28 FRIDAY, SEPTEMBER 8

Study Methods: Four suburban, antenatal clinics were included in this study. Two were nominated “control” clinics and two “intervention” clinics. These two categories were compared regarding syphilis screening and treatment. In total, 929 pregnant women with positive RPR test were enrolled, 453 in the intervention clinics and 476 in the control clinics. In control clinics the normal routine regarding syphilis screening was adhered to implying RPR testing in local laboratory. The positive cases were sent to STD clinics with virtually no partner notification. In intervention clinics the nurse-midwives were trained to perform the RPR test. The RPR-seropositive cases were immediately treated on site by the nurse-midwives and the partners were invited to come any afternoon for treatment. The remaining sera was sent to the reference laboratory of microbiology at the Faculty of Medicine. At the first visit the antenatal card was filled out and also a questionnaire regarding background characteristics, and obstetric history. The subsequent visits were according to norm, but in the third trimester (around 30 weeks) a new RPR test was performed and all women with positive RPR test results were again treated and the partners were invited to come for treatment. All women in the two groups were advised to go to the Central Hospital for delivery where a new RPR test was performed. Results: At delivery, the drop out rate was 15.7% in the intervention and 20.1% in the control group. The perinatal deaths were significantly higher in the control group than in the intervention group, 3.4% vs. 1.3% (p=O.O30). The seroconversion results at delivery showed that the intervention group had significantly more negative RPR results 40.9% vs. 24.2% (p=O.OOO). Conclusion: A more active training of nurse-midwives in antenatal care to perform on site RPR tests and give syphilis treatment results in improved perinatal outcome and more seronegative partorient women.

FC5.08.07 HYSTERECTOMY IN OBSTETRIC EMERGENCIES: A BANGLADESH STUDY M.A. Taher Khan, R. Begum, Dept. OB/GYN, Chittagong Medical College, Chittagong, Bangladesh.

Objective: To study the factors related to high incidence of hysterectomy in obstetric emergencies and how this can be reduced in minimizing maternal mortality and morbidity. Method: This study was carried out in the department of OB/GYN at the Chittagong Medical College Hospital from January to December ‘98. All the cases of hysterectomy from obstetrical reasons were studied with preset protocol. Results: The incidence of hysterectomy in obstetric cases was 1 in 112 live birth. All of these cases were unbooked and emergencies coming from rural areas. The commonest indication was ruptured uterus (50%). Post-operative mortality was 13.3% and morbidity was seen in 56.6% cases. Conclusion: Mortality and morbidity from hysterectomy in emergency obstetric practices is high in underdeveloped and developing countries that often undesirably inspire the sacrifice of a woman’s uterus. This can only be reduced by easy access to “emergency obstetric care services” and establishment of first referral units with facilities for cesarean section.

FC5.08.08 THE DELIVERY CRITICAL BRONCHIAL ASTHMA PATIENTS I. Shoueinin, V. Krasnopolsky, S. Vekker, L. Titchenco, Y. Yantovsky, L. Kuzmenko, Moscow Region Scientific Institute of OB/GYN, Moscow, Russia

Objectives: The aim of the investigation was the optimization of delivery in 22 critical bronchial asthma patients. Study Methods: All the patients were delivered per vias naturales during inducted partum. The cateterization of epidural space of the level of Th7-Th8 has been used before the beginning of partum. After 8 ml 0.125% solution of marcaine was injected into the space. The parameters of respiration function and central blood circulation have been sufficiently optimized. As method of anesthesia, the epidural anesthesia by 2% lydocaine at the level of Ll-L2 was used. Results: The reliable decrease of peripheral spasm and increase of central blood circulation parameters and the parameters of respiration function have been reached. All the 22 newborn weight 2600.32008

were alive and had 7-8 Apgar balls after birth. Conclusion: This method made it possible not to avoid labors during partum per via naturals in critical bronchial asthma patients.

FC5.08.09 PRIMARY MYELOFIBROSIS WITH THROMBOCYTOSIS IN PREGNANCY: A CASE REPORT w Cvetkovic M, Ljubic A, Kesic V, Petkovic S, Dokanac .I, Ciric R, Gotic M*, Institute of Gynecology and Obstetrics, Clinical Center of Serbia, *Institute of Haemathology, Clinical Center of Serbia

The aim of the authors is to present the course, therapy and outcome of pregnancy in patient with primary myelofibrosis and thrombocytosis. Discussion: Thrombocytosis appears as a consequence of different diseases and conditions of the body. It can be asymptomatic. However, arterial or venous thromboses can often happen. Thrombocytosis in pregnancy disturbs the placental circulation thus leading to increased rate of spontaneous abortions, premature deliveries, intrauterine growth retardation or fetal death. Myelosuppressive therapy considers the application of cytostatic drugs which is contraindicated in pregnancy. Due to the impossibility of treatment, the pregnancies complicated by thrombocytosis had unfavourable outcome. In our case report, the history of the patient shows that she previously have had two pregnancies complicated by antenatal fetal death. Histopathological examination of the placenta after second delivery indicated that the fetal death happened due to the disturbances in circulation. Afterwards, the primary myelocytosis with thrombocytosis was diagnosed. The medicament Roferon A was administered and it regulated thrombocyte and other blood cell levels. In such a condition the pregnancy happened. The same therapy was proceeded along the course of the pregnancy. Alfa interferon (Roferon A) does not transverse the placenta, thus not jeoparadizing fetus (Waysbrot A, 1993). Alfa interferon was applied in pregnancies complicated by essential thrombocytaemia. Favourable outcome of pregnancy as well as the absence of significant side effects to both mother and fetus was noticed in this disease. Based on the data showing favourable pregnancy outcome after administration of alfa interferon in myeloproliferative diseases, it was decided to use the same medicament for the first time in pregnant patient having primary myelofibrosis with thrombocytosis. Close follow-up and permanent corrections of the therapy obtained normal course and outcome of the pregnancy. Conclusion: Primary mielofibrosis with thrombocytosis jeoparadizes pregnancy due to the disturbances in circulation. It is necessary to bring the disease to remission by adequate therapy and permanent haemathological follow-up. Afterwards, in planned pregnancy it is necessary to continue alfa interferon therapy in collaboration with haemathologist. The disease which is controlled gives the chance of reaching normal course and favourable outcome of the pregnancy for both mother and the child. According to our knowledge, this is the first case of successfully finished pregnancy in primary mielofibrosis with thrombocytosis treated by Roferon, published in the literature.

FC5.09 OBSTETRICS AND GYNECOLOGY HEALTH DELIVERY

FC5.09.01 ABORTION DILEMMAS-SAFE OR UNSAFE- STILL A PUBLIC HEALTH PROBLEM IN RURAL INDIA Anita Sharma *Dept. of OB/GYN., K.D.J. & K.M. Hospital & Research Centre, Baradari Crossing, Morar, Gwalior-474006 (MP) INDIA.

Objectives: 1. The aim of the study was to evaluate the impact of unsafe abortion in rural areas of India. 2. To highlight the safety of early & safe abortions in contrast to unsafe abortions which still is a global emergency. 3. To evaluate various methods of reducing the incidence of unsafe abortions. Study Methods : Two thousand & seventy two women who underwent abortions (1st & IInd trimester) were included in this study; which was conducted from April*96 to March*99 at KDJ & KM Hospital Gwalior, out of these 65 women had been referred following illegal abortions. Detailed epidemiological surveying of every patient was performed, 86 %

FRIDAY, SEPTEMBER 8 29

women having illegal abortions were belonging to rural areas & were illiterate. Various results showed a very low maternal morbidity i.e. 3.5% among the safe abortions case which were performed during 1st trimester & 8.6 % morbidity among second trimester abortions in contrast the morbidity which was very high among unsafe abortions i.e. up to 43 % while the mortality being nil & 1.6 % among safe & unsafe abortions respectively. Conclusion : In spite of liberalization of M.T.P. act (1972) in India, the incidence of unsafe abortions is very high. The various ways to reduce the morbidity & premature loss of life due to this entirely preventable complication is by improving mass illiteracy, health & sex education early access of M.T.P., refresher courses for health personnel, early referral services & prompt surgical intervention. ??More so in no case should abortion be prompt as contraceptive method. ??We have to publicly promote safe abortion & fight the stigma attached to abortion by a sympathetic attitude. ??We obstetricians in particular have a great role to play in implementing that will reduce the consequences of unsafe abortions for women & society.

FC5.09.02 QUEENSLAND’S FLYING 0 & G SERVICE .I. Baker, Flying OB/GYN Service, Queensland Health Dept., Roman, Queensland, Australia.

Queensland’s Flying 0 & G Service commenced operation on 4/7/1998. The service is based in Roma in S.W. Queensland and provides a specialist obstetric and gynecological consultative and operative service to 30 small hospitals in rural Queensland for elective as well as emergency cases. Aircraft are used as the means of covering large distances quickly. The team consists of a gynecologist-obstetrician (Assoc. Prof. J.W. Baker), an anesthetist, an 0 & G training registrar (usually in the latter part of training), a medical student and the pilot. In 11 years, 25,500 patients have been seen. 11,300 operations have been performed, including 880 emergencies dealt with and the team has spent over 7,000 hours in the air and traveled a distance of approxmately two m&on kilometers i.e. 44 tunes around the world. The detailed work of the FOG service is presented and it is demonstrated how this type of outreach service can be used in countries where small populations in rural areas are disadvantaged and threatened by the tyranny of distance.

FC5.09.03 REPRODUCTIVE HEALTH PROFILE IN RURAL PAKISTAN R. Sohail, S. Lodhi, F. Zaman, Dept. OB/GYN, Postgraduate Medical Institute/Service Hospital, Lahore, Pakistan.

Objectives: To assess awareness of women regarding reproductive health concepts in a rural area of Pakistan and to evaluate the knowledge and practices of Traditional Birth Attendants (TBAs) and Lady Health Visitors (LHVs). Study Methods: 1634 women aged 15-50 having at least one child were included in the study. Data collection instruments comprised three interview schedules, one for each woman, TBAs and LHVs. Results: The majority (76.67) f D o women were illiterate. 63% were married by 19 years of age. _ of women interviewed had never visited a health center and 86.6% had home confinements. (23.3%) of women had at least one abortion and the incidence of induced abortion was 14%. Amongst the TBAs, 78.2% had no formal training while LHVs had been trained in 93% cases. 75% of TBAs did not think they needed assistance for complications. On the other hand, referral by LHVs for eclampsia, prolonged labor, hemorrhage and sepsis was lOO%, 85%, 70% and 60% respectively. Conclusion: Women in rural area were mostly uneducated and had early marriages. Aware of health services, they did not utilize the facilities for various reasons. Incidence of induced abortions was low at 14%. TBAs being the primary service providers, lack awareness of their limitations and are short on referral. LHVs having the benefit of education and formal training referred and reported complications.

FC5.09.04 INNOVATIVE APPROACHES TO MEASURING MATERNAL HEALTH: TRANSLATING INDICATORS INTO EVIDENCE BASED POLICIES .I. Hussein. E. Goodbum. H. Damisoni. W. Graham. V. Lema and H. Ashwood-Smith, Safe Motherhood Project, P.O. Box 3, Blantyre, Malawi.

Objectives: Conventional maternal health indicators like maternal mortality ratios, skilled birth attendant deliveries and antenatal care attendance are in common use. However, they do not provide sufficient information to influence specific policy changes. Alternative indicators have been proposed by UNICEF/WHO/UNFPA to measure accessibility, utilisation and quality of services. In one of the first large scale efforts to use these indicators in a monitoring system, their utility in influencing policy change is addressed. Study Methods: In a descriptive correlational study, trend data for two years was obtained from a population base of 250 000 expected deliveries per year. Five key process indicators met need for emergency obstetric complications, case fatality rate, population based Caesarean section rate, institutional delivery rate and availability of obstetric care were used to measure obstetric coverage and performance. 145 government and mission maternity units in southern Malawi participated in collecting data for the monitoring system. Results: A distribution of 1.6 hospitals per 500 000 population was recorded, with an institutional delivery rate of 34%. Of the women expected to experience obstetric complications, only 17.5% of need was met. Case fatality rates range from 0.8% to 26.5% and most fall short of a maximum acceptable level of 1%. Conclusions: This study demonstrates that the alternative indicators proposed can be successfully introduced, providing essential information for policy makers. The met need indicator reveals that many women with complications are not receiving critical medical care suggesting that a policy shift towards provision of emergency obstetric care is well justified.

FC5.09.05 RISK OR CHANCE - FACTORS WHICH ARE IMPORTANT IN WOMEN’S CHOICE OF PARTICIPATION OR NOT IN THE PROPHYLACTIC EXAMINATION FOR CERVICAL CANCER U. Jeuuesen, Dept. OB/GYN, Aalborg Sygehus Nerd, Aalborg, Denmark.

Objectives: The aim of the study was to shed light on women’s perspective in relation to the choice they have made to participates in the prophylactic examination for cervical cancer, in order to understand the reasons behind women’s decision and actions. Study methods: Empirical material was obtained from ethnographic interviews with seventeen women, aged 41 - 50, invited to attend for cervical cancer screening. Eight of the women had chosen to participate in the screening program and nine had chosen not to participate. The empirical material was analyzed according to the principles described by J.P. Spradley in The Ethnographic Interview (1979). Results: Three domains were found to be essential and important in relation to the women’s decision: their conception of illness, resources in everyday life, and previous experiences with doctors and hospitals. Frequently one of the domains, however, was attributed greater meaning by the individual woman than the other domains. The woman’s choice also has to be considered as dynamic in that it may be changed continually. Conclusions: The choice, made by the individual woman in relation to participate or not in the cervical screening program is determined by: her perception of illness, her personal resources, her earlier experiences with the health care system and her relationship to her GP.

FC5.09.06 COMMUNITY-BASED INTERVENTIONS FOR SAFE MOTHERHOOD: AN INDIAN EXPERIENCE M.G. Mishra, H.H. Sinha, Dept. OB/GYN, Patna Medical College Hospital, Patna, India.

Objectives: The aim of the study was to assess the problem of safe motherhood in a rural population and to achieve safe motherhood by total reproductive health care. Study Methods: A pre-intervention community survey was conducted for a year in a block of Patna district, India, to assess the utilization of available health care facilities and assessment of goals for safe motherhood.