6^th Asia Pacific Gynecology and Obstetrics Congress July 26-27, 2019 Melbourne, Australia

Biography:

Maria Maricar A Manuel has completed her Degree of Doctor of Medicine from Far Eastern University-Nicanor Reyes Medical Foundation Institute of Medicine. She is currently pursuing her second year Resident in Training of Obstetrics and Gynecology in Far Eastern University-Nicanor Reyes Medical Foundation Medical Center in Quezon City, Philippines.

Abstract:

Introduction: Preeclampsia is classified as a hypertensive disorder in pregnancy, which occurs in the absence of other causes of elevated blood pressure and in combination with generalized edema, proteinuria or both. Preeclampsia is an obstetric disease of unknown cause that affects approximately 5% of pregnant women. It is a systemic disorder that can affect almost every organ in the body. The visual system may be affected with variable intensity, being the retinal detachment a rare complication. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis is related to the choroidal ischemia secondary to an intense arteriolar vasospasm. Exudative retinal detachment is an unusual cause of visual loss in Preeclampsia. The visual system may be affected with variable intensity, being the retinal detachment a rare complication. The majority of patients have complete recovery of vision with clinical management, and surgery is unnecessary. This reports a case of bilateral exudative retinal detachment in a 30-year-old woman at term who developed preeclampsia during her first pregnancy and complained of worsening blurring of vision described as vision of being underwater, obscuring her sight.

Case Report: We report a case of 30-year-old Myopic; term Primigravid with severe preeclampsia that developed bilateral exudative retinal detachment at the time of labor. Labor was induced due to low amniotic fluid volume and subsequently reached second stage of labor. She underwent emergency low segment cesarean section-I due to prolonged second stage of labor secondary to cephalopelvic disproportion at the level of the midplane. Preeclampsia, myopia and maternal exhaustion could have been contributed to the development of bilateral retinal detachment in this patient. She was co-managed with ophthalmology retina service was given oral and topical steroids and advised strict blood pressure monitoring and control. Two weeks after delivery, there was spontaneous and complete resolution of the bilateral exudative retinal detachment, with residual pigmentary changes of the retinal pigment epithelium.

Conclusion: The management of retinal detachment as a complication in preeclampsia is conservative and the prognosis is usually good.

Biography:

Niyitegeka has worked as an Assistant Lecturer, Chief Resident Teacher, Past Chief Resident. He has received Innovation Award in Leadership in Department of Anesthesiology, Critical Care and Emergency Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda. He has been a Mentor in Global Health Case Competition in University of Virginia in 2018 and has been certified in Global Health Research Core in Partners in Health in collaboration with Harvard Medical School. He received Travel Award from Africa Oxford Initiative for Global Surgery Training in University of Oxford. He has been working for the Rwanda Ministry of Rwanda for more than six years as Medical Doctor and has worked in Rwanda Rural District Hospitals for three years. He is pursuing his Postgraduate Program studies in Anesthesiology at University Rwanda. He co-founded and manages, The Answer Consulting Group Ltd.

Abstract:

Background: In low-resource settings, access to emergency cesarean section is associated with various delays leading to poor neonatal outcomes. In this study, we described the delays a mother faces when needing emergency cesarean delivery and assessed the effect of these delays on neonatal outcomes in Rwanda.

Method: This retrospective study included 441 neonates and their mothers who underwent emergency cesarean section in 2015 at three district hospitals in Rwanda. Four delays were measured: duration of labor prior to hospital admission, travel time from health center to district hospital, time from admission to surgical incision and time from decision for emergency cesarean section to surgical incision. Neonatal outcomes were categorized as unfavorable (APGAR <7 at 5 min or death) and favorable (alive and APGAR ≥7 at 5 min). We assessed the relationship between each type of delay and neonatal outcomes using multivariate logistic regression.

Result: In our study, 9.1% (40 out of 401) of neonates had an unfavorable outcome, 38.7% (108 out of 279) of neonates' mothers labored for 12-24 hours before hospital admission and 44.7% (159 of 356) of mothers were transferred from health centers that required 30-60 min of travel time to reach the district hospital. Furthermore, 48.1% (178 of 370) of cesarean sections started within 5 h after hospital admission and 85.2% (288 of 338) started more than 30 min after the decision for cesarean section was made. Neonatal outcomes were significantly worse among mothers with more than 90 min of travel time from the health center to the district hospital compared to mothers referred from health centers located on the same compound as the hospital (aOR=5.12, p=0.02). Neonates with cesarean deliveries starting more than 30 min after decision for cesarean section had better outcomes than those starting immediately (aOR=0.32, p=0.04).

Conclusion: Longer travel time between health center and district hospital was associated with poor neonatal outcomes, highlighting a need to decrease barriers to accessing emergency maternal services. However, longer decision to incision interval posed less risk for adverse neonatal outcome. While this could indicate thorough pre-operative interventions including triage and resuscitation, this relationship should be studied prospectively in the future.

Biography:

Sedigheh Pakseresht has completed her PhD from Delhi University, India University. She is working as an Associate Professor, Women Health Promotion, Community Health, Obstetric Dept. Member of Reproductive Health Research Center & Social Determinants of Health Research Center (SDHRC), Guilan University and Medical Science, Rasht, Iran. She has published more than 40 papers in Persian journals and many papers in ISI about breast cancer and published a book about breast cancer (in English) and Women Health. She is Chief- in-editor in holistic nursing and midwifery journal in Guilan, Iran for 19 years.

Abstract:

Introduction & Aim: Fetal weight is one of the most important factors in the management of prenatal care. The knowledge of the weight of the fetus helps obstetrician to decide on the mode of delivery. Assessment of fetal weight is essential in detecting neonatal complication. The purpose of this study was to compare the clinical examination and ultrasound methods for predicting fetal weight estimates.

Method: This was a narrative study that by searching articles published in the Persian and English databases SID, Google Scholar, Pubmed, Scopus and Web of Science. The present study aims to compare clinical examination and ultrasound methods for the assessment of fetal weight between January 2014 and December 2018 by using the keywords such as; Estimation, Fetal weight, Clinical methods, Johnsons’ formula, Dares’ formula, Dawns’ formula and Ultrasound.

Result: The articles were searched from 2014-2018. In all of 73 articles, 32 articles were reviewed. The results indicated that Dare's formula is superior among the clinical methods and in the ultrasound method; Headlock’s formula is the highest accuracy.

Conclusion: The results of most studies show a significant direct correlation between estimated and actual birth weight for the all the methods. Dare's formula is better than ultrasound estimated fetal weight. Also, Dare's formula can be important in developing countries such as our country, where ultrasound is not available in remote areas. Clinical methods are easy and simple in estimation of fetal weight. So, suggested clinical methods to be used to estimate fetal weight and the need to be to be training among medical and health service providers.

Biography:

Toan Khac Nguyen is an Obstetrician and Gynecological Surgeon currently working at the Hanoi Obstetrics and Gynecology Hospital. He is also pursuing his Doctoral studies from University of Tartu, Estonia and the University of Helsinki, Finland.

Abstract:

Pregnancy after hysterectomy is one of the most uncommon conditions in modern medicine. Since the first reported case in 1895, there have been merely 40 cases described. Post-hysterectomy pregnancy diagnosis is not often entertained due to its unusualness which leads to delayed remedy and in some cases, life-threatening or catastrophic conditions. In this article, a case of a 40-year-old multigravida woman having a pregnancy in the left fallopian tube 3 years after a supra-cervical hysterectomy at Hanoi Obstetrics and Gynecology Hospital was described. The patient underwent a successful laparoscopic intervention and was discharged after 3 days of postoperation. A brief review of literature is also discussed.

Biography:

Nooshin Peyman is currently working as a Professor in the Department of Health Education and Health Promotion at the Mashhad University of Medical Science. Her research is focused broadly on designing health literacy level-appropriate education based on our findings for both patients and their family caregiver. She works with the interdisciplinary team to enhance health literacy responsiveness across the health and community services system in Iran by building workforce capability and embedding health literacy practices within organizations.

Abstract:

Maternal health literacy during pregnancy is essential in maintaining health of themselves and their children. The aim of this study was to determine the effects of a maternal education intervention based on the self-efficacy theory and health literacy on birth weight. This clinical trial study was performed on 76 pregnant mothers, referred to Mashhad University of Medical Sciences health centers, Mashhad, Iran for routine prenatal checkups in 2016. The participants were assigned to two groups based on multistage cluster sampling method. Study questionnaires included demographic, maternal health literacy, pregnancy outcome and perceived dietary self-efficacy questionnaires, educational intervention including oral presentation, group discussion and multimedia tutorials. The questionnaires were completed at baseline, after intervention and at three months of follow up. The mean age of mothers was 24.92±4.84 years (23.92±4.59 and 25.92±4.94 years in intervention and control groups, respectively). There was no significant difference between the intervention and control groups in terms of age, maternal health literacy and self-efficacy at baseline. Intervention resulted in significant improvement in health literacy (p<0.001) and nutrition self-efficacy (p<0.001) in the intervention group compared to control group. The mean birth weight of children was significantly higher in the intervention group 3324.14±416.12 g compared to the control group 3007.73±468.63 g (p=0.003). The present findings indicate the effectiveness of the designed educational intervention based on self-efficacy theory in improving maternal health literacy and promoting normal birth weight in newborns.

Biography:

Huma Sheikh has been working in Reproductive Health Care for almost last 18 years. She is Gynecologist and Obstetrician and is serving in Government Maternity Hospital, Gujranwala Pakistan.

Abstract:

Statement of Problem: Chronic pelvic pain presents in primary care as frequently as migraine or low back pain. It is a symptom not a diagnosis but has significant impact on women quality of life and carries a heavy economic and social burden. This is affecting as many as 15% women and provides both diagnostic and therapeutic challenge. The objective of study is to evaluate chronic pelvic pain in females of reproductive age at primary health care.

Method: This is a descriptive study which is conducted at government maternity hospital Satellite Town, Gujranwala, Pakistan. A sample of 150 subjects is selected through convenient sampling technique with after taking prior informed consent. The survey was conducted using questionnaires comprising of questions regarding pain, gynecological, medical and surgical history.

Findings: Data was analyzed using SPSS 21 and the results indicated that out of 150 patients 28% presented with sole chronic pelvic pain while 55% presented with vaginal discharge, 7% with infertility, 3% with menstrual irregularities and 7% with dysmenorrhea. Most presenting complaint is vaginal discharge because of lack of hygiene and unsafe sexual practice acquiring infections. Increase in caesarian sections and associated nerve entrapment and pain due to adhesions is also an important reason.

Conclusion: At primary health care with first contact with GP and gynecologist detailed history of the patient and examination is key towards diagnosis. Sexual abuse, unsafe sexual practice has to be enquired in a very sensitive manner. Continuous antenatal care, safe home births, and avoidance of undue surgeries are keys towards prevention of complications and health burden on developing countries.

Biography:

Mohamed Zakaria Sayer Dayer is consultant gynecologist and working in the Menoufia University, Egypt.

Abstract:

Data of 92 patients diagnosed with Borderline Ovarian Tumours (BOTs) during the period from 2010 to 2017 in the National Cancer Institute (NCI), Cairo University, Egypt were retrospectively evaluated, median follow up period was 42 months. The mean age at diagnosis was 42.7 yrs. Histopathology was serous in 63%, mucinous in 28.3% and endometrioid in 3.3%. 65 patients (70.7%) had stage IA disease, 17 patients had stage IB disease (18.5%), 4 patients had stage IC disease (4.3%), 2 patients had stage II disease (2.2%) and 4 patients had stage III disease (4.3%) at diagnosis. 49 patients (53.3%) underwent fertility sparing surgery, of which 19 patients underwent unilateral ovarian cystectomy, 5 patients underwent bilateral ovarian cystectomy, 25 underwent unilateral salpingo-oopherectomy. 43 patients (46.7%) underwent radical surgery including hysterectomy, bilateral salpingo-oopherectomy. 39 patients had micropapillary disease (42 %) and 2 patients had microinvasive disease (2.2%) on histopathology. 6 patients (6.5%) had peritoneal implants of which 1 was invasive and 5 were non-invasive. Recurrence rate in the entire study group was 18.5%, 17.6% among patients underwent radical surgery and 82.4% among patients underwent fertility sparing surgery. 12 of the recurrences (70.6%) were borderline whereas, 5 were invasive (29.4%). Stages IA and IB had significantly higher disease free survival than other stages. Patients with micro invasion had significantly lower disease free survival 10.5 (9.52-11.5) vs. 77.6 (70.9-84.1). Radical surgery had significantly higher DFS than fertility sparing surgery 75.8 (70.2-81.4) vs. 68.5 (58.2-78.8).

Biography:

George Eleje is currently working as a Senior Lecturer at the Nnamdi Azikiwe University, Nnewi Campus, Nigeria and a Consultant Obstetrician-Gynecologist at the Nnamdi Azikiwe University Teaching Hospital, Nigeria. He is also Research Coordinator at the Effective Care Research Unit, Nnamdi Azikiwe University, Nigeria.

Abstract:

Introduction & Objective: Prophylactic risk-reducing Salpingo-oophorectomy (RRSO) refers to surgical removal of both fallopian-tubes and ovaries in women not thought to have cancer prior to surgical procedure but have a high lifetime risk. Despite previous studies, the role of RRSO in reducing breast and High-grade Serous Cancer (HGSC) of ovarian, tubal and peritoneal origin are uncertain. This study assesses benefits and harms of prophylactic RRSO in women with BRCA1 or BRCA2 mutations.

Method: We searched Cochrane Central Register of Controlled Trials, MEDLINE /Embase Ovid and trial registries, and abstracts with no language restrictions up to July 2017. We included non-randomized trials that used statistical adjustment analyses comparing RRSO versus no RRSO in women without a previous/coexisting gynecological malignancy and in women with a Risk-reducing Mastectomy (RRM). We extracted data and performed meta-analyses of Hazard Ratios (HR) for time-to-event variables and Risk Ratios (RR) for dichotomous outcomes, with 95% Confidence Intervals (CI). We used ROBINS-I 'Risk of bias' assessment tool and quantified inconsistency using I² statistic. We used random-effects models.

Results: Ten cohort studies were included comprising 8087 BRCA1/BRCA2 mutation carriers (2936 surgical and 5151 controls). GRADE assessment certainty of evidence was very low. Overall survival was longer with RRSO compared with no RRSO (HR 0.32, 95% CI 0.19 to 0.54; P<0.001; 3 studies, 2548 women; very low-certainty evidence). HGSC cancer mortality (HR 0.06, 95% CI 0.02 to 0.17; I²=69%; P<0.0001; 3 studies, 2534 women; very low-certainty evidence) and breast cancer mortality (HR 0.58, 95% CI 0.39 to 0.88; I²=65%; P=0.009; 7 studies, 7198 women; very low-certainty evidence) were lower with RRSO compared with no RRSO. No study reported adverse events.

Conclusion: There is very low-certainty evidence that RRSO may increase overall survival and lower HGSC and breast cancer mortality for BRCA1/BRCA2 carriers. Very low-certainty evidence suggests that RRSO reduces the risk of death from HGSC and breast cancer in women with BRCA1 mutations. Evidence for the effect of RRSO on HGSC and breast cancer in BRCA2 carriers was very uncertain due to low numbers. Further research is warranted to explore differential effects for BRCA1 or BRCA2 mutations.