SOGC MEETING ABSTRACTS
Study Methods: A retrospective cohort study of all females (1–18 years-
old) presenting with an adnexal mass to an academic pediatric hospital
between 04/2011 and 03/2016 was conducted. A radiologist blinded
to final diagnosis evaluated presenting ultrasounds according to DTS
rules by determining the Morphology Index (MI) score and presence/
absence of the Ovarian Crescent Sign (OCS). Diagnostic performance
of DTS was compared to our current algorithm, which uses ultra-
sound criteria of >8 cm and complex/solid and tumor markers to
indicate higher risk of malignancy.
Results: 245 patients with 261 masses were included. 183 masses were
managed surgically: 163(89%) benign; 20(11%) malignant. Pre-
operative sensitivity, specificity, PPV, and NPV (95% CI) of each
diagnostic parameter were: MI ≥ 7: 100%(100), 74%(68–81), 32%(21–
44), 100%(100); absent OCS: 80%(74–86), 75%(69–82), 29%(17–
40), 97%(94–100%); DTS Rules: 80%(74–86), 77%(71–83),
30%(17–42), 97%(94–100); >8 cm and complex/solid: 90%(86–
94), 72%(66–79), 29%(17–40), 98%(96–100); abnormal tumor
markers: 63%(55–71), 85%(79–91), 40%(22%-58%), 94%(89–98).
Conclusion: The previously reported sensitivity and specificity was not
replicated in our current study. The DTS has a higher specificity but
lower sensitivity than our current algorithm. The diagnostic performance
of MI ≥ 7 alone has 100% sensitivity and 74% specificity, thus sup-
porting integration of the MI into risk stratification algorithms. Future
investigation should determine how to best incorporate other DTS
components.
Key Words: Adnexal mass; algorithm; malignancy
■ V-OBS/GYN-PE/AD-272 .........................................................
OOPHOROPEXY FOR MANAGEMENT OF OVARIAN
TORSION IN THE PEDIATRIC POPULATION
Hanna Goldberg
Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G
1X8, Canada
Carol King, Lisa Allen, Sari Kives
Video Abstract Summary: The incidence of ovarian torsion (OT) in
the pediatric population is 4.9–20/100,000. OT may be caused by
the presence of mass, or in the absence of a mass, an elongated
ovarian ligament or fallopian tube, or a hypermobile mesosalpinx
or meso-ovarium. Effective management is critical as OT can result
in loss of reproductive potential. Recent SOGC guidelines have rec-
ommended conservative management, specifically, detorsion and
preservation of the ovary despite a blue-black appearance, rather
than performing an oophorectomy. As a result of conservative man-
agement, there is potential for rate of recurrent OT to increase.
Oophoropexy (OP) can be used to prevent OT in patients with con-
genitally long utero-ovarian ligaments, recurrent OT, and idiopathic
OT. There are two types of OP procedures: (1) Plication of adnexal
ligaments (2) Fixation of the adnexa to the pelvic sidewall or the ip-
silateral uterosacral ligament. In this video, both types of oophoropexy
procedures are demonstrated.
Key Words:
■ P-GYN-Masters-242.....................................................................
OPTIONS FOR WOMEN SEEKING PERMANENT
CONTRACEPTION IN HIGH RESOURCE COUNTRIES:
A SYSTEMATIC REVIEW
Rebecca Gormley
Contraception Access Research Team (CART-GRAC), 320-5950
University Boulevard, Dept Family Practice, UBC, Vancouver, British
Columbia, V6T 1Z3, Canada
Wendy V. Norman
836 • JUNE JOGC JUIN 2018
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Objectives: Women and their clinicians seeking long-term or permanent
contraception are confronted with several options, all with accom-
panying potential risks and benefits: yet there is not a decision support
tool that compares available options. We aimed to perform a sys-
tematic review and network meta-analysis comparing hysteroscopic
tubal occlusion (HTO), laparoscopic tubal ligation (LTL), bilateral sal-
pingectomy (BS), and the LNG-IUC on effectiveness, adverse effects,
tolerability, non-contraceptive benefits for women and health system
cost-effectiveness in high resource countries.
Study Methods: We published our protocol following PRISMA guide-
lines. We searched EMBASE, Pubmed, and Web of Science and
undertook secondary screening May 2016, with an update in
November 2017. Two reviewers extracted data independently, and
assessed articles for bias using the Newcastle-Ottawa Scale and
the Cochrane Collaboration tool. Objectives were analyzed according
to the Cochrane collaboration descriptive analysis guidelines. Due
to inconsistent reporting a network meta-analysis was not appropriate.
Results: Of the 5,408 abstracts identified, 31 met inclusion criteria.
Studies compared LTL and HTO (n = 13); LTL and a control (n = 9);
LNG-IUC and LTL against a control (n = 4); LTL and BS against a
control (n = 2); LTL and BS (2). and LTL, BS, HTO (n = 1). Descrip-
tive analyses provide tentative conclusions between pairs of methods,
but there was insufficient data to support rigorous comparison between
all methods.
Conclusion: There is a lack of research comparing available methods
for permanent and long acting contraception, which impacts the ability
for clinicians and women to undertake informed shared decision
making, and for health systems to determine cost-effective alternatives.
Key Words: permanent contraception, LNG-IUS, tubal ligation, tubal
occlusion, salpingectomy
■ O-OBS-JM-175 .............................................................................
WHAT IS THE SAFEST MODE OF BIRTH FOR
EXTREMELY PRETERM BREECH INFANTS WHO ARE
ACTIVELY RESUSCITATED? A SYSTEMATIC REVIEW
AND META-ANALYSES
Marinela Grabovac
McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1,
Canada
Jehan N. Karim, Tetsuya Isayama, Sugee Korale Liyanage,
Sarah D. McDonald
Objectives: To determine the safest mode of birth for extremely preterm
(23 + 0–27 + 6 weeks) breech singletons who are actively resuscitated.
Study Methods: We searched five databases from January 1994 to
May 2017 (Cochrane Central, Medline, EMBASE, CINAHL,
ClinicalTrials.gov). We included randomized controlled trials (RCT)
and observational studies comparing outcomes between Caesar-
ean and vaginal birth in extremely preterm breech singletons who
were actively resuscitated. Our primary outcomes were death (neo-
natal, before discharge or by 6 months of age) and severe
intraventricular hemorrhage [(IVH), grades III/IV]. We synthesized
the data using random effects model generating odds ratios (OR)
with 95% confidence intervals (CI). We calculated the number-
needed-to-treat (NNT).
Results: We included 12 335 infants from 15 studies, mainly obser-
vational data due to recruitment difficulties in RCTs. We found that
Caesarean section was associated with 41% decrease in the odds
of death in 23 + 0 to 27 + 6 week infants compared to vaginal birth
(OR 0.59, 95%CI 0.36–0.95, NNT 8). In 23 + 0 to 27 + 6 week infants,
Caesarean section was associated with a 49% decrease in the odds
of severe IVH (OR 0.51, 95% CI 0.29–0.91, NNT 12).