6216 ranzcog 2013 handbook by Salt Creative

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g Evidence in O&G Food for thought or recipe for disaster?

program t and abstrac book

8-11 September 2013 Sydney Convention & Exhibition Centre www.ranzcog2013asm.com.au

8-11 September 2013 Sydney Convention & Exhibition Centre

W e l c o me T o S y d n e y ! Contents Welcome 1 Sponsors 2 Awards 2 Organising Committee 3 RANZCOG 2013 ASM Secretariat 3 Continuing Professional Development 3 Keynote Speakers 4-5 Invited Speakers 6 Memorial Oration and Lecture 8 Opening Ceremony 10 Academic Sessions 10 Fast Food & Fast Facts Sessions 11 Scientific Program 12-20 E-Poster Presentations 22-23 Social Program 24 General Information 25-26 Darling Harbour Location Map 27 Sydney Convention & Exhibition Centre 28-29 Trade Exhibition 30-39 Abstracts 40-63 E-Poster Abstracts 64-85 Presenter Index 86-87

Meeting App Sponsored by Bayer Australia For the first time the RANZCOG ASM has a Web App available for smart phones. To access the RANZCOG 2013 ASM Web App please visit the Meeting Website www.ranzcog2013asm.com.au on your smart phone. If you have an iPhone just click the â&#x20AC;&#x153;Add to Home Screenâ&#x20AC;? prompt to install. Android users can add the Web App as a bookmark.

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

Evidence in O&G Food for thought or recipe for disaster? Evidence. It is what separates us from the snake-oil sellers. It enables us, through rigorous methodology, to pose the right questions – and find the answers – that will aid the women who come to us for help. Evidence-based medicine is the mantra for modern practice – but what happens when the evidence is not present? Or when it is present and we choose to modify it for our patient, or even ignore it? Let’s consider the science (and art) of baking a cake. You may select the finest ingredients, weigh them with exacting care, mix them with a rigorous combination of gusto and finesse – and bake meticulously at the specified temperature. And yet the result is rarely the same, falling anywhere between a masterpiece of melting intensity and a moat of unresolved sogginess. Now, what is the connection between baking and our specialty? Both are examples of predictable precision – and unpredictable imprecision. Just as recipes can tell us everything in theory and still end in failure, so our specialty is driven by protocols that, even if evidence-based, can deliver disappointing results when applied to the realities of patient management. Tick-box medicine, cost-constrained operating theatres and an endless array of patient variance often mean working in less than ideal circumstances and with contradictory information. Yet, despite the odds, we have had spectacular success stories: the universal recommendation of folic acid for reduction of neural tube defects, chemotherapy regimes for malignant gynaecological conditions and endometrial ablation for the management of abnormal uterine bleeding. These all have solid foundations in evidence with a variety of methodologies contributing to their place in our specialty. Join us as we examine Evidence in O&G: is it food for thought or are we creating and recreating recipes for disaster? We venture into what the ideal study would look like (and whether it is even possible), and how we manage when evidence is not present. Covering topic areas as diverse as mental health in O&G, infections, surgery and the booming industry of supplements, our celebrated international and national faculty will drive fact, opinion and controversy as we delve into delivering care in the information age. Our international faculty is amongst the most prolific researchers, presenters and promoters in women’s health globally. From the Netherlands, Ben Willem Mol, from the United Kingdom, Sabaratnum Arulkumaran and from the United States of America, Malcolm Munro and Anthony Odibo join a stellar faculty from Australia and New Zealand to ponder, propose, poke and preach the successes and failures at the very core of what underpins our specialty: Evidence. A/Prof Jason Abbott Chair, Organising Committee

Dr Stephen Lyons Chair, Scientific Committee

Sydney Harbour

e r Bridg

Harbou Sydney

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

G o l d S p o n s o rs Thank you to the following Gold sponsors for their valued contribution:

Delegate Satchel Luggage Tag Sponsor

Delegate Name Badge Sponsor

Diplomates Day Two Sponsor Sunday 8 September 2013

Morning/Afternoon Tea Sponsor Tuesday 10 September 2013

Internet Cafe Sponsor

Plenary Session Sponsor Pieces of the Pie: Global Womenâ&#x20AC;&#x2122;s Health in O&G Monday 9 September 2013

Morning/Afternoon Tea Sponsor Monday 9 September 2013 Meeting App Sponsor

Registration Brochure Sponsor Speaker Preparation Room Sponsor

Awards Thank you to Wiley Blackwell for their continued support and sponsorship of the Researcher Awards Best Free Communication and Best Electronic-Poster (E-Poster) During the Meeting, prizes will be awarded to the Best Free Communication oral presentation and Best Electronic Poster Presentation (E-Poster). RANZCOG Early Career Researcher Award A prize of A$1,000 will be awarded to the Best Free Communication presented by an Early Career Researcher. To be eligible the presenting author must be a FRANZCOG trainee or a RANZCOG Fellow five years or less post-Fellowship at the time of the Meeting. RANZCOG Diplomate Researcher Award A prize of A$1,000 will be awarded to the Best Free Communication presented by a Diplomate Researcher. To be eligible the presenting author must be a Diploma trainee or a DRANZCOG / DRANZCOG Advanced holder. 2

8-11 September 2013 Sydney Convention & Exhibition Centre

Organising Committee A/Prof Jason Abbott Chair Dr Stephen Lyons Chair, Scientific Committee Prof Gabrielle Casper Committee Member Prof Jon Hyett Committee Member

Continuing Professional Development MAXIMISING POINTS Fellows, Associate Members and Educational Affiliates This Meeting has been approved as a RANZCOG accredited Meeting and eligible Fellows, Associate Members and Educational Affiliates of this College will earn Continuing Professional Development (CPD) points for attendance as follows:

Dr Greg Jenkins Committee Member

Full Attendance (Meeting only) Attendance Opening Ceremony

1 point

Prof Bill Ledger Committee Member

Attendance 9 September 2013

8 points

Attendance 10 September 2013

8 points

Dr John Pardey Committee Member

Attendance 11 September 2013

8 points

Attendance Fast Food & Fast Facts Sessions

1 point per session

Prof Ian Symonds Committee Member

Pre-Meeting Workshops

Ms Lee Dawson NSW Regional Committee, RANZCOG Ms Kylie Grose ASM Secretariat, RANZCOG Ms Lee-Anne Harris ASM Secretariat, RANZCOG Ms Val Spark ASM Secretariat, RANZCOG

Diagnosis and Management of 3rd and 4th Degree Obstetric Anal Sphincter Injury

23 points

Refer to meeting website

Pelvic Floor Assessment Workshop Refer to meeting website Training Supervisors Workshop

8 points

Satellite Meetings Urogynaecology for Clinical Practice 5 Meeting points and 2 PR&CRM points

RANZCOG Diplomates Women’s Health Points – ACRRM ACRRM has approved points for attendance as follows:

ASM Secretariat 119 Buckhurst Street South Melbourne VIC 3205 Australia T +61 3 9645 6311 F +61 3 9645 6322 E ranzcog2013asm@wsm.com.au www.ranzcog2013asm.com.au

RANZCOG 2013 ASM

21 MOPS Core Points

Diplomates Day One

30 PRPD points + 30 PRPD Obstetrics MOPS points

Diplomates Day Two

30 PRPD points + 30 PRPD Obstetrics MOPS points

Women’s Health Points – RACGP The RACGP has approved Women’s Health points for attendance as follows: RANZCOG 2013 ASM

30 Category 2 points

Diplomates Day One

40 Category 1 Women’s Health Points

Diplomates Day Two

40 Category 1 Women’s Health Points

Procedural & Obstetric Grants: Both Diplomates Days are eligible for rural procedural grants. The RANZCOG 2013 ASM qualifies for a three-day obstetric grant. The Diagnosis and Management of 3rd and 4th Degree Obstetric Anal Sphincter Injury workshop qualifies for a one day obstetric grant.

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

K e y n o t e S peakers Professor Sir Sabaratnam Arulkmaran

Prof Sir Sabaratnam Arulkumaran

Prof Ben Willem Mol

St George’s University of London United Kingdom Sir Sabaratnam Arulkumaran is Emeritus Professor of Obstetrics & Gynaecology at St George’s University of London after serving there for 12 years as Professor and Head of Department. He served as treasurer and secretary of the International Federation of Obstetrics and Gynaecology (FIGO) and is currently the President. He was Vice President and then President of the Royal College of Obstetricians and Gynaecologists (RCOG) from 20072010. He became President of the British Medical Association (BMA) in June 2013. In 2009 he was recognised with the highest National Honours ‘Knight Bachelor’ in the Queen’s Birthday honours list. The London Gazette stated that this recognition was for ‘his services to medicine and is considered as one of the most forward thinking medical leaders in this country’.

Professor Ben Willem Mol Academic Medical Centre The Netherlands Dr Ben Willem Mol is Professor of Clinical Evaluative Research in Obstetrics, Gynaecology and Reproductive Medicine in the Faculty of Medicine of the University of Amsterdam (AMC-UvA). He is focused on the organisation of multicentric evaluative research in obstetrics, gynaecology and fertility. In the context of a national research consortium, over 50 hospitals, including all eight academic centres, are working together to carry out multi-centric randomised trials.

The research is focused mainly upon everyday practices. As a Professor, Dr Mol considers his most important task to be the stimulation and innovation of evaluative research in obstetrics, gynaecology and reproductive medicine. His professional adage is ‘A day without randomisation is a day without progress.’ Dr Mol studied Medicine at the University of Amsterdam. From 1993 to 1997, he worked in the department of Clinical Epidemiology and Biostatistics at the AMC. In 1999 he obtained his doctorate with honours at the Faculty of Medicine of the UvA with his dissertation entitled Evaluating the effectiveness of diagnostic tests: tubal subfertility and ectopic pregnancy. Between 1997 and 2003 he was trained as a Gynaecologist at the Máxima Medical Centre (Máxima Medisch Centrum, MMC) in Veldhoven, the University Medical Centre (Universitair Medisch Centrum) in Utrecht and the Tweesteden Hospital (Tweestedenziekenhuis) in Tilburg. Since 2002, Dr Mol has been a Senior Researcher in the department of Obstetrics and Gynaecology at the AMC and worked since 2003 as a GynaecologistPerinatologist at the MMC in Veldhoven. Dr Mol is chairman of the Guideline Commission (commissie Richtlijnen) and member of the Scholarship Commission (commissie Wetenschap) of the Dutch Association for Obstetrics and Gynaecology (Nederlandse Vereniging voor Obstetrie en Gynaecologie, NVOG).

8-11 September 2013 Sydney Convention & Exhibition Centre

Professor Malcolm Munro University of California United States of America Dr Malcolm Munro is a Professor in the Department of Obstetrics and Gynecology of the David Geffen School of Medicine at UCLA, and Director of Gynecologic Services at Kaiser Permanente’s Los Angeles Medical Center. Dr Munro’s clinical and research interests are oriented to minimally invasive approaches to gynecological disorders with particular interests in surgical education and training as well as the problem of abnormal uterine bleeding including investigation, medical and procedural interventions. He is co-chair of the new FIGO Menstrual Disorders Working Group that has been responsible for the development and publication of the FIGO Nomenclature and Classification Systems for causes of abnormal bleeding in the reproductive years that has been created to facilitate the design and interpretation of related clinical trials. He is also the study chair of STOP-DUB, a US federally funded multicenter randomised clinical trial comparing hysterectomy to endometrial ablation that, to date, is the largest of its kind. He has published more than 90 papers, 26 chapters, and four books including Abnormal Uterine Bleeding, released by Cambridge University Press in January of 2010. Dr Munro is also a contributing editor for the Journal of Minimally Invasive Gynecology, an Associate Editor for Human Reproduction, and a reviewer for numerous other peer-reviewed specialty journals. He has served the American Association of Gynecologic Laparoscopists (AAGL) as a member of the Board of Trustees (2000-2002) and is

the inaugural chair of the AAGL Practice Committee, charged with the development of evidence based practice guidelines related to minimally invasive approaches to gynaecology.

Professor Anthony Odibo Washington University United States of America Dr Anthony Odibo is a Professor of Obstetrics and Gynecology in the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University, St Louis. He is the Vice Chair for Imaging, Director of the Division of Ultrasound and Genetics and CoDirector of the Fetal Care Center. He completed his medical school training at the University of Benin, Nigeria. He had residency training in Obstetrics and Gynecology in the United Kingdom and at Thomas Jefferson University in Philadelphia and a Fellowship in Maternal Fetal Medicine at the University of Connecticut’ School of Medicine. He underwent further Fellowship training in Clinical Epidemiology, resulting in a Masters Degree from the University of Pennsylvania. Dr Odibo’s areas of clinical interest include prenatal diagnosis and therapy and screening for aneuploidy. His research interests include first-trimester screening for adverse pregnancy outcomes, the epidemiology of preterm delivery and intrauterine growth-restriction as well as evaluation of new technologies using decision analytical modeling. He is an Editor for Ultrasound in Obstetrics and Gynecology and on the Editorial Board for BJOG: an International Journal of Obstetrics and Gynecology; and Prenatal Diagnosis.

Prof m Malcol o r n Mu

Prof Anthon y Odibo

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

I n v i t e d S peakers

Jason Abbott New South Wales, Australia

Jane Ford New South Wales, Australia

Jim Nicklin Queensland, Australia

Marie-Paule Austin New South Wales, Australia

Denise Furness South Australia, Australia

Andreas Obermair Queensland, Australia

Rodney Baber New South Wales, Australia

Tony Geraghty New South Wales, Australia

Martin Oehler South Australia, Australia

Ron Benzie New South Wales, Australia

Katie Groom Auckland, New Zealand

John Pardey New South Wales, Australia

Philip Boyce New South Wales, Australia

Neville Hacker New South Wales, Australia

Felicity Park New South Wales, Australia

Jennifer Bradford New South Wales, Australia

Roger Hart Western Australia, Australia

Michael Permezel Victoria, Australia

Richard Bryant New South Wales, Australia

Annemarie Henessey New South Wales, Australia

Andrew Pesce New South Wales, Australia

Leonie Callaway Queensland, Australia

Alison Hey-Cunningham New South Wales, Australia

Carol Pollock New South Wales, Australia

Gabrielle Casper New South Wales, Australia

Ray Hodgson New South Wales, Australia

Philippa Ramsay New South Wales, Australia

Georgina Chambers New South Wales, Australia

Lisa Hui Victoria, Australia

Ajay Rane OAM Queensland, Australia

Michael Chapman New South Wales, Australia

Tamara Hunter Western Australia, Australia

Bill Rawlinson New South Wales, Australia

Tony Chung Hong Kong, China

Jon Hyett New South Wales, Australia

Vijay Roach New South Wales, Australia

George Condous New South Wales, Australia

Greg Jenkins New South Wales, Australia

Luk Rombauts Victoria, Australia

Michael Costello New South Wales, Australia

Neil Johnson Auckland, New Zealand

Glynis Ross New South Wales, Australia

Caroline Crowther Auckland, New Zealand

Juliette Koch New South Wales, Australia

Roger Smith New South Wales, Australia

Phil Daborn Western Australia, Australia

Monica Lahra New South Wales, Australia

John Smoleniec New South Wales, Australia

Rebecca Deans New South Wales, Australia

William Ledger New South Wales, Australia

Ian Symonds New South Wales, Australia

Michael Dibley New South Wales, Australia

Stephen Lyons New South Wales, Australia

Glyn Teale Victoria, Australia

Peter Dietz New South Wales, Australia

Brian McCaughan New South Wales, Australia

Sarah Tout Auckland, New Zealand

Basil Donovan New South Wales, Australia

Andrew McLennan New South Wales, Australia

Sally Tracy New South Wales, Australia

Creswell Eastman AM New South Wales, Australia

Tony Merritt New South Wales, Australia

Maria Traversa New South Wales, Australia

John Eden New South Wales, Australia

Jonathan Morris New South Wales, Australia

Susan Valmadre New South Wales, Australia

Gayle Fischer New South Wales, Australia

Henry Murray New South Wales, Australia

Sue Walker Victoria, Australia

Terri Foran New South Wales, Australia

Michael Nicholl New South Wales, Australia

Leeanda Wilton Victoria, Australia

Confidence that lasts

Approved for 5 years continuous use with over 99% contraceptive efficacy1

Start a conversation... MIRENA速 Minimum Product Information Mirena: 速, levonorgestrel 52 mg, intrauterine drug delivery system. Indications: Contraception, idiopathic menorrhagia and prevention of endometrial hyperplasia during oestrogen replacement therapy. Contraindications: Known/suspected pregnancy; current or recurrent pelvic inflammatory disease; lower genital tract infection; postpartum endometritis; infected abortion during the past three months; cervicitis; cervical dysplasia; uterine or cervical malignancy; progestogen-dependent tumours; undiagnosed abnormal uterine bleeding; congenital or acquired uterine anomaly including fibroids if they distort the uterine cavity; conditions associated with increased infection susceptibility; acute liver disease/ tumour; hypersensitivity to the constituents. Precautions: migraine; exceptionally severe headache; jaundice; marked increase in blood pressure; severe arterial disease; young nulligravid women; post-menopausal women with advanced uterine atrophy; thrombosis; breast cancer; congenital or valvular heart disease; diabetes; pelvic infections; expulsion; uterine perforation; ectopic pregnancy; sexually transmitted diseases; lost threads; delayed follicular atresia. Adverse effects: headache; abdominal/pelvic pain; changes in menstrual bleeding; vulvovaginitis; genital discharge; depressed mood; depression; nervousness; decreased libido; migraine; nausea; acne; hirsutism; back pain; upper genital tract infection; ovarian cyst; dysmenorrhoea; breast tenderness/pain; intrauterine contraceptive device expelled (partial and complete); weight increased; uterine perforation. Others: refer to full Product Information. Interactions: CYP450 inducers e.g. anticonvulsants & anti-infectives. Dosage & administration: Initial release rate 20 microgram levonorgestrel per 24 hours. Mirena has an in-situ life of 5 years; Inserted into the uterine cavity by trained healthcare professional. Date of most recent amendment: 19 July 2011 References: 1. Approved Product Information.

Please review product information before prescribing.

Full product information is available from Bayer Australia Ltd. PBS dispensed price $266.32. ABN 22 000 138 714, 875 Pacific Highway, Pymble NSW 2073. Registered Trademark of Bayer AG, Germany. L.AU.WH.12.2011.0209

PBS Information: Restricted Benefit. Contraception. Idiopathic menorrhagia where oral therapies are ineffective or contraindicated.

BA1401 Mirena ANZJOG 2012.indd 1

19/07/12 2:07 PM

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

M em o r i a l Orat i o n & Lec t u re Ian McDonald Memorial Oration

Ella Macknight Memorial Lecture

Evidently, Evidence in Obstetrics is Essential

Amniotic Fluid Cell-free RNA: A Novel Source of Information About Human Development

0830 â&#x20AC;&#x201C; 0900 Wednesday 11 September 2013 Room: Bayside Auditorium A Prof Caroline Crowther Prof Caroline Crowther is a maternal fetal medicine subspecialist and Professor of Maternal and Perinatal Health at the Liggins Institute, University of Auckland, and Clinical Director of ARCH (Australian Research Centre for Health of Women and Babies) at the Robinson Institute, University of Adelaide. With extensive experience in evidence based health care, she has conducted many systematic reviews and multicentre trials evaluating new maternal and perinatal therapies especially prior to preterm birth, such as antenatal corticosteroids, progesterone and magnesium sulphate, and care practices including mode of birth after a previous caesarean and treatment for women with gestational diabetes.

1330 â&#x20AC;&#x201C; 1400 Wednesday 11 September 2013 Room: Bayside Auditorium A Dr Lisa Hui Dr Lisa Hui MBBS FRANZCOG received her subspecialist certification in maternal fetal medicine in 2010. She was awarded the RANZCOG Fotheringham Research Fellowship for 20102011 and spent two years at the Mother Infant Research Institute at Tufts Medical Center, Boston, studying amniotic fluid cell-free fetal RNA. Her work at the Bianchi lab demonstrating novel fetal gene expression information in amniotic fluid has won awards at major international scientific meetings and has been published in obstetric and genetics journals. She returned to Australia in 2012 and now works at the Mercy Hospital for Women in Melbourne.

Now, after more than 50 years of advances in combined oral contraceptives, ZOELY – the pill made from hormones similar to her own – is here.1,2

Please refer to Product InformatIon before PrescrIbIng. aPProved Product InformatIon Is avaIlable from msd. Minimum Product Information: ZOELY® 2.5mg nomegestrol acetate/1.5mg oestradiol. Indication: Oral contraception. Contraindications: Risk or history of venous or arterial thrombosis; migraine with focal neurological symptoms; pancreatitis associated with severe hypertriglyceridaemia; severe hepatic disease; liver tumours; sex steroid sensitive malignancies; pregnancy; hypersensitivity to any of the ingredients of ZOELY.® Precautions: A medical history/examination prior to initiation. Exclude pregnancy before use. Medical checkups during use. Liver dysfunction; risk or history of thrombosis or thromboembolism; diabetes; hypertension; lactose intolerance; lactation; colitis. Changes in menstrual bleeding. Interactions: Hepatic enzyme inducers e.g. phenytoin, carbamazepine, griseofulvin, St John’s wort. Others: ketoconazole; cyclosporin; lamotrigine. Adverse effects: acne; abnormal withdrawal bleeding; depression; headache; migraine; nausea; metrorrhagia; menorrhagia; breast or pelvic pain; weight gain; others see full PI. Dosage: One tablet daily at about the same time. Take with liquid as needed and in the order as directed on the package. Based on product information last amended August 2011. References: 1. ZOELY Product Information. Approved August 2011. 2. Dhont M. Eur J Contracept Reprod Health Care 2010; 15(S2): S12–S18. Copyright © 2011 Merck Sharp & Dohme (Australia) Pty Limited. Level 4, 66 Waterloo Road, North Ryde NSW 2113. All rights reserved. ® Registered Trademark of Laboratoire Theramex. WOMN-1012966-0000. First issued January 2012. MEZO5550/OBF. 1/12.

PBS Information: This product is not listed on the PBS.

MEZO5550 ANZ OBF FA.indd 1

6/08/13 12:34 PM

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

Opening Ceremony Sunday 8 September 2013 1800 – 1830 hours Art Gallery of New South Wales Master of Ceremonies: Dr Stephen Lyons, Chair, Scientific Committee

Welcome Associate Professor Jason Abbott, Chair, Organising Committee

Academic Sessions Clinical Academic Workshop Tuesday 10 September 2013 Session One:

Dr Peter White, RANZCOG Chief Executive Officer

RANZCOG Universities and College Liaison Committee (closed session)

Professor Michael Permezel, RANZCOG President

1230 – 1330 hours

Ceremonial Proceedings

Session Two:

– Introduction of New RANZCOG Fellows and Subspecialists – Presentation of Honorary Fellowship, Associate Professor Annabelle Farnsworth

Academic Session (open session) 1330 – 1500 hours Topics include:

– Presentation of Examination Awards

– The Future of Academic Workforce Development.

Presentation of Examination Awards

– The FRANZCOG Academic Career Pathway.

Outstanding Achievement in the MRANZCOG Oral Examination This award is presented to the highest scoring candidate in the Membership Oral Examination. Awardees of the RANZCOG Medal for Outstanding Achievement in the Membership Oral Examination: Dr Anthia Rallis, October 2011

– Is it Time to Revisit a National Undergraduate Curriculum for Obstetrics and Gynaecology? – What Influences Student Intentions to Practice in Obstetrics and Gynaecology? – The ITP Research Project – Outcomes and Current Status.

Dr Claire Allanach, May 2012 Dr Eliza Eddy, October 2012 Dr Kylie Gayford, May 2013 Outstanding Achievement in the DRANZCOG Oral Examination This award is presented to the highest scoring candidate in the Diploma Oral Examination. Awardees of the RANZCOG Medal for Outstanding Achievement in the Diploma Oral Examination: Dr Jaclyn Brown, September 2011 Dr Kate Ton, April 2012 Dr Ruth Howie, September 2012 Dr Jade McKay, April 2013

Facilitators: Steve Robson and Ian Symonds Venue:

Session One: Bayside 102, Level 1, Sydney Convention & Exhibition Centre

Session Two: Bayside 103, Level 1, Sydney Convention & Exhibition Centre

Fas t F o o d & Fas t Fac t s S ess i o n s All Fast Food & Fast Facts Sessions will run concurrently and be held in the Bayside Grand Hall, Ground Floor, Sydney Convention & Exhibition Centre.

Monday 9 September 2013

Tuesday 10 September 2013

Wednesday 11 September 2013

0730 – 0810

Session 1

Delivering the Rural Goods

Fibroid Fricassee – Top Tips for Hysteroscopic Removal

Thymic Ultrasound and Pre-eclampsia Prediction

Tony Geraghty Session 2

Malcolm Munro

Minor Sonographic Markers for Aneuploidy

Session 2

Ron Benzie Session 2 Caesarean Delivery on Demand

Outpatient and Office Procedures – For Patient or Profit?

Sabaratnum Arulkumaran

Hormone Hotpot – How to Handle Menopausal Symptoms

John Pardey

Managing an Acute Gynaecology Service

Rod Baber

Monochorionic Twins – Surgical Management of Complications

Anthony Odibo Session 3

Session 4

Session 3

George Condous Session 4

Scanpan – Gynaecological Ultrasound Essentials for Your Practice

John Smoleniec

Mullerian Fusion Failures: The Lower Third

Session 4

Rebecca Deans

Phillipa Ramsay

Indications for Induction of Labour Ben Willem Mol

st Food & Entry to the Fa ssions is by Fast Facts Se elegates with ticket only. D gistration for conﬁrmed re will have these sessions t included in an entry ticke n envelope. their registratio

Scientific Program Monday 9 September 2013 0730 – 0810 Breakfast Sessions: Fast Food & Fast Facts

Room: Trade Exhibition, Bayside Grand Hall

Session 1 Delivering the Rural Goods Tony Geraghty

Session 2 Minor Sonographic Markers for Aneuploidy Anthony Odibo

Session 3 Hormone Hotpot – How to Handle Menopausal Symptoms Rod Baber

Session 4 Scanpan – Gynaecolocical Ultrasound Essentials for Your Practice Phillipa Ramsay

0825 – 0830 Opening Comments

Room: Bayside Auditorium A

Jason Abbott & Stephen Lyons

0830 – 1030 Food for Thought: Evidence in O&G

Room: Bayside Auditorium A

Chairs: Ian Symonds & Ajay Rane

0830 Current Diagnosis and Treatment of Ectopic Pregnancy Ben Willem Mol 0900 Fertility – The Ultimate Study Neil Johnson 0920 Obstetrics – The Ultimate Study Glyn Teale 0940 Gynaecological Oncology – The Ultimate Study Andreas Obermair 1000 Is Evidence-based Surgery an Oxymoron? Malcolm Munro 1030 – 1100

Morning Tea – Sponsored by Bayer Australia

Monday 9 September 2013 continued… 1100 – 1230 Make Sure it’s Cooked! Prematurity in O&G

How Do You Want Your Eggs? The Ovary in O&G

Room: Bayside Auditorium A

Room: Bayside Gallery B

Chairs: Sue Walker & Boon Lim

Chairs: Stephen Robson & James Bacon

1100 The Aetiology of Preterm Labour Roger Smith

1100

Saving the Torted Ovary – Why Bother? Evidence-based Conservative Management Stephen Lyons

1115 Recognising and Treating Infection to Reduce the Risk of Preterm Labour Jonathan Morris

1115

PCOS: Australian Alliance Evidence-based Guidelines Michael Costello

1130 Cervical Length and Predicting Risk of Premature Delivery Jon Hyett

1130 Endometrioma: Ablate, Strip or Do Nothing to Maximise Fertility? Luk Rombauts

1145 Progesterone and the Prevention of Preterm Delivery Katie Groom

1145

‘What’s the Best Way to Freeze Your Eggs?’ William Ledger

1200 MgSO4 for Neuroprotection Caroline Crowther

1200

It Takes More Than Eggs to Make an Omelette: News for the Male Roger Hart

1215

Questions From the Audience

1230 – 1330

1215

Questions From the Audience

Lunch

1330 – 1500 There Are Weevils in the Flour! Infections in O&G

Getting the Mix Right: Workforce, Recruitment & Assessment in O&G

Room: Bayside Auditorium A

Room: Bayside Gallery B

Chairs: Stephen Lyons & Jon Hyett

Chairs: Greg Jenkins & Martin Ritossa

1330 Antenatal Screening for CMV, Parvovirus & Toxoplasmosis – A Dangerous Game? Bill Rawlinson

1330 Workplace-based Assessments and Other TLAs Ian Symonds

1345

Mode of Delivery in Women Infected with Herpes Simplex Ben Willem Mol

Getting the Right Ingredients – Selection for Training Sarah Tout

1400 Food Safety in Pregnancy: Listeria and Friends Tony Merritt

1400 Is There a Future in Academic Training in O&G? Michael Permezel

1415 Sepsis and Maternal Morbidity & Mortality Monica Lahra

1415

Like a Good Cheese, the Old O&Gs Are the Best Michael Chapman

1430 Chlamydia & HPV – Current Status Basil Donovan

1430

The RCOG Workforce Experience Sabaratnam Arulkumaran

1445

Questions From the Audience

1445

Questions From the Audience

Monday 9 September 2013 continued... 1500 – 1530

Afternoon Tea – Sponsored by Bayer Australia

1530 – 1720 Pieces of the Pie: Global Women’s Health in O&G

Session sponsored by MSD

Room: Bayside Auditorium A

Chairs: Jason Abbott & Talat Uppal

1530 ‘Medical Tourism’ and ‘Making a Difference’ Are NOT the Same Things Ajay Rane 1550 ‘Medical Tourism’ is Not a Holiday Ray Hodgson 1610 China, Hong Kong and the Politics of Childbirth Tony Chung 1630 Contraception is Still an Important Global Issue Greg Jenkins 1650 Violence Against Women: A Pervasive Human Rights Violation of Pandemic Proportions Gabrielle Casper

1710

Panel Discussion and Questions From the Audience

Scientific Program Tuesday 10 September 2013 0730 – 0810 Breakfast Sessions: Fast Food & Fast Facts

Room: Trade Exhibition, Bayside Grand Hall

Session 1 Fibroid Fricassee – Top Tips for Hysteroscopic Removal Malcolm Munro

Session 2 Outpatient and Office Procedures – For patient or profit? John Pardey

Session 3 Monochorionic Twins – Surgical Management of Complications John Smoleniec

Session 4 Indications for Induction of Labour Ben Willem Mol

0830 – 1030 Recipes for Disaster? Controversies in O&G

Room: Bayside Auditorium A

Chairs: Gabrielle Casper, James Bacon & Bill Ledger

0830 When to Deliver the Pre-term Growth-restricted Fetus? A Review of the Evidence Anthony Odibo 0900 Tick-box Medicine – Protocols on the Birthing Suite: Evidence-based or Bureaucracy-based? Michael Nicholl 0920 Caesarean Section – Why Not? Peter Dietz 0940 Colposcopy is Adequately Taught During Training Susan Valmadre 1000 Surgical Training is Not For Everyone Sabaratnum Arulkumaran 1030 – 1100

Morning Tea – Sponsored by MSD

1100 – 1230 Early Career Researcher Presentations / Diplomate Researcher Presentations / Free Communications

Early Career Researcher Presentations / Diplomate Researcher Presentations / Free Communications

Room: Bayside Gallery B

Room: Bayside Auditorium A

Chairs: Joanne Ludlow, Sean Seeho & Anthony Geraghty

Chairs: Jon Hyett, Sue Walker, Kenneth Appen & Rupert Sherwood

1100 Surgical Anatomy in Obstetrics and Gynaecology: The Trainees’ Perspective Erin Nesbitt-Hughes

1100

Obstetric Outcomes in Patients with Classical Bladder Exstophy Rebecca Deans

Tuesday 10 September 2013 continued... 1110 Fetal Welfare, Obstetric Emergency, Neonatal Resuscitation Training (FONT) and Improved Statewide Pregnancy Outcomes Warwick Giles

1110

1120 Association of Low Maternal Serum Concentrations of Pregnancy-Associated Plasma Protein A (PAPP-A) and Free Beta-Subunit Human Chorionic Gonadotropin (fß-hCG) with Adverse Neonatal Outcome Jiayi Liu

1120 Only Time Will Tell: The Effect of Extending Dinoprostone Pessary Placement from 12 to 24 Hours on the Need for Transcervical Balloon Catheters Vanessa Lusink

1130 Laparoscopic Abdominal Cerclage: 6 Year Experience in Melbourne, Australia James May

1130 PLGF in Combination With Other Commonly Utilised Tests and Other Biomarkers Predicting Need for Delivery Within 14 Days from Pre-Eclampsia in Women Presenting Prior to 35 Weeks Gestation Andrew Shennen

1140

The Value of MRI in the Investigation of Pudendal Nerve Entrapment Jason Chow

1150 Long-Term Childhood Health and Developmental Outcomes After Caesarean Delivery (CD) Stephen Robson

1150

Anti Müllerian Hormone (AMH) Levels in Recurrent Miscarriage Patients are Frequently Abnormal and Predict Pregnancy Outcomes Catherine McCormack

1200 PaPP-A at 5-11 Weeks’ Gestation and the Prediction of Pregnancy Outcome Sumanthi Rajendran

1200

Placental Growth Factor Measurement as a Marker of Subsequent Disease and Harm in Placental Insufficiency Conditions Aimee Woods

1210 Dual-Progestogen-Delivery Systems Therapy with Levonorgestrel Intrauterine System and Etonogestrel Subdermal Implant for Refractory Endometriosis-Associated Pelvic Pain: An Effective New Therapy Celia Ng

1210

Community Blood Pressure Monitoring in Rural Africa: Detection of Underlying Pre-Eclampsia Samara Radford

1220 Third Trimester Ultrasound: An Audit of Current Practices at St George Hospital Kristina King

1220

Ultrasound Assessment of Cervical Length at 18-21 Weeks Gestation in an Australian Obstetric Population: Comparison of Transabdominal and Transvaginal Approaches Anthony Marren

1230 – 1330

Lunch

1230 – 1330

Meeting of the RANZCOG Universities and College Liaison Committee

Adnexal Torsion – An Under Recognised Emergency. To Cut or Not to Cut Should No Longer Be the Question Annie Kroushev

Maternal Health and Pregnancy Outcomes Among Women of Refugee Background in Australia Melanie Gibson-Helm

Room: Bayside 102

Tuesday 10 September 2013 continued... 1330 – 1500 Would You Like Cracked Pepper, Madame? Supplements in O&G

Kitchen Crisis! Mental Health in O&G

Academic Session

Room: Bayside Gallery B

Room: Bayside 103

Chairs: John Regan & Penelope Fotheringham

Room: Bayside Auditorium A

Chairs: John Pardey

Chair: Ian Symonds

1330 Evidence-based Herbs & Nutrients for Premenstrual Syndrome John Eden

1330

Mental Health Screening in the Context of Obstetric Practice Vijay Roach

Topics include:

1345 Antenatal Calcium and Vitamin D Supplementation Glynis Ross

1345

PTSD and Childbirth Richard Bryant

The FRANZCOG Academic Career Pathway

1400 Role of Folate and Antenatal Multivitamins in Pregnancy – An Update Denise Furness

1400

What Can We Do to Minimise Negative Birth Outcomes? Early Identification of Women With Mental Health Morbidity Marie-Paule Austin

Is it Time to Revisit a National Undergraduate Curriculum for Obstetrics and Gynaecology?

1415 Iron Deficiency in Pregnancy: 1415 Screening, Supplementation & Transfusion Michael Dibley

Postnatal Psychosis Phillip Boyce

1430 Iodine Deficiency and Thyroid 1430 Function in Pregnancy Creswell Eastman

The Impact of Surgical Morbidity on the Surgeon Phil Daborn

Questions From the Audience

1500 – 1530

1445

Questions From the Audience 1445

The Future of Academic Workforce Development

What Influences Student Intentions to Practice in Obstetrics and Gynaecology? The ITP Research Project – Outcomes and Current Status

Afternoon Tea – Sponsored by MSD

1530 – 1615 President’s Address

Room: Bayside Auditorium A

Michael Permezel

1615 – 1715 Forum: Robotics in Gynaecological Surgery – Can We Afford To, Can We Afford Not To?

Room: Bayside Auditorium A

Chairs: Stephen Lyons & Chris Smith

1615 Robotics and Benign Gynaecology – For the Patient or the Doctor? Jason Abbott 1630 Robotically Assisted Hysterectomy for Benign Disease: Is There an Economic Argument? Georgina Chambers 1645 Robotic Surgery in Gynaecological Oncology Martin Oehler

1700

Panel Discussion and Questions From the Audience

1900 til late ‘A Taste of Sydney’ – Doltone House

Scientific Program Wednesday 11 September 2013 0730 – 0810 Breakfast Sessions: Fast Food & Fast Facts

Room: Trade Exhibition, Bayside Grand Hall

Session 1 Thymic Ultrasound and Pre-eclampsia Prediction Ron Benzie

Session 2 Caesarean Delivery on Demand Sabaratnum Arulkumaran

Session 3 Managing an Acute Gynaecology Service George Condous

Session 4 Mullerian Fusion Failures: The Lower Third Rebecca Deans

0830 – 0900 Ian McDonald Memorial Oration

Room: Bayside Auditorium A

Chair: Michael Permezel, President

Evidently, Evidence in Obstetrics is Essential Caroline Crowther

0900 – 1030 Who’s in the Kitchen? Models of Care in O&G

Room: Bayside Auditorium A

Chairs: Vijay Roach, John Pardey & Jason Abbott

0900 Caseload Midwifery and Beyond Sally Tracy 0920 Mixed Models of Obstetric Practice Andrew Pesce 0940 Unwarranted Clinical Variation... A Health Care Dilemma Brian McCaughan 1000 What are the Drivers for Variation in Practices, Costs and Outcomes? Carol Pollock 1030 – 1100

1020

Panel Discussion and Questions From the Audience

Morning Tea

Wednesday 11 September 2013 continued… 1100 – 1230 The Oven’s Broken! The Uterus in O&G

What’s the Recipe? New Diagnostics in O&G

Room: Bayside Auditorium A

Room: Bayside Gallery B

Chairs: Jon Hyett & Greg Jenkins

Chairs: Bill Ledger & Celia Devenish

1100 Predicting Risk of Pre-eclampsia From First Trimester Screening Felicity Park

1100 Evaluation of Ovarian Reserve Tamara Hunter

1115 sFLT and Endoglin: Third Trimester Markers for Pre-eclampsia Annemarie Hennessy

1115 Screening Embryos for Single Gene Defects Leeanda Wilton

1130 Acute Triggers of Pre-eclampsia Jane Ford

1130

Aneuploidy Screening in 2013 Maria Traversa

1145 Diagnosis of Fetal Growth Restriction: To Customise or Not? Anthony Odibo

1145

Free Fetal DNA Aneuploidy Screening Andrew McLennan

1200 Late-onset Fetal Growth Restriction Sue Walker

1200

Assess Tubal Patency in Subfertile Women Ben Willem Mol

1215

Questions From the Audience

1230 – 1330

1215

Questions From the Audience

Lunch E-Posters Moderated Session Room: Bayside Auditorium A

1330 – 1400 Ella Macknight Memorial Lecture

Room: Bayside Auditorium A

Chair: Sue Walker

Amniotic Fluid Cell-free RNA: A Novel Source of Information About Human Development Lisa Hui

Wednesday 11 September 2013 continued... 1400 – 1530 Gynaecology Hotpot: Issues in O&G

Obstetric Hotpot: Evidence in O&G

Room: Bayside Auditorium A

Room: Bayside Gallery B

Chairs: Anthony Geraghty

Chairs: Ian Symonds & Celia Devenish

1400 Vulval Dermatoses for the Generalist Gayle Fischer

1400 Decreasing the Obstetric Workload: Contraceptive Conundrums Terri Foran

1415 Management of Early Vulvar Cancer Neville Hacker

1415

When is a Placenta Truly “Low Lying”? Anthony Odibo

1430 Gynaecological Issues in Cancer Survivors 1430 Obesity & Pregnancy – An Update Jennifer Bradford Leonie Callaway 1445 Endometrial Diagnosis of Endometriosis Alison Hey-Cunningham

1445

The Intra-partum Management of Breech Presentation 10 Years Post Term Breech Henry Murray

1500 AUB Alphabet Soup: Can FIGO’s PALM COEIN System Bring Order to Chaos? Malcolm Munro

1500

Recurrent Miscarriage: Do First Trimesterm Interventions Work? Juliette Koch

1515

Questions From the Audience

1530 – 1600

1515

Questions From the Audience

Afternoon Tea – BAYSIDE FoYER, Level 1

1600 – 1700 Forum: Post-partum Haemorrhage is Not a Malignant Condition! Evidence and Demarcation in O&G

Room: Bayside Auditorium A

Chairs: Stephen Robson & Boon Lim

1600 The Obstetrician’s Point of View Sabaratnum Arulkumaran 1615 The Gynaecologist’s Point of View Malcolm Munro 1630 The Gynaecological Oncologist’s Point of View Jim Nicklin 1645 1700 – 1715

Panel Discussion and Questions From the Audience Jon Hyett, Malcolm Munro and Jim Nicklin

Meeting Close: Final Comments and Announcement of Awards

Stephen Lyons, Ian Symonds & William Ledger

E - P o s t er P rese n tat i o n s 1 Anti-N-methyl-D-aspartate Receptor Encephalitis in Females; A Routine Search for Ovarian Teratoma and the Role of a Gynaecologist Rehena Ahmed 2 Outcomes of Extreme Morbid Obesity in Pregnancy at Western Health Mais Ali 3 External Cephalic Version for Breech Presentation – A Single Centre Experience Poornima Amaranarayana 4 Diagnosis and Management of Endometrial Polyps: A Critical Review of the Literature Stephanie Salim Andriputri 5 Cost Effectiveness of Induction of Labour at Term with Inpatient Vaginal Prostaglandin E2 Gel Compared to an Outpatient Foley Catheter (FOG Trial) Kathryn Austin 6 Motor Vehicle Accidents and the Pregnant Patient – Retrospective Analysis of Clinical Presentation, Management and Composite Maternal and Fetal Outcomes to Determine the Need for Delivery Karen Baker 7 A Retrospective Review of Undiagnosed Breech at the Mercy Hospital for Women Laurel Bennett 8 An Audit on the Incidence and Management of Obstetric Anal Sphincter Injuries (OASIS) Sophia Berkemeier 9 Iodine Intake and Thyroid Function in Pregnant Women in a Private Clinical Practice in North Western Sydney before Mandatory Fortification of Bread with Iodised Salt Norman Blumenthal 10 Uterine Rupture with Peri-hepatic Migration of Foley Catheter and Associated Coagulopathy Following Hysteroscopy and Polypectomy for Treatment of Acute Menorrhagia; A Case Report and Review of the Evidence for Uterine Tamponade in the Non-puerperial Uterus Angela Boulton 11 Pravastatin Blocks Production of Soluble Endoglin in Primary Endothelial and Placental Cells: A Potential Therapeutic for Preeclampsia Fiona Brownfoot 12 Does Weighing at Each Antenatal Visit Result in Appropriate Pregnancy Weight Gain? A Randomised Control Trial Fiona Brownfoot 13 A Case Series of Caesarean Section Scar Ectopic Pregnancies: Characteristics, Management, and Outcomes Nimithri Cabraal

14 CUSUM Plot for Quality Assurance Monitoring of Caesarean Section, Instrumental and Normal Vaginal Delivery Rates in Nulliparous Singleton Pregnancies Lily Chen

27 The Development and Validation of a New Tool to Predict Spontaneous Preterm Birth in High-risk Women Using Quantitative Fetal Fibronectin and Cervical Length Claire Foster

15 Serum Levels of 25 Hydroxyvitamin D in Pregnant Women with Established Diabetes or Gestational Diabetes Mellitus in Far North Queensland Hon Chuen (Alan) Cheng

28 Complications When Using Balloon Tamponade Technology in the Management of Postpartum Haemorrhage Chris Georgiou

16 Developing a Dataset for Clinical Auditing for E0/ ‘Code Green’ Immediate Caesarean Sections Georgiana Chin

29 Mapping High-risk Obstetric Transfers Across New South Wales and the Australian Capital Territory (High-Risk Obstetric Transfer Study) Amy Goh

17 Midwifery-led Intervention Group for Pregnant Women of High Body Mass Index: Engagement with and Outcomes of SSWInG Sarah Chwah 18 Factors Influencing Successful Trial of Instrumental Delivery: A Three-year Review Georgina Davis 19 Radical Vaginal Trachelectomy: Fertility Preserving for Women with Early Stage Cervical Cancer Simran Dhillon 20 Tablet Technology: iPad Prescription for Medical School Teaching and Training in Obstetrics and Gynaecology Michelle Durst 21 Successful Monochorionic Triplet Pregnancy Complicated by Early-onset Selective Intrauterine Growth Restriction Lindsay Edwards 22 Chlamydia Trachomatis Infection in the Antenatal Population at the Royal Hobart Hospital – Should Universal Screening be Offered? Lindsay Edwards 23 Fetal Supraventricular Tachycardia: A New Approach to Surveillance and Treatment Lindsay Edwards

30 Initial Commercial Results from a Non-invasive Prenatal Aneuploidy Test That Employs Massively Multiplexed Targeted PCR Amplification and Sequencing of 19,488 Single-nucleotide Polymorphisms (SNPs) Megan Hall 31 Exploring the Psychosocial Support Services for Women with Disorders of Sex Development Chloe Hanna 32 Effect of a Gestational Diabetes Management Program on Weight Loss After Pregnancy Tasnim Hasan 33 Pregnancy Outcomes Before and After Institution of Specialised Twins Clinic Care Amanda Henry 34 Global Gene Expression Analysis of Amniotic Fluid Cell-free RNA from Recipient Twins with Severe Twin-twin Transfusion Syndrome Lisa Hui 35 Review of Instrumental Deliveries: Who Needs Them and Does Our Practice Reflect Current Recommendations? Albert Jung

24 Brow Presentation: Manual Flexion and Keilland Rotation Forceps Delivery Magage Fernando

36 Do All Accouchers on Birth Suite at Western Health Have the Experience and Confidence to Perform an Appropriate Episiotomy When Required? Room For Improvement Arzoo Khalid

25 Management of Premenopausal Abnormal Uterine Bleeding at Auckland District Health Board (ADHB) Sarah Fitzgibbon

37 Screening for Perinatal Anxiety and Depression: An Australian Private Hospital First Jane Kohlhoff

26 A Literature Review of Evidence Based Practice and Models of Maternity Care of Women with Body Mass Index (BMI) >/= 30 kg/m2 Laura Forsyth

38 Women’s Attitudes Towards Their Management Following Prelabour Rupture of Membranes at Term, as Determined By Their Group B Streptococcus Status Kin Ying Kong 39 Is Anorectal Physiology Testing Useful in Asymptomatic Primiparous Women with Obstetric Anal Sphincter Injury? Swetha Kumar

Electronic Poster (E-Po ster) Presentations will be displayed in the E-Poster Zone within the Trade Exhibition for the duration of the Meeti ng. Delegates are encoura ged to view the E-Posters du ring the catering breaks.

40 Histological Risk Factors for CIN Recurrence After LLETZ: A Case Controlled Study Precious Lusumbami

53 Urinary Retention Following Laparoscopic Gynaecological Surgery With or Without 4% Icodextrin Anti-adhesion Solution Erin Nesbitt-Hawes

67 Confined Placental Mosaicism: Outcomes of Pregnancies Over a Decade From a Tertiary Centre Katherine Stewart

41 Neonatal Outcomes in Twin Vaginal Births – Twin Birth Time Interval: A Retrospective Study Kassam Mahomed

54 Breastfeeding: The Attitudes and Level of Knowledge Amongst a Cohort of General Practitioners Michael Petinga

68 Improving Severe Preeclampsia with Resolution of Clinical Features and Endothelial Activation: A Case Study Peter Stone

42 OEIS Complex – A Rare Complication of Twin Pregnancy Bhavna Maindiratta

55 Does Perfect Antenatal Blood Sugar Control Prevent Neonatal Hypoglycemia? Helen Phipps

69 Multifetal Reduction: Important Findings From a Single Centre Audit Peter Stone

43 Ovarian Ectopic Pregnancy – A Challenging Diagnosis Bhavna Maindiratta

56 Early Prediction of Spontaneous Preterm Birth in Asymptomatic High Risk Women at 18-22 Weeks’ Gestation Using Quantitative Fetal Fibronectin Samara Radford

70 A Case Report on an Unusual Complication of Imperforate Hymen Maria Katrina Torres

44 Pre-term Uterine Scar Dehiscence: A Case Report Highlighting Management Considerations and Imaging Modalities Bhavna Maindiratta 45 Acute Aortic Dissection in Pregnancy in a Woman with Undiagnosed Marfan Syndrome Mandana Master 46 A Single Nucleotide Polymorphism (SNP)-based Approach to Non-invasive Prenatal Testing (NIPT) Identifies Lingering Cell-free Fetal DNA (cffDNA) in Pregnancies with Vanishing Twins Sallie McAdoo 47 Serial Self-weighing Integrated into Routine Pregnancy Care is Welcomed By Overweight and Obese Women But is Insufficient to Prevent Obstetric Complications or Excess Gestational Weight Gain: A Randomised Controlled Trial Elizabeth McCarthy 48 Temporary Resolution of Severe Pre-eclampsia Following Spontaneous Single Twin Demise at 23 Weeks in a Dichorionic Pregnancy with a Priori High Risk of Pre-eclampsia: A Case Report and Literature Review to Inform Risk, Reproductive Options and Rural Challenges Elizabeth McCarthy 49 Midtrimester Severe Liver Failure as an Adult Presentation of an Inborn Error of Urea Cycle Metabolism Elizabeth McCarthy 50 Pregnancy Complicated By Spontaneous Pneumathoraces, A Case Study and Review of the Literature Matthew McKnoulty 51 Adnexal Torsion – Dead or Not? Alexandra McRae 52 Correct Placement of the Essure Device Detected By Transvaginal Ultrasound at 1 Month Predicts Correct Placement at 3 Months Sarah Mitchell

57 Dysregulated Immuno-suppression in Women with Endometriosis-associated Infertility? Azmat Riaz 58 Perinatal and Social Factors Predicting Caesarean Delivery in an Australian Birth Cohort Stephen Robson 59 Carbetocin – Is It An Alternative Oxytocic for Caesarean Sections? Thangeswaran Rudra 60 Role of Bakri Balloon Catheter for Vaginal Lacerations Thangeswaran Rudra 61 The Obstructed Hemivagina, Ipsilateral Renal Anomaly, Uterine Didelphys Triad: Institutional Case Series of Eleven Patients Including 16p11.2 Microdeletion and Cervical Aplasia Salma Sabdia 62 Venous Thromboembolism Prophylaxis Around the Time of Caesarean Section: A Survey of Current Practice Sean Seeho 63 An Analysis of the NSW Midwives Data Collection (MDC) Over An 11 Year Period to Determine the Risks of Induced Delivery for Non-obstetric Indication at Term Aiat Shamsa 64 “Desperate Deborah”: Evaluation of a Training Mannequin for Stuck Heads at Caesarean Section Andrew Shennan 65 Improving Pregnancy Care Documentation Through Audit of Hand-held Records Portia Spaulding 66 Cervidil V. Prostin: Efficacy, Safety and Implications for Our Health Service Edward Springhall

71 Impact of Surgical Complications on Obstetricians and Gynaecologists in Australia and New Zealand Elizabeth Varughese 72 Social Perspectives on Contraception Use in Sub-Saharan Africa: A Review Jessica Vidler 73 Is An Oxytocin Infusion Required After An Oxytocin Bolus at Emergency Caesarean Section? Carole-Anne Whigham 74 Is Cell Salvage a Cost Effective Intervention in Lower Segment Caesarean Sections? Adam White 75 Reducing Excessive Gestational Weight Gain During the Antenatal Period Alice Whittaker 76 Early Pregnancy Assessment Service – The Riverina Experience Kieren Wilson 77 The Success Rate of Medical Management of Miscarriage on Surgical Management and Its Impact on Surgical Management Clare Wong 78 Dendritic Cells in the Endometrium: Dysregulated in Endometriosis? Yee Tak Cecilia Wong 79 Maximising the Training Opportunities for Medical Students in Gynaecology Clinics: Information Prior to the Clinic May Improve Patient Acceptance Jenny Yang 80 Evaluating Discrepancies Between Neonatal Outcomes and Fetal Scalp Lactate Measurements Ellen Yeung 81 Third Trimester Incarceration of a Gravid Retroverted Uterus: Case Report and Review of Literature Ellen Yeung 82 Vitamin D Supplementation in Pregnancy: One Size Fits All? Cheryl Yim

S o c i a l P r o g ram Opening Ceremony & New Fellows Welcome Reception

New Fellows Welcome Reception 1830 – 2000 hours The New Fellows Welcome Reception will follow from 1830 hours; an opportunity to view the iconic artworks within the Modern Australian Artists Gallery and catch up with new and old colleagues and friends alike.

Sunday 8 September 2013 Art Gallery of New South Wales Art Gallery Road The Domain, NSW 2000 Opening Ceremony 1800 – 1830 hours Situated in the picturesque Royal Botanic Gardens, the Art Gallery of New South Wales will host the Opening Ceremony from 1800 – 1830 hours. Newly elevated Fellows and recently certified subspecialists will be joined by family and friends to celebrate this significant milestone in their career.

Includes: Drinks and canapés Cost: Inclusive with full registration Tickets:

Bookings were required in advance. Additional tickets $75 per person

Dress code: Smart casual

Coach transportation will be available from the Sydney Convention & Exhibition Centre, Bayside end to the Gallery. 1630 hours New Fellows + Guests 1715 hours Guests to the Opening Ceremony 1800 – 1815 hours Guests for the Reception Coaches will return to the Sydney Convention & Exhibition Centre Centre from 1945 hours.

Island Darling

Wharf

A Taste of Sydney hosted by Libbi Gorr Tuesday 10 September 2013 1900 – until late Doltone House Darling Island 48 Pirrama Road Pyrmont NSW 2009 Come and experience a taste sensation! Celebrate all that is wonderful about fresh local produce – the sights, sounds and smells won’t disappoint! Enjoy a relaxed and informal evening at Doltone House, a spectacular waterfront venue on the foreshore of Sydney Harbour, with views of the iconic Sydney Harbour Bridge and city skyline. Includes: Dinner, drinks and entertainment Cost:

$155 per person

Tickets:

Bookings were required in advance. Additional tickets $155 per person

Dress code: Smart casual Travel: Guests are required to make their own way to Doltone house. Directions are provided with attendance ticket; further directions can be obtained from the Registration and Information Desk. If you have registered to attend ‘A Taste of Sydney’, a ticket is included in your registration envelope. Please remember to bring your ticket as admission is by ticket only.

Sydney

ouse Opera H

Ge n era l I n f o rmat i o n Sydney Tower Eye Telephone numbers

Delegate list

Transport

A delegate list will be distributed electronically. Delegates who indicated on their registration form that they did not want their name and organisation to appear on the list will be excluded.

Taxis 133 300

Car Hire Avis 13 63 33 Budget 1300 362 848

Dress code

Europcar 13 13 90

The dress standard is smart casual for all Meeting sessions.

Hertz 13 30 39 Thrifty 1300 367 227

Airlines Qantas 13 13 13 Jetstar 13 15 38 Virgin Blue 13 67 89 Tiger Airways 02 8073 3421

Catering Morning teas, lunches and afternoon teas will be served in the Trade Exhibition located in the Bayside Grand Hall. Car parking The Convention Centre parking and Exhibition Centre parking is located off Darling Drive, underneath the Centreâ&#x20AC;&#x2122;s five exhibition halls, in Darling Harbour. The car park provides direct access to the Centre and the Darling Harbour precinct. The car park features 18 disabled parking spaces and access to the Centre can also be gained via ramps and lifts. The car park is open for 24 hours, Monday to Sunday. Parking is $34 per day. Rates are applicable at the time of printing.

Certificate of Attendance Certificates of Attendance will be emailed to delegates after the Meeting.

Evacuation procedure In the event of an evacuation, Sydney Convention & Exhibition Centre staff will act as fire wardens to assist in the movement of patrons to the designated assembly point. The current evacuation meeting point is located at Palm Grove, which is a short walk to the bottom of the stairs at the eastern entrance to the Sydney Convention & Exhibition Centre. Venue staff will inform guests when safe to return to the venue.

Sydney

Harbo

ur Bri dge

at nigh t

Insurance Registration fees do not include insurance of any kind. The Meeting Secretariat, Organising Committee and The Royal Australian and New Zealand College of Obstetricians and Gynaecologists will take no responsibility for any participant failing to insure. Liability disclaimer The RANZCOG 2013 ASM, including the Organising Committee, RANZCOG and the Meeting Secretariat, and all suppliers to the Meeting and their servants, agents, contractors and consultants, will not accept liability for the damages of any nature sustained by participants or their accompanying persons or loss or damage to their personal property as a result of the RANZCOG 2013 ASM or related events.

ocks at The R , ey n d y S istoric

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

Ge n era l I n f o rmat i o n Meeting App

People with special needs

Sponsored by Bayer Australia

Every effort has been made to ensure that people with special needs are catered for. Should you require any specific assistance, please see staff at the Registration and Information Desk to enable us to make your attendance at the Meeting a pleasant and comfortable experience.

For the first time the RANZCOG ASM has a Web App available for smart phones. To access the RANZCOG 2013 ASM Web App please visit www.ranzcog2013asm.com.au on your smart phone. If you have an iPhone just click the â&#x20AC;&#x153;Add to Home Screenâ&#x20AC;? prompt to install. Android users can add the Web App as a bookmark. Or simply use the QR Code below:

Messages

Special dietary requirements Every effort has been made to cater for all delegates who specified special dietary requests at the time of registering. Please make yourself known to a venue staff member at catering times and functions in order to obtain your meal. Vegetarians will be catered for on the buffet during lunches. If you did not provide this information at the time of registering, please advise the staff at the Registration and Information Desk immediately.

Messages can be left at the Registration and Information Desk. The messages will be posted on the message board situated near the desk. Please advise potential callers to contact the Registration and Information Desk on 02 9282 5116. No guarantee can be given to deliver messages personally. Mobile phones As a courtesy to fellow delegates and speakers, please ensure your mobile phones are switched off during Meeting sessions. Name badges Please wear your name badge at all times. It is your official pass to Meeting sessions, morning tea, lunch and afternoon teas. If you misplace your badge simply ask at the Registration and Information Desk for a replacement.

ney ur, Syd

Harbo Darling

8-11 September 2013 Sydney Convention & Exhibition Centre

Hotels 1 Adina Apartment Hotel Sydney, Harbourside (formerly Medina Grand Harbourside) T +61 2 9249 7000 2 Parkroyal Darling Harbour T +61 2 9261 1188

3 Novotel Rockford Darling Harbour T +61 2 8217 4000

5 Ibis Sydney Darling Harbour T +61 2 9563 0888

4 Novotel Darling Harbour T +61 2 9934 0000

6 Four Points by Sheraton T+61 2 9290 4000

6 4

Darling Harbour, Sydney, New South Wales

Internet access The RANZCOG 2013 ASM offers free Wi-Fi to delegates during the meeting days, 9-11 September. The Wi-Fi is ideal for checking emails and web surfing.

To log onto the wireless network: 1 Log on to RANZCOG2013 User ID: Sydney Password: RANZCOG2013

Please note by default Safari on Apple devices are set to block pop ups, you will need to click ok to move onto an internet connection.

2 Agree to the Terms and Conditions 3 If your device allows pop ups, the status screen will appear.

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

Sydney Convention & Exhibition Sydney Convention & Exhibition Centre Darling Harbour, Sydney NSW 2000 T +61 2 9282 5000 Bayside Grand Hall (Trade Exhibition)

www.scec.com.au

Registration and Information Desk The Registration and Information Desk is located in the Bayside Office on the Ground Floor of the Sydney Convention & Exhibition Centre and can be contacted on 02 9282 5116 during opening hours. The desk will be opened during the following times:

Registration Convention Centre Parkside & Exhibition Centre

Bayside Office

Bayside Foyer

main entrance

Sunday 8 September 2013 0800 – 1730 hours Monday 9 September 2013 0700 – 1730 hours

Gro und flo o r

Tuesday 10 September 2013 0700 – 1730 hours

Bayside Grand Hall Trade Exhibition & E-Posters

Wednesday 11 September 2013 0730 – 1730 hours

Bayside Office Registration and Information Desk

Speaker Preparation Room Sponsored by MSD The Speaker Preparation Room is located in Bayside 108 on Level One of the Sydney Convention & Exhibition Centre and is operational at the following times: 103

Sunday 8 September 2013 1200 – 1700 hours

102

105

Monday 9 September 2013 0730 – 1730 hours

It is requested that all presenters visit the Speaker Preparation Room to submit and preview their PowerPoint presentation as early as possible and, at the latest, two hours prior to the session in which they are presenting – this may mean the day before your presentation.

Bayside Auditorium A

101

Tuesday 10 September 2013 0730 – 1730 hours Wednesday 11 September 2013 0730 – 1700 hours

104

Convention Centre Parkside & Exhibition Centre

108

Bayside Foyer

Bayside Gallery B

Speaker Preparation Room

Exhibition Centre

108

Convention Centre Parkside & Exhibition Centre

Bayside Foyer Speaker Preparation Room

Bayside Gallery B

C e n t re 103

104

102

105

Bayside Auditorium A

101

Convention Centre Parkside & Exhibition Centre

108 Bayside Terrace Bayside Foyer

Bayside Foyer Speaker Preparation Room

Bayside Gallery B

201 202

Leve l one

Level t wo

Bayside Rooms 101 to 105 Diplomates Days

Bayside Rooms 201 & 202 Pre Meeting Workshops

Pre Meeting Workshops UGSA Satellite Meeting Academic Session Bayside Room 108 Speaker Preparation Room Bayside Auditorium A Plenary Sessions Breakout Concurrent Session 1 Bayside Gallery B Breakout Concurrent Session 2

Bayside Terrace Bayside Foyer

202

Sydney

re ion Cent

it & Exhib nvention

201

8-11 September 2013 Sydney Convention & Exhibition Centre

Tra d e E x h i b i t i o n Exhibitors AMS Australia 23 Applied Medical 36-37 Ariosa Diagnostics 38 Aspen Pharmacare 32 AstraZeneca 55 & 60 Australian Medical Couches 59 Avant Insurance 39 Avnet Technology Solutions 29 Bayer Australia 03-04 & 12-13 bioCSL 49 Boston Scientific 40 Cell Care 30 Charterhouse Medical 28 Conmed Linvatec 17 Cook Medical 19 Douglass Hanly Moir Pathology 26 Endeavour Medical and Surgical 50 Endotherapeutics 20 Ferring Pharmaceuticals 43 FUJIFILM SonoSite 58 GE Healthcare 09 Global Medics 16 Healthscope Advanced Pathology 27 High Tech Laser Australia 11 Hologic 45-46 Innovative Medical Technologies 33 Insight Oceania 57 Investec Specialist Bank 41 In Vitro Technologies 48 IVFAustralia: Natera Prenatal Test 05 JB Medical Supplies 44 Johnson & Johnson Medical 31 Limbs & Things 42 Medibroker 02 Medical Industries Australia 56 MSD 53-54 & 61-62 MS Health 47 Priority Life 22 QRS International AG 08 RANZCOG 01 & 14 RANZCOG CPD Online 15 Rocket Medical 35 Sonologic Pty Ltd 25 & 34 SRC Enterprises 18 Ultrasound Training Solutions 24 Wiley-Blackwell 21 30

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

The RANZCOG 2013 ASM Organising Committee gratefully acknowledges the support of all exhibiting companies.

45 46

57 56

14 1

Internet Stations Fast Food 2

Fast Food 3

19 4 3 11

27 23

26 25

49 39

36 e-Posters

62 53

33 34

48 43

17 16

29 28

10 9

42 40

7 50

Fast Food 1

Fast Food 4

Entrance

The Trade Exhibition is located in the Bayside Grand Hall and is open as follows: Monday 9 September 10 September Maximum2013 Build Height: Tuesday 4 metres high 52013 metres high Wednesday 11 September 2013 0800 – 1730 hours 0800 – 1730 hours 0900 – 1330 hours

Main Entrance

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

E x h i b i t o r D i rec t o r y AMS Australia

Ariosa Diagnostics

AstraZeneca

BOOTH 23

BOOTH 38

BOOTHS 55 & 60

American Medical Systems is the world’s leading company focused on developing, manufacturing and marketing medical devices that restore male and female pelvic health. We are the only company that solely focuses on male and female pelvic floor conditions. Our Women’s Health portfolio includes Continence and Prolapse Repair Solutions. On display at RANZCOG, our female pelvic health range includes our unique fixation system, introduced in the MiniArc Single Incision Sling several years ago, and now applied to our Elevate Apical and Anterior; and Apical and Posterior Prolapse repair systems.

Ariosa® Diagnostics, Inc. is a molecular diagnostics company committed to innovating together to improve patient care. The flagship product, the Harmony™ Prenatal Test, is a safe, highly accurate and affordable prenatal test for maternal and fetal health. Led by an experienced team, Ariosa is using its proprietary technology to perform a directed analysis of cell-free DNA in blood. The Harmony Prenatal Test equips pregnant women and their healthcare providers with reliable information to make decisions regarding their health, without creating unnecessary stress or anxiety.

ADDRESS Unit

www.ariosadx.com

AstraZeneca Australia (AZA), based in North Ryde, Sydney, is the largest pharmaceutical company operating in Australia. AstraZeneca Australia are one of Australia’s largest private sector investors in medical research and development (R&D) and have invested more than $250 million in Australia in the last decade. AstraZeneca Australia is the largest national manufacturer of pharmaceuticals, providing $1.2 billion of medicines to the local market and $200 million in exports. AstraZeneca Australia business is driven by their mission to bring new innovative medicines into peoples’ lives and are currently involved in more than 50 clinical trials at more than 200 sites across Australia.

TEL

+61 2 9425 6800

Aspen Pharmacare

FAX

+61 2 9427 6296

BOOTH 32

31F 16 Mars Road Lane Cove West NSW 2066

EMAIL sharee.mitchell@ammd.com

www.americanmedicalsystems.com

Applied Medical BOOTHS 36-37

Applied Medical listens and responds to evolving clinical needs with elegant solutions. Applied features the first and only total 5mm solution, a comprehensive suite of breakthrough technologies that provides the performance and reliability of 10mm devices in 5mm formats. The Alexis® wound protector/retractor improves patient outcomes by significantly reducing surgical site infections. Applied offers innovative access solutions, including the Kii® Fios® first entry with a unique indication for primary insufflation, and Kii advanced fixation for unmatched retention. Applied’s GelSeal® technologies enable single site surgery, hand access laparoscopy and transanal minimally invasive surgery.

Aspen Australia* is a pharmaceutical company that commenced operations in Australia and New Zealand in May 2001. Today, one in five scripts written in Australia is for a brand marketed by Aspen making it the number one prescription company in Australia as measured by scripts generated.1 * Aspen Australia comprises Aspen Asia Pacific Pty Ltd (ABN 75 146 444 484) and its subsidiaries, including Aspen Pharmacare Australia Pty Ltd (ABN 51 096 236 985), Aspen Pharma Pty Ltd (ABN 88 004 118 594), Orphan Holdings Pty Ltd (ABN50 115 816 209), Orphan Australia Pty Ltd (ABN 11 067 189 342), and Arrow Pharmaceuticals Pty Ltd (ABN 17 003 144 170). Reference 1: IMS Statistics as of December 2012 CONTACT Frazer TEL

Mackenzie-Andrew

+61 2 8436 8416

EMAIL frazer.mac@

aspenpharmacare.com.au

www.aspenpharma.com.au

ADDRESS

Alma Road North Ryde NSW 2113

TEL

+61 2 9978 3500

FAX

+61 2 9978 3700

www.astrazeneca.com.au

Australian Medical Couches BOOTH 59

Australian Medical Couches specialise in manufacturing examination couches for specialists and General Practitioners in the medical field. Our couches are designed to meet the individual needs for Doctors, Gynaecologists, Sonographers and Dermatologists amongst others and are manufactured meeting the standards specified in ISO-9001. We have a range of 30 fabric colours to meet you practices individual requirements and all of our fabrics are medical grade, hard wearing and stain resistant. We offer a lifetime warranty on the frame and five years warranty on the motors which makes a clear statement about our quality. CONTACT

Cameron Reed

ADDRESS

11 Frankston Gardens Drive Carrum Downs VIC 3201 Australia +61 3 9708 2661

ADDRESS

1/32 Windorah Street Stafford, Brisbane QLD 4053

TEL

1800 666 272

EMAIL info@austmc.com

www.appliedmedial.com

EMAIL ClientServices@ariosadx.com

www.austmc.com

dge ur Bri

Harbo ydney

Avant Insurance

Bayer Australia

Boston Scientific

BOOTH 39

BOOTHS 03-04 & 12-13

BOOTH 40

As Australia’s leading medical defence organisation, Avant offers medical professionals more expertise, claims experience, and an extended range of insurance products spanning medical indemnity, cover for medical practices, health, income, life and total permanent disablement. Avant is a mutual, notfor-profit organisation. We’re financially strong with growing net assets and a new reward plan offering loyalty benefits when we perform well. We offer expert medicolegal advice and assistance to over 60,000 health practitioners and students. Avant has the largest “in-house” legal team of all MDO’s in Australia.

Bayer is celebrating 150 years of operation as an international, researchbased company specialising in health care, nutrition and high-tech materials. It has operated in Australia since 1925 and has a long term commitment to the health of all Australians, the agricultural industry and the welfare of animals, large and small. Bayer Australia currently employs over 850 people across the country and is dedicated to servicing the needs of rural Australia and the local community. Bayer is deeply committed to research and development and has a strong tradition of innovation with over 5,000 products and services. The company’s focus on people, partnerships and innovation underpins all aspects of its operations, consistent with its mission, “Bayer: Science For A Better Life.”

Every day, Boston Scientific works to develop medical innovations in pelvic floor reconstruction and incontinence that may help women lead longer healthier lives. Boston Scientific are pursuing new ideas in Women’s Health, and exploring new ways to apply them. Boston Scientific are changing the way the world thinks about delivering health care for women.

TEL

1800 128 268

EMAIL memberservices@avant.org.au

www.avant.org.au

TEL

+61 2 9391 6000

www.bayer.com

Avnet Technology Solutions BOOTH 29

Avnet (previously Sydmed) has served the Australian medical industry for over 20 years, specialising in sales and service for ultrasound and urodynamics equipment. Mindray is a leading developer and manufacturer of ultrasound scanners, with a worldwide reputation for outstanding quality and reliability. Avnet have distributed Mindray products since 2005, and combined with our extensive experience and exceptional after-sales support, have developed Mindray to be one of the most dependable ultrasound brands in Australia. Avnet also exclusively distribute Laborie urodynamics products. CONTACT

Angela Conlon

ADDRESS

67 Epping Road North Ryde NSW 2113

TEL

+61 2 8875 0443

bioCSL BOOTH 49

bioCSL, a division of CSL Limited, is a leading provider of essential vaccines, pharmaceuticals and diagnostic reagents. We have served Australia’s healthcare needs for almost a century and today we develop, manufacture and source medicines that support the health and wellbeing of many thousands of people around the world. bioCSL operates one of the world’s largest influenza vaccine manufacturing facilities, and manufactures products of national significance such as antivenoms. In Australia, bioCSL’s established contract logistics business provides services both to Government and global health care product suppliers.

CONTACT

Paula Crameri

ADDRESS

PO Box 322 Botany NSW 1455

TEL

+61 2 8063 8207

EMAIL Paula.crameri@bsci.com

www.bostonscientiﬁc.com

Cell Care BOOTH 30

Cell Care is Australia’s leading family cord bank, providing Cord Blood and Cord Tissue stem cell storage for expectant parents. Cord blood stem cells are currently used to treat a range of conditions. Cord tissue contains mesenchymal stem cells, which, in the future, might be used to treat conditions like arthritis and cartilage injuries. Family banking allows cord blood to be stored and used to treat siblings and compatible family members. In the future more treatments may emerge as researchers investigate stem cell treatments for a variety of conditions, including cerebral palsy, brain trauma, spinal injury and type 1 diabetes. CONTACT Frank TEL

Cashen

1800 071 075

EMAIL info@cellcareaustralia.com

www.cellcareaustralia.com

EMAIL angela.conlon@avnet.com

www.avnet-tp.com.au/healthcare

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

E x h i b i t o r D i rec t o r y Charterhouse Medical

Cook Medical

BOOTH 28

BOOTH 19

Charterhouse Medical provide locum and permanent recruitment services for the private and public health sectors. Our consultants specialize in specific areas ensuring a greater depth of knowledge and networks. Presently we place doctors and nurses across most specialty areas and work with clients in rural, remote, coastal and suburban health providers.

Since its founding, Cook Medical has focused on collaborating with physicians and medical researchers in order to create minimally invasive medical devices that meet patients’ needs. Cook’s Women’s Health clinical division brings that focus and collaboration to the practices of diagnostic imaging, assisted reproductive technology, maternal fetal medicine, obstetrics and gynecology. As a result, we have created procedurechanging devices such as the Bakri Balloon, which effectively manages postpartum hemorrhage, and the Cervical Ripening Balloon, which safely and naturally helps to induce labor. Visit www.cookmedical.com/wh to learn more about Cook Women’s Health.

CONTACT Francine

Clair

ADDRESS Level

10 155 George Street Sydney NSW 2000

TEL

+61 2 9641 2401

FAX

+61 2 9251 6146

EMAIL Francine@

charterhousemedical.com

www.charterhousemedical.com

ADDRESS

95 Brandl Street Brisbane Technology Park Eight Mile Plains QLD 4113

Conmed Linvatec

TEL

+61 7 3434 6000

BOOTH 17

FAX

+61 7 3434 6001

ConMed Linvatec Australia is committed to providing healthcare products and services that deliver enhanced clinical outcomes to our customers and their patients. We take pride in the breadth of our product offering with products in the areas of Advanced Energy (RF & thermal fusion single-use devices and related capital equipment); EndoMechanical Instrumentation (abdominal access, ligation & stapling, suction/irrigation and uterine manipulators (VCare) for minimally-invasive surgery); and Advanced Visualisation (multi-specialty medical video and digital capture systems in both 2DHD & 3DHD formats).

EMAIL caucustserv@cookmedical.com

TEL

1800 238 238

EMAIL linvatec_australia@linvatec.com

www.conmed.com

www.cookmedical.com/wh

Douglass Hanly Moir Pathology BOOTH 26

Trained, accredited collection staff – A comprehensive range of routine, esoteric and emergency testing – 24 hour operation, 365 days a year – More than 68 pathologists with specialities in all sub-disciplines of pathology – Highly qualified and trained scientists – Fully automated, purpose built testing facilities combining the latest equipment with expert scientific knowledge – Rapid turnaround of very high quality results – Electronic downloading of results Douglass Hanly Moir Pathology is fully accredited with the National Association of Testing Authorities (NATA) and the Royal College of Pathologists of Australasia (RCPA) to AS 4633 (ISO 15189). TEL

+61 2 9855 5222

www.dhm.com.au 34

Endeavour Medical and Surgical BOOTH 50

Endeavour Medical and Surgical Supplies Pty Ltd was founded in 1988 with a focus on women’s health issues. We believe that in order for Medical Practitioners to give the highest level of care, they should have available to them the best technologies. Over the past 23 years we have earned the respect of the Medical Practitioners and Healthcare industry by specialising in distributing innovative and quality range of medical devices service and support to improve common medical procedures in Obstetrics and Gynaecology. CONTACT Leo

Mijatovic

ADDRESS Unit

2/9 Kellaway Place Wetherill Park NSW 2164

TEL

+61 2 9725 5977

FAX

+61 2 9725 5448

EMAIL leo@endeavourmedical.com.au

Endotherapeutics Pty Ltd BOOTH 20

Endotherapeutics specialises in the regulatory approval, sales, marketing and distribution of leading medical devices for various health care segments. Endotherapeutics has many years of experience across many specialties including gynaecology, laparoscopic surgery, treatment of female stress urinary incontinence, and pelvic health. www.endotherapeutics.com.au

Ferring Pharmaceuticals

GE Healthcare

BOOTH 43

BOOTH 09

Ferring Pharmaceuticals is a Swissbased research-oriented pharmaceutical company which specialises in products in the field of Urology/Oncology, Gastroenterology, Endocrinology and Reproductive Health. In the Reproductive Health portfolio, Ferring Pharmaceuticals has recently launched MENOPUR® (human menopausal gonadotrophin) for use in assisted reproductive technologies. In addition, DURATOCIN® (carbetocin) is available for the prevention of postpartum haemorrhage following elective caesarean section under epidural or spinal anaesthesia. Please visit the Ferring stand to learn more about their Reproductive Health portfolio of products.

GE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (NYSE: GE) works on things that matter – great people and technologies taking on tough challenges. From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients.

BOOTH 27

CONTACT

Clare Campbell

CONTACT

Eileen Butler

TEL

+61 4 1486 5684

TEL

+61 4 4706 4594

ADDRESS Ferring

Pharmaceuticals Pty Ltd Pymble NSW 2073

TEL

+61 2 9497 2300

Healthscope Advanced Pathology Healthscope Advanced Pathology develops, validates and provides the latest in molecular pathology services. Healthscope is the Australian partner of the Sequenom Center for Molecular Medicine who was the first to develop the non-invasive prenatal blood test MaterniT21 PLUS. In conjunction with GenesFX Health, Healthscope helped to develop DNAdose, a genetic test that can be used by clinicians to determine the right medicine and dose for their patients. Healthscope also offers a national Cystic Fibrosis Carrier Screening program.

EMAIL Clare.Campbell@ge.com

EMAIL eileen.butler@healthscope.com.au

www.gehealthcare.com.au

www.healthscopepathology.com.au

Global Medics

High Tech Laser Australia

BOOTH 16

BOOTH 11

Global Medics Australia has been operational since 2007 providing locum and permanent solutions across all states and territories. Our efforts have forged long standing relationships with both public and private health providers on a local and a state level basis. As a top tier provider of doctors our team of industry specialists are focused on individualised areas of medicine to create synergy with the common medical practitioner.

High Tech Laser is Australia’s largest supplier of European-made medical lasers and distributes lasers for surgery and Vulvo-Vaginal Laser Resurfacing. High Tech Laser , Australia has 14 years experience across a variety of medical laser industries and offers a nationwide customer support network.

EMAIL enquiries@ferring.com

www.ferring.com.au

FUJIFILM SonoSite BOOTH 58

FUJIFILM SonoSite, Inc., the world leader in bedside and point-of-care ultrasound, delivers solutions that meet the imaging needs of the medical community. SonoSite offers a family of products backed by their industry leading 5-year warranty. – Edge® ultrasound system’s enhanced image quality. – M-Turbo® is their most versatile system for abdominal, nerve, vascular, cardiac, venous access, pelvic and superficial imaging. – S Series™ mountable ultrasound systems, its simplified controls lets you focus on target areas in seconds. – NanoMaxx® uniquely simple control and high-quality diagnostic imaging. ADDRESS

Suite 9 13a Narabang Way Belrose NSW 2085

TEL

+61 2 9479 0400

CONTACT

Michael Fernandes

TEL

+61 2 8248 2918

CONTACT

Matt Moncrieff

TEL

1300 309 233

EMAIL info@hightechlaser.com.au

www.hightechlaser.com.au

EMAIL Michael.Fernandes@

globalmedics.com.au

www.globalmedics.com

EMAIL australasia@sonosite.com

www.sonosite.com

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

E x h i b i t o r D i rec t o r y Hologic

Insight Oceania

BOOTHS 45-46

BOOTH 57

Hologic, Inc.,a leading developer, manufacturer and supplier of premium imaging systems and surgical products dedicated to serving the healthcare needs of women. Hologic is focused on mammography and breast biopsy, radiation treatment for early-stage breast cancer, cervical cancer screening, mennorrhagia treatment, osteoporosis assessment, and preterm birth screening.

InSight is the exclusive distributor in Australia and New Zealand for Samsung Medison and Zonare’s industry leading range of diagnostic ultrasound systems. Insight is recognised as the leading Medical Imaging distribution company providing professional sales, service and clinical support staff located in all states of Australia and New Zealand. InSight is a wholly owned subsidiary of Quantum Energy Ltd [ASX:QTM]. Please visit our main website www.insight.com.au for further information on other market leading manufacturers we represent.

EMAIL Australia@hologic.com

www.hologic.com

EMAIL gclark@insight.com.au

TEL

1800 111 483 (IVF)

www.insight.com.au

EMAIL info@ivf.com.au

BOOTH 33

Paul Baltas

ADDRESS

101 Atherton Road Oakleigh VIC 3166 Australia

TEL

1800 888 983

FAX

+61 3 9569 5549

EMAIL info@innovative.com.au

www.innovative.com.au

Clarke

www.ivf.com.au

Investec Specialist Bank BOOTH 41

Investec is a leading specialist bank offering a full range of financial services to the medical profession. We are thrilled to support RANZCOG where we would invite you to learn more about our innovative products that include: – Equipment and fit-out finance – Goodwill funding – Commercial property finance (up to 100%) – Car finance – Home loans (up to 100%) – Credit cards – Transactional banking and overdrafts – Savings and deposits – SMSF lending and deposits – Foreign exchange – Comprehensive insurance services. For more information, please contact 1300 131 141 or go to www.investec.com.au/medical. CONTACT

Sandy Constanti

TEL

+61 410 647 660

EMAIL sandy.constanti@investec.com.au

www.investec.com.au/medical

IVFAustralia, leaders with infertility and advanced sciences presents the Natera Panorama Non-Invasive Prenatal Test – the only one that detects triploidy, works from 9-weeks’ gestation and demonstrates the greatest accuracy. The journey to parenthood does not always happen as quickly as many expect but our advances in assisted conception treatments delivered by leading fertility specialists can achieve success – a baby – making a real difference to people’s lives. 176 Pacific Highway Greenwich NSW 2065

CONTACT Greg

CONTACT

BOOTH 05

ADDRESS

Innovative Medical Technologies Lasers for Gynaecology Fotona’s versatile laser platforms offer a wide range of applications such as the treatment of condyloma and balanitis and removal of HPV lesions from the cervix, many other surgical and non-invasive aesthetic laser treatments can also be performed. Fotona recently developed a revolutionary non-invasive Erbium laser therapy for Incontinence and vaginal relaxation syndrome. The IntimaLase™ and IncontiLase™ procedures are virtually painless, without incisions, ablation, bleeding or sutures. Recovery is extremely quick without need for analgesics or antibiotics.

IVFAustralia: Natera Prenatal Test

In Vitro Technologies BOOTH 48

In Vitro Technologies’ Women’s and Children’s Health Division will proudly be launching our new Time to Delivery test, PartoSure, from Amnisure. This exciting new product will compliment our world leading Premature Rupture of Membranes test (ROM) also from Amnisure. We will also be displaying our Sonicaid/Huntleigh Doppler and CTG range. Our quality products are supported by experienced and knowledgeable staff, working closely with customers to ensure the smooth integration of systems and regular training to update and maintain the level of skills, for the operation of each product. CONTACT

Alex de Meyrick

TEL

+61 4 0206 9112

EMAIL alexandra.demeyrick@

invitro.com.au

Night

time b y the w aterfr

ont

JB Medical Supplies

Limbs & Things

Medical Industries Australia

BOOTH 44

BOOTH 42

BOOTH 56

JB Medical Supplies is an Australian Company providing specialised medical products for women’s health. We are the Australasian agents for the Kiwi Vacuum Delivery Systems, the ROM+plus point-of-care immunoassay test for PROM, the C-Snorkel device to assist the release of the impacted fetal head, the PeliSpec speculum with Smoke Extractor and the Koala intrauterine pressure catheter.

Medical Industries Australia is located in Lane Cove in New South Wales, in a modern and efficient distribution facility, the centre comprises approximately 3000m2 of warehouse facilities and offices. Medical Industries Australia provides both sterile and non-sterile products. The comprehensive range of product categories include: Medical and Surgical Consumables and Instruments; Falls Prevention, Incontinence Care, Respiratory Care, Diagnostic Test Kits, & Hospital Furniture. Medical Industries Australia also sponsor medical devices and complies with the Therapeutic Goods Administration requirements. Medical Industries Australia is certified to ISO 9001:2008.

CONTACT

Sophie Pill or Belinda Vacca

At Limbs & Things they are dedicated to improving patient care by supporting healthcare professionals in their training. Limbs and Things design manufacture and promote skills training products which allow clinical educators to successfully deliver their curriculum requirements for physical examination, procedural and clinical skills. Their products are designed with realism, durability and ease of use in mind to assist with the fundamental needs of clinical skills tutors, trainees and technicians alike.

ADDRESS

PO Box 255 Albion QLD 4010

ADDRESS

92 Wedgewood Road Hallam VIC 3803

TEL

+61 7 3862 2000

TEL

+61 3 9708 6511

FAX

+61 7 3862 2077

FAX

+61 3 9708 6566

EMAIL enquiries@

jbmedicalsupplies.com.au

EMAIL info@limbsandthings.com.au

www.jbmedicalsupplies.com.au

www.limbsandthings.com.au

Johnson & Johnson Medical

Medibroker

BOOTH 31

BOOTH 02

Ethicon is part of Johnson & Johnson Medical Pty Ltd (JJM), the leading provider of medical devices to the Australian and New Zealand health care systems. JJM has a longstanding commitment to the Gynaecological Community in women’s health, adhesion prevention, advanced energy, wound closure, sterilization and hand hygiene. Their Credo is at the heart of what they do every day and reminds them of their responsibilities to their patients; doctors and nurses; employees; they community and the environment and their shareholders. (E201307-119)

MediBroker provides specialist risk insurance advice to medical fraternity. With no institutional ownership, products are sourced and brokered from the wider market in pursuit of a harmonious balance between quality and value for money.

CONTACT

Kym Wirth

TEL

+61 4 3861 5339

EMAIL KWirth@its.jnj.com

CONTACT

Aaron Zelman

ADDRESS Level

9 440 Collins Street Melbourne VIC 3000

TEL

1300 1400 88

FAX

+61 3 4206 8794

EMAIL service@medibroker.com.au

www.medibroker.com.au

CONTACT

Briony Cook

TEL

+61 4 1382 1234

EMAIL briony.cook@medind.com.au

www.medind.com.au

MSD BOOTHS 53-54 & 61-62

MSD is a leader in Women’s Health and offers an innovative portfolio of products and solution that improve the wellbeing of women across their lives. MSD is committed to supporting patients by offering women multiple options in areas such as hormone therapy, contraception, and fertility with products such as IMPLANON NXT®, LIVIAL®, NUVARING® and ZOELY®. CONTACT

Merck Sharp & Dohme (Australia) Pty Limited

ADDRESS

Building A, Level 1 26 Talavera Road Macquarie Park NSW 2113

www.msd-australia.com.au

2 0 1 3 A n n u a l S c i e n t i f i c M ee t i n g

E x h i b i t o r D i rec t o r y MS Health

QRS International AG

RANZCOG CPD Online

BOOTH 47

BOOTH 08

BOOTH 15

MS Health is a not-for-profit pharmaceutical company established to deliver vital reproductive health products and medicines. We are proud to be part of Marie Stopes International, delivering a global mission of children by choice, not chance. We believe that all women have the right to determine if and when they have children and how many they have. We believe that women should have accessible and affordable sexual and reproductive health care no matter where they live in Australia or the world.

QRS-International, Germany (1990) has in the last 25 years been the technological leader in field of “Evidence Based Magnetic Applications”. QRS solutions have helped cure millions of elderly patients suffering from chronic pain. At the RANZCOG 2013 ASM, QRS exhibits the QRS-PelviCenter, a unique, proprietary and powerful solution which automatically improves the coordination and strength of the Pelvic Floor Muscles. The QRS-PelviCenter has revolutionised the existing ExMI technology and as a complementary therapy strongly increases the effectiveness of physiotherapy treatment of Urinary Incontinence and Erectile Dysfunction.

Your new CPD Program The RANZCOG is committed to ensuring its Continuing Professional Development (CPD) Program is relevant, valid and achievable for the variety of practice undertaken by the College Fellowship. The program is designed to facilitate three endeavours: training, continuing education and review to ensure a high standard in the delivery of health care to women and their families. The revised RANZCOG CPD Program, CPD Online, uses a two-dimensional framework that aligns the types of CPD activities that may be undertaken, including Professional Development (PD) and Practice Audit and Reflection (PAR), to the FRANZCOG Curriculum. This ensures that activities undertaken by RANZCOG Fellows are directly linked and relevant to contemporary clinical practice, and therefore, best suited to an individual’s professional needs.

Priority Life BOOTH 22

Priority Life is Australia’s No. 1 risk insurance advisory firm for medical specialists. Priority Life broker the wider market in search of the most beneficial insurance portfolio Available. Based in Melbourne, the firm’s advisers personally service and consult with medical clients across Australia. Income Protection is now available to $30,000 per month with special options available up to $60,000 per month. Consultations are free of charge and are obligation free. Testimonials available upon request. CONTACT

Bradley Gecelter

ADDRESS

28-30 Jackson Street Toorak VIC 3142

TEL

+61 3 8199 9000

FAX

+61 3 8199 9049

EMAIL admin@prioritylife.com.au

CONTACT

Mr E.F.A. Spiessens

TEL

+66 8 5246 2365

EMAIL emiel.spiessens

@qrs-international.com

www.qrs-international.com

CONTACT

Val Spark CPD Senior Coordinator

RANZCOG

TEL

+61 3 9412 2921

BOOTH 01 & 14

EMAIL vspark@ranzcog.edu.au

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) is the peak body responsible for the training and education of specialists and GP obstetricians in obstetrics and gynaecology in Australia and New Zealand. The RANZCOG is committed to the establishment and maintenance of the highest possible standards of practice in women’s health. The RANZCOG provides programs in training, accreditation and continuing professional development that are responsive to the evolving health care needs of women. The RANZCOG supports research and advocacy for women’s health by forging productive relationships with individuals, the community and professional organisations, both locally and internationally.

www.ranzcog.edu.au

CONTACT

Kylie Grose ASM Coordinator

CONTACT

Pauline Whittle

TEL

+61 3 9147 1699

TEL

+61 4 0453 2746

EMAIL kgrose@ranzcog.edu.au

www.ranzcog.edu.au 38

Rocket Medical BOOTH 35

Rocket Medical are award winning medical designers and manufacturers who continue to maintain an enviable reputation for innovation, quality and value. Representatives from their dedicated Australian sales support team presenting their market leading Fetal Blood Sampling kits and accessories along with their latest developments for long term, indwelling and short term ascites drainage. In addition to their newest products, their best-selling uterine aspiration catheters, fetal scalp electrodes and pudendal needles will also be available for viewing at stand No 35.

EMAIL Pauline@rocketmedical.com

www.rocketmedical.com

Sonologic Pty Ltd

Ultrasound Training Solutions

BOOTH 25 & 34

BOOTH 24

SONOLOGIC is a progressive company combining a synergy of three core values – integrity, reliability and, above all, customer care. SONOLOGIC is proud to be distributing exclusively for Australia and New Zealand an exciting range of portable colour Doppler systems from SonoScape. 2013-14 Brings an all NEW range of Examination Couches and Colposcopes adding to our extensive Ob & Gyn product line-up. Our team has over 40 years combined experience in the ultrasound industry. For your next Ultrasound, Colposcope or Examination Couch please don’t hesitate to contact us.

Using ultrasound but can’t get ‘the’ view? Want to discover new techniques? Struggling with your machine? Ultrasound Training Solutions can help. With courses designed and delivered by leading physicians Ultrasound Training Solutions provide skills that improve point of care outcomes. Ultrasound Training Solutions offer introductory to advanced level courses, covering first trimester, ectopic, dating, foetal biometry and well being Ultrasound Training Solutions can also work with you to develop a program that can be delivered at their place or yours.

CONTACT

Rob Ewens

TEL

+61 4 0712 7558

EMAIL rob@sonologic.com.au

CONTACT Oriana TEL

Tolo

+61 418 506 878

EMAIL oriana@ultrasoundtraining.com.au

www.ultrasoundtraining.com.au

www.sonologic.com.au

Wiley Blackwell

SRC Enterprises

BOOTH 21

BOOTH 18

SRC Enterprises designs and manufactures pregnancy, post-pregnancy and post-operative compression support garments. Patients discover pain relief during pregnancy, speed up their recovery after delivery. SRC Enterprises has developed proprietary fabrics and garments that provide sustained graduated compression, support and amazing comfort. Ongoing development has followed with successful registration on the Australian Register of Therapeutic Goods (ARTG – 188014). SRC products have been used by over 30,287 women and are recommended by O&G’s and Physiotherapists for relief of pain associated with pregnancy, post-pregnancy and post-operative procedures. www.recoveryshorts.com

Wiley Blackwell is a global provider of content-enabled solutions to improve outcomes in research, education and professional practice with online tools, journals, books, databases, reference works and laboratory protocols. With strengths in every major academic, scientific and professional field, and strong brands including Wiley Blackwell and Wiley VCH, Wiley Blackwell proudly partners with over 800 prestigious societies representing two million members. CONTACT Tom

Griffin

ADDRESS

155 Cremorne Street Richmond VIC 3121 Australia

TEL

+61 3 9274 3135

EMAIL tgriffin@wiley.com

www.wiley.com

Monday Abstracts BREAKFAST SESSIONS: FAST FOOD & FAST FACTS #1

0730 – 0810

Odibo A

0830 – 0900

Delivering the Rural Goods

Department of Obstetrics and Gynecology, Washington University, St. Louis, MO, United States of America

Current Diagnosis and Treatment of Ectopic Pregnancy

Geraghty T Dubbo Base Hospital, Dubbo, New South Wales

Many of the disadvantages associated with provincial practice have been overcome. The formation of Provincial Fellows, as a separate entity within RANZCOG, with representation on state and federal committees, has given rural Fellows a voice in decisions which affect practice. Provincial Fellows ASMs have fostered great collegiality within the Provincial Fellowship, as well as enhancing our relationship with GP obstetricians who support these meeting in good numbers. Such meetings have helped to reduced the sense of isolation often felt by Provincial Fellows. Such initiatives as ROALS have made it possible for Provincial Fellows and Diplomates to take holidays without leaving their towns without an obstetric service and without undue cost. CPD has been made easier with such RHCE projects as perinatal mortality audits, practice visits, laparoscopy audits as well as the teleconference series now presented as webinars. However, many challenges remain. The provincial workforce continues to age and without the recruitment of SIMGs would, in some locations, already have ceased to exist. The further recruitment of SIMGs cannot be assumed and support for these doctors by locally trained specialists, under whose oversight many need to practice, may not be possible for too much longer. The training of local specialists in provincial centres for provincial practice is a priority while the experienced workforce remains to train them. A training program for both core training and advanced training is being devised by a working party set up by College Council. There remains a significant difference in remuneration between provincial and metropolitan practice which can be addressed by increased Medicare and hospital payments. Despite such problems, most Provincial Fellows enjoy their practice because of its wider scope, it’s appreciation by the communities they serve and many are extending their professional careers to ensure the service, that many of these doctors established, survives beyond their retirement.

Minor Sonographic Markers for Aneuploidy

Ultrasound plays a significant role in aneuploidy screening. When major anomalies are detected, invasive testing for aneuploidy is usually recommended. With minor sonographic markers, a balance between the risks and benefits of invasive procedure has to be made. The talk will cover the screening efficiency of minor markers for aneuploidy and cover controversies regarding disclosing finding of such minor markers as echogenic intracardiac focus, choroid plexus cyst and mild renal pyelectasis. 0730 – 0810

Hormone Hotpot: How to Handle Menopausal Symptoms Baber R Sydney Medical School, The University of Sydney, Sydney, New South Wales

In December 2012, The International Menopause Society convened a meeting of peak medical groups with an interest in the menopause from around the world with a view to developing a Global Consensus Statement on the appropriate use of Menopausal Hormone Therapy (MHT), its risks and benefits. This statement has been published in the Journals Climacteric1 and Maturitas2. The statement affirms that the benefits of MHT include alleviation of menopausal symptoms and prevention of osteoporosis and related fractures, that therapy is best initiated within 10 years of the menopause and that MHT should be continued for as long as is appropriate to meet treatment goals. The statement also affirms that RCT and observational data agree that MHT using oestrogen only is associated with cardiovascular benefit in women within 10 years of their menopause and that a similar trend is seen for women using combines estrogen plus progestin therapy. The key points of the Global Consensus Statement will be presented with particular reference to updated cardiovascular data including data from The Kronos Early Estrogen for Prevention Study. References: 1 Climacteric 2013;16:203-4 2 Maturitas 2013;74:391-2

0730 – 0810

Scanpan – Gynaecological Ultrasound Essentials for Your Practice Ramsay P Abstract not available at time of printing.

FOOD FOR THOUGHT: EVIDENCE IN O&G

Mol BW for the European Surgery in Ectopic Pregnancy (ESEP) study group Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Until two decades ago, ectopic pregnancy (EP) used to be a large clinical problem as diagnostic methods were inaccurate. In the absence of reliable pregnancy tests and transvaginal sonography, clinicians had to rely on clinical signs and symptoms and culdocentesis, which inevitably lead to laparotomies in patients without an EP, while the diagnosis was made in patients with an EP only when serious complications had occurred. Nowadays, transvaginal sonography is the cornerstone of an early diagnosis, and either serum progesterone and/or serum hCG can be used to determine who needs immediate treatment and who can be managed expectantly. Basically, there are three diagnostic categories; viable intrauterine pregnancy, ectopic pregnancy and a pregnancy of unknown location. It is getting to emerge from randomised clinical trials in whom Methotrexate should be applied, but more data are needed before a definite position can be taken. Once a diagnosis of EP requires surgical intervention, it was until recently uncertain whether salpingotomy offers advantages over salpingectomy in women who want to preserve their reproductive capacity. Salpingotomy preserves the tube, but bears the risks of persistent trophoblast (PT) and repeat ipsilateral tubal EP. Salpingectomy avoids these risks, but leaves only one tube. Two randomised clinical trials from France and from the international ESEP consortium comparing these interventions have now addressed this dilemma. Cumulative three year pregnancy rates were just over 60% after 36 months for salpingotomy and salpingectomy, and the pooled RR obtained from the two studies showed no significant benefit (Fecundity Rate Ratio (FRR) 1.08 (95% CI 0.86 to 1.4)). The risk of repeat ectopic pregnancy was higher after salpingotomy, although not statistically significant (RR 1•2, 0•70 ¬– 2•4). In the Dutch centers participating in ESEP, these costs were €3,408 for salpingotomy and €2,714 for salpingectomy (mean difference €694). It can be concluded that in women with tubal ectopic pregnancy and a normal contra lateral tube, salpingotomy does not improve time to spontaneous ongoing pregnancy, but leads more often to persistent trophoblast, probably more repeat EP and higher costs.

0900 – 0920

0920 – 0940

Fertility – The Ultimate Study

Obstetrics – The Ultimate Study

Johnson N

Teale G

1 University of Auckland and Repromed Auckland, Auckland, New Zealand 2 University of Adelaide, Adelaide, South Australia

Women’s and Children’s Services, Western Health, Victoria

1,2

Has fertility practice really graduated from cookery to science?1 What are the pivotal studies in fertility that have changed practice at a global level? Besides case reports that have delineated undeniably the most dramatic advances in this field, including success of in vitro fertilisation (IVF)2 and intracytoplasmic sperm injection (ICSI),3 there have been many landmark studies, the largest of which have generally been funded by the pharmaceutical industry and thus have been affected by the difficulties associated with industry funding. Some of the biggest advances have been made through the metaanalysis of fertility trials that, of themselves, have not solved clinical management dilemmas, but systematic review of randomised trials from different settings in Cochrane subfertility reviews has provided evidence that has changed practice the world over – in managing hydrosalpinges, comparison of stimulation protocols for IVF to gold standard protocols including antagonist versus agonist protocols, culturing embryos to blastocyst, single embryo transfer, interventions preventing ovarian hyperstimulation syndrome (OHSS) and other key interventions. Synthesis of RCT evidence has allowed a distinction between so-called ‘adjunct treatments’ in IVF that carry evidence of benefit and those that remain unproven, allowing us to move away from ‘cookery based’ practice. Future advances in fertility and other fields depend on large multi-centre randomised trials in order to generate sufficient power to detect important differences. The reproductive medicine trials network in Australia and New Zealand is REACT-ANZ (Reproduction And Clinical Trials in Australia and New Zealand). Our aim is to define a safe simple low-invasive low-cost intervention that improves the chance of a live born baby – preferably a live born healthy singleton at term – whilst minimising important complications such as multiple pregnancy and severe OHSS. References: 1 Vandekerckhove P, O’Donovan PA, Lilford RJ, Harada TW. Infertility treatment: from cookery to science. The epidemiology of randomised controlled trials. Brit J Obstet Gynaecol 1993;100:1005-36. 2 Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet 1978;2(8085):366. 3 Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 1992;340(8810):17-8.

In the late 1970s Archie Cochrane awarded the ‘wooden spoon’ to the discipline of obstetrics in criticising the paucity of high level studies, in particular randomised controlled trials, that were available to guide pregnancy care. Since then a plethora of studies and their ever more inventive acronyms have transformed the evidence basis of obstetrics: MAGPIE, ACHOIS, HAPO, CLASP, ACTORDS, PROGRESS, COMET, COSMOS, TermPROM, TermBreech, DIGITAT, HYPITAT, GRIT, ORACLE …. to name a few of the practice changing studies of the past two decades. Unfortunately, despite the recognised improvements in the evidence base supporting pregnancy care, fundamental questions remain. Frustratingly, the obstetric pendulum, whereby advice now is replaced by the opposite advice a few years later, continues to swing: Advice 10 years ago to stop weighing women has been reversed; advice that immediate cord clamping is beneficial is being challenged. The next ‘swing’ might be a move away from believing that induction increases caesarean section rates… even in women with no medical indication! Once the bête noir of some sectors of the profession, evidence is accumulating that induction may, after all, be good and not evil. Is it possible that all of the effort at reducing apparently unnecessary induction may have inadvertently increased caesarean section rates? More significantly, routine induction at term appears to be associated with an overall reduction in perinatal mortality. Time for the ultimate study....RECRIATE... REducing Caesarean Rates by Induction at TErm 0940 – 1000

Gynaecological Oncology – The Ultimate Study Obermair A1,2 1 Queensland Centre for Gynaecological Cancer, Brisbane, Queensland 2 SurgicalPerformance.com, Brisbane, Queensland

Evidence is the information that is available to indicate whether a belief is true or false. It will inform clinical decision-making and hence impact on processes and clinical outcomes. Generation of evidence develops in phases. In Phase 1 trials, an experimental treatment is tested in a small group of participants to evaluate its safety and identify side effects. Phase 2 trials focus on effectiveness and screen side effects and if successful lead into phase 3 trials. Phase 3 trials are designed confirm the treatment’s effectiveness and compare it to current standard treatment. Phase 4 (postmarketing) trials focus on risks, benefits, and optimal use.

In gynaecological oncology surgery is one of the cornerstones of successful patient treatment. While the evidence for the use of chemotherapy is established, the evidence for surgery is weak. Barriers of developing evidence and barriers of adopting evidence into clinical practice are in place and effective. The presentation will demonstrate some of the barriers and will suggest ways to negotiate them. 1000 – 1030

Is Evidence-based Surgery an Oxymoron? Munro M Departments of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA; Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States of America

The effect of a pharmaceutical agent on a disease process can be evaluated by performance of a randomised controlled trial, comparing the subject drug with either an established intervention, or placebo. While there are always challenges, investigators can generally create an environment where there is a reasonable chance that the drug is delivered to the patient in the prescribed dose and at the appropriate time. As a result, if other elements of trial design are sound, there can be reasonable confidence that the results of the clinical trial are not only accurate, but reproducible and potentially generalisable – the patient in Alice Springs should have the same impact as the one in Melbourne. So is the situation with surgical devices or procedures similar or different? Is it possible, or even ethical, to include a “placebo” equivalent in a surgical randomised trial? Can the investigator be confident that the operation will be consistently performed from patient to patient by a spectrum of surgeons with a variety of experience and skill? How can the nature of the procedure – the route of hysterectomy, for example – be concealed from the patient? Or from the research staff? If any or most of these questions are addressed in the design of a surgical RCT, are the results generalisable? Can the gynaecologist in Adelaide be as confident about the impact of a sacral colpopexy on vault prolapse as she is about the impact of an LNG-IUS on a patient with AUB-E? This presentation will explore these issues, explore some “food for thought” for investigators, and, for the “consumers” of evidence, provide some guidance about interpreting and implementing the results of surgical clinical trials in the context of clinical medicine.

Monday Abstracts MAKE SURE IT’S COOKED! PREMATURITY IN O&G 1100 – 1115

The Aetiology of Preterm Labour Smith R Mothers and Babies Research Centre, HMRI, University of Newcastle, New South Wales

Preterm labour arises from many causes but all ultimately operate on the normal physiological pathways that regulate human birth. Humans are mammals, one of the groups of vertebrates that comprise the amniotes. Amniotes evolved the ability to lay eggs on dry land. The amniote egg is surrounded with a semipermeable membrane that allows gas exchange without drying out. The egg covering is added after fertilisation in a specialised area of the female reproductive tract. To allow the addition of the egg covering, or shell, the transit of the egg down the reproductive tract must be arrested. Progesterone and cAMP regulated pathways arrest transit of the zygote down the reproductive tract of amniotes including mammals. Laying of the egg, or, in mammals, labour and birth of the baby require the brake on reproductive tract contractions produced by progesterone and cAMP pathways to be turned off. The contractions of the reproductive tract require the smooth muscle of the reproductive tract wall to function in a controlled manner. For smooth muscle contractions to occur several critical functions must be present: the protein actin must transform from a globular to a fibrillar form, myosin must be phosphorylated by myosin kinase to allow ATP dependent movement across the fibrillar actin fibres to increase tension, the cells must depolarise to allow entry of calcium ions to activate the myosin kinase, and the cells must be linked together to allow synchronous contraction to increase intraluminal pressure. These multiple physiological events are regulated by a hormonal system including hCG, progesterone, estrogens and corticotrophin releasing hormone. Preterm labour occurs when the brake on uterine activity is prematurely released, this may occur via multiple avenues but all involve activation of the myometrial cells to promote uterine contractility. This provides multiple opportunities for interrupting the preterm labour therapeutically. 1115 – 1130

Recognising and Treating Infection to Reduce the Risk of Preterm Labour Morris J1 1 Royal North Shore Hospital, Sydney, New South Wales

Preterm birth remains the leading cause of perinatal mortality and globally is the leading contributing cause to early infant death. The association of infection with preterm death is well established with

clinical, histological and microbiological confirmation more likely the more remote from term that birth ensues. Ascending infection from the non sterile lower genital tract is the most common route by which pathogens enter the choriodecidua. Many interventions to reduce preterm birth by the prophylactic treatment of genital infection have proven to be of limited clinical efficacy. This presentation will review the microbiological findings in preterm birth and examine the evidence for and against interventions to prevent infection related prematurity. Finally, current studies that will reveal possible new strategies for the prevention of preterm birth and neonatal sepsis will be profiled. 1130 – 1145

Cervical Length and Predicting Risk of Premature Delivery Hyett J RPA Women and Babies, Sydney, New South Wales

Preterm birth is still a significant problem affecting >10% of pregnancies, including 2% that deliver <34 weeks’ gestation, with significant rates of morbidity and mortality. Accurate prediction of spontaneous preterm delivery would potentially allow therapeutic intervention to reduce the risk of the onset of early labour and / or to improve neonatal wellbeing as well as to facilitate timely transfer to access tertiary neonatal facilities. Ultrasound assessment of cervical length can be used as a predictive tool for preterm delivery. Data suggest that this is of value in three situations; for serial surveillance in ‘high risk’ pregnancies, to appraise risk in women attending with symptoms and signs of preterm labour and as a screening tool in low risk populations attending for their routine 20week anomaly scan. Cervical surveillance enables some women to avoid interventions like cerclage, and provides reassurance to those with a previous history of preterm delivery. Formal appraisal of cervical length has a high negative predictive value for preterm delivery and can therefore be used to minimise admission and / or transfer of women presenting with symptoms of preterm birth and to optimise timing of steroid therapies that optimise neonatal outcome. Routine surveillance in asymptomatic women can define a high risk group that will benefit from closer ongoing surveillance and therapeutic interventions designed to prevent preterm delivery. Despite the apparent success of cervical screening in predicting preterm birth, many unanswered questions about management of ‘high-risk’ patients remain. Programs designed to predict preterm labour should include cervical assessment but need to be audited to confirm the validity of screening and efficacy of therapeutic intervention.

1145 – 1200

Progesterone and the Prevention of Preterm Delivery Groom KM University of Auckland and National Women’s Health, Auckland District Health Board, Auckland, New Zealand

Progesterone is a ‘pro-pregnancy’ hormone with a suppressive action on labour associated proteins and cytokines. Animal studies support the theory that progesterone withdrawal initiates labour. In humans this theory is more complex, however, a functional withdrawal of progesterone is likely to be fundamental to the onset of labour both at term and preterm. There are now a large and diverse number of randomised placebo controlled trials investigating the role of progesterone for the prevention of preterm birth. These include studies in low, general and high risk populations; in women with multiple pregnancies, short cervices or who are positive for cervicovaginal fetal fibronectin; they use a variety of drug preparations, delivery systems, doses and gestational age ranges of treatment. The 2013 Cochrane meta-analysis reports a significant reduction in preterm birth delivery rates and short term neonatal outcomes with progesterone use. However, the most recent Australasian study in women with a prior history of preterm birth demonstrated no effect on with preterm birth rates or the incidence of neonatal respiratory distress syndrome. Long-term infant outcomes (two year cognitive and neurosensory) have been investigated in the UK led OPPTIMUM study, the results are awaited. At present there are diverse attitudes towards the use of progesterone for the prevention of preterm birth across the world. 1200 – 1215

MgSO4 for Neuroprotection Crowther CA1,2 1 Liggins Institute, The University of Auckland, New Zealand 2 ARCH: Australian Research Centre for Health of Women and Babies, The Robinson Institute, University of Adelaide, South Australia

Survival rates for infants born very preterm have improved although the risk of neurological impairments has not. Basic science research shows that magnesium sulphate before birth may be neuroprotective for the preterm fetus. The Cochrane review on ‘Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus’ (Doyle et al 2009) included five trials that enrolled 6,145 babies. Antenatal magnesium sulphate therapy given to women at risk of preterm birth substantially reduced the risk of cerebral palsy in their child. Several professional bodies have now released consensus statement or guidelines on the use of antenatal

magnesium sulphate. High quality evidence-based clinical practice guidelines for Australia and New Zealand on the use of antenatal magnesium sulphate for neuroprotection have been released. They contain seven recommendations and six good practice points that provide practical guidance for clinicians. The key recommendation is ‘in women at risk of early preterm (where gestational age is less than 30 weeks), imminent birth (where early preterm birth is planned or definitely expected within 24 hours), use magnesium sulphate for neuroprotection of the fetus, infant and child’. The WISH study, funded by the Australian CP Alliance, is providing support for tertiary hospitals within Australia and New Zealand to implement and audit the clinical practice guidelines. An individual participant data meta-analysis is in progress through the AMICABLE Collaboration. Whether magnesium sulphate given at later gestations (30 to <34 weeks’ gestation) is similarly beneficial is being assessed in the MAGENTA Trial. Antenatal magnesium sulphate prior to very preterm birth is one of the very few interventions shown to improve perinatal survival and to prevent cerebral palsy. Implementation and audit of the use of antenatal magnesium sulphate will contribute to lessening some of the devastating consequences of very preterm birth.

HOW DO YOU WANT YOUR EGGS? THE OVARY IN O&G 1100 – 1115

Saving the Torted Ovary – Why bother? Evidenced-based Conservative Management Lyons SD Mater Clinic, Sydney, New South Wales University of Sydney, Sydney, New South Wales University of New South Wales, Sydney, New South Wales

Ovarian torsion is the fifth most common gynaecological emergency. It remains a diagnostic challenge and timely management is necessary to prevent necrosis and loss of the ovary, especially important in the premenopausal woman. Historically, torsion has been managed by salpingo-oophorectomy, whether by an open or closed surgical route, irrespective of the time since the onset of symptoms. However, the recent medical literature supports a less radical approach to torsion with preservation of the torted ovary the goal. Torsion is generally associated with an adnexal mass and results in continued arterial supply to the ovary that usually persists long after interruption of the lower-pressure venous drainage. Consequently, a large, blue/black ovary engorged with blood results within hours. This appearance is often presumed to represent necrosis of the ovary and many a viable ovary has been sacrificed on this basis. However, evidence from animal and

human studies indicate that the ovary is probably viable for at least 24 hours, and up to 36 hours, after torsion onset. Torted ovarian masses may also be removed at the time of surgical management due to concerns that malignancy may otherwise be retained. In fact, studies indicate that the risk of torsion of a malignant adnexal mass is lower than for benign adnexal torsion; furthermore, the incidence of malignant torsion in premenopausal women is rare. Conservative management of ovarian torsion in the premenopausal woman should be the default management in Australia. Evidence will be presented that indicates that the torted ovary is much more likely to be conserved in hospitals with a dedicated gynaecology emergency on-call roster, separate to the obstetric on-call service. 1115 – 1130

PCOS: Australian Alliance Evidence-based Guidelines Costello MF1,2,3 1 University of New South Wales, Sydney, New South Wales 2 Royal Hospital for Women, Sydney, New South Wales 3 IVF Australia, Sydney, New South Wales

Polycystic ovary syndrome (PCOS) is a common endocrine condition affecting 5% to 18% of women of reproductive age. The diagnostic features include oligo-anovulation or anovulation, clinical or biochemical hyperandrogenism, and presence of polycystic ovaries on ultrasound. Polycystic ovary syndrome has serious clinical sequelae including reproductive manifestations (oligo/ amenorrhea, infertility, hirsutism/acne, and pregnancy complications), metabolic complications (insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, and risk factors for cardiovascular disease), and psychological problems (poor self-esteem, anxiety). Guidelines are different to Cochrane Reviews as they reflect evidence based practice which is integration of best research evidence, with clinical expertise and patient values. Guidelines aim to provide pragmatic guidance, even in the absence of evidence, by drawing on clinical expertise and consumer preferences. However, the ultimate decision about clinical management of an individual patient will always depend on the clinical circumstances, clinical judgment of the health care team and the preferences of the patient. The PCOS evidence based guidelines1 were developed over two years by the PCOS Australian Alliance in collaboration with the Jean Hailes Foundation for Women’s Health, with support from the Australian Government Department of Health & Ageing. The project was supported by the consumer advocacy group Polycystic Ovary Syndrome Association of Australia (POSAA). This world’s first evidence-based guideline for PCOS was approved by the National Health and Medical Research Council

(NHMRC) and launched at the Endocrine Society of Australia Conference in Perth on 29 August 2011. The guidelines provide 38 recommendations addressing four key areas: Diagnosis and Assessment, Emotional Wellbeing, Lifestyle and Therapy for Infertility. 1 PCOS Australian Alliance. Evidence-based guideline for the assessment and management of polycystic ovary syndrome, 2011. Available from URL: www. managingpcos.org.au/pcos-evidencebased-guidelines.

1130 – 1145

Endometrioma: Ablate, Strip or Do Nothing to Maximise Fertility? Rombauts L1,2 1 Monash Health, Melbourne, Victoria 2 Monash IVF, Melbourne, Victoria

The treatment of ovarian endometriomas in the context of infertility remains a difficult and hotly debated topic. It has been customary to treat endometriomas surgically to improve a patient’s fertility, but that dogmatic approach is now being questioned, in particular since the arrival of IVF. There are indeed growing concerns that surgery may be causing more harm than good. The two questions at the center of the debate are whether surgery still has a place and, if so, which procedure gives the best results. 1145 – 1200

‘What’s the Best Way to Freeze Your Eggs?’ Ledger W University of New South Wales, Sydney, New South Wales

Egg freezing has long been one of the major research goals in human fertility. Women run out of fertility at a much younger age than men and this has created increasingly common problem as couples defer attempts to conceive until later in life. If we were able to freeze eggs easily and reliably, then women would be able to “store” their fertility and reproduce happily in their 40’s and 50’s. For many years, embryologists believed that the best way to freeze eggs was by a process of slow freezing, using complex technology to progressively reduce the ambient temperature to that of liquid nitrogen; however results were generally disappointing with survival rates after freezing of less than 60% in most studies. The intervention of the Roman Catholic Church in Italy into the field of reproductive medicine meant that, for several years, embryo freezing was disallowed in Italy. This gave new importance to scientific development in freezing technology resulting in a move to vitrification, ultra rapid freezing, which has produced much better results in terms of egg survival and subsequent fertilisation. These results appear to be translating into improved pregnancy rates, provided that the woman is relatively young at the time of freezing her eggs. However at present, the process of collecting and freezing eggs remains complex, highly medicalised and expensive and further developments 43

Monday Abstracts are necessary before the practice becomes widely adopted. The best advice to those who believe that having a family will be an important part of their lives is to complete childbearing before the woman is in her late 30s and the man is in his late 40’s. 1200 – 1215

It Takes More Than Eggs to Make an Omelette: News for the Male Hart R1,2 1 School of Women’s and Infants’ Health, University of Western Australia, Western Australia 2 Fertility Specialists of Western Australia, Western Australia

Unfortunately, too often potential male causes of subfertility are overlooked with our enthusiasm to commence fertility treatment for a couple. Sometimes merely addressing some lifestyle factors is all that is required to enable spontaneous conception, however, in many instances there are more significant factors involved that may limit conception. A brief overview of the potential male causes of subfertility and their treatment will be discussed.

GETTING THE MIX RIGHT: WORKFORCE, RECRUITMENT & ASSESSMENT IN O&G 1330 – 1345

Workplace Based Assessment (WBA) and Other TLAs Symonds I1 , Nair B2, Hensley M2, Parvathy M2, Lloyd D2, Murphy B2, Ingham K2, Wein J2 1 University of Newcastle, New South Wales 2 Centre for professional development, Hunter New England Local Health District

Traditional methods of assessment in medical training rely on formal written and oral examinations and supervisor reports. Whilst these provide an indication that the trainee has the knowledge base required for professional practice,they do not measure the trainees actual performance in real clinical settings. Workplace based assessment (WBA) encompasses a suite of instruments that provide a structured assessment of a trainees performance over time that are both formative and summative. Although there is no single approach to WBA most programs include some form of multi-source feedback, case review and structured direct observation of procedural and communication skills. The key principle of all WBA is to make a judgment on how trainees perform in practice using multiple points of observation over time from multiple assessors with specific timely feedback that allows remediation. The AMC has recently developed an alternative pathway for international medical graduates to the oral examination

using WBA. More than 120 candidates have completed the six month program in Newcastle. More than 4,000 individual assessments have been performed with a combined estimated generalisability coefficient of 0.81. The format was associated with a high degree of face validity for candidates but was also notable for the effect that the process itself had on their performance over the period of the program. We discuss the proposed developments and potential application of WBA in obstetrics and gynaecology 1345 – 1400

Getting the Right Ingredients – Selection for Training Tout S Middlemore Hospital, Auckland, New Zealand

For many, trainee selection begins at medical school when students are first introduced to Obstetrics and Gynaecology (O&G). Their personal experience and interaction with patients and the multidisciplinary team in these early clinical years appears to greatly influence career choices when qualified. It is therefore paramount that we are good mentors clinically, academically and professionally. O&G is a unique speciality and requires a range of qualities essential for training and specialist practice which, by no means, appeals to everyone. The RANZCOG trainee selection process recently became a bi-national based process to help ensure that there is equity across Australia and New Zealand and continues to be reviewed, and evolve, to indeed “get the right ingredients”. Both internationally, and locally by other colleges, there is interest in evaluating different skill sets and moving away from the more traditional process of a fearsome interview panel. Qualities such as decision making and communication skills are vital for O&G and so looking at what makes a good specialist currently is essential to assist us in this process. Having said that, the profession appears to have in general succeeded in this quest, as reflected by the present audience, but refinements are appropriate. The RANZCOG Training Program itself has also developed over time to ensure that those poorly suited to O&G can appreciate this early and select a more appropriate career path. Selection also continues during training and early specialist years, with some sub-specialising and many developing special interests; a process that continues throughout our working lives. O&G is evolving too and who knows what an O&G specialist job will look like in 10 years time? Already this depends on where in the world you practice and, over time, will be influenced by medical advances, budgetary restrictions and the changing needs of women.

1400 – 1415

Is There a Future in Academic Training in O&G? Permezel M Mercy Hospital for Women, University of Melbourne, Melbourne, Victoria President, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

There can be no doubt with respect to the difficulty filling Senior Academic positions in Obstetrics and Gynaecology (O&G). Across academic departments of O&G in Australia and New Zealand, close to half of those Obstetricians and Gynaecologists at Level E (Professor) or above were not trained in Australia or New Zealand. Advertised positions are repeatedly not filled. A recent survey of workforce intentions amongst trainees found that 73% of trainees perceived a career in academic O&G as unlikely, 19% possible, and 9% likely. These figures should be reassuring given that the workforce demand for fulltime academic O&G can be no more than 5% of the O&G workforce. Amongst those who gave a reason that discourages them from pursuing an academic career, 36% cited administrative tasks, 31% financial remuneration, 28% research and only one person identified a dislike of teaching. What can the College do to overcome the academic workforce shortage? The first and most important initiative is the establishment of a Universities and College Liaison Committee – whose first meeting will be held at the 2013 ASM in Sydney. This is the first time the College has convened this committee and we have hope that this will be a continuing forum for discussion around common areas of interest linked including the FRANZCOG Research Project, the RANZCOG Research Foundation and the College publications – O&G Magazine and ANZJOG. A second strategy for increasing the academic workforce centres around selection of trainees. An important area of research is defining attributes at selection that increase the likelihood of a future specialist following specific career paths within O&G. Finally, the College has established a specific Academic stream to facilitate the integration of a PhD with the training program. A future academic path is a legitimate area of special expertise and will be appropriately recognised as such.

1415 – 1430

Like A Good Vintage Cheese, Old Obstetricians are the Best Chapman M Head of School, Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales

As we head towards the end of our professional careers, older obstetricians are often regarded as passed our “used by date”. The young turks see us blocking progress, conservative and reactionary with the standard catch phrase of “it is not what it was like the good old days” uttered from our dribbling mouths. This presentation from a vintage of some repute, hopefully, presents a rationale for keeping the “old” cheese on, at least while the experience they bring is worthwhile and the enjoyment remains. Age does have value. However, when the taste sours, it is vital to move on and accept that no matter how good the name and all the joys they have given, all vintages have their ”day”. The skill is to accept that moment gracefully! 1430 – 1445

The RCOG Workforce Experience Arulkumaran S St George’s University of London, United Kingdom

Tomorrow’s workforce in terms of quantity and quality will influence specialist recruitment. This will be based on the needs of the specialty. The education and training to achieve this would have work place based assessments, quality assurance of the training, CPD and revalidation. Tomorrow’s specialists will work in multi-professional teams delivering high quality women’s health care. The proposal is innovative and spells out rewarding ways of how tomorrow’s specialists will work, that embraces training, lifelong learning and professional challenge. The issues that need to be tackled are; changing health service, care closer to home, non-NHS providers, productivity and efficiency, changing demographics of the population and medical profession, fiscal environment, patient/public expectations i.e. the drive for quality and revalidation for doctors. The Royal College of Obstetricians and Gynaecologists’ (RCOG) recommendations are – Womancentred care; Professional support and workforce development; Quality of service; Education and training and Lifelong learning. They would be flexible and adaptable specialists, who are women focused and take women’s views into account. The specialists will deliver more/ majority of service and they will work in teams providing the medical component of multi professional clinical teams. The training is a run through training for seven years. Annually, approximately 235 ST1 posts are on offer across the United Kingdom. On an average there are 600 applications for these posts, most

of which will receive an interview. The present Workforce based on the census of May 2008 (England and Wales) the total number of consultant posts is 1,777; total number of SpR (training) posts are 1,173 and total SAS (non-training) doctor’s posts are 593. Proposed number of consultants required 3,000 – 3,300. Excluding the retirements of 330, the total new posts required are 1,800. Based on the current expansion this will be in 2025 provided the fiscal state allows such expansion.

Then an evidence-based decision can be made regarding screening for congenital CMV, followed by provision of analogous evidence for or against screening for TG and PVB19. Such evidence is needed now, to assess how best to reduce the ongoing, significant burden of disease from congenital CMV, TG and PVB19.

THERE ARE WEEVILS IN THE FLOUR! INFECTIONS IN O&G

Mol BW

1330 – 1345

Antenatal Screening for Cytomegalovirus, Toxoplasmosis, and Parvovirus in Pregnancy Rawlinson WD Virology Division SEALS Microbiology, Prince of Wales Hospital, Randwick, New South Wales; School of Biotechnology and Biomolecular Science and School of Medical Sciences, University of New South Wales, Sydney, New South Wales

Congenital cytomegalovirus (CMV) infection causes prematurity, hearing loss, and neurodevelopmental abnormalities in 0.7% (350 annually) of Australian infants. Congenital CMV is the second most frequent cause of serious congenital disability in liveborn Australian infants. Infection with Toxoplasmosis gondii (TG) or Parvovirus (PVB19) during early pregnancy can result in similar disability (TG) or hydrops fetalis (PVB19), although in fewer infants. Many infants with congenital CMV have non-specific symptoms, with most infected infants undiagnosed in Australia (McMullan 2011 MJA 194:625). Screening is presumptive identification of unrecognised disease by tests applied rapidly to identify pre disease, early disease, and risk markers (WHO). Different strategies for preventing congenital CMV (TG and PVB19) have been proposed, although few have been trialled in a systematic manner, and none properly assessed in Australia. Potential protocols include screening all adolescents, pregnant women before pregnancy, during first trimester, women at higher risk of primary infection, all infants, or infants at higher risk (preterm, disability, hearing loss). A subset of these could be assessed – particularly seroscreening at first antenatal visit, and screening all infants. Our modelling neonatal screening demonstrates net cost-benefit, although models of antenatal screening do not show clear benefit. Congenital CMV screening would potentially simplify diagnosis, use established assays, identify at-risk women for prevention strategies, fulfil some criteria for appropriate screening, cost less than current therapy for affected infants, and reduce the number of affected infants. These potential benefits need assessment, to prove or disprove whether screening for congenital CMV is cost-effective, with inclusion of the cost of pre and post-test counselling.

1345 – 1400

Mode of Delivery in Women Infected with Herpes Simplex Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Neonatal herpes infections is a very serious condition with up to 50% mortality for disseminated herpes simplex virus (HSV) infections in the newborn. Neonatal HSV is most commonly transmitted at the time of delivery, and the risk is higher if the mother has a first-episode of genital HSV and does not have an elective Cesarean section. Maternal HSV type-specific serology can be used to differentiate first-episode from recurrent infection in this setting, allowing for triage of mode of delivery and use of empiric acyclovir for the highest risk infants. In cases of absent lesions, there is no evidence that a Caesarean section improves outcome over vaginal delivery. Obviously, when there are other indications for Caesarean delivery, including for example twin pregnancy or breech presentation, or when the secondary Caesarean section rate is high anyway, the threshold for planning elective Caesarean section decreases. After transmission has occurred, early recognition of neonatal HSV improves the prognosis. Diagnosis needs to be considered in all infants who develop vesicles, unexplained seizures, or possible sepsis in the first five weeks of life. This presentation will discuss management of antenatal and peripartum herpes infections, considerations for mode of delivery, and the course of neonatal HSV infections. References: Robinson JL, Vaudry WL, Forgie SE, Lee BE. Prevention, recognition and management of neonatal HSV infections. Expert Rev Anti Infect Ther. 2012;10:675-85. Westhoff GL, Little SE, Caughey AB. Herpes simplex virus and pregnancy: a review of the management of antenatal and peripartum herpes infections. Obstet Gynecol Surv. 2011;66:629-38.

Monday Abstracts 1400 – 1415

Food Safety in Pregnancy: Listeria and Friends Merritt T Hunter New England Population Health, Newcastle, New South Wales

Recent large outbreaks in Australia and overseas have reinforced the potential for Listeria to cause serious illness and death for people at risk of infection, including pregnant women. Lessons from these outbreaks will be reviewed along with an update on clinical features, significant risk factors for illness and identification of the most vulnerable ante-natal patients. Key messages and resources to support risk reduction will be discussed. 1415 – 1430

Sepsis and Maternal Morbidity & Mortality Lahra M WHO Collaborating Centre for STD, Sydney, The Department of Microbiology, South Eastern Area Laboratory Services, The Prince of Wales Hospital Randwick, New South Wales

Sepsis in pregnancy and the peripartum period is an infrequent, but important, complication resulting in significant maternal morbidity and mortality globally. Lancefield Group A streptococci (GAS) is the leading cause of severe, life threatening maternal sepsis. In recent decades maternal GAS sepsis has reemerged in developed countries. Early diagnosis and treatment is critical, but diagnosis can be difficult or delayed because this infection is uncommon and early symptoms are nonspecific. This talk will provide an overview of maternal GAS sepsis and related morbidity and mortality; and pathogenesis, virulence factors, clinical presentation, diagnosis and management will be discussed. GAS is an important and formidable pathogen and early recognition, diagnosis and management is essential to reduce morbidity and mortality. 1430 – 1445

Chlamydia & HPV – Current Status Donovan B1,2 1 The Kirby Institute, University of New South Wales, Sydney, New South Wales 2 Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales

As in all high-income countries, Australia has witnessed a relentless increase in notifications of genital chlamydial infections over the past 20 years: up to 80,800 in 2011. Most of this increase is attributable to increased testing in primary care services. However, sentinel site data indicate that there has been an underlying increase in the population prevalence of chlamydia, particularly in women aged 15-24 years. Reassuringly, there has not been an increase (and in some cases there has been a decrease) in chlamydia-related

diseases such as pelvic inflammatory disease (in general practice and in hospital), ectopic pregnancy, epididymitis, and female-factor infertility. Current RACGP guidelines recommend annual testing of all sexually active men and women up to the age of 29 years, though, unlike other countries, Australia has not launched a national chlamydia screening program. A large randomised community cluster randomised trial (ACCEPt) is underway to determine if enhanced screening in primary care can reduce the prevalence of chlamydia. Australia leads the world in its quadrivalent HPV vaccination coverage of girls (>80%) and young women (>60%) since 2007. As a result we have been the first country to document dramatic declines in: • infection with the vaccine target viruses (HPV 6/11/16/18); • genital warts (HPV 6/11, down 93%); and • high-grade cervical lesions (HPV 16/18) in young women. Through herd immunity, young heterosexual men were shown to be substantially protected against genital warts, with a suggestion that unvaccinated women may also be getting some protection. However, gay men were gaining no protection from the female only vaccination program and they are disproportionately affected by HPV-related disease. At least 25% of HPV-related cancers in Australia affect men, and the incidence of anal and oropharyngeal cancers in men is increasing. In another world-first, the Commonwealth Government launched a HPV vaccination program for schoolboys in 2013.

PIECES OF THE PIE: GLOBAL WOMEN’S HEALTH IN O&G 1530 – 1550

‘Medical Tourism’ and ‘Making a Difference’ are Not the Same Things Rane A James Cook University, Townsville, Queensland

Traditionally Gynaecological surgery was taught by apprenticeship of ‘practising on the Poms’. This obviously was decades ago. For various reasons gynaecological surgical experience is getting less and less for our trainees. What may be the solution? Travel to the United Kingdom is no longer feasible. Can we maybe look at low resource countries? This lecture describes a personal experience of working in low resource settings and my views on offering surgical solutions to women from low resource settings. The final conclusions have to be that we cannot ‘practice’ on women unless we understand their culture, lifestyle, challenges of being a woman and offering them solutions which include follow up and care.

1550 – 1610

‘Medical Tourism’ is Not a Holiday Hodgson R Director, Australians for Women’s Health

Growing interest in global health issues and the desire to remedy the inequities has led to an increase in short-term international medical trips. If this volunteer work does not follow best practice principles such trips can be wasteful, unethical, and harmful. In order to avoid the pitfalls of short-term medical and surgical camps, the following principles must be observed: • Partnerships should be forged with local government or non-government organisations to determine the nature and extent of services required. Local organisations with understanding of the community’s infrastructure can facilitate the integration of medical and public health projects. • Prior to any trip, volunteers must be educated regarding the significant aspects of the community’s culture, medical and economic problems and the ethical aspects of aid in the developing world. • Rather than promoting patients to be dependent upon outside medical care, it is important to support and train local providers and improve locals’ access to financial care. Success should not be measured in terms of the numbers of patients seen, surgical cases performed or prescriptions filled during the camp. Rather, success should be judged by the numbers of patients successfully treated by local health staff in the time following completion of the camp. • Intangible results need to be accepted. These include training of local medical staff, knowledge transfer, participants’ understanding of local customs and health problems, and provision of public health measures. Such processes are essential in the promotion of the most important aspect of medical assistance: the sustainability of the project. • Regular evaluation of the interventions through data collection and analysis is essential to provide an evidence-base of the value of the medical ventures. Despite the challenges posed by shortterm medical trips, when guiding principles are correctly applied they can provide significant improvements to the health of communities in the developing world. 1610 – 1630

China, Hong Kong and the Politics of Childbirth Chung T The Chinese University of Hong Kong, China

Hong Kong has become one of the safest places in the world for childbirth. Since 2000, it has seen a dramatic increase in its birth rate because it became a favoured destination for mainland Chinese mothers who wished to deliver outside of China.

The main reasons for this phenomenon are the circumvention of the one child policy, Hong Kong citizenship, quality of medical care and cross border marriages. As previously strict travel restrictions were relaxed, the influx led to severe strain in the obstetric services. Eventually, as a result of protest from the local Hong Kong population, the government has introduced a ban on mainland mothers delivering in Hong Kong starting 2013. Various historical and social aspects will be discussed.

accidents, war and malaria”. This is not a ‘developing world’ problem, it is a global problem. Violence against women including sexual violence is recognised as a serious crime, a serious social issue and a serious human rights issue. Violence is also a serious long term public health issue for the individual and the community. Obstetricians and gynaecologists are an integral part of the Prevention of Violence Against Women Agenda and need to be equipped to offer holistic healthcare which avoids retraumatisation.

1630 – 1650

Contraception: Still an Important Global Issue Jenkins G Auburn and Westmead Hospitals, New South Wales

A large proportion of the global population live in very resource poor environments. Maternal mortality rates in these countries are dramatically higher than those of the developed world. In fact, there are countries in our region with maternal mortality rates almost 100 times higher than ours in Australia. It is well recognised that there is an enormous unmet need for contraception in the developing world. It has been estimated that if this need could be met there would be a 20-25% reduction in maternal mortality in these areas. The provision of reliable contraception is by far the most cost effective strategy for reducing maternal mortality in the developing world. Not only does contraception reduce maternal mortality, it also reduces perinatal mortality. It also has the capacity to change societies. If women have reliable control of their fertility then potentially a range of life and educational options become much more readily available to them. The availability of inexpensive, safe and reliable contraceptive implants has the capacity to revolutionise contraception in the developing world. It is possible to provide this option for less than $2AUD per woman per year of contraception. 1650 – 1710

Violence Against Women – A Pervasive Human Rights Violation of Pandemic Proportions Casper G School of Medicine Sydney, The University of Notre Dame Australia, Sydney, New South Wales

According to UN Women, violence against women and girls is a problem of pandemic proportions. Citing available country data, UN Women estimate that as may as 70 percent of women experience physical and sexual violence during their lifetime, the majority occurring at the hands of husbands, intimate partners or someone else the woman knows. Based on World Bank data, the UN concludes that “women aged 15-44 are more at risk from rape and domestic violence than from cancer, motor

Tuesday Abstracts BREAKFAST SESSIONS: FAST FOOD & FAST FACTS #2 0730 – 0810

Fibroid Fricassee – Top Tips for Hysteroscopic Removal Munro M Abstract not available at time of printing. 0730 – 0810

Outpatient and Office Procedures – For Patient or Profit? Pardey J Abstract not available at time of printing. 0730 – 0810

Monochorionic Twins – Surgical Management of Complications Smoleniec J

for induction of labour are either maternal (pre-eclampsia, pregnancy-induced hypertension) or fetal (post-term dates, growth retardation, ruptured membranes, diabetes). There is extensive literature assessing the effectiveness of induction of labour. Since induction of labour does not influence the caesarean section rate, the dilemma in induction of labour is the degree of neonatal development versus the maternal and neonatal consequences of awaiting spontaneous labour. Induction of labour should be considered when the neonatal or maternal risks of continuing the pregnancy are greater than the risk of prematurity for the neonate. Effectiveness and safety are important issues in induction of labour. In the comparison between mechanical (balloon) and pharmaceutical methods (prostaglandins), both methods seem to have a comparable effectiveness, while the mechanical methods have a better safety profile in terms of hemorrhage and fetal asphyxia.

Fetal Medicine Unit, Liverpool Hospital, Sydney, New South Wales

This talk will emphasise the critical role (“How to ...”) of the general obstetrician in the management of monochorionic twins and how this role may influence the surgical management. MonoChorionicity (MC) is currently the commonest association with fetal intra-uterine surgery (IUS). However, the numbers suitable for IUS do not justify more than one fetal surgery centre per state. The role of the fetal surgery centre is inclusive of referring obstetricians in the management. Conditions amenable to surgery include: TTTS; selective-IUGR; discordant anomaly; TRAP. Surgery may occur from as early as the beginning of the 2nd trimester. Optimal surgical management required teamwork: a) early diagnosis of chorionicity in multiple pregnancy eg 1st trimester; b) documented counselling re: complications; c) regular surveillance such that timely diagnosis of MC complications made such that surgery may be offered; d) networking with Fetal Surgery Centre; e) surveillance after fetal surgery for complications of surgery eg Fetal CNS insults; f) delivery timing; g) neurodevelopmental followup; h) postnatal counselling follow-up appropriate to the outcome eg fetal loss; and i) quality assurance. 0730 – 0810

Indications for Induction of Labour Mol BW Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Induction of labour is one of the most common interventions applied in obstetrics. Induction of labour is an intervention (artificial rupture of membranes (ARM) or intravenous oxytocin administration) designed to artificially initiate uterine contractions resulting in progressive effacement and dilatation of the cervix and birth of the baby. Indications 48

RECIPES FOR DISASTER? CONTROVERSIES IN O&G 0830 – 0900

When to Deliver the Pre-term Growth-restricted Fetus? A Review of the Evidence Odibo A Department of Obstetrics and Gynecology, Washington University,St. Louis, MO, United States of America

Pregnancies complicated by fetal growth restriction are at risk for adverse prenatal and postnatal complications. When diagnosed in the preterm gestational period, a delicate balance has to be made in deciding the timing of delivering these pregnancies. The presentation will review the evidence and controversies surrounding delivery timing. 0900 – 0920

Tick-box Medicine – Protocols on the Birthing Suite: Evidence-based or Bureaucracy-based?

0920 – 0940

Caesarean Section – Why Not? Dietz HP1 1 Sydney Medical School Nepean, Penrith, New South Wales

Caesarean Section rates have become a political issue, attracting the attention of health bureaucrats worldwide. The result is guidelines and policy directives designed to increase the likelihood of vaginal delivery, sometimes with limited input from clinicians and researchers. This has been the case in New South Wales with the policy directive ‘Towards Normal Birth’, released in 2010. I will argue that a focus on Caesarean Section (C/S) rates as the main quality measure for obstetric services is inappropriate and may well do more harm than good. The state-wide attempt at changing clinical practice implicit in ‘Towards Normal Birth’ has to be considered a huge experiment conducted without consent, without ethics approval and in ignorance of recent literature - an uncontrolled, poorly designed multi-centre trial that would never have made it through research governance. Currently available data suggests that certain aspects of this experiment, such as the emphasis on VBAC, are likely to lead to excess morbidity and mortality. The same is true for a 2007 policy directive governing the timing of elective delivery. I will argue that it is our moral and ethical duty to resist ideologically driven experimentation on entire populations when there are grounds to suspect net negative consequences for the health and wellbeing of our patients. At the very least we have a legal duty to provide unbiased, up to date information on both benefits and risks of proposed maternity care options such as VBAC. To date, any evaluation of the risk- benefit profile of C/S versus planned vaginal delivery has excluded data on maternal trauma. In light of recent evidence this is no longer tenable, given the long-term morbidity arising from anal sphincter and levator ani defects. However, the most striking negative impact of recent bureaucratic interference with professional freedom in O&G is likely to be on stillbirth rates.

Nicholl M

0940 – 1000

Royal North Shore Hospital, Sydney, New South Wales

Colposcopy is Adequately Taught During Training

Clinical practice variation in maternity care is common and the reasons for such variation are multiple and complex. Some of this variation is healthy and reflects the diversity of practice in the obstetric workforce, however, gaps between evidence and practice can result in less than optimal outcomes. More effective translation of maternity related research into practice has the potential to significantly improve maternal care and outcomes. This presentation will examine the evolution and utility of maternity policy, protocols, and guidelines as vehicles for translation of research into practice.

Valmadre S Abstract not available at time of printing. 1000 – 1030

Surgical Training is Not for Everyone Arulkumaran S St George’s University of London, United Kingdom

To be successful in the medical profession one has to have seven C’s, i.e. should be committed, compassionate, have good communication, must be competent, collaborate with the team, consult when needed, inspire confidence and trust.

Surgical performance is a complex construct that not only needs knowledge of the subject, and when to operate and when not, in addition to technical skills. The surgeon should also have the right attitude and ability to communicate. Non technical skills (NTS) are essential to be a good surgeon as it negatively correlates with technical errors in surgery. Many errors and poor outcomes relate to poor team-work or communication failures. Surgical training is not for everyone; we should assess them explicitly as not everyone can be completely trained in these aspects. The essential features are situational awareness (gathering and understanding information to project and anticipate future state), decision making, communication and team work and leadership – supporting others and coping with pressure. Psychologists describe situational awareness as ‘perception’ or ‘attention’, others describe it as ‘continuous monitoring of the environment, an assessment of it and the detection of any changes’ or ‘knowing what is going on around you’. In decision making one should generate options, evaluate risks, select option and enact, review consequences of decision and modify the decision if required. Team working problems can be due to failure to recognise problems, failure to refer, inappropriate delegation or lack of teamwork. A surgeon should be an effective leader and should communicate tasks and balance responsibilities, involve appropriate resources, communicate expected ‘norms’, model appropriate behavior and should have motivation and consideration. As effective leaders surgeons should have a high emotional Intelligence Quotient. Hence surgical training is not for everyone as the above qualities cannot be instilled unlike the technical aspects.

EARLY CAREER RESEARCHER / DIPLOMATE RESEARCHER / FREE COMMUNICATION PRESENTATIONS 1100 – 1110

Surgical Anatomy in Obstetrics and Gynaecology: The Trainees’ Perspective Nesbitt-Hawes E1,2*, Sgroi J1, Abbott J1,2 1 Royal Hospital for Women, Randwick, New South Wales 2 University of New South Wales, Sydney, New South Wales

Background: The aim of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Integrated and Elective Training Program is to ensure both clinical and surgical competence. Underpinning surgical competence is the ability of trainees to recognise important anatomical structures. To date there has been no quantification of RANZCOG trainees’ anatomical knowledge and their perceptions on the adequacy of anatomy training and College assessment.

Methods: RANZCOG trainees were asked to participate in an online survey pertaining to their perceptions of anatomy knowledge, skills and assessment. Results: 218/475 (46%) trainees participated in the survey. Prior anatomy knowledge had been taught as a distinct subject for 51% of trainees, or as problem based learning for the remaining 49%. At the commencement of training 11% of trainees thought their anatomical knowledge was adequate, increasing to 77% of trainees in their final elective year. The majority of final year trainees perceived their anatomy skills to be sufficient to perform a total abdominal hysterectomy (78%). Eighty-four percent of trainees thought the RANZCOG Training Program provided inadequate anatomy teaching with 100% of respondents supporting a College approved anatomy training course. Conclusion: There is a lack of confidence by trainees in their surgical anatomy training. Furthermore changes to work practices and the decrease in operative gynaecology have limited the opportunities to acquire surgical anatomical skills. Consideration of a formal anatomy training program is recommended, the value of which could be objectively measured by pre and post test scores and longitudinal follow-up. 1110 – 1120

Fetal Welfare, Obstetric Emergency, Neonatal Resuscitation Training (FONT) and Improved Statewide Pregnancy Outcomes Giles W1*, Cooke H2, Foureur M3, Bisits A4 1 University of Sydney, Northern Clinical School, Sydney, New South Wales 2 NSW Pregnancy and Newborn Services, Sydney, New South Wales 3 University of Technology, Sydney, New South Wales 4 Royal Hospital for Women, Randwick, New South Wales

Objectives: Fetal Obstetric emergency Neonatal resuscitation Training (FONT) is a combination of the K2 Fetal Monitoring program; a session on fetal assessment: and a session for obstetric and neonatal emergencies. The initial short-term outcomes for FONT were presented at the RANZCOG ASM (2009) and published (2010). We are now able to present longterm data from participant learning and have been able to correlate the data from the New South Wales Maternity reports for the time periods prior to and following the introduction of FONT in 2008. This paper reports on the outcomes associated with the fetal welfare education only. Findings: The improved diagnosis of pathological fetal heart rate traces has been maintained (P<0.001). To date there have been approximately 4,000 maternity practitioners in 80 hospitals in New South Wales (NSW) who have attended the fetal welfare education over the past four years. On reviewing the perinatal outcomes data for the period before the education and since (2006 to 2011) the following are noted. There is a trend towards a higher rate of public LSCS’s. However, the rates

of term NICU neonatal deaths (NND’s) (13.5% vs. 0.4%, P=0.0005) and seizures (61% vs. 14.3%, P=0.0000) where there was a diagnosis of fetal distress in labour and a vaginal delivery are significantly less; despite deliveries increasing by 5,000 births per annum since 2006. Conclusions: FONT is the largest interprofessional maternity program ever developed and is associated with a falling rate of term NND and seizures in NSW despite rising numbers of deliveries. Reference: ANZJOG. 2010:50;334-9

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 Liu JY1*, Lim ZYV1, Tan WC2 1 National University of Singapore, Singapore 2 Obstetrics & Gynaecology Department of Singapore General Hospital, Singapore

Introduction: Low maternal serum concentrations of PAPP-A and ß-hCG used in the First Trimester Screening (FTS) 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 ßf-hCG concentrations in relation to adverse neonatal outcomes. Methodology: 962 patients who underwent FTS between January and December 2010 at the Singapore General Hospital were identified. Pregnancies with fetal anomalies, multiple fetuses, miscarriages before gestational age of 24 weeks, and incomplete data were excluded. Maternal serum PAPP-A and ßf-hCG concentrations 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. Results: Out of the 649 patients 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 fßhCG levels were higher than the control group. Both PAPP-A and fß-hCG, at low levels, were significantly associated with neonatal hypoglycemia (OR 3.7, 95% CI 1.2-11.8; OR 4.0, 95% CI 1.4-10.0). Low PAPPA-A levels were also associated with neonatal jaundice (OR 2.6, 95% CI 1.1-6.4). Preterm delivery (<37 weeks) was found to be a significant risk factor for neonatal hypoglycemia and neonatal jaundice (OR 3.3, 95%CI 0.1-0.9; OR 2.7, 95% CI 0.2-0.9). Conclusion: Low serum levels of PAPP-A and fß-hCG are significantly associated with higher incidence of some adverse neonatal outcomes. However, other possible risk factors such as maternal smoking should be investigated in future studies.

Tuesday Abstracts 1130 – 1140

Laparoscopic Transabdominal Cervical Cerclage – A 6 Year Experience in Melbourne, Australia May J2*, Ades A1, Cade TJ1, Umstad M1 1 Department of Obstetrics and Gynaecology, Royal Women’s Hospital, Melbourne, Victoria 2 Frances Perry House, 20 Flemington Road, Melbourne, Victoria

Background: Cervical cerclage has been used as a treatment for cervical insufficiency for over 50 years. Transabdominal cerclage is indicated for cervical insufficiency not amenable to a transvaginal procedure, or following previous failed vaginal cerclage. A laparoscopic approach to abdominal cerclage offers the potential to reduce the morbidity associated with laparotomy. Aims: To evaluate the obstetric outcome and surgical morbidity of laparoscopic transabdominal cerclage. Methods: A prospective observational study of consecutive patients undergoing laparoscopic transabdominal cerclage from 2007 to 2013. Eligible patients had a diagnosis of cervical insufficiency based on previous obstetric history and/ or a short or absent cervix. Primary outcome was neonatal survival. Secondary outcomes were delivery of an infant at ≥34 weeks. Surgical morbidity and complications were also evaluated. Results: Sixty-four patients underwent laparoscopic transabdominal cerclage during the study period. Three patients underwent cerclage insertion during pregnancy; the remaining 61 patients were not pregnant at the time of surgery. Thirty five pregnancies have been documented to date. Of those, 24 were evaluated for the study. The remaining patients were either early miscarriages, ectopic pregnancies or are still pregnant. The perinatal survival rate was 95.8% with a mean gestational age at delivery of 35.8 weeks. Eighty three percent of patients delivered at ≥ 34 weeks. There was one adverse intraoperative event (1.6%), with no post-operative sequelae. Conclusion: Laparoscopic transabdominal cerclage is a safe and effective procedure resulting in favourable obstetric outcomes in patients with a poor obstetric history. Success rates compare favourably to the traditional laparotomy approach. 1140 – 1150

Adnexal Torsion – An Under Recognised Emergency. To Cut or Not to Cut Should No Longer Be the Question Kroushev A1,2*, Perera A1, EgertonWarburton D1, Vollenhoven B1 1 Southern Health, Melbourne, Victoria 2 Eastern Health, Melbourne, Victoria

Objective: To describe the clinical and sonographic findings in women with operatively proven adnexal torsion via a structured chart review. To investigate risk

factors for delay in diagnosis, correlate the pathology and surgical outcomes and develop guidelines for expediting diagnosis and treatment to reduce ovarian loss. Results: A total of 245 cases were identified using ICD codes. This is the largest case series, we are aware of, in the general female population – average age 33 years (0.09 – 93 years). 72% presented via an Emergency Department. The majority did not have any prior risk factors and 5% were pregnant. Presence of a benign cyst (70%), intractable pain despite narcotic analgesia, nausea and vomiting were frequent features. 69% of cases resulted in removal of the affected adnexa despite a poor correlation between operative appearances and histological evidence of infarction. Delays in diagnosis and treatment occurred in obtaining ultrasounds, and time to surgery. Conclusions / Recommendations: Ovarian torsion remains difficult to diagnose due to often non-specific signs and symptoms and investigations that are not highly sensitive or specific for the condition. It is imperative that clinicians have a high index of suspicion and consider this as a differential diagnosis in women presenting with severe lower abdominal pain. We recommend more judicious consideration regarding conservation of an affected ovary, especially in the young, as histological infarction is only seen after prolonged delays to surgery and no cases managed conservatively resulted in returns to theatre. Local guidelines should be developed to remind clinicians of and expedite the management and treatment of this condition. 1150 – 1200

Long-term Childhood Health and Developmental Outcomes After Caesarean Delivery (CD) Robson S1*, Westrupp E2, Mohamed AL1, Vally H3 1 Australian National University, Canberra, New South Wales 2 Parenting Research Centre, Melbourne, Victoria 3 LaTrobe University, Melbourne, Victoria

Background: Despite a doubling in the rate of caesarean delivery (CD) and some evidence of poor health outcomes in the first year of life, little is known about the long-term effects of CD on the health and development of children. Our objective was to provide evidence of long-term outcomes across the early childhood period (0-7 years) for children born via CD. Method: Data from Longitudinal Study of Australian Children (LSAC), a prospective study of more than 5,000 children, across four Waves of biennial data collection, were analysed. Birth data was collected via face-to-face interviews with mothers at Wave 1. Outcomes related to child physical health (allergies/asthma, global health, special health care needs, BMI), and psychological functioning were collected via parent questionnaire and interview across Waves 1-4.

Results: One third (30%) of children were delivered by CD. For singleton babies born after 37 weeks and with normal birth weight, CD was associated with increased special health care needs, less prescribed medication, higher BMI, and improved social functioning. Conclusions: This study provides reassurance to parents who give birth by caesarean. 1200 – 1210

PaPP-A at 5-11 Weeks’ Gestation and the Prediction of Pregnancy Outcome Rajendran S1*, Pelosi M1, Cheney K1, Williams P2, Black K3, Hyett J1 1 Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales 2 Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales 3 Department of Obstetrics and Gynaecology, Central Clinical School, University of Sydney, Sydney, New South Wales

Objective: Pregnancy associated plasma protein A (PaPP-A) is a biochemical marker currently used as part of combined first trimester screening. A low PaPP-A at 11-13 weeks’ gestation is predictive of miscarriage and other late (>24 weeks) adverse pregnancy outcomes. We aimed to determine whether PaPP-A was predictive of poor outcome when measured at 5-11 weeks’ gestation. Methods: Women attending our Early Pregnancy Assessment Service at 5-11 weeks with symptoms of miscarriage were asked to participate. Those with sonographic evidence of a failed pregnancy were excluded. Maternal serum PaPP-A was quantified (Siemens Immulite XPi, New York, USA) and levels were analysed in relation to pregnancy outcome. Results: 95 women were recruited at a median of 7+1 (5-11) weeks’ gestation; 84 (88%) with a sonographically viable pregnancy, 11 (12%) with an intrauterine pregnancy where viability had not yet been confirmed. Three women were subsequently excluded (two congenital anomalies / one lost to follow-up); final pregnancy outcome data were available for 87 (95%) women. 14 (15%) women had a non-viable pregnancy; with 13 first and one second trimester loss. The median PaPP-A was 0.4 (<0.03-2.63) IU/L. Using a cut-off value of ≤0.05 IU/L, PaPP-A had a sensitivity of 93%, and a negative predictive value of 98% for pregnancy loss. Conclusions: PaPP-A level at 5-11 weeks could be used to predict ongoing risk of miscarriage. Greater numbers of women are required to determine if risk of other adverse outcomes can be predicted from this early gestation.

1210 – 1220

Dual-Progestogen-Delivery Systems Therapy with Levonorgestrel Intrauterine System and Etonogestrel Subdermal Implant for Refractory EndometriosisAssociated Pelvic Pain: An Effective New Therapy Ng C1,2,3*, Fraser I2,3, Al-Jefout M4, Pardey A5, Pardey J5, Marren A2,3 1 Department of Maternal-fetal Medicine (High-risk Obstetrics), RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales 2 Department of Reproductive Endocrinology and Infertility, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales 3 Department of Obstetrics, Gynaecology and Neonatology, Queen Elizabeth II Research Institute for Mothers and Infants, The University of Sydney, Sydney, New South Wales 4 Department of Obstetrics and Gynaecology, Mutah Medical Faculty, Mutah University, Karak, Jordan 5 Department of Obstetrics, Gynaecology and Neonatology, Nepean Clinical School, The University of Sydney, Sydney, New South Wales

Background: Endometriosis usually presents with chronic pelvic pain and/ or infertility. Where conservative surgery, often combined with first-line medical management (e.g. NSAIDs, oral or intramuscular progestogens and/or COCP, etc.), fails to adequately control the patient’s symptoms, more advanced medical treatment and/or surgical treatment maybe offered. Objectives: To determine if the simultaneous use of dual progestogendelivery systems (DPS) with the levonorgestrel intrauterine system (LNG-IUS) and etonogestrel subdermal implant (ESI) is an effective new therapy for refractory endometriosis-associated pelvic pain. Results and Findings: Medical records (n=40) of two clinicians who utilised the DPS were searched. These forty patients’ used the DPS following failure of various first-line and/or advanced medical therapies. Mean duration of symptoms (dysmenorrhoea, deep dyspareunia, dyschezia, heavy menstrual bleeding and other symptoms) was 7.9 (range 0.5–30) years. Overall, responses were particularly favourable in a difficult group of adolescents (n=4; 10%) who had “dramatic” improvement (amenorrhoea with no pelvic pain). Marked improvement (major resolution of symptoms) was reported in 26/40 (65%). Three had borderline initial response, then obtained marked ongoing improvement (with shortterm additional therapy), five reported borderline benefit and seven women had either the LNG-IUS or ESI or both systems removed due to some persistent pain or side-effects. Conclusion: The DPS is an effective new treatment option in women with persistent endometriosis-associated symptoms who have failed multiple advanced medical therapies and/or conservative surgery. A

randomised controlled trial comparing the dual therapy versus LNG-IUS alone is warranted to determine broader application of this novel therapy in management of endometriosis symptoms.

EARLY CAREER RESEARCHER / DIPLOMATE RESEARCHER / FREE COMMUNICATION PRESENTATIONS

1220 – 1230

1100 – 1110

Third Trimester Ultrasound: An Audit of Current Practices at St George Hospital

Obstetric Outcomes in Patients with Classical Bladder Exstophy

King K1*, Foo J1, Henry A1,2

Deans R1*, Banks F2, Liao LM2, Wood D2, Woodhouse CR2, Creighton SM2

1 Department of Women’s and Children’s Health, St George Hospital, Kogarah, New South Wales 2 School of Women’s and Children’s Health, UNSW Medicine, Sydney, New South Wales

1 University of New South Wales, and Royal Hospital for Women, Sydney, New South Wales 2 University College London Hospital, London, United Kingdom

Objective: Studies supporting risk assessment-based over routine third trimester ultrasound (T3US) may not apply to current Australian practice. We assessed incidence, indications, and utility of singleton T3US at St George Hospital, Sydney. Findings: 52.0% (256/492) singleton pregnancies October-December 2012 had at least one T3US. Of these, 205 (80.1%) had a documented, medical/protocolsupported reason. The remaining 19.9% had another or no documented reason (e.g. maternal request). Major indications for T3US were low lying placenta (7.3%), reduced fundal height (5.1%), and morphology scan abnormalities (4.1%). 34.0% of first T3US were abnormal and 23.4% required a change in management (repeat/more specialised ultrasound, change in delivery, altered care modality or paediatric follow-up). 39.0% of the study population had two or more T3US, mostly for the same indication as the first T3US (35.9%), or incidentally identified first T3US abnormalities (35.9%). None of the 16 small for gestational age (SGA) cases without T3US were identified antenatally versus 7 of 23 in the T3US group (p=0.02). Of high-risk women requiring protocoldriven T3US, all women with insulinrequiring gestational diabetes, 80% with maternal age over 40, and 83% with Body Mass Index ≥35 received one. Conclusions: Over half the singleton pregnancies at our hospital undergo T3US, >80% being for valid, protocol-driven indications. Additionally, 5.9% who should receive T3US did not. Many abnormal T3US initiated management changes; conversely, many detected incidental abnormalities requiring follow-up. SGA detection rate was higher using ultrasound but still poor. Further studies are needed to determine whether routine T3US improves maternal/neonatal outcomes, and is feasible.

Aims: To report the obstetric outcomes of 50 patients with classical bladder exstrophy (BE). Patients and Methods: 50 women with BE were identified from the departmental database and all medical notes were available for review. Nine patients were deceased or lost to follow-up and 25 of the remaining 41 (61%) completed a questionnaire on obstetric outcomes. Results: The average age was 33 years (Range 17-63). There were 52 pregnancies in 17 patients resulting in 27 live births. 15 patients had no pregnancies reported in the questionnaire or notes, and in 18 this was not known. Of the 52 pregnancies, there were 27 live births (52%), 21 miscarriages (40%), one termination of pregnancy (2%), and three (6%) stillbirths or neonatal deaths. There were three sets of twins. The average gestational age of the livebirths was 36 weeks (Range 29-39+4), and nine (41%) were delivered premature. All patients delivered by Caesarean section, of which three were emergencies. Two of the emergency Caesarean deliveries resulted in two neonatal deaths due to delivery delay. Three classical Caesarean sections were performed due to adhesions in the lower segment. A urologist or general surgeon was present in all but four planned Caesarean deliveries. Eight women (47%) had prolapse in pregnancy. Four deliveries resulted in major complications including one transection of the ureter (4%), one fistula formation (4%), and two post-partum haemorrhage (8%). Twelve (71%) patients had renal tract complications antenatally including urinary tract infections (71%), retention requiring permanent catheterisation (35%) or nephrostomy tube (24%), hypertension or pre eclampsia complicated 35% of pregnancies, and one woman had an eclamptic fit post-partum. There were two ITU admissions, one for urinary sepsis and another for massive obstetric haemorrhage. Discussion: Improvements in the treatment of BE has led to more girls being successfully reconstructed and surviving through to adulthood with the associated expectations regarding parenthood. This study however demonstrates that pregnancy is high risk both for the mother and baby and mortality rates far exceed the national stillbirth and neonatal mortality rate of 5.2/1000 and 3.3/1000

Tuesday Abstracts respectively. Patients should be counselled about these risks before embarking on pregnancy and when pregnant should book high-risk obstetric and urology cover. Delivery should be by elective Caesarean Section with a urologist present in theatre. 1110 – 1120

Maternal Health and Pregnancy Outcomes Among Women of Refugee Background in Australia Gibson-Helm M1*, Teede H1,2, Cheng I-H3,4, Block A5, Knight M6, East C6,7,8, Wallace E6,7,9, Boyle J1 1 Monash Applied Research Stream, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria 2 Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria 3 Southern Academic Primary Care Research Unit, (Monash University, South Eastern Melbourne Medicare Local, South Eastern Health Providers Association, Monash Health), Dandenong, Victoria 4 South Eastern Melbourne Medicare Local, Dandenong, Victoria 5 Refugee Health Service, Monash Health, Clayton, Victoria 6 Monash Women’s Services, Monash Health, Clayton, Victoria 7 The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria 8 School of Nursing and Midwifery, Monash University, Clayton, Victoria 9 Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria

Background: Migration is associated with increased risks of adverse pregnancy outcomes. However, it is unclear whether the risks differ between migrants of refugee and non-refugee background. Objective: To describe maternal health, pregnancy care attendance, and pregnancy outcomes among women of refugee background compared to nonrefugee migrant women. Method: Retrospective, observational study of migrant women born in nonhumanitarian and humanitarian source countries (HSC) having a singleton birth at a large metropolitan maternity service in Australia 2002-2011 (n=14870 and n=3603 respectively). Results: Compared to non-HSC migrant women, the following were more common in HSC migrant women: maternal age <20years (0.9 vs 3.7% p<0.001), multiparity (52.2 vs 74.7% p<0.001), BMI ≥25 (38.3% vs 50.1% p<0.001), anaemia (3.5% vs 6.4% p<0.001), tuberculosis (0.2% vs 0.4% p=0.007) and syphilis (0% vs 0.6% p<0.001). Maternal HSC birth was independently associated with poor/no pregnancy care attendance (OR=2.5 95% CI:1.7-3.6), late booking visit (OR=1.3 95% CI:1.1-1.5) and post-term birth (OR=2.5 95% CI:1.9-3.5). Stillbirth (0.6% vs 1.1% p=0.004, OR=1.4 95% CI:0.8-2.4) and birth before arrival (BBA) (0.6% vs 1.4% p<0.001, OR=1.3 95% CI:0.8-2.1) were more common in HSC-born women but not independently associated with maternal HSC birth. However, some risk

factors for stillbirth (overweight, age <20 years) and BBA (age <20 years, multiparity) were more common in HSC-born women. Conclusion: These findings suggest a need for targeted strategies to support engagement in pregnancy care among women of refugee background. This would be expected to improve general health and reduce the rate of key poor pregnancy outcomes more common in women of refugee background than in non-refugee migrant women.

1130 – 1140

1120 – 1130

Introduction: Current means of assessing women presenting with suspected preeclampsia using BP and proteinuria are of limited use in predicting ned for imminent delivery. Objectives/ Method/ Design: We undertook a prospective multicentre study to determine diagnostic accuracy of PlGF <5th centile (Triage assay) and other candidate biomarkers in women presenting with suspected pre-eclampsia at 20- 35 weeks’ gestation, in determining need for delivery for pre-eclampsia within 14 days. We calculated ROC curves for predictive potential and undertook principal factor analysis to determine additional predictive ability for biomarker combinations. Results: In 287 women enrolled prior to 35 weeks, ROC area (0.88, SE 0.03) for PlGF <5th centile for pre-eclampsia requiring delivery within 14 days was greater than all other commonly utilised tests (systolic and diastolic BP, urate, ALT), either singly (range 0.58 to 0.68), or in combination (0.69) (p<0.001 for all comparisons), and was greater than that of all other biomarkers; addition of two other biomarker panels (either procalcitonin, nephrin and BNP; or cystatin and PAPP-A) increased ROC area to 0.90 but these biomarkers had limited predictive ability on their own. Conclusion: In women presenting prior to 35 weeks’ gestation with suspected pre-eclampsia, low PlGF has a greater ROC area than other commonly utilised tests. Additional biomarkers add only a small increment to the predictive value of a single PlGF measurement.

Only Time Will Tell: The Effect of Extending Dinoprostone Pessary Placement From 12 to 24 Hours on the Need for Transcervical Balloon Catheters Lusink V1*, Usher L1, Day T2 1 The Maitland Hospital, Department of Obstetrics and Gynaecology, Maitland, New South Wales 2 John Hunter Hospital, Maternity and Gynaecology, Newcastle, New South Wales

Objective: To examine if a protocol change in February 2013 from 12 to 24 hour dinoprostone pessary placement for cervical ripening reduces the requirement for additional ripening with a transcervical balloon catheter. Methods: Consecutive women undergoing cervical ripening with a dinoprostone pessary were identified from the Obstetrix database before and after a protocol change from 12 to 24 hour placement. With an 80% power and alpha of 0.05, 72 women per group are required to find a reduction in balloon use from 35% to 15%. Data were collected on demographics, transcervical balloon catheter use, syntocinon use, and mode of delivery. Results: We analysed 79 women in the 24 hour and 91 women in the 12 hour group, with an average gestational age at induction of 40 weeks in both groups. There was no significant difference in transcervical balloon use (21% vs 21%; RR, 0.98; CI, 0.55-1.73), syntocinon use (54% vs 61%; RR, 0.88; CI, 0.68-1.15), or vaginal birth (78% vs 70%; RR, 1.12; CI, 0.90-1.31). Conclusions: We have not detected a reduced need for further cervical ripening with a balloon catheter after extending the duration of dinoprostone pessary use from 12 to 24 hours. There is a trend in the 24 hour group towards lower syntocinon use and higher vaginal birth rates. We will continue to collect data with a target of at least 150 women per group to enable detection of a 15% absolute difference in the outcomes of balloon use and vaginal birth.

PLGF in Combination with Other Commonly Utilised Tests and Other Biomarkers Predicting Need for Delivery within 14 Days From PreEclampsia in Women Presenting Prior to 35 Weeks Gestation Shennan A1*, Griffin M1, Redman C2, Seed P1, Duckworth S1, Chappell L1 1 Kings College London, United Kingdom 2 Oxford University, United Kingdom

1140 – 1150

The Value of MRI in the Investigation of Pudendal Nerve Entrapment Chow JSW1*, Sachinwalla T1,2, Jarvis SK1, Vancaillie TG1 1 Women’s Health & Research Institute of Australia (WHRIA), Sydney, New South Wales 2 Connect Medical Imaging, Sydney, New South Wales

Objective: MRI of the sacral spine and pudendal nerves has been part of the investigations for perineal and pelvic pain at our unit since 2008. This retrospective study examines the correlation of MRI findings of suspected pudendal nerve compression with outcomes of pudendal nerve blocks. Statement of Findings: MRI studies were evaluated for dimensions of the

pudendal nerve canal above and below the level of the ischial spine. Positive studies demonstrated narrowing of the interligamentous space less than 3mm when superior to the ischial spine and focal reduction in perineural fat when below the ischial spine. Positive studies distal to Alcock’s canal demonstrated focal changes consistent with scarring around distal pudendal nerve branches. Patients also underwent a pudendal nerve block as a diagnostic test for pudendal nerve entrapment according to the criteria of Nantes. The block was performed under image intensifier control with contrast. A positive block is defined as the occurrence of numbness in the distribution of the pudendal nerve and resolution of pain. 149 patients underwent an MRI in 2012 and 55 patients underwent a pudendal nerve block with the above protocols. 62.3% (33) patients had a positive block. MRI had sensitivity 84.8%, specificity 45.0%, positive predictive value 71.8% and negative predictive value 64.3% for diagnosis of pudendal nerve entrapment (p<0.05). Key Conclusions: Patients with a positive pudendal nerve block did not have findings on MRI different from patients with a negative pudendal nerve block. MRI may impart anatomical information about the location of pudendal nerve compression. 1150 – 1200

Anti Müllerian Hormone (AMH) Levels in Recurrent Miscarriage Patients are Frequently Abnormal and Predict Pregnancy Outcomes McCormack CD1,2*, Furness DLF2, Dekker GA2, Roberts CT2 1 Women’s and Children’s Hospital, North Adelaide, Adelaide, South Australia 2 Robinson Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia

Objective: To determine AMH levels and pregnancy outcomes in recurrent miscarriage patients. Study Design: Serum AMH testing was offered to 182 recurrent miscarriage patients. The results were compared to an age matched population attending an IVF clinic for male factor infertility. Pregnancy outcomes were recorded, including whether the pregnancy was spontaneous or via Artificial Reproductive Technologies (ART). Results: The patients showed significantly lower AMH levels than those in a normal population. Women aged 35 years and less had pregnancy rates of 78.6%, 92% and 80% in the low (<10pmol/L) normal (10-30pmol/L) and high (>30pmol/L) AMH groups. The spontaneous pregnancy ‘take home baby’ rates were 43.7%, 82.4% and 100% respectively. The rates of ART were 56.3%, 17.6% and 0%. Women aged 36 years and more had pregnancy rates of 65.2%, 68.4% and 100%, with a spontaneous pregnancy rate ‘take home baby’ rate of 47.6%, 91.7%%, and

100%. The rates of ART in this group were 52.4%, 8.3% and 0% respectively. Conclusions: AMH levels in Recurrent Miscarriage populations are lower than in a normal population and predict pregnancy outcomes, as well as the need for ART. The higher the AMH, the less need for ART, which may suggest that ART should be considered in those patients with a low AMH, as they may be able to select better embryos for transfer, than if the patient plans pregnancy spontaneously. Finding a low AMH in a young patient allows realistic planning regarding her future fertility options. 1200 – 1210

Placental Growth Factor Measurement as a Marker of Subsequent Disease and Harm in Placental Insufficiency Conditions Woods A*, Dekker G Lyell McEwin Hospital, Elizabeth Vale, South Australia

Objective: To investigate the clinical usefulness of Placental growth factor (PLGF) testing, prior to 35 weeks and at all gestations, as a marker of subsequent disease and harm in placental insufficiency conditions (specifically pre-eclampsia and intrauterine growth restriction). Method: A prospective cohort study was conducted, blinded to treating clinicians, analysing PLGF levels in women being investigated for pre-eclampsia. Serum PLGF levels were measured in 125 pregnancies, gestations ranging from 28 to 42 weeks. 46 patients developed preeclampsia (diagnosis based on SOMANZ criteria) and 28 IUGR (birth weight <10th centile customised). Test results were highly abnormal <12pg/ml, normal >100pg/ml, and also stratified to gestation specific reference ranges. Results: For patients tested at all gestations, a result of <12pg/ml indicates an almost nine times increased risk of developing pre-eclampsia (LR=8.7 p=<0.0001), a four and half times increased risk of developing pre-eclampsia with growth restriction (LR=4.5 p=0.0002) and an almost seven times increased risk of developing pre-eclampsia or growth restriction (LR=6.7 p=0.0002). Whilst for patients tested prior to 35 weeks, a result of >100pg/ml indicates a six times decreased risk of developing pre-eclampsia (LR=6.0 p=0.0021), and an almost nine times decreased risk of developing pre-eclampsia with growth restriction (LR=8.7 p=<0.0001). Conclusion: Preliminary results indicated that PLGF testing at all gestations is a useful marker for the development of placental insufficiency conditions. Prior to 35 weeks, its value appears to lie as a negative marker. Further testing is being done to analyse the correlation between PLGF level and disease severity and timing to delivery.

1210 – 1220

CRADLE: Community Blood Pressure Monitoring in Rural Africa: Detection of Underlying Pre-Eclampsia Radford S*, Hezelgrave NL, De Greef A, Irvine L, Seed P, Shennan AH Women’s Health Academic Centre, Kings College London, United Kingdom

Introduction: In many developing countries pre-eclampsia is underdetected partly due to inadequate training in accurate blood pressure (BP) measurements and insufficient, poorly functioning equipment. Objective: To evaluate whether the introduction of ergonomic, low cost novel BP devices (Microlife 3AS1-2; designed by our research group specifically for use in developing countries and validated in pregnancy (B/A grade) according to BHS criteria) into rural clinics in Tanzania, Zimbabwe and Zambia increases referrals for suspected pre-eclampsia to a central referral hospital (as reflected by an increase in mean BP in pregnant women seen in the central referral site). Methods: International prospective longitudinal pre and post-intervention pilot study. BP measurements were taken from consecutive women ≥20 weeks gestation who accessed care at a referral site (N=694). 20 BP devices were distributed to 20 rural antenatal clinics in each country. Post-intervention data was collected the following year (N=547). Results: After adjustment for confounders, there was a significant increase in primary outcome; post-intervention mean diastolic BP for all women (2.39 mmHg, p<0.001, 95% CI 0.97-3.8), implying an increased proportion of referred hypertensive women; and a reduction in proportion of women (median gestation 35 weeks) who had never previously had a BP taken in pregnancy (25.1% to 16.9%, OR 0.58, p=0.001, CI 0.42-0.79). Conclusion: Equipping community health care providers with this novel validated BP device is feasible, widely accepted and results in increased referrals of suspected pre-eclampsia. A cluster RCT to evaluate the effect of these monitors equipped with a traffic-light ‘early warning system’ is planned.

Tuesday Abstracts 1220 – 1230

Ultrasound Assessment of Cervical Length at 18-21 Weeks’ Gestation in an Australian Obstetric Population: Comparison of Transabdominal and Transvaginal Approaches Marren A1*, Mogra R1, Pedersen L2, Walter M1, Ogle R1, Hyett J1,3 1 RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales 2 Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark 3 Discipline of Obstetrics, Gynaecology and Neonatology, Sydney Medical School, University of Sydney, Sydney, New South Wales

Objective: Using a fixed cut-off of ≤25mm ultrasound assessment of cervical length during the 18-23 week anomaly scan has been shown to identify approximately 50% of pregnancies that would deliver prior to 34 weeks. This prospective cohort study aims to determine if a policy of reverting to transvaginal cervical assessment only if the cervix appears short (≤25mm) on transabdominal assessment affects the efficiency of screening. Women with a singleton pregnancy that presented for a routine anomaly scan had their cervical length assessed transabdominally, initially with the maternal bladder full (TABF) and then empty (TABE). Cervical length was then assessed transvaginally (TV). Statement of findings: 198 women agreed to participate in the study. Identification of the internal and external cervical os was possible during TABF, TABE, and TV sonography in 97.0%, 82.8%, and 100% respectively. Compared to TV sonography, TABF over-estimates cervical length (6.1mm difference in median values; p<0.01). There was no significant difference between TV and TABE. However TABE assessment was not possible in one in six women making it an unreliable screening tool. If TABF sonography was to be used as a screening tool, and using ≤25mm as the critical cutoff, the sensitivity and specificity of was 15.4% and 93.2% respectively. Conclusion: This study has shown that assessment of cervical length using a TA approach is only routinely possible when the bladder is full. However, measurements are significantly overestimated. Therefore, TA assessment of the cervix at the time of the routine anomaly scan should not be performed.

WOULD YOU LIKE CRACKED PEPPER, MADAME? SUPPLEMENTS IN O&G 1330 – 1345

Evidence-based Herbs & Nutrients for Premenstrual Syndrome Eden J Royal Hospital for Women, Sydney, New South Wales

Premenstrual syndrome (PMS) is a common and disabling problem and many women are keen to use natural therapies to relieve their symptoms. PMS typically worsens after the mid-30s and some women date their problems to a bout of postnatal depression. The symptoms are present only in regularly ovulating women. The symptoms do not occur in women who are not ovulating (e.g. during pregnancy or after menopause). Medicines that increase synaptic serotonin in the brain are immediately effective therapies for PMS. A literature review was performed focusing on randomised trials (RCTs) of complimentary therapies and metaanalyses. Whelan et al 2009 found that 62 products were advocated for PMS, but could only find 29 RCTs for 10 products. They found four RCTs of agnus castus that were mostly positive; three RCTs of evening primrose oil and all were negative; one RCT of ginko (160-320mg/d) which improved breast pain; one RCT of saffron extract (30mg/d) which found improved depression scores; two RCTs calcium carbonate (1g) which improved all symptoms; three RCTs magnesium which were mostly negative; and 13 RCTs Vit B6 (50-200mg), with mixed results. Three RCTs of agnus castus extracts (especially Ze440) found this extract to be effective for both physical and psychological symptoms of PMS. RCTs of soy or evening primrose oil were negative. In summary, calcium, agnus castus extract Ze440 and vitamin B6 had reasonable evidence to recommend their use for treating PMT symptoms. 1345 – 1400

Antenatal Calcium and Vitamin D Supplementation Ross G Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales Department of Endocrinology, Bankstown-Lidcombe Hospital, Sydney, New South Wales

Maternal vitamin D and calcium status can impact on the pregnancy and the short and long-term wellbeing of the offspring. Vitamin D has important roles in calcium absorption as well as bone and muscle strength. There has been increasing interest in the role of vitamin D in its many non-bone effects as well as in bone health. Vitamin D deficiency is prevalent locally and internationally. Maternal vitamin D

levels determine the fetal vitamin D status, and indeed contribute to the future bone density and fracture risk in the offspring. There has been re-emergence of rickets and neonatal hypocalcaemia when maternal vitamin D deficiency has been severe. Vitamin D deficiency seems to be more common in women with gestational diabetes and there has been an association with increased likelihood of pre-eclampsia and possibly caesarean section rates. Some other associations of early life vitamin D deficiency have been type 1 diabetes, multiple sclerosis, and childhood respiratory infections. Diet is a poor source of vitamin D. The average Australian dietary intake is below 100IU per day. The recommended minimum is 400-600IU per day, though in pregnancy at least 1000IU daily is needed for most women to achieve a minimum 25OHD level of 50nmol/L all year. Many women need vitamin D supplements during, as well as following, pregnancy. A balanced approach to sunlight exposure is necessary to avoid increasing the risk of skin cancer. Infants of vitamin D deficient mothers should be given 400IU vitamin D daily. This can be given via a readily available liquid multivitamin mixture. Dietary calcium intake of many women in pregnancy and lactation is below the recommended 1200-1500mg daily. Low calcium intake is associated with increased risk of pregnancy-related hypertension, maternal bone loss and adverse offspring bone health. Dairy intake should be encouraged but calcium supplements may be needed. 1400 – 1415

Role of Folate and Antenatal Multi-Vitamins in Pregnancy – An Update Furness D*1,2, McKern J1, Rabinov B1 1 Research Centre for Reproductive Health, University of Adelaide, South Australia 2 Your Health Integrative Medical Practice, Brighton, Victoria

In Australia, many women lack a healthy well balanced diet and do not meet the recommended intake of fruits and vegetables. Women who have a poor nutritional status at conception and nutrient intake during pregnancy increase their risk for pregnancy complications and fetal abnormalities. For these reasons it is now mandatory to fortify bread with folic acid and iodine. In addition, women who are planning pregnancy are encouraged to supplement with vitamins and minerals. Current clinical practice recommends folic acid supplementation one month prior to pregnancy and during the first trimester to prevent congenital malformations. Although folic acid supplementation is regarded safe, it has been hypothesised that high dose folic acid could lead to the presence of unmetabolised folic acid that may be detrimental. Over the past decade little research has been published explaining the absorption and saturation levels of folic acid.

Folate is required for the synthesis of DNA, RNA and S-adenosyl methionine (SAMe), critical for gene expression and cell proliferation. However, folate does not work alone and needs additional B vitamin cofactors, including B12, B6 and B2 for it’s metabolic functions. Most prenatal multivitamins contain B vitamin combinations, along with other micronutrients essential for pregnancy health, but quality and absorption can be questionable. More emphasis needs to be placed on educating couples about the importance of a healthy diet and the impact nutrition has on their future child. In addition, investigations into the quality of the ingredients and manufacturing processes used to make vitamin supplements should be readily available. 1415 – 1430

Iron Deficiency in Pregnancy: Screening, Supplementation & Transfusion Dibley M Abstract not available at time of printing. 1430 – 1445

Iodine Deficiency and Thyroid Function in Pregnancy Eastman C Sydney Thyroid Clinic Westmead Private Hospital, Sydney Medical School, Sydney, New South Wales

Iodine is a trace element essential for maintaining thyroid function to ensure normal physical and neurological development and regulation of metabolism from conception until old age. Iodine deficiency is a global problem of immense magnitude afflicting two billion of the world’s population. The spectrum of adverse effects of iodine deficiency, collectively termed iodine deficiency disorders (IDD), results from lack of thyroid hormone and vary in severity from thyroid enlargement (endemic goitre) to severe, irreversible brain damage (endemic cretinism). Early in pregnancy iodine requirements increase dramatically to meet the demand for a 50% increase in maternal thyroid hormone production and to accommodate transfer of both iodine and thyroxine (T4) to the fetus. Maternal hypothyroxinaemia threatens the sustainability of the pregnancy and viability of the fetus, as exemplified by obstetric complications and neurodevelopmental disorders in the offspring. Iodine deficiency has re-emerged in Australia with a national study confirming mild iodine deficiency in over 50% of school children. While there are no national data for pregnant women, studies performed in several States have confirmed mild iodine deficiency with daily intake in pregnant women estimated to be half of the recommended intake. There are no studies examining the direct effect of iodine deficiency on pregnancy

outcome. However, recent research data, from Australia and the United Kingdom, have shown an adverse effect on school performance of children born to mothers with mild iodine deficiency. Therefore, it is imperative that all women of reproductive age be made aware of the need for increased iodine intake before and during pregnancy and while breastfeeding. The recommended iodine supplement is 150 µg per day.

KITCHEN CRISIS! MENTAL HEALTH IN O&G 1330 – 1345

Mental Health Screening in the Context of Obstetric Practice Roach V North Shore Private Hospital, Sydney, New South Wales

The perinatal period, which was historically perceived as protective against mental illness, is now recognised as a period of heightened risk. For many, feelings of worry and stress resolve by themselves. But in some, pregnancy and early parenthood can trigger symptoms of more serious mental health problems, including anxiety and depression. The likelihood is greater for women who have had mental health problems before, do not have enough support, are subject to external psychosocial stressors or traumatic experiences in pregnancy or childbirth. However, women with no apparent history can manifest symptoms of anxiety and depression during and/or after pregnancy. The obstetrician in private practice is uniquely isolated in their interaction with a pregnant woman and her family. The infrastructure of midwives, social workers and mental health care providers is not easily accessible. Obstetricians and midwives do not have specific training or clinical expertise in the identification or management of perinatal mental health disorders. Time constraints are a significant barrier to adequate assessment. Furthermore, the inherent co-dependent nature of the obstetrician-patient relationship can inhibit discussion or revelation of mental health concerns. The introduction of Australia’s first antenatal screening program for perinatal anxiety and depression in a private hospital setting will be discussed, with preliminary data suggesting that the program is able to identify women at risk and facilitate follow-up. Patient satisfaction responses will be tabled. The presenter will discuss his personal experience of severe perinatal anxiety and depression in his wife and the impact, both personal and professional.

1345 – 1400

PTSD and Childbirth Bryant R University of New South Wales, Sydney, New South Wales

Posttraumatic stress disorder (PTSD) is the most common psychological disorder to arise following exposure to a traumatic event. It comprises repeated distressing memories of the event, avoidance of reminders of the experience, maladaptive appraisals about oneself and the future, and anxiety. Although traditionally reserved for traumatic experiences, such as war, disaster, and assault, it can also describe psychological responses to traumatic childbirth/pregnancies. PTSD can affect 10%-15% of those who survive a traumatic event, and, accordingly, it is increasingly gaining attention in the domain of traumatic childbirth. This overview will describe the major mechanisms underpinning PTSD, the risk factors for the condition, and how gold standard treatments function. This presentation will also overview the intersection with traumatic grief, which is an overlapping condition that frequently affects parents who manage the psychological effects of bereavement following traumatic loss during childbirth. This overview aims to provide the platform for considering how obstetrics can be informed by better understanding of, preparing for, and responding to, traumatic births by learning from the advances made by PTSD research in recent years. 1400 – 1415

What Can We Do to Minimise Negative Birth Outcomes? Early Identification of Women with Mental Health Morbidity Austin MP Perinatal & Women’s Mental Health Unit, St John of God Hospital; School of Psychiatry, University of New South Wales; Royal Hospital for Women; Sydney, New South Wales

‘Negative birth outcomes’ – range from the obstetric to the psychological, with the two sometimes fusing in an explosive manner. In an age of increasingly high expectations of “perfect” outcomes, much of the impact of a negative birth outcome will be driven by mothers’ unrealistic expectations of themselves and the healthcare system, as well as individual psychological vulnerabilities. Birth plans are increasingly encouraged and may lead to a false sense of control in a situation which may not be controllable. Obstetricians, midwives and healthcare systems will often bear the brunt of unmet expectations when a birth plan goes astray. Getting a psychological understanding of your pregnant patient is a critical first step in minimising perceived or real negative outcomes. Routine psychological assessment in pregnancy is essential and will greatly assist with early identification. Just as it is important to identify obstetric risk factors, there is a

Tuesday Abstracts need to identify psychological risk factors: in particular past reproductive losses; and negative experiences with the healthcare system; women with high level anxiety, perfectionism, need for control, or a sense of their needs never being adequately met. Some women will have a history of sexual trauma which must be addressed in preparation for the very real challenges of advancing pregnancy and delivery. Women who become severely depressed or psychotic in pregnancy will also present major challenges and must be quickly referred on for psychiatric care. Early identification of mental health morbidity in conjunction with judicious referral is the key. Practical suggestions, illustrated with examples, will be highlighted. 1415 – 1430

Postnatal Psychosis Boyce P Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School and the Department of Psychiatry, Westmead Hospital, Westmead, New South Wales

The onset of a psychotic disorder following childbirth has been described for centuries. Studies that have examined the association between childbirth and psychiatric admissions have consistently identified that 1-2 women/1000 confinements will have a psychotic disorder within the first month postpartum. The nature of this disorder has been controversial, but recent studies suggest that the disorder is a variant of bipolar disorder. Women who have had a postpartum psychosis, and women with pre-existing bipolar disorder are at high risk of having a relapse in the three weeks following childbirth. Preventing women from having such a relapse is a key goal in perinatal psychiatry. Relapse prevention involves preconception counselling to discuss the safety of medications, careful clinical management during pregnancy and putting in to place strategies to ensure women can maintain a stable sleep wake cycle in the first three weeks postpartum. In this presentation, the clinical features of postpartum psychosis (puerperal psychosis) will be described and possible mechanisms for relapse will be discussed. The safety of mood stabilisers, in particular sodium valproate, to the developing fetus will be reviewed. The use of lithium to prevent relapse and how lithium should be managed during pregnancy and around parturition will be reviewed.

1430 – 1445

The Impact of Surgical Morbidity on the Surgeon Daborn P King Edward Memorial Hospital, Perth, Western Australia

Surgical complications occur in all clinical practice. How the surgeon psychologically responds to the adverse events is a topic that is infrequently discussed and inadequately reported in the literature. This talk will address some of the relevant factors. The stages of the psychological response include the “kick”, the fall, the recovery and the long-term impact. Counterfactual thinking affects recovery and various models will be analysed. Difficulty to disclose the error, appropriate training, supports and structures will also be covered. Strong emotions evoked by a complication may become imprinted in the memory of the surgeon and potentially influence future decision making. Longterm potential consequences include worsening of reactions over time and burn out.

FORUM: ROBOTICS IN GYNAECOLOGICAL SURGERY – CAN WE AFFORD TO, CAN WE AFFORD NOT TO? 1615 – 1630

Robotic-Assisted Gynaecological Surgery for Benign Disease in ANZ – or the Patient or the Doctor?

costs associated with the robotic-assisted procedures. There may be advantages in hospital stay compared with an abdominal approach. Consideration of the long-term benefits of robotic-assisted procedures is yet to be evaluated. This includes the progression of skill acquisition (open > laparoscopic > robotic-assisted) and the capacity for health care providers to support the costs. As costs reduce with greater competition in the provision of the capital, there may be additional benefits. Costs were a substantial consideration when laparoscopy was introduced into main-stream surgery and has a welldocumented cost-benefit. This largely relies on the time to discharge – down to a day for many procedures. It is hard to imagine that there could ever be substantive reductions in time associated with robotic-assisted surgery, using laparoscopy as a comparator. The other major discussion point is around longevity of the surgeon due to the ergonomic advantages in the seated operating position for a long duration. In Australia and New Zealand, the mean age of Fellows reflects that few gynaecologists are retiring early and continue practicing well into their 60’s. The question remains as to whether this should be further increased. The actual risk of injury due to occupational causes is not yet known. Conclusion: There are few data to support the use of robotic-assisted gynaecological surgery for benign disease from a clinical perspective. Operative times are greater and there is no change in complication rates. Costs are also greater with this modality of surgery.

Abbott J

1630 – 1645

School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales

Robotically Assisted Hysterectomy for Benign Disease: Is There an Economic Argument?

Background: Robotic assisted gynaecological surgery is a new procedure with just over 300 citations in the world literature to date. The main advantage vaunted is a reduction in post-operative stay when comparing robotic and abdominal hysterectomy (largely USA data) where more than 2/3 of hysterectomies are done by this route. In Australia, 2/3 of hysterectomies are undertaken by the laparoscopic or vaginal routes and the superior training in these minimally invasive modalities is evidence in this case mix. Interventions: Given the expense associated with both capital and consumable costs, there needs to be clearly defined benefits for the performance of robotic-assisted surgery compared with other modalities for both hysterectomy (the procedure with most data available) and other benign gynaecological diseases such as myomectomy, pelvic floor surgery including sacrocolpopexy and advanced endometriosis surgery. Discussion: To date, there are no reported clinical benefits that show superiority of robotic-assisted gynecologic procedures compared to laparoscopic procedures, with a longer operative time and higher

Chambers G1* 1 National Perinatal and Epidemiology Research Unit (NPESU), School of Women’s and Children’s Health, The University of New South Wales, Sydney, New South Wales 2 School of Women’s and Children’s Health, The University of New South Wales, Sydney, New South Wales

Hysterectomy for benign gynaecological disease is one of the most commonly performed procedures for women in Australia, and one that has been proposed as a candidate for robotically assisted surgery. In this study we report on the economic feasibility of robotic-assisted versus laparoscopic hysterectomy in the Australian setting. A decision-analytic model was constructed to undertake a cost-minimisation study of the two alternatives, given that the short term outcomes of each surgery method are equivalent. To inform the model we obtained data on all hysterectomies performed for benign disease at the Royal Hospital for Women (RHW) over a 12 month period including operating times, length of stay, blood transfusions, conversion rates to abdominal hysterectomy, and hospital operating and

stay costs. These were modelled against published estimates for robotic-assisted hysterectomy based on the purchase, maintenance and consumable costs for the da Vinci Si System (Intuitive Surgical, Inc, Sunnyvale CA). Sensitivity analyses were used to assess the affect of varying surgical volumes, and clinical and cost parameters. 1645 â&#x20AC;&#x201C; 1700

Robotic Surgery in Gynaecological Oncology Oehler M Department of Gynaecological Oncology, Royal Adelaide Hospital, Adelaide, South Australia

Robotic surgery is the latest innovation in the field of minimally invasive surgery. It provides superior visualisation and dexterity and therefore allows to perform complex tasks that are difficult to master with conventional laparoscopy and are associated with increased morbidity if performed by laparotomy. Current evidence establishes the role of robotic surgery in the treatment of gynaecological malignancies, especially with the distinct advantages it offers over management by open surgery. Most reports have supported the equivalence of robotic surgery and laparoscopy in many perioperative outcomes. However, robotic surgery has advantages over laparoscopy in the learning curve required to perform oncological procedures and allows a minimally invasive approach in morbidly obese patients. Another advantage of robotics is the more ergonomic position of the surgeon, reducing discomfort and fatigue and potential musculoskeletal occupational injury associated with conventional laparoscopic procedures. Existing data point towards a higher cost of robotics when compared with laparotomy or traditional laparoscopy. Careful procedure and patient selection reserving robotic surgery for complex oncological cases can improve the cost-benefit calculation. Furthermore, a decrease in the costs of robotic surgery can be expected with new technological developments and more market competition in the near future. Robotic surgery significantly expands the minimally invasive surgical options for women undergoing operations for gynaecological cancer.

Wednesday Abstracts BREAKFAST SESSIONS: FAST FOOD & FAST FACTS #3

0730 – 0810

Condous G

Thymic Ultrasound and Pre-eclampsia Prediction

The acute gynaecology model of care is an extension of the ultrasound-based model of care for women with early pregnancy complications. The use of transvaginal ultrasound at the primary clinical interface reduces both the admission rates and occupied bed stays for women attending such a service. In this symposium, I will discuss the set up and rationale for the introduction of this model of care for women with acute gynaecology problems.

Benzie R Abstract not available at time of printing. 0730 – 0810

Caesarean Delivery on Demand Arulkumaran S St George’s University of London, United Kingdom

Women request CS for the following non-medical reasons; fear of pain of labour – tokophobia; maternal or fetal injury or mortality; past poor medical experience or poor outcome; psychological – past sexual abuse / fear of loss of autonomy; concerned about long-term outcomes; urinary or faecal incontinence – poor quality of sexual life; timing of birth to suit husband/ partner/ family/ work. The following are the reasons for physicians debating or reluctant to perform CSMR; rising CS rate and its consequences; concerned about morbidity and mortality associated with primary CS and subsequent pregnancy, labour & delivery; cost implications to the practice and the individual; confusing evidence regarding short and long-term complications to the mother (urinary and faecal incontinence); fetal and neonatal complications. WHO performed a global Health Survey to assess safety. This study conducted in 24 countries from 2004 to 2008 revealed that CS is associated with an intrinsic risk of increased severe maternal outcomes. It concluded that CS should only be performed when a clear benefit is anticipated. Obvious benefits of CS on MR are; scheduling benefits, fewer uncertainties, reduced induction of labour, episiotomy or perineal trauma, painful and difficult labour; baby less exposed to drugs, manipulation and less incidence of fetal deaths, miscellaneous maternal benefits that are claimed; decreased risk of anal sphincter damage reported as 30-60%, urinary incontinence OR of vaginal delivery vs C/S, three fold, pelvic organ prolapse – 50% of vaginally parous women, sexual dysfunction – Lax vagina/prolapse/scarring/nerve damage. Maternal immediate risks are infection, bladder and ureteric injury, admission to ITU, haemorrhage, anaesthetic risks and death. Delayed risks are thromboembolic disease, hospital readmission, postoperative adhesions/ pain and incisional hernias. CSMR is a privilege and not a right, till such time definitive benefits could be demonstrated.

Managing an Acute Gynaecology Service

Transverse vaginal septae can be of varying thicknesses, and complete removal is essential to try to prevent a stenotic ring at the site of surgery. For thick transverse vaginal septae, a combined abdominoperineal procedure is often required.

IAN MACDONALD MEMORIAL ORATION 0830 – 0900

Evidently, Evidence in Obstetrics is Essential Crowther C Abstract not available at time of printing.

0730 – 0810

Mullerian Fusion Failures: The Lower Third Deans R

WHO’S IN THE KITCHEN? MODELS OF CARE IN O&G

University of New South Wales, Royal Hospital for Women and Sydney Children’s Hospital, Sydney, New South Wales

0900 – 0920

The cause of Müllerian anomalies is unknown. It is assumed that there has been failure of fusion of the two Müllerian ducts, failure of one or both ducts to develop, or failure of resorption of the areas of Müllerian duct fusion. The spectrum of anomalies is wide. Around 75% of women will remain asymptomatic. The remaining 25% will present in a variety of ways. Müllerian anomalies may present with primary amenorrhoea, cyclical abdominal pain (obstruction to menstruation), severe dysmenorrhoea (obstruction to menstrual drainage from one Müllerian duct, e.g. the non-communicating rudimentary horn associated with a unicornuate uterus), pelvic mass – haematocolpos (vagina distended with menstrual blood) or haematometra (uterus distended with menstrual blood), menorrhagia, dyspareunia (transverse or longitudinal vaginal septae), infertility and recurrent miscarriage, as well as ectopic pregnancy, and obstetric complications, e.g. preterm birth, abnormal lie and uterine rupture. The investigation of Müllerian anomalies includes an assessment of the internal and external uterine contours. Ultrasound, MRI and hysterosalpingogram are often used, sometimes in association with laparoscopy or hysteroscopy. Imaging of the renal tract is also indicated. Management of these anomalies depends on the type of anomaly and the presenting features. Symptomatic uterine and longitudinal vaginal septae can be resected hysteroscopically. The horns of a bicornuate uterus can be joined by an abdominal metroplasty. Any form of obstruction to menstrual flow requires surgery to relieve the obstruction and prevent pain and endometriosis. The didelphic uterus is often associated with vaginal septae that can lead to unilateral obstruction and requires careful vaginal surgery to remove the septum.

Tracy S

Caseload Midwifery and Beyond Abstract not available at time of printing. 0920 – 0940

Mixed Models of Obstetric Practice Pesce A Abstract not available at time of printing. 0940 – 1000

Unwarranted Clinical Variation. A Health Care Dilemma McCaughan B Chair, Board of ACI and CEC New South Wales

Variation is a normal part of clinical practice determined by the nature of the condition being treated and the condition of the patient. Unwarranted clinical variation (UCV) is that variation that cannot be explained by the condition or the preference of the patient; it is the variation that can only be explained by difference in health system performance. By any measure, there is too much UCV in terms of both process of care and outcomes of care and there is too much tolerance of it. UCV is often dismissed as conspiracy theory, random theory, sickest theory, money theory or the better theory. Analysing a wide range of data sources there is evidence of UCV in all dimensions of quality in health care delivery in equity of access, appropriateness of care, effectiveness, efficiency, safety of care and consumer focus What is the “right” rate of intervention such as coronary artery stenting, Caesareans, myringotomies.

Why are some conditions rarely admitted to hospitals in some jurisdictions but commonly in others such as emphysema and heart failure. Why does the length of stay for the same conditions vary so much in hospitals only kilometres apart? Why are consumer perceptions so variable from hospital to hospital? Why is the mortality so different for the same conditions treated at different hospitals? To minimise UCV we need acceptance of the problem and what it costs, system wide changes in models of care, transparent, accurate, timely comparative data, loss of clinical autonomy, effective clinical governance and consultant led coordinated multidisciplinary care. 1000 – 1020

What are the Drivers for Variation in Practices, Costs and Outcomes? Pollock C Abstract not available at time of printing.

THE OVEN’S BROKEN! THE UTERUS IN O&G 1100 – 1115

pregnancy outcome were obtained from the obstetric birth registry. After delivery, risks for early onset (delivery prior to 34 weeks) pre-eclampsia, late pre-eclampsia and gestational hypertension were calculated using the FMF risk algorithm. Screening efficacy for prediction of early pre-eclampsia was calculated. Results: A total of 3,099 women were screened and delivered locally. 3,066 (98.9%) women had all data to perform pre-eclampsia screening available. This included 3,014 (98.3%) women with a live birth, where risks for early pre-eclampsia were calculated. Twelve women were delivered before 34 weeks because of early pre-eclampsia with a prevalence of early pre-eclampsia of 1 in 256 pregnancies. Risks generated through the use of maternal history, MAP, UtA PI and PAPP-A detected 41.7% and 91.7% of early pre-eclampsia at a false positive rate of 5% and 10% respectively. Conclusions: This study shows that the FMF early pre-eclampsia algorithm is effective in an Australian population. 1115 – 1130

sFLT and Endoglin: Third Trimester Markers for Pre-eclampsia Hennessy A Abstract not available at time of printing.

Predicting Risk of Pre-eclampsia From First Trimester Screening

1130 – 1145

Park F1,2*, Leung C2, Poon L3,4, Williams P5,6, Rothwell S1, Hyett J1,2

Ford JB1*, Roberts CL1, Morris JM1,2

1 Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales 2 Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales 3 Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom 4 Department of Obstetrics and Gynaecology, St Mary’s Hospital, London, United Kingdom 5 Discipline of Medicine, University of Sydney, Sydney, New South Wales 6 Endocrinology Laboratory, Royal Prince Alfred Hospital, Sydney, New South Wales

Background: The aim of this study is to validate the Fetal Medicine Foundation (FMF) multiple logistic regression algorithm for prediction of risk of pre-eclampsia in an Australian population. This model, that predicts risk using the population rate of pre-eclampsia, a variety of demographic factors, mean maternal arterial blood pressure (MAP), uterine artery PI (UtA PI) and Pregnancy Associated Plasma Protein A (PAPP-A), has been shown to predict early onset pre-eclampsia (delivery prior to 34 weeks) in 95% of women at a 10% false positive rate. Methods: All women who attended first trimester screening at the Royal Prince Alfred Hospital had their BMI, MAP and UtA PI assessed in addition to factors traditionally used to assess aneuploidy (including PAPP-A MoM). Details of

Acute Triggers of Pre-eclampsia 1 Kolling Institute of Medical Research, University of Sydney, New South Wales 2 Royal North Shore Hospital, St Leonards, New South Wales

Pre-eclampsia complicates 2-8% of pregnancies in New South Wales. While some women appear to be at increased risk, it is unknown what triggers onset of symptoms in susceptible women. An important question is ‘why did this woman develop pre-eclampsia this week rather than last week?’ We are using a novel case-crossover design to investigate acute triggers for pre-eclampsia among women presenting to hospital with new onset pre-eclampsia. The design is similar to a case-control study, however, cases also act as their own controls. This approach is of particular merit for time-sensitive events and transient exposures. In our study, women are being asked via questionnaires about a range of exposures occurring over the previous two weeks. To date, 230 of 315 women have been recruited. If associations between triggers and timing of pre-eclampsia onset are found, this can inform preventive strategies including educating women about risky behaviours/ environments in late pregnancy. In the absence of demonstrated associations, women can be reassured that specific behaviours/ activities are not related to timing of pre-eclampsia onset.

1145 –1200

Diagnosis of Fetal Growth Reestriction: To Customise or Not? Odibo A Professor of Obstetrics and Gynecology Washington University in St. Louis, MO, USA

The ideal criterion for the diagnosis of fetal growth restriction is a significant prenatal challenge. Traditional definitions have been based on using estimated fetal weight less than the 10th percentile based on population growth standards. Recently, customised growth standards that adjust for maternal anthropometric measurements and ethnicity have been proposed. The talk will review the advantages and limitations of each approach. 1200 – 1215

Late Onset Fetal Growth Restriction Walker SP* Mercy Hospital for Women, University of Melbourne, Victoria

That over half of term stillbirths are growth restricted at delivery is certainly ‘food for thought’, and that less than one third of growth restriction at term is detected antenatally constitutes a ‘recipe for disaster’. Our clinical tools for determining whether the ‘oven is broken’ are poor; measurement of symphysis fundal height has only a 17% sensitivity – and 20% positive predictive value – for detection of term fetal growth restriction. In this session, we will discuss potential inroads to improving the detection and management of placental insufficiency causing late onset fetal growth restriction. Clinical interpretation of ultrasound derived fetal weight estimates may be improved by using customised growth charts, although the limitations of customisation need to be appreciated. Slowing of fetal growth trajectory in late pregnancy may also be an important indicator of placental insufficiency. Other ultrasound parameters, such as Doppler interrogation of the fetal middle cerebral artery, may be of benefit to identify ‘downstream’ indicators of ‘upstream’ placental insufficiency. While existing biomarkers have poor sensitivity for the detection of late onset fetal growth restriction, mRNA transcripts in maternal blood have exciting biomarker potential. When do we decide to take the bun out of the oven? In the post DIGITAT era, is there ever a place for continuing the pregnancy with suspected late onset fetal growth restriction? If so, what form of fetal surveillance is necessary, and- if notwhat steps can be taken to minimise the maternal and fetal hazards of early delivery.

Wednesday Abstracts WHAT’S THE RECIPE? NEW DIAGNOSTICS IN O&G 1100 – 1115

Evaluation of Ovarian Reserve Hunter T 1 Fertility Specialists of Western Australia, Perth, Western Australia 2 King Edward Memorial Hospital, Perth, Western Australia

In Australia, the average age at first birth for a woman has now surpassed 30 years. Considering this trend for family postponement, combined with the increased demand for assisted reproduction, assessment of ovarian reserve has become a key component of patient counselling and management. Patients and clinicians now demand a reliable and predictable evaluation of their ovarian reserve and fertility potential in making decisions regarding their reproductive future in everything from oncologic to social settings. This review examines the varied markers of ovarian reserve from clinical (age, menstrual cycle) to endocrine (FSH, estrogen, inhibin B, AMH, dynamic tests) to ultrasonographic (antral follicle count, ovarian size). The accuracy, reliability, limitations and usefulness of these markers are discussed in this presentation and the place of ovarian reserve testing in reproductive medicine is examined. 1115 – 1130

Screening Embryos for Single Gene Defects Stock-Myer S, Wilton L Abstract not available at time of printing. 1130 – 1145

Aneuploidy Screening in 2013 Traversa M*, Leigh D Genea, Sydney, New South Wales

Debate on the efficacy of aneuploidy screening of embryos reached a peak several years ago. With recent reports though, there is ample demonstration that the impact on transfer outcomes is not only measurable but also quite substantial. The debate now has shifted to the impact of the biopsy process with several reviews questioning the efficacy of the different approaches. Aneuploidy screening in IVF patients has been widely applied in an attempt to improve implantation rates and birth outcomes with individual clinic approaches varying in culture system, biopsy stage, test type, analysis and general experience levels. These differences may be the critical contributors for successful application of PGD procedures and provide answers to questions regarding past performance. New studies have now substantiated earlier work which highlighted a potential negative impact on embryo implantation 60

when using cleavage stage biopsy. Increasing acceptance of and experience with blastocyst stage biopsy has led to accumulating evidence of improvements in embryo selection, implantation rates and pregnancy outcomes. Additional advantages in technical aspects such as sample selection, sample size and resulting test robustness are also apparent. Several new technological advances, with regards to studying changes at the chromosome and DNA level, permit newer techniques more in-depth and extended analyses and have brought with them the capacity for complete chromosome screening thus providing a genuine test advantage. Testing all chromosomes allows exclusion of any gross chromosomal abnormality so that a bona fide improvement in implantation potential is now possible. The use of blastocyst biopsy coupled with comprehensive chromosome analysis is now fast becoming the new standard of PGD aneuploidy screening and brings with it a larger positive impact on implantation and birth outcomes than ever before seen. 1145 – 1200

Free Fetal DNA Anueploidy Screening McLennan A1,2 1 Sydney Ultrasound for Women, Discipline of Obstetrics and Neonatology, University of Sydney, Sydney, New South Wales 2 Maternal Fetal Medicine Unit, Royal North Shore Hospital, Sydney, New South Wales

Non-invasive prenatal testing (NIPT) for aneuploidy using cell-free DNA in maternal plasma is revolutionising prenatal screening and diagnosis. There are a number of NIPT methodologies currently employed, including wholegenome sequencing, targeted sequencing and assessment of single nucleotide polymorphism (SNP) differences between mother and fetus. Several, mainly retrospective, studies have demonstrated the efficacy of NIPT for Down and Edwards syndromes and, to a lesser extent, Patau syndrome and sex aneuploidy, mostly in high-risk women. It is important to recognise that NIPT is not a diagnostic test but is an advanced screening test with small false positive and false negative rates. Consequently, positive NIPT results must be confirmed using invasive prenatal testing techniques. Universal NIPT does not appear to be cost-effective, but using NIPT in a contingent fashion in women found to be at intermediate risk by conventional combined first trimester screening is cost-effective. Established screening using fetal nuchal translucency, placental biochemistry, fetal structural ultrasound and invasive procedures with microarray testing allow the detection of a broad range of additional abnormalities not yet detectable by NIPT. Using the SNP technique opens up a range of testing possibilities, potentially allowing the identification of triploidy, uniparental disomy and separate

evaluation of dizygotic twins. Fetal fraction enrichment, improved sequencing and selected analysis of the most informative sequences should result in tests for additional chromosomal abnormalities in the near future. This presentation will review the role of NIPT in the context of established screening and invasive technologies, outline the range of cytogenetic abnormalities detectable and highlight the counseling, technical and ethical issues involved. Providing adequate prenatal counseling is clearly a growing challenge given the range of prenatal screening and testing options now available. 1200 – 1215

Tests to Assess Tubal Patency in Subfertile Women Mol BW Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Diagnostic tests for tubal patency are usually planned as last tests in the work-up for subfertility. The reasons for postponement of these tests are several fold. They are invasive procedures, uncomfortable to women, need to be planned and generate healthcare costs. Because of their invasive nature, complications such as infection or injury to the genital or internal organs can occur. Also, a planned invasive test may have become unnecessary, because natural conception has occurred after the first consultation of a couple but before the planned diagnostic test has been performed. However, early patency tests are warranted in women at high risk for tubal pathology because in women with bilateral tubal pathology, natural conception is severely reduced and undue delay in referral for surgery or IVF can be prevented. For this reason, early identification of women at high risk and those at low risk for tubal pathology is of importance. At present, guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing. In view of the more prominent role of IVF, the question is whether one should invest in invasive and costly procedures such as HSG and laparoscopy, or do a very basic work up, as IVF will be the treatment of choice anyhow. In the evaluation of the costeffectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment, we evaluated six scenarios: 1) no tests and no treatment; 2) immediate treatment without tubal testing; 3) delayed treatment without tubal testing; 4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); 5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and 6) DL followed by tailored treatment. The outcome was expected cumulative live births after three years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio.

For a 30 year old woman with otherwise unexplained subfertility for 12 months, three-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6,968, €5,063, €5,410, €5,405 and €6,163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. The most cost-effective scenario was to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more costeffective than DL.

OBSTETRIC HOTSPOT: EVIDENCE IN O&G 1400 – 1415

Decreasing the Obstetric Workload: Contraceptive Conundrums Foran T School of Women’s and Children’s Health, University of New South Wales, Kensington, New South Wales

This presentation will use a series of case studies in order to explore the issues involved in tailoring contraceptive choice to an individual woman’s needs. It will examine the usefulness of the WHO Medical Eligibility Criteria when considering medical contraindications to contraceptive use and will also briefly cover some of the more common non-contraceptive benefits of hormonal contraception. 1415 – 1430

ELLA MACKNIGHT MEMORIAL LECTURE

When is a Placenta Truly “Low Lying”? Odibo A

1330 – 1400

Amniotic Fluid Cell-free RNA: A Novel Source of Information About Human Development Hui L Mercy Health, Ivanhoe, Victoria

Recent advances in molecular biology are transforming the landscape of fetal medicine. DNA-based techniques, such as non-invasive prenatal testing for fetal aneuploidy using next-generation sequencing, have already impacted clinical care. These DNA-based techniques provide diagnostic information about the fetal genome, which is static. RNA, contrast, is dynamic and reflects gene expression during specific health and disease states. Gene expression studies of the human fetus are understandably restricted due to ethical limitations on sample collection. However, amniotic fluid supernatant, which is routinely discarded after diagnostic testing, contains cell-free fetal RNA. This biofluid has only recently been recognised as a rich source of information about normal and abnormal human development. The application of high dimensional biology techniques to amniotic fluid cellfree fetal RNA has provided new insights into the fetal pathophysiology associated with aneuploidy, twin-twin transfusion syndrome and maternal obesity. Ultimately, the goal of this approach is to improve pregnancy outcomes. The identification of a candidate antenatal therapy for Down Syndrome that may improve fetal neurogenesis and postnatal cognitive outcome is an exciting example of the enormous translational potential of this research.

Department of Obstetrics and Gynecology, Washington University, St. Louis, MO, United States of America

Placental previa is a common cause of antepartum hemorrhage and contributes significantly to perinatal and maternal mortality and morbidity. While the diagnosis is high in the second-trimester, majority resolve by the early thirdtrimester. The talk will review the diagnosis of placenta previa and controversies regarding the use of the term “low-lying” placenta. 1430 – 1445

Obesity and Pregnancy: An Update Callaway L School of Medicine, The University of Queensland and The Royal Brisbane and Women’s Hospital, Brisbane Queensland

Obesity is arguably the most important public health problem encountered in the delivery of pregnancy care in Australia at present. Well over 60% of all pregnant women are overweight and obese in some jurisdictions across Australia. This translates to increased rates of adverse maternal, perinatal and neonatal outcomes. Further, there is a significant economic burden associated with caring for obese pregnant women. Ultimately, it would be ideal to re-divert resources spent on the complications of obesity to preventative measures. However, at present, much work is required to find successful preventative strategies for at risk communities. This talk will review the epidemiology of obesity in pregnancy, examine the current evidence for the management of obese pregnant women, review areas of controversy and highlight areas for further research and consideration.

1445 – 1500

The Intra-partum Management of Breech Presentation 10 Years Post Term Breech Murray H G John Hunter Hospital, Newcastle, New South Wales

After publication of the ‘Term Breech Trial’ in 2000, elective caesarean section has been widely adopted as the delivery method of choice for women presenting with a persistent breech presentation at term. However, given the considerable issues with the trial itself, the follow-up of the children from the trial, and the risks posed by LUSCS to mothers in future pregnancies, it seems reasonable to question the original conclusions and the way practice was allowed to radically change. Data from well conducted trials by experienced obstetricians suggest that there is a place to offer women the option of a planned vaginal breech delivery at term provided strict selection criteria are met. Guidelines from RANZCOG, ACOG, SOGC, and RCOG published in the last eight years are similar in the advice about the management of the term breech. Such management includes complete assessment of the status of the fetus, consideration of ECV in experienced hands, and the offer of breech delivery in units with sufficient expertise in carefully selected cases. Whether this option of breech delivery is offered or not, teaching vaginal breech delivery and ECV must continue to remain an integral part of the trainee program given a) the possibility of the unexpected rapid multiparous breech delivery, and b) the findings of the twin trial that demonstrated that uncomplicated twin delivery does not benefit from the use of caesarean section even with the second twin presenting by the breech. The processes that brought about the demise of vaginal breech delivery raise questions about the acceptance of ‘evidence’ in the discipline of obstetrics. There is a need for debate as to how the conclusions of trials should be interpreted and used to alter well established practice in the future. 1500 – 1515

Recurrent Miscarriage: Do First Trimester Interventions Work? Koch J Abstract not available at time of printing.

Wednesday Abstracts GYNAECOLOGY HOTPOT: ISSUES IN O&G

1430 – 1445

1400 – 1415

Bradford J

Vulval Dermatoses for the Generalist

Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales

Fischer G

Royal North Shore Hospital, The Northern Clinical School of the University of Sydney St Leonard’s, New South Wales

The vulva is part of the skin and many conditions causing vulval symptoms are skin diseases that gynaecologists may not be very familiar with. Despite this, patients with such symptoms are frequently referred to gynaecologists, or their problem may be noted when they are referred for something else. The commonest dermatoses involving the vulva include psoriasis, lichen sclerosus, atopic and seborrhoeic dermatitis, chronic vulvovaginal candidiasis and allergic reactions to topically applied substances and drugs. This presentation will familiarise gynaecologists with basic dermatology as it affects the genital region: clinical presentation, investigation and basic management, including safe use of topical corticosteroids, will be covered. 1415 – 1430

Management of Early Vulvar Cancer

Gynaecological Management of Cancer Survivors

This talk will focus on entry dyspareunia. The diagnosis and management of entry dyspareunia after treatment for cancer is essentially no different from other clinical situations. However, an understanding of specific cancer treatments is important, especially chemotherapeutic, endocrine and immuno-modulating drugs and their potential impacts on genital skin. Patients are frequently rendered menopausal by their treatments, but other factors such as sarcogenic obesity may influence their hormonal situation. Entry dyspareunia is often multifactorial, and the pelvis in its entirety must be considered before an adequate assessment can be made. It is helpful to enquire about symptoms in the following groups: • urological • vulvo-vaginal • ano-rectal • lumbo-sacral spine, and hip • psychological/ relational. Once a set of accurate diagnoses is established, a rational management plan can then be implemented.

Hacker N Royal Hospital for Women and School of Women’s and Children’s Health, University New South Wales, Sydney, New South Wales

The incidence of VIN has been rising, but this will decline with the HPV vaccination program. The clinical appearance of VIN is variable, and any abnormal area on the vulva should be biopsied to allow definitive diagnosis. VIN should generally be excised with margins of about 5mm. If invasive vulvar cancer is diagnosed the treatment should be individualised. It is important to determine the optimal management of (i) the primary lesion and (2) the groin lymph nodes. Colposcopy of the entire lower genital tract should be performed to determine the extent of any associated intraepithelial neoplasia in the cervix, vagina or remaining vulva. The primary lesion will be adequately treated by a radical local excision, with skin margins of at least 1cm. Depth of excision should be to the deep fascia. Lesions greater than 2cm in diameter, or with more than 1mm stromal invasion, require at least an ipsilateral inguinal-femoral lymphadenectomy. Sentinel node biopsy has been introduced in recent times to decrease the incidence of lymphedema, but the patient needs to fully understand the small but definite risk of death from groin recurrence, due to a false-negative sentinel node.

1445 – 1500

Endometrial Diagnosis of Endometriosis Hey-Cunningham A Queen Elizabeth II Research Institute for Mothers and Infants, Department of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales

Currently definitive diagnosis of endometriosis relies on surgical intervention, which is not only invasive but also costly and operator dependent. There is frequently considerable delay, averaging up to eight years, from onset of symptoms to clinical diagnosis of endometriosis1. There is a clear need for a simple and reliable diagnostic test for endometriosis. While the precise pathophysiology of endometriosis remains unclear, there is mounting evidence that eutopic endometrium in women with endometriosis is fundamentally different to the endometrium of women without the disease. The eutopic endometrium from women with endometriosis shows decreased apoptosis and defective immune-surveillance; along with increased adhesiveness, proteolytic activity, angiogenic potential, proliferation, oestrogen production and neurogenesis2. These characteristics are hypothesised to facilitate increased survival of endometrial tissue in ectopic locations, lesion establishment and growth, and generation of pain symptoms.

Endometrial differences in endometriosis have considerable potential to be utilised in development of endometrial diagnostic approaches for endometriosis. This is clinically feasible with collection of endometrial samples from outpatients without the need for anaesthesia, using a narrow suction curette. Diagnosis of endometriosis by endometrial biopsy has been investigated by a number of groups around the world using a range of approaches including genomics, proteomics and histology. Various single markers and combinations have been tested, including the presence of nerve fibres3, aromatase expression4, and protein expression profiles5. A definitive endometrial biomarker that can practically replace the current gold standard of laparoscopic diagnosis has not yet been identified. However, several of the identified endometrial anomalies in endometriosis show promise as candidates for endometrial diagnosis of endometriosis in future. References: 1 Ballard K, et al. Fertil Steril 2006; 86:1296-1301. 2 Al-Jefout M, et al. Expert Rev Obstet Gynecol 2009; 4:61-79. 3 Al-Jefout M, et al. Hum Reprod 2009; 24:30193024. 4 Dheenadayalu K, et al. Fertil Steril 2002; 78:825829. 5 Kyama CM, et al. Fertil Steril 2011; 95:1338-1343. e1333.

1500 – 1515

AUB Alphabet Soup: Can FIGO’s PALM-COEIN System Bring Order to Chaos? Munro M Departments of Obstetrics & Gynecology, David Geffen School of Medicine, UCLA; Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States of America

Investigation and management of the clinical problem of abnormal uterine bleeding (AUB) in the reproductive years has been plagued by a relatively vast spectrum of inconsistently used nomenclature and the lack of a generally accepted system for classification of causes that facilitates education, research, and the design and interpretation of both basic science and clinical investigation. This presentation describes an ongoing process that was designed to address these issues and conducted under the aegis of FIGO (International Federation of Gynecologists and Obstetricians), involving experts and clinicians from six continents using a combination of evidence and modern consensus building techniques and tools. The result is a standardised but flexible pair of systems – one for nomenclature and one for the classification of potential causes of AUB in the reproductive years. The nomenclature system for description of menses and menstrual bleeding symptoms replaces now-rejected terms such as menorrhagia, metrorrhagia, menometrorrhagia, and dysfunctional uterine bleeding with a set of four parameters (frequency, regularity,

duration and volume) that are further characterised by one of three modifiers (eg normal, increased, decreased). The classification system is organised around the “PALM-COEIN” acronym (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified); any given patient with AUB may have one or more of the potential contributing factors. Included is an exemplary subclassification system for leiomyomas, an expansion of the existing ISGE system. The systems have been approved by the FIGO Executive Board and they have also been endorsed by the American College of Obstetricians and Gynecologists (ACOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC) and other national organisations and societies. It is hoped that these two systems will serve to facilitate communication amongst professional and lay populations and to improve the precision and reduce the confounding inherent in many clinical trials.

FORUM: POST-PARTUM HAEMORRHAGE IS NOT A MALIGNANT CONDITION! EVIDENCE AND DEMARCATION IN O&G 1600 – 1615

The Obstetrician’s Point of View Arulkumaran S St George’s University of London, United Kingdom

Malignant condition is an abnormal growth from a tissue that invades other tissues locally and could metastasise distally to give rise to complications; threat to health and life if not diagnosed and treated early. PPH may end in maternal illness or death if not detected and treated early. This may be due to abnormal placentation i.e. placenta accrete / percreta when placenta invades adjacent tissues and result in PPH and may necessitate removal of the uterus – akin to a malignant condition. Vast majority of massive PPH is due to uterine atony. Knowledge from confidential inquiries suggests prostaglandins should be used when there is no response to ergometrine and oxytocin infusion. During PPH, vast amount of clotting factors are utilised and lost with the bleeding. The lack of clotting factors, activation of fibrinolysis, large infusion of fluids, metabolic acidosis and hypothermia leads to coagulopathy and should be controlled with tranexamic acid, fibrinogen concentrate and other clotting factors or 1:1 RBC/PC to Plasma transfusion. Adequate blood and fluids need to be transfused to maintain the circulation and to prevent shock. Shock is proportionate to blood loss. Her Hb prior to PPH is a determinant of outcome. Failure of medical therapy is followed by aortic compression, anti-shock garment and ‘Tamponade Test’; once trauma and retained tissue are excluded. Patient should have broad-spectrum antibiotics

and oxytocin infusion. If the tamponade fails compression sutures should be employed. Failure of this should lead to systematic devascularisation or ligation or embolisation of the anterior branch of the internal iliacs. Failure to arrest haemorrhage should prompt sub-total or total hysterectomy. This sequence of ‘HAEMOSTASIS’ is effective. In placenta accrete/percreta hysterectomy or wedge resection and reconstruction of the uterus or a conservative approach can be utilised. 1615 – 1630

The Gynaecologist’s Point of View Munro M Departments of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA; Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States of America

In many developed countries the rate of maternal mortality is increasing; in the state of California the rate of maternal death rose from eight to 14 per 100,000 live births between 1999 and 2008, probably secondary to an increasing prevalence of obesity and other comorbidities, and, perhaps an increased risk of peripartum haemorrhage in part related to the rising incidence of Cesarean Section. Previously, hysterectomy was the principle method used for intractable postpartum haemorrhage that was most commonly related to uterine atony, but its use for this indication has been reduced in part because of improvements in pharmacological agents, and, perhaps, by additional procedures such as interventional radiological arterial embolisation, and techniques such as intrauterine balloon tamponade, O’Leary style ligation of the uterine arteries, and the B-lynch compression sutures. The incidence of intrapartum hemorrhage for disorders of placentation is increasing, especially placenta previa and accrete/ increta, reflecting the increased use of cesarean section and other prepregnancy procedures such as myomectomy. These entities may not be as responsive to medical and some conservative surgical interventions. The introduction the spectrum of new techniques, in combination with reduced training time for residents or registrars who increasingly depend on minimally invasive techniques for gynaecologic interventions may undermine the safety and efficacy of peripartum hysterectomy when performed by the “general obstetrician”. Such a circumstance would create either the need for additional training of general obstetricians, or demand the ready availability of gynaecological surgeons with expertise in peripartum hysterectomy for the patient who fails or is inappropriate for the other techniques, or, when, for example, IR embolization is not available. Such an approach creates a number of logistical issues, as the availability of such surgeons may not be uniform both across and within medical centers. These issues will be explored in the context of this panel discussion.

1630 – 1645

Postpartum Haemorrhage is Not a Malignant Condition Nicklin JL Royal Brisbane and Women’s Hospital, University of Queensland, and Wesley Hospital, Brisbane, Queensland

Although postpartum haemorrhage (PPH) is potentially lethal and placental tissue may be locally invasive, postpartum haemorrhage is not a malignant condition. The incidence of caesarean section has risen and so too the incidence of placenta praevia and accreta, and attendant PPH. Optimal management of PPH involves a multidisciplinary approach. Gynaecological oncologists have a background in obstetrics, skills in advanced pelvic surgery and may be a useful member of the multidisciplinary team. Involvement is at the discretion of the obstetrician and will vary with the clinician’s skills, experience, resources, availability and philosophy.

E-Poster Abstracts E-POSTER 1

Anti-N-methyl-D-aspartate Receptor Encephalitis in Females; A Routine Search for Ovarian Teratoma and the Role of a Gynaecologist Ahmed R*, Nahar P John Hunter Hospital, Sydney, New South Wales

Introduction: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a relatively new addition to the spectrum of autoimmune encephalitis. It is a unique limbic encephalitis that presents as a multistage disease, with prominent extrapyramidal, neuropsychiatric and autonomic symptoms. The syndrome predominantly affects young women and is frequently associated with an underlying neoplasm, most often an ovarian teratoma. Case presentation: We report a case of a 26 year old female who experienced a series of psychiatric and behavioural symptoms which included confusion, hallucinations, self-harm, suicidal ideation. A diagnosis of anti-N-methyl-D-aspartate receptor encephalitis was made and a search for a neoplasm explored an enlarged right ovary with heterogeneous features without any obvious evidence of a teratoma. Following this finding, a laparoscopic removal of the right ovary was suggested by the neurology team supported by the growing body of literature in favour of the tumour removal. Such non-specific features in the ultrasound and the relative rarity of the condition rather created a dilemma in the management among the gynaecologists and caused hesitancy in removing the ovary in such a young patient. Finally, a laparoscopic resection of a right ovarian mass was performed and subsequent histopathology revealed immature teratoma. She recovered fully after immunotherapy and tumour removal. Conclusion: Anti-NMDAR encephalitis is a rare but potentially treatable condition. Delayed diagnosis can result in a worse condition and sometimes fatal outcome. Increased awareness among the neurologists and psychiatrists, as well as gynaecologists, is essential for an holistic approach to the management of this condition. E-POSTER 2

Outcomes of Extreme Morbid Obesity in Pregnancy at Western Health Ali M*, Teale G Sunshine Hospital, Western Health, Melbourne, Victoria

Objective: Obesity in pregnancy is associated with an increased risk of a number of serious adverse outcomes including maternal and fetal/neonatal death. Commensurate with the worsening obesity epidemic, women with extreme morbid obesity (EMO) (BMI >50 kg/m2) are now being managed through pregnancies.

Western Health, by virtue of its birth rate and demographics regularly manages pregnancies in this high risk group. Few studies to date have included women in this extreme group. Findings: Birth outcome data from 2008â&#x20AC;&#x201C;2012 identified 76 women with a BMI of >/= 50 kg/m2. This represents 0.5% of women delivering at Western Health. Analysis demonstrates a seven fold increased risk of pregnancy induced hypertension, a 5.5 fold increased risk of pre-eclampsia and over 25% have gestational diabetes with an 8.5 fold increased risk of requiring insulin compared to women with normal BMI. This group also had five-fold reduction in breast feeding and three-fold increase in depression and anxiety disorders. Conclusions: Pregnant women with EMO represent a high risk group that require extensive multidisciplinary care. The increased likelihood of pregnancy complications warrants specific management protocols to prevent the increased risk profile being transferred into poor maternal and fetal outcomes. E-POSTER 3

External Cephalic Version for Breech Presentation â&#x20AC;&#x201C; A Single Centre Experience Amaranarayana P*, Mahomed K Ipswich Hospital, Ipswich, Queensland

Background: Incidence of breech presentation at term is about 3-4%. Currently most centres in Australia would offer these women a caesarean birth. External cephalic version (ECV) reduces non cephalic presentation at birth as well as reducing Caesarean Section (CS) rates. ECV is offered with varying enthusiasm and an acceptance rate of as low as 18% has been reported in a unit, with success rate of 53% for nulliparous and 75% for multiparous women. Aim: To report experience with ECV at a single centre, Ipswich Hospital, Ipswich. ECVs were performed by or under the guidance of one clinician with much experience. Methods: A retrospective audit of charts of all ECVs between January 2006 and June 2012. Results: 147 ECVs were performed. 64 women (43.5%) were nulliparous. 52 (35.4%) had a BMI of <25, 22 (15%) were obese, 20 (13.6%) were morbidly obese. Seven women (4.8%) had had one previous CS. Overall the success rate was 54%. Of these 84% had a vaginal birth. Contrary to reports of a higher CS rate in women after a successful ECV compared to women with cephalic presentation from onset, our CS rate was relatively low at 16%. This is encouraging for women who undergo the procedure with the aim of avoiding CS particularly in their first pregnancy. Conclusion: We confirm the role of ECV in modern obstetrics and urge that clinicians provide such women with information in a proactive manner.

E-POSTER 4

Diagnosis and Management of Endometrial Polyps: A Critical Review of the Literature Andriputri S1*, Won H1,2, Nesbitt-Hawes E1,2, Campbell N2, Abbott J1,2 1 University of New South Wales, Randwick, New South Wales 2 Royal Hospital for Women, Randwick, New South Wales

Introduction: Endometrial polyps are common gynaecological conditions, frequently associated with vaginal bleeding or found incidentally on imaging for another reason. Despite how common endometrial polyps are, there is a paucity of high grade evidence in the literature for diagnosis and management of endometrial polyps. Methods: We performed a systematic review of the literature and retrieved 330 relevant articles that were tabulated and classified according to level of evidence. Data pertaining to clinical outcomes on diagnosis and management for endometriosis was abstracted. Results: For women with AUB, the fist line of investigation is 2D transvaginal ultrasound, with 3D and contrast sonography marginally increasing efficacy of diagnosis. Hysteroscopy is the gold standard for both diagnosis and management of endometrial polyps, since it allows histopathological investigation for malignancy. The rates of malignant transformation are low, with increasing age and postmenopausal bleeding being the most important risk factors. Blind dilatation and curettage is not recommended when guided removal is available due to the low diagnostic accuracy. Surgical removal will resolve most symptoms of AUB. Small polyps may be managed conservatively with spontaneous resolution occurring in 1:4 polyps <8mm. Recurrence risk is low at <5%. Removal of polyps may increase the chances of both spontaneous and assisted reproduction when this is an issue. Conclusions: Endometrial polyps are common, have an increasing incidence with age and are infrequently associated with malignancy. They may be diagnosed by sonography. Conservative hysteroscopic removal is appropriate when symptomatic. There are few high-grade studies that examine clinical outcomes for polyps.

E-POSTER 5

E-POSTER 6

Cost Effectiveness of Induction of Labour at Term with Inpatient Vaginal Prostaglandin E2 Gel Compared to an Outpatient Foley Catheter (FOG Trial)

Motor Vehicle Accidents and the Pregnant Patient – Retrospective Analysis of Clinical Presentation, Management and Composite Maternal and Fetal Outcomes to Determine the Need for Delivery

Austin K1*, Chambers G3, Susic D3, Madan A2, De Abreu Lourenco R4, Henry A1,2 1 Royal Hospital for Women, Randwick, New South Wales 2 School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Randwick, New South Wales 3 National Perinatal Epidemiology and Statistics Unit, School of Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales 4 Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales

Objectives: To assess the costeffectiveness of labour induction with mechanical cervical ripening as an outpatient (outpatient Foley catheter – OFC) compared to chemical cervical ripening (Prostin gel) as an inpatient (IPG) in an Australian tertiary hospital setting. Statement of findings: 101 FOG trial patients were randomised, 50 to OFC and 51 to IPG. Total mean hospital costs tended to be higher in the OFC group but were not statistically different to those in the IP groups ($6,524 and $5,876, 95%CI -$366–$1,652). The OFC group experienced fewer inpatient hours between randomisation and birth than the IP group (mean difference 11.3h, 95% CI 6.0-16.6), resulting in an incremental cost per inpatient hour prevented of $57 (95% CI -79.44-190.65). At a notional willingness to pay threshold of $100 per inpatient hour prevented the mean net monetary benefit for each women in the OFC group was $437, indicating OFC is a cost-effective alternative to IPG. Conversely, the OFC group had statistically fewer patients delivering vaginally within 12 hours of admission to the delivery unit (OR 0.35 95% CI 0.15-0.79) indicating that it offered no clinical or economic advantage over IPG. Caesarean section rates and total inpatient maternal hours did not differ between groups. Conclusions: Given current service delivery arrangements outpatient mechanical cervical ripening was not significantly cheaper than inpatient chemical cervical ripening. However, given the potentially high net monetary benefit of freeing up antenatal beds, further studies should investigate the clinical and cost effectiveness of utilising OFC in an outpatient setting.

Baker K1*, Kimble R1,2 1 Royal Brisbane and Women’s Hospital, Brisbane, Queensland 2 University of Queensland, Brisbane, Queensland

Objective: Review of the predictive value of clinical symptoms or signs (contractions, seat belt sign), methods of fetal assessment (ultrasound and cardiotocography), and laboratory tests (Kleihauer-Betke test) to determine need for delivery based on composite maternal/ fetal outcomes following a motor vehicle accident during pregnancy. Composite maternal and fetal outcomes are defined as delivery indicated for maternal condition, intrauterine death, abruption and preterm birth (within one week of injury). Hypothesis: A composite of clinical findings (symptoms/signs and fetal heart/cardiotocography) performed at presentation is the most accurate in determining need for delivery/intervention to improve both maternal and fetal outcomes. Addition of ultrasound and the Kleihauer-Betke test provides little further predictive value, and the performing of such investigations may delay intervention as well as have an associated economic cost without benefiting maternal/fetal outcomes. Method: Retrospective chart review of 160 admissions of pregnant patients involved in a motor vehicle accident for the period of July 2000 to January 2010 (inclusive) to the Royal Brisbane and Women’s Hospital, Brisbane. Findings: There is no specific clinical symptom or sign, test of fetal assessment or laboratory test which can accurately predict the need for delivery when a pregnant patient is involved in a motor vehicle accident. However, the absence of contractions and a normal fetal heart pattern (either via doppler or CTG) has a significantly high sensitivity and negative predictive value indicating no need for intervention, with no difference in adverse maternal or fetal outcomes. E-POSTER 7

A Retrospective Review of Undiagnosed Breech at the Mercy Hospital for Women Bennett L*, Permezel M Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria

Background: Breech malpresentation occurs in 4% of babies after 37 weeks of pregnancy. The much debated randomised trial research suggests most of these would be best delivered by caesarean section. However, about 20% of breech presentations will be missed prior to labour, even with regular antenatal clinic attendance.

Aims: To ascertain the incidence of undiagnosed breech at our hospital; identify any risk factors; and determine if an undiagnosed breech worsens maternal or neonatal outcomes. Methods: A retrospective review of breech deliveries at the Mercy Hospital for women in 2009-2010 was performed. Undiagnosed breech presentations were identified by reviewing the medical records of patients who had a vaginal breech delivery or had an emergency caesarean section. Maternal and neonatal outcomes were compared to deliveries of known breech babies. Results: There were 11,546 deliveries at the Mercy Hospital in 2009-2010. 310 were term breech (2.7%); 275 remained after exclusions. There were 25 undiagnosed breeches presenting in labour (9.1%). A further 15 patients were diagnosed breech >40 weeks (5.5%). Undiagnosed breeches were more likely to be primiparous (72% vs 52% p=0.02) and booked publically (94.9% vs 79.2% p=0.02). Over 50% had either midwifery lead or shared care. Of the 25 presenting in labour, five delivered vaginally, all afterhours, with a registrar as accoucher. One minute Apgar scores <7 were significantly higher in those with undiagnosed breech (40% vs 15.2% p=0.0004) and delivery complications high, occurring in 33%. Discussion: Undiagnosed breech remains a common obstetric occurrence that is associated with a concerning high rate of delivery complications. It is important that all those performing antenatal care have ready access to ultrasound to determine presentation where there is a significant degree of doubt on examination. E-POSTER 8

An Audit on the Incidence and Management of Obstetric Anal Sphincter Injuries (OASIS) Berkemeier S1*, Ghosh B1,2 1 Campbelltown Hospital, Campbelltown, New South Wales 2 University of Western Sydney, Sydney, New South Wales

Objective: Obstetric anal sphincter injuries (OASIS) are relatively rare, but can significantly impact the lives of women. An audit was designed to determine the incidence and management of OASIS in our unit. Method: This audit was a retrospective review of cases of OASIS over a one year period (July 2011-June 2012) at Campbelltown hospital. Data was extracted by a single reviewer and statistics analysed using PASW Statistics 18. The management of OASIS was reviewed, comparing current practice in our unit to that of a recommended standard (RCOG Green-top Guideline No. 29)1. Results: 49 cases of OASIS were identified, equating to 2.25% of all term singleton vaginal deliveries. In 47% of cases (n=23), the classification of OASIS was not documented. 100% of women with OASIS were prescribed antibiotics and laxatives. 98% of OASIS cases were referred for gynaecology outpatient follow up. 65

E-Poster Abstracts Conclusion: Good adherence to recommendations was seen with the use of antibiotics and laxatives, and post-operative follow up referral. The areas of improvement identified were documentation of OASIS repair; type of anaesthetic used; and location of repair. Comparing our audit with peer-reviewed literature and the RCOG recommended standards, we have proposed the following recommendations: firstly that an operative proforma be developed to improve documentation and management of OASIS; and secondly, encouraging registrars and CMOs to attend formal repair training. A re-audit will then be completed following the introduction of interventions. Reference: 1 Royal College of Obstetricians and Gynaecologists (RCOG). The management of third and fourthdegree perineal tears, Green-top Guideline No. 29. London: RCOG Press; 2007.

E-POSTER 9

Iodine Intake and Thyroid Function in Pregnant Women in a Private Clinical Practice in North Western Sydney Before Mandatory Fortification of Bread with Iodised Salt Blumenthal N1*, Byth K2, Eastman C3 1 Blacktown Hospital and Norwest Private Hospital, Sydney, New South Wales 2 NHMRC Clinical Trials Centre, Faculty of Medicine, University of Sydney, Sydney, New South Wales 3 Sydney Medical School, University of Sydney, Sydney, New South Wales

Aims: The primary objective was to assess iodine nutritional status and its effect on thyroid function during pregnancy. The secondary objective was to determine the association between urinary iodine excretion, and the intake of iodine rich foods and iodine supplementation during pregnancy. Methods: A prospective observational study was undertaken between November 2007 and March 2009. Serum TSH, T4, T3 and urinary iodine were assessed. Blood and urine samples and a questionnaire were taken from 367 women at their first visit for assessment of thyroid function. Results: The median urinary iodine concentration (UIC) was 81ug/l. For those on supplementation, the median UIC was 115ug/l which was significantly greater than the median UIC of 72ug/l for those not taking a supplement. 71.9% of the women were iodine deficient. 26% of the women were moderately iodine deficient (UIC <50ug/l) and 12% severely iodine deficient (UIC <20ug/l). The only detectable influences on UIC were dairy intake and pregnancy iodine supplements. While 6.5% of the women had a serum TSH >2.5 mIU/l (subclinical hypothyroidism), there was no statistical association between UIC and thyroid function (serum TSH and Free T4 levels), and no evidence for an effect of iodine intake on thyroid function. Conclusions: A high prevalence of mild to moderate iodine deficiency was found in women attending a private antenatal clinic 66

in Sydney, but no evidence of a significant adverse effect on thyroid function. The 6.5% prevalence of subclinical hypothyroidism is unlikely to be due to iodine deficiency. E-POSTER 10

Uterine Rupture with Peri-Hepatic Migration of Foley Catheter and Associated Coagulopathy Following Hysteroscopy and Polypectomy for Treatment of Acute Menorrhagia; A Case Report and Review of the Evidence for Uterine Tamponade in the Non-Puerperial Uterus Boulton A*, Joshi S The Maitland Hospital, Newcastle, New South Wales

A 32 year old woman presented to a rural referral hospital with a three day exacerbation of menorrhagia. She was taken to surgery the following day for hysteroscopy, dilatation and curettage, and polypectomy. At the end of the procedure there was significant brisk bleeding. An intrauterine Foley catheter was placed and filled with 30mLs of water and the patient transferred to the high dependency unit. Over the next 18 hours there was significant watery blood loss in the catheter bag and the patient developed a mild coagulopathy. CT angiogram revealed peri-hepatic migration of the Foley catheter. The patient returned to theatre for a midline laparotomy and hysterectomy. Balloon tamponade in the management of PPH is well documented, however, the evidence available for the non-puerperial uterus is sparser. A number of small studies suggest the use of Foleys catheter can control uterine bleeding without associated adverse events, however, a growing number of case reports are demonstrating complications including consumptive coagulopathy and uterine rupture. While balloon tamponade should be considered in an attempt to avoid hysterectomy, it is important to be mindful of these possible complications in the immediate post-operative period. To the authors’ knowledge this is the first case of coexisting uterine rupture and coagulopathy following intrauterine Foley catheter placement. E-POSTER 11

Pravastatin Blocks Production of Soluble Endoglin in Primary Endothelial and Placental Cells: A Potential Therapeutic for Preeclampsia Brownfoot FC*, Kaitu’u-Lino TJ, Hannan N, Onda K, Tuohey L, Tong S Translational Obstetrics Group, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria

Objective: Preeclampsia is globally responsible for 60,000 maternal deaths per year. A safe therapeutic that quenches disease severity would be a major advance. One of the key anti-angiogenic factors central to the pathogenesis of severe preeclampsia is soluble endoglin.

Recently, oxysterols (a cell signaling molecule) were shown to increase soluble endoglin production by activating the Liver X receptor (LXR, a transcription factor). Statins have vaso-protective properties and, interestingly, are known to both reduce oxysterol production and inhibit LXR. Therefore, we assessed whether pravastatin can block soluble endoglin production in primary endothelial (blood vessel cells) and placental cells. Statement of findings: In placenta, we performed immunohistochemical staining and confirmed LXR was strongly localised to the syncytiotrophoblast (surface layer of placenta abutting the maternal circulation) and blood vessels. As expected, staining of LXR was increased in placenta from cases of severe preeclampsia compared to preterm controls (n=6). Furthermore, we confirmed LXR mRNA expression was significantly elevated in placenta from severe preeclampsia (n=27) compared to the gestationally matched preterm controls (n=25; p<0.05). We next demonstrated a significant (p<0.05) dose dependent increase in soluble endoglin levels following oxysterol treatment in human umbilical vein endothelial cells (endothelial cell model) and primary trophoblast cells isolated from placenta. Excitingly, adding pravastatin decreased soluble endoglin production (p<0.05). Conclusions: We conclude LXR is upregulated in preeclampsia and pravastatin reduces soluble endoglin, possibly by blocking oxysterol/LXR pathway. This work supports the therapeutic potential of pravastatin to treat preeclampsia. E-POSTER 12

Does Weighing at Each Antenatal Visit Result in Appropriate Pregnancy Weight Gain? A Randomised Control Trial Brownfoot FC1*, Davey MA2, Kornman L1 1 Department of Obstetrics and Gynaecology, The University of Melbourne, Royal Women’s Hospital, Parkville, Victoria 2 Faculty of Health Sciences, LaTrobe University, Bundoora, Victoria

Objective: Overweight and obesity pose a significant health burden and are now the most common risk factor in obstetric medicine. Excessive weight gain in pregnancy is also increasing and is an independent risk factor for poor pregnancy outcomes. Regular weighing in the non-pregnant population has been found to reduce weight gain. Therefore we assessed whether weighing patients at each antenatal visit, compared to routine care, kept their pregnancy weight gain within the American Institute of Medicine (IOM) recommendations. Statement of findings: We recruited 782 women from 2010 to 2013 at <22 weeks gestation. We randomised 386 to the intervention group involving weighing at every visit and 396 to the control group involving routine care with a baseline weighing at first consult and one added weighing at 36 weeks gestation. We found no difference in excessive weight gain between the intervention

group and the control group (p=0.92). Weighing did, however, reduce excessive weight gain in the normal Body Mass Index (BMI) group (BMI 19.9-24.99 p=<0.05). Similarly, it reduced excessive weight gain in the low BMI group (BMI <19.8) when women were seen and weighed at >5 visits. Unfortunately weighing did not alter excessive weight gain in overweight women (p=0.61) and lead to weight gain above recommendations in obese women (BMI >30) when they attended 5 visits or more (p=<0.05). Conclusions: We conclude that weighing in clinic is a simple and effective way of reducing excessive weight gain in pregnant women with a normal BMI, however, caution must be taken in implementing this in obese women. Funding: The Victorian Managed Insurance Authority funded this study. Acknowledgments: We would like to thank Sue Nisbet, Carmen Jeffers and Jinlin Wang for their contributions to this study. E-POSTER 13

A Case Series of Caesarean Section Scar Ectopic Pregnancies: Characteristics, Management, and Outcomes Cabraal N1*, Belgrave S2, Stone P2 1 Auckland City Hospital, Auckland, New Zealand 2 North Shore Hospital, Sydney, New South Wales

Objective: To present a case series of caesarean section scar ectopic pregnancies at two hospitals in the Auckland Region. Method: Twelve cases identified in retrospective review of the preceding five years (2009-2013). Statement of findings: Variables such as maternal age, number of prior caesarean sections, caesarean interval to ectopic diagnosis, presenting symptoms, method of diagnosis, peak BHCG and median gestation at diagnosis will be presented. Approaches to treatment in these cases will be discussed along with a review of the evidence behind these methods. Nine cases in our series were treated with methotrexate (75%). Intra gestational sac potassium chloride/methotrexate combinations were used in three cases where the ectopic was live or a more advanced gestation. It was felt that this method would improve success of concurrent medical management. Surgical management was also important with four patients undergoing surgical evacuation of the uterus and two patients needing to undergo hysterectomy. Outcomes will also be reviewed, including complications from treatment and numbers achieving subsequent pregnancy. Conclusion: Caesarean section scar ectopics are a rare cause of morbidity from caesarean sections. Moreover, diagnosing and managing this rare diagnosis can be challenging both for clinicians and patients. A range of treatment options should be carefully considered and tailored to each individual patient to improve outcomes.

E-POSTER 14

CUSUM Plot for Quality Assurance Monitoring of Caesarean Section, Instrumental and Normal Vaginal Delivery Rates in Nulliparous Singleton Pregnancies Chen L1,2*, Li Y1,3, Hyett J1,3 1 Royal Prince Alfred Hospital, Sydney, New South Wales 2 The University of New South Wales, Sydney, New South Wales 3 The University of Sydney, Sydney, New South Wales

Objective: To use CUSUM plots for quality assurance monitoring of caesarean section, instrumental and normal vaginal delivery rates in nulliparous singleton pregnancies, as categorised in Robson Groups 1 and 2. Method: Audit of singleton deliveries at Royal Prince Alfred Hospital, Sydney, from 2011-2012. Median caesarean section, instrumental and normal vaginal delivery rates were pre-determined, based on literature review at 10%, 15% and 75%, respectively. Deliveries were analysed by weekly intervals of last 100 deliveries for constructing the CUSUM plots. Statement of findings: 4,016 (98.41%) singleton, 63 (1.54%) twin and two (0.5%) triplet pregnancies among 4,081 women (4,157 pregnancies). Average maternal age was 31.90 years (range 15-48). Average gestation was 35.7 weeks (SD +/-3 weeks). Robson Groups 1 and 2 consisted of 1,216 (29.24%) and 835 (20.09%) pregnancies, respectively. Using CUSUM, Robson Group 1 had initial spikes in caesarean section rates that levelled out to within 2 SD of median; whilst instrumental rates were consistently above acceptable levels, indicating an area for further investigation. In Robson Group 2, the cumulative caesarean section and instrumental delivery rates were well above 2 SD of median, while the normal vaginal delivery rate was well below 2 SD of median. Key conclusions: CUSUM is an effective visual quality assurance tool to monitor caesarean section and instrumental rates that allows for detection of subtle summation of deviation from set standards of each measure. This in turn allows for easy identification of areas for improvement in intrapartum care to maximise normal vaginal delivery rates. E-POSTER 15

Serum Levels of 25 Hydroxyvitamin D in Pregnant Women with Established Diabetes or Gestational Diabetes Mellitus in Far North Queensland Cheng H1*, de Costa C1, McLean A2 1 School of Medicine and Dentistry, James Cook University, Cairns, Queensland 2 Cairns Base Hospital, Cairns, Queensland

We consecutively recruited 101 pregnant women with pre-existing diabetes mellitus (DM) or gestational diabetes mellitus (GDM) and measured serum levels of 25-hydroxyvitamin D. Several studies have indicated that a large proportion of pregnant women living in southern parts

of Australia are vitamin D insufficient or deficient, and universal vitamin D screening has been suggested. Suboptimal vitamin D levels have been linked to several pregnancy complications. DM/ GDM pregnancies are associated with suboptimal vitamin D levels, and low vitamin D status is associated with poor glycaemic control. Suboptimal vitamin D levels appear to be much less common in northern Australia, however the vitamin D status of pregnant women with DM/GDM has not been well studied in the north. Our study cohort demonstrated a mean vitamin D concentration of 110.3nmol/L; in non-Indigenous and Indigenous subjects, means were 114.9nmol/L and 98nmol/L. Six percent of subjects were vitamin D deficient, 12% insufficient and 81% sufficient. The average vitamin D level in this cohort with diabetes is similar to that of non-diabetic pregnant women in the north, and is significantly higher than those in the southern states regardless of diabetic status. Spearman correlation revealed that low vitamin D levels correlated with higher HbA1c values. In conclusion, the rates of vitamin D deficiency and insufficiency in far north Queensland are much lower than in southern states. The introduction of universal antenatal vitamin D screening in Australia is therefore premature at this stage. E-POSTER 16

Developing a Dataset for Clinical Auditing for E0/ ‘Code Green’ Immediate Caesarean Sections Chin G1,3 *, Dillon D1*, Dunbabin T1, Messmer A1, Dargaville, P1,2 1 The Royal Hobart Hospital, Hobart, Tasmania 2 University of Tasmania, Hobart, Tasmania 3 University of Melbourne, Parkville, Victoria

In Royal Hobart Hospital (RHH), a ‘Code Green’ for immediate caesarean section is planned to be introduced in 2013. As part of the implementation process, a data set has been developed for clinical auditing before and after the introduction of this new emergency procedure and protocol. Useful and meaningful clinical indicators are required to: i) evaluate whether the introduction of the new emergency procedure/protocol has been successfully and safely implemented; and ii) develop a sustainable way for ongoing monitoring of this process for continuing improvement. We developed a dataset for clinical auditing of immediate caesarean sections through a two-step process: i) literature review; and ii) hospital clinician and clinical support person stakeholder review of data criteria. This same stakeholder focus group has been crucial in the hospital process of the development and implementation of the ‘Code Green’. Consensus from this group was sought when finalising data criteria for the clinical audit. An extensive list of data criteria of more than 100 data points was finally selected for use in the primary clinical audit cycle. Having a larger set of data criteria in the primary clinical audit was felt to assist: i) feedback facilitating initial 67

E-Poster Abstracts implementation of the ‘Code Green’; and ii) condensing and identifying the dataset for ongoing sustainable hospital audit of the process of clinical indicators that were easily accessible and meaningful to the institution. E-POSTER 17

Midwifery-led Intervention Group for Pregnant Women of High Body Mass Index: Engagement with and Outcomes of SSWInG Chwah S1*, Reilly A2, Hall B3, Henry A1,4 1 St George Hospital, Kogarah, New South Wales 2 St George and Sutherland Weight Intervention Group, Sydney, New South Wales 3 Royal Hospital for Women, Randwick, New South Wales 4 School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Randwick, New South Wales

Background: To compare the pregnancy care, maternal and neonatal outcomes of women with BMI >30 enrolled in the St George and Sutherland Weight Intervention Group (SSWInG) versus other models of antenatal care. A case-control study of 108 SSWInG mothers versus 105 age-matched mothers with a BMI >30 enrolled in alternate models of antenatal care was conducted. Findings: Between April 2010 – October 2012 11% (1,115) of 9,954 women with singleton births at the study hospitals had BMI >30. Of these, 9.6% enrolled in SSWInG. 96% attended >50% of SSWInG classes; 80% attended all classes. The overall BMI >30 cohort had a high rate of hypertensive pregnancy (14.6%) and gestational diabetes (14.8%), confirming their high-risk status. Compared to controls, SSWInG group had superior implementation of local high BMI guidelines, including; nutritional advice/ weight gain goals (86% vs 46%, p<0.001), regular weighing (80% vs 33%, p<0.001), lactation consultant referrals (8.3% vs 0.9%, p<0.001), third trimester anaesthetic review (50% vs 20.9%, p=0.04) and third trimester ultrasound (55% vs 43%, not significant). Failure to initiate breastfeeding was lower in SSWInG group (0% vs 10.5%, p=0.001). No significant difference was noted in other pregnancy and birth outcomes. Overall caesarean rate was 32.6%. Conclusions: Women enrolled in specialised antenatal care for high BMI in pregnancy received increased care targeted towards reducing adverse outcomes of high BMI and had superior breastfeeding initiation rates. However, engagement with SSWInG was poor (<10% of eligible women), and no significant differences were noted in antenatal or postnatal complications, mode of birth or neonatal outcome.

E-POSTER 18

Factors Influencing Successful Trial of Instrumental Delivery: A Three-Year Review Davis G*, Ludlow J Department of Women’s Health and Neonatology, RPA Women and Babies, Sydney, New South Wales

Despite an increasing Caesarean Section (CS) rate at a tertiary obstetric centre, the incidence of CS in the second stage has decreased. We retrospectively reviewed the details of all women delivered in the operating theatre via CS in the second stage or successful instrumental delivery over a three-year period to ascertain whether there were any predictive factors for successful vaginal delivery. Women with a singleton, cephalic fetus at >37 weeks were included. Demographic, antenatal, labour and delivery details were collected, and maternal and neonatal morbidity recorded. The seniority of accoucher and supervision of junior obstetric staff was noted. From 2009-2011 there were 445 women delivered in theatre in the second stage of labour. There were 269 trials of instrumental delivery. 52.7% were successful. 175 (39.5%) women had a caesarean section at full dilatation without attempted instrumental delivery. Trial of instrumental delivery was most commonly performed for failure to progress in the second stage and 45% were completed with the Neville Barnes forceps. There was a 12% double instrumentation rate. Consultant obstetrician supervision in theatre was rare. Predictive factors for successful vaginal delivery were multiparous women, including those with prior CS, with no epidural (p<0.02) and a fetus in the OA position (p<0.001). There was a 10% third degree tear rate. Successful vaginal delivery was less likely if a consultant was present. Major deficits in documentation standards were recorded. E-POSTER 19

Radical Vaginal Trachelectomy: Fertility Preserving for Women with Early Stage Cervical Cancer Dhillon S*, Kathurusinghe S The Royal Women’s Hospital, Parkville, Victoria

Vaginal radical trachelectomy (VRT) is primarily used where fertility preservation is intended in young women at early stage of cervical cancer. In terms of perioperative morbidity, VRT is the same or less than for radical hysterectomy. It is therefore mainly reserved in younger women intending to conceive. Current literature has supported that the majority of women can anticipate conceiving spontaneously and delivering near term if they have had a VRT. This study aims to investigate and report the obstetrical results following VRT in treatment of early-stage cervical cancer. A retrospective observational study of 25 women from 1 January 2003 to 30 May 2013 was conducted at our tertiary centre. The charts of these patients were

retrospectively reviewed for medical and obstetric history, characteristics and complications of surgical procedures, and pregnancy outcomes. In our patient cohort, the median age of VRT was 27 years. The medium follow up period was 36 months with four patients lost to follow up. 21 patients (84%) were nulligravida and 19 (76%) women expressed intention to conceive, with seven (37%) women seeking infertility treatments. The outcomes measured were the rate of first and second trimester miscarriage, preterm and term delivery, and neonatal outcomes. Other outcomes measured were rate of disease recurrence, rate of hysterectomy and complication rate following VRT. Based on our experience, the obstetrical results following VRT for early-stage cervical cancer indicates lower rates of successful pregnancies than currently published literature. E-POSTER 20

Tablet Technology: iPad Prescription for Medical School Teaching and Training in Obstetrics and Gynaecology Durst M1*, Deura J1, Georgiou C1,2,3 1 University of Wollongong, Graduate School of Medicine, Wollongong, New South Wales 2 Illawarra Health and Medical Research Institute, Wollongong, New South Wales 3 Wollongong Hospital, Wollongong, New South Wales

Introduction: Tablet computing technology is creating a revolution in medicine with reports describing the use of this new-age technology in both clinical practice and teaching. The fingertip availability of a plethora of information, whether web-based or device-restricted, is considered advantageous to both clinicians and patients. Over the last few decades, medical school teaching has evolved into intercalating clinical exposure throughout the course, instead of the traditional “preclinical/ clinical” structure. At the University of Wollongong, the graduate-entry course includes an intense hospitalbased component, 18 months into the curriculum. As with other specialties, the relative amount of time spent in Obstetrics & Gynaecology (O&G) is restricted. Objective: The objective of this paper is to demonstrate how a medical student in O&G and a clinical academic have used tablet computer technology (Apple iPad) to remedy some of the anxieties experienced while transitioning into the clinical years. Findings: The advantages of the iPad during the O&G rotation included easy access to course modules, on-the-go learning, course textbook access and environmentally friendly means for note keeping. Some barriers and limitations included limited internet access, hygiene concerns, particularly in environments such as Operating Theatres, the relative inconvenience of carrying a delicate and expensive tablet, and the potential for breach of confidentiality.

Conclusion: We demonstrated how integration of tablet technology into a medical curriculum may facilitate optimum learning and teaching opportunities while students transition into clinical years. In addition, a review of the use of tablet technology in Australian (NSW) medical schools is included. E-POSTER 21

Successful Monochorionic Triplet Pregnancy Complicated by EarlyOnset Selective Intrauterine Growth Restriction Edwards L1*, Weeraseeri T2, Choong S2, Cluver C1, McCarthy EA1, Hui L1, Walker SP1, Fung AM1 1 Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria 2 Department of Obstetrics & Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria

Although triplet pregnancies are becoming more common since the advent of assisted reproduction, monochorionic triplet pregnancies are exceedingly rare. In addition to the risks of higher order multiple pregnancies, these pregnancies carry the risks of monochorionicity – selective growth restriction and feto-fetal transfusion syndrome. We describe the first successful case of a monochorionic triplet pregnancy complicated by early-onset selective fetal growth restriction, resulting in three survivors. We also reviewed the literature on the outcomes of monochorionic triplet pregnancy. A 26 year old woman with an IVF monochorionic triplet pregnancy was referred to our Complex Multiple Pregnancy Clinic after she developed selective growth restriction at 18 weeks gestation. From the time of referral, she was monitored with weekly ultrasound, later increasing in frequency as progressive Doppler deterioration in the growthrestricted fetus developed. At 27 weeks, she was delivered by caesarean section due to static growth in the smallest triplet and when abnormal Doppler indices also appeared in the other two triplets. All three fetuses were delivered in good condition and transferred to the neonatal intensive care nursery. Review of the literature reveals that there are numerous case reports and series describing the management of feto-fetal transfusion syndrome in monochorionic triplets. However, there are limited reports on the management of selective growth restriction and minimal evidence to guide management. Conclusion: Given the lack of evidence to guide management of monochorionic triplets we feel management is optimised by care from a dedicated clinic. Monitoring should aim to watch for the development of growth restriction or feto-fetal transfusion syndrome. Frequency of surveillance and timing of delivery should be determined by fetal size, gestation and fetal well-being.

E-POSTER 22

Chlamydia Trachomatis Infection in the Antenatal Population at the Royal Hobart Hospital – Should Universal Screening Be Offered? Edwards L*, Cluver C Mercy Hospital for Women, Heidelberg, Victoria

Objective: Universal testing for Chlamydia trachomatis in pregnancy has not been standard practice at the Royal Hobart Hospital. A study was undertaken to determine the incidence of chlamydia so as to enable recommendations for antenatal screening. 482 women were enrolled in the study. Testing for Chlamydia trachomatis was by polymerase chain reaction, on a selfcollected low vaginal swab. Participants were asked to complete a questionnaire in an attempt to identify potential risk factors for infection. Results: There were 21 positive results, giving a prevalence of 4.3%. Chlamydia infection was highest in those under 25 years. Approximately half of the positive results occurred in women aged 15-19 years, with an incidence of 18.96% in this group. There were no positive test results in women over the age of 30. Women with a positive result were more likely to have had a previously treated sexually transmitted infection (STI) (38.1% versus 15.6%), Odds Ratio (OR) 3.30 (95% CI 1.32-8.25); had more than one sexual partner in the last 12 months (33.3% versus 6.5%), OR 7.15 (95% CI 2.68-19.05); and to be of Aboriginal or Torres Strait Islander (ATSI) origin (81% versus 7%), OR 56.71 (95% CI 8.01-178.55). There was no difference in the presence of vaginal bleeding or discharge between the two groups. Recommendations: Routine screening for Chlamydia trachomatis is recommended for pregnant women under the age of 25 years, in those of ATSI origin, in those who have had more than one sexual partner in the last 12 months, and in those with a previously diagnosed STI. E-POSTER 23

Fetal Supraventricular Tachycardia: A New Approach to Surveillance and Treatment Edwards L1*, Cluver C1, Fung A1, Wilson D2,3, Walker SP1,2 1 Mercy Hospital for Women, Heidelberg, Victoria 2 University of Melbourne, Melbourne, Victoria 3 Austin Health, Heidelberg, Victoria

Background: Fetal cardiac arrhythmias occur in 1 to 2% of pregnancies, with supraventricular tachycardia (SVT) the second most common type. Twodimensional ultrasound provides the best assessment of fetal arrhythmias, with the ability to evaluate the cardiac anatomy, cardiac function, and look for the presence of hydrops fetalis simultaneously. Ultrasound assessment is not routinely used for longer surveillance of fetal heart

rate. External fetal heart rate monitoring, with standard cardiotocography (CTG), is widely available, but is cumbersome to use for long periods of time and the ability to reliably trace rapid tachyarrhythmias is impaired. Findings: We describe two cases of SVT that resulted in significant fetal hydrops. The first case was typical and was diagnosed at 34 weeks. The second case was an atypical presentation at 21 weeks gestation. In each case, the tachyarrhythmia was initially refractory to standard maternal treatment of Flecainide 150mg twice a day. Serial ultrasounds, fetal echocardiography and external heart rate monitoring with standard CTG monitoring were employed. Monica AN24® monitoring (Monica Healthcare Ltd) was then used and enabled a prolonged assessment of fetal heart rate and captured runs of fetal SVT that other investigations, such as intermittent auscultation, CTG monitoring and ultrasound, had previously not detected. This explained the limited resolution of hydrops in these cases, despite the fact that the fetus was thought to be back in sinus rhythm. Medication was titrated based on the Monica AN24® findings. Conclusion: We propose that the use of the Monica AN24® monitor may help improve surveillance and treatment of fetal arrhythmias. E-POSTER 24

Brow Presentation: Manual Flexion and Keillands Rotation Forceps Delivery Fernando M*, Vatsayan A Hornsby Ku-ring-gai Hospital, Sydney, New South Wales

A 34 year old woman, gravida two para one, presented to the birthing unit in spontaneous labour following an uncomplicated antenatal course. After syntocinon augmentation, she progressed to full dilatation but was found to be in frontal anterior brow presentation. A senior obstetrician examined her and her pelvis was found to be adequate, with the presenting part at the level of the spines and no caput or moulding. The woman was keen to avoid a Caesarean section, so a manual rotation and instrumental delivery was offered. In the operating theatre under epidural anaesthetic, the fetal head was manually rotated and flexed to direct occipito posterior position. Keillands rotational forceps were then applied and the baby converted to direct occipito anterior position, then delivered. Continuous cardiotocography was reassuring throughout, however the baby had Apgar scores of one at one minute and four at five minutes and was transferred to the special care nursery. An episiotomy was not performed and the woman sustained a 3C perineal tear. The woman and her baby were discharged home on day four postpartum. The woman was incontinent of flatus on discharge, with some improvement after two months. However, she was 69

E-Poster Abstracts pleased with the outcome and avoidance of a Caesarean section. The baby was completely well at two months of age. This case will be discussed, with reference to Verspyck’s (2012) case series of 13 similarly successful instrumental vaginal deliveries of brow presentations.

E-POSTER 26

E-POSTER 27

A Literature Review of Evidence Based Practice and Models of Maternity Care of Women with Body Mass Index (BMI) >/= 30 kg/m2

The Development and Validation of a New Tool to Predict Spontaneous Preterm Birth in High-Risk Women Using Quantitative Fetal Fibronectin and Cervical Length

Forsyth L1*, Bodger C2, Chin G2,3

E-POSTER 25

1 School of Medicine, University of Tasmania, Hobart, Tasmania 2 Royal Hobart Hospital, Hobart, Tasmania 3 Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria

Foster C1*, Kuhrt K2, Smout E2, Abbott D2, Hezelgrave N2, Shennan A2

Management of Premenopausal Abnormal Uterine Bleeding at Auckland District Health Board (ADHB) Fitzgibbon S1*, Sadler L National Women’s Hospital, Auckland, New Zealand

Introduction: The 2009 National Women’s Clinical Report indicated low numbers of hysterectomies at ADHB, not increasing concomitantly with population growth. Aims: To compare standardised hysterectomy ratios across District Health Boards (DHBs) in New Zealand and to investigate contributory factors to suspected disparities using premenopausal abnormal uterine bleeding as a model. Methods: Ministry of Health data was accessed to compare hysterectomy ratios at ADHB to the national average. Referrals to General Gynaecology and Menstrual Disorders clinics in 2009-2010 were reviewed to identify premenopausal abnormal uterine bleeding cases. Data was extracted on pre-referral workup and treatment, investigations and management through the Gynaecology Service to discharge or resolution. Results: ADHB had the lowest standardised hysterectomy ratio (observed:expected) of DHBs (0.63). From 1,455 referrals, 444 cases were identified. For pre-referral workup and treatment, investigations were inadequate in 80%, oral treatment trialled in 52% and Levonorgestrel-IUS in 8%. Specialists performed endometrial sampling on 117 patients (54%) with normal endometrial thickness on ultrasound. Hysteroscopy D&C was the primary sampling method in 39% with endometrial thickening on ultrasound. Cases had an average of 3.1 (SD 1.7) appointments over 45.9 (SD 33.1) weeks from referral to discharge. In those who underwent surgical management, time to resolution averaged 61.7 (SD 36.7) weeks. Conclusion: The ADHB hysterectomy intervention ratio is lower than expected. The pathway for premenopausal abnormal uterine bleeding is unacceptably protracted due to multiple factors including inadequate pre-referral investigation and treatment, long wait times, and failure to adhere to best practice. Recommendations are proposed to address these issues.

Background: Maternal obesity in pregnancy is strongly associated with an increased risk of obstetric, medical, anaesthetic and neonatal complications. Modern maternity care advocates a woman-centric approach; the diversity of specialties and services involved are partially determined by their obstetric risk. Objective: To review current literature with a view to exploring: i) determinants for best practice for management with elevated BMI; ii) different models of care available for this group; and iii) evidence supporting these models of care. Methodology: A literature review was undertaken using PubMed and Google Scholar databases for academic articles and grey literature. Combinations of search terms included: ‘BMI’, ‘pregnancy’, ‘management’, ‘guidelines’, and ‘model of care’. Articles published in English from 2002 were examined. Common themes were then identified and further explored. Findings: Themes that were identified from the articles included: evidence based practice, knowledge and application of guidelines, barriers to evidence based care, stratification of risk as a determinant of care, patient experience of maternity care, different models of care, and clinical indicators. Conclusion: Pregnancy in women with elevated BMI is associated with elevated risk. More work is needed to develop and evaluate safe, woman-centric models of care for this group. Clinical indicators including those reflecting patient experience may assist evaluation of service. We recommend local clinical audit, benchmarking and further research for improvement of maternity care in those with elevated BMI to assist planning care. This is of increasing importance given increases in numbers of patients in this group in settings with limited clinical resources.

1 Geelong Hospital, Geelong, Victoria 2 Kings College London, Women’s Health Academic Centre, Division of Women’s Health, London, United Kingdom

Preterm birth (PTB) rates are rising, but models to predict spontaneous PTB (sPTB) are unreliable. Fetal fibronectin (fFN) using a single threshold (50ng/mL) and cervical length (CL) are the best predictors of sPTB but quantitative fFN (qfFN) measurement has never been included in a prediction model with other clinical factors. Data from 804 women attending a Preterm Surveillance Clinic at St Thomas’ Hospital, London, was analysed. All women were at high risk of sPTB following previous PTB or cervical surgery. A parametric survival model was developed using clinical and biometric data from 405 women and selected using AIC and BIC criterion. The model was used to calculate an individual percentage risk of delivering at <37, <34 and <30 weeks gestation and within 14 days of testing. The model was then validated on a further 399 women. The final model used gestation, cervical length and qfFN with cut-points at 20 and 500ng/mL. The rate of sPTB was 17.3% (70/405) and 18.0% (72/399) in the training and validation sets respectively. Using the model, the ROC AUC for predicting delivery <30, <34, <37 weeks gestation and within 14 days of testing were similar for the training (0.84/0.82/0.74/0.96) and validation (0.92/0.86/0.75/0.99) data sets. With odds ratios for each gestational endpoint of 23/11/3/132 and 23/13/5/32 in the training and validation data sets respectively. Spontaneous PTB in high-risk women can be predicted using a model combining qfFN, gestational-age and CL. These variables supersede the previous single threshold fFN, demographic information and previous history. E-POSTER 28

Complications When Using Balloon Tamponade Technology in the Management of Postpartum Haemorrhage Georgiou C1,2,3 1 University of Wollongong, Graduate School of Medicine, Wollongong, New South Wales 2 Illawarra Health and Medical Research Institute, Wollongong, New South Wales 3 Wollongong Hospital, Wollongong, New South Wales

Introduction: The use of Balloon Tamponade Technology (BTT) has steadily increased in the management of postpartum haemorrhage over the last five years. Initially, non-uterine specific 70

balloons (NUS) were predominantly used. These included the Rusch balloon, the Sengstaken-Blakemore tube, the Foleyand the Condom-catheter. Recently however, of the three uterine-specific balloons that have been developed (Bakri balloon, BT-Cath, and the Ebb Double balloon), the published literature has a predominance of data on the Bakri balloon. Interestingly, although the initial nonuterine specific balloon cases reported complications of use, recent data does not appear to contain specific complications when using the uterine-specific balloons. Objective: The objective of this paper is to review the published data involving specific complications/failures when using BTT in the management of postpartum haemorrhage. Unpublished examples within a personal case series using a uterine-specific balloon are also included. Findings: Few cases from the published literature were identified that reported difficulties/complications or failures when using BTT. Five cases however are described from a personal case series in which “complications” were identified when using the Bakri balloon. These include: balloon leakage, balloon migration/misplacement, balloon damage at caesarean section, balloon shaft damage at vaginal delivery, and balloon expulsion secondary to an inappropriate uterine cavity capacity. Conclusions: Complications involving Balloon Tamponade Technology when used in the management of postpartum haemorrhage do occur, although they are rarely published. These complications have the potential to result in a failed Tamponade Test with the subsequent necessity to proceed to other treatment options including peripartum hysterectomy. E-POSTER 29

Mapping High-Risk Obstetrics Transfers Across New South Wales and the Australian Capital Territory (High-Risk Obstetric Transfer Study) Goh A1,2*, Browning Carmo K3,4, Morris J2,5, Berry A4, Wall M3, Abdel-Latif ME6 1 Westmead Hospital, Westmead, New South Wales 2 University of Sydney Medical School, Sydney, New South Wales 3 The Children’s Hospital at Westmead, Westmead, New South Wales 4 Newborn and Paediatric Emergency Transport Service New South Wales, Westmead, New South Wales 5 Royal North Shore Hospital, St Leonards, New South Wales 6 Australian National University Medical School, Canberra, Australian Capital Territory

Objective: The HROTS aims to examine the process of transferring women with high-risk pregnancies to tertiary obstetric units across NSW/ACT. Transfer outcomes were divided into three categories: “delivered at receiving hospital”, “failed/

delayed transfer” and “discharged/ transferred undelivered”; it is hypothesised each outcome has different associated clinical and demographic factors. Methods: A prospective observational study was conducted from 1 July 2010 to 30 June 2011. It included requests for transfer to tertiary units that were accepted, not accepted, advised for non-tertiary transfer or advised safer for neonatal retrieval. Patients were at least 20 weeks gestation and identified by hospitals involved in the transfers and through the NETS NSW database. Results: The study included 249 requests for transfer. The transfer outcomes and identified statistically significantly associated factors were: 39% were delivered at the receiving hospital – older mothers, twin pregnancies, essential hypertension, three or more indications, PROM, PIH and TPL plus PROM; 8% were failed/delayed transfers – TPL, APH and TPL plus APH; and 45% were discharged/ transferred undelivered – younger mothers, singletons, one indication, TPL, APH and TPL plus APH. Conclusion: The hypothesis was confirmed in that different demographic and clinical factors were associated with each outcome category. The findings also suggest, however, that there are significant numbers of women in NSW receiving suboptimal care resulting in high-risk deliveries in non-tertiary hospitals or being moved unnecessarily. This suggests a more robust system of triage and/or an increase in tertiary obstetric and neonatal resources is needed. E-POSTER 30

Initial Commercial Results from a Non-Invasive Prenatal Aneuploidy Test that Employs Massively Multiplexed Targeted PCR Amplification and Sequencing of 19,488 Single-Nucleotide Polymorphisms (SNPs) Hall MP*, Hill M, Zimmermann B, Sigurjonsson S, Demko Z, Rabinowitz M Natera Inc., San Carlos, CA, United States of America

Objective: Identify the characteristics of >5,000 commercial samples analysed with the non-invasive PanoramaTM prenatal aneuploidy test. Findings: Commercial samples were processed at a single reference laboratory. Isolated cfDNA was amplified using multiplex PCR targeting 19,488 SNPs covering chromosomes 13, 18, 21, X, and Y. Sequencing data was analysed using Next-generation Aneuploidy Test Using SNPs (NATUS) technology that uses Bayesian statistics to analyse multiple copy number hypotheses and determine the Maximum Likelihood hypothesis, calculating chromosome-specific accuracies without requiring a reference chromosome. Fetal fraction and risk of trisomies 13, 18, and 21, Monosomy X, and, when requested, fetal sex were reported. Fetal fraction remained approximately constant from 10-20 weeks of gestation

(average: 10.5%), but increased with gestational age at >20 weeks gestation. 2.3% of samples fell below 4% fetal fraction and 29.3% of samples had a fetal fraction of 4-8%. Maternal weight and fetal fraction were negatively correlated. Paternal sample inclusion did not effect accuracy and only slightly improved (<1%) the overall number of samples that required a redraw. However, at maternal weights of >250 pounds, paternal sample inclusion reduced the number of samples that required a redraw by more than one-third. Conclusions: This confirms a positive correlation between fetal fraction and gestational age beyond approximately 20 weeks gestation, and a negative correlation with maternal weight. Nearly 30% of samples had a fetal fraction from 4-8%, where other methods reported decreased detection rates. Including a paternal sample in the analysis significantly reduced the redraw rate for patients with high weight. E-POSTER 31

Exploring the Psychosocial Support Services for Women with Disorders of Sex Development Hanna C1*, Grover SR1,2,4, Di Pietro L2,4,5, Menezes M2,3,4 1 University of Melbourne, Parkville, Victoria 2 Murdoch Children’s Research Institute, Parkville, Victoria 3 Monash Ultrasound for Women, Richmond, Victoria 4 Royal Children’s Hospital, Parkville, Victoria 5 Victorian Clinical Genetic Services, Parkville, Victoria

Women with disorders of sex development (DSD) usually have significant reproductive health needs presenting with complex genetic differences and gynaecological features. These differences can have an impact on fertility, body image, and selfesteem. This qualitative study is designed to explore the psychosocial support needs of women who have a DSD. It involves looking further into the wishes, needs and expectations that women have of support services, with emphasis on identifying services considered to be useful. Eleven semi-structured interviews have been conducted with women aged between 18 to 40 years. All participants are currently having their ongoing management with a gynaecologist (SRG). Their diagnoses include congenital adrenal hyperplasia, androgen insensitivity syndrome, bladder exstrophy, gonadal dysgensis, turner syndrome, premature ovarian insufficiency and vaginal agenesis. Interviews were transcribed and examined using phenomenological thematic analysis. Preliminary findings revealed that overall participants felt satisfied with the available support systems. However, the data presented three recurring themes in all participant accounts of the issues central to their support needs: overall experience of the health system; utility of support services; and informed reproductive decisions. 71

E-Poster Abstracts Common challenges identified by the participants were: health professional’s delivery of diagnosis (language used and level of information shared), stigma surrounding seeing a psychologist/ counsellor, stigma associated with condition, and preference for face-toface peer support. They rarely identified with online support groups specific to their conditions. These preliminary findings provide valuable insights into the psychosocial support systems women have found beneficial, as well as discussing the importance of peer support. E-POSTER 32

Effect of a Gestational Diabetes Management Program on Weight Loss after Pregnancy Deshmukh T*, Grewal T, Hasan T, Weir T, Ison S, McLean M University of Western Sydney, Sydney, New South Wales

Background: Gestational Diabetes Mellitus (GDM) increases maternal and perinatal complication rates as well as the risk of Type 2 Diabetes in later life. Therefore, it is desirable to lose excess weight after a GDM pregnancy or to avoid future weight gain. We examined whether the diet and lifestyle education provided as part of the GDM management program at Blacktown Hospital helped to control weight between pregnancies in women managed for GDM in their initial pregnancy. We also sought to identify barriers to weight control for this group of women. Methods: Quantitative and qualitative data was collected. The Obstetrix database was used to identify women who were managed for GDM between 2002 and 2009, and who had a subsequent pregnancy. These cases were compared with age and BMI matched controls for weight changes between pregnancies. Qualitative data was obtained through focused interviews with 20 women attending the GDM clinic at Blacktown hospital. Results: 80 cases (GDM in index pregnancy) and 222 controls were identified. Weight gain between pregnancies was 0.31±2.64 kg in the cases compared with 1.54±2.88 kg in the controls (p<0.001). Both groups had a similar interval (mean two years) between pregnancies. Most women with past GDM pregnancies were not aware of the importance of weight control. The greatest barriers to weight control were time constraints and lack of motivation. Conclusion: The educational intervention provided during pregnancy has a legacy effect which limits weight gain in the following two years; however, further improvements could be made to this intervention.

E-POSTER 33

E-POSTER 34

Pregnancy Outcomes Before and After Institution of Specialised Twins Clinic Care

Global Gene Expression Analysis of Amniotic Fluid Cell-Free RNA from Recipient Twins with Severe TwinTwin Transfusion Syndrome

Henry A1,2*, Lees N2, Bein K3, Hall B4, Lim V1, Chen K1, Welsh A1,2, Hui L5,6, Shand AW1,2 1 School of Women’s and Children’s Health, UNSW Medicine, Sydney, New South Wales 2 Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales 3 Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales 4 Midwifery and Women’s Health Nursing Research Unit, University of Sydney, Sydney, New South Wales 5 Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria 6 Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria

Objectives: To compare maternal and neonatal outcomes of twin pregnancy before and after Twins Clinic (TC) commenced at the Royal Hospital for Women (RHW), Sydney. TC is a consultant-led multidisciplinary clinic. Patient characteristics and outcomes were obtained from hospital databases and stratified according to model of care. Findings: 513 twin pairs delivered at RHW January 2007 to November 2011: 212 prior to TC implementation in March 2009 and 301 post-implementation. 16% attended non-specialised antenatal clinic (ANC), 20% TC, 36% private care, 24% were high-risk referrals, and 3.5% midwiferyled. Proportion of nulliparas (59% vs 60%) was similar across time periods: there were fewer monochorionic twins pre-TC (22% vs 34%, p<0.01). Compared to ANC women, TC women had similar demographics but lower Caesarean section rates (55% vs 69%, p<0.01) and fewer inpatient days (mean 7.2 vs 10.7, p<0.001). Gestation at birth (36.2 vs 36.1 weeks), admission to nursery (49% vs 47%), blood loss and maternal postnatal stay (6.0 vs 5.6 days) were similar. Compared to post TC private patients, TC patients had significantly lower Caesarean rates, fewer inpatient days, longer gestation, higher birthweight and decreased nursery admissions (all p values <0.05). Private patient demographics and outcomes did not change from 2007-2009 to 20092011, apart from mean maternal age (33.8 vs 35.8 years, p<0.001). Conclusions: Introducing a dedicated Twins Clinic in our setting decreased Caesarean delivery rates and inpatient stay compared to ANC, with no change in other maternal or infant outcomes. Unchanged private care outcomes over this period make it unlikely effects were purely time-related.

Hui L1,2*, Wick H3, Moise K4, Johnson A4, Luks F5, Haeri S6, Johnson K1, Bianchi D1 1 Mother Infant Research Institute at Tufts Medical Center, Boston, United States of America 2 Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales 3 Department of Computer Science, Tufts University, Boston, United States of America 4 Division of Maternal-Fetal Medicine, University of Texas School of Medicine, Houston, United States of America 5 Warren Alpert Medical School and the Fetal Treatment Program of New England, Providence, United States of America 6 Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, United States of America

Objective: To identify the cardiovascular pathways and genes involved in severe twin-twin transfusion syndrome (TTTS) by performing global gene expression analysis of amniotic fluid (AF) cell-free RNA. Methods: This was a prospective whole transcriptome microarray study comparing AF cell-free RNA from TTTS recipient twins with and without critically abnormal Doppler measurements. Significantly, differentially-regulated genes in Quintero Stage II (N=5) versus Stage III recipients (N=5) were identified using the independent t test and the BenjaminiHochberg correction for multiple testing. Functional analysis was performed with Ingenuity Pathways Analysis to identify annotations within the “cardiovascular system development and function” category. Results: A total of 611 genes were significantly differentially regulated in Stage II versus III fetuses. As predicted, cardiovascular system development and function was significantly enriched in the differentially regulated gene list (p<0.03). Cardiogenesis was the most statistically significant functional annotation within this category (p=0.0002, 24 genes). Morphology of cardiovascular system (p=0.001, 35 genes) and angiogenesis (p=0.005, 32 genes) were also statistically significant. A novel finding was the 8-fold downregulation of apelin, an endogeneous positive inotrope, in Stage III twins. Other individual genes of interest that were differentially regulated in Stage III versus Stage II fetuses included angiotensin converting enzyme and angiopoietin 4. Conclusions: This study provides the first transcriptome-wide data on stagedependent differences in TTTS. Our results suggest an important role for apelin in the hemodynamic deterioration in severe TTTS and may have relevance for the development of future biomarkers.

E-POSTER 35

Review of Instrumental Deliveries: Who Needs Them and Does Our Practice Reflect Current Recommendations? Jung A*, Ng H, Fleming T Gold Coast Hospital, Gold Coast, Queensland

Objective: To retrospectively assess maternal characteristics and intrapartum factors associated with successful instrumental deliveries over the course of one year. In addition, to assess local practices in relation to current national and international instrumental delivery guidelines. Although studies suggest that instrumental deliveries account for approximately one in ten deliveries in Australia, there is a paucity of data looking at the women and the circumstances surrounding an instrumental vaginal birth. Current guidelines from ALSO and others suggest no more than three pulls, three “pop-offs” and an application time of no greater than 20 minutes for safe instrumental vaginal deliveries. Statement of Findings: As anticipated, the majority of deliveries requiring instrumental assistance were in women that had not previously had a vaginal delivery. The indications for instrumental delivery appeared to be equally divided between “fetal distress” and “failure to progress”. Regardless of instrument used, 79% of deliveries are achieved in three or less pulls. Key Conclusion: Clinically, most deliveries occur within the recommended maximum of three pulls, with less than three “popoffs” and within 20 minutes of instrument application. Deliveries requiring more than three pulls were almost twice as likely to result in a neonatal injury. 13.4% of deliveries with more than three pulls resulted in a neonatal cephalohaematoma or subgaleal haemorrhage when compared to just 7% of deliveries with three pulls or less. Of the two deliveries with greater than 20 minutes of instrument application, one resulted in a cephalohaematoma and the other in a subgaleal haematoma. E-POSTER 36

Do All Accouchers on Birth Suite at Western Health Have the Experience and Confidence to Perform an Appropriate Episiotomy When Required? Room for Improvement Khalid A1*, Teale G1, Cunningham C2 1 The Sunshine Hospital, Western Health, St Albans, Victoria 2 Rural Health Academic Unit, The University of Melbourne, Shepparton, Victoria

Despite a relatively high episiotomy rate, Sunshine Hospital experiences above average obstetric anal sphincter injury (OASI) rates. Objective: To assess the experience, training, confidence and technique of episiotomy amongst senior and junior medical and midwifery staff at Sunshine Hospital, Western Health.

Method: Birth suite staff were asked to complete a questionnaire about performing and training in episiotomies. Responses were analysed by discipline and experience using descriptive, chi-square and kappa statistics. Results: The 74 respondents included medical (24%) and midwifery staff (76%). Overall, 77% had more than two years experience on birth suite, 76% felt they had received adequate training in episiotomies, 78% felt confident in their ability to decide the need for an episiotomy, with greater confidence in lithotomy than ‘all fours’ or left lateral position. Only 42% felt confident to suture an episiotomy. Contrary to recent reports of best practice, 47% of staff felt the incision should commence at the fourchette. Of those correctly identifying an appropriate commencement point, most were midwives. There was inconsistent angle preference amongst all participants. Medical staff reported higher confidence in training junior staff (p<0.05) than midwives and this was related to experience (p<0.05). Conclusion: There is variation in performing episiotomies with a significant number of staff utilising techniques that recent reviews suggest contribute to OASI. More training and consistency of practice is required. E-POSTER 37

Screening for Perinatal Anxiety and Depression: An Australian Private Hospital First Kohlhoff J1,2*, Hickinbotham R1,3, Trumper R1, Gidget Research Group1 1 Gidget Foundation, Sydney, New South Wales 2 Karitane, Sydney, New South Wales 3 North Shore Private Hospital, Sydney, New South Wales

Background and objectives: Given the well documented prevalence and negative impacts of perinatal mood disorders, the importance of early identification and intervention is clear. Many public hospitals in Australia have integrated universal screening for depression, anxiety and assessment of psychosocial risks into routine perinatal care, but such processes do not exist in the private sector. With a significant proportion of Australian women choosing the private model of obstetric care, many miss out on the support and treatment that they require at this important time. The ‘Emotional Wellbeing Program’ is a depression and anxiety screening and psychosocial assessment program implemented at North Shore Private Hospital in Sydney, New South Wales. The program is delivered by a team of midwives and a social worker who work in close collaboration with treating obstetricians. Statement of findings: Since its introduction in 2012, over 1,500 women have participated in the program, approximately 16% of whom scored over the threshold for minor depression on the Edinburgh Postnatal Depression Scale (EPDS), and many others who were identified with psychosocial risks (e.g.

history of depression or anxiety disorders, low support and significant life stressors). Qualitative feedback from patients was positive, highlighting the benefits felt after meeting with a midwife to discuss and reflect on their pregnancy, their mental health and other concerning issues. Recommendations: The Emotional Wellbeing Program at North Shore Private Hospital has been associated with a range of successes and challenges, which will be of interest to private health care practitioners and services across Australia. E-POSTER 38

Women’s Attitudes Towards Their Management Following Prelabour Rupture of Membranes at Term, as Determined by their Group B Streptococcus Status Kong KY*, Reece M, Chua SC Women’s Health, Westmead Hospital, Westmead, New South Wales

Background: At Westmead Hospital, rapid PCR testing for GBS is performed on women who presented with term PROM. GBS positive women are induced immediately. GBS negative women were given the options of hospital admission or discharge home for self-monitoring with return to the day assessment unit the next day. Induction of labour is offered if labour does not begin within 24 hours. Aim: To assess the women’s viewpoints regarding home versus hospital management following PROM. The medium term clinical outcome variables and factors contributed to their feelings and future choices were evaluated. Methods: Phone interviews were conducted between February and November 2009. Of 579 women who were phoned, 310 were contactable and 215 agreed to participate in the survey. The survey addressed clinical outcomes which were not available via the patient’s medical records. Patients reported a score between 1 and 10 to evaluate their satisfaction with the care they received between presentation with PROM and representation in labour. Results: Seven women had infection after birth. There were 13 admissions to NICU. Eight babies were admitted to hospital. Women ranked their experience more satisfactory if they were given a choice of home or hospital management or felt that an adequate instruction was given on discharge. Women who were admitted, not having a VBAC, GBS negative, with no obstetrics complication and had a vaginal delivery were more satisfied. Conclusion: Women were satisfied with management of term PROM at Westmead Hospital. There was no significant maternal and neonatal complication. Patient education and autonomy would improve patients’ satisfaction.

E-Poster Abstracts E-POSTER 39

E-POSTER 40

Is Anorectal Physiology Testing Useful in Asymptomatic Primiparous Women with Obstetric Anal Sphincter Injury?

Histological Risk Factors for CIN Recurrence after LLETZ: A Case Controlled Study

Kumar S1*, Patton V2,3, Lubowski DZ2,3, Karantanis E2,4 1 Department of Obstetrics and Gynaecology, St George Public Hospital and The Sutherland Public Hospital, Sydney, New South Wales 2 UNSW St George Clinical School and St George Public Hospital, Sydney, New South Wales 3 Department of Colorectal Surgery, St George Public Hospital, Sydney, New South Wales 4 Department of Obstetrics and Gynaecology and Pelvic Floor Unit, St George Public Hospital, Sydney, New South Wales

Objective: Few obstetric units have access to anorectal physiology testing (ARP) to assess women with obstetric anal sphincter injury (OASIS). While guidelines suggest routine ARP for women with OASIS, the value of testing all women with OASIS is unclear. It is assumed women who are asymptomatic of faecal incontinence will have normal physiology and clinical decisions are based on this. This study aimed to determine the value of routine ARP in asymptomatic women with OASIS. Findings: Primiparous women with OASIS attending a perineal clinic were assessed at six months postpartum using validated scoring (St Mark’s Score), endoanal ultrasound, anal manometry and pudendal nerve terminal motor latency (PNTML). Severity of sphincter injury was classified at delivery using Sultan Classification. Of 220 women analysed, 78 were asymptomatic (St Mark’s score = 0). Of the asymptomatic, 21 had reduced internal sphincter tone and 19 had reduced external sphincter tone. Left PNTML was prolonged in two and right PNTML in three. Endoanal ultrasound showed 14 with internal sphincter defect and 12 with external sphincter defect. In asymptomatic women, OASIS classification distribution was: 3A n=32 (41%); 3B n=19 (24%); 3C and 4 n=9 (12%); unclassified “3rd” n=18. A higher grade defect at delivery related to reduced sphincter tone at six months postpartum (p=0.04). Conclusion: Up to 26% of clinically asymptomatic women with OASIS had abnormal ARP and a higher grade injury increased the likelihood of abnormal results. This may suggest ARP is warranted in women with higher grades of OASIS, regardless of symptoms. Further relevant studies are in progress.

Lusumbami P1*, George S2 1 Gold Coast Hospital and Health Service Gold Coast, Gold Coast, Queensland 2 Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland

Cervical intraepithelial neoplasia (CIN) is a premalignant condition that can become cancer of the cervix if left untreated. Large loop excision of the transformation zone (LLETZ) is the standard treatment for biopsy confirmed high grade lesion. Objective: The purpose of this study was to find out the histological factors that increase the risk of CIN recurrence after LLETZ. Method: This was a retrospective case control study. LLETZ procedures performed between 1 July 2005 and 30 June 2008 at a district hospital in Brisbane were reviewed. Cases were defined as those women with CIN recurrence after LLETZ up to 24 months following treatment. Controls were women who had LLETZ during the same period and had negative pap smears during the defined follow up period. Baseline characteristics were collected for both cases and controls. The following histological data was collected: referring pap smear, colposcopy biopsy histology, LLETZ histology, number of specimens or LLETZ passes, endocervical and ectocervical margin status. Volume of specimen was calculated from the measurements reported. Cases were excluded if they were less than 18 years old at the time of LLETZ or if there was incomplete data. The chi squared test will be used to determine risk factors for CIN recurrence and the odds ratio will be calculated for each identified risk factor. Results: 254 LLETZ procedures were performed during this period. The data analysis is currently being performed and will be complete in time for the RANZCOG 2013 ASM. Conclusions: This will be drawn from the findings. E-POSTER 41

Neonatal Outcomes in Twin Vaginal Births – Twin Birth Time Interval: A Retrospective Study Mahomed K1,2*, Willmott Z1 1 University of Queensland, Brisbane, Queensland 2 Department of Obstetrics, Ipswich Hospital, Ipswich, Queensland

Background: Twin pregnancies have poorer pregnancy outcome compared to singleton pregnancies especially for twin 2. Studies on twin birth time interval have included outcome of all second twins irrespective of mode of birth. We could find no Australian studies in a clearly defined population.

Methodology: Retrospective study of all twins ≥37 weeks in Queensland, during January 2005 – December 2011: a Both cephalic and delivered vaginally; b Twin 1 cephalic and twin 2 non cephalic and delivered vaginally. Results: 693 eligible women were analysed. a When both cephalic and born vaginally there were significantly more newborns in the shorter time interval that required resuscitation and needing to stay in SCN for >3 days. b Where second twin was non cephalic and born vaginally, all outcomes, although not reaching statistical significance, were poorer for neonates where delivery interval was greater than 30 minutes. Conclusion: This large dataset looking at a specific group of women suggest: a with both twins cephalic, in the absence of fetal distress, it is safer to allow slow and gradual birth of twin 2. b with second twin being non cephalic, twin birth time interval should be kept short at around 15-20 minutes. Restricting cases that are at term and where twin 1 was cephalic and both were born vaginally allowed us to focus accurately on twin birth time interval. We did not address chorionicity, level of experience of the accoucher, timing and competence of intrauterine manipulation and the wish of the woman giving birth. E-POSTER 42

OEIS Complex – A Rare Complication of Twin Pregnancy Maindiratta B1*, Lim BH1, Brothers L2 1 Departments of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart, Tasmania 2 Medical Imaging, Royal Hobart Hospital, Hobart, Tasmania

OEIS (Omphalocoele Exstrophy Imperforate anus Spina bifida) complex is a rare condition in pregnancy, more so in MCMA twins. We present this rare case and discuss the diagnostic challenges. A 23 year old woman in her third pregnancy with confirmed MCMA twins was diagnosed following a routine ultrasound scan at 16 weeks to have one twin with a low sacral cystic meningocoele along with bladder exstrophy and abnormal perineum with a short bifid penis and an amorphous mass replacing the scrotum. There were diagnostic difficulties due to multiple pregnancy and her Body Mass Index of 37. Whilst Magnetic Resonance Imaging was thought to be potentially helpful, her BMI was deemed unsuitable for the examination. Further specialised ultrasound scans showed a pelvic cystic lesion possibly dilated renal pelvis with crossed fused renal ectopia. The spectrum of anomalies were thought be part of OEIS complex. Due to increasing polyhydramnios, the twins were delivered at 32 weeks by Caesarean section after fetal lung maturation with corticosteroids.

Twin 2 was noted to be normal at birth but twin 1 was confirmed to have bladder exstrophy, completely bifid penis, imperforate anus with rectovesical fistula and omphalocoele with a 6cm diameter abdominal wall defect containing a few intestinal loops in it. Spina bifida with terminal cyst and cord tethering along with cross fused renal ectopia was confirmed by ultrasound. Palliative care was provided and the affected twin survived for 48 hours. The prognosis of OEIS complex is variable depending on the severity of the structural defects. E-POSTER 43

Ovarian Ectopic Pregnancy – A Challenging Diagnosis Maindiratta B , Patel S , Chin G 1*

1 Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart, Tasmania 2 Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria

A 31 year old woman, gravida 4 para 2, presented with an acute abdomen in a haemodynamically unstable condition. Her beta HCG was 2129IU/L in the setting of four weeks amenorrhea. At laparotomy, the finding was of an enlarged left ovary with ongoing, significant haemorrhage. This was treated by cystectomy and further haemostatic ovarian sutures. The estimated blood loss was 2.5 litres and intraoperative haemoglobin was 55g/L. She was transfused three units of packed red blood cells; a further two units of red blood cells transfused during her post-operative admission. The patient was well on day four postop and was discharged home. The histology report confirmed presence of chorionic villi with associated villous and extravillous trophoblast; these products of conception were embedded in ovarian tissue and also present on the ovarian surface. The intervening stroma was necrotic indicating rupture. The adjacent ovarian stroma contained corpus luteum with central area of organising haemorrhage. Ovarian pregnancy occurs in 1:7,000 pregnancies. It is a rare form of ectopic pregnancy. The incidence of ovarian ectopic pregnancy is rising, being approximately 0.5 to 3% of all ectopic pregnancies. The pre-operative diagnosis of ovarian ectopic pregnancy is still difficult. It is often confused with a ruptured corpus luteum in 75% of cases or mistaken for an ovarian cyst. The recent advances in bHCG determination and transvaginal scanning have been invaluable tools in the diagnosis of this condition. However, in acute presentations such as this case, immediate resuscitation and timely operation may be indicated as a priority over ultrasound diagnosis.

E-POSTER 44

E-POSTER 45

Pre-term Uterine Scar Dehiscence: A Case Report Highlighting Management Considerations and Imaging Modalities

Acute Aortic Dissection in Pregnancy in a Woman with Undiagnosed Marfan Syndrome

Maindiratta B1*, Edwards L2, Blanchette G1, Chin GSM1,3 1 Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart, Tasmania 2 Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria 3 Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria

A 32 year old woman, gravida 6 para 5, was reported to have asymptomatic thinning at the level of her uterine scar on fetal growth ultrasound at 31 weeks gestation. She had one previous caesarean section (CS) 10 years ago followed by three vaginal births. Magnetic Resonance Imaging (MRI) one week later described focal thinning and dehiscence, and a shelf of myometrium adjacent to the uterine scar. After MRI, she was admitted to hospital for corticosteroids and planned CS. Management plans were formulated balancing voiced patient concerns about childcare for an immediate/protracted admission to hospital. Within six hours of admission, precipitated by later onset of regular painful uterine tightenings, she had an emergency lower uterine segment caesarean section through her previous uterine scar. Operative findings were a bulging hourglass of membranes through a central uterine scar rupture and adjacent palpable shelf of myometrium. The fetus was in transverse lie (back down) at the level of the uterine scar (above the bulging membranes) and delivered by breech extraction. The uterus was closed in two layers; haemostasis achieved. Apgars were 6, 7 and 8. Cord blood gases were pH 7.35 (arterial) and 7.39 (venous). Birthweight was 2,130 grams. Management of asymptomatic uterine CS scar thinning +/- dehiscence at pre-term gestations can produce challenges. MRI may provide additional useful information. Management plans should be discussed with patients. Engagement with the patient in this way can improve patient compliance, reduce obstetric risk and therefore facilitate safe outcomes for mother and baby.

Master M1*, Day G2 1 Department of Obstetrics and Gynaecology, Women’s and Children’s Hospital, Adelaide, South Australia 2 Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, South Australia

We report a case of acute aortic dissection in a lady of 28 weeks gestation with undiagnosed Marfan syndrome. The patient had been seen in our antenatal clinics. Her history documented in her pregnancy record was negative for genetic/congenital abnormalities. There was no family history documented. Subsequently at 28 weeks gestation, the patient presented with sudden onset chest, jaw and back pain. Further history revealed that her father had died age 27 of an aortic dissection. Echocardiography showed aortic root dissection with occlusion of aortic branches. She subsequently underwent an emergency lower segment caesarean section followed by surgical repair of a Type A dissection. A simultaneous Type B dissection was managed conservatively. On later examination our patient fulfilled the diagnostic criteria for phenotypic expression of Marfan syndrome. Genetic testing also confirmed that she had a mutation of the fibrillin (FBN 1) gene associated with the disease. E-POSTER 46

A Single Nucleotide Polymorphism (SNP)-based Approach to NonInvasive Prenatal Testing (NIPT) Identifies Lingering Cell-Free Fetal DNA (cffDNA) in Pregnancies with Vanishing Twins McAdoo S*, Savage M, Hall MP, Hill M, Zimmermann B, Sigurjonsson S, Demko Z, Rabinowitz M Natera Inc., San Carlos, CA, United States of America

Objective: Using a SNP-based NIPT to analyse cffDNA allows for identification of samples with multiple maternal and/ or paternal haplotypes; these additional parental haplotypes distinguish single from multiple gestations. Vanishing twins may confound fetal copy number calling in singleton pregnancies due to lingering cffDNA from the vanishing twin. A SNP-based approach allows detection of vanishing twins in reportedly singleton pregnancies, and may reduce the frequency of incorrect results. We present three such cases. Findings: Commercial samples were analysed using the Next-generation Aneuploidy Test Using SNPs algorithm. Follow-up was collected on samples with multiple parental haplotypes. Case 1: vanishing twin reported at 6w0d, maternal blood drawn at 14w3d; Case 2: twin loss reported at 6w5d, maternal blood drawn at 13w5d. Neither case had evidence of

E-Poster Abstracts a second sac at blood draw. Case 3: two sacs but one fetus reported at 12w6d, maternal blood drawn at 19w1d. Conclusions: This method detected cffDNA from a vanishing twin as many as eight weeks after demise. The contribution of cffDNA from a vanishing twin increases the total cffDNA estimate, potentially resulting in analysis of samples with cffDNA levels from the surviving twin below that which is appropriate for accurate detection of aneuploidy. Additionally, residual cffDNA from the vanishing twin is more likely to be abnormal. Together, this may result in incorrect results when using non-SNPbased methods, as these are classified as singleton pregnancies at the time of maternal blood draw. This SNP-based NIPT approach identifies these cases, potentially decreasing incorrect results. E-POSTER 47

Trial Self-Weighing Integrated Into Routine Pregnancy Care is Welcomed by Overweight and Obese Women But is Insufficient to Prevent Obstetric Complications or Excess Gestational Weight Gain: A Randomised Controlled Trial McCarthy EA1,2*, Leong O2, Walker SP1,2, Ugoni A3, Shub A1,2 1 Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria 2 Mercy Hospital for Women, Heidelberg Victoria 3 Department of Physiotherapy, University of Melbourne, Melbourne, Victoria

Objective: Does targeted self-weighing in pregnancy prevent obstetric complications for overweight and obese women? Design: Assessor blinded randomised controlled trial. ACTRN12611000881932 http://www.ANZCTR.org.au/ ACTRN12611000881932.aspx Setting: Tertiary obstetric hospital. Sample: 382 normotensive, non-diabetic overweight and obese pregnant women at <20 weeks gestation. Methods: 1:1 randomisation to serial self-weighing with Institute of Medicine (IOM) 2,000 targets, supported by existing maternity caregivers or to standard care. Main Outcome Measures: Primary outcomes: obstetric complications defined as gestational hypertension and pre-eclampsia, gestational diabetes, assisted or Caesarean birth, shoulder dystocia, severe perineal trauma, postpartum haemorrhage, maternal high dependency care or mortality. Secondary outcomes: gestational weight gain (GWG) between booking and 36 weeks gestation; C-reactive protein and adiponectin at 28 weeks; quality of life and frequency of self-weighing reported at 36 weeks of gestation. Findings: 68% of women experienced one or more obstetric complications; not significantly different between standard care and serial self-weighing.

Serial self-weighing was associated with a non-significant trend to reduced GWG (point estimate 0.9kg lower, p=0.1). Good quality of life was recorded at 36 weeks for women in both intervention and standard care arms. An unexpectedly high number of women already serially selfweigh during pregnancy. Conclusions: Serial self-weighing does not diminish quality of life in late pregnancy but is insufficient to prevent maternal obstetric morbidity. More rigorous containment of gestational weight gain by 1-4kg or specific metabolic goals, such as reducing insulin resistance or achieving eulipidaemia, may be needed to reduce obstetric morbidity in overweight and obese women. E-POSTER 48

Temporary Resolution of Severe Pre-Eclampsia Following Spontaneous Single Twin Demise at 23 Weeks in a Dichorionic Pregnancy with Prior High Risk of Pre-Eclampsia: A Case Report and Literature Review to Inform Risk, Reproductive Options and Rural Challenges McCarthy EA1,2*, Palmer KR1, Pill W3 1 Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria 2 Perinatal Centre, Mercy Hospital for Women, Heidelberg, Victoria 3 Womenâ&#x20AC;&#x2122;s Health, The Northern Hospital, Epping, Victoria

Background: Pre-eclampsia does not resolve until placental anti-angiogenic factors are removed, usually by delivery of placenta and fetus. Demise of one twin of a dichorionic pregnancy reduces the maternal burden of anti-angiogenic factors as evidenced by nine previous case reports of temporary resolution of pre-eclampsia following spontaneous or iatrogenic single twin demise. Recurrent pre-eclampsia or fetal growth concerns typically prompt delivery six to eight weeks after single twin death. Case: A 34 year old multigravid woman at high risk of pre-eclampsia due to twin pregnancy, obesity and previous eclampsia developed severe pre-eclampsia and selective fetal growth restriction at 21+6/40 with dichorionic placentation. Pre-eclampsia improved following spontaneous single twin death at 23+5 weeks but recurred requiring delivery at 29+4 weeks. Conclusion: This case report confirms the pattern of pre-eclampsia resolution after death of a single twin: blood pressure normalises within one or a few days, proteinuria resolves within a week, elevated trans-aminases and/ or thrombocytopaenia resolve within a month. The case report also supports the hypothesis that involution of vascular villi and normalisation of anti-angiogenic factors may take nine weeks following single fetal twin death. During this

time, pre-eclampsia and fetal growth restriction risks remain elevated above that of a singleton pregnancy of the same gestation. The literature review provided information for the patient and her family about risk and reproductive options. The review also provided information for effective shared care between rural obstetric and academic perinatal care. E-POSTER 49

Midtrimester Severe Liver Failure as an Adult Presentation of an Inborn Error of Urea Cycle Metabolism McCarthy EA1,2*, Wilcox G3, Paulsen G2, Walker SP1,2 1 Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria 2 Perinatal Centre, Mercy Hospital for Women, Heidelberg, Victoria 3 Department of Adult Inherited Metabolic Disorders, Salford Royal NHS Foundation Trust, Salford, Greater Manchester, United Kingdom

Introduction: Classically presenting in infancy, critical hyperammonamia due to urea cycle disorders can also present for the first time in adults, particularly around pregnancy. Postpartum presentations relate to catabolism of involuting gestational tissues. First trimester presentations relate to accelerated starvation of pregnancy. We present a case of type 1 citrullinaemia diagnosed in the midtrimester with relapsing liver failure at 13 and 18 weeks of gestation. Case: A 19 year old G2P0M1 at 18 weeks in a planned pregnancy presented with her second episode of severe synthetic liver failure of unknown origin during pregnancy. The hepatology team sought perinatal advice about pregnancy termination. Liver biopsy and cholecystectomy were non-diagnostic. No toxic, infective or pregnancy related cause was identified. A dietary history revealed fluctuating severe hyperemesis with weight loss which preceded both episodes of liver failure and metabolic investigations diagnosed type 1 citrullinaemia, an autosomal recessive disorder of the urea cycle. The patient improved with anti-emetics, dietary advice and specific doses of L-arginine. She gave birth to a healthy 2.9kg girl at 37 weeks gestation. With close metabolic surveillance, the patient suffered no further decompensation in pregnancy, labour, lactation or the puerperium. Discussion: Abnormal conscious state and/or liver failure during pregnancy or postpartum should prompt measurement of serum ammonium. High ammonia should then prompt metabolic assessment. Exemplified by this case, expert metabolic diagnosis and management, diet advice and supplementation can reverse critical maternal illness, permitting the patient to achieve a healthy term pregnancy.

E-POSTER 50

Pregnancy Complicated by Spontaneous Pneumathoraces: A Case Study and Review of the Literature

of symptoms. Expeditious surgical exploration and increased conservatism in premenopausal women in whom there is a low suspicion of malignancy is recommended.

McKnoulty M

E-POSTER 52

Logan Hospital, Meadowbrook, Queensland

Correct Placement of the Essure Device Detected By Transvaginal Ultrasound at One Month Predicts Correct Placement at Three Months

Primary spontaneous pneumothorax is rare in pregnancy, with just over 60 reported cases to date. The significant reduction in respiratory function during pregnancy is further compromised in these patients, resulting in an obstetric and medical emergency that can potentially lead to severe outcomes. Review of the literature reveals little consensus on appropriate management, with no current guidelines available to assist obstetricians. We report on a patient who developed two spontaneous pneumothoraces in a single pregnancy and discuss dilemmas associated with investigation, management and delivery. E-POSTER 51

Adnexal torsion – dead or not? McRae A1*, Lyons S2 1 Academic Dept of Adolescent Medicine Westmead Childrens Hospital, Westmead, New South Wales 2 Royal North Shore Hospital, St Leonards, New South Wales

Background: Adnexal ischemia/reperfusion models involving cycling female rodents demonstrated that regardless of ischemia time, all of the twisted adnexa were blackish blue in appearance. Histologic examination of ovaries with an absolute ischemia time of between 4-24 hours revealed intact ovarian structure similar to controls suggesting that macroscopic appearance was not a reliable indicator of the degree of ischemia. Aim: To determine accuracy of surgical assessment of adnexal viability in surgically diagnosed adnexal torsion and assess histological presence of ischemia or necrosis in relation to duration of symptoms in those who underwent extirpation. Method: A retrospective audit of medical records of all women at Royal North Shore Hospital identified with a diagnosis of Ovarian/ Adnexal Torsion on ICD coding between July 1999 and 2009. Results: 40% of extirpated adnexae described by surgeons as demonstrating infarction and or necrosis did not have this confirmed on histopathology. 13% of adnexae not described as necrotic and or infarcted showed evidence of such at histopathology. Average time elapsed from symptom onset to surgery in those adnexae showing no evidence of infarction or necrosis was 42 hours and those who had histopathological evidence of infarction and or necrosis was 177 hours. Conclusion: Surgical assessment of ovarian viability is unreliable and absolute ischemia may not begin with first onset

Mitchell S1*, May J2, Ades A1 1 Department of Obstetrics and Gynaecology, Royal Women’s Hospital, Melbourne, Victoria 2 Frances Perry House, Parkville, Victoria

Background: Correct placement and tubal occlusion following Essure sterilisation is presently confirmed with imaging three months post procedure. Compliance with post procedure imaging is low and non-compliance has been implicated in unintended pregnancies following Essure insertion. Patient adherence to medical advice is known to decrease over time. Earlier imaging may improve compliance. Objective: To determine if correct placement of the Essure micro-insert detected at one month by transvaginal ultrasound (TV US) is predictive of correct placement at three months. Methods: Prospective cohort of 31 patients in a single centre who underwent the Essure procedure and had TV US at one month and three months post procedure. Findings: The Essure micro-insert was detected in the accurate position by TV US in all 31 women at both one month and three months post insertion. Conclusions: Correct placement of the micro-insert detected at one month is predictive of correct placement at three months. TV US at any time from one month could be used as the confirmation test for correct placement of the Essure device. This may provide earlier reassurance to women and improve compliance with follow up, potentially reducing numbers of unintended pregnancies. The importance of alternative contraception until three months post insertion should still be emphasised. E-POSTER 53

Urinary Retention Following Laparoscopic Gynaecological Surgery with or without 4% Icodextrin Anti-Adhesion Solution Nesbitt-Hawes EM1,2*, Zhang C1, Won H1,2, Law K1,2, Abbott JA1,2 1 University of New South Wales, Sydney, New South Wales 2 Royal Hospital for Women, Randwick, New South Wales

Urinary retention is a recognised complication of laparoscopic surgery. Previous work showed an association with 4% icodextrin solution and urinary retention. We aimed to determine the incidence of urinary retention following laparoscopic gynaecological surgery with or without the use of 4% icodextrin.

A prospective observational study of 147 women undergoing laparoscopic gynaecological surgery for benign pathology was performed from May 2011 to February 2012. Women had their planned laparoscopic procedure and either received icodextrin solution or nothing as determined by their treating surgeon at the time of the operation. Of the 124 women included in the data analysis, 62 received icodextrin and 62 did not. The women in the non-icodextrin group were significantly older (p=.007) and had a higher BMI (p=.03) than those in the icodextrin group. Following surgery, 27/124 (21.8%) women had postoperative urinary retention. Icodextrin was associated with significantly more urinary retention (p=.017), but did not extend hospital admission significantly (p=.14). The administration of icodextrin was associated with resection of moderate or severe stage endometriosis involving multiple surgical sites, whereas women in the non-icodextrin group were more likely to be having a hysterectomy. In this non-randomised study, there were significantly more women with postoperative urinary retention when icodextrin was used, however this did not contribute to an extended hospital admission. While there may be confounding factors, women receiving icodextrin should be warned of the possibility of urinary retention post-operatively, but that this is unlikely to affect their stay in hospital. E-POSTER 54

Breastfeeding: The Attitudes and Level of Knowledge Amongst a Cohort of General Practitioners Petinga M1*, Wann D3, Cummins L3, Georgiou C1,2,3 1 University of Wollongong, Graduate School of Medicine, Wollongong, New South Wales 2 Illawarra Health and Medical Research Institute, Wollongong, New South Wales 3 Wollongong Hospital, Wollongong, New South Wales

Introduction: Breastfeeding is a significant public health issue requiring a multidisciplinary approach to ensure appropriate education and support. General Practitioners (GPs) are often the first of a series of healthcare professionals that are encountered by pregnant women. Although current breastfeeding knowledge and positive attitudes are components in the promotion of breastfeeding, studies have shown that breastfeeding knowledge deficiencies exist in doctors. Furthermore, an apparent paucity exists of research focused on the breastfeeding attitudes/ knowledge and the ways in which Australian GPs are accessing breastfeeding education. Objective: A previously published survey format was used to assess breastfeeding attitudes and knowledge levels. This was expanded to include participant demographics and information about the preferred form of medical education, and then distributed to GPs affiliated with the University of Wollongong’s Graduate 77

E-Poster Abstracts School of Medicine. The following objectives were then assessed in relation to breastfeeding: 1 Attitudes and level of knowledge. 2 The impact of age, gender and training location. 3 Access to breastfeeding education. Findings: The overall attitudes towards breastfeeding were positive with few significant differences found between age, gender and training location groups. Although knowledge deficiencies, as assessed by the specific survey questions, were evident, few were of any statistical or clinical significance. Conclusions: The preferred method for additional training is though local GP training sessions. Based on the results of this project, a suggested approach to “breastfeeding education” for students rotating in O&G has been implemented within the MBBS course. E-POSTER 55

Does Perfect Antenatal Blood Sugar Control Prevent Neonatal Hypoglycemia? Phipps H1*, Lee X2 1 Queensland Health, Ipswich Hospital, Ipswich, Queensland 2 Queensland Health, Hervey Bay Hospital, Hervey Bay, Queensland

This study attempts to identify whether perfect antenatal glycaemic control in women with gestational diabetes eliminates the risk of neonatal hypoglycaemia. If healthy babies of women with perfect diabetic control have less hypoglycaemia, they may not require 24 hours of blood sugar monitoring and may be eligible for early discharge from hospital. A chart audit was performed of all women with gestational diabetes who delivered at Ipswich Hospital in 2010 (138 women). Women with diet controlled diabetes and those managed on insulin or metformin were eligible. Women with type 1 or type 2 diabetes were excluded from the study. Women were defined to have perfect glycaemic control if blood sugars from the last antenatal visit and during labour were <5.5mmol/L fasting and <7mmol/L two hours postprandial and in labour. Twenty seven women with normal readings were allocated to the perfect group, and 39 women with high readings were allocated to the imperfect group. The number of neonates who became hypoglycaemic and the duration of hypoglycaemia were recorded. Babies who had other medical issues contributing to hypoglycaemia were excluded. Student’s T-test showed that average duration of hypoglycaemia in the perfect group (3.91 hours) was not significantly different from the imperfect group (3.65 hours) with p=0.98 (a=0.05, two tailed test). This implies that perfect antenatal blood sugar control does not prevent neonatal hypoglycaemia and that babies of these women still require blood sugar monitoring in hospital. 78

E-POSTER 56

Early Prediction of Spontaneous Preterm Birth in Asymptomatic High Risk Women at 18-22 Weeks’ Gestation using Quantitative Fetal Fibronectin Radford S*, Hezelgrave NL, Abbott D, Seed P, Tribe RM, Shennan AH Women’s Health Academic Centre, Kings College London, United Kingdom and Monash University, Melbourne, Victoria

Objective: This study evaluated the predictive capability of quantitative fetal fibronectin (QfFN) at 18+0 to 21+6 weeks’ gestation for spontaneous preterm birth (sPTB) in high-risk asymptomatic women compared with the standard 22-34+6 week gestational window. Methods: A blinded observational study of 469 asymptomatic pregnant women deemed to be at high-risk of sPTB. fFN was measured from cervico-vaginal samples using a bedside quantitative rapid fFN analyser. The value of qfFN concentration measured at the ‘early test’ (18+0 and 21+6 weeks’) to predict spontaneous preterm delivery before 30, 34 and 37 weeks’ gestation and within four and eight weeks’ of testing was assessed. This was compared to the 349 samples taken in the ‘standard 22-34+6’, with participants acting as their own controls. Results: Overall, in all women having an ‘early’ fFN test, there was a sPTB of 78/479 (16.3%) <37 weeks’, 42/479 (8.8%) <34 weeks’, 23/479 (4.8%) <30 weeks’. With increasing fibronectin concentrations (<10 to>200ng/ml) at 18 weeks’ and 22 weeks’, the proportion of women experiencing sPTB <34 weeks increased from 3.7% to 26.5% (early) and 2.6% to 28% (late). fFN samples taken from 18 weeks showed a strong and significant predictive value for the prediction of sPTB. The predictive value of fFN sampled between 18+0 and 21+6 weeks were comparatible to tests conducted beyond 22 weeks via receiver operator curve areas (ROC) AUC 0.74 (0.63-0.84), (early) and 0.76 (0.53-0.97) (late) for delivery before 30 weeks. Conclusion: QfFN screening is valid for the prediction of sPTB from 18 weeks in high-risk asymptomatic women. Earlier identification of women at high-risk of sPTB may enable earlier targeted management and potentially improve fetal outcomes. E-POSTER 57

Dysregulated Immuno-Suppression in Women with EndometriosisAssociated Infertility Riaz A1*, Wong C1, Berbic M1, Jansen RPS2, Schmidt U2, Markham R1, Fraser IS1, Hey-Cunningham AJ1 1 Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales 2 Genea Limited, Sydney, New South Wales

Objective: To evaluate the role of regulatory T cells (Tregs) in the pathogenesis of endometriosis-associated infertility.

Supporting information: Endometriosis is a leading cause of infertility. Immunological alterations have a likely role in the pathophysiology of endometriosisassociated infertility1. Endometrial Treg numbers are increased in early pregnancy normally and induce immune tolerance to facilitate embryo implantation. Numbers and/or function of Tregs may be inadequate in unexplained infertility2. Tregs are also highly disturbed in endometriosis3, yet their precise roles in endometriosis-associated infertility are unclear. Statement of findings: In this ongoing study, Tregs in blood and endometrium of infertile women with endometriosis are compared to fertile controls using multi-colour flow cytometry with antibodies to CD45, CD4, CD25 and CD127. Preliminary results from infertile women with endometriosis (n=5) and controls (n=3) show the presence of CD4+CD25+CD127dim Tregs with proportions ranging 4.9-19.8% of CD4+ cells in the endometrium and 3.3-5.4% in blood. Key conclusions: Recruitment is continuing to comprehensively characterise Tregs in endometriosisassociated infertility. Current evidence suggests Treg dysregulation may be important in infertility in women with endometriosis. Better understanding of the pathophysiology of infertility in endometriosis may lead to development of improved treatment approaches for women desiring to become pregnant. References: 1 Eisenberg VH, et al. Autoimmun Rev 2012; 11(11):806-14. 2 Aluvihare VR, et al. Nat Immunol 2004; 5(3):26671. 3 Berbic M, et al. Hum Reprod 2010; 25(4):900-7.

E-POSTER 58

Perinatal and Social Factors Predicting Caesarean Delivery in an Australian Birth Cohort Robson S1*, Westrupp E2, Mohamed AL1, Vally H3 1 Australian National University, Canberra, New South Wales 2 Parenting Research Centre, Melbourne, Victoria 3 LaTrobe University, Melbourne, Victoria

Background: The rate of caesarean delivery (CD) in Australia and the developed world has more than doubled over the last 20 years, which has attracted enormous interest and concern. To date, attempts to understand and lower this rate have been unsuccessful. Our study sought to identify modifiable risk factors associated with CD. Method: Data from the Longitudinal Study of Australian Children (LSAC), a long-term prospective study of approximately 5,000 children, was analysed. Information about pregnancy, birth and family characteristics was examined. Logistic regression was used to examine perinatal and social factors predicting caesarean birth (representing 30% of the sample).

Results: Mothers using assisted reproduction, or with diabetes, high blood pressure, or prescribed medication during pregnancy were 1.5-1.7 times more likely to have a CD. However, mothers facing social adversity (low socio-economic position, language other than English, young mothers, large families, low education) were much less likely to have a CD. Conclusions: A number of factors were found to be associated with CD. Factors that reduce the risk of CD may well be confounded by access to private health insurance, since private hospitals are known to have higher rates of caesarean birth. E-POSTER 59

Carbetocin – Is it an Alternative Oxytocic for Caesarean Sections? Rudra T*, Siddiq L, Gourlay T Hervey Bay and Maryborough Hospital, Queensland

Introduction: Carbetocin, a synthetic oxytocin analogue, is recommended prevention of uterine atony in Caesarean sections. Objectives: Whether Carbetoin could replace the use of traditional oxytocics in preventing uterine atony during all caesarean sections. Methodology: This retrospective observational study was conducted at the Fraser Coast Heath Care for an eight month period from October 2012. The first 100 patients who had Carbetocin intravenously for Caesarean Section were analysed. Results: 43 and 57 of these women had elective and emergency Caesarean sections respectively. 77% were between 20 to 40 years of age. 79% had normal BMI and 89% were Caucasians. Seven of them had CS before 37 weeks. 23.2% of Electives and 61.4% of Emergency CS were primiparas. 21% were of the Emergency CS group were following induction. 81% and 4% had Spinal and GA respectively. 32.5% of Elective CS and 28% of Emergency CS had PPH. Five of them had blood loss between 1 to 1.5 litres. All except for one were following uterine hypotonia. None of them had elevated BP following administration of Carbetocin and only six had nausea and vomiting. 11 of them had additional oxytocics and four had Oxytocin infusion for four hours. 8% had stayed in the recovery for longer than four hours. Conclusion: Carbetocin is a safe drug used for caesarean sections with minimal adverse effects and peripartum blood loss.

E-POSTER 60

Role of Bakri Balloon Catheter for Vaginal Lacerations Rudra T*, Jesudas D North West London Hospitals NHS Trust, Harrow, Middlesex, United Kingdom

Introduction: Bakri Balloon had been recently used for management of intractable vaginal lacerations. Objectives: Whether the Bakri Balloon Catheter would be an alternative method to manage vaginal laceration. Methodology: The prospective observational study was conducted in the North West London Hospitals NHS trust from 2007 to 2013. The Cock’s Balloon catheter was introduced for intractable vaginal lacerations which were not responding to suturing of the lacerations. Results: This unit had an annual delivery rate of 5,400 with a PPH rate of 12% and MOH rate of 2.7%. 42 patients had needed Bakri Balloon used as a tamponade in the vagina as an additional measure, 54.8% were Primiparas, 42.5% extremes of age, 81% were either Asian or Afro Caribbean. Two, 33, seven had first, second and third degree lacerations respectively. 26 with uterine hypotonia and three were complicated with DIC. 73.8% had MOH. 28.5%, 12% and 28.5% had Ventouse, forceps delivery and sequential delivery respectively. Except for 9.5% all others had additional uterotonics. 37 had one catheter inserted into the vagina and others had two. 34 had more than two units of blood transfused. Post procedural blood loss was less than 200ml in 61.9%. 29 had postpartum sepsis. 39 had longer hospital stay. Conclusion: Bakri Balloon Catheter is an excellent substitute to conventional vaginal pack for managing complex vaginal lacerations with PPH, with minimal adverse effects. E-POSTER 61

The Obstructed Hemivagina, Ipsilateral Renal Anomaly, Uterine Didelphys Triad: Institutional Case Series of Eleven Patients Including 16p11.2 Microdeletion and Cervical Aplasia Sabdia S1*, Kimble R2 1 Royal Brisbane and Women’s Hospital, Brisbane, Queensland 2 University of Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Queensland

This report is intended to expand the literature regarding diagnosis and management of the triad of obstructed hemivagina, ipsilateral renal anomaly and uterus didelphys, including a rare variant. We present a case series of 11 patients with this uncommon congenital Müllerian anomaly managed between 20052013 at a tertiary centre for adolescent gynaecology. Parallels in this cohort compared to the literature included heterogenicity of presentation, presence of endometriosis, and asymmetry of the affected side, with right side abnormalities more frequent than left;

notable differences included one patient with a 16p11.2 microdeletion and three patients with unilateral cervical aplasia. Initial workup for severe dysmenorrhoea in adolescence should include a pelvic ultrasound, although magnetic resonance imaging, preferably at a tertiary centre with experience in Müllerian anomaly interpretation, remains more accurate than ultrasound at adequately delineating abnormalities and aiding in surgical planning. Laparoscopy is advocated as an adjunct to diagnosis and enables further assessment and management of concurrent pathology, such as endometriosis. Vaginal septum division for obstructed hemivagina appears to have a better short term outcome compared with excision, which may be associated with vaginal constriction. The triad in combination with ipsilateral cervical aplasia has been described in only one prior report. Three cases are described in this series, with hemi-hysterectomy of the affected side proposed as the ideal definitive treatment to prevent recurrent presentations with obstructive symptoms and assist in pre-pregnancy planning. Greater awareness of the complexity of these cases can facilitate prompt referral to a tertiary facility for assessment and surgical intervention. E-POSTER 62

Venous Thromboembolism Prophylaxis Around the Time of Caesarean Section: A Survey of Current Practice Seeho S1,2*, Nippita T1,2, Nasser N2, Roberts C2, Morris J1,2 1 Department of Obstetrics and Gynaecology, University of Sydney, Royal North Shore Hospital, Sydney, New South Wales 2 Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, Sydney, New South Wales

Background: Pregnancy, the postpartum period and caesarean section (CS) are risk factors for venous thromboembolism (VTE). Although rare, VTE is a leading cause of maternal death in Australia. There is a lack of data regarding VTE prophylaxis around the time of caesarean birth. Aim: This study aims to describe the practice of obstetricians with regard to VTE prophylaxis during and following caesarean birth. Methods: An online survey was sent to all Fellows and trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Questions were related to VTE prophylaxis use based on various scenarios and intention to include patients in randomised trials. Results: Of those emailed, 596 (28%) responded. During CS, 49% recommended intermittent calf compression and 80% graduated compression or thromboembolic deterrent (TED) stockings, compared to 25% and 88%respectively following CS. Low molecular weight heparin (LMWH) use varied, with 42-65% of respondents recommending LMWH for any length of 79

E-Poster Abstracts time postpartum. Factors that increased usage of LMWH were BMI (OR 1.7; 95%CI 1.6-1.9) and after emergency CS (OR 1.3; 95%CI 1.2-1.4). Maternal age or preeclampsia did not impact practice. 58-79% of respondents would be willing to randomise patients to a randomised trial, but were less likely if patients had an increased BMI or an emergency CS. Conclusion: There is variation in use of non-pharmacological and pharmacological methods of VTE prophylaxis for women around the time of CS, with LMWH more likely to be utilised for women with increased BMI and after emergency CS. E-POSTER 63

An Analysis of the NSW Midwives Data Collection (MDC) Over an 11 Year Period to determine the Risks of Induced Delivery for Non-obstetric Indication at Term Shamsa A2*, Raviraj P1, Bai J3, Gyaneshwar R3 1 Blacktown Hospital, Blacktown, New South Wales 2 Westmead Hospital, Westmead, New South Wales 3 Liverpool Hospital, Liverpool, New South Wales

Objective: To determine the risks of induced term delivery to the mother and baby at different gestational ages in the absence of obstetrical indications. Supporting Information: All deliveries in NSW between 1998-2008 were reviewed from the MDC. 231,456 uncomplicated pregnancies which were induced for non-obstetric reasons after 37 completed weeks were studied. This was a retrospective, historical cohort study and both maternal and neonatal outcomes were analysed and compared between different gestational age groups. An analysis of the data provided the information that there is a significant (p<0.001) increase in the trend of induction rates through the years and that induction of labour after 37 completed weeks exposes the fetus and mother to different levels of risk at different gestations. Conclusions: In an uncomplicated pregnancy, induction of labour is associated with the highest rate of neonatal complication at 37 weeks as compared with rates at later gestations. With each ensuing week the neonatal outcome improves. At 40 weeks the likelihood of neonatal intensive care admission, low Apgar scores, and perinatal death rate is at its lowest and then there is a slight but not significant rise after 41 weeks. Furthermore, the data shows that the earlier the gestation of induction, the longer the length of stay for the baby. The likelihood of caesarean section is lowest when inductions are carried out at 39 weeks, and is highest at 41 weeks and over.

E-POSTER 64

“Desperate Deborah”: Evaluation of a Training Mannequin for Stuck Heads at Caesarean Section Shennan A1*, Vousden N1, Cargill Z1, Briley A1, Tydeman G2 1 Kings College London, United Kingdom 2 Victoria Hospital, Kincaldy, Scotland

The aims of this study were to determine expert consensus on the most important techniques for safe delivery of full dilatation CS and to validate a new second-stage CS simulation device. Questionnaires on techniques for safe delivery during second-stage CS were sent to senior specialists (response n=47). Three training scenarios were created using a second-stage CS simulator with different fetal positions with varying difficulties of impaction. Specialists (n=30) performed each training scenario then completed visual analogue scores (VAS) on perceived difficulty of each task. Important techniques for safe delivery reported were high uterine incision (60%), an additional person to help push the fetal head transvaginally (53%), correction of flexion of the fetal head (43%), determination of the fetal position prior to starting (36%) and disimpaction of the fetal head in the caudal direction prior to elevation out of the pelvis (26%). The degrees of impaction correlated with perceived difficulty of delivery (position 1-2 vs. position 3 linear regression p<0.001). The likelihood of successful delivery inversely correlated with the degrees of impaction (position 1-2 vs. position 3 binomial regression p<0.05). 87% of specialists found the simulation device to be realistic and 93% thought it was a useful training device. E-POSTER 65

Improving Pregnancy Care Documentation Through Audit of Hand-Held Records Spaulding P1*, Teo R1, Wallace EM1,2,3, Schlipalius M1,2 1 Monash Health, Melbourne, Victoria 2 Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3 The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria

Objective: To evaluate completion of women’s hand-held maternity records and, through feedback to clinicians and reaudit, improve documentation. Background: Satisfactory completion of hand-held maternity records is an important component of pregnancy care. For women receiving care outside of hospital it is the only record of progress through pregnancy, forming the basis of care provided in labour and postnatally. Method: Using convenience sampling, an initial audit of hand-held records was undertaken in 2009. For each record, documentation completeness for each pregnancy investigation and the care provider was noted. Results were presented at hospital quality meetings

to care providers. A second audit and feedback cycle was undertaken in 2010. This led to a re-design of the hand-held record. A third audit was completed in 2013. Results: In 2009, 2010, and 2013, 90, 111, and 204 records were audited, respectively. There were marked differences in satisfactory documentation rates between care providers ranging from 25% to 98%. The satisfactory completion rates were significantly higher for women attending hospital clinics than for those attending GPs or specialists in the community. Overall completion rates improved across the audit cycles, from 75.3% in 2009, to 80.1% in 2010, and to 88.9% in 2013. Conclusion: Engagement with care providers improved the rate of satisfactory completion of maternity handheld records for women attending our services. The audit feedback cycles led to improved design of the record, simplifying completion, and improved completion rates. This project highlights the usefulness of clinical audit and feedback to clinicians in the recording of care. E-POSTER 66

Cervidil V. Prostin: Efficacy, Safety and Implications for Our Health Service Springhall E*, Aldridge R Monash Medical Centre, Clayton, Victoria

Monash Medical Centre, Victoria, is a large tertiary referral centre that provides care for 3,500 births per year. In June 2008, the method of induction of labour for women with an unfavourable cervix was changed. Vaginal dinoprostone gel (Prostin 1mg and 2mg) was replaced by dinoprostone 10mg pessary (Cervidil®). We have retrospectively audited a cohort of women one year prior and one year following this change in induction method. We considered the effect of each method on promoting cervical change, inducing labour, and success at achieving delivery within 24 hours, and investigated any associated maternal or fetal complications. From our stratified analysis of the two heterogeneous groups, we found there were no significant differences in efficacy of each induction method, however, Prostin was more effective in inducing labour without additional induction agents. Both induction methods appeared as safe, however, Cervidil® may be more likely to promote tachysystole. There were no significant differences in associated CTG changes. We concluded that our data required further refinement to solve for confounding factors and our outcomes may not have been powered enough to produce a statistically significant result. We plan to present further analyse of our data in the hope of solving for confounders. Additionally, we will collect data on standardised groups for comparison. In a novel approach to the subject, we will investigate the implications relating to service provision required for each induction agent. We plan to examine the impact the change of protocol has had on staffing and use of resources.

E-POSTER 67

Confined Placental Mosaicism: Outcomes of Pregnancies Over a Decade from a Tertiary Centre Stewart K1*, Thomas J2, Byran J3 1 Rockhampton Hospital, Rockhampton, Queensland 2 Mater Mothers Hospital, South Brisbane, Queensland 3 Mater Health Services, South Brisbane, Queensland

Pregnancies affected by Confined Placental Mosaicism (CPM) are reported to have varying clinical outcomes including: spontaneous abortion, IUGR, IUFD, preterm delivery, delivery of larger than normal sized fetus, and normal pregnancy outcome. A retrospective audit of all pregnancies affected by CPM at the Mater Mothers Public Hospital from 20002013 was completed. 20 pregnancies were identified from a database at the Mater cytogenetics laboratory that met the inclusion criteria of being diagnosed during the antenatal period by chorionic villous sampling. Of the 20 pregnancies, there were a total of 16 live births, three cases of stillbirth (two affected by tetraploidy, one affected by Trisomy 18), and one case of neonatal death on day one of life in a pregnancy affected by tetraploidy and bilateral renal agenesis. Of the 16 live births, nine were associated with a poor birth outcome as defined by birth at <34 weeks gestation and/or <10th percentile for estimated fetal weight, four were associated with large birth weight at >90th percentile, and the remaining three were unaffected. The pregnancies with the lowest birth weight were affected by Trisomy 16 and Trisomy 2, while the pregnancies that were unaffected were all associated with Trisomy X. In conclusion, our small cohort of data suggests that CPM does indeed have varied clinical outcomes. Pregnancies affected by CPM should be monitored closely for the development of IUGR. E-POSTER 68

Improving Severe Preeclampsia with Resolution of Clinical Features and Endothelial Activation: A Case Study Stone P1*, Chen Q2, De Sousa J2, Snowise S1, Chamley L1 1 Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand 2 National Womenâ&#x20AC;&#x2122;s Health Auckland City Hospital, Auckland, New Zealand

Objective: To report a case of improvement of pre-eclampsia with HELLP variant and present assessments of endothelial activation after endothelial cells were exposed to maternal serum in tissue culture. A healthy 31 year old Chinese primigravida was admitted at 24 weeks gestation with early onset severe pre-eclampsia, characterised by hypertension, proteinuria, deranged liver function tests, low platelets and severe fetal growth restriction. Booking blood pressure was 110/70, and first trimester aneuploidy screen was low risk.

On admission the blood pressure was 180/100 mmHg, there was gross oedema involving extremities, face and abdominal wall and urine protein-creatinine ratio was 263mmol/L. Nifedipine and subsequently labetalol was used to control the blood pressure, Serum was taken during the four weeks of admission to assess its effect on endothelial cells in culture, both directly and after these cells were exposed to trophoblastic debri from explants grown with maternal serum. Findings: By the sixth day of admission, all clinical blood tests had become normal and remained so for the duration of the pregnancy with vaginal delivery at 37 weeks gestation of a healthy baby weighing 1.825kg. At admission ICAM-1 a marker of endothelial activation showed a 2.5 fold increase over background levels. 17 days after admission the ICAM-1 levels had decreased to 1.75 fold and after 31 days had reduced to 1.5 fold. Conclusions: Resolution of maternal clinical features of severe preeclampsia was associated with reduction in endothelial activation. Nifedipine reduces endothelial activation in vitro and its use may in part explain the results in this case. E-POSTER 69

Multifetal Reduction: Important Findings from a Single Centre Audit Stone P2*, Khan KM1, Groom K2 1 Imperial College School of Medicine, London, United Kingdom 2 Department of Obstetrics and Gynaecology, The University of Auckland, New Zealand

Objective: To audit outcomes of multifetal reduction performed in Maternal Fetal Medicine at Auckland City Hospital. The primary aims were for clinical governance and accurate counselling. Method: All reductions from 1993 to January 2013 recorded in the clinical database were reviewed. Information about patient outcomes was checked on the hospital databases. 69 reductions were reviewed. Findings: Consistent with published data regarding operator experience, success of triplet reductions to singletons or twins, and average gestational age at delivery was greater with experience. The rates of pregnancy loss were higher than some published data, however many reductions involved late referrals and 9 of 11 pregnancy losses occurred after 20 weeks gestation. This emphasizes the need to avoid late referral. The indications for fetal reduction varied dependent on the mode of conception. Fetal abnormality was the most common reason reduction in spontaneous conception. After use of assisted reproductive technologies resulting in multiple pregnancy patient choice was the primary indication for reduction. Overweight or obese women had an increased risk of intraoperative complications, postoperative

complications, and pregnancy loss as well as increased risk of pre-term birth and neonates requiring intensive care. Key recommendations:Clinicians must endeavour to limit multiple pregnancy after assisted reproductive techniques in order to avoid requests for reduction Early referral is essential to reduce complications from reduction procedures In risk counselling, BMI is a risk factor for complications and pregnancy loss after fetal reduction. E-POSTER 70

A Case Report on an Unusual Complication of Imperforate Hymen Torres MK*, Alensuela AB Jose Reyes Memorial Medical Center, Manila, Philippines

Imperforate hymen is a fairly common obstructive anomaly of the female reproductive tract, which usually presents with intermittent and cyclical abdominal pain. It is seldom associated with complications if it is detected and corrected early. This is a case of a 20 year old female with imperforate hymen who presented with abdominal pain and fever. The patient had also undergone a surgery for Imperforate Anus at one year of age. Assessment on admission was hematometra, hematocolpos and tuboovarian abscess. There was dilemma in the management of this unusual complication of this congenital outflow tract obstruction. This paper delves on a unusual complication and sequelae of imperforate hymen. E-POSTER 71

Impact of Surgical Complications on Obstetricians and Gynaecologists in Australia and New Zealand Varughese E1*, Obermair A2 1 Tamworth Rural Referral Hospital, Tamworth, New South Wales 2 Royal Brisbane & Womenâ&#x20AC;&#x2122;s Hospital, Brisbane, Queensland

Objective: The aim of the survey was to analyse the impact of complications on the day-to-day life, work and health of Australian and New Zealand Obstetricians and Gynaecologists. It also evaluated existing support systems and coping strategies. Methods: A validated 43-question survey addressing self-assessment, quality assurance tools, impact of complications and the support that is currently available was emailed to Fellows, trainees, subspecialists and subspeciality trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). The survey was collected electronically online. Results: We received 606 responses from a target population of 2,296 (26.3%) and within those were 135 open-ended responses (comments). A large number of respondents believe that knowing their own complication rates would help them to improve their clinical skills 81

E-Poster Abstracts (60.7%) and alleviate stress (46.1%). When complications occur sleep was affected in 80.1%, family and social relationships in 55.1%, and physical health in 47.7%. The major sources of support at the time of complication were from colleagues (83.4%), family (82%) and medical defense organisations (73.0%), with professional bodies perceived as providing least support. Nearly 80% of respondents felt the need to talk to someone they trust during times of complications. Conclusion: Surgical complications have a significant impact on the lives of obstetricians and gynaecologists in Australia and New Zealand. Existing support comes from non-professional sources such as colleagues, family and medical defense organisations (MDOs). A structured, unbiased support for surgeons from a professional source is urgently warranted. E-POSTER 72

Social Perspectives on Contraception Use in Sub-Saharan Africa: A Review Vidler J Nambour Hospital, Nambour, Queensland

Objective: This paper seeks to deconstruct the social contributors to contraceptive use in the sub-Saharan Africa population and make suggestions for improved contraceptive utilisation. Statement of Findings and Supporting Information: Sub-Saharan Africa demonstrates the world’s highest rates of sexually transmitted diseases, including HIV. This problem is confounded by high fertility rates, early sexual debut and unplanned pregnancy. As such, sub-Saharan Africa is plagued by high maternal morbidity and mortality related to childbirth, maternal-fetal transmission of HIV, and poor child health outcomes due to short birthing intervals. These problems have been tackled in recent decades through the introduction of barrier, hormonal and surgical contraception measures. However, the use of contraceptives by men and women in sub-Saharan Africa is a nuanced decision impacted by cultured sexuality, gender power imbalance, religious belief and community expectations. Further, in spite of these cultural factors that complicate the use of contraception in sub-Saharan Africa, contraceptive availability can fall short of the demand for fertility control. As such, social and structural factors play a decisive role in the suboptimal uptake of contraceptive measures in this region, and there is still a large unmet need for contraception.

Key Conclusions and Recommendations: Community based distribution of contraceptive measures, along with promotion of combined contraceptive therapy, are key front-line solutions for improving contraceptive use in subSaharan Africa. These initiatives will need to be supported by the breakdown of medical barriers to contraceptive distribution and by challenging ingrained structural inequalities at a systemic level by empowering women through education and economic support. E-POSTER 73

Is an Oxytocin Infusion Required After an Oxytocin Bolus at Emergency Caesarean Section? Whigham C1*, Manivasagan H2, Loughnan T3, Trivedi A3 1 Sunshine Hospital, Melbourne, Victoria 2 Monash University, Melbourne, Victoria 3 Frankston Hospital, Frankston, Victoria

Objective: There are wide variations in the use of oxytocin at caesarean section. The UK NICE guidelines recommend a 5 unit IV bolus, however many obstetricians also request a 40 unit oxytocin infusion. Carbetocin is a long acting oxytocin analogue, the use of which may negate the need for an infusion. We aim to compare the use of oxytocin infusion during emergency caesarean sections when: 1 A blinded bolus of either carbetocin or oxytocin was administered 2 The obstetrician requested the oxytocin dose. Over six months, women undergoing emergency caesarean section were randomly assigned to receive a blinded bolus of either carbetocin (100 micrograms) or oxytocin (5 units). Further requests for a 40 unit oxytocin infusion were then recorded. With the trial, we retrospectively analysed which uterotonics were chosen to be used in emergency caesarean sections. Findings: The blinded trial: 1 58 women in the carbetocin arm. In 10 cases an infusion was requested (17%). 2 48 women in the oxytocin arm. In five cases an infusion was requested (10%). Retrospective analysis of unblinded cases: 1 51 cases received five units oxytocin. 17 received an oxytocin infusion (33%). 2 12 cases received 10 units of oxytocin. Five received an oxytocin infusion (42%). 3 Two cases only a 40-unit oxytocin infusion was given. Conclusions: In more cases, if a known oxytocin bolus is administered, a 40 unit infusion of oxytocin is preferred. However, the blinded trial shows that often only a 5 unit bolus of oxytocin is required to maintain effective uterine tone.

E-POSTER 74

Is Cell Salvage a Cost Effective Intervention in Lower Segment Caesarean Sections? White A*, Keedwell R, Narayanan S South Devon Healthcare NHS Foundation Trust, Torquay, United Kingdom

Objective: Maternal haemorrhage is a main cause of morbidity in the perinatal period. Cell salvage reduces allogenic blood transfusion by 40%, reduces transfusionrelated complications and offers improved oxygen delivery1. It is recommended where blood loss is estimated to be more than 1,000ml2. We aimed to identify the frequency of blood transfusion of lower segment caesarean sections (LSCS) and ascertain whether cell salvage is likely to be beneficial and cost effective. Statement of Findings: 200 LSCS were identified from the Birth Register. The transfusion rate was 2.5%. None of these had risk factors for post-partum haemorrhage (PPH). 17 units were transfused in total, with category 1 and 2 LSCS most likely to require one. There was no documented use of cell salvage. The cost of cell salvage locally is estimated at £20 (GBP) per operation. The cost of blood transfusion is estimated at £370 per unit3. In category 1 and 2 LSCS the use of routine cell salvage was found to be considerably cheaper than the cost of transfusion:

Number of LSCS Number of Units transfused Cost of transfusion Cost of routine cell salvage

Cat-1 26 9 £3,326 £520

Recommendations: A local protocol has been introduced requiring the use of cell salvage at all category 1 and 2 LSCS, and in patients with known risk factors for PPH. References: 1 Carless PA, Henry DA, Moxey AJ, O’Connell DL, Brown T, Fergusson DA. Cell salvage for minimising perioperative allogeneic blood transfusion (review). Cochrane Database Syst Rev 2006:CD001888.pmid:17054147. 2 Ashworth A, Keir AA. Cell salvage as part of a blood conservation strategy in anaesthesia. Br J Anaesth (2010); 105(4):401-416. 3 Abraham I, Sun D. The cost of blood transfusion in Western Europe as estimated from six studies. Transfusion (2012); 52:1983–1988.

E-POSTER 75

Reducing Excessive Gestational Weight Gain during the Antenatal Period Whittaker A1*, Wilkinson S2 1 Caboolture Hospital, Caboolture, Queensland 2 Mater Mother’s Hospital, South Brisbane, Queensland

Objective: The objective of this project was to investigate a technique to reduce excessive gestational weight gain (GWG), as defined by the Institute of Medicine (IOM) Guidelines, at a peripheral Queensland hospital. The technique involved distributing a self-monitoring brochure to women booking-in at antenatal clinics. This “Weight Tracker” brochure contained information about GWG and the IOM Guidelines, as well diet and exercise advice. It also featured a graph where women plotted their weight gain over the course of pregnancy, colour coded to show the appropriate range and rate of gain for various BMIs. Antenatal clinic staff were encouraged to remind women about the weight tracker and give support if they were gaining too much or too little. Scales were provided in each clinic room. Statement of findings: More women who were given the “Weight Tracker” at booking met IOM recommendations for GWG compared to a historical control group of women who did not receive the “Weight Tracker”. Specifically, this difference was noted in the normal weight (24.4% vs. 40%), overweight (20% vs. 26.1%) and class I obese women (31% vs. 45.5%). There was also an increase in weighing of women at clinic visits (61% vs. 70% of visits). Key conclusions/recommendations: Gestational weight gain is a normal part of healthy pregnancy but gaining excessive weight is significantly associated with adverse pregnancy outcomes as well as long term adverse effects on both infant and mother. A simple cost-effective intervention such as this brochure, based around education and self-efficacy, has the potential to positively impact women across Australia.

Cat-2 74 6 £2,217 £1,460

Cat-3 35 0 £0 £680

Cat-4 65 2 £739 £1280

Total 200 17 £6,282 £3,940

E-POSTER 76

Early Pregnancy Assessment Service – The Riverina Experience Wilson K*, Jarrell S, Foda M Obstetrics and Gynaecology, Wagga Wagga Base Hospital, Wagga Wagga, New South Wales

Objective: Wagga Wagga Base Hospital is the major referral hospital for the Riverina area within New South Wales. This hospital provides a twenty four-hour Early Pregnancy Assessment service for women within this district. The objective of this study was to review the activity of the service over a two year period. Key findings: This review found 176 patients were treated within the service. There were 92 intrauterine pregnancies, 66 miscarriages, and six ectopic pregnancies diagnosed. In addition, six inappropriate referrals were identified and six patients lost to follow up. Key conclusions: These findings support the necessity for such a service within the Riverina, to continue the facilitation of appropriate care for women experiencing early pregnancy complications. Furthermore, women residing within rural areas across Australia require ongoing access to early pregnancy’s services to ensure the gap is closed between rural and metropolitan health services. E-POSTER 77

The Success Rate of Medical Management of Miscarriage and its Impact on the Choice of Surgical Management of Miscarriage Wong C1, Moses F2, Black K1,2, Pelosi M1, de Vries B1, Ludlow J1 1. Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 2. University of Sydney, Sydney, New South Wales, Australia

Introduction: Since 01/02/11 the Early Pregnancy Assessment Service (EPAS) in our institution introduced medical management of miscarriage using misoprostol. This was to improve the options available to women who have been diagnosed with a miscarriage. Aims: Is medical management of miscarriage effective? Are women choosing this option? Has this reduced or increased the need for surgical management? Is it safe? Methods: All miscarriages diagnosed between 01/02/2010 and 31/07/2012 were identified from the EPAS database. They were divided into two groups: 01/02/2010 to 31/01/2011 the 12 months prior to and 01/02/2011 to 31/07/2012 the 18 months post the introduction of medical management. Within these groups the

choice of miscarriage, success rates and any subsequent surgical management were measured. Further to this data was collected from women undergoing medical management between 01/08/12 to 31/01/13. Results: 1811 women were diagnosed with a miscarriage at EPAS Between 01/02/2010 and 31/07/2012. 656 were diagnosed between 01/02/2011 to 31/07/2012. Of these 107 (16%) chose medical management. 89/108(82%) women had successful medical management. The remaining 19 underwent secondary surgical management. Medical management led to a 17% (95% CI:11-22%, p < 0.001) reduction in the proportion of women undergoing surgical management from 79% to 62%. However, there was a slight increase in the number of emergency surgical cases. Conclusion: Medical management of miscarriage is effective and is chosen by 18% of miscarrying women and reduces the number of primary surgical procedures. Further evaluation is required to comment in detail on its safety profile. E-POSTER 78

Dendritic Cells in the Endometrium: Dysregulated in Endometriosis? Wong C1*, Riaz A1, Berbic M1, Fromm PD2, Kupresanin F2, Hart DNJ2, Schmidt U3, Jansen RPS3, Markham R1, Fraser IS1, Hey-Cunningham AJ1 1 Department of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales 2 Dendritic Cell Biology and Therapeutics Group, ANZAC Research Institute, The University of Sydney, Sydney, New South Wales 3 Genea Limited, Sydney, New South Wales

Objective: To comprehensively characterise DC subpopulations in the endometrium of women of reproductive age. Supporting information: Endometrial dendritic cells (DCs) play important roles in protection from pathogens, regulating endometrial changes during the menstrual cycle, and preparation for implantation1,2. Human blood and tissues contain two main DC subtypes, myeloid (mDC) and plasmacytoid (pDC), crucial for initiating and regulating both innate and adaptive immune responses3. Dysregulation of endometrial DCs are implicated in endometriosis and other reproductive pathologies such as recurrent miscarriage4. However, detailed knowledge is lacking. Statement of findings: Matched endometrial and peripheral blood samples (n=9) were analysed using multi-colour flow cytometry. DCs were identified as lineage negative (CD3,14,19,20,56) and HLA-DR positive cells. Our preliminary data show three CD11c+ mDC (CD1c+, CD141+, CD16+) and two CD304+ pDC (CD2+/-) subsets in the endometrium. There is a higher proportion of CD11c+ mDC (33.2±12.6% of Lin-HLADR+ cells, range 17.4-52.9%) than CD304+ pDC (21.8±20.7%, range 0.1-53.2%). mDCs peak during the secretory phase, whereas pDCs 83

E-Poster Abstracts appear to peak during menstruation. The large ranges observed indicate a high degree of variation between women and during the menstrual cycle Key conclusions: A larger range of endometrial DC subpopulations has been characterised than has been previously investigated. The cyclical changes of both mDC and pDC indicate involvement in the signalling and functional changes of the uterus. Ongoing investigations are underway to more comprehensively characterise the DC populations during the normal menstrual cycle and in women with endometriosis. References: 1. Schulke, L., et al, 2008. Hum Reprod., 23, 15741580.

E-POSTER 80

Evaluating Discrepancies Between Neonatal Outcomes and Fetal Scalp Lactate Measurements

2. Rieger, L., et al, 2004. J. Soc. Gynecol. Investig., 11, 488-493.

Yeung E*, Fleming T, Slavin V

3. Gasiorowski, R.E., et al, 2012. Immunol. Lett., 149, 93-1004.

Gold Coast Hospital, Gold Coast, Queensland

4. Sshulke, L., et al, 2009. Hum Reprod., 24, 16951703.

Background: Fetal scalp lactate sampling (FBS) is a useful adjunct for investigating fetal status in the presence of an abnormal cardiotocography trace (CTG). It has been demonstrated to reduce the incidence of caesarean sections and neonatal hypoxic ischaemic encephalopathy. Objective: To correlate intrapartum FBS values with umbilical cord blood lactates and APGAR scores to evaluate its reliability in predicting neonatal outcomes. A retrospective cohort study was conducted on labours occurring within a seven month period in 2011-2012 (n=2053). Statement of Findings: Emergency caesarean section was conducted in 52% of deliveries post scalp lactate. There was a correlation of 83% between scalp and venous lactate samples. Of lactates greater than 4.2mmol/L, there was a 37.5% correlation, with a low APGAR score at five minutes (<7). Interestingly, we demonstrated that more than half of the babies (54%) with a lactate within normal range (<4.2mmol/L) required SCN or NICU admission, in contrast to 21% of the babies who did not require FBS. This potentially suggests an alternate pathology aside from fetal hypoxia resulting in an abnormal CTG. Conclusion: During the period analysed, there was a significant discrepancy between the incidence of babies requiring admission to SCN despite a normal lactate compared with those not requiring FBS. This suggests that a normal lactate does not necessarily dictate a low risk fetal outcome. Furthermore, there does not appear to be an obvious correlation between admissions to SCN or NICU and the scalp lactate level. Further investigation is required to evaluate this disparity.

E-POSTER 79

Maximising the Training Opportunities for Medical Students in Gynaecology Clinics: Information Prior to the Clinic May Improve Patient Acceptance Yang JM1*, Woods K2, Johnson A1, Sum Y1, Black KI3 1 Royal Prince Alfred Hospital, Sydney, New South Wales 2 Southern General Hospital, Glasgow, Scotland 3 University of Sydney, Sydney, New South Wales

Objective: This study aimed to investigate the factors which influence patientsâ&#x20AC;&#x2122; acceptance of medical studentsâ&#x20AC;&#x2122; involvement in their consultation when attending a public hospital gynaecology clinic. Methods: This was an observational study of women attending gynaecology clinics at Royal Prince Alfred Hospital (RPAH) from January to December 2011. The questionnaire sought demographic information and asked women about their knowledge of medical student attendance at the clinics, if they would allow a student to be present during their consultation, and whether they would allow a student to examine them. It also sought reasons for their responses. Results: Of the 460 questionnaires distributed, 97% (446) were completed. Overall, 85.6% (382) of patients expressed acceptance of medical students in their consultation, and 63.9% (285) said they would allow students to examine them. Factors significantly associated with increased acceptance of examination by medical students included having knowledge that a student may be present (p=0.003), and being married or in a de facto relationship (p=0.023). Age and level of education were not significantly associated with acceptance of being examined by a student; and ethnicity was too diverse to assess. All groups maintained a clear preference for female students. 84

Conclusion: This study has found that having knowledge that medical students may be present in gynaecology clinics may increase patient acceptance of being examined by a student. This demonstrates a role for information material to be distributed to patients prior to their appointment to facilitate medical training. Ethics approval for this study was obtained from Sydney South West Area Health Service Human Research Ethics Committee (RPAH zone).

E-POSTER 81

Third Trimester Incarceration of a Gravid Retroverted Uterus: Case Report and Review of Literature Yeung E1*, Wright G1, Homar L1, Hanafy AM2, Singh MN1,2 1 Gold Coast Hospital, Gold Coast, Queensland 2 John Flynn Private Hospital. Gold Coast, Queensland

We describe a rare case of incarceration of a retroverted gravid uterus diagnosed in a primigravid patient at 25 weeks. The diagnosis was suspected by a clinical triad and confirmed by MRI. The patient was subsequently delivered at 35 weeks gestation by a midline abdominal incision and classical Caesarean section. This rare diagnosis in pregnancy has severe maternal morbidity if undiagnosed prior to delivery and remains relatively unknown. Surgical trauma to the bladder and cervix has been described. We aim to present the clinical indicators for diagnosis, MRI findings, and subsequent images and video footage of the surgery. In addition, we discuss the risk factors associated with this rare presentation, the risks of uterine rupture and thromboembolism as well as the surgical considerations required in delivery. E-POSTER 82

Vitamin D Supplementation in Pregnancy: One Size Fits All? Yim C1*, Wallace EM1,2,3, Hodges R2,3, Davies-Tuck M2 1 Monash Health, Clayton, Victoria 2 The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria 3 Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria

Objectives: To quantify changes in vitamin D levels from early to late pregnancy based on current supplementation guidelines of 1,000IU daily, to identify factors that influence these changes, and to determine the effect of increasing vitamin D levels on pregnancy outcomes. Findings: In women who were vitamin D deficient (<50nmol/L) and insufficient (50-74nmol/L) in early pregnancy, there was an overall increase in mean vitamin D levels by late pregnancy (p<0.001). In those who were deficient (n=654), 44% became insufficient and 15% replete. In those who were insufficient (n=449), 31% became replete. The mean increases in vitamin D level differed significantly by season (F=5.96, p<0.001), maternal age (F=2.74, p=0.026) and maternal country of birth (F=6.78, p<0.001), and was negatively correlated with early pregnancy vitamin D concentration (r=-0.46, p<0.001). Among women who were vitamin D deficient in early pregnancy, becoming insufficient or replete over pregnancy was associated with a 65% (95% CI 0.13-0.98, p=0.03) reduced likelihood of intrauterine growth restriction (IUGR), compared to women who remained deplete.

Conclusions: Although vitamin D supplementation may increase serum concentrations in most pregnant women with vitamin D deficiency or insufficiency, current guidelines for 1,000IU daily may not be adequate to achieve repletion. The mean increase in vitamin D levels over pregnancy differed by maternal and environmental factors. Additional research into adapting vitamin D doses according to these factors is needed to improve supplementation efficacy. We identified a protective association between increasing vitamin D over pregnancy and IUGR, but further studies elucidating the potential mechanisms are needed.

P rese n t er I n d e x Oral Presentations Oral Presenter Abbott, Jason Arulkumaran, Sabaratnam

56 45,48,58,63

Oral Presenter

Page

Oral Presenter

Page

Hart, Roger

Oehler, Martin

Henessey, Annemarie

Pardey, John

Austin, Marie-Paule

Hey-Cunningham, Alison

Park, Felicity

Baber, Rodney

Hodgson, Ray

Permezel, Michael

Benzie, Ron

Hui, Lisa

Pesce, Andrew

Boyce, Philip

Hunter, Tamara

Pollock, Carol

Bradford, Jennifer

Hyett, Jon

Radford, Samara

Bryant, Richard

Jenkins, Greg

Rajendran, Sumathi

Callaway, Leonie

Johnson, Neil

Ramsay, Philippa

Casper, Gabrielle

King, Kristina

Rane, Ajay

Chambers, Georgina

Koch, Juliette

Rawlinson, Bill

Chapman, Michael

Kroushev, Annie

Roach, Vijay

Chow, Jason

Lahra, Monica

Robson, Stephen

Chung, Tony

Ledger, William

Rombauts, Luk

Condous, George

Liu, Jiayi

Ross, Glynis

Costello, Michael

Lusink, Vanessa

Shennan, Andrew

42,58

Lyons, Stephen

Smith, Roger

Marren, Anthony

Smoleniec, John

May, James

Stock-Myer, Sharyn

Crowther, Caroline Daborn, Phil Deans, Rebecca

Page

56 51,58

Dibley, Michael

McCaughan, Brian

Symonds, Ian

Dietz, Peter

McCormack, Catherine (Dee)

Teale, Glyn

Donovan, Basil

McLennan, Andrew

Tout, Sarah

Eastman AM, Creswell

Merritt, Tony

Tracy, Sally

Eden, John

Mol, Ben Willem

40,45,48,60

Traversa, Maria

Fischer, Gayle

Morris, Jonathan

Valmadre, Susan

Foran, Terri

Munro, Malcolm

41,48,62,63

Walker, Sue

Ford, Jane

Murray, Henry

Woods, Aimee

Furness, Denise

Nesbitt-Hawes, Erin

Geraghty, Tony

Ng, Cecilia

Gibson-Helm, Melanie

Nicholl, Michael

Giles, Warwick

Nicklin, Jim

Groom, Katie

Obermair, Andreas

Hacker, Neville

Odibo, Anthony

40,48,59,61

E-Poster Presentations E-Poster Presenter

Page

E-Poster Presenter

Page

E-Poster Presenter

Page

Ahmed, Rehena

Kohlhoff, Jane

Wilson, Kieren

Ali, Mais

Kong, Kin Ying

Wong, Yee Tak Cecilia

Amaranarayana, Poornima

Kumar, Swetha

Wong, Clare

Andriputri, Stephanie Salim

Lusumbami, Precious

Yang, Jenny

Austin, Kathryn

Mahomed, Kassam

Yeung, Ellen

Baker, Karen

Maindiratta, Bhavna

74,75

Yim, Cheryl

Bennett, Laurel

Master, Mandana

Berkemeier, Sophia

McAdoo, Sallie

Blumenthal, Norman

McCarthy, Elizabeth

Boulton, Angela

McKnoulty, Matthew

Brownfoot, Fiona

McRae, Alexandra

Cabraal, Nimithri

Mitchell, Sarah

Chen, Lily

Nesbitt-Hawes, Erin

Cheng, Hon Chuen (Alan)

Petinga, Michael

Chin, Georgiana

Phipps, Helen

Chwah, Sarah

Radford, Samara

Davis, Georgina

Riaz, Azmat

Dhillon, Simran

Robson, Stephen

Durst, Michelle

Rudra, Thangeswaran

Edwards, Lindsay

Sabdia, Salma

Fernando, Magage

Seeho, Sean

Fitzgibbon, Sarah

Shamsa, Aiat

Forsyth, Laura

Shennan, Andrew

Foster, Claire

Spaulding, Portia

Georgiou, Chris

Springhall, Edward

Goh, Amy

Stewart, Katherine

Hall, Megan

Stone, Peter

Hanna, Chloe

Torres, Maria Katrina

Hasan, Tasnim

Varughese, Elizabeth

Henry, Amanda

Vidler, Jessica

Hui, Lisa

Whigham, Carole-Anne

Jung, Albert

White, Adam

Khalid, Arzoo

Whittaker, Alice

83 87

N o t es

RCOG WORLD CONGRESS 2015

Brisbane AUSTRALIA

Joint RCOG/RANZCOG Event | 12-15 APRIL 2015 | Brisbane Convention & Exhibition Centre

www.rcog2015.com

Sydney

Harbo

ur at n ight

Sydney Tower Eye

Sydney, istoric

ocks at The R

riat

ASM Secreta

ariat 13 ASM Secret RANZCOG 20 ent em ag an M ITH WALDRONSM t Street 119 Buckhurs Australia ne VIC 3205 ur South Melbo 6311 T +61 3 9645 6322 45 96 3 61 F+ om.au 3asm@wsm.c E ranzcog201 .au 2013asm.com www.ranzcog