Scientific Program

Day 1 :

Biography:

Professor Natalia Artymuk - Head of the Department of Obstetrics and Gynecology of Kemerovo State Medical University, President of the Kemerovo Regional Public Organization "Association of Obstetricians-Gynecologists", Chief Specialist of the Ministry of Health of the Russian Federation of Obstetrics and Gynecology in the Siberian Federal District, member of the Presidium of the Board of the Russian Society of Obstetricians-Gynecologists

 

Abstract:

Statement of the Problem: Preterm birth is one of the major global health problems and part of the Millennium Development goals because of the associated high number of perinatal or neonatal mortality and long-term risks of neurodevelopmental and metabolic diseases. Globally, preterm birth (PTB) rates are rising and have a significant impact on neonatal morbidity and mortality. Cervical pessary and vaginal progesterone is safe and feasible option, which may be beneficial for the prolongation of the pregnancy and therefore could be an effective method for preventing SPB. Despite being a common clinical practice, some authors consider that evidence to support the combined use of multiple versus single interventions for preventing PTB is scarce. Purpose of this study was to evaluate the efficacy of dome-shaped obstetric pessary and cerclage in combination with intravaginal progesterone in managing pregnant women at high risk for preterm birth. Methodology & Theoretical Orientation: This was a prospective comparison study of 150 women with singleton pregnancies with history of PTB or middle trimester miscarriage Group I consisted of 100 women who applied a cerclage, Group II consisted of 50 women with pessary placement. All patients administered intravaginal progesterone in the dosage of 200 mg per day. Findings: The results of this study showed the similar primary outcomes (the frequency of spontaneous PTB before 37, 34, and 28 weeks gestation) and secondary outcomes (average weight of newborns, the infant's score on the Apgar scale, and the percentage of low-weight newborns). The frequency of term birth in high risk women were 54% and 57.1% correspondingly. Conclusion & Significance:  The dome-shaped obstetric pessary and cerclage with vaginal progesterone showed equally efficacy in the prevention of PTB in high risk women with singleton pregnancy in the middle trimester. Further multicenter studies are necessary to confirm these findings and determine as guidelines in the future.

 

Biography:

To be updated

Abstract:

Stillbirth affects over 2.64 million families worldwide annually. Stillbirths are often preceded by maternal perception of decreased fetal movement (DFM). DFM is also strongly linked to adverse perinatal outcomes such as neurodevelopmental disability, infection, fetal to maternal haemorrhage (FMH), emergency delivery, umbilical cord complications, small for gestational age (SGA) and fetal growth restriction (FGR /IUGR). Decreased fetal movements for some women may be associated with placental dysfunction, which could lead to fetal growth restriction and/or stillbirth. While evidence is still emerging in this area, some studies indicate that a reduction in stillbirth rates may be achieved by increasing maternal, clinician and community awareness about the importance of DFM. Fetal movements are an important simple maker of fetal wellbeing, while reduced fetal movements can be the early symptom of fetal compromise and failure to respond by a mother or maternity provider might lead to intrauterine fetal death (IUFD). Fetal movement counting (Fetal Kicks monitoring) is very controversial, maternal anxiety has been highlighted as a big issue in those who follow fetal kick counting advice. The value of maternal fetal movements (FM) monitoring has been assessed in a number of studies of pregnant women. There are conflicting results with most showing no overall reduction in perinatal losses even when fetal movement monitoring has been recommended. Fetuses that are experiencing sub acute and slow progressing fetal compromise can be saved if mothers detect reduced fetal activity and present to their midwife or Obstetrician. Fetal movements are an important simple maker of fetal wellbeing, while reduced fetal movements can be the early symptom of fetal compromise and failure to respond by mother or maternity provider might lead to intrauterine fetal loss (IUFD). Fetal movement counting (Fetal Kicks monitoring) is very controversial, maternal anxiety has been highlighted as a big issue in those who follow fetal kick counting advice. The value of maternal fetal movements (FM) monitoring has been assessed in a number of studies of pregnant women. There are conflicting results with most showing no overall reduction in perinatal losses even when fetal movement monitoring has been recommended.Fetuses that are experiencing sub acute and slow progressing fetal compromise can be saved if mothers detect reduced fetal activity and present to their midwife or Obstetrician. We present a case report here where a mother’s attention to reduced fetal movements saved the life of a severely anaemic fetus.

 

Keynote Forum

Tatiana Belokrinitskaya

Russian Federation

Keynote: Amenorrea: guidelines and practice

Time : 11: 00 a.m to 11: 30 a.m

Biography:

Tatiana Belokrinitskaya, MD, PhD, Professor, Principal Ob&Gyn of the Far Eastern Federal District of Russia, Head of Obstetrics & Gynecologycal Department of Chita State Medical Academy, President of Transbaikal Society of Obstetricians and Gynecologists (2013), Board Member of Russian Society of Obstetricians and Gynecologists (2014), Board Member of Obstetrical Anesthesiologists Intensivists Association (2016),The Member of Russian Society of Gynecological Endocrinology (2000), The Member of Russian Society of Menopause (2000), The Member of Russian Society of Cervical Disease (2004

 

 

Abstract:

Statement of the Problem. Amenorrhea is the absence of menstrual bleeding as a result from a number of different conditions. The purpose of this study is to describe the guidelines for the diagnosis and treatment of different types of amenorrhea and relate the major recommendations for the patient management. The ESHRE/ESGE classification system of female genital anomalies (2013) is recommended to use in cases with amenorrhea due to Congenital malformations of the female genital tract. Turner syndrome is usually accompanied by hypergonadotropic hypogonadism and primary or secondary amenorrhea. Estrogen replacement should start between 11 and 12 years of age increasing to adult dosing over 2–3 years, and adding progesterone once breakthrough bleeding occurs or after 2 years of estrogen treatment (European Society of Endocrinology Guidelines, 2017). Functional hypothalamic amenorrhea (FHA) is a form of chronic anovulation, not due to identifiable organic causes, but often associated with stress, weight loss, excessive exercise, or a combination thereof. FHA is a diagnosis of exclusion. 1-st line of therapy is to correct the energy imbalance to improve hypothalamic–pituitary–ovarian axis function, psychological support. 2-nd line for adolescents and women who have not had return of menses:  short-term use of transdermal E2 therapy with cyclic oral progestin (not oral contraceptives or ethinyl E2) (Endocrine Society Guideline, 2017). Premature ovarian insufficiency is characterised by menstrual disturbance (oligo/amenorrhea) with raised gonadotropins and low estradiol before the age of 40. Diagnostic criteria of ESHRE Guideline (2015) are: oligo/amenorrhea for at least 4 months, and an elevated FSH level >25 IU/l on two occasions >4 weeks apart. The chance of spontaneous pregnancy is small, but oocyte donation is an established option for fertility. HRT is indicated for the treatment of estrogen deficiency symptoms and to reduce future risk of cardiovascular disease, cognitive impairment, reduced bone mineral density.

 

 

Biography:

To be updated

 

Abstract:

We study the impact of the dehydroepiandrosterone (DHEA) by the women with diminished ovarian reserve and very low DHEA-S in the blood. In vivo study. The paper also presents a review of the literature regarding diminished ovarian reserve and the use of dehydroepiandrosterone. We present a description of 5 patients with diminished ovarian reserve (DOR). Patients reported because of problems with getting pregnant. Infertility lasted for several years. The patients disagreed on IVF for ethical  and religious reasons. All of the presented patients were diagnosed with diminished ovarian reserve (very low AMH or high FSH, elevated estradiol concentration on day 3 of the cycle). We found also a very low DHEA-S concentration. The patients were given dehydroepiandrosterone. After several months of treatment (3-6 months), the patients became pregnant. None of them had procedures for in vitro fertilization. Five patients gave birth to healthy children. Our experience with DHEA is much bigger, but these 5 cases are very well documented. The obtained results indicate that DHEA supplementation in conditions of its deficiency improves the functioning of the ovaries and increases the chance of pregnancy.

Keynote Forum

Manal Hubeish

American University of Beirut, Beirut, Lebanon

Keynote: Maternal Vitamin D Level and Rate of Primary Cesarean Section

Time : 1: 00 p.m to 1: 30 p.m

Biography:

Dr. Manal Rashid Hubeish is the assistant chairman of the department of obstetrics and gynecology at Makassed General Hospital affiliated with AUBMC. She is the director of  OBGYN residency program at MGH and the program director Of CREOG exam. She is a Member of the lebanese society of obstetrics and gynecology and of the lebanese society of osteoporosis. She has several publications in the field of obstetrics and gynecology. 

 

Abstract:

Background: Vitamin D deficiency has been a worldwide health problem, and pregnant women were considered as ahigh risk group among whom the prevalence of vitamin D deficiency is increasing to be around 5-40% and to reach a rate of 10-56% in breastfed infants.  Recent studies revealed the importance of vitamin D during pregnancy and correlated its level to several pregnancy and neonatal outcomes.

Objectives: We aimed to assess the effect of low level of maternal vitamin D on the progress of labor affecting primary C-section rate, pregnancy outcomes (such as: risk of uterine atony and postpartum hemorrhage, pregnancy induced hypertension, preeclampsia and gestational diabetes) and neonatal outcomes (such as: low birth weight and preterm birth).

Methods: A prospective cohort study was conducted in two university hospitals in Lebanon between September 2016 and January 2017. A questionnaire was used for collecting date after taking informed consent to participate in the study. Demographic data, calcium intake, vitamin D intake including the dose, obstetric history complicating the current or previous pregnancy, mode of delivery and finally maternal and neonatal outcomes were recorded. Blood samples were collected from all patients participating in the study for vitamin D level measurement. Patients were divided in two groups: the control group (vitamin D level>30ng/ml) and the deficient group (≤30ng/ml).

Results: A total of 381 patients were included in this study. In total, 40.9% of the deficient group delivered by C-section for failure of induction, failure to progress or failure to descend; compared to 12.8% only of the control group (p value <0.0001). There was also a significant association between vitamin D deficiency and risk of uterine atony and postpartum hemorrhage (4.7% and 5.6%, respectively in the study group with low level of vitamin D compared to 0.7% and 1.3% in the control group with significant p value 0.033 and 0.040, respectively).

Conclusion: Low maternal vitamin D level was associated with increased risk of primary C-section, uterine atony and postpartum hemorrhage.

 

.

 

Keynote Forum

Susan Laing

Brighton and Sussex Medical School, UK

Keynote: American University of Beirut, Beirut, Lebanon

Time : 1: 30 p.m to 2: 00 p.m

Biography:

Dr Laing is an epidemiologist, trained at the London School of Hygiene and Tropical Medicine in London.  For many years she worked in non-communicable diseases, cardiovascular disease, diabetes and cancer.  For the past ten years, in addition to teaching at the Medical School, she has been volunteering in an Antenatal Clinic in the Gambia and during that time has been running the first cohort study of birth outcomes in the Gambia.

 

 

Abstract:

At the outset of this century the World Health Organisation recommended that the first visit to the antenatal clinic should be during the first trimester, women should attend at least 4 times and delivery accompanied by a trained birth attendant.  Attendance in the first trimester enables both the early detection and treatment of existing complications and also offers opportunities to prevent complications. Between 2012 and 2016 we conducted a cohort study of 1611 consecutive pregnant women attending the antenatal clinic at a health centre in the Gambia.  Overall 384 (23.9%) women attended during the first trimester. Of the 1366 women who were followed to the end of the pregnancy 468 (41.6%) had at least 4 antenatal visits.  The women almost all planned an attended birth.  Overall only 212 women (15.8%) complied with all 3 WHO recommendations. To examine factors associated with compliance we conducted a quantitative and a qualitative study.  Following multivariate analysis women aged 30 or more, and women whose partner had tertiary education were most likely to attend in the first trimester.  Married women and women with educated partners were most likely to attend at least 4 times. The qualitative study consisted of in-depth interviews with 25 women, 13 health care workers and 9 male partners.  Three areas were identified: intentional concealment of early pregnancy was common inititally to avoid adverse social consequences or for fear that malign interventions would cause a miscarriage.  In the absence of symptoms many women considered it unnecessary to attend the antenatal clinic until well into the second trimester.  Practical barriers included conflicting domestic demands and the attitudes of some health care workers. Barriers to antenatal care are many and these will vary considerably from health centre to health centre.  Prior to outreach programmes local issues should be considered.

 

Keynote Forum

Jan Tesarik

Spain

Keynote: Luteal phase deficiency in IVF and natural conception: New findings and solutions

Time : 2: 00 p.m to 2: 30 p.m

Biography:

To be updated

 

Abstract:

Luteal phase deficiency (LPD) was first described, as a primary cause of infertility, by Georgeanna Seegar Jones in the 1940s, while working at the Johns Hopkins Hospital and University in Baltimore (Maryland), well before achieveing, together with her husband, Howard W. Jones, the first US baby born after in vitro fertilisation (IVF) in Norfolk (Virginia), in 1979. Later studies have shown that the techniques used for ovarian stimulation and oocyte recovery for IVF can aggravate the risk of LPD. This is particularly the case  of the ovarian stimulation protocols using gonadotropin releasing hormone (GnRH) antagonist to prevent premature ovulation, followed by ovulation triggering with a GnRH agonist. These protocols can efficiently prevent the development of severe ovarian hyperstimulation syndrome (OHSS) in women at risk. On the other hand, the GnRH antagonist-controlled and GnRH agonist induced cycles result in a significant impairment of the corpus luteum (CL) function, resulting in LPD with subsequent embryo implantation failure or early pregnancy loss. However, recent data have shown that some women are particularly prone to the development of LPD, with any type of the ovarian stimulation protocol used, and even in natural ovulatory cycles. Consequently, the serum progesterone concentration should be controlled repeatedly, beginning with the day of embryo transfer, and then every week, even before knowing if pregnancy has occurred. This is particularly important in oocyte donation treatment cycles where CL is usually absent, unless the treatment is performed in a natural cycle. If CL is present, it’s function can be improved by daily administration of GnRH agonist during 2 weeks after fertilisation. If not (most of cycles with the transfer of the patient’s own frozen embryos and fresh or frozen embryos resulting from oocyte donation), LPD has to be corrected by individual dosing of progesterone, applied by vaginal, oral, transdermal, intramuscular or subcutaneous routes. In patients with unexplained infertility, luteal phase serum progesterone concentration should be determined and corrected by external progesterone administration, if necesssary, thus avoiding the recourse to IVF in many cases.

 

Biography:

To be updated

 

Abstract:

Objective: To describe the advanced integral vascular surgical technique (AIVS) applied in patients with placenta previa adhered abnormally with in situ fetus.

Materials and methods: Prospective and descriptive study presenting a se- ries of cases, carried out in patients with abnormally attached placenta previa to whom the advanced integral vascular surgical technique was applied, attended at the Hospital of Specialties of the Child and the Woman of Querétaro, and Hospital Maternal Celaya, between January and June 2017. Using descriptive statistics of central tendency, maternal variables were analyzed such as: maternal age, gestational age at the time of the interruption of the obstetric event, time and estimated surgi- cal bleeding, hemoglobin concentration and pre and post hematocrit postsurgical patients who required "biosurgery", admission to obstetric intensive care unit and intrahospital stay; perinatal variables: Capurro at birth, neonatal weight, Apgar score and umbilical cord blood gas.

Results: 16 patients were registered. All the patients were operated on in a single surgical event, with no need for reoperation, with average surgical bleeding objectified with pre- and postoperative hemoglobin, without indication of admission to the Obstetric Intensive Care Unit, with adequate postoperative evolution and perinatal outcomes without associated neonatal morbidity.

Conclusion: The advanced integral vascular surgical technique (AIVS) is a safe, accessible, affordable and available technique, having to integrate a properly organized medical surgical team.

 

Biography:

To be updated

 

Abstract:

Objective: To evaluate Subendometrial and Uterine artery resistance and pulsatility index continuous analysis as a predictor of Endometrial receptivity in Assisted Reproductive Technology (ART) Cycles.

Design: Serial 2D transvaginal coloured power doppler ultrasound performed in women on ART cycle to evaluate a pattern that better predicts implantation rates. 169 subjects on a prospective case control study were assessed. Uterine artery and Subendometrial resistance and pulsatility index was performed to all subjects at baseline (prior to ovarian controlled stimulation), at day 6, 8 and 10 of controlled ovarian stimulation, at trigger day and at embryo transfer day. Also the ratio of fluxometric parameters between Subendometrial blood flow and uterine artery was measured.

Results: No statistical difference was noted between two groups in terms of demographics and ART procedures and scores. Uterine artery resistance and pulsatility index showed statistical difference between the two groups (implantation versus non-implantation group). Also statistical significance was obtained between two groups in terms of Subendometrial vascularization. Ratio between Subendometrial and Uterine artery showed lower values of fluxometric parameters in all range for the Subendometrial territory.

Conclusions: Serial Subendometrial and Uterine artery fluxometry may be a useful tool for clinicians in predicting endometrial receptivity enhancing elective embryo transfers in the same ART cycle.

 

 

 

Keynote Forum

S.V. Chigrinets

Ural State Medical University of Russian Ministry of Health, Chelyabinsk, Russia

Keynote: Effect of endocrine disrupting chemicals bisphenol A and triclosan on semen quality

Time : 03:30 P.M to 04:00 P.M

Biography:

Dr. Stanislav Chigrinets is an endocrinologist, andrologist and antiage spesialist at the DNA clinic in Chelyabinsk and at the same time he is a postgraduate student at the Ural-South State Medical University. Scientific interests are related to male reproduction, the influence of xenobiotics on it and reproductive endocrinology in general. Stanislav Chigrinets author of the Russian monograph «Infertility and Endocrine Disruptors», member of the Human Reproduction Association, Russia and the League of Male Reproduction Specialists, Russia.

 

 

Abstract:

Background: The violation of the reproductive health of men is one of the urgent problems of medicine throughout the world. In this case, the most common form of male infertility is idiopathic one. The most likely causes of idiopathic infertility are considered oxidative stress, genetic factors, as well as endocrine disruptors. In this regard, it becomes relevant to study the effect of endocrine disruptors, in particular bisphenol A and triclosan, on male reproductive health.

Aims: To establish a relationship between the concentration of bisphenol A and triclosan in the seminal fluid and the quality of semen in men with normo- and pathozoospermia, as well as sperm DNA fragmentation.

Materials and methods: 84 samples of seminal fluid were studied in men with normo-and pathozoospermia. In the seminal fluid, the concentrations of bisphenol A and triclosan were determined by gas chromatography with mass spectrometry (GC-MS). For comparative analysis, patients were divided according to the degree of sperm DNA fragmentation into two groups: group 1 patients with sperm DNA fragmentation <15% (n = 18) and group 2 ≥ 15% (n = 29). Spermological research was carried out according to the recommendations of WHO (2010), taking into account the assessment of the number, motility and morphology of sperm, as well as the degree of fragmentation of sperm DNA. The results were considered statistically significant at p <0.05.

Results Bisphenol A and triclosan were found in 100% and 84.3% of ejaculate samples with a median concentration of 0.150 ng / ml and 0.11 ng / ml, respectively.

 

Keynote Forum

Dr. Ioannis G. Papanikolaou

Humanitas University and Research Hospital, Milan.

Keynote: Robotic surgery: is it better for Reproductive Surgery and Gynecological Oncology?

Time : 04: 30 P.M to 05:00 P.M

Biography:

Doctor Ioannis G. Papanikolaou is born in Athens. In 2009 he graduates in Medicine with Excellent votation - Medical Degree (MD). During his University studies he is distinguished with 6 University Scholarships from the ‘‘ADSU Foundation’’. Afterwards, he returns in Athens,  being selected from the Faculty for a 2 years Postgraduate Programme, which confers the title of Master of Science in ‘‘Robotic Surgery, Minimally Invasive Surgery and Telesurgery’’, in the University of Athens, Medical School in Greece. In 2011 he is distinguished again with Excellent votation and obtains the title of “Master of Science” in the Athens Medical School in “Robotic Surgery, Minimally Invasive Surgery and Telesurgery”. In 2011 he begins his PhD research on Mesenchymal Stem Cells (MSCs) transplantation in experimental models, a research conducted on wistar rats. In 2018 he is distinguished with the PhD (Doctor of Philosophy) in the Athens Medical School for his PhD research, with Excellent votation. In 2016 he is selected for the 1,5 years Postgraduate Programme – Master of Science in “Reproductive and Regenerative Medicine” in the Athens Medical School, which represents his second Master. He has obtained many Scholarships in National and International level from various Foundations such as: The Empeirikeion Foundation, The Experiment & Research Centre of Elpen, the Facuty of Medicine – ‘‘ADSU’’ foundation. He has gained many important prizes and awards such as the first Prize in the “Robotic Surgery Marathon”. He has been also distinguished with the First Prize in the “Laparoscopic Simulation Cup”. He is a Da Vinci Si certified surgeon for Robotic Gynaecology (Intuitive cerification). He has been awarded by Allied Academies in United Kingdom – London, for his research activity. He has participated in more than 250 international and national congresses as Organizing Committee Member, Invited Speaker, Keynote Speaker or Speaker. He has organized the Gynaecology and Breast Cancer Congress in Milan, in 2019.

 

 

Abstract:

In recent years, surgical practice has been changed since the introduction of minimally invasive surgery. Laparoscopic and robotic surgery have significant advantages compared with laparotomy. Robotic technology has helped surgeons overcome many technical difficulties of conventional laparoscopic surgery. Robotics are feasible in the treatment of benign gynecologic conditions including endometriosis and uterine fibromatosis. Feasibility is also proven for endometrial cancer along with a short learning curve. Evidence suggests longer operative times compared to laparotomy, but similar or shorter than laparoscopy. Robot dogging time increases the global length of the procedure, but it decreases with experience. The overall morbidity rate seems lower than with other approaches. Hospital stay, postoperative pain and time to recovery are decreased when compared to laparotomy as well as to laparoscopy for some authors. Robotics may offer significant advantages in the treatment of morbidly obese patients who represent the vast majority of endometrial cancer patients. Furthermore, robotics are a real challenge in the treatment of pelvic endometriosis in which, surgery by laparoscopy often becomes extremely demanding and time consuming. Robotic techniques have benefits over traditional open surgery for management of endometrial cancer, especially in the group of obese patients for whom laparoscopy presents significant limitations. The main limit for the diffusion of robotic surgery is accessibility because of its important cost, although the new systems including Da Vinci Xi are much more beneficial for a more anatomic and accurate surgery, essential in reproductive surgery and oncology.

 

 

Biography:

Dr. Alfred Shihata, President/CEO of FemCap Inc., invented FemmyCycle menstrual cup and FemCap cervical cap. He is affiliated with Scripps Institutions of Medicine & Science and holds medical degrees in England, Canada and the USA. He has six patents and brings over four decades of women’s reproductive health research as a medical device designer. He received the “Why Didn't I Think of That?” award from BIOCOM, Southern California’s largest biotech trade association. He has published in the New England Journal of Medicine and other medical/scientific journals. * Dr. Shihata is a Life Member of the Society of American Inventors and the Association of Reproductive Health 

Abstract:

Globally 1.9 billion women are of menstruating age.  Menstrual cups are gaining more popularity among women, who prefer cups over pads and tampons. [1]. The innovative FemmyCycle (Figure 1) has several advantages over traditional menstrual cups. (Figure 2) Objective: To mitigate and correct the side effects caused by traditional menstrual cups. The most common side effect among traditional cups is leakage.

Methodology: We focused our study on all causes of leakage and other side effects caused by traditional menstrual cups. Methods of corrective and preventive actions included; the no-spill design, the use of a removal ring instead of a rigid stem, the use of a flask shaped body rather than the conical shape of traditional menstrual cups (Figure 2), and the elimination of suction holes as well as the need to manually open the cup. (Figure 3 & 4)  We analyzed 834 independent reviews by women who have had prior experience with traditional menstrual cups to obtain objective results. Findings: The implementation of these design changes and enhancements of the written and digital instructions produced measurable, positive results in favor of the FemmyCycle. We analyzed all the reviews for FemmyCycle to measure the prevention of leakage and other side effects. We selected the reviewers who volunteered to compare the FemmyCycle with their experience using traditional cone shaped cups. There were many reasons why women preferred FemmyCycle, but the most common by far was the prevention of leakage followed by the ease of insertion, ease of removal and comfort when inserted. Conclusion: The implementation of the design changes from a conical shaped cup with a removal stem to a flask shape cup with a removal ring, in addition to the added no-spill feature and enhanced instructional material, improved the acceptability of the FemmyCycle.

Biography:

Dr. Novak has experience in assessing the disease and its effects on the health and well-being of the female population. Data analysis and her own ongoing research of optimizing the technology for analyzing potential molecular-genetic markers of this disease can be useful for improving the diagnostic significance (sensitivity / specificity) of diagnostic methods for endometriosis based on the analysis of micro-RNA in endometrial tissue. This opportunity is the result of the interaction of specialists from the fields of clinical gynecology, molecular biology, bio-statistics and analytical technologies.

 

Abstract:

Statement of the problem. Endometriosis is a chronic, progressive and / or recurrent disease affecting women of reproductive age. The disease manifests itself in pain, dysmenorrhea and infertility. The social significance of the problem is due to the reliably high frequency of infertility, spontaneous abortion and premature birth. Our work presents data of hereditary factors for the development of endometriosis, including the genes WNT4, VEZT, ID4, NFE2L3, CDKN2BAS1, GREB1, IL1A, ETAA1, FN1, RND3, associated with an increased risk of endometriosis. It has been shown that a hereditary predisposition to the development of this disease is multifactorial and  it is still poorly understood. We systematized the previously described molecular genetic characteristics of ectopic and eutopic foci of endometriosis, including a study to simultaneously evaluate the expression levels of 1488 miRNA molecules in eutopic endometrium. We also supplement the review with data from our own research. The aim of the research is the study of new effective diagnostic methods for endometriosis. Methodology and theoretical orientation: The analysis of the expression profile of endometrial cells obtained from patients with endometriosis was performed by the method of chip hybridization (Affimetrix platform) using a specific panel: miRCURY ™ LNA Array (Exiqon platform). We used analysis of data from other authors and the same methods of laboratory diagnostics. Findings: Detected significant deviations in the expression of regulatory micro-RNA in eutopic endometrium among infertile and fertile patients with endometriosis. We continue the study with the expansion and refinement of micro-RNA profiles. Conclusion and significance: Our study continues the work of other authors in the search for effective markers for the diagnosis and monitoring of the effectiveness of the treatment of fertile and infertile patients with endometriosis.

 

Day 2 :

Biography:

To be updated

 

Abstract:

Objective. Improving the accuracy of the diagnosis of endometrial consistency and predicting endometriopathy.

Subjects and methods. 96 patients with a history of reproductive failure were examined. An analysis was made of menstrual blood with the measurement of glutathione peroxidase-1, interleukin-6 and E-selectin by the ELISA method of the "sandwich" type with monoclonal antibodies. In order to determine the normative parameters, the material of 30 healthy women was examined. To evaluate the results, the logistic regression method was applied. A mathematical model was developed that made it possible to determine the probability of endometriopathy at the threshold value of the integrative index P≥0.29.

Results. Patients with diagnostically significant P levels have signs of chronic inflammation, dyshormonal mucosa, and dystrophic changes in the endometrium. The average probability of the disease is Pc. For the patients it was 0.59, for the healthy - 0.22. The diagnostic sensitivity of the test is 93.3%, specificity is 92.86%.

Conclusion. The calculation of the prognostic probability of endometriopathy based on the measurement of the concentration of biologically active substances in menstrual secretions is appropriate for the primary non-invasive diagnosis (screening) of the non-tumor pathology of the endometrium. The diagnostic technique is patented.

 

 

Biography:

To be updated

 

Abstract:

Introduction: cervical cancer is a common cancer. It is accessible for early detection and treatment. The aim was to describe and analyze the lesions observed and their management with a view to reducing the rate of female cancer morbidity and death in Gabon.

Methodology: this was a 31-day descriptive and analytical cross-sectional study over two successive years (2017 and 2018), 62 days. All women who consulted for cervical cancer screening were enrolled. Visual inspection methods (VIA/IVIL) were the procedure method, a biopsy was indicated or not, and management was codified. A simple descriptive analysis and the results expressed as a percentage and on average were performed.

Results: the target population was 629 women (45.45%) in 2017 and 755 (54.55%) in 2018, or 1,384 women and an increase of 9.10%. The average age of women was 37.02±1.2 years [15-72 years]. The 25-39 age groups were the most represented (51.5%), 24.4% were over 50 and 68.56% were single. There were as many IELG (4.77%) as there were IELHG (4.48%). Eight cases of invasive cancer (0.58%) were found including 3 cases in the 15-24 age. All precancerous lesions were immediately treated and all 8 cancers were surgically treated after Multidisciplinary Consultation Meeting (MCM)

Conclusion: organized screening and efficient use of resources reduce the mortality of women from cervical cancer.

 

Biography:

To be updated

 

Abstract:

Objective. To determine the clinical significance of circulating tumor cells expressing the targeted genes BIRC5 and HER2-neu - markers of minimal residual disease, as markers of the "purity" of the surgical stage of breast cancer treatment,

Methods. The study involved 230 patients with verified primary non-metastatic breast cancer (BC) stage I-IIIC at the age of 58.2 ± 9.9 years. All women underwent surgery in the amount of radical mastectomy in Madden (group 1) – 113 (49.1%), oncoplastic radical resection of the breast (group 2) – 49 (21.3%), and 68 (29.6%) women underwent bilateral subcutaneous mastectomy with regional lymph node dissection on the affected side with simultaneous implant reconstruction (group 3). In all patients on the day of surgery, as well as on day 2 after surgery, peripheral blood was examined for the presence of circulating tumor cells (CTCs). To identify the CTCs, the expression of the BIRC5 and HER2-neu genes was studied using real-time PCR.

Results. Positive BIRC5 mRNA and HER2-neu mRNA CTCs before surgery in the total sample were found in 158 of 230 women (68.7%). Before the operation, in the group of patients subject to radical mastectomy in Madden, the target CSCs were found in 81 women (71.%), in the group of oncoplastic resection subject in 34 (69.4), in the group of subject subcutaneous mastectomy with reconstruction in 43 (63.2).

After surgery, targeted CTCs were identified in venous blood samples of 99 patients (43.0%). After radical mastectomy according to Madden (group 1) CTCs were identified in 46 patients (40.7%), in group 2 after oncoplastic resection of CTCs were identified in 22 women (44.9%), in group 3 after subcutaneous mastectomy with reconstruction of CTCs were identified 31 patients (45.6%). There were no significant differences in the frequency of identification of CTCs expressing the BIRC5 and HER2-neu genes after surgery, depending on its size (p> 0.05). Accordingly, the risk of disease return in patients of these three groups, regardless of the extent of surgical treatment, is comparable. However, the dynamics of decrease in targeted CTCs depending on the volume of the operation is significantly different. In group 1, the proportion of reduction in patients who were positive for CTCs was 31.0%, in group 2 – 24.5%, in group 3 – 17.6% (p = 0.019, ANOVA). In the general sample, the frequency of preservation of targeted CTCs after surgery was significantly higher in the early stages (I-IIA) without regional lymph nodes, 66.2%, than in the more advanced stages (IIB – IIIC), 45.0%.

A significant change in the frequency of identification of the CTCs in the downward direction after the operation was established with luminal A and luminal B HER2 non-expressing cancers. However, in a comparative analysis of the frequency of preservation of CTCs in peripheral blood, depending on the tumor subtype, no significant differences were obtained.

Conclusion. The definition of CTCs expressing the BIRC5 and HER2-neu genes in enriched peripheral blood samples after radical surgery for breast cancer is a reliable marker of the "purity" (radically) of the surgery. In the present study, the most “cleaning” operation was radical Madden mastectomy, which allows removal of CTCs from peripheral blood in 31.0% of patients, compared with oncoplastic resection (24.5%) and subcutaneous mastectomy with implant reconstruction (17.6%). However, the mean frequency of maintaining CTCs in peripheral blood at the level of 43.7±1.9% (M±SD) after the operation in all groups, which is not significantly different, does not significantly differ from the volume of the surgical operation. the amount of surgery does not affect the frequency of return of the disease. Early dissemination of tumor cells contributes to their preservation in the peripheral blood in the form of the CTCs in spite of the surgical intervention.

 

 

Biography:

To be updated

 

Abstract:

The traditional method of acquiring surgical skills by observing and assisting in surgical procedures involving human beings has been challenged during the past several years. Lessons obtained from aviation suggested that the use of simulators is related to reduced costs, increased efficiency in performing certain tasks and above all safety. A shift in paradigm is also required in modern surgical training. The development of endoscopic surgery allowed for the incorporation of medical simulators into training programmes. Surgical training with box trainers and/or virtual reality simulators confers a significant benefit in terms of surgical skills development, increases patient safety and reduces costs. Nevertheless, the use of virtual reality simulators was significantly more expensive. Simulation training allows trainees to learn from their mistakes, to repeat surgical tasks multiple times so as to establish muscle memory, and enhance skill competency with the aid of informative feedback. Simulators are necessary for the development of the skills required to meet the specific needs of endoscopic surgery in the 21st century. Teaching hospitals should introduce simulation training programmes in order to increase efficiency, reduce costs and improve patient safety. As medical advancements continue to transform the way we perform surgery day by day, simulation training will play a pivotal role in Gynecologic Endoscopy and every surgical specialty.

 

Keynote Forum

Mina Garashova

Azerbaijan

Keynote: Obesity and Endometrial Pathology in Postmenopausal Women In Azerbaijan

Time : 01: 00 P.M to 01:30 P.M

Biography:

Dr Garashova is an experienced healthcare provider in the field of obstetrics&gynecology and a sciensist.. She had years of experience in research, evaluation, teaching and administration both in hospital and education institutions. Her first scientific research was devoted to the study of clinical significance of soluble FAS antigen and VEGF-factor in women with ovarian cancer. Her present research is devoted to the study of incidence, pathogenetic mechanisms and clinical manifestations of tumors of the genitalia in postmenopausal women. She has more than 40  articles and Textbook of Gynecology for student of a medical university. Dr.Garashova also has experience in private healthcare sector management.

 

Abstract:

Statement of the Problem: It is known that obesity is a predisposing factor for many pathological conditions, including the hyperplastic processes of the endometrium and endometrial cancer, thereby reducing the quality of life. Researchers established a relationship between an increase in body mass index (BMI), the age of a woman, and the presence of endometrial cancer. Obesity plays a significant role in the development of endometrial cancer type I and is characterized by an increase in its frequency by 4-5 times compared with women with normal body weight. An increase in BMI for every 5 kg / m2 increases the likelihood of endometrial cancer by 1.5 times. Metabolic and endocrine changes in postmenopausal women associated with obesity may explain the increased incidence of endometrial pathology. The purpose of this study is to reveal the relationship between the increased BMI and the incidence of endometrial pathology in postmenopausal women in Azerbaijan. Materials&Methodology: 115 postmenopausal women with a thickening of the endometrium (according TVU data) were examined.  Of these, 50 (43.5%) had endometrial cancer, 34 (29.6%) had complex endometrial hyperplasia without atypia, 15 (13%) had atypical endometrial hyperplasia, and 16 (13.9%) patients had endometrial polyp.  The average age of patients was 59.7 ± 0.6 (50-83) years.  The body mass index was calculated for all patients and was average 32.3 ± 6.7 (23.2-58) kg / m2. Results: Among 50 patients with endometrial cancer 22 (44%) had I degree of obesity, 12 (24%) had II degree, and 7 (14%) patients had III degree of obesity (BMI>40 kg/m2). 20 (58.8%) of patients with complex endometrial hyperplasia without atypia, and 10 (66.7%) with atypical hyperplasia had different degrees of obesity with BMI>30kg/m2. 11(68.7%) patients of 16 with endometrial polyp were obese. Thus, 82 (71.3%) of 115 postmenopausal women with increased endometrial thickness were obese.  Conclusion: Increased BMI is a consistent and leading risk factor for endometrial hyperplasia and endometrial cancer in postmenopausal women.  Recommendations: to increase the awareness of women about the screening methods, to improve the lifestyle and nutritional habits for the prevention of gynecological and other obesity related diseases.

 

Biography:

To be updated

Abstract:

To evaluate the role of measuring umbilical cord thickness, interventricular septum thickness and HbA1c level in prediction of fetal macrosomia in patients with gestational diabetes mellitus. Methods: This prospective case-control study included 80 pregnant women. They were divided into two groups: 40 pregnant women as case group with gestational diabetes mellitus and 40 non-diabetic pregnant women as control group. Ultrasound examination was performed where the sonographic cross sectional area of umbilical cord. The umbilical arteries and the umbilical vein were measured in a free loop of the umbilical cord, using the software of the ultrasound machine. The cross-sectional area of Wharton’s jelly was computed by subtracting the cross sectional area of the vessels from that of the umbilical cord and the interventricular septum thickness was measured. HbA1c level was measured for diabetic patients.

 

Biography:

Dr Gondjout taliana stéphie is actually doing her 3rd year residency in gynecology and obstetrics in Dakar at the University of Cheikh Anta DIOP. She did her medical study in Ukraine at I. Horbachevsky Ternopil Medical University.

Abstract:

This case report, it’s about a patient I met during prenatal consultation, she was in the 2nd semester of her pregnancy, exactly at 25 weeks. During the physical examination, we found, she had a hypoplasia of minor labia, an incomplete vaginal diaphragm with a vaginal cup, and a hypertrophy of clitoris. We decide to make some biological and instrumental examinations. After getting the result, we concluded she has a pseudo hermaphroditism associated with malformation of 1/3 of vagina. Reason why the way of the delivery choose was a C-section. Female pseudo hermaphroditism isthe most frequent (FPH) sexual ambiguity. It is characterized by the extension of abnormality of the sexual differentiation during the fetal life in the female fetus by a maternal or fetal hyper-genesis. The authors propose through a clinical case with a patient 46XX DSD pregnant. The main cause of this pathology is congenital adrenal hyperplasia, which we lead to deficits of 21-hydoxylase, 11-beta-hydroxylase, 3-beta-hydroxysteroid dehydrogenase, but 95% of the congenital adrenal hyperplasia is the deficiency of 21-hydoxylase. The treatment of congenital adrenal hyperplasia depend of the cause, hormone replacement therapy like (dexamethasone, hydrocortisone), most often the treatment for life is needed. From this we propose to make review of literature focusing on it. Conclusion: The pseudo female hermaphroditism isthe most frequent affection of sexual ambiguities, when it is associated with a pregnancy as in this clinical case, the interest is even greater. From a practical point of view, the etiological diagnosis procedure must begin with a clinical examination of anomalies of external genital development, a karyotype and a hormone balance (17- hydroxy-progesterone).The management is multidisciplinary combining medical, surgical, and psychological treatment, and the patient may decide to undergo surgery later for clitoridoplasty.

Biography:

Dmitry Kravchenko graduated on 2010:From the Sechenov Moscow Medical Academy cum laude (diploma number BCA 0733875).

2010 – 2012: residency on oncology, department of radiosurgery of the Blokhin Cancer Research Center.

2012 – 2017: post-graduate research.

2018: defended a thesis (PhD) on “features of adjuvant hormonal therapy in young breast cancer patients”.

2018 – 2019: worked as a chemotherapist in a consult department of the Blokhin Cancer Research Center.

2019 – currently: works as a chemotherapist in a chemotherapy department of the Blokhin Cancer Research Center.

Specialization: breast, ovarian, gastric and colorectal cancer.

Symposia attended as a speaker:

29.03.2019 - V annual Russian Head-and-Neck Congress (“febrile neutropenia prophylaxis”).

Speaks Russian (native), English (C2), Spanish (C2), Italian (C1), Portuguese (B2), French (A2).

Professional interests: cancer targeted and immunotherapy.

Abstract:

Breast cancer (BC) keeps being the most predominant malignant disease in women. In recent years, a trend towards “rejuvenescence” of the malady has been observed that affects its features. Despite modern methods of diagnosis and complex treatment used in young patients, survival rates in this age group are inferior that’s associated with biological and morphological peculiarities of BC in young age. Gradually are being collected data according to what age might be an independent factor exacerbating prognosis. For BC patients younger 40 years, various aspects of adjuvant therapy remain ambiguous: prolonged tamoxifen use, aromatase inhibitors prescription, BRCA profiling, ovarian function suppression, a role of chemotherapy-induced amenorrhea in prognosis, fertility and social concerns. The issue of appropriate, personalized adjuvant hormone therapy of BC is complex and heterogenous that requires a necessity to further conduct international randomized trials.

Key words: breast cancer, young age, endocrine therapy, chemotherapy, BRCA, ovarian suppression

 

 

Biography:

Dr. André Vinícius A. Florentino is a Professor of Gynecology for medical students at Federal University of Campina Grande and at Unifacisa University in Brazil. He is also a Preceptor of the Gynecology and Obstetrics Residency Program at Federal University of Campina Grande.He did his Residency in Gynecology and his specialization in Gynecological Endoscopy at The Public Servant Hospital of São Paulo – Brazil. After that he obtained the title of “Master of Science” with his studies in Quality of Life in patients with Ovarian Endometriosis. He is Post-graduate in Female Hormonal Physiology and Nutrology. He is Member of the Brazilian Federation of Gynecology and Obstetrician. His Scientific interests and current research are related to the genetic basis of Endometriosis, and now he is developing a Genetic test to identify Single Nucleotide Polimorphism related to Ovarian Endometriosis. 

Abstract:

To be updated

Biography:

To be updated

Abstract:

Fertilization assessment is routinely made at 16-18 hours post-ICSI and 18-20 hours post-insemination. However, the absence of pronuclei (PN) during standard fertilization assessment does not necessarily indicate fertilization failure. The aim of this study is to assess the chromosomal status of blastocysts derived from 0PN and 1PN zygotes as well as to assess the clinical outcome after transfer of such embryos. In this study, we use microarray comparative genomic hybridisation (MaCGH) or next generation sequencing (NGS) to analyse the chromosomal status of 271 blastocysts (204 from 2PN, 41 from 0PN, 26 from 1PN) obtained from 42 patients who underwent conventional IVF (cIVF) and ICSI cycles with preimplantation genetic testing for aneuploidy (PGT-A). Euploidy was confirmed in 126 (126/204; 61.8%), 31 (31/41; 75.6%) and 18 (18/26; 69.2%) 2PN-, 0PN- and 1PN-derived blastocysts respectively while the remaining 96 blastocysts displayed various chromosomal abnormalities. A Y-chromosome was observed in 0PN-derived blastocysts (19/41; 46.3%) and 1PN-derived blastocysts (13/26; 50%), indicating that sperm had penetrated the oocyte and not due to parthenogenetic activation. Four euploid 0PN-derived blastocysts were transferred to 4 patients and 3 healthy live births were achieved. Four euploid 1PN-derived blastocysts were transferred to 4 patients and 1 on-going pregnancy was achieved. 

Conclusion(s): 0PN- and 1PN-derived zygotes can be chromosomally normal and result in healthy live births. Such zygotes should not be discarded but instead be subjected to extended culture with PGT-A to ascertain the chromosomal and ploidy status and be considered for transfer.

 

 

Biography:

To be updated

Abstract:

Embryo transfer, the final stage of assisted reproductive technique (ART), is a crucial step in ensuring successful in vitro fertilization (IVF) cycles. Studies evaluating the ideal depth of embryo transfer in the uterine cavity have reported that fundic transfer is associated with higher pregnancy rates (PRs), but there is no consensus. The objective of the present study was to determine the influence of the embryo placement depth on the endometrial cavity in relation to the reproductive outcomes, after frozen-thawed embryo transfer of embryos performed under transabdominal ultrasound guidance. Retrospective cohort study that evaluated the influence of the placement depth of the embryos in the endometrial cavity in relation to reproductive outcomes of patients submitted to cryotransfer cycles at a private assisted reproduction clinic, from 2012 to 2017. Patients were classified into three variables: ≤ 10 mm, 10 to 15 mm and > 15 mm. Primary outcome was clinical pregnancy, and secondary outcomes were miscarriage, ongoing pregnancy and live birth. Data was summarized as relative risk, with a 95% confidence interval. Clinical and ongoing pregnancy rates were higher in the groups 10-15mm and >15mm, when compared to the group < 10mm; there was no statistical difference between the groups for miscarriage and live birth rates. We performed a subsequent analysis, using the same sample of patients, comparing only the variables < 10 mm and ≥ 10 mm. The group ≥ 10 mm showed better reproductive outcomes, with higher clinical and ongoing pregnancy rates. Pregnancy rates are influenced by embryo transfer site, obtaining better results when the tip of the catheter is placed in the central area of the endometrial cavity, specially when the distance from the endometrial fundus is > 10mm.

 

Biography:

To be updated

Abstract:

 To analyze progesterone and prolactin plasma levels nine days after oocyte retrieval and evaluate their correlation with pregnancy rates in in vitro fertilization cycles. To achieve pregnancy, several factors are analyzed before and during the in vitro fertilization cycle. Progesterone supplementation for adequate luteal phase support is indicated despite the presence of multiple corpus luteum in IVF stimulation cycles because of blockage caused by hypothalamic agonists and antagonists. The dosage of progesterone and prolactin on day 09 after follicular retrieval could function as a predictive marker of success in fertility treatments.  A retrospective study was performed using data from 238 patients submitted to intracytoplasmic sperm injection (ICSI) at a private infertility clinic from January 2013 to December 2015. Hormonal measurements were performed on day 09 after follicular uptake. The data was compared to assess the correlation between prolactin and progesterone dosages and pregnancy rates. Results: The ICSI pregnancy rate was 40.8% (n=238). No statistically significant difference was observed when correlating the success of the procedure with the prolactin dosage (p=0.71). However, progesterone showed a significant difference (p=0.021). The cutoff point, indicated by the ROC curve fit according to which gestation would be identified, is 25.95ng/ml of progesterone. The sensitivity of this point is 61.9% and the specificity is 57.4%. Progesterone dosage may be one of the indicators of gestation on day 09 after follicular uptake. Such data can help physicians to monitoring and provides suitable early gestational care. More studies are needed to corroborate the data found.

Keynote Forum

Jose J. Macias

Mexico

Keynote: Report of two cases of cervical pregnancy treated in a divergent way

Time : 05: 30 p.m to 06: 00 p.m

Biography:

Dr. Jose J. Macias Duvignau is Gyn/Obs specialist. His practice in addition to the operating room includes being Professor of Anatomy, Embryology, and   gynecology and obstetrics in the Medicine School of the Instituto Politécnico Nacional in México city. Is professor for gynecologic endoscopy and advanced gynecological surgery in the IGOYP Hospital.

 

Abstract:

Objective: The presentation of these cases is intended to show the results of two treatments used for cervical ectopic pregnancy that are minimally invasive: One in the first trimester and another in the third trimester of pregnancy. 

First case: A 34-year-old primiparous patient who came to the emergency room with abdominal pain and transvaginal bleeding and was 6 weeks pregnant. There, an endovaginal ultrasound was performed, which showed a sac without embryo and "incomplete abortion". She was admitted to performing uterine curettage and during the procedure, the empty uterine cavity was found, so a transoperative ultrasound was requested that demonstrated the gestational sac in the cervix, with a live embryo of 7 weeks. This patient was admitted to the hospital and was treated with methotrexate plus folic acid, monitoring the beta-fraction levels of chorionic gonadotrophin and ultrasound every 48 hours until its negativization and resorption. 

Second case: Patient of 30 years. G2C1 who attended the consultation with abdominal pain and intermittent transvaginal bleeding for 4 months. She started her condition after interrupting her first-trimester pregnancy in a clinic where she was initially treated with medication and then with a curettage. Upon examination, a 20-cm uterine fundus was found, and a fetal focus was heard. The ultrasound showed a pregnancy of 19.5 weeks with placenta previa and later in the service of maternal-fetal medicine the diagnosis of placenta accreta was established. In this case, the diagnosis of cervical pregnancy was made by magnetic resonance until week 37 and was resolved by cesarean section, achieving the birth of a live product. 

Conclusions: Cervical ectopic pregnancy is rare and difficult to diagnose an entity whose incidence increases. It is possible to perform conservative medical treatments in first trimester pregnancies and some cases may come to term.