Ine Riphagen

Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy.

Introduction  Abnormal vaginal flora (AVF) before 14 gestational weeks is a risk factor for preterm birth (PTB). The presence of aerobic microorganisms and an inflammatory response in the vagina may also be important risk factors.

Change in knowledge of women about cervix cancer, human papilloma virus (HPV) and HPV vaccination due to introduction of HPV vaccines

OBJECTIVES Test knowledge of HPV, cervix cancer awareness and acceptance of HPV vaccination of women now and a year ago. STUDY DESIGN Questionnaires were filled out by 305 women visiting four gynaecologists of the Regional Hospital Heilig Hart, Tienen, Belgium during two subsequent weeks. Fisher T or Chi(2) were used as statistical methods to compare the data with the survey of 381 women exactly one year before. RESULTS Knowledge about HPV as a cause of cervix cancer and the presence of a vaccine rose from roughly 50% in 2007 to over 80% in 2008 (p<0.0001). Level of education and having daughters, sons or no children no longer influenced the level of knowledge or willingness to accept the vaccine. Most parents favor the age group 12-16 years as an ideal time for vaccination. In contrast with the 2007 survey, women below 26 years had now acquired almost equivalent knowledge to older women about the virus, cervix cancer and the vaccine, but they were far less likely to accept the vaccine due to its cost, unless it would be reimbursed (OR 4.2 (1.6-11) p=0.0055). CONCLUSION One year after introduction of the first two HPV vaccines, over 75% of women attending an ambulatory gynaecology clinic know HPV causes cervix cancer and that you can get vaccinated against it. Compared with a year earlier, young and lower educated women had dramatically improved their knowledge. However, women below 26 years are less prepared to pay the cost for vaccination if it is not reimbursed.

Bilateral Mammary Tuberculosis Associated with a Borderline Ovarian Tumor

Background: Mammary tuberculosis is rare in the Western world. It has no defined clinical or imaging features, and has to be differentiated from breast cancer and an abscess. Case Report: We present a case of mammary tuberculosis combined with borderline ovarian cancer. The bilateral breast tuberculosis was the first and only symptom of underlying tuberculosis with Ziehl-Neelsenpositive para-aortic lymph nodes. During further exploration, an asymptomatic pelvic mass was discovered, which appeared later to be a borderline ovarian tumor. The patient was treated with tuberculostatic therapy for 6 months, resulting in a complete regression of the breast lesions. She also underwent hysterectomy with bilateral salpingo-oophorectomy and lymph node dissection for her ovarian cancer. Conclusions: This case report emphasizes that breast tuberculosis should be included in the differential diagnosis of any atypical breast mass.

OP20.02: Should the peak systolic velocity influence the management of residual trophoblastic tissue?

Objectives: To determine if a consistently retroverted or retroverted retroflexed uterine position is associated with pelvic pain. Methods: 969 sequential gynecological sonograms were reviewed by a radiologist on-line. Uterine position on transvaginal examination was categorized as anteverted (746–77%), retroverted (129–13%), axial (49–5%), anteverted retroflexed (40–4%), and retroverted anteflexed (5−.5%). 118 of the retroverted uteri had transabdominal and transvaginal examinatons. 41, anteverted on transabdominal exam, became retroverted on transvaginal exam (‘‘variable’’), 77 were retroverted on transabdominal and transvaginal views (‘‘fixed’’). The gynecological referral indication was compared between the ‘‘variable’’ and ‘‘fixed’’ groups. Results: Pelvic pain as an indication was commoner in the ‘‘fixed’’ group (27%) than in the ‘‘variable’’ group (14%). IUD issues (either malposition or ‘‘lost string’’) were more common in the variable group (24%) than in the fixed group (8%). Other indications such as abnormal uterine bleeding, abnormal uterine bleeding with pain, postmenopausal bleeding, retained products of conception, adnexal mass or ‘‘miscellaneous’’ were the equivalent in both groups. Conclusions: A consistently retroverted or retroverted retroflexed uterine position on both transabdominal and transvaginal ultrasound views is assocaited with pelvic pain. IUD issues occur more commonly if the uterine position changes from anteverted to retroverted between the transabdominal and endovaginal ultrasonic examinations.

P07.02: The surgical removal of residual trophoblastic tissue in case of enhanced myometrial vascularity with a peak systolic velocity > 50 cm/sec

Objectives: To check for the feasibility of transcervical surgery inside the endometrial cavity with standart laparoscopic instruments and under continuous ultrasonographic surveillance. Methods: Women with suspected endometrial polyps, submucous myoma < 2 cm and septum uteri underwent transcervical intrauterine surgery with laparoscopic instruments under ultrasonographic guidance. After dilatation of the os intern until 6 mm, a 5.5 mm laparoscopic trochar sleeve was guided over a blunt trochar into the uterine cavity. A pressurized irrigation fluid (glycine) bag was attached to the sleeve after removing the trochar. Standard hydrosonography under transabdominal ultrasonography was followed by the insertion of a 5 mm laparoscopic grasper or a straight scissor to extirpate polyps and myomas or to cut intrauterine septum under continuous ultrasonographic surveillance. Thereafter diagnostic or if needed operative hysteroscopy was done in all cases. Results: A total of 39 patients with a mean age 37.1 ± 9.1 had participated in the study. 5 cases had normal endometrial cavity after hydrosonography and hysteroscopy. Of the remaining 34 women 26 had endometrial polyps, 4 submucous myoma and 5 septum uteri. Extirpation under ultrasonographic guidance was successful in 21 (80.8%) and 4 (75%) of endometrial polyps and submucous myomas respectively. Successful septotomy was achived in 4 (80%) cases with uterine septum. There were no complications. Conclusions: Transcervical surgery inside the endometrial cavity using simple laparoscopic tools under continuous ultrasound guidance is a feasible option with a high success rate.

OP25.02 Abnormal vaginal flora (AVF) and cervix length (CL) as risk factors for preterm birth (PTB)

G. G. Donders1, C. Van Calsteren2, G. Bellen3, R. Reybrouck4, T. Van den Bosch1, I. Riphagen2, S. Van Lierde5 1Obstetrics and Gynecology, H Hart Tienen & University Hospital Gasthuisberg Leuven, Tienen, Belgium; 2Ob Gyn, Regional Hospital H Hart Tienen, Tienen, Belgium; 3OB Gyn Research, Femicare Clinical Research for Women, Tienen, Belgium; 4Medical Laboratory, Regional Hospital H Hart Tienen, Tienen, Belgium; 5Pediatrics, Regional Hospital H Hart Tienen, Tienen, Belgium