María Fernanda Nozar

Tocolysis and delayed delivery versus emergency delivery in cases of non‐reassuring fetal status during labor

Aim:  To determine whether fetal intrauterine resuscitation using tocolysis and delayed delivery is better for the fetus than emergency delivery when fetal hypoxia is suspected because of a non‐reassuring fetal heart‐rate (FHR) pattern using conventional heart rate monitoring.

The role of medical abortion in the implementation of the law on voluntary termination of pregnancy in Uruguay

To evaluate the implementation of the law that liberalizes voluntary abortion in Uruguay and enables health services to offer these services to the population.OBJECTIVE To evaluate the implementation of the law that liberalizes voluntary abortion in Uruguay and enables health services to offer these services to the population. METHODS The legal and regulatory provisions are described and the national data-provided by the Ministry of Public Healths National Information System (SINADI)-on the number of voluntary terminations of pregnancy, the abortion method (medical or surgical), and whether it was performed as an outpatient or inpatient are analyzed. To determine complications, the number of maternal deaths and admissions to intensive care units for pregnant women was used. The study period ran from December 1, 2012, to December 31, 2014. RESULTS A total of 15 996 abortions were performed during the study period; only 1.2% were surgical and 98.8% were medical. Of the latter, only 3.4% required hospitalization. Less than half of the pregnancies were terminated up to 9 weeks of gestation and 54% were at 10 to 12 weeks in a sample from the Pereira Rossell Hospital. CONCLUSION The rapid nationwide rollout of voluntary termination of pregnancy services to all women was possible to a large degree thanks to the availability and broad acceptance of medical abortion, facilitated by the prior experience in applying the risk and harm reduction strategy.

Tratamiento radical mínimamente invasivo en cáncer de cuello uterino invasor: experiencia de la Clínica Ginecotocológica “A”

Introduccion: el cancer de cuello uterino es el cuarto mas frecuente a nivel mundial en mujeres. En estadios precoces la cirugia es el tratamiento de eleccion. El tratamiento quirurgico estandar es la histerectomia radical tipo C1 y linfadenectomia pelvica. La via de abordaje clasicamente utilizada en Uruguay es la laparotomia. Los resultados oncologicos por las diferentes vias de abordaje se consideran equiparables. Presentamos la primera serie de casos publicada en Uruguay de tratamiento quirurgico de minima invasion en cancer de cuello uterino. Metodo: estudio descriptivo prospectivo de serie de casos. Se incluyen todas las pacientes operadas por cancer de cuello uterino invasor como tratamiento primario con via de abordaje de minima invasion, desde enero de 2013 hasta diciembre de 2016 en la Clinica Ginecotocologica A del Centro Hospitalario Pereira Rossell. Resultados: se operaron 17 pacientes: 14 histerectomia radical laparoscopica + linfadenectomia pelvica laparoscopica y 3 histerectomia radical vaginal + linfadenectomia pelvica laparoscopica. Edad media: 44 anos. Tiempo quirurgico medio: 261 minutos. Tiempo medio de internacion posoperatoria: cinco dias. Conversion a laparotomia: dos casos. Se resecaron una media de 14,4 ganglios pelvicos. Ningun caso con margenes comprometidos. Hubo dos lesiones vesicales. Ningun caso de sangrado severo, transfusion, lesion intestinal, vascular ni ureteral. No hubo ningun caso de infeccion, dehiscencia, trombosis, reintervencion o readmision. No hubo recurrencias, con media de seguimiento de 29 meses. Conclusiones: la cirugia de minima invasion es factible para el tratamiento del cancer de cuello uterino en estadios precoces en nuestro medio, obteniendo un buen resultado anatomopatologico, quirurgico y oncologico con baja morbilidad.

M431 TRANSOBTURATOR POLYPROLYLENE HERNIA MESH (TOT) FOR URINARY STRESS INCONTINENCE. URUGUAYAN EXPERIENCE IN A UNIVERSITY HOSPITAL

Objectives: To evaluate the efficacy, safety and complications of TOT procedures for the treatment of female stress urinary incontinence in a university Hospital. Materials: 559 patients who underwent TOT procedure from January 2003 to January 2012 were enrolled in a retrospective observational study. Methods: The procedures were done by gynecologists and gynecology residents in learning process. The technique used was with recyclable needles and a simple polypropylene hernia mesh instead of using commercials kits. Audit was conducted of medical records. The outcomes analyzed were: surgical complications, postoperative hazards procedure’s efficacy, and subjective satisfaction. Results: There was 2 cases of bladder injury and 1 case of urethral injury with the needle (0.5%). 1 patient presented a thigh hematoma. No nervous, neither digestive injury during surgery was registered. There wasn’t postoperatory urinary retention. 3 patients needed to release the mesh for significant urinary residual in the evolution (0.5%). The principal complication was the mesh extrusion that was reported in 2.14% of cases. 78% of the population was asymptomatic or better about the incontinence, and 80% are very satisfied. Conclusions: TOT, with the technical modifications done, is a safe and effective technique, with an acceptable complications rate, for the female urinary stress incontinence treatment in an educational sphere.

P299 Implementation of a risk reduction strategy to prevent maternal death associated with unsafe abortion (health initiatives against unsafe abortion) in first level health centers of Uruguay

P299 Implementation of a risk reduction strategy to prevent maternal death associated with unsafe abortion (health initiatives against unsafe abortion) in first level health centers of Uruguay V. Fiol, M. Nozar, M. Gorgoroso, A. Labandera, C. Stapff, L. Briozzo. Pereira Rossell Hospital, School of Medicine, Health Initiatives, Pereira Rossell Hospital, Health Initiatives, Pereira Rossell Hospital, School of Medicine, Health Initiatives

O313 Implementation of a risk reduction strategy to prevent maternal death associated with unsafe abortion in the major third level health center of Uruguay

Objective: To evaluate the implementation of the risk reduction strategy Health Initiatives Against Unsafe Abortion in the major third level women health center of Uruguay, Pereira Rossell Hospital. Methodology: Comparative analysis between 2 periods: 2004– 2005, first experience of implementation of the strategy (“Advisory Service”); and 2007–2008, implementation of the strategy under a comprehensive Sexual Health Service. Population: 675 users in the first period and 640 users in the second. Data was collected using a pre-designed form for the “before-abortion” and “after-abortion” visit, filled by the professionals and identified with a number. Results: In the first period most of users (68%) attended before and after abortion visits, while in the second period most of them (70.5%) attended only the before-abortion visit. Concerning gestational age, in the second period more users attended the before-abortion visit with ages less than 12 weeks (77% vs. 82.5%). Concerning the final decision, in both periods most women decided to abort. In some cases (4% and 6%) women were either not pregnant or the embryo was dead, which kept them away from any risks. Concerning post-abortion contraception, it increases in the second period (56% vs.67%) with a substantial increase in the use of the intrauterine device (5.5% vs. 33%). Conclusions: The implementation of the Health Initiatives Against Unsafe Abortion in the Pereira Rossell Hospital offers a necessary service to women undergoing an unwanted pregnancy who desire an abortion. The strategy is effective in reducing unsafe abortions and their health consequences. Its implementation under a comprehensive Sexual Health Service improves access to contraception.