Day 1 :
Keynote Forum
Shahin Qadri
Ministry of Health, Brunei Darussalam
Keynote: Category 2 caesarean section: An audit
Biography:
Dr. Shahin Qadri received her bachelor’s in medicine degree in 2005 and post graduate degree in Obstetrics and Gynecology in 2009, both from the Rajiv Gandhi University of Health Sciences, India. She specializes in general obstetrics and gynecology, including prenatal care, gynecologic surgery, colposcopy, well women care, and contraceptive counseling. She has attained MRCOG in 2018 and currently working in Ministry of Health, Brunei Darussalam.
Abstract:
Background: Suri Seri Begawan Hospital in Kuala Belait is a District Hospital where the annual delivery rate is 951 and caesarean rate is 18.6% (mean of past 5 years). 65% caesareans are done as emergency and we follow the Lucas classification for categorization. The study aims to see the performance of obstetric unit in SSB hospital. NICE recommends using both 30 and 75 minutes of DDI (Decision to Delivery Interval) for category 2 caesareans.
Method: A retrospective audit of 50 cases of category 2 caesareans was done for various indications from February to August 2018. Data was collected from the computerized medical records of patients. The auditable standards are (1) Timing of DDI in category 2 caesarean, of 75 mins should be met in 100% cases (2) Strict adherence to categorization of caesareans-100% and (3) Cord pH should be taken in all fetal distress cases-100%.
Result: 56% of patients were Primigravida’s. Most of them were done for fetal distress (32%) and failure to progress (26%). 96% of cases were justified to be category 2 caesareans. Only 86% met criteria of DDI of 75 minutes in category 2 caesareans. In 78% of fetal distress, cord pH was taken. Mean DDI was 58.78 minutes with least 29 minutes. Only 2% were done within 30 minutes. The audit was analyzed in different arms including, decision - arrival in OT interval (mean 25 mins), arrival in OT-induction of anesthesia (mean 12 mins), anesthesia-surgery start time (Mean 4 mins), surgery start time- delivery time (Mean7 mins).
Conclusion: Major cause for delay in unmet DDI was dense adhesions which made difficult entry, delay in availability of blood and lack of dedicated maternity OT. Measures are needed to improve standards of current services with a re-audit in 1 year.
Keynote Forum
Namitha Josy,
All India Institute of medical sciences, India
Keynote: Effectiveness of yoga therapy on stress and depression among women undergoing infertility treatment
Biography:
Namitha Josy has completed her BSc Nursing from All India Institute of Medical Sciences, New Delhi and Masters in Obstetrical and Gynecological Nursing from Bhopal Memorial Hospital and Research Center, Bhopal, India. She is currently working as Nursing Officer at All India Institute of Medical Sciences, Raipur.
Abstract:
Introduction & Aim: Infertility is regarded as a major life crisis that has the potential to threaten the stability of individuals and relationships in a severe way. During recent years, the development and flourishment of Assisted Reproduction Technique (ART) methods has made the parenting possible for a substantial number of infertile couples all over the world. Yoga and meditation can help women in experiencing the challenges of infertility and give patients the patience to undergo the rigors and of infertility treatments. However, persuasive research and studies in this scientific field is still unmapped. The aim of the study is to assess the effectiveness of yoga therapy on stress and depression among women undergoing infertility treatment.
Method: An experimental study was done on women undergoing infertility treatment in Bansal, Madhya Pradesh. Sixty patients were randomized into control and experimental groups. The patients were explained about study, after informed written consent, the tools measuring aggression and its correlates were administered. Tools: Demographic data sheet, Infertility characteristics, fertility problem inventory and Becks depression scale were used for data collection. Ethical clearance was obtained from Ethics Committee, BMHRC. Yoga therapy was administered to the experimental group after both groups pretest.
Results: Majority of the patients were within the age group of 20 to 30 years suffering from primary infertility. The study revealed a significant difference between stress (p=0.01) in experimental (155.9+/-3.6) and control group (185.0+/-4.7) and depression (p=0.05) in experimental (17.8+/-2.43) and control group (31.4+/-2.76). The study found a positive association between the levels of stress and depression on age and duration of infertility.
Conclusion: The study concludes that yoga therapy is effective in reducing stress and depression among patients undergoing infertility treatment in various ART centers.
- Gynecology and obstetrics
Session Introduction
Maria Maricar A Manuel
Far Eastern University, Philippines
Title: A case of bilateral retinal detachment in a pregnant patient with severe preeclampsia
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.
Sedigheh Pakseresht
Guilan University and Medical Science, Iran
Title: Estimation of fetal weight by clinical examination and ultrasound methods in predicting actual birth weight
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.
Toan Khac Nguyen
Hanoi Obstetrics and Gynecology Hospital, Vietnam
Title: Pregnancy after supracervical hysterectomy. A case report from hanoi obstetrics and gynecology hospital and literature review
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.