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Gynecology 2019 PDF
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Scientific Federation
Scientific Federation
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172nd Scientific Federation
Conference
2nd World Congress on
Page 4
2018 Conferences
Plenary Forum
(Day 1)
Page 14
2nd World Congress on
Nicoletta Di Simone
Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
Recent Insights on the Inflammatory and Immune Players of the Human Endometrium
C urrently the concept of a sterile endometrium is highly debated, in fact several recent studies suggest the endometrial
presence of resident microorganisms. Some reviews focused on correlations between commensal uterine colonization
and pregnancy complications; these papers suggest the endometrial presence of resident population of microorganisms, which
reaches a 25% of concordance with those of the cervical-vaginal flora. However, no consensus has been reached regarding the
origin, the role of these pathogens and the mechanisms by which they might interfere with embryonic implantation. Culture-
based microbial studies show several limitations since <1% of bacteria reliably grow and form colonies even in appropriate
conditions. The presence of an endometrial infection has been suggested as possible etiologic factor of chronic endometritis.
Its diagnosis is difficult because it is often asymptomatic, and it is still challenging since it is highly dependent on a specific
expertise in the hysteroscopy and in the histological field.
A possible marker of infection-related endometrial inflammation is the inflammosome (NALP-3). The activation of NALP-
3, enables the caspase-1 mediated proteolytic processing of the pro-inflammatory cytokines IL-1 beta, IL-18 and IL-33,
generating their mature forms. All these events are necessary for the induction of tissue inflammation. Of interest, we observed
a significant increased expression of NALP-3 and interleukins in endometrial biopsies obtained from women with history of
recurrent pregnancy loss as compared to fertile patients.
The understanding of the microbiota of human endometrium and its utility in the diagnosis and treatment of reproductive
disorders is still in its beginning. Further studies are needed to clarify: a) the mechanisms of bacterial colonization in the human
endometrium; b) the relationships between endometrial cells and microbes; c) the pathways activate by different microbiota; d)
the role of an endometrial dysbiosis on reproduction.
References:
Endometrial microbes and microbiome:recent insights on the inflammatory and immune players of the human endometrium.
Dippolito S, Di Nicuolo F, Pontecorvi A, Gratta M, Scambia G, Di Simone N. Am. J. Reprod. Immunol., 2018 Dec; 80(6).
e13065.doi;10.1111/aji.13065. Epub 2018 Oct 30.
How uterine microbiota might be responsible for a receptive, fertile endometrium. Benner M, Ferwerda G, Joosten I, van der
Molen RG. Hum Reprod Up 2018 Jul 1; 24 (4):393-415.doi:10.1093/humupd/dmy012.
Infammosome in the human endometrium:further step in the evaluation of maternal side. Dippolito S, Tersigni C, Marana R, Di
Nicuolo F, Gaglione R, Rossi ED, Castellani R, Scambia G, Di Simone N. FertilSteril 2016 Jan; 105(1):111-8.doi: 10.1016/j.
fertnstert.2015.09.027.Epub 2015 Oct 30.
Biography
Nicoletta Di Simone is Associate Professor of Gynecology and Obstetrics (MED / 40), Faculty of Medicine and Surgery, Gemelli Polyclinic,
Catholic University of the Sacred Heart (UCSC), Rome. October 1982. She enrolled in the 1st year of the course of the Faculty of Medicine
and Surgery of the UCSC, Rome. October 1988. Degree in Medicine and Surgery at the Faculty of Medicine and Surgery of the UCSC,
with experimental thesis entitled "Recent acquisitions on the physiopathology of the corpus luteum", vote 110/110 and honors. Qualification
for professional practice in the 1988 autumn session. Academic year 1988/89. Winner of the competition for the School of Specialization in
Gynecology and Obstetrics at the Faculty of Medicine and Surgery of the UCSC. Scholarship winner of the Ministry of University for Scientific
and Technological Research (MURST) for the duration of the specialization course in Gynecology and Obstetrics: years 1988-1992. November
1992. Specialization in Gynecology and Obstetrics at the UCSC, with experimental thesis entitled "Role of growth hormone in the regulation
of luteal function: in vitro studies", 50/50 vote and honors. Academic year 1993/94: winner of the competition for the PhD in Obstetric and
Gynecological Sciences, IX cycle, La Sapienza University, Rome.
Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) - A Tool for Selecting the Best
Sperm in Real Time for the Proper Patient
I ntracytoplasmic sperm injection (ICSI) in humans was introduced, in 1992, for couples with male infertility factor. ICSI, the
technique of injecting a single sperm to an oocyte, enables to achieve fertilization, embryo development and pregnancies.
Sperm morphology decreased in the field of assisted reproduction. One of the main concerns in ICSI is to aspirate a good-
quality spermatozoon for microinjection into an oocyte. However, practically, the injected spermatozoa are randomly chosen
and their selection is based on rough morphologic aspects and motility. Sperm morphology is the only criteria for evaluation
the quality of the sperm cell, during ICSI. Thus, it is important to score and aspirate a good quality motile spermatozoon, which
will contribute to the quality of the developing embryo after ICSI, in real time of the procedure.
In ICSI, assessment of sperm morphology is limited due to the low magnification (200X-400X) and concomitant low resolution.
It has been demonstrated that by using Intracytoplasmic morphologically selected sperm injected (IMSI), a spermatozoon
with normal morphology, and more precisely normal nucleus, might affect the incidence of pregnancy. Although the usage
of IMSI is currently wider, it is necessary to standardize which sperm to aspirate, due to criteria based on accumulating data.
Moreover, the benefits of IMSI could be noticeable in cases of patients with repeated implantation failures, severe male factor
infertility and advanced paternal and maternal age. The magnified "on screen image" obtained in IMSI, is a combination of the
magnification of the objective, the camera adapter, ratio between the diagonal screen size in mm, diagonal of the camera chip
size in mm, and internal magnification of the microscope. Final values obtained (up to X6000and more ) is the amplification of
the surface of the sperm cell image, not observed by the routine X200-400 in ICSI, due to objective limitations of the human
eyes. IMSI is still considered as a controversy technical and laboratory procedure, however, it seems to become a promising
procedure in terms of improving the outcome of ICSI treatments.
Biography
Dr. Yona Barak is one of the pioneers in the field of In Vitro Fertilization (IVF). She graduated the Faculty of Life Sciences in conjunction with the
Department of Clinical Biochemistry, in Tel Aviv University. A desired lecturer, expert, one of the world-seniors scientists in the field of IVF and
former chairman of the IVF organization “Alpha – Scientists for Reproductive Medicine.” Dr. Barak has been involved in more than 40,000 IVF
babies around the world. Her expertise in the field of reproductive medicine was completed as part of the team which initiated one of the first IVF
laboratories in Israel combining science with medicine. Dr. Barak is engaged in setting up IVF units, around the world. Over the years, she was
a partner, and founded and managed a number of IVF laboratories in Israel and abroad. The need for treatments in unconventional timings, the
requirements of her thousands of customers and her partners along the way – all led her to the opening of private laboratories in Israel, where
she advises, investigates and develops the field of IVF.
Keynote Forum
(Day 1)
Page 17
2nd World Congress on
Salma Iftikhar
Mayo Clinic, USA
C ardiovascular disease is fast emerging as a leading cause of death among women. Polycystic ovarian syndrome is a common
disorder affects about 4% to12% of females during their childbearing years. Stein and Leventhal first described it in 1935.
It is characterized by hirsutism, infertility, anovulatory cycles, hyperandrogenemia and abdominal obesity. Recent insights
into the pathophysiology of PCOS have shown it to be also associated with a number of metabolic abnormalities including
low HDL, higher levels of small dense LDL-cholesterol, triglycerides, homocysteine, and endothelial dysfunction, insulin
resistance, higher BMI and hyperandrogenemia. There are many atherogenic risk factors as well as Proinflamatory markers
identified in women with PCOS. All of the above mentioned abnormalities are known risk factors for cardiovascular disease,
and the risk of CAD and MI has been reported to be increasing in patients with PCOS as compared with regular cycling women.
The objective of this talk is to highlight the various risk factors and address any modifiable risk factors in women with PCOS
to help manage these women better. We will also highlight gaps in management which will be important to consider as basis
for research in order to provide best care for women with PCOS.
Biography
Dr. Salma Iftikhar is an Assistant professor in medicine, working in the International Clinic in General Internal Medicine at the Mayo Clinic,
Rochester Minnesota, USA since 2006. She completed her medical school from gum in Medical College Srinagar, Kashmir, India and completed
a residency in Internal Medicine from Mayo Clinic. She has a fellowship in Women's Health from the Mayo Clinic and a master's degree in clinical
research, also from the Mayo Clinic. Dr. Iftikhar is board-certified in ABIM. She also is a fellow of the American College of Physicians (FACP).
Her interests include Women's Health, insulin resistant states and obesity. She has presented at many National and international conferences.
H uman papillomavirus (HPV) infection does not induce the production of immune mediators by host epithelial cells. This
allows the virus to replicate without been noticed. The objective was to evaluate the cell-mediated immune response
to HPV after bivalent HPV vaccination, assessing cell proliferation and quantifying cytokines. Methods: Cell Culture was
performed with peripheral blood mononuclear cells (PBMC) from 30 patients one month after the total HPV immunization. Cell
proliferation was assessed by MTT reduction assay. For the analysis of cytokine mRNA expression, cellular RNA was extracted
from PBMC. Relative quantification of cytokines (IFN (interferon)-beta, IFN-gamma, IL-12, TNF-alpha, IL-6, IL-17 or IL-
10) in comparison to the transcripts of beta-actin gene (endogenous control) was performed using “real time” PCR. Results:
The cell viability of the culture stimulated with the vaccine compared to the negative control was different (118% X 100%,
p<0.001). The cytokines were upregulated in stimulated PBMC cultures following vaccination compared to in unstimulated
cultures. The median n-fold increase theses cytokines were: IFN beta=334.4-fold, IFN gamma=12.64-fold, IL-12, =46.33-
fold, TNF alpha = 2.36-fold, IL-6= 9.07-fold, IL17=7.33-fold and IL-10 =6.47-fold. The cytokines expressions in stimulated
cultures were different. IFN beta expression was significantly higher than IFN gamma, TNF alpha, IL-6, IL-10 and IL-17 (p
< 0.05). Conclusion: proliferative PBMC responses against HPV-16 and HPV-18 were detected in women who received the
vaccine HPV immunization. HPV vaccine stimulates antiviral immune response, with robust induction of IFN-beta production.
The post-vaccination activation of this response could explain a possible therapeutic effect following HPV vaccination.
Biography
Ana Katherine Gonçalves has completed his Ph.D. and postdoctoral studies from UNICAMP-Universidade Estadual de Campinas - UNICAMP.
She is the Coordinator of the postgraduate program in health sciences at the Federal University of Rio Grande do Norte. She has published more
than 70 papers in reputed journals and has been serving as an editorial board member of repute.
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Biography
Dr. Yona Barak is one of the pioneers in the field of In Vitro Fertilization (IVF). She graduated the Faculty of Life Sciences in conjunction with the
Department of Clinical Biochemistry, in Tel Aviv University. A desired lecturer, expert, one of the world-seniors scientists in the field of IVF and
former chairman of the IVF organization “Alpha – Scientists for Reproductive Medicine.” Dr. Barak has been involved in more than 40,000 IVF
babies around the world. Her expertise in the field of reproductive medicine was completed as part of the team which initiated one of the first IVF
laboratories in Israel combining science with medicine. Dr. Barak is engaged in setting up IVF units, around the world. Over the years, she was
a partner, and founded and managed a number of IVF laboratories in Israel and abroad. The need for treatments in unconventional timings, the
requirements of her thousands of customers and her partners along the way – all led her to the opening of private laboratories in Israel, where
she advises, investigates and develops the field of IVF.
Nana Wiberg
Department of Gynecology and Obstetrics, Lund University, Sweden
C ardiotocography (CTG) was introduced in the late 1960s. The aim was to early recognize and respond on signs of intrapartum
fetal distress to avoid severe intrauterine hypoxia resulting in cerebral palsy and perinatal deaths. Unfortunately CTG is
characterized by a high sensitivity, low specificity, low positive predictive value for adverse outcome and a high intra- and
inter-observer variation. To decide whether to manage the labor course expectantly to avoid an unnecessary and inappropriately
high operative delivery rate with risk for both the fetus and mother or to intervene for better neonatal outcome various second
line tools are recommended by most of the obstetric scientific societies worldwide.
Fetal scalp stimulation test (FSS) is preferred for fetal scalp blood sampling (FBS) by the ACOG although the poor evidence for
its safety. The method was first described in 1936 by Sonntag and rests on the assumption that a reassuring fetus will respond
to an irritation or a pain stimulus of the scalp by an increase in the heart rate, read of the CTG as an acceleration (an increase in
the fetal heart rate above baseline with minimum amplitude of 15 beats per minute for a minimum of 15 seconds). Absence of
accelerations and repetitive decelerations are normal phenomes during the second part of labor and we were not able to show
a satisfying specificity (0.14 (95% CI 0.06-0.25)), likelihood ratio for a positive test (0.94 (95% CI 0.81-1.11) or for a negative
test (1.32 (95% CI 0.64-2.72)) by scalp puncture within 20 before delivery.
Fetal scalp blood can be analyzed for pH or lactate. Lactate is shown to better correlate with poor neonatal outcome and a
higher lactate is also correlated to impaired outcome at 4 years of age. Lactate can be measured easily and bedside by a point-
of-care devise. The StatStrip®XpressTM (SSX) is FDA approved and CE/ISO certified and is the only lactate meter developed
specifically for hospital use, employing technology reducing interference of hematocrit, Paracetamol and bilirubin among
others. Until today, it is only recommended for use in adults, but recent studies have demonstrated promising properties for
measurement of lactate also in fetal blood. From an international multicenter study including more than 3500 deliveries we will
present recommended cut-offs to rule out hypoxia during labor in case of a pathological CTG.
Biography
She is a passionate obstetrician and associate professor at Lund University, Sweden. Her scientific carrier started at medical school in the field
of assisted reproduction. Today she had specific interest in fetal monitoring during labor and obesity/diabetes during pregnancy and the impact of
these conditions on the off-spring. For nearly 10 years she has been responsible for one of the largest delivery departments in Sweden (Skåne
University Hospital). In Scandinavia they are very proud of their obstetric performance starting with a scheduled antenatal care for all women
independent of social status, delivery departments staffed mainly by midwives with high competence, low cesarean section rate and a very low
incidence of children born with asphyxia. Besides her clinical carrier she teaches medical students and PhD students at university.
Scientific Sessions
(Day 1)
Page 22
Sessions Day 01
September 19, 2019
Session Introduction
Title: Combined Sequential Managemant of Caesarean Scar Pregnancies
Indira Vijayakrishnan, Amar Maternity and Fertility Centre, India
Title: Detection of human papillomavirus (HPV) and association of interleukin-17/IL-17RA and
IL-10 polymorphisms in patients with Lesion and Cervical Cancer
Janaína C. O. Crispim, Federal University of Rio Grande do Norte, Brazil
Title: Single Loading Dose Versus Standard 24-Hour Magnesium Sulfatein Women with Severe
Preeclampsia and Eclampsia: A Systematic Review and Metaanalysis
DirdrahAina C. Salvador, Philippines
Title: Influence of Gestational Diabetes Mellitus on Defects in the Enamel of Offspring
Angélica M. P. Barbosa, Universidade Estadual Paulista (UNESP), Brazil
Title: Impact of Gestational Diabetes Mellitus on Pelvic Floor Muscle Contraction: Three-
Dimensional Ultrasound
Fabiane A. Pinheiro, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Brazil
2nd World Congress on
I ncreasing numbers of cesarean scar pregnancies(CSP) have been reported over the past years. Earlier the rarity of the
condition and lesser diagnostic sensitivity rendered CSP susceptible to missed/late/intraoperative diagnosis, leading to
torrential haemorrhage and emergency hysterectomy or even mortality. Early diagnosis by ultrasonography has decreased
morbidity. During the last decade, in an attempt to preserve fertility, a more conservative approach was developed.
Objectives: To discuss the causes of the increasing incidence of CSP, currently accepted diagnostic criteria, evidence based
management options, possible complications and to detail successful management of 7 cases of CSP. There is presently no
consensus on the preferred mode of treatment for CSP. The safety and efficacy of combined sequential management treatment
using systemic methotrexate and mifepristone, intralesional methotrexate and aspiration of the sac under ultrasound guidance
is promising in the management of CSP, optimising future fertility.
Method: All women diagnosed with CSP, between January 2015 to December 2018, at Amar Maternity and Fertility Centre,
India, were analysed for risk factors, response to combined sequential treatment, and outcome in future pregnancies, if
applicable.
Results: Combined sequential management of CSP reduces the risk of bleeding, hysterectomy and major surgery and
allows quicker recovery and discharge. None of the patients required blood transfusion/ major surgery. Normal subsequent
pregnancies have been observed.
Conclusion: Diagnosis and management of CSP requires considerable expertise. CSP is an uncommon but potentially
devastating occurrence. Knowledge regarding early diagnosis and treatment with sonographic guidance improves outcomes,
directs therapy, and allows preservation of future fertility.
Biography
Dr. Indira Vijayakrishnan has completed her DGO from JSS University, India and has been conferred MRCOG from the Royal College of
Obstetricians and Gynaecologists, London. She has trained in Gynecological Endoscopy from Kiel University, Germany and in Embryology from
Bangalore, India. She has special interest in Obstetric Ultrasound and Infertility. She has presented several papers in several state conferences.
She is presently working as Consultant Obsterician and Gynecologist, Infertilty consultant, Laparoscopic Surgeon at Amar Maternity and Fertility
Centre, India.
A ssociated with Human papillomavirus (HPV) infection, cytokines may play important roles biomarkers risk in Cervical
Cancer (CC). This present study was performed to examine a polymorphisms of IL-17/ IL-17RA and IL-10 associated
with a HPV infection in patients with CC. Four hundred twenty-seven (427) no-pregnant Brazilian women, sexually active,
older than 18 years, were evaluated. Cervical Intraepithelial Lesion (CIL) group were stratified according to the results of
the anatomopathological examination: Low-grade squamous intraepithelial lesions (LSIL) n=76 and High-grade squamous
intraepithelial lesions (HSIL) n=121, CC n=63 and Healthy Group (HG) consisted of 167 women without abnormalities
detected. The peripheral blood of these patients was collected for analysis of IL-17/IL-17RA and IL-10 polymorphisms using
PCR and sequencing. Cervical sample was collected for HPV test using Nested-PCR. The analysis indicated a significantly
higher in site rs4819554 IL-17RA genotypes frequency in CIL group when compared to HG (P= 0.046, OR= 3.55, 95%CI=
1.07- 11.77). Moreover, the frequency of GG genotype is significantly higher in site (-1082 A/G) the gene IL10 in HG than
CIL (P= 0.026, OR= 0.35, 95%CI= 0.14-0.88). Quantitative analysis revealed that HPV is most detected in CIL and CC group
than HG (P= 0.87; OR=1.11, 95%CI=0.58-2.08). In resume, we showed than polymorphisms RIL-17 are associated with a
significantly increased risk to CIL. Moreover, the polymorphism of IL-10 have an important role anti-inflammatory in HG.
The results from our study suggest a possible use of RIL-17 as risk biomarker in the CIL associated an HPV infection evolve
to CC.
Biography
Janaina Cristiana de Oliveira Crispim has completed her PhD from University São Paulo USP, Brazil and postdoctoral studies from USP, Brazil.
She is a assistant Professor Federal University of Rio Grande do Norte, Natal, Brazil and director of leader of the research and technological
innovation management sector of woman hospital. She has published reputed journal in the area of woman´s health.
Single Loading Dose Versus Standard 24-Hour Magnesium Sulfate in Women with Severe
Preeclampsia and Eclampsia: A Systematic Review and Meta Analysis
Dirdrah Aina C. Salvador and Floriza C. Salvador
De La Salle University Medical Center, Philippines
O bjectives: The primary goal of this study is to determine if a single loading dose of Magnesium sulfate (MgSO4) is
comparable to standard 24-hour therapy in preventing seizures with severe preeclampsia and eclampsia
Study Design: Metaanalysis and Systematic review of six randomized controlled trials
Patients/ Subject Selection: Patients diagnosed with severe preeclampsia and eclampsia
Intervention: Giving of single loading dose only (study group) versus 24-hour MgSO4 therapy (control) in patients with
severe preeclampsia and eclampsia
Outcome Measures: (1) Anti-convulsant effects (2) Maternal: loss of deep tendon reflex and oliguria, incidences of caesarean
section, Hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome, post-partum hemorrhage and intensive care unit
admissions and (3) Neonatal complications: incidences of neonatal intensive care unit (NICU) admission, APGAR score at 5
minutes and death
Results: Occurrence of seizures was similar in both groups. The risk difference of -0.00 (95% Confidence interval (CI): -0.04
to 0.03; p=0.84) showed no significant difference and the combined studies were found to be homogenous with an I2 of 0.0
Conclusion: A single loading dose of MgSO4 is comparable in preventing seizures of Preeclamptic and eclamptic patients
with similar maternal and neonatal complications except for a lesser occurrence of decreased patellar reflex in the study group
(p=<000001)
Keywords: Preeclampsia; Eclampsia; Single Loading Dose; 24-hour regimen
Figure: Forrest plot and subgroup analysis of seizure occurrence in severe preeclampsia and eclampsia
Biography
Dirdrah is a recent graduate in her residency training in Obstetrics and Gynecology in the Philippines and has found love for research since her
senior high school days. She is planning to pursue subspecialty training in Gynecologic Oncology and Clinical Research and Epidemiology.
G estational diabetes mellitus (GDM) is associated with short and long-term maternal and perinatal repercussions. Several
studies suggest that maternal health conditions, particularly hyperglycemia during pregnancy, can alter fetal development
to affect organ formation and increase the risk of diseases however, the effects of maternal diabetes on tooth development and
the associated underlying mechanisms have not been thoroughly investigated. Our objective was to evaluate the long-term
consequences of intrauterine exposure to hyperglycemia on Developmental Defects of Enamel (DDE) in offspring. This study
was part of a prospective cohort study to evaluate the short- and long-term effects of GDM on mothers and their offspring.
The study was conducted in the Perinatal Diabetes Research Center (PDRC) of Botucatu Medical School/UNESP/ Brazil
from March 2016 to September 2017. Overall, 50 children of women with GDM and 250 children of normoglycemic women
participated, the latter serving as controls. Children were examined at the age between 3 and 12 years. In addition to physical
examination, two independent observers examined and rated photographs to identify specific types of DDE in a blinded
fashion. Among offspring of mothers with GDM, rates of DDE (all types combined) were significantly higher (p<0.001, p =
0.04), in comparison to offspring of normoglycemic mothers. Considering only the affected teeth (1060 in GDM category;
5499 in controls), rates of DDE (all types combined) were significantly higher for total teeth (p <0.001). GDM was associated
with the adverse effects of DDE on offspring. This study lays the foundation for future studies to determine the impact of
GDM on long-term risk of DDE.
Biography
Angélica Mércia Pascon Barbosa has completed her postdoctoral studies from Sao Paulo State University, Brazil. She was the director of the
department of physiotherapy and occupational Therapy São Paulo State University – Marilia (2014-2018). Member of the Research Group
"Diabetes and Pregnancy: Clinical and Experimental", registered at CNPq. She acts as Coordination of Masters and PhD in the Graduate Program
of FMB-Unesp. Principal Investigator of the Thematic Project Fapesp (Process 2016 / 01743-5 - Effective 2017-2022) as. Research Associate of
SPRINT FAPESP project in collaboration with Imperial College London (2018 / 22406-2). Collaborating Researcher at Universal CNPq (Process:
409902 / 2018-7).
T here is a lack on literature about the influence of maternal hyperglycemic environment on changes of PFM function
just before the GDM diagnosis and throughout gestation. The aim was to investigate the effect of GDM on pelvic floor
muscle (PFM) contraction at two-time points of pregnancy by transperineal three-dimensional (3D) ultrasound. Prospective
cohort study was approved by the Research Ethics Committee of the Institution (Protocol Number 972.104). The inclusion
criteria were pregnant women in their first or second pregnancy with previous elective Cesarean-section, 18-40 years of
age, singlet on pregnancy and GDM or normoglycemia diagnosis. Personal, clinical, Obstetric and anthropometric data was
collected. Transperineal 3D ultrasound was performed at two-time points , between 24-30 weeks of gestation and 36-40 weeks
of gestation, in the supine lithotomy position after voiding, using the GE Voluson “I” system with RAB 2-6RS(2-6 MHz)
curved array 3D transducer (GE Healthcare, Zipf, Austria). Imaging data sets were taken at rest, during maximal voluntary
PFM contraction by a trained and experient investigator The ultrasonographic images were stored offline by anonymous code
numbers. 83 participants were included in the final analysis, 38 in GDM group and 45 in NG group. Clinical, obstetric and
anthropometric wasn’t different between groups. The results showed a weak muscle at 24-30 weeks of gestation, demonstrated
by a larger LH area during contraction, meaning a less muscle contraction. The increase of these dimensions during contraction
is inversely proportional to contractile function capacity of the muscle. In conclusion, we identified that GDM have a relevant
impact on PFM.
Biography
Fabiane is graduated in physiotherapy from the University of Marilia, state of São Paulo.Pelvic physiotherapy specialist with 10 years of clinical
experience, Master's degree by São Paulo State University (Unesp), Medical School, Botucatu, Brazil, Department of Gynecology and Obstetrics,
Botucatu Medical School, Universidade Estadual Paulista (UNESP), Brazil and in the final stage of doctorate degree. Member of the Diamater
Research GroupGestational Diabetes Mellitus (GDM)that also investigates the functionality of the pelvic floor muscles in GDM pregnant women.
Poster Presentation
Page 29
2nd World Congress on
E normous efforts need to be made towards the reduction of perinatal and maternal mortality especially in poor resource
countries of the subsaharan regions of Africa. This study aimed at determining the incidence of grandmultiparity, possible
promoting factors and how it affects pregnancy outcome. The data of women who delivered between January 2007 and
December 2011 were collated. 328 of them were of grandmultiparous women giving an incidence of 4.4%. Most of them
(48.8%) were between 35 – 39 years. 74.4% were unaware of contraceptive methods. Most women in this study (70.1%) did
not have any form of education nor had only primary education. There were more booked pregnancies (70.1%). Anaemia
was the highest antenatal complication (43.9%), highest intrapartum complication was obstructed labour (39.4%) while that
of postpartum was PPH (47.8%). There were 3 maternal deaths, each from Haemorrhagic shock, uraemic encephalopathy
and suspected amniotic fluid embolism respectively. Caesarean birth was 35% while 3.4% and 1.5% required vacuum and
forceps respectively. 7.6% had still births while 5.3% had early neonatal death. The perinatal mortality rate was 113/1000.
Grandmultiparity is indeed a contributor to maternal and perinatal mortality and morbidity. Lack of education of the girl
child and overcrowded antenatal care class sessions, as witnessed in our public hospitals, are clear contributors to increased
grandmultiparity. Grandmultiparity should be seen and treated as high risk pregnancy. Strong efforts must be made at reducing
its prevalence. Laying strong emphasis on girl child education and effective contraception and family planning counselling
during antenatal visits is crucial for prevention.
Biography
Chinedu Barry Iheukwumere is a member, College of Obstetrics and Gynaecology of the National Postgraduate Medical College, Nigeria (MCOG,
Nig). He has published thirteen research papers in reputable journals and he is currently working on his PhD research in Reproductive Physiology
at college of Medicine, Abia state University Uturu Nigeria.
Accepted Abstracts
Page 31
2nd World Congress on
Periconceptional Parental Lifestyle: New Evidence of the Impact on Early Health and Challenges
to Implement Blended Lifestyle Care
Régine P.M. Steegers-Theunissen
Division of Neonatology, Erasmus MC, University Medical Centre, Netherlands
B ig health problems in reproduction are subfertility, miscarriages, preeclampsia, gestational diabetes, congenital
malformations and fetal growth restriction. These adverse reproductive outcomes have in common that they largely
originate in the periconceptional window, a time span defined as 14 weeks before until ten weeks after conception. Parental
lifestyles, such as smoking but also over- and under nourishment, have a detrimental impact on the development and health of
gametes, embryo and placenta. Embryonic and placental health predict fetal and newborn health outcomes and are associated
with obesity and non-communicable diseases in childhood. In the first part of this presentation, an overview will be given of
new evidence on this topic derived from the ongoing Rotterdam periconception cohort at the Erasmus MC in Rotterdam, The
Netherlands.
Mothers-to-be, but increasingly also fathers-to-be, are most motivated to change poor lifestyle behaviors when they are aware
of the short-term health benefits of getting pregnant and having a healthy baby. In the second part, the implementation and
valorization of the new knowledge on the importance of nutrition and lifestyle for patient care will be addressed. Since 2007
we have experience with an outpatient clinic for lifestyle counseling and support. This kind of care is not often included in
usual patient care. Recent opportunities to empower patients as well as health care professionals to adopt a healthy lifestyle
by offering mobile-health technology-based interventions, such as the mHealth coaching program www.smarterpregnancy.
nl, are very promising. In the future, we believe however that the only sustainable manner to implement evidence-based
personalized lifestyle care in usual patient care is a blended lifestyle care approach. The first results of the implementation of
the combination of an outpatient lifestyle clinic together with evidence-based mHealth programs will be presented.
Biography
Régine P.M. Steegers-Theunissen, MD, PhD, is a professor of periconception epidemiology at the departments of Obstetrics and Gynaecology, and
Paediatrics /division of Neonatology at the Erasmus MC. From 1986 she is conducting multidisciplinary and translational research on the impact
of periconception folic acid, parental nutrition and lifestyle on fertility and adverse maternal pregnancy and neonatal outcomes with implications
for future health. Last 10 years she implemented the research findings in a preconception outpatient clinic and developed the mHealth nutrition
and lifestyle coaching programs ‘smarter pregnancy’ and ‘smarter eating with your child (launch 2011). These web-based platforms increase the
quality of preconception and pregnancy care by adopting healthy behaviors and compliance of medical treatment in couples and young children.
She contributed to >320 international publications and completed the supervision of 28 PhD thesis.
O bjectives: To evaluate estradiol levels and autotransplantation heated ovarian tissue effects, after vitrification, on rats
bone metabolism previously oophorectomized bilaterally.
Methods: Experimental study with 27 rats aged 11 to 12 weeks and weighing 200g to 300g, submitted to bilateral oophorectomy
and ovarian tissue cryopreservation for subsequent reimplantation. Animals were divided into two groups, A and B, with 8 and
19 rats, respectively. Autotransplantation occurred in two periods according to castration time: after one week, in group A, and
after one month in group B. Serum estradiol measurements and ovary and tibia histological analysis were performed before
and after oophorectomy period (early or late) and one month after reimplantation.
Results: In groups A and B, tibia median cortical thickness was 0.463±0.14mm (mean±SD) at the baseline, 0.360±0.14mm
after oophorectomy and 0.445±0.17mm one month after reimplantation p<0.005). Trabecular means were 0.050±0.08mm
(mean±SD) at baseline, 0.022±0.08mm after oophorectomy and 0.049±0.032mm one month after replantation (p<0.005).
There was no statistical difference in estradiol variation between the two study groups (p=0.819).
Conclusion: Cryopreserved ovarian tissue transplantation restored bone parameters, and these results suggest that ovarian
reimplantation in women may have the same beneficial effects on bone metabolism.
Keywords: Menopause; Osteoporosis; Postmenopausal; Estrogens; Primary Ovarian Insufficiency; Tissue Transplantation;
Cryopreservation
Biography
Graduated in Medicine from the Faculty of Medicine of Catanduva (2004), Specialization in Obstetrics and Gynecology from the General Hospital
of Fortaleza – HGF. She was a professor of the Medicine course at Christus Fortaleza CE College teaching Gynecology and Obstetrics and
Ultrasound classes. Has experience in Public Health, having headed the administrative team of the Family Health Program.
E ndometrial cancer is the most prevalent of all gynecological malignancies. Currently, the endometrial adenocarcinoma is
the fourth most common cancer in females. . In 75% of the cases the tumor is confined to the uterine corpus at the time
of the diagnosis which means it can be approached surgically with an expected survival rate of over 75%.The high survival
rate of an efficient surgical management impose the standardization of the procedure, which will lead to reduction of human
errors and complications. This video presents in 10 steps the surgical strategy that should be followed not only by the surgeon
but also by the 1st and 2nd assistant, in order to achieve the best surgical outcome in minimum time. We focus on the pre-
operative work-up, the practical manoeuvres in order to expose the necessary anatomical spaces of the pelvis and tips that
will maximize the results of collaboration among the surgeon and his assistants. Ten important steps that will facilitate the
laparoscopic surgery in patients with early endometrial cancer are presented and standardized:
• Pre-operative vaginal ergonomy
• Pre-operative laparoscopic ergonomy
• Exploration of abdominal cavity
• Bilateral tubal coagulation
• Introduction of uterine manipulator
• Dissection of the necessary anatomical spaces
• Colpotomy
• Removal of the uterus
• Vaginal Closure
• Final actions before exhufflation of the abdominal cavity
Due to the high prevalence rate of patients with early endometrial cancer who underwent minimal invasive treatment,
the standardization of the surgical procedure is of high value for the patient and the surgeon. Every step demonstrates the
importance of knowing specific tips and tricks that will enhance the surgical management, the spirit of harmonious cooperation
among surgeon and assistants and most importantly the surgical outcome.
Biography
Eleni Karatrasoglou has completed her MSc from the University Hospital of Attikon, Greece and specialised in minimal access surgery at the
university hospital of Clermot-Ferrand, France. At the same time she was a member of the educational team of C.I.C.E. (The International Centre
for Endoscopic Surgery). She participated as an oncology fellow at the Gemelli University Hospital, Rome, Italy. She is a member of the World
Association of Laparoscopic Surgeons and the International College of Robotic Surgeons. Currently working at the laparoscopic-robotic team of
’Euroclinic’ and ‘Hygeia’ hospital, Athens, Greece.
Long Term Mortality in Adults with Congenital Heart Disease: A Systematic Review of Literature
A. Cristina Rossi1 and Federico Prefumo2
1
Ospedale della Murgia, Italy
2
University of Brescia, Italy
P urpose: To review literature about mortality in adults with Congenital heart defects (CHD)
Method: Search in PubMed, EMBASE, Medline, Clinicaltrials.org, reference list. Inclusion criteria: death after >30
days from cardiac surgery or patients >15 years old, CHD-survivors compared with CHD mortality. Exclusion criteria: CHD-
adults compared with CHD-free adults, studies not aimed to analyze mortality. PRISMA guidelines were followed. Statistical
differences were significant if 95%ConfidenceInterval (95%CI) of the Odds Ratio (OR) did not encompass.
Results: From 8 articles, mortality rate was 2465 of 17,186 (14.3%) without difference between gender (OR:0.97; 95%CI:
0.50 – 2.96). Cardiac surgery occurred more frequently among survivors than dead (OR:0.59; 95%CI: 0.40 – 0.86). Septal
and Conotruncal defects equally occurred between dead and survivors. Right heart anomalies (OR:1.83; 95%CI: 1.44 – 3.0),
Eisenmenger (OR:2.53; 95%CI: 1.98 – 3.23), single ventricle (OR:2.83; 95%CI: 2.23 – 3.60) were more common in dead
than survivors. Valve defects (OR:0.52; 95%CI: 0.32 – 0.87) and left heart anomalies (OR:0.59; 95% CI: 0.44 – 0.79) were
detected more frequently in survivors than dead. The etiology of death was extracardiac in 11.8% cases, cardiac in 88.2%.
Cardiac death was due to heart failure (80.4%), cerebral stroke (9.0%), pulmonary embolism (6.0%), myocardial infarction
(3.5%), multiorgan failure (1.1%).
Conclusions: Single ventricle is the most severe CHD leading to death, whereas Septal valve, Conotruncal and left heart
defects might be considered curable. Management of adults with CHD should be aimed to prevent heart failure.
Prevalence and Risk Factors of Unintended Pregnancy Among Pregnant Sudanese Women at
Omdurman Maternity Hospital, 2016
Esra. Saleh and Magdi. Sabahalzein
Ahfad University for Women, Sudan
O bjective: To identify the proportion and risk factors associated with unintended pregnancy among currently pregnant
Sudanese women at Omdurman maternity hospital, 2016.
Methods: Cross-sectional hospital based study comprised of 330 pregnant women attended antenatal care clinics at Omdurman
maternity hospital between January and February 2016. Systematic Random sampling was used to select the study participants.
A standard structured tested questionnaire was used to collect the required information.
Results: Overall, (47.9%) of the current pregnancies were unintended. The findings showed that, contraceptive use (p.value
=0.031) were strongly associated with unintended pregnancy, (47%) of women used contraception prior to their current
pregnancy, the commonest method used were oral contraceptive pills (73.6%)
Conclusion: The proportion of unintended pregnancy was high. The commonest reason for the pregnancy being unintended
was that it happened soon after the previous one, community awareness to continue the use of modern contraceptive methods
through training of service providers to provide enough needed information to choose a contraceptive method and to use it
correctly is crucial.
Biography
Graduated from School of Medicine, Ahfad University for Women, obtained MPH Reproductive health from the same university. Prior to joining
Sudanese American Medical Association, she worked at the Federal Ministry of Health -Health Emergency and Epidemic Control department for 3
years where she gained the program management experience. She was interested in public health especially maternal and child health. She works
closely with the FMOH to organize midwifery training workshops throughout Sudan. Since joining SAMA in April 2018 over 650 midwives and 50
master trainers have been trained on the Helping Mothers Survive modules: Bleeding after birth and pre-eclampsia & eclampsia.
T he question of whether patients with squamous cell carcinoma in a mature cystic teratoma should undergo conservative
surgery or postoperative adjuvant treatment remains unresolved. Ovarian cancer is the second most common malignancy
of the lower part of the female genital tract, occurring less frequently than cancers of the endometrium but more frequently than
cancers of the cervix. Germ cell tumors are the second most frequent type of ovarian neoplasm and account for approximately
10-20% of all ovarian tumors. The most frequent germ cell tumor is the Mature Cystic Teratoma; overall, only 2% to 3% of
germ cell tumors are malignant, and more than 80% of malignant transformations are squamous cell carcinomas arising from
the ectoderm. There are currently no reliable procedures for the early detection of ovarian cancer. Available potential screening
techniques have included pelvic examination, ultrasound examination, serum CA-125 determination and other tumor markers.
There is no established definitive treatment protocol available due to lack of research on this rare case, thus frozen Section of
the affected ovary is imperative in dermoid cysts to ensure that it is benign. Frozen sections are utilized mainly to aid in the
differentiation of benign from malignant disease. Determining the type of tumor and extent of surgery is very important in
Gynecologic Oncology. In this report, we present a rare case of a mature cystic teratoma, which was found to be malignant
on frozen section with Intraoperative Stage I-A, and therefore managed by cytoreductive surgery followed by chemotherapy.
Biography
Maria Rheapaz B. de Guzman has completed her degree in Doctor of Medicine at the age of 25 years old from Far Eastern University-Nicanor
Reyes Medical Foundation, Manila, Philippines. She is currently in her Residency at the Department of Obstetrics and Gynecology in the same
institution.
Quantification of Cell Free Fetal DNA in Maternal Plasma During Pregnancy as a Predictor of
Preeclampsia
Amany El-Sayed Ahmed Awad, Mohamed Salama Gad, Hala Hany El Said and Sherif M.S. Abd El-Salam
Menoufia University School of Medicine, Egypt
S everal studies showed that free fetal DNA increase before occurance of preeclampasia. The aim of this study was
to determine if cell free fetal DNA in maternal circulation during early pregnancy is increased before appearance of
preeclampasia and if we can use it as a predictor of development of preeclampsia or not. Blood samples were obtained from
patients attending outpatient clinic of Obestetric and Genecology at Menoufia university hospital at first half of pregnancy.
Cases were asymptomatic patient, but had risk factors for occurance of pre eclampas ia. Twenty five cases who subsequently
developed preeclampsia matched to twenty five control women for parity and gestational age. Real-time polymerase chain
reaction (PCR) using TaqMan primers and probes directed against DYS 14 gene sequences quantified fetal DNA in the
maternal circulation.We found a statistically highly significant increase in circulating free fetal DNA in maternal plasma in
preeclamptic patients prior the onset of clinical diseases as compared with controls. (78 – 1220) and (0 – 3.18) [p < 0.001]
respectively. And this increase was more pronounced in sever PE (715.01-230.1) than in mild PE. (258.9-140.1) p<0.001.
We concluded that, free fetal DNA in maternal plasma was increased in preeclamptic patients before the onset of its clinical
symptoms, and free fetal DNA might be used as a marker for predicting preeclampsia.
Biography
Dr. Amany Awad has completed her Master dgree from Menoufua University, Faculty of Medicine. She is an assistant lecturer in the department of
Obstetric and Gynaecology and is completing Ph.D degree.
I n vitro fertilization, popularly referred to as IVF, has attracted the attention of the public since its introduction in 1978.
Today Assisted Reproductive Technology (ART) is available throughout most of the civilized world, and the practice is
largely different from that used during the early days. The birth of Louise Brown in 1978 was the culmination of decades of
scientific research in reproductive medicine. Since then, an abundance of breakthroughs in both clinical medicine and basic
science have allowed increasing numbers of infertile couples the chance to have a baby. I started working in IVF lab 20 years
ago. Since then, I have worked in several laboratories in three different countries as an operational Lab director and senior
embryologists while the innovation and refinements in technology took placed, which led me to experience the different ways
of running a successful IVF lab. By working in very different labs: the most busiest one with 500 cases annually, private with
200 case and academic IVF lab, I learnt one important aspect, the success is in keeping the procedures for each patient simple
and straight forward. Furthermore, consistency in each process for each patient is a key to success. Efficiency in IVF lab highly
depends on advanced technologies and embryologists expertise, therefore, in this perspective keeping a records of procedures,
QC, QA, QM statistics in very simple way retain IVF lab in their optimum performance. This simplicity and consistency help
a lab director to see the issues clearly and track back the problem more effectively which may effect the results
Biography
Avisa Asemi has completed her PhD in 2015 from Florida Atlantic University in Complex System and Brain Sciences and her master degree was
from Georgetown University in double major biochemistry and molecular biology. She is an operational IVF lab director and senior embryologist
in University Miami Fertility Department. She used to work in Boca Fertility, Boca Raton and Shady Grove Fertility Center, Maryland, USA as an
operational lab director and senior embryologist. She has worked in Canada and Iran as embryologist. She has published 2 papers in reputed
journals.
P olycystic ovary syndrome (PCOS) is characterized by the presence of polycystic ovaries, menstrual dysfunction, infertility,
biochemical & clinical hyperandrogenism which is associated with an increased prevalence of cardiometabolic risk factors
& psychological problems. Reproductive failures in women with Polycystronic ovary syndrome (PCOS) are common due
to endocrinal disorders. Despite the well-established benefits of exercise training & it recommendation as a cornerstone of
PCOS management, few well-controlled randomized studies have been conducted evaluating the benefits of exercise training
& specific exercise regimes in women with PCOS. From the limited studies there appears to be a beneficial effect of exercise
either alone or in combination with energy restriction has shown to improve fitness, cardiovascular, hormonal, reproductive &
psychological outcomes. While the addition of regular exercise to energy restriction appears to only have additional benefits
for improving body composition, these greater improvements are likely to have long-term implications. While lifestyle
modification including regular exercise appears to be an effective strategy for the management of overweight PCOS women,
methodological limitations in the studies limits the generalisability of the 40 findings. Future research with rigorous study
designs is needed to determine specific exercise guidelines that will provide the greatest benefit for these women.
Conclusions: Women with PCOS recognize the importance of diet,but few received dietary advice. The dietary information
women with PCOS received was often from an unregulated source. The multifaceted health implications of PCOS & its potential
to increase in prevalence in the future have underscored the importance of identifying effective therapies for prevention &
treatment of PCOS & its associated consequences. The women need to take precautions in their lifestyle adaption. Diet alone
cannot be effective without exercise PCOS women with Infertility or Obesity need to go set like exercise along hypo-diet in
their life for reproductive improvement & good health.First line treatment of lifestyle management, physical exercise with diet
is recommended in current treatment. Lifestyle modification, for improvement of reproductive hormones, here we reviewed
by a study of meta-analysis, before & after hormones level changes by lifestyle modification with exercise, in infertile PCOS
women. It is well documented that modest weight loss via energy restriction improves an array of deranged factors inPCOS
women. However, despite the well-established benefits of exercise training for the general population.
Biography
Dr Mili Sarkar, IVF Project Expert ,MD, Certified Human Genetic, Senior Adviser& Committee Member Of CPHFS, Ghalib University Kabul, Feni
pvt hospital, Bangladesh, Pearl Hospital, Baby Joy IVF Center / Rafa-e-Herat Hospital, Key Note Speaker in International Conference at Sri
Lanka 2016.Organizing Committee Member Of PCOS 2018.Women's Health, Reproduction, & Fertility, UAE, 2019. Awarded as a, International
Global Achiever Award / Multi Talented Rashtrawad Patrakarita Global Achiever Award, Global Achievers Award, Thailand-international Sahitya
Conference, Awarded by Rx pharma, Equinox Lab Published Articles & blogs in Health Times, Via media Newsletter.
T he transition to menopause varies from women to women and especially within women of colour. Menopause is the
cessation of periodsin women when they have attained certain age or by surgical implications. The decision to focus
on women of colour stemmed from lack of other research work within this area although there are many studies carried out
outside the United Kingdom. The research used literature review method to narrow the study down to West African women
particularly the Nigerian women. Currently 15 women from this background are being approached for their consent and
participation in the research to examine their understanding of menopause, symptoms experience and methods chosen to
manage symptoms.
As the research will be studying life experiences of these women, phenomenological method will be used with semi structured
interview method. Ethical approval has already been applied to the University. For analysis, interpretative analytical method
will be applied after transcribing the recorded interviews verbatim. This research will give an insight into factors that affects
their decision making process during this transition, the symptoms they experience and the different methods of management
used.
The research study will add to the knowledge already known about menopause, and also serve as a starting point for other
research to be carried out within this particular group of women.
Biography
Juliet Okoye (Hammond) is a 'Personal Health Budget Lead/Assessor' for a National Health Service(NHS) organization in United Kingdom. She
is also a 'Continuing Healthcare Manager/Assessor' working independently to provide a robust and organized way of assessing funding request
for healthcare management. She recently appointed as an 'Independent Chair Officer' for CHC NHS England. At her spare times she works as a
'Clinical Health Advisor' for a private company in London. Juliet completed her first undergraduate degree at University of Porthar court in Nigeria,
then completed a degree in Nursing at University of Northampton, United Kingdom. Her interest in research started immediately following her
nursing career which lead to her enrolment to study at a Master's level. With her pioneer work on Menopause among the women of colours,
she earned a Mary Seacole Leadership award, and later obtained an MSc in Nursing Research/Healthcare following the completion of her field
research work. Juliet is coming towards the end of her Doctorate Degree completion at Anglia Ruskin University, Cambridge. She was awarded
the 'Outstanding Woman of the Year' award by Divas of Colour in London 2017, the WAW (Women Awarding Women) of the year award. Juliet
has spoken at many Research and Leadership events including speaking at the United Kingdom House of Lords. Juliet is also an Author of
'Mount Moriah: a place of sacrifice' book, and co-author of the book 'Inspirational Book by Women for Women'. She is a regular writer and blogger
with passion for Research and Personal Development. As a Motivational Speaker, and an ordained Apostle, she has spoken at different forums
including Church, Business and Health forums. She is a natural motivator, speaker and passionate for anything she engages herself with.
Assessment of Uyghur Women’s Knowledge and Attitude in Xinjiang Province of China Regarding
Prevention and Early Detection of Cervical Cancer
Sumeyya Azam
Shifa International Hospitals Ltd., Pakistan
C ervical Cancer continues to be one of the leading female genital cancer worldwide. The prevalence of cervical cancer
in Uyghur women has been remarkably higher than the ethnic groups living in the same region, and the mortality rate
was more than the other ethnic minorities in China. This study was undertaken to explore the knowledge of Uyghur women
in Xinjiang Autonomous region, China, regarding cervical cancer issues, Human Papillomavirus (HPV) and HPV vaccine.
A cross-sectional interview-based survey of 5,000 Uyghur women was conducted between 2013 and 2014 in Xinjiang
Autonomous region, to assess their knowledge and perception of cervical cancer and its issues. A very small proportion of
participants had heard of cervical cancer, HPV and HPV vaccine, that is, 27.0%, 13.0% and 6.0%, respectively. According to
the demographic characteristics, women aged 31 to 40 years were more aware of the knowledge of cervical cancer (32.9%),
HPV (17.8%), and HPV vaccine (9.1%), and women with undergraduate or higher educational level had more knowledge of
cervical cancer (30.0%), HPV (21.0%), and HPV vaccine (9.7%). Lack of the related knowledge about cervical cancer may be
one of the important factors for high incidence rate of cervical cancer in Uyghur population. Our survey reported that despite
of relatively higher incidence rate of cervical cancer in Xinjiang, less than a quarter of the respondents were not at all or very
less aware of cervical cancer, HPV and HPV vaccine. Thus, health literacy programs which are effective not only in increasing
knowledge but also in creating a positive attitude among women towards Pap smear test should be organized to increase Pap
smear coverage in Xinjiang.
Biography
Dr. Sumeyya Azam is working as a ‘Senior Clinical Research Associate (Departmental Head)’ in Shifa Clinical Research Center at Shifa International
Hospitals, Ltd., Islamabad, Pakistan. She is a co-investigator of Six ongoing International Clinical trials During 2016-2018. She was a Clinical
Research Officer in Asia’s only JCI (USA) accredited trust hospital, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Pakistan.
She holds MBBS and MS (Master of Surgery in Obstetrics & Gynecology) degrees from Xinjiang Medical University, China in 2012 and 2015,
respectively. She cleared her Post-graduation with distinction. She is ICH-GCP certified by NIH, USA; LSHTM, UK; Roche, Switzerland. She has
presented at various National and International conferences and also serves as Organizing Committee Members for International conferences.
She has been awarded with “Certified Sentinel of Science Award Recipient” by Publons, recognized as one of the world’s top ten percent of
researchers contributing to peer-review of the field of Medicine (2016). Graduated from Publons Academy as a certified reviewer and also served
as a Mentor for Publons Academy Graduates.
ICSI Outcome after Assisted Oocytes Activation in Patient with History of Recurrent ICSI Failure
Hend Salah Abdelmoneim
Al-Azhar University, Egypt
B ackground: Despite the success of ICSI, total fertilization failure (TFF) still occurs in 1–3%of all ICSI cycles. Total
fertilization failure after ICSI is a rare event in cases with normal oocytes and sperms, and few patients may experience
repeated TFF despite normal sperm parameters and a good ovarian response.
Aim of the work: The aim of this study is to evaluate the efficiency of assisted oocyte activation with calcium ionophore in
cases of recurrent ICSI failure including severe male factor infertility, previous fertilization failure &implantation failure.
Patients and Methods: This study was done on 150 (one hundred and fifty) ICSI patients with history of recurrent ICSI failure.
The first Group: The oocyte treated by calcium ionophore: The Second Group: Oocyte not treated by calcium ionophore.
Results: Our study included two equal groups: the first group: the injected oocytes were treated by calcium ionophore. In this
group we had 5 cases with history of fertilization failure,10 cases with history of implantation failure,10 cases with severe male
factor abnormality (either oligospermia, athenospermia, or teratospermia or combination) and 50 cases of combined causes;
the second group: the oocyte was not treated by calcium ionophore. In that group we had 2 cases with history of fertilization
failure ,13 cases with history of implantation failure,16 cases with sever male factor abnormality and 44 cases with combined
causes.There was a statistically significant difference between median fertilization rates in the two groups (P-value = 0.044).
Calcium ionophore group showed statistically significantly higher median fertilization rate than No Calcium ionophore group.
There was also a statistically significant difference between fertilization rate categories (< or > 50%) in the two groups (P-value
= 0.002). Calcium ionophore group showed statistically significantly higher prevalence of fertilization rates >50% than No
Calcium ionophore group. There was a statistically significant difference between pregnancy in the two groups(P-value =
0.033). Calcium ionophore group showed statistically significantly higher pregnancy rate than No Calcium ionophore group.
Conclusion: In conclusion we found that using calcium ionophore in cases of recurrent ICSI failure increases the fertilization
rate, pregnancy rate with enhancement of embryos quality.
Keywords: ICSI; Assisted oocytes activation; Calcium ionophore
O bjective: To compare the pregnancy outcomes of singleton pregnancies in patients who have undergone fresh embryo
transfers in an IVF cycle to the patients undergoing Frozen Thawed embryo transfers.
Design: Retrospective cohort study
Setting: Department of Reproductive Medicine. Gunasheela IVF centre
Study period: January 2016 to December 2016
Patients: Women undergoing IVF/Intra cytoplasmic sperm injection(ICSI)
Exclusion criteria: Twin gestation, Donor embryo transfers, age >40 years
Results: Pregnancy rates in fresh and frozen transfers were comparable. The rate of abortions was seen to be as follows
in fresh and frozen transfer (13.36% vs8.75%). The rate of PPROM and preterm labour were 5.08 % vs 2.05%, 7.34% vs
3.42 % respectively. The incidence of IUGR was found to be lower in frozen thawed embryo transfers than fresh transfers.
The incidence of LBW and PIH was found to be statistically significant with P Value of 0.0076 and 0.0387 respectively. In
conclusion, singletons born after cryopreservation and thawing of embryos have a higher mean BW and gestational age than
those born after transfer of fresh-IVF and -ICSI embryos, and, correspondingly, their risk of LBW,PPROM & PTB is lower.
Discussion:
1. IVF outcomes are better in fresh versus frozen cycles among south Asian women.
2. Although there have been concerns about the impact of cryopreservation on the health of the children born, outcome data
after frozen ET have been reassuring.
3. Singleton pregnancies after the transfer of frozen thawed embryos were associated with better perinatal outcomes compared
to fresh IVF embryos.
4. Perinatal morbidity is higher in IVF pregnancies conceived after fresh ET compared with Frozen ET.
Biography
Dr. Smrithi D Nayak has completed her MBBS from JSS medical college and Post Graduation in Obstetrics and gynecology at the esteemed
Bangalore Medical College and Research Center, Bangalore. She has completed her Fellowship in Reproductive Medicine in 2017 from Gunasheela
IVF center, Bangalore India. Dr. Smrithi D Nayak has ample amount of experience in IVF and treating infertile couples. She has attended plenty
of National and International conferences and presented papers. She is a dedicated clinician and has performed numerous cases of Laproscopy,
hysteroscopy and oocyte pick up. She is well versed with the latest developments in the field of Infertility.
Success Rate of Trial of Labor after Previous Cesarean Section (TOLAC) and Determinant Factors
at Jimma University Medical Center (JUMC): A Prospective Longitudinal Study
Habtemu J. Hebo1 Ukasha A. Ambeto2 and Fitsum A1
1
Institute of Health, Jimma University, Ethiopia
2
Shashemene Referral Hospital, West Arsi zone, Ethiopia
V aginal delivery after previous one cesarean section (CS) for a non-recurring indication has been described as safe by
several authors. Encouraging the vaginal birth after CS has been considered a key method of reducing the cesarean
rate. Therefore, assessing rate of success and determinant factors is very important for counseling mothers while offering
option of TOLAC. A prospective longitudinal study was conducted from December 2017-July 2018 among 209 women with
one previous CS scar admitted to JUMC, Ethiopia. Trained midwives collected the data through face-to-face interview and
record review using pre-tested structured questionnaire and checklist respectively. Epidata was used to enter data and SPSS
was used for analysis. Logistic regression was conducted to identify factors associated with success of TOLAC. The success
rate of TOLAC was 133(63.6%) where most (112,[84.2%]) delivered by vaginal delivery, 16(12.0%) by forceps vaginal
delivery and 5(3.8%) by vacuum vaginal delivery. Indication for previous CS being CPD [AOR:0.36,95%CI(0.14,0.91)],
and mal-presentation [AOR:0.34,95%CI(0.12,0.94)] compared to NRFHR, < 2 years interval from previous pregnancy
[AOR:0.45,95%CI(0.22,0.91)] compared to ≥ 2 years, active phase of labor [AOR:2.42,95%CI(1.24,4.72)] and second stage
[AOR:4.55,95%CI(1.03,22.95)] compared to latent, and para-I [AOR:0.40,95%CI(0.20,0.78)] compared to ≥ para-II, were
determinants of success. The success rate of TOLAC was high in the study area and factors identified in this study should be
considered in selecting candidates for TOLAC.
Biography
Hebo has completed his MPH from Jimma University, Ethiopia. He is an academic staff of Jimma University. He has published more than 15 papers
in reputed journals and has been serving as a reviewer of Ethiopian Journal Health Sciences.