RCOG 2024

Objective

To evaluate the efficacy and safety of Elagolix 150 mg (EgolixTM150 manufactured by Sun Pharma) compared to Dienogest 2 mg in alleviating pain associated with endometriosis. Design: Phase-III, randomized, multi-centric, double-blind, double-dummy, parallel-group, active-controlled, comparative, non-inferiority study.

Methods

This study included premenopausal female patients with documented endometriosis having pain assessed via numeric rating scale (NRS) ≥4, dysmenorrhoea scale (DYS) ≥2, and non-menstrual pelvic pain (NMPP) ≥2. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Elagolix 150 mg [Test] or Dienogest 2 mg [Comparator] and matching placebos for 24 weeks. For efficacy outcomes NRS, DYS, NMPP, proportion of patients requiring rescue medication and proportion of overall responders on Patient Global Impression of Change (PGI-C) scale were evaluated and for safety outcomes treatment emergent adverse events (TEAEs) were assessed. [Clinical trial registration: CTRI/2023/01/049292]

Result

A total of 340 patients were screened out of which 230 patients (115 each in Test arm and Comparator arm) were enrolled. The baseline demographic characteristics were comparable in between treatment arms. The primary endpoint of reduction in NRS score from baseline to Day 85 in Test arm was non-inferior to Comparator arm [Test: −2.43 ± 1.28; Comparator: −2.47 ± 1.26; treatment difference [T-C] (95% CI): 0.04 (−0.3, 0.37)] as the upper 95% CI was below the pre-defined margin of 1.5. The reductions in NRS score from baseline to Day 169 in Test arm was non-inferior to Comparator arm [Test: −4.33 ± 1.46; Comparator: −4.37 ± 1.28, T-C (95% CI): 0.04 (−0.32, 0.4)]. The reduction of DYS score and NMPP score from baseline to Day 85 and Day 169 were comparable in both Test and Comparator arms. The proportion of patients requiring rescue medication at Day 169 were comparable in both Test and Comparator arms [Test: 17.7%; Comparator: 17.0%; p > 0.9999]. The proportion of overall responders in PGI-C scale at Day 169 were comparable in both Test and Comparator arms [Test: 92.9%; Comparator: 94.6%; p = 0.5928]. The incidence of TEAEs were similar in both treatment arms and no serious adverse events were reported.

Conclusion

This first-in-the-world active-controlled study demonstrates Elagolix 150 mg tablets to be non-inferior to Dienogest 2 mg tablets in treatment of pain associated with endometriosis as assessed via NRS score from baseline to Day 85 and Day 169 and both treatments were found to be well tolerated. Hence, Elagolix can be considered as valuable treatment option in management of pain associated with endometriosis. OP-02 Tranexamic acid for the prevention of postpartum bleeding in women with anaemia H. Shakur-Still1; I. Roberts1; E. Balogun1; R. Chaudhri2; P. Muganyizi3,4; O. Olayemi5; F.A. Bello5; M.K. Lubeya6; B. Vwalika6; The WOMAN-2 Trial Collaborators 1London School of Hygiene & Tropical Medicine, London, UK, 2Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan, 3Muhimbili University of Health and Allied Sciences, Dares Salaam, Tanzania, 4University of Dar es Salaam Mbeya College of Health and Allied Sciences, Dares Salaam, Tanzania, 5College of Medicine, University of Ibadan, Ibadan, Nigeria, 6University of Zambia School of Medicine, Lusaka, Zambia

Objective

About half a billion women of reproductive age are anaemic and about 20 million are severely anaemic. Anaemic women are at a greater risk of postpartum haemorrhage (PPH), which is responsible for about 70 000 maternal deaths every year, most of which occur in low- and middle-income countries. Tranexamic acid (TXA) reduces bleeding by inhibiting the enzymatic breakdown of fibrin blood clots and when given within three hours of birth, TXA reduces deaths due to bleeding in women with PPH. However, for many women, PPH treatment is too late to prevent poor health outcomes or death. The WOMAN-2 Trial aimed to determine whether TXA can prevent PPH in women with moderate/severe anaemia. Design: A multicentre, randomised, double-blind, placebo-controlled trial.

Method

Moderately/severely anaemic (Hb < 100 g/L) women with vaginal births at hospitals in Nigeria, Pakistan, Tanzania and Zambia were randomised to receive 1 g of TXA or matching placebo by intravenous injection immediately (within 15 min) after the umbilical cord was cut or clamped. The primary outcome was the proportion of women with a clinical diagnosis of primary PPH. Data on maternal health and wellbeing (fatigue, headache, dizziness, palpitations, breathlessness, exercise tolerance, ability to care for baby, health related quality of life, breastfeeding); maternal blood loss and its consequences (estimated blood loss, haemoglobin, haemodynamic instability, blood transfusion, signs of shock, use of interventions to control bleeding); and other health outcomes (including death by cause, vascular occlusive events, sepsis, side effects and baby/ies’ status) were also collected as secondary outcomes.

Results

A total of 15 068 women were recruited and outcome data were obtained for 15 066. We will present the full results of our primary and secondary analysis comparing the proportion of women with PPH in the TXA vs. placebo groups, on an intention to treat basis. A sensitivity analysis adjusting for baseline risk factors of PPH and excluding women with ongoing antepartum bleeding prior to delivery will also be presented. We will also report the effect of TXA on cause specific PPH (atony, placenta implantation abnormalities, tears, retained placental tissue, uterine rupture, other and unknown); and subgroup analyses based on the severity of anaemia (moderate versus severe anaemia), antepartum bleeding, type of birth (traumatic versus non-traumatic), use of pain control (any versus none) and baseline risk of PPH (low, intermediate, high).

Conclusion

WOMAN-2 will provide reliable evidence on the safety and effectiveness of TXA in preventing PPH in women with moderate/severe anaemia. OP-03 Using machine learning to identify follicle sizes that optimise clinical outcomes A.C. Yeung1; S. Hanassab1; S.M. Nelson2; A. Akbarov3; A. Hramyka4; T. Alhamwi1; R. Salim5; A.N. Comninos1; G.H. Trew6; T.W. Kelsey4; T. Heinis3; W.S. Dhillo1; A. Abbara1 1Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK, 2University of Glasgow, School of Medicine, Glasgow, UK, 3Department of Computing, Imperial College London, London, UK, 4University of St Andrews, School of Computer Science, St Andrews, UK, 5Imperial College Healthcare NHS Trust, London, UK, 6The Fertility Partnership, Oxford, UK

Objective

Follicles sizes on day of trigger (DoT) that are either too small or too large are less likely to yield oocytes in response to the trigger. Limited data exists to identify which follicle sizes are most likely to yield mature oocytes and lead to live birth. Here, we use explainable artificial intelligence (XAI) to determine the size of follicles that optimise oocyte yield and live birth rates (LBR). Design: Multicentre, retrospective study including 19 082 patients undergoing first fresh IVF/ICSI cycle between 2005 to 2023 across 11 European clinics.

Method

An ensemble-based XAI model, developed through 'internal-external validation', was trained, Bayesian optimised, and independently iteratively tested on hold-out clinic datasets. Permutation importance and “SHAP” values were used in the model to determine follicle sizes that contribute most to successful laboratory outcomes. Model performance was evaluated and optimised for mean absolute error (MAE).

Results

Follicles sized 13–18 mm on DoT were most impactful on the number of mature oocytes retrieved (MAE: 3.60 ± 0.35), leading to high quality blastocyst formation particularly in the 15–18 mm range. Using an hCG trigger, follicles most likely to yield mature oocytes were sized 12–19 mm in GnRH antagonist cycles and 14–20 mm in GnRH agonist cycles. In patients aged > 35 years, a slightly wider range of follicle sizes (11–20 mm) were important for retrieval of mature oocytes. Consistent with current criteria for trigger administration, having three lead follicles ≥17 mm on DoT resulted in a 10% median improvement in mature oocyte yield (p < 0.0001). Comparatively, maximising the proportion of follicles on DoT within the optimal size range further improved mature oocyte yield, for example, by 42% when at least 70% of follicles were sized 15–18 mm (p < 0.0001). Using a logistic regression model (p < 0.0001; n = 9209), the proportion of follicles within 13–18 mm on the DoT was positively related to LBR (p = 0.047) when adjusted for age, total follicle count, and type of trigger administered. Serum progesterone on the DoT (n = 995) was increasingly elevated with the number of larger follicles sized > 18 mm, and was negatively associated with LBR.

Conclusions

Follicles sized 13–18 mm are most likely to yield mature oocytes. LBR was increased with a greater proportion of follicles in this range. These findings show the potential of a data-driven XAI approach to optimise clinical outcomes by forming the basis of precision decision-making for the management of ovarian stimulation. ABSTRACTS IN STREAM SESSIONS OS-01 Laparoscopic surgery in pregnancy: Experience at a tertiary care center in Oman J. Shaikh1; T. Al Rawahi1; M. Al Busaidi2 1Royal Hospital, Muscat, Oman, Obstetrics and Gynecology, Muscat, Oman, 2Sultan Qabus University HJospital, Obstetrics and Gynecology, Muscat, Oman

Objective

To study the maternal and fetal outcome in patients who underwent laparoscopic surgery during pregnancy, and in turn study the safety of laparoscopic surgeries in pregnancy at our center. Design: It was a retrospective observational study.

Method

All patients who underwent laparoscopic surgery during pregnancy at Royal Hospital, Muscat, Oman from 1st January 2009 to 31st December 2020 were studied retrospectively. Data was collected from medical records, in a predesigned proforma. The pregnancy outcome including mode of delivery, the gestational age at delivery were recorded. The fetal outcome was also studied.

Results

In the 12 years duration of the study total number of patients delivered were 1000138 of which 101 women underwent laparoscopic surgery, giving a percentage of 0.01%. Thirty-eight patients had surgery in the first trimester, 57 in second and 6 in third trimester. Forty-three patients underwent appendicectomy, 13 cholecystectomies, 37 had Ovarian cystectomy, 4 had corpus luteal rupture, 3 had heterotrophic pregnancy and one had de functioning colostomy for rectal malignancy. In 4 percent of patients surgery was converted to laparotomy and one patient had uterine perforation. Six patients had miscarriage, 4 had preterm delivery and 91 delivered at term. Seventy-one patients had vaginal delivery and 24 had cesarean section. Fourteen percent of neonates were small for gestational age, 4 percent of were admitted to Neonatal intensive care unit.

Conclusion

Maternal and neonatal outcome was good in patients who underwent Laparoscopic surgery in pregnancy. Laparoscopic surgery can be safely performed in all three trimesters of pregnancy at our institute. The rate of surgical complications was very low. The limitation of our study was the small number of cases performed specially in third trimester. Another limitation was no control group for comparison, like patients who had laparotomy in pregnancy, as being tertiary care center patients were referred specially for Laparoscopic surgery. OS-02 Maternal anaemia and the risk of postpartum haemorrhage R. Mansukhani1; I. Roberts1; H. Shakur-Still1; R. Chaudhri2; F.A. Bello3; P. Muganyizi4,5; O. Olayemi3; E. Balogun1; The WOMAN-2 Trial Collaborators 1London School of Hygiene & Tropical Medicine, London, UK, 2Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan, 3College of Medicine, University of Ibadan, Ibadan, Nigeria, 4Muhimbili University of Health and Allied Sciences, Dares Salaam, Tanzania, 5University of Dares Salaam Mbeya College of Health and Allied Sciences, Dares Salaam, Tanzania

Objective

Worldwide, half a billion women of reproductive age are anaemic. Each year, 70 000 women die from postpartum haemorrhage (PPH). Most deaths are in low- or middle-income countries. In this study, we examined the association between anaemia and the risk of PPH. Design: Updated cohort analysis of data from the WOMAN-2 trial which enrols women with moderate or severe anaemia giving birth vaginally.

Method

We did a prospective cohort analysis using the data of WOMAN-2 trial participants collected at hospitals in Pakistan, Nigeria, Tanzania, and Zambia. Moderate anaemia was defined as a haemoglobin concentration of 70–99 g/L and severe anaemia as less than 70 g/L. Prebirth haemoglobin was measured after hospital arrival and before giving birth. Post-partum haemorrhage was defined in three ways: (1) clinical PPH (estimated blood loss ≥ 500 mL or any blood loss sufficient to compromise haemodynamic stability); (2) estimated blood loss ≥ 500 mL (WHO PPH); (3) calculated estimated blood loss of ≥1000 mL (estimated from the peripartum change in haemoglobin and body weight). We used logistic regression to examine the association between haemoglobin and PPH adjusting for confounders.

Results

Our analysis of data from 10 561 women with moderate or severe anaemia showed that a 10 g/L reduction in prebirth haemoglobin increased the odds of clinical PPH by 29% (aOR = 1.29 95% CI 1.21–1.38) and that severe anaemia was associated with a sevenfold increased odds of death or near miss (OR = 7.25 95% CI 4.45–11.80) compared with moderate anaemia. Mean (SD) prebirth haemoglobin was 80.7 (11.8) g/L. Mean (SD) blood loss was 301 (183) mL for women with moderate anaemia and 340 (288) ml for women with severe anaemia. 742 women (7.0%) had clinical PPH. The risk of clinical PPH was 6.2% in women with moderate anaemia and 11.2% in women with severe anaemia. We will present an updated and expanded analysis on data from 15 066 women.

Conclusion

This presentation will update and expand on previous analyses of impact of anaemia on the risk of postpartum haemorrhage. We will also explore potential mechanisms. OS-03 Novel regimen of antibiotic management in Preterm Premature Rupture of Membranes (PPROM) A. Elbareg1; F. Essadi2 1Misrata University, Obstetrics & Gynecology, Misrata, Libya, 2Misrata Medical Centre, Obstetrics & Gynecology, Misrata, Libya

Objectives

(PPROM) is defined as the spontaneous rupture of the fetal membranes before 37 weeks gestation, complicating approximately 3% of pregnancies and is one of the leading causes of prematurity. It is frequently associated with intra-amniotic infection. Antibiotic treatment is recommended to prolong the latency period and reduce fetal morbidity, decrease risk of clinical chorioamnionitis, and improve neonatal outcomes. Aim of our study is to find out the impact of Prolonged administration of Fosfomycin with Clindamycin & Metronidazole in comparison to Erythromycin plus Metronidazole on outcomes in patients with (PPROM). Design & Methods: Total of (89) patients who met the inclusion criteria, aged 22 to 38 years with (PPROM), and of 29 to 34 weeks gestation, were enrolled in a prospective controlled clinical trial at Tertiary Referral Hospital over a period of 20 months. (11) excluded because they delivered within 72 h after admission. Two antibiotic prophylactic protocols were used for 7 days: (A) 41 patients received oral Fosfomycin (6 g daily) + IV Clindamycin (600 mg every 8 h) + IV Metronidazole (500 mg twice daily), (B) 37 women were initiated on oral Erythromycin regimen (250 mg four times daily) +IV Metronidazole (500 mg twice daily). All patients received (12 mg Dexamethasone, 2 doses 12 h apart & 4 gm MgSO4) Exclusion criteria: contraindication to expectant management; sensitivity to any antibiotic involved in the study, unwell fetal status, fetal anomalies, twin pregnancy, placental abruption, cerclage, active labor or suspected intrauterine infection. Outcomes: duration of pregnancy latency period, gestational age at delivery, development of chorioamnionitis, respiratory distress syndrome (RDS), postpartum endometritis, and neonatal sepsis. Statistical analysis using SPSS package. p-value considered significant if (<0.05).

Results

None of patients were lost to follow-up in both groups. Latency period was significantly longer in (A) when compared to (B) (P = 0.031). Statistically significant difference in terms of gestational age at delivery between the (A) & (B) (p < 0.05). Clinical chorioamnionitis rate was significantly higher in (B) than (A) (p = 0.042). Rates of (RDS) (31.1% in (A) vs. 49.2% in (B) (p < 0.05)). Postpartum endometritis was significantly higher in (B) (p < 0.05), but no neonatal sepsis was encountered in either group. No drug related complications were reported.

Conclusion

Combination of Fosfomycin with Clindamycin & Metronidazole is superior to Erythromycin & Metronidazole with a safety profile, favorable maternal & neonatal outcomes. It should be used as a first line management of PPROM. OS-04 Endometriosis and the complications of pregnancy: A systematic review and meta-analysis B. Parry1; C. Stone1; A. Newnham-Hill1,2; S. Quenby1,2; J. Odendaal1,2 1University of Warwick, Warwick Medical School, Coventry, UK, 2University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK

Objective

This study aimed to further elucidate the relationship between endometriosis and key obstetric complications including miscarriage, pre-eclampsia, preterm birth, placenta previa, placenta abruption and small for gestational age (SGA) infants. Design: Endometriosis is a prevalent gynaecological condition. Its pathophysiology, whilst unclear, is in part immune-mediated. Endometriosis has previously been associated with infertility but its role in obstetric complications is less clear, despite it sharing pathophysiological pathways with several obstetric complications. Therefore, a systematic review and meta-analysis was conducted to establish whether any previously shown associations between endometriosis and obstetric complications are consistent, generalisable and statistically significant.

Method

EMBASE, Medline and CINAHL were searched for all studies published before 9th October 2023, limited by the English language. 61 cohort and case-control studies reporting on the incidence of certain obstetric outcomes in women with endometriosis, compared to women without endometriosis, met the inclusion criteria and were included in the review. A meta-analysis was performed where the data allowed, and risk of bias was assessed using the Newcastle Ottawa Scale.

Results

Women with endometriosis had a higher risk of preterm birth (OR 2.02; 95% CI, 1.54–2.65), pre-eclampsia (OR 1.29; 95% CI, 1.20–2.40), placenta previa (OR 3.18; 95% CI, 2.66–3.81), placenta abruption (OR 2.44; 95% CI, 1.41–4.19), and SGA infants (OR 1.61; 95% CI, 1.16–2.25). No difference in the incidence of miscarriage (OR 1.95; 95% CI, 0.86–4.42) was found. Heterogeneity between studies was high for all outcomes except pre-eclampsia but a low risk of bias was seen.

Conclusions

Endometriosis is associated with increased risk of key pregnancy complications, namely pre-eclampsia, preterm birth, placenta previa, placenta abruption and SGA infants. These women should therefore be streamed for high-risk care in pregnancy. Future work should focus on standardised methodology for associative cohort studies to reduce study heterogeneity. OS-05 Azithromycin versus erythromycin as a part of antibiotic prophylaxis in PPROM S. Tanveer; S. Hakim Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Aligarh, India - The research question: Is single dose of 1 g intravenous azithromycin better than standard seven-day course of 250 mg oral erythromycin given 6 hourly as a part of antibiotic prophylaxis in patients of PPROM (both regimen including a two-day course of intravenous ampicillin, followed by a five-day course of oral amoxicillin) with respect to the following outcomes: - Duration of latency period. - Incidence of chorioamnionitis. - Secondary objectives: To compare both regimens in terms of the following outcomes: - Incidence of postpartum endometritis. - Incidence of MSAF. - Rates of caesarean sections. - Incidence of neonatal sepsis. Design: Study design: Randomised clinical trial. Study setting: Department of OBGYN, AMU, India. Study population: Patients with PPROM between 24 to 33+6 weeks of gestation.

Method

Sample size: With reference to trial by Martingano et al. (power of study 80%), the minimum estimated sample size was 88 participants per group. Sample size of 100 patients was taken in each group. Randomisation: Randomisation was done in a 1:1 ratio in azithromycin and erythromycin groups through computer generated random allocation sequence. - All patients meeting the study eligibility criteria were included after taking written informed consent. - Detailed maternal demographic history including maternal age, gestational age at initial diagnosis of PPROM, BMI, pre-gestational diabetes, and group β-streptococcal status was recorded. - All participants were followed from diagnosis of PPROM until 42 days after delivery. - All details were recorded in a predesigned, pretested pro forma.

Results

Mean latency period in azithromycin and erythromycin groups was 5.05 and 4.33 days respectively. This increase in latency period in the azithromycin group was statistically significant (p value: 0.02). Azithromycin group showed a statistically significant decrease in incidence of chorioamnionitis (p value: 0.03). There was no statistically significant difference between the two groups in terms of postpartum endometritis (p value: 0.22), MSAF (p value: 0.43), caesarean deliveries (p value: 0.66) and neonatal sepsis (p value: 0.36).

Conclusions

PPROM is responsible of for one-third of preterm births and is the most common identifiable factor associated with preterm delivery. The use of azithromycin instead of the standard seven-day course of oral erythromycin has been proven to be effective in expectant management of PPROM in recent studies. This interventional study is first of its kind in India and concludes that azithromycin improves latency period and decreases the incidence of chorioamnionitis. OS-06 Human Papillomavirus (HPV) vaccination and the risk of spontaneous preterm birth X. Xu1; M. Cruickshank2; A. Woolner2 1Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing Clinical Research Institute, Beijing, China, 2University of Aberdeen/Aberdeen Centre for Women's Health Research, Institute Applied Health Sciences (IAHS), Aberdeen, UK

Objective

To determine if implementation of the Human papillomavirus (HPV) vaccination programme has improved obstetric outcomes in vaccinated women. HPV vaccination has fulfilled its destiny by reducing rates of cervical cancer in vaccinated populations. However, given the previous epidemiological research suggesting that women with HPV, precancerous cervical disease, and particularly those who had deeper cervical treatments were at increased risk of preterm birth, this study aimed to review if there has been a reduction in spontaneous preterm birth (sPTB) or other adverse pregnancy outcomes in women vaccinated for HPV. Design: This was a population-based and data-linkage cohort study including data from 4 routinely collected hospital or public health databases including pregnancy data, HPV vaccine status, colposcopy exams, histology diagnosis and subsequent cervical treatment for women in Aberdeen, Scotland, UK.

Methods

We used multivariable and generalised estimation equation (GEE) model to identify any associated changes in spontaneous preterm birth or other adverse pregnancy outcomes in women vaccinated for HPV compared to women who have not received the HPV vaccination. Women were identified from the Aberdeen Maternity Neonatal Databank (AMND) and pregnancy data were linked with Scottish national vaccination, colposcopy and cervical histology databases.

Results

9200 women with over 11 000 pregnancies who had a pregnancy recorded within Aberdeen, Scotland between 2006 and 2020 were included. There was no difference in sPTB according to HPV vaccination status [adjusted Odds Ratio (aOR) 1.00 (95%CI 0.82 to1.22) p = 0.27]. Preterm prelabour rupture of membranes (pPROM) [aOR 0.52 (95%CI 0.30 to 0.89); p = 0.03] and prelabour rupture of membranes at term (PROM) [aOR 0.25 (95%CI 0.17 to 0.36); p < 0.01] were significantly reduced in women vaccinated against HPV.

Conclusion

To our knowledge, this is the first research study to specifically investigate spontaneous preterm birth risk in HPV vaccinated and non-vaccinated women. Spontaneous preterm birth rate was unchanged since the introduction of the HPV vaccination. Our data however does suggest that other adverse pregnancy outcomes including PPROM, PROM, pre-eclampsia and antepartum haemorrhage were significantly reduced in women with HPV vaccination. High grade cervical lesions, CIN2+ diagnoses and colposcopy referrals were all significantly reduced in women who had received the HPV vaccine. OS-07 Exploring a digital solution for identifying mental health problems in obstetric clinics P.S. Chandra1; S. Lotlikar1; G. Desai1; S. Mohanty Quantius2 1National Institute of Mental Health and Neurosciences, Psychiatry, Bangalore, India, 2Swiss Institute of Technology, Zurich, Switzerland

Background

Antenatal anxiety and depression rates vary between 12 to 20% in Low and Middle Income countries. Screening for mental health though important does not happen uniformly due to high workloads and inadequate resources. Women may not reveal these problems because of stigma or lack of awareness. Therefore, digital solutions that offer opportunities for women to rate their own mental health and life circumstances with privacy and confidentiality appear to be an optional solution. Aim: This study evaluates the feasibility, acceptability, and utilization of digital self-screening for antenatal mental health in urban obstetric clinics through an application on a tablet.

Method

A multilingual (English, Hindi and Kannada) digital application was developed for self screening for psychosocial risk factors as well as for anxiety and depression. The application provided to women on a tablet integrated the Patient Health Questionnaire – 9 (PHQ 9) and the Generalized Anxiety Depression Scale 7 (GAD 7). Risk factors assessed included- poor social support, poor quality of marital relationship, past history of mental illness, past poor obstetric history, and recent adverse life events. While women waited for their antenatal appointments, they were requested to fill up the questionnaires on the digital application after obtaining informed consent. Women rated themselves for anxiety and depression as well as risk factors. The application was assessed for feasibility and acceptability among 101 pregnant women in two urban obstetric clinics. Follow-up phone calls after 24 h gathered participant feedback.

Results

Conducting assessments in waiting areas facilitated participant comfort, with only 17 women declining participation due to time constraints or perceived lack of need. The self-assessment, taking 6–8 min, revealed 17.8% of women experiencing mild anxiety and 9.9% reporting moderate to severe anxiety. Regarding depressive symptoms, 30.6% displayed mild symptoms, and 14.8% reported moderate to severe symptoms. Additionally, 64.3% reported positively to at least one risk factor, while 7.9% had a past history of psychiatric illness. Notably, among the 60 of 100 participants responding to the follow-up call, 46.7% preferred digital self-assessment for its ease and non-judgmental nature, while 21.1% favored self-assessment followed by discussion with their obstetrician. Only 14 (23.3%) expressed a preference for consulting with their obstetrician or a mental health professional instead of using self-assessment.

Conclusion

Digital self-screening for mental health in obstetric clinics may offer an acceptable and less stigmatizing early detection method and can support obstetricians in identifying and providing care for women with psychological distress. OS-08 Zuranolone for postpartum depression: A systematic review and meta-analysis of two RCTs J. Almeida Oliveira1; K. Eskandar2; M.A. Araújo Freitas3; C.E. Philip4 1Federal University of Minas Gerais, Belo Horizonte, Brazil, 2Pontificial Catholic University of Paraná, Curitiba, Brazil, 3State University of Tocantins Region of Maranhão, Tocantins, Brazil, 4Beaumont Hospital, Dublin, Ireland

Objective

To evaluate the maternal outcomes in women with postpartum depression using zuranolone, a neuroactive steroid recently approved by United States Food and Drug Administration (FDA) as the first oral medication indicated to treat postpartum depression. Design: We conducted a systematic search on Pubmed, Embase, Lilacs and Cochrane, performed in September 2023. We selected randomized controlled trials comparing the effectiveness and safety of zuranolone versus placebo in women with postpartum depression. Data was collected and analyzed by two authors and Review Manager 5 was used for statistical analysis. Random effects was applied.

Results

The search strategy yielded 287 results, of which 2 studies were included, comprising 346 women, of whom 174 (50.2%) were treated with zuranolone. Both studies included similar populations: women aged 18 to 45 years, with major depressive onset during the third trimester of pregnancy, or ≤4 weeks after delivery. The 2021 study used a 30 mg dose while the 2023 one used 50 mg. We found that zuranolone was significantly associated to an improvement of Clinical Global Impression response rate (p < 0.001); Hamilton Depression Rating Scale 15 days (p < 0.001) and 45-day remission (p < 0.001), 3-day (p = 0.04), 15-day (p = 0.002), and 45-day symptom remission (p = 0.001), and reduction in the dose of antidepressants (p = 0.002). As for safety outcomes, it was noticed that zuranolone increases sedation risk (p = 0.005), which can be dose related. No significant differences were found for diarrhea, dizziness, headache, nausea, somnolence, and upper respiratory tract infections.

Conclusions

While Zuranolone showed efficacy in improving PPD symptoms compared to placebo, with a manageable safety profile, the study's scope was limited to two U.S. trials with a short follow-up period of 45 days. Long-term studies and broader population analyses are needed. Additionally, the small number of studies precluded more extensive statistical analysis of population subgroups, such as the effect at different age groups and potential interaction of treatment with baseline severity of PPD. Overall, our findings suggest that zuranolone is associated with a higher rate of clinical remission in women with PPD as compared with placebo. This novel therapy could be a valuable option in the treatment of PPD. OS-09 Association of antithyroid antibodies with persisting subclinical hypothyroidism in post natal mothers R Sujithra Devi1; H. Aithal1; J. Sahoo2; T Chitra1 1Jawaharlal Institute of Post Graduate Medical Education and Research, Obstetrics and Gynecology, Puducherry, India, 2Jawaharlal Institute of Post Graduate Medical Education and Research, Endocrinology, Puducherry, India

Background

The prevalence of Subclinical hypothyroidism (SCH) in pregnancy is 3.4% worldwide and approximately 9.5% in India. 18% of the them continued to be SCH /Overt hypothyroid in postnatal period, the incidence is high in the presence of antithyroid antibodies. The two important antithyroid antibodies are Anti-thyroid peroxidase antibodies (Anti-TPO antibodies) and Anti thyroglobulin antibodies (Anti TG antibodies).In pregnant women T-Regulatory cells reduce the level of Antithyroid antibodies transiently with a rebound increase by 6 weeks postpartum. ATA 2017 recommends testing of antithyroid antibodies in the postnatal period but it is not done routinely in developing countries like India due to resource constraints, hence this prospective study was conducted to estimate the proportion of persistant SCH/hypothyroidism and its association with antithyroid antibodies at 6 weeks postnatal follow up. Aims and Objectives: In women diagnosed with SCH during pregnancy to estimate the proportion of persistent subclinical/overt hypothyroidism at 6 weeks postpartum and its association with anti-thyroid antibodies, and to estimate the proportion of congenital hypothyroidism in babies.

Materials

& Methods: This is a Prospective cohort study conducted in a tertiary care centre, South India from January 2022 to May 2023 after obtaining Institute Ethical clearance. A total of 180 antenatal women >18 years of age diagnosed with SCH during current pregnancy between 14 to 28 weeks of gestation with singleton pregnancy were included in study .156 women were available for postnatal follow up at 6 weeks after excluding women requiring >50 micrograms of Thyroxine and lost to follow up. Women with thyroid disorder prior to pregnancy and post thyroidectomy were not included in the study. TSH, fT3, fT4, Anti-TPO, Anti TG antibodies were assessed antenatally and postnatally. Chi-square/Fisher's exact test were used to study the association. Proportion of babies developing congenital hypothyroidism were noted.

Results

In our study 15.38% women were SCH at 6 weeks postpartum.24% of women were positive for antithyroid antibodies antenatally while 31% in postnatal period. Though there was statiscally significant increase in anti-thyroid antibody positivity in postnatal period there was no significant association between anti-thyroid antibody positivity and persistence of SCH. 2% of the babies developed congenital hypothyroidism.

Limitation

Follow up at six weeks postnatal period may be too early to estimate the persistence of Subclinical hypothyroidism and its association with antithyroid antibodies.

Conclusion

Long term follow up is required to study the association of antithyroid antibody with persistence of SCH/Overthypothydoidism. OS-10 Prenatal adversity triggers placental endocrine insufficiency via loss of imprinting gene Phlda2 A. Stoddart; R. John Cardiff University, School of Biosciences, Cardiff, UK

Objective

This study compared the phenotype of Phlda2 overexpression with a published prenatal low protein diet model to test the hypothesis that these alterations phenocopy each other. Design: Adversity during pregnancy has been linked to low birthweight and poor future outcomes for offspring. Adversities include maternal depression and anxiety, poor diet, obesity, and smoking. The mechanism(s) linking exposure to prenatal adversity to these offspring outcomes remains unknown. Animal studies have reported that dietary adversity can result in changes in the placenta consistent with placental endocrine insufficiency. Mice modelling loss-of-imprinting of the maternally expressed gene Phlda2 also demonstrate placental endocrine insufficiency alongside low birth weight, disruptions in maternal caregiving and anxiety in offspring later in life. This gene may therefore be a target of environmental stressors.

Methods

Placental and foetal samples were generated from an existing transgenic line overexpressing Phlda2 by two-fold. 31 wild-type and 30 Phlda2 transgenic mice were used. Wet weights of foetuses and placenta were measured after dissection at E14.5. RNAscope technology was used to produce Prl3b1 stained placental images and endocrine cells were identified and counted. Gene expression from different endocrine cell lineages was determined through RT-qPCR. Statistical comparisons were made using the two-tailed T-test with p < 0.05 considered statistically significant. Animal studies and breeding were approved by the Universities of Cardiff ethical committee, under license (RMJ; PAD270E16).

Results

Phlda2 overexpression was associated with reduced placental weight and a loss of the junctional zone area at E14.5. The number of spongiotrophoblasts and glycogen trophoblasts was significantly reduced in the transgenic placenta. Placental hormone gene expression for these lineages was also reduced. These findings showed overlap with the low protein diet model.

Conclusions

Two-fold expression of Phlda2 partially phenocopies the impact of low-protein diet on placental characteristics. This study provides partial support for the theory that prenatal adversity drives placental endocrine insufficiency via loss-of-imprinting of Phlda2. These placental hormones normally help supply nutrients to the foetus, ensuring a healthy pregnancy and are involved in development of maternal nurturing behaviours. This study will aid future research on the endocrine role of the placenta as well as how imprinted genes play a role in pathophysiology during pregnancy. This also provides evidence that maternal behaviours during pregnancy (diet/depression/anxiety/smoking) lead to poor outcomes for offspring both as a foetus and in early childhood. Meaning clinical intervention and public education could play a role in improving these outcomes for children. OS-12 Cardiac chronicles: 5-year retrospective study in tertiary obstetric referral center K. Amirthalingam1; R. Vairavan1; N.B. Ramli2; N.B. Habizal2; I.M. Netto3 1Hospital Sultan Idris Shah, Obstetrics and Gynecology, Kajang, Malaysia, 2Hospital Sultan Idris Shah, Cardiology, Kajang, Malaysia, 3Hospital sultan Idris Shah, Obstetrics and gynecology, Kajang, Malaysia

Objective

To study the prevalence, clinical characteristics, management strategies, maternal and perinatal outcomes of pregnant women with cardiac conditions in a tertiary cardiac referral center. Design: A retrospective cohort study. Data is collected from electronic medical records (EMRs) of patients admitted between year 2019–2023 in the combine obstetric cardiology clinic, admissions to the obstetrics and cardiac wards, labour room, operating theater, intensive care unit and cardiac care unit.

Methods

During the study period 1210 patients data was manually analysed. The patients included were those from the regional referral areas and nearby states. Data collected inclusive of demographics feature, cause of cardiac disease, staging of cardiac disease where available, procedures done during pregnancy, assessment in combine cardiac clinic, mode of delivery, maternal and perinatal outcome and contraception method. All results were tabulated in a google form for analysis.

Results

Patient age range of 15 to 50 years with the median age of 30 years. Most patients are of malay in ethnicity (87.7%). 26% were primigravida. 98.8% were singleton pregnancies. Most common referrals were for evaluation of suspicion of cardiac condition like maternal tachycardia, dyspnea, palpitations and evaluation of cardiac murmur (47.9%). The most common organic cause was congenital heart disease (18.1%) closely followed by arrhythmia (17%). Among the congenital heart disease patients 1/3 of them were surgically corrected prior to pregnancy. Among the chronic rheumatic heart disease the mitral valve was the commonly involved valve (80.6%), followed by the aortic valve (8.3%). The most lesions were regurgitant lesion. Right heart catheterization for evaluation of pulmonary hypertension was done in 6 out of 28 patients. Coronary angiogram was done in 17 out 35 patients (48.6%) with ishemic heart disease. Out of 1210 patients 310 had modified WHO classification and 42 were who class III and IV of (13.5% of available data). 38.9% patients delivered in other centers .31.7% of patients delivered at our center by caesarean section. Preterm delivery was 27% (17.7% was iatrogenic and 9.3% was spontaneous). Among those delivered at our center, there were 7 maternal deaths (1.1%) and 20 perinatal deaths (2.7%) during this period. The main cause of maternal death were attributed by cardiomyopathy 72%. The most common method of contraception used was etonogestrel implants.

Conclusion

The audit established a need for appropriate guidelines, a more stringent care to improve maternal and perinatal outcome. Yearly audit will be continued prospectively to improve referral systems, pre-pregnancy care and multidisciplinary involvement. OS-13 Multicentre, prospective test accuracy study of ovarian cancer in symptomatic pre-menopausal women S. Sundar1; R. Agarwal1; K. Scandrett1; C. Davenport1; S. Mallett2; P. Sengupta3; S. Johnson4; R. Selvi-Vikram5; C. Rick6; S. Kehoe7; D. Timmerman8; T. Bourne9; H. Stobart10; R. Neal11; U. Menon2; A. Gentry-Maharaj2; L. Sturdy1; R. Ottridge1; J. Deeks1 1University of Birmingham, Birmingham, UK, 2University College London, London, UK, 3County Durham and Darlington NHS trust, Durham, UK, 4Southampton University Hospitals, NHS trust, Southampton, UK, 5West Hertfordshire Hospitals NHS trust, West Hertfordshire, UK, 6University of Nottingham, Nottingham, UK, 7St Peter's College – University of Oxford, Oxford, UK, 8University Hospitals Leuven, Leuven, Belgium, 9Imperial College London, London, UK, 10Patient Representative, UK, 11University of Exeter, Exeter, UK

Objective

Diagnosing Ovarian cancer (OC) in premenopausal women is challenging; OC is rare whilst ovarian cysts are common. The Refining Ovarian cancer Test accuracy Scores (ROCkeTS) study investigated the accuracy of risk prediction models for diagnosing OC in women with symptoms; no previous studies have compared the accuracy of all commonly used risk prediction models, head-to-head, in the same population and in a real world setting. Design: An initial prospective cohort study recruiting women undergoing surgery, changed to a case-control study after 575 women recruited due to low (1%) prevalence of OC in recruits.

Methods

Newly presenting premenopausal women with non-specific symptoms and raised CA125 and/or abnormal imaging donated blood for Risk of malignancy algorithm (ROMA) testing and underwent an International Ovarian tumour analysis (IOTA) ultrasound scan. Ultrasound scans were performed mainly by NHS sonographers with certification in IOTA models who underwent quality assurance. Compared to Risk of Malignancy Index (RMI) (threshold 250), index tests and thresholds evaluated were IOTA ADNeX model (3% and 10%), RMI1 (200), ROMA at multiple thresholds and CA125 (87 IU/mL) and (posthoc analysis) Ovarian-Adnexal Imaging-Reporting-Data System (ORADS) (10%). The reference standard was tissue biopsy/cytology within 3 months or follow-up at 12 months. Tests were conducted blinded to outcomes. Primary outcomes were sensitivity, specificity, area under Receiver Operating Characteristic curve, Positive and Negative Predictive values and for risk prediction models, a calibration plot of primary invasive OC versus benign or normal.

Results

1123 premenopausal women were recruited from 23 hospitals of whom 88 (7.3%) had primary OC, the majority early stage (53/88, 60%). For the primary outcome, in comparison to RMI 1 250, sensitivity 40.3% (95% CI 28.1, 53.6), specificity 96.4% (95% CI 94.9, 97.6); IOTA ADNEX at 10% was more sensitive (difference of 50.0%, 95% CI 35.7, 64.3), p < 0.001 but less specific (difference of 23.0%, 95% CI 19.7, 26.3), p < 0.001, ROMA at the manufacturer recommended threshold of 11.4 was more sensitive (difference of 38.3%, 95% CI 23.5, 53.1), p < 0.001, but less specific, (difference 22.1%, 95% CI 18.7, 25.5), p < 0.001.

Conclusions

Compared to RMI (250), IOTA ADNEX (10%) had the highest sensitivity but lower specificity. ROMA (11.4%) achieved good sensitivity but with a similar specificity to IOTA ADNEX (10%). IOTA ADNEX at 10% should be considered the new standard of care diagnostic test for OC in premenopausal women. Posthoc analysis of the accuracy of ORADS and cost effectiveness analysis to inform system implications are ongoing. OS-14 Predicting malignancy for adnexal masses in menopausal women: Comparative study in Tunisia A. Chermiti1; N. Souayeh2; B. Ltifi1; H. Bettaieb2; H. Rouis2; N. Hsayaoui2; M. Nouira3; C. Mbarki2 1University of Tunisel Manar, Faculty of Medicine, Tunis, Tunisia, 2University of Tunis el Manar, Faculty of Medicine, Gynecology and Obstetrics, Ben Arous Regional Hospital, Tunis, Tunisia, 3University of Tunisel Manar, Faculty of Medicine, Epidemiology and Community Medicine, Tunis, Tunisia

Objective

The aim of our study was to compare imaging scores in predicting malignancy for adnexal masses in menopausal women. Design: A multicentric retrospective observational study.

Methods

Our study included menopausal women with adnexal masses. Data was collected between January 2016 and December 2022 in obstetrics and gynecology department of Charle Nicole hospital, Ben Arous hospital and Mahmoud el Matri hospital. Pre-operative evaluation involved clinical examination, imaging findings (ultrasound, CT scan and magnetic resonance imaging (MRI)) and tumor markers. - The international Ovarian Tumor Analysis (IOTA): including 5 simple rules of benignancy or malignancy in ultrasound. - Risk malignancy Index (RMI)-4: this score involve 4 parameters (ultrasound findings, menopausal status, CA125 level and the mass size). - Ovarian-Adnexal Imaging-Reporting Data System (ORADS): the patients were grouped in 5 categories using ultrasound or MRI. All our patients have been operated and histopathological examination was performed confirming or infirming malignancy.

Results

We included in our study 198 patients diagnosed with adnexal mass. The mean age was 58 years old. Pelvic or abdominal pain was the most frequent complain (25.25%). Malignancy was suspected in 40 cases (20.3%) using IOTA score. Fifty-three patients (26.9%) had been classified US ORADS 5. Among the 54 patients having an MRI, 27.8% were classified ORADS 5 MRI. RMI-4 score was > 450 in 24 cases. After surgery, histopathological examination concluded malignancy in 17.7% of cases and the most frequent type was mucinous cystadenocarcinoma. Our study revealed that the orads-MRI score had the highest specificity (100%) and negative predictive value (100%). Regarding ultrasound scores, the simple rules of the IOTA, as well as the orads-US classification, showed a higher negative predictive value compared to the RMI-4 score (99.15%, 98.85%, and 88% respectively). On the other hand, the RMI-4 score exhibited the highest estimated specificity at 96.08%. Additionally, the cut-off of 490 for the RMI-4 score demonstrated the best balance between specificity and negative predictive value, with a sensitivity of 54.45%, specificity of 98.04%, positive predictive value of 85.71%, and negative predictive value of 90.91%.

Conclusions

Managing adnexal masses in menopausal women remains a challenge for all gynecologists due to the increased risk of ovarian cancer. Predictive malignancy scores are considered valuable tools to guide therapeutic decisions. Therefore, treatment decisions should take into account all these factors to ensure comprehensive care. OS-15 International variations in surgical morbidity and mortality post gynaecological-oncology surgery (GO SOAR1) F. Gaba1,2; K. Ash3; O. Blyuss4; N. Bizzarri5; P. Kamfwa6; A. Saiz7; D. Cibula8 1The Royal London Hospital, London, UK, 2University of Aberdeen, Aberdeen, UK, 3Aberdeen Royal Infirmary, Aberdeen, UK, 4Queen Mary University of London, London, UK, 5Fondazione Policlinico Universitario A. Gemelli, Rome, Italy, 6Cancer Diseases Hospital, Lusaka, Zambia, 7Northwestern University, Chicago, USA, 8Charles University and General University Hospital, Prague, Czech Republic

Objective

Gynaecological-malignancies affect women in low-and-middle-income-countries (LMICs) at disproportionately higher rates compared with high-income-countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity-and-mortality following gynaecological-oncology surgery between HIC-and-LMIC settings. Design: Multicentre, international prospective cohort-study of women undergoing gynaecological-oncology surgery (NCT04579861).

Method

Investigators included consecutive patients undergoing curative/palliative-surgery for primary/recurrent gynaecological-malignancies from a 30-day period. To confirm surgical outcome data collected were representative of care received in each country, large/medium/small centres performing gynaecological-oncology surgery were recruited in a 1:1:1 ratio. Multilevel-logistic-regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820-patients from 73-hospitals in 27-countries. In addition, qualitative-data were collected via in-depth semi-structured 1:1 interviews.

Results

Minor-morbidity (Clavien-Dindo I-II) was 26.5% (178/672) and 26.5% (267/1009), whilst major-morbidity (Clavien-Dindo III-V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Mortality was 2.1% (14/672) versus 1% (10/1009) for LMICs/HICs, respectively. Higher minor-morbidity was associated with pre-operative mechanical bowel-preparation (OR = 1.474, 95%CI = 1.054–2.061, p = 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066–1.472, p = 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081–1.502, p = 0.004). Higher major-morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128–1.664, p = 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175–1.664, p ≤ 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major-complication (OR = 2.982, 95%CI = 1.509–5.894, p = 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. Our quantitative-data indicate access to early detection, screening and deficiencies in patient health education contributing to late stage disease presentation and emergency surgery in LMICs. Qualitative-data also show lack of postgraduate training in gynaecological-oncology in LMIC settings with particular difficulties in staff retention compromising care. Our qualitative-data also suggest a culture of exclusion of LMIC-partners from high impact factor international gynaecological-oncology research.

Conclusions

We conclude that LMICs and HICs were associated with similar post-operative major-morbidity. However, policymakers must balance investments in early detection and treatment with concurrent improvements in safe perioperative cancer care, including postgraduate training and retention of clinicians to further reduce morbidity in LMIC settings. In order for research findings to be truly generalizable and to maximise benefit, there must be LMIC representation. Without these measures, mortality gains in gynaecological cancer control will not be fully realised. OS-16 Risk of endometrial cancer for women referred with unscheduled bleeding on HRT C. Wood1; G. Petrovska1; S. Vaseeharan1; E. Eggleton2; M. White2; S. Farooq1; V. Kumar1 1Hampshire Hospitals NHS Foundation Trust, Obstetrics and Gynaecology, Basingstoke, UK, 2University of Southampton, Medical School, Southampton, UK

Objective

Unscheduled bleeding is a common problem for women taking hormone replacement therapy (HRT). There was a 47% increase in HRT use in 2022–23 from the preceding year, placing significant pressure on the fast-track referral pathway. Currently there is no consensus on when to refer for investigations. We have audited the risk of endometrial cancer, comparing those taking HRT to those not taking exogenous hormones. Design: We conducted a retrospective audit for patients referred following an unscheduled bleed after the menopause on the suspected gynaecology cancer 2 week wait pathway from January to December 2022 in a District General Hospital.

Method

Patients were identified by referral code and electronic notes reviewed. Overall, 719 patients with electronic notes available were identified.

Results

Of the 719 patients identified, 43.2% were taking HRT at the time of referral. The average age of patients taking HRT was younger at 56.5 years compared to 60.3 years, and BMI lower at 27.7 compared to 30.3. Average parity was the same for both groups, 1.9 children. In the patients taking HRT, data was collected in 286, 93.3% were using a continuous combined regime and 5.6% a sequential combined regime. Only 2 patients had accidental unopposed oestrogen and both had a normal histology result. The amount of bleeding prior to referral was similar in both groups, those classified as spotting/minor bleeding was 91.0% or major bleeding was 7.7% in those taking HRT; and 93.1% or 5.6% in those not taking HRT. Endometrial thickness was <4 mm in 29.3% of those taking HRT compared to 39.2% in those not taking HRT. Where endometrial thickness was greater than 4 mm, the average was 7.6 mm (range 4–27 mm) in those taking HRT compared to 10.3 mm (range 4–30 mm) in those not taking HRT. The histology showed a lower overall risk of endometrial hyperplasia and endometrial cancer in patients taking HRT, 0.96% risk of complex atypical hyperplasia and 0.96% risk of endometrial cancer; compared to the group not taking HRT who had a 4.4% risk of complex atypical hyperplasia and 6.1% risk of endometrial cancer. In both groups one patient was diagnosed with cervical cancer.

Conclusions

This audit provides valuable information that locally the risk of endometrial cancer remains small in women referred with unscheduled bleeding on HRT at 1% but accounts for 43% of the referrals on the fast track pathway, supporting a change to the referral pathway for these women. OS-18 Improving essential gynaecological healthcare in Bangladesh by introducing EGS implementation package S. Jabeen1; S. Acharya2; M.M. Rahman1; M. Hasan1; E. Rafii-Tabar3; S.R. Chowdhury4; M. Mustufa5; F. Dewan4; S. Akhter4; S. Hall3; M. Khan6; F. Akhter7; W. Siraj8; M.H. Islam9; Q.M. Hossain10; A.B. Siddique1; P. Biswas1; A. Ahmed1; R. Thakar3; H. Shehata3; S. El Arifeen1; A. Alim5; A.E. Rahman1 1International Centre for Diarrhoeal Diseases Research (icddr, b), Maternal and Child Health Division, Dhaka, Bangladesh, 2Royal Collage of Obstetrician and Gynaecologists (RCOG), Glasgow, UK, 3Royal Collage of Obstetrician and Gynaecologists (RCOG), London, UK, 4Obastetrical and Gynaecological Society of Bangladesh, Dhaka, Bangladesh, 5The Government of Bangladesh, Maternal Health Programme, DGHS, Dhaka, Bangladesh, 6World Health Organnization, Dhaka, Bangladesh, 7Save the Children, Bangladesh, Dhaka, Bangladesh, 8Ipas, Bangladesh, Dhaka, Bangladesh, 9UNICEF, Bangladesh, Dhaka, Bangladesh, 10UNFPA, Dhaka, Bangladesh Over the past three decades, in spite of significant progress achieved in improving global women's health, particularly in maternal health, the gynaecological health has largely been ignored. Especially in low and middle-income countries (LMICs) nearly 8% of all years lost to disability (YLDs) from benign gynecological conditions occur in women aged 15–49 years, compared to only 4% in high-income countries. Bangladesh, as an LMIC, faces challenges in providing quality gynaecological services due to shortages of trained healthcare providers, the absence of structured gynaecological data recording systems, and inadequate service delivery areas in the outdoor settings of public health facilities. To address these complex gaps in gynaecological healthcare, an initiative was undertaken to design, develop and demonstrate the Essential Gynecological Skills (EGS) implementation package adapted from EGS training of the Royal College of Obstetricians and Gynaecologists (RCOG) in selected public health facilities of Bangladesh.

Objectives

The object of the work was to assess the implementation outcome of the package. Design: An implementation research was conducted.

Methods

From May 2022 to April 2024, the project activities took place using a four-step stakeholder engagement model (identification, sensitisation, involvement, and engagement). Four facilities were selected from Kushtia and Dinajpur districts as demonstration sites. Training was conducted in a cascade pattern, with expert trainers training non-specialized healthcare providers. WHO's implementation research outcome variables (usability, acceptability, adoption, fidelity, and utility) and WHO's training evaluation guideline were used to assess the implementation and training outcome.

Results

Within the EGS implementation package demonstration period of six months, a total of 12 897 gynaecological patients took treatment from the implementing facilities, indicating a high level of acceptability and demand for the services. The package exceeded benchmarks for all WHO implementation research outcome variables, demonstrating its effectiveness in improving gynecological healthcare. Trainees were reported to be satisfied with the training, facilitators, course content, and environment in a five- point Likert's scale, indicating the quality and relevance of the training program. There was a significant improvement in the knowledge levels of both doctors (p = 0.001) and nurses (p < 0.001) from pre-test to post-test, highlighting the impact of the training on healthcare providers' skills and knowledge.

Conclusion

The demonstration of the EGS implementation package has demonstrated its potential to achieve success. The overall model can be used in different countries with proper conceptualisation coupled with adequate time, resources, commitment and stakeholder engagement. OS-19 Risk factors for obstetric anal sphincter injury and its outcome after repair J. Susan Thomas; A. Anna Biju; M. Mammen Roy Khoula Hospital, Obstetrics and Gynaecology, Muscat, Oman

Objective

To analyse the risk factors associated with third and fourth degree postpartum perineal tears in women who delivered at our Obstetrics department and to assess the long-term outcome following repair of these injuries. Design: An observational, retrospective cohort study. The rationale of this study was that the identification of maternal and perinatal risk factors could help minimize third- and fourth-degree perineal tears during childbirth.

Methods

The study was carried out in women who delivered at the Obstetrics department of Khoula hospital during the period from January 2019 to December 2023. The patients were divided into two groups: Group I, those with a third- and fourth-degree tears, and Group II, the rest of the patients, including those with less severe tears (first- and second-degree tears). Exclusion criteria included Caesarean delivery, Intrauterine fetal death and multiple gestations. In both the groups of patients, the maternal factors (age, gestational age, and parity), obstetric factors (spontaneous/induced delivery, epidural anaesthesia/no anaesthesia, instrumental delivery, performance of episiotomy) and neonatal factors (weight of the newborns, Apgar test values at 1 and 5 min) variables were analysed. The statistical analysis was performed with SPSS version 25. A p-value <0.05 was defined for statistical significance.

Results

During the study period, a total of patients 19 458 who delivered were included in the study. One hundred and eighteen patients had a third- or fourth-degree perineal tear (0.6%). Out of 118 patients, 56 had 3a tear (47.4%), 46 had 3b tear (38.9%), 12 had 3c tear (10.1%), 6 had 4th degree tear (5.08%) and 3 had rectal buttonhole tear (2.54%). For maternal variables, there was associated increased risk of severe perineal tearing in nulliparous women (56%), following induced labour (16%) and instrumental delivery (16.1%). For the neonatal variables, the weight of the newborns has a directly proportional relationship with the risk of severe tears which was significant (p < 0.05). On follow up, majority were asymptomatic (68%).31 patients were lost on follow-up. However, few patients had flatus, fecal incontinence, wound infection and dyspareunia.

Conclusion

Primiparity, induced labour, episiotomy, instrumental delivery, and a birth weight of 3500 g or more were significantly associated with an increased risk of third- and fourth-degree perineal tears. Good training in the proper conduct of normal vaginal and instrumental deliveries would help prevent these injuries to a significant degree thus improving the quality of life and prevention of future operative deliveries due to these complications. OS-20 The impact of BMI on the procedure and outcomes of sacral neuromodulation Y. Durrani; V. Tailor; A. Bhide; V. Khullar; A. Digesu Department of Medicine, Imperial College London, London, UK

Objective

Sacral neuromodulation (SNM) is a treatment for chronic voiding dysfunctions and faecal incontinence. The two-stage procedure is theorised to modulate the sacral nerves that influence the neural reflexes controlling the bladder. The first stage establishes whether patients can demonstrate a ≥50% improvement in bladder symptoms, allowing progression to the second stage. Studies into predictive factors of SNM success are emerging, however, there is limited research regarding the role of body mass index (BMI). We aimed to evaluate whether BMI affects the efficacy of SNM. The null hypothesis was that BMI has no impact on the progression to the second stage of SNM. Design & Methods: This single-centre retrospective analysis compared obese (BMI, ≥30.0 kg/m2) and non-obese (BMI, <30.0 kg/m2) women who underwent the first-stage of SNM for refractory overactive bladder with or without urge urinary incontinence, voiding dysfunction and/or urinary retention. The prerequisites for SNM in this data set included a history of failed conservative, pharmacological or surgical treatments. The primary outcome was successful progression to stage-2 SNM, determined by a ≥ 50% reduction in urinary symptoms during the staged-SNM approach. This was determined using a 3-day voiding diary and quality-of-life measures during the test-phase. Secondary outcomes included postoperative complications and quality-of-life outcomes. Postoperative complications included lead-migration, infection, pain, and undesirable sensations. Quality-of-life measures using the patient-global-impression of improvement questionnaire were compared between the two groups at follow-up. The secondary outcomes were only assessed on those patients who underwent the second-stage of SNM.

Results

51 female patients were identified (obese = 24, non-obese = 27). Both groups had similar stage-1 success (91.67% versus 85.15%, respectively). Obese women experienced a significantly (p = 0.035) lower total-complication rate, than non-obese women. Total-complication rate included lead-migration, infection, pain, and undesirable sensations.

Conclusion

Contrary to the general understanding that increasing BMI correlates to poor surgical outcomes, our primary results suggest that SNM can be successfully implemented in both obese and non-obese patients. This indicates that an advanced BMI alone should not be a reason for exclusion. Additionally, an increased rate of total postoperative complications in our non-obese women, suggests that obesity may be a protective factor during SNM implantation. Nonetheless, the limitations present in our study make it difficult to draw definitive conclusions. This highlights the need for further research with greater standardisation of patient selection and outcome measures to better understand the true impact of BMI on SNM outcomes, which could help develop clearer criteria for SNM patient selection. OS-21 Botox injection for myofascial pelvic pain. A case for a wider indication? M. Batayneh1; P. Toozs-Hobson1; C. Chilaka1; A. Chan2; P. Latthe2; M. Parsons2 1Birmingham Women's and Children NHS Foundation Trust, Urogynaecology, Birmingham, UK, 2Birmingham Women's and Children NHS Foundation Trust, Birmingham, UK

Background

& Objectives: We have previously reported on the utility of Botox into the pelvic floor for treatment of myofascial pain. We aim to present an extended series using our published series as a baseline and comparing subsequent outcomes. Secondly, we aimed to examine the treatment effect based on indication and outcome. A third objective was to estimate the incidence of post operative pelvic pain at our unit. Design & Methods: A retrospective observational case review of patients receiving Botox to the pelvic floor over a 4-year period. The PGII scale was used to evaluate the outcomes.

Results

There were 33 women in our extended series. Our initial baseline cohort demonstrated a 76% positive response rate (1). The subsequent series showed an identical response rate [25/33 (76%)] as ‘very much better’, ‘much better’ or ‘a little better’. All 3 patients with Endometriosis and 2 with an anal fissure were better after Botox. 6/7 women who had had previous mesh surgery responded positively. 4/5 patients who were treated for primary vaginismus improved. Conversely, only 1 of the 3 patients who had posterior colpoperineorrhaphy responded. In terms of estimating the risk of chronic pain after non mesh Urogynaecological surgery, review of the BSUG database indicated that we performed 1455 urogynaecological surgeries during the study period and 9 of these developed subsequent pain. As such, our crude estimate of postoperative chronic pain rate was 0.6%.

Conclusion

We observed a consistent response rate of 76% pain in our extended series. Reassuringly, no patients were made worse, and Botox remains a safe treatment option in refractory pelvic pain. Previous mesh surgery responded well with an 86% response. Whilst our results show a potential role to play in women with primary vaginismus, the role may be more nuanced. Likewise, the role in endometriosis and pudendal neuralgia is yet to be defined and requires more research. Our crude pain rate is likely be an under representation and we would estimate the risk of chronic pain to be between 1 and 3% after non mesh urogynaecological surgery which is in keeping with other estimates (2). Overall, whilst there remains a risk of pain after urogynaecological surgery the results are reassuring that the risk is low, and that Botox is an effective therapeutic option. 1. Int Urogynecol J 2021;32(5):1151–1156. 2. The Lancet 2006;367:1618–1625. OS-22

Abstract

Withdrawn OS-23 TVT-O complication in management of urinary stress incontinence E. Alramsi1; M. Elredy2; M. Fadda2; F. Alharmi3; N. Alguzi3; R. Alawadi3; S. Alkaabi3; H. Alyammahi4 1NMC Royal Women Hospital, Abu Dhabi, United Arab Emirates, 2Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates, 3Cornich Hospital, Abu Dhabi, United Arab Emirates, 4Fakih IVF Center, Abu Dhabi, United Arab Emirates The objective of this study is to examine the short and long-term complications of transvaginal Tension-Free Vaginal Tape-Obturator (TVT-O) procedures. It also explores the correlation between factors like age, body mass index (BMI), 1 menopausal status and patient satisfaction. Design: This retrospective study was undertaken within our specialized urogynecology. Department between February 2020 to 2024. It specifically focused on patients who underwent surgical intervention for stress urinary incontinence utilizing the TVT-O procedure. Following the procedure, patients were slated for four successive postoperative assessments at 1, 2, 3, and 12 months, serving to meticulously monitor and evaluate their progress. Patients who failed to adhere to the scheduled follow-up appointments were excluded from the study. Approval for this investigation was obtained from the Institutional Review Boards.

Methods

The electronic health records of selected patients were scrutinized to gather pertinent data, encompassing demographic details and follow-up records. Patient satisfaction was evaluated based on reports of dryness, absence of stress urinary incontinence symptoms, and negative cough stress tests during postoperative assessments. Descriptive statistics were employed to analyze both continuous and categorical data, with results presented as means and percentages. Further statistical analyses were conducted using Microsoft Excel 2019, with associations considered statistically significant at p < 0.05.

Result

The study included 107 female participants, primarily aged between 40 and 50 years (39.25%) and 50–60 years (27.1%). Most participants were obese (54.21%), of Arab descent (96.26%), and non-smokers (95.33%). Menopausal status varied, with pre-menopausal, peri-menopausal, and menopausal hysterectomy cases comprising 38.32%, 35.51%, 17.76%, and 8.41% of the sample, respectively. The majority reported parity exceeding six (57.94%). Common comorbidities included asthma (16.82%), constipation (22.43%), and diabetes (29.91%) and (30.84%) report none. Pure USI (69.16%) and MUl with predominant stress (30.84%) were prevalent. Within 72 h post-procedure, 2.80% of respondents reported complications, predominantly urinary tract infection (33.3%), numbness (33.3%), leg and back pain (33.3%). Long-term complications were reported by 17.76% of subjects, primarily comprising de novo voiding dysfunction (5.26%), de novo urgency (47.37%), defective healing (10.53%), dysuria (15.79%), numbness (5.26%), and mesh erosion (5.26%). High body mass index (BMI) was associated with increased complication rates, while menopausal status significantly influenced both short-term and long-term complications. Dissatisfaction rates were minimal (0.93%) and lacked statistical significance. Factors such as BMI, menopausal status, and ethnicity exhibited influence on complication rates, while smoking did not yield significant impact.

Conclusion

TVT-O study reveals BMI, menopausal status impact complications and patient satisfaction in stress incontinence. OS-24 Investigating perineal care and obstetric anal sphincter injury rates at two hospitals C. Johnston1; C. Haken2; R. Parker3; S. Muzaffar1 1Royal Hampshire County Hospital, Winchester, UK, 2Basingstoke and North Hampshire Hospital, Basingstoke, UK, 3Royal Hampshire County Hospital, Maternity, Winchester, UK

Objective

Rates of obstetric anal sphincter injury (OASI) were found to be markedly different between two hospital sites within the same trust (5.5% at site 2 vs. 2.6% at site 1) over a 5 month period. This review aimed to investigate whether variation in perineal care in the second stage of labour at both sites was responsible for the discrepancy between OASI rates. Design: This retrospective cohort study of vaginal deliveries without OASI at two hospital sites was performed to assess whether differences in practice could explain the difference in OASI rates. Prior to this study, electronic medical records of patients who sustained OASI from August 2022 to January 2023 were reviewed but no common themes were identified.

Method

A random sample of 50 patients from both sites who delivered vaginally between July 2022 and March 2023 was identified. All patients were nulliparous before this vaginal delivery. Electronic medical records were retrospectively reviewed and data on perineal care (extra midwife at delivery, warm compress use, episiotomy, hands on perineum) was compared between the two sites. This data was further compared to the cohort with OASI.

Results

The site 1 cohort had a much higher rate of warm compress use compared to site 2 (79% vs. 44%). This was also higher than in the OASI cohort (43%). The site 1 cohort also had higher rates of hands on the perineum compared with both the site 2 and OASI cohorts (79% vs. 68% and 63% respectively). The site 1 cohort had a higher rate of an extra midwife present at delivery compared to site 2 (71% vs. 49%). However, this was a lower rate than in the OASI cohort (71% vs. 78%). Overall episiotomy rates were 19% at site 1 and 31% at site 2. These rates are both much higher than in the OASI cohort, which only had a 4% episiotomy rate.

Conclusions

This review has shown wide variations in practice between the two sites, which may reflect the difference in OASI rates. Site 1 had a much higher rate of warm compress use than site 2, which could be one of the contributing factors for a lower OASI rate at site 1. The data from this review can direct future work on reducing OASI rates in our unit, with particular focus on increasing warm compress use in the second stage of labour as per current national guidance. OS-27 Enhancing the induction of labour services at Nottingham University Hospitals NHS Trust M. Wright1; V. Rumyantseva2; F. Barton1; H. Kapaya1 1Nottingham University Hospitals NHS Trust, Nottingham, UK, 2United Lincolnshire Hospitals NHS Trust, Lincolnshire, UK

Background

The UK National Maternity and Perinatal Audit identified Nottingham University Hospitals (NUH) to have higher than expected Induction of Labour (IOL) rates. In addition, the Care Quality Commission (CQC) surveys, highlighted the need for improving the IOL pathways and enhance service effectiveness and safety. To address these concerns, in July 2023, maternity NUH introduced an electronic booking system and implemented weekly multi-disciplinary team (MDT) meetings as an integral part of the IOL decision-making process.

Objective

The study evaluates the impact of electronic pathway and MDT meetings on the IOL service at NUH. Design: A retrospective observational audit was conducted from 1st January 2023 until 31st January 2024.

Methods

Data from the electronic maternity system (BADGERNET) and IOL booking system (CAREFLOW) were extracted using R language. Data quality was enhanced by the IT team, followed by the exploratory analysis using a Quarto workbook. The dataset was divided into pre-implementation (1st January 2023 until 2nd July 2023) and post-implementation (3rd July 2023 until 31st January 2024) periods. The post implementation cohort was further subdivided into two groups to assess the impact of MDT discussions on reducing the IOL requests outside NUH IOL guideline.

Results

While the overall IOL rates showed no significant change in the post-implementation phase (34.3% vs. 34.8%; p = 0.65), there was a non-significant decreasing trend for IOL under 39 weeks (9.5% vs. 9.1%; p = 0.62). However, there was no improvement in the total number of IOL requests outside clinical guidance (12.5% vs. 13.9%; p = 0.38).

Conclusions

Regular MDT communications correlated with a reduction in pre-39 weeks IOL requests, indicating the efficacy of shared learning. Nonetheless, the study emphasises the need of aligning NUH IOL guideline with the national standards to drive further improvements in service delivery. OS-28 Decoding AI's perspective: Comparative analysis of ChatGPT's HPV vaccine recommendations versus OB/GYNs D. Lima; G. Silva; M. Paiva; D. Silva; C. Montellano; M. Pinho; A. Lopes Unidade Local de Saúde do Arco Ribeirinho, Ginecology and Obstetrics, Barreiro, Portugal

Objective

To compare the average likelihood of HPV vaccination recommendations from Chat Generative Pretrained Transformer versions 3.5 (ChatGPT-3.5) and 4 (ChatGPT-4) against average recommendations given by obstetrician/gynecologists (OB/GYNs), focusing on variations in patient age, marital status, and parity. Design: The study involved analyzing responses from ChatGPT versions 3.5 and 4 to eight clinical vignette variations, altering patient age (23 or 33 years old), marital status (in a relationship or single), and parity (first or third child). These vignettes were strategically selected to mirror the conditions of a prior study with 207 OB/GYN participants, aiming to investigate potential disparities in HPV vaccination recommendation practices. The design was selected to evaluate the potential impact of these variables on vaccination advice and to explore AI's capability for delivering consistent recommendations.

Methods

Each clinical vignette was submitted twenty times to both ChatGPT-3.5 and ChatGPT-4 interfaces to assess response consistency. The responses were analyzed for the average likelihood of recommending HPV vaccination on a scale from 0 (definitely would not recommend) to 100 (definitely would recommend). The Mann-Whitney-U test analyzed changes in recommendation likelihood based on age, marital status, and parity. Due to the unavailability of individual data from the prior study, a direct comparison with OB/GYNs' responses was not conducted.

Results

For 23-year-old patients, ChatGPT-3.5 and ChatGPT-4 showed stronger inclination towards recommending HPV vaccination, with average scores of 89 to 90.3 and 95.3 to 98, respectively, compared to the average scores of OB/GYNs (64.5 to 84.6). Similar trends were observed for 33-year-old patients, with ChatGPT versions scoring 80.5 to 89.5 and 88 to 97, respectively, against OB/GYNs' average scores of 53.3 to 68.7. Notably, ChatGPT's recommendations did not exhibit any statistically significant variation when altering marital status, highlighting a contrast to the variability observed in OB/GYNs’ scores.

Conclusions

ChatGPT-3.5 and ChatGPT-4 closely align with HPV vaccine guidelines, offering unbiased recommendations regardless of marital status. Despite the limitations of comparing aggregate data, this study highlights AI's potential in clinical decision-making and patient counseling, promoting standardized patient care. Further exploration of AI's ethical and practical use in healthcare is recommended. OS-29 The application of 3D-printed models in gynecological counseling D. Saleh1; N.A. Mousa1; H. Ibrahim1; A. Hussein1; A. Elmeligy2; H. Salih1; N. Elhadi3; G. Mohammed1 1University of Sharjah, Sharjah, United Arab Emirates, 2McGill University, Montréal, Canada, 3University Hospital Sharjah, Sharjah, United Arab Emirates

Objective

The field of 3D-printing has emerged in the 1970s and has ever since undergone noticeable evolvement and development. In the medical field, 3D-printing has been used in academic education, surgical planning, and clinical counseling. However, 3D-printed models have not been well-studied in the field of gynecology. The aim of this study is to explore potential improvements in patient understanding upon the introduction of 3D-printed uterus models during patient counseling. Design: This study adopts a quasi-experimental study design (pre-post design). Participants were interviewed before and after a session of model-guided counseling. This design permitted the evaluation of any improvement brought by the addition of a 3D model during patient counseling. Data collection took place at the University Hospital Sharjah, United Arab Emirates during September 2022-April 2024.

Method

72 patients visiting the gynecology clinic were eligible and agreed to participate in the study. The study tool is a self-constructed 24-item questionnaire validated by experts in the field. A 3D-printer was used to convert STL files to 3D-printed models of multiple gynecological pathologies such as fibroids, ovarian cysts, polycystic ovaries, and endometrial polyps. Patients received their usual verbal consultation at the gynecologist's clinic followed by a session of 3D-printed model-aided counseling. Their comprehension and understanding were assessed before and after the model-guided counseling session. Descriptive analysis and chi-square tests were conducted.

Results

The participants' mean age was 34.7 years with a standard deviation of 11 years. The understanding of pelvic anatomy significantly improved following the addition of the 3D-printed model, and the average rating of the model-guided consultation was significantly higher than the verbal consultation (p < 0.000). Patient's knowledge about their condition's management prior to the model-guided session was significantly related to their education level (p = 0.023). Healthcare workers displayed better knowledge of their lesions' location (p = 0.018), management plan (p = 0.007), and its potential complications (p = 0.017) prior to the 3D model-guided consultation. Patients receiving their diagnosis for the first time had significantly less understanding of their disease compared to those with a previous diagnosis (p = 0.030). 97.2% of all study participants preferred the future use of a 3D-printed model in upcoming gynecology consultations.

Conclusions

The incorporation of a 3D-printed model for illustration and counseling in a gynecology clinic has shown statistically significant outcomes in terms of patient education and understanding. Therefore, we recommend the future incorporation of 3D-printed models into clinical practice and further exploration of their utility in medical education and pre-operative planning. OS-30 Optimising the potential of Tommys Clinical Decision Support Tool to reduce inequity J. Carter1; D. Anumba2; L. Brigante3; C. Burden4; S. Gillespie5; A. Howell4; V. Komolafe3; S. Pérez Amack5; E. Sheehan5; B. Thilaganathan5,6; M. Viner7; H. Wilson5; J. Sandall1; O.B.O. Tommy's National Centre for Maternity Improvement8 1King's College London, Women and Children's Health, London, UK, 2University of Sheffield, Sheffield, UK, 3Royal College of Midwives, London, UK, 4University of Bristol, Bristol, UK, 5Royal College of Obstetricians and Gynaecologists, London, UK, 6St George's University Hospitals NHS Foundation Trust, London, UK, 7Mothers for Mothers, Bristol, UK, 8Tommy's National Centre for Maternity Improvement, London, UK

Objective

Tommys Clinical Decision Support Tool, a web-based application for assessing risk of preterm birth and placental dysfunction, offers both maternity service user and provider interfaces. The Tool utilises validated algorithms and rule engines and instantly recommends evidenced-based care pathways. This novel intervention has potential to reduce the variation in care that could contribute to the higher rates of preterm birth and stillbirth seen in women and birthing people from ethnic minority and socially deprived groups. We evaluated implementation of Tommys Tool in five early-adopter NHS hospitals to inform a cluster randomised controlled trial. Design: Mixed-methods implementation evaluation.

Method

The NASSS framework (Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability) informed analysis. We used online surveys, semi-structured interviews, focus groups, and aggregate data gathered through the Tool, to investigate: maternity service user and healthcare professional (HCP) experience; barriers and facilitators to implementation; reach (whether particular groups are excluded and why), fidelity (whether the intervention was delivered as intended), and unintended consequences.

Results

1181 women and 112 HCPs participated, completing 1260 online surveys, 8 focus groups and 29 semi-structured interviews (women: n = 24; HCPs: n = 23). Findings highlighted the importance of: ensuring the device was used in routine care management for all eligible service users; top-level and multidisciplinary buy-in; dedicated resources; local champions; clarity in purpose, scope, potential benefits and evidence base; mitigation of double data entry; IT infrastructure optimisation. Findings informed developments of device and implementation strategy including those aimed at addressing digital and social exclusion. These included allowing HCPs to create device profiles for those who had not registered themselves before their booking appointment. Before this feature was introduced the proportion of service users registered on the Tool was ~70%, compared to ~90% afterwards. Proportions of women registered from Asian and black ethnic groups, and those from the most deprived areas (IMD quintiles 1 & 2) also increased after the change, from 14.6%, 5.8% and 40.9% (of all maternity service users), to 16.9%, 14.2% and 52.4%, respectively. Further refinements will include integration with electronic maternity records and translation into non-English languages.

Conclusions

Tommys Tool has the potential to make provision of optimal care easier for HCPs, which could lead to reductions in care inequity and poor pregnancy outcomes. We identified barriers and opportunities to inform an NIHR funded cluster randomised controlled trial which, now addressed, will maximise the chance of trial results being conclusive. OS-31 Novel ultrasound signs for placenta accreta spectrum: Anticipating technical difficulties A. Fazari1,2; R. Alzubaidi1; A. Kamil1; M. Elemam1; A. Ammar1; F.N. Khan1; A. Fahad1; P. Mohamed1; A. Omar3 1Latifa Hospital, Dubai, United Arab Emirates, 2University of Medical Sciences & Technology, Khartoum, Sudan, 3Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE

Objective

Validation of the novel ultrasound signs in the surgical management of the placenta accreta spectrum, specifically the Dubai criteria, Fazari's signs, (L), and Equal signs, and explore their correlation with surgical duration and blood transfusion requirements. Design: This was a prospective longitudinal hospital-based study, we included 75 cases of placenta accreta spectrum conducted at Latifa Hospital, Dubai, UAE.

Methods

Placenta accreta spectrum poses significant risks during pregnancy, requiring accurate preoperative assessment. The Dubai criteria, Fazari's signs, (L), and Equal signs, were documented during the assessment of the placenta accreta spectrum. The surgical technique incorporated the Bird Picking Seeds (BPS) technique. Statistical analysis explored the correlation between those findings, surgical duration, and blood transfusion requirements, reflecting the technical difficulties.

Results

The presence of Dubai criteria, Fazari's signs, (L), and Equal signs correlated significantly with anticipated technical difficulties during surgery (p < 0.05). The surgical duration was prolonged due to the release of adhesions and increased vascularity. Patients meeting Dubai criteria exhibited expected higher blood loss. However, implementing the BPS technique reduced intraoperative blood loss and fewer blood transfusions in approximately two-thirds of cases.

Conclusion

Accurate ultrasound assessment using the Dubai criteria, Fazari's signs, (L), and Equal signs enables the anticipation of technical difficulties associated with the placenta accreta spectrum. Dubai criteria are significantly correlated with prolonged surgical duration and increased blood loss. Implementation of the BPS technique shows promise in reducing blood loss and transfusion requirements. Incorporating these novel ultrasound signs and the BPS technique improves patient outcomes and optimizes surgical complications. OS-32 The role of MRI in secondary screening for placenta accreta E. Golob; J. Gajadhar; T. Datta; K. Burney; S. Lewis; R. Ganapathy Epsom and St Helier NHS Trust, London, UK

Objective

Rates of both Placenta Praevia and Placenta Accreta Spectrum (PAS) are rising. There is significant morbidity associated with PAS and antenatal detection reduces morbidity at delivery. In the UK (UK) there is a move to centralise care of these cases in dedicated units. Incidental diagnosis is more common, in the absence of a regular screening program. In non-specialist hospitals, there is a need to consider adjunct confirmatory diagnostics prior to referral to specialist centres. This is important to ensure capacity management in specialist centres. Ultrasound (US) and Magnetic Resonance Imaging (MRI) have both been used to diagnose PAS with high levels of accuracy with experienced operators. The role of MRI as an adjunct with US has not been clearly defined but is often requested. The aim of this project was to determine whether the use of MRI in addition to US improves the detection rate for placenta accreta in high risk patients. Design/Method: A retrospective analysis of all cases referred for MR imaging as a secondary modality after US to evaluate possible PAS. A total of 41 cases had MRI performed over 13 years with a trend of increasing demand over time.

Results

The series identified eleven cases of PAS. MRI demonstrated a high level of accuracy, similar to published literature, (sensitivity 81.8%, Specificity 86.6%) and correctly reclassified 2 cases as PAS which were considered normal on US. There were 2 cases of PAS which were missed by both US and MRI.

Conclusions

This series demonstrates increasing demand for MRI over time and possibly improved accuracy in this setting. MRI has a role in secondary screening for PAS in non-specialist units. OS-33 Reproductive planning and contraceptive use among women with heart disease in Malawi W. Kumwenda1; S.J. Meja1,2; E. Mwabutwa2,3; M. Kumwenda4 1Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital, Blantyre, Malawi, 2Kamuzu College of Health Sciences, Blantyre, Malawi, 3Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi, 4Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi

Objective

Heart disease is linked to poor maternal outcomes, particularly in low-resource areas. Women with heart disease are advised to limit pregnancies by using appropriate contraception. The objective of this study was to investigate the factors that affect reproductive planning and contraception use among women who have heart disease. Design: This qualitative study was conducted over 3 months with the support of the African Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM). The qualitative approach was adopted to enable a more in-depth exploration of social issues experienced by women living with heart disease.

Method

Participants were recruited from the Chest Clinic at Queen Elizabeth Central Hospital, the largest government-owned tertiary facility in Malawi. Convenience sampling was used to select 25 women with heart disease for in-depth interviews. Additionally, two doctors and a clinic nurse were interviewed to explore the impact of systemic factors on women's reproductive choices and practices. The Health Belief Model (HBM) was used as the theoretical framework for the analysis of the data as it is a useful tool that explains and predicts changes in individual health behaviours. Analysis of the data was completed using Braun & Clarke's reflexive thematic analysis method.

Results

The emerging themes were categorized according to four constructs of the HBM: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. Women who were aware of and concerned about pregnancy complications were more likely to use contraception. This anxiety was heightened by previous pregnancy complications, current symptoms, and knowing other women from the clinic who had died from pregnancy complications. The women in the study believed that good reproductive planning was essential for ensuring a healthy life and providing better care for their children. However, there were several barriers to reproductive planning, including a lack of knowledge about complications, the desire for children, spousal pressure, and fear of contraception side effects and myths. Both healthcare workers and women expressed that preconception care would encourage good reproductive planning.

Conclusions

The results suggest that reproductive health behaviour in women with heart disease has a complex pattern and should always be considered when caring for women with heart disease. When developing interventions to promote the reproductive health of women with heart disease, health programs must always consider factors such as personal, social, and systemic influences. OS-34 A cross-sectional sample study of pregnancy and renal outcomes after renal transplant C. Condon Department of Obstetrics and Gynaecology, Coombe Hospital, Dublin, Ireland

Background

Women receive 40.6% of transplants at the National Kidney Transplant Service located in Beaumont Hospital, Dublin1. Transplantation restores reduced fertility in women with renal disease2. Despite this, pregnancy rates in transplant recipients are lower than the general population3.

Objectives

We performed a cross sectional study of a sample of women of childbearing age who received a transplant between 1989 and 2019, to assess pregnancy outcomes and renal outcomes after pregnancy.

Methods

We obtained a database of women between the ages of 18 and 50 who received a renal transplant between 1989 and 2019. We identified patients who had immunosuppression changed for planning pregnancy. We reviewed the centralised renal Electronic Patients Records (EPR) to collect details of successful pregnancies, pregnancy complications and renal function after pregnancy.

Results

41 patients were identified who were planning pregnancy. 18 patients who never became pregnant, had been lost to follow up or had no documentation on the EPR were excluded. 36 pregnancies were documented in 23 patients. 9 (25%) pregnancies ended in miscarriage. 8 (29%) full term pregnancies were complicated by pre-eclampsia. None of the women required dialysis during pregnancy. 21% (5) required a subsequent transplant after pregnancy. Mean time to repeat transplant after pregnancy was 4.4 years.

Conclusion

This sample provides an insight into pregnancy outcomes of women who received a transplant at Beaumont Hospital. Levels of miscarriage are slightly higher than the general population. Rates of pre-eclampsia are higher than the general population. In those that went onto require further transplant, renal failure was not pregnancy related. OS-35 10 years follow up of women following 2nd Generation Endometrial Ablation S. Gurubasappa; R. Black; S. Bhaskar NHS FIFE, Obstetrics and Gynaecology, Kirkcaldy, UK - To assess the rate of re-presentation of the women to gynaecology with Abnormal Uterine Bleeding (AUB) seeking treatment. - Investigation and management of Post Menopausal Bleeding (PMB) following Endometrial Ablation. Design: Retrospective review of online and paper records of patients who underwent an Endometrial Ablation in District General Hospital, between 1st January 2012 and 31st December 2013.

Method

All women who underwent an Endometrial Ablation for the study period were identified from Theatre records. This was then cross referenced with patients' paper records and online records to collect the data. All women were followed up till December 2023 to identify re-presentation and further management of AUB including post menopausal bleeding.

Results

A total of 83 women were identified from Theatre records to have had an Endometrial ablation between 1st Jan 2012 to 31st Dec 2013. The demographics included age, BMI, parity, previous caesarean sections, risk factors for endometrial hyperplasia. All women in our study had 2nd generation Endometrial Ablation for Heavy Menstrual Bleeding (HMB). The age varied between 27–54 years and nearly 85% were between the age group of 40–50 years. Out of 83 women, 12 were excluded, as in 10 women the ablation was not possible and for 2 women there was no evidence of the operative procedure. 21 (29%) patients presented with AUB, most of them within the first 3 years of their Endometrial Ablation. 15 had HMB, 4 had PMB and 2 patients with intermenstrual bleeding. Of the 15 patients who presented with HMB, 10 patients (66%) had hysterectomy. 9 patients had benign histopathology and 1 had sarcoma. All PMB patients had successful outpatient hysteroscopy and biopsy (3 with normal histology and 1 no sample).

Conclusions

70% of the women had good results following 2nd generation endometrial ablation. Even though 29% of patients presented with AUB, only 14% of them required Hysterectomy. Endometrial ablation in early reproductive years didn’t increase the risk of AUB. Our results supports NICE recommendation, where endometrial ablation should be preferred over surgical option in women with HMB alone who have a uterus no larger than 10 weeks gravid uterus. Published literature suggests rates of re-operation for recurrent menstrual symptoms following endometrial ablation are at least 20% and our results are comparable to published literature. All women with PMB had successful investigation and follow up. OS-36 An RCT comparing ENSEAL and standard bipolar for TLH in large uterus B. Divya; S Murali; M. Dilip Kumar Jawaharlal Institute of Postgraduate Medical Education and Research, Obstetrics and Gynaecology, Pondicherry, India

Objective

Many studies compared various vessel sealing devices in Total Laparoscopic Hysterectomy (TLH). As there are no RCTs comparing energy devices in TLH of large uterus till date, this study was conducted with aim of comparing operative times between ENSEAL, advanced vessel sealing device and standard bipolar in TLH of large uterus. Secondary objective was to compare blood loss, postoperative pain, time to recovery, intraoperative and postoperative complications, surgeon's perception of ease of instrument use and work load using NASA Raw task load index (RTLX) scale. Design: This was a single center randomized controlled trial was conducted in Department of Obstetrics and Gynecology, JIPMER, Pondicherry (December 2019–July 2021).

Method

Considering 20% reduction in operative time to be clinically important, for a power of 80 and confidence interval of 95%, we calculated total sample size to be 38 using operative time for TLH of large uterus from earlier study. Sample size could not be achieved due to ongoing COVID 19 pandemic during study. A total of 33 woman scheduled to undergo TLH for benign gynecological diseases with uterus size >12 weeks were enrolled. After screening for Exclusion criteria of uterus >24 weeks & acute PID, 30 women were randomly allocated to either Group A (standard bipolar group n = 18) or Group B (articulating advanced bipolar device ENSEAL group n = 12) by block randomization with varying block size. Total operative time (T1), Time from cutting of cornual structures to complete transection of bilateral uterine arteries (T2) were recorded along with other parameters and subjects were followed up postoperatively & after 1 month.

Results

Comparison done with Chi square test for categorical variables, Unpaired t test or Mann-Whitney test for continuous variables based on normality of the data. Baseline characteristics were similar with respect to mean age, BMI, Parity, No. of previous C sections, uterine size in weeks and preoperative hemoglobin levels in both groups. Difference in T1 Median was not found to be statistically significant (p = 0.25). However, we found significant difference in T2 (p = 0.03) with Median (IQR) T2 of Standard Bipolar group 61.5 (45–72) min vs. 47.5 (40–56.5) min in ENSEAL group. Estimated blood loss, intraoperative complications, surgeon's perception of workload, postoperative pain, time to recovery were similar in both groups.

Conclusions

Usage of ENSEAL in large uterus was associated with significantly lesser time for resection of cornual structures till bilateral uterine artery. OS-38 Feasibility of same day discharge following total laparoscopic hysterectomy in District General Hospital N. Malik1; B. Sahu2; W. Parry-Smith2; M. Elsheikh2 1Shrewsbury and Telford NHS Trust, Obstetrics and Gynecology, Telford, UK, 2Shrewsbury and Telford NHS Trust, Telford, UK

Introduction

Hysterectomy is one of the commonest gynecologic surgical procedures and an increasing number of hysterectomies are being completed minimally invasively. Previously, hysterectomies have been performed as in-patient operative procedures to manage post-operative pain and monitor post-operative complications such as symptomatic anemia or delayed return of bowel function. Studies have described same-day discharge after laparoscopic hysterectomy to be safe and acceptable and same-day discharge can reduce hospital costs and decrease iatrogenic complications associated with hospitalization such as venous thromboembolic complications due to delayed mobilization or infections.

Objective

A quality improvement project to assess the feasibility of implementing same-day discharge protocols for patients undergoing total laparoscopic hysterectomy (TLH) in district general hospital in west midlands. Design: A quality improvement project was conducted to evaluate success rates of same-day discharge, adherence to pre and postoperative protocols, incidence of complications, readmission rates, and patient satisfaction levels.

Material and methods

The project involved analysing clinical records of patients who underwent TLH for benign and oncological indications over a six-month period (May2023 to October 2023) at shrewsbury and telford NHS Trust. Compliance with multimodal perioperative protocols, readmission rates, and patient satisfaction were assessed retrospectively.

Results

Out of 40 cases of Total laparoscopic hystrectomies, 12 cases (30%) were successfully discharged on the same day. Further analysis revealed that oncological cases had a higher same-day discharge rate (40%) compared to benign cases (12%). Reasons for overnight stay were, anxiety (5 patients), Haematuria (2 patients), Surgeons decision (10 patients), drain insitu (3 patients) social reasons (5 patients) and no reason was documented in three patients. Two patients were readmitted in 24–48 h with pain and infection symptoms.

Conclusion

In gynecology, laparoscopic hysterectomy has become increasingly prevalent due to its minimally invasive nature. This shift aims to enhance patient outcomes and reduce healthcare costs. The findings of this study indicate that same-day discharge following TLH is feasible without compromising patient safety. Key factors contributing to successful implementation include standardized techniques, collaboration with anesthestists and theatre teams, adequate postoperative nursing care, and comprehensive preoperative patient counseling. This study underscores the importance of a coordinated approach involving various healthcare professionals to ensure successful same-day discharge protocols for TLH patients. By optimizing perioperative care pathways and patient education, hospitals can effectively implement same-day discharge practices, thereby improving patient experience and resource utilization. OS-39 Obstetrics and gynaecology residents' attitudes to clinical research: Jordanian multicenter study E. Amaireh1; L. Asfour2; G. Khlaifat1; R. Haddad3; R. Altheeb2; G. Alsheikh4 1Jordanian Ministry of Health, Amman, Jordan, 2Royal Medical Services, Amman, Jordan, 3Al-Balqa Applied University, Obstetrics and Gynaecology, Al-Salt, Jordan, 4Jordan University Hospital, Amman, Jordan

Background

Research conducted in clinical settings is essential for establishing evidence-based practices, helping trainees develop their critical thinking abilities, and enabling them to approach clinical obstacles with inquisitiveness. Nevertheless, attitudes toward research vary significantly across different clinical disciplines, and substantial barriers impede its implementation. Obstetrics and Gynaecology (OBGYN) residency programs confront unique challenges that impede residents' active participation in research endeavours.

Objective

To characterise the prevailing attitudes and identify the primary obstacles that hinder OBGYN residents in Jordan from conducting research, with the aim of providing valuable insights that can aid in enhancing the participation of residents in research activities in the healthcare context of Jordan. Methodology: This cross-sectional observational study targeted obstetrics and gynaecology (OBGYN) residents across various healthcare institutions in Jordan, including public, private, university, and military hospitals. The participants completed a survey, either electronically or on paper, which covered their demographic information, attitudes towards clinical research, prior research involvement, and perceived barriers to research. Data analysis was performed using Jamovi software for Windows (version 2.3).

Results

This study included 165 OBGYN residents of all training levels (1st to 5th), working in governmental, private, university, or military hospitals. The mean age of the participants was 28.7 years, with the majority having obtained their medical degree from a Jordanian university (62.4%). Only 40.6% of the cohort had prior research experience, and 52.2% had a track record of publications in peer-reviewed journals. The involvement of residents in clinical research was not significantly affected by their postgraduate level (p = 0.521). However, residents in university hospitals were found to be more engaged in research compared to their counterparts in public, private, or military hospitals (p < 0.001). Around 50% reported insufficient time as a barrier to research participation, while 45.5% cited workload as the primary obstacle. Additionally, 15.8% cited inadequate funding and resources as a challenge. Despite these barriers, many participants showed positive attitudes toward clinical research, with 63% expressing a strong interest in conducting it. Furthermore, 65% and 50% believed that research should be mandatory in their training and is essential for advancing medical knowledge and improving patient care, respectively.

Conclusion

Despite their high interest in research engagement, OBGYN residents encounter significant barriers. Implementing structured mentorship programs, enhancing research training opportunities, and allocating sufficient resources and funding are recommended solutions to foster a more conducive research environment for OBGYN residents. OS-40 Patient and public involvement in maternal research in low- and-middle-income-countries: Systematic review J. Sheikh1,2; E. Taylor2; R. Watts2; N. Moss3; C. Gillett4; J. Allotey2,4,5; S. Thangaratinam2,4,5; Dame Hilda Lloyd Network 1Guy's and St Thomas' NHS Foundation Trust, London, UK, 2University of Birmingham, Dame Hilda Lloyd Network, Birmingham, UK, 3Queen Mary University of London, Katie's Team, London, UK, 4University of Birmingham, Institute of Metabolism and Systems Research, Birmingham, UK, 5University of Birmingham, World Health Organization Collaborating Centre for Global Women's Health, Birmingham, UK

Objective

Patient and public involvement (PPI) is crucial in promoting high-quality research and ensures that research is relevant and meets the needs and priorities of service users. We identified and characterised PPI strategies reported in maternal and perinatal health research in low- and middle-income countries (LMIC). Design: Systematic review with narrative synthesis.

Method

We searched MEDLINE and Embase databases from 1 December 2017 to 31 December 2022, in addition to grey literature and reference lists for relevant studies. We included studies reporting any maternal and perinatal health research in an LMIC setting that involved pregnant and/or postnatal women or the public in the development, delivery, or dissemination of research. We extracted study characteristics, level of PPI and the impact of PPI and developed a coding framework using an inductive approach. We classified PPI according to the NIHR research cycle: identifying and prioritising; design; development of the grant proposal; undertaking the research; analysing and interpreting; dissemination; implementation; and monitoring and evaluation. The results are presented as a narrative synthesis and as proportions where appropriate.

Results

One hundred twenty-six studies were included (37 LMICs). 48% were qualitative studies (61/126), 26% were interventional (33/126), 25% were observational studies (31/126), and one study reported on research policy-making. The majority of studies focused on antenatal care (67/126). The discussion of PPI was presented in the papers secondary to reporting results and comprised a few sentences. Only one study included PPI members as co-authors. 29% of PPI participants were pregnant and postnatal women (405/1379). For the studies which quantified the level of PPI (41/126), an average of 34 pregnant and postnatal women were involved in PPI (minimum 0; maximum 209). PPI involvement was most common during the design (11/126) stage, followed by undertaking the research (23/126) and then identifying and prioritising (18/126). Most studies did not have evidence of participation in other stages: development of grant proposal (2/126), analysing and interpreting (17/126), dissemination (11/126), implementation (13/126) and monitoring and evaluation (17/126). The impact of PPI was coded in 63 studies, where 67% of studies (42/63) implemented changes to study design related primarily to input and refining of study documents and questionnaires; four studies with PPI input progressed to clinical trials.

Conclusion

PPI involvement in maternal and perinatal health research in LMIC is sparse, with minimal involvement in prioritising, delivering, or reporting research. A suitable framework for establishing and training PPI groups in LMIC is urgently needed. OS-41 Safety and efficacy of intravenous opioid analgesics tramadol fentanyl in labor analgesia A. Nelakuditi1; S. Gottipati2 1Aster Ramesh Hospital, Obstetrics and Gynaecology, Guntur, India, 2Vignan Pharmacy College, Pharmacy Practice, Guntur, India Aim: To assess the safety and effectiveness of Opioid Analgesics (Tramadol + Phenergan) for relieving labor pain during the latent stage of labor, and Fentanyl for managing labor pain during the active stage of labor. To measure the maternal hemodynamic effects, adverse effects profile, pain score, and neonatal outcomes. Design: A prospective observational study was carried out for a period of 6 months in the Obstetrics and Gynecology Department in a tertiary care hospital.

Materials and methods

A total of 130 pregnant women who are undergoing the trial of NVD are taken and the drug (Tramadol + Phenergan) will be given during the latent stage of labor and the drug. Fentanyl will be given during the active stage of labor. Effective pain relief for expectant mothers while balancing the potential side effects and impacts on the labor process is assessed. Inclusion criteria: pregnant women who are undergoing the trial of normal vaginal delivery. Exclusion criteria are: pregnant women undergoing Elective Lower Segment Caesarean Section.

Results

and Discussion: Administration of these opioids was associated with significant pain relief, as evidenced by a marked decrease in pain scores post-administration. Furthermore, opioid use was correlated with shorter durations of the active stage of labor, accelerated cervical effacement and dilation, and reduced rates of emergency cesarean sections, indicating positive effects on labor progression. There were no significant differences in maternal physiological parameters or fetal heart rate among the opioid groups, suggesting their safety profiles. Additionally, opioid administration did not increase the risk of postpartum hemorrhage or cervical dystocia. Birth satisfaction scores significantly improved post-opioid use, highlighting a positive impact on the overall childbirth experience. These findings support the use of intravenous opioid analgesics, particularly fentanyl, in labor pain management, providing effective relief with favorable maternal and neonatal outcomes, in line with previous studies comparing opioid analgesics and emphasizing their safety and efficacy in labor pain management.

Conclusion

Our study findings on Intravenous Labor Analgesia emphasize the essential role of opioid analgesics like tramadol, and fentanyl in ensuring both maternal well-being and favorable delivery outcomes without compromising neonatal health. In low-resource settings where trained anesthesiologists and epidural catheter availability are limited and considering its high cost, we recommend the use of opioid analgesics, with appropriate timing particularly during different stages of labor, due to their cost-effectiveness and potential to provide timely pain relief across various stages of labor for a positive birthing experience. OS-42 Vaginal dinoprostone versus oral misoprostol for labour induction: Individual participant data meta-analysis S. Tan1; P. Dallenbach2; J. Dodd3; A. Deussen3; P. Leroux4; F. Tessier5; D. Young6; D. Croll7; M. Peel1; W. Li8; B.W. Mol1,9 1Monash University, Obstetrics and Gynaecology, Melbourne, Australia, 2Université de Genève, Obstetrics and Gynaecology, Geneve, Switzerland, 3University of Adelaide, Obstetrics and Gynaecology, Adelaide, Australia, 4University of Cape Town, Obstetrics and Gynaecology, Cape Town, South Africa, 5BC Women's Hospital, Obstetrics and Gynaecology, Vancouver, Canada, 6IWK Health Centre, Halifax, Canada, 7University of Utrecht, Obstetrics and Gynaecology, Utrecht, Netherlands, 8University of New South Wales, National Perinatal Epidemiology and Statistics Unit (NPESU), Sydney, Australia, 9Monash Health, Obstetrics and Gynaecology, Melbourne, Australia

Objective

Oral misoprostol or vaginal dinoprostone are commonly used methods of induction of labour (IOL) world-wide. Our aim is to compare the efficacy and safety of oral misoprostol and vaginal dinoprostone for IOL using an individual participant data meta-analysis. Design: An Individual Participant Data Meta-Analysis of Randomized Controlled Trials.

Methods

We conducted a comprehensive search from January 2014 to February 2023, identifying relevant randomized controlled trials. Studies predating January 2014 were identified from the Cochrane Review “Oral misoprostol of induction of labour”. Authors of eligible studies were invited to participate. Primary outcomes were mode of delivery, and a composite of adverse perinatal, and maternal events. We used the ROB2 tool to assess study quality. A two-stage random-effect model was used according to the intention-to-treat principle.

Results

Of the 19 eligible trials, eight provided individual participant data. Three studies were excluded due to concerns over data integrity. In total, 1891 women were included (881 allocated to oral misoprostol, 1010 allocated to vaginal dinoprostone). Vaginal dinoprostone demonstrated comparable efficacy for achieving vaginal birth compared to oral misoprostol (five trials; aOR 0.98, 95% CI 0.79–1.22; I2 0%). There was no significant difference in the composite perinatal outcome (three trials; aOR 1.24, 95% CI 0.57–2.67; I2 37.4%). Vaginal dinoprostone led to a higher rate of composite adverse maternal outcome than oral misoprostol (three trials; aOR 1.35, 95% CI 1.01–1.82; I2 0%).

Conclusions

Vaginal dinoprostone and oral misoprostol were equally effective at achieving vaginal birth and have similar perinatal outcomes. However, women receiving oral misoprostol had fewer adverse maternal outcomes. OS-43 Randomised comparative study of Mifepristone and Dinoprostone gel for induction of labour C. Sherwin; S. Karanth St John's National Academy of Medical Sciences, Obstetrics and Gynaecology, Bangalore, India

Objective

To know the efficacy and safety of Mifepristone in comparison with Dinoprostone gel for induction of labour. Design: Randomised control study.

Method

Participants were all pregnant women who met the inclusion and exclusion criteria. They were selected on the basis of random chits. A total of 200 patients in Mifepristone group and 200 patients in Dinoprostone group were taken. The patients are assessed in the labour room at term. Those patients who have unfavourable cervix or Bishop score less than 4 after assessing the inclusion and exclusion criteria were randomised into Mife group and Dinoprostone group. The Mife group received Tab Mifepristone 200 mg and reassessed after 24 h with Bishop score if there is no improvement they were continued with routine induction with Dinoprostone. The Dinoprostone group received 3 doses of gel 6–8 h interval. The study was done over a period of 2 years from December 2020 to December 2022 in a tertiary care hospital.

Results

Out of 400 patients, 69.5% in Mife group and 49.5% in Dinoprostone group undergone normal vaginal delivery which is statistically significant. The mean induction to delivery interval in Mifepristone group was19.40 h and Dinoprostone group was 15.97 h. 14% babies in Mifepristone group required NICU admission post delivery and 44% in Dinoprostone group which is statistically significant.

Conclusion

Mifepristone is an effective induction agent for cervical ripening with reduced need for prostaglandins and can be administered safely with no adverse effects on the foetus or mother. Patient compliance is better with use of Mifepristone. Multiple pelvic examinations can be avoided. According to our study Maternal and neonatal outcomes were good Mifepristone. OS-45 Sexual assault: A study of 5942 female survivors over a 7-year period D. Kane1,2,3; J. Walshe3,2; N. Maher3,2; K. Flood1; M. Eogan1,3,2 1Royal College of Surgeons in Ireland, Dublin, Ireland, 2Dublin Sexual Assault Treatment Unit, Dublin, Ireland, 3Rotunda Hospital, Dublin, Ireland

Objective

To describe the incident and attendance details of female survivors of sexual assault (SA) at the national Sexual Assault Treatment Unit (SATU) network in the Republic of Ireland. Design: Retrospective cohort study.

Method

All females attending the national SATU network between 2017 and 2023 underwent a standardised data collection procedure, on a national web-based database. Descriptive bivariate analysis and logistic regression analysis were performed on these data. Statistical significance was defined as a p-value <0.05.

Results

During the research period, there were a total of 5942 female attendances to the national SATU network. Those aged 18 and above constituted 79.3% (n = 4712), with individuals aged 18–25 years comprising 38.1% (n = 2263) of this group. 38.1% (n = 2266) of those attending were in full-time education. Forensic examinations were carried out in 76.6% (n = 4549) of attendances, while 11.8% (n = 1274) attended for health checks, and 2% (n = 119) sought advice or other assistance. The majority of attendances occurred within 7 days of the incident (76.4%, n = 4540), with 39.6% (n = 2352) presenting within the first 24 h. The assailant was male in 92% (n = 5469) with multiple assailant assaults reported in 7.3% (n = 435) of cases. Strangers and recent acquaintances accounted for 38.5% (n = 2290) of incidents, while those close to the survivor (friend, intimate partner, or family member) made up 22.9% (n = 1359). Incidents took place at the survivor's home in 22.0% (n = 1306) of cases and at the assailant's home in 22.6% (n = 1342). Drug use within the 24 h prior to the incident was reported in 15.1% (n = 897) of cases, while alcohol use was reported in 72.0% (n = 4276). 14.4% (n = 855) were unsure if a SA had occurred. Drug facilitated SA was suspected by 16.1% (n = 955) of attendances of the study period. The prevalence of injury (genital and extra-genital) was 30.3% (n = 1800). Injuries were significantly more likely in cases where alcohol consumption (RR1.325, CI 1.205–1.457, p < 0.001) or drug use (RR1.111, CI 1.003–1.231, p = 0.04) were disclosed. Injuries were also more likely in those who attended in the first 24 h (RR1.646 CI1.525–1.777 p < 0.001), those over 18 years of age (RR1.07 1.025–1.117 p = 0.003) or incidents occurring outdoors (RR1.24, CI 1.135–1.354, p < 0.001).

Conclusion

This study summarises the significant number of female attendances to a national SATU network. It highlights the settings in which SA can occur and the care needs of those accessing SATU. It emphasises the importance of responsive care and is useful to inform education and mitigation strategies. OS-47 Antibacterial suture to reduce infection in a primary sutured tear at delivery K. Sonnichsen1; P.-E. Isberg2; J. Elers3; N. Wiberg4 1Dept OB/GYN, Skåne University Hospital, Malmö, Sweden, 2Lund University, Lund, Sweden, 3Dept OB/GYN, Sjaelland University Hospital, Roskilde, Denmark, 4Institute for Clinical Science, Lund University, Malmö, Sweden

Objective

Preventing infection in a primary sutured perineal tear after delivery is crucial, but evidence regarding the choice of suture material is lacking. Theoretically, an antibacterial suture should have beneficial properties. The PLUS-study aimed to investigate the efficiency of the antibacterial suture in reducing infection in a primary sutured perineal tear at delivery. Design: The PLUS-study is a single-center, single-blinded, adaptive-parallel-group randomized trial. Detection of a 50% decrease in infection with an estimated prevalence of 10% with a two-tailed test, a significance level of 5%, alpha 0.05, and a power of 80% resulted in a sample size of 960 women (430 in each arm).

Method

Women ≥18 years with a perineal tear at delivery were randomly assigned 1:1 to intervention (triclosan-coated-absorbable suture, VicrylPlus®) or to control (conventional-absorbable suture, Vicryl®).

Results

838 women were enrolled after one year. In the group with a second-degree tear (n = 544), the incidence of infection was 5%. A new power calculation based on an infection rate of 5% showed that 1810 women, 905 in each arm, were needed to obtain power as mentioned. The study continued until 1890 women were enrolled, and randomized to either Vicryl® (n = 953, final analysis 945) or VicrylPlus® (n = 937, final analysis 926). The cruel infection rate was 4.6% (n = 84) and distributed as Vicryl® 5.2% (n = 48) and VicrylPlus® 4% (n = 36) (OR 0.75, 95% CI 0.48–1.17, p = 0.22). After analyzing only grade two tears, the risk for infection was for Vicryl® 7.2% (n = 44) versus 4.4% (n = 27) (OR 0.6 (0.36–0.98), p = 0.05) for VicrylPlus®. In the crude cohort and independent of suture material there was a significant increased risk for infection in primiparas (OR 2.91 (1.65–5.12), p < 0.001), after administration of peri- and intrapartum antibiotics (OR 2.76 (1.52–5.00), p < 0.001) or NSAIDs (OR 2.5 (1.5–4.27), p < 0.001), by episiotomy (OR 8.59 (4.03–18.31), p < 0.001) or by instrumental deliver (OR 4.44 (2.68–7.34), p < 0.001). On the other hand, a previous perineal tear was associated with a decreased risk for infection (OR 0.30 (0.15–0.59), p < 0.001). Body mass index or education level were not associated with higher or lower infection risk.

Conclusions

The crude risk for infection in a perineal tear after delivery is 4.6%. Antibacterial sutures are significantly associated with a reduced infection risk in grade two tears. Regardless of suture material primiparity, peripartum administrated antibiotics, intake of NSAIDs, episiotomy, and instrumental delivery are associated with increased risk for infection. OS-48 The impact of suture material on recurrence rates in prolapse repair surgery S. Nawaz1; M. Iqfat1; S. Siddiqui2; V. Wong2 1Obstetrics and Gyanecology, University Hospital Sussex, Hayward Heath, UK, 2University Hospital Sussex, Haywards Heath, UK

Objective

Pelvic organ prolapse is a condition that affects between 40% to 60% of women who have had children. It is more common for women to experience recurrence of anterior vaginal prolapse repair than posterior vaginal prolapse repair. This study aims to investigate the effect of using slowly absorbable sutures versus rapidly absorbable sutures on the risk of recurrence in both anterior and posterior prolapse surgeries. Design: The study was conducted as a retrospective case note review of 201 patients who had undergone surgery for anterior and posterior repair surgery over a period of five years in the University Hospital Sussex.

Methods

The study recorded the effects of slowly absorbable and rapidly absorbable sutures on the risk of symptomatic prolapse recurrence. Preoperative and postoperative findings were also recorded. A total of 494 surgeries were performed between January 2018 to December 2022, out of which 201 cases were included that were operated by two experienced urogynaecologists. The procedures were undertaken at a single centre by two experienced surgeons and one training fellow. The data was collected from hospital case files and electronically stored data, and analyzed using Excel. Ethical approval was not required as this was a review of standard clinical practice.

Results

The results of the study showed that 186 surgeries were anterior repairs, while 140 were posterior repairs. Slowly absorbable sutures were used in 94 (45%) of anterior repairs and 53 (38%) of posterior repairs, while rapidly absorbable sutures were used in 102 (55%) of anterior repairs and 87 (62%) of posterior repairs. The study found that rapidly absorbable sutures had higher symptomatic prolapse recurrence rates (14% and 2.2%) compared to slowly absorbable sutures (11% and 3.3%) for anterior and posterior repair. No intra-operative visceral injuries were observed.

Conclusion

This study suggests that using slowly absorbable sutures could potentially decrease the risk of symptomatic recurrence after an anterior colporrhaphy compared to using rapidly absorbable sutures. Anterior repair has a higher recurrence rate compared to posterior repair (13.4% vs. 2.8%). OS-49 Medical litigation against obstetric service in Oman – Retrospective review over 12 years J. Santhosh1; M. Al Salmani2; A. Al Asmi3; T. Al Rawahi4; N. Ali Al Hasani4; S. Al Abri5; R. Kayed6; S. Jaju7 1High Risk Pregnancy and General Gynecology Unit, Department of OB GYN, Royal Hospital, Muscat, Oman, 2Fetal Medicine Unit, Department of OB GYN, Royal Hospital, Muscat, Oman, 3Neurology Unit, Medicine Department, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman, 4Gyne Oncology, Department of OB GYN, Royal Hospital, Muscat, Oman, 5Department of OB GYN, Armed Forces Hospital, Muscat, Oman, 6Higher Medical Committee, Muscat, Oman, 7Epidemiology Department of Family Medicine and Public Health, Sultan Qaboos University, COM&HS, Muscat, Oman

Objectives

To analyze the nature of medical litigation cases against obstetric services in Oman from 2010 to 2022 and identify the contributory factors in medical error and malpractice cases. Design: Retrospective observational study.

Method

We included all cases against obstetric services in Oman that were investigated by the Higher Medical Committee (HMC) from January 1st, 2010, to December 31st, 2021. Details of patients and concerned staff were blinded. Researchers extracted data regarding the complaint details, level of care of the facility in question, HMC conclusion, root cause of the medical error or malpractice and recommendations from HMC. Data was analyzed using SPSS version 25. Categorical variables were summarized with frequencies and percentages. Ethical approval-MOH/CSR/22/26657 dated 23/02/2023.

Results

HMC investigated 200 cases during the study period. Cases filed against private care health facilities were 28 (14%), government hospitals included tertiary care hospitals-22 (11%), regional hospitals-128 (64%), secondary care-21 (10.5%) and primary care-1 (0.5%). HMC received complaints through the Ministry of Health, public prosecutor and court system in 97 (48.3%), 45 (24.4%) and 55 (27.4%) cases respectively. The main issues relating to the mothers were organ injury/loss in 47 (21.46%), postpartum hemorrhage in 32 (14.61%), maternal death in 23 (10.50%) and lack of adequate communication by doctors in 32 (14.61%) of cases. Fetal issues included hypoxic-ischemic encephalopathy in 38 (22.48%), fetal death in 33 (19.32%) and neonatal death in 31 (18.34%) cases. Out of 144 complaints related to mothers, medical malpractice (mistake and harm) was identified in 59 (40.97%) cases. Regarding the 116 babies, medical malpractice was identified in 54 (46.55%) cases. Individual errors were the leading cause of medical errors, contributing to 102 (76.11%) cases. Communication issues, lack of organizational knowledge transfer, staffing patterns, inadequate information flow and technical failure were identified as other causes. HMC recommended disciplinary action against the 102 personnel involved. Recommendations to the involved health care facility included developing new policies/guidelines in 8 (7.07%), reinforcing existing policies in 12 (11.5%), improving human resources in 4 (3.53%), improving availability of biomedical equipment in 2 (1.76%), improving continued professional development among staff in 5 (4.42%), conducting clinical audits in 3 (2.65%) and combinations of above said measures in 56 (49.55%) cases.

Conclusion

Maternal death, organ injury/loss, fetal death, and hypoxic-ischemic encephalopathy are the main causes leading to litigation against obstetric services. The HMC recommendations to individuals, and healthcare facilities regarding system improvements aim to contribute to developing the obstetric services in Oman. OS-50 Does selective use of surgical swab prevent scar endometriosis? H. Akhter1; D. Akter2 1CD Path Hospitals Pvt. Ltd., Obs & Gyn, Cumilla, Bangladesh, 2Moynamoti Medical college, Obs & Gyn, Cumilla, Bangladesh

Background

Cesarean section is the most common surgical procedure in obstetrics. We use a number of surgical swabs during the procedure to soak blood and fluid and make the surgical field clear and visible. In Bangladesh, there is no guideline regarding the optimal use of surgical swabs nor there is practice and implementation of WHO check list to complete the swab count. If we use multiple swabs, there are chances of retained swab inside the peritoneal cavity. On the contrary, if we use single swab there are chances of contamination by skin organism inside and contamination of endometrial cells outside. This was an retrospective observation to see relationship between use of surgical swab and scar endometriosis.

Objectives

To find out the appropriate number of surgical swabs during cesarean section to prevent scar endometriosis & wound infection. Design: This retrospective observational study was designed to find out the relationship between the number of surgical swab used & risk of scar endometriosis & surgical site infection.

Method

This was a comparative study for 5 years (2016–2021) between 2 hospitals in private setting in Cumilla, Bangladesh, where one hospital (CD Path Hospital) used single swab and another (Cumilla Diabetic Hospital) three swabs during cesarean section.

Result

Average number of cesarean section were 3500, where we observed number of scar endometriosis were 5 in single swab use (CD Path Hospital). In other hospital (Cumilla Diabetic Hospital) number of cesarean section were 4500 & scar endometriosis was 1 in multiple swab used over the study period. Incidence of surgical site infection was almost same in both hospitals. This study showed the incidence of scar endometriosis is more in single swab used hospital. Possibly the single surgical swab which was used to clean blood & fluid, can contain endometrial tissue which might embedded in skin and subcutaneous that can lead to scar endometriosis.

Conclusion

Scar endometriosis is believed to be a mechanical transplantation. There is no evidence-based recommendation to outline the methods to prevent scar endometriosis. Contamination of endometrial cells using the same swab inside & outside the peritoneal cavity may be a contributing factor. Introduction of WHO check list and use of multiple swabs can be recommended as a preventive measure. This can be one of the hypothesis, we need more robust study in large scale or Randomized controlled trial to establish this hypothesis. OS-51 Letrozole with cabergoline compared to dienogest in management of endometriosis pelvic pain A. Elbareg1,2; F. Essadi3 1Misrata University, Obstetrics & Gynecology, Misrata, Libya, 2Al-Jazeera International Hospital, Misrata, Libya, 3Misrata Medical Center, Obstetrics & Gynecology, Misrata, Libya

Objectives

Endometriosis (EM) is among the most common causes of deep pelvic pain (DPP), in addition to menstrual irregularity, dysmenorrhea (DM) & Dyspareunia (DP). Letrozole (LTZ) prevents peripheral conversion of androgens to estrogens resulting in deactivation of (EM) implants. Cabergoline (CBG) inhibits neoangiogenesis resulting in decreasing (EM) tissue size. Dienogest (DNG) is with an anovulatory, antiproliferative, anti-angiogenic local effects on (EM) lesions. Our aim was to investigate efficacy & safety of combined (LTZ) with (CBG) in comparison to (DNG) alone in treatment of (DPP) caused by (EM). Design: Hospital Based Prospective Controlled Clinical Trial.

Materials

& Methods: (45) patients, mean age of (39.4 ± 6.5 years) diagnosed with pelvic (EM) & suffering (DPP) were enrolled in in the study for 3 months (M), & 3 (M) as follow-up. Exclusion criteria: treatment for (EM) 3 (M) before study including GnRH analogues, PV bleeding of unknown cause, undiagnosed origin of (DPP), and known systemic diseases. Women were divided into 2 groups: (A) [22] received (LTZ) 2.5 mg daily & 0.5 mg (CBG) twice weekly for 3 (M), and (B): [23], received only 2 mg daily (DNG) for same period], all started from 1st day of period. Fortunately, none of patients in (A), but 2 in (B) were lost to follow-up. Assessment of pain severity for (A&B) after 3 (M) by using a 10 cm visual analogue scale, (VAS), recorded & compared with each other. The (VAS) scores categorized as none or mild (0–3), moderate (4–6), and severe (7–10) pain. Complications if any documented. Statistical analysis performed using SPSS packages for Windows. p-value significant if (<0.05).

Results

A total (43) participants were available for analysis (95.5%). The VAS score of DPP after 6 (M) from starting treatment was significantly lower in (A) when compared to (B) (p < 0.032). The reduction of (DM) & (DP) was significantly greater in (A) than (B) (p < 0.011). Quality of life improved significantly in group (A) (p < 0.05). No major side effects were reported in both groups.

Conclusion

Combination of (LTZ) & (CBG) most effectively reduce the severity of (EM)-related pain symptoms in comparison to (DNG) alone with improvement quality of life. Both regimen showed an acceptable safety- profile. OS-52 Are uterine fibroids pro-thrombotic? O. Nzelu1,2; C. Rea3; D. Nana2; J. Patel2; L. Roberts1; J. Ross1; R. Arya1,2; J. Johns1 1King's College Hospital, London, UK, 2King's College London, London, UK, 3East Sussex Healthcare Trust, Sussex, UK

Objective

To investigate pro-thrombotic markers in women with uterine fibroids. Fibroids are the commonest benign tumour, estimated to affect up to 70–80% of women by menopause. Whilst they have a well-documented symptom profile, their link to deep vein thrombosis (DVT) and pulmonary embolism (PE) is less understood. Direct venous compression is a potential causative mechanism, but DVT/PE has been described in women with intramural, non-compressive fibroids. Understanding this association is important because heavy menstrual bleeding is the predominant presenting complaint of women with fibroids and a recognised side effect of the treatment for venous thromboembolism. Thus, these conditions in combination can cause significant morbidity and reduction in quality of life. Design: This was a prospective observational study. 3 groups of women were recruited: 1-controls; 2 – women with fibroids and not on hormonal treatment; 3 – women with fibroids undergoing myomectomy/hysterectomy. Demographic data was recorded. Participants had an ultrasound scan to measure their uterine ± fibroid volumes (Uvol&Fvol) and blood tests including full blood count, d-dimer, fibrinogen and factor VIII activity (FVIII).

Method

35 participants were recruited to groups 1&2 and 24 to group 3 from a London teaching hospital gynaecology clinic. Data was analysed using IBM®SPSS®Premium29. Analysis of variance of means and medians was performed using ANOVA Tukey HSD and Mann-Whitney U respectively. Correlation between independent variables was assessed using Spearman's rank coefficient.

Results

Median age for groups 1, 2 & 3 was 33, 44 & 39.5 respectively. Black ethnicity was prevalent in groups 2&3 (63%&75%) whereas white ethnicity was predominant in group 1 (65.5%). Groups 1 & 2 had significantly different BMI (mean difference 4.15 kg/m2, p = 0.005) and Uvol (median 51 vs. 148 mls, p < 0.001). Groups 2 & 3 had significantly different FVIII (mean difference 41.85 iU/dL, p = 0.005), Fvol (median 45 vs. 559 mls, p < 0.001) and d-dimer levels (median 237 vs. 388 ng/ml, p = 0.002). Groups 1 & 3 had significantly different BMI (mean difference 5.14 kg/m2, p = 0.001), haemoglobin (Hb) (mean difference −6.95 g/dL, p = 0.015), FVIII (mean difference 67.15 iU/dL, p < 0.001), fibrinogen (mean difference 0.51 g/L, p = 0.019) and d-dimer (median 220 vs. 388 ng/ml, p < 0.001). Fvol was negatively correlated with Hb (r = −0.284, p = 0.029) and positively correlated with FVIII (r = 0.427, p < 0.001) and d-dimer (r = 0.474, p < 0.001).

Conclusions

The negative correlation between Fvol and Hb suggests menorrhagia worsens with increased Fvol. D-dimer – a marker of haemostatic activation associated with increased risk of recurrent DVT/PE – was positively correlated with Fvol. Increased FVIII is a risk factor for first and recurrent DVT/PE and activity was positively correlated with Fvol. These findings suggest a pro-thrombotic state associated with increasing Fvol. OS-53 Ultrasound assessment of adnexal masses in pregnancy J. Gaughran1; C. Magee1; S. Mitchell1; C. Knight1; A. Sayasneh2 1Guy's & St Thomas' Hospitals, Women's Health, London, UK, 2Guy's & St Thomas' Hospitals, Surgical Oncology, London, UK

Objective

To prospectively assess the nature of adnexal masses being diagnosed during pregnancy, and assess whether ultrasound was a reliable and accurate means of assessing and monitoring these. Design: A single centre prospective observational cohort study was conducted. Patients with an incidental finding of an adnexal mass detected at, or prior to the 12-week routine antenatal ultrasound scan were eligible. A detailed ultrasound assessment of the mass was performed by a level II gynecology ultrasound practitioner at the time of detection; 12 weeks; 20 weeks and 6 weeks postpartum. The following information was recorded/calculated: patient demographics; subjective impression of each mass; International Ovarian Tumor Analysis (IOTA) simple rules classification; resolution and intervention rate; incidence of complications related to the adnexal mass and the agreement between ultrasound and MRI and histology.

Results

A total of 274 participants were included in the analysis, giving an adnexal mass count of 282. The incidence of adnexal masses was 0.01%. The mean age at diagnosis was 32.03 years (95% CI: 31.45–32.61). Subjective impression was as follows: simple 208/274 (75.91%); dermoid 25/274 (9.12%); endometrioma 18/274 (6.57%); hemorrhagic 9/274 (3.29%); para-ovarian 7/274 (2.56%); torted simple 2/274 (0.73%); decidualised endometrioma 1/274 (0.37%); fibroma 1/275 (0.4%); theca luteal 1/275 (0.4%) and mucinous BOT 2/274 (0.74%). There was an overall significant reduction in the volume of the adnexal masses by the time of post-partum scan (mean reduction of −11.78 cm3, p = 0.0026). A total of 74.2% of masses resolved spontaneously. MRI was used in 1/274 (0.37%). Surgery was performed antenatally in 2/14 (14.29%), at the time of Caesarean Section in 6/14 (42.86%) and post-partum in 6/14 (42.86%). In 3/247 (1.2%) participants there was a recorded complication due to the mass. Using IOTA simple rules, 272/274 (99.27%) were classifiable and 2/274 (0.73% were unclassifiable (p < 0.0001). Only 1/274 (0.37%) had malignant features as per IOTA (p = 0.05). Due to the fact that there was no histologically confirmed malignancy in this cohort the accuracy of IOTA simple rules could not be calculated.

Conclusions

Adnexal masses in pregnancy are uncommon and the vast majority self-resolve by the second trimester. Malignancy is rare, as are complications directly related to the adnexal mass. Based on this, we propose there is no role for the routine assessment of the adnexa during the 12-week antenatal scan. In light of this studies’ inability to assess the reliability of IOTA simple rules in pregnancy, further prospective work is required. OS-55 Isthmocele determinants, what are the odds? A cross-sectional study A.Q. Ghazi; H.H. Elgammal; M.S. Swelem; A.F. Galal Alexandria University, Alexandria, Egypt

Objective

Evaluate the most influential factors affecting isthmocele prevalence and the odds for each. Design: Prospective cross-sectional study conducted at Elshatby University Hospital, Alexandria, Egypt.

Method

300 cases were recruited and divided into two groups; elective group (150 cases) and emergency group (150 cases).Cases had been reviewed after 12 weeks from last CS using 2D TVUS with expert supervision. The uterus and uterine scar had been examined in a standardized way. The uterus had been screened for the presence of isthmocele using parallel sagittal planes and also transverse planes until the largest isthmocele depth is defined. The residual myometrium and the adjacent normal myometrium had been measured. Statistical analysis was performed using IBM SPSS software package version 20.0. The used tests were: Chi-square test, Fisher's Exact or Monte Carlo correction, Student t-test and Logistic regression.

Results

Isthmocele following elective CS 17.6% versus 20% following emergency CS. History of more than one CS is associated with significantly higher risk of CS isthmocele (p-value 0.046). History of > 4 CSs is associated with 600% increase in isthmocele risk (p-value 0.006). EmCS cases are 2 times more vulnerable to develop isthmocele compared to ElCS. Mother age at delivery poses no risk (p-value 0.982). However, with each week of gestational age, there is 12.7% risk increase of isthmocele.

Conclusions

Isthmocele prevalence doesn't differ with CS type (emergency versus elective). The prevalence significantly increases hand in hand with the increase in CS order. The risk multiplies with consecutive CSs reaching up to 6 folds risk in cases with history of four or more CSs. RVF uteri have 2.26 folds risk for developing isthmocele compared to AVF uteri. OS-56 Vaginal continence devices versus pelvic-floor-muscle-training for female stress-urinary-incontinence: Systematic-review and meta-analysis M. De Gouveia De Sa1; A. Mostafa2; M. Lamackova2; M. Abdel-Fattah2 1NHS Grampian, Gynaecology, Aberdeen, UK, 2University of Aberdeen, Aberdeen, UK

Objective

To evaluate the clinical efficacy, safety and cost-effectiveness of self-inserted vaginal continence devices (VCDs) as a non-surgical treatment option for female stress urinary incontinence (SUI) compared to pelvic floor muscle training (PFMT) in the treatment of female SUI. Design: A Systematic review and meta-analysis.

Method

Literature search was performed for all RCTs and quasi RCTs comparing VCDs to placebo/no treatment versus PFMT and VCDs and PFMT versus PFMT alone. The literature search had no language restrictions and was conducted on 1st September 2023 and will be updated closer to the conference. Authors were contacted for any missing data. The primary outcomes assessed were the subjective (patient-reported) and objective cure/improvement rates up to 12-month follow-up. The secondary outcomes included women's quality of life, sexual function, discomfort or pain, compliance with continence device and adverse effects. Risk of bias across studies was assessed using risk of bias tables and the GRADE methodology was used to subjectively assess quality of included studies and certainty of outcomes. Sensitivity analyses were undertaken by removing studies with high risk of bias or unclear quality. Data were analysed using Review Manager 5.4.1.

Results

Six RCTs were identified (n = 613 participants)1–6. Five RCTs1–5 compared VCDs with placebo or no treatment and one RCT6 compared VCD and PFMT versus PFMT alone. Our meta-analysis included 4 RCTs that used pad-weighing tests as primary endpoint. This showed statistically significant results favouring VCDs (RR 3.64, 95%CI 1.72 to 7.69). Caution is required as all RCTs were small (maximum n = 72), with high risk of bias. Three2–4 were single-centred and two1,5 were funded by the device company. One RCT6 published in 2010 compared one type of vaginal pessaries (continence dish/ring) plus PFMT versus PFMT alone. At 3-month, combined PFMT and pessary was significantly better than PFMT alone (RR 1.10, 95%CI 0.88 to 1.38). This study evaluated an old technology which is different to the current VCDs and had high drop-out rates (40%). In addition, it only reported subjective outcome and did not assess objective outcomes. The literature search and meta-analysis will be updated closer to the conference.

Conclusions

Based on the current evidence, VCDs show promise as a potential adjunct to PFMT for managing SUI. Despite encouraging results, the lack of robust, large-scale RCTs emphasises the need for further research to ascertain the long-term efficacy, safety, and cost-effectiveness of VCDs compared to standard treatments. OS-57 CO2 laser therapy for management of stress urinary incontinence in women B. Hafidh1; S. Baradwan1; H. M Latifah1; A. Gari1,2; H. Sabban1,3; H. Hassan Abduljabbar1; A. Tawfiq1; G. Farouk Hakeem1; A. Alkaff1; N. Alzawawi1; R. Iskandarani1; K. Khurshid1; K. Aisha Syed1; A. Y Alkhiary1; I. Abdulaziz Bukhari4; M. Al Baalharith5; A. Abu-Zaid6 1Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, 2Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia, 3Department of Obstetrics and Gynecology, King Abdulaziz University Rabigh Medical College, Jeddah, Saudi Arabia, 4Department of Obstetrics and Gynecology, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia, 5Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, Saudi Arabia, 6Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

Objective

To examine the efficacy of Carbon dioxide (CO2) laser therapy for management of stress urinary incontinence (SUI)-related symptoms in women. Design: A systematic review and meta-analysis of randomized controlled trials and cohort studies.

Method

Four databases were screened until January 2023. All efficacy continuous endpoints were assessed via subtraction of the posttreatment from pretreatment values. The data were summarized as mean difference (MD) with 95% confidence interval (CI) using the random-effects model.

Results

A total of 15 studies with 700 patients were analyzed. CO2 laser therapy significantly decreased the 1-h pad weights at 3 months [n = 5 studies, MD = −3.656 g, 95% CI (−5.198, −2.113), p < 0.001], 6 months [n = 6 studies, MD = −6.583 g, 95% CI (−11.158, −2.008), p = 0.005], and 12 months [n = 6 studies, MD = −3.726 g, 95% CI (−6.347, −1.106), p = 0.005]. Moreover, CO2 laser therapy significantly decreased the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form Scores at 3 months [n = 10 studies, MD = −4.805, 95% CI (−5.985, −3.626), p < 0.001] and 12-months [n = 6 studies, MD = −3.726, 95% CI (−6.347, −1.106), p = 0.005]. Additionally, CO2 laser therapy significantly decreased the Pelvic Floor Impact Questionnaire scores at 6 months [n = 2 studies, MD = −11.268, 95% CI (−18.671, −3.865), p = 0.002] and 12 months [n = 2 studies, MD = −10.624, 95% CI (−18.145, −3.103), p = 0.006]. Besides, CO2 laser therapy significantly decreased the Urogenital Distress Inventory-6 scores at 3 months [n = 2 studies, MD = −21.997, 95% CI (−32.294, −11.699), p < 0.001], but not at 6 months [n = 3 studies, MD = −3.034, 95% CI (−7.357, 1.259), p = 0.169]. Lastly, CO2 laser therapy significantly increased the Vaginal Health Index Score at 6 months [n = 2 studies, MD = 2.826, 95% CI (0.013, 5.638), p = 0.047] and 12 months [MD = 1.553, 95% CI (0.173, 2.934), p = 0.027].

Conclusion

CO2 laser therapy improved the SUI-related symptoms in women. To obtain solid conclusions, future studies should be well-designed with standardized settings, consistent therapeutic protocols, and long-term follow-up periods. OS-58 Squamous cell carcinoma antigen levels in women with cervical cancer M. Isikhuemen; M. Ezeanochie; C. Okonkwo; F. Okonofua University of Benin Teaching Hospital, Benin, Nigeria

Objective

Globally, cervical cancer is one of the most common cancers among females with 604 000 new cases and 342 000 deaths annually. It is a disease of public health importance. Detection of a tumour specific antigen may be useful in the detection and early management of the disease The squamous cell carcinoma antigen a glycoprotein produced in squamous epithelial cells, could serve as a tumour marker in the diagnosis and management of cervical cancer. The aim of this study was to compare the serum levels of squamous cell carcinoma antigen in women with cervical cancer with normal non-cancerous controls and to identify its clinical and sociodemographic correlates. Design: This was a comparative cross-sectional study between women with histologically confirmed squamous cell carcinoma of the cervix and women without cervical cancer at the University of Benin Teaching Hospital in Nigeria.

Method

Eighty women were recruited for the study, which consisted of 40 cases of cervical cancer and a comparative group of 40 women without cervical cancer. Levels of squamous cell carcinoma antigen were determined by enzyme-linked immunosorbent assay (ELISA). Data was analyzed using the Statistical Package for Social Sciences (SPSS) for Windows, version 27.

Results

There was a statistically significant difference in the mean ± SD squamous cell carcinoma antigen levels in women with cervical cancer (0.7 ± 0.5 ng/mL) and those without cervical cancer (0.4 ± 0.2 ng/mL) (p = 0.0003). Using a cut off value of 0.45, the sensitivity of SCCA was 75% while specificity was 70%. Its positive predictive value was71.4% while the negative predictive value was 73.7%. The stage of disease, parametrial involvement, metastasis, body mass index, age, parity, alcohol consumption and menopausal status did not significantly affect levels of the tumour marker.

Conclusions

The serum levels of squamous cell carcinoma antigen are elevated in Nigerian women with cervical cancer compared to those without cervical cancer. Sociodemographic factors and extent of disease do not appear to significantly affect levels of the tumour marker. Routine estimation of the antigen may be useful in determining the presence and severity of cervical cancer in countries with limited routine cervical screening programmes. OS-59 Atypical endometrial hyperplasia & endometrial cancer: Non-surgical management and its outcomes A. Rafiq; S. Kasture; S. Mathukumar; N. Das Sherwood Forests Hospitals NHS Foundation Trust, Obstetrics & Gynaecology, Sutton-in-Ashfield, UK

Objective

To evaluate the management and outcomes of women being conservatively managed after the diagnosis of atypical endometrial hyperplasia or stage 1 endometrial cancer. Design: It was a retrospective review. It allowed us to identify the cases that were managed conservatively and to evaluate the investigations they had had and their outcomes as well.

Method

Cases diagnosed with "Atypical Endometrial Hyperplasia (AH)" OR "Endometrial Cancer (EC)" between January 1st 21019 to December 31st 2023, who DID NOT have a hysterectomy, were identified with the help of the clinical coding department. Case notes were reviewed and those diagnosed with stage 2 or higher cancer were excluded. Using a proforma, the data was collected about demographics, risk factors, the reason for conservative management, follow-up investigations, and final outcome. Data was analyzed using Microsoft Excel.

Results

A total of 23 cases were included in the study. There were 5 cases of atypical endometrial hyperplasia (AH) and 18 of Stage 1 Endometrial Cancer (EC). Two patients declined hysterectomy for fertility preservation reasons, while the rest were not suitable for surgery due to different health concerns. When diagnosed, the average age was 63.6 years (Range 30–86) and the average BMI was 37.0 (R 18–55, Median: 38.5). Management plan for all EC patients was discussed and agreed in Gynae Oncology MDT. 11 patients had hysteroscopic resection of the visible lesion. Different progesterone treatments, alone or combined, were used to treat the endometrial pathology, which included Megestrol Acetate (06), Medroxyprogesterone (04), and LNG-IUS (07). In 06 cases a combination of these treatments was used. For AH cases, follow-up endometrial biopsies with or without hysteroscopy were arranged at 3 and 6-month intervals. One case of AH was negative at 3 months, while the other 04 cases became negative at 6 months. Out of 18 EC cases, 11 were referred to Oncology and 06 received Radiotherapy. Out of 18 cases of EC, One became negative at 6 months, and two progressed to an advanced stage after 12 months. The rest are still under surveillance.

Conclusion

Progesterone treatment with regular monitoring and biopsies can be offered conservative management of AH, in carefully selected patients. In cases of Stage 1 EC, that are not suitable for surgery, after MDT discussion an individualized treatment plan should be made involving oncology input and patient's preferences. OS-63 To study expression and role of EGR2 gene in term LBW newborns U. Pandey1; G. Rai2; A.R. Konakondla1; H. Myoki2 1Banaras Hindu University, Obstetrics and Gynaecology, Varanasi, India, 2Department of Molecular and Human Genetics, Institute of Science, Varanasi, India

Objective

Annually, >80% of the world's 2.5 million newborns who die are LBW, and one in seven newborns are born with LBW worldwide (UNICEF-WHO, 2015). India alone contributes 40% of the global LBW burden. Relative expression of EGR-2 regulates macrophage versus neutrophil cell fate during hematopoiesis. EGR-2 along with another transcription factor GFI-1 represents a conserved counter-regulatory switch that functions to resolve mixed lineage gene expression patterns and thereby regulate cell fate determination in a variety of developmental contexts. Evaluating the expression of the EGR-2 gene in LBW newborns would help in understanding the underlying mechanism of impaired hematopoiesis and innate immunity in them. Design: Total RNA was isolated from 1 mL of cord blood sample using Trizol reagent. The choloroform-isoproponal method was used to isolate RNA from samples. Concentration was measured using NanoDrop instrument. Quantitative Real-time PCR: One-step real time PCR was performed using One Step TB Green®PrimeScriptTM RT-PCR Kit. 0.5 μg RNA was used as a starting template. EGR-2 and β-actin primers (β-actin is used for normalization), were used to amplify the gene. Data interpretation: The comparative Ct method was used to interpret the data. Relative expression of each gene among LBW and NBW was determined using formula, Fold change = 2−ΔΔCt, where ΔCt = Ct (EGR2) – Ct (Beta actin) and ΔΔCt = ΔCt(LBW) − ΔCt(NBW). T-test analysis was done to interpret the data. (p = 0.0499) (Ct- cycle threshold).

Method

Using quantitative real-time polymerase chain reaction (RT-PCR), the expression level of the EGR-2 gene in cord blood samples from women with term gestation and LBW newborns (<2500 g) was determined and compared to gene expression levels in cord blood samples from women with term gestation and NBW newborns (≥2500 g). The comparative Ct method was used to interpret the data.

Result

Expression of the EGR-2 gene in cord blood-derived RNA of term NBW and LBW newborns (n = 8). Fold change was represented as 2−ΔΔCt, where ΔCt = Ct (target gene) − Ct(beta-actin) and ΔΔCt = ΔCt (LBW) – ΔCt (NBW). *p < 0.05 vs. NBW.

Conclusion

The EGR-2 gene is an important zinc finger transcription factor that plays regulatory roles in hematopoiesis and multi-lineage cell differentiation. The regulatory circuit of the EGR-2 gene redundantly regulates macrophage versus neutrophil cell fate choice. Lower expression of the EGR-2 gene in LBW newborns as compared to NBW newborns suggests impaired hematopoiesis thereby affecting the differentiation of immune cells. OS-64 Knowledge and awareness regarding Human Papillomavirus Vaccines in adolescent girls and mothers A. Anand1; Y. Mala2; S. Tyagi2; P. Sharma3 1Maulana Azad Medical College, Delhi, India, 2Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India, 3Department Of Community Medicine, Maulana Azad Medical College, Delhi, India

Background

Cervical cancer is the fourth most prevalent cancer in females globally and second most common in India. Lack of awareness about cervical cancer, its etiology, and preventive measures are barriers to cervical cancer control.

Objectives

To study the knowledge, attitudes, and practices of secondary school girls and mothers regarding cervical cancer, its vaccine, and the preventive strategies available for reducing its prevalence and factors affecting the same and to study the effectiveness of the intervention in improving awareness. Design: A quasi-experimental study was performed amongst secondary school girls of age groups 15–18 years and their mothers. Assuming a dropout of 10%, the sample size was calculated at a confidence interval of 95% and power of 80% to be 63.

Methods

110 consenting adolescents and 100 mothers were subjected to a pre-interventional questionnaire to assess baseline knowledge and attitudes towards cervical cancer, HPV (human papillomavirus) vaccine, and cancer preventive strategies. This was followed by provision of educational material on cervical cancer on the same day. A post interventional survey was done amongst the population after a minimum gap of 2 weeks to determine the efficacy of the print media. Printed educational material was prepared using information from various government sources and PubMed indexed research articles.

Results

91 adolescent females and 82 mothers belonging to a diverse demographic profile completed the study. Pre-intervention findings revealed a notable baseline awareness of cervical cancer among participants, albeit with a limited understanding of associated symptoms and preventive measures, including HPV vaccination. Post-intervention knowledge regarding the symptoms of cervical cancer was found to increase significantly in both groups. (p (daughters) = 0.000, p (mothers) = 0.041). The awareness about early detection of cervical cancer increased significantly in both groups. (p (daughters) = 0.027, p (mothers) = 0.002). Knowledge about pap smear tests increased among daughters (p = 0.000). There was a significant increase in vaccinated adolescent girls at the end of the study (pre-intervention = 23.1%; post-intervention = 31.9%; p = 0.045).

Conclusion

Post-intervention, significant improvements were observed in both groups regarding the awareness of cervical cancer symptoms and early detection of cervical cancer. The awareness regarding pap smears and centers for early detection of cervical cancer showed significant improvement. Lastly, a positive change was noted in the number of vaccinated individuals before and after the study. OS-65 Prediction of early pregnancy viability in pregnancies of uncertain viability on ultrasound O. Nzelu1,2; A. Ucyigit3; E. Doran2; D. Nana2; J. Johns1; J. Ross1 1King's College Hospital, London, UK, 2King's College London, London, UK, 3Epsom & St. Helier University Hospitals NHS Trust, Obstetrics & Gynaecology, London, UK

Objective

To develop a new prediction model for predicting pregnancy viability in a population of patients with pregnancies of uncertain viability (mean gestational sac diameter <25 mm without a visible embryo, or an embryo measuring <7 mm without cardiac activity). Providing women with a numerical prediction of viability has been shown to be acceptable and useful in reducing anxiety while they await their follow-up scan, but the model in use was derived before the definition of miscarriage was changed in 2012.

Method

This was a prospective observational study of 220 women with a diagnosis of pregnancies of uncertain viability following an ultrasound scan. Eleven independent variables were analysed in two stages using logistic regression – maternal age, body mass index, smoking status, gestational age, bleeding status, pain score, gestational sac diameter, yolk sac diameter, crown-rump-length, serum progesterone and beta hCG. First, the association between each variable and pregnancy viability was assessed in a series of univariable analyses. Subsequently, the joint association between the factors and a viable pregnancy was examined in a multivariable analysis. A backwards selection procedure was adopted in the final model by omitting non-significant variables, one at a time, so that only factors associated with pregnancy viability were retained.

Results

Maternal age [OR 0.36 (95%CI 0.23–0.57, p < 0.001)], gestational age [OR 0.38 (95%CI 0.24–0.62, p < 0.001)], mean sac diameter [OR 1.72 (95%CI 0.93–3.18, p = 0.08)], presence of a yolk sac [OR 4.53 (95%CI 1.81–11.3, p = 0.001)], and serum progesterone [OR 2.33 (95%CI 1.60–3.38, p < 0.001)] were independently associated with pregnancy viability. The following model was devised to produce a probability score p = ey/(1+ey) where p = probability of a viable pregnancy, e = exponential function (inverse log) and y = 8.488 – 0.205.age – 0.960.gestational age + 0.109.sac diameter + 1.510 (if yolk sac present) + 0.042 progesterone.

Conclusion

We have successfully produced a prediction model for pregnancy viability based on maternal age, gestational age, mean sac diameter, presence of a yolk sac and serum progesterone and a prospective validation study is currently underway. This could be integrated into clinical practice in Early Pregnancy Units. OS-67 The effects of low-dose aspirin on preterm: A systematic review and meta-analysis S. Baradwan1; A. Tawfiq1; G. Farouk Hakeem1; A. Alkaff1; B. Hafidh1; Y. Faden2,3; K. Khadawardi4; S. H Abdulghani5; H. Althagafi6; A. Abu-Zaid7 1Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, 2College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia, Jeddah, Saudi Arabia, 3King Abdullah International Medical Research Center, Jeddah, Saudi Arabia, Jeddah, Saudi Arabia, 4Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia, 5Department of Obstetrics and Gynecology, Security Forces Hospital, Riyadh, Saudi Arabia, 6Department of Obstetrics and Gynecology, King Abdulaziz University Rabigh Medical College, Jeddah, Saudi Arabia, 7Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

Objective

To systematically examine and clarify whether the low dosage of aspirin (LDA) (<160 mg/day) can play a preventive role in preterm birth (PB). Design: A systematic review and meta-analysis of randomized controlled trials.

Methods

Five databases were screened from their inception until June 25, 2023. All kinds of clinical trials that examined aspirin's effects on PB parameters were included. Statistical analyses were conducted using STATA version 17.0 (Stata Corp, College Station, TX). p-value less than 0.05 were reported as statistically significant. The randomized controlled trials (RCTs) were assessed for quality according to Cochrane's risk of bias tool. The endpoints were summarized as risk ratio (RR) with 95% confidence interval (CI).

Results

Overall, 40 RCTs were analyzed. LDA significantly decreased the risk of PB <37 weeks (RR: 0.91, 95% CI: 0.87, 0.96, p < 0.001, moderate certainty of evidence) with low between-study heterogeneity (I2 = 23.2%, p = 0.11), and PB < 34 weeks (RR: 0.78, 95% CI: 0.61, 0.99, p = 0.04, low certainty of evidence) with high between-study heterogeneity (I2 = 58.3%, p = 0.01). There were no significant differences between both groups regarding the risk of spontaneous (RR: 0.94, 95% CI: 0.83, 1.07, p = 0.37) and medically indicated (RR: 1.28, 95% CI: 0.87, 1.88, p = 0.21) BP < 37 weeks. Results of the sensitivity analysis revealed robustness for all outcomes, except for the risk of PB < 34 weeks. For PB < 37 weeks and PB < 34 weeks, publication bias was detected based on visual inspection of funnel plots for asymmetry and statistical significance for Egger's regression test (p = 0.009 and p = 0.0012, respectively).

Conclusion

LDA can significantly reduce the risk of PB < 37 and < 34 weeks. Nevertheless, further high-quality RCTs conducted in diverse populations, while accounting for potential confounding factors, are imperative to elucidate the optimal aspirin dosage for preventing preterm birth and to arrive at definitive conclusions. OS-68 Effect of N-acetyl cysteine on PAF-AH activity in semen in male infertility J. Jain; A. Singh; R. Aggarwal; S. Garg University College of Medical Sciences, Obstetrics and Gynecology, Delhi, India

Objective

To assess Platelet activating factor-Acetyl hydrolase activity in semen of male infertility cases before and after N-acetyl cysteine therapy. Design: Prospective interventional study.

Method

54 men with abnormal semen parameters namely oligospermia and/or asthenozoospermia were screened. 38 men satisfying the inclusion and exclusion criteria were finally recruited as the study group. However, 8 patients lost to follow up and thus, the entire study was conducted on 30 patients. Semen samples were taken from these patients by masturbation after abstinence of 3–5 days. 0.5 ml of sample was utilized for semen analysis. After centrifugation of the semen at 3000 rpm for 20 min at 5°C, 100 μL of supernatant was stored at −80°C for batch analysis. N-Acetyl cysteine 600 mg twice daily was given to the patients for 3 months and repeat semen samples were collected. PAF-AH activity was analyzed in a commercially available kit based on the spectrophotometric method. Wilcoxon signed-rank test was applied to compare the parameters before and after N-Acetyl cysteine therapy. p-value < 0.05 was taken as significant. Spearmann 's rho correlation coefficient was applied to correlate semen parameters with PAF-AH activity. - After N-Acetyl cysteine therapy, a significant increase in PAF-AH activity was noted (p- value = 0.010) after the application of the Wilcoxon signed-rank test. - A negative correlation was found between PAF-AH activity and sperm count before NAC therapy but a positive correlation was found between these 2 parameters after NAC therapy, but both the correlations were non-significant. - Before NAC therapy, progressive motility showed a positive correlation with PAF-AH activity with a significant p-value, but this positive correlation was non-significant after NAC therapy. - On comparison of semen parameters before and after N-Acetyl cysteine therapy, a significant increase in sperm count and progressive motility was observed, however, there was no significant effect on non-progressive motility. Sperm morphology was normal in all the cases, thus this parameter could not be compared. - After NAC therapy, 66.6% of oligoasthenozoospermic and asthenozoospermic cases showed improvement. Also, 88.8% of oligozoospermic cases improved. - The patients were also observed for any side effects due to N-Acetyl cysteine therapy, only 1 patient reported nausea, likely due to the drug.

Conclusion

Increase of PAF-AH activity and improvement of semen parameters before and after N-Acetyl cysteine therapy implies the role of this enzyme as a marker of seminal oxidative stress, which may help further in evaluation of idiopathic male infertility. OS-69 The impact of woman's age and pregnancy success rates following ICSI A. Elhaj1; S. Elbaruni2 1Tripoli, Obstetrics and Gynecologist, Tripoli, Libya, 2Tripoli, Deblen, Ireland

Introduction

As clinicians work closely to address cases of infertility, one thing becomes evidently clear; the choice between the ideal days for Et to ensure successful implantation is a highly discussed topic.

Objective

This study focuses on the impact of maternal age on pregnancy success rates when patients undergo Intracytoplasmic Sperm Injection (ICSI). The question that this study aimed to answer is, “Does delayed embryo transfer (D3-ET versus D5-ET) affect the rates of pregnancy, and do particular age groups experience greater success or failure from cleavage-stage – embryo transfer or blastocyst-stage -embryo transfer?”

Materials and methods

A prospective randomised controlled trial was conducted on 1184 patients at the Specialty Center of Infertility and Genetics in Tripoli – Libya (Private center), to evaluate and compare day 3-embryo transfer (D3-ET) versus day 5-embryo transfer (D5-ET) across various age groups. Gonadotrophin releasing hormone agonist long or short desensitizing protocol for down regulation was carried out with 0.1 mg Decapeptyl (Ferring Germany).Or on the 5th or 6th day, treatment began with (fixed antagonist protocol), Cetrotide (Merck Serono Europe Ltd.). Ovarian stimulation was carried out from the Day-2 of menstrual cycle using Human menopausal gonadotrophins (HMG) Menogon Ferring Gmbh in Germany ((Menotrophin injection) or Gonal-F drug manufactured by Merck Serono Ltd UK, depending upon the age and serum FSH levels of the subject while ovulation was induced with Human Chorionic Gonadotropin (HCG) Choriomon (IBSA, Institut biochimique SA). Ultrasound guided oocyte retrieval was performed 36–37 h post HCG and in embryo transfer.

Results

The transfer of blastocysts generated increased ongoing fertilization rate, implantation rate, and pregnancy rates when compared with cleavage-stage embryo transfer. A significance was determined in the role of age in success rates of ICSI treatment (p < 0.00), as younger women (<30 years old) were more likely to achieve a successful treatment in comparison to their counterparts (women aged 30–49). The highest number of oocytes retrieved per patient was greatest in the youngest group. The prolonged embryo culture in the laboratory allowed for the selection of advanced and best-suited embryos for transfer and determined the efficiency of blastocyst-stage transfer across a multitude of parameters.

Conclusion

For future research, this study further highlights the necessity of the use of single blastocyst embryo transfer to limit multiple gestations. The results of this study additionally emphasizes the significance of age on infertility treatments as well as the increased success rates in day 5 embryo transfer versus day 3. OS-71 Bridging the gap: Oncofertility care in Africa M. Odhiambo; C. Muteshi Aga Khan University Nairobi, Obstetrics and Gynaecology, Nairobi, Kenya

Introduction

Cancer represents a significant global public health burden, contributing significantly to both mortality rates and diminished quality of life. The rise in the annual incidence of cancer among adolescents and young adults (AYAs) over the past several decades has led to a growing population of young cancer survivors. While the five-year survival rate for AYAs with cancer is projected to exceed 80%, cancer treatment is associated with an 80% increase in the likelihood of experiencing diminished fertility among survivors. Oncofertility, the practice of preserving fertility before cancer treatment, offers hope for these patients.

Objective

This abstract addresses the need of oncofertility care in Africa and evaluates associated barriers and facilitators. Design: A narrative review that summarizes the current literature on cancer epidemiology, the effect of cancer treatment on fertility, barriers to oncofertility, facilitators of oncofertility, and studies on oncofertility in Africa.

Methods

A literature search was undertaken using databases such as PubMed, Google Scholar, and pertinent organizational websites. The inclusion criteria included research on cancer prevalence, fertility preservation procedures, oncofertility awareness among healthcare practitioners, and barriers to oncofertility care in Africa.

Results

There are multiple barriers to oncofertility care in Africa. Patient level barriers include lack of awareness about fertility preservation options, financial constraints and a heavy emotional burden of cancer diagnosis and treatment. Healthcare provider barriers encompass lack of awareness, prioritization of prompt cancer treatment and implicit biases. Health system barriers include limited facilities that can provide assisted reproductive technologies, limited insurance coverage for oncofertility services, weak referral systems and the absence of national guidelines on oncofertility care. Facilitators for oncofertility care in Africa include regular CME meetings to among healthcare providers to foster awareness on oncofertility, educational programs for cancer survivors, incorporation of oncofertility into the curriculum of gynecology and oncology trainees, establishment of oncofertility guidelines and dedicated oncofertility teams. Telemedicine and integration of oncofertility care into national cancer plans are other facilitators to oncofertility care in the region.

Conclusion

Oncofertility is a critical but under-addressed and underutilized aspect of cancer care in Africa. By bridging the gap between cancer treatment and reproductive health, we can empower young cancer survivors in Africa to preserve their fertility and envision a future beyond cancer. OS-72 Enhancing operational efficiency in the obstetrics emergency: A 3-year quality improvement project L. Alansari1; S. Athar1; H. Mrabet1; A. Cruz1; A. Zakaria2; T. Alshdafat1 1Hamad Medical Corporation, Obstetrics and Gynecology, Al Wakra, Qatar, 2Hamad Medical Corporation, Al Wakra, Qatar

Objective

Reducing waiting times in obstetrics ED improves outcomes, patient satisfaction, patient care, alleviate overcrowding, and enhance operational efficiency in the department. This Quality Improvement Project (QIP) aimed to assess the impact of operational enhancements on reducing waiting times to see a physician and waiting time for admission to the ward in the Obstetrics and Gynecology Emergency Department (OB-GYN ED) at Al Wakra Hospital. Design: The QIP utilized the Plan-Do-Study-Act (PDSA) model to guide the implementation and evaluation of operational improvements in reducing waiting times for patient care in the OB-GYN ED.

Methods

Over the period of 2020 to 2023, a comprehensive review was conducted, incorporating pre- and post-implementation performance metrics, patient flow records, and feedback from patients and staff. Interventions included digitalization of systems, resource optimization, budget efficiency improvements, and various patient care and communication strategies. Key outcomes measured were the average waiting time to see a physician and the waiting time for admission to the ward. Secondary outcome measures were reduction in Discharged Against Medical Advice (DAMA), patients Leaving Without Being Seen (LWBS), and absconded patient rates.

Results

The overall average waiting time in the Obstetrics and Gynecology Emergency Department significantly decreased from 35 min to approximately 14 min by the end of 2023 (60% reduction). Priority 1 case waiting times decreased from 22 min to 0 min (100% compliance), indicating immediate attention and care for critical cases. Priority 2 case waiting times also saw a reduction from 32 min in 2020 to approximately 13.6 min by 2023 (57.50% reduction), improving the timely care for moderately urgent cases. The percentage of patients waiting for beds > = 8 h in ED observation area reduced from 36% to 2%, indicating expedited admission and treatment processes (p < 0.05). There was a noticeable decrease in Discharged Against Medical Advice (DAMA), patients Leaving Without Being Seen (LWBS), and absconded patient rates, reflecting improved patient satisfaction and care delivery.

Conclusions

The QIP highlights the success of targeted operational improvements in the OB-GYN ED at Al Wakra Hospital in enhancing patient care and departmental efficiency, particularly in reducing waiting times to see a physician and waiting time for admission to the ward. These improvements, fostered by a culture of continuous improvement and teamwork, have led to significant operational benefits and cost savings. The findings provide a roadmap for implementing similar enhancements in other healthcare departments and pave the way for future research in optimizing healthcare operational efficiency. OS-73 Gynaecology dashboard a tool for service and safety S. Sivalingam University Hospitals of Leicester NHS Trust, Gynaecology, Leicester, UK - A set up a data tool to capture service and safety performance of gynaecology department, University Hospital of Leicester NHS trust. - To use the data to improve performance and maintain safety. Design: Dashboards are well known in their use to monitor set parameters within a service. Obstetrics has a long and successful history of using this tool for its service and risk review. However gynaecology did not have such oversight or a structured governance review in our department. This was proposed as an active and effective way of capturing our service and risk. Parameters are broadly presented under clinical areas (GAU/EP, Ambulatory, General gynaecology clinics waiting times), Quality and safety (Iatrogenic organ injury, readmission data, Complaints, Datix incidents, FFT), Staffing levels (Consultant, Middle grade and Nurses), Mandatory training data and attendances in QI & Audit days. Over the course of 3 years it has been modified to add in additional information to meet the departmental needs.

Method

The parameters included were based on feedback received from stakeholders, datix trigger list and to meet service/RISK requirements. SPC charts are used to plot the parameters. SPC chart can give a visual representation of both extremes and trend of a variable. This data is collected by our business analysists and Risk lead (author). It is presented monthly to the governance board and circulated among clinicians. It is also used to collect information from this for M&M meeting discussions and data.

Results

Some examples of improvement with this detailed review and assessment are increase middle grade medical staff in gynaecology assessment unit, requires re-modification to support acuity, evidence to support clinical activity and initiative lists for gynaecology outpatient clinics and procedure clinics. GIRFT highlighted we had higher than expected readmission rates by using this digital platform we identified that re-admission is in line with national standards.

Conclusion

This is a new digital tool set up to monitor the parameters described, it continues to evolve and has been helpful in providing an oversight, evidence required to provide gynaecology services within UHL. OS-74 Prediction of adverse intrapartum outcomes at 35–37 weeks M. Lopian1; S. Prasad1; E. Segal2,3; A. Elmalech4; A. Khalil1,5 1St George's University Hospital NHS Foundation Trust, Fetal Medicine Unit, London, UK, 2Tel Aviv University Faculty of Medicine, Tel Aviv, Israel, 3Sheba Medical Center Tel Hashomer, Tel Aviv, Israel, 4Information Science, Bar Ilan University, Givat Shmuel, Israel, 5Liverpool Women's Hospital, Fetal Medicine Unit, Liverpool, UK

Objectives

Large-for-gestational age (LGA) and small-for-gestational-age (SGA) neonates increase the risk of emergency operative delivery (EOD) and adverse maternal outcomes (AMO). Identifying women at 35–37 weeks at increased risk of these events offers a window of opportunity to mitigate these outcomes. This study evaluated the performance of biometric and Doppler parameters assessed at a routine third-trimester scan, in combination with maternal characteristics, in predicting adverse intrapartum outcomes.

Methods

This was a cohort study of low-risk singleton pregnancies undergoing routine ultrasound at 35+0 – 37+6 weeks. Demographic characteristics, estimated fetal weight (EFW), abdominal circumference (AC) centiles, and the Pulsatility Index (PI) of the Umbilical Artery (UA), Middle Cerebral Artery (MCA), and Uterine Artery (UtA) were evaluated. The Cerebroplacental ratio (CPR) was calculated and all indices were converted to Multiples of the Median (MoM). Multivariable logistic regression analysis was performed. Receiver-operating curves (ROC) were created to determine factors predictive of EOD (emergency caesarean, forceps or vacuum delivery) and AMO (High Dependency Unit admission, >1000 mL blood loss or EOD).

Results

A total of 14 161 pregnancies were included. After adjustment for confounders, EFW centile (adjusted odds ratio (aOR) 1.01, 95% CI, 1.0–1.02, p < 0.0001) and UA PI (aOR 3.6, 95% CI, 1.1–11.5, p = 0.03) were independent predictors of EOD. EFW centile (aOR) 1.01, 95% CI, 1.0–1.01, p < 0.0001), UA PI (aOR 4.1, 95% CI, 1.4–12.4, p < 0.0001) and CPR (aOR 2.8, 95% CI, 1.1–7.1, p < 0.001) were independent predictors of AMO. The combination of maternal demograhphic characteristics and EFW centile, UA, MCA and UtPI and CPR was associated with an Area under the Curve (AUC) of 0.74 (95% CI 0.73–0.75) p < 0.001 for the prediction of EOD and 0.71 (95% CI 0.7–0.72 p < 0.001) for the prediction of AMO.

Conclusions

In an unselected population, the combination of maternal demographic characteristics and sonographic variables can predict adverse intrapartum events and adverse maternal outcomes. OS-75 Intravenous immunoglobulin for treatment of severe maternal alloimmunization: Individual patient data meta-analysis H. Mustafa1; E. Sambatur2; G. Pagani3; F. D’Antonio4; E. Maisonneuve5; P. Maurice6; C. Zwiers7; J. Verweij7; A. Flood8; A. Shamshirsaz9; J.-M. Jouannic6; A. Khalil10 1Indiana University School of Medicine, Indiana, USA, 2The Fetal Center at Riley Children's and Indiana University Health, Indianapolis, USA, 3ASST-Papa Giovanni XXIII, Bergamo, Italy, 4University Hospital of Chieti, Chieti, Italy, 5Lausanne University Hospital, Lausanne, Switzerland, 6APHP Sorbonne Université, Paris, France, 7Leiden University Medical Center, Leiden, Netherlands, 8Indiana University School of Medicine, Indianapolis, USA, 9Boston Children's Hospital and Harvard School of Medicine, Boston, USA, 10St George's Hospital, University of London, London, UK

Objective

To investigate the outcomes associated with the administration of maternal intravenous immunoglobulin (IVIG) in high-risk red blood cell (RBC) alloimmunized pregnancies. Design: Systematic review and meta-analysis.

Methods

We systematically searched Medline, Embase, and Cochrane Library until June 2023. We included studies reporting on pregnancies with severe RBC alloimmunization, defined as either a previous fetal or neonatal death or the need for intrauterine transfusion (IUT) before 24 weeks in the previous pregnancy as a result of hemolytic disease of fetus and newborn (HDFN), that were treated with IVIG. Cases included pregnancies that received IVIG, while controls did not. Individual patient data (IPD) meta-analysis was performed using the Bayesian framework.

Results

IPD analysis included eight studies comprising 97 cases and 97 controls. IVIG was associated with prolonged delta gestational age (GA) at first IUT (GA of current pregnancy – GA at prior pregnancy) (Mean Difference (MD): 3.19 weeks, 95% CrI 1.28, 5.05), prolonged GA at first IUT (MD: 1.32 weeks, 95% CrI 0.08, 2.5), reduced risk of fetal hydrops at time of first IUT (Incidence Rate Ratio (IRR): 0.19, 95% CrI 0.07, 0.45), reduced risk of fetal demise (IRR: 0.23, 95% CrI 0.10, 0.47), higher chances of livebirth ≥28 weeks, ≥32 weeks, and survival at birth (IRR: 1.88, 95% CrI 1.31, 2.69; IRR: 1.93, 95% CrI 1.32, 2.83; IRR: 1.82, 9% CrI 1.30 to 2.61, respectively). There were no significant differences in the numbers of IUTs, hemoglobin level at birth, bilirubin level at birth, or survival at hospital discharge for live births.

Conclusion

IVIG treatment in pregnancies at risk of severe early HDFN seems to have a clinically relevant beneficial effect on the course and severity of the disease. OS-76 Intrauterine adaptive changes of the fetal heart in assisted reproductive pregnancies C.-V. Stefanescu1; E. Mihalceanu2; R. Gireada2 1Euromaterna Hospital, Maternal-Fetal Medicine, Constanta, Romania, 2Gr. T. Popa University of Medicine, Iasi, Romania

Objectives

To analyze the atrial, ventricular and global parameters of the heart in fetuses conceived by ART from 28 to 31+6 weeks of gestation and to review the international published data. Design and Methods: The authors designed a prospective case-control observational study of 200 cases of singleton pregnancies, 100 cases of ART related and 100 spontaneous conceived (SP). All cases with cardiac and extracardiac malformations, chromosomal anomalies, maternal pathologies, multiple gestation, increased estimated risk of PE or LBW at 1st trimester screening calculated according FMF criteria were excluded. Every patient underwent a comprehensive morphological scan, echocardiography and Doppler assessment and only those with complete normal results were included in both groups. A number of 15 parameters were evaluated. The results were compared with published data. An evaluation of fresh versus frozen embryos was also performed.

Results

Overall, in comparison to the SP, assisted reproductive fetuses displayed statistically significant differences, mainly those from fresh transfers. Subclinical adaptations of both systolic and diastolic function, mainly of TAPSE, MAPSE and right cardiac output were demonstrated. We have not noticed a distinct modification of RVFAC, therefore we presume this might be a late-emerging dysfunction. Also, an increased atrial dimensions and more globular hearts were observed. The myocardial performance index was slightly impaired. The data are juxtaposed with data published till now.

Conclusions

A trend of impaired ventricular function in the IVF group was observed in our study. Both ventricles are affected with a predominance of the right one (TAPSE, RVEF, RVSF, RCO, CCO, LCO, LMPI). Also, the atrial architecture was modified. These findings, even subclinical, provide new evidence for the presence of in-utero adaptive changes of the heart and suggest IVF as an independent factor in inducing cardiac remodelling. Winner of the best in topic Award 2023 ISUOG world congress. OS-77 Fetal conditional growth and body proportions in predicting newborn anthropometry/perinatal complications A. Vasudeva1; K.V. Samskruthi2; H. Gagana2; J. Samanth3; P.S. Roopa2; S. Hebbar2; V. Guddattu4; T. Srinivas5 1Kasturba Medical College, Manipal Academy of Higher Education, Obstetrics and Gynecology and Head-Division of Fetal Medicine, Manipal, India, 2Kasturba Medical College, Manipal Academy of Higher Education, Obstetrics and Gynecology, Manipal, India, 3Manipal College of Health Professionals, Manipal Academy of Higher Education, Cardiovascular Technology, Manipal, India, 4Prasanna School of Public Health, Manipal Academy of Higher Education, Data Science, Manipal, India, 5Kasturba Medical College, Manipal Academy of Higher Education, Critical Care Medicine, Manipal, India

Introduction

Despite their potential for assessing individual fetal growth, conditional centiles are seldom used in clinical practice due to computational challenges and average accuracy. Unlike various population-based growth charts, conditional centiles were not analyzed through prospective studies in mixed obstetric cohorts (low and high risk).

Objectives

To compare the efficacy of conditional centiles and fetal body proportions against multiethnic (Intergrowth 21-chart 1) and locally developed (chart-2) population-based growth charts in predicting neonatal anthropometry/adverse perinatal outcomes. Design and Methods: Prospective study conducted at tertiary center focusing on a mixed obstetric cohort with singleton fetuses. Obstetric ultrasound data collected. Third-trimester conditional centiles were calculated using 17–22 weeks USG estimated fetal weight (EFW). Neonatal anthropometry documented. Adverse Perinatal Outcomes (APNO) were noted. Fetal conditional growth centiles and HC/AC ratio were used to predict A – neonatal anthropometry using Intergrowth-21charts and B-APNO, and then their predictive accuracy was compared to Charts 1 and 2.

Results

Important antenatal variables among the 500 cases recruited are (mean SD): EFW in grams 17–22 weeks 293.7 ± 52.89, 34–38 weeks 2685.7 ± 358.1, HC/AC ratio at 34–38 weeks 1.031 ± 0.441.Birthweight 3012.5 ± 445.75 gm, Birth-length 47.5 ± 2.28 cm, neonatal HC 34.11 ± 1.7 cm. Sixty-three (12.6%) neonates were SGA, 125 (25.4%) had birth length <10th centile, 31 (6.3%) had HC 1.013 (best cut-off) in 185 (42.6%). Neonatal smallness (BW, BL, HC <10th centile) and APNO were significantly associated with antenatal diagnosis of SGA using charts 1 and 2 and a high HC/AC ratio but not with conditional charts. Prediction of SGA neonate was better with charts 1, 2 and HC/AC ratio compared to conditional centile (sensitivity, PPV of 14.29%, 59.61%; 23.81%, 62.5%; 66.04%, 19.47% and 38.71%, 11.81% respectively). While the conditional chart was not predictive (OR 0.884), chart 2 predicted SGA neonate well (OR 14.86). Chart 2 and HC/AC ratios were good predictors of birth length <10th centile (OR 4.515 and OR 1.80). Prediction of APNO was poor with charts 1 and 2 (sensitivity 5.73% and 7.5%) and better with conditional chart and HC/AC ratio (sensitivity specificity 42.41%, 59.23%; and 53.96%, 62.71%, respectively).

Conclusion

EFW near-term, plotted on locally developed population-based growth charts, performs better than conditional centile predicting SGA neonate. Nonetheless, conditional centiles and term body proportions help predict APNO at the cost of a high screen-positive rate. OS-78 Pregnancy following transplantation: Systematic review of patient psychology and quality of life K.-B. Papalois1; E. Tsarna2; P. Vakas3; S. Stavrou4; A. Matsas3; P. Christopoulos2 1Royal Berkshire NHS Foundation Trust, Reading, UK, 2Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece, 32nd Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, Athens, Greece, 4Third Department of Obstetrics and Gynecology, General University Hospital, Athens, Greece

Objective

Organ transplantation is a curative treatment for patients suffering from organ failure prolonging survival and improving quality of life. Pregnancy in women who undergo organ transplantation at reproductive age has shown to be possible albeit synonymous with maternal and fetal complications. Studies have explored the aforementioned complications albeit a systematic evaluation of the psychology in this group during pregnancy and an assessment of their quality of life has not been conducted until now. Design: We conducted a systematic review related to donors or recipients of organ transplantation and their reported psychological parameters and quality of life measures during pregnancy.

Methods

Relevant papers were identified by two independent reviewers before data extraction and analysis. Our search generated 4489 results and 12 studies were included in the final analysis, 6 focused on liver, 3 on uterine, 2 on kidney and 1 on heart transplantation. Results from the one quantitative paper were reported, and the Joanna Briggs Institute meta-aggregation evidence synthesis tool was applied to the 11 qualitative studies. Risk of bias tools were used to assess all included studies.

Results

The qualitative studies underwent thematic analysis and 15 categories were later grouped into 6 synthesized findings(SF) consisting of the following: (1SF) Focus of worry centered around pregnancy and impact on expectant mother and others (partners, recipients, donors family, society), (2SF) Fear of the effects of pregnancy on the physical health of the fetus, (3SF) Fear of the physical health of the mother, (4SF) Emotional burden on expectant mothers, (5SF), Perception of pregnancy (6SF) Methods to cope with expectations and anxiety. The quantitative paper which was included showed that in women who had undergone a uterus transplant, their SF-36 mental health scores were stable before and after transplantations albeit for the women who became pregnant the SF-36 mental health components scores increased from an average of 37.8 at baseline to 48.6 in the follow up period of their pregnancy.

Conclusion

This is the first systematic review to report on the psychology and quality of life of women during pregnancy who have previously undergone an transplant. Our results show that concerns for the mother and the unborn child are prevalent in all common solid transplant recipients and donors. Therefore, more studies to further elucidate concerns and infrastructural set-up to support this patient cohort and their families through counselling and support networks is key to optimise health outcomes and the experience of pregnancy. OS-80 Etiology and risk factors of Postpartum Acute Kidney Injury in Pakistan Z. Maqsood1; K. Sultan2; H. Bilqees3; S. Abbasi2 1Rawalpindi Medical University, Islamabad, Pakistan, 2Pakistan Institute of Medical Sciences, Islamabad, Pakistan, 3Rawalpindi Medical University, Rawalpindi, Pakistan

Objective

Post-partum Acute kidney injury is still a huge burden on healthcare system in developing countries while its incidence has decreased in developed countries. Etiology and risk factors of Post-Partum AKI in developing counties are different from developed countries. This study was conducted is determine the etiology and risk factors of post-partum AKI in a public sector tertiary care hospital of Pakistan. Design: Observational study.

Method

This observational study was conducted in Department of Nephrology Pakistan Institute of Medical Sciences Islamabad from July 1, 2012 to June 30, 2022. We included all patients who presented with post-Partum AKI. Patients with previous renal disease were excluded. AKI was defined as a rise in serum creatinine >0.3 mg/dL or drop in urine output <0.5 mL/kg/h for 6 h. Detailed history was taken to find out etiology and risk factors. Examination and required investigations were done to reach the diagnosis. Patients were followed up for 3 months to see disease outcome.

Results

408 patients of post-partum AKI were included in our study according selection criteria. Out of total 408 patients 312 (76.4%) were non-booked and 294 (72%) had no history of antenatal visits. 174 (42.6%) patients had no or limited access to standard healthcare facilities. 194 (47.5%) patients has no formal education. 213 (52.2%) patients belong to poor socio-economic status with monthly family income less than 20000 PKR (90 USD).Puerperal sepsis was the most common cause of post-partum AKI in 246 (60%) patients followed by Preeclampsia /eclampsia in 69 (17%) patients. Antepartum/ postpartum hemorrhage was the cause in 65 (16%) of patients while HELLP was observed in 24 (5.8%) patients. Only 4 (1%) were diagnosed as HUS. Out of 246 patients with puerperal sepsis 182 (74%) patients were handled by traditional birth attendants before coming to tertiary care hospital. Out of total 408 patients 351 (86%) required dialysis while remaining responded to conservative management during stay at hospital. During follow up 273 (67%) patients achieved complete recovery, 98 (24%) partial recovery while 30 (7.3%) became dialysis dependent. Unfortunately 7 (1.7%) patients died during hospital stay.

Conclusion

Sepsis is the most common cause of postpartum AKI in our setup which is due to poor maternal care. These facts demand special efforts to improve healthcare system at primary and secondary level in Pakistan. OS-83 Abdominal subcutaneous fat-pad thickness (SFT) – an independent predictor of adverse pregnancy outcomes K.M. Lufna ASTER MIMS, Obstetrics and Gynaecology, Kozhikode, India

Objective

To determine the association of maternal abdominal subcutaneous fat pad thickness with adverse pregnancy outcomes. Design: A hospital based prospective study.

Materials and methods

A hospital based longitudinal study was conducted among 260 pregnant women with singleton pregnancy between 11 and 13+6 weeks of gestation excluding those with chronic hypertension, overt diabetics and fetal chromosomal abnormalities in the Department of Obstetrics and Gynaecology of a teritiary care centre in south India over a period of 2 years. The mean age of the study participants was 26.2 (2.3) years with a minimum of 19 years and a maximum of 33 years.A predefined proforma was used to collect the sociodemographic characteristics and the clinical profile of the mothers. A baseline blood investigation such as, hemoglobin, serum glucose, serum calcium and blood pressure were also taken. Maternal subcutaneous fat thickness was measured on routine ultrasound scan between 11 and 13+ 6 weeks gestation-Nuchal Translucency (NT SCAN). Then they were divided into 5 groups (<5 mm, 5–9 mm, 10–14 mm, 15–19 mm, 20 mm and above). The mean maternal SFT was 22.1 (7.1) mm and the mean BMI of the pregnant women was 27.1 (3.9) kg/m2. These patients were followed up till delivery for development of adverse pregnancy outcomes.

Results

There was a significantly strong positive correlation between the BMI and the maternal SFT thickness a (r = 0.546; p < 0.001). Among the adverse pregnancy outcomes, Caesarean delivery was the common complications (51.5%) followed by low birth weight (24.2%), low APGAR at 1 min (16.2%), macrosomia (12.3%), gestational diabetes mellitus (8.5%), hypertensive diseases of pregnancy (8.1%), preterm birth (8.1%), NICU admission (7.3%), neonatal jaundice (5%), neonatal respiratory distress (4.2%). On multivariable logistic regression analysis maternal SFT was found to be a significant predictor for hypertensive disease of pregnancy, gestational diabetes mellitus, caesarean delivery, low birth weight, preterm delivery, macrosomia, low APGAR score at 1 min, neonatal respiratory distress and NICU admission. It was found that the overall predictive value for SFT and BMI in predicting adverse outcomes with AUC was 0.746 and 0.652 respectively.

Conclusion

Maternal abdominal subcutaneous fat pad thickness was found to be a significant predictor for adverse pregnancy outcomes like hypertensive disease of pregnancy, gestational diabetes mellitus, caesarean delivery, low birth weight, preterm delivery, macrosomia, low APGAR score at 1 min, neonatal respiratory distress and NICU admission. OS-84 Early lifestyle modification plan in high-risk pregnant ladies for prevention of GDM S. Sultana1; N.A. Khan2 1IIMC, Riphah International University, Obstetrics & Gynaecology and Medical Education, Islamabad, Pakistan, 2IIMC, Riphah International University, Pathology, Islamabad, Pakistan

Objective

To provide evidence that early pregnancy counselling about adherence to Lifestyle Modification, by high-risk pregnant females for GDM, will decrease the chances of disease in current pregnancy. Design: Interventional study- at IIMC -Pakistan from January 2022 to February 2023.

Methods

A total of 200 pregnant females were recruited through consecutive convenience sampling. Inclusion criteria: ladies of 21–40 years with singleton pregnancy and having at least two-three risk factors for GDM. High risk factors are: previous history of GDM, PCOS, first degree relative with GDM, previous baby weighing > 4 kg, BMI > 30 kg/m2 etc. Whereas, pregnant ladies with pre-existing diabetes, with any comorbidity or with medical disorders were excluded. Participants were randomly allocated to the Lifestyle Medicine Intervention (LMI) group or the Routine Care (RC) group; hundred in each group. Complete data could be collected from 93 in LMI group & 90 from RC group. 75 g OGTT was performed. The participants of the RC group received regular antenatal care. They were advised to follow up 4 weekly and OGTT were performed at 16–18 weeks and 24–26 weeks. The LMI group participants received 16–20-week ‘lifestyle intervention routine’, beginning on their first antenatal checkup, with particular focus on diet, physical activity & body weight. Individualized, consultations were provided by the consultants. The advised dietary composition was: approximately 50% carbohydrates, 20% protein, and 30% fat. Women were also counselled to increase their physical activity of moderate-intensity to 150 min per week. Each subject received a take home printout. They were also advised to follow up 4 weekly and OGTT was performed at 16–18 weeks and 24–26 weeks. Diagnosis of GDM was the Primary outcome measure. Secondary outcomes were maternal weight gain, mode of delivery and birth weight. Data was analyzed using SPSS version 26. p-value <0.05 was reasoned to be statistically significant.

Results

Frequency of patients with GDM in high-risk pregnant ladies in LMI group was 19% as compared to 40% in RC group. No considerable difference in pregnancy weight gain, gestational age at birth, birth weight of baby and cesarean section rate was observed.

Conclusion

Early lifestyle intervention decreases the risk of GDM in ladies entering pregnancy with risk factors. Hence, this intervention could contribute to the prevention of GDM and in reduction of healthcare budgets, especially in this region of the world where Diabetes/GDM are extremely prevalent. OS-85 Role of endocrine disrupting chemical (Bisphenol A) in etiopathogenesis of PCOS P. Sankhwar1; S. Jaiswar2; S. Mahrotra1; M. Verma1 1King George Medical University, OBGYN, Lucknow, India, 2King George Medical University, Lucknow, India

Objective

To estimate and correlate the serum levels of Bisphenol A in PCOS cases and non-PCOS females. Clinical and experimental evidence suggests that BPA may play a significant role in the pathogenesis of PCOS via multiple pathways. A bidirectional association between androgens and serum BPA levels has also been found. So, we hypothesize that increased levels of BPA in women's blood is a risk factor for the development of PCOS. Study Design: Prospective case-control study. Study Setting: The study was conducted in the outpatient department (OPD) of the Department of Obstetrics and Gynecology in collaboration with the Department of Biochemistry, King George's Medical University, Lucknow over one year. Sample Size: The sample size in this study was 88. (We recruited 88 cases and 88 controls).

Method

The married women aged 21 to 45 years giving written informed consent to participate in the study and fulfilling the inclusion/exclusion criteria were recruited in the study. The enrolled women were then subjected to detailed history and complete physical examination including anthropometry. Relevant investigations including hormone profile, and metabolic parameters including fasting blood sugar were determined. Five ml of venous blood was collected in an EDTA Vial from the antecubital vein of each subject. Each sample was, then, transferred into a special tube (without bisphenol A compound) within 1 h, and then it was centrifuged at 2000 RPM for 10 min and then, it was stored at −80° C in the Biochemistry Department where serum BPA Analysis was done using ELISA Kit.

Results

BPA levels were significantly higher in the PCOS group (1.04 ± 0.28 ng/mL) as compared to the controls (0.69 ± 0.10 ng/mL). A significant association of serum-free testosterone (r = 0.408, p < 0.05) with BPA was observed. BPA also positively correlated with fasting blood glucose levels in the PCOS group (r = 0.192, p < 0.05).

Conclusions

There were significantly Higher serum Bisphenol A levels in women with PCOS than in controls independent of BMI. We found a significant positive association between BPA and androgens, pointing towards a potential role of this endocrine disruptor in PCOS pathophysiology. OS-86 Hormone replacement therapy uptake & discontinuation trends in Wales from 1998 to 2022 R. Andrews1; A. Lacey2; K. Bache3; E.J. Kidd1; Predicting the Risks of Oestrogen-related Pathologies on Health Erosion to Conserve Healthy Years (PROPHECY) 1Cardiff University, Welsh School of Pharmacy and Pharmaceutical Sciences, Cardiff, UK, 2Swansea University, Swansea University Medical School, Swansea, UK, 3Health & Her, Cardiff, UK

Objective

This study analysed prescribing trends of Hormone Replacement Therapy (HRT) in Wales from 1998 to 2022. Predictors of HRT discontinuation within one year of the first prescription were explored. Secondary outcomes investigated year-on-year variations in HRT prescriptions concerning HRT type (transdermal, local, oral) and deprivation levels. Design: Utilising the Secure Anonymised Information Linkage (SAIL) databank, containing medical records for most of Wales, this observational study explored primary and secondary care data.

Method

Cox proportional hazard ratios assessed predictors of HRT discontinuation within one year, focusing on women aged 40–65 with spontaneous menopause and controlling for year of initiation. Annual HRT prescription rates from 1998 to 2022 were categorised by transdermal, local, and oral preparations. Annual prescribing rates per Townsend deprivation quintile were normalised per 1000 people.

Results

Between 1998 and 2022, 378 923 women were prescribed HRT in Wales. Cox regression analysis demonstrated a curvilinear effect of age on HRT abandonment within one year of first prescription with abandonment high among women aged 40–43, lowest in the mid 40's to early 50's, before rising again from the mid 50's onwards. Combined oestrogen/progesterone tablets had the lowest abandonment rates, followed by oestrogen tablets, and combined patches. Oestrogen patches, vaginal creams and pessaries were associated with increased abandonment. Oestrogen gels had the highest abandonment rate. Higher deprivation was associated with increased abandonment, and lower prescription rates overall. Year of initiation influenced discontinuation and uptake: trends showed transdermal and oral prescriptions rapidly declined from 2002, following adverse reports on HRT safety from the Women's Health Initiative and the Million Women Study, until 2021 where transdermal prescriptions substantially increased. Conversely, local prescriptions gradually increased across time. However, controlling for initiation year did not alter regression outcomes.

Conclusions

These findings highlight disparities in HRT prescribing patterns based on the type of HRT administered, with oral prescriptions declining, local prescriptions gradually increasing, and transdermal prescriptions rapidly increasing. Predictors of HRT discontinuation suggest that women are more likely to adhere to HRT in their mid 40's to early 50's possibly due to variances in menopause stage, particularly if initially prescribed tablets rather than transdermal preparations, possibly due to variances in application or symptom relief. Deprivation reduced the likelihood of HRT prescriptions and increased discontinuation, indicating potential barriers to menopause support in deprived areas. Further research is warranted to address socioeconomic disparities and evaluate routes to economic and optimal HRT prescribing practices. OS-88 MARIE-Malaysia (WP2a): A mixed-methods study exploring menopause (Interim analysis) J.B. Jaafar1; T.-H. Toh2; G. Delanerolle3,4; S. Wu5; Y. Weng5; A.H.B. Azmi6; N.F.B. Mohd Nasir7; E. Yien-Mei Sim8; F.B. Zamri9; A.B. Mohamad Mohsin10; J. Yen-Sing Lee11; J. Soon-Yit Lee2; K. Dahian2; N.A.B. Jaafar2; S.N.A.B. Ali Madinah2; K.-Y. Lee12; X.-S. Wong8; P. Briggs13; J. Taylor4; H. Cavalini3; O. Kurmi14; K. Riach15; S. Hinchliff16; C. Atkinson17; K. Potocnik18; V. Talaulikar19,20; L. Saraswat15; J.Q. Shi21; A. Shetty19,20; S. Elneil19,20; I. Muhammad22; R. Kareem22; N. Rathnayake23; V. Pathiraja23; J.V. Vlymen3; T. Mudalige23; Y. Bouchareb24; G.U. Eleje25; C.L.B. Pinto26; N. Mintah-Afful3; I. Aggarwal27; J. Manonai28; H.F. Kemp29; M. S30; I. Litchfield4; P. Phiri3,31 1Kuala Berang Health Clinic, Ministry of Health Malaysia, Terengganu, Malaysia, 2Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sarawak, Malaysia, 3Research and Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK, 4Institute of Clinical Sciences, University of Birmingham, Birmingham, UK, 5Southern University of Science & Technology, Shenzhen, Guangdong, China, 6Department of Obstetrics & Gynaecology, Seberang Jaya Hospital, Ministry of Health Malaysia, Penang, Malaysia, 7Sagil Health Clinic, Ministry of Health Malaysia, Johor, Malaysia, 8Department of Obstetrics & Gynaecology, Sibu Hospital, Ministry of Health Malaysia, Sarawak, Malaysia, 9Department of Obstetrics &Gynaecology, Pulau Pinang Hospital, Ministry of Health Malaysia, Penang, Malaysia, 10Pokok Sena Health Clinic, Ministry of Health Malaysia, Kedah, Malaysia, 11Department of Obstetrics & Gynaecology, Mukah Hospital, Ministry of Health Malaysia, Sarawak, Malaysia, 12Sibu Jaya Health Clinic, Ministry of Health Malaysia, Sarawak, Malaysia, 13Liverpool Women's Hospital Foundation NHS Trust, Liverpool, UK, 14University of Coventry, Coventry, UK, 15Adam Smith Business School, University of Glasgow, Glasgow, UK, 16University of Sheffield, Sheffield, UK, 17Manchester Metropolitan University, Manchester, UK, 18University of Edinburgh Business School, Edinburgh, UK, 19University College London Hospitals NHS Foundation Trust, London, UK, 20Female Pelvic Medicine and Reconstructive Surgery, University College London, London, UK, 21Department of Data Science &Statistics, Southern University of Science and Technology, Shenzhen, Guangdong, China, 22Peshawar Medical College, Peshawar, Pakistan, 23Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka, 24College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman, 25Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria, 26Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil, 27KK Women's and Children's Hospital, Singapore, Singapore, 28Mahidol University, Nakhon Pathom, Thailand, 29Trauma Healing Together, Scotland, UK, 30JSS Medical College, Mysore, India, 31Psychology Department, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK

Objective

To assess the mental health implications among perimenopausal, menopausal, or post-menopausal women who were undergoing natural, surgical, or medical menopause in Malaysia. Design: A mixed-methods study was designed and conducted in Malaysia following Ethics committee approval.

Methods

This interim analysis involved 50 women, aged 18–90 residing in Malaysia who provided written informed consent. Participant recruitment took place in nine health clinics or hospitals throughout Malaysia. The Qualtrics XM platform was employed for data collection, with the interim analysis concentrating on outcomes derived from the Hospital Anxiety and Depression Scale (HADS) and the Greene Climacteric Scale (GCS). Descriptive statistics were employed to analyse the categorical data.

Results

The median age (in years) of all participants, their first period and menopausal symptoms were 54, 13 and 50, respectively. The sample comprised women from the ethnicity of Malay (68.42%), Sarawak indigenous (13.15%), Chinese (7.89%), Indian (7.89%), and other Asian (2.63%), that were Muslim (86.83%), Christian (7.85%), and Buddhist (5.26%). Of the sample, 78.94% were married whilst 10.53% were widowed and single, respectively. The sample consisted of full-time (58.76%) and part-time employees (5.41%), homemakers (21.62%), carers (2.70%), unemployed (5.41%) and retired (8.11%). Most participants were menopausal (37.84%) and post-menopausal (37.84%), whilst 13.51% and 10.81% were perimenopausal and pre-menopausal, respectively. The mean (standard deviation (SD)) for HADS scores at Day 0 was 7.63 (6.34). The mean (SD) scores for anxiety and depression were 4.5 (3.69) and 3.13 (3.02), respectively. The GCS mean (SD) values at Day 0 were 14.47 (11.43), respectively. The mean (SD) values for somatic and vasomotor symptoms at Day 0 were 4.42 (3.90), 1.50 (1.62), respectively. The mean (SD) scores for psychological symptoms were 7.5 (6.64), respectively. Mean (SD) scores for clinical anxiety and depression based on GCS were 4.21 (4.0) and 3.29 (3.11), respectively.

Conclusion

The interim analysis suggests that individuals experiencing menopause undergo a negative mental health impact, primarily associated with their somatic and vasomotor symptoms. OS-90 Clinical nurse specialist leading perinatal mental health screening, assessment and patient-care J. Brito1; S. Al Rawaili2 1Hamad Medical Corporation, Obstetrics & Gynecology, Doha, Qatar, 2Hamad Medical Corporation, Doha, Qatar Perinatal mood and anxiety disorders (PMADs) are the most common complications of pregnancy and have been found to have long-term implications for both mother and child (Lancaster, 2010). Systematic reviews, suggest increased psychological symptoms, especially depressive and anxiety symptoms, in pregnant and postpartum women during COVID19 (Iyengar, 2021). In July 2020, after the implementation and evaluation of PDSA model, the perinatal mental health project was approved and implemented. The main objective was to establish an integrated patient-centered care for all women leading to a better health and wellbeing to our generation, as well as for those that follow. The Clinic was driven in a collaborative and a multidisciplinary team of physicians, consultants, nurses/midwives, Clinical Nurse and midwife specialist and psychiatrists. The first two tools used are General Anxiety Disorders self-questionnaire two questions and (GAD2) and Patient Health Questionnaire two questions (PHQ2). If patient score equal or more than 3 in one or both self-screening questionnaires, they will be referred to a wellbeing Clinic to a second stage composed by triage assessment with GAD 7, PHQ9, PTSD. Results from August 2020 to Agosto 2024, 8.400 women were screened for anxiety and depression, 85% screened at antenatally and 25% postnatally. The clinic covered 48 nationalities. The principal nationalities were Indian (25%), Egyptian (15%) and 2% Qataris women. Triage shows 671 (11%) women presented score more than 10 for depression and, 304 (13.3%) more than 10 for Anxiety. After triage assessment 553 (12%) women presented with anterior history of mental issues or PMAD's. The principal diagnosis found were related to: Grief Complication (8.6%), bipolar disorder (5.7%), Panic attack/PTSD (9%), Anxiety (14%), OCD (6%), Psychosis (6%) Depression (35%) and Dissociation Disorder 6%). The principal risk factors associated were: partner/family support, social isolation, financial and social situation of expatriate families during COVID-19, domestic conflict/violence, Diseases (chronic pain, GDD, obesity) and perinatal trauma/loss. Highlighted that the most common cause (92%) referred by women's sadness and excessive worries were absence of mother/family during delivery principally husband. The incidence rate found for anxiety and depression was 15.3% and 13.3%, respectively. The data on Anxiety and depression corroborate with international incidence rate of perinatal mood and anxiety disorders, between 7% and 20% in high income countries (Melville et al., 2010). OS-91 One stop contraception clinic for refugees and asylum seekers in UK N. Ghosh; L. Turner; K. Gibbs; H. Ibbotson Locala Health Care, Contraception and Sexual Health, Stockpoert, UK

Objective

Refugee and asylum-seeking women are often physically, socially, and psychologically vulnerable, owing to past experiences. Barriers to these women accessing the care they need include experiences of persecution, oppression, inadequate health care in the country of origin, insecurity, poverty, loss of community and being in an unfamiliar environment. Our objective was to make effective contraception available easily to this vulnerable group. Design: A project was devised (1.6.23–31.12.23) along with Public Health England, to attend hotels housing these women in Stockport, along with interpreters, to deliver sessions on effective contraception and sexual health.

Method

We worked with Dari, Pasto, Farsi, Kurdish, Sorani and Tigrinian interpreters. At sessions, we conveyed information about all the different methods of contraception, and sexual health services they can access via our service. The interpreters ensured this information was translated accurately and allowed each person the opportunity to ask any questions. At the end of the session, those who wanted to access contraception, were supported by interpreters to complete a registration form. We then registered each person and the nurse saw them individually, in a confidential space, where she completed the consultation, with the interpreter present.

Results

Session 1- 8 women were present, out of whom 5 (62.5%) had contraceptive subdermal implants (Nexplanon) fitted, and 3 (37.5%) accepted oral contraceptive pills. Session 2- 18 women were present out of whom 7 (38.8%) wanted intra uterine contraceptive Coils, 5 (27.7%) had contraceptive subdermal implants (Nexplanon) fitted, and 6 (33.3%) wanted oral contraceptive pills. We then organised a procedure clinic for these 7 women at Locala Sexual Health, Stockport. The interpreters from the hotel came into the clinic-on the day to support the women at their coil insertion appointments. Session 3- 7 women were present, out of whom one had subdermal contraceptive implant (14.2%), 2 (28.6%) had oral contraceptive pills, and 2 (28.6%) had contraceptive injection Depo-Provera.

Conclusions

Our project show how contraception can be made more accessible to this vulnerable group of women. The provision of culturally sensitive services is particularly important for effective communication and engagement. Effective contraception would go a long way to prevent late antenatal bookings, concealed pregnancies, requests for late abortions (and subsequent consequences) which all are known to be common in this group. We intend to continue with this model of care and would encourage other Sexual Health services to follow suit too. OS-92 Barriers to cervical screening: The perspective of patients at a London-based GP P. Goel; A. Josan; M. Carrim; H. Johal Lyndhurst Surgery, London, UK Cervical cancer claims the lives of 850 people in the UK annually (1). To combat this, cervical screening is offered to all women aged 25–64, saving an estimated 2000 lives per year (2). However, the current cervical screening coverage rate is 72.2% (3). To address this gap, we conducted a survey among patients within our practise in attempts to eludicate beliefs and barriers to screening, which will allow us to tailor our service and improve screening uptake. Participants included women aged 25–49 at a London based GP who had not booked cervical screening despite three text reminders. 182 patients were called. Only 38 patients (20.9%) were contactable and provided a definite response. Based on their responses, we obtained two groups: Group 1, who then declined the screening, and Group 2, who booked screening following the call. Group 1 were given questionnaire 1 to explore the reasons for declining and any previous screening experiences. Group 2 were given questionnaire 2 to understand why they booked via the call. Out of 182 participants, only 54 answered. The breakdown of the attempted calls is displayed in Figure 1, with answered calls in Figure 2. Results from questionnaire 1 indicated the main barrier to screening was a previous bad experience. For those who've never had a screening before, reasons included not understanding the purpose of the screening and hearing about bad experiences. 90% of participants also expressed a preference for screening in the form of home urine or vaginal swabs. Results from questionnaire 2 indicated patients preferred the active aspect of a phone call when booking an appointment, rather than the passive text messages which they were more likely to put off or ignore. The key barrier to screening within our patient cohort was many of them were uncontactable. Letters may serve as a viable solution to address this. For those who have attended screening in the past and subsequently declined, home screening could significantly improve uptake. The approach is particularly relevant as many cited emotional factors including a previous poor experience as dissuading uptake. As for never attenders, it is crucial to prioritise education initially, as many of them did not understand the reasons for screening. Ultimately home testing has the potential to eradicate both emotional and practical barriers to cervical screening and its uptake across the UK will surely go some way to improving adherence to national targets in GP practices. OS-93 Knowledge, attitude and prevalence of postpartum depression in postnatal women in Dubai S. Morbiwala1; M. Maharoof1; R. Nusrath1; R. Sultana2 1Dubai Health Authority, Dubai, United Arab Emirates, 2Department of Health, Abu Dhabi, United Arab Emirates - To assess the knowledge, attitude, and prevalence of postpartum depression in postnatal women. - To determine the factors that put mothers at a higher risk of developing postpartum depression in Dubai. Design: Cross-sectional study design through survey.

Methods

A cross sectional study was conducted on postpartum mothers who visited Immunization clinics for their infants at Primary Health Centers in Dubai. The study participants were administered a survey using “The Patient Health Questionnaire (PHQ) 9”, which is a multipurpose instrument for screening, diagnosing, monitoring, and measuring the severity of depression. The data was analysed by SPSS version 22.0. Chi-square test was used to compare continuous and categorical variables. Multivariate analysis was undertaken to identify the association of depression.

Results

A total of 101 mothers took part in the survey. The average age of the mothers was between 30 and 39 (53.9%). Among the overall sample 70.3% of mothers possessed good knowledge (p = 0.03) while 89% of mothers had a good attitude (p > 0.05) towards PPD. The prevalence of postpartum depression in our population was 23.8% with varying degree of severity, including mild (45.8%), moderate (29.2%), moderately severe (16.7%), and severe (8.3%). The study identified two primary independent factors associated with PPD, which were complicated pregnancy (p = 0.037) and previous history of PPD (p = 0.031).

Conclusion

The study concludes that there is a high degree of prevalence of PPD among postpartum mothers in Dubai, and this risk is higher in mothers with a history of depression in their past pregnancies or a complicated pregnancy. This encourages conducting more postpartum screening for PPD for all mothers during their antenatal period, especially for mothers with such histories. Additionally, our study also indicates a high degree of good knowledge and a good attitude towards postpartum depression. We recommend spreading deeper understandings of PPD among the general population and healthcare providers through awareness campaigns and educational initiatives to help eradicate the stigma surrounding psychiatric disorders. Since postpartum depression is a treatable condition, early recognition of the symptoms and diagnosis will markedly improve the quality of life for those affected. MINI THEATRE EPOSTER PRESENTATIONS MTeP-01 Calcium versus cabergoline for prevention of ovarian hyperstimulation syndrome S. Baradwan1; D. AlJaroudi2; M. Agdi3; B. Hafedh1; H. Hassan Abduljabbar1; H. Sabban4; N. Alzawawi1; N. Alsaad5; M.S. Alshahrani6; A. Idriss7; R. Alsghan8; M. Asiri9; A. Baradwan10; A. Edrees11; A. Abu-Zaid12 1King Faisal Specialist Hospital and Research Center, Obstetrics and Gynecology, Jeddah, Saudi Arabia, 2King Fahad Medical City, Reproductive Endocrine and Infertility Medicine, Riyadh, Saudi Arabia, 3Department of Reproductive Endocrinology & Infertility – IVF, Dr. Sulaiman Al Habib Medical Group, Sahafa Hospital, Riyadh, Saudi Arabia, 4King Abdulaziz University Rabigh Medical College, Obstetrics and Gynecology, Jeddah, Saudi Arabia, 5Prince Sultan Military Medical City, Reproductive Endocrine and Infertility Medicine Unit, Riyadh, Saudi Arabia, 6Faculty of Medicine, Najran University, Obstetrics and Gynecology, Najran, Saudi Arabia, 7King Faisal Specialist Hospital and Research Center, Pathology and Laboratory Medicine, Jeddah, Saudi Arabia, 8Maternity and Children Hospital, Obstetrics and Gynecology, Al Kharj, Saudi Arabia, 9Abha Maternity and Children Hospital, Obstetrics and Gynecology, Abha, Saudi Arabia, 10Al Salama Hospital, Obstetrics and Gynecology, Jeddah, Saudi Arabia, 11King Faisal Specialist Hospital and Research Center, Research, Jeddah, Saudi Arabia, 12College of Medicine, Alfaisal University, Obstetrics and Gynecology, Riyadh, Saudi Arabia

Objective

To conduct the first-ever systematic review and meta-analysis evaluating calcium infusion versus cabergoline in preventing ovarian hyperstimulation syndrome (OHSS) among high-risk women undergoing assisted reproductive technology. Design: A systematic review and meta-analysis of randomized and non-randomized controlled trials.

Methods

Six databases were screened from inception until April 1st, 2024. The included randomized and non-randomized controlled studies were checked for quality assessment. The endpoints included the severity of OHSS and select pregnancy-related outcomes. The endpoints were summarized as risk ratio (RR) and 95% confidence interval (CI) in a random-effects model.

Results

Six studies were analyzed, comprising 1687 patients (calcium group = 828 and cabergoline group = 859). The quality of studies varied and comprised low and high risk in two and four studies, respectively. There was no significant difference between both groups regarding the rates of the overall (n = 5, RR = 0.65, 95% CI [0.39, 1.07], p = 0.09), mild (n = 4, RR = 1.05, 95% CI [0.59, 1.89], p = 0.86), moderate (n = 5, RR = 0.41, 95% CI [0.15, 1.08], p = 0.07), and severe (n = 6, RR = 0.36, 95% CI [0.11, 1.22], p = 0.1) cases of OHSS. Leave-one-out sensitivity analysis of an outlier study revealed that calcium significantly reduced the occurrence of severe OHSS compared with cabergoline (n = 5, RR = 0.16, 95% CI [0.09, 0.43], p < 0.001, Higgins I 2 = 0%). There was no significant difference between both groups regarding the rates of clinical pregnancy (n = 4, RR = 0.97, 95% CI [0.88, 1.07], p = 0.57), ongoing pregnancy, live birth, and spontaneous abortion (all Higgins I2 < 50%).

Conclusion

Both agents yielded similar pregnancy-related outcomes. However, calcium infusion could potentially be more effective than cabergoline in reducing the rate of severe OHSS. Additional high-quality and well-controlled are essential to draw firm conclusions. MTeP-02 Penthrox®; cheap, easy to use analgesia to reduce general anaesthetic need L. Croft1; C. Rogers2; M. Chalmers3; L. McCabe1 1Leeds Teaching Hospitals NHS Trust, Obstetrics & Gynaecology, Leeds, UK, 2University of Leeds, Leeds, UK, 3Leeds Teaching Hospitals NHS Trust, Leeds, UK

Objective

Commonly performed gynaecological procedures such as surgical evacuation for retained products of conception, a type of which is manual vacuum aspiration (MVA), can be performed in both an inpatient and outpatient setting. In the outpatient setting these procedures may not be well tolerated due to lack of analgesia and patients may require a general anaesthetic. Penthrox® (methoxyflurane) provides short acting analgesia through a hand-held, self-administered inhaler device. It can be used alone or in combination with local anaesthetic allowing same day procedures to be performed without the risks of general anaesthetic and the need of an operating theatre team. This audit aims to address whether Penthrox® is well tolerated and provides adequate analgesia for women undergoing outpatient gynaecology procedures, particularly MVA.

Method

Over a 6-month period, any woman seen on the Gynaecology Acute Treatment Unit (GATU) Leeds, with retained products of conception following a miscarriage, opting for an MVA, were offered the use of Penthrox®. Following the procedure women were asked to rate their pain score on a scale of 0–10 (10 worst). The majority of women undergoing an MVA did so using both Penthrox® and local anaesthetic in the form of a paracervical block. Women were excluded if Penthrox® was contraindicated, Entonox® or general anaesthetic were used instead.

Results

During the 6-months studied, Penthrox® was used 74 times in total, 53 times for an MVA, 21 times for other minor gynaecology procedures. 7 women didn’t provide a pain score, 2 were unable to tolerate the Penthrox®. Of the 44 women remaining, 70% reported a pain score of 0–5, 30% a pain score of 6–10, mean score 4.2. 1 MVA had to be abandoned. Prior to the introduction of Penthrox®, out of a total of 30 women undergoing MVA with either local anaesthetic or Entonox®, 13% reported a pain score of 0–5, 87% a pain score of 6–10, mean score 7.2.

Conclusion

This audit shows that Penthrox® is a well-tolerated inhaled analgesic suitable for use in minor gynaecology procedures. It is quick and effective to use in an outpatient setting, avoiding the need for costly general anaesthetics and prolonged hospital stays and provides superior pain relief to the use of local anaesthetic or Entonox® alone. Further data is required to assess the benefits of Penthrox® without the use of local anaesthetic and the scope in which it can be used in ambulatory gynaecology. MTeP-03 Multicentre, prospective test accuracy study of ovarian cancer in symptomatic post-menopausal women S. Sundar1; R. Agarwal1; K. Scandrett1; C. Davenport1; S. Mallett2; P. Sengupta3; S. Johnson4; R. Selvi-Vikram5; C. Rick6; S. Kehoe7; D. Timmerman8; T. Bourne9; H. Stobart10; R. Neal11; U. Menon2; A. Gentry-Maharaj2; L. Sturdy1; R. Ottridge1; J. Deeks1 1University of Birmingham, Birmingham, UK, 2University College London, London, UK, 3County Durham and Darlington NHS Trust, Durham, UK, 4Southampton University Hospitals, NHS Trust, Southampton, UK, 5West Hertfordshire Hospitals NHS Trust, West Hertfordshire, UK, 6University of Nottingham, Nottingham, UK, 7St Peter's College – University of Oxford, Oxford, UK, 8University Hospitals Leuven, Leuven, Belgium, 9Imperial College London, London, UK, 10Patient Representative, UK, UK, 11University of Exeter, Exeter, UK

Objective

Diagnosing Ovarian Cancer (OC) is challenging. The Refining Ovarian cancer Test accuracy Scores (ROCkeTS) study investigated the accuracy of risk prediction models for diagnosing OC in women with symptoms. No previous studies have compared the accuracy of all commonly used risk prediction models, head-to-head, in the same population and in a real world setting. Design: A prospective cohort study recruiting women undergoing surgery.

Methods

Newly presenting postmenopausal women with non-specific symptoms and raised CA125 and/or abnormal imaging donated blood for Risk of malignancy algorithm (ROMA) testing and underwent an International Ovarian tumour analysis (IOTA) ultrasound scan. Ultrasound scans were performed mainly by NHS sonographers with certification in IOTA models and who underwent quality assurance. Compared to Risk of Malignancy Index (RMI) at a threshold of 250, index tests and thresholds evaluated were IOTA ADNeX model (3% and 10%), ROMA at multiple thresholds, RMI1 (200), IOTA sRisk model (3% and 10%), IOTA simple rules, and (posthoc analysis) Ovarian-Adnexal Imaging-Reporting-Data System (ORADS) (10%) and Ca125 (35 IU/mL). The reference standard was tissue histology/cytology within 3 months or follow-up at 12 months. Tests were conducted blinded to outcomes. Primary outcomes were sensitivity, specificity, area under Receiver Operating Characteristic curve, Positive and Negative Predictive values and for risk prediction models, a calibration plot of primary invasive OC versus benign or normal. Findings: 1242 postmenopausal women were recruited from 23 hospitals of whom 215 had primary OC (17%). Compared to RMI 1 at 250, sensitivity 82.9% (95% CI: 76.7, 88.0), specificity 87.4% (95% CI: 84.9, 89.6), IOTA ADNEX at 10% was more sensitive (difference of 13.9, (95% CI: 7.6, 20.2, p < 0.001)) but less specific (difference of 28.5, (95% CI: 24.7, 32.3, p < 0.001)). ROMA at 29.9% had comparable sensitivity (difference of 3.6, (95% CI: −1.9, 9.1, p = 0.2379)) with lower specificity (difference of 5.2 (95% CI: 2.5, 8.0, p = 0.0001)). In posthoc analysis, ORADS achieved comparable sensitivity of 76.4%% (95% CI 70.1, 82.0, p = 0.5966) with significantly lower specificity of 78.3% (95% CI 75.3, 81.0, p < 0.001).

Conclusion

Compared to RMI (250), IOTA ADNEX (10%) had higher sensitivity but significantly lower specificity whilst ROMA at manufacturer recommended threshold (29.9%) and ORADS (10%) had comparable sensitivity but reduced specificity. Gains in sensitivity are likely to be preferred over reduced specificity in postmenopausal women. IOTA ADNEX at 10% should be considered the new standard of care diagnostic test for OC in postmenopausal women. MTeP-04 Incidence of ovarian cancer in pelvic organ prolapse women received prolapse surgery L.W. Yim1; S.S.C. Chan2; R.Y.K. Cheung2 1Department of Obstetric and Gynaecology, Prince of Wales Hospital, New Territories, Hong Kong, SAR of China, 2Prince of Wales Hospital, New Territories, Hong Kong, SAR of China

Objective

Ovarian cancer tends to present at advanced stage of disease. The overall lifetime risk of developing ovarian cancer is 1–1.4%. Women who planned for prolapse surgery, prophylactic bilateral salpingo-oophorectomy (BSO) is offered in order to reduce the risk of ovarian cancer. The objective of the study is to study the benefit of prophylactic BSO in patients having prolapse surgery. This would help to formulate a clinical recommendation in future. Design: This is a retrospective observational study on prospectively collected data in a tertiary university hospital. Patients with pelvic organ prolapse (POP) planned for surgery were counselled for option of prophylactic BSO. Patients who received surgery in 2016–2017 were reviewed.

Methods

Demographics including patient's age, body mass index (BMI), personal history of malignancy, history of procedure on ovaries and fallopian tubes were included. Prolapse surgery included vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy, laparoscopic sacrocolpopexy, laparoscopic hysterosacropexy. Pre-operation counselling, procedures and histopathology result were reviewed. Patients with history of BSO were excluded. The electronic records of the patients were reviewed in January 2024 for any incidence of ovarian cancer after the prolapse surgery.

Results

From 2016–2017, 227 patients received prolapse surgery in the study unit. Among them 218 (96%) with ovary/ovaries presence, 9 (4%) had ovaries being removed before prolapse surgery and are excluded. The mean age of the patients was 64.6 (SD 9.5) year. In all, 201 (92%) received vaginal hysterectomy, 2 (1%) received laparoscopic assisted vaginal hysterectomy, 10 (5%) received laparoscopic sacrocolpopexy, 5 (2%) received laparoscopic hysterosacropexy. 52 (24%) out of the 218 patients underwent prolapse surgery with ovaries presence had complete removal of bilateral fallopian tubes and ovaries, 25 (11%) had incomplete procedure, and majority of them 141 (65%) had no BSO performed. At the time of this review, the mean follow-up time was 84.1 (SD 6.8) months. None (0%) of the patients developed ovarian cancer.

Conclusion

None of the 201 patients with prolapse surgery performed in 2016–2017 developed ovarian cancer up to the review date. However, limiting factors including small sample size, the incidence of ovarian cancer could be underestimated. In view of quoted prevalence of ovarian cancer in general population at 1% and is usually presence at the late stage, and the procedure of salpingo-oophorectomy is feasible to be performed during the time of prolapse surgery, it is reasonable to offer options of salpingo-oophorecomy at the time of prolapse surgery. MTeP-05 Premature ovarian insufficiency a rising challenge for general practice physicians S.T. Amber1; S. Malick1; S. Malick2 1King Faisal Specialist Hospital & Research Centre, Family Medicine, Riyadh, Saudi Arabia, 2County Durham & Darlington NHS Trust, Paediatrics, Darlington, UK

Objective

Premature Ovarian Insufficiency (POI) is a condition of young women with long term health consequences. The prevalence of POI over the past 20 years is on the rise affecting 1 to 1.9% of younger women. To our knowledge, there is no study to date looking at prevalence of POI in Middle East in particular Kingdom of Saudi Arabia (KSA). Our study aims to identify the number of women referred from Family Medicine Clinic to specialist Gynaecology clinic labelled with PCOS but later diagnosed to have POI. Design: Retrospective cross sectional analysis.

Method

A cross sectional analysis was done on a cohort of patients referred from Family Medicine as polycystic ovaries syndrome (PCOS) to the specialist Gynaecology clinic at King Faisal Specialist Hospital & Research Centre. We looked at patients’ electronic records from October till December 2023. POI was diagnosed based on ESHRE guidelines i.e. oligo/amenorrhea for at least 4 months, and an elevated FSH level > 25 IU/L on two occasions > 4 weeks apart.

Results

All patients reported a wide range of symptoms from irregular periods including oligo/amenorrhea and hypo-estrogenic symptoms including hot flushes, vaginal dryness and fertility issues. Five out of fifty referred patients with ages less than 40 were diagnosed with POI. They were, initially, misdiagnosed as PCOS and were offered other treatments. It was a missed opportunity to manage them with treatment options like hormone replacement therapy. There was no cardiovascular or fracture risk assessment performed.

Conclusions

On an average a woman is seen multiple times before diagnosis. Often she is misdiagnosed as PCOS as seen in our cohort. POI can lead to psychosomatic, vasomotor and genito-urinary symptoms affecting the quality of life in these women. This is also associated with long-term complications such as cardiovascular disease, osteoporosis, cognitive issues thus increasing the disease burden on health resources. Delayed diagnosis also prevents timely referral to IVF services. We recommend an increased awareness amongst family physicians through organized training sessions to timely diagnose POI with a simple set of tools. This can significantly improve health outcomes of women with POI. We also propose a collaboration with the RCOG and RCGP for joint guidance. We are pleased to confirm that based on above study, our organization has approved our large scale Research Project to establish the prevalence of POI in KSA. MTeP-06 Will vNOTES salpingectomy replace laparoscopy in the management of ectopic pregnancy? J.C.E. Ho1; V. Mathieu2; S. Wylie3; W. Lodhi3; S. Rouabhi3; W. Yoong3 1University College London, London, UK, 2St George's International School of Medicine, St George's, Grenada, 3Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK

Objective

While laparoscopic salpingectomy is the surgical treatment of choice for ectopic pregnancy, vNOTES approach is emerging as an alternative route with its avoidance of abdominal incisions and good optical visibility. The aim of this study is to assess the safety and efficacy of vNOTES vs. conventional laparoscopic salpingectomy for the management of ectopic pregnancy. Design: Prospective case control study.

Methods

Demographic and outcome data from 15 cases of vNOTES salpingectomy were compared with 15 cases conventional laparoscopic salpingectomy for the surgical management of ectopic pregnancy.

Results

The mean patient age (29.7 ± 1.1 vs. 30.7 ± 2.3 years), parity (1.2 ± 1.1 vs. 1.5 ± 2.1), BMI (26.3 ± 2.3 vs. 27 ± 1.8 kg/m3), gestation age (8.5 ± 2.1 vs. 7.3 ± 1.7 weeks) and βhCG levels (3321.7 ± 3674.8 vs. 4402.0 ± 6493.4 mIU/mL) comparable (p > 0.05, t test) between patients having vNOTES vs. conventional laparoscopic salpingectomy. While estimated intraoperative blood loss (130.2 ± 8.4 vs. 136.0 ± 8.1 mls) (p > 0.001), vNOTES patients had statistically shorter duration of surgery (39.8 ± 72.3 vs. 76.6 ± 130 mins) (p < 0.001, t test) and length of stay (14.6 ± 9.1 vs. 22.2 ± 13.9 h) (p = 0.02, t test). Less patients in the vNOTES group required postoperative opioids (9% vs. 25%) and mean Visual Analogue Score (/10) for pain at 24 h was significantly lower (2 ± 0.5 vs. 5 ± 1.9) (p < 0.05, t test). Further, patients from the vNOTES group were able to return to normal daily activity almost three times quicker (5.2 ± 4.3 vs. 14 ± 8.2 days) (p < 0.05, t test).

Conclusion

vNOTES cases cost approximately £130 (USD150) more than conventional laparoscopy, mainly due to the price of the commercial kits but this is offset by the shorter intraoperative time and length of stay. These patients also reported less postoperative pain and were able to return to normal daily activity almost three times quicker than conventional laparoscopy. While the vNOTES approach for ectopic pregnancy appears safe and efficacious, more robust data from larger randomised studies are needed to support this. MTeP-07 Knowledge, attitude, and practice of FGM among Al-Neelain University medical students S. Ali; A. Ahmed; R. Mohamed Faculty of Medicine, Community Medicine Department, Al Neelain University, Khartoum, Sudan

Background

Female genital mutilation (FGM) is described as ‘all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. It is considered gender-based violence and a negative social norm. FGM is a common practice throughout Sudan, with a prevalence rate of 86.6%. In sixteen states out of eighteen, more than half of all girls since birth underwent FGM before turning 15. They further expect that if they don't respect social rules, they will suffer social consequences such as derision, and loss of status.

Objective

This study aims to assess the knowledge, altitude, and practice of FGM among Al Neelain University medical students in 2024. Design: This is an observational, cross-sectional, institutional-based study that was conducted at Al-Neelain University, Faculty of Medicine, between November 2023 and March 2024.

Methods

The number of participants in this study was 292, and the data were collected through an online Google Forms-structured self-administered questionnaire, which was sent via social media applications. Data entered prior to the analysis was copied to Excel using the Microsoft Excel 2021 program. The data was analyzed using the Statistical Package for Social Sciences software version 26. Informed consent was obtained from all participants.

Results

The majority of participants were females (68.8%) with a mean age of 22 years who lived in urban areas (84%). Around 96.6 percent of the participants know what FGM is and have heard about it from their families, community, and social media. Only 25.8% of the participants underwent FGM. FGM is a common practice in 30.5% of the participants origin states. Most of the participants strongly disagreed with FGM practices (88.3%) and knew about its complications. 83.9 percent of participants didn't receive information about FGM in college. Over 54.8% of participants didn't hear about the Sudanese law of FGM crimnilization.

Conclusion

We found that the majority of students have a moderate level of knowledge but good practices and attitudes regarding FGM. Respondents who agreed with FGM practices did so for mostly religious reasons, but most of them didn’t intend to circumcise their future daughters. The majority of respondents have not participated in activities against FGM or received information about FGM in college. Regarding the factors that may influence the medical students’ knowledge, attitude, and practice toward FGM, we found strong statistically significant associations with gender, residency, and knowledge level. MTeP-08 Etherena: An innovative loading and inserting device for Copper-T 380A insertion technique S. Singh1; L. Chawla2; S. Thakur2; M.K. Sah2; S. Prateek2; J. Chaturvedi2,2 1Pregna International Limited, Medical, Mumbai, India, 2Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India

Objective

This study aimed to compare the outcomes of Copper-T 380A insertion using a conventional method versus an innovative inserter (Etherena) in terms of ease of insertion, fundal placement, insertion time, training requirements, client comfort, and perception during the use of a uterine sound. Design: A single-blinded, randomized controlled trial (RCT) was conducted at AIIMS, Rishikesh, India, between July 2020 and October 2021. A total of 100 women were randomly selected and enrolled in the study, with 50 participants in each group (Group A: conventional method, Group B: Etherena). All participants were counseled for family planning, met eligibility criteria, and opted for an interval IUD.

Methods

In Group A, the conventional no-touch technique with a metallic uterine sound was used, while Group B utilized the Etherena inserter with a disposable uterine Sound (Esa). The Etherena inserter features an integrated system for safe one-hand operation with a simple 2-step operation (Push-Pull), allowing for easy loading and insertion of the Copper-T 380A. Outcome Parameters: Evaluation included noting the type of IUD and uterine sound used, ease of loading T arms, experience during sounding, measurement of uterine depth on the inserter tube, technique of placement, time taken for sounding, loading and insertion, confirmation of IUD position via ultrasound, provider satisfaction, device handling, and overall client satisfaction.

Results

Pain during sounding was significantly lower with Etherena compared to the conventional method (p < 0.0001). Providers in Group B found loading of Cu T IUD arms easier 94% of the time, while Group A reported ease only 26% of the time (p < 0.0001). Setting measurement of uterine depth on inserter tube was easy every time in group B and 90% of times in group A (p = 0.054). Technique of placement of device was easy every time in group B as compared to 86% of the times in group A (p = 0.012). Over all handling of device was significantly easy with Etherena (98%) as compared to conventional method (64%) [p = >0.0001]. Time taken for insertion (sounding, loading and insertion) was significantly less with Etherena as compared to conventional method [p < 0.0001].

Conclusion

The study concludes that the Etherena inserter offers a more satisfactory handling experience for providers, requiring minimal training and ensuring adequate fundal placement with quicker insertion times. This innovative and safe insertion process makes Copper-T 380A insertions more convenient, accessible, and significantly less painful for clients, enhancing overall satisfaction and safety. MTeP-09 IMA (Ischemia Modified Albumin) as a potential diagnostic marker in adult PCOS P. Sankhwar; S.P. Jaiswar; U. Singh; M. Verma Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, India

Objective

The study aimed to estimate and evaluate the elevated level of IMA as a diagnostic marker in PCOS women. Design: A case-control study to evaluate the levels of IMA in PCOS cases and compare with the Non-PCOS women.

Background

Polycystic ovarian syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age, affecting around 18% of them. The complex etiopathogenesis of PCOS involves genetic, environmental, and hormonal factors leading to metabolic and ovarian dysfunction. Oxidative stress (OS) is increasingly recognized as a contributing factor to PCOS pathophysiology. Ischemia Modified Albumin (IMA), a marker of oxidative stress, has been investigated in various endocrine disorders, but its role in PCOS remains contradictory in existing literature. This study aimed to assess the correlation between elevated levels of IMA and PCOS in women from Northern India.

Material and methods

In this case-control study a total of 100 participants (50 cases and 50 controls) aged 21 to 45 years willing to participate in the study were enrolled, according to the inclusion/exclusion criteria based on the Rotterdam criteria for PCOS diagnosis and healthy females as controls. Serum IMA levels were estimated using an ELISA kit. SPSS 17.0 (Statistical Package for Social Sciences 17.0) was used to carry out the statistical analysis.

Result

The results revealed a significant difference in serum IMA levels between PCOS patients (197.79 kU/L) and controls (100.19 kU/L) (p < 0.001). Additionally, PCOS patients exhibited significant differences in serum levels of LH, FSH, LH/FSH ratio, testosterone (p < 0.001 respectively), and fasting insulin compared to controls (p < 0.05). Positive correlations were observed between IMA levels and also parameters such as BMI (p < 0.001), serum LH/FSH ratio, testosterone, and duration of PCOS, while a negative correlation was noted with LH/FSH ratio. The sensitivity of the IMA test to diagnose PCOS was 90% and the specificity was 84% with89% negative predictive value and 84.9% positive predictive value with diagnostic accuracy of 87%.

Conclusion

This study suggests that elevated serum IMA levels could serve as a potential diagnostic marker for PCOS, reflecting increased oxidative stress in affected individuals. Further research involving larger population samples is warranted to explore the prognostic significance of serum IMA levels in PCOS and evaluate the potential therapeutic interventions targeting oxidative stress to improve patient outcomes. MTeP-10 Converging routes: Consolidating the multifaceted approaches to post-coital bleeding management A. Sharif1; S. Nath1; Y. Achampong1; R. Wuntakal2 1Barking, Havering and Redbridge University Hospitals NHS Trusts, Obstetrics and Gynaecology Specialty Registrar, London, UK, 2Barking, Havering and Redbridge University Hospitals NHS Trusts, Obstetrics and Gynaecology Consultant, London, UK

Objective

Post-Coital bleeding (PCB) is a common presentation faced by the gynaecologist. Patients can be referred to the 2-week-wait (2WW) gynaecology outpatient clinic (GOPD) or directly to colposcopy services by their GP or via emergency gynaecology unit. PCB can be an important presenting symptom of cervical malignancy; thereby thorough examination and investigation is vital. However, often the causes of PCB are benign or self-limiting. Currently, a lack of national guidance has meant various routes exist for investigating patients with PCB. This may include over-investigating or inappropriate referrals to the Colposcopy unit, leading to prolonging patient anxiety and ill-use of resources. Design: To analyse the investigation of patients presenting with PCB and assess impact on our colposcopy services at our London District Teaching Hospital. Retrospective study undertaken of women referred with PCB during the period 1/10/2023 and 31/12/2023.

Methods

Electronic clinical letters for all new patients referred to the 2WW GOPD were reviewed to reveal those referred with PCB as their main symptom. Additionally, Colposcopy database was reviewed for direct new referrals with PCB. Patient demographics, gynaecological, smear and contraceptive history, smoking status as well as the investigations performed were recorded in an electronic proforma. Analysis was performed on Microsoft Excel. - During this period there were 911 new referrals to the gynaecology 2WW clinic. 48 (5.3%) referred with PCB as their main symptom. - During this period there were 41 new referrals to the Colposcopy clinic. 26 (63%) due to PCB. - Median age 38 (range 20–65). - 70% patients had up to date smears, 85% of these HPV negative. - 50% presented with PCB alone; 48% PCB +additional IMB or menorrhagia. - Speculum examination revealed 35% ectropion, 33% normal, 6% cervical polyp, 2% suspicious cervix. - 54% of those referred to colposcopy had normal findings; 23% treated for ectropion and 23% had biopsies of suspicious areas of which only 1 case was confirmed CIN1.

Conclusions

Patients with normal cervical examination, up-to-date normal smear and no signs of infection can be reassured and do not require referral to colposcopy. Silver nitrate treatment can be applied to clinically confirmed cervical ectropion in the OPD to alleviate symptoms. Patients with abnormal cervical appearance or previous history of abnormal smear warrant urgent referral to Colposcopy. Pelvic ultrasound ± outpatient hysteroscopy should be offered to patients presenting with concurrent intermenstrual bleeding. Streamlining investigations appropriately can allow swift patient diagnosis, earlier reassurance; reduce inappropriate investigations and reduce impact on colposcopy services. MTeP-11 Assessing the outcomes of women referred to 2 week wait clinics for post-menopausal bleeding V. Pereira; B. Joseph; J. Nippani South Warwickshire University Hospital and Foundation Trust, Obstetrics & Gynaecology, Warwickshire, UK

Objective

The aim of this study is to assess the utilization of post-menopausal clinics within the 2-week wait pathway. Design: A retrospective audit was conducted, involving the collection of data from 100 patients referred within a one-month period.

Method

The study involved screening 100 referrals and stratifying them based on various risk factors such as age, BMI, comorbidities, ultrasound findings, and hormone replacement therapy (HRT) usage. Detailed histories, clinical examinations, interventions, and histology results were reviewed. Data analysis was performed using Excel.

Results

Data from 100 patients were analyzed. Clinical history and examination documentation were found to be inadequate in 80% of cases, while 20% had good documentation. Of the patients, 13% were pre-menopausal and 85% were post-menopausal. Endometrial thickness was observed to be less than 4 mm in 47% of cases, greater than 4 mm in 53%, with irregular endometrium in 2%, and other findings in 3%. Nearly half (49%) of the patients did not require any interventions, while 2% declined intervention. Procedures included Pipelles biopsy in 21% of cases, outpatient hysteroscopy in 19%, and inpatient hysteroscopy in 7%. Histology results revealed normal findings in 89% of cases, scanty tissue in 4%, no tissue obtained in 2%, cervical polyp in 2%, and Grade 1 Ca endometrium in 2%.

Conclusions

Nearly half (49%) of the women referred did not require intervention. Improved history-taking and clinical examination practices could potentially reduce referrals to post-menopausal clinics, thereby alleviating the workload on the NHS. MTeP-12 Obesity and menstrual disturbance among Omani school girls I. AlBalushi1; R. AlGabshi2; N. AlBusaidi2; H. AlBalushi3 1Ministry of Health, OBGYN, Muscat, Oman, 2Ministry of Health, Muscat, Oman, 3Oman Medical Specialty Board, Muscat, Oman Menstruation is a normal physiological phenomenon for females indicating their capability for procreation. Menstrual irregularities are common among adolescent, adversely affecting their quality of life. Obesity is one of the factors that contributes to irregularity in menstrual cycles. In Oman due to lifestyle changes over the last 4 decades prevalence of obesity among young females aged (5–19 years) increased from 5.1% to 43.5%. Hence the prevalence of menstrual disorders and future subfertility expected to increase over the coming years.

Objective

The aim of this study is to assess the relationship between menstrual disturbances and BMI, and to determine the current mean age of menarche among Omani schoolgirls.

Materials and methods

This study was cross-sectional survey, conducted with collaboration of NDEC, among schoolgirls at grade 11 in two governmental schools in Sep 2019. Ethical approval was obtained from research and ethics committee at RH. Written informed consent taken from the parents of schoolgirls. Information was collected using a questionnaire that include demographic details, anthropometrics measurements, standard questions describing the menstrual patterns, concerned their age at menarche, duration of the most recent menstruation intervals average days of bleeding, and any menstrual problems and their frequency. The data were analyzed in SPSS.

Results

The total number of girls included in this study was 385. Their mean age was 15.71 years and mean age of menarche was 12.77 years. The age of menarche noticed to be earlier among obese girls. Total of 55 girls (14.2%) were overweight and 40 girls (10%) were obese. 79 (20.5%) girls had infrequent cycle with intermenstrual length of more than 34 days. 26 (32.9%) out of them were overweight and obese and 2 (2.5%) were underweight. 85% of obese girls had dysmenorrhea. Almost 88% of girls with acanthosis nigricans were overweight and obese. Around 42.5% of obese girls and 30% of overweight had hirsutisim while only 13% of those with normal and under weight had hirsutisim.

Conclusion

Menstrual disturbances are more common among obese girls. Girls who reported more physical activity and healthy diet were less likely to have menstrual irregularities. A significant association between obesity, menstrual irregularities and healthy lifestyle among adolescent, highlights the importance of taking measures for educating adolescents and their families to adapt simple and effective lifestyle modifications for a healthy reproductive life during adulthood. MTeP-13 Pregnancy in a frozen cycle after triggering ovulation with progesterone A. Gatagazheva Doctor Fomin's Clinic, ART, Moscow, Russian Federation

Objective

A clinical case of successful use of progesterone as a trigger in a frozen modified natural cycle. Design: A clinical case report.

Method

In June 2023, a 32-year-old woman with anovulatory infertility for 6 years presented to our department. In her medical history, she underwent controlled ovulation stimulation and had 2 failed frozen embryo transfers in HRT cycles. A thorough examination recommended before the IVF protocol was conducted in our clinic. No additional infertility factors or contraindications for another controlled ovarian stimulation were identified. In July 2023, a controlled ovarian stimulation was performed, yielding 28 oocytes, 15 zygotes, and 5 blastocysts, two of which were euploid by PGT-A results. In September 2023, an embryo transfer was performed in a modified natural cycle according to standard patient management protocols in such cases, but pregnancy did not occur. Based on the successful use of progesterone for ovulation trigger as reported by Lina Villar, et al., 2023, it was decided to proceed with the transfer of another embryo in a modified natural cycle using progesterone as an ovulation stimulantion agent. Patient consent was obtained. On the 2nd day of the menstrual cycle, ultrasound revealed no additional pathology; progesterone level was 0.32 pmol/L; LH – 12.5 mIU/mL. On the 14th day of the menstrual cycle, optimal endometrial thickness (8.8 mm) and a dominant follicle measuring 18 mm were achieved. Progesterone level was measured at 0.32 pmol/L; LH – 11.8 mIU/mL. That evening, 10 mg of progesterone were administered intramuscularly.

Results

24 h post-progesterone administration, progesterone level was revealed to be 0.32 pmol/L; LH – 25.18 mIU/mL. After 36 h, progesterone level rose to 55.5 pmol/L; LH – 15.8 mIU/mL; ultrasonography confirmed the presence of the corpus luteum. Six days after progesterone administration, the embryo transfer was performed on the 7th day, leading to the current pregnancy successfully progressing for over 26 weeks.

Conclusions

Based on Lina Villar, et al.'s successful use of progesterone in single ovulation induction, we combined their method with the standard IVF protocol and saw positive outcomes. Our case provides strong evidence for using progesterone as an ovulation trigger in embryo transfer during modified natural cycles, particularly when traditional methods have not resulted in pregnancy. Further research could confirm this approach as a valuable option for patients with recurrent implantation failures. MTeP-14 Prediction of pregnancy outcomes in IVF patients using multi-modal deep learning methods M. Vali1; J. Yang2; S. Vali3,4; T. Azevedo2; P. Lio2; Y. Thum5 1University of Cambridge, Physics, Cambridge, UK, 2University of Cambridge, Computer Science and Technology, Cambridge, UK, 3Hillingdon Hospitals NHS Foundation Trust, Obstetrics and Gynaecology, Uxbridge, UK, 4Department of Surgery and Cancer, Imperial College London, London, UK, 5The Lister Hospital, The Lister Fertility Clinic, London, UK

Objective

Multi-modal artificial intelligence (AI) methods, which use various data modalities including images and text, have recently demonstrated success in representing underlying data patterns more comprehensively, leading to better predictions. IVF protocols rely on ultrasound (US) images, hormonal and other text-based data for determining individualised protocols. In this work, we utilise such multi-modal datasets to build a prediction tool for pregnancy outcomes. We work towards developing an automated, individualised set of interventions to maximise embryo transfer outcomes. To date, this is the first work leveraging multi-modal AI methods in this cohort with a future roadmap for personalised fertility treatments. Design: An observational study using retrospective patient data from a UK IVF institution, analysing over 1000 US images and data from nearly 2000 patients undergoing fresh and frozen embryo transfer (ET) cycles. Data included couple demographics, hormonal profile, outcome following egg collection, BMI, embryo culture and grading, and nearly 50 other patient-specific parameters.

Method

We utilise different multi-modal model architectures, notably the Contrastive Language-Image Pretraining (CLIP) for the classification task of predicting pregnancy outcomes. Shapley values are used to calculate the marginal contribution of each patient-level parameter, to improve model interpretability. We also use multi-task learning models, previously not used in this field, to improve computational efficiency and thereby applicability for use in clinics. Finally, we incorporate model uncertainty to assist clinicians in decision-making.

Results

We have developed a multi-modal AI platform that can be trained on text, quantitative and US image data collected from patients undergoing ET cycles to predict clinical pregnancy, with a high degree of accuracy and compatible with clinical use. Uni-modal classification using standard methods such as support vector machines with less than 10 patient-specific parameters yields an F1 score of 0.82, whilst utilising over 50 variables yields 0.92. Multi-modal classification, which includes ultrasound images results in significant improvement. The Shapley values also provide a ranked list of the most important parameters in predicting clinical pregnancy following ET. Full results will be available at presentation.

Conclusions

This work develops a multi-modal AI platform capable of processing various data types collected in IVF clinics to make predictions on likelihood of success of ET cycles. We identify the most important types of patient-level data in predicting such outcomes. We also provide recommendations on IVF protocols for clinicians by analysing the predictive power of typical data collected during a routine IVF process. MTeP-15 Why is HIFU the safest for patients with fibroids: Systematic review M. Maged Ali1; C. Raphael Mpehle2; E. Olusola2; P. Khomotso Ratshabedi2; A. Ragab Shehata3; M. Ashraf Youssef3; E. Ali Helal Farag4 1Obstetric and Gynaecology Department, Ministry of Health, Fayoum General Hospital, Obstetrics and Gynecology, Fayoum, Egypt, 2Faculty of Health Science, University of the Witwatersrand, Obstetrics and Gynecology, Johannesburg, South Africa, 3Beni-Suef University, Beni-Suef, Egypt, 4Faculty of Medicine – Al-Azhar University, Cairo, Egypt

Background

High-intensity focused ultrasound (HIFU) is an emerging intervention which uses the high-intensity ultrasound waves from ultrasound probes to focus on the targeted fibroids. It is a non-invasive technique that causes instant coagulated necrosis in a well-circumscribed area of a few millimeters in diameter and can be performed under the guidance of either MRI or ultrasound. Design: A systematic Review

Objective

To evaluate the safety of HIFU in the treatment of uterine fibroids whatever site and size. We specifically aim to determine the incidence of possible side effects which can occur during and after HIFU.

Methods

We searched the PubMed, Scopus, ScienceDirect and Mendeley archive using only these terms (HIFU AND Fibroid). 1077 records were identified including randomized controlled trials (RCTs), non-RCTs, cohort studies, and case reports from 2014 to March 2024. 300 studies remained for full title screening and 239 were excluded. Then, A total of 61 studies were included in the end.

Results

About 61 studies met the inclusion criteria. Adverse events (AEs) was estimated in fibroid patients submitted to HIFU treatment, According to SIR (Society of Interventional Radiology) guidelines class A adverse events showed no significant results also individuals experienced these AEs required no treatment and no long-term consequences. Similarly, Class B reported no significant results. However, 3943/10204 (38%) of patients complained from lower abdominal pain among class B after the procedure which resolved by analgesics. Only 161/24972 (0.6%) of patients suffered from skin burns, blisters, or nodules which resolved by conservative treatment and only 84 / 24013 (0.3%) patients suffered from hematuria. Additionally, 882 / 5970 (14.7%) patients had abnormal vaginal discharge, 414 / 23449 (1.7%) patients had vaginal bleeding, and 267 / 7598 (3.5%) of patients suffered from Leg paresthesia. Major AEs (SIR class C&D) showed almost no existence such incidence of death in our study was zero.

Conclusion

This systematic review aimed to determine the incidence of possible side effects which can occur during and after HIFU. HIFU ablation of uterine fibroids whatever site and size is safe and causes mostly light side effects and very few severe complications. The comparative safety of HIFU with other types of minimally invasive techniques, such as uterine artery embolization, still deserve to be further assessed. MTeP-16 Effect of pharmacological interventions on metabolic & endocrine outcomes in women with PCOS C. Ukoha; L. Dobbie; M. Molokhia Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Kings's College, London, UK

Background

PCOS is common, affecting approximately 10% of women. Current treatment options for PCOS are sub-optimal and are based on treating metabolic (i.e., metformin) and reproductive (i.e., contraceptive pill) associated concerns. There is considerable scope to utilise novel therapies in treating PCOS, particularly the recently developed type 2 diabetes interventions (GLP-1 agonists, SGLT-2 inhibitors, DPP-4 inhibitors). This umbrella review aimed to analyse systematic reviews and meta-analyses of RCTs on PCOS pharmacological interventions. Design: An Umbrella Review of Systematic Reviews and Meta-analyses Of Randomised Control Trials. Search Methods: An electronic search was conducted on PubMed/Medline, Embase, Cochrane, and Scopus, including only English-language publications. Inclusion criteria comprised females of any age, diagnosis duration, or ethnicity, with diagnoses adhering to the Rotterdam Criteria, NIH-Criteria, or AE-PCOS Criteria. The search spanned from Jan 1st, 1980, to January 5th, 2024, focusing on pharmacological interventions (Metformin, GLP-1, SGLT-2 inhibitors, statins, sitagliptin, pioglitazone, orlistat). Outcome measures included endocrine (total testosterone, SHBG, DHEAS, FSH, LH, LH: FSH, progesterone, oestradiol, androstenedione) and metabolic (BMI and fasting glucose) parameters. Abstracts and full-text reviews were conducted in duplicate, followed by quality assessment using the AMSTAR-2 method. Meta-analysis was performed using the standardised mean difference (SMD) in R Studio (version 4.2.3). The protocol was registered with PROSPERO (CRD42023443524).

Results

The review included 8459 participants from 184 trials worldwide, without any ethnic restrictions. Sitagliptin demonstrated the most significant decrease in serum total testosterone (n = 4, N = 232, SMD = −0.66, 95% CI: [−1.30; −0.01], p = 0.02, I2 = 69%). GLP-1 exhibited notable reductions in BMI compared to metformin (n = 7, N = 344, SMD = −0.75, 95% CI: [−1.11; 0.39], p = 0.07, I2 = 48%), while SGLT-2 inhibitors were most effective in lowering fasting glucose (n = 3, N = 105, SMD = −0.596, 95% CI: [−0.997; −0.196], p = < 0.01, I2 = 37.76%) and DHEAS (n = 3, N = 64, SMD = −0.549, 95% CI: [−0.942; −0.156], p = < 0.56, I2 = 31.88%). Combined therapy with simvastatin and metformin reduced LH: FSH compared to metformin monotherapy (n = 2, N = 219, SMD = −2.66, 95% CI: [−3.02; −2.29], p = 0.36, I2 = 0%). The certainty of evidence ranged from moderate to high for these outcomes.

Conclusion

This review highlights the effectiveness of monotherapy, combined therapy, and new type 2 diabetes drugs in PCOS management. GLP-1s exhibit evidence in weight management and mitigating cardiometabolic risks. SGLT-2 inhibitors demonstrate potential in reducing hyperglycemia, hyperandrogenism, and cardiovascular risks. Evidence suggests sitagliptin may decrease testosterone levels and hyperandrogenism, although its effects on glucose and weight remain uncertain. MTeP-17 Transabdominal versus transvaginal follicular aspiration for oocyte retrieval for social oocyte freezing A. El Bohoty1; A. Kanan2; S. Davamani2; M. Liswi3 1Healthplus Fertility Center, ART, Abu Dhabi, United Arab Emirates, 2Healthplus Fertility, ART, Abu Dhabi, United Arab Emirates, 3Global Health, Technical Advisor, Amman, Jordan

Introduction

Social egg freezing is usually offered to women between 30 to 40 years who want to preserve her fertility1. For future use, which offers higher chances of successful pregnancy after the age of 40 years in addition to the reduction of having chromosomal abnormal offspring2,3. The standard approach for egg retrieval is Ultrasound-guided transvaginal, however transabdominal ultrasound-guided approach can be used alternatively if the vaginal rout is technically unsuitable4,5 or vaginal route is declined especially in communities supporting virginity till marriage status . Thus, the justifying the abdominal route for folliculometry and egg retrieval special inclusion and inclusion criteria where used to select patients Abdominal route to ensure safety, accessibility of retrieved ovaries.

Objective

Assessment of the efficacy of transabdominal follicular aspiration (AFA), compared with the vaginal aspiration (VFA) for social oocyte freezing.

Methods

This study was conducted in the Health-Plus fertility center (UAE). after proper counselling and examination Ovarian stimulation was initiated on day 2–3 of the menstrual cycles with short antagonist protocol. All oocyte retrievals were performed under general anesthesia. For Vaginal oocyte retrieval: the usual way was performed in vaginal preparation and egg retrieval. For Ultrasound guided abdominal oocyte retrieval: The patient was placed in the dorsal supine position with an empty bladder, and a Betadine solution was used for skin preparation, which was then washed off the abdomen. A sterile needle guide was attached to a sterilely draped vaginal ultrasound probe. The ultrasound operator placed the probe over the ovary where it was best visualized in the abdomen. Under ultrasound guidance, a double lumen 17-gauge retrieval needle (Cook IVF, Spencer, IN) was inserted through the skin using the needle guide. All retrieved mature oocytes were cryopreserved by MediCult Vitrification Cooling protocol. The egg freezing cases over the period January 2023 till now will recruited.

Results

The dataset includes two groups the Transabdominal (TA) and Transvaginal (TV), with 10 and 24 cases, respectively. The analysis showed no significant difference in the mean proportion of collected oocytes to expected follicles between the 2 groups, with a mean of approximately 1.1 (p-value = 0.507). Similarly, the number of mature oocytes and postoperative pain scores showed no significant differences between the groups.

Conclusions

Observational data revealed a favorable safety profile for TA approach for social oocyte freezing, with a good number of mature eggs retrieved compared to tv approach, but TA group experiencing longer procedures. MTeP-18 How trustworthy is the evidence on treatment in women with recurrent miscarriage? M.H. Vu1; B.W. Mol1,2 1Monash University, Obstetrics & Gynaecology, Melbourne, Australia, 2University of Aberdeen, Aberdeen Centre for Women's Health Research, Aberdeen, UK

Objective

Until recently, little attention has been paid to the trustworthiness of randomised controlled trials (RCTs). It is however estimated that as much as 30% of published RCTs are not trustworthy (1). Here, we assess the trustworthiness of RCTs investigating medical management options of recurrent miscarriage (RM). Design: Reassessment of existing meta-analyses.

Methods

We used the existing Cochrane reviews and meta-analyses to identify RCTs evaluating the effectiveness of antithrombotics, Levothyroxine and Progesterone in women with RM. We assessed the integrity of these RCTs with the Trustworthiness in Randomised Controlled Trials checklist (TRACT). This checklist covers 19 items across seven domains including Governance, Authors, Plausibility of intervention, Timeframe, Drop-out rates, Baseline Characteristics and Outcomes. We identified characteristics that seriously questioned the integrity of these studies. The remaining studies were classified as low or moderate risk for integrity problems.

Results

From six Cochrane systematic reviews and two meta-analyses assessing the use of antithrombotics, levothyroxine and progesterone as treatment options for RM, we identified 51 RCTs published between 1953 and 2023. From 27 RCTs on antithrombotics, 11 were considered untrustworthy (1 retracted, 1 expression of concern, 1 impossible calculations, 1 conflict between conference abstract and paper, 2 data copying, 4 unfeasible recruitment, 1 unfeasible treatment effect). From 13 RCTs on progesterone, 3 were considered untrustworthy, while from 11 RCTs on Levothyroxine, 3 were considered untrustworthy. From the remaining 34 RCTs, 18 were classified as low risk and 16 as moderate risk for integrity problems. Exclusion of the 17 untrustworthy RCTs affected the conclusions for Cochrane reviews on Low Molecular Weight Heparin (LMWH) versus no treatment (78% of the weight), LMWH + aspirin versus aspirin alone (50.9% of the weight), LMWH versus no treatment (100% of the weight), LMWH + aspirin versus or Unfractionated Heparin + aspirin (70% of the weight) and Higher dose heparin + aspirin versus lower dose heparin + aspirin (100% of the weight), progesterone versus placebo (25% of the weight), levothyroxine (21% of the weight), leading to a reduction of the estimated treatment effect after leaving out untrustworthy studies. The effect of progesterone was no longer statistically significant.

Conclusion

In Cochrane reviews on medical treatment of recurrent miscarriage, 33% of RCTs are untrustworthy. This leads to overestimation of treatment effects, with some anticoagulants and progesterone no longer being statistically significant.

Reference

Carlisle JB. False individual patient data and zombie randomised controlled trials submitted to Anaesthesia. Anaesthesia 2021;76(4):472–9. MTeP-19 Letrozole in ART: New insights and experiences for developing counties A. Galal Alexandria University, Alexandria, Egypt

Objective

To survey our experiece for using aromatase inhibitos in different ART protocols namely in IUI using the novel step up ovaran stimulation protocol, sequential use in ICSI cycles and its use in endometrial preparation for frozen cycle transfer.

Materials and methods

3 series of studies, the first its IUI use. A prospective randomized controlled study. 100 couples with unexplained infertility undergoing IUI were randomized into two groups with each group include 50 women. Group A controlled ovarian hyperstimulation (−COH) was done by step up protocol of letrozole from day 2 or 3 of menstrual cycle starting by a dose 2.5 mg increased daily by 2.5 mg for other 3 days. Group B, COH was done by HMG ampoules that was tailred according to the response, HCG given when leading follicle 17 mm and IUI done 36 h after HCG. Luteal support by vaginal progesterone was achieved and serum B HCG was measured after 14 days of IUI and clinical pregnancy was confirmed by detection of fetal heart pulsation at 6–8 weeks by vaginal ultrasonography.

Results

The step-up letrozole protocol was associated with multifollicular ovarian development with a mean of 1.5_0.7 that was less than this detected with HMG 3.1_1.0 however this did not affect so much clinical pregnancy rate that was statistically insignificant (16% in letrozole group versus 18% in HMG group) that may reflect the good quality of oocyte in addition to the good receptivity suggested by non significant difference in endometrial thickness. The cost of letrozole cycles was significantly lower than HMG group. The second for ICSI prospective trial comparing Sequential letrozole HMG protocol versus HMG ovarian super stimulation for ICSI cycles in good responders. Results showed lowr HMG dosage and fewer stimulation duration with insignificantly higher clinical pregnancy rate and marked cost reduction. Third for endometrial preparation prospective study comparing endometrial preparation with letrozle versus HRT cycle preparation, results. Letrozole in preparation of endometrium for FET cycles is another area of experience with 58% pregnancy rate compared to 52% in usual artificial cycle using estrogen and progesterone.

Conclusions

Aromatase inhibitor is a suitable option for developing counties in conducting ART cycles. MTeP-21 Yanae®: Painless alternative for successful IUD insertion – interim results from study S. Singh1; A. Agarwal2; D. Srivastav2; R. Singh2; V. Jain3; B. Joshi3; R. Bansal3; K. Mahadik4; R. Sultana4; R. Singh5; H. Mathé6; C. Desjardin6; V. Michaels Lopez6; A. Ulmann6 1Pregna International Limited, Mumbai, India, 2King George's Medical University, Lucknow, India, 3Post Graduate Institute of Medical Education & Research, Chandigarh, India, 4Ruxmaniben Deepchand Gardi Medical College, Ujjain, India, 5Sarojini Naidu Medical College, Agra, India, 6Cemag Care, Paris, France

Objective

The objective of this study is to evaluate the efficacy of Yanae® in intrauterine device (IUD) insertion, presenting a novel, painless approach to accessing the uterine cavity without the use of tenaculum/vulsellum or hysterometer/uterine sound. Design: This was a prospective, multicenter, open-label, one-arm study.

Method

Women desiring long-term contraception were invited to participate from four distinct clinical sites or medical Institutes in India. The efficacy of Yanae® in IUD insertion was assessed based on successful insertion and correct fundal placement, confirmed by ultrasound immediately post-insertion. The necessity for additional instruments such as hysterometer/uterine sound or tenaculum/vulsellum was also recorded. Pain levels experienced by participants were evaluated using a Visual Analog Scale (VAS-10 cm). Follow-up safety data were collected to monitor adverse events for up to 12 months post-insertion.

Results

For this interim analysis, 94 women were included out of a planned sample size of 164, with participant ages ranging from 21 to 50 years and a median age of 32 years. The majority (92.5%) had prior experience with contraceptive methods, with 42.5% having previously opted for an IUD. All participants were multiparous. Yanae® facilitated successful IUD insertion in 93 (98.9%) women and without the need for a vulsellum or hysterometer in 83 (89.2%) cases. The primary reasons for vulsellum use were to enhance visualization of the external os or stabilize the cervix. In one case (1%), insertion failed after two attempts despite vulsellum use due to an impassable cervix. Hysterometer use prior to insertion was never required. Participants reported minimal or no pain, with a median pain level of 1 on the 10-point VAS scale. Most women (90.3%) experienced less pain during insertion than anticipated. Women and healthcare providers rated the insertion procedure as satisfying or very satisfying in all cases (100%) and in 94.6% of cases, respectively. No adverse events were reported during the insertion procedure. One pregnancy was documented two months post-insertion, and one case of heavy bleeding/menorrhagia occurred two weeks after insertion, resolving upon IUD removal.

Conclusions

Interim findings demonstrate that Yanae® facilitates successful IUD insertion in nearly all cases (98.9%), with minimal need for prior use of a vulsellum (89.2%). Furthermore, the procedure is associated with minimal or no pain for all participants. MTeP-22 Abdominal myomectomy with sublingual misoprostol and pericervical tourniquet versus pericervical tourniquet alone A. Agboola1; O. Awolude2; O. Ojengbede2 1Lincoln County Hospital, Obstetrics and Gynaecology, Lincoln, UK, 2University College Hospital, Obstetrics and Gynaecology, Ibadan, Nigeria

Objectives

This study aimed to compare the effectiveness of a single preoperative dose of 400 micrograms of sublingual misoprostol plus pericervical tourniquet versus pericervical tourniquet alone in reducing intraoperative blood loss and operating time during abdominal myomectomy. Design: This prospective, randomized placebo-controlled trial was conducted with 68 eligible patients undergoing abdominal myomectomy at the University College Hospital, Ibadan over eight months. Ethical approval was obtained from the University of Ibadan/University College Hospital Ethical Review Committee with assigned number UI/EC/19/0130 and the study was registered with the Pan African Clinical Trial Registry (www.pactr.org) database with unique identification number PACTR202103517062817. Patients were randomly assigned to either Group I (misoprostol plus tourniquet) or Group II (placebo plus tourniquet). We excluded women with previous abdominal myomectomy, post-menopausal women, patients with a history of gynaecologic malignancy, known bleeding/clotting disorders, on anticoagulant therapy or history of allergic reactions attributed to misoprostol.

Methods

A total of 68 eligible patients undergoing abdominal myomectomy were randomized into two groups: Group I received 400 micrograms of sublingual misoprostol plus pericervical tourniquet, while Group II received placebo plus pericervical tourniquet. Intraoperative blood loss, change in haematocrit, duration of surgery, need for blood transfusion, and febrile morbidity were assessed. Statistical analysis was performed using T-test and Chi-square/Fisher's exact test.

Results

Demographic characteristics, uterine size, preoperative haematocrit, and fibroid characteristics were comparable between the two groups. The Misoprostol group exhibited a significantly shorter duration of surgery compared to the placebo group (65.09 + 47.35 vs. 100.21 + 49.00, p = 0.004). Although the Misoprostol group showed lower mean intraoperative blood loss, higher post-operative haematocrit, lower change in haematocrit, and reduced need for blood transfusion, these differences were not statistically significant (p > 0.05). Febrile morbidity occurred in two women, both in the Misoprostol group.

Conclusions

The preoperative use of misoprostol alongside pericervical tourniquet in abdominal myomectomy reduced operation time without statistically significant differences in intraoperative blood loss, change in haematocrit, or need for blood transfusion compared to placebo. Additionally, misoprostol use was not associated with increased febrile morbidity. These findings support the rationale for misoprostol adjunct in abdominal myomectomy to reduce operating time.

References

Kongnyuy E, Wiysonge C. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev 2014;8: CD005355. Agboola AD, Bello OO, Olayemi OO. A clinical audit of the patterns of presentations and complications of abdominal myomectomy at the University College Hospital, Ibadan, Nigeria. J Obstet Gynaecol 2021;41(7):1145–1150. doi: 10.1080/01443615.2020.1845632. Epub 2021 Jan 16. PMID: 33459101. MTeP-23 Spatial transcriptomics identifies dysregulated pathways within endometrium of adenomyosis, endometriosis and fibroids D. Badran1; A. Maclean1; E. Johnson2; E. Caamano Gutierrez2; D. Hapangama1 1University of Liverpool, Institute of Life Course and Medical Sciences, Liverpool, UK, 2University of Liverpool, Computational Biology Facility, Liverpool, UK

Objective

Adenomyosis, endometriosis and fibroids (AEF) affect a third of women worldwide, causing heavy periods, chronic pain and subfertility. AEF are associated with endometrial abnormalities; however, their underlying pathogeneses remain unclear. This study aimed to interrogate the transcriptional differences in AEF endometrium, compared to control, to elucidate pathogenic pathways. Design: A retrospective observational study of 36 women undergoing surgery for heavy and/or painful periods, with a diagnosis of adenomyosis (n = 7), endometriosis (n = 15) or fibroids (n = 14). Adenomyosis and fibroids were diagnosed histologically, and endometriosis was diagnosed surgically. Control endometrial biopsies (n = 3) were obtained from women without AEF. All biopsies were from the endometrial functionalis in the secretory phase, without exogenous hormone influence.

Method

Nanostring GeoMx Digital Spatial Profiling and whole transcriptome analysis was performed. Immunofluorescent morphology markers identified epithelial, stromal, and immune cells within. A generalised linear-mixed model was designed and unsupervised clustering, differential gene expression comparison, functional enrichment analysis, and ligand-receptor signalling were performed. Deconvolution analysis was performed on the immune cells between groups. Statistical analyses were adjusted for a false discovery rate <0.05.

Results

There were 79 significant differentially expressed genes (DEGs) between adenomyosis and control endometrium, 5 between endometriosis and control endometrium and 127 between fibroid and control endometrium. Compared to control endometrium, DEGs in adenomyosis were associated with cell growth and proliferation (OAZ2, RASSF4), fibroids with immune cell generation (CARD11) and both exhibited downregulation of estrogen-signalling gene SULT1E1. DEGs in endometriosis were associated with gene regulation (ZNF43) and mitotic processes (ANKFN1). Functional enrichment analysis identified positively enriched terms relating to olfactory signalling in adenomyosis and fibroids within immune cells. Mitochondrial protein-containing complex was positively enriched in endometriosis and fibroids within epithelial cells. Cell-cell communication was different in endometrium from women with fibroids, where immune cells were the top sender and epithelial cells were the top receiver cell types, with loss of the expected stromal-epithelial cell talk. Deconvolution analysis of immune cell segments between groups revealed an increased number of T cells in AEF endometrium compared to control endometrium.

Conclusions

This study provides cell-type specific comparative transcriptional differences pertaining to the secretory endometrial functionalis from women with AEF compared to control endometrium. Pathway analysis revealed novel insights into the underlying pathogenic mechanisms within AEF endometrium, and cellular interactions specific to immune cells within fibroid endometrium. This bodes potential for developing fertility-sparing treatment targets. MTeP-24 Delay in interval debulking surgery after neoadjuvant chemotherapy in ovarian cancer M. Habib; K. Azam Khalil; A. Saeed; M. Usman; S. Khattak; A. Ali Syed Shaukat Khanum Memorial Cancer Hospital and Research Center, Gynae-Oncology, Lahore, Pakistan

Objective

To determine the impact of delay between neoadjuvant chemotherapy and cytoreductive surgery on progression-free survival. Design: Retrospective study.

Method

All women diagnosed with stage III high-grade serous ovarian cancer who received neoadjuvant chemotherapy and underwent subsequent interval debulking surgery from January 2019 to January 2022 were included. The patients were divided into two groups based on time to surgery >6 weeks and time to surgery <6 weeks. The endpoint was taken as progression-free survival on follow-up. Survival curves were constructed using the Kaplan-Meier method.

Results

Twenty one hundred patients were obtained from cancer registry who underwent surgery for ovarian cancer during the time defined in this study. Out of these 118 were identified to fulfill the inclusion criteria. 53 patients underwent surgery within 6 weeks of NACT whereas 65 had surgery at an interval of more than 6 weeks. Overall recurrence rate in this cohort was 64.4%. The rate of recurrence was comparable in the two groups undergoing surgery up to 6 weeks and beyond 6 weeks which was 67.9% and 61.5% respectively. The mean progression free survival was 15 months for patients with surgery done within 6 weeks and 18 months for those who had delayed surgery > 6 weeks. This difference was not found to be statistically significant (p = 0.854).

Conclusion

Delay from neoadjuvant chemotherapy to interval debulking surgery was not found to impact progression free survival. MTeP-25 Comparing liquid based cytology (LBC) to conventional papanicolaou (CP) in cervical dysplasia detection U.U. Singh1; Q. Ambusaidi1; R.H. Al Shukaili1; R.N.A. Al Ishaqi1; T.A.S. Al Busaidi2; A. Kaushal3 1Nizwa Hospital, Obstetrics and Gynaecology, Nizwa, Oman, 2Nizwa Hospital, Nizwa, Oman, 3University of Alabama, Birmingham, Alabama, USA

Objective

To compare Papanicolaou (Pap) Cervical smear by LBC to CP cytology in detecting Cervical Dysplasia on cervical screening. Design: Cross sectional study. - All the women who attended the Gynaecology Clinic from January 2019 to June 2022, at Nizwa hospital were included in the study for cervical screening. - Cervical smear screening was done by two methods; the LBC method by using the cervical brush and the CP smear method by using the Ayer's spatula, from the cervix.

Results

In our study, a total of 1414 women were screened, 651 (46%) by LBC and 763 (54%) by CP. Overall 78% smears were satisfactory. Satisfactory smear by LBC were 536 (82.4%) compared to 566 (74.2%) by CP. Unsatisfactory smear were 17.6% by LBC, compared to 25.8% by CP. Dysplastic, malignant cells, and non-malignant abnormal cell detection was 6.71% by LBC compared to 4.24% with CP. Dysplastic and malignant cells detection was 3% By LBC as compared to 1.4% with CP. Low grade squamous intraepithelial lesion (LSIL), High grade squamous intraepithelial lesion (HSIL), Squamous cell carcinoma detection was better with LBC. LBC was found to be 3 times better than CP in detecting LSIL, HSIL and Squamous cell carcinoma.

Conclusions

There are conflicting conclusions in previous meta-analysis regarding LBC. Out of the five different meta- analysis, only two studies found higher LSIL and HSIL detection by LBC, as compared to CP. One found the sensitivity and thin prep characteristics were higher with LBC. Other study the diagnostic accuracy was identical by LBC and CP. Our study results concluded that LBC improved the smear's quality and reduced the number of unsatisfactory smears. Also, dysplastic cell detection improved with LBC. Advantages of LBC includes: the remaining solution can be used for Human Papilloma Virus (HPV) testing, reading of LBC slide is easier and faster, automatic reading of slides is possible, the number of inadequate smears is lower and this method is more economical and cost effective. In Oman, introduction of HPV vaccination for primary prevention and National program for cervical cancer screening for secondary prevention; in addition to already available, treatment of cervical cancer (surgery, radiation therapy, chemotherapy and other measures) to allow women to return to a full life after treatment as Tertiary prevention, will definitely contribute to achieving the World Health Organisation (WHO) goal of 90-70-90 by 2030. MTeP-26 Marie-UK (WP2a): A mixed-methods study exploring menopause (Interim analysis) G. Delanerolle1; J. Taylor2; H. Cavalini3; O.P. Kurmi4; K. Riach5; S. Hinchliff6; C. Atkinson7; K. Potocnik8; P. Briggs9; V. Talaulikar10; L. Saraswath11; J. Qing12; Y. Weng12; A. Shetty13; S. Elneil13; I. Muhammad14; R. Kareem15; N. Rathnayaka16; V. Pathiraja16; J. Van Vlymen17; T. Mudalige16; Y. Bouchareb18; T. Teck-Hock19; C. Benetti-Pinto20; G. Uchenna Eleje1; I. Aggarwal21; J. Manonai22; S Mamatha23; I. Litchfield17; P. Phiri1 1Southern Health NHS Foundation Trust, Research and Innovation, Southampton, UK, 2University of Birmingham, College of Medicine, Birmingham, UK, 3Southern Health NHS Foundation Trust, Southampton, UK, 4Coventry University, Research Centre for Healthcare and Communities, Coventry, UK, 5Glasgow University, Glasgow, UK, 6University of Sheffield, School of Allied Health Professions, Nursing and Midwifery, Sheffield, UK, 7Manchester Metropolitan University, Professor of Human Resource Management, Manchester, UK, 8University of Edinghburg, Business School, Edingburgh, UK, 9Liverpool Women's NHS Foundation Trust, Liverpool, UK, 10University College London Hospitals NHS Foundation Trust, London, UK, 11Aberdeen Royal Infirmary, Aberdeen, UK, 12Department of Statistics and Data Science, Southern University of Science and Technology, Shenzen, China, 13University College London, Institute of Womens Health, London, UK, 14Department of Mental Health, Psychiatry & Behavioral Sciences, Peshawar Medical College, Peshawar, UK, 15Peshawar Medical College, Peshawar, Pakistan, 16Department of Nursing, University of Ruhuna, Matara, Sri Lanka, 17University of Birmingham, Birmingham, UK, 18Sultan Qaboos University, Muscat, Oman, 19Sibu Hospital, Ministry of Health, Sibu, Malaysia, 20Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Sao Paulo, Brazil, 21Department of Gyanecological Oncology, KK Women's and Children Hospital, Singapore, Singapore, 22Department of Obstetrics & Gynaecology, Ramathibodi Hospital, Nakhon Pathom, Thailand, 23J.S.S. Hospital, Mysore, India

Objective

This study aims to determine the mental health impact and workforce issues of perimenopausal, menopausal, or post-menopausal women and trans men who have had natural, surgical, or medical menopause. Design: A mixed-methods study was conducted in England, Wales, Scotland and Northern Ireland following Ethics committee and Health Research Authority approval.

Methods

This interim analysis includes (n = 150) participants’ that completed the quantitative questionnaire, of which 23 completed a qualitative interview. All women and trans-men of 18–90 years living in the UK that provided informed consent were included. Participants were recruited using social media platforms. The Qualtrics XM platform was used to deploy multiple validated questionnaires but for the interim analysis the results from the Hospital Anxiety and Depression Scale (HADS) and Greene Climacteric scale (GCS) were used. Qualitative interviews were performed using Microsoft Teams with a pre-specified topics guide. Descriptive statistics were performed for categorical and non-categorical data.

Results

The median age of all participants, their first period and first signs of initial symptoms were 51, 13 and 46 years, respectively. The sample comprised of White, Black and Asian people at 92.62%, 2.68% and 1.34%, respectively. Most participants were full-time, part-time or casual employees; 64.83%, 22.76% and 2.07% respectively. Of the sample, most participants were perimenopausal (48.67%) whilst 30% confirmed they were menopausal and 20% as post-menopausal. The median HADS scores at days 0 and 30 were 18.78 and 18.35, while the anxiety scores were 10.66 and 10.27, respectively. The average depression scores were 8.12 and 8.08 at days 0 and 30, respectively. The GCS mean values at days 0 and 30 were 27.42 and 25.95. The mean values for somatic and vasomotor symptoms at days 0 and 30 were 6.39, 6.29, 2.67, and 2.15, respectively. Of the 23 participant interviews, 91.3% of the sample confirmed natural menopause, while 9.7% affirmed surgical menopause. Commonly reported symptoms included anxiety, low mood, brain fog, hot flushes, poor quality of sleep, depression, fatigue, leg or lower back pain, and verbal episodic memory loss. Approximately 65.3% of the participants reported using HRT either as a single oestrogen regimen or in combination with progesterone. Approximately 80% of the participants confirmed they had been offered anti-depressants by their general practitioner.

Conclusion

The interim evidence indicates that menopause’ has a negative mental health impact that is largely correlated with the physical presentation. These findings underscore the need asses clinical and non-clinical approaches to improve overall well-being. MTeP-27 Interstitial ectopic pregnancy diagnosis and outcomes: Service evaluation at Kings Mill Hospital M. Saleh; J. Alanen; R. Laiyemo Kings Mill Hospital, Sutton on Ashfield, UK

Objective

To evaluate the effectiveness and outcomes of diagnosis and management of interstitial ectopic pregnancies at Kings Mill Hospital, focusing on diagnostic accuracy, clinical management strategies, and patient outcomes. Design: This retrospective analysis spans from August 1, 2018, to July 31, 2023, reviewing 9 cases of interstitial ectopic pregnancy. The study aims to assess the efficiency of various management strategies, including laparoscopy and methotrexate treatment.

Method

Patient records were meticulously reviewed for management details, operative techniques, scans, and blood results. Data were methodically analyzed using Microsoft Excel, focusing on demographics, diagnostic methods, management techniques, and follow-up care.

Results

The study involved 7 patients treated laparoscopically and 2 with methotrexate for interstitial ectopic pregnancies. Ages ranged from 23 to 34, with varying parities. Risk factors were present in 5 cases. Diagnosis often required multiple scans. Laparoscopic management included advanced techniques like vasopressin, endoloops, and suturing, resulting in minimal blood loss (mostly under 100 mL) and no conversions to open surgery or return to theaters. Complications were rare, with most patients discharged within 1–2 days. The effectiveness and safety of laparoscopic management were highlighted, with most patients following a smooth postoperative course. Two patients conceived few months after management of interstitial ectopic, receiving thorough counselling on delivery options. Both induced for obstetric reasons, resulted in a caesarean section due to failed induction.

Conclusions

The study highlights the challenges in diagnosing interstitial ectopic pregnancies, often requiring multiple scans and interventions for a definitive diagnosis. The careful, step-by-step diagnostic approach is crucial. Patients managed with methotrexate had follow up till Bhcgs became negative. All surgical cases managed laparoscopically demonstrated proficiency and adherence to minimally invasive standards. The average blood loss low, signifying effective management, though readiness for high-risk scenarios is vital. Advanced surgical techniques like were effectively utilised. While most patients had prompt postoperative discharge, the study identified areas for improvement for discharge and follow up plans. The findings advocate for continuous staff training and research, contributing to the evolving best practices in managing complex gynaecological conditions. MTeP-28 Tackling the elective gynaecology backlog: Effectiveness of a super-clinic model A. Sharif1; R. Nair2 1Barking, Havering and Redbridge University Hospitals NHS Trusts, Obstetrics and Gynaecology Specialty Registrar, London, UK, 2Barking, Havering and Redbridge University Hospitals NHS Trusts, Obstetrics and Gynaecology Consultant, London, UK

Objective

Gynaecology waiting lists have grown since Covid and women have been left waiting too long as these appointments were considered non-urgent. In October 2022 there were over 7200 Gynaecology patients on the waiting list at our Trust. Of these, over 1400 patients were long waiters, having waited more than 45 weeks for the first outpatient appointment. Design: Proposed solutions to reduce the waiting list via the following methods were implemented between October 2022 to September 2023. - Create extra capacity via Super Sunday clinics, evening clinics and outsourcing to private agencies. - A booking Strategy of focussing on first appointments & long waiting patients; chasing outstanding diagnostic tests to ensure smooth follow-up appointments and confirming appointments with patients to maximize attendance. - Efficient clinic organisation by ensuring consultant availability to match waiting list bottleneck areas; providing correct clinical space and nursing support and where applicable additional streams added for specialist nurse or registrar support (hysteroscopy, urodynamics study). - 7 × Super-Sunday clinics organised using substantive staff with around 180–200 appointments booked for each of these superclinics. - Theatre operating weeks (Perfect weeks) organised in November 2022 and April 2023 where 80 cases were performed each week. Further projects held were Endometriosis weeks and Project 3.0 for hysteroscopies which enabled targeted clearance of waiting lists. - Evening Clinics – January 2023 (WOMB project) - Outsourcing Project: weekend outpatient clinic appointments from November 2022 to March 2023. This model led to a reduction of the 46+ week pathway from > 1200 October 2022 to < 400 in September 2023. Challenges: - Diagnostic department increased imaging capacity - Pathology department reported backlog - Increased physiotherapy demand due to urogynaecology referrals. - Increased hysteroscopy demand

Conclusions

A superclinic/ super theatre week model enables targeted clearance of waiting lists with focus on specific conditions with longer waits such as Endometriosis and Urogynaecology. There are challenges associated with diagnostic capacity when these clinics are run, and service modelling should have mitigations and plans in place so that the benefit of the initiatives are sustained. MTeP-29 A dedicated adolescent gynecology clinic, bridging the gap in teen healthcare A. Tellisi1; L. Alansari1; K. Al-Maslamani1; S. Athar1; M. Moghrabi1; S. Wazir1; S. Zaoui1; S. Abd-Elmagid1; Y. Kayani1; Y. El khawly2 1Hamad Medical Corporation, Obstetrics and Gynecology, Al Wakra, Qatar, 2Hamad Medical Corporation, Pharmacy, Al Wakra, Qatar

Objective

Adolescent gynecology issues in the Gulf and Middle East region population represent a pressing and under-addressed concern. The region comprises several countries with distinct cultural, social, and healthcare systems, and within this diverse landscape, adolescent girls face unique challenges related to their reproductive health. Addressing these adolescent gynecology issues in this population is crucial to ensuring the well-being and empowerment of young girls in the region. Culturally sensitive and evidence-based interventions, along with educational campaigns, should be developed to raise awareness, reduce stigma, and improve access to adolescent-friendly healthcare services. This study aims to assess the transformative impact of the recently established adolescent gynecology service at Al Wakra Hospital on the health outcomes of young women. Design: This study adopts a retrospective analysis approach, examining data collected from the adolescent gynecology clinic.

Methods

A specialized multidisciplinary clinic, led by female gynecologists trained in adolescent healthcare, was established to address the specific needs of young women. The clinic provided a comprehensive range of services, including routine check-ups, screenings for common gynecological conditions, and educational sessions focusing on reproductive health. Data collection focused on patient presentations (diagnoses) and the age distribution of clinic attendees.

Results

Analysis of clinic utilization revealed that 1216 adolescent girls benefited from the clinic's services, highlighting its significance in meeting the healthcare needs of young women in Qatar. The most prevalent presentations included polycystic ovary syndrome (PCOS) (35%), amenorrhea (11%), delayed periods (9%), pain (9%), ovarian cysts (8%), hormonal disorders (4%), and anemia (4%). Examining the age distribution of clinic attendees, 42% were aged 14–16, 38% were aged 17–18, and 20% were aged 11–13, showcasing a broad representation across different age groups. The clinic's services facilitated early detection and management of these conditions, contributing to improved health outcomes among adolescent girls.

Conclusion

The implementation of the adolescent gynecology service at Al Wakra Hospital has been a game-changer, equipping young women with essential knowledge about their health and enabling prompt intervention for gynecological issues. Through its holistic approach and inclusive care, the clinic has showcased its capability to elevate the health outcomes of adolescents in Qatar. By acknowledging and addressing the distinct needs of young women in gynecological health, we have not only boosted their physical welfare but also empowered them to make educated decisions, thus enriching their overall well-being during this pivotal developmental stage. MTeP-30 Acceptability of mifepristone and misoprostol experience with early pregnancy assessment clinics S. Farooqi1; E. Lackie2; A. Pham2; L. Zolis2; K. Sharma2; K. Devarajan2; K. Smith2; A. Nevin-Lam2; S. Lee2; H. Tempest2; E. Mei-Dan2; M. Tunde-Byass2 1University of Toronto, Obstetrics and Gynaecology, Toronto, Canada, 2North York General Hospital, Obstetrics and Gynaecology, Toronto, Canada

Objective

Early pregnancy loss is a common complication of pregnancy. Research has demonstrated the efficacy of Mifepristone pre-treatment followed by Misoprostol for the induction of a missed-abortion. Having a well-organized and accessible center with appropriate counseling and follow-up is imperative for treating early pregnancy loss. North York General Hospital (NYGH) provides an all-in-one Early Pregnancy Assessment Clinic (EPAC) to streamline the care of women. We conducted a qualitative survey to understand patients’ experience with medical management of their miscarriage and the EPAC at NYGH. Design: We conducted a prospective single cohort qualitative survey to understand patients’ satisfaction with the Mifepristone and Misoprostol and their experience with EPAC at NYGH. This design enabled us to capture a diverse patient population and ensure a high response rate follow-up appointments. - Acceptability of Mifepristone and Misoprostol: cramping, bleeding, duration of treatment, and recommendation to others; - Effect on Social Activities; and - Participants’ overall satisfaction with the EPAC at NYGH.

Results

We found that 96% of our participants responded completely to our questionnaire. For cramping, 24% reported definitely acceptable, while 8% reported definitely unacceptable. For bleeding, 26% reported definitely acceptable, while 4.8% reported definitely unacceptable. For the duration of treatment, 27% reported definitely acceptable and 2.7% reported definitely unacceptable. Finally, for recommendation to others, 41% reported definitely acceptable and 2.1% definitely unacceptable. Thus, the acceptability of the treatment was high overall. Effect on social activities was variable. Finally, the rating for NYGH's EPAC was high, where 68% of participants rated it excellent.

Conclusions

We found that the acceptability of the medical management for an early pregnancy loss is high with the Mifepristone and Misoprostol protocol. Overall, this study helps elucidate the positive experience of patients’ with the management of their early pregnancy loss at NYGH's EPAC and its utility in promoting the establishment of similar centers coupled with the use of Mifepristone followed by Misoprostol. MTeP-31 Is it necessary to remove incidentally identified cervical polyps? R. Gisby; S.L.J. Ang; N.-O. Bosompra; A. Üçyiğit Epsom and St Helier University Hospitals NHS Trust, Obstetrics and Gynaecology, Carshalton, Surrey, UK - To establish the incidence of malignancy in both symptomatic and asymptomatic cervical polyps removed at an NHS District General Hospital - To analyse the cost effectiveness of cervical polyp removal in secondary care Design: A retrospective case notes review of all cervical polyps removed and examined histologically, over an eight-year period at Epsom and St Helier University Hospitals (ESTH).

Method

Electronic patient records were accessed to identify all cases of cervical polyps examined at ESTH from July 2015 to July 2023. Epidemiological and clinical data were collected, including referral indication. Histopathology results were assessed for diagnosis, and collated data was analysed using excel.

Results

1067 cases of cervical polyp removal were identified in the study period. In 73 cases, it was not possible to review the electronic records. In 7 cases, histological analysis identified an endometrial rather than cervical polyp. Histological results were available for 994 (93.2%) of the patients identified. Age at presentation ranged from 25.7 to 93.3 years (mean 52.4 years). For the 89.1% of patients (n = 886) for whom clinical information was available, 43.7% were pre-menopausal, 38.1% were post-menopausal and 7.3% were identified as peri-menopausal. Only one case of cervical malignancy was identified (0.1%), in a symptomatic, premenopausal patient. In two further cases, which also presented with bleeding, concomitant endometrial biopsies demonstrated endometrial cancer (0.2%). Over half of cases (58.0%) referred during the study period were for asymptomatic/incidental cervical polyps. The mean total number of cervical polyps removed was 138.6 per year, with the mean number of asymptomatic cervical polyps removed at 80.4 per year.

Conclusions

Cervical polyps are present in 2–5% of the female population. The incidence of malignancy in asymptomatic cervical polyps, identified incidentally, was 0% in this study. The cost of a first appointment in a Gynaecology outpatient department is charged a tariff of £174(1), with the cost of standard histological analysis estimated at £150(2). This represents an annual cost of £13 990 to primary care for the initial appointment alone, and a cost of £12 060/year for histological analysis, for all asymptomatic polyps referred & removed. Adjusting clinical policy to reflect this, so that only patients with symptomatic polyps are referred, will result in significant improvement in cost-saving, waiting list times and efficiency in the Gynaecology outpatient setting.

References

1) England, N. (2023). Annex A of 2023/25 NHS Payment Scheme (NHSPS). NHS England. 2) The Path Lab. Price List 2021. Available from: http://thepathlab.co.uk/Price-List-2021.pdf MTeP-32 Kisspeptin as a test of hypothalamic function in women presenting with oligo-amenorrhea A.C. Yeung1,1; A. Abbara1; B. Patel1; M. Phylactou1; J. Tsoutsouki1; K. Koysombat1; M. Young1; S. Nyunt1; A. Qayum1; A. Patel1; A. Zielinska1; Y. Omar1; P.C. Eng1; E. Mills1; S. Hanassab1; L. Webber2; C. Jayasena1; T. Tan1; R. Quinton3; S. Clarke4; A.N. Comninos1; W.S. Dhillo1 1Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK, 2Imperial College Healthcare NHS Trust, London, UK, 3The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK, 4University College London Hospitals NHS Foundation Trust, London, UK

Objective

Polycystic ovary syndrome (PCOS) and functional hypothalamic amenorrhea (FHA) are the two commonest causes of anovulation and oligo-amenorrhea in women. Abnormal hypothalamic function is a hallmark of both, with increased gonadotropin-releasing hormone (GnRH) pulse frequency in PCOS but reduced in FHA. Despite this polarised difference in pathophysiology, differentiating these diagnoses can be challenging. Kisspeptin is known to stimulate hypothalamic GnRH neurons. Here, we evaluate the clinical utility of kisspeptin to interrogate hypothalamic function in women presenting with oligo-amenorrhea. Design: Single-centre, prospective, experimental study of healthy women (n = 33), women with PCOS (n = 30), FHA (n = 30), or congenital hypogonadotropic hypogonadism (CHH) (n = 8).

Method

All participants underwent two separate study visits. We assessed the gonadotropin response to hypothalamic stimulation with an intravenous bolus of kisspeptin-54 (9.6 nmol/kg), and pituitary stimulation with an intravenous bolus of GnRH (100 mcg). Serum luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels were measured every 15 min for 8 h after administration of each peptide. The maximal rise in LH and FSH from baseline was compared between groups using an unpaired t-test. Receiver operator characteristic (ROC) analysis was used to assess the discriminatory potential of the hormone response to kisspeptin and GnRH.

Results

The gonadotropin response to kisspeptin was increased in women with FHA compared to all other groups. The mean (SD) of the maximal rise in LH (IU/L) after kisspeptin was 9.7 (11.4) in healthy women, 9.7 (8.3) in women with PCOS, 17.6 (10.8) in women with FHA, and 1.0 (1.1) in women with CHH. The mean (SD) of the maximal rise in FSH (IU/L) after kisspeptin was 4.2 (3.4) in healthy women, 2.8 (2.1) in women with PCOS, 9.2 (5.6) in women with FHA, and 0.7 (0.5) in women with CHH. In lean women (BMI < 25 kg/m2), the maximal rise in FSH after kisspeptin differentiated women with PCOS from those with FHA (area under ROC curve 0.91, p = 0.0001). Furthermore, the maximal rise in FSH after kisspeptin differentiated women with FHA from women with CHH (auROC 1.00, p < 0.0001), whereas the equivalent auROC for FSH rise after GnRH was 0.7 (p = 0.086).

Conclusions

The specific action of kisspeptin at hypothalamic GnRH neurons enables its use to assess hypothalamic function in patients with oligo-amenorrhea due to different anovulatory disorders. Our data suggests that the hormonal response to kisspeptin has promising diagnostic potential, offering a novel approach for the assessment of hypothalamic function in patients presenting with oligo-amenorrhea of different aetiologies. MTeP-33 Laparoscopic De-ventrofixation of the Uterine Corpus M. Kenber; K. Rathod Queens Hospital, Gynaecology, London, UK Uterine adherence to the anterior abdominal wall is not a long-term recognised complication of a Caesarean section. The exact incidence of this is unknown as there is no reliable way to confirm it, although it can be diagnosed specifically by an MRI scan and, in some cases, by an abdominal scan. Most patients with dense uterine adhesions suffer from long-term pain, seeking medical help. Depending on the parity status and patient's desire, laparoscopic and robotic adhesiolysis or a hysterectomy can be offered, bearing in mind that there is more than a 50% chance of recurrence of adhesions. Surgical entry can be challenging as there could be a risk of dense scarring in the anterior abdominal wall. In our case we made an initial supraumbilical incision (5 cm above umbilicus) and used a Veress needle for insufflation. A 10 mm 30° scope and 5 mm contralateral ports were used. An ultrasonic device was used for adhesiolysis. We describe a stepwise approach to successfully reverse ventrofixation of the uterus in this video. Step 1: Dissection of the parietal peritoneum between the right round ligament and the central adhesion. Step 2: Opening of medial Para-vesical space on the right side. Step 3: Dissection of the parietal peritoneum between the left round ligament and the central adhesion. Step 4: Opening of the medial Para-vesical space on the left side. Step 5: Division of the central band of dense adhesions. Step 6: Dissection of the vesicovaginal fascia. Step 7: Bladder integrity test with methylene blue. Step 8: Reconstruction of the central uterine defect with a suture. Step 9: Anti-barrier agent placement. El-Shawarby S, Salim R, Lavery S, Saridogan E. Uterine adherence to anterior abdominal wall after caesarean section. BJOG 2011;118:1133–1135 MTeP-34 Impact of COVID-19 pandemic on menstrual health amongst undergraduate medical students B. Anjanappa1; S.H.M. Shiva1; K.S. Rimla1; A. Burade2 1ESIC MC PGIMSR, Rajajinagar, OBG, Bangalore, India, 2ESIC MC PGIMSR, Rajajinagar, Bangalore, India

Objective

The COVID-19 pandemic has profoundly affected global populations, influencing mental health due to stress, social isolation, financial strain, and fear of the virus. Stress and psychological distress can impact menstrual health through the activation of the hypothalamic-pituitary-gonadal axis, leading to functional hypothalamic amenorrhoea (FHA) and other menstrual disturbances. The objective of this study is to investigate the effects of the COVID-19 pandemic on menstrual health among undergraduate medical students and to estimate the prevalence of menstrual disturbances since the onset of the pandemic. Design: Cross Sectional Study.

Methods

A cross-sectional study was conducted using a web-based survey distributed via social media platforms to female undergraduate medical students across India. The survey included questions on socio-demographic data, stress (PSS-4), anxiety & depression levels (PHQ-4), menstrual symptoms before and after the pandemic, previously diagnosed gynaecological disorders, and menstrual practices.

Results

Among 192 participants, 74% were in medical studies, 26% in Ayurveda. Institutional backgrounds varied: 27.6% private, 72.4% government. Only 1.6% were married. Regarding COVID-19, 15.1% were affected, 6.8% had symptoms but tested negative. A minority (0.5%) used contraceptive pills. 28.1% reported menstrual cycle changes, 54.2% tracked cycles. Common PMS symptoms: abdominal and breast pain (64.1%), mood changes (57.3%), irritability (56.8%). Excessive flow (7.8%) and decreased flow (20.3%) noted. High PMS severity in 31.1%, menstrual pain more in 18.6%, less in 7.3%. Other symptoms: altered bowel habits (33%), leukorrhea (34.45%), appetite change (34.4%), weight gain (20%). 30.2% reported dietary changes, including increased junk food consumption. During the pandemic, symptoms like low mood, binge eating, anxiety, poor sleep, concentration issues, and loneliness were 1.5 times higher. Psychological distress scores showed mild stress in 30%, moderate in 16.25%, severe in 15.6%. Coping methods included yoga, meditation, pranayama (34–37%), prayer (60%), family support (86%), and energy healing (13%). Stressors included COVID-19 illness, financial concerns, and lack of offline classes.

Conclusions

The pandemic-induced lifestyle changes have impacted menstrual health among female undergraduate medical students. Mitigation strategies could involve promoting healthy lifestyles, offering psychological support, and fostering social connections. Further research is needed to understand long-term effects and develop targeted interventions for menstrual health during challenging times like COVID-19.

Keywords

Covid 19, menstrual health, energy healing, undergraduate students, pandemic, coping. MTeP-35 Core outcome set in chronic pelvic pain: Delphi survey and consensus meeting V. Ghai1; V. Subramanian2; H. Jan3; S. Doumouchtsis4 1Epsom and St Helier's University Hospital NHS Trust, Gynaecology, Epsom, UK, 2King's College Hospital, London, UK, 3Epsom and St Helier's University Hospital NHS Trust, Epsom, UK, 4Epsom and St Helier's University Hospital, Epsom, UK

Objective

To develop a core outcome set (COS) in female chronic pelvic pain (CPP) Design: Modified Delphi method and consensus meeting.

Method

Outcomes identified from a systematic review and meta-synthesis were entered into an online two-round Delphi survey. Participants rated outcomes based on the importance to include in a final COS using a Likert scale (1–9). A steering committee consisting of a patient representative helped develop the survey including outcome definitions. Participants were able to suggest additional outcomes for consideration in round two. Participants were shown outcome ratings per stakeholder group from round one to facilitate consensus and were requested to re-rate outcomes in round two based on these results. Those outcomes after round two which meet consensus were discussed at the consensus meeting for inclusion into the final COS. Those participants who completed both rounds of the Delphi survey were invited to attend a virtual consensus meeting to finalise a COS in CPP. We aimed to recruit a range of stakeholders including health professionals, researchers and women with CPP. Participants were recruited using a range of sources including: NHS hospitals, social media, patient groups and professional societies. There was no set number of stakeholders required for inclusion as per COS development guidelines. Descriptive statistics were used to present findings from each survey. For every outcome, percentage scoring for 1–9 was calculated for the stakeholder groups. Mean scores of those completing round one only was compared to those completing round one and two. An unpaired t-test was used to assess whether a statistically difference (p < 0.05) exists between participants that completed/not completed both rounds of the survey.

Results

Twenty-six outcomes were used to populate the first round of the Delphi survey. Fifty-four participants completed round two of the Delphi survey. Twenty-three potential core outcomes were considered for inclusion into a final COS. Sixteen participants from four countries attended the online consensus meeting. The final COS consists of 10 outcomes (pain intensity, dysmenorrhoea, dyschezia, dyspareunia, psychological functioning, physical functioning, health-related QoL, satisfaction/user acceptability, persistent pain and adverse events) categorised across three domains (pain, quality of life and clinical effectiveness).

Conclusion

An established Delphi model was used to develop a COS for future studies evaluating interventions in women with CPP. This COS is intended to be used in RCTs, systematic reviews and clinical practice guidelines. Effective implementation of this COS will ensure future CPP trials inform clinical practice, patient care and outcomes. MTeP-37 Prevention of surgical site infection – audit and re-audit S. Saquib1; Z.Y.A. Lakdawala Tambawala1; W. Mustufa Arif1; O.A.R. Abdel Karim1; S.W. Zahmak1; H. Alabdali2 1Dubai Hospital, Obstetrics and Gynecology, Dubai, United Arab Emirates, 2Worthing University Hospital, Sussex, UK

Objective

Surgical Site Infection (SSI) ranks as the second most frequent type of Hospital Acquired Infection (HAI) in high-income countries. Numerous factors in a patient's journey contribute to the risk of SSI. The World Health Organization (WHO) provides evidence-based recommendations to be implemented during the pre-, intra-, and postoperative periods for the prevention of SSI. In 2018, our incidence of SSI in the obstetrics and gynecology department was recorded at 3.5%. Subsequent infection control meetings resulted in recommendations to adhere to departmental protocols in line with WHO guidelines. An audit was conducted in our hospital in 2019 to assess compliance with the protocol and to significantly reduce the rate of SSI. Design: A prospective audit was conducted in Obstetrics and Gynecology department at Dubai Hospital, Dubai between March 1, 2019, and June 31, 2019. Re-Audit was conducted in 2023.

Method

Audit standards included adherence to the local protocol of Dubai Hospital, where 100% of our patients should have undergone a chlorhexidine bath pre-operatively and received prophylactic antibiotics within 60 min of surgical incision in elective cases. The inclusion criteria comprised all Grade 3 and 4 Cesarean sections, gynecological abdominal and laparoscopic surgeries, while vaginal surgeries and Grade 1 and 2 Cesarean sections were excluded. The information was taken from electronic system, nurses and anesthetist records. The type of SSI and organism affecting the wound was also retrieved. The audit results were discussed in departmental meeting with infection control team members. The recommendations were circulated within the concern staff for improvement and reaudit was done in 2023 (delayed due to covid)

Result

During the audit period, the rate of SSI was reduced to 2.5%. 97% of patients received a chlorhexidine bath before surgery, and 95% received prophylactic antibiotics within 60 min. The mean duration for prophylactic antibiotic administration before surgical incision was 22 min. No cases were required readmission with wound infection. The most common organism was staphylococcus aureus. There was significant reduction in cases of Methicillin Resistant Staphylococcus Aureus. The re-audit done in year 2023 showed the rate of SSI reduced to 1.6%.

Conclusion

Our audit emphasizes the effectiveness of implementing evidence-based protocols aligned with WHO guidelines. Proactive infection control strategies like chlorhexidine baths before surgery and timely administration of prophylactic antibiotics, reduces the incidence of SSI from 3.5% to 1.6%. Regular audits and re-audits serve as valuable tools for ongoing assessment, enabling us to identify areas of improvements. MTeP-38 Improved pregnancy outcomes after resolution of chronic endometritis – The PREMA Study A.D. Chenniappan1; R.D. Thriunavukkarasu1; H.B. Venkatanarayanan2 1Ramakrishna Medical Centre, Obstetrics & Gynecology, Trichy, India, 2Sathyabama Institute of Science and Technology, VivagenDX Labs, Chennai, India

Objective

The aim of this study was to investigate the effect of targeted antibiotic treatment for chronic endometritis (CE) on reproductive outcomes based on a molecular diagnostic approach. Design: In this prospective study, 42 women seeking infertility treatment were recruited. Chronic endometritis was diagnosed based on endometrial microbial analysis (multiplex RT-PCR test). Targeted antibiotic regimen was administered along with probiotics supplementation till the targeted Lactobacillus level is reached.

Method

Participants were women with Recurrent Implantation Failure (RIF) with two previous failed Assisted reproductive techniques (ART) cycles or 2 embryo transfer. Endometrial biopsy specimen were aseptically collected within day 14 of the follicular phase. Tissue samples were processed using optimized protocols for DNA extraction. Study participants had no history of antibiotics intake in the previous three months and were administered antibiotics based on the bacterial profile of the endometrium as revealed by a multiplex PCR test. PREMA (Pregnancy Related Endometrial Microbial Analysis) test is a multiplexed RT-PCR test that detects 11 most common bacteria causing CE, 7 most common bacteria causing dysbiosis and 4 most common Lactobacillus spp detected in the uterine microenvironment. The bacteria detected are represented as a percentage value of the total number of bacteria detected in the endometrial tissue specimen. For certain bacteria, antibiotics were prescribed based on RT-PCR tests that detects Antimicrobial Resistance (AMR) genes. Multiplex RT-PCR on endometrium was repeated every 8 weeks (max 3 cycles) to check for the improvement in the uterine microenvironment.

Results

The major pathogenic and dysbiotic bacteria detected were Atopobium vaginae, Gardnerella vaginalis, Escherischia coli, Klebsiella pneumonia, Streptococcus pneumoniae, Ureaplasma urealyticum, Ureaplasma parvum and Mycobacterium genitalium. Interestingly, Mycobacterium genitalium was the most difficult bacteria to treat with resistance to tetracycline and macrolides. Fluroquinolone treatment (Moxifloxacin 400 mg) resulted in better treatment outcomes for Mycobacterium genitalium. Chronic endometritis was fully resolved and healthy microbiota was significantly improved in all 42 subjects by 2nd or 3rd cycle of PREMA STUDY. 12/42 (28.5%) subjects had successfully conceived at the time of writing this abstract.

Conclusions

Chronic endometritis is asymptomatic and undetectable through routine test and imaging studies. Targeted antibiotic regimen based on a molecular diagnostic approach (PREMA) supplemented with probiotics may lead to improved conception rates and pregnancy outcomes in patients with recurrent implantation failure in ART cycle. MTeP-39 vNOTES hysterectomy for patients with large uteri: Experience from a tertiary center R.C.A. Tan1; S.I. Tan1; Q.J. Ng2; M. Qi2; J.M. Lee2; K. Bhutia2 1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, Singapore, 2KK Women's and Children's Hospital, Singapore, Divison of Obstetrics and Gynaecology, Singapore, Singapore

Objective

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been increasingly described as an approach to perform hysterectomy. In our study, we aim to evaluate the feasibility and outcomes of patients with large uteri undergoing vNOTES hysterectomy. Design: This was a retrospective study of all patients who underwent vNOTES hysterectomy at KK Women's and Children's Hospital (KKH), Singapore's largest gynaecological tertiary care centre between the time period 15 April 2021 and 21 March 2024.

Method

Patient demographic data and surgical outcomes was analysed for patients with large uteri with uterine weight >280 g. In our subgroup analysis, we compared surgical outcomes for patients with uterine weight >280 g and uterine weight <280 g. Comparisons between both groups were performed using the student t-test and Fisher exact test for quantitative and qualitative data, respectively. Person's correlation coefficient was used to study the association of uterine weight, estimated blood loss and operative time.

Results

A total of 176 patients who underwent vNOTES hysterectomy during this time period were included in our study, out of which 58 patients were identified to have large uterus. There was one patient with intra-operative conversion to laparoscopy in the group with due to difficulty to enter Pouch of Douglas. There were four post-operative complications. In our subgroup analysis, patients with uterine weight >280 g had significantly longer operative time (126.2 ± 48.4 min vs. 101.6 ± 39.9 min, p < 0.01) and higher estimated blood loss (271.7 ± 264.9 mL vs. 110.8 ± 93.1 mL, p < 0.01) compared to patients with uterine weight <280 g. There was also an association with uterine weight, operative time (r = 0.22, p = 0.003) and estimated blood loss (r = 0.44, p < 0.0001).

Conclusions

In conclusion, vNOTES hysterectomy is a safe and feasible approach for patients with large uterus and may be performed with low rates of conversions or complications. However, patients should also be counselled on potential risk of increased operative time and higher estimated blood loss. More studies are needed to validate our findings. MTeP-41 Exploring caesarean scar endometriosis: A case series on diagnosis, management, and outcomes S. Bracke; G. Vorona; M. Kathirvel; R. Khasriya Whittington Health NHS Trust, London, UK

Objectives

Caesarean scar endometriosis is a frequently overlooked cause of extra pelvic endometriosis. Whilst rare, the condition is an important cause of long-term, cyclical pelvic pain and reduced quality of life. This case series highlights this frequently missed differential diagnosis, guiding diagnosis, surgical management and follow-up. Design: A retrospective four-case series of reproductive-age women with a diagnosis of caesarean scar endometriosis, focusing on investigations, medical and surgical management, and ultimate resolution of symptoms.

Methods

This case series showcases four reproductive-age patients who sought care at the Whittington Hospital Endometriosis clinic due to persistent chronic pelvic pain refractory to medical treatments. Following thorough evaluations to rule out other causes of pelvic pain, a diagnosis of caesarean scar endometriosis was confirmed, prompting a surgical excision approach. An open resection technique achieved a complete margin excision in all cases. To enhance surgical education and knowledge dissemination, patients consented to having their surgeries recorded on video. These recordings were instrumental in educating clinicians on the management of this intricate presentation and facilitating the dissemination of best practices in the surgical treatment of caesarean scar endometriosis. The successful outcomes highlighted in this case series underscore the importance of tailored surgical approaches in addressing complex presentations of endometriosis-related pelvic pain.

Results

There were no postoperative complications. Histology confirmed that endometrial glands and stroma are present with the resected scar tissues, with full margins. The glands are positive for PAX2, beta-catenin and PTEN, with no evidence of atypia, hyperplasia, or malignancy within the endometrial glands. Full-margin excision was reported. Follow-up assessments revealed complete resolution of chronic pelvic pain, with a Visual Analogue Score (VAS) of 0 and no ongoing need for analgesia.

Conclusions

Caesarean section scar endometriosis nodules represent a frequently overlooked aetiology of chronic pelvic pain. Healthcare providers should maintain a heightened awareness of this condition in reproductive-age women presenting with localised symptoms near the incision site following gynaecological or obstetric surgeries. As demonstrated in this case series, surgical resection effectively addresses caesarean scar endometriosis, improving patient satisfaction and enhancing quality of life. By emphasising the importance of recognising and addressing caesarean scar endometriosis, clinicians can optimise patient care and alleviate the burden of chronic pelvic pain. Early identification, prompt diagnosis, and surgical intervention are crucial in comprehensively managing individuals affected by this challenging condition. MTeP-42 RCT comparing the clinical and cost effectiveness of various catheter washout policies M. Abdel-Fattah1; M.I. Omar1; D. Johnson1; D. Cooper1; L. Constable1; S. Tripathee1; S. MacLennan1; S. Cotton1; J. Norrie2; G. MacLennan1 1University of Aberdeen, Aberdeen, UK, 2Queen's University Belfast, Belfast, UK

Objective

Do weekly prophylactic saline or acidic catheter washouts in addition to standard long-term catheter (LTC) care improve the outcomes of adults with LTC compared to standard LTC care only? Design: CATHETER II was a pragmatic three-arm open-label multi-centre superiority RCT with internal pilot and embedded qualitative component.

Method

The trial methodology was in accordance with CONSORT guidelines. A community-based RCT in the UK recruiting from 21 centres in primary, community, and secondary care and remotely. 80 adults with LTC (any type/route) ≥28 days in situ and with no plans to discontinue and deemed capable to self-manage the washout and study documentation with or without the help of a carer. All 80 participants received standard LTC care and were randomly allocated (26:27:27) to receive weekly saline washouts or weekly citric acid washouts or no prophylactic washouts for upto 24-months. The primary outcome was catheter blockage requiring intervention per 1000 catheter days. Secondary outcomes included S-CAUTI requiring antibiotics, adverse events, participants’ QoL and day-to-day activities, acceptability and adherence to intervention.

Results

Recruitment commenced in December 2019. Follow up continued upto August 2023. The mean (SD) age was 65 (17) with those in the control group slightly older and similar numbers of males and females in all three groups. LTC blockages (/1000 catheter days) requiring treatment were 9.96, 10.53, and 20.92 in the saline, acidic, and control groups respectively. The incident rate ratio (IRR) favours the washout groups [0.65 (0.24 to 1.77); p-value = 0.33 for saline washout and 0.59 (0.22 to 1.63); p-value = 0.25 for acidic washout], albeit these differences are not statistically significant. The S-CAUTI rate was 8/1000 catheter days (control) and 6.72/1000 (acidic washout), IRR 0.98 (0.54 to 1.78); p-value = 0.93; and 3.71/1000 (saline washout), IRR 0.40 (0.20 to 0.80); p-value = 0.003. Participants in both washout groups had better QoL scores in EQ-5D-5L (0.056(−0.022 to 0.134); p-value = 0.11 and 0.053(−0.024 to 0.131); p-value = 0.12) and ICECAP-A (Adult version) (−0.076(−0.221 to 0.068); p-value = 0.24 and −0.086 (−0.214 to 0.042); p-value = 0.13) than control. However, both findings were not statistically significant. Treatment satisfaction scores were generally high in both washout groups. The trial was terminated before reaching target recruitment (n = 600) primarily due to COVID pandemic-related difficulties in recruitment of primary and secondary care centres with research capacity.

Conclusion

The results are favourable, albeit not statically significant, for lower rates of LTC blockages without a rise in S-CAUTI when employing prophylactic LTC washouts. We therefore recommend an international RCT to ascertain the clinical and cost-effectiveness of prophylactic LTC washouts. MTeP-43 The value of the multidisciplinary team in management of deep infiltrating endometriosis I. Ahmed1; M. Chadwick2; L. Antoun2; Y. Afifi2 1University of Birmingham, Medical School, Birmingham, UK, 2Birmingham Women's Hospital, Birmingham, UK

Objective

Women with deep infiltrating endometriosis should be managed in a tertiary centre that offers advanced laparoscopic treatment in a multidisciplinary context. This study aims to review the potential benefits, disadvantages, and barriers of the multidisciplinary team in the management of severe endometriosis. Design: A retrospective clinical audit into the presenting complaints and multidisciplinary team meeting outcomes of complex endometriosis patients from December 2016 to September 2023 was conducted.

Methods

1045 endometriosis cases were identified from December 2016 to September 2023. Cases were included if they had been discussed in a multi-disciplinary team (MDT) meeting. Baseline characteristics were collated, with imaging reviewed. Cases were analysed based off the patients’ symptoms, including pelvic pain, dyspareunia, infertility, bowel/bladder involvement and whether a laparoscopy or laparotomy had been conducted. Post-MDT outcomes were reported including preoperative work-up and operative planning. - the urologist performing a cystoscopy, inspecting the bladder wall, and inserting ureteric stents; - the gynaecologist excising all endometriosis to restore normal pelvic anatomy; - the urologist excising any bladder endometriosis; lastly - the colorectal surgeon excising bowel disease. If deep infiltrating endometriosis is found incidentally, we will only perform what was agreed and documented on the consent form.

Conclusions

A formalised MDT preoperative work-up and surgical treatment in an endometriosis referral centre is necessary to plan patients counselling and treatment plan implementation which assure improved outcomes. Future research should focus on the effect of MDT on patient long term outcomes, cost effectiveness and perception amongst clinicians. MTeP-44 Indocyanine green in excision of stenosed ureteric endometriosis nodule: A way forward F. Sanaullah York and Scarborough Teaching Hospital NHS Foundation Trust, Obstetrics and Gynaecology, York, UK

Objective

Laparoscopy is two dimensional vision and ureters are difficult to identify without palpation. Traditionally ureteric stents /ureteric catheters and uroglow are used at laparoscopic surgery to facilitate ureteric identification. Indocyanine Green (ICG) is licenced by FDA in 1959 and is widely used in other specialities. Recently ICG has made its indication in benign Gynaecology especially ovarian torsion, endometriosis and ureteric anatomy. It is excreted by liver and is given IV. For ureter, it is injected directly in the ureters through ureteric catheters and its effect can last up to 6 h. Appropriate camera head, laparoscope and stack is required to visualise green glow in the ureter. This is a video case presentation to demonstrate benefits of ICG in stenosed ureter due to endometriosis and how ICG helps to safely excise endometriosis around stenosed ureter. Case Report: 44 years old, Para 3 presented with chronic pelvic pain symptoms and heavy periods. Right hydroureter and gross hydronephrosis on MRI. NM renogram confirmed dilated non-obstructed right collecting system with split renal function Right kidney 48% and Left kidney 52%. She underwent Total laparoscopic hysterectomy + Right salpingo-oophorectomy + Excision of pelvic peritoneal endometriosis and excision of rectovaginal endometriosis + ureterolysis+ Adhesiolysis + Cystoscopy +, Replacement of Right ureteric stent+ Injection ICG into the right ureter was done. Right ureter was mobilised away from the ovary and appendix. Stricture identified and ureterolysis was continued till the level of ureteric canal. Thick scarred tissue around the ureter was excised. ICG illumination was utilised to demarcate the path of the ureter through the scarred tissue. She made uneventful recovery.

Discussion

In this video presentation, it has been demonstrated that ICG is a useful tool in advanced deep endometriosis around ureter. It not only demonstrated ureter clearly but facilitated excision of endometriosis without causing damage to the ureter and its blood supply. Compared to ureteric stents which also cause postoperative haematuria, ICG glow is quick to demonstrate and its effect can last for up to 6 h giving enough time to complete the operation. ICG can be easily injected through the ureteric catheters via cystoscope by gynaecologists.

Conclusion

ICG is useful tool for Gynaecologist to demonstrate stenosed ureter in endometriosis. Its use should be more widely promoted even in deep endometriosis cases without ureteric stenosis. Experiences of ICG use should be shared at national and international platforms to prevent incidences of ureteric injuries in Gynaecology. MTeP-45 Maternity outcomes of minority ethnic women: A thematic synthesis of human experiences O. Olajide1; C. Che2 1York and Scarborough Teaching Hospitals NHS Foundation Trust, Obstetrics & Gynaecology, Scarborough, UK, 2University of Cumbria, Robert Kennedy College, Carlisle, UK

Objective

Black women are 4–5 times more likely to die in pregnancy and childbirth while mixed-ethnic women are 2–3 times more likely to when compared to their white counterparts. There is a consistent/increasing trend in the pregnancy-related deaths of Black, Asian, and Minority/Mixed Ethnic (BAME) women and widening disparities in their maternal and perinatal outcomes. Design: This project aimed to identify documented evidence of the root causes of the disparities in maternal and perinatal outcomes of women of minority ethnic groups in the UK and identify solutions and interventions to narrow the disparity gap through the lived experiences of service users and service providers.

Method

A systematic literature search was done using MEDLINE, CINAHL, and Cochrane library databases for UK qualitative and mixed-method studies in the English language, and published between 1946 and 2022. The Critical Appraisal Skills Programme Qualitative Research Checklist was used to assess the quality of studies. Nineteen studies were eligible and included for data analysis which was done by thematic synthesis using the Nvivo 1.7.1 software.

Results

Five analytical themes and ten descriptive sub-themes were identified concerning the root causes of maternal and perinatal health inequalities in the UK. The five identified themes include “the UK healthcare system and maternity services”, “maltreatment of BAME women”, “failure of communication”, “maternity staffing” and “understated complex social needs of women”. Four analytical themes and seven descriptive sub-themes were identified concerning solutions and interventions to reduce maternal and perinatal health inequalities in the UK. The four identified themes include “women-centered care”, “tackle racism in healthcare and maternity care”, “collaboration and partnerships” and “workforce planning”.

Conclusion

This thematic synthesis found evidence of a wide range of fundamental, institutional, and structural barriers and mistreatment of BAME women, limiting their access, choices, engagement, and quality of care with maternity services. The provision of individualized, culturally sensitive, and non-discriminatory care of BAME women, with quality communication by adequately trained and diversified staff in a safe and inclusive working environment is necessary to narrow the inequality gap. Further research is required to assess the direct effect of current healthcare policies and the effectiveness of recommended interventions on the care provided to BAME women, and their maternal and perinatal outcomes. MTeP-46 Impact of preterm clinic – A proposal to include low risk group N. Gomaa1; A. Rajasi1; J. Toohey2 1East Kent Hospital University NHS Foundation Trust, Obstetrics and Gynecology, Kent, UK, 2East Kent Hospital University NHS Foundation Trust, Obstetrics, Kent, UK

Objective

East Kent NHS trust (EKHUFT) serves a population with two third of pregnant mothers living above the 3rd quintile of Index of Mass deprivation. A dedicated preterm Surveillance service was established in March 2021 with referral criteria based on intermediate and high risk as per saving babies live care bundle 2 (SBLCV2). The objective was to analyse the outcome on reduction of preterm birth in the cohort who underwent surveillance and also prevalence of any risks in those who had preterm birth. Design: A cohort study with prospective data collection. Retrospective analysis of all preterm births was performed for major/ intermediate and low risk.

Method

Clinical outcome and preterm birth data was collected from January 2022 till December 2023 from pregnancy notes, Euroking records and validated with clinical database. All preterm births were analysed for major, intermediate and low risk factors such as extremes of age and BMI, social deprivation, anxiety and domestic violence. Analysis was performed with Excel.

Results

308 women underwent surveillance during this period, 45% had interventions following cervical shortening. 85% of those who delivered, delivered after 37 weeks; 10% had preterm birth between 34–36 + 6 weeks; 5% had a preterm birth below 34 weeks of which all were related to iatrogenic prematurity due to preeclampsia or antepartum bleed. The rate of extreme preterm births before 28 weeks was 7.56/1000 in 2021 (before the service was established), and reduced to 5.6/1000 in 2023. 92% of the extreme prematurity did not have any intermediate or high risk for preterm birth at booking and hence did not have surveillance. However, 2/3rd of them had at least one low risk factor for preterm birth such as age below 18 and above 40, social deprivation, extremes of BMI, domestic violence and anxiety.

Conclusion

Preterm birth rate had reduced since initiation of surveillance in preterm clinic as per the Saving babies live care bundle 2. Our preliminary analysis identified that majority of women who delivered extreme preterm had only a low risk factor. Hence in order to reduce prematurity burden further we propose a care bundle which is inclusive of these low risk factors of public health relevance. Even a modest reduction of prematurity in this deprived population group will have a huge population effect. This is the first study we are aware of with proposal for an inclusive service for surveillance and appropriate risk modification. MTeP-47 Hydroxychloroquine attenuates Cadmium-induced Pre-eclampsia parameters in a rat model F. Sardar1; Y. Kamsani2,3; N.A. Mohd Noor Khan2,3; A.A. Aminuddin4; F. Ramly4,5 1Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia, 2Department of Physiology, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia, 3Maternofetal and Embryo (MatE) Research Group, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia, 4Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia, 5MFM Unit, Department of Obstetrics & Gynaecology, Hospital AL-Sultan Abdullah UiTM, Puncak Alam, Malaysia

Objectives

Evaluate the effect of Hydroxychloroquine (HCQ) intervention on blood pressure, heart rate, and pups’ size in a Cadmium (Cd)-induced pre-eclampsia rat model. We hypothesize that HCQ, which has endothelial modulation properties, can reduce pre-eclampsia manifestation. Design: Animal study using a rat model with intervention across three distinct intervals.

Methods

Animal research ethics approval was obtained prior to the experiment (UiTM CARE 419/2023). A total of 72 female Sprague Dawley pregnant rats were used and divided into 6 groups. 0.125 mg/kg/day Cadmium Chloride (CdCl2) (to induce pre-eclampsia) and 60 mg/kg/day HCQ (intervention) were administered via intraperitoneal injections. Three models (based on the timing of Cd and HCQ) were used in this study: sequential model (CdCl2 from D9-D14 followed by HCQ from D14-D19), the extended inducer model (CdCl2 from D9-D19 and HCQ from D14-D19), and the prophylaxis model (CdCl2 from D9-D14 and HCQ from D9-D19). Systolic-diastolic blood pressure, and heart rate, were monitored every five days throughout the experiment. Half of the pregnant rats were euthanized on day-20, and the pups’ anthropometric measurements were recorded. Another half of the rats continued their pregnancy, and after delivery, the number of pups, weight at day-1, and anthropometric measurements were evaluated.

Results

CdCl2 induced pre-eclampsia and significantly affected maternal blood pressure (p < 0.001), heart rate (p < 0.001), pup's birth weight (p < 0.001), and pup's anthropometric measurements (p < 0.001). Systolic-diastolic blood pressure and heart rate in sequential, extended inducer, and prophylaxis models were significantly lower compared to the pre-eclampsia group (all p < 0.05). This was evidence from day-15. At day-20, in the euthanized group, the mean pups’ weight and fetal head-tail lengths were significantly higher in all three models compared to the pre-eclampsia group (p = 0.0001). Meanwhile, in the non-euthanized group, the sequential and prophylaxis models showed longer gestational length (p = 0.001), a higher mean pups’ weight at day 1 (p = 0.0003), and a longer head-tail length (p = 0.0003) compared to the pre-eclampsia group.

Conclusions

HCQ attenuated the pre-eclampsia effect across all different intervention timings in a Cd-induced pre-eclampsia rat model. HCQ administration during the induction of pre-eclampsia using Cd was found to be the best intervention model, as the measured parameters were close to those of the control group. Further study is warranted to elucidate the role of HCQ in pre-eclampsia, dosage, and timing of HCQ intervention. MTeP-48 Previous spontaneous miscarriages and the risk of adverse pregnancy outcomes M. Rahma; A. Khashan Department of Epidemiology and Public Health, University College Cork, Cork, Ireland

Background

Spontaneous miscarriage is among the most common complication in pregnancy. It affects 15% of recognized pregnancies and may reach up to 30% of clinical pregnancies. The number of miscarriages increases the risk of preterm birth, and small for gestational age possibly pre-eclampsia in the next pregnancy. Aims: The effects of previous spontaneous miscarriage were investigated on risk for adverse outcomes from pregnancy. Family History of miscarriage was also investigated on the risk of adverse outcomes from pregnancy.

Methods

The study cohort consisted of 5690 nulliparous women recruited in the Screening for Pregnancy Endpoints (SCOPE) study performed in Auckland, New Zealand; Adelaide, Australia; Cork, Ireland; Manchester and London, UK between November 2004 and August 2011. Women were interviewed at 15 ± 1 weeks' gestation and at 20 ± 1 weeks' gestation. Primparous women were compared to women who had one or two spontaneous miscarriages. The primary outcome measure was spontaneous preterm birth and secondary outcome measure included small for gestational age and pre-eclampsia. Odds ratios (ORs) and 95% confidence intervals (CIs) for the association between previous spontaneous miscarriage and pregnancy outcomes were estimated by using logistic regression adjusted for several potential confounders.

Results

Women who had no previous spontaneous miscarriage were 4331 (87%), with one miscarriage 559 (11%) and two miscarriages 94 (2%). Multivariate logistic regression showed significant association between two miscarriage and spontaneous preterm birth (adjusted OR = 3.23, [95% CI: 2.34–4.47]) p < 0.0001.There did not appear to be an association between spontaneous miscarriage and small for gestational age (adjusted OR = 1.45[95% CI: 0. 73–2.88]) or pre-eclampsia (adjusted OR = 1.26 [95% CI: 0. 83–1.92]). Women with family history of sister miscarriage was significantly associated with spontaneous preterm birth (OR = 3.11 95% CI: [2.23–4.34]).

Conclusion

Women with two previous spontaneous miscarriages had a higher rate of spontaneous preterm birth compared to women previous spontaneous miscarriage. Those women who had a family history of sister miscarriage had higher risk rate of spontaneous preterm birth. Investigations and management should be directed to those women with two previous spontaneous miscarriages rather than three. Further research is required in the field of family history of miscarriage. MTeP-50 The sFlt-1/PlGF ratio for suspected preeclampsia: An economic assessment in the Netherlands E. Lodewijks1; S. Al-Nasiry1; M. Hendrix1; L. Scheepers1; J. Bons2 1Maastricht University Medical Centre, Obs&Gyn, Maastricht, Netherlands, 2Maastricht University Medical Centre, Maastricht, Netherlands

Objective

Implementation of the soluble fms-like tyrosine kinase (sFlt-1) to placental growth factor (PlGF) ratio test for accurate triage of women with suspected preeclampsia (PE) can improve clinical management mainly by excluding the development of PE after a negative test (low sFlt-1/PlGF ratio). Shortage of hospital staff and rising healthcare costs have led to increased pressure on the healthcare facilities. Improving the efficiency of the healthcare system through implementation of tests that have a high negative predictive value could lead to cost savings. In this study, we aim to assess the economic impact of utilizing the sFlt-1/PlGF ratio test, in addition to standard of care, in women with suspected PE. Design: A simulated cohort in Maastricht UMC+ in the Dutch healthcare system.

Methods

A decision tree model was developed to analyse the costs associated with introducing the sFlt-1/PlGF test. A theoretical cohort of 180 pregnant women with suspected PE were exposed to the test scenario, in which the sFlt-1/PlGF test was used in addition to current clinical practice, and to the no-test scenario, in which clinical management was based on current clinical practice. Patient stratification into low-/intermediate- and high-intensity management groups were derived from the PROGNOSIS, a non-interventional study for women with clinical suspicion of PE. Follow-up and hospitalization length were derived from own retrospective data and costs were obtained from the Dutch Healthcare Authority. A sensitivity analysis tested the model's robustness, focusing on cost savings per patient as the primary outcome.

Results

Integration of the sFlt-1/PlGF ratio test in clinical practice is expected to result in €156.241 cost savings for Maastricht UMC+ in one year. This accounts for €868 cost savings per patient and a reduction of 13.41% in costs in the test scenario.

Conclusions

Implementation of the sFlt-1/PlGF ratio test, for women with suspicion of PE, is expected to result in cost savings in the Maastricht UMC+ in the Netherlands. This can be explained by improved diagnostic accuracy and reduction of unnecessary hospitalization. MTeP-52 Novel tool for prediction adverse pregnancy outcome placental volume by ultrasound A. Kalisetty1; S. Nuthakki2 1Tulasi Multi Speciality Hospital, ObGyn, Guntur, India, 2Sujatha Laparoscopy Infertility Center, Obgyn, Guntur, India

Objective

The aim of this study is how estimation of placental volume during antenatal period helpful for prediction of adverse pregnancy outcome and helpful to decrease maternal and neonatal mortality and morbidity. Design: Prospective study of antenatal pregnant women and by measuring placental volume by ultrasound at TULASI MULTI SPECIALITY HOSPITAL, GUNTUR, INDIA in between September 2021 to November 2022.

Method

By using ultrasound, we measure the placenta volume by taking maximal width, height and thickness of placenta and EPV calculated and percentile charts are prepared. There by we can early detect SGA, LGA, oligohydramnios, PIH, GDM cases and took early intervention.

Results

Women with EPV >75th percentile had an increased odds of delivering an LGA infant and EPV <25th percentile had an increased odds of delivering an SGA infant. Among 306 women, 81 women are having adverse pregnancy outcome like preeclampsia, gestational diabetes mellitus, SGA & LGA. Among 306 women, 18 women land into gestational diabetes mellitus, 63 patients have PIH. Among 306 women, 12 babies are LGA, 42 are having SGA, 21 babies need NICU support.

Conclusion

Simple and rapid placental volume evaluation is feasible in routine ultrasound screening in trimesters helpful for identification of adverse pregnancy outcome there by reducing maternal & neonatal morbidity and mortality. Measuring EPV is best tool for pregnant women from 14 wks to 36 wks of gestation as a screening for closer surveillance and helpful for identifying high risk women and take early intervention for better pregnancy outcome. Abnormal placenta size is a risk factor for stillbirth and other poor pregnancy outcome. EPV is a NEW TOOL of estimation of placental volume by ultrasound with two dimensional method by using three parameters during trimesters which helps in identifying placental insuffiency. We will start early intervention to get better pregnancy outcome. MTeP-53 Maternal risk factors for early onset neonatal sepsis: A case control study H. Mohan1; D.K. Maurya1; N. Plakkal2 1Jawaharlal Institute of Postgraduate Medical Education and Research, Obstetrics and Gynaecology, Puducherry, India, 2Jawaharlal Institute of Postgraduate Medical Education and Research, Neonatology, Puducherry, India

Objectives

To assess the maternal risk factors associated with EONS (Early-Onset Neonatal Sepsis) and to study its common etiological agents. Design: This was a case control (1:4 ratio) observational study. Cases- Mothers of neonates developing clinical or culture proven early onset neonatal sepsis. Controls- Mother of gestational age matched neonates without early onset neonatal sepsis. This study design helped to accurately enumerate the antenatal and intrapartum risk factors in mothers for neonatal EONS.

Methods

The babies admitted in NICU with clinical early onset neonatal sepsis with or without culture positivity, were identified based on NICU protocol of JIPMER. The mothers of these babies were selected as cases. For each case four gestational age (± 1 week) matched mothers, of babies without neonatal sepsis, were selected as controls. After obtaining consent, maternal case records were reviewed to collect details and were recorded using a predesigned proforma. Sample size was calculated to be 90 cases and 360 controls. SPSS software was used for data analysis. Descriptive statistics was used to assess the maternal and neonatal features. Categorical variables were compared using a Chi-squared or Fisher Exact test. Student's t-test was used to compare continuous variables. A multivariate logistic regression was done to identify the risk factors. The level of significance for all analysis was set at p < 0.05.

Results

The significant risk factors associated with development of EONS (on multivariate logistic regression) were: lower socioeconomic status (Adjusted Odds Ratio (AOR) = 2.85, 95% CI: 1.11–7.30), maternal diabetes (AOR = 2.74, 95% CI: 1.06–7.06), three or more vaginal examinations in active labour (AOR = 12.21, 95% CI: 4.61–32.66), intrapartum fever (AOR = 6.59, 95% CI: 2.29–18.97), pathological CTG (AOR = 2.24, 95% CI: 1.10 – 4.55) and caesarean section (AOR = 3.29, 95% CI: 1.45–7.44). Neonatal low birth weight of < 1.5 kg and APGAR < 7 at 5 min were also associated with EONS. The most common causative agents for EONS were gram negative organisms like E. Coli, Klebsiella, and Acinetobacter.

Conclusions

The study helps to identify the mothers whose neonates are at increased risk of EONS, and who will benefit from appropriate and timely intrapartum antibiotics. It also showed the need to include intrapartum prophylaxis for not only GBS but also against gram negative organisms in our population. There is need for future research regarding the appropriate and effective intrapartum antibiotic prophylaxis in our population which can reduce EONS and hence neonatal mortality and morbidity. MTeP-55 Analgesia requirements during induction of labour with synthetic osmotic dilator (Dilapan-S) R. Elboraei1; O. Sanu2; C. Otigbah3; S. Zaher4 1Aneurin Bevan University Health board, Cardiff, UK, 2West Hertfordshire Hospitals NHS Trust, Watford, UK, 3Havering and Redbridg HOSPITAL TRUST, London, UK, 4Cardiff University, Cardiff, UK

Background

Traditional methods of induction of labour (IOL) are associated with significant pain, with subsequent use of analgesic medications, potentially resulting in unpleasant birth experience and adverse side effects. That is in addition to the cost burden on the health services related to the price of treatment and healthcare workers required to administer and monitor their side effects. As induction of labour rates rise and new methods of cervical priming become available, national guidelines such as NICE call for the availability of more evidence.

Objectives

We report a real-world evidence on the analgesia usage in 1509 women who had IOL started with Dilapan-S, and its potential implications. Design: A multi-centre national retrospective service evaluation based on real-world data on outcomes with Dilapan-S for cervical ripening.

Methods

Five participating institutions were requested to obtain local directorate approval. Once obtained; a depersonalised data from 1509 patients undergoing IOL with Dilapan-S as a first line agent was collected retrospectively via an agreed Case Report Form. Data was collated and centralised in a secure Electronic registry host platform (MedSciNet) to provide real time information on analgesia use while Dilapan-S was in place. Inclusion criteria were. The University Hospital of Wales was the lead site and coordinated the registry. Statistical support was provided by Cardiff University. Participating sites included Watford, Queens Hospital Romford, Leeds DGH and Kingston. Chi square was used for statistical analysis.

Results

Depersonalised data from 1509 patients were obtained retrospectively. Primary outcome was use of analgesia while Dilapan-S is in situ: 90% of the patients did not require any form of analgesia. Secondary outcomes: (1) type of analgesia required: only 0.8% required opioid (2) success rate after first round, defined as percentage who were ready for artificial rupture of membranes after first round of Dilapan-S: 53.4% of the cohort, Dilapan-S was successful for cervical ripening with no other induction agent required, (3) safety: Dilapan-S demonstrated high safety profile in terms of CTG changes suggestive of foetal distress, low complications at insertion, and need for early removal.

Conclusions

Synthetic osmotic cervical dilator (Dilapan-S) use is associated with significantly low analgesic requirements. In view of its high safety profile, success rate and cost- effectiveness, we recommend its use as a first line induction agent, including outpatient ripening. MTeP-56 Quality improvement project: Médecins sans frontières Maternity Hospital, Khost M. Gallagher1,2 1Médecins Sans Frontières, Khost, Afghanistan, 2Monash Health, Obstetrics and Gynaecology, Melbourne, Australia

Objective

To improve recognition, clinical assessment and escalation of the acutely unwell and deteriorating patient, in Médecins Sans Frontières Maternity Hospital, Khost, Afghanistan. Design: Quality improvement methodology using a PDSA (Plan-Do-Study-Act) cycle was implemented to conduct this project. The planning stage involved leads for obstetrics and gynaecology, anaesthetics, midwifery and management. There were two paralleled interventions.

Method

First there was the introduction of the ‘Médecins Sans Frontières Vitals Chart’ with an ‘Early Warning System’ as tools for recognition and escalation of unwell patients for midwifery and nursing staff. This was implimented by organising teaching sessions for the lead midwifery and nursing staff in the unit, and then rolled out simultaneously in all clinical areas. The second intervention, in parallel, was a series of multidisciplinary simulation teaching sessions for obstetric and anaesthetic staff implementing systematic clinical assessment, using the ‘A-B-C approach’, and communication, using the ‘S-B-A-R approach’, during clinical emergencies.

Results

Following these interventions short audits were conducted to capture whether the vitals charts were being utilized correctly and facilitating appropriate clinical escalation. The results showed a higher compliance rate during dayshift, within the antenatal wards and the least experienced midwifery and nursing staff. A questionnaire following the simulation teaching sessions was given to all obstetric and anaesthetic staff that attended the session. This facilitated self-reflection and perception of change in clinical practice, which was globally positive.

Conclusion

This project utilised quality improvement methodology to introduce systems to improve the recognition, assessment and escalation of unwell and deteriorating patients at the largest maternity facility currently operational in Afghanistan. MTeP-57 Predictors of mortality in peripartum cardiomyopathy: A 10-year study D. Rehmani1; A. Malik2; A. Zehra2; A. Rehman2; M. Abdullah3; A. Raza1 1Aga Khan University Hospital, OBGYN, Karachi, Pakistan, 2AKU, OBGYN, Karachi, Pakistan, 3Aga Khan University Hospital, Karachi, Pakistan

Objective

To determine the predictors of adverse outcomes including maternal mortality in patients with peripartum cardiomyopathy in a tertiary care Centre. Design: This is analytical cross-sectional study. Identifying predictors of adverse outcomes has the potential to facilitate risk stratification in PPCM patients, enabling healthcare providers to tailor management based on individual patient risk. This approach can improve clinical decision-making, patient care and outcomes.

Method

Conducted at Aga Khan University Hospital by retrospectively reviewing the 10-year record of patients with peripartum cardiomyopathy (PPCM) from year 2012 to 2021. Data was extracted from hospital medical records. Patients were identified as PPCM by using the AHA criteria. Patients with preexisting or congenital heart defects or any severe lung disease were excluded. Adverse outcomes were defined as: hospital stay more than 7 days, need for mechanical ventilation, ionotropic support for >48 h and mortality. Patients with any adverse outcome was explored in terms of demographics factors, clinical and cardiac factors. Univariate and multivariate analysis was done. Data was analyzed using SPSS version 19 and results were made.

Result

There were 129 patients with PPCM from 2012 to 2021 out of 47 207 deliveries 2.7/1000). There were 68 of 129 (52.7%; 95%CI: 43.7% to 61.5%) patients with adverse outcomes. Out of these, 59% of patients were less than 30 years of age (p value 0.053). Majority were with BMI >30 kg/m2 (p value 0.0005). Anemia was associated with a twofold increase in the probability of poor outcomes (OR = 2.05; 95% CI: 1.01–4.19; p = 0.048). Women with PPCM who experienced preeclampsia (66.7%), eclampsia (100%), ejection fraction < 30% (57.9%), QRS time on ECG (ms) < 120 (58.2%), and NYHA class 3 or 4 (57.3%) had adverse outcomes. A total of 94.4% patients with Adverse outcome were managed in ICU (p value 0.0005) rather than CCU. There was a total of 10 mortalities due to PPCM. Most of them were un-booked, came with EF < 30% at NYHA class 3 or 4 and were managed in ICU rather than CCU.

Conclusion

Patients with PPCM should be managed in CCU under supervision of a cardiologist in a multidisciplinary setting rather than by intensivist alone. We believe this is the first study to demonstrate that place of intensive care has an impact on the survival of patients with PPCM. Findings of this study can be used to recommend site of care for critically ill patients with PPCM. MTeP-58 Prediction of large-for-gestational-age neonates at 35–37 weeks M. Lopian1; S. Prasad1; E. Segal2,3; A. Elmalech4; A. Khalil1,5 1St George's University Hospital NHS Foundation Trust, Fetal Medicine Unit, London, UK, 2Tel Aviv University Faculty of Medicine, Tel Aviv, Israel, 3Sheba Medical Center Tel Hashomer, Tel Aviv, Israel, 4Bar Ilan University, Information Science, Givat Shmuel, Israel, 5Liverpool Women's Hospital, Fetal Medicine Unit, Liverpool, UK

Objectives

Large-for-gestational-age (LGA) neonates are at increased risk of adverse outcomes. Identifying women at risk of delivering an LGA neonate offers a window of opportunity to mitigate these outcomes. This study aimed to evaluate the performance of sonographic biometric and Doppler parameters, assessed at a routine third-trimester scan, in combination with maternal characteristics, in predicting LGA neonates.

Methods

This was a cohort study of low-risk singleton pregnancies undergoing routine ultrasound between 35+0 and 37+6 weeks. Demographic characteristics, estimated fetal weight (EFW) and abdominal circumference (AC) centiles, the Pulsatility Index (PI) of the Umbilical Artery (UA), Middle Cerebral Artery (MCA), and Uterine Artery (UtA) were evaluated. The Cerebroplacental ratio (CPR) was calculated. All indices were converted into Multiples of the Median (MoM). Multivariable logistic regression analysis was performed. Receiver-operating curves (ROC) were created to determine predictors of LGA neonates (birthweights > 90th centile) and LGA neonates with adverse outcomes (Intrauterine death, Neonatal death, and Neonatal Intensive Care Unit Admission).

Results

A total of 14 161 pregnancies were included. EFW centile (adjusted odds ratio (aOR) 1.12, 95% CI, 1.11–1.12, p < 0.001), AC centile (aOR 1.1, 95% CI, 1.08–1.09, p < 0.001), UA PI (aOR 0.34, 95% CI, 0.19–0.61, p < 0.001), MCA PI (aOR 1.98, 95% CI, 1.3–3.0, p = 0.002) CPR (aOR 2.2, 95% CI, 1.57–3.20, p < 0.001), UtA PI (aOR 0.6, 95% CI, 0.42–0.86, p = 0.006) and gestational age at birth (aOR 1.4, 95% CI, 1.3–1.51, p 90th centile. AC centile (aOR 1.1 (95% CI 1.02–1.16) p = 0.007 was an independent predictor of LGA with adverse outcomes. The combination of EFW centile, CPR, and UtA PI MoM was associated with an Area Under the Curve of 0.89 (95%CI 0.88–0.9) p < 0.001.

Conclusions

In an unselected population, the UA PI, MCA PI, CPR, and UtA PI are independent predictors of LGA and adverse perinatal outcomes. The combination of these parameters can reliably predict LGA outcomes with a high degree of accuracy. MTeP-59 The unmet needs of menopausal women in primary care U. Fatima1; R. Rasheed2 1Imperial College London, Medicine, London, UK, 2Chapel Street Surgery, Billericay, UK

Background

The average age for menopause is 51 years, this is preceded by a transitional perimenopausal stage, with vasomotor symptoms, muscular and joint pain, lowered libido and disordered sleep, impacting on mental health. In some women, the quality of life is considerably affected. This remains under-reported. There is no national screening service, or specialised clinics for menopausal services available in primary care. Aim: We undertook a survey of women in primary care as part of a needs assessment to understand the prevalence of peri and menopausal symptoms and women's knowledge of these symptoms and available treatment options.

Methods

A questionnaire was sent to women aged 45–65 years registered with the practice. They were asked to list any menopausal symptoms experienced. They were also asked to rate their knowledge of general menopausal symptoms and treatment options available for menopause. This was measured through a self-reported scale of 0–10, with 0 being no knowledge on the topic and and 10 being full knowledge. The women were also asked to state whether they believe they receive adequate support from their general practitioner and if they are aware of what support is available. This was measured through a list of statements which the women were asked to rate, stating the extent to which they agreed or disagreed with these.

Results

Of a total of 73 women, 78.1% complained of > 4 symptoms. The most common symptoms were memory problems and brain fog (82.4%), sleep disturbance (72.1%) and muscle/joint pain (72.1%). Women were asked to rate their knowledge of therapy options on a self-reported scale of 0–10, a high proportion (64.3%) rated 4 points. A high proportion (58.9%) rated inadequate support received from primary care and 75.3% felt they had no support at all.

Conclusion

Our results of this preliminary study showed the vast majority of women were unaware of treatment options for their menopausal symptoms and felt they received inadequate to no support from primary care providers. The present ongoing study highlights the lack of resource allocation to women's health and insufficient commissioning of services to address this health need. Thus, it is important to implement adequate resources to help meet the needs of menopausal women in primary care. MTeP-60 Impact of implementation of twin-specific growth charts perinatal outcomes in twin pregnancies S. Prasad1; I. Ayhan1; D. Mohammed1; O. Yaghi1; A. Khalil1,2,3 1St George's University Hospital NHS Foundation Trust, Fetal Medicine Unit, London, UK, 2Liverpool Women's Hospital, Fetal Medicine Unit, Liverpool, UK, 3Twin and Multiple Pregnancy Centre for Research and Clinical Excellence, St George's University Hospital, London, UK

Objective

To evaluate the impact of implementation of twin-specific growth charts on management and perinatal outcomes in twin pregnancies. Design: Retrospective cohort study including twin pregnancies delivered at St George's Hospital, London, between January 2013 to December 2023.

Methods

St George's hospital, a tertiary maternal fetal medicine referral unit, has adopted a policy of using chorionicity-specific twin charts for growth surveillance in multiple pregnancies since July 2017. The study population comprised of (i) Pre-intervention group (year 2013–2016, assessed by singleton charts), and (ii) post-intervention group (year 2017- 2023, assessed by twin-specific charts). Our primary outcome measure was stillbirth per 1000 births while secondary outcome measures included antenatal diagnosis of small for gestational age (SGA) and fetal growth restriction (FGR), induction of labour (IOL) rates, iatrogenic late preterm birth rates between 34 + 0–36 + 6 weeks (iPTB) and admission to the neonatal unit. Standard statistical tests were used to compare the study groups.

Results

The final analysis included 641 pregnancies (1282 births) and 440 pregnancies (880 births) in the pre- and post-intervention epochs, respectively. Following implementation of twin-specific growth charts, there was a significant reduction in the antenatal diagnosis of SGA from 51.2% to 10.6% (p < 0.001) and FGR from 38.6% to 6.4% (P < 0.001) alongside a trend of non- significant decrease in stillbirth rates (10.9/1000 births pre versus 8.0/1000 births post, p = 0.495). Additionally, there was non-statistically significant reduction in late iPTB rates (28.7% pre versus 25.4% post, p = 0.232), IOL rates (23.4% pre versus 20.2% post, p = 0.213) and neonatal unit admission rates (32.7% pre versus 29.6% post, p = 0.129) following implementation of twin-specific growth charts.

Conclusion

Our results indicate that management of twin pregnancies based on twin-specific charts was associated with a significant reduction in antenatal labelling of SGA and FGR. Proponents of singleton standards argue against use of twin-specific charts citing possibility of increased adverse outcomes like stillbirths due to underestimated growth restriction; on the contrary, our data shows a non-significant reduction in stillbirths, post-implementation of twin charts, suggesting that they are safe to use. MTeP-61 Using high-fidelity simulation to evaluate a novel swab-counting device (iCount) A. Elgharably1,2; K. Desai2; A. Omilakin1; M. Elmezaien1; C. Obianeli1; M. Kulakarni1; A. Desai1,2 1Royal Wolverhampton NHS Trust, Obstetrics & Gynaecology, Wolverhampton, UK, 2Eureka Inventions, Wolverhampton, UK

Objective

The benefits of simulation are well established in the fields of human-factors and medical error. However, simulation could offer further under-explored applications in the assessment of health technologies and medical innovations. This study evaluates a novel swab-counting device (iCount) using a simulated delivery-suite scenario to explore the efficiency and safety of the device. The study examines whether simulation can offer valuable performance insight and guide development decisions. Design: Participants used a model vagina/perineum with a perineal incision (simulating a patient post-episiotomy) and used both traditional swabs and iCount to suspend bleeding. A four-station simulation study explored time taken to count swabs in and out and weigh swabs in and out. These are essential procedures that occur in most delivery suites which simulate typical use within maternity. Enhancing the efficiency of these safety processes will work to limit swab retention and simplify actual blood loss monitoring which has been cited in improving outcomes related to obstetric haemorrhage – a significant maternal mortality indicator.[1]

Methods

40 participants – clinicians, midwives and maternity support workers voluntarily enrolled and gave written consent for participation. Participants were paired and timed as they conducted the simulated stations. The participants completed the same stations with both iCount and Traditional swabs. The starting device was equally randomly allocated to account for training effect. Following the simulation participants completed a short questionnaire giving their views on safety and usability of iCount.

Results

iCount demonstrated a statistically significant reduction (single-tailed, paired T-test) in the time taken to conduct a complete swab count (p = 3.91E−5) and to calculate blood loss (p = 0.03). These reduced by 36.8% and 14.9% respectively. In addition, 100% of participants believed that iCount increased their confidence in swab counts and simplified the identification of missing swabs. 100% of participants also agreed that the device could be integrated as part of a systems-based solution to improve safety in maternity.

Conclusions

This study demonstrates that simulation offers insights into device usability, generating user-feedback, without exposing patients to potential harm. However, simulation cannot wholly encompass the challenges and patient-facing factors that are present in clinical environments thereby limiting conclusiveness of outcomes. In the case of iCount, exploring it's potential to reduce swab-retention will rely on extensive clinical testing. Therefore, simulation offers a useful adjunct to clinical trials that can be implemented early and throughout device development. Sources: ACOG (2019) Quantitative blood loss in obstetric hemorrhage. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/12/quantitative-blood-loss-in-obstetric-hemorrhage MTeP-62 Virtual reality integration in medical education: Study of acceptability and learning impact A. Gosavi1; A. Kanneganti2; L. Chang3; M. Choolani4; E.T. Khoo5; M. Rauff4 1Obst and Gynecology, NUHS, National University of Singapore, Singapore, Singapore, 2NUHS, Singapore, Singapore, 3NUS, School of Engg and Design, Sngapore, Singapore, 4Ob/Gyn, NUHS, National University of Singapore, Singapore, Singapore, 5NUS School of Engg and Design, Ob/Gyn, Singapore, Singapore

Introduction

Virtual reality (VR) platforms using retail head-mounted display (HMD) platforms are an emerging means of providing procedural skills training. It has a particularly useful role for training in normal vaginal deliveries (NVD) due to the intimate nature and sensitivities associated with medical student involvement.

Methods

We conducted a prospective crossover study comparing a novel in-house developed immersive NVD VR simulator utilizing an Oculus Rift® HMD with the PROMPT Flex® mannequin simulator. We randomly assigned medical student clinical groups undergoing NVD simulation training as part of their OBGYN clerkship to either VR or legacy mannequin. Participants took an 11-item knowledge quiz before and after their first simulation (Phase 1) before crossing over to the second simulation (Phase 2). Participants also took a 14-item feedback questionnaire covering six domains after each phase to evaluate each simulation modality. The primary outcome was the percentage improvement in knowledge scores. Secondary outcomes were the adjusted mean difference in mean feedback scores between each modality and preferred method of instruction.

Results

20 clinical groups comprising 111 medical students participated. An equal number of clinical groups were assigned to either modality. There was no difference in either arm for baseline characteristics such as gender, prior NVD skill, and pre-simulation mean percentage correct knowledge scores. Medical students undergoing VR simulation had significantly higher overall mean percentage correct scores (79.0% vs. 54.0%, p < 0.001). The mannequin simulator had significantly higher feedback scores at 61.0 vs. 58.3 (adjusted mean difference 2.45 [95% CI 0.95–3.95, p = 0.002]) in five out of six domains. 40.5% of respondents preferred the mannequin simulation, 42.5% both, 4.5% the VR simulation, and 12.6% had no response.

Conclusions

Our novel VR NVD simulator was superior to a traditional mannequin simulator in content delivery. As more respondents preferred a mixed approach over any single method, the VR simulator would serve as a non-inferior adjunct to the traditional mannequin simulator for remote learning. Future iterations should improve haptic feedback, facilitate peer observational learning, cover more obstetric scenarios, and enhance its role in a blended approach with mannequin simulators. MTeP-63 An interactive online learning resource for teaching obstetric ultrasound scanning N. Khan1; M.A. Khan2 1Ashford and St Peter's Hospitals NHS Foundation Trust, Obstetrics and Gynaecology, Surrey, UK, 2St George's University of London, London, UK

Objective

Our aim was to create an interactive and accessible online learning resource for the purpose of obstetric ultrasound training. Design: Xerte is a user-friendly open-source tool, providing a user-friendly platform that empowers educators to create engaging and visually appealing e-learning material. The purpose of creating this resource was to equip postgraduate doctors and midwives, with the essential theoretical knowledge necessary for conducting a basic obstetric ultrasound scan. This includes understanding the principles of ultrasound, fetal lie, fetal presentation, placental location, fetal biometry, and Doppler assessment.

Method

The Xerte platform was used to create interactive learning objects such as quizzes, presentation, and interactive videos. Through the integration of multimedia elements such as computer graphics, modelling, animation, audio clips and interactive simulations we ensured the creation of learning materials that are inclusive and accessible to all learners. Throughout the design process, target learners were analysed using the PACT (people, activities, context, technology) framework, providing essential information regarding the type of online learning required, and thus providing evidence of learner engagement. Following this, a storyboard was created to prototype the online learning resource, with further constructive feedback from learners incorporated into the design adjustment. The learning resource is designed to run on a MicrosoftTM WindowsTM 10 or higher operating platform, which can adapt to various screen sizes and devices including desktops, laptops, tablets, and smartphones ensuring a consistent and optimal learning experience across various platforms. In addition, Xerte enable seamless integration with Learning Management Systems including Moodle, Blackboard and Canvas, allowing the learning resource to be uploaded onto existing online courses.

Results

The creation of this online learning resource is complementary to the RCOG core curriculum for basic obstetric ultrasound training. It offers learners the flexibility to access high quality educational materials to obtain the theoretical knowledge for obstetric ultrasound scanning. The feedback received is that this is an engaging and interactive learning environment, which enhances motivation and retention of knowledge to support continuous professional development. It serves as a stepping stone to practical ultrasound sessions or virtual simulators.

Conclusions

In summary, we have created an effective online learning resource in medical education for the purpose of teaching the basics of obstetric ultrasound scanning. This resource provides enhanced learning opportunities, flexibility, interactivity in training which contributes to the development of competent and skilled healthcare professionals in delivering high quality care for patients. MTeP-64 Enhanced vaginoscopy training: Self-invented low-cost high-fidelity simulator and validated scale K.-W. Lau1; V. Cheung2 1Queen Elizabeth Hospital, Obstetrics and Gynaecology, Hong Kong, Hong Kong, SAR of China, 2Queen Elizabeth Hospital, Multi-Disciplinary Simulation & Skills Centre, Hong Kong, Hong Kong, SAR of China - To develop a simple, modifiable high-fidelity simulator modifiable for various levels of hysteroscopy complexities. - To validate the Vaginoscopy Task Simulator Scale (VTSS-18) to objectively define and assess the cognitive, psychomotor and functionality domains of vaginoscopy. Methodology: In the planning phase, a multidisciplinary workgroup consisting of gynaeologists, psychologist, simulation technicians, and administrators was tasked with developing a low-cost, high-fidelity vaginoscopy simulator and pertaining scale. With 3D printing, gynaeologists were enabled to fabricate a central mold representing the vaginal space, endocervical canal, and endometrial cavity. A silicone simulator was created by casting silicone material over the central mold. Upon removal of the central mould, the simulator was encased within a pneumatic cuff to simulate the natural elastic apposition of the vagina and cervix, allowing for vaginoscopy practice. Based on expert advice and service guidelines, a research psychologist drafted a set of domain-specific scales and examined content validity with all members by reviewing and modifying content to reach agreement standards at 80% or above, represented by “Average of Summary Content Validity Index”(S-CVI/Ave) and “Scale Content Validity index with Universal Agreement”(S-CVI/UA). The finalized VTSS-18 comprised 18 items on three domains, including cognitive, psychomotor, and overall functionality of vaginoscopic technique in hysteroscopy, rated on a 5-point Likert Scale. In training phase, participants with varying years of hysteroscopy experience underwent vaginoscopy procedures with a trainer, engaged in self-practice, and were then assessed by the trainer across all domains. VTSS-18 was provided to elicit participants’ feedback on their experiences with vaginoscopy simulator.

Results

The entire VTSS-18 demonstrated excellent content validity (S-CVI/Ave = 0.98; S-CVI/UA = 0.89). The total cognitive and psychomotor domain scores were 23.07 out of 25 (93%) and 42.36 out of 45 (94%), respectively. The results indicating that the vaginoscopy task simulator not only consolidated participants' memory on how to prepare vaginoscopy procedures but also enhanced their practical knowledge and technical skills in the nine vaginoscopy steps. Additionally, the total functionality score at 18.71 out of 20 (94%) demonstrated that participants could effectively improve their vaginoscopy technique following training with our simulator.

Conclusion

The satisfactory result of VTSS support our vaginoscopy simulator as a simple but effective tool to enhance training quality, thereby promoting the quality of vaginoscopy to improve care in patients requiring hysteroscopy. Advanced simulators, customizable locally for various shapes or pathologies, could meet increasing demands of standard hysteroscopy training for all gynaecologists. EPOSTER VIEWING SESSION eP-001 Mental health issues Anxiety, depression, and post-traumatic stress disorder after early pregnancy loss S. Somini1; S. Mohamed Reagu2; S.M. Abu Yaqoub3; T. Anthony Farrell4; H.H. Hassan Elamin2; F. Minisha3; R.M. Ragab El Midany1 1Women's Wellness and Research Centre, Hamad Medical Cooperation, Obstetrics and Gynaecology, Doha, Qatar, 2Forensic Psychiatry, Hamad Medical Cooperation, Mental Health Services, Qatar, Qatar, 3Women's Wellness and Research Centre, Hamad Medical Cooperation, Obstetrics and Gynaecology, Qatar, Qatar, 4Women's Wellness and Research Centre, Hamad Medical Cooperation, Obstetrics and Gynecology, Qatar, Qatar Maternal mental health issues affect around 10% of pregnant women in the world. Early pregnancy loss is one of the most common adverse outcomes in pregnancy, with underestimated psychological outcomes for mothers and their families. Given the multinational population of Qatar, we would like to explore how nationality and cultural differences impact on the mental health consequences of early pregnancy loss. Primary Objective: To understand the impact of early pregnancy loss on maternal mental health, and to evaluate the differences based on nationality and partner support.

Methods

A prospective cohort study enrolling women diagnosed with first-trimester miscarriage was conducted. Initial assessment included demographic details and information about their experience post-miscarriage. Primary outcomes included Patient Health Questionnaire-9 (PHQ-9) to evaluate depression (score > 4), General Anxiety Disorder-7 (GAD-7) for anxiety (score > 7), and Post Traumatic Diagnostic scale (PDS-5) for post-traumatic stress disorder-PTSD (score > 28) measured 2 weeks after miscarriage, and at 3 months (secondary outcomes).

Results

Of the 132 women included in the study, 18% were Qatari. A higher proportion of Qatari women were university-educated (92% vs. 70%), employed (75% vs. 52%), and twice well supported by their birth families (68% vs. 31%); all p < 0.05. Pregnancy loss was highest in 7–10 weeks period, more in nationals (83% vs. 54%), and no difference in the partner support available among the groups. A higher proportion of Qatari women felt their partner could do more to support them, and felt their partner is less affected psychologically compared to non-Qatari. However, a higher proportion of nationals felt adequately supported and had a better experience with healthcare, 96% having a follow-up visit (vs. 69% of expatriates). At 2 weeks, 28% had high scores for anxiety, 9.1% for depression and 5.3% for PTSD; proportions being higher in non-Qatari women. PHQ scores were higher in those unemployed, university educated, partner unemployment and medical management of miscarriage. PDS scores were higher in those having their first miscarriage. The proportion having the outcomes at 3 months reduced to 3.5% (anxiety), 1.8% (depression) and 1.8% (PTSD), significant drop being noted in the anxiety levels.

Conclusion

Post miscarriage multi-disciplinary care, including obstetrics, mental health, and primary care, is essential. It's important to include partner and family support systems as lack of partner support has the highest impact on maternal mental health. Cultural differences exist with more expatriates developing mental health concerns, mainly due to lack of family support. eP-002 Laparoscopic cervico-isthmic cerclage after failure of McDonald cerclage H. Aloui1; H. Frikha1; R. Hentati1; W. Khayati1; R. Hammami1; F. Slama2 1Faculty of Medicine of Tunis, Department ‘C’ of Gynecology and Obstetrics, Tunis Maternity and Neonatology Center, University of Tunis El Manar, Tunis, Tunisia, 2Department C, Maternity and Neonatology Center of Tunis, Tunis, Tunisia

Objective

To evaluate the effectiveness and feasibility of laparoscopic cervico-isthmic cerclage after Failure of McDonald Cerclage. Design: This is a retrospective study conducted over a period of 2 years from January 2020 to December 2022.

Method

Enabling the gathering of six observations from patients who underwent laparoscopic cervico-isthmic cerclage following the Benson technique, conducted outside of pregnancy.

Results

The average age was 31.5 years. All our patients had at least one history of late or premature miscarriage. The indications for cervico-isthmic cerclage were a history of failed cerclage using the McDonald. No intraoperative or postoperative complications were found in our series, and the length of hospitalization was one day. Out of the 6 cerclages, 5 cases resulted in term pregnancies delivered by elective cesarean sections. The 6th case was marked by the occurrence of a spontaneous miscarriage in the 1st trimester.

Conclusion

The performance of laparoscopic cervico-isthmic cerclage has made it possible to offer the advantages of laparoscopy while providing the same safety as the abdominal approach. eP-003 Revealing patterns in recurrent voluntary termination of pregnancy: Comprehensive secondary care study D. Lima; M. Campante; M. Paiva; D. Silva; G. Silva; M. Pinho; A. Lopes Unidade Local de Saúde do Arco Ribeirinho, Ginecology and Obstetrics, Barreiro, Portugal

Objective

To uncover the frequency, as well as socio-demographic and reproductive characteristics of recurrent voluntary termination of pregnancy (VTP) within a secondary care setting, aiming to inform public health policies and intervention strategies. Design: This study employs an observational retrospective analysis, leveraging 15 years of VTP data from a secondary care hospital database.

Method

Standardized questionnaires administered during nursing consultations collected VTP data. Women with more than one record were refined to the latest entry. Incomplete or implausible records were excluded. Descriptive statistics using SPSS v29, targeted key variables including age, nationality, marital status, educational level, employment status, and previous contraceptive use. The study juxtaposed women undergoing their first VTP against those with recurrences, applying Chi-square or Fisher's exact test for categorical variables and t-test or Mann-Whitney U test for numerical variables.

Results

Among 5386 women surveyed, 290 (5.4%) experienced recurrent VTP. This group was characterized by an older average age (30.64 years) and a higher number of children (average 1.77), with 13.1% being nulliparous. The majority were Portuguese, with domestic partnership being the most common marital status. There was a lower proportion of women with higher education (7.3% vs. 16.7%, p < 0.01) and higher rates of unemployment (27.6% vs. 19.4%, p < 0.01) and unskilled labor (25.9% vs. 18%, p < 0.01). Additionally, 38.6% reported not using any contraceptive method prior to their last VTP, suggesting a critical area for targeted educational interventions.

Conclusions

Our findings highlight a distinct socio-demographic profile of women with recurrent VTP, underscoring the need for nuanced, evidence-based reproductive health strategies. Addressing socio-economic and educational disparities is imperative for reducing recurrent VTP rates. Future research should explore targeted educational programs and health policy adjustments to meet the needs of this vulnerable population. eP-004 Medical management by misoprostol in first and second trimester abortions S.B. Asif1; H. Yeasmin Hashi2; P. Ahmed3 1Sher -E-Bangla Medical College and Hospital, Barisal, Bangladesh, 2Chittagong Medical College and Hospital, Chittagong, Bangladesh, 3Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh

Objective

The primary objective of the paper is to assess the efficacy and safety of a two-dose mifepristone regimen followed by misoprostol in first and second-trimester abortions, aiming to optimize abortion outcomes while minimizing complications. The major hypothesis tested is whether administering a second dose of mifepristone on day two, along with the standard regimen, reduces the induction abortion interval (IAI), misoprostol dosage requirement, and incidence of incomplete abortion compared to the traditional single-dose mifepristone protocol. The study explores the impact of this modification on various outcomes, including abortion success rate, adverse effects, and the need for additional interventions like uterine curettage. Design: The study aimed to optimize the medical management of first and second-trimester abortions, specifically investigating the efficacy and safety of a two-dose mifepristone regimen followed by misoprostol administration. By administering mifepristone over two days and assessing its impact on the need for additional misoprostol and incidence of incomplete abortion, the study aimed to refine existing protocols and enhance patient outcomes.

Methods

Participants for the study included ñwomen aged between 18 and 45, carrying a single live fetus at a gestational age of 13 to 20 weeks, and providing consent. Exclusions included those with a history of uterine surgeries, vaginal bleeding, moderate anemia, heart disease, uncontrolled hypertension or diabetes, or contraindications to mifepristone or misoprostol. Data was collected on 100 women who received the intervention and 100 historical controls. Statistical analysis used Student's paired t-test and Mann–Whitney test with SPSS version 20.0. The main outcome assessed was the incidence of intra-amniotic infection (IAI), with secondary outcomes including abortion success rate, misoprostol dosage, and side effects.

Result

Misoprostol, a prostaglandin E1 analogue, is integral in first and second-trimester abortions, offering a non-surgical, safe option. Combined with mifepristone, it induces contractions, although it poses risks like uterine rupture.

Conclusion

The study on the role of misoprostol in first and second-trimester abortions presents crucial conclusions. Firstly, misoprostol, in conjunction with mifepristone, offers a safe and effective non-surgical alternative for terminating pregnancies. Secondly, the two-dose mifepristone regimen significantly reduces the induction abortion interval (IAI) and misoprostol dosage while minimizing adverse effects. Thirdly, the study underscores the importance of promptly reporting discomfort, as mifepristone is often administered on an outpatient basis. This study contributes to refining abortion protocols, emphasizing safe and accessible reproductive healthcare worldwide. eP-005 Recurrent pregnancy loss affects choices for prenatal screening and invasive testing M. Hugens; M. Thijssen; S. Al-Nasiry Dept. of Obs&Gyn, Maastricht University Medical Centre, Maastricht, Netherlands

Objectives

The process by which a couple decides to use prenatal screening or invasive prenatal testing (IPT) can be complex and potentially influenced by adverse events in the past obstetric history. If pregnancies are conceived following recurrent pregnancy loss, they might be considered more ‘precious’ and this could influence decisions made regarding screening and IPT. The aim of the study is to examine the association between recurrent pregnancy loss (RPL) and the stated choice to undergo prenatal screening or IPT. Design: cross-sectional study in the Netherlands.

Method

An online questionnaire was sent to non-pregnant women attending preconceptional clinic with either a history of RPL (study group) or an uneventful pregnancy (control group) comprising of theoretical questions regarding their choice to undergo prenatal screening or IPT in case of an abnormal screening test. In addition, participants were asked about factors influencing their decision, the opinion of their partners and the possibility to terminate the pregnancy in case of a severe fetal abnormality. Lastly, the psychological status of women were assessed using a validated questionnaire for depression, anxiety, stress, and self-efficacy. Odds ratios were adjusted for maternal age, level of education and if they received counselling from a midwife of gynaecologist in the past.

Results

The analysis included 275 participants, of which 74 women had RPL in the past. More women in the study group (RPL) stated they would not opt for non-invasive prenatal testing (NIPT) (17.6% vs. 10%, AdjOR = 3.14, 95% CI [1.16–8.47]) than the control group. Furthermore, women with recurrent pregnancy loss were more likely to choose not to undergo invasive prenatal testing after an abnormal 13-week anomaly scan (13.5% vs. 8.5%, AdjOR = 2.87, 95% CI [1.00–8.20]) or after an abnormal 20-week anomaly scan (25.7% vs. 17.4%, AdjOR = 2.46, 95% CI [1.10–5.40]). There was no significant difference in stated choice to opt for 13-week ultrasound, 20-week ultrasound or IPT after an abnormal NIPT.

Conclusion

Our results suggest that women with RPL were less likely to choose prenatal screening or invasive prenatal testing compared to women without RPL. This indicates that history of RPL should be taken into account when offering prenatal screening and diagnostic tests as it potentially influences the decision women would take in these circumstances. eP-006 Indications and outcomes of manual vacuum aspiration in AEFUTH, Abakaliki, Nigeria A. Olaleye; J.C. Obasi Department of Obstetrics and Gynecology, Alex Ekwueme Federal University Teaching Hospital, Ebonyi State, Abakaliki, Nigeria

Objective

To document the main indications of manual vacuum aspiration and outcome of the procedure in Federal Teaching Hospital Abakaliki. Design: This is a retrospective cross-sectional study performed to determine the indication and outcome of manual vacuum aspiration in our facility.

Method

A retrospective review of MVA records book of patients who underwent MVA was carried out in Obstetrics and Gynaecology department of Alex Ekwueme Federal University Teaching Hospital Abakaliki from 1st January 2020 to 31st December 2023. Data were collected in a pre-designed proforma and analyzed for age, marital status and parity, gestational age, presenting complaints, indications, analgesic methods used and complications following the MVA.

Results

During the study period, 512 case files of patients who underwent Manual Vacuum Aspiration were retrieved. However 12 of the case files lacked complete information needed for the study and were not analyzed. The remaining 500 case files that had complete information of the patient were analyzed in the study. Most of the patients 162 (32.4%) being 25–29 years with mean age of 28.56 ± 3.35 years. Majority of the patients were married 440 (88.0%) and primigravida accounted for highest number of cases 229 (45%). Most of the patients 230 (46.0%) had the procedure at 7–9 weeks of gestation. Majority of the patients presented with bleeding per vagina at a rate of 248 (49.6%). While the commonest indications for MVA were incomplete miscarriage at a rate of 420 (84.0%). Majority of the patient had pentazocine and diazepam 244 (48.8%) as a form of analgesics. Pain was recorded as the commonest immediate complication of MVA at a rate of 340 (68.0%).

Conclusion

VA is an effective alternative to conventional suction curettage, avoiding general anaesthesia and need for access to theatre. Complications such as uterine perforation, bleeding and retained products of conception are minimal when done at or below 12 weeks gestational age. Thus, safe, easily performed and possibly cost effective procedure, with advantage for both patient and the health care system. eP-023 Whole exome sequencing for fetal structural anomalies: Diagnostic yield in prenatal care N. Alhahsmi1; E. Nader2; M. Al Hinai1; I. Al Alawi1; R. Al Lawati1; M. Al Bandari2; M. Al Salmani3; B. Al Fahdi3; B. Al Saadi3; S. AlAamri3; A. Al Ghailani3 1Royal Hospital, National Genetic Center, Muscat, Oman, 2Royal Hospital, Child Health, Muscat, Oman, 3Royal Hospital, Obstetrics and Gynaecology, Muscat, Oman

Introduction

Prenatal ultrasound scans can identify fetal structural anomalies, but the underlying genetic cause often remains elusive. Whole exome sequencing (WES) is a powerful tool for identifying genetic variants associated with disease. This study aimed to evaluate the yield of WES in fetuses with structural anomalies and assess its role in prenatal diagnosis.

Methods

We conducted a retrospective cohort study reviewing the electronic medical records of 88 fetuses with structural anomalies identified by prenatal ultrasound scan at the Royal Hospital Muscat between 2017 till 2023. WES was performed on all fetuses.

Results

A molecular diagnosis was obtained in 64 fetuses (73%) while no diagnosis was reached in 24 (27%). The highest diagnostic yield was observed in fetuses with multisystemic involvement. Among the positive results, 44 (69%) were pathogenic variants, and 20 (31%) were variants of uncertain significance (VUS). Notably, we identified AARS2: c.2027 A > C, p.(Gln676Pro) in five unrelated cases, suggesting a potential founder mutation associated with hydrops fetalis. Interestingly, 7% of the positive results had an autosomal dominant inheritance pattern, while 93% followed an autosomal recessive inheritance pattern.

Conclusion

WES demonstrated a significant diagnostic yield in fetuses with structural anomalies, particularly those with multisystemic involvement. Our findings support the expanding role of WES as a valuable tool for prenatal diagnosis, potentially alongside conventional genetic testing approaches. The identification of a potential founder mutation (AARS2: c.2027 A > C, p.(Gln676Pro)) associated with hydrops fetalis warrants further investigation.

Keywords

prenatal testing, fetal exome, whole exome sequencing, ultrasound phenotype. eP-029 Cornual (Interstitial) ectopic pregnancy: Conservative surgical management A. Blaou1; A. Bin Eisa1; E. Alfituri1; S. Altahir Ahmed2; A. Abushwereb1; M. Abudabbous3 1Tripoli University, Obstetrics and Gynecology, Tripoli, Libya, 2Sebha University, Obstetrics and Gynecology, Tripoli, Libya, 3Tripoli University, Obstetrics and Gynecology, Misurata, Libya

Background

Interstitial (IP) and cornual ectopic pregnancy (CEP) is a rare and most dangerous form of ectopic pregnancy, accounting for 2–4% of all ectopic pregnancies. Patients may present with abdominal pain and/or vaginal bleeding, may be asymptomatic. Risk factors for IP include previous ectopic pregnancy, tubal surgery, in vitro fertilization (IVF), ovulation induction, or history of sexually transmitted disease. IP diagnosed by the presence of a gestational sac separate from the cavity and >1 cm from the lateral most edge of the cavity with continuation of the myometrial mantle around the sac and an interstitial line joining the sac and the uterine cavity. MRI may be used in clinically stable patients whose diagnosis remains uncertain despite having a TVUS. A case of unruptured cornual ectopic pregnancy in a patient with abnormal uterine bleeding is reported which was successfully managed by Laparoscopy and Hysteroscopy. Aim: To discuss a possible conservative surgical management option to preserve fallopian tubes without significant blood loss. Case report: A 37-year-old patient, G4P2A1, with the last delivery by C-section and a history of ectopic pregnancy in left tube treated conservatively through milking of the tube. Patient presented with vaginal bleeding, associated with amenorrhea and pelvic pain. TVUS ultrasound showed a gestational sac outside the uterine cavity on right cornea with positive fetal heart. B-hCG level was 11254 IU/L, 7 weeks pregnant with period of amenorrhea. On admission, she was hemodynamically stable. Abdominal examination was normal. On per vaginum examination os was closed with bleeding and positive cervical excitation pain. The decision was made for Hysteroscopy and Laparoscopy. Starting with Laparoscopy, uterus was normal size, freely mobile and normal fallopian tubes and no blood collection in the pelvis. There was a swelling at right corner of uterus (Figure 1). Change to Hysteroscopy that showed normal uterine cavity, left ostium visualized, right ostium seen with blood coming from it (Figure 2). Material of conception was removed by forceps from the right cornea (Figure 3) as showed in the video record and sent to Histopathology that confirmed the diagnosis.

Conclusion

With expertise in ultrasound imaging and advances in endoscopic skills progressively, conservative surgical measures are being used to treat interstitial/ cornual ectopic pregnancy successfully to preserve fallopian tubes and the chance of normal pregnancy. And according to our practice in our daily clinical activity this way of management is superior on laparoscopic intervention and reconstruction of the corneal part. eP-030 Mifegymiso in the management of missed miscarriage: A prospective study S. Farooqi1; E. Lackie2; A. Pham2; L. Zolis2; K. Sharma2; K. Devarajan2; K. Smith2; A. Nevin-Lam2; S. Lee2; H. Tempest2; E. Mei-Dan2; M. Tunde-Byass2 1University of Toronto, Obstetrics and Gynaecology, Toronto, Canada, 2North York General Hospital, Obstetrics and Gynaecology, Toronto, Canada

Objective

Previously, misoprostol alone was used in the management of early pregnancy loss (less than 14 weeks gestational age) and had a variable success rate from 25% to 82% depending on the dose and the route of administration. North York General Hospital (NYGH) is a community academic hospital that sees over 27 000 patients for obstetrical and gynecological concerns each year. Through a dedicated Early Pregnancy Assessment Clinic (EPAC), NYGH has provided compassionate care for women undergoing early pregnancy loss since 2005. Prior to the pandemic, we treated missed miscarriage with 2 doses of 800 μg of misoprostol, 24 h apart. However, in response to the limitations on operating room access during the pandemic, our protocol at NYGH was modified to incorporate Mifepristone pre-treatment followed by two doses of misoprostol to medically manage early pregnancy loss (less than 12 weeks gestational age). Our aim was to provide a safe, accessible, low-cost, and effective alternative to surgery, while minimizing the need for hospital admission or readmission. Design: This prospective single-arm study was conducted to understand the expulsion rate of the gestational sac in the management of missed and anembryonic miscarriages with our study protocol of two doses of Misoprostol after pretreatment with Mifepristone.

Method

Research Ethics Board approval was achieved for this prospective single-arm trial from January 2021 to March 2022. 188 healthy participants 18 years of age and older who experienced a confirmed missed miscarriage (<12 weeks gestational age) or anembryonic pregnancy at the initial visit were recruited. Participants were given 200 mg of Mifepristone pre-treatment orally followed by Misoprostol 800 mcg to be taken vaginally after 24 h followed by a second dose of misoprostol 24 h after the administration of the first dose of misoprostol. Participants were seen in follow-up on day 14 to confirm the absence of a gestational sac.

Results

181 participants followed the protocol instructions and received Mifegymiso. Of these, 169 (93.3%) participants had a complete expulsion of the gestational sac and therefore had treatment success by the second visit (day 14). A total of 12 (6.6%) participants failed the treatment defined by presence of a gestational sac.

Conclusions

This study demonstrates a high expulsion rate of the gestational sac for miscarriages. With no adverse outcomes, this is a safe alternative to increasing the rate of complete miscarriage and reducing the need for surgery with care streamlined through early pregnancy assessment clinics. eP-031 Predictors of successful medical management of first trimester miscarriage: A systematic review M. Abdelrahman; S. Elsayed; A. O’Higgins The Coombe Hospital, Dublin, Ireland

Background

Spontaneous miscarriage is the commonest complication of early pregnancy. Many trials and meta-analyses have shown that medical management is a safe, convenient, and acceptable treatment of early pregnancy loss. However, the rate of complete evacuation with medical management is unpredictable ranging from 13 to 95% (NICE, 2012). This uncertainty of outcome is a major deterrent for acceptability of treatment for many women and clinicians.

Objective

This systematic review sought to provide an up-to-date summary of the evidence in the literature on clinical, biochemical and/or ultrasound predictors of the efficacy of medical management of first-trimester miscarriage.

Methods

and Design: A search strategy was developed for Pubmed, Embase and Cochrane databases. Covidence tool was used to screen 1348 studies (abstracts and/or full text). Fifty eight studies were deemed eligible for inclusion; 18 RCT's, 19 prospective, 19 retrospective and 2 undefined studies. Data was extracted and analyzed in a narrative format. Further meta-analysis was not done due to heterogeneity of the data which deemed further quantitative analysis inappropriate.

Results

Forty-nine studies assessed clinical factors, while 42 assessed ultrasound characteristics and 13 assessed biochemical markers (HCG and/or progesterone). Nine studies assessed all three categories of predictors simultaneously. Fifty-five percent of studies evaluated success of treatment <1 week from medication administration while 27.5% allowed 1–4 weeks prior to follow-up. Thirty-six studies defined successful treatment at follow-up according to ultrasound criteria, while 15 studies used both clinical and ultrasound criteria, 1 used clinical signs only and 6 studies did not define the criteria or method used to diagnose complete miscarriage. There is significant heterogeneity in the medication, dosage, route of administration and definition of complete miscarriage among the studies. The results are contradictory and make it difficult to determine clearly if there are predictors for successful medical management.

Conclusion

Further studies examining predictive factors as a primary outcome measure would aid in analysis for a definitive conclusion and help design a prediction tool to stratify patients into likelihood of achieving successful complete miscarriage with medical management. This would reduce failed treatments, complication rates, re-admissions and surgical interventions. This tool would aid clinicians and inform future care with a tailored approach to managing first trimester miscarriage that is in the best interest of the patients while reducing the stress and anxiety associated. However, for such a tool to be designed, international standardization in the terminology used, follow up and treatment protocols is needed. eP-032 Diagnosis and management of interstitial complete hydatidiform mole: A case report A. Devarajan1; S. Morgan2; J. Muglu2 1Obstetrics and Gynaecology Department, University Hospital Lewisham, London, UK, 2University Hospital Lewisham, London, UK

Objective

Interstitial ectopic with Gestational trophoblastic neoplasia is extremely rare. Our aim is to report a case of Interstitial ectopic with complete molar pregnancy diagnosis and management. Case Report: 30 years women, Gravida 4 para 2. She presented to emergency department with abdominal pain and bleeding per vaginum. She was haemodynamically stable, on examination tenderness on the left iliac fossa, her B HCG 135 768. She had a transvaginal ultrasound which showed ' Sac like structure within the uterus measuring 22 × 16 × 10 mm appeared like haemorrhage within an intrauterine gestation sac, also heterogenous mass in the left fundal region of the uterus with multiple cystic areas within it vascular and acoustic shadowing, suggestive of a degenerating fibroid' . She was admitted in the hospital, she had a repeat scan which was consistent with the previous one with her BHCG increased 213, 557. Decision was taken to do an MRI to rule out the possibility of interstitial ectopic pregnancy the report was ' Left fundal intramural mass containing multiple pockets of blood representing a degenerating fibroid. No gestational sac was seen, she was suspected to have an interstitial molar pregnancy. Diagnostic laparoscopy done found to have an Left interstitial pregnancy. Wedge resection done was sutured with V Lock sutures along with Left salphingectomy. BHCG dropped to 4898, Histology then confirmed complete hydatidiform mole she was referred to Charing cross (Molar specialist centre), Her BHCG was monitored regularly which started to raise later she had was given 6 cycles of Dactinomycin. She was then followed up for a period of 12 months before she was discharged.

Discussion

Interstitial pregnancy occurs when the ectopic pregnancy implants in the interstitial part of the fallopian tube. The reported incidence varies between 1.0% and 6.3% of ectopic pregnancies. GTD associated with interstitial ectopic pregnancy is a rarer situation with an estimated incidence lower than 0.01%. An early diagnosis of an interstitial pregnancy diagnosis is extremely important for timely management but challenging because of difficult ultrasound aspects. MRI is the best modality to diagnose interstitial ectopic pregnancies. We report one of the rarest conditions: a patient with interstitial ectopic with complete hydatidiform mole. Surgery combined with chemotherapy is needed in this rare condition. eP-033

Abstract

Withdrawn eP-034 Role of serum progesterone in pregnancies of unknown location: A Singapore experience R. Kathirvel1,2,3,4; K. Koh1; M. Mathur1,3,4,2 1KK Women's and Children's Hospital, Obstetrics and Gynaecology, Singapore, Singapore, 2Lee Kong Chian School of Medicine, Singapore, Singapore, 3Yong Loo Lin School of Medicine, Singapore, Singapore, 4Duke NUS Medical School, Singapore, Singapore

Objective

Pregnancy of unknown location (PUL) presents commonly at early pregnancy assessment units and presents challenges in diagnosis and prognostication. Management encompasses multiple blood tests to trend serum beta-human chorionic gonadotropin (hCG) levels and serial ultrasound scans, resulting in multiple hospital visits and physical, emotional, and economic distress. This study aims to determine the feasibility of using serum progesterone in prognostication of PUL and to manage patient expectations on their likely pregnancy outcome. Design: Prospective cohort study of 150 women diagnosed with PUL.

Methods

Serial serum beta-hCG levels were performed as routine and serum progesterone level was obtained in study participants between December 2021 and July 2022 and their final pregnancy outcomes were studied. The collected data was reviewed by two separate team members and analysed using SPSS with comparison of means using the t-test, with p value < 0.05 to determine significance.

Results

Data analysis was performed in 145 patients after excluding five patients who did not meet the eligibility criteria. Final pregnancy outcomes included viable intrauterine pregnancy (IUP) in 26.2% (n = 38), miscarriage in 59.3% (n = 86), ectopic pregnancy (EP) in 13.8% (n = 20), and persistent PUL in 0.7% (n = 1). Mean serum progesterone levels were 61.5 nmol/L (range: 19.5–125.7 nmol/L), 13.0 nmol/L (range: 1.6–114.9 nmol/L), 23.2 nmol/L (range: 1.6–79.5 nmol/L), and 14.9 nmol/L, respectively for each outcome. When serum progesterone levels were <10 nmol/L (44.8%, n = 65), 90.7% (n = 59) of women had a miscarriage, and none had a viable IUP or persistent PUL. When the serum progesterone levels were <20 nmol/L (n = 83), there was only one (1.2%) viable IUP, whereas, with levels <30 nmol/L (n = 91), there were four viable IUPs (4.4%). In our study, EP was diagnosed at all levels of serum progesterone (range: 1.6–79.5 nmol/L). All women with miscarriages at progesterone levels under 30 nmol/L resolved spontaneously without intervention.

Conclusion

Although our study could not establish a single serum progesterone level to risk stratify women with PUL, our results could be used to manage their expectations based on serum progesterone levels. They can be counselled that when progesterone levels are under 10 nmol/L, viable IUP is unlikely. When progesterone levels are <20 nmol/L and <30 nmol/L, the chance of viable IUP is around 1% and less than 5%, respectively. Those with a diagnosis of miscarriage and progesterone levels <30 nmol/L are likely to resolve without intervention. eP-035 Caesarean scar ectopic pregnancy case series managed at tertiary care hospital UAE T. Ramzan1; S. Ishtiaq2; S. Yusuf Rdiowala1; H. Bint Raees1; H. Yasmin3 1Zulekha Hospital, Obstetrics & Gyneacology, Sharjah, UAE, 2Ziauddin Hospital, Obstetrics & Gyneacology, Karachi, Pakistan, 3Jinnah Post Graduate Medical Centre, Obstetrics & Gyneacology, Karachi, Pakistan

Objective

To present a series of clinical cases of Caesarean Scar Ectopic Pregnancy in which the early and adequate diagnosis made it possible to individualized management and achieved a successful treatment, outcome and preserved future fertility at our tertiary care hospital. Design: A retrospective case series.

Method

A retrospective analysis was undertaken. Patients were identified through the hospital's clinical information services coding system and data were collected from medical records.

Results

A total of 10 cases were identified. In these 10 cases, 8 were endogenous type and 2 cases of exogenous type of SCEP. Four patients received ovulation induction with clomiphene citrate for secondary infertility. Transvaginal ultrasound with colour Doppler was the diagnostic modality, the mean gestational age of all 10 cases were 6 plus weeks. 4 patients were with myometrium thickness less than 2 mm on TVS and BHCG levels more than 5000, 9000, 12 000 and 21 000 iu/L respectively and these patients opted for medical management. All patients were hemodynamically stable. They were predominantly managed according to local expertise via intramuscular methotrexate, surgical evacuation under ultrasound guidance and hysteroscopy/laparoscopic guided resection of scar pregnancy. Three cases were treated with suction evacuation and post suction administration of injection MTX, with one of it was continued with hysteroscopy and Laparoscopic resection. Six patient treated with Administration of systemic MTX in which 1 patients received single dose, 3 received 2 doses and 1 patient received 3 doses of MTX. Each patient received an individualized treatment according to the case need and patient's own choice. The rate of success depended on the particular maternal condition in each case. The cases which were managed medically the pregnancy resolving period exceeded up to 5 months and provided women have closely monitored follow-up.

Conclusions

Herein, we presented a rare pathological phenomenon whose frequency is on the rise, and for which transvaginal ultrasound and flow Doppler provide high diagnostic accuracy. Our results show that either medically treated or ultrasound-guided surgical evacuation of pregnancy were successful methods for treatment of early CSP that provides a rapid resolution of pregnancy and is accepted by most women. The risk of hysterectomy and blood transfusion is low and women's fertility is preserved. Further work is required to develop more effective management strategies for women with CSP who present later in pregnancy. The cases presented here showed that diagnosis of CSP is truly a challenge for obstetricians. eP-037 Predicting fetal viability in women with recurrent miscarriages using early ultrasound markers M. Marrone1; S. Al-Nasiry1 1Dept. of Obs&Gyn, Maastricht University Medical Centre, Maastricht, Netherlands

Objectives

Couples suffering from recurrent miscarriage (RM) are often anxious and depressed because of the fear of losing another pregnancy. The use of a predictive model for pregnancy outcome will support appropriate counseling and guidance for couples with RM. Currently available prediction models have not been widely validated. Our study aimed to externally validate the currently used prediction model (based on age and number of previous miscarriages) and to identify ultrasound parameters that could further improve viability prediction. Design: Retrospective cohort in a tertiary acedemic centre in the Netherlands.

Methods

Ultrasound data at 6, 8 and 10 weeks gestation and obstetric history of 116 women attending the recurrent miscarriage outpatient clinic between 2018 and 2022 were retrosprospectively collected. All women had a history of recurrent miscarriage, defined as at least 2 miscarriages before 20 weeks of gestation. Ultrasound characteristics that were significantly different between the viable verus non-viable pregnancy group were identified. Further, binominal logistical regression and receiver operator curves were used to explore the benefits of these parameters in prediction models.

Results

No significant differences between viable and non-viable pregnancy were seen in progesterone levels, gestational sac diameter and yolk sac diameter at any of the three measurements as well as crown-rump-length (CRL) at 10 weeks. Besides the age and the number of previous miscarriages, embryonic heart rate (eHR) at 6, 8 and 10 weeks, as well as the CRL at 8 and 10 weeks were found to differ significantly between the two groups. CRL at 6 and 8 weeks and eHR at 6 weeks contributed significantly to the prediction when individually combined with age and number of previous miscarriages. For all three parameters the AUC was larger (0.86; 0.86; 0.80) compared to the one only using age and previous miscarriage (0.72), without an increase of the 95% confidence interval.

Conclusions

Our study found that the addition of ultrasound markers, especially CRL and eHR in early pregnancy can improve the prediction of fetal viability in women with recurrent miscarriage. Subsequent studies with larger sample sizes are necessary to confirm these results and potentially implement an improved prediction model in the clinic. eP-068 Correlation of various pain scales in endometriosis with elagolix: A post-hoc analysis N. Gupta1; T. Palve2; G. Kamilya3; S. Srivastava4; P Malathi5; S. Bohir6; J.S. Patel7; M.K. Dash8; S. Saigal9; K.P. Savalia10; T. Gupta11; D. Chaudhary12; R Manohar13; P. Shah14; V.V. Bhat15; A. Shetty16; S. Saha16; R. Quadros16; D. Patil16; P. Patel16; P. Ghadge16; A. Mane16; S. Mehta16 1GSVM Medical College, Kanpur, India, 2Cama And Albless Hospital, Mumbai, India, 3IPGME&R and SSKM Hospital, Kolkata, India, 4Om Surgical Center & Maternity Home, Varanasi, India, 5Modern Government Maternity Hospital, Hyderabad, India, 6KKasturi Medicare Pvt Ltd, Thane, India, 7Pagarav Hospital & ICU, Gandhinagar, India, 8Sparsh Hospital & Critical Care Pvt Ltd, Bhubaneshwar, India, 9Brij Medical Centre Pvt Ltd, Kanpur, India, 10Priyadarshani Nursing Home, Virar (E), India, 11Udyan Health Care Pvt Ltd, Lucknow, India, 12SMS Hospital, Jaipur, India, 13Mandya Institute of Medical Sciences, Mandya, India, 14SVP Hospital, Ahmedabad, India, 15Radhakrishna Multispeciality Hospital and IVF Center, Bangalore, India, 16Sun Pharma Laboratories Limited, Mumbai, India

Objective

To evaluate the correlation of various pain scales used in patients of endometriosis when treated with Elagolix 150 mg (EgolixTM150 manufactured by Sun Pharma) or Dienogest 2 mg. Design: A phase-III, randomized, multi-centric, double-blind, double-dummy, parallel-group, active-controlled, comparative, non-inferiority study.

Methods

The study included premenopausal female patients with documented endometriosis having pain assessed via numeric rating scale (NRS) of ≥4, dysmenorrhoea scale (DYS) score of ≥2, and non-menstrual pelvic pain (NMPP) score of ≥2. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Elagolix 150 mg [Test arm] or Dienogest 2 mg [Comparator arm] and matching placebos for 24 weeks. In this post-hoc analysis correlation between efficacy scales (NRS, DYS, and NMPP scores) were evaluated. [Clinical trial registration: CTRI/2023/01/049292]

Result

This post-hoc analysis included 230 patients (115 each in Test arm and Comparator arm). The baseline demographic characteristics were comparable in between treatment arms. The Spearman's correlation coefficient between NRS score and DYS score was statistically significant for both treatment arms at Day 169 [Test: 0.2485, p = 0.0077; Comparator: 0.3735, p < 0.0001] indicating weak positive correlation between the 2 scales. The Spearman's correlation coefficient between NRS score and NMPP score was statistically significant for both treatment arms at Day 169 [Test: 0.3423, p = 0.0002; Comparator: 0.3322, p = 0.0003] indicating weak positive correlation between NRS and NMPP scores. The Spearman's correlation coefficient between DYS score and NMPP score was statistically significant for both treatment arms at Day 169 [Test: 0.2815, p = 0.0024; Comparator: 0.4023, p < 0.0001] indicating weak positive correlation between DYS and NMPP scores. The incidence of TEAEs were similar in both treatment arms and no serious adverse events were reported. Most common TEAE in both arms was pyrexia [Test: 5.2%; Comparator: 11.3%].

Conclusion

This study demonstrated that patients with endometriosis when treated with Elagolix 150 mg or Dienogest 2 mg, the reduction of NRS score is directly proportional to reduction in DYS and NMPP scores and both DYS and NMPP score are directly proportional to each other as well and both treatments are well tolerated. eP-069 Efficacy and safety of Elagolix in endometriosis: Baseline NRS score subgroup analysis N. Gupta1; T. Palve2; G. Kamilya3; S. Srivastava4; M. Ponnuru5; S. Bohir6; J. Patel7; M. Dash8; S. Saigal9; K. Savalia10; T. Gupta11; D. Chaudhary12; M. Rangaswamy13; P. Shah14; V.V. Bhat15; A. Shetty16; S. Saha16; R. Quadros16; D. Patil16; P. Patel16; P. Ghadge16; A. Mane16; S. Mehta16 1GSVM Medical College, Kanpur, India, 2Cama And Albless Hospital, Mumbai, India, 3IPGME&R and SSKM Hospital, Kolkata, India, 4Om Surgical Center & Maternity Home, Varanasi, India, 5Modern Government Maternity Hospital, Hyderabad, India, 6KKasturi Medicare Pvt Ltd, Thane, India, 7Pagarav Hospital & ICU, Gandhinagar, India, 8Sparsh Hospital & Critical Care Pvt Ltd, Bhubaneshwar, India, 9Brij Medical Centre Pvt Ltd, Kanpur, India, 10Priyadarshani Nursing Home, Virar (E), India, 11Udyan Health Care Pvt Ltd, Lucknow, India, 12SMS Hospital, Jaipur, India, 13Mandya Institute of Medical Sciences, Mandya, India, 14SVP Hospital, Ahmedabad, India, 15Radhakrishna Multispeciality Hospital and IVF Center, Bangalore, India, 16Sun Pharma Laboratories Limited, Mumbai, India

Objective

To evaluate the efficacy and safety of Elagolix 150 mg tablets (EgolixTM150 manufactured by Sun Pharma) compared to Dienogest 2 mg tablets in patients with moderate to severe pain associated with endometriosis in three subgroups based on baseline numeric rating scale (NRS) score: 4–6 (Subgroup 1 [S1]), > 6–8 (Subgroup 2 [S2]), > 8–10 (Subgroup 3 [S3]). Design: This is a subgroup analysis of a phase-III, randomised, multicenter, double-blind, double-dummy, parallel-group, active-controlled non-inferiority study.

Method

Study was conducted after receiving regulatory and ethics committee approvals [CTRI/2023/01/049292]. Patients were randomised (1:1) to either receive Elagolix 150 mg [Test] once-daily or Dienogest 2 mg [Comparator] once-daily and matching placebos for 24 weeks. Efficacy was evaluated based on NRS, dysmenorrhoea (DYS), non-menstrual pelvic pain (NMPP) scores, rescue-medication assessments, and Patient Global Impression of Change (PGI-C) scale.

Result

This subgroup analysis included 102 patients in S1 (Test [n = 55], Comparator [n = 47]), 76 patients in S2 (Test [n = 34], Comparator [n = 42]), and 52 patients in S3 (Test [n = 26], Comparator [n = 26]). Primary-endpoint results showed that Test arm was non-inferior to Comparator arm in reduction of mean ± SD NRS score from Baseline to Day 85 in all three subgroups: S1 (Test [−1.76 ± 0.98] and Comparator [−1.78 ± 0.77]); S2 (Test [−3.04 ± 1.31] and Comparator [−2.70 ± 1.29]); S3 (Test [−3.11 ± 1.08] and Comparator [−3.34 ± 1.29]) and treatment difference (95% CI): S1[0.02(−0.34, 0.37)]; S2[−0.34(−0.96, 0.27)]; S3[0.23(−0.43, 0.89)] as the upper limit of 95% CI was below the pre-defined margin of 1.5. Similar results were observed at Day 169 in all three subgroups. Reduction of DYS and NMPP scores from Baseline to Days 57, 85, 127 and 169 was statistically significant within each arm and were comparable between both arms, in all three subgroups. Responders with improvement in PGI-C scale at Day 169 were comparable in both arms in all three subgroups; S1 [Test [94.5%], Comparator [100%]; p = 0.2485), S2 (Test [93.8%] and Comparator [90.0%]; p = 0.6863); S3 (Test [88.5%] and Comparator [92.3%]; p > 0.9999). Patients requiring rescue medication at Day 169 were comparable in both arms in all three subgroups. The incidence of treatment-emergent adverse events (TEAEs) were similar in both arms and no serious adverse events were reported. Most common TEAE was pyrexia in all three subgroups.

Conclusion

The study demonstrated that Elagolix 150 mg was effective and well-tolerated compared to Dienogest 2 mg in all three subgroups assessed via NRS score from Baseline to Days 85 and 169. Hence, Elagolix can be considered as valuable treatment option in relieving moderate to severe pain associated with endometriosis. eP-070 Pharmacological interventions for dysmenorrhea in adenomyosis: A systematic review and network meta-analysis K. Eskandar1; P. Orsini2; L. Crosara2; T. Milbrandt2; S. Khalil3; C. Philip4 1Department of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil, 2Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil, 3Buenos Aires, University of Buenos Aires, Argentina, 4Department of Gynaecology, Beaumont Hospital, Dublin, Ireland

Objective

To evaluate the efficacy of various pharmacological interventions in managing dysmenorrhea associated with adenomyosis. Design: Adenomyosis, characterized by endometrial tissue within the myometrium, often presents with dysmenorrhea that significantly impacts the patient's quality of life. Despite the availability of various non-surgical interventions, there remains no consensus on the most effective approach. Therefore, we performed a systematic review and bayesian network meta-analysis prospectively documented at PROSPERO under the registration number CRD42023451241 to evaluate the efficacy of various pharmacological interventions in managing dysmenorrhea associated with adenomyosis.

Methods

We systematically searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) from their inception until March 2024. Studies comparing two or more interventions in patients with symptomatic adenomyosis were considered for inclusion. The main outcome was dysmenorrhea. Data was manually extracted and formatted into an Excel spreadsheet to be utilized by the statistical software. Markov chain Monte Carlo (MCMC) simulation was conducted using Bayesian inference as the method for statistical analyses performed using R statistical software, version 4.2.2 (R Foundation for Statistical Computing).

Results

We included a total of 7 RCTs encompassing 661 women with adenomyosis treated with either placebo or one of the four different therapies: combined oral contraceptive (COC), dienogest (DNG), levonorgestrel intrauterine system (LNG-IUS) and progesterone receptor modulators (PRM). The most effective intervention for decreasing dysmenorrhea measured by the visual analog scale (VAS) score was PRM (MD −4.88 cm, 95% Crl −8.64 ~ −0.57 cm, SUCRA: 84.2%). None of the investigated therapies demonstrated a significant reduction in uterine volume; however, PRMs exhibited the most favorable performance (MD −47.03 mm, 95% Crl −101.70 to 5.44 mm, SUCRA: 96.3%). DNG was associated with a significant increase in hot flashes (odds ratio [OR] 35.08, 95% Crl 2.53 to 113.87, SUCRA: 98.9%), and none of the therapies significantly impacted hemoglobin levels.

Conclusion

Administration of progesterone receptor modulators has been shown to decrease dysmenorrhea in women with adenomyosis. eP-071 Patients global impression of change in endometriosis with Elagolix: A post-hoc analysis N. Gupta1; T. Palve2; G. Kamilya3; S. Srivastava4; P Malathi5; S. Bohir6; J.S. Patel7; M.K. Dash8; S. Saigal9; K.P. Savalia10; T. Gupta11; D. Chaudhary12; R Manohar13; P. Shah14; V.V. Bhat15; A. Shetty16; S. Saha16; R. Quadros16; D. Patil16; P. Patel16; P. Ghadge16; A. Mane16; S. Mehta16 1GSVM Medical College, Kanpur, India, 2Cama And Albless Hospital, Mumbai, India, 3IPGME&R and SSKM Hospital, Kolkata, India, 4Om Surgical Center & Maternity Home, Varanasi, India, 5Modern Government Maternity Hospital, Hyderabad, India, 6KKasturi Medicare Pvt Ltd, Thane, India, 7Pagarav Hospital & ICU, Gandhinagar, India, 8Sparsh Hospital & Critical Care Pvt Ltd, Bhubaneshwar, India, 9Brij Medical Centre Pvt Ltd, Kanpur, India, 10Priyadarshani Nursing Home, Virar (E), India, 11Udyan Health Care Pvt Ltd, Lucknow, India, 12SMS Hospital, Jaipur, India, 13Mandya Institute of Medical Sciences, Mandya, India, 14SVP Hospital, Ahmedabad, India, 15Radhakrishna Multispeciality Hospital and IVF Center, Bangalore, India, 16Sun Pharma Laboratories Limited, Mumbai, India

Objective

To evaluate the correlation of patient Global Impression of Change (PGI-C) with various pain scales used in patients of endometriosis when treated with Elagolix 150 mg (EgolixTM150 manufactured by Sun Pharma) or Dienogest 2 mg. Design: A phase-III, randomized, multi-centric, double-blind, double-dummy, parallel-group, active-controlled, comparative, non-inferiority study.

Methods

The study included premenopausal female patients with documented endometriosis having pain assessed via numeric rating scale (NRS) of ≥4, dysmenorrhoea scale (DYS) score of ≥2, and non-menstrual pelvic pain (NMPP) score of ≥2. The study was conducted after receiving regulatory and ethics committee approvals. The patients were randomized (1:1) to either receive Elagolix 150 mg [Test arm] or Dienogest 2 mg [Comparator arm] and matching placebos for 24 weeks. In this post-hoc analysis correlation of PGI-C scale with NRS, DYS, and NMPP scores were evaluated. [Clinical trial registration: CTRI/2023/01/049292]

Result

This post-hoc analysis included 230 patients (115 each in Test arm and Comparator arm). The baseline demographic characteristics were comparable in between treatment arms. The Spearman's correlation coefficient between NRS score and PGI-C scale was statistically significant for both treatment arms at Day 169 [Test: 0.2852, p = 0.0022; Comparator: 0.2039, p = 0.0311] indicating weak positive correlation between the 2 scales. The Spearman's correlation coefficient between NMPP score and PGI-C scale was statistically significant for both treatment arms at Day 169 [Test: 0.3113, p = 0.0008; Comparator: 0.249, p = 0.0081] indicating weak positive correlation between NMPP and PGI-C. The incidence of TEAEs were similar in both treatment arms and no serious adverse events were reported. Most common TEAE in both arms was pyrexia [Test: 5.2%; Comparator: 11.3%].

Conclusion

This study demonstrated that patients with endometriosis when treated with Elagolix 150 mg or Dienogest 2 mg, the reduction of NRS and NMPP scores is directly proportional to improvement in PGI-C scale and both treatments are well tolerated. eP-072 Effect of vasopressin injection on ovarian reserve during laparoscopic ovarian endometrioma cystectomy S. Baradwan1; H. Hassan Abduljabbar1; H. Sabban1,2; N. Alzawawi1; M. Saeed Alshahrani3; R. AlSghan4; A. Mohamed Abdelhakim5; A. A. AlAmodi6; A. Fouad Elgamel7 1Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, 2Department of Obstetrics and Gynecology, King Abdulaziz University Rabigh Medical College, Jeddah, Saudi Arabia, 3Faculty of Medicine, Department of Obstetrics and Gynecology, Najran University, Najran, Saudi Arabia, 4Department of Obstetrics and Gynecology, Maternity and Children Hospital, AlKharj, Saudi Arabia, 5Kasralainy, Faculty of Medicine, Cairo University, Cairo, Egypt, 6College of Health Sciences and Public Health, Jackson State University, Jackson, USA, 7Faculty of Medicine, Department of Obstetrics and Gynecology, Beni-Suef University, Beni-Suef, Egypt

Objectives

To evaluate the effect of injecting vasopressin during laparoscopic excision of ovarian endometriomas on ovarian reserve. Design: A systematic review and meta-analysis of randomized controlled trials.

Methods

Four different databases (PubMed, Cochrane Library, Scopus, and ISI web of science) were searched for the available trials from inception to June 2023. We selected randomized controlled trials (RCTs) that compared vasopressin injection in the intervention group versus normal saline or no injection of vasopressin in the control group among women undergoing laparoscopic cystectomy of ovarian endometriomas. Our main outcomes were operation time, amount of bleeding, and number of coagulation events. In addition, levels of serum anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were recorded 6 months post-surgery.

Results

Seven RCTs were retrieved with a total number of 440 patients. The operation time from detaching of the cyst wall until hemostasis of ovarian tissue was shorter within the vasopressin group in comparison with the control group (p = 0.02). The amount of blood loss and number of coagulation events were significantly reduced within the vasopressin group compared to the control group (p = 0.01 & p = 0.003). There was a significant improvement in the AMH concentration within 6 months after surgery in the vasopressin group (MD = 0.53, 95% CI [0.18, 0.88], p = 0.003). In addition, there was a significant reduction in the FSH levels within 6 months after laparoscopic cystectomy with vasopressin injection (p = 0.02).

Conclusion

Vasopressin injection during laparoscopic cystectomy of ovarian endometriomas is effective in reducing operation time, blood loss amount, and frequency of coagulation as well as protecting the ovarian reserve. eP-075 Efficacy and safety of elagolix in endometriosis: Disease duration subgroup analysis N. Gupta1; T. Palve2; G. Kamilya3; S. Srivastava4; P Malathi5; S. Bohir6; J.S. Patel7; M.K. Dash8; S. Saigal9; K.P. Savalia10; T. Gupta11; D. Chaudhary12; R Manohar13; P. Shah14; V.V. Bhat15; A. Shetty16; S. Saha16; R. Quadros16; D. Patil16; P. Patel16; P. Ghadge16; A. Mane16; S. Mehta16 1GSVM Medical College, Kanpur, India, 2Cama And Albless Hospital, Mumbai, India, 3IPGME&R and SSKM Hospital, Kolkata, India, 4Om Surgical Center & Maternity Home, Varanasi, India, 5Modern Government Maternity Hospital, Hyderabad, India, 6KKasturi Medicare Pvt Ltd, Thane, India, 7Pagarav Hospital & ICU, Gandhinagar, India, 8Sparsh Hospital & Critical Care Pvt Ltd, Bhubaneshwar, India, 9Brij Medical Centre Pvt Ltd, Kanpur, India, 10Priyadarshani Nursing Home, Virar (E), India, 11Udyan Health Care Pvt Ltd, Lucknow, India, 12SMS Hospital, Jaipur, India, 13Mandya Institute of Medical Sciences, Mandya, India, 14SVP Hospital, Ahmedabad, India, 15Radhakrishna Multispeciality Hospital and IVF Center, Bangalore, India, 16Sun Pharma Laboratories Limited, Mumbai, India

Objective

To evaluate the efficacy and safety of Elagolix 150 mg (EgolixTM150 manufactured by Sun Pharma) compared to Dienogest 2 mg in endometriosis in two subgroups based on duration of disease, i.e., ≤6 months (Subgroup 1 [S1]) and > 6 months (Subgroup 2 [S2]). Design: A phase-III, randomized, multi-centric, double-blind, double-dummy, parallel-group, active-controlled non-inferiority study.

Methods

This subgroup analysis of phase 3 study included patients with moderate to severe pain associated with endometriosis. The study was conducted after receiving regulatory and ethics committee approvals [Clinical trial registration: CTRI/2023/01/049292]. The patients were randomized (1:1) to either receive either Elagolix 150 mg [Test] or Dienogest 2 mg [Comparator] and matching placebos for 24 weeks. For efficacy outcomes NRS, DYS, NMPP, patients requiring rescue medication, and proportion of responders on Patient Global Impression of Change (PGI-C) scale were evaluated.

Result

This subgroup analysis included total 230 patients (S1 [n = 85]: Test [n = 43] and Comparator [n = 42]; S2 [n = 145]: Test [n = 72]; Comparator [n = 73]). The primary endpoint of reduction in NRS score from baseline to Day 85 in Test arm was non-inferior to Comparator for both subgroups (S1: Test [−2.17 ± 1.42] and Comparator [−2.33 ± 1.45]; S2: Test [−2.58 ± 1.17] and Comparator [−2.55 ± 1.14]; treatment difference [T-C] (95% CI): S1 [0.15 (−0.48,0.79)]; S2 [−0.03 (−0.42,0.35)] as the upper 95% CI and was below the pre-defined margin of 1.5. The reductions in NRS score from baseline to Day 169 in Test arm was non-inferior to Comparator arm and followed similar pattern. The reduction of DYS score and NMPP score from baseline to Day 85 and Day 169 were comparable in both Test and Comparator arms in both subgroups. The proportion of patients requiring rescue medication at Day 169 were comparable in both Test and Comparator arms in both subgroups (S1: Test [24.4%] and Comparator [15.0%]; p = 0.4038); S2: Test [13.9%] and Comparator [18.1%]; p = 0.6499). The proportion of overall responders in PGI-C scale at Day 169 were comparable in both Test and Comparator arms in both subgroups (S1: Test [92.7%] and Comparator [95.0%]; p > 0.9999); S2: Test [93.1%] and Comparator [94.4%]; p > 0.9999). The incidence of TEAEs were similar in both treatment arms and no serious adverse events were reported in any subgroups.

Conclusion

This study demonstrated that Elagolix 150 mg was effective and well tolerated compared to Dienogest 2 mg in treating moderate to severe pain associated with Endometriosis as assessed via NRS score from baseline to Day 85 and Day 169, irrespective of duration of disease. Hence, Elagolix can be considered as valuable treatment option in management of pain associated with endometriosis. eP-076 Diagnosis and classification of congenital uterine abnormalities: 3D-TVUS versus MRI E. Tsakos1; E.M. Xydias1; P.N. Liasidi2; A.C. Ziogas3; S. Doumouchtsis4 1EmbryoClinic IVF, Thessaloniki, Greece, 2Department of Gynaecology, Agios Dimitrios General Hospital, Thessaloniki, Greece, 3University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece, 4Epsom & St. Helier University Hospitals, Epsom, UK

Objective

To ascertain the diagnostic performance of three-dimensional transvaginal ultrasound (3D-TVUS) in the assessment of congenital uterine abnormalities and compare it to that of Magnetic Resonance Imaging (MRI). Design: A systematic review and meta-analysis of the available literature.

Method

The Scopus, Web of Science, Ovid, CINAHL and PubMed databases were systematically searched in accordance with the PRISMA 2020 guidelines. Published articles were screened for relevance and evaluated for risk of bias before their inclusion into the analysis.

Results

Of the initial study pool, only 9 studies were ultimately eligible for inclusion. With regard to diagnostic accuracy data, 3D-TVUS had superior specificity compared to MRI in diagnosing bicornuate (99% vs. 92%) and didelphys (100% vs. 87%) and superior sensitivity for septate uterus (99% vs. 81%), with the aforementioned abnormalities being classified using the ASRM system. Inter-method agreement was substantial for hypoplastic, unicornuate, didelphys, bicornuate and septate (Cohen's k: 0.65, 0.75. 0.74, 0.61, 0.77 respectively) and almost perfect for arcuate and iatrogenic (Cohen's k: 0.82 and 1.0 respectively) when using the ASRM classification system in the absence of a reference standard. The cumulative agreement for all types of abnormalities was substantial (Cohen's k: 0.7). Inter-method agreement for the studies using the ESHRE/ESGE classification was perfect for U1, U4 and U5 anomalies (Cohen's k: 1) and almost perfect for U2 and U3 anomalies (Cohen's k: 0.91 and 0.94 respectively). The cumulative inter-method agreement for all uterine anomalies in the ESHRE/ESGE studies was overall almost perfect (Cohen's k: 0.91). It should be noted that available data on congenital uterine abnormalities other than septate, bicornuate and arcuate uterus were considerably limited and there was significant statistical heterogeneity amongst the studies that utilized the ASRM classification system.

Conclusions

These findings support the application of 3D-TVUS in the diagnosis and classification of uterine abnormalities, as it combines diagnostic efficacy with practical advantages over MRI, such reduced cost and better tolerability by the patients. However, further research is required to validate these findings, particularly with regard to the more rare abnormalities, as they might have not been accurately represented in the present analysis. eP-077 Effectiveness of vasopressin injection in laparoscopic cystectomy for ovarian endometriomas: Systematic review M. Deameh1; E. Amaireh2; H. Abu-Rayyan1; R. Thaher3 1Al-Balqa Applied University, Al-Salt, Jordan, 2Jordanian Ministry of Health, Amman, Jordan, 3Hamad Medical Corporation, Doha, Qatar

Objective

This study aims to compare the surgical outcomes of patients undergoing laparoscopic cystectomy with vasopressin injection versus a control group. The focus is on reducing leakage and bleeding during tissue separation, minimizing tissue damage, and preserving ovarian reserve.

Method

We followed PRISMA guidelines and conducted a systematic review using databases such as PubMed, Scopus, and ScienceDirect. Our study included randomized controlled trials and retrospective cohort studies comparing the vasopressin injection group with control groups (no vasopressin) in patients undergoing laparoscopic cystectomy.

Results

The systematic review included four studies comparing the use of vasopressin injection during laparoscopic cystectomy with control groups (no vasopressin) in patients with ovarian endometriomas. The total number of participants across all studies was 137 in the vasopressin groups and 139 in the control groups. The results consistently showed favorable outcomes associated with vasopressin injection. Studies reported significantly less bleeding and fewer coagulation events in the vasopressin group compared to controls, indicating improved hemostasis during surgery. Vasopressin injection also led to shorter operative times for stripping and hemostasis in one study. Additionally, histologic findings revealed differences in the occurrence rate and thickness of ovarian tissue in endometrioma wall specimens between the groups. Overall, the findings suggest that vasopressin injection during laparoscopic cystectomy may be beneficial in reducing intraoperative bleeding, improving surgical efficiency, and potentially preserving ovarian function.

Conclusion

Vasopressin injection during laparoscopic cystectomy for ovarian endometriomas significantly reduces bleeding, coagulation events, and operative times compared to procedures without vasopressin. These findings suggest that vasopressin injection may improve surgical outcomes and potentially preserve ovarian function in these patients. eP-097 Fetal skeletal dysplasia case series; diagnostic options and prognosis prediction Z. Shamsul Islam; F. Fatima; M. Kalsoom; A. Malik Aga Khan University Hospital, ObGyn, Karachi, Pakistan

Objective

To review all the cases of prenatally diagnosed skeletal dysplasia on sonography for the accuracy of diagnosis and prediction of lethality. Design: Retrospective cohort.

Method

A retrospective review of fetal medicine unit records between January 2012 and December 2022 to identify cases where a skeletal dysplasia was suspected. Perinatal outcome, the accuracy of prenatal diagnosis, and prediction of lethality were ascertained. Lethality prediction was made by femur to abdominal circumference ratio and chest circumference. Pregnancies that resulted in fetal or neonatal death (NND) were considered to have lethal dysplasia.

Results

Twenty-three cases of fetal skeletal dysplasia were diagnosed on ultrasound. The mean maternal age was 27.7 ± 5.9 years and mean BMI was 26.5 ± 6.1. Eleven women (47.8%) were in consanguineous relationships and in two cases there was a history of previous affected fetus. Invasive testing were performed in 10 cases including Karyotype in 3 (reported normal), FISH in 3 cases (report euploid) and DNA banking was performed in 4 cases. Termination of pregnancy was performed in nine (39.2%) cases at a median gestational age of 22 weeks and one case resulted in a stillbirth (4.3%) at 34 weeks. One pregnancy resulted in spontaneous miscarriage. In this cohort, 5 cases were predicted to be lethal, out of which two underwent termination of pregnancy, two were live born resulted in early NNDs and one was a stillbirth. Data regarding lethality was missing in five cases, out of these four underwent termination of pregnancy and one was NND due to severe skeletal dysplasia and lung hypoplasia. Thirteen cases were predicted to be non-lethal, one was a spontaneous miscarriage, and three pregnancies were terminated. In the nine live born babies, three children are currently 11, 11 and 16 years old, respectively with confirmed diagnosis of skeletal dysplasia. One had infantile death diagnosed with osteogenesis imperfecta and one was lost to followup after 3 months of age. However, four babies could not survive beyond neonatal period, one due to associated cyanotic heart disease, and another was diagnosed as congenital rubella syndrome. One baby died in neonatal period, delivered at 28 weeks of pregnancy later diagnosed as chondroectodermal dysplasia. Fourth NND was due to lung hypoplasia and skeletal dysplasia.

Conclusion

Lethal skeletal dysplasia can be diagnosed by prenatal ultrasound using several sonographic parameters. Guidelines need to be followed for correct diagnosis and lethality prediction to improve pregnancy management. eP-099 Survival rates in pregnancies complicated by twin-to-twin transfusion syndrome: Systematic review & meta-analysis F. D'Antonio1; D. Marinceu2; N. Eltawheel3; S. Prasad4; A. Khalil5 1University of Chiety, Center for Fetal Care and High Risk Pregnancy, Chieti, Italy, 2York District Hospital, Obstetrics, York, UK, 3University of Warwick, Biomedical Science, Warwick, UK, 4St George's Hospital, Fetal Medicine Unit, London, UK, 5Twins and Multiples Centre for Research and Clinical Excellence, Fetal Medicine Unit, London, UK

Objective

Twin-to-twin transfusion syndrome (TTTS) is associated with excess perinatal mortality and morbidity. Recent literature indicates that fetal survival, whether for both twins or at least one, following fetoscopic laser photocoagulation of the placental anastomoses is similar in TTTS Quintero stages I and II (combined) and III and IV (combined). In this context we performed a systematic review and meta-analysis of the published literature to elucidate the survival rate of twins according to the stage of TTTS and to compare the survival rates in pregnancies complicated by stage I and II (combined) vs. those with stages III and IV (combined).

Methods

Medline, Embase and Cochrane databases were searched for monochorionic diamniotic (MCDA) twin pregnancies complicated by TTTS. The primary outcome was double survival at birth. The secondary outcomes were no survival, single survival, and survival of at least one twin. Furthermore, we compared all the observed outcomes in pregnancies complicated by TTTS affected by stage I and II vs. those with stages III and IV. Random-effect meta-analyses were used to combine data and the results reported as pooled proportions or odd ratios (OR) with their 95% confidence intervals (CI).

Results

1045 articles were identified, and 27 studies included in the systematic review. No significant difference in the incidence of double survival (p = 0.871), at least one survivor (p = 0.808), and no survivors (p = 0.737) between stage I & stage II TTTS. The incidence of double survival (p = 0.107), at least one survivor (p = 0.329), and no survivors (p = 0.394) didnt significantly differ between stages III&IV. Comparing the outcome of pregnancies with stage I and II (combined) vs. III or IV (combined), the incidence of double survival was significantly higher in pregnancies with stage I/II, with an OR of 2.27 (95% CI 1.7–3.0, p < 0.001). Likewise, the odds of at least one survivor was significantly higher (OR: 1.66, 95% CI 1.3–2.1, p < 0.001) while that of no survivor lower (OR: 0.60, 95% CI 0.5–0.8, p < 0.001) in pregnancies with stage I/II compared to III/IV.

Conclusion

Perinatal survival of MCDA twin pregnancies complicated by TTTS and treated with fetoscopic laser coagulation of placental anastomoses is not significantly different between stages I and II, or between stages III and IV, apart from a higher chance of one survivor in stage III compared to stage IV. The findings from this systematic review will be useful in individualised risk assessment of twin pregnancies complicated by TTTS and tailored counselling of the parents. eP-101 Accuracy of ultrasonographic transcerebellar diameter for dating in third trimester of pregnancy O.U. Ofoegbu1; O.A. Babah2; T.T. Saalu1; O.E. Familusi1; O.A. Kusamotu2; N. Irurhe3 1Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria, 2Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria, 3Department of Radiodiagnosis, College of Medicine, University of Lagos, Lagos, Nigeria

Objective

Routine sonographic estimation of gestational age using biparietal diameter, head circumference, abdominal circumference and femur length is popular but has limitations especially when used singly or in late pregnancy. This study determined the accuracy of ultrasonographic trans-cerebellar diameter measurement for dating in third trimester of pregnancy. Design: It was an analytic cross-sectional study.

Method

The study was conducted at Lagos University Teaching Hospital, Idi-Araba, Lagos, on 110 pregnant women in their third trimester. Data on sociodemographic and obstetric characteristics of the women was collected using an interviewer administered questionnaire. Transabdominal ultrasound scan was done to determine the gestational age, biparietal diameter, head circumference, abdominal circumference, femur length and trans-cerebellar diameter. Spearman's correlation coefficient was used to determine the correlation between the biometric measurements. Accuracy was determined using gestational age from menstrual date as gold standard and comparisons made using Chi square test.

Results

Mean age of participants was 31.5 ± 5.8 years; mean gestational age 236 ± 25 days. Compared to biparietal diameter, head circumference, abdominal circumference, and femur length; trans-cerebellar diameter was found to correlate best with gestational age (r = 0.8837, p < 0.001). At an error margin of ± 2 weeks, trans-cerebellar diameter had a high predictive accuracy of 84.6% significantly comparable to abdominal circumference alone, 86.4% (p = 0.003), and to all four well known fetal biometric parameters (biparietal diameter, head circumference, abdominal circumference, and femur length) combined, 85.5% (p < 0.001).

Conclusion

Trans-cerebellar diameter has a better correlation with gestational age than other routine fetal biometric parameters and has a high predictive accuracy for dating in third trimester of pregnancy. It may thus play a relevant role in low resource settings where there is shortage of staff and limited skills in obstetric ultrasonography. eP-103 Management of CongenitalCMV in tertiary fetal medicine unit in London over 25 years N. Elbarbary; C. Pegorie; A. Bhide St George's University Hospitals NHS Trust, Fetal Medicine, London, UK

Objectives

Cytomegalovirus is the commonest congenital infection. However, diagnosis and management remain challenging. Our aim was to audit management of confirmed cases of maternal primary infection in pregnancy presented to our unit over the past 25 years, and to show changing trends in diagnosis and treatment. Design: Retrospective cohort of historical data.

Methods

Records from fetal medicine unit were searched for cases referred with confirmed primary maternal CMV or signs of fetal CMV infection, cases diagnosed with primary maternal infection during work up for other referrals were also included. For each case, we identified method of diagnosis of maternal primary infection, fetal infection, presence of ultrasound signs, performance of amniocentesis/fetal blood sampling, performance of MRI, treatment options offered, and pregnancy outcomes.

Results

Total of 83 cases were identified. The changes of diagnostic methods over time reflected emerging evidence. The diagnosis of maternal infection was based on seroconversion or positive IgG, IgM with low avidity. Amniocentesis is currently the mainstay for diagnosis of fetal infection. Fetal blood sampling, as a method of diagnosis of fetal infection had declined over years. Treatment with Valacyclovir has been offered to cases with confirmed infection starting from 2017, with developing evidence of reduced risk of fetal transmission. Termination of pregnancy occurred in 18 cases (18/83, 21%), most cases had a combination of confirmed fetal infection and signs of multiorgan affection on ultrasound and/or signs of CNS affection on MRI.

Conclusion

The diagnosis and management of congenital CMV infection remains a challenge in fetal medicine. Our cohort reflects the changes in practice to follow emerging evidence in the field, drawing insights on diagnosis and counselling from tertiary fetal medicine unit. eP-104 Ethnic variations in fetal nasal bone length and it's prenatal clinical impact P. Divya Chandran; S. Vikraman; R. Chandran; E. Sowjanya; P. Raj ARMC Aegis Hospital, Fetal Medicine, Perinthalmanna, India

Objective

Down syndrome is the most common genetic cause for moderate intellectual disability. Prenatal screening for Down syndrome is imperative as it aids the couples in early informed decision making. Inspite of first trimester combined screening for Down syndrome being an effective strategy, assessment of second trimester aneuploidy markers especially absent/hypoplastic fetal nasal bone length (NBL) continues to hold its grounds for being an established screening strategy for aneuploidies. However, ethnic variations in NBL continue to defy an universal criteria for its shortness. This study aims at introspecting a new methodology for creating nasal bone reference values for 15–24 + 6 weeks of gestation in a Southern Indian population, compare it with other reference charts, and study its clinical utility in a cohort of prenatally diagnosed Down syndrome cases. Design: Prospective cross-sectional study performed in three institutions in Southern India.

Method

300 singleton low risk pregnancies were randomly assigned at 11–13 + 6 weeks for visits between 15–24 + 6 weeks of gestation. Single measurement of NBL was taken in each case. All pregnancies were followed up to confirm normal neonatal outcome. The 5th centiles values from other charts were converted to z scores using the mean and standard deviation from our chart for comparative purpose. The newly created nasal bone nomogram was applied to a cohort of 42 cases of prenatally diagnosed Down syndrome cases collected from the same population during this period, to study its clinical utility.

Results

A total of 300 cases, 30 per gestational week were analyzed from 15–24 + 6 weeks of gestation. The best fit linear regression equation was determined to be NBL = −2.334 + 0.376 x GA (R2 = 0.614, p value < 0.001). The mean NBL were 3.37, 3.67, 4.13, 4.45, 5.04, 5.23, 6.11, 6.19, 6.38 and 6.58 mm for 15, 16, 17, 18, 19, 20, 21, 22, 23 and 24 weeks of gestation respectively. The 5th, 50th and the 90th centiles were calculated. Using the 5th centile NBL value from our nomogram as the cut-off, the performance indices were- sensitivity 68.57% (95% CI 50.7183.15) specificity 95.67% (95%CI 92.70–97.67), positive likelihood ratio 15.82 (95% CI 8.8928.18) and negative likelihood ratio 0.33 (95% CI 0.20–0.54).

Conclusions

Significant differences were noted in the 5th centiles values of our study and other Indian nomograms. The NBL values from our study were observed to be shorter than all other non Indian nomograms except the Korean chart. It is prudent to use population specific NBL charts for improved clinical performance. eP-105 Consultant led preterm birth clinic outcomes compared to a control group E. Davies; A. Sau; M. Mehta Lewisham and Greenwhich NHS Trust, Obstetrics and Gynaecology, London, UK

Objective

The Ministry for Health set an ambition to reduce the rate of preterm birth (PTB) in the UK from 8% to 6%. Saving Babies’ Lives V2 (SBLV2) recommends the provision of clinics for patients at risk for spontaneous PTB. Clinics should offer screening using cervical length scanning and quantitative fibronectin (FFN) tests and interventions such as cervical cerclage and progesterone pessary. This study compared the frequency of screening, treatments and outcomes of a consultant led PTB clinic to a control group with near identical risk factors at the same London district general hospital. Design: 275 cases were referred to the PTB clinic between April 2020 and December 2022. Multiple pregnancies (N = 2), patients who did not attend (N = 23) and patients lost to follow up (N = 20) were excluded. Comparisons were made to the cohort recruited for the POPPIE (Pilot study of midwifery Practice in Preterm birth including women's Experiences) trial. Indications for referral to the clinic and recruitment to the trial were near identical.

Results

232 cases from the PTB clinic were compared to 331 cases in the control group. There was a significantly greater use of FFN testing (37.9% vs. 9.4%) and cervical length scanning (87.5% vs. 52.6%) in the PTB clinic compared to the control group. There was greater use of cervical cerclage (11.2% vs. 5.7%) and progesterone (35% vs. 15.4%). The rates of PTB was slightly higher in the PTB clinic group (18.1% vs. 15.1%). However, iatrogenic PTB births were higher in the PTB clinic group (5.2% vs. 3.3%). There was a reduction in the percentage of late miscarriages (15–22 + 6 weeks) (2.2% vs. 2.7%), deliveries <24 weeks (2.2.% vs. 3.3.%) and deliveries 24 to 27+6 weeks (1.7% vs. 1.8%). There was improvement in percentage of births between 28 to 33+6 weeks (5.2% vs. 3.0%) and 34 to 36+6 weeks (11.2% vs. 6.9%).

Conclusion

These results show that consultant led PTB clinics lead to increased use of the screening tools and interventions recommended by SBLV2. There was a reduction in rates of late miscarriages and delivery <27+6 weeks and improvement in gestational age at delivery (<33+6 weeks and <36+6 weeks) after introduction of a consultant led PTB clinic. Areas for future research include examining the outcomes for patients who underwent cervical cerclage and re-auditing the clinic over an extended time period to account for fluctuations in local PTB rates. eP-107 Transvaginal cervical length assessment at 11–14 and 20–24 weeks and preterm labor prediction P. Divya Chandran; R. Chandran; P. Raj; E. Sowjanya ARMC Aegis Hospital, Fetal Medicine, Perinthalmanna, India

Objective

To compare the role of ultrasonographic transvaginal cervical length assessment at 11–14 weeks and 20–24 weeks of gestation in prediction of preterm labor and delivery. Design: Prospective observational study.

Method

A total of 375 pregnant women attending the antenatal clinic underwent transvaginal cervical length measurements during routine ultrasound scan at 11–14 weeks and 20–24 weeks of gestation by trained feto maternal specialists certified by FMF, UK. The patients were followed up till delivery.

Results

The percentage of preterm births was 16% in the study population. Out of the 60 subjects who delivered preterm, 24 (40%) had cervical length at 11–14 weeks ≤3 cm whereas only 12.1% in the non preterm group had cervical length ≤3 cm (p < 0.0001).The ROC curve for the same showed a new cut off of 3.25 cm with an AUC of 0.648 and 95% confidence interval of 0.562–0.734 with sensitivity, specificity and negative predictive value of 55%,73.3% and 89.5% respectively. Similar correlation was obtained for cervical length at 20–24 weeks and preterm delivery with ROC curve new cut off of 2.85 cm with AUC of 0.837 and 95% confidence interval of 0.778–0.897 and sensitivity, specificity and negative predictive value of 75%, 80% and 96.2% respectively. The comparison of cervical length measurements at 11–14 weeks and 20–24 weeks revealed a significant difference (p < 0.001) in those who delivered preterm as opposed to those delivered at term. This difference was found to be more for the cervical length measurements at 20–24 weeks. (2.55 ± 0.46 cm in preterm delivery group vs. 3.16 ± 0.38 cm in the term delivery group). Both previous history of preterm delivery as well as previous history of cervical incompetence were found to have a positive association with preterm delivery each with a p value of < 0.001.

Conclusions

Our study on comparison of first trimester and second trimester ultrasound cervical length for prediction of preterm labour showed that the measurement of cervical length at 11–14 weeks gestation is not a good predictor of preterm labour and needs further evaluation whereas the same at 20–24 weeks seems to be a good predictor for preterm delivery. The good sensitivity and specificity of the cervical length at 20–24 weeks as derived by ROC curve analysis shows that it could be recommended routinely as a screening test in prediction of preterm delivery. The inclusion of demographic and obstetric history to identify those at risk of preterm delivery may be of significance. eP-108 Cerebral placental ratio and fetal growth velocity in predicting adverse intrapartum outcomes E. Isameldin Wagealla1; F. Minisha1; L. Al-Romaihi1; S. Abdelazim Hassabelrasoul Ahmed1; N. Khenyab1; A. Al Ibrahim1; T. Farrell1 1Women's Wellness and Research Centre, Hamad Medical Corporation, Obstetrics and Gynecology, Doha, Qatar

Background

Estimates of fetal size fail to differentiate between a small but growing (constitutional) and a pathologically small fetus (due to placental insufficiency), the latter representing 70% of term stillbirths. The use of third-trimester fetal growth velocity (FGV) can help differentiate between them. Pathological FGR is associated with increased resistance of blood flow in the umbilical artery (UA) and an increase in diastolic flow in the middle cerebral artery (MCA)- the ratio of MCA pulsatility index (PI) to UA PI represented as the cerebroplacental ratio (CPR)- denoting a brain sparing effect. Methodology: Women undergoing third-trimester fetal MCA PI measurements as part of fetal growth assessment (index scan), who had a previous scan 14–42 days prior, were included. Data was extracted from Astraia FMU database and electronic patient files. CPR was calculated as MCA PI/UA PI. The FGV was calculated as the difference in estimated fetal weights divided by number of days between scans, converted to customized Z scores. Composite neonatal outcome consisted of any one of cord arterial pH < 7.2, APGAR < 7 at 1 minute, need for resuscitation at birth, and admission to neonatal intensive care unit.

Results

Among 246 women in the study, 80 had FGV <10th centile and 18 had CPR <1. The median FGV z-score for the cohort was −0.39, and the mean CPR was 1.78 ± 0.55. Those with FGV<10th centile had higher odds of cesarean birth (aOR 2.20; p = 0.019), low birthweight (aOR 3.29; p = 0.002), preterm birth (aOR 2.87; p = 0.008) and small for date (SFD) baby (aOR 1.79; p = 0.042) and lesser birthweight (−482 gms; p < 0.001). Those with CPR < 1 had higher odds of composite neonatal outcomes (aOR 3.93; p = 0.013), fetal distress in labor (aOR 4.99; p = 0.002), preterm birth (aOR 5.12; p = 0.002), SFD (aOR 3.86; p = 0.008) and a lesser birthweight (−482 gms; p < 0.001) and centiles (−21.5; p = 0.011). For every unit increase in CPR and FGV, the birthweight centiles increased by 14.6 units (p < 0.001) and 3.54 units (p < 0.001), respectively. FGV was better at predicting birthweight centiles compared to CPR based on the adjusted R squared. Using both CPR and FGV improved the model slightly compared to the individual models.

Conclusion

Abnormally low FGV and CPR are associated with adverse perinatal outcomes, such as lesser birthweight, preterm birth, fetal distress in labor and poor composite neonatal outcomes. These ultrasound parameters represent placental insufficiency, and this study shows that they can be effectively used to predict adverse clinical outcomes. Larger studies are required to corroborate these findings, including other variables that can influence neonatal outcomes, such as maternal comorbidities and intrapartum complications. eP-109 Perinatal outcomes of sFGR in monochorionic pregnancies diagnosed with different criteria O. Yaghi1,2; S. Sorrenti3; F. Fathima2; S. Prasad2; D. Mohammed2; A. Khalil1,2,3 1St George's University of London, London, UK, 2St George's University Hospitals NHS Foundation, Fetal Medicine Unit, London, UK, 3Liverpool Women's Hospital, Liverpool, UK Perinatal outcomes of selective fetal growth restriction in monochorionic pregnancies diagnosed with different criteria: ISUOG vs. Delphi criteria.

Objective

The aim of this study is to evaluate the outcomes of fetuses diagnosed with sFGR using different diagnostic criteria. Study Design and Methodology: This is a cohort study of monochorionic diamniotic (MCDA) twin pregnancies. Cases diagnosed with TTTS before sFGR, TAPS, or fetal anomalies were excluded. All twins were assessed using twin growth charts, and were diagnosed with sFGR using either ISUOG or any Delphi criteria. We compared perinatal outcomes between cases diagnosed with different criteria and uncomplicated twin pregnancies using non-parametric tests.

Results

220 monochorionic diamniotic twin pregnancies were included in the final analysis, of which 45 were complicated by sFGR. Applying ISUOG criteria, 11.4% of cases were diagnosed as sFGR, whereas Delphi classified as sFGR 20.4% of all pregnancies (p = 0.009). Small fetuses diagnosed with either ISUOG or Delphi criteria had significantly higher rates of perinatal morbidity and mortality compared to controls (p < 0.05). Adjunctive analysis also showed that single diagnostic criteria (EFW < 3rd centile, EFW < 10th centile, 25% growth discordance) identified fetuses at significantly higher risk of adverse perinatal outcomes compared to uncomplicated cases. The analysis of all sFGR cases showed that Delphi criteria increased the diagnostic rate by 9%. However, twins diagnosed with one of these criteria but not with ISUOG had better outcomes than those diagnosed with ISUOG (livebirth rate 92.5% vs. 74%, p = 0.02; GA at delivery 33.0 ± 4.2 vs. 30.9 ± 5.0, p = 0.02, composite adverse perinatal outcome 32.5% vs. 58%, p = 0.02; length of stay in NICU in days 19.9 ± 16.5 vs. 41.6 ± 43.2, p = 0.02).

Conclusion

Both ISUOG and Delphi criteria identify fetuses at higher risk of perinatal morbidity and mortality compared to uncomplicated twins. Delphi criteria increased the diagnostic rate of sFGR but included cases at lower risk of adverse outcomes. Beyond those identified with an EFW < 3rd centile, there was no notable escalation in the prevalence of severe neonatal morbidity or mortality amongst those extra cases recognised when compared to the traditional definition. eP-110 Congenital anomalies in Bahrain: Prevalence and predictive factors in pregnant women A. Buhasan1; R. Jeddy1; L. Al Zayer1; A. Mohamed1; L. Al-Jabery1; A. Al Madhoob2; E.S. Al Zaman2 1RCSI, Busaiteen, Bahrain, 2SMC, Manama, Bahrain

Objective

Kingdom of Bahrain, congenital anomalies (CA) account for 8.1% of total deaths in children under 5, indicating a need to understand the patterns, predictors and prevalence to improve antenatal standards of care and reduce the burden of disease. This study aimed to determine the prevalence and characteristics of congenital anomalies in the Kingdom of Bahrain and investigate the association of measured neonatal and maternal risk factors with CAs. Design: A retrospective cohort study was conducted over five years from January 2018 to December 2022 in Salmaniya Medical Complex (SMC), which represented 33% of total births in the Kingdom of Bahrain.

Method

In the study period, 31 615 neonates were born, of which 354 had confirmed CAs. CAs, neonatal and maternal risk factors were collected using the Labor Ward registry and confirmed through the hospital's electronic medical records system. Stillbirths, abortions and congenital anomalies discovered later in life were excluded from the study. IBM's SPSS v26 was used to analyze the results. Descriptive analysis was conducted to determine the frequency of measured neonatal and maternal risk factors and CA prevalence. A chi-square test was conducted to determine the association between measured neonatal and maternal risk factors and CAs.

Results

The prevalence of CAs was determined to be 1.1% (incidence of 11.2 per 1000 births). The highest prevalence of CAs affected multiple systems (21.5%), followed by syndromes and chromosomal abnormalities (18.6%), musculoskeletal (14.4%), cardiovascular (10.7%), oral & maxillofacial (9.3%), central nervous system (8.5%), GI (7.9%), genitourinary (4.2%), ear, nose and throat (2.5%), skin (1.4%), respiratory (0.6%) and ophthalmology (0.3%). A statistically significant association was found between CAs and nationality, method of conception, method of delivery, gender, diabetes status, hypertension, gestational age at birth, and transfer to NICU after birth. However, the association between CAs and pregnancy type were deemed statisictally insignisifcant.

Conclusions

Our research identified an overall CA prevalence of 1.1%, lower than the global estimated average of ~6%. As the first study exploring the associations between CAs and potential risk factors and outcomes in the Kingdom of Bahrain, it provided a foundation for further exploration in the topic and insight to factors healthcare providers would target during preconception and antenatal care. Further research is required with a nationally representative sample to determine the overall prevalence in the Kingdom of Bahrain. eP-111 Sextuplet pregnancy: Management of higher order pregnancy in a low resource setting R. Raamachandran1; T. Dias2 1Base Hospital, Mirigama, Sri Lanka, 2Faculty of Medicine, University of Kelaniya, Department of Obstetrics and Gynecology, Ragama, Sri Lanka

Background

Since 1968, only 18 sextuplet pregnancies had been notified. Higher order pregnancy (3 or more foetuses) rate is rising due to more availability and accessibility to ovulation induction methods and Assisted reproductive techniques. However, there are regulating authorities in developed countries and there is availability of Multifetal reduction therapy to prevent higher order pregnancy as it carry increase maternal and fetal morbidity. Case Report: 30 years old woman in her second pregnancy with one first trimester miscarriage, conceived after Ovulation induction for primary subfertility secondary to PCOD. Her viability ultrasound scan confirmed six foetuses with six placentas and sacs. Both parents counselled on possible complications and offered multifetal reduction therapy (MFTR).As facility for MFRT not available in the country patient was planned to send to Singapore. However, due to covid travel restriction, MFRT could not be done. She had a dating USS at 12 weeks which confirmed six viable foetuses and short cervix. She underwent cervical cerclage at12 weeks and was started on high dose progesterone (IM progesterone 500 mg twice weekly and Oral progesterone10 mg bd) throughout pregnancy to prevent pre-term labour. High dose calcium given to prevent pre-eclampsia. Detailed anomaly USS done by fetal medicine specialist and excluded any anomalies. She was diagnosed with Gestational Hypertension at28weeks and managed with Nifedipine 20 mg bd, Methyldopa 250 mg tds. Regular blood pressure monitoring carried out and needed to adjust methyldopa up to 750 mg tds. Serial two weekly ultrasound scan done to ensure fetal growth and wellbeing. Antenatal corticosteroids provided at 28 weeks and thromboprophylaxis provided from 28 weeks. MDT team has planned to deliver by 32 weeks. However, she ended up with caesarean section at 31 weeks due to worsening symptoms of overdistension. Multidisciplinary team involved in delivery include Obstetrician, two neonatologist and six separate midwives. The birth weights varied from 800 to 1600 g. Apgar scores were greater than 9 at five min. Respiratory support varied from intermittent positive pressure ventilation to oxygen via head box. Mother and babies discharged on day 26. All the babies were followed up and did well up to six months.

Discussion

Higher order pregnancy carries increased risk such as pre-term labour, Pre-eclampsia, Gestational Diabetes mellitus, Fetal growth restriction, Postpartum haemorrhage and prematurity and its complications. In our patient additional measures taken to monitor and prevent these complications, which lead to good maternal and neonatal outcome.

Conclusion

Higher order pregnancies carry tremendous strain on limited health services and social and economic resources of the country, in addition to great stress to the concerned family. Therefore, every effort should be taken to prevent higher order pregnancies. eP-112 Health economic assessment of twin pregnancies complicated by selective fetal growth restriction O. Yaghi1,2; J. Agwuna3; S. Prasad2; H. Boorman1; D. Mohammed2; A. Haeley3; A. Khalil1,2,4 1St George's University of London, London, UK, 2St George's University Hospitals NHS Foundation, Fetal Medicine Unit, London, UK, 3King's College London, London, UK, 4Liverpool Women's Hospital, Liverpool, UK

Objective

To estimate the costs associated with various management approaches of selective fetal growth restriction in twins. Methodology: Data from a single tertiary unit in the UK between 2000 and 2024 were analysed, excluding cases with major structural anomalies or other monochorionic twin complications detected before the diagnosis of sFGR. We assessed hospital resource utilisation costs for expectant management versus intervention, considering the timing and staging of diagnosis. The analysis, from the perspective of an NHS hospital provider, included ultrasound scans, fetal interventions, delivery methods, and neonatal care costs. Ordinary least squares regression was utilised for cost comparison, with model interactions identifying differences between management approaches at different diagnostic stages and timings. Statistically significant findings were based on 95% confidence intervals.

Results

For all monochorionic pregnancies, the mean cost of ultrasound scans and delivery were lower for fetal intervention versus expectant management, though differences were statistically insignificant for the former category of cost: −£1152 (−£3314 to £1010) and −£806 (−£1198 to −£413), respectively. The mean cost of neonatal care was higher for the smaller twin, though these differences were not statistically significant: £4897 (−£10 496 to £20 291) and −£2756 (−£15 049 to £9538). The mean total cost was higher for the intervention group, though statistically insignificant: £1445 (−£27 687 to £24 797). Cost comparisons across all monochorionic pregnancies masked differences between expectant and intervention within sub-groups. For type 3 sFGR, mean total costs were significantly higher for intervention compared to expectant: £181 437 (£86 019 to £276 856). This difference was largely driven by higher costs of neonatal care. The mean cost of ultrasound scans was significantly higher for monochorionic compared to dichorionic pregnancies: £3286 (£1593 to £4978). While the mean cost of neonatal care provided to small twins was lower for monochorionic twins: −£9267 (−£23 666 to £5132 – not statistically significant), it was higher for the larger twin compared to dichorionic pregnancies: £4962 (−£4216 to £14 140 – statistically insignificant). Overall total cost was higher for monochorionic versus dichorionic pregnancies: £4260 (−£17 061 to £26 301 – statistically insignificant).

Conclusion

Monochorionic twins undergoing intervention showed cost advantages in ultrasound scans and delivery, especially in late-stage diagnoses. However, neonatal care costs varied, resulting in overall higher total costs for pregnancies receiving prenatal interventions. When comparing monochorionic to dichorionic pregnancies, monochorionic pregnancies incurred significantly higher ultrasound costs, but the differences in overall total costs did not exhibit statistical significance. eP-113 Can the sFlt1/PlGF ratio be used to predict fetal growth restriction? S. Touloumi; K. Barrett; S. Chiu; N. Djedovic; R. Hamid; H. Samarage Northwick Park Hospital, London North West University Healthcare NHS Trust, Obstetrics & Gynaecology, London, UK

Objective

Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are angiogenic-related biomarkers of placental dysfunction and have been demonstrated to predict adverse maternal and perinatal outcomes in pre-eclampsia. The aim of this study was to assess the correlation between high levels of sFlt-1/PlGF ratio and risk of developing fetal growth restriction. Design: A retrospective observational study.

Method

Retrospective analysis of pregnancies (n = 211) that were triaged for pre-eclampsia with sFlt-1/PlGF ratio between April 2021 and March 2022 at Northwick Park hospital, London. The maternity notes were reviewed and data were analysed using statistical software JASP and SPSS. The birthweight centile was calculated using the Fetal Medicine Foundation's birth weight assessment tool.

Results

Two hundred and eleven (211) patients were triaged using the sFlt-1/PlGF ratio. The sFlt-1/PlGF ratio was categorised in 3 groups as per the NICE diagnostics guidance (GD49): ≤ 38 in 167 patients, 39–85 in 12 and > 85 in 32. Gestational age at delivery was significantly earlier when sFlt-1/PlGF ratio was > 85, compared to the other cohorts, with a mean difference of 5 weeks. This correlated with statistically significant lower birthweight at delivery. There were significantly more babies born below the 10th centile when sFlt-1/PlGF ratio was > 85. The differences were even more pronounced for the high risk group with sFlt-1/PLGR > 110.

Conclusions

sFlt-1/PlGF values are predictive of small for gestational age fetus, likely on a background of placental insufficiency. Further research is needed in order to define specific cut-offs for fetal growth restriction and determine the clinical utility of this biochemical marker. eP-114 20 week uterine artery Doppler association with pregnancy outcomes at different gestations A. Rondoni1,2,3; M. Garbagnati1; S. Dockree1; M. Shea1; C. Aye1,2; L. Impey1,2 1Oxford University Hospitals NHS Trust, Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK, 2Nuffield Department of Women's and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK, 3Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy

Objectives

To determine the association of raised uterine arteries pulsatility index (UtAPI) at the anomaly scan with severe pregnancy outcomes at different gestational age bands. Design: A retrospective cohort of singleton, non-anomalous pregnancies, undergoing universal uterine artery Doppler velocimetry at the anomaly scan. For different gestational age bands (23–27 + 6 weeks, 28–31 + 6 weeks, 32–36 + 6 weeks, ≥37 weeks) we calculated the OR of UtAPI ≥ 90th centile with stillbirth, extended perinatal mortality and severe small for gestational age (BW < 3rd centile). For pregnancies ≥37 weeks we calculated the OR of a composite adverse outcome (CAO, defined as at least one of: umbilical artery pH < 7.10, 5-min Apgar score < 7 and admission to neonatal unit). Between groups comparison was performed using Mann-Whitney U test for continuous variables and Pearson's chi square Test for categorical variables. Odds Ratios (OR) and 95% confidence intervals (95% CI) were calculated.

Results

33364 pregnancies were included. UtAPI ≥ 90th centile was present in 3392 (10.1%). Stillbirths numbered 109 (0.3%); 21 occurred in pregnancies with UtAPI ≥ 90th centile (OR 2.1 (95% CI 1.13–3.4)). The OR was highest at gestational age <28 weeks (OR 4.8 (95% CI 1.78–13.06)) and lowest after 37 weeks (OR 0.98 (95% CI 0.39–2.46)). Perinatal mortality occurred in 147 pregnancies (0.4%); 29 occurred in the raised UtAPI group (OR 2.1 (CI 95% 1.45 – 3.28)). The OR for this outcome was also highest (4.64 (CI 95% 2.24 – 9.63)) at < 28 weeks and decreased to OR 0.7 (CI 95% 0.27 – 1.66)) at term. Severe SGA at birth occurred in 422 cases (1.3%); 103 occurred in women with UtAPI ≥ 90th centile (OR 2.92 (2.33 – 3.66)). At < 28 weeks all 8 cases of FGR occurred in the UtAPI ≥ 90th centile group (OR not calculated); the OR (80.4 CI 95% 10.1–634) at 28–31 + 6 weeks reduced with gestation but remained significant (OR 1.84 (CI 95% 1.36–2.47)) at term. The CAO incidence in pregnancies reaching 37 weeks occurred in 1784 (5%) cases, of which 200 were in women with UtAPI ≥ 90th centile (OR 1.2 (CI 95% 1.04 – 1.4)).

Conclusions

Raised UtAPI ≥90th centile at the anomaly scan confers an increased risk of adverse outcomes that diminishes with advancing gestation. By term there is no increase in mortality despite a near doubling of the risk of severe SGA and an increase in a CAO. Current intervention protocols are insufficient, at least before term, to eliminate the risk associated with raised UtAPI. eP-142 Are infertile women more prone to HPV carcinogenesis: A comparative study P. Naik; S. Singh VMMC and Safdarjung Hospital, Obstetrics and Gynecology, New Delhi, India

Objective

To determine the proportion of infertile women having abnormal cervical cytology and to compare the frequency of abnormal cervical cytology in infertile and fertile women. Design and Method: It's a prospective cross-sectional study conducted in the Department of Obstetrics & Gynaecology VMMC & SJH. A total of 610 women, fertile women 305 and infertile women 305 were screened with paps smear at their visit to OPD.

Results

Majority of the screened women were in the age group of 26–30 years in both the groups. We found that higher parity significantly increases the risk of abnormal cervical cytology (p < 0.001). Women with multiple sexual partners in both the groups were not found to have abnormal cervical cytology (p value = 0.384). Increased frequency of sexual activity per week was associated with more inflammatory smears i.e., bacterial vaginosis (40%, 7%), candida (22.9% and 2.5%), inflammatory (62%, 7.4%) in infertile and fertile group respectively, but it did not increase the incidence of premalignant cervical lesions in both the groups. In infertile women 0.7% had ASCUS and 0% HSIL while in fertile women 1.3% had ASCUS and 0.3% had HSIL. Nonspecific inflammation was observed to be 2.9% in infertile group and in 30.8% fertile group. Various infections were found on cytology i.e HSV (0%, 0.3%) Gardnerella (3.0%, 6.9%), candida (2.0%, 3.0%) and granulomatous changes (0%, 0.3%) in infertile and fertile group respectively. Similar patterns of cervical cytology were observed in primary and secondary infertile women. (p value = 0.605). No correlation was found between age of menarche, age of sexual intercourse, anal intercourse, usage and type of contraception with abnormal cervical cytology.

Conclusion

NILM was observed more in infertile women while infections and inflammatory smears were found to be more in fertile group.(p 0.005). Age of menarche, age of marriage, age of first sexual intercourse had no correlation with abnormal cervical cytology in both fertile and infertile groups. We found that higher parity significantly increases the risk of abnormal cervical cytology (p < 0.001). Sexual practice like having multiple sexual partners, anal intercourse, perineal wash before and after intercourse had no impact on pap smear findings. In our study only 1.6% of unsatisfactory smears due to low cellularity even by conventional pap. eP-143 The relationship between HRT administration form and VTE risk: A review I. Ahmed; S. Cherukad; S. Thillainadarajah; Y. Dinesh; M.F. Saiyed University of Birmingham, Medical School, Birmingham, UK

Objective

Menopause is the biological state at which menstruation permanently ceases due to loss of ovarian follicular activity. National guidelines recommend several treatments for menopausal symptoms, a major treatment being hormone replacement therapy (HRT). There are several adverse effects associated with HRT, with it being documented that their occurrence varies between administration forms. One such adverse effect is increased risk of venous thromboembolism (VTE). The aim of this review is to explore if clinical evidence suggests that oral preparations of HRT should be replaced with transdermal preparations as the first-line recommendation for management of menopausal symptoms based on relative risk of VTE occurrence. Design: A systematic review with meta-analysis was conducted to conclude whether transdermal administrations of HRT should become first line management in UK guidelines for menopausal symptoms based on their relative VTE risk.

Methods

The NICE Evidence Search, Medline, Embase, and Cochrane were searched from inception to 2022 identifying guidelines, systematic reviews and primary research articles. Two guidelines, six systematic reviews and three primary studies were retrieved and appraised.

Results

Reviews of current guidelines showed that administration form of HRT is largely determined by patients’ personal choice, and transdermal HRT use is only officially considered for those already at increased risk of VTE. Four of the six systematic reviews and two of the three primary studies suggest a significant decrease in VTE risk when using transdermal HRT compared to oral. Some studies included in these systematic reviews suggest the increased risk of VTE in those taking transdermal HRT is negligible compared to the general population.

Conclusion

Current evidence suggests that there is a decreased risk of VTE in menopausal women taking transdermal over oral HRT, regardless of their health status. However, further research into other associated factors – such as further adverse effects and drug conjugation – is required to determine whether UK guidelines should be updated to recommend transdermal HRT as first-line treatment for all menopausal women. eP-144 MARIE-Nigeria (WP2a): A mixed-methods study exploring menopause (interim analysis) G.U. Eleje1; P. Briggs2; G. Delanerolle3; S. Wu4; Y. Weng4; J. Taylor5; H. Cavalini6; O. Kurmi7; K. Riach8; S. Hinchliff9; C. Atkinson10; K. Potocnik11; V. Talaulikar12; L. Saraswat8; J.Q. Shi4; A. Shetty13; S. Elneil13; I. Muhammad14; R. Kareem14; N. Rathnayake15; V. Pathiraja15; J.V. Vlymen3; T. Mudalige15; Y. Bouchareb16; T.T. Hock17; C. Laguna18; K. Elliot3; N. Mintah-Afful3; I. Aggarwal19; J. Manonai20; H.F. Kemp21; S Mamatha22; I. Litchfield5; P. Phiri3; L.I. Eleje23; I.C. Umeoranefo24; S.O. Oriji25; I.I. Mbachu26; C.O. Ndukwe27; O.Z. Ikpeze24; E.C. Egwuatu24; A.A. Onwuegbuna28; N.P. Obiegbu24; O.K. Nnabuchi24; I.S. Nweje29; D.E. Malachy1; C.G. Okafor24 1Nnamdi Azikiwe University Awka, Obstetrics and Gynecology, Nnewi, Nigeria, 2Liverpool Women's Hospital Foundation NHS Trust, Liverpool, UK, 3Research and Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK, 4Department of Data Science and Statistics, Southern University of Science and Technology, Shenzhen, China, 5University of Birmingham, Birmingham, UK, 6Research and Innovation Department, Southern Health NHS Foundation Trust, Oxfordshire, UK, 7University of Coventry, Coventry, UK, 8University of Aberdeen, Aberdeen, UK, 9University of Sheffield, Sheffield, UK, 10Manchester Metropolitan University, Manchester, UK, 11University of Edinburgh, Scotland, UK, 12University of Southampton, Psychology, Southampton, UK, 13University College London Hospitals NHS Foundation Trust, London, UK, 14Peshawar Medical College, Peshawar, Pakistan, 15University of Ruhuna, Ruhuna, Sri Lanka, 16Sultan Qaboos University, Muscat, Oman, 17Sibu Hospital, Sarawak, Malaysia, 18University of Campinas, Unicamp, Brazil, 19KK Women's and Children Hospital, Singapore, Singapore, 20Mahidol University, Mahidol, Thailand, 21Trauma Healing Together, Scotland, UK, 22JSS Medical College, Mysore, India, 23Nnamdi Azikiwe University Awka, Measurement and Evaluation Unit, Educational Foundations, Awka, Nigeria, 24Nnamdi Azikiwe University Teaching Hospital, Obstetrics and gynecology, Nnewi, Nigeria, 25Nnamdi Azikiwe University Awka, Mental Health, Nnewi, Nigeria, 26Nnamdi Azikiwe University Awka, Obstetrics and gynecology, Nnewi, Nigeria, 27Nnamdi Azikiwe University Awka, Anatomic Pathology and Forensic Medicine, Nnewi, Nigeria, 28Nnamdi Azikiwe University Awka, Ophthalmology, Nnewi, Nigeria, 29Nnamdi Azikiwe University Teaching Hospital, Nursing Services, Nnewi, Nigeria

Objective

To assess the mental health implications among perimenopausal, menopausal, or post-menopausal women that are undergoing natural, surgical, or medical menopause. Design: A mixed-methods study was designed and conducted in Nigeria following Ethics committee approval.

Methods

This interim analysis encompasses 40 participants, including all women aged 18–90 living in Nigeria who provided informed consent. Participant recruitment was conducted through clinics associated with the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. The Qualtrics XM platform was used for data collection, with the interim analysis focusing on results from the Hospital Anxiety and Depression Scale (HADS) and the Greene Climacteric Scale (GCS). Descriptive statistics were employed to analyse the categorical data.

Results

The median age for all participants and their initial menopausal symptoms was 49. The sample consisted of married and single women, accounting for 92.6% and 5.13%, respectively. Participants were from Abia (5%), Anambra (77.5%), Delta (2.5%), Enugu (12.5%), and Ogun (2.5%). Of the sample, 89.74% were employed and 7.69% retired. Most participants were perimenopausal (56.41%) and post-menopausal (25.64%), while 17.95% were in another stage. The mean and standard deviation (SD) for HADS scores on Day 0 were 7.90 and 6.20, respectively. The mean anxiety and depression scores were 4.05 and 3.85. The proportion of “Normal” was 85% at baseline, the proportion of “Borderline abnormal” was 10%, and the proportion of “Abnormal” was 5%. The mean and standard deviation values for the Greene Climacteric Scale (GCS) on Day 0 were 7.5 and 8.51, respectively. The mean and SD values for somatic and vasomotor symptoms on Day 0 were 1.875, 4.90, 0.6, and 1.34, respectively. The mean and SD scores for psychological symptoms were 4.15 and 4.90, respectively. Mean and standard deviation scores for clinical anxiety and depression based on GCS were 2.70, 2.97, 1.45, and 2.18, respectively.

Conclusion

The interim evidence suggests that individuals experiencing menopause undergo a negative impact on their mental health, primarily correlated with their physical symptoms. eP-145 Postive pregnancy test in a post-menopausal female on hormone replacement therapy A. Helbig; H. Brown; S. Al-Juboori The Queen Elizabeth Hospital Kings Lynn, Obstetrics and Gynaecology, Kings Lynn, UK

Objective

This case report presents an unexpected finding of repeated positive urine-pregnancy-tests (UPTs) and elevated serum beta-human chorionic gonadotropin (−hCG) levels in an otherwise asymptomatic post-menopausal woman on continuous combined hormone replacement therapy (ccHRT). This case poses a diagnostic challenge to clinicians and highlights the importance of considering other sources of b-hCG elevations in the absence of pregnancy and malignancy. Case Report: A 48-year-old post-menopausal woman, on ccHRT for 7 years, not sexually active for 3 months, undergoing preoperative assessment for orthopaedic surgery had repeated positive UPTs. Following the positive UPTs, her elective procedure was postponed to exclude malignancy considering her post-menopausal status and age. On further investigation, gynaecological pelvis ultrasound was normal, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were within expected postmenopausal ranges but serial serum b-hCG levels were elevated at 14.0 IU/L and HCG at 14.4 IU/L, despite having no gynaecological or systemic signs or symptoms. She had a complex gynaecological history, with four failed pregnancies while on fertility treatment, a successful in vitro fertilisation (IVF) pregnancy, and a premature ovarian insufficiency at the age of 40.

Discussion

Elevated b-hCG levels have been detected in 0.2–10.6% of perimenopausal and postmenopausal women who are neither pregnant nor have malignancy. In this case, a multidisciplinary advice was sought from a Tertiary Centre which highlighted the relationship between raised b-hCG and inadequate HRT; as insufficient therapy can lead to hypothalamic-pituitary axis dysregulation and increased FSH, LH and pituitary hCG release. As the blood showed a raised LH, FSH, and oestradiol in the context of receiving therapy and excluding malignancy, it can be inferred that her HRT has not been optimised. This case highlights the importance of ongoing monitoring for patients receiving HRT for dose optimisation and symptomatic control. Additionally, Cole et al. described 28 cases of elevated b-hCG in which unnecessary treatments were administered, including chemotherapy, surgeries and/ or other treatments. This emphasises the importance of clinicians carefully considering the differentials and exploring underlying causes to guide appropriate management and further evaluation.

Conclusion

This case supports current literature that physiological pituitary b-hCG elevation in perimenopausal, and postmenopausal women is still a largely unrecognised phenomenon and confusion can delay medical therapy or lead to unnecessary treatments. Future practice must consider appropriate and cost-effective evaluation of positive b-hCG levels to improve HRT dosing, avoid unnecessary treatments and testing, plus reduce cancellations or delays to surgeries. eP-146 Minimally invasive approach of tubo-ovarian abscesses: Transvaginal US-guided drainage versus laparoscopic drainage I. Hamra; H. Sebri; T. Necib; A. Belhadj; A. Triki; A. Ben Amor; A. Halouani Department of Gynecology and Obstetrics, University Hopsital Mongi Slim La Marsa, La Marsa, Tunisia

Objective

Tubo-ovarian abscesses (TOAs) pose significant medical, social, and economic challenges, making them a notable public health concern. Treatment typically involves antibiotics, with surgical management reserved for cases of visible abscess, poor clinical tolerance, or resistance to medical treatment. Minimally invasive techniques, such as laparoscopy and ultrasound-guided transvaginal drainage, are established methods for managing TOAs. Our study aimed to assess the feasibility, efficacy, and safety of ultrasound-guided transvaginal drainage compared to laparoscopic drainage. Design: This is a retrospective, monocentric and comparative study.

Methods

This study included 27 patients admitted for TOA over a four-year period from January 2018 to December 2022. We compared two approaches: ultrasound-guided transvaginal drainage (n = 17) and laparoscopic drainage (n = 10). The primary evaluation criterion was the cure rate assessed by a composite score encompassing clinical improvement (pain and temperature) and biological improvement (regression of biological inflammatory syndrome).

Results

The patients had a mean age of 39.7 years. On ultrasound, the mean abscess size was 6.25 cm. Pathogens were isolated in cultures from 75% of cases, with chlamydia being the most prevalent. All patients were hospitalized and received intravenous antibiotics. In the ultrasound-guided transvaginal drainage group, only one-third of the patients received general anesthesia. By the third day, the patients reported minimal pain with a mean visual analog scale (VAS) score of 0, and the mean C-reactive protein (CRP) level was 30 mg/L. The operation duration averaged 20 min, and patients stayed in the hospital for an average of 3 days. No intraoperative complications were reported. In the laparoscopic drainage group, all patients received general anesthesia. On average, by the third day, they reported mild pain (mean VAS of 1) and the mean CRP level was 80 mg/L. The mean duration of the operation was 45 min, with an average hospital stay of 4 days. No complications were noted. In summary, although both groups exhibited similar outcomes in terms of pain and fever after three days, the transvaginal drainage group required less general anesthesia and analgesics and had shorter hospital stays, making it a potentially favorable choice for treatment.

Conclusion

Ultrasound-guided transvaginal drainage is as effective as laparoscopy in treating TOAs when combined with IV antibiotic therapy. Additionally, transvaginal drainage offers the advantage of reduced operating time and analgesic consumption during hospitalization. eP-147 Comparative efficacy of GnRH agonist and aromatase inhibitor in management of adenomyosis S. Jain1,1; D. Ghosh2; J. Bardhan3 1Medical College & Hospital, Kolkata, Obstetrics & Gynaecology, Kolkata, India, 2R.G. Kar Medical College & Hospital, Obstetrics & Gynaecology, Kolkata, India, 3R.G. Kar Medical College & Hospital, Radiology, Kolkata, India Aims and Objectives: Adenomyosis of the uterus is a common condition affecting about 1% of the women. Nowadays the diagnosis of adenomyosis is being made more frequently due to improved imaging of the pelvic organs. Since surgical management of adenomyosis is the preferred mode of management, there is lack of information about the medical management of adenomyosis in premenopausal women. We performed this study to compare the efficacy of aromatase inhibitors over GnRH agonists in the management of symptomatic uterine adenomyosis. Design: In this prospective observational study, 64 women with symptomatic uterine adenomyosis undergoing medical management were observed. Group A consisted of 32 women who received T. Letrozole (2.5 mg) per day for 3 months and Group B consisted of 32 women who received Inj. Leuprolide (3.75 mg depot) IM/SC on day 0, at 4 weeks and 8 weeks. All participants were observed for a period of three months and uterine volume reduction was measured by TVS at day 0, at 4 weeks, at 8 weeks and 12 weeks and efficacy of both the drugs were compared.

Method

Sample size was calculated based on the result of the study of Badawy et al. showing a post-treatment difference of total uterine volume in the two treatment groups (137 ± 29.8 versus 116.4 ± 28.9, p = 0.06) at 12 weeks in aromatase inhibitor group and GnRH agonist group respectively. Taking this result as guidance data, power of the study as 80% and level of significance as 5%, 32 patients were assigned in each group. The results were analyzed as per intention-to-treat basis. Chi-square Test was used for categorical data. Two-tailed unpaired student t-test was used for analysis of continuous data. p ≤ 0.05 was considered to be statistically significant. Appropriate tables and graphs were used for data representation.

Results

The result of this study showed that there was a 45.99% reduction in uterine volume at the end of 12 weeks in Group A whereas there was a 50.21% reduction in uterine volume at the end of 12 weeks in Group B respectively.(p = 0.0724)

Discussion

& Conclusion: There was no statistically significant difference in uterine volume reduction, adenomyoma volume reduction and symptomatic improvement in both the groups at the end of 12 weeks. There was a statistically significant difference in the development of side-effects. Patients receiving GnRH analogues showed a greater development of side-effects. Hence, Letrozole may be a better option for medical management of adenomyosis as compared to GnRH analogues. eP-148 Anemia secondary to abnormal uterine bleeding requiring blood transfusion in reproductive women S. Jesrani1; A. Santosh2; J.J. Al-Mahrooqi1; T. Al-Badi1; M. Al- Shukri1; G. Vaidyanathan1 1Sultan Qaboos University Hospital, Obstetrics and Genecology, Muscat, Oman, 2Hinchingbrooke Hospital, Obstetrics and Genecology, Cambridge Shire, UK

Objective

The main aim is to find the treatable causes of abnormal uterine bleeding in patients who needed blood transfusion and injectable iron in the reproductive age group and to provide appropriate treatment of those underlying pathologies. Design: A retrospective study in a tertiary care hospital.

Methods

This was a retrospective descriptive cohort study of all women with anemia from uterine bleeding, admitted to the gynecology department of Sultan Qaboos University Hospital, Muscat, Sultanate of Oman, over a period of 10 years from Jan 2013 to Dec 2022. All females from menarche till menopause, with significant uterine bleeding with or without hemodynamic instability, who required blood transfusion were included in this study. Women with pregnancy, nutritional deficiency anemia, bleeding disorders, and with known gynecological malignancies were excluded from study. The data was collected from the hospital electronic patient record database. The different causes of abnormal uterine bleeding according to PALM COEIN, FIGO classification was studied. In women who underwent surgical management the different histopathological diagnosis was studied.

Results

During the study period 266 women needed blood transfusion for abnormal uterine bleeding mean age 37.66 ± 11.4 years, mean parity 3 ± 3, mean BMI: 29.4 ± 8.9, most of them have regular cycles. About 35% of women have continuous bleeding, in about 41% uterus was enlarged and about 50% have fibroid and adenomyosis on US imaging, mean hemoglobin at 5.7 ± 1.14 grams/dl, mean ferritin 11.01 ± 21.88 ug/L, mean number of blood transfusion was 2.83 ± 1.2 at first presentation and about 24% needed further transfusions. 70% of them preferred oral hormonal treatment. Polyp is 9%, Leiomyoma 13%, adenomyosis 3%, malignancies 4.5%, Coagulopathy 3.5%, Ovulatory 66%, endometrial less than 1%. Surgical management was done in about 35% of patients.

Conclusion

The main cause of abnormal uterine bleeding appears to be related to ovulation the morbidity of blood transfusion is possibly avoidable in these women. Iatrogenic causes of bleeding were difficult to estimate from study.

Reference

S Boone, et al. management of Iron deficiency anemia caused by uterine blood loss, retrospective cohort study country Hospital Huston and Texas (10-2018-03-2019). jemermed.2020; 1–9. eP-149 Factors informing hysterectomy following endometrial ablation: Our experience in North-East England P.S.R. Gurusamy; H. Awad; A.R. Nabeel; D. Basu North Tees and Hartlepool NHS Foundation Trust, Obstetrics and Gynaecology, Stockton-on-Tees, UK

Objective

Benefits of endometrial ablation (EA) when compared to hysterectomy to treat heavy menstrual bleeding are multi-fold including being less invasive, lower rates of severe complications, improved healthcare costs, shorter hospitalisation, faster recovery and return to ADLs. This study aims to identify associated factors and performance indicators of all EA performed in this trust, evaluate the EA that resulted in hysterectomies, set baseline standards for future studies, and assess compliance with NICE TA78 and NG88. Design: Observational (retrospective) design used to investigate impact of the exposure (EA), minimising resources required for the study.

Method

All EA performed over 36 months (n = 216, Jan 2017 to Dec 2019) were included with minimum 48 months (maximum 84 months) follow-up. Paper medical notes, NHtop, TrakCare, MediViewer to extract data that was analysed using Microsoft Excel. Procedure success rates, recovery time, complication rate, long-term efficacy and rates of repeat procedures were assessed directly and quality of life Improvement, patient satisfaction, procedure duration, adverse events reporting and cost-effectiveness were indirectly assessed. Factors associated with likelihood of failure of EA were comparatively analysed.

Results

Post active establishment of service, nearly 100 EA were completed each year. Total of 216 patients underwent EA (all as inpatient) during the study period with an average age of 44.1, BMI of 30, parity of 2.5. 90 of them were affected by fibroids and 7 by adenomyosis. The overall failure rate was observed at 18% (n = 39), majority (85%) due to symptoms of irregular bleeding, heavy menstrual bleeding and chronic pelvic pain, and remainder due to complications (post ablation syndrome, 15%). Diagnosis of all-cause failure of EA peaked at 24 to 35 months post procedure. Majority of patients with failed EA opted for hysterectomy (22 of 39), followed by conservative (11) and medical (Prostap, 6) managements. Upon further breakdown, patients with pain (chronic pelvic pain and post ablation syndrome) were more likely to opt for hysterectomy. Although EA were more likely to fail in patients with fibroids and adenomyosis, 76% and 43% of patients with fibroids and adenomyosis, respectively, achieved successful remission of symptoms.

Conclusions

EA results in significantly reduced need for hysterectomy, with associated benefits. This study supports EA in patients with fibroids and adenomyosis and guides counselling of patients, given TA 88 highlights this as an unclear area requiring further research. This study also provides guidance on indictive timing of failure of EA, possibly guiding patient selection and counselling. eP-150 Assessing outcomes of women with PMB on HRT under suspected cancer pathway F. Naqvi; M. Ali; V. Panwar Royal Surrey County Hospital, Obstetrics and Gynaecology, Surrey, UK 9% of women who present with postmenopausal bleeding (PMB) are diagnosed with endometrial cancer(1). In the UK currently women with PMB irrespective of HRT use are seen under the urgent suspected cancer pathway (USCP) to exclude endometrial carcinoma, despite evidence suggesting this patient cohort is at a lower risk of developing malignancy compared to women who are not on HRT. This results in increasing demands on an already burdened USCP system.

Objectives

1. To assess compliance with the local PMB guideline. 2. To assess the diagnostic outcomes of women with PMB on HRT. 3. To evaluate the effect of investigating PMB on HRT on the performance of USCP. Study Design: Retrospective review.

Method

Electronic patient records were reviewed for 100 patients seen with PMB on USCP. Data collected included patient demographics, menopausal status, HRT use, risk factors for endometrial cancer, endometrial thickness on transvaginal ultrasound, hysteroscopy and endometrial biopsy. Women with bleeding on HRT were included and an endometrial thickness of ≥5 mm was the cut off for further investigations. An excel spreadsheet was used to collect and analyse data.

Results

48 patients were included (52 excluded due to not being on HRT). 47 patients were postmenopausal; 1 perimenopausal. 100% were on continuous combined HRT. Age range: 53–97, BMI range: 21–39. Medical conditions were poorly recorded. 8/48 women had an ET <5 mm and therefore discharged. 10/40 women had a pipelle biopsy only (0% fail rate) 30/40 women had an OP hysteroscopy and biopsy (27% fail rate (5 patients)). 5 patients went on to a have a further hysteroscopy under general anaesthesia. 34/40 women had a benign result. 1 patient had benign papillary hyperplasia and will be monitored with a repeat TVUS in 3 months time. No endometrial carcinoma was identified. 4 patients failed hysteroscopy due to stenosed cervix and declined further treatment and 1 patient had their care transferred mid-investigations.

Conclusion

Although, a small study, it suggests the risk of endometrial cancer in the presence of bleeding on HRT is lower when compared to those who are not on HRT – this is in keeping with the published literature. There was 100% adherence to the local PMB guideline for further investigations. Improving patient and GP education about HRT use could improve the quality of referrals and an alternative referral pathway for unscheduled bleeding on HRT could significantly reduce the strain on the USCP and improve performance. (1) National Cancer Institute. Available at: https://www.cancer.gov/news-events/cancer-currents-blog/2018/endometrial-cancer-bleeding-common-symptom#:~:text=Approximately%209%25%20of%20postmenopausal%20women,a%20diagnosis%20of%20endometrial%20cancer (Accessed:14/4/2024). eP-151 The definitive management of persistent retained products of conception G. Vorona; N. Sharmin; C. Brett-Miller; R. Flemming Whittington Health, Gynaecology, London, UK

Objectives

and Background: Retained products of conception (RPOC) pose a significant risk in 1%–6% of pregnancies, causing complications such as bleeding, infection, intrauterine adhesions, and subfertility, if left untreated. The absence of comprehensive, evidence-based guidelines for managing persistent retained products underscores the need for addressing this clinical challenge. At Whittington Hospital, the utilisation of the TruClear™ Hysteroscopic Tissue Removal system has been proposed in the management of persistent products of conception where we aim for complete resection of RPOC. Design: This quality improvement project (QIP) utilised electronic data collected from the Obstetric Risk Management Information System (ORMIS), Electronic Patient Records (EPR), and the Integrated Clinical Environment (ICE) system retrospectively.

Methods

The data collected patients who underwent treatment for persistent (RPOC) between January 2022 and April 2024. A total of 21 patients included, with RPOC following miscarriage management or having placental remnants after cesarean section or vaginal delivery.

Results

Our QIP revealed that the management of (RPOC) using the Truclear yielded positive outcomes, as supported by histopathology findings. Among the 21 patients analysed, the age varied from 28 to 44 years. The gestational ages ranged from 5 to 14 weeks. Notably, outpatient hysteroscopy was performed in 11 cases, while ten patients underwent the procedure under the general anaesthesia. The initial step for RPOC management varied, with 26.5% of cases undergoing medical management, 31% opting for surgical interventions, 14.5% following expectant management of miscarriage and 28% retained placental tissue after term delivery. Transvaginal sonography (TVS) with or without colour Doppler proved valuable in diagnosing RPOC, with 90% of cases showing hyperechoic vascular lesions. Furthermore, our findings demonstrated in 90% cases complete resection achieved by truclear. And 80% concordance rate found between hysteroscopic findings and histopathology reports, underscoring the diagnostic accuracy and therapeutic efficacy of utilising the TruClear™ system for management of RPOC. These results emphasise the importance of proper diagnostic modalities and targeted interventions in the successful resolution of RPOC, ultimately improving patient outcomes and care.

Conclusion

Compared to conventional blind evacuation procedures, tissue removal devices optimise the operating time, reducing risks of the operating time, reducing risks of uterine perforation and facilitating complete excision. The main barriers to broad adoption include staff training and the skills required by surgeons.

Keywords

retained products of conception, placenta remnants, hysteroscopic tissue removal device. eP-152 A Comprehensive video on the KAPT Block technique for outpatient hysteroscopy M. Saleh; R. Laiyemo Kings Mill Hospital, Sutton on Ashfield, UK

Introduction

This video presentation demonstrates the technique of the King's Mill Anterior-Posterior and Transverse (KAPT) Block, an innovative local anaesthetic technique for outpatient hysteroscopy, essential for effective pain management. Initially presented as a top-scoring abstract at the RCOG congress in 2016. The video presentation offers a detailed visual guide to this technique including laparoscopic view when it's administered vaginally. Technique: The KAPT Block specifically targets the Lee-Frankenhauser (LF) plexus 1.65–3.3 cm distal to the cervical insertion of the Uterosacral Ligament Complex (USLC). It involves an initial 0.2 mL local anaesthetic injection at the cervix's 6 and 12 o'clock positions. This is followed by a strategic 4 mL anaesthetic application at 5 and 7 o'clock positions. This method aims to denervate the cervix and fundus effectively by temporarily transecting the LF plexus, thereby offering comprehensive pain control. Efficacy: Initial studies have demonstrated KAPT Block's efficacy in reducing pain during Myosure® and Novasure procedures, with notably low pain scores. Furthermore, an ongoing randomized control study is comparing the KAPT Block's effectiveness with traditional paracervical blocks, aiming to further validate its clinical utility. These studies highlight the KAPT Block's role in enhancing patient comfort and procedural success.

Conclusion

The KAPT Block technique marks a development in local anaesthesia for outpatient hysteroscopy. Its precise approach not only improves patient comfort but also facilitates the successful completion of procedures. This video demonstration aims to demonstrate the technique and its beneficial impact on outpatient hysteroscopy. eP-153 An audit of procedure related complications in out-patient hysteroscopy setting S. Al Najjar Portinucula University Hospital, Obstetrics & Gynecology, Ballinasloe, Ireland

Objective

To audit the rate of procedure-related complications in Out-patient Hysteroscopy Clinic (OHC) at University Hospital Kerry (UHK) in Ireland for almost 2 years (from January 2016 to December 2017).The Royal College of Obstetricians and Gynaecologists (RCOG) recommends that all gynecology units are equipped with a dedicated OHC. Standard: We compared our study against the standard set by RCOG Best Practice in Out-Patient Hysteroscopy Green- Top-Guideline No.59 and STRATOG e-learning-Complications of Diagnostic Hysteroscopy.

Methods

A retrospective audit was carried out on women attending OHC at UHK from January 2016 to December 2017. A total of 232 women attended OHC during the study period for the following indications: post-menopausal bleeding, Inter-menstrual bleeding, suspected endometrial polyp, and/or thickened endometrium. Eight patients were excluded from the study group as they attended OHC for other procedures such as insertion of Intrauterine device and Endometrial Biopsy without Hysteroscopy.

Results

and Discussion: Results were analyzed by the two researchers and reviewed by the supervising Consultant. The RCOG Best practice in Outpatient Hysteroscopy Green-top Guideline No.59 and STRATOG e learning-complications of Diagnostic Hysteroscopy was used to compare the service to best practice. Almost most of the aspects of the service met the standards for the best practice. - Failure to complete an adequate examination in 5.3% cases (12/224). - Inability to tolerate the procedure: 6/12. - Pre-existing excessive bleeding: 6/12. - Failed procedure-Cervical stenosis: 2.2% (5/224). - Pain: - Mild Pain: - Moderate Pain: - Severe pain:0.4% (1/224) - Vasovagal reaction: 3.5% (8/224) - Re-admission: 0.89% (2/224) - Uterine Trauma: 0% (0/224)

Conclusions

The complication rates were almost in line with RCOG Best practice green top guideline No. 59 and STRATOG e learning-Diagnostic Hysteroscopy. Our recommendation for areas of improvement include cervical preparation before outpatient hysteroscopy especially for women with previous HX LLETZ or cone biopsy and possible use of progesterone prior to the Hysterosocpy for women with persistent vaginal bleeding. Using topical application of local anesthetics to the ectocervix where application of a cervical tenaculum is necessary. A re audit will be completed following these changes. eP-154 Management of per-vaginal bleeding presenting to emergency department: Implementation of new pathway A. Ashir; R. Rafi; A. Al-Kufaishi Imperial College Healthcare NHS Trust, Obstetrics and Gynaecology, London, UK

Introduction

Abnormal per-vaginal bleeding (PVB) is often under-diagnosed and poorly managed in the community. Subsequently, patients present to the Emergency Department (ED), leading to increased pressure on acute care services, prolonged waiting times, financial implications for the healthcare system and patient, and negatively impacting the patient's quality of life. These effects are poorly appreciated. We audited non-pregnant patients presenting to the ED with PVB, and surveyed ED and on-call Gynaecology doctors. We assessed patient outcomes, ED confidence in assessment and management of cases and the impact on acute gynaecology service workload.

Methods

Data on non-pregnant patients presenting to ED with PVB between January – March 2023 was extracted from a centralised database (66 patients). Data was collected on ED patient work-up and treatment outcomes, and outcomes of patients referred to gynaecology. An anonymised online survey was distributed; 10 triage nurses, 10 ED junior doctors and 4 on-call Gynaecology junior doctors responded.

Results

Overall, 96% of patients were managed conservatively (23%) or medically (63%), and 4% surgically (Fig 1). 23% were referred to the gynaecology on-call team (Fig 2), of which 87% were managed conservatively/medically (Fig 3) and 47% were discharged home (Fig 4). 80% of triage nurses felt confident triaging these patients, with 30% of ED doctors reporting they were not confident in their assessment and management (Fig 5). 75% of Gynaecology junior doctors received at least 2 referrals of patients with PVB per shift. 95% of ED staff felt a Per-Vaginal Bleeding (PVB) pathway would be helpful (Fig 6). All respondents felt inappropriate referrals of PVB negatively impacted departmental workload.

Conclusion

Lack of confidence amongst ED doctors in management of these patients is likely due to lack of training. Teaching on Emergency Gynaecology presentations has been implemented and a PVB pathway/guideline created. This includes a tailored GP discharge letter to empower patients and ensure continuity of appropriate and timely patient centred care in the community. eP-155 Radio-histological correlation of ACR 4 breast lesions F.E. Tekaya; H. Sebri; I. Hamra; T. Ben Necib; S. Bayar; A. Triki; A. Kammoun Department of Gynecology and Obstetrics, University Hopsital Mongi Slim La Marsa, La Marsa, Tunisia

Objective

The Bi-Rads (Breast Imaging Reporting and Data System) classification from the ACR (American College of Radiology) is the system for grading radiological images, recommended for breast cancer screening. ACR4 lesion corresponds to an indeterminate or suspicious anomaly with a probability of malignancy ranging from 2 to 95% according to studies. ACR IV lesion requires a histological investigation. The objective of our study is to report the histological results of breast lesions classified radiologically as ACR4 in order to establish a radio-histological correlation, evaluate the findings in our department, and thereby improve our management approach. Design: This is a retrospective study conducted from January 2021 to December 2023 at the Gynaecology-Obstetrics Department of Mongi Slim's Hospital in Tunis, Tunisia.

Method

We’ve analysed the records of 30 patients, with ACR4 classified lesions, who were initially admitted for a variety of clinical Breast symptoms (lump, mastodynia, discharge) or as part of scheduled radiological monitoring. Age, personal medical history and family history, menopause, symptoms, clinical exam findings, mammography, ultrasonography and pathology results were evaluated. All our patients underwent radiological exploration with ultrasound associated or not with mammography and an anatomopathological evidence was taken using various techniques: ultrasound-guided micro-biopsy, or surgical biopsy with or without radiological marking.

Results

The mean age was 32.7 (22–54) years. The most common complaint was breast lump (54%). then Mastodynia (18%), nipple discharge (9%) and routine mammography screening (27%). 3 patients had a personal record of previous surgery for breast adenofibroma. The average size of the nodule is 3.4 cm (1–5.1 cm). In the majority of cases, one nodule was palpable (83%). For 4 patients, 2 homolateral nodules were found (13%), and for one patient, the lesion was not clinically palpable. Histopathological diagnosis was obtained either by micro-biopsy in 55% of cases or by tumorectomy in 45% of cases. The most frequent lesion is adenofibroma in 66% of cases, it was associated with dystrophic lesions in 16%. The other lesions were Grade I phyllode tumours in 3%, papilloma without atypia in 3%, and infiltrating ductal carcinoma in 3%. These results are consistent with the literature data.

Conclusion

The pathological analysis of radiological features allows for a good diagnostic approach; however, histopathological examination remains fundamental for determining the tumour's nature. The number of unnecessary surgical interventions remains quite significant. Subclassification according to ACR into ACR4a, b, and c seems to be an interesting option for tailored therapeutic management. eP-156 Vulvar leiomyoma in adolescent girl, diagnostic dilemma V. Pandit1; S. Shrivastava2 1Apollo Superspeciality Hospital, Obstetrics and Gynecology, Muscat, Oman, 2Apollo Superspeciality Hospital, Radiolgy, Muscat, Oman

Objective

Vulvar swelling in adolescent female is always a diagnostic dilemma. Vulvar leiomyoma is a rare soft tissue tumor with around 300 cases described in world literature. Reporting a rare case of large vulval tumor in adolescent female, highlighting the diagnostic and surgical challenges in management of the patient. Case Report: Our patient is a 16 years old sexually inactive unmarried female presented with swelling of right labium majus for few years. Patient denied pain or menstrual irregularities. On examination there was a large firm non-pedunculated mass about 8–10 cm, was non-tender and stretching labium minus. Differential diagnosis was Lipoma, large epidermal inclusion cyst, leiomyoma. Perineal ultrasound revealed a large neoplasm with increased vascularity, Suspected fibroma. MRI was suggestive of large lesion 8–10 cm with heterogenous contrast enhancement, smooth marginT1 hypointense, T2 intermediate signal intensity with multiple tiny cystic areas within lesion. No macroscopic connection to vagina seen. These features were consistent with Vulval leiomyoma. Patient underwent surgical excision of vulval tumor. Histopathology demonstrated solitary fibrous tumor possible smooth muscle leiomyoma to rule out superficial angiomyxoma. Immunohistochemistry (SMA, CD34, SATAT6, Caldesmon) confirmed the findings of leiomyoma.

Discussion

Wide local excision with adjacent normal tissue is essential to avoid recurrence. MRI intensity signal on T2 weighted scan can help to define nature of tumor Immuno-histochemistry reconfirms the nature of tumor and recurrence risk which helps to counsel patient and follow up plan.

Conclusion

Leiomyoma of vulva is extremely rare tumor in teenagers. It is often misdiagnosed. Timely diagnosis, early surgical excision without compromising virginity and correlation with Histopathology and Immuno-histochemistry to confirm the nature of tumor is important to assure patient and parents.

Reference

Sun C, Zou J, Wang Q, Han L, Batchu N, etal. J Int Med Res 2018:46(2):663–74. Ammouri S, ElKarkri C, Zeradi N, Lakhdar A, Baydada A. Pan Afr Med J 2019;32:1–5. eP-158 Endometrial biopsies: Adequacy and indications in Mayo University Hospital R. Abdalla; A. Trulea; A. Elowni Mayo University Hospital, Obstetrics and Gynaecology, Mayo, Ireland

Background

Endometrial biopsy is one of the toolsused to assess women with potential endometrial pathology. The incidence of insufficient tissue for histopathological diagnosis among these women is reported to be 6 to 33% of cases. Endometrial biopsies classified as inadequate or insufficient by the histopathologists can cause difficulties for gynaecologists in planning further management. Moreover, it may cause anxiety for patients having inconclusive results and hence the potential need for repeat investigations.

Objective

This project is designed as part of the ongoing quality improvement programme to the “one-stop” “see and treat service provided to womenin our Ambulatory Gynaecology Unit (AGU). The aim is to establish the incidence of inadequate endometrial biopsies in our unit and to identify potential factors associated with insufficient endometrial tissue for histological examination. Study Design and Methods: A retrospective analysiswas conducted on the medical records of all women who had an endometrial biopsy sent for histological diagnosis between October 2022 and March 2023 in the AGU in MUH. The data were collected electronically from prospectively maintained live electronic databases. These were cross checked for accuracy with the specimen tracking logs and the electronic laboratory reporting system. Data were anonymised and unlinked prior to analysis. Descriptive statistics were performed and presentedusing Microsoft Excel.

Results

From the 266 endometrial biopsies reviewed, 39 (14.6%) were deemed inadequate forhistological interpretation. According to our analysis, 27 (69%) of the inadequate biopsies were taken fromwomen with postmenopausal bleeding. Half of these women had an endometrial thickness (ET) on transvaginal scan of ≤4 mm and only one had hysteroscopy performed prior to endometrial sampling. Non consultant hospital doctors were more likely to sample a patient with a normal ET and obtain an insufficient sample.

Conclusion

There is no general consensus on the best management of symptomatic and asymptomatic (incidental finding on scan) women with potential endometrial pathology. We recommend assessment with hysteroscopy and avoidance of ‘blind’ endometrial biopsy if ET is less than 4 mm on TVS, as this is the single strongest predictor factor for inadequate endometrial biopsy and a reassuring finding with a 99% negative predictive value for endometrial cancer. eP-160 Effects of Myo-inositol in PCOS patients to alleviate dysmenorrhea and ovarian volume O. Kulsoom; R. Khatoon Ziauddin University Hospital, Obstetrics & Gynaecology, Karachi, Pakistan

Objective

This study was aimed to assess the efficacy of Myo-inositol in alleviating dysmenorrhea and reducing ovarian volume in women diagnosed with polycystic ovary syndrome (PCOS). Design: Prospective Observational.

Method

The study was conducted in a tertiary care hospital teaching hospital in Karachi, Pakistan, during 2022–23. Fifty women diagnosed with PCOS, aged 18–45 years, were recruited and enrolled for the study. Patients with hyperprolactinemia, hypothyroidism, adrenal hyperplasia, Cushing's syndrome, or ovulatory dysfunction were excluded. Ethical approval was obtained from the Research Evaluation Committee/Ethics Review Committee (Reference No.) of Dr. Ziauddin Hospital and University. After initial screening, written informed consent was obtained from all the enrolled patients was made to recruit the patients for the study. The recruited patients were given a daily dose of 2 grams of myo-inositol for a period of three months. The data was collected on ovarian volume, dysmenorrhea severity, and menstrual irregularities at day zero (before administering the dose of myo-inositol), day 30, day 60 and day 90. Analysis was made on data of Pre- and post-treatment with Myo-inositol, using SPSS version 23.

Results

The mean age of the participants was 27.68 years (SD ± 4.787), with a range of 19 to 38 years. The mean body mass index (BMI) was 27.89 kg/m2 (SD ± 3.68), ranging from 17.60 to 37.84 kg/m2. Myo-inositol treatment resulted in a statistically significant decrease in ovarian volume for both ovaries (p-value < 0.001 for each). Dysmenorrhea completely cured in approximately half of the participants. Notably, a significantly higher treatment efficacy for dysmenorrhea was observed in the younger age group (21–30 years old, p-value = 0.011).

Conclusion

This study suggested that three months administration of 2 grams of Myo-inositol per day is effective in reducing ovarian volume, improving dysmenorrhea symptoms, and regulating menstrual irregularities in women with PCOS. Additionally, the treatment was found to be more effective for alleviating dysmenorrhea in younger patients with PCOS.

Keywords

Myo-inositol; polycystic ovary syndrome (PCOS); Dysmenorrhea; Ovarian volume. eP-161 Revolutionizing TOA treatment: A streamlined and effective approach S. Bayar1; A. Dhai1; A. Belhadj1; T. Necib1; H. Sebri1; A. Kammoun1; N. Ben Aissia1; A. Triki; A. Ben Amor; A. Halouani Department of Gynecology and Obstetrics, University Hospital Mongi Slim La Marsa, La Marsa, Tunisia

Objective

The primary objective of this study was to assess the efficacy of transvaginal ultrasound-guided drainage in the management of tubo-ovarian abscesses (TOA) complicating upper genital tract infections. Design: This retrospective longitudinal monocentric study examined ten cases of upper genital tract infections complicated by TOA, treated with transvaginal ultrasound-guided drainage. Data were collected from April 2019 to May 2021.

Method

Participants were selected from patients presenting with symptoms suggestive of upper genital tract infections and undergoing transvaginal ultrasound-guided drainage for TOA. Data were collected from medical records. Treatment included intravenous antibiotic therapy combined with transvaginal ultrasound-guided drainage.

Results

A total of ten patients with tubo-ovarian abscesses (TOA) complicating upper genital tract infections were included in the study, with an average age of 37 years. Among these patients, 30% had no identifiable risk factors for TOA, while 70% presented with at least one risk factor, including unprotected sexual intercourse, previous history of upper genital tract infections, endo-uterine manipulation, intrauterine device (IUD) use, or smoking. Upon diagnosis, all patients received intravenous antibiotic therapy, and transvaginal ultrasound-guided drainage was performed within a range of a few hours to two weeks after diagnosis. The abscesses treated had an average size ranging from 3 to 7 cm. Bilateral TOAs were identified in 10% of cases. The overall success rate of the treatment, defined by the resolution of symptoms (fever and pelvic pain) and normalization of inflammatory markers, was 80%. In cases where treatment failed to achieve resolution, defined primarily by the persistence of an adnexal mass, surgical intervention was required in 20% of cases.

Conclusions

Upon diagnosis of tubo-ovarian abscesses (TOA), initiating empiric parenteral antibiotic therapy targeting common pathogens, alongside percutaneous drainage for abscesses exceeding 3–4 cm, ideally guided by ultrasound or laparoscopy, represents a progressive and efficient treatment strategy. Transvaginal ultrasound-guided drainage emerges as an effective intervention for non-severe cases, while prompt surgical intervention remains imperative for severe presentations. eP-163 Retrospective review of single-incision laparoscopic surgery in gynaecology from 2015 to 2023 H.C.C. Cheung1; C.P. Cheung2 1The University of Melbourne, Biomedical Science, Melbourne, Australia, 2Hong Kong Adventist Hospital, Obstetrics and Gynaecology, Hong Kong, Hong Kong, SAR of China

Objective

The advancement of single-incision laparoscopic surgery (SILS) is increasingly popular in gynecologic practice, which may supersede conventional laparoscopic surgery (CLS). However, the data on the efficiency and safety of SILS is limited. Therefore, the objective of this study is to try to determine the safety and efficiency of SILS in various gynecologic conditions. Design: A retrospective study of patients receiving SILS for laparoscopic myomectomy and laparoscopic ovarian cystectomy between January 2015 and December 2023 was the methodology used in this study.

Method

217 laparoscopic surgery cases were retrieved from private hospitals in Hong Kong and were performed by the same gynecologist. Moreover, all demographic data and surgical outcomes are obtained using a pro forma. SILS and CLS patients were selected according to the type of surgery they received including laparoscopic myomectomy on 5 cm fibroids and laparoscopic bilateral and unilateral ovarian cystectomy. When comparing the means of two independent groups, an unpaired t-test, a statistical method to discover if there is a significant difference between the two, from Microsoft Excel version 2021 is used (Gleichmann, 2020).

Results

217 cases were included, involving 119 patients (54.8%) from SILS and 98 patients (45.2%) from CLS. The two groups were compared in terms of their operative time. There is no significant difference in the cases that received blood transfusions. But, there is a significant difference in the cases that received drainage. The mean operative time of SILS laparoscopic myomectomy on 5 cm fibroids was significantly shorter than CLS (148.9 ± 55.5 min vs. 213.0 ± 49.2 min) (p = 0.000079). The mean operative time of SILS laparoscopic bilateral ovarian cystectomy was not significantly shorter than CLS (131.3 ± 32.7 min vs. 154.6 ± 65.1 min) (p = 0.1457). The mean operative time of SILS laparoscopic unilateral ovarian cystectomy was significantly shorter than CLS (119.6 ± 39.9 min vs143.0 min ± 54.1 min) (p = 0.0473).

Conclusions

From our recorded data, SILS is a practical, safe, and efficient treatment option. SILS requires a shorter operative time. However, given the limited cases, further study is required for verification.

Reference

Gleichmann (2020). Paired vs. unpaired T-test: Differences, assumptions and hypotheses. Informatics from Technology Networks. https://www.technologynetworks.com/informatics/articles/paired-vs.-unpaired-t-test-differences-assumptions-and-hypotheses-330826#:~:text=An%20unpaired%20t%2Dtest%20(also,significant%20difference%20between%20the%20two. eP-164 Reproductive outcome of hysteroscopic uterine septum resection F. Al falahi1; K. Al Hattali2 1Sultan Qaboos university Hospital, OBGYN, Barka, Oman, 2Royal hospital, OBGYN, Muscat, Oman The Mullerian duct anomalies classification is a seven-class system that can be used to describe several embryonic Mullerian duct anomalies. The uterine septum is the most common type of uterine anomaly. It occurs when part or all of the Mullerian ducts – two embryonic ducts that develop into the vagina, uterus and fallopian tubes – fail to reabsorb either partially or completely, resulting in muscle or tissue that divides the uterus partly or wholly into two separate cavities. Aim of our study is to determine the pregnancy rate and the miscarriage rate following septum resection in patient with recurrent pregnancy loss or infertility in female who was operated in Royal Hospital during the period of 2006 and 2020. It's a retrospective cohort study included 50 patients. Our study showed that the pregnancy rate for women who underwent hysteroscopic septum resection is around 60.9%, 28 in number. The percentage of women who got pregnant and completed the pregnancy till full term is 37%. There was an 8.7% of patients who had a preterm delivery, while 15.2% had a miscarriage. The proportion of women who did not conceive after septum resection is 39.1%. The study showed a increased pregnancy rate after septum resection. This study was conducted in single center, better results might be obtained if multicenter was included. eP-165 Ovarian torsion – from presentation to surgery – An audit of 20 cases O. Nwachukwu; M. Mishra; A. Sanyang; M. Hussain; L. De Silva Obstetrics and Gynaecology, Southend University Teaching Hospital, SS0 0RY, UK

Objective

Review the management of ovarian torsion who presented to our hospital in order to develop a pathway for the management of ovarian torsion. Design: A retrospective study of 20 cases who presented within the last five years who had surgery for adnexal masses.

Method

An electronic search was performed using the words ‘emergency laparoscopic ovarian torsion’, ‘emergency laparotomy for ovarian torsion”. Hard copy of patients notes were reviewed as well as the electronic records.

Results

The mean age was 32.6 years, ranging from 14 years to 65 years. 10% were under 15 years of age and 20% were 45 years or older. 7/20 women had CT abdomen and pelvis as the first imaging modality while 50% of the patients had transvaginal ultrasound as first line. Three patients needed second imaging modality. 75% patients had vomiting along with other symptoms, 50% had right iliac fossa pain compared to 35% with left iliac fossa pain. Only 10% had loss of appetite. Guarding was evident in 45% of the patients and 30% had rebound tenderness. White cell count was >9000 in 45% patients, CRP was raised more than 9 in only 10% cases. 70% cases had an adnexal cyst ranging in size from 5 to 10 cm. Only 10% (2/20) of radiology report categorically mentioned torsion, 8 cases (40%) mentioned that either torsion cannot be ruled out or that the findings are suggestive of torsion. In 13 cases (65%) torsion was diagnosed on laparoscopy. Diagnosis of torsion was achieved in 15% of the cases within 3 h either based on clinical examination, imaging modality or at the time of surgery. 9 (45%) of the patients had their surgery within 6 h of diagnosis. Laparoscopy approach was used in 75% of the cases while the rest of the patients had laparotomy. 60% of the cases had ovarian cystectomy, 5 (25%) had oophorectomy and 6 (30%) had salpingectomy. One case had bilateral salpingoophorectomy due to suspected neoplasm and two cases had de-torsion with no follow up plan. All cases were benign.

Conclusions

Ovarian torsion can be difficult to diagnose. Pain in either iliac fossa with vomiting has a high correlation with adnexal torsion. About 35% cases are diagnosed only on imaging, heavy reliance on imaging should be avoided. Early Senior medical review of the patients within presentation is encouraged as well as early surgical intervention. eP-218 Impact of consanguinity on pregnancy outcomes: A retrospective Middle-Eastern population-based cohort study F. Minisha; J. Thomas; T. Farrell Women's Wellness and Research Centre, Hamad Medical Corporation, Obstetrics and Gynecology, Doha, Qatar

Background

Consanguinity is widely practised in many Middle Eastern communities. Consanguinity has been long established to be associated with multitude of complications including spontaneous miscarriages, low birth weight, congenital malformations, metabolic disorders, and increased rates of autosomal recessive disorders. Despite its high prevalence among the Middle eastern population, there is paucity of data on the reproductive outcomes of consanguineous relationships from this part of the world.

Objectives

The objective of our study is to compare the perinatal outcomes in babies from consanguineous relationships to those with non-consanguineous relationships.

Methods

Retrospective cohort study of pregnancies beyond 20 weeks of gestational age between March 2016 and April 2018 in Qatar, using data from the PEARL registry. The outcomes included congenital anomalies, chromosomal anomalies, preterm births, multiple pregnancies, still birth, neonatal death, low birth weight (LBW) and small for gestational age (SGA).

Results

The rate of consanguinity among the women is Qatar was 30.8% with higher rates of first-degree consanguinity (74%) compared to the second-degree (24%). Consanguinity was significantly higher in Qatari women, multiparity, overweight and obese women. There was higher incidence of congenital anomalies (2.3% versus 1.6%), chromosomal anomalies (0.5% versus 0.1%) and stillbirths (0.5% versus 0.1%) in first degree consanguinity compared to second degree. There were higher rates of multiple gestation were higher in the second-degree consanguinity (1.5% versus 1%). After adjusting for confounders, consanguinity had 1.4 times higher odds of major congenital anomalies (p = 0.049). There were higher odds of having stillbirth ((OR 3.10, p = 0.007) and neonatal deaths (OR 3.2, p = 0.042) even in anatomically normal babies in consanguinity. There were no statistically significant differences noted in the incidence of chromosomal anomalies, preterm births, SGA, and LBW babies between the groups.

Conclusion

Our study concludes that consanguinity is associated with an array of major risks including congenital anomalies, stillbirths, and neonatal deaths even in morphologically normal babies. The results should be used to improve the obstetric outcome by raising awareness among the communities in which consanguinity is practised. eP-219 Does prenatal tobacco exposure affect child neurodevelopment? An ECHO cohort study A. Zar1; S. Abdulrahman1; A. Abdulrahman1; M. Framarzi1; A. Almalki1; A. Karen1; A. Elkhalaf1; G. R Babu2 1Qatar University, College of Medicine, Doha, Qatar, 2Department of Public Health, Qatar University, College of Medicine, Doha, Qatar

Objective

The aim of this study is to explore the association between prenatal tobacco exposure (PTE) in pregnant women and the neurodevelopment of the infant. Design: This is a cohort study, as the data was extracted from the ECHO cohort dataset.

Method

Data collected for 1001 pregnancies by the Environmental influences on Child Health Outcomes (ECHO) cohort database we used in the study. Participants were included if exposure, outcome, and covariates data were present. We measured the PTE using self-reported data, any mother who either smoked or lived with someone who smoked was considered exposed. Infant neurodevelopment was measured using Bayley Scale of Infant and Toddler Development (BSID) version 3, focusing on the cognitive, motor, and language domains. Neurodevelopmental delay was defined as a score of below 85 in the composite scores of each domain, which were analyzed independently. We used Stata 18 to run logistic regression models and estimated the odds ratio of tobacco exposure and composite scores of below 85, after adjusting for socioeconomic status, prenatal alcohol exposure, pre-pregnancy BMI, maternal age, and psychological distress. Additionally, we assessed the mediating effects of birthweight on the relationship between PTE and neurodevelopmental delay.

Results

The regression models show that the covariates included in the adjusted regression model confound the association. After adjusting, PTE had no effect on motor and language domains, with odds ratios of 0.99 (95% CI 0.65–1.52) and 1.05 (95% CI 0.73–1.51), respectively. Conversely, children whose mothers were exposed to tobacco during pregnancy had 1.5 times greater odds of cognitive delay compared to those who were not exposed. Mediation analysis indicated a significant direct effect of tobacco exposure on cognitive function of the baby (estimate = −2.10, p = 0.020), with a significant indirect effect mediated by birth weight (estimate = −0.64, p = 0.032).

Conclusions

Our study contributes to the growing evidence linking PTE to neurodevelopmental outcomes. Moreover, our findings underscore the importance of understanding prenatal smoking cessation interventions to mitigate the risk of cognitive delay. eP-220 Preliminary results of a programme aimed to reach 500 000 pregnant women S. Malick1; A. Sukhera2; S. Malick3 1King Faisal Specialist Hospital & Research Centre, Ambulatory Health, Riyadh, Saudi Arabia, 2Mohi-ud-Din Islamic University, Vice Chancellor, Azad Kashmir, Pakistan, 3County Durham& Darlington NHS Trust, Paediatrics, Darlington, UK

Objective

The burden of maternal mortality is alarmingly high in Pakistan, ranking number 5 in this latest evidence. 186 women die for every 100 000 live births. We intend to reduce the maternal mortality by 30% by reaching 500 000 pregnant women and provide them with a care package including eradication of anaemia. - Enrolling pregnant women who do not have access to care. - Encouraging them to receive a minimum of four antenatal visits as per WHO recommendations. - Provide an injection of IV Ferric Carboxymaltose to all anaemic pregnant women. - Clean Birthing Kits to all women delivering in a resource poor setting. - Increasing breastfeeding uptake which will help reduce new born deaths due to infections. - Create awareness regarding contraception - Provide awareness and empowerment to women between 15 to 49 years.

Method

Our target population includes any pregnant woman unable to access health care facilities. Structured questionnaires are used to record demographic details and number of antenatal visits. A clean birth kit is provided to all and those with anaemia are administered one single dose of IV Ferric Carboxymaltose. We have established partnerships with local trusts and government health authorities to help train midwives to measure postpartum blood loss with the help of a pictorial guide. They are trained to perform bimanual uterine massage and to call for help immediately if there is ongoing PPH. After the delivery, phone calls are made to the patient to record details of birth and postnatal parameters. All data is recorded in digital formats, which will be accessible on smartphones in local languages.

Results

1625 women have received the package and we have the data of 450 women. There have been minimum of four antenatal visits and they all delivered at term. PPH occurred in 0.9% and 5.8% developed puerperal complications. No maternal death and 2 fetal deaths and one neonatal death were reported. 90% of the women were breastfeeding at 6 months.

Conclusions

We believe the strength of our project is to reach out to the unreachable section of pregnant women who are at a high risk of death. Our eradication of anaemia package will reduce the major cause of PPH and decrease risk of stunted growth in children. eP-221 Intrauterine misoprostol during cesarean section in prevention of primary post partum haemorrhage S. Ishtiaq1; H. Sharaf Ali2; T. Ramzan3; H. Yasmin4 1Ziauddin Hospital, Obstetrics and Gynaecology, Karachi, Pakistan, 2Ziauddin University and Hospital, Obstetrics and Gynaecology, Karachi, Pakistan, 3Zulekha Hospital, Obstetrics and Gynaecology, Sharjah, United Arab Emirates, 4Jinnah Postgraduate Medical Centre, Obstetrics and Gynaecology, Karachi, Pakistan

Objectives

Excessive bleeding during and after caesarean section is a major cause of maternal morbidity and mortality, especially in low resource countries. This study evaluates the efficacy and safety of intrauterine misoprostol with oxytocin in comparison with oxytocin alone on blood loss during caesarean section. Design: A randomised control trial. To compare the efficacy and safety of intrauterine misoprostol with intravenous oxytocin during Cesarean Section In preventing postpartum haemorrhage.

Method

A total 300 pregnant women at term (37–40 weeks) gestation undergoing elective or emergency caesarean delivery were randomised into two groups: women who received 400 mcg intrauterine misoprostol in addition to intravenous infusion of 10 IU oxytocin as Group I (150) while women who received an intravenous infusion of 10 IU oxytocin after delivery of the neonate as Group 2 (150).Primary outcome measures were Estimated Blood Loss (EBL) during caesarean section and need for additional uterotonic drugs intraoperatively. Secondary outcomes included the occurrence of excessive blood loss (>1000 mL) within the first 6 h postoperatively and the occurrence of any maternal or fetal side effects.

Result

The difference in the postoperative haemoglobin and postoperative hematocrits was found to be highly significant between the two groups (10.12 ± 1.55 vs. 9.24 ± 1.52; p < 0.01) and (2.48 ± 1.38 vs. 3.75 ± 1.77; p < 0.001) respectively. Estimated blood loss in two groups was found to be very highly significant (440.19 ± 257.75 vs. 677.38 ± 343.04; p < 0.001). Intraoperative blood loss was significantly lower in the group I compared to group II (408.27 ± 123.34 vs. 486.04 ± 135.84; p < 0.001). Blood loss during the first 6 h after delivery was also lower in the group I (58.87 ± 9.86 mL vs. 63.29 ± 12.39 mL; p 0.05). The difference in the side effects of both the groups was found to be statistically non significant.

Conclusion

The combined use of intrauterine misoprostol (400 mg), when added to oxytocin infusion during caesarean section is effective in decreasing the intraoperative blood loss, post-operative blood loss and prevent postpartum hemorrhage misoprostol is also effective by the intrauterine route. It is a convenient way to insert misoprostol during caesarean section and it can be considered to prevent intrapartum and postpartum haemorrhage. eP-222 Ethnogeographic disparity in perinatal health – A study of 30 000 women from Qatar F. Minisha; S. Abu Yaqoub; N. Khenyab; T. Farrell Women's Wellness and Research Centre, Hamad Medical Corporation, Obstetrics and Gynecology, Doha, Qatar

Background

Differences in pregnancy outcomes among different ethnicities are often attributed to inequalities in the provision of healthcare. However, there exist differences in genetic constitutions of women from different ethnogeographic origins. This study evaluated more than 30 000 women delivering in high-quality secondary and tertiary care hospitals in Qatar to assess the impact of ethnic origins (nationalities) on pregnancy outcomes.

Methods

Data was extracted from the PEARL Peristat registry (2017 to 2018). Women belonged to seven ethnogeographic groups based on internationally accepted classifications- Qatar, GCC, Arab countries, South Asian (SA), South-East Asian (SEA), African and European/American countries. Antenatal, intrapartum, and neonatal outcomes were compared between the groups using adjusted multivariate regression models (Qatar baseline).

Results

The majority of the 30 667 women included in the study were from the Arab region (39%), followed by Qatari women (24%). Women from 124 nationalities delivered in Qatar; after Qatar, the highest represented country was Egypt (12.3%), followed by India (11.6%). 90% belonged to 15 countries, including Pakistan, Syria, Philippines, Sudan, Yemen, and Jordan. 62% of Qatari were obese, compared to only 39% in SEA. Preexisting diabetes was highest in Qatari, chronic hypertension highest in SEA and thyroid disease highest in SA. Anemia was highest in Qatar and GCC, while lowest in SEA. 34% of SA had gestational diabetes (Odds ratio = 1.7) compared to only 14% in Europe, whereas 7.4% of SEA had hypertensive diseases of pregnancy (OR = 3.5) compared to only 3% in Qatari. Preterm birth was highest in SEA, with postdated pregnancy being highest among African (OR = 2.6). Vaginal birth after cesarean was highest in GCC (27%) and lowest at 13% in SEA. 43% of African had a cesarean delivery compared to the lowest of 25% in GCC. Qatari women had a stillbirth risk of 4.8 per 1000 compared to 6–6.5 per 1000 in GCC, SA and African women, lowest being in European (3.7 per 1000). SEA had the highest risk of postpartum hemorrhage (12.5%). Neonatal intensive care (NICU) admission for preterm babies was highest in GCC (64%), whereas term NICU admission was highest in African babies (OR = 1.4). Neonatal death was 5.5 to 6.5 per 1000 in SEA, African and European, and was lowest in GCC (1.9 per 1000).

Conclusion

Significant differences exist in the pregnancy outcomes among the different nationality groups, even with equality in healthcare. Understanding these differences is essential for adequate risk assessment so that appropriate utilization of specialized services and professionals can be done in a timely manner to reduce maternal and fetal morbidity and mortality. eP-223 Factors influencing mode of delivery: Insights from Bogotá's healthcare system A. Sarmiento1,2; S. Pérez1; S. Ríos2,3; N. Rodríguez4; A. Bernal2; E. Osorio3; S.M. Ballesteros5; F. Abril3; M.X. Meneses5; C. Rodríguez3; A. Rodríguez3; D. Moyano3; A. Castañeda3; D. Franco3 1Fundación Santa Fe de Bogotá, Gynecology, Obstetrics and Human Reproduction, Bogotá, Colombia, 2Universidad de los Andes, School of Medicine, Bogotá, Colombia, 3District Health Secretariat of Bogotá, Bogotá, Colombia, 4Universidad CES, Escuela de Graduados, Medellín, Colombia, 5Fundación Santa Fe de Bogotá, Clinical Epidemiology, Bogotá, Colombia

Objective

Global cesarean section rate has increased significantly in the last decade. In Colombia, the same trend is observed with an increase in the national rate from 27% in 2001, to 46% in 2021. The situation represents an obstetric and public health concern due to an increase in maternal and neonatal morbimortality, as well as costs to healthcare systems, among other factors. This trend arises from multifactorial phenomena, including individual and contextual characteristics of the population. The objective of this study is to establish the individual and contextual factors affecting the route of childbirth in users of obstetric care networks in Bogotá, Colombia. Design: Analytical cross-sectional study.

Method

Clinical and sociodemographic information was obtained from the national birth registry (Unique Affiliates Registry) between 2008 and 2021. Sociodemographic information was acquired from the patients’ residence districts through the city's Household Survey. The variables were stratified according to the route of childbirth. A bivariate analysis was performed using Student's t-test for numerical variables and chi-square test with Yates correction for categorical variables.

Results

A total of 1 372 464 births were analyzed, of which 59% were vaginal deliveries and 41% cesarean sections. Patients who underwent cesarean section had a shorter gestation period (37.8 vs. 38.6 weeks, p < 0.001) and a higher number of prenatal visits (7.7 vs. 6.8, p < 0.001). In patients over 25 years-old, the proportion of cesarean sections versus vaginal deliveries was significantly higher (66.1% vs. 51.3%, p < 0.001), as well as in those with education beyond secondary school (43% vs. 26% p < 0.001), with a subsidized insurance regime (82.1% vs. 73.6%, p < 0.001), and with a current marital status (84.1% vs. 80.1% p < 0.001). In private obstetric care institutions, 64.8% of births were by cesarean section, compared to 32.5% in public institutions (p < 0.001). The analysis of contextual factors in the districts of residence demonstrated how water availability, lower unemployment rates, lower informal employment, lower insufficient income, lower air pollution, higher educational levels, and lower multidimensional poverty index were associated with a higher proportion of cesarean sections (p < 0.001).

Conclusions

In the obstetric care networks in Bogotá, there are individual and contextual factors associated with the route of childbirth. This trend should be evaluated in other cities in Colombia and Latin America, as the information provided could be valuable for decision-makers in the development of public health policies and medical care. eP-224 Surrogacy and mitochondrial replacement therapy in the 21st century C. Burrell BHRUT NHS Trust, Romford, Essex, UK

Objective

This article looks at the evolving role of surrogacy in women's health globally. Design & Method: Literature Review.

Result

Surrogacy allows a woman to carry a pregnancy (with or without using her egg) with the purpose of handing over the baby to the intended parents after delivery. The first surrogate pregnancy occurred in the UK (1985). Since then, several thousands babies have been delivered, although the Surrogacy Act is not enforcible legally. Unlike IVF that occurs in HFEA licenced Fertility Clinics with associated legal regulations; surrogacy has no official data base so the number of cases remains unknown. The role of surrogacy have changed from merely assisting sub-fertile couples to have a genetically related baby. Surrogacy has evolved to fit other niche – to help couples affected by mitochondrial disease. Mitochondrial disease transmission is uniparental of maternal origin (lineage), therefore faulty mitochondial DNA is passed from mother to child via dominant vertical transmission. There is no FDA approved drug to cure for mitochondrial disease, thus the only option is egg donation to eliminate the faulty DNA transmission. Mitochondrial Replacement Therapy (MRT) involves removing the mutated DNA from the affected female's egg and replacing it with the un-affected donor's motochondrial DNA. The UK was the first country in the world to legalize MRT to enable women with mitochondrial disease to have healthy genetically related children (2016) with DNA from three parents. MRT uses part of donated egg to replace faulty mitochondria, so the child will inherit DNA from a 3rd person. MRT replaces only 37 genes (0.1% of the adult genome). MRT does not cure mitochondrial disease as the mother is still affected; instead the baby is unaffected. In the UK, about 100 babies/year are born with severe mitochondrial disease, while in the USA about 12 500 babies/year are similarly affected. The common mitochondrial diseases are – Leigh Syndrome, Pearson Syndrome, Myoclonic Epilepsy with Ragged Red Fibres (MERRF), Leibers Hereditory Optic Neuropathy (LHON), and Neurogenic Ataxia and Retinitis Pigmentosa (NARP).

Conclusion

Surrogacy continues to evolve to help couples overcome hurdles to produce genetically related babies. The ethics of MRT and selective reproduction (removing mutated genes) versus embryo modification (replacement of defective genes) remains controversial. MRT Opponents argue against creating ‘designer babies’ and germline gene manipulation which affects subsequent generations. Proponents defends MRT as it facilitates reproductive autonomy, and they view MRT as mitochondrial donation similar to other organ donation. eP-226 Birth plan utilization, associated factors and delivery outcomes among Ugandan postnatal mothers B.R.G. Kakoba1; R.N. Byaruhanga1,2; G. Tumwine2,1; F. Nansubuga2,1 1Mother Kevin Postgraduate Medical School, Obstetrics and Gynaecology, Kampala, Uganda, 2St. Francis Hospital Nsambya, Obstetrics and Gynaecology, Kampala, Uganda

Background

Birth Preparedness and Complication Readiness is a safe motherhood strategy that increases the seeking of skilled obstetric care leading to positive birth outcomes. The World Health Organization recommends that the components of the birth plan should be adopted in local settings with cultural appropriateness hence Uganda developed a Birth and Emergency Preparedness Plan. However, there is a paucity of literature on the utilization of the Birth and Emergency Preparedness Plan of Uganda.

Objective

To assess the utilization of birth plans, its associated factors and delivery outcomes among postnatal mothers at St. Francis Hospital, Nsambya.

Methods

A cross-sectional study was conducted from 5th November 2023 to 30th January 2024. Systematic sampling was used and data was collected using a structured questionnaire. Data analysis was done using STATA version 15, modified Poisson regression with standard robust errors to determine the association, and Fischer's exact test to determine the relationship of outcomes with the dependent variable. Results were deemed significant when the p-value was < 0.05.

Results

Of 385 mothers, 67% utilized the Birth plan. The least utilized component was placental care (6.0%). The majority of participants had poor knowledge of the components of the birth plan (53.8%). Important predictors of Birth Plan were Mothers having ‘Average’ (aPR = 1.71, p < 0.001), ‘Good’ (aPR = 2.05, p < 0.001) knowledge of birth plan components and having no information on birth preparedness (aPR = 0.59, p = 0.036). Health facility delivery was associated with the Birth Plan utilization and mothers who suffered perinatal mortality had a decreased likelihood of having utilized the birth plan, p-value = 0.035 and p-value < 0.001 respectively.

Conclusion

Birth plan utilization is high in this study setting and knowing the birth plan components is associated with its utilization. Health workers should discuss the birth plan components with pregnant mothers at each antenatal contact. eP-227 Maternal near-miss and mortality in humanitarian settings: A systematic review V. Ithayaruban; P. von Dadelszen; L. Singh King's College London, London, UK

Objective

Maternal Near-Miss (MNM) events refer to events in which a woman survived a life-threatening complication occurring during pregnancy or within 42 days of termination of pregnancy. MNM can lead to longer-term morbidity, impacting quality of life and socioeconomic status. The specific aim of this review was to address the incidence of MNM and maternal mortality in humanitarian settings and the increased risk women are put at during a humanitarian event. Design: A systematic review using the PRISMA guidelines was undertaken. This is the first systematic review addressing this research question.

Method

Following a pre-defined protocol (PROSPERO (2024 CRD42024495998)), the review was conducted through a systematic search of Medline via Ovid, EMBASE via Ovid and Global Health. The search was carried out with restrictions on publication date (2010 – 2024) to capture studies conducted after the publication of the WHO Maternal Near Miss Approach Tool. Studies that provided quantitative data regarding maternal near-miss and mortality were included. Quality Assessment of the studies were conducted using ‘The Newcastle-Ottawa Quality Assessment Scale’.

Results

In total, 2883 studies were screened, and 19 studies met the inclusion criteria; 18 of which were cross sectional studies and 1 case-control study. The most reported MNM event was emergency peripartum hysterectomy along with severe haemorrhage. Descriptive analysis was conducted to investigate the main themes and contributors to the incidence of MNMs.

Conclusion

Results revealed a heightened risk of complications among women in humanitarian settings, particularly among immigrant women from conflict-zone countries, who faced elevated rates of MNM events and mortality. This underscores the pressing need to address the multifaceted factors and comorbidities affecting pregnant women, particularly those in low socioeconomic situations. Additional research is needed to deepen our understanding of, and mitigate disparities in, pregnancy outcomes. Moreover, there is a clear call to establish a more standardised and easily measurable approach for assessing MNM events. Government legislators and policymakers and multilaterals must actively seek and integrate novel methods to enhance access to, and provision of, reproductive healthcare in humanitarian settings. eP-228 Exploring the efficacy of hormone replacement therapy: A network meta-analysis (MARIE-WP1) G. Delanerolle1; J. Taylor2; R. Zou3; X. Yang3; Y. Bouchareb4; H. Cavalini1; P. Jagadeesan5; O. Kurmi6; K. Riach7; S. Hinchliff8; C. Atkinson9; K. Potocnik10; P. Briggs11; V. Talaulikar12; L. Saraswath13; J. Shi3; A. Shetty14; S. Elneil14; N. Rathnayake15; I. Litchfield2; V. Pathiraja15; T. Mudalige15; I. Muhammad16; R. Kareem17; T. Teck-Hock18; C. Benetti-Pinto19; G. Uchenna-Eleje20; B. Vwalika21; I. Aggarwal22; J. Manonai23; S Mamatha24; K. Elliot1; P. Phiri1 1Southern Health NHS Foundation Trust, Research and Innovation, Southampton, UK, 2University of Birmingham, College of Medicine, Birmingham, UK, 3Department of Statistics and Data Science, Southern University of Science and Technology, Shenzen, China, 4Sultan Qaboos University, Muscat, Oman, 5Imperial College London, London, UK, 6Coventry University, Research Centre for Healthcare and Communities, Coventry, UK, 7Glasgow University, Glasgow, UK, 8University of Sheffield, School of Allied Health Professions, Nursing and Midwifery, Sheffield, UK, 9Manchester Metropolitan University, Professor of Human Resource Management, Manchester, UK, 10University of Edinghburg, Business School, Edingburgh, UK, 11Liverpool Women's NHS Foundation Trust, Liverpool, UK, 12University College London Hospitals NHS Foundation Trust, London, UK, 13Aberdeen Royal Infirmary, Aberdeen, UK, 14University College London, Institute of Womens Health, London, UK, 15Department of Nursing, University of Ruhuna, Matara, Sri Lanka, 16Department of Mental Health, Psychiatry & Behavioral Sciences, Peshawar Medical College, Peshawar, UK, 17Department of Mental Health, Psychiatry & Behavioral Sciences, Peshawar Medical College, Peshawar, Pakistan, 18Sibu Hospital, Ministry of Health, Sibu, Malaysia, 19State University of Campinas (UNICAMP), Faculty of Medicine, São Paulo, Brazil, 20Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Effective Care Research Unit, Nnewi, Nigeria, 21University of Zambia, School of Medicine, Lusaka, Zambia, 22Department of Gyanecological oncology, KK Women's and children hospital, Singapore, Singapore, 23Ramathibodi Hospital, of Obstetrics & Gynaecology, Nakhon Pathom, Thailand, 24JSS Medical College, Mysore, India

Objective

This study aims to report the efficacy of hormone replacement therapy (HRT) in modulating lipid profile including a decrease in triglycerides (TG), subcutaneous fat thickness (SFH), and low-density lipoprotein cholesterol (LDL-C), alongside an increase in high-density lipoprotein cholesterol (HDL-C) and serum Estradiol levels. Design: We designed a multi-workstream menopause project called MARIE to develop a data-connectivity study. This abstract is the first of a four-part evidence synthesis.

Methods

A systematic methodology was developed and published in PROSPERO (CRD420222346057). We conducted a network meta-analysis to estimate the pooled efficacy of current HRT interventions, using 95% confidence intervals (CI), p-values and Egger's test.

Results

Out of the 1258 studies reviewed, 45 studies were included in the analysis. Limited demographic details such as race, ethnicities, gender including trans-men and age were reported within these studies. The statistical analysis showed that HRT reduced TG levels with an effect size of −23.85 with a 95% CI of −43.31 and −4.39.The efficacy of HRT in reducing LDL-C indicated I2 of 73.9% with a p-value less than 0.0001 indicating statistically significant heterogeneity. The mean difference of all interventions, directly and indirectly, compared to a placebo group showed statistically significant difference between SERM and LDL-C levels with an effect size of −11.61 and a p-value of 0. Efficacy of HRT on increasing HDL-C showed a I2 of 56.8% and a p-value less than 0.0001 showing statistically significant heterogeneity. The efficacy of HRT on increasing serum oestradiol showed I2 value of 93.3% with a p-value less than 0.0001. Oral and oral plus transdermal administration of HRT showed a statistically significant difference in oestradiol level with effects sizes of 61.66 and 46.52, respectively. The Egger's test showed a p-value of 0.6901 indicating a lack of significant publication bias.

Conclusion

Our analysis concludes that HRT may contribute to an improved overall lipid profile although there is a requirement for robust evidence with larger sample sizes and significantly improved inclusivity with representation of all ethnicities, races and genders. Additionally, long-term clinical epidemiological studies with extended follow-up periods are necessary to evaluate the long-term efficacy, tolerability, and acceptance of HRT across diverse populations. eP-229 Frequency of maternal morbidity and mortality among pregnant women with COVID infection B. Farooqui1; U. Shabab1 1Liaquat National Hospital and Medical College, Obstetrics and Gynaecology, Karachi, Pakistan

Background

Women diagnosed with COVID-19 face significantly increased risks of severe pregnancy complications. These risks include conditions such as pre-eclampsia, eclampsia, and HELLP syndrome, which can pose serious threats to maternal health and require immediate medical attention. Additionally, Covid-19 can lead to a higher likelihood of ICU admission due to the severity of symptoms and complications that may arise during pregnancy. Furthermore, infections require antibiotics are more common among pregnant women with Covid-19, further complicating their health status and pregnancy outcomes. Tragically, there is also a heightened risk of maternal mortality associated with Covid-19 during pregnancy. These findings underscore the critical importance of monitoring and managing Covid-19 infections in pregnant women to mitigate these serious risks and ensure better outcome.

Objective

To determine the frequency of maternal morbidity and mortality among pregnant females with Covid-19 infection.

Material and methods

This cohort study was conducted on 134 pregnant women with diagnosed COVID-19 infection. The maternal morbidity and mortality were observed and recorded. SPSS was used for data compilation and analysis. The results were expressed as mean ± standard deviation for quantitative variables and frequency/proportion were reported for qualitative variables. Chi-square/fisher exact test was applied to determine association between qualitative variables. p-value less than 0.05 were considered as significant.

Results

The mean age was 29.78 ± 6.50 years. The maternal mortality was 6.7%. Preterm delivery accounted for 24.6%, pre-eclampsia/eclampsia for 14.2%, and previous stillbirth or infant mortality for 11.2%. 32.1% were found to have been admitted to the intensive care unit, 61.9% had chest discomfort, 79.1% had fever, 72.4% had sore throat, 84.3% had flu-like symptoms, 67.9% had dyspnea, 78.4% had coughed, and 9.7% were determined to be asymptomatic. Strong association of COVID mortality with age group (p = 0.000), obesity (p = 0.000), and preterm delivery (p = 0.000) was observed.

Conclusion

It can be concluded that maternal mortality rate was high. Among maternal morbidities, preterm delivery and pre-eclampsia/eclampsia were the most observed morbidities. Strong association of COVID mortality with age, obesity, and preterm delivery was observed.

Keywords

Maternal, Morbidity, Mortality, Covid-19 Infection. eP-230 Self-collected vaginal samples in cervical cancer screening with dual stain p16/Ki-67 S.K.D. Ho1; C. Karen Kar Loen2; A. Cheung3; K.Y. Tse2; M.Y. Chu1; N. Siew Fei2 1Queen Mary Hospital, Obstetrics and Gynaecology, Hong Kong, Hong Kong, SAR of China, 2University of Hong Kong, Obstetrics and Gynaecology, Hong Kong, Hong Kong, SAR of China, 3University of Hong Kong, Pathology, Hong Kong, Hong Kong, SAR of China

Objective

Application of p16/Ki-67 dual-staining cytology has emerged as a promising tool to triage patients at risk of cervical cancer. Furthermore, there is growing advocacy for self-collected (SC) vaginal samples in hope to increase coverage of population screening. The objectives of this study were to evaluate the concordance rate of dual-stain in clinician-collected (CC) cervical samples versus SC vaginal samples. Design/Methods: This was a cross-sectional study of 208 women seen at our colposcopy clinic because of an abnormal Papanicolaou smear. The collected material underwent liquid-based cytology, high-risk HPV (HrHPV) detection and immunocytochemical testing (p16/Ki67). The positive reference was those collected from CC samples.

Results

114 women tested positive for one or more HrHPV (54.3%) on CC samples. Amongst those tested positive, the concordance rate for HrHPV in CC and SC samples was 78.9% (90 out of 114). Overall, dual stain was found to be positive in 34.1% of CC samples. The overall concordance, positive concordance and negative concordance were found to be 73.3%, 25.3% and 97.8% respectively. The sensitivity of dual stain performed on the CC and SC specimens to predict high grade disease, as determined by colposcopy and biopsy, was 71.1%.vs. 21.1%.

Conclusion

Though self collected samples are useful for HrHPV screening, our findings suggest that dual-stain testing of self-collected vaginal specimens cannot be routinely advocated as part of cervical screening programs for dual stain studies. eP-232 Pilot of community-based point-of-care placental growth factor testing (POC-PlGF) in Sierra Leone O.B. Forge Risk1,2,3; A. Dickson Sankoh4; A. Ridout5; K. Bramham5; K. Kuhrt5; NIHR CRIBS 1Imperial College London, Institute of Reproductive & Developmental Biology, London, UK, 2Queen Charlotte's & Chelsea Hospital, London, UK, 3Royal College of Obstetricians & Gynaecologists, Global Health Trainees Committee, London, UK, 4Welbodi Partnership, Freetown, Sierra Leone, 5King's College London, London, UK

Objective

This is the first pilot of community-based POC-PlGF in Sierra Leone, which aims to establish its feasibility in a research setting. Delays in referral contribute to pre-eclampsia being Sierra Leone's second leading cause of maternal death. The PINEAPPLE study has demonstrated that POC-PlGF in hospital identifies hypertensive women at risk of adverse outcomes. However, hospital presentation may be the tip of the iceberg of disease burden. Community screening to improve referral and reduce preventable morbidity presents a novel test case for POC-PlGF. Design: Exploratory screening study.

Methods

Recruitment and outcome instruments were piloted after stakeholder engagement over two weeks in December 2023. Hypertensive (BP > 140/90) women between 24 to 36+6 weeks were eligible and consented to participation, which comprised a single blinded POC PlGF test and routine care. Outcomes were collected from medical notes, telephone follow-up, and home visits over two weeks in March 2024. Feasibility outcomes included patient recruitment, loss to follow-up, data completeness, and methods of follow-up. Clinical outcomes included maternal death, eclampsia, prematurity, birth setting, birthweight, stillbirth, and neonatal death.

Results

Thirteen eligible patients were recruited in routine antenatal clinics at two community health posts and one district hospital. All provided consent (100%). Urinalysis & ultrasound dating were not routinely available (0%). There was no loss to follow-up (0%). One patient is yet to deliver (7.69%). Twelve remaining participants had attended births at the same centre as their recruitment (92.3%). Two very abnormal (0 to 60 pg/mL) PlGF levels were measured. No maternal deaths, two term stillbirths (PlGF levels 0 & 295.06 pg/mL), one case of eclampsia (0 pg/mL), and two pre-term births (17.53 & 224.71 pg/mL) were identified. PlGF ranged from 0 to 1137.88 pg/mL (median 178 pg/mL). Analytical statistics will be performed on completion of the PINEAPPLE study.

Conclusion

One case of term stillbirth in a patient with eclampsia (PlGF 0 pg/mL) highlights the gravity of potentially preventable pre-eclampsia in the community. The piloted processes & instruments are available for a planned interventional trial of POC-PlGF to inform delivery timing decisions in Sierra Leone. Researching POC-PlGF in the community is feasible. The antenatal population shows significant maternal and fetal morbidity. Implementation strategies including community and healthcare worker engagement and expanding study sites can improve recruitment rate per day. Funder: RCOG EGA Hospital Charity Travelling Fellowship. eP-234 Postpartum depression: A prospective study investigating prevalence, risk factors, and outcomes H. Sebri; I. Hamra; A. Dhai; A. Triki; A. Ben Amor; A. Halouani Department of Gynecology and Obstetrics, University hopsital Mongi Slim La Marsa, La Marsa, Tunisia

Introduction

Postpartum depression (PPD) is a significant public health concern affecting maternal well-being and infant development. PPD can occur in the first week after delivery and is more distressing than “baby blues”. This prospective study aimed to assess the prevalence, risk factors, and outcomes of PPD in a cohort of postpartum women. Design: A total of 157 women were enrolled during their third trimester and followed up at regular intervals postpartum. The Edinburgh Postnatal Depression Scale (EPDS) was the screening tool utilized to assess PPD symptoms. Demographic, obstetric, and psychosocial factors were analyzed for their association with PPD.

Methods

Participants were assessed for PPD symptoms using the EPDS at one month interval postpartum. Demographic, obstetric, and psychosocial data were collected through interviews and medical records review. Logistic regression analysis was conducted to identify significant predictors of PPD.

Results

11.2% of women experienced PPD. Risk factors identified for PDD were: first time motherhood, financial or employment problems, lack of social support, family history of depression, previous experience of anxiety. These risk factors were being identified as significant predictors. PPD was associated with adverse maternal health outcomes and impaired infant bonding.

Conclusion

Early identification and intervention strategies are crucial in managing PPD and improving maternal and infant health outcomes. These findings highlight the need for comprehensive screening and support programs for women at risk of PPD. eP-235 Acceptability of self-sampling for DNA methylation-based cervical cancer screening in nigerian women O. Illah1; M. Paul2; P. Daru2; Y. Okunowo3; I. Morhason-Bello4; R. Anorlu3; A. Sagay2; I. Adewole4; M. Widschwendter1; A. Olaitan1 1University College London, London, UK, 2Jos University Teaching Hospital, Jos, Nigeria, 3Lagos University Teaching Hospital, Lagos, Nigeria, 4University College Hospital, Ibadan, Nigeria

Objective

Cervical cancer (CC) should be a rare disease given the effectiveness of cervical screening and Human Papillomavirus (HPV) vaccination. On the contrary, CC remains a significant global health burden. CC is commonly referred to as a disease of inequity, given the huge variation in mortality between the developed and the developing world. Current CC screening approaches have limitations due to subjectivity, high costs, and/or low specificity. This has left a gap in many developing countries for an objective screening test with improved diagnostic accuracy and lower resource intensity compared to existing tests. The ongoing PECCaN study is investigating the diagnostic performance of the WID™-qCIN test, a DNA methylation biomarker-based test, for detecting high-grade cervical premalignant disease in Nigerian women. As part of the PECCaN study, this study aims to determine the acceptability of self-sampling for DNA methylation-based testing in Nigerian women. Design: Cross-sectional observational study.

Method

Participants were recruited for the PECCaN study from a pool of patients attending hospital-based CC screening services in three teaching hospitals in Nigeria. As part of the PECCaN study, participants were asked to complete a written survey. Survey questions were analysed to determine the acceptability of self-collection for CC screening. - 120 women completed the survey. - Mean participant age was 43. - The majority of women (90%) had heard about CC. - The majority of women (86.7%) had had a previous CC screening test. - 12.5% of study participants indicated that they would prefer a self-collected cervical cancer screening test. The remainder indicated that they would prefer a clinician-collected sample. Commonly stated reasons for this preference were a lack of knowledge of how to correctly take a self-sample, and the belief that healthcare professionals would perform the procedure ‘better’.

Conclusions

The literature often quotes shame and embarrassment from intimate clinical examinations as a barrier to CC screening uptake in many developing countries. In this study, the majority of participants indicated a preference for an examination by a healthcare professional for CC screening, over a self-collected sample. This preference may be ascribed to a lack of knowledge and education of self-collection procedures. This would need to be carefully considered and addressed prior to implementing self-collected CC tests in this population, in order to ensure that the desired effect of increasing CC screening uptake is achieved. eP-269 Should we do routine appendectomy in Mucinous Borderline Ovarian Tumors? K. Azam Khalil; M. Habib; Y. Ahmed; A. Saeed Usmani; A. Ali Syed Shaukat Khanum Memorial Cancer Hospital and Research Centre, Surgical Oncology, Lahore, Pakistan

Objective

To determine the frequency of appendiceal involvement in patients who undergo surgery for mucinous borderline ovarian tumors (mBOTs) and to determine associated morbidity and recurrence after surgery. Design: Retrospective cohort study.

Method

This retrospective study was conducted in Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Pakistan. The hospital database was searched for all the patients from Jan 2008 to Dec 2022 (15 years), whose final diagnosis was mBOTs. All women who have been operated for mBOTs were included in the study. Patients who have had prior appendectomy and those with mucinous ovarian cancer were excluded. Descriptive analysis was performed for study variables. Mean ± standard deviation (SD) and median (interquartile range, IQR) was calculated for quantitative variables and frequency (%) was calculated for qualitative variables. A chi square test was used to compare the frequency distributions between categorical variables. Survival curve was calculated according to the Kaplan–Meier method. A p value of < 0.05 was considered statistically significant.

Results

Ninety cases were identified from Cancer registry whose final diagnosis was mBOTs. Of those, thirty nine cases were excluded as they didn’t fulfill the inclusion criteria. Fifty one patients were included in the study. Of these 51 patients, appendectomy was not performed in three patients and the reason was not mentioned in the record. Appendix was macroscopically abnormal in only 2 patients. None of the patients were diagnosed with mucinous borderline tumor of the appendix in our study. Appendectomy itself was not associated with any complications. Only one patient with mBOT had recurrence after 4 months of surgery which was surgically treated and no patient died during median follow up of 36 months.

Conclusion

If appendix is grossly normal looking then appendectomy should not be performed as a routine procedure to rule out primary appendiceal origin of the mucinous borderline ovarian tumor. eP-270 Robotic, laparoscopic and open hysterectomy for endometrial cancer: A comprehensive comparative analysis E. Tsakos1,2; E.M. Xydias1,2; A.C. Ziogas2,3; S. Doumouchtsis2,4 1EmbryoClinic IVF, Thessaloniki, Greece, 2Hellenic Robotic Gynaecological Society (HERGS), Thessaloniki, Greece, 3University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece, 4Epsom & St. Helier University Hospitals, Epsom, UK

Objective

To compare the performance of robotic hysterectomy (RH) with regard to surgical, anaesthesiological and oncological outcomes versus the more conventional alternatives of laparoscopic hysterectomy (LH) and open hysterectomy (OH) in endometrial cancer treatment. Design: A systematic review and meta-analysis of the available literature.

Method

The Scopus, Web of Science, Ovid, CINAHL and PubMed databases were systematically searched in accordance with the PRISMA 2020 guidelines. Published articles were screened for relevance and evaluated for risk of bias prior to their inclusion into the analysis.

Results

From the initial pool of studies, 82 ultimately fulfilled all the stringent inclusion criteria and entered the analysis. The studies were all performed between 2000 and 2018, involved 146 128 women with endometrial cancer who underwent hysterectomy in total, with 71 100 of said hysterectomies performed on a robotic system. The mean age of the patients ranged from 49.4 ± 9.4 to 78 ± 4 years and the mean BMI from 23.4 ± 3.1 to 51.6 ± 6.9. The majority of cancer cases were stages I-II and of low-grade, endometrioid histology. The surgical outcomes for RH were as follow: operative time was longer than both alternatives, intra-operative blood loss was lower than OH (even lower in elderly and obese women) and LH, necessity of transfusion was lower than OH but similar to LH, excised pelvic lymphnodes were fewer than OH, but more than LH, complication rate was lower than OH, but similar to LH, length of stay was shorter than both (even shorter for elderly and obese women), readmission rate was lower than OH but similar to LH, conversion to laparotomy rate was lower than LH (even lower in obese women) and same day hospital release rate was higher than LH. Anaesthesiological outcomes for RH: PACU opioid usage was lower than both, hospitalization opioid usage was lower than OH but similar to LH and post-operative pain was lower than both. Oncological outcomes: recurrence rate was lower than OH but similar to LH and overall survival was higher than OH but similar to LH.

Conclusions

RH outperformed OH in almost every outcome and was at least equal to LH, while offering significantly lower morbidity (lower conversion to laparotomy rate) and speedier recovery (shorter length of stay, increased same day release rate, reduced post-operative pain) than the latter. The aforementioned advantages were even more prominent in special patient subgroups, particularly women with obesity. eP-272 Endometrial cancer rates in HRT users with postmenopausal bleeding N. Farmer; M. Omura; C. Buchanan; M. Macdonald Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

Objective

To determine the endometrial cancer rate of hormone replacement therapy (HRT) vs. non-HRT users referred to secondary care with postmenopausal bleeding. Design: Retrospective cohort study in a rapid access gynaecology clinic at a tertiary hospital. This was to ensure the data collected were representative of the general population.

Method

All women referred to Sheffield Teaching Hospitals NHS Foundation Trust outpatient gynaecology service on a suspected cancer pathway with postmenopausal bleeding, aged under 60 years, were included. Data from 1 January 2019 to 31 December 2022 inclusive were collected retrospectively and HRT status and subsequent diagnosis noted. 3173 women were included. Data were analysed using Microsoft Excel and Graphpad Prism used to perform Chi-squared test to determine statistical significance.

Results

3173 women were included. 897 women were taking HRT at the time of postmenopausal bleeding, and 5 of these were subsequently found to have cancer (4 endometrial, 1 ovarian), giving a cancer detection rate of 0.56%. Contrastingly, 2261 women were not taking HRT at the time of symptoms and 61 of these were found to have cancer (56 endometrial, 3 cervical, 2 ovarian), giving a rate of 2.70%. Chi-squared analysis showed that this was statistical significant (p = 0.0001).

Conclusions

Endometrial cancer rates are extremely low in patients under 60 years presenting with postmenopausal bleeding whilst taking HRT. Women presenting who have recently started, or changed preparations of, HRT within the previous six months should be reassured and managed in primary care or referred non-urgently in the absence of other risk factors. eP-275 Emotional experiences of women after mastectomy surgery: Insights from a research study H. Aloui; F. Slama; H. Frikha; W. Khayati; S. Dhaoui Department C, Maternity and Neonatology Center of Tunis, Tunis, Tunisia

Objective

Breast cancer affects many women and is a top cause of cancer-related deaths. The treatment journey is tough and often lengthy. Giving emotional support, from diagnosis to recovery after surgery, helps patients cope with the disease and body changes. This study aims to understand different emotions after mastectomy surgery to improve care and support. Design: A prospective study was conducted.

Methods

This investigation enrolled 40 participants over a one-year period (March 2023 to March 2024), employing structured direct interviews and questionnaire-based data collection. Eligible participants comprised women who underwent either unilateral or bilateral mastectomy following breast cancer diagnosis at the Maternity and Neonatology Centre of Tunis, Department C.

Results

The mean age of participants was 54 years, with 70% reporting marital status. Anxiety was prevalent in 90% of cases, while over 60% articulated diminished perceptions of physical attractiveness. Additionally, 80% reported feelings of social isolation, and 50% expressed apprehensions about becoming a burden to their support network. More than half of the patients (56%) experienced disruptions in their sexual functioning, with 38% expressing interest in breast reconstruction.

Conclusion

Life after cancer surgery can be tough emotionally. Many patients still struggle with the effects of the disease and treatment. This shows the importance of having emotional support available throughout the cancer journey. eP-276 Tamoxifen therapy in menopausal breast cancer patients: An in-depth look at endometrial pathology T. Ben Necib; S. Bayar; H. Sebri; F.E. Tekaya; I. Hamra; A. Triki; A. Halouani Department of Gynecology and Obstetrics, University Hospital Mongi Slim La Marsa, La Marsa, Tunisia

Objective

To asses endometrial abnormalities associated with tamoxifen therapy in menopausal patients with breast cancer. Design: An observational longitudinal study was conducted including 18 patients over a period of 2 years, from January 2020 to December 2021.

Method

Menopausal patients receiving adjuvant tamoxifen therapy for breast cancer and diagnosed with endometrial abnormalities were enrolled in our study. Endometrial thickness prior to tamoxifen therapy was less than 5 mm in all patients. A regular 6-month follow-up was performed, including physical examination and transvaginal ultrasound (TVS) for endometrial assessment. Patients diagnosed with endometrial abnormalities underwent hysteroscopy for endometrial biopsy. Histological sampling of endometrial tissue was conducted. Quantitative variables are represented in medians (DS) and frequencies (Percentages).

Result

In our study, we observed that the mean age of the patients was 59.3 ± 7 years. The total treatment duration averaged 31.4 ± 16 months. Abnormal uterine bleeding was a common presentation, noted in 8 patients (44.4%). Among the endometrial abnormalities, multiple endometrial polyps were the most frequently reported, affecting 50% of the patients. 33.34% thickened endometrium and 16.66% non uniform heterogeneous endometrium were found in the transvaginal ultrasound. Pathological analysis revealed that 44.4% of the cases (n = 8) showed simple endometrial hyperplasia without atypia. Endometrial benign polyps were identified in 50% of cases (n = 9). One case of endometrial hyperplasia with atypia was identified.

Conclusion

Our study highlights the importance of careful monitoring and management of endometrial abnormalities in patients undergoing tamoxifen therapy for breast cancer. These findings are particularly relevant as both breast cancer and endometrial cancer are hormone-dependent cancers, and tamoxifen, is a cornerstone therapy in the treatment of hormone receptor-positive breast cancer. The prolonged use of tamoxifen can lead to endometrial hyperplasia and an increased risk of endometrial cancer. Therefore, it is crucial for clinicians to remain vigilant for endometrial abnormalities in patients receiving tamoxifen therapy. Regular monitoring through imaging and histological evaluation can help detect and manage these abnormalities early, thus minimizing the risk of serious complications such as endometrial cancer. Collaborative efforts between oncologists, gynecologists, and pathologists are essential in providing comprehensive care for these patients. eP-277 Predictors of Single-agent resistance in LOW RISK Gestational trophoblastic neoplasia B. VijayKumar1; J. Ramesh Chandran1; S. Kuriakose2 1Government Medical College, Obstetrics and Gynecology, Kozhikode, India, 2Government Medical College, Gynecologic Oncology Division, Kozhikode, India

Objective

To determine the predictors of chemoresistance to first line Single agent chemotherapy with methotrexate in low risk Gestational trophoblastic neoplasia (GTN) and to analyse the clinical characteristics and treatment outcomes in FIGO score 5,6. Design: Retrospective Cohort study.

Method

Clinical notes of Low risk GTN patients with FIGO score 0–6 from January 2014 to January 2023 were retrospectively reviewed to assess treatment outcomes and subsequent resistance. For the purpose of comparison, sub-stratification of FIGO/WHO low riskgroup (≤6) into low (0–4) and intermediate (5–6) risk was done. All patients who had been followed up for at least 12 months after remission were included. Variables associated with chemoresistance to single agent therapies were identified by using Chi Square and Fisher's Exact test. Odd's Ratio and corresponding 95% confidence interval was calculated to analyse the strength of association between drug resistance and clinicopathological variables.

Results

88 women diagnosed with low-risk GTN were included. The rates of complete response to first-line single agent chemotherapy was 90.9%. Switching to second-line treatment due to chemoresistance to single-agent Methotrexate occurred in 9.1% cases. Of these Second-line treatment with Actinomycin-D succeeded in 4 cases and 4 cases needed multiagent chemotherapy although all patients had a complete remission after a combination of chemotherapy and/or surgery. 2 patients needed hysterectomy as adjuvant treatment. Patients having FIGO scores of (5–6) had a 6.6 fold higher chance of developing resistance (OR = 6.6, 95% CI = 1.24–35.01). 20% of patients with risk score of 5,6 developed resistance to single agent. Higher risk of resistance was seen among patients with metastasis (OR = 13; 95% CI = 1.54–109.24: p value 0.04), high pretreatment β-hCG (>1 Lakh IU/L) (OR = 12.33; 95% CI = 2.44–62.10; p value 0.005) and a diagnosis more than 4 months after pregnancy event (OR = 5.66; 95% CI = 1.24–25.79; p value 0.034), compared with their referencegroup. 25% of patients with a choriocarcinoma histology developed resistance. Univariable and multivariable logistic regression revealed metastatic disease status, choriocarcinoma histology, and pretreatment human chorionic gonadotropin concentration as significant predictors of resistance to single-agent therapies.

Conclusion

Risk of chemotherapy resistance was higher in women with risk score 5,6. Controversy remains as to whether such patients should initially receive single-agent chemotherapy or more toxic multiagent chemotherapy. Clinical trials with larger number patients are needed to suggest a better treatment program for the intermediate risk group. eP-278 Patterns of presentation in cervical cancer – Learning points from a cohort G. Pearson Salisbury NHS Foundation Trust, Salisbury, UK

Objective

Cervical cancer remains one of the most common cancers in women worldwide despite effective screening programmes and vaccines. In the UK the NHS Cervical Screening Programme has been established since 1988 and while it has dramatically reduced rates of cancer, around 2500 women per year are still diagnosed (those that have engaged in screening and those who have not). These women are enrolled in an invasive cancer audit (ICA). We present information from our ICA from 2020 to 2023 with particular emphasis on learning points for those practicing in a generalist setting. Design: Invasive (cervical) cancer audit from a District General Hospital in England providing secondary care gynaecological-oncology/colposcopy services.

Method

Analysis of women diagnosed with cervical cancer (squamous, adeno and other) between 2020 and 2023 and registered for invasive cancer audit.

Results

In total 42 women were diagnosed over the study period. 17 had a diagnosis at stage 1a1 (median age 35), 9 at 1B+, 4 at stage 2B, and 11 at Stage 3 or 4 (median age 76); although 2 of these cancers were screen-diagnosed. While 28 cancers were detected by the screening programme, 15 (36%) women presented to gynaecology clinic; 95% of the latter were diagnosed at stage >/= 2B. In this cohort 21% had adenocarcinoma; 44% of these women had screening with the last 3 years.

Conclusions

While the UK's ICA is mainly designed to audit the screening programme, it can provide valuable information to generalists. Many women present after their screening has finished, referred on a postmenopausal bleeding pathway and had engaged in the screening programme. While most women were diagnosed with early stage disease, advanced disease disporportionately affect those older women with postmenopausal symptoms. Furthermore, glandular lesions are not as reliably detected by the screening programme as squamous lesion. Last screen date outwith programme intervals, persistent irregular bleeding despite a negative smear, or postmenopausal bleeding >65 (age of discharge from the screening programme) regardless of endometrial thickness should provoke consideration of cervical carcinoma as a differential diagnosis and colposcopy considered. There may be benefit from 'diagnostic LETZ' or endocervical/endometrial biopsy (aspirate or curettage) where the transformation zone is not easily accessible. However, our series suggests most benefit would come from continuing to promote adherence to screening intervals to protect from cervical cancer. With the current issues in English Public Health and crisis in Primary Care, this latter recommendation is likely to be challenging to achieve. eP-279 The Queen Elizabeth Hospital gynaecology post-menopausal bleeding One Stop Clinic S. Al-Juboori; H. Brown The Queen Elizabeth Hospital Kings Lynn, Obstetrics and Gynaecology, Kings Lynn, UK

Objective

The Queen Elizabeth Hospital (QEH) gynaecology department has sustained continually significant pressures to facilitate cancer pathways in an adequate timeframe. The QEH have trialled a ‘One Stop Clinic’ (OSC) to mitigate the increasing referral numbers and improve our ‘Faster Diagnostic Standard’ rates and patient outcomes. Design: This OSC aims to combine the initial outpatient appointment, with imaging studies, and if deemed appropriate hysteroscopy plus treatment and/or biopsies. To facilitate and expand this clinic, the hospital now needs to invest in equipment, planning, new patient leaflets, and increased staffing, and the department has created several new OSC leaflets. The OSC has many positives, including reducing the time between a suspected cancer referral and the diagnosis, providing patient empowerment through knowledge and understanding of their diagnosis early. The clinic helps to reduce anxiety for patients awaiting outcomes and result of diagnostic tests. It benefits the QEH elderly population with fewer visits to the hospital for patients by combining clinic appointments and telephone consultations. The service benefits the links between primary and secondary care with new implementation of the e-referral pathways and triaging. It improves the ability to meet increasing demands and ensure best utilisation of a highly skilled workforce and resources.

Method

In the continued development of the OSC, we aim to reform the triaging process for e-referrals, to help provide a better patient experience and transform the early diagnosis pathway. A dedicated team of clinicians, nurses, other health care professionals collaborated to modify the clinic set-up and increase supplies and equipment. Together, we created a ‘One-Stop Clinic’ pack which includes the pre-filled consent form and three newly designed leaflets providing information on hysteroscopy procedure, Mirena coil insertion and Pipelle biopsy. This clinic pack is sent to the patient by post with an appointment letter to prepare them for the appointment and give information.

Results

Based on early statistical data, there have been a total of 120 e-referrals to the OSC between 14/11/23 and 26/03/24, with 84 cased completing the pathway. Of these 84 referrals, 21 patients required hysteroscopy, and 2 had a confirmed cancer diagnosis. Overall, 47 patient pathways were closed within the 28-day target.

Conclusions

The continued development of the OSC will be driven by MDT collaboration and feedback review through quarterly reporting to evidence project success and improvements. The results are positive thus far with 56% of patients meeting the NHS England 28-day diagnosis for gynaecological cancers. eP-280 Evaluation of serum CYFRA 21-1 in women with cervical cancer in Lagos S.A. Yusuf-Awesu1,2; A.A. Okunowo3; O.E. Familusi2; F.O. Gabriel-Raji2; O. Olorunfemi4; R.I. Anorlu3 1North Middlesex University Hospital, Obstetrics and Gynaecology, London, UK, 2Lagos University Teaching Hospital, Obstetrics and Gynaecology, Lagos, Nigeria, 3College of Medicine Lagos University Teaching Hospital, Obstetrics and Gyanecology, Lagos, Nigeria, 4University of Witwatersrand, Division of Epidemiology and Biostatistics, Johannesburg, South Africa

Introduction

Cervical cancer has remained a public health problem with a very high burden in low and middle- income countries due to multiple factors, including the lack of established population-based screening programmes. As a result, there is a need for highly sensitive, specific and minimally invasive biomarkers for early detection, prognostication and management of cervical cancer. Cytokeratin 19 fragment antigen (CYFRA 21-1) is one of the few serum biomarkers that have been studied for its utility in the clinical diagnosis and prognostication of cervical cancer. However, there is no traceable evidence in the literature, investigating this biomarker in an African population where the disease burden is high.

Objective

We aimed to measure the serum CYFRA 21−1 level in women with and without cervical cancer and to assess its relationship with cervical cancer in Lagos Nigeria. The study set out to answer this question; Is there a significant relationship between serum CYFRA 21-1 and cervical cancer. Design: This was an analytical cross-sectional study among women with and without cervical cancer who received care at the gynaecological oncology and oncology clinics at Lagos University Teaching Hospital (LUTH) Lagos, Nigeria.

Methods

Eligible participants for both the case and comparative groups were selected using convenient sampling method. A total of 150 participants were recruited. Consent was obtained and appropriate information was obtained using a structured proforma. Blood sample was collected from each participant, stored at −80oC and later analysed for serum CYFRA 21-1 using Human CYFRA21-1(Cytokeratin Fragment Antigen 21-1) ELISA Kit. Data analysis was done using Stata version 17 (StataCorp, USA) Statistical software for analysis.

Result

Fifty-six percent of the women with cervical cancer had late-stage disease. The mean serum CYFRA 21-1 level in women with cervical cancer is 0.6 ± 0.09 g/dL while the mean serum level in women without cervical cancer is 0.4 ± 0.04 g/dL, this was however not statistically significant on both univariate and multivariate analysis (p > 0.05). However, serum CYFRA 21-1 level was significantly associated with stage of cervical cancer with late stage disease having significantly higher level of serum CYFRA 21-1 as compared to early stage disease.

Conclusion

Serum CYFRA 21-1 may be a useful indicator of the stages of cervical cancer disease and prognostication but not for detection purposes. However, more robust population-based studies are needed to further investigate this association. eP-281 Revolutionizing cervical cancer screening: The cost-effective quest for accuracy S. Athar Department of Obstetrics and Gynecology, Al Wakra Hospital, Al Wakra, Qatar

Objective

New methods of screening cancer cervix such as Care HPV assays, Hybrid Capture 2 test, TERC detection, p16/Ki-67 dual-staining, and optical methods are emerging as cost-effective and efficient alternatives to conventional methods. These tests have shown higher sensitivity and specificity, reducing the need for unnecessary follow-ups. This aim of the study is to review the diagnostic accuracy and cost-effectiveness of alternative methods of cancer cervix screening. Design: A narrative literature review.

Method

An internet-based literature search was performed for all the available methods of cancer cervix screening in the PubMed/MEDLINE, Scopus, Cochrane, and EMBASE databases. The studies published between 1990 and 2020 on the specified topic were evaluated. 52 studies were included in the review. Relevance screening, data extraction, risk of bias analysis, and quality assessments were conducted. The sensitivity and specificity of different screening methods and their cost-effectiveness were evaluated.

Results

Care HPV assays and Hybrid Capture 2 tests are both sensitive and specific for detecting oncogenic HPV infections in cervical samples. However, Care HPV assays are more sensitive (91.1%) than Hybrid Capture 2 tests (82.9%). HPV DNA tests, on the other hand, have been shown to have higher sensitivity than both Care HPV assays and Hybrid Capture 2, but are generally more expensive and technically complex. Detected TERC is a promising method for predicting the progression of CIN1/2 to CIN3, with 100% sensitivity and 70% specificity for identifying individuals at high risk for cervical cancer. However, TERC detection requires specialized equipment and may be more expensive than other available methods. The p16/Ki-67 dual-staining method is a cost-effective tool and has a sensitivity ranging from 74.9% to 90.9%, and a specificity ranging from 72.1% to 95.2%, depending on the study. The limitation of this method is that it does not detect HPV infection directly and therefore must be used in conjunction with other tests. Optical methods of screening are emerging as accurate, non-invasive and cost-effective alternatives to traditional Pap smear tests. They have high sensitivity rates ranging from 90% to 98%, though lower specificity rates. Optical methods may be considered as the first-line screening and triage during the same medical visit, thus, significantly reducing the cost.

Conclusion

The novel methods of cervical cancer screening have shown promising results in terms of diagnostic accuracy and cost-effectiveness compared to conventional methods. With higher sensitivity and specificity, these tests can help reduce the number of unnecessary follow-ups and provide early detection of cancer. eP-282 The swede score using retrieved images from a hand held colposcope J. Susan Thomas1; S. Selvaraj2; S. Korah Kuruvila2 1Khoula Hospital, Obstetrics and Gynecology, Ruwi 112 muscat, Oman, 2Pondicherry Institute Of Medical Sciences, Obstetrics and Gynecology, Puducherry, India

Objective

To compare the Swede Colposcopy score done on patients with that done on retrieved colposcopic images and to evaluate the inter-observer variation using retrieved images. Design: Cross-sectional Study. This study focuses on the telemedicine resources using mobile phones and high-resolution images in the field of cervical cancer screening techniques.

Method

The study included 400 women at a risk of cervical cancer attending the gynaecology clinic and excluded pregnant women, during menstruation, women 64 years, patients with history of hysterectomy for benign diseases and past history of treatment for CIN or carcinoma cervix. The vagina and cervix were inspected with the help of a handheld colposcope, Gynocular, which functioned as a binocular or a molecular microscope to magnify the view of cervix, vagina and vulvar surface. Visual inspection with acetic acid and Lugol's iodine under magnification was performed and images. The Swede scoring was done. These pictures along with the patient's information obtained were saved to the accessories of the colposcope which is the smart phone. The images were uploaded to Icloud software. These images were under security control and was visualised by the trained gynaecologist. Swede scoring was done again by the trained gynaecologist based on the pictures available. These pictures were also scored by the colposcopist. The data collected was then entered into an Excel spreadsheet and percentage of agreement between observers were analyzed with SPSS.

Result

The percentage of agreement between direct visualisation using hand held colposcopy and retrieved image based Swede scores was found to be 66.75%. It shows fair agreement was found between two methods with a kappa value of 0.341. The percentage of agreement between the observers using retrieved images was found to be 94.00% with Kappa = 0.931, SE of kappa = 0.014, 95% confidence interval from 0.905 to 0.958. The strength of agreement is 'very good'.

Conclusion

The use of a handheld battery operated colposcope and transmission of images could be the basis of a home – based screening program in the future. eP-283 Audit of clinical outcome of patients referred for evaluation of postmenopausal bleeding A. Iqbal; H.-K. Ojikutu-Shodipe; S. Akhtar Wye Valley Trust, Hereford county Hospital., obstetrics and genecology, Hereford, UK

Objective

Effective and systematic approach in screening patients presenting with postmenopausal bleeding (PMB) is essential to correctly identify the sinister causes requiring urgent intervention. The aim of our audit was to assess the performance of our gynecology department in evaluating patients presenting with PMB against set standards. Design: Retrospective audit performed to identify the factors which can be addressed to optimize the existing services.

Methods

Retrospective data over four months (1/09/2023–31/12/2023) was collected using patient medical records, imaging and pathology databases. Inclusion criteria were all women presenting with bleeding after more than 12 months of amenorrhea. Evaluation included assessment of risk factors, endometrial thickness on imaging, endometrial pathology results and reason for hysteroscopy referrals.

Results

Data for 91 cases was analyzed. Mean age was 58.2 years, 34.7% patients had BMI of 30 or above. The most common risk factor identified was the usage of hormone replacement therapy (HRT) which was present in 38% of cases. Transvaginal assessment of endometrial thickness was performed for all patients. 39.5% (36) patients had endometrial thickness (ET) less than 4 mm, out of which 58.3% (21) were discharged after examination. The remaining were evaluated with either endometrial biopsy or hysteroscopy due to presence of risk factors. Eventually all patients with ET less than 4 mm were discharged after histology results. Among patients having ET of more than 4 mm, 56.3% (31/59) were discharged after normal result of endometrial biopsy, while 36.3% (20) were referred for hysteroscopy. 4 cases (4.3%) of endometrial precancerous or cancerous changes were diagnosed on biopsy who were fast-tracked for surgery. No sinister pathologies were identified in any woman on HRT.

Conclusion

The audit identified adequate adherence to local protocols as well as areas of improvement. Hysteroscopy referrals can be reduced further if correct risk assessment is performed in the clinic and in evaluating the biopsy results. The ever-rising popularity and usage of HRT is causing an increased load on the system and resources for evaluation of irregular bleeding patterns. The requirement for revising the ET cut-off threshold for screening of women on different forms of HRT is the need of the hour. eP-335 Evaluation of the utilization of thrombo-prophylaxis in out-patient pregnant women at SQUH R. Al Haddabi1; S. Mubasher2; R. Al Rashdi2 1Sultan Qaboos University Hospital, OBGYN, Muscat, Oman, 2Sultan Qaboos University, OBGYN, Muscat, Oman

Objectives

and Rationale: To find the prevalence of Omani pregnant women with thrombo-prophylaxis medication, to evaluate the adherence and non-adherence to the medication and to discuss the possible factors contributing to not adhering to the medication in Sultan Qaboos University Hospital (SQUH) in Oman.

Materials and methods

A cross-sectional survey conducted in Obstetrics and Gynecology (OBGYN) clinic in SQUH between November 2018 and January 2019. With the help of the hospital electronic medical records, total number of pregnant women who visited OBGYN clinic at the study period were included in this study and the number of patients who were on thrombo-prophylaxis medication was obtained. Patients were grouped into adhering and non-adhering group according to WHO definition of non-adherence. Different parameters were collected from a question sheet which was distributed to the targeted patients and data were compared between the two groups by SPSS version 23.

Results

Total number of pregnant women who visited OBGYN at the study period was 375 patients. Out of them, 75 patients were prescribed on thrombo-prophylaxis but 65 agreed to be part of the study. About 73.8% of patients were on anticoagulant drugs throughout pregnancy while the rest started the drug from week 28 onwards. It was found that 33.8% of pregnant women on anticoagulant drugs do not adhere to their medication. Forgetfulness was the main reason of not adhering at 71.4% whereas 28.6% stated non-adherence due to other reasons. One significant factor that led to low adherence was in case of noticing any medication side effect and stopping the medication immediately. Other factors are discussed in the result section.

Conclusion

Proportion of pregnant women who are prescribed thrombo-prophylaxis in the study period was 20%. Majority of pregnant women on thrombo-prophylaxis medication are highly adherent to their therapy. Minority that did not adhere to medication stated non-adherence due to forgetfulness. Front-line clinical staff should stress in informing the patient about adherence importance and may suggest medication reminder apps. eP-336 Magnesium sulphate and short term neonatal outcomes M. Jahan; A. Ahmed; B. Ishaq; A. Asif; S. Mushtaq Pakistan Institute of Medical Sciences, Islamabad, Pakistan

Objective

To compare efficacy of antenatally administered parenteral magnesium sulphate verses controls on short term neonatal outcomes at pre-term birth between 28 to 34 weeks of the gestation. Study Design: Randomized Control Trial. Methodology: A total of 136 patients at gestational age between the 28 to 34 weeks were included in study with 68 patients in each group. After approval of Institutional Ethical Committee, all the patients presenting at mother and child health center unit 1 and fulfilling inclusion criteria were selected after the informed verbal consent. All women with the singleton pregnancy at gestational age between the 28 to 34 weeks were recruited in study and were divided into the two groups; group A & group B. Group A was controls and Group B was cases that received Magnesium sulphate 1 g/h for at least 12 to 24 h. Neonatal outcome of the study was assessed in terms of need for resuscitation at the time of birth, five-minute APGAR score, Respiratory distress syndrome, Nursery/NICU admissions, intraventricular haemorrhage, neurologic dysfunction and neonatal death.

Results

The mean age of patients in Group A (Control) was 29.35 ± 4.01 and in Group B (Cases) was 29.40 ± 4.41. The mean gestational age of patients in Group A (Control) was 30.85 ± 2.07 and in Group B (Cases) was 30.82 ± 2.12. The results of our study showed that women who received magnesium sulphate had better 5- min APGAR score (8.50 ± 0.50 vs. 7.62 ± 0.49, p = 0.000), duration of nursery (4.97 ± 0.86 vs. 5.66 ± 1.42, p = 0.001), resuscitation at birth (23.5% vs. 42.6%, p = 0.018), respiratory distress syndrome (16.2% vs. 35.3%, p = 0.011), intraventricular haemorrhage (20.6% vs. 36.8%, p = 0.037), neurological dysfunction (17.6% vs. 32.4%, p = 0.048) and neonatal death (7.4% vs. 23.5%, p = 0.009). Also the side effects (flushing/hot flashes, nausea/vomiting and blurred vision) were rarely observed in women who received magnesium sulphate.

Conclusion

In our study we concluded that administration of the antenatal magnesium sulphate to women in preterm labour has better neonatal outcome. Magnesium sulphate is safe and effective in use. eP-337 Spontaneous ureteric injury following a vaginal birth: A rare case report J. Karpagavalli Sankar; V. Kumar; O. Ilori; G. Goumalatsos Basingstoke and North Hampshire Hospital, Obstetrics and Gynaecology, Basingstoke, UK

Objective

Spontaneous ureteral injury, defined as injury which occurs in the absence of any interventional procedure, external trauma or surgery, is a rare cause of acute abdominal pain. Intrapartum rupture of the ureter is an uncommon complication and in the absence of known renal pathology is particularly rare. Complications of ureteral rupture include urinoma, abscess and sepsis t is important to consider this as a potential cause of acute abdominal pain in the obstetric population so that the diagnosis is not delayed. Case Report: A 35 year old Para 2 low risk pregnancy following a vaginal birth with epidural analgesia was transferred to the post natal ward. Six hours following birth she was reviewed for severe right sided leg pain and abdominal pain radiating to the shoulder tip. Upon further evaluation, it was noticed that the symptoms started whilst in labour. In examination patient appeared unwell with tachycardia and hypotension with very tender abdomen. Subsequently patient's meows detoriated and CT abdomen and pelvis was done which showed a right ureteric injury. She was then referred to the urologist where the rupture was noted at right proximal ureter which was repaired and a stent was inserted.

Discussion

Spontaneous ureteral rupture is defined as ureteral damage in the absence of external trauma, degenerative kidney disease, previous surgery or iatrogenic manipulation . Ureteral rupture is caused by increased pressure in the renal collecting system when pressure exceeds a critical level, reported as 20 mmHg to 75 mmHg, rupture may occur. The most common causes of increased intraluminal pressure are nephrolithiasis or ureteric strictures. Rarely, malignancy, bladder retention or external compression by tumours, vascular structures, or the gravid uterus can elevate pressure in the ureter, causing ureteric injury. Renal tract injury during pregnancy or delivery, whilst very rare, has been described at the distal, mid and proximal ureter as well as at the renal calyces and the bladder. Rupture of the ureter is an exceptionally rare obstetric complication. Complications of ureteral rupture include urinoma, abscess and sepsis.

Conclusion

This case compels us to consider spontaneous ureteral rupture in the differential diagnosis for postpartum abdominal pain when common causes have been ruled out. We report this case to inform clinicians of this rare complication so that diagnosis is not delayed. Diagnosis can be made with contrast-enhanced computed tomography scan and cystoscopy, and ureteral stenting is a reasonable option for management. eP-338 Serum sFlt/PlGF can predict morbidity and shorter interval to delivery in preeclampsia M. Suiters1; M. Hendrix1; J. Bons2; S. Al-Nasiry1 1Dept. of Obs&Gyn, Maastricht University Medical Centre, Maastricht, Netherlands, 2Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, Netherlands

Objectives

Placental angiogenic factors soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are useful serum biomarkers in the triage of suspected pre-eclampsia (PE). We aimed to examine differences in placental angiogenic biomarker levels stratified according to three final clinical outcomes; diagnosis of PE, maternal morbidity, and neonatal morbidity, and to assess the predictive value of the sFlt-1/PlGF ratio > 38 and > 85 for the above mentioned outcomes and delivery within one, two and three weeks from sampling. Design: Retrospective cohort of mixed risk women in a tertiary academic centre.

Methods

Serum sFlt1/PlGF ratio levels were retrospectively measured in a cohort of singleton pregnancies attending antenatal clinic. The predictive value of sFlt-1/PlGF for PE, maternal and neonatal morbidity, and interval to delivery was analyzed. Maternal morbidity was defined as one or more of the following; severe hypertension, low platelet count, impaired liver function, increased serum creatinine, pulmonary edema or new-onset cerebral or visual disturbances. Neonatal morbidity was defined as one or more of the following; admission to the neonatal unit, low Apgar score or delivery with metabolic acidosis. Time to delivery was defined as the number of days between the blood sample collection and delivery. One-way analysis of variance (ANOVA) and the bonferroni post hoc test was used to compare continuous data. Pearson's chi-square or Fisher's exact test was used to compare frequencies.

Results

A total of 289 pregnancies were included. sFlt-1/PlGF ratios were significantly lower in the reference group of no PE (n = 185) compared to the confirmed PE group (n = 23), and the suspected PE group (n = 81). Ratios > 38 were strongly associated with PE (OR = 12.2 (95% CI 4.9–30.7; p < 0.001)), neonatal morbidity (OR = 4.0 (95% CI 2.0–8.0; p < 0.001)) and maternal morbidity (OR = 22.1 (95% CI 8.7–56.2; p 38 were also strongly associated with a shorter time to delivery compared to ratios ≤38: OR = 20.0 (95% CI 6.0–66.5; p < 0.001), OR = 9.2 (95% CI 4.0.-21.2; p < 0.001), and OR = 14.6 (95% CI 6.8–31.6; p < 0.001), respectively for delivery within one, two and three weeks from sampling.

Conclusions

This study suggests that high sFlt-1/PlGF ratios are associated with pre-eclampsia, maternal and neonatal morbidity and a short time to delivery. The test has the potential in guiding individualized monitoring in women with high risk of pre-eclampsia. eP-339 Placental biomarkers in prediction of adverse neonatal outcomes in fetal growth restriction M. Hendrix1; J. Bons2; S. Al-Nasiry1 1Dept. of Obs&Gyn, Maastricht University Medical Centre, Maastricht, Netherlands, 2Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, Netherlands

Objectives

In fetal growth restriction (FGR), the fetus is unable to reach its predetermined growth potential due to impaired placental function. This is associated with short and long-term health risks. Identifying true fetal growth restriction (FGR) from constitutionally small fetuses remains a challenge since these definitions are arbitrary and validation of robust definition is urgently needed. A consensus-based definition for both early and late FGR have been determined by a panel of experts through a Delphi procedure. This study aims to investigate whether the Delphi FGR definition and placental biomarkers (sFlt-1 and PlGF) can better predict adverse neonatal outcomes (ANO) than the standaard definition of FGR based on AC or EFW <10th centile. Design: retrospective cohort study in a tertiary academic centre.

Methods

In this retrospective cohort of women with singleton pregnancies delivered in Maastricht UMC, FGR diagnosis using Delphi criteria was based on biometry and Doppler measurements from medical records. Placental biomarkers sFlt-1 and PlGF were measured in blood samples collected after 24 weeks gestation. Outcomes were compared between the "FGR Delphi" group, the FGR group not fulfilling Delphi criteria "FGR non-Delphi" and a reference non-FGR group. The predictive value of Delphi and biomarkers was calculated for developing composite ANO: 5-min Apgar score <7, metabolic acidosis (cord blood pH 10 mmol/L) and admission to the neonatal intensive care unit.

Results

We included 289 pregnancies, of which 57 pregnancies had an AC or EFW <10th centile. There was a significantly higher risk of composite ANO in the Delphi group compared to non-Delphi (RR = 5.5). The Delphi group has a significantly higher sFlt-1/PlGF ratio compared to reference or non-Delphi, and this higher ratio leads to an increased risk of composite ANO (RR = 3.1). The combination of Delphi with the biomarker ratio in the prediction of ANO showed excellent discriminatory ability (AUC = 0.833, p < 0.001).

Conclusions

Both the Delphi FGR definition and the sFlt-1/PlGF ratio are able to identify fetuses at increased risk for adverse neonatal outcomes. The combination of Delphi and biomarkers is superior in the prediction of ANO in a standard IUGR group. This combination has the potential to identify true FGR fetuses from constitutionally small fetuses. eP-340 Case series on ara stitch in morbidly adherent placenta previa S. Deshmukh; A. Anand Grant Government Medical College Mumbai, Obstetrics and Gynaecology, Mumbai, India

Introduction

The incidence of morbidly adherent placenta, a life threatening hemorrhagic condition is gradually increasing owing to the increase in the incidence of cesarean section. In cases of central placenta and morbidly adherent placenta previa, massive pelvic hemorrhage is dangerously inevitable and life threatening. The Ashok Anand's stitch is an easy, simple, less invasive and effective technique in controlling lower segment bleeding in cases of placenta previa during cesarean section, thus efficiently decreasing blood loss and avoiding the need for blood transfusions and obstetric hysterectomy and decreasing the possible risk to maternal life. Aims and Objectives: Case series on ARA STITICH in placenta accreta spectrum.

Materials and methods

We hereby present cases in which we took this stitch. Logic behind the stitch is that when the placenta is previa, the blood supply is maximally from the descending cervical and collaterals. Taking this stitch bilaterally occludes the collaterals supplying the lower segment, hence achieving hemostasis by their occlusion. Along with bilateral uterine artery ligation there is devascularsation of lower segment making placenta easy to seperate. Blood loss was estimated by standardized visual method. The demography data we recorded included, maternal age, parity, the number of previous abortions, number of previous scars and gestational age. Our variables of interest were indications of cesarean section; the type of CS; admission to the ICU; blood transfusion; length of hospital stay as well as fetal and maternal morbidity and mortality.

Results

With the use of the stitch, there was significant reduction in the blood loss intra-operatively, and creates an almost bloodless field during the detachment of the morbidly adherent placenta, thereby reducing the need for blood transfusion and even the need for obstetric hysterectomy. Also owing to the reduced maternal morbidity and mortality with this simple stitch.

Conclusion

Ashok Anand's stitch is a simple and effective technique in controlling lower segment bleeding in cases of placenta previa during cesarean section thus avoiding the need for blood transfusions for operative blood loss and obstetric hysterectomy. The technique is easy to apply, less invasive and does not require any special instruments. It has been used in 450 cases till date. Obstetric hemorrhage, being one of the leading causes of maternal deaths in India, is the leading indication for obstetric hysterectomy. Key to successful outcome is awareness, anticipation, preoperative counseling, planning and multidisciplinary team. eP-341 Causes of stillbirths and maternal deaths in Pakistan – National household survey analysis S. Nausheen1; I. Hussain2; S. Soofi2; S. Nooruddin2 1Aga Khan University, Ob/Gyn, Karachi, Pakistan, 2Aga Khan University, Women and Child Health, Karachi, Pakistan

Objectives

The global impact of stillbirths and maternal deaths is enormous, with over 2 million deaths occurring each year, affecting public health outcomes and global development practices. Despite Pakistan's commitment to SDGs, the country faces a substantial burden of stillbirths and maternal deaths; however, the information is limited on cause-specific mortality and timing of deaths. In this context, this study aims to estimate the cause distribution and proportion of stillbirths (antepartum and intrapartum) and maternal deaths among married women aged 12–49 years, through high-quality, standardized population-based data. Design: A retrospective survey was conducted in urban and rural households from all four provinces of Pakistan and regions – Gilgit Baltistan (GB), Azad Jammu & Kashmir (AJK), and Islamabad Capital Territory (ICT.)

Methods

For the cause of death estimation, a sample size of 2100 households for both stillbirths and maternal deaths were determined and distributed in proportion to the population in each province/region. The mortality survey questionnaire collected information on births, stillbirths, and maternal deaths. Verbal and Social Autopsy (VASA) questionnaire was used to assess the causes of death. The study teams had extensive training and conducted fieldwork to interview households with identified deaths, ensuring electronic data capture for quality control. Data analysis involved a cause of death allocation through a review process by trained physicians and two computer-based methods.

Results

The study recorded 2076 stillbirths and 848 maternal deaths from the identified households during the 2017–2018 study period. The overall rate of stillbirth at the country level was 30.5/1000 total births and the maternal mortality rate was 176.2 per 100 000 live births, with higher rates observed in rural areas. The leading causes of death for both stillbirths and maternal deaths remained generally similar, including obstetric haemorrhage, pregnancy-induced hypertension, sepsis, and obstructed labor. Delays in seeking and accessing care both for stillbirths and maternal deaths resulted from issues in the identification of illness severity, decision-making, transportation issues, and delayed provision of health care once reaching a provider.

Conclusion

High rates of still births and maternal deaths highlights the healthcare pathway delays and health system inequities despite several efforts at national and international levels. stakeholder collaboration, improved service delivery channels, raising community awareness, and prioritizing early detection and care is crucial to avert poor fetal and maternal outcomes. eP-342 Preterm birth rate and related factors in cases with cervical cerclage T.C. Vo1; C.T. Bui1; D. Đao Tuan2; H. Phan Thi2 1University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam, 2Hung Vuong Hospital, Ho Chi Minh, Vietnam

Objective

Cervical cerclage can be offered as a potential preventive method of preterm birth in singleton pregnancies with high risks, such as those with a history of multiple preterm births/miscarriages in the 2nd trimester or with a combination of short cervical length and prior preterm delivery. Data on cerclage's effectiveness in preventing preterm birth for specific pregnant women in Vietnam remains limited. To assess the impact of cerclage on high-risk pregnancy in Vietnamese patients, we conducted a study to determine the prevalence of preterm birth before 34 weeks and associated pregnancy outcomes in cerclage cases.

Method

A retrospective cohort study followed 217 pregnant women with singleton pregnancies who underwent cerclage and delivered at Hung Vuong Hospital in Vietnam, between January 2020 and December 2021. Women with missing data on cervical length, gestational age of prior miscarriages, or terminations before 37 weeks due to fetal growth restriction, placental insufficiency, or preeclampsia were excluded. Primary outcomes were gestational age at birth and related factors. Secondary outcomes included neonatal outcomes and complications of cerclage. Data was collected from hospital software and medical records, and Epidata 4.6 software was used to enter and manage data.

Result

Overall preterm delivery before 34 weeks was 22.1% (95% CI: 16.6–27.6). Multivariate analysis revealed a statistically significant association between preterm birth and indication for cerclage. The lowest rate (13.5%) occurred in women with a history suggestive of cervical insufficiency. Rates increased for those with a short cervix but no prior preterm birth (29.1%) and were highest for women with both factors (34.2%). Additionally, pre-pregnancy BMI and cervical canal shape (Y-, V-, U-shaped) were statistically significant predictors of preterm birth. Newborn outcomes were generally favorable. Newborns averaged 2623.6 g (± 769.4 g) at birth. We had 5.5% Apgar scores ≤ 3 points after 1 min, 20.7% required admission to the pediatric ward, and the mortality rate at discharge was low at 3.7%. Cerclage placement was associated with a low complication rate. Only 0.5% of cases experienced premature rupture of membranes (PROM), and there were no reports of infections, suture loss, or cervical tears.

Conclusion

This retrospective cohort study provided evidence of the prevention of preterm birth when cerclage in high-risk Vietnamese pregnant women. These findings suggest cerclage as a potential preventive strategy for high-risk pregnancies in Vietnam, necessitating further exploration in prospective studies. eP-343 8 hours magnesium sulphate: A suitable alternate in low resource countries? A. Ahmed1; S. Mushtaq1; B. Ishaq1; N. Sher1 1Pakistan Institute of Medical Sciences, Islamabad, Pakistan

Objective

To compare the outcome of 8 versus 24 h postpartum magnesium sulphate for eclampsia prophylaxis in women with moderate to severe pre-eclampsia.

Methods

A total of one hundred and eight women with moderate to severe pre-eclampsia presenting at MCH, PIMS hospital Islamabad, between August 2021 to January 2023, were recruited. All the patients were randomized into two groups. Group A patients received MgSO4 for 8 h and group B patients received MgSO4 for 24 h only. Primary outcome was the occurrence of eclamptic fit in the first 72 h. Secondary outcomes were ambulation time, initiation of breast feeding, patient's hospital stay and patient satisfaction.

Results

Baseline demographic and clinical characteristics were similar in both groups.Mean gestational age in group A females was 36.5 ± 2.7 weeks and in group B it was 37.3 ± 2.3weeks (p = 0.101). Mean systolic BP in group A females was 176.9 ± 10.4 mmHg and in group B it was 174.3 ± 10.7 mm Hg (p = 0.206). Mean diastolic BP in group A females was 116.9 ± 4.7 mm Hg and in group B it was 114.4 ± 6.6 mm Hg (p = 0.132). Mean urinary proteins in group A females were 630.2 ± 160.1 mg and in group B it was 588.6 ± 178.3 mg (p = 0.207). Main symptoms was headache, blurred vision and epigastric pain in both groups (p = 0.853). Eclamptic fits in the first 72 h were not observed in both groups. In group A patients, mean ambulation time was 10.6 ± 1.1 h and in group B it was 18.8 ± 7.5 h (p = 0.001). In group A patients, mean time to initiate breast feeding was 14.6 ± 1.9 h and in group B it was 24.3 ± 8.3 h (p = 0.001). In group A patients, mean duration of hospital stay was 2.8 ± 0.43 days and in group B it was 3.4 ± 0.49 days (p = 0.001). In group A patients, mean patient satisfaction score was 8.9 ± 1.1 days and in group B it was 4.5 ± 1.8 h (p = 0.001).

Conclusions

Both the dosing regimens were equally effective and Eclamptic fits in the first 72 h were not observed in both groups. Mean ambulation time, mean time to initiate breastfeeding and mean duration of hospital stay was significantly shorter in patient treated with MgSO4 for 8 h compared to those treated with MgSO4 for 24 h. Patients treated with MgSO4 for 8 h demonstrated better satisfaction when compared to those treated with MgSO4 for 24 h. eP-344 Emergency cerclage in dichorionic diamniotic twin pregnancy, a systematic review M. Kunjachen Maducolil1; E. Loughman2; M. Mohan3; V. Venugopalan3; S. Lindow2 1Obstetrics and Gynecology, Latrobe Regional Hospital, Traralgon, Victoria, Australia, 2The Coombe Hospital, Dublin, Ireland, 3Aster Hospital, Doha, Qatar

Objective

The primary objective is to compare the delayed pregnancy delivery interval for the second twin after a second-trimester delivery of the first twin, with and without emergency cerclage among dichorionic diamniotic twin pregnancies (DCDA). Design: This is a systematic review and meta-analysis of published and peer-reviewed literature.

Method

The study was Prospero registered (CRD 42024496254). Two independent reviewers used the PubMed database to search for literature—the eligibility criteria included published studies with data on the survivability of second twins with DCDA twin pregnancies. The intervention included studies with and without emergency cervical cerclage after the delivery of the first twin. The outcomes included the gestation age and birth weights of each baby, with the duration of the delayed interval from the delivery of the first twin to the delivery of the second twin with and without emergency cervical cerclage. We included only cohort case series and case reports in this systematic review. Two independent reviewers collected the data, and the meta-analysis was performed using CMA version 4.

Results

In the cohort case series, there were 22 included studies; there were 70 DCDA pregnancies with cerclage from 14 studies and 62 pregnancies without cerclage from 13 studies. We also had 36 case reports, which we analysed separately, of which 19 were with cerclage and the other 17 reports without cerclage. The study showed a statistically significant difference in the mean gestational age of the second twin with cervical cerclage, a significant increase in the latency period, and increased survival rates in the cervical cerclage group. The risk of bias was assessed by two independent reviewers for the case-series cohort, and the results will be reported graphically.

Conclusion

From this systematic review of the published literature, it can be concluded that in DCDA twin pregnancies, cervical cerclage insertion after extremely premature delivery or miscarriage of the first twin may increase the gestational age at delivery of the second twin. However, a large prospective multicentric randomised control trial should be performed to assess the benefit of cervical cerclage in DCDA twins and understand all the potential harms the cervical cerclage may be associated with the possible potential benefits shown in this study. eP-345 Myoinositol and prevention of gestational diabetes mellitus A. Ahmed; A. Asif; B. Ishaq; N. Sher; S. Mushtaq Pakistan Institute of Medical Sciences, Islamabad, Pakistan

Objectives

The study was aimed to compare myo-inositol and control in frequency of prevention of GDM in high risk pregnant women. Study Design: Randomized Control Trial.

Methods

This study was conducted at Gynecology and Obstetrics Department, MCH Unit 1 PIMS, Islamabad for a duration of 6 months from 10-11-2020 to 11-05-2021. A sample size of 122 (61 in each group) pregnant women was considered in this study. After taking informed consent, a detailed history was taken. A screening OGTT was performed. Each patient in the intervention group was given myo-inositol in a dose of 2 g once daily for 3 months and women in control group were given standard management. Women were followed according to the usual schedule typically every 4 weeks. Pregnant women underwent second OGTT at 24–28 weeks for the diagnosis of GDM.

Results

An overall mean age of subjects was 36.39 ± 3.27 years. A total 35(28.7%) patients presented with GDM in this study of which 14.75% were from Group A (lifestyle modification + myo-inositol) whereas 42.62% were from group B (lifestyle modification only) and chi-square test showed a significant difference (p-value = 0.001) considering a good effect of myo-inositol to avoid GDM. Of total 35 GDM, 28 (80.0%) were diagnosed at gestational age of 24–28 weeks of gestation.

Conclusion

Myo-inositol supplementation in high risk group of GDM, has been proved to have a significantly better (p < 0.0001) effect in reducing the occurrence of GDM as only 9/61(14.75%) high risk women with prior history of GDM showed recurrence subsequently in comparison to 26/61 (42.62%), who were not using Myo-inositol. eP-346 Comparison of serum antiphospholipid antibody levels in recurrent miscarriages versus preterm deliveries Z. Abba1; A.I. Sulaiman2; S.G. Abdullahi2; D.H. Gwarzo3 1National Obstetric Fistula Centre Babbar Ruga, Clinical services, Katsina, Nigeria, 2Aminu Kano Teaching Hospital, Obstetrics and Gynaecology, Kano, Nigeria, 3Aminu Kano Teaching Hospital, Haematology and blood transfusion, Kano, Nigeria

Objective

To compare the serum levels and titres of aCL antibody in pregnant women with history of recurrent miscarriages versus those with preterm deliveries in Aminu Kano Teaching Hospital, Kano, Nigeria. Design: Comparative observational study.

Method

Using convenient sampling technique, 53 pregnant women with history of recurrent miscarriages and 53 with history of preterm deliveries (secondary to severe pre-eclampsia/eclampsia, unexplained abruptio placenta, unexplained fetal demise and unexplained intrauterine growth restriction) were recruited from the antenatal clinic of Aminu Kano Teaching Hospital. Assay for serum aCL antibody and Lupus anticoagulant was carried out in both groups. Analysis was done using Statistical Package for Social Sciences version 23 (SPSS Inc., Chicago IL USA 2023). Numerical variables were presented using measures of central tendencies and dispersion while categorical variables were presented using frequencies and percentages. Serum levels and titres in the 2 groups were compared using independent t test and Chi2 test respectively. p value < 0.05 was considered statistically significant.

Results

The age range of the patients was 18–42 years. The prevalence of APA was 41.5% in those with recurrent miscarriages and 35.8% in those with preterm deliveries. The mean serum level of anticardiolipin antibody in the recurrent miscarriages group was 144.9 GPL units + 45.1 while that in the preterm delivery group was 112.2 GPL units + 47.1. There was no statistically significant difference in the serum levels of APA in the two groups (t = 1.977, df = 30, p = 0.057 95% CI = −1.0764 to 66.4235). The mean titre in both groups fall within the high titre range. There was no statistically significant difference in the serum titres of APA in the two groups. (Chi2 3.979, p-value 0.057). All patients who tested positive for both LA and aCL had history of recurrent miscarriages. Anticardiolipin antibody was commoner than LA in both groups. The diagnostic yield for antiphospholipid antibodies was similar in those with 2 compared to those with 3 or more miscarriages.

Conclusion

The prevalence of antiphospholipid antibodies among women with recurrent miscarriages and preterm deliveries is high. There was no statistically significant difference in the serum levels and titres of the antibodies in the two groups. This implies that patients with positive antiphospholipid antibodies can either have recurrent miscarriages or preterm delivery irrespective of having a moderate or high titre. Thus, it still remains unclear why some women with antiphospholipid antibodies will have early pregnancy loss while others will experience late pregnancy complications/preterm deliveries. eP-348 Monitoring the beat: CTG and postpartum fetal acidemia unveiled S. Athar; M. Moghrabi; M. Maghrabi; H. Saleem; A. Hamcho; L. Ansari Department of Obstetrics and Gynecology, Al Wakra Hospital, Al Wakra, Qatar

Objective

Advancements in fetal monitoring techniques, such as cardiotocography (CTG), have allowed for the early detection of fetal heart rate abnormalities, aiming to prevent adverse outcomes. Postpartum fetal acidemia, characterized by low blood pH levels in the umbilical artery, poses critical risks necessitating a clear understanding of its relationship with CTG readings to ensure optimal neonatal outcomes. The identification of predictors of postpartum fetal acidemia guides decision-making on interventions during labor. This study aimed to investigate the correlation between abnormal CTG readings during labor and the occurrence of postpartum fetal acidemia. It also aimed to review CTG features predictive of fetal acidemia. Study design: The study design of this research is a retrospective cohort study.

Methods

This study was conducted after the approval of a medical research center at a secondary care hospital in Qatar. It included pregnant women who underwent Cesarean Section due to fetal distress as determined by CTG monitoring (N = 458). The study included cases of infants with immediate postpartum acidemia, defined as umbilical artery pH levels below 7.20. Data was collected through medical records on maternal demographics, antenatal risk factors, labor characteristics, CTG findings, and neonatal outcomes, were assessed. Logistic regression analysis was utilized to determine the association between CTG diagnosis of intrapartum fetal distress and immediate postpartum acidemia while considering potential confounding variables.

Results

The study population comprised 458 women who underwent C-section due to abnormal or pathological CTG readings. 33.72% of the babies were found to have umbilical artery pH < 7.20. Of these, 18.39% had pH < 7.0. 20.93% had umbilical artery pH between 7.20–7.25, and the remaining were within the normal range. After adjusting for confounding variables, multivariable logistic regression analysis revealed a significant association between abnormal CTG and immediate postpartum acidemia (p-value < 0.05). Other factors such as prolonged deceleration lasting more than 7 min (OR: 2.44, 95% CI: 1.48–3.40; p-value < 0.05) and presence of meconium (OR: 1.88, 95% CI: 1.07–3.30; p-value << 0.05) were also identified as significant predictors of acidemia.

Conclusion

This study provides compelling evidence of a significant association between the diagnosis of intrapartum fetal distress using CTG and immediate postpartum acidemia in the fetal umbilical artery. These findings underscore the paramount importance of accurate and timely assessment of fetal well-being during labor to prevent adverse neonatal outcomes. Accurate interpretation of CTG results is essential to reduce unnecessary C-sections and provide optimal care for both mother and baby. eP-350 5-year analysis of outcomes in acute fatty liver disease of pregnancy K.R. Jacob1; V.V. Thomas2; S. Kandasamy2; J.E. Mathews1 1Christian Medical College Vellore, Obstetrics and Gynaecology, Vellore, Tamil Nadu, India, 2Christian Medical College Vellore, Critical Care, Vellore, Tamil Nadu, India

Objectives

1. Describe the clinical severity, treatment course and complications of patients admitted to ICU with AFLP (acute fatty liver of pregnancy) 2. Describe the maternal and pregnancy outcomes among patients admitted to ICU (intensive care unit) with AFLP. Design: This is a retrospective cohort study of patients diagnosed with AFLP, who were admitted to the ICU from the years 2018–2022.

Method

The medical records of all patients from 2018 to 2022 admitted to Intensive Care Unit (ICU) were reviewed. Among these, 18 (3.6%) cases were diagnosed to have AFLP based on Swansea criteria. Details of clinical features, hematological, biochemical, and microbiological parameters were obtained. Data was entered in Microsoft Excel and was analyzed using SPSS.

Results

We found that there was no maternal mortality recorded from the cohort,(although 2 patients were discharged against medical advice) while neonatal mortality was 22%, as compared to 2.2% in our hospital during the same study period. The median duration of ICU and hospital stay were 6 and 14 days respectively. The most common complications during hospitalization were acute kidney injury (94%) and hemorrhage requiring transfusion (89%). Cesarean section was performed in 13 (72%) as the mode of delivery with maternal deterioration being the most common indication (54%) for delivery, in comparison to the hospital's median cesarean section rate of 32% in same period. There were 4 twin-pregnancies in our cohort with a total of 22 neonates. 11 (64%) were preterm with a median birth weight of 2.66 kg. Neonatal ICU admission was indicated in 14 (64%) of our cohort. Multivariate analysis of comorbidities, maternal complications and scoring systems were analyzed against neonatal mortality. We found that preterm delivery (p-value 0.038) and raised admission maternal creatinine (1.64 vs 2.53; p-value 0.031) was associated with a higher neonatal mortality. Univariate analysis against the AFLP group found statistically significant higher prevalence of cesarean section and neonatal mortality.

Conclusion

There was no maternal mortality among the pregnant mothers, however there were 2 cases with uncertain outcomes. Preterm delivery and higher stage of acute kidney injury at admission was associated with neonatal mortality. Current ICU scoring systems do not accurately estimate the ICU mortality of AFLP in pregnancy. eP-352 Maternal-perinatal outcome comparisons between spontaneous and IVF twin pregnancies in Bangladesh N.T. Mahtab1; T.S. Chowdhury1; R. Laila1; T. Begum2 1BIRDEM Women and Children Hospital, Obstetrics and Gynaecology, Dhaka, Bangladesh, 2BIRDEM General Hospital, Epidemiology and Biostatistics, Dhaka, Bangladesh

Objective

Multiple gestation are typically considered high risk pregnancies. The study aims to compare select maternal and perinatal outcomes between twin pregnancies spontaneously conceived and by successful in vitro fertilization (IVF). Design: A prospective cohort study of women with twin pregnancies, conceived spontaneously or through IVF, was conducted.

Method

Data from 48 purposively sampled patients were collected after delivery at BIRDEM Women and Children Hospital, Dhaka, using a structured questionnaire over one year. 6 patients who were given ovulation induction were excluded.

Results

Among the 42 samples included in the study, 10 (23.8%) conceived spontaneously and 32 (76.2%) secondary to IVF. The mean maternal age of non-IVF group (26.6 years ± 4.33) was significantly lower than IVF group (33.22 years ± 4.79). Duration of marriage between the groups did not differ significantly. Women in IVF group were more significantly nulliparous (68.8%, p < 0.001), while non-IVF group had significantly higher number of previous living issue(s) (p = 0.001). No significant differences were found between the groups with regards to their pregestational diabetes mellitus, chronic hypertension and hypothyroidism. No significant differences in the rate of complications, such as gestational diabetes, antepartum and postpartum hemorrhage, pregnancy induced hypertension, pre-eclampsia and eclampsia were present between the groups. Occurance of preterm labour, premature rupture of membrane and less fetal movement were not found to be significantly different, neither were the rates of missed abortion and single fetal demise. The mean gestational age at delivery and the rate of women who delivered at term were not significantly different either. Mean birth weights of neonates between the groups did not significantly differ. The study found that the perinatal morbidity was not significantly different between the groups, probably due to the similar rate of preterm births (<37 weeks) in both groups.There were no significant differences in all the parameters of neonatal outcome between the groups, except for a higher occurance of neonatal jaundice (p = 0.032) in IVF group. Finally, no significant differences were found regarding need for admission to neonatal intensive care unit (NICU), and neonatal death between the groups.

Conclusion

Prior studies comparing the outcome of spontaneous versus IVF twin pregnancies report heterogeneous results. Findings of our study, in contrast, cannot justify the need for notable differences in practices to manage outcomes in both these groups. As the findings are limited by the small sample size, we suggest a larger study sample be used before such policies are adopted in Bangladesh. eP-353 Decreased fetal movement: Maternal characteristics and pregnancy outcome K. Magdoud1; S. Bayar2; R. Ben Hmid1; A. Karoui1 1Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia, 2Maternity and Neonatology Center, Tunis, Tunisia

Objective

Decreased fetal movement is a common reason for consultation. It can reveal an intrauterine death or fetal distress. The aim of this study was to evaluate the epidemiological profile of decreased fetal movement and to identify the predictive factors of poor pregnancy outcome. Design: We performed a retrospective and descriptive study in the department of Maternity between January 2015 and December 2019 including patients hospitalized for decreased fetal movements.

Methods

We included in our series all pregnant women with a singleton pregnancy with a gestational term beyond 24 weeks without fetal malformation admitted to the service for the reduction of MAF. The endpoints were adverse pregnancy outcomes: MFIU, prematurity, small weight for gestational age, Apgar score at 5 min of life less than 7 and admission to the neonatology department.

Results

The study included 150 patients with a mean age of 30.7±5.8 years. The patients were primiparous in 45.3% of cases. The mean term of pregnancy was 37.17 ± 2.97 weeks. Cardiotocography was pathological in 22.7% of patients. The delivery rate during the hospitalization was 87.3% with a mean term of 37.9 ± 2.5 SA. Poor pregnancy outcome was noted in 22.1% of cases. The identified predictive factors of poor pregnancy outcome were: gestational term less than 37 weeks (ORa = 9.42), insufficient prenatal care (ORa = 2.85), delayed maternal reporting of decreased fetal movement (ORa = 1.29), complications during pregnancy (ORa = 3.01),small symphysiofundal height for gestational age (ORa = 6.17), pathological cardiotocography (ORa = 1.66), fetal growth restriction (ORa = 6.17), abnormal Umbilical Artery Doppler (ORa = 6.51).

Conclusion

Decreased fetal movement can be a false alarm but it is important to identify predictive factors of poor pregnancy outcome to recognize patients at increased risk and optimize their management. eP-354 Cataracts development risk in patients exposed to cystic fibrosis modulator therapies in-vitro S. Elsaadany1; K. Wiles1; N. Shafai2; D. Watson2 1Royal London Hospital, OBGYN, London, UK, 2Barts NHS Trust, London, UK

Introduction

Cystic fibrosis is an autosomal recessive condition resulting from variations in the CTFR gene resulting in abnormalities int he CFTR ion channels. Highly effective modulator therapies (HEMT) are becoming more commonly used in treating patients CF due to their success in reducing symptom burden and improving Quality of life. With the widespread use of HEMT, there are more pregnancies in women with CF. However, HEMT are known to cross the placenta and be present in breast milk. Studies of HEMT in rates demonstrated development of infant cataracts and case reports in the US reported presence of non-congenital cataracts in early exposure. This abstract assesses the development of cataracts in foetuses who were exposed in-utero and through lactation and emphasises the need to counsel patients who continue HEMT during pregnancy and breast feeding.

Methods

This is a cross sectional study looking at 6 cystic fibrosis patients receiving CFTR modulator therapy and assessing for the development of cataracts in infants during eye screening 6 months post birth.

Results

A total of 6 patients were included in the eye screening programme all born to mothers between the age of 21–34. None of the patients had other risk factors for developing cataracts. 83.3% of the mothers with CF also had diabetes and 50% had hypertension. 16.7% of patients attended the screening which showed no subclinical cataracts. Out of the 5 patients that did not attend, 60% of patients were contacted and reported no symptoms of cataracts although we are unable to rule out subclinical cataracts. 20% of patients moved out of the area and were no longer under follow up in our hospital and 20% of patients were not reached.

Conclusion

Although based on the above, the probability of developing cataracts post Intra-uterine exposure is low, we are unable to rule out subclinical cataracts and thus a screening programme is needed particularly as case reports in other countries have emerged showing link between that. Counselling is also required to ensure expecting mothers are aware of the risks. eP-355 Central blood pressure, cardiac biomarkers and maternal complications in hypertensive pregnancies X.B. Mbongozi1,2; S.D.R. Galloway2; A. Hunter3; C.B. Businge1 1Obstetrics & Gynaecology, Walter Sisulu University, Mthatha, South Africa, 2Faculty of Health Sciences & Sport, University of Stirling, Stirling, UK, 3School of Science and Technology, Nottingham Trent University, Nottingham, UK

Objective

The objective of the study was to explore the relationships between high-sensitivity cardiac Troponin I (hs-cTnI), NT-proBNP, central blood pressure (CBP) and maternal complications in hypertensive cases. Design: This was a prospective case-control study evaluating CBP and biomarkers in pregnant women with hypertensive disorders of pregnancy (HDP) at Nelson Mandela Academic Hospital, Eastern Cape, South Africa.

Method

The study used a consecutive sampling method to recruit patients who were admitted with HDP and normotensive controls. The estimated required sample size was 400 participants. Blood samples were taken for hs-cTnI and NT-proBNP, and CBP was measured antenatally. Follow-up evaluations were conducted one day after delivery and at discharge. The data was analysed using SPSS statistical software, and a p-value of less than 0.05 was considered statistically significant.

Results

466 participants were enrolled in the study: 258 (55.4%) hypertensive cases and 208 (44.6%) normotensive controls. More than half of the hypertensive cases (136/258, 52.1%) had preeclampsia, 80 (31%) eclampsia, 25 (9.7%) gestational hypertension, and 17 (6.6%) chronic hypertension. The median levels (p25, p75) of the cardiac biomarkers were significantly higher among hypertensive participants with maternal complications (80/258) than those without complications (178/258). These were hs-cTnI 11.5 (7.0–32.5) ng/L vs 8.5 (5.0–16.0) ng/L, p = 0.006 and NT-proBNP 349.0 (133.5–1009.5) ng/L vs 160.0 (50.0–513.0) ng/L, p = 0.001. Patients with HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome, disseminated intravascular coagulopathy (DIC), or those who were admitted to the intensive care unit (ICU) had significantly higher median central diastolic blood pressure (CDBP) compared to those who did not have these complications [79 (64.5–94) vs 70 (54–83); 121(121–121) vs 73 (60–89); 97(95–121) vs 73(60–88)]. Additionally, hypertensive cases with high CBP had a 3.1 times higher risk of being admitted to the ICU. However, the central systolic blood pressure did not show any significant difference between cases with and without maternal complications [129(119.5–140.5) vs. 129(117–140)].

Conclusion

Pregnant women with hypertension and maternal complications had higher levels of cardiac biomarkers (hs-cTnI and NT-proBNP) compared to women without these complications. This indicates that measuring these biomarkers in hypertensive pregnancies might be helpful in screening and monitoring maternal complications. Furthermore, it suggests that women with HDP and maternal complications may be more susceptible to developing cardiovascular problems than those without maternal complications. Finally, the CDBP was higher in patients with HELLP syndrome, DIC, or those admitted to the ICU, suggesting the importance of monitoring this vital sign in these patients. eP-356 Estimation of serum fibrinogen level as a predictive marker for PPH V. Kumari; P. Shankhwar Kgmu, Obstetrics & Gynaecology, Lucknow, India

Objective

1. To estimate the level of fibrinogen level in antenatal women > 28 weeks of gestation who will be delivering at kgmu obstetrics and gynaecology department. 2. To evaluate the amount of blood loss during labour. 3. To correlate the level of serum fibrinogen with occurrence of PPH. Study design: Prospective analytical study.

Method

This is a prospective analytical study done in department of obstetrics and gynaecology,Kgmu from duration August 2022 to December 2024.Total 200 pateints enrolled in the study meeting inclusion and exclusion criteria.Pateints demography, detailed history and thorough physical examination done.Along with routine relevant investigations additional 2 mL of blood sample taken for assessment of serum fibrinogen level by Clauss method,which has a low coefficient variation.All the women followed up till 24 hrs of delivery and amount of bleeding is assessed by graduated V- bag and the pad soaked during delivery.

Result

The majority of cases of PPH occurred in the lower fibrinogen level ranges, particularly between 200 and 400 mg/dL, while higher fibrinogen level (>600 mg/dL) corresponds to fewer occurrences of PPH.Our study showed significant association between serum fibrinogen levels and and PPH (p value < 0.001). This suggests a potential correlation between lower levels of fibrinogen and increased risk of PPH.

Conclusion

Serum fibrinogen level can be used as a potential marker for risk of PPH. eP-357 Modified Well's Score for predicting pulmonary embolism diagnosis in obstetric patients A. AlMasalami; M. AlShukri; G. Vaidyanathan; S. Arumugam; A. AlMasalami; M. AlShukri; G. Vaidyanathan; S. Arumugam Sultan Qaboos University Hospital, Muscat, Oman

Objective

Pulmonary Embolism (PE) is linked to maternal mortality worldwide. Unfortunately, its diagnosis is an area of a dilemma because of non-specific clinical presentations. To date, there are limited clinical models for predicting PE in pregnant and postpartum women. So, any antenatal or postnatal patient who is suspected of having PE will be referred for imaging investigations to rule out PE. Those imaging studies are associated with radiation exposure for the mother and foetus. Therefore, this study aimed to examine the predictive value of modified Well's score (MWS) in a cohort of pregnant and postpartum population to stratify their risk of PE. Design and methods: This was a retrospective cohort study that used records from an electronic patient record at Sultan Qaboos University Hospital. All pregnant and postpartum patients who underwent Computed Tomography-Pulmonary Angiography (CTPA) as a suspected case of PE, over 7-years were included. The patient's record was used to obtain the clinical probability of PE based on MWS, and then assess the relationship between score and CTPA results. MWS was further modified to address specific risk factors in our population of obesity and sickle cell disease and compare the score with CTPA results.

Results

A total of 96 women, 31 pregnant (32%) and 65 postpartum (68%) women were studied. 12 women were confirmed to have PE on CTPA. The PE prevalence was 0.041%. 22 (23%) of the patients had low, 71 (74%) moderate, and 3 (3%) high clinical probability of PE based on the MWS score. Among the 22 women with low clinical probability, one had PE on CTPA. No association was evidenced between MWS score and CTPA (p = 0.295). Besides, the modified MWS core was not associated with CTPA results for the studied risk factors (p = 0.40).

Conclusion

Collectively, our results indicate that MWS score failed to show good prediction results for PE in Omani pregnant and post-partum women, even when incorporating sickle cell disease and obesity, as risk factors. A large study including several centres in Oman is recommended. eP-358 Provider adherence to aspirin prophylaxis guidelines for preeclampsia: Cross sectional study in Srilanka W. Gankanda1; K. Kalansuriya1; U. Nishadi1; S. Premarathna1; A. Jayawardena1; P. Harshani1; K. Rathnasekara1; K. Rathnasiri1; D. Jayasekara1; L. Ruparathne1; S.M. Fahim2 1District General Hospital, Negombo, Sri Lanka, 2Base Hospital Valachchenai, Valachchenai, Sri Lanka

Introduction

Preeclampsia stands as a significant contributor to maternal mortality rates. Clinical trials have robustly demonstrated that low-dose aspirin can reduce the incidence of preeclampsia by up to 30% among high-risk women which is recommended in NICE guidelines.

Objectives

We evaluated the knowledge of doctors involved in antenatal care provision regarding their knowledge and current practices on Aspirin prescription. Design: Cross sectional descriptive study amoung doctors involved in provision of antenatal care.

Methods

Consent was obtained . A structured web based questionare was used to collect data. NICE guidline was used as explicit criteria.

Results

Total number responded were 46 with a response rate of 76%. The majority of respondents were middle grade doctors (Senior House Officers/Medical Officers/Registrars) (73%), with Intern Medical Officers (27%). All participants had completed or were undergoing rotations in obstetrics and gynecology, with speciality specific experience ranging from 4 to 130 months (mean 44) and as doctors experience ranging from 6 to 160 months (mean 48 months). Sixty nine percent had received a formal learning on aspirin prescribing ever. Most respondents correctly identified the indications for aspirin use, such as prophylaxis of preeclampsia and fetal growth restriction (91%) and were able to recognize risk factors for preeclampsia from a list (78%). However, only 82% correctly stated that one high-risk factor is sufficient for aspirin prescription, while 69% erroneously believed that multiple high-risk factors were necessary. The correct dosage of 150 mg and recommended timing of administration (nocte) were known by 74% and 100% respectively, with 82% aware of the need to start before 16 weeks of gestation and discontinue it at 36 weeks or beyond. Most respondents (95%) were aware of aspirin's side effects and contraindications (92%) , but 78% incorrectly believed that a proton pump inhibitor (PPI) was essential alongside aspirin. Interestingly 48% admitted feeling not confident in prescribing aspirin, also 48% had not read local or international guidelines on aspirin prescribing. All respondents expressed a desire for further education on aspirin, with 43% preferring continuing medical education (CME) lectures and others suggesting printed checklists and reminder cards as useful tools for learning and implementation.

Conclusion

While most participants demonstrated a good understanding of aspirin prescribing guidelines, significant numbers are not confident and notable misconceptions persisted.The findings stresses the importance of targeted continued medical education interventions to ensure consistent and accurate prescribing practices among healthcare. eP-359 The determinants of antenatal anxiety and implications on maternal & birth outcome S. Siva Prasad1; Geetha K1 1Obstetrics & Gynaecology, Aster MIMS (Malabar Institute of Medical Sciences), Kozhikode, India

Objective

To assess the important determinants contributing to anxiety in pregnancy and identify the adverse maternal and perinatal outcomes of antenatal anxiety (AA) Design: Single Centre Prospective Observational Study.

Method

480 pregnant women who attend a Tertiary level hospital in Kerala, India were selected and Socio-demographic characteristics were collected using a semi-structured proforma. Each of the pregnant women were screened with antenatal anxiety (AA) questionnaire and assigned anxiety level in accordance with GAD 7 questionnaire. Subjects in first and second trimester were followed up after a period of three months to assess for progression in anxiety as well as complications. Pregnant women in third trimester were followed up longitudinally to assess the birth outcomes and perinatal mental health status.

Results

The mean age of the pregnant women was 28 years. The prevalence of antenatal anxiety was 6.3% in first trimester, 13.1% in the second and 21.9% in third trimester. Antenatal anxiety was significantly more among those with determinants such as: History of a miscarriage or stillbirth, Recent death in the family, Higher educational status, Poor partner support during pregnancy, Poor relationship with in-Laws, Unemployment (p < 0.001) and recent marriage (p = 0.04). Antenatal Anxiety is associated with a higher likelihood of developing adverse maternal outcomes such as Threatened miscarriage, Fetal growth restriction (p < 0.005), Gestational Diabetes (p < 0.005). Perinatal outcomes associated with antenatal anxiety include Preterm delivery, Postpartum blues (p < 0.05) Emergency LSCS and Lactational difficulty (p < 0.001). Likelihood of complications such as Threatened miscarriage, FGR, Preterm delivery, Emergency CS and postpartum blues increased significantly with increasing severity of anxiety.

Conclusions

The prevalence of antenatal anxiety is maximal in third trimester. Several socio-demographic factors were significantly associated, such as: Higher educational status, Unemployment, Poor partner support, Poor relationship with in-Laws, History of a miscarriage or stillbirth, Recent death in family. Antenatal Anxiety is associated with a higher likelihood of developing adverse maternal and perinatal outcomes such as Threatened miscarriage, FGR, GDM, Preterm delivery, Emergency CS, Postpartum blues and Lactational difficulty. This shows the importance for general screening for anxiety in all antenatal women and closely monitoring for development of severe anxiety/perinatal mental health issues. eP-360 Serum magnesium levels after prophylactic magnesium sulphate in pre-eclamptics: Does BMI matter? H. Bilqis1; S. Zaffar1; L.E. Kahloon1,2; H. Noreen1; A. Arooj1; Z. Maqsood1; U. Almas1 1Rawalpindi Medical University, Ob/Gyn, Rawalpindi, Pakistan, 2Instituite of Public Health, Nursing & Midwifery, Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Objective

To compare the serum magnesium levels after prophylactic dose of magnesium sulphate (MgSO4) in pre-eclamptic women having normal vs high body mass index (BMI). Design: Descriptive, cross-sectional study.

Method

The study was conducted at a tertiary care hospital in Pakistan. After approval from the institutional ethical review board, study was conducted over a period of six months (September 2022 to February 2023). Fifty nine women with severe pre-eclampsia were included after taking written informed consents. Their weights and heights were measured and BMIs were calculated. Grouping was done according to the BMIs; Group A having normal BMI (18.5–24.9 kg/m2) and Group B having high BMI (>25.0 kg/m2). In both the groups, prophylactic dose of MgSO4 (4 g MgSO4 diluted in 12 mL normal saline given intravenous as loading dose followed by 10 g diluted in 60 mL normal saline @1 g/h intravenous infusion as maintenance dose for 24 h) was administered to every participant in both the groups. Blood samples were drawn by venipuncture for serum Magnesium levels at three occasions; 1. just before loading dose of MgSO4, 2. one hour after loading dose & 3. four hours after loading dose. Serum Magnesium levels were compared between the two groups, taking 4.8–8.4 mg/dL as therapeutic range. Tests of significance were applied. p-value of <0.05 was considered as significant. Effects of modifiers were controlled through stratification of data.

Result

Therapeutic levels of Magnesium were achieved in 81.5% in normal BMI group vs 50.0% in high BMI group. There was statistically significant difference (p < 0.0001) between the number of women achieving therapeutic serum levels in both the groups.

Conclusions

Women with high BMI have higher risk of having sub-therapeutic serum Magnesium levels as compared to normal BMI women. Studies should be conducted to find the alternate dosage regimens of Magnesium sulphate as prophylaxis in pre-eclamptic women with high BMI. eP-361 Unexplained vaginal bleeding in the second trimester: A systematic review and meta-analysis A. Eshag1; I. Armata2; S. Noreldeen3 1Obstetrics/Rosie Maternity, Cambridge University Hospital, Cambridge, UK, 2Obstetrics and Gynaecology, Peterborough City Hospital, Peterborough, UK, 3Obstetrics and Gynaecology, Princess Alexandra Hospital, Harlow, UK To evaluate the effect of unprovoked vaginal bleeding (UVB) in the second trimester on preterm birth, late miscarriage and preterm premature rupture of membranes (PPROM), we conducted a literature review. Design: Unexplained vaginal bleeding (UVB) during the second trimester of pregnancy is a recognised risk factor for premature labour/birth, premature rupture of fetal membranes (PPROM) and late miscarriage. Currently, management strategies for UVB in second trimester are constrained, with a dearth of standardised guidelines for addressing causes and managing it. A Systematic review and meta-analysis of studies examining the effect of UVB in the second trimester on preterm birth was considered to be most appropriate to summaries and showcase the current evidence in order to highlight the significance of UVB.

Method

A systematic review and meta-analysis was conducted to examine all current evidence on the effect of UVB and preterm birth. Studies focused on episodes of UVB between 13–23+6weeks and pregnancy outcomes following this presentation. Studies including placental pathologies e.g. placenta previa, were excluded. Outcomes of UVB were concentrated on the effect of preterm birth to clarify and establish the association of the two parameters. The incidence of preterm birth was compared on women with UVB in the second trimester versus women with no vaginal bleeding. Articles were selected, subdivided into case-controls and cohort studies. Data was analysed using SPSS for all the observational studies together and each type separately. Data was adjusted as per availability of confounding variables on age, BMI, ethnicity, socioeconomic status, smoking status, parity, medical comorbidities for example pre eclampsia and diabetes.

Results

In total 751 articles were identified through the preliminary database search, eventually 21 were selected for the review. The overall odds ratio (OR) for preterm birth due to 2nd trimester UVB compared to patients with no bleeding was 4.10 (95% CI 2.77–6.07, p < 0.001). Case control studies yielded OR 4.47(95% CI 2.42–8.26, p < 0.001) and Cohort studies demonstrated an increased risk of 3.79 (95% CI 2.20–6.52, p < 0.001). All the included studies exhibited statistical significance. Due to substantial heterogeneity observed among the included studies the random model was employed (I2 = 89%, Cochrane Q test = 39.16, p < 0.001).

Conclusions

UVB in the second trimester is a significant risk factor of preterm birth, PPROM and late miscarriage with detrimental impact on patients' emotional health. Health care professional on this field need to be aware of this association to improve clinical practice and conduct further research to identify better management options. eP-362 Impact of morbid obesity (BMI ≥ 40) on pregnancy outcomes L. Alansari1; Y. Khawly2; S. Athar1; M. Abu Kuhail1; S. Zaoui1; M. Thompson1; A. Telissi1 1Hamad Medical Corporation, Obstetrics and Gynecology, Al Wakra, Qatar, 2Hamad Medical Corporation, Pharmacology, Al Wakra, Qatar

Objective

Obesity poses significant challenges in maternal health globally, with pregnancy complications being a major concern. This study delves into the impact of maternal Body Mass Index (BMI) on postpartum hemorrhage (PPH), birthweight, and preterm delivery, focusing specifically on women with morbid obesity (BMI ≥ 40) delivering at Al Wakra Hospital. Design: Clinical Survey.

Methods

A retrospective analysis was conducted using data from Al Wakra Hospital's electronic medical records between January 2022 and October 2023. The study included 1860 deliveries categorized into two BMI classes: Class 2 (BMI 35.0–39.9, n = 1369) and Class 3 (morbid obesity, BMI ≥ 40, n = 491). We analyzed the occurrences of PPH (defined as blood loss ≥ 1000 mL after Cesarean section delivery and ≥ 500 mL after normal delivery), macrosomia (birthweight ≥ 4000 g), and preterm delivery (delivery before 37 weeks gestation) using Chi-square tests. Statistical significance was set at p < 0.05.

Results

PPH incidence was 0.66% (9 cases) in Class 2 and 0.41% (2 cases) in Class 3. Birthweight ≥ 4000 g occurred in 5.70% (78 cases) of Class 2 and 7.13% (35 cases) of Class 3. Preterm delivery rates were 4.52% (62 cases) in Class 2 and 6.74% (33 cases) in Class 3. Significant differences (p < 0.05) were found between groups for PPH and baby birthweight.

Conclusion

Women with morbid obesity experienced a lower incidence of PPH but a higher prevalence of high birthweight deliveries. Although preterm delivery rates show a slight increase in Class 3, further comprehensive analysis is warranted for conclusive evidence. These findings have important implications for screening and care of morbidly obese pregnant women, to try to decrease adverse outcomes. eP-364 Stillbirths classification based on ReCoDe classification system – A retrospective cohort study A. Kazmi1; D. Krishna2; M. Boumedjane2; A. Abdel Aziz1; F. El Taher1; T. Farrell1 1Women Wellness and Research Center, Obs and Gyne, Doha, Qatar, 2Women Wellness and Research Center, Doha, Qatar

Background

Stillbirths are the largest contributor to perinatal mortality, but current classification systems consistently report about two-thirds of stillbirths as being unexplained. Understanding the cause of death at birth will not only help to reduce the number of mortality but also have a positive impact on parent's counseling. There is currently no classification system used within Qatar to determine and qualify stillbirths. We utilized the ReCoDe classification system to demonstrate the cause of stillbirths within the Women Wellness and Research Centre (WWRC).

Objectives

To help institutional review and monitoring process to improve screening and intervention to lower the rate of stillbirths within WWRC by using ReCoDe classification system.

Methods

This was a retrospective study that included a random selection of women who attended WWRC between 1/1/2017 to 31/12/2021 with a diagnosis of stillbirth with a gestation age of more than 24 weeks. The ReCoDe classification system was used to identify the relevant condition at the time of death. An adjusted customized birthweight centile was generated using GROW software and results were analyzed by using STATA software.

Results

Of the 254 women included, nearly 25% were 35 years or older, with a mean age of 30.5. More than 50% were multiparous with a mean body mass index of 29 at booking. The mean gestational age at diagnosis of stillbirth was 32 weeks (nearly 90% diagnosed antenatally), with 90% delivering within 7 days, 18% requiring cesarean delivery. Overall, Fetal Growth Restriction (FGR) was the most common diagnosis (n = 122, 52%), followed by placental abruption (n = 42, 16.5%) lethal congenital anomalies (n = 35, 13.8%), chorioamnionitis (n = 35, 13.8%) and maternal diabetes (n = 61, 24.0%). According to ReCoDe, the most common primary diagnosis was FGR (n = 94, 37.0%), followed by congenital anomalies (n = 35, 13.8%), placental abruption (n = 23, 9.1%) and maternal diabetes (n = 17, 6.7%). 54 stillbirths (21%) were initially documented as unclassified; this reduced to 16 (6.3%) after applying the classification. In those with FGR as a primary diagnosis, nearly 77% had a secondary diagnosis, the most common being placental insufficiency on histopathology and abruption. FGR was the most common secondary diagnosis in babies with lethal congenital anomalies.

Conclusion

The introduction of the ReCoDe classification system resulted in a reduction in the number of stillbirths being assigned as unexplained. This will have a positive impact on patient counseling and also on enabling institutional review and monitoring processes aimed at understanding the causes of stillbirths and interventions to reduce the number. eP-366 Assessing multiple pregnancy care: Local vs. national perspectives (2016–2020) H.J. Lim; A. Niazi; S. Nazir Obstetrics and Gynaecology, Maidstone and Tunbridge Wells Hospital, Tunbridge Wells, UK

Objective

This study conducted a five-year (2016–2020) evaluation of multiple pregnancy services to collate and analyse data from a local hospital. The primary objectives were to compare this local data with national figures from the National Maternity and Perinatal Audit (NMPA NHS) and identify variations in maternity care for women with multiple births. The ultimate goal was to share accessible findings with healthcare staff and service users, facilitating informed decision-making through Robson Group 8 infographics. Design: A retrospective study design was employed to analyse data collected over the specified period, allowing a comprehensive exploration of trends in multiple pregnancies and maternity care practices.

Method

Data collection focused on multiple pregnancies at the local hospital from 2016 to 2020. Parameters included twin and triplet birth rates, types of twins (DCDA and MCDA), modes of delivery, onset of labour, gestational age at birth, and the incidence of preterm birth. Statistical analyses utilized descriptive statistics to present numerical findings.

Results

The local hospital exhibited a twin birth rate of 3.15%, slightly lower than the NMPA England rate of 3.3%. Among twin births, 76% were DCDA twins, differing from the NMPA's 70%, while MCDA twins comprised 24%, compared to the NMPA's 30%. Triplet births were observed at 0.65%, below the national rate of <1%. Modes of delivery included 66.2% caesarean sections, 3.3% unassisted vaginal deliveries, 14.43% vaginal births and sequential caesarean sections, and 8.7% instrumental deliveries. Onset of labour varied, with 54% not experiencing labour, 25% induced, and 21% spontaneous. Gestational age at birth revealed 47% beyond 37 weeks, 22% between 36–37 weeks, 16% between 34–35+6 weeks, 9% between 32–33+6 weeks, and 6% below 32 weeks. The incidence of preterm birth was 50%, slightly lower than the NMPA data of 55.7%.

Conclusions

Identified variations in multiple pregnancy care between the local hospital and national averages emphasize the need for continuous evaluation and data sharing. Findings guide healthcare professionals and empower service users for informed decisions, contributing to enhancing multiple pregnancy services. Utilizing Robson Group 8 infographics effectively communicates complex data, serving as a practical tool for diverse audiences.

References

NMPA multiple birth report 2020 [https://maternityaudit.org.uk/FilesUploaded/NMPA%20Multiple%20Births%20Report%202020.pdf] eP-367 Hepatic rupture in pregnancy, a grave complication of HELLP syndrome S. Ramakrishna1; V. Paliwal1; S. Manjiani1; I.P. Jonathan1; M. Rizwan Naseem2 1Sultan Qaboos Hospital, Ministry of Health, Obstetrics & Gynecology, Salalah, Oman, 2Sultan Qaboos Hospital, Ministry of Health, General Surgery, Salalah, Oman

Objective

HELLP syndrome (Hemolysis , elevated liver enzymes and low platelet count ) is a life threatening complication of pregnancy. It occurs in 0.1%–6% of all pregnancies and in 4%–12% of patients with preeclampsia. Hepatic rupture in association with HELLP syndrome is rare and can be fatal. We highlight the difficulties in diagnosis and management of such a case. Case report: A 37-year-old, lady with Chronic Hypertension and previous three caesarean sections presented at 30.4 weeks pregnancy with dizziness, blurring of vision and epigastric pain radiating to right shoulder for one day with hemodynamic instability. Abdominal ultrasound showed large amount of free fluid in the peritoneal cavity with clots in the subhepatic region. Investigations showed HELLP syndrome with anemia and thrombocytopenia. Emergency laparotomy revealed massive hemoperitoneum with an intact uterine scar and a dead fetus was delivered by caesarean section. There was a left hepatic lobe rupture with large hematoma. It was managed by removal of blood and clots, hepatic packing, insertion of drains and blood loss was 3.3 L. Post operatively she had cardiac arrest thrice and was revived and 3 days later packs were removed. She survived this maternal near miss event but suffers from neurological damage following hypoxic brain injury.

Discussion

Incidence of hepatic rupture is approximately 1: 45 000 to 1: 225 000 deliveries and in about 1% to <2% of cases with HELLP syndrome. Risk factors include advanced maternal age, multiparity and preeclampsia .Maternal mortality associated with liver rupture is as high as 60% with fetal mortality of 56%–75%. The management hepatic rupture is challenging and may be surgical or non-surgical depending on whether the patient is actively bleeding. Surgical options include liver packing, partial resection, embolization, hepatic artery ligation and liver transplant in selected cases. Despite surgery, hemorrhagic shock remains the cause of death in over one third of patients.

Conclusion

Spontaneous hepatic rupture occurring during pregnancy, is rare and potentially fatal. It is almost always associated with preeclampsia/eclampsia and/ or HELLP syndrome. Rarity of such cases means few doctors have experience in diagnosing and dealing with this condition. It should always alert suspicion and be considered when pregnant women present with sudden onset of epigastric and or right hypochondrial pain accompanied with shock. Management involves efforts of multidisciplinary team. eP-368 Audit of induction of labour in women with previous caesarean section S. Mahran; H. Katali Obstetrics and Gynecology, Wye Valley NHS Trust, Hereford, UK

Objective

To audit the outcomes following the different methods used for induction of labour (IOL) after one previous caesarean section in the Hereford County Hospital (HCH) maternity unit. Design: A retrospective clinical audit. The standards used were the Green-top Guideline No. 45, Birth After Previous Caesarean Birth (October 2015) and NICE guideline [NG207] Inducing labour (04 November 2021).

Method

The maternity records (Badgernet) of Women booked for IOL after one previous caesarean section were reviewed. The audit period was from January 2017 to June 2022. The data collected included maternal characteristics (Parity, gestational age, previous vaginal birth, Bishop score), success rates (spontaneous and instrumental vaginal birth), maternal and neonatal outcomes (birth weight, Apgar score, blood loss), and the duration of hospital stay associated with the different methods of IOL.

Results

From a total number of 177 women with a planned VBAC, 26 women had induction of labour (14 with Propess, 5 with Balloon, and 7 with ARM/Oxytocin). The overall success rate was 50% (n = 13/26), Propess: 50% (n = 7/14), Balloon: 60% (n = 3/5), and Artificial rupture of membranes (ARM): 43% (n = 3/7). Balloon IOL was associated with a slightly higher successful VBAC rate, lower blood loss, no complications and shorter postnatal hospital care compared to the other two methods. IOL after one previous caesarean section in HCH was not associated with major maternal or neonatal complications (scar rupture or NND). All three methods of IOL are associated with comparable maternal and neonatal outcomes.

Conclusions

The decision to induce VBAC labour should be individualized and determined following careful obstetric assessment and be made by senior obstetricians in consultation with the women. VBAC counselling should include a discussion of IOL, available methods and risks. Bishop score is an important factor in deciding the method of IOL. Planned mode of delivery after a previous caesarean and IOL should be booked on Badgernet and the management plan updated for clear record keeping, continuity of care and auditing. The use of Cook Balloon was included in the trust guidelines on IOL were updated for use in women at risk of uterine hyperstimulation and for the second cycle of IOL. eP-369 Rheumatic heart disease in pregnancy: Experience from an apex institute of India S. Dhiman1; A. Gupta1; K.A. Sharma1; R. Vatsa1; V. Kulshrestha1; V. Dadhwal1; L. Kadiyani2; N. Malhotra1 1Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India, 2All India Institute of Medical Sciences, New Delhi, India

Objective

Although rheumatic heart disease (RHD) has decreased significantly in developed countries, it is still prevalent in India because of childhood infections with an estimated prevalence of 1.5–2 per 1000 individuals (1). In India, RHD contributes to approximately 42% of cardiac disorders seen in pregnancy (2). In most of cases it present as mixed mitral valve disease and contributes a major part of patients having mechanical heart valves which is one of the main indication for anticoagulation in pregnancy. Hence, this study was planned to compare the cardiac and obstetrical outcomes in pregnant women with rheumatic heart disease with or without mechanical heart valve. Design: This was a retrospective observational study for a period of past 5 years from January 2019 to December 2023 at the Department of Obstetrics and Gynaecology at our institute.

Method

A five-year retrospective data was collected for pregnant women with RHD from hospital record keeping system and adverse feto-maternal and cardiac outcomes were noted.

Result

There were total 118 women with RHD in past 5 years delivered at our institute. The mean age of the women was 27.8 years. Out of 118 women, 55% were primigravida. The most commonly affected valve was mitral valve accounting for 83% of women with RHD. Out of 118, 55.9% were surgically corrected, in which 55% was replaced with mechanical heart valve. All of the patients were managed with the help of cardiologist. Out of 118, 58% women were delivered by LSCS and 53% of newborn was low birth weight.

Conclusion

Pregnant women with RHD is a vulnerable group specially women with mechanical heart valves. Management of these women poses a big challenge to obstetrician and cardiologist all across the world. Multidisciplinary team management is the key for good maternal and fetal outcomes.

References

1. A. Sreeniwas Kumar and Nakul Sinha Cardiovascular disease in India: A 360 degree overview. Med J Armed Forces India. 2020; 76(1): 1–3. 2. Justin Paul G, Anne Princy S, Anju S, Anita S, Cecily Mary M, Gnanavelu G, et al. Pregnancy outcomes in women with heart disease: the Madras Medical College Pregnancy And Cardiac (M-PAC) Registry from India. Eur Heart J. 2023;44(17):1530–1540. eP-370 Implementation of risk-based screening and aspirin prophylaxis for preeclampsia in the Netherlands L. Timmers1; S. Al-Nasiry1; M. Hendrix1; L. Scheepers1; L. Smits2 1Obs&Gyn, Maastricht University Medical Centre, Maastricht, Netherlands, 2Department of Epidemiology, Maastricht University Medical Centre, CAPHRI Care and Public Health Research Institute, Maastricht, Netherlands

Objective

There is convincing evidence that aspirin can reduce the incidence of early onset preeclampsia (EOPE) in high risk women. In the province of Limburg in the Netherlands, a risk factor-based screening for preeclampsia (PE) using a prediction model was implemented since April 2017. A cut-off of > 3% was considered as high risk for PE and women were counseled on the option of using aspirin to reduce the risk of PE. Our objective was to examine how real-life implementation of this screening and prophylaxis affects rates of preeclampsia with a delivery before 32 weeks (EOPE) before and after implementation and the effect of adherence to the screening and aspirin prophylaxis. Design: retrospective cohort in a tertiary university medical centre.

Methods

All women with conformed EPE before 32 weeks were referred to Maastricht University Medical Centre from the whole Limburg region. The total number of deliveries in the region was taken from the central bureau for statistics. The rates of EPE was compared between the cohorts before and after implementation: "before cohort" (BC, 2010–2016) vs. "after cohort" (AC, 2019–2023) using chi square test, both as intention-to-treat and per protocol analyses. Adherence was measured by actual chart review of all cases of EPE and defined as women with high risk that were offered aspirin (caregiver factor) and of those who were offered aspirin that actually used aspirin (patient factor).

Results

The BC consisted of 63.603 women of whom 90 developed EPE (0.14%) compared to 50 out of 44.366 women in the AC (0.11%) (p 0.20). Based on first trimester screening 31 of the 50 women in the AC were identified as high risk, 11 as low risk and 8 had missing data. Aspirin was discussed in 22 of the 31 high-risk women (71%). Of these 22 women, 13 women actually used aspirin (59%). After real-life implementation, 11 out of 44.366 women were falsely identified as low risk but developed EPE. In the per protocol analysis of high-risk women that used aspirin, the incidence of EPE was 0.08%, which is significantly lower (p = 0.016) compared to rates in the before cohort.

Conclusion

The incidence of PE with a delivery < 32 weeks is lowered from 0.14 to 0.08% when the protocol is adequately followed. However, factors related to both caregiver and patient may result in incomplete implementation. eP-371 Fetal death: Risk factors and preventive measures N. Karmous1,2; B. Abaidi1; A. Masmoudi1; B. Bouguerra1,2 1Obstetrics and Gynaecology Department B, Charles Nicolle Hospital, Tunis, Tunisia, 2Faculty of Medicine- University Tunis el Manar, Tunis, Tunisia

Objective

Fetal death (FD) is a common obstetrical complication, posing both emotional and medical challenges. Our study aimed to assess the prevalence and risk factors of FD in order to update the etiological assessment to prevent recurrences. Design: Retrospective, longitudinal and descriptive case–control study was carried out in Department B of Obstetrics and Gynaecology of Charles Nicolle Hospital, Tunis, Tunisia. This study occurred over 3 years period spanning from 1st of May 2018 to 31st of April 2021. We have identified parturients whose pregnancy was complicated by FD occurring beyond 22 amenorrhea weeks and/or a fetal weight at birth more than 500g. The study was done in two times. First, a descriptive study of 5577 deliveries allowed to determine the frequency of FD. Then, the determination of risk factors was made using a case–control study in which the characteristics of 67 fetal death were compared to 114 controls constituted of alive borns.

Methods

Maternal characteristics, obstetric and gynaecological history, pregnancy's course as well as maternal and neonatal outcomes were retrieved. Descriptive and inferential statistics were performed with SPSS (IBM, v26).

Results

The prevalence of FD was 1.2%. FD was very high in women aged over 35 (40.3%) and primiparous women (35.82%). Most of parturients (55.22%) benefited from a good prenatal follow-up, including 25.37% of pregnant women with spontaneous abortion history. The decrease of fetal active movements was the most found reason for consultation with a percentage of 40.29%. Among the etiological factors of FD, we found mainly gestational diabetes (20.9%), intrauterine growth restriction (20.9%), retroplacental hematoma (19.4%), funicular anomalies (16.42%) and pre-eclampsia (10.45%). Using the etiological investigation, the cause of FD was found in 95.52% of cases. After adjustment, maternal age over 35 years (OR = 6.23; IC = (1.30–29.80)) and diseases during pregnancy (OR = 31.6, IC = [7.66–130.71]) have been identified as factors significantly associated with increased FD occurrence. The high maternal education (OR = 0.11; IC = (0.03–0.42)) decreased this risk.

Conclusions

The advanced maternal age and disease during pregnancy were associated with FD but the high maternal instruction reduced the risk. The monitoring of at-risk pregnant, screening and the treatment of diseases during pregnancy are critical measures ensuring the safety of high-risk pregnancies. eP-372 The effect of myo-inositol supplementation on fetal and maternal outcomes: MiGDM trial H. Abdullahi1; C. George Samuel2; G. Okunoye1; F. Badri3; I. Ibrahim4 1Sidra Medicine, Obstetrics, Doha, Qatar, 2Sidra Medicine, Research, Doha, Qatar, 3Sidra medicine, Research, Doha, Qatar, 4Sidra Medicine, Endorinology, Doha, Qatar

Objective

The primary objective of this study was to assess the effect of antenatal dietary myo-inositol supplementation on the incidence of Gestational Diabetes Mellitus (GDM) among pregnant women in Qatar. Secondary objectives include evaluating its impact on gestational weight gain, the need for metformin or insulin therapy, and fetal outcomes such as macrosomia and neonatal hypoglycaemia, among others. Design: This was a prospective, randomized, double-blind, placebo-controlled clinical trial (RCT)

Methods

This RCT was approved by the institutional board with a plan to enrol 640 pregnant women attending antenatal care at Sidra Medicine, with 320 participants allocated to each arm. Eligible participants were randomized to receive either Myo-inositol supplementation or placebo within the first 16 weeks of gestation until delivery. Data collection included maternal demographics, anthropometric measurements, glucose and insulin levels, and pregnancy outcomes.

Results

Although the study ended prior to achieving target recruitment due to funding challenges, an analysis of cumulative data was carried out. Sixty-seven pregnant women were recruited, and only 43 patients completed the study till delivery. There were 18 patients in the Myo-Inositol group and 25 in the placebo group. No significant differences between the two groups were observed in maternal age, BMI, or gestational weight gain. The two groups had no significant difference in HOMA B or HOMA IR. Additionally, the two groups had no significant difference in maternal or neonatal complications. Dividing the groups into those who developed GDM vs those without showed significantly higher fasting insulin levels (p = 0.027)and an increase in insulin resistance measured by HOMA IR (p = 0.010) in the GDM group compared to the non-GDM group. Additionally, the GDM group had a higher rate of caesarean section (p = 0.003*) and a lower gestational age at delivery (p = 0.03*) than the non-GDM group.

Conclusion

Myo-Inositol supplementation in women during pregnancy did not affect maternal or neonatal outcomes. However, the reported numbers of this study were small, and a larger RCT with enough power is recommended to answer whether Myo-Inositol reduces the incidence of GDM and its impact on maternal and neonatal health outcomes in the Qatari population. eP-373 An analysis of maternal and fetal outcomes of second stage cesarean sections R. Mahil Cherian; A. Thomas; M. Al Barwani Department of Obstetrics and Gynaecology, Khoula Hospital, Muscat, Oman

Introduction

The incidence of second stage cesarean sections have increased recently and is associated with risks like major hemorrhage, extension of uterine angles, blood transfusions, infections, fetal injuries, low APGAR score, etc. The rates of instrumental delivery have also reduced due to concerns of the potential harm to the newborn and also due to lack of expertise.

Objective

To study the maternal and fetal outcomes of second stage cesarean sections for a period of 12 months.

Method

A retrospective analysis was conducted in Khoula Hospital( which is a tertiary care hospital in Oman) for a period of 12 months (January 2023 to December 2023). The details were obtained from computer based labour register of the hospital.

Results

Our incidence of cesarean section was 27%- (1187 in 4296 deliveries). Second stage cesarean section rate was 5.2%. Indications of second stage cesarean sections were failure to progress-48%, fetal distress-48%, Patient request-4%. Major maternal and fetal outcomes were postpartum haemorrhage with > 1 L blood loss-16.1% (10 patients), Urinary tract infections -6.4% (4 patients) Post partum fever-1.6% (1 patient), ICU admission due to desaturation 1.6% (1 patient) and Wound infection which needed resuturing 1.6% (1 patient). 4.8% of babies has an Apgar score <6 at 5 min and 30% of babies were admitted to NICU for observation. There were no birth injuries, cephalhematomas or fractures. 27% of second stage cesarean sections had complications (17/62) out of which 40% were for failed trial of instrumental delivery. Failed Trial of instrumental delivery was 20% (13/62 patients) out of which 46% had major morbidities (6/13 patients). 2 patients had complicated cervical tears.

Conclusions

Second stage cesarean sections have increased incidence of maternal morbidities especially when done after a failed trial of instrumental delivery. Decision making is important for delivery in delay in second stage of labour and senior obstetrician should be available to decide whether to proceed with a second stage cesarean section or an instrumental delivery. More drills and practice should be available for junior doctors for conducting an instrumental delivery . eP-375 An audit on the outcome of vaginal birth after previous cesarean section (VBAC) S. Aatif; S. Zaher; F. Al Ateeqi; A. Nishat; M. Almohsen Obstetrics & Gynaecology, Danat Al Emarat Hospital Abu Dhabi, Abu Dhabi, United Arab Emirates

Objective

To review delivery outcome and associated risk factors in patients with one previous cesarean section who opted for a trial of VBAC. Design: A 6-month retrospective audit of patients who consented to a trial of vaginal birth after cesarean (VBAC) at term.

Method

The audit was conducted at Danat Al Emarat Hospital Abu Dhabi, a private tertiary care hospital in UAE, from October 2023 to March 2024, including delivery outcome and risk factors for VBAC and Emergency Repeat Cesarean Section (ERCS) for patients with previous cesarean who consented for VBAC after explaining risks and benefits. Data was collected from a computerized database after obtaining ethical approval from the hospital committee.

Results

A total of 1561 deliveries took place during 6 months, and 148 (9.5%) patients with previous one cesareans at the gestational age of 37–41 weeks chose VBAC. The results were analyzed using Excel. Out of the 148 patients, 60.8% (89/148) had ERCS, while 39.2% (58/148) had VBAC. Patients were aged between 22–43 years with an average BMI of 29.9.out of these 49.3% (73/148) were obese (BMI 30 and above), 28.3% (42/73) of obese patients had ERCS, and 20.9% (31/73) had VBAC. 50% (74/148) had no previous VBAC or vaginal delivery, 83.8% (62/74) had ERCS, and 16.2% (12/74) had VBAC. 18.9% (28/148) patients had an inter-pregnancy interval of 1 year or less, 67.8% (19/28) had an ERCS, and 32.2%(9/28) had VBAC. 16.8% (25/148) patients had a previous cesarean section due to failure to progress, 76%(19/25) had ERCS due to failure to progress, and 24% (9/25) had VBAC. Gestational diabetes mellitus (GDM) was diagnosed in 33.7% (50/148). 66% (33/50) had ERCS, and 34% (17/50) had VBAC. The overall indications for cesarean section were as follows: failure to progress (37%, 33/89), pathological CTG (14.6%, 13/89), scar tenderness (10.1%, 9/89), spontaneous rupture of membranes (7.8%, 7/89), malpresentation (2.2%, 2/89), and others (28%, 25/89) oligohydramnios, polyhydramnios, and antepartum hemorrhage.

Conclusions

Obese women, those with a short interpregnancy interval of one year and below, previous cesarean section due to failure to progress, or GDM have a higher likelihood of repeat cesarean section. Successful VBAC is more likely after previous vaginal delivery or VBAC. Provider institutions should provide more tailored information to allow women to make informed decisions. Cesarean section rates are increasing in Abu Dhabi, as they are in other countries. Strategies to combat this trend should be tailored to local statistics. eP-376 Comparison of pregnancy outcomes between early and late onset gestational diabetes mellitus M. Nekkanti; H. Sagili; Yavana Suriya J JIPMER, Obstetrics and Gynaecology, Puducherry, India

Objective

To compare the pregnancy outcomes between Early and Late onset Gestational Diabetes Mellitus (GDM). Design: Prospective analytical cohort study of Early and Late onset GDM followed up till delivery and pregnancy outcomes noted.

Methods

This study was carried out in a tertiary care teaching hospital in South India. Pregnant women aged >18 years with singleton foetus and diagnosed with GDM on 75 g OGTT using IADPSG criteria were included in the study. The participants were divided into two groups of 306 each based on their gestational age at the time of GDM diagnosis, namely Early onset GDM- < 24 weeks gestation and Late onset GDM- ≥24 weeks gestation. They were followed up until delivery, and the pregnancy outcomes were noted in a predesigned proforma. The data was entered into MS Excel and analysed with Stata version 14. Continuous variables were analysed using Mean (±SD) or Median (IQR) depending on the normality of the data and categorical variables were expressed as proportions. Chi-square and Student's t-test were used to compare categorical and continuous variables respectively. A p-value of < 0.05 was considered statistically significant.

Results

Among the 612 participants, Early onset GDM was higher (9.47% vs 4.24%) and Late onset GDM was lower (2.61% vs 4.57%) in elderly gravida when compared to teenage pregnancies (p = 0.019). Preterm Premature Rupture of membranes (6.21% vs 3.26%, p = 0.08), Polyhydramnios (1.96% vs 0.65%, p = 0.155), Need for Insulin (29.08% vs 23.52%, p = 0.077), Low Apgar (13.07% vs 11.11%, p = 0.338), Need for resuscitation (14.37% VS 11.76%, p = 0.197) and Neonatal Intensive Care Unit admission (12.09% vs 8.16%, p = 0.114) were higher in Early onset GDM when compared to Late onset GDM. Birth injuries (1.3% vs 0%, p = 0.063) and Shoulder dystocia (0.32% vs 0%, p = 0.319) were observed only in women with Early Onset GDM. Late onset GDM had a higher proportion of Hypertensive disorders in Pregnancy (15.02% vs 12.08%, p = 0.564), Premature Rupture of membranes (12.74%vs 15.03%, p = 0.41) and Induction of Labour (40.85% vs 36.93%, p = 0.603) when compared to Early onset GDM.

Conclusions

Maternal and perinatal outcomes appear to be similar between Early and Late onset GDM pregnancies. Future prospective studies with large sample size and long-term follow-up are required to understand better the pregnancy outcomes in Early onset GDM when compared to Late-onset GDM. eP-377 Early versus late onset GDM in obese women: A retrospective cohort study L. Troìa; M. Garassino; D. Surico; V. Remorgida Department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy

Objective

Gestational diabetes is one of the most common metabolic disorders in pregnancy. Among the risk factors for developing GDM is maternal obesity, and early screening is recommended for these women. The purpose of our study is to determine whether early screening for GDM improves perinatal and maternal outcomes in obese women. Design: Retrospective chort study comparing early (16–18 weeks) versus late (24–28 weeks) onset of GDM in obese women (BMI ≥ 30 kg/m2) at one Tertiary care centers in North Italy, between 2021 and 2023.

Method

A total of 122 obese women were screened at 16–18 weeks, using a 75-g, 3-h glucose tolerance test. Women with negative early OGTT were rescreened at 24–28 weeks. GDM was diagnosed using IADPSG criteria. Women were divided into two groups according to the time of diagnosis of GDM: early diagnosis (Ed-GDM group, n = 58) and late diagnosis (Ld-GDM group, n = 64). Pre-existing diabetes, major medical illness or fetal malformation were exclusion criteria. Primary outcomes examined were macrosomia, hypertensive disorders during pregnancy, cesarean delivery, preterm birth.

Results

Patients in the Ed-GDM group more often had a history of previous GDM (p = 0.019) and macrosomia (p = 0.0049). Only fasting blood glucose values in the first trimester and at the time of early OGTT (p = 0.0179) were significantly higher in the Ed-GDM group. The average daily dosage of both long-acting (p = 0.0069) and fast-acting (p = 0.0001) insulin was higher in the Ed-GDM group. The incidence of hypertensive disorders, gestational age at delivery and mode of delivery showed no differences between the groups. Induction of labor and the need for augmentation were more frequent in the Ed-GDM group. However, the rate of PPH was higher in the Ld-GDM group (p = 0.003). Although the number of macrosomic fetuses was higher in the Ed-GDM group (15.5% vs. 6.2%), the difference was not statistically significant. The rate of NICU admission or shoulder dystocia was not different between the groups.

Conclusions

Women screened early required insulin more frequently than those without positive early screening, but they had similar rates of cesarean delivery, preterm birth, hypertensive disorders, and macrosomia. In this high-risk population, early screening may be not beneficial. However, it is important to monitor fasting blood glucose levels in the first and second trimesters and implement lifestyle interventions early. eP-378 Correlation of ultrasound and histopathological scoring system in placenta accreta spectrum S. Deo; A. Singh; P. Kumari Obstetrics and Gynaecology, King George's Medical University, Lucknow, India

Objective

To study the ultrasound and histopathological scoring system to predict prognosis of placenta accreta spectrum in terms of surgical outcome. Hypothesis: sonographic and histopathological score for placenta accreta spectrum are well-corrected and could help in predicting the surgical outcome. Design: Prospective observational study.

Material and methods

This study was conducted in Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow from January 2023 to January 2024 after the institutional ethical clearance committee. Total 53 patients with USG Doppler/MRI diagnosis of PAS were enrolled. They were divided into four groups: Group 0- without PAS (8 patients), Group 1- Placenta accreta (25 patients), Group 2- placenta increta (14 patients), and Group 3-placenta percreta (6 patients). All 53 patients underwent cesarean hysterectomy and after surgery sample of uterus with placenta was sent for histopathology and HPE grading was done as per FIGO.

Results

Among 53 patients, 58.4% patients had history of previous 1 LSCS,35.8% patients with history of 2 LSCS and 45.2% patients had history of dilatation and curettage. 15% patients were diagnosed as PAS0, 47.1% as PAS 1, 26.4% as PAS2, and 49% as PAS 3 on ultrasound. Maximum patients underwent cesarean hysterectomy between 34–36 weeks of gestation. Preoperatively 3.7% patients underwent Uterine artery embolization and 7.5% underwent ureteric stenting. 62% patients presented with APH, 2% with scar dehiscence and 2% with uterine rupture.All Patients Had Hysterectomy due to massive PPH. Intraoperatively bladder injury occurred in 11.3% patients. Postoperatively 9.4% patients developed acute kidney Injury and 5.6% patients underwent relaprotomy with internal iliac artery ligation due to hemoperitoneum. ICU stay and blood product transfusion (>4) was needed in all cases. Among 53 patients, there were 5 (9.4%) maternal deaths due to hemorrhagic shock, sepsis and Disseminated intravascular coagulation. On histopathological study of uterus and placenta, placental villi invasion upto myometrium was seen in 27 (73.5%) specimen (FIGO grade 3) , Two (3.7%) specimen had invasion of villi upto uterine serosa(FIGO Grade 4–5) and no placental invasion was seen in 12 (22.6%) specimen(FIGO grade 1–2).

Conclusions

Patients with PAS need multidisplinary approach team like an obstetrician, anesthesiologist, urologist, interventional radiologist, blood bank physician and should be managed at tertiary care centre for better outcomes. Accurate Prenatal diagnosis of PAS is essential for planning safe delivery and Histopathology is gold standard for diagnosing PAS. eP-379 Prevalence maternal neonatal outcomes of preeclampsia during pregnancy at single tertiary center F. Alshehhi1; I. Alsulaimi2; N. Alryami3; I. Albusaidi4 1Oman Medical Specialty Board, Obstetric and Gyne, Oman, Oman, 2Sultan Qaboos University, Muscat, Oman, 3Sultan Qaboos University, Obstetric and Gyne, Muscat, Oman, 4Sultan Qaboos University, Muscat, Oman

Objectives

Maternal and neonatal morbidity and mortality have been an issue in the healthcare in Oman. Hypertensive disorders of pregnancy, led by preeclampsia, were shown to contribute significantly to that due to their adverse maternal and neonatal outcomes. The study aimed to assess the prevalence, the maternal and neonatal outcomes, and test the association between variables in women with preeclampsia managed at a tertiary care center. Design: A retrospective cross-sectional study was conducted at Sultan Qaboos University Hospital (SQUH), a teaching hospital, and a tertiary health care center located in the city of Al-Khodh in the governate of Muscat in Oman.

Method

For the sub-analysis, the required sample size was determined for single proportion-Absolute Precision using the n Master 2.0 software for retrospective study. A reference study from the region documented the incidence of PE as 2.47%.(Al-Mulhim et al., 2003) For a desired confidence level of 95%, an expected proportion of 3% PE and an absolute precision of 2%, the minimal desired sample size of PE females needed to study the proposed maternal and fetal outcomes was 279. Accordingly, and based on an estimated average of 30 preeclamptic patients attending SQUH per year, the present study focused on a 10 year time-period from January, 2013 to the end of December, 2022.

Results

During the study period, 390 patients were managed for preeclampsia, giving a rate of 1.00% (95% CI 0.02%–1.98%). The mean gestational age at delivery was 35.3 (± 3.7) weeks and the mean birthweight was 2225.6 (± 813.7) g. Of the total women with preeclampsia, almost a quarter reported at least one maternal complication, including 14 (3.6%) eclampsia cases, 31 (7.9%) HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) cases, 17 (4.4%) abruption placentae cases, and 222 (56.9%) patients delivered via cesarean section. Furthermore, low birth weight rates were noted in 225 (61.2%) fetuses and fetal growth restriction in 104 (24.9%) neonates. There were 13 (3.1%) reported cases of perinatal deaths. Moreover, bilateral pedal edema and neonatal Apgar score of less than 7 at 1 or 5 min were significantly associated with being a primigravida women (p value = 0.000 and 0.021 respectively).

Conclusion

The burden of preeclampsia on maternal and neonatal morbidity and mortality ascertains the importance of continuous and adequate antenatal care and raising community awareness on this problem. Further explorative research is needed including multi centers in Oman. eP-380 Uterine artery Doppler in 11–14 weeks gestation for prediction of preeclampsia T. Akter1; A.i.b. Raunak2 1Gynae & Obstetrics, Dhaka Medical College Hospital, Dhaka, Bangladesh, 2Mugda Medical College & Hospital, Dhaka, Bangladesh

Objectives

To assess the role of pre diastolic notch in uterine artery doppler ultrasonography in predicting the development of preeclampsia in early pregnancy (11–14 weeks of gestation). Design: Longitudinal prospective study.

Method

This study was conducted from November 2022 to November 2023 at Dhaka Medical College Hospital and RMC Hospital, Dhaka. A total 67 women with singleton pregnancy having pre diastolic notch in uterine artery doppler between 11 and 14 weeks of gestation were included in this study. A single doppler ultrasonographic machine with a 5–7 Mhz convex probe was used was used in all subjects. All the patients were then screened periodically for development of preeclampsia. Participants were advised to be followed-up according to the appointments and to come to the hospital immediately if abnormal symptoms, such as generalized edema, headache, blurred vision or epigastric pain developed. Follow up was done monthly up to 28 weeks of pregnancy,every 15 days up to 32 weeks then weekly till delivery.Outcomes were measured in terms of developing preeclampsia or not.

Result

81% (54) patients who had pre diastolic notch developed preeclampsia in this study. Among them 34 patients developed early onset preeclampsia (<32 weeks) and 20 patients (≥32 weeks) developed late onset preeclampsia.The frequency of preeclampsia was more among primigravidmothers and younger age group.

Conclusion

Uterine artery Doppler can be a useful tool to predict preeclampsia during early gestation. Such a non-invasive tool can greatly reduce maternal and fetal morbidity and mortality by ensuring early prediction and timely intervention of preeclampsia. eP-382 Case series of myomectomies at caesarean section in a tertiary referral unit L. Wheeler; H. Lally; J. Iskaros University College London Hospital, London, UK

Objective

The rising prevalence of fibroids across the pregnant population dictates that practising obstetricians will encounter, with increasing frequency, fibroids during caesarean section. A comprehensive strategy to provide this patient cohort with effective and safe management is required. Design: We reviewed patients who underwent myomectomies prior to or after caesarean section, performed by a single surgeon at a large tertiary referral centre in the UK. We discuss steps used to minimise blood loss during surgery and reported outcomes across our included cohort [N = 8].

Method

We identified 8 patients who underwent elective caesarean section due to the presence of large obstructing uterine fibroids. These patients were cared for in a specialist antenatal clinic and were offered multimodal imaging, including MRI and ultrasound scan by a specialist obstetric surgeon at 36 weeks.

Results

Six patients underwent myomectomy at the time of caesarean section. All patients underwent an ultrasound scan immediately prior to operating for further surgical mapping. The number of fibroids documented at the 36 week ultrasound scan ranged from 1 to 5 fibroids, with maximal diameter ranging from 21 to 165mm and median size of the fibroids was 125 × 119 × 92mm. Operating time ranged from 58 to 156 min, with a median of 111 min. Five patients had optimisation of their haemoglobin with iron supplementation, four with oral iron and one with an iron infusion. Estimated blood loss was a median of 1250 mL [Range 720–2200 mL]. Intraoperative cell salvage was utilised in three operations. Two patients required a blood transfusion post operatively. The hospital stay ranged from 2 to 7 days [median stay 3 days]. The extended stay of 7 days was complicated by haemorrhage in a patient who refused blood transfusion and required erythropoietin. Post operatively one patient developed ileus and one patient required intravenous antibiotics for possible endometritis. One patient required readmission to hospital for conservative management of an abdominal collection.

Conclusions

Although we are reporting on myomectomies that were necessary to perform, a discussion needs to be had about performing myomectomies in planned caesarean sections. If the patient is optimised pre-operatively and adequately counselled, then performing a myomectomy at caesarean section is an opportunity to avoid future surgery and repeated hospital admissions. This must be balanced against the potential of excessive blood loss and need for blood transfusion, prolonged operating time and length of stay. eP-457 QI project of VTE prophylaxis following surgical management of ectopic pregnancy M. Rahma; P. Campbell Belfast Trust, Gynaecology, Belfast, UK

Objective

NICE recommend VTE prophylaxis to patients undergoing abdominal surgery who are at increased risk of VTE.Thrombosis and thromboembolism (VTE) continues to be the leading cause of direct maternal deaths .Of the 35 maternal deaths attributed to VTE one of which occurred after surgical management of an ectopic pregnancy.Four published original research studies, one clinical comment paper, and six guidelines were reviewed. Despite clear evidence of the increased risk of VTE in pregnancy, there is a lack of guidance regarding evaluation and management after early pregnancy loss. Design: Retrospective audit of patients (n = 39) who had undergone surgical management of ectopic pregnancy during a 6-month period (April–September 2023).Patients identified from theatre log at RVH emergency theatre. This included patients operated on in Mater and BCH. Notes reviewed.

Results

39 patients identified.Age range (20–37), mean age = 30 BMI range (17–35), average = 25 Indication: unruptured (n = 31), ruptured (n = 8). Management: laparoscopy (n = 32), laparotomy (n = 7)100% of patients were prescribed enoxaparin. 82% of patients were discharged home with 7 days enoxaparin. 18% of patients were not discharged with 7 days enoxaparin. 8 patients had ruptured ectopic with over 1000 mLs blood loss and had blood transfusion. Of note, 25% of these patients were not prescribed enoxaparin on discharge.

Discussion

NICE guideline recommend minimum of 7 days enoxaparin for patients undergoing abdominal surgery. Whilst ectopic pregnancy and surgery are risk factors for VTE, this patient group can have additional risk factors; Age 51% of patients were > 30 years BMI 36% of patients had BMI >30 Smoking 27% of patients were smokers. Recommendation: The pathway for review to ensure that compliance is achieved in timely manner. How can this be achieved? To ensure the NICS guideline and requirement to adhere to best practice in record keeping is shared at junior doctors' induction. Ensuring 7 days Enoxaparin written in post op notes and handover sheet. VTE Risk assessment scoring. The trust should consider funding a clinical pharmacist for who could also contribute to education and training programmesTo ensure the NICS guideline and requirement to adhere to best practice in record keeping is shared at junior doctors' induction. Ensuring 7 days Enoxaparin written in post op notes and handover sheet. VTE Risk assessment scoring. Re-audit was done during 3 months period January 2024–March 2024.There were 100% compliance of enoxparin written/prescribed in post op ,handover sheet and discharge letter. eP-459 Assessment of transient abnormal uterine bleeding patterns post COVID-19 vaccination N. Jabeen; M. Shahid; R. Mushtaq Gynaecology and Obstetrics, Rawal Institute of Health Sciences, Islamabad, Pakistan

Objective

To document the presence of transient changes in the menstrual cycle post-COVID-19 vaccination. Design: Cross-sectional study. Methodology: This study was conducted after approval from the ethical committee in Rawal Institute of Health Sciences, Islamabad from 1st September 2021 till 31st March 2024.WHO calculator was used to collect sample size and 1000 Female residents of Rawalpindi and Islamabad visiting the Obstetrics & Gynecology Department between 18–45 years of age were selected. Women with regular menstrual cycle three months prior to vaccination, with evidence of vaccination (certificate, card, mobile message from CDC), women reporting with change in menstrual cycle their friends and family members, doctors community and their friends and family members regarding any change in the cycle, were included in the study. Females with menstrual irregularity three months prior to vaccination, using contraceptives, and menstrual irregularities associated with pelvic pathology were excluded. Data was collected on a structured proforma after taking informed consent. Percentages were calculated for descriptive variables like age, education, marital status, occupation, social status, type of vaccine, menstrual cycle, and any change in the menstrual cycle. Data were analyzed on SPSS version 25. p-value < 0.05 was considered significant.

Results

We enrolled 1000 vaccinated females in this study. Females between the age of 18 and 45 years were included in the study with a mean age of 27 years. Regarding the education of patients, 46% (460) had done bachelors, 78% (780) were residents of Islamabad, 58% (580)married and 60% (600) belonged to the middle class. Regarding menstrual changes no change in the menstrual cycle was experienced by 800 (80%) cases, 160 (16%) experienced menorrhagia while 40 (4%) complained of oligomenorrhoea. Regarding follow-up of cases from menorrhagia group 18 and from oligomenorrhea group, 11 are still on follow-up.

Conclusion

Changes in the menstrual cycle after the COVID vaccine are found to be transient for 2–3 months without any medical intervention. However, in a few cases where abnormality persists regular follow-up is required.

Keywords

Covid-19, Vaccine, Menstrual changes, Menstruation, Abnormal bleeding eP-460 Effect of blood thinners on hysteroscopy and polypectomy outcomes in postmenopausal bleeding R.H. Shaikh; S. Palaparthy; J. Murdock University Hospital Crosshouse, Obstetrics & Gynaecology, Kilmarnock, UK

Introduction

In this retrospective study, we focused on postmenopausal bleeding patients taking anticoagulants and antiplatelet therapy during hysteroscopic polypectomies. We looked at the advice given to patients before their appointments with the aim to generate separate pathway for these patients and investigate if medications need discontinued prior to these procedures. The goal was to ensure patient safety and minimize the risk of bleeding complications and to provide standard care to all these patients. We also assessed the uniformity of medication management and identified areas for improvement.

Method

We conducted our study at NHS Ayrshire and Arran, focusing on Patients attending postmenopausal bleeding clinics undergoing hysteroscopic polypectomies, using Bigatti devices in outpatient settings and hysteroscopic polypectomies under general anesthesia. We collected patient data from January to December 2023 using TRAK and the Clinical portal. Details included age, type of anticoagulant/antiplatelet agents, complications and advice given was collected.

Result

In the outpatient PMB clinics: - Out of 1670 patients, 6.3% (106 patients) were on anticoagulant or antiplatelet medication. Among them, 63.2% (67 patients) had hysteroscopy, 10.4% (11 patients) had polypectomy, and 2 (18.18%) had post-polypectomy bleeding. 12.3% (13 patients) taking the above medications were referred for further operative procedures. For outpatient Bigatti: - Out of 54 patients, 7.4% (4 patients) were on anticoagulant or antiplatelet medications- 2 on antiplatelet medications and 2 on DOACs -only 1 patient (25%) on Apixaban was advised to stop the medications. All 4 patients had polypectomy without complications. Polypectomies under general anesthesia: - Out of 170 patients, 5.9% (10 patients) were on anticoagulant or antiplatelet medications—8 were on clopidogrel (75mg) and 2 on Apixaban. Only 5 of the 10 (50%) were advised (by anesthetists) to stop medications before the procedure.

Conclusion

We evaluated medication management, identified areas for improvement to generate pathways for discontinuing these medicines if needed before the procedures to provide uniformity. Our findings contribute to patient safety by minimizing bleeding risks. Clear and consistent advice to patients on these medications is crucial. Implementing the guidelines in practice will enhance care for postmenopausal bleeding patients. Further audit can assess long-term outcomes. Even though the numbers are small given that outpatient Bigatti procedure commenced in our hospital from last year and numbers are minimal at present. If we generate guidelines at this stage, we can develop standardized practice which is safe for patients. We hope our findings guide future practice and improve patient care. eP-461 “Oops! Your surgery is cancelled.” Case cancellations in a Bahamian healthcare system A. Brown; S. Bodie-Williams; S. Bowe Rand Memorial Hospital, OBGYN, Freeport, Bahamas

Objectives

This study explores specific causes of case cancellations in a Bahamian healthcare system.

Materials and methods

An audit was developed to determine the amount of case cancellations that occurred between December 2022- February 2023 at the Rand Memorial Hospital. The overall data was collected by assessing how various cases were booked by the Obstetrics and Gynecology and General Surgery Departments respectively. Cases were routinely booked by utilizing a department planner or calendar application to document patient demographics, the intended surgical date and the paFent's diagnosis/surgical procedure. The predicted list was then given to the operating theater staff and was then transcribed by the team the day before the surgery as the official list for the following day. If a case was not completed at the end of the day on the official theater list, it met the definition of a cancelled case. The case is then added to an excel spreadsheet with the intended procedure and the reason for cancellation.

Results

A total of 53 cases were cancelled between December 2022–February 2023. The most common reasons for case cancellations were due to overbooked lists in 16 cases (30%), understaffed departments in 13 cases (26%), and no beds being available in 6 cases (11%).The department with the most cancellations was General Surgery as they were noted to have 38 cancellations (72% of cases). The most common cases that were cancelled by General Surgery were 14 cases of biopsies and the excision of various masses (36%). 15 cases (28%) were noted to be cancelled by Obstetrics and Gynecology and the most common cases that were cancelled were 4 cases of dilation and curettages (27%).

Conclusion

To resolve case overbooking as this was the most common result, a cap should be placed on how many patients should be booked to complete the official list. Staffing issues and equipment failure should also be addressed by theater staff and the heads of each department to maximize overall efficiency. Hospital Administration should be notified on the concerns of minimal ward space that is present to accommodate patients that present the day before the surgery. For example, a ward can be made specifically for outpatients. Overall, these cancellations can be avoided. eP-462 Impact of the affordable care act on breast cancer survival in America O. Akinyemi1; M. Fasokun2; F. Babarinde3; I. Akinyemi4; H. Fatima5; S. Muhammad6; M. Michael7; K. Hughes8; S. Lawson9 1Department of Health Policy and Management, Oluwasegun Akinyemi, College Park, Maryland, USA, 2Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA, 3Federal Medical Center, Internal Medicine, Idi-Aba, Abeokuta, Ogun State, Nigeria, 4Spoon River College, Nursing, Macomb, USA, 5North Tees University Hospital, Obstetrics and Gynecology, Stockton-on-Tees, UK, 6Obstetrics and Gynecology, Isle of Wight NHS Trust, Newport, UK, 7Internal Medicine, Howard University College of Medicine, Washington, UK, 8Department of Surgery, Howard University College of Medicine, Washington, DC, USA, 9Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC, USA

Introduction

In 2023, nearly 300 000 invasive breast cancer cases will be diagnosed in the U.S., resulting in approximately 50 000 fatalities. This underscores the substantial health impact of breast cancer in the country. The introduction of the Affordable Care Act presents an opportunity to enhance survival rates among these women.

Objective

To determine the impact of the implementation of the Affordable Care Act ACA on cancer-specific survival among women with breast malignancies. Methodology: We utilized data from the SEER registry to determine the causal impact of the implementation of the ACA on cancer-specific survival among women with breast malignancies. The study covered the years 2000–2020, divided into pre-ACA (2000–2009) and post-ACA (2017–2020) periods, with a 3-year washout (2010–2013) since New Jersey implemented the policy in 2014. Using a Difference-in-Differences approach, we compared Georgia (a state yet to adopt the ACA) and NJ, which adopted the policy in 2014. We adjusted for patient demographics, income, metropolitan status, disease stage, and treatment modalities.

Result

We compared 262 635 women with breast cancer in the study period. Among these women, 52.2% were from New Jersey, which adopted the ACA, while only 47.8% were from Georgia, which has not implemented the policy. The post-ACA period was associated with an 18% reduction in the hazard of dying from breast cancer (HR = 0.82, 95% CI 0.77–0.88). After confirming the parallel trend assumption, implementing the policy led to a 23% reduction in the hazard of death in New Jersey compared to Georgia (HR = 0.77, 95% CI 0.70–0.85).

Conclusion

The implementation of the Affordable Care Act led to a substantive improvement in cancer-specific survival among women with breast cancer in the United States. eP-463 Research proposal: Comparative efficacy of KAPT vs paracervical block in outpatient hysteroscopy M. Saleh; R. Laiyemo Kings Mill Hospital, Sutton on Ashfield, UK

Objective

The golden fleece of outpatient hysteroscopy (OPH) is to obtain the best anaesthetic technique to ensure patients experience minimal to no pain during the procedure. Whilst advancements in hysteroscopic technology have expanded the scope of procedures feasible in OPH, managing pain during these procedures have been far from optimal. King's Mill Anterior-Posterior and Transverse (KAPT) Block has recently been described and presented as a top scoring abstract at the RCOG congress in 2016 with a mean pain score of 0.704/10 (SD ± 0.24) for Myosure® and 1.2/10 (SD ± 0.44) for Novasure®. The block targets the Lee-Frankenhauser plexus, a part of the Inferior Hypogastric Plexus, within the Uterosacral Ligament Complex (USLC). The KAPT Block is strategically applied 1.65–3.3 cm distal to the cervical insertion of the USLC. According to recent metanalysis, Paracervical block is the best method for pain control in OPH, however KAPT block was not included in this metanalysis. Our Objective is to evaluate and compare the pain scores of women undergoing OPH when administered either the KAPT Block or the Paracervical Block during different stages of the procedure. Design: A randomized controlled trial design to compare pain scores between with either KAPT Block or Paracervical Block. Ethical approval has been obtained from the ethics committee in Kings Mill Hospital.

Method

Women aged 18 and above attending OPH at Kings Mill Hospital will be included, with contraindications and allergies to local anaesthetics as exclusion criteria. A sample size of 48 patients will be randomly and blindly divided equally into 2 groups according to the method of anaesthetic during OPH. An increase of 10% will be added to overcome any dropout with a study power of 80% (1-β error probe) and a probability of type I error (α error = 0.05). Pain scores will be assessed using patient questionnaires via the use of Visual Analogue Scale at three stages: during cervical dilatation, during the procedure, and 10 min post-procedure with a mean score calculated overall.

Results

The study anticipates demonstrating a significant difference in pain relief between KAPT and Paracervical Blocks, we aim to publish the results in the next RCOG Congress.

Conclusions

This research aims to contribute valuable insights into pain management in OPH, potentially influencing clinical practices and guidelines. By establishing a more effective anaesthetic technique. The findings could fill a gap in current literature and pave the way for future research in this area. eP-464 Uterine fibroids: Age at diagnosis lower among Afro-Caribbean females? A literature review P. Ojo1,2 1University of East Anglia, Norwich, UK, 2Imperial College London, London, UK

Objective

This literature review aims to evaluate current research analysing the age at the time of fibroid diagnosis in women; whilst also identifying notifiable differences between the ethnic groups. Design: Uterine Fibroids (UF), are benign neoplasms seen in 70% of women by menopause. The effects of the physical, psychological, social and economic burdens can be debilitating. There is strong evidence recognising that black females are 3 times more likely to develop UF compared to white females. The impact that further economic, social and psychological burdens can have on a population group that already faces significant social and economic pressures is profound. Therefore, achieving the aforementioned objectives will buttress this burgeoning discussion, highlighting potential shortcomings in the evidence base. Fulfilling this will aid current management tools to improve patient outcomes and enable professionals across the healthcare sectors to better support these women.

Method

A Search of MEDLINE and EMBASE in February 2023, identified 49 relevant publications. The MESH terms: Uterine fibroid, Uterine Leiomyoma, Afro-Caribbean, Black, and Age were used. Only 3 studies proved to be appraisable; focusing on participant's demographics and the data investigating age-specific incidence rates (ASIR).

Results

E A Stewart et al (2017) summarised in a systematic review that black race was the only factor recurrently reported as increased UF risk, and further data is required from large prospective studies. IO Bello-Morhason, C Adebamowo (2022) echoed similar sentiments in their systematic review conducted in Sub-Saharan Africa. Neither paper adequately commented on ASIR, potentially as a result of limited data. However, due to the scoping nature of the systematic reviews, the information was considered significant to this appraisal. The only study directly assessing ASIR, K Huyck et al (2008), evaluated that black females were on average 5.3 years younger than white females at the time of diagnosis. This study had significant limitations.

Conclusion

Restricting the population group to sisters in the K Huyck (2008) study hinders generalisability and introduces sampling bias. A distinctive result was identified despite prominent differences in the population demographics (26% black and 74% white). A similar study that reflects the general population is required to allow for optimal interpretation. Numerous outdated publications were key limitations to this literature review. The systematic review conducted in 2017 greatly expresses the drawbacks of current papers. Upon critical appraisal and coupled with growing international efforts to improve women's health research, further exploration into this area is required. eP-465 Beyond cytology – HR-HPV persistence: Unmasking recurrence risks post-LLETZ S. Hirsi-Farah; J. Gbadamosi George Eliot Hospital NHS Trust, O&G, Nuneaton, UK

Objective

To assess the outcomes of women who failed the test of cure (TOC) following Large Loop Excision of Transformation Zone (LLETZ) for cervical dysplasia, aiming to identify treatment failure, residual/recurrent disease, and inform surveillance strategies. Design: This retrospective audit analysed 65 cases of failed TOC out of 335 LLETZ procedures performed over 18 months at a single centre. Data were collected to evaluate HR-HPV positivity, cytology, colposcopy findings, and subsequent management.

Method

Patient records were reviewed to ascertain HR-HPV status, cytology, and colposcopy results post-LLETZ. Patients were categorized based on subsequent management: discharge to routine recall, repeat cytology ± colposcopy in 12 months, or second treatment. Data on repeat LLETZ and hysterectomy rates were also collected.

Results

All cases (100%) were positive for HR-HPV, while only 18.46% exhibited abnormal cytology. Abnormal colposcopy impressions were observed in 18.46% of cases, with 6.15% deemed unsatisfactory. Sixty percent of patients were discharged for routine recall, 35.38% underwent repeat cytology ± colposcopy, and 4.62% required second treatment. One patient underwent repeat LLETZ for high-grade lesions, and two had hysterectomies due to low-grade/unsatisfactory colposcopy post-multiple LLETZ, with no residual CIN detected. Similar outcomes were observed regardless of margin completeness.

Conclusions

HR-HPV persistence post-LLETZ underscores its role in disease recurrence, emphasizing the importance of vigilant surveillance. While abnormal TOC results were common, many patients had normal cytology and colposcopy, challenging traditional management paradigms. The low rates of repeat treatment suggest favourable outcomes following LLETZ, but the potential for missed disease necessitates careful consideration in post-treatment surveillance strategies. Further research is warranted to optimize the management of women with cervical dysplasia who fail TOC. eP-466 A systematic review and meta-analysis on vaginal pelvic oragan prolapse (MARIE-WP1) V. Pathiraja1; T. Mudalige2; G. Delanerolle3; J. Taylor4; S. Wu5; Y. Weng5; Y. Bouchareb6; H. Cavalini3; O. Kurmi7; K. Riach8; S. Hinchliff9; C. Atkinson10; K. Potočnik11; P. Briggs12; V. Talaulikar13; L. Saraswat14; J. Qing Shi3; A. Shetty13; N. Rathnayake2; I. Litchfield4; K. Elliot3; I. Muhammad15; R. Kareem15; T. Teck Hock16; C. Laguna Benetti-Pinto17; G. Eleje18; I. Aggarwal19; J. Manonai20; P. Phiri3; S. Elenil13 1Department of Pharmacy, University of Ruhuna, Galle, Sri Lanka, 2Department of Nursing, University of Ruhuna, Galle, Sri Lanka, 3Research and Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom, 4University of Birmingham, Birmingham, United Kingdom, 5Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China, 6College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman, 7University of Coventry, Coventry, UK, 8University of Glasgow, Adam Smith Business School, Glasgow, UK, 9University of Sheffield, Sheffield, UK, 10Manchester Metropolitan University, Manchester, UK, 11University of Edinburgh, Scotland, UK, 12Liverpool Women's Hospital Foundation NHS Trust, Liverpool, UK, 13University College London Hospitals NHS Foundation Trust, London, UK, 14University of Aberdeen, Aberdeen Royal Infirmary, Aberdeen, UK, 15Riphah International University, Peshawar Medical College, Islamabad, Pakistan, 16Sibu Hospital, Sarawak, Malaysia, 17University of Campinas, UNICAMP, São Paulo, Brazil, 18Nnamdi Azikiwe University, Nnewi, Nigeria, 19KK Women's and Children Hospital, Singapore, Singapore, 20Mahidol University, Nakhon Pathom, Thailand

Objective

To identify the prevalence and outcomes of women undergoing pelvic organ prolapse (POP). Design: An evidence synthesis was conducted using a systematic reivew and meta-analysis.

Method

A systematic methodology was developed and published in PROSPERO (CRD42022346051). Searches were conducted using PubMed and Science Direct between 30th of April 1980 to 30th of April 2022. Peer reviewed and published articles in English, that were clinical trials or observational studies that reported on POP were included. The finalised dataset was analysed using a random-effect model and a thematic analysis. We used odds ratios (OR) and 95% confidence intervals (CI) to establish prevalence using multiple variables of surgical interventions used to treat POP and their complications and ongoing complications related to surgery. Heterogenity was reported using I2.

Results

Of the 505 articles identified, 44 were included into the systematic review and 19 into the meta-analysis. To assess the effectiveness of surgical interventions used, common outcome measures of perioperative complications such as pelvic organ damage, estimated blood loss, the need for blood transfusions, and post-operative factors such as duration of hospital stay and operating time were indentifed. Most studies comprised of small sample sizes and were not representative of all ethnicities. The studies were primarily conducted within high income countries. We identified women that had bladder injury following their hysterectomy had a pooled prevalence of 1.70% with a 95% CI of 0.92%–3.08%. I2 indicated a high statistical heterogeneity of 69%. In contrast, the prevalence of bladder injury among women who did not have a hysterectomy was 1.42% with a 95% CI of 0.53%–3.73%. The pooled prevalence of infection among these women was 11.92% with a 95% CI of 5.73%–22.97% with a I2 81% indicating a high heterogeneity. The prevalence of mesh complications were 3.32% with a 95% CI of 2.46%–4.23%. The prevalence of infections were 2.56% with a 95% CI of 1.31%–4.88%. A significant statistical heteregoentiy of 74% (I2) was identified. The pooled prevalence of hospital re-admisssion following a hysterectomy was 3.93% with a 95% CI of 2.99%–5.07% and a I2 of 0%. The re-operative prevalence was 4.44% with a 95% CI of 2.51%–7.73% with a significant heterogeneity (I2) of 78%.

Conclusions

Bladder injuries, infections and re-admissions were common outcomes among women with POP. Comprehensive research is required to report short and long-term outcomes for women undergoing POP. eP-467 A 5-year review of robotic assisted myomectomies in University Hospital Limerick L. Shailendranath; U. Mahmood; G. Munawar University Hospital Limerick, Gynaecology, Limerick, Ireland

Introduction

Robotic technology is a novel and innovative minimally invasive approach with demonstrated feasibility in gynaecological and reproductive surgery. Robotic assisted gynecological surgeries have revolutionized the surgical approach of minimal invasive surgery. It has advantage of excellent visualization through 3 -Dimensional view, improved ergonomics. It offers many benefits from patient perspectives like shorter hospitalization, integrated care, less postoperative pain, reduced intraoperative blood loss. Following FDA approval in 2005 robotic assisted surgery has made exponential progress in specialty of gynecology. One area that has leveraged the unique aspects of robotics has been in the surgical management of uterine fibroids.

Materials and methods

This is a 5-year review of cases of robotic assisted myomectomies from January2019 till February2024. So far there have been 165 robotic assisted procedures to date which includes myomectomies, endometrial excision, hysterectomies and cervical cerclage. Out of 165 procedures 43 are myomectomies. This study involved prospective collection of data.

Results

All the myomectomies were performed for subfertility reasons. Age group ranged from 25 to 50, with mean age of 38 years. Body Mass index ranged from 22 to 50, with mean BMI of 30. In relation to ethnicity, 33 were Caucasian, 5-African and others constituted 5. The size of fibroids as per MRI ranged from 1–32 cm, with mean size of 5 cm. The weight of fibroid post-surgery ranged from 26–3294 g with mean of 457 g. 3 out of 43 (6.8%) had to be converted to laparotomy. Out of 43 myomectomies, 7 had additional stage 4 endometriosis and 1 had dermoid cyst. No Breach of uterine cavity intraoperatively. The docking time ranged from 4 to 20 min with mean time of 8 min. Console to incision close time ranged from 1.5 to 5 h and 57 min with mean time of 3 h. Average blood loss ranged from 10 to 2650 mL with mean blood loss of 384 mL. Average length of inpatient admission ranged from 0–6days with mean of1.6 days. All patients had preoperative assessment and admitted on the day of surgery. All patients were reviewed 6–8 weeks post-surgery. No documented Day 7 and day 30 post operative complications. 1 out of 43 (2.3%) developed rectus sheath dehiscence at umbilicus.

Conclusion

Robotic assisted approach is associated with the removal of significantly larger myomas. The procedure can be performed safely in patients with morbid obesity and high BMI does not affect the surgical outcomes. The advantages of robotic assisted procedures include less complications, lower blood loss and shorter hospitalization. eP-468 Menopause training among obstetrics & gynaecology trainees in UK: Are we getting it right? N. Malik; B. Sahu; M. Wood; M. Afzal Shrewsbury and Telford NHS Trust, Obstetrics and Gynecology, Telford, UK

Background

The menopause has garnered significant media attention in recent times due to the rising number of working menopausal women, accounts of women being disregarded, and anxiety surrounding the prescription and usage of hormone replacement therapy (HRT) due to lack of training and knowledge gap among physicians.It is a normal, natural, and inevitable part of ageing. Yet for too long, too many people experiencing menopause have struggled with societal stigma, inadequate diagnosis and treatment, workplace detriment and discrimination.The management of menopausal symptoms requires a comprehensive understanding and specialized training, particularly among obstetrics and gynecology trainees in UK.

Objective

The national survey was conducted among obstetrics and gynecology trainees to evaluate the depth of knowledge with regards to management of menopause and menopause services provided at their hospital and training opportunities. Participants and Methods: This online Menopause Training review surveyed 103 postgraduate obstetrics and gynecology trainees in the UK from September 2023 to October 2023. The national survey was distributed to all deaneries in the UK for circulation to all their trainees via social media, WhattsApp groups and emails. The survey comprised of questions regarding trainees' level of training, country of training, menopause clinics in their hospital, their clinic regularity, and any designated lead clinician for menopause clinics in their hospital, management of menopause, the trainees' confidence advising patients with menopausal symptoms, and any benefit from their patient care.

Results

The majority of responders 70 (68.63%) belonged to England followed by 21 (20.59%) Wales and Ireland 11 (10.78%). About 56 (54.36%) had a menopause clinic in their hospital and 46 (45.10%) responders conducting regular clinics. Approximately 44 (42.72%) had a designated lead clinician present in their hospital. Specific trust guidelines on the management of menopause were applied in 30 (29.13%). About 21 (20.39%) respondents felt confident advising patients with menopausal symptoms and 99 (96.12%) participants thought that going through additional formal menopause training could benefit patient care.It is imperative to adopt a novel pedagogical strategy for teaching menopause in healthcare curriculum.

Conclusion

The survey emphasized that the need for ongoing evaluation and enhancement of menopause training programs for obstetrics and gynaecology trainees in the UK to ensure optimal patient care during this critical life stage.

Keywords

Menopausal training, Obstetrics and Gynecology, Management, Knowledge eP-470 Feasibility of robot-assisted surgery in Benign gynaecology at a district general hospital I. Njoku1; A. Sharif1; A. Talluri1; Y. Coker2; K. Mahendra2; R. Nair2 1Barking, Havering and Redbridge University Hospitals NHS Trusts, Obstetrics and Gynaecology Specialty Registrar, London, UK, 2Barking, Havering and Redbridge University Hospitals NHS Trusts, Obstetrics and Gynaecology Consultant, London, UK

Objective

The primary objective of our review is to analyse our newly established robotic assisted surgery within complex gynaecology and urogynaecology at our hospital. Design/Rationale: Robotic assisted laparoscopic (RAL) surgery is increasingly used to assist in gynaecological procedures world-wide. RAL in gynaecology has predominantly been used for gynaecological malignancies but the use of the robot has been now increasing for cases of endometriosis and other subspecialties such as urogynaecology.

Methods

We undertook a retrospective observational cohort study of women who underwent RAL in Benign gynaecology, Endometriosis and Urogynaecology performed at our hospitals from October 2021 to December 2023. Patient demographics, surgical data, operation timings, conversion rates, complication rates and readmission rates were analysed. - 148 robotic assisted benign gynaecological procedures were carried out by 3 consultants. - 45% Benign Gynaecology cases; 42% Endomteriosis cases and 13% Urogynaecology cases. - Colposuspension (32%); Sacrocolpopexy (26%) and Iliopectineal suspension (26%) were the three most commonly performed RAL urogynaecological procedures. - Average EBL for TRH± BS/BSO was 161 mL; for adnexal surgery was 128 mL; Resection of endometriosis was 50 mL and for urogynaecological procedures was 90 mL. - The average inpatient stay was 1.72 nights. - Conversion to laparotomy was done in 3 cases (1.6%). - Intraoperative complications encountered in 4 cases (2.7%). - 6 cases were readmitted (4.1%).

Conclusion

As one of the first UK trusts performing RAL in urogynaecology, our trail blazing centre has shown that RAL is feasible and safe, and has positive outcomes in urogynaecology as well as in complex Endometriosis surgery. Quicker operating and recovery times and reduced blood loss have been advantageous. We aim to facilitate daycase procedures in Urogynaecology. Dual consoles will allow second operators for concurrent multi-disciplinary operating in complex endometriosis cases. PLEASE NOTE THIS ABSTRACT WAS ACCEPTED FOR ORAL PRESENTATION – TO BE PRESENTED AT THE BSGE ASM IN NORTHERN IRELAND IN MAY 2024 eP-472 Impact of the affordable care act on breast cancer metastasis and survival O. Akinyemi1,2; M. Fasokun3; F. Babarinde4; T. Weldeslase5; R. Williams6; K. Hughes6; S. Lawson7 1Oluwasegun Austine Akinyemi, The Clive O. Callender MD Outcomes Research Center, Howard University, Washington, DC, USA, 2Department of Health Policy and Management, University of Maryland School of Public Health, College Park, USA, 3Mojisola Fasokun, Epidemiology, Birmingham, USA, 4Federal Medical Center, Internal Medicine, Abeokuta, Nigeria, 5Terhas Weldeslase, General Surgery, Washington, DC, USA, 6Howard University College of Medicine, General Surgery, Washington, DC, USA, 7Howard University College of Medicine, Obstetrics and Gynecology, Washington, DC, USA

Objective

The Affordable Care Act (ACA), through its expansion of Medicaid eligibility, aimed to enhance access to care for minorities and low-income individuals. This study examines the impact of the ACA on breast cancer metastasis and survival. Methodology: We conducted a retrospective study using the SEER database to evaluate the impact of the implementation of the ACA on cancer metastasis among women with breast cancers between 2007 and 2020. The patients were stratified into pre-ACA (2007–2013) and post-ACA (2014–2020) period. We compared risk of presentation with breast cancer metastasis in California, where the ACA was implemented in 2014, and Texas, which has not adopted the policy. We utilized multinomial logistic regression to determine the association between implementation of the ACA and breast cancer metastasis adjusting for patient demographics, income and metropolitan status.

Result

The study included 476 553 women with Breast cancer, with 231 968 (48.7%) in the pre-ACA period and 244 585 (51.3%) post-ACA. In Texas, 182 112 women were analyzed, with 46.5% pre-ACA and 53.5% post-ACA, while in California, the numbers were 294 441(50.0% pre-ACA and 50.0% post-ACA). Proportion of women with metastasis reduced in the post-ACA in Texas (7.8% vs. 7.0%) while it increased in California in the same period (6.0% vs. 6.8%). Post- ACA, there was a 14% overall reduction in metastasis (OR = 0.86; 95% CI 0.81–0.90). However, California experienced an increased risk compared to Texas (OR = 1.23; 95% CI 1.15–1.31). This trend was consistent across different races and among low-income, Medicaid-eligible women. Specifically, the rates of distant metastasis in Texas decreased from 5.9% to 5.3% for white women, from 8.9% to 8.1% for non-Hispanic Black women, and from 6.6% to 6.0% for Hispanic women. Conversely, in California, these rates increased from 5.4% to 5.7% for white women, from 8.1% to 8.7% for non-Hispanic Black women, and from 6.0% to 6.4% for Hispanic women. Among low-income women, the risk of distant metastasis followed a similar pattern, with decreases in Texas and increases in California for all racial groups. However, there was no statistically significant difference in survival among women presenting with metastatic breast cancer between the two states (HR = 0.96; 95% CI 0.89–1.05).

Conclusion

The similar breast cancer survival rates despite increased metastasis in California could indicate effective treatment and management strategies in the state. This suggests that while the ACA may have improved access to care, further policy efforts are needed to address the underlying factors contributing to higher metastasis rates. eP-473 Transforming norms and practice: The changing landscape of labiaplasty surgery A.E. Awe1; L. Frodsham2,3 1King's College London, GKT School of Medicine, London, UK, 2King's College London, GKT School of Medicine, Women's Health Block co Lead, Transition to F1 Module Lead, Stage 3, London, UK, 3Guy's and St Thomas' NHS Foundation Trust, Consultant in Obstetrics and Gynaecology, Psychosexual Service Lead, London, UK

Objective

Labiaplasty has emerged as a procedure enveloped in both controversy and increasing demand. UK Google search volume for ‘labiaplasty’ doubled from April 2023 till March 2024 (Google Trends). This study, aimed to highlight the paucity of physician education and advocate for standardised guidelines to ensure safe, ethical practice in labiaplasty procedures. Design: We performed a literature review using databases such as Ovid/MEDLINE with terms like "labiaplasty", "vulvar cosmetic surgery".

Method

55 sources were eligible and used in this literature review. The timeframe for publication was focused on the past three decades, to highlight current trends. Analysis involved categorising data thematically to establish norms in surgical practice.

Results

Studies showed there are different clinical perspectives on labiaplasty between physicians. Male physicians were more likely to opt for a surgical reduction procedure than their female colleagues (p < 0.01) (Reitsma et al., 2011). Likewise, gynaecologists and GPs are less inclined to operate based on ‘abnormality’ than plastic surgeons (p < 0.01) (Reitsma et al., 2011). This highlights the gap in professional education and leads one to question patient safety standards in cosmetic gynaecology. Anatomical comparisons show little distinction between FGCS (female genital cosmetic surgery) and FGM (female genital mutilation) yet there are no guidelines to legally protect physicians in this grey zone. There is no framework to determine what constitutes labiaplasty and what constitutes more extensive psychological support (Barbara et al., 2015). The procedure is carried out by plastic surgeons and there are numerous surgical techniques including de-epithelization and Z-plasty (Creighton & Liao, 2019) yet no standardised training from governing bodies such as BAAPS who describe the procedure as ‘relatively simple’ (BAAPS, 2024). There is a need for standardisation and more robust research in the field. Most studies report satisfaction rates greater than 80% despite using subjective, non-validated outcome measures (Giarenis et al., 2014). This raises concerns about the reliability of assessing patient satisfaction and post-operative outcomes.

Conclusion

This project highlights differences in clinical perspectives in labiaplasty preoperatively, operatively and postoperatively. It underscores the urgent need for standardised labiaplasty guidelines and training. Additionally, there is a need for robust, large-scale research to assess the long-term outcomes of labiaplasty patients. eP-480 Hegazy's Hypothesis for Gestation (HHG) (II) A. Hegazy Midland Regional Hospital Mullingar, Obstetrics and Gynaecology Department, Mullingar, Co. Westmeath, Ireland

Background

The clock that measures the duration of pregnancy consists of two interacting timers: an interval timer measuring the overall length of gestation and a circadian timer that defines when a 24-h birth cycle occurs. The timing of birth dictates both the interval and circadian timers. Spontaneous preterm birth is the leading global cause of neonatal death, and countless efforts have failed to establish a single effective treatment for preterm labour, partly because the mechanisms that regulate the uterus and the cervix during pregnancy are not understood. When a post-term pregnancy truly exists, its cause is mostly unknown.

Objective

Supporting HHG: Laplace's Law Dictates Birth Timing and Mode of Delivery Through Exponential Uterine Wall Tension (EUWT) and Its Light-Dark Cycle Modulation. Study Design: This study investigated the current evidence-based literature and research that may support the hypothesis, accompanied by a 40-second 3D animation.

Result

Light-dark cycle modulation of interactive inhibitory and stimulatory systems divides gestation into five clinical phases: growth, maturation, transition, parturition, and involution. Growth phase: conception–30 weeks gestation. The inhibitory system is dominant with poorly coordinated Braxton-Hicks contractions. Maturation phase: 30–40 weeks gestation. Light-dark cycle modulation of the inhibitory system (cortisol) and the stimulatory system (oxytocin, melatonin) results in nocturnal synchronization and synergy of the two systems, transforming the cervix into the lower uterine segment. At the end of the maturation phase, the cervix loses all its strength and becomes fully effaced, resulting in EUWT failure. Pregnancy interval and circadian timer are achieved by a single mechanism, namely EUWT failure, secondary to the complete loss of cervical strength nocturnally. Transition phase: It is the period between EUWT failure and the onset of labor where Laplace's law is no longer applicable. Myometrial cells build up momentum to change from stretching during pregnancy to shortening during labor. It varies from a few hours to a few days, depending on the maturity of the stimulatory system. https://www.youtube.com/watch?v=0_J-UBns72o.

Conclusion

The creation, autonomic maintenance, and eventually autonomic EUWT termination secondary to light-dark cycle modulation make pregnancy an autonomic cycle with constant intervals and circadian timers where EUWT malfunction changes birth timing and pregnancy duration. Inhibitory system malfunction causes preterm labour, and most of the current therapeutic modalities for preterm labour focus on preventing EUWT failure. Stimulatory system malfunctions cause post-term pregnancy. Laplace's law measures EUWT, which might be the law of physics that controls birth timing and pregnancy duration. eP-483 Outpatient versus inpatient cervical ripening: Individual participant data meta-analysis of randomised trials M. Patabendige1; F. Chan1; M.R. Wise2; J.M. Thompson3; M. Beckmann4; A.F. Saad5,6; G.R. Saade7,6; A. Subramaniam8; A. Tita8; C. Policiano9; N. Clode10; A. Henry11; H. Haavisto12; K. Rinne12; V. Chen13; P. Sheehan14; K. Kohari15; H. Hosier15; R. Pierce-Williams16; V. Berghella16; D.L. Rolnik1; B.W. Mol1; W. Li1,17 1Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia, 2Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand, 3Department of Obstetrics and Gynaecology and Paediatrics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand, 4The University of Queensland, Mater Health and Mater Research, South Brisbane, Australia, 5Inova Health Fairfax, Perinatal Research Unit, Falls Church, Virginia, United States, 6Division of Maternal-Fetal Medicine, University of Texas Medical Branch, Galveston, USA, 7Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA, 8Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama, USA, 9Faculdade Medicina da Universidade de Lisboa, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal, 10Unidade Local de Saúde de Santa Maria, Hospital de Santa Maria, Lisbon, Portugal, 11School of Clinical Medicine, UNSW Medicine & Health, Discipline of Women's Health, Sydney, Australia, 12Department of Obstetrics and Gynaecology, Turku University Hospital and University of Turku, Turku, Finland, 13Department of Obstetrics and Gynaecology, Eastern Health, Melbourne, Australia, 14Department of Obstetrics and Gynaecology, Eastern Health and Monash Health, Melbourne, Australia, 15Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine and Yale New Haven Hospital, New Haven, Connecticut, USA, 16Department of Obstetrics and Gynaecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, USA, 17National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health, and School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia

Objective

To perform a meta-analysis of individual participant data (IPD) from randomised controlled trials (RCT) comparing effectiveness and safety outcomes following induction of labour (IOL) utilising outpatient versus inpatient cervical ripening approaches. Design: IPD meta-analysis.

Method

We systematically searched MEDLINE, Embase, Emcare, CINAHL Plus, Scopus, Cochrane Library, WHO ICTRP and clinicaltrials.gov from inception to March 2024 for RCTs comparing outpatient versus inpatient cervical ripening before IOL in women with a viable singleton gestation. For each study, we approached the authors to share the de-identified data. Primary outcomes were vaginal birth, a composite of adverse perinatal outcomes (stillbirth, neonatal death, low Apgar score at 5 min, acidosis, seizures, hypoxic ischaemic encephalopathy, intensive care admission, meconium aspiration syndrome, infection, cord prolapse, endotracheal intubation, external cardiac compressions) and a composite of adverse maternal outcomes (intensive care admission, infection, postpartum haemorrhage ≥1000 mL, death, uterine rupture). Two-stage random-effects models were used according to the intention-to-treat principle. Age- and parity-adjusted odds ratios (aOR) with 95% confidence intervals were reported. This meta-analysis was registered with PROSPERO (CRD42022321378) on 27-04-2022.

Results

Eleven out of 18 (61.1%) eligible RCTs provided IPD, totalling 2593 pregnant individuals undergoing IOL, representing 62.5% of all participants in the published RCTs. Of these, 1283 (49.5%) were assigned to outpatient and 1310 (50.5%) to inpatient management. Of the seven non-shared RCTs, four were unwilling to share, and the reasons for the other three were the inability to trace authors, no response after initial response and data unavailability. Among the shared RCTs included in this meta-analysis, four had balloon catheters alone in both groups, three had balloon catheter outpatient versus balloon catheter plus oxytocin inpatient, three had balloon catheter outpatient versus inpatient vaginal dinoprostone, and one had Dilapan-S® in both groups. Overall, when all 11 RCTs were combined, vaginal birth rate (aOR, 0.95 (95% CI, 0.70:1.28), p = 0.70; I2 = 31%), composite perinatal (aOR, 0.82 (95% CI, 0.62:1.10), p = 0.15; I2 = 0%), and maternal outcomes (aOR, 0.88 (95% CI, 0.64:1.20), p = 0.37; I2 = 9%) did not differ between outpatient and inpatient groups. As a post hoc analysis, composite adverse maternal outcomes were significantly lower in the outpatient group (aOR, 0.53 (95% CI, 0.36:0.78), p = 0.01; I2 = 0%) when mechanical methods (balloon alone or Dilapan-S®) were used in both settings.

Conclusions

Overall effectiveness, perinatal and maternal safety were comparable in the outpatient compared to the inpatient setting. Outpatient management with a mechanical method is associated with significantly better maternal safety. eP-484 Oxytocin vs carbetocin for PPH prevention: An individual participant data meta-analysis M. Flanagan1; B. Mol1,2,3; M. Patabendige1; A. Rattan1; G. Attilakos4; A. Fenix5; H. Van Der Nelson4; L. Torres-Gomez6; S. Rabow7,8; T. Lartbunnaphong9,10; O. Reyes11; C.-A. Whigham2; L.-A. Rosseland12,13; W. Li1 1Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia, 2Monash Health, Women's and Newborn Health, Clayton, Australia, 3Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, 4Southmead Hospital, North Bristol NHS Trust, Directorate of Women's and Children's Health, Bristol, UK, 5Department of Obstetrics & Gynaecology, Cardinal Santos Medical Center, Calamba Citym Laguna, Philippines, 6Hospital General de Subzona 13, Instituto Mexicano del Seguro Social, Servicio de Ginecología y Obstetricia, Coahuila, Mexico, 7Department of Obstetrics and Gynaecology, Lund University, Institution of Clinical Sciences, Lund and Malmo, Sweden, 8Department of Obstetrics & Gynaecology, Skane University Hospital, Lund and Malmo, Sweden, 9Department of Obstetrics and Gynaecology, Faculty of Medicine, Mahidol University, Bangkok, Thailand, 10Department of Obstetrics & Gynaecology, Siriraj Hospital, Bangkok, Thailand, 11Department of Obstetrics & Gynaecology, Saint Thomas Maternity Hospital, Panama City, Panama, 12Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway, 13Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway

Background

Postpartum haemorrhage (PPH) remains one of the most common causes of maternal morbidity and mortality in developed and developing countries. Uterotonics are used to promote uterine contraction, decreasing the risk of PPH. WHO guidelines recommend oxytocin for active management of the third stage of labour.

Objectives

To compare the efficacy of oxytocin versus carbetocin for the prevention of PPH through individual participant data (IPD) meta-analysis (MA). To evaluate the quality and trustworthiness of Randomised Controlled Trials (RCTs) comparing oxytocin and carbetocin for the prevention of PPH with the Trustworthiness in RAndomised Controlled Trials (TRACT) tool. To compare the results of IPD MA with aggregate data MA of RCTs ranked as low versus high risk for data integrity concerns. Design: This study used IPD-MA for all trial data received. Aggregate data MA was used when trial data was unavailable or trialists were uncontactable.

Methods

We searched randomised controlled trials (RCTs) comparing systemic oxytocin and systemic carbetocin used to prevent PPH in labouring women. Authors of eligible trials were invited to contribute their IPD. The main outcomes were estimated blood loss (EBL) and occurrence of PPH (EBL ≥500 mL). For RCTs that did not share IPD, we assessed trustworthiness using the reason not to share data and the TRACT data integrity checklist.

Results

We identified 49 RCTs, of which 16 contributed IPD (N = 3093 oxytocin; N = 3093 carbetocin). From the 33 RCTs that did not share IPD, we classified 8 as ‘trustworthy’. Studies sharing IPD and ‘trustworthy’ studies not sharing IPD showed carbetocin decreased EBL by 40 mL [55.26, 24.62], and in RCTs that did not meet ‘trustworthy’ criteria carbetocin decreased EBL by 86 mL [96.73, 74.81]. Regarding PPH ≥500 mL, IPD and ‘trustworthy’ studies showed that carbetocin did not decrease the risk of PPH (OR = 0.99, [0.94, 1.05]), whereas RCTs that did not meet the ‘trustworthy’ criteria demonstrated that carbetocin decreased the risk of PPH by 36% (OR = 0.64, [0.49, 0.82]).

Conclusion

We conclude from studies sharing IPD and trustworthy studies not sharing IPD that oxytocin and carbetocin are equivalent in preventing PPH. The fact that studies not sharing IPD that did not fulfill the trustworthiness criteria showed different results should be a reason for concern. eP-486 Postoperative functional recovery with ERAS after elective caesarean: A randomized clinical trial V. Kulshrestha1; N. Nisha1; R. Vatsa1; R. Subramaniam2; P. Vanamail1; S. Dhiman1; A. Aravindan2; V. Dadhwal1 1Obstetrics and Gynaecology, All India Institute of Medical Sciences New Delhi, New Delhi, India, 2Anaethesiology, All India Institute of Medical Sciences, New Delhi, New Delhi, India

Objective

To compare efficacy of ERAS protocol and routine perioperative care for postoperative functional recovery after elective caesarean delivery. Design: Randomized study conducted after ethical approval and CTRI registration (2020/10/028652).

Method

Total 140 women were randomized. ERAS was implemented in group-1(n = 70) and conventional protocol was followed in group-2 (n = 70). Women with significant obstetric/medical complications, BMI 35 kg/m2, ≥2 caesarean, and contraindications for neuraxial-anaesthesia were excluded. ERAS protocol included TAP block, multimodal analgesia for 24 h, intravenous paracetamol at shifting to recovery followed by oral analgesics. Primary outcome was postoperative functional recovery assessed by first oral intake of fluids/solid diet, catheter removal, resumption of bowel function, ambulation, self and baby-related activities, and postoperative complications. Adherence to ERAS protocol, patient's readiness for discharge from the Maternity unit was also noted.

Results

Patients ambulated earlier in group-1. Patients first reclined on bed after 8.76 ± 4.27 and 22.37 ± 8.16 h, sat on edge of bed after 14.34 ± 4.09 and 28.23 ± 6.61 h in group-1 and group-2 respectively, p < 0.001. Patients first moved around bed after 17.11 ± 5.04 vs. 34.77 ± 8.08 h, and ambulated with support after 17.71 ± 6.46 vs. 35.49 ± 9.16 h in group-1 and group 2 respectively; p < 0.001. Bowel recovery was faster in group-1; bowel sounds appeared after 4.26 ± 2.05 and 10.40 ± 4.15 h; time to tolerate clear fluids was 4.56 ± 1.86 and 20.26 ± 6.13 h; time to tolerate solid diet was 11.99 ± 4.54 vs. 28.31 ± 6.10 h; flatus passed after 8.31 ± 3.09 and 19.87 ± 7.21 h respectively in group-1 and group-2, p < 0.001. Bladder functional recovery was also faster in group-1 as assessed by catheter removal and first voiding, p < 0.001. Time to first breast feed and complications were comparable. Mean time for patient's readiness for discharge from the maternity unit was 53.69 ± 7.6 h post-caesarean in group-1 which was significantly lesser than 81.91 ± 33.85 h in group-2, p < 0.001. All patients were satisfied with ERAS protocol on a Likert scale of 5; the mean score was 4.4 ± 0.60 in group-1 and 3.4 ± 0.78 in group-2; p < 0.001. Also, 94.2% of patients in group-1 showed willingness for the ERAS implementation in their next surgery and were also willing to recommend ERAS to their relatives.

Conclusion

The present study demonstrates efficacy and feasibility of ERAS protocol implementation for earlier functional recovery in women undergoing elective caesarean. eP-487 Hegazy's Hypothesis for Gestation (HHG) (III) A. Hegazy Obstetrics and Gynaecology Department, Midland Regional Hospital Mullingar, Mullingar, Co. Westmeath, Ireland

Background

Dystocia is associated with poor progress during labour, and it is a major cause of primary caesarean deliveries; however, the biological mechanisms of dystocia are poorly understood.

Objective

Supporting HHG: Laplace's Law Dictates Birth Timing and Mode of Delivery Through Exponential Uterine Wall Tension (EUWT) and Its Light-Dark Cycle Modulation. Study Design: This study investigated the current evidence-based literature and research that support HHG.

Result

Parturition phase: Regarding uterine function during labour, the uterus should not only contract but must also relax to keep the foetus alive. Intrinsic myometrial cell character (IMCC) may be the ideal mechanism for this function, where the uterus becomes essentially denervated during gestation. IMCC makes parturition an autonomic, intrinsic, interactive, repetitive contraction and relaxation cycle due to the myometrial tension-contraction interaction character. Low tension induces contraction and high tension induces relaxation, resulting in labour progression and protecting the foetus against hypoxia. Formation of the lower uterine segment (LUS): Contractions of the stimulatory system pull the cervix and stretch it up, transforming it into the LUS. Cervical transformation into the LUS happens during the third trimester and the first stage of labour, and each stage has clinical and radiological signs. During the third trimester, cervical transformation into the LUS appears clinically as progressive cervical shortening and effacement and radiologically as progressive TYVU pattern formation. During the first stage of labour, after full cervical effacement, the remaining cervical tissues are inverted inside up, which completes the transformation of the cervix into the LUS, and appears clinically as progressive cervical dilatation, and radiologically, the U-pattern transforms into an inverted U-pattern formation. The second stage of labour: the cervix has completely transformed into the LUS which becomes a wedge-shaped birth canal that extends from the vaginal vault (cervicovaginal junction) into the physiologic retraction ring. The cervical changes reverse instantly after foetal delivery, and the cervix returns to its anatomical site.

Conclusion

Progressive cervical shortening and effacement during the third trimester and then dilatation during the first stage of labour are the clinical signs of the mechanism of transformation of the cervix into the LUS. Failure of this mechanism, secondary to combined inhibitory and stimulatory system malfunction, causes labour dystocia. Most of the cervical transformation into the LUS by the stimulatory system happens during the third trimester, so the treatment of labour dystocia should focus on the causes of the stimulatory system's malfunction before the onset of labour. eP-488 Mifepristone vs dinoprostone in induction and its outcome in full term pregnancy M. Patil; M. Sailakshmi Obstetrics and Gynecology, Rajarajeswari Medical College and Hospital, Bengaluru, India

Introduction

Induction of labour is defined as the process of artificially stimulating the uterus to start labour. The present-day obstetrics calls for induction of labour for a myriad of obstetrical, medical, and fetal indications. We should only induce labour when we are sure that we can do better. The prostaglandins (PGs) and antiprogesterones have a major role in labour induction. Mifepristone is a synthetic steroid hormone analogue that has both antiprogesterone and anti-glucocorticoid activities. It increases the sensitivity of the uterus to prostaglandins and facilitates labour. Dinoprostone is a naturally occurring prostaglandin that is involved in promoting labour. This study aimed to compare the safety and efficacy of oral mifepristone with dinoprostone gel in the induction of labour in primigravidas.

Objectives

To compare the safety and efficacy of oral mifepristone with dinoprostone gel in the induction of labour at term.

Materials and methods

To compare the safety, efficacy and fetomaternal outcome following induction of labour with oral mifepristone and endocervical PGE2 gel. 100 antenatal women were selected among which 50 women received 200 mg oral mifepristone and 50 women received 0.5 mg endocervical PGE2 gel, if required repeat gel at intervals of 6 h max. of 3 doses is kept in 24 h. Progress of labour was seen and further augmentation was done with oxytocin whenever required.

Results

74% (72% primigravida and 76% multigravida) had favourable Bishop scores in the mifepristone group whereas only 62% (60% primigravida and 64% multigravida) in the PGE2 gel group. Oxytocin augmentation was needed in 19 (76%) primigravida in the mifepristone group and 20 (80%) primigravida in the PGE2 gel group who delivered vaginally. Duration of II and III stages of labour was shorter in the mifepristone group. The cesarean section rate was 30% in the mifepristone group whereas 40% in the PGE2 gel group. Blood loss was less in the mifepristone group. Neonatal complications and neonatal admissions were lesser in the mifepristone group. Drug administration to delivery interval shorter with PGE2 group. Maternal complications were similar in both groups. The outcome of induction in this study reveals that the mifepristone was successful in 70% in achieving vaginal delivery whereas PGE2 gel was successful in 60%

Conclusion

We concluded that Mifepristone is a safe and efficient agent for cervical ripening and for initiation of labour in term patients as it causes improvement in bishops score and increase in vaginal delivery. It is more effective in multigravida than primigravida. eP-489 Carbetocin: A longer lasting alternative to oxytocin in low risk cesarean sections P.J. Nair; S. Anvarsadath; Z. Kukkady; M. Kurup; S. Mathen; T.A. Joy; A. Sadasivan; M. Udayakumar Obstetrics and Gynecology, Aster Medcity, Cochin, India

Objective

Post-partum hemorrhage is a preventable cause of maternal morbidity and mortality. Oxytocin is most widely used in the prevention of post-partum hemorrhage. Carbetocin is a long-acting, heat stable, synthetic analogue of oxytocin with agonist properties. This study compares the effectiveness, hemodynamic effects and safety profile of carbetocin and oxytocin in the prevention of postpartum hemorrhage in low risk caesarean sections. Design: This study is a prospective cross-sectional comparative study conducted over a period of 6 months in a quarternary care centre in Cochin.

Methods

Low risk pregnant women (n- 110) undergoing caesarean section in the study period were enrolled in the study and alternatively allocated to oxytocin and carbetocin groups. Women in the carbetocin group received a bolus of 100 μg IV while women in the oxytocin group received oxytocin – 5 units IV, and 20 units IV infusion in 500 mL of 0.9% Na-Cl solution IV at 125 mL/h. The parameters evaluated were the haemodynamic effects of drugs on blood pressure, the need for additional uterotonic agents, blood loss, the drop in haemoglobin level, the uterine fundal state and diuresis.

Results

Significantly more women needed additional uterotonic agents in the oxytocin group (29.1% vs. 12.7%, p – 0.035). With respect to the hemodynamic effects, there was a greater reduction in the systolic blood pressure in the carbetocin group (p value – 0.001). Other variables such as blood loss, hemoglobin drop, diuresis and uterine fundal state showed statistically no significant difference.

Conclusion

Prophylactic administration of a single bolus injection of carbetocin is a better alternative to a continuous infusion of oxytocin in the prevention of post-partum haemorrhage and is superior to oxytocin in terms of heat-stability, rapid onset and prolonged duration of action. eP-490 Invisible threats: Confronting the rise of drug-resistant UTIs in pregnancy S. Athar1; O. Navti1; A. Shauqat2; L. Alansari1 1Department of Obstetrics and Gynecology, Al Wakra Hospital, Al Wakra, Qatar, 2Department of Infectious Diseases, Al Wakra Hospital, Al Wakra, Qatar

Objective

Infections caused by multiple drug resistant organisms are on the rise worldwide. Urinary tract infections (UTI) are one of the most common infections in pregnancy. These infections are known to be associated with poor feto-maternal outcomes. UTIs caused by drug resistant organisms (MDRO) have higher likelihood of complications like pyelonephritis and sepsis in the mother and adverse neonatal outcomes. Hence, this study was conducted to assess the epidemiology and risk factors associated with UTIs caused by multiple drug resistant organisms.

Methods

The methodology employed in this clinical study involved conducting a case-control analysis at a secondary hospital over a period spanning 2016 to 2019 after ethical approval was obtained for the study, A total of 21 520 women who had undergone delivery were included in the study. The primary objective was to assess the prevalence of urinary tract infections (UTIs) and multi-drug resistant organism (MDRO)-associated UTIs among the participants. Epidemiological data pertaining to each individual was collected and categorized into case groups (MDRO UTIs, n = 50) and the control group (non-MDRO UTIs, n = 150). Logistic regression was used to determine the Odds' ratio, employing a significance level of p < 0.05 to determine statistical significance.

Results

The overall prevalence of UTIs during pregnancy was found to be 1.88%. Among these cases, 11.88% were identified as UTIs caused by MDROs. The majority of MDRO-associated UTIs (72.92%) were caused by extended-spectrum β-lactamases producing Escherichia coli. Several epidemiological factors were identified as being associated with MDRO-associated UTIs, including nulliparity, maternal age over 30 years, and infections occurring in the third trimester. Additionally, certain risk factors showed a positive correlation with MDRO UTIs, such as a body mass index (BMI) over 30 kg/m2 (odds ratio [OR] = 3.13, 95% confidence interval [CI] = 1.51–6.51, p < 0.05), maternal anemia (OR = 4.26, 95% CI = 2.05–8.85, p < 0.05), multiple catheterizations during labor (OR = 2.27, 95% CI = 1.03–5.02, p < 0.05), and prolonged catheterization (OR = 2.23, 95% CI = 1.03–4.81, p < 0.05). Although gestational diabetes and multiple vaginal examinations in labor showed a higher likelihood for MDRO UTIs, the results did not reach statistical significance (p < 0.05).

Conclusions

Despite adherence to antimicrobial stewardship guidelines, a high prevalence of MDRO-associated UTIs was observed in pregnant women. Identifying these risk factors can facilitate appropriate management and follow-up of such cases to mitigate pregnancy complications. eP-493 Efficacy of 50-point scoring system to predict mode of delivery post induction S. Dinakar; H.S. Sheela; M. Prasad Obstetrics and Gynaecology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India

Background

Induction of labour is a risk factor for caesarean delivery. The time-tested Bishop score is one entity made to predict the possibility of failure of induction, needing cesarean delivery. A newly validated 50-point score, developed by Jochum et al, shows promise and this study is being done to test the efficacy of this 50-point scoring system to predict the mode of delivery after labour induction in the local setting. - To apply the 50-point scoring system and the Bishop scoring system on women undergoing induction of labour in the study group - To correlate the predicted mode of delivery using the 50-Point scoring system with the actual mode of delivery. - To compare the predictive rate of the 50-point scoring system with the conventional Bishop Score. Study Design: Prospective Observational Cohort study.

Method

152 women who underwent induction of labour at Vydehi Institute of Medical Sciences & Research Centre, Bangalore, India, were studied. Both the Bishop Score and the 50-Point score at the time of induction were calculated. The outcome predicted by the 50-Point score was compared with the actual outcome of the induction of labour. The Bishop score and 50-Point score were compared. Analysis of individual parameters was done. The Pearson correlation coefficient graph was drawn between Bishop Score and 50-point score. ROC curves were drawn for both scoring systems and compared.

Results

Of the 152 women, 85 delivered vaginally while 67 underwent caesarean section. All the individual parameters of the 50-Point scoring system like parity, height, BMI, gestational age, cervical factors, medical indications, suspicion of PROM, macrosomia, and fetal anomaly of vitality were found to have an impact on the mode of delivery in the study, as backed by previous studies. There was a good correlation between Bishop Score and 50-point score, with a pearson correlation coefficient of −0.5387 with a statistically significant correlation – p value of <0.0001. The ROC curve of the 50-point score system is at higher location than the ROC curve of the Bishops scoring system at all points.

Conclusion

The 50-Point scoring system is feasible, has good correlation with Bishop Score, and in fact, is a better predictor than the Bishop score in predicting the success of vaginal delivery. Hence, we can incorporate the use of the 50-Point scoring system in our daily clinical practice for better assessment of success of induction of labour and better counseling of the patient. eP-494 Overcoming the challenges of implementing ockenden recommended ‘High Dependency Maternity Care (HDC)’ E. O'Kane; P. Borrelli; C. Niven; F. Pack; L. Mitchell; P. Ferranti; R. Elbanna; M. Simpson; C. Kanu; C.R. Gabor Lister Hospital, East and North Herts NHS Trust, Stevenage, UK

Objective

To set up an enhanced maternity care service at Lister, a district general hospital in the East and North Hertfordshire NHS Trust (UK), including training provision, in line with Ockenden recommendations. Design: We designed a model, addressing; midwife training, equipment needs and clinical guidelines enabling in-house provision of HDC, which is reproducible.

Method

A multi-disciplinary team was recruited, consisting of a Consultant Obstetrician, ITU and Anaesthetic Consultants, senior midwives, O&G trainee and SAS doctors. This team conducted research of local units establishing what HDC provision they had. Through collaboration with the maternity training team a hybrid programme was designed which included both external university teaching and in-house training, the result being the ability to train up a ‘core’ group of HDC competent midwives. The second key element was establishing the setting. The main discussions were between a defined unit similar to our current recovery, or a mobile system. Our preliminary direction is a mobile, fully equipped trolley, which can be moved to the patient with the HDC needs, including those in labour.

Discussion

Enhanced maternity care is a new standard of care for women who become unwell during or shortly after pregnancy, but who do not require admission to critical care [1]. In March 2022 the Ockenden report was published, highlighting a series of recommendations with the purpose of improving the quality and safety of maternity services in England [2]. One of the immediate and essential actions was that ‘all trusts must develop a core team of senior midwives who are trained in the provision of high-dependency maternity care’. One of the main barriers we encountered was defining what a ‘HDC competent midwife’ is, and how we can provide this in a cost-effective way, on the scale required. Feedback from midwives who had attended external university led courses was largely negative, resulting in a hybrid programme.

Conclusion

Setting up our Enhanced Maternity Care service has not been a straightforward process; however, the resulting model is comprehensive and meets all original objectives. As we pilot the service, it is our ambition for it to be adapted and used across the Hertfordshire and West Essex local Maternity and Neonatal System (LMNS). We hope that this model design can help other units navigate the process. 1. Royal College of Anaesthetics. Care of the critically Ill woman in childbirth; Enhanced Maternal Care. 2018. 2. Ockenden D. Final report of the Ockenden review. 2022. eP-495 “Asking for help” The ability of junior doctors to escalate clinical concerns N. Holmes; S. Abdalla; K. Johnston Royal Jubilee Maternity Service, Maternity, Belfast, UK

Objective

The Ockenden review March 2022, found that “delays in escalation …resulted in the many poor outcomes experienced by mothers or their babies”. We wanted to find out in our local service what the delays to escalation may be. Psychological safety or lack of, may inform the ability to escalate concern or ask for help. Design: We formulated a questionnaire based recognised questions to assess psychological safety. We asked some direct questions based on potential barriers and facilitators identified in the primary care setting. We asked an open question at the end to allow for potential suggestions. We asked our lead clinical psychologist to review and advise.

Methods

We used a Likert Scale questionnaire disseminated via a what's app group, membership which was of the current junior doctors. It was anonymous. The information was collected on the Microsoft Forms App.

Results

We had a 61% response rate (41 questionnaires and 25 responses). When asked around the ability to ask for advice the score was 9.0/10 in favour of being able to ask. Asking about being able to challenge a decision, scores fell to 5.88/10. Over 75% stated that the ability to ask for help would change dependent on who their senior was. We asked regarding worry in being judged negatively, and the scores spread to both ends of the scale, this was also true for worry about capability. The score for feeling listened to was 8.2/10. The open comments and ideas for improvement were most interesting. To include issues with hierarchy, personalities, previous experiences both positive and negative, lack of positive feedback, and lack of a forum for open discussions.

Conclusions

We felt the basic responses on ability to escalate were good. However, when pressed on challenging decisions, scores dropped. Fear about capability and judgment saw a wide spread. To improve requires adaptive change in culture. We are designing a poster with consultants photos and first names to aid escalation. We continue to embed RCOG/RCM Teach and Treat methods and Greatix. For the future we want to expand this survey across the region, and to include our midwives, as Lady Ockenden talked about collaborative escalation across disciplines being important. Open forum for discussion is needed, however it is so difficult to make time. Although a small project, this raises the question regarding mandatory supervision for this speciality, which applies to other NHS specialities, which may close this gap. eP-496 To compare conservative treatment with ganglion impar block in postpartum coccygodynia P.D. Singh1; N. Malhotra2; R. Malhotra3; N. Malhotra4 1Obstetrics and Gynaecology, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, India, 2General Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India, 3Obstetrics and Gynaecology, AAS Fertility & Maternity Centre, Rohtak, India, 4Anesthesia, AAS Pain Management Centre, Rohtak, India

Objective

To evaluate and compare the role of conservative treatment with ganglion impar block for management of postpartum coccygodynia. Design: After written informed consent of patients, a prospective study was conducted in 40 consequent female patients in postpartum period diagnosed as coccygodynia.

Methods

Patients were initially given conservative treatment comprising of analgesic & anti-inflammatory medications (tab. diclofenac sodium 50 mg plus serratiopeptidase 10 mg BD for 14 days), hot fomentation, diclofenac gel locally and sitting on doughnut. If patients pain score (Numeric Rating Scale, NRS) was >4 after 2 weeks then patients were administered ganglion Impar block under fluoroscopic guidance by the pain physician by trans-coccygeal approach with 8 mL of 0.25% bupivacaine plus 2 mL of 40 mg/mL triamcinolone acetate. Following parameters were recorded at baseline, one week, two weeks, one month, three months and six months study period: Pain Score using Numeric Rating Scale (NRS, 0–10), Oswestry Disability Index (ODI), patient satisfaction on a four point scale, number of ganglion blocks and side effects, if any.

Result

Twenty four patients (group I, 60%) responded well to conservative treatment. Pain Score in these patients was 7.21 at baseline; 2.22, 2.13, 2.66, 0.82 and 0.89 at one week, two weeks, one month, three months and six months after injection, respectively. Sixteen patients (group II, 40% had pain score >4 after 2 weeks. These were administered ganglia Impar block. NRS was 7.56 before injection; 1.4, 2.1, 1.2, 0.6 and 0.62 at one week, two weeks, one month, three months and six months after injection, respectively (p < 0.001). ODI scores at before injection, one week, two weeks, one month, three months and six months after conservative treatment were 44.2, 10.11, 10.12, 14.22, 9.65 and 6.21, respectively and after ganglia Impar block were 47.21, 8.24, 10.1, 9.21, 8.15 and 4.15 at the same intervals, respectively (p < 0.001). All patients in group-I reported good improvement at six months follow-up. However, patients in group II reported excellent satisfaction at six months interval (p < 0.05). Only two patients required second injection during the six months period and none had any side effect.

Conclusion

Majority of the patients with post partum coccygodynia respond well to conservative treatment. However, in the patients who fail to respond to conservative treatment, ganglion impar block is safe and effective for management of patients with postpartum coccygodynia. Both the approaches of treatment lead to significant and comparable improvement in pain scores and disability. However, with ganglia Impar block, patient satisfaction is better than conservative treatment. eP-497 SMARThealth GPT: Large language models for improved maternal care in resource-constrained environments Y. Al Ghadban1; A. Sharma1; H. Lu2; U. Adavi3; N. Das4; S. Gara5; P. Devarsetty4; J. Hirst5 1Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK, 2Department of Engineering Science, University of Oxford, Oxford, UK, 3The George Institute for Global Health, Sydney, Australia, 4The George Institute for Global Health, New Delhi, India, 5The George Institute for Global Health, London, UK

Introduction

Recently, the natural language processing landscape has seen spectacular advances with the increasing availability of pre-trained large language models (LLMs), such as ChatGPT. These models have had applications in several fields and are increasingly being employed in medical education and healthcare. The objective of this study was to develop and validate retrieval-augmented generation (RAG) based models for enhancing healthcare education in low- and middle-income countries. Design: This paper describes the iterative co-development and validation of an LLM to aid community health workers (CHWs) in delivering high-quality maternal care.

Methods

First, we curated and validated an extensive repository of Indian pregnancy-related guidelines, which forms the foundation of the model's knowledge base. We then optimised retrieval methods, prompt designs and model parameters for effective information retrieval and effective answer generation. Finally, the model was technically evaluated and iteratively adapted through three rounds of user feedback. The final model was clinically evaluated with clinical experts, end-users (ASHAs) and beneficiaries (pregnant and postpartum women). These steps collectively form the process through which SMARThealth GPT was developed and validated.

Results

We selected the RAG methods based on the tool's clinical needs – traceability to source material, scalability across vast knowledge bases, and seamless adaptability to evolving clinical guidelines. The final repository included 20 pregnancy-related guidelines, including a range of pregnancy-related conditions with a particular focus on the three key conditions: anaemia, gestational diabetes, and hypertension in pregnancy. The technical evaluation results highlight the efficacy of the chosen RAG model, emphasizing the rationale behind parameter selection and the model's feasibility in terms of processing time and technical considerations. The clinical evaluation findings indicate a moderate to high performance for accuracy, appropriateness, and bias across all health topic areas.

Conclusion

This paper highlights the potential of LLMs in building CHWs capacity and enhancing guideline-based health education; and offers insights for similar applications in resource-limited settings. It also addresses the potential adverse consequences associated with artificial intelligence in maternal care, including the amplification of bias and the dissemination of misleading information, while delving into effective mitigation strategies. eP-499 Prevention of atonic PPH by spiral compression sutures: Regardless of uterine anatomy N. Banu1; R. Akhter2 1Lab Aid Diagnostic, Obstetrics & Gynaecology, Chattogram, Bangladesh, 2CSCR, Obstetric & Gynaecology, Chattogram, Bangladesh Post Partum Hemorrhage (PPH): a life-threatening obstretic emergency (80% is atonic). Therapeutics (oxytocic & TXA), mechanical effort (message, bimanual uterine compression, aortic compression, UBT), surgical measures (compression sutures, devascularization or hysterectomy) etc.- use for atonic PPH. Efficacy and safety of compression suture is time tested for treatment of atonic PPH and prevention of hysterectomy. B-Lynch Brace Compression Suture is a standard practice. This paper introduces a compression suture, invented by default (“Spiral Compression Suture – SCS)” to prevent atonic PPH in altered uterine anatomy (acquired & congenital). Subsequently SCS applied onto atonic uterus of normal anatomy during LSCS. Seven cases described to illustrate the procedure.

Objective

To introduce SCS as a preventive measure of atonic PPH during LSCS.

Methods

Case series/ 2020 – 2023/ Private clinics of Chattogram, Bangladesh/ Purposive sampling. Case – 4th stage atonic uterus during LSCS. Suture material – Vicryl – # 1, 3/8th circle round body needle. Procedure: a) The first stroke of needle – from bottom of anterior wall, through a midline, longitudinal myometrial fold; b) subsequent all strokes horizontally upwards up to fundus; c) same way strokes revert back downwards from top to bottom, at the starting point to tie two ends. Seven cases of SCS : Case (i) – atonic anterior wall, (pelvic endometriosis with firm posterior wall). Case (ii) and (iii) – focal placenta increta (cornu fundal placental insertion). Case (iv), (v) and (vi) atonic uterus (repeat c/s). Case (vii) atonic gravid horn (uterus didelphys uni-collis). Outcome -I) Primary ---prevention of primary & secondary PPH II) Secondary- fertility preservation.

Results

Primary & secondary PPH-- nil; hysterectomy ---nil.

Discussion

Similarities of SCS with all compression sutures- i) *reduces myometrial blood flow (approximately 700 mL/min) by compressing vessels, altering direction of blood flow (straight line to angulation) with reduction of surface area. ii)** prevents hysterectomy. Speciality of SCS--- i) applied in all forms of atonic uterus; ii) compression is neither too tight to cause ischemia, nor too loose to cause bleeding. ii) easy & quick procedure; iii) no chance of vascular &/or visceral injury; iv) clinicians can easily acquire skill by observing a few cases and practicing on placenta.

Limitation

Not applied in praevia with/without PAS or after vaginal delivery with refrectory PPH. Long term follow up -not done. Conclusion – Each compression suture is a unique individual technique. One type may not be suitable for all cases. Investigators own experiences (SCS) added for consideration where appropriate. eP-500 Hegazy's Hypothesis for Gestation (HHG) (I) A. Hegazy Obstetrics and Gynaecology Department, Midland Regional Hospital Mullingar, Mullingar, Co. Westmeath, Ireland

Background

Failure to understand uterine function during pregnancy is a major shortcoming in modern healthcare.

Objective

Supporting HHG: Laplace's Law Dictates Birth Timing and Mode of Delivery Through Exponential Uterine Wall Tension (EUWT) and Its Light-Dark Cycle Modulation. Study Design: This study investigated the current evidence-based literature and research that may support the hypothesis, accompanied by a 40-second 3D animation.

Result

The anatomical existence of the isthmus of the cervix should be reconsidered, as there has been no convincing evidence to support its existence since Aschoff first proposed it in 1905. Division of the cervix into isthmus and non-isthmus may be the flaw that prevents understanding of the uterine function during pregnancy. Uterine mechano-transduction may be the main system that controls uterine function during pregnancy. It has functional and molecular components; wherein intrinsic myometrial cell character (IMCC) is the molecular component and EUWT is the functional component. IMCC results from the myometrial tension-contraction interaction character, which enables the uterus to control its functions autonomically and intrinsically, where high tension induces relaxation and low tension induces contraction. EUWT is created and maintained by the interaction between the gestational sac, uterus, and cervix, for which the primary function is to maintain EUWT. EUWT mechano-transduction and progesterone/estrogen stimulation induce the stretch-dependent inhibitory system responsible for maintaining pregnancy. They also induce the stimulatory system by inducing myometrial hyperplasia and hypertrophy. Embryologically and evolutionarily, the human uterus is composed of two uteri. To push the foetus, the uterus should be fixed to the pelvic bone through the uterine ligaments. The stimulatory system contractions create direct and indirect uterine-cervical interactions (DIDUCI). DIDUCI components are the uterus, cervix, uterine ligaments, pelvis, and foetus. DIDUCI creates two opposing forces: one pushes the fetus through the cervix, and the other fixes the uterus to the pelvic bone, simultaneously pulling and stretching the cervix upward. DIDUCI makes the cervix lose its strength through TYVU pattern formation, transforming it into a birth canal, which is called the lower uterine segment, resulting in EUWT failure. https://www.youtube.com/watch?v=dyyG-Jhxr7o&t=149 s.

Conclusion

Pregnancy is a state of balance between the two opposing and interactive inhibitory and stimulatory systems, secondary to EUWT mechanotransduction and progesterone/estrogen stimulation. Pregnancy is mainly maintained through the stretch-dependent inhibitory system secondary to EUWT, while the stimulatory system induces EUWT failure, which terminates pregnancy. EUWT is measured using Laplace's law, which might be the law of physics that controls uterine function during pregnancy. eP-501 Postnatal readmissions: Retrospective review of presentations and outcomes at a tertiary centre K. Maslowski; B. Bennett; S. Basude University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK

Objective

The postnatal period has been identified by national reports (Ockenden and MBRRACE) as being a high-risk period for maternal morbidity and mortality. This audit aimed to evaluate the current state of care for women being readmitted postnatally with pregnancy-related concerns. Design: A retrospective analysis of case notes for women readmitted within 6 weeks of delivery was analysed to investigate the reasons for readmission, their treatment, and outcomes.

Method

All women with readmissions within 6 weeks of delivery to our tertiary centre in 2022 were identified. A random sample of 100 women was taken. Patient notes were accessed, in relation to reason for admission, length of stay, treatment, outcomes and complications.

Results

33 patients were readmitted for baby reasons, seven did not have a reason documented and one was registered as a readmission in error. Of the 59 women who were admitted for maternal reasons, 48 were unplanned. Infections such as mastitis, endometritis and pyrexia of unknown cause were the most common reasons for readmission (25%). Hypertension (16.7%), abdominal wound problems (14.6%) and perineal wound problems (12.5%) were the next most common reasons. 23 (48%) women required at least one night in hospital, with the longest stay being seven days for a caesarean section wound haematoma. Nine women required intravenous antibiotics. One woman was taken back to theatre twice for treatment of a perineal wound breakdown. Half of the women readmitted with hypertension spent at least one night in hospital and all of them were treated with antihypertensives. None of the women in the sample had long term complications documented.

Conclusions

While some readmissions will be unavoidable, there is potential to prevent readmissions with infection, hypertension and complications of an abdominal or perineal wound. Results from the ‘PreciSSIon’ trial may be helpful in reducing surgical site infection after caesarean section. There is lack of national guidance relating to preventing wound haematoma after caesarean section and specific repair techniques to reduce perineal trauma complications. NICE provides clear guidance on management of hypertension in the postnatal period. Lack of adherence to this guidance and inadequate personalised plan before discharge may be contributing to avoidable readmissions. Furthermore, women having difficulty in accessing primary care or reducing confidence in managing postnatal conditions in community teams may be contributing to readmissions further. eP-502 Prevalence of fear of childbirth among Omani pregnant women F. Francis1; D. Raghavan1; D. K Y1; S. Elizabeth Johnsunderraj1; R. Al Zahli2; M. Al Dughaishi2; G. G1 1Sultan Qaboos University, Al Khoud, Oman, 2Sultan Qaboos University Hospital, Al Khoud, Oman - to identify the prevalence of fear of childbirth among the pregnant women in Oman - to assess the level of fear among the pregnant women in different parity and trimesters. - to identify the predictors of fear of childbirth (Age, Education, Gestational week, Parity, Media influence, pregnancy complications) - to associate level of fear to preferred mode of delivery. Design: Descriptive cross-sectional survey was used to identify the point prevalence of fear of childbirth among pregnant women attending the outpatient department. For population-based surveys as well as estimating the prevalence of diseases in clinic-based samples, cross-sectional designs are best employed.

Method

Using the Kish formula for a prevalence of 20 percentage and absolute precision of 0.05 the sample size calculated was 246. Target population were Omani pregnant women of any parity attending the outpatient department of the Sultan Qaboos University Hospital. Simple random technique was used to recruit participants based on inclusion criteria. Wijma Delivery Expectancy Questionnaire for antenatal women (W-DEQ version A) was used as the survey questionnaire. A score above 100 indicated prevalence of pathological fear. After obtaining the ethical clearance and informed consent, the questionnaire was distributed which was self-reported by the participants. Data was entered and analysed using SPSS version 23. Data was reported in frequency and percentage. Pearson's correlation was used to look at the associations between the sociodemographic variables and the scores on the fear of childbirth.

Results

The main findings are as follows of the people surveyed, over half (55.5%) had moderate fear of childbirth, 43.1% had high or very high fear, and 1.4% had pathological fear. It was also observed that the preferred mode of childbirth was based on their intensity of fear. Participants verbalizing very high fear chose elective caesarean section. It was also observed primigravida expressed more high fear compared to the multigravida.

Conclusion

Fear of childbirth shouldn't be ignored. This highlights the need for awareness and proper knowledge to be provided to women from their periconceptional phase. Increasing rates of patient chosen elective caesarean section could be because of the hidden fear of childbirth. Pathological fear needs to be treated too. eP-503 Birth mode and deprivation level: An analysis of NHS Maternity Statistics (2013–2023) P. McDonagh Hull1; B. Huang2; E. Brennand3 1Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada, 2Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Canada, 3Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada

Objective

In January 2024, the All-Party Parliamentary Group (APPG) on birth trauma launched an inquiry to investigate causes of trauma, and to develop policy recommendations for reducing harm. The inquiry specifically welcomed submissions from marginalised communities, including racial minorities and lower socio-economic groups. Previous research suggests birth trauma is more likely to be experienced by women who have forceps, ventouse (vacuum), and/or emergency caesarean interventions, so our study aimed to explore any association between these birth modes and living in the most or least deprived areas of England. Design: An exploratory analysis of NHS Maternity Statistics tables reporting level of deprivation by method of delivery, from 2013 to 2023. Index of Multiple Deprivation (IMD) is the measure of relative deprivation in >32 000 geographic areas of similar size in England, based on factors including income, employment, education, health, crime, barriers to housing and services, and living environment, and is ranked in 10 deciles from most deprived to least.

Method

Logistic regression was employed on aggregated data to explore associations between levels of deprivation and the likelihood of four birth modes where intervention occurred, as reported in NHS England's annual statistics: instrumental (forceps and/or ventouse), emergency caesarean, elective caesarean, and breech extraction. Exposure was defined as the IMD 10% most deprived population, with the IMD 10% least deprived population being the reference group. Odds ratios (ORs) with 95% confidence intervals (CIs) were computed, and compared across the years 2013 to 2023.

Results

Based on a total of 106 999 delivery episodes among women living in the 10% most and least deprived areas of England in 2022–23, women in the most deprived areas were more likely to have an emergency caesarean (OR 1.12, 95% CI 1.09–1.16) or a breech extraction (OR 3.07, 95% CI 1.07–8.86), and less likely to have an elective caesarean (OR 0.68, 95% CI 0.66–0.70) or an instrumental delivery (OR 0.74, 95% CI 0.71–0.77). With varying strength, these associations persisted across all 11 years (2013–2023) except for breech extraction, which tended to exhibit null associations in most years. No data was available for women who experienced an attempted instrumental delivery prior to an emergency caesarean.

Conclusion

Our findings provide evidence that mothers living in the most deprived areas of England are more likely to experience at least two birth modes associated with higher rates of morbidity and mortality, suggesting they may be at greater risk for physical and psychological trauma. eP-504 Estimating blood loss during caesarean deliveries: Are we doing it right? A.W.M. Tan1; S.H. Lee1; D. Mathur2; S. Tagore3; M. Mathur1 1Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore, 2Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore, 3Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore Effective measurement of blood loss during delivery is key in timely recognition of haemorrhage and prevention of PPH (post-partum haemorrhage). Blood loss estimation in caesarean deliveries is challenging, with their propensity towards PPH and complicated assessment of blood loss with the mix of amniotic fluid, irrigants and blood.

Objective

To assess the level of agreement of visual estimated blood loss (vEBL), gravimetric estimated blood loss (gEBL) and calculated estimated blood loss (cEBL) in women who have undergone caesarean delivery. Design: A secondary analysis of a double blinded, randomised controlled trial in the largest maternity unit in Singapore.

Method

Between June 2020 and October 2021, 200 multi-ethnic women aged 21 years or older undergoing elective caesarean section were recruited. Blood loss estimation was assessed by vEBL (by the anaesthetic and surgical teams), gEBL (involved weighing of soiled gauzes and measuring fluid volume) and cEBL (formula based calculation using pre- and post-delivery haemoglobin). Mean EBLs obtained were compared using Pearson's correlation and with the Bland-Altman method. SAS Version 9.4 was employed for data analysis.

Results

vEBL had the lowest mean blood loss, lowest proportion of women with EBL ≥ 500 and ≥1000 mL, while cEBL had the highest blood loss for all three outcomes. Intraclass correlation ranged from 0.29 (low) between vEBL and cEBL to 0.68 (moderate) between vEBL and gEBL. On average, vEBL is 249.7 mL (95% CI −822.7 to 323.3) less than gEBL, and 287.9 mL (95% CI −1143.9 to 568.0) less than cEBL. As blood loss increases, vEBL is more likely to underestimate blood loss as compared with gEBL and cEBL. The difference between gEBL and cEBL was −23.3 mL, but confidence intervals are wide. Women with body mass index (BMI) ≥ 30 kg/m2 were more likely to have EBL ≥ 500 mL by cEBL (OR 1.13, 95% CI 1.05–1.21, p < 0.01). Women with longer operative duration have higher odds of having EBL ≥ 500 mL by vEBL or gEBL.

Conclusions

vEBL grossly underestimates blood loss. To compensate for the lack of objectivity in vEBL, regular simulation trainings are recommended to refresh and hone team members' skills. gEBL and/or cEBL should be considered in cases of PPH, but factors that can affect their accuracy such as operative duration and BMI should be considered. Combining different methods may also yield more accurate results. Longitudinal analyses can be performed to evaluate clinical outcomes from the different approaches. eP-505 Disparities in antenatal care uptake for Black, Asian, and minority ethnic women M. Bharadia1; K. Mayers2 1Queen Mary University of London, London, UK, 2Homerton Healthcare NHS Foundation Trust, London, UK

Objective

In the UK, maternal mortality rates for Black and Asian women are thrice and twice the rates respectively, of white women1. East London contains vastly ethnically diverse and socially deprived boroughs within the UK; across which rates of stillbirth for Black, Asian, and minority ethnic (BAME) women are higher than their white counterparts2. This literature review aims to assess the disparities in antenatal care uptake for BAME women, the effects on maternal and neonatal outcomes, and how to address them at a local and national level. Design: A literature review analysing data surrounding maternal mortality from the MBRRACE-UK audit for 2019–2021, and North East London data.

Method

A needs assessment from the Local Maternity and Neonatal System for North-East London (NEL) regarding maternal outcomes for women from BAME backgrounds using data from Hospital Episode Statistics and Secondary Uses Service, alongside an online survey, interviews, and focus groups to assess the experiences of antenatal care for BAME women carried out by NEL Healthwatch, have been analysed looking at current literature in antenatal care disparities for BAME women3. Additionally, a qualitative set of interviews into BAME women's experience of antenatal care in the UK has been analysed.

Results

Whilst there are certain pre-existing conditions and co-morbidities for BAME women including hypertension, which affect maternal and neonatal outcomes, it is evident systemic bias plays an integral role within this2. Barriers to antenatal care for BAME women include lack of proficiency in English, lack of advocacy and empowerment within decisions, and reinforcement of harmful stereotypes.

Conclusions

It will be important to help break down the systemic biases that exist within antenatal care, through training of healthcare professionals to cater towards cultural and social needs. Additionally, patient centred care will allow for informed decisions. Future research is paramount to assessing whether policies implemented will be efficacious in improving maternal and neonatal outcomes for BAME women. - Knight M, Bunch K, Felker A, Patel R, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers' Care Core Report – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019–21. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2023 - NHS. North East London Local Maternity and Neonatal System. Equity and equality strategy and action plan; 2022 - NHS. North East London Local Maternity and Neonatal System. Equity and Equality needs assessment; 2021 eP-506 Case series in utilisation of Interventional radiology in placenta accreta spectrum disorders H. Mohamed; Y. Mohammed Manchester Foundation Trust, Saint Marys Hospitall, Manchester, UK

Introduction

Interventional radiology (IR) can play crucial role in the management of placenta accreta spectrum (PAS) disorders. In appropriately selected cases it may reduce the maternal morbidity and mortality associated with PAS, but has been subject to some controversy and debate within obstetrics and maternal-fetal medicine. This includes debate over the optimal timing and use of interventions, the role of IR in offering uterine conservation management, long term outcomes, cost effectiveness and the lack of a clear consensus guidelines for the management of PAS and IR. This has contributed to discrepancies in published reports of practice/ IR approach, case selection, and decision-making among healthcare providers.

Method

and Materials: Within our trust over the last 12 month (2022–2023) we delivered 17 women with PAS FIGO staging 2–3. With this notable significant rise in numbers compared to previous years (July 2017–July 2022: 27 cases), access and consideration of IR has been essential, in addition to correct case selection, and a patient centred surgical approach for which the utilisation of IR may support. The use of IR locally feeds into the controversy surrounding the management of PAS, and the complexity of balancing maternal and fetal outcomes. We present our experience in the utilisation of IR in a cohort of 7 cases in the time period between 2022 to 2024 . The local preference within the unit is Bilateral Internal Iliac balloon insertion. We present how a multidisciplinary care model has been used for case selection. This includes advanced imaging such as MRI to help plan surgical intervention, maternal and fetal outcomes, timing of intervention and any immediate/late post operative complications.

Results

Within our cases series-we present various management strategies, and surgical approaches of IR intervention which included heparinised/non heparinised internal iliac balloons, immediate/delayed removal of sheath and closure, time of total occlusion of the internal iliac balloons with each procedure. We report an average blood loss of 2500 mL. We describe complications experienced including bilateral arterial thrombus, parathesia, and a successful fertility preservation.

Conclusions

IR procedures can provide a viable but not an only alternative in supporting and advancing traditional surgical approaches.

References

Jauniaux, E., Ayres-de-Campos, D. and (2018), FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction†,‡. Int J Gynecol Obstet, 140: 261–264. https://doi.org/10.1002/ijgo.12406 eP-507 Trends and impact of the affordable care act on maternal deaths O. Akinyemi1,2 1Department of Surgery Outcomes Research Center, Washington, DC, USA, 2Department of Health Policy and Management, University of Maryland School of Public Health, College Park, USA

Introduction

Maternal mortality continues to be a grave and adverse outcome of pregnancy, yet its incidence has significantly decreased in the United States. However, this reduction in maternal mortality rates has been uneven, with notable disparities persisting among minority groups and individuals with low socioeconomic status. Implementing the Affordable Care Act may enhance overall pregnancy outcomes, particularly among minority populations, to promote equity.

Objective

The objective of this study is to analyze the trends and assess the impact of the ACA on pregnancy-related mortality in the United States by comparing two of the largest states: California, which implemented the ACA in 2014, and Texas, which has yet to implement the ACA as of 2024. Methodology: We combined data from the CDC Wonders data and the Natality files to explore the trends in maternal mortality rates in the United States, comparing data from Texas and California to the national trends. The study covered the years 2000–2020, divided into pre-ACA (2000–2013) and post-ACA (2014–2020) periods.

Results

During the study period, there were 17 830 maternal deaths in the United States, with Texas and California contributing 11.9% and 10%, respectively. Black women, representing 15.8% of total deliveries, accounted for 33.3% of these deaths. Nationally, maternal mortality increased from 9/100 000 births in 2000 to 34.9/100 000 in 2020, a 287.8% rise. Texas experienced a more significant increase, from 8.3/100 000 to 40.7/100 000 deaths (390.4%), while California's rate grew from 9.6/100 000 to 19.5/100 000 (103%). Racial disparities were evident, with Black women's mortality rates escalating from 19.8/100 000 in 2000 to 73.8/100 000 in 2020. Post-ACA, Black women in California saw a 10% reduction in mortality, unlike Texas, where no improvement was observed.

Conclusion

From 2000 to 2020, maternal mortality rose nationally and in Texas, while California's rates remained stable after ACA implementation. The rise was predominantly due to increased fatalities among Black women. Our findings suggest that state-specific sociocultural dynamics profoundly influence maternal outcomes beyond mere policy adoption. eP-508 Data sharing or non-sharing: How valid are randomised trials evaluating labour induction? M. Patabendige1; D.L. Rolnik1; B.W. Mol1; W. Li1,2 1Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia, 2National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health, and School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia

Objective

To compare characteristics, trustworthiness of randomised controlled trials (RCTs) and outcomes on labour induction that shared individual participant data (IPD) versus those that did not. We hypothesised that RCTs without data sharing as IPD have more concerns compared to those shared. Design: A meta-epidemiological study.

Method

RCTs included in five IPD-MAs comparing different methods of labour induction were evaluated using published data. We used Monte Carlo simulation with baseline characteristics to assess randomisation. Trustworthiness of RCTs was evaluated using the TRACT checklist (pubmed.ncbi.nlm.nih.gov/37337220/). Agreement in outcomes (caesarean delivery and hyperstimulation) between shared and non-shared was performed with random-effects meta-analysis.

Results

Of 112 RCTs, 29 (25.9%) shared data, and 83 (74.1%) did not. The median publication year of the shared group was 2015 (range 1996–2023) versus 2008 (1983–2021) for non-sharing RCTs. Shared RCTs had a larger median (range) than non-shared: 339 (101–1859) versus 126 (38–1358). Studies that did not share data had a small probability of having proper randomisation (p = 0.03), whereas shared group seems to be having proper randomisation (p = 0.85). In the non-shared group, authors who refused to share were less likely (p = 0.003) to have proper randomisation than authors who could not share data as data were not available (p = 0.14). There were discrepancies between shared and non-shared groups in the results of random effects meta-analyses as shown using Ratios of Odds Ratios (95% Confidence Interval) – Balloon catheter versus low-dose oral misoprostol comparison: caesarean delivery – 0.52 (0.02;12.76), no data for hyperstimulation in non-shared RCTs; Single balloon versus double-balloon: caesarean delivery – 2.54 (0.29; 22.01), no data for hyperstimulation in non-shared RCTs; Vaginal dinoprostone versus low-dose vaginal misoprostol – caesarean delivery – 1.42 (1.05; 1.92), hyperstimulation – 0.86 (0.49; 1.51); Outpatient versus inpatient methods – caesarean delivery – 1.45 (1.08; 1.95), hyperstimulation – 0.29 (0.01; 14.42). There was no discrepancy for the balloon catheter versus vaginal prostaglandin comparison: caesarean delivery – 1.02 (0.78; 1.34) and hyperstimulation – 1 (0.23; 4.37). Proportion of RCTs with ‘concerns’ under seven domains of the TRACT checklist between shared vs non-shared was: Governance 36.8% vs 75.1%; Author Group 2.3% vs 11.2%; Plausibility of Intervention 0% vs 16.9%; Timeframe 3.4% vs 21.1%; Drop-Out Rates 0% vs 27.7%; Baseline Characteristics 0% vs 11.7%; Outcomes 12.6% vs 32.1%.

Conclusions

In studies on labour induction, RCTs without IPD sharing have lower quality and more trustworthiness concerns than those who shared IPD. The availability of IPD and willingness to share are good indicators of quality and trustworthiness. eP-509 Assessment of the scar on the uterus after one or more CS A. Saveleva; P. Samchuk; E. Malysheva I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

Objective

To compare the possibilities of intraoperative visual and histological methods for assessing the viability of a scar after CS surgery with metroplasty. Design: Cross-sectional study.

Methods

The study included 89 women with a second or subsequent pregnancy who were delivered on time by CS followed by metroplasty. The reasons for the metroplasty are analyzed. During the CS, a visual assessment of the viability of the scar zone was performed according to intraoperative criteria. For histological analysis, myometrial samples were taken from the scar area after the previous CS. The comparability between the visual assessment data and the results of the histological conclusion was studied, including taking into account the number of previously performed CS operations.

Results

Of the 89 women included in the study, 75% (67) had a history of 1 CS operation, 17% (15) had 2, and 8% (7) had 3. The most common reason for metroplasty was an incomplete scar area, which was recorded in 57% of cases according to visual estimates and in 84% of cases according to histological examination. In general, in this cohort, the viability of the scar according to visual assessment was established in 43% (38) of women, whereas according to the results of histological assessment – in only 16% (14). The coincidence of these two methods of scar assessment was high in women with two (in 15 out of 15 women, the scar was found to be invalid in both visual and histological assessment) and three CS operations in the anamnesis (the scar was invalid in 6 out of 7 and 7 out of 7 women in visual and histological assessment, respectively). In the subgroup of women with a single CS operation, a history of scar failure was visually established in 30 out of 67 women (45%), and histologically in 53 out of 67 (79%) women.

Conclusions

In determining the viability of a scar on the uterus after CS surgery, low comparability was found between visual and histological assessment methods, with the exception of a small subgroup of women with 2 and 3 previous CS operations, where the coincidence was high. eP-510 Evaluation of pregnancy outcomes in patients with previous second stage caesarean section M. Niphadkar; N. Vaithilingam Queen Alexandra Hospital, Obstetrics and Gynaecology, Portsmouth, UK

Objective

Caesarean section at full dilatation is a recognised risk factor for subsequent spontaneous preterm birth. It is important to acknowledge the psychological impact of such delivery on subsequent pregnancies. We aim to evaluate the preterm birth prevention service introduced in our unit to care for patients at higher risk of preterm birth. Design: The preterm birth prevention clinic was introduced in our unit to assess all such patients at risk of preterm birth and to provide continuity of care. The high risk patients include those with previous second stage caesarean section, previous cervical surgery, previous late trimester miscarriage etc. The patients were identified by the midwives at booking and referred to the clinic to be seen between 16 and 24 weeks.

Methods

A retrospective data analysis was done on eligible patients booked between January 2021 to June 2022, from electronic patient records.

Results

102 patients were referred to the clinic. 95 eligible patients were identified out of which 94 were referred to the preterm birth prevention clinic out of which 1 did not attend. Cervical length was assessed in 100% patients. 75% (71) patients had cervical length >40 mm, 17% (16) had between 30 to 39 mm, 6% (6) had no length documented and none below 30 mm. 95% (90) delivered after 37 weeks, 3%(3) between 34–37 and 2% (2) between 28–34 weeks and none before 28 weeks. 58%(55) had an elective caesarean section, 17%(16) had a spontaneous vaginal delivery, 16%(15) required an emergency section and 8%(8) needed an assisted vaginal delivery 1% with unknown outcome since transferred out of area mid pregnancy. Only 5 patients were offered Cyclogest, 1 patient declined. The cervical lengths in these patients were between 36 to 42 mm. Some other factors were evaluated like age of the woman at delivery, BMI at booking, other risk factors and baby weight in birth centile. When risk factors were looked at, 62% (21) were GDM in current pregnancy, 14% (5) had LGA babies, 6% (2) had GDM in previous pregnancy, 6% (3) had previous LLETZ.

Conclusion

The pathway of referral to preterm birth prevention clinic has been successful in providing the continuity of care to the eligible patients. This analysis also recognises the possible psychological impact of the caesarean at full dilatation and preference for elective caesarean section in subsequent pregnancy. There is scope to study impact of second stage caesarean sections on subsequent pregnancies. eP-511 Caesarean scar ectopic pregnancy, an Unicenter Case Series treated successfully with medical management T. Ramzan1; S. Ishtiaq2; H. Yasmin3 1Zulekha Hospital, Obstetrics & Gyneacology, Sharjah, United Arab Emirates, 2Ziauddin Hospital, Obstetrics & Gyneacology, Karachi, Pakistan, 3Jinnah Post Graduate Medical Centre, Obstetrics & Gyneacology, Karachi, Pakistan

Objective

To Learn about available medical treatment options and the factors influencing treatment choices. Study design: A retrospective case series.

Method

A retrospective analysis was undertaken. Patients were identified through the hospital's clinical information services coding system and data were collected from medical records.

Results

In this retrospective, uni-centric case series examined six patients aged between 33 and 42 years (mean age = 36.5 years) with Cesarean scar ectopic pregnancy (CSEP) between 2022 and 2023. All were endogenous type 1 SCEP (implantation occurs on the scar and the gestational sac grows towards the cervico-isthmic or uterine cavity). All patients received ovulation induction with clomiphene citrate for secondary infertility. Transvaginal ultrasound with colour Doppler was the diagnostic modality, the mean gestational age of cases were 6 plus weeks. Four patients were with myometrium thickness less than 2 mm on TVS and BHCG levels more than 5000, 8000, 12 000 and 19 000 iu/L respectively and these patients opted for medical management. All patients were hemodynamically stable. They were predominantly managed in our facility with an intra-muscular injection of methotrexate (at 1 mg/kg body weight) that resulted in a significant success rate and not needed surgery. Two patients received single dose, three received 2 doses and one patient received 3 doses of MTX. Each patient received an individualized treatment according to the case need and patient's own choice. The cases managed medically the pregnancy resolving period exceeded up to 5 months and provided women have closely monitored follow-up.

Conclusion

Caesarean scar pregnancy (CSEP) is a rare form of ectopic pregnancy whereby the gestational sac is fully or partially implanted within the scar caused by a previous caesarean section (CS). Estimates of CSEP incidence range from 1/1800 to 1/2500 of all pregnancies. Prompt diagnosis of the condition is required to reduce associated morbidity. Ultrasound scan is the diagnostic tool of choice. Management options include expectant management, medical therapy, surgical intervention and uterine artery embolization. Major hemorrhage and hysterectomy are the main risks associated with CSEP. Therefore, adequate counselling and availability of surgical expertise and blood transfusion should be part of a comprehensive management strategy. Due to the low frequency of this entity, there are no clear protocols for its treatment and thus there are numerous options for treatment. Therefore, appropriate patient selection is important for optimal results and success for medical management. eP-512 External validation of web-based calculator to predict caesarean-delivery after induction of labor D. Parth1; S. Malini1; A. Maimoona1; P. Krina2 1Obstetrics and Gynaecology, Fernandez Foundation and Hospital, Hyderabad, India, 2Neonatology, Fernandez Foundation and Hospital, Hyderabad, India

Objective

To externally validate a prediction model for the risk of a cesarean section after induction of labour (IOL) using a web-based cesarean risk calculator in a tertiary perinatal centre and to compare the performance of three calculators in predicting the cesarean risk after IOL based on their sensitivity & specificity. Design: Prospective Observational study.

Method

We studied 577 women over a period of 1 year at a tertiary perinatal centre in India.Women with singleton-term pregnancies with intact membranes that underwent induction were included.Multifetal gestation, intra-uterine fetal demise,non-Cephalic presentation other contraindications to vaginal birth were excluded.We used three prediction tools, Levin's calculator which requires 5 components: height,body mass index(BMI),parity,gestational age at the time of induction,cervical examination findings, Rossi's calculator based on 7 variables,which were prior vaginal delivery, maternal weight at delivery, maternal height, maternal age, prior cesarean delivery, gestational age at induction,maternal race & Irwinda's prediction model requiring 7 factors were associated with caesarean delivery which were gestational age, maternal BMI, previous uterine surgery, obstetric complications, birthweight , history of vaginal delivery,non-cephalic presentation for predicting caesarean delivery rates at the start of induction.These factors were entered directly into the calculator at the start of IOL, producing an individualized risk of cesarean delivery.The mode of delivery was the primary outcome variable.Web-based Caesarean risk calculators were considered as screening tests. AUC, Calibration plots and Decision-making curve analysis were used for comparison.

Results

out of 577 mothers who underwent IOL ,345(59.79%) women had a vaginal birth and 232(40.21%) underwent caesarean section.Levine calculator reached the maximum discriminative capacity (AUC 0.785) for our population, followed by Rossi (AUC 0.7723) and Irwinda.(AUC 0.6608).Levin's calculator performed better than Rossi's calculator from threshold probabilities between 21% to 60% whereas Rossi's calculator performed slightly better than Levin's calculator from threshold probabilities between 61% to 87% and between 6% to 20%.Rima Irwinda's calculator performed slightly better than Rossi's calculator from threshold probabilities between 21% to 38%.Levin's calculator slightly overestimates the risk of caesarean section at lower thresholds but underestimates the risks at higher threshold probabilities whereas Rossi's calculator underestimates the risk of caesarean section at all threshold probabilities above 11%.

Conclusion

Calculators by Levine and Rossi have the greatest potential for use in clinical settings.However, these cannot be used individually for clinical decision-making without prospective studies evaluating their clinical impact on pregnant women undergoing induction of labour. eP-513 Association of ultrasonographic placenta thickness with obstetric outcome and placental histopatholog a prospective study P. Darshni OBGYN, SRM Medical College Hospital And Research Centre, Kanchipuram, India

Objectives

This study aims to determine the association between abnormal placental thickness and maternal vascular malperfusion pathology and to correlate placental thickness with adverse pregnancy outcomes. Design: This prospective observational study involved 144 pregnant women with singleton pregnancies who underwent routine ultrasound examinations between 18 and 20 weeks of gestation at a tertiary care hospital in Chengalpattu, Kanchipuram, Tamil Nadu. The study was conducted from November 2022 to October 2023.

Method

During the ultrasound examination, the thickness of each placenta was measured with a precision of 1mm, perpendicular to the uterine wall. A placenta was considered thick if it was above the 95th percentile and thin if it was below the 10th percentile. Patients with abnormal placental thickness were monitored until delivery to determine the incidence of adverse fetal outcomes such as low birth weight, preterm birth, hypertensive disorders of pregnancy, and gestational diabetes mellitus. Following the delivery of the placenta, a histopathological examination was conducted to establish the relationship between placental thickness and maternal vascular malperfusion.

Results

The mean thickness of the placenta was found to be 2.64 cm. Placentas with a thickness of 2.20 cm or less were considered thin, while those with a thickness of 3.20 cm or more were considered thick. Women with thick placentas had a higher risk of developing gestational diabetes mellitus and hypertensive disorders of pregnancy. This association was statistically significant, with a p-value of less than 0.001*. Conversely, women with thin placentas had a higher risk of fetal growth restriction and low birth weight, also with a statistically significant association (p-value < 0.001*). Upon histopathological examination of placentas from women with fetal growth restriction or low birth weight babies, syncytial knot formation was found in most cases (57.1%), along with intramural fibrin deposition (61.9%). Abnormal placental villi (13.1%), multifocal infarction (8.3%), and decidual vasculopathy (3.6%) were also observed in placentas from women with gestational diabetes mellitus and hypertensive disorder of pregnancy.

Conclusions

This study finds that thick placenta is significantly associated with Gestational diabetes mellitus and hypertensive disorders of pregnancy, while thin placenta is significantly associated with low birth weight and fetal growth restriction.

Keywords

placenta thickness; maternal complication; maternal vascular malperfusion; low birth weight; gestational diabetes mellitus; fetal growth restriction eP-545 WHY ExEm® Foam INSTEAD of hysterosalpingogram? A. Bin eisa1; A. Blaou1; E. Alfituri1; S. Ahmed Altahir2; A. Abushwereb1; M. Abudabbous3 1Obstetrics and Gynecology, Tripoli University, Tripoli, Libya, 2Obstetrics and Gynecology, Sebha University, Misurata, Libya, 3Obstetrics and Gynecology, Tripoli University, Misurata, Libya

Introduction

ExEm® Foam is an ultrasound contrast agent indicated for Sono hysterosalpingography to assess fallopian tubes patency in women with known or suspected infertility, As ExEm® Foam is the only FDA-approved contrast agent for use with Trans-Vaginal Ultrasound (TVUS), which could be performed in the privacy and comfort of the gynaecological office. The appropriate time for the procedure is 6–11 days after the end of the menstrual cycle “pre-ovulatory phase”. This procedure could be performed in outpatient gynaecological office, allowing immediate results and diagnosis, also less time consuming for fertility journey. Design and Aim: Prospective comparative study to compare the effectiveness and costs of management guided by ExEm® Foam with HSG Hysterosalpingogram in terms of describing and diagnosing tubal patency, pain score, and pregnancy outcome.

Methods

This study included (58) Patients, of which (32) patients underwent HSG, while (26) patients had ExEm® foam.

Results

regarding evaluation of tubal patency with HSG (11, 35%) diagnosed with patent tubes, (21.65%) with blocked tubes, (13.62%) with unilateral Obstruction and (8.38%) with bilateral Obstruction. In contrast, with ExEm® foam; (6.23%) diagnosed with patent tube, (20.77%) tubal obstruction, (9.45%) unilateral Obstruction, (11.55%) bilateral Obstruction. In terms of pain score, with HSG (25.78%) expressed severe pain, three of them with cervical stenosis, 7 moderates to mild pain, while with ExEm® foam only (4.15%) expressed moderate pain. Also, in first 2days post procedure vaginal spotting noticed in (5.16%) who had HSG, (0.0%) post ExEm® foam. On the other hand, the risk of vaginal infection one week after procedure was (15.47%) after HSG, but only (5.19%) with ExEm® foam. Pregnancy rate was increased after both procedures, with (4.15%) who had ExEm® foam, and (6.19%) with HSG.

Conclusion

ExEm® foam could be relied upon in diagnosing tubal patency, it also has a lower rate of pain and risk of infection than that of HSG. The tubal flushing effect with ExEm® foam has been proposed to have a positive impact on fertility. eP-547 Role of laparoscopy in adnexal masses in tertiary care hospital A. Patil; T. Palve Obstetrics and Gynaecology, MUHS, Mumbai, India

Objective

Evaluation of symptomatic adnexal masses – chronic pelvic pain in women by laparoscopic methods . Design: A prospective study conducted in Sir J.J. Groups of hospital, Mumbai. The rationale was to evaluate the efficacy of radiological, noninvasive and minimally invasive method such as laparoscopy in different symptomatic pelvic pathologies.

Method

A sample size of 44 women presenting with symptomatic adnexal masses in OPD for more than 6 months. Inclusion criteria: Women in 20–50 years age group presenting with symptoms related to pelvic pathology. Exclusion criteria: Women not willing for study, women with medical illness and orthopaedic, musculoskeletal injuries and psychological cause of pain ruled out. The observations were recorded in standard pro forma and analysed bai statistical package for social sciences software (SPSS).Pearson's Chi square test and Fischer Exact test were used to evaluate categorical variables. Student t test for statistical significance between 2 independent groups and paired student t test for significance between 2 dependent groups. A p value of less than 0.05 was taken to be significant.

Result

Out of 44 patients with symptoms, 1 patient had no detectable pelvic pathology by laparoscopy. 14 patients out of 44, have normal pelvic usg done prior. Hence usg under diagnosed 13 patients who actually had pelvic pathology on laparoscopy. Out of 44 patients. 3 had normal clinical diagnosis, hence clinical examination under diagnosed 2 patients who had pelvic pathology on laparoscopy. No statistically significant association was seen between the 3 methods – laparoscopy, usg, clinical diagnosis with CC value of 0.193 and p value of 0.54.

Conclusion

Laparoscopy remains gold standard for definitive diagnosis of pelvic pain as well as therapeutic for patients with abnormal findings. As we can visualise pathologies in laparoscopy, it helps in giving reassurance to patients with pelvic pain when no abnormality is found on laparoscopy. eP-548 Gynaecological incidentalomas in emergency general surgery patients: The incidence, management, and follow-up G. Williams; R. Lunevicious Aintree University Hospital, Emergency General Surgery, Liverpool, UK

Objective

‘Incidentalomas’ are findings on imaging that are not directly related to the presenting symptoms. Advancements in quality and increased quantity of CT scans has resulted in more incidental gynaecological diagnoses. This project aims to identify the incidence of gynaecological incidentalomas diagnosed by CT in the Emergency General Surgery setting, characterise them, and assess the management and follow-up of patients.

Method

This project was a retrospective study conducted at Aintree University Hospital's SAU and Emergency General Surgery (EGS) wards. Data was collected by reviewing patients admitted in October and November 2023. Female surgical patients who had CT scans of the abdomen and pelvis were selected. CT scans were reviewed for any subsequent identification of gynaecological incidentalomas. Data was also collected on additional investigations, follow up and management.

Results

189 female patients were assessed. 89 in October and 100 in November 2023. 78% of female patients (148/189) received a CT scan. Females who did not receive a CT scan were investigated using different imaging modalities. Of the females who underwent investigation by CT scan, 16% (24/148) had an incidental gynaecological finding. Cases included eleven simple cysts—three bilateral and eight unilateral (six pre-menopausal females and five in post-menopausal female), four fibroids (two in premenopausal females, and two in postmenopausal women), five masses of unknown origin (three in pre-menopausal females, and two in postmenopausal females) and four ‘other’ problems. Three female patients (aged 32, 45, 69 years) out of the eleven diagnosed with cysts were followed up by a transvaginal ultrasound scan at Liverpool Women's Hospital. No females diagnosed with fibroids were followed up. All five masses identified incidentally on the CT scan were followed up and later diagnosed as 2 pyosalpinx, one ovarian cyst and one case of ovarian cancer.

Conclusions

Gynaecological Incidentalomas identified on CT scans of women in SAU in October and November 2023 is 16%, higher than suggested in the literature at around 5%. The majority of incidentalomas are benign including ovarian cysts which are the most common incidentaloma found in 46% of women. Women diagnosed with ovarian cysts on CT are not always followed up appropriately or in concordance with ROCG guidance. CT confirmed masses must be followed up to exclude malignancy which is occurring consistently. However, there lacks clear literature to guide management of incidental gynaecological findings meaning follow up and further care is variable. This project has produced an intervention that will be re-audited. eP-549 The diagnostic performance of ultrasound in adenomyosis I. Hamra; S. Bayar; F. Tekaya; H. Sebri; A. Triki; A. Ben Amor; A. Halouani Department of Gynecology and Obstetrics, University Hopsital Mongi Slim La Marsa, La Marsa, Tunisia

Objective

Uterine adenomyosis, though benign, poses diagnostic challenges in clinical practice and is commonly addressed through hysterectomy. However, managing it presents particular challenges in young women or those seeking fertility preservation. For these patients, early diagnosis, ideally at less advanced stages of the disease, is crucial to allow for conservative treatments. This study aimed to assess the effectiveness of ultrasound in diagnosing adenomyosis compared to histopathological examination of hysterectomy specimens, which is considered the gold standard method. Design: Retrospective, monocentric, descriptive study.

Methods

This is a retrospective study including 45 patients who underwent hysterectomy for benign gynecological conditions between January 2018 and December 2022, and whose histological examination of the surgical specimen revealed the presence of adenomyosis. Preoperative pelvic ultrasound reports were collected. The ultrasound results are compared to histological analysis of hysterectomy specimens.

Results

We included 139 patients; 45 had adenomyosis on histopathological examination. The histological prevalence of adenomyosis is 32.4%. A preoperative ultrasound (pelvic and/or transvaginal) is available for all patients. In 75.5% of cases, suspicion of adenomyosis is mentioned with an enlarged uterus without modification of myometrial texture. An ovarian cyst was associated in 10% of cases. This study concludes a sensitivity of 80.27% with a positive predictive value of 66.27%.

Conclusion

Pelvic and/or transvaginal ultrasound is the primary examination tool in gynecology and proves to be suitable for diagnosing adenomyosis, owing to its accessibility and affordability. Moreover, its performance closely parallels that of MRI, making it a viable option. The adoption of standardized classification systems could enhance and standardize adenomyosis diagnosis. eP-550 Contribution of ultrasound in preoperative assessment of adnexal masses in postmenopausal women C. Abdelhedi1; N. Souayeh2; E. Gomri1; H. Bettaieb2; H. Rouis2; N. Hsayaoui2; M. Nouira3; C. Mbarki2 1Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia, 2Gynecology and Obstetrics Department, Faculty of Medicine, Ben Arous Regional Hospital, University of Tunis el Manar, Tunis, Tunisia, 3Epidemiology and Community Medicine Department, Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia

Objective

The aim of our Study was to assess the performance of ultrasound examination in the preoperative evaluation of adnexal mass in post-menopausal women. Design: This is a seven-year retrospective and multicentric study, conducted over three gynecology departments: Charles Nicolle Hospital, Ben Arous Regional Hospital and Mahmoud El Matri Regional Hospital.

Method

Our study was conducted over seven years, from January 1st, 2016 to December 31st, 2022. We included 198 postmenopausal women who were diagnosed with a symptomatic or asymptomatic adnexal mass, that had undergone a preoperative evaluation including at least a pelvic ultrasound and tumor marker assays (CA-125, CA 19-9, ACE, HE4) and in whom surgical excision was performed with final anatomopathological examination. Data were collected from medical files and analyzed using Statistical Package for Social Science Version 23.

Results

On the ultrasound examination, 95.5% of the patients had unilateral adnexal masses, only nine women (4.5%) had bilateral tumors. The mean size was 7.74 ± 5 cm, with extreme values ranging from 2.5 to 22.1cm. Most of them were cystic (77.7%), the others were classified as solid and cystic (20.8%) and completely solid (1.5%). Doppler signal and intra-peritoneal effusion were found in 20.8% of the cases. According to IOTA classification, adnexal masses were presumed benign in 123 women (61.9%), malignant in 40 women (20.3%) and of indeterminate nature in 35 cases (17.8%). According to ORADS-US, they were classified ORADS 2, 4 et 5 in respectively 26.9%, 36.5% et 36.5% of the cases. The final anatomopathological examination revealed that 17.7% of the masses were malignant, mostly Serous (47%) and Mucinous (14.7%) Cystadenocarcinomas. When ultrasound results were compared to final anatomopathological examination, we found that in most cases, a first-line ultrasound scan was sufficient to rule out malignancy. Indeed, using both IOTA and ORADS-US scores offered an excellent negative predictive value (Respectively 99.15% and 98.85%), as well as great sensibility (93% and 94.44%) and specificity (84.17% and 86.87%).

Conclusions

Adnexal masses in postmenopausal women are frequently benign but the fear is to miss out on ovarian cancer. A pelvic ultrasound should be performed as the first-line examination to identify potentially malignant masses and is often sufficient for pre-operative evaluation. Indeed, the ultrasound assessment using widely studied scores such as IOTA and ORADS-US offers great negative predictive value, sensibility, and specificity. eP-551 Diagnostic accuracy of sonohysterography in the diagnosis of uterine cavity diseases H. Laamiri1; N. Souayeh2; H. Bettaieb2; M. Ouederni1; H. Rouis2; N. Hsayaoui2; M. Nouira3; C. Mbarki2 1Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia, 2Gynecology and Obstetrics Department, Faculty of Medicine, Ben Arous Regional Hospital, University of Tunis el Manar, Tunis, Tunisia, 3Epidemiology and Community Medicine Department, Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia

Objective

The aim of this study was to evaluate the diagnostic accuracy and the tolerability of sonohysterography (SHG) in uterine cavity diseases compared to hysteroscopy (HSC) which was the gold standard. Design: This was a prospective, monocentric study.

Methods

Our study included 120 patients. It was conducted in the gynecology and obstetrics department of Ben Arous regional hospital over a period of eight months. All patients had transvaginal sonography (TVS), SHG et HSC. Sensitivity, specificity, and Kappa coefficient of SHG were calculated, compared to HSC.

Results

Mean age was 49 years. 43.3% were postmenopausal. The most frequent symptom was the abnormal uterine bleeding (81.6%). TVS had a good sensitivity of 94.6% and a bas specificity of 40%, all lesions included. Its correlation with HSC was low (K = 0.35). SHG was successfully completed in 116 cases. We failed to pass the catheter into the uterine cavity in two cases. The mean exam duration was 5.2 min, and it was well accepted by most patients. The most diagnosed lesions were polyps (48.3%) and endometrial hyperplasia (29.3%). SHG showed an excellent global sensitivity of 98.1% and a specificity of 80%. Overall, Kappa coefficient was 0.78. Sensitivity and specificity varied from 98.1% to 100% and from 90.3% to 100% respectively depending on the lesion. Correlation with HSC was also good for the different pathologies with a Kappa between 0.67 and 1.

Conclusion

Sonohysterography is an easy, accepted, and reliable exam to analyze the uterine cavity lesions. It's accurate compared to hysteroscopy and less invasive. Thus, it can be part of the first intention exams. eP-556 Fetal adrenal gland and thymus gland volumes in normal versus growth-restricted fetuses M.K. Etman1; A. Abdelmonem2; H. Badran2 1Obstetrics and Gynecology, Fayoum University, Fayoum, Egypt, 2Fayoum University, Fayoum, Egypt

Objective

This study aimed to determine the association between fetal adrenal gland volume and thymus gland volume and late onset fetal growth restriction. Design: Case-control study. Patients and Methods: This was conducted at a tertiary hospital's obstetrics and gynecology department. The study recruited pregnant women with late onset fetal growth restriction with gestational age ≥ 32 weeks and presented for antenatal care. A control group was recruited, including women with normal pregnancies of the same gestational age. Upon recruitment, fetal adrenal gland volume and medulla width and the thymus gland volume were measured using 3D ultrasound.

Results

There were 32 and 36 participants in the study and control groups respectively. Both groups were matched in their primary demographic data. The estimated fetal weight was significantly lower among the fetal growth restriction group than the control group (1786.66 ± 320.35 vs. 2518.75 ± 402.52, respectively. p-value was < 0.001). The adrenal gland volume was significantly higher among fetuses with fetal growth restriction than the control group (384.69 ± 70.79 vs.312.33 ±62.33, respectively. p-value < 0.001). The thymus gland volume was significantly lower among growth-restricted fetuses (p-value 0.027). When combined together, both markers predicted FGR with a sensitivity and specificity of 72% and 80%, respectively.

Conclusion

Fetal adrenal gland volume and thymus gland volume predicted FGR with great sensitivity and specificity. eP-558 Sonographic evaluation of antenatal umbilical coiling index, associating with adverse pregnancy outcomes N. Patnaik1; K. Guru Mishra2; N.R. Pradhan3; A. Pradhan1 1Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India, 2Department of Community Medicine and Family Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, India, 3Aig Hospitals, Institute of Vascular and Endovascular Surgery (Ives), Hyderabad, India

Background

Abnormal umbilical cord coiling has been associated with adverse neonatal outcomes such as preterm births, interventional deliveries, low birth weight etc. but the etiology of these findings remains poorly characterized with lesser evidence in Asian population. Hence, this study was undertaken to explore associations of antenatal umbilical coiling index (aUCI) with perinatal and fetal outcomes and provide the magnitude of risk.

Objective

To explore associations of antenatal umbilical coiling index (aUCI) with perinatal and fetal outcomes and provide the magnitude of risk. Design: A Prospective Cohort Study.

Materials and methods

Women with singleton pregnancies were recruited at their second-trimester scan at a tertiary-care hospital. Images of the umbilical cord were used to calculate the aUCI. Pregnancy and birth outcomes were recorded and statistical associations between aUCI and the outcomes were recorded (n =1200).

Results

A total of 1242 were recruited from November 2019 to August 2020 of which 1200 participants could be followed up post-delivery of the baby. Within the entire study population, hypocoiling was associated with preterm births (OR = 2.87(1.85–4.45)) and intra-uterine growth retardation (IUGR) (OR = 1.66(1.31–5.41)) while hypercoiling was significantly associated with abnormal FHR (OR = 1.88(1.21–2.94)), meconium stained liquor (OR = 1.71(1.11–2.61)), LSCS (OR = 2.05(1.40–2.99)) as well as with adverse fetal outcomes such as LBW (2.28(1.47–3.55)), IUGR (14.31(9.33–21.94)) and admission to NICU (OR = 3.26(2.20–4.82)).

Conclusion

The antenatal UCI as a factor can prove as an important diagnostic tool to predict adverse perinatal and fetal outcomes. This would decrease the incidences of the perinatal morbidity and help in realizing the exceptions for the delivery of a healthy baby. However, without attaining a deeper knowledge regarding the variables affecting UCI and other confounders, it will not be appropriate to implement the same in clinical practice. Hence, further research to explore this aspect is essential with increased sample size and diverse population group to vouch for its generalizability. eP-559 Is estimated fetal weight an overestimated calculation of predicted birth weight? S. Jindal1; M. Win1 1Pilgrim Hospital, Obstetrics and Gynecology, Boston, UK

Objective

The objective of this study was to evaluate the precision of estimated fetal weight (EFW) by ultrasound (USS) in predicting birth weight (BW) when scan is performed close to the date of delivery. We aimed to establish the relationship between EFW-BW and investigate the accuracy of EFW measurements. Design: Prenatal estimation of fetal weight is a critical aspect of antenatal care, aiding in predicting fetal survival and guiding delivery decisions for babies who are at risk. Studies have shown that when scans are performed by well-trained sonographers, the mean absolute error in predicting birth weight is typically within an acceptable range of 6–11% of the actual birth weight. Our study aimed to assess the precision of EFW obtained by USS conducted antenatally, particularly within two weeks of delivery.

Method

In this retrospective study involving 98 deliveries at United Lincolnshire Hospitals NHS Trust, UK, a subset of 50 cases met inclusion criteria, which required serial scans in third trimester, with the last scan conducted within two weeks of delivery, and no significant maternal health issues which could impact the authenticity of this study.

Results

Based on the results of the study, EFW tends to be an overestimated calculation of predicted BW in most cases. Though EFW demonstrated a positive linear relationship with BW, but nearly 60% of cases showed EFW higher than BW despite the two week proximity of the scan to delivery. Notably, nearly 20% of cases had an EFW-BW difference ranging from approximately 300g to 500g within two weeks of measurements, and 14% had a nearly 10% difference between EFW and BW. The study found that maternal body mass index (BMI) did not correlate significantly with birth weight, with the highest birth weight observed in BMI of 27 (4420 g) and the highest BMI (44) corresponding to birth weight of 2710 g.

Conclusion

Our findings underscore the importance of understanding the limitations of accuracy in EFW in clinical practice and confirmed that EFW tends to overestimate actual birth weight. This overestimation contributes to challenges in accurately diagnosing small-for-gestational-age (SGA) fetuses, with reported scan accuracy being between 50%–60% only. Traditional methods of EFW estimation rely on biometric measurements which can be subject to variability and potential human error. Further research is required to overcome these barriers and artificial intelligence (AI) could hold significant promise in improving the accuracy of estimating EFW offering clinicians a powerful tool to optimise prenatal care. eP-569 AI revolutionizes women's health: A new era in obstetrics, gynecology, and fertility H. Mrabet1; S. Athar2; P. Alshibani3; S. Alrawaili3; T. Alshdafat1; L. Alansari2 1Obstetrics and Gynecology Department, Hamad Medical Corporation, Doha, Qatar, 2Obsterics and Gynecology Department, Hamad Medical Corporation, Doha, Qatar, 3Nursing and Midwifery Department, Hamad Medical Corporation, Doha, Qatar

Objective

This review aims to assess the integration and impact of Artificial Intelligence (AI) in Obstetrics, Gynecology, and Reproductive Medicine. The primary objective is to evaluate how AI technologies improve diagnostic accuracy, treatment efficacy, and patient satisfaction within these fields. A major hypothesis is that AI-driven tools significantly enhance patient outcomes compared to traditional care methods. Design: A systematic review was designed following the PROSPERO protocol, with a comprehensive search strategy to capture relevant studies from key databases, including PubMed, Embase, IEEE Xplore, and the Cochrane Library. The rationale for this approach is to synthesize current evidence on AI applications in women's health care, highlighting advances, challenges, and future directions.

Method

The review targeted studies published from January 2010 to December 2023. Inclusion criteria were set to select studies that directly involve AI in diagnosing, treating, and managing conditions relevant to the targeted medical domains. Exclusion criteria filtered out non-English studies, duplicates, and those not within the scope. A total of 66 full-text articles were assessed for eligibility after initial screening, with 30 studies meeting the inclusion criteria across Obstetrics (10), Gynecology (5), and Reproductive Medicine (15). Data extraction focused on study characteristics, AI intervention details, outcomes, and quality assessment.

Results

Preliminary analyses indicate that AI-enhanced methods demonstrate significant improvements in diagnostic accuracy (75%–85% accuracy), sensitivity (70%–80%), and specificity (80%–90%) across various applications compared to traditional methods. AI has shown notable potential in improving the success rates of IVF treatments (Amorim et al., 2019), enhancing prenatal and neonatal care (Malani et al., 2023; Kim et al., 2023), and providing comprehensive insights into AI's current and future role in Obstetrics and Gynecology (Iftikhar et al., 2020). Themes identified include the capability of AI to predict IVF success accurately, improve prenatal care through advanced diagnostic imaging, and tailor patient-specific treatment plans. Challenges noted involve data privacy, ethical considerations, and the imperative for interdisciplinary collaboration to effectively integrate AI into clinical practice.

Conclusions

The integration of AI into Obstetrics, Gynecology, and Reproductive Medicine has the potential to revolutionize patient care, offering more accurate diagnostics, personalized treatments, and enhanced patient engagement. However, to fully harness AI's potential, addressing challenges related to data security, ethical dilemmas, and ensuring rigorous validation of AI tools in clinical settings is crucial. Future research should focus on validating AI tools in clinical settings, exploring novel applications, and fostering interdisciplinary collaborations to advance women's healthcare. eP-570 Can AI-assisted models use uterine activity to predict preterm birth? J. Chopra1,2; C. Maden1,2; B. Howlett1; M. Ozbey Arabaci1; A. Kermack1,2; H. Perry2; D. Altamirano1; Y. Cheong1,2 1University of Southampton, Southampton, UK, 2Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK

Background

Preterm birth (PTB), defined as birth before 37 completed weeks of pregnancy, affects >10% of births globally and ranks as the second leading cause of death in children under five. The benefit of interventions to improve neonatal outcomes of preterm birth must be balanced with the associated foetal and maternal risks. Uterine contractility evolves in labour and may be assessed using Artificial intelligence (AI) to predict preterm birth and allow appropriate patient selection.

Objective

Assess the predictive accuracy and applicability of AI models currently using uterine contractions in preterm birth prediction. Design: A systematic review of Embase, Medline, Pubmed and Web of Science was conducted using PRISMA guidelines.

Methods

Eligible studies were related to AI (deep learning/machine learning/neural networks) and preterm birth. Data was collected relating to AI model performance measures, validity and applicability. Results are reported as a narrative review due to study heterogeneity. Bias was assessed using PROBAST framework.

Result

45 studies were included, 15 studies examined EHG features, 21 studies assessed AI classifiers and 3 studies tested both. 6 studies focused on other variables including signal pre-processing. 40% (6/15) of studies examining EHG features (including the non-linear measures of entropy, multifractal and topological features) reported excellent classification performance (AUC ≥ 0.9). 86% (18/21) of studies assessing AI classifiers reported excellent accuracy (ACC) and/or AUC values (≥0.9). Comparison of AI classifiers demonstrated that deep-learning neural networks produced higher ACC and/or AUC values. Most studies (91%, 41/45) had an unclear or high risk of bias. Key concerns include unbalanced data, small sample numbers and lack of validity outside of the sampled dataset.

Conclusion

Overall, 44% (20/45) of studies show ACC and/or AUC values of ≥0.95 and non-linear features for classification of preterm birth offered more accurate outcomes than linear features. However, we did not find any evidence of external validation in these studies; thus the applicability of the models in uterine contraction assessment remains limited. Future research requires emphasis on study quality with clinical data integration. eP-571 Increasing engagement in multi-professional obstetric emergency training through podcast production: Lessons learnt K. Lattey1,2; S. Harrington2; C. Winter2; S. Athwal2,3; N. Muchatuta4,2; M. James2,3; T. Draycott2,1; C. de Souza2 1North Bristol Trust, Bristol, UK, 2PROMPT Maternity Foundation, Bristol, UK, 3Gloucester Royal Hospital, Gloucester, UK, 4University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK

Objective

The objective of this project was to increase awareness and engagement in multi-professional obstetric emergencies training, and wider issues within maternity safety, through a podcast entitled the PROMPTCast. We have documented the process, challenges and lessons learnt during this project. Design: When developing the PROMPTCast we liaised with multi-professional maternity teams and podcast producers. As PROMPT produces a variety of packages, such as the Annual Update, Pre-hospital, Community, Undergraduate and Global training resources, we wanted to broach a number of topics. Our design for each episode was based on common formats for other popular, non-medical podcasts, with four individual six-minute interviews making up one episode, and a maximum running time of 30 min to encourage engagement.

Method

We aimed to release regular PROMPTCast episodes featuring interviewees covering a variety of topics, and focussing on new training resources, as well as important maternity topics such as equity, civility and human factors. We gained information from podcast producers about technical skills, equipment and facilities required. To monitor reach and engagement, we investigated different podcast platforms to retrieve listener data, and reviewed social media feedback. - Process: At the time of submission, we continue to release episodes for the PROMPTCast. Technical skills have improved with each episode due to increasing experience and expert support. - Reach: We have used social media to reach and encourage listeners. - Monitoring engagement: We have received positive feedback on episode content via podcast platforms and social media. We will publish the number of listeners at the time of the Congress. - Challenges: Producing each episode has required extensive planning including: liaising with interviewees, topic research, generating questions, recording interviews (both face-to-face and online), editing for final production and publishing episodes on podcast platforms. These processes are currently not widely documented for medical podcasts. - Lessons learnt: These include optimising recording set up, briefing interviewees appropriately and honing recording skills to ease the editing process. In addition, gaining experience with interviewer skills to promote succinct answers and a more natural conversational tone, can facilitate the listeners' experience.

Conclusion

In conclusion, a podcast appears to be a dynamic and versatile way of reaching out to multi-professional maternity teams on a number of topics, and provides another medium for wider engagement. We have encountered challenges, but have also learnt valuable lessons which would benefit other teams aiming to produce similar podcasts. We aim to do further research to assess listener reach and feedback. eP-572 Improving patient understanding of IVF treatment through a 2D animated video S. Aggarwal Homerton University Hospital, Fertility, London, UK

Objective

1) To improve patient care and reduce stress and anxiety by providing visual and auditory aids to enhance understanding of IVF procedures. 2) To increase healthcare efficiency through streamlined information delivery. 3) Zero carbon emission by going paperless, thus promoting environmental sustainability. 4) Zero use of NHS resources. 5) Optimizing resource utilization, and leveraging technological advancements to enhance patient engagement and information retention. Design: The project utilizes a comparative design, contrasting the effectiveness of a 2D animated video with traditional Patient Information Leaflets (PILs) in conveying information about IVF treatment to patients. The design incorporates elements of patient-centered care and quality improvement methodologies to assess the impact of the intervention on patient understanding, satisfaction, and anxiety levels.

Method

As the lead in the project, I initiated the development process by creating a rough storyboard, designing the video, scripting the content, mapping out visuals and narrative elements, and Incorporating AI-generated voice and animation. Feedback from patients and stakeholders was solicited and integrated into the refinement process, which involved three rounds of the Plan-Do-Study-Act (PDSA) cycle. Patient satisfaction, anxiety levels, and understanding of IVF procedures were assessed through surveys and feedback forms.

Results

The project resulted in a 97% improvement in patient satisfaction rates compared to traditional PILs. Patients expressed appreciation for the simplified explanation of complex ideas and reported reduced anxiety levels and enhanced understanding of the IVF procedure. The project received high ratings on feedback scales, indicating its effectiveness in meeting patient needs and expectations.

Conclusion

By integrating the completed video onto the hospital's website, patients seeking information on IVF treatment can easily access it. The video's total views and live patient comments are visible, enhancing engagement. This dissemination strategy, including the generation of QR codes in clinical areas, promotes widespread access to the project's benefits, thereby contributing to improved patient care and satisfaction. The success of this innovative Quality Improvement (QI) initiative highlights the substantial impact of utilizing technology to augment healthcare delivery and patient outcomes. Additionally, Generative AI and technological advancements can be employed to develop exceptionally interactive medical teaching sessions. Upcoming future project: To make a series of multilinguistic animated videos on various obstetrics and Gynaecology topics to meet the needs of the diverse population. eP-573 Feasibility, and acceptability of S-Condom-Uterine Balloon Tamponade in managing atraumatic postpartum hemorrhage T. Karim1; S. Akhter2; S. Tasnim3; S. Akter4; S. Chowdhury4; Z.I. Noman5; Q. Nahar6 1Department of Obstetrics and Gynaecology, Chittagong Medical College Hospital, Chattogram, Bangladesh, 2MAMM'S Institute of Fistula and Women's Health (MIFWOH), Dhaka, Bangladesh, 3Department of Obstetrics and Gynaecology, Dhaka Community Medical College, Dhaka, Bangladesh, 4Department of Obstetrics and Gynaecology, Chittagong Medical College, Chattogram, Bangladesh, 5icddr,b, Programme for Emerging Infections, Infectious Diseases Division, Dhaka, Bangladesh, 6icddr,b, Maternal and Child Health Division, Dhaka, Bangladesh

Objective

Post-partum hemorrhage (PPH) is one of the major causes of maternal death in Bangladesh. The aim of this study was to assess the feasibility, acceptability and experience of using S-Condom-Uterine Balloon Tamponade (S-Condom-UBT) in controlling atraumatic PPH by providers and patients satisfaction regarding the management protocol and their tolerance to the device. Design: A cross-sectional observational study using a mixed method design.

Method

This study was carried out in the Obstetrics and Gynaecology department of Chittagong Medical College Hospital from January 2023 to March 2024. The study enrolled 70 patients with atraumatic PPH refractory to first-line treatment, who underwent treatment with S-Condom-UBT. S-Condom-UBT is a standard prepackaged, preassembled, sterilized low cost UBT which was prepared by a local supplier. These patients were followed up, and a service record form was completed, along with structured interviews using a questionnaire. Critically ill patients were excluded from the study. Twelve in-depth interviews were conducted with healthcare providers who participated in the training on using S-Condom-UBT devices. Quantitative data was analyzed using STATA-version15 (univariate and bi-variate), while qualitative data was analyzed through thematic analysis.

Result

The application of S-Condom-UBT demonstrated a 100% success rate in managing atraumatic PPH of all participants. On average, bleeding control required 3.32 min (SD 2.68), while balloon inflation required 240.4 mL of fluid (SD 76.13) and took 2.17 min (SD 0.88). The mean duration of hospital stay was 6 days (SD 2.71) and only 4% patients required ICU support. The mean duration of catheter in situ was 24.78 h (SD 7.04). Parity and occupation were found significantly associated to bleeding control time, while women's monthly family income and mode of delivery were significantly associated with duration of catheter in situ. No patients experienced any notable adverse effect. There were no complaints during follow-up evaluations at 2 weeks and 6 weeks. About 87% patients were satisfied with the use of S-Condom-UBT. As the S-condom-UBT was preassembled, health providers found easy and convenient to use as the device was ready to use and sterile. They also did not need any other person to assist them during administering it. They opined that this device is more useful during emergency.

Conclusion

The use of S-Condom-UBT is found feasible in low-resource setting and the healthcare providers perceive it as a pragmatic solution for addressing uncontrolled PPH. eP-574 Vaginal morcellation versus power morcellation in specimen retrieval during laparoscopic myomectomy M. Nambiar1; A. Sreenivas2; A. Suresh3; J. Surendran4 1Obstetrics and Gynaecology, Meenakshiamma Memorial Hospital, Kannur District, India, 2Head and Neck Surgery, Meenakshiamma Memorial Hospital, Kannur district, India, 3Obstetrics and Gynaecology, Kasturba Medical College, Mangalore, India, 4Community Medicine, Kasturba Medical College, Mangalore, India

Objective

To Compare manual vagianal morcellation technique of specimen retrieval with laparoscopic power morcellation technique to retrieve specimen during laparoscopic myomectomy. Design: This was a retrospective study from October 2018 – Sep 2022.

Method

After ethical committe clearance, data of various patients undergoing laparoscopic myomectomy was collected from hospital records. All women with single fibroid with size between 5 cm and 7 cm were included in this study. Unmarried women who were sexually inactive, women with multiple fibroids and those with co-existing endometriosis were excluded from this study. Various study parameters were Specimen extraction time, Cost of surgery, additional analgesia requirement post operatively, discharge readiness and wound related adverse effects.

Results

A total of 150 patients underwent laparoscopic myomectomy. Specimen extraction time was about 9.744 ±1.076 min in the vaginal morcellation group and 77.366 ±324.067 min in power morcellation group (p value 0.062). Cost of surgery in US dollars was 954.550 ± 2.272 USD in vaginal morcellation group and 1266.329 ± 215.246 USD in power morcellation group (p value < 0.001). About 0.013 ± 0.112 patients in vaginal morcellation group required of additional analgesia post operatively. This was required in about 0.171 ± 0.379 patients in power morcellation group (p value < 0.001). Patients who had vaginal morcellation were discharge ready at 128.625 ± 13.664 min. Where as this was 182.561 ± 30.381 min in power morcellation group (p value of < 0.001). About 0.013 ± 0.112 patients in the vaginal morcelaltion group had wound related adverse effects. About 0.171 ± 0.379 patients had such adverse effects in the power morcellation group (p value < 0.001). From our findings we conclude that Manual vaginal morcellartion is a much quicker, inexpensive and less painful alternative to power moecellation to extract specimens after laparoscoic myometomy. Manual vaginal morcellation also has less wound related complications with quicker post operative discharge readiness.

Conclusions

Manual vaginal morcellartion is a much quicker, inexpensive and less painful alternative to power moecellation to extract specimens after laparoscoic myometomy. Manual vaginal morcellation also has less wound related complications with quicker post operative discharge readiness. eP-575 Diathermy versus scalpel in women with previous one caesarean H. Ramzan; F. Bashir; H. Sharaf; S. Chaudhary; S. Sohail; R. Hussain Obstetrics and Gynaecology, Dr Ziauddin Hospital, Karachi, Pakistan

Background

The use of scalpel has been the traditional choice, but cautery's invention has gained interest for dissecting tissues and securing blood supply. It is widely used for dissecting and hemostasis, but fear of inadequate wound healing and improper scarring limits its usage in skin incisions.

Objectives

To compare surgical outcomes of diathermy vs scalpel in patients with previous one cesarean section in term of blood loss and incision time. Design: A comparative interventional study was conducted on 60 women undergoing caesarean due to previous one caesarean section using consecutive sampling to assess difference between incision time and blood loss in diathermy versus scalpel group to find a method that is safe, quick, effective and satisfactory for mother.

Material and methods

Data was collected from pregnant mothers with one previous cesarean section, who were willing to participate and were undergoing elective sections at term while those with health conditions or undergoing emergency operation were excluded. Participants were divided into two groups after informed and written consent, group I who received abdominal incision from skin to peritoneum with diathermy and group II which received skin to peritoneum incision with scalpel. The data was analyzed by using SPSS version 20. Chi Square test and independent sample t test were used for comparison of qualitative and quantitative variables between diathermy and scalpel groups. p-value ≤0.05 will be considered as significant.

Results

When comparing the parameters, blood loss was higher in scalpel group as depicted by the greater number of blood-soaked gauze pieces. The diathermy group had mean blood loss of 47.8 ± 42.1 mL, while in scalpel group mean blood loss was 149 ± 97.6 mL. The diathermy group had a shorter incision time duration as compared to the scalpel group; 104.3 ± 63.7 s in the former and 195.3 ± 78 s in the latter.

Conclusions

The study supports the shifting trend regarding the use of electrocautery, which gives quicker incisions and associated with reduced blood loss as compared to scalpel. It contributes to the existing pool of literature that diathermy is completely safe and advance method. We may conclude that the correct use of diathermy for skin incision during caesarean section produced superior outcomes than scalpel incision. For future research, we should conduct multicenter studies with bigger sample size and include all elective caesareans like primiparous and patients with previous 2 or more caesarean. eP-576 Prediction models of gestational diabetes short- and longer-term outcomes: A systematic review Y. Al Ghadban1; N. Astbury2; A. Kurdi3; A. Sharma1; B. Ope4; T.Y. Liu5; L. MacKillop1; H. Lu6; J. Hirst1 1Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK, 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, 3American University of Beirut, Beirut, Lebanon, 4Faculty of Medicine, School of Public Health, Imperial College London, London, UK, 5Department of Population Health, University of Oxford, Oxford, UK, 6Department of Engineering Science, University of Oxford, Oxford, UK

Objective

Gestational diabetes mellitus (GDM), affecting 1 in 7 pregnant women worldwide, can have short and long-term adverse outcomes for both the mother and her baby. Identifying which women and babies are at highest risk of developing these adverse outcomes could help target therapeutic and preventative strategies. However, despite numerous prognostic models aiming to predict these outcomes, their clinical impact remains limited. This systematic review evaluates existing prognostic models for adverse maternal and child GDM outcomes. Design: This paper describes a systematic review of prediction models for short- and longer-term outcomes in pregnant women affected by gestational diabetes.

Methods

We searched EMBASE, MEDLINE, Web of Science, CINAHL, CENTRAL for studies published in any language up to September 8th, 2023, that reported the development of predictive models for adverse outcomes following GDM in mother or offspring with or without internal or external validation of the model. Data were extracted using the CHARMS and model quality was assessed using PROBAST.

Results

The search returned 5964 unique publications, with 137 full texts screened. Our review included 64 articles detailing the development of 103 models and validation of 12 models. Most studies (45%) predicted long-term outcomes, while 31% focused on birth outcomes and 23% on pregnancy outcomes. However, 87% of these models had a high risk of bias due to small sample size, failure to evaluate calibration, and lack of internal or external validation. Only 8 unique models were found to have low risk of bias.

Conclusion

Our findings highlight a gap in rigorously developed prediction models for adverse GDM, outcomes especially related to neonatal outcomes and no models currently implemented in clinical practice. Before developing additional models, there is a need to further validate existing models and evaluate their clinical utility, as well as improve the methodological rigor of model development to generate risk prediction tools capable of improving clinical decision-making in the care of women with GDM and their children. eP-577 Virtual reality in obstetrics – Usability study of a manual rotation simulator D. Parris1; D. Siassakos1; P. Snow2; H.H. Le2; E. Magee2; Y. Xue2; A. Kalkal2; R. Loureiro2; M. Tiwari2 1Institute for Women's Health, University College London, London, UK, 2University College London, London, UK

Background

Skills and confidence in rotational vaginal birth are waning worldwide. This is partially responsible for the current rising rates of fully dilated caesarean births globally, carrying additional maternal and fetal risks compared with a caesarean prior to or during an earlier stage of labour. Manual rotation is the most common rotational method used to manage fetal malposition at full cervical dilatation in the UK. Simulation training is commonplace in the teaching and refining of practical skills, including rotational vaginal birth. However, the models used for the simulation of manual rotation have limitations: the resistive force applied to the fetal model required for manual rotation is subjective, as is the location and amount of force applied to the fetal head. We developed virtual reality (VR) and robotic systems to replicate manual rotation. A glove with force sensors has been devised alongside.

Objective

1) To examine if a robotic and VR system can be used as a training tool for manual rotation; and examine desirable improvements. 2) To assess the location and amount of force applied to a fetal head during manual rotation. Design: A usability study of a VR and robotic simulator of manual rotation.

Method

Between November 2023 and February 2024, 57 participants ranging from novice to consultant obstetrician trialled the VR and robotic simulator of manual rotation with the force sensor glove. Data on location and amount of force were captured. Participants were able to provide feedback and suggestions for improvement through questionnaires.

Results

Participants mostly used their fingertips to perform manual rotation with the simulator, despite many attempting to use a technique where rotational force is applied through the palm. This may be due to the small size of the fetal skull model, as reflected in feedback from multiple consultant users. There was no consistent trend in performance and accuracy of manual rotation between the ranging experience levels from novice to consultant. However, data collected from the gold standard participant showed the best performance and accuracy. If a participant is familiar with the system and knows how to perform manual rotation, the system can be used with success.

Conclusion

A VR and robotic simulator of manual rotation has been successfully created. The system demonstrates the potential to be used to simulate other obstetric skills. eP-578 Competency level in Atencio technique for delivering impacted fetal head during C-section K.S. Gabasa; H. Maglaya-Ang Obstetrics and Gynecology, East Avenue Medical Center, Quezon City, Philippines

Objective

To determine the surgical competency level of the 3rd year and 4th year OBGYN residents in performing the Atencio technique to deliver an impacted fetal head at C-section using the modified Objective Structures Assessment of Technical Skills (OSATS) scoring system in a tertiary government hospital. Study design and method: Monocentric descriptive cross-sectional study among nineteen (19) residents who were anonymously video recorded while doing the Atencio technique for three trials. Training consultants graded each resident using the modified OSATS Scoring system, which included the mean delivery time and maternal blood loss.

Results

17 out of 19 (89%) residents passed the OSATS scoring sheet for the Atencio technique in the third trial. The mean delivery time was 2:52 mins, 2:02 mins, and 1:36 mins in the first, second, and third trials, respectively. The mean maternal blood loss was 545.78 ± 245.63 mL, 463.15 ± 185.839 mL, and 458.94 ± 147.268 mL in the first, second, and third trials respectively.

Conclusion

The Atencio technique is almost similar to Modified Patwardhan III but provides a detailed and technical step-by-step approach to disengaging a deeply impacted fetal head in reverse breech extractions. Despite being a novel technique, the Atencio technique can successfully be taught to residents-in-training. The majority of the residents succeeded in correctly performing the technique, with improvement in delivery time and no excessive blood loss in all trials. eP-580 iCount – A novel swab-monitoring device offering safety and efficiency, tested in simulation A. Elgharably1,2; K. Desai2; A. Omilakin1; M. Elmezaien1; C. Obianeli1; M. Kulakarni1; A. Desai1,2 1Obstetrics & Gynaecology, Royal Wolverhampton NHS Trust, Wolverhampton, UK, 2Eureka Inventions, Wolverhampton, UK

Objective

Vaginal swab retention continues to be a persistent, unacceptable ‘never event’ with 30–40 incidents per year in England [1] and known underreporting. This comes with significant health, financial and reputational penalties. Despite successive interventions including checklists, two-person counts and technical innovations, there lacks a globally applicable, cost-efficient solution. iCount is a human-factors-engineered swab monitoring device that aims to eliminate retention. It comes in sterile packaging with five swabs, or 4 swabs and a tampon that are docked into a base. Visual-haptic feedback ensures that swabs are monitored and returned. This study compares iCount with gold-standard two-person counting to evaluate the speed of swab counting and calculation of blood loss – two essential safety procedures. The study explores quantitively whether iCount offers more efficient swab monitoring and explores professionals' perception of safety when using iCount. Design/methods: 40 participants- clinicians, midwives and maternity support workers voluntarily enrolled. Participants were randomly paired and timed as they simulated swab ‘count-in’, ‘count-out’, ‘weigh-in’ and ‘weigh-out’. The participants then used the pre and post-procedure swab weights to calculate blood loss. Having completed the simulation with one method, the participants swapped to the alternative method and repeated the stations. The starting device was equitably, randomly allocated to mitigate for training effect. Following the simulation, participants completed a short questionnaire considering their perspectives on the safety and usability of iCount. Simulation with models replicated the use of swabs within maternity whilst avoiding exposure of patients to potential harm. As the study was conducted in simulation ethics approval was not required. All participants gave written consent before involvement.

Results

iCount demonstrated a statistically significant reduction (single-tailed, paired T-test) in the time taken to conduct a swab count of 36.8% (p = 3.91E-5). iCount similarly demonstrated a statistically significant reduction in weighing time (p = 0.03) with a mean reduction of 14.85%. In addition, 100% of participants believed that iCount increased their confidence in swab counts and simplified the identification of missing swabs. 100% of participants also agreed that the device could be integrated as part of a systems-based solution to improve safety in maternity.

Conclusions

This study demonstrates iCount's potential to enhance vaginal swab monitoring by offering quicker and safer swab accounting. These benefits could translate to enhanced patient safety outcomes, increased clinician confidence and cost-saving for trusts – however, these initial findings must be further qualified in the clinical setting. Sources: 1.NHS (2023) NHS Never Events data. Available at: https://www.england.nhs.uk/patient-safety/never-events-data/ eP-593 In-depth investigation of cesarean section rates: scientific analysis using modified robson criteria H. Shaikh; Z. Khuwaja; Z. Kamal; S. Masheer Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, Pakistan

Objective

The rate of cesarean sections is steadily rising in both developed and developing nations. While cesarean sections are often perceived as life-saving interventions, they come with associated dangers for both current and future pregnancies. The Modified Robson criteria classifies all caesarean sections into ten groups with further sub-divisions based on the gestational age, various pregnancy categories, prior obstetrical records, and the progress of labor and delivery. It will help us in categorization of caesarean section, by taking into consideration which group has the highest rate and what actions and training skills can be incorporated in the future trainings of clinicians, so this rate can be lowered in future. Design: A retrospective cross-sectional study was carried out at the Aga Khan Hospital, Karachi, Pakistan.

Method

All patient undergoing cesarean section in the last 6 months, from approval of ERC exemption were included in the study. Sampling technique was consecutive probability sampling. Inclusion criteria: All pregnant patients undergoing cesarean section in our hospital in the 6 months' time period. Exclusion criteria: Patient undergoing cesarean section before 26 weeks' gestation.

Results

At the Department of Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, a total of 2616 deliveries were conducted from 1st July to 31st December 2022, among these, 1198 (45%) were delivered by cesarean section. Group 5 (Previous scar, singleton, cephalic, 37 weeks) and Group 10 (all singleton, cephalic < 36 weeks) emerged as the most prevalent categories, constituting 34.3% (30.9% in subgroup C {C-section before labor }) and 28.5% (18.5% in subgroup C {C-section before labor }) of the cases, respectively. Meanwhile, Group 2 (Nulliparous, singleton, cephalic > 37 weeks) accounted for 16.4% of cases, with 12% in subgroup A {induced}.

Conclusion

The modified Robson's classification can be used to analyze laboring women and provides clearer, more important information about the characteristics of labor and delivery, with a focus on independently examining primary and repeat CS. Because it is simple and easy to comprehend, it aids in keeping an eye on the indications of CS and helps in devising targeted strategies to reduce the CS rate. Repeat CS rate in our center can be reduced by targeting VBAC trial in carefully selected population. Hopefully there will be a reduction of cesarean section rate after introduction of yearly training of entire staff in CTG interpretation and introduction of ECV for breech presentation. eP-594 Labor induction in twin pregnancies: A prospective cohort study E. Andreasen1; E. Graae1; S. Möller2; N. Uldbjerg1; M. Khalil1 1Gynaecology and Obstetrics, University of Southern Denmark, Kolding, Denmark, 2Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark

Introduction

In dichorionic twin pregnancies, the Danish national guidelines advocate for labor induction at 38 weeks gestation. This recommendation stems from heightened risks of cesarean section and perinatal death associated with later gestational ages. Additionally, this procedure demonstrates a success rate of successful vaginal delivery well above 60%. However, there remains inadequate documentation regarding potential variances in outcomes between induction methods such as amniotomy, prostaglandins, and balloon catheter. Therefore, our aim was to address this knowledge gap.

Methods

The study comprises a single-center cohort study encompassing 921 twin pregnancies between 2007 and 2019 at Lillebaelt University Hospital, Kolding, Denmark. The research database was updated in a prospective manner.

Results

Maternal mortality was zero. Perinatal mortality was 100% between weeks 22 and 24, gradually declining to 0% beyond 34 weeks. Among those who underwent labor induction, the rates of emergency cesarean section were 22% (30/138) for amniotomy, 45% (46/102) for prostaglandin, and 53% (8/15) for ballon methods.

Conclusion

The notably high rates of cesarean section associated with labor induction by prostaglandin or balloon catheter in twin pregnancies warrant consideration when contemplating labor induction. eP-595 Pregnancies complicated with meconium-stained liquor at teaching hospital peradeniya – Cross-sectional study M. M. H. Dissanayake1, I. C. Kandauda1, S. S. N. Chandrasiri1, W. M. R. D. Weerakoon1, S. Gnanarathne2 1Teaching Hospital Peradeniya, Professorial Unit of Obstetrics & Gynaecology, Kandy, Sri Lanka, 2Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka

Introduction

Meconium is a dark green substance passed by foetus which contains mucus, bile and epithelial cells. Passage of meconium occurs due to foetal distress and post maturity. It can lead to increased perinatal morbidity and mortality due to meconium aspiration syndrome. Though this is a very common complication in pregnancy, very few number of studies have been conducted in worldwide, to assess the causative factors and epidemiological variations.

Objectives

Aim of this study is to assess the prevalence of pregnancies complicated with the passage of meconium and to analyse it according to parity, age, period of gestation, mode of delivery, duration of abdominal pain prior to the induction of labour or caesarean section, consistency of meconium, maternal comorbidities, pregnancy complications and previous history of meconium complicating pregnancies among mothers delivered at Professorial Unit of Obstetrics and Gynaecology, Teaching Hospital Peradeniya.

Method

This is a descriptive cross-sectional study conducted at Professorial Unit of Obstetrics and Gynaecology, Teaching Hospital Peradeniya from 1st of May to 31st of August in 2019 over 4 months duration. All mothers complicated with passage of meconium during intrapartum period were included. Data collection was done using study proforma and analysed using SPSS statistical software.

Results

During this 4-months period, 1479 mothers were delivered and 163 (11.02%) pregnancies were complicated with meconium, out of which 19 (10.4%), 93 (9.6%) and 51 (15.4%) were delivered by mothers less than 20 years, between 20 and 35 years and more than 35 years of age respectively. 71 (14.7%) were delivered by primi mothers. 120 (73.6%) pregnancies were complicated with thin meconium and 43 (26.4%) were complicated with moderate, thick & old meconium. 83 (24.2%) were emergency caesarean sections, 16 (3.3%) were elective caesarean sections, 53 (8.4%) were vaginal deliveries and 11 (30.5%) were instrumental deliveries. 77 (17.4%) delivered at 40–42 weeks, 69 (7.8%) delivered at 37–40 weeks, 14 (11.2%) delivered at 34–37 weeks and 3 (8.1%) delivered at less than 34 weeks of gestation. 71 (43.5%), 35 (21.4%) and 21 (12.8%) mothers had abdominal pain more than 48 hours, 24–48 hours and less than 24 hours prior to delivery respectively. 36 (22.0%) mothers had no pain prior to delivery. 134 (82.2%) mothers had medical comorbidities and pregnancy complications. 25 (27.1%) out of 92 multipara mothers had previous pregnancies complicated with the passage of meconium.

Conclusion

Risk of passage of meconium during intrapartum period is increased with advanced maternal age, primi and grand multiparity, continuation beyond 40 weeks of gestation, increased duration of pain prior to delivery, previous pregnancies complicated with meconium, maternal comorbidities and pregnancy complications. eP-596 Elective Repeat Caesarean or induction of labour (ERCOLI TRIAL) at term gestation D. Gowri1; B. Manoj1; B. Adhisivam2 1Obstetrics and Gynaecology, JIPMER, Puducherry, India, 2Neonatology, JIPMER, Puducherry, India

Background

induction of labor and planned repeat caesarean section are the two alternatives for women with previous one cesarean section eligible for trial of labour at term, requiring termination of pregnancy. There is lack of evidence as to which of the two alternatives is better for maternal and perinatal outcome due to lack of randomised trials on this subject1. Therefore, this randomised control trial was undertaken.

Methods

This trial was undertaken in a tertiary care teaching hospital in Pondicherry after the institute ethics committee approval and clinical trial registry of India registration (CTRI/2020/06/026114). Women above 18 years with previous one caesarean section with a term singleton foetus in vertex presentation, eligible and willing for trial of labour, requiring termination of pregnancy were randomized using computer generated blocks of varying numbers, (allocation concealment using sealed envelope) to either induction of labour (IOL) or planned repeat caesarean section (ERCS). If the Bishop score was favourable (>6), induction was done using low dose oxytocin and artificial membrane rupture, and when unfavourable (<6), pre induction ripening of cervix was done with Foley's balloon catheter. The composite perinatal and maternal outcome were compared in the two groups by Chi-square test.

Results

153 women were randomized, 77 to IOL and 76 to ERCS group. Intention to treat analysis was done. The demographic variables were comparable in the two groups. The vaginal birth rate in induction group was 50.65%. Scar dehiscence was noted in seven in IOL and four (silent dehiscence) in ERCS group respectively (X2 = 0.84, p = 0.36). At least one adverse maternal morbidity was observed among 16 in IOL and nine in ERCS group. This appears clinically though not statistically significant. (X2 = 2.234 p = 0.135). Total new-borns with at least one adverse event were 3 in each group. None of the women required peri-partum hysterectomy. There were no maternal deaths, still births or perinatal mortality.

Conclusion

We found no difference in perinatal outcome and a clinically (1.7times higher) though not statistically significant higher maternal morbidity in the IOL compared to the ERCS group. A randomized controlled trial on this subject is feasible. A study with larger sample size and multicentre trial is recommended powered to study the effect on maternal outcome.

Reference

1. Dodd JM, Crowther CA, Grivell RM, Deussen AR. Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth. Cochrane Database Syst Rev. 2017;7:CD004906. eP-597 Clinical evaluation of a new cut-off in foetal blood sampling measuring lactate S. Norrestam1; Y. Carlsson2,3; L. Iorizzo4,5 1Department of Obstetrics and Gynaecology, Helsingborg Hospital, Helsingborg, Sweden, 2Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden, 3Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Gothenburg, Sweden, 4Department of Obstetrics and Gynaecology, Skane University Hospital Lund, Lund, Sweden, 5Department of Clinical Sciences Lund, Lund University, Lund, Sweden

Objective

The use of Foetal blood sampling (FBS) during labour as adjunctive tool to cardiotocography (CTG) to intervene appropriately is debated. Simultaneously, there is a concerning global increase in the rate of caesarean sections. FBS lactate is an attractive alternative to FBS pH since it can differentiate between metabolic and respiratory acidosis and has a much higher sampling success rate of approximately 99%. Recently, a new cut-off for FBS lactate for intervention was proposed based on a large cohort study. The new cut-off of 5.2 mmol/L was for the first time based on neonatal outcomes and showed a high predictive value (AUC 0.87) for metabolic acidosis in umbilical cord blood at birth. The objective of this study was to assess the practical application of this new cut-off in a large delivery unit. Design: Prospective observational study.

Method

February 2022 to January 2023, in Helsingborg delivery unit, Sweden, all labouring women with an indication for FBS were included. Inclusion criteria: singleton pregnancy, vertex presentation, ≥35+0 weeks of gestation. FBS was measured bedside with Statstrip® Lactate meter requires only 0.6 microliters of capillary blood and provides the result within 13 s. Data was collected from the lactate meter, electronic files, and analyses of umbilical cord blood from the stationary blood gas machine ABL 800 were reviewed. Main outcome measures were pH < 7.0 and metabolic acidosis in umbilical cord blood, the latter defined as pH 10 mmol/L or lactate >10 mmol/L. Obstetrical and neonatal outcomes were reviewed.

Results

Out of 3070 planned vaginal labours, FBS was utilized in 17.2% (529) of the labours. In the initial FBS lactate measurement 90.4% showed normal values. When FBS lactate value during labour was <5.2 mmol/L, there were no cases with pH < 7.0 or pH < 7.05+BDecf ≥12 mmol/L at birth, thus negative predictive value was 100%. However, for FBS lactate samples analysed within 25 min before birth, there was one case of metabolic acidosis with FBS lactate below the cut-off of 4.1mmol/L. For metabolic acidosis and FBS within 25 min from birth the sensitivity, specificity, and negative predictive value were 80%, 71.1% and 99.3% respectively. Emergency caesarean section was performed in 9.6% (294) and vacuum extraction 6.2% (191) in the entire cohort.

Conclusions

In cases of non-reassuring intrapartal CTG, FBS lactate values <5.2 mmol/L, measured with StatstripConnectivity, can effectively rule out a pH < 7.0 in umbilical cord blood at birth. This allows labour to safely progress with continuous CTG monitoring, along with repeated lactate measurement if necessary. eP-598 Vaginal misoprostol for labor induction in obese and non-obese women: A meta-analysis J. Almeida Oliveira1; C.E. Philip2; A. Godoi3; M.E. Silveira Buhrnheim4; L.L. de Oliveira do Nascimento5 1Federal University of Minas Gerais, Belo Horizonte, Brazil, 2Beaumont Hospital, Dublin, Ireland, 3Cardiff University School of Medicine, Wales, United Kingdom, 4Univerisdade do Estado do Pará, Belém, Brazil, 5Odete Valadares Maternity, Belo Horizonte, Brazil

Objective

To investigate the impact of obesity on the effectiveness of labor induction with misoprostol in both obese and non-obese pregnant women. Obesity is increasingly more prevalent among women of reproductive age and obesity influence in labor induction with misoprostol in pregnant women is still unknown. High volume distribution of lipophilic drugs, such as misoprostol, might decrease the efficacy of certain drugs in women who are obese. Design: Pubmed, Embase and Cochrane Central were systematically searched, yielding 105 results, of which 6 were selected, including 7178 women, 3659 (50.9%) of whom were obese (50.97%). We included pregnant women carrying a single fetus, without restrictions on time frame or language of publication. Data was collected and analyzed by two authors and RStudio (PBC, Boston, MA) and was used for statistical analysis.

Results

Obese women experienced higher rates of cesarean delivery (OR 1.79; 95% CI 1.57–2.04; p < 0.001) and labor induction failure (OR 1.79; 95% CI 1.21–2.64; p = 0.003). Postdates occurence was not significantly different between groups. There was a lower incidence of oligohydramnios in women who were obese but this finding emerged fortuitously.

Conclusions

Induction failure with misoprostol had a 1.8-fold higher rate of induction failure and cesarean delivery, as compared with non-obese women. So far, there are no consensus of oligohydramnios association with obesity nor birth induction. These findings highlight the need for further investigations to determine the ideal labor induction strategies for this patient population. eP-599 Does implementation of the OASI care bundle reduce rates of OASI? A. Nolan; R. Ganapathy Epsom and St Helier University Hospitals NHS Trust, London, UK

Objective

1) To determine if the risk of a woman obtaining an obstetric anal sphincter injury (OASI) is lower when the OASI Care Bundle is utilised. 2) To analyse risk factors for OASI to consider and reduce an individual woman's risk. Design: Retrospective cohort study.

Method

Data was collected from the electronic maternity records on all deliveries greater than 24 weeks gestation from 1st November 2018 to 31st July 2023 at our hospital trust. The hospital trust employed the OASI Care Bundle as standard practice during the study period. The rate of OASI was compared to national rates in the UK. Risk factors for OASI were also analysed; these included ethnicity, parity, birthweight, instrumental delivery, waterbirth and induction of labour.

Results

There was a total of 319 OASI in 18 667 deliveries over this period. The overall incidence of OASI at the hospital trust (1.71%) was lower than the reported national incidence (2.9%). South Asian women were at greater risk of OASI than women of other ethnicities, with an incidence of 3.15% amongst this patient group. The risk of a patient acquiring an OASI decreased with increasing parity. The incidence in nulliparous women was 2.98%, whilst no women who had at least two previous deliveries had an OASI. Women who had an infant with birthweight 4kg or greater were more likely to sustain an OASI (1.98%) than those whose infant's birthweight was less than 4kg (1.66%). An instrumental delivery increased a woman's risk of OASI, with a forceps birth associated with an OASI rate of 7.54% and a ventouse birth with an OASI rate of 2.25%. Those patients who opted for a waterbirth were more likely to sustain an OASI: 2.32%. Finally, the risk of OASI was increased following induction of labour (1.74%) compared to spontaneous labour (1.69%).

Conclusions

Since the introduction of the OASI Care Bundle as standard practice in 2018, rates of OASI have been notably lower in our experience when compared to nationally reported rates. Whilst we have lower numbers of OASI, recognising potentially modifiable risk factors in individual patient cases and ensuring women are informed of the risk with different birth choices (e.g. vaginal birth in macrosomia, waterbirth) will contribute towards reducing the rate further. eP-600 Contribution of ultrasound in the delivery room: Diagnosis of fetal head engagement H. Sebri; T. Ben Necib; S. Bayar; I. Hamra; A. Triki; A. Halouani; A. Ben Amor Department of Gynecology and Obstetrics, University Hospital Mongi Slim La Marsa, La Marsa, Tunisia

Introduction

Fetal head engagement is a critical milestone in labor progression and is crucial for determining the mode of delivery. Ultrasound has become a valuable tool in assessing fetal head engagement, but its role in routine practice is not well-defined. This study aims to evaluate the contribution of ultrasound in diagnosing fetal head engagement in the ultrasound room. Design: We conducted a prospective study of 168 pregnant women presenting for routine antenatal care.

Methods

Fetal head engagement was assessed clinically by midwives and obstetricians and confirmed using ultrasound. The ultrasound assessment of the fetal head engagement was performed by measuring the perineum-fetal presentation distance using transperineal ultrasound. The degree of engagement was classified as high, low, or floating. The agreement between clinical assessment and ultrasound findings was analyzed using kappa statistics.

Results

A total of 168 pregnant women were included in the study. Clinical assessment identified 88.69% of fetuses as engaged, while ultrasound in the ultrasound room confirmed engagement in 83.33% of cases. The agreement between clinical assessment and ultrasound findings was substantial (κ = 0.71). Ultrasound identified 28.57% of cases with high engagement, 50% with low engagement, and 21.42% with floating head.

Conclusion

Ultrasound in the ultrasound room is a valuable tool for diagnosing fetal head engagement and provides additional information beyond clinical assessment alone. Its use can improve the accuracy of diagnosis and help guide clinical management, particularly in cases where clinical assessment is uncertain. Incorporating ultrasound into routine antenatal care may lead to better outcomes for both mother and baby. eP-601 Second stage caessarean births: A comparison of maternal and perinatal outcomes J. Henry Family and Clinical Support Services, Basingstoke and North Hampshire Hospital, Basingstoke, UK

Objective

Over 200 000 emergency caesarean births per year in UK. 10% are at full dilatation. Second stage caesarean sections are associated with increased complications, maternal and foetal morbidity. Design: In this observational retrospective cohort study, I investigated the maternal and perinatal complications of caesarean delivery performed in the second stage at an NHS Trust in the UK.

Method

This study was performed from January 2022 to December 2022. Primary maternal outcomes measured included intraoperative surgical complications, surgery duration, post-partum haemorrhage, blood transfusion, extension of uterine incision and hysterectomy. Neonatal outcomes included impacted foetal head, 1 min Apgar score ≤ 5, abnormal cord gases, admission to a neonatal intensive care unit, foetal injury including fractures or laceration. In total, 1104 non-elective caesarean deliveries were available for analysis; 958 (86%) were performed in the first stage, and 146 (13%) in the second stage.

Results

Caesarean deliveries performed in the second stage were associated with higher rates of maternal and neonatal complications. Majority patients were primigravida 76%; para 1: 21% of which 85% had augmentation with Syntocinon. There were increased intraoperative complications such as: major obstetric haemorrhage in 6 cases (4.1%), 4 of which required blood transfusion. Unintended angle extensions occurred in 26% of cases with 1 case of emergency hysterectomy. These were associated with longer operation time and longer hospital stay. Foetal head was impacted in 65% of cases, with dis-impaction achieved via push method in 77% of cases aided by combination of sublingual GTN, step or Trendelenburg in 22% and by reverse breech extraction in 4%. There were 3 cases of foetal scalp laceration. No case of foetal skull or limb fracture. The condition of the baby at birth, there were 17 cases of abnormal cord gases with venous pH < 7.20, low Apgar less than 5 at 1 min were found in 6 cases, 6 of which required NICU admission for respiratory support.

Conclusion

Caesarean deliveries performed in the second stage of labour were associated with higher rates of maternal and neonatal complications. This study demonstrated that the push method of foetal disimpaction was not associated with an increased risk of foetal skull or limb fractures. eP-602 Postpartum hemorrhage at a teaching hospital in Oman -5 year retrospective study M. Fenn1; M. Al Falahi1; T. Al Hannai2; L. Al Shukaili2; N. Al Riyami3 1Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman, 2College of Medicine, Sultan Qaboos University Hospital, Muscat, Oman, 3Obstetrics & Gynaecology, College of Medicine, Sultan Qaboos University Hospital, Muscat, Oman

Objective

To study the incidence, risk factors, etiology, management, and outcomes of patients who had postpartum hemorrhage (PPH) following vaginal and cesarean delivery at Sultan Qaboos University Hospital (SQUH). Design: Retrospective cohort study.

Methods

All women who delivered at SQUH from Jan 2017 to Dec 2021 who had PPH, were studied. PPH was defined as per the WHO criteria of blood loss more than 500 mL after vaginal delivery and 1000 mL after cesarean delivery. The demographic parameters investigated were age, parity, pre-delivery Hemoglobin (Hb), estimated blood loss, etiology of blood loss. The pharmacological, mechanical, and surgical interventions undertaken to treat PPH and the need for blood and blood products were studied. The outcome and Hb at discharge were also studied.

Results

There were 18 136 vaginal deliveries during the study period of which 729 patients had PPH with an incidence of 4%. There were 2771 cesarean sections of which 360 patients had PPH, with an incidence of 13%. Hb of less than 11 gm% was found in 278 (38.1%) and 140 (38%) patients prior to vaginal delivery and cesarean section respectively. Grand multipara had the highest incidence of PPH after vaginal delivery, 311 out of 729 (43%). While the majority, 179 out of 360 (50%) were women of parity 2–4 among patients with PPH after cesarean section. One hundred and forty (39%) patients after cesarean were with previous sections. Poor uterine tone was the cause of PPH in 649 (89%) and 300 (83%) patients after vaginal and cesarean delivery respectively. Up to four uterotonics were used to treat atonicity. Surgical interventions required in 244 (34%) patients following vaginal delivery, mainly suturing of vaginal or perineal tears. Eighty-two (23%) of patients at cesarean section needed compression sutures or devascularization or hysterectomy. Average blood loss was 860 mL after vaginal delivery, and 1400 mL after cesarean section. Blood transfusion was required in 74 (10%) of patients after vaginal and in 127 (35%) of patients after cesarean. There was one maternal mortality due to atonic PPH after vaginal delivery.

Conclusions

The incidence of PPH was 4% after vaginal and 13% after Cesarean delivery. Active management of third stage of labor and repeated emergency obstetric drills to recognize and promptly act in the setting of PPH has reduced adverse outcomes. Incidence of anemia in pregnancy was high which needs to be addressed. Carbetocin for prevention of PPH especially at cesarean section must be studied. eP-603 Unlocking comfort: How birth companion impacts pain perception in labor! P. Saini; S. Tyagi; S. Agarwal; P. Sachdeva; Y.M. Mala Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India

Objective

The objective of the study was to assess the impact of birth companion on pain perception during childbirth, need for pharmacological analgesia and anxiety levels among nulliparous women. Design of study: This Non-Randomized Interventional study was conducted in the Department of Obstetrics and Gynecology at Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, spanned over a duration of one year, from 2023 to 2024, after taking ethical clearance from the ethics committee.

Methods

The study enrolled 150 singleton, nulliparous women intending to deliver at LNH, after obtaining informed consent. Participants were categorized into two distinct groups: the Birth Companion group, comprising women accompanied by a birth companion during active labor, and the Control group, consisting of women without birth companion. Pain perception was measured through the Visual Analog Scale (VAS) score, alongside the assessment of the need for pharmacological analgesia. Anxiety levels were similarly measured using VAS scores immediately after delivery. Other outcomes analysed to know the impact of birth companion were duration of labor, need for augmentation of labour, satisfaction score and mode of delivery. Data amassed were meticulously recorded into Microsoft Excel, subsequently undergoing analysis utilizing SPSS PC-25.The distinction between proportions was analysed via the chi-square test or Fisher's exact test, with statistical significance set at a ‘p’ value less than 0.05. Additionally, the divergence between the two groups was evaluated through either the student t-test or Mann Whitney U test.

Results

The outcomes yielded a statistically significant reduction in pain scores, decreased requirements for pharmacological analgesia, lower anxiety scores, shortened labor durations, and decreased necessity for labor augmentation with synthetic oxytocin among women with birth companion in comparison to those without birth companion.

Conclusion

This study illuminates the crucial function of a birth companion and the benefits it offers during childbirth, highlighting its pressing importance in the present time. It also underscores a meaningful correlation between women's labor pain perception and subsequent post-delivery satisfaction levels. It accentuates the paramount importance of raising awareness, both among patients and healthcare personnel, regarding the invaluable support and comfort that birth companion provide throughout the labor process. eP-604 Intrapartum care for twin pregnancy in a tertiary hospital in UAE S. Elsayed; S. Valappil; S. Ubaid; N. Hassan; S. Elsheshtawy Corniche Hospital, Abu Dhabi, United Arab Emirates

Background

Vaginal delivery in twin pregnancy is associated with multiple challenges. Delivery of non-cephalic second twin requires special expertise. Perinatal morbidity & mortality is increased for both babies but second twin is at greater risk intrapartum.

Objective

To assess the perinatal outcomes of vaginal deliveries in twin pregnancies. Design: Retrospective observational study.

Method

Hospital records of all twin pregnant women and their babies were reviewed from January 2021 to December 2022. Data was collected retrospectively to evaluate perinatal outcome of vaginal twin deliveries, patients that underwent elective cesarean delivery were excluded from the study. Study was done at Corniche Hospital, the largest tertiary maternity unit in the United Arab Emirates.

Results

There were total of 352 cases of twin deliveries in 2021 and 2022. 140 (39%) women were planned to have vaginal deliveries, from which 119 women ((85% ) had successful vaginal deliveries. From the population of women that underwent vaginal delivery, 6% had previous cesarean sections scars. One hundred and seven (90%) cases were DCDA twins and fourteen (10%) MCDA twins. Forty eight (36%) women spontaneously labored and ninety two (96.4%) had to be induced. Regarding mode of delivery of second twin. 40% cases had spontaneous delivery following delivery of first twin. Instrumental delivery was required in 21% cases, 14% delivered by assisted breech delivery and 13.4% cases required breech extraction. Internal podalic version was performed in 10.9% cases. Grade 1 Caesarean section for second twin occurred in 2.5% cases due to cord prolapse and bradycardia. Inter-twin delivery interval was less than 30 min in majority of cases (96.6%). Neonatal admission to NICU occurred 33.6% cases. Vast majority happened due to prematurity (62.5%), RDS (22.5%) and suspected sepsis (15%). There were no cases of neonatal death, HIE or low cord pH.

Conclusion

Vaginal delivery for twin pregnancy in cephalic presentation of twin one seems to be safe with presence of obstetricians who has experience in internal podalic version and breech extraction. However, proper team work and preparedness to manage potential serious intrapartum complications are important to achieve good outcome. Simulation training in twin delivery through the RCOG Robust course has enabled our senior obstetricians to achieve these skills. Our experience shows that in skilled hands, safe vaginal delivery of twin pregnancies can be achieved. eP-605 Sequential operative vaginal delivery: Maternal and fetal outcomes in a tertiary unit M.J. Abdul Wahab; S. Vayante Valappil; N.I. Bukhari; M. Begum Obstetrics and Gynecology, Corniche Hospital, Abu Dhabi, United Arab Emirates

Objective

To evaluate the maternal and fetal outcomes of sequential operative vaginal delivery in Corniche Hospital, Abu Dhabi. Corniche hospital is a tertiary care maternity unit having 4000 deliveries per year. Design: Retrospective study over a six-month period from January to June 2023.

Method

An electronic record review of all vaginal births were reviewed using CERNER Database. Factors reviewed were parit, partogram/labor progress, indication, number of pulls with first and second instrument, location, operator, escalation. Maternal outcomes focused on postpartum hemorrhage, perineal trauma, high dependency unit admissions. Neonatal outcomes included were cord gases, trauma and hypoxic events.

Results

Over this six month period, there were a total of 1856 vaginal deliveries. The sequential deliveries were 24 accounting for 1.3% of all these deliveries. There were total of 25 babies (one set of twins). There were no failed sequential deliveries. 92% of these deliveries were in primigravida. In all these deliveries Kiwi cup was the first instrument and delivery was completed by Neville Barnes forceps. The indication was fetal distress in 84% of cases. Majority (92%) had Epidural analgesia. The second stage duration ranged 1–3 h.67% were performed in Labor ward, 33% in Operation Theatre (Trial in OR). Operator was primarily Senior Registrar in the presence of consultant in 90% of cases. 38% had third degree perineal tear, 63% had postpartum hemorrhage, 12.5% had HDU admissions. Reviewing neonatal outcomes 12% had low cord gases (<7.1), 20% had NICU admissions,12% cases had facial Nerve palsy (transient) Cephalohematoma in 1 baby, Neonatal encepahalopathy in 1 baby (MRI normal on day14), 1 baby had subdural hematoma discharged on day 7.

Conclusions

Our study reflects the need for more training in correct identification of fetal position, Kiwi application at the flexion point, safety checks in forceps and the place of delivery.The management of second stage of labor can be very complex even in the most experienced hands.Timely,wise decision making and acquiring the skill of performing instrumental vaginal deliveries is an integral part of good labor ward practice .Standardized, systematic approach, safety check and correct choice of first instrument is imperative to a successful outcome. Sequential use of instruments might be needed when there is an equipment failure or improper application /traction. Resorting to second stage caesarean section carries an increasing maternal morbidity and should be decided by the senior most obstetrician. eP-606

Abstract

Withdrawn eP-607 Efficacy and complications of two cervical ripening methods M. Zangeneh; F. Veisi; M. Fatahi Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran

Objective

Cervical ripening, commonly used for labor induction, can be performed by various methods. We aimed to investigate the efficacy and complications of injection of oxytocin, whether simultaneous or subsequent to the Foley catheter. Design and method: In this randomized clinical trial, pregnant mothers admitted to Imam Reza Hospital, Kermanshah, Iran, for labor with induction, during 2018, were enrolled and randomized into two groups; in the simultaneous group, oxytocin was given simultaneous with catheter insertion, and in subsequent group after the removal of the balloon. In both groups, sterile 16 or 18 Foley catheter was used, and oxytocin was perfused, starting from 2 mIU/min and increased every 30 min until labor. Duration of cervical ripening, induction to delivery interval, 1st- and 5th-min's Apgar score, need for cesarean section (C/S), neonatal intensive care unit (NICU), postpartum hemorrhage, chorioamnionitis, and the number of deliveries in the first 12 h after intervention were recorded.

Results

The mean age and gestational age of mothers were not different between the groups (p > 0.05). The number of successful deliveries was significantly higher in the simultaneous group vs. the subsequent group (p = 0.004). The mean duration of cervical ripening was significantly shorter in the simultaneous group vs. the subsequent group (p = 0.009). Mean induction to delivery interval, Apgar scores, need for C/S, and NICU were not different between the groups (p > 0.05).

Conclusions

The results showed that administration of oxytocin simultaneous with balloon insertion is an efficient method for increasing the success rate of deliveries within 12 h and can ripen the cervix faster than its administration after balloon removal. eP-609 CTG in Vasa praevia D. Gibb Obstetrics, The Birth Company, London, UK

Objective

To understand Vasa Praevia better. Case report: Patient Y had a painless antepartum haemorrhage at 39 weeks of gestation. There were mild contractions and the bleeding was only light. There had just been a spontaneous rupture of the membranes: amniotic fluid drained mixed with blood. The CTG was seriously abnormal. An emergency Caesarean section was performed and the baby was pale and in very poor condition. The baby's haemoglobin level was 30 g per litre and the baby died after 24 h in spite of treatment.

Discussion

Antepartum haemorrhage is common and in most cases is maternal blood from abruption or placenta praevia. With the first bleed the CTG is usually reasonably normal because the normal placenta has a good reserve. In the early stages or after a small bleed the mother's vital signs are stable as she has a good volume reserve of blood. In most cases the situation settles. Vasa praevia is different because the baby's circulating blood volume is much less than an adult. A small bleed threatens the baby's cardiovascular status and its life. This is therefore a serious emergency requiring urgent action to deliver the baby by Caesarean section and notification of the paediatrician. The key is that the CTG is very abnormal with a relatively small bleed. Babies often die of this relatively rare condition because of a lack of misunderstanding and preparedness. It is said that it is difficult to save these babies but routine imaging of the placenta in the antenatal period is lifesaving. Vasa Praevia is more common in placentas situated low in the uterus. The edge of the placenta and the cervical area should be checked in all these cases with colour Doppler: this is not difficult and can be done at the mid pregnancy scan or later. Planned Caesarean section should be done. The staff can then be prepared for an emergency situation and this can save the baby's life. There is a clear logic suggested by many experts for scanning all pregnancies for this conditions (vasapraevia.co.uk). This may not be feasible or possible. In addition we need this CTG knowledge.

Conclusion

CTGs should be understood and interpreted using principles of fetal pathophysiology. With urgent action these babies lives can be saved. (Illustrations of CTG and pathology of placenta and membranes). eP-610 Term abdominal pregnancy with a healthy newborn D. Correia E D'Costa1; M. Ntanini Joseph1; V. Pereira2 1Obstetrics and Gynecology, Mavalane General Hospital, Maputo, Mozambique, 2Obstetric and Gynecology, South Warwickshire University Hospital, Warwick, UK

Objective

Term abdominal pregnancy with a live fetus is a rare form of ectopic pregnancy with a high mortality and morbidity for both the mother and fetus.Diagnosis and management can pose some difficulties especially in low resource centers. High index of suspicion is needed in making prompt diagnoses. Abdominal pregnancies represent just about 1% of ectopic pregnancies.The incidence differs in various publications between 1:10 000 and 1:30 000 pregnancies. These pregnancies generally do not get to 37 weeks and usually the end result is the extraction of a dead fetus. The main maternal complications are severe bleeding,intestinal fistulas and sepsis. Fetus may present with facial and cranial asymmetry, deformity of limbs and central nervous system. Design: A 24 year old, in her second pregnancy, transferred from a health center as a post term pregnancy for termination of pregnancy. She only had one USG done at 12 weeks which confirmed her dates as post term (42.1 Weeks).Her antenatal period was uneventful and she had 9 antenatal visits. On abdominal examination, fetal parts were palpated and a fetus was found in longitudinal lie. Fetal heart sounds were difficult to auscultate. Ultrasound was performed which reported? fetus with congenital malformations, ? Intrauterine fetal demise, ? molar pregnancy. Decision for exploratory laparotomy was taken. On entering the cavity, we encountered a large mass occupying the inferior and superior abdomen which was attached to the omentum.Delivery of the mass, was followed by a term female fetus in the lower abdomen. The placenta was then followed to its attachments, superiorly largely attached to the omentum,inferiorly to ascending colon and fundus of the uterus and partly to the left fallopian tube, not were separated carefully and ligated, part of the uterine muscle was resected at the fundus and sutured.

Conclusion

This is a extremely rare case where diagnosis was difficult especially in advanced gestation. High suspicion is needed where resources are limited. Maternal bleeding can be life treating during laparotomy secondary to unexpected placental implantation on vascular abdominal organs.MRI is useful in this regard. Placenta may or may not be removed depending on surgeons expertise. It is generally recommended to leave the placenta in situ and follow up with human chorionic gonadotropin levels. For the newborn, congenital malformations is as high as 40% in abdominal pregnancies. eP-611 DDI for category one EMCS and its impact on the neonatal outcome O.H.E. Elhag1; H. Logman2 1Obstetric and Gynaecology, Border General Hospital, Melrose, UK, 2Obstetric and Gynaecology, King Faisal Military Hospital, Khamis Mushyt, Saudi Arabia

Introduction

Category one (EMCS) is a critical intervention in obstetrics, often necessitated by emergent maternal or fetal conditions. The Decision to Delivery Interval (DDI) is a crucial determinant of maternal and neonatal outcomes. This retrospective case-control study conducted over a three-year period from January 2018 to January 2021 at the Saudi Arabia Armed Forces Hospitals of Southern Region (AFHSR) aimed to assess DDI for category one EMCS and its impact on neonatal outcomes. The study included 1135 cases meeting the criteria of category one EMCS, with data collection encompassing various maternal and neonatal parameters, focusing on DDI and its association with neonatal outcomes such as Apgar scores, cord pH, and the need for intensive care unit (ICU) admission.

Objectives

1. To assess the (DDI) for category one EMCS at an AFHSR. 2. To evaluate the impact of DDI on neonatal outcomes, including Apgar scores at 1 and 5 min, cord pH, and the need for ICU admission. 3. To compare the observed DDI with international standards. 4. To identify clinical factors associated with shorter DDIs, including specific indications for cesarean section and maternal-fetal conditions. 5. To investigate potential interventions or strategies aimed at reducing DDI and improving neonatal outcomes in emergency obstetric care settings. Methodology: A retrospective case-control study was conducted at AFHSR, including 1135 category one EMCS cases from January 2018 to January 2021. Data collection involved reviewing patient files, with variables including maternal age, GA , indication for EMCS , decision time, delivery time, neonatal Apgar scores, cord pH, and ICU admission. Data analysis included descriptive statistics, t-tests, ANOVA, and logistic regression. Ethical approval was obtained, ensuring compliance with ethical standards and patient confidentiality.

Results

A median DDI of 45 min, with only 26% of cases operated within the recommended 30-min timeframe. Shorter DDIs were observed in specific clinical scenarios, such as second-stage cesarean sections and cord prolapse . DDI correlated with neonatal transfer and Apgar scores, but no significant association was found with ICU admission.

Conclusion

While variations in DDI may not significantly impact neonatal health indicators or ICU admission, the study highlights the importance of swift interventions to minimize delays and improve care quality. Further research is warranted to validate findings and explore additional factors impacting DDI and neonatal outcomes, contributing to ongoing efforts to enhance emergency obstetric care practices and maternal-neonatal health outcomes. eP-650 Expectations around acupuncture in pregnancy: A qualitative assessment of symptoms S. Manji; A. Eftime; S.H. Hassan; I. Gafson Maternity, Whittington Hospital, London, UK

Objective

Acupuncture is one of the most common treatments used by traditional systems of medicine, emerging into Western medicine as a complementary therapy. NICE guidelines support its use for chronic pain and by RCOG as a first-line non-pharmacological intervention for pain and nausea in pregnancy. Despite evidence for its efficacy and safety, it has not been readily taken up around the UK. The Whittington Hospital is the only known hospital in London that provides this service at no cost or low cost to maternity service users, with over 2000 sessions in the past year, proven to result in fewer surgical births, less intrapartum analgesia and reduced length of hospital stay. This service evaluation aimed to assess patient expectations and goals towards the service, compare practice with recommendations and provide an evidence basis to advocate the role of acupuncture in pregnancy care. Design and methods: Patients could self-refer to the acupuncture service at any gestation, antenatally and postnatally, for symptoms encompassing nausea and vomiting, pelvic pain, mental health conditions and preparation for labour. A small pilot study was run with a survey based on adapted validated scoring systems such as the Acupuncture Expectancy Scale, MYMOP2 and questions based on RCOG recommendations. Users were given multiple choices to identify their symptoms, initial expectations, scale their progress and impact of the treatment and free text to describe how their patient journey has been throughout.

Results

Around 75% were treated due to nausea and vomiting in the first trimester. 50% were hopeful that their symptoms would improve. The MYMOP scale (0–6, 0 being the worst and 6 the best) to measure alleviation of symptoms, showed 50% scored a 6, 30% scored a 4, and 20% scored a 2. All participants mentioned a positive experience with 50% finding that acupuncture had positively impacted their pregnancy journey.

Conclusions

The provision of a complementary therapy is important in a maternity unit to cater for a vast population. In a climate where we can offer a variety of pain relief and birth options for patients, thinking about non-medical or surgical methods is important to lower birth anxieties, adversities towards medicalisation of births and reduce the burden on healthcare with common musculoskeletal presentations in pregnancy. This has implications on cost-effectiveness, improves attitudes and anxieties around birthing, enhance the link between medical input and alternative therapies and creates an environment where symptoms are cared for and heard. eP-665 Evaluation of haematologic parameters as predictors of adverse maternal outcomes in pre-eclampsia P. Bosrotsi1; M. Archibong2; A. Abe3 1Obstetrics and Gynaecology, State Specialist Hospital Yenogoa, Yenogua, Nigeria, 2Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Teaching Hospitals Complex, Ile Ife, Nigeria, 3Obstetrics and Gynaecology, Federal Medical Center, Owo, Nigeria

Background

Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide, especially in developing countries, due to its varied multisystemic complications. Abnormalities in haematological indices are frequently seen in patients with pre-eclampsia, and the frequencies at which these haematologic changes are seen are dependent on the severity and duration of pre-eclampsia.

Objective

To evaluate the predictive value of some selected haematological parameters on adverse maternal outcomes in patients with pre-eclampsia.

Methods

This was a prospective study involving 121 patients with pre-eclampsia at the Obafemi Awolowo University Teaching Hospitals, Ile- Ife. Mercury sphygmomanometer was used to measure blood pressure and urinalysis reagent strip was used to determine significant proteinuria. Blood samples were obtained for analysis of some selected haematological parameters.

Results

The ROC analysis of platelet count, neutrophil count, neutrophil lymphocyte ratio, platelet lymphocyte ratio and platelet red cell ratio were performed for all subjects. Neutrophil count, neutrophil lymphocyte ratio and platelet red cell ratio were considered to be possible predictors of adverse maternal outcome. Maternal platelet count was significantly predictive of fetal adverse outcome.

Conclusions

The prompt analysis of full blood count parameters of patients with pre-eclampsia will help in categorisation of patients into high or low risk for adverse outcomes in pre- eclampsia and thus ensure appropriate and timely interventions.

Keywords

Pre-eclampsia, neutrophils, lymphocytes, platelets, red cell count eP-666 QIPs in maternal medicine & high-risk pregnancy service at University Hospitals Birmingham S. Mukherjee; A. Ahmed University Hospital Birmingham, Birmingham, UK

Objective

Implementation of various changes related to Maternal Medicine and maternity services at University Hospitals Birmingham. Design: Multiple audits and quality improvement projects (QIP) were conducted to evaluate the effectiveness of ward rounds, patient management in triage, joint clinics and management of complex pregnancies.

Methods

Various aspects of maternity service were looked at and multiple QIP were conducted. Service mapping was done, and services reconfigured accordingly. Daily consultant led ward rounds for all inpatients at both sites were started (Heartlands and Good Hope). 5 months data from April to August 2023 were collected to see the consultant involvement, in both antenatal and postnatal ward rounds. As per recent CQC recommendations, our Maternity triage system was upgraded (previously called PAER, now MUAU). There is a dedicated service including senior & junior doctors and midwives which has improved the service significantly. Antenatal triage system and patient -centred dedicated maternal medicine and obstetric clinic with named consultant for each patient have been introduced. Audit on Complex pregnancy and risk assessment were done, with the aim to improve the identification and care of women in UHB who are at higher risk and ensure a consistent, optimised approach to the care of these women to improve their experience and outcomes. 80 patients were randomly selected cross sites from complex pregnancy list. Twice monthly Maternal Medicine MDT meetings are arranged which are very well attended. There have been participations in regional Maternal Medicine Network and Maternal Medicine Webinar on ‘Cystic Fibrosis in Pregnancy’ has been organised.

Results

It was observed that in about 2/3rd of cases the wards rounds were done timely and effectively. This has significantly improved quality of patients care in Maternity. PAER was attended by 13 240 patients in the last year with midwives' compliance and doctors' compliance on average of 95% and 85% respectively. Audit on complex pregnancies revealed that the proper documentation and consultant reviews prior to mid T scan are improving.

Conclusions

These quality improvement projects, organised patients and colleagues feedback have brought about positive changes over last two years in Maternity service, subsequently improving the quality of service and reduced adverse incidents. Our Governance team has been presenting all the data in departmental meetings and MDTs. All these measures have been reflected in improvement of the perinatal mortality and morbidity data. eP-667 Practices associated with episiotomy reduction globally: A systematic review A.W. Chen1; M.J. Hall2; M.R. Altman2 1Health Systems and Population Health, University of Washington, Seattle, USA, 2Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, USA

Objective

Episiotomy is still a common surgical procedure performed during childbirth worldwide, despite decades of scientific evidence that indicates no justification for its routine use. Routine episiotomy is associated with increased risk of serious maternal morbidity and no improvements in neonatal outcomes. We sought to analyze this gap between evidence-based knowledge and implementation surrounding reducing episiotomy practice. We conducted a systematic review of the literature to assess practices that have resulted in a change in episiotomy rates. Design: We searched three databases (PubMed/MEDLINE, CINAHL Complete, Embase) from 6/5/2023 to 6/8/2023 using key words and subject headings with no time restriction. Any studies published in English and reporting an original empirical analysis in any global, regional, or country-specific context that examined practice changes that were implemented and reported episiotomy as an outcome were included in our review. Studies were excluded if they only reported on trends or changes in episiotomy rates without examining the specific practices implemented.

Method

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines for systematic review. Risk of bias was also assessed using a combined adaptation of the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool and a National Institute of Health (NIH) quality assessment tool. Title, abstract, and full-text screening was performed independently by two authors and disagreements were discussed and resolved in consensus meetings.

Results

Search results returned 1265 records; 40 papers met the inclusion criteria for a full review. Twenty-five papers met all our inclusion criteria and were included in our final analysis. All included studies documented a decrease in episiotomy rates, with 21 studies reporting a statistically significant reduction. Most studies were mixed interventions, often a combination of an educational intervention and audit and feedback strategy for successfully reducing episiotomy rates.

Conclusions

Specific practice changes have been shown to effectively decrease the incidence of episiotomy in varied country and population settings. Continuing research should be undertaken with longer follow-up periods to effectively measure effects of sustained behavior change on reducing episiotomy rates. Practices including a combination of audit and feedback and education appear to be the most effective at promoting change to reduce routine episiotomy. This study provides insight and impetus for changing obstetrical practices that are not evidence-based using strategies that have been found to be effective and resulted in change to promote respectful birthing practices. eP-669 Audit of care and outcomes of pregnant women living with epilepsy A. Toluwase; H. Mumtaz; S. Usman Obstetrics and Gynaecology, University Hospital North Midlands NHS Trust, Stoke on Trent, UK

Objective

To identify the quality of care received by epileptic pregnant women and compare it with national guidelines. Design: Retrospective audit of all booked pregnant women with epilepsy between March – August 2022 ,at University Hospital North Midlands, irrespective of the outcomes of their pregnancies.

Methods

39 women were included in the final analysis to determine their demographics, follow- up features, antiepileptic drugs (AEDs) element and child related attributes. We manually collected and analysed the data using Microsoft excel, presented as median for continuous variables for proportions.

Results

We recorded more than 90% compliance according to the national guidelines as regards the quality of care received by pregnant WWE. 80% received preconception care and had their epilepsy type documented. Only 20% received pre pregnancy counselling. Mean age for booking was 8 weeks.41% required no anti-epileptic medications. 1 in 2 of the women using AEDs received single medication, Levetiracetam and they all had their bloods monitored and dosage adjusted. Worsening seizures occurred in 26% of pregnancies and one woman had intrapartum seizure. The women's clinical condition did not influence their modes of deliveries. No maternal or neonatal death occurred. There was one termination of pregnancy for a congenital anomaly. One woman and three babies had admission to the dependency units, these were not epilepsy related.

Conclusions

The audit highlighted the importance of specialised care, provided by the obstetrician and neurologist, in reducing maternal and neonatal morbidity.There is a need to advocate preconception counselling as well as post-natal contraception as a high number of the pregnancies are unplanned. This should be conducted at the primary care level as we only see these women during their antenatal period. eP-670 Effectiveness of blood sugar testing after 36 weeks' gestation A. Amer1; N. Deole2 1Obstetric, Ipswich Hospital, Ipswich, UK, 2Fetal Medicine, Ipswich Hospital, Ipswich, UK Aims and objectives: To study effectiveness of one week blood sugar testing in patient when GDM is suspected in late third trimester.

Method

Retrospective review of notes of at Ipswich Hospital, which is a district general hospital with 3500 deliveries a year of women offered one week blood sugar testing when GDM was suspected late in pregnancy. The test is offered to women when GDM is suspected in late pregnancy due to persistent glycosuria, large for gestational age baby, polyhydramnios or accelerated fetal growth. We collected data over 4 months from Jan 2022-April 2022.

Results

The study included 89 women during the period of inclusion. Majority (88%) of these were White British ethnicity and 29% of the women had no risk factors for a 28 weeks GTT. Those who had a GTT @ 28 weeks, it was normal. Most common reason for blood sugar monitoring was large for gestational age (50%) and polyhydramnios (29%) in late pregnancy. Abnormal blood sugar results were noted in 22% of the women; 65% of there were controlled with diet alone, 30% needed insulin and 5% needed metformin to manage their abnormal sugar. There was no difference in any of the maternal and fetal outcomes in the 2 groups apart from higher incidence of IOL in women with abnormal sugar readings ( 65% vs 33%) and higher rate of admission to Neonatal unit ( 20% vs 11%). The rate of caesarean delivery, average gestational at delivery, mean birth weight at delivery, rate of 3rd and 4th degree tear and PPH > 1000 mL were similar.

Conclusion

We present the outcomes from small cohort of women who had GDM diagnosed with one week blood sugar monitoring when GDM has been suspected late in pregnancy. Whilst it is reassuring that majority of this women have normal readings on testing 22% (1/5) women had abnormal sugar readings and 1/3 of these women who had abnormal readings needed treatment with insulin and/ or metformin. Whilst the late diagnosis of GDM made no difference in any of the major maternal and neonatal outcomes. This may have implications for how their pregnancies are managed in the future and may encourage these women to change life style factors which may predispose for type 2 diabetes in the future. eP-671 Treatment for asymptomatic vaginal-candidiasis to reduce preterm-birth: A systematic review and meta-analysis H. Abdel Fattah; S. Aljuwaiser; C. Munro; A. Mostafa Aberdeen University, Aberdeen, UK

Objective

The objective was to evaluate the treatment of vulvovaginal candidiasis and its relation to adverse pregnancy outcomes. This systematic review was performed per the Cochrane Handbook of Systematic Reviews of Interventions guidelines and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Design: A Systematic Review and Meta-analysis.

Method

A literature search was performed for all randomised controlled trials comparing treatment for vaginal candidiasis (clotrimazole) with usual care (no treatment) on four electronic databases. The literature search (last updated on 1 August 2023 and conducted from 1947 to 2023) had two independent reviewers and no language restrictions. Pregnant women enrolled in all included studies were between 12 to 20 weeks' gestation. The primary outcome measured preterm birth (babies born alive before 37 weeks of gestation). The secondary outcomes included adverse pregnancy outcomes: premature rupture of membranes, perinatal death (death of a baby between 20 to 22 weeks of gestation, low birth weight (babies weighing less than 8 ounces at birth) and stillbirth (loss of a baby at or after 20 weeks of gestation).

Results

Three randomised controlled trials were included in the systematic review (including a total of 3868 pregnant women: 1942 women in the clotrimazole treatment group versus 1926 women allocated to the usual care (no treatment) group. The primary outcome showed that spontaneous preterm birth was 2/50 (4%) and 7/258 (3%) in the treatment groups to 3/49 (6.3%) and 20/238 (8%) in the usual care (no treatment) group. Secondary outcomes reported in one study are pregnancy complications, including gestational diabetes, in the clotrimazole group 6/50 (12%) vs the usual care group 5/49 (10%), and antepartum haemorrhage/abruption in the clotrimazole group 2/50 (4%) vs the usual care group 4/49 (8%). 3 Women with labour induction in the clotrimazole group 16/50 (32%) and the usual care group 11/49 (22%). Meta-analysis showed a statistically significant effect favouring the treatment group compared to the standard care group, with a pooled effect size of −0.05 (95% CI −0.09, −0.01) The quality of studies ranged from low to moderate.

Conclusions

This systematic review demonstrates that treating asymptomatic candidiasis in early pregnancy reduces spontaneous preterm birth rates. Further well-designed and adequately powered studies are needed to assess the effectiveness of treating asymptomatic candidiasis in early pregnancy on preterm birth and other neonatal and pregnancy outcomes. eP-672 An innovative paperless proforma that improved patient safety in iron infusion D. James Fenn1; W. Aziegbe2; F. Cantillo2; S.S. Aye2 1Royal Devon Univeristy Hospital NHS Foundation Trust, Barnstaple, UK, 2Obstetrics and Gynaecology, Royal Devon Univeristy Hospital NHS Foundation Trust, Barnstaple, UK

Objectives

We aimed to improve patient safety in our maternity setting by retrospective review of documentation of the patients who had an IV(intravenous) iron infusion. We found discrepancies in documentation and therefore proposed a proforma on the Electronic patient record (EPR) which would enable good documentation and a follow up plan. Design: Retrospective audit. It included antenatal and post-natal patients. It was carried out in 2 stages. Measures for improvement proposed from the 1st stage were implemented through the proforma. Analysis at the end of 2nd stage evidenced the clinical effectiveness after the use of the proforma.

Method

1st stage included 16 participants chosen between a time period. There was no specific reason to choose the time period. 2nd stage involved 21 patients and this was 6 months after the 1st stage to analyse the impact. The following documentation was checked in the 1st stage and also formed a part of the final proforma on the EPR: 1. Indication for IV iron infusion. 2. Was there a trial of oral iron before infusion? 3. Documentation of counselling before infusion. 4. Administration of prior antihistamines and withholding oral iron before infusion. 5. Documented pre-infusion blood tests. 6. If Senior Doctor was informed before transfusion? 7. Documentation of calculated dose of IV iron, infusion rate. 8. Record of baseline observations and reactions to drug. 9. Follow up plan – including restarting oral iron and blood tests. The proforma is in a simple format mostly consisting of YES/NO questions which requires only a click and minimises the need to type. We encouraged use of the proforma by sending out awareness emails, displays on ward. Analysis was carried out using Microsoft Excel in the form of charts.

Results

On comparison of 1st and 2nd stage, there was significant improvement in documentation of almost all parameters after the use of the proforma. Documentation of counselling improved to 86% in 2nd stage vs 62% in the 1st. Informing senior clinician before an infusion improved to 100% in 2nd stage vs 25% in the 1st. Dose calculation and documentation improved to 100% in 2nd stage vs 81% in the 1st. Documented plan to restart oral iron was 100% in 2nd stage vs 38% in the 1st.

Conclusion

We conclude that the implementation of the proforma has been a major quality improvement strategy in turn improving patient safety and demonstrating clinical effectiveness. This proforma is being used regularly for IV iron infusion. eP-673 Resistant anuria in HELLP syndrome: What to do? M. Abdalla; H. Hadawi; A. Mertdag; A. Steshenko Obstetrics and Gynaecology, Princess Royal University Hospital – King's College Hospital NHS Foundation Trust, London, UK

Objective

HELLP syndrome with resistant anuria can emulate thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS), which can present a significant challenge for prompt differential diagnosis and appropriate management. Case report: A 33-year-old woman developed late-onset pre-eclampsia and was offered induction of labour (IOL) at 37 weeks gestation, which she declined and had expectant management. The patient had IOL at 40+2 weeks and started on labetalol to control blood pressure. Following a vaginal birth, she had manual removal of retained placenta complicated by PPH of 1.6 litres requiring blood transfusion. Immediately after delivery, the patient became anuric despite adequate fluid resuscitation progressing to AKI 3. Her haemoglobin and platelet decreased to 72 g/L and 17 × 109/L within the first 24 h. High LDH levels indicating haemolysis in combination with the dramatic reduction in platelet count and resistant anuria suggested the possibility of developing TTP and aHUS. Although the patient remained stable, she was transferred to HDU for close monitoring and treatment. On advice from a haematologist, the client received one unit of platelets and one unit of blood cells. A comprehensive autoimmune screen including C3 and C4 complement levels, ADAMTS-13, and renal ultrasound scan were performed and yielded normal results. She made a good recovery with completely recovered renal function and improvement in biochemical markers being discharged home on day six.

Discussion

Declining early IOL resulted in the development of severe complications from PET, intensified by PPH, contributing to the early onset of anuria served as an indicator of AKI. Given the absence of specific laboratory tests for rapid differentiation between HELLP, and TTP/ aHUS, the diagnosis was challenging. However, multidisciplinary involvement facilitated the exclusion of TTP/aHUS, as evidenced by normal ADAMTS-13, C3/4 and a significant drop in platelets below 20 × 109/L suggestive of HELLP syndrome. Effective supportive management was successful.

Conclusions

Misdiagnosing TTP/aHUS as severe HELLP can delay specific therapeutic interventions and lead to a higher risk of rapid maternal deterioration and even death. The absence of rapid diagnostic tests to distinguish between HELLP and TTP/aHUS contributes to adverse outcomes. Utilizing concurrent LDH and AST values to calculate the LDH to AST-ratio can aid in rapid differentiation. ADAMTS-13 confirms TTP, which is not universally available and requires several days for results. This case highlights the importance of multidisciplinary collaboration in managing obstetric emergencies in patients presenting with overlapping clinical signs of rare conditions. eP-703 Mentoring for Yorkshire obstetric and gynaecology trainees: An update K. McCrossan1; K. Saul2; K. Barton3; M. Flynn4 1Barnsley Hospital, Barnsley, UK, 2Leeds Teaching Hospital, Leeds, UK, 3Mid Yorkshire Hospitals NHS Trust, Wakefield, UK, 4Hull University Teaching Hospital, Hull, UK

Introduction

Successful mentoring within healthcare settings has many benefits. For the mentee, it can enhance technical ability;improve confidence and job performance. Mentors benefit by developing and enhancing personal skills of empathy andleadership; gaining the satisfaction of supporting colleagues to achieve their potential. Building relationships within the team creates a cohesive workforce; we propose this model can improve team functioning. The Yorkshire & Humber O&G Trainees Peer Mentoring Scheme commenced in 2021. We presented initial data at RCOG World Congress 2022. We present further data on the effectiveness of the scheme. Design: The mentoring scheme is voluntary, and is offered to all trainees within the deanery. All trainees were contacted in August 2023 via email for expressions of interest. An baseline questionnaire collected participant details; including background demographics, current training grade and location, and clinical area of interest. Pairings were matched based upon locality wherever possible as a means of facilitating face-to-face meetings.

Method

In total 39 pairs of mentors (ST3+) and mentees (ST1/2/3) were matched. All mentors and mentees were encouraged to attend an online welcome meeting, providing further detail, as well as an online HEE e-learning module for mentors. A feedback meeting was held virtually in December to gather informal feedback from participants and an online feedback form was sent to trainees in January 2024 to evaluate experiences further.

Results

There were similar numbers involved compared to last year, with many choosing to keep their previous pairing. 23 individuals completed the feedback form: 13 mentees and 10 mentors. Common themes emerged: difficult work experiences, e-portfolio guidance, career aspirations, exams and work/life balance. 74% felt that the mentoring scheme had enhanced their training, 39% finding it ‘very beneficial’. A suggested area for improvement was formal mentor training, which we will look into particularly regarding funding options.

Conclusions

The Yorkshire and Humber Obstetrics and Gynaecology mentoring scheme continues to benefit both junior and senior trainees. This scheme offers support and guidance to early career obstetricians/gynaecologists; offers flexibility and incurs no extra training costs. The NHS workforce is under significant pressure, a friendly face in an informal setting can make the world of difference and improve wellbeing. We aim to continue to build upon this scheme in order to improve job satisfaction, reduce stress and burnout and ultimately improve patient care. eP-704 Effect of feedback on reflection, on deep learning of undergraduate medical students Z. Maqsood1; M. Sajjad2; H. Bilqees3; T. Farkhanda3; S. Nawaz3; K. Sultan4 1Gynae, Rawalpindi Medical University, Islamabad, Pakistan, 2Histopathology, Riphah International University, Rawalpindi, Pakistan, 3Rawalpindi Medical University, Rawalpindi, Pakistan, 4Maxhealth Hospital, Islamabad, Pakistan

Objective

Reflection is crucial for deep learning and self-regulation. However, reflection alone may not produce the desirable effects unless coupled with feedback. This study aims to investigate the impact of ‘feedback on reflection’, on deep learning and concept building among undergraduate medical students in gynaecological setting. Design: Experimental study.

Method

This study was conducted from February 2023 to July 2023, following approval from the Ethics Review Committee. The study sample were 68 final year MBBS students divided into study and control group through simple randomization. A pre-test was done to establish baseline measurements. Both groups then received similar teaching sessions on obstetrics and gynecology topics over a period of 6 days. Written reflections based on Gibbs reflective cycle were collected from all participants, and the study group additionally received verbal feedback. A post-test concluded the study. Both the pre and post-tests comprised 30 multiple-choice questions at a higher cognitive level. Data evaluation was done through SPSS 26. Descriptive statistics and t- test was used to compare the means of both groups. p-value of < 0.05 was considered significant.

Results

No significant difference in gender distribution was found between the two groups. Baseline pre-test scores showed no significant difference between control group (37%) and study group (39%). Both groups demonstrated significant improvement from pre-test to post-test (p < 0.0001). However, post-test results showed a significant increase in the scores of study group (69%) compared to the control group (51%) (p < 0.0001). Net gain of learning after addition of feedback along with reflection in intervention group was 18.6%. Student feedback supported the effectiveness of the teaching method in facilitating learning and exam preparation.

Conclusion

Incorporating feedback along with reflection enhances conceptual learning among undergraduate medical students, resulting in significantly improved test scores compared to reflection alone. eP-705 Impact of CTG course on DDI of emergency LSCS and delayed test scores A. Malik1; R. Zuberi2; A. Zaidi1; T. Zehra2; S. Shakil2; A. Khalid1; S. Ahmed3; F. Zubair3 1Aga Khan University Hospital, OB/GYN, Karachi, Pakistan, 2Aga Khan University Hospital, Educational Development, Karachi, Pakistan, 3Aga Khan University Hospital, Karachi, Pakistan

Objective

To develop and implement a Structured CTG course at the Aga Khan University Hospital for obstetric doctors and nurses that will reduce DDI (Decision to delivery Interval) for emergency cesarean sections done for pathological CTG and improve perinatal markers such as APGAR score, Cord Ph <7.2 and shift to NICU as well as immediate and delayed post-test scores. Design: Quasi-experimental study.

Method

CTG course consisted of three components; the first component was an asynchronous online module which was accessible to the participants one week before the face-to-face workshop. It had a pre and post-module MCQ test and a passing score of 85% was mandatory to attend the workshop. Second component was the onsite workshop; a full-day event with interactive lectures with quizzes in the first half. The second half consisted of case-based discussions and a final written test comprising of MCQs and short answer questions. Scoring 85% was mandatory for CTG certification. Third component was an online case based test conducted 2 months post workshop and formative one-on-one feedback was given to the participants. Post-workshop and online case-based test scores were compared to assess the retention of knowledge.

Results

A total of 281 participants underwent CTG training. Among the doctors there was a statistically significant change in pre test score, that is the median test score pre-test was 75(59.4–87.5)/100 and post test score was 92(87.7–95) (p =0.0005). The score in the refresher module done two months later was 95.5(p = 0.46). In the nurses group the pre-test score was 60.9(37.5–87.5) and post test score was 86(81.7–90) (p = 0.0005).In the refresher module the post-test score was 95.4(82–90) (p = 0.0005). Data was collected on DDI for pathological CTG, babies shifted to NICU and cord pH < 7.25 before the CTG module and will be collected for post module 2 months later. The DDI for 78.5% of patients was more than 30 min. 32.8% of patients had cord Ph less than 7.25 and 27% of babies were shifted to NICU.

Conclusion

Our study shows that an online CTG module, followed by an in-person workshop and a 2 month later online refresher module results in the nurses attaining the same level of knowledge as doctors and this was depicted in similar refresher module scores.We are in the process of collecting follow-up data and expect this significant improvement in nurse's knowledge of CTG to be also translated in improved DDI and reduced proportion of babies shifted to NICU. eP-706 Management of placenta accrete: Anterior uterine excision not possible, subtotal hysterectomy performed A. Alojayli1; S. Bologa1; M. Magro2; C. Otigbah2 1Obstetrics and Gynaecology, Queen's Hospital, Romford, UK, 2Queen's Hospital, London, UK

Objective

Teaching video to show how to manage elective presentations of placenta accrete spectrum disorder (PASD) Design: Short video to show pre-op preparation, identification of PASD intra-operatively, delivery of the baby, use of prophylactic abdominal Aortic balloon occlusion (PABBO) technique, It was not possible to manage the affected area by wedge resection (excision) because of large placenta bulge laterally especially on the left side extending to the broad ligament , therefore subtotal hysterectomy and managing transfusion including the use of cell salvage and post op complications.

Methods

Video presentation of a case showing why was not possible to excise an anterior PASD, and how to perform hysterectomy this includes. 1. identification of a PASD. 2.how to proceed to delivering the foetus avoiding the placenta, (pre-op mapping, fundal classical incision) and closing the incision. 3. the use of abdominal Aortic balloon occlusion (PABBO) technique in an elective cases of placenta accrete. 4. when to excise as opposed to performing a hysterectomy. 5. performing a hysterectomy.

Results

The stepwise method of pre-op ultrasound placental mapping, recognising features of PASD and avoiding the area by applying PABBO technique delivering the baby and closing the incision with placenta in-situ. This followed by trying to preserve the fertility, however, it was not possible and the safest method was subtotal hysterectomy. Queens Hospital has provided a multi-disciplinary approach to the management of PASD since 2015. This has proven to improve the outcome of the women reducing the incidence of maternal morbidity such as blood loss and need for transfusion, need for intensive care, and reduced incidence of bladder injury. It has facilitated the introduction of fertility sparing surgery, reduced length of stay needs for intensive care and morbidity. This video should enable doctors to learn how to manage these conditions electively.

Conclusion

The increasing incidence of caesarean sections has resulted in an increase in the incidence of placenta accrete disorders. PASD centres have been created to manage these conditions, however all obstetricians must be trained on how to identify and manage the presentation of these conditions in emergency and electively. This video aim to show how to manage these conditions in a stepwise manner. eP-707 E-research: A novel e-learning course on critical appraisal of research N. Elbarbary1,2 1Cambridge University Hospitals NHS Trust, Cambridge, UK, 2East of England Deanery, Blended Learning Fellowship, Cambridge, UK

Introduction

Critical appraisal of research is an essential skill for practicing evidence-based medicine. In the post-pandemic era, with insights from changes to ways of life brought by Covid-19, there is a rapid adoption and explosion of online distance learning and blended learning platforms. The aim is to provide a readily available and easily accessible online learning platform and enhance training and learning opportunities. Within medical training in the England, we identified that whilst there was some learning content online, there was a distinct lack of an organised e-learning course to educate junior doctors on clinical research. Therefore, we sought to create a comprehensive course that would enable medical team to learn the key elements of research appraisal via an interactive e-learning platform.

Method

We utilised the 5 step ADDIE model (Analyse, Design, Development, Implementation and Evaluation) as the template to guide our course design. We ensured institutional alignment by mapping the learning objective of the course to those currently set by the Royal College curriculum. Our target audience were junior doctors in early stage of their training together with more senior team members who may need a refresher. The course was designed to rely on an adult learning theory model and we ensured that the design of the course would appeal to all learner types such as visual, auditory and kinaesthetic learners. To ensure high quality content, resources from Cochrane learning were used to support the creation of the course content. Once the content had been created by the specialist, we then refashioned the information to make it more interactive and segmented the content into smaller sections to reduce learner cognitive load. We then created the course using the Rise Articulate platform. Outcome: Once the course was completed on the platform, it was sent to a small pilot group of trainees for review from a learner perspective and edited the course accordingly based on initial feedback. The course will be added to East of England Deanery blended learning platform "Bridge" to ensure wider accessibility to the medical team across specialities.

Conclusion

Distant learning is becoming a stable in education. It allows doctors to learn independently at a time that suits their needs. We believe that we have created a highly interactive e-learning resource that will engage the learner and support their knowledge and practice of evidence-based medicine. eP-708 Empowering obstetric professionals through education: Enhancing fetomaternal health through series of educational workshops in Pakistan A. Malik; R. TulSania OBGYN, Aga Khan University Hospital, Karachi, Pakistan

Background

Pakistan struggles with alarmingly high rates of stillbirths, neonatal and maternal deaths. Aga Khan University Hospital is the first Hospital to develop the subspecialty of Maternal Fetal Medicine (MFM) in Pakistan. Section of MFM took the initiative of designing series of workshops to educate obstetricians nationwide on maternal and fetal conditions contributing to mortality and morbidity.

Objectives

This initiative aimed to enhance knowledge and skills among healthcare professionals, facilitating improved outcomes for maternal and fetal health in Pakistan. Design and Method: This was a quasi-experimental study. A series of four workshops were conducted. Three were dedicated to fetal medicine and one to maternal medicine. Fetal medicine Workshops covered fetal neurological abnormalities, first trimester diagnosis of structural abnormalities, and hands-on ultrasound workshop to detect fetal growth abnormalities. The fourth workshop was on haematological disorders in pregnancy. Workshop size was limited to twenty-four participants, ensuring active engagement through small group activities. Participants prepared presentations on case-based scenarios, followed by interactive sessions led by facilitators. Pre-and post-tests were conducted to assess knowledge change. Kahoot-based quizzes and post-workshop feedback forms were utilized for assessment and participant satisfaction. Post workshop, facilitators emailed participants summarized clinical algorithms developed during the sessions. These serve as quick references for busy clinicians, aiding in active recall of knowledge in busy clinical settings.

Results

A total of 57 participants completed all the pre- and post-tests. Mean pre- test score was 3.89 ± 2.02 out of 10,mean post-test score was 8.94 ± 1.72. There was a significant improvement in knowledge after participating in the workshop. Participants answered 70%–83% of Kahoot Quiz questions correctly. 90% of the participants thought that the objectives of the activity were clearly defined. Responding to whether the presentations were at the level of the participants' understanding 86% of learners graded it as excellent. 86% of the learners rated the acquisition of new knowledge at an excellent level. 95% of the participants thought that all their queries were answered well. 90% of the participants graded the overall activity as excellent .80% of participants responded that the workshop has improved their competence and clinical ability to 50 -100%

Conclusion

This initiative demonstrates utilizing evidence based educational strategies in interactive workshops significantly improves knowledge of obstetric healthcare providers. We plan to study long term knowledge retention through these workshops in our subsequent projects. eP-711 Tackling racial inequalities in maternal outcomes: Amplifying patient voices in undergraduate teaching S. Adebisi; A.A. Khair; S. Atapaka; N. Hossain; V. Sheriff; N. Hajimohammadimalekabadi St George's University of London, London, UK

Objectives

1. To tackle the racial disparities in maternal mortality rates in the UK by incorporating the patient experiences of black and brown mothers into medical school education. 2. To educate healthcare students on how to optimise the maternal care of black and brown women through patient-involved teaching. Design: Two 1.5-h panel discussion events were organised for healthcare students. The first event was an in-person panel of four mothers sharing their most recent maternity experiences. The second event was an online panel with an obstetrician, midwife, and mother sharing their insights on the racial disparities in maternal mortality rates and their proposed solutions. Feedback forms were used to gather data on student engagement.

Method

Panellists were acquired by advertising the speaking opportunities to black and brown mothers on social media, and directly emailing obstetricians and midwives. The events were then promoted through word of mouth, social media, flyers, and university notice boards. The first event with the mothers followed a semi-structured interview format focused on their (1) Antenatal, (2) Labour and (3) Postnatal experiences. The mothers were also asked to provide advice on how future clinicians can optimise their maternal care at each stage. The second event also followed a semi-structured interview format focused on the themes of (1) Addressing the Causes of the Racial Inequalities in Maternal Mortality rates, and (2) Finding Solutions. Narrative summaries were written up of panellist experiences and insights were shared with attendees and local obstetricians. A feedback form was emailed to all attendees after each event.

Results

Across both events, there were 88 attendees and 49 feedback forms submitted. 65% of those who submitted feedback forms reported an increased knowledge of the causes of the disproportional black and brown maternal mortality rates, and 71% expressed an improved understanding of the maternity experience from a patient's perspective. The narrative summary of the discussions highlighted unconscious bias of healthcare professionals and institutional neglect worsening maternal outcomes for black and brown women. Feedback followed the consensus that students want more events like these within their medical training.

Conclusion

By amplifying the voices of black and brown mothers within undergraduate obstetric training, our results show an improvement in healthcare students' understanding of their experiences. This form of patient-involved education may lead to optimised maternal care from healthcare professionals towards black and brown women, and contribute towards decreasing their maternal mortality rates in the UK. eP-712 CREOG scores as a predictor of performance at the MRCOG examinations D. Qadir1; S.A. Neubronner2; C. Mattar2; A. Gosavi2; J. Lee1; M. Mathur1; A. Kanneganti2 1Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore, 2Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore

Objective

The Council on Resident Education in Obstetrics and Gynaecology (CREOG) in-training examination is a formative, MCQ-based knowledge assessment that is organised by the American College of Obstetricians and Gynecologists and is taken yearly by specialty trainees in Singapore's Obstetrics & Gynaecology (O&G) residency training programme since 2011 on top of the requirements to sit for summative examinations to attain membership with the Royal College of Obstetricians and Gynaecologists (MRCOG). This national study was conducted to assess if the CREOG examination could predict performance at the MRCOG Part 2 written examination.

Method

All Singapore O&G specialty trainees who had undergone their MRCOG Part 2 examinations between 2014 and 2023 were invited to this questionnaire study where demographic details and MRCOG scores were correlated with archived CREOG scores. Main comparators were number of attempts and MRCOG Part 2 scores compared with CREOG scores in the first year of training, the year before MRCOG Part 2 (typically year 3 of training), and on the year of MRCOG Part 2 examination (typically year 4).

Results

Our study yielded 36 respondents of whom 19 had their MRCOG Part 2 scores. There was a strong, positive Pearson correlation when comparing MRCOG Part 2 scores with CREOG scores taken in the same year and the year before (r = 0.622, p = 0.004 and r = 0.673, p = 0.002 respectively). There was also a significant positive point-biserial correlation between CREOG scores taken the year before the MRCOG Part 2 examination as well as percentage difference in CREOG scores in the year before MRCOG examination and on the first year of training and on passing the MRCOG Part 2 examination on the first attempt (r = 0.342, p = 0.041 and r = 0.383, p = 0.021 respectively). ROC curve analysis demonstrated that a CREOG examination score of 56.5 in the year before had a sensitivity of 66.7% and a specificity of 100% for passing the MRCOG Part 2 on the first attempt (AUC = 0.822).

Conclusion

In our O&G specialty training programme where, uniquely, both CREOG in-training annual examinations and summative MRCOG examinations are undertaken, both scores correlate well. Continual assessment throughout training is important and may identify trainees at risk of failing the MRCOG Part 2 examination up to a year before and who may benefit from early intervention. eP-729 Pregnancy following bariatric surgery: A retrospective, single-centre study V. Eves; J. Mountfield University Hospital Southampton NHS Trust, Southampton, UK

Objective

Bariatric surgery is affecting increasing numbers of women of reproductive age. Women who become pregnant post-bariatric surgery have greater risk of micronutrient deficiencies and small for gestational age (SGA) infants. Health tourism allows more patients to access bariatric services overseas. However, without appropriate aftercare, complications including poor nutritional status pre-conceptually can arise, making pregnancy higher risk. In the absence of national guidelines for the management of pregnancy post-bariatric surgery, this study aims to assess the current practice at a tertiary maternity unit in the United Kingdom. Design: A retrospective single-centre observational study.

Method

Patients who gave birth at University Hospital Southampton NHS Trust between January 2022-December 2023, who had undergone bariatric surgery were included. Informed by our literature review we included the following criteria and standards of care: type of bariatric surgery, booking BMI, micronutrient screening, vitamin supplementation, gestational diabetes mellitus (GDM) screening, serial growth scans from 28 weeks gestation, mode of birth and infant birth weight centile. Data was collected through analysis of medical records.

Results

A total of 39 women were identified. The most common form of surgery was a gastric sleeve (n = 25, 64%), then gastric bypass (n = 9, 23%) and gastric band (n = 5, 13%). 51% of patients (n = 20) had a BMI >30 and 13% (n = 5) had a BMI >40. 64% (n = 25) were screened for GDM. Nine patients were screened using the oral glucose tolerance test, leading to a risk of dumping syndrome. Four cases of GDM were identified and one had pre-existing diabetes mellitus. Micronutrient screening was carried out in 17% (n = 7) pre-conception, 2% (n = 1) in the first trimester, 12% (n = 5) in the second trimester, 7% (n = 3) in the third trimester and 0% postpartum. 82% of patients (n = 32) were taking vitamin supplements. Serial growth scans were organised for 82% (n = 32). 48% (n = 19) had vaginal births, 10% (n = 4) instrumental births and 41% (n = 16) caesarean sections, similar to the overall departmental rates. An equal number of infants were SGA or large for gestational age (8%, n = 3). Two pregnancies resulted in mid-trimester losses (spontaneous and suspected chorioamnionitis) and six infants were preterm (34+4- 36+6 weeks).

Conclusion

Our study has shown that there is variation locally in the management of women who become pregnant following bariatric surgery. Due to the unique pregnancy-associated risks, national guidelines would be beneficial to standardise care. A local guideline has been developed and a repeat audit of care will be carried out following implementation. eP-730 Implications of coexistence of obesity and pre-gestational diabetes (Diabesity) on pregnancy outcomes S. Minocha; J. Shaikh Obstetrics and Gynecology, Royal Hospital, Muscat, Oman

Objective

The incidence of obesity & diabetes is increasing in reproductive age group. They are both known to result in adverse outcomes in pregnancy, although the effect of their coexistence (Diabesity) is less explored, hence we decided to study it. The objective was to compare outcomes of pregestational diabetes in pregnancy with diabesity in pregnancy at a single tertiary center in Oman. Design: Retrospective observational study.

Methods

All patients with Pregestational Diabetes attending the Diabetes in Pregnancy clinic, at National endocrine center from 1st of January to 31st December 2022 were studied retrospectively. The data was obtained from medical records. The pregnancy outcomes, maternal as well as fetal were studied and comparison made between patients with Preexisting diabetes without Obesity and those with Diabesity.

Results

There were 264 patients during the study period who had pregestational diabetes, of which 188 (71%) were Obese. There were 8 miscarriages, 156 vaginal deliveries, 10 Instrumental deliveries and 140 patients delivered by Cesarean section. Ninety-two (34.8%) of the babies were large for gestational age and 52 (19.2%) were small for gestational age. On comparing the two groups the Women with Diabesity had a significantly higher number of Emergency Cesarean sections and Large for gestational age babies than those with only Pre gestational diabetes. On studying the neonatal outcome, we found 44 (16.6%) had hypoglycemia, 56 (21.6%) had jaundice, 40 (15%) were born prematurely, 64 (24%) were admitted to neonatal intensive care unit and 16(6%) had congenital anomalies.

Conclusion

It was observed that the diabetic women with coexisting obesity had higher incidence of emergency cesarean deliveries and large for gestational age fetuses. This awareness can be applied to care of the women with diabesity during antenatal period. Risk reducing strategies like weight reduction and glycemic control impact the pregnancy outcomes which can be achieved by counseling and multidisciplinary antenatal care focusing on diabetes and obesity together instead of treating them as separate entities. eP-731 Pre-gestational BMI, trimester specific and total gestational weight gain on pregnancy outcomes E. Issac Obstetrics and Gynaecology, SRM Institute of Science and Technology, Kancheepuram, India

Objective

To determine the association between pre gestational body mass index, total gestational weight gain and/or trimester specific weight gain with adverse maternal or neonatal outcomes. Design: Retrospective observational study.

Method

After an extensive review of previous literature, the sample size formula for odds ratio was used to determine the study sample size. We set the proportion as 83% and the odds ratio as 8.42, with a limit of accuracy of 5% and power of 80%; the sample size of this study is 144. We used the universe sampling method to collect obstetric and postnatal details from previous records, and we obtained consent from the patients to access those details through a phone call.

Results

Data compilation and statistical analysis: The data was compiled and analyzed using the Statistical Package for Social Sciences (SPSS) version 20 software. Descriptive statistics were calculated for continuous variables (mean ± SD) and categorical variables (frequency and percentages). A binary logistic regression model was used to determine the relationship between predictors and their predicted variables to account for possible confounders. The adjusted odds ratio was calculated with a 95% confidence interval. A p-value of less than 0.05 was considered statistically significant. To determine the discriminative power of the predictors, the receiver operating characteristic curve (ROC) was used, and the area under the curve (AUC) was calculated. The receiver operating characteristics (ROC) probability curve showed that the model had moderate discrimination capacity for GDM (AUC = 0.591), GHTN (AUC = 0.531), and PROM (AUC = 0.553), but no discriminating ability for LGA (AUC = 0.509). Additionally, the model demonstrated moderate discriminating capacity of pre-gestational BMI (AUC = 0.522) and trimester-specific weight gain (AUC for first trimester = 0.533; AUC for 2nd and third trimester = 0.525) in predicting GHTN.

Conclusion

1st trimester weight gain and total gestational weight gain(GWG) had a positive association with gestational diabetes mellitus (GDM). 2nd trimester weight gain had a positive association with PROM. 3rd trimester weight gain had a higher risk for LGA babies. Hence it is important to know that high quality preconception care is essential to ensure that a woman is in optimal weight prior to becoming pregnant. eP-746 Publishers' post-publication response to concerns regarding false data in women's health B.W. Mol1; S. Siddharth1; J. Nielsen1; J. Thornton2 1Monash University, Melbourne, Australia, 2University of Nottingham, Nottingham, UK

Background

There is increasing concern about the integrity of clinical research. The post-publication review process allows the assessment of potentially problematic papers after publication. The effectiveness and efficiency of post-publication assessment, which adheres to the Committee on Publication Ethics (COPE) guidelines, has not been assessed. Shortcomings of this process will allow the dissemination of potential false clinical research data, thus negatively impacting healthcare. The current study assessed and quantified publishers' and editors' post-publication responses and outcomes on original articles with potentially untrustworthy data.

Objective

To evaluate the effectiveness and efficiency of the post-publication review system in a series of concerns raised on papers published in women's health. Study design: Cohort study.

Methods

Between 2017–2023, we wrote to editors and publishers of women's health journals about potential problematic papers and requested an investigation according to the criteria established by the Committee of Publication Ethics (COPE). For each potentially problematic paper, we tabulated the trial characteristics (type of study, publication year, etc), the timeline of e-mail correspondence with journals and the outcome of the process [retraction, expression of concern (EOC), correction and no wrongdoing found].

Results

We wrote to editors and publishers of 732 precarious papers ((58% randomised clinical trials; 42% cohort studies) published in 185 journals. Until October 2023, 183 (25%) of 732 papers received an outcome (95 papers being retracted, 64 papers received EOC, four corrections, 20 no wrongdoing found) (total retraction/EoC n = 159, 87%), mostly for problems attributed to containing false data (78%). The response rate per journal to issue these outcomes varied between 0% to 100%. One journal retracted 18 articles out of the 19 completed investigations, with the remaining one being challenged for obvious problems (mainly even numbers) It took a median time of 32 months for editors and publishers to issue any outcome. The median time to retraction was 40 months, and the median time taken to issue an EOC was 52 months.

Conclusion

Concerns regarding integrity in clinical research are much more widespread than initially assumed. The post-publication assessment process guided by COPE has many shortcomings, including absent timelines. This has immediate consequences for guideline and meta-analyses, and through that for patient safety. eP-747 Standardising inpatient postnatal care S. Basha1; L. Basha2; S. Mabbutt1; S. Babelli3 1University Hospitals of Leicester NHS Trust, Leicester, UK, 2Wishaw General Hospital, Wishaw, UK, 3Obstetrics and Gynaecology, Raigmore Hospital, Inverness, UK

Objectives

Approximately two-thirds of maternal deaths occur in the postnatal period, with thrombus being the most common direct cause of death in the UK. Rapid repeat pregnancy is another concern in the postnatal period and is associated with increased risk of preterm birth, low birth weight, stillbirth and neonatal death in the second pregnancy. The National Institute for Health and Care Excellence (NICE) in the UK sets out clear guidelines for the care of women in the postnatal period after discharge from hospital but there are no clear guidelines for in-hospital postnatal care. The aim of this project therefore was to standardise the medical review of women in the immediate postnatal period prior to their discharge in University Hospitals of Leicester (UHL) through the development of a proforma with a focus on venous thromboembolism (VTE) prevention and contraception discussion. Design: Initially an audit was carried out to assess the current practice of day 1 post-delivery medical reviews as compared to NICE recommendations. A proforma was then developed with consultant and midwifery input and used on the ward during postnatal reviews by junior staff. Feedback was received from senior clinicians about the practical application and the proforma was adjusted accordingly. A second audit was then carried out to assess if the proforma improved practice.

Methods

This project reviewed medical notes of patients (41 in the initial audit and 38 in the second) in the post-natal ward in UHL. All data were routinely collected and anonymised for the purpose of the audits. Descriptive analysis of results was carried out.

Results

Percentage of reviews documenting specific outcome measures before and after the proforma introduction were compared. VTE score was documented in 15% of reviews before and 79% after, VTE symptoms 44% and 95%, per-vagina blood loss 39% and 95%, uterus examined 41% and 92% and contraception discussed 7% and 16% respectively.

Conclusion

Thorough postnatal reviews are crucial for women in the postnatal period to identify risk factors and discuss future family planning. This project identified gaps in day 1 post-natal reviews in UHL and demonstrated the positive change achieved through the introduction of a proforma to standardise practice. As there are no clear guidelines for inpatient postnatal care, this proforma could be used as an example for other trusts to improve inpatient care for patients. eP-748 Improving estimated fetal weight accuracy at a tertiary center Z. AlSomali1; L. Halawani1; A. Werlang1; T. Zhang2 1Ottawa, MFM, Ottawa, Canada, 2Ottawa Hospital Research Institute, Ottawa Hospital Research Institute, Ottawa, Canada

Objective

This study aims to evaluate the precision of estimated fetal weight (EFW) following the implementation of improvement strategies targeting identified error drivers from a quality assurance project in a tertiary healthcare center in Canada. Design: A cross-sectional retrospective study was conducted, collecting data from two hospitals.

Methods

Building upon a previous quality improvement project at our center, we set a lean goal of reducing errors by 15% through sonographer education and feedback integration. Six months post-intervention, we audited our population and conducted PDSA cycles. Images taken within 14 days prior to delivery were independently analyzed by two examiners, adhering to the 2019 ISUOG biometry guidelines framework. Descriptive statistics were employed, and pre- and post-intervention phases were compared using T-tests (p < .05).

Results

EFW errors decreased from 20% to 5%, with 81 cases identified post-intervention. Individual image analysis and comparison of EFW parameters revealed statistically significant improvements. Particularly, portal vein visualization and corpus callosum splenium (CSP) in abdominal and head parameters, respectively, exhibited significant enhancement. Symmetrical plane alignment for abdominal circumference and head measurements emerged as primary contributors to errors, with abdomen circumference scoring 89% and head measurement symmetry 26%.

Conclusion

Precise EFW is pivotal for clinical decisions and serves as a quality benchmark in antenatal care. The identification of key sonographic error drivers and subsequent feedback resulted in notable improvements, emphasizing the importance of ongoing ultrasound image quality audits. This intervention significantly enhanced EFW accuracy, demonstrating the effectiveness of feedback-driven quality improvement initiatives. eP-749 Patient/healthcare professionals' perception of weekly prophylactic catheter washout: CATHETER II Qualitative study M. Abdel-fattah1; S. Tripathee2; D. Johnson3; L. Constable3; S. Cotton3; M.I. Omar2; S. Maclennan2; T. Catheter Ii3 1Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK, 2Academic Urology Unit, University of Aberdeen, Aberdeen, UK, 3Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK

Objectives

To explore trial participants' experience of long-term catheters (LTC), the acceptability of washout policies, their experience of the CATHETER II trial and satisfaction with outcomes. The objectives for the healthcare professionals (HCPs) were to explore attitudes towards weekly prophylactic catheter washout and views on the provision of training, and participants' ability to enact wash-out behaviours. Design: A longitudinal qualitative study embedded within the CATHETER II randomised controlled trial. This was a community-based study in the UK.

Method

Participants were recruited from the CATHETER II RCT. Study included Semi-structured interviews with trial participants and semi-structured interview and focus group with HCPs. Data were analysed using the Theoretical Framework of Acceptability and Theoretical Domains Framework.

Results

Fifty (24 female, 26 male) CATHETER II trial participants, aged 23–100 years, with LTC and able to self-manage the washout and study documentation participated. Seven HCPs (5 female, 2 male) also participated. The participants had positive attitudes towards weekly prophylactic saline or acidic catheter washouts and other trial elements. Their perceived effectiveness of, and optimism towards washouts, and their altruistic desire to contribute to research motivated them to take part in the trial. HCPs highlighted the need for the trial due to the current lack of robust evidence on best washout policies to guide clinical practice. Participants and HCPs found the ‘ask’ of the CATHETER II trial and the weekly self-administered prophylactic washout to be feasible. Participants engaged in and adhered to all elements of the trial. The participants found the catheter washout training provided during the trial enhanced their self-efficacy, skills, and capability to carry out the washouts. Participants and HCPs agreed that self-management of prophylactic catheter washouts is both feasible and, following training, achievable without any additional support. Participants reported positive outcomes from the weekly washout. These included reduced blockage, reduced pain/infection, reduced need for HCP support, and greater psychological reassurance.

Conclusions

To our knowledge, this is the first qualitative study embedded within an RCT to report on patients and HCPs' perceptions of prophylactic washout. The study shows that weekly prophylactic washout could be beneficial in reducing LTC related complications. Self-management of prophylactic catheter washouts was found to be feasible and acceptable to patients following in-person or distant video training. The catheter washout training was found to be essential, acceptable, and effective in empowering patients to self-manage their catheter washout. These results have the potential to influence guidance for LTC maintenance. eP-751 Improving safety and functionality of maternity triage service at Nottingham University Hospitals N. George; C. Feist; Z. Bond; A. Worsley; H. Kapaya Nottingham University Hospitals NHS Trust, Nottingham, UK

Background

Nottingham University Hospitals (NUH) was established in 2006 following the merger of Nottingham City Hospital and Queen's Medical Centre and serves over 8000 births per year. Over the past five years, Care Quality Commission (CQC) surveys have shown a decline in maternity care experiences with nearly half of all inspected maternity services in the UK rated as needing improvement or inadequate. In response to the CQC inspections, maternity triage services at NUH sought to improve quality of care by addressing inadequacies in risk assessment through implementing the Birmingham Symptom-specific Obstetric Triage System (BSOTS). The BSOTS is a recognised tool aimed at improving the assessment and management of women attending hospitals with unexpected pregnancy concerns. It mandates an initial review within 15 min of presentation and defines clinical urgency using a four-colour category scale.

Objective

To evaluate the effectiveness of BSOTS within auditable standards. Design: This retrospective observational study focused on pregnant women attending hospital post-BSOTS implementation.

Method

Following CQC inspections from 2020–2022 actions were taken to address knowledge gaps and recruitment issues. Operational challenges were tackled by separating our ABC into Maternity Triage, for urgent care and Day Assessment Unit, for planned appointments and additional surveillance for high-risk women. Data from the electronic maternity database (BADGERNET) were used to determine compliance with BSOTS initial 15-min triage. A mixed evaluation method was employed to assess timely review by the medical team once women were assigned a colour category.

Results

The September 2023 CQC report demonstrated that 96.4% women were triaged within 15 min, surpassing the national target of 90%. This represented an improved performance from 39% (CQC, 2021). Post CQC inspection, our internal audits between November 2023 and January 2024 indicated that of 1123 women attending triage, 1046 (93.14%) were triaged within 15 min window. However, a review of January 2024 attendances, showed that 52.6% of women were not timely assessed by the medical team.

Conclusion

The study suggests that adopting standardized maternity triage approaches like BSOTS enhances care flow. However, optimising BSOTS necessitates meticulous planning to meet standards. Despite ongoing scrutiny and regulatory pressures, the NUH maternity team demonstrated commitment to learning and improvements. While initial efforts targeted barriers to achieving the 15-min triage window, recent data highlights the need to address medical review issues for consistent and safe care delivery to women and babies. eP-752 Invasive bacterial infections and antimicrobial management in the peri-partum period H. Machnouk1; S. Sharma2; S. Platt2 1Imperial College London, London, UK, 2Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

Objective

Peri-partum related infections are important contributors to maternal and neonatal morbidity. We investigated maternal and newborn antibiotic use in the peri-partum period and the incidence of bacteraemia. Design: Retrospective review of clinical records of those who gave birth and blood culture requests made between April 2022 and March 2023 in a maternity unit based in London, England.

Methods

Data was collected from electronic health records (Cerner®) and included patient characteristics, mode of birth, labour onset (spontaneous or induction), maternal and newborn blood culture results, maternal urine culture results and antibacterial prescriptions. We analysed positive blood cultures in maternal (-3 to +14 days post-partum) and newborn (+7 days old) patients. Antimicrobial prescribing was interrogated for appropriateness against empiric antimicrobial guidelines.

Results

During April 2022 and March 2023, the median age of women who received maternity care was 34 years (IQR 31–37), and 59.3% were of White British ethnicity. Blood culture was undertaken in 1010/5827 (17.3%) of patients. A positive culture was identified in 40/1010 (4.0%); with non-clinically significant cultures common (e.g. commensal skin flora cultured). Suspected invasive bacterial pathogens were found in 22/40 of blood culture positive women; Group B Streptococcus (9; 22.5%), Escherichia coli (3; 7.5%), Enterococcus faecalis (3; 7.5%) were the most prevalent pathogens. Microbiologically confirmed invasive Group A Streptococcus rates were low (1;0.017%). Maternal age, ethnicity and gestational age was similar in patients with confirmed invasive infections and those without. Positive bacteraemia was confirmed in 11 of 5858 newborns; [SS1] including Escherichia coli (5; 45.5%), Enterococcus sp. (3; 27.3%) and Group B Streptococcus infection (2; 0.03%). As part of the management of peri-partum fever or sepsis screening, empirical antibacterials were prescribed in 1363/5827 (23.4%) of peri-partum women. This included intravenous Cefuroxime (in combination with Metronidazole) (87.7%), Co-amoxiclav (11.7%), Clindamycin (5.3%), with 5.2% of patients receiving multiple classes of therapies. Eighty one percent of those commenced on antibacterials went home on oral medications (most commonly Cefalexin plus Metronidazole (912/1107;82.4%)). Median duration of antibacterial use was 6 days (IQR 5–7).

Conclusions

Febrile episodes during peri-partum period are common and necessitate timely antibacterial initiation. In our study group, approximately 20% of peri-partum women required antibacterials. However, rates of confirmed invasive bacterial infection in mothers and babies remained low. To address the increasing concerns of antimicrobial resistance, clinical prediction models are required to identify those who require antibiotics in the peri-partum period and when the therapy can be discontinued safely. eP-753 MTW infographics S. Nazir1; S. Gregson2 1Obstetrics and Gynaecology, Maidstone and Tunbridge Wells NHS Trust, Pembury, UK, 2Maidstone and Tunbridge Wells NHS Trust, Pembury, USA

Objective

Maternity care relies heavily on data analysis to improve clinical outcomes and enhance patient satisfaction. However, the accessibility and utilization of this data at the frontline of care provision have often been limited. Our primary objective was to introduce a user-friendly tool—infographics—to convey local maternity data effectively to frontline staff, enabling them to better support women in making informed birth choices. Design: We developed a series of six infographics presenting recent local maternity data categorized by Robson groups, accompanied by evidence-based information on coping strategies to improve clinical outcomes and birth experiences. These infographics were designed to be easily accessible and comprehensible by all members of the multidisciplinary team.

Method

Collaborating with the Maternity Voice Partnership, a small multidisciplinary team undertook the development of the infographics. Through iterative cycles of design, pilot testing, and refinement based on feedback from staff and women, the infographics were tailored to meet the specific needs of frontline care providers. Subsequently, the infographics were integrated into clinical practice through mandatory staff training sessions and dissemination across multiple communication channels, including social media platforms.

Results

The adoption of infographics within our trust has yielded transformative outcomes. Over 100 testimonials from staff members across various roles underscored the significant impact of infographics on communication practices and decision-making processes. Notably, staff reported instances where infographics influenced women's choices, leading to more informed decision-making regarding birth preferences and interventions. Furthermore, the ease of access to visualized data empowered frontline staff to engage more effectively with women and their families, fostering collaborative decision-making and enhancing patient satisfaction. The infographics have been adopted by the LMNS and are being rolled out by the other maternity providers.

Conclusion

The widespread adoption of infographics within the LMNS by all four providers of maternity care will be instrumental in bridging the gap between data analysis and frontline practice. By facilitating the effective communication of local maternity data, infographics have empowered frontline staff to support women in making informed birth choices, ultimately improving clinical outcomes and enhancing the overall birthing experience. This successful implementation highlights the value of innovative tools in optimizing maternity care delivery and underscores the importance of continued collaboration and adaptation to meet the evolving needs of patients and healthcare providers. eP-754 Evaluating patient experience of preterm birth prevention clinic at a London hospital A. Ghosh1; S. Parmar1; A. Lawin-O'Brien2; I. Gafson2; S. Bracke2 1UCL Medical School, London, UK, 2Obstetrics & Gynaecology, Whittington Hospital, London, UK

Objective

Preterm birth is the primary determinant of poor infant outcomes and brings huge financial impact [1]. ‘Preterm Birth Prevention’ (PBP) clinics for at-risk patients are instrumental in risk reduction. Follow-up post-preterm delivery is a vital pre-conceptual counselling opportunity, particularly given the increased preterm birth risk in subsequent pregnancies [2]. - Postnatal appointment rates for eligible patients. - Postnatal counselling experiences. - Experiences of antenatal patients receiving preterm birth risk management. Design: Cross-sectional, Mixed-Method Service Evaluation.

Method

Post-preterm birth cohort: Patients who delivered preterm in 2023 and were eligible for follow-up at PBP clinic were identified using electronic hospital databases. The referral rate and inclusion of counselling in follow-up were recorded. Selected patients had telephone interviews to explore their experiences. Preterm prevention cohort: Randomly selected antenatal patients attending PBP clinic completed clinic experience surveys. Some respondents underwent structured face-to-face interviews for further insight. Thematic analysis extracted key feedback.

Results

In 2023, 7.4% of the hospital's deliveries were preterm. 49 patients qualified for postnatal follow-up and 34 were referred. 18 appointments occurred – only 14 included future PBP counselling. All four postnatal patients interviewed found preterm birth traumatic. Three received PBP clinic follow-up and felt well-informed regarding future PBP. One was unaware of eligibility and desired further support. 11 out of 14 surveyed antenatal patients understood their indication for referral to PBP clinic. Seven reported pre-appointment anxiety, attributed by some to previous preterm birth trauma. All patients reported positive clinic experiences but 11 believed a leaflet would be useful for additional pre-appointment information.

Conclusions

Preterm birth can often be traumatic for patients. Patient-centred care and clear communication are crucial in informing and empowering patients during pregnancy. Raising patient awareness of preterm birth optimises individual and national outcomes. - Local education to increase postnatal referral rate, including for those with uncomplicated preterm births. - Provide pre-appointment leaflets to antenatal patients referred to PBP clinic outlining its purpose and structure. - Adjust guidelines to specify the cohort and timing of postnatal follow-up to avoid scheduling during the neonate's hospital admission. [1] NHS England. Saving Babies' Lives Version Two – A care bundle for reducing perinatal mortality [Internet]. 2019 Mar p. 40. Available from: https://www.england.nhs.uk/wp-content/uploads/2019/07/saving-babies-lives-care-bundle-version-two-v5.pdf. [2] Phillips C, Velji Z, Hanly C, Metcalfe A. Risk of recurrent spontaneous preterm birth: a systematic review and meta-analysis. BMJ Open. 2017;7(6):e015402. eP-756 Audit on management of major obstetric haemorrhage and recommendations to improve care N. Sadeghi1; N. Rashid2; I. Lodhi1; S. Banu1 1Frimley Health NHS Trust, Slough, UK, 2The Hillingdon Hospitals NHS Foundation Trust, London, UK

Objective

Major obstetric haemorrhage (MOH) is a leading cause of maternal morbidity and mortality worldwide and primary postpartum haemorrhage (PPH) is the most common form of MOH. As per RCOG, severe PPH is considered a blood loss of more than 2000 mL in women with body weight of more than 60kg. Our objective was to analyse our Trust's compliance with the local and national guidelines on peri partum management of MOH and provide recommendations to improve service and patient care. Design: This study was a retrospective audit from patients maternity notes.

Method

Women who experienced MOH with the blood loss of 2000 mL or more between January 2022 and January 2023 at a district hospital in the UK were included. 40 cases were identified and their medical records evaluated. Data was collected from Electronic Patient Records for patient demographics, risk factors, interventions and outcomes during pregnancy, labour and postnatal period. A questionnaire was designed for data entry and results analysed using Microsoft Excel. This audit was registered with the Trust Quality and Clinical Effectiveness team.

Results

Our analysis demonstrated 35% (n = 14) of cases were primipara and 77% (n = 31) were at term gestation. MOH was noticed in 57.5% (n = 23) of women who had either elective or emergency caesarean section. The most common antenatal risk factor for MOH was sub optimal correction of anaemia (65%, n = 26). Similarly the most common intrapartum risk factors were prolonged labour more than 24 h (12.5%, n = 5) and prolonged oxytocin infusion (10%, n = 4) more than 12 h; both contributed to atony of uterus and trauma that were the two major causes of MOH. Consultant obstetricians were informed of the events in 96% (n = 38) of cases and all cases were investigated using robust internal process and women debriefed appropriately. No mortalities happened as a result of MOH.

Conclusion

In our study, MOH rate was higher than the national average. Prompt identification of ‘at risk’ patients, eg correcting anaemia, may reduce the morbidity and mortality associated with MOH and improve outcomes. Regular retraining of staff on the ‘MOH protocol’ and documentation of proformas raises awareness of major events. Multi-disciplinary team involvement in the prompt recognition and management plans as well as ‘skills drills may also improve outcomes. eP-757 Clinical audit: Management of massive obstetric haemorrhage at Hereford County Hospital A. Tahir1; A. Pervaiz2; F. Nazim2 1Hereford County Hospital, Wye Valley NHS Trust, OGYN, Hereford, UK, 2Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK

Objective

This audit aimed to evaluate the management and care provided to women experiencing massive obstetric hemorrhage against the standards outlined in the RCOG' Prevention and Management of Postpartum Hemorrhage', Green-top Guideline No. 52. Design: It was a retrospective audit spanned from January 1, 2022, to December 31, 2022.

Method

All patients who developed massive obstetric hemorrhage within hospital were included . Patients with bleeding disorders and on anticoagulants were excluded. Data collection was done from Badgernet (electronic record system) and included antenatal screening, risk assessment during labour, multidisciplinary team involvement, medical and surgical management followed by debriefing, documentation and incident reporting. Data analysis was done using percentages and compared against set standards from RCOG GTG #52.

Results

This study encompassing 1643 deliveries, with 45 cases of major PPH, resulting in an incidence rate of 2.73%.The most common cause identified was Uterine atony (67%) followed by genital tract trauma (28%). Results indicated high compliance rates in antenatal anaemia screening, uterotonic administration, risk factor assessment, notification protocols, and multidisciplinary team training. However, areas for improvement were identified, particularly in documenting the use of high-flow oxygen (5%) and insertion of two wide-bore cannulas (33%).

Conclusion

In conclusion, while adherence to certain standards was high, there were areas identified for improving care, particularly in documentation practices and optimization of medical interventions. Recommendations for improvement included the use of ROTEM in all cases, optimizing the use of medical management options such as Misoprostol and Carboprost when not contraindicated, and ensuring thorough debriefing of the patient as well as staff providing care and documentation of events. To address documentation gaps, it was proposed to incorporate scanning of scribe sheets into electronic medical records systems such as Badgernet. eP-758 Ensuring safety in caesarean section deliveries: A comprehensive approach H. Akter; M. Leelakutty Obstetrics & Gynecology, Furness General Hospital, University Hospitals of Morecambe Bay NHS Trust, Cumbria, UK

Background

In the UK, the prevalence of caesarean sections has risen due to various medical, cultural, and organizational factors. Approximately 25% to 30% of women undergo caesarean births, with factors such as maternal age and body mass index (BMI) contributing to the increase. The World Health Organization recommends a caesarean section rate of 10%–15% for optimal maternal and neonatal outcomes. It aims to improve the consistency and quality of care for women who are having a caesarean birth. While the procedure is often necessary and lifesaving, it carries risks for both mother and child which itself can be serious and life threatening. Hence, ensuring appropriate education for women regarding delivery options and adherence to standards is crucial.

Objective

To determine adherence to NICE NG192 Caesarean Section, UHMB Maternity Services Clinical Guideline Review the indication for, timeliness, counselling, booking, preparing, performing and documenting caesarean section. To determine the measurable impact of the action-planning process following the previous round of the audit. Design: A prospective rolling audit was conducted on all caesarean section operations performed at Furness General Hospital (FGH) over a one-year period.

Method

The data was manually extracted from case notes available on Lorenzo and Badgernet and analyzed using Excel. Important auditable standards are indication, documentation, counselling, types of anesthesia, decision delivery interval, antibiotic administer, appropriate referral and thromboprophylaxis.

Results

Out of 960 births, 44.6% were by caesarean section, 26.4% emergency and 18.2% elective. Documentation standards met in 100%. Analysis of emergency caesarean revealed improvements in incident reporting, prophylactic antibiotic administration, and cord gas collection. However, initial data on elective caesareans showed poor adherence to counseling and referral to appropriate services. Results were analyzed quarterly and if standards were not met, recommendation and action plans were made for improvement. We used 3 min brief, learn from audit posters, reminder emails, preoperative check list on regular basis to remind staff. Subsequent audit meetings led to significant improvements in these areas.

Conclusion

The analysis demonstrates that FGH provides good obstetric care to caesarean section patients, although the rates of the procedure surpass national levels. Additionally, there are identified gaps in ensuring that women opting for elective caesarean sections are adequately informed about delivery options and referred to appropriate support services. eP-759 Quality of care in the management of intrauterine fetal death L. Singh; S. Vali; D. Paraschiv Obstetrics and Gynaecology, King's College Hospital, London, UK

Objective

Intrauterine death (IUD) is a captivating area within obstetrics and gynaecology. It has profound biopsychosocial effects for women and their families. According to the 8th Annual Report of the Confidential Enquiries into Stillbirths and Deaths in Infancy (CESDI), suboptimal care is evident in 50% of pregnancies resulting in IUD. King's College Hospital (KCH) is a major tertiary referral hospital in London with nearly 5000 deliveries per year. This project aimed to assess the characteristics of women experiencing an IUD alongside management for induction of labour (IOL), assessment for cause of IUD and overall grading of care. Design: A retrospective audit of all intrauterine deaths from 22+0/40 onwards occurring in 2022.

Methods

Data was obtained via the national Perinatal Mortality Review Tool (PMRT) and electronic patient records. Data including demographics, obstetric risk factors, medical management of IUD, investigations conducted and grading of care were extracted onto a pre-designed Excel spreadsheet. Simple descriptive analysis was undertaken. Local hospital trust guidelines and national PMRT data were used as the auditable standard.

Results

A total of 25 women and 28 intrauterine deaths were included. Women experiencing an intrauterine death were more likely to be late bookers (36% within IUD cohort vs 10% of all women booking at KCH in 2022) and of Black African ethnicity (28% in cohort vs 7% of all booked women). The majority had correct administration of mifepristone (86%) and misoprostol/Propess (64%) where indicated for IOL. There was poor adherence to protocol for active 3rd stage, with only 17% receiving Syntocinon 10iu IM. The majority (56%) had care issues identified which would have made no difference to the outcome of the baby, with themes including non-identification of high risk women, management of vulnerable patients and non-attendances.

Conclusion

Within KCH, women who are late bookers and of Black ethnicity are at higher risk of experiencing an IUD. Our regime for induction following IUD is generally administered well, however improvements are needed in provision of active 3rd stage and investigations following IUD. Targeted interventions to improve care issues are required. eP-760 Quality audit: Defaulters in outpatient department, obstetrics and gynaecology, Nizwa Hospital U.U. Singh1; I. Hamdi2; Q. Ambusaidi1; A. Kaushal3 1Obstetrics and Gynaecology, Nizwa Hospital, Nizwa, Oman, 2Nizwa Hospital, Nizwa, Oman, 3University of Alabama, Birmingham, USA - To find the causes, leading to default in attending the appointments. - To suggest the methods to reduce the number of defaulters. Design: Prospective observational study. - A list of appointments and defaulters were studied daily from 2nd to 16th April, 2017. - Defaulters were contacted telephonically with the help of Medical record staff to find out the reasons for non-attendance. - A re-audit after 12 months.

Results

In this study, Defaulter rate is the percentage of patients who did not attend their appointments, out of the total appointments given by the medical records, in Obstetrics & Gynaecology outpatient clinic. In the year 2016, a total of 17 385 appointments were given in the department, out of which only 11 905 visits were registered, and 5480 patients were defaulters. A defaulter rate of 5480/17 385 = 31.5%. - One third of the defaulters could not be reached to know the reason for their default.Causes for default included – Patient was admitted, forgot about the appointment, Lack of transport, improved clinically, change in institute, among others. - 24% were admitted but their appointments were not deleted. - 11.5% appointment could not be changed or deleted by the Clinician. A meeting between the clinician and medical records was organized, to update how to delete the unwanted appointments. Financial limitations of calling the Patient's limited the study to 2 weeks. Re-audit was done after one year for 2 weeks from 1st April 2018 to 16th April 2018. In the second part of the study, total Defaulters- 177 out of 781 appointments (22.6%). Actual defaulters were only 83(10.6%). 54(6.9%) defaulted due to error in medical record system. 29(3.7%) supposedly defaulted as even after admission, their appointment were not deleted. This can be reduced further to zero. A falling trend in the defaulter's rate is noted- 35% in 2015 to 27.1% in 2018.

Conclusions

Defaulters, at outpatient clinics, are common with rates ranging between 5% and 39%. We conclude that improved strategies for communications with patients, a flexible appointment system, & better communication between the clinical and administrative teams can result in a decrease in defaulter's rate in this busy clinic. Defaulter rate can be studied as one of the Key performance indicator for the department's strategic plan.

Keywords

Defaulter rate, Outpatient clinics eP-761 Preterm birth prevention: A clinical and educational quality improvement project G. Monaghan; R. Ampomah; I. Gafson; A. Lawin-O'Brien; S. Bracke Whittington Hospital, London, UK

Objective

To assess the success of accurate risk stratification for preterm birth as per NHS England's Saving Babies Livers Version Three (SBLV3), using a screening tool at booking, and its effectiveness in therefore preventing preterm birth within a maternity hospital. To evaluate the success of educational interventions introduced as a result of the previous year's audit and identify areas for further education and improvement. Design: Reducing the incidence of preterm birth involves prediction, prevention, and preparation as per SBLV3. A year on from the initial quality improvement project, this re-audit allowed us to investigate the effectiveness of our screening tools in predicting and preventing preterm birth in intermediate and high-risk pregnancies. - Audit of 35 consecutive cases from May-July 2023 to measure; - The percentage of women that are assessed for preterm birth risk factors at booking and stratified to low, intermediate, and high-risk pathways. - The percentage of those assessed to have an increased risk who received referral to the appropriate pathways. - Audit of the cases seen in the preterm birth prevention clinic from May-July 2023. Studied the proportion of women who received intervention, as well-as those who did not receive intervention and their subsequent outcomes. - Audit of all the preterm births in 2023 to see if any could have been prevented through better risk assessment at booking. - Of the 35 consecutive cases, 24 patients were correctly screened and identified as low risk for pre-term birth. 11 cases were identified as intermediate or high risk. - Of the 35 patients, 7 of them received intervention (5 progesterone only, 2 progesterone + cerclage). 1 patient receiving progesterone had a pre-term delivery, and 1 patient receiving progesterone had a miscarriage. No patients without intervention delivered prematurely. - During 2023, 120 patients (7.4%) who were booked at an early gestation delivered prematurely. All those with a pre-existing risk factor for preterm birth were referred to the appropriate clinic.

Conclusions

This quality improvement project concludes that the educational interventions introduced from the previous year audit have significantly improved screening and referral at booking. Multi-disciplinary education at study days, message of the week and adaptation of the screening tool itself have all served to improve patient care and outcomes. New national guidelines need to be disseminated through educational interventions to ensure that practice changes in accordance. eP-762 Obstetric early warning sign system to identify deterioration in pregnant, postnatal women A. Nelakuditi Obstetrics and Gynaecology, Aster Ramesh Hospital, Guntur, India

Objective

To monitor the compliance to documentation of oews charts to reduce the incidents related to delayed identification of early signs of patient deterioration and enable prompt and appropriate intervention thus improving patient outcomes. Design: As a clinical audit for the study period. The appropriate use of OEWS-Ensures an accurate assessment of a patient's clinical parameters, followed by calculation and documentation of the OEWS charts, Enabling an appropriate and prompt intervention based on the derived score with a goal of improving patient outcomes related to postpartum hemorrhage, and hypertension. Methodology: • Study Period-January2023 – June 2023 • Number of cases audited -326 Data Collection Sources: 1. checklists regarding staff knowledge about OEWS use and importance of escalation and prompt action. 2. Documented OEWS charts. 3. Patients EMR records including patients plan of care. Inclusion Criteria: Every time a set of observations is performed on antenatal or post natal women, All obstetric inpatients must have a full set of observations and a OEWS calculated at every transfer to a new area ), in order to help identify changes in trends of observations. Exclusion Criteria: Women in active labour.

Results

In the month of January incomplete documentation was 73% which improved to 10% in the month of February after staff training , continuous monitoring and observation the documentation .The incidents related to delayed documentation were 3 cases where patients had to be shifted to intensive care unit due to deterioration which improved in the subsequent months dure to the audit where there were no further incidents and there was 100% complete documentation and we formed our own PPH , Hypertension and bundle care pathways.

Conclusion

Meticulous monitoring strategies will prevent morbidity and mortality in Pregnant women. It facilitates prompt communication between nursing and medical staff when deterioration in a ward patient's condition first becomes apparent on the observations chart. Intention of this system is to result in earlier intervention on the ward so that transfer to a critical care facility is either prevented or occurs without unnecessary delay. We shall audit the monitoring of OEWS charts when ever there is involvement of new staff among care givers so as to avoid the gaps in patient care. • Training is made mandatory in the induction for new joiners (nursing staff) and competency check. • OEWS is an important risk management tool in saving lives and improving maternal care. eP-763 Enhancing NIPT uptake: Fetal RhD genotyping in Rhesus negative pregnant women C. Oseki; D. Obeng-Tuudah; S. Dymek; R. Takpe; V. Sowunmi; A. Adeyemo Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK

Background

Non-Invasive Prenatal Testing (NIPT) for fetal Rhesus D (fRhD) genotype aims to optimize antenatal anti-D immunoglobulin prophylaxis in RhD negative pregnant women, thereby reducing the risk of haemolytic disease of fetus and newborn. Despite its potential benefits, initial uptake was suboptimal.

Objective

This study aimed to assess the awareness and uptake of NIPT for fRhD genotyping among eligible women and identify barriers to implementation. Additionally, the performance of NIPT in our local population was compared to national statistics. Design: A quality improvement project (QUIP) was conducted at a North London District Hospital, involving questionnaire-based patient interviews/surveys and a reaudit of hospital records. A subset analysis comparing fRhD genotype and post-delivery cord blood group was performed.

Methods

Two hundred and thirty-two RhD negative pregnant women were identified, and their NIPT fRhD status reviewed. Additionally, 110 eligible women were interviewed to ascertain reasons for uptake or non-uptake of NIPT. Data analysis was performed using proportions and percentages.

Results

Over the study period, NIPT uptake improved from 48% to 73%. Fetal RhD genotyping yielded positive results in 60% of cases and negative results in 32%. Subgroup analysis demonstrated high sensitivity (100%) and specificity (97.3%) of antenatal NIPT compared to post-delivery cord blood group. Patient survey revealed a high level of awareness (87%) of fRhD genotyping, with 85% of respondents undergoing testing. Barriers to uptake included lack of interest and gestational age eligibility.

Conclusion

Despite improvements in awareness and uptake of NIPT, further patient education and engagement are warranted, particularly among ethnic minority populations with limited English proficiency. Strategies such as translation of patient information, posters in waiting areas, and integration of fRhD testing with combined aneuploidy screening may enhance uptake and optimize antenatal care delivery. eP-764 HPV awareness in Delta, Egypt O. Shady1; M. Ragab2; R. Barakat1; G. Elkanishy2 1Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt, 2Mansoura University, Mansoura, Egypt

Objective

This study aimed to evaluate and enhance awareness concerning Human Papillomavirus (HPV) and its implications, particularly cervical cancer, across diverse age and socioeconomic groups in Delta, Egypt. Design: A survey of nine multiple-choice questions was conducted among 1200 participants to gauge their understanding of HPV, its role in cervical cancer, and the importance of cervical cancer screening.

Method

Participants were selected from various demographic backgrounds. Data collection involved administering the survey and analyzing responses to assess awareness levels before and after intervention. Subsequently, targeted interventions were initiated, including awareness campaigns in Mansoura University outpatient clinics and Gezirat Elward Sporting Club, along with educational video posted on social media platforms, TV interview and international CNN interview and providing the VIA test and the vaccine in Mansoura University Hospitals.

Results

Initial findings revealed low awareness levels regarding HPV, its transmission, and preventive measures, with only 7.57% aware of HPV and 54.5% cognizant of cervical cancer. Following interventions, significant improvements were observed, with 27.3% reporting awareness of HPV and 81.4% aware of cervical cancer. Additionally, knowledge about HPV transmission increased to 30.2%, and 9.9% recognized genital warts. Notably, willingness to receive the HPV vaccine surged from 80% to 87% post-intervention.

Conclusions

The study underscores the critical need for targeted awareness campaigns to enhance knowledge about HPV and cervical cancer prevention. Positive changes post- intervention underscore the effectiveness of targeted educational initiatives. Recommendations include sustained awareness campaigns in healthcare and educational settings, integration of HPV education into school curriculums, and efforts to improve accessibility and affordability of HPV vaccination. Long-term strategies are essential for sustained improvement in HPV awareness and prevention efforts. eP-765 Patient self-referral pathway for the early pregnancy assessment unit M. Morje1; C. Gangoo2; B. Champion3 1Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK, 2University Hospital Lewisham, Lewisham and Greenwich NHS Trust, Women's Health, London, UK, 3The Portland Hospital, London, UK

Objective

To improve patient access to the Early Pregnancy Assessment Unit (EPAU) at Lewisham and Greenwich NHS Trust. Design: Prior to our intervention, patients were referred to the EPAU by General Practitioners (GPs) or the Accident & Emergency (A&E) department using an electronic form that needed to be emailed to the generic EPAU inbox. Between August 2020 and December 2021, 32% of formal complaints made to EPAU stemmed from challenges in accessing the unit. To improve accessibility and patient satisfaction, we implemented a self-referral pathway in March 2022, inspired by the well-established antenatal care booking model.

Method

We developed a concise electronic form accessible to patients, GPs and A&E practitioners through the hospital's website. The form comprised of specific questions that would enable the nurses to prioritise cases based on clinical urgency. Once completed, the forms were automatically routed to the EPAU email inbox which was staffed from 08:00 to 16:00 on weekdays. Subsequently, the EPAU nurses would telephone the patients to gather additional details and provide personalised clinical advice, reassurance and/or schedule an ultrasound scan assessment. The electronic form was advertised on the hospital website. Hospital staff were informed through the intranet and GPs were informed through the local Clinical Commissioning Group's email bulletins. Moreover, to accommodate a diverse population, the electronic form could be translated into multiple languages via the hospital website. Patients without internet or telephone access retained the option of seeing their GPs to seek a referral through the same pathway.

Results

Following a 3-month pilot phase, patient feedback on the accessibility of the service was obtained through a short questionnaire. 97% of patients stated that the form was easy to use. Qualitative feedback stated that the process was straightforward and avoided unnecessary attendances to A&E. Since the implementation of the electronic self-referral system in 2022, there have been no complaints regarding access to the EPU, marking a significant achievement in our ongoing efforts to enhance patient care pathways.

Conclusion

An electronic self-referral form made accessible to patients, A&E and GPs can improve patients' access to care, reduce the burden on emergency services and improve patient satisfaction. Implementing this solution is straightforward and efficient as well as being a sustainable alternative to traditional paper forms. It can also serve as a valuable audit tool for the EPAU dashboard as it provides accurate timestamps and an electronic trail. eP-766 Improving compliance to correct dose of dexamethasone for antenatal steroid cover H. Shaikh; A. Aziz; Z. Islam; A. Malik; A. Raza Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, Pakistan

Objective

Prescribing corticosteroids before an expected preterm birth is a vital prenatal preventive strategy that significantly improves neonatal outcomes. Many societies recommend standard four dose regime of dexamethasone or 2 dose regimes of betamethasone, to be administered to fetuses at risk of preterm birth. However, in our department there is a wide variation in the practices regarding administration of dexamethasone and we have not yet achieved compliance with international guidelines. This project aims at improving 100% compliance with the standard dose and regimen of antenatal corticosteroids used for fetal lung maturity. Design: Plan-Do-Study-Act (PDSA) quality improvement methodology.

Methods

All preterm patients being admitted in our department to receive steroid cover for lung maturity were included in this project. The study was conducted in three phases. Phase I involved planning and conducting a baseline assessment in the department which included observing current steroid cover practices, indications, and dosage regimens. Data was collected on proforma. Phase II involved implementing an intervention phase: (i) Briefing for consultants, residents, and nursing staff to ensure correct dosage implementation; (ii) an awareness week was planned featuring quizzes, and reinforcement posters; (iii) Compliance record sheet is maintained, with a focus on exploring individual reasons for noncompliance. Phase III, the Post-Implementation Assessment, involves ongoing monitoring of compliance to the regimen and ensuring the correct dose is administered. It will identify non-compliant individuals and explore their reasons for not adhering to the evidence-based standard recommendation.

Results

A total of 100 patients were included, 50 in each pre- and post-intervention groups. The most common risk factors for administration of dexamethasone were fetal compromise (24%) followed by preterm labor (21%). Before the awareness campaign, 40% of patients received the 4-dose, 6 mg regimen, which increased to 82% post-campaign (p = 0.041) after the 1st PDSA Cycle. Among the 41 patients following the new regimen, 32 completed all 4 doses of dexamethasone, while 9 delivered before completion of regimen. Incidences of intraventricular hemorrhage (IVH) were observed in 4 neonates, sepsis, and hypoglycemia were observed in 4, 1, and 20 neonates, respectively. Notably, there was no statistically significant difference in neonatal outcomes between groups receiving 2 doses of 12 mg or 4 doses of 6 mg dexamethasone.

Conclusions

By using the PDSA methodology, there was significant improvement in standardization of the dexamethasone administration to patients delivering preterm, initially the compliance to correct dosage was 40% which post campaign is now increased to 82%. eP-768 Unmasking UTIs in pregnancy: A look at bugs and drugs M. Ramanunny1; L. Alansari1; Y. El khawly2; S. Kassim1; S. Wazir1; F. Koujan1 1Obstetrics and Gynecology, Hamad Medical Corporation, Al Wakra, Qatar, 2Pharmacy, Hamad Medical Corporation, Al Wakra, Qatar

Objective

Urinary tract infections (UTIs) during pregnancy pose substantial risks to maternal and fetal health. Physiological changes and hormonal fluctuations increase susceptibility to UTIs in pregnant women. This retrospective study at Al Wakra Hospital aimed to assess the prevalence, causative microorganisms, and antibiotic sensitivity of UTIs in pregnant women, providing valuable insights for effective management and prevention strategies. Design: Retrospective analysis Methods: A retrospective analysis was conducted on 485 urine cultures obtained from pregnant women for a period of two years at Al Wakra Hospital. The reasons for culture requests, causative microorganisms, and antibiotic sensitivity patterns were evaluated.

Results

The prevalence of positive urine cultures was 11.75%, indicating a significant burden of UTIs in pregnant women attending Al Wakra Hospital during the study period. Among the reasons for culture requests, routine screening emerged as the most common, representing 60.62% of cases. Other indications included evaluations for chorioamnionitis (2.06%), preterm labor (1.65%), fever (2.27%), and specific symptoms (<1% each). The predominant causative microorganisms identified were Escherichia coli (2.45%), Streptococcus agalactiae (9.78%), and Klebsiella pneumoniae (1.22%). Additionally, other microorganisms such as Candida, Pseudomonas spp., Staphylococcus saprophyticus, coagulase-negative staphylococcus, Streptococcus viridians group, Lactobacilli, Pseudomonas aeruginosa, and Enterobacter cloacae were identified, highlighting the diversity of pathogens associated with UTIs in this population. Antibiotic sensitivity analysis revealed that common UTI bacteria showed good sensitivity (66.67%) to penicillin, Augmentin, Nitrofurantoin, and Ampicillin. However, a subset of bacteria, including those resistant to extended-spectrum beta-lactamases (ESBL), exhibited lower sensitivity (17.54%). Notably, Pseudomonas demonstrated reduced sensitivity (15.79%) to commonly used antibiotics.

Conclusion

This comprehensive analysis underscores the significant burden of UTIs in pregnant women at Al Wakra Hospital. Routine screening emerged as a crucial approach for identifying UTIs in this population, emphasizing the importance of proactive screening and diagnosis. The diversity of causative microorganisms and their varying antibiotic sensitivities highlights the complexity of UTI management during pregnancy. Tailoring treatment strategies based on antibiotic sensitivity profiles is essential for optimizing clinical outcomes and minimizing adverse consequences for maternal and fetal health. These findings provide valuable insights for guiding clinical practice and enhancing care delivery for pregnant women with UTIs. Further research is warranted to explore additional factors influencing UTI prevalence and management in this population. eP-769 Associations between delivery on high obstetric volume days and severe maternal morbidity I. Yun1; E.-C. Park1; J.Y. Nam2 1Department of Public Health, Yonsei University, Seoul, Korea, 2Department of Healthcare Management, Eulji University, Seongnam, Korea

Background

Interest in the effects of obstetric provision factors on maternal health is increasing; however, a few large-scale, nationwide cohort studies have identified the effects of hospital-specific volume performance on severe maternal morbidity (SMM). Design: Retrospective cohort study.

Objective

To estimate the association between delivery on high-volume days and SMM and the association stratified based on the type of hospital.

Methods

A population-based cohort study using delivery cohort data from the Korean National Health Insurance Service database from 2013 to 2015 was conducted. Overall, 1 210 223 individuals were included after the exclusion of those who gave birth at non-medical institutions and those with missing data. Hospital-specific high obstetric volume days were defined as unusually busy days in a labor and delivery unit. A high-volume day was set when the number of births on that day exceeded the 75th percentile of the average number of each hospital's daily deliveries. The main outcome, SMM, was established using an algorithm developed by the Centers for Disease Control and Prevention and was defined as the occurrence of at least one of the 21 indicators during hospitalization for childbirth.

Results

Those with SMM accounted for approximately 2.1%, and those who delivered on high-volume days accounted for 34.0%. Compared to those who delivered on low/average-volume days, those who delivered on high-volume days showed a tendency to experience increased SMM; however, the adjusted association was not statistically confirmed (crude risk ratio [RR]: 1.05, 95% confidence interval [CI]: 1.02–1.08; adjusted RR: 1.01, 95% CI: 0.99–1.04). When stratified analysis was performed according to the type of delivery institution, it was confirmed that individuals who gave birth on high-volume days at general hospital-level institutions were more likely to experience SMM than those who delivered on low/average volume days at the same level of institutions (crude RR: 1.16, 95% CI: 1.10–1.24; adjusted RR: 1.07, 95% CI: 1.00–1.14). Particularly, the association was remarkably observed when giving birth at a general hospital outside of Seoul (general hospitals in metropolitan cities, adjusted RR: 1.18, 95% CI: 1.05–1.32; general hospitals in cities and counties, adjusted RR: 1.13, 95% CI: 1.03–1.24).

Conclusion

This study found the associations between delivery with high-volume days and risk of SMM, especially general hospitals outside of Seoul were significantly associated with SMM. Thus, policies that can improve the quality of maternity care, such as the allocation of sufficient medical resources to nonurban areas, are required. eP-770 Improving and updating the gynecology handover in Queen Elizabeth University Hospital N. Badr1; C. Hardie2 1Obstetrics and Gynaecology, St John's Hospital NHS Lothian, Livingston, UK, 2Obstetrics and Gynaecology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK

Objective

It is recommended by RCOG (Improving Patient handover Good Practice No.12) to follow ISBAR during any handover between medical staff. This is to maximise on patient safety and to avoid missing information. The aim in this QI is to improve the quality of the handover sheet, to make it more informative and organised and to improve the communication between the gynecology on call team during the shift. Design: Team assigned to collect Information about the medical staff opinion on the current handover by using feedback survey. From this data we recognized that we need to improve the Handover sheet and to emphasize more on the importance of the catch up meetings between the middle grade and the junior team.

Method

Two cycles of changes were applied . We amended the initial changes as it was confusing to the staff as we did not follow the ward room order. We adopted the second cycle successfully after collecting data from the feedback survey and after agreement of Gynecology lead team . The approved changes were : 1) We added one column of status which defines which patients are waiting for CEPOD, for early pregnancy ultrasound urgent slot, new admission, inpatient for follow up or inpatient waiting discharge. 2) Age was added in the background column. 3) Date of the sheet was added to make sure that we are discussing the most recent sheet. 4) We kept the numerical order of the beds in the sheet.

Results

Before starting the QI, only 37% of the medical staff evaluate the sheet 8 out of 10 and 50% stated that they attend the catch up meeting. After implementing the changes, 90% of medical staff evaluate the new handover sheet by 8 out of 10, 80% attend the catch up meetings and 75% of them agreed and acknowledge the changes made.

Conclusions

Changes made to the handover sheet aimed to improve handling information and subsequently improve patient safety. That aimed to avoid unnecessary loosing the Gynecology slots in the CEPOD or in the early pregnancy scan daily slot. The changes were recognized by the team after using the new handover sheet. learning points were : Small but effective changes are more acceptable by the team. Gradual alteration is better received and understood by the medical team. We kept the layout of the sheet in the ward room order to avoid confusion during the ward round. eP-771 Ambulatory hysteroscopy services – In patients' eyes T. Valencia; S. Das; S. Sadiq Obstetrics and Gynaecology, West Middlesex University Hospital Chelsea and Westminster Hospital NHS Trust, London, UK

Introduction

Hysteroscopy is the gold standard test for uterine and endometrial abnormalities following abnormal uterine bleeding. Failed outpatient hysteroscopies (OPH) can lead to unnecessary harm by delaying diagnosis and increasing risk through general anaesthetic. Our aim is to quantify the experience of patients undergoing OPH in West Middlesex Hospital (WMH) during October 2023.

Method

We used the British Society for Gynaecological Endoscopy OPH- Patient Satisfaction Survey (OPH-PSS) questionnaire. This 22-item questionnaire details patient experience pre-consultation, during consultation and throughout procedure. Results were compared to outcomes of the benchmark OPH-PSS study(1).

Results

N = 50 questionnaires were collected. Smaller proportion received written information in the audit (80%) compared to the study (87%). 94% of patients agreed that they were given the opportunity to discuss analgesia compared to 71% in the benchmark study, with 94% receiving pain relief information. A smaller proportion (22%) felt slight pain (vs 47.7%). Fewer (2%) felt pain mostly versus 12.5% reporting pain throughout procedure in the study. A higher percentage reported never feeling anxiety (28%) compared to the study (24.45%). Overall, more of patients in this audit (94%) agreed that their overall experience was good (vs 90%). However, there was a high number of participants who abstained replies to some items in the questionnaire (36%–42%).

Conclusions

Overall, there was excellent patient experience, and the majority would choose the same procedure again. We recommend producing a local patient information leaflet regarding OPH; pre-procedure counselling to reduce waiting times; and exploring other novel forms of analgesia: gas and air, virtual reality, topical analgesia, or nerve blocks.

Reference

1. Mahmud, A., Smith, P. and Clark, T.J. (2021). Eur J Obstet Gynecol Reprod Biol, 259(259), pp. 211–221. https://doi.org/10.1016/j.ejogrb.2021.01.028. eP-772 Effectiveness of interventions to enhance person-centered maternity care and evidence-based care M. Rishard1; H. Riyal1; H. Senanayake1; M. Lazzerini2 1Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, 2WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy

Objective

We aimed to implement tailor-made interventions to improve PCMC and evidence-based care in the maternity wards and to assess its impact on key obstetric outcomes. Design: A before and after study was conducted at De Soysa Hospital for Women (DSHW), Colombo.

Methods

Baseline studies were conducted on a cohort of mothers (n = 400) who delivered at DSHW in the year 2019. A validated PCMC scale was administered among postnatal women to assess the PCMC. In the same set of women, Bologna score was used to assess the care provision in the labour wards. Gaps in the PCMC and care provision were identified. Tailor-made Interventions aimed at enhancing PCMC and care provision were developed and implemented. The intervention development included an online training module of PCMC, a series of workshops to improve the knowledge and attitudes of the caregivers, the development of unit protocols, development of patient information leaflets and videos to educate and empower women and their families. End-line studies were carried out in 2022 similar to the baseline study. PCMC, Bologna score and Key obstetrics outcomes before and after interventions were compared.

Results

Overall PCMC improved from 47.1% to 85.3%. This included improvement in all 3 subscales of PCMC (Dignity & Respect; from 59.7% to 95%, Communication & Autonomy; from 34.6% to 80%, Support & Care; from 48.7% to 84%). The Bologna score exhibited improvement, leading to increased rates of having a labour companion (from 9.5% to 12.7%), reduced occurrences of lack of stimulation (from 4.8% to 15.3%), higher instances of delivery in a non-supine position (from 73.3% to 94.4%), and a substantial rise in skin-to-skin contact (from 41.3% to 96%). The utilization of a partogram remained consistently high in both instances, exceeding 91%. Despite efforts to enhance maternal care, the rate of vaginal births decreased from 70.1% to 59.7%, resulting in a 10% increase in emergency C-sections. Notably, improvements were observed in key quality indicators, with a reduction in episiotomy rates from 88.5% to 83.2% and a decrease in near-miss rates from 3.1% to 1.9%. Women's overall satisfaction improved from 70.2% to 81.4%.

Conclusions

Tailor-made interventions can be successfully developed to improve the PCMC and care provision in LMIC settings. Interventions aiming to improve PCMC and care provision do not necessarily improve obstetric outcomes. QI team should focus on interventions to reduce CS rates. Further studies should be conducted to assess the sustainability of these interventions. eP-773 A collaborative quality improvement project to reduce surgical infections following cesarean delivery J. Harris1; M. Spitzer2; J. Murdoch3 1EvergreenHealth Medical Center Kirkland, Infection Prevention, Kirkland, USA, 2Smith and Nephew, Global Clinical and Medical Affairs, Fort Worth, USA, 3Smith and Nephew, Global Clinical and Medical Affairs, Hull, UK

Objective

Cesarean delivery (CD) facilitates delivery of the baby through an incision and is performed in situations where vaginal delivery poses risks to the mother, baby, or both (1. Rahman M, Khan N, Rahman A, Alam M, Khan A. Long-term effects of caesarean delivery on health and behavioural outcomes of the mother and child in Bangladesh. J Health Popul Nutr. 2022;41(1):45. 2. WHO. Caesarean section rates continue to rise, amid growing inequalities in access. https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access. Published 2021. Accessed October 9, 2023.) Over 1.2 million CDs are performed in the US annually (3. Curtin SC, Gregory KD, Korst LM, Uddin SF. Maternal Morbidity for Vaginal and Cesarean Deliveries, According to Previous Cesarean History: New Data From the Birth Certificate, 2013. Natl Vital Stat Rep. 2015;64(4):1–13). An interdisciplinary council was created to drive regular data analysis and sharing, interdisciplinary collaboration, and standardized processes to reduce surgical site infections (SSI) following CD. Design: The standardized infection ratio (SIR), a summary measure used to track hospital-acquired infections at a national, state, or local level over time, was used to evaluate SSI status, pre and post (4.The NHSN Standardized Infection Ratio (SIR). https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sir-guide.pdf April 2022).

Method

A bundle was implemented and components included: pre- and post-surgical education and access to follow up, peri- and intra-operative practice changes, and a risk-stratification tool for post-operative dressing selection.

Results

The bundle was initiated in April 2022. After use was established for 6 months, the SIR was evaluated in fourth quarter 2022. The expected SIR for the hospital was 2.64, and the actual SIR measured just 0.38. In 2022, which included 3 months pre-bundle and 9 months post-bundle, the expected SIR was 10.57, with an actual SIR of just 0.66 for the full year. In 2023, the expected SIR is 8.57, with an actual SIR of 0.35 through September 2023. 98% of patients that underwent CD received the full bundle.

Conclusions

The ongoing analysis and sharing of data, the implementation of standardized processes, and interdisciplinary collaboration were imperative to the success of this hospital's quality improvement project to reduce SSI for patients undergoing CD. eP-775 Enhancing the pathway for elective Caesarean section theatre lists S. Manji; C. Depoers Maternity, Whittington Hospital, London, UK

Objectives

With ever-increasing rates of births and planned Caesarean sections (CS), the burden on healthcare to provide an efficient service has become important, relying on factors including staffing, availability of equipment, appropriate facilities, and capacity. At the Whittington Hospital in the years 2022–2023, in 29% (15/52) and 23% (12/52), lists were overbooked causing delays and use of emergency theatres, misaligning with national recommendations to manage category 4 CS separately. To identify areas to streamline elective CS theatre lists, this audit analysed their current workings in a busy DGH in London, identify obstacles causing delays, collect feedback on user attitudes and suggest methods to enhance cost-efficiency, productivity, and experience. Design and methods: Data collection, via online surveys, revolved around: timings of surgery; patient feedback; and staff feedback on improvement suggestions. Reasons for delays were recorded. Patients provided feedback via survey on their experience and suggestions to improve efficiency. Finally, staff were surveyed and ranked suggested solutions, such as moving timings of lists and allocating separate staff for administration.

Results

We had 23 responses. Prospective analysis showed median time interval from patient arrival to meeting with the team as 24 min [0–1020], delayed (by >15 min) in 65% of cases. Delays were caused by discrepancies between arrival of patients and medical staff, emergency or teaching activity. Median time interval between arriving in theatre and anaesthetic was 17 min [7–43], prolonged (>20 min) in 32% of cases. Median surgery duration was 51 min [29–103], delayed (>60 min) in 26% of the cases. Median time spent in theatre was 103 min [75–197]. Staff feedback mentioned the lack of staffing available. 84% (21/25) in favour for dedicated midwives allocated to the list. All staff members agree a coordinator for the planned CS list is needed. 7 patients reported a positive experience but commented on waiting around after arrival, extra help with breastfeeding in recovery bay and better communication on pain relief.

Conclusions

Significant difference of arrival times between patient and midwife was the main factor that causes late start, followed by unavailability of anaesthetic and obstetric teams. A coordinator dedicated for the elective CS list, changing the start time, and adding an extra list are changes to be implemented. Longer operating time due to twins, placenta praevia or additional procedures should be anticipated. This should positively impact productivity and quality of experience as well as prevent staff burnout caused by delays, shortages and last-minute changes. eP-776 Inadequate maternal referral management: Impact on PROM-linked maternal infection in rural area, Indonesia I.D.L. Tobing1; S.N. Lumbanraja2; I.H. Effendi3 1Obstetrics and Gynecology Department, Universitas Sumatera Utara, Medan, Indonesia, 2Obstetrics and Gynecology, Universitas Sumatera Utara, Fetomaternal Division, Medan, Indonesia, 3Obstetrics and Gynecology Social, Universitas Sumatera Utara, Medan, Indonesia

Background

According to the 2020 Population Census data, Indonesia recorded 189 maternal deaths per 100 000 live births, indicating a significantly higher maternal mortality ratio (MMR) compared to other Southeast Asian countries. Infection stands out as one of the leading causes of maternal mortality in Indonesia, with premature rupture of membranes being a common maternal infection. Indonesia experiences elevated rates of infection and complications associated with preterm premature rupture of membranes (PPROM), including chorioamnionitis and maternal sepsis. Furthermore, PPROM not only contributes to maternal and neonatal mortality but also imposes economic burdens on the national healthcare system due to medication and hospitalization costs.

Objective

This study aims to assess the knowledge and attitudes of midwives regarding premature rupture of membranes, the prevention of fetomaternal infections, and appropriate referral preparation in Sumatera Utara, Indonesia.

Methods

The study employed an analytical-descriptive research design with a cross-sectional approach. The target population consisted of all midwives working in healthcare facilities in Samosir Regency, Sumatera Utara.

Results

The demographic characteristics of the respondents revealed that the majority were aged between 31 and 40 years (45.5%), employed in primary healthcare or government facilities (82%), and had worked for 5–10 years (57.1%). Additionally, 60% of the respondents had not undergone any training in the past year. The level of knowledge among the participants varied, with 57.5% possessing sufficient knowledge, 32.2% having good knowledge, and 10.3% exhibiting deficient knowledge. Similarly, the majority of respondents demonstrated sufficient attitude levels (35.1%), followed by good (26.9%) and deficient (10.8%) attitude levels. The most common practices among midwives included performing internal examinations (70.3%) and conducting speculum and litmus tests (24.8%). Moreover, the majority of midwives referred less than five patients per month (87%). The study also identified incidences of chorioamnionitis (20.5%), fetal death (6.8%), fetal respiratory distress (26.7%), and maternal death (17.8%).

Conclusion

The findings indicate that midwives' knowledge and management practices related to premature rupture of membranes are suboptimal, resulting in low referral rates and an increased risk of maternal infection.

Keywords

Premature Rupture of Membranes, Midwives, Maternal Infection, Fetomaternal, Indonesia eP-777 Service-user experience from out-patient hysteroscopy clinic M. Ruby; P. Acuna; S. Thenuwara; G. Kumar OBGYN, Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham, UK

Objective

This survey was undertaken to gain information about the experiences of women attending the outpatient hysteroscopy clinics at Wrexham Maelor Hospital (DGH) in North Wales. Design: Out-patient hysteroscopy patient satisfaction survey (OPH-PSS) questionnaire devised by British Society for Gynaecological Endoscopy (BSGE) was used to collect women's experience.

Methods

All eligible women attending OPH between January 2023 and December 2023were offered the opportunity to complete the survey following their procedure. A total of 116 forms (paper questionnaire) were completed and evaluated. This included diagnostic and therapeutic hysteroscopies, with considerable number undergoing endometrial biopsies ± polyp resections.

Results

Eighty-six percentacknowledged receiving clear pre-procedure information with 94% feeling adequately informed about what to expect during the procedure. Satisfaction with reception and waiting area facilities was high, with 97% expressing appreciation and 71% rating them as excellent. Notably, communication from clinic staff was reported as excellent with 99% finding explanations easy to understand and feeling comfortable discussing individual concerns. Most patients (88%) did not feel distressed or embarrassed during the procedure and felt in controlPrivacy, respect, and involvement in decision-making were highly rated with 98%–99% positive remarks. Pain scores were recorded to note the worst level of pain experienced during menstrual periods and worst level experienced during OPH. While 10% reporting no pain and 70% reporting OPH as slightly-somewhat painful, on the Likert scale (0–10, 10 being worst), 20% reported pain scores of 8–10 during OPH. Despite this, significant majority (89.7%) would choose the same setting for future procedures.High level of satisfaction was reportedregardingreceiving post-procedure advice.Ninety-five percent expressed satisfaction with their overall OPH experience, with high ratings for care received. Overall, the survey highlighted a positive experience amongstwomen undergoing outpatient hysteroscopy in our clinics.

Conclusion

OPH is well-tolerated, with positive overall experience reported by majority. Ensuring a positive experience is paramount, with efforts focused on offering choice of care settings for hysteroscopy for 100% of women, involving patients in decision-making, providing comprehensive pre-procedure information, offering all possible safe options for pain relief, and ensuring comfortable facilities. Future research: Research into pain relief options, informed consenting for 100% of service-users, development of validated patient reported experience surveys is crucial to improve our women's experience with OPH. eP-778 Review of postnatal care in stillbirth cases in Dhofar Region, Oman V. Paliwal; A.C. Mankar; V. Khardenevis Ob Gyn, Sultan Qaboos Hospital Salalah, Salalah, Oman

Objectives

To assess quality of postnatal care in stillbirth cases. Intra uterine fetal death (IUFD) has a profound physical, emotional, psychological and social effect on parents, family and health care providers. It is important to generate information about stillbirth, which will be useful to guide us to provide appropriate management and support to these women. Design: Retrospective study. Methodology: Duration May 2019 – Dec 2019 (8 months ) we looked for. Immediate postnatal care Lactation suppression, VTE risk assessment/thromboprophylaxis and support. Review of women before discharge to discuss management, offer psychological support, follow up and advise for future births. Follow up visit with a senior obstetrician to review the case with the patient and her family in a high risk clinic. 6 weeks Postnatal Visit Investigation reports review (Blood, infantogram, cultures, placental histopathology) to allow parents to discuss the results of tests and the likely cause of IUFD. Focused counseling on the cause of IUFD, chance of recurrence, any specific means of preventing further loss, the prognosis and options. Obstetricians have a duty of candour; a professional responsibility to be honest with patients when things go wrong. To have an open and honest discussion about their concerns. To ascertain about the physical and emotional well being of the mother. Documentation should include probable cause of death, investigation reports, contraception/fertility, outline and document future pregnancy care plans after discussion. Data collection & Analysis: from Clinical records — Computerized Al-shifa system / Pregnancy Greencards / Fetal death notification. Data was collected in Microsoft Excel sheet and analyzed for frequency. All the names and personal details were kept confidential.

Results

Total number of deliveries were were 4691. There were 55 still births during the period with stillbirth rate being 11.72. Immediate care lactation suppression was 100%, thromboprophylaxis was good. Completion of investigations was done in 55% cases, hb1ac in 65%, APA in 30%, TORCH In 45%, infantogram in 34%, swabs in 25%, placental histopathology in 85%, none of the case had karyotyping, counselling and birth spacing in 25%, psychological assessment in 10%. Only 50% attended post natal care at 6 weeks at SQH and only 15% were seen by senior doctor. Next pregnancy plan was documented in 41%.

Conclusion

We found Postnatal care in these cases seems to be overlooked and has scope for improvement. There are some existing policies and protocols of postnatal care, we need specific ones for improving outcomes in stillbirths. eP-779 Improving patients' experiences in obstetrics & surgery wards: Making differences in patients' lives S.M. Ali1; S. Nausheen2 1Surgery, Hammad Medical Corp, Doha, Qatar, 2Ob/Gyn, Aga Khan University, Karachi, Pakistan

Objectives

Patient experience encompasses the range of interactions that patients have with the health care system, including doctors, nurses, and staff in hospitals, physician practices, and other facilities. Understanding patient experience is a key step in moving toward patient-centered care. our aim was to improve patient satisfaction through targeted interventions by improving their experiences from 80% to 90% in six months in obstetrics and surgery wards at hospital in Karachi. Design: Quality improvement through a survey tool. Methodology: Patients are increasingly making health care decisions based on `their perception of “quality.”, Patients may interpret quality as how well their doctors and nurses communicated with them, how well their pain was managed, how easy or difficult it was for them to get an appointment, whether all of their questions were answered or not. We used Standardized Survey Tool called the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS which is being used across world. CAHPS surveys do not ask patients how satisfied they were with their care; rather, they ask patients to report on the aspects of their experiences that are important to them. All patients (n = 2500) discharged from hospital after at least one 24-h overnight stay were eligible to receive a survey. Brainstorming sessions , pareto analysis done. we found the top four concerns of our patients as respect, communication with doctors and nurses, labour room privacy, staff responsiveness. We used patients comments to implement strategies. Daily Rounds by admin staff twice a day. Fortnightly Meetings with stake holders. Feedback to staff. Communication with doctors and nurses was improved by nurse rounding twice a day to attend patients requests and needs. Plan of Care Rounds by Collaborative Physician and Nurse Teams: Sharing daily plan of care improved communication among team members and patients. Update given to patients attendants every six hours by doctors or as per need. Twice a day round by admin staff. Fortnightly meetings with staff to review patient satisfaction, data and patient comments, develop action plans based on feedback themes and emerging trends. Users feedback. Labor privacy was improved by renovation.

Results

By implementing strategies to address patients concerns, staff (doctors and nurses) responsiveness increased from 50% to 80% in Q1 and 92% in Q2. Patient satisfaction increased from 80% to 89.2% in Q1 and 92.5% in Q2 2021.

Conclusion

Understanding patients needs, their experiences, and putting patients first improves patients' satisfaction. eP-780 Blood transfusion practices in Obstetrics & Gynaecology – Experience Ibri Hospital, Oman N. Waleem; N. Arora; M. Catley Lazaro; M. Grace Pascua Joaquin Obstetrics & Gynaecology, Ibri Regional Hospital, MOH, Ibri, Oman

Objective

To analyse the indications, adverse reactions and appropriate use of blood and component transfusions. Design: Cross-sectional Cohort Study carried out in Obstetrics and Gynaecology Department of Ibri Regional Hospital, Oman (IRH) over a period of 3 years from Jan 2020 to Dec 2022

Method

All patients who received blood/blood component transfusion in obstetrics and gynaecology department were included in the study. 422 cases of blood transfusions were reviewed. Patient's record from Alshifa 3 Plus, was used for data acquisition and collection. Data regarding units of blood requested, cross-matched and issued were retrieved from the blood bank computer record. SPSS software was used for data analysis.

Result

422 patients were transfused, transfusion rate of 2.41%, including 279 (66.11%) obstetrics and 143 (33.88%) gynaecological cases.The cross-match/transfusion ratio was 7.98. Majority of obstetric cases (84.6%) were young, multiparous women. In the gynaecology cases, the majority (57.34%) were over the age of 40. Obstetric haemorrhage (151 cases, 54.14%) was the most common indication for blood transfusion, especially postpartum haemorrhage (121 cases, 80.13%). Out of 121 PPH cases, Atony was the cause in 58/121 cases (48%) and Genital tract trauma was the cause in 55/121 cases (45.45%). In gynaecology, the majority of the subjects (66.43%) received blood transfusions for abnormal uterine bleeding. Single unit blood transfusion was administered in 50.23% (212/422). Anaemia is found to be an indication for blood transfusion in less than 1/4th of cases (23.46%) in obstetrics (75 [26.88%]) and gynaecology (24 [16.78%]). The percentage of adverse reactions seen during the transfusion was 0.94%. In over 96% of cases, the decision of blood transfusion was made by doctors, at least a specialist or above. All units of blood transfused were screened, typed and cross-matched.

Conclusion

In our practice, haemorrhage and anaemia continue to complicate pregnancies and the main reasons of blood transfusion. Additional efforts need to be employed to train healthcare professionals at all levels in risk assessment and management of each individual case. Alternative strategies, such as early diagnosis and treatment of anemia-causing conditions, the use of oral and parentral iron supplements, and the use of appropriate medical and surgical techniques in emergency situations, must be implemented in order to reduce the need for blood transfusions. A high cross-match to transfusion ratio necessitates transfusion audit on a regular interval to promote the blood utilization pattern and judicious implementation of guidelines for the use of various blood components. eP-781 PREM 7 preterm optimization pathway – Experience from a tertiary maternity unit A. Mathur1; A. Matah1; N. Vaithlingam1; L. Davis1; G. New1; F. Tucker1; N. Keefe1; A. Dawson2 1Obstetrics & Gynaecology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK, 2Neonatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK

Objective

Optimization of perinatal care in preterm is complex due to unpredictable labour and variability in care dependent on gestation, place of birth and local policies. PREM 7 is a quality improvement project in the South-East region of UK based on 7 best practice interventions namely- correct place of birth, MgSo4, antenatal steroids, intra partum antibiotic prophylaxis (IAP), optimal cord management (OCM), ensuring normothermia and early breast milk within first 24 h. PREM 7 aims to standardise perinatal care to reduce mortality and severe brain injury due to prematurity by 50% in line with the National Health Service (NHS) long term plan. Design: Retrospective audit of maternity and neonatal Badger Net electronic notes. Methodology: Multidisciplinary maternity and Neonatal PREM 7 team established at Portsmouth NHS Trust in April 2023.The team underwent a series of team coaching sessions by an external provider with an objective to build a highly functioning team with psychological safety. The gaps in our practice in management of our preterm babies were identified and a care bundle implemented with focus on key areas where compliance could be maximized. Steps taken in the form raising staff awareness with PREM 7 posters, early prescription of IAP in established preterm labour, drive towards ensuring OCM for eligible babies, Breast milk posters on maternity and NICU, colostrum packs to parents, establishment of neonatal feeding teams with 7 days a week support and monthly audit of all 7 interventions with MDT review.

Results

Retrospective audit of our PREM 7 indicators was performed for October 2022-March 2023(pre-QI) and compared with post QI data for Sept 2023-February 2024.The data demonstrated an improved compliance for all PREM7 interventions from 3% to 29% (p < 0.001). A significant increase was noted in IAP (84% to 96%), Optimal cord management (42% to 70%) and early breast milk (79% to 95%). When examining the impact of Team Coaching for PREM7, on psychological safety and team-working, linear mixed models indicated an improvement in team function (p = 0.020), situation monitoring (p = 0.028) and communication within teams (p = 0.001).

Conclusion

Multi disciplinary team collaboration can be significantly improved by team coaching resulting in the successful implementation of quality improvement pathways in maternity and neonatal services. Larger studies across operational delivery networks may be useful to demonstrate effectiveness of these interventions. eP-782 Language barriers in Obs/Gynae: Patient information leaflet availability in alternative languages S. Takhtechian University of Glasgow, MVLS, Glasgow, UK

Objective

To explore language barriers in practice by investigating the availability and distribution of Patient Information Leaflets in alternative languages in Glasgow's Queen Elizabeth University Hospital Maternity Unit. Design: Communication is a key element in delivering safe and high-quality care. Barriers to good communication can result in greater risk of adverse events, poorer quality and satisfaction of care, and worse clinical outcomes. Considering long standing disparities in Obstetrics and Gynaecology, including maternal mortality rates in patients of ethnic minorities, the impact of language-barriers in delivery of care must be placed in the spotlight when addressing these inequities and promoting non-discriminatory care. One important medium of communication in healthcare is the use of Patient Information Leaflets to encourage ethical consent giving and informed, shared clinical decision-making. This project aimed to gauge the availability of standardised Patient Information Leaflets (such as those available on RCOG.org.uk and local health board websites) in alternative languages, as well as whether or not these are as regularly distributed amongst patients with limited English proficiency as compared to fluent English speakers.

Method

Using a mixed quantitative/qualitative method, an online survey via Microsoft Forms was distributed amongst healthcare professionals within the Maternity Unit to analyse the access to and distribution of Patient Information Leaflets in alternative languages.

Results

Results of this indicated that 65% of respondents ‘Always’ or ‘Often’ give out Patient Information Leaflets and 98% of respondents find these to be beneficial to their practice. Despite this, 67% of respondents did not know how to access leaflets in languages other than English and 72% responded with ‘Never’ or ‘Rarely’ giving out leaflets in alternative languages. 60% of respondents claimed that there had been incidences where they had opted to not give out leaflets due to a language barrier.

Conclusion

In conclusion, the findings underscored significant inconsistencies in access to outpatient information and variability in patient education and resources for shared clinical decision-making, all stemming from language barriers. The uncertainty surrounding access to resources and the lack of standardised availability are critical issues identified. These results emphasise the pressing need for targeted interventions aimed at improving access to and utilisation of Patient Information Leaflets in alternative languages within obstetrics and gynaecology practice by furthering this quality improvement journey. Addressing these language barrier-based inequities is paramount for achieving equitable healthcare outcomes and enhancing patient-centred care delivery in diverse populations. eP-784 Patient centred delivery of perinatal mental health care M. Taiwo1; R. Narunsky1; S. Bharj1; D. Hammar2; I. Gafson2; S. Bracke2 1UCL, Medical School, London, U, 2Whittington Health NHS Trust, London, UK

Objective

The aim of this quality improvement project is to explore patient perspectives of a newly designed joint obstetrics and midwifery clinic devised by a healthcare team in London, focusing on providing patient-centred maternal mental health care. Design: Qualitative study involving structured interviews with patients following their attendance to the joint clinic.

Method

15 women were recruited and interviewed immediately following their antenatal appointments. A series of open and closed questions were asked to establish their experiences of the clinic. Notes were taken during the interviews and thematically analysed thereafter.

Results

12 patients (80%) had a good understanding of the reasons for being referred to this joint clinic focused on perinatal mental health. 6 individuals (40%) were aware of what would take place during their appointment. Some women had high anxiety levels about attending the clinic, self-rated between 5 and 9 out of 10 for reasons including: fear of the unknown; the prospect of having difficult discussions during the appointment; and the physical health of their baby. 8 patients (53%) felt as if they could benefit from being given a leaflet prior to attending the clinic, as it would better prepare them for their appointment. All patients had positive feedback regarding the clinic, felt supported and relieved upon completion of their appointments, and felt as if it was informative.

Conclusions

This project provides an insight to the need for individualised antenatal care in the context of patients with complex mental health concerns. A joint clinic ensures a united approach to the delivery of antenatal care and clear pathways of communication between service users and healthcare professionals. Additionally, our study illustrated that supporting the anxiety of patients by providing pre-appointment information would enhance their experience. Moving forward, we aim to create a leaflet to help mitigate these areas of uncertainty. This could be distributed along with the initial letter inviting the patient to their appointment. Further research could explore patient satisfaction with a virtual reality mindfulness experience that was recently piloted at the clinic. This was proposed with an objective to establish an environment where patients can unwind following difficult conversations and provide a safe space for reflection before leaving the hospital. In conclusion, this project not only highlights the benefits of implementing joint maternity clinics, but also enabled us to identify ways to further enhance patient care, such as provision of informative leaflets and a trial of virtual reality experiences. eP-785 Elevating medication reconciliation practices in the OBS/GYN department L. Alansari1; Y. El khawly2; A.H. Salem1; M. Shahab1; H. Al Hamwi1; E. Alhmoud2; K. Al Masalamani1; T. Al Shdafat3; M. Thompson1; M. Abu Kuhail1; R. El Enany2; S. Al Hassan1 1Obstetrics and Gynecology, Hamad Medical Corporation, Al Wakra, Qatar, 2Pharmacy, Hamad Medical Corporation, Al Wakra, Qatar, 3Nursing, Hamad Medical Corporation, Al Wakra, Qatar

Objective

Medication reconciliation is an indispensable process in healthcare to prevent medication errors and enhance patient safety. This quality improvement project was undertaken to optimize medication reconciliation practices in the Obstetrics and Gynecology Department at AWH, focusing on improving compliance with medication reconciliation protocols and ensuring accurate medication histories. The primary objective of this project was to achieve a medication reconciliation compliance rate of 95% by the end of 2023. The project aimed to increase adherence to hospital policy, educate physicians about the significance of medication reconciliation, reduce discharge process time, and enhance the accuracy of medication lists. Design: A quality improvement project.

Methods

The initiative recognized significant hurdles encompassing misconceptions about the purpose of reconciliation, time limitations, and uncertainties about the individuals accountable for documenting home medications. To surpass these obstacles, we utilized a diverse range of strategies, including interactive inperson presentations, consistent daily follow-ups, and the designation of accountable personnel for documentation. Furthermore, monthly audits were systematically conducted to evaluate adherence to medication reconciliation protocols.

Results

The project's interventions yielded promising outcomes, with substantial improvements observed in medication reconciliation compliance. The statistical data from January to July 2023 demonstrated a progressive increase in compliance percentages, ranging from 75.00% to 95.24% This upward trend underscores the success of the project in effectively enhancing medication reconciliation practices.

Conclusion

Through the implementation of targeted interventions and ongoing education, this quality improvement project achieved commendable results in optimizing medication reconciliation processes in the OBS/GYN Department. The accomplishments include heightened physician compliance, increased understanding of reconciliation's benefits, and improved accuracy of medication histories. Continuous monitoring, education, and engagement are essential for sustaining and further improving these gains. This project exemplifies the power of quality improvement initiatives in enhancing patient safety and overall healthcare efficiency. eP-786 Optimal cord management audit D. Mohammed1; S. Shah2; N. Al-Emara2; H. Wisa2 1Obstetrics and Gynaecology, Medway Foundation NHS Trust, Gillingham, UK, 2Medway Foundation NHS Trust, Gillingham, UK

Objectives

The British Association of Perinatal Medicine (BAPM) and the Resuscitation Council UK emphasize the importance of implementing optimal cord management (OCM) for all live-born babies, unless specific reasons prevent its application. To ensure adherence to these guidelines, an audit of OCM practices was conducted in 2022. A re-audit was followed in the next year 2023. In both cycles we were focusing on infants delivered alive from 22 weeks gestation onward, including both singletons and twins. The initial audit revealed several reasons for non-compliance with OCM implementation, such as insufficient documentation, misunderstanding of contraindications for OCM, and inadequate training. As a result, the following recommendations were proposed improve documentation practices, update local guidelines to clearly specify contraindications and provide training through programs like the PROMPT course and dedicated teaching sessions on OCM. Design: Following the implementation of these recommendations, a retrospective audit was conducted in 2023 using data from all live deliveries throughout the year.

Method

The allocated team extracted the data from the local online system (Euroking), covering singleton and multiple pregnancies from 22 weeks gestation onward. Infants were categorized based on whether they received optimal cord management, with reasons for non-compliance investigated in line with clear contraindications. Compliance with adequate documentation was also assessed.

Result

The results showed improvement compared to the initial audit. For elective cesarean section deliveries, 92% received OCM, an increase from 85% in the first cycle. Emergency cesarean section deliveries saw a rise to 85% OCM from 75% in the first cycle. Instrumental deliveries, including KIWI and forceps, showed improvement, with 88% and 84% receiving OCM, respectively. Breech deliveries also showed significant improvement, with OCM increasing to 75% from 50% in the first cycle. Spontaneous vaginal deliveries maintained high levels of OCM at 94%. Documentation of OCM also improved across all delivery methods, with elective cesarean section showing 100% documentation compared to 85% in the first cycle. Emergency cesarean section documentation increased to 92% from 68% in the first cycle. Instrumental deliveries showed notable improvements in documentation, with 100% for both KIWI and forceps deliveries, compared to 25% and 50% respectively in the first cycle. Breech deliveries achieved 100% documentation, while spontaneous vaginal deliveries had 82%.

Conclusion

In conclusion, significant improvements were observed in documentation and the identification of clear contraindications. Continued efforts to maintain these standards and provide ongoing training will be essential to ensure optimal cord management practices in the future. eP-831 Recurrent miscarriage: Assessment of aetiology and prediction of subsequent livebirth S. Palanisamy; N. Kadam; M. Pragnell; K. Jayaprakasan Fertility Unit, Royal Derby Hospital, Derby, UK

Objective

The study aims to evaluate the prevalence of various conditions investigated for recurrent miscarriage as per the RCOG recommendations. Further, we estimated the chances of subsequent live birth in women according to various clinical and aetiological variables. Design: A retrospective observational cohort study as part of service evaluation of recurrent miscarriage clinic at a tertiary hospital in the UK.

Method

The study included women who attended the recurrent miscarriage clinic between 2020 and 2022. Baseline demographic and clinical variables like age, BMI, ethnicity, smoking status, and previous pregnancy history were collected from hospital patient records. Investigations were conducted as per RCOG recommendations and appropriate treatment was suggested. The study examined the outcomes of subsequent pregnancies with a minimum follow-up duration of 12 months. The main outcome measures were the prevalence of investigated diseases and subsequent live births. Participants were divided into two groups – those with explained and unexplained miscarriages. The outcome variables were compared between the groups using chi-square tests. Univariate and multiple logistic regression analysis was performed to evaluate the effect of different variables (age, BMI, ethnicity, number of previous miscarriages and screening tests) on the chances of subsequent live birth.

Results

A total of 251 women had appointments in the clinic, but 12 were excluded as per the exclusion criteria. The mean age of the study participants was 34 (SD ± 1.36) years. While 25.8% of participants had an identifiable (explained) cause, 74.2% had normal test results (unexplained). The live birth rates in the subsequent pregnancies during the follow-up period were similar (42.5% vs 43.2%; p = 0.93) in the explained and unexplained groups respectively. The prevalence of thyroid dysfunction, abnormal HbA1C and anti-phospholipid antibody syndrome were 9.2% (5.06% hypothyroidism, 0.4% hyperthyroidism, 4.1% abnormal thyroid antibodies), 0.4% and 3.04% respectively. On regression analysis including the clinical and aetiological factors, none were influencing the future live birth outcome.

Conclusion

The data from this study, albeit a small sample size, indicate that the chances of live birth rate are similar in both explained and unexplained recurrent miscarriage groups. The data on the prevalence of identifiable conditions and the prognosis is valuable in counselling women and couples with a history of recurrent miscarriage. None of the clinical and screening test variables analysed were significant predictors of live birth outcome. Further research with larger sample sizes is warranted to validate these findings. eP-834 The prognostic accuracy of endometrial patterns on ultrasound to predict implanation H. Elhassan1,2,3; W. Maalouf4; J. Thornton4,5; N. Raine-Fenning3,4,5 1Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK, 2Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK, 3Nurture Fertility, The Fertility Partnership, Nottingham, UK, 4University of Nottingham, Nottingham, UK, 5Nottingham University Hospitals NHS Trust, Nottingham, UK

Objectives

To investigate whether endometrial pattern on ultrasound can predict the outcome of in vitro fertilisation (IVF) or intracytoplasmic injection (ICSI) Design: This is a prospective observational single-site study that took place at a fertility centre in (Nottingham, UK) between September 2018 and September 2021. The study looked at two main groups: women who had fresh embryo transfer and women who had frozen embryo transfer. The study was designed around routine patients' visits to minimise inconvenience for patients while gathering all needed information. The protocol has been prospectively registered at trials.gov with pre-defined primary and secondary outcomes, and clear inclusion and exclusion criteria. The registration number is NCT03860636.

Methods

155 women took part in this prospective study. This included 116 fresh and 75 frozen cycles. Four grade endometrial pattern classification system was used. Pattern 1 (triple), pattern 2 (early intermediate), pattern 3 (late intermediate) and pattern 4 (homogenous). Endometrial pattern was recorded at trigger, oocyte retrieval and embryo transfer for fresh cycles. For frozen cycles, endometrial pattern was recorded at day 15 of the cycle and at embryo transfer.

Results

The odds of becoming pregnant (clinical pregnancy) with the homogenous pattern is less likely when compared to the triple group at egg collection OR is 0.05 with 95% CI (0.0027 to 1.05) and less likely for the late intermediate group in comparison to the triple pattern OR 0.65 (0.21 to 1.98), p value = 0.009. The odds of becoming pregnant with homogenous pattern at embryo transfer was three times higher than early intermediate. Similarly women with late intermediate pattern were 6 times more likely to become pregnant than women with early intermediate at embryo transfer p value is <0.05. The odds of having live birth with homogenous pattern at embryo transfer is higher than early intermediate OR 1.79 with 95% CI (0.08 to 40.82). Similarly women with late intermediate pattern were almost 5 times more likely to become pregnant than women with early intermediate at embryo transfer OR 4.86 with 95% CI (0.23 to 104.92) p value 0.031.

Conclusions

The results from this study demonstrate that endometrial pattern can be utilised as an additional tool to improve IVF/ICSI success rate. Women with unfavourable endometrial patterns (for example homogenous pattern at trigger/egg collection) can be counselled to freeze their embryos depending on the other clinical parameters. Studies with a larger sample size and randomised controlled trials are needed to validate these results. eP-835 End-to-end deep learning pipeline for prediction of IVF outcomes using ultrasound data M. Vali1; J. Yang2; S. Vali3,4; T. Azevedo2; P. Lio2; Y. Thum5 1Physics, University of Cambridge, Cambridge, UK, 2Computer Science and Technology, University of Cambridge, Cambridge, UK, 3Department of Surgery and Cancer, Imperial College London, London, UK, 4Obstetrics and Gynaecology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK, 5The Lister Fertility Clinic, The Lister Hospital, London, UK

Objective

There has been significant interest in applying deep learning techniques to enhance reproductive health outcomes. However there has been limited work in developing a systematic, end-to-end pipeline for using ultrasound (US) images taken periodically during in-vitro fertilisation (IVF) to predict pregnancy outcomes. Here, we aim to solve a pipeline of tasks from initial capture of US images through to pregnancy outcome prediction, including US image annotation removal, analysis of US images for informative content, and prediction of pregnancy outcomes using semi-supervised deep learning methods. We analyse the informative content of US images taken by sonographers with a view to streamline existing IVF practice. Design: An observational study analysing over 500 anonymised US images taken from a diverse cohort undergoing embryo transfer (ET) at a UK IVF centre. A series of US images were collected per patient as part of their routine IVF journey and pregnancy outcomes analysed.

Method

We utilised a variety of deep learning methods and trained a neural network to automatically remove sonographer annotations from US images and then predict pregnancy outcome. We applied spatial transformers to automatically detect the region of interest in the uterus for sonographer guidance. We used a gradient class activation map (GRAD-CAM) approach to enhance interpretability, determining which US images / features are most informative to predictions. We also used multi-task learning models, previously not explored in this field, to improve model efficiency and clinical use.

Results

We have developed an end-to-end pipeline that pre-processes and transforms US images with sonographer annotations of the endometrial thickness into model-friendly data capable of predicting clinical pregnancy outcome with a high degree of accuracy, compatible with clinical use. We find AI-assisted annotation removal has 10x lower mean squared error over unprocessed US images. Automated classification results in 90%+ accuracy, however this is due to an imbalanced distribution which is explored. Full results will be available at presentation.

Conclusions

We present an end-to-end automated pipeline for predicting pregnancy outcomes in patients undergoing embryo transfer using US data. This is a ‘plug-and-play’ approach and can be deployed by clinicians without any data preprocessing. We use this pipeline to automatically remove annotations from US images, predict pregnancy outcomes using time-series US image data and automatically segment regions of interest in the uterus. We provide recommendations for existing IVF protocols by analysing the predictive power of US images. Future work will aim to develop a more diverse patient cohort. eP-836 Antimullerian hormone, endometrial thickness in predicting follicular maturation in Polycystic Ovary syndrome A. Omer1; W. Nabag2 1Sudan Medical Specialization Board, Khartoum, Sudan, 2Alzaiem Alazhari University, Khartoum, Sudan

Introduction

Polycystic ovary syndrome (PCOS) is an anovulatory infertility problem that needs ovulation induction. Clomiphene citrate (CC) is the first-line ovulation induction regimen. The anti-mullerian hormone is produced by granulosa cells of small, growing follicles in the ovary. Folliculogenesis is an essential process for ovarian function. Endometrial thickness (EMT) has important value throughout a females life, especially with ovulation induction medications.

Objectives

To determine the role of basal antimullirian hormone and endometrial thickness in predicting follicular maturation and pregnancy in a patient with polycystic ovary syndrome on clomiphene citrate. Design: This was a prospective cohort study that was conducted at El-sir Abualhassans Fertility Center (September 2020 to August 2021).

Method

The study included 197 PCOS patients using Rotterdam Criteria; who had the first stimulation with 100 mg CC. Data was collected using a questionnaire that was filled out after informed consent. The basal AMH was measured by enzyme immunoassay technique and the EMT and follicular size was measured before and after CC by Transvaginal ultrasound. The data were analyzed using the statistical package for the social sciences version 26. Then correlation was done using the Chi-square test.

Results

Almost two third of participants have average AMH. Before giving CC, 95.4% of the cases have EMT≤ 5mm and follicular size of 1–6mm. After CC, 74.6% have EMT of 6–10mm and 46.2% have a follicular size of 7–12mm. A significant correlation was found between basal AMH, follicular maturation, and pregnancy (p = 0.001). A significant association was present between EMT after CC and achieving pregnancy (p = 0.001).

Conclusion

Clomiphene citrate is a first-line regimen in PCOS patients with normal AMH. After CC treatment, there was a correlation between AMH and follicular maturation and pregnancy. Also, there was a correlation between Midcycle EMT and pregnancy.

Keywords

PCOS; AMH; Endometrial thickness; Follicular maturation; Pregnancy eP-839 Diagnostic accuracy of AMH and AFC in PCOS R. Rahim Obstetrics/Gynaecology, Lady Reading Hospital, Peshawar, Pakistan Diagnostic accuracy of anti-mullerian hormone and antral follicle count in the diagnosis of polycystic ovary syndrome with Rotterdam criteria as gold standard.

Introduction

Polycystic ovary syndrome (PCOS), is one of the most common endocrine system disorders affecting women of reproductive age with metabolic, cardiovascular, psychological and adverse reproductive outcomes. The AMH assay seems to be an increasingly excellent substitute for follicular count and is likely to emerge as the official PCOM marker. This study is aimed to provide us with evidence to use AMH as a quick marker for the diagnosis of PCOS in our population, and if found to be significantly high, the results of this study will formulate future recommendations for use of AMH where ultrasound facilities are scarce.

Objective

To determine the diagnostic accuracy of Anti-Mullerian hormone and antral follicle count in the diagnosis of polycystic ovary syndrome, keeping Rotterdam criteria as a gold standard. Methodology: The current study was carried out at Obstetrics and Gynecology Department of Lady Ready Hospital Peshawar after obtaining ethical approval from Hospital Ethical Committee. This was a cross sectional study which was conducted for the period of six months with a sample size of 182 patients on the basis of WHO sample size calculator. All patients presenting with suspicion of PCOS in age between 18–40 years were included while patients with history of other endocrine disorders were excluded. PCOS on Rotterdam criteria was diagnosed in patients with oligoanovulation, hyperandrogenism and polycystic ovaries (≥ 12 follicles measuring 2.9 mm in diameter and/or an ovarian volume > 10 mL in at least one ovary). PCOS with AMH levels of >4.9 ng/mL and AFC >12 on ultrasound were included compared and analyzed in study. Data was analyzed in SPSS version 22.

Results

In the present study a total of 182 patients were observed in which mean age was 27.53 years with SD± 4.994. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of AMH were 80.91%, 88.23%, 94.64%, 64.28% and 82.96% and for AFC were 76.33%, 94.11%, 97.08%, 60.75% and 81.31%.

Conclusion

Our study concludes that both AMH and AFC are highly effective and comparable for the diagnosis of Polycystic ovary syndrome among women of reproductive age and AMH can be used as a sensitive diagnostic tool for the detection of Polycystic ovary syndrome.

Keywords

Diagnostic accuracy, Anti-Mullerian hormone, antral follicle count, polycystic ovary syndrome eP-840 Endometrial pattern to predict pregnancy in women undergoing embryo-transfer: Systematic review & meta-analysis H. Elhassan1,2,3; J. Thornton2,4; W. Maalouf2; H. Baig4; H. Elhassan5; E. Park2; K. Odubamowo4; A. Alarbed2; N. Raine-Fenning2,3,4 1Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK, 2Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK, 3The Fertility Partnership, Nurture Fertility, Nottingham, UK, 4Nottingham University Hospitals NHS Trust, Nottingham, UK, 5Imperial College NHS Trust, London, UK

Objectives

Investigate whether endometrial pattern on ultrasound can predict pregnancy outcomes in women undergoing embryo transfer. Design & Methods: This systematic review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidance. The study selection was assessed according to the PICOT (population, index prognostic factor, comparator prognostic factor, outcome, time setting) framework. The search strategies were designed using expert advice and consultation with the help of librarians to assess the ability of endometrial pattern to predict clinical pregnancy. Screening of each paper was undertaken independently by at least two reviewers and when there was a disagreement, advice was sought from a third reviewer. This review has been prospectively registered on Prospero (CRD42021219015).

Results

There were 33 eligible studies which were included in the systematic review and meta-analysis. The results of this review showed that women with triple pattern at trigger are more likely to become pregnant when compared to women with a homogenous pattern (OR 1.89 95% CI:1.39, 2.58). Similarly, women with a homogenous pattern at fresh embryo transfer were more likely to become pregnant compared to women with an intermediate pattern (OR 0.53 95% CI 0.31, 0.92).

Conclusions

The results from this review suggest that endometrial pattern can provide useful information about endometrial receptivity. Women with triple pattern at trigger are more likely to become pregnant compared to women with homogenous pattern. However, this is limited by the low to moderate quality evidence of some of the studies and is also limited by the substantial heterogeneity of the studies and the different classification systems used. A consensus on terms and definitions for a classification of endometrial pattern followed by the production of well-designed prospective studies and adequately powered randomised controlled trials would place us in good stead for determining whether endometrial pattern on ultrasound can be used to predict and improve outcome in assisted conception. eP-842 Hysteroscopic isthmocele repair on IVF outcome: A protocol for randomized controlled trial A. Elbohoty1; A. Kanan1; M. Liswi2; S. Davamani3; H. Wedyan1; W. Sayed1 1Healthplus Fertility, ART, Abu Dhabi, United Arab Emirates, 2Global Health, Technical Advisor, Amman, Jordan, 3Healthplus Fertility Center, ART, Abu Dhabi, United Arab Emirates

Introduction

Uterine niche occurs in up to 70% women with previous caesarean of whom 30% are symptomatic1. In some cases, it can cause abnormal uterine bleeding, dysmenorrhea, dyspareunia, chronic pelvic pain or subfertility2. There are a lot of mechanisms responsible for the subfertility; scarring and distortion of the anterior isthmus leads to collection of menstrual debris in the niche, altered mucus production, impaired sperm passage and interfere with embryo implantation3,4. The management of isthmocele should be individualized based on the presenting symptoms and plans for fertility. It has different methods of correction. The most common ways either laparoscopic or hysteroscopic approaches 5. IVF outcome can be affected by isthmocele in different ways; it can increase difficulty of embryo transfer, presence intrauterine fluid at the time of transfer can affect the chances of embryo implantation and increase the rate of spontaneous miscarriages6,7. It is not yet established to treat the isthmocele to improve the reproductive outcome 8. Aim of the work: The aim of this prospective randomized controlled trial is to assess the efficacy of Hysteroscopic CS scar defect repair on the clinical pregnancy rate after embryo transfer. Study method: Patients who was diagnosed with significant caesarean section scar defect and had a previous unsuccessful ongoing pregnancy after embryo transfer of one or more euploid embryo will be offered to be recruited in the study after applying the inclusion and exclusion .Randomized controlled trial at Healthplus fertility center. Study population: Patients meeting the eligability requirements of the study will be randomly assigned to receive either Hysteroscopic CS scar defect repair or expectant management. Each patient who approves to participate in this study should sign an informed consent form. - Group A (Hysteroscopic CS scar defect repair), - Group B (Expectant management) medicated embryo transfer cycle Sample size: The sample size is based on anticipating an improvement of the ongoing pregnancy rate from 20% without surgery to 60% with surgery. Using a two-sided test, an alpha-error of 5% and a beta-error of 20%, two groups of 22 women are needed to demonstrate this difference. Anticipating lost-to-follow up and protocol violation, an additional 10% is needed. Thus, 50 women need to be randomized. Ethical consideration: Patients information and informed consent

Results

and conclusions: To be declared in June 2024 eP-843 The cumulative success rate of stimulated IUI vs IVF and its cost-effectiveness? S. Aggarwal; R. Bhagat Fertility, Homerton University Hospital, London, UK

Background

Unexplained infertility represents a significant proportion (25%) of infertility cases in the UK, prompting the consideration of assisted reproductive technologies such as intrauterine insemination (IUI) and in vitro fertilization (IVF). While IVF is often considered more effective; however, the cumulative success rate of multiple stimulated IUI cycles may be comparable to that of a single IVF cycle.

Objective

To assess the cumulative success rate and cost-effectiveness of three stimulated intrauterine insemination (IUI) cycles compared to a single in vitro fertilization (IVF) cycle in achieving a positive pregnancy among couples with unexplained infertility. Design: This retrospective study involved couples with unexplained infertility who underwent either three stimulated IUI cycles or a single IVF cycle between December 2022 and January 2024. The study design aimed to compare the outcomes of these two treatment approaches in terms of cumulative clinical pregnancy rates and cost-effectiveness.Virtual reality in obstetrics – usability study of a manual rotation simulator.

Method

Data from 100 couples were analyzed, with 40 undergoing three stimulated IUI cycles and 60 undergoing a single IVF cycle. The primary outcome measure was the cumulative clinical pregnancy rate, defined as the proportion of couples achieving a positive pregnancy test after completing the specified treatment regimen. Direct medical costs associated with each treatment option, including procedure costs, medication expenses, and additional healthcare utilization, were estimated to assess cost-effectiveness.

Result

The cumulative clinical pregnancy rate after three stimulated IUI cycles was found to be 35%, while the pregnancy rate after a single IVF cycle was 40%. The cost of three stimulated IUI cycles was significantly lower than that of a single IVF cycle. However, the cumulative clinical pregnancy rate after three stimulated IUI cycles was slightly lower compared to that after a single IVF cycle, suggesting that three stimulated IUI cycles may be a cost-effective alternative to IVF in certain clinical scenarios.

Conclusion

This study suggests that three stimulated IUI cycles may be a cost-effective treatment option compared to a single IVF cycle for couples with unexplained infertility. While IVF remains the preferred choice for some patients, particularly those with specific prognostic factors, three stimulated IUI cycles offer a potentially viable and more affordable alternative. These findings support the consideration of multiple stimulated IUI cycles as a viable treatment option for couples before undergoing IVF, particularly in settings where access to IVF may be limited or cost-prohibitive. However, individual patient preferences, prognostic factors, and healthcare system considerations should be carefully considered when making treatment decisions. eP-844 Reproductive outcomes of using GnRH agonists in females receiving chemotherapy A. Al Noufali1; R. Al Ajmi2; Y. Al Badawi3; A. Nair4; M. Al Shukri4; V. Gowri2 1Obstetrics and Gynecology, Oman Medical Speciality Board, Muscat, Oman, 2College of Medicine, Sultan Qaboos University, Muscat, Oman, 3College of Medicien, Sultan Qaboos University, Muscat, Oman, 4OBGYN, Sultan Qaboos University Hospital, Muscat, Oman

Objective

Thousands of young females of reproductive age are diagnosed with cancer every year for which they require chemotherapy. Chemotherapy breaks DNA strands, induces apoptosis, and reduces stromal function within the ovaries. As a consequence, around two-thirds of females who receive chemotherapy may develop premature ovarian failure (POF). Some of the existing techniques to protect techniques to protect females from POF is the use of Gonadotropin releasing hormone (GnRH) prior to chemotherapy and during chemotherapy. Studies showed that 85% to 90% of patients who received GnRH-agonists as a co-treatment with chemotherapy resumed menses and normal ovarian function compared to 40% to 50% in the chemotherapy-only group. Aim: To report the main outcomes of using gonadotropin-releasing hormone agonist to reduce the likelihood of chemotherapy-induced premature ovarian failure. Design: Retrospective cross sectional study.

Methods

The study was conducted in two tertiary hospitals in Oman. Data was collected form hospital information system from Jan 2017 to October 2023. The inclusion criteria were Females between 9 years to 40-year-old, any malignancy at any stage. received GnRH agonist as a co-treatment with chemotherapy. Exclusion criteria were, those who received radiation to pelvic region and those who had relapse after initial therapy. Women were followed up to see if they resumed periods and got pregnant and if pregnancy occurred, the outcome of pregnancy. Also FSH, LH and AMH were measured in women who wished to conceive.

Results

The total sample size was 174. After excluding women who either died, received radiation or lack of information in the system, data is available for 147 women. Mean age at diagnosis was 30±6, years. Breast cancer was found in 55 women, Lymphoma (Hodgkins, non Hodgkins and B cell) in 58 women, leukemia in 16 women and in the rest other malignancies. Triptorelin and Goserelin were the GnRH used and the median dose was 11.25mg or 10.8mg respectively. Most of the times GnRH was initiated just prior to chemotherapy or immediately after starting the chemo. FSH, LH and AMH was done only in a minority of patients post chemotherapy. About 50% resumed periods after chemotherapy and 24% conceived.

Conclusion

The most common malignancies were breast cancer and Lymphomas. The administration of the GnRH was not timely and the results of fertility and resumption of periods were low compared to what is reported in the literature. Future work should focus on methods to improve the reproductive outcome for these women. eP-845 Effects of zinc sulfate on subfertility related to male factors: Randomized clinical trial F. Sharifzadeh1; M. Ashrafi2; S. Norouzi1 1Obstetric and Gynecology, Iran University of Medical Science, Tehran, Islamic Republic of Iran, 2Iran University of Medical Science, Tehran, Islamic Republic of Iran

Background

Different studies found that zinc is necessary for sexual maturity, growth and fertility. But there are no distinct studies that clarify the role of zinc supplements on semen parameters.

Objectives

The current study aimed to evaluate the zinc supplement therapeutic effects on semen samples of infertile males. Patients and Methods: The study comprised one-hundred-twenty sub fertile males. The study was a double-blinded placebo- controlled clinical trial. The subjects were randomly allocated to treatment with zinc supplement (n = 60) or placebo (n = 60) groups. Subjects in both groups were given 10 mL, three times daily. In order to determine the sperm concentration, Motility and morphol- ogy, standardized semen and blood samples were obtained before and after treatment, according to the World Health Organization (WHO) guidelines; semen morphology according to strict criteria, and blood and semen zinc concentration also were measured. Effects of the two interventions were evaluated in sub fertile males.

Results

Sub fertile males demonstrated a significant increase (8.8 ± 7.4 × 106 cells/mL to 17.2 ± 13.5 × 106 cells/mL) in concentration and normal sperm in zinc group versus the placebo group. Blood serum zinc concentration increased in the interventional group significantly (p = 0.000), and also semen plasma zinc concentration increased significantly (p = 0.000).

Conclusions

Normal sperm percentage and total sperm concentration increased after zinc sulfate treatment. The beneficial effect of zinc and all results of the current study opened new way to medical purposes and public health researches.

Keywords

Intervention, Zinc Sulfate, Semen Parameters, Male Fertility eP-846 The association of PCOS with maternal outcomes: Retrospective study in tertiary hospital J. Dizon; S. Navarro; J. Rey Matias St Luke's Medical Center – Quezon City, Quezon City, Philippines

Objective

One of the most common endocrine disorders in the reproductive age group is PCOS with a worldwide prevalence of 10%.1 The association of PCOS with adverse maternal outcomes is yet to be determined due to variable results of existing studies owing to the differences in source population, sample size and socio-demographic factors. Thus, this study aims to determine the association of PCOS with adverse outcomes in Filipino pregnant women. Design: This is a retrospective cross-sectional study.

Methods

This study includes 572 pregnant in St. Luke's Medical Center – Quezon City, Philippines from January 1, 2018, to January 1, 2023. The subjects comprising 287 PCOS and 285 Non PCOS were comparable in terms of demographic data and adverse outcomes. Chi square test and odds ratio was used in the univariate analyses. Multiple logistic regression was utilized in the multivariate analysis.

Results

There are 263 cases who had adverse outcomes while 309 cases without. Polycystic ovary syndrome has about twice (95% CI 1.54–3.02 p value < 0.001) the odds of adverse outcomes compared to those without PCOS. Among the adverse outcomes univariate analysis showed that preeclampsia is significant with six times (95% CI 1.83–21.5 p value 0.001) the odds in patients with PCOS. In addition, the odds ratio of preterm birth in patients with PCOS is 1.9 times (95% CI 1.09–3.62, p value 0.021) more than those without PCOS.

Conclusion

There is significant association in preeclampsia and preterm delivery among patients with PCOS who delivered in St. Luke's Medical center – Quezon City, Philippines for the past 5 years. eP-848 Exploring fertility and pregnancy outcomes after myomectomy M. Omura; M. Krishnan Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, UK

Background

Uterine fibroids are common benign tumours that develop in the myometrium with a prevalence of over 70% in women of reproductive age (1). They are associated with several gynaecological problems including infertility, with uterine fibroids estimated to be the sole cause of infertility in 3% of women (2). This is more likely with submucosal or deep intramural fibroids, which may distort the uterine cavity and interfere with implantation and live birth rates (2). Myomectomy is a surgical procedure to remove fibroids from the uterus and is performed when preservation of fertility is desired. However, the evidence to support the role for myomectomy in enhancing fertility by any route is limited (3).

Objectives

The aim of this service evaluation was to examine the effect of myomectomy on pregnancy outcomes for patients referred to Sheffield Teaching Hospitals for a myomectomy due to subfertility. The secondary aims were to evaluate surgical approach and post-operative outcomes. Design: This was a retrospective study looking at all patients who had a myomectomy at Sheffield Teaching Hospital between 2017 and 2019 due to subfertility.

Method

The patients' electronic records, investigations and operative notes were reviewed and data was collected using a proforma. Data collected included patient demographics, scan findings, surgical approach, post-operative and pregnancy outcomes.

Results

23 out of 71 cases (32%) had a myomectomy due to subfertility. 14 cases (61%) were due to primary infertility. 18 cases (78%) had open myomectomy. Post-operatively, out of 23 cases, no patients required readmission, only two (9%) required blood transfusion and one needed to return to theatre. In terms of long-term outcomes, 13 out of 23 cases (57%) achieved a pregnancy after a myomectomy. 10 cases (77%) achieved a term delivery. 77% of patients who achieved a pregnancy were primiparous.

Conclusion

Removal of fibroids by myomectomy had a positive impact on pregnancy outcomes, particularly with achieving live births. Further research with clinical trials is needed to assess the relationship between myomectomy and reproductive outcomes. - Lumsden, M.A., Hamoodi, I., Gupta, J., Hickey, M. Fibroids: diagnosis and management. Br Med J. 2015;351:h4887 - Freytag, D., Günther, V., Maass, N. ,Alkatout, I. Uterine Fibroids and Infertility. Diagnostics (Basel). 2021;11(8):1455 - Metwally M, Raybould G, Cheong YC, Horne AW. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev. 2020;29(1):CD003857 eP-849 Can medical management of miscarriage provide samples for chromosomal analysis? Y.J. Chew1; W. Wang1; S. Lam2; M.H. Yong2; R.T.Y. Phua2; S. Liu1 1Department of Obstetrics and Gynaecology, Kandang Kerbau Women's and Children's Hospital, Singapore, Singapore, 2Department of Pathology and Laboratory Medicine, Kandang Kerbau Women's and Children's Hospital, Singapore, Singapore

Background

25%–30% of pregnancies end in miscarriages. In patients with recurrent pregnancy loss (RPL), evaluation for underlying chromosomal abnormalities in the product of conception (POC) will help guide clinicians in their work up and provide couples with an explanation for their recurrent miscarriages. Traditionally, specimens were obtained through surgical evacuation of uterus. Medical management of miscarriages (with Mifepristone and Misoprostol) has allowed POC to be collected in a non-invasive manner. This method gained popularity during the COVID-19 pandemic as patients were advised to minimise hospital visits.

Objective

This study aims to demonstrate that karyotype analysis can be performed on specimens obtained from medical management of miscarriages with comparable success rates as those obtained from evacuation of uterus. We also aim to show that the incidence of maternal contamination of specimens obtained from medical management is at least comparable to that obtained from surgical management. Design and Method: The study is a retrospective study of POC samples processed by the hospital's cytogenetics laboratory from January 2018 to July 2023. Only samples from first trimester miscarriages were included in this study. The data are categorised into two groups, namely the medical and surgical management group. Culture success rates and maternal contamination rates from each group are then studied and compared. All samples were examined by the laboratory staff and placental tissues (maternal contamination) were identified.

Results

A total of 293 specimens were included in this study, of which 201 were obtained from medical management and 92 were from surgical management. The overall culture failure rate was 8.5% (25 out of 293 specimens). There were 23 failed cultures (11.4%) using specimens obtained through medical therapy and 2 failed cultures (2.2%) using specimens from evacuation of uterus. The incidence of maternal tissue contamination were 19.4% and 12.0% in the medical and surgical group respectively. 68.2% of specimens (137 out of 210) obtained from medical management produced successful karyotyping results.

Conclusion

The success and contamination rate of chromosomal analysis on specimens obtained from medical management of miscarriages are comparable to those obtained from evacuation of uterus. This provides an alternative for patients who are keen to pursue further work up for their miscarriages, especially couples who are facing RPL. The study also addresses the gap in knowledge identified by RCOG, on the comparison of different techniques for POC collection. Further studies can be performed to examine the use of medical management in an outpatient setting. eP-850 Air contrast sono hysterosalpingography versus hysterosalpingography for tubal evaluation in subfertility Z. Muslim1,2; S.B. Mazhar3 1Private, Obstetrics & Gynaecology, Islamabad, Pakistan, 2MCH-C PIMS (Former PG Trainee), Obstetrics & Gynaecology MCH-Center, Islamabad, Pakistan, 3Prof. Syeda Batool Private Clinic, Obstetrics & Gynaecology, Islamabad, Pakistan

Introduction

Couples unable to conceive after regular unprotected intercourse for a period of 12 months have subfertility which can be primary or secondary. The commonest cause of secondary subfertility is pelvic inflammatory disease resulting in tubal damage. Different imaging techniques, utilizing different contrast agents, oil or water based, to evaluate tubal patency in subfertile women are available.

Objective

To compare the diagnostic accuracy of sono-hysterosalpingography (HyCoSy) using gaseous spring water for tubal patency with hysterosalpingography (HSG) as reference standard in sub fertile women. Study design: Cross sectional validation study.

Materials

& Methods: This study included a total of 65 women of reproductive age presenting with subfertility. These sub-fertile women with either primary or secondary subfertility underwent tubal evaluation in late follicular phase of menstrual cycles, immediately after cessation of menstrual bleed in the outpatients of MCH Centre, PIMS, Islamabad by Hystero contrast – sono – salpingography. Air-contrast with gaseous spring water was used during HyCoSy with transvaginal ultrasound, visualizing the uterine cavity, ovaries, tubes and other pelvic pathology. Hysterosalpingography was also done in all included women in radiology department using oil based iodinated contrast.

Results

A total of 65 women with subfertility were recruited. Among these, 23 (35.4%) had primary subfertility while 42 (64.6%) had secondary subfertility. Mean age of women was 32.25 + 5.46 years. The average duration of subfertility was 5.09 + 2.50 years. HSG showed 58.4% women had Patent tubes while blocked tubes were noted in 36.15%. With HyCoSy patent tubes were reported in 66.1% and 29.2% were blocked. HSG and HyCoSy had unilateral non visualization of fallopian tubes in 5.3% and 4.6% cases respectively. No patient with hydrosalpinx was noted in either of the two tests. The positive predictive value of HyCoSy compared to HSG for diagnostic accuracy for tubal patency evaluation was 86.41%. The negative predictive value of HyCoSy compared to HSG for diagnostic accuracy was 90.41%.

Conclusion

Both HSG and HyCoSy are complementary for tubal factor evaluation subfertility with HyCoSy showing high positive and negative predictive value compared to HSG. eP-851 Factors influencing follicle output rate and follicle-to-oocyte index: Insights from India S. Prakash1; S. Prasad1; S. Prakash2 1Matritava Advanced IVF and Maternity Centre, Delhi, India, 2UCMS and GTB Hospital, Delhi, India

Objective

To investigate ovarian sensitivity using follicle output rate (FORT) and Follicle to oocyte index(FOI) in infertile Indian women with low prognosis as defined by POSEIDON classification and identify factors influencing FORT and FOI. Design: A cross sectional study was designed to evaluate ovarian sensitivity to controlled Ovarian stimulation (COS) to assess relevance of using FORT and FOI and factors affecting the same.

Method

The study included women who underwent controlled ovarian stimulation utilizing GnRH antagonist protocol for IVF/ICSI treatment at a single IVF clinic in delhi between January 2022 to December 2023. Patients with a poor response were categorized into four groups according to POSEIDON criteria: Group 1 – patients <35 years with adequate ovarian reserve parameters (AFC ≥ 5 or AMH ≥ 1.2 ng/mL), presenting with an unexpected poor ( 5 or AMH ≥1.2 ng/mL), presenting with an unexpected poor (<4 oocytes retrieved – Subgroup 2a) or a suboptimal (4–9 oocytes retrieved – Subgroup 2b) ovarian response; Group 3 – patients <35 years with poor ovarian reserve parameters (AFC <5 or AMH<1.2 ng/mL); Group 4 – patients ≥35 years with poor ovarian reserve parameters (AFC <5 or AMH<1.2 ng/mL). Patients parameters were assessed such as type of infertility, menstrual cycle characteristics, BMI(Body mass index), and their treatment protocol and response assessed using health records.

Result

A total of 140 patients were enrolled in this study among the four groups. The FORT according to descending order were as group 3(1.2), group 2(0.88), group 1(0.62) followed by group 4(0.56). A statistically significant relationship was found between FORT and BMI (p = 0.04), Total dose of FSH used (p = 0.032) and AMH(p = 0.021). FOI was significantly associated with starting dose of FSH used(p = 0.05). A significant relation was found between FORT and FOI.

Conclusion

A positive correlation was found between total dose of FSH used and AMH with whereas BMI was negatively correlated with FORT. Similarly, FOI was positively associated with the starting dose of FSH. eP-852 Ovarian hyperstimulation syndrome: Clinical aspects, treatment and prevention N. Karmous1,2; H.S. Abouda1,2; M.B. Channoufi1,2; A. Karmous3 1Department C of Obstetrics and Gynaecology, Maternity and Neonatology Center, Tunis, Tunisia, 2Faculty of Medicine – University Tunis el Manar, Tunis, Tunisia, 3Psychiatry Department, Razi Hospital, Tunis, Tunisia

Objective

The ovarian hyperstimulation syndrome (OHSS) is a major complication of ovulation induction, with severe morbidity and possible mortality. As no etiologic treatment is available, the therapeutic management of OHSS should focus on its related complications. Data on incidence and severity of OHSS in Tunisia are limited. Our study aimed to assess the incidence of moderate to severe OHSS and describe its different clinical aspects. Design: Retrospective, longitudinal and descriptive study was carried out in Department C of Obstetrics and Gynaecology of maternity and neonatology Center of Tunis, Tunisia, over 3 years period. We have identified patients followed for infertility who presented OHSS.

Methods

For each included patient, the following informations were retrieved: general characteristics (age, medical and surgical history, characteristics of fertility…), infertility treatment (inductor treatment and protocol used, ovarian response monitoring, criteria for triggering ovulation…) OHSS features (delay in appearance compared to triggering, clinical presentations, morphological exams…). Descriptive and inferential statistics were performed with SPSS (IBM, v26).

Results

Among the 1250 women followed for infertility during the period of study, 15 have presented moderate to severe OHSS, which accounts for 1.2%. Patients' average age was 31. One patient had history of mild OHSS. Nine anti-Müllerian hormone were higher than 3.36 ng/mL. Ten antral follicules counts were higher than 14. During the induction's cycles for in vitro fertilization, 5 patients received agonist long protocol and one received antagonist short protocol. During the 6 cycles of artificial inseminations, clomifene citrate and follicule stimulating hormone were concomitantly used. For the 3 intracytoplasmic sperm-injection programs, long protocol was used. Tiggering ovulation was obtained using human chorio-gonadotrophin (hCG) 5.000 UI in 11 cases. For the luteal phase support, progesterone was administered. The average appearance delay OHSS from triggering ovulation was 11 days. The major symptom was abdominal pain. Ascites occurred in all cases and varied in abundance. An association with pleurisy was noticed in 3 cases. We listed a case of thromboembolic accident. We noticed: 5 cases of hemoconcentration, 7 of ionic disorders, 1 of functional renal insufficiency, 1 of acute respiratory distress syndrome and 3 of elevated liver fuction tests. All in all, we identified 3 moderate OHSS and 12 severe.

Conclusions

To date, there is no known curative treatment for OHSS. Therapeutic management is purely focused on symptomatic treatment. That is why it is crucial to adopt preventive measures. eP-853 Ovarian abcess a rare complication of transvaginal oocyte retrieval a case report R. Bhagat; A. Borkar; S. Agarwal Homerton University Hospital, Fertility, London, UK

Objective

IVF has become a very common procedure; but there is a risk of complications like bleeding, organ injury and infection during transvaginal oocyte retrieval (TVOR). The infection may remain localised, forming abcess, or can cause serious morbidity as septicemia. Design: A case report. In this report, we present the case of a 37-year old woman, who presented with ovarian abscess which occured following TVOR in a 8 week ivf pregnancy. She had 3 cm endometrioma in left ovary and 5 cm in right ovary before oocyte retrieval.she presented with pelvic pain and 20 cm grossly distended right ovarian cyst 8 weeks after transvaginal oocyte retrieval.

Result

Despite antibiotic therapy, she developed acute abdomen that resulted in pregnancy loss and necessitated laparoscopic right ovarian cystectomy.

Conclusion

Endometriosis can add extra-challenges during TVOR. It's crucial to discuss potential complications with the patients. Awareness of risk of development of ovarian abcess specially in women with endometriosis following TVOR is important. Also early diagnosis and surgical management of ovarian abscess should be considered if a severe infection occurs to salvage the ovary. eP-854 Risk of OHSS in PCOS M. Mohammed; M. Elmahaishi; H. Elmahaishi LAMIS IVF Center, Misrata, Libya Risk of ovarian hyper stimulation syndrome in infertile patients with PCOS treated by HP HMG Polycystic ovarian syndrome (PCOS) is the commonest endocrinopathy affecting women in reproductive age group. The prevalence may vary from 8.7% to 17% depending on clinical criteria used. PCOS women having IVF presents multiple challenges ranging from a poor to an exaggerated response, poor fertilization, poor blastocyst conversion and ovarian hyper stimulation syndrome (OHSS). OHSS is at increased risk in PCOS patients receiving fertility treatment & varying from mild to severe cases which can be life threatening.

Objective

The presence of OHSS in infertile PCOS patients who followed non pituitary down regulation protocol by using HP HMG injections. Design: Case series study during period 01-09-2021 to 31-08-2022.

Method

The study type was case series study which was done in LAMIS IVF center – Misurata / Libya. 118 infertile patients with PCOS were randomly selected for the study. All patients were selected started ovulation induction with non pituitary down regulation protocol using highly purified HMG injections.

Results

The age of the patients ranges between 18 and 45 years with a mean age of 30 years. The mean number of retrieved oocytes was 19.33 ± 10. The study also that the mean number of mature oocytes picked up was 9.41 ± 5.5 with mean success of 77.6%. Hyper stimulation syndrome was reported only in one case (prevalence of 0.8%) which was mild (needed no admission). Regarding the embryo, the mean number of transfers was 2.36 ± 0.6 with two cases showed no fertilization and 82 cases were associated with poor sperm.

Conclusion

In our study ovarian hyper stimulation syndrome in PCOS patients treated by highly purified HMG injections developed in only one case which was mild (needed no admission). eP-855 Etiology and risk factors of infertility among Omani couples – Tertiary care experience A. Al Farsi1; D.G.M. Prabhakaran2; N.A.H.R. Al Saadi3; K.K. Al Zaabi4; V. Gowri3 1Sultan Qaboos University, Student, Muscat, Oman, 2Sultan Qaboos University, College of Nursing, Muscat, Oman, 3Sultan Qaboos University, Muscat, Oman, 4Sultan Qaboos University, Intern, Muscat, Oman

Objective

Infertility is declared as global health issue by WHO affecting millions of people of reproductive age and there was an increment in rate through years. Oman statistics also reports decline in fertility rate by 1.81% when compared to the previous year with varying etiological factors reported. WHO called for innovative strategies to treat, and this treatment can be achieved through proper identification of risk and causative factors. This study aimed to investigate the etiology and risk factors of infertility and categorizing them as female factors and male's factors among Omani couples aged 18–49 years, in a tertiary care hospital with referrals from rest of the regions in the country. Design: A quantitative cross sectional retrospective design used in this study.

Method

A convenient sample of 259 infertile couples who attended infertility clinic, in a University hospital, from January 2015 to December 2022 were selected based on inclusion criteria. The data were collected from hospital information system (HIS) after the formal ethical approval from institutional review board. Data was analyzed by SPSS version 25.

Results

The mean age of participants were 37 and 43 for primary and secondary infertility respectively. More than 100 (40%) women had BMI of obese and overweight. Secondary infertility (61%) was found to be more prevalent compared to primary infertility (39%). The main identified female infertility factors were fibroids (14.3%), PCOS (19.3%), Endometriosis (6.9%), tubal block (14%). There was a robust association between BMI and PCOS, suggesting that variations in BMI are closely linked to the presence or severity of PCOS symptoms. Not surprisingly there was significant correlation between age and fibroids. Male factors were also looked at using semen analysis. Asthenospermia was the most common semen characteristic observed in (21.6%), oligospermia was found in 14.4% of the sample size and only 3.1% of cases showed azoospermia.

Conclusion

This study results of identified etiological and risk factors of infertility among Omani couples help to throw light on the need for more facilities for early scanning of etiological factors and definite treatment. Reaching out to the community for the awareness regarding the risk factors such as age and obesity as leading to Infertility is essential. Local public health departments and medical professionals may be able to extend and deliver more health-related facilities to address the high incidence of infertility and thus protect Oman's reproductive health indices. Ref: https://www.macrotrends.net/global-metrics/countries/OMN/oman/fertility-rate) eP-856 Can we save women's declining fertility? L. Ibrahim1 1Reproductive Medicine & Infertility, Bourn Hall Fertility Clinic Mediclinic Middle East, Abu Dhabi, United Arab Emirates

Introduction

Infertility has increased significantly from 3.5% in1990, to more than 17% at present (WHO 2023), (Mascarenhas MN. et al 2012). Female infertility encounters for 35% of couple infertility. The most common cause of female infertility is ovulatory disorders (25%) (Walker MH. et al 2022). Low ovarian reserve has undoubtedly increased in the last few years, both in old & young women. The main causes of low reserve are, advanced age, iatrogenic, as well as premature ovarian insufficiency (POI) (resistance, failure). It has been noticed that POI prevalence is gradually increasing (Chon SJ. et al 2021). Should regular ovarian screening be implemented?

Method

Online search on PUBMED, MEDLINE (OVID), Cochrane data base, EMBASE and LI-LACS cited reference lists of publications from 1990 to 2024 was conducted using the key words: infertility, female infertility, ovarian reserve, ovarian reserve tests, premature ovarian insufficiency, and failure. PRISMA guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses) were used as the primary search tool.

Results

Why is female infertility on the rise? Some of the factors that has enhanced this decline are lifestyle (couples, longer wait to start families education, career), social structures, more divorce & remarriages, religious beliefs, economic prosperity and urbanization (The National Institute of Child Health and Human Development (NICHD) 2023).Can regular testing of ovarian reserve at early age for women at reproductive age diagnose low ovarian reserve and allows for freezing gametes /embryos? (Jirge P. 2016).

Conclusion

With the significant decline of ovarian reserve & increase in POI, ovarian reserve screening & cryopreserving of oocytes/ embryos can be a useful tool in fertility preservation for young women at risk. This approach allows women to have their own biological offspring. Avoiding all the psychological dilemmas to both parents & children. Especially in cultures & religions where oocyte donation is not acceptable & only married women can have babies which might occur later in their lives. Education & counseling should be available to all women. For identifying women at risk, applying screening tests as well as proper intervals of screening, further research & evaluation is needed. eP-857 Audit on ovulation induction treatment for PCOS anovulatory infertility S. Banu; I. Jones; N. Sadeghi Frimley Health NHS Trust, Slough, UK

Objective

In women with Polycystic ovary syndrome (PCOS), letrozole is recommended as the first line treatment for ovulation induction with proven safety and efficacy because of its higher ovulation, pregnancy and live birth rates when compared to clomiphene citrate. This study aimed to identify outcome of ovulation induction treatment in this group and assess compliance to NICE Guideline. Design: This study was a retrospective audit from patients' clinic notes.

Method

Women who received either clomiphene citrate or letrozole between July 2022 – September 2023 at a district hospital in the UK were included. 103 notes were identified with 47 retrieved following exclusion of duplicates and patients receiving letrozole for breast cancer. Data was collected for demography, test of response and outcome of treatment. A questionnaire was designed for data entry and results analysed using Microsoft Excel. This audit was registered with the Trust Quality and Clinical Effectiveness team.

Results

Out of 47 patients commenced on letrozole, 3 patients discontinued treatment due to side effects and 1 of them opted for clomiphene citrate instead. 57.4% of women (n- = 27/47) were between 31–35 years of age, only 38% were in the ideal BMI range of 20–25 (n = 18/47). 45% (n = 21/47) had no other contributing factor in addition to PCOS for infertility. 68% of cases (n = 32/47) had infertility for >24 months at the time of referral. Overall, 68% of women (n = 32/47) conceived following ovulation induction treatment, all in Letrozole arm and 66% (n = 31/47) conceived within 6 months. The woman on clomiphene citrate showed ovulatory response however didn't conceive at 6 months.

Conclusion

In our study, significant number of women receiving ovulation induction treatment were in the older age group (>30 year) and obese (BMI > 30). Considering the established fact that PCOS is the most frequent cause of anovulatory infertility, 70% of women were referred late for fertility treatment, non-compliant to NICE Guideline. Our study demonstrated a significant conception rate within 6 months of commencement of letrozole for PCOS anovulation, monitored in a dedicated ovulation induction clinic. Our audit was a retrospective study with low power that can be reproduced in a larger group. A robust reproductive health plan to increase awareness on preconception risk factors, prevention of weight gain, optimisation of fertility and timely treatment of women with PCOS anovulatory subfertility is of paramount importance. eP-858 Impact of COVID 19 on ovarian reserve, an observation L. Fernandes; J. Madkaikar; E. Noronha; D. Dias Sub-District Hospital Ponda, Ponda, India

Introduction

COVID 19, caused by the novel coronavirus, SARS-CoV-2 emerged as a pandemic with extensive and profound impact on global health. While much attention, rightly has been directed towards understanding the virus's acute respiratory and systemic manifestations, the pandemic's impact on reproductive health has also emerged as a significant area of concern. Aims & Objective: This study aims at finding an association between COVID 19 infection and ovarian reserve and identify if this is a potential sequelae of long covid.

Materials

& Method: An Observational study was carried out among patients belonging to the age group of 25 to 35 years attending the fertility clinic at a secondary level hospital in goa. The study period was from October 2021 to October 2023, wherein all patients who consented were subjected to baseline testing for infertility, which included an ovarian reserve testing. Among these women, those with a low ovarian reserve, determined by the Antral Follicle Count and AMH (Anti Mullerian Hormone) estimation were included in the study. The total sample size in this study was 52. Antral follicles were manually counted on each ovary by transvaginal ultrasound by a reproductive endocrinology and infertility physician on the second day of menses. Follicles measured were between 2 and 9mm in diameter. Total antral follicle count is the summation between the counts from the left and right ovaries. An AMH value of <1 ng/mL was used as the cutoff. Exclusion criteria included those women with prior history of any ovarian surgery, ovarian malignancy, infections like tuberculosis or mumps and those women with history or findings suggestive of endometriosis. Along with the above parameters, socio-demographic data like age, occupation, Body mass index, addictions like tobacco chewing, smoking and alcohol were also included in the self designed questionnaire. History of COVID 19 was specifically asked among these women included in the study. The collected data was charted on SPSS Sheet and subjected to data analysis. Institutional Ethics Committee permission was taken.

Results

Among the 52 study participants, 46 study participants were found to have prior documented covid 19 infection whereas the remaining 6 participants didn't give history specific to COVID 19 infection. Among these 46 study participants, 12 had Covid 19 infection along with other risk factors.

Conclusion

The study concluded that Covid 19 infection could be attributed to a diminished ovarian reserve, however, the small study group warrants further research in this area. eP-859 The relationship between ultrasound endometrial pattern, histology and microarray in endometrial biopsies H. Elhassan1,2,3; W. Maalouf2; J. Thornton2,4; I. Soomro4; M. Castellanos2; N. Raine-Fenning2,3,4 1Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK, 2Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK, 3Nurture Fertility, The Fertility Partnership, Nottingham, UK, 4Nottingham University Hospitals NHS Trust, Nottingham, UK

Objectives

The aim of this study is to look at the endometrial pattern in relation to endometrial receptivity, and to assess if there is any correlation between the endometrial pattern on ultrasound scan, histology, and genetic markers of receptivity. Design: Single centre, prospective study.

Methods

30 women who were electing to have endometrial scratch as part of their IVF were invited to take part in the study. The study took place on the proposed day of endometrial scratch. Women had ultrasound scan prior to their scratch and endometrial pattern was recorded as either pattern 1 (triple), pattern 2 (early intermediate), pattern 3 (late intermediate), pattern 4 (homogenous). After the endometrial scratch was performed, sample was divided into two (one for histological assessment in formalin) and one sample was snap frozen in nitrogen and sent for microarray analysis.

Results

The PCA plots showed a clear correlation between the endometrial pattern on ultrasound and histology. Early intermediate pattern is closely related to the proliferative phase, and is distinct from the homogeneous pattern. In the mid to late secretory endometrium, there was an overlap between the early intermediate and late intermediate pattern, and between the late intermediate and homogeneous pattern. The endometrial pattern and histology are closely related which is expressed in the PCA plot according to their transcriptomic signature.

Conclusions

The PCA plots showed a clear correlation between the endometrial pattern on ultrasound and histology. The endometrial pattern and histology are closely related which is expressed in the PCA plot according to their transcriptomic signature. Further testing is required to further elucidate the “genomic” factors regulating this relationship. eP-860 Granulocyte colony-stimulating factor use in recurrent implantation failure and spontaneous miscarriages M. Alhmoudi; H. Alyammahi; R. Nad; M. Akhtar; M. Fakih; Y. Sajjad Fakih IVF Center AbuDhabi, IVF, Abudhabi, United Arab Emirates

Objective

Recurrent miscarriage (RM) and recurrent implantation failure (RIF) in assisted reproductive treatment, is a distressing reproductive health issue as the aetiology remains elusive in many cases. One potential contributing factor is inadequate endometrial receptivity, leading to implantation failure. Granulocyte Colony-Stimulating Factor (GCSF) has been proposed as a therapeutic agent to enhance endometrial receptivity due to its role in promoting tissue repair, angiogenesis, and immunomodulation. The effectiveness and safety of GCSF is yet to be established before standardizing it as part of IVF treatment. The objective of this study is to investigate the effects of intrauterine GCSF infusion on pregnancy outcomes in women with recurrent miscarriage or recurrent implantation failure who underwent Frozen embryo replacement (FER) cycle. Design: A retrospective data collection on a series of RM or RIF cases to investigate the effect of intrauterine GCSF infusion in frozen embryo replacement cycle on pregnancy outcomes. Methodology: This was a single Centre retrospective cohort analysis of women with RIF & RM who underwent FER cycles with intrauterine GCSF between April 2023 -January 2024. Data were analysed regarding women's demographics, aetiology for infertility and pregnancy outcomes. Total of 19 patients were included in the study with mean age of 35 years, BMI ranging from 24.6–38.5. Ultrasound guided Intrauterine infusion of Filgrastim (GCSF) 300 mcg/0.5 mL was performed once endometrial thickness of 7 mm was achieved. Single Embryo transfer was undertaken on the 6th day after commencing standard luteal support. Pregnancy outcomes were assessed based on positive serum βhCG test 9 days post ET, positive fetal heart by transvaginal ultrasound 2 weeks after positive HCG (clinical pregnancy), miscarriage and ongoing viable pregnancy.

Results

Out of the 19 patients, two patients had cancelled embryo transfer due to non-survival of thawed embryo and endometrial shedding prior to ET. Five patients (29%) had negative outcome, twelve had positive HCG test (70.5%). Out of these 12 patients, two had biochemical pregnancy (16.6%), two patients had first-trimester loss (16.6%), and eight patients (66.7%) achieved ongoing pregnancies. None of the patients developed any side effects.

Conclusion

Intrauterine GCSF infusion may have a beneficial impact on pregnancy outcomes in ART. However, further research is warranted to validate these results and compare it with subcutaneous route and use of GCSF media following blastocyst thawing to elucidate its mechanisms of action of GCSF in enhancing endometrial receptivity. Such research may contribute to the development of novel therapeutic strategies for these patients. eP-861 Effectiveness of ovulation induction with timed intercourse as treatment for secondary infertility M. Silva Edge1; B. Al Wattar2,3,4; H. Jan5,6; H. Shehata5,6 1Centre for Reproductive Immunology and Pregnancy, London, UK, 2Institute of Clinical Trials and Methodology, University College London, London, UK, 3Beginnings Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK, 4Clinical Trials Unit, Anglia Ruskin University, Chelmsford, UK, 5Epsom and St Helier University Hospitals NHS Trust, London, UK, 6Centre for Reproductive Immunology and Pregnancy, Epsom, UK

Introduction

Approximately 17% of women experience secondary infertility, yet consensus on optimal fertility treatments for achieving subsequent pregnancies remains elusive. Ovulation induction with pharmacological agents with timed intercourse could offer a cheap, and effective treatment for couples with anovulatory or unexplained secondary infertility. Our aim was to evaluate the efficacy of this treatment and explore potential effect modifiers across varied population subgroups.

Method

A retrospective cohort study was conducted, including 207 patients who underwent mild ovarian stimulation/ovulation induction at a tertiary gynaecology centre in London-UK between January 1, 2022, and December 31, 2023. Data were extracted from both electronic health records and paper notes. Patients included experienced delays in achieving pregnancy and/or exhibited low ovarian reserve as indicated by anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) levels. We collected data on patients age, AMH and FSH levels, semen analysis results, findings from tubal assessment, and the number of cycles per patient. The primary outcome was pregnancy, confirmed biochemically or on ultrasound evaluation. The treatment protocol for mild ovarian stimulation/ovulation induction involved administering Letrozole and/or Gonal F to stimulate follicular growth. Dosages of drug was individualised according to response to treatment, with adjustments made as necessary. Sonographic assessments were conducted to monitor the number and size of follicles, with the desired number of follicles targeted at 2 or 3. The optimal follicle size for ovulation induction trigger injection was 20–21 mm, followed by timed intercourse one and two days after injection. We reported using natural frequencies and percentages. We compared data distribution using a Chi square or fisher exact test.

Results

In total, we analysed data on 207 women, and a total of 766 cycles. Letrozole was the ovulation induction agent in 89% of these cycles, whereas gonadotrophins were used in 3%, and a combination of both in 8%. The program achieved a success rate of a 36% (74/207). The success rate per cycle was 10% (74/766), which is comparable to IUI success rates. The majority (91%) of pregnancies occurred within the first four cycles. Younger age and better ovarian reserve markers, such as higher levels of AMH and lower levels of FSH, are associated with higher success rates.

Conclusion

The findings suggest that superovulation in couples experiencing unexplained secondary subfertility may reduce the time taken to achieve pregnancy and could be a cost-effective alternative to more invasive assisted reproductive techniques, such as intrauterine insemination (IUI) or in vitro fertilisation (IVF). eP-862 Laparoscopic ovarian drilling in polycystic ovarian syndrome: Efficacy and safety H. Aloui; F. Slama; H. Frikha; R. Hentati Department C, Maternity and Neonatology Center of Tunis, Tunis, Tunisia

Objective

Polycystic Ovary Syndrome (PCOS) presents a multifaceted challenge to affected individuals and is a leading contributor to infertility. Therapeutic strategies for PCOS encompass both pharmacological and surgical modalities, with laparoscopic ovarian drilling (LOD) emerging as a prominent surgical intervention. This study aims to evaluate the efficacy and safety profile of Laparoscopic Ovarian Drilling (LOD) in patients with anovulatory PCOS resistant to Clomiphene Citrate. Design: We conducted a retrospective analysis spanning a four-year period.

Method

Our study included 23 patients diagnosed with PCOS who underwent LOD.

Results

The mean age of the patients was 32 years. Seventy-four percent presented with primary infertility, while the remaining sought intervention for secondary infertility. Ultrasound confirmed PCOS diagnosis in 62% of cases, while laparoscopy achieved definitive diagnosis in all instances. No intraoperative or postoperative complications were observed. Among the 23 patients, 13 (56%) achieved conception, with two (8%) experiencing miscarriages and one (4%) encountering an ectopic pregnancy. The pregnancy rate within the first year post-drilling was 56%, with an average conception time of 8 months post-procedure.

Conclusion

Laparoscopic Ovarian Drilling emerges as a viable therapeutic modality for managing infertility associated with PCOS, particularly following resistance to first-line treatment with Clomiphene Citrate. Its notable advantages include a low risk of ovarian hyperstimulation syndrome and reduced likelihood of multiple pregnancies. eP-886 Fetal outcomes for women with asymptomatic bacteriuria at booking: A retrospective audit L. Hawker; E. Turner; M. El-Mabruk; U. Rao Obstetrics and Gynaecology, Wirral University Teaching Hospitals, Wirral, UK

Objective

Asymptomatic bacteriuria is common in pregnancy with an incidence of 2%–10% and is associated with both maternal and fetal complications. The Saving Babies' Lives Care Bundle v3 (SBLCBv3) and Safer Maternity Care strategy recognise that to reduce the rates of stillbirth, neonatal deaths and brain injuries occurring during or around birth, the rate of preterm birth needs to reduce from 8 to 6%. As part of SBLCBv3, all women should be screened for asymptomatic bacteriuria at booking, treated appropriately and have a repeat midstream urine (MSU) to confirm clearance. The aim of this study was to establish the incidence of asymptomatic bacteria, the compliance with the SBLCBv3 and NICE recommendations around screening and management and understand the implications on birth outcomes within our local population. Design: A retrospective audit carried out for the first 500 women booked in for their pregnancy between January 1st and February 22nd 2022.

Method

Local electronic obstetric records were used to identify women booked within the study time period, and data was extracted regarding urinary symptoms and MSU result from booking, treatment given if applicable, follow up MSU result, and birth outcome. Audit standards were derived from SBLCBv3 and NICE guideline 109, with expected 100% compliance for each standard.

Results

483 women were included in the analysis, with 17 excluded due to being booked outside the audit range, transferring care or not attending any further antenatal care after booking (3). 89.6% of women had MSU screening at booking, with a positive MSU rate of 6% (n = 29). 96.6% of women with asymptomatic bacteriuria were treated with appropriate antibiotics, but only 65.5% had a repeat MSU to confirm clearance. E coli was the most common organism (n = 19). The overall spontaneous preterm birth rate in this cohort was 3.5%, with a higher rate for women with asymptomatic bacteriuria (13.8% vs 4%; 4/29 vs 13/454). All cases of preterm birth in women with asymptomatic bacteriuria were in samples with E coli growth.

Conclusions

Whilst screening for asymptomatic bacteriuria is part of the national screening, our study highlights the need to increase uptake of this screening and the importance of understanding the implications of improper or incomplete management, with an increased rate of preterm birth. eP-888 Audit of postpartum hemorrhage management at Queen's Hospital Romford, London B. Sharma1; N. Madipola1; A. Ahmed1; D. Sangtani2 1Obstetrics and Gynecology, Queens Hospital, Romford, UK, 2Anesthesia, Queens Hospital, Romford, UK

Objective

To assess and improve our efforts in preventing postpartum hemorrhage (PPH) due to its significant contribution to indirect maternal deaths. Design: Criteria-based clinical audit following the typical cycle: setting standards, measuring current practice, feedback findings, implementing changes, and reaudit.

Methods

We retrospectively analyzed 113 patients who delivered in our obstetric unit between April 2022 and March 2023 and had an estimated blood loss of 1500 mL or more. We used a proforma to collect data on demographics, high-risk factors for PPH, preventive measures, major obstetric hemorrhage calls, and documentation. The data was compared with RCOG Guideline standards to identify areas for improvement and implement evidence-based practices to enhance patient outcomes.

Results

The prevalence of anemia in pregnant women was found to be 11.5%, with 61.5% of those who received iron supplements still having anemia by the end of pregnancy due to non-compliance caused by side effects and non-absorption. This is a significant deviation from the RCOG guidelines, which recommend that antenatal anemia should be investigated and treated appropriately in all women. Regarding the use of uterotonics and controlled cord traction (AMTSL), 92.9% of patients received this treatment, while only one patient had physiological management. Three patients did not receive tranexamic acid, which is a deviation from the guideline that recommends that all women should be offered uterotonics for the third stage of labour. In 80% of the patients, a Management of Obstetric Hemorrhage (MOH) call was made, while in 23 patients, the call was not made. Ten patients were undocumented, and in 19 patients, the MOH scribe was incomplete. This deviates from the guideline that recommends that a multidisciplinary team involving senior members of staff should be summoned to attend to women with major PPH (blood loss of more than 1000 mL) and ongoing bleeding or clinical shock. To rectify these changes, several actions were proposed such as alternating-day oral iron supplements to improve compliance, enhancing skills and drills, establishing distinct communication channels for mobilizing the MOH call team, electronic documentation, and fostering a culture of accountability. A reaudit is planned to evaluate the impact of these changes.

Conclusion

The audit highlighted areas for PPH improvement: anemia management, uterotonic use, controlled cord traction, and MOH call handling. Recommended actions target compliance, communication, documentation, and enhancing patient outcomes." eP-889 Trends in postnatal readmissions: A retrospective analysis S. Ibrahim1; G. Ranjan2; C. Gabor2 1Lister Hospital, O&G, Stevenage, UK, 2Lister Hospital, Stevenage, UK

Objective

This retrospective analysis aims to examine the trends in postnatal readmissions over a two-year period, from April 2022 to March 2024, focusing on the reasons for readmission, management and associated maternal morbidities.

Methods

Data were collected from hospital records of postnatal readmissions. The cases were categorized based on the primary reason for readmission, including hypertension, sepsis, wound infection, urological issues, postpartum haemorrhage, and other complications. - Hypertension: 25-cases(30%) - Sepsis: 20-cases(24%) - Wound infection: 13-cases(15.5%) - Post Partum Haemorrhage/ RPOC: 13-cases(15.5%) - Urological issues: 6-cases(7.5%) - Others: 6-cases(7.5%) - Hypertension : 14-cases(33%) - Sepsis: 11-cases(26%) - Wound infection: 7-cases(17%) - Urological issues : 4-cases(9%) - PPH: 3-cases(7%) - Others: 3-cases(7%)

Conclusion

The substantial increase in postnatal readmissions from 2022–2023 and 2023–2024 from 42 to 83 cases indicates a significant shift in healthcare utilization or maternal health outcomes within the observed period. Such a spike warrants careful examination to identify underlying factors driving this change. Possible factors may include increased number of complex cases, maternal age alteration in healthcare policies, changes in patient demographics, or variations in postpartum care practices. Despite the increase in total readmissions, the distribution of reasons for readmission remains relatively consistent between the two periods. Hypertension is a predominant cause, underscoring the persistent challenge of managing hypertensive disorders during the postpartum period. The prevalence of sepsis, wound infection emphasizes the importance of robust infection prevention strategies and vigilant postpartum surveillance. Half of the patients in this group had positive blood , urine or swab culture. Addressing these issues requires a multifaceted approach, including improved infection control measures, timely intervention, and patient education. Furthermore, the data suggest that despite efforts to reduce postpartum haemorrhage, it remains a significant contributor to readmissions. 70% of the patients had surgical intervention in the form of surgical suction evacuation, EUA and Bakri balloon insertion .This highlights the ongoing need for effective preventive strategies and prompt management protocols to minimize the incidence and severity of PPH-related complications. Understanding the trends of postnatal readmissions is crucial for targeted interventions and reducing maternal morbidity and healthcare costs. Prolonged hospital stay and separation from family and baby causes psychological anxiety and difficult bonding. Continued efforts are needed to address postpartum complications and optimize postnatal care. eP-892 Co-relation of abnormal CTG with cord pH in patients delivered by emergency-CS A. Khalil1,2; S. Minai1; S. Bukhari1; K. AlMarwani2 1King Abdulaziz Medical City, Ministry of National Guard, Obstetrics and Gynaecology, Jeddah, Saudi Arabia, 2King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia

Objective

To investigate the correlation between abnormal CTG findings and perinatal outcomes, specifically focusing on the relationship between abnormal CTG patterns and cord blood pH levels in infants delivered by emergency caesarean section at KAMC, Jeddah. Design: This retrospective study examined 295 infants delivered by emergency caesarean section due to abnormal CTG findings between November 2020 and February 2021. The study aimed to determine whether there was a correlation between abnormal CTG patterns and cord blood pH levels, providing insight into the management of fetal distress during labor.

Method

Participants included women with singleton pregnancies, cephalic presentation, and gestational age >34 weeks. Exclusion criteria comprised elective caesarean sections, gestational age <34 weeks, multiple pregnancies, and babies with congenital anomalies. All patients underwent continuous CTG monitoring during labor, with indications for emergency caesarean section based on non-reassuring or abnormal CTG patterns according to RCOG guidelines. Cord arterial and venous pH were measured at delivery, and Apgar scores were assigned by neonatology staff. Data were analyzed descriptively, with a focus on the correlation between CTG patterns and cord blood pH levels.

Results

Of the 295 infants delivered by emergency caesarean section, 273 had cord blood gas results available for analysis. Among these, 6.99% had an arterial cord pH ≤ 7.05, 31.25% had an arterial pH > 7.05 but 7.25. For venous cord pH, 2.5% had a pH ≤ 7.05, 18.93% had a pH > 7.05 but 7.25. Notably, 36.36% of infants admitted to the neonatal ICU had an arterial cord pH < 7.20. Apgar scores at 1 and 5 min did not show a significant correlation with cord pH levels.

Conclusions

The study findings suggest that abnormal CTG patterns are associated with low cord pH levels, indicating fetal distress. Timely recognition of abnormal CTG patterns can lead to prompt intervention and potentially reduce unnecessary interventions in emergency caesarean sections. Further research is needed to explore additional factors influencing perinatal outcomes in these cases. eP-900 Pain management in IUD insertions: A systematic review and meta-analysis G. Francis1; A. Cacheiro Bofarull2; V. Alzogaray3; P.H. Costa Matos da Silva4; C.E. Philip5 1School of Medicine, Universidad Iberoamericana (UNIBE), Distrito Nacional, Dominican Republic, 2Division of Urogynecology, UCI Health, California, USA, 3Centro de Reproducción Humana del Interior, Montevideo, Uruguay, 4Departamento de Ginecologia e Obstetricia, Universidade Federal de Goiás, Goiânia, Brazil, 5Department of Gynaecology, Beaumont Hospital, Dublin, Ireland

Objective

The primary objective of this systematic review and meta-analysis was to quantitatively synthesize the evidence on the effectiveness of various pain management strategies employed during the insertion of intrauterine devices (IUDs). We aimed to determine the impact of these interventions on pain reduction, as reported by patients using the Visual Analog Scale (VAS), and to identify which strategies are most effective in clinical practice. Design: This systematic review and meta-analysis, adhering to PRISMA guidelines, included eight randomized controlled trials involving 1157 participants. Studies were selected based on their evaluation of pain management strategies during IUD insertion, with interventions ranging from local anesthetics like lidocaine in various applications to systemic analgesics such as diclofenac.

Method

A comprehensive search was conducted across multiple electronic databases, including PubMed, EMBASE, Cochrane Library, and others, from their inception until the present. Only RCTs comparing pain management interventions with control during IUD insertions were included. Pain intensity was measured using a Visual Analog Scale (VAS). Data were pooled using a random-effects model to calculate standardized mean differences (SMD) with 95% confidence intervals (CIs).

Results

The meta-analysis demonstrated that pain management interventions significantly reduced pain during IUD insertion (SMD -0.66, 95% CI -0.80 to -0.52, I² = 97%). Specific interventions included the application of lidocaine in various forms—spray directly on the cervix, cream via cotton swab and angiocatheter, and injection at the cervicovaginal junction for paracervical block, as well as the use of diclofenac potassium orally combined with 2% lidocaine gel applied topically on the anterior cervical lip and into the cervical canal. Subgroup analyses indicated a greater effect when the intervention was applied at specific stages of the insertion process, particularly with the use of a tenaculum (SMD -0.92, 95% CI -1.10 to -0.75) and at 5 min post-insertion (SMD -1.43, 95% CI -2.65 to -0.21). The heterogeneity was high in most analyses, which may be attributed to the variations in intervention types and pain assessment timings.

Conclusions

Pain management interventions appear to be effective in reducing the pain experienced during IUD insertions. This could have significant implications for clinical practice, improving patient comfort and potentially increasing the uptake of IUD as a method of contraception. Future research should focus on identifying the most effective interventions and optimizing their use in clinical settings. eP-901 Female sexual function within infertile Tunisian women R. Swayah1; N. Souayeh1; K. Amara2; H. Bettaieb1; H. Rouis1; N. Hsayaoui1; M. Nouira3; C. Mbarki1 1Faculty of Medicine, Gynecology and Obstetrics, Ben Arous Regional Hospital, University of Tunis el Manar, Tunis, Tunisia, 2Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia, 3Faculty of Medicine, Epidemiology and Community Medicine, University of Tunis el Manar, Tunis, Tunisia

Objective

The objectives of our study were to assess the prevalence of sexual dysfunction among Tunisian women facing infertility issues, while identifying the most affected areas of their sexuality. Design: This was a prospective, cross-sectional, descriptive study.

Method

We conducted our study over a period of three months from November 24, 2023, to February 24, 2024. Infertile couples were surveyed in our outpatient clinic and on private social media groups.

Results

We enrolled 100 Tunisian women married for at least one year, with primary or secondary infertility. The mean age of women was 30 ± 4 years, with ages ranging from 21 to 45 years. The majority of women (70%) were under 35 years old. In our series, all couples were married with an average duration of marriage of 3.75 years. The majority, 80%, had completed their university education. 38% of the women included in our study were unemployed, and 37% were civil servants. The majority of women in our sample (84%) had no medical or surgical history. Three women reported taking antidepressants. Most of the women surveyed (62%) had no history of gynecological surgery. 17% of them had undergone diagnostic hysteroscopy. Regarding spouses, they had a mean age of 39 years, with extremes ranging from 19 to 48 years, and 53% had a university education. Premature ejaculation and erectile dysfunction were the most commonly reported sexual dysfunctions, found in 14% and 8% respectively. Two partners experienced both of these issues simultaneously. The mean Female Sexual Function Index (FSFI) score in our study population was 20.47 (±7.197) with extremes ranging from 2 to 35.4, indicating overall sexual dysfunction in 82 patients. Analyzing the different items of the FSFI score, we found that the most affected domains were sexual satisfaction (50%), orgasm attainment (45%), followed by lubrication (44%) and arousal (44%).

Conclusion

Infertility and its treatment can constitute a long and difficult journey with a negative impact on the sexual life of the couple. It is essential to assess the significance of sexual dysfunction and provide psychological and sexological support to infertile couples throughout their management. eP-904 Postpartum long-acting reversible contraception (LARC) continuation – A Quasi experimental study T. Wasim Obstetrics & Gynecology, Services Institute of Medical Sciences, Lahore, Pakistan Aim: To determine the continuation rate and factors associated with the continuation of immediate postpartum insertion of intra-uterine contraceptive devices (PPIUCD ) in low-middle income setting using multivariable analysis. Design: Quasi experimental study.

Methods

This study was conducted at the Department of Obstetrics, Services Hospital, Lahore, Pakistan from November 2017 to October 2020. All patients attending the antenatal clinic and those who came in early labour were counselled regarding immediate postpartum placement of IUCD. Those who opted for PPIUCD were explained the method of insertion, advantages, mode of action, potential side effects, the need for follow up and were enrolled in the study. Written informed consent was taken from them. The antenatal cards of the ones who gave informed consent were stamped for willingness. Patients with anemia (HB < 10 g/dL), premature rupture of membranes more than 18 h, PPH, congenital malformation of the uterus, active infection of genital tract were excluded. All those who chose the method were inserted IUCD immediately after delivery or within 48 h before discharge by the doctors trained as master trainers The patients were followed up and those who completed follow up for 24 months were included in the study. Primary outcome variable was the continuation rate at 24 months. Secondary outcome variables were reasons for continuation and discontinuation. Data was entered and analyzed using SPSS version 23

Results

A total of 8000 patients were placed PPIUCD ,out which 3400 patients completed the follow-up at 24 months. Regarding demographics, 2392(70.35%) patients were 21–30 years old, 1614(47.47%)uneducated, 1447(42.55%) belonged to urban area. 1988(58.47%)were not using any contraception previously although 1867 (54.91%) had knowledge of healthy timing & spacing of pregnancy. Myths regarding contraception 888 (44.66%) & family pressures 472(23.74%) were main reason for not using any contraception previously. Out of 3400, 2132 (62.70%) continued PPIUCD at 24 months. Women who were educated, counseled during the antenatal period, having more than three children and prior contraceptive use continued the method for up to two years. (AOR = 2.4, 95% CI: 1.08–7.20). [d1] 1268 (37.29%) got IUCD removed mainly due to bleeding irregularities 483(38.09%) and family pressure 320(25.23%).

Conclusion

Population explosion is a serious issue in Pakistan. PPIUCD is a promising intervention with high continuation rate at 24 months. Factors such as education, family size, prior contraceptive use, and antenatal counseling significantly influences contraceptive continuation. [d2] Family counselling and doctors training on managing side effects can help continuation. eP-905 Global female sexual function assessment in women with treated breast cancer C. Abdelhedi1; N. Souayeh2; E. Gomri1; H. Bettaieb2; H. Rouis2; N. Hsayaoui2; M. Nouira3; C. Mbarki2 1Faculty of Medicine, University of Tunis el Manar, Tunis, Tunisia, 2Faculty of Medicine, Gynecology and Obstetrics, Ben Arous Regional Hospital, University of Tunis el Manar, Tunis, Tunisia, 3Faculty of Medicine, Epidemiology and Community Medicine, University of Tunis el Manar, Tunis, Tunisia

Objective

Our study aimed to evaluate sexual function of Tunisian women with Breast cancer in remission and determine prevalence and nature of their sexual dysfunction. Design: This is a two month transversal and descriptive monocentric study.

Method

Our study was conducted over two months. We enrolled 60 women under the age of 60, who were treated for non-metastatic breast cancer and who were then in remission and had a regular sexual partner over the month before. Data were collected from medical files and patients were questioned using the Female Sexual Function Index (FSFI).

Results

Most of the women were aged between 32 and 59, with average of 46.53, and 56.7% were postmenopausal. 67.7% had a mastectomy, of whom only 5.4% had a breast reconstruction, 39.3% had radiotherapy, 75% had chemotherapy and 71.7% had hormonotherapy. Treatment follow-up showed that 80% presented complications due to treatment. Before cancer diagnosis, the average frequency of sexual intercourse (SI) reported by our respondents was 2.66 per week, and three women (5%) already presented a sexual dysfunction (Dyspareunia). After the diagnosis, the average frequency of SI was 1.47 per week, and 21.7% of respondents had no sexual activity. Most of the patients (78%) described a change in their sexual life. The most frequent complaints reported among them were decreased frequency of SI (80.85%), decreased or absent desire (68.1%) and pleasure (19.1%), dyspareunia (42.6%), vaginal dryness (48.9%) and lack of foreplay (36.2%). The most common influencing factors reported were changes of the body after treatment (79.6%), psychological condition of the woman (53.1%) or the partner (12.7%) and lack of self-confidence (30.6%). The average FSFI was 20.2, with extremes ranging from 2 to 32.6, and 50 women (83.3%) presented a global sexual dysfunction. The analysis of the FSFI various items showed that the most affected areas were pain, lubrication, and orgasm.

Conclusions

Breast cancer and its treatments have a direct and indirect impact on women's sexual function, resulting in an important decrease of the frequency and quality of SI. Awareness of sexuality remains insufficient or even absent in our society, as it is a taboo subject. Therefore, we recommend including sexual assessment during follow-up of patients treated for breast cancer, and providing information about alternative therapies, which can help reduce anxiety and stress related to sexuality after cancer. eP-906 Knowledge, attitude, practice of reproductive and sexual health among women in India T. Bansal; P. Bansal; J. Bansal Obstetrics and Gynaecology, Sumitra ECMC, Lucknow, India

Objective

Sexual and reproductive health (SRH), a globally recognized fundamental health concern and a basic human right is improperly addressed and seldom researched in the India. Disregarding this aspect of health creates various obstacles to accessing SRH related services and education. This threatens the health of a female, mainly through increasing the probability of unplanned pregnancies and unsafe abortions, augmenting the risk of acquiring sexually transmitted infections, and most importantly, increasing the hazard of maternal and neonatal death. Thus, this study aimed to assess the level of SRH related knowledge and awareness among women visiting a speciality clinic. Design: A descriptive cross-sectional study.

Methods

The study was conducted using a self administered questionnaire in both English and Hindi languages. The questionnaire included different sections; socio-demographic, sexually transmitted infections (STIs) section, premarital tests section, vaccines section, menstruation , pregnancy symptoms and identification section, contraception section, and honeymoon events section. The questionnaire was distributed among 672 sexually active women between 20 and 45 years , who attended Gynae OPD of SUMITRA ECMC LUCKNOW ,INDIA. Student t-test and Chi-Square test were used to analyse results.

Results

It was found that only 9.7% of all the participants had adequate knowledge. Knowledge was directly propotional to the level of education. The highest level of SRH related knowledge was about pregnancy (91.0%), and the least was about contraception (16.5%) & only 7.2% was about Infertility awareness. Most of the knowledgeable participants lived in urban & sub urban area.

Conclusions

Due to the inadequate level of knowledge, SRH education campaigns are recommended in the Community and Hospitals to enhance the awareness level and make SRH knowledge readily available among sexually active women. Knowing the massive role of social media nowadays, the messages they present should contribute to enhancing the level of SRH knowledge. eP-907 Breaking burriers: Unveiling women menstrual hygiene management practices in Lahore, Pakistan M. Janjua1,2; N. Tu Zahra2; H. Tariq2 1OBGY, Fatima Jinnah Medical University, Lahore, Pakistan, 2OBGY, Fatima Jinnah Medical University, Lahore, Pakistan

Objective

This cross-sectional mixed-method study aimed to explore factors influencing menstrual hygiene management practices (MHMP) among women attending Lady Willingdon Hospital in Lahore, Pakistan, in 2023. Design: The study utilized a cross-sectional mixed-method design to investigate the factors influencing MHMP. Quantitative data were collected using self-administered semi-structured questionnaires, while qualitative data were obtained through in-depth interviews with twenty participants.

Method

A total of 382 females participated in the study, recruited with approval from the hospital's ethical committee and their informed consent. Participants were selected based on their attendance at Lady Willingdon Hospital. Quantitative data were collected using self-administered semi-structured questionnaires, while qualitative data were obtained through in-depth interviews with twenty participants. Data were analyzed using bivariate analysis for quantitative data and thematic analysis for qualitative data.

Results

The mean age at menarche was found to be 14.5 years, with mothers being the primary (89%) source of menstrual hygiene information. Notably, 65% of participants had no prior awareness of menstruation before their menarche. Sanitary pads were the predominant menstrual hygiene product (99%), with 64% of participants disposing of them in garbage. Factors such as age, maternal education, family income, perceived socioeconomic class, and age at menarche showed significant associations with MHMP in the bivariate analysis. Interviews revealed that cost, comfort, durability, and accessibility influenced menstrual hygiene product choices. However, participants exhibited minimal knowledge about menstruation's reasons and proper menstrual product disposal methods. Moreover, cultural taboos and limited sanitation facilities during menstruation were reported.

Conclusions

The study highlights the importance of targeted interventions to improve menstrual hygiene practices and women's overall well-being. Addressing cost and accessibility constraints, increasing awareness about menstruation, and ensuring adequate sanitation facilities during menstruation are essential steps for promoting better MHMP. These findings have implications for future research, practice, policy, and theory related to menstrual hygiene management in low-resource settings like Lahore, Pakistan. eP-908 5 years analysis of laparoscopic sterilisation at a district general hospital S. Bhaskar; K. O'Sullvan; S. Gurubasappa; W. Truong; C. Norman NHS Fife, Obstetrics and Gynaecology, Fife, UK

Objective

To assess the immediate and late complications of sterilisation including regret and reversal. Design: Retrospective Analysis of online records at a District General Hospital in Scotland.

Method

465 women who had Endoscopic Bilateral Tubal Occlusion (Laparoscopic Sterilisation) between January 2013 to December 2018 were identified by online Theatre Records. The data was collected from online records and all women were followed up till December 2023. 10 women were removed from the cohort due to lack of sufficient documentation.

Results

All women in our cohort had laparoscopic sterilisation using Filshie clips. The ages of the patients ranged from 21–51 years with 70% of the patients being 30 years or above. 450 (99%) patients had successful procedure without any intraoperative complications. 3 patients had uterine perforation (0.6%) and in 2 patients (0.4%), procedure was abandoned due to inability to create pneumoperitoneum. In one patient the procedure was converted to min-laprotomy due to ovarian cyst torsion. All women were followed till December 2023. Late complications analysed were abnormal uterine bleeding (AUB), pelvic pain, ectopic pregnancy, failed sterlisation, regret and requesting reversal. In our cohort there was one failed sterilisation (0.2%) and no ectopic pregnancies. 15% of the women were referred to the hospital for AUB and 11% of the women for chronic pelvic pain of which nearly 4% had Hysterectomy with or without bilateral salpnigo-oopherectomy. 5 patients presented with lower abdominal pain following sterilisation (clip pain), for which three had bilateral salpingectomy, 1 had clip removal and the last patient had removal and re-application of the clip on one side. 9 patients requested reversal of sterilisation, giving an overall rate of request of 2%. 7 of the 9 were aged < 30 giving a reversal rate of 5% compared to only 0.6% of those aged over 30 years. 8 of the 9 patients who requested reversal cited a new relationship as one of their reasons. Only one woman was successful in obtaining funding for reversal and achieving three successful pregnancies following reversal.

Conclusions

With technical advancements in Laproscopy and structured training of the doctors has made Laproscopic sterilisation a safe procedure. The data from our retrospective study does suggest that, those undergoing sterilisation at a younger age do have higher rates of requesting reversal of sterilisation than those undergoing the procedure over the age of 30, consistent with existing literature evidence. eP-909 To assess acceptability of post placental insertion of intrauterine contraceptive device J. Anna Iype Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India

Objective

Primary objective. (1) To study the acceptability of PPIUCD among antenatal mothers who are counselled once or multiple times. (2) To assess if counselling by any particular cadre improves acceptability. (3) To assess if group counselling improves acceptability. Hypothesis: The acceptability for PPIUCD improves when counselling is done on multiple occasions by a consultant.

Background

Even though contraceptive methods are widely available, they are not much accepted due to a lack of knowledge and ignorance. PPIUCD has the potential to be a key differentiator in India's Family Planning Programme. The present study is to assess the acceptance rate among the women attending antenatal clinics in CMC Vellore. And to see the level of acceptance with single and multiple counselling with the different cadre. Design: Observational cohort study.

Methods

This was an observational cohort study done to assess the acceptance of immediate PPIUCD insertion among the antenatal women who had delivered in Christian Medical College, Vellore. Participants was recruited in antenatal clinic from 32 weeks of gestation of pregnancy by Block randomization method. Method specific Counselling on PPIUCD was done by different cadre: Consultants (more than 5 years experience), Postgraduate registrar and group counselling. At the time of delivery all the study participants who accepted and gave documented consent, had CuT-380 A as PPIUCD inserted by the treating clinician in Labour Room and Analysis was done on the data collected.

Results

The acceptance rate of PPIUCD in this study was 9.5%. Acceptance after counselling in the consultant group was 9.0% and in the Registrar group was 10%. Among the participants who agreed to use PPIUCD antenatally, the acceptance in 11 Single counselling was 14%, in Group counselling was 9.1% and in multiple counselling was 5.2%.

Conclusion

Our society's awareness and acceptance of PPIUCD is still very low. Counselling antenatal women and their families are beneficial for PPIUCD acceptance. Even after effective counselling, the most common reason for the nonacceptance of PPIUCD is family refusal and apprehension about complications.

Keywords

PPIUCD, Acceptance, single counselling, multiple counselling eP-910 A survey on pain relief measures in outpatient intrauterine contraception device insertion S. Sekar; P. Shetty; M. Dealwis; S. Fernando Obstetrics and Gynaecology, Betsi Cadwaldr Health Board, Wrexham, UK

Background

Intrauterine Contraception Devices (IUDs) are a highly effective, long-acting reversible contraceptive method used globally. Despite this, Wales reported a decline in IUD uptake from 7082 to 6315 between 2021 and 2023. Recent concerns have been raised in media about the discomfort experienced during IUD insertion.

Objective

This study aimed to explore current clinical practices in the Wales for mitigating pain associated with IUD insertions in outpatient clinics.

Methods

An online questionnaire was distributed to practitioners across Wales who performs IUD insertions. The questionnaire, aligned with recent FSRH guidelines, comprised 23 structured questions and was created using Microsoft Forms. The survey targeted contraception clinics, sexual health clinics, GP surgeries, and various specialists within the UK(Wales) NHS healthcare trusts.

Results

Out of 200 participants contacted, 35 (17.5%) responded. Among these respondents, 85% had formal training, 94% felt confident in inserting IUDs, 97% provided pre-placement counselling, and all utilized an assistant for patient support and offered alternative options before the procedure. Moreover, one respondent indicated the use of Entonox, while another opted for a combination of treatments including 10% lidocaine spray, 2% lidocaine gel, EMLA cream, and intracervical block. Interestingly, five respondents emphasized the importance of clear communication, providing emotional support, and building rapport with patients. Areas for improvement are identified: Ensuring all facilities have proper equipment, mandating formal training for practitioners, and standardizing analgesia options (82.9%). Only 17% use patient satisfaction surveys, suggesting a need for broader implementation. Action plan: Standardize pre-placement counselling within 6 months led by clinical lead and training department. Implementing a patient satisfaction survey system using the BSGE Patient Survey Template within 6 months through quality improvement team. Initiate formal training for identifying high-pain-risk patients and IUD insertion and different pain relief strategies within 6 months.

Conclusion

The study provides valuable insights into current practices and areas for improvement in pain management during IUD insertion. Enhanced training, better facility provision, and consistent use of patient feedback are crucial for improving patient experiences in intrauterine contraception procedures. eP-912 Genital and anal injury after sexual assault: Prevalence rates and associated risk-factors D. Kane1,2,3; J. Walshe1,2; D. Richardson1; C. Pucillo1; O. Farrell1; N. Maher1,2; K. Flood2,3; M. Eogan1,2,3 1Dublin Sexual Assault Treatment Unit, Dublin, Ireland, 2Rotunda Hospital, Dublin, Ireland, 3Royal College of Surgeons in Ireland, Dublin, Ireland

Objectives

To investigate the prevalence of, and risk factors for, ano-genital injury in females who attended a Sexual Assault Treatment Unit (SATU) in a capital city following sexual assault. Design: Cross-sectional study.

Method

All females who underwent a genital and/or anal forensic examination at the Dublin SATU from 1/1/2023–31/12/2023 were included. A standardised dataset of demographic and assault details was collated. Genito-anal injury data was collected by forensically trained specialist doctors and nurses using a standardised tool with fixed definitions. Descriptive bivariate analysis and logistic regression analysis were performed on these data. Statistical significance was defined as a p-value <0.05.

Results

During the study period, 405 women accessed the SATU service with 294 (72.6%) of those undergoing a forensic examination that included a genital and/or anal examination. The overall prevalence of genital injury was 25.9% (n = 76/294), with those who reported completed vaginal penetration having a genital injury prevalence rate of 31.1% (n = 65/209). Anal injury was observed in 20% (n = 8/40) of those who reported completed penile-anal penetration. The most commonly injured site was the posterior fourchette (n = 29) followed by the fossa navicularis (n = 24) and the labia minora (n = 23), with the most common injury type being a laceration (n = 81) followed by an abrasion (n = 37). Genital injury was significantly more likely to be present in women who disclosed digital-vaginal penetration (OR 3.86 CI 1.42–10.51 p = 0.005), a mental health history (OR 1.94 CI 1.11–3.39 p = 0.01), were sure a sexual assault had taken place (OR 2.91 CI 1.31–6.45 p = 0.008), who disclosed genital bleeding after the incident (OR 2.35 CI 1.25–4.42 p = 0.007), and had extra-genital injuries (OR 2.17 CI 1.26–3.76 p = 0.005). Previous sexual activity (p = 0.34), age (p = 0.64), assailant-survivor relationship (p = 0.07) or incident location (p = 0.17) did not have a significant effect on the presence of genital injury.

Conclusion

This study sheds light on the prevalence and patterns of genital and anal injuries in women presenting following sexual assault, providing valuable insights into the nature and extent of harm experienced by survivors when consistent data collection tools are used. These findings contribute to the body of evidence guiding forensic examination protocols and care strategies, as well as to the evidence base considered during detection and prosecution of sexual crime. eP-913 Teenage pregnancy, multiple disadvantage and postnatal contraception T. Kubba; J. Rennie; G. Brown; A. Pereira Newham University Hospital, Barts Health NHS Trust, London, UK

Objective

UK teenage pregnancy rates are the highest in western Europe. Teenagers who fall pregnant are more likely to experience ‘multiple disadvantage’, defined as 3 or more of: substance/domestic/childhood abuse, arrival in UK within 5 years, refugee/asylum seeker, mental health diagnosis, female genital mutilation, and learning difficulties. The 2023 MBRRACE report highlighted that women with multiple disadvantage are at increased risk of maternal morbidity/mortality. Newham University Hospital (NUH) serves a population that experiences multiple disadvantage. We undertook this retrospective review due to concerns that this vulnerable group were not receiving adequate information regarding postnatal contraception. Design: A retrospective review of pregnancies in women aged <20 over a 3-year period at NUH. - A review of all pregnancies in women aged <20 over a 3-year period (Jan 2021-Jan 2024) - Deep dive into all pregnancies in women aged <20 in 2023 - Deep dive into all women aged <20 who had more than one pregnancy episode.

Results

467 patients booked a pregnancy aged <20, giving an annual ‘teenage pregnancy’ rate of 2.92% (mean birth rate – 5330 births/year). 2023 114 women booked a pregnancy aged <20 in 2023. 64.0% booked the pregnancy late (15% in 3rd trimester). 45.6% had safeguarding concerns. 35.1% had difficulty reading/writing English. 20.2% had a mental health diagnosis. 10.5% had experienced domestic/childhood abuse. 10.0% experienced substance misuse. Overall, 24.3% experienced multiple disadvantage. 8.8% of women had a documented antenatal discussion regarding postnatal contraception. 25.4% had a postnatal plan documented; none received contraception whilst an inpatient postnatally. Multiple pregnancy episodes: 19 patients aged <20 had more than one pregnancy episode during the 3-year period. 53.4% booked the pregnancy late (15.4% in 3rd trimester). 73.7% had safeguarding concerns. 31.6% had difficulty reading/writing English. None of these women had a mental health diagnosis. 47.4% of women had experienced domestic/childhood abuse. 5.4% experienced substance misuse. Overall, 31.6% of these women experienced multiple disadvantage. None of these women had a documented antenatal discussion regarding postnatal contraception. 10.5% had a postnatal plan documented; none received contraception whilst an inpatient postnatally. 63.2% of women had an inter-pregnancy interval of <12 months.

Conclusions

These women are complex and high risk, with a significant proportion experiencing multiple disadvantage. Our data found clinicians are missing key opportunities for intervention, which informs our next steps to create a postnatal contraception education package. This will aid reproductive choice and support optimal pregnancy spacing for this vulnerable group of women. eP-914 Barriers to contraceptive use and adherence in women attended center health J. Matzumura-Kasano1; H. Gutiérrez-Crespo1; P. Moquillaza-Vizarreta2; W. Quispe-Mori1 1Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru, 2Gynecology and Obstetrics Service, Hospital Nacional Hipolito Unanue, Lima, Peru

Objective

Describe barriers to contraceptive use and adherence in women. Design: Non-experimental, descriptive, cross-sectional.

Methods

Research with a quantitative approach included a population of women ≥ 18 years of age who were attended at the first level of care in the city of Lima, Peru, during January to August 2023. A non-probability sample by convenience was used and included women who provided their consent. For data collection we used the instrument: Barriers to Adolescent Contraception Adherence, which contains 26 questions, consisting of two sections; the first describes the sociodemographic characteristics. The second section assesses preference and access to information on contraception. It also assesses concerns about side effects. The instrument has a reliability of 0.79. Data analysis was performed using SPSS version 22.

Results

The final sample consisted of 607 women. The mean age was 31.9 years ± SD 9.8. 50.4% reported being in a stable civil union, 40.9% are affiliated with subsidized insurance, 10.7% do not have insurance and 83.9% are currently having sexual relations. 83.7% use a contraceptive method: 30% condoms, 18.5% contraceptive pills and 10% subdermal implants. 45.5% use contraceptives more than 2 years, 16.1% use for 2 years, 14.8% ≤1 year. Women reported using other contraceptives; 13.3% pills, 9.2% injectable and 7.1% condoms. 75.5% use contraceptives according to the doctor's explanations, 28.8% do not use contraceptives, because they consider that they do not need it or become pregnant. 90.9% have knowledge about emergency contraception and 31.9% used it twice and 8.6% up to three times. 65.4% feel concerned about side effects; 31.6% about weight gain, 13% irregular bleeding. 81.9% expressed concern about obtaining their contraceptive at the health facility. 14.2% do not consider their contraceptive method ideal because they do not remember to take it daily, because it causes irregular bleeding and pain. 63.4% are aware of all contraceptives. 62.7% reported obtaining information through the doctor and 23% through the Internet.

Conclusion

The majority of women use a contraceptive method. Condoms and pills are most widely accepted, most use them >2 years and one third of women use emergency contraception up to 2 times. Weight gain and irregular bleeding are considered the main concerns. eP-928 British Undergraduate Society of Obstetrics and Gynaecology Mentorship Scheme: Impact and future K.-B. Papalois1; A. Zielinska2; M. Kavanagh3; I. Valcheva4; S. Sukumaran3; S. Sheikh5; J. Jiat Teh3; P. Iyer3; A. Bleumel6 1Royal Berkshire NHS Foundation Trust, Reading, UK, 2Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London, UK, 3The British Undergraduate Society for Obstetrics and Gynaecology, BUSOG, London, UK, 4Ayrshire Maternity Unit, University Hospital Crosshouse, NHS Ayrshire and Arran, London, UK, 5The British Undergraduate Society for Obstetrics and Gynaecology, BUSOG, Watford General Hospital, London, UK, 6Newcastle University, Newcastle upon Tyne, Newcastle, UK

Objective

The British Undergraduate Society of Obstetrics and Gynaecology (BUSOG) is a Royal College of Obstetricians and Gynaecologists-supported specialist society committed to supporting postgraduate doctors considering a career in Obstetrics and Gynaecology (O&G). The BUSOG Mentorship Scheme was launched in 2021. It aims to match UK Foundation Doctors with Specialist Trainees in O&G to support their personal and professional development. Design: We conducted an observational study over two consecutive mentorship cycles (2021–2022 and 2022–2023). The primary outcome was to measure the proportion of Mentees who fully completed the scheme (at least three in person/virtual meetings with assigned mentor). Secondary outcomes included scheme satisfaction through willingness to continue in the scheme, proportion of mentees who participated in clinical shadowing or conducted research, as well as gathering feedback to identify common themes and inform future cycles.

Method

Outcomes were compared within the two mentorship cycles. Once recruitment finished, Mentor-Mentee allocation was based on geographical proximity of hospitals as well as aims of Mentees. The progress of the scheme was measured through a record of meetings and completion of mentorship questionnaires, which were used to collect data and monitor progress of the scheme. Converting more scheme resources to electronic format was introduced in the 22–23 cycle.

Results

145 mentor-mentee pairs were established in the first cycle and 76 in the second cycle. In the first cycle 15.0% of participants fully completed the scheme compared to 49.0% in the second cycle. In the 21–22 scheme 50.0% of mentees where happy to continue in the scheme compared to 85.3% in the 22–23 cycle. The proportion of trainees who participated in clinical shadowing and research opportunities decreased slightly from the 21–22 cycle. Themes identified from feedback of both cycles revealed the scheme was useful in assisting junior doctors with the interview and application process as well as providing advice and facilitating networking with O&G trainees. Better matching of Mentors and Mentees by geographical location was a common theme in both cycles in regards to future improvement.

Conclusions

Changes introduced in the 22–23 cycle improved completion rates and overall scheme satisfaction. Surgical shadowing and research opportunities were hindered by difference in geographical locations of mentors and mentees and lack of engagement. Closer control of participant numbers, extended period of mentoring, altering the process of scheme completion requirements and better matching mentees and mentors by geographical location will hopefully address the above areas of improvement in future cycles. eP-932 Perception of female staff towards OBGYN patients' involvement in medical students training L. Aljunaid1; R. Mirghani2; M. Begam3; I. Ahmed1; H. Mirghani4 1Obstetrics and Gynecology, Tawam Hospital, Al Ain, United Arab Emirates, 2University Collage Cork, Medical Students, Cork, Ireland, 3Medclinic Hospital, Consultant Maternal-Fetal Medicine, Abu Dhabi, United Arab Emirates, 4United Arab Emirates University/NMC Royal Khalifa City Hospital, Consultant Maternal-Fetal Medicine, Abu Dhabi/Al Ain, United Arab Emirates

Objectives

To determine the perception of female healthcare providers towards the involvement of medical students in obstetrics and gynecology training.

Method

and design: This prospective longitudinal survey study used an anonymous, self-administered questionnaire to female healthcare providers regarding medical students' training in the Obstetrics and Gynecology department in 2013 (n = 114) and repeated in 2021 (n = 105). Descriptive analyses were done. A comparison of the variables between 2013 and 2021 was performed using a paired t-test. The p-value was considered significant if p < 0.05.

Results

A total of 219 healthcare providers participated in the study. Their perception regarding female patients' acceptance of medical students was low. This increased from 81.6% (n = 114) in 2013 to 93.3% (n = 105) in 2021 towards male students (p = 0.01). Similar findings were perceived among female medical students. Agreement on the use of simulation-based training for male medical students increased from 53.5% (n = 114) to 70.5% (n = 105) (p = 0.01). The percentage of healthcare providers who disagreed with having a vaginal examination by a male obstetrician increased from 39.5% (n = 114) to 54.3% (n = 105) (p = 0.02).

Conclusions

The study raises concerns regarding the clinical exposure of medical students during OBGYN training. Male medical students remain at a disadvantage during their training. Greater attention might be needed towards educating healthcare providers to encourage patients' engagement during clinical training sessions. Simulation-based training should be incorporated within medical curriculums.

Keywords

OBGYN, gender, students, training, healthcare providers eP-933 The use of e-learning in developing procedural skills in O&G: Scoping review P.S.R. Gurusamy1,2; S.N. Roy1; K. Evans2 1North Tees and Hartlepool NHS Foundation Trust, Obstetrics and Gynaecology, Stockton-on-Tees, UK, 2The University of Western Australia, Crawley, Australia

Objective

The COVID-19 pandemic has reshaped healthcare and clinical education through virtualization. Evidence indicates successful e-learning acceptance in healthcare, yet high-quality research on outcomes in Obstetrics and Gynaecology (O&G) surgical and technical skills is scarce. This scoping review targets knowledge gaps for further research. Design: Scoping review, enabling systematic analysis of all existing literature involving the use of e-learning in developing procedural skills in O&G.

Methods

This scoping review follows the framework of Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The review included all original studies from January 2013 to March 2023 on e-learning interventions promoting procedural skills in O&G. The development and implementation of the interventions contained in the included studies were analysed. The outcomes of the interventions were analysed using Kirkpatrick's model.

Results

Eight studies were eligible for inclusion. Gynaecological domain, in particular laparoscopic surgical skills were most targeted area of intervention. Only one study focused on continuing professional development (CPD) of trained specialists. The studies concluded that the interventions were practical and viable, and trainees rated the interventions positively. Evaluation modalities were heterogenous, and seven out of eight interventions reported positive findings regarding content acquisition. Knowledge application and impact on service provision was not studied adequately by the studies.

Conclusions

Future research should aim for standardized evaluation of e-learning interventions, enhancing result comparability, strengthening evidence for effectiveness, and offering insights for implementation. Additional research is needed to analyze higher-level Kirkpatrick's outcomes (3 and 4). Educators should factor in the role of e-learning in CPD and O&G curriculum when designing interventions. eP-934 Creation of a high-fidelity clinical simulation center in Nigeria F. Okonofua1; V. Onoh2; R. Ugiagbe2; A. Atimati2; K. Martin2; B. O'Connel2; C. Egbuta2; M. Niescierenko2; M. Isikhuemen2 1University of Benin Teaching Hospital, Edo State, Nigeria, Benin, Nigeria, 2Center of Excellence in Reproductive Health Innovation, Benin, Nigeria

Objective

There is very limited amount of high-fidelity clinical simulation in Nigeria. Evidence shows that high-fidelity clinical simulation centers are effective at increasing the knowledge and skills of health care workers when they are actively engaged in this learning method. The objectives of this study were to create a high-fidelity clinical simulation center, create a cohort of faculty simulation facilitators and validate facilitator's skills through evaluated simulation scenario practice. Design: A high-fidelity simulation center with multiple simulation rooms and dedicated training space at the Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Edo State, Nigeria.

Method

We developed a technical partnership with Boston Children's Hospital who have expertise in Simulation and Global Health. Simulation equipment was purchased with a primary focus on obstetrics/gynecology and pediatric mannequins and skills trainers.

Results

Full installation of high-fidelity infant, child, adult and pregnant woman simulation mannequins was completed. A total of 16 University of Benin clinical staff members were trained on how to facilitate a clinical simulation. A total of 2 academic staff members were trained on how to function as a simulation technologist. Of the 16 trained to be facilitators, 11 of them met the criteria for certification (68.8%). Both technologists became certificated. Twenty-two simulations were completed over the one year period with 117 participants receiving training using simulation.

Conclusions

Both the facilitator training course and the subsequent simulation trainings were successful in applying simulation teaching methodology. The demonstrated success of the trainings and the relative scarcity of published literature on simulation-based research in Nigeria, highlights a gap in research and educational programmes. eP-941 mHealth interventions during the perinatal period in India: A scoping review Z. Small1; S. Thompson1; A. Sharma2; S. Majumdar3; P. Devarsetty3,4; J. Hirst5 1University of Oxford, Oxford, UK, 2Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK, 3The George Institute for Global Health, Hyperabad, India, 4The George Institute for Global Health, Hyderabad, India, 5Imperial College London, The George Institute for Global Health, School of Public Health, London, UK

Objective

Perinatal and maternal mortality rates remain high in India compared to global levels, and there is significant heterogeneity in outcomes across Indian states. Many mobile health (mHealth) interventions have been developed to improve maternal and child health outcomes in India, however it is unclear how mHealth can best support women in this culturally and resource diverse setting. Therefore, we aimed to identify mHealth interventions targeting women and their families in the perinatal period in India, identify barriers and facilitators to their uptake, and directions for future research. Design: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Joanna Briggs Institute guidelines for scoping reviews was used for study selection and screening and the World Health Organisation mHealth evidence reporting and assessment checklist was used to evaluate mHealth interventions.

Methods

PubMed, CINAHL, Global Health, and ACM digital library were searched for records up to 2 April 2023. Studies were included where women and their families living in India received maternal and child health advice via a technological medium.

Results

1783 records were screened, 29 met the inclusion criteria, describing 22 different mHealth interventions. The most frequent behavioural targets for interventions were breastfeeding, antenatal nutrition, and infant healthcare. Most interventions communicated to women through one-way communication, most frequently SMS. Most participants reported positive views of mHealth, reported facilitators for use included group communication, use of non-maternal informative content, and a pictorial information format. Reported barriers included household responsibilities, technical difficulties, difficulty accessing a phone and difficulty understanding, or misinterpreting messages.

Conclusions

We conclude that mHealth interventions are feasible and acceptable to women in India during the perinatal period. However, current interventions are limited by a lack evidence of long term behavioural change and fail to report on features important in sustainability and scalability, namely network infrastructure, data security, and interoperability. We propose the need for a framework to understand existing cultural beliefs and support structures to develop user trust and avoid early intervention failure. Future research should investigate multimodal mHealth interventions as a behavioural change strategy, and address access limitations such as shared mobile phone ownership and high illiteracy rates. eP-943 Use of telemedicine in obstetrics and gynaecology N. Sharma Chauhann1; R.D. Katke2 1Obstetrics and Gynaecology, Saifee Hospital, Mumbai, India, 2Obstetrics & Gynaecology, St. George Hospital, Mumbai, India

Objective

To highlight the use of Telemedicine in Obstetrics and Gynaecology. Telemedicine is widely used now a days , especially in the covid and the post covid era. A knowledge of the advantages and limitations of telemedicine is essential to provide good patient care even by online consultations. Design: A simple yet detailed poster about the use of telemedicine in Obstetrics and Gynaecology. The pros and cons of tele-consultation have been discussed.

Method

A review was done of the various telemedicine platforms that I have been consulting on since the first wave of Covid . The patients were given a set of clear instructions to be followed for a virtual consultation. All the prescriptions were send to the patients on the templates created by the telemedicine platforms.

Results

Telemedicine is a useful tool in Obstetrics and Gynaecology for certain patients. The patients who are likely to benefit are those who seek a second opinion, those with chronic gynaecological issues, those with infertility or sub fertility who may not require an examination at every visit. Tele-consultations avoid unnecessary travel to the hospital for follow up consultations. Women are more comfortable to consult from their homes or even their workplaces at a time outside the hospital hours, at the convenience of the doctor and the patient. Out of the 2000 patients that I have consulted starting during the start of Covid March 2020 till December 2023, 80% women had gynaecological concerns. Out of these many had sub fertility or infertility issues . The other 20% has Obstetric concerns like early pregnancy problems.

Conclusion

The use of telemedicine is increasing in Obstetrics and Gynaecology and keeping the limitations of tele-consultation in mind ,it can be a very good and convenient way of consultations. Tele-consultations picked up during the Covid era and were very beneficial to a lot of patients who could avoid contact with other patients.Telemedicine can be done across continents , across time zones and to the remote areas as well. Consultants can remotely monitor and advice patients in Obstetric HDUs and ICUs in remote areas where expertise may not be available. The limitations of telemedicine , like lack of examination of the patient and being limited to non emergency conditions needs to be borne in mind. eP-947 Robot-assisted laparoscopic colposuspension: Initial experience of the first 10 cases R. Nair; A. Sharif; Z. Kropiwnicka; Y. Coker Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK

Objectives

To evaluate the initial experience with robot -assisted colposuspension for treatment of stress urinary incontinence. Laparoscopic colposuspension is a technically and ergonomically challenging operation. The robotic platform with its three dimensional vision, stable camera and wristed movements not only makes the operation easier to perform but also enables a minimally invasive approach by avoiding the need to dissect down the bladder and precision suturing in a confined space at the level of the bladder neck. Design and Methods: Data was collected prospectively from patients with stress urinary incontinence who desired surgical correction and underwent robot-assisted laparoscopic colposuspension with the daVinci Xi robot by two surgeons. All patients had urodynamic diagnosis of stress incontinence and had failed conservative therapy. All cases were discussed at the pelvic floor multidisciplinary team meeting prior to listing. 4 patients had a history of previous continence surgery. ICIQ-UI(SF) and ICIQ-OAB questionnaires were completed pre and postoperatively.

Results

10 patients underwent this procedure between Oct 2023 and March 2024. 9 patients stayed in hospital for less than 24 h and 1 patient went home on the same day. The average docking time was 7 mins. The average console time was 89 mins(range 68–137 mins). The average blood loss was 140 mL. There were no intraoperative or postoperative complications recorded. There were no bladder injuries. There were no readmissions within 1 month. No patient required self-catherisation postoperatively. 7 patients were seen for postoperative follow-up between 6 weeks and 3 months. There was an overall 71% improvement in the global score for urinary incontinence with 3 patients reporting they were cured, 2 reporting their symptoms had improved and 2 with no change.

Conclusions

Robotic-assisted laparoscopic colposuspension is safe and has quicker operating times, lower rates of complications, is feasible as daycase and has comparable success rates to standard laparoscopic colposuspension. eP-948 Retrospective observational study: Outcomes of laparoscopic pectopexy and sacrospinous ligament fixation K.-W. Lau1; W.C. Cheon1,2 1Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong, Hong Kong, SAR of China, 2Obstetrics and Gynaecology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

Objectives

1. The primary objective is to compare the outcome in point C of the POP-Q after laparoscopic pectopexy (LP) and sacrospinous ligament fixation (SSLF). 2. Secondary objectives are to determine any significant difference in the time of surgery, blood loss, length of hospital stay, intra- and post- operative complications, side effect profiles, and de-novo urinary and bowel symptoms. Design: A retrospective observational study was performed for the urogynaecology divisions of two tertiary referral hospitals.

Methods

Patients received surgical treatment of primary and recurrent apical prolapse were traced, from September 2019 to May 2023. Baseline patient demographics were recorded. Surgery records and follow-up records were reviewed. Data collection was performed using the Microsoft Excel, statistical analysis was performed with SPSS 29.0.1.0. Descriptive statistics were performed for demographic data. Man-Whitney U test and Fisher's exact test were used for continuous and ordinal variables, and categorical variables respectively. Any p-value less than 0.05 was considered statistically significant.

Results

Total 143 patients were identified, with 105 cases of LP and 38 cases of SSLF. The patients received LP were significantly younger (mean age 62.1 vs 66.4 years old, p = 0.008) and has significantly lower body mass index(BMI) (mean BMI 24.2 vs 25.7, p = 0.01), There were no significant difference in number of previous vaginal or instrumental deliveries. LP has significantly better post operative improvement in apical compartment (mean change in Point C: LP -7.0cm, SSLF -5.9cm, p < 0.05) with less vaginal shortening (mean change in TVL: LP -0.05cm, SSLF -1.56cm, p < 0.001). LP had significantly longer operation time (mean 275 min vs 201 min, p 1), pooled blood loss and length of post operative hospital stay between two groups. There was also no significant difference in side effects, de-novo bowel or urinary symptoms between SSLF and LP.

Conclusion

Compared with SSLF, although LP has a longer operation time, it has better improvement in the apical support and less vaginal shortening. Both LP and SSF have no significant difference in procedure-related complication and de-novo bowel or urinary symptoms. Larger studies are need to exclude the confounding effects of simultaneous procedures on complication rates, blood loss and length of post operative stay. eP-949 Perineal rupture, fetal diversion from typical birth canal path: Lilongwe case C. Dzorani1; T. Patel2; B. Rajab3; B. Shayo3; J. Wilkinson2; J. Draganchuk2 1Kamuzu University of Health Sciences, Lilongwe, Malawi, 2Department of Obstetrics and Gynaecology, Global Women's Health Baylor College of Medicine, Texas, USA, 3Department of Obstetrics and Gynaecology, Global Women's Health Baylor College of Medicine and Kamuzu Central Hospital, Texas, Lilongwe, Malawi

Objective

To showcase the peculiarity of birth traumas and how they can be managed. Case report: A 24 year old with a parity of 2 was referred to us 8 h post a delivery that took place in a ox-cart, enroute to the hospital. The outcome was a live infant weighing 2500g. During pregnancy, she had attended 5 antenatal clinic visits. On the day of delivery, she had gone for her usual antenatal visit where a malaria test was positive upon which malaria treatment was given. Upon initial examination in our center, a gauze was found packed in the vagina with trauma to the perineum without active bleeding requiring an examination and repair under anesthesia. The anus, rectum, paraurethral areas, and cervix were all intact. There was a left perineal defect of about 12 by 6cm. The baby had delivered via the posterior vagina through the perineum evading the vaginal introitus. Devitalised tissues were excised, and extensive irrigation with normal saline and chlorhexidine was intermittently done throughout the repair. The vagina and rectovaginal fascia were closed in an interrupted manner with vicryl 2-0. The external anal sphincter was closed with polydioxanone monofilament. The skin was apposed with a running subcuticular vicryl 3-0. Postoperatively, she was put on analgesia for pain control and antibiotics because she was at a high risk of developing an infection. We kept her on a liquid diet and stool softeners for 3 days.

Discussion

Perineal rupture is a rare phenomenon. Old literature, as far back as 1945, estimated an incidence of 1 in 3000 to 4000 laborers. We do not know the current incidence but improved obstetric care over the decades has led to a perceived extinction of the condition. The most common risk factor is unattended deliveries as witnessed in our case. A birth attendant who helps guide the route of the fetal presenting part in the second stage, would have prevented the baby from diverting its route in the birth canal. In our case, malaria presence put the woman at high risk of preterm delivery and in-hospital observation could have prevented an unattended delivery.

Conclusion

Perineal rupture cases are rare considering the majority of women nowadays deliver in hospitals. It is necessary to know how to manage such cases for obstetric care providers, however, they can be complex requiring the skills of an experienced provider and even a urogynaecologist, as was this case. eP-950 Short and long term outcome of Altis in treatment of stress incontinence E. Al ramsi1; M. Elredy2; M. Fadda2; F. Alharmi3; S. Al kaabi3; N. Alguzi3; R. Alawadi3 1NMC Royal Women Hospital, Abu Dhabi, United Arab Emirates, 2Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates, 3Cornich Hospital, Abu Dhabi, United Arab Emirates This study aimed to study the short and long term complication of Single Incision Sling System Altis® (Coloplast) procedures. Additionally, investigates the relationship between various factors such as age, body mass index (BMI), menopausal status, parity and chronic disease with the aforementioned outcomes. Moreover, assessing patient satisfaction. Design: This is a retrospective study, conducted at our specialized urogynecology department between February 2020 to 2024. The study included patients who underwent surgery for stress incontinence using Altis® (Coloplast).the patient undergoes four followup visit at 1, 2, 3 and 12 months after the procedure for monitoring and assessment. Patients who did not attend follow-up appointments were excluded. The study was approved by the Institutional Review Boards.

Methods

Electronic health records of selected patients were reviewed to collect relevant data, including demographic data and follow-up information. Patient satisfaction was assessed through reports of dryness, absence of SUl symptoms, and negative cough stress test during postoperative visits. Continuous and categorical data were analysed using descriptive statistics and presented as means and percentages. Microsoft Excel 2019 was used to carry out further statistical analysis and association with p < 0.05 were considered statistically significant.

Result

The study involved 60 female respondents with the majority (36.67%) falling in the 40–50 age range, followed by 50–60-year-olds at 25%. The sample primarily comprised obese individuals (51.67%), with the majority being Arab (96.7%) and all were non-smokers. Pre-menopausal, menopausal, peri-menopausal, and menopausal hysterectomy subjects accounted for 36.67%, 30%, 26.67%, and 6.67%, respectively. Parity ranged from 0 to over 6 children, with a significant majority (41.67%) reporting parity of more than 6. Common chronic diseases included asthma (15.2%), constipation (10%), hypertension 3.3%, and diabetes 28.8% where 23.33% report none. The most prevalent incontinence types were pure stress (73.33%) and mixed Ul with predominant stress (26.7%). Complications within 72 h were reported by 8.33% of respondents, with dysuria (20%), numbness ( 20%), leg and back pain (60%) being the main issues. Long-term complications were reported by 13.33% of subjects, mainly comprising DENOVO voiding dysfunction (50%), DENOVO urgency (25%) and defective healing (25%). High BMI was associated with increased complications, while menopause status significantly influenced both short-term and long-term complications. Dissatisfaction rates were low and statistically insignificant. Factors such as BMI, menopause status, and ethnicity influenced complication rates, while smoking had no significant impact.

Conclusion

This study on Altis® procedures for SUl assessed complications, revealing BMI and menopause as significant factors, with low dissatisfaction rates. eP-951 Robotic showdown: Hugo RAS vs. da Vinci Xi in VVF repair M. Ragavan; A. Ragavan; N. Ragavan; D.K. Sakthivel Apollo Hospitals, Chennai, India

Objective

To compare the outcomes of vesicovaginal fistula (VVF) repair using the Hugo RAS versus the da Vinci Xi robot. Design: This retrospective comparative study analyzed the surgical outcomes of VVF repair using two different robotic systems: the Hugo RAS Medtronic robot and the da Vinci Xi robot.

Methods

Nine cases of VVF repair performed with the Hugo RAS Medtronic robot and eleven cases performed with the da Vinci Xi robot were included in the study. Patient demographics, operative details (including operative time and blood loss), intraoperative complications, and postoperative outcomes were recorded and analyzed. The primary etiology for VVF in most patients was hysterectomy.

Results

The average age of patients undergoing VVF repair was 41 years. In the Medtronic arm, the mean operative time was 176 min with a mean blood loss of 130 mL, while in the da Vinci arm, the mean operative time was 166 min with a mean blood loss of 130 mL. No intraoperative complications were observed in either study group. Postoperative complications were minimal, with none exceeding Clavien Dindo grade 2. All the outcomes were comparable in both the arms.

Conclusions

Our study demonstrates the feasibility and safety of utilizing both the Hugo RAS Medtronic robot and the da Vinci Xi robot for VVF repair. These preliminary findings suggest that robotic-assisted surgery holds promise in addressing the challenges associated with VVF repair, regardless of the robotic system used. Further research and long-term follow-up studies are warranted to validate these initial results and establish standardized guidelines for robotic VVF repair in urology. eP-974 How much can we prevent delivery-related medical costs associated with maternal mortality? J.Y. Nam Department of Healthcare Management, Eulji University, Seongnam, Korea

Objective

This study evaluated the effects of delivery-related medical costs in cases with and without maternal mortality and the extent to which delivery-related medical costs associated with maternal mortality can be prevented. Design: A retrospective cohort study.

Methods

This study used data from the National Health Insurance Service Delivery Cohort Database of South Korea. We included all delivery mothers in South Korea from 2003 to 2021, excluding those with incomplete data, for a total of 7 171 578 participants. The outcome measured was delivery-related medical costs associated with maternal mortality. A Generalized Estimating Equation model with a log link and gamma distribution was used to estimate delivery-related medical costs, adjusted for the participants' demographic and clinical covariates.

Results

The maternal death rates was 9.7 per 100 000 births. The adjusted mean delivery-related medical costs were approximately six times higher in cases with maternal death than in those without ($2802 vs. $480, p < .0001). The total delivery-related medical costs for all women with maternal mortality were approximately $2 million, representing 0.06% of total delivery-related medical costs. Notably, 86% of direct medical costs associated with maternal mortality among South Korean women are preventable.

Conclusion

Medical costs associated with delivery-related maternal deaths were significantly higher than those associated with normal deliveries. Therefore, policymakers should consider implementing support programs to prevent high medical costs by improving maternal health. eP-975 Barriers in tuberculosis screening in pregnancy using quality improvement tools in India P. Bansal1; A. Kumar1; M. Jain2 1Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal, India, 2Emory University, Atlanta, USA - To understand the gaps in screening and treatment of TB among pregnant women(PW) receiving hospital and community-based antenatal care. - To explore the impact of tailored interventions on improving maternal TB screening and awareness. Design: A cross sectional TB Knowledge, Attitudes, and Practices (KAP) survey was conducted amongst the Healthcare workers and Pregnant women in Madhya Pradesh, India between June to November 2023. A structured , pre-validated questionnaire was used to collect data which was analyzed using Microsoft Excel using descriptive statistics.

Methods

To identify the gaps in implementation of the collaborative framework, Qualitative and Quantitative data was collected using a pre-designed semi structured and tested questionnaires to conduct baseline and endline assessments. The data collection process was led by an interviewer and data was collected through google form. The questions were derived from WHO guide and Framework for TB and Maternal health developed by GOI. Baseline data on screening of TB amongst pregnant women was collected for one month from the facility records. The gap in implementation of guidelines was identified based on the KAP of healthcare staff, infrastructural and systemic issues, socio-economic barriers, etc. A quality improvement intervention utilizing Plan-Do-Study-Act (PDSA) tool was designed on identified process-related gaps. A predesigned template and worksheet on PDSA developed by the partner organization was used to implement the PDSA tool.

Results

Among 287 pregnant women, 81.61% believed TB is treatable, 25.58% prioritized TB screening in pregnancy, and 67.44% were open to screening. 48.28% would seek doctor guidance, 88.37% would discuss symptoms, but only 36.04% would seek TB treatment immediately. Of the 38 doctors and nurses, 66.66% prioritized TB screening in pregnant women, 83.33% lacked awareness of India's TB pregnancy guidelines, and 55.56% felt inadequately informed. Among 62 field workers, 53.06% knew about TB welfare schemes, 57.41% worried about acquiring TB at work, and 28.57% received relevant training.

Conclusions

Lack of knowledge on maternal TB screening guidelines among HCWs is a major impediment to screening and diagnosis among PW. Nevertheless, PW demonstrated a willingness to receive TB education and treatment. • Despite the guidelines in place and willingness of the majority of PW to be screened for TB, most are not being screened. Healthcare workers reported being unfamiliar with the guidelines and lacking knowledge on maternal TB screening. eP-976 Trends in opioid-related deaths among women in 21 Century America O. Akinyemi1; T. Ogundare2; M. Fasokun3; F. Babarinde4; M. Michael5 1Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA, 2Psychiatry, Boston University College of Medicine, Boston, USA, 3Epidemiology, University of Alabama at Birmingham, Birmingham, USA, 4Federal Medical Center, Internal Medicine, Idi-Aba, Abeokuta, Ogun State, Nigeria, 5Howard University College of Medicine, Internal Medicine, Washington, UK

Introduction

The opioid crisis in America has escalated into a national public health emergency, with a disturbing rise in opioid-related deaths among women in the 21st century. This alarming trend has prompted a closer examination of gender-specific factors contributing to this increase.

Objective

The study aims to explore the epidemiology of opioid-related mortality among women, identifying key demographic shifts, prescribing patterns, and social determinants that have influenced these trends. Methodology: We retrospectively analyzed the Centers for Disease Control and Prevention (CDC) mortality records from 2000 to 2020. The data extracted included all recorded instances of opioid-related deaths among women. Key variables assessed comprised demographic information (age, race, ethnicity), the classification of death (unintentional, suicide), and educational levels.

Results

During the study period, there were 348 227 opioid-related deaths among women. Of these, 246 567 (70.8%) were categorized as unintentional, while 53 213 (15.3%) were suicides. A majority of the deceased were non-Hispanic Whites, numbering 281 572 (80.9%), followed by 37 181 non-Hispanic Blacks (10.7%) and 20 543 Hispanics (5.9%). The incidence of opioid-related fatalities among women escalated from 3.0 per 100 000 in 2000 to 19.0 per 100 000 in 2020, marking a 533% surge. This increase was observed across all racial groups: 349.2% among Whites, 300% among Blacks, 233.3% among Hispanics, 250% among Asian/Pacific Islanders, and 585.7% among Native American Indians. The uptick in incidence was most pronounced among women under 25 years (361.9%), followed by those aged 45–64 years (302.9%), 25–44 years (255.2%), and was least among those over 65 years (116.1%). Compared to natural deaths, factors associated with an increased likelihood of opioid addiction included being aged 25–44 years (Odds Ratio [OR] = 3.2; 95% Confidence Interval [CI] 3.10–3.29), being of White race, possessing lower education levels, and having depression (OR = 2.3; 95% CI 2.15–2.46) or bipolar disorders (OR = 1.46; 95% CI 1.31–1.64). The COVID period also saw a 13% rise in opioid-related deaths (OR = 1.13; 95% CI 1.12–1.50). Age emerged as the most significant factor, with individuals aged 25–44 years exhibiting the highest predicted probability of opioid-related death at 21% after covariate adjustment. In contrast, the predicted probabilities for opioid-related death based on race were 2.02% for Whites, 1.10% for Blacks, and 0.99% for Hispanics.

Conclusion

The study underscores a stark escalation in opioid-related fatalities among women in 21st-century America. The disproportionate increase among non-Hispanic Whites and the notable vulnerability of women aged 25–44 years signal critical areas for targeted intervention. eP-977 Vitamin D deficiency in pregnant population UHB – Does it justify universal screening? S. Zubair1; U. Habiba1; S. Patni1 1University of Birmingham, Brimingham, UK

Objective

To estimate the vitamin D deficiency in pregnant women and ascertain the risk factors of vitamin D deficiency. Study design: Cross sectional, Observational study. Place and duration of study: The study was conducted in University Hospital Birmingham, UK, from January to December, 2022. Methodology: Patients were selected retrospectively from hospital record from January 2022 to December 2022. 2757 patients had Vitamin D testing in 2022 during Pregnancy. Vitamin D status is usually estimated by measuring the level of plasma 25(OH)D. Lab values and cut offs as below ,Normal Value: >50 nmol/mL, Mild: 25- 49.9 nmol/L ,Severe: <25 nmol/L.300 women, 100 women from each group were randomly selected to ensure that they are comparable in terms of their risk factors for Vitamin D deficiency. One sample t test was used to estimate the population proportion having vitamin D deficient/insufficient. Vitamin D were assessed through tendem mass spectroscopy. To find out the risk factor of deficiency of vitamin D we further test the association between vitamin D status and the characteristics of the patients, through chi-square test. The p value ≤ 0.05 was considered as significant.

Results

We have reviewed the record of 2757 cases, retrospectively and found that 1701 (61.7%) cases have vitamin D insufficient/deficient levels. Our sample result showed that, there were > 60% cases in pregnant women who have insufficient/deficient vitamin D, in Birmingham.

Conclusion

Our Study Suggests that prevalence of Vit D deficiency is significantly higher in the pregnant population in our catchment area .Risk based screening is not fit for purpose in our population. And we assessed that Vitamin D test is easy to do and it is cheap as well and treatment for Vitamin D Deficiency is cheap if the right formulation is used.

Keywords

Ethnic groups, Hypovitaminosis D, Vitamin D deficiency, Vitamin supplementation, Women health in pregnancy eP-978 Empowering expecting mothers: Impact of antenatal classes on pregnancy and birth experience U. Ahmed; F. Yousuf; Z. Wadani; A. Raza Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan

Introduction

Antenatal education can increase a women's knowledge about pregnancy and childbirth, which could improve self-efficacy during labor. Well-structured antenatal classes can divulge this information. Such classes are part of many countries' healthcare system, proving to decline maternal anxiety, shorten labor, increase partner involvement, and overall improve labor experience. Simultaneously, such classes could augment more interventions in labor, induction of labor, and epidural usage. Despite the heterogeneous results of their effect, high demands of antenatal education amongst pregnant women can justify their incorporation into antenatal care. By allowing the women to identify labor correctly and preventing admission in false labor, shortening labor, and teaching women non-pharmacologic ways to manage labor pains, it can reduce the patient and fiscal burden on the already overwhelmed maternity units of Pakistan. Design: This cross-sectional study was conducted in ‘Department of Obstetrics and Gynecology’ of Aga Khan University Hospital Karachi, Pakistan, between the months of December 2020 till June 2021.

Method

All pregnant women, aged 18 to 45 years, between gestational ages of 37 to 42 weeks, with singleton, cephalic pregnancy, booked during the first or second trimester, and who attended at least one antenatal class were invited to participate. Women who had any contraindication to vaginal delivery, whose labor was induced, or who suffered from medical, psychological or obstetric comorbidities were excused. Labor out comes monitored were stage of labor on arrival, use of epidural analgesia, mode of delivery and childbirth experience, using a validated research tool, known as the ‘Questionnaire for Assessing the Childbirth Experience (QACE)’ to identify women with a positive or negative childbirth experience. Data was analyzed using IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, Version 19.

Results

The mean QACE score was reported as 18.2±3.00, reflecting that on average the mothers had a positive childbirth experience. Modes of delivery revealed 57.6% of the women delivering spontaneously, with 60.4% of them arriving in active labor. Demand for labor analgesia in the form of epidural was 64%. Majorly the participants attended only one antenatal class, with 66.91% women reporting a positive childbirth experience.

Conclusion

Antenatal classes are a low input, high yielding resource that can be used to empower mothers with pertinent information and support for a pleasant childbirth experience while simultaneously taking the edge off the overburdened maternity wards of low resource, densely populated countries. Investing in them to allow their wide availability is needed. eP-979 Tackling the trainee recruitment and retention crisis in Rural and Coastal England L. Bejan; S. Bugren Obstetrics and Gynaecology, East Kent Hospitals University, Margate, UK

Objective

There is a crisis in trainee recruitment and retention in rural and coastal areas, leading to healthcare inequalities across the country. Health Education England (HEE) published a three-year inquiry in February 2022, revealing that coastal communities suffer some of the country's worst health outcomes. The Royal College of Physicians report published in October 2019 showed that just 13% of Consultants appointed in England went to hospitals serving mainly rural or coastal. In Obstetrics and Gynaecology (O&G), this is an issue where only 5% of women receive maternity care in rural areas. Despite recruitment and retention challenges, success stories exist in regions like South East England (SEoE). This paper assesses HEE's strategies for addressing healthcare gaps, evaluates success in SEoE's coastal region, and advocates for professionals to consider employment opportunities in such areas. Design/Method: Utilizing analysis and data from prior studies, reports, and academic literature on healthcare workforce recruitment, this paper integrates testimonies from current trainees at East Kent Hospitals University Foundation Trust (EKHUFT).

Results

As part of the NHS People Plan, HEE has increased trainee places in rural and coastal areas, with O&G being one of the specialities to undergo equitable redistribution of 940 trainee places beginning in the summer of 2022, with already an increase of 8 trainee posts, 4% across SEoE in O&G. Additionally, EKHUFT promotes local Consultant recruitment through the Family First Initiative, which supports family relocation by offering suitable roles to partners. This programme was launched to meet the target of expanding consultant numbers in over 50% of O&G subspecialist units over the next five years. Plans also include increasing the establishment of medical schools (i.e. Kent &Medway Medical School) in areas with a shortage of doctors, providing teaching opportunities for medical postgraduates. EKHUFT promotes inclusive leadership through the BAME Leadership Programme and supports overseas recruitment through programmes such as Agenda for Change.

Conclusion

Non-trainee junior doctor recruitment and retention numbers in O&G in EKHUFT have increased in the past year, with projected increases in trainee numbers. Many trainees cited EKHUFT's supportive environments and accolades such as the Royal College of O&G Training Evaluation Form award for Professional Development at Queen Elizabeth the Queen Mother Hospital. HEE's success in specialities like O&G, particularly in SEoE, reflects efforts to provide fulfilling career opportunities. Inclusive initiatives ease trainees' transitions to coastal regions, with ongoing efforts to attract additional participants. Prospective candidates are encouraged to join this cohort. eP-980 Revolutionising maternity care: ANNA faculty initiative's impact on staff morale & healthcare J. Owusu Adjei; L. Velauthar Barts Health, London, UK

Objective

To assess the transformative effects of the ANNA Faculty Initiative on maternity care and staff morale at a district general hospital in East London. Design: The ANNA faculty initiative was launched with the goals of enhancing staff training, improving patient engagement, and implementing quality improvement initiatives. Extensive teaching and training programs were introduced, focusing on various aspects of maternity care, including hypoxic brain injuries in babies, pre-eclampsia, obstetric emergencies, perineal tears, first-trimester screening for Down's syndrome, and stillbirths. Collaborations with expert speakers and innovative courses were key components of the initiative.

Method

Launched in July 2016, the ANNA (Alan Naftalin Newham Academic) Faculty Initiative targeted enhancements in maternal healthcare at Newham University Hospital Extensive teaching and training programs were introduced, including collaborative efforts with expert speakers and innovative courses like the Combined Online and Practical Perineal Suturing (COPPS) program. Multidisciplinary Obstetric and Midwifery Simulations (MOMS) courses were conducted abroad, raising funds and enhancing staff teaching skills. Key lessons learned were identified through persistent cultural change efforts, stakeholder engagement, and continuous feedback mechanisms.

Results

The initiative successfully addressed challenges in maternal healthcare delivery, evidenced by improvements in various areas including the reduction of neonatal brain injuries – the current HIE rate stands at 0.56/1000 births, compared to the London average of 1.14/1000 births, increased uptake of Down's syndrome screening, and improved management of pre-eclampsia. MOMS@Zimbabwe raised £20 000 through fundraising events, contributing to staff morale and enhancing teamwork. Verbal quantitative staff surveys revealed positive shifts in staff perceptions, indicating improved morale, job satisfaction, and collaboration among healthcare professionals.

Conclusions

The ANNA Faculty Initiative demonstrated significant improvements in maternal healthcare delivery and staff morale through a multifaceted approach. Collaboration with expert speakers, training programs, and fundraising events contributed to tangible outcomes. Challenges such as communication barriers and resistance to change were overcome through continuous efforts. Future plans include further engagement with patients, addressing funding constraints, and streamlining data collection and analysis processes. The initiative's success highlights the potential for broader dissemination of its approach to address maternal health challenges globally. eP-981 It's time for a change in myoma care: Tertiary centre experience I. Ptacek; S. Mahdi Ameli-Renani; R. Das; L. Ratnam; A. Gunasekera; M. Khulendran; S. Das St George's University Hospitals NHS Foundation Trust, London, UK

Introduction

Uterine fibroids are the most common benign gynaecological condition affecting up to 80% of women in their reproductive years. Whilst most fibroids can be managed safely in a general gynaecology setting, patients with very large fibroid uteri and complex medical and surgical conditions are at increased risk of major surgical complications. The success of endometriosis centres has demonstrated that comprehensive, multidisciplinary care leads to optimised outcomes for severe endometriosis. This case series highlights the need for dedicated myoma centres for complex fibroid surgery.

Objective

To demonstrate that a multidisciplinary approach within a specialist myoma centre leads to optimised outcomes in complex patients. - Subtotal abdominal hysterectomy for a Jehovas Witness, declining blood products, with a 32 week size uterus. - Total abdominal hysterectomy and ureteric stenting for a 38 week size uterus causing hydronephrosis with a history of previous open myomectomy. - Cervical stump fibroid excision and bowel adhesiolysis for a 12 cm fibroid with a background of two previous myomectomies, subtotal hysterectomy, hypertension, epilepsy and insulin dependent diabetes. Preoperative optimisation involved a multidisciplinary team (MDT) comprising gynaecology, interventional radiology, urology, colorectal, and anaesthetics. All 3 cases underwent pre-operative uterine artery embolization (UAE) to minimise blood loss. A dedicated Jehovas' Witness meeting facilitated discussion on blood conservation strategies including UAE, autologous transfusion and vasopressin use. High risk anaesthetic assessment ensured safe perioperative management of medical co-morbidities.

Results

Due to a collaborative approach within the MDT, there were no intra-abdominal injuries, intensive care admission, return to theatre or readmission to hospital. Pre-operative UAE was successful in achieving minimal blood loss in cases 1 and 3 resulting in 300 and 350 mL respectively. Uterine anatomy in the second case prevented bilateral UAE resulting in 1200 mL blood loss but autologous transfusion avoided the need for donated blood.

Conclusion

Complex cases, such as these, are referred for the expertise offered by our specialist MDT. Without careful pre-operative planning and a tailored surgical technique, these patients might otherwise have received no or inadequate treatment. There is currently no standardised pathway or supplementary funding for complex fibroid patients and referrals are made on ad hoc basis. We recommend that dedicated myoma centres, analogous to endometriosis centres, should be established for safe and cost-effective effective management of complex fibroids. eP-982 Efficacy of self-collected tampons for HPV, STIs detection: A novel tool V. Milanova; K. Mihaylova; M. Gomes Anne's DAYE LTD, London, UK Efficacy and Acceptability of Self-Collected Medical Grade Tampon as a Novel Vaginal Sample Collection Tool for the Detection of HPV and STIs Background/Objectives: Cervical cancer remains a significant health concern, particularly in low-income and middle-income countries (LMICs). This study aims to compare the efficacy and suitability of a self-collected tampon for the detection of human papillomavirus (HPV) and sexually transmitted infections (STIs) using qualitative TMA-based assays (Transcription Mediated Amplification; APTIMA® HPV, APTIMA® Combo 2 (CT/NG; AC2 from now on) and APTIMA®Bacterial Vaginosis (BV from now on). Additionally, we assess the acceptability of tampons as a self-collection tool.

Methods

A cohort of 75 female participants aged 18–54 years was recruited through female-focused social networks. Participants provided informed consent and underwent both Health Care Workers (HCW-collected) and self-collected sample collection using the Daye Diagnostic Tampon. Samples were stored in ThinPrep Vials (TP Vial) or Aptima® Multitest Swab Collection Kit (APTIMA®) solutions. HPV and STI testing were performed using TMA-based assay on the fully automated Panther® Platform. Acceptability was assessed through a questionnaire with Likert-scale responses.

Results

The study involved 60 participants who completed the study (80% of recruited participants). The self-collected tampons showed sensitivity and specificity of 66.67% and 90.74% (when rinsed in TP Vial) and 83.33% and 85.42% (when rinsed in APTIMA®) for HPV detection, respectively. For bacterial vaginosis (BV) detection, the tampons exhibited sensitivity and specificity of 100.0% and 96.43% (TP Vial) and 88.89% and 98.04% (APTIMA), respectively. For detection of chlamydia and gonorrhoea (AC2), the sensitivity and specificity were 100.00% and 100.0% (TP Vial) and 100.00% and 98.31% (APTIMA), respectively. Participants expressed a preference for tampon self-collection over HCW-collected swabs (90%).

Conclusion

Self-collected tampons demonstrated promising diagnostic accuracy to HCW-collected swabs for HPV and STI detection. The tampon self-collection method was well-accepted and preferred by participants, suggesting its potential as an alternative screening tool, particularly in low-resource settings. Further research with larger and more diverse populations is recommended to validate these findings and inform tampon-based self-collection programs for cervical cancer screening. Randomised controlled trials and comparisons with gold standard methods would enhance validation.