5^th Asia Pacific Gynecology and Obstetrics Congress August 22-23, 2018 Tokyo, Japan

Biography:

Dr. Olson’s is a former OB hospitalist who practiced in a community hospital in Bellingham, Washington. After 28 years in a successful solo OBGYN practice, Rob was drawn to the hospitalist model because it allowed him to focus on labor and delivery. Dr. Olson moved to the OBGYN Hospitalist sub-specialty as he could see the positive impact this model provided to medical institutions, especially related to improved patient care and safety.

Dr. Olson received his medical degree from Rutgers Medical School and completed his residency at Los Angeles County Hospital/University of Southern California.  He is board-certified and a fellow in the American Congress of Obstetrics and Gynecology, a member of the Society of Hospital Medicine, and was the founding president of the Society of OB/GYN Hospitalists (SOGH).

Abstract:

Women admitted into labor and delivery in the United States are traditionally attended by registered nurses while the physician is located either in their offices or at home. The physician is called in only when complications have presented themselves on the pregnant mother and unborn child at the time of delivery.  Frequently, complications happen unpredictably and quickly and it is difficult for the nurse to judge when the physician should arrive for the actual delivery. Predictably, the safety and quality of care provided to the mother and unborn baby is compromised unnecessarily.  OBGYN Hospitalists are Board Certified physicians who physically stay in labor and delivery on 24/7 rotating shifts. OBGYN Hospitalists are able to immediately begin treatment for health complications such as postpartum hemorrhage as well as to be present for the delivery if the attending physician does not arrive in time.  Statistics have proven the markedly improved safety and quality of care provided to women in labor.  This lecture will illustrate the short history and present conditions of OBGYN hospitalists in the United States and predict the future.  Conclusion & Significance: In the United States alone, there are on average 4,000,000 births per year.  While the United States is considered a developed country, the United States has one of the developed world’s highest maternal morbidity and mortality rates. This presentation will provide facts and data on why and how OBGYN hospitalists are able to lower maternal mortality rates, reduce morbidity, improve fetal outcomes, and the overall safety and quality in women’s healthcare.

Biography:

Dr. Lei Jin has her expertise in improving the health and wellbeing on maternal and child health. Maternal folic acid supplementation can effectively prevent the fetal occurrence of neural tube defects. Mandatory or non-mandatory dietary folic acid supplement policy conducted in 87 countries in the world till 2016. Chinese government provide 400 μg folic acid tablet free to women planning to get pregnancy since 2009. The adverse effects of folic acid supplementation were found in a few studies, including gestational diabetes mellitus (GDM). She and her colleague explored association of peri-conceptional folic acid supplementation and risk of GDM in a large cohort of Chinese women in this study

Abstract:

The adverse effects of folic acid supplementation were mentioned in a few studies, including gestational diabetes mellitus (GDM). The objective of this study was to explore the association peri-conceptional folic acid supplementation and risk of GDM in Chinese women. The subjects were the singleton pregnant women who gave birth in Maternal and Child Hospital of Tongzhou District. The data were selected from the Prenatal Health Care Database of Tongzhou District, Beijing. A total of 15691 pregnancies are included in the study. All of the pregnant women underwent 75g oral glucose tolerance test (OGTT) at 24-28 gestational weeks in the maternal and Child hospital. The GDM diagnosis was verified by the inpatient medical records. Multivariate logistic regression model was used to adjust the confounders. The prevalence of GDM was 22.7%, and the proportion of folic acid or multiple micronutrients with folic acid supplementation was 89.0%, among the women. Compared to the women who didn’t take the tablets before or in pregnancy (reference group), the adjusted ORs of taking folic acid, taking folic acid regularly, and taking folic acid from pre-pregnancy and risk of GDM were 1.24 (95%CI: 1.07-1. 3), 1.20 (95%CI: 1.10-1.31), and 1.15 (95%CI: 1.05-1.26), respectively. Compared to the reference group, regularly use of folic acid tablets or multivitamin tablets from pre-pregnancy had a higher incidence of GDM [adjusted ORs were 1.31 (95%CI:1.11-1.55) and 1.44 (95%CI:1.21-1.71)], regularly or irregularly use multivitamin tablets during pregnancy also had a higher incidence of GDM [adjusted ORs were 2.03 (95%CI:1.36-3.04) and 1.18 (95%CI:1.01-1.39)]. Compare to the reference group, regularly taking folic acid supplementation before or after pregnancy both increased the risk of GDM [adjusted ORs were 1.36 (95%CI: 1.17-1.60) and 1.62 (95%CI: 1.13-2.33)]. Conclusion: Folic acid supplementation before or during pregnant period, especially when consuming regularly, may increase the risk of gestational diabetes mellitus.

Biography:

Renda Al-habib,medical student at Unziah Collage of Medicine, Saudi Arabia .

Abstract:

Haemorrhage is defined as 10% or greater decrease in hematocrit. It is considered as a major complication of surgeries and is one of the most common causes of death during surgical settings (1). Despite the low mortality and morbidity of Caesarean Sections (CS), hemorrhage is still considered as a threat to the patients and surgeons (2). Knowing the accurate blood loss is very helpful for resuscitation process and reducing in plenty of hemorrhagic shocks (3).

The objectives of this study :

1- To define the estimation of blood loss made by the obstetricians.

2- To correlate the exact amount of blood loss measured by the difference of hemoglobin level based on complete blood count (CBC) test done before and after the surgery.

3- To determine the accuracy of estimated blood loss made by the obstetricians during Caesarean Sections based on drop of hemoglobin level.  

Biography:

Dr. Magda Helmi is an Obstetrics and Gynecology consultant who lives and works in Cairo, since her birth 1951. She graduated in Medicine from Cairo University in 1975, specialized in Ob.Gyn. from 1979, fulfilled the MD in the same specialization in 1991. She conducted research work of many years in the field of Ob.Gyn., specially in reproductive biology, where she collaborated with international entities. After a long period of responsibilities at Al Azhar University in Cairo she devoted herself to the dissemination of medical culture and helping poor people.

She has three books in Arabic with a fourth under publication, her books cover topics about Ancient Egyptian Medicine, Antenatal care, Infertility and Menopause. She participated in many international meetings with clinical application papers, as well as social and scientific activates in urban rural areas all over the world in Egypt, Italy, Saudi Arabia and Kuwait.

Abstract:

It has been reported that excessive weight gain in pregnancy is associated with adverse maternal and fetal outcomes. Trying to reduce weight gain during pregnancy have the potential to reduce adverse outcomes, Interventions based on diet and physical activity, or metformin, in pregnancy could influence maternal and fetal weight and obstetric outcomes.

 The purpose is to evaluate different methods used during antenatal care to reduce weight gain during pregnancy diet, exercise and metformin.

 Methodology & Theoretical Orientation:

All 139 women in this study had a confirmed diagnosis of obesity with pregnancy (body mass index >30 kg/m2), these women were followed up during their course of pregnancy; data forms were completed once they had delivered. Cases were divided into three groups (A,B and C): (A) 54 on healthy meal; and (B) 47 on exercise and DASH diet, and (C) 20 on metformin 500mg twice daily. All groups were matched by age, height and weight. Comparison was in terms of early and late pregnancy complications. In A, B and C the rate of pregnancy-induced hypertension/pre-eclampsia was 43.7%, 23.3% and 13.9% respectively (P<0.020). Rates of gestational diabetes requiring insulin treatment in A and B, were 33.3% and 18.7% compared to 2.5% in group C, (P<0.004). The rate of intrauterine growth restriction was significantly low in C, 2.5% compared to 19.2% and 16.6% in A and B respectively, (P<0.046). Frequency of preterm labor and live birth rate was significantly better in C compared to A and B. Overall rate of miscarriages was 7.2%.

CONCLUSION:

In obese pregnant women, continuous use of metformin during pregnancy significantly reduced the rate of complication and improves outcome.

 

Biography:

Dr Ho Yau Bong is an Associate Consultant and Team Leader of Assisted Reproductive Technology Unit in United Christian Hospital in  Hong Kong. He  has performed a wide range of fertility surgeries, advanced laparoscopic surgeries and advanced hysteroscopic surgeries including laparoscopic myomectomy and total laparoscopic hysterectomy for complex cases

Abstract:

This case illustrates the importance of having active gynaecological intervention for patients with sudden onset of anti-NMDA receptor encephalitis with the presence of ovarian dermoid cysts.  A 18-year-old Chinese lady was presented with acute onset of confusion, development of unsteady gait, slurring of speech and gradual deterioration of Glasgow Coma Scale. Lumbar puncture was performed and cerebrospinal fluid revealed mild leukocytosis and a slight elevation in protein. CT and MRI brain, septic workup and toxicology screening were all normal. Patient was treated as viral meningoencephalitis with Acyclovir and Antibiotics. Nevertheless, she developed episodes of tonic-clonic seizures requiring intubation and admission to Intensive Care Unit. Serum auto-antibody titre was checked and anti-NMDA receptor antibody was positive. Diagnosis of anti-NMDA receptor antibody encephalitis was made. She was treated with Prednisolone, plasmapheresis, IVIG and Rituximab. CT abdomen and pelvis scan revealed a 4x3x2cm right ovarian teratoma. Emergency laparoscopic right ovarian cystectomy was done and histology confirmed the presence of mature cystic teratoma. Her conscious level gradually improved 5 weeks after the operation and she was discharged 13 weeks afterwards.  Subsequent follow-up showed she has a full recovery with no seizure nor other functional deficits. Anti-NMDA receptor antibody encephalitis was first discovered in 2007 and around half of the cases were associated with ovarian teratoma. It is thought that this condition can be caused by auto-antibodies produced by cross-reactivity with NMDA receptors in teratomas. Ovarian cystectomy can improve this condition as it can eradicate the source of auto-antibodies.

 

Biography:

Ma. Paula Rhove R. Ortega, MD is a resident physician at the University of the Philippines – Philippine General Hospital Department of Obstetrics and Gynecology. Ireene Cacas-David practices Obstetrics & Gynecology and specializes in Perinatology

Abstract:

Tuberculosis, a disease highly prevalent in developing countries, masquerades itself in various forms. Amidst the availability of treatment spearheaded by the government, there remains in the Philippines a great burden of morbidity and mortality from this illness. It most usually affects the lungs, but extrapulmonary forms also exist.

This case focuses on a patient with abdominopelvic tuberculosis with a chief complaint of constipation, who presented on physical examination with vaginal synechiae, and was revealed on ultrasound to have hematopyotrachelometra. Initially, there was a dilemma in the diagnosis of the 79-year-old patient. Is the cause of the synechiae infectious or is it malignant? After which, comes the dilemma in the management. Is the hematometra best treated conservatively or surgically? The history, physical examination, diagnostics and course of this patient who was admitted twice for the same clinical presentation was explored in this case report.

Biography:

Stefani D. Dela Cruz, MD-MBA has completed her Doctor of Medicine and Masters in Business Administration at the age of 25 from The Ateneo School of Medicine and Public Health in the Philippines. She is currently a resident in training from the Department of Obstetrics and Gynecology, The Medical City, Ortigas, Pasig City.

 

Abstract:

The rate of cesarean section (CS) has been increasing worldwide, and many countries exceed estimated ideal-population CS rate of the WHO of 15%. The most common indication for a repeat cesarean section (RCS) was a previous CS. The recommended optimal timing for RCS is 39 weeks, yet, 10-12% undergo spontaneous labor prior to 39 weeks. Due to these, they are at an increased risk of maternal and neonatal complications. The primary objective of this study was to determine the rate of spontaneous onset of labor prior to scheduled RCS at 39 weeks age of gestation (AOG) among low-risk women in a tertiary hospital. A retrospective, cohort study was done to determine the rate of spontaneous onset of labor prior to 39 weeks AOG among low-risk (no medical condition) women admitted in a tertiary hospital from January 2012 to December 2016. Information regarding prenatal/antenatal care, delivery, maternal and neonatal outcomes were obtained from chart review. Descriptive analysis was done to summarize demographic profile; and STATA 12.0 was used to further data analysis. Of 2618 women who underwent RCS from 2012 to 2016, 834 (31.8%) were classified as low-risk. Among the 834 pregnancies, deliveries occurred at 39 (53%), 38 (26%) and 37 (21%) weeks AOG. Spontaneous labor occurred prior to 39 weeks in 47% (n=396). More patients had history of infection (5%, P=.015), threatened/preterm labor (5% vs 3%), premature rupture of membranes (7%, P<.0001) and uterine contractions (94%, P <.0001); and three neonates had Transient tachypnea of the newborn (TTNB) among those who underwent spontaneous labor. Over-all, maternal and neonatal outcomes did not vary significantly between patient groups. The rate of spontaneous labor among low-risk women was greater than the estimate of the WHO. Maternal and neonatal outcomes were not statistically significant among gestational age. To note, the risk of TTNB among patients who underwent spontaneous labor validates the delivery at 39 weeks AOG. Information obtained from this study may contribute to the patients’ and doctors’ awareness of the possibility to undergo spontaneous labor prior to scheduled RCS, for them to be prepared during pregnancy.

 

Biography:

Dr. Denise Elaine A. Reyes received the Doctor of Medicine degree in Far Eastern University- Dr. Nicanor Reyes Medical Foundation, Philippines. She graduated with the honor of cum laude and is currently having her Obstetrics and Gynecology residency training on the same institute. She is a strong advocate of women’s health and aims to help achieve the World Health Organization’s fifth millenium developmental goal which is to improve maternal health

Abstract:

 

Biography:

Dr.Hongwen Zhang ，Professor，from The Second  Xiangya Hospital of Central South University，Chief of the Gynecology and Obstetrics Department.Nearly 40 years of clinical experience. Skilled in gynecologic inflammation, female diseases, gynecological oncology, uteroscope and laparoscopy surgery. First to perform research on cesarean scar pregnancy in China, then, concluded the Clinical classification and treatment of cesarean scar pregnancy. 1 SCI paper, Multiple journal articles published. Treated  CIN III with cold knife conization without suture under uteroscope assist for over two years and achieved great prognosis

Abstract:

Aim: Embryo implantation in a cesarean scar resulting in a cesarean scar pregnancy (CSP) is a special form of ectopic pregnancy. The aim of this article is to present our clinical classification and therapeutic strategy for CSP and to assess the efficacy, safety, and social benefits.

Methods: We categorized CSP as either risky or stable. Risky CSP have a high risk of severe hemorrhage and should be treated immediately, while stable CSP patients have neither obvious vaginal bleeding nor significantly elevated serum β-human chorionic gonadotrophin (β-hCG). According to the thickness of the myometrial wall between the sac and the bladder and the location of the gestational sac, risky CSP were classified into three types and the thinner myometrial wall type (type I) was divided into three subtypes. Four treatment categories were applied to the corresponding types and subtypes of CSP. A total of 331 patients with CSP in our hospital were studied. The study group (n = 81) was treated based on our classification and optimized treatment system, while the control group (n = 250) underwent the conventional methods. We assessed the efficacy, safety, and social benefits of our classification and optimized treatment system.

Results: The values of intraoperative blood loss, operative time, hospital stay, and hospital cost in the study group were significantly lower than those in the control group (P < 0.05). Suction curettage was more frequently used in the study group (P < 0.005).

Conclusion: Our clinical classification system and therapeutic strategy provide an effective and safe way to treat CSP patients resulting in reduced intraoperative bleeding, operative time, hospital days, and hospital cost.

Biography:

Obstetrics and Gynaecology doctor Olarik is currently working for Chaophya Abhaibhubejhr Hospital in Prachinburi, Thailand, Born in a rural province, Prachinburi, Thailand. Dr.Olarik Musigavong has graduated from Faculty of Medicine, Khon Kaen University majoring in Obstetrics and Gynaecology. He also attended professional classes from Reproductive medicine of Ramathibodi Hospital in coordination with Mahidol University and Reproductive surgery training course in Belgium. Furthermore, he received a master degree in the Biotechnology of Human Assisted Reproduction and Embryology from University of Valencia in Spain, and lately became a graduate of doctor’s degree in philology and clinical epidemiology of faculty of medicine from Thammasart University.

With regard to his extraordinary achievements, he has been appointed in honorary positions : Vice

President of Complementary and Alternative medicine Special interest group of American Society of

Reproductive Medicine in USA, Social Media Team Leader of American Association of Gynecologic Laparascopist in USA, 

Abstract:

Integrative medicine is a combination of conventional medicine and alternative medicine for patient treatment. Its use has increased worldwide in recent years. Endometriosis is one of the most common disorders among infertile patients seeking medical advice. Etiology of the association is still unclear, but a number of studies suggest endometriosis alteration of hormonal cells and mediated functions, reduction of oocyte and embryo quality, endocrine and ovulatory abnormality, alteration of peritoneal functions, pelvic distortion, and dyspareunia that decreases sexual activities. Nowadays, the medical treatment of conventional medicine does not improve the rate of pregnancy in patients with endometriosis-associated infertility.

Chaophya Abhaibhubejhr Hospital has experiences in using Thai integrative medicine in endometriosis-associated infertility patients. Our experiences include the use of the following: curcumin capsules for post laparoscopic ovarian cystectomy, Plasaplai formula for endometriosis-associated pain, massage therapies for uterine repositioning, and herbal diets for lifestyle modification.

Biography:

Kok-Min Seow received his MD degree from the National Yang-Ming University, Taipei, Taiwan in 1996. After completing residency training at the Shin-Kong Wu Ho-Su Memorial Hospital, he served as an attending physician at the Shin-Kong Wu Ho-Su Memorial Hospital. In 2007, he obtained his PhD degree from the department of clinical medicine, National Yang-Ming University. He is also an associate professor at the school of medicine, National Yang-Ming University since 2014. His clinical interests include prenatal ultrasound diagnosis and laparoscopic surgery and his research interest is insulin resistance in polycystic ovary syndrome and high risk pregnancy, such as cesarean scar pregnancy.

Abstract:

oxytocin in preventing primary postpartum hemorrhage in infertile women with twin pregnancy undergoing elective cesarean delivery.

Uterine atony is the major cause of postpartum hemorrhage (PPH), accounting for up to 80% of PPH cases. PPH is the leading cause of maternal morbidity and mortality worldwide, resulting in up to 28% of maternal deaths. This study is to compare the efficacy and safety of carbetocin with those of oxytocin infusion in women with twin pregnancy undergoing elective cesarean delivery.

The present observational study conducted from January to December 2014 at a single center in Taiwan enrolled 64 women with twin pregnancy induced using in vitro fertilization–embryo transfer. The women were divided into a carbetocin group who received a single injection of 100 mg carbetocin (n = 25) and a control group who received a continuous intravenous infusion of 10 IU oxytocin in 500 mL 0.9% NaCl solution (125 mL/h) for 24 h (n = 39). Operative outcomes were compared between the groups. The mean estimated blood loss during surgery was lower in the carbetocin group compared with the control group (871 ± 305 and 922.8 ± 430 mL, respectively), but the difference was not significant (P = 0.06). There was also no significant difference in the drop in hemoglobin level between two groups. The mean operative time was significantly shorter in the carbetocin group compared with the control group (P = 0.001). In conclusion, carbetocin is as effective as 

Biography:

Sosa-Palaviccini MO

 MD Ob Gyn

Head of Service of Prenatal Diagnosis

Universitary Hospital Antonio María Pineda. Barquisimeto – Venezuela

Abstract:

Pregnancy with trisomy 18 and hepato omphalocele. Antenatal ultrasound showed longilinear avascular structures inside the umbilical cord and attached to the small intestine within the omphalocele. The insertion of the cord into the fetal omphalocele is lateral, which would allow traction movements as a pulley. Fetus dies from ruptured omphalocele. Stillbirth presents postaxial polydactyly of one foot (not diagnosed antenatally) and tubular structures coming from the umbilical cord attached to the intestine, pulling it firmly until it forming intestinal diverticules. It is postulated that this is the mechanism as the physiological umbilical hernia originates and as the Meckel's diverticulum originates. It is recommended to perform color Doppler ultrasound to any umbilical cord of fetuses with omphalocele. The fetal surgeon could cut these adherences during pregnancy, to allow the intestinal return inside the abdomen

Biography:

Juan Ren, female, MD，PH.D, Professor, Oncology Department, Did researches in Cleveland Clinic Foundation,USA from 2003 to 2008. Reviewers of the National Natural Science Foundation of China (NSFC) and the Scientific Research Scholarship for the Returned Overseas Chinese Scholars of Education Ministry of China. Has published more than 40 articles and won the second Prize of Progress in Scientific Technology of Shaanxi Province, the First Prize award of Science and Technology of Shaanxi Province, and the First Prize award of research findings of Cleveland foundation. Got New Century Talent Supporting Project of Education Ministry. Got 4 NSFC projects and 2 science and technology projects of Shaanxi Province. She has been invited as speakers in more than 40 international academic meetings and has been served as Editorial members of many international journals.

Abstract:

The purpose of this study was to comprehensively compare the 3-dimensional (3D) magnetic resonance imaging (MRI)-guided and conventional 2-dimensional (2D) point A-based intracavitary brachytherapy (BT) planning for cervical cancer with regard to target dose coverage and dosages to adjacent organs-at risk (OARs). Methods: A total of 79 patients with cervical cancer were enrolled to receive 2D point A-based BT planning and then immediately to receive 3D planning between October 2011 and April 2013 at the First Hospital Affiliated to Xi’an Jiao Tong University (Xi’an, China). The dosevolume histogram (DVH) parameters for gross tumor volume (GTV), high-risk clinical target volume (HR-CTV), intermediate-risk clinical target volume (IR-CTV) and OARs were compared between the 2D and 3D planning. Results: In small tumors, there was no significant difference in most of the DVHs between 2D and 3D planning (all p>0.05). While in big tumors, 3D BT planning significantly increased the DVHs for most of the GTV, HR-CTV and IR-CTV, and some OARs compared with 2D planning (all P<0.05). In 3D planning, DVHs for GTV, HR-CTV, IR-CTV and some OARs were significantly higher in big tumors than in small tumors (all p<0.05). In contrast, in 2D planning, DVHs for almost all of the HR-CTV and IR-CTV were significantly lower in big tumors (all p<0.05). In eccentric tumors, 3D planning significantly increased dose coverage but decreased dosages to OARs compared with 2D planning (p<0.05). In tumors invading adjacent tissues, the target dose coverage in 3D planning was generally significantly higher than in 2D planning (P<0.05); the dosages to the adjacent rectum and bladder were significantly higher but those to sigmoid colon were lower in 3D planning (all P<0.05). Conclusions: 3D MRI image-guided BT planning exhibits advantages over 2D planning in a complex way, generally showing advantages for the treatment of cervical cancer except small tumors.

Biography:

My name is Dr Jeni Panaiotova. I have graduated medicine and took speciality in Obst and Gyn in Medical University, Sofia, Bulgaria.  During the years the passion in Fetal medicine, that was rising in me, made me to apply and finish training in Fetal Medicine at Fetal Medicine Foundation, London, United Kingdom. Being part of the FMF team and observing how most of the diseases could be predict as early as first trimester of pregnancy me and my team decided to start a research of predicting placenta accreta in the first trimester. The aim of our research was to improve the work of obstetricians, dealing with this serious and life threatening obstetric condition, which incidence is rising due to the rising incidence of delivery by Cesarean Section worldwide. After four years of hard work, we completed our research and according to the results we were able to predict placenta accreta.

Abstract:

To estimate the diagnostic accuracy of ultrasound in prediction of morbid adherent placenta at 11-13 weeks.

This was a prospective study in women attending the first trimester screening test for chromosomal abnormalities. Patient-specific risk was designed, based on the history of previous uterine surgery and placenta position. On the basis of these risks, the population was stratified into high-and-low risk groups for MAP. High risk group was followed up in a special designed MAP clinic at 11-13,20-24 and 28-34 weeks. The ultrasound markers used in this study were: non-visible CS scar, irregularity of the uterine-bladder interface, retroplacental myometrial thickness, presence of intraplacental lacunar spaces, presence of retroplacental arterial/trophoblastic blood flow and 3D Power Doppler irregular placental vascularization. The diagnosed was made on three or more than three ultrasound markers.

The study population of 22,604 pregnancies at 11-13 weeks, were assessed. 1,130, were exclude, because of no pregnancy outcome at the end, or because the pregnancy ended with termination or a miscarriage.  The rest 21,474 were assessed at 11-13 weeks for previous uterine surgery and low lying placenta. We exclude 20,176 and 1,298 were assessed as high risk patients and those patient were referred to the MAP clinic at 11-13 weeks. 42 patients did not attend the first appointment and 243 were excluded, because the placenta was high. From the rest 1,013 patients, 14 patients were diagnosed with MAP and 999 patients with no MAP. All of the patients were followed at 20-24, 28-34 weeks and at the time of the delivery. 13 patients were correctly diagnosed with MAP, there was one false positive and 34 patients correctly diagnosed with placenta previa.

This study shows the feasibility of first trimester prediction of MAP, by using a combination of patient’s history of a previous uterine surgery, placenta position and specific ultrasound markers

Biography:

Dr. Shalini Rathore Consultant Gynaecologist, Specialist in High Risk Pregnancy, Fetal Medicine, Endo-Gynaecologic Surgery & Fertility Med. Experience Director & Consultant November 2009 - Present

Abstract:

In this study middle cerebral artery (MCA) peak systolic velocity(PSV)  and ductus venosus (DV) spectral waveform was measured with doppler to investigate their role in management of non immune hydrops foetalis.

METHOD : 30 singleton pregnancy with non immune hydrops foetalis were included in the study. The MCA-PSV and DV spectral waveforms were recorded in all foetuses. If MCA-PSV values greater than 1.50 MoM, fetal blood sampling by cordocentesis was performed and managed accordingly for anaemia. In foetuses with abnormal DV spectral waveform, cardiovascular causes and chromosomal abnormalities were examined.

RESULT : 11 of 30 foetuses had MCA-PSV values greater than 1.50 MoM. The causes of anaemia were investigated and include severe maternal anaemia, pre- eclampsia, cytomegalovirus infection etc. 8 cases showed reversed flow in the DV; of them 7 had congenital heart disease on echocardiography; and 1 had a normal echocardiogram, but had an abnormal karyotype.

CONCLUSION : Estimation of the MCA-PSV and DV spectral waveforms during colour doppler study of these foetuses with nonimmune hydrops  foetalis can help in their categorisation and further management which improved their outcome

Biography:

Dr.Muhamed Bakry, KFS General Hospital, Egypt

Abstract:

Among the many physiologic changes that occur during pregnancy, the maternal immune system is altered to dampenthe maternal inflammatory response and allow for fetal antigen tolerance (1, 2). Although such immunologic changesdiminish the chance of fetal rejection, they potentially increase maternal and fetal vulnerability to certain infectiousdiseases. Common infections that cause mild-to-moderate disease in healthy adults and children can cause serious maternal and fetal complications if acquired during pregnancy. A unique concern with maternal infection is the potential for mother-to-child transmission or congenital infection. Cytomegalovirus (CMV), parvovirus B19, varicellazoster virus (VZV), and toxoplasmosis are common infections associated with moderate-to-severe fetal and infant complicationswhen acquired congenitally. The purpose of this document is to update the current understanding of these infections, including their clinical presentations; their modes and risks of perinatal transmission; and their maternal,fetal, and infant effects, and to offer guidelines for preventing and managing these infections during pregnancy

Biography:

Dr. Swadha Kotpalliwar is a gynecology and obstetrician at K.J.Somaiya Medical College And Research Cente, Mumbai, India

Abstract:

Objective

To evaluate the risk of pregnancy-associated morbidities such as hypertension, diabetes, hypothyroidism and adverse perinatal outcomes in elderly women (age >=35 years) in comparison to controls (age 25 to 30 years)

Methods

All women delivered in Fernandez hospital in 2015 were eligible for the study. Those with age 35 years or more at conception were considered as cases, for each case a control was chosen matching for date of birth (the immediate next delivery), singleton pregnancy and parity status (primi or multi). The outcomes of the study included adverse pregnancy outcomes (PIH or diabetes or hypothyroidism), delivery outcomes (very preterm (<35 weeks) or C-section or assisted vaginal delivery) and fetal/ neonatal outcomes (very low birth weight or LGA or fetal or neonatal death).

Results

Among the 7605 deliveries during the study,  928 mothers are included in the study. Elderly women were likely to have hypertension, diabetes mellitus, hypothyroidism, elective C-section rate, and neonatal complications such as earlier gestation at delivery, need for NICU admission, respiratory distress and jaundice. In comparison to controls, elderly women are likely to have adverse pregnancy outcomes (n=298, 64.2% vs. n=171, 36.9 %, p=<0.001), similar delivery outcomes (n=365, 78.7% vs. n=355, 76.5%, p=0.47) and similar adverse neonatal outcomes (n=75, 16.2% vs. n=84, 18%, p=0.48) as defined in the study. On regression analysis correcting for pre-pregnancy hypertension, diabetes, hypothyroidism, BMI at booking and mode of conception, elderly pregnancy increases the risk of adverse pregnancy outcomes by an Odds of 2.4 (95% CI 1.73 to 3.20).

Conclusion

Elderly women are an increased risk of having adverse pregnancy outcomes, elective C-section, earlier gestational at delivery and increased neonatal morbidities. 

Biography:

I am 33 years old. I graduated from Tarbiat Modares University in 2010 in midwifery. I am currently a Ph.D. student of reproductive health of Shahid Beheshti University and I teach at the Azad Islamic University of Qom branch.

Abstract:

Preeclampsia is potentially life-threatening and dangerous complications of pregnancythis study were performed to assess the relationship between blood lead levels with preeclampsia. This longitudinal (prospective) study conducted on 1033 pregnant women who came to prenatal clinics of Tehran city, IRAN. The gestational age of mothers upon entry in the study was 14-20 weeks. Demographic questionnaire and reproductive history was completed and also a venous blood sample was taken from all the pregnant women upon entry. Preeclampsia was defined as blood pressure equal or more than 140/90 mmHg along with proteinuria after 20th week of pregnancy. In present study, the incidence of preeclampsia was 1.9% .mean level of maternal blood lead was 4.7±4.9 µg/dl. There was a significant relationship between maternal blood lead levels and preeclampsia. The results of this study showed that the high blood lead levels in early pregnancy can causes preeclampsia and regard to importance of it to prevention of its complication, Its requires to more consideration and advise.

KEYWORDS: Preeclampsia, Maternal blood lead levels, Pregnancy.

 

Biography:

-           Jordanian Board in OBGYN.

-           Consultant Obstetrician and Gynecologist, Head of OBGYN ED till 2016, Al-Yamamah Women and Children's Hospital, Ministry of Health, Riyadh /Saudi Arabia.

-           Member and cofounder of Optimizing Maternal Mortality and Healthcare Advisory Taskforce (OMMAHAT) established in 2015.

-           Member and cofounder of the Critical Obstetric Care Group (COC) established in 2011, Riyadh/ Saudi Arabia.

Since 2008, special interest in OBGYN emergency and critical care as a unique specialized unit serving high risk population.

- Since 2000, special interest in legal medicine and bioethics.

Abstract:

- Critical, because all these areas deal with critical patients.

- Maternity, because all are related to pregnant women.

- Complex, because they congregate nearby in one area.

OBGYN Emergency Room:

Is the main reception of any case coming, it is a specialized ER that deals with Obstetrical and gynecological cases by triaging them and accordingly to their final destination.

Operating Room:

An operating room(s) that is dedicated for OBGYN emergency cases.

Labor and delivery Room:

For those in active labor, an area for active management.

High Dependency Unit:

It is an intermediate care unit, or step down, or level-I ICU.

-  It is one area from administration point of view; all the policies are carried out similarly in all areas, like medication protocols, booking priority code, admission discharge policies….etc. By this, work process is carried out in harmony.

- Once a patient is admitted through ER any further destination within the CMC is like moving a patient from one bed to another within the same ward, thus preventing bureaucracy, delay in care, personal conflicts, and jeopardy to patient's safety.

- Any obstacle, problem, or complaint is easily monitored and corrected.

-  Any point of care test can serve the whole area, like a CBC machine, or coagulation profile, or patient controlled analgesia PCA pump….etc.

- Interdepartmental relation between the CMC and radiology department, laboratory and blood bank, pharmacy, will be more defined and clear.

- Forms, check lists; flow charts are unified.

- Data, census, quality indicators, and performance, all are unified.

-  OVR's, supply, maintenance, baby protection, infection control, patient safety, training, rotation of staff from one area to another, familiarity with different places is so helpful and important.

-  Code Orange (massive transfusion) implementation will be easier and more reliable.