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The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) All about Women’s Health Paris, France, December 4-7, 2014 Abstract Book A comprehensive Congress fully devoted to clinical controversies, debates and consensus on a wide spectrum of topics in Obstetrics, Gynecology and Infertility The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Timetable Thursday, December 4, 2014 09:30-16:00 Pre Congress Workshop:  VITRIFICATION HANDS-ON WORKSHOP – OOCYTE AND EMBRIO VITRIFICATION  18:30-19:30 OPENING SESSION 19:30-20:30 NETWORKING COCKTAIL Friday, December 5, 2014 Hall A Infertility   08:30-10:00 Hall B  Fetomaternal INDUSTRY SYMPOSIUM  INDUSTRY SYMPOSIUM  See page 61 See page 62 INDUSTRY SYMPOSIUM See page 61 NON-INVASIVE PRENATAL TESTING (NIPT)  Hall E Free Communications MANAGING THE MENOPAUSAL SYMPTOMS INFERTILITY LABORATORY MISTAKES AND PATIENT SAFETY  HRT: WHO SHOULD BE TREATED?  FETOMATERNAL Poster Viewing 11:50-12:10 12:10-13:40 RISK MANAGEMENT IN IVF LABORATORIES  Hall D Gynecology Coffee Break 10:00-10:20 10:20-11:50 Hall C IFV Laboratory Workshop ANTI-MULLERIAN HORMONE (AMH) & INDIVIDUALIZED DOSING FOR OVARIAN STIMULATION FOR IVF  INDUSTRY SYMPOSIUM See page 62 IMPROVING EMBRYO QUALITY NEW COMBINATION IN THE AND SELECTION MARKET    GYNECOLOGY     Lunch Break 13:40-14:30 INDUSTRY SYMPOSIUM 14:30-16:00 STIMULATION OR MILD STIMULATION? INDUSTRY SYMPOSIUM  See page 63 See page 63 CONTROVERSIES IN IVF LABORATORIES PRACTICE I Coffee Break 16:00-16:30 16:30-18:00 TREATMENTS OF MENOPAUSE  GYNECOLOGY The Ovarian Zone Workshop: RECONSTRUCTING THE OVARIAN STORY: TOWARDS A NEW CLINICAL SOLUTION METHOD VALIDATION FETAL MONITORING CONTROVERSIES IN IVF LABORATORIES PRACTICE II MANAGING THE MENOPAUSAL SYMPTOMS INDUSTRY SESSION: ‘MEET THE EXPERT’ See page 64 Saturday, December 6, 2014 Hall A Infertility   08:30-10:00 Hall B  Fetomaternal PERICONCEPTIONAL MEDICINE: WHERE REPRODUCTIVE AND FETALMATERNAL MEDICINE MEET PRE-GESTATIONAL WEIGHT AND WEIGHT GAIN DURING PREGNANCY: AN OLD DILEMMA REVISTED THE UTERUS TRANSPLANTATION WORKSHOP- PART I PROGESTERONE SUPPORT DURING PREGNANCY THE UTERUS TRANSPLANTATION WORKSHOP PART II DECREASED OVARIAN RESERVE (DOR) TIME-LAPSE TECHNOLOGY POSTPARTUM HEMORRHAGE INDUSTRY LECTURE See page 65 See page 65 PRENATAL DIAGNOSIS OF MULTIPLE PREGNANCIES FREEZING GAMETE FOR FERTILITY PRESERVATION CMV SCREENING AND BEYOND  INDUSTRY SYMPOSIUM FETOMATERNAL Workshop in HPV and adolescence gynecology: HPV SCREENING GYNECOLOGY INDUSTRY SYMPOSIUM See page 65 HPV VACCINATION AND COMBINED PROTOCOLS  INFERTILITY OPERATIONS BEFORE IVF TREATMENT A MULTI-DIMENSIONAL GYNECOLOGICAL CARE OF ADOLESCENTS FETOMATERNAL CONTRACEPTION AND FAMILY PLANNING GYNECOLOGY     Coffee Break 16:00-16:30 16:30-18:00 OVARIAN CANCER Lunch Break 13:40-14:30 14:30-16:00 Hall E Free Communications Poster Viewing  11:50-12:10 12:10-13:40 Hall D Gynecology Coffee Break 10:00-10:20 10:20-11:50 Hall C Reproduction ENDOMETRIOSIS  Sunday, December 7, 2014 Hall A Infertility   08:30-10:00 CONTROVERSIAL ISSUES IN BASIC CLINICAL ASPECTS OF ART 2 PRENATAL DIAGNOSIS AND ULTRASOUND Hall C Free Communications GYNECOLOGY Coffee Break  10:00-10:20 10:20-11:50 Hall B  Fetomaternal NEW PARADIGMS IN PCOS BEWARE OF THE LAWYERS: ISSUES IN PERINATAL LITIGATION GYNECOLOGY     Abstract Book Table of Contents Welcome Letter 4 Invited Speakers 5 Oral Presentations 21 Posters 67 book only 153 Index 161 3 -3- The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Welcome letter Dear Colleagues, We would like to personally welcome each of you to the 20th COGI Congress in Paris, France.  As COGI continues to grow, the Organizing Committee is motivated to bring you current controversies we are facing today in gynecology, infertility and obstetrics. We would like to give you an idea of what you can expect and what we hope to achieve over the next few days. 150 invited speakers will debate, discuss and lecture in 5 parallel halls including the “Annual Robert G. Edwards Nobel Prize Laureate Lecture” which will be delivered in the opening session.  The program will also include a IVF Laboratory Workshop, Uterus Transplantation Workshop, and an HPV and Adolescence Gynecology Workshop. A total of 650 abstracts were accepted, out of which 100 were selected for oral presentation. The number of participants has grown to over 2,000 delegates.  21 pharmaceutical and medical equipment companies are sponsoring and/or exhibiting at the Congress. We thank each of you for attending the COGI Congress and for bringing your own expertise to our gathering. We are happy to be associated with you, as leaders in your communities, to teach and learn, and to pave the way to a better future in the field of Ob/Gyn. Sincerely, Zion Ben-Rafael, Rene Frydman, Bart C.J.M Fauser Congress Co-Chairpersons 4 -4- The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) All about Women’s Health Invited Speakers 5 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Notes 6 Abstract Book INVITED SPEAKERS ABSTRACTS Thursday, December 5, OPENING SESSION S01 THE RW GENOME, EPIGENETICS, EVOLUTION AND PREGNANCY J.A. Shapiro University of Chicago, USA 60 years of molecular biology have changed our view of the genome. Instead of a ROM (read-only memory), we now realize that the genome is a RW (readwrite) data storage system. The relevant discoveries included: (1) The elucidation of "natural genetic engineering”, biochemical systems responsible for genome changes at all levels of DNA structure; (2) The recognition of cells' ability to control genome function and expression by transcription factor complexes and epigenetic chromatin modifications. These discoveries allow us to see evolutionary processes as active cell-mediated changes to genome structure. Among the main agents of natural genetic engineering and inscription of epigenetic signals are viruses and mobile genetic elements, including retroviruses. Endogenous mammalian retrovirus has played a major role in placental evolution, and epigenetic regulation is key to understanding the development of the placenta and the embryo. The lecture will outline connections between molecular evolution science and real-world influences on fetal health. CAPSULE BIOSKETCH: James A. Shapiro, author of the 2011 book Evolution: A View from the 21st Century, is Professor of Microbiology at the University of Chicago. He has a BA in English Literature from Harvard (1964) and a PhD in Genetics from Cambridge (1968). During a postdoctoral at the Institute Pasteur in 1968, he established insertion mutations in bacteria. In 1969, he and colleagues at Harvard Medical School used in vivo genetic manipulations to clone and purify the lac operon. With Bukhari and Adhya in 1976, he organized the first conference on DNA insertion elements. In 1979, Shapiro formulated a molecular model for transposition. In 1984, he showed that selection stress triggers transposon action. Since 1992, he has been writing about the importance of biologically regulated natural genetic engineering. READINGS: Shapiro, J.A. 2011. Evolution: A View from the 21st Century. FT Press Science. Shapiro JA 2013. How Life Changes Itself: The Read-Write (RW) Genome. Physics of Life Reviews 10:287-323. Friday, December 5, Hall A S02 CAN AMH PREDICT PREGNANCY RATES BETTER THAN OTHER MARKERS? S. Nelson University of Glasgow The age-related decline in oocyte quantity and quality underpins the decline in success rates and prospect of live birth after assisted conception with advancing maternal age. Age alone however is of limited accuracy in predicting live birth; thus there is a need for improved prediction. The substantial heterogeneity in the size of the ovarian reserve at any given age results in marked inter-individual variation in ovarian response despite optimal ovarian stimulation. Analysis of this heterogeneity may provide insights into understanding individual fertility and how it changes with age, and it is also a likely source of clinically useful biomarkers. A variety of ovarian reserve tests have been developed and their predictive capacity for ovarian response examined. In recent systematic reviews, individual patient data meta-analysis and international multicentre trials, antiMüllerian hormone (AMH) has been confirmed as the current best biomarker for prediction of oocyte yield and poor and excessive ovarian response. Given the strength of the relationships with oocyte yield, the association of AMH with pregnancy after assisted conception has been examined, but results have been inconclusive. Some studies have concluded that AMH is not associated with pregnancy while others have found a positive association. An individual patient data meta-analysis in 1008 patients undergoing fertility treatment demonstrated a weak association of AMH with ongoing pregnancy. To further clarify the role of AMH for prediction of live birth we undertook a meta-analysis of 6306 women. This suggested that although AMH has some association with predicting live birth independent of age in women undergoing IVF, its predictive accuracy was poor. Consequently given this poor diagnostic accuracy for live birth we suggest that it should not be used to exclude couples from IVF/ICSI based on a low AMH. In addition, these data do not justify adoption of an AMH threshold for access to such treatments and further studies are needed to investigate whether a universal AMH threshold is possible, or appropriate. S03 IS LOW INTENSITY ("MILD" OR "MINI") OVARIAN STIMULATION PREFERABLE? NO N.H. Zech IVF Centers Prof. Zech, Bregenz, Austria The main argument for mild stimulation is that it requires relatively low doses of hormones. Thereby the likelihood of the occurrence of side effects is thought to be reduced. Additionally, per stimulation cycle, the costs for medication are lower as compared to classic stimulation protocols. This is said to reduce overall costs per treatment. The terms “mild”, “light”, “soft”, “mini” or “low-dose” stimulation are usually used synonymously and express that only few follicles should grow resulting in few, mostly not more than 1-3 oocytes per ovarian pickup (OPU). However, with such low numbers of oocytes, several cycles are likely to be necessary to achieve one live birth. Concluding, overall costs per baby will accumulate with the number of stimulation cycles and OPUs needed due to physics of nature. In contrast, when applying conventional ovarian stimulation protocols followed by single embryo transfer (SET) at the blastocyst stage in combination with optimal aseptic vitrification protocols (e.g. Vitrisafe), we may expect the birth of several consecutive babies per OPU. To minimize the risks and inconvenience of OHSS, a primary embryo transfer in a consecutive cryo-cycle is nowadays regarded as the best option without compromising pregnancy rates. In this regard our target should be to reach the highest possible individual EGP (expected gametes performance) for the couples in means of obtaining several good quality blastocysts after only one stimulation cycle. To reach this goal, we need a good number of oocytes to work on the target EGP. With this in mind we have to ask following question: what is the least harmful and most cost effective approach for patients? Several mild stimulation cycles to obtain one baby, or one classical stimulation cycle with a high probability to obtain more than one child, one at a time. S04 MITOCHONDRIAL REPLACEMENT THERAPY. A. Murdoch Newcastle Fertility Centre at Life, UK It is important at the start of this review to be clear about the scope and limitations of the procedures that will be described. Firstly, these are techniques that are being developed to help women who carry abnormal mitochondrial DNA. It is not a technique that is relevant to the subfertile population as there is no evidence that mitochondrial abnormalities are related to fecundity. Secondly, at the time of writing, mitochondrial replacement is not a legal therapy in the UK. The work that is described relates to basic research although the current legal and ethical debate will be summarised. The required Regulations in the UK have been prepared but are still subject to Parliamentary debate. Mitochondria within the cytoplasm provide the energy required for normal cell function. Each cell in the body may contain up to several thousand mitochondria depending on the energy requirements of that cell. The mitochondria contain DNA (mtDNA) which contain 37 genes (0.01% of the total DNA in cells). Unlike nuclear DNA, the mtDNA is inherited entirely through the maternal line. 1 in 6500 children will inherit significantly abnormal mtDNA. Most individuals are homogeneous for normal mtDNA, some carry mostly abnormal mtDNA and some are heterogenous. The phenotypes associated with abnormal mtDNA are highly variable because there may be different proportions of abnormal mtDNA in different cells. Thus an apparently healthy woman may 7 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 have a very high risk of passing abnormal mtDNA to her child if there is a high number of abnormal mtDNA in her oocytes. Disorders caused by mutated mitochondrial DNA are progressive and can appear at any time from birth onwards. The spectrum of associated health problems includes heart and other major organ failures, stroke, dementia, blindness, deafness and premature death. There is currently no cure for disorders related to abnormal mtDNA. It is not surprising therefore that the leading supporters of the research to develop mitochondria transfer techniques are the patient groups. The current fertility options available for this patient group include remaining childless, adoption, egg donation or PGD. Any future therapy will be placed alongside these options. The techniques being developed use the skills and knowledge acquired from the clinical and research studies within the IVF setting to help those with abnormal mtDNA. A simple description of the technique is that an egg is donated by a healthy woman, her nuclear DNA is removed and replaced with the DNA from the egg of the patient with abnormal mtDNA. This could be done before or after fertilisation. The optimal technique is still to be determined. Studies to develop these techniques have been ongoing for over 10 years. They have been shown to be successful in producing live mice. Others have carried out the techniques successfully in primates. Translating this to humans has been more complicated because of the relatively poor reproductive potential of humans and the ethical and legal considerations. Our studies using abnormally fertilised human oocytes (from the IVF clinic) confirmed the ‘proof of principle’ of the procedures e.g. the low mitochondrial carry over and potential for onward development of reconstructed embryos. This work is ongoing using eggs donated by healthy volunteers and aims to optimise the techniques and evaluate the subsequent embryo quality. A more detailed review of the mitochondria and the relevant research is given in the HFEA Scientific Reviews Alongside the scientific development of the techniques, there is a need to engage the public, the legislators and the regulators. There are several issues that are raised. The ethical issues were more widely discussed in the Nuffield Council Report. A summary of their main areas for consideration is given below. Implications for identity: whilst nuclear DNA clearly relates to individual identity, the role, if any, of mtDNA is debatable. It is arguable that our health (or unhealth) is a determinant of identity. Germline therapies: since the transferred normal mitochondria are passed on to the next generation, this is germline therapy. Whilst clearly unacceptable for nuclear DNA, this is arguably the desired benefit for families who carry abnormal mtDNA. The introduction of novel techniques and follow-up of children: Whilst it is obviously vital that the outcome of these techniques is monitored over future generations, this in itself presents ethical problems. Parentage of the child: the significance of mitochondrial donation techniques in the biological, social and legal context of the relationship between the donor and the child requires consideration. The status of the mitochondrial donor: there are practical issues relating to the regulations in the UK about egg donation that have ethical considerations e.g. should the donor remain anonymous? Implications for wider society and future generations: If there is concern about future generations, the techniques could be limited to the birth of boys only. This would resolve one problem whilst introducing others. In the UK, the HFEA carried out a public consultation and subsequently the government has responded. In addition the HFEA has carried out a further Scientific Review of the procedures in 2014. As a result of this, the UK government is preparing Regulations that, if approved, would permit these techniques to be licensed by the HFEA for treatment if the HFEA consider that this scientific evidence supplied with an application is acceptable. In anticipation of the debate on Regulations, Parliament is being briefed. The UK is not the only country working on these techniques but it is leading on the regulatory and ethical issues. It is hoped therefore that when the scientific evidence is compelling, there will be no barrier to translating this into treatment. The research in Newcastle is supported by The Wellcome Trust 8 Friday, December 5, Hall B S05 EFFECT OF PRE-PREGNANCY WEIGHT AND GESTATIONAL WEIGHT GAIN ON THE INCIDENCE OF PREECLAMPSIA AND GESTATIONAL DIABETES Natasa Tul, MD, PhD1 ; Miha Lucovnik, MD, PhD1; Isaac Blickstein, MD2; Lili Steblovnik, MD1; Ivan Verdenik, PhD1; Andreja Trojner Bregar, MD1 , Vesna Fabjan Vodušek MD1 1Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Slovenia; 2Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, affiliated with the Hadassah-Hebrew University school of Medicine, Jerusalem, Israel Number of obese women of reproductive age is increasing. These women are at increased risk of several pregnancy complications, among which preeclampsia and gestational diabetes mellitus (GDM). Excessive gestational weight gain has also been demonstrated to be associated with an increased risk of both preeclampsia and GDM. It is important, however, to differentiate between the effect of pre-pregnancy body mass index (BMI) and gestational weight gain on the incidence of these two conditions, since weight gain is amenable to interventions during pregnancy while high pre-pregnancy BMI is not. Conclusions of two studies on Slovenian population of pregnant women are that pre-pregnancy BMI is strongly associated with preeclampsia and GDM in both twin and singleton pregnancies. Gestational weight gain is also associated with risk of preeclampsia, although seemingly less so than pre-pregnancy BMI. Smaller gestational weight gain noticed in patients with GDM may reflect the importance of dietary counseling after GDM diagnosis. References Lucovnik M, Blickstein I, Verdenik I, Trojner-Bregar A, Tul N. Maternal obesity in singleton versus twin gestations: a population-based matched case-control study. J Matern Fetal Neonatal Med. 2014 Lucovnik M, Blickstein I, Verdenik I, Steblovnik L, Trojner Bregar A, Tul N. Impact of pre-gravid body mass index and body mass index change on preeclampsia and gestational diabetes in singleton and twin pregnancies. J Matern Fetal Neonatal Med. 2014 Friday, December 5, Hall C S06 PERSONAL QUALIFICATION AND COMPETENCY MAINTENANCE V. de Larouziere, Hôpital Tenon, France IVF laboratory work requires high precision and technology. Therefore the personal qualification and competency maintenance according to ISO 15189 is a major subject in an ART laboratory. Then 3 different aspects have to be defined: -the personnel concerned (embryologists, biologists, technicians, trainees), -the critical activities in laboratory work -qualitative and quantitative criteria of personal competency for these activities, Finally, once a person is qualified, his competency has to be maintained (internal and external evaluation programs...). All the criteria will be defined according to the 15189 requirements and the embryologist experience. S07 FRANCE ORGANISATION: AMP VIGILANCE G. Lemardeley, J-O Galdbart; F. Merlet, D. Royère France organisation : ART vigilance Introduction: In France, ART (assisted reproductive technology) vigilance is a recent mandatory vigilance system which has been set up to monitor adverse reactions and adverse events in the field of reproductive cells (eggs, sperm) and reproductive tissues, in order to improve safety and quality of the practices. The whole system became fully operational in June 2008 through a ministerial decree, after the transposition of the European directive, i.e. Directive 2004/23/EC of the European Parliament and of the council of March 31, 2004 which set standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells. Abstract Book The "Agence de la biomedecine" (ABM) is responsible for the management of this system at the national level. Material and methods: In France, a total of about 200 ART centres are spread all over the country. These centres develop clinical and/or laboratory activities in the field of ART. Each center must appoint a local correspondent for ART vigilance. Up till now, 96 % of the ART centres have appointed one correspondent. The correspondent should carry out specific tasks particularly to report all ART adverse reactions and adverse events to the “Agence de la biomedecine” and to coordinate the investigations. Each reported incident is analyzed on the basis of its seriousness and frequency. An assessment is carried out by the “Agence de la biomedecine” with ART external experts to evaluate the impact in terms of safety at the national level. Based on the assessment results, the ABM develops specific actions to inform health professionals and recommends corrective measures when necessary. France took part of the two European projects funded by the European commission, Eustite and Soho whose aim was to define standardization and common tools in the fields of biovigilance, ART vigilance and inspection throughout European countries. Results: In 2013, a total of 469 notifications have been reported to the "Agence de la biomedecine" by the ART centres. Among these 469 incidents, 107 adverse events and 362 adverse reactions were reported by 86 centres. Nearly 80 % were serious incidents. The average time of notification to the agency is about 2 months. Most of the adverse reactions were related to an ovarian stimulation. Among reported cases, we observed ovarian hyperstimulation syndrome which accounted for around 50 % of the notifications, thromboembolic accidents, adnexal torsions, surgical or anaesthetic complications, or infectious events. Most of the adverse events were related to the loss of gametes or embryos at different stages of the process. Those events were most often linked to a human error or an equipment failure (ex: misidentification, fall of the culture dish…) or in some cases, to an environmental problematic (ex: contamination of cultures...). Part of the reports collected through the ART vigilance system also concerned other vigilance systems (pharmacovigilance, medical devices vigilance, biovigilance). Conclusion: ART vigilance is a new regulatory vigilance that contributes to enhance the quality of care for patients who need assisted reproductive technology. This system should be coordinated with other vigilance systems in order to increase its efficiency both at the national and the European levels. Feedback to the ART professionals is essential to develop the system in a confident way. Further cooperation through EU member states should be developed. S08 HOW TO AVOID LABORATORY MISTAKES? R. Lévy Service d’Histologie-Embryologie-Cytogénétique-CECOS, Hôpital Jean Verdier (AP-HP), Bondy, France; Service de Médecine de la reproduction, Hôpital Tenon, 4 rue de la Chine, 75020, Paris (AP-HP), France According to European and national guides and recommendations (Guide for good analysis (GBEA), rules of good practice for ART (arrêté du 3 août 2010 modifiant l'arrêté du 11 avril 2008), transposition of European standard (décret n°2008-588 du 19 juin 2008), report form for ART vigilance (arrêté du 18/12/2008), Accreditation ISO15189, risk assessment) and specific recommendation from Biomedecine Agency Director (14/01/2010), centres must have in place continuous quality improvement with robust and effective processes to ensure that no laboratory mistakes occur, including misidentifications of gametes or embryos or identification errors. Centres must carefully check the identification of all samples and the patients, or donor, to whom they relate at all critical points of the clinical and laboratory process. These checks must be completed and recorded at the time of the relevant clinical or laboratory process/procedure takes place. A record must be kept in each patient’s/donor’s medical record. Manual double witnessing (MDW) for all IVF laboratory processes involving gametes or embryos has been mandated by HFEA to reduce the risk of misidentification of patient samples. Electronic witnessing systems to track samples at predefined procedural steps in IVF laboratories worldwide to prevent mix-ups and provide an automated solution for mandatory double-witnessing are now available, using for example Radio Frequency Identification (RFID) technology. Clinical and laboratory procedures: The identified critical steps are: - Collecting eggs: pick up and retrieval, collecting sperm / surgical spermatozoa, preparing sperm - Mixing sperm and eggs or injecting sperm into eggs, transferring gametes or embryos between tubes or dishes, embryo transfer and intra uterine insemination with sperm prepared in the laboratory - Freezing gametes or embryos and placing gametes or embryos into cryopreservation container - Removing gametes or embryos from cryopreservation and thawing - Disposing of gametes or embryos, transporting gametes or embryos - Centres performing embryo biopsy should have protocols in place to ensure that embryos and the material removed from them for analysis are labeled Keeping a record: The checking of identifying samples, patients and donors should be recorded, the record stating: - The control check (name, first name, birth date), the date and time of the check, the signature of the person doing the check - If available, the signature of the witness or patient (sperm sample) Training: centres should have an induction programme for new staff to ensure they understand the principles of check and follow the centre’s protocol. Staff should also receive refresher training as the centre decides is appropriate. Interruptions and distractions in the clinic and laboratory: the centre should consider the implications of distractions in the clinic and laboratory, such as from phones and external noise, and ensure they are minimized. Interrupting and returning to a task is a common source of human error. In case of laboratory mistake, a clinic-biological staff will analyze each situation (risk analysis, corrective action, and eventual procedure optimization) and a statement to Biomedecine Agency will be addressed. Conclusion: strict procedures must be implemented to avoid laboratory mistakes, part of accreditation. Identification mismatches reflect the specificity of ART procedure (couples, gametes, embryos, and donor). In case of rare bur inevitable error, there is a clear need for transparency. S09 IMPROVING EMBRYO QUALITY AND SELECTION - EMBRYOS GROUPING TO IMPROVE DEVELOPMENT R. Lévy1, 2, P.-Villard2 1 Service d’Histologie-Embryologie-Cytogénétique-CECOS, Hôpital Jean Verdier (AP-HP), Bondy, France; 2Service de Médecine de la reproduction, Hôpital Tenon, 4 rue de la Chine, 75020, Paris (AP-HP), France Embryo culture conditions are key determinants of ART procedures efficacy. In routine IVF procedures, droplets of medium may contain one or more than one embryos, depending on the embryologist’s choice or specific requirements such as mandatory individual embryo traceability: e.g. PGS/PGD procedures, timelapse embryo development analysis, research protocols). The latter is generally referred as individual embryo culture, whereas cultivating more than one embryo in one drop is referred as group embryo culture. It has been hypothesized that preimplantation-stage human embryos were able to produce and secrete trophic factors into their culture medium. Candidates factors include several embryotrophic ligand with mitotic stimulating abilities, such as PAF or IGF1 and IGF2.The possibility that these factors could act in a autocrine/paracrine way has led to the hypothesis that cultivating more than one embryo in the same drop of media or reducing drop volume could improve in vitro embryo development and consequently IVF procedures outcomes. On the other hand, increasing embryo density by multiplying the number of embryo in one drop or by diminishing drop volume could result in a potentially harmful accumulation of toxic substances such as ammonium or oxygen derived free radicals in the vicinity of the embryos, which could in return negatively influence IVF outcomes (Virant-Klun et al., 2006). Ultimately, the use of such trophic agent in embryo culture could improve IVF outcomes (Jin et O’neill 2014). Animal models suggested an increased blastocyst development when group culture is applied. Group culture at an optimum density of 9 murine embryos in 50µl droplets of volume media was superior in terms of blastulation rate and good quality blastocysts number to individual embryo culture or group culture 9 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 with greater or lower embryo density (Dai et al 2012). Interestingly, when individual embryo culture was considered, a significant increase in blastocyst quality was found when embryos were placed in a microwell carved on the bottom of the Petri dish, although it was not the case for group culture embryo. The same modified microwell dishes were used to evaluate the effect of embryo density on in vitro development and gene expression in a bovine model (Sugimura et al 2013). An optimal density of embryo for blastocyst formation was described and differential expression of IFN tau and IGF2R gene was reported. In the group of maximum embryo density and blastocyst formation, these two genes were respectively up and down regulated compared to a group with less embryo density. These results were not reproduced when embryo where cultured into microwell. Animal models suggest that an optimal embryo density exist and that microwell culture could rescue the detrimental effect of an eventual suboptimal embryo density, possibly by concentrating autocrine factors around the developing embryo. However, no significant statistical differences in terms of in vitro embryo development or pregnancy rates were initially found in prospective human studies. These results, and the fact that individual culture allows individual assessment and embryo traceability, explain the popularity of this practice among ART facilities. In a recent randomized prospective study (Ebner et al 2010) including 936 zygotes from 72 patients, Ebner and colleagues were able to demonstrate a statistically significant improvement in compaction and blastulation rates, as well as blastocyst quality, when group culture in sequential medium was applied. Ultimately, the fact that the best in vitro embryo development occurred in the subgroup of maximum embryo density and contact raises the question of a possible beneficial physical effect of close vicinity between embryo such as optimum space between embryo, or even mechanical interaction between embryos in the same droplet. Such optimal space between embryos has previously been described in bovine model (Gopichandran and Leese, 2006) and a beneficial effect of mechanical stimulation of embryo during in vitro culture has recently been demonstrated (Isachenko et al 2011) Grouping 2 to 5 embryos in 50µl droplets from day 3 today 5/6 after individual culture from day 1 to day 3, (Tao et al 2013), the authors found a significantly higher blastulation and blastocyst utilization rate when good and poor morphological quality day 3 embryos were separately grouped, compared to random grouping, regardless of embryo quality. An Italian team (Restelli et al 2014) recently tried to improve Ebner’s group culture strategy by grouping good quality zygotes in separate drops from morphologically non-optimal zygotes. They compared pronuclear morphology based grouping versus random zygotes grouping in an observational time-course study. As previously described, blastulation rate was higher when symmetrical zygotes were grouped together, compared to unsymmetrical ones. But surprisingly, significantly better clinical outcomes were observed after fresh blastocyst transfer in the « random » zygote grouping cohort (n=594) compared to the other cohort where grouping was based on pronuclei morphology (n=649). Interestingly, the mean number of zygotes per drop was significantly lower in the latter cohort (2,9+/-0,9 Vs 3,3+/-0,5, p<0,001), due to the selection process. The underlying mechanisms of embryo cross talk are largely unknown, even if previously described trophic factors have been identified. Recently, it has been suggested that human embryo could secrete miRNAs into culture media, and that their differential expression could be related to implantation potential of the embryo (Rosenbluth et al, 2014) Exosome/microvesicles could also play a part in paracrine regulation of embryo development. The fact that exosome can be associated with RNA molecules and be incorporated into porcine embryos open new perspectives for embryo group culture methods (Saadeldin et al 2014). To conclude, even though it has to be confirmed by prospective randomised clinical trials, these recent findings may indicate that embryo density or proximity rather than embryo quality may influence IVF outcome when considering group culture, especially in blastocyst transfer programs. Finally, large scale multicentric prospective studies should be promoted to better understand the influence of culture conditions on IVF conceived children’s health. 10 S10 SPERM DNA DAMAGE: NEW STRATEGIES OF INTERVENTION BASED ON INDIRECT ANTIOXIDANTS M. Dattilo1, M. Cohen2, Y. Menezo3 1Parthenogen, Via F. Pelli 1, Lugano 6900, Switzerland; 2Procrelys Association de recherche en Infertilité, Lyon 69008, France; 3Laboratoire Clément, 17 avenue d’Eylau, Paris 75016, France Problem statement: Sperm chromatin structure is often impaired by oxidative damage and has been related to poor reproductive outcomes in both natural and assisted reproduction. We aimed to test a new intervention based on the administration of indirect antioxidants acting within the frame of cellular homeostasis1. Methods: 84 male partners of couples with at least 2 ART failures (range 2-6, mean 2.4) and with a sperm DNA fragmentation index (DFI) and/or a sperm nuclear decondensation index (SDI) > 20% were recruited irrespective of their spermiogram (1 out of 4 normospermic) and of female factors (present in 28 out of 84). They took a 4 month nutritional support with indirect antioxidants in preparation of a new ART attempt. The support contained a methyl donor (folic acid) to feed transmethylations, a cysteine donor to feed GSH synthesis and all the rate limiting co-factors for the concerned enzymes (Vit. B2, B6, B12, zinc). The product of concern, CondensylTM, also contained small amounts of Vit. E and of quercetine and betalaines. The DFI was measured by TUNEL and the SDI by blue aniline staining both before and after the treatment. Results: 18 out of 84 couples experienced a spontaneous pregnancy and a live birth before the time for the planned ART. The remaining 66 couples underwent ART (4 IUI; 18 IVF; 44 ICSI) resulting in 22 further clinical pregnancies and 15 live births. The positive pregnancy outcome was related to the decrease of the SDI. DFI and SDI response according to the occurrence of a clinical pregnancy, mean values DFI Groups n (%) % Pre Post change Any pregnancy 40 YES 29.4% 20.1% -9.3% (47.6) 44 NO 30.1% 25.9% -4.2% (52.4) Spontaneous pregnancy 18 YES 23.2% 18.4% -4.8% (21.5) 66 NO 31.5% 24.4% -7.2% (78.5) ART pregnancy 22 YES 34.4% 21.4% -13.0% (33) 44 NO 30.1% 25.9% -4.2% (67) SDI p Pre Post % change p 0.168 40.6% 39.6% 29.3% 42.6% -11.3% 3.0% 0.000 0.571 44.8% 38.8% 29.8% 38.0% -15.0% -0.7% 0.000 0.046 37.2% 29.0% -8.2% 0.001 39.6% 42.6% 3.0% Mann-Whitney test Conclusion: Nutritional support with indirect antioxidants (Condensyl) may improve the clinical outcomes in couples infertility due to a male factor. The Abstract Book strong correlation between the pregnancies and the SDI decrease supports a positive effect on the sperm chromatin architecture. 1Dattilo et al. Reproductive Biology and Endocrinology 2014, 12:71 S11 DO WE GO DIRECTLY TO BLASTOCYST WITHOUT CLEAVED EMBRYO EXAMINATION? G. Cassuto Art Unit, Drouot Laboratory, Drouot Street, Paris, France. At the beginning we thought that embryo culture must mimic the nature with the sequential media systems. Today most of IVF center have evolved in their practice from sequential to one single step culture medium. Let the embryo choose and select which nutrients it needs to metabolize. Let it eat all it can.Going ahead we decide to put all the embryos together in the same culture media and in the well dish. We present here a comparison of blastocyst rates, which were grown in a same CSC media (Irvine Scientific) but with a follow up and different culture conditions. The study included in 2014, 20 couples programmed for ICSI or IMSI with 8 and more oocytes. Sibling injected oocytes were randomly split between Galaxy (Group 1) and Miri incubator (Group 2); cultured for the two groups in 250 µl CSC medium + 10% SSS covered with 150 µl mineral oil. The Group 1 was performed in 6% CO2, examined at day 1 to assess fertilization, cleavage, embryo quality and transferred to fresh media on day 3. In opposite Group 2 was in static environment, reduced oxygen 5%, 6% CO2 and 89% N2; without examined microscopically, without any change and medium renewal and without any disturbances. We previously calculated during 2 years the triploids number after injection: 4 out of 13 886 injected oocytes were triploids (0.0003%) and the ammonium levels in the presence of embryos did not compromise their development. The blastocyst rate between the Group 1 and 2 show a statistically significant difference: 34 out of 141 (24%), and 55 out of 138 (40%), respectively. (p< 0.04; chi square= 4.12) Several factors affect the morpho kinetics of the embryo development and the blastocyst rate is dependent on the in-vitro culture environment. Do not disturb them! S12 DO WE GO DIRECTLY TO BLASTOCYST WITHOUT CLEAVED EMBRYO EXAMINATION? I. Koscinski Laboratory of Biology of Reproduction, CHRU Strasbourg, CMCO, 1 place de l’Hôpital, 67000 STRASBOURG, FRANCE. Pregnancy results of implantation of a normal embryo in an appropriate endometrium. The morphology of the embryo is historically a usual method to appreciate the evolutive parameter. The high miscarriage rate observed after ART has been largely explored and partially explained by the DNA state of the embryo. Several studies have demonstrated that chromosomal abnormalities are one of the most common causes of abnormal embryos in IVF, and PGS is probably the most effective method to selection normal embryo (s). When this practice is forbidden as in France, some other tools have been developed to explore the embryo DNA and try to select the embryo(s). On the other hand, the transfer of a vitrified embryo offering the same chances of pregnancy as the transfer of a fresh embryo, the risk of no transfer of a normal embryo of the cohort is reduced. Of course, this theoretical consideration should be modulated by the emotional impact for the couple exposed to the attempt failure and by the cost of frozen embryo procedures. That is why the embryo culture to blastocyst stage is regularly used as selection tool of normal embryos even if a recent study showed around 45% of blastocysts with aneuploidy. In this context, it is of the greatest importance for the ART lab to offer the best culture conditions, ensuring the best embryo development. The daily human observation of embryos as practiced in a lot of ART labs unequipped with a Time-lapse system is limited since the embryo morphology is linked to its kinetics which is affected by the culture conditions. Animal studies highlighted that culture conditions can affect pre and post natal phenotype. As already exposed, all culture conditions like hypoxia, PH, temperature, light result in a culture system impacting on the blastulation rate. We expose here another important condition of the human embryo culture system: the culture medium. Two types of media are available: single media used for the whole culture or sequential media whose composition varies according with the stage of embryo development. Material and methods: The prospective study reported here compares embryo development obtained in 300 couples either with a unique medium (Global ®, Global life, JCD) either with sequential media of the COOK company (5 different media from the Gamete Buffer ®, to the Blastocyst Medium ®). Inclusion criteria were the first and second attempts at IVF, ICSI or IVF half - half ICSI performed in couples where women were under 37 years. Elective transfer of an embryo was systematic at Day3 stage as well as at blastocyst stage. Exclusion criteria were couples beneficing of a pre- implantation genetic diagnosis or a oocyte donation. In addition to pregnancy rates and embryo freezing at day 3 and at day 5, we focused our attention on development events like compaction of embryos on Day3 and embryo kinetic. The recording the birth weight in each group is still in progress. Results: no difference in the pregnancy rate per retrieval and transfer between the two groups: 39.6% per oocyte retrieval and 49.6% per transfer (of fresh or frozen embryo) in the Global ® group and 44.5% per oocyte retrieval and 51.2% per transfer of a fresh embryo or 53% per transfer of a frozen embryo in the sequential group. We observed more good quality embryos, a greater blastulation rate and we froze more blastocysts in the group of sequential media. The kinetics of early embryo development was significantly accelerated with the Global® medium: 28% of embryos with more than 8 cells J3, versus 17% with the sequential media. The embryos are more frequently compact J3 in the Global ® group (16% versus 10%). It is still too early to compare the birth weight in both groups since a lot of pregnancies obtained after transfer of frozen embryo are still ongoing. The results will be compared with the literature, pointing the impact of media culture as well as other in vitro culture conditions affecting the embryo development in the pre-implantation, post-implantation and post natal stages. Friday, December 5, Hall D S13 PHARMACEUTICAL INTERVENTIONS AT THE TIME OF THE MENOPAUSE THAT REDUCE THE INCIDENCE OF BREAST CANCER. M.P. Brincat, A. Calleja J, M.F.J. Brincat, J. Gambin Dept of O&G, Mater Dei Hospital, Malta. Breast cancer is the most frequently diagnosed cancer in women in both developed and developing countries. In this regard, the identification of primary chemoprevention strategies targeting breast cancer is an important priority in healthcare. Chemoprevention refers to the use of agents, both pharmacologic and natural, with the aim of inhibiting the development of invasive breast cancer. This may be achieved either by blocking an existing carcinogenic mutation, or through the reversal of any cellular oncogenic processes. This can permit the development of therapeutic agents aimed at preventing cancer in individuals, either before having any encounter with cancer (primary chemoprevention), or else to prevent recurrence of a previous instance of cancer (secondary chemoprevention). Overall evidence points to accumulation of risk through the life course. Selective estrogen receptor inhibitors (SERMs) may offer potential to inhibit the final stages of progression to cancer, with prevention being greatest among those with high estrogen levels. There is evidence that lifestyle contributes to cumulative risk. Other forms of medication ranging from Asprin to Vit D have also been suggested as agents that reduce the incidence of breast cancer. Aromatase Inhibitors have been shown to also be useful in this regard. In conclusion, although there is no one single intervention which, in isolation, will prevent breast cancer, there is much that can be done to reduce its incidence, and strategies to ascertain just by how much and which therapeutic maneuvers are necessary and when, are being established. 11 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 S14 BENEFICIAL ACTIONS OF PROGESTERONE INCLUDING ON THE BRAIN R. Sitruk-Ware1, N. Kumar1, M. El-Etr2, M. Schumacher2 1Population Council and Rockefeller University, New York, and 2INSERM 788, University Paris-Sud 11, Kremlin-Bicêtre, France Progesterone is a steroid hormone essential for the regulation of reproductive function. The natural hormone has been approved for contraception during lactation, maintenance of pregnancy, and prevention of premature labor. Progestogens including natural progesterone and synthetic progestins have been approved for a number of indications including the treatment of an ovulatory cycles, and, when combined with estrogen, for contraception, and the prevention of endometrial hyperplasia in hormonal replacement therapy (HRT). There is strong evidence of specific differences between natural and synthetic molecules without any progestin class-effect, with regard to beneficial or adverse effects. In addition to its main role in reproduction, progesterone regulates a number of biologically distinct processes in other tissues, particularly in the nervous system. Recently, we showed in animal experiments that progesterone and the synthetic progestin Nestorone®, trigger neuroregeneration and brain damage repair, as well as myelin repair. In addition, both progesterone and Nestorone were shown to promote the remyelination of axons by oligodendrocytes after demyelination in mouse models. Also, Progesterone and Nestorone induced positive effects on hippocampal neurogenesis and cell viability, leading to possible memory benefits. These protective effects were mediated via progesterone receptors (PR). Thus progestins such as Nestorone which target PR with high specificity may prove useful to promote myelin regeneration and open new therapeutic options for women with multiple sclerosis or other neurodegenerative disorders. The potential benefits of natural progesterone and its related derivatives warrant further investigation and may lead to better future therapies for men and women. S15 HORMONE THERAPY AND FRACTURE R.D. Langer University of Nevada School of Medicine,Las Vegas, USA Throughout the world, postmenopausal fractures due to osteoporosis, particularly hip and vertebral fractures, are a major cause of morbidity, with a high rate of accelerated downstream mortality. In the U.S., a woman's risk of hip fracture is equal to her combined risk of getting breast, uterine and ovarian cancer. Hip fracture is not a trivial event, approximately 1 in 4 hip fracture patients over the age of 50 die in the year following the fracture. Hormone therapy promotes both preservation of bone, and increases in bone density, in a physiologic manner. Clinical trial evidence demonstrates that Hormone Therapy (HT) is effective in reducing fracture rates in postmenopausal women. The most definitive evidence comes from the Women's Health Initiative (WHI) clinical trial. In contrast to the populations studied in most clinical trials of interventions to prevent fractures, participants in the WHI hormone trials were not selected for increased fracture risk. And, because their average body mass index was somewhat higher than average for women of similar ages worldwide, their baseline fracture risk was lower. Nonetheless, even within that more challenging design, the WHI demonstrated significant reductions in hip, wrist, vertebral and total fractures. Other clinical trials have demonstrated significant improvements in bone mineral density (BMD) in women taking HT, and increased BMD correlates strongly with reduced fracture risk. However, in the aftermath of the early stopping of the WHI for a marginal increase in breast cancer and a lack of coronary benefit – driven by the fact that the average participant was more than a decade past menopause – there has been a dramatic shift away from the use of HT for the prevention of osteoporosis, although it remains licensed for this indication in most countries. Longitudinal studies conducted since the end of the WHI clinical trials have demonstrated that the flight from HT has been associated with a reduction in 12 BMD and an increase in fractures, including the most devastating type, hip fracture. As these trends have become more obvious, major professional organizations, including the International Menopause Society and the North American Menopause Society have published recommendations supporting the use of HT for the prevention of osteoporosis, particularly in women below the age of 60. While other therapeutic modalities are also available, including bisphosphonates, HT remains an important option. The World Health Organization Fracture Assessment Tool, known as the FRAX, is a simple and critically important element in the assessment of disease risk in postmenopausal women. Versions optimized for most nations are available online. FRAX assessments should be conducted for all menopausal women and appropriate interventions, potentially including HT, should be initiated for any woman with risk above the intervention threshold. S16 WHY DON'T WE GIVE COC USERS THEIR ANDROGENS BACK?" R.H.W. van Lunsen*, E. Laan*, X.Y Zimmerman**, H.J.T.Coelingh Bennink** *Dept Sexology & & Psychosomatic Ob/Gyn, Division Obstetrics & Gynaecology; Academic Medical Center, University of Amsterdam, ** Pantarhei Bioscience, Zeist, The Netherlands. In women androgens, and especially testosterone (T), are not only essential for the sensitivity for sexual stimuli and some other aspects of sexual functioning, but for general wellbeing and long-term general health as well (Davis 2013). Treatment with testosterone of perimenopausal women with low levels of free testosterone significantly increases sexual desire, orgasm frequency and sexual pleasure. Nevertheless, studies on the relationship between androgen levels and sexual functioning in women show contradictory results. The main explanation for the absence of evidence is that the effects of androgens on sexuality are rather discrete. In general, androgens do not directly influence sexual responses, but they modulate the sensitivityreceptivity to sexual stimuli. Moreover, there may be large interindividual differences in women’s sensitivity for changes in androgen levels. There are indications that this sensitivity is related to prenatal exposure of androgens, and is reflected in the 2D-4D ratio; lower ratios are indicative of sensitivity being more androgen dependent. (Oinonen 2009) Also, dependency on androgen levels depends on the preferential pathways of sexual processing. In several psychophysiological studies, for instance, fantasyprovoked sexual responses showed to be androgen dependent, while responses provoked by visual stimuli are not (Bancroft & Wu, 1986; Laan & van Lunsen, 1997). T in women arises from three sources: Approximately 50–60% is derived from the peripheral conversion of the ovarian and adrenal pro-hormones androstenedione (AD) and dehydroepiandrosterone (DHEA) and its sulphate (DHEA-S), whereas 25% is secreted by the ovary and 25% by the adrenal gland. Around 65–70% of circulating T is bound and inactivated by sex-hormonebinding globulin (SHBG). Most of the remaining 30–35% is bound by albumin and only 0.5–3% represents freely circulating T (free T). Since the binding of T to albumin is rather weak, the free- and albumin-bound T together are defined as the bioavailable T. Combined oral contraceptives (COCs) reduce levels of bioavailable T, by inhibiting ovarian and adrenal androgen synthesis and by increasing levels of sex hormone-binding globulin (SHBG). Due to this combination of suppression of T synthesis and SHBG binding, free T levels decrease during COC use by a mean of 61%. (2) Androgen deprivation therefore should be considered as a side effect of the negative feedback of COC’s on the hypothalamic pituitary gonadal axis. The estrogen deprivation is restored by the estrogen in the COC and the T suppression and SHBG increase, which occurs in most COC’s, is partly counteracted by the androgenic properties of some progestagens (e.g. levonorgestrel). We hypothesized that restoring androgen levels in COC users to a physiological level would improve sexual functioning and general well-being of women on COC’s. We studied the effects on endocrine parameters and sexual function when testosterone concentrations are normalized during combined oral contraceptive (COC) use by co-administration of dehydroepiandrosterone (DHEA). Abstract Book A randomized, double-blind, placebo-controlled, comparative, two-way crossover study was conducted in healthy COC users aged 20-35 years, with a stable and satisfactory sexual relationship, who stopped taking their usual COC for one month. Women were subsequently treated with either 5 cycles COC (ethinylestradiol (EE)/levonorgestrel (LNG) or EE/drospirenone (DRSP)) and 50 mg/day DHEA followed by 5 cycles COC and placebo, or treatment was received in the reverse order. Endocrine parameters and sexual function (physical & psychological aspects) were assessed at baseline and after each of the 5 treatment cycles. In total 81 women were randomized and treated. Seven women discontinued early (3 during DHEA and 4 during placebo). Results showed that: 1) COC use significantly suppresses androgens. (P<0.0001) In the placebo condition free T is reduced with 68% in the EE/LNG and with 76% the EE/DRSP group. 2) COC use has unfavorable effects on sexual function (lower FSFI and diary scores; P<0.05) 3) By adding DHEA to an LNG/EE COC, the loss of androgens, especially free T, can be restored (P<0.0001) without inducing side effects, but the favorable effects of COCs on acne are lost 4) Favorable clinical effects were observed on several aspects of sexual function. Women on COCs with DHEA reported more frequent partnered sexual activity and more responsivity to partner initiative (P<0.05) These data confirm that COCs suppress androgen concentrations and provide evidence that COCs interfere with optimal sexual function. Addition of DHEA restores free T when combined with an LNG pill, but this does is too low for a DRSP pill. Several aspects of sexual function can be improved by restoring androgen levels through concomitant DHEA treatment. An EE/ LNG COC with 50 mg DHEA is suitable as a first choice preparation for all women, except for women who use the pill with the additional objective to treat androgen-related skin symptoms. Literature: Bancroft J, Wu, FCW. Changes in erectile responsiveness during androgen therapy. Archives of Sexual Behavior 1983;12 :59-66. Davis SR. Androgen therapy in women, beyond libido. Climacteric 2013;16(Suppl 1):18–24 Laan E, van Lunsen RHW. Hormones and sexuality in postmenopausal women: a psychophysiological study. J Psychosom Obstet Gynecol 1997;18;126-133 Oinonen KA . Putting a finger on potential predictors of oral contraceptive side effects: 2D:4D and middle-phalangeal hair. Psychoneuroendocrinology 2009;34,713—726 Zimmerman Y et al. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Hum Reprod Update. 2014; 20 : 76–105. S17 MENOPAUSE, HORMONES, WELL-BEING AND SEXUALITY - A PSYCHOSOMATIC APPROACH IN "REAL" LIFE M. Lachowsky Consultant Psychosomatic Gynecology, President AFEM (French Menopause Association), Founder and Vice-President SeFGOP (French Society of Psychosomatic OBS/GYN) Paris, France The menopause that “turn of life”, seems to be, in our patient’s mind, a wellknown if troublesome event, where evidence based medicine adds its value to a personal and almost historical knowledge. It is part of an expected program, physiological and biological, a normal if unpleasant part of femininity, as even the Talmud acknowledges it! But it is still considered a difficult and even risky period by most women, paradoxically made sometimes even riskier by medical intervention, but that is another discussion, and a tumultuous never-ending one! It has long been a private and intimate moment. To-day it has become a public issue, a red question mark in our patients’ minds, exposed and discussed on Internet and other media. Two major reasons, two major trends: Age and ageing, what it means for our present society, and quality of life with/without medical help. A woman’s life expectancy means that almost half of her lifespan will be spent after menopause, so how to get old without getting older, how to advance without age’s marks and failings, how to use medicine with no adverse but only positive effects, that is the question! “Beautiful people”, slim, sun-tanned, bearing children whenever they desire, without any financial problems, that is the image our young century wants to promote, rather than that simple reality: we are not equal before health and age. Why not try and help our patients to live their postmenopausal time as an Indian summer rather than an icy winter? In the 21st century, sexuality and age is still an unusual topic, even in medical circles. If sexuality is nowadays a recurrent subject of discussion, especially in everyday conversation and media, our society seems much less at ease with age and aging. Danger is lurking, our longevity is adding year after year to our life expectancy, but what about our expectations? Getting old, older, has become one of the major anguish of our society and how to bear with that gift of science is the “to be or not to be” of our time. Seniors, 3rd and now 4th age, anything but old and elderly, anything to avoid the unmentionable. This presentation will of course work on those problems, on quality of life and one of its parameter, quality of sexuality. Rather than expanding on how postmenopausal women may experience dyspareunia mostly due to vaginal dryness, or shame because of the changes in their bodies, how older men may fear and experience erection difficulties, how these situations may have disastrous consequences on a couple’s quality of life, how a “good” gynecologists should be of assistance not only with effective drugs but also with tactful indiscreet questions and empathic counselling, I would like to share with you some thoughts about that entity, the elderly couple, as seen by a psychosomatic gynecologists. That does not mean “the psychology of the elderly couple”, as this heading would imply two capital prerequisites. One is scholarly and theoretical : “Is there such a thing as a psychological profile?”, the other sociological :”How long will such a concept as an elderly couple, two people having stayed together long enough to reach old age, be a relevant issue in the 21st century?” Last but not least, the semantic question we already mentioned: from what age on is one elderly, when is the word old more appropriate, or is it simply a delicate way to express the hard facts of life? And now a more down-to-earth question: what about their past life together, what about memory and souvenirs, what about their “real life”? Let us work on those –apparently- rhetoretical questions to understand the implications of age and aging in body and mind, not similar in man and woman, as well as their impact on each other in that particular situation, being a couple. An elderly couple, meaning two individuals of opposite gender having wanted hopefully still wanting,-to create a separate unit, with an eye on their future on the genealogical tree, all this by way of sharing a special intimacy, their own private and somewhat secret blend of love, sex and mutual investment. Let us imagine the most common situation: a man and a woman meet during the socalled golden years of youth, they chose to join hands, bodies and lives. Born by the hope and glory of mutual desire and similar dreams, they decide to build an ideal future, with perfect children and sound jobs as common aims. Be they beautiful people or ordinary Mr. and Mrs. Jones, be it ages ago or to-day, the beginning of that story is almost always the same. But a notable change has occurred, dating already from the last century: the new status of women. Status? Maybe more of a great shift in woman’s place and image, endowing her with a new role in her couple and modifying its evolution. One could well argue that apart from their new longevity, still to woman’s advantage, no known mutation has happened to human beings whatever their gender, nothing new. Nothing? What about contraception, and the complete change of life it brought to women? What about that famous –infamous?- time, that ”turn of life”, the menopause and its medical approach, what about the roads and rights to feminine sexuality, all those new acquisitions in the wedding presents of today’s woman? True, all those openings concern the womenfolk, no such thing happened to the other half. Was that half as much in dire need of support and amelioration, that is another question, but those considerations should help us to understand how the elderly couple of the 3rd millennium, surfing on the crest of that new wave (did they meet on the barricade of May 1968 in Paris?) may well be a different one, opening a new era in man and woman relationship. For better or for worse, depending what one looks for, from what time, place or point of view, anyway the answer stays open. Being fifty or sixty today is different for both genders, as well as between them. There is neither actual nor social equivalence for men and women: age and aging are weighed on different scales: wrinkles are rarely called interesting and silvery 13 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 temples do not enhance woman’s seduction, neither does that specific endpoint, the menopause. This is why the role of man is capital, he is the one able to soften the blow if he accepts his own aging image when reading the passing of time on his companion’s face and body. But if he cannot bear what her body tells him, and what he sees and feels in his own body, it is HER self-esteem which will be the victim of his wish to deny reality. Love and libido are a troublesome pair, both are necessary in a couple to keep the flame burning, even if it is not an Olympic one anymore…And this is where we might be needed, we doctors and gynecologists, with both hormonal and psychological bolstering, helping man and woman to focus things differently, to readjust to that new deal. It is not only an estrogen/androgen replacement which is expected of us, but almost a way-of-life replacement. No wonder those elderly women chose to come to us gynecologists: We are partners of all their life-events, ours being a medicine of life and not concerned with disease alone. She lets us know she is still a woman, still in her rightful place whatever her age, with no abdication of her femininity. Far from denying ageing, she defies it with her new demands about quality of life, including her sexuality. There arises a new question: are we prepared, are we trained for that approach? Why is it still so difficult to talk sexuality with our patients, even more so with the “elderly” ones? Let us summarize, as you certainly experienced that feeling of uncertainty on both sides: On the PATIENT’s side: *fear of the lack of “right” words *Fear of ridicule (at my age!) *Fear of embarrassing the doctor * Fear of taking too much of the doctor’s valuable time *Not a “medical” problem, what can the Dr. do about it? On the DOCTOR’s side *Unease, the right words for each patient *Own personal problems about sex and sexuality *Mixed feelings: indiscretion lack of tact violation of intimacy Sexuality and its troubles need to be addressed with as much knowledge and know-how as any part of our medical science and art. Time, the time, is not always easy to define, the right moment as well as the right setting are of the utmost importance, the right distance –not to near, not too far- also plays an important part in the success of our relationship to that particular woman, that particular patient. But let us come back to our couple. What makes it all the more complicated is that both partners may not always be in the best of health. As age blends into old age, small problems, arthritic joints or bad digestion, will rather help the couple, giving them common preoccupations as well as conversation topics, especially useful when children's illnesses or job's difficulties have long disappeared from the agenda. As often as not, there may have been a bad period, the retirement of the husband, with the wife either still working or having long ago arranged her own life. The man's permanent presence in a home he did not really know during his usual working day, that free time so coveted, how can it have turned into that feeling, into that empty time-table with nothing worth telling about?.Some have given thought soon enough to those years after the officially active ones, and have carefully arranged their lives around new interests, or old cherished ones, some couples have also taken care not to leave their usual environment to rashly, for fear of losing their circle of friends, losing all that social web independent of the professional one, as this one usually does not survive very long after one's departure from the office. There is another deep gender difference and that is friends: with small talk, healthy laughter or murmured confidences helping to bear day to day troubles, women are the great sweet cocoon for women whatever their age or way of life. Men seem to be less lucky in that domain. Apart from the one childhood inseparable friend, men seem to establish most of those relations in their working background and often lose contact after a few months, leaving them deprived and disappointed. All this should teach us to enlarge our vision: not to take into account their family, their colleagues, the small or large world in which they live, would deprive us of an important level of responses, those reactions to society which 14 mould at least part of everybody's way and quality of life. The influence of time is to be read not only on the skin but also deeper, where it cannot always be expressed. Imagination and images sometimes collide and superimpose themselves on a past which may be either exaggeratedly enhanced or reproachfully devaluated. Sexuality is one of the best examples, age may be used as an excuse for putting an end to something which was never satisfactory for one of the partners or for both. This is true for women who hide behind hormonal explanations, and for men who consider erectile dysfunction too humiliating for words. Man often accepts even less than woman the treasons of the mind coupled or revealed by the lapses of the body. Maybe we gynaecologists should remember that sex is always present in our consultations, whatever the official cause for consulting and the age. Sexuality is a language, maybe the first one between human beings, why should one forget or forsake it? It may be different for our elderly couple, coping with changes of pace, arrangements for less lithe bodies and with the possibility of a revival of desire after troubled waters finally crossed. But sexuality needs intimacy, and the privacy one is entitled to hope for in later years is nowadays often torn open either by offsprings coming back with their own children after a divorce or by declining parents needing day and night attention. Crowded, but what about the other side of the problem, what is better, too many or too few people around? With, in the background, the conscious or unconscious anxiety of being left alone, what if one of us is too sick to take care of the other, and what if we lose our autonomy? Coping with one's own difficulties, coping with the partner's approach to his/her problems and coping with what each one sees -or believes to see- in the other's eyes, all this does apply to any couple but how much more do elderly spouses have to work on it, that is the question. Sexuality and its troubles are not on the agenda of most medical universities, although there is scarcely a consultation where we are not talking sex, whatever the official cause of the referral or the age. Be it contraception at menopause, late pregnancy or Pap smears, sexuality is always in the background, there is no gynecological practice that does not refer to “a person’s ability to experience sexual feelings” as the Collins Cobuild English Dictionary defines sexuality in1988. In 2009, we still have to take individual steps to learn how to avoid the many pit-falls threatening our relationship with some patients, in order to help them with the answers they are seeking. We may also help them discover that tender and warm companionship is one of the best links, sustaining the acceptation of nature's toll. What with empathy and attention, time to listen and to counsel, hormonal systemic and local treatments, we do have ways and means to make our patients life a life of quality, although they sometimes forget we have no magical wand to give them their youth back! Abstract Book S18 UPDATE ON VAGINAL LACTOBACILLI AND BIOFILM FORMATION G. Ventolini School of Medicine at Texas Tech University Health Sciences Center, Odessa, USA A German physician, Albert S. Döderlein, described in 1892 a micro-organism that he isolated from a vaginal sample of a pregnant patient that he named: Döderlein’s bacillus. This bacterium was far along renamed Lactobacillus. Döderlein studied and classified the bacterial groups into normal (Grade A: dominated by the vaginal Döderlein’s bacillus) and abnormal (Grade C: dominated by other micro-organisms). He also contended a fundamental concept: that the Döderlein’s bacilli in addition to the vaginal acidity were necessary to maintaining the normal vaginal secretions free of harmful bacteria. Recent introduction of modern technologies like high-throughput sequencing (Pyrosequencing), software for computational analysis and genus-specific quantitative PCR (qPCR) assays have weighty corroborated the interpretations made by Döderlein and his colleagues. Today it is recognized by most investigators that the majority of normal flora of fertile women’s vagina are populated, with a small number of exceptions, by mainly 4 groups of lactobacilli: L. crispatus, L. iners, L. jensenii, and L. gasseri. Healthier vaginas include L. crispatus and L. jensenii. Lactobacilli found in women are primarily derived from the intestinal microflora, they colonize the nutrient-rich vaginal environment therefore they maintain a steady environment. Vaginal epithelium, which is glycogen rich and ovarian dependent, when degrades makes glucose available. Lactobacilli are obligate homo-fermenters of glucose and produce lactic acid. Additionally they also produce hydrogen peroxide and both are responsible for conserving a vaginal pH between 3.8 and 4.2. Furthermore lactobacilli secrete bacteriocins, organic acids, bio-surfactants and other products that consent receptors attachment to vaginal epithelial cell and co-aggregate to form biofilms. The majorities of lactobacilli possesses small genomes, and have acquired new protein transporter gene systems that enable vaginotropism. Biofilm formation by lactobacilli: Biofilms are particularly complex biological conglomerates structures were bacteria commonly thrive. The formation of biofilm is a refined procedure that usually involves two foremost divided steps: first the adhesion and second. Embraces: first, the recognition of surface-related stimuli that enables the adhesion of the micro-organism to a surface and second, a matrix biofilm and buildup production. This matrix is known as the extracellular polymeric substances (EPS) and inside it the micro-organisms are entangled. Biofilm is species-specific for each group of micro-organisms. In recent times research has developed to analyze the influence of genetic determinants in the formation of biofilms. Also we have learned more about the ecological conditions that affect this complex process. Biofilm formation is a very important clinical issue. The complete knowledge of it will allow us to understand and identify which micro-organism bacteria exhibit biofilm-linked traits. Therefore we will be better equipped to discriminate which microorganism exhibit tolerance to a specific antibiotic therapy and which to a precise host defense. Lactobacilli were studied by a few researchers regarding biofilm formation utilizing different growth media. The conclusion of those studies showed that almost all lactobacilli isolates produce biofilm on a polystyrene surface. L. acidophilus was the one lactobacillus that demonstrated the uppermost biofilm formation. Last year, Ventolini verbally presented at COGI in Vienna findings regarding biofilms produced by human vaginal lactobacilli (manuscript under consideration by Medical Hypothesis Journal). Follow-up with qPCR research he and his work group has further categorized these lactobacilli as L. jensenii (the topic of this presentation at COGI here in Paris that will include microphotography pictures and motion pictures). Conclusions: Lactobacilli are accountable for sustaining healthy micro-flora equilibrium in women’s vagina. Our knowledge and understanding of the biofilm formation process has greatly progress. Today we have a more comprehensive understanding and clarification of the complexities and relations between the assorted vaginal micro-flora and lactobacilli. Clinical research is still ongoing to identify the influences that lactobacilli biofilm could make regarding protection against bacterial and fungal infections recurrences but more important regarding prevention of preterm labor. S19 PATHOGENIC BIOFILMS: LEADING CONTRIBUTORS TO RECURRENT VAGINITIS AND CYSTITIS A. Graziottin1, P. Paolo Zanello2 1Center of Gynecology and Medical Sexology, San Raffaele Hospital, Milan, 2 University of Parma, Parma, Italy Problem Statement: Recurrent cystitis and vaginitis have an increasing relevance in gynecological practice. They are a major health issue for women and their sexual life, with a specific impact on vaginal and bladder pain associated with intercourse (Graziottin A. 2014; Graziottin A. et al., 2014 a). At the same time recidivism of cystitis and vaginitis may cause frustration to the practitioner, whose therapeutic expertise appears to be too often significantly jeopardized. Significant data on both the dramatic increase of bacterial resistance and common escalation of microbial aggression in urology and gynecology diseases suggest a connection with the frequent, and sometimes indiscriminate, use of antibiotics. Methods: This abstract focuses on pathogenic biofilms, as they may lead to a new understanding of the pathogenesis of recurrent urogynecological infections. Results: In the urogynecological field, biofilms can be: extracellular, usually in the vagina, and intracellular, in urothelium. An extracellular biofilm is composed by pathogenic microorganism-secreted polysaccharides, with a primitive circulatory system, and a complex assembly of synergistic micro-organisms. The polysaccharides network acts as a protection system that prevents drug’s penetration and action and immune response effectors. Increasing evidence proves that the majority of urogynecological infections are supported by pathogenic biofilms. This evidence parallels the same pathophysiologic mechanisms operating in recurrent nose, sinus, bronchial or lung infections thus underlying a general microbiologic aggressive and survival-oriented strategy. It may explain the:  incomplete or absent response to common drugs  high presence of co-morbid forms of urogynecological antibiotic-resistant infections and diseases  the increasing bacteria resistance to immune response effectors  the infection’s tendency to become chronic Extracellular biofilm grows close to the vaginal vestibule, and all along the vaginal wall. They usually reside near the apical cell surface of the vaginal mucosa and protrude towards the cavity. They can also be found on the surface of mucous membranes or different inert supports such as all kind of medical devices (Aparna M.S. and Braz Y.S., 2008; Leonhard M. et al., 2013). Inside the biofilm, bacteria have a gradient of metabolic activity, the higher at the surface, the lower in the deeper part of the biofilm, close to the vaginal mucosa. In the deeper part of biofilms, reduced levels of oxygen and nutrients facilitates the growth of a sub-population (0.1-1%) of quiescent bacterial cells called persisted cells, dormant phenotypic variants of regular cells whose slow metabolism fits perfectly into the habitat. Thanks to their minimal metabolic activity, persisted cells are the most resistant to antibiotics and to immune system attacks. Intracellular biofilm resides inside the urothelium that covers the inner bladder/wall bladder. They are characterized by a specific pathogenic strain of Escherichia coli, carrier of the antigen K. This strain is responsible for 75-85% of recurrent cystitis and intracellular biofilm formation, (Rosen D.A. et al., 2007). Conclusion: Understanding the pathophysiology of pathogenic biofilms, and the most effective modulation of their role, may add a new potentially effective arrow in the physician’s arms. Controlled prospective studies are needed to substantiate the impact and limits of this new approach. Disclosure of Interest: A. Graziottin Consultant for: Bayer, Deakos, Epitech, Janssen-Cilag, Menarini, Palatin, Pfizer, Speaker Bureau for: Deakos, Epitech, Lo.Li.Pharma, Menarini, Sanofi, P. P. Zanello Consultant for: Deakos 15 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 S20 NON HORMONAL TREATMENT OF THE MENOPAUSE S. Palacios Director of Palacios Institute of Women´s Health. Madrid. Spain Hormone therapy (HT) is the gold standard treatment for the control of vasomotor symptoms (VMS). However, with the first publications and interpretations of the WHI study and the negative reaction that brought, many doctors and women reconsidered the use of HT. Although in recent years we have seen the windows of opportunity, in terms of cardiovascular risk, posed by his administration in women younger than 60 years and using low doses since the adverse effects are minimized. But, many doctors and women think that are unacceptable risks and they are asking for non-hormonal treatments for the management of vasomotor symptoms. That is why we are looking for new therapeutic products that have less side effects than Traditional Hormone Therapy ones. Many treatments have been tested, among which are:  Antihypertensives (clonidine): Clonidine is an antihypertensive that has been used for the treatment of hot flashes, with modest results and a clear increase in side effects, highlighting dry mouth, drowsiness, constipation and sedation. Moreover, decreasing blood pressure and heart rate, and high doses were observed arrhythmias.  Anticonvulsants (gabapentin): In a review of 4 clinical trials, gabapentin reduces the frequency of hot flashes by 45-71% after 8-12 weeks of administering 600-2400 mgr/day repeated dose. The most common side effects found, especially in the first two weeks, were somnolence, dizziness and instability.  Antidepressants (fluoxetine, paroxetine, venlafaxine, desvenlafaxine): With adaptable results. Mechanism of action in VMS thought to be related to potentiation of CNS neurotransmitters which impact regulation of body temperature.  Phytotherapic Products (black cohosh, dong quai, ginseng, and soy isoflavones among others): though their mechanisms of action are not exactly known and the studies conducted have mostly inconsistent results. We reviewed the results published in Medline during 1993 to April of 2013 on the efficacy and safety of soy isoflavones and SSRIs and SNRIs, especially, paroxetine and desvenlafaxine for VMS. Saturday, December 6, Hall A S21 PRECONCEPTION CARE; AN ESSENTIAL NEW STRATEGY TO IMPROVE WOMEN’S AND CHILD’S HEALTH E.A.P. Steegers Department of Obstetrics and Gynaecology, Erasmus MC, Erasmus Medical Center Rotterdam, the Netherlands Having a healthy child is one of the highest values in almost every parent’s life. However, 15% of the couples with a child wish remain subfertile and more than 50% of the pregnancies results in adverse pregnancy outcomes (congenital malformation, miscarriage, premature birth, stillbirth, low birth weight, fetal growth restriction). All those conditions originate in the periconception period (14 weeks before up to 10 weeks after conception), in which gene-environment interactions play an important role. These experiences have a great impact on the health and the quality of life of parents, children, and families and even of the health of future generations. Moreover, the lifetime costs for care and medical treatment of subfertility and adverse pregnancy outcomes are substantial. During the last decade, the ‘Erasmus MC Preconception Expert Centre’, embedded in the Department of Obstetrics and Gynaecology gained knowledge and expertise in preconception health and health care. Preconception health is determined by multiple factors ranging from constitutional and genetic factors to (none) modifiable environmental factors. To primary and secondary prevent subfertility and adverse outcome in the short and long term, preconception care warrants a multidisciplinary approach in which evidence based screening and 16 (tailored) interventions are needed. The periconception period can be considered as a window of opportunity to change the poor health of couples as a consequence of medical problems, poor nutrition, lifestyle, housing and working circumstances. So far, the following projects and programs have been initiated: 1) Development of protocols for preconception care targeted on medical, nutrition and lifestyle risk assessment. 2) International textbook on preconception care for health care providers. 3) Book on preconception care for the general population. 4) Development of outpatient preconception care clinics: a) Specialized preconception care for (chronic) medical conditions and pregnancy complications. b) Preconception care clinic tailored on nutrition and lifestyle (called clinic for achieving a healthy pregnancy). 5) Development of preconception E-health tools: a) (‘preparing for pregnancy’), a screening instrument to identify medical, genetic, environmental, nutrition and lifestyle risk factors to be used by couples planning pregnancy. The identification of risk factors results in recommendations and referral to the midwife, general practitioner or obstetrician. b) (‘Preconception guide’), an instrument developed for health care providers to be used together with Individual risks of a couple identified in can be linked to protocols regarding preconception advice and suggestions for referral patterns in case of high risks. In this way preconception care can be offered in a structured, protocolized way as part of chain care. c) (‘Smarter Pregnancy’), a personal coaching program of 26 weeks on the mobile phone tailored on improvement of nutrition and lifestyle to be used by couples before and during pregnancy. This program consists of a website in combination with SMS and Email messages, through which personal support is given at any time, at any place and at very low costs. The screenings module on nutrition and lifestyle can be used in preconception care by health care providers. 6) Organization of campaigns to increase the awareness of the importance of preconception health and care. The Erasmus MC, together with the Star-Medical Diagnostic Centre and the municipal health authority conducted a comprehensive field study at the end of 2006 to examine the interest for organized, chain-oriented preconception care. We conducted a small campaign in the North of Rotterdam: posters along the road and in offices of care providers, and a house-to-house information leaflet were distributed. The short campaign resulted in a temporary increase in the use of of 250 percent (the last two years, the average number of visitors per day is 400). People thus seem to be interested in preconception and subsequently start to look for information. 7) Program based Preconception Care in Primary Care. In January 2009, an urban perinatal health program, entitled ‘Ready for a baby’, officially started in Rotterdam. The aim of the 10-year program is to improve perinatal health outcome in Rotterdam. The program consists of projects that are based on standard care in the obstetrical chain of care and supplemented by a number of non-medical measures. Within the program Ready for a baby, we have invested a great deal in the development and organization of program based PC in primary care (midwifes and GP’s). Major challenges are not only to raise public awareness for the concept of PC but also to reach the most vulnerable population groups (such as immigrants and those with a low socio-economic status). One very important aspect is to combine PC with public health and social welfare services. Since 2011, funded by the Dutch Government, the Erasmus MC coordinates a national program entitled ‘Healthy Pregnancy 4 Al’ in which experiments are being conducted regarding preconception care and broadened atenatal risk assessment with respect to non-medical risks during pregnancy. The preconception care experiments are carried out in 14 cities in the Netherlands. Women contemplating pregnancy, between eighteen to forty-two years of age are recruited for individual preconception care consultations at a midwife- or GP’s practice. Via different recruitment strategies women are invited to attend PC. Firstly, the municipal health care service sends invitations by mail. Secondly GP’s send invitations to women enlisted in their practice. Thirdly, women are Abstract Book recruited for interconception care by infant and children health welfare centers. Fourthly, peer educators perinatal health forms a bridge between the women that they recruit for educational programs on preconception/ perinatal health and caregivers. 8) Education about Preconception Care. The Midwifery Academy Rotterdam together with the Erasmus MC has developed a preconception education curriculum for midwives. The Erasmus MC has also developed such curriculum for GPs. Furthermore, a Peer Educator Perinatal Health course was developed. High-risk groups are difficult to reach by the regular care. Not only linguistic and cultural differences may constitute barriers, but also low training and lack of specific knowledge. 16 bilingual women of immigrant origin with a high school diploma were trained full time in six months’ time. Since May 2011, they are available for professional support. Tailored made products are developed to provide group education for high risk difficult to reach groups. The peer educators also play a bridging function between caregiver and clients. They are able to translate the (medical) message in their own language and culture. 9). A Dutch national summit was organized in 2012 to achieve consensus about (I) the definition and categories of preconception care, target groups, prepregnancy risk factors and interventions and risk assessment instruments (Temel et al. Journal of Community Genetics, in press). S22 CAN WE IMPROVE RESPONSE BY INCREASING THE DOSE OF MENOTROPINS? YES: HIGHER DOSE CAN STIMULATE OOCYTES WHICH NEED HIGHER FSH THRESHOLD J. A Garcia-Velasco Obstetrics and Gynecology, Director IVI Madrid, Spain Although natural cycle is an option to practice ART, it is a common practice to stimulate the ovaries to obtain multiple follicular growth in order to make the cycle –and the treatment- more efficient. Just one oocyte may be obtained after a non-stimulated cycle, but how many do we need in IVF? How much should we stimulate the ovaries to be successful in IVF? Today we do know that “more” is not always “better”. More oocytes means that healthy embryos might be obtained even if some are immature, some do not fertilized, a few do not cleave and part of them are not good quality embryos. But too many follicles do bring along well known risks, very specially OHSS. On top of that, a too aggressive ovarian stimulation may retrieve oocytes that do not have enough quality to progress to healthy embryos. Thus, an adequate stimulation seems to be optimal. But what is ‘adequate’? Is it the same for all patients? Does it only depend only on age or ovarian reserve makers? It seems that not all patients respond to COS similarly. And in fact, some patients do need significantly higher dose of gonadotropins than other patients of similar age or ovarian reserve markers. We will try to reinforce the concept that mild stimulation is not the best option for these particular subgroup of patients. S23 HOW TO ASSESS THE POLYCYSTIC OVARY; AN ULTRASOUND AND AMH UPDATE D. Dewailly Department of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre, Centre Hospitalier de Lille, France Given its strong involvement in the pathophysiology of polycystic ovary syndrome, measurement of serum AMH is a topic of interest to clinicians involved in this field. Some would even make the plasma concentration of this hormone the "Gold Standard" for the diagnosis of PCOS. This position is at least premature and excessive. Certainly, the concentration of serum AMH is increased in most patients with PCOS and the strong association between AMH and number of follicles at ultrasound (U/S) has led some to compare the performance of serum AMH and antral follicle count (AFC) for the diagnosis of PCOS. However, the results of the current literature are not consistent across studies as demonstrated in recent reviews. Part of this heterogeneity is due to the absence of well-defined populations. It should be noted in particular that many authors have used the threshold established in 2003 at the Consensus Conference Rotterdam, i.e. 12 follicles 2-9 mm in diameter per ovary to define polycystic ovaries. We know that this threshold is now obsolete. With the latest generation of ultrasound devices and from well-defined populations, recent studies have suggested increasing the threshold to 19 or even 25. This threshold is likely to continue to evolve in parallel with the technical improvements in equipment and in particular ultrasound probes. Besides the difficulty of defining patients by ultrasound criteria, the variability of results is also explained by the problem of different serum AMH assays. Until 2010, about half of all published studies using the DSL assay (Diagnostic Systems Laboratories) while the other half used the Immunotech assay. Both tests used two different standards and different antibodies with corresponding values of problem (Iliodromiti, Kelsey et al. 2013). More recent studies using the Gen II kit (which uses the DSL antibodies Gen I with standards Immunotech assay) should be interpreted with great caution, because this kit suffered until July 2013 from an underestimation of the values due to interference with serum complement in undiluted patient samples. It is now replaced by a new kit from the same company and other kits from other companies are emerging, including automated assays that should minimize the inter-center variability of results. It is however impossible to date to propose a consensual and universal threshold of serum AMH for the diagnosis of PCOS. However, in our experience, with the Immunotech test, serum AMH was considered more powerful than the number of follicles with excellent sensitivity and specificity for a threshold of 35 pmol L (4.9 ng/ml). Unlike other studies, the specific thresholds for AMH and number of follicles were calculated concurrently without using present values for the number of follicles, through a complex statistical method called "clusters." In addition, women with polycystic ovaries were excluded from the asymptomatic control group of menstruating women regularly. These results have been recently replicated with another AMH assay in a totally independent large population. Therefore, we are close to get an accurate and reliable marker of PCO that will eventually replace the AFC that also suffers from a great controversy in the current literature. It seems reasonable to propose the elevation of serum AMH levels as a substitute for the item "polycystic ovary morphology" in the Rotterdam classification. Also, since we now have at our disposal two different markers, one being morphological (AFC) and the other biochemical (increase in serum AMH), we suggest using instead the term "PCOlike anomalies" as the third element of the Rotterdam classification. It must be emphasized, however, that the threshold of follicle excess and serum AMH levels should be reviewed and validated around the world in different ethnic populations, as recent technical developments in ultrasound procedures and AMH assays can lead to a change in thresholds previously proposed. Until then, we recommend clinicians to define their own thresholds fitting their populations. Saturday, December 6, Hall B S24 EFFECT OF PRE-PREGNANCY WEIGHT AND GESTATIONAL WEIGHT GAIN ON THE INCIDENCE OF PREECLAMPSIA AND GESTATIONAL DIABETES N. Tul1; M. Lucovnik1; I. Blickstein2; L. Steblovnik1; I. Verdenik1; A. Trojner Bregar1, V. Fabjan Vodušek1 1Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Slovenia 2Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, affiliated with the Hadassah-Hebrew University school of Medicine, Jerusalem, Israel Number of obese women of reproductive age is increasing. These women are at increased risk of several pregnancy complications, among which preeclampsia and gestational diabetes mellitus (GDM). Excessive gestational weight gain has also been demonstrated to be associated with an increased risk of both preeclampsia and GDM. It is important, however, to differentiate between the effect of pre-pregnancy body mass index (BMI) and gestational weight gain on the incidence of these two conditions, since weight gain is amenable to interventions during pregnancy while high pre-pregnancy BMI is not. Conclusions of two studies on Slovenian population of pregnant women are that pre-pregnancy BMI is strongly associated with preeclampsia and GDM in both twin and singleton pregnancies. Gestational weight gain is also associated with risk of preeclampsia, although seemingly less so than pre-pregnancy BMI. 17 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Smaller gestational weight gain noticed in patients with GDM may reflect the importance of dietary counseling after GDM diagnosis. References Lucovnik M, Blickstein I, Verdenik I, Trojner-Bregar A, Tul N. Maternal obesity in singleton versus twin gestations: a population-based matched case-control study. J Matern Fetal Neonatal Med. 2014 Lucovnik M, Blickstein I, Verdenik I, Steblovnik L, Trojner Bregar A, Tul N. Impact of pre-gravid body mass index and body mass index change on preeclampsia and gestational diabetes in singleton and twin pregnancies. J Matern Fetal Neonatal Med. 2014 S25 THEORETICAL REASONS TO CHOOSE NATURAL PROGESTERONE F. Facchinetti, L. Pignatti Unit of Gynecology and Obstetrics, Mother-Infant Dept, University of Modena and Reggio Emilia Progesterone received its name due to its role as a pro-gestational agent and it is responsible for a variety of effects that help maintain pregnancy. The use of progesterone may be important in maintaining uterine quiescence in the latter half of pregnancy by limiting the production of stimulatory prostaglandins and inhibiting the expression of contraction-associated protein genes (ion channels, oxytocin and prostaglandin receptors, and gap junctions) within the myometrium. Progesterone stimulates morphological changes to the cervix and other tissues that help to maintain pregnancy. Throughout pregnancy, progesterone inhibits the immune system. Such immunosuppression prevents the maternal immune system from rejecting the fetus and ensures that the pregnancy goes to term. Parturition is widely accepted to be an inflammatory event, as it is largely driven by inflammatory cytokine and prostaglandin signalling. Inflammatory pathways stimulate the various events that lead to parturition, such as cervical ripening, rupture of membranes, and uterine contractions. Progesterone holds off these inflammatory events until pregnancy reaches term. Progesterone also inhibits uterine contractions, both through suppression of prostaglandin production and by reducing the contractility of the smooth muscle cells. Progesterone due to its effects is widely used for preterm birth (PTB) prevention. Evidence seems to favour two mechanisms that explain the beneficial effect of progesterone administration in PTB prevention: an anti-inflammatory effect that counteracts the inflammatory process leading to delivery, and a local increase in progesterone in gestational tissues that counteracts the down-regulation leading to PTB. Two pharmacological approaches are extensively used to prevent labour: progesterone itself or the synthetic progestin 17-alpha-hydroxy-progesteronecaproate (17P). Administration of progesterone instead of its derivatives has the advantage of ensuring that all the pathways activated by endogenous progesterone will be activated. It has been described that progesterone activates also non-genomic or yet unknown pathways. Progesterone is more likely to replicate the endogenous pregnancy maintaining activation of uterine membrane receptors. Progesterone, but not 17P, inhibits the contractions of human myometrial cells, apparently acting through non-genomic receptors. There are many progesterone metabolites that have some activities that are not still understood and that are unlikely to be mimicked by a progesterone derivative, particularly one designed to be resistant to metabolism. Indeed, 5beta-reduced progesterone metabolites are important in maintaining pregnancy and these effects are unlikely to be replicated with 17P or other synthetic derivatives. Exogenous progesterone is rapidly metabolized by kidneys and liver. Due to this rapid decay, progesterone is usually administered vaginally during pregnancy to ensure that as much progesterone as possible reaches the target. For the same reasons, progesterone must be administered frequently, typically once daily when administered vaginally. However it is still debated how much exogenous progesterone reaches its receptor in target tissues. On the other hand, 17P is not metabolized by traditional steroid transforming enzyme and is not a prodrug. The only known metabolism observed with 17P is oxidation by cytochrome p450 enzymes. This metabolic stability causes 17P to have a longer half-life that allows for its weekly administration. Different metabolism pathway between progesterone and 17P also means that the latter is not subject to 18 regulation via progesterone metabolizing enzymes and may behave differently in target tissues. Vaginal progesterone is associated with reduction in PTB and composite perinatal morbidity and mortality, in women with singleton gestations, no prior spontaneous PTB, and short cervix at ultrasound (< 20mm identified at 24 weeks). 17P administration is beneficial in preventing PTB in singleton gestation with prior spontaneous PTB, and unknown cervical length. There is at present stronger evidence of effectiveness for 17P rather than for vaginal progesterone. In this subgroup of patients. 17P should be recommended to women with prior spontaneous PTB starting at 16 weeks. There are no data comparing the different preparations of progestogens. In multiples, progestogen treatment, regardless if vaginal progesterone or 17P, have no significant effect on adverse perinatal outcome and time to delivery, compared with controls. However, in a subgroup of women with a short cervical length (<25mm before 24 weeks), vaginal progesterone treatment seems beneficial. It has often been assumed that vaginal progesterone and i.m. 17P are interchangeable. However, differences in the chemistry and biochemistry of the two molecules suggest that this is probably not the case as also supported by clinical trials. Byrns M.C., Regulation of progesterone signaling during pregnancy: Implications for the use of progestins for the prevention of preterm birth. J Steroid Biochem Mol Biol 2014 Jan;139:173-81. Martinez de Tejada B. et al, Prevention of preterm delivery with vaginal progesterone in women with preterm labour (4P): randomised double-blind placebo-controlled trial. BJOG 2014 Sep 11. Parízek A. et al., Progesterone, inflammation and preterm labor. J Steroid Biochem Mol Biol. 2014 Jan;139:159-65. Schuit E. et al, Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis. BJOG 2014 Aug 22. Society for Maternal-Fetal Medicine Publications Committee, with assistance of Vincenzo Berghella, Progesterone and preterm birth prevention: translating clinical trials data into clinical practice. Am J Obstet Gynecol. 2012 May;206 (5):376-86 S26 SURGICAL TREATMENT OF PPH L. Sentilhes Department of Obstetrics and Gynecology, Angers University Hospital, 4, rue Larrey, 49933 Angers Cédex 9. Peripartum hysterectomy remains the gold-standard to control severe PPH and is the final option when the other procedures failed. However, uterine-sparing sparing procedures have been developed during this last decade. The two possible options are (1) vessel ligation, including bilateral uterine artery ligation as described by O’Leary (1995), stepwise uterine devascularization as described by AbdRabbo (1994), triple ligation as described by Tsirulnikov (1974), and/or bilateral internal artery ligation; and/or (2) uterine compression suture, of which the B-Lynch procedure (1997) is very likely the most frequently used. Bilateral internal artery ligation has been found to be considerably less successful (about 60-70%) than previously thought, and many practitioners are only slightly familiar with this technique. Bilateral uterine artery ligation and stepwise uterine devascularization procedures present the main advantage, similarly to B-Lynch suture, of being quicker and easier to perform than internal artery ligation. The success rate and morbidity do not seem to differ between vessel ligation involving the uterine arteries (about 75-90%) and uterine compression sutures (about 75-90%). However, the methodological quality of these studies remains limited, and there is no controlled trial regarding these different procedures reported in the literature. Therefore, at present there is no strong evidence to suggest that any one method is better for the management of severe PPH. Uterine or hypogastric artery ligation does not appear to compromise a woman’s subsequent fertility and obstetric outcome. Uterine compression sutures do not also appear to compromise a woman’s subsequent fertility and obstetric outcome. Nevertheless, there are limited but alarming data suggesting that uterine compression suture may increase the risk of subsequent intrauterine synechia. Abstract Book The highest cause of uterine-sparing procedure failure is placenta accreta/percreta. The cesarean hysterectomy is generally considered the standard treatment for placenta accreta. This option may reduce maternal morbidity, but by definition it leaves women sterile. Accordingly, conservative treatment may be applied for some women who want to be able to have more children. In this approach, the placenta adhering either partially or totally to the myometrium is left in situ. Conservative management is an option with a success rate of 78% for patients who are properly counselled and motivated. Moreover, successful conservative treatment for placenta accreta does not appear to compromise the patients’ subsequent fertility or obstetrical outcome, although these patients should be advised of the high risk that placenta accreta may recur during future pregnancies (30%). Nevertheless, there are significant risks of serious immediate and delayed morbidity (6%) associated with conservative management requiring a close follow-up monitoring after delivery. B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique for the control of massive postpartum hemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol 1997; 104:372-5. O’Leary JA. Uterine artery ligation in the control of postcesarean hemorrhage. J Reprod Med 1995;40:189–193. Poujade O, Grossetti A, Mougel L, Ceccaldi PF, Ducarme G, Luton D. Risk of synechiae following uterine compression sutures in the management of major postpartum haemorrhage. BJOG 2011;118:433-9. Sentilhes L, Trichot C, Resch B, et al. Fertility and pregnancy outcomes following uterine devascularization for postpartum haemorrhage. Hum Reprod 2008;23:1087-92. Sentilhes L, Gromez A, Caroline Trichot, Aude Ricbourg-Schneider, Philippe Descamps, Loïc Marpeau. Fertility after B-Lynch suture and stepwise uterine devascularization. Fertil Steril 2009;91:934.e5-9. Sentilhes L, Ambroselli C, Kayem G, et al. Maternal outcome after conservative treatment for placenta accreta: Obstet Gynecol 2010;115:526-34. Sentilhes L, Kayem G, Ambroselli C, et al. Fertility and pregnancy outcomes following conservative treatment for placenta accreta. Hum Reprod 2010;25:2803-10. Tsirulnikov MS La ligature des vaisseaux utérins au cours des hémorragies obstétricales. J Gyn Obst Biol Reprod 1979;8:751-753. S27 EFFECT OF PRE-PREGNANCY WEIGHT AND GESTATIONAL WEIGHT GAIN ON THE INCIDENCE OF PREECLAMPSIA AND GESTATIONAL DIABETES N. Tul1, M. Lucovnik1; I. Blickstein2; L. Steblovnik1; I. Verdenik1; A. Trojner Bregar1, V. Fabjan Vodušek1 1 Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Slovenia 2Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, affiliated with the Hadassah-Hebrew University school of Medicine, Jerusalem, Israel Number of obese women of reproductive age is increasing. These women are at increased risk of several pregnancy complications, among which preeclampsia and gestational diabetes mellitus (GDM). Excessive gestational weight gain has also been demonstrated to be associated with an increased risk of both preeclampsia and GDM. It is important, however, to differentiate between the effect of pre-pregnancy body mass index (BMI) and gestational weight gain on the incidence of these two conditions, since weight gain is amenable to interventions during pregnancy while high pre-pregnancy BMI is not. Conclusions of two studies on Slovenian population of pregnant women are that pre-pregnancy BMI is strongly associated with preeclampsia and GDM in both twin and singleton pregnancies. Gestational weight gain is also associated with risk of preeclampsia, although seemingly less so than pre-pregnancy BMI. Smaller gestational weight gain noticed in patients with GDM may reflect the importance of dietary counseling after GDM diagnosis. References Lucovnik M, Blickstein I, Verdenik I, Trojner-Bregar A, Tul N. Maternal obesity in singleton versus twin gestations: a population-based matched case-control study. J Matern Fetal Neonatal Med. 2014 Lucovnik M, Blickstein I, Verdenik I, Steblovnik L, Trojner Bregar A, Tul N. Impact of pre-gravid body mass index and body mass index change on preeclampsia and gestational diabetes in singleton and twin pregnancies. J Matern Fetal Neonatal Med. 2014 Saturday, December 6, Hall C S28 Strategies of management of genital endometriosis L.V. Adamyan Russian Scientific center for obstetrics, gynecology and perinatology named after V.I. Kulakov, Moscow, Russia Endometriosis is classically defined as the presence of endometrial glands and stroma in ectopic locations. Affecting from 6% to 10% of reproductive-aged women, endometriosis may result in dysmenorrhea, dyspareunia, chronic pelvic pain, and subfertility. The prevalence of this condition in women experiencing pain, infertility, or both is as high as 50%. Endometriosis is a debilitating condition, posing quality-of-life issues for the individual patient. The significant individual and public health concerns associated with endometriosis underscore the importance of understanding its pathogenesis. Despite the passage of time and extensive investigation, the exact pathogenesis of this enigmatic disorder remains unknown. Endometriosis is a progressive disease that does not regress spontaneously and tends to aggravate with time, suggesting early surgical intervention. One of the challenges of endometriosis is the prompt and accurate diagnosis of the disease, which is of great importance in order to avoid long delay before possible surgical management. Saturday, December 6, Hall D S29 CONSULTATION WITH THE ADOLESCENT: MORE THAN A GYNECOLOGICAL EXAMINATION G. Creatsas G University Of Athens, Greece Pediatrics and adolescent gynecology deals with the gynecological pathologies during childhood and adolescence, adolescent pregnancies and contraception. Early diagnosis, with clinical and laboratory evaluation as well as prevention and consultation are the important tools for the management of the above conditions. The evaluation of the “paediatric and adolescent gynaecological patients’ also includes the clinical history, the gynecological examination, the pelvic ultrasonography and occasionally the laparoscopy and hysteroscopy. Consultation is related to the relative pathology itself, and includes: discussion on the menstrual disorders, (i.e. the dysfunctional uterine bleeding [DUB], the amenorrhea, the dysmenorrhea, the premenstrual tension syndrome) and other pathologies as: the ectopic pregnancy, the termination of unwanted pregnancies, the miscarriages, the polycystic ovarian syndrome)- (PCO), the short stature and the primary hypogonadism, the congenital uterovaginal anomalies, the hermaphroditism, as well as the injuries of the external genitalia. The young girl and the family, mainly the mother, should know that DUB is a painless endometrial bleeding that is prolonged, excessive, and irregular, which is not attributable to any underlying structural or systemic disease. Furthermore consultation is related to the prevention of undesired pregnancies (the use of the new generation oral contraceptives), the adolescent sexuality and the prevention of the sexually transmitted diseases, including information on the vaccination against the human papilloma viruses. It is recommended to the health care professionals (HCPs) to avoid, during the discussion, medical terms related to the pathophysiology and the management of the disease. On the contrary they should provide information in simple words and reassurance, as many families and especially their young children may be easily afraid or over worried after the first appointment. Unfortunately the problem of communication is getting worst when the family or the child has already received information through other sources as the Internet and the peers. A study presented by our Institution showed that adolescents rely on information received through the media and secondly through the HCPs and the family. 19 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Stress, anorectic and athletic amenorrhea are strongly related to the psychology of the girl. Consultation in these cases should be also provided by experts focusing on the positive and negative effects of the physical exercise and the importance of healthy and balanced nutrition. The discussion also includes information on the fertility issues and the quality of life, especially in cases of PCO, obesity, hirsutism and /or acne, congenital anomalies, amenorrhea and oligomenorrhea. In the preparation for the first gynecological examination, the role of the midwifes and the trainees of the Unit, is of major importance, as it affects the attitude of the child and especially the cooperation and the follow up. The mother should accompany the girl while an informed consent should be signed, in all cases, according to the law. The International Federation of Pediatrics and Adolescent Gynecology (FIGIJ) presents through the Word Congresses, the latest information for consultation and management related to the above mentioned pathologies. Relative meetings are organized by the European Pediatrics and Adolescent Gynecological Society as well as by the Hellenic Society of Pediatrics and Adolescent Gynecology. S30 DEFICIENCIES IN THE ADOLESCENT: KEY SUPPLEMENTATIONS S. Palacios Director of Palacios Institute of Women´s Health. Madrid. Spain Adolescence is that period of life when children grow into young adults physically, mentally and socially. During this phase of life, approximately 20% of final adult height and 50% of body weight are attained. This period of rapid growth and development requires proper nutrition and, as a consequence, it is a time of risk for the individual since nutritional status can impact their general health, cognition and subsequently their academic achievement. There are many factors and conditions which affect nutrient needs during adolescence including pregnancy, lactation, level of physical activity, and chronic illnesses. There are also many other considerations relating to general health (food supply, underweight, overweight, eating disorders, etc.), personal choice (eg. vegetarianism), and special circumstances (perioperative care and celiac disease), which the health practitioner needs to be aware. Iron deficiency is the most prevalent nutrient deficiency, and it is most common during infancy and adolescence because of the increased need for iron to support rapid growth. As a consequence, adolescents are especially vulnerable to anaemia, particularly girls. Management of individuals with anaemia comprises three possible steps: Increasing the diversity of foods consumed (this may not always resolve anaemia since the diet may include insufficient amounts of iron or poorly bioavailable iron); Food fortification (addition of micronutrients to processed foods - useful for calcium and iodine but not so useful for iron because of the poor bioavailability of iron from food sources; Pharmacological supplementation (many iron preparations are available). S31 ADOLESCENT CONTRACEPTION G. Creatsas University of Athens, Greece Adolescent sexuality and contraception is related to the prevention of adolescent pregnancies, termination of undesired pregnancies, prevention and treatment of sexually transmitted diseases and other gynecological pathologies. Next table presents the contraceptive methods available for adolescents (table 1). Table 1. Contraceptive methods for adolescents HORMONAL  COCs  Emergency contraception    20 LARCs Injectable Mini IUD’s NON HORMONAL  The condom     The double method Mini IUD’s The sponge Abstinence? douthce COCs: Combined oral contraceptives LARCs: Long acting reversible contraceptive methods IUD’s: Intrauterine devices SI: Sexual intercourse The condom and the new generation combined oral contraceptives (COCs) are the recommended methods for the prevention of unwanted pregnancies. The combination of these methods also prevents the sexual transmitted diseases including the papilloma virus infections. The failure rate of (COCs) during adolescence is reported between 5%- 15%. Recently, research was directed towards the development of new COCs with 17β estradiol (17β- COCs) and new progestings as the dienogest, drospirenone, nomegestrol acetate and others. An emphasis was also given to the development of new progestins with both progestagenic and antiandrogenic efficacy. During the last years an effort was undertaken to reduce the dose of ethinylestradiol in COCs. However the decrease of the dose had negative effect on the regulation of the menstrual cycle. On the other hand early attempts to develop 17β- COCs, accompanied with a prolonged or heavy uterine bleeding and high discontinuation rates. The new generation COCs cater for several effects especially during adolescence, including: the regulation of the menstrual cycle, the improvement of acne, hirsutism and endometriosis, as well as the prevention of the ovarian and endometrial cancers. The 17β – COCs also provide beneficial effects on the lipid and the carbohydrate metabolism, as well as on and the liver and thyroid function. Adolescents should be informed that COCs are effective if taken regularly. If not, another contraceptive method should be proposed. The use of the long acting reversible contraceptive methods is also recommended as they provide better compliance, especially for adolescents. The emergency contraception is recommended in cases of no contraception use, condom breakage or incorrect use of the condom and failed coitus interrupts. The following products may be used: the “estrogen and progestin” emergency contraception kit, the progestin – only tablets, the single dose of RU – 486 – “mifepristone” and the 19 – nor progestagenic derivative. The levonorgestrel intrauterine devices (IUDs) are still not in use during adolescence, until further data is presented on the mini IUDs. Consultation and sexual education are very important tools for the prevention of unwanted pregnancies. Information should be provided by experts in Pediatrics and Adolescent Gynecological Centers and Family Planning Units. During the discussion with the young girl it is recommended to avoid medical terms to overcome psychosocial problems. Abstract Book The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) All about Women’s Health Oral Presentations 21 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Notes 22 Abstract Book ORAL ABSTRACTS O01 ARE DIFFICULTY OF BECOMING PREGNANT AND FERTILITY TREATMENTS ASSOCIATED WITH CHILDHOOD ACUTE LEUKEMIA? RESULTS FROM THE ESTELLE STUDY. R. Ajrouche 1,*, J. Rudant 1, L. Orsi 1, D. Hémon 1, J. Clavel Inserm, Villejuif, France Problem Statement: The number of couples who are finding difficulty in becoming pregnant and seeking treatment for infertility has dramatically increased over time. The consequences of such exposures on the outcomes of pregnancies are unclear. In addition, there have been little investigations regarding childhood cancer risk, especially Childhood leukemia (CL), which has in utero origin in most cases. If a recent cohort study did not show any increase in the leukemia risk of children who were born after non-donor assisted conception, only a few other studies reported on the associations between other fertility treatments, infertility and CL, with inconsistent results. We investigated the potential involvement of fertility treatments and infertility in the etiology of CL. Methods: The ESTELLE study included 747 cases of CL (636 cases of acute lymphoblastic leukemia (ALL) and 100 of acute myeloblastic leukemia (AML)) diagnosed in France in 2010-2011 and 1421 population controls frequencymatched with the cases on age and gender. Data were obtained from structured telephone questionnaires administered to mothers. In particular, mothers were asked whether they had difficulty becoming pregnant, which was defined as taking more than a year to conceive the index child and/or the need to consult a doctor and/or the need for the mother or father to undergo fertility treatment. In the latter case, the mothers were asked to specify the type of treatment: In vitro fertilization (IVF), IVF with intracytoplasmic sperm injection (ICSI), artificial insemination (AI), zygote intrafallopian transfer (ZIFT), gamete intrafallopian transfer (GIFT) or hormonal treatment (clomiphene, gonadotropin, dopamine agonist or other). The odds ratios (OR) and their 95% confidence intervals were estimated using unconditional regression models adjusted for potential confounders. Results: Difficulty becoming pregnant was reported by 18% of the control mothers and 16% of the CL mothers. CL was not associated with infertility or the use of a fertility treatment for the index pregnancy (table1), even after taking into account folic acid supplementation and other conditions of becoming pregnant (getting pregnant on contraception and maternal reproductive history). The present study is the first study to investigate the specific types of fertility drugs; it showed no association with the various types of drug. Table 1: Difficulty for becoming pregnant with the index child and childhood acute leukemia, the ESTELLE study, France, 2010–2011 Difficulty for becoming pregnant No Yes Mother fertility treatment No Yes In vitro fertilization Artificial insemination Ovulation induction drug only Controls (N=1421) CL cases (N=74 7) OR 95%CI 1167 254 627 120 1.0 0.9 ref 0.7-1.2 1323 706 1.0 ref 98 23 16 30 41 7 4 16 0.8 0.6 0.5 1.0 0.5-1.1 0.3-1.5 0.2-1.4 0.6-1.8 a AORs and 95%CI estimated by unconditional logistic regression adjusted for age, gender, last professional category and maternal age at child's birth Conclusion: The results are reassuring for mothers seeking infertility treatments; the findings support the absence of increasing risk of CL after IVF, as recently reported in a 17-year period UK cohort study, and more generally, after any fertility treatments. Disclosure of Interest: None Declared O02 LATE FOLLICULAR VERSUS LUTEAL PHASE RANDOM START OVARIAN STIMULATION FOR DONOR EGG IVF CYCLES N. K. Duru 1,*, T. Isidan 1, M. Haxhia 1, B. Ferhati 1, L. Kansiz 1, A. Sula 1, J. Gjoshe 1 1Obstetrics and Gynecology, IVF Unit, American Hospital, Tirana, Albania Problem Statement: Random start emergency ovarian stimulation for reproductive age cancer patients has been reported to result in cryopreservation of mature eggs and embryos. The objective of this study is to perform oocyte donation cycles using random start ovarian stimulation of the donor, instead of donor-recipient cycle synchronization, and to transfer fresh embryos. Methods: In a private hospital IVF clinic setting, 15 oocyte donation cycles were prospectively done using GnRH-antagonist/Recombinant FSH. Donor ovarian stimulation was started randomly during either late follicular (n:7) or luteal (n:8) phase, according to recipient's cycle start for endometrial preparation. For the late follicular versus luteal start groups respectively, the age of the donors (28.3 vs 28.6 years) and recipients (42.3 vs 45.3 years) did not differ significantly. Results: Mean duration of stimulation (9.6 vs 10.0 days) and mean amount of recombinant FSH used (2858 vs 2925 IU) did not differ significantly in the late follicular versus luteal start groups, respectively. Mean number of mature oocytes retrieved (10.6 vs 11.3), embryos transferred (1.6 vs 1.5), and clinical pregnancy rates (71 % vs 62%) did not differ significantly in the late follicular versus luteal start groups, respectively. Conclusion: Ovarian stimulation of the donor can be started randomly either at the late follicular or luteal phase, as an easy and convenient method for oocyte donation cycles. This finding may be evaluated further for the future setting of oocyte banking. Disclosure of Interest: None Declared O03 PREDICTIVE VALUE OF SERUM BETA- HUMAN CHORIONIC GONADOTROPHIN (B-HCG) FOR THE PREGNANCY OUTCOME IN INTRAUTERINE INSEMINATION (IUI) CYCLES H. Grigoryan,*, E. Hambartsoumian Fertility Center, Yerevan, Armenia Problem Statement: As there were a number of study concerning predictive value of betta-Human Chorionic Gonadotrophin (b-HCG) after Invitrofertilization (IVF) cycles and embrio transfer , we`ve decided to determine if there is a relation between pregnancy outcome and betta-human chorionic gonadotrophin (b-HCG) level on day 15 after ovulation in Intrauterin inseminatin cycles. The main objective of this study was to evaluate the predictive value of beta- Human Chorionic adotrophin (β-HCG) for the successful outcome in Intrauterine Insemination (IUI) cycles on day 15 after ovulation. Methods: It was the prospective study 230 pregnant patients ages 19-40 with positive β-HCG after intrauterine insemination (IUI) cycles were studied from Januanry 2010 to Januanry 2014 in << Fertility Center>> Yerevan. Results: Patients were assigned two groups on the basis of the β-HCG level on day 15 after ovulation. Group A if the betta- human chorionic gonadotrophin (βHCG) level was more than 130 mIU/mL, and Group B if betta- human chorionic gonadotrophin (β-HCG) level was less than 130 mIU/mL. There were 96.7% normal pregnancies in group A vs. 26% in a group B. There were 1.7 % ectopic pregnancies and 1.6% spontaneous abortions in group A vs. 52% and 22% in a group B. Conclusion: A betta- human chorionic gonadotrophin (β-HCG) value of 130 mIU/mL on 15th day after the ovulation in intrauterine insemination cycles (IUI) appeares to be a suitable cut-off point to predict viable pregnancy. Disclosure of Interest: None Declared O04 CLOMIPHENE BASED OVARIAN STIMULATION IN A COMMERCIAL DONOR PROGRAM. S. Gupta 1,*, R. Satwik 2, A. Majumdar 1, S. Mittal 2, N. Tiwari 1 1Sir Ganga Ram Hospital, New Delhi, India, 2Centre for IVF and Human Reproduction, Sir Ganga Ram Hospital, New Delhi, India 23 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Problem Statement: Clomiphene has proven efficacy for minimal-stimulation in PCOS patients. Its isomer en-clomiphene effectively suppresses LH and can eliminate the use of high dose gonadotropins. Donor recipient cycle provides a unique setting to test a clomiphene based stimulation regimen, as the recipient’s endometrium remains unaffected of its antagonistic effect. The present study was conducted at a tertiary care centre in New Delhi, India to compare a clomiphene-based ovarian stimulation regimen with the conventional antagonist protocol applied to donor-recipient cycles. Methods: A total of 170 donors were stimulated between January 2013 and December 2013. Conventional antagonist protocol (group I) was employed in 139 cycles, and clomiphene was used in 31 donor cycles (group II). 50mg Clomiphene was given simultaneously with gonadotropins from day 2 of the cycle till the day of trigger. Analysis was performed retrospectively for pregnancy rates, fertilization rates, cycle cancellation and blastocyst formation. The dosages, cost, terminal E2 (Estradiol) were also compared between the two groups. Results: The donor age groups were comparable in both the groups. There were no unsuccessful egg retrievals with clomiphene. The pregnancy rate (positive beta HCG) was significantly higher in the clomiphene group (odds ratio: 2.453; p=0.02). Similarly, fertilization rate was significantly higher in the clomiphene group (59.5/50.5, p=0.04). Eggs retrieved were similar in both groups, but the terminal E2 was significantly lower in the clomiphene group (p=0.001). Average gonadotropin used was also significantly lower in clomiphene group (p<. 001). Conclusion: Clomiphene alone can effectively prevent LH surge and limit the dose of gonadotropins thus bringing down the costs and negative impact of high dose gonadotropin on the endometrium and oocyte quality. Disclosure of Interest: None Declared O05 CLINICAL AND REPRODUCTIVE OUTCOMES FOLLOWING HYSTEROSCOPIC ADHESIOLYSIS FOR ASHERMAN SYNDROME C. Hui 1,*, M. Lau 2, G. Ng 1, H. H. Tan 2 1 Obstetrics and Gynaecology, 2Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore Problem Statement: Women with Asherman Syndrome have intrauterine adhesions and present with menstrual abnormalities, infertility or recurrent pregnancy loss. It is now recognized that the prevalence of Asherman Syndrome varies geographically because of the different laws and methods of abortions in the world. To date, there is paucity of data looking at the clinical characteristics and reproductive outcomes of women with this condition in our population. Methods: This is a retrospective case series analysis of 76 patients diagnosed with Asherman Syndrome in a tertiary women’s hospital in Singapore from January 2008 to December 2009. All patients underwent hysteroscopic evaluation and treatment of intrauterine adhesions. Our center uses a modified classification based on that by the European Society of Gynecological Endoscopy to grade adhesions into mild, moderate or severe. The demographics, predisposing factors and the menstrual symptoms and reproductive outcomes following treatment at two-year follow up were recorded. Results: The median age of the 76 patients was 35 years, with age ranging from 24 to 45 years. The racial ethnicity of our study population were 71% (54/76) Chinese, 13.1% (10/76) Malay, 7.9% (6/76) Indian and other races constituted the remaining 7.9% (6/76). 81.6% of patients with Asherman Syndrome had prior trauma to the gravid uterus, making this the main predisposing factor. Other factors documented included trauma to the non gravid uterus (hysteroscopy/ polypectomy), infection and uterine manipulation during hysteroscopy. No obvious predisposing factor was found in 5.3% of our study group. 65.8% of the patients in our study had presented purely with subfertility, of which 50% had mild adhesions. In contrast, 60.8% of the patients who presented with menstrual abnormalities had moderate to severe adhesions. Mild adhesion s Moderat e 24 Number of Patients 24 Clinical pregnancy Live birth 14/24 (58.3%) 11/14 (78.5%) 17 9/17 (52.9%) 7/9 (77.8%) adhesion s Severe adhesion s Total 6 5/6 (83.3%) 1/5 (20%) 47 28/47 (59.6%) p=0.503 19/28 (67.8%) p=0.0566 There was a return of normal menses in 20/23 (87%) of patients presenting with menstrual abnormalities. Of the 56 patients who presented with subfertility, 9 were lost to follow up for the two-year period. Clinical pregnancy was achieved in 59.6% of patients. When comparing mild and severe adhesions, the live birth rate was significantly higher (78.5%) in the mild adhesions group when compared to the group with severe adhesions (20%), p=0.038. When comparing the patients presenting with subfertility who had prior trama to a gravid uterus, there was no significant difference in the conception and live birth rate when comparing groups with increasing number of procedures to the gravid uterus. For 19 patients who achieved live births in our study population, 21% (4/19) had preterm deliveries while 10.5% (2/19) had abnormal placentation (one placenta accreta and one placenta praevia major). Conclusion: The most common predisposing factor for developing Asherman syndrome in our population was trauma to the gravid uterus. The severity of adhesions has an impact on the prognosis of reproductive outcomes, with patients diagnosed with mild adhesions achieving a significantly higher live birth rate than patients with severe adhesions. Successful pregnancies after hysteroscopic adhesiolysis should be monitored closely antenatally due to the high rates of obstetric complications reported in this population. Disclosure of Interest: None Declared O06 EXPRESSION PATTERNS OF HOXA-10, HOXA-11 AND LIF IN THE ENDOMETRIUM OF FERTILE AND INFERTILE WOMEN: PILOT RESULTS. C. MARGIOULA-SIARKOU 1 2,*, S. PETOUSIS 1 2, S. MILIAS 3, K. HAITOGLU 4, G. MAVROMATIDIS 1, Y. PRAPAS 1 2, D. ROUSSO 1, N. PRAPAS 1 2 13rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 2IAKENTRO, Infertility Tretament Center, 3Division of Pathology, 424 General Army Hospital, 4Laboratory of Biochemistry, Aristotle University of Thessaloniki, Thessaloniki, Greece Problem Statement: ΗΟΧΑ-10, HOXA-11, as well as Leukemia Inhibitory Factor (LIF) have been indicated to have an important role in endometrial receptivity. Nevertheless, the possible relationship between their expression patterns and cause of infertility has not yet been clarified. Main objective of the present study was to analyze expression patterns of ΗΟΧΑ-10, HOXA-11 and LIF in the endometrial tissue of fertile and infertile women, during the window of implantation. Methods: : A prospective PhD research study was conducted during 1/20133/2014 in 3rd Department of Obstetrics and Gynecology of Aristotle University of Thessaloniki and Iakentro, Infertility Treatment Center. Women having delivered at least one alive newborn and without signs of potential infertility were the study’s control group (fertile women, group 1) while those with diagnosed infertility were the patients’ group (infertile women, group 2). An endometrial biopsy was obtained by Pipelle on 7th-8th day after ovulation confirmation in each woman. Immunohistochemistry was performed to assess expression of HOXA10 and HOXA-11 in stromal cells as well as expression of LIF in both epithelial and stromal cells. Primary outcomes were defined to be positive nuclei percentage (expressed as % percentages) as well as intensity of staining and the combined rate of h-score (expressed as mean ± SEM). The former parameters were compared between fertile and infertile women. Statistical significance was defined as P<.05 while statistical trend as P<.20. Results: There were overall 25 women (10 fertile and 15 infertile) meeting the inclusion criteria during the study’s period, of which endometrial sample was successfully obtained by 7 fertile and 14 infertile women. Mean age was 30.7 ± 0.8 years for group 1 and 37.3 ± 3.5 for group 2 (P=.002). Endometrial staining was out-of-phase in 1 out of 7 controls (14.3%) while in 7 out of 14 infertile women (50.0%) (P=.16). HOXA-11 staining was significantly increased in the endometrium of infertile women (P=.02). Similarly HOXA-11 h-score was 0.7 ± 0.3 in fertile vs. 1.4 ± 0.2 in infertile women (P=.08). In contrary, LIF positive Abstract Book nuclei percentage in epithelial cells was 50.7% in group 1 vs. 27.3% in group 2 (P=.16), while h-score was respectively 1.3 ± 0.4 vs 0.6 ± 0.2 (P=.18), demonstrating a statistical trend of higher expression in fertile women. No significant difference or trend was detected regarding the expression of HOXA11 and LIF in stomal cells between the two groups (P>.20). Conclusion: Pilot results of our study indicate that HOXA-11 expression is significantly higher in the endometrium of infertile women. LIF expression in epithelial endometrial cells may also be impaired in the infertile group. Conversely, HOXA-10 and LIF expression in stromal cells may not differ significantly between fertile and infertile women. Progesterone receptors’ impaired expression may potentially present an important aitopathogenetic factor of causing implantation failure. O07 PROGESTERONE RECEPTORS’ EXPRESSION IS SIGNIFICANTLY DECREASED IN THE ENDOMETRIUM OF INFERTILE WOMEN AND PRESENTS SIGNIFICANT DIFFERENCES AMONG VARIOUS SUB-CATEGORIES OF INFERTILITY: PILOT RESULTS. S. PETOUSIS 1 2,*, C. MARGIOULA-SIARKOU 1 2, S. MILIAS 3, K. RAVANOS 2, K. HAITOGLU 4, Y. PRAPAS 1 2, D. ROUSSO 1, N. PRAPAS 1 2 1 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 2IAKENTRO, Infertility Treatment Center, 3Division of Pathology, 424 General Army Hospital, 4Laboratory of Biochemistry, Aristotle University of Thessaloniki, Thessaloniki, Greece Problem Statement: Controlled ovarian hyperstimulation (COH) is one of the key steps of assisted reproductive technology (ART). Safe and cost-effective COH protocols with good patient compliance play a pivotal role in improving the success rate for in vitro fertilization/embryo transfer (IVF/ET). In recent years, GnRH antagonist (GnRH-ant) is increasingly being used in China. It can induce a rapid decrease in LH and FSH, preventing and interrupting the premature LH surge. For women of advanced reproductive age with relatively poor ovarian function, whether GnRH-ant protocols can provide good quality of embryo and high pregnancy rate? In this study, we compared the effect of different ovarian stimulation protocols with GnRH antagonist and agonist on the oocyte and embryo quality. Our aim was to select personalized COH protocols with improved softy, efficiency and cost-effectively. Methods: This study was approved by the local ethics review committee. Retrospective analysis of the 844 cycles of IVF data between the period of January 2012 and December 2012 from patients (38~42 years of age) with an indication for IVF in our center was performed. Patients with the following conditions were enrolled: cycle number ≤ 2, FSH ≤ 12, and retrieved oocyte number ≥ 4. Patients with mini-stimulation protocol and natural cycles were excluded. The patients were divided into four groups: GnRH-ant group (n=212), GnRH agonist short protocol group (n=367), GnRH agonist long protocol group (n=126), and GnRH agonist ultra-long protocol group (n=139). The data of FSH, E2, LH, HCG, serum LH, serum E2, Gn days, Gn dosage, retrieved oocyte number, cycle available embryo number, oocyte maturation rate, fertilization rate, low fertilization rate, fertilization failure rate and implantation cancelling rate of different groups were collected, respectively. Data were analyzed using SPSS18.0 software package. P<0.05 was considered significantly different. Results: In women of advanced reproductive age, the retrieved oocyte number and cycle available embryo number in the GnRH-ant group was significantly higher than that in the short protocol group (10.500±5.224 vs. 18.603±4.427, P<0.05;4.515±3.668 vs. 3.557±3.403; P<0.05); P<0.05); the implantation rate and pregnancy ratein the GnRH-ant group was significantly higher that of the short protocol group (12.62% vs. 8.85%, P<0.05;28.35% vs. 16.81%;P<0.05), the abortion rate in the GnRH-ant group was significantly lower than that in the short protocol group (26.92% vs. 47.37%;P<0.05); the live birth rate in the GnRHant group was significantly higher than that of the short protocol group (18.04% vs. 6.98%;P<0.05). Conclusion: In our studies, it shows GnRH-ant protocol is advantageous in the aspects of being simple and quickly enrolling in the treatment period. The Gn doses and Gn days in the GnRH-ant protocol were less than that in the long protocol. Compare with the agonist protocols, the GnRH-ant protocol was more suitable for the elderly patients. The laboratory data and clinical outcomes of the GnRH-ant protocol are comparable to that of the GnRH agonist long and ultra-long protocols, whereas are better than that of the agonist short protocol. Compared with the short protocol, the embryo quality as well as the clinical pregnancy rate and live birth rate were significantly improved and the aborting rate was significantly reduced in the GnRH-ant protocol group. Disclosure of Interest: None Declared Disclosure of Interest: C. MARGIOULA-SIARKOU Grant / Research support from: IKY FELLOWSHIPS OF EXCELLENCE FOR POSTGRADUATE STUDIES IN GREECE, S. PETOUSIS: None Declared, S. MILIAS: None Declared, K. HAITOGLU: None Declared, G. MAVROMATIDIS: None Declared, Y. PRAPAS: None Declared, D. ROUSSO: None Declared, N. PRAPAS: None Declared Problem Statement: The expression of progesterone receptors type A and B is involved in the normal implantation procedure of blastocyst. Main objective of the present study was to compare the expression of total progesterone receptors (A+B), as well as type-B receptors between fertile and infertile women as well as between the various categories of infertility. Methods: These are the pilot results of a PhD research performed since 1/2013 in 3rd Department of Obstetrics and Gynecology of Aristotle University of Thessaloniki and Iakentro, Infertility Treatment Center. Women having delivered at least one alive newborn and without signs of infertility consisted the study’s control group (fertile women, group 1) while infertile women the patients’ group (group 2). Infertile women were also categorized according to their infertility cause to those with ovarian failure (group 2a), tubal factor infertility (group 2b) or with recurrent pregnancy loss and multiple IVF failures (group 2c). All women recruited in our analysis were set on daily ultrasound examination from 7th menstrual day in order to detect ovulation day and were afterwards performed an endometrial biopsy by Pipelle on 7th-8th menstrual day after ovulation. Immunohistochemistry was performed to measure expression of total progesterone receptors (TPR) as well as type-B receptors (PR-B) in both epithelial and stromal cells. Primary outcomes were positive nuclei staining, intensity of staining and their combined rate h-score. The former outcomes were compared between groups 1 and 2 as well within the different sub-groups of infertility. Results: There were overall 30 women (10 fertile and 20 infertile) meeting the inclusion criteria during the study’s period. Endometrial sample was successfully obtained by 7 fertile and 19 infertile women, 8 of which were diagnosed with ovarian failure, 5 with tubal infertility and 6 with RPL or multiple IVF failure. Mean age was 30.7 ± 0.8 years for group 1 and 37.3 ± 3.9 for group 2 (P=.001). TPR and PR-B expression was significantly decreased in the epithelial cells of infertile women compared with fertile controls. Specifically, TPR h-score was 2.2 ± 0.3 for group 1 vs. 1.0 ± 0.3 for group 2 (P=.05), while PR-B h-score was 1.5 ± 0.4 for group 1 vs. 0.7 ± 0.2 for group 2 (P=.05). No significant difference was observed regarding their expression in stromal cells. Finally, when comparing within the different sub-categories of infertility, both TPR and PRB expression in epithelial cells presented significant differences among groups (P=.05 and P=.02 respectively), the lower rates being observed in group 2c (1.1 ± 0.3 for TPR and 0.2 ± 0.1 for PRB). Conclusion: Pilot results of our study indicate that progesterone receptors’ expression in epithelial cells is decreased in infertile women, the lower expression being observed in women with recurrent pregnancy loss. Disclosure of Interest: S. PETOUSIS Grant / Research support from: STATE SCHOLARSHIP FOUNDATION OF GREECE, C. MARGIOULA-SIARKOU: None Declared, S. MILIAS: None Declared, K. RAVANOS: None Declared, K. HAITOGLU: None Declared, Y. PRAPAS: None Declared, D. ROUSSO: None Declared, N. PRAPAS: None Declared O08 COMPARISON OF OVARIAN STIMULATION PROTOCOLS WITH GNRH ANTAGONIST AND AGONIST: A LARGE RETROSPECTIVE STUDY IN WOMEN OF OVER 38 YEARS OLD X. Shi 1,*, P. Liu 2, J. Qiao 2 1Medical Center for Human Reproduction, Beijing University Third Hospital, 2Beijing University, Beijing, China 25 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 O09 A NOVEL METHOD OF PRIMING WITH A GNRH AGONIST BEFORE IMMATURE OOCYTE RETRIEVAL MAY IMPROVE MATURITY OF OOCYTES AND OUTCOME IN IN VITRO MATURATION (IVM) CYCLE: A CASE REPORT A. Smirnova 1,*, M. Anshina 1, A. Ellenbogen 2 1 IVF&Genetics Center "FertiMed", Moscow, Russian Federation, 2Department of Obstetrics and Gynecology, IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel Problem Statement: IVM of oocytes technique was introduced into clinical practice more than 20 years ago. It was demonstrated that HCG priming has an important value in IVM outcome. It was shown in an antagonist cycle that GnRH agonist (GnRHa) is as effective as HCG to induce adequate follicular maturation. The possible mechanism is simultaneous induction of FSH surge, comparable to the surge of natural cycle which promote development of LH receptors in granulosa cells and oocyte nuclear maturation and cumulus expansion. Two RCTs reported the retrieval of more mature oocytes after GnRHa trigger, which might be attributed to the presence a FSH surge as well as LH. Methods: The purpose of this report was to examine the effect of GnRHa priming, instead of HCG, before immature oocytes retrieval in an IVM cycle. Methods: A 38 years old woman was referred to IVF&Genetics Center for fertility preservation. She underwent adnexectomy from the right side because of large papillar mucinous ovarian cystadenoma and cystectomy of the left ovary because of mucinous cystadenoma. The recurrence of cystadenoma of the left ovary was diagnosed 3 years after last surgery and present up to her admittance in our unit. Basal FSH was 6.9 IU/l, AMH 0, 35 ng/ml, AFC 5. Results: Results: In accordance with Russian legislation ovarian stimulation including HCG is forbidden in women with ovarian tumors. Therefore triggering of ovulation with a GnRHa was conducted. A first IVF attempt was performed in a natural cycle. No oocyte was obtained. In order to maximize the number of oocytes obtained without stimulating the ovaries, three IVM attempts were performed. 1st attempt: Decapeptyl 0, 2 mg was given on day 8, when leading follicle achieved 9,5 mm in diameter. OPU was performed 39 hours later, 3 oocytes were retrieved. All of them were cultured for 5 hours in maturation medium (SAGE), stripped and fertilized by ICSI on the day of follicle aspiration. Three good quality embryos were vitrified on day 3. 2nd attempt: Same trigger was given on day 10, leading follicle = 10,5 mm. OPU was performed 39 hours later, 6 oocytes were retrieved, all MII after 4 hours of culture in proper medium. Five oocytes developed in 2pN 19 hours after ICSI. One good quality embryo was vitrified on day 3, other were cultured till day 6, and two poor quality blastocyst were obtained. 3rd attempt: Decapeptyl 0, 2 mg was given on day 10, leading follicle = 10 mm. OPU was performed 39 hours later. 3 oocytes were retrieved, cultured for 5 hours, denudated and fertilized by ICSI on the day of follicle aspiration. Two good quality embryos were vitrified on day 3. In summary, six good quality embryos were vitrified on day 3. After performing cystectomy in order to rule out malignancy frozen embryo transfer is planned. Conclusion: In an IVM cycle the percentage of MII oocytes after 6-48 hours of maturation in IVM media usually don’t exceed 70%. In our case all retrieved oocytes became MII on the day of follicle aspiration. It is possible that the high early maturation rate obtained is due to GnRHa-induced surge of FSH which may promote nuclear and cytoplasmic maturation of oocyte. Disclosure of Interest: None Declared O10 CAN INTRA CYTOPLASMATIC MORPHOLOGICALLY SELECTED SPERM INJECTION (IMSI) TECHNIQUE IMPROVE OUTCOME IN PATIENTS WITH REPEATED IVF/ICSI FAILURE- A COMPARATIVE STUDY E. Adrian 1,*, S. P. Einat 1, M. Medeia 1 1IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel Problem Statement: Spermatozoal morphology was reported to effect fertilization, embryo quality and pregnancy results in spontaneous conception and ART. IMSI is an innovative, not invasive technique, which examines the sperm with no harm at a magnification of x6000 in order to obtain optimal sperm to perform ICSI. We evaluated the efficiency of IMSI technique in patients with 26 repeated IVF/ICSI failure of at least 3 cycles with no viable pregnancy and /or very poor sperm quality. Methods: All couples that performed IMSI between the years 2009 to 2012 were enrolled retrospectively to the study. Couples with male infertility who were treated with IMSI were included in the study. All their treatments were evaluated and divided into 2 subgroups: conventional IVF-ICSI treatment and their subsequent IMSI treatment. Demographic data, clinical parameters and outcome were recorded. The IMSI treatments were compared to previous nonIMSI treatments in terms of fertilization rates, cleavage rates, number of embryos and their quality, number of embryos transferred and pregnancy outcome. Results: Forty two couples were reviewed. Basic characteristics of the groups were comparable. Fertilization and cleavage rates of the two groups were comparable. The embryos quality demonstrated a trend towards superior quality (grade 1-2) embryos in the IMSI vs. ICSI (60% vs. 47%; P=0.07 and 53% vs. 40%; P=0.07) respectively. Implantation and clinical pregnancy rates were significantly superior in IMSI group (19.2% vs. 7.8%; P=0.042 and 41.3% vs. 10.5%; P=0.02 respectively). Miscarriage rate was significantly higher in conventional IVF-ICSI group (100% vs. 15.8%; P=0.04) and live birth rate was significantly higher in IMSI group (0 in conventional IVF-ICSI and 34.7% per transfer in IMSI group; P=0.003) Conclusion: IVF outcome of IMSI resulted in a higher implantation rate, pregnancy rate and most importantly delivery rate compare to non IMSI treated cycles. Disclosure of Interest: None Declared O11 DOES BMI INFLUENCE OOCYTE VOLUME IN IN VITRO FERTILIZATION-INTRA CYTOPLASMATIC SPERM INJECTION CYCLES? E. Adrian 1,*, S. P. Einat 1, M. Medeia 1 1IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel Problem Statement: Oocytes from animal models with insulin- resistant and obese mice showed delayed maturation, smaller oocyte size, and increased granulosa cell apoptosis. These findings are linked to adverse embryonic and fetal outcomes including delayed embryonic development, growth restriction, anatomic defects, and smaller fetuses. In humans, excess body fat is associated with chronic oligo-anovulation and infertility due to hyperinsulinemia and ovarian hyperandrogenemia.Obesity is also associated with higher miscarriage rates, a higher prevalence of gestational diabetes as well as pregnancy induced hypertension. Obesity induced elevations in insulin, glucose, and free fatty acids. It appears to impact the developmental competence of the oocyte as well as other tissues: sperm, embryo, placenta, or uterine environment. Negative environmental exposures may affect the developmental competence of the oocyte; defined as the ability of the oocyte to be fertilized and support embryo development. The aim of the study was to evaluate the effect of BMI on oocyte volume and treatment cycle outcomes Methods: Prospective, cohort study - Women undergoing IVF-ICSI cycles were divided into two subgroups according to their BMI: Obese BMI > 30; Lean BMI < 25. We evaluated the effect of BMI on the number of oocytes retrieved, fertilization and cleavage rates, number of top quality embryos, pregnancy rate and oocyte’s diameter and volume. All oocytes were captured after denudation of the granulosa cells before ICSI by an Olympus camera in the inverted microscope. A Zilos laser and software allowed the measurement of computercaptured digital images by using built-in tools that automatically calculated the mean and standard deviation of each measurement. We measured the diameter of each mature oocyte, zona pellucida and oolema and calculates the oocyte volume. Results: 26 cycles of IVF-ICSI were analyzed. 10 obese patients (77 oocytes) and 16 lean patients (149 oocytes). FSH, LH, Estradiol and number oocytes retrieved were comparable between the two groups. The oocytes obtained from obese patients were significant smaller in total oocytes diameter and volume (162.5±5.2 vs. 164.5±5.1, P=0.01; 2.2*10^6±0.2 vs. 2.3*10^6±0.2, p=0.01). However, oolema diameter and volume were comparable. Significantly higher percent of top quality embryos and higher pregnancy rate was obtained in the lean group (49% vs 33% and 50% vs 37.7% respectively, p<0.04). Abstract Book Conclusion: Oocytes from obese patients have lower volume than from lean patients. A direct correlation was found between smaller oocyte volume and oocytes function in terms of less TOP quality embryos.and lower pregnancy rate. It is possible that this finding may be caused by an abnormal metabolism of fat in oocytes of obese patients causing a decrease in vital elements needed for energy buildup into the oocytes. Our study suggests that the results of In Vitro Fertilization treatment are correlated with body mass index. Disclosure of Interest: None Declared O12 SIGNIFICANCE OF HYSTEROSCOPIC EVALUATION AND TREATMENT OF UTERINE ANOMALIES BEFORE ASSISTED REPRODUCTIVE TECHNOLOGIES A. Fazekas *, Z. Benedek, A. Vereczkey Versys Clinics Human Reproduction Institute, Budapest, Hungary Problem Statement: Uterus anomalies (e.g. septum, subseptum, arcuatus, and T shaped endometrium) with different severity may be the reason of infertility in 20-40 % of cases. It has been known already that operative treatment of these anomalies significantly increases the pregnancy and live birth rates and reduces miscarriage rate and preterm birth. Currently it has been proven that surgerical correction of smaller variances (e.g. uterus arcuatus) may be reasonable as well in case of infertility or recurrent misscarriages. Methods: Our aim was to retrospectively analyse the experiences of hysteroscopic septum/subseptum resection and its possible effect on infertility treatment on patients appearing at our clinic between October 2010 and March 2014. We were interested in the average age of the women, the success of the IVF (in vitro fertilization) treatment (pregnancy and live birth rates). Results: Average age of the patients was 36.2 years old. We performed 155 hysteroscopy during the examined time period. In 132 cases we executed hysteroscopy only, while in 23 cases hysteroscopy was performed together with laparoscopy. In total, we fulfilled 62 hysteroscopic septum/subseptum resections. Out of these, follow-up of 54 cases was possible. All of these patients obtained clinical pregnancy (41 spontaneous and 13 after IVF treatment), but in four cases the pregnancy ended in misscarriage (1 spontaneous and three after IVF treatment). In summary, after surgical treatment of uterus septum/subseptum the clinical pregnancy rate was 100 %, while the live birth rate was 92 %. Conclusion: The results obtained at our clinic fit well in international trends and support recent data in literature, as uterus septum with different severity treated by hysteroscopic septum resection is necessary to obtain successful pregnancy in infertile patinets. Further prospective trials would be needed though with higher number of cases to prove its exact role in the treatment of infertile patients. Disclosure of Interest: None Declared O13 ARE PROTEASE INHIBITORS ASSOCIATED WITH IMPAIRED GLUCOSE METABOLISM IN HIV-INFECTED PREGNANT WOMEN? H. Adler 1,*, R. Moore 2, V. Jackson 3, M. Eogan 2, M. Byrne 4, M. Lawless 5, J. Lambert 1 5 6 1Infectious Diseases, Mater Misericordiae University Hospital, 2Obstetrics and Gynaecology, 3Clinical Audit & Surveillance Scientist, Rotunda Hospital, 4Endocrinology, Mater Misericordiae University Hospital, 5Infectious Diseases, Rotunda Hospital, 6School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland Problem Statement: Metabolic complications including diabetes mellitus have been increasingly recognized in HIV-infected individuals since the introduction of antiretroviral therapy (ART). Protease inhibitors (PIs) are a particular concern in this regard. PI-based ART regimens are frequently employed in pregnant HIVinfected women and previous studies have given conflicting results regarding the contribution of PIs to impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM) in such patients. An association with GDM has the potential to limit the choices of ART regimens in pregnant women. Methods: This study was a retrospective review of all HIV-infected women attending a combined infectious disease and antenatal clinic between 2007 and 2013 who underwent a 100g oral glucose tolerance test (OGTT) at 24-28 weeks gestation with blood glucose levels measured at 0, 1, 2 and 3 hours. Carpenter/Coustan thresholds were used for diagnosis of GDM. Test results, baseline demographics, ART regimens and obstetric outcomes were collated. Results: 141 women with HIV underwent an OGTT in our clinic over the time frame of the study. The average age was 31 years, all women were of European or African origin and 33% had a body-mass index >30kg/m2. 93.6% were on protease-inhibitor based regimens. The prevalence of IGT was 2.84%, while the prevalence of GDM was 2.13%; this is similar to the rates of GDM in our general pregnant population. 71.4% (n = 5) of women with abnormal glucose metabolism were taking PIs, versus 94.8% (n = 127) of normoglycaemic women (p = 0.06). No differences in obstetric outcomes were observed. Conclusion: This study did not detect an increased rate of GDM in HIV-infected women in our patient population and found no association between PI use and GDM. The ethnic makeup of our study population may partially explain the low rates of GDM compared with previous studies. Glucose tolerance in pregnant women infected with HIV should remain a priority for future research, but our study does not suggest any linkage between PI use and GDM. Disclosure of Interest: None Declared 014 EFFECTS OF CONTINUOUS USE OF ENTONOX IN COMPARISON WITH INTERMITTENT METHOD ON MATERNAL OUTCOMES: A RANDOMIZED CLINICAL TRIAL J. Agah 1,*, R. Baghany 1, S. H. Safiabadi Tali 2, Y. Tabarraie 3 1gyn&obstetrics, SABZEVAR MEDICAL UNIVERSITY, sabzevar, 2Internal medicine, Ghazvin medical university, Ghazvin, 3Biostatics, SABZEVAR MEDICAL UNIVERSITY, sabzevar, Iran, Islamic Republic Of Problem Statement: Background: Entonox is commonly used intermittently. Practically, synchronization of using Entonox and uterine contractions in this method, is difficult. So, some laboring women are interested in breathing in face mask continuously. On the other hand, health staff remind them to put the mask aside between contractions strictly. In such situation, the intermittent method can be associated with anxiety and fatigue for both mothers and midwives. So we decided to compare the maternal complications induced by two methods to find out whether it is safe to permit the mothers using Entonox continuously or not? Methods: This randomized clinical trial was performed in Mobini Hospital, Sabzevar, Iran. 50 parturients used Entonox intermittently and 50 persons used it continuously during labor. Then maternal obstetrical outcomes were compared in two groups. Statistical Analysis was performed by spss17 software, t-test and chi square test. Results: This study showed maternal collaboration during delivery was more in continuous group significantly (p=0.03). Perineal lacerations was less in the continuous group significantly (p=0.04). Assisted vaginal birth was not different significantly (0.4). Uterine atony had no significant difference in two groups (p=0.2). Satisfaction rate was higher in continuous group significantly (0.000). Conclusion: Our study showed that parturiens in continuous group had less obstetric complications than the intermittent group. Also, they were more satisfied by this method significantly. It seems by further researches, we can suggest continuous method of Entonox to laboring women. Disclosure of Interest: None Declared O15 POSTPARTUM UNFORESEEN CONVULSION: A RARE CASE OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES) J. Agah Department of obstetrics & gynecology, Faculty of medicine, Sabzevar university of medical sciences, Sabzevar, Iran Gyn&obstetrics, SABZEVAR MEDICAL UNIVERSITY, sabzevar, Iran, Islamic Republic Of 27 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Problem Statement: One of the causes of peripartum convulsion is posterior reversible encephalopathy syndrome (PRES).The symptoms are including: headache, nausea and vomiting, confusion, blurred vision, blindness and seizure. Some situations can predispose the mother to this syndrome including; hypertensive encephalopathy, preeclampsia and eclampsia, lupus erythematous, thrombotic thrombocytopenic purpura, renal failure and long use of immunosuppressive drugs like cyclosporine.Usually it is accompanied by other events mostly hypertensive disorders. The following case is a pure rare case of "pres" without any associated factors. Methods: A postterm primigrvida woman aged 25 years admitted for induction of labor in Mobini hospital, Sabzevar, Iran. After an uneventful vaginal delivery. She suddenly involved in a generalized tonic-clonic seizure. Her blood pressure was normal and the tests rolled out eclampsia and brain CT-scan was normal.but MRI revealed hyperintensive T2 signals in cortical part of parietooccipital lobes indicating ”PRES”. The convulsion was controlled and did not appear by administration of anticonvulsant drug. Results: She was discharged with Phenytoin and showed healthy status in several months follow up. Image / Graph: Conclusion: “PRES” is a dreadful but reversible phenomenon, if the approach in acute phase is prompt and proper, the patient will recover completely. Disclosure of Interest: None Declared O16 SCREENING FOR GESTATIONAL DIABETES: DOES A FALSE POSITIVE GLUCOSE CHALLENGE TEST PREDICT ADVERSE PREGNANCY OUTCOME? R. H. Al-Haddabi 1,* and Rahma Al-Hadabbi, Heather Scott, Colleen O’Connell, Krista Jangaard, B. Anthony Armson. 1Obstetrics and gynecology, Sultan Qaboos University Hospital, MUSCAT, Oman Problem Statement: To determine if women with a positive glucose challenge test (GCT) and negative oral glucose tolerance test (OGTT) are at greater risk for pregnancy complications than women with a negative GCT. Methods: : A retrospective cohort of all pregnant women who underwent a GCT from 1998 to 2005 at the IWK Health Centre was divided into four groups: 1) negative GCT (control); 2) positive GCT, negative OGTT (false positive GCT); 3) impaired glucose tolerance (IGT); 4) gestational diabetes (GDM). The primary outcome was neonatal macrosomia. Demographic and pregnancy outcome information was obtained from the Nova Scotia Atlee Perinatal Database. SPSS statistical software was used for univariate and regression analysis. Results: Among the cohort of 23,801 parturients, 89.2% were GCT negative, 6.3% had a false positive GCT, 2% had IGT and 2.5% had GDM. Women with a false positive GCT were more likely to be older, nulliparous, obese and have a past history of GDM than controls. The risk of neonatal macrosomia > 4500g, was increased in women with a false positive GCT compared to controls (OR1.43 95% CI 1.08 – 1.88) as was the risk of other adverse outcomes associated with GDM. Only neonatal hypoglycemia, hyperbilirubinemia and preterm birth remained significant after controlling for other risk factors for adverse perinatal outcome including maternal obesity. Conclusion: Women with a false positive GCT are at risk for adverse pregnancy outcomes commonly associated with GDM. The magnitude of this risk is mitigated by other risk factors, particularly maternal obesity. Disclosure of Interest: None Declared 28 O17 EARLY VERSUS LATE INTRAUTERINE FETAL DEATH: A COMPARAISON OF THE ETIOLOGY FROM SINGLE HEALTH CENTRE H. Al-Mandeel,*, S. Al-Mutairy, A. Alhazzaa, M. Bukhari, A. Al-Badr Obstetrics & Gynecology, King Saud University, Riyadh, Saudi Arabia Problem Statement: intrauterine fetal death is one of the major obstetrics complications that remain a significant and understudied. Objectives: to compare etiologies in early versus late Intrauterine fetal death (IUFD). Methods: A retrospective cohort study of all cases of intrauterine fetal death presented to a university hospital from 2006 to 2013. Study population was based according to WHO as a baby born with no signs of life at or after 20 weeks of gestation. Cases were classified in to two groups early IUFD (20weeks33weeks) and late IUFD (34 weeks and above). Results: Total number of births during the study period was 26539 births including 304 cases (1.14%) of IUFD. 24 cases were excluded from analysis, due to missing records or being incorrectly coded, leaving 280 cases (92.1%) for analysis. The cases included130 cases (46.4%) in group 1 (from 20 weeks to33 weeks) and 150 cases (53.6%) in group 2(34 weeks and more). 46.4% of group 1 and 68% of group 2 were not having regular antenatal care. There were no significant difference in the etiology of IUFD such as obstetrics complications, maternal medical diseases, fetal congenital anomalies, umbilical cord abnormalities, and maternal/fetal infections between the 2 groups except for IUGR and GDM which were significantly higher in late IUFD group (41% vs.18.4% and 20.7% vs. 7.7%, respectively). Placental abnormalities were also higher in both IUFD groups though; there was no significant difference between two groups. Conclusion: Intrauterine feral death is not a rare incidence. Intrauterine growth restriction and GDM are associated with late IUFD in comparison to early IUFD. Disclosure of Interest: None Declared O18 RISK FACTORS FOR MATERNAL AND NEONATAL MORBIDITIES ASSOCIATED WITH OPERATIVE VAGINAL DELIVERIES M. R. C. Arcilla*, B. Zamora OB GYN, St. Luke's Medical Center, Quezon City, Philippines Problem Statement: Risk Factors for Maternal and Neonatal Morbidities Associated with Operative Vaginal Deliveries. Objective: To determine the risk factors for maternal and neonatal complications associated with operative vaginal deliveries. Methods: A retrospective chart review of 435 patients who underwent operative vaginal deliveries was done. Patient profiles – age, parity, AOG, duration of labor – and outcomes – birthweight, maternal and neonatal complications - were tabulated and multivariable analysis and logistic regression were performed using SPSS® Statistics Base. Results: Results and Conclusion: There was no significant difference in the incidence of maternal and neonatal complications between those that underwent vacuum and forceps extraction. Among the variables analysed, parity and duration of labor reached statistical significance. The odds of maternal complications were 3 times higher among nulliparous patients. Neonatal complications were seen in those whose labor lasted more than 9 hours. Conclusion: This study concludes that in a tertiary-hospital setting, instrumental vaginal delivery is a relatively safe alternative for effecting vaginal delivery. The choice of instrument, whether silicone rubber cups or forceps, does not impact the possibility of morbidities. However, if vaginal delivery in a nullipara is predicted to be difficult and complex, after more than 9 hours of labor, then maternal and neonatal complications must be anticipated and outweighed. Operative vaginal delivery should only be performed if there is an appropriate indication. No indication is absolute because the option of cesarean delivery is always available. Disclosure of Interest: None Declared Abstract Book 019 INTRAVENOUS TRANEXAMIC ACID- CAN IT REDUCES BLOOD LOSS IN CAESAREAN SECTION CASES? S. S. M. Aris 1 2 3,*, A. azizi 3, S. Khalid 1, N. naim 2 2 1O&G, Universiti Sains Islam Malaysia (USIM), NILAI, 2O&G, PPUKM, Cheras, 3O&G, SGH, Kuching, Malaysia Problem Statement: To study the effectiveness of tranexamic acid in reducing blood loss during and after caesarean section in Sarawak General Hospital. Methods: A prospective, randomised, case-controlled clinical trial was conducted on 174 patients who underwent caesarean section. The study group, 93 patients received intravenous Tranexamic Acid 1Gm immediately before caesarean section whereas the control group, 81 patients did not receive any. Blood losses were measured in two periods; the intra-operative loss (from placental delivery to the end of caesarean section) and the post-operative loss (from the end of caesarean section to 6 hours post-partum). Full blood count was tested 24 hours after caesarean section. It was then compared between the two groups. Any adverse effects and complications during the study also evaluated. Results: Tranexamic acid significantly reduced the blood loss during and after caesarean section. Median blood loss was significantly less in the study group compared with control group in intra-operative loss 302.38 ml (202.85-501.19) vs 402.85ml (302.38-503.09) ) and post-operative loss 150.00 ml (90.00-180.00) vs 180.00ml (150.00-270.00) ) with p=0.001 respectively. Median haemoglobin level 24 hours post-operation was significantly greater in study group compared to control group 11.10g/dL (10.15-12.05) vs 11.00g/dL (9.60-11.90) with p=0.02. No complications or adverse effects of tranexamic acid were reported in both groups. Conclusion: Intravenous Tranexamic acid significantly reduced intra-operative and post-operative blood loss during Caesarean Scetion. It can be use safely and effectively in women undergoing caesarean section. Disclosure of Interest: None Declared 020 PRENATAL DIAGNOSIS OF FETAL ANEUPLOIDIES USING QF-PCR: THE EGYPTIAN STUDY S. H. Atef 1 1Clinical Pathology, AIN SHAMS UNIVERSITY, FACULTY OF MEDICINE, Cairo, Egypt Problem Statement: The most common chromosomal abnormalities identified at birth are aneuploidies of chromosome 21, 18, 13, X and Y. Prenatal diagnosis of fetal aneuploidies is routinely done by traditional cytogenetic culture, a major drawback of this technique is the long period of time required to reach a diagnosis. In this study we evaluated the QF-PCR as a rapid technique for prenatal diagnosis of common aneuploidies Methods: This work was carried out on Sixty amniotic fluid samples taken from patients with one or more of the following indications: Advanced maternal age (3 case), abnormal biochemical markers (6 cases), abnormal ultrasound (12 cases) or previous history of abnormal child (39 cases).Each sample was tested by QF-PCR and traditional cytogenetic. Aneuploidy screenings were performed amplifying four STRs on chromosomes 21, 18, 13, two pseudoautosomal, one X linked, as well as the AMXY and SRY; markers were distributed in two multiplex QFPCR assays (S1 and S2) in order to reduce the risk of sample mishandling Results: All the QF-PCR results were successful, while there was two culture failures, only one of them was repeated. No discrepancy was seen between the results of both techniques. Fifty six samples showed normal patterns, three sample showed trisomy 21, successfully detected by both techniques and one sample showed normal pattern by QF-PCR but could not be compared to the cytogenetics due to culture failure, the pregnancy outcome of this case was a normal baby Conclusion: Our study concluded that QF-PCR is a reliable technique for prenatal diagnosis of the common chromosomal aneuploidies. It has the advantages over the cytogenetic culture of being faster with the results appearing within 24-48 hours, simpler, doesn't need a highly qualified staff, less prone to failure and more cost effective. Disclosure of Interest: None Declared O21 PREGNANCY OUTCOMES IN SYSTEMIC LUPUS ERYTHEMATOSUS WITH PREVIOUS NEPHRITIS: STUDY OF 28 PREGNANCIES FROM A PORTUGUESE UNIVERSITY HOSPITAL A. Braga 1,*, C. Vasconcelos 2, J. Braga 1 1Obstetrics and Gynecology, 2Unidade de Imunologia Clínica, Centro Hospitalar do Porto, Porto, Portugal Problem Statement: Systemic lupus erythematosus (SLE) affects women in childbearing age, so its association with pregnancy is not a rare event. These pregnancies are associated with an increased risk of preeclampsia, fetal growth restriction, and preterm delivery, and fetal demise, neonatal and maternal death. Nephritis is known to be one of the most serious complications of SLE, and traditionally an important predictor of poor obstetric outcome. Our objective is to analyze the maternal and embryo-fetal outcomes in a group of Portuguese pregnant women with previous lupus nephritis. Methods: Retrospective study of all pregnant women with previous or present histologically proven lupus nephritis followed in a Portuguese University Hospital between 1999 and 2013. Results: 28 pregnancies in 24 patients were included in our study. 71,4% were nulliparous, the average age at delivery was 29,1 years and the mean time between lupus nephritis and the first pregnancy was 6,4 years. Diffuse proliferative nephritis was the most frequent histological type. 3 patients had antiphospholipid antibodies but only one had criteria for antiphospholipid syndrome before the first pregnancy. At time of conception 88% of patients were under treatment with immunosuppressive medication, 78,5% were treated with corticosteroids, 46,4% with hydroxychloroquine and 23% of patients were treated with anti-hypertensive drugs. 78,6% of pregnant women were also medicated with acetylsalicylic acid and 7,1% with low molecular weight heparin. During pregnancy, 23% of patients experienced an exacerbation of renal function, and 25% an increment on proteinuria. Lupus flare was diagnosed in 23% of patients during pregnancy and postpartum. Obstetric complications were found in 46,4% of these patients. The most frequent was gestational hypertension (28%), followed by preeclampsia (20%), fetal growth restriction (12%) and preterm delivery (12%). We also report 2 miscarriages, 2 cases of HELLP syndrome and 1 case of medical pregnancy termination during the 20th week of gestation in a case of aggressive renal flare resistant to medical treatment. In our study we found a positive association between the renal function deterioration and the development of obstetrics adverse outcomes, especially development of pre-eclamspia. There were a cesarean rate of 52% in this group of patients. There were 1 neonatal death to report, secondary to extreme permaturity. There were no cases of maternal deaths or congenital malformations to report. Conclusion: Pregnant SLE patients are a group of high risk pregnancies. Previous or actual lupus nephritis is traditionally associated with poor obstetrics outcomes. In our study we confirm that a deterioration of renal function during pregnancy is an important risk factor for the development of obstetric adverse outcome, especially preeclampsia. We also find a high rate of HELLP syndrome and cesarean delivery in this group of patients. Disclosure of Interest: None Declared O22 OBSTETRICS AND GYNAECOLOGY EMERGENCY TRIAGE – THE EXPERIENCE USING MANCHESTER TRIAGE SYSTEM D. Bruno 1 2 3,*, D. Ermida 1, P. Freitas 3, F. Matos 2 1Centro de Investigação e Criatividade em Informática, 2Obstetrics Department, HOSPITAL PROF. DR. FERNANDO FONSECA, 3Portuguese Triage Group, Amadora, Portugal Problem Statement: Most emergency departments (ED) worldwide use triage tools to prioritise patients in need of acute evaluation and determine those who can safely wait. Obstetrics and gynaecology (OB/GYN) ED face similar challenges leading to the implementation of those triage tools. Nevertheless, the evidence of any triage tool in OB/GYN ED is sparse, with most well-known systems not being validated in this setting. The aim of this study was to study the usage of a 29 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 well-established five-category triage scale – Manchester Triage System – in OB/GYN ED setting. Methods: We conducted a retrospective study of all patients admitted to our OB/GYN ED from January to December 2013. Patient age and pregnancy status, triage data and priority, delay to specialist evaluation, diagnostic studies, treatment approaches and discharge outcomes were studied. Statistical analysis was performed using STATA 12.1. Results: A total of 14869 patients were triaged, 62.8% of which were pregnant. Mean patient age was 31.4 ± 10.7. 0.1% were allocated to immediate (red) priority, 10.3% to very urgent (orange), 61.7% to urgent (yellow), 25.6% to standard (green) and 2.4% to non-urgent (blue). Time to secondary health provider was 7.2, 31.3, 50.9, 61.4 and 64.3 minutes respectively. These times were significantly different between immediate, very urgent, urgent and standard subgroups (p<0.05); that was not the case between standard and non-urgent patients (p>0.05). Any type of therapy was used in 25.0%, 15.0%, 16.2%, 8.0% and 2.0% respectively. The utilisation rate was significantly lower in the standard and nonurgent groups compared to higher priority groups. Hospital admission rate was 75.0%, 69.6%, 15.7%, 6.0% and 0.8% respectively. The rate difference was not significant between immediate and very urgent priority patients (p>0.05), but it was significant among all other priority changes (p < 0.0001). Total death cases were 6, with no tendency among priority subgroups. Conclusion: The MTS can be effectively used in OB/GYN ED and priority allocations are related both to resource utilisation and hospitalisation rate, which are indirect markers of disease severity. Disclosure of Interest: None Declared O23 CLINICAL AND SUBCLINICAL HYPOTHYROIDISM DURING PREGNANCY: PREVALENCE AT THE NATIONAL INSTITUTE OF PERINATOLOGY. SCREENING IS JUSTIFIED? E. A. Cruz 1,*, A. Ramirez 2, R. Pelaez 3, R. Zamora 4 1Human Reproduction Biology, 2Endocrinology, 3Gynecology and Obstetrics, 4Medical Director, National Institute of Perinatology, Mexico, Mexico Problem Statement: The prevalence of overt and subclinical hypothyroidism during pregnancy is 0.3% to 0.5% and 3 to 5% accordingly. No prevalence studies in Mexico of thyroid disease during pregnancy exist. Evidence on thyroid disease screening during pregnancy is controversial. Several studies show the association of thyroid hormone deficiency with adverse effects during pregnancy, childbirth and postpartum. Clarification of this controversy could lead changes in regards to antenatal care. Methods: This was a transverse study conducted at the National Institute of Perinatology in Mexico City from October 2012 to March 2013. Pregnant patients attending their first time consultation at the National Institute of Perinatology were invited to participate. Inclusion criteria were: singleton pregnancy without preexisting thyroid disease or autoimmune diseases. Patients of all gestational ages could be included. Informed consent was obtained for all participants. A questionnaire was applied to participants in order to classify them as high or low risk for thyroid disease according to American Thyroid Association recommendations. Determination of serum thyrotropin (TSH), triiodothyronine (T3) and free thyroxin (FT4) was performed to all patients. Treatment was initiated with levothyroxine to achieve normal levels of thyrotropin (TSH). Results: 123 patients were included. Subsequent follow-up of 14 of them (11.4%) no thyroid function tests were performed. Monitoring was performed in 109 patients. Fifty-eight patients (53.2%) were euthyroid. Thyroid disease during pregnancy was 33.9% (n=37); with 12.8% (n=14) having overt hypothyroidism and 21.1% (n=23) subclinical hypothyroidism. Isolated hyptohyroxinemia was present in 12.8% (n=14). In regards to gestational age: 5.5% (n=6) of patients were enrolled in the first trimester of pregnancy, 60.6% (n=66) second trimester and 33.9% (n=37) in the third trimester. The biochemical diagnosis of thyroid disease according to each trimester was as follows: 6 patients in the first trimester (83.3%, n=5) were euthyroid, 6.6% (n=1) had subclinical hypothyroidism. During the second trimester: 51.5% (n=34) were euthyroid, 30 13.6% (n=9) had overt hypothyroidism, 19.6% (n=13) were diagnosed with subclinical hypothyroidism, and 15.1% (n=10) with isolated hypothyroxinemia. In the third trimester of pregnancy 51.3% (n=19) were euthyroid, 13.5% (n=5) with overt hypothyroidism, 24.3% (n=9) diagnosed with subclinical hypothyroidism, and the remaining 10.8% (n=4) with isolated hypothyroxinemia. Therefore it can be concluded that only 12.8% (n=14) of patients had no screening indication, of where 57.1% (n=8) had some alteration in thyroid profile. On the other hand, 87.1% (n=95) of the patients had a risk, history or symptoms of thyroid disease. Modifications in thyroid function were present in 45.2% (n=43), while the remaining 54.7% (n = 52) had a normal result. Conclusion: The prevalence of both overt and subclinical thyroid disease was higher in our population than reported in literature. The presence of thyroid disease symptoms or risk factors has no relation in regards to development of clinical or subclinical thyroid disease during pregnancy. Detection of thyroid disease during pregnancy would increase 100% if universal screening were performed. This is in order to prevent adverse perinatal outcomes and prompt treatment. Disclosure of Interest: None Declared O24 EFFECT OF DELAYED CORD CLAMPING ON HEMOGLOBIN LEVEL AMONG NEWBORNS IN RAJIV GANDHI GOVERNMENT WOMEN & CHILDREN HOSPITAL, PUDUCHERRY M. B. Dash Nursing, Mother Theresa Post Graduate and Research Institute of Health Sciences, Puducherry, India, Puducherry, India Problem Statement: EFFECT OF DELAYED CORD CLAMPING ON HEMOGLOBIN LEVEL AMONG NEWBORNS IN RAJIV GANDHI GOVERNMENT WOMEN & CHILDREN HOSPITAL, PUDUCHERRY Objectives of the Study 1. To estimate the cord blood hemoglobin among the Group I newborns, where the cord was clamped within 15 seconds of birth. 2. To estimate the cord blood hemoglobin among the Group II newborns, where the cord was clamped at 3 minutes after birth or immediately after cessation of cord pulsation. 3. To estimate the hemoglobin level at 24 hours after birth in both Group I (cord clamped within 15 seconds) and Group II newborns (cord was clamped at 3 minutes after birth or immediately after cessation of cord pulsation). 4. To compare the level of Hemoglobin among the study groups (I, II) 5. To correlate the cord clamping time with Hemoglobin level of the term newborns. 6. To associate the Hemoglobin level of term newborns of study groups (I, II) with their selected demographic variables. Methods: Quantitative research approach and true Experimental Design with two groups was adopted for this study. The total sample size was 61 term infants- 30 in group I (cord clamped within 15 seconds of birth) and 31 in group II (cord clamped at 3 minutes of birth or immediately after cessation of pulsation). The inclusion criteria were, term newborns born, babies having APGAR 8/10 or above at birth, Mothers having Hemoglobin greater than or equal to (>) 10 gm/dl at the time of delivery. The sampling technique was Simple random sampling. The tool had two sections: Section A had 2 parts for collecting demographic variables of mother and baby. Section B had checklist for mean hemoglobin and timing of cord clamping Hemoglobin level at birth and 24 hours was estimated by using standardized sahli’s hemoglobin meter. Results: The distribution of demographic variables of the mothers shows that majority of the mothers 25 (83.33%) and 26 (83.87%) were in the age group of 18-25 years, 23 (76.66%) and 21 (67.74%) were completed secondary/higher secondary level of education, 21 (70%) and 20 (64.52%) gave birth for the first time, 12 (40%)and 13 (41.94%) mothers had more than 12gms% Hb from Group I and Group II respectively. With regard to demographic distribution of the newborn highlights that 15 (50%) and 19 (61.29%) subjects were males and about 15 (50%) and 12 (38.71%) of samples were females, 12 (40%) and 17 (54.84%) samples had birth weight of 2.5-3 kg, in Group I and Group II respectively (Table 2). Abstract Book Conclusion: Clamping and cutting of the umbilical cord at birth is the oldest and most prevalent intervention in humans. In spite of that, the optimal timing of cord clamping has been a controversial issue for decades (Eileen K. Hutton & Eman S. Hassan, 2007). It is a safe, simple and low cost delivery procedure that should be incorporated in integrated programs that are aimed at reducing iron deficiency anemia in infants in developing countries. Vaginal delivery facilitates this action. Disclosure of Interest: None Declared O25 CIRCULATING LEVELS OF OBESTATIN AND COPEPTIN IN OBESE AND NONOBESE WOMEN WITH POLYCYSTIC OVARY SYNDROME. M. Islimye Taskin 1,*, E. Bulbul 2, A. Hismiogulları 3, E. Adali 1, U. Inceboz 1 1 Obstetrics and Gynecology, 2Radiolgy, 3Biochemistry, Balıkesir University School of Medicine, Balikesir, Turkey Problem Statement: Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathy which affects 5-8% of reproductive-age women. Although PCOS is actually considered as reproductive disease because of chronic oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism and related fertility problems, it is also associated with insulin resistance, central obesity, type 2 diabetes mellitus, dyslipidemia, and cardiovascular diseases. The current study was undertaken to evaluate plasma copeptin, obestatin levels, carotid arter intima-media thickness and brachial arter flow mediated dilatation in obese and non-obese women with PCOS and age matched healty controls and to investigate their relationship with each other and with clinical, metabolic, and hormonal parameters and cardiovascular risk factors. Methods: This was a cross sectional controlled study setting in a university hospital. In the study population, we analyzed 60 patients with PCOS and 30 agematched healthy women as controls. The patients with PCOS were divided into two groups based on body mass index (BMI): an obese (BMI>30 kg/m2, n=30) or non-obese group (BMI<30 kg/m2, n=30). History and physical examination, peripheral venous blood sampling, carotid and brachial artery ultrasonography were performed. Serum copeptin, obestatin levels, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), total testesterone, C-reactive protein (CRP), glucose, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (LDL) cholesterol, triglycerides, homeostasis model assessment for insulin resistance (HOMA-IR, ), carotid arter intima-media thickness (CIMT), brachial artery flow-mediated vasodilation (FMD) were determined and compared among groups. Results: Our results have shown that women with PCOS especially obese PCOS have higher triglyserides, HOMA-IR, total testesterone, CRP, sistolic and diastolic blood pressure, WHR, and lower HDL. Serum obestatin levels were significantly lower in the obese PCOS group than those in the non-obese and control groups (p<0,001). Serum copeptin levels were significantly higher in obese PCOS group than non-obese PCOS and control group (p<0,001). CIMT were similar among groups (p>0,05). Brachial artery FMD has been found lower in PCOS groups than the control group (p<0,001). Obestatin and FMD values have been negatively correlated with cardiovascular risk factors; whereas copeptin has been positively correlated. A significant positive correlation was found between copeptin, BMI, WHR, hirsutism score, total testesterone and HOMA-IR. There was no correlation between CIMT, copeptin, obestatin and FMD. Positive correlation was shown between CIMT, BMI, triglycerides and HOMA-IR. Conclusion: Copeptin and obestatin may provide useful information for future cardiovascular risk in PCOS patient as copeptin was found positively correlated with cardiovascular risk factors; whereas obestatin was found negatively correlated with cardiovascular risk factors. Disclosure of Interest: None Declared O26 UTERINE NECROSIS FOLLOWING UTERINE FIBROID EMBOLIZATION: A CASE SERIES A. D. Knoll 1,*, S. Pham 1, N. Astill 2, N. J. Resnick 3, M. Elmadijan 4, J. Arampulikan 5 1Radiology, Columbia University/Harlem Hospital Center, 2Obstetrics and gynecology, Cornell University/Lincoln Medical Center, 3Columbia University/Harlem Hospital Center, 4Cornell University/Lincoln Medical Center, New York, United States, 5Radiology, Cornell University/Lincoln Medical Center, New York, United States Problem Statement: Uterine fibroid embolization (UFE) is a common primary treatment for symptomatic uterine fibroids, and can often replace the need for hysterectomy. Uterine necrosis is a rare complication following UFE. We present a case series of two patients who underwent UFE and developed subsequent uterine necrosis. Methods: We retrospectively reviewed patients in our institution who underwent UFE. We identified patients who developed uterine necrosis and reviewed the medical history, imaging, and operative reports. Results: Our center performed 67 UFE procedures during the study period from July 2013—July 2014. The overall clinical success rate of the procedure was 97% (65/67). The most frequently reported indication for the procedure was moderate to severe pelvic pain, which was reported in 80% of patients (54/67). Forty eight percent of patients reported menorrhagia (32/67). We observed post embolization syndrome (PES) as the most common adverse outcome following the procedure, which occurred in 12% of patients (8/67), which was treated and resolved with supportive care. Additional postprocedural complaints which occurred in nearly all patients included mild vaginal bleeding, mild pelvic pain, and nausea, all of which resolved with supportive care alone. Two patients (2/67) experienced uterine necrosis following the procedure. Both of these patients reported a history of severe pelvic pain and menorrhagia. Patient A had extensive medical co-morbidities including HIV, hypertension, dyslipidemia, trichomoniasis, and morbid obesity. Patient B had a surgical history notable for failed myomectomy due to abdominal adhesions from prior abdominal surgery. Pre-procedural imaging assessment noted the uterus to be markedly enlarged for both patients. Following the procedure, both patients continued to complain of severe pain and vaginal bleeding. Eventually, both patients were subsequently found to have radiographic evidence of uterine necrosis. Patient A had a hysterectomy 72 days post UFE. Patient B had a hysterectomy 22 days post UFE. Conclusion: UFE can achieve high success rates and is a primary treatment for symptomatic uterine fibroids. Serious and rare complications such as uterine necrosis and pyomyoma were observed in a minor percentage of our patients. We surmise the immunocompromised state of patient A and the recent surgical interrogation of patient B may have predisposed them to the negative outcomes. With the rising ubiquity of UFE for symptomatic fibroid treatment, interventional radiologists should be mindful of the rare, but serious risks which can be associated with UFE in select patient populations. Knowledge of specific imaging findings associated with post-procedural complications is crucial for proper assessment and management. Finally, a detailed medical and surgical history may aid in risk stratification for post-procedural complications. Disclosure of Interest: None Declared O27 FERTILITY-SPEARING TREATMENT OF WOMEN WITH CERVICAL PREGNANCY A. Kozachenko *, L. Adamyan Operative gynecology, Russian Scientific center for obstetrics, gynecology and perinatology named after V.I. Kulakov, Moscow, Russian Federation Problem Statement: To evaluated the effectiveness of modern approaches and technologies for preserving fertility in young nulliparous patients with cervical pregnancy Methods: 31 women with cervical pregnancies (ages 25-43 years) were treated in Operative Gynecology department during 8 recent years. 20 of them underwent combined therapy with preoperative methotrexate chemotherapy and minimal invasive surgery (ligation of cervical branches of uterine arteries and resectoscopic removing of cervical pregnancies) for preserving fertility. Results: Clinical protocol included transvaginal ultrasound investigation with transducer for color Doppler mapping, magnetic resonance imaging to visualize gestational sac, definition of the boundaries between the chorion and stroma of the cervix; definition of the blood flow intensity in the chorion, the definition of β-subunit of human chorionic gonadotropin (β-hCG) in serum in dynamics, general clinical research: clinical parameters, biochemical 31 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 blood tests and hemostasis in the dynamics, diagnostic hysteroscopy and followed resectoscopy with material removed. The term of pregnancy on admission ranged from 5 to 9 weeks of gestation and the average term was 6,1 ± 0,9 weeks. Patients with cervical pregnancy received methotrexate at an average of 50 mg/every 48 hours, leucovorin administered at a dose of 6 mg after 28 hours after methotrexate injection. The total dose of administered methotrexate ranged from 200 to 300 mg and depended on the patient's body weight, week of gestation and intensity of chorion blood flow. Surgical procedure started at decreased level of β-hCG about 4000-7000 IU/l. Conclusion: The results of this study suggest that resectoscopic removing of embryo with previous cytostatic therapy with methotrexate in combination with leucovorin allows to save fertility in young women with early cervical pregnancy. Disclosure of Interest: None Declared 028 THE SAFETY AND DIAGNOSTIC VALUE OF HYSTEROSCOPY BEFORE ART I. F. Kozachenko 1,*, L. Adamyan 1 1operative gynecology, RUSSIAN SCIENTIFIC CENTER FOR OBSTETRICS, GYNECOLOGY AND PERINATOLOGY, Moscow, Russian Federation Problem Statement: Hysteroscopy is the gold standard test for assessing the uterine cavity. Hysteroscopy not only provides accurate visual assessment of the uterine cavity, but also provides a chanceto treat any pathology detected during the examination. Currently, there is evidence that performing hysteroscopy before starting IVF treatment could increase the chance of pregnancy in the subsequent IVF cycle in women who had one or more failed IVF cycles. However, recommendations regarding the efficacy of routine use of hysteroscopy prior to starting the first IVF treatment cycle are lacking. Methods: The safety and diagnostic value of hysteroscopy before ART was examined in 600 patients seeking treatment for subfertility. The following parameters were analyzed: the presence of minor and major pathology of the endometrium, type of anesthesia, technique of operative work, instruments and energy used during hysteroscopy and complications. Results: Seventy-eight percent of all procedures were done under intravenous anesthesia. Diagnostic hysteroscopy was performed successfully in all women. The most common operative procedure was polypectomy and the most complicated one was myomectomy. The combination of mechanical instrument and bipolar energy were used in most of the cases, while the percentage of complications was extremely low. Diagnysteroscopy was performed successfully in all women. 53.7% had a history of ART failures. In 36% findings at hysteroscopy were normal, whereas in 64%, hysteroscopy revealed intrauterine lesions (polyps, septa, submucosal leiomyomas, or synechiae) that led to operative hysteroscopy. The total percentage of abnormal intrauterine findings was higher in women with a history of repeated ART failures in comparison with those with no history of ART attempts. Conclusion: Hysteroscopy is a safe, highly sensitive, precise diagnostic and operative endoscopic procedure. Diagnostic hysteroscopy should be performed after all ART failure and maybe before ART in all patients, because a significant percentage of them have undiagnosed uterine disease that may impair the success of fertility treatment. Disclosure of Interest: None Declared O29 THE VIVEVE PROCEDURE IS A NONSURGICAL TREATMENT WITH RADIOFREQUENCY THERMAL THERAPY FOR VAGINAL INTROITAL LAXITY AFTER CHILDBIRTH THAT HAS DEMONSTRATED SUSTAINED 12-MONTH EFFECTIVENESS AND IMPROVED SEXUAL FUNCTION. M. L. Krychman Southern California Center for Sexual Health, Newport Beach, United States Problem Statement: Childbirth may result in trauma to the pelvic floor and vagina with laxity of the introitus that may alter genital sensation and reduce sexual satisfaction. There are either behavioral exercises or surgical interventions to correct this problem- no intermediate non-invasive non-surgical procedures exist to correct this problem 32 Methods: Prospective, single-arm study to treat 30 Japanese women with an office procedure using RF energy (90 joules/cm2) applied to the vaginal introitus occurred. Main outcome measures included: The linguistic validated Japanese versions of the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) and the vaginal laxity and sexual satisfaction questionnaires. Results: Sexual function improved significantly: the mean total FSFI score improved from a baseline mean of 22.4 ± 6.7 to a mean of 26 ± 5.8 (P=0.005) at 6 months post treatment. In 22 of 30 subjects, at 12 months, the mean was 26.0 ± 5.2 (P=0.055). The orgasm and satisfaction domains of the FSFI also showed significant improvements from baseline means of 3.4 ±1.5 and 3.6 ±1.5 to 4.2 ±1.3 and 4.2 ± 1.3, respectively at 12 months (P=0.006 and 0.047). Distress related to sexual activity reported on the FSDS-R significantly decreased: from a mean score of 15.8 ± 11.7 at baseline to a mean of 10.3 ± 8.7 (P<0.001 ‒ 0.003) at one month and was sustained through 12 months. Subjects perceived increased feelings of decreased laxity was maintained at this level out to 12 months. No significant treatment-related adverse events were reported. Conclusion: A single, low-dose RF treatment as a non-surgical office-based medical procedure for vaginal introital laxity achieved significant and sustained 12-month improvements in reported tightness of the vaginal introitus and improved sexual satisfaction. Treatment was well-tolerated with no adverse events. This procedure had a positive impact on the condition of vaginal laxity and on sexual health and function in this cohort of Japanese women. Research supported by Viveve, Inc., Sunnyvale, CA. Disclosure of Interest: M. Krychman Consultant for: Bayer, Shionogi Inc, Pfizer, Palatin, Noven Therapeutics, Viveve, Sprout Pharmaceuticals, Speaker Bureau for: Pfizer, Noven, Shinogi 030 NEW LAPAROSCOPIC PERITONEAL PULL-THROUGH VAGINOPLASTY TECHNIQUE P. Mhatre 1,*, J. Mhatre 2 1Obstetrics and Gynecology, Seth G.S. Medical college, Mumbai India, 2Obstetrics and Gynecology, Kedar Hospital, Mumbai, India Problem Statement: Many reconstructive surgical procedures have been described for vaginal agenesis. Almost all of them are surgically challenging, multi-staged, time consuming or leave permanent scars on abdomen or skin retrieval sites. New simple technique using laparoscopic peritoneal pull-through in creation of neo vagina in 39 patients has been described.This technique has given excellent results over a period of 1 to 8 years of follow-up. The peritoneal lining changes to stratified squamous epithelium resembling normal vagina and having acidic Ph. Methods: 39 patients with congenital absence of vagina (MRKH syndrome) were treated with laparoscopic peritoneal pull through technique of Dr. Mhatrebetween 2003 till 2013. Dr. Mhatre has described 3 different techniques of peritoneal vaginoplasty thin peritoneal graft, thick peritoneal graft with substratum,Combined use of peritoneum with amnion grafts.(patients with pelvic kidney peritoneum retrieval is difficult) The technique describes laparoscopic application to modify original Davydov procedure. 1) Neovaginal space was created by surgical dissection. 2) The anterior and posterior flaps were created laparoscopically. Usuallythin flaps of peritoneum are created. In 6 cases thick peritoneal flaps were obtained. 3) Top of the neo-vaginal space is divided.Peritoneal flaps are drawn through this opening and are attached to introitusNeo-vaginal top is closed. 4) Glass dilators are used to maintain the desired length till sexual activity is resumed. Results: 1) The patients were between 16 to 27 years of age. 2) Marital Status 9 out of 39 were married and 18 patients married post vaginoplasty. 3) PreOperative Laparoscopic findings All had small bilateral rudimentary horns and normal ovaries.9 patients had associated renal anomalies, 4 having pelvic kidney, 3 with single kidney,1 with horseshoe kidney and 1 having double ureter. 4) Pre-operative vaginal length varied between 0.5 to1 cm. 5) Operative time average was 60-90 minutes. 6) Hospitalization average was 3 days except 2 patients required 5 days 7) Complications There were no major complications except 1 with small rectal damage which was sutured with uneventful recovery and 1 patient had voiding difficulty requiring 3 days of catheterization. 8) Sexual Abstract Book satisfaction Of 39 patients 9 were married and 18 patients married later. All 27 patients reported no difficulty to either partner. Nine patients had vaginal biopsy after 6 to 12 months of surgery and showed normal stratified vaginal lining All 39 patients had vaginal cytology done after 6 months showing normal pattern. 9) As the ovary became accessible per vaginum 3 patients underwent ovum retrieval and pregnancy using surrogate mother. Conclusion: In conclusion the new laparoscopic peritoneal pull-through vaginoplasty offers a relatively easy surgical procedure with excellent results on long term follow up. This procedure is practically devoid of morbidity. Peritoneal lining having the same parentage of mullerian duct undergoes metaplasia and transforms itself in to stratified squamous epithelium resembling normal vagina. This transformation has been documented in 9 patients. As the ovary became accessible per vaginum 3 patients underwent ovum retrieval and pregnancy using surrogate mother, making this a fertility enhancing procedure. Disclosure of Interest: None Declared O31 TROCHANTERIC CORTICAL THICKNESS AND SOFT TISSUE THICKNESS AT THE HIP IN VARIOUS GROUPS OF WOMEN–NEW MARKERS FOR POSTMENOPAUSAL OSTEOPOROTIC HIP FRACTURE Y. Muscat Baron Department of Obstetrics and Gyanecology, Mater Dei Hospital, Mosta, Malta Problem Statement: The assessment of the greater trochanter cortical thickness and soft tissue thickness on the lateral aspect of the left hip in various groups of women. Methods: One hundred and sixty-two women were recruited sequentially to have the outer cortical thickness of the left lower limb’s greater trochanter measured ultrasonically. Sixty-two women were young menstrual (under the age of 35 years) while there were 25 women in the older menstrual group (35+ years). The other groups were perimenopausal women (17) and treated (30) and untreated postmenopausal women (28). The woman would be placed on the right flank with both lower limbs extended. The greater trochanter would then be palpated and a 3.5 MHz ultrasound sector probe Aloka (SD 500) would be placed at right angles to the point where the trochanter could be felt. Under the sonolucent subcutaneous tissue, a “/\” shaped hyperechoic signal could be seen representing the greater trochanter and is consistently noted to be thinnest point of outer cortical bone in this region. The inner and outer hyperechoic edges at the obtuse angle of the trochanteric“/\” could be consistently delineated allowing the accurate measurement of the cortical thickness. Results: The lowest cortical thicknesses were registered for the untreated menopausal group (0.776 +/-0.2cm) and the perimenopausal group (0.878 +/0.15 cm). The oestrogen replete group were consistently higher – young and old menstrual group (0.943+/- 0.19 cm and 0.928 +/- 0.16 cm) respectively and 0.936 +/-0.18 cm in the hormone treated group. The trochanteric thickness of menopausal group was significantly lower than all the other groups of women. The lowest fat pad thicknesses were registered for the untreated menopausal group (2.04+/-0.69 cm), the perimenopausal group (2.06 +/-0.86 cm) and young menstrual group (2.09+/-0.64 cm). The oestrogen replete group were consistently higher – old menstrual group and 2.3 +/- 0.76 cm) respectively and 2.33 +/-0.72 cm in the hormone treated group. These differences did not reach statistical significance except between the hormone treated group and the untreated postmenopausal group. However significant correlations were noted between the fat pad thickness and trochanteric cortical thickness all groups of women. Conclusion: The low cortical thicknesses of the greater trochanter may represent a weak point where postmenopausal fracture of the hip may initiate. This area may be most vulnerable as it experiences significant shearing forces from all directions. Moreover possibly with less mobility related to the ageing process, osteoporosis may set in at a faster rate in this region due to the diminished strain applied through the ligamental insertions. Measurement of this region is easily performed and reproducible. This may be another marker for women at risk of the classical postmenopausal osteoporotic fracture of the hip. Disclosure of Interest: None Declared O32 MICRO RNA 135A AND 135B ARE PRESENT IN THE ENDOMETRIOSIS LESIONS AND DOWN REGULATED IN THE SECRETORY PHASE R. Petracco 1,*, A. C. Dias 2, F. Heldt 3, H. Taylor 4, J. Michelon 5, A. Petracco 5, M. Badalotti 5, D. Machado 1 1Pos Graduacao em Medicina e Ciencias da Saude, Pontificia Universidade Catolica do Rio Grande do Sul, 2Quatro G Pesquisa e Desenvolvimento, 3Instituto de Pesquisa Biomédica, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil, 4Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, United States, 5Departamento de Obstetricia e Ginecologia, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil Problem Statement: Endometriosis is a well know estrogen dependent disease and it´s most common symptoms are severe pelvic pain and infertility. It affects up to 15% of patients on reproductive age and up to 50% of infertile patients. Its pathogenesis still unclear and there is evidence for a role of genetic components. The microRNA 135a and 135b (miR 135) silence gene expression and increased miR 135 down-regulated HOXA 10, a key mediator of endometrial receptivity and implantation. MiR are aberrantly regulated in the endometrium of women with endometriosis when compared to the endometrium of disease free women. Considering that several genes are known to be differentially expressed in eutopic and ectopic endometrium of women with endometriosis, we analyzed the expression of miR 135 in the ectopic endometrium, compared with the expression in the eutopic from the same patients in different phases of the menstrual cycle. Methods: Thirty one subjects who underwent surgery from March 2013 through May 2014 for diagnosis or treatment of endometriosis had endometrium and endometriosis lesions biopsies taken. Approval was obtained from the PUCRS and Santa Casa Hospital Investigations Committee. Eight subjects were excluded due to low levels of mRNA. The samples were divided according to the menstrual cycle as follows: proliferative, day 1-14 (n=11) and secretory, day 15-28 (n=12). For miRNA detection, we used the poly (A) RT-PCR method using Invitrogen NCode miRNA first-strand cDNA synthesis MIRC-50 kit (Invitrogen, California, USA). Gene transcripts were amplified by real-time PCR using the Bio-Rad iCycler iQ system (Bio-Rad Laboratories) with the forward specific primers to miR135a and miR 135b and the universal reverse primer complementary to the anchor primer. U6 small nuclear RNA was used as a control to determine relative miRNA expression. Relative mRNA level was presented using the formula 2−ΔΔCt. Statistical analysis was performed using unpaired Mann Whitney test for the ectopic vs.eutopic endometrium samples between different phases of the menstrual cycle. All the analyses were considered a p< 0.05 as significant. Results: Tweenty three patients submitted to laparoscopic surgery for diagnosis or treatment of endometriosis had endometrium biopsy taken and excision of endometriosis lesions. When the subjects were divided by the menstrual cycle phase, during the secretory phase the expression of mir135a and 135b was lower in the ectopic endometrium comparing to the proliferative phase. Conclusion: Micro RNA is involved in endometrial receptivity, and there is evidence of a relation between miR 135a and miR 135b with HOXA10, a well know gene that is down regulated in women with endometriosis and has a strong influence on embryo implantation. Here we detected a lower expression of miR 135 during the secretory phase that is likely due to physiological lower levels of estrogen and higher levels of progesterone during this phase. Disclosure of Interest: None Declared O33 SURGICAL OR MEDICAL TREATMENT FOR UNRUPTURED INTERSTITIAL (CORNUAL) ECTOPIC PREGNANCY? THAT IS THE QUESTION. (INTRODUCING A NEW SIMPLE, SWIFT AND SAFE LAPAROSCOPIC TECHNIQUE FOR TREATMENT OF CORNUAL GESTATION). M. A. Rahimi Obstetrics and Gynaecology, Wyong Hospital - CCLHD, Gosford, Australia Problem Statement: Cornual pregnancy is a rare and most dangerous form of ectopic pregnancy which is usually treated by cornual excision or hysterectomy. The consequence of cornual location of gestation is usually massive 33 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 intraperitoneal haemorrhage, necessitating blood transfusion. Controversies exist between the group of gynaecologists who excise the corneum via laparoscopy or laparotomy and the group of gynaecologists who leave the corneum intact and use drugs (i.e., Methotrexate) for treatment of cornual EP. Expectant management of this type of ectopic pregnancy is suitable only for woman with low and diminishing levels of βhCG. Each group claim their way of managing unruptured EP is preferable over the other method. There are advantages and disadvantages in each mode of treatment. (This will be the subject of discussion at the presentation of this paper at the congress). Patients with cornual EP usually have signs and symptoms of ectopic gestation later in the first trimester of pregnancy. This is because the location of the gestation allows more room for the growing EP. Therefore the size and the level of βhCG are higher than other types of EP. In fact there are anecdotal reports of term interstitial EP. In view of this fact, these patients with high levels of βhCG are not suitable for medical therapy. Currently laparoscopic surgery is the preferred treatment for EP. But wedge resection and repair of the cornual needs experienced gynaecologist laparoscopists whom are capable of performing advanced laparoscopic surgery. This technique was developed in New Zealand in 1995 on an unexpected cornual EP undergoing emergency laparoscopy. This case was presented at the 26th annual meeting of the American Association of Gynaecologic Laparoscopists in Seattle, (September 23-28 1997) and published in the Journal of the American Association of Gynaecologic Laparoscopists (May 1999, vol. 6, No 2). Methods: A simple, swift and safe (SSS) laparoscopic technique for the treatment of interstitial pregnancy is applying 2-3 Vicryl endoloops below the corneum incorporating the proximal third of the tube, mesosalpinx and portion of the myometrium adjacent to the cornual EP. This should be done after cornuostomy and suction evacuation of the product of conception in the corneum. This technique is easy to perform by any gynaecologists whom have some experience in laparoscopy. Conclusion: In the authors opinion the above laparoscopic technique is preferred to the medical treatment because it ends the EP and anxiety in one session. Methotrexate may be a reasonable option in selected women with a low betahCG level but is not successful in every interstitial pregnancy. Disclosure of Interest: None Declared O34 INTRAVENOUS LEIOMYOMATOSIS: A RARE CONDITION - ABOUT A CASE A. J. P. Rocha 1,*, A. Castro 2, P. Correia 3, D. Freitas 3, C. Carnide 3, O. Moutinho 3 1Gynecology, CENTRO HOSPITALAR SÃO JOÃO, Porto, 2Centro Hospitalar Trás-osMontes Alto Douro, Vila Real, Portugal, 3Gynecology, Centro Hospitalar Trás-osMontes Alto Douro, Vila Real, Portugal Problem Statement: Intravenous Leiomyomatosis (IVLM) is a rare condition associated to uterine leiomyomatosis and is a differential diagnosis of Benign Leiomyomatosis metastization and disseminated peritoneal leiomyomatosis. IVLM consists on benign proliferation of smooth muscle cells that starts in uterine or gonadal veins and extends to the venous drainage system of pelvis and abdomen. This condition could reach the right heart and the pulmonary arteries and despite non-malignant could be a life-threatening condition. Methods: A 46-year-old woman, gravida 5, para 5, regular cycles, with abundant menses, and non-cyclic pelvic pain. She denied any important pathologic event. The physical/gynaecological examination revealed a 12 weeks uterus, without any other palpable masses. The transvaginal ultrasound showed a uterus with augmented dimensions, with external limits deformed by multiple leiomyomas, the bigger with 33x28x16mm, in intramural/subserous (IM/SS) localization, heterogeneous myometrium and endometrium with 8mm. Right adnexial area: complex heterogeneous mass, with cystic bilobulated component, measuring 100x91x52, the major loca measure 67x46mm, and two solid components with 50x17mm and 18x10mm, respectively, without vascularisation. Left adnexial area was normal. There was no ascites. It was performed tumoral marker, Ca 125 that was normal. It was proposed surgical treatment, with explorer laparotomy. Results: Surgery findings: large uterus, with 3 SS fibroids, ovaries and fallopian tubes were macroscopically normal. It was identified a 100mm para-ovaric mass, both cystic and solid, extending from infundibulopelvic ligament to the 34 paracervix. This white-gray elastic mass was enucleated and removed. Smaller pieces were extracted from uterine and ovaric veins. Hysterectomy and bilateral adnexectomy was made. Pathological analysis confirmed intravenous leiomyomatosis. The patient had an uneventful post-operative recovery. Further investigation with MRI was done (exam results are not available yet), and it was initiated continuous progestative, as adjuvant hormonal treatment. (We have images to document this case) Conclusion: We present this case to illustrate how important is to be alert for such a rare condition, because the anticipation of diagnosis could prevent surgical and potential fatal complications. The follow up of these women could prevent thrombotic events by early recurrence diagnosis. Disclosure of Interest: None Declared O35 NOVEL SERJURY METHOD NAMED “CORNOPLASTY” FOR RECONSTRUCTION OF UTERUS UNICORNUATE UTERUS WITH RUDIMENTARY HORN A. Saremi *, M. Rasekhi Gynecology, Sarem Women's Hospital & Sarem Cell Research Center (SCRC), Tehran, Islamic Republic of Iran Problem Statement: Unicornuate uterus with rudimentary horn is one of the uterus abnormalities that formed during the embryogenesis, as the alteration happened due to developing of one of the Müllerian/Paramesonephric ducts and the other one is developrd only in a rudimentary fashion. In these patients, pregnancy may implant into such a horn setting up a dangerous situation as such pregnancy can lead to a potentially fatal uterine rupture. Surgical resection of the horn is indicated. In the following case report, we performed a novel surgery methd for a patient by reserving her uterine rudimentary horn and reconstruction of her uterus and build a relative normal uterine. Methods: In this paper, we report a woman with infertility presentation and a history of the IUFD, base on her histrosalpingography, she candidate for laparoscopic surgery and discovered a Unicornuate uterus with rudimentary horn & unlike the sugessted treatments for resection of the rudimentary horn, we repaire it and linked it to the main uterus, by this method the uterus be reconstructed and a relative normal uterine has been performed, with increase the chance of fertilization and reduction in abnormal pregnancy in uterine rupture risk. In this laparotomy, connective stalk was removed in wedge shape. Results: In this case, the patient’s histrosalpingography became normal after 3 months with one uterus cavity and two open fallopian tubes. Conclusion: The mentioned surgical method named by the authors as "Cornoplasty". Disclosure of Interest: None Declared O36 C DUBLINIENSIS IN PATIENTS WITH RECURRENT VAGINAL CANDIDIASIS G. Ventolini 1,* and Cendrowski E, MS III; Graham G, MS IV; Meachum W, BA. 1Regional Chair and Professor, Texas Tech University Health Sciences Center Permian Basin, Odessa, United States Problem Statement: The prevalence of vaginal candidiasis (mostly C. albicans) has dramatically increased in recent years. Also, other pathogenic species that are resistant to commonly used antifungal agents began to emerge. Among these is Candida dubliniensis (described in 1995 on HIV positive patients in Dublin, Ireland). It is dimorphic yeast of the genus Candida, phenotypically similar but genotypically distinct to C. albicans with a unique phylogenetic cluster in DNA fingerprinting. These fungi form dark green colonies on chromogenic Candida agar plates and are identified by the Bichro-Dubli latex agglutination test and by not surviving cultures above 42 °C. C. dubliniensis has a decreased ability to form hyphae, but the species does form chlamydospores (in pairs, chains, and clusters). Additionally, an enhanced adherence to vaginal epithelial cells and an increased production of aspartic proteinases explains why is associated with vaginal candidiasis. C. dubliniensis has the ability to rapidly develop resistance to fluconazole (resistance mediated by a multidrug transporter that is rapidly mobilized in vitro after fluconazole exposure). Retrospective studies have revealed that C. dubliniensis had been Abstract Book commonly misidentified as Candida albicans; therefore, a proper identification is mandatory in patients with recurrent vaginal candidiasis. Methods: To report the prevalence of C. dubliniensis in West Texas, USA we reviewed a database of 60 patients with recurrent vaginal candidiasis (positive fungal culture and microscopic photograph of wet mount). Each patient had a wet mount photograph obtained at the time their fungal culture was submitted. Reviewing and reporting de-identified microscopic photographs was not considered to require IRB approval by TTUHSC IRB guidelines. Results: Six microphotographs from 6 different patients were identified and matched as positive cultured C. dubliniensis. The microphotographs demonstrated abundance of chlamydospores in pairs, chains, and clusters, and at the tip of short pseudohyphae. Image / Graph: Conclusion: We are reporting a high prevalence (10%) of C. dubliniensis in nonimmunocompromised patients with recurrent vaginal candidiasis in West Texas, USA. Since other countries in the world are increasingly reporting this resistant yeast, a proper identification is mandatory in patients with recurrent vaginal candidiasis. Disclosure of Interest: None Declared O37 TREATMENT OF VAGINAL ATROPHY - COMPARISON OF NEW MINIMALLY INVASIVE ER: YAG LASER TREATMENT AND HORMONAL REPLACEMENT THERAPY A. Gaspar 1, Z. Vizintin 2,* 1Gynecology Department Faculty of Medicine, Mendoza University, Mendoza, Argentina, 2FOTONA, Ljubljana, Slovenia Problem Statement: The objective of this study was to compare the efficacy and safety of two minimally invasive procedures for treatment of vaginal atrophy; a new Er: YAG laser procedure and hormonal replacement therapy with estriol. Methods: 50 vaginal atrophy patients were randomly divided in two equal groups. Group A patients were submitted to long term estriol therapy: 0.5 mgr/day 3 times a week during 2 weeks, followed with the same estriol dosage twice a week for 4 weeks. B group patients firstly got the same short term estriol therapy for 2 weeks, followed with 3 sessions of ErYAG laser treatment, with 3 weeks interval between the sessions. Therapy efficacy was measured using maturation value, pH value, VAS scores for atrophy symptoms: Dyspareunia, Dryness, Irritation and Leukorrhea. On 6 patients from each group biopsies were taken (before and 3 months post-op). Follow-ups were at 1 month, 3 months and 6 months after the therapy. Results: Both groups showed improvement in atrophy, but laser therapy showed better and longer lasting effects. Maturation value in A group improved from 22,5 points to 24,7 points at 6 months follow-up. In comparison to that B group improvements was from 20,8 points to 47,9 points. pH value improved at 3 months for 7,2% in A group, and for 17,6% in B group. Dyspareunia in A group improved for 48%, and in B group for 72%; Dryness in A group for 68%, in B group for 76%; Irritation in A group for 48%, in B group for 60% and Leukorrhea in A group for 81%, while in B group for 94%. Both groups tolerated the therapy well and adverse effects were mild and transient. Conclusion: Hormonal replacement therapy is considered to be the first choice for vaginal atrophy, but this new minimally invasive Er: YAG laser procedure seems to be safe and efficacious alternative with potential to offer to vaginal atrophy patients longer period of symptom free life. Disclosure of Interest: A. Gaspar: None Declared, Z. Vizintin Consultant for: Application Development O38 AROMATASE INHIBITORS IS AN EFFECTIVE WAY OF TREATMENT OF EXTENSIVE FORMS OF GENITAL ENDOMETRIOSIS M. I. Yarmolinskaya 1,*, A. Molotkov 2, V. Bezhenar 2 1 Gynecological endocrinology, .O. Ott Research Institute of Obstetrics and Gynecology, 2operative gynecology, D.O. Ott Research Institute of Obstetrics and Gynecology, Saint-Petersburg, Russian Federation Problem Statement: Problem statement: taking into consideration the fact that endometriosis is a chronic progressive and recurrent disease, its combined treatment (surgery and postoperative hormonal therapy) is considered to be the most effective way of therapy. The choice of effective therapeutic scheme for patients with recurrent genital endometriosis (GE) and reduced ovarian reserve who previously received GnRH agonists (aGnRH), is an unsolved problem. The aim of the study was to examine the effectiveness of therapy and severity of side effects of aromatase inhibitor letrozole in combined treatment of GE. Methods: Materials and methods: we examined 127 patients aged from 22 to 43 years with GE. The diagnosis in all the patients was stated during laparoscopy and was confirmed by histological examination. 93 (73.3%) patients complained on peri - and intermenstrual bleeding. Chronic pelvic pain was observed in 86 (67.7%) women, dyspareunia - in 39 (30.7%) patients, infertility – in 71 (55.9%) cases. In 22.8 % of patients GE was diagnosed for the first time, in 77.2% of patients it was a recurrence of the disease. Reduced ovarian reserve was observed in 103 (81.1%) patients, history of treatment with aGnRH - in 63% of patients. When assessing the prevalence of GE on R-AFS classification, I stage was diagnosed in 2 patients (1.6%), II stage- in 8 females (6.3%), III stage - in 33 (26.0%) and IV stage of the disease was diagnosed in 84 patients (66.1%), respectively. After surgery patients were prescribed aromatase inhibitor (letrozole 5 mg/day) in combination with progestogen, derivative of 19nortestosterone (orgametril 5 mg 2 times/day) daily continuously for 6 months. Results: Results: within the course of treatment with aromatase inhibitors in combination with progestogens, pain syndrome was absent in almost all the patients (97.6%). None of the patients had symptoms and findings of recurrence of the disease, based on laboratory tests and pelvic ultrasound examination. Control laparoscopy was performed in 9 (7.1%) cases. Regression of endometriotic lesions was confirmed. One of the most frequently observed sideeffects was spotting from genital tract (32.3% of patients), 22.1% of patients had a slight increase of body weight, 2.6±0.6 kg in average, and 13.4% of women had acne. None of the above side effects were the reason for early termination of therapy. After treatment with aromatase inhibitors and progestogens 22 patients with infertility (31%), repeated courses of ineffective hormonal therapy, extensive GE, became pregnant. In 18.2% of patients pregnancy occurred spontaneously, in 22.7% after ovulation induction with gonadotropins, in 59% of patients after IVF procedure (using own (27.2%) or donor (31.8%) oocytes). 14 patients (63.6%) to the present time delivered healthy babies in time, 4 of them were natural deliveries, others – Cesarean section. The rest of the pregnancies are still in progress. Conclusion: Conclusion: Therapy of extensive forms of GE with the use of aromatase inhibitors appears to be effective for patients with recurrence of the disease and reduced ovarian reserve, but certainly it requires further study. Disclosure of Interest: None Declared O39 OUTCOMES OF COLD COAGULATION (CC) FOR TREATING CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) IN THE UNDER 25 POPULATION. M. Aref-Adib 1,*, S. Kingdon 2, J. Rains 2, T. Adib 2, F. Bano 2, A. Ahmed 3 1Obstetrics and Gynaecology, QUEENS HOSPITAL, London, 2Obstetrics and Gynaecology, QUEENS HOSPITAL, Romford, 3Medical school, Liverpool University, Liverpool, United Kingdom Problem Statement: The overtreatment of women aged under 25 with high grade CIN presents a dilemma for clinicians as it is well known that over half of these cases will regress or will still be of a treatable precancerous stage at 25 35 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 when they can join a screening program. Excisional treatment (eg large loop excision of the transformation zone (LLETZ)) is associated with an increased risk of obstetric complications. CC (100 degrees celcius for 120 seconds) is an alternative, ablative therapy with fewer risks and no evidence of inferiority to LLETZ. We set out to review the outcomes of women under 25 with CIN treated with cold coagulation. Methods: A retrospective study of all women treated for CIN1 or above with CC. Data from 01/2010−10/2011 was gathered from treatment diary, clinical failsafe books, Cyberlab and CIMS database for Colposcopy. Women treated for symptomatic ectropion (SE) were excluded. The women were then followed up to review smear outcomes and pregnancy. Results: Between January 2010 and December 2011- 38 patients received cold coagulation and were included in the study. Following treatment, no further follow up was available for 6 patients who did not undergo repeated smear tests in our unit. 32/38 patients attended for follow up smear tests with a mean length of follow-up of 16 months. Over the study period 5/38 patients became pregnant. 26/38 patients had negative smear result at the last available smear. 1/38 patients had a borderline smear at the last smear. Conclusion: The data suggests that CC may be a good option in the treatment of CIN in women under 25, however longer data term are needed. Disclosure of Interest: None Declared O40 OOCYTE’S CRYOPRESERVATION IN ONCOLOGICAL PATIENTS: EXPERIENCE OF A TERTIARY CARE REFERRAL CENTER A. Baggiani 1,*, E. Albani 1, C. Specchia 1, A. Smeraldi 1, C. Tinterri 2, A. Santoro 2, P. E. Levi Setti 1 1Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, 2Humanitas Cancer Center, Humanitas Research Hospital, Rozzano, Milan, Italy Problem Statement: The cryopreservation of female gametes in order to preserve fertility is a therapeutic strategy that a modern center of Reproductive Medicine should be able to offer. Around 1 in 10 of all cancer diagnosis occurs in reproductive age and modern oncologic treatments have increased survival rates. However these various treatments can cause long-term effects, such as loss of fertility, so the demand for effective and individualized fertility preservation options has increased. Methods: Aim of this work is to report all patients who have undergone a female gametes (oocytes) cryopreservation from July 2001 to September 2014 at our Institute. In 2012 a cooperation was established between Cancer Center and Fertility Center. This project grew gradually until the establishment of a service with a multidisciplinary team (gynecologists, oncologists, psychologists). We routinely evaluate in all patients ovarian reserve, based on age, clinical and biochemical parameters (Antimullerian Hormone, Follicular Stimulating Hormone and Antral Follicular Count). Patients are fully informed and counselled about the risks of ovarian depletion related to the type of cancer therapies proposed, the chances of drug-protection, the procedure of oocytes freezing, the feasibility of the procedure focused on risks and prognosis of pregnancy. The growing strict relation between oncologists and reproductive care specialists and awareness of fertility preservation options are the reasons of a yearly higher number of performed procedures. Results: Between 2001 and 2014 78 women underwent ovulation induction for oocytes cryopreservation and 1 ovarian tissue cryopreservation was performed. One patient has cryopreserved oocytes in two different cycles; 6 stopped therapy of ovulation induction cause inadequate response. The most prevalent cancers in the female cohort were breast cancer (67%), lymphomas (17%) and sarcomas (6%). Others diagnosis (10%) included colorectal, cervix and ovarian border-line carcinomas. All patients underwent ovulation induction used recombinant gonadotropins in association with GnRH antagonists. We used GnRH agonist analogues as a trigger to prevent ovarian hyperstimulation syndrome. Recently, on the basis of scientific evidence, for patients with breast cancer we have added an aromatase inhibitor in order to reduce the exposure to high levels of estrogen in cases of hormone-sensitive tumours. Only 2 female patients out of 78 attempted to conceive utilizing cryopreserved oocytes after in vitro fertilization and embryo transfer with a negative outcome. 36 Conclusion: The early diagnosis of cancer and modern cancer therapies, allow us to improve survival rate and quality of life of these patients. Fertility preservation should therefore be offered. The number of cancer long survivors that have been treated during the first decades of life is growing every year and their desire to have a child needs to be approached even before a therapeutic strategy is offered. Only a multidisciplinary work and an integrated team of gynaecologists, oncologists and other specialists is the basis for a correct approach to these patients Disclosure of Interest: None Declared O41 STAGE I OVARIAN CARCINOMA: A HISTOLOGICAL, MOLECULAR AND CLINICAL STUDY L. Deligdisch, A. Mares *, M. Castillo-Martin, J. de la Iglesia-Vicente, C. CordonCardo Pathology, MOUNT SINAI HOSPITAL, New York, United States Problem Statement: Ovarian carcinoma (OC) are the most lethal gynaecological tumors due to their diagnosis in late stages. OC are rarely diagnosed in stage one, when confined to the ovaries, with a 5-year survival of 80-90% as compared to 32% for all stages. Stage I OC are a heterogeneous group of tumors with a different histological distribution, requiring different therapeutic approaches as compared to all stages OC. Methods: Representative histological slides of ovarian tumors from 50 patients diagnosed with stage I OC were reviewed and classified into serous (OSC) and nonserous (NSOC): endometrioid (OEC), clear cell (CCC), mucinous (OMC) and mixed carcinoma (MC). Paraffin sections were stained routinely with H&E and with special immunohistochemical stains for molecular markers: AE1/AE3, HLA, Notch and beta-catenin. Results: The histological distribution of stage I OC was different from that of OC in all stages, in which OSC predominate. In our group of 50 stage I OC, there were 13 OSC (26%) and 37 NSOC (74%): OEC 13 (26%), CCC 10 (20%), OMC 9 (18%) and MC 5 (10%). As in our previous studies of stage I OC, the NSOC were seen in younger women, most presenting with symptomatic pathology, such as endometriosis and uterine neoplasias. Immunohistologic stains (see Table 1) showed a positivity of >80% for cytokeratins AE1/AE3 in all histologic groups, except for 5 cases of OSC (with 70-75% positivity). HLA stains showed a wide spectrum of immunoreactivity; NOTCH and beta-catenin immunoreactivity exhibited low values in all histological groups, the highest being 5% positivity in one OEC. Table 1: Serous Endomet Clear cell Mucinou Mixed carcinom rioid carcinom s carcino a carcinom a carcinom mas (n = 13) a (n = 10) a (n = 5) (n = 13) (n = 9) AE1/A >80 % >80% >80% >80% >80% E3 (n=8) <80% ( n = 5) HLA 1-30% Negative 1-2% Negative 10-20% (n=9) (n=2) (n=1) (n=2) (n=3) 60-75% 1% (n=1) 5-10% 1-2% 60% (n=4) 15-30% (n=2) (n=1) (n=1) (n=2) 50% 10-20% 60-90% (n=1) (n=5) (n=8) 60-90% 90% (n=6) (n=1) Notch Negative Negative Negative Negative Negati or 1-2% or 1-2% or 1-2% or 1-2% ve or 1positive positive positive positive 2% positiv e BetaNegative Negative Negative Negative Negati cateni to 1% to 5% to 1% to 1% ve to n positive positive positive 1% Abstract Book positive positiv (n=1) e Conclusion: The study confirmed our previous finding of a major shift in the histological distribution of stage I OC versus all stage OC, with OSC representing a minority of cases (26%) and NSOC predominating (for example, CCC represents only 6% of all stage OC and 20% of stage I OC). This stage I histologically heterogenous group of tumors also displays a heterogeneous molecular composition. The immunoreactivity to cytokeratin is high in most of the tumors. There is a wide variability in the reactivity to HLA, possibly related to the degree of tumor differentiation; Notch and beta-catenin reactivity is low or absent. Stage I OC require a different management than late stage OC. Chemotherapy is not indicated in some cases and there is a need for chemotherapeutic agents different from those used for advanced OC, as is the case of the more commonly diagnosed in stage I CCC. The identification of the various phenotypical and genotypic characteristic of stage I OC offers an insight into their early carcinogenesis and can have an impact on early diagnosis and therapeutic choices. Disclosure of Interest: None Declared O42 USE OF ROY ADAPTATION MODEL IN NURSING CARE FOLLOWING HYSTERECTOMY A. Kacaroglu Vicdan 1, T. Demirel 2,* 1 Nursing, Selçuk University Akşehir Kadir Yallagöz School of Health, 2Public Health Nursing, Selcuk University, Konya, Turkey Problem Statement: Hysterectomy affects women in physiological, psychological and social aspects. A patient whose organ will be removed in a surgical operation experiences such fears and anxieties as pain, danger of death, possibility of injury, leaving the beloved ones and quitting the hobbies and change in the bodily image. The women who will undergo hysterectomy, on the other hand, are afraid of losing sexual function, reproductive potential and femininity in addition to the afore mentioned fears and anxieties and feel anxious about a breakdown in the relationships with their husbands, suffering from the negative impacts of the menopause and losing physical strength. Nursing is a health discipline which is built on philosophy, theory, application and research. Basic purpose of a professional discipline is to reveal the scientific knowledge content that could be used in the practices of the profession. This basic knowledge is expressed with concepts and theories specific to the profession.This research was conducted in an attempt to attract attention to the necessity of using the nursing models and to enable the widespread use of these models by explaining the utilization of “Roy’s Adaptation Model” with a sample. Methods: Data of Mrs. Y.T. who underwent hysterectomy surgery were collected through Roy Adaptation Model between 01 September and 10 September 2014. At the end of the data, NANDA nursing diagnoses were determined and nursing interventions specific to the patient were planned. Results: Physiological Assessment: Mrs. Y.T. who is aged 40 underwent total hysterectomy two days ago. She is married and has two daughters. She experience insomnia, pain and pain around the stitches. Self-Concept Assessment: She thinks that she is no more a woman. She perceives herself as a half –person. She feels anxious and nervous. Role Function Assessment: She states that the most important role of femininity no longer exists. Mutual Attachment Assessment: Mrs. Y.T. thinks that her relations with her husband are not like before and will never be and her sexual functions have come to an end. Conclusion: It was concluded that the care plan applied according to Roy Adaptation Model increased the physiological, psychological and social adaptation of Mrs. Y.T. after the hysterectomy surgery. Disclosure of Interest: None Declared O43 BREAST CANCER SCREENING AMONG ARABIC WOMEN LIVING IN THE STATE OF QATAR: RECOMMENDATIONS FROM WOMEN, MEN AND HEALTH CARE PROVIDERS T. T. Donnelly 1,*, A.-H. Al-Khater 2, S. B. Al-Badar 2, M. G. Al-Kuwari 3, M. A. Malik 4, N. Al-Meer 5, R. Singh 6, S. Sharara 7 1Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada, 2Department of Hematology and Oncology, Hamad Medical Corporation, 3Sport Medicine, Aspetar, 4Primary Health Care, 5Nursing Affairs, Qatar Supreme Council of Health, 6Research, Hamad Medical Corporation, 7Research, University of Calgary-Qatar, Doha, Qatar Problem Statement: Breast cancer is the most common cancer among women in Qatar, and the incidence rate is rising. Arab women are at a significant risk due to being diagnosed at advanced stages of breast cancer. This study investigates breast cancer screening (BCS) practices among Arab women in Qatar and recommendations for increasing BCS uptake. Methods: Data was collected from two studies; a quantitative cross-sectional survey conducted with 1,063 Arabic women 35 years of age or older, and a qualitative study conducted with 135 men, women and health care providers living in Qatar. Results: 13.8% of the female participants performed BSE monthly, 31.3% had a CBE once a year or once every two years, 26.9% had a mammogram every 1-2 years (40+ years old). Recommendations included expansion of health care facilities and availability of providers; raising awareness among men, women and the younger generation on the benefits of early detection; promoting awareness through extensive participation of health care professional, media campaigns, at health centers and educational facilities; working with influential religious and community leaders; implementing a population-based national screening program. Conclusion: Qatari women are at risk for lack of early detection and treatment of breast cancer in its early stages. It is vital to establish a culturally appropriate, socially-acceptable, and effective intervention program to promote BCS. The results of this research will impact health care policy and provision of BCS to women in Qatar. Findings may also be applicable and benefit other female populations in the Middle East and women of similar ethnocultural backgrounds worldwide. Disclosure of Interest: None Declared O44 MORCELLATION OF A SARCOMA IN PLACE OF A FIBROID BY MINIMALLY INVASIVE TECHNIQUES: IS IT AVOIDABLE? A. Fazel Obstetrics and Gynecology, Hopital Lariboisiere, Paris, France Problem Statement: Recent controversies over sarcoma morcellation ended up with the retrieval of laparoscopic morcellation devices and controversial FDA statements on one hand, and scientific statements (AAGL, ISGE, and ESGE) on the other hand. To follow up with this debate we present our experience of uterine sarcomas diagnosed among a continuous cohort of 2824 patients referred for fibroid treatment in an academic setting with minimally invasive procedures. Methods: Prospective study (Canadian Task Force classification II-3) 2824 patients were referred for treatment of uterine fibroids between 01.01.2002 and 31.12.2013. Patients were from over 20 different ethnical origins. All patients had an ultrasound, MRI, and a multidisciplinary discussion prior to surgical treatment (laparoscopy, vaginal surgery, and laparotomy) or Uterine Artery Embolization (UAE). Endometrial sampling and hysteroscopy were performed when needed and on all women over 40. All suspected cases were thouroughly reviewed prior to surgery or UAE by a specific panel of oncologic radiologists. All specimens operated had pathology examination and all sarcomas were reviewed by a panel of pathologists specialized in sarcomas. Results: 579 patients were treated by laparoscopy, 263 patients by a vaginal procedure, and 262 patients by UAE. Six patients had a final diagnosis of uterine sarcoma. None of them was treated by a minimally invasive procedure nor had a uterine morcellation. One patient had a ruptured uterine sarcoma and 37 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 operated in emergency. No hazard due to uterine or myoma morcellation by laparoscopy or vaginal route with an unrecognized sarcoma was reported. Conclusion: The incidence of uterine sarcoma in a continuous population of 2824 patients of diverse ethnical origins referred for treatment of fibroids in a tertiary center was 0.21%. All sarcomas had a suspected diagnosis of malignancy or cellular fibroid prior to surgery. No hazard was reported due to the morcellation of an unrecognized sarcoma. A thourough workup prior to surgery including MRI and office hysteroscopy could help in counseling and preventing from accidental morcellation of a malignancy. Disclosure of Interest: None Declared O45 PATIENTS WITH EARLY ENDOMETRIAL CANCER IN SINGAPORE HAVE A BETTER QUALITY OF LIFE AFTER ROBOTIC HYSTERECTOMY COMPARED TO OPEN HYSTERECTOMY J. Liu Obstetrics and Gynecology, National University Health System, Singapore, Singapore Problem Statement: Total hysterectomy bilateral salpingo-oopherectomy (THBSO), is the mainstay of treatment for early endometrial cancer. Robotic assisted hysterectomy (RAH) has been reported to have better surgical outcomes than total abdominal hysterectomy (TAH) [1, 2]. However, there is limited data on the quality of life (QOL) after RAH compared to TAH. This study aims to evaluate the post-operative QOL in patients with early endometrial cancer who underwent RAH and TAH. Methods: A DSRB-approved retrospective study of Singaporean patients who underwent surgical treatment for FIGO stage 1 endometrial cancer between January 2006 and December 2011 at the National University Hospital was conducted. The patients’ post-operative QOL was assessed using a questionnaire based on the validated SF-36 health questionnaire, administered via direct teleconference. All data were analyzed using the SPSS version 20. Results: A total of 82 patients were called and 71 (86.6%) responded. 34 (47.9%) patients had TAH and 37 (52.1%) had RAH. In terms of primary outcomes, patients in the RAH group reported experiencing less activity limitation (p=0.044), better health perception (p=0.029) and reported better general health (p=0.053) compared to patients in the TAH group. The RAH group also had significantly better results in all secondary outcomes such as shorter postoperative hospital stay (p<0.001), shorter time to return to normal activities (p=0.009), greater satisfaction with scar appearance (p<0.001) and lower postoperative pain scores (p<0.001). Conclusion: Singaporean women with early endometrial cancer are more likely to report better quality of life indices after robotic hysterectomy than with open hysterectomy Disclosure of Interest: None Declared O46 PRIMARY NON-HODGKIN LYMPHOMA OF VAGINA - REPORT OF A RARE CLINICAL ENTITY V. C. Silva 1,*, P. Correia 2, N. Oliveira 2, M. Gomes 3, M. C. Coelho 2, L. Sá 2 1Obstetrics and Gynecology, Tondela-Viseu Hospital Center, Viseu, 2Gynecology, 3Clinical Pathology, Portuguese Institute of Oncology, Coimbra, Portugal Problem Statement: Primary lymphomas of the female genital tract represent about 1% of all primary extranodal lymphomas. Lymphomas of the vagina are extremely rare and can occur at any age. They are infiltrative tumors which affect the vaginal wall thickening. The most frequent clinical presentation is vaginal bleeding, but may also present as a mass, symptoms of dyspareunia or vaginal discharge or irritative urinary symptoms. Methods: The authors report a case of primary lymphoma of the vagina and do a review of the literature about similar published cases. Results: Clinical case - 52 years woman, with no personal history of relief and a family history of breast cancer (mother), who referred bleeding with intercourse since 2 months ago. Gynecological examination revealed traces of blood in the vagina, no visible lesions in the cervix and a hardened plaque on the posterior vaginal wall invading the posterior vaginal fornix up to 2 cm from the introitus; 38 on digital rectal examination a 6cm tumor was evident but not invading the rectal mucosa; fresh excisional biopsy revealed it was a malignant non-Hodgkin's lymphoma of large cells; it was excluded marrow or lymph node disease; the patient had a good response to chemotherapy with anthracyclines with complete tumor regression and currently have a disease-free survival of 72 months. Conclusion: A high degree of suspicion is required to diagnose this rare entity since these tumors may have a nonspecific presentation, may mimic squamous cell carcinoma and colposcopic biopsy may have a false-negative result. A review of the literature revealed that a good response to treatment and a good prognosis are frequent when the disease is still localized. Disclosure of Interest: None Declared O47 THE OBSTETRICIAN BEFORE COURT: A CRITICAL CASE STUDY ON (SUB) STANDARD PERI-AND POSTNATAL CARE M. Eggermont Law, Ghent University, Melden, Belgium Problem Statement: In case of birth injuries, such as brain damage or even death, parents are often incited to lodge a complaint, with civil, criminal, or disciplinary suits following. Through a case study of judicial proceedings of Belgium, the Netherlands and France related to the delivery process, this paper addresses the risks of liability for the obstetrician during peri-and postnatal care. Every medical malpractice law suit necessitates an individual analysis, but similarities are frequent. These commonalities allow us to draw some conclusions. By assessing the risks involved in intrapartum care, juridical recommendations for avoiding medical liability can be developed. Methods: A 118 closed cases (facts from 1975-2008) on medical negligence in maternity care in Belgium, the Netherlands and France, were analyzed in depth. The legal databases used were Jura and Judit (Belgium), Legifrance, Juricaf and Dalloz (France) and Recht, Rechtspraak (the Netherlands). A minority of the cases were retrieved through contacts with insurance companies (Belgium only) and courts. The first juridical analysis concerned the procedural aspects such as time of facts, place of facts, civil/criminal procedure and the involved health care professional and qualification of liability (personal/vicarious). After the analysis of the medical aspects, the cases were categorized in domains of expertise and then subdivided into types of pathologies. The last analysis concerned the type of damage. Results: Most cases involved the performance of the obstetrician in recognizing a specific pathology in time. Two obstetric complications were well documented: uterine rupture and placental abruption. The highest liability rate (more than eighty percent) was reflected in the category of interpreting fetal monitoring. Failure to identify a pathological fetal heart rate (suggesting fetal distress) was without exception medical negligence on the part of the obstetrician. In some cases in instrumental delivery - though life-saving on some occasions - was the direct cause of the obstetrician’s liability. The medical indication, the positioning of the instrument and the duration of the intervention were assessed. In cases without medical risk factors, shoulder dystocia was considered an obstetric complication, if maneuvers were performed to relieve the shoulders. Not correctly performing a caesarean section or not addressing a haemorrhaghia post partum also involved the liability of the obstetrician. Conclusion: Although this is not an exhaustive quantitative study, a liability rate of more than sixty percent is high. The two most important juridical recommendations, which may reduce this rate, are: respond to the first symptoms of obstetric complications and recognize abnormal fetal heart rate patterns. Cardiotocograph interpretation skills are important to implement appropriate clinical decisions. Also consider the risk of failed instrumental delivery when choosing an instrument. In relation to shoulder dystocia, be aware of the risk factors and order examinations to purchase a diagnosis. Disclosure of Interest: None Declared Abstract Book O48 BRAIN NATRIURETIC PEPTIDE LEVELS IN LABOR AND POSTPARTUM A. Hamaoui *, C. M. Santiago, R. Upadhyay, E. Chadwick, C. Henderson, R. Mercado Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Weill Cornell Medical College, Bronx, United States Problem Statement: Brain Natriuretic Peptide (BNP) is an important marker for heart failure. Recently studies have shown that elevated values are found associated with hypertension in pregnancy (Resnick et al, Hamaoui et al). However, the difference or similarity in the range of levels of BNP in these clinical entities has not been established. Methods: This is a chart review of women admitted from January 2013 to August 2014 to the surgical intensive care and/or to the obstetric labor service and found to have elevated BNP levels equal to or above 100 pg/mL. Women with at least two elevated blood pressures equal to and/or above 140/90 mmHg and proteinuria defined by an albumin to creatinine ration above 30 mg/g were classified as preeclamptic. Results: Most women, 91.8%, admitted to the intensive care with elevated BNP were over 50 years old, and 77.1% were over 60 years old. The range of maximum measurable values was 101 to 2980 pg/mL, a third of which (29.5%) were above 1000 pg/mL; and more than a half (54.1%) of which were above 500 pg/mL. Diagnoses involved some level of heart failure (66.7%), multi-organ failure (30%) and/or sepsis (46.7%) compounding the surgical condition. Most women, 82.3%, admitted without cardiac involvement or other underlying disease, other than hypertension, and in labor who had elevated BNP were younger than 35 years old; and 41.4% were younger than 25 years old. The range of maximum measurable values was 100 to 1060 pg/mL, of which only 0.6% were above 1000 pg/mL and only 6.2% were above 500 pg/mL; most, 53.1%, were below 200 pg/mL. After at least 24 hours into the postpartum, the range of maximum measurable BNP values was 101 to 994 pg/mL, of which only 1.6% were above 500 pg/mL, and 65.8% were below 200 pg/mL. The majority of parturients with elevated BNP beyond 100 pg/mL, 96.5%, had some form of hypertension. Almost three quarters of women, 73.4%, with elevated BNP, met the criteria for preeclampsia, while 23.0% had gestational hypertension. Conclusion: The BNP levels of hypertensive women in pregnancy are associated with lower maximum levels than in women with cardiac events and/or severe disease (P 0.0001). A possible criticism to this conclusion is that there was a huge difference in age between the cohorts. Nonetheless, healthy women at all ages do not have elevated BNP of such magnitude. Levels higher than 500mg/mL in hypertensive parturients should lead to consideration of compounding conditions whether sepsis, pulmonary emboli, cardiac stress or some other serious condition. Disclosure of Interest: None Declared O49 DIAGNOSTIC VALUE OF 3T MRT FOR SUSPECTED UTERINE DEFECT IN PATIENTS WITH PREVIOUS CESAREAN SECTION - 2 CASES J. Hoffmann 1,*, P. Stumpp 2, T. Kahn 2, H. Stepan 1 1Obstetrics, 2Radiology, University of Leipzig, Leipzig, Germany Problem Statement: A scar defect/uterine rupture in a new pregnancy is a rare but threatening secondary complication of a previous cesarean section. Scar dehiscences or covered ruptures are often low or not symptomatic and raise the risk for uterine rupture during the delivery. For that reason, 2D-sonography is used for prenatal diagnosis by measuring the lower uterine segment. Because of methodical limitations of ultrasound examinations with regard to dependency on the examiner and patients constitution different accessory techniques are needed for a more detailed prenatal diagnostic. These case reports of two patients demonstrates the usefulness 3T MRI in case of suspected uterine dehiscence. Methods: Two pregnant women presented with lower abdominal pain after previous cesarean section with 31+1 and 26+1 gestational weeks. Transabdominal 2D sonografie (GE Healthcare®, Voluson E8 Expert) was used for primary diagnostics of the lower uterine segment. T2 weightend sequences in sagittal and axial orientations were performed on a 3 Tesla MRI scanner (Magnetom Trio, Siemens HealthCare) for advanced diagnostics. Results: In both cases the lower uterine segment sonographically (GE Healthcare®, Voluson E8 Expert) appeared very thin. In the first case a uterine dehiscence was suspected and likewise could not be safely excluded by ultrasound in the second case. In the first case a uterine rupture was confirmed by additional MRI examination and the women was delivered by caesarean section with 31+3 weeks of gestation. In the second case, MRI examination could definitively exclude a uterine rupture and pregnancy could be prolonged to 37+0 weeks of gestation. This patient was delivered by cesarean section as well. In both cases MRI findings were verified intraoperatively. Image / Graph: Conclusion: These two cases demonstrate the use of additional MRI examination in case of a sonografically suspected uterine dehiscence or symptomless uterine rupture after previous uterine section. Since MRI is noninvasive and applicable without contrast agents or any premedication, it can be performed safely in pregnancy. Additional MRI findings can be helpful to classify sonographic findings more accurately and to decide about the following management. MRI findings and intraoperative findings correlated well in the presented cases. Disclosure of Interest: None Declared O50 PRENATAL DIAGNOSIS OF DIFFUSED DILATED BOWEL LOOPS: FETAL CHARACTERISTICS AND NEONATAL OUTCOME G. Katz 1 2,*, B. Pode-Shakked 3, M. Berkenstadt 4, R. Bilik 5, R. Achiron 1, Y. Gilboa 1 1Department of Obstetrics and Gynecology, 2Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, 3Department of Pediatrics, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, TelHashomer, Ramat Gan, Israel., 4The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Ramat Gan, 5Department of Pediatric Surgery, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, TelHashomer, Ramat Gan, Israel, Israel Problem Statement: The purpose of this study was to describe the characteristics and outcomes of fetuses prenatally diagnosed with diffused dilation of bowel loops. Methods: We conducted a retrospective study of all pregnancies with fetal diagnosis of diffuse dilated bowel loops (DDBL) during a period of 14 years in a large tertiary referral center. By assessing the electronic medical records of all patients referred for dilated bowel loops we selected those diagnosed with DDBL. After confirming the diagnosis by evaluating the recorded ultrasound examination, we assessed the pregnancy, delivery and neonatal outcomes. Results: Forty two patients were referred for counseling due to dilated bowel loops. All were assessed for other structural malformations, were counseled by a pediatric surgeon and underwent genetic counseling. Six cases were ultimately diagnosed with DDBL. The mean gestational age at diagnosis was 31 weeks and 4 days (±18 days). In 3 patients a normal karyotype was confirmed. The mean gestational age at delivery was 36+0 weeks (±18 days), all but one delivered by normal vaginal delivery. Four cases had a premature rupture of membranes beyond 33 weeks. The mean birth weight was 2530 ± 401 g, and Apgar score was 8.7 (±0.5) and 9.7 (±0.5) at 1 and 5 minutes, respectively. The mean length of hospitalization was 27 (±27) days. All cases but one, who was operated for ileal atresia, were managed conservatively. Two cases were presented with hematochezia in the early hours after delivery, following admission to the preterm ward and were treated by a special dietary formula. One case required 39 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 repeated packed RBC transfusions. Hematochezia resolved spontaneously and the neonates were discharged home without apparent anomaly following a thorough investigation. After a follow-up of up to 8 months, both cases were developing well with no gastrointestinal complications. Conclusion: DDBL diagnosed in the second half of pregnancy is associated with premature rupture of membranes and newborn hematochezia, and therefore requires special neonatal care, after which a favorable outcome is expected. Disclosure of Interest: None Declared O51 IMMUNOHISTOCHEMICAL STUDIES IN CASES OF PLACENTA PREVIA Z. S. Khodzhaeva 1 1 1,*, A. Safonova 1, E. Dubova 2, N. Klimenchenko 1, A. Tschegolev 2, G. Sukhikh 3 1 Maternal-Fetal Medicine, 2Pathomorphologic Laboratory, 3Director, Federal Research Center for Obstetrics, Gynecology&Perinatology, Moscow, Russian Federation Problem Statement: Placenta [] previa is known to cause significant maternal and perinatal morbidity and mortality and occurs in approximately 0.3–0.5% of all pregnancies at term. With the increasing incidence of both cesarean delivery and poor obstetric history, this pathologic condition is becoming more common. Most studies investigated the role of metalloproteinases and their inhibitors in the placenta, but their expression and potential role in cases of placenta previa regardless of the presence of a uterine scar have not been investigated adequately. Objectives: Immunohistochemical study of the matrix metalloproteinases (MMP-2 and MMP-9) and their inhibitors (TIMP-2 and TIMP-3) expression in cases of placenta previa. Methods: 40 placentas obtained by Cesarean Section at term were studied: Group 1 - placenta previa, in the absence of a uterine scar (n = 12), 2 - placenta previa in women with a uterine scar (n = 14), group 3 – as a control (n = 14). Clinical, morphological and special immunohistochemical methods used. Results: In the control group, the maximum values of MMP and TIMP expression were observed in the trophoblast and decidual cells of the basal lamina. Reaction intensity in the terminal villi was higher than in endothelial cells of capillaries: syncytio-endothelial rate for MMP-2 was 1,44; MMP-9 - 1,41; TIMP-2, - 2,59; TIMP-3 - 2 12. In group 1 the expression levels of MMP-2 and MMP-9 in cells of basal lamina was higher than in control group: 15.9% and 17.2% more in trophoblast, 11.6% and 21.3% in decidual cells respectively. These changes indicate the severity of proteolysis in the adjacent tissues and thus contribute to the excessive trophoblast invasion and placenta previa. Expression of MMP-9 was 6.1% higher in the syncytiotrophoblast and 5.1% higher in the endothelial cells. But MMP-2 was lower than the control values (13.6% and 2.0% respectively). Significant reduction of TIMP-2 levels detected in the syncytiotrophoblast (by 20.6%) and EVT (by 17,5%), and TIMP-3 - in sincitiothrofoblast (by 7.7%) compared with the control group. In group 2, the levels of MMP-9, TIMP-2 and TIMP-3 were lower than in women without a uterine scar (group 1): MMP-9 in the decidual cells- by 15.5% and in the trophoblast of basal lamina by 9.9%. In the sinciothrofoblast and in villi capillary endothelial cells the levels of TIMP-2 were higher by 5.3% and 15.4% respectively, which indicates a violation of the relationship between MMPs and their inhibitors in women with a uterine scar. Syncytio-endothelial rate for MMP2 was 1,31, MMP-9 - 1,44, TIMP-2, - 2,11, TIMP-3 - 1.96. Conclusion: Identified abnormalities in MMP-2,9 and their inhibitors TIMP-2,3 activity are accompanied by increased proteolysis of extracellular matrix, which contributes to violations of the structure and function of the placenta. The imbalanced expressions of MMP-2 and MMP-9 and TIMP-2,3 in placenta previa, regardless of the presence of a uterine scar is likely to result in a pathological invasion. Further researches based on the molecular genetic studies will contribute to a better understanding of the mechanisms of pathological placentation and development of preventive measures. Disclosure of Interest: None Declared 40 O52 ESTIMATING TRENDS IN THE MEAN AND OPTIMAL BIRTH WEIGHT IN JAPAN, 1979 - 2010 M. Kita 1,*, S. Gilmour 1, E. Ota 2 1Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 2Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan Problem Statement: Low birth weight (LBW) is an important indicator of perinatal mortality, and long-term negative health outcomes such as premature adolescence, low cognitive functioning, respiratory problems and increased prevalence of non-communicable diseases (NCDs) in adulthood. Compared to other industrialized nations, the proportion of LBW neonates has been increasing in Japan in recent years, reversing a post-world war two decrease. In 2007 Japan reported the highest proportion of LBW infants in the OECD, reaching 9.7% of newborns, which is 2.9% higher than the OECD average. The proportion of LBW infants has increased by 86.5% from 1980 to 2007, and the mean birth weight among singletons has fallen more than 150g from 1980 to 2003. Estimation of prevalence of and trends in LBW and optimal birth weight is essential for understanding future changes in perinatal mortality risk and adultonset NCDs. Methods: We analyzed vital statistics of births, deaths, and stillbirths from 1979 to 2010, which were obtained from the Ministry of Health, Labour and Welfare. The outcomes of this study were birth weight, perinatal mortality rate (PMR), and LBW. The trend in birth weight was analyzed from 1979 to 2010, as these years had consistent measurements of gestational age, using a monthly timeseries analysis. Splines were used to fit perinatal mortality to birth weight in 100g increments, and the optimum of the derivative of the spline was estimated to calculate the optimal birth weight. The predicted perinatal mortality rate corresponding to the mean birth weight and the optimal birth weight was obtained from the smoothed spline for every year. Results: The proportion of LBW babies has increased from 6.2% in 1979 to 8.5% in 2010. There has been a decline in mean birth weight of 200 grams among preterm neonates, and 170 grams among neonates born during term. The optimal birth weight decreased by year from 3662 g (95% CI: 3584 – 3730) in 1979 to 3481 g (95% CI: 3421 – 3545) in 2010, while the optimal birth weight range has increased and the perinatal mortality rate at the optimal birth weight has also decreased. The mean birth weight has been less than the optimal birth weight during the entire time period. The perinatal mortality rate could be reduced by elevating the mean birth weight closer to the optimal birth weight. Conclusion: The mean birth weight in Japan has decreased, especially among premature and term neonates. Some perinatal mortality could be averted, by increasing birth weight so that it is closer to the optimal birth weight. Policies that drive birth weight further from the optimal birth weight such as strict restriction of weight gain among pregnant women need to be revised, if Japan’s past gains in perinatal mortality reduction are to be maintained in the future. Disclosure of Interest: None Declared O53 REPEATED CONTROLS OF GESTATIONAL ANGIOGENIC BIOMARKERS IN HIGHRISK PREGNANCIES- DO THEY DERIVE A CLINICAL BENEFIT? V. Kolovetsiou-Kreiner 1,*, E.-C. Stern 1, K. Mayer-Pickel 1, I. Lakovschek 1, U. Lang 1 , M. Cervar-Zivkovic 1 1Department of Obstetrics and Gynecology, Medical University of Graz, Austria, Graz, Austria Problem Statement: Pathogenesis of severe placenta mediated gestational complications (preeclampsia, eclampsia, HELLP-Syndrome, abruption of placenta, IUGR) are associated with altered angiogenic biomarker levels. Aim of this study is to determine if maternal serum angiogenic biomarker ratio (sFlt1/PIGF) can predict maternal and/or fetal, neonatal complications during pregnancy. Methods: We prospectively studied 58 women with high-risk pregnancies (previous preeclampsia/eclampsia/HELLP-Syndrom, preexisting hypertension, thrombophilia, and antiphospholipid-syndrom). We measured serum levels of Abstract Book sFlt-1 and PLGF by ELISA and calculated sFlt-1/PLGF-ratio every 4-6 weeks from week 10 until the end of pregnancy. Maternal and fetal/neonatal complications were analyzed subsequently. We also evaluated effects of applied medication (acetylsalicylic acid, low molecular heparin) on gestational biomarker levels. Results: sFlt-1/PLGF ratio was higher in women with adverse pregnancy outcome, even without preeclampsia, i.e. early placenta abruption at 24th week of pregnancy. Application of acetylsalicylic acid and/or heparin was associated with an immediate and constant strong decrease of the ratio after administration. Image / Graph: Conclusion: Women with high risk to develop severe complications during pregnancy like abruption of placenta or severe preeclampsia showed strong increase of sFlt-1/PIGF ratio up to twelve weeks before clinical manifestation of these events. Protective effects of acetylsalicylic acid can be demonstrated once again by a decrease of sFlt-1/PLGF ratio levels in our study. Disclosure of Interest: None Declared c.*465A>T were found in 5’-UTR. The frequency of each variation in GH and PE groups were compared to controls (Table 1). dbSNP ID HGVS name rs5479 c.468C>A rs4548329 3 c.534G>A rs5640687 0 c.*197C>T rs7265012 8 c.*465A>T genotype genotype frequency GH PE controls CC 0.857 0.941 0.897 CA+AA 0.143 0.059 0.103 GG 0.857 0.941 0.897 GA+AA 0.143 0.059 0.103 CC 0.905 1.000 0.917 CT+TT 0.095 0.000 0.083 AA 1.000 1.000 0.949 AT+TT 0.000 0.000 0.051 p value Fisher’s exact test 1.000a 0.657b 1.000a 0.657b 1.000a 0.546b 0.526a 1.000b Table 1. Frequencies of genotypes and their associations with GH and PE a GH vs. controls; b PE vs. controls Conclusion: Preliminary studies indicate several variants of HSD11B2, however the relevance of the observed SNPs to the development of GH or PE has to be further analyzed involving more subjects. On the other hand, the impaired activity of 11β-HSD2 may be a result of changes in DNA methylation and gene expression in placenta instead of mutations having impact on amino acid sequence in the protein [7]. References 1. Arulkumaran N, Lightstone L. Clin Obstet Gynaecol 2013, 27:877 2. Wallis AB et al. Am J Hypertens 2008,21:521 3. Causevic M, Mohaupt M. Mol Aspects Med 2007, 28:220 4. Harris A, Seckl J. Horm Behav 2011, 59:279 5. Reynolds RM. Psychoneuroendocrinol 2013,38:1 6. Mukherjee S et al. Placenta 2011,32:687 7. Baserga M et al. Am J Physiol Regul Integr Comp Physiol 2010, 299: R334 Disclosure of Interest: None Declared O54 SEQUENCE VARIATIONS IN HSD11B2 GENE IN GESTATIONAL HYPERTENSION AND PRE-ECLAMPSIA - PRELIMINARY STUDIES K. Kosicka 1,*, A. Siemiątkowska 1, A. Pękal 1, G. Bręborowicz 2, M. Krzyścin 2, A. Majchrzak-Celińska 3, W. Baer-Dubowska 3, M. Resztak 1, F. Główka 1 1Department of Physical Pharmacy and Pharmacokinetics, 2Department of Perinatology and Gynecology, 3Department of Pharmaceutical Biochemistry, Poznan University of Medical Sciences, Poznan, Poland O55 ASSOCIATION OF LOW MATERNAL SERUM CONCENTRATIONS OF PREGNANCYASSOCIATED PLASMA PROTEIN A (PAPP-A) AND FREE BETA-SUBUNIT HUMAN CHORIONIC GONADOTROPIN (Fß-HCG) WITH ADVERSE NEONATAL OUTCOME J. Liu 1 Obstetrics and Gynecology, Singapore General Hospital, Singapore, Singapore Problem Statement: Hypertension is observed in 3-10% of pregnancies, but the incidence of gestational hypertension (GH) and pre-eclampsia (PE) in recent years is increasing steadily [1,2]. The etiology of GH and PE has not yet been fully elucidated. One of the hypotheses assumes that they develop as a result of placenta malfunctioning at the early stage of pregnancy. Placental dysfunction is associated with decreased activity of 11β-hydroxysteroid dehydrogenase 2 (11β-HSD2), which catalyzes the conversion of cortisol (F) to biologically inactive cortisone in placenta. It constitutes a barrier reducing the impact of maternal F on the developing fetus and protecting it from the excess of maternal GC. It was shown that 11β-HSD2 activity is reduced in GH, so that the baby is overexposed to F, which at high concentrations has pro-apoptotic effects, leading to abnormal development of the child and low birth weight [3-6]. The aim of the study was to analyze the sequence of HSD11B2 gene encoding 11β-HSD2, searching for mutations that could be associated with the increased risk of GH or PE. The variations in coding fragments of HSD11B2 may lead to abnormal structure of enzyme protein with impaired activity. Methods: The study included 77 women with a singleton pregnancy after 20 week of gestation: 39 normotensive (controls), 21 with GH and 17 with PE. The research comprised DNA sequencing of coding regions of HSD11B2, followed by restriction analysis (PCR-RFLP). Results: The study indicated 4 sequence variations in HSD11B2 that occurred most commonly. Two synonymous mutations were observed in coding region: c.468C>A in exon 2 and c.534G>A in exon 3, the other two: c.*197C>T and Problem Statement: Low maternal serum concentrations of pregnancyassociated plasma protein-A (PAPP-A) and free β-human chorionic gonadotrophin (β-hCG) used in the First Trimester Screening have been associated with adverse obstetric outcomes. However, there is limited literature on their associations with adverse neonatal outcomes. This study aims to evaluate low maternal serum PAPP-A and βf-hCG concentrations in relation to adverse neonatal outcomes. Methods: A retrospective cohort study of 962 patients who underwent first trimester screening during 11-14 weeks of gestation between January and December 2010 at the Singapore General Hospital was conducted. Pregnancies with fetal anomalies, multiple fetuses, miscarriages before gestational age of 24 weeks, and patients with incomplete obstetric and neonatal data were excluded. Concentrations of maternal serum PAPP-A and βf-hCG were converted to gestational age-adjusted multiples of the medians (MoM), and low levels were defined by less than 10th percentile. Outcome variables included Neonatal Intensive Care Unit (NICU) admission, neonatal jaundice, neonatal hypoglycemia, neonatal infection and poor Apgar scores. Neonatal information was obtained via electronic records. Results: A total of 649 patients were included. 35 (4.5%) had low PAPP-A levels and 51(7.9%) had low fß-hCG levels. Incidence rates of all the adverse neonatal outcomes in the groups with low PAPP-A and fß-hCG levels were higher than the control group. Both PAPP-A and fß-hCG, at low levels, were significantly associated with neonatal hypoglycemia (OR 3.72, 95% CI 1.17-11.8; OR 3.69, 95% CI 1.36-10.0). Low PAPPA-A levels were also associated with neonatal jaundice (OR 2.59, 95% CI 1.06-6.34) and low birth weight (OR 3.49, CI 1.55-7.85). Preterm 41 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 delivery (<37 weeks) was found to be a significant risk factor for neonatal hypoglycemia and neonatal jaundice (OR 4.07, 95%CI 1.44-11.5; OR 3.01, 95% CI 1.03-5.08). Conclusion: Low serum levels of PAPP-A and fß-hCG are significantly associated with higher incidence of some adverse neonatal outcomes but not NICU admission. However, other possible risk factors such as maternal smoking were not included and hence should be investigated in future studies. Disclosure of Interest: None Declared O56 THE NEED FOR SCIENTIFIC RESEARCH OF CLINICAL PREDICTORS OF STROKE RISK IN PREGNANCY V. Novikova1, G. Penzhoyan1 1Department of Obstetrics, Gynecology and Perinatology Faculty of Postgraduate Education, Kuban State Medical University, Krasnodar, Russian Federation Problem Statement: Objective: identify clinical predictors of stroke risk in pregnancy. Methods: The study was conducted on the bases of the territorial Perinatal Center of Krasnodar territorial Hospital № 2. were analyzed 7 cases of stroke in women during pregnancy. The average age 30,67±5,27 years (24-38). In the anamnesis number of labor 1,33±1,51 (0-4), pregnancies 2,33±2,42 (0-6), pregnancy was desired, occurred spontaneously. Results: BMI was 22,17±2,64 (20-27). All women have no complications by cardiovascular and cerebrovascular disorders in hereditary and own anamnesis. 2 women identified inherited thrombophilia. 1woman smoked up to 20 cigarettes per day. Only 1 woman from 26 weeks of pregnancy complicated by mild preeclampsia, other was without major complications. Stroke occurred in gestational age 35±3,48 (30-39) weeks. In 6 cases diagnosed ischemic stroke (in the basins of the right posterior cerebral artery, the right middle cerebral artery, the right common carotid artery or cortical branches of the left middle cerebral artery). In one case there was a thrombosis of the right transverse and sigmoid sinus with areas of secondary ischemia left temporo-occipital and right occipital areas. In 5 cases of stroke occurred against a background of well-being, in 2 cases, during a brief headache. ADsist 129±21,9 (120-140) mm Hg, ADdiast 80±15,81 (70-90) mm Hg. 2 women revealed distinctive features of ultrasound: signs of a small diameter of the vertebral artery (2.8 mm) in spinal canal (CIV). Delivery is made by caesarean section at 37,83 (35-39) weeks of gestation with living fetus and physiological blood loss. Postpartum without obstetric complications. In one case, Pregnant V., 33 years old, expected second delivery of the second pregnancy. Heredity, extragenital, obstetric anamneses unremarkable. Regularly observed in the present pregnancy by obstetrician. At 30 weeks of pregnancy appeared moderate arching growing headaches, there was disorientation, confusion, speech disorder. Immediately taken to the Perinatal Center, where revealed thrombosis of the transverse and right sigmoid sinus. Also installed progressively increasing signs of fetal hypoxia, performed a cesarean section (CS), fetus were alive with signs of prematurity with satisfactory Apgar scores. At the time CS for the first time found a solid inclusion in the tissues of one of the ovaries, immediately histological diagnosed as metastasis of breast cancer. In the future, was diagnosed with breast cancer with metastases to the liver, lungs, brain, mediastinal lymph nodes, the kidneys, adrenal glands, lymph nodes of abdomen, ovaries. Conclusion: Uniquely clinical predictors of stroke is not revealed. Clinically normal pregnancy in the absence of significant risk factors can be complicated by stroke. Multicenter studies are needed to assess women cerebrovascular disorders during pregnancy and the postpartum period, in order to prevent stroke, able to significantly affect a woman's health, lead to her disability, mortality. It is necessary to create an international registry of cases of stroke during pregnancy to be able to organize and analyze data. Disclosure of Interest: None Declared 42 O57 PREGNANCY OUTCOMES IN HIV-INFECTED WOMEN – 5-YEAR EXPERIENCE IN MATERNAL FETAL UNIT J. M. Raimundo 1 2,*, L. Pinto 2, A. Zagalo 3, F. Prata 4 1Obstetrics and Gynecology, Centro Hospitalar de Setubal, Setubal, 2Obstetrics and Gynecology, 3Infectious Diseases , 4Pediatric , Centro Hospitalar Lisboa Norte - Hospital Santa Maria, Lisbon, Portugal Problem Statement: HIV infected pregnant women require multidisciplinary care. Prevention of mother-to-child transmission is of paramount concern but we must be aware of obstetric and perinatal complications related to the underlying disease. OBJECTIVE: To evaluate obstetric outcomes of HIV-infected pregnant woman in a Maternal Fetal Unit of a tertiary hospital. Methods: Retrospective observational study of the HIV-infected pregnant women, submitted to highly active antiretroviral therapy, whose surveillance and delivery occurred at Hospital Santa Maria, between January 2009 and December 2013. The maternal and neonatal clinical records were reviewed. Results: 102 pregnant women, mean age of 29,3 years. The major risk factors for HIV infection were heterosexual transmission (68.62%) and intravenous drug use (31.3%). The diagnosis of HIV-infection was made during pregnancy in 18.6%. Obstetrics outcomes: 24.48% (24/102) gestational diabetes, 9.18% (9/102) obstetric hemorrhage, 6.12% (6/102) preeclampsia, 3.06% (3/102) pregnancy hypertension, other 14.7% (15/102). Segmentary cesarean rate was 40.1% (41/102) (elective cesarean: 87.8% 36/41). The mean birthweight was 2.290g with 18,6% having low birthweight. There were 16 preterm births (15.7%). Preliminary data show a mother-to-child transmission rate of 0.98% (1/102). Conclusion: These results highlight the importance of prenatal screening for HIV infection and the need for a multidisciplinary approach in order to minimize obstetric and neonatal complications. Disclosure of Interest: None Declared O58 PREGNANCY IN WOMEN >40 YEARS: EGG DONATION VS. IVF/ICSI VS. SPONTANEOUS CONCEPTION M. Langer 1,*, A. Perricos 2 1Dept. of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, 2Dept. of Obstetrics and Fetomaternal Medicine, Dept. of Obtetrics and Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria Problem Statement: The age of women at their first pregnancy rose continually and now lies above 30 years. It has been shown that advanced maternal age and certain procedures of reproductive medicine correlate with increased morbidity in pregnancy. We therefore studied the influence of the mode of conception upon the course of pregnancy and birth. Methods: In a retrospective design we analyzed all pregnancies of women <40 years at birth who attended the Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna between Jan 1st, 2011 – Dec 31st, 2013. Patients were allocated according to mode of conception to one of 3 groups: egg donation (ED), autologous IVF/ICSI (IVF) and spontanous conception (SC). Outcome parameters were: multiple pregnancies, preeclampsia, gestational diabetes, hospitalization during pregnancy, mode of birth and fetal outcome. Results: 736 women >40 years at conception were treated in our department; 618 births resulted of these pregnancies. 260 patients were included in the study: ED 47, IVF 71, spontanous 140. The group ‚ED‘differed in several clinically relevant parameters from the ‚IVF‘and the ‚SC‘groups. The following were higher in the ED group: age (45,0 vs. 41,6 vs. 41,6), percentage of multiple pregancies (53,3% vs. 40% vs. 5.9% p<0,001), preeclampsia (24,4% vs. 11 vs. 4,4%), caesarean section rate (97,6% vs. 79% vs. 59%) , whereas gestational age (34,2 vs. 36,8 wks, p<0,01) and birth weight (2349g vs. 2627g vs. 2971g, p<0,01) were significantly lower. There was no maternal or fetal mortality; one patient of the ED group had to be transferred to the Intensive Care Unit because of postpartum myocardiopathy and recovered after 9 days of treatment. Abstract Book Conclusion: Mode of conception had a decisive impact upon the course of pregnancy and on fetal outcome. These results may be used for counselling of women before IVF or ED. Image / Graph: Disclosure of Interest: None Declared O59 COGIParis-1069 LAPAROENDOSCOPIC SINGLE-SITE SURGERY (LESS) FOR HUGE OVARIAN CYSTS A. Alobaid King Fahad Medical City, Riyadh, Saudi Arabia Problem Statement: Many patients with huge ovarian cysts are managed by laparotomy. We present our experience with 9 Patients who had Laparoendoscopic single-site surgery (LESS) for huge ovarian cysts ranging between 20 to 30 cm in diameter. The objective of this review is to assess the feasibility, safety and operative outcome of the management of huge ovarian cysts by LESS. Methods: We performed a retrospective chart review for all patients who underwent LESS for huge ovarian cysts that were 20 cm or more in diameter at our hospital. We analyzed the patient’s age, body mass index (BMI), tumor maximum diameter as measured by ultrasound, operative time, estimated blood loss (evaluated by the hemoglobin drop after the surgery), amount of fluid drained from the cyst and the histopathology result. All patients had normal tumor markers and the radiologic evaluations were in favor of a benign nature of the cysts (figure 1). The procedures were performed through a 2.5 cm umbilical incision. Using the open technique, initially the cyst surface was evaluated, that was followed by drainage of the cystic fluid if the initial evaluation supports a benign nature of the cyst. The surgery was then done similar to procedures performed using the conventional technique. The specimens were retrieved through the umbilical incision. Results: The patient's chracteristics and the results are shown in the below table. All patients had benign cysts. The median patient’s age was 25 years. The mean BMI was 26.96 (21.9-29.6). The mean tumor size was 22.3 cm (20-30). The mean mount of fluid aspirated from the cysts was 3644 ml (500-8500). The mean operative time was 78.4 minutes (56-109) and the mean drop in hemoglobin was 0.5 gm/dl (0- -1.7). There were no operative complications. Figures 2 and 3 show the images of a patient with a huge cyst before and after the surgery with no visible scars. BMI (cm/m2) Cyst maximum diameter (cm) Operativ e time (min) Hgb drop (gm/ dl) flui d drai ned (ml) 850 0 procedu re perform ed pathol ogy 22 25.7 30 109 -1.3 Salpingo oophere ctomy -0.1 500 -1.4 540 0 56 NA 250 0 Cystecto my Salpingo oophere ctomy Cystecto my Mucino us Cystade noma Terato ma Terato ma 24 29.6 20 76 25 26.2 28 88 25 28.2 20 27 21.9 23 71 0 200 0 Cystecto my 27 27.6 27 95 0.1 800 0 Salpingo oophere ctomy 24 27 20 88 0.2 31 28.2 20 58 -1.7 130 0 110 0 Cystecto my Salpingo oophere ctomy 34 28.3 22 65 -0.2 350 0 Salpingo oophere ctomy (years) age Mucino us Cystade noma Serous Cystade noma Serous Cystade nofibro ma Terato ma Mucino us Cystade noma Mucino us Cystade noma Conclusion: With proper patient selection and expertise, we believe that LESS may be a safe and favorable surgical option for the management of patients with huge ovarian cysts and provides a great cosmetic benefit. The short-term outcome evaluated by the operative time, complications and blood loss was satisfactory. Disclosure of Interest: None Declared 060 DO SONOGRAPHIC FINDINGS OF RESIDUA TWO WEEKS AFTER PREGNANCY TERMINATION WITH MIFEPRISTONE INDICATE FAILURE? J. Amer - Alshiek 1,* and Jonia Amer-Alshiek, MD, MSc;1 Osama Shekh, MD2 Arnon Agmon, MD;1 Yifat Ochshorn, MD;1 Dan Grisaru, MD, PhD1 1Obsteterics and gynecology, Tel Aviv medical center, Tel Aviv, Israel Problem Statement: The objective of the study was to determine if uterine transvaginal sonographic (TVS) findings suspicious for residua 2-4 weeks after medical termination of pregnancy (MTOP) with mifepristone indicate a failure of the procedure as determined by the pathology results of surgical intervention by hysteroscopy/curettage. Methods: The records of 301 consecutive women undergoing MTOP with mifepristone (600 mg orally) followed by misoprostol (400 mcg orally) 36-48 hours later between 7/2010-7/2011 were studied retrospectively. The imaging protocol included a TVS study at two weeks following MTOP. Surgical TOP was offered when pregnancy was found to be ongoing, and either hysteroscopy/curettage or a repeat TVS two weeks later was offered when the endometrium appeared to be thick and irregular with a positive Doppler flow. The rate of women positive for residua was calculated, and TVS results were compared to the pathology findings following hysteroscopy/curettage. Results: The highest rate of women who had TVS findings suspicious for residua was observed at two weeks following mifepristone/misoprostol administration. This rate declined as the interval between the imaging evaluation and mifepristone/misoprostol administration was longer (i.e., up to 10 weeks). Conclusion: TVS findings suspicious for residua two weeks following MTOP by mifepristone/misoprostol administration do not conclusively indicate a failure of the pregnancy termination procedure. It is recommended that imaging studies should be done two weeks following mifepristone administration to rule out ongoing pregnancy, and again after another four weeks for women with suspicious residua before diagnosing procedural failure. Disclosure of Interest: None Declared O61 WHICH HORMONE REPLACEMENT THERAPY (HRT) AFTER HYSTERECTOMY? M. Aref-Adib 1,*, F. Bano 2, B. Lamb 3, A. Ahmed 4, J. Barrington 5 1Obstetrics and Gynaecology, QUEENS HOSPITAL, Romford, 2Obstetrics and Gynaecology, QUEENS HOSPITAL, 3Centre for patient safety and service Quality, Dept of Surgery,, Imperial College, London, 4Liverpool University Medical School, Liverpool University, Liverpool, 5Obstetrics and Gynaecology, Torbay Hospital, Torquay, United Kingdom Problem Statement: The role of HRT in women’s health is controversial. Evidence is lacking in the use of HRT following TH/SH/BO for benign conditions including endometriosis. Current practice in the UK has not previously been defined. We set out to ascertain the preferences of UK gynaecologists regarding the type and the route of HRT prescribed after total hysterectomy (TH), subtotal hysterectomy (SH) and bilateral oophorectomy (BO) for benign condition including endometriosis. Methods: A questionnaire to assess the type and route of HRT prescribed following TH/SH/BO for benign conditions and endometriosis was sent out to 43 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 400 UK O&G Consultant, randomly selected from the RCOG Members and Fellows Database. Postal surveys were sent with a covering letter informing participants about the nature of the study. Participation was opt-in, and consent was implied by participation. Results: 212 (53%) UK O&G consultants responded; 81% from district general hospitals, 19% from teaching hospitals. Regarding benign conditions (nonendometriosis) 96% would prescribe oestrogen only HRT following TH/BO, 2% favour combined oestrogen and progesterone preparations, 2% prescribe different combinations. Following SH/BO 55% would prescribe oestrogen only HRT, 32% favoured combined oestrogen and progesterone, and 13% other combinations. Regarding TH/BO for endometriosis, 42% would prescribe oestrogen only HRT, 39% combined oestrogen and progesterone preparations, 9% preferred Tibolone, 7% other combinations, and 2% would not offer HRT. Following SH/BO for endometriosis, 42% would prescribe combined oestrogen and progesterone preparation, 29% oestrogen only, 17% Tibolone, 7% other combinations and 5% would not prescribe HRT. Conclusion: Our results suggest that prescribing practice in the UK for HRT following hysterectomy are varied, reflecting the lack of available evidence. Decision-making should be shared between patients and health care providers, and should take account of benefits and risk and a patient’s individual circumstances. Disclosure of Interest: None Declared O62 THE INNOVATIVE APPROACH TO PI3K/ACT-SIGNALLING PATHWAY UNBALANCE IN ENDOMETRIAL HYPERPLASIA AND ITS MODULATION WITH MICRONIZED PROGESTERONE A. Asaturova 1,*, M. Dumanovskaya 2, G. Chernukha 2, E. Kogan 1, N. Fayzullina 1 1 2 pathology, gynecological endocrinology, Federal State Budget Institution"Research Center for Obstetrics, Gynecology and Perinatology", Moscow, Russian Federation Problem Statement: Molecular and biological implications of endometrial hyperplasia (EH) development and treatment impact are very important and at the same time are poorly investigated. Therefore the purpose of our research is to investigate PI3K/Act -signalling pathway disbalance in endometrial hyperplasia (EH) and endometrial endometrioid adenocarcinoma (EEA) and possibility to modulate them with micronized progesterone in simple EH. Methods: 113 patients with simple EH (n=64), complex EH (n=15), atypical EH (n=8), EEA (n=11) and control group (proliferative endometrium, n=8) were examined morphologically and immunohistochemically (patients with simple EH – before and after treatment). The patients with simple EH were treated with MP (400 mg/day) and subdivided into 2 groups: the group A was treated during 14 days (n=31), the group B – during 21 days (n=33). Expression of estrogen and progesterone receptors (ER and PgR), Ki-67, NDRG1, PTEN and BIRC 5 was investigated in endometrial glands. Results: Non-atypical EH into atypical EH transformation results in 1.1-fold Pg/ER correlation increase, 1.6-fold proliferative activity increase, tumor suppressor expression decrease (1.1-fold on the basis of both NDRG1 and PTEN). Atypical EH into EEA transformation involves 1.1-fold Pg/ER correlation increase, 1.4-fold proliferative activity increase, tumor suppressor expression decrease (1.3-fold on the basis of PTEN and 1.1-fold both NDRG1 and PTEN). After MP treatment simple EH regression was observed in both groups (group A – 75%, group B – 84,6% (р>0,05),secretory transformation of endometrium (STE) developed in 47,2% and 38,5% accordingly, endometrial decidualization (ED) – in 46,1% and 27,8% accordingly. Because either STE or ED was registered in both groups, immunohistochemical results depended only on the endometrial reaction, but didn’t depend on MP regimen. Thus, ER expression was 137.5±45.5 in simple EH, 65±10 in STE, 39.5 ±8.4 in DE (the control group 175.1±12.2). PgR expression was 139.4±44.3 in simple EH, 79±7.4 in STE, 80.7±6.7 in ED (the control group: 236.4±1.9). Ki-67 expression was 25.6±10.5 in simple EH, 7.6±1.3 in STE, 2.7±0.8 in ED (the control group: 73.5±0.7). BIRC 5 expression was 75.9±17.8 in simple EH, 60±10 in STE, 37.2±4.5 in ED (the control group: 75.7±16.3). PTEN expression was 98.1±2.9%, in simple EH, 100% in STE and DE (the control group 100%). NDRG1 expression was 81.5±23.6% in simple EH, 82.1±20.1 in STE, 32.1±12.1 in DE (the control group 95±7.1) 44 Conclusion: Transition from less to more severe types of EH and further to EEA induces changes in ER/PgR correlation, proliferation, apoptosis and tumor suppressors activity. Differences between non-atypical EH and atypical EH and between atypical EH and EEA were statistically significant for all markers, p<0,05). It is PI3K/Act -signalling pathway unbalance that plays the key role in pathologic changes progression in endometrium (BIRC5, PTEN and NDRG1 are the components of this pathway). Simple EH treatment with MP leads to ER, PgR, Ki-67, BIRC5, NDRG1 and PTEN expression decrease and differences between endometrial samples before and after the treatment were statistically significant for all markers except NDRG1, p<0,05). These changes were twofold-fourfold more evident in ED than in STE. Thus, 21-days regiment suppresses proliferation, activates apoptosis and may impact PTEN expression more powerfully than 14days regimen. Disclosure of Interest: None Declared O63 COST EFFECTIVENESS OF MINIMALLY INVASIVE VAGINAL HYSTERECTOMY USING ERBE BICLAMP® FORCEPS: ENOUGH TO INCENTIVISE CHANGE FROM CONVENTIONAL COUNTERPARTS? G. Blayney 1,*, J. Beirne 1, L. Hinds 1, D. Quinn 1, G. Dorman 1 Obstetrics and Gynaecology, Antrim Area Hospital, Antrim, United Kingdom Problem Statement: Hysterectomy is a common gynaecological procedure. The vaginal approach has fewer complications than its abdominal counterpart. Yet difficulties regarding technique, access and ease of surgery have previously hindered the use of the vaginal approach. In addition, recent significant advances in electro-surgery, coupled with ever-increasing time pressures and demands for cost reduction have resulted in a vast increase in electro-surgery. The ERBE BiClamp® bipolar vessel sealing system (BVSS) is helping to increase the preference for vaginal hysterectomy through its ease of access and simplified, yet similar technique, thus reducing the learning curve. It is a safe, effective alternative to conventional methods of suture ligation and confers better outcomes on post-operative complications, hospital stay and analgesia requirements. However, little literature is available on its economic value over alternatives. Accordingly, we investigated the cost effectiveness of Biclamp® vaginal hysterectomy. Methods: We conducted a retrospective 200-case review of vaginal hysterectomy using the ERBE BiClamp® BVSS performed by a single surgeon over a 7-year period. Data was collected on patients undergoing Biclamp® Vaginal hysterectomy (VH) +/- Bilateral Salphingoophrectomy (BSO) (vaginal or laparoscopic) or pelvic floor repair (PFR). Data obtained included surgery duration, post-operative analgesia requirements, length of hospital admission and complication rate. Estimated costs provided by Hospital Procurement were obtained for hospital admission and BiClamp® vaginal hysterectomy. Results: Operating time, defined as time from knife-to-skin to close (or GA time where knife-to-skin time was not available) was available for 98% of patients: 64% of operations took < 60 minutes - 78% of Biclamp® VH +/- vaginal BSO/PFR and 27% of Biclamp® VH + Laparoscopic BSO. The median was 55 minutes (range 23 - 157minutes) 76.5% of patients required simple analgesia postoperatively: an average of 2.58 doses/day of paracetemol or codeine and 0.8 doses/day of non-steroidal anti-inflammatories. Of those requiring opioid analgesia 77% needed >/= 5mg morphine/day. Mean post-operative stay was 2.1 days; 89% were discharged on post-operative Day 3 or earlier; 37% on Day 1. Complications were minimal: bladder injury 2.5%; ureteric injury 0.5%; bowel injury 0%; conversion to open 2%; blood transfusion 1%; return to theatre 2.5%; and readmission 2%. Long term complication rate was 2.5%: persistent pelvic pain and prolapse. The average cost for Biclamp VH was €3145, 29% cheaper than LAVH/TLH, with 1 night admission to the gynaecology ward costing €1346. Conclusion: These findings, we believe to be the largest documented for a single surgeon, highlight the ERBE Biclamp® BVSS in vaginal hysterectomy as a safe and effective alternative to conventional methods. In comparison to published data on its alternatives, Biclamp® confers quicker operation times, quicker recovery, with less analgesic requirements resulting in shorter post-operative hospital admission, and without compromising on safety or long-term outcome. The use of Biclamp® forceps is an innovative technique which should be considered as first line in minimally invasive hysterectomy and overcomes obstacles that have Abstract Book previously hindered the vaginal approach. Biclamp® confers greater benefit to the patient, surgeon and hospital. Disclosure of Interest: None Declared O64 WAYS OF COPING WITH STRESS AND GIVING SOCIAL SUPPORT FOR CAREGIVERS OF PATIENTS WITH GYNECOLOGIC CANCER M. Demirgoz Bal 1, S. Dereli Yılmaz 2,*, N. Kızılkaya Beji 3, M. Arvas 4 1 Obstetric and Gynecological Nursing, School of Nursing, Karaman, 2Department of Midwifery, Selcuk University Health Sciences Faculty , Konya, 3Florence Nightingale Nursing Faculty, Istanbul University, 4Obstetri and Gynecology, Istanbul University Cerrahpasa Health Faculty , Istanbul, Turkey Problem Statement: Cancer affects not only the patients but also their caregivers. The aim of this study was to determine whether ways of coping with it are related to social support given to caregivers of patients with gynecologic cancer, or not. Methods: The descriptive study was performed in The Gynecological Oncology Department of Cerrahpasa Medical School of Istanbul University. Approval was obtained from the ethical board of the institution. The study was performed as a cross-sectional design in a university hospital in Istanbul, Turkey, with 200 caregivers the data were collected via 3 questionnaires, the first with socio-demographic features, the second with multidimensional scale of perceived social support, and the third with the scale of ways of coping with stress. Results: The characteristics of participants have been summarized in Table 1. n % Marital status Educational status Professional status Relative Level Unmarried 52 26.0 Married 148 74.0 Primary school and under Secondary school and over Employed 102 51.0 98 49.0 55 27.5 Unemployed 145 72.5 First level 135 67.5 Second level 65 32.5 Mean age rate and care duration of our participants were 41.06 (SD, 11.5) years, 14.0 (SD, 36.5) months, and 2.4 (SD, 2.7), respectively. The ECW and ICW mean scores of women were 30.13 (SD, 7.74) and 14.44 (SD, 7.06), and the total score of the MSPSS was 58.59 (SD, 20.46). Conclusion: Social support is the basic of coping with stress for caregivers of patients with gynecologic cancer. In line with these findings, it is recommended that caregivers should be given a social support. Such caregiver should be backed up further in order to increase social support by family and friends, and governmental and non-governmental organizations. Disclosure of Interest: None Declared O65 ATOSIBAN: THE CLINICAL EXPERIENCE IN PREVENTION OF PRETERM DELIVERY B. Dewan Medical Department, Zuventus Healthcare Limited, Mumbai, India Problem Statement: Preterm birth is one of the major causes of perinatal morbidity and mortality. India has the highest number (3.5 million) of preterm births in the world. Management of preterm labor thorough tocolysis is an established clinical strategy. Most of the tocolytics are not utero-specific; therefore, multi-organ fetomaternal side effects are expected. Atosiban, an oxytocin receptor antagonist, is a uterine specific tocolytic with more favorable safety profile. The current study was conducted to establish the efficacy and safety of atosiban (7.5 mg/ml) in Indian population Methods: This was a prospective, open label, non comparative study conducted at Lokmanaya Tilak Municipal Medical College Mumbai, India. The study was performed in accordance with the Declaration of Helsinki, Good Clinical Practice (GCP) guidelines and the protocol was approved by the institutional ethics committee of the hospital. Pregnant Indian women (n=110) between the gestational age of 24 to 34 weeks, presenting preterm labour were enrolled in the study. Atosiban was administered as intra venous (i.v.) infusion for 48 hrs. The treatment was initiated by an initial bolus dose (6.75mg), then continuous high dose infusion (300μg/min) for a period of 3 hours followed by 100μg/min up to 48 hrs. Efficacy was assessed by the proportion of women remaining undelivered for a period of 72 hrs and not requiring an alternative tocolytic within 48 hrs post administration of study medication. Safety and tolerability of atosiban was assessed in terms of maternal and fetal side effects. The study was registered with Clinical Trial Registry of India with the registration number: CTRI/2013/11/004166 [Registered on: 22/11/2013] Results: Out of 110 patients enrolled in the study, 98 patients (89.09%) remained undelivered up to 72 hrs after completion of 48 hrs treatment phase. Ninety seven patients (88.18%) remained undelivered till the end of their hospital stay (upto 7 days). There were 7 patients with multiple birth pregnancy. Atosiban therapy was successful in delaying labor for 72 hrs in all the 7 patients who had multiple birth pregnancy. None of the patients required any alternative tocolytic agent or retreatment with atosiban throughout the study period. The study medication was well tolerated as no adverse events were observed throughout the study duration. Conclusion: Atosiban, an oxytocin receptor antagonist, has proven to be an effective tocolytic drug in Indian pregnant females for the management of preterm labour with a better safety profile. Disclosure of Interest: B. Dewan Employee of: Zuventus Healthcare Limited O66 FOLIC ACID SUPPLEMENTATION IN THE MANAGEMENT OF MENOPAUSAL SYMPTOMS IN CANCER SURVIVORS AND HEALTHY POSTMENOPAUSAL WOMEN (FOAM TRIAL) – LAUNCHING A NEW RCT A. Ewies Gynaecology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom Problem Statement: Hot flushes are experienced by 75% of menopausal women. Oestrogen was shown to ameliorate hot flushes by reducing noradrenaline and increasing serotonin in the brain. Hormone replacement therapy (HRT), the first treatment option, causes concerns over possible increased risks particularly breast cancer. There is emerging evidence that folic acid supplementation ameliorates hot flushes by the same mechanism as oestrogen. Methods: To explore this hypothesis, we designed a national multi-centre (8 centres in the UK), phase III, double-blind, placebo-controlled randomized to primarily compare the effect of 5 mg folic acid capsule daily for 12 weeks v placebo (randomized on 1:1 basis) in reducing the frequency and severity of hot flushes (using the validated Hot Flush Score) in postmenopausal women (both healthy and breast and endometrial cancer survivors). The secondary objectives are to study the efficacy on other menopausal symptoms (using Greene Climacteric Scale) and quality of life domains (using Utian Quality of Life Scale). The exploratory translational objectives are to assess the effect on the blood levels of serotonin and nor-adrenaline, and to measure the correlation between clinical improvement, serum folic acid levels and blood levels of serotonin and nor-adrenaline. Results: Not available yet. Conclusion: I would like to present as the chief investigator, for the first time in a scientific international meeting, the hypothesis, rational, methodology of this important RCT. If folic acid supplementation is demonstrated to be effective, it will be a turning point in the clinical practice since it represents a cheap, safe, easily deliverable and well-tolerated alternative to the conventional HRT. Disclosure of Interest: None Declared O67 THE ASSOCIATIONS BETWEEN THE CODON 72 POLYMORPHISM OF TP53 GENE AND THE RISK OF ENDOMETRIOSIS: A COMPREHENSIVE META-ANALYSIS Y. Feng 1,*, Y. Wu 2, Z. Luo 2, Z. Lin 2, X. Zhao 1 1Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 2Department of Gynecology and 45 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Obstetrics, Affiliated Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning, China Problem Statement: Endometriosis is a chronic, inflammatory and one of the most common gynecological diseases that characterized by the presence of functional endometrial glands and stroma outside of the uterine cavity, which affects approximately 6-15% of women in reproductive age. The TP53 codon 72 polymorphism has been implicated in susceptibility to endometriosis, but many researchers have reported inconclusive results. The aim of this article is to investigate the associations between TP53 codon 72 polymorphism and the risk of endometriosis. Methods: A comprehensive search for relevant articles was conducted in PubMed, Embase, CNKI, Wanfang, and Weipu database, and Google Scholar until August 13, 2014. The odds ratios (ORs) and 95% confidence intervals (CIs) for CC + GC vs. GG genotype, CC vs. GC+GG genotype, CC vs. GG genotype, GC vs. GG genotype, and for C vs. G allele were estimated. Publication bias and sensitivity analysis were explored. Statistical analyses were performed using the RevMan 5.2 software and Stata 11.0 software. Results: A total of 13 case-control studies in 12 articles with 2552 endometriosis cases and 2749 controls were included. Overall random-effect OR of 1.49 (95% CI, 1.16–1.90) in the dominant model (CC + GC vs. GG) was found. The results suggested that individuals who carried CC homozygote and heterozygote GC might have a 49% increased endometriosis risk compared with the homozygote GG. In the subgroup analysis by ethnicity, significantly increased risk was observed among Asians (OR, 1.97; 95% CI, 1.39–2.80; P = 0.0002) and Latin American (OR, 1.66; 95% CI, 1.14–2.42; P = 0.009) but not in Caucasians (OR, 0.99; 95% CI, 0.77-1.28; P = 0.93) in the dominant model. Image / Graph: application was performed to women in the intervention and placebo groups for a period of 6 weeks, twice a week for 25 minutes for each session, totally 12 sessions. The reflexology, applied to ıntervention group was performed by the researcher and non-spesific foot massage in the plasebo group were performed by trained assistant researcher. The data were collected by using identification and evaluation form, visual analog scale, menopause-specific quality of life scale and hot flash diaries. Data obtained were evaluated by Chi-Square test, t-test and Mann Whitney U test. In all tests, the level of statistical significance was taken as 0.05. Results: It was detected that prior to intervention the hot flashes, sweating and night sweats VAS score means of respectively, 8.1, 6.9 and 7.1 on the other hand after the intervention, 5.7, 4.3 and 5.0 on the women in the placebo group. Additionally It was detected that prior to intervention the hot flashes, sweating and night sweats score means of respectively 7.5, 7.3, and 6.9 on the other hand after the intervention, 3.3, 3.2 and 2.3 on the women in the intervention group. The hot flashes, sweating and night sweats score avarage was decreased after intervention in both group (p<0.05). However, after the application score average in the intervention group was found lower than that in the placebo group and, the difference between groups was determined to be statistically significant (p<0.001). The mean scores of the vasomotor, psychosocial and physical area which is the sub-group of Menopause-specific Quality of Life Scale, improvement was detected on the both groups after the application (p<0.001). In the sexual area while there was significantly improvement for intervention group (p<0.05) no any improvement detected for placebo group (p>0.05). Conclusion: The result of this study showed that reflexology was effective to reduce vasomotor symptoms and to increase quality of life in menapousal women. Disclosure of Interest: None Declared O69 ECHOGRAPHIC ASPECTS OF CESAREAN SCARS IN NON-PREGNANT UTERUS AFTER SINGLE OR MULTIPLE CESAREAN SECTIONS C. A. Ionescu 1,*, I. Pacu 1, D. Gheorghiu 2, H. Haradja 1, M. Banacu 2, C. Coroleuca2 1Obstetrics Gynecology, UMF Carol Davila,Clinical Emergency Hospital Sf Pantelimon,Bucharest, 2Obstetrics Gynecology, Clinical Emergency Hospital Sf pantelimon, Bucharest, Bucharest, Romania Conclusion: This meta-analysis shows that the TP53 codon 72 polymorphism was associated with the endometriosis risk, especially in Asian and Latin American populations. Disclosure of Interest: None Declared O68 THE EFFECT OF FOOT REFLEXOLOGY APPLIED TO WOMEN AGED BETWEEN 40 AND 60 ON VASOMOTOR COMPLAINT AND QUALITY OF LIFE E. Gozuyesil 1,*, M. Baser 2 1Cukurova University, Vocational School of Health Services, Adana, 2Erciyes University, Nursing department, Kayseri, Turkey Problem Statement: The hot flushes that common symptoms of menopause are negatively affects the quality of the women’s life. Althought Horman therapy reduces hot flushes, it is not preferred by women for some risk factors. In order to reduce vasomotor symptoms, non-hormonal method of treatment preferred by women and in this regard refers to methods outside of modern medicine. This method is generally called complementary or alternative medicine (TAT). The Reflexology that is one of the applications of T.A.T, is one of the nonpharmacological methods used in the treatment of diseases. Methods: This is a randomized, placebo-controlled study which was performed in order to determine the effect of foot reflexology applied to women aged between 40 and 60 on vasomotor complaint and quality of life. This study was performed with 120 women who presented to Balcalı Hospital of Cukurova University, Menopause Policlinic between 22.02.2013 – 22.02.2014. The ethical approval was taken from Ethics Committee in order to perform the study. The 46 Problem Statement: The objectives of our study was to establish an association between echographic parameters of the cesarean scar in non-pregnant uterus and the number of previously performed Cesarean sections. Some studies have proposed that thinning of lower uterine segment diagnosed by vaginal ultrasound can predict the uterine rupture during labour. Methods: The study group include 110 nonpregnant women with a history of low transverse Cesarean section with single or 2 layer uterine closure. The transvaginal ultrasound was performed to establish the parameters of the cesarean scar: the thickness of the tissue scar segment, the triangular shaped anechoic scar defect. Results: The cesarean scar section was evidence with transvaginal ultrasound. In 98,4% of cases the scar was identified. In 24,4 % of cases the completely hysterotomy scar tissue was identified. In 75,5 % of cases an anechoic triangle identified as scar defect , was observed. The thickness of the tissue scar segment varies with the number of cesarean section. So the mean thickness after a single Cesarean section was 10,1 mm, after two cesarean section was 8,1 mm and after 3 cesarean section was 4,4 mm. We identified the basis of the triangle (P) and the height of the triangle (W) and we made the the index Thickness/basis and thickness/height of triangle. Conclusion: The thickness of the scar tissue segment and the index thickness/height decrease with the number of cesarean section. Also there is no diference according to single layer closure or two layer closure Disclosure of Interest: None Declared O70 A LARGE DOUBLE-BLIND EFFICACY AND SAFETY TRIAL OF CORIFOLLITROPIN ALFA VERSUS DAILY RECOMBINANT FSH IN WOMEN 35 TO 42 YEARS OF AGE UNDERGOING OVARIAN STIMULATION PRIOR TO IVF OR ICSI (PURSUE TRIAL). B. Stegmann 1,*, R. Boostanfar 2, T. Yeko 3, B. Shapiro 4, J. Elbers 5, H. Witjes 5 Abstract Book 1Merck & Co., Inc., Whitehouse Station, 2Huntington Reproductive Center, Encino, 3The Reproductive Medical Group, Tampa, 4The Fertility Center of Las Vegas, Las Vegas, United States, 5MSD, Oss, Netherlands Problem Statement: To examine the efficacy and safety of a single injection of corifollitropin alfa vs daily rFSH for ovarian stimulation in women aged 35-42 years. Methods: In this phase 3, double-blind trial (noninferiority margin -8%), 1390 women were randomized to a single injection of 150 µg corifollitropin alfa (n=694) or daily 300 IU rFSH. (n=696) during the first 7 days of ovarian stimulation. When required, they continued the cycle with daily rFSH (maximally 300 IU) until 3 follicles reached ≥17 mm. Ganirelix (0.25 mg) was started on stimulation day 5. Recombinant human chorionic gonadotropin was given for oocyte maturation. 2 embryos were transferred on day 3. Results: Vital and ongoing pregnancy rates per started cycle were 23.9% and 22.2% in the corifollitropin alfa group and 26.9% and 24.0% in the rFSH group. The estimated differences (95% confidence intervals) were -3.0% (-7.4 to 1.4) for the vital pregnancy rate and -1.9% (-6.1 to 2.3) for the ongoing pregnancy rate. The mean (SD) number of recovered oocytes was 10.7 (7.2) and 10.3 (6.8) in the corifollitropin alfa and rFSH groups, respectively, with an estimated difference of +0.5 (-0.2 to 1.2) oocytes. The incidence of serious adverse events (SAEs) was 0.4% vs 2.6% in the corifollitropin alfa and rFSH groups, respectively. The incidence of AEs (SAEs) of moderate/severe ovarian hyperstimulation syndrome was 0.7% (0%) vs 1.4% (0.7%), respectively. Conclusion: Corifollitropin alfa was proven noninferior to rFSH in terms of efficacy and was well tolerated in women aged 35–42 years. Financial support for this study was provided by Merck & Co., Inc. Disclosure of Interest: B. Stegmann Shareholder of: Merck, Employee of: Merck, R. Boostanfar Grant / Research support from: Merck, T. Yeko: None Declared, B. Shapiro: None Declared, J. Elbers Shareholder of: Merck, Employee of: Merck, H. Witjes Shareholder of: Merck, Employee of: Merck 071 THE EFFICACY OF A NEW REGIMEN OF DAILY GNRH ANTAGONIST ADMINISTERED FROM DAY 6 OF MENSES FOR CONTROLLED OVARIAN STIMULATION IN IVF/ICSI. K. J. Thong 1,*, F. Shakur 1, R. Bano 1, S. Pickering 1 1Reproductive Medicine, Edinburgh Royal Infirmary, Edinburgh, United Kingdom Problem Statement: The efficacy of a new regimen of daily GnRH antagonist administered from day 6 of menses for controlled ovarian stimulation in IVF/ICSI. The primary objective was to see the efficacy of this new regimen of daily GnRH antagonist Cetrorelix/Ganirelix) administered from day 6 of menses for controlled ovarian stimulation. GnRH antagonists are increasingly used in IVF treatment. GnRH antagonists result in down regulation of pituitary by binding to GnRH receptors and prevent endogenous LH surge. The IVF clinical pregnancy rate using GnRH antagonist is similar to GnRH agonist and is known to have a lower incidence of OHSS. Although premature LH surge has been reported in GnRH antagonist treatment cycles, there is no large study on the use of GnRH antagonist using this new regimen. Methods: This study is a retrospective analysis of consecutive GnRH antagonist IVF /ICSI cycles over a period of nearly 6 years in a University teaching hospital. Women with polycystic ovary syndrome (PCOS) were excluded from analysis and the total number of treatment cycles was 408. Serum oestradiol/LH was measured on day 6 of menses and every visit until ovulation trigger. Women in the study had regular menses (25-35 days) and BMI < 32 kg/m2. Ovarian stimulation was started from 2 to day 3 of menses. The dose of gonadotrophin for ovarian stimulation was individualised according to AMH level and antral follicle count. The GnRH antagonist (Cetrorelix/Ganirelix) was started from day 6 of menses in a daily dose of 0.25mg. Results: Premature LH surge was observed in five (n=5/408), 1.2% of women who had IVF/ICSI treatment. The median (range) age of women having treatment was 34 (20-44) years. The median (range) of days of ovarian stimulation and oocytes retrieved were 11 ((6-20) and 11(1-32) respectively. Women had a maximum of two embryos replaced. The overall clinical pregnancy rates were 37.8% (102/270) in women up to 35, 35.1% (39/111) in women 3639 and 11.1% (3/27) for women 40 and over. Of the five women who had premature LH surge, 3 had clinical pregnancy (60%) and one had all embryos electively frozen because of risk of OHSS and one failed to conceive. The incidence of failed fertilisation was 0.9% (4/408) and a total of 19 (4.6%) women had embryos electively frozen because of risk of OHSS. Conclusion: This large study demonstrated the efficacy of using this GnRH antagonist regimen for controlled ovarian stimulation. The incidence of premature LH surge was low (1.2%) and the findings suggest that serum LH measurement during treatment may be omitted with no detriment to clinical outcome. Further studies should be carried out to confirm these findings. Disclosure of Interest: None Declared O72 REPRODUCTIVE HEALTH PROBLEMS IN WOMEN WITH DISABILITIES M. Ugurlu 1,*, T. YAVAN 1 Obstetrics and Gynecology Nursing, GULHANE MILITARY MEDICAL ACADEMY, Ankara, Turkey Problem Statement: To determine the reproductive health problems of the women with disabilities. Methods: Data which is obtained by scanning databases (Ebscohost, Ovid, Science Direct, and Google Scholar), magazines and related literature is evaluated. Results: World Health Organization determined disability rate of 12% for developing countries. Women constitute the majority of people with disabilities. They live the diffuculties of both being “woman” and “disable”. Disabled women’s health is affected negatively because of their physical limitations, psychological problems, and economical problems, lack of education and attitudes of social enviroment. These problems increase the risk of health problems of women with disabilities. In society, sexual lives of disabled individuals are treated as an unknown and ignored issue, and moreover it has been assumed that they have no such needs. Whereas the sexuality of disabled people is one of the important areas for quality of life. Disabled women look for gynecological care but can not reach. Therefore, women with disabilities are faced with reproductive health problems more often compared to other women. Disabled women’s reproductive health problems can be classified as menstruel cycle, sexuality, family planning, pregnancy and parenting. Disability does not affect usually menstruation, fertility or sexual response. Many women with disabilities are considered asexual and sexual health are ignored. These women are in need of information about family planning. Women with disabilities are exposed to social pressures on parenting. Their family and friends, as well as medical personnel tend to discourage them the desire to have a child. Considering all these problems of women with disabilities, reproductive health needs should not be overlooked. Conclusion: Women with disabilities is a group that should be seriously considered because of the importance reproductive health problems. Health workers should be educated about their reproductive health problems and awareness should be increased. Reproductive health programs should be prepared training materials according to the needs of women with disabilities. The education of women with disabilities should also be included their families and husbands. Disclosure of Interest: None Declared 073 SHOULD TUBAL PATHOLOGY BE SURGICALLY MANAGED PRIOR TO IVF - YES OR NO? S. Babu 1,*, Y. Beebeejaun 2, D. Rajeswari 3 1Imperial College Healthcare NHS Trust, 2Queen Elizabeth Hospital, London, 3Ashford & St. Peter's Hospital NHS Trust, Chertsey, United Kingdom Problem Statement: Tubal disease is responsible for around 14% of cases of subfertility in women. Hydrosalpinx, distorted tubal anatomy and pelvic adhesions have been known to cause lower implantation rates and increase risk of miscarriage after assisted reproductive techniques such as in-vitro fertilisation (IVF). Hydrosalpinx is the most common form of tubal pathology. It is believed that the excessive amount of fluid in this condition compromises transfer of the embryo and implantation. Furthermore this fluid is thought to have detrimental 47 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 effects on the embryo’s growth and maturity. Performing a surgical procedure prior to IVF is thought to increase its chances of success. Salpingectomy, salpingostomy, surgical management of hydrosalpinx and tubal ligation are all frequently performed before commencing IVF. In this presentation, we aim to explore the various surgical options available and present the success rates of each. Methods: We carried out literature searches on MEDLINE, PUBMED and consulted the recent Cochrane Review which included five randomised controlled trials in its analysis. This review analysed the success rates of IVF after surgery in subfertile women. The primary outcome measure in the literature was live birth. Secondary outcomes included an ongoing pregnancy, viable pregnancy and a clinical pregnancy. Results: We found that performing a laparoscopic salpingectomy prior to IVF was associated with an increased chance of a successful pregnancy. This benefit has been documented many times and the Cochrane review further supports it. Laparoscopic occlusion of the tubes was also shown to improve the odds of clinical pregnancy. In our presentation, we will outline the chances of a successful pregnancy with each potential surgical procedure before IVF. Conclusion: After statistical analysis of the probabilities of achieving a pregnancy, we recommend women suffering from tubal pathology undergo surgical management prior to commencing an IVF cycle. Through this poster we aim to remind delegates on the current surgical managements available and the success rates associated with each one. Disclosure of Interest: None Declared O74 CALCIUM GLUCONATE AS A PREVENTIVE THERAPY FOR OVARIAN HYPERSTIMULATION SYNDROME A. Salve Srishti assisted fertility and advanced laparoscopy centre, Pondicherry, India Problem Statement: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition and potentially life threatening complication of ovarian stimulation. It complicates almost 33% of stimulated ovarian cycles. It is categorized into mild, moderate, severe and critical forms. Incidence of moderate form varies between 3-6% and severe form between 1-2% of stimulated cycles. The treatment for OHSS is mainly supportive. Primary and secondary preventive measures form the mainstay of management. Our study aims at evaluating the effectiveness of intravenous infusion of calcium gluconate in reducing the incidence of severe ovarian hypersimulation syndrome in high risk patients undergoing assisted reproductive techniques. Methods: We conducted an interventional study in our center from October 2013 to April 2014. Patients included were women attending our clinic between 20 and 40 years of age, with an antral follicle count exceeding 15 and an FSH level between 3-10 mIU/ml; undergoing the long agonist protocol in whom more than 20 oocytes were retrieved. They were given intravenous infusion with 10 ml of 10% calcium gluconate solution in 200 ml normal saline on the day of ovum pick up and continued thereafter on day 1, day 2 and day 3, subsequently. Results: The incidence of OHSS among stimulated cycles (n=63) after intravenous infusion of calcium gluconate was 19 %( n=12) Among them, there was not a single case of severe OHSS. Incidence of moderate OHSS was less than 3%. Conclusion: Conclusion OHSS is a well known complication of ovarian simulation. This can lead to life threatening complications if not recognized early. Calcium gluconate infusion can be an important preventive strategy to reduce the occurrence of OHSS and its complications in high risk patients. Disclosure of Interest: None Declared O75 THE NEW METHOD OF TREATMENT OF THIN ENDOMETRIUM DURING THE PREPARATION OF PATIENT TO IVF PROGRAM- AN ALTERNATIVE TO A HORMONE THERAPY M. Schneiderman 1,*, A. Kuzemin 1, K. Alieva 1, S. Pavlovich 1, E. Kalinina 1, V. Smolnikova 1, L. Levkov 1, N. Mishieva 1 1RESEARCH CENTER OF OBSTETRICS, GYNECOLOGY AND PERINATOLOGY, Moscow, Russian Federation 48 Problem Statement: Thin endometrium can be a cause of failed implantation and reduction of pregnancy rates after IVF procedure during the treatment of infertility. It is considered that the endometrium thickness less than 5-7 mm (during the implantation window) provides minimal chance for successful conception. We did not find in the literature any evidence about the treatment of patients with thin endometrium by using the gas mixture (5% CO2 and 95% N2) for stimulation of development of endometrium to enhance the blood circulation and, as a result, to increase a thickness of basal and functional layers of endometrium. Carbon dioxide in some concentrations is a great vasorelaxant. It was shown that the local effect of the CO2 on the tissues is accompanied by several mechanisms of action: an enhancement of blood flow, an increasing the speed of oxygen consumption by tissue, an enhancement of metabolism in organ tissue, a recovery of sensibility of some receptors, an increasing of reparative processes, and the activation of fibroblasts. Methods: In our study endometrium thickness (ultrasonography) was measured three times repeatedly: first time before the inclusion of the patient into the research program, second time during the treatment cycle and the third time during the next cycle after the treatment. Ultrasonography was performed on the 7th, 11th, 13th, 15th days of the menstrual cycle.Sixty five patients of the fertile age with the diagnosed primary of secondary infertility with sign of thin endometrium, which is not responding to medical treatment, participated in the study. All patients were investigated by laboratory methods before infertility treatment and transvaginal ultrasonography investigation. Results: During the first ultrasonography before the gas ablution the thickness of endometrium was in range between 3,1 mm and 5,9 mm in all patients. During the second ultrasonographic investigation after 2 days after the first gas ablution the endometrium thickness increased in different patients by 2,7-3,3 mm, and after 2 days after the second ablution – it was increased on additional 1,8-3,4 mm. After the third ablution endometrium thickness was in range of 7,3-10,8 mm. Conclusion: In this study we demonstrated that in women with previous repeated unsuccessful stimulation of endometrium by using hormone therapy there is the evident trend of growth of endometrium thickness after treatment with using ablution with gas mixture of Carbone dioxide and nitrogen. Disclosure of Interest: None Declared 076 VERY RAPID SHRINKAGE OF LARGE UTERINE FIBROIDS BY ULTRASOUND GUIDED HIGH INTENSITY FOCUSED ULTRASOUND ABLATION BASED ON MAGNETIC RESONANCE IMAGING J. H. Suh 1,*, S. H. Kim 2, P. J. Cho 2, K. J. Yoon 2 1Obstetrics and Gynecology, Gangnam St. Peter's Hospital, 2Obstetrics and Gynecology, Gangnam St.Peter's Hospital, Seoul, Korea, Republic Of Problem Statement: Noninvasive treatment of fibroids has recently emerged as a highly desirable alternative to surgery. Although large fibroids are indicated for laparotomy, increased risk of morbidity related to major surgery has led physicians to seek minimally invasive treatment modalities. Since High Intensity Focused Ultrasound (HIFU) ablation was first reported to be a feasible treatment for uterine fibroids in 2003, numerous clinical studies were actively performed worldwide revealing data that suggest HIFU may be an efficient nonsurgical therapy, reducing the volume of fibriod by delivering intense acoustic sonication energy to induce coagulative necrosis at a focused region of fibroid. We selected patients diagnosed of large fibroids and evaluated the immediate therapeutic effects of ultrasound-guided HIFU (USgHIFU) ablation on large fibroids not feasible for pelviscopy based on MRI imaging. Methods: Between June 2014 and August 2014, 30 symptomatic patients (mean age, 43±7 years) underwent USgHIFU ablation for large uterine fibroids defined as more than or equal to 8 cm mean diameter at Gangnam St. Peter’s Hospital, Seoul, Korea. Under the guidance of dynamic real-time ultrasonographic imaging, fibroids were ablated using acoustic sonication power output of average 410 W. Exposure time, T1-weighted and T2-weighted MRI imaging of fibroid volume at pre- and post-treatment 24 hours were assessed. Volume was calculated using the ellipsoid formula: D1x D2 x D3 x 0.523 (D1: longitudinal, D2: anteroposterior, D3: transverse). The percentage of decrease in fibroid volume Abstract Book was calculated by 100 x (pretreatment volume – post treatment volume) / pretreatment volume. Results: USgHIFU ablation was well tolerated in all patients. The mean exposure time was 1318±779 sec. uterine fibroids ranged from 8 cm to 21 cm. Mean pretreatment volume of fibroid was 525.3±367.4 cm3. Post-treatment MRI showed statistically significant volume reduction of fibroid. The mean volume of fibroid at 24 hours after procedure was 406.2±304.3 cm3 (P<0.001 compared with pretreatment volume). The absolute difference was 119.2±88.1 cm 3 and the percentage of decrease in fibroid volume was 24.1±9.0%. When we performed subgroup analysis in patients with huge uterine fibroid (mean diameter ≥10 cm, n=18), the treatment effect was consistent. Fibroid volume decreased significantly by USgHIFU ablation (703.5±379.8 cm3 to 548.4±321.1 cm3, P<0.001). The absolute difference was 155.1±97.5 cm3 and the percentage of decrease in fibroid volume was 23.1±10.1%. Image / Graph: Methods: This is a prospective audit of the pre-treatment of symptomatic uterine fibroids using Ulipristal acetate, particularly large fibroids. There are indications that this preparation is efficacious in the treatment of symptomatic fibroids before hysterectomy or myomectomy irrespective of site and size (Pearl Study). Institutional research and audit board approval was obtained prior to the audit and consent was obtained for imaging and use of the images presented. We audited the effects of this medication in inducing amenorrhoea in women with excessively heavy menstrual bleeding secondary to fibroids, effect on pain and pressure symptoms and size reduction in 52 women with fibroids of varying sizes and sites. We also analysed the effects on the treatment modality – blood loss at surgery, requirement for blood transfusion, planned versus actual treatment undertaken and immediate post-operative or post-treatment complication. Results: The selective Progesterone receptor modulator Ulipristal, shows promise with beneficial effects in some of the parameters studied. The results are as presented. Conclusion: Currently recommended pre-treatment for symptomatic uterine fibroids are the gonadotrophic hormone release hormone analogues. The introduction of Ulipristal acetate provides another treatment option with possibly less side effects and equal efficacy that may be of benefit. Disclosure of Interest: None Declared 078 THE EFFICACY OF THE PPH SHELF TO FACILITATE UTERINE COMPRESSION USING A MANNEQUIN MODEL: A RANDOMISED CROSS-OVER STUDY N. Aflaifel 1 2,*, A. Weeks 3, J. Porter 4, P. Watt 5 1Sanyu Research Unit, Department of Women’s and Children’s Health, University of Liverpool, Liverpool Women's , University of Liverpool, Libverpool, United Kingdom, 2Department of Obstetrics and Gynecology, University of Omer AlMukhtar , Al-Bayda, Libya, 3Sanyu Research Unit, Department of Women’s and Children’s Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, 4Electronic Product Supplies Limited, Wirral, 5Department of Clinical Engineering, University of Liverpool, Liverpool, United Kingdom Conclusion: Noninvasive ultrasound-guided HIFU ablation efficiently reduces large fibroids within 24 hours of treatment, and may be a promising therapeutic modality in patients with large fibroids not suitable for minimally invasive surgery. Disclosure of Interest: None Declared O77 PRETREATMENT OF UTERINE FIBROIDS USING A SELECTIVE PROGESTERONE RECEPTOR MODULATOR - ULIPRISTAL ACETATE M. Wong 1,*, M. O. Thompson 1 Obstetrics & Gynaecology, Barking Havering & Redbridge University Teaching Hospitals, Romford, United Kingdom Problem Statement: Uterine leiomyomas are common, benign tumours of the female reproductive tract which when complicated, can present with problems of heavy menstrual bleeding including severe anaemia requiring blood transfusion, organ compression with pressure effects on bladder, bowel, ureters and ultimately kidneys, abdominopelvic pain, and subfertility. They are commoner in women of black or Asian ethnicity. Our centre serves a large multiethnic population and presentation with large symptomatic uterine fibroids is common creating a significant healthcare burden from recurrent hospital admissions for heavy bleeding requiring transfusion and other symptomatology in a population of women who are acculturally keen to retain their fertility. There are various treatment options available for symptomatic small to moderate sized uterine fibroids > 3.0cm in diameter, including endoscopic or open surgery, selective arterial embolisation, and magnetic resonance guided focused ultrasound ablation, while pharmaceutical treatment has been recommended for small fibroids < 3.0cm in the absence of structural or histological uterine abnormality, where there is no cavity distortion (NICE guidelines 2007). There are newer pharmaceutical agents that can be used either for pre-treatment prior to definitive vascular interventions or surgery, including the selective Progesterone receptor modulator Ulipristal acetate. Problem Statement: Postpartum haemorrhage (PPH) remains the major cause of maternal mortality worldwide. The treatment of PPH has for many years focused on the provision of uterotonics. However, there are problems not only with the provision of the drugs to low resource community settings, but also in the escalation of care for those women who continue to bleed despite oxytocics. For treatment of atonic PPH bimanual uterine compression and massage is an appropriate procedure to initiate the management, followed by uterotonic drugs. However, the technique of bimanual compression requires the insertion of a fist into the vagina, an act that is both painful and has overtones of genderbased violence. It is therefore currently only used in extreme situations. If, however, it could be performed in a less invasive manner, then it could act as a low-cost complete treatment for PPH. The development of a simple, low cost, treatment for PPH that can be easily used by low-level providers is therefore crucial. The PPH shelf is a new device, invented by Professor Andrew Weeks, designed to make uterine compression available for use at a much earlier stage in the PPH process, and provide a treatment without the need for medicines or advanced diagnostic skills. This study tested the use of the PPH shelf in a mannequin model by delivery suite staff, with the hypothesis that using the PPH shelf produces an equivalent amount of uterine pressure as standard bimanual compression, but can be sustained for a longer time. Methods: The study was carried out at Liverpool Women’s Hospital. The participants were 26 delivery experienced obstetricians, who are expert at bimanual uterine compression, and 26 midwives, who had not done bimanual compression before. Each participant conducted two forms of uterine compression on a mannequin model: bimanually and using the PPH shelf. The order in which they performed the test was randomly allocated. The mannequin (Noelle®, Gaumard, Florida) was supplied with an atonic uterus, modified to facilitate bimanual compression and containing a pressure sensor. The sensor assessed the amount of intrauterine pressure produced by compression of each participant. Results: Recruitment to the study is underway. We will compare the results between the two methods, as well as examining the effect of experience on 49 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 uterine pressures. 32 participants have already taken part – the study is expected to be completed at the end of September 2014. The results will be presented at the conference. Conclusion: The results will be presented at the conference. Disclosure of Interest: None Declared O79 DETERMINING PREGNANT WOMEN’S KNOWLEDGE ON THE INVASIVE AND NON-INVASIVE PRENATAL TESTS AND THEIR ANXIETY LEVELS H. Alan 1,*, T. Demirel 2, S. Dereli Yilmaz 1 1Midwifery, 2Nursing, Selcuk University, KONYA, Turkey Problem Statement: This study aimed at determining the pregnant women’s knowledge on the invasive and non-invasive prenatal tests and their anxiety levels. Methods: The study was descriptive and cross-sectional. Data were collected from 350 pregnant women resorting to the pregnancy polyclinics of a hospital between 3 April 2014 and 8 August 2014. In the collection of the data, the questionnaire form assessing the socio-demographic features of the pregnant women, current features of the pregnancy, foetal tests applied and knowledge on these tests and the State-Trait Anxiety Inventory aiming at determining the levels of anxiety were used. In the analysis of the data, percentage, mean, Standard deviation and Mann Whitney U test were used. Prior to the study, local ethical permission was received. Results: Age average of the pregnant women participating in the study is 28.87±5.46 while the mean length of the married life is 5.76±4.91. 73 % of the pregnant women and 63.4 % of their spouses are primary school-secondary school graduates. 77 % of the participants classified their economic situations to be moderate. While the mean of the gestational week is 34.89±6,372, the mean number of pregnancies is 2.28±1.34. Pregnant women received prenatal care for 7.41±3,097 times on average during their pregnancies. ‘Low level of anxiety’ was detected among the pregnant women whose mean score in the State-Trait Anxiety Inventory was 38.80±8.35. In 11 % of the pregnant women, the pregnancy was accompanied by a chronic disease. While 76.6 % of the participants got pregnant on purpose, 6.3 % of them had intended to terminate their current pregnancies. 22 % of the participants did not experience any problems in their current pregnancies. 11.4 % of the pregnant women underwent the risk of preterm labour while 6.3 % of them suffered vaginal bleeding. 25 % of the participants took NST while 15 % of them took double test, triple test and oral glucose tolerance test together. 4 % of the pregnant women had amniosynthesis done. When the participants were asked whether they were provided with an adequate level of information on the tests evaluating the foetal health, 55 % of them stated that they could not receive information sufficiently. The most common sources of information among the participants were physicians (35 %) and nurses (17 %). While 70.6 % of the pregnant women found explanations made by the health professionals on the tests insufficient, only 27 % of them stated that the explanations helped them reduce their anxieties concerning the health of the baby. 14 % of the pregnant women said that none of the questions was answered. While a statistically significant relationship (p<0.05) was found between the participants’ mean score in the State-Trait Anxiety Inventory and having health problems during pregnancy, receiving regular prenatal care and being informed sufficiently during pregnancy, no statistically significant relationship (p≥0.05) was found among education level of the woman, education level of the spouse, income level, presence of chronic diseases in the pregnant woman. Conclusion: It was determined in the study that pregnant women were not informed sufficiently on the tests evaluating the foetal health and they were unsatisfied with this situation. It is recommended that the pregnant women are provided with information adequately by the health professionals during the pregnancy which is stressful in nature and their questions are answered properly. Disclosure of Interest: None Declared 50 O80 DOES THE GENDER OF MEDICAL STUDENTS AFFECT THE ACQUISITION OF KNOWLEDGE AND SKILLS DURING AN OBSTETRICS AND GYNAECOLOGY ROTATION IN MEDICAL SCHOOL? S. Babu 1,*, Y. Beebeejaun 2, D. Rajeswari 3 1 Imperial College Healthcare NHS Trust, 2Queen Elizabeth Hospital, London, 3Ashford & St. Peter's Hospitals NHS Trust, Chertsey, United Kingdom Problem Statement: Over the last decade, Obstetrics and Gynaecology has witnessed major changes in its workforce. We now work in a speciality that is increasingly female. Data from the United States shows the percentage of female Obstetricians and Gynaecologists has risen from 12% in the 1980s to over 40% in recent years. This gender shift has had a direct effect on the number of male graduates entering higher speciality training. Indeed, a drop from 46% to 23% has been reported between 1998 and 2003. In the United Kingdom, third or fourth year medical students are attached to an Obstetrics and Gynaecology firm. Here they are expected to acquire the required medical knowledge and surgical skills necessary for managing women’s health. We designed a study to analyse the effect medical student gender on their experience during their Obstetrics and Gynaecology rotation. We focused on the effects of students' gender on quality of teaching, amount of surgical exposure, patient interaction and bedside teaching received. We also asked whether their medical school experience affected their decision to pursue a career in this specialty. Our hypothesis was that male students would have perceived an element of gender discrimination and consequently obtained a different experience to their female counterparts. This would translate to less patient interaction and exposure to procedures, compromising the acquisition of knowledge and skills. Methods: All medical students who rotated through an Obstetrics & Gynaecology department were given an anonymous questionnaire. This questioned whether they felt their gender had a positive, negative, or neutral effect on their learning experience. We also asked students to list the number of bedside procedures they performed and the surgical opportunities they had. Furthermore we asked about how comfortable they felt in their ability to counsel women in their future careers. Finally we assessed whether their medical school experience had affected their desire to pursue a career in Obstetrics and Gynaecology. Results: We observed that medical student gender did not affect the quality of teaching male students received. However we did find that patients were less likely to allow men to be actively involved in their medical and surgical management. Therefore male students were unable to get as much clinical experience as their female colleagues. This in turn dissuaded many men from considering a career in Obstetrics & Gynaecology. Conclusion: We therefore advise that educators actively encourage patients to allow male and female medical students to participate in their care equally. This is crucial to ensure that male medical students gain an interest in Obstetrics & Gynaecology so the specialty does not miss out on talented individuals purely because of their gender. Disclosure of Interest: None Declared O81 EVALUATION OF UNIVERSITY STUDENTS' KNOWLEDGE REGARDING SEXUAL/REPRODUCTIVE HEALTH T. Demirel 1,*, H. Alan 2 1Public Health Nursing, 2Midwifery, Selcuk University, Konya, Turkey Problem Statement: Educational initiatives targeting young people is very important in order to prevent their lack of knowledge regarding sexual health (SH) and reproductive health (RH). It should not be forgotten that in the absence of adequate information and counseling, young people may be at risk in this context. The purpose of this research is to determine university students' knowledge level regarding SH/RH matters Methods: This study was conducted between February – March 2014 in five faculties of Konya Selçuk University. For sample selection of the study, cluster sampling, a probability sampling method was utilized. Sample size was determined as 396 via sampling calculation of known universe method. Data was collected via face to face interviews and a questionnaire form which consists of demographic as well as SH/RH related questions. Necessary permits and Abstract Book permissions were obtained both from the university and from students themselves prior to research. Data analysis were conducted using SPSS 20 program utilizing number, percentage, mean, standard deviation and chi square tests Results: 52.5% of students who participate in the research were male while 94% were between ages 18-24. 60.6% of students have defined 'safe sex' as 'to be protected from sexually transmitted diseases'. SPECIAL; 23% of all participants stated that they have had at least one sexual intercourse before. A statistically significant relationship between knowledge level and gender had been found (p<0.05). It was observed that female students have more information about sexual/reproductive health when compared to males (59.6%). A statistically significant relationship between experiencing problems about sexual/reproductive health and gender had also been found (p<0.05). This showed that female students had more health problems regarding SH/RH than male students. The research also revealed that there is a statistically significant difference between 'gathering information about SH/RH, having information about institutions which provide counseling about SH/RH and faculties (p<0.05). It was observed in our research that students who study in departments/faculties affiliated with institute of health sciences have more information regarding SH/RH than students who study in departments/faculties that are not affiliated with institute of health sciences. SPECIAL; 72% of students who don't receive any SH/RH counseling or service stated that they don't receive these services because they don't need them while 10.7% of students said they don't receive counseling because they are ashamed. When asked about family planning methods that they are familiar with, the answer that was given the most was birth control pills (84.2%). 78.3% of students stated that the responsibility for using birth control/family planning methods during sexual intercourse falls on shoulders of both genders/partners. SPECIAL; Students who participate in the research stated that they gather information regarding sexual/reproductive health from following sources: media (46.5%), books (41.9%), school (42.3%), friends (27.8%) and relatives (21.6%). Conclusion: It was found that students who study in departments/faculties affiliated with institute of health sciences have more information about sexual/reproductive health. It was also observed that female students have/gather more information regarding sexual/reproductive health when compared to males. Disclosure of Interest: None Declared O82 SEVERE PERINEAL LACERATION DURING PROLONGED SECOND STAGE OF LABOR: THE IMPACT OF INSTRUMENTAL DELIVERY M. Simic 1,*, S. Cnattingius 1, A. Sandström 1, O. Stephansson 1 Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet and University Hospital, Stockholm, Sweden Problem Statement: Severe perineal lacerations represent a significant complication of vaginal delivery with a strong impact on quality of life. Previous research has described various factors that contribute to the occurrence of perineal lacerations. By separating different risk factors, we investigated how maternal, fetal and delivery characteristics influence the risk for perineal laceration. The aim or our study was to investigate the impact of duration of second stage of labor on risk for severe perineal laceration. Methods: We conducted a population based cohort study including primiparous mothers undergoing vaginal delivery with cephalic presentation, at 37 completed gestational weeks or later, 2008- 2012 in Stockholm/Gotland region in Sweden. Information on duration of second stage of labor were collected from partograph data and categorised into 5 groups: 0-59 min (reference); 60-119; 120-179; 180-239; and ≥ 240 minutes. The outcome was define as perineal laceration grade III and IV. Logistic regression models were adjusted for maternal, delivery and fetal characteristics. Results: The multivariate analysis found that the risk for perineal lacerations increased with duration of second stage of labour from OR 1 at first hour till OR 1.36 (95% CI 1.19-1.56) at four hours. Factors associated with perineal laceration included in multivariate analysis were: epidural analgesia (OR 0.98; 95% CI 0.871.10), oxytocin use for labor augmentation (OR 1.56; 95% CI 1.44-1.68), increasing gestational age- week 42 compared to week 37 (OR 1.79; 95% CI 1.47- 2.19) induction of labor (OR 1.12; 95% CI 1.03-1.22), head circumference (OR 1.61; 95% CI 1.51-1.73) birth weight >4500 gr (OR 2.42; 95% CI 1.98-2.97), occiput posterior position (OR 1.56; 95% CI 1.44-1.68), episiotomy (OR 1.39; 95% CI 1.27-1.53) , maternal age > 35 years (OR 1,18; 95 % CI 1.07-1.30), BMI 25.029.9 (OR 1,12; 95 % CI 1.02-1.22), maternal height 130-154 cm (OR 1. 36; 95 % CI 1.12-1.65) parental cohabitation (OR 1.14; 95 % CI 1.06-1.22), and smoking (OR 0.65 CI 0.54-0.77) . The rate of perianal laceration at instrumental delivery was approximately twice the rate at vaginal delivery (OR 2.49; 95% CI 2.34-2.67). Stratification by mode of delivery indicated that occiput posterior position was significantly associated with perineal laceration among instrumental, but not among normal deliveries while episiotomy had an opposite effect. High birth weight increased risk for perineal laceration among both groups. Duration of second stage of labor had no significant influence on the risk for perineal laceration among instrumental deliveries. Conclusion: The risk for severe perineal laceration increases with time from retracted cervix to birth. However, instrumental delivery is an independent risk factor for perineal lacerations and is not correlated to duration of second stage of delivery. Disclosure of Interest: None Declared O83 MATERNAL URIC ACID LEVELS AND PRE-ECLAMPSIA: A CAUSAL ASSOCIATION? E. Staines Urias 1,*, C. C. Colmenares 2, N. C. Serrano 3 on behalf of GenPE, A. Hingorani 4, J. P. Casas 1 1NCDE, London School of Hygiene and Tropical Medicine, London, United Kingdom, 2Centro de Investigaciones Biomédicas, Universidad Autónoma de Bucaramanga, 3Fundación Cardiovascular de Colombia, Bucaramanga, Colombia, 4Department of Epidemiology and Public Health, University College London, London, United Kingdom Problem Statement: Pre-eclampsia is a main cause of maternal and foetal morbidity and mortality. Despite intensive research, the pathogenesis of this complex disease remains unclear. The increase in maternal uric acid that precedes pre-eclampsia onset has traditionally been viewed as a consequence of decreased renal excretion, and so uric acid is considered a marker of disease severity rather than having a role in pre-eclampsia pathogenesis. Current evidence suggests that, in the general population, uric acid might be causally related to two pathognomonic signs of pre-eclampsia: hypertension and impaired renal function. It remains possible that uric acid is causally associated with pre-eclampsia and could represent a therapeutic target for pre-eclampsia prevention. Methods: GenPE is a case-control study of women with first pre-eclampsia (N=1365) and healthy pregnant controls (N=1886) from eight Colombian cities recruited at the time of delivery between December 2000 and February 2012. Maternal concentrations of uric acid were measured on serum samples. Information on potential confounders was obtained through a verbal interview. Adjusted odds ratios for uric acid levels were estimated. A meta-analysis of reported measures of effect from prospective studies was conducted. Results: Uric acid levels were positively associated with increased risk of preeclampsia, with evidence of a linear effect across quintiles (linear trend p-value <0.001). The adjusted odds ratio of pre-eclampsia was 1.45 (95%CI 1.23-1.71) for a top vs. bottom quartile comparison. Three studies with uric acid measured before 20 weeks’ gestation were identified (385 cases and 7006 non-cases), with a pooled OR of pre-eclampsia of 1.46 (95%CI 1.22-1.75) for a top vs. bottom quartile comparison. Conclusion: This study provides large-scale evidence for elevated uric acid levels being associated with increased odds of pre-eclampsia; this association followed a linear shape without an observable threshold that was robust to adjustment for a comprehensive set of possible confounders. Concordant results from a meta-analysis of prospective studies supports that reverse causation is not likely to entirely explain the observed association. The recent evidence from randomised trials for a role of uric acid in the pathogenesis of hypertension and endothelial and renal dysfunction, both characteristic features of pre-eclampsia, favours the evaluation of an scenario in which uric acid is a causal contributor to pre-eclampsia. Current knowledge of the genetics of uric acid metabolism and 51 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 the existence of potential sources of data from consortiums like the InterPregGen Collaboration would support a Mendelian randomisation study with multiple instrumental variables that could inform on the feasibility of an RCT of uric acid lowering therapy for pre-eclampsia prevention. Disclosure of Interest: None Declared O84 ANGIOGENIC FACTORS AND UTERINE ARTERY BLOOD FLOW FOR PREDICTION OF PREECLAMPSIA V. Taraseviciene 1,*, D. Simanaviciute 1, R. Maciuleviciene 1 Obstetrics and Gynecology, Lithuanian University of Health Sciences, Kaunas, Lithuania Problem Statement: It is widely accepted that key proteins responsible for endothelial dysfunction during preeclampsia are soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF). Inadequate trophoblast invasion into spiral arteries result in increased placental vascular resistance that can be detected by uterine artery Doppler. There are number of studies investigating those factors use for prediction of preeclampsia. However the data regarding their effectiveness, timing of testing are controversial. The aim of our study was to investigate the sFlt-1, PlGF and uterine artery Doppler for prediction of preeclampsia. Methods: 206 women having high risk for preeclampsia were examined prospectively at 22+0–22+6 and 27+0–27+6 weeks of gestation. SFlt-1, PlGF and uterine artery Doppler (mean pulsatility index (PI) and mean resistance index (RI)) were performed and evaluated. All included women were followed until delivery and the event of preeclampsia if occurred was recorded. Discriminant function analysis was performed to determine significant predictors of preeclampsia. Subsequently the cut-off point was established for each of them by receiver operating characteristic (ROC) curve analysis. Logistic regression was performed to calculate the combined prediction of preeclampsia. Results: Preeclampsia developed in 17 cases. At 22+0–22+6 weeks of gestation PlGF, mean uterine artery PI and RI were determined as significant predictors of preeclampsia.If the values of these predictors surpassed the cut-offs, determined by ROC curve analysis, the probability of preeclampsia and preterm preeclampsia increased to 64.5% and 95.5%. Neither of tested variables or their combination could predict late preeclampsia at this gestational age. At 27+0–27+6 weeks of gestation, the strongest preeclampsia predictors appeared to be sFlt-1 and PlGF ratio and mean uterine artery PI. Logistic regression showed that the ratio of sFlt-1/PlGF more than 10.7 could predict preterm preeclampsia with 100% sensitivity and specificity. The most significant predictor of term preeclampsia at 27+0–27+6 gestational weeks appeared to be mean uterine artery PI. Conclusion: We conclude that at 22 weeks of gestation best predictors of preeclampsia are PlGF, mean uterine artery PI and RI. While at 27 weeks of gestation best predictor was found to be sFlt/PlGF ratio. Disclosure of Interest: None Declared O85 RELATIONSHIP OF SUPPORTIVE CARE, PAIN AND SATISFACTION IN LABOR S. Mete 1, E. Uludağ 1,*, G. Şaşmaz 1 Dokuz Eylul University Nursing Faculty, Izmir, Turkey Problem Statement: Labor is an important experience for women, which has physical and emotional effects. Therefore, women's satisfaction in labor is important. Women’s satisfaction in labor decreases from labor pain. Supportive care decreases labor pain and increases satisfaction in labor. Aim: To determine the relationship between the supportive care, pain and satisfaction in labor. Methods: It was a descriptive study. A sample of the study 250 women who has vaginal birth at one state hospitals participated. Written permission was obtained from the Ethics Committee, hospital and participants. Data was collected with the Women’s Information Form, Visual analog scale (VAS), Postpartum Self-Evaluation Scale’ Subscale of the Satisfaction with The Labor, The Women’s Perception For Supportive Care Given During Labor Scale. Sociodemographic and obstetric characteristics were evaluated by percentage. 52 Relationship between the supportive care in labor, labor pain and satisfaction with the labor evaluated Pearson correlation coefficient. Results: The average age of women was 26.56. The percentages of woman unemployment rate were 93.6%. Illiterate rate were 10.8 %, primary school graduates were 38 %, middle school graduates were 31.2 %, high school graduates were 20% and university graduates were 2 %. There was very weak positive correlation Supportive care point and satisfaction scores in the labor (r: 0.245, p<0.001). There was no correlation between first, second and third phase pain score with supportive care and satisfaction with the labor. Conclusion: Woman’s awareness levels can be increased when supportive care increases from the care givers. By this way they can feel happiness from having a new baby. There are no relationship between first, second and third phase pain score and supportive care. In this research, woman's low educational levels and their unemployment rate is being high can affect perceive in supportive care. Woman who has low sociocultural level are known as their low expectations in supportive care. For this reason, care givers similes and asking their needs is enough for them. Also they are accepting care giver’s negative behavior. Having a baby and birth has positive effect and also it gives a positive statue for woman in Turkey. In additional to this, women are expected to having an intense pain while give birth. That is why, even their birth process was painful they could still state they pleasant from their labor experience. Disclosure of Interest: None Declared O86 PRECONCEPTION HEART RATE AND RISK OF PRETERM DELIVERY IN CHINESE REPRODUCTIVE AGE WOMEN Y. Yang 1,*, Y. Wang 1, Z. Peng 1, X. Ma 1 National Research Institute for Family Planning, Beijing, China Problem Statement: Preterm delivery (PTD) is an important adverse pregnancy outcome for pregnant women, which threaten maternal and child health. The report of WHO in 2012 showed that around 1 million children die each year due to complications of preterm birth. Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems. Pregnancy is a special physiological period for women, in which the maternal cardiac load would significantly increase caused by volume expansion. Maternal cardiac function may have a marked impact on pregnancy outcome, such as PTD. Previous studies mostly focus on the effect of gestational maternal cardiac function on PTD risk. However, the preconception cardiac function indicators on PTD risk in women who prepare to get pregnant remain uncertain. In the present study, we examined the relationship between preconception heart rate (HR) level and the risk of PTD. Methods: We conducted a historical cohort study which recruited 380848 rural reproductive age women participated National Free Pre-pregnancy Checkups (NFPC) in 2010-2012 in China. Data on preconception HR, blood pressure, history of pregnancy and diseases, fasting glucose level and other variables were obtained from the physical examination record in NFPC. Follow-up evaluation was conducted from June 2010 to Oct 2013. Successful conception and pregnancy outcomes were documented during the follow-up period. In the present study, PTD which is defined as babies born alive within 28 to 37 weeks of pregnancy are completed was the end point event of the cohort. Participants who are failure to get pregnant, suffered from fetal death, still birth abortion, and multiple gestation were excluded from the analysis. Multivariate logistic regression models were undertaken to adjust baseline variables with PTD as the outcome variable. Results: Until Sep 30th 2013, 3503 PTD events were documented. The PTD incidence rate was lowest in women with a heart rate of 70-89 bpm (incidence rate=0.85%), while the PTD incidence rate was highest in women with a heart rate<60 bpm (incidence rate=1.74%). Compared to the participants with a heart rate of 70-79 bpm, women with a heart rate <60, 60-69, 80-89, 90-99, 100-109 and ≥110bpm had higher risk of PTD, and the corresponding multivariateadjusted RRs and 95% confidence intervals (CIs) were 2.02(1.15-3.44), 1.37(1.231.53),1.01(0.92-1.44), 1.20(1.00-2.04), 1.51(1.12-2.04) and 1.78(1.08-2.93). Table 1. Incidences and RRs of PTD by preconception heart rate level Abstract Book HR (bpm) <60 PTD incidence (%) 1.74 60-69 1.18 70-79 0.86 80-89 0.85 90-99 1.06 100109 >=110 1.32 1.54 RRa (95%CI) P-valuea RRb (95%CI) P-valueb 2.02(1.193.44) 1.37(1.231.53) 1.00 0.009 2.04(1.153.62) 1.36(1.201.54) 1.00 0.015 0.99(0.921.08) 1.24(1.051.46) 1.58(1.202.08) 1.85(1.162.95) 0.915 1.01(0.921.44) 1.20(1.002.04) 1.51(1.122.04) 1.78(1.082.93) 0.840 <0.001 - 0.011 0.001 0.010 <0.001 - 0.053 0.006 0.025 a adjusted for age. b adjusted for age, BMI, smoking, alcohol consumption, diabetes, hypertension, thyroid dysfunction, history of adverse pregnancy outcome, northern residents and high school education. Conclusion: Preconception heart rate level was significantly associated with risk of PTD incidence. Either preconception heart rate too high or too slow can increase the risk of PTD incidence. Disclosure of Interest: None Declared O87 EPIDEMIOLOGY OF INTRAUTERINE FETAL DEATHS: A 5 YEARS STUDY IN THE HOSPITAL OF PORTIMÃO A. F. Rafael 1,*, C. Paixão 1, S. Costa 1, P. Guedes 1, F. Guerreiro 1 Centro Hospitalar do Algarve - Hospital de Portimão, Portimão, Portugal Problem Statement: Still birth is a tragic event for the parents and a great cause of stress for the caregiver. Stillbirth incidence is 1 in 200 births. 2.6 million 3rd trimester stillbirths occur worldwide every year. Portimão's maternity is a level 3 unit, without a neonatal intensive care department. The present study was conducted to understand the characteristics of the pregnant population, and to know the prevalence, socio-epidemiological and etiological factors of stillbirths in the Hospital of Portimão, Portugal, in order to improve fetal and maternal outcomes. Methods: Stillbirth data was collected from doctors' records and maternity unit birth statistics, including all the cases with more than 24 weeks of gestation. Clinical notes were reviewed retrospectively to identify information relevant to the study. Ante partum and intra partum events leading to fetal demise were recorded, socio-demographic and clinical characters were noted, as well as post mortem archives. Results: 28 cases of stillbirth were identified between January 2009 and December 2013 including 8 at term (> = 37 weeks). The stillbirth rate was 4.11 per 1000 births (national average of 2.5 per 1000 from 2009 to 2013). Risk factors recognised were diabetes, maternal age over 40 years, being overweight or obese, narcotic drug abuse and cigarette smoking in the 3 months prior to pregnancy. There was 2 cases (7%) of Abruptio placenta and 3 cases (10%) associated with maternal diabetes, 1 presented in multiple gestation, 3 cases (10%) of umbilical cord lesions, 2 cases had some malformation, fetal growth restriction was the main cause of death in 4 cases (14%) and 3 had documented infection. 10 cases (35%) had no relevant condition identified. Conclusion: Advances in diagnostic and therapeutic modalities allow the rate of still birth to be constant in Portugal. In the region of Portimão, the rate is higher due to socio-cultural background, illiteracy, lack of adequate antenatal care and inaccessible health care. Universal and improved antenatal care is needed to continue to lower the stillbirth rate. Disclosure of Interest: None Declared O88 CAN ADVERSE CHILDHOOD EXPERIENCES AFFECT THE DEVELOPMENT OF PAIN DURING PREGNANCY? J. Drevin 1,*, T. Tydén 1, M. Larsson 2, J. Stern 1, E.-M. Annerbäck 1, M. Petersson 1, S. Butler 1, P. Kristiansson 1 1Department of Public Health and Caring Sciences, 2The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden Problem Statement: Experiencing pain is common during pregnancy, 46% of Swedish women report having pelvic girdle pain and 78% report having back pain sometime during pregnancy. Adverse Childhood Experiences (ACEs) include a range of potential traumatic events during the first 18 years in life. These are physicial, mental and sexual abuse and different forms of household dysfunctions. Previous studies have shown that ACEs increase the risk for various health problems in adulthood such as having sexually transmitted diseases, obesitas and ischeamic cardiac diseases. It is unknown if ACEs affect development of pain during pregnancy. Methods: A prospective longitudinal cohort study was made as a pilot study. Women were enrolled at 18 antenatal clinics in south Mid-Sweden and 232 (78%) women participated and answered to the first questionnaire in early pregnancy. A follow-up questionnaire was distributed in late pregnancy and was answered by 160 (72%) of the enrolled women. The questionnaires included sociodemographic questions, pain drawings, visual analogue scales for pain intensity and eight ACE categories, which were summed to a score. The distribution of pain was coded in 41 predetermined areas. Spearman’s correlation coefficient and the χ2 test were used to study relationships. For regression analyses General Linear Model and logistic regression were used. Results: In late pregnancy 72% reported any pain and 62% any category of ACE. Among women reporting experience of ACE the prevalence of any reported pain was not different from that of women without such experiences whereas women reporting child physical abuse category of ACE reported higher prevalence of sacral and pelvic pain (p=0.0003 and p=0.02, respectively). Worst pain intensity during the past week was significantly higher among women reporting any ACE (p=0.01) but not among those reporting child physical abuse (p=0.3) as compared to women without such experience. The number of pain locations was positively associated to the ACE score (rs=0.19, p=0.02). This association remained significant adjusting for factors measured in early pregnancy in a multiple regression analysis (p<0.0001). Conclusion: ACEs were commonly reported and might influence development of pain with onset during pregnancy. Disclosure of Interest: None Declared O89 KIELLAND'S ROTATIONAL FORCEPS DELIVERY: IS IT A DYING ART? S. Mukherjee 1,*, S. Umranikar 1, V. Perry 1, S. Slater 1 Obstetrics and gynaecology, University of Southampton, Princess Anne Hospital., Southampton, United Kingdom Problem Statement: There has been a significant decline in the use of Kielland's rotational forceps for malpositions, and also a rise in rate of second stage Caesarean section.This is due to previous reports that their use results in increased maternal and neonatal complications. However, most of these studies date from more than 25 years ago, and there is a lack of recent data regarding maternal and neonatal outcomes following Kielland’s rotational forceps delivery (KRFD). The aim of this study is to describe maternal and neonatal outcomes of KRFD, to compare maternal complications with those of other modes of delivery, and to examine whether more training and more senior involvement is needed to improve the outcome of KRFD. Methods: This is a Retrospective observational study from January 2013 – December 2013 at Princess Anne Hospital, University of Southampton, which is a very busy tertiary teaching Hospital in Southampton, UK and we collected data mainly from our electronic database. We prepared the proforma to collect the data and reviewed all the cases who had KRFD during the above time period. Our standards were set from the Guideline of RCOG. The data were analysed to get the result and recommendations were made for further improvement of the local practice. Results: Total births during the period were 5910. Forceps delivery rate was 9.8%, Keilland was attempted in 129 (2.18%) cases with a Success rate of 63%. Majority of the successful KRFD were nulliparous (75%) and average age group was 30-40 years. Average gestational age for successful KFD was 30-41 weeks and average birth weight of the babies were 3.5-4 kg. Rate of sequential 53 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 use of instruments 9.2%. Rate of emergency LSCS 28% (failed KF) .Rate of third and fourth degree tear was 5.4 % and a significant number of the women (57%) had PPH of less than 500ml. Rate of minor neonatal morbidity was 9.3 % and there was very minimal neonatal complication rate. Majority of cord gases results were within normal range. Rate of Low Apgar score was 13.6%. Adequate analgesia was given in 100%cases and no Urinery retention was noted after KFRD. This study shows that 86% of cases were done by the Consultant or Senior Registrar. Conclusion: Kielland forceps deliveries have not gotten serious complication rate Majority of the babies were with good Apgar score and Cord Gases .Majority of the deliveries were conducted by Senior Trainees. Kielland forceps deliveries definitely contributed towards lowering Second Stage Section rate. Risk of major PPH in KRFD is not high .Risk of third & fourth degree tear is also comparable to overall rate of third & fourth degree tear. (5.4 % vs 4.1%) There was no complication of urinary retention after delivery. Hence, the result of our study suggest that in experienced hands, assisted vaginal birth by Kielland Forceps is likely to be the most effective and safe method to prevent the ever rising rate of Caesarean sections when malposition complicates the second stage of labour. Disclosure of Interest: None Declared O90 EXAMINATION OF TRADITIONAL POSTPARTUM PRACTICES OF WOMEN AND INFANTS IN KONYA/TURKEY S. Cankaya 1,*, G. GUNEN 1, F. KARAKAS 1, A. ARI 1, S. SAHİN 1, T. YİLMAZ 1, B. GORGULU 1 Midwifery, Health sciences faculty, Konya, Turkey Problem Statement: To gain an understanding of traditional postpartum practices for women and babies, and to investigate the factors influencing such practices. Methods: The study was conducted with 302 voluntary mothers who had babies aged 0-12 months and who accepted to participate in the study at three different family health centers located in Konya city center. For the data collection; a survey form about mothers’ socio-demographic characteristics and their babies was administered. Results: It was determined that mean age of the mothers was 26.3±5.8 years, 39.7% of them were graduated from primary school, 69.9% of them were housewife. A number of women (37.4%) had their abdomen tightly wrapped and more than half of the women (76.2%) avoided sexual intercourse for 40 days after giving birth. It was determined that (19.5%) fed their babies with water containing sugar just after the birth, 29.8% of them salted to the infant, 55.3% of mothers were a bath to the infant after the umbilical cord had dopped, and 70.9% of women kept their babies’umbilical cord in a special place. Afterwards, the mothers threw the cords into a river or they buried them in thegrounds of a mosque or a school. Most of the mothers (62.9%) reported that they covered their babies with a yellow cloth in order to protect them from jaundice. Conclusion: It was result of the research, mothers were often applied of traditional practices because of mothers were young and educational level low. Postpartum care of women and their babies are important cultural practices. Some of these practices may have harmful effects on women and their babies. Midwives and nurses should discuss these findings and their implications when they educate new mothers and their families about contemporary methods of postnatal maternal and infant care. Keywords: Traditional practices in Turkey; Midwifery–nursery; postpartum period; Women; Infants Disclosure of Interest: None Declared O91 EFFECT PREGNANT WOMEN IN THE ACTIVE PHASE IN LABOUR PERFORMED FOOT MASSAGE ON POSTPARTUM COMFORT Y. Erkal Aksoy 1,*, S. Dereli Yılmaz 1 Midwifery, Faculty of Health Sciences, Konya, Turkey Problem Statement: In the process of labor performed for 20 min head, neck, back and foot massage has a positive effect such as anxiety, worry and pain levels 54 decrease significantly, shortening of the duration of labour. This research is the intervention study in order to perform on determine the effect of postpartum comfort of foot massage pregnant women in the active phase of delivery. Methods: Research was carried out with primipara pregnant women who admitted birth services in city of Konya maternity hospital. Sample size was determined for suitability of parametric test as 30 controls and 30 experimental groups. In this study, the standard of care was applied to both groups, in addition the foot massage was applied experimental group the active phase until the transition phase during period rest of the labour contractions. Foot massager made through pressure the base of foot and thumb, massage time was determined according to range of the contraction of every pregnant and was continued massage until the transition phase. In addition was used in massage oil. Collection of data were used socio-demographic question form and Postpartum Comfort Questionnaire (PPCQ). Data was analyzed with percentage, average, t-test. Results: The average age of pregnants were 23.16 ± 3.86 (min = 17, max = 35), 66.7% were primary education, 81.7% were housewives, montly income expense was equivalent (medium) at 55.0% of pregnants, %81.7 of pregnants have social insurance, 80% of pregnants willingly were conceived. 38.3% of women experienced problems during pregnancy and 20,0% of pregnants faced with the problem of nausea and vomiting. 90.0% of pregnant women were controled prenatal care regular. 41.7% of pregnants were educated related to the delivery on antenatal care and 48.3% were trained by midwives. Postpartum Comfort Questionnaire total and subscale scores of pregnant women in the between experimental and control groups were not significantly different (p>0.05). Conclusion: In this research was found that foot massage was conducted in the active phase of labour have no effect on postpartum comfort. More studies are needed to investigate relationship between the foot massage in the active phase of labour with postpartum comfort. Disclosure of Interest: None Declared O92 EFFECTS OF ADOLESCENT PREGNANCIES ON MATERNAL AND NEONATAL HEALTH E. KIZILER 1,*, D. YILDIZ 1, D. SULUHAN 1 Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey Problem Statement: To determine whether adolescent pregnancy is associated with increased risk for maternal and neonatal health. Methods: Data which is obtained by scanning databases (Ebscohost, Ovid, Science Direct, and Google Scholar), magazines and related literature is evaluated. Results: Adolescent pregnancy which is a pregnancy at the age 19 or younger, is associated with higher rates of illness and death for both the mother and infant. Each year, approximately 16 million women give birth under 19 years old, about 11% of all births worldwide. Adolescents are twice as likely to die during pregnancy or childbirth compared to women over 20 years of age. Adolescent pregnancy is a complex issue with many reasons for concern. Pregnant teens are at much higher risk of having serious medical complications and health problems. These include anemia, sexually transmitted infections, postpartum haemorrhage, toxemia, placenta previa, pregnancy- induced hypertension and mental disorders, such as depression. Infant and child mortality is also highest. Stillbirths and death in the first week of life are 50% more frequent among babies if the mother is an adolescent. Additionally, adolescent mothers are more likely to have low birth weight babies who are at risk of malnourishment and poor development. The rates of prematurity, preterm birth, IUGR, low birth weight and asphyxia are higher among the children of adolescents, all of which increase the chance of death. Adolescent mothers are also more likely to have unhealthy habits such as substance abuse and poor health care that can cause a greater risk for inadequate growth, infection, or chemical dependence for the baby after birth. Conclusion: Adolescent maternal morbidity and mortality constitutes a major public health problem on a global level. Research shows that low education levels and socioeconomic status are closely associated with early pregnancies. Education programs focus on teaching adolescents about their bodies, Abstract Book encourage teens to wait to have sex until marriage or until they are mature enough to handle sexual activity. It also provides information about birth control and how to prevent sexually transmitted infections to decrease complications. Disclosure of Interest: None Declared O93 CELL SAVER SAVES LIVES- A STUDY LOOKING AT THE USE OF CELL SALVAGE TRANSFUSION DURING CAESAREAN SECTIONS IN A DISTRICT GENERAL HOSPITAL IN MERSEYSIDE, ENGLAND. E. Pye 1, A. Neville 2,*, C. Nwosu 2, M. Omar 2, P. Yoxall 3, N. Srivastava 2, S. Rao 2, T. Idama 2 1 Student, Newcastle University, Newcastle, 2Obstetrics and gynaecology, 3Anaesthetics, Whiston hospital, Liverpool, England, Liverpool, United Kingdom Problem Statement: Autologous blood replacement may be required at caesarean section. Intra-operative cell salvage transfusion is used in cardiac, orthopaedic and vascular surgery. It reduces the incidence of blood transfusions, transfusion reactions and occasional difficulties with cross matching blood. In obstetrics it is yet to be universally adopted due to the potential risks of amniotic embolism and re-infusing fetal cells with the associated risk of future development of haemolytic disease of the new born. Should we be using cell salvage more frequently in both routine elective and emergency caesarean sections? This audit aims to answer this question. Methods: This was a year long retrospective study at Whiston Hospital in Merseyside, England from 1/6/2013 – 31/05/2014. A list of patients given autologous transfusion at caesarean section was identified from operating theatre records and the department's electronic patient note system. Patient details were then extracted including: ethnicity, age, body mass index, parity, gestation, indication for cell saver, amount of red cells obtained and transfused, post operative recovery and discharge, pre-operative and post-operative haemoglobin and breastfeeding rates. The same information was obtained for a group of randomly selected matched control patients that had no transfusion. Comparisons were then made between the two groups. Results: 56 patients with sufficient documentation who received an autologous blood transfusion during the time period were identified. The same number of matched controls were used. Average patient demographics between the two groups (age/body mass index /ethnicity) showed no significant differences. The average amount of blood recovered and transfused back to patients during cell salvage (327mls) was in keeping with other studies. There was a positive linear relationship between the estimated blood loss at caesarean section and the amount of cell salvaged blood returned. The average post-operative drop in haemoglobin value was significantly reduced in the cell salvage versus the control group (11.4 g/l vs. 16.4g/l respectively). The patients transfused salvaged blood were discharged earlier (2.6 vs. 2.9 days) although this was not statistically significant. In rhesus negative cell salvaged patients 17% needed further AntiD when the maternal blood kleihauer test showed >2mls of fetal cells. None of the rhesus negative patients in the control group required extra AntiD. Patients’ transfused salvaged blood suffered no immediate complications such as DIC, hypothermia, anaphylaxis or infection. The amount of cell salvaged blood given to patients would have depleted blood bank stores with significant cost. There was not a significant difference in breastfeeding rates between the two groups. Conclusion: Study numbers are too small to make a reliable conclusion. However initial results are positive towards using cell salvage transfusion more readily at elective and emergency caesarean sections because the benefits outweigh the potential risks. A multidisciplinary team at Whiston hospital will draw up an inhouse protocol to reflect this. Future work is needed on: (1) A continuous rolling audit on this topic as more patient numbers are required to prove significant outcomes. (2) Long term future pregnancy follow up of rhesus negative women transfused an autologous transfusion Disclosure of Interest: None Declared O94 ANTENATAL UTERINE ARTERY EMBOLISATION FOR MORBIDLY ADHERENT PLACENTA – THE EXPANDING ROLE OF INTERVENTIONAL RADIOLOGY IN MODERN OBSTETRICS. A. Obloza 1,*, A. M. Coady 2, P. Scott 3, P. Lesny 1, S. Lindow 4 1O&G, 2O&G Radiology, Women and Children's Hospital NHS trust, 3Interverntional Radiology, Hull Royal Infirmary NHS Trust, Hull, United Kingdom, 4Head Division Obstetrics, Sidra Medical and Research Centre, Doha, Qatar Problem Statement: There is undisputed evidence that the rising incidence of caesarean sections (CS) are associated with the increase of abnormal placentation disorders, including morbidly adherent placentas and caesarean scar pregnancies (CSP). Both carry high maternal morbidity and mortality risks including uterine rupture, severe hemorrhage and hysterectomy. Fertility preservation is, in these cases, one of the emerging challenges in modern obstetrics when an obstetric hysterectomy has become increasingly obsolete. Current literature describes different treatment modalities for uterine preservation. Interventional radiology is already commonly used for treatment of postpartum haemorrhage, placental attachment disorders and caesarean scar pregnancies. Methods: Antenatal use of interventional radiology with pelvic arteries embolization appears to be a valid management option in selected cases. We present a case illustrating such example. A 35 year old insulin dependent diabetic patient, who had had two previous CS with only one living child, attended the medical obstetrics team clinic at 17 weeks gestation with ultrasound diagnosis of a hypoplastic left heart syndrome. Sadly, her first child died of the same condition following surgery during neonatal period. Under these circumstances the patient requested termination of pregnancy. To complicated the situation a placental attachment disorder in form of placenta accreta was confirmed by subsequent ultrasound scans (Fig.1). At 18 weeks of gestation the patient underwent radiologically guided bilateral uterine artery embolization (Fig.2) 2 hours prior to an operative delivery via a longitudinal incision of the upper uterine segment. The fetus was dead at delivery. The morbidly adherent placenta was left in situ, the umbilical cord and membranes were carefully removed. Results: She was followed up weekly for ten weeks with scheduled blood tests: full blood count (FBC) and HCG (Graph 1). Serum HCG became undetectable after nine weeks and placental tissue resolution occurred after twelve weeks. Subsequent hysteroscopy showed a normal uterine cavity. The menstrual cycle had also resumed by then. Image / Graph: Conclusion: Although there is still no uniform approach in the management of placental attachment disorders our case demonstrates selective pelvic artery embolization as a successful therapeutic modality for the management of invasive placentation in the second trimester of pregnancy especially when there is no concern with fetal survival. The effectiveness of the embolisation in reducing placental perfusion was confirmed by the demise of the fetus. Whether the procedure and placental absorption would have been as uneventful if no embolisation had taken place is speculative. Furthermore, arterial embolization is a safe alternative for women with placenta accreta who wish to preserve fertility, with a 76.9% success rate and an 11% complication rate. Pre-operative 55 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 selective artery embolization appears to reduce the risk of hemorrhage, decrease morbidity and mortality, and increase the chance of fertility preservation in patients with placenta accreta, increta, and percreta. It can be used in selected cases only (at the cost of fetal demise) and wiith a long follow up. We further propose it as a method that can be also utilized in cases of caesarean scar, cervical and cornual pregnancies. Disclosure of Interest: None Declared O95 HIGH-RISK HUMAN PAPILLOMAVIRUS AND RISK OF PREECLAMPSIA: A POSSIBLE CONNECTION? C. Dragosloveanu 1,*, R. Vladareanu 2 1Obstetrics and Gynecology, Clinical Hospital of Obstetrics and Gynecology "Professor Dr. Panait Sarbu", 2Obstetrics and Gynecology, Elias University Hospital, Bucharest, Romania Problem Statement: Human papillomavirus (HPV) affects up to 80% of women in their lifetime. There is growing evidence in literature of the high prevalence of HPV trophoblast infection in both spontaneous abortions and spontaneous preterm delivery; furthermore, defective trophoblast invasion in early pregnancy may lead to other obstetric adverse outcomes, such as preeclampsia. Our purpose was to determine whether there is a correlation between high-risk human papillomavirus (HR-HPV) cervical infection in early pregnancy and preeclampsia (PE). Methods: We conducted a retrospective case control study carried out in "Prof.Dr. Panait Sarbu” Hospital in Bucharest over a one-year period.Women who tested positive for HR-HPV at entry to prenatal care (n=108) were compared with those who were HR-HPV negative (n=216). We used for reporting the results of HR-HPV cervical infection the Hybrid Capture II system (Digene Diagnostics Inc., Gaithersburg, MD, USA). We assessed the relationship between the presence of HR-HPV and preeclampsia (as defined by clinical guidelines). Unadjusted and adjusted analyses were performed. All patients delivered in our clinic and signed an informed consent at admission according to the World Medical Association Declaration of Helsinki regarding both delivery and anesthesia. This study was approved by the Committee of Ethics and Research in Humans of our institution. Results: One hundred and eight women with HR-HPV were matched with two hundred sixteen women HR-HPV negative. Patients carrying HR-HPV were younger (mean age 25.03 ± 3.42 years old vs. 27.08±3.14 years old, p< 0.001), more likely to be nulliparous, had lower body mass index (mean value 22.58± 3.01 Kg/m2 vs. 25.35± 3.19 Kg/m2, p< 0.001) and more likely to develop preeclampsia (13% vs 3.7%, p= 0.001; adjusted odds ratio 5.30; 95% confidence interval, 2.03-13.84). We also observed a tendency of women in the exposed group to develop severe preeclampsia compared with the unexposed group (6.5% vs. 1.4%, p< 0.01). Conclusion: We showed that HR-HPV infection was associated with an increased risk of developing preeclampsia. The results obtained in our study could be explained on a molecular basis by the growing evidence of the possible transplacental transmission of human papillomavirus. Recently, it has been revealed that HPV-16 is able to replicate its DNA de novo and produce progeny in placental trophoblasts cultures. This is a surprising report taking into account that HPV was previously believed to be an exclusively keratinocyte/skin-specific virus. Further prospective studies or larger cohorts are needed to confirm our findings and also to evaluate the mechanisms by which this association takes place; if this is to happen, then HPV vaccination may prove to have additional health benefits by possibly participating in the prevention of various adverse pregnancy outcomes, including preeclampsia. Disclosure of Interest: None Declared O96 KNOWLEDGE OF HPV, CERVICAL CANCER, AND PAP SMEAR AMONG TURKISH WOMEN V. Savaş Çimke 1,*, G. Börekçi 2 1Nursing, HEALTH SCIENCES INSTITUTE, hatay, 2Nursing, HEALTH SCIENCES INSTITUTE, Mersin, Turkey 56 Problem Statement: cervical cancer is one of the most widely seen cancer types. Persistent infection with a human papillomavirus (HPV) is the main cause for cervical cancer. However, cervical cancer is a preventable disease and Pap smear screening is the best methods for prevention of the disease. But awareness of womens about HPV, Pap smear test and cervical cancer for prevention is very important. This study aims to find out the level of knowledge, behaviors of women about HPV, cervical cancer and Pap smear test. Methods: This study is conducted with 753 women who live in Hatay İskenderun. 228 nurses, 135 teachers, 28 doctors, 20 academicians, 21 police officer, and 321 married house wife take part in this research. The data are collected by using “ A questionnaire directed to determine socio-demographic characteristics and obstetric story” which contains knowledge about women and a questionnaire used to determine the knowledge of HPV, Pap smear test, and cervical cancer. The questionnaires are conducted with the face-to-face interview method. The analysis of data collected between 1 November 2012 and 1 November 2013 is made with chi square, student t-test, One-Way ANOVA test on SPSS 11.5 programme. Results: 78,1% of women whose average age is 34,71±7,51 (min:18 max::64) are married and 52,9% of them have middle income. 62,6% of them live in town. 32,9 % of them smoke. 57,4% of them have a job, and 42,6% of them are housewife. 42,9% of them have a university degree whereas 58,6% of housewives are primary school graduate. 75% of women have at least one pregnancy story, 64,5% of them have 1 or 2 children. 51,4% of the women state that they do not use family planning method. The most widely used family planning method is preservative (39,9%). Although 69,2% of women get gynecological examination, 27,8% of them state that they get pap smear. 1,3% of women in the study state that they are vaccinated for HPV. 59,5% of the women in our study state that they have not heard HPV, 61,33% of them states that they have no idea about HPV vaccination. 41,9% of them do not know that HPV results in cervical cancer. 29,0% of whom have heard HPV state that they have learned it from medical personnel. 33,1% of the participants say that they will be vaccinated if the state finance it. The women who says “they will not be vaccinated” state that they do not have enough knowledge about it. (64,7%). The level of knowledge of the women who live in city, have a good income and educational level, is found to have high level of knowledge of HPV, HPV vaccination, Pap smear test, and cervical cancer (p<0,05). The relationship between the level of knowledge of Pap smear and cervical cancer and age is not determined while the level of encountering with HPV decreases when the age of women increases. 74,6% of nurses have heard HPV, but the nurses constitute the group who gets the least gynecologic examination., and the doctors are the ones who mostly get the gynecological examination. Conclusion: It is seen that the vaccination and getting Pap smear test level of the women in our study is very low, and their knowledge of HPV, Pap smear test and cervical cancer is not enough. It is required multidisciplinary education and consultancy services to be widened to protect against HPV infections and cervical cancer. Disclosure of Interest: None Declared O97 DETERMINATION OF THE ATTITUDES OF DISABLED WOMEN ABOUT FAMILY PLANNING R. Aydin 1,*, D. V. Yılmaz 2 1Nursing, Health Sciences Institute, Ankara, 2Nursing, Health Sciences Institute, Mersin, Turkey Problem Statement: This study is methodological and descriptive in character and is based on a survey applied to disabled women at the age of 18-49 aiming to assess their attitudes towards family planning (FP) and the factors that may be thought to have a role in effecting these attitudes. The sample of the study consists of a total of 108 disabled women at the age of 18-49 enrolled at Mersin Disabled People Platform and six intitutions bound to it. Methods: The collected data is collected by using the questionnaire form and “Family Planning Attitude Scale (FPAS)”. The questionnaire applied consisted of two parts with the first part recording the socio-demographic characteristics of the spouses of women and their families while the second part contained Abstract Book questions regarding the obstetric aspects of disabled women. The FPAS which is developed by Orsal and Kubilay (2007) is a five point likert scale consists of 34 clauses and the scale has three sub-dimensions. The questionnaire and the FPAS was applied between January 7th and June 21st in 2013. The collected data was processed in MedCalc 12.3.0 packaged software and was analyzed with levels of means, standard deviation, median, minimum and maximum values and percentage points by means of t-test, One-way ANOVA test, Shapiro Wilk test, Student t test, Levene test, Welch test and Games Howell test. The statistical significance level was set at p<0,05. The collected data is collected by using the questionnaire form and “Family Planning Attitude Scale (FPAS)”. The questionnaire applied consisted of two parts with the first part recording the socio-demographic characteristics of the spouses of women and their families while the second part contained questions regarding the obstetric aspects of disabled women.The FPAS which is developed by Orsal and Kubilay (2007) is a five point likert scale consists of 34 clauses and the scale has three subdimensions. The questionnaire and the FPAS was applied between January 7th and June 21st in 2013. The collected data was processed in MedCalc 12.3.0 packaged software and was analyzed with levels of means, standard deviation, median, minimum and maximum values and percentage points by means of ttest, One-way ANOVA test, Shapiro Wilk test, Student t test, Levene test, Welch test and Games Howell test. The statistical significance level was set at p<0,05. Results: The study results are determined as disabled women’s average score of FPAS is 116,72 points; the average score of the attitude of society about FP is 51,68 points, the average score of the attitude about the FP methods is 36,23 points and the average score of the attitude about birth is 28,80 points. The average score of FPAS of the disabled women at the age of 26 and over is indicated high and statistically significant and meaningful comparing to the disabled women at the age of 19-25 and this is. (p<0,05). The disabled women who have 1-2 pregnancy have higher average score of sub-dimension than the ones who have 3 or more pregnancy and the difference between them is more meaningful statistically. Conclusion: The disabled women’s positive attitude about FP and the aspects that have a role in FP are designated and the suggestions are made in accordance with these aspects. Keywords: Disability, Disabled Women, Family Planning, Family Planning and Disabled Women, Family Planning and Attitudes Towards Family Planning. The disabled women’s positive attitude about FP and the aspects that have a role in FP are designated and the suggestions are made in accordance with these aspects. Disclosure of Interest: None Declared O98 PATHOLOGICAL FINDINGS ASSOCIATED WITH PAIN IN TRANSVAGINAL MESHES V. Iakovlev 1 2,*, E. Carey 3, G. Iakovleva 4, J. Steege 5, R. Bendavid 6 1Pathology, St. Michael's Hospital and the Keenan research Centre of the Li Ka Shing Knowledge Institute, 2Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada, 3Department of Obstetrics and Gynecology, University of Kansas, Kansas City, United States, 4Pathology, Markham Stoufville Hospital, Markham, Canada, 5Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, United States, 6Surgery, Shouldice Hospital, Richmond Hill, Canada Problem Statement: Although effective in most patients, transvaginal meshes present a steady complication rate of chronic pain, dyspareunia, urinary symptoms and erosion. This leads to a proportion of meshes excised, however the available material has been underutilized and no studies correlating pathologic findings with clinical symptoms have been published. Methods: 29 explanted transvaginal slings were assessed for morphological features: bridging fibrosis as % of mesh pores with scar; foreign body reaction on a scale of 3; chronic inflammation on a scale of 3; nerve density as nerves/twigs in 200x microscopic fields, other parameters as +/-. Results: Out of 29 explants 10 were retropubic and 19 transobturator. Reasons for excision were: erosion - 38%; pain/dyspareunia - 57%; de novo urinary symptoms - 33%. Image / Graph: Conclusion: The findings indicate that the degree of foreign body reaction, intramesh edema, involvement of smooth muscle and density of innervation likely play a role in the development of pain and dyspareunia. Disclosure of Interest: V. Iakovlev Consultant for: Medico-legal Consultations. E. Carey Consultant for: Medico-legal Consultations. G. Iakovleva: None Declared, J. Steege Consultant for: Medico-legal Consultations. R. Bendavid: None Declared O99 SUBACUTE UTERINE INVERSION, UNEXPECTED HOSPITAL ENCOUNTER: A CASE SERIES R. Mizan 1,*, I. Hutagaol 2, S. Maryuni 3 1 Obstetric and Gynecology, University of Indonesia, Jakarta, 2Division of Reproductive Endocrinology Fertility, 3Division of Reconstructive Urogynecology, Arifin Achmad Regional Hospital, Pekanbaru, Indonesia Problem Statement: Acute puerperal uterine inversion is a rare life threatening case. The relatives prevalence is 2,6% compare to acute (83,4%) and chronic (13,9%)1. It is the rarest, it is often less aware by clinicians since patient is usually still in hospital care. Moreover it is a sad encounter for Health Provider if such case present in Hospital where the patient is under close observation. It is said that timing is the key for a successful management of uterine inversion. But even in Hospital setting where immediate diagnosis can be made and immediate management performed, subacute uterine inversion may appear in wide clinical variation result in dramatically different outcome. The following manner are performed to manage uterine inversion. Immediate manual repositioning of the uterus (Johnson procedure) on conscious patient without tocolysis. If failed, tocolysis is required or direcly sfift to general anesthesia. If manual repositioning still fail surgical intervention is needed2. Methods: We are reporting two unexpected hospital encounter of stage 3 sub acute uterine inversion. The first case was a 45 yo parity four post spontaneous delivery peurperal day 4. The second case was a 23 yo parity one post spontaneous delivery peurperal day 3. Both case were refered to our Emergency Room due to severe anemia. On our examination anteflexed uterus was palpated below navel with good contraction. Normal portio was visualized with no laceration nor active bleeding from inpeculo examination. Ultrasound examination recorded normal involution of uterus. Both patient were then sent to ward planned for blood transfusion to correct anemia. Both case develop stage 3 uterine inversion in our ward. On both case immediate manual repositioning of the uterus were fail, repositioning under general anesthesia were then performed. Results: On the first case such attempt was fail to correct the inversion due to tight cervical ring and tissue oedema. The surgical Haultein’s procedure was performed successfully but uterine atony occured left the operator with no choice but performed hysterectomy. On second case manual repositioning was successfully done but uterine atony also then occured. The patient managed with compression, uterotonics and condom tamponade. Whole blood were transfused immediately as there was still continuous bleeding. The patient was shifted to ICU for close observation. After 7 days of hospital stay both patients were discharged from hospital in good condition. Conclusion: This case series was reported as an eye opening for clinicians, as such rare life threatening case may slipped from our attention. It is imperative that the condition is recognized quickly and managed promptly in order to minimize the potential for maternal morbidity and even mortality. It is crucial for clinicians to have a heightened awareness of the condition and know how to best manage it when such condition occurs as it will remain a big challenge for every health care provider especially in developing country. 57 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Disclosure of Interest: None Declared O100 EVALUATION OF ER: YAG LASER TREATMENT FOR HIGHER GRADE PELVIC ORGAN PROLAPSES – 1 YEAR FOLLOW-UP S. Sencar 1,*, U. Bizjak-Ogrinc 1, Z. Vizintin 2 1Juna Clinic, 2FOTONA, Ljubljana, Slovenia Problem Statement: The objective of this study was to evaluate new minimally invasive, non-ablative Er: YAG laser technique for prolapse reduction. Methods: During 15 months period (between March 2012 and June 2013) 61 patients (average age 54.9 yrs, parous status 2.2 and BMI of 25.5) with cystoceles of grades II–IV were treated with new non-ablative Er: YAG laser treatment. Preoperative evaluation included history and physical examination and classification of cystocele grades using Baden-Walker scale. Patients received between two and five treatment sessions with intervals of 2 months in between the sessions. Pain during the treatment was measured at every session with 10 point VAS pain scale. Digital photographs of prolapses were obtained at every visit. Follow-ups were performed at 3, 6 and 12 months. At each follow-up aside of physical examination and prolapse photographing cystoceles grading by two physicians were performed and patients were interviewed about post-op adverse effects, degree of improvement of their cystocele and satisfaction. Results: Before the treatment there were 40 patients with cystocele of grade II, 15 of grade III and 6 of grade IV. At last follow-up the large majority of patients (58 or 95%) reduced their prolapse grades for at least one grade, 27 of them (44%) for two grades and 8 (13%) even for three grades. At 12 months follow-up 85% of patients had either 0 or I grade of prolapse and the remaining 15% of patients had II grade prolapses. One year after the treatment there were no patients with III or IV grade prolapses. Treatment discomfort was very low (average score of 0.4 on 10 grade scale) large majority of patients asses their satisfaction as satisfied or very satisfied and their subjective assessment of improvement was also very positive. There were no adverse effects of this treatment reported. Conclusion: New non-invasive Er: YAG laser treatment for higher-grade cystocele demonstrated good efficacy in improvement of cystocele with minimal patients’ discomfort during the treatment, at least 12 months lasting improvement and no adverse effects. Disclosure of Interest: S. Sencar: None Declared, U. Bizjak-Ogrinc: None Declared, Z. Vizintin Consultant for: Application Development O101 MINIMALLY INVASIVE NON-SURGICAL ERYAG LASER TREATMENT FOR FEMALE STRESS AND MIXED URINARY INCONTINENCE- ONE YEAR FOLLOW-UP U. Bizjak-Ogrinc 1,*, S. Sencar 1, Z. Vizintin 2 1Juna Clinic, 2FOTONA, Ljubljana, Slovenia Problem Statement: The purpose of this study was to report the outcomes of newly proposed minimally invasive laser therapy for female stress and mixed urinary incontinence (SUI and MUI). There were two main objectives of our study: to assess the efficacy of this therapy and to evaluate its safety. Methods: This is a single arm prospective study performed in one medical center from March 2012 to May 2013. Patients with stress and mixed urinary incontinence were treated with new Er: YAG laser treatment. Prior to treatment all patients were clinically inspected, and classified by incontinence types and grades using ICIQ-UI and forming Incontinence Severity Index (ISI) upon Klovning proposal. Patients received one to three treatment sessions with interval of 2 months in between the sessions. Treatment discomfort was measured at every session with 10 point numerical pain scale. Follow-ups with repeated measurements were performed at 2, 6 and 12 months. Results: 175 patients (average age 49.7 years, average BMI of 24,7 and parity of 2,0) were treated. Of all patients 66,0% were diagnosed SUI and 34% MUI. Average ISI score before the treatment was 5,7 points (moderate UI). Most of the patients, 51% had severe UI, 27% moderate , 17 % mild and 5% very severe UI before the treatment. At 12 months follow-up 82% of patients with SUI and 37% with MUI were cured, 25% of all patients remained with mild UI, 12% with moderate and 2% with severe UI. There were no patients with very severe UI at 58 12 months follow-up. Treatment discomfort was very low (average grade 0.6 on 10 points scale). There were no significant differences (p<0.001) in UI improvement among the age groups. However, there were statistically significant differences (p<0.001) in the UI improvement among the severity (ISI) groups. The largest ISI score decrease (of 8.4 points) was achieved in very severe group, followed by 5,7 points decrease in severe group, 3.6 points in moderate and 2.6 points in mild group. There were also no statistically significant differences (p<0.001) in the UI improvement at 6 and 12 months follow-up. Adverse effects were mild and transient: negligible discomfort, mild erythema and edema. 11% of patients developed transient de-novo urge incontinence. Conclusion: This clinical evaluation of a new non-invasive Er: YAG laser treatment for stress and mixed urinary incontinence showed high efficacy in improvement of UI with no major adverse effects noted. Transient urge incontinence can appear as adverse effect. Patients’ discomfort during the treatment was minimal and satisfaction very high. So far we can say that treatment effects last for more than one year. Disclosure of Interest: U. Bizjak-Ogrinc: None Declared, S. Sencar: None Declared, Z. Vizintin Consultant for: Application Development O102 ANTI-DIABETIC AND ANTIOXIDANT EFFECT OF WATER MELON SEEDS EXTRACTS (CITRULLUS VULGARIS) ON SERUM TESTOSTERONE. Khaki 1,*, E. Ouladsahebmadarek 2, A. A. Khaki 2, F. Fathiazad 3 1Department of Pathology, College of Vet Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran. 2Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, 33-Department of Pharmacognosy , Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Islamic Republic of Iran Problem Statement: Citrullus vulgaris is an antioxidant and it has been shown to reduce oxidative stress. Previous study confirmed antioxidants have essential effect on infertility by their role on reactive oxygen’s spaces, chronic hyperglycemia is known to cause infertility in diabetes disease. Methods: Wistar male rat (n=40) were allocated into three groups, control group (n=10) and citrullus vulgaris seeds extract (CVE) group that received 55mg/kg by gavage method (n=10), and Diabetic group that received 55mg/kg (IP) streptozotocin (STZ) (n=20) which was subdivided to two groups of 10; STZ group and treatment group. Treatment group received 55mg/kg (IP) STZ plus55mg/kg CVE, daily for,4 weeks, respectively; however, the control group just received an equal volume of (0.9% NaCl) daily(gavage) . Diabetes was induced by a single (IP) injection of streptozotocin (55mg/kg). Animals were kept in standard condition. In 28day, 5 cc blood sample of each rat was taken for biochemical analysis, sperm samples from epididymis were collected. Results: sperm parameters suach as count,viability and motality, Testosterone levels and TAC significantly were increased in groups that has received 55mg/kg (CVE) in comparison to other groups (P<0.05). Conclusion: Since in our study 55mg/kg (CVE) by increasing serum TAC cause to significantly improving effect on testosterone levels, it seem using it in infertile patients has beneficial antioxidant effects. Disclosure of Interest: None Declared O103 APPLICABLE ROLE FOR URINARY LH SURGE KIT IN FROZEN EMBRYO TRANSFER CYCLES. E. Pourmatroud 1,*, P. Jelodaian 1 AHVAZ JUNDISHAPUR UNIVERSITY OF MEDICAL SCIENCE, Ahvaz, Islamic Republic of Iran Problem Statement: Embryo cryopreservation is an important progress in recent decades adjust to in vitro fertilization (IVF) or intra cytoplasmic sperm injection (ICSI) cycles, which means freezing the embryos at a temperature which all of the metabolic cell function have been arrested To assess the effectiveness of adding urinary LH surge kit to hormonal prepared frozen embryo transfer (FET) cycles we design this study. Methods: In this prospective clinical trial, 48 patients enrolled in two groups. Endometrial hormone priming in both groups was similar; but in group A, from day 10 of cycle, urinary LH surge detection was started embryo transfer (ET) Abstract Book scheduled after first positive test. In group B, ET was done after reaching endometrium thickness to at least 7mm. The duration of cycle, the frequency of sonographic monitoring, the total dosage of estrogen consumption and the result of cycle were measured. Results: The duration of cycle before ET in group A was shorter (8.79±1.14 VS 11±1.47 days, P Value: 0.0005), the number of sonography repetition also was lesser (2.42±0.58 VS 3.67±0.86, P Value: 0.001). Respectively, in group A the total dosage estrogen consumption was less than group B (35.58±5.2 VS 46.83±5.27 mg, P value: 0.0005). The pregnancy rate in group A was more than group B, although it was not significantly different (37.5% VS 25%, P value: 0.52). Conclusion: We suggested that prediction of LH surge and determination of ovulation time. Neither in natural cycle but in hormonal primed FET cycle could lead to better result due to most accurate time for transfer. We think if repeat the study in larger population of patients the positive result of cycle would be increased; in addition, it's obvious except endometrial characters, assurance about the best time for implantation will be more important and applicative and prevent wasting valuable frozen embryo by incorrect timing of thawing and transfer. It seems except endometrial characters, assurance about the best time for embryo implantation prevent wasting valuable frozen embryo by incorrect timing of thawing and transfer. Disclosure of Interest: E. Pourmatroud Grant / Research support from: AJUMS, P. Jelodaian: None Declared O104 CORRELATION BETWEEN DONOR SPERM PARAMETERS AND PREGNANCY OUTCOME AFTER INTRAUTERINE INSEMINATION: A RETROSPECTIVE STUDY IN CHINA M. Rao 1,*, T. Meng 2, W. Xia 1, C. Zhu 1, C. Xiong 2, H. Guan 2 1Family Planning Research Institute, Tongji Medical College, 2Reproductive Medicine Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Problem Statement: The predictive value of sperm parameters on clinical pregnancy outcome have been debated for several decades, and currently no consensus has been reached regarding the optimal semen parameters necessary for success with AID (artificial insemination by donor sperm). The aim of this study was to investigate whether sperm parameters can affect the pregnancy outcome of AID. Methods: This study was conducted in the Reproductive Medicine Center of the Tongji Medical College. A total of 1355 couples received 2821 AID treatment cycles between January 2010 and December 2013, the data were collected and retrospectively analyzed. The relationship between pre-freezing, post-thawing as well as optimized sperm parameters and AID pregnancy outcome were investigated through semen parameters in pregnant cycles and non-pregnant cycles. Then we used multivariable logistic regression method to evaluate the effect of these parameters on pregnancy outcome. Results: A total of 728 cycles from 2821 treatment cycles achieved pregnancies and clinical pregnancy rate was 25.81%. Pre-freezing progressive sperm motility in pregnant cycles was higher than that in non-pregnant cycles (p=0.001); prefreezing progressive sperm motility could significantly, positively affect pregnancy outcome (OR 0.97, 95%CI: 0.95-0.98; p=0.0001, table 1). Other parameters seemed to be no obvious influence. Table 1. Multivariable logistic regression model to evaluate the effect of parameters on pregnancy outcome. Seperm parameters Pre-freezing sperm concentration (×106⁄ml) Pre-freezing progressive sperm motility (%) Post-thawing sperm concentration (×106⁄ml) Post-thawing progressive sperm motility (%) Optimized sperm concentration (×106⁄ml) Optimized progressive sperm motility (%) Optimized total progressive sperm count (×106) OR 1.00 0.97 1.01 1.00 1.01 1.00 1.00 95%CI 0.99-1.02 0.95-0.98 1.00-1.01 0.98-1.03 1.00-1.01 0.99-1.02 0.99-1.01 OR=odds ratio; CI = confidence interval; ** :< 0.05. Conclusion: Pre-freezing progressive sperm motility should be a valuable predictor for AID pregnancy outcome. We put forward that donors with relatively high value of motility whereas suboptimal value of concentration compared with sperm bank criteria should not be rejected. This will be very helpful to ease the tense situation of screening eligible sperm donors, and also elevate the AID pregnancy rate. Disclosure of Interest: M. Rao Speaker Bureau for: no competing interest, T. Meng Employee of: no competing interest, W. Xia Employee of: no competing interest, C. Zhu Grant / Research support from: no competing interest, C. Xiong Shareholder of: no competing interest, H. Guan Consultant for: no competing interest O105 RETROSPECTIVE ANALYSIS OF THE FIRST 1238 PREIMPLANTATION GENETIC SCREENING DONE IN HUNGARY USING ARRAY COMPARATIVE GENOMIC HYBRIDIZATION A. Vereczkey 1,*, D. Debreceni 1, M. Csenki 1, J. Schönléber 1, G. Téglás 1, L. Nánássy 1, E. Gajdócsi 1, G. Báthori 1 1Versys Clinics Human Reproduction Institute, Budapest, Hungary Problem Statement: Preimplantation Genetic Screening (PGS) with array Comparative Genomic Hybridization (aCGH) is a widely spreading technique to improve the outcome of assisted reproduction. It refers to the screening of the chromosomes of embryos and oocytes for numerical chromosome errors. PGS is dedicated to increase the success of in vitro fertilization (IVF) cycles in women with advanced maternal age, or those who are suffering from recurrent miscarriage or repeated implantation failure. Methods: Retrospective analysis of data obtained from chromosome analysis of 1000 embryos was conducted between May 2011 and August 2014. Array Comparative Genomic Hybridization was performed on single blastomeres using 24sure and 24sure+ microarrays from Bluegnome/Illumina. Results: We diagnosed 365 euploid (29,48%), 275 single aneuploid (22,21%) and 499 complex aneuploid embryos (40,31%). Ninety-nine embryos (8%) could not be diagnosed because of cell degradation or the failure of the embryo biopsy or the whole genome amplification (WGA). Average maternal age/cycle was 37,86 years old. We have found the following numbers of viable single autosomal aneuploidies: Down syndrome (Trisomy 21): 8, Edwards’s syndrome (Trisomy 18): 2, Patau syndrome (Trisomy 13): 4. Conclusion: Array Comparative Genomic Hybridization is a reliable and robust technique utilizing a chip of DNA technology. The whole process can be performed within 12-24 hours enabling fresh embryo transfer following cleavage stage biopsy. Hopefully, further clinical trials will support the acceptance of PGS in reproductive medicine and the method will make a significant positive difference in clinical outcomes for couples who require IVF to establish a successful pregnancy and ultimately a healthy live birth. Disclosure of Interest: None Declared O106 ADJUVANT GROWTH HORMONE THERAPY IN POOR RESPONDERS: EFFECT ON OVARIAN STIMULATION AND PREGNANCY J. Rajendran 1,*, F. Louis 2, P. Gopinath 2, K. Gopinathan 2 1Reproductive Medicine, Shrishti Assisted Fertility and Advanced Laparoscopy Center, Puducherry, 2Reproductive Medicine, Center for Infertility Management and Assisted Reproduction, Cochin, India Problem Statement: About 10 – 24% of women show poor ovarian response to controlled ovarian hyperstimulation (COH), presenting a challenging and often frustrating problem for the care giver. Several strategies are used to overcome this challenge namely modifications of the pituitary down regulation or stimulation protocols and adjuvant use of growth hormone, dehydroepiandrostenedione sulphate (DHEAS), L- arginine etc. We aimed to study the effect of adjuvant growth hormone (GH) therapy on COH and pregnancy in poor responders Methods: We studied a case series with historical controls. Cases were women that were classified as poor responders (age ≥ 37 years, D2 FSH levels ≥ 8 IU/ mL but ≤ 15 IU/mL, D2 antral follicular count < 5, or a history of poor response in previous cycles characterized by less than 3 mature oocytes retrieved) and received subcutaneous GH 2U/day along with stimulation protocol from D2 till hCG injection during January 2010 through December 2011. Controls were women treated in the preceding two years with the same protocol except for adjuvant GH. The stimulation was done using human menopausal gonadotropin 59 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 (HMG) in both groups. Primary outcome was mature metaphase II oocytes retrieved; secondary outcomes were peak estradiol (E2) serum levels and pregnancy rate. Statistical analysis was carried out using SPSS version 20 Results: During the study period, out of 2559 couples undergoing fertility treatment, 128 women (5%) were classified as poor responders receiving adjuvant GH. In the preceding 2 years, 81 women fulfilled the same criteria and had the exact same treatment protocol except adjuvant GH. Mean age was lesser in the cases than controls (35.5 years vs. 37.4 years, p < 0.001); duration of infertility, abnormal semen parameters, female factors such as tubal factor, endometriosis, pelvic adhesion, poor ovarian reserve etc were similar between the groups. The mean stimulation duration was similar between cases vs controls (11.6 days vs 11.9 days, p = 0.3); total HMG dose in either group did not differ significantly (999.8 IU vs 1229 IU). The total number of ripe follicles on the day of hCG (5.5 vs 3.7; p < 0.001); mean peak estradiol levels achieved ( 2118 vs 1273 pg/mL; p < 0.001); number of women with peak estradiol level > 1000 pg/mL (109 vs 43; p < 0.001); mean number of metaphase II oocytes ( 6.3 vs 4.3; p < 0.001); number of women achieving > 10 M II oocytes (20 vs 4, p < 0.048) were all significantly higher in the cases than controls. The overall pregnancy rates was higher in cases (32% vs 21%; p = 0.024); rates of pregnancy that continued beyond first trimester were 24.2 % and 12.3 % (p = 0.048) in the cases and controls respectively. Multivariate regression analysis established independent effect of GH on the number of M II oocytes retrieved, peak E2 levels achieved and rate of pregnancy beyond first trimester in women with poor ovarian reserve Conclusion: Addition of 2U of GH to COH long protocol resulted in significantly more number of M II oocytes retrieved and higher levels of peak estradiol levels. In women with poor ovarian reserve, adjuvant GH therapy improves the rate of pregnancy that continue beyond first trimester. Disclosure of Interest: None Declared O107 UTERINE ARTERY EMBOLIZATION FOR TREATING POSTPARTUM HEMORRHAGE – DOES IT HELP? K. Aas-Eng 1,*, E. Qvigstad 1 2, N.-E. Kløw 2 3, K. Hald 1 1Department of Obstetrics and gynecology, Oslo university hospital, 2Faculty of medicine, Oslo University, 3Department of Radiology and interventional medicine, Oslo university hospital, Oslo, Norway Problem Statement: To evaluate the clinical effectiveness, safety, long-term complications and fertility after uterine artery embolization (UAE) for management of postpartum hemorrhage (PPH). Secondly, to find whether the introduction of UAE influenced the incidence of postpartum hysterectomy. Methods: Retrospective study in a Norwegian tertiary referral centre. Women who underwent postpartum hysterectomy from January 2003 to December 2010 (n=20) and women that underwent embolization for PPH from January 2007 to December 2010 (n=34) were included. Patients were identified with diagnosis-related group (DRG) coding system and their hospital records were reviewed. Patients who were embolized were contacted by questionnaire to evaluate long-term complications and fertility. Clinical success was defined as not needing further intervention after embolization. Secondary outcome measures were registered pregnancies and labors among those who were embolized only. Additionally, incidence of postpartum hysterectomy in the period before (2003- 2006) and after (2007- 2010) the introduction of UAE for PPH was registered. Results: Clinical success was achieved in 28 out of 34 patients (82 %) who underwent UAE. Five needed subsequent hysterectomy; four due to continuous hemorrhage, one because of uterus necrosis. There were nine reported pregnancies and seven live births. Recurrent PPH occurred in 57 %. None required repeat embolization. The incidence of postpartum hysterectomy was unchanged since the introduction of UAE for postpartum hemorrhage (p=0.80). Conclusion: UAE as treatment for PPH was effective and safe with preservation of fertility in most cases. No statistically significant reduction in hysterectomy rate was found. High recurrence rate of PPH after previous UAE was observed. Disclosure of Interest: None Declared 60 O108 PROSTATIC TISSUE, AN APPENDIX AND A MUCINOUS CYSTADENOMA, ALL IN ONE MATURE CYSTIC TERATOMA. W. M. Al Ghafri 1,*, M. Al-Shukri 1, M. Al Riyami 2, K. Al Amrani 3 1Obstetrics and Gynecology, Sultan Qaboos University Hospital, 22. Department of Emergency of Pathology, Sultan Qaboos University, 33. Department Medicine, Sultan Qaboos University Hospital, Al Seeb, Oman Problem Statement: Mature cystic teratomas can contain tissue from any of the three embryonic germ cell layers. The most common type of gastrointestinal tissue found in mature teratomas is intestinal type epithelium usually of duodenal type. Up to our knowledge no cases have been reported of finding tissue resembling the appendix in such tumors. In addition to that we are reporting a rare ovarian neoplasm composed of an admixture of mature teratoma and a benign mucinous cystadenoma in an appendix in the teratoma and presence of prostatic tissue Methods: Mature cystic teratomas are the third most common benign tumors next to serous and mucinous cystadenomas and the most common germ cell tumor. They range in size but the majority is 5 to 10 cm in diameter. Most commonly, they are filled with thick sebaceous material and hair. In 30 to 50% of the cases formed teeth are present. The other cellular elements present are skin with its appendages, gastrointestinal epithelium, salivary gland, thyroid tissue, cartilage, bone, muscle, nervous tissue, choroid plexus, etc. Results: Here we are reporting a 35 years old lady, Para 11 Abortion 1 Living 10 who undergone laparoscopic Bilateral ovarian cystectomy for bilateral dermoid cysts. Operative findings were normal looking uterus and tubes, normal looking bowel, appendix, liver and hemidiaphragm. The left Ovary was enlarged with dermoid cyst around 8x7 cm and the right ovary was enlarged with dermoid cyst around 3x 4 cm. post- operative course was uneventful and she was discharged home on the next day. On histopathologic examination of the right ovarian cyst it was largely lined by keratinizing squamous epithelium with skin adnexa in its wall. In one area, prostatic tissue including acinar glands and fibromuscular stroma is noted. Mature glial tissue and ganglion cells are also present. A smaller locule is lined by urothelium with squamous metaplasia. There was a cystic area filled with mucoid material proven histologically to be reminiscent of an appendix with an epithelial lining of a benign mucinous cystadenoma. The wall of this appendicular structure has an inner and outer muscle coat with intervening nerve bundles and ganglion cells identical to the architecture of a gastrointestinal appendix. There is no dysplasia or malignancy in any of the elements. The other ovarian cyst was typical of a mature cystic teratoma. Image / Graph: Conclusion: Ovarian teratomas are the most common germ cell neoplasms and accounts for 10–20% of all ovarian tumors. These include: mature cystic teratomas, immature teratomas and monodermal teratomas. They are composed of tissue derived from the three pluripotential germ cell layers: ectoderm (skin derivates and neural tissue), mesoderm (fat, bone, cartilage, muscle) and endoderm (gastrointestinal and bronchial epithelium, thyroid tissue). Gastrointestinal type epithelium is found on microscopy in 7-13% of teratomas. Kwon et al and Nelson et al reported grossly visible loops of intestine. Our patient represents an interesting combination of intestinal type epithelium specifically identical to the appendix with a mucinous cystadenoma within that structure in addition to prostatic tissue. Disclosure of Interest: None Declared Abstract Book O109 THE ROLE OF VITAMIN D IN THE PREVENTION OF OSTEOPOROSIS M. Brincat 1,*, M. Brincat 1, J. Calleja Agius 1 Dept of Obstetrics and Gynaecology, Birkirkara, Malta Problem Statement: It is known that circulating Vitamin D predominantly orginates from cutaneous synthesis and therefore should be considered as a hormone rather than a vitamin. Vitamin D deficiency (<50nmol/L) is a worldwide epidemic with multiple implications on human health, due to its role in various physiological systems. Methods: Various studies have shown that with higher serum 25 hydroxyvitamin D levels, there is a decrease in the incidence of non-vertebral and hip fractures. Results: it is recommended that a deficiency in vitamin D should be treated with pharmacological doses of vitamin D (for example 800 – 1000IU of vitamin D3 daily) to rapidly restore vitamin D levels and have minimal risk of toxicity. The National Osteoporosis Guideline Group (NOGG) recommended a daily intake of at least 1000mg of calcium, 800 U of vitamin D, and 1 g/kg body weight of protein as a general measure for osteoporosis prevention [17]. Currently NOGG states that Calcium and vitamin D supplementation is widely recommended in older people who are housebound or living in residential or nursing homes, where vitamin D deficiency and low dietary calcium intake are common. Conclusion: There is limited research data on the management of vitamin D deficiency using therapeutic doses.The majority of studies focus on lower physiological doses rather than high pharmacological doses In order to reach serum levels of 75nmol/L from a deficiency state, higher doses than 800 – 1000 IU/day are required. Future focus should be on the implications of a rise in systemic 25 (OH) D3 levels from a deficiency state to 75nmol/L on bone density and fracture risk, and the use of high doses in cases of vitamin D deficiency. Disclosure of Interest: None Declared O110 MENOPAUSE-RELATED CHANGES IN THE MUSCULOSKELETAL SYSTEM, CARTILAGES & JOINTS J. Calleja Agius 1, M. Brincat 1,* Dept of Obstetrics and Gynaecology, Birkirkara, Malta Problem Statement: Postmenopausal osteoporosis is a silent systemic progressive disease characterised by a decrease in bone mass per unit volume. Osteoporosis and related fractures are a significant concern for the global community. As the population continues to age, morbidity and mortality from fractures due to osteoporosis will likely continue to increase. Methods: The menopause has been shown repeatedly to have a negative effect on the connective tissue in the bone matrix. Such an effect is prevented and in some cases reversed with oestrogen therapy. Studies show that oestrogen prevents osteoporosis partly by inhibiting bone resorption. In the wake of the WHI trial, many dilemmas have yet to be resolved regarding the use of HRT in postmenopausal women. Selective oestrogen receptor modulators (SERMs) act through oestrogen receptors and are agonists for bone and antagonists for breast and uterine tissue. Results: The lumbar intervertebral disc height has been shown to be significantly higher in the premenopausal group (height of three lumbar discs 2.16+/- 0.1cm) and hormone treated group (disc height 2.2+/- 0.12cm), compared to the untreated postmenopausal women (disc height 1.86+/- 0.06cm) (p<0.0001). This has been confirmed by another study on a bigger cohort. The premenopausal women and hormone treated women had disc heights of 2.01 +/- 0.09cm and 2.15 +/- 0.08cm respectively, the latter results being significantly higher than the untreated postmenopausal group (height of three lumbar discs 1.82 +/- 0.06cm) and the osteoporotic fracture group (1.58 +/- 0.1cm) (p=<0.0001). A new approach to menopausal therapy is the tissue selective oestrogen complex or the pairing of a selective oestrogen receptor modulator with oestrogens. Conclusion: Novel bone-targeting Oestradiol delivery systems have the potential to improve the safety profile of Oestradiol in the treatment of osteoporosis. Disclosure of Interest: None Declared O111 BREAST SAFETY OF CONJUGATED ESTROGENS/BAZEDOXIFENE: POOLED ANALYSIS OF RANDOMIZED, PLACEBO-CONTROLLED TRIALS IN POSTMENOPAUSAL WOMEN J. H. Pickar 1, K. A. Ryan 2, M. Messig 3, S. Mirkin 2, B. S. Komm 2,* 1Columbia University Medical Center, New York, 2Pfizer Inc, Collegeville, 3Pfizer Inc, New York, United States Problem Statement: Clinical studies have shown that progestin-containing hormone therapy (HT) is associated with an increased risk of unfavorable breast effects. Conjugated estrogens/bazedoxifene (CE/BZA) is a tissue-selective estrogen complex that combines the benefits of CE on menopausal symptoms and bone with the protective effects of BZA on the breast and uterus. The breast safety profile of CE/BZA was assessed using pooled data from the Selective estrogens, Menopause, And Response to Therapy (SMART) clinical trial program. Methods: Data for CE 0.45 mg/BZA 20 mg (n=1585), CE 0.625 mg/BZA 20 mg (n=1583), CE 0.45 mg/medroxyprogesterone acetate (MPA) 1.5 mg (n=399 [SMART-4 and -5 only]), raloxifene (RLX) 60 mg (n=423 [SMART-1 only]), and placebo (PBO; n=1241) were pooled from the randomized, double-blind, PBOand active-controlled, phase 3 SMART trials in postmenopausal women with a uterus. Breast procedure incidence (biopsies, aspirations, nipple discharge cytology), mammography data, breast pain/tenderness (measured by daily diaries), and breast-related adverse events (AEs) were assessed; breast cancer incidence was determined from cumulative meta-analysis with inverse variance weighting. Results: Overall incidence of breast cancer per 1000 woman-years was 1.00 (95% confidence interval [CI] 0.00–3.21) for CE 0.45 mg/BZA 20 mg, 0.00 (0.00–1.54) for CE 0.625 mg/BZA 20 mg, 1.05 (0.00–6.89) for CE/MPA, 0.00 (0.00–2.20) for RLX, and 1.40 (0.00–4.17) for PBO (Table). Incidences of abnormal mammograms were similar for both CE/BZA doses vs PBO and CE/MPA and significantly lower vs RLX. Percentage of subjects who had follow-up breast procedures was similar for CE 0.45 mg/BZA 20 mg (0.76%), CE 0.625 mg/BZA 20 mg (0.88%), and PBO (0.89%); percentage of subjects was numerically higher for CE/MPA (1.50%) and RLX (1.33%). Incidence of breast pain/tenderness for CE 0.45 mg/BZA 20 mg (9.8-11.5%) and CE 0.625 mg/BZA 20 mg (9.8-10.2%) was similar to PBO (8.1-11.2%) and RLX (6.2-8.7%) and significantly lower vs CE/MPA (21.6-29.1%; P<0.001). The incidence of breast-related AEs was low (£1% for each AE) and similar among groups. Table. Breast Cancer Incidence (SMART-1 to -5), Abnormal Mammograms (SMART-1, -4, and -5) and Breast Pain/Tenderness (SMART-1, -2, -4, and -5a) Treatment Breast cancer incidence per 1000 woman-years (95% CI) Women with abnormal mammogram at month 12, n (%) CE 0.45 mg/BZA 20 mg 1.00 (0.00–3.21) 20 (2.58)b CE 0.625 mg/BZA 20 mg 0.00 (0.00–1.54) 20 (2.60)b CE 0.45 mg/MPA 1.5 mg 1.05 (0.00–6.89) 3 (1.66) RLX 60 mgf 0.00 (0.00–2.20) 16 (5.33) PBO 1.40 (0.00–4.17) 20 (3.16) aBreast pain was not assessed in SMART-3. bP<0.05 for CE/BZA vs RLX. cP<0.001 for CE/BZA vs CE/MPA. d P<0.001 for CE/MPA vs PBO. eP<0.001 for CE/MPA vs RLX. fStatistical tests of RLX vs PBO and RLX vs CE/MPA were not done. Conclusion: CE 0.45 mg/BZA 20 mg and CE 0.625 mg/BZA 20 mg were associated with an acceptable breast safety profile with no increase in breast-related tolerability concerns. CE/BZA provides a therapeutic alternative to conventional HT for postmenopausal women, which may be particularly valuable for those with safety or tolerability concerns with progestin-containing HT. Disclosure of Interest: J. H. Pickar Consultant for: Wyeth/Pfizer, Ausio Pharmaceuticals, Besins Healthcare, Shionogi, Depomed and TherapeuticsMD, Employee of: Former employee of Wyeth Research, K. A. Ryan Employee of: Pfizer Inc, M. Messig Employee of: Pfizer Inc, S. Mirkin Employee of: Former employee of Pfizer Inc, B. S. Komm Employee of: Pfizer Inc 61 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 O112 INFLUENCE OF HORMONAL CONTRACEPTION IN PATIENTS WITH THROMBOEMBOLIC EPISODE UNDER THE AGE OF 40 YEARS P. M. M. Figueiredo 1,*, D. Coelho 1, M. Mesquita 1, F. Queirós 2, L. Graça 1 1Ginecologia/Obstetrícia, 2ImunoHemoterapia, Centro Hospitalar do Alto Ave, Guimarães, Guimarães, Portugal Problem Statement: In the fifties, after the introduction of hormonal contraception, it was early recognized and identified the association of thromboembolic episodes and the use of contraceptives, particularly the ones with estrogenic component. Nowadays, the occurrence of these events has been declining with lower hormone dosages, but they are still occurring, even in young women. Methods: Retrospective analysis of all patients with thromboembolic events with less than 40 years referred to the Centro Hospitalar do Alto Ave between 1st January 2010 and 31st December 2013. Variables such as age, type of contraception used, relation between the start of contraception and the event, presence of thrombophilia and risk factors were collected. Data were analyzed using the SPSS application, version 22.0. Results: A cohort of 141 patients from different specialities intra and extrahospital (all referenced to Immunohematology/ Thromboembolic Diseases) were obtained. In almost 10% of the cases, the episode occurred after the introduction of combined oral contraception; 30% of the patients had family history of thrombosis. The most frequent risk factors encountered were dyslipidemia, obesity and immobility. In the study, the etiology more frequent were MTHFR and combination of gene modifications. We verified also the presence of thromboembolic events in very young women, with one or more risk factors but also cases without identified risk. Conclusion: Combined hormonal contraception was one of the great revolutions of the twentieth century, keeping a place in family planning today. However, and despite lower estrogen dosages used, the contraceptive approach on an individual basis, with the identification of risk factors and history of women, continues to be fundamental in choosing the better method, with weighing the risks / benefits. Disclosure of Interest: None Declared O113 USE OF TRADITIONAL MEDICINE FOR THE TREATMENT OF INFERTILE WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS) R. Ershadpour 1, M. Sahraeian 2, R. Jahromi 1,*, S. sobhaniyan 3 1Jahrom University of Medical Sciences, 2Jihad versity of Jahrom, 3Faculty of Nursing and Para medicine, Jahrom University of Medical Sciences, Jahrom, Islamic Republic of Iran Problem Statement: Beside Pharmaceutical treatment, traditional medicine could be an alternative way to induce ovulation and treat infertility due to polycystic ovary syndrome. This study aimed to compare traditional medicine with medical therapy in the treatment of infertile PCOS patients. Methods: This study is a retrospective cohort, from June 2012 to March 2013. 32 of the patients were treated by prescribing drugs such as Apometformin, Medroxy progesterone, metformin, letrozole, clomiphene and 32 patients by taking the herbal drugs; vitex, nettles and over 15 sessions of cupping therapy. The standard of PCOS improvement was ovarian follicular growth more than 10 millimeter. Data such as the results of the ultrasonic and ovary tests, duration of the treatments, fertility creation and demographic information were entered in standard statistic software. Results: The mean duration of the treatment in medical therapy was 127.34 ± 70.38 days and 81 ± 47.09 days in traditional medicine. Indeed patients recovered faster by using traditional medicine. On the other hand improvement of PCOS in both methods had no significant difference (P ≤ 0/108), but fertility creation after the course of treatment, in both groups, showed statistically significant difference (P ≤ 0.003), which means by traditional medicine, ovarian follicles were capable of fertilization more effectively. Conclusion: Improvement of PCOS had no significant difference in growth of ovarian follicles in both methods, that means increase in follicle size had been seen in both groups, but this improvement allocated less time and the 62 probability of fertilization significantly increased in traditional medicine method, compared to medical therapy. Traditional medicine could be an appropriate method for the treatment of infertile PCOS patients. For appropriate decision about the use of traditional medicine alongside classical treatments, further studies are necessary in future. Disclosure of Interest: None Declared O114 ULTRA-STRUCTURAL STUDY BY TRANSMISSION ELECTRON MICROSCOPY: EFFECT OF OMEGA-3 ON OVARY CELL ORGANELLES AFTER EXPERIMENTAL INDUCED POLY CYSTIC OVARY SYNDROME A. Khaki 1,*, E. Ouladsahebmadarek 2, N. Ainehchi 3, Z. Ghanbari 2 1 Department of Pathology, College of Vet Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran. 2Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, 3Department of Pharmacognosy, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, and Islamic Republic of Iran Problem Statement: Polycystic ovary syndrome (PCOS) is the most frequent cause of female infertility, affecting about 4% to 8% of women in the age of procreation. For evaluation the protective effects of omega-3 polyunsaturated fatty acid on ovarian structure in experimental PCO induced by estradiol-valerat, this research was done. Methods: Wistar female rats (n=40) were allocated into four groups, one control (n=10) and three test groups (n=30), that one group received omega-3 (60 mg/rat/orally/daily), second and third groups were induced PCO by single injection of estradiol-valerate (16mg/ kg/ i.m), third group also received omega3 (240 mg/kg) for 60 consequence days. Animals were kept in standard conditions. On day 60, the ovarian tissue of Rats in whole groups were removed and prepared for pathological analysis. Results: vacuolated area and rough endoplasmic reticulum expanded, degranulated, disorganized were seen in PCO groups; however, these side effects decreased in the groups that received omega-3 significantly (p<0.05) in comparison to experiment groups and ovarian weights in PCO experimental decreased significantly (p<0.05). Conclusion: Results revealed that administration of omega-3 could significantly treat PCO. This suggested that polyunsaturated fatty acid could diminish negative side effects of PCO on ovary tissue.sugestion is take omega-3 in women diet could be show good effect in thier ovariaon working. Disclosure of Interest: None Declared O115 CIRCULATING ENDOMETRIAL CELLS: A BIOMARKERS IN ENDOMETRIOSIS? V. Bobek 1, K. Kolostova 1,* Dpt. of Laboratory Genetics, FNKV, Prague, Czech Republic Problem Statement: Endometriosis is a common disorder amongst women of reproductive age. Despite extensive research, no reliable blood tests currently exist for the confirmation of endometriosis diagnosis. We report a new noninvasive testing for enrichment and culturing of viable circulating endometrial-like cells (CECs). Methods: A size-based filtration method (MetaCell®, Ostrava, Czech Republic) has been used for the enrichment CECs out of peripheral blood (PB) and and peritoneal endometrial cells (PECs) out of peritoneal washing (PW). Filtration flow is driven by capillary action through polycarbonate membrane with predefined pores sized 8mM. Results: Together 17 patients with newly diagnosed endometriosis have been enrolled into the study. The PECs were found in the PW in all of the tested patients using the size-based filtration method, but circulating endometrial cells (CECs) only in 23, 5% (4/17) cases in PB. Besides cytomorphological analysis to confirm the origin of the captured cells following antibodies has been used: Pancytokeratin, Vimentin and CD10. In the 9 of the 17 cases we have successfully cultured the PECs in vitro as well directly on the separating membrane. We identified two cell types growing in PECs- fractions: glandular - and stromal -like cells. Some of the CECs and PECS were able to grow through the membrane Abstract Book pores and set up new cell colonies on the culture flask- bottom. CECs proliferated successfully in the two of the four positive cases. Conclusion: The occurrence in CECs in peripheral blood is a very specific evidence of endometrial disease. To date we are not able to describe the prognostic information of the CECs, but we are able to use the captured cells for evidencing endometriosis disease. We demonstrated efficient, quick and user friendly CECs capture platform based on a different cells size. Furthermore, we demonstrated the ability to culture the captured cells, a critical requirement for post-isolation cellular and molecular analysis, which could improve significantly the endometriosis management in future. Disclosure of Interest: None Declared O116 CLINICAL AND MORPHOLOGICAL FEATURES OF PELVIC ADHESIONS IN PATIENTS WITH UTERINE LEIOMYOMA L. Kondratovich 1,*, A. Kozachenko 2, L. Adamyan 2, E. Kogan 3 1 Operative gynecology, 2Russian Scientific Center for Obstetrics, gynecology and perinatology named after V.I. Kulakov, Moscow, Russian Federation, 3 pathomorfology, Russian Scientific Center for Obstetrics, gynecology and perinatology named after V.I. Kulakov, Moscow, Russian Federation Problem Statement: To study the clinical and morphological features of formation of pelvic adhesions in patients with uterine leiomyoma after laparoscopic myomectomy. Methods: 110 patients with uterine leiomyoma included in this study. The patients were divided into 2 groups. The first group - with pelvic adhesions (n = 34). The second group - without pelvic adhesions (n = 76). All 110 patients underwent laparoscopic myomectomy in Operative Gynecology department during last year. Clinical investigation, morphological method, morphometric, immunohistochemical staining with detection of Ki67, C-KIT, VEGF, MMP2, TIMP2, Col 1, Col 3 type expression in leiomyoma and adhesions were used. Results: Dystrophic changes accompanying with growth foci in the uterine leiomyomas prevailed in I group of patients. Markers of proliferative activity, markers of intercellular interactions, and angiogenesis were overexpressed in a fiber tissue. Morphological features of the adhesive fibers were characterized by presenting of adipose tissue and cells with signs of steam cells. Conclusion: Severe pain syndrome, high frequency of infertility, low pregnancy rate were in a group of patients with pelvic adhesions. Existence of the steam cells in adipose tissue in adhesive fibers in patients with uterine leiomyoma needs to be investigated. Further studies of influence of steam cells in adhesive fibers on pelvic adhesion formation and fertility in patients after laparoscopic myomectomy are required. Disclosure of Interest: None Declared 0117 MENOPAUSE SYMPTOMS & IMPACT ON QUALITY OF SEXUAL LIFE G. KURT 1,*, T. YAVAN 1, G. G. NIZAM 2 1 Obstetrics and Gynecologic Nursing, Gulhane Military Medical Academy, School of Nursing, 2Gulhane Military Medical Academy, Ankara, Turkey Problem Statement: Menopause appears as period during which many physical and psychological symptoms are observed in middle aged women. Menopause symptoms affect almost 70% of all women and can begin a long time prior to menopause. While menopause is experienced differently by different women, there are some commonly experienced physical and psychological menopausal symptoms, one of which is loss of libido. Menopausal Symptoms must be determined and intervened to improve quality of life of women. The aim of the study was to determine the menopausal symptoms and the effects of menopausal symptoms on the quality of sexual life in postmenopausal women. Methods: This cross-sectional study was conducted in the menopause outpatient clinic of a university hospital between January-March 2014. The sample consisted of 178 postmenopausal women who had menopause term and accepted to participate in the study. Data was collected by using a form which was developed by the researcher in accordance with consulted relevant literature. In addition “Menopause Symptoms Rating Scale (MSRS)” and “Sexual Quality of Life Questionnaire-Female (SQLQ-F)” were used. Statistical analyses were performed using the SPSS for the Windows version 15.0 program. Categorical variables were reported as number and percent. Continuous variables were reported as mean±standard deviation. The Pearson correlation test was used for statistical analyses. A value of p<0.05 was considered statistically significant. Results: The mean age of women was 54.83±68.26 years. The average of menopause age was 45.85±3.78. The 14.0% of women took HRT. MSRS total score of the women was found as 18.17±12.07 which shows us menopausal complaints of them were moderate and affected their quality of life adversely. Approximately half of the women are experiencing urogenital (x=4.24±4.00), one third of the women are experiencing somatic (x=7.00±4.68), and pschological (x=6.93±4.38) symptoms violently. Most of the menopausal complaints of them were sexual problems (81.6%), hot flashes and sweats (63.0%), irritability and anger (34.0%). SQLQ-F total score of the women was found as 62.30±20.17. It shows that quality of sexual life of women were moderate. 44.1% of women avoided from sexual intercourse. 39.3% of the women experienced sexual dissatisfaction and 37.6% of the women’s sexual intercourse frequency decreased. There are significant statistically between SQLQ-F and MSRS total score. When the intensity of menopausal complaints increase, the quality of sexual life is reduced (p<0.001). Conclusion: In this study, it was shown that women’s SQLQ-F and MSRS total score were moderate. Menopausal symptoms are affected sexual life of women negatively. For this reason, nurses and health care institutions must give information to women about sexual life and psychologic consultancy services during menopause. Disclosure of Interest: None Declared O118 TISSUE SELECTIVE ESTROGEN COMPLEXES: A NOVEL MECHANISM OF ACTION FOR THE TREATMENT OF MENOPAUSAL SYMPTOMS B. S. Komm 1,*, S. N. Jenkins 1, S. Mirkin 1 Pfizer Inc, Collegeville, United States Problem Statement: Estrogens bind with and activate estrogen receptors (ERs) to modulate gene transcription and signaling, impacting cellular processes in various tissues, including bone, breast, and endometrium. ER-mediated activity has shown benefits for menopause-related conditions in women; however, estrogens are associated with proliferation in uterine tissue compartments. Consequently, traditional estrogen therapy for postmenopausal women with a uterus requires use of progestins, which, via the progesterone receptor, inhibit cellular proliferation in the endometrium, counteracting estrogenic effects. Progestins, however, are associated with tolerability issues including breast pain and uterine bleeding. A newer approach to menopausal therapy, the tissue selective estrogen complex (TSEC), pairs a selective estrogen receptor modulator (SERM) with 1 or more estrogens. Because SERMs exhibit distinct profiles of gene and target-tissue activity, TSECs maintain the benefits of estrogens on menopausal symptoms without the stimulatory effects on breast and uterus. Methods: A series of preclinical and clinical studies was conducted in the course of the clinical development of the first TSEC, which combines conjugated estrogens (CE) with the SERM bazedoxifene (BZA), to characterize the mechanisms of action underlying the therapeutic effects of TSEC therapy. Results: The components of a TSEC can form a heteroligand-ER complex with distinct effects on gene expression and target tissues, compared with their individual SERM or estrogen components. Preclinically, the TSEC CE/BZA is associated with ER agonist effects on bone turnover and vasomotor function as well as concurrent antagonist effects in breast and endometrium resulting from the presence of the BZA SERM component. CE/BZA also promotes ER degradation somewhat tissue-selectively, further minimizing endometrial and breast estrogenic responses. In five phase 3 clinical trials, CE 0.45 mg/BZA 20 mg and CE 0.625 mg/BZA 20 mg relieved vasomotor symptoms and some measures of vulvar-vaginal atrophy related to menopause, increased bone mineral density, and decreased bone turnover without increasing breast density or risk of endometrial hyperplasia in nonhysterectomized postmenopausal women. Conclusion: Via receptor-binding competition, variable gene transcriptional activity associated with heteroliganded receptor dimers, and ER degradation, CE/BZA is mechanistically and pharmacologically distinct from its individual 63 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 components. By blending estrogen and SERM activity, TSECs provide a unique combination of attributes different from that of hormone therapy or SERMs alone. Disclosure of Interest: B. S. Komm Employee of: Pfizer Inc, S. N. Jenkins Employee of: Pfizer Inc, S. Mirkin Employee of: Former employee of Pfizer Inc O119 CLINICAL FEATURES AND MANAGEMENT OF PULMONARY ENDOMETRIOSIS: A COMPREHENSIVE SINGLE CENTER ANALYSIS J. H. Park 1 Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea, Republic Of Problem Statement: To analyze the diagnostic profiles and treatment outcomes of pulmonary analysis including diagnosis surgical and medical treatment. Methods: A comprehensive review of medical records was performed in a retrospective manner for patients with pulmonary endometriosis at Gangnam Severance Hospital, Yonsei Univerity College of Medicine from Jan, 2007 to July, 2014. Results: A total of 15 patients with pulmonary endometriosis were evaluated. With a median age of 35(23-48) years, 8 patients presented with catamenial hemoptysis whereas 7 patients presented with catamenial pneumothorax. The median age was 26 (23-36) years for catamenial hemoptysis group and 42(3548) years for catamenial pneumothorax group. Only 3 (20%) of the 15 patients had coexisting pelvic endometriosis and all were pre-menopausal states. All patient underwent chest CT scans, where the lesions predominantly influenced the right lung (n=13, 86.7%) opposed to the lung (n=2, 13.3%) or bilateral lung (n=0). Lesions were mainly distributed on the right upper lobe (n=9, 60%). 10 of these patients underwent video assisted thoracoscopic surgery (VATS), one patient received a thoracotomy. Intraoperatively, endometriosis specific findings (red lesion, endometriotic spots) were observed in 8 of 11 (72.7%) patients. 5 of 11 (45.4%) patients had detected endometriosis only upon microscopic examination and staning. The mean follow up period was 18.4 months (range 2-65 months). Five patients (33%) had clinical signs of recurrence. Recurrence was not detected in all of the five catamenial pneumothorax patients that received adjuvant hormonal therapy after surgery. Image / Graph: Conclusion: Pulmonary endometriosis could only be diagnosed and treated through a multidisciplinary approach based upon skillful differential diagnosis through careful gynecologic evaluation and assessment of the cyclicity of pulmonary symptoms. Although the imaging findings are non-specific, laterality towards the right lung should be considered. Since recurrence of symptom is more common in those with pneumothorax, extra caution is warranted, with a strong recommendation for adjuvant medical therapy. Disclosure of Interest: None Declared O120 INTRAOPERATIVE MONITORING AND EVALUATION OF MRI IN WOMEN OF REPRODUCTIVE AGE AFTER PREVIOUSLY PERFORMED UTERINE ARTERY EMBOLIZATION I. Porotikova 1,*, T. Gavrilova 1, E. Kulabukhova 1, L. Adamyan 1 64 1Operative gynecology, Russian scientific center for obstetrics, gynecology and perinatology, Moscow, Russian Federation Problem Statement: Uterine fibroids is the most common disease among women of reproductive age and consist of 10 to 30% of all gynecological diseases. Despite the fact that quite often uterine fibroids have no symptoms, it can become a cause of serious complaints such as menorrhagia, infertility and miscarriage.Nowadays there are different methods of treatment of uterine fibroids, one of them is the uterine artery embolization, but this method is not a radical, and its efficiency depends on the patient's age and clinical manifestation, size, localization of uterine fibroids. Many researchers suppose that the failure of uterine artery embolization (UAE) may be due to the existence of an additional blood supply to the fibroids from ovarian, bladder artery and collateral arterial anastomoses from pelvis Methods: We have examined a group of 23 patients. All of them previously underwent UAE. Age of the women ranged from 22 to 40 years. The main complaints were menorrhagia (80.2%), pelvic pain in the abdomen (70%), absence of pregnancy (95%). The size of uterine fibroids ranged from 7 to 22 weeks of pregnancy. All patients underwent MRI with the magnetic field strength of 1.5 Tesla. The study was conducted using T1 and T2-weighted standard sequences. To estimate the size and location of fibroids sections arranged along the axes of the uterus. The maximum diameter of leiomyoma was 10 cm. Later all women underwent surgical treatment. Results: Analysis of the MRI showed that 77.4% had significant degenerativedystrophic changes fibroids, varicose of pelvic and uterine wall found in 21.5% of cases. During surgery in 100% of cases were multiple uterine fibroid, in 86% patients multiple fibroids with secondary degeneration changes, in 17.2% - the number of fibroids was more than 50. Increased diffuse bleeding tissue was observed in 81, 7% of patients. Conclusion: Further research including the development of clear indications for embolization in patients with uterine leiomyoma in reproductive age is required. Disclosure of Interest: None Declared O121 THE DETERMINATION OF OGTT (ORAL GLUCOSE TOLERANCE TEST) SENSITIVITY IN DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS M. Jaladat 1, A. Rasekh 1,*, M. Naseri 1, S. Pourshojae 1, M. Alborzi 1, F. Alipoor 1, S. Mohammadzade 1 Jhrom University, Shiraz, Iran, Islamic Republic Of Problem Statement: It is well documented that the pregnancy is the insulin resistant state which can be tolerated by most of the women with normal glucose metabolism. However, some pregnant women experience carbohydrate intolerance with various degrees during their pregnancies. Although the certain mechanism of this pregnancy dependent carbohydrate intolerance has not been well known yet, excessive insulin resistance, which means reduced insulin response to carbohydrates or low insulin sensitivity and beta cell dysfunction are the common characteristics of the subjects. Diagnostic methods of this heterogeneous group of pregnant women are also under debate. Gestational diabetes mellitus (GDM) affects the 1 to 14 percent of the pregnancies according to the diagnostic test which was performed by the physicians. Today, one-step and two-step approaches are the common tests for the detection of gestational diabetes At present, the status of carbohydrate metabolism of pregnant women with high glucose levels, which exceeds the critical threshold value of GCT, but normal 100-g, 3-hour OGTT have not been evaluated clearly yet. The aim of this study to find the sensitivity of OGTT in diagnosis of GDM. Methods: This study was performed on 460 pregnant women referred to Dr.Rasekh clinic between 24 and 28 weeks of gestation in Jahrom city. Gestational age was based on last menstrual period and according to a reliable menstrual history confirmed by ultrasonography before 20 weeks of gestation. All the pregnant women underwent 50-g glucose challenge test as our routine antenatal screening protocol. Venous plasma glucose was measured at the first hour of the glucose load. A value of plasma glucose 140 mg/dL as accepted as the threshold value for the positive glucose challenge test. Pregnant women with a positive challenge test underwent 3-hour 100-g OGTT within 7 days .At least two plasma glucose levels exceeding the cut-off values following OGTT Abstract Book were essential for the diagnosis of GDM. Women with one abnormal value were excluded from the study, and the pregnant women who had normal GTT followed up with FBS and 2hr blood sugar test every two or three weeks until the end of pregnancy .The value of FBS 105 and the value of 2hr GTT 120 as accepted as the threshold value for GDM. OGTT Results: The subjects with abnormal GCT were 125 pregnant women that were classified into 3 groups according to the OGTT and GCT results: group 1 (n: 20) pregnant women with abnormal GCT and abnormal GTT. group 2 (n: 92) women with abnormal glucose challenge test but normal GTT who didn’t have gestational diabetes in the follow up., and group 3 (n: 10) pregnant women with abnormal GCT but normal GTT but had gestational diabetes. Conclusion: The sensitivity of GTT in finding gestational diabetes is 66 % that is not good enough for detecting in this important disease in pregnancy. So, we suggest, if GCT is positive, the patient must be followed carefully to rule out gestational diabetes. So that we can prevent complications due to the timely diagnosis of gestational diabetes. We were able to avoid maternal and fetal complications with early detection of GDM in our patients. Disclosure of Interest: None Declared O122 PROBIOTICS AND BACTERIAL VAGINOSIS: THE IMPORTANCE OF AEQUILIBRIUM. USE OF LACTOBACILLUM RHAMNOSUS BMX 54 AS ADJUVANT IN THE STANDARD TREATMENT OF BACTERIAL VAGINOSIS N. Recine 1,*, L. Domenici 1, M. Giorgini 1, V. Marcone 2, E. Palma 1, P. Benedetti Panici 1 1 Dept Gynecologic, Obtetrics and Urologic Sciences, University Sapienza of Rome, 2Italian Association for Prevention in Obstetrics and Gynecology, AIPOG, Rome, Italy Problem Statement: Bacterial vaginosis (BV) is the most common gynaecologic disorder in the primary care setting. The prevalence of BV among girls and women aged 14 to 49 years was about 29.2%. Although the aetiology of bacterial vaginosis is not completely understood, research has confirmed that BV is a synergistic, polymicrobial infection characterized by a shift in the bacterial flora of the vagina, characterized by a decline in the concentration of lactobacilli and an overgrowth of other microorganisms. A healthy vagina normally contains many microorganisms, predominantly lactobacilli, and a natural host defence by producing both lactic acid, which maintains the vaginal pH below 4.5, and hydrogen peroxide, which inhibits the growth of non-catalase producing microorganisms. The BV is characterized by a high rate of recurrence in sexual active women, the patients having three or more relapses each year. The aims of this work were to assess the effectiveness of intravaginal treatment with Lactobacillus Rhamnosus BMX 54 (NORMOGIN®) on the vaginal pH and on the clinical symptoms in a group of 252 women affected by BV diagnosed by the Amsel criteria. Methods: We have evaluated the evolution of patients with bacterial vaginosis who received the classical antibiotic therapy associated or not with an intravaginal probiotic product (NORMOGIN®). The study group consisted of 252 non-pregnant, sexually active patients, 18-45 years old, with no additional health problems and no contraceptive undergoing treatment, which have been admitted to the department of Gynecological Obstetrics and Urological Sciences of the University Sapienza of Rome. Patients were randomized into two groups: group A (126 treated with metronidazole 500 mg orally twice a day for 7 days) and group B (126 patients treated patients treated with metronidazole 500 mg orally twice a day for 7 days followed by vaginal tablets of Lactobacillus Rhamnosus BMX 54 -NORMOGIN®- once a day for 15 days, twice a week for 15 days months and then once a week for 1 month). The patients were valued four times (at 0, 60, 90 and then after 4 months from the beginning of the tretment) and returned to our department during the follow up only in the case of worsening of the BV symptoms. Results: After 60 days, 114 of group B patients (90.4%) showed a restore of physiological vaginal microflora and 101 of group A (80.2%) a complete clinical remission of BV (p<0.05). Vaginal pH was above the physiological value of 4.5 in 88% of all patients at the first visit. It returned under 4.5 value in 113 of group B (89.6%) and 99 of group A patients (78.5%) after 2 months of treatment, respectively (p<0.05). The gradual return to a vaginal physiological pH was associated with a reduction of the intensity of symptoms as shown by the decrease in the symptoms score. After 4 months, 15% of group B (19 pts) and 75.4% (95 pts) of group A showed a recurrence of BV (p<0.01). Conclusion: The dominance of lactobacilli in healthy vaginal microbiota and its depletion in bacterial vaginosis (BV) has given rise to the concept of treatment of probiotic Lactobacillus strains for the management of this condition. We demonstrate that the administration of vaginal tablets containing Lactobacillus Rhamnosus BMX 54 (NORMOGIN®) represents an effective and safe treatment for restoring the physiological vaginal pH, controlling symptoms and reducing recurrences of BV. Disclosure of Interest: None Declared O123 PERCEPTIONS OF NURSING STUDENTS ABOUT HPV VACCINATION: A PHENOMENOLOGICAL STUDY G. Kurt 1, S. Açıksöz 1,* School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey Problem Statement: The human papillomavirus (HPV) vaccine provides an effective strategy against HPV infection and cervical cancer. A greater understanding of HPV disease and prevention among nursing students may lead to greater reductions in the burden of cervical and other HPV-related diseases. While the HPV vaccine represents substantial progress towards cervical cancer prevention, little is currently known about nursing student's beliefs regarding the HPV vaccine. Although young women are central to the HPV vaccination programme, perceptions of nursing students as young women are underrepresented in the qualitative literature. Methods: The aim of this study was to identify the perceptions of nursing students about HPV vaccination. The study was performed using the phenomenological approach, a qualitative study design. The data were collected by the investigators using the face-to-face in-depth interview technique. All participants (n=23) were female nursing students of a university in Turkey. A semi-structured interview form created as a result of a relevant literature survey. The interviews were recorded after obtaining the consent of the students. The interviews lasted about 30-45 minutes. Colaizzi's phenomenological interpretation method was used to evaluate the data collected through the interviews. The interviews were transcribed by investigators at the end of the interviews, the relevant points were marked and the main theme and sub themes arranged. Then the statements of the participating students were evaluated and a report created. Results: Two themes were identified in the qualitative content analysis: information needs and vaccine anxieties. In this study, each participant showed poor knowledge regarding to HPV vaccine and there were significant vaccinerelated knowledge gaps. The participants presented anxiety about the effectiveness and side effects of the vaccines. The participants expressed concerns with medical risks, such as side effects and unknown long-term effects of the HPV vaccine. Health belief factors relating HPV vaccination included: cost and availability of vaccine, and recommendations from others. The students stated that they did not want as they did not have enough information about HPV vaccines and they were more willing to receive the HPV vaccination if it was recommended by clinicians. The high cost of the vaccine which was not covered by health insurance were identified as an important barrier to provision of, and access to the HPV vaccine. Conclusion: This study highlights a need for more education to promote a greater understanding of HPV vaccination among nursing students. Perceptions towards the HPV vaccine appear to be an important contributing factor in vaccination, to promote HPV vaccination, and to help young women make informed decisions. In order to increase awareness and knowledge about HPV vaccination and develop positive behaviors, young people should be provided with accurate information through educational activities in the community and health care services. Further quantitative and qualitative research is needed to design educational activities targeting female students in the health professions in order to create a positive effect and improve HPV vaccination coverage levels in Turkey. Disclosure of Interest: None Declared 65 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 O124 MOLECULAR CHARACTERIZATION OF CIRCULATING TUMOR CELLS IN GYNECOLOGICAL CANCER MANAGEMENT K. Kolostova 1,*, V. Bobek 1 Dpt of Laboratory Genetics, FNKV, Prague, Czech Republic Problem Statement: We present size-based enrichment protocol for CTCs isolation, followed by in vitro culture of CTCs and cytomorphological characterization. In parallel, gene expression profiling of tumor associated markers and markers of chemoresistance is provided in CTCs. Methods: To date, 75 patients with ovarian cancer and 59 with carcinoma of endometria have been enrolled into the study. Peripheral blood (PB) (2 x 8 mL) was collected within the disease management, mainly before adjuvant chemotherapy treatment. The size-based separation protocol (MetaCellTM) enabled to enrich viable cancer cells out of the peripheral blood and peritoneal lavage, allowing their in vitro propagation on the separating membrane directly. Immediately after the filtration process captured cells were evaluated by light microscopy and subsequently by fluorescent microscopy using unspecific stains (NucBlueä, CellTrackerä) to identify viable cell morphology. A part of enriched CTC fraction has been used for gene expression profiling immediately after completing the separation process. The gene expression profiling of tumor associated genes (cytokeratin (CK) CK7, CK19, MUC1, MUC16, EpCAM, CD45, CD68) and chemoresistance associated genes (ERCC1, MDR1, MRP1, MRP2, MRP4, MRP5, MRP7) was provided. Results: We report successful isolation and cultivation of CTCs, characterized by above mentioned approaches with CTC- positivity 43 % in ovarian cancer, 59% in endometrial cancer. The chemoresistance profiles have to be reported for each patient individually. Conclusion: We believe that implementation of parallel cytomorphological and molecular CTC- testing could help in process of more precise CTCcharacterization and subsequent clinical utility. Disclosure of Interest: None Declared O125 SYNCHRONOUS PELVIC ORGAN PROLAPSE AND URODYNAMIC STRESS URINARY INCONTINENCE: ONE - OR TWO - STEP SURGICAL MANAGEMENT? C. Grigoriadis 1,*, P. Bakas 1, E. Liapis 1, A. Tympa 2, D. Hassiakos 1, A. Liapis 1, G. Creatsas 1 12nd Department of Obstetrics and Gynecology, Aretaieion Hospital, 21st Department of Anesthesiology, Aretaieion Hospital, University of Athens, Athens, Greece Problem Statement: Pelvic organ prolapse (POP) is a common gynecological problem with an increased incidence of recurrence. It is often associated with urodynamic stress urinary incontinence (USUI) and causes not only health but quality of life issues as well. During the last decade, conflicting data concerning the ideal therapeutic management of synchronous POP and USUI came into light. Several studies support the therapeutic value of a two – step management, in which anti-incontinence procedure follows only if USUI persists. On the other hand, the one – step surgical treatment of synchronous POP and USUI is widely accepted by the urogynecological community. The aim of this study was to examine the outcome of the one - step surgical treatment of patients with synchronous POP and USUI. Methods: This was a 4-year prospective cohort clinical study. The study was organized by the Urogynecology Unit of the University Hospital and received approval by the Institutional Ethics Committee. All patients provided informed consent. The study group included patients diagnosed with synchronous POP (grade II or grader according to the POP-Q classification system) and USUI between September 2010 and August 2011. Preoperative assessment included patients’ history, gynecological and physical examination, as well as urodynamic study (uroflow, filling and voiding cystometry). All study group patients underwent synchronous surgical treatment of POP and USUI. The inside–out transobturator tension free vaginal tape (TVT–O) method was selected for the management of USUI in all cases. All operations were performed by the same experienced urogynecological team. Patients were reassessed six weeks 66 postoperatively with clinical examination and urodynamic study and then every 12 months with only clinical examination. Results: Totally, 32 women aged between 47 – 73 years old (mean age 61.1 years) were included in the study. Fourteen patients underwent vaginal hysterectomy with synchronous anterior repair and TVT-O placement, 8 patients underwent Manchester operation and TVT-O placement, while in 10 cases anterior or posterior repair with synchronous TVT-O placement took place. No severe intra- or postoperative complications occurred. No patients had urinary tract injuries or required blood transfusion. No postoperative urinary retention was diagnosed in any patient. Postoperative incomplete bladder emptying (residual urine > 100 ml) was reported in 2 cases (6.3%) and was effectively treated by a 7- day Foley catheter placement. Early postoperative symptoms of frequency and urgency were reported in 3 cases (9.4%). No tape rejection was diagnosed. During the 3-year follow-up, no recurrence of POP was observed among the study group patients. The cure rate of USUI at 3-years follow-up time was estimated at 81.3%. The improvement and failure rates at the same follow-up period were 6.3% and 12.4%, respectively. Conclusion: The one step surgical approach in cases of synchronous POP and USUI seems to be a safe and effective method. Disclosure of Interest: None Declared The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) All about Women’s Health Posters 67 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Notes 68 Abstract Book POSTER ABSTRACTS P01 ELECTIVE SINGLE-EMBRYO TRANSFER: TWO YEARS EXPERIENCE FROM A PORTUGUESE CENTER S. Aguilar 1,*, M. Rato 1, C. Julio 1, S. Figueiredo 1, T. Simões 1, G. Pinto 1 Maternidade Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central, Lisboa, Portugal Problem Statement: The purpose of elective single-embryo transfer (eSET) is to reduce the ocurrence of multiple pregnancy in assisted reproduction treatments, in order to avoid the resulting obstetrical and neonatal complications. As such, eSET should be considered in selected cases. Our objective was to characterize the population of women who underwent an elective transfer of one fresh embryo (eSET group) and to compare the reproductive outcomes of this approach to the ones associated with fresh double-embryos transfers (DET). Methods: Retrospective analysis of fresh transfers of one embryo - eSET group (group 1 – G1) and of two embryos - DET group (group 2 – G2), performed at our center’s Assisted Reproduction Unity, between January/2012 and December/2013. Results: Fifty-three cases of eSET (G1) and 590 cases of DET (G2) were included. Woman’s age, duration of infertility and previous assisted-reproduction cycles were significantly lower in G1; there were no significant differences between the two groups when it comes to type and cause of infertility and assisted reproduction technique. In G1 37,7% of women (n=20) were more than 35 years-old; in that subpopulation, eSET was performed because of: previous cervical conization in 3 cases; another uterine factor in 6 (3 with an uterine malformation and 3 with clinical important myomatosis or adenomyosis masses); couple’s choice in 7; and a particular favourable prognosis for an eSET cycle in the remaining 4 cases. The rate of clinical pregnancy was inferior in G1 (36,5% vs 46,5% in G2), but this difference didn’t reach statistical significance (p=0.214); there were no multiple pregnancies in G1 versus an incidence of 27% in G2. Regarding obstetrical outcomes we analized the transfers performed until 31/7/2013: 32 in G1 and 488 in G2. Comparing G1 to G2, the rate of pregnancies that resulted in at least one live birth (31,3% vs 38,2%), gestational age (GA) at birth, (36 weeks (wks) in both groups), birth weight (2923grams (gr) vs 2589gr), births at a GA ≤32wks (10% vs 9,2%) and newborns with less than 1500gr (10% vs 7,8%) were not significantly different. Twenty-six frozen-embryos transfers were performed in 25 couples from G1: in 12 of them of a single frozen-embryo - G1.1 (46,2%) and in the remaining 14 cases of two frozen-embryos –G1.2. We registered 3 pregnancies in G1.1 (25%), all of them singletons, and 8 in G1.2 (57,1%), 4 of which twins; the cumulative rate of clinical pregnancy was 57,7% in G1 (eSET plus an additional frozen-embryo transfer); that rate equaled 42,3% when taking into account only G1.1 (eSET plus an additional single frozen-embryo transfer).Conclusion: Even though the rate of clinical pregnancy after a fresh elective single embryo transfer was inferior, is was not significantly different from the one resulting from the transfer of two fresh embryos. When eSET was associated with an additional transfer of one or two frozen-embryos its clinical pregnancy rate exceeded the one resulting from the transfer of two fresh embryos, with a significantly inferior frequency of multiple pregnancy (7,7% vs 27%). The cumulative clinical pregnancy rate of eSET followed by the transfer of one frozen-embryo was only 4% inferior to the the clinical pregnancy rate of fresh double-embryos transfers. Disclosure of Interest: None Declared P02 DECREASE MALE FERTILITY IN OBESE RATS IS ASSOCIATED WITH TESTICULAR UP-REGULATION OF GHRELIN AND DOWN REGULATION OF STEM CELL MRNAS: A PROTECTIVE ROLE OF REGULAR EXERCISE F. Al-Hashem 1,*, M. Alshahrani 1, M. Alsunaidi 1, M. Alkhateeb 1 Physiology, King Khalid University, College of Medicine, Abha, Saudi Arabia Problem Statement: Increased oxidative stress and hormonal imbalance have been hypothesized to underlie infertility obese animals. However, recent evidence suggests that Ghrelin and Stem Cell Factor (SCF) play an important role in fertility, in lean individuals. Therefore, this study aimed at investigating whether changes in the levels of Ghrelin and SCF in rat testes underlie semen abnormal parameters observed in obese rats, and secondly, whether endurance exercise or Orlistat can protect against changes in Ghrelin, SCF, and/or semen parameters in diet induced obese rats. Methods: Obesity was modelled in male Wistar rats using High Fat Diet (HFD) 12-week protocol. Eight week-old rats (n=40) were divided into four groups, namely, Group I: fed with a standard diet (12 % of calories as fat); Group II: fed HFD (40 % of calories as fat); Group III: fed the HFD with a concomitant dose of Orlistat (200 mg/kg); and Group IV: fed the HFD and underwent 30 min daily swimming exercise. The model was validated by measuring the levels of testosterone, FSH, LH, estradiol, leptin, triglycerides, total, HDL, and LDL cholesterol, and final change in body weight. Levels were consistent with published obesity models Results: As predicted, the HFD group had a 76.8 % decrease in sperm count, 44.72 % decrease in sperm motility, as well as 47.09 % increase in abnormal sperm morphology. Unlike the control group, in the HFD group (i.e. obese rats) Ghrelin mRNA and protein were elevated, while SCF mRNA and protein were diminished in the testes. Furthermore, in the HFD group, SOD and GPx activities were significantly reduced, 48.5±5.8 % (P=0.0012) and 45.6±4.6 % (P=0.0019), respectively, while TBARS levels were significantly increased (112.7±8.9 %, P≤0.0001). Finally, endurance exercise training and Orlistat administration individually and differentially protected semen parameters in obese rats. The mechanism includes, but is not limited to, normalizing the levels of Ghrelin, SCF, SOD, GPx and TBARS.Conclusion: The present study showed that obesity is inversely correlated with reproductive function in male rats namely sperm count, motility and morphology; an effect that was observed to be concomitant with decreased serum levels of total Testosterone, and gonadotropins. Interestingly, this effect was associated with down regulation of testicular stem cell factor (SCF) levels and up own regulateion of Ghrelin levels. The reproductive function and the levels of these proteins were normalized effectively by exercise and to a lesser extent by Orlistat administration, the results of which have direct implications for Phase-1 Translational Clinical Trial. Disclosure of Interest: None Declared P03 THE IMPACT OF ZONA PELLUCIDA THICKNESS ON DAY-5 BLASTOCYSTS IN CLINICAL PREGNANCIES. V. Athanassiou 1,*, E. Timotheou 1, G. Ntoutsoulis 1, D. Kostomenos 1, G. Nikolopoulos 1, M. Sakellariou 1 1IVF Athens Center, Marousi, Athens, Greece Problem Statement: The aim of the study is to analyze if the zona pellucida thickness (ZPT) in laser assisted hatching (L-AH) day-5 blastocysts impact the rate of clinical pregnancies. Since 1995 several reports are dealing with the ZPT regarding the fertilization and pregnancy rate. On the other hand, many reports clearly indicate that L-AH has beneficial effect in cases of increased ZPT. However, in our knowledge, there is not any report to correlate the ZPT on L-AH day-5 blastocysts and the rate of clinical pregnancies.Methods: A retrospective analysis of 43 cases including the transfer of 86 L-AH day 5-blastocysts, 2 blastocysts/embryotransfer (ET), in the period between January and October 2013 enrolled the study. A total of 86 day5 blastocysts were studied. In Group I (n=32) were cases with clinical pregnancies and Group II (n=11) without. Both groups had similar age and sperm characteristics. L-AH was performed 30 minutes before ET and ZPT was measured with OCTAX Eyeware Software 115 hours post intracytoplasmic sperm injection (ICSI).Results: Although L-AH was performed in all cases 30 minutes before embryo transfer (ET), clinical pregnancies were observed only in Group I with ZPΤ 2.62±0.8 μm (mean ± SD). No clinical pregnancies were found in Group II with ZPΤ 8.36±4.8 μm (mean ± SD). The differences in zona pellucida thickness between the two groups were significant (p<0.01).Conclusion: Our results suggest that when the ZPT is more than 3.5 μm the prognosis for clinical pregnancy is poor. L-AH is of limited value in cases when the zona pellucida is very thick. 69 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 P04 EFFECTIVENESS OF RECTAL NONSTEROIDAL ANTI-INFLAMMATORY DRUG IN VAGINOSCOPIC OUTPATIENT HYSTEROSCOPY IN PRIMARILY INFERTILE WOMEN E. Karakas 1, H. Hassa 1, Y. Aydin 1,*, T. Oge 1, K. Cicek 1 Department of Obstetrics and Gynecology, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey Problem Statement: To assess whether rectally administered nonsteroidal anti inflammatory drug reduces pain during vaginoscopic diagnostic outpatient hysteroscopy in nulliparous infertile patients.Methods: This was a randomized, prospective, controlled paralel group study. Women who visited our infertility department and required diagnostic outpatient hysteroscopy for investigation of infertility were enrolled in the study group. In the control group, 51 patients had rectal placebo 1 hour before the procedure. Indomethacin 100 mg were administered to the second group of patients (n: 50) 1 hour before the procedure by rectal route. Office hysteroscopy was performed with vaginoscopic approach. Patients were asked to record the severity of pain, which was the primary outcome of the study, during the procedure by using 10-cm visual analog scale (VAS) ranging from 1(very favorable) to 10 (very unfavorable). Secondary outcomes were time of the procedure, rate of the vasovagal symptoms and requirement of analgesia after the procedure. Results: As a primary outcome of our study, we evaluated VAS scores between groups. Mean scores were 4.40 2.87, 4.91 2.51 for rectal placebo and rectal indomethacin groups respectively. There was no significant difference between groups according to VAS values (p: 0.681). Among medication groups; any analgesic drug requirement and vasovagal symptoms are 5 (9.8%), 4 (8%) for analgesic requirement and 2 (39.1%), 1 (19%) for vasovagal symptoms as rectal placebo and rectal indomethacin respectively. There were no significantly difference among groups. Conclusion: Pain relief is an important circumstance for patients’ during invasive procedures like office hysteroscopy even if it is diagnostic. Thus some medications are tested to reduce pain during and after the procedure. According to our results, it seems that rectally administered indomethacin are not effective in pain relief during diagnostic vaginoscopic hysteroscopy. New interventions and/or drugs should be studied to decrease pain perception during vaginoscopic diagnostic outpatient hysteroscopy in nulliparous infertile patients. Disclosure of Interest: None Declared P05 ASSISTED REPRODUCTIVE TECHNIQUES- AN OVERVIEW OF THE CURRENT METHODS AND TECHNOLOGY AVAILABLE S. Babu 1,*, Y. Beebeejaun 2, G. Ho 3 1St Mary's Hospital, 2Women's Health, Guy's and St Thomas' Hospital, London, 3 Brighton and Sussex University Hospital, Brighton, United Kingdom Problem Statement: Since the first test tube baby was born in the year 1978, fertility treatments have advanced greatly. With the increasing age at which women now desire to start a family, Assisted Reproductive Techniques (ART) are becoming increasingly popular and it is currently estimated that a total of five million children have now been conceived through ART. This number is expected to rise and recent literature state that as many as one in six couple will now encounter problems with experience subfertility. Fertility treatments are complex and undergoing one cycle of ART involve various key steps from ovarian stimulation, follicle maturation, egg collection, in-vitro fertilisation to embryo transfer and eventual luteal phase support. These steps are highly complex and understanding the key concepts behind each step is key to a successful clinical pregnancy and eventual live birth. In this review, we aim to assess at the various methods available for each step, compare them and summarise the evidence behind them. We also compared the costs associated with ART and further compare its cost globally. Methods: We performed a literature review of articles looking at the current methods and technologies involved in ART. We also looked at the published Cochrane reviews which analysed the efficacy of each method. This included at a further 54 Cochrane reviews which analysed the various stages of an ART cycle with primary outcome of these reviews being a live birth. We also performed literature search and compared the cost benefit of various steps in an ART cycle and looked at the extent of public funding for an ART cycle and 70 the factors that affect this. Results: This review allowed us to fully compare and summarise the various modalities available through Assisted Reproductive Technique. We reviewed various clinical review articles, analysed the results of Randomised Controlled trials and compared the current methods available. Through this poster, delegates will be able to learn about the ART, the methods available and understand the various steps involved in an Assisted Reproductive Technique cycle better. Conclusion: Subfertility is becoming a global issue with more and more couple seeking ART as a way to complete their family. It is therefore important for us to fully understand the various methods currently available so as we can counsel our patients even better. Disclosure of Interest: None Declared P06 INFERTILITY AND IVF: A SENTIMENT ANALYSIS WITH CASE STUDIES ON TWITTER E. M. Clark 1,*, C. Jones 2, R. Raj 3, P. Dodds 1, C. Danforth 1, D. Gaalema 4, R. Redner 4, T. White 4, A. Schneider 5, M. Couch 2, M. Norotsky 2, E. Sills 6 1 Mathematics, 2Surgery, 3Gynecology, 4Psychiatry, 5Economics, University of Vermont, Burlington, 6HRC-Fertility, HRC-Fertility, Newport Beach, United States Problem Statement: Social Media provides a lens for data scientists to investigate public sentiments regarding the health and social implications of infertility. Twitter, a popular social media outlet, has become a useful tool for the study of social behavior through user interactions called tweets. Case studies regarding the emotional effects of patients participating in in vitro fertilization (IVF) programs can be studied from the tweets of users who have identified themselves as members of an IVF treatment regimen.Methods: Two distributions of tweets were processed in this social experiment. All tweets with geo-spatial coordinates spanning from May to August 2014 were salvaged from millions of twitter-feeds, a collective sampling that represents approximately 1% of the entire twitter- sphere, along with a 10% sample of all tweets collected from the Twitter ‘fire-hose’ spanning 2013. Pattern matching by key-words relating to infertility (i.e. infertility, infertile, IVF, in vitro fertilization) yielded ~50,000 tweets from 2013 and ~2000 tweets from the 2014 Geo-Data set. Tweets from 20 users who self-identified as undergoing IVF were also collected to compare sentiments before and after the procedure. Emotionally charged words that contribute to the positivity of various subsets of tweets were quantitatively measured using hedonometrics. We then examined the density of behavioral tweet indicators over time to illuminate public sentiments regarding infertility issues as well as patients currently involved in IVF treatments.Results: A word-shift graph comparing the emotionally charged words of patients before and after participation in an IVF regimen over a six month period is presented below. After undergoing IVF, the average happiness score of post-IVF binned tweets grows due to an increase in the positive words ‘mom’,’gorgeous’,’thanks’,’congrats’,’excited’,’love’,’happy’, along with a decrease in negative words such as ‘never’,’hate’, and ’regret,’ among others. We additionally evaluated a happiness and frequency time-series. The happiness and frequency outliers help identify important events regarding infertility and IVF sentiments over time. Image / Graph: Conclusion: We demonstrate the potential of twitter to perform case studies on patients undergoing IVF treatment. Social Media can be harnessed to help understand public sentiment surrounding health disparities. It is anticipated that understanding these sentiments can lead to improvements in patient centered care. Disclosure of Interest: None Declared Abstract Book P07 CONTROLLED OVARIAN HYPERSTIMULATION AND IUI CYCLES IN PATIENTS WITH MILD ENDOMETRIOSIS M. Ebrahimi 1,*, F. akbari Asbadh 1, S. Esapoor 2 1Tehran Women General Hospital, 2Tehran University of Medical Science, Tehran, Islamic Republic of Iran Problem Statement: Sever endometriosis is one of cause of female infertility. Association of between minimal or mild endometriosis and infertility has not been completely established. The aim of this study was to compare the results of COH-IUI cycles in minimal or mild endometriosis and unexplained infertility.Methods: A prospective study, between October 2008 and October 2011 in academic reproductive endocrinology and infertility center. Two groups of patients undergoing stimulated IUI cycles were compared, thirty-four infertile couples with mild endometriosis as the sole cause of infertility in the group (І), and thirty-four couples with unexplained infertility in the group (II). The patients underwent 3 consecutive ovarian hyperstimulation (Clomiphen citrate and human Menopausal Gonadotropin) and IUI cycles. The main outcome measures were cumulative pregnancy rates (CPR) per patient for 3 consecutive stimulated IUI cycles. For statistical analysis Fisher exact test, Chi-squared test and independent T -test were used.Results: Cycle characteristics were found to be homogenous between the both groups. CPRs were similar in the group І (7/34, 23.5%) and the group II (8/34; 20.6%) (P =0.7) Conclusion: Both groups with minimal or mild endometriosis and unexplained infertility did not have any difference in response to COH-IUI. So, performing laparoscopy and other invasive procedures, in order to differentiate between minimal or mild endometriosis and unexplained infertility, is not recommended. Disclosure of Interest: None Declared P08 CONTROLLED OVARIAN HYPERSTIMULATION AND INTRAUTERINE INSEMINATION CYCLES IN PATIENTS WITH UNILATERAL TUBAL BLOCKAGE DIAGNOSED BY HYSTEROSALPINGOGRAPHY M. Ebrahimi 1,*, F. Akbari Asbagh 1, A. Rasekh Jahromi 2, M. Alborzi 2, S. Namazi 3 1IVF Ward/Tehran Women General Hospital, Tehran University of Medical Science, Tehran, 2OB&GYN Ward, Jahrom University of medical science, jahrom, 3psychiatric ward, bushehr university of medical science, bushehr, Islamic Republic of Iran Problem Statement: Tubal pathology ranks among the most frequent causes of subfertility, next to ovulatory disorders and sperm defects .The assessment of tubal patency is a fundamental part of infertility workup.Hysterosalpingography(HSG) is widely used as a first-line approach to assess uterine anatomy and tubal patency in routine infertility workup.HSG has 65% sensitivity and 83% specificity for tubal obstruction. Controlled ovarian hyperstimulation and intrauterine insemination cycle is an ideal protocol for some subfertile patients. So, we decided to try this therapeutic protocol for the patients with unilateral tubal blockage diagnosed by hysterosalpingography. Methods: A Cross-sectional analysis, between October 2006 and October 2009 in an academic reproductive endocrinology and infertility center was done. Two groups of patients undergoing stimulated IUI cycles were compared. Sixty-four unfertile couples with unilateral tubal blockage diagnosed by HSG as the sole cause of infertility in the group (I) and two hundred couples with unexplained infertility in the group (II). The patients underwent 3 consecutive ovarian hyperstimulation (Clmiphen citrate and human Menopausal Gonadotropin) and IUI cycles. The main outcome measurements were the Cumulative pregnancy rates (CPRs) per patients for 3 consecutive stimulated IUI cycles. Results: Cycle characteristics were found to be homogenous between the both groups. CPRs were similar in the group І (26.6%) and the group II (28%) (P =0.87; OR=1.075; 95% CI: 0.57 -2.28). Conclusion: Unilateral tubal blockage (diagnosed on HSG) has not effect on success rate of stimulated IUI cycles, so COH and IUI could be recommended as the initial therapeutic protocol in these patients. Disclosure of Interest: None Declared P09 PREGNANCY AFTER ENDOMETRIAL ABLATION: MIRACLE OR MINEFIELD? J. Loganathan 1, R. Farah 1,* Lister Hospital, East and North Hertfordshire NHS Trust, Chelsea, United Kingdom Problem Statement: Endometrial ablation is a widely used treatment for menorrhagia after medical treatment has failed 1,2. It has been available since the 1980s and acts by removing the endometrial lining and deep basal glands to prevent regeneration2. Although conception after ablation is unlikely, it has been reported, and often with disastrous consequences.Methods: A 36 yr old para 2 presented at 29 weeks gestation with epigastric pain. She had 2 previous vaginal deliveries then balloon endometrial ablation to treat menorrhagia. Five years on she had intrauterine adhesiolysis in order to aid conception and she conceived spontaneously 6 months later. Her anomaly scan was normal.At presentation the CTG was reassuring, there was no vaginal bleeding and the pain settled with codeine. During admission an MRI and ultrasound scan were done to evaluate the placenta. Both modalities showed no features to suggest abnormal placentation.Results: At 31 weeks the pain worsened and she became haemodynamically unstable. The CTG remained reassuring, but given the clinical suspicion of intra-abdominal bleeding, an ultrasound was done which showed perihepatic and perisplenic fluid.At laparotomy a haemoperitoneum of 2000mls was confirmed with the placenta seen breaching the serosa at the uterine fundus. The live fetus was delivered by lower segment incision and a subtotal hysterectomy was performed. Overall, a five unit blood transfusion was required. Image / Graph: Conclusion: Pregnancy after endometrial ablation is rare, with a reported incidence of 0.7%3. However it can occur and there are over 120 reported cases in English literature so far4. Abnormal placentation is a significant risk and in a case series by Yin et al, the incidence was 25%, compared to 0.017% amongst women with no uterine surgery4. The risk of preterm delivery, premature rupture of membranes and fetomaternal morbidity is also higher, and in a study by Vinograd et al perinatal mortality in placenta accreta cases was reported at 6.7% compared to 0.9% in the control group5.Current screening with Doppler ultrasound has a reported specificity of 89.6% and sensitivity of 82%6. Magnetic resonance imaging is often used if ultrasound is equivocal. It detects features such as uterine wall bulging and focal interruptions in the myometrial wall. In cases of abnormal placentation delivery planning should involve a multidisciplinary team. This can reduce emergency deliveries and blood loss, which is critical as placenta accreta has a 40% chance of requiring more than 10 units’ blood transfusion7. In our case, delivery was by emergency caesarean section with 5 unit’s blood transfused and subtotal hysterectomy. Placenta accreta is one of the leading causes of caesarean hysterectomy in the developed world8 as placental removal can precipitate massive haemorrhage, and repairing uterine rupture may not be possible. In the literature reviewed, caesarean hysterectomy particularly for cases of placenta increta and percreta, is recommended to reduce transfusion requirements and complication rates9,10. In conclusion, pregnancy after endometrial ablation is a rare but important occurrence. These pregnancies are high risk for abnormal placentation and associated fetomaternal morbidity and mortality. Imaging is vital antenatally to evaluate placentation and delivery planning requires a multidisciplinary approach. Despite these precautions the risks are high, therefore thorough counselling before endometrial ablation must include the need for reliable contraception. 71 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 References: 1. Fergusson RJ, Lethaby A, Shepperd S, Farquhar C. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochranr Database Systematic Review 2013 Nov 29;112. Lethaby A, Hickey M, Garry R, Penninx J. Endometrial resection/ablation techniques for heavy menstrual bleeding. Cochrane Database of Systematic Reviews 2009, Issue 4. 3. Lo J.S., Pickersgill A. Pregnancy after endometrial ablation: English literature review and case report. J Minim Invasive Gynecol. 2006;13:88914. Yin C.S. Pregnancy after hysteroscopic endometrial ablation without endometrial preparation: a report of five cases and a literature review. Taiwan J Obstet Gynecol. 2010 Sep;49(3):311-95. Vinograd A, Wainstock T, Mazor M, Weisel RB, Klaitman V, Dukler D et al. Placenta accreta is an independent risk factor for late pre-term birth and perinatal mortality. J Matern Fetal Neonatal Med. 2014 Aug;21:1-28 [epub ahead of print]6. Elhawary T, Dabees L, Youssef M. Diagnostic value of ultrasonography and magnetic resonance imaging in pregnant women at risk for placenta accreta. J Matern Fetal Neonatal Med. 2013 Sep;26(14):1443-97. Shamshirsaz A, Salmanian B, Fox KA, Diaz-Arrastia CR, Lee W, Baker BW. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstetric Gynecol. 2014 Aug 27.pii:S0002-9378(14)00855-28. Flood KM, Said S, Geary M, Robson M, Fitzpatrick C, Malone FD. Changing trends in peripartum hysterectomy over the last 4decades. Am J Obstet Gynecol. 2009 Jun;200(6):6329. The American College of Obstetricians and Gynecologists. Placenta accreta. Committee opinion. Number 529 July 2012. Reaffirmed 2014. 10. Siwatch S, Chopra S, Suri V, Gupta N. Placenta percreta: rare presentation of haemorrhage in the second trimester. BMJ Case Reports. 2013 Feb; doi:10.1136/bcr-2012-007782 Disclosure of Interest: None Declared P10 HYSTEROSALPINGOGRAPHY – A THREE YEAR REVIEW IN UNIDADE LOCAL DE SAÚDE DO ALTO MINHO S. C. Ferreira 1,*, J. Prata 1, A. P. Ferreira 1, G. Taketani 2, D. Ribeiro 1, P. Pinheiro 1 1Ginecologia/Obstetrícia, 2Imagiologia, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal Problem Statement: Histerosalpingography (HSG) is a radiological exam that evaluates the uterine cavity and the fallopian tubes after injection of radioopaque medium through the cervical canal. Its main propose is to study infertility and recurrent miscarriage. A therapeutic effect has been described, resulting in an increased rate of pregnancy in the months after the procedure. The aim of this study was to characterize the population submitted to HSG in our hospital (Unidade Local de Saúde do Alto Minho) and to evaluate the reproductive success after the exam. Methods: Retrospective study that included all the HSG performed in Unidade Local de Saúde do Alto Minho in a three year interval, from January 2011 to December 2013. The information was collected from the patients clinical files and the exam reports.Results: in the study period, 147 HSG were performed in our hospital. The median patients age was 32 years old. The main indication for the procedure was the study of infertility (96%), most of the cases primary infertility. Fourty-four of these women got pregnant after the exam procedure and 54,5% (n=24) of this pregnancies were spontaneous. The time from the date of exam realization until conception, in spontaneous pregnancies, was between 0 and fourty months, with 37,5% of this pregnancies occurring in the first 6 months after the procedure. Fifteen of this pregnancies referred to cases of primary infertility, while 8 cases were in couples referred because of secondary infertility. With the exception of one case of unilateral obstruction and one case of inconclusive exam, all cases revealed tubar bilateral patency. Conclusion: the results obtained seem to support the existent evidence that HSG has a therapheutic efect, increasing the fertility in the months after the procedure. The mechanism that results in this increased in fertility is not totally understood. Disclosure of Interest: None Declared P11 ELECTIVE SINGLE BLASTOCYST TRANSFER AND CLEAVAGE STAGE DOUBLE EMBRYO TRANSFER P. L. Ho 1,*, T. Y. Tan 2, C. Melinda 3, H. H. Tan 4, S. Nadarajah 2 1Department of Obstetrics and Gynaecology, 2Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 3Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 4Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore 72 Problem Statement: In IVF treatment, the standard practice of transferring two cleavage stage embryos (Double Embryo Transfer, or DET) is often associated with risk of multiple pregnancy, which is also related to increased fetal and maternal mortality and morbidity. This study examines the outcomes of using an alternative approach, elective Single Blastocyst Transfer (eSBL), and whether it reduces the above risks while maintaining pregnancy rates. Methods: A prospective study was conducted between January 2011 to December 2013 at the KK IVF centre. Samples were divided into the DET and eSBL groups. The inclusion criterias for the DET group are participants with first stimulated cycle, age 35 years and below, and have at least four good grade embryos. For the eSBL group, inclusion criterias are participants with age 36 years and below and have at least 4 good grade embryos, or participants with previous successful pregnancy regardless of age. The treatment outcomes are measured in terms of clinical pregnancy rate, multiple pregnancy rate, live birth rate for both groups under study. Results: In 2011 and 2012, both groups were observed to have good clinical pregnancy rate of 50% or more, and live birth rate of 40% or more. In 2013, as more patients underwent eSBL our results show that clinical pregnancy rate was still maintained at above 50%, without compromising pregnancy rate. In fact, eSBL resulted in 100% singleton rate for all years observed. The DET group results show an overall twin pregnancy rate of 25.1%, with a twin live birth rate of 24.7%. For those who received DET, our results also show that younger patients aged 30 years or below had higher multiple pregnancy rates (28.3%) compared to older patients aged between 31-35 years old (22.8%). Image / Graph: Conclusion: Elective Single Blastocyst transfer (eSBL) produces a comparable clinical pregnancy rate when compared to the current practice of Double Embryo transfer (DET). Our study also shown that eSBL treatment resulted in 100% singleton pregnancies, thus achieving the aim of reducing multiple pregnancy and its associated risks in reproductive treatment. In fact, we observed that younger patients who underwent DET have an increased risk of multiple pregnancy. Overall, our observations suggest that the adoption of elective single blastocyst transfer could reduce the incidence of multiple pregnancies and associated fetal and maternal complications while maintaining good pregnancy and live birth rates. Disclosure of Interest: None Declared P12 DO ENDOMETRIAL MOVEMENTS AFFECT THE ACHIEVEMENT OF PREGNANCY DURING INTRAUTERINE INSEMINATION? T. Kim 1,*, H. M. Park 2 1OBGYN, Korea University Anam Hospital, 2OBGYN, Chung-Ang University, Seoul, Republic of Korea Problem Statement: Although several studies have assessed endometrial movements and pregnancy rates resulting from in-vitro fertilization (IVF) and have concluded in negative correlation between the frequency of movements and pregnancy outcomes, few have examined the relationship between endometrial movements and pregnancy achievement after intrauterine insemination (IUI). In IVF cycles, implantation is a key determinant of pregnancy, whereas both processes of spermatozoa transport and implantation occur after Abstract Book IUI.This study was aimed to assess the effect of endometrial movements on pregnancy achievement in intrauterine insemination (IUI) cycles. Methods: The study population was composed of unexplained infertility couples who undergo first-time IUI with clomiphene citrate between September 2010 and October 2013. Not only endometrial movements, but also thickness, volume, pattern, and echogenic change of endometrium were analyzed prospectively in prediction of pregnancy. Results: The total number of 241 cycles of IUI with 49 intrauterine pregnancies (20.3%) was analyzed. Pregnancy was not related to endometrial thickness and endometrial volume, but significantly related to endometrial movements, trilaminar pattern, and hyperechoic change (p < 0.05). Pregnant group showed higher cervicofundal movement rate (89.8% vs 75.5%). Conclusion: For IUI cycles stimulated by clomiphene citrate in unexplained infertility women, endometrial movements on the day of IUI could be a predictor of pregnancy. Disclosure of Interest: None Declared P13 DETECTION OF ENDOMETRIAL SUBENDOMETRIAL VASCULATURE ON THE DAY OF EMBRYO TRANSFER AND THE PREDICTION OF PREGNANCY DURING FRESH IN VITRO FERTILIZATION CYCLES T. Kim 1,*, H. Choi 2, H. Y. Kim 3, W. Y. Paik 4 1OBGYN, KOREA UNIVERSITY ANAM HOSPITAL, 2OBGYN, Inje University Sanggye paik Hospital, Seoul, 3OBGYN, Kosin University, Busan, 4OBGYN, Gyeongsang National University hospital, JinJu, Republic of Korea Problem Statement: Successful implantation depends on a close interaction between the blastocyst and the receptive endometrium. Endometrial vasculature has been considered to play an important role in the early endometrial response to blastocyst implantation, and vascular changes may affect uterine receptivity. This study was aimed to investigate whether vascular parameters measured using three-dimensional power Doppler ultrasound (3D PD-US) can predict pregnancy following fresh in vitro fertilization and embryo transfer (IVF-ET) with fresh GnRH agonist long protocol. Methods: In this prospective observational study, the total number of 236 nulliparous women who underwent the first IVF-ET with GnRH long protocol stimulated by recombinant FSH (rFSH) between May, 2009 and April, 2014 were enrolled. Except two cases of tubal pregnancy, 234 cases were classified as the pregnant group (n=113), and as the non-pregnant group (n=121). A color Doppler ultrasound and 3D PD-US examination were performed on the day of embryo transfer. Pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D) of uterine artery, and vascuarization index (VI), flow index (FI), and vascularization flow index (VFI) of endometrium as well as those of subendometrial region were obtained as main outcomes. These measurements were analyzed in the relation to IVF-ET outcome (pregnant vs. non-pregnant groups). Results: There were no significant differences in patients’ age, infertility duration, BMI, basal FSH levels, the number of retrieved oocytes and good quality embryos, and endometrial thickness and volume between two groups. The pregnant group had higher endometrial VI, FI, and VFI scores than the nonpregnant group (p = 0.001, 0.000, 0.021, respectively). In contrast, the subendometrial region VI, FI, and VFI scores did not differ between the groups (p = 0.770, 0.252, 0.451, respectively), nor did the uterine artery PI, RI, and S/D scores (p = 0.256, 0.527, 0.365, respectively). Cut-off values of endometrial VI, FI, and VFI scores for pregnancy achievement were 0.95, 12.94, and 0.15, respectively.Conclusion: 3D PD-US was a useful and effective method for assessing endometrial blood flow in IVF cycles. Good endometrial blood flow on the day of ET in GnRH long protocol may be associated with high success in pregnancy, which is indicative of endometrial receptivity in fresh IVF cycles. Disclosure of Interest: None Declared P14 CLINICAL EFFICIENCY OF IVF CYCLES FOLLOWING EMBRYO CULTURE IN THE PRESENCE OF GM-CSF IN PATIENTS WITH PREVIOUS IMPLANTATION FAILURE S. N. A. Lee 1,*, M. N. Lim 1, C. F. To 1, S. L. Yu 1 1Obstetrics & Gynaecology, Singapore General Hospital, Singapore Problem Statement: Our Centre reported the first pregnancy in Singapore with EmbryoGen in November 2011. EmbryoGen, Origio, Denmark is the first culture medium that contains a natural cytokine growth factor, GranulocyteMacrophage Colony-Stimulating Factor (GM-CSF), which is found in the female reproductive organs during early pregnancy. GM-CSF has been documented to stimulate cell growth, promote and regulate embryonic development from early stage to implantation and placentation and prevent miscarriages. Since then, we started using EmbryoGen routinely in women with previous implantation failure. In this study, we evaluate the clinical pregnancy, implantation and miscarriage rates of IVF cycles in which embryos were cultured and transferred in EmbryoGen.Methods: This retrospective study includes a total of 93 patients with antral follicle count between 4-29, aged between 30-46 years old with a past history of failed IVF cycles. The oocytes were denuded using hyaluronidase. Metaphase II (MII) oocytes, selected by the presence of the first polar body were considered suitable for ICSI. The injected oocytes were cultured individually in microdrops of EmbryoGen in 6% CO2, 5% O2 and 89% N2 atmosphere. A maximum of three embryos were replaced three days after egg retrieval between 2012-2013.Results: Clinical pregnancy rate per transfer was 34.4% (32/93). Implantation rate was 21.6% (43/199) and miscarriage rate was 15.6% (5/32). None of the patients had OHSS. Conclusion: The results showed that the use of GM-CSF supplemented IVF culture medium improves the chance of a baby who have previously failed. It is concluded that GM-CSF helps to regulate cell division and viability. The addition of growth factor, GM-CSF to an IVF culture medium has been shown to benefit human embryo development, increasing the blastulation rate and increase in blastocyst cell number. It enhances the composition of the medium to make it more closely mimic the natural surroundings of the embryo and thereby increase the chance of implantation and pregnancy and reduce the miscarriage rate in assisted reproduction for patient. EmbryoGen may be an additional investment for the couple in a state-of-the-art treatment to improve their pregnancy chance. The pregnancy rate is promising and our Centre will continue to evaluate the commercial medium. Disclosure of Interest: None Declared P15 TRASNSDERMAL TESTOSTERONE ON POOR OVARIAN RESPONDERS UNDERGOING IVF/ICSI – EXPERIENCE OF A CENTER B. G. Lopez 1,*, C. Tomas 1, I. Bravo 1, J. Metello 1, S. Ramos 1, P. Ferreira 1, P. Sá e Melo 1 Centro de Infertilidade e Reprodução Medicamente Assistida, Hospital Garcia de Orta, Lisboa, Portugal Problem Statement: Poor response to controlled ovarian stimulation was first described in 1983 and has an estimated incidence of 9-26%. There are several studies testing interventions such as dehydroepiandrosterone, transdermal testosterone, inhibitors of aromatase, recombinant LH and HCG, however, the evidence is weak and controversial given the small numbers and the heterogeneity of the studied population. In 2009, Fabregues et al published the first randomized study demonstrating that pretreatment with transdermal testosterone improved the ovarian response in patients with a previous cycle canceled due to poor response. Our aim was to describe the results obtained with the use of transdermal testosterone among poor ovarian responders in our population. Methods: We conducted a single-center prospective observational study of patients who performed a cycle with agonist and transdermal testosterone prior to stimulation ovarian gonadotropin, from November 2012 to July 2014. It was defined as inclusion criteria having had at least one previous course with ≥ 300 IU/day of gonadotropins, one previously cancelled cycle or with less than 3 oocytes, regular cycles of 25-34 days and BMI 19-30 kg/m2. The presence of endocrine or metabolic disease and prior ovarian surgery were exclusion criteria. We analyzed the following variables: number of oocytes and embryos obtained per cycle; number of embryos transferred per cycle; cancellation rate and pregnancy rate.Results: A total of 24 cycles were analyzed. The mean age of patients was 35.2 years, day 2 FSH mean level was 11.4 mg/dL and antral follicle mean count was 7. There were no cases of discontinued therapy due to intolerance or adverse effects. In three cases the cycle was 73 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 canceled – no retrieval was performed due to poor response. The average number of oocytes collected and embryos obtained per cycle started was 4.62 and 2.82, respectively. In 19 cases there was embryo transference and in the majority of cases (n=14) 2 embryos were transferred. Six clinical pregnancies occurred, one of them resulted in a spontaneous abortion at 8 weeks, 3 in healthy newborns and the remaining 2 are currently ongoing pregnancies. The pregnancy rate per started cycle was 25% (28,5% per retrieval)Conclusion: The testosterone treatment in this subgroup of patients, with previous cycles canceled or with previous response with less than three oocytes obtained, seems to improve the ovarian sensitivity to the gonadotropin and reduce the likelihood of cancellation of the cycles for poor response. Although our study is single-centered and with a relatively small sample, our findings are in agreement with the results from a recent meta-analysis demonstrating that the use of transdermal testosterone in poor responders patients increases the likelihood of live birth using lower doses of gonadotropins. More randomized studies are necessary to confirm these benefits. Disclosure of Interest: None Declared P16 TRANSLOCATIONS INVOLVING THE Y NON- ACROCENTRIC CHROMOSOMES: A PROPOSE OF A CASE G-Y. G. Marta 1,*, A. Muñoz Ledesma 1, A. B. Rodriguez Bujez 1 on behalf of 1, Y. Pascual Arevalo 1, E. Mancha Heredero 1, B. Gonzalez Soto 1 on behalf of * Embriologist Obstetrics and Ginecology, Hospital Río Hortega Valladolid, Valladolid, Spain Problem Statement: In mammals, the Y chromosome is essential for sex determination, early sexual differentiation and control of spermatogenesis. In general population the incidence of Y- autosome translocations is 1:2000. In particular, translocations involving the Y non- acrocentric chromosomes are even rarer and may involve any segment of the Y chromosome. Methods: We report a well- masculinised 39 year-old man who was referred to our institution because of a history of two years of infertility. There was no family history of infertility or other genetic disorders. Repeated Seminal analysis showed azoospermia with an average seminal volume of 5 ml. Hormonal studies revealed hypergonadotropic hypogonadism with serum levels of FSH at 64 IU/ml, LH at 22 IU/ml and testosterone at 222 ng/ml.2qThe Karyotype was investigated by a cytogenetic study of peripheral blood. Chromosome analysis revealed a 46 xx karyotype. Results: G-banding analysis of 25 metaphases showed a 46, XX chromosome constitution (46 chromosomes with XX sexual composition). Fluorence in situ hybridation (FISH analysis) showed mosaic sex chromosome constitution: X two crhomosomes in 96% of the peripheral blood cells and one X crhomosome in 4%. In both lines an SRY translocation (locus Y p11.2) was found in X crhomosome. An intra-uterine insemination using donor sperm was proposed. Conclusion: This syndrome is a rare but important cause of hypergonadotropic hypogonadism in which the diagnosis can be delayed or missed. Disclosure of Interest: None Declared P17 ASSISTED REPRODUCTIVE TECHNOLOGY: ARE EMBRYO SCORES AND PREGNANCY OUTCOMES RELATED? A. T. Marujo 1,*, L. Correia 1, M. Rato 2, S. Pinto 2, G. Pinto 2, T. Simões 2 1Fetal-Medicine Department, 2Assisted Reproductive Technology Departement, Maternidade Dr. Alfredo da Costa, Lisboa, Portugal Problem Statement: The consensual opinion states that an optimal day-2 embryo should have four equally-sized mononucleated blastomeres in a threedimensional tetrahedral arrangement, with <10% fragmentation. The consensus scoring system for cleavage-stage embryos is: Grade 1 – <10% fragmentation, stage-specific cell size, no multinucleation; Grade 2 – 10-25% fragmentation, stage-specific cell size for majority of cells, no evidence of multinucleation; Grade 3 – Severe fragmentation (<25%), cell-size not stage-specific, evidence of multinucleation. Several studies have focused on the predictive value of these parameters on the implantation rate. In this study, we tried to evaluate the 74 correlation of these scores with the evolution of the pregnancy. Do good embryos have better pregnancy outcomes? Methods: We analyzed 826 IVF and ICSI cycles performed at Maternity Dr. Alfredo da Costa in the Reproductive Medicine Unit between 2012 and 2013, corresponding to the period during which the classification of embryos was done using the Istambul consensus from the workshop on embryo assessment classification. We selected the 406 with a positive Beta-hCG test and from this subset we selected the 288 which had a transference of one single embryo or two embryos with the same score (either G1 or both G2 or both G3). We then compared pregnancy outcomes for the three groups. SPSS version 13 (Chicago, IL) and True Epistat Software (Math Archives, Round Rock, TX) were used for statistical analysis. P-values <0.05 were considered significant. Results: From the 288 cycles, 185 pregnancies (64.2%) resulted from G1 embryos (G1); 94 (32.6%) from G2 embryos (G2) and 9 (3.1%) from G3 embryos (G3). Maternal age was similar in all the groups (p=0.5): 33.3±3.8 (G1); 33.7±4.2 (G2); 33.8±4.2 (G3). Duration of infertility was also similar in all groups (p=0.2): 5.0±2.5 (G1), 5.1±2.5 (G2); 5.8±1.5 (G3). Agonists were used in 74.6% (G1); 69.1 %( G2) and 66.7 % (G3), p=0.6. On average, higher doses of gonadotropins were used in groups G2 and G3 (1939 ±735 IU and 2022±802 IU) compared to group G1 1705±613 IU (p=0.09).The average number of days of stimulation was similar across the three groups: 10.2±1.9 (G1), 10.7±2.1 (G2) and 10.7±2.2 (G3), p=0.5. Clinical pregnancy (ultrasound confirmation of fetal heartbeat) was not different among the groups: 74.6% (G1); 72.3% (G2) and 66.7% (G3), p=0.8. We found statistically significant differences with respect to delivery: 68.2% of G1 embryos had delivery compared with 55.3% of G2 embryos and 42.9% of G3 embryos (p=0.02). Group G1 had a higher rate of cryopreserved embryos: 58.9% (G1), versus 33% (G2) and 11.1% (G3), p<0.001. We did not find statistically significant differences with respect to mean gestational age at delivery: 36.8±3.1 (G1), 37.2±3.1 (G2) and 37.7±1.5 (G3) weeks of gestation, p=0.07 and to mean birth weight 2700±695 g (G1), 2838±676 g (G2) and 2788±252g (G3), p=0.3 There were 30 twin deliveries in group G1 (16%); 7 in group G2 (14.9%) and none in group G3. Conclusion: Top quality of embryos (G1) were associated with a higher rate of delivery. However, differences between G1, G2 and G3 embryos were not statistically significant with respect to gestational age at delivery and mean birth weight. Disclosure of Interest: None Declared P18 OVERWEIGHT AND PREVALENCE OF B-CLASS EMBRYOS APPARENTLY DO NOT AFFECT PREGNANCY RATE J. D. Micic 1,*, L. Surlan 1, J. Dotlic 1, V. Stankovic 1, M. Terzic 2 1 ART, 2Infertility, Clinic of Ob/Gyn, Clinical Center of Serbia, Belgrade, Serbia Problem Statement: Overweight and obesity, as some of the biggest health problems in the world, are evidenced to co-relate with an increased risk of infertility. The effect of patient’s body mass index on IVF procedure still remains a controversial subject, since published data demonstrated variety of conflicting conclusions. Methods: We subjected 445 patients from National funded IVF program at the Clinic of Ob/Gyn, Clinical Center of Serbia. Female patients are viewed through BMI (<25; 25-30), infertility background and age, stimulation protocol, gonadotropin doses, number and quality of oocytes and embryos obtained, and achieved clinical pregnancy rates. Results: Women had 34.16 +/- 3.74y. The mean patients’ BMI was 22.49 +/- 2.79 with 16.2% having BMI over 25. The most frequent causes of infertility were male and unknown factor (p=0.001). BMI positively correlated with age (p=0.009) and used rFSH doses (p=0.031). On average, 9.47+/-6.63 oocytes were retrieved and 4.96 +/- 4.08 embryos were achieved. There were 1.54 +/- 2.36 type A, 2.28 +/- 2.54 type B and 1.14 +/- 1.98 type C embryos. Overweight group had higher proportion of type B embryos (p=0.022) and total number of embryos (p=0.037). BMI had no influence on clinical pregnancy rate. Conclusion: If BMI is below 30 kg/m2 it has no influence on IVF course and procedure outcome. The fact that embryos are graded as B morphologic type Abstract Book does not necessarily mean their lower implantation capacity, but confirms high dynamics and plasticity of early development. Disclosure of Interest: None Declared P19 IMPORTANCE OF MULTIDISCIPLINARY TREATMENT OF INFERTILITY WITH RESPECT TO PATIENTS' SATISFACTION V. Nagy 1,*, É. Margittai 1, A. Vereczkey 1 Versys Clinics Human Reproduction Institute, Budapest, Hungary Problem Statement: High-quality care for patients faced with infertility should be based on complex treatment offered by the fertility clinic and continuous analyses of patients’ feedback reports. There is a new trend in the services of infertility clinics worldwide: some centers give full range of medical services. The so called “multidisciplinary”, or “complex” approach involve many specialties besides gynecology and in vitro fertilization (IVF). In the present study, we aimed to examine infertility care from the patients' viewpoint to obtain in-depth insights into their perspective on infertility care. Methods: Data were collected from 20 patients participating voluntarily in the study who have already gone through at least one IVF cycle at our clinic. All patients filled out a questionnaire containing issues about patient’s tendency to participate on the offered consultations and examinations, and content analysis with the multidisciplinary approach. The research was conducted in 2014. Results: The average age of the participting women was 37, and 45 years old. All of them had previously undergone at least one IVF program in our institute. 85% of the participating women were fully satisfied with the information received about the complex treatment of infertility. 100% of the respondents agreed to be advised to more than one specialists during infertility treatment and thought that an individual treatment should be developed by the collaboration of different specialists. The great majority of patients did not consider infertility only a gynecological problem and found advantegous that all the related professions are represented at our clinic. Preimplantation genetic examinations were found substantial by 95% of participating patients, while andrological/urological checkups were important to 85% of them. Psychological, genetic, endocrinological, immunological consultations were found equally important to 100% of participating women. Dietetic consultation was found to be the less important for them. Further results obtained from the filled out questionnaires are going to be presented in the lecture. Conclusion: The Versys Clinics Human Reproduction Institute was founded with a purpose of giving a full range of services for patients suffering from infertility, with a multidisciplinary approach being pioneer in Central Europe. Its central idea is that infertility is not any more under the control only of gynecology; many other specialties should be involved. According to our questionnaire, the vast majority of patients is fully satisfied with the above concept and they participate at all of the consultations proposed in order to elaborate the treatment. Our experience shows that the complex infertility treatment is more successful, precise and results highly satisfied patients, thus multidisciplinary approach should have a central role in in infertility care worldwide. Disclosure of Interest: None Declared P20 FIRST HUNGARIAN EXPERIENCES WITH PREIMPLANTATION GENETIC TESTING USING ARRAY COMPARATIVE GENOMIC HYBRIDIZATION (ACGH) FOR PATIENTS CARRYING BALANCED CHROMOSOMAL REARRANGEMENTS L. Nanassy 1,*, E. Gajdocsi 1, A. Nemes 1, G. Teglas 2, A. Vereczkey 1 1Human Reproduction Institute, 2Reprogenex Genetic Diagnostic Laboratory, Budapest, Hungary Problem Statement: Chromosome rearrangements in a balanced form have a frequency of ~0.2 % in newborns. In most cases affected individuals experiences no obvious problems until they try to reproduce. Patients carrying chromosomal rearrangement experience decreased fertility, increased rate of miscarriage and in some cases it can lead to a birth of a child affected with congenital abnormalities. Preimplantation genetic testing of embryos using aCGH provides an effective tool for selecting embryos with no unbalanced chromosome rearrangements. Methods: Data from patients attending at our infertility clinic with chromosome rearrangements were gathered and analyzed. Intracytoplasmic sperm injection was used as fertilization technique in all cycles. Embryo biopsy was carried out on day 3, one blastomere was removed and analyzed using aCGH (24 sure +, Illumina, Cambridge, UK). Where normal/balanced embryo was available embryo transfer was carried out on day 5. Positive chemical pregnancy was considered if βhCG level in blood serum was above 15. Clinical pregnancy was noted when fetal heart beat was seen. Results: Ten patients showed abnormal karyotype, 5 of them had reciprocal, two of them had Robertsonian translocation, two of them had inversion on chromosome 9 (1 homozygous) and one patient showed heterochromatin variations. These 10 patients went through 13 IVF cycles. One hundred and thirteen mature eggs was collected that resulted in 79 embryos having a fertilization rate of 69,99%. Fifty one embryo was biopsied and 50 of them was diagnosed (98,04%). A total of 16 embryo was diagnosed as euploid (32,00%). Over forty percent of aneuploid embryos (15/34) was unbalanced or had a chromosome involved in the aneuploidy that in the rearrangement. One patient had no normal embryo after two cycles; the remaining patients had euploid embryos at least in one cycle. Nine embryo transfer was carried out resulting in 5 (55,56%) chemical and 4 clinical (44,44%) pregnancies. Clinical pregnancy rate calculated per cycles started was 30,77% (4/13). Conclusion: Following its introduction in assisted reproduction aCGH quickly replaced fluorescent in situ hybridization (FISH). However, FISH has been successfully applied for patients with chromosome rearrangements in several hundred cases, it suffers many limitations. Array based CGH is proved to be efficient for selecting embryos for transfer for patients with balanced chromosome rearrangements. In our setting pregnancy rates achieved were similar to that currently available in the literature. We have concluded that our clinic successfully adopted embryo selection with aCGH for patients with structural chromosome abnormalities. Disclosure of Interest: None Declared P21 COMPARISON OF FERTILIZATION RATES AND PREGNANCY OUTCOMES AMONG THE INSEMINATION AND HALF INTRACYTOPLASMIC SPERM INJECTION (HALF ICSI) VERSUS TOTAL ICSI IN IN-VITRO FERTILIZATION PATIENTS WITH MODERATE MALE FACTOR INFERTILITY E. J. Park 1,* Won IL Park, Jung Whan Shin, Yong Soo Seo 1Obstetrics and gynecology, Eulji Medical Center of Eulji University, Seoul, Korea Problem Statement: To compare fertilization rates and pregnancy rates among the insemination and half intracytoplasmic sperm injection (half ICSI) versus total ICSI in in-vitro fertilization patients with moderate male factor infertility. Methods: 212 patients completed IVF cycles done for the tubal factor and moderate male factor infertility (strict morphology of sperm is 4-10%, or high variation of strict morphology of sperm between the 2-3 analyses of semen) were included. 40 women (Group 1) underwent insemination after oocyte aspiration. 31 women (Group 2) underwent insemination of half oocytes and ICSI of half oocytes aspirated. 51 women (Group 3) underwent total ICSI after oocyte aspiration. Results: 3 patients (3 patients in Group 1) were cancelled by failed fertilization. 119 patients were evaluated. There was no difference in the mean age, aspirated oocytes numbers, strict morphology of sperm. There was no difference fertilization rates between three groups (74.1%, 70.8%, 66.1%, P=0.164). Group 1 and 2 was higher than Group 3 in ongoing pregnancy rate (43.2%, 41.9%/ 27.5%, P=0.008) significantly. Conclusion: The use of insemination or half ICSI in in-vitro fertilization patients with moderate male factor infertility is superior to total ICSI in pregnancy rate. Also, benefit of half ICSI in moderate male factor infertity is to prevent failure of fertilization in using insemination, but half ICSI didn`t increase fertilization rate significantly Disclosure of Interest: None Declared 75 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 P22 COMPARISON BETWEEN FRESH AND FROZEN BLASTOCYSTS TRANSFER REGARDING TO PREGNANCY R. Petracco 1,*, L. Okada 1, R. Azambuja 1, D. Kvitko 1, V. Reig 1, A. Tagliani-Ribeiro 1 ,M. Badalotti 1, A. Petracco 1 Fertilitat- Centro de Medicina Reprodutiva, Porto Alegre, Brazil Problem Statement: In vitro fertilization has become a widely method to achieve pregnancy in infertile couples. Considering the advances regarding new drugs and new laboratory techniques, the embryo quality and chance of pregnancy have increased consistently. Recent studies have suggested that transferring frozen embryos would have a higher chance of pregnancy considering that hormonal stimulation that is present during the fresh cycle could impair endometrial receptivity. This aspect is especially important considering patients with risk for ovarian hyperstimulation syndrome (OHSS). Firstly because of hyper estrogen levels that modify uterine contractility in these patients. Also due to eventual use of agonist for triggering final oocyte maturation that due to its shorter duration of the agonist-induced LH surge might not transform the existing follicles efficiently to corpora lutea capable of supporting implantation and consequently decreasing pregnancy rate. The aim of this study is to compare the pregnancy rates of transferred blastocysts derived from fresh and frozen cycles. Methods: A retrospective study that included couples who underwent embryo transfer at the blastocyst stage (fresh = 551 and frozen = 264), from January 2012 until July 2014. The results of pregnancy regarding to blastocyst transfer cycles were evaluated. The method for cryopreservation used was vitrification (according to Kuwayama et al 1998). Statistical analysis was performed using Fisher's exact test (p <0.05). Results: The mean age of patients in the fresh cycle and frozen embryo transfer (FET) cycle was 34.7 and 34.6, respectively. The number of embryos transferred in both groups (fresh and FET) were 1018 and 474, respectively, with an average of 1.84 and 1.79 per patient. The rates of pregnancies and clinical pregnancies were 46% and 39% for fresh embryos and 52% and 43% for frozen/thawed blastocysts, respectively. No statistical difference (p> 0.05) was observed in any of the results reported above. Conclusion: Transfering frozen/thawed embryos is a good option considering patients that could have their pregnancy rates decreased for different reasons (for example, OHSS). Our results didn't find a reason to have the frozen/thawed embryos transfer cycle as a routine, because the pregnancy rates dind't show difference in both groups. Disclosure of Interest: None Declared P23 PREGNANCY AFTER IN VITRO MATURATION OF OOCYTES IN A PATIENT WITH REPEATED FERTILIZATION FAILURE IN IVF A. Smirnova 1,*, M. Anshina 1, A. Ellenbogen 2 1IVF&Genetics Center "FertiMed", Moscow, Russian 2Department of Obstetrics and Gynecology, IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel Problem Statement: The incidence of fertilization failure decreased dramatically since ICSI was successfully introduced into clinical practice. However even in very successful units with high pregnancy rates there are couples who face repeated IVF failure due to low or absence of fertilization attributable to various follicular development abnormalities, oocyte incompetence or cytoplasmic immaturity in which no embryos are available for transfer. Different stimulation protocols were proposed in order to overcome this problem. Another option is in vitro maturation (IVM) of immature oocytes retrieved from small antral follicles. Methods: We presented a case of a 36 years old woman who was referred to IVF&Genetics Center for infertility treatment after bilateral salpingectomy due to two tubal pregnancies. Basal FSH level was 11,8 mIU/ml, AMH 0,5 ng/ml, LH 4,7 mIU/ml, E2 75 pg/ml, antral follicle count on day 3 was 6. Results: First IVF attempt was performed using a short agonist protocol with Decapeptyl 0,05 mg/daily and Pergoveris (300 IU of FSH daily) for 14 days. Following routine HCG administration 5 MII oocytes were retrieved. Nineteen hours after ICSI one oocyte developed in 3pN and other 4 oocytes degenerated. Second IVF attempt was performed with a long agonist protocol 76 (Decapeptyl 0,05 mg/daily from day 21 of cycle and Merional 450 IU daily for 11 days started when ovarian suppression was achieved). Four follicles > 18 mm were aspirated 35 hours after HCG triggering and no oocytes were retrieved. A second aspiration of other 4 follicle > 17 mm was performed 40 hours after triggering, 4 oocytes being obtained: 2 MII, 1 MI and 1 GV. No sign of fertilization was found 24 hours after ICSI. Third attempt with ovarian stimulation by clomiphene citrate 50 mg for 11 days resulted in single follicle growth and cycle cancellation. Taking into consideration the repeated fertilization failure in conventional IVF attempts IVM+IVF was performed with FSH priming (Merional 150 IU on day 2, 3 and 4 of cycle), hCG 10000 IU was given as a trigger on Day 7 of cycle. Six follicles 5-12 mm in diameter were aspirated 39 hours later and five oocytes were obtained. All oocytes were cultured for 5,5 hours in maturation medium (SAGE) and stripped for maturity assessment. Four oocytes were MII and 1 GV. MII oocytes were fertilized by ICSI on the day of aspiration; three good quality embryos were obtained. Two of them were transferred to the patient and one was vitrified on day 3. Luteal phase support with Proginova 6 mg and Utrogestan 600 mg vaginally was provided. Singleton ongoing pregnancy was diagnosed by ultrasound scan six weeks after the embryo transfer. Conclusion: IVM should be considered for patients with repeated fertilization failure. Disclosure of Interest: None Declared P24 TWIN PREGNANCY WITH SINGLE INTRAUTERINE FETAL DEMISED IN LIMITED RESOURCE; A CASE REPORT R. Agustine 1,*, N. Obgyn 2 1Obstetry and Gynecology Department of Indonesia University, University, East jakarta, 2Obstetry and Gynecology Department of Indonesia University, Riau University, Pekanbaru- Riau, Indonesia Problem Statement: Single twin demise occurs in 2- 5% of twin pregnancies occur during second and third trimester with potentially profound consequences It is believed to be associated with increase risk of perinatal morbidity and mortality for the surviving twin and risk of coagulopathy affecting mother. 4 The occurence of single fetal death is 3 to 4 fold higher with loss rates up to 30- 50 % in monochorionic twins than in dichorionic twins. The exact rate of single intrauterine fetal death (sIUFD) is difficult to define as the loss may occur before the diagnosis of a multiple pregnancy. However, it emphasizes the importance of first trimester scanning and the identification of sIUFD 1, 2, 13 In this report we present two cases of single intrauterine fetal demised in twin pregnancy, the first case ilustrates a 33 y.o woman with G4P3 with two live children, came to Arifin Achmad General Hospital in Pekanbaru- indonesia on April 2014, reffered from midwive in active phase of labour. This pregnancy is a twin gestation with single intrauterine fetal dimised, other fetus was normal, mother with anemia suspected iron deficiency, patients admitted she never done ultrasound (US) examination during her pregnancy. 2nd case was 35 y.o woman with G1 at term pregnancy, Patient came to ANC Clinic of Arifin Achmad General Hospital on July 2014, to control her pregnancy, and the other maternal complication was gestational hypertension. Methods: 1st patient got a twin pregnancy, with single intrauterine fetal dimised and Monochorionic Diamniotic placentation type. Patient was planned to have vaginal delivery and packed red cells transfussion. In 6 hours born 1st baby boy 1980 grams, 43 cm, Apgar score 8/9. 2nd baby boy 580 grams, 31 cm, died macerated grade III. The placenta type was monochorionic diamnotic 2nd patient's US examination result was Intrauterin twins with Single IUFD, longitudinal lie breech-breech presentation, oligohidramnious, placenta type was monochorionic diamniotic. Patient was planned to have a termination by cesarean section. Under C-section Born 1st baby boy 2300 grams, 44 cm, Apgar score 7/9, Balard score correspond to 36- 38 weeks of gestatonal age. Born 2nd baby boy 1000 grams, died macerated grade III, diminished greenish amniotic fluid, withered umbilical cord. We could not have additional examination such as milk test to see whether there's vascular anastomoses of placenta to help determine the possibility of SIUFD due to cultural problems. Results: These two cases terminated atterm pregnancy with no any significant difference. Vaginal delivery is not contraindicated in cases of sIUFD however caesarean section may avoid the risk of acute TTTS due to vascular anastomoses. Abstract Book In these two cases we didn't find any significant difference of normal fetal outcome between two modes of deliveries. Conclusion: These cases illustrate the importance of antenatal care is well supported by the possibility of early diagnosis of complications of twin pregnancies. In monochorion diamniontic twin pregnancies management guided by ultrasound in assessing fetal development, the type of placentation, Doppler assessment, fetal surveillance and other investigations such as MRI, blood tests are necessary needed in order to reduce morbidity and mortality of the fetuses and the mother. In monochorionic twins the gestation of delivery following a sIUFD is still debatable but most would suggest delivery by 38 weeks and some as early as 32- 34 weeks. Vaginal delivery is not contraindicated in cases of sIUFD Disclosure of Interest: None Declared P25 CONJOINED THORACOPHAGUS TWIN WITH NON IMMIUNE HYDROPS FETALIS - A CASE REPORT L. Ahmad 1,*, S. Al-abri 1, J. Al-busaide 1 Gynae and Obs, Armed Forces Hospital, Muscat, Oman Problem Statement: The incidence of conjoined twins is estimated at 1 in 50,000 births. Thoracopagus is the most common form, with fusion from the anterior thorax to the umbilicus. Approximately half are stillborn, and a smaller fraction of pairs born alive have abnormalities incompatible with life. The overall survival rate for conjoined twins is approximately 25%. The condition is more frequently found among females, with a ratio of 3:1. Methods: A case report.Results: A 27-year-old, G2P1 woman with previous cesarean section was referred to our hospital at 28 weeks gestation because of a conjoined twin (thoracopagus) diagnosed by ultrasonography. She had no personal or family history of twins. Sonography was performed and found two fetuses with 2 heads, both fetuses were joined at the anterior chest wall with two fused heart and liver, two spines, cord had multiple vessels, with 2 arms and 2 legs, Polyhydroamnios was also visualized. Abdominal ascites and pleural effusion noted. The placenta was localized anteriorly. On the basis of these findings, the diagnosis of thoracopagus conjoined twins with Hydrops fetalis was made and the parents were informed about the malformation and the twin’s poor prognosis of survival by the senior obstetrician in collaboration with senior pediatrician. The parents decided to continue the pregnancy. After one-week patient reported in accident and emergency with per vaginal leaking and mild labor pain, speculum examination confirmed leaking. Patient proceeded with emergency LSCS in next half an hour. J- Shaped incision made and plenty of thin Meconium stained liquor drained, baby girls with Conjoined thoracophagus delivered and weight of each baby was 1 kg with Apgar score 2 and 2. Babies shifted to SCBU and both died in next 2 hours. Conclusion: Conjoined twinning is one of the most fascinating human malformations. Early diagnosis of conjoined twins with ultrasound, threedimensional ultrasound, computed tomography, or magnetic resonance imaging is helpful in early termination of pregnancy. The surgical separation of conjoined twins is a delicate and risky procedure, requiring extreme precision and care. Therefore, the decision to separate twins is a serious one. Most cases of separation are extremely risky and life threatening. Disclosure of Interest: None Declared P26 EARLY FETAL ABDOMINAL CIRCUMFERENCE MEASUREMENT IN THE PREDICTION OF FETAL MACROSOMIA M. Alshebly 1 Ob/ Gyn, King Saud University, Riyadh, Saudi Arabia Problem Statement: Abdominal circumference measurement (AC) was missed out as an important predictor of fetal macrosomia especially in Saudi Arabia. This study therefore was done to evaluate the value of early fetal AC measurement in the prediction of fetal macrosomia in diabetic and non diabetic pregnant Saudi mothers and the fetal outcome. Methods: This is a retrospective study conducted at the Department of Obstetrics and Gynecology, King Khalid University Hospital, Riyadh, Saudi Arabia. The study includes 139 neonates who were born during the period of one year with a birth weight of 4 kg or more. All ultrasonographic measurement of AC was done during the antenatal period which were reviewed and analyzed using SPSS. The mode of delivery and neonatal complications were also reviewed.Results: AC measurement was found to be above 50th percentile in both ultrasound scans done in 2nd and 3rd trimester. Only 36.4% of macrosomic infants were born to mothers diagnosed to have gestational diabetes and most of these patients were managed by diet restriction. 63.4% of macrosomic infants were delivered by mothers who were normal and carried on with their pregnancy till spontaneous delivery. Screening of gestational diabetes was carried only once in this group and it was not repeated even when the ultrasound showed high AC measurement. Conclusion: High AC measurement in second and third trimester of gestation was associated with fetal macrosomia. The antenatal measurement of fetal abdominal circumference is an easy and practical method in the prediction of fetal macrosomia. Fetomaternal complications can be reduced by adopting strict screening and good planning if fetal macrosomia is suspected early during antenatal follow up. Disclosure of Interest: None Declared P27 ATTITUDES OF SAUDI MOTHERS TOWARDS BREAST FEEDING M. Alshebly 1 Ob/ Gyn, King Saud University, Riyadh, Saudi Arabia Problem Statement: Breastfeeding is very important to both mother and fetus but nowadays most of mothers are not following the recommendations for proper breastfeeding. This study was done to explore the practice and attitudes of Saudi mothers towards breastfeeding. Methods: A cross-sectional survey done on a total of 517 Saudi mothers using a questionnaire inquiring about their demographic data, breastfeeding practice in the first 6 months after delivery and longer, different reasons for stopping breastfeeding. Furthermore, their impression on the relation between breastfeeding and breast cancer as well as prevention of infant’s allergic and infectious diseases. Results: Only 37.5% of the mothers practiced exclusive breastfeeding for 6 months. 31.9% of the mothers continued breastfeeding until 9-12 months, and only 23% continued until 18-24 months. Insufficient breast milk was the commonest reason for stopping breastfeeding (25.9%). The vast majority of the mothers (95.2%) believe that breast milk can prevent allergy and infection to their infants, and 88.4% agreed that breastfeeding may decrease the risk of breast cancer. 30% of mothers with higher income and higher socio-economic class tend to have less compliance with breastfeeding. Conclusion: Exclusive breastfeeding in the first 6 months lag far behind the WHO recommendation. There is a major problem with adequacy of breast milk production in the majority of mothers in this study which might indicate the need for proper awareness and teaching programs regarding breastfeeding in our community. Disclosure of Interest: None Declared P28 NON-REASSURING FETAL STATUS AND UMBILICAL CORD BLOOD GAS ANALYSIS Â. M. Alves 1,*, M. Morais 1, H. Fachada 1, R. Verissimo 1, N. Nogueira Martins 1, F. Nogueira Martins 1 Departamento de Obstetrícia e Ginecologia, Centro Hospitalar Tondela-Viseu, EPE, Viseu, Portugal Problem Statement: Introduction: The umbilical cord blood gas analysis represents a valuable marker of the metabolic status of the fetus in the peripartum period, and it must be included in the assessement of the obstetrical practice. Objective: To establish the relationship between peri-partum diagnoses of nonreassuring fetal status, based on cardiotocography; and the results of the umbilical cord blood gas analysis after birth Methods: Prospective study that included the umbilical cord blood gas samples collected between 01.09.13 e 31.01.14; divided in two different groups. A study 77 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 group, which included the ones collected for singleton pregnancies and nonreassuring fetal status, prematurity, fetal growth restriction, and maternal disease; and a control group, including those collected for operative vaginal deliveries excluding the diagnosis of non-reassuring fetal status, and twin pregnancies without associated patologies. The two groups were compared regarding arterial pH at birth, bases excess and Apgar score at the first minute of life. The authors used the IBM Statistical Package for the Social Sciences® (SPSS) 21 for the statistical analysis. Results: During the five-month study, 136 umbilical cord blood gas samples were collected according to protocol. Only 113 were valid for statistical analysis. The average age of women was 30.1; and the average gestational age at birth was 38.5 weeks. None of these items had significant difference between groups. The t-Student test for independent samples was used to compare the arterial pH at birth, bases excess and Apgar score at the first minute of life. Authors established a p value ≤ 0,005 for statistical significance. The difference between the arterial pH resulted in p=0.343; the difference between the bases excess resulted in p= 0.525; and only the difference between the Apgar score achieved statistical significance, with p=0.037. Conclusion: The diagnosis of non-reassuring fetal status can lead to early fetal extraction, and the acid-base status after birth is not always in agreement with the motive that lead to the fetal extraction. The sistematic review of the umbilical cord blood gas analysis in a context of non reassuring fetal status may represent a valuable contribution to the improvement of the accuracy of the obstetrical practice. Disclosure of Interest: None Declared P29 SELECTIVE EPISIOTOMY VS AN IMPLEMENTATION FOR A PROTOCOL OF NO EPISIOTOMY: A RANDOMIZED CONTROLLED TRIAL M. Amorim 1,*, L. Katz 2, I. Coutinho 2, I. Melo 2, A. H. França Neto 1 1 Obstetrics and Gynecology, UFCG AND IMIP, Campina Grande, 2Obstetrics and Gynecology, IMIP, Recife, Brazil Problem Statement: An episiotomy rate around 10% is recommended by World Health Organization. However, the procedure is still routinely performed in several regions and settings. Current rate of episiotomy in Brazil is 54%. Episiotomies should be limited and physicians must use their clinical judgment to decide when the procedure is necessary. There is no clinical evidence corroborating any indication of episiotomy, so it is not yet known whether it is in fact necessary in any context in modern obstetric practice. The objective of this study was to compare the maternal and perinatal outcomes in women undergoing a protocol of not conducting episiotomy versus selective episiotomy. Methods: A randomized open clinical trial was conducted in the maternity ward at Instituto de Medicina Integral Prof. Fernando Figueira, from January 2013 to February 2014. Clinically stable women in labor with term pregnancy with a live fetus in vertex cephalic presentation and maximum cervical dilation between 6cm and 8cm were included. Women with bleeding disorders of pregnancy and cesarean indication were excluded. Primary outcomes were frequency of episiotomy, duration of second period of labor, frequency of spontaneous lacerations, instrumental delivery and perineal trauma, postpartum blood loss, need for perineal suturing, number of sutures used, Apgar scores in the first and fifth minutes, need for neonatal resuscitation and pH in cord blood. Secondary outcomes were assessed: frequency of severe perineal trauma, complications of perineal suturing, postpartum perineal pain, maternal satisfaction, neonatal morbidity and admission to the NICU. Data analysis was performed using EpiInfo statistical program version 7, adopting the principle of intention to treat. Student’s t-test, the Mann-Whitney test, Pearson’s chi-square test and Fisher’s exact test were used in the statistical analysis. All p-values were two-tailed and the significance level adopted was 5%. The study was approved by the Ethics Committee in Research of IMIP (CAAE 114,993) and registered in the Under number NCT02178111. All participants agreed to participate and were included only after signing an informed consent. Results: Nineteen of the 263 women approached were excluded for cephalopelvic disproportion or failure to progress. Four women agreed to participate and were excluded after randomization for non-reassuring fetal 78 heart rate and so 115 women were allocated for a protocol of not conducting episiotomy (experimental group) and 122 to a group in which episiotomy could be performed selectively (control group). There was no difference between the two groups regarding maternal or perinatal outcomes. Episiotomy rate was similar (two cases in each group, around 1.7% of total), as well as the duration of second stage, frequency of perineal lacerations and blood loss at delivery. Conclusion: A protocol of not conducting an episiotomy seems to be safe for mother and child and points to the need of investigating if there is in fact any indication of this procedure in current Obstetrics practice. Further research should evaluate the need of episiotomies in the situations commonly described as indications, like non-reassuring fetal heart rate, instrumental deliveries, macrosomia, shoulder dystocia and prolonged second stage of labor. Until these evidences are available obstetricians should try to reduce their rates of episiotomy. We think that is possible to never perform an episiotomy: this is the final cut. Disclosure of Interest: None Declared P30 CLONIDINE VERSUS CAPTOPRIL FOR SEVERE POSTPARTUM HYPERTENSION M. Amorim 1,*, S. Maia 2, C. Noronha 2, L. Katz 2, A. H. França Neto 1, A. S. Rolland de Souza 2, I. Coutinho 2 1Obstetrics and Gynecology, UFCG AND IMIP, Campina Grande, 2Obstetrics and Gynecology, IMIP, Recife, Brazil Problem Statement: The choice of antihypertensive drugs both to control very high blood pressure episodes and to keep blood pressure stable in postpartum women remains controversial. Captopril plays an important role in the treatment of very high blood pressure episodes and may be used postpartum with no effect on breastfeeding. Nevertheless, in cases of acute renal disease or drug reactions, captopril should be avoided. Clonidine has been used as an alternative in pregnant or postpartum women with contraindications to captopril, with satisfactory effects. The objective of the present study was to determine the effectiveness and safety of clonidine compared to captopril for treating severe postpartum hypertension.Methods: A randomized, triple-blind, drug-controlled clinical trial was conducted to compare oral captopril (25 mg) with oral clonidine (0.1 mg) for 90 postpartum women with hypertensive disorders of pregnancy and very high blood pressure episodes. The study was developed at the obstetric intensive care unit (ICU) of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). The study was approved by the institute’s internal review board. All patients agreed to participate and signed a consent form. Student’s t-test, the Pearson chi-square test and Fisher’s exact test were used in the statistical analysis. All p-values were two-tailed and significance level was established at 5%.Results: A total of 90 women were randomized to receive captopril (n=45) or clonidine (n=45). The baseline characteristics of the women in the two groups were similar, with no statistically significant differences. The frequency of the clinical parameters was also similar in the two groups; however, there were fewer very high blood pressure episodes during hospitalization (2.1 ± 2.1 vs. 3.5 ± 4.7; p = 0.08), a greater percentage reduction in systolic pressure (14.0% ± 8.6% vs. 10.8% ± 8.8%; p=0.08) and less need for sodium nitroprusside (2.3% vs. 13.3%; RR: 0.17; 95%CI: 0.02–1.39; p=0.06) in the clonidine group compared to the captopril group. Repeated measures analysis of variance for the first four days of hospitalization showed no differences between the groups with respect to mean daily SBP (p = 0.20) or DBP levels (p = 0.67). Nevertheless, mean SBP was lower on the third day in the clonidine group (151.9 ± 11.8 mmHg vs. 158.1 ± 13.6 mmHg; p = 0.02). The same was not found for DBP, which remained similar in both groups. Although not statistically significant, adverse reactions were more common in the captopril group (28.8%) compared to the clonidine group (18.6%).Conclusion: Clonidine and captopril represent safe, effective treatments for severe postpartum hypertension. We consider that antihypertensive treatment with clonidine may constitute a safe, effective alternative for avoiding postpartum very high blood pressure episodes, with certain advantages such as a shorter hospital stay and lower treatment costs. In addiction, clonidine can be used in patients with acute renal injury that cannot receive captopril. To define whether this antihypertensive should be adopted in different services and regions, each hospital or physician should take into consideration the characteristics of the Abstract Book population, the frequency of very high blood pressure episodes in postpartum women and the confidence and ease of the medical team with the use of this drug. The protocol of this study was registered at (NCT01761916) Disclosure of Interest: None Declared P31 TEENAGE PREGNANCY – DOES MARITAL STATUS AFFECTS THE OUTCOME? S. S. M. Aris 1 2,*, S. khalid 1 2, M. A. Masri 1 2 1O&G, Universiti Sains Islam Malaysia (USIM), NILAI, 2O&G, Ampang hospital, Ampang, Malaysia Problem Statement: Teenage pregnancy is associated with poor obstetrics outcome. However, whether this is attributable to deleterious socioeconomic environments or biological immaturity remains controversial. This study aimed to specifically compare the outcome of teenage pregnancy in those who are married with those who are single. Methods: A retrospective study of all pregnant teenagers delivered in Hospital Ampang, Malaysia between January 2009 and June 2012 were reviewed. Data about marital status, antenatal booking, and mode of delivery, birthweight, Apgar score and neonatal intensive care unit (NICU) admission were collected and analysed. Results: There were a total of 752 teenage deliveries of whom 29.9% (173/579) were single. 34.1% (59/173) of the single mothers were unbooked compared with 2.6% (15/579) of the married mothers (P < 0.005). 18.5% (32/173) of single mothers had preterm deliveries compared with 11.6% (67/173) of married mothers (P < 0.05). The average birthweight among the single mothers was 2.7 kg (SD 0.513) compared with 2.86 kg (SD 0.514) among married mothers (P < 0.005). 19.1% (33/173) of the single mothers had low birthweight compared with 15% (87/579) of married mothers (P > 0.05). 2.9% (5/173) babies had a low Apgar score among the single mothers compared with 0.35% (2/579) of the married mothers (P < 0.005). NICU admissions were 17.9% (31/173) in babies delivered by single mothers compared with 15% (87/579) among married mothers (P > 0.05). Conclusion: In this study, being married had significantly changed the outcome among the teenage pregnancies. It was associated with a booked pregnancy, higher percentage of term deliveries and less likelihood of a low Apgar score. However, there were no significant differences as regards to NICU admission and preterm labour. This may suggest similar predisposing factors between the two groups such as immaturity. Being married is associated with a better pregnancy outcome among teenage mothers. Marriage can be seen as a means of providing some form of socioeconomic stability. Disclosure of Interest: None Declared P32 GESTATIONAL HYPERTENSION. MANAGEMENT AND TREATMENT IN AN UNIVERSITARY CLINIC FROM ROMANIA R. Botezatu 1,*, B. Raluca 1, T. Daia 1, G. Peltecu 1 Obstetrics and Gynecology, FIlantropia Clinical Hospital - Bucharest, Bucharest, Romania Problem Statement: Gestational hypertension is a major obstetrical complication with unknown etiology which is life threatening for both mother and fetus. Current trends are to resolve by Caesarian section the cases of gestational hypertension in the third trimester of pregnancy. Methods: Objective: Analysis of Filantropia Hospital experience regarding pregnancies complicated by gestational hypertension between 2013-2014. Retrospective observational study that followed the onset of hypertension, treatment and outcomes of therapy, associated complications, duration of hospitalization time until birth, way of delivery, birth and postpartum outcomes. The study included 104 pregnant women with gestational hypertension, preeclampsia and severe preeclampsia who gave birth in Filantropia Hospital. Results: The vast majority of cases had favorable outcome under treatment and the delivery occurred at more than 48 hours since admission. In 20 cases hypertension was diagnosed before 35 weeks' gestation of which 9 cases the birth was delayed 48 hours to perform corticosteroid therapy for fetal lung maturation. In one case of severe preeclampsia unresponsive to treatment ended with cesarean section at 27 weeks gestation. Conclusion: Gestational hypertension is a major obstetric complication requiring follow-up in a specialized medical center. The moment and way of delivery should be decided after balancing clinical and laboratory findings in selected cases and may be delayed in fetal benefit when blood pressure is controlled. This paper was co-financed from the European Social Fund, through the Sectorial Operational Programme Human Resources Development 2007-2013, project number POSDRU/159/1.5/S/138907 "Excellence in scientific interdisciplinary research, doctoral and postdoctoral, in the economic, social and medical fields -EXCELIS", coordinator The Bucharest University of Economic Studies Disclosure of Interest: None Declared P33 PREGNANCY WITH BEÇHET´S DISEASE - THE EXPERIENCE OF A PORTUGUESE UNIVERSITY HOSPITAL A. Braga 1,*, C. Vasconcelos 2, J. Braga 1 1Obstetrics and Gynecology, 2Unidade de Imunologia Clínica, Centro Hospitalar do Porto, Porto, Portugal Problem Statement: Behçet's disease (BD) is a rare multisystem chronic disease of unknown etiology characterized by oral and genital ulcers. BD has been described worldwide with a higher prevalence in Turkey, Japan, Middle East and Mediterranean "silk route" countries. In Portugal was reported an intermediate prevalence of 5 cases per 100,000. This disorder is typically diagnosed during the 2nd decade of life, so, its association with pregnancy is not unlikely. It has been described that BD adversely affects pregnancy so, our objective is to analyze the maternal and embryo-fetal outcome in a group of Portuguese pregnant women with BD.Methods: Retrospective study of all pregnant women with BD followed in a Portuguese University Hospital between 2002 and 2013.Results: 28 pregnancies in 16 patients were included in our study. 13.6% of these patients experienced clinical exacerbation during pregnancy and 22.7% at postpartum. The most frequent symptoms were oral ulcers and cutaneous lesions. One patient experienced a lower limb deep vein thrombosis that was treated with low molecular weight heparin (LMWH). Obstetric complications were found in 32.1% of pregnancies, where the most frequent was first trimester miscarriage (21.4%), followed by fetal growth restriction (13.6%) and preterm deliveries (9.1%). There were no statistically significant association between the development of obstetric complications and the presence of BD clinical worsening, presence of autoantibodies or use of immunosuppressive medication during pregnancy. The presence of antiphospholipid antibodies was detected in 16.7% of miscarriage cases. None of the cases had criteria for antiphospholipid syndrome. 32.1% of pregnant women were medicated with acetylsalicylic acid and 14.2% with LMWH. Use of these medications were no associated with a statistically significant reduction of obstetric complications. However, there were no cases of miscarriage or fetal growth restriction in pregnant women medicated with LMWH. Two newborns had congenital heart malformations (1 case of ventricular septal defect, 1 case of pulmonary valve stenosis) that were diagnosed during pregnancy and confirmed after delivery. There were no cases of hypertensive disorders of pregnancy, maternal or neonatal deaths. There were a cesarean rate of 50% in this group of patientsConclusion: There are 279 pregnancies in BD patients described in the literature. We found a high rate of miscarriage and a higher incidence of fetal growth restriction in the population studied. There were no association between the development of obstetric complications and the severity of the BD, development of BD clinical worsening or use of immunosuppressive medication. In our study the average gestational age at delivery was 37 weeks, with a low rate of preterm deliveries, and a high incidence of cesarean deliveries in the population studied. Disclosure of Interest: None Declared P34 THE ROLE OF POLYMORPHISM ОF PROKONVERITINE GENE WITH THE PATIENTS WITH RETROCHORIAL HEMATOMA I. Bushtyreva 1,*, N. Kuznetsova 1, E. Pelageina 1, V. Kovaleva 1 Rostov state medical university, Rostov-on-Don, Russian Federation 79 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Problem Statement: Chorion detachment is a common complication of gestational process and according to different authors meets with from 3 to 18% of all pregnancies. The purpose of this study is to evaluate the role of polymorphisms of genes of hemostasis in the genesis of the development of chorion detachment. Methods: The present study was conducted in Rostov Perinatal Center (Russia) in 2013-2014. The study included 43 pregnant women with chorion detachment in the first trimester, verified by ultrasound research, the control group comprised 43 pregnant with no signs of chorion detachment. The average age of patients in the group with chorion detachment was 30±0,8, in the control group – 29±of 0,9 years. The average duration of pregnancy, when retrohotel hematoma was revealed – 6,8±of 1.3 weeks. There was conducted genotyping of 7 polymorphisms of genes of hemostasis (F 2 (prothrombin KF II) G20210A, F5 (proaccelerin, labile factor KF V) G1691A (Laden mutation), F VII (proconvertin, KF VII) G10976A, 13 F (Fibrinosa, KF XIII) (G>T, FGB (beta-chain of fibrinogen) G455А, ITGA2 (alpha-2–integrin) C807T, ITGB3 (platelet glycoprotein IIIA) TS, PAI-1 (inhibitor of plasminogen activator 1) -675 5G/4G). Material for research – peripheral blood. There has been used a set of reagents “CardioGenetics Thrombophilia” DNA-Technology, Russia. Statistical processing of the results was performed in accordance with HardyWeinberg tests on compliance of balance and identifying associations by the method x2 with the help of DeFinetti program. For all statistical calculations pvalue <0.05 result was considered statistically significant. Results: From the presented set of polymorphisms of genes on the basis of statistical analysis there have been selected the options, the carriage of which with the patients with chorion detachment in the first trimester was higher in comparison with the patients in the control group. Frequencies of alleles and genotypes of polymorphic loci FVII gene in the first trimester and their association with the detachment of chorion is presented in Table 1. Table1: Frequencies of alleles and genotypes of polymorphic loci of polymorphism 353Gln (G10976A) FVII gene in the group of pregnant with detachment and in the control group and their association with chorion detachment. Group, n Frequency of genotype (n) Polymorphic locus G 10976 of the A gene F 7 GG GA AA The 0,74 0,23 0,02 control (32) (10) (1) group n=43 The 0,40 0,51 0,09 group (17) (22) (4) with detachm ent n=43 Accordance to HardyWeinberg law, Chi-square Revealed association OR, C.I., chi2, p p=0,836193 For allele A OR=3.131 chi2=10.29 p=0.00134 p=0,407961 Polymorphism of FVII gene leads to a decrease in the expression of the gene and the lowering of the level of coagulation factor VII according to the literature by 30%. In the case of gipoproteinemia the formation of thrombin which catalyzes the conversion of fibrinogen to fibrin slows down. This explains the development of hemorrhagic complications. According to the results of our research with carriers of allele 10976A FVII gene the risk of developing retromobile hematoma increased 3.1 times (OR=3.131, chi2=10.29, p=0.00134). Conclusion: Awareness of individual genetic defects in hemostasis allows forecasting the development of the retrochorial hematoma, identifies opportunities of pathogenetically substantiated therapy and prevention of late gestational complications in this group of patients. Disclosure of Interest: None Declared P35 LABOR INDUCTION AFTER A CESAREAN SECTION - A ONE-YEAR EXPERIENCE AT A TERTIARY CARE HOSPITAL IN PORTUGAL M. C. Cavazza 1,*, R. Teixeira Ribeiro 1, F. Santos 1, V. Veiga 1, G. Moura Ramos 1 Centro Hospitalar Leiria, Leiria, Portugal Problem Statement: Labor induction (LI) during a trial of labor after cesarian (TOLAC) is, according to the 2010 ACOG guidelines, of level B evidence. Studies 80 show that women with a previous cesarean section (CS) who undergo LI have a two to three-fold increased risk of CS and a higher chance of uterine rupture. The goals of this study were to caracterize the mode of delivery and analyze possible predictive factors for successful vaginal delivery (VD) after LI in women with a previous CS. Methods: Retrospective analysis of 149 deliveries that occurred during a TOLAC in a tertiary care unit during 2013. Multiple pregnancies were excluded. Statistical analysis was performed with the use of the SPSS software system. Results: Of the 149 deliveries, 37 (24.8%) occurred after LI. The indications for LI were: prolonged gestation (15), premature rupture of membranes (8), nonreassuring fetal statuses (NRFS) (6), gestational diabetes (5) and maternal pathology (3). Dinosprostone was the preferred method of LI (23; 62.2%). Only 2.7% of the women had a favorable Bishop index at admission compared to 41.1% in the spontaneous labor group. The success rate for VD was 37.8% compared to 49.1% in the spontaneous labor group. Half (7) of the VD after LI were vacuum-assisted. The most common indication for CS in TOLAC was failed IL which occurred in 24.3%. Other indications included: stationary labor (6), fetopelvic disproportion (4) and NRFS (4). The existence of a previous VD was the only predictive factor for a successful TOLAC (p=0,047). There weren't any cases of uterine rupture. There was no statistically significant difference in perinatal morbimortality. Conclusion: The decision to undergo TOLAC should be individualized and, if indicated, LI can be performed. In the studied sample, it was offered to 37 women prior to spontaneous labor with VD occurring in 37.8% of them. A previous VD was a predictive factor for a successful TOLAC. There were no statistically significant differences in maternal and perinatal morbimortality. Disclosure of Interest: None Declared P36 IN UTERO INFECTION BY SCHMALLENBERG VIRUS INDUCES ARTHROGRYPOSIS MULTIPLEXA CONGENITA IN OVINE FETUSES G. Boseret 1, F. Claine 2, D. Coupeau 2, B. Muylkens 2, C. Saegerman 1, F. Chantraine 3,*, N. Kirschvink 2 1Médecine vétérinaire, ULg, Liege, 2Médecine vétérinaire, UnNamur, Namur, 3Obstetrics & Gynecology, CHR Citadelle, CHU, ULg, Liege, Belgium Problem Statement: Some viral infections occurring during pregnancy are reported to induce arthrogryposis multiplex congenita (AMC). In ruminants, vector-borne Bunyaviruses, such as Akabane, LaCrosse, Cache Valley virus are known to induce AMC syndromes in lambs and calves whose dams underwent infection during early gestation. In 2011, Schmallenberg virus (SBV), a new vector-borne Bunyavirus emerged in Europe and heavily affected ruminant offspring born in late 2011 and 2012. Methods: SBV-affected lambs of the Ovine Research Centre of the University of Namur born in January 2012 underwent necropsy in order to compare lesions with those reported in human AMC. Virological analyses were performed in ewes and offspring order to confirm SBV infection. Results: Among 99 pregnant ewes, 23 gave birth to lambs presenting an AMC syndrome (n=28). In 11 cases, one healthy sibling was also born. All other lambs were clinically healthy. The most severely affect lambs were stillborn (n=4), 18 lambs died shortly after birth due to breathing incapacity and 6 lambs were euthanized. At necropsy, gender, body weight, macroscopic malformations (scoliosis, torticolis, arthrogryposis, macroscopic central nervous system (CNS) lesions and weight of gonads, lungs…) were recorded. RTq-PCR was performed on CNS tissue aiming at detecting SBV. 13 newborn lambs born in early 2012 and that died from other causes than SBV were used as necropsy controls. Necropsy results are shown in Table 1 and a representative case of an SBV-affected lamb is shown in Figure 1. Serum samples of all lambing ewes were analyzed by seroneutralisation test aiming at SBV antibody detection. Clinically healthy lambs as well as SBV-siblings and underwent precolostral blood sampling aiming at SBV antibody detection. 65% of SBV-affected lambs were positive at Rtq-PCR and all tested sampled showed SBV antibodies. 86% percent of their clinically healthy siblings as well as 44% of clinically healthy control lambs were positive at SNT. Abstract Book Table 1: Necropsy results Death due to SBV (n=28) Death due to other causes (n=13) M/F ratio 21:7 8:5 Arthrogryposis 96% 0% Scoliosis 75% 0% Torticolis 64% 0% Macroscopic CNS lesions 81% 0% Brachygnathia 64% 0% Cryptorchidism 86% 25% Testicles weight (g) 3.6±0.25 6.15±0.27* Lung weight (g) 55.4±8.5 117±13* *p<0.001 Figure 1: SBV affected lamb with severe front- and rear-limb arthrogryposis and torticolis. Sagittal section of the head shows hypoplasia of cerebrum, brainstem and cerebellum. Image / Graph: artery. Complete occlusion of the right ovarian artery being the only effective treatment, laparoscopic ovariectomy of the right ovary was performed for ovarian cryopreservation and in vitro maturation of the immature oocytes prior to a second embolization of the right ovarian artery. Six weeks after this second intervention computed tomography and Doppler US revealed complete resolution of the AVM. Currently the patient is trying to conceive. Results: UAVM is a rare condition consisting of a proliferation of high-flow heterogenous-sized vascular channels with an arteriovenous fistula formation and bypass the capillary system. Acquired UAVMs can be confined within the myometrium and/or the endometrium. A direct connection between the intramural branches of the uterine artery and myometrial veins is possible. UAVM during pregnancy is even more exceptional and related to recurrent pregnancy loss or abnormal bleeding. UAVMs can be detected with US and color Doppler US as masses with multiple hypo- or anechoic tubular like structures of varying sizes or as focal endometrial and myometrial thickenings. Diagnosis is made with MRI or conventional angiography. Treatment by embolization is the gold standard because it is minimal invasive, surgery is indicated when embolization is not feasible. Obstetrical outcome after embolization of UAVM is unclear. Some case-reports describe placental pathology. Conclusion: Review of the literature reveals that UAVM during pregnancy remains a rare entity yet in patients with a history of uterine surgery it should be suspected if abnormal vascular structures are detected on US. Since UAVM is related to recurrent pregnancy loss or abnormal bleeding during pregnancy and delivery we conclude that AVM should be treated prior to conception. Disclosure of Interest: None Declared Conclusion: These data show that fetal SBV infection is able to induce AMC in lambs. Surprisingly, siblings could remain clinically healthy, although fetal antibody production (assessed by procolostral blood sampling) demonstrated that they underwent in utero infection. Similarly, clinically normal singletons also demonstrated an active prenatal immune response. Disclosure of Interest: None Declared P37 UTERINE ARTERIOVENOUS MALFORMATION DURING PREGNANCY: CASEREPORT AND REVIEW OF THE LITERATURE N. Coryn 1,*, A. Vorsselmans 1, F. Van Tussenbroek 2, M. De Vos 3, M. Breugelmans 1, M. Laubach 1 1Obstetrics, 2Interventional Radiology, 3Center for Reproductive Medcine, UZ Brussel, Brussel, Belgium Problem Statement: A uterine arteriovenous malformation (UAVM) is a rare and potentially life threatening vascular disease. It can be congenital or acquired. Acquired lesions are mainly related to previous uterine surgery such as hysteroscopy frequently performed in patients during fertility treatment. High index of suspicion and timely diagnosis are necessary in order to assure uncomplicated outcome for the patient. The best treatment of this condition in pregnancy is yet to be established. Methods: We report a case of a 26-year-old gravida 3 para 0 with history of two uterine curettages and diagnostic hysteroscopy. An AVM on the anterior wall of the uterus was detected on 2-D ultrasonography (US) and power Doppler at 16 weeks gestation. There was no vascular communication with the placental side. After counseling the patient choose to continue the pregnancy with follow up by US and magnetic resonance imaging (MRI). However at 20 weeks gestation the patient had a second trimester pregnancy loss, clinically suggestive for cervical insufficiency. The patient had no abnormal bleedings. MRI post-expulsion confirmed the persistence of the UAVM measuring three centimeter on the anterior side of the uterus, the structure bulking the endometrium. On intraarterial angiography the AVM originated from three different arteries: the left uterine artery, the left superior vesical artery and the right ovarian artery. The AVM connects to the left ovarian vein. A therapeutic embolization was performed from the left uterine artery and the right ovarian artery. Computed tomography ten weeks after embolization revealed persistent arterial flow on the AVM with wash-out in the venous phase originating from the right ovarian P38 PERINATAL OUTCOMES IN WOMEN WITH ANTIPHOSPHOLIPID SYNDROME DURING PREGNANCY TREATED WITH ACENOCOUMARIN IN THE NATIONAL INSTITUTE OF PERINATOLOGY R. Pelaez 1, E. A. Cruz 2,*, E. Reyes 3, R. Zamora 4, S. Vargas 5 1Gynecology and Obstetrics, 2Human Reproduction Biology, 3Endocrinology, 4Medical Director, 5Hematology, National Institute of Perinatology, Mexico Problem Statement: The antiphospholipid syndrome (APS) during pregnancy is associated with increased risk of preeclampsia, preterm delivery, intrauterine growth restriction (IUGR), and venous thrombosis (VT). The recommended treatment is unfractionated heparin (UFH), and/or low molecular weight heparin (LMWH) plus low-dose aspirin. Few studies have evaluated the use of acenocoumarin in pregnant patients with APS. The objective of this study is to describe perinatal outcomes in pregnant women with APS using acenocoumarin plus aspirin. The cost of acenocumarin in Mexico is 15.15 USD while LMWH cost is 36.69 USD. Therefore we used this treatment in the National Institute of Perinatology. Methods: This is a retrospective cohort study. Patients with APS were recruited from 2001–2013 and were following during their pregnancy. These patients received acenocoumarin from the 12th until 37th week of pregnancy. Adverse perinatal outcomes (APO) were analyzed. Results: 48 women were included. Mean age was 29.54 ± 5.9 years, parity 3.1 ± 1.3, Body Mass Index (BMI) 27.4 ± 3.8 kg/m2, and weigh gain (WG) 11.4 ± 3.8. The mean weekly dose of acenocoumarin was 13.8 ± 5.1 mg, maintaining an International Nationalized Ratio (INR) 2.4 ± 0.5. The frequency of APO was: preterm delivery (29.1%), preeclampsia (25.0%), miscarriage (8.4%), IUGR (6.9%) thrombocytopenia (8.4%), VT (2.3%), gestational hypertension (2.3%), immature birth (2.3%) and stillbirth (2.3%). No major malformations were reported. Mean gestational age at resolution was 36.2 ± 3 weeks. Newborn average weight was 2,416 ± 762 g. Conclusion: The use of acenocoumarin plus aspirin from the 12th to 37th week of gestation could be an alternative treatment in patients with APS, with similar rate of APO as the use of UFH and / or LMWH plus aspirin. Disclosure of Interest: None Declared 81 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 P39 SOCIAL-CULTURAL PROFILE OF THE PREGNANT TEENAGERS FROM CHTVVISEU, PORTUGAL A. H. B. Fachada 1,*, Â. Melo 1, C. Ferreira 1, R. Veríssimo 1, S. Espírito Santo 1, M. Santos 1 Departamento Obstetrícia e Ginecologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal Problem Statement: Adolescence encompasses dynamic changes in all the spheres of the human development. The impact of an adolescence pregnancy comprehends the management not only of internal resources, but also of constraints imposed by the external environment, whereby the experiences of pregnancy demand from the teenager an adaptive capacity which could still be reduced. Therefore, it becomes relevant to enquire about the social, familiar and cultural characteristics of the teenagers. Objective: To evaluate the social-demographic (scholarity and age of the pregnant and her partner), behavioral (first sexual intercourse, number of partners), familiar (teen mother, acceptance of pregnancy) and cultural (ethnicity) aspects of the adolescents. Methods: A retrospective and analytical study of the adolescent pregnancies observed in the Adolescent Pregnancy outpatient Unit between 2003 and 2013, based on the outpatient questionnaire and in the computer records. Statistical study performed with IBM Statistical Package for the Social Sciences® (SPSS) version 21. Results: During the analyzed period 408 adolescents were followed, with ages between 12 and 19 years old. 3 were unlettered and 178 had schooling below the 9th grade. In our sample, 240 of the adolescents abandoned school, 55 of those during the pregnancy, and the main reason for abandonment was disinterest. As for family data, 139 of the adolescents had mothers who got pregnant in the adolescence, most of them had the pregnancy accepted by the family and the majority of them where supported by the own family. About the relationship which gave rise to the pregnancy, most refer a serious relationship, 8 refer casual relationship and 57 were married (36 before and 21 during pregnancy). Noteworthy of the married adolescents 20 of them were gipsy. Conclusion: The identification of the circumstances and difficulties that influence pregnancy in adolescence contribute to the better comprehension of the specificity associated to this problem, necessary to the right answer to the real needs of the future mothers. Disclosure of Interest: None Declared P40 PENTALOGY OF CANTRELL WITH ABNORMAL POSTERIOR FOSSA IN THE FIRST TRIMESTER ANOMALY SCAN C. Ferreira 1, H. Fachada 1,*, R. Nogueira 2 3, N. Pereira 1, P. Manso 1 1Obstetrics and Gynecology Department, Tondela-Viseu Hospital Centre, Viseu, 2Pathology Laboratory CGC Genetics, Centro Genetica Clinica, Porto, 3 PhD Associated Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal Problem Statement: In the first trimester anomaly scan many major abnormalities can already be diagnosed. Pentalogy of Cantrell is a rare form of thoraco-abdominal-wall defect, consisting of the association of five features: midline epigastric abdominal wall defect, lower sternal defect, anterior diaphragmatic defect, diaphragmatic pericardium defect and intracardiac defects. Pentalogy of Cantrell can also be associated with other abnormalities, including craniofacial abnormalities, spine and limb defects, malrotation of the colon and chromosomal abnormalities. Prognosis depends on the severity of cardiac lesions and associated anomalies. Methods: The authors report a case of Pentalogy of Cantrell associated with abnormal posterior fossa and spine defect diagnosed at the 12 weeks scan. Results: A 33 year-old pregnant woman gravida 1 para 0 was referred to our unit at 12 weeks of gestation for first trimester screening. A live fetus with supraumbilical exomphalos containg liver, stomach and bowel, a lower sternal defect, ectopia cordis, and diafragmatic hernia was diagnosed on the scan. A scoliosis with 90º rotation of the lumbar spine and abnormal posterior fossa were also seen. NT was increased (7.39 mm). Umbilical cord appeared normal 82 and there was no amniotic band. These findings led to the diagnosis of Pentalogy of Cantrell with abnormal posterior fossa and severe lumbar scoliosis. After counselling, the parents opted for termination of pregnancy. The pregnancy was terminated with misoprostol at 12 weeks. Pathological examination confirmed the diagnosis, revealing enlargement of posterior fossa with cystic cerebellum, lumbar scoliosis and cervical straightening in addition to Pentalogy of Cantrell. Left ventricular noncompactation and limb defects as clubfoot, clinodactyly of the right hand and arthrogryposis of the elbows were also diagnosed. Fetal karyotype was normal (46 XX). Conclusion: The improvement on ultrasound technologies and fetal maternal medicine subspecialization with expertise in obstetric ultrasound enable the evaluation of fetal anatomy systematically in the 11-13 weeks scan. Pentalogy of Cantrell is a rare but easily feasible diagnostic in the first trimester. There are reports of many other abnormalities associated to the condition, worsening the prognosis, yet posterior fossa abnormality has not been previously described to be associated to Cantrell’s complete form. Diagnosis of fetal abnormalities in the first trimester gives the option of an earlier and safer termination of pregnancy. Disclosure of Interest: None Declared P41 MANAGEMENT OF TWO PREGNANCIES WITH FETAL SACROCOCCYGEAL TUMOR IN DIFFERENT SETTINGS: A CASE SERIES A. F. C. N. Fathoni 1,*, K. H. Hadi 1 Obstetric and Ginecology, University of Indonesia, Jakarta, Indonesia Problem Statement: Obstructed labors due to fetal anomalies are rare. Fetal ascites, fetal tumors, hydrocephalus, and conjoined twins are described as the common causes.1 Antenatal ultrasonography can effectively screen these conditions, thus decreasing the incidence of labor complications arising due to such anomalies.1 SCT is the most common congenital neoplasm, usually presenting as a large midaxial exophytic mass in the sacrococcygeal region.2 The incidence of the disease is between 1:35,000 and 1:40,000 live births, and show a female preponderance at a ratio of four to one3, 4 They are believed to originate from pluripotent cells in Hensen’s nodule, which is located on the anterior surface of the sacrum or coccyx.5 It is a neoplasm composed of tissue derived from all three germinal layers and mostly arises from the fetal sacral area.1 Methods: We are reporting a case series of two dramatically different approaches to labor management of two pregnancies with fetal sacrococcygeal teratomas. First case of an arrested vaginal delivery baby whose birth was complicated by an under-diagnosed SCT, referred from rural area to a regional hospital with limited resources setting. The patient, a 28-years-old woman, was presented with the complication of an arrested vaginal delivery to the level of baby’s papilla mammae on her first pregnancy, and did not undergo routine antenatal care. Second case affects a-24-years-old woman, who was presented with premature rupture of membrane, with a better antenatal care gives better outcome. Results: Both tumors affect two baby girls that matched in the prevalence ratio Male: Female=1:4, both rose from the coccyx where the greatest concentrations of primitive cells exist for the longest period of time during development, midline structured, located in the posterior portion fetus, attached in the fetal rump that are most likely macroscopically sacrococcygeal teratoma, the second baby undergone biopsy and confirmed. Conclusion: The case histories described in this case will help clinicians, especially in the limited resource settings to approach in the better way, diagnose such case more appropriate, to enhance better treatment, patient care, and better outcome. This will be a challenge for general practitioners and obstetrician in developing countries, where pregnancies often remain under supervised. Disclosure of Interest: None Declared P42 EFFECTIVENESS OF LOADING DOSE OF ORAL VERSUS SUBLINGUAL NIFEDIPINE FOR TOCOLYSIS: A RANDOMIZED CONTROLLED TRIAL A. H. França-Neto 1,*, C. C. Leal-Junior 2, M. Amorim 3, A. S. Rolland de Souza 2 Abstract Book 1Obstetrics and Gynecology, FCM and IMIP, Campina Grande, 2Obstetrics and Gynecology, IMIP, Recife, 3Obstetrics and Gynecology, UFCG and IMIP, Campina Grande, Brazil Problem Statement: Nifedipine is currently considered to be the best tocolytic agent as demonstrated in the Cochrane Review, but the ideal dose and route of administration remains to be established. This study was conducted to determine the effectiveness of oral versus sublingual loading dose of nifedipine for tocolysis in women with preterm labor. Methods: An open randomized controlled trial was carried out at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) and Instituto de Saúde Elpídio de Almeida (ISEA), between March 2013 and May 2014. Patients in preterm labor were randomized to receive sublingual or oral loading dose of nifedipine for tocolysis. The study was approved by the institute’s internal review board. All patients agreed to participate and signed a consent form. Results: A total of 80 patients were included, 40 randomized to receive 20mg of sublingual and 40 to receive 20mg of oral nifedipine. This initial dose could be repeated each 30 minutes until tocolysis, with a maximum dose of 60mg. The time required for tocolysis was significantly lower with the use of sublingual nifedipine (160 mm x 340 min, p = 0.0003). There was an inhibition of preterm labor by up to 90 minutes more frequent with sublingual nifedipine (20,5%) compared with oral nifedipine (2,5%). However, no significant difference between groups in the first 12 to 48 hours was found. In the same way, the rate of preterm delivery within 48 hours was similar between groups (only one case in the sublingual group). Image / Graph: auscultation, the use of a partograph, emotional and physical support, freedom in position and movement, respect for the women’s choice of companions, the inclusion of the women in decision making during labour and the use of nonpharmacological methods for pain relief. The acupuncture/acupressure is one of the nonpharmacological methods during labour for support process. Methods: The purpose of this study is to identify the effect of ice pressure applied on Large Intestinal 4 (LI4) acupressure energy meridian area on women’s perceptions of labor pain as well as on the labor process. The study, designed as pre-test post-test controlled, was conducted in the delivery room of Adana Maternity and Children Hospital. Target population of the study is all pregnant women at first stage labor who consulted to the hospital between 1st of November 2012 and 1st of February 2013. The participants, who met the research criteria according to the results of power analysis, were 72 healthy pregnant women divided into one experiment (n=36) and one control group (n=36). The data were collected using “Pregnant Women Identification Form”, “Inspection Form about Labor”, “Visual Analogue Scale (VAS)” and “Partograph”. In the active phase of labor, the women in the experimental group were provided with ice massage on the LI4 area on both hands throughout contractions until the 80th minute. However, the women in the control group were not provided with any interference except for the routine clinical practices. At the beginning of the study, both experimental and control groups were administered the forms; and the labor duration and progression were identified using “Inspection Form about Labor” and “Partograph”. VAS was administered to both groups before the ice practice, and in the 40th and 80th minutes after practice. Results: Results show that ice pressure applied on the LI4 point on pregnant women’s hands was not effective in reducing pain in the 40th minute, but it was found to be effective in the 80th minute (p=0.001). Moreover, in terms of the effect of ice pressure on labor duration, the practice was found to reduce the labor duration of the women in the experimental group approximately one hour on the average (p<0.05). Conclusion: It was found that the ice pressure applied on the LI4 area by midwives/nurses in the active phase of delivery could reduce pain and shorten the delivery duration. Disclosure of Interest: None Declared Conclusion: A loading dose of sublingual nifedipine was more effective than the oral route to achieve faster tocolysis in patients with preterm labor. Although no differences in rate of preterm delivery with 48 horas were found, the faster effect can be desirable for women in preterm labor. Register of protocol: Registro Brasileiro de Ensaios Clínicos (ReBEC):U111111566186 Disclosure of Interest: None Declared P43 IDENTIFICATION OF THE EFFECT OF ICE PRESSURE APPLIED ON LARGE INTESTINAL 4 IN HANDS DURING THE FIRST STAGE OF LABOR ON THE LABOR PAIN AND LABOR PROCESS E. Yildirim 1, S. Alan 2, S. Gokyildiz 2,* 1Nigde University Zubeyde Hanim School of Health, Nigde, 2Cukurova University Adana Health High School, Adana, Turkey Problem Statement: The aim of intrapartal care in normal birth is to achieve a healthy mother and child using the least possible number of interventions that is compatible with safety. Instead of medical interventions, the WHO suggests careful monitoring of labour progress and foetal well-being with intermittent P44 CHANGES IN VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) AND SOLUBLE FMS-LIKE TYROSINE KINASE-1 (SFLT-1, VEGFR-1) CORD SERUM CONCENTRATIONS IN GESTATIONAL DIABETES MELLITUS (GDM) O. Hadarits 1,*, Z. Al-Aissa 2, A. Zoka 2, D. Bancher-Todesca 3, J. Rigo 1, G. Firneisz 2, A. Somogyi 4, K. Rosta 5 1 1st Dept of Ob/Gyn 22nd Dept of Internal Medicine, Semmelweis University, Budapest, Dept of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Austria, 42nd Dept of Internal Medicine, 5Dept of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Austria Problem Statement: Gestational diabetes mellitus is characterized by altered fetoplacental angiogenesis and endothelial dysfunction. Angiogenic markers including vascular endothelial growth factor (VEGF), and fms-like tyrosine kinase 1 (Flt-1) play important roles in the development of endothelial dysfunction. The aim of our study was to measure the concentrations of the pro-angiogenic factor VEGF and its soluble receptor sFlt-1 in cord blood serum samples of neonates born to gestational diabetic mothers and non-diabetic controls. Methods: One-hundred and sixty-three pregnant women (76 control, 87 GDM cases) were enrolled into the study in Hungary and Austria after signing informed consent. A standardized oral glucose tolerance test (OGTT) was performed at the 24-28th gestational week. Cord blood samples were obtained at delivery and cord serum VEGF concentrations and sFlt-1 level were determined using a Quantikine solid phase Elisa Kit (R&D Systems). Results: Cord serum VEGF concentrations did not differ between GDM and control groups. Cord serum sFlt-1 levels were lower in GDM than in controls (p=0.00017). Cord serum sFlt-1 concentration negatively correlated with maternal 2-hour serum glucose OGTT (p=0.0003, r2=0.18), and with maternal preconceptional BMI (p=0.025, r2=0.07) respectively. Neither VEGF nor sFlt-1 83 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 levels correlated with fasting glucose values, HbA1c, birth weight, and birth weight for gestational age. Conclusion: Decreased sFlt-1 levels might contribute to the altered fetoplacental angiogenesis in GDM. The association of sFlt-1 with 2-hour OGTT value demonstrates that early changes in glucose metabolism may have long-term effects on fetoplacental homeostasis. The association of cord serum sFlt-1 levels with maternal BMI may show that obesity alters fetal metabolism and angiogenesis. Disclosure of Interest: None Declared P45 STILLBIRTHS - CAN WE PREVENT THEM? (A 3-YEAR SERIES) E. Y. Huang 1,*, K. H. Tan 1 2 1Division of Obstetrics & Gynaecology, KK Women's & Children's Hospital, 2OBGYN Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore Problem Statement: With advances in perinatal care, the number of stillbirths in the developed world has reduced significantly. However, there are cases which may be potentially preventable. A critical analysis and audit of stillbirth cases can highlight problems which can be corrected in the hope of further reducing perinatal mortality. We aim to review all cases of stillbirths over a 3-year period, based on epidemiological factors, possible causes and suboptimal factors. Methods: Stillbirth is defined in our unit as a baby born without life at or after 28 weeks and weighing at least 500 grams. We collated a 3-year series of stillbirths from 2006 to 2008, and the data were analysed and peer-reviewed by two assessors. Consensus was reached regarding the cause and any suboptimal factors leading to the stillbirth, and whether the case was preventable. We used our unit’s stillbirth classification system, known as ‘KK Hospital Stillbirth Classification’ as it is more robust compared to other standard classification systems and it is more tailored towards an obstetrician’s perspective. Results: The total number of stillbirths was 124 and total number of births was 36466, giving a stillbirth rate of 3.4 per 1000 births. 25.8% of the cases were unexplained stillbirths, and majority (16/32) had no known risk factors. 8 cases of unexplained stillbirths had cord abnormalities from placental and/or postmortem examination but not found as a cause of death. There were 1 case each of hypertensive disease and diabetes, and 2 cases of multiple pregnancy, but no suboptimal factors were detected. 4 cases of unexplained stillbirths were cases of placental disease and included a case of incidental vasa praevia on placenta histology in which there were no clinical evidence of bleeding complications. Lethal malformations leading to stillbirths were due to multiple fetal abnormalities (6/15), cardiac abnormalities (4/15), chromosomal abnormalities (3/15) and central nervous system abnormalities (2/15). 52.4% (65/124) of cases had suboptimal factors in their care. We identified the group primarily responsible for each case of stillbirth with suboptimal care. Patients were responsible in 57 of the cases (87.7%), and physicians were responsible for 12.3% of the cases. Our analysis showed that 41.9% of stillbirth cases can be prevented. Preventable causes include uncontrolled diabetes (6 cases (11.5%) where all were grade 3, patient factor) and severe hypertensive disease (9 cases (13.8%) of which 5 were grade 3, patient factor and 4 were grade 2, patient factor). We also identified 1 case (1.5%) of an anencephalic fetus (grade 3, physician factor), in which perinatal outcome could be improved if periconceptional folic acid was prescribed. There were also 2 cases (3.1%) of poor management of fetuses with intrauterine growth restriction (grade 2, physician factor). Conclusion: A significant number of stillbirths can be prevented from this analysis, in which patient factor is a major contributor. Patient education on control of medical conditions and adherence to antenatal management and follow-ups are therefore essential. Continual medical education for trainees and physicians is vital to keep up-to-date with current knowledge and evidence of antenatal management to reduce and prevent stillbirths. Disclosure of Interest: None Declared P46 UNDIAGNOSED PHEOCHROMOCYTOMA MASQUERADING AS PREECLAMPSIA K. Hyeon Ji 1,*, B. Ju Won 1 84 1Obstetrics Korea and gynecology, Chung-ang university hospital, Seoul, Republic of Problem Statement: Pheochromocytoma in a pregnancy is rare condition with a reported incidence of less than 0.2 per 10000 pregnancies. Diagnosis is often delayed because pheochromocytoma produced signs and symptoms that mimic preeclampsia or gestational hypertension. However maternal and fetal mortality is around 50% if unrecognized antenatally. So we report a case of undiagnosed pheochromocytoma masquerading as preeclampsia. Methods: A 32-year-old woman, para 2 presented for severe headache, palpitation and sweating at 37weeks gestation. At that time, the fetus had intrauterine hypoxia and regular uterine contraction. Systolic blood pressure (SBP) was 220mmHg even though we used labetalol. Cesarean section was performed under general anesthesia immediately, baby was delivered with 8 and 9 of Apgar score. In recovery she was hypertensive (170mmHg systolic) and had tachycardia at 160 beats/min with glyceryl trinitrate and magnesium infusions. Even though patient did not have any symptoms or signs, she had still tachycardia at 120 beats/min. Results: We suspected that she might have thromboembolic lesion on chest or pheochromocytoma. On chest and abdominal CT, patient had about 4cm sized mass in left para-aortic space. Serum and urinary catecholamine levels were obtained and increased significantly. Although she had tachycardia (120 beats/min), echocardiography revealed mild diastolic dysfunction. Therefore she discharged with alpha blockade. She underwent laparoscopic mass removal seven months later and pathology was confirmed as pheochromocytoma. Conclusion: Typical paroxysmal hypertension with triad of headache, palpitation and sweating during pregnancy, pheochromocytoma should be considered. Early diagnosis and treatment based on the period of pregnancy can reduce the maternal and fetal mortality rate. Disclosure of Interest: None Declared P47 PERINATAL MORBIDITY ASSOCIATED WITH MATERNAL PREGNANCY INDUCED HYPERTENSION – IN SGA AND GROWTH RESTRICTED FAETUSES C. A. Ionescu 1,*, G. Sardescu 1, I. Pacu 1, D. Gheorghiu 1, H. Haradja 1, M. Banacu 1 1Obstetrics Gynecology, UMF Carol Davila, Clinical Emergency Hospital Sf Pantelimon, Bucharest, Bucharest, Romania Problem Statement: Gestational hypertension is a severe pathology leading to important maternal and neonatal effects. It represents one of the most important causes of maternal morbidity and contributes to a high percentage of perinatal mortality, determined by fetal hypoxia and especially by prematurity and low birth weight. The objectives of the study was to compare perinatal outcomes between SGA newborns and those with intrauterine growth restriction from mothers with pregnancy induced hypertension Methods: We included all foetuses with fetal weight below 10th percentile from hypertensive mothers from January 2009 to December 2013 (62 foetuses). 48 of these 62 gestations were complicated with intrauterine growth restricted (IUGR, EFW <3rd percentile or <10th percentilewith Doppler alterations) and 14 with small for gestational age (SGA, EFW <10th percentile but >3rd percentile without Doppler alterations). We followed up the immediate postnatal complications.Exclusion criteria were: twins, intrauterine infections, chronic hypertension and major malformations Results: We observed significant differences (p: 0.04) in prenatal nonreassuring fetal heart rate status (electrocardiotocography) (32% IUGR vs. 2% SGA) and in Caesarean section rate (pȘ0.046) (93% IUGR vs. 68% SGA). We didn’t find significant differences referring to gestational age at diagnostic (33 weeks for IUGR and SGA), to gestational age at birth (35 weeks for IUGR and SGA), birth weight, umbilical artery pH. We found differences between Apgar scores form the SGA with IUGR newborns and SGA without IUGR. Neonatal complications were observed in some newborn admitted to neonatal intensive care unit: 9 respiratory distress syndromes (7 IUGR vs. 2 SGA), 5 pathological cerebral scans (4 IUGR vs. 1 SGA), mechanical ventilation (2 IUGR vs. 1 SGA), 5 inotropic drugs (2 IUGR vs. 1 SGA), 1 sepsis (1 IUGR vs. 0 SGA), and 1 cerebral hemorrhage (IUGR). No neonatal deaths were recorded. Abstract Book Conclusion: Growth restricted foetuses have more probability of admission to neonatal unit, as well as obstetrical (Caesarean section) and neonatal complications. Disclosure of Interest: None Declared P48 THE EFFECT OF PRE PREGNANCY BODY MASS INDEX (BMI) AND INTRAPREGNANCY WEIGHT GAIN ON THE PREGNANCY OUTCOME AMONG PRIMIGRAVIDA. A CROSSECTIONAL STUDY AT HOSPITAL TENGKU AMPUAN AFZAN KUANTAN H. Ismail 1,*, S. A. Mohamed @ Mohd Adnan 2, Z. Nusee 1 Obstetric and Gynaecology, International Islamic University Malaysia, 2Obstetric and Gynaecology, Ministry of Health Malaysia, Kuantan, Malaysia Problem Statement: In 2006, 29.1% of Malaysian adult population was overweight and the prevalence of obesity was 14.0%. Total population of overweight and obese was 43.1%. Obesity in young women is a major public health concern as it leads to major impact on pregnancy outcome. The aim of the study was to measure the maternal and neonatal outcome among primigravida as per body mass index (BMI). This study also aimed to determine the optimum intra pregnancy weight gain which is associated with good outcome. Methods: This was a crossectional study on primigravida who delivered between December 2011-June 2013. The study population include primigravida who booked <14 weeks gestation. Mother with multiple="multiple" pregnancy, underlying medical problem such as hypertension or diabetes mellitus before pregnancy and no BMI data available at booking were excluded. The women were categorized into five groups according to their BMI (WHO classification): underweight (BMI≤ 19.9kg/m2), normal (BMI of 20-24.9kg/m2), overweight (BMI of 25-29.9kg/m2), obese (BMI of 30-34.9kg/m2) and morbidly obese (BMI >35kg/m2). Normal BMI group was used as reference or comparison group for the analysis. Data were analyzed using statistical package SPSS version 18.Chisquare (λ2), independent t-test, one-way ANOVA and simple logistic regression were performed and p-value of <0.05 considered as statistically significant. Results: Total of 500 women were enrolled: 130 (26%) underweight, 184 (36.8%) normal, 100 (20%) overweight, 53 (10.6%) obese and 33 (6.6%) morbidly obese. Overweigth, obese and morbidly obese group had increased risk of gestational diabetes mellitus with the odd ratio of {OR2.199 (1.111, 4.352)}, {OR3.755 (95%CI 1.766, 7.986)} and {OR3.776 (95%CI 1.564, 9.114)} respectively. The risk of gestational hypertension were {OR 1.965 (95%CI 1.007, 3.836)} for overweight, {OR 2.272 (95%CI 1.034, 4.994)} for obese and {OR 5.719 (95% CI 2.503, 13.070)} for morbidly obese women. Underweight group had a protective effect against gestational hypertension {OR 0.308(95%CI 0.113, 0.839)}. Preterm delivery was highest in the underweight women {OR2.038 (95%CI 1.158, 3.586)}. Induction of labour were high for the overweight, obese and morbidly obese women with odd ratio of {OR 1.945(95%CI 1.128, 3.354)}, {OR 2.440 (95%CI 1.268, 4.693)} and {OR 2.417(95%CI 1.105, 5.286)} respectively. Morbidly obese women had increase risk of caesarean section {OR 2.339(95%CI 1.086, 4.993)}. Underweight women had significantly lower risk of caesarean delivery {OR 0.616(95%CI 0.379, 1.001)}. Women who are overweight, obese and morbidly obese also had higher incidence of augmentation of labour and wound infection. For neonatal complication, underweight women faced higher risk of low birth weight baby {OR 1.801(95%CI 1.055, 3.076)}. Women who were overweight and obese had significantly low risk for low birth weight {OR 0.458(95%CI 0.081, 0.934)} and {OR 0.275(95%CI 0.081, 0.934)} respectively. As for macrosomia, morbidly obese women had higher incidence compared to normal BMI women. Conclusion: High pre pregnancy BMI is associated with increased maternal risk of gestational diabetes mellitus, gestational hypertension, induction and augmentation of labour, caesarean delivery and macrosomic babies. However the underweight women are associated with poor perinatal outcome namely preterm labour and low birth weight baby. Disclosure of Interest: None Declared P49 SECOND PREGNANCY IN PATIENT WITH PPCM IN FIRST PREGNANCY - CASE REPORT L. Jevdjic 1 1,* Institute for Gyn/Obs, Clinical Centar of Serbia, Belgrade, Serbia Peripartum cardiomyopathy (PPCM) is a rare but devastating form of heart failure. Maternal mortality is high (30-60%). PPCM represent a unique syndrome or a pregnancy related exacerbation of some other form of cardiomyopathy. There are small numbers of patients who developed recurrent disease in a subsequent pregnancy. Female 40 year old with PPCM diagnosed three months after first delivery in September 2005. EF was 25% end LVEDD 7,2. During 2006 and 2007 she was often in hospital becouse of heart decompensation. She first came to our clinic in November 2011 in fifth month of second pregnancy. Patient was without dyspnea, cough, legs oedema and other signs of PPCM. On Echo we found EF 30% and LVEDD 6, 4. Seven months before, she stop to take therapy. Since there were no changes in results it was decided to continue the pregnancy with regular monitoring of Echo and ECG in 15 days. In December we find changes in ECG- VES. In therapy we included LMWH and Ca-antagonist.In January 2012 it came to a deterioration of the general condition EF 26% LVEDD 6.9. Pregnancy ended at 34 weeks gestation with cesarean delivery. Postoperative course was duly passed with out changes in the Echo end ECG findings. EF was 25 % and LVEDD 7.2.With oral anticoagulant therapy was discharged from hospital. By observing this patient we came to the conclusion that second pregnancy, in this case, does not deteriorate heart function. Methods: Female 40 year old with PPCM diagnosed three months after first delivery in September 2005. EF was 25% end LVEDD 7,2. During 2006 and 2007 she was often in hospital becouse of heart decompensation.She first came to our clinic in November 2011 in fifth month of second pregnancy. Patient was without dyspnea, cough, legs oedema and other signs of PPCM. On Echo we found EF 30% and LVEDD 6,4. Seven month before, she stop to take therapy. Since there were no changes in results it was decided to continue the pregnancy with regular monitoring of Echo and ECG on 15 days. In December we find changes in ECG- VES.In therapy we included LMWH and Ca-antagonist. In January 2012 is coming to a deterioration of the general condition EF 26% LVEDD 6.9. Pregnancy ended at 34 weeks gestation with cesarean delivery. Postoperative course was duly passed with out changes in the Echo end ECG findings. EF was 25 % and LVEDD 7.2.With oral anticoagulant therapy was discharged from hospital. Results: By observing this patient we came to conclusion that second pregnancy, in this case, does not deteriorate heart function. Disclosure of Interest: None Declared P50 MANAGEMENT OF TWIN REVERSED ARTERIAL PERFUSION (TRAP) SEQUENCE BY ULTRASOUND GUIDED RADIOFREQUENCY ABLATION FOCUSING A FEEDING ARTERY ON THE PLACENTAL SURFACE. B. Ju Won 1,*, K. Hyeon Ji 1 Obstetrics and gynecology, Chung-ang university hospital, Seoul, Korea Problem Statement: Radiofrequency ablation (RFA) has become widely accepted as first line management for twin reversed arterial perfusion (TRAP) sequence. Most RFA procedures have been performed using RFA needles of 14-17 gauge(G) focusing on an acardiac mass at an average age of 21 weeks of gestation(17-24 weeks), In this case report, we describe treatment of TRAP sequence using RFA with a 20G needle focusing artery on the placental surface at gestational age 11-18 weeks. Methods: The vascular connection site of the arterio-arterial anastomosis, which showed arterial blood flow from the normal fetus to the acardiac member, was detected on the placental surface using the color power Doppler setting. A 20G 150mm RFA needle (Cosman Medial, Burlingame, CA, USA) was introduced to reach the anastomosis site through the placenta under the color power Doppler setting. No anesthetic was employed. RFA was performed at the vascular connection site on the placental surface under color flow mapping guidance. RFA was performed in a cyclic manner, with 2min of ablation and 1min of rest. The duration of RFA was 5min (two sets). Radiofrequency was generated 85 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 with an RFA-1A Generator (Cosman Medical) with the temperature set 90℃. Immediate cessation of blood flow in the target vessel after RFA procedure was detected. A normal fetal heart rate and normal movements were present in the normal fetus following RFA. Results: Cases Before RFA At time RFA After RFA Delivery 7.3㎠(11 weeks) 13㎠ (38weeks) 40+2weeks, Vaginal delivery, female 2.56Kg, Apgar score(A/S); 810 B 34㎠ (18weeks ) 6.4㎠(12 weeks) 12㎠(22 weeks) 38+5weeks, Vaginal delivery, male 2.8Kg, A/S: 9-10 C 23㎠ (15+1 weeks) 0.5㎠ (9weeks) 4,2㎠(11 +6weeks) 4㎠ (16weeks) 35+6weeks, Cesarian female 1.8Kg, A/S: 2-5 A section, Conclusion: Intrafetal RFA has been reported to be an uncomplicated and effective treatment when compared with other methods. RFA has been associated with lower rates of premature delivery and rupture of membranes before 32weeks of gestation, and higher rate of clinical success than with cord occulusion techniques. Intrafetal RFA for an acardiac twin was performed using 14G RFA needles at an average age of 21weeks of gestation. In the present cases, we used a 20G RFA needle. We successfully treated the acardiac twin using RFA on the communicating vessel at the gestational age of 11+6 – 18+0weeks. Early RFA might have some advantages over the conventional RFA. First, early RFA uses a small caliber needle, which makes the procedure safer and less painful. Second, it can be done through the placenta without breakin fetal membranes. In conclusion, if vascular anastomosis is seen on the placental surface on ultrasound/Doppler examination, early vascular RFA can be an easy and safe option compared with intrafetal RFA. P52 IS CARDIOMEGALY MEANT HEART FAILURE AT TERM PREGNANCY: A MEDIASTINAL TUMOR K. Kim 1,*, Y. Lee 2, H. Kang 3 1 Obstetrics gynecology, Seonam University, 2Obstetrics gynecology, presbyterian medical center, Jeonjusi, 3Nursing, kongju natioal university, Kongju, Korea Problem Statement: Is Cardiomegaly meant a heart failure at term pregnancy? A 28 years-old Korean woman visited out- patient dispensary with dyspnea with exertion. She was 38 weeks gestation with poor prenatal care. She had para 1 with previous cesarean section. Fetal ultrasonogram biometry revealed 2.8 Kg baby with regular heart beat. For the preoperative evaluation, vital sign was stable, chest X- revealed cardiomegaly. Hemoglobin was 11.6 mg/ml. We performed echocardiography to evaluate cardiac function. The results revealed large round homogenous mediastinal tumor displaced the heart. Methods: Tumor marker studies were AFP 74.8 mg/ml, Beta-hCg 18.8mu/ml. repeated cesarean section was done under spinal anesthesia. A healthy 2.8kg male was delivered. After 6wrrks later of postpartum periods. Chest CT revealed Lt Thorax was occupied by 2/3 involving large tumor with normal heart, Figure showed the tumor and normal heart. The tumor excision was done under the general anesthesia by chest surgern Results: Histologic result was benign thymoma. Thymoma is found in 15% of patients with myasthenia gravis. She had no symptom of myasthenis gravis. She recovered well Image / Graph: Disclosure of Interest: None Declared P51 DOUBLE MARKER TEST AND UTERINE ARTERY DOPPLER IN CASES WITH HYPEREMESIS GRAVIDARUM A. Kholeif Obstetrics & Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt Problem Statement: The objective of this work was to evaluate any correlation between the double marker test (serum B-HCG and PAPP-a) and uterine artery Doppler indices in cases with hyperemesis gravidarum at 11-13 weeks gestation. Methods: The study was conducted on 60 cases, admitted to El-Shatby Maternity University Hospital, Alexandria. They were divided equally into 2 groups; study and control groups. The study group cases were 11-13 weeks of gestation, singleton pregnancy and with full picture of hyperemesis gravidarum. The control group cases were with uncomplicated pregnancy and of the same duration of pregnancy. Both groups were subjected to the assay of the double marker test and the evaluation of uterine artery Doppler. The double marker test was done using the Chemi-illuminescence (Siemens-Germany), PRISCA 4.0 for prenatal risk assessement. The uterine artery Doppler was done using the machine Medison SonoAceX8. Results: Analysis of the results revealed that serum level B-HCG and PAPP-a showed no significant difference in cases with hyperemesis in comparison to cases with normal pregnancy of the same duration. Also, Doppler indices showed no significant difference as well between both groups. Conclusion: Double marker test is not recommended for routine clinical practice in cases with hyperemesis gravidarum. Doppler indices results signify that hyperemesis gravidarum is not a risk factor for the development of pre-eclampsia or IUGR later in pregnancy. Disclosure of Interest: None Declared 86 Conclusion: Cardiomegaly may be have various causes. Chest X-ray and cardiac echocardiogram may be helpful to evaluate and verify cardiac function and differentiate other causes. We can role out cardiomyopathy, and structural abnormality with Chst computerized tomogram (CT) also. Our case was a mediastinal thyoma. Disclosure of Interest: None Declared P53 TRENDS IN PERINATAL MORTALITY AND ITS RISK FACTORS IN JAPAN M. Kita 1,*, S. Gilmour 1, E. Ota 2 1Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 2Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan Problem Statement: Perinatal mortality is an important indicator of quality in obstetric care during pregnancy. There have been rapid past declines in perinatal mortality rate (PMR). Assessing whether these declines can be sustained as total mortality falls, and how to identify risk groups is important in order to sustain PMR reductions in the future. Methods: Data on deaths, live births and stillbirths were obtained separately from the Ministry of Health, Labour and Welfare, and merged to obtain a complete record of all birth outcomes in Japan between 1979 and 2010 in all 47 prefectures. The data included information on perinatal death, birth weight, maternal age, gestational age, parity, nationality, and household occupation. Multiple births were excluded because twins have very different PMR and risk factors. Deaths were merged to births using a deterministic matching process; Abstract Book for those that did not match, probabilistic matching was applied based on the highest predicted probability of mortality in a multilevel Poisson regression model. An autoregressive moving average (ARIMA) model was fitted to the differenced natural log of PMR separately by sex, after assessing its serial dependence structure. A multilevel Poisson regression was conducted with a prefecture-level random effect, to estimate the perinatal mortality risk ratio for possible risk factors such as household occupation, birth weight, gestational age, maternal age, and year. Results: From January 1979 to December 2010, there were 41,073,669 pregnancies and 594,391 perinatal deaths. The PMR ranged from 21.8 per 1000 in 1975 to 3.9 per 1000 in 2010. A decreasing trend in the PMR was clearly seen for both sexes. There was a significant continuous monthly reduction of PMR by 0.5 (0.4 -0.7) percent for males and 0.5 (0.3-0.7) percent for females among all years. Compared to the reference group, perinatal mortality was 2.5 times higher and on average 4.8 times higher for high birth weight (>4000g) and low birth weight (<2500g) neonates, respectively. The risk was 2.7 times higher for premature delivery, and 4.3 times higher for postmature delivery, more than 5.0 times lower for nulliparous mothers, 15.9 times higher for mothers who experienced past neonatal mortality, and 1.6 times higher for mothers from poorer or unemployed families. Conclusion: A significant linear reduction in the logged PMR indicates that future reductions in PMR can be expected, although future reductions in absolute mortality numbers will become smaller. As the cost and challenge of maintaining these gains increases, policies need to be targeted towards higher risk groups. Health expenditure targeted to key indicators, and optimization of gestational age and birth weight are necessary to further decrease the PMR in Japan in a cost-effective way. Disclosure of Interest: None Declared P54 PREOS (PREECLAMPSIA OPEN STUDY), A MULTICENTER, PROSPECTIVE, NONINTERVENTIONAL STUDY EVALUATING THE INFLUENCE OF THE SFLT-1/PLGF RATIO ON PHYSICIAN DECISION-MAKING IN PREGNANT WOMEN WITH SUSPICION OF PREECLAMPSIA E. Klein 1,*, D. Schlembach 2, A. Ramoni 3, E. Langer 4, F. Bahlmann 5, R. van der Does 6, D. Messinger 6, W. D. Verhagen-Kamerbeek 7, M. Reim 8, M. Hund 9, H. Stepan 10 1Women’s Clinic and Polyclinic, Munich Technical University Hospital, Munich, 2Vivantes Clinics Neukölln, Clinic of Obstetrics, Berlin,Germany 3University Hospital of Innsbruck, Austria, 4Dept of Obstetrics, Leipzig University, Leipzig, 5Bürgerhospital, Frankfurt, 6IST GmbH, Mannheim, 7Roche Diagnostics International Ltd, Rotkreuz, 8Roche Diagnostics GmbH , Penzberg, Germany, 9Roche Diagnostics International Ltd, Rotkreuz, Switzerland, 10Dept of Obstetrics, Leipzig University, Leipzig, Germany Problem Statement: Preeclampsia is a major cause of maternal, fetal and neonatal morbidity and mortality. Levels of serum sFlt-1 (soluble fms-like tyrosine kinase-1) are increased and serum PlGF (placental growth factor) decreased in pregnant women developing or having diagnosed preeclampsia/eclampsia/HELLP syndrome. The sFlt-1/PlGF ratio is a valuable tool in preeclampsia diagnosis. However, the clinical utility of the sFlt-1/PlGF ratio in guiding physicians’ surveillance and treatment decisions for patients with suspicion of preeclampsia has not yet been evaluated in routine clinical practice. PreOS assessed the influence of the sFlt-1/PlGF test result on physicians’ clinical decision-making for hospitalization, treatment and monitoring of patients with suspicion of preeclampsia. Methods: PreOS (multicenter, prospective, non-interventional) included pregnant women (≥24+0 weeks) with suspicion of preeclampsia for whom the physician considered that the sFlt-1/PlGF ratio should be determined. The Roche Elecsys® sFlt-1 and PlGF assays were used. Before the test result was known, physicians documented intended clinical procedures using an iPad® application. Decisions were data locked, time stamped and transferred to an online data center. After the sFlt-1/PlGF result was available, the decisions for clinical procedures were confirmed or revised on the iPad®. Investigators were free to manage patients according to their own decisions. Primary objective: to assess the influence of the sFlt-1/PlGF result on the decision-making of the physician to hospitalize women with suspected preeclampsia. Secondary objectives focused on the influence of the sFlt-1/PlGF result on decisions regarding induction of delivery/ fetal lung maturation, additional laboratory measurements, cardiotocography, Doppler sonography, change of intensity of patient monitoring within one week and drug treatment. Maternal/neonatal outcomes were documented at delivery and postpartum. An independent adjudication committee evaluated the appropriateness of clinical decisions (based on outcome). Primary endpoint: the proportion of appropriate decisions to hospitalize/not to hospitalize patients with suspicion of preeclampsia before and after knowledge of the sFlt-1/PlGF result. Results: 118 of 209 enrolled patients comprised the per-protocol population. For 16.9% of patients in the per-protocol population, the sFlt-1/PlGF ratio influenced the decision to hospitalize patients. For 11.0% of patients the sFlt-1/PlGF result influenced the investigator towards not to hospitalize the patient. For 5.9% of patients, the sFlt-1/PlGF result influenced the investigators to hospitalize the patient after initially deciding not to hospitalize her. All changes regarding hospitalization were assessed as appropriate by the independent adjudication committee. Changed decisions on hospitalization and other clinical procedures concurred with outcomes in mothers/neonates. Conclusion: PreOS is the first study to demonstrate the influence of sFlt-1/PlGF testing on physicians’ clinical decision making for pregnant women with suspicion of preeclampsia in routine clinical practice. The test may be used to guide appropriate intensity of patient management with respect to hospitalization and diagnostic and therapeutic decisions in a clinically relevant proportion of pregnant women with signs and symptoms of preeclampsia/eclampsia/HELLP syndrome. Disclosure of Interest: E. Klein: None Declared, D. Schlembach Consultant for: F. HoffmannLa Roche , A. Ramoni : None Declared, E. Langer : None Declared, F. Bahlmann : None Declared, R. van der Does Employee of: CRO IST GmbH involved in the conduct and analysis of the study, D. Messinger : None Declared, W. D. Verhagen-Kamerbeek Employee of: Roche Diagnostics International Ltd., M. Reim Employee of: Roche Diagnostics GmbH, M. Hund Shareholder of: F. Hoffmann-La Roche , Employee of: Roche Diagnostics International Ltd., H. Stepan Consultant for: Roche Diagnostics P55 CESAREAN SECTION ON REQUEST OF THE PATIENT, CAN BE A LEGITIMATE CHOICE OF THE WOMAN? C. S. Laranjeira 1,*, C. H. Mascarenhas Silva 1, R. Lamaita 1, K. Moreira Lana 1, B. Hermanny 1, D. Seixas 1, M. Salvador Geo 1 Obstetrics and Gynecology, Rede Mater Dei de Saude, Belo Horizonte, Brazil Problem Statement: A cesarean section is a surgical procedure originally designed to reduce the risk of maternal and / or fetal complications during pregnancy and childbirth, and should be avoided in the absence of a medical indication. Some authors report that enhancements in surgical techniques, prevention of complications, and the procedure is indicated to the satisfaction of the desires of the mother and / or family. The main reasons found for the increases cesarean section rates are social, cultural and economic factors associated with maternal request and factors related to the health care model, involving aspects of medical assistance and other professionals, preferences and economic interests of the actors this process. In Brazil, cesarean rates are high and cesarean section for maternal choice is a frequent point of discussion between managers and obstetricians. In this context, the present study aims to evaluate neonatal and obstetric results in women undergoing cesarean section by choice in term pregnancies. Methods: A retrospective case series study, 297 women undergoing delivery in a private hospital, quaternary care, from Jan to Sep/13. The women were divided into two groups: group 1 with 140 women undergoing cesarean section by choice in the absence of labor and group 2 with 157 women undergoing vaginal delivery. Inclusion criteria: signed an informed consent according to the choice made at admission, primiparous, greater than 37 weeks, cephalic presentation and flexed, no fetal malformations. It was analyzed the type of anesthesia, the weight of the newborn, the Apgar score less than 7 at 1 and 5 min, referral to rooming and admission to neonatal intensive care unit, immediate breastfeeding, maternal death and / or early neonatal, maternal readmission to and / or neonatal increased uterine bleeding, maternal blood transfusion, use of 87 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 uterotonic and time of maternal hospitalization. We performed a statistical study of the results obtained in both groups with the EpiInfo software. Results: The average gestational age of group 1 and 2 was 275.67 and 274.04 days, respectively. The results showed that significant differences are described in Table 1, the other evaluated variables showed no significant difference. Table 1: Maternal and neonatal outcomes after cesarean by request and after vaginal delivery Outcomes Use of uterotonic (N /%) Maternal blood transfusion (N /%) Maternal hospitalization time (media) hours Birthweight (mean) g Apgar score <7 (1min) (N /%) Group 1 (n = 140) 105 (80,7%) 1 46,1 (+ 11,6) Group 2 (n=157) 139 (91,4%) 2 33,4 (+ 4,9) p 3292 378,6) 7(5%) 3137 (+ 382,2) s 29(19,1%) S (+ s s s Conclusion: Considering that pregnancy and childbirth is a physiological event in any woman's life, it is recommended that health professionals involved in the birth of a child only when necessary. This study found that gestational age and birth weight were higher in the group Cesarean by choice, and that maternal and/or fetal complications were not higher in these women. The protocol established in the institution where the study was conducted advocates Cesarean by choice only if the patient has more than 39 completed weeks, is well targeted and signing a consent form. Whereas the choice of the type of delivery woman concerns the autonomy of your own body, to have a well established protocol is crucial to have good results and not increase belated prematurity rates. Further studies with a larger number of cases and include objective and subjective evaluation of pre and postpartum women are needed. Disclosure of Interest: None Declared P56 FETAL CYSTIC ADENOMATOID MALFORMATION OF THE LUNG: A CASE REPORT A. Castro 1, J. Lisboa 1,*, P. Alves 1, C. Carnide 1, O. Moutinho 1 CHTMAD, Vila Real, Portugal Problem Statement: Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare anomaly of fetal development of terminal respiratory structures. CCAM has a variable natural history that may result in hydrops in up to 40% or regress in up to 15%. Methods: We present a case of CCAM of the lung. Results: Our patient was a 33 years-old pregnant woman, primigravida. Second trimester ultrasonographic examination showed bilateral hyperechogenic intrathoracal structures, occupying the middle and lower lung lobes of the right hemithorax, measuring the largest cystic image 16,8x10,7mm. These sonographic findings were compatible with type 2 CCAM. Fetal MRI confirmed the initial diagnosis. Throughout pregnancy, the serial scans excluded the presence of hydrops, polyhydramnios and other anomalies. . There was regression of the CCAM and there was a decrease in the cyst larger. Delivery occurred at 39 weeks of gestation without complications. Computed tomography of the chest confirmed postnatal diagnosis of type 2 CCAM. Until the 41st day of life, the child has no respiratory problems. Conclusion: The importance of prenatal diagnosis of cystic intrathoracic malformations is that these are responsible, at birth, by severe respiratory failure and heart failure. However, as happened in this case presented, in 15% of cases CCAM regresses and prognosis is better. The identification and appropriate follow-up of these anomalies become essential for programming specialized neonatal care adverse pregnancy outcomes such as recurrent pregnancy loss, gestational hypertension, fetal distress; and abnormalities in fetal growth and development Methods: We report a case of a 31-year-old gravida 1 para 0 who presented at 34 weeks age of gestation with facial spasm and preterm labor. Work-up for possible causes of facial spasm was done including serum electrolytes, which revealed hypokalemia. Initial management include supplementation with potassium chloride durules. There was persistent hypokalemia prompting referral to a nephrologist. Work-up for persistent hypokalemia included random urine potassium, random urine osmolality, arterial blood gas, serum electrolytes, serum anion gap and urinalysis. Results: Arterial blood gas and serum anion gap showed a normal anion gap acidosis, which is a characteristic of RTA. Serum electrolytes showed a low level of bicarbonate and high level of chloride. The combination of depressed serum bicarbonate, hyperchloremia, acidemia, and a normal serum anion gap indicates that the patient has hyperchloremic non-gap metabolic acidosis. Urinalysis showed a high urine pH despite an abnormally low serum pH, relating to impairment of urinary acidification, which confirmed the diagnosis of distal RTA. Hypokalemia was corrected not just by potassium supplementation but also by addressing the underlying acidosis. Conclusion: Persistent hypokalemia in pregnancy despite adequate medical management should prompt further search for possible etiologies. Possible adverse maternal and fetal effects may be inevitable if accurate diagnosis is not made. Disclosure of Interest: None Declared P58 SONOGRAPHIC FINDING OF A CAUDAL APPENDAGE IN A SECOND TRIMESTER GESTATION N. F. B. B. Maciel 1,*, C. Frias 1, J. L. Borges 1, A. Sampaio 1, P. Melo 1, C. Ponte 1 Gynecology and Obstetrics, HOSPITAL DO DIVINO ESPÍRITO SANTO, Ponta Delgada, Portugal Problem Statement: The human tail has been categorized in true vestigial tail and pseudotail, which include other forms of caudal appendages. The first one contains adipose and connective tissue, striated muscle, blood vessels, and nerves and is covered by skin. Bone, cartilages, notochord, and spinal cord are not present. The pseudotail is composed of other tissues such as lipoma, teratoma ou myelomeningocele. True tails are often associated with spinal dysraphism such as spina bifida occulta. Methods: Description of a clinical case. Results: A 22-year-old Gravida I Para 0 woman was referred at 21week and 3 days gestation for second trimester sonogram. The patient was obese and epileptic, treated with carbamazepine 200mg id. First trimester combined screening was negative and there were no family records of malformations. The authors report the finding of a 15mm caudal appendage in the lumbosacral region with apparently no other associated malformations. The patient was sent to a tertiary referral hospital for advanced diagnosis and is now waiting for fetal MRI. Image / Graph: Disclosure of Interest: None Declared P57 RENAL TUBULAR ACIDOSIS IN PREGNANCY PRESENTING AS FACIAL SPASM: A CASE REPORT J. C. M. Macalintal,*, E. Tan Obstetrics and Gynecology, St. Luke's Medical Center, Quezon City, Philippines Problem Statement: Renal tubular acidosis (RTA) is rarely encountered in pregnancy, and when it does, it is expected to be worse than in the general population. Undiagnosed cases of maternal systemic acidosis have multiple 88 Conclusion: By 2013 there were over 30 cases of caudal appendages diagnosed by sonography and this report provides some good images, which could help in the study of this phenomenon. Such rare anatomic lesions can be seen in isolation or with associated spinal abnormalities, additional congenital anomalies or underlying genetic disease. For this reason fetal MRI is warranted Abstract Book for evaluation of associated anomalies and the position of spinal cord conus to help guide counseling and prognosis. Disclosure of Interest: None Declared P59 CELL-DERIVED MICROPARTICLES IN PREGNANT PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME: RELATIONSHIP WITH PREGNANCY OUTCOME AND THROMBOSIS M.-Á. Martínez-Zamora 1,*, D. Tàssies 2, J. Munrós 1, J. C. Reverter 2, G. Espinosa3, R. Cervera 3, F. Carmona 1, J. Balasch 1 1Institut Clínic of Gynecology, Obstetrics and Neonatology, 2Department of Hemotherapy and Hemostasis, 3Department of autoimmune diseases, Hospital Clínic of Barcelona., Barcelona, Spain Problem Statement: Circulating microparticles (MP) are small membrane-coated vesibles with a diameter of 0.1-1µm delivered upon activation or apoptosis by exocytic budding, by different cells. The most abundant originate from platelets, but also from other cell types such as endothelial cells, leukocytes and red blood cells. MP induce cell signaling that drives processes such as apoptosis, invasion, and angiogenesis. Morevoer, exposure of new negatively charged phospholipids in the outer membrane leaflet could easily explain the role of MP in the onset of inflammation, thrombosis, and vascular dysfunction. Therefore, MP may play a role in thrombotic pregnancy complications. The antiphospholipid syndrome (APS) is a common acquired prothrombotic condition characterized by vascular thrombosis and pregnancy morbidity in association with persistently positive circulating antiphospholipid antibodies (aPL). The association of aPL with pregnancy complications has increased the frequency with which APS is diagnosed and has generated substantial interest in elucidating its pathophysiology. Recent investigations have suggested that MP levels correlated with the presence of aPL and thrombotic events in nonpregnant patients. This study evaluated MPs in pregnant patients with APS in relation to pregnancy outcome and thrombosis. Methods: A total of 60 patients were prospectively recruited in the third trimester of pregnancy. The study group consisted of 30 pregnant patients that had been previously diagnosed with primary APS (Group 1). These patients were managed as having high-risk pregnancies and treated with low-dose aspirin alone or associated with low-molecular weight heparin. The control group (Group 2) comprised the next consecutive pregnant patient having a normal term pregnancy and delivery after each patient of Group 1 was recruited. Other thrombophilias, except from APS in Group 1, were excluded in all patients. Venous blood samples were obtained at 28-32 weeks of pregnancy, and MP were measured by capture on immobilized annexin V, which is the momst common marker used to detect and quantify MP. Results: Patients in Group 1 had more previous abortions and fetal deaths compared with Group 2. There were more cesarean sections and lower neonatal weight in Group 1. Seven patients of Group 1 had poor obstetric outcome: there were two gestacional thromboses (1 arterial and 1 venous) and five severe preeclampsias. Groups 1 and 2 had similar levels of MP (MP levels in mean ± SD: Group 1: 7.8 ± 3.8; Group 2: 7.06 ± 4.7; p=0.5). MP were significantly higher in patients of Group 1 with obstetric complications (severe preeclampsia o thrombosis) compared with patients of Group 1 without complications (MP levels in mean ± SD: Group 1 with complications: 11.9 ± 3.5; Group 1 without complications: 7.3±3.9; p=0.009). Conclusion: MP levels do not present statistical differences between pregnant patients with or withour APS in the third trimester of pregnancy. There were statistically significant higher levels of MP in patients with the APS who presented with thrombotic obstetric complications (severe preeclampsia or maternal thrombosis), sugggesting a role of MP in the pathogenesis of these complications in APS pregnant patients. Acknowledgements: Work supported in part by Grant FIS PI11/01560 and the Agència de Gestió d´Ajuts Universitaris i de Recerca- Generalitat de Catalunya (2009SGR1099). Disclosure of Interest: None Declared P60 TRIPLET PREGNANCY: ARE DICHORIONIC TRIPLETS A HIGH RISK EVENT? A. T. Marujo 1,*, L. Correia 1, A. Queiroz 2, M. Rosal Gonçalves 3, I. Periquito 3, T. Simões 1 1Fetomaternal Department, 2Prenatal Diagnosis Department, 3Pediatric Department, Maternidade Dr. Alfredo da Costa, Lisboa, Portugal Problem Statement: The policy of transferring no more than two embryos in assisted reproduction techniques (ART) and more judicious use of fertilityenhancing drugs have contributed to the decline of the incidence of triplet gestations over the last few decades. The vast majority of triplets after ART are trichorionic; however, spontaneous conceptions may lead to dichorionic triplets and there are few studies focused on this last entity. The aim of this study was to analyze obstetric and perinatal outcomes in triplet pregnancies according to chorionicity. Methods: This study is a retrospective analysis of all triplet pregnancies diagnosed in a tertiary center between 1994 and 2012, at Maternity Dr. Alfredo da Costa CHLC, Lisbon, Portugal. A total of 91 triplet pregnancies were followed and delivered at this institution during that period. For this study, we identified triplet pregnancies by chorionicity. We excluded 6 cases of monochorionic triplets and compared only dichorionic with trichorionic triplets. Chorionicity was established by standard ultrasonographic criteria performed by level III ultrasonographers, confirmed by careful examination of the delivered placenta by experienced obstetricians, and double-checked by pathologic examination of the placentas. We evaluated maternal characteristics (age, parity, pre-gravid mass index, mode of conception) and analyzed obstetric (incidence of feto-fetal transfusion syndrome , premature contractions , hypertensive disorders, premature rupture of membranes , gestational age at birth, mode of delivery, days of hospitalization) and perinatal outcomes (incidence preterm births, birth weight, Apgar score, major malformations, neonatal morbidity and death and days of hospitalization). We used SPSS version 13 (Chicago, IL) and True Epistat Software (Math Archives, Round Rock, TX) for statistical analyses. P-values <0.05 were considered significant. Results: From the 85 pregnancies included, 41 were dichorionic (48.2%) and 44 (51.8%) trichorionic. We found no statistically significant differences in maternal age (32±4.6 versus 31±3.8, p=0.18). Nulliparity was lower in the dichorionic group (68% versus 84%, OR: 0.4, CI: 0.1-1.3) and spontaneous conception was higher (51% versus 20.5%, OR: 4.0; CI: 1.4-11.9). Maternal complications were similar between the two groups and we found an incidence of feto-fetal transfusion syndrome of 14.6%; half of these cases required laser ablation of the placental anastomoses. The dichorionic group had a lower mean gestational age at delivery (31 weeks±3.5 versus 32±2.6, p=0.05) with 48.7% of deliveries ≤32 weeks versus 31.8% in the trichorionic triplets (OR: 2.0; CI: 0.8-5.4). Although no differences in the mean birth weight of the triplets were observed (1456 g versus 1604g, p=0.62), dichorionic triplets presented a higher risk of early neonatal death (11.4% versus 4.5%, OR: 2.5; CI: 0.9-7.6) and a twofold risk of perinatal mortality (15.4 versus 6.8, OR: 2.5; CI: 1.1-6.3). Both groups presented a similar mean number of days in neonatal intensive care (8.3± 6.5±13.5, p=0.41). Conclusion: In our sample, despite good survival rate obtained in dichorionic triplets group (84.6%), we found that this group had worse outcomes when compared to trichorionic triplets with respect to risk of very preterm birth and perinatal death. Disclosure of Interest: None Declared P61 DIDELPHYS UTERUS AND UNCOMPLICATED PREGNANCY: CASE REPORT V. Mourinha 1,*, A. Rodrigues 1, R. Martins 1, G. Abreu dos Santos 2, O. Viseu 1 Obstetrics Department, 2Faro's Hospital, Faro, Portugal Problem Statement: It is estimated that uterine malformations affect 1 to 10% of women. However it's difficult to know a true prevalence once in most cases the diagnosis is made during the study of infertility causes, repeated miscarriages or complications in pregnancy. Uterus didelphys is characterized by a duplication of the uterus and cervix. It may coexist with other genitourinary malformations. 89 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Methods: 30 years-old woman diagnosed with didelphys uterus associated with a longitudinal vaginal septum and history of a single miscarriage. After 10 months without contraception she got pregnant with no need of fertility treatments. The pregnancy proceeded without complications and she was submitted to elective caesarean section at gestational age of 38 weeks and 2 days, with a fetus in breach presentation. The newborn was female with 2865g and Apgar score 10/10. Results: Image / Graph: patient. Some literature explained that increased risk of preterm labor and low birth weight is associated with chronic intake of oral corticosteroid such as prednisolone or prednisone. On August 13, 2013, the patient conceived a boy at 34 weeks of gestation. His weight is 2,370 grams and the height is 18.5 inch. The patient’s methylprednisolone therapy is still continued. Any history of hypertension, diabetes mellitus, heart anomalies, and lung anomalies, as preterm labor risk factors were denied. Other risk factors such as smoking, caffeine consumption, low nutrition status, and history of previous premature birth were also denied. Methods: Case report of a patient with borderline lepromatous Morbus Hansen with reversal reaction and erythema nodosum leprosum while pregnant. Results: It is impressive that the preterm labor and low birth weight of patient's baby can be associated with the long-term use of methylprednisolone in pregnancy, although the use of dapsone which can lead to anemia needs to be considered as well. Conclusion: Administration of corticosteroids for Morbus Hansen patient with pregnancy may indirectly affect fetal development. Research on this topic is recommended. Disclosure of Interest: None Declared Conclusion: Despite studies that evaluate outcomes of pregnancy in 2nd and 3rd trimester in women with uterine malformations are still limited, the results have been consensual with respect to an increased risk of complications such as preterm delivery, fetal growth restriction, and premature preterm rupture of membranes, abnormalities of placentation or even stillbirth. In the specific case of the didelphys uterus, the most frequent complication appears to be preterm delivery. Studies are limited and should mainly serve to guide clinicians in the surveillance of these patients, to alert for early diagnosis of complications and to assist in counseling the parents on making decisions regarding their current and future pregnancies. However, there are exceptions. Alerting the womem doesn't necessarily mean to alarm them. Despite the increased risk, there are cases of uncomplicated pregnancies and it is important to remember that many women with uterine malformations enjoy normal pregnancies and deliveries without ever being diagnosed. Disclosure of Interest: None Declared P62 PRETERM LABOR AS SIDE EFFECT OF METHYLPREDNISOLONE TREATMENT IN MORBUS HANSEN PATIENT WITH PREGNANCY N. N. Afifa *, F. A. Trinanda, A. C. Prasetyo Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia Problem Statement: Morbus Hansen, or leprosy, is a chronic granulomatous infection that mainly attacks the skin and peripheral nerves. It is caused by Mycobacterium leprae. Leprosy on women has been a complex health problem because of some physiological changes of women such as hormonal changes, pregnancy, lactation, and so on. On January 31, 2013, a 26-year-old female was admitted to Dermatovenerology Department of Cipto Mangunkusumo Hospital for BTA examination. When admitted, patient was having her first pregnancy at 2 months. Patient was diagnosed with borderline lepromatous Morbus Hansen with reversal reaction and erythema nodosum leprosum while pregnant. Patient’s primary complaints were fever, red bump on upper and lower limbs, sore, and rash on her face since a week after taking her second MDT MB (multidrug therapy multi-basilar).Physical examination of face, abdomen, proximal left upper extremity, bilateral upper, and lower extremity dermatological status showed erythematous plaque to hyperpigmentation, multiple discrete, lenticular-placate sized, clear border and half-diffuse, warm, and hypestation. Bilateral upper and lower extremity showed lenticular-numular sized erythematous plaque. A dilatation of right ulnar nerve was also found. BTA examination showed bacterial index of 10/6 and morphological index of 0%. At first, the patient was prescribed 4 mg 1x6 pills of methylprednisolone per day for two weeks before the dose was lowered. Every time the methylprednisolone dose is lowered to 4 mg 1x4 pills per day, a new bump appears accompanied by soreness, and methylprednisolone dose is then returned to normal. Methylprednisolone is one of corticosteroid drugs which has certain effects on 90 P63 POSTPARTUM VAGINAL HEMATOMA AS A RISK FACTOR FOR MASSIVE BLOOD LOSS V. Novikova1, G. Penzhoyan1 Dept of Obstetrics, Gynecology and Perinatology Faculty of Postgraduate Education, Kuban State Medical University, Krasnodar, Russian Federation Problem Statement: The reason for this study was the analysis of eight clinical cases of postpartum hematoma with acute massive hemorrhage 1850± 239, 58 ml (500-3000 ml), identified in hospitals in Krasnodar territory for 2006-2009. In all cases a hematoma formed without damage the integrity of the vaginal mucosa; all women had varicose veins of various locations; all women performed labor pain relief by continuous epidural analgesia. Methods: In 2009 - 2011 at the territorial Perinatal Center of Krasnodar territorial Hospital № 2 surveyed 120 women (Group I) with varicose veins of the lower extremities. The control group consisted of 100 women without varicose disease. Average age 24, 2± 5, 12 years; weight 74, 03± 11, 25 kg. Gestational age with the onset of labor 38, 20± 12, 09 weeks. In 26 (21.7%) of the women ahead for the first birth, 40 (78.3%) repeated (in history 2-8 delivery). Births were conservative, spontaneous. 2 hours after birth underwent ultrasound study of the vagina, perineum by perineal access to scanner PHILLIPS HD-11. Results: The women in Group I were identified visceral phenotypic markers of connective tissue dysplasia (CTD): mitral valve prolapse in 38 (31.7%) women (p<0.05), atrial septal defect in 4 (3%), joint hypermobility in 31 (25, 8%) (p<0.05), elastosis skin in 56 (46.7%) (p <0.05). In Group I, threatening miscarriage occurred in various stages of pregnancy in 120 (100%) (p<0.01) women, and 25 (20.8%) women ultrasound revealed Cervical incompetence. Preeclampsia complicated pregnancy in 63 (52.5%) women in Group I (p<0.05). Chronic placental insufficiency in 75 (62.5%) (p<0.05) in Group I. A significant excess frequency anomalies of labor in women of Group I: the weakness of labor in 28 (23.3%) of women (p <0.05), rapid delivery in 18 (15%) women (p <0.05). Rupture of the vaginal walls of varying degrees was found in 35 (29%) women (p<0.05), I degree perineal rupture in 24 (20%) (p<0.05) women. Occasion careful surgical hemostasis with revision seams when translated into maternity ward, a dynamic evaluation of clinical symptoms of possible formation of hematomas. However, ultrasonography 2 hours after vaginal delivery hematoma was detected in 31 (25.8%) women, with only 10 (8%) had a damage of the integrity of the mucosa, in 21 (17%) damage of the vaginal mucosa was not . In any case, a woman did not show the characteristic for the formation of hematomas. Diameter hematoma on ultrasound was 10,1±3,6 cm (5 to 15 cm). Conclusion: Revealed, hematoma of   vagina up to 15 cm in greatest diameter in the early postpartum period may be asymptomatic. Presents a risk of massive blood loss in the transfering to the postnatal ward without timely Abstract Book diagnosis of postpartum vaginal bruising, perineum or defects of hemostasis in the area of suturing episiotomy suturing or breaks the soft tissues of the birth canal, especially when coagulopathy due to pre-eclampsia, abruptio placentae, hereditary defects hemostasis and others. Availability asymptomatic postpartum vaginal hematoma may cause underestimation of additional blood loss in women with early postpartum hemorrhage. This risk increases with use of anesthesia. Especially be aware that even with the full surgical hemostasis possible relapse formation of hematomas, especially in women with undifferentiated CTD. That's why is necessary in the early postpartum period with a view to the prevention of acute massive hemorrhage perform transperineal ultrasound access to avoid bruising the vagina. Disclosure of Interest: None Declared P64 THE EFFECTS OF MATERNAL SERUM LIPID ON MATERNAL BLOOD PRESSURE AND FETAL BIRTH WEIGHT: A PROSPECTIVE COHORT STUDY AT PRIMARY MATERNAL CHILD HEALTH CENTER Z. Nusee 1,*, H. Kah Seong 1, H. Ismail 1, S. Abdullah 1 Obstetrics & Gynaecology, International Islamic University Malaysia, Kuantan, Malaysia Problem Statement: Pre-eclampsia (PE), a pregnancy specific condition, can be fatal if left untreated. The purpose of the present study was to assess the sociodemographic characteristic and the maternal risk factors for PE, especially, the maternal fasting serum lipids (FSL) between trimesters. In addition, we also aimed to find out whether there is any association between FSL and fetal birth. Methods: Pregnant women in their first trimester were prospectively studied at a primary maternal child health center (KKIA) in Jalan Gambut Kuantan, Pahang, Malaysia. The study involved measuring fasting serum lipids (FSL), blood pressure (BP), and urine albumin in every trimester. The data were analyzed using (SPSS) version 17.0, and p values < 0.05 were considered statistically significant. Results: We found increase in triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL) and total cholesterol (TC) as the gestational age increased. The mean of TC surged from 5 mmol/L in the first trimester to 7.4 mmol/L in the third trimester (p<0.05). A similar trend was also observed with TG, LDL, and HDL. There were no significant changes in blood pressure and urine albumin throughout the pregnancy. Serum lipid did not statistically influence the birth weight (P > 0.05). Meanwhile, serum triglyceride level was doubled (4.5 mmol/L) in one patient who developed eclampsia at 25 weeks gestation. Conclusion: Serum lipid increased in parallel to increase in gestational age; however, it did not influence the maternal blood pressure and birth weight. Further study with larger sample size is required to confirm the factors associated with PE. Disclosure of Interest: None Declared P65 SPANISH COST-EFFECTIVENESS ANALYSIS OF INCORPORATING THE SFLT1/PLGF RATIO TEST INTO STANDARD CLINICAL PRACTICE FOR DIAGNOSIS OF PRE-ECLAMPSIA AND/OR HELLP SYNDROME N. Piella 1,*, D. Allegranza 2, M. Hund 3, E. Bertranou 4 1Roche Professional Diagnostics, Roche Diagnostics, Sant Cugat, Spain, 2Clinical Operations, 3Medical and Scientific Affairs, Roche Diagnostics International Ltd., Rotkreuz, Switzerland, 4Health Economic Modelling Unit, HERON Commercialization - A PAREXEL Company, London, United Kingdom Problem Statement: Pre-eclampsia affects 2% of pregnancies in Spain and is the main cause of maternal and perinatal morbidity and mortality; thus, preeclampsia is a leading concern in pregnancy care. Uncertainty in diagnosis of preeclampsia may lead to unnecessary hospitalisation of women who do not develop pre-eclampsia; thus, early diagnosis of pre-eclampsia may save costs. The sFlt-1/PlGF ratio test accurately rules-out the onset of preeclampsia/Hemolyis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome within 1 week (sFlt/PlGF ratio ≤38), and rules-in pre-eclampsia/HELLP syndrome within 4 weeks in women with suspected pre-eclampsia. Early prediction of pre-eclampsia onset may lead to cost savings by reducing unnecessary hospitalisation. The study aim was to evaluate the costeffectiveness of the test in clinical practice in Spain. Methods: A decision tree model was developed from a Spanish payer perspective to estimate costs associated with diagnosis and management of pregnant women from first presentation with clinical suspicion of pre-eclampsia until delivery. Two levels of management were defined: intermediate-intensity (daily control visits and weekly to fortnightly outpatient appointment with a specialist) and high-intensity (hospital inpatient care). Cost-effectiveness was evaluated by comparing expected costs between two scenarios. In the 'no test' scenario, current diagnostic criteria in Spain informed management decisions (according to SEGO [Spanish Society for Gynaecology and Obstetrics] guidelines) and the proportion of women hospitalised prior to diagnosis was taken from PROGNOSIS, a prospective, non-interventional, blinded study of 1050 women with suspected pre-eclampsia. In the 'test' scenario the proportion of women assigned to each level of management intensity was determined by the test result indicative of the patient's risk of pre-eclampsia diagnosis. Test results, incidence of pre-eclampsia, and length of hospitalisation were available from PROGNOSIS. The analysis conservatively assumed that neither the introduction of the test, nor changes in management affected the incidence and severity of pre-eclampsia. A proportion of women developing pre-eclampsia while not hospitalised require emergency admission (EA), and/or neonatal ICU (nICU) stay for the new-born. These costs were included in the analysis. Results: The model predicts that introducing the test into clinical practice will reduce the number of women hospitalised prior to pre-eclampsia by 50% from 368 to 183, in a cohort of 1050, leading to a cost saving of €228 per patient. The model predicts that in the 'test' scenario, 37.1% of women hospitalised prior to diagnosis will develop pre-eclampsia, compared with 26.9% in the 'no test' scenario, indicating more targeted decision-making when the test is used. As fewer women are hospitalised, there may be an additional 3 EAs and 1 nICU admission. Conclusion: Pre-eclampsia is a severe complication of pregnancy in Spain and there is a need for improved diagnostic techniques to optimise management of pre-eclampsia. The sFlt-1/PlGF ratio test enables more accurate identification of patients most likely to develop pre-eclampsia, thereby reducing unnecessary hospitalisation. As such, introduction of the test into clinical practice in Spain has the potential to generate substantial cost savings, with a small increase in EAs and nICU admissions. Disclosure of Interest: N. Piella Employee of: Roche Diagnostics, D. Allegranza Employee of: Roche Diagnostics Ltd., M. Hund Employee of: Roche Diagnostics Ltd., E. Bertranou Consultant for: HERON Commercialization - A PAREXEL Company P66 CERVICAL AND VAGINAL FLUID IL-6 AND IL-8 LEVELS IN PREGNANCIES COMPLICATED BY PRETERM PRELABOR RUPTURE OF MEMBRANES M. Kacerovsky 1, B. Jacobsson 2, M. Prochazka 3,*, P. Janku 4, C. Andrys 5 1Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine Hradec Kralove, , Hradec Kralove, Czech Republic, 2Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden, 3Obstetrics and Gynecology, Medical Faculty of Palacký University, Olomouc, 4Obstetrics and Gynecology, University Hospital and Masaryk University, Brno, Brno, 5Department of Clinical Immunology and Allergy, Charles University in Prague, Faculty of Medicine Hradec Kralove,, Hradec Kralove, Czech Republic Problem Statement: To determine the vaginal and cervical fluid interleukin (IL)6 and IL-8 concentrations in pregnancies complicated by preterm prelabor rupture of membranes and their correlation to microbial invasion of the amniotic cavity (MIAC) as well as histological chorioamnionitis (HCA) Methods: Sixty-eight women with singleton pregnancies were included in this study. Vaginal and cervical fluid was collected at the time of admission. IL-6 and IL-8 concentrations in the vaginal fluid were determined using ELISA. Results: Women with MIAC had higher vaginal fluid IL-6 levels compared to those without MIAC (with MIAC: median 374 pg/mL vs. without MIAC: median 174 pg/mL; p = 0.03). IL-8 levels were higher in women with MIAC only in the crude analysis but not after adjustment for gestational age. There was no difference in the IL-6 and IL-8 concentrations between those with and without HCA. Women with both MIAC and HCA had higher IL-6 vaginal fluid levels than those 91 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 without both MIAC and HCA (with MIAC and HCA: median 466 pg/mL vs. without MIAC and HCA: median 178 pg/mL; p = 0.02). IL-8 levels were higher in women with MIAC and HCA only in the crude analysis but not after adjustment for gestational age. The women with MIAC had higher cervical fluid IL-6 and IL-8 levels than did the women without MIAC (IL-6: p=0.01; IL-8: p=0.003). There was no difference in the cervical fluid IL-6 levels between women with and without HCA (p=0.37). The women with HCA had higher IL-8 levels only in the crude analysis (p=0.01) but not after adjustment for gestational age (p=0.06). The women with both MIAC and HCA had higher cervical fluid levels of IL-6 and IL-8 than did the other women (IL-6: p=0.003; IL-8: p=0.001). The cervical fluid IL-8 level of 2653 pg/mL was found to be the best cutoff point in the identification of PPROM pregnancies complicated by both MIAC and HCA with a likelihood ratio of 24. Conclusion: The presence of MIAC is the most important factor impacting the local cervical inflammatory response, which is determined by IL-6 and IL-8 levels in the cervical fluid. The cervical fluid IL-8 levels seem to be a promising noninvasive marker for the prediction of pregnancies complicated by the presence of both MIAC and HCA.Vaginal fluid IL-6 but not IL-8 levels reflect the presence of MIAC and both MIAC and HCA. Supported by the grant of Min.of Health of the Czech Republic NT 14104-3/2013 Disclosure of Interest: None Declared P67 THE ROLE OF SCREENING TESTS DURING PREGNANCY AND NEONATAL OUTCOME A. Rasekh Jahromi 1,*, N. Davari 1, M. A. Nasseri Jahromi 2, N. pad 3, S. pourshojaee 1, S. sobhanian 4, L. kalavani 3, F. gorgin 5 1dr rasekh clinic, Jahrom University of Medical Science , Jahrom, 2economic, shiraz Azad university, shiraz, 3OB&GYN, 4nursery , Jahrom University of Medical Science , 5physiology, Jahrom Azad university , Jahrom, Iran Problem Statement: Nuchal translucency (NT) thickness is one of the major screening markers during the first trimester that could be influenced by several factors. A number of maternal serum markers have proven useful in screening for Down syndrome and other chromosomal abnormality. Quad screening performs better than triple screening with both lower false positive rates and higher detection rates. They can be performed between 15 and 21 weeks. The quad test is a better method of screening for Down's syndrome than use of maternal age alone and is more effective than other screening tests. Measurements of nuchal translucency (NT) contribute to improve screening performance. Amniocentesis is the most extensively used fetal sampling technique for detecting chromosome abnormality. The goal of first -trimester prenatal screening is to provide risk information early in pregnancy, thereby allowing for additional diagnostic testing and optimal pregnancy management or early termination. The aim of this research is detection of association between NT, Quad marker screening test, amniocentesis and neonatal outcome. Methods: This clinical study was performed on 106 pregnant women that referred to Dr.Rasekh’s clinic during 12 months. Fetal nuchal translucency measurements were performed on consecutive mothers attending the prenatal diagnosis in 11-14 gestational weeks by ultrasonography. Then Quad screening tests were performed at 15-18 weeks of gestational period. Results: mean of nuchal translucency: 1.7 (max: 2.1 min: 1.4). The frequency of the negative screening test for Down syndrome was 88.7% (94) and positive test was 11.3 %( 12).In group with positive screening test, 25 %( 24 from 94 patients) of them accomplished amniocentesis. All of them were reported normal and without cytogenetic abnormalities and in follow up, all of their neonates were normal. 8.3 %( from12pts (11.3%) of women with positive screening test, their fetus were dead.Those who were not willing to amniocentesis were followed up by ultrasononography and at last with mean of apgar scores 9, completely normal neonate were born. In evaluation of relationship between positive quad screening test and birth of neonate with Down syndrome, there was not virtual association (p.value: 0.06), but with attention to different age group, the lowest percent of the positive screening test was found in 19-25 years group(3%) and highest percent of them in 35-40 years group(71.4%). Though in our study, the most population of pregnant women were 25-35 years. The relation between 92 high maternal age and positive quad screening test is considerable (p.value: 0.005). Conclusion: In our study, significant association between positive quad screening test and birth of neonates with Down syndrome and was not seen.But there is relationship between NT and amniocentesis and neonatal outcome. When NT is normal range, amniocentesis is negative. Therefore, NT is important factor in evaluating of the fetus. Factors which contribute in the false positive Quad screening test should be considered in laboratory and to minimize that the pregnant women are not undergone invasive and expensive procedures. In our study, positive quad test was seen in pregnant women > 35 years significantly. So by encourage the women to pregnancy at appropriate age and perform required tests, the birth of Down syndrome and other chromosomal abnormality will be decreased more and more. Disclosure of Interest: None Declared P68 DIAGNOSTIC AMNIOCENTESIS - RESULTS AND COMPLICATIONS L. M. Reis 1,*, M. Miranda 2, S. Nascimento 2, D. Bruno 2, C. Paixão 3 1Obstetricia, 2Obstetricía, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, 3Obstetrícia/Ginecologia, Centro Hospitalar do Barlavento Algarvio EPE, Portimão, Portugal Problem Statement: Amniocentesis is an invasive technique for withdrawing amniotic fluid from the uterine cavity; the fluid can then be used for various laboratory studies, including prenatal genetic studies. It is an invasive procedure and, as such, there are risks. The major complications are rupture of membranes, fetal injury, infection and fetal loss, the latter being the most feared by couples. It is one of the most common used procedures for prenatal diagnosis, but a precise assessment of the risks is difficult, because the rate of complications is affected by several factors, and the true risk of fetal loss associated with the procedure is still uncertain. Our goal was to analise the diagnostic amniocentesis performed at the Prenatal Diagnosis Department of Hospital Professor Doutor Fernando Fonseca (HFF), and evaluate the results and complications of the procedure. Methods: We conducted a retrospective observacional study of the diagnostic amniocentesis performed at the HFF Prenatal Diagnosis Department in 2013, using the information contained in the clinical files. Data analysis was performed using Numbers 3.2® (Apple Inc., EUA). Results: In 2013, 305 diagnostic amniocentesis were performed at our Prenatal Diagnosis Department; 301 were single pregnancies and five were twin pregnancies (three of them bichorionic); all procedures were performed under ultrasound guidance. The average maternal age was 35.9 years. The most common indications were: maternal age (65.9%), positive first trimester screening (15.7%) and ultrasound with morphologic anomalies (11.1%). The procedures were performed at a median gestational age of 16 weeks of gestation; there were no amniocentesis performed before 15 weeks or after 32 weeks of gestation. There were two complications- one vaginal bleeding and one fetal loss. The karyotype was normal in 289 cases; of the abnormal results (14), there were seven cases of aneuploidy, of which three were Down syndrome and two trisomy 18; in one case no karyotypo was obtained due to cell culture failure and in other case the karyotype is unknown due to absent information in the clinical file. Conclusion: In 2013, at the HFF Prenatal Diagnosis Department unit, 305 diagnostic amniocentesis were performed. In 4.6% of cases there was an abnormal karyotype, with a prevalence of aneuploidy of 2.3% (approximately 1% of Down syndrome). The procedure-related fetal loss was 0.3%, which is in accordance with the information cited by the American College of Obstetricians and Gynecologists. Diagnostic amniocentesis is a safe procedure if performed by trained professionals, but more studies are needed to asses the true rate of complications. Disclosure of Interest: None Declared Abstract Book P69 PRE-PREGNANCY BODY MASS INDEX AND GESTATIONAL WEIGHT GAIN ROLE ON BLOOD GLUCOSE AND BLOOD PRESSURE LEVELS DURING PREGNANCY M. Romano 1,*, E. Lacaria 1, M. Rossi 1, M. Aragona 1, L. Battini 2, M. Corfini 1, S. Del Prato 1, A. Bertolotto 1 1Department of Endocrinology and Metabolism, 2Department of Obstetrics and Gynecology 2, University Hospital, Pisa, Italy Problem Statement: The Institute of Medicine (IOM) defines guidelines for gestational weight gain (GWG) based on Pre-pregnancy body mass index (PPBMI), in order to prevent maternal (hypertensive disorders, gestational diabetes mellitus (GDM), non-elective cesarean delivery, post-partum weight retention and obesity) and neonatal (large for gestational age and macrosomic infants, obesity in offspring) adverse outcome. This study was undertaken to evaluate to which extent the IOM’s guidelines on GWG are followed and to determine the effect of GWG on glucose values during the oral glucose tolerance test (OGTT) screening for GDM and blood pressure (BP) values in pregnant women. Methods: A total of 230 Caucasian pregnant women referred to Pisa University Hospital, in Tuscany, underwent a 2 hr 75 g OGTT between the 24th-28th week of gestation (WoG). Clinical, anthropometric, and laboratory data were recorded on the screening test day by direct measurement, while PP-BMI was provided by each woman. Based on PP-BMI the study population was sub-divided in normalweight (NW, n=78, 21,1±1,9 kg/m2), over-weight (OW, n=78, 26,9±1,2 kg/m2) and obese (OB, n=74, 33,8±3,6 kg/m2 ). Weight gain was recorded again at delivery. Statistical analysis was performed on StatView program using Anova, LSD Fisher's test and Fisher exact test. Results: The 3 groups were comparable for age (35,2±4,5 years), WoG (26,5±1,72 week), family history of type 2 diabetes (24,8%) and previous macrosomia (3,5%). The percentage of women with previous GDM was significantly higher (p=.0114) in OB women (9,5%) respect to NW an OW (both 1.3%). The OW and OB women had an excessive GWG at delivery (+13,5±5,5 and +10,3±6,2 Kg, respectively), particularly until the 24th-28th WoG (OW +8,5±5 Kg, OB +5,6±4,4 Kg) while NW women reached the target values (+8,5±2,7 kg at 24th-28th WoG, +14,2±3,2 kg at delivery). At the OGTT screening OW and OB women had fasting plasma glucose (FPG) and 1-hour glucose (1hG) significantly higher than NW (FPG: OB 86,3±9 mg/dl, OW 85,7±8,7 mg/dl, NW 82,9±7,3 mg/dl; OB vs NW p=.0212; OW vs NW p=.0497; 1hG: OB 145±31 mg/dl, OW 141,9±30,7 mg/dl, NW 125,7±31,2; OB vs NW p=.0003, OW vs NW p=.0018), OB women had also 2-hG values significantly higher than NW (OB 116,9±24,4 mg/dl, NW 106±25 mg/dl; p=.0072). The percentage of GDM was double in OB when compared to NW (35,14 vs 17,95%) and greater than in OW (24,5%). Systolic (S) and diastolic (D) BP values were significantly different between NW and OW (S 108,6±11,2 vs 115,6±13,8 mmHg p=.0011, D 66,8±7,8 vs 70,7±8,4 mmHg p=.0046), NW and OB (S 108,6±11,2 vs 120,5±13,9 mmHg p<.0001, D 66,8±7,8 vs 74,6±9,4 mmHg p<.0001), OW and OB (S 115,6±13,8 vs 120,5±13,9 mmHg p=.020, D 70,7±8,4 vs 74,6±9,4 mmHg p=.0051). Conclusion: Our data demonstrates that the IOM’s guidelines are no longer being followed satisfactorily. OB an OW women had excessive GWG, glucose and BP values significantly higher than NW women, and a greater prevalence of GDM. It would be useful to have an effective pre-gestational counselling program, and a strict GWG control during pregnancy, particularly during the 1st and 2nd trimester to reduce the risk of developing metabolic diseases during pregnancy and later in the life. Disclosure of Interest: None Declared P70 ETHNICITIES AND POSTPARTUM MATERNAL REHOSPITALIZATION C. M. Santiago 1,*, A. Hamaoui 1, A. Chadee 1, R. Mercado 1 Ob/Gyn, Lincoln Medical and Mental Health Center, Bronx, USA Problem Statement: With the increasing number of cesarean deliveries performed over the recent years, there has been a rise in maternal morbidity and mortality. There have been few studies which evaluate complication rates across ethnic groups. This study assesses the rates of maternal readmission, an indicator of associated complications in the index admission, among women of African and of Hispanic descent during the postpartum period. Methods: The study reviewed the electronic medical records of all postpartum women readmitted within 60 days of delivery over a five year period from 20072011. The dataset was collected from 11,333 deliveries, 66.89% of which were of Hispanic and 26.67% of which were of African descent. Results: Rehospitalization rates after vaginal deliveries for both groups were low, 0.44% for women of African descent and 0.60% for Hispanic women, and not significantly different from each other. However, the patients who underwent cesarean delivery had four times (1.95% vs. 0.52%, P <0.0001) (OR 3.80 95% CI 2.57 to 5.62 P<0.0001) the readmission rates when compared to patients who had vaginal deliveries. This was similar to both ethnicities. Collectively, the average time from delivery to rehospitalization was 12.16 ± 8.89 days after vaginal delivery and 15.36 ± 10.73 days after a cesarean, with no differences in these rates among the ethnic groups. On the other hand, considered separately, the rate of readmission was twice as high in women of the African descent as compared to women of Hispanic heritage (OR 2.30, 95% CI 1.42 to 3.74, P 0.0007). And when admitted, women of African descent tended to stay longer (3.43% vs 1.52%, P 0.0009). For both ethnicities (being similar the data were combined), the most common causes of rehospitalization were: infection (75.23%), hypertensive disorders of pregnancy (12.84%), and late postpartum hemorrhage (7.34%). Conclusion: Cesarean delivery is associated with higher rates of maternal morbidity for both groups; however, the more so among women of African descent. The majority of postpartum readmissions occurred within the first two weeks of discharge. Infections were a major challenge to both ethnicities, postoperative wound infections following cesarean delivery, and endometritis following vaginal deliveries. Notably paucity in readmissions for hypertensive disorders of pregnancy and postpartum hemorrhage was found. Prevention of maternal infections continues to be an important priority. Disclosure of Interest: None Declared P71 IS IMPEDANCE CARDIOGRAPHY AN EFFICIENT METHOD TO EVALUATE PREGNANT PATIENTS WITH MULTIPLE CARDIOVASCULAR RISKS? - CASE REPORT R.-M. Sima 1,*, I.-A. Badarau 2, C. Ciornei 2, R. Papacocea 2, C. Moisei 1, L. Ples 1 1Obstetrics-Gynecology, "Bucur" Maternity, 2Physiology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania Problem Statement: Preeclampsia, gestational diabetes, or pregnancy-induced hypertension identify a woman at risk for cardiovascular disease. Diabetic women carry a 2-4 times increased risk of a hypertensive pregnancy compared to non-diabetic people. Impedance cardiography (ICG) is a noninvasive technology that can be used to assess cardiovascular function. Methods: We present the case of 34 years old, obese and smoker, patient investigated in our clinic and developed gestational diabetes in the third trimester of pregnancy. She had normal blood pressure Patient underwent a complete assessment including screening history, physical examination, blood glucose level, blood pressure and body weight measurements, ultrasound and impedance cardiography examination. All the results were compared with similar findings of a smoker patient in the third trimester of pregnancy, non obese, with normal blood pressure and without gestational diabetes. Results: Here we report the hemodynamic parameters that we measured using impedance cardiography in a diabetic, obese, normotensive third trimester pregnant patient compared with a non diabetic, non obese, diabetic third trimester pregnant patient. Using ICG we performed measurements in supine position. Our findings were: diabetic patient has increased heart rate. Base impedance was also elevated in this patient, but with no statistical significance. Cardiac index was increased in the diabetic patient. Systemic vascular resistance registered lower values for the diabetic patient. The diabetic patient had a good outcome of pregnancy. Conclusion: Impedance cardiography is a noninvasive method which provided us the hemodynamic profile in a case of obesity and diabetes during pregnancy, without associated gestational hypertension. Disclosure of Interest: None Declared 93 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 P72 DOPPLER PARAMETERS IN FETAL HYPOXIA-PERINATAL ASPHYXIA T. Stefos Ob-Gyn, University of Ioannina, Ioannina, Greece Problem Statement: Fetal hypoxia-perinatal asphyxia is a complex phenomenon and a complicated situation.It is very difficult to be given a precious definition for these two conditions.Preeclampsia and gestational diabetes are two conditions which could cause fetal hypoxia.Do we have methods to predict or to detect the fetal hypoxia? Methods: A variety of criteria has been used to characterize the fetal hypoxia and perinatal asphyxia. Biochemical indices, acidosis, fetal monitoring methods, Apgar score, neurologic signs or multiple organ dysfunctions are some of the conditions which characterize the asphyxia in general. It is known that oxygen is transfered across the placenta and it has a reversible binding to fetal hemoglobin, in order to be achieved the growth and metabolism of the fetus. Fetal hypoxia means oxygen deficiency in the tissues. It happens because of reduced placental perfusion or reduced arterial blood oxygenation or reduced blood flow to the fetal tissues, especially in cases of “microangeiopathy” as pre-eclampsia or gestational diabetes are some of them. Results: In such cases the fetus reacts with a brain-sparing phenomenon, increasing the flow to the brain, heart, adrenals and decreasing the flow to the fetal body, gut, and kidneys. It is observed an increased impedance to flow in the uterine and umbilical arteries. So an increased resistance index and a presence of an early diastolic notch are the characteristics in the Doppler study of the uterine arteries. An increased resistance, absent end– diastolic flow or reversed end –diastolic flow are the manifestations of fetal impairment. The overall perinatal mortality is increased four times in cases with absent end-diastolic flow and 10-11 times in cases with reversed flow. It is also known that low cerebroplacental ratio increases fetal motrality. The presence of end–diastolic pulsation in umbilical vein is a sign of acidemia as also a reduction in umbilical venous flow with normal peak velocity in ductus venosus is a significant manifestation of fetal hypoxemia. Conclusion: In summary hypoxia is a severe stress for the fetus .The fetus reacts with redistribution of the blood flow to the brain. So high resistance in umbilical artery and simultaneously low flow restistance in middle cerebral artery suggests fetal hypoxia. Disclosure of Interest: None Declared P73 UK COST-EFFECTIVENESS ANALYSIS OF INCORPORATING THE SFLT-1/PLGF RATIO TEST INTO STANDARD CLINICAL PRACTICE FOR DIAGNOSIS OF PREECLAMPSIA AND/OR HELLP SYNDROME T. Strunz-McKendry 1,*, D. Allegranza 2, M. Hund 3, J. Posnett 4 1Health Economics, Roche Diagnostics Ltd., Burgess Hill, UK, 2Clinical Operations, 3Medical and Scientific Affairs, Roche Diagnostics International Ltd., Rotkreuz, Switzerland, 4Health Economic Modelling Unit, HERON Commercialization - A PAREXEL Company, London, UK Problem Statement: Hypertensive disorders, such as pre-eclampsia, affect approximately 10% of pregnancies in the UK, resulting in substantial maternal and perinatal mortality and morbidity. NICE guidelines recommend hospital admission for women diagnosed with pre-eclampsia, but not for women with mild/moderate gestational hypertension only. Uncertainty in diagnosis of preeclampsia may lead to unnecessary hospitalisation of women who do not develop pre-eclampsia, and early prediction of pre-eclampsia onset may therefore save costs. The sFlt-1/PlGF ratio test accurately rules-out the onset of pre-eclampsia/Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome within 1 week (sFlt-1/PlGF ratio ≤38), and rules-in preeclampsia/HELLP syndrome within 4 weeks. The study aim was to evaluate the cost-effectiveness of the test in clinical practice in the UK. Methods: A decision tree model was developed from a UK NHS payer perspective to estimate costs associated with the diagnosis and management of pregnant women from first presentation with clinical suspicion of pre-eclampsia until delivery. Three levels of management intensity were defined: low (midwifeled, average weekly outpatient clinic appointment), intermediate (midwife-led, 94 average twice-weekly outpatient clinic appointment), and high (specialist-led, hospitalisation). Cost-effectiveness was evaluated by comparing expected costs between two scenarios. In the 'no test' scenario, current diagnostic criteria informed management decisions, and the proportion of women hospitalised prior to diagnosis was taken from PROGNOSIS, a prospective, noninterventional, blinded study of 1050 women with suspected pre-eclampsia. In the 'test' scenario the proportions of women assigned to each level of management intensity was determined by the test result indicative of the patient's risk of pre-eclampsia diagnosis. Test results, incidence of preeclampsia, and length of hospitalisation were available from prognosis. The analysis conservatively assumed that neither the introduction of the test, nor changes in management affected the incidence and severity of pre-eclampsia. A proportion of women developing pre-eclampsia while not hospitalised require emergency admission (EA), and/or neonatal ICU (nICU) stay for the new-born. These costs were included in the analysis. Results: The model predicts that introducing the test into clinical practice will reduce the number of women hospitalised prior to pre-eclampsia diagnosis by 50% from 379 to 188, in a cohort of 1050, leading to a cost saving of £399 per patient. The model predicts that in the 'test' scenario, 41% of women hospitalised prior to diagnosis will develop pre-eclampsia, compared with 26% in the 'no test' scenario, indicating more targeted decision-making when the test is used. As fewer women are hospitalised, there may be an additional 5-6 EAs and 1-2 nICU admissions in the 'test' scenario. Conclusion: The majority of women hospitalised with a suspicion of preeclampsia in the UK will not develop pre-eclampsia, indicating a need for improved assessment of risk. The sFlt-1/PlGF ratio test enables more accurate identification of patients most likely to develop pre-eclampsia, thereby reducing unnecessary hospitalisation. As such, introduction of the test into UK clinical practice has the potential to generate substantial cost savings, with a small increase in EAs and nICU admissions. Disclosure of Interest: T. Strunz-McKendry Employee of: Roche Diagnostics Ltd., D. Allegranza Employee of: Roche Diagnostics Ltd., M. Hund Employee of: Roche Diagnostics Ltd., J. Posnett Consultant for: HERON Commercialization - A PAREXEL Company P74 WOMEN'S EXPERIENCE OF CERVICAL RIPENING BALLOON FOR INDUCTION OF LABOUR T. L. Tan 1,*, G. Y. H. Ng 1, S. E.-L. Lim 1, S. Tagore 1, G. S. H. Yeo 1 KK Women's and Children's Hospital, Singapore Problem Statement: The Cochrane Database of Systematic Reviews concluded that mechanical methods of induction of labour (IOL) were as effective as prostaglandins (PGE) in achieving delivery with no change in caesarean section or infection rates. It also concluded that mechanical methods were less likely to lead to excessive uterine contractions and discomfort. The cervical ripening balloon (CRB) is licensed for IOL. Its acceptability by women however is not well studied. We aim to assess the pain and satisfaction scores of women undergoing IOL with either CRB or PGE. Methods: Women aged 21 – 40 years old with singleton term pregnancy and no major fetal anomaly suitable for vaginal delivery were recruited unless they were in labour, had cervical dilatation ≥3cm, confirmed ruptured membrane, abnormal CTG or scarred uterus. Participants were randomized to receiving CRB or PGE. If the woman was randomized to receive CRB, the CRB was inserted in lithotomy position with the use of a bivalve speculum. The CRB was filled with Trainer p Trainee CRB insertion at 1st attempt (31) 87.5% Help sought (31) - Time to insert CRB, min (31) 3:38 ± 2:16 Pain score at IOL, 1-10 (83) 2.9 Pain score after IOL, 1-10 (83) 4.6 Satisfaction score, 1-5 (83) Would recommend (31) (7) 91.3% (21) 8.7% (2) 5:34 ± 2:27 1.000 * 0.059 ± 2.0 3.2 ± 1.2 0.623 ± 2.7 4.5 ± 2.3 0.881 3.75 ± 1.5 3.3 ± 1.6 0.491 87.5% (7) 65.2% (15) 0.379 * Abstract Book normal saline over a period until both balloons contain 80 mls of normal saline. If the woman was to receive PGE, the PGE would be inserted in the posterior fornix of the vagina and repeated as necessary. Cardiotocogram was performed before and after the IOL. After 12 hours of IOL, the CRB is removed if inserted, and artificial rupture of membrane (ARM) performed with the use of oxytocin infusion as indicated to augment labour. The characteristics of the women, as well as their pain and satisfaction scores were obtained by interviewing the women at IOL and after delivery. Pain scores were rated on a scale of 1 (no pain) to 10 (most painful), while satisfaction score was rated on a scale of 1 (poor) to 5 (good). The data is analysed with SPSS version 19. Results: A total of 87 women were recruited. Three cases were excluded for preterm delivery, cervical dilatation >3 cm, breech in labour. One case of CRB withdrew because of pain. The remaining 83 women were analysed and their characteristics are shown below. CRB Maternal age, years (83) Ethnicity (83) 29.0 p PGE2 ± 5.3 29.5 ± 5.0 0.649 0.222 Chinese 35.5% (11) 42.3% (22) Malay 54.8% (17) 36.5% (19) Indian 3.2% (1) 15.4% (8) Primip (83) 61.3% (19) 44.2% (23) 0.174 BMI, kg m-2 (83) 25.5 ± 5.2 25.2 ± 5.2 0.817 Gestational age, wks (83) Cervical dilatation,cm(83) 39.4 ± 1.1 39.2 ± 1.2 0.357 1.0 ± 0.7 0.9 ± 0.7 0.855 There was no difference in the pain score at IOL between the CRB and PGE group (3.1 ± 1.4 vs 2.6 ± 1.9, p = 0.181). However, pain score in the CRB group was lower than the PGE group subsequently (4.5 ± 2.3 vs 5.6 ± 2.4, p = 0.044). Women were equally satisfied with both methods (3.4 ± 1.5 vs 3.2 ± 1.4, p = 0.465) and were equally likely to recommend the method for IOL (71.0% vs 69.2%, p = 1.000). Conclusion: The experience of women undergoing IOL with CRB or PGE were equally satisfactory although the perception of pain after IOL was lower in the CRB group. Both methods of IOL are acceptable to women and should be made available to offer women choice. Disclosure of Interest: None Declared P75 LEARNING CURVE IN THE USE OF CERVICAL RIPENING BALLOON T. L. Tan 1,*, G. Y. H. Ng 1, S. E.-L. Lim 1, S. Tagore 1, G. S. H. Yeo 1 KK Women's and Children's Hospital, Singapore, Singapore Problem Statement: Compared to prostin (PGE), cervical ripening balloon (CRB) is equally acceptable and efficacious in induction of labour (IOL). CRB is reported to have lower risk of excessive uterine contractions and is a useful alternative in women where prostagladins are contraindicated or caution. Its use is however less prevalent and training clinician may require undue resources. Our literature search did not reveal any published study on the ease of training. The aim of this study is to analyse the learning curve in the use of cervical ripening balloon. Methods: Trainees were given a lecture followed by hands-on session on models in the use of CRB by an experienced trainer. Posters showing step-by-step instructions are available for reference. When opportunity arises, trainees observe a live insertion of CRB before being supervised for their initial insertion of CRB in women aged 21 – 40 years old with uncomplicated singleton term pregnancy suitable for vaginal delivery and induction of labour. Comparison between trainer and trainee insertions were analysed. Results: A total of 31 CRB insertion were analysed. There were no difference in maternal age, weight, BMI, ethnicity, primiparity and cervical dilatation in women with CRB insertion by trainer or trainee. The gestational age in the 2 groups were also similar. The outcome of CRB insertions by the trainer and trainees are shown in the table below. The time taken to insert CRB by the trainer was shorter compared to that by the trainees who had 2 previous insertion experience (3:38 ± 2:16 vs 8:59 ± 5:39, p = 0.048). Trainees who had 3 or more previous insertion experience however similar timings had and do not require help. We therefore conclude that after 3 insertion experience, competency can be achieved. Conclusion: The use of CRB can be easily taught with competency achieved rapidly after about 3 insertions. Training and availability in the use of CRB should be available to offer maternal choice in their birth plans. Disclosure of Interest: None Declared P76 ANTENATAL DIAGNOSIS OF CYSTIC MASSES IN THE FETAL LUNG: THE NATURAL HISTORY AND OUTCOMES - A SINGLE INSTITUTION'S EXPERIENCE S. Thain 1,*, E. Thia 2, G. Yeo 2 1KK Women's and Children's Hospital, Singapore, Singapore, 2Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore Problem Statement: Congenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration of the lung are the most common lung lesions to be identified by fetal ultrasound imaging. This study aims to look at the natural history and outcomes of these fetal cystic lung masses detected in our centre. Methods: This study was a retrospective observational case review of cases of fetal cystic lung masses of CCAM and bronchopulmonary sequestration diagnosed antenatally in KK Women’s and Children’s Hospital from September 2006 to February 2013 looking at the pregnancy, fetal and paediatric outcomes and natural history of antenatally diagnosed fetal cystic lung masses based on our institution’s management protocol. A secondary objective was to assess if a method if using the mass: chest ratio to monitor progression of the mass antenatally would be useful in the prediction of outcomes. Results: Fetal CCAM and bronchopulmonary sequestration masses typically plateaued in size between 26 and 30 weeks gestation. Antenatal ultrasound features of initial mass size and mass: chest ratio, as well as largest mass size and mass: chest ratio were not significantly associated with respiratory morbidity at birth. There was also no significant relationship between trend of lung mass size over gestation and respiratory morbidity at birth (p=0.2093). Two of three fetuses with prenatal ultrasonographic regression of the cystic lung lesion had persistent cystic lung mass on postnatal CT chest imaging. Conclusion: The natural history of fetal cystic lung lesions generally follows a benign course with excellent antenatal, neonatal and paediatric outcomes. Lack of correlation between antenatal involution of cystic lung lesions and postnatal imaging was observed, highlighting the need for postnatal imaging. Disclosure of Interest: None Declared P77 PARTIAL PLACENTAL INSERTION ON INTRA UTERINE ADHESION – CASE REPORT AND REVIEW OF THE LITERATURE. A. Wafi 1,*, L. De Catte 2, A. Vorsselmans 1, L. Monika 1 Obstetrics, UZ Brussels, Brussel, 2Obstetrics, UZ Leuven, Leuven, Belgium Problem Statement: Uterine adhesions complicate up to 0.6% of pregnancies. The increase in incidence during the last decades is attributed to increasing numbers of uterine surgery in the fertile population. Mostly uterine adhesions are considered benign during pregnancy. Placental insertion on uterine adhesions is even more exceptional. Only 41 cases are described in the literature. The obstetrical risks in these patients are unclear. Increased numbers of placental abruption, PPROM and cord prolapse are found. We report an unusual case of a 28-year-old patient with a partial placental insertion on an intra-uterine adhesion diagnosed on 2-D ultrasound at 20 weeks gestation. Amniotic band was excluded through maternal Doppler’s signals in the adhesion. Part of the placenta was implanted on the uterine adhesion with a velamentous insertion of the umbilical cord. Magnetic resonance imaging confirmed the placental implantation over the horizontally oriented adhesion with signs of tension over the adhesion too. There was no argument for umbilical cord prolapse or placental invasion in the myometrium. The patient was admitted for close fetal observation as from 30 weeks of pregnancy and delivered at 34 weeks by primary C-section from a healthy baby. The placental 95 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 implantation was confirmed during the intervention a resection of the adhesion was carried out which allowed histological confirmation. Methods: case report Results: Post C-section Maternal and neonatal evolutions were uneventful. Conclusion: We conclude that pregnancy in presence of intra uterine adhesions is a high-risk situation. Prenatal diagnosed should prompt close feto-maternal surveillance. Surgical resections should be offered if adhesions are found prior to pregnancy. Disclosure of Interest: None Declared P78 DETERMINANTS OF PSYCHOLOGICAL WELL-BEING IN WOMEN HOSPITALIZED FOR HIGH-RISK PREGNANCY. R. Watrowski 1,*, A. Rohde 2 1Obstetrics & Gynecology, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, 2Gynecologic Psychosomatics, Women’s University Hospital Bonn, Bonn, Germany Problem Statement: Pregnancy is associated with a variety of positive and negative mood states, which have been traditionally assessed separately (e.g., depression or anxiety). Recently, growing attention has been dedicated to the “holistic” assessment of mood. The construct of psychological well-being is a sum of negative and positive mood states. The recognition of positive psychological well-being is in accordance with neurophysiological evidence that positive and negative mood states are not only “the other side” of each other, and that they are differentially mapped in the brain. In pregnant women, maternal positive well-being was positively associated with length of gestation and reduced risk of preterm delivery. Methods: We studied factors influencing the psychological well-being and overall negative affectivity in 126 women hospitalized for high-risk pregnancy at the tertiary medical center in Poland (University of Medical Sciences, Poznan). The women completed a questionnaire about their age, parity, education level, marital status, pregnancy week, history of miscarriage, hospitalization reason, perceived partner’s interest, familial support and material conditions (the last three variables indicated on a four-point scale). The psychological well-being was assessed with the 12-Item Well-being Questionnaire (W-BQ12), consisting of three subscales (positive well-being, negative well-being and energy). The negative mood was scored on the Hospital Anxiety and Depression Scale (HADS), consisting of two subscales (depression, HADS-D, and anxiety, HADS-A). Results: 126 patients responded to the W-BQ12, and 124 patients responded to the HADS. The median age of the patients was 26 (17–43) years. The mean gestational age was 30.9 (SD 6.9) weeks of pregnancy. 43% of the patients were primigravidae, whereas 67% were multigravidae. The most common diagnoses were threatening preterm delivery and bleeding in pregnancy. In the univariate analysis, the total scores of the W-BQ12 and HADS correlated significantly only with self-perceived material conditions (p= 0.04 and p=0.03, respectively). The scores for positive well-being (W-BQ12) correlated with familial support (p=0.002), partner’s interest (p=0.02), and material conditions (p=0.005). Planned pregnancy was associated with better scores for positive well-being (p=0.01) and lower scores in HADS-D (p=0.03). The W-BQ12 score for negative well-being was influenced by familial support (p=0.04) and history of miscarriage (non-significant, p=0.09). In a multivariate analysis, only self-perceived material conditions influenced significantly the W-BQ12 scores for general well-being (p=0.02), positive well-being (p=0.04) and energy (p=0.03). As a strong predictor of positive well-being (p=0.02) and energy (p=0.02) emerged also familial support. Conclusion: The study’s main limitation was its reliance on self-reporting. Therefore, the potential impact of pregnancy complication or related medication (e.g. tocolytics) on psychological states could not be determined. However, our study demonstrated that the perceived partner’s interest, familial support and stable material conditions influenced the positive and negative wellbeing significantly more than the age, educational level, parity, pregnancy week, or history of miscarriage. Disclosure of Interest: None Declared P79 96 PREDICTION OF SHORT-TERM OUTCOME IN PREGNANT WOMEN WITH SUSPECTED PREECLAMPSIA: THE PROGNOSIS STUDY H. Zeisler 1,*, E. Llurba 2, F. Chantraine 3, M. Vatish 4, A. C. Staff 5, M. Sennström 6, M. Olovsson 7, S. P. Brennecke 8, H. Stepan 8, D. Allegranza 9, P. Dilba 10, M. Schoedl 11, M. Hund 11, S. Verlohren 10 1Medical University Vienna, Austria, 2Hospital Vall d´Hebron, Barcelona, Spain, 3University of Liège, CHR de la Citadelle, Liège, Belgium, 4University of Oxford, UK, 5Oslo University Hospital and University of Oslo, Norway, 6Karolinska University Hospital, Stockholm, 7Uppsala University, Uppsala, Sweden, 8The University of Melbourne and Royal Women’s Hospital, Melbourne, Australia, 9Dept of Obstetrics, Leipzig University , Leipzig, Germany, 10Roche Diagnostics International Ltd, Rotkreuz, Switzerland, 11Roche Diagnostics GmbH, , Penzberg, Germany Problem Statement: Preeclampsia is a potentially life-threatening syndrome for mother/fetus, diagnosed by hypertension and proteinuria. However, clinical diagnosis is not straightforward and these signs are poor for predicting who will develop preeclampsia/associated adverse outcomes. Where preeclampsia is suspected, there is a need for reliable short-term prediction to optimize prenatal care. An imbalance of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) has been implicated in preeclampsia pathogenesis, with high sFlt-1/PlGF ratio observed before onset. PROGNOSIS (sponsor: Roche Diagnostics) investigated the sFlt-1/PlGF ratio for short-term prediction of preeclampsia and maternal/fetal adverse outcomes in women with suspected preeclampsia. Methods: (multicenter/prospective/double-blind/non-interventional) enrolled 1273 pregnant women (gestational age 24weeks+0days to 36weeks+6days at visit 1) with clinical suspicion of preeclampsia. A cutoff-based model for preeclampsia prediction was derived from the first 500 evaluable subjects and validated with data from a further 550 subjects. Primary objectives: to demonstrate that low sFlt-1/PlGF ratio predicts absence of preeclampsia/eclampsia/HELLP syndrome for 1 week after visit 1 (1-week ruleout), and high sFlt-1/PlGF ratio predicts diagnosis of preeclampsia/eclampsia/HELLP syndrome within 4 weeks of visit 1 (4-week rulein). Secondary objectives included correlation of low and high sFlt-1/PlGF with absence and presence, respectively, of maternal/fetal preeclampsia-related adverse outcomes within 1 and 4 weeks. Preeclampsia and adverse outcomes were combined for an exploratory analysis. Subjects/investigators were blinded to sFlt-1/PlGF data. Diagnostic criteria were protocol-defined from international guidelines. SFlt-1 and PlGF were measured at an independent laboratory (Elecsys® system, cobas e platform, Roche Diagnostics). Results: Preeclampsia prevalence was 19.0%. Feasibility cohort: a sFlt-1/PlGF cut-off of 38 for all gestational ages was favorable. The validation cohort had 90% power to show: a negative predictive value (NPV) of >96%, with the cut-off confirmed for 1-week rule-out of preeclampsia by a 95% CI of 97.9–99.9%; a positive predictive value (PPV) of >25%, with the cut-off confirmed for 4-week rule-in by a 95% CI of 28.4–45.7%. In the full evaluable dataset (n=1050), the sFlt1/PlGF cut-off showed promising NPV, PPV, sensitivity and specificity (Table/Fig); primary objectives were met. Women with adverse outcomes (n=2; cerebral hemorrhage plus preeclampsia; isolated cerebral thrombosis) had high sFLt1/PlGF ratios. sFlt-1/PlGF was correlated with fetal adverse outcomes and a combined endpoint of maternal and/or fetal adverse outcomes and/or preeclampsia. Low and high sFlt-1/PlGF ratios were associated with absence and presence of combined outcomes, respectively. Predictive value of sFlt-1/PlGF cut-off of 38 (n=1050) % (95% CI) NPV 1-week rule-out of preeclampsia 4-week rule-in of preeclampsia 99.1 (98.2–99.6) 94.9 (93.1–96.3) PPV 16.7 (12.3–21.9) 38.6 (32.6–45.0) Sensitiv ity Specific ity 85.7 (72.8–94.1) 70.3 (61.9–77.8) 79.1 (76.5–81.6) 83.1 (80.5–85.5)Image / Graph: Abstract Book Conclusion: A single sFlt-1/PlGF ratio cut-off value of 38 was validated to reliably rule-out (within 1 week) and rule-in (within 4 weeks) preeclampsia in women with suspicion of preeclampsia (gestational age 24–37 weeks), and was predictive of fetal adverse outcomes. The test may help optimize care by improving management of suspected preeclampsia. Disclosure of Interest: H. Zeisler Grant / Research support from: F.Hoffmann La Roche, Consultant for: F.Hoffmann La Roche, E. Llurba: None Declared, F. Chantraine: None Declared, M. Vatish: None Declared, A. C. Staff: None Declared, M. Sennström: None Declared, M. Olovsson: None Declared, S. P. Brennecke Grant / Research support from: Cost recovery financial support received from Roche Diagnostics GmbH for conduct of PROGNOSIS study, H. Stepan Consultant for: Roche Diagnostics International Ltd., D. Allegranza Shareholder of: F.Hoffmann La Roche, Employee of: Roche Diagnostics International Ltd., P. Dilba: None Declared, M. Schoedl Shareholder of: Roche Diagnostics International Ltd., Employee of: Roche Diagnostics International Ltd., M. Hund Shareholder of: Hoffmann La Roche, Employee of: Roche Diagnostics International Ltd., S. Verlohren Grant / Research support from: Roche, Novartis, Consultant for: Roche, ThermoFisher P80 ENDOMETRIAL PATHOLOGY IN TAMOXIFEN USERS: A RETROSPECTIVE STUDY S. Aguilar 1,*, V. Ribeiro 1, S. Valadares 1 Maternidade Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central, Portugal Problem Statement: Tamoxifen improves survival rates in hormonal receptor positive breast cancer patients, but is associated with endometrial proliferation, hyperplasia, polyp formation, carcinoma and uterine sarcoma. Regular ultrasound endometrial surveillance in tamoxifen users is controversial since it can lead to women overtreatment. Our objective was to determine the role of gynaecological ultrasound screening for endometrial pathology in tamoxifen treated women. Methods: Retrospective analysis of gynaecological ultrasound, hysteroscopic and endometrial histologic findings in breast cancer patients who started tamoxifen (TAM) between 1990-2005. Inclusion criteria: a minimum of 5 years of TAM use, regular gynaecological ultrasound and a follow-up for at least 5years after TAM treatment onset or until a hysterectomy was performed. Exclusion criteria: endometrial pathology or hysterectomy previous to TAM use. An endometrial thickness ≥10mm on ultrasound defined endometrial thickening. Patients were considered symptomatic if they had abnormal uterine bleeding (AUB). Results: One-hundred and forty-five TAM users were included. Mean age at TAM treatment onset was 53,7years; 13,9% were nulliparous, 59,2% post-menopause and 66,7% had a body mass index ≥25. The mean duration of endometrial followup (from TAM treatment onset until a patient’s hysterectomy or last appointment) was 9,6years. Endometrial pathology was suspected by ultrasound and/or AUB in 48,3% (n=70): 41,4% (n=60) had endometrial thickening, 4,8% (n=7) other atypical ultrasound endometrial pattern and 2,1% (n=3) were symptomatic but had a normal endometrium on ultrasound. Based on those suspicions 65 women were subjected to an invasive endometrial evaluation: 62 had a diagnostic hysteroscopy and 3 endometrial aspiration alone. Endometrial pathology was detected in 36,6% of TAM users (n=53): 33,1% were diagnosed with polyps, 5,5% with hyperplasia without atypia and 2,1% with cancer (n=3) – 2 adenocarcinomas and 1 carcinosarcoma. 43% had more than 1 invasive procedure until diagnosis. Symptomatic patients had endometrial pathology in 90% of the cases. Endometrial pathology incidence in the sub-group of patients with asymptomatic endometrial thickening (n=43) was 79,1%, rising to 88,2% if endometrial thickening was symptomatic (n=17). AUB was significantly more frequent in the group with endometrial pathology compared to women subjected to an invasive endometrial study but without a subsequent diagnosis of endometrial pathology (32,7% versus 10%). All 3 endometrial cancer subjects were obese; 2 were symptomatic; they were older at TAM treatment onset and endometrial pathology diagnosis than individuals with other endometrial pathologies; diagnosis was made 1 and 6 years after 5 years of TAM treatment in two cases and in the other one during the second year of TAM use. Conclusion: In our study endometrial pathology incidence in the group with asymptomatic ultrasound endometrial thickness ≥10mm was 79,1%, rising to 88,2% if endometrial thickening was accompanied by abnormal uterine bleeding. Using this clinical marker in association with gynaecological ultrasound we detect endometrial pathology in 36,6% of tamoxifen users. Polys were the most frequent entity. Three of the 53 endometrial pathology cases were malignant (5,7%); they strongly correlated to older age, abnormal uterine bleeding and obesity. Disclosure of Interest: None Declared P81 MAYER-ROKITANSKY-KÜSTER-HAUSER SYNDROME WITH UNILATERAL RENAL AGENESIS - A CASE REPORT. L. Ahmad 1,*, S. Al-abri 1 Gynae and Obs, Armed Forces Hospital, Muscat, Oman Problem Statement: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a disorder that occurs in females and mainly affects the reproductive system. This condition causes the vagina and uterus to be underdeveloped or absent. Women with MRKH syndrome have a female chromosome pattern (46, XX) and normally functioning ovaries, they also have normal female external genitalia, pubic hair and normal breasts. Women with MRKH syndrome may also have abnormalities in other parts of the body. The kidneys may be abnormally formed or positioned, or one kidney may fail to develop (unilateral renal agenesis). Methods: A case report Results: A- 25-year-old female, married since 3 years, reported to infertility clinic with complaints of unable to initiate menses since 12 years, severe dyspareunia along with voiding difficulties and recurrent UTI, patient did not seek any medical advice earlier. The patient undergoes puberty with normal thelarche and adrenarche. Physical examination revealed normal secondary female sexual characteristics with normal height, breast, axillary and pubic hairs. The vulva, labia majora, labia minora, clitoris and urethra all were normal. Speculum examination showed blind vagina around 1.5-2 cm and cervix was not visualized. Hormonal profile showed FSH- 6.470m IU/ml, LH- 8 mIU/ml, estradiol 216.400, testosterone 0.707 nmol/L. Imaging modalities used in which Ultrasonography showed vaginal region with small tubal structure, aplastic uterus and both ovaries were not visualized. MRI showed aplastic uterus, non-appreciable cervix, and ovaries with no abnormality and thin vagina in the lower 1/3rd. Ultrasound KUB showed normal right kidney however, left kidney was not seen. IVU showed left renal agenesis. Informed consent obtained from the couple for vaginoplasty and vaginal reconstruction. During Postoperative follow up, patient reported to have satisfactory coitus. No vaginal scarring, infection and bleeding. Conclusion: The cause of MRKH syndrome is unknown, although it probably results from a combination of genetic and environmental factors. The goal of treatment is to provide the patient with an unscarred vagina that allows sexual functioning. Patients with Mayer-Rokitansky-Kuster-Hauser syndrome can become pregnant by having oocytes harvested, fertilized, and implanted in a surrogate. Disclosure of Interest: None Declared P82 WOMEN'S ATTITUDES TOWARD EARLY DIAGNOSIS OF CERVICAL CANCER M. Akbas 1,*, S. Gokyildiz 1, T. Ucar 1, N. Yalcin 1 Midwifery, Cukurova University Adana Health High School, Adana, Turkey Problem Statement: Cancer is a major public health problem for both the world and our country because of the burden of the disease, its lethality and the increasing trend in its incidence. Women are at high risk throughout their lives 97 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 for the structural disorders related to the reproductive system and the formation of tumor diseases. Screening programs have a significant impact on the reduction of the cervical cancer. This study is conducted as descriptive and crosssectional in order to determine the attitudes of women towards early diagnosis of cervical cancer. Methods: The study population consists of all women between the ages of 20 and 64 applied to the obstetrics and pediatrics outpatient clinic of the hospital for any reason between 14 July and 31 December 2014. Women who participated in the survey are divided into "20-29", "30-39", "40-49", "50 and up" age groups according to Adana female population data of Turkey Statistical Institute in 2012. The study sample consists of 599 women who participated voluntarily. Before the study, the hospital ethics committee approval, necessary permits from the hospital management and written consent of women are taken. Data were taken by a questionnaire, and a 30-item "Cervical Cancer Early Diagnosis Attitudes Scale", which is developed by Ozmen. Results: It is obtained that participants' mean age is 37.62 ± 11.733, average marriage age is 20:17 ± 4.681, and average number of children is 2.95 ± 1.818. It is determined that of the participants, 74.8% (n = 448) had gynecological examination, 53.8% (n = 322) of those who had gynecological examination goes to gynecological examination due to illness complaint, 22.7% (n = 136) of those who had not gynecological examination did not go to examination because of lack of an illness complaint, 50.3% (n = 301) have cervical cancer related knowledge, 32.1% (n = 192) obtained this information from health care providers, 1.2% (n = 7) received cervical cancer diagnosis, 6.8% (n = 41) have family member diagnosed with cervical cancer, 56.1% (n = 23) of those who have family member diagnosed with cervical cancer have a second degree relative diagnosed with cervical cancer, 41.7% (n = 250) have knowledge about pap smear tests, 31.6% of the (189) have pap smear test, 54.5% (n = 103) have pap smear test due to doctor recommendation when she went to a doctor for gynecological examination, 90.5% (n = 371) of those who had not pap smear screening test because of lack of an illness complaint. It is found that total score average of the attitude scale towards early diagnosis of cervical cancer is 109.33 ± 9.345, the distribution range is from 77 to 137; perceived sensitivity subscale average of the scale is 31.96 ± 3.837, perceived severity subscale average of the scale is 31.62 ± 4.709, perceived barriers subscale average of the scale is 24.29 ± 4.160, perceived benefits subscale average of the scale is 21:47 ± 2.522. The relationship between the situations, having children, having a gynecological examination, having information about cervical cancer, having a family member diagnosed with cervical cancer, having information about pap smear, having a pap smear test and total score average of the scale is statistically significant (p<0.05). Conclusion: In the light of these results, the regulation of educational programs for women related to the importance of cervical cancer and Pap smear tests and awareness-raising among women are recommended. Disclosure of Interest: None Declared P83 THE ROLE OF DOPPLER ULTRASOUND IN PRE AND POST TREATMENT OF UTERINE ARTERIOVENOUS MALFORMATION – A CASE SERIES R. Amster 1,*, J. Hartoov 1 Ob&Gyn, Lis Maternity Hospital, Tel Aviv, Israel Problem Statement: Arteriovenous malformations (AVM) of the myometrium are considered a rare entity. Data from recent studies suggest AVM are more prevalent than previously believed. Pregnancy related uterine trauma is a major risk factor for the development of acquired uterine AVM. It is believed that acquired uterine AVM is fed from a solitary vessel while congenital lesions have many feeding vessels. Intermittent torrential hemorrhage is the hallmark of AVM. We now realize that some women with AVM are asymptomatic or may present with variable bleeding pattern. Although Angiography is still the gold standard in diagnosing AVM, Doppler Ultrasound is the most common first diagnostic tool and acquired uterine AVM can be from more than soluitary vessel. Methods: Patiens reffered to our unit after ultrasound exam that revealed myometrial hypo-echogenic mass raising the suspicion of an AVM. Doppler Ultrasound imaging established the diagnosis of a uterine wall AVM. The patient 98 was treated with selective embolization treatment and than evaluated by post treatment Doppler Ultrasound. Results: Doppler Ultrasound imaging established the diagnosis of a uterine wall A-V Malformation in two suspected cases. The patients was treated with consecutive selective embolization evaluated by Doppler ultrasound. Image / Graph: Conclusion: Arterial venous malformation of the uterus should be suspected in women presenting with Intermittent, torrential vaginal hemorrhage, especially following abortion or delivery but can be found post pelvic gynecological procedure like IVF. High index of suspicion is required when hypo echogenic mass is observed in the myometrium. AVM can be reliably diagnosed and followed using Doppler ultrasound. Disclosure of Interest: None Declared P84 COMPARISON OF TWO DOSES OF MIFEPRISTONE IN COMBINATION WITH SUBLINGUAL MISOPROSTOL FOR EARLY MEDICAL ABORTION T. Belokrinitskaya 1,*, N. Frolova 1, D. Ananyina 1, E. Selesnyova 1, E. Hromykh 1, I. Belokrinitskaya 2 1Obst/Gynec Department, Chita State Medical Academy, 2Obst/Gynec Department, Medical Center “Health plus”, Chita, Russian Federation Problem Statement: Medical methods of abortion have been proved to be safe and effective (WHO, 2012). Combined regimens of mifepristone with prostaglandins are more effective than single agents. In the combined regimen, the oral dose of mifepristone can be lowered to 200 mg and the subsequent misoprostol can be administered vaginally, sublingually or buccally. Methods: The present study was prospective, randomized, and cohort; it was approved by the Ethics Committee of the Chita State Medical Academy. In the study, 1728 pregnant women with up to 9 weeks amenorrhoea received 600 mg (group I, n=908) or 200 mg (group II, n=820) oral mifepristone (Pencrofton; Pencroft Pharma, Russia), followed 24-48 h later by sublingval misoprostol 800 μg (Mirolut; Stada Arzneimittel AG, Stada CIS, Russia), for the induction of first trimester abortion. Efficiency was definded as the termination of pregnancy with complete expulsion of pregnancy without the need for surgical evacuation. Outcome measures were the need for surgical evacuation in patients with bleeding or incomplete abortion, and the presence of an ongoing pregnancy. Clinical history was obtained and physical examination was performed in all cases. Post-abortion ultrasound scanning was used on 14 days. We have analyzed the frequencies, χ2 test, odds ratio (OR) and its 95% confidence interval (CI) to compare the failure rate between the two groups. Results: Efficacy rates were 99.34% (902/908, group I) and 99.88% (819/820, group II) (рχ2 >0.05). The overall frequencies of complications for the group I (600 mg mifepristone) and group II (200 mg mifepristone) are 2.31% (21/908) and 2.07%, respectively (OR=1.1; 95%CI 0.11–2.06) (Table). Continuing pregnancies were more frequent in patients of group I than in group II (0.66% vs 0.12%, OR=5.4, 95% CI 1.70–10.37). All of these women (14) had a history of early nondeveloping pregnancy. Six (0.66%) women of group I and eleven (1.34%) of group II had required surgical intervention to resolve an incomplete abortion (OR=0.5; 95%CI -0.71–0.77). This complication was associated with history of Abstract Book surgical abortion. Nine (52.9%) of those seventeen women had one and eight (47.1%) two previous unsafe abortions. Vacuum aspiration was performed in all cases of incomplete abortion (17). The incidence of severe bleeding with uterine curettage were 1.6-times higher in women received 600 mg mifepristone (0.99% vs 0.61%, OR=1.6; 95%CI 0.49–4.31). Table: Complications of medical abortion in the comparison groups. Complications Continuing pregnancy Bleeding with surgical intervention Incomplete abortion Total Group I (600 mg mifepristone) n=908 6 (0.66%) Group II (200 mg mifepristone) n=820 1 (0.12%) OR 95% CI 5.4* 1.70–10.37 9 (0.99%) 5 (0.61%) 1.6* 0.49–4.31 6 (0.66%) 11 (1.34%) 0.5 -0.7–0.77 21 (2.31%) 17 (2.07%) 1.1 0.11–2.06 * – statistically significant associations. Conclusion: Reduced dose of mifepristone (200 mg) with sublingual misoprostol has been proven highly effective, safe and acceptable for abortions occurring up to 9 weeks (< 63 days) since the last menstrual period. Disclosure of Interest: None Declared P85 UP-REGULATION OF TRANSIENT RECEPTOR POTENTIAL VANILLOID 1 (TRPV1) AND ANKYRIN 1 (TRPA1) ION CHANNELS IN THE EUTOPIC AND ECTOPIC ENDOMETRIUM OF DEEP INFILTRATING ENDOMETRIOSIS AND ENDOMETRIOMA PATIENTS N. Bohonyi 1 2 3,*, B. Szalontai 2, K. Pohóczky 1, K. Kovács 4, B. Kajtár 4, A. Hírné Perkecz 1, M. Koppán 3, Z. Helyes 1 2 1Pharmacology and Pharmacotherapy, University of Pécs Medical School, 2 János Szentágothai Research Centre, University of Pécs , 3Obstetrics and Gynaecology, 4Pathology, University of Pécs Medical School, Pécs, Hungary Problem Statement: TRPV1 and TRPA1 receptors are non-selective cation channels predominantly localized on peptidergic sensory nerves integrating a variety of nociceptive stimuli and mediating neurogenic inflammation. Although recent results indicate its localization on several non-neural cell types, its physiological and pathophysiological roles are unclear. TRPV1 has been described in the human endometrium, but its hormone-dependent alterations and function has not been elucidated. However, TRPA1 expression has not been investigated. Since both channels are activated by a lot of inflammatory mediators and might play a role in pain initiation and maintenance, we analysed their expression in the human endometrium, as well as its alterations in common painful inflammatory gynaecologycal disorders, such as deep infiltrating endometriosis (DIE) and endometrioma at mRNA and protein levels. Methods: A total number of 35 patients undergoing laparoscopic surgeries due to 1) DIE (n=15), 2) endometrioma (n=7), 3), uterine fibroid-induced dysmenorrhea (n=7), or 4) endometrial pipelle biopsies (healthy controls, n=6) were enrolled in this study. None of these women in reproductive age received hormonal therapy. TRPV1, TRPA1 mRNA expression of the samples was determined with quantitative real-time PCR in comparison with the housekeeping gene Ribosomal Protein L9 (RPL9). Immunostaining was performed on formalin-fixed paraffin-embedded sections to investigate TRPA1 and TRPV1 protein localization and distribution. Results: Both TRPV1 and TRPA1 were detected at the mRNA level in the healthy endometrium showing its non-neural expression. Immunostaining for these channels showed scattered cytoplasmatic positivity for stromal and epithelial cells, in turn no cycle-dependent changes were observed. Both TRPV1 and TRPA1 mRNA significantly, 1.5-2.5-fold and 5-7-fold increased in DIE lesions, as well as in endometrioma samples, respectively. In DIE samples epithelium and stroma were densely immunostained for both receptors, while plasmocytes presented stronger reactivity for TRPV1. These cells, alongside with endothelia and granulocytes had moderate staining for TRPA1. Colon epithelium appeared to be weakly positive. Endometrioma samples stained intensely for TRPA1 in epithelia, stroma and fibroblasts. The epithelium and plasmocytes were positive for TRPV1. TRPV1, but not TRPA1 mRNA expression increased significantly (by 1.5- 2.5 folds) in the eutopic control endometrium of women suffering of endometriosis. Conclusion: We provide here the first evidence on TRPA1 expression in healthy eutopic endometrium both at mRNA and protein levels. In addition, TRPV1 and TRPA1 expressions significantly up-regulated in DIE and endometrioma lesions in parallel with an increase of TRPV1, but not TRPA1 transcripts at the autocontrol endometrium samples. These finding were confirmed by immunohistochemistry describing important non-neuronal distribution for these channels. Determining the functional significance of these results needs further investigation. Support: The work was funded by Hungarian GrantS SROP-4.2.2.A-11/1/KONV-20120024, SROP-4.2.2.A-11/1/KONV-2012-0053 and SROP-4.1.1.C-12/1/KONV-2012-0010 Disclosure of Interest: None Declared P86 METABOLIC FINGERPRINTING OF GRANULOSA CELLS FROM NORMAL AND POLYCYSTIC OVARIES M. F. J. Brincat *, J. Gamibin Foundation Year 2, East of England Deanery, Cambridge, UK Problem Statement: By comparing the metabolic profiles of granulosa cells from normal ovaries and those from women with polycystic ovary syndrome (PCOS), one should be able the see differences in the active pathways can be demonstrated. Metabolomic techniques may permit pinpointing of metabolic cycles which are inactive or active in the polycystic ovary. Methods: PCOS Polycystic ovary syndrome is a common disease in premenopausal women. There is much debate as to whether PCOS is a single disease or a combination of several disorders. Insulin resistance and hyperinsulinaemia are well recognized characteristics of anovulatory women with PCOS. Granulosa cells are somatic cells found closely associated with the developing female oocyte gamete. Granulosa cells were extracted from follicular fluids from normal and PCOS patients, then cultured and treated with insulin. After 4 hours incubation with insulin, the cell extract’s and media were stored, freeze dried and MR spectra were obtained using a Bruker 600 MHz spectrometer (pulse angle 45; repetition time, 3.5s) Results: The results from this study show that metabolomics and the examination of metabolic profiles of granulosa cells could be an important part of an integrative approach for assessing the possible causes of PCOSpolycystic ovary syndrome. Conclusion: Metabolomics and the examination of metabolic profiles of granulosa cells could be an important part of an integrative approach for assessing the possible causes of PCOSpolycystic ovary syndrome. Disclosure of Interest: None Declared P87 EXPERIENCE OF KNOTLESS WOUND CLOSURE DEVICE USED IN LAPAROSCOPIC MYOMECTOMY OF UTERUS C.-C. Chan ObGyn, Taipei City Hospital, Taipei, Taiwan, Province of China Problem Statement: Hemostatic control, suturing, and renovating leiomyoma are the most important procedures associated with laparoscopic myomectomy. When compared to the normal situation, suturing and tieing off using slender instruments are more imprecise and more difficult. As a result, problems may occur, such as when the joining of tissue is not strong enough and when there are difficulties carrying out stypsis during suturing and cross-cutting. Knotless wound closure device is a superior device that is equipped with an efficient barb and welded loop design. This suture invention is able to help the surgeon to close a wound, to stabilize the closure and to tie off rapidly. Methods: We applied this wound closure device to laparoscopic myomectomy with the aim of diminishing surgery time, reducing blood loss and reducing the number of complication; such improvement ought to result in better uterus recovery and pregnancy.This prospective study evaluated data on the efficacy of treatment of 62 women who underwent laparoscopic myomectomy at Taipei City Hospital Zhongxiao Branch from January 2010 through to August 2012. The 99 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 patients were randomly assigned to either the Knotless wound closure device group or the 2-0 vicryl suture group. Results: The two groups were similar in terms of age, body weight, delivery number, hemoglobin and hematocrit before surgery. After surgery, blood loss, operation time, change in hemoglobin, change in hematocrit and the presence of uterus defects among the knotless wound closure device group were significant less than among the vicryl group. There are 26 patients pregnant after accepted surgery within 2 years. 12 of them are classified as Knotless wound closure device group and the others are 2-O Vicryl. Among these 26 patients, 1 patient classified as 2-O Vicryl has received hysterectomy cause of uterine rupture on the timing of the 24 week during her pregnancy, and the others have taken Cesarean Section successfully for childbirth. Conclusion: When compared with traditional suture material, the knotless wound closure device, which is equipped with an efficient barb and welded loop design, allows the surgeon to stably close any wound rapidly without having to tie-off separately. The wound margin is held firmly together, which is especially important during the critical stage of wound heal over and the stage of pregnancy; furthermore, the sutures are absorbable in 180 days. In conclusion, the knotless wound closure device brings a lot of benefits when used for laparoscopic myomectomy. Disclosure of Interest: None Declared P88 HISTOLOGICAL FINDINGS IN POST MENOPAUSAL WOMEN REFERRED FOR ATYPICAL GLANDULAR CELLS IN THEIR PAP SMEARS. V. Costa Ribeiro* and Aguilar S; Paula T.; Borrego J. Gynecology, Alfredo da Costa Maternity, Lisbon, Portugal Problem Statement: The aim of this study was to evaluate the histopathology and the long-term follow-up outcome of post menopausal women who had atypical glandular cells on Pap smears. Methods: We conducted a retrospective study, at the Department of Colposcopy at Alfredo da Costa Maternity in Lisbon, including all AGC cervical liquid-based cytology in post menopausal women (ThinPrep) between January 2009 and December 2013. All specimens were evaluated and reported using 2001 Bethesda System terminology. Age of diagnosed AGC, parity, colposcopic-directed biopsies, endocervical curettage, histological findings from cervical cones and endometrial sample studies were analyzed. Statistic significance (p<0.05) was calculated using SPSS 20.0. Results: The overall prevalence of post menopausal women in AGC ThinPrep was 26.7% (n=23 from a total of 86 identified AGC liquid-based cytology). The medium age of AGC diagnose among the study group was 63.4. The average age of first menses and menopause was 12.3 and 50 years respectively, women had their first intercourse around 19.2 years and the group accounted for 69.6% (n=16) of multiparous. When analyzing the different subtypes of AGC we found an incidence of 65.2% (n=15) of AGC not otherwise specified (NOS), 21.7% (n=5) of AGC in favor of neoplasia (FN), 8.7% (n=2) of concomitant AGC-NOS and atypical squamous cells of undetermined significance (ASCUS) and 4.3% (n=1) of AGC-FN in the presence of high-grade squamous intraepithelial lesion (HSIL). Colposcopic-directed biopsies were performed in 17.4% (n=4) patients with identification of 75.0% of squamous cervical intraepithelial neoplasia (CIN) (CIN I= 1; CIN III=2). Endocervical curettage was performed in 39.1% (n=9) with an 11.1% identification of CIN (CIN III=1). A total of 13.0% (n=3) patients were submitted to treatment by excisional cone with a 66.7% identification of CIN (CIN III=2). Endometrial study was performed by ultrasound and hysteroscopydirected biopsies with the identification of 8 cases of endometrial pathology (2 cases of endometrial hyperplasia and 6 cases of endometrial neoplasia). In this retrospective study of 23 post menopausal women who present with an AGC liquid-base cytology we were able to identify 2 cases of CIN III, 6 cases of endometrial neoplasia and 2 cases of endometrial hyperplasia. Conclusion: Studies show that women with ACG cytology older than 50 or more commonly have endometrial carcinoma. Our study identified 8.7% (n=2) of CIN III, 8.7% (n=2) of endometrial hyperplasia and 26.1% (n=6) of endometrial carcinoma. In our small sample the presence of endometrial pathology among post menopausal women with AGC liquid based cytology is the most frequent diagnose (p=0.038). Disclosure of Interest: None Declared 100 P89 ECTOPIC PREGNANCY ON INSTITUTO NACIONAL DE PERINATOLOGÍA ISIDRO ESPINOSA DE LOS REYES, EVALUATION OF THE EXPERIENCES AND RESULTS OBTAINED WITH CONSERVATIVE MANAGEMENT WITH METHOTREXATE FROM JANUARY 2013 TO JUNE 2014 A. García Luna Vásquez , O. P. Cruz Orozco, A. Belmont Gómez, E. A. Cruz Cruz *, R. E. Rodríguez Guerrero Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, México D.F., Mexico Problem Statement: Ectopic pregnancy happens approximately in 1-2% of all pregnancies. The prevalence of ectopic pregnancy in México is reported to be 1 in 200 to 1 in 500 pregnancies. Cases of suspected or confirmed ectopic pregnancy were admitted to the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, from January 2013 to June 2014. In the past, an ectopic pregnancy was considered a surgical emergency, requiring open abdominal surgery and post-operative hospitalization. With early diagnosis, the availability of laparoscopy and conservative management with methotrexate has become possible. Tubal pregnancy treatment with methotrexate has shown to be more effective on early pregnancies where the risk of tubal rupture is small. Methods: Asses the success and failure of conservative treatment with methotrexate in the Instituto Nacional de Perinatología from January 2013 to June 2014, and include the related factors involved on the final outcome of treatment. A retrospective cohort study of all cases that were admitted to our institution through the emergency department with confirmed diagnosis or suspected ectopic pregnancy from July 2013 to June 2014 was evaluated. From these patients, the method used to make initial diagnosis was assessed by means of using basal determinations of hCG and/or ultrasound. hCG was registered and so posterior determinations. Other ultrasound variables were also evaluated such as: extrauterine pregnancy location, gestational sac length, cardiac activity presence, and free abdominal fluid. The information was taken directly from clinical files, including physical as electronic. All data were obtained on the gathering instrument and subsequently filled to an Excel data page. Results: A total of 110 cases were registered with a confirmed or suspected ectopic pregnancy. Ectopic pregnancy was localized to Fallopian tube on 93% of the times and the rest on other regions. Of all patients, 45% required laparotomy as definitive treatment, following laparoscopy. Only 12.7% (18 patients) received conservative management with methotrexate. Mean gestational age was 6.58 +/- 1.41 weeks, with basal gonadothropin of 1203.5 +/- 1268.9mUI. Gestational sac length was less than 3.5cm. Fetal activity was present in only 1 case. Free abdominal fluid was reported in 7 cases. The success with methotrexate treatment was 77.78%, and the rest of patients required some other intervention. Therapeutic failure was considered as the necessity to realize some other intervention to the patient apart from methotrexate administration. Variables like gestational age, gestational sac length, and free abdominal fluid are similar on all patients with therapeutic success and therapeutic failure, though, basal values of quantitative hCG were greater on patients with failure treatment than those with success. Both groups showed higher increments of hCG on the second and fourth days following treatment. This increment was greater than 50% on all cases associated with failure compared with success. Conclusion: Different studies demonstrate that initial values of hCG possess great predictive value for determining success or failure of methotrexate treatment. Other values turn out to be important, such as cardiac fetal activity or the following behavior of hCG. Disclosure of Interest: None Declared P90 OFFICE GYNAECOLOGICAL SURGERY: PRELIMINARY RESULTS AT HOSPITAL DEL MAR, BARCELONA E. Del Amo*, K. Vellvé, P. Nicolau, R. Carreras Gynaecology and Obstetrics, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain Problem Statement: In January 2007 an office gynaecological surgery programme was developed as a way to alleviate the waiting list for minor surgical procedures. Given the positive results of diagnostic hysteroscopies and Abstract Book tubal occlusion it was agreed to outsource most of these procedures to primary care from October 2010, keeping only patients of special consideration at the hospital. Methods: All office surgical records were reviewed from January 2007 to December 2013 and the results are reported below. All patients were informed about the technique potential complications and signed the informed consent. None of the breast tumours removed had any malignancy suspicion prior to procedure. The surgical team was composed of senior staff as well as supervised residents. COMMON OFFICE SURGICAL PROCEDURES: Diagnostic hysteroscopy +/- biopsy 16, tubal occlusion Essure 200, polypectomy/septoplasty 13, Bartholin’s gland marsupialization 83, imperforate hymen 11, labioplasty 10, vaginal/vulvar tumours 38, vaginal fibrosis/granulomas 22, cystoscopy and treatment of SUI 7, remove stress incontinence devices 12, breast tumours 58, remove contraceptive implants 35, cesarean scar granuloma 3. Results: 508 office surgical procedures were performed under local anaesthesia (either mepivacaine 2% or lidocaine 2% without vasoconstrictor) in 93.11% of patients. Length of surgery was around 20 min (range: 7-46 min). 34 complications were detected (6.69 % of all procedures) (table 1). None of them was considered to be a major event and no further hospital admission was required in any case. Each office surgery average cost was 654.50 € (range: 375.52-2474.94 €). Table 1. Complications observed according to the proceduresImage / Graph: Conclusion: Office gynaecological surgery could become an important tool to reduce the surgical waiting list and save resources as it is less costly than hospital admission. Only few and minor complications were observed, the whole contributing to generate a smaller number of leaves. It is also a good opportunity for residents to improve and master their surgical skills. Therefore, this kind of programme should be encouraged always bearing in mind that its success requires a careful scrutiny of all candidates. Disclosure of Interest: None Declared P91 ZELESSE A NEW INTIMATE HYGIENE WASH SOLUTION FOR THE RELIEF OF SYMPTOMS AND SIGNS OF ACUTE VULVOVAGINITIS J.L. Delgado 1,*, R. Oliva 1, J. E. Blanco 1, R. San Martin 2, I. Muñoz 2, I. Huerta 3, M. Cuerva 4, J. Lazaro 5 1Dept of Ob/Gyn, University Hospital Virgen de Arrixaca, Murcia, 2 Dept of Ob/Gyn, Specialist Medical Clinic, 3Medical Dept, Italfarmaco, 4 Dept of Ob/Gyn, Hospital Quirón San José, 5 Dept of Ob/Gyn, University Hospital Ramón y Cajal, Madrid, Spain Problem Statement: Vulvovaginitis, an inflammatory disease of the vulvar and vaginal area, is a highly prevalent condition -with diverse symptoms and signsaffecting women of all ages. The most annoying and relevant symptom, the women’s principal complaint, is itching. In many cases the genital area is shown red and edematous, and increased vaginal discharge may occur. Zelesse an intimate hygiene wash solution, based on Chamomile, Burdock and Aloe Vera, with soothing, antipruritic and antiseptic properties may be beneficial for the symptomatic relief of vulvovaginitis. The aim of this study was to evaluate the effect and tolerability of Zelesse indicated alone or in combination with specific pharmacological treatment in patients with symptoms suggestive of vulvovaginitis.Methods: This is a prospective observational multicenter clinical trial. 137women with symptoms of acute vulvovaginitis (mean age 38.6±11.1years) were included, 50women (SF group) with symptoms of nonspecific vulvovaginitis (mean age 42.4±11.9years) received Zelesse once or twice a day during 12 days. 87women (CF group) with vulvovaginal infection (mean age 36.5±10.1years) were treated with specific pharmacological therapy and also received Zelesse twice a day. At baseline and at the end of treatment, symptoms and signs were evaluated with a validated numeric scale 0=absent, 1=mild, 2=moderate and 3=severe. A composite score of symptoms, the Global Symptom Score (GSS), was obtained to assess the effect of treatment on all individual symptoms taken as a whole.Results: At baseline, 93% of women reported pruritus, erythema 80%, 59%edema, and 75% leucorrhoea. In the SF group, 93% of women who afflicted pruritus at baseline experienced improvement after treatment, reducing its intensity from 1.9 to 0.5 (p<0.0001,tstudent). Zelesse also showed beneficial effect on the rest of the evaluated signs of vulvovaginitis. Zelesse improved erythema, edema and vaginal discharge in 68%, 87% and 77% of women who had these signs at baseline, respectively. Also, after treatment, 94%, 96% and 84% of women either did not show or only presented mild erythema, edema or leucorrhea, respectively. In the CF group 89.6% of patients with moderate to severe pruritus decreased its intensity to absent or mild, being reduced from 2.35 to 0.5 (p<0.0001,t-student). On the rest of the evaluated signs, the effects of the combination therapy were also beneficial, 95.2% of patients with moderate/severe erythema decreased its intensity to absent/mild, as well as 97.3% of those with edema and 92.0% of women with leucorrhoea. Interestingly after treatment, both groups showed similar significant improvement of the GSS with respect to baseline: in the SF group GSS decreased from 4.8 to 1.5 (p<0.0001,t-student) and in the CF group the GSS decreased from 7.41 to 1.42 (p<0.0001,t-student). Finally, 84.5% of women felt that the tolerability of the product was very good or excellent, highlighting its soothing and refreshing properties.Conclusion: Zelesse is effective for relieving symptoms and signs of acute nonspecific vulvovaginitis as well as good adjuvant therapy in the management of vulvovaginal infection. The similar final GSS after treatment also suggests the beneficial effects of Zelesse on signs and symptoms of vulvovaginitis. The significant effect on pruritus, the most disturbing symptom, is considered clinically relevant since pruritus is a very distressing and persistent symptom which usually does not diminish without treatment. Disclosure of Interest: None Declared P92 OFFICE HYSTEROSCOPY IN THE MANAGEMENT OF INFERTILITY: PAST, PRESENT AND FUTURE M.Y. Eliseeva 1 2 3,*, L. Kindarova 2, I. Belokon 2, N. Danilova 3 4, A. Khachatryan 1, O. Mynbaev 1 2 3 5 and The International Translational Medicine and Biomodeling Research Team 1 Dept of Obstetrics, Gynecology and Reproductive Medicine, Peoples’ Friendship University of Russia, 2Russian-German Center for Reproduction and Clinical Embryology “Genertion NEXT”, Moscow, 3The International Translational Medicine and Biomodeling Research Team, MIPT Center for Human Physiology Studies, Laboratory of Cellular and Molecular Technologies, Dept of Applied Mathematics, Moscow Institute of Physics & Technology (State University), Dolgoprudny, Moscow, 4 Dept of Physiology & Basic Pathology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, 5Laboratory of Pilot Projects, Moscow State University of Medicine and Dentistry, Moscow, Russian Problem Statement: The role of office hysteroscopy in the management of infertility has intensively debated. We present a systematic historical review concerning an impact of basic sciences in improvements of an office hysteroscopy as an effective diagnostic and surgical tool in the management of infertility which has triggered an outpatient application of this technique.Methods: We searched the Medline and other electronic databases for appropriate sources, including hand-search for cross references to find studies indicating an impact of new technologies on hysteroscopy and also contacted experts in the field for a consultation.Results: Office hysteroscopy is a product of a translational medicine, which required application of achievements of broad spectrum of basic sciences, such as mathematics, optics, electrics, electronics, liquid resorption and conductivity and other disciplines. Developments of technologies have had a crucial impact on improvements of diagnostic and surgical abilities of hysteroscopy. Most of hysteroscopic diagnostic and surgical techniques used today had been described between 1980 and 2000, subsequently guidelines concerning 101 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 application of two stage hysteroscopy (the first step, as diagnostic outpatient procedure and the second step, as inpatient procedure in the surgical theatre with anesthesia) were formulated in terms of knowledge accumulated in that period. Since then hysteroscopic technique has been miniaturizing owing to the improvements of modern Hopkins telescopes, illumination, fibreoptics, digitalvideo, laser, electosurgery and other state-of-the-art technologies. Subsequently today possibilities of surgical treatment of endometrial pathologies by office hysteroscopy in the management of infertility are dramatically extended and improved by an application of miniaturized hysteroscopic technique, including thin mechanical instruments, laser and bipolar electrosurgery and other innovative technologies with new working principles. Nowadays an attitude of gynecologists and surgeons has been metamorphosing taking into account implementations of new generation of thin hysteroscopy with improved ergonomic handles, miniaturized surgical instruments, when outpatient surgical procedures can be performed without anesthesia with reduced costs and improved patient’s quality of life.Conclusion: Developments of the state-of-the-art technologies have made an office hysteroscopy as a reliable approach of modern medical service in the management of infertility with appropriate tools and instruments. Further applications of this approach with obtaining evidence based results of clinical trials will open roads for widely implementations of this technology in the management of infertility. Conflict of interest: None declared. Acknowledgments: We thank the International Translational Medicine and Biomodeling Research Team members (Michael Stark, Andrea Tinelli, Antonio Malvasi, Tahar Benhidjeb, Ioannis Kosmas, Mikhaylo Medvediev, Madina Mazitova) and professor Bruno van Herendael from Antwerp for their consultation. We cordially thank Professor Stefano Bettocchi from Bari University for his special course, lessons in office hysteroscopy for ME, OM and also for his consultation. Funding: This work was supported by the Russian Science Foundation grant 1431-00024. Disclosure of Interest: M. Eliseeva Shareholder of: none, Grant / Research support from: none, Consultant for: none, Employee of: none, Paid Instructor for: none, Speaker Bureau for: none, L. Kindarova Shareholder of: none, Grant / Research support from: none, Consultant for: none, Employee of: none, Paid Instructor for: none, Speaker Bureau for: none, I. Belokon Shareholder of: none, Grant / Research support from: none, Consultant for: none, Employee of: none, Paid Instructor for: none, Speaker Bureau for: none, N. Danilova Shareholder of: none, Consultant for: none, Employee of: none, Paid Instructor for: none, Speaker Bureau for: none, A. Khachatryan Shareholder of: none, Grant / Research support from: none, Consultant for: none, Employee of: none, Paid Instructor for: none, Speaker Bureau for: none, O. Mynbaev Shareholder of: none, Grant / Research support from: This work was supported by the Russian Science Foundation grant 14-31-00024., Consultant for: none, Employee of: none, Paid Instructor for: none, Speaker Bureau for: none P93 UTERINE BLEEDING CONTROL WITH ULIPRISTAL ACETATE T. Esteves 1,*, A. Codorniz 1, I. Matias 1, S. Mineiro 1, L. Caseiro 1, E. Pereira 1, A. Regalo 1, F. Fernandes 1 1Hospital do Espírito Santo de Évora - EPE, Évora, Portugal Problem Statement: Ulipristal acetate (UA) is a selective progesterone-receptor modulator, currently approved for pre-operative treatment of moderate-tosevere symptoms caused by uterine leiomyomas in adult women in reproductive age – abnormal uterine bleeding (AUB), pelvic discomfort/pain and pressure effects. The posology is 5 mg/day, for 3 months, and it can be repeated once. UA has a direct effect in leiomyomas, reducing its volume through inhibition of cellular proliferation and inducing apoptosis – reducing the associated symptoms within the first ten days of treatment. Therefore, besides the volume reduction, it also provides better surgical conditions.Methods: Retrospective study of 60 women with symptomatic uterine leiomyomas, who were proposed to receive treatment with AU 5 mg/day, during 84 days. Subsequently, they had scheduled appointments every three months (for 12 months), with evaluation of treatment compliance, side effects, and uterine bleeding control.Results: Of 102 the 58 women that completed treatment, AUB was the main complain in 93,1% (with anemia [hemoglobin <11.8 g/dL] in 35,2% of those). Four women didn’t return for any appointment; the remaining 54 had surveillance for an average of 7,5±4,3 months (23 are still being followed and 18 abandoned the study in different stages). Of the patients whose main complaint was AUB, 94,4% attained amenorrhea during treatment (74,4% within the first month); the average duration of amenorrhea was 3,5±1,5 months (minimum 1, maximum 9). The menstrual blood flow was subjectively diminished in 33,3% of the patients that never had amenorrhea and in 60,8% of the patients who had at least one month of amenorrhea (total of 59,3%). Non-serious adverse events occurred in 59,3% of the patients; the most common being hot flashes (22,5%), worsening/beginning of urinary incontinence (15,5%), breast tenderness (13,8%), irritability (8,2%) and flatulence (6,9%), most of them not needing therapy. Endometrial thickness equal or greater than 16 mm in two subsequent appointments was registered in 7,4% (half is still waiting for biopsy, half didn’t had pathological changes). Only 15,5% of the women needed additional therapy for fibroids (55,6% of those had anemia that didn’t improve) – 6 hysterectomies and 3 surgical hysteroscopies.Conclusion: Unlike previous medical therapies for fibroids, that had limitations, AU appears to be an effective and safe treatment, in controlling uterine bleeding, with acceptable non-serious adverse events. It induces amenorrhea in most patients and, even after, subjectively diminishes menstrual flow. Being a recent therapy and with the latest developments, there may be potential benefits proven in futures studies. Disclosure of Interest: None Declared P94 ENDOMETRIAL PATHOLOGY IN PRE-MENOPAUSAL, ASYMPTOMATIC WOMEN I. Ferreira 1,*, E. Baptista 1, M. J. Carvalho 1, F. Falcão 1, I. Torgal 1 1Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Problem Statement: The aim of this study was to evaluate the type of endometrial pathology diagnosed in asymptomatic women with abnormal gynaecological ultrasound. Another objective is to evaluate the accuracy of hysteroscopy in the prediction of endometrial pathology in these patients.Methods: Retrospective study of 1103 premenopausal women that performed office hysteroscopy between January 2009 and December 2013 at Gynaecology A Service of Hospital and University Center of Coimbra. The performance of hysteroscopy was described according to sensitivity (S), specificity (E), positive predictive value (PPV) and negative predictive value (NPV). The agreement between gynaecological ultrasound and hysteroscopic findings with histology was evaluated using Cohen's κ test. Results: Concerning premenopausal women, 68.2% (n=752) presented abnormal uterine bleeding and 31.8% (n=351) were asymptomatic. The mean age of the premenopausal asymptomatic group was 41.4 ± 8.13 [20-58]; 25.1% (n=88) were nulliparous. Analyzing the findings at ultrasonography in the asymptomatic women, 60.1% (n=211) suggested endometrial polyps; 13.7% (=48) endometrial thickening and 9.1% (n=32) submucosal myoma. The most common diagnosis at hysteroscopy were isolated endometrial polyps in 51.3% (n=180), isolated myomas in 6% (n=21), anatomic malformations in 5.1% (n=18), diffuse endometrial thickening in 3.1% (n=11), ovular remainings in 2.85% (n=10) and carcinoma in 1.1% (n=4) patients. This exam showed no alterations in 17.7% (n=62). Regarding the concordance between ultrasound and hysteroscopy, kappa values were 0.135, (p < .0005) for endometrial polyps; 0.265, (p < 0.0005) for myomas; 0.085, (p = n.s.) for endometrial thickening and 0.154 (p = .002) for endometrial cancer. A histological exam was performed in 50.9% (179/351) patients. The most common histological finding was endometrial polyp in 57.0% (n=102), isolated myomas in 17.3% (n=31), endometrial hyperplasia without atypia in 6.1% (n=13), ovular remainings in 7.9% (n=11), carcinoma in 1.7% (n=3) and atypical endometrial hyperplasia in 1.1% (n=2). The concordance between hysteroscopy and histological findings was moderate, kappa values were 0.535 (p < 0.0005) for polyps; 0.509 (p < 0.0005) for myomas and 0.563 (p < 0.0005) for carcinoma. When diagnosing polyps, hysteroscopy had a S of 86.3%, E of 66.3%, a PPV of 77.2% and a NPV of 78.5%. For myomas it presented a S of 45.2%, E of 97.3%, a PPV of 77.8% and a NPV of 89.4%. For endometrial carcinoma, the S was 66.7%; the E was 98.9%, the PPV was 50.0% and the NPV was 99.4%.Conclusion: Hysteroscopy detected endometrial cavity alterations in Abstract Book 75.5% of asymptomatic women with abnormal ultrasound. Cancer diagnosis was rare in this group (1.7%). Hysteroscopy had a good performance in predicting the type of lesions. In general, hysteroscopy proved a good specificity and negative predictive value, which emphasizes the utility of the exam in the indication for surgical intervention. Disclosure of Interest: None Declared P95 ADNEXIAL TORSION IN AN ADOLESCENT AGE: CASE REPORT P.M.M. Figueiredo 1,*, C. Guerra 1, L. Gonzaga 1, M. Mesquita 1, P. Oliveira 1 1Ginecologia/Obstetrícia, Centro Hospitalar do Alto Ave, Guimarães, Guimarães, Portugal Problem Statement: The adnexal torsion is an infrequent condition but significant cause of acute lower abdominal pain in women. Occurring mainly in early reproductive years (changes in weigth of the adnexa) or postmenopausal women (associated with adnexal pathology - cistadenoma). An early diagnosis and appropriate management are important, to increase the ovarian “saving rate”.Methods: We describe a case of adnexial torsion in an adolescent, admitted in emergency room. Results: S.R.C.S., 15 years, admitted to the emergency department with abdominal pain in the right iliac fossa. Few days before, there was two previous admissions of pain with lower intensity, associated with nausea and vomits. In pelvic suprapubic sonography it was documented normal uterus, with regular contours and homogeneous structure, normal characteristics of left ovary; retrouterine region occupied by solid, heterogeneous formation, about 70 x 85 mm in the probable dependence of right adnexa. Analitic investigation presented without remarks, negative PCR, β-hCG and tumoral markers (AFP, CA 125, CA 19.9). In this episode, she presented with intense right abdominal pain, signs of peritoneal irritation and was proposed to laparoscopic exploration. During the surgery, was observed torsion of right adnexial cyst, with above 80 mm on diameter, with congestive surface and three circunvolutions. Attempt to “untwist” of the cyst and preservation of the adnexa was unsuccessful. Thus, it was proceeded to right adnexectomy (the cist involved the entire ovary). The uterus and left adnexa were normal. The histopathological exam revealed right adnexa constituted by Falopian tube (with 7cm length), and ovary (with weight of 80 g and 80 mm of major length) both showing congestive signs, with hemorragic cystic lesions in the surface of the ovary; findings compatible with adnexal torsion.Conclusion: The adnexal torsion of a cyst is a rare condition but remain a differential diagnosis to consider. The arousal of acute abdominal pain or repeated visits are some clues to the diagnosis. It must be made early as possible, to decrease damages and aime to spare the adnexa, mainly in young women. When not possible, a fast intervention will be extremely helpful, reducing the spreading of the inflammatory process. Disclosure of Interest: None Declared P96 THE ASSESSMENT OF QUALITY OF LIFE IN WOMEN WITH ENDOMETRIOSIS LITERATURE REVIEW N. Gica 1,*, G. Iancu 2, G. Peltecu 3 1Dept of Ob/Gyn, Filantropia Clinical Hospital, Dept of Ob/Gyn, "Carol Davila" University of Medicine and Pharmacy Filantropia Clinical Hospital, Dept of Ob/Gyn, Carol Davila University of Medicine and Pharmacy Filantropia Hospital, Bucharest, Romania Problem Statement: Endometriosis affects approximately 10% of premenopausal women. We conducted a literature review aiming to evaluate the quality of life in women with endometriosis.Methods: We specifically assessed the impact of endometriosis on health-related quality of life, mental and social wellbeing. PubMed/Medline, Cochrane Clinical Trials, Embase and other online resources were search for studies published between January 2008 and January 2014. Only the studies using standardized instruments (Questionnaires WPAI, EHP-5, EHP, SF-12, SF-36v2) were considered. We found sixteen studies of whom only ten satisfied the inclusion criteria.Results: Healthrelated quality of life was decreased in all dimensions of the generic (SF-12, WPAI) and specific (EHP-5) instruments. The present review confirms that endometriosis has a significant impact on education, work, mental and social wellbeing of affected women, despite its complex management in tertiary care centers.Conclusion: Many studies, conducted in diferent countries, on women with endometriosis demostrate that this pathology has a negative impact on work productivity and health-related quality of life in affected women. In conclusion women with endometriosis have impaired quality of life and continue to bear the consequences of this pathology; the best instrument to assess their quality of life and its influence on the optimal management of endometriosis needs to be defined in future research. Disclosure of Interest: None Declared P97 CORRELATION AND SIGNIFICANCE OF ATYPICAL GLANDULAR CELLS OF UNDETERMINED SIGNIFICANCE (AGUS) PAPANICOLAU SMEAR IN AN ASIAN POPULATION J.C.G. Goh 1,*, R. Nadarajah 1, W. W. Lim 1, W. Cheng 1 1 Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore Problem Statement: AGUS is a rare diagnosis, representing <1% of all Papanicolaou smears. Compared to its squamous counterpart (ASCUS), where the evaluation and treatment is usually straightforward, glandular lesions of the cervix are more challenging both diagnostically and therapeutically because of their relative rarity, lack of colposcopic findings, endocervical origin and broader differential diagnosis. The aim of this study is to determine the clinical implications of AGUS in our Asian population, with the intention to establish appropriate evaluation and treatment guidelines at our institution.Methods: In this 3-year retrospective review of all pap smears performed in our institute from 2011 to 2013. We identified women with a cytologic diagnosis of AGUS. Medical records were reviewed to identify patient demographic characteristics, including age, ethnicity and menopausal status. We correlated the final histologic correlations and performed subgroup analysis based on menopausal status and age. Results: A total of 124 women who were diagnosed with AGUS on Papanicolaou smear were included in our study. The mean age of our study population was 53.4 years. The majority of women were post-menopausal (61.3%). Final pathological diagnoses for our subjects with diagnosis of AGUS were as follow: benign in 58.9% (n=73), pre-cancerous in 10.5% (n=13) and malignant in 30.6% (n=38). Our analysis showed that there was a significant relationship between postmenopausal status and final histopathological diagnosis of malignant lesions in our subjects (RR 2.79, p=0.005). However, when subgroup analysis was performed based on age groups, the relationship did not prove to be statistically significant.Conclusion: Close to a third of women with Papanicolaou smears reporting AGUS will be found to have a malignant lesions on eventual histopathological diagnosis. Women who have post-menopausal have higher risk of glandular lesions. The finding of AGUS on Papanicolaou smears is significant and should be investigated further. Disclosure of Interest: None Declared P98 EFFECTS OF MENOPAUSE ON THE LIFE OF WOMEN WHO EXPERIENCE HOT FLASHES AND THEIR HEALTH-SEEKING BEHAVIOURS S. Alan, E. Gozuyesil*, S. Gokyildiz Cukurova University, Adana, Turkey Problem Statement: Menopause is a natural and inevitable phenomenon which affects all women. The menopausal period is characterized by different features in every woman. The combination of hot flashes and night sweats, the most typical indications of this period, are defined as vasomotor symptoms. Vasomotor symptoms affect from 60 to 90 % of women in the menopausal and early postmenopausal period and cause serious physical complaints. Having a healthy menopausal period is of great importance for women. A lot of women who do not get sufficient health care in this period develop chronic illnesses; and inability to cope with the menopausal complaints causes negative effects on their quality of life. Hot flashes, one of the most common menopausal complaints, affect women’s quality of life negatively. Methods: The purpose of this study is to identify what health seeking behaviours women who experience hot flashes use with a view to eliminating these complaints. The target 103 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 population of this study which is qualitative in nature is the women who applied to Cukurova University Balcalı Hospital Department of Obstetrics and Gynaecology Menopause polyclinic. The participants were 40 women who volunteered to participate in the study, who had the complaint of hot flashes, and who went through menopause naturally. The data collection phase continued until data saturation was achieved; and this phase was finished when information repetition started. Data were collected using semi-structured interview forms through an in-depth interview method conducted face-to-face. The interviews were tape-recorded with the consent of the participants. Data collected from the participants who did not want to be involved in voice and/or image recording were written down. The data obtained from the semistructured interview form were analysed using the content analysis method, one of the qualitative data analysis methods. Interview transcriptions were created by transferring the interviews onto the computer. Similar groups were coded so as to create themes; and then the data were analysed. Results: Results showed that the quality of life of the women with the complaint of hot flashes in the menopausal period was affected significantly; the women displayed various health seeking behaviours, and they had expectations from both their relatives and health professionals. In line with the data obtained, the themes emerging from the study included negative perceptions about menopause, decrease in quality of life, preparedness for menopause, complaints, coping, expectations from health professionals, and expectations from family. Conclusion: This study revealed that the quality of life of the women with the complaint of hot flashes decreased considerably, that they made use of various practices in order to cope with the complaints in this period, and that they could not cope with the complaints effectively due to their lack of knowledge on the issue. It is recommended that health professionals who provide women’s health services should help women to increase their quality of life and to cope with the complaints effectively by providing them with the training and guidance regarding the menopausal period and dealing with complaints during this period. Disclosure of Interest: None Declared P99 FACTORS AFFECTING ISRAELI WOMEN'S DECISION WHETHER TO DONATE CORD BLOOD K. Grinberg 1,*, M. Ben Natan 1 2 1Nursing, Ruppin Academic Center, Emelk Hefer, 2Nursing, Hillel Yaffe Medical Center, Hadera, Israel Problem Statement: Women's consent to donate cord blood is rarely obtained. Despite Israel's high ranking in the world with regard to the number of donations its ethnic diversity is a barrier to locating matching donations and therefore there is still a significant lack of cord blood in Israel. Donations of cord blood may be banked at either a public bank or a private bank. The current study will focus on donations to the public bank in Israel. The aim of the study is to analyze willingness to donate cord blood and the factors motivating one to donate cord blood. Methods: A descriptive, correlational study, employing the TPB. A questionnaire constructed based on a literature review of research on cord blood donation and on the TPB was administered to 207 Israeli women of childbearing age. Results: Behavioral attitudes (women’s total appraisal of cord blood donation), subjective norms (women’s perception of the opinion of significant others regarding the specific behavior), and perceived behavioral control (women’s total appraisal of their control of the behavior and perceived ease or difficulty of cord blood donation) were found to predict women’s intention to donate cord blood.Conclusion: It is important for the medical and nursing staff to cooperate and to take part in workshops on the subject .Increasing the awareness of obstetricians regarding the significance of consultations with women on donating cord blood may lead to a significant rise in such donations in the future. Obstetricians must be required to hold a joint consultation with both the mother and spouse in order to explain to them about the option of donating cord blood. Disclosure of Interest: None Declared 104 P100 UTERINE ARTERY EMBOLIZATION AND FERTILITY, OUR EXPERIENCE I.-A. horhoianu 1,* on behalf of "Excelis" postdoctoral individual research project, B. Dorobat 1, R. Scaunasu 2, V. V. Horhoianu 1 1Obstetrics and Gynecology, University Emergency Hospital Bucharest, 2general surgery, Coltea Hospital, Bucharest, Romania Problem Statement: Uterine artery embolization is a minimally invasive interventional radiology technique with large therapeutic aplicability in the gynecological pathology of the fertile female patient ranging from the treatment of fibroids, ectopic pregnancy to uterine bleeding remission. According to general literature low level evidence has showed an increased rate of fertility and pregnancy related complications following uterine artery embolization such as small for gestational age infants, stillbirths, early miscarriages or postpartum hemorrhages. Thus, it is very important to assess in a precise manner all the uterine artery embolization consequences which might impair future fertility as this kind of occlusion is considered a useful fertility sparing technique in many circumstances.Methods: We conducted a retrospective evaluation of 7 such cases gathered in our hospital during a period of time of 8 years (2006-2014) who underwent uterine artery embolization. All the above found patients delivered after uterine artery embolization. All necessary information regarding the complications following embolization, the pregnancy outcome and the pregnancy related pathology was gathered.Results: Out of the 7 cases registered, 5 underwent uterine artery embolization for leiomyomas and 2 for ectopic pregnancies. All the patients became pregnant and delivered in a period of time ranging from 1 to 4 years after uterine artery embolization. The pregnancies were uneventful with delivery by cesarian section of healthy neonates. We discovered only one mild intrauterine growth restriction and one low lying placenta. None of the following feto-maternal complications mentioned in literature such as preterm delivery, postpartum hemorrhage, malpresentations, early miscarriages, stillbirths or severe small for gestational age infants were found.Conclusion: Associated with correct use and careful reevaluation, embolization is an efficient conservative treatment technique which can be used in patients without severely compromising the fertility and pregnancy outcome. Still, higer level evidence is needed in order to attain certainty regarding this subject as conflicting evidence is presented in literature. Disclosure of Interest: None Declared P101 SEXUAL ORIENTATIONS OF WOMEN WITH POLYCYSTIC OVARY SYNDROME: CLINICAL OBSERVATION IN TAIWAN C.-H. Chen 1, M.-T. Hsieh2,*, C.-R. Tzeng 1, H.-Y. Chang 1 1Dept of Obs/Gyn, School of Medicine, College of Medicine, , 2Taipei Cancer Center, Taipie Medical University Taiwan, Taipei, Taiwan Problem Statement: Polycystic ovary syndrome (PCOS) is a commone endorcrine disorder and a complex problem for women of various ages. The current study aim to explore the association between sexual orientations and polycystic ovary syndrome (PCOS)-related parameters.Methods: A cross-sectional study method with participants recruited from the regular outpatient clinic at the department of Obstetrics and Gynecology at Taipei Medical University Hospital Taiwan between July 2012 and December 2013 was carried out. A total of 97 women met the criteria to diagnose PCOS. Among these 97 women, 89 were heterosexual and 8 were self-identified as lesbians. At the same time, 78 women without PCOS were collected for the control group. Participants were given a standard questionnaire and had blood withdrawn for the biochemistry measurement on androgen parameters (including total testosterone [T], androstenedione [A4], sex hormone binding globulin [SHBG], and free androgen index [FAI]), 17β-estradiol (E2), luteinizing hormone (LH), and follicularstimulating hormone (FSH). Biochemistry data was measured to compare the PCOS clinical parameters present in people of different sexual orientations (lesbians and heterosexuals). Results: PCOS women, regardless of sexual orientations had higher percentages and serum levels of hyperandrogenismrelated clinical (acne [87.5% and 60.7% vs. 23.1%], p <0.001) and hirsutism [62.5% and 57.3% vs. 15.4%, p≦0.001]) and biochemical parameters (total T, p<0.05 or 0.001, and LH/FSH ratio, p≦0.001) than non-PCOS controls did. Sexual Abstract Book orientations in women with PCOS affected women’s body mass index (BMI), since lesbians with PCOS possessed higher BMI than PCOS women with heterosexuality did (26.5±1.9 vs. 22.5±0.55; p<0.05), although hyperandrogenism-related clinical and biochemical parameters were not statistically significantly different between these 2 different sexual orientations of women with PCOS.Conclusion: Our preliminary data showed that high rates of lesbian were found among the PCOS patients collected at this study and sexual orientations influenced on the BMI of women with PCOS, but did not significantly affect hyperandrogenism-related clinical or biochemical characteristics in Asian. Disclosure of Interest: None Declared P102 THYROID STIMULATING HORMONE IS THE MAJOR PREDICTOR FOR INSULIN RESISTANCE IN NON-OBESE WOMEN M.-I. Hsu 1,*, S.-H. Shen 2 1OIbs/Gyn, 2Taipei Medical University - Wan Fang Hospital, Taipei, Taiwan, Province of China Problem Statement: Body mass index (BMI) is the major indicator to predict insulin resistance in obese women, however, the risk factors of insulin resistance in non-obese women remains debatable.Methods: The homeostasis model assessment insulin resistance index (HOMA) was used as indicator of insulin resistance. A total of 268 non-obese women (BMI <25) were classified as two subgroups, 99 women with insulin resistance (IR (+); HOMA >2.14) and 169 women without insulin resistance (IR (-); HOMA <=2.14) were evaluated and compared. Results: There is no difference in age (26.9±7.0 vs. 26.8±5.9; p=0.929) and BMI (20.7±1.9 vs. 20.5±1.7; p=0.293) between IR (+) group and IR (-) group. Although IR (+) group associated with higher risk of metabolic syndrome than IR (-) group, the prevalence of polycystic ovary syndrome (PCOS), premature ovarian failure (POF), and hyperprolactinemia were no difference between IR (+) and IR(-) group. IR (+) group presented with higher serum triglycerides (mmol/L; 0.85±0.69 vs. 0.67±0.31 p=0.003), LDL (mmol/L; 2.83±0.77 vs. 2.58±0.75, p=0.008) and lower serum HDL (mmol/L; 1.54±0.34 vs. 1.68±0.39; p=0.003) levels than IR (-) group. Sex Hormone-binding globulin (SHBG), high sensitivity Creactive protein (hs-CRP), Anti-Müllerian hormone (AMH), serum total testosterone, androstenedione, free androgen index, and dehydroepiandrosterone sulfate (DHEA-S) were no difference between IR (+) group and IR (-) group. Multivariate regression was used to evaluate the association of HOMA with age, BMI, testosterone, AMH, hs-CRP, SHBG, and thyroid stimulating hormone (TSH); results revealed that TSH is the only predictor of insulin resistance in non-obese women.Conclusion: Non-obese women with insulin resistance presented with higher prevalence of metabolic syndrome and lipid dysfunction. However, the prevalence PCOS, POF and hypderprolactinemia did not significantly differ in non-obese women with or without insulin resistance. Serum TSH level is the major predictor for insulin resistance in non-obese women. Disclosure of Interest: None Declared P103 THE APPROACHES OF EFFECTIVE ANTIRECURRENT TREATMENT OF UTERINE FIBROIDS V. Radzinsky 1, V. Khorolsky 2,* 1Peoples’ friendship university of Russia, Moscow, 2Kuban State Medical University, Krasnodar, Russia Problem Statement: Uterine fibroids are the most common nonmalignant hyperplastic diseases in women during the reproductive period. Before fibroids was the most common indication for hysterectomy. Modern surgical techniques provides reservation of reproductive organ, save fertility. Fibroids can complicate by menorrhagia, different menstrual disorders, but at least 50% remain asymptomatic. Despite of symptoms fibroids may impair fertility or cause miscarriage. Conservative myomectomy is the unique treatment for women of reproductive period. Therefore it’s very important to prevent recurrence of fibroids by individual antirecurrent treatment. To evaluate efficiency of antirecurrent pharmacotherapy of fibroids in women of reproductive period after conservative myomectomy the comparative investigation were performed. Objective: To compare the effectiveness of different pharmacological antirecurrent treatment of uterine fibroids after conservative myomectomy in women of reproductive age.Methods: Were examined 75 women, average age 32,4±3,1 years, duration disease (fibroids) 4,29±1,5 years (2-7 years). Before conservative myomectomy diameter of fibroids 45,82±20,76 mm, after 16,55±2,56 cm. Number of fibroids/per woman 5,18±2,5. Pharmacotherapy were provided with agonists of GnRH agonists, levonorgestrel intrauterine device (LNG-IUD), antigestagens.Results: GnRH agonists provide decrease of volume of uterus on 30% (from 325,4±16,2 cm3 to 227,8±10,1 cm3), number of fibroids nodes (from 5,45±2,53 to 2,54±1,36), diameter of dominant node (from 18,14±0,45 cm to 12,29±0,28 cm). LNG-IUD provide decrease of volume of uterus on 20% (from 312,4±15,0 to 252,5±8,8 cm3), number of fibroids nodes (from 4,87±2,7 to 2,27±1,9), diameter of dominant node (from15,57±0,4 сm to 11,57±0,22 сm). Antigestagens provide decrease of volume of uterus on 20% (from 315,0±9,0 to 250,6±10,0 cm3), number of fibroids nodes (from 4,87±2,7 to 2,27±1,9), diameter of dominant node (from16,22±0,55 сm to 12,87±0,5 сm).Conclusion: No significant deferens of efficiency depended from type of pharmacotherapy was found. During the аntirecurrent treatment of uterine fibroids required noninvasive (ultrasound) monitoring the effectiveness of treatment: rectovaginal examination; transabdominal and transvaginal pelvic ultrasound; blood flow study of the myometrium and fibroid (IR, MAC, V1, F1, VF1, uterine volume, the amount of nodes). When the negative dynamics or lack of positive dynamics in the first month necessary to decide to change of pharmacotherapy. Disclosure of Interest: None Declared P104 THE VIVEVE® PROCEDURE IS A NON INVASIVE INTERMEDIATE OFFICE BASED INTERVENTION THAT IMPROVES VAGINAL INTROITAL LAXITY AND IMPROVES SEXUAL FUNCTION. M. L. Krychman* Southern California Center for Sexual Health, Newport Beach, USA Problem Statement: Many women report sexual complaints as a direct result of changes in the integrity of vaginal introitus. This may happen as a direct result of genital aging, childbirth or other pelvic trauma. Present treatment options include behavioral pelvic floor muscle training, which has limited success, and invasive surgical intervention, which is costly, and has serious complications with variable success rates in improving sexual function. An intermediate, noninvasive, non-surgical procedure, such as the Viveve Procedure, offer women reporting this condition an alternative to less successful and highly invasive procedures. Methods: The Viveve® System is a safe, effective, office based treatment for Vaginal Introital laxity that has demonstrated the ability to improve laxity and sexual function in adult female subjects. The Viveve System is a monopolar radiofrequency (RF) system that uses surface cooling and (RF) energy delivery to provide a non-surgical and minimally invasive approach. During the Viveve Procedure, coolant is delivered to the membrane of the Viveve treatment tip. Then the application of RF energy create a reverse thermal gradient, which gently heats the deeper tissue while the coolant protects the surface epithelium.Results: To date, over 300 procedures have been performed in the US, Canada, Japan and Hong Kong). Two clinical studies and multiple preclinical and histological studies have demonstrated safety and efficacy. Further randomized, sham-controlled trials are planned for this office-based, 20-30 minute procedure which is gaining popularity amongst health care professionals and womenConclusion: The Viveve® Treatment is a viable non surgical treatment for women who have sexual complaints as a result of vaginal introital changes in the genitopelvic matrix. Research supported by Viveve, Inc., Sunnyvale, CA Disclosure of Interest: M. Krychman Consultant for: Bayer, Shionogi Inc, Pfizer, Palatin, Noven Therapeutics, Viveve, and Sprout Pharmaceuticals, Speaker Bureau for: Noven, Pfizer and Shionogi 105 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 P105 ATYPICAL PELVIC MASS - AN INCIDENTAL FINDING DURING ROUTINE EVALUATION J. Lisboa*, D. Freitas, P. Alves, O. Soares Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal Problem Statement: Pelvic masses are common in women of all ages. These, may be gynecologic as well as non-gynecologic in origin and may be detected during a routine gynecologic exam, found upon examination of a specific complaint, or found incidentally during radiologic evaluation of the pelvis. Pathology in this area may arise from the uterus, adnexa, bowel, retroperitoneum or metastatic disease. The principal goals of the evaluation are to address acute conditions and to determine whether a mass is malignant.Methods: During a routine gynecologic evaluation of a 41-year-old female, with no relevant medical history, was performed a pelvic ultrasound that revealed a 4cm, solid well defined pelvic mass with mixed echogenicity in the paraspinal region with no further pathology. The CT scan showed a 44mm pre-sacral mass, with no apparent relationship with the uterus, in intimate relation with the left S2 foramen. The patient was operated with extemporaneous examination, with total excision of the mass. Histology showed a well circumscribed spindle-cell tumor, S100 immunohistochemistry was positive.Results: The final diagnosis was Schwannoma.Conclusion: The goal of the evaluation of a patient with an adnexal mass is to determine the most likely etiology of the mass. This process is often challenging and a definitive diagnosis often requires a surgical evaluation. With this case report the authors aim to demonstrate that in the gynaecologic evaluation of a patient with a pelvic mass is important to exclude rarer cases such a Schwannoma. Disclosure of Interest: None Declared P106 THE IMPLEMENTATION OF ROBOTIC SURGERIES IN ISRAEL. A. F. Matanis *, S. Bolous OB/GYN, Rambam Healt Care Campus, Haifa, Israel Problem Statement: Introduction: During the last decade the numbers of robotic devices and of the medical procedures utilizing them have increased significantly around the world. Aims: To evaluate the implementation of robotic surgeries in Israel in various surgical disciplines.Methods: A retrospective study accessing information about the annual purchases of robots, the number of physicians trained for their use, and the number of robotic surgeries performed each year, according to indications of surgery and the disciplines of the operating medical staff. The data were taken from the database of Intuitive Surgical Inc.Results: Six robots were purchased by six medical centers in Israel during the years 2008-2013. There are currently 150 doctors trained to use the robot in one of the simulators of Intuitive Surgical Inc. Of them, 104 are listed as active robotic surgeons. Most are urologists, gynecologists, or general surgeons. The number of robotic surgeries increased each year in all fields in which it has been implemented. In 2013, 975 robotic surgeries were performed in Israel. Of them, 52% were performed by urologists; 80% of which were radical prostatectomy.Conclusion: The use of robotic surgery increased considerably in Israel over recent years, in urology, gynecology, general surgery, and otolaryngology. Despite the lack of conclusive evidence of the advantages of robotic surgery over the laparoscopic approach, the market power and the desire to be at the technological forefront, drive many medical centers to purchase the robot and to train physicians in its use. Disclosure of Interest: None Declared P107 EXTRA-PULMONARY TUBERCULOSIS – A CLINICAL CASE OF GENITAL DISEASE B. S. Melo*, N. Maciel, A. Pereira Ginecologia/Obstetrícia, Hospital Divino Espírito Santo - Ponta Delgada, Ponta Delgada, Portugal 106 Problem Statement: Tuberculosis is an infectious disease associated to an elevated morbility and mortality, especially in developing countries. Pulmonary affection is the usual form of presention, but it can be manifest as extra-pulmonary.Methods: Description of a clinical case of genital tuberculosisResults: 34 years-old women, admitted to the urgency with asthenia, fever, dry cough with three weeks of evolution. In her personal history there was a secondary infertility that was studied three months earlier by hysterossalpingography, revealing tubal obstruction. On examination, she was emaciated, pale, sub-febrile, and tachycardic, with decresead breath sounds on the right. Abdominal palpation identified a bulky abdominal mass occupying hypogastric and periumbilical areas. Laboratory tests showed leukocytosis and elevated C-reactive protein. The CT scan revealed a large mass with 13*11*8 cm in size and tubular images filled by water content and gas, suggesting tuboovarian abscess. An exploratory laparotomy was performed and revealed a pelvic mass with spontaneous purulent discharge. During the surgery the right ovary and tube were removed and sent to pathological examination. The hospitalization lasted 15 days, under antibiotics. Blood cultures, urine and pus results were negative. The pathological examination revealed necrotizing epithelioid granuloma of tuberculoid type. Molecular biology was positive for Mycobacterium tuberculosis complex DNA. Due to this result the patient was referred to infectious diseases consultation.Conclusion: Genital tuberculosis accounts for about 15-20% of extra-pulmonary tuberculosis. The hematogenous pathway is the main form of spread. Clinically it can be manifested by infertility, pelvic pain, amenorrhea or vaginal bleeding. The most affected organ is the fallopian tube, but all female genital tract can be affected. Presentation as tuboovarian abscess is extremely rare. The diagnosis is difficult and, in this case, it was suspected based on pathological features. The introduction of molecular biology tecnics with elevated sensivity and specificity came to improve and to accelerate this diagnosis. The patients are treated with anti-bacilary drugs for a period of 6-9 months. Surgical treatment is reserved to particular cases. Disclosure of Interest: None Declared P108 SURGICAL MANAGEMENT OF INTRA-UTERINE DEVICE COMPLICATIONS T. Meneses 1,*, A. I. Machado 2, C. Marques 2 1 Gynecology, Maternidade Dr. Alfredo da Costa, Lisbon, 2Gynecology, Maternidade Dr. Alfredo da Costa, Lisbon, Portugal Problem Statement: IUDs are one of the most effective and long-lasting contraception methods available. They can, however, lead to complications including non-visible strings, dislocation or uterine perforation. All of these require surgical intervention, with previous determination of IUD location by ultrasound or pelvic X-Ray. Methods: This was a retrospective study of 32 cases of IUD complications requiring surgical intervention in our Center, between January 2007 and December 2013. Clinical databases were searched to assess age at diagnosis, time elapsed between placement and diagnosis, type of IUD, presence of complications and chosen procedure for removal.Results: We identified 17 cases regarding copper IUDs and 15 cases envolving levonorgestrelreleasing intrauterine systems. Mean age at diagnosis was 40,5 years (±10,43), with most patients being multiparous (90,9%). In 75% of patients, diagnosis was suspected to due IUD strings not being visible on speculum examination in asymptomatic women. Mean time elapsed between placement and removal of IUD was 5 years and 4 months, with greater intervals for copper IUD when compared to LNG-releasing IUS (8 years vs. 1 year). In cases of suspected uterine perforation, mean time elapsed was significantly shorter than in cases without this complication (51 days vs. 6.8 years). The procedure of choice for removal was hysteroscopy (66,7%), followed by exploratory laparoscopy (30,3%). There were no cases of pregnancy or severe complications.Conclusion: With little or no symptoms for IUD complications, a high suspicion índex remains the key to correct diagnosis. Time elapsed between IUD placement and diagnosis of complications depends on the type of IUD, presence of symptoms and final IUD location (uterine cavity vs. abdominal cavity). In most cases hysteroscopy is the best procedure for retrieving IUD, but laparoscopy will be necessary in cases of confirmed uterine perforation. Disclosure of Interest: None Declared Abstract Book P109 PREGNANCY AFTER TUBAL STERILIZATION 14 YEARS AGO: A PAINFUL SURPRISE S. Mineiro 1,*, A. Toller 2, A. Codorniz 3, J. Carvalho 3 1 Gynecology and Obstetrics, Espírito Santo Hospital, Évora, 2Hospital de S. Francisco Xavier, Lisboa, 3Hospital Espírito Santo Évora, Évora , Portugal Problem Statement: Surgical sterilization is a safe, highly effective, permanent, and convenient form of contraception. It can be performed postpartum, postabortion or in conjunction with another surgical procedure. Performance of the procedure postpartum or during the menstrual or proliferative phase of the cycle reduces the chance of pregnancy at the time of the procedure. The technique differs and can be achieved by laparoscopy and postpartum sterilizations are done by minilaparotomy or per caesarean section. The advantages of the laparoscopic procedure include decreased operative time, less postoperative pain, shorter hospital stay, and more rapid return to normal functional activities.Methods: The authors report a case of a healthy 42 aged woman that went to the Hospital emergency department due to acute severe abdominal pain in lower quadrant, more precisely in the right iliac fossa. The last menstruation has been two months ago (68 days of amenorrhea) and sparse vaginal bleeding was present. Despite the patient has undergone tubal ligation during caesarean section 14 years ago (modified Pomeroy technique), the immunological pregnancy test was surprisingly positive. The clinical presentation revealed a painful abdomen, left shoulder pain and dolorous culde-sac assessment at gynecological examination.Results: Clinical suspicion of ectopic pregnancy was raised and the diagnosis was confirmed by transvaginal sonography. The main findings were thick endometrium, hemoperitoneum and right adnexal Doppler ring containing a yolk sac and embryo with cardiac activity (Crown Rump Length-7.2 mm). Surgery block was immediately informed about laparotomy approach.During surgery we could state a great hemoperitoneum with an ectopic pregnancy in the right ampullary portion. Right partial salpingectomy and peritoneal toilette were performed.Conclusion: Pregnancy is uncommon after tubal sterilization but when it does occur, the risk that it will be an ectopic pregnancy is increased over that in the general population. Resection methods failed most frequently because of spontaneous reanastomosis or fistula formation. Operator failure occurred when the occluding device was placed on the round ligament or mesosalpingeal veins. It also can be associated with a suboptimal location of the tubal occlusion, incomplete closure of a clip or incomplete encapsulation of the tube and lumen, increasing the likelihood of spontaneous regeneration of the tubal lumen. Disclosure of Interest: None Declared P110 MYOMA FIBROID EXPULSION AS FLESHY TISSUE DEBRIS AFTER THE UTERINE ARTERY EMBOLIZATION: A CASE REPORT AND LITERATURE REVIEW O. A. Mynbaev 1,*, M. Medvediev 2 and The International Translational Medicine & Biomodeling Research Team 1Laboratory of cellular and molecular technologies, Moscow Insririute of Physics and Technology, Dolgoprudny, Russia, 2Obstetrics and Gynecology, State Establishment “Dnepropetrovsk Medical Academy of Health Ministry of Ukraine”, Dnepropetrovsk, Ukraine Problem Statement: The uterine artery embolization (UAE) has become as an accepted minimally invasive treatment with established safety, and efficacy as well as outcomes with adverse events. We report a case presenting UAE with repeated sloughing of fibroid as fleshy tissue debris followed successful spontaneous pregnancy and term delivery with healthy newborn without complications supplemented with a literature review.Methods: Case report. The review inclusion criteria were as follows: all articles described repeated sloughing of fibroid as fleshy tissue debris following UAE or case reports with confirmed diagnosis of this condition from PubMed and other databases.Results: Case report: A 34-year-old woman G2P0A2 was admitted to the hospital because of severe regular painful uterine bleedings with pronounced hemorrhagic anemia (Hb – 7-8 g/dl). Her periods have lasted 7-10 days with average menstrual blood loss 1(MBL) 028 points according to the pictorial blood assessment chart (PBAC) for 12 months. Bimanual examination revealed a slightly enlarged painful uterus. The submucous fibroid (D6 cm) localized within posterior uterine wall (type 2 by Wamsteker classification) was registered by US and confirmed by MRI (Fig 1). The selective bilateral UAE was performed by the standard technique through right femoral artery (Fig. 2). The efficacy of UAE was monitored by injection of contrasting solution into the internal iliac arteries which presented a stagnation of embolization particles into the uterine blood vessels and capillaries with blocking them. The patient has complained on fever up to t 38,5 C°, lower abdomen pain and mild nausea during first two days after surgery, which was treated symptomatically with intravenous infusion of Ringer's lactate solution, oral hydration therapy and meloxicam 7,5 mg. Patient was discharged on postoperative day 2. MBL has dropped sufficiently after the procedure. Patient reported progressively decreased menorrhagia from baseline to 3, 6 and 12 months after UAE respectively 1028, 256, 124 and 88 according to PBAC score. A decreased MBL was accompanied by significantly increased values of blood parameters: hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration. In 3 months after UAE patient started to complain on vaginal discharge as fleshy tissue debris with larger size up to 2 cm with an unpleasant odor irrespectively of menstruations and during menses, which had lasted during 6 months of follow-up. Histological examination of tissue debris confirmed purulent necrotic leiomyoma tissue residues. A slight deformation of posterior uterine wall was noted in sagittal MRI after 6 months, whereas uterine wall was completely free from fibroids on US during both follow up evaluation at the 6th and 12th months after UAE. Patient conceived spontaneously at the 18th month after UAE. Her pregnancy was ended by a vaginal term delivery with 3340 g male newborn. A postpartum hemorrhage volume was 200 ml, without further complications. Fig. 1. MRI, T2: Submucous 6 cm fibroid, type 2, located within posterior wall. a). An axial view in T2. b). A sagittal view in T2. Angiography of pelvic left uterine artery embolization (UAE) through catheterization of a right femoral artery. c). before; d). after.Image / Graph: Conclusion: In conclusion, more cases need to be collected and analyzed regarding this type of rare post-UAE outcomes to make the appropriate treatment options of this condition. Disclosure of Interest: O. Mynbaev Shareholder of: none, Grant / Research support from: This work was supported by the Russian Science Foundation grant 14-31-00024, Consultant for: none, Employee of: none, Paid Instructor for: none, M. Medvediev: None Declared P111 THE EFFECT OF VAGINAL DOUCHING CESSATION ON VAGINITIS F. Okumuş 1,*, N. Demirci 2 1Department of Midwifery, Istanbul Medipol University, 2Department of Nursing, Marmara University, Istanbul, Turkey Problem Statement: Vaginal Douching (VD) to the practice of washing the vaginal canal with a fluid by using a finger, hose or cloth. Various contribution of the literary wealth in this field point it out that vaginal douching has many negative effects, such as the increasing of the risk of PID, infertility, ectopic pregnancy and premature birth. These negative effects are known to be the complications of vaginal infections. This study was carried out to determine the effect of vaginal 107 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 douching cessation in women with vaginitis on the recovery.Methods: This is a follow-up research conducted in southern Turkey. It focused on women diagnosed with vaginitis. The participating women were divided into two groups, one of which performed vaginal douching while the other did not. A subgroup of the douching women were informed on the subject and instructed to stop VD. Women were asked to undergo a vaginal examination 3 months later. The women that had ceased performing vaginal douching were considered as the experimental group of this study, the ones continuing to perform VD as the 1 st Control Group and those non-douching as the 2nd Control Group. The Patient Monitoring Form (PMF) and Inventory of Genital Hygiene Behaviors (IGHB) were used to collect data. The vaginal examination was performed through a speculum and a smear was taken for Pap-test. Consent of the Faculty of Medicine's Ethical Commission was taken for this study.Results: The study subjects presented to the outpatients with symptoms of vaginal discharge, dyspareunia, itching, lower abdominal pain, bad vaginal odor, dysuria and irritation. 62.2% of the women had grayish-white discharge and 14.2% had curdlike discharge on pelvic examination. The Pap-smear slides showed mild inflammation in 33.8%, moderate inflammation in 48% and severe inflammation in 18.2%. There was no statistically significant difference between the experimental and control groups in terms of the participants’ vaginal symptoms, or pelvic examination and microscopic examination results in phase 1. In our study, 86% of women who were trained stopped performing VD. A statistically significant decrease was found in all groups regarding the itching, irritation, and dyspareunia symptoms (p<0.05). Although there was a statistically significant decrease regarding bad vaginal odor and lower abdominal pain symptoms in douching observation and douching cessation groups (p <0.05), no change was present in the non-douching group when compared to phase I (p>0.05). Females with no inflammation on microscopic examination were concluded to have recovered. A statistically significant difference was found between the experimental group and 1st control group in terms of improvement (p=0.018) while there was no statistically significant difference with the 2 nd control group (p>0.05).Image / Graph: P112 POSSIBILITYTOPRESERVEREPRODUCTIVNESS OF THE WOMAN WITH BIG SIZES UTERINE FIBROID G. Omarova * Department of Obstetrics and Gynecology #1, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan, Almaty, Kazakhstan Problem Statement: In literature they constantly keep discussing the subject about the size of fibroidnodes under which it is possible to do myomectomy by laparoscopic method. According to the majority author’s opinion, the size of node shouldn’t exceed 8-10 cm.Methods: The surgery of 25.04.2013: Laparoscopy, myomectomy, dranaigeofabdominalcavity. The uterus is enlarged up to 14 weeks due to multiple subserous-interstitial fibroid lesions. From the bottom of uterus closer the left corner there is visible subserous fibroid node, size 11x12x13cm on the wide base, on the front wall of the uterus there are 2 interstitial nodes, diameters 2 cm and 4 cm, on the back surface of the upper one-third of uterus there is 1 interstitial node, diameter 6 cm.Fallopian tubes are without any pathology, ampulla parts are free. The ovaries are of the regular sizes, without peculiarities.The myomectomy of 4 nodes was carried out. The vicryl sutures were put in on the myoma nodes bed. Full hemostasis. Blood loss – 250,0 ml.Morcellum: myoma nodes were removed. The small pelvis drainage.Removedmorcellatedsubserosalfibroidlesions. Total weight 1080 g.Results: Leiomyoma, fibroidThe pregnancy occurred after 9 monthsagaist the background of pre-gravidal preparation with gestagens (didrogesteron).Ultrasound examination of 08.08.2014- Making progress pregnancy of 32 weeks.Image / Graph: Conclusion: The results indicate that VD cessation reduces the risk of vaginal inflammation. Raising the awareness of women by informing them about the negative effects of VD will decrease the performing of this practice. The development of education programs that focus on the practices of female genital hygiene habits and instruct on the abandonment of harmful practices like VD as well as the adoption of appropriate behaviors may decrease the rates of vaginitis. Disclosure of Interest: None Declared Conclusion: This clinical case demonstrates the fact that the laparoscopic myomectomy allows to preserve the reproductive function even with big sizes fibroid nodes. Disclosure of Interest: None Declared 108 Abstract Book P113 POSSIBILITY TOP RESERVE REPRODUCTIVNESS OF THE WOMAN WITH BIG SIZES UTERINE FIBROID G. Omarova,* Kazakh State Medical University Asfendiarova, Almaty, Kazakhstan Problem Statement: Inliteraturetheyconstantlykeepdiscussing the subject about the size of fibroidnodes under which it is possible to do myomectomy by laparoscopic method. According to the majority authors opinion, the size of node shouldn’t exceed 8-10 cm.Patient S., 31 years, was hospitalized routinely24.04.2013 (сase report№7112). She had complaints on the heavy vaginal bleeding, dragging pain in the lower part of abdomen,secondary infertility during the last 2 years.GTPAL score is 21102: G - number of pregnancy, T – number of full term pregnancies, P – premature birth, A - number of spontaneous or induced abortions, L - number of children (born alive or living).2002 – premature birth, baby body mass – 1500,0 g, died.2005 – delivery at term, baby body mass – 4200,0 g.Uterine leiomyoma was diagnosed in 2011, the patient refused from hysterectomy many times, wishing to keep the reproductive function.Ultrasound examination (20.03.2013): the uterus is ball – shaped, length 7,2 cm, thickness 7,9 cm, width 9,2 cm. The thickness of functional layer is 3 mm. There were several nodes visualized, including 1 subserous node with sizes 11,3x12,1x13,0 cm at the bottom of the uterus, and 3 interstitial nodes, 2 of them on the front-side wall of the uterus and 1 node on the back surface,sizes: 5,7x4,7; 1,8x2,2 and 4,2x4,0 cm respectively. Methods: The surgery of 25.04.2013: Laparoscopy, myomectomy, dranaigeofabdominalcavity.The uterus is enlarged up to 14 weeks due to multiple subserous-interstitial fibroid lesions. From the bottom of uterus closer the left corner there is visible subserous fibroid node, size 11x12x13cm on the wide base, on the front wall of the uterus there are 2 interstitial nodes, diameters 2 cm and 4 cm, on the back surface of the upper one-third of uterus there is 1 interstitial node, diameter 6 cm.Fallopian tubes are without any pathology, ampulla parts are free. The ovaries are of the regular sizes, without peculiarities.The myomectomy of 4 nodes was carried out. The vicryl sutures were put in on the myoma nodes bed. Full hemostasis. Blood loss – 250,0 ml.Morcellum: myoma nodes were removed. The small pelvis drainage. Results: Leiomyoma, fibroid. The pregnancy occurred after 9 monthsagaist the background of pre-gravidal preparation with gestagens (didrogesteron).Ultrasound examination of 08.08.2014- Making progress pregnancy of 32 weeks.Conclusion: This clinical case demonstrates the fact that the laparoscopic myomectomy allows to preserve the reproductive function even with big sizes fibroid nodes. Disclosure of Interest: None Declared P114 EVALUATION OF THE RELATIONSHIP BETWEEN FOOD CRAVING AND DEPRESSION IN PREGNANT WOMEN K. Ozdemir 1,*, S. Sahin 2, A. Unsal 3 1Sakarya University, School of Health, Sakarya, 2Yildirim Beyazit University, Faculty of Health Sciences, Ankara, 3Eskisehir Osmangazi University, Public Health, Eskisehir, Turkey Problem Statement: This study was conducted to determine frequency of food craving in pregnant women, to review some factors that are believed to be associated and to evaluate depression level.Methods: This is a cross-sectional study conducted on pregnant women who applied to Sakarya Training and Research Hospital from 25 March 2013 to 25 May 2013. The study group consisted of 363 women (46%) who agreed to take part in the study out of 782 pregnant women who applied to pregnancy follow-up polyclinic of the hospital based on the records of Sakarya Training and Research Hospital. A questionnaire form prepared by using the literature in line with the study objective was used to collect data. The questionnaire consisted of the questions of depression scale, some socio-demographical characteristics, presence of food craving and some factors that are believed to be associated. The women who agreed to take part in the study were discussed in the waiting room of the pregnancy follow-up polyclinic. Previously prepared questionnaires were completed by the pregnant women under supervision. In this study, those who replied yes to the question "Have you craved/do you crave for any food during your pregnancy?" were regarded to have a history of food craving. Beck Depression Inventory was used to evaluate the presence of suspected depression. Individuals with a score of 17 and above from this inventory were regarded to have suspected depression. Chisquare test was used for data analyses. Statistical significance level was accepted as p < 0.05.Results: The age of women in the study group ranged from 17 to 49 with a mean age of 29.10 ± 6.14 years. The number of pregnant women with a history of food craving was found to be 260 (71.6%) in our study. Of the pregnant women with a history of food craving, 38 (14.6%) reported craving for clay/soil, 79 (30.4%) reported craving for pickle/lemon, 20 (7.7%) reported craving for chocolate, 71 (27.3%) reported craving for desserts, 11 (4.2%) reported craving for pastry and 41 (15.7%) reported craving for other foods. More than half of pregnant women (n=177; 68.1%) reported that they craved in the evenings and at night. Food craving was most frequently reported in third month of pregnancy and least frequently reported in first month of pregnancy (p < 0.05). In our study, frequency of food craving was determined to be higher in those working actively in an income-generated job, with good family income level, who consume chocolate, who used drug during pregnancy, who used no contraceptive method before pregnancy, with a history of chloasma in pregnancy, with a history of food craving in previous pregnancies, with a history of food craving in before pregnancy, with a family history of food craving in pregnancy and with obesity (p < 0.05 for each). The number of women with suspected depression was found to be 72 (19.8%) in this study. Frequency of food craving was determined to be higher in those with suspected depression (p < 0.05).Conclusion: Food craving is a common problem in pregnant women. The food which is the most craved during pregnancy was pickle/lemon followed by desserts and clay/soil. Frequency of suspected depression was higher in those with a history of food craving. It may be advantageous to perform depression screens in pregnant women and to refer suspected cases to advanced centers for definitive diagnosis and treatment. Key words: Pregnancy, food craving, depression Disclosure of Interest: None Declared P115 XANTHOGRANULOMATOUS SALPINGO-OOPHORITIS MIMICKING AN OVARIAN MALIGNANCY – A SERIES OF 3 CASES AND REVIEW OF LITERATURE S. Y. Pang*, I. Madan Department of Obstetrics & Gynaecology, KKH, Singapore, Singapore Problem Statement: Xanthogranulomatous salpingo-oophoritis is an uncommon form of chronic inflammation manifesting in the genito-urinary tract with symptoms and radiological finidings which mimic ovarian malignancy or severe pelvic inflammatory disease (PID). Methods: We describe three cases of xanthogranulomatous salpingo-oophoritis diagnosed in our hospital and explore available literature on the risk factors, clinical features, diagnostic pitfalls and treatment of this condition. Results: There are three cases of salpingo-oophoritis identified in literature and a total of 23 cases with the inclusion of isolated salpingitis or oophoritis. The age of patients range from 19-84. Risk factors described include endometriosis, leiomyoma, inadequately treated PID, IUCD in situ, and previous abdominal surgery. Most women had abdominal pain, fever and adnexal mass on examination. Ultrasound and radiological findings suggested the presence of complex cystic adnexal masses for nearly all cases. One report suggested that there may be characteristic findings on magnetic resonance imaging (MRI). Most women were treated based on the working diagnosis of malignancy or PID disease and underwent staging surgery, often with bilateral salpingooophorectomy. Intra-operative frozen-section was performed for two patients. In three patients, immunohistochemical stains were performed on postoperative histological samples. Our first patient is a 45-year-old nulliparous lady with diabetes mellitus, previous appendicectomy and uterine leiomyoma who presented with abdominal pain and fever. She was treated as having PID and underwent total hysterectomy with bilateral salpingo-oophorectomy. The second patient is a 51-year-old lady who had 2 previous Caesarean sections, who presented similarly. She underwent total hysterectomy with bilateral salpingooophorectomy. The last patient is a 35-year-old nulliparous lady who had dysfunctional uterine bleeding with a complex adnexal mass. She underwent a 109 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 diagnostic laparoscopy which resulted in left salpingo-oophorectomy. Intraoperative frozen section was performed for all three women. Conclusion: Xanthogranulomatous salpingo-oophoritis is a rare condition that is often mistaken for ovarian malignancy clinically and radiologically. Salpingooophorectomy is the recommended treatment but most women are “over treated” with operations such as hysterectomies that render them infertile. The presence of fever, abdominal pain, identifiable risk factors, MRI characteristics and the use of intra-operative frozen-section may aid in the diagnosis. Disclosure of Interest: None Declared P116 SINGLE-PORT (GROVE PORT) LAPAROSCOPIC HYSTERECTOMY WITH EXTRACORPOREAL VAGINAL CUFF CLOSURE VERSUS CONVENTIONAL LAPAROSCOPIC HYSTERECTOMY WITH INTRACORPOREAL VAGINAL CUFF CLOSURE Y. S. Lee, I. Jung, E. Park,* Obstetrics and Gynecology, The catholic university, Daejeon ST. Mary's Hospital, Daejeon, Korea Problem Statement: The objective of this study was to evaluate surgical outcomes and complication rates between single-port and three-port laparoscopic hysterectomy with different suture technique of vaginal cuff using conventional straight instruments.Methods: 75 patients who underwent singleport laparoscopic hysterectomy with extracorporeal suture technique and 75 patients who underwent conventional laparoscopic hysterectomy with intracorporeal suture technique from September 2010 through December 2012 were included in the study. The operative video and electronic chart reviews of the 150 patients were done retrospectively. We analyzed the following variables for all the patients : age, body mass index, adhesion, weight of uterus, operative time, vaginal cuff suture time, estimated blood loss, complications, length of hospital stay and postoperative pain.Results: Both group have no statistically significant differences in estimated blood loss., complication, length of hospital stay and postoperative pain. However, the mean operative time in single-port group was significantly longer than conventional group ( 98.2± 26.0 min VS. 80.2±20.3 min:P=0.02). Vaginal cuff suture time was decreased with experience in both group Conclusion: Surgical outcomes and complication rates seems to be similar in both group. Vaginal cuff suture time wasn’t cause of increased total operative time in single port group. Single port group needs more patients than conventional group for decrease of total operative time. Disclosure of Interest: None Declared P117 STUDY FOR USEFULNESS AND SAFETY OF SONOGRAPHY-GUIDED HIGHINTENSITY FOCUSED ULTRASOUND ABLATION OF UTERINE MYOMA C. Pil Je*, Y. Kang Jun, S. Gi Hyun, K. Sang Hun Department of Obstetrics and Gynecology, St.Peter’s Hospital, Seoul, Korea, Problem Statement: The Objective of this study is to evaluate the usefulness and safety of US-guided high-intensity focused ultrasound (HIFU) ablation of uterine myoma.Methods: The study group designed by 27 patients who underwent USguided HIFU ablation due to uterine myoma between April and October 2013 in St. Peter's Hospita with Model JC Focused Ultrasound Tumor Therapeutic System. We assessed the differences volume at baseline and 6 months after treatment based on contrast-enhanced T1-weighted image on MRI. Also we evaluated safety of HIFU by presence of complications.Results: Mean age of patients was 40.11 years. We divided 3 groups, below 100㎤, 100-200㎤, above 200㎤ on volume of myoma at baseline (㎤). Mean volume of contrast-enhanced T1-weighted image on MRI was 225.55(35.81-834.43)㎤ before HIFU treatment and 84.64(9.19-343.90)㎤ 6 months after HIFU treatment. Reduction rate was 62.47(%). No severe complications like bowel injury, bladder injury, infection was not observed. Table 2. Changes in Myoma Volume Before and 6 months After HIFU Treatment on 110 Contrast-enhanced T1-weighted image of MRI Characteristics Before 6 months after Mean contrastenhanced 225.55(35.81-834.43) 84.64(9.19-343.90) Reductio n Rate (%) 62.47 Below 100 ㎤ (n=5) 66.19(35.81-84.26) 16.33(9.19-24.29) 75.53 100-200 ㎤ (n=11) 149.80(109.94-195.35) 58.74(19.54-147.88) 60.78 Above 200 ㎤ (n=11) 373.90(201.93-834.43) 141.59(37.58-343.90 62.15 Volume(range),㎤ (n=27) Figure. Contrast-enhanced T1-weighted images, baseline and after 6 Months: Conclusion: US-guided HIFU treatment appears to be a safe and useful to ablate uterine myoma. Disclosure of Interest: None Declared P118 SYMPTOMATOLOGY OF ENDOMETRIOSIS- A PROSPECTIVE STUDY R. D. Rajkumaralal*, H. Rajesh, S. L. Yu Obstetrics and Gynaecology, Sinapore General Hospital, Singapore Problem Statement: Endometriosis is a common gynaecological condition often diagnosed at surgery and by histology. Efforts to develop a nonsurgical method of diagnosing endometriosis have focused on imaging, biomarkers and patientreported symptoms. Raised serum CA-125 is advocated for diagnosing endometriosis but is also elevated in ovarian cancer, pelvic inflammatory disease and fibroids. Transvaginal ultrasonography and MRI are useful in diagnosing ovarian endometriosis but cannot image small peritoneal lesions. Utilisation of symptoms typical of endometriosis like dysmenorrhoea, pelvic pain, dyspareunia etc is a simple, cost effective and noninvasive method in diagnosing endometriosis. Hence this study was conducted to analyse all the possible symptoms associated with endometriosis and the strength of association.Methods: This prospective questionnaire based study was conducted in the department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore between July 2011 and September 2012. A total of 200 women of 21-55 years undergoing surgery for nonmalignant gynaecological conditions were recruited. Women undergoing surgery for acute conditions such as ectopic pregnancy, cyst accidents and malignant gynaecological conditions were excluded. The patients were asked to complete a questionnaire related to symptoms experienced by the patient in the past 12 months. Later the participant's surgical notes were reviewed and histology reports were traced. All patients with either a surgical or histological diagnosis of endometriosis were allotted to the study group and the rest were allotted to the control group. Data analysis was done and statistical comparisons were made on various symptoms of endometriosis between the two groups.Results: Out of the 200 participants enrolled in the study, 66 (33%) women were found to have endometriosis and 134 (67%) did not have endometriosis. The patients in both groups were homogenous in characteristics. The symptoms recorded for endometriosis and non- endometriosis group are given in Table 1. In comparison with women who did not have endometriosis, more women with endometriosis had significant pain symptoms like dysmenorrhoea (P value .006), pelvic pain (P value .003) and abdominal pain (P value .002). Back pain, dyspareunia and dyschezia were more seen in the endometriosis group but the difference was not statistically Abstract Book significant. Women with endometriosis had less menorrhagia than the other group as the majority of patients in that group were operated for fibroids and menorrhagia being a predominant symptom in them. Table 1: Distribution of symptoms in patients Symptoms Endometriosis (n=66) % Dysmenorrhoea Pelvic pain Abdominal pain Back pain Dyspareunia Menorrhagia Dyschezia 46 27 26 32 12 31 9 69.7 40.9 39.4 48.5 18.2 47.0 13.6 NonEndometriosis (n=134) 66 28 26 48 18 84 8 % PValue 49.3 20.9 19.4 35.8 13.4 62.7 6.0 .006 .003 .002 .086 .376 .034 .068 Conclusion: The importance of this research lies in identifying strong predictive symptoms of endometriosis like dysmenorrhoea, pelvic pain and abdominal pain and the use of this information for patients attending gynaecological consultation to prompt further investigation to diagnose or exclude endometriosis and treat accordingly. Disclosure of Interest: None Declared P119 HORMONAL ASSAY IN DETECTION OF EARLY OVARIAN FAILURE IN WOMEN WITH ABNORMAL UTERINE BLEEDING A. Rasekh Jahromi 1,*, R. Javidalsadi 1, M. Maalhagh 1, A. Nasseri Jahromi 2, S. Pourshojaee 3, F. Alipour 1, M. Alborzi 1 1OB&GYN, Jahrom University of Medical Science , Jahrom, 2Economic, Azad University, shiraz, 3dr Rasekh Clinic, Jahrom University of Medical Science , Jahrom, Iran Problem Statement: AMH could indicate ovarian number of antral follicles and ovarian age. Low levels of AMH in the blood is indicative of low ovarian reserve, that could be a sign of early menopause.POF disease is determined with decreased estrogen and increased FSH before the age of 40 years and it can be detected by measurement of the FSH or AMH. Measurement of AMH many years before the increase of FSH may be realized Impending POF. In this study, the sensitivity and specificity of AMH and FSH were compared for the diagnosis of early POF. Methods: 96 samples referred to Dr. Rasekh clinic were selected for AMH and FSH testing that they were not exclusion criteria. After obtaining serum levels hormones in patients referred, this information along demographic information including age was entered in SPSS program then statistic analysis was performed for evaluation of diagnostic accuracy of AMH and FSH tests.Results: The sensitivity and specificity of AMH is specified respectively 80%, ,78.89% in diagnostic POF in women suffering menstrual disorders(AUB) in this study that the response rates for FSH is obtained respectively 28.57%, 78.65% .The positive and negative predictive value of AMH test is specified in diagnosis of POF in women suffering menstrual dysfunction, respectively ,17.39, 98.61 percent that the rates for FSH is obtained respectively 17.39 , 87.5 percent.Conclusion: : Anti-Mullerian hormone(AMH) due to higher sensitivity and negative predictive value greater than follicle stimulating hormone(FSH),It can be said that the use of this hormone for the diagnosis and prediction of reduced ovarian reserve early menopause appear to be useful. As AMH levels is constant during the cycle, but FSH levels varies on cycle length, so it can be measured at the same time of patient visit. Disclosure of Interest: None Declared P120 THE ROLE OF LACTOBACILLUS RHAMNOSUS-BMX 54 IN RESTORING PHYSIOLOGICAL VAGINAL ECOSYSTEM AND PREVENTING INFECTIONS. A PILOT STUDY N. Recine1,*, L. Domenici 1, M. Giorgini 1, V. Marcone 2, R. Tripodi 1, E. Palma 1, P. Benedetti Panici 1 1 Dept Gynecologic, Obtetrics and Urologic Sciences, University Sapienza of Rome, 2Italian Association for Prevention in Obstetrics and Gynecology, AIPOG, Rome, Italy Problem Statement: Lactobacilli are of crucial importance for the maintenance of the vaginal ecosystem. Through the production of lactic acid, lactobacilli lower vaginal pH and help prevent the development of potentially pathogenic microorganisms. Other mechanisms of lactobacilli action are production of oxygen peroxide, bacteriocins and surface-binding proteins that inhibit adhesion to uroepithelial cells. Altogether, these actions contribute to inhibit the growth of pathogenic microorganisms. Disturbance of this delicate ecosystem by hormonal changes, sexual behavior, pregnancy or antibiotic therapy can diminish the levels and activity of the lactobacilli, rendering the vagina more susceptible to infection by pathogens, in particular to bacterial vaginosis. Alteration of normal vaginal flora sometimes remains untreated, predisposing to recurrence of vaginal infections (for example by E. Coli, Gardnerella spp, Chlamydia, Ureaplasma spp, Streptococcus spp, etc). Infact, exogenous vaginal lactobacilli can produce lactate and lower the vaginal pH, inhibiting the growth of pathogens, while concomitantly favoring the development of the lactobacilli. The aim of the present study was to assess the potential value of vaginal tablets containing viable Lactobacillus Rhamnosus BMX 54 (NORMOGIN ®) in the treatment of abnormal vaginal flora (AVF), preventing new vaginal infections or their recurrences.Methods: A total of 60 patients with abnormal vaginal flora (AVF), were enrolled. Diagnosis of AVF was performed through microscopy of vaginal content, indicating the proportion between Lactobacilli and other microorganisms determine the type of vaginal microbiota. PAP smear and cultures were performed at the first visit. All women were treated with Lactobacillus Rhamnosus BMX 54 vaginal tablets (NORMOGIN ®) according to the following protocol: 1 tablet/day for 15 days, than two tablets per week for 1month and then one tablet once a week till 4 months. Patients were evaluated after 2 and 4 months. Results: After 2 months, 54 patients (90%) showed a restore of physiological vaginal microflora (p<0.05). After 4 months, 48 patients (80%) maintained the natural healthy balance of the vaginal flora while 12 patients (20%) showed a recurrence of AVF with a vaginal documented infection.Conclusion: Considering the low recurrence rate of vaginal infections, in particular of bacterial vaginosis during follow-up it seems that treatment with vaginal tablets of Lactobacillus Rhamnosus BMX 54 could reduce recurrence of vaginal infections. Antibiotic treatment should be always performed in case of documented vaginal infections, such as Chlamydia or Ureaplasma spp. Disclosure of Interest: None Declared P121 TUBERCULOSIS OF THE CÉRVIX – A RARE CASE PRESENTATION C. F. Paixao 1, L. Reis 2,*, V. Mourinha 3 1Gynecology , Centro Hospitalar do Algarve - Portimão, Portimão, 2Obstetrics, Hospital Fernando Fonseca, Amadora, 3Gynecology , Centro Hospitalar do Algarve - Faro, Faro, Portugal Problem Statement: The incidence of genitourinary tuberculosis is increasing, being more common in 20-40 years of age group in developing countries Genital organs most frequently affected include fallopian tubes (95-100%), endometrium (50-60%), and ovaries (20-30%). Tuberculosis of the cervix is rare and accounts for 0.1-0.65% of all cases of tuberculosis (TB) and 5-24% of genital tract TB.Methods: A review of literature and presentation of a rare clinical caseResults: 35-years-old multiparous, black race, with story of chronic hepatitis B and right adnexectomy for a benign cyst, was referred to our colposcopic unit with reapeted inflammation on cytology and vaginal bleeding. On examination, she had an abnormal cervix, with ulceration, bleeding, and a friable papillary growth. The colposcopic exam showed increased vascularity without any acetowhite or iodine negative areas. A clinical diagnosis of high grade cervical dysplasia was made and a cervical cytology and punch biopsy were taken. The PAP smear revealed an inespecif inflammation and the histological examination showed ulcerated fragments of cervix with severe chronic active inflammation with granuloma formation. The test for acid-fast bacilli and mycobacterium culture failed but the tuberculin skin test was positive. The pulmonary X-ray was normal. The patient was a non-smoker, non-alcoholic and did not have any other significant medical conditions in the past. There was a story of a pelvic surgery, when a suspicious right ovary tumor with associated ascites was operated, but 111 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 the anatomopathological exam didn´t revealed granulomatosis desease. Patient started on antitubercular treatment and now it´s on follow up.Conclusion: This case emphasizes that though uncommon, tuberculosis is an important alternative in the differential diagnosis of a malignant appearing lesion of the cervix. The macroscopic findings of cervical TB are illustrated by this case. There may be papillary or vegetative growths, a miliary appearance, and/or ulceration present thus simulating invasive cervical cancer. The diagnosis of cervical tuberculosis is usualy made by histologic examamination of the cervical biopsy, witch reveals caseating granulomas and Isolation of the mycobacterium is the gold standard. Because a third of cases are culture negatives, the presence of typical granulomata is suficiente for diagnosis if other causes of granulomatous cervicitis are excluded or a primary focus is identified. Disclosure of Interest: None Declared P122 A RARE CASE OF A GIANT RETROPERITONEAL LEIOMYOSARCOMA IN YOUNG AGE C. F. Paixao 1, L. Reis 2,*, F. Rafael 3, P. Guedes 1 1Gynecology , Centro Hospitalar do Algarve - Portimão, Portimão, 2Obstetrics, Hospital Fernando Fonseca, Amadora, 3Obstetrics, Centro Hospitalar do Algarve - Portimão, Portimão, Portugal Problem Statement: Sarcomas are rare malignant tumors that arise from mesenchymal tissue at any body site. They represented only 0.64 percent of all new cancers in United States in 2006. Ten to twenty percent of soft tissue sarcomas occur in the retroperitoneum, typically in the fifth to seventh decade of life. Liposarcoma, leiomyosarcoma and fibrosarcoma are the most common histologic types of retroperitoneal sarcomas. The retroperitoneum provides a widely expansible anatomic location for tumors arising there and these tumors often become very large before symptoms manifest. We report a rare case of a gigant retroperitoneal leyomisarcoma occurring in young age.Methods: Report of a rare clinical case and review of the literature.Results: 29-year-old healthy nuliparous, appealed to our hospital for a chronic states of pain and bloating. At physical exame we observed a good general sate of health and, during abdominal palpation,we identified a palpable pelvic hard mass, about 10-12 cm, well delimited, extending to left iliac fossa. Gynecological examination without other changes. The ultrasound revealed a masse similar to uterine tissue. She was admitted to undergo complementary imaging studies. The magnetic ressonance (MRI) suggested a primitive giant tumor of the left ovary, compressing the ureters and no obvious cleavage plane. By a clinical state of hypovolemic shock we performed an urgent exploratory laparotomy, where we identify a bulky retroperitoneal tumor about 20 cm, with rupture of the capsule and extensive hemoperitoneum. The uterus and adnexa were normal. Lumpectomy was performed. The hystological exam revealed a necrotic mass with 1200g, compatible with leyomiosarcoma grade II. The patient was discharged on the 12th day post surgery, with indications for follow-up in oncology consultation and start of radiotherapy. She is currently alive 6 months after diagnosis without recurrence or metastasis. TConclusion: The most common clinical picture in reported cases occurs late in life and includes back pain, weight loss, and in-crease abdominal girth. This case is an atypical presentation of, in the 3rd decade of life, with acute symptons associated to tumor rupture. Complete surgical resection is the treatment of choice. Adjuvant therapy with radiation is commonly recommended for patient with highgrade resected tumors. The benefits of adjuvant chemotherapy remain controversial. Treatment of this rare neoplasm is complicated by the large size of the tumor at diagnosis and frequent presence of metastases; therefore, prognosis is poor. The overall 5-year survival rate of retroperitoneal sarcomas 36%–58% and is dependent on tumor histology and extent of tumor invasion. Early recognition and aggressive surgery are the keys to long-term survival of patients with retroperitoneal sarcomas, but the mainstay of treating advanced disease is yet to be determined and needs further research as the overall prognosis of advanced disease is relatively poor. Disclosure of Interest: None Declared 112 P123 LARGE FIBROTHECOMA IN A WOMAN WITH MAYER-ROKITANSKY-KUSTERHAUSER SYNDROME F. A. Santos on behalf of Author, R. Ribeiro*, V. Veiga, C. Cavazza, M. Ponte, A. Claudia, G. Ramos Gynecology , Centro Hospitalar Leiria - Hospital Santo André, Leiria, Portugal Problem Statement: We described a rare case of an ovarian fibrothecoma in a woman with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome.Methods: Data were obtained by analysis of clinical file and a brief review of the literature, using “Pubmed” and key words “Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome” and “Ovarian fibrothecoma”.Results: Mayer-Rokitansky-KusterHauser (MRKH) syndrome is a rare congenital aplasia or hypoplasia of uterus and upper vagina with normal outer genitalia, productive ovaries, normal development of sexual secondary characters and a 46, XX karyotype. Ovarian fibrothecoma is a relatively new term that is used to describe an ovarian sex cord stromal tumor that has mixed features of both fibroma and thecoma. The prevalence of this tumors is very rare and is reported to be about 1,2% of all ovarian tumors. We report a case of 50 year-old woman with MRKH syndrome and an ovarian fibrothecoma. Patient presented with a pelvic-abdominal mass and pain in the lower abdomen for three months, with no other symptoms. Medical records of a laparoscopy at age 19 years, which report two rudimentary hemi-uterus with normal bilateral fallopian tubes and ovaries. At this age was submitted to vaginoplasty. Physical examinations revealed normal sexual secondary characters with a blind vaginal pouch of 2 cm length. Her abdominal examination revealed a large mobile mass of approximately 15 cm size. Ca 125 was normal as other laboratory analysis. Transabdominal ultrasonography revealed a large pelvic mass with solid predominance and central liquid areas, no ovary stromal visible. MRI showed a pelvic mass with heterogeneous T2 signal, pseudocapsule and welldefined central cystic lesions, suggestive of fibroma. It was made biopsy guided by CT scan that reveled fibrothecoma. Patient was taken up for laparotomy being excised the mass with 15 cm of large diameter. The histology confirms an ovarian fibrothecoma. Patient had good recoveryConclusion: Ovarian fibrothecomas and MRKH syndrome are both rare conditions. Ovarian fibrothecoma should be considered in women presenting with pelvic pain and a large pelvic mass. Surgical excision is the preferred treatment and is associated with a good prognosis. Disclosure of Interest: None Declared P124 CARDIOVASCULAR SURROGATE MARKERS DURING ESTRADIOL/PROGESTIN THERAPY COMBINED WITH STATIN THERAPY IN POSTMENOPAUSAL WOMEN WITH KNOWN CORONARY HEART DISEASE X. Ruan 1,*, H. Seeger 2, A. Mueck 2 1 Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital; Capital Medical University, Beijing, China, 2Endocrinology and Menopause, University Women's Hospital, Tübingen, Germany Problem Statement: Statins play an important role in the secondary prevention of coronary heart diseases. Combined hormone therapy in the postmenopause may not reduce the risk of coronary heart disease although favourite effects on lipid parameters have been shown. In the present study the combination of estrogen/progestin plus statin therapy was investigated in comparison to a statin monotherapyMethods: Twenty postmenopausal women with known coronary heart disease were included in this study. The patients received either Locol® combined with Merigest® or Locol® alone in a randomised cross-over study design. Blood flow measurement was conducted before, after 6 weeks’ and after 12 weeks of treatment. Urinay vasoactive parameters (cGMP, metabolites of prostacyclin and thromboxane) and serum parameters (lipids, Pselectin, ICAM-1, MCP-1 and homocysteine) were also measured basal and after 6 and 12 weeks of treatment.Results: Mean age of the patients was 62.3 years (SD 6.6). In the intention-to-treat analysis no significant difference was found in terms of blood flow measurements. A significant difference in total-Chol and LDL was found between both treatment groups favouring the hormone/statin group Abstract Book (p<0.001), whereas no significant differences were found for LDL, HDL and Lp(a). For the vasoactive surrogate marker in serum and urine no significant differences between both treatment groups were observed.Conclusion: Combined hormone/statin therapy may have beneficial effects on cardiovascular risk factors beyond the effect of a statin monotherapy. However it is very difficult to assess as to whether the observed benefits of a hormone/statin therapy elicit a significant influence on the risk of coronary heart desease. Disclosure of Interest: None Declared P125 REVIEW OF VAGINAL DOUCHING AND ASSOCIATED FACTORS AND ASSESSMENT OF QUALITY OF LIFE AMONG MARRIED WOMEN S. Sahin 1,*, S. Kaplan 1, A. Unsal 2, H. Abay 1, N. Yüzbasıoglu 3, G. Pınar 1 1Yildirim Beyazit University, Faculty of Health Sciences, Ankara, 2Eskisehir Osmangazi University, Public Health, Eskisehir, 3Dr. Nafiz Körez Sincan State Hospital, Ankara, Turkey Problem Statement: This study intended to review vaginal douching and associated factors and to assess quality of life among married women admitted to Ankara Dr. Nafiz Körez Sincan State Hospital.Methods: This is a cross-sectional study conducted on married women admitted to Ankara Dr. Nafiz Körez Sincan State Hospital between 01/03/2014 and 01/06/2014. Based on the records of Ankara Dr. Nafiz Körez Sincan State Hospital, the study group consisted of 221 women (37%) out of 601 patients who applied to the gynecology polyclinic of the hospital throughout the study and agreed to take part in the study. The questionnaire form prepared in line with the literature to collect data included some socio-demographic characteristics of women, vaginal douching practice, some variables believed to be associated and questions of SF-36 quality of life survey. The women who agreed to take part in the study were discussed in the waiting room of the gynecology polyclinic. Previously prepared questionnaires were completed by the women under supervision. The women who replied “Yes” to the question “Do you perform vaginal douching?” were considered to perform VD. The women with diagnosed genital and urinary infection within last 1 year were regarded to have “genital and urinary infection history” in this study. SF-36 Health-related quality of life survey was used to assess quality of life. Chisquare test and Mann-Whitney U test were used to analyze the data. Statistical significance level was accepted as p < 0.05.Results: The ages of women in the study group ranged from 18 to 55 with a mean age of 32.937 ± 9.37 years. The number of women performing VD was determined to be 100 (45.2%) in this study. VD is mostly performed for cleaning and feeling comfortable (29.9%), most frequently after sexual intercourse (16.7%) and approximately half of the women performing VD (45.0%) use soap and water for VD. Frequency of VD was determined to be higher in women who had no pregnancy before, with dyspareunia history, with urinary incontinence, with genital infection history and with frequently recurring urinary infection history (p < 0.05 for each). Frequency of VD was not associated with age, education level, working status, family type, family income level, marriage period, menopause, number of birth, menstrual regularity, dysmenorrhea, chronic pelvic pain, frequency of sexual intercourse, use of contraceptive methods and urinary system infection history (p > 0.05 for each). No difference was observed between women performing VD and women not performing VD in terms of scores obtained from all domains of SF-36 quality of life survey (p > 0.05 for each domain).Conclusion: Almost half of the women in our study perform VD. Genital infections and frequently recurring urinary infections were found to be higher in women performing VD. There is no difference with regard to health-related quality of life between women performing and not performing VD. It would be advantageous for healthcare professionals to support women in acquiring proper behavior about VD and for educating them about the fact that VD is unfavorable. More extensive studies are required to demonstrate the relationship between VD and quality of life. Key words: Married women, vaginal douching, health-related quality of life Disclosure of Interest: None Declared P126 THE EFFECT OF PERIOVULATION ADMINISTRATION OF ESTROGEN ON ONGOING PREGNANCY OUTCOME M. Sayyah-Melli 1,*, S. Taghavi 2, M. Kazemi-shishvan 2 1 Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, 2Tabriz University of Medical Sciences, Tabriz, Iran Problem Statement: For successful implantation, embryo needs a receptive state which in turn needs a preprepared tissue to respond to progesterone postovulation. Ignoring this processes and complex events that occur in the human endometrium during the menstrual and proliferative phase will result pregnancy failure. A randomized clinical trial was conducted to compare response to treatment protocol with ethinyl estradiol (EE) in infertile women with poly cystic ovaries (PCO).Methods: From Sep. 2011 to Oct. 2012, sixty consecutive patients 20-34 years with infertility and PCO (as the only known factor), with thin endometrium at the time of follicle maturation (<7 mm), in two consecutive cycles induced ovulation with clomiphene citrate (CC), were included and examined in three equal groups. Group one received EE for three courses, day from 13-17 for three months and then underwent induction ovulation with CC (100mg/d), started from day 3 for 7days and in group two, the EE, 0.25mg was administrated in CC induced cycles for four days, after the size of follicles reached 18-28mm, and the same protocol used for group three as controls without EE. All groups received HCG to induce ovulation. Pregnancy rates and early pregnancy outcomes were evaluated. Participants were evaluated for 3 courses of intervention. Statistical analyses were carried out using SPSS17.0/Win statistical software. Values were given as median (range) or means (SD). Analysis was performed with one- way analysis of variance (ANOVA) to compare variables in three groups. Chi-Square test (χ²) was used to examine differences between groups. For all analyses P<0.05 was considered statistically significant.Results: Administration of EE, improved pregnancy outcome in group one and two, and the rate of pregnancy was comparable and was not significantly different (p>0.05). Cumulative ongoing pregnancy rates in group three was low (21%), compared to 58% and 62% in group one and two. Live birth rates were 63% vs. 66% and 30% in group 1-3, respectively, which the difference was significant (p <0.001).Conclusion: Periovulatory ethinyl estradiol administration improved the conception rate and the outcome of pregnancy in patients with PCO and thin endometrium. Prior to ovulation, the role of estrogen is considered to be important in the regeneration and growth of the endometrium and to prepare the tissue to respond to progesterone post-ovulation. These results opposing the hypothesis that mid-luteal rise in estrogen is not essential for successful implantation in the human.More studies are necessary to clarify the importance of these findings. Disclosure of Interest: None Declared P127 CLINICAL SIGNIFICANCE OF ATYPICAL GLANDULAR CELLS ON PAP SMEARS SEEN IN SINGAPORE GENERAL HOSPITAL FROM 2005-2012 C. Sim 1,*, Y. Pang 1, C. Goh 2, F. Siddiqui 3 1O&G, 2Pathology, Singapore General Hospital, 3Public Health, Duke-NUS, Singapore Problem Statement: Cervical cancer is ranked the 8th most frequent cancer death in Singapore. National cervical cancer screening programme in Singapore encourages women aged 25 years old and above, who have ever had sex or sexually active to go for Pap smears once every three years. Pap smear provides a cytological diagnosis from cells obtained from the endocervix. Cervical cytology uses the Bethesda system, with the latest revision in 2001 that renamed Atypical Glandular Cells of Unknown Significance (AGUS) to Atypical Glandular Cells (AGC), with further subcategories. The incidence of AGC ranges from 0.1 to 2.1%. Due to small sample sizes, correlation between AGC and a clinically significant histological diagnosis are widely varied among different institutions. A diagnosis of AGC on pap smears has a high correlation with a clinically significant histological diagnosis. National guidelines in Singapore recommend for all cases of atypical glandular cells (AGC) to undergo colposcopy, regardless of the subcategory. 113 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 The study aims to identify the incidence of clinically significant histological diagnosis in a Singapore population with AGC.Methods: A retrospective review of patients with cervical cytological diagnosis of AGUS or AGC will be identified via a computerized database between 1 January 2005 to 31 December 2012. Any subsequent histological diagnosis and evaluation will also be retrieved and analysed. For the purpose of this study, patients were followed up for a maximum of 1 year. The pap smears were all reported by the pathologists using the Bethesda System criteria and classified as "Atypical Glandular Cells of Unknown Significance (AGUS)" then subdivided into "favour reactive", "favour neoplastic" or "not otherwise specified". For the purpose of this study, histological findings were subdivided into "benign lesions" or "clinically significant lesions". Patients were excluded from the study if they had a previous history of cancer.Results: A total of 249 patients were classfied as AGC on Pap smear from 2005 – 2012. The majority of patients were aged between 50-59 years old, forming a total of 36.1% of all AGC cases. Only 6.4% of cases had no documented follow up subsequently. Benign findings include proliferative endometrium, polyps, cervicitis, and endometriosis, forming 43.6% of the AGC cases. Malignant findings formed 40.6% of the cases. Endometrial cancer formed the highest proportion of the malignant cases with 68.3%. The next highest group were extra-genital maligancies, forming 11.9% of the cases. Conclusion: Our study is consistent with previous studies demonstrating that AGC is often associated with a clinically significant lesion more than 50% of the time. Based on current guidelines, majority of AGC cases were correctly referred for further colposcopy to obtain a histological diagnosis. It is interesting to note that a significant number of extragenital malignancy cases were detected from the histological diagnosis. While these findings may be considered to be incidental, it further highlights the importance of obtaining histology for AGC cases. Our study showed that the majority of the AGC Pap smear diagnosis were classfied under the “not otherwise specified” category, which may suggest that a cytology diagnosis is almost always insufficient to accurately classify AGC cases. As such, the term “favour reactive” was dropped from the 2001 Bethasda classification of atypical glandular cells as it may potentially lead to a false negative diagnosis. Disclosure of Interest: None Declared P128 HOPELESSNESS AND ANXIETY AMONG INFERTILE WOMEN S. Sahin 1, K. Ozdemir 2, A. Unsal 3, O. Simsek 4,* 1Yildirim Beyazit University, Faculty of Health Sciences, Ankara, 2SAKARYA Universiyt, School of Health, Sakarya, 3Eskisehir Osmangazi University, Public Health, Eskisehir, 4Sakarya University, School of Health, Sakarya, Turkey Problem Statement: Aim of the study is to assess hopelessness and anxiety level among infertile women.Methods: This is a descriptive study conducted on women who applied to Sakarya Training and Research Hospital Infertility Polyclinic between 01 March 2013 and 01 July 2013. The study group consisted of a total of 774 women (88.1%) admitted to the infertility polyclinic of the hospital and agreed to take part in the study. The questionnaire forms prepared by using the literature in line with the study objective were completed by the investigators with face-to-face interview method. Beck Hopelessness Scale was used to assess hopelessness and Beck Anxiety Inventory was used to assess anxiety level. Data analysis was made with Mann-Whitney U test, Kruskal-Wallis test and Spearman’s Correlation Analysis. Statistical significance was accepted as p ≤ 0.05.Results: The age of women in the study group ranged from 17 to 48 with a mean age of 28.27 ± 5.45 years. The scores obtained by women from Hopelessness Scale ranged from 0 to 15 with a mean score of 4.70 ± 3.66 whereas the scores obtained from Anxiety Inventory were between 1 and 48 with a mean score of 12.86 ± 9.64. In this study, hopelessness level was found to be higher in women aged 30 and above, with education level of primary school and below, with Type B personality, married more than once, whose age of menarche is 12 and below, with irregular menstruation, with secondary infertility, whose infertility period is 5 years and more and with family infertility history whereas hopelessness level was lower in women with alcohol addiction, with gynecological surgical operation history and having love marriage (p < 0.05 for each). Hopelessness levels increase with longer marriage period (p < 0.05). 114 There is a positive relationship between hopelessness and anxiety levels (r = 0.277; p = 0.000). Conclusion: Hopelessness is an important mental health problem in infertile women. Hopelessness level rises with anxiety level. It would be beneficial to refer the women with increased hopelessness and anxiety level to advanced centers for definitive diagnosis and treatment, if any. Keywords: Infertility, hopelessness, anxiety, Turkey Disclosure of Interest: None Declared P129 SUCCESSFUL TREATMENT FOR NECROTIZING FASCIITIS OF THE VULVA WITH ADEQUATE DEBRIDEMENT PLUS HYPERBARIC OXYGEN: A CASE REPORT P. Sutchritpongsa 1,* 1 Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand Problem Statement: Necrotizing fasciitis was an uncommon soft-tissue infection and associated with severe systemic toxicity and high mortality rate unless promptly recognized and aggressively treated. The author reported a case of vulva necrotizing fasciitis with successful treatment by aggressive debridement, proper antibiotics combined with hyperbaric oxygen therapy.Methods: A 56year-old Thai woman with history of type II Diabetes mellitus, was admitted due to vulva ulcer. She had localized edema, induration, and exquisite pain at left labia majora for 10 days. Seven days later, the lesion became pustule and then burst out by itself, leaving to a raw area with yellowish, foul smelling sticky discharge. On examination revealed swelling and redness of entire left labia majora with extension to buttock. Ulcerative lesion with necrotic subcutaneous tissue size 2 x 5 centimeters was noted. After initial resuscitation, controlled blood sugar, she was given IV broad spectrum antibiotics, and scheduled for surgical debridement within 6 hours after admission. The necrotic subcutaneous tissue was found on surgical exploration with extension to entire left labia majora and also to the left groin and buttock. The initial debridement was performed to get rid of necrotic tissue as much as possible. Repeated debridement was performed every 24-48 hours for totally 6 times. After area of necrosis was controlled, hyperbaric oxygen (HBO) therapy was scheduled. The patient received HBO in 90-minute daily session of 100% oxygen breathing in hyperbaric chamber for 4 consecutive days. After HBO therapy, the condition of the vulvar lesion improved dramatically and finally the suture was successfully made at day 25th after initial debridement. The patient was discharged from the hospital and the vulva lesion was completely healed at one month follow up period.Results: Necrotizing fasciitis was characterized by widespread necrosis of the subcutaneous tissue and fasciae without invade the deep fascia and muscle due to invasion by microorganisms that lead to angiothrombosis and impairment of microcirculation. The incidence was rare but the mortality rate was approximately 40%. Vulva area involvement was extremely rare. The most common risk factor was diabetes mellitus. Early diagnosis, broad spectrum antibiotics and emergency comprehensive debridement of all dead tissue was essential. Further debridement should be repeated every 24 to 48 hours until the infection and area of necrosis was controlled. Delay or inadequate surgical debridement was responsible for the high mortality rates. Hyperbaric oxygen therapy was used to treat in this condition due to its therapeutic efficacy: hyperoxia (elevated partial pressure of oxygen in tissues). The physiologic effects of HBO at the tissue level have been shown to include increased killing ability of leukocytes, killing of certain anaerobes, reduction of tissue edema, stimulation of fibroblast growth, and increased formation. Several studies had shown decreased morbidity and mortality when HBO is used postoperatively as adjuvant therapy. HBO therapy significantly reduced the time to wound stabilization and fresh granulation production, as well as the occurrence of wound complications Image / Graph: Abstract Book Conclusion: This case report demonstrated a classic clinical manifestation of vulva necrotizing fasciitis and also described the successful treatment modality with adjuvant hyperbaric oxygen therapy to facilitate better outcome. Disclosure of Interest: None Declared P130 LITERATURE REVIEW OF SPONTANEOUS HEMOPERITONEUM IN PREGNANCY ASSOCIATED WITH ENDOMETRIOSIS P. Tan*, M. Mathur KK women's and cildren's hospital, Singapore, Singapore Problem Statement: Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but life threatening condition. Perinatal mortality remained high (31%), with 44% of the deaths attributable to maternal shock. Recent literature has identified increasing cases of ShiP associated with endometriosis.Methods: A search of Pubmed for all cases of SHiP published associated with endometriosis was carried out for publications in peer-reviewed journals with the following key words: ‘‘spontaneous hemoperitoneum,’’ ‘‘pregnancy,’’ and ‘‘endometriosis.’ 21 suitable publications, reporting a total of 25 cases, were retrieved.Results: 17 (74%) out of 23 cases were nulliparous. The mean age was 32 (SD ±4.6) years. In 15 (60%) out of 25 cases, there was a prior diagnosis of previous endometriosis with surgery performed and in 9 (36%) cases, the endometriosis was described as severe or r-AFS stage 4. 10 (40%) of the 25 cases had endometriosis unknown prior to pregnancy There were 12 (48%) pregnancies conceived after IVF of which 7 (28%) were twin pregnancies. 3 (12%) cases of SHiP occurred prior to 24 weeks of gestation, 16 (64%) occurred between 24 and 33 weeks, 2 (8%) between 33 and 37 weeks, 2 (8%) occurred at term and 2 (8%) occurred post natal (day 7 and 14 post delivery). All presented with abdominal pain, 13 (52%) cases were reported to have severe or progressive anemia and 15 (60%) cases had evidence of hypovolemic shock. Free intraperitoneal fluid was detected on imaging in 15 (60%) cases of which ultrasound was the main modality of imaging used. 4 cases had a non-reassuring trace on fetal cardiotocography. 3 cases of bradycardia with resultant fetal demise of both twins and 5 cases of intrauterine fetal demise of singletons were detected on ultrasound. Laparotomy was performed in all but one case where there was uneventful recovery with conservative management. 4 (16%) cases of supracervical hysterectomy were performed. In 5 (20%) cases, adnexectomy was performed for hemostasis and histological diagnosis of suspicious adnexal lesions.Concurrent caesarean section or hysterotomy for delivery of the fetus was performed in 18 (82%) cases out of the 22 cases with existing intrauterine fetus/fetuses. Actively bleeding endometriotic deposits were the source of hemorrhage in 11 (61%) out of 18 cases where SHiP was directly attributed to endometriosis and this was confirmed on histology in 7 of the cases. 4 (22%) cases of hemoperitoneum were secondary to a ruptured ovarian cyst showing decidualised endometriosis of which 3 were confirmed on histology. No maternal deaths were reported. Excluding 3 cases where spontaneous hemoperitoneum occured post-delivery and 2 cases where neonatal outcome was not reported, 9 (45%) out of 20 cases had good neonatal outcome in spite of morbidity associated with earlier pre term delivery, of which 3 (15%) were twin pregnancies. 3 (15%) cases of poor neonatal outcome resulting in severe asphyxia and pregnancy termination, cerebral palsy or neonatal death occurred. 5 (25%) cases of intrauterine fetal demise of singletons and 3 (15%) cases of fetal demise of twin pregnancies occurred making the perinatal mortality rate 40%.Conclusion: With the advent of assisted reproductive techniques, patients with infertility from severe endometriosis have a higher chance of pregnancy. Increased incidences of SHIP may occur. There should be no hesitation to perform an exploratory laparotomy for hemostasis and maternal survival always takes precedence over fetal viability. Disclosure of Interest: None Declared P131 BENIGN TUMORS OF THE VULVA, A DESCRIPTIVE EPIDEMIOLOGICAL STUDY L. Tinoco 1,*, A. Nicolalde 2, S. Carrillo 3, R. Tinoco 4, D. Tinoco 3, P. Avilés 5 1Lower Genital Tract Pathology, 2Dept of Pathology, Oncology Hospital Solón Espinosa Ayala "Solca", 3Gynecology & Obstetrics, Ginecomast, 4Dept of Gynecology & Obstetrics, Ecuadorian Institute of Social Security , 5Postgraduate Obstetrics and Gynecology , Catholic University of Ecuador, Quito, Ecuador Problem Statement: The vulva corresponds to the female external genital organs; includes the labia majora, labia minora, clitoris and mons Venus. The vulva is continued with the vagina from the vestibule and behind it is limited by the anus. Above mons Venus there is the abdominal skin and laterally reaches the inguinal-femoral folds. Due to the controversy between classifications of dermatological and vulvar lesions, in this study we followed the histologic classification of WHO CLASSIFICATION OF TUMORS.Methods: It is a descriptive epidemiological study of case series with collection cases 10 years, in which he found 170 cases of benign tumor of the vulva lesions histologically diagnosed and treated surgically, GINECOMAST and SOLON ESPINOSA AYALA “SOLCA” HOSPITAL QUITO-ECUADOR. OBJECTIVE: Identify benign tumor lesions of the vulva that occur in the gynecological consultation, diagnose and properly treat them.Results: AGE RANGE: Between 5-83 years. The most common benign tumor was fibroepithelial polyp 22(12.96%) cases, followed by 21 condylomata acuminate (12.35%), Squamous Papilloma 20 (11.76%), Nevus 16 (9.41%), Epidermal Inclusion Cyst and Hidradenoma Papilliferum 8 (4.70%) each one, Lichen Simplex Chronicus 7 (4.11%), Syringoma 6 (3.52%), Molluscum Contagiosum 5 (2.94%), Lichen Planus and Aggressive angiomyxoma 4(2.35%) each one. Angiokeratoma, Capillary Hemangioma and Seborrheic Keratosis 3 (1.76%) each one. Subcutaneous Lipoma, Lichen sclerosus, Hidradenitis suppurativa, Juvenile Xanthogranuloma, Leiomyoma and Hymenal Caruncle Hypertrophy 2(1.17%) each one. Submucosal Angioleiomyoma, Angiomyofibroblastoma, Lipofibroma, Mucinous cystadenoma, Cysts of the canal of Nuck, Skene duct cyst, Keratocyst, Verrucous Dyskeratoma, Eccrine Spiradenoma, Pemphigus Vegetans, Lentigo, Intraductal papilloma 1(0.58%) each one.Image / Graph: Conclusion: Benign tumors of the vulva are associated with tumors of the skin and may be peculiar to the vulva as systemic injury as in the case of Von Recklinghausen Disease and Xanthoma. Biopsy is mandatory for diagnosis, papilloma squamous followed by fibroepithelial polyp and condylomata acuminata are the most frequent, the latter which can be treated by chemical methods such as imiquimod and physical, as laser. The gynecologist must get used to the terminology used by dermatologists and pathologists, it is little known in our specialty. Disclosure of Interest: None Declared P132 EISENMENGER SYNDROME: WHY CONTRACEPTION IN THESE WOMEN? C. Tomás 1,*, B. Lopez 1, S. Couto 1, Á. Vieira 1, F. Romão 1 1Dept of Gynecology and Obstetrics , Hospital Garcia de Orta, Almada, Portugal Problem Statement: Eisenmenger syndrome (ES) is the triad of systemic-topulmonary cardiovascular communication, pulmonary arterial disease causing 115 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 severe pulmonary hypertension and cyanosis. It requires the presence of congenital heart disease and, in some cases, the diagnosis is not established until adulthood. Actually, the therapies are designed to improve patient survival and functional capacity. Pulmonary vasodilator therapy may improve hemodynamics and other important aspects of management include avoidance of high-risk situations such as pregnancy, among others, and a specific attention to hematologic issues. Pregnancy is absolutely contraindicated in women with ES. The reported rate of mortality has ranged from 30 to 50 percent. The fixed pulmonary arterial resistance cannot accommodate the hemodynamic fluctuations of labour, delivery and the puerperium. Most deaths are due to thromboembolism, volume depletion, which can augment the right-to-left shunt and precipitate intense cyanosis and preeclampsia. On order of this, the women and her partner should be educated regarding safe and appropriate method of contraception. Hysteroscpic sterilization is the ideal method, but, in a patient that declines nonreversible methods, other options are progestin-only contraception with depot medroxyprogesterone acetate injections, etonogestrel implant or an intrauterine device. This last one is an option for acyanotic or mildly cyanotic women who are at low risk of acquiring a sexually transmitted infection and is the preferred method because it reduces menstrual blood loss by 40 to 50 percent and may induce amenorrhea. A copper-containing IUD is not recommended and estrogen-progestin contraceptives are contraindicated because of the increased risk of thromboembolism.Methods: The authors pretend to report a case of a 47 year-old women with ES, due to an auriculoventricular sept defect, with severe menorrhagia and consequent hemodynamic repercussion. In our case, contraception wasn’t the primary gold. The main issue was to control the menorrhagia in order to avoid volume depletion and institute anticlotting agents. The menorrhagia were refractory to the use of desogestrel. Then, it was tried a levonogestrel-realising intrauterine device, which, however, was expelled after one week. Subsequently an etonogestrel implant was applied, that was effective in the control of menorrhagia and subsequent recovery to normal hemoglobin levels.Results: Conclusion: Patients with cyanosis develop secondary erythrocytosis, a physiologic response in attempt to improve tissue oxygenation. Menorrhagia is a common problem in women with cyanotic heart disease and, if severe, can lead to iron deficiency and its suppression is often helpful. Disclosure of Interest: None Declared P133 A RARE CASE OF POSTCOITAL BLEEDING: CAN IT BE AIS? A. Unipan 1*, M. Kingsley 2, F. Bano 2, I. Opemuyi 2 1Obstetrics&Gynaecology, 2O&G, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, United Kingdom Problem Statement: Androgen insensitivity syndrome (AIS) is an X-linked recessive condition with an incidence of 1 case per 20,400 liveborn males. AIS represents the failure of masculinization of the external genitalia in chromosomally male individuals. It was first described in 1953 by John Morris at Yale and is also known as Testicular Feminization Syndrome. It can be complete or incomplete with the same 46XY karyotype. The etiology of AIS is a loss-offunction mutation in the androgen receptor (AR) gene, localized to the long arm of the X chromosome. Most patients with complete androgen insensitivity syndrome have a female gender.Methods: Case report: An 18 years old black African patient presented to A&E department with profuse postcoital bleeding and was referred to gynecological team for the suturing of vaginal tear. On examination she had feminine outlook, her face was clean with no signs of acne. Breasts were developed but pubic and auxiliary hair were absent. Examination of the external genitalia showed well-developed labia majora, minora and clitoris. Each inguinal region presented with a 3 cm long scar. Vaginal examination revealed a 5.5cm long vagina, with a 3 cm lateral wall tear, active bleeding. No cervix was visualized. Further discussion with the patient revealed that she was diagnosed with AIS as a child. She has never had a menstruation, and she was aware of the absence of the uterus and ovaries. Following diagnosis she suffered gonadectomy and she was prescribed hormone replacement therapy. She received counseling and she was using vaginal dilatators. 116 Results: Patient was consented for vaginal repair under general anesthetic. The vagina wall was reconstructed during the procedure and haemostasis was achieved. Patient had an uneventful recovery and wasdischarged on the 2nd postoperative day.Conclusion: Conclusion Androgen insensitivity syndrome requires sensitive handling once diagnosed. AIS is responsible for 10% of all cases of amenorrhea. Medical care is complex and consists in hormone replacement therapy and physiological support. Appropriate treatment with estrogen is required to prevent osteoporosis. Many patients require long-term psychotherapy to resolve psychosexual identity issues. Therapy should be provided from the time of diagnosis. These are rare cases that present to emergency department and generally good communication with the patient is vital for further treatment and management. Disclosure of Interest: None Declared P134 THE EFFECT OF APPLYING ICE ON THE PERINEUM FOLLOWING AN EPISIOTOMY ON PAIN REDUCTION AND WOUND HEALING E. Velioğlu*, N. Demirci Marmara University, Istanbul, Turkey Problem Statement: The most frequently employed surgical procedure to facilitate vaginal delivery is an episiotomy (Duran, Eroğlu and Sandıkçı 2002). The application of ice after an episiotomy to eradicate episiotomy-related perineal pain(Ghosh, Mercier, Couaillet, Benhamou 2004) that hinders the puerpera from going about her daily activities causes vasoconstriction, which in turn prevents the development of edema, stops bleeding, slows down the inflammatory process and it also dispels pain by producing an anesthetic effect (Kozier et al. 2008). This study was planned as experimental research to examine the effect on pain reduction and wound healing of applying ice on the perineum of women undergoing an episiotomy during vaginal delivery.Methods: The sample comprised women who had vaginally delivered with a mediolateral episiotomy between the period August 1-October 1, 2013 at the Bursa Çekirge State Hospital Obstetrics and Gynecology Clinic; of the mothers, 73 were recruited into the study group and 75 into a control group. A Data Collection Form, the REEDA(evaluating the healing of the episiotomy/wound) and the Visual Analogue Scales(VAS) were administered to the mothers immediately after delivery.The REEDA and VAS were readministered at the 1st, 3rd, 24th hour and on the 7th day. Ice was applied to the mothers in the study group for 20 minutes in the first 3 hours at 10 minute intervals. No ice was applied to the mothers in the control group. The Wilcoxon test was used in the analysis.Results: At the end of the research, it was found that the mothers in the control group displayed no significant difference between their VAS, REEDA and Edema baseline (0 min.) and 1st hour scores (p>0.05), whereas the mothers in the study group did exhibit significant differences between their VAS, REEDA and Edema baseline and 1st hour scores (p<0.001). The mothers in the study group experienced an immediate reduction in their pain as soon as the ice was applied, after which accelerated healing of the wound was observed. The mothers in the control group, however, felt a reduction in their pain after the 3rd hour with ensuing accelerated healing of the wound (Table 1). There was a significant difference between the study and control groups in terms of the difference in their VAS, REEDA and Edema scores (p<0.001). In addition, a positive correlation was found between the length of labor and the newborn's birth weight and pain, edema and wound healing. Table-1. Comparison of VAS and REEDA values of the Study and Control Groups at the 1st, 3rd, 24th hour and 7th day Abstract Book Study Group Median(min-max) n=70 7(5:8) 5(4:7) 3(1:4) 0(0:0) Median (min-max) n=70 7(5:9) 7(4:9) 5(2:6) 1(0:2) VAS p-values compared to 0 <0.001 <0.001 <0.001 <0.001 VAS p-values compared to 0 1.000 0.004 <0.001 <0.001 REEDA 1st hour Median (min-max) n=70 9(9:11) REEDA p-values compared to 0 <0.001 REEDA 3rd hour 8(7:10) <0.001 REEDA 24th hour 7(5:9) <0.001 REEDA 7th day 3(2:5) <0.001 Control Group REEDA 1st hour Median (min-max) n=70 11(9:13) REEDA p-values compared to 0 1.000 REEDA 3rd hour 10(9:13) <0.001 REEDA 24th hour 8(7:12) <0.001 REEDA 7th day 6(4:8) <0.001. VAS 1st hour VAS 3rd hour VAS 24th hour VAS 7th day Control Group VAS 1st hour VAS 3rd hour VAS 24th hour VAS 7th day Study Group Conclusion: The conclusion was drawn that ice applied to the perineum area following an episiotomy reduces pain and edema and hastens wound healing. The application of the ice in the first hour in particular was seen to produce the greatest effect on pain, edema and wound healing Disclosure of Interest: None Declared P135 PROFILE OF ESTROGEN METABOLISM IN ENDOMETRIOSIS PATIENTS T. Verani*, K. Sumapraja Obstetrics and Gynecology, Faculty of Medicine University of Indonesia, Jakarta, Indonesia Problem Statement: Background: The role of estrogen in the pathophysiology of endometriosis has been well known. However, no study has observed the ratio of estradiol, estrone, and estriol between women with endometriosis and without endometriosis. Objectives: To assess the estrone (E1), estradiol (E2) and estriol (E3) blood level and its ratio (E2:E1, E2:E3 and E1:E3) between women with and without endometriosis. Methods: An analytical cross sectional study with 27 women with endometriosis and 27 women without endometriosis who met the inclusion criteria. The samples were recruited in Cipto Mangunkusumo hospital and other satellite hospitals from October 2012 to April 2013. The blood level of estrogen metabolites was examined by enzyme-linked immunosorbent assay (ELISA). The data comparison between two groups was analyzed by using Mann-Whitney test. Results: The level of Estrone was found to be lower in endometriosis group compared to this in control group (54,66 pg/ml vs 73,52 pg/ml, p 0.229). Similarly, the level of estradiol and estriol were lower in endometriosis group (29 pg/ml vs 35 pg/ml, p 0.815 and 1,11 pg/ml vs 1,67 pg/ml, p 0.095, consecutively). The E2:E1 ratio was higher in endometriosis group (0,51 pg/ml vs 0,38 pg/ml, p 0.164), as well as E2:E3 ratio (26,53 pg/ml vs 21,11 pg/ml, p 0.223) and the E1:E3 ratio (58.55 vs 50.28, p 0.684). However, all those differences were not statistical significant. Conclusion: The estrone, estradiol and estriol level in women with endometriosis group was lower compared to these in women without endometriosis group. The ratio E2:E1, E2:E3 and E1:E3 was higher in endometriosis group. However, all those differences were statistically insignificant. Disclosure of Interest: None Declared P136 VAGINAL DELIVERY IN PATIENTS WITH PREVIOUS CESARIAN SECTION. SELECTION CRITERIA. R. Victor*, G. Tatiana, M. Nara, G. Anna Department of obstetrics and gynecology, PFUR, Moscow, Russian Federation Problem Statement: According to the last randomised multicentral trials of ACOG and RCOG in 2011 the majority of women with one or two previous cesarean sections (CS) with normal pregnancy are strong candidate for vaginal delivery. Russian obstetrics allows to provide vaginal delivery in 30,6% of women with surgically operated uterus.Methods: The research has been performed on the clinical site of the department of obstetrics and gynecology of PRFU. The research covers 100 women with previous Misgav-Ladach с-section who have been admitted to vaginal delivery. All patients have been divided into 2 groups, one of which included 50 patients who underwent cesarean section repeatedly (Group I), and the other group including 50 patients after vaginal delivery (Group II). All pregnancies were singleton and full-term. The average patient age was 34 years.Results: In Group I 6 women had 2 previous cesarean sections, 44 women had only one previuos operation. Programmed labor with Foley catheter and amniotomy has been сarried in 26 patients. Amniotomy with mature uterine cervix was produced in 16 women, premature rupture of membranes occurred in 8 patients. Ultrasound uterine scar assessment in patients of 1 group indicated: 30 patients had scar 2,0-2,4 mm (4 of them had 2 previous CS), 18 patients has scar 3-3,5 mm(2 of them had 2 CS); 2 patients — 4-5 mm. Placenta was located on the front uterine wall in 18 women, on the back uterine wall — 24, in the uterine fundus — 8. Indications for emergency cesarean section in Group I included poor uterine contraction strength — 36 cases (31 with failed oxytocine stimulation, 15 of with the imperfect uterine scar), acute hypoxia — 5 patients, contracted pelvis — 2 insufficiency of imperfect scar — 7. In Group I 4 neonates had weight over 4000 g. In Group II one woman had 2 previous CS, 49 had only one CS. 5 patients had spontaneous uterine contraction. Programmed vaginal labor with Foley catheter and amniotomy has been сarried in 17 patients. Amniotomy with mature uterine cervix was produced in 20 women, premature rupture of membranes occurred in 8 patients. Ultrasound uterine scar assessment in patients of gGroup II indicated: 3 women had scar less than 2,0 mm, 16 patients had scar 2,0-2,4 mm (1 of them had 2 previous CS), 21 patients has scar 2,5-3,0 mm; 10 patients — more than 3,0 mm. Placenta was located on the front uterine wall in 25 women, on the back uterine wall — 19, in the uterine fundus — 4, on the side uterine wall — 2. Epidural analgesia has been performed in every delivery in group 2. In 5 cases poor uterine contractions have been corrected with oxytocine. Only 1 neonate had weight over 4000 g.Conclusion: Favorable signs for conservative delivery included placenta location on the front uterine wall over the uterine scar and the thickness of the scar more than 2,5 mm. Unfavorable signs included large birth weight. The most frequent indication for emergency CS was a poor uterine contraction strength caused by imperfect postoperative scar. The research is currently in progress. Disclosure of Interest: None Declared P137 THE MANAGEMENT OF TUBAL ECTOPIC PREGNANCY IN LINE WITH NICE CLINICAL GUIDELINES M. Vogiatzi*, J. Allsop Obstetrics and Gynaecology, Royal Derby Hospital, Derby, United Kingdom Problem Statement: Tubal ectopic pregnancies comprise over 90% of all ectopics.Ectopic pregnancy remains the commonest cause of maternal mortality in early pregnancy.The diagnosis of ectopic pregnancy is largely based on the use of transvaginal ultrasound scan. Serial β-chorionic gonadotrophin (HCG) measurements are used as an adjunct.The management of an ectopic pregnancy may include:Surgical treatment, medical treatment and expectant managementMethods: We reviewed retrospectively the notes of all women diagnosed with an ectopic pregnancy in our hospital over a period of 12 months between January to December 2013. 54 women were included in our study. We analyzed the time from presentation to diagnosis,the number of visits 117 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 to the Gynaecology Assessment Unit (GAU), the number of hCG measurements necessary to reach a diagnosis, the type of treatment offered, and the level of seniority of doctor at which both the diagnosis was made and the treatment offered.Results: 3 out of 54 women had a previous ectopic pregnancy. One had 3 previous ectopics (treated by salpingectomy, methotrexate administration and salpingostomy), whereas the other 2 were treated by laparoscopic salpingectomy. Many patients only attended once in GAU (20/54), most needed only one transvaginal ultrasound scan (40/54) and required 1-2 hCG measurements before the diagnosis of ectopic pregnancy was reached. 34/54 women had treatment offered within 48 hours of admission (half of them within 24 hours).43/54 women underwent surgical treatment, 8 had systemic methotrexate, one was treated expectantly, one had surgical therapy following failed medical management and another one required methotrexate treatment post-surgery, as histology did not confirm the diagnosis of ectopic. There were 2 cases of laparoscopic salpingectomies converted to an open procedure (one due to extensive pelvic adhesions and the other due to significant bleeding). 5 women had laparotomy and salpingectomy as they presented with ruptured ectopic and were haemodynamically unstable.Seniors were involved in the management of most cases. All operative procedures were preformed by either Consultant or experienced trainees.Conclusion: The diagnosis of ectopic pregnancy occurred within 48 hrs in the vast majority of cases. Most patients required 1-2 β-HCG measurements and only one transvaginal ultrasound scan.However, there were cases where the management was suboptimal.The lack of Consultant input played an important role in those case.senior input is highly recommended and all cases ought to be discussed with a Consultant prior to offering any treatment. Disclosure of Interest: None Declared P138 GENTLE BUT EFFECTIVE: HEMOSTATIC GELATIN-THROMBIN MATRIX (FLOSEAL®) IN LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY R. Watrowski* Obstetrics & Gynecology, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany Problem Statement: Ectopic pregnancy (EP), resulting from implantation and development of the blastocyst outside of the uterine cavity, occur in 1.5-2% of all pregnancies. The most frequent localization of EP is the Fallopian tube (95%). Non-tubal EP localizations (e.g. ovary, peritoneal cavity or uterine wall) are rare, but not less insidious. The incidence of EP has increased in the last 30 years, accompanying the widespread use of infertility treatments, increasing maternal age, popularization of intrauterine devices, or rising number of surgeries. EP remains the leading cause of death in early pregnancy, mostly due to intraabdominal hemorrhage. The current "state of the art" in EP treatment is laparoscopic surgery with organ preservation (expectant or medical management can be considered in early and asymptomatic cases). The main challenge in the surgical treatment of EP is the hemostasis. The bleeding from tubal mucosa, salpingotomy incisions or a peritoneal defect after trophoblast removal can cease spontaneously. However, if the trophoblast grows deep into surrounding tissues, the bleeding after trophoblast removal can become uncontrollable. In those cases, the surgeon has to manage a balance act between local bleeding control and organ preservation on the one hand, and patient’s safety on the other hand. During laparoscopy, the common hemostatic manoeuvres like sutures, clamping or thermal coagulation can be impractical or unsafe (e.g. impairment of tubal integrity or functionality; proximity to fragile intra-abdominal structures in non-tubal pregnancies). Therefore, agents providing quick and tissue-preserving hemostasis deserve interest.Methods: We demonstrate on a sequence of cases how quick and sufficient hemostasis can be achieved with the hemostatic matrix (Floseal®, Baxter), a locally applicable agent consisting of bovine-derived gelatin and human thrombin. The drug is prepared directly at the operating table within approximately 1 minute and can be applied with a 5-mm endoscopic applicator directly on the bleeding tissue (e.g. bleeding area after trophoblast removal). All excess hemostatic matrix (not incorporated in the clot) should be irrigated after two minutes, since cases of intra-abdominal granuloma formation or bowel obstruction have been reported after inappropriate Floseal® use.Results: We used Floseal® in four laparoscopic 118 surgeries for EP. In each case, the hemostasis was achieved by application of one unit (5 ml) of the hemostatic matrix. Our experiences with Floseal® applications during EP surgeries are illustrated on intra-operative pictures. None of the patients required salpingectomy, laparotomy, or blood transfusions. We did not observe any short term complications within 24-48h postoperative hospital stay. Unfortunately, we do not know about the long term follow up of these patients.Conclusion: The ideal treatment of EP should prevent maternal mortality and morbidity without impacting the reproductive function. Our data present a new way towards tissue-preserving bleeding control. It could be particularly important in patients with fertility-reducing factors. Our case series demonstrates that Floseal® can be a valuable option for achieving hemostasis, especially if conventional thermal coagulation, modern sealing devices or ligatures are of limited value. Disclosure of Interest: None Declared P139 EXPRESSION OF AROMATASE AND STEROID HORMONE RECEPTORS IN ENDOMETRIOTIC HETEROTOPIES M. I. Yarmolinskaya 1,*, V. Denisova 2, A. Molotkov 2, I. Kvetnoy 2, V. Bezhenar 2 1Gynecological endocrinology, 2D.O. Ott Research Institute of Obstetrics and Gynecology, Saint-Petersburg, Russian Federation Problem Statement: Problem statement: Genital endometriosis (GE) is still considered to be one of the unsolved problems of modern gynecology. Despite new data on the etiology and pathogenesis of GE, effective treatment, that guarantees recovery or absence of recurrence of the disease, doesn’t exist. Of course, hyperestrogenemia influences on the development of the disease, however, the synthesis and reception of steroid hormones in endometriotic foci are still a mystery. Investigation of the change in steroid hormones and their enzymes synthesis, as well as a violation of their reception will give an opportunity to clarify some aspects of pathogenesis and development of the disease. It could also be a promising therapeutic target in the combined treatment of GE. The aim of this study was to evaluate expression of aromatase, estrogen receptors-α (ERα) and progesterone receptors (PR) in endometrioid heterotopies.Methods: Methods: we examined 81 patients of reproductive age with GE. In all the patients the diagnosis was stated by laparoscopy and was confirmed by histological examination. The control group consisted of 21 healthy women who underwent laparoscopy and hysteroscopy and during these surgeries no gynecological diseases were revealed. For immunohistochemical studies in patients with GE we performed excision of endometrioid heterotopies and endometrial biopsy, in women of the control group – endometrial biopsy. We assessed the expression of aromatase in 45 patients with GE, and determined the expression of ERα and PR in 36 patients. We used primary monoclonal antibodies to the aromatase, ERα and PR; as secondary antibodies we used antibodies, labeled with peroxidase. For evaluation of the results we performed morphometric study with computer analysis of microscopic images with determination of relative surface expression, average brightness and optical density.Results: Results: In endometrioid heterotopies square of aromatase expression was increased in all the samples (averaged 11.94±2.11%), which was significantly higher (p<0.01) than square of aromatase expression in endometrium of healthy women (average size equal to 0.35±0.35%). We determined significant decrease (p<0.05) of the expression of ERα and PR in endometrioid heterotopies as well as in eutopic endometrium of patients with GE compared with the endometrium of healthy women. The relative surface expression of ERα in endometrioid heterotopies was 0.7±0.2% in average, in eutopic endometrium of patients with GE it was 0.9±0.3% and in the endometrium of healthy women of 4.9±1.5%. The relative surface expression of PR was also minimal in endometrioid heterotopies and was 4.8±0.9% in average, in eutopic endometrium of patients with GE - 8.6±1.7%, and in the endometrium of healthy women - 10.2±2.2 %. We didn’t receive statistically significant difference in the average brightness and the optical density of the expression of aromatase, as well as receptors of sex steroid hormones among patients with GE and patients of the control group.Conclusion: Conclusion: with the use of immunohistochemical method, the most informative indicator of aromatase and receptors of sex steroid hormones expression is relative density. Increased expression of aromatase and reduced expression of ERα and PR in endometrioid Abstract Book heterotopies may contribute to progression, recurrence of the disease and resistance of GE to different schemes of hormonal therapy. Disclosure of Interest: None Declared P140 METHOTREXATE IN COMBINATION WITH VASOPRESSIN AND MISOPROSTOL – A NOVEL THERAPEUTIC APPROACH TO CERVICAL ECTOPIC PREGNANCY S. Yeo 1,*, S. Teo 2 1 Obstetrics & Gynaecology, Singhealth, 2Reproductive Medicine, KK Women's and Children's Hospital, Singapore Problem Statement: Our patient was a 35-year-old Gravida 0 Para 0 lady with an 8-year history of subfertility, including failed Clomiphene therapy and intrauterine insemination. She underwent a fresh cycle of Intracytoplasmic Sperm Injection (ICSI) at our centre, with uncomplicated transfer of two fresh embryos. On day 19 post embryo transfer (ET), she complained of vaginal bleeding, with fresh blood seen from the cervical os on speculum examination. The b-hCG trend is presented in table 1. Pelvic ultrasound on day 20 reported a 1.4 x 0.4 x 0.9cm gestational sac with a 0.1cm yolk sac within the lower endometrial / endocervical canal, corresponding to 5 weeks and 5 days. A cervical ectopic was suspected. Our patient was counseled on treatment options, and chose Methotrexate.Methods: Under general anaesthesia, we injected intracervical (stromal) vasopressin on her cervix. An IVM needle was introduced into the gestational sac under ultrasound guidance, and the sac contents were aspirated. Methotrexate (at a dosage of 1.2mg/kg) was injected into the sac, advanced beyond the visible trophoblastic rim, and injected into the cervical stroma. She was discharged the next day. Our patient was readmitted to the high dependency ward one week later for heavy vaginal bleeding with passage of clots and tissue. A single dose of Misoprostol (400 mcg) was administered vaginally. The bleeding subsided, and a >50% drop in her b-hCG levels was seen. Histology confirmed products of conception. Transvaginal ultrasonography demonstrated heterogenous clots in place of the previous cervical ectopic. (Figure 1). She was monitored outpatient with spontaneous resolution of the clots.Results: Our case demonstrates a conservative, fertility-sparing approach to an early cervical ectopic, using single a dose of intra-sac Methotrexate and vaginal Misoprostol. Table 1: b-hCG Trend Post ET Day Event D17 D17 post ET b-hCG level 2379.9 D24 D30 Re-admitted with bleeding 18940.7 23960.8 D19 1st presented with PV bleeding 6828.7 D31 Re-solution of ectopic on scan 10561.2 D21 11343.0 D23 Intra-sac Methotrexate injection 14328.0 D40 Clinic follow-up D61 Clinic follow-up 1340.0 1.8 Figure 1:(Clockwise from top left) Cervical EP before passage; cervical EP before passage (sagittal / coronal); endocervix after passage of EP (coronal / sagittal); normal uterus and cervix; endocervix healed; resolving endocervical clot.Image / Graph: Conclusion: Termination with local Methotrexate has reported success rates approaching 100%, either alone or in combination with repeat local therapy or cervical curettage. No official guidelines exist due to the rarity of experience with cervical ectopics. However, multiple studies have found that Methotrexate can be offered in the absence of fetal cardiac activity, and if ultrasound dating of the pregnancy is less than nine weeks. Conservative therapy with single dose intra-sac Methotrexate and vaginal Misoprostol is an effective treatment option, and should be offered to patients with early cervical ectopic pregnancies who desire future fertility. Disclosure of Interest: None Declared P141 HUMAN PAPILLOMAVIRUS TESTING IN THE MANAGEMENT OF ATYPICAL GLANDULAR CELLS ON CYTOLOGY. V. Costa Ribeiro,* and Aguilar S.; Paula T.; Borrego J. Gynecology, Alfredo da Costa Maternity, Lisbon, Portugal Problem Statement: the aim of this study was to evaluate the presence of human papillomavirus (HPV) deoxyribonucleic acid (DNA) in patients with atypical glandular cells (AGCs) from cervical liquid-based cytology (ThinPrep) and to report the relationship between the presence of HPV DNA and cervical histological abnormalities.Methods: we conducted a retrospective study, from 2010 to 2013 at the Colposcopy Department in Alfredo da Costa Maternity in Lisbon, including all AGC cervical liquid-based cytology with a concomitant HPV DNA study. Age of diagnosed AGC, parity, colposcopic-directed biopsies, endocervical curettage and histological findings from cervical cones were compared between group A (n=9): HPV DNA positive and group B (n=21): HPV DNA negative group. Statistic significance (p<0.05) was calculated using SPSS 20.0.Results: The overall prevalence of HPV DNA was 30% among the total 30 AGC cervical liquid-based cytology included in this study. The medium diagnosed age of AGC was similar between groups (Group A=43.3, Group B=45.7; p=0.790). We also found no differences in what concerns the age of first menses (Group A=13.2, Group B=12.1; p=0.193), the age of first intercourse (Group A=18.3, Group B=17.1; p=0.283) or parity. Colposcopic-directed biopsies identified squamous cervical intraepithelial neoplasia (CIN) in 33.3% (n=3) on Group A. The same procedure detected one case of cervix glandular dysplasia on Group B, there were no reports of CIN in this group. 119 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 Endocervical curettage indentified 2 patients with CIN in Group A. No malignancies were reported in group B. When submitted to treatment by excisional cone we identified CIN in 55.5% (n=5) of Group A patients (n=1 case of CIN I and n=4 cases of CIN III). There was one case of in situ adenocarcinoma identified in cone on Group B, there were no reports of CIN in this group. When testing positive for HPV DNA the risk of underlining cervical malignancy, in AGC ThinPrep cytology, is showed to be higher (Group A: n=5, Group B: n=1; p=0.005)Conclusion: Our study shows that the concomitant use of HPV DNA testing in AGC cervical liquid-based cytology has a positive predictive value of 83% with a 55% of sensibility and 95% of specificity. The accuracy of this diagnose test in our study rounds 83%. This study, although small in sample agrees with the existing literature that states that when having an AGC cytology the risk of cervical malignancy becomes higher when patients test positive for HPV DNA. Disclosure of Interest: None Declared P142 FACTORS ASSOCIATED WITH UTERINE CERVICAL ADENOCARCINOMA A. H. França-Neto 1,*, M. Amorim 2, A. S. Rolland de Souza 3, T. M. Lubambo 3, S. Heráclio 3, P. R. Eleutério Souza 4, N. Lubambo 3, A. Paulino da Silva 3 1Obstetrics and Gynecology, FCM and IMIP, 2Obstetrics and Gynecology, UFCG and IMIP, Campina Grande, 3Obstetrics and Gynecology, IMIP, 4Genética, UFRPE, Recife, Brazil Problem Statement: Cervical adenocarcinoma is a type of malignant tumor originating from epithelial cells with glandular growth pattern. This type is much less frequent than squamous cell carcinoma, but more difficult to diagnose, with a greater number of false negative cytology and a worse prognosis due to failure in therapeutic response. Identification of factors associated with cervical adenocarcinoma in our setting can contribute to the development of appropriate preventive strategies. This study was conducted to determine the factors associated withadenocarcinomaof the cervix and the genotyping of Human Papilloma Virus (HPV). Methods: A case-control study was carried out at Institute of Integral Medicine Prof. Fernando Figueira (IMIP), located in Recife, Pernambuco, Brazil, in the period of February 2001 to February 2014. Were included 64 pacients with histopathological diagnosis of uterine cervical adenocarcinoma (case) and 260 women without the disease (controls). Women of the control group women had normal cytology and colposcopy and their data were available in a database of other study previously carried out in IMIP. For the collection of information of cases the medical records were used and the extraction of HPV DNA for genotyping was performing using the blocks of biopsies and surgical pieces. Statistical analysis was performed using the statistical program Epi- Info 7.1.4. Chi-square test of association (Pearson) and Fisher's exact tests were used, when indicated, for the categorical variables. Odds ratio (OR) and its 95% confidence interval (95% CI) were calculated as an estimative of relative risk. Logistic multivariable regression analysis was performed to determine the adjusted risk factors associated with uterine cervical adenocarcinoma. A significance level of 5% was adopted. Results: Among the patients with adenocarcinoma, 98,4% (n=63) had a diagnosis of invasive adenocarcinoma. It was observed that adenocarcinoma was associated with age greater than or equal to 40 years (OR 2.34; 95% CI 2.02 – 5.37) , schooling less than or equal to three years (OR 2.34; 95% CI 1.02- 5.37), presence of HPV (OR 6.75; 95% CI 2.41 – 18.91), women in menopausal status (OR 4.76; 95% CI 1.70- 13.31) , black race (OR 6.71; 95% CI 2.11-21.32), and never have done Pap smears (OR 9.92; 95%; CI 2.41- 40.81. Among the types of HPV found in the analysis, it was observed that HPV18 showed a strong expression of association with uterine cervical adenocarcinoma (OR=99.1; 95% CI 12.96757.78) only when associated with one or more types of HPV. Similarly, HPV 31 was only associated with adenocarcinoma when associated with one or more types of HPV in the same women (OR 4.76; 95% CI 2.62-8.66). However, HPV 16, isolated (OR 0.71; 95% CI 0.36-1,39) or associated to one or more types of HPV (OR 1.62; 95%; 95% CI 0.93- 2.84) had no expression of significant association with adenocarcinoma. Conclusion: The main factors associated with adenocarcinoma were age greater than or equal to 40 years, schooling less than or equal to three years of age, black race, menopausal status, never have done 120 Pap screening and present of any HPV type studied. HPV 18 was associated with adenocarcinoma when associated with other types of HPV in the same patient, while HPV 16 was not associated with adenocarcinoma isolated or associated with other types. These findings suggest that not only the types of HPV are involved in the genesis of uterine cervical adenocarcinoma but the types of associations can be a risk factor even more. Disclosure of Interest: None Declared P143 CERVICAL CANCER SCREENING UPTAKE AND AWARENESS AMONGST RURAL MALAYSIAN WOMEN C. Lake * Acute Medicine, Hammersmith Hospital, London, United Kingdom Problem Statement: Cervical cancer is one of the most common cancers in women worldwide and there is a huge global disparity in the uptake of screening programmes to detect it. The uptake of cervical cancer screening (Pap smear) in Malaysia has been low since its introduction in the 1960s and promoting uptake remains a challenge. This study was conducted whilst on a medical elective in Malaysia to determine the uptake of cervical cancer screening amongst women, to assess awareness and to evaluate the factors affecting uptake.Methods: The study was qualitative and adopted face-to-face interviews with 35 Malaysian women aged 21-45 years attending their first antenatal appointment. Structured questions were asked with the help of a local translator were asked to investigate uptake of screening and analyse awareness of the methods and purpose of screening. Questions were also posed to assess knowledge of cervical cancer (risk factors, symptoms) to determine whether there was a correlation between knowledge and uptake.Results: Among the 35 respondents, 89% were aware that a screening programme for cervical cancer existed. However, only 54% had attended previously for a Pap smear. There was confusion amongst the respondents about the need for a Pap smear and its use as a screening rather than diagnostic tool was often misunderstood. Furthermore, many of the respondents did not understand the importance of cervical cancer screening as a tool to detect early changes that could progress to cancer. Those respondents who had previously attended for a Pap smear demonstrated better knowledge of the symptoms and risk factors for cervical cancer than those who had not. A 5 point Likert Scale indicated that 54% of respondents would be very likely and 37% would be likely to undergo further screening if their doctor suggested this was important. Conclusion: The findings demonstrate that there is good overall awareness that the Pap smear exists in Malaysia, however there is continued poor uptake. The study highlighted that there is a general lack of awareness about the importance of screening for cervical cancer amongst Malaysian women. The findings also emphasised the importance of doctors in advising women about the importance of screening. Future interventions aimed at increasing uptake should aim to emphasise accurate information about cervical cancer screening and the purpose of the Pap smear. Disclosure of Interest: None Declared P144 THE ROLE OF CULTURAL FACTORS IN MAMMOGRAPHY SCREENING: SYSTEMATIC REVIEW S. Z. Akar 1,*, I. yeşilçınar 2, H. bebis 1, T. yavan 2 1Department of Public Health Nursing, 2 Obstetrics and Gynecology Nursing, Gulhane Military Medicine Academy, Ankara, Turkey Problem Statement: Breast cancer appears to be a significant disease of both the developing and developed countries. Among Turkish women, breast cancer is the second leading cause of cancer-related deaths. Cancer screening tests such as mammography play a pivotal role in reducing breast cancer related mortalities. It is broadly accepted that breast cancer prevention efforts should consider cultural factors when addressing the needs of diverse populations, yet there is surprisingly little evidence that doing so boosts effectiveness. The aim of this literature review is to present cultural factors that affect mammography screening.Methods: A literature search of six electronic databases (Wiley, Medline, Springer Link, Ovid, EBSCOhost and PubMed) was conducted using the terms breast cancer, mammography, culture, and nursing. Articles published in Abstract Book English and Turkish, from January 2009 to April 2014, were searched. 155 literatures founded and 50 literatures were related with our topics.Results: Nurses need to understand the reasons behind why women don’t practice mammography, especially cultural factors. According to literature, despite the increasing incidence of and mortality from breast cancer, Asian women in the United States of America and Turkey report consistently low rates of mammography screening. A number of health beliefs and socio demographic and cultural characteristics have been associated with mammogram participation among women. However, studies systematically investigating cultural factors in relation to mammogram experience have been scarce around Turkey and some countries. While rates of participating mammogram show differences in terms of rural and urban areas in Turkey, rates show differences in terms of age in Jordan. For example, “Social norms and self-efficacy highly influenced these women’s intention to engage in mammography screening and younger women were more willing to indicate intention to engage in mammographic screening.”Conclusion: Nurses are important persons to increase the rates of mammogram participating and they must know cultural factors of women. Nurses should consider the inclusion in culturally variety interventions of more targeted outreach and health care system navigation assistance for promoting mammography screening since mammography is very important for early diagnosis of breast cancer. Disclosure of Interest: None Declared P145 DETERMINATION OF KNOWLEDGE ABOUT CERVICAL CANCER AND EARLY DIAGNOSIS OF UNIVERSITY STUDENTS B. Altinel * Selcuk University, Konya, Turkey Problem Statement: This study of university students and early diagnosis oof cervical cancer was conducted to determine the level of knowledge about.Methods: Kastamonu University, studying in the part of the 4-year girl students are studying in 1588. Planned as a descriptive study of these students are pov-probability sampling method was used to analyze the work was completed by 381 students. Statistical analysis of the data, SPSS 20.0 package programwas carried out using. Percent statistical evaluation, correlation and chisquare tests were conducted.Results: The mean age of the 19 students who participated in the study and 99.7% are single. Of these students, 70.8% have social security, 90.6% have heard the diagnosis of cervical cancer. Students accounted for 3.4% of the individuals in the family are diagnosed with cervical cancer. The students who enrolled in the study 45.1% of early diagnosis of cervical cancer is feasible, 8.4% have heard of the pop smear test. 11.5% is a vaccine for prevention of cervical cancer is to know. Surveyed students with ages cervical cancer control how often should be made aware of marital status with cervical cancer early detection inquire about want of social security and not the situtaion with the pop-smear hear the case of a statistically significant relationship was found.Image / Graph: Conclusion: In our study of university students and for the early diagnosis of cervical cancer was found to be insufficient information Disclosure of Interest: None Declared P146 NEUROENDOCRINE CARCINOMA ARISING FROM A MATURE CYSTIC TERATOMA: A CASE REPORT M. R. C. Arcilla * OB GYN, St. Luke's Medical Center, Quezon City, Philippines Problem Statement: Neuroendocrine tumors (NETs) are often characterized by excessive hormone production localized more commonly in the gastrointestinal and respiratory tract. Only 500 cases of ovarian origin have been reported and often, diagnosis is retrospective. Excessive hormone production by the tumor occurs less frequently with rare NETs. Methods: However, immunohistochemical staining may still be positive, and thus, aids in characterizing the neoplasm. Here we describe a case of a neuroendocrine carcinoma of the ovary found incidentally after oophorocystectomy for a mature cystic teratoma.Results: The specimen was sent for histopathology. The left ovarian cyst wall consisted of two previously opened cystic tissues measuring 4x3x3 cm. and 7x6x5 cm. The larger tissue was multiloculated while the smaller tissue was uniloculated. Both were filled with tan, pasty material, fibrofatty tissues and hair (APPENDIX B, Figure 2). A yellowish ovoid, solid nodule measuring 2.3 cm in widest dimension was seen attached to one of the locule walls of the larger tissue (APPENDIX B, Figure 3). Histopathology revealed a neuroendocrine carcinoma arising in a mature cystic teratoma of the left ovary. The tumor was 2.3cm in widest dimension. There were no lymphovascular invasion. The tumor stained positive for synaptophysin and calretinin, and negative for chromogranin A and inhibin (APPENDIX B). A baseline vanillylmandelic acid was obtained for monitoring purposes. Conclusion: Neuroendocrine tumor of the ovary is a rare neoplasm that may be seen in women in the reproductive as well as postmenopausal age. The functionality of such tumors, mass effect, and/or as an incidental finding during imaging or on histopathology leads to diagnosis. Excessive hormone production by the tumor occurs less frequently with rare NETs, thus may not be seen. However, immunohistochemical staining may still be positive, and thus, aids in characterizing the neoplasm.6 when detected early, surgical resection leads to high survival rates. However, with aggressive histopathologic types, adjuvant treatment may or may not halt disease progression. Disclosure of Interest: None Declared P147 COMPARISON OF RECURRENCE RATE, DISEASE-FREE SURVIVAL AND OVERALL SURVIVAL AFTER SENTINEL LYMPH NODE BIOPSY OR INGUINAL LYMPH NODE DISSECTION IN PATIENTS WITH NODAL-NEGATIVE VULVAR CANCER A. Beyer 1,*, T. W. Friedl 1, N. Degregorio 1, E. Vorwerk 1, T. Blankenstein 2, A. Rempen 3, W. Janni 1, F. Ebner 1 1 Obstetrics & Gynecology, University of Ulm, Ulm, 2Obstetrics and gynecology, LMU munich, Munich, 3Obstetrics and gynecology, Diak SHA, Schwäbisch Hall, Germany Problem Statement: Sentinel lymph node biopsy (SNB) has been shown to reduce the postoperative morbidity in women with vulvar cancer. However, data on long-term outcome of SNB in vulvar cancer in terms of recurrence rates, disease-free survival (DFS) and overall survival (OAS) as compared to women with complete inguinal lymph node dissection (ILND) are scarce.Methods: Data of women diagnosed with T1/T2 and histologically confirmed nodal-negative vulvar cancer (pN0 or pN0sn) at three different hospitals (O&G Department University Ulm, O&G Department University Munich, O&G Department Diakonie Schwäbisch Hall) between 1992 and 2011 were retrospectively analyzed. Based on a median follow-up of 72 months, recurrence rates, DFS and OAS were calculated and compared between patients who had undergone either SNB or ILND. Women with a secondary tumor were excluded.Results: A total of 122 (60 SNB; 62 ILNE) patients with T1/T2 nodal-negative vulvar cancer were analyzed. Patients in the ILND group had a significantly higher proportion of T2 tumors (57% vs. 14%; p < 0.001) and received more often a complete vulvectomy (39% vs. 3%; p < 0.001) as compared to the SNB group. During the follow-up period (median 57 months for the SNB group and 92 months for the ILND group), 17 out of 60 (28%) patients in the SNB group had a recurrence; this includes 8 (13%) patients with an inguinal lymph node recurrence. In the ILND group 29 out of 62 121 The 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Paris, France • December 4-7, 2014 (47%) patients had a relapse, including 6 (10%) with an inguinal recurrence; the rate of inguinal recurrences did not differ between the SNB and ILND group (p=0,526). 5 out of 60 (8%) women died in the SNB group, and in 4 of these 5 cases (80%) death was due to vulvar cancer. In the ILND group 19 out of 62 (31%) women died, with 9 of these deaths (47%) because of vulvar cancer. Multivariate survival analyses accounting for tumor stage (T1, T2) and type of surgery (complete vulvectomy, partial vulvectomy, wide excision) using cox regressions revealed no significant effect of treatment group (SNB vs. ILND) on DFS (hazard ratio 1.619; 95% confidence interval 0.828 – 3.165; p = 0.159) and OAS (hazard ratio 1.167; 95% confidence interval 0.363 – 3.747; p = 0.796).Conclusion: In our investigation no difference between SNB and ILND was found concerning DFS and OAS. SNB seems to be a safe treatment in women with T1/T2 nodal-negative vulvar cancer not only short-term but also long-term. Disclosure of Interest: None Declared P148 BASAL CELL CARCINOMA IN OVARIAN MATURE TERATOMA - A CLINICAL CASE F. Caeiro*, V. Santos, T. Diniz-Costa, J. Silva Pereira Women's Health, Prof. Dr. Fernando Fonseca's Hospital, Lisbon, Portugal Problem Statement: Introduction: Ovarian teratomas are the most common type of germ cell tumors. They correspond to a neoplasm that differentiates toward somatic-type cell populations (typically including cell populations that would normally derive from ectoderm, endoderm, and mesoderm) that can be found in either adult or embryonic development. The component tissues in a teratoma range from immature to well differentiated, and are foreign to the anatomic site in which they are found representing somatic cell type differentiation, the majority of them benign. They are classified in 4 categories: mature, imature, malignant due to a component of another somatic malignant neoplasm, and monodermal or highly specialized. Mature teratomas correspond to 95% of all teratomas, with a 0,2 to 2% of malignant transformation (in any of their components). Risk factors to malignant transformation include: age over 45 years (mean age 50 years versus 33 years for benign teratomas), tumor diameter greater than 10 cm, rapid growth, and findings on imaging suggesting malignancy.Methods: The authors describe a case of malign transformation of a mature teratoma, with basal cell carcinoma. Results: Clinical Case: A 48-year old black woman, with irrelevant gynecological and personal antecedents, comes to the Urgency Service with abdominal pain associated a rapid volume growth. At clinical examination it was described an voluminous, distended and globally painful abdomen, with higer intensity of pain in left quadrants. Bimanual observation defined a giant pelvic mass difficult to delimitate. An abdominopelvic computerized tomography was performed describing an adnexal heterogeneous mass with 14x9x9,5cm, compatible with a teratoma with malignant characteristics, with ascites and no large lymph nodes. Tumor marker CA125 (cancer antigen 125) was elevated (68,9). It was performed a unilateral adnexectomy and a contralateral prophylactic salpingectomy and the pathologic evaluation of the surgical piece was basal cell carcinoma in mature teratoma. The case was discussed in multidisciplinary meeting and was decided to follow up with seriated SCC (squamous cell carcinoma) tumor marker and no further treatments were performed. Up till now the patient is in good clinical condition.Conclusion: Though rare, malignant teratomas may appear, and there are some characteristics that may create a clinical suspition of the malignancy, that are described in the literature and were present in our patient: age over 45, rapid growth, diameter greater than 10cm and imaging f