Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1e127
References
[1] RCOG. Preventing entry-related gynaecological laparoscopic injuries;
Green-Top Guideline No. 49. London: RCOG; 2008.
[2] Tinelli A, Eur J. Abdominal access in gynaecological laparoscopy: a
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needle. Obstet Gynecol Reprod Biol 2009.
http://dx.doi.org/10.1016/j.ejogrb.2016.0
7.224 Post-partum haemorrhage
No Preference
Anaemia a prevalent risk
factor for post-partum
haemorrhage
Sangeetha Nagenthiran , Mausumi
Ghosh, Maheswari Srinivasan
Birmingham City Hospital, Department of
Obstetrics and Gynaecology, United
Kingdom
E-mail address:
sangeetha.nagenthiran@gmail.com (S.
Nagenthiran).
Introduction: There has been signicant progress in
the pre- vention and management of post-partum
haemorrhage (PPH) in recent years. However, PPH
remains a leading cause of maternal mortality and
morbidity globally, affecting approximately 2% of all
women who give birth. Major Obstetric Haemorrhage is
blood loss of 1500 ml or more in the immediate post-
partum period.
Aim: To audit the management of women with Major
Obstetric Haemorrhage at Birmingham City Hospital.
Methods: Retrospective case note analysis of
patients who had Major Obstetric Haemorrhage between
1st June 2014 and 31st May 2015 at Birmingham City
Hospital. Data was extracted retrospec- tively from
patients electronic notes and entered into an audit
proforma designed to collect data pertinent to maternal
age, par- ity, risk factors for PPH and treatment
interventions. The data was analysed using Excel.
Results: For the dened period there were a total of
5646 deliv- eries. All 44 cases which satised the criteria
of the audit were audited. The prevalence rate of
primary PPH of 1500 ml or greater was 0.78%. 45% of
patients were primigravida and one patient was a
grandmultipara of 6. 34% had pre-existing anaemia at
time of deliv- ery. 61% of the patients had a Caesarean-
section, of these, 67% had an emergency Caesarean
section.
Conclusion: Pre-existing anaemia was one of the
most common maternal risk factors in this group.
Anaemia is a manageable risk factor robust screening
and treatment of anaemia in the antenatal period is
crucial. A pathway is currently being devised at Birming-
ham City Hospital to improve the identication and
management of these patients. Furthermore, low
socioeconomic status and grand multiparity in this
diverse ethnic minority population contributes to
anaemia in pregnancy.
http://dx.doi.org/10.1016/j.ejogrb.2016.0
7.225
e83
Vulval diseases
No Preference
Iso-prognostic factors which predicts
local disease recurrence in vulvar
squamous cell carcinoma: a literature
review
Sangeetha Nagenthiran 1,, Danielle ONeill 1,
David Luesley 1, Jason Yap 2
1
Pan Birmingham Gynaecological Cancer
Centre, United Kingdom
2
University of Birmingham, United Kingdom
E-mail address:
sangeetha.nagenthiran@gmail.com (S.
Nagenthiran).
Introduction: Vulval cancer is a rare gynaecological
malig- nancy, with approximately 1200 new cases
diagnosed in the UK each year. It mainly affects
postmenopausal women, however up to 15% of all cases
are below the age of 50. The most common can- cer
affecting the vulva is squamous cell carcinoma (VSCC)
forming 90% of all diagnoses. Local vulval recurrence
(LVR) after treatment occurs in approximately 2040% of
cases, with at least 50% of the LVR cases occurring
distant to the original tumour. Many factors have been
postulated to affect LVR, and therefore long-term sur-
vival. As vulvar cancer has such a low prevalence it is
difcult to get a large enough cohort to say with
condence which factors affect its recurrence.
Aim: To identify the iso-prognostic factors which
predict VSCC identied from published literatures to
potentially follow these women more closely after
curative treatment; to reduce morbidity and mortality
from recurrent disease.
Method: Articles were sourced in September 2015 with
MED- LINE and EMBASE systematic searches (from 1964 to
present). Search terms were: squamous cell cancer,
squamous cell carci- noma, vulva carcinoma, vulva, cancer
recurrence, reoccur*, recur*, neoplasm recurrence, local.
Limits were applied for English lan- guage only. All
abstracts were read by both authors and individually
excluded if not applicable to our study. Discrepancies were
over- come through discussion with a third person. Each
paper was sourced and read through in depth. Articles
were excluded if no article was available, i.e. conference
abstract only, poster abstract or case reports. All relevant
data was sourced from the main text, tables, graphs and
gures. If data was not available in the initial paper then
attempt was made to contact the author.
Results: A total of 38 studies were eligible for review.
We were not able to perform a meta-analysis due to
inconsistency in the methodology used in each study
for data collection and survival/recurrence analysis in
each study varied. Collectively 15 clinico-pathological
variables have been suggested by different studies to
predict LVR. None of the studies came out with common
predictor(s) which modulate the risks of LVR.
Conclusion: It remains unclear which risk factors
constitute to local recurrence. An obvious candidate,
histological evidence of disease extending to the lines of
surgical resection, has been shown to be an unreliable
predictor. A retrospective analysis performed at our
centre using a competing risk model showed that on a
multivariable analysis the presence of LS adjacent to VSCC
was the only independent predictor that was associated
with increased risk of developing LVR (HR: 3.383, 95% CI:
1.7976.381, P < 0.001)
compared to those without LS; suggesting that the non-
neoplastic epithelium which VSCC arise from play an
important role in predicting LVR. Therefore, we
advocate the use of biomolecular