue. She also have
hyponatremia (133mEq/L), and the recurrence at multiple para aortic lymph
nodes. The patient was treated with combined chemotherapy and surgical
resection of enlarged lymph nodes. Three month after second operation, she
also showed hyponatremia and recurrence at subclavian lymph node
Conclusion: this report of the small cell carcinoma of the uterine cervix with
symptomatic SIADH. It is extremely rare case, these rapidly recurrent cervical
cancer also showed tumour associated para-neoplastic syndrome in every
recurrence
B13
PREVALENCE OF HIGH-GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA IN
PATIENTS WITH ATYPICAL SQUAMOUS CELLS OF UNDETERMINED
SIGNIFICANCE
G. -.-Y. G. Marta 1,*, A. Muoz Ledesma 1, C. Montoya Garcia 1, M. Navarro
Monge 1, F. Vazquez Camino 1, A. Arnal Burro 2
1Obstetrics and Ginecology, Hospital Ro Hortega Valladolid, 2Ginecology,
Hospital ro hortega , Valladolid, Spain
B15
DIFFERENTIAL EXPRESSION OF THREE MIRNAS AS POSSIBLE BIOMARKERS FOR
DIAGNOSIS OF PREECLAMPSIA AND INTRAUTERINE GROWTH RESTRICTION.
M. D. C. Alvarez 1,*, R. Mendieta 1, P. Fuentes 1, A. Barrera 2, I. Vazquez 3, M. Osorio
3
, G. Robles 3, H. Flores 1
1
Biochemistry and Molecular Biology, 2Emergency, 3Obstetric and ginecology,
Instituto Nacional de Perinatologa, Mexico City, Mexico
Problem Statement: To determine the prevalence of cervical intraepithelial

neoplasia (CIN) 2 and CIN 3 in patients with atypical squamous cells of
undetermined significance (ASC-US) Pap smear result in Hospital Rio Hortega.
Methods: A cross sectional study based in the review of 66 patients who had a
cytology showing ASC-US in the west area of Valladolid, Spain between January
2012 and December 2013. All subjects were sent for colposcopy examination to
our unit. All were HPV PCR DNA tested previous biopsy. Patient HPV negative
were excluded for colposcopy study and were followed with annual cytology and
HPV. Conisation was performed after abnormal histologic findings.
Results: We found 51 cases of high-grade cervical intraepithelial neoplasia. CIN
2 was detected in 36% of the patients (n=24) and CIN 3 in 41% cases (n=27). HPV
DNA was detected in 67% of patients. HPV type 16 and/or 18 were detected in
44% (n = 29) of women. One of the cases of CIN 3 was ultimately diagnosed as
squamous cell carcinoma (1.5%) after conisation.
Conclusion: The prevalence of high-grade cervical intraepithelial neoplasia in
women with an atypical squamous cells of undetermined significance (ASC-US)
Pap smear was 77%. A finding of ASC-US requires further evaluation to
determine the presence of a precancerous or cancerous condition. Cytological
screening for cervical cancer and HPV DNA testing results in earlier diagnosis and
treatment of high-grade lesions.
B14
CASE OF SMALL CELL CARCINOMA OF THE UTERINE CERVIX ASSOCIATED WITH
SYNDROME OF
INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION (SIADH)
H. J. Yun 1,*, D. Y. Kim 2, C. J. Kim 3
1Obstetrics and Gynaecology, 2Seoul St. Mary Hospital, 3Seoul St.Paul Hospital,
Seoul, Republic of Korea
Problem Statement: Small cell carcinoma of the uterine cervix is rare. Generally,
10% of small cell lung cancer have SIADH. A proportion of small cell carcinoma
of the uterine cervix exhibit neuroendocrine characteristics by
immunohistochemistry. However, case presenting typical symptom due to
SIADH are extremely rare. Here, we report a case of ADH producing cervical
small cell carcinoma who showed rapidly progression with hyponatremia.
Methods: A 41-years-old Korean women, para3, referred bloody discharge. Preoperative investigation diagnosed a small cell carcinoma over 4cm in diameter.
She had hyponatremia (124mEq/L), decreased serum osmolality (25mOsm/L)
and elevated urine osmolality (184mOsm/L). After the operation, i.e. radical
hysterectomy with both salpingectomy, pelvic and para-arotic
lymphadenectomy, the serum sodium level increased to 135mEq/L.
Results: The tumour was immune-reactive for neuroendocrine specific enolase
as well as for chromogranin A. Final diagnosis was small cell neuroendocrine
tumour, FIGO state Ib2 cervical cancer with lymph node metastasis on both
external iliac lymph nodes. Adjuvant chemo-radiotherapy was done. Four month
158
Problem Statement: Preeclampsia (PE) is a pregnancy multi-systemic syndrome

characterized by hypertension and proteinuria. PE remains as a leading cause of
maternal-fetal mortality and is associated with intrauterine growth restriction
(IUGR). Clinically the IUGR is determined by the inability of fetal growth induced
by placental dysfunction. Actually, the diagnosis is not specific and accurate.
MiRNAs are small non-coding single-stranded RNAs which can regulate up to
30% of human gene expression. It is currently estimated that, and has been
demonstrated that they participate in development of PE and IUGR. The main
objective of this study was to evaluate the expression of three miRNAs in
maternal plasma with PE and IUGR.
Methods: *Ethics statement this study was reviewed and approved by the National
Institute of Perinatology Ethics and Research Committees. All patients were explained the
purpose of the study and informed consent was obtained.
Patients Preeclampsia was defined according to the ACOG criteria. Maternal

blood was collected from 1) without labor (n=14); 2) with active labor (n=14); 3)
preeclampsia (n=14); and preeclampsia with active labor (n=14). Five milliliters
of peripheral maternal blood was obtained by puncturing the cephalic vain. The
blood was centrifuged at 1500 rpm to obtain the plasma. Growth restriction was
confirmed at birth neonatal weight <10th percentile and gestational age.
MiRNAs expression. Total RNA extraction was obtained with TRIzol reagent. A
reverse transcription was carried out with AMV reverse transcripatase, and PCR
was performed using specific primers. PCR products were identified through a
4% agarose electrophoresis gel. The results are presented as mean deviation
and statistical analysis was performed using the Mann-Whitney test with a
significant difference of p<0.05.
Results: In the cases of IUGR weight (p=0.001) and height (p=0.012) were
statistically difference with respect to control group. We observed a significant
decreased 1.36 (p =0.33) and 1.25-fold (p =0.04) in the expression of miRNA-29
in the group with preeclampsia and preeclampsia with active labour respectively
with respect to control group. The expression of miRNA-376 in the preeclampsia
group significantly increased 1.27-fold with respect to without active group (p
=0.003). Finally, the expression of miRNA-141 significantly increased 2.0-fold
with respect to the control group without labour (p 0.001).
Conclusion: The main findings in this study were: 1) PE reduces miR-29a
expression. 2) miR-376 and -141 increased their expression. It has been shown
that miR-29 coordinates the expression of MMP-2 and VEGFA. While the miR141 coordinate expression of PLAG1 which is involved in development
intrauterine restriction.
B16
PATIENTS CHOICE REGARDING WAY OF DELIVERY IN MODERN ROMANIA AND
CORRELATION WITH LEVEL OF MEDICAL KNOWLEDGE AND SOCIAL STATUS
R. Botezatu, L. Dumitrasi, P. Gheorghe
Obstetrics and Gynecology, FIlantropia Clinical Hospital - Bucharest, Bucharest,
Romania
Abstract Book
Problem Statement: Increased caesarean section rate is revealed in a press

release of WHO studying 137 countries and observing an increasing trend of
caesarean section in developed countries. This trend leads to significant
morbidity among young women. In Romania the rate of caesarean section reach
80% in some clinics. In 2013 the American College of Obstetrician and
Gynaecologists introduce in practice the term "caesarean on demand". The level
of medical knowledge and social status of the patient influences the birth option.
Methods: The questionnaires were given to pregnant women who present at
Filantropia Clinical Hospital before and after graduation the internal hospital
course "Future Mother School". The results obtained before and after were
compared, verifying the level of medical knowledge, the social status and the
option
regarding
the
way
of
delivery.
Inclusion criteria: pregnant women aged under 35 years, pregnancy obtained
spontaneously without previously known materno-fetal complications that
represent caesarean indication.
Results: 155 pregnant women who presented Filantropia Clinical Hospital were
interviewed. Of these, 70 participated at the Future Mother School course and
85 were randomly interviewed at the emergency room presenting for the first
time. Level of knowledge about the period of pregnancy and birth was
significantly higher in those who had completed the course versus those that
were presented to the emergency room for the first time (95% of the group who
have graduated the course answered correctly to 90% of questions compared to
only 55% in the other group). Among pregnant women who responded correctly
to 90% of the questions, 87% noted their option for vaginal birth. 60% from the
emergency room group opted for planned caesarean, most frequent reason
being fear of vaginal birth.
Conclusion: Possible cause of the increased rate of caesarean section in Romania
is the poor medical information of pregnant women, a situation that creates
panic at the thought of vaginal delivery. Organizing more training and improving
information dissemination channels to patients may be a mode to decrease the
number of caesarean sections.
Conclusion: SW elastography gives quantitative information on breast masses.

Elasticity standard deviation has almost the same diagnostic accuracy as
grayscale ultrasound.
*This paper was co-financed from the European Social Fund, through the Sectorial
Operational Programme Human Resources Development 2007-2013, project number
POSDRU/159/1.5/S/138907 "Excellence in scientific interdisciplinary research, doctoral and
postdoctoral, in the economic, social and medical fields -EXCELIS", coordinator The
Bucharest University of Economic Studies
B17
THE COMPARISON BETWEEN PERFORMANCE OF GRAYSCALE ULTRASOUND
AND ELASTICITY STANDARD DEVIATION OF SHEAR WAVE ELASTOGRAPHY IN
FEMALE BREAST LESIONS
E. Kroi 1,*, R. Hasa 2, N. Manoku 3
1Gynecogy department, Hygeia Hospital Tirana, 2Radiology department,
Diagnostic Orthodoxy Medical Centre Evangelism, 3Gynecogy department,
Medicine faculty, Medicine University, Tirana, Albania
Problem Statement: The purpose of this study is to find the correlation between
elasticity standard deviation of shear wave elastography with histology results
in female breast masses, and to compare its performance with that of standard
ultrasound.
Methods: From January 2012 to April 2013, we had the result in 79 lesions in 76
patients. Patients underwent standard breast US supplemented by quantitative
SW elastography using the Aixplorer ultrasound system. The lesions features in
B-mode ultrasound were classified according the Bi-RADS (categories >3 were
classified as malignant). For each lesion was calculated elasticity standard
deviation of the stiffest portion of the mass. An elasticity standard deviation of
10kPa was selected for benign/malignant differentiation. Standard ultrasound
and elasticity standard deviation results were correlated with histology of the
lesions.
Results: Mean participant age was 50 years. In total 79 lesions were noticed. 36
lesions were benign and 43 were malignant. Grayscale ultrasound BI-RADS
versus elasticity standard deviation performance were: sensitivity 88.4% vs
83.8%; specificity 86.1% vs 88.9%; PPV 88.4% vs 90%; NPV 86.1% vs 82.1%;
accuracy was 87.3% vs 86.1%, misclassification 12.7% vs 13.9% respectively.
159
Notes
160
Index
161
162
Abstract Book
Anna, S.
P177
Abay, H.
P125, P204
Annerbck, E.-M.
O88
Abdullah, S.
P64
Anohov, S.
P182
Abreu Dos Santos, G.
P61
Anohova, L.
P182
Acevedo, J.
P176
Anshina, M.
O09, P23
Achiron, R.
O50
Anthony Armson., B.
O16
Aksz, S.
O123
Aragona, M.
P69
Adali, E.
O25
Arakawa, M.
P198, P199, P209
Adamyan, L.
O116, O120, O27, O28
Arampulikan, J.
O26
Adib, T.
O39
Ari, A.
O90
Agmon, A.
O60
Arnal Burro, A.
B13
Ahmad, L.
P220
Arvas, M.
O64
Ahmed, A.
O39, O61
Astill, N.
O26
Ainehchi, N.
O114
Atanackovic, J.
P153
Akalin, A.
P204, P216
Avils, P.
P131
Akasaka, K.
P178, P198, P199, P209
Awang, M.
P219
Akbari Asbadh, F.
P07
Aydin, Y.
P04, P211
Akbari Asbagh, F.
P08
Azambuja, R.
P22
Akdolun Balkaya, N.
P172
Azizi, A.
O19
Akkurt, E.
P218
Azpeitia Rodriguez, M.
O108
P226
Al Amrani, K.
Al Farsi, Y.
P173
Badalotti, M.
O32, P22
Al Hoqania, F.
P173
Badarau, I.-A.
P71
Al Riyami, M.
O108
Baer-Dubowska, W.
O54
Al_Maamari, N.
P175
Baghany, R.
O14
Al-Abri, S.
P25, P81
Bahlmann, F.
P54
Al-Aissa, Z.
P44
Bakas, P.
O125
Alan, H.
O81
Balasch, J.
P59
Alan, S.
P155, P43
Banacu, M.
O69, P47
Al-Badar, S.B.
O43, P152
Bancher-Todesca, D.
P44
Al-Badr, A.
O17
Bano, F.
O39, O61, P133
Albani, E.
O40
Bano, R.
O71
Alborzi, M.
O121, P08, P119
Baptista, E.
P94
Al-Busaide, J.
P25
Barbi, M.
P156
Al-Dugashi, T.
P175
Barbosa, A.
P224, P225, P229, P230
Aleksandrova, N.V.
P231
Barrera, A.
B15, P176
Alhazzaa, A.
O17
Barrington, J.
O61
Alieva, K.
O75
Baser, M.
O68
Alipoor, F.
O121
Bthori, G.
O105
Alipour, F.
P119
Battini, L.
P69
Alkhateeb, M.
P02
Bebis, H.
P144
Al-Khater, A.-H.
O43, P152
Beebeejaun, Y.
O73, O80, P05, P180
Al-Kuwari, M.G.
O43, P152
Beirne, J.
O63
Allegranza, D.
P65, P73, P79
Belmont Gmez, A.
P89
Allsop, J.
P137
Belokon, I.
P92
Al-Maamarri, N.
P175
Belokrinitskaya, I.
P84
Al-Meer, N.
O43, P152
Ben Natan, M.
P99
Al-Mutairy, S.
O17
Bendavid, R.
O98
Alshahrani, M.
P02
Benedek, Z.
O12
Al-Shukri, M.
O108
Benedetti Panici, P.
O122, P120
Alsunaidi, M.
P02
Berkenstadt, M.
O50
Alu Tokat, M.
P193
Bertolotto, A.
P69
Alvarez Gonzalez, A.
P226
Bertranou, E.
P65
Alves, P.
P105, P56
Bezhenar, V.
O38, P139
Amma, J.L.S.
P190
Bila, J.
P153
Amorim, M.
P142, P42
Bilgic, D.
P184
Ananyina, D.
P84
Bilic, N.
B5
Andreeva, Y.Y.
P149, P150
Bilik, R.
O50
Andrijasevic, S.
P153
Bizjak-Ogrinc, U.
O100
Andrys, C.
P66
Blanco, J.E.
P91
Anna, G.
P136
Blankenstein, T.
P147
163
Blickstein, I.
S05, S24, S27
Coelho, D.
O112
Bobek, V.
O124
Coelho, M.C.
O46
Bolous, S.
P106
Coelingh Bennink, H.J.T.
S16
Boostanfar, R.
O70
Cohen, M.
S10
Breki, G.
O96, P166
Colmenares, C.C.
O83
Borges, J.L.
P58
Cordon-Cardo, C.
O41
Boovi, A.
B12
Corfini, M.
P69
Braga, J.
O21, P33
Coroleuca, C.
O69
Bratucu, E.
P163, P164
Correia, L.
P17, P60
Bravo, I.
P15
Correia, P.
O34, O46
Brborowicz, G.
O54
Costa, S.
O87
Brennecke, S.P.
P79
Couch, M.
P06
Breugelmans, M.
P37
Coupeau, D.
P36
Brincat, M.
O109, O110
Coutinho, I.
P29, P30
Brincat, M.F.J.
S13
Couto, S.
P132
Bruno, D.
P68
Creatsas, G.
O125
Bukhari, M.
O17
Cruz Cruz, E.A.
P89
Bulbul, E.
O25
Cruz Orozco, O.P.
P89
Bushtyreva, I.
B4
Cruz, E.A.
P38
Butler, S.
O88
Csenki, M.
O105
Byrne, M.
O13
Cuerva, M.
P91
Cvjetianin, B.
P156
164
Calleja Agius, J.
O109
Calleja J, A.
S13
Daglar, G.
P183
Carey, E.
O98
Daia, T.
P32
Carmona, F.
P59
Damaceno, D.
P224
Carnide, C.
O34, P56
Damasceno, D.
P229, P230
Carrasco, E.
P167
Danforth, C.
P06
Carrer, D.P.
P169, P170
Danilova, N.
P92
Carreras, R.
P90
Davari, N.
P67
Carrillo, S.
P131
Davidova, S.U.
P149
Carvalho, J.
P109, P191
De Catte, L.
P77
Carvalho, M.J.
P94
De La Iglesia-Vicente, J.
O41
Casas, J.P.
O83
De Los Reyes, L.
P167
Caseiro, L.
P93
De Vos, M.
P37
Castillo-Martin, M.
O41
Debreceni, D.
O105
Castro, A.
O34
Degregorio, N.
P147
Cavazza, C.
P123
Del Olmo Bautista, S.
P226
Cerar, O.
P156
Del Prato, S.
P69
Cervar-Zivkovic, M.
O53
Demetra, S.
B8, P221
Cervera, R.
P59
Demirci, N.
P111, P134
Cetinkaya, S.
P185
Demirel, G.
P183
Chadee, A.
P70
Demirel, T.
O42, O79, P174, P189
Chadwick, E.
O48
Denisova, V.
P139
Chang, H.-Y.
P101
Dereli Yilmaz, S.
O79, P174
Chantraine, F.
P36, P79
Dereli Ylmaz, S.
O64, O91
Chen, Y.-Y.
P200
Dias, A.C.
O32
Cheng, W.
P97
Diaz, N.
P176
Chernukha, G.
O62
Dilba, P.
P79
Cho, P.J.
O76
Diniz-Costa, T.
P148
Choi, H.
P13
Dodds, P.
P06
Chrysi, M.
P170
Domenici, L.
O122, P120
Cicek, K.
P04
Dorman, G.
O63
Ciornei, C.
P71
Dorobat, B.
P100
Ciprian, I.
B8
Dotlic, J.
P154, P18
Claine, F.
P36
Dubova, E.
O51
Claudia, A.
P123
Dubova, E.A.
P231
Clavel, J.
O01
Dubovoy, A.
B2, B3
Cnattingius, S.
O82
Dumanovskaya, M.
O62
Coady, A.M.
O94
Dumitrasi, L.
B16
Codorniz, A.
P109, P191, P93
II
Abstract Book
Gwka, F.
O54
Ebner, F.
P147
Goh, C.
P127
Einat, S.P.
O10, O11
Gokyildiz, S.
P43, P82, P98
El Tayeb, S.
P173
Gomes, M.
O46
Elbers, J.
O70
Gonzaga, L.
P95
El-Etr, M.
S14
Gonzalez Soto, B.
B1, P16
Eleutrio Souza, P.R.
P142
Gopinath, P.
O106
Ellenbogen, A.
O09, P23
Gopinathan, K.
O106
Elmadijan, M.
O26
Gorgin, F.
P67
Eogan, M.
O13
Gorgulu, B.
O90
Erdogan, S.
P161
Goudeli, C.
P168, P169
Ermida, D.
O22
Gowri, V.
P173
Esan, M.
P180
Gozuyesil, E.
P98
Esapoor, S.
P07
Graa, L.
O112
Espinosa, G.
P59
Grisaru, D.
O60
Esprito Santo, S.
P39
Guan, H.
O104
Evcili, F.
P183
Guedes, P.
O87, P122
Guerra, C.
P95
Fabjan Voduek, V.
S05, S24, S27
Guerreiro, F.
O87
Fachada, H.
P28, P40
Gumus, H.
P218
Falco, F.
P94
Gunen, G.
P09
O90
Farah, R.
Fata, S.
P193
Hadi, K.H.
P41
Fathiazad, F.
O102
Haitoglu, K.
O06, O07
Fayzullina, N.
O62
Hald, K.
O107
Felisbino, S.
P224, P229, P230
Hamaoui, A.
P70
Ferhati, B.
O02
Hambartsoumian, E.
O03
Fernandes, F.
P93
Han, H.C.
P228
Ferreira, A.P.
P10
Haradja, H.
O69, P47
Ferreira, C.
P39
Hartoov, J.
P83
Ferreira, P.
P15
Hasa, R.
B17, P206
Figueiredo, S.
P01
Hassa, H.
P04
Firneisz, G.
P44
Hassiakos, D.
O125
Flores, H.
B15, P176
Haxhia, M.
O02
Frana Neto, A.H.
P29, P30
Heldt, F.
O32
Frank, G.A.
P149, P150
Helyes, Z.
P85
Freitas, D.
O34, P105
Hmon, D.
O01
Freitas, P.
O22
Henderson, C.
O48
Frias, C.
P58
Herclio, S.
P142
Friedl, T.W.
P147
Hermanny, B.
P55
Frolova, N.
P182, P84
Hinds, L.
O63
Fuentes, P.
B15
Hingorani, A.
O83
Hrn Perkecz, A.
P85
Gaalema, D.
P06
Hismiogullar, A.
O25
Gaida, O.
B4
Ho, G.
P05, P180
Gajdocsi, E.
P20
Hong, J.E.
P208
Gajdcsi, E.
O105
Horhoianu, V.V.
P100
Galdbart, J.-O.
S07
Hosono, T.
P178, P209
Gall, V.
B6
Hromykh, E.
P84
Gambin, J.
P195, S13
Hsieh, M.-T.
P101
Gamibin, J.
P86
Huerta, I.
P91
Garcia-Yuste Gonzalez, M.
B1, P226
Hund, M.
P54, P65, P73, P79
Gavrilova, T.
O120
Hussin, H.
P219
Ghanbari, Z.
O114
Hutagaol, I.
O99
Gheorghe, P.
B16
Hyeon Ji, K.
O69, P47
P50
Gheorghiu, D.
Gi Hyun, S.
P117
Iakovleva, G.
O98
Gilboa, Y.
O50
Iancu, G.
P96
Gilmour, S.
O52, P53
Idama, T.
O93
Giorgini, M.
O122, P120
Igi, C.
P199
Gjoshe, J.
O02
Inan, E.
P216
III
165
Inceboz, U.
O25
Koec, V.
B6
Ionescu, S.
P163, P164
Kostomenos, D.
P03
Ishida, M.
P198
Kovcs, K.
P85
Isidan, T.
O02
Kovaleva, V.
P34
Ismail, H.
P64
Kozachenko, A.
O116
Ivona, L.A.
B8, P221
Kristiansson, P.
O88
Krzycin, M.
O54
Jackson, V.
O13
Kulabukhova, E.
O120
Jacobsson, B.
P66
Kumar, N.
S14
Jahromi, R.
O113
Kuna, K.
B5, B6
Jangaard, K.
O16
Kuo, S.-J.
P200
Janku, P.
P66
Kurnaz, G.
P216
Janni, W.
P147
Kuzemin, A.
O75
Javidalsadi, R.
P119
Kuznetsova, N.
P34
Jelodaian, P.
O103
Kvetnoy, I.
P139
Jenkins, S.N.
O118
Kvitko, D.
P154
P22
Jeremic, K.
Jones, C.
P06
Laan, E.
S16
Ju Won, B.
P46
Lacaria, E.
P69
Julio, C.
P01
Lakovschek, I.
O53
Jung, I.
P116
Lamaita, R.
P55
Lamb, B.
O61
166
Kadija, S.
P154
Lambert, J.
O13
Kah Seong, H.
P64
Lang, U.
O53
Kahn, T.
O49
Langer, E.
P54
Kajtr, B.
P85
Lara Padovani, J.
P181, P223
Kalavani, L.
P67
Larsson, M.
O88
Kalinina, E.
O75
Lau, M.
O05
Kang Jun, Y.
P117
Laubach, M.
P37
Kang, H.
P52
Lawless, M.
O13
Kansiz, L.
O02
Lazaro, J.
P91
Kaplan, S.
P125, P202, P216
Leal-Junior, C.C.
P42
Karakas, F.
O90
Lee, H.N.
P157
Kardanova, V.
B10
Lee, Y.
P52
Karrer, D.P.
P168
Lesny, P.
O94
Katz, L.
P29, P30
Levi Setti, P.E.
O40
Kazemi-Shishvan, M.
P126
Levkov, L.
O75
Khachatryan, A.
P92
Liapis, A.
O125
Khadra, M.
P207
Liapis, E.
O125
Khaki, A.A.
O102
Lim, M.N.
P14
Khalid, S.
O19, P31
Lim, S.E.-L.
P74, P75
Khorolsky, V.
B10, P103
Lim, W.W.
P97
Kim, C.J.
B14
Lim, Y.K.
P160
Kim, D.Y.
B14
Lin, Z.
O67
Kim, H.Y.
P13
Lindow, S.
O94
Kim, S.H.
O76
Lisboa, J.
P56
Kindarova, L.
P92
Liu, P.
O08
Kingdon, S.
O39
Llurba, E.
P79
Kingsley, M.
P133
Lopez, B.
P132
Kirschvink, N.
P36
Louis, F.
O106
Kzlkaya Beji, N.
O64, P222
Lubambo, N.
P142
Klimenchenko, N.
O51
Lubambo, T.M.
P142
Klw, N.-E.
O107
Lucovnik, M.
S05, S24, S27
Kocijancic, D.
P153
Luo, Z.
O116, O62
O67
Kogan, E.
Kolostova, K.
O115
Ma, X.
O86
Komm, B.S.
O111
Maalhagh, M.
P119
Komurcu, N.
P203
Machado De Almeida, A.P.
P181, P223
Koppn, M.
P85
Machado, A.I.
P108
Ksa, Z.
P197
Machado, D.
O32
Kosec, V.
B5
Maciel, N.
P107
IV
Abstract Book
Maciuleviciene, R.
B7, O84
Mirkin, S.
O111, O118
Madan, I.
P115
Mishieva, N.
O75
Maia, S.
P30
Mittal, S.
O04
Majchrzak-Celiska, A.
O54
Mohamed, S.A.
P48
Majumdar, A.
O04
Mohammadzade, S.
O121
Makovsky, A.A.
P150
Moisei, C.
P71
Malik, M.A.
O43, P152
Molina, A.
P176
Malkov, P.G.
P149, P150
Molotkov, A.
O38, P139
Mancha Heredero, E.
B1, P16
Monika, L.
P77
Mancini, P.E.
P212
Montoya Garcia, C.
B13, P226
Mannion, C.
P201
Moore, R.
O13
Manoku, N.
B17, P206
Morais, M.
P28
Manso, P.
P40
Moreira Lana, K.
P55
Marcone, V.
O122, P120
Morgan, P.
P190
Mares, A.
O41
Moura Ramos, G.
P35
Margioula-Siarkou, C.
O07
Mourinha, V.
P121
Margittai, .
P19
Moutinho, O.
O34, P56
Marincas, M.
Mozheyko, L.
B2, B3
Marini, G.
P163, P164
P181, P223, P224, P225,
P229, P230
Mueck, A.
P124, P165
Marques, C.
P108
Muoz Ledesma, A.
B13, P16
Martins, R.
P61
Muoz, I.
P91
Maryuni, S.
O99
Munrs, J.
P59
Mascarenhas Silva, C.H.
P55
Murase, J.
P188
Masri, M.A.
P31
Muylkens, B.
P36
Matheus, S.
P224, P229, P230
Mynbaev, O.
P92
Mathews, F.
P171
Mynbaev, O.A.
P149
Mathur, M.
P130, P194
Matias, I.
P93
Nadarajah, R.
P97
Matos, F.
O22
Nadarajah, S.
P11
Mattar, R.
P212, P213
Naim, N.
O19
Mavromatidis, G.
O06
Nakamoto, M.
P178, P198, P199
Mayer-Pickel, K.
O53
Nakamura, M.U.
P212, P213
Mccaffrey, G.
P201
Namazi, S.
P08
Md Nor, A.
P219
Nnssy, L.
O105
Medeia, M.
O10, O11
Nara, M.
P136
Medvediev, M.
P110
Nascimento, S.
P68
Megli, L.
P156
Naseri, M.
O121
Mehrizi, M.
P192
Nasseri Jahromi, A.
P119
Meirmanova, A.
B9
Nasseri Jahromi, M.A.
P67
Melinda, C.
P11
Navarro Monge, M.
B13
Melo, .
P39
Navarro Monje, M.
P226
Melo, I.
P29
Nefedova, N.A.
P149
Melo, P.
P58
Nemes, A.
P20
Mendieta, R.
B15
Neville, A.
O93
Menezo, Y.
S10
Nezhdanov, I.
B2
Meng, T.
O104
Ng, G.
O05
Mercado, R.
O48, P70
Ng, G.Y.H.
P74, P75
Merlet, F.
S07
Nicolalde, A.
P131, P167
Mesquita, M.
O112, P95
Nicolau, P.
P90
Messig, M.
O111
Nikoli, B.
B12
Messinger, D.
P54
Nikolopoulos, G.
P03
Metello, J.
P15
Nishimura, Y.
P178, P198, P199, P209
Mhatre, J.
O30
Nizam, G.G.
O117
Michelon, J.
O32
Nogueira Martins, F.
P28
Micic, J.
P153
Nogueira Martins, N.
P28
Milias, S.
O06, O07
Nogueira, R.
P40
Milic, S.
P154
Noronha, C.
P30
Milosevic, B.
P154
Norotsky, M.
P06
Milovanov, A.
B4
Novikova, O.V.
P150
Mineiro, S.
P93
Ntoutsoulis, G.
P03
Miranda, M.
P68
Nur, N.
P183, P184
167
Nusee, Z.
P219, P48
Pham, S.
O26
Nwosu, C.
O93
Pickering, S.
OConnell, C.
O16
Piculo, F.
O71
P181, P223, P224, P225,
P230
Obgyn, N.
P24
Pignatti, L.
S25
Ochshorn, Y.
O60
Pilic, I.
P153
Odabas, O.F.
P218
Pinar, G.
P204, P216
Oge, T.
P04, P211
Pnar, G.
P125
Okada, L.
P22
Pinheiro, P.
P10
Oleg, B.
P177
Pinto, G.
P01, P17
Oliva, R.
P91
Pinto, L.
O57
Oliveira, N.
O46
Pinto, S.
P17
Oliveira, P.
P95
Ples, L.
P217, P71
Olovsson, M.
P79
Pode-Shakked, B.
O50
Omar, M.
O93
Pohczky, K.
P85
Omarova, G.
B9
Ponte, C.
P58
Opemuyi, I.
P133
Ponte, M.
P123
Ordiyants, I.
B10
Popescu, M.
P217
Orsi, L.
O01
Porter, J.
O78
Osorio, M.
B15, P176
Posnett, J.
P73
Ota, E.
O52, P53
Pourshojae, S.
O121
Ouladsahebmadarek, E.
O102, O114
Pourshojaee, S.
P119, P67
Ozdemir, K.
P128, P214, P215
Prapas, N.
O06, O07
Ozgen, D.
P216
Prapas, Y.
O06, O07
Ozgunen, F.T.
P155
Prasetyo, A.C.
P62
Ozturk, E.
P211
Prata, F.
O57
Ozturk, M.
P155
Prata, J.
P10
Prochazka, M.
P66
Qiao, J.
O08
Queirs, F.
O112
Queiroz, A.
P60
Quinn, D.
O63
Qvigstad, E.
O107
Radovic Radovcic, S.
B5
Rafael, F.
P122
Rains, J.
O39
Raj, R.
P06
Rajesh, H.
P118
Rajeswari, D.
O73, O80
Raki, S.
B12
Raluca, B.
P32
Ramirez, A.
O23
Ramoni, A.
P54
Ramos, A.
P191
Ramos, G.
P123
Ramos, S.
P15
Rao, S.
O93
Rasekh Jahromi, A.
P08
Rasekh, A.
O121
Rasekhi, M.
O35
Rathfisch, G.
P179
Rato, M.
P01, P17
Ravanos, K.
O07
Razvan, S.
B8, P221
Redner, R.
P06
Regalo, A.
P93
Reig, V.
P22
Reim, M.
P54
Reis, L.
P121, P122
Rempen, A.
P147
168
Pacu, I.
O69, P47
Pad, N.
P67
Padmavathi, N.R.
P160
Padovani, J.
P225
Paik, W.Y.
P13
Paixo, C.
O87, P68
Palma, E.
O122, P120
Pang, Y.
P127
Paolo Zanello, P.
S19
Papacocea, R.
P71
Paraoulakis, J.
P168
Park, E.
P116, P162
Park, H.M.
P12
Pascual Arevalo, Y.
B1, P16
Paulino Da Silva, A.
P142
Pavlovich, S.
O75
Paydas, S.
P161
Pkal, A.
O54
Pelaez, R.
O23
Pelageina, E.
P34
Peltecu, G.
P32, P96
Peng, Z.
O86
Penzhoyan, G.
O56, P63
Pereira, A.
P107
Pereira, E.
P93
Pereira, N.
P40
Periquito, I.
P60
Perricos, A.
O58
Perry, V.
O89
Petersen, E.V.
P149
Petersson, M.
O88
Petousis, S.
O06
Petracco, A.
O32, P22
VI
Abstract Book
Resnick, N.J.
O26
Sencar, S.
O101
Resztak, M.
O54
Sennstrm, M.
P79
Reverter, J.C.
P59
Seo, Y.
P21
Reyes, E.
P38
Serrano, N.C.
O83
Ribeiro, D.
P10
Shakur, F.
O71
Ribeiro, R.
P123
Shapiro, B.
O70
Ribeiro, V.
P80
Sharara, S.
O43, P152
Rigo, J.
P44
Shekh, O.
O60
Robles, G.
B15
Shen, S.-H.
P102
Rodrigues, A.
P61
Shin, J.W.
P21
Rodriguez Bujez, A.B.
B1, P16
Shin, S.Y.
P157
Rodrguez Guerrero, R.E.
P89
Siddiqui, F.
P127
Rohde, A.
P78
Siemitkowska, A.
O54
Rolland De Souza, A.S.
P142, P30, P42
Sills, E.
P06
Roman De La Pea, A.
P226
Silva Pereira, J.
P148
Romo, F.
P132
Sima, R.-M.
P217
Roogi, R.
P207
Simanaviciute, D.
B7, O84
Rosal Gonalves, M.
P60
Simes, T.
P01, P17, P60
Rossi, M.
P69
Simsek, O.
P128
Rosta, K.
P44
Singh, R.
O43, P152
Rousso, D.
O06, O07
kof, E.
P156
Royre, D.
S07
Slater, S.
O89
Rudant, J.
Smeraldi, A.
O40
Rudge, M.
O01
P181, P223, P224, P225,
P229, P230
Smolnikova, V.
O75
Ryan, K.A.
O111
Soares, O.
P105
Sobhanian, S.
P67
Sobhaniyan, S.
O113
Somogyi, A.
P44
Song, M.J.
P162
Song, Y.J.
P208
Soydan, S.
P155
Specchia, C.
O40
Srivastava, N.
O93
Staff, A.C.
P79
Stankovic, V.
P18
Steblovnik, L.
S05, S24, S27
Steege, J.
O98
Stefanovic, A.
P154
Stepan, H.
O49, P54, P79
Stephansson, O.
O82
Stern, E.-C.
O53
Stern, J.
O88
Stumpp, P.
O49
Stykin, Y.
B10
Subair, S.
P187
Sukhikh, G.
O51
Sula, A.
O02
Sli, .
P197
Suluhan, D.
O92
Sumapraja, K.
P135
Surlan, L.
P18
Szalontai, B.
P85
Tabarraie, Y.
O14
Taghavi, S.
P126
Tagliani-Ribeiro, A.
P22
Tagore, S.
P74, P75
Taketani, G.
P10
Tan, E.
P57
Tan, H.H.
O05, P11
Tan, K.H.
P45
S E Melo, P.
P15
S, L.
O46
Sabolovic Rudman, S.
B5
Saegerman, C.
P36
Safiabadi Tali, S.H.
O14
Safonova, A.
O51
Sahin, S.
O90, P114, P204
Sahraeian, M.
O113
Sakellariou, M.
P03
Salvador Geo, M.
P55
Sameshima, T.
P210
Sampaio, A.
P58
San Martin, R.
P91
Sandstrm, A.
O82
Sang Hun, K.
P117
Santiago, C.M.
O48
Santoro, A.
O40
Santos, F.
P35
Santos, M.
P39
Santos, V.
P148
Sardescu, G.
P47
amaz, G.
O85
Satwik, R.
O04
Scanavino, M.D.T.
P213
Scaunasu, R.
P100
Schlembach, D.
P54
Schneider, A.
P06
Schoedl, M.
P79
Schnlber, J.
O105
Schumacher, M.
S14
Scott, H.
O16
Scott, P.
O94
Seeger, H.
P124, P165
Seixas, D.
P55
Selesnyova, E.
P84
VII
169
Tan, T.Y.
P11
Verlohren, S.
P79
Tapia, V.
P167
Vesentini, G.
P181, P223, P225
Tssies, D.
P59
Vieira, .
P132
Tatiana, G.
P136
Villard, P.
S09
Tatsi, C.
P168, P169
Viseu, O.
P61
Taylor, H.
O32
Vizintin, Z.
O100, O101, O37
Teglas, G.
P20
Vladareanu, R.
O95
Tgls, G.
O105
Vorsselmans, A.
P37, P77
Teixeira Ribeiro, R.
P35
Vorwerk, E.
P140
P147
Teo, S.
Terzakis, E.
P168, P169, P170
Wang, Y.
O86
Terzic, M.
P153, P18
Watt, P.
O78
Thia, E.
P76
Weeks, A.
O78
Thompson, M.O.
O77
White, T.
P06
Timotheou, E.
P03
Witjes, H.
O70
Tinoco, D.
P131
Wu, Y.
P131
O67
Tinoco, R.
Tinoco, V.
P167
Xia, W.
O104
Tinterri, C.
O40
Xiong, C.
O04
O104
Tiwari, N.
To, C.F.
P14
Yalcin, N.
P82
Toller, A.
P109
Yamamoto, M.
P178
Tomas, C.
P15
Yavan, T.
O117, O72, P144
Torgal, I.
P94
Yazc, S.
P196
Torloni, M.R.
P212, P213
Yeko, T.
O70
Trinanda, F.A.
P62
Yeo, G.
P76
Tripodi, R.
P120
Yeo, G.S.H.
P74, P75
Trojner Bregar, A.
S05, S24, S27
Yesil, P.
P161
Tsai, H.-D.
P200
Yeilnar, I.
P144
Tschegolev, A.
O51
Yildirim, E.
P155
Tydn, T.
O88
Yildiz, D.
O92
Tympa, A.
O125
Ylmaz, D.V.
O97
Tzeng, C.-R.
P101
Yilmaz, H.
P218
Yilmaz, T.
O90
Ucar, T.
P82
Yoon, K.J.
O76
Uluda, E.
O85
Yoxall, P.
O93
Umranikar, S.
Yu, S.L.
P118, P14
Unsal, A.
O89
P114, P125, P128, P214,
P215
Yzbasoglu, N.
P125
Upadhyay, R.
O48
Zagalo, A.
O57
Zamora, B.
O18
Zamora, R.
O23, P38
Zhalsapova, B.
P182
Zhao, X.
O67
Zhernovaya, N.
B3
Zhu, C.
O104
Zimmerman, X.Y.
S16
Zoka, A.
P44
Zurac, S.
P164
170
Vaidakis, D.
P170
Valadares, S.
P80
Van Der Does, R.
P54
Van Tussenbroek, F.
P37
Vargas, S.
P38
Vasconcelos, C.
O21, P33
Vasilyev, I.
B2
Vatish, M.
P79
Vazquez Camino, F.
B13, P226
Vazquez, I.
B15
Veiga, V.
P123, P35
Vellv, K.
P90
Verdenik, I.
S05, S24, S27
Vereczkey, A.
O12, P159, P19, P197, P20
Verhagen-Kamerbeek, W.D.
P54
Verissimo, R.
P28
Verssimo, R.
P39
VIII
Abstract Book
171
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The 20th World Congress on

Paris, France, December 4-7, 2014

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

Pre Congress Workshop:

LABORATORY MISTAKES AND

HRT: WHO SHOULD BE

RISK MANAGEMENT IN IVF

IMPROVING EMBRYO QUALITY

TREATMENTS OF MENOPAUSE GYNECOLOGY

The Ovarian Zone Workshop:

FREEZING GAMETE FOR

CMV SCREENING AND

Workshop in HPV and

HPV VACCINATION AND

OPERATIONS BEFORE IVF

Sunday, December 7, 2014

CONTROVERSIAL ISSUES IN BASIC CLINICAL

PRENATAL DIAGNOSIS AND ULTRASOUND

NEW PARADIGMS IN PCOS

BEWARE OF THE LAWYERS: ISSUES IN PERINATAL

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

The 20th World Congress on

INVITED SPEAKERS ABSTRACTS

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

Friday, December 5, Hall B

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

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

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

against bacterial and fungal infections recurrences but more important

incomplete or absent response to common drugs

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

the increasing bacteria resistance to immune response effectors

the infections tendency to become chronic

Antihypertensives (clonidine): Clonidine is an antihypertensive that has

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

Antidepressants (fluoxetine, paroxetine, venlafaxine, desvenlafaxine):

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

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

regulation via progesterone metabolizing enzymes and may behave differently

The highest cause of uterine-sparing procedure failure is placenta

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

COCs: Combined oral contraceptives

The 20th World Congress on

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

Progesterone receptors impaired expression may potentially present an

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

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

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

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

Disclosure of Interest: None Declared

Disclosure of Interest: None Declared

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

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

Disclosure of Interest: None Declared

Disclosure of Interest: None Declared

Disclosure of Interest: None Declared

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

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

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

blood tests and hemostasis in the dynamics, diagnostic hysteroscopy and

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

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

intraperitoneal haemorrhage, necessitating blood transfusion. Controversies