Jahreskongress gynécologie suisse, SGGG Congrès annuel ...

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Jahreskongress gynécologie suisse, SGGG

Congrès annuelgynécologie suisse, SSGO

22. bis 24. Juni 2016du 22 au 24 juin 2016 Congress Centre Kursaal Interlaken

Abstracts • Freie Mitteilungen/Communications libres

• Posters/Posters

• Videos/ Vidéos

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Index

A

Achtari C. . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/61, FM-VI/62Ackermann S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/40Adorjan P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/21Aebi-Popp K. . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/54, P-III/36Alam S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/115Alkatout I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/110Ammerdorffer A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/50Amstad Bencaiova G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/37Amylidi-Mohr S. . . . FM-I/10, FM-III/31, FM-V/53, P-III/34, P-III/36, P-V/53Antonescu M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/166Anugraham M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/46Arbogast S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/170Arnold E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/164Au-Yeung G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/44Azar W. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/44

B

Bachmann S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/24Badir S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/32Bajka M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/32Ballabeni P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/116Ballabio N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/102Balsyte D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/14Barben C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/135Bartkute K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/14

Autoren / Auteurs

FM = Freie Mitteilungen / Communications libres

P I - P VI = Posterpräsentationen und Ausstellung / Présentation des poster et exposition

P = Posterausstellung / Exposition des poster

V = Videopräsentation / Présentation des vidéos

Änderungen vorbehalten

Jahreskongress / Congrès annuel gynécologie suisse 2016 Autoren / Auteurs

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Bärtschi C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/54, P/139Bass B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/156Bättig B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/108Baud D. . . . . . . FM-III/30, FM-V/50, FM-V/54, FM-VI/61, P-III/33, P-V/51,

P-V/57, P/109, P/113, P/149Baumann M. . . . . . . . . . . . . . . FM-I/11, FM-V/53, P/102, P/104, P/124Belhia F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/147Beltraminelli H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/148Ben Ali N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/134, P/168Benski A.C. . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/40, FM-IV/41Berlinger A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/161Bernasconi I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/141Bertrang Warncke A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/149Bessire A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/104Betschart C. . . . . . . . . . . . . . . . . . . . . . . FM-IV/42, P-II/24, P-II/26Biedermann K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/118, P/125Bilancioni A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/65Bitzer J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/67Blindenbacher H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/112Bloch A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/166Bodenmann Gobin P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/145Bodenmann P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/33Bolla D. . . . . . . . . . . . . . . FM-I/12, P-V/54, P/102, P/104, P/109, P/149Bongoe A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/48Bonollo M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/127Borcard A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/152Bosshard A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/130Bougel S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/65Boukrid M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/131Boulvain M.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/23Bouquet de la Jolinière J. . . . . . . . . . . . . . . . . . . . . . P/134, P/168Bousouni E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/103Bowtell D.D.L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/44Brand B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/165Brandner S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/63Breitling K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/105, P/126Bringolf L.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/64Bronz C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/96Brossard P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/34Bruder E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/158


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Brühlmann E.. . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/25, P-IV/42Brülhart L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/170Büchel J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/58Bucher S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/42Burkhard Staub V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/36Burkhardt T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/14, P/140Butenschön A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/63

C

Calvalcanti N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/108Canonica C.. . . . . . . . . . . . . . . . . . . . . P-V/55, P/127, P/138, P/144Capanna F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/64Capoccia Brugger R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/153Cartwright R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/62Castella V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/51Catarino R. . . . . . . . . . . . . . . . . FM-IV/40, FM-IV/41, P-IV/48, P-VI/65Cerny D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/104Challande P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/30Chatziioannidou K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/23Christ E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/31Christmann C. . . . . . . . . . . . . . . . . . . . . . . . . P-II/25, V/108, P/106Christoph P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/18, P-III/30Cindea-Drimus R. . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/68, V/105Cubal-Pena R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/168

D

Dällenbach P.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/23Dangel M.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/38Dedes K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/64Delavy M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/41De Luca G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/127DeOliveira S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/106Desseauve D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/57De Vuyst H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/41De Zordo C.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/150Dhakal C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/50Diener P.-A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/167Digesu A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/23Di Meglio L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-I/12Diomande I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/42Dirksen U.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/167


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Diserens C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/116Di Serio M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/62Dommann-Scherrer C. . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/68Dubar S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/134Dubuisson J. . . . . . . . . . . . . . . . . P-IV/47, V/106, V/109, V/111, P/131Dubuisson JB. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/111Durand R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/145

E

Eberhard M. . . . . . . . . . . . P-VI/68, V/102, V/105, P/126, P/129, P/162Eberli D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/24Eberz B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/60Eggemann C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/121Egg R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/62Eich G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/141Eisenhut M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/117Ekatomati M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/153Engel W.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/107Eperon I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/111Epple G.P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/142Erb S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/158Esber H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/50Etemadmoghadam D. . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/44

F

Fadhlaoui A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/134, P/168Fäh M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/101Fähnle-Schiegg I. . . . . . . . . . . . . . . . . . . . . . . . . . . V/108, P/106Farina P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/56, P/158Fasel P.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/117Favre D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/102Fedier A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/46, P/115Fehres O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/118, P/160Fehr M.K. . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/42, P-II/22, P/142Fehr P.M. . . . . . . . . . . . . . . . . . . . . . . . . . . . P/118, P/125, P/160Feki A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/134, P/168Fellmann B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/101Filippakos F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/102Fink A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-II/24, P-II/21, V/98Fink D. . . . . . . . . . . . . . . . . FM-II/23, FM-IV/42, P-II/26, P-VI/64, P/154Fischer A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/130


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Fischer T. . . . . . . . . . . . . . FM-I/13, P-I/11, P/136, P/143, P/159, P/171Flury R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/126Förger F.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/124Frei J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/125Frei L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/121, P/157Freydanck M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/105Fürer K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/24Furrer R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/17

G

Gabriel N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/42Gahleitner E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/170Gamper M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/22Gaston G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/168Genoud S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-II/20Gerull R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/102, P/109Ghisu G.-P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/42, P/154Giaglis S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/100, P/103Giannis G.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/102Girard T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/158Gobrecht U. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-II/20Graf U. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/164Granado C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/38, P-V/56Grawe C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/114Greub G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/30Grimolizzi F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/100, P/103Guilon T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/134Gülmez H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/58Günthert A. . . . . . . . . . . . . . . . . . . . . . . . FM-I/14, P-II/25, P-IV/42Gyftomitrou A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/146Gyger J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/50, P-V/51

H

Häberli B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/156Hacker N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-II/23Hagen D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/122Hahn S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/100, P/103Hamburger M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/24Hammerschmid N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/143Harlacher S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/123Haslinger C. . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/64, P-I/17


➔

Hebisch G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/142Hecht C. . . . . . . . . . . . . . . . . . . . . . . . . . FM-II/22, P-I/18, P-IV/43Heinzelmann V. . . . FM-II/23, P-IV/44, P-IV/46, P-VI/62, P-VI/63, P-VI/67,

P/105, P/115Heriniainasolo J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/41Hettich T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/46Hilfiker P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/108Hodel M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-I/14, P/113Hofstaetter C. . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/33, P-V/52Hofstetter A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/31Hohfeld P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/61Honegger Ch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/123Hornung R. . . . FM-I/13, P-I/11, P-I/12, P/136, P/143, P/150, P/155, P/159,

P/167, P/171Hösli I. . . . . . . . . P-I/13, P-III/35, P-III/37, P-III/38, P-V/56, P-V/58, P/100,

P/103, P/158Huang D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/38Hüsler M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/110Hussung B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/125Hustinx H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/165Hutter D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/52Hutton K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/43

I

Imboden S. . . . . . . FM-II/24, P-II/27, P-II/28, P-VI/61, V/97, V/98, V/100, V/104, P/128

In-Albon S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/102Irion O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/34, P/146

J

Jacob F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/46, P/115Jacot-Guillarmod M. . . . . . . . . . . . . . . . . . . . . . . . . P/116, P/133Jägli N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/155, P/167Jinoro J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/41Jörger-Messerli M.. . . . . . . . . . . . . . . . . . . . . . . . . P-I/10, P-III/32Junod R.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/145

K

Kadner A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/52Kaelin Gambirasio I.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/23Kahlert C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/54


➔

Kanellos P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/126Kashiwagi M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/42Kavvadias T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/62Keller B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/13Keller N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/152Kenfack B. . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/40, P-IV/48Khomsi F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/134, P/168Khullar V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/62Kiechle K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/109Kimmich N. . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/64, P/107, P/165Kinkel J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/136, P/171Knabben L. . . . . . . . . . . . . . . . FM-II/22, P-IV/43, P/111, P/135, P/139Knabenhans M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/15Knipprath-Mészáros A.M. . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/63Knüsel P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/118Kochanowski A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/154Köchli O.R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/108, P/120Kohler L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/157Kohler R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/115Kohler S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/46Kohl J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/113, P/130Kohl Schwartz A. . . . . . . . . . . . . . . . . . . . . . . . . . . P/101, P/117Komarek A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/165Konstantinidou E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/119Körnig M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/25Kostov P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/128Krähenmann F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/96, P/110Krebs Th. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/136, P/143Kreft M. . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/64, P/107, P/140Kreklau A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/113Kuhn A. . . . . . . . . . . . . . . FM-II/20, FM-VI/60, FM-VI/63, P-II/21, V/97Kunckler M.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/48Kurmanavicius J.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/14

L

Landolt A.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/108, P/120Lange S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/111Lang F.M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/44Lanz S.. . . . . . . . . . . . . . . . . . . . . . . . P-II/27, P-II/28, V/100, V/104Lapaire O. . . . . . . . . . . . . . . . . . . . . . . P-I/13, P-III/31, P/100, P/103Ledermann-Liu H. . . . . . . . . . . . . . . . . . . . . . . . . . . . V/99, V/103


➔

Lepigeon K.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/33Linoni C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/117Lipp von Wattenwyl B. . . . . . . . . . . . . . . . . . . . . . . . P-V/55, P/138Low N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/54Lugo J.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/43Lüscher B.P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-I/11Lütolf Ch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/152

M

Machado S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/161Magg H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/99Malzacher A. . . . . . . . . . . . . . . . . . . . . . . . . . P/136, P/143, P/171Manegold-Brauer G. . . . . . . . . . P-I/13, P-III/31, P-V/56, P-VI/63, P/158Marci R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/47Marini C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-I/11Markus A. . . . . . . . . . . . . . . . . . . . . . . . . . . . P/150, P/155, P/167Marthaler C. . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/60, P/148Martinez de Tejada B. . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/34Masciocchi M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/42Mathevet P. . . . . . . . . . . . . . . . . . . . . FM-VI/62, V/107, P/116, P/145Mattenberger C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/147Matt L.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/105Mayer D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/140Mazza E.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/32Mennet M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/24Merkel T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/67Mettler L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/110Meyer-Hamme U. . . . . . . . . . . . . FM-IV/40, FM-IV/41, P-IV/45, P-VI/65Meyer S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/61, P/147Michaelis S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/157Michael M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/108, P/120Michael N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/152Minger M.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/117Mirza U. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-II/23Mitchell C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/44Mitter, V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/117Mohaupt MG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/111Mohr S. . . FM-II/20, FM-VI/60, FM-VI/63, P-II/21, P-II/27, V/97, V/98, V/104Monga A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/60Montavon Sartorius C. . . . . . . . . . . . . . . . . . . . . . . . . . . FM-II/23Moser N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/133


➔

Mosimann B. . . . FM-I/10, FM-I/12, FM-III/31, FM-V/53, FM-V/54, P-III/34, P-III/36, P-V/53

Mueller M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/52, P-I/10Mueller M.D. . . . FM-II/20, FM-II/22, FM-II/24, FM-VI/60, FM-VI/63, P-II/21,

P-II/27, P-II/28, P-IV/43, P-VI/61, V/97, V/98, V/100, V/104, P/128, P/135, P/139, P/148

Mulkey A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/43Müller Borer D.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/56Müller D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/38

N

Nauwerk M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/52Nelle M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/102, P/109Neumann S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-II/22Newell D.R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/44Nirgianakis K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/27Nötzli S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/24Nowakowski L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/63Núñez López M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/46Nussbaumer J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/105, P/158

O

Obwegeser J.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/108Ochsenbein-Kölble N. . . . . . . . . . . . . . . . . . . . . . . . . V/96, P/110Oehler R. . . . . . . . . . . . . . . . . . . . . . . . V/101, V/102, V/110, P/157Offel S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/15Oppliger B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/10, P-III/32Otti G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/101

P

Pace M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/144Papadia A. . . . . . . . . . . . . . . . FM-II/24, P-II/27, P-V/54, P-VI/61, V/98Passweg D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/141, P/170Pavlovic M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/52Pelikan S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/113Peric A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-I/14, P-V/50Pestalozzi B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/64Petignat P. . FM-IV/40, FM-IV/41, P-IV/45, P-IV/47, P-IV/48, P-VI/65, P/146Pfammatter J.-P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/52Pfister S.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/36Pfister T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/38


➔

Pfofe D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/162Popescu S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/106Potterat O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/24Prince-dit-Clottu E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/147Putora K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/136

Q

Quach A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/116Quack Lötscher K. . . . . . . . . . . . . . . . . . . FM-III/32, FM-V/51, P/119Queisser M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/171Quentin G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/37

R

Radan A-P. . . . . . . . . . . . . . . . . . . . . . . . FM-II/20, FM-V/52, P/128Raio L. . . . . . . . . . . . . FM-I/10, FM-I/12, FM-III/31, FM-III/33, FM-V/53,

P-III/30, P-III/34, P-III/36, P-V/52, P-V/53, P-V/54, P/102, P/104, P/109, P/111, P/113, P/124, P/149

Rauch A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/54Rau T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/139Rautenberg O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/142Redling K.. . . . . . . . . . . . . . . . . . . . . . . . FM-II/21, P-III/35, P-IV/41Regauer S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/22, P-VI/60Reina H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/127, P/138Reinhart U. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/10, P-III/32Renteria S-C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/116Richard A.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/51Riese F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/26Rimoldi S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/104Risch L. . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/53, P-V/53, P/124Rittmann P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/123Robyr D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/33Rohling K.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/32Rohner S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/101Rohrmann S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/51Rosseel G.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/45Rossi S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/100, P/103Rothermundt C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/167Rotmistrovsky Valcarcel N. . . . . . . . . . . . . . . . . . . . . . . . . . . P/133Rouiller-Cornu S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/147Rovina L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/52Rüegger J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/140


➔

Rüegg L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/110Ruf K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/11, P/159Rutschmann O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/34

S

Sager P. . . . . . . . . . . . . . . . . . . . . . FM-II/22, P-IV/43, P/135, P/139Sajjadi Maeder K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/121Salchli F.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/61Salihi E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/108Samartzis E.P.. . . . . . . . . . . . . . . . P-VI/68, V/102, V/105, P/126, P/162Sarlos D.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/99, V/103Schädeln S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/35Schäffer L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/17Schär G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/99, V/103Schaub A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/108Scheiner D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/32, P-II/26Schlabritz-Loutsevitch N. . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/43Schlatter B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/31, P-III/34Schliemann G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/110Schlotterbeck G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/46Schmid J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/130Schmid S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/152, P/161Schmidt-Jakob A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-I/10Schmidt M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/44Schneider M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/68, P/129Schneider N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/112, P/160Schneider P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-I/11, P-I/10Schnelle M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/24Schoeberlein A. . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/10, P-III/32Schoenenberger C-A. . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-II/21Schönberger H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/31Schöning A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/54Schorer A.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/142Schötzau A.. . . . . . . FM-II/21, FM-II/23, P-III/38, P-IV/41, P-IV/46, P-VI/67Schrempf K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/156Schumacher C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/118Schumacher F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/48Schürch R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/101Schwab F.D. . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-II/21, P-IV/41Schwander A. . . . . . . . . . . . . . . . . . . . . . . . . P-II/28, V/104, P/148Schwedler K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/42


➔

Seidler S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/166Sekulowski M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/122Sichitiu J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/153Siebert M.. . . . . . . . . . . . . . . . . . . . . . . . FM-II/21, P-IV/41, P-VI/67Siegenthaler F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/61, V/97Siegenthaler S.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/98Silber P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/123Simões-Wüst A.P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/24Simonson C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/107Soave I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/146Soheil S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/60Somaini A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/141Spielmann C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/15Spinelli M. . . . . . . . . . . . . . . . . . . . FM-I/10, FM-I/12, P-III/32, P/104Stähler K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/121Steinmann C.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/120Stocker G.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/156Stoikou M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/100, P/103Stojanov M.. . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/50, P-V/51Strahm K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/43Streuli I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/109Stute P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/101Surbek D. . . . . . FM-I/10, FM-I/11, FM-I/12, FM-III/31, FM-III/33, FM-V/52,

FM-V/53, FM-V/54, P-I/10, P-I/18, P-III/30, P-III/32, P-III/34, P-III/36, P-V/53, P/104, P/124

Suter FM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/36

T

Taghavi K.. . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/31, FM-VI/63Tan Z. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/168Taramarcaz T.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/112Tebeu P.M. . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/40, P-IV/48Temogne L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/40Thanner M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/12Theill N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/26Tincho E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/40, P-IV/48Todesco Bernasconi M. . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/15Tomic K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/31Tran A.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/162Trelle S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-I/10Trippel M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/128


➔

Tsakiris D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/56Tschudin S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/38Tutschek B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/96

U

Uerlings V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/130Undurraga Malinverno M. . . . . . . . . . . . . . . . . . . . . P-IV/45, P/146Urner E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/41

V

Vachette M.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/134Valent E.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/144Valsangiacomo E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/96Vanetti A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/55Vassilakos P. . . . . . . . . . . . . . . . FM-IV/40, FM-IV/41, P-IV/48, P-VI/65Veit-Rubin N. . . . . . . . . . . . . FM-III/34, FM-VI/62, P-II/23, V/107, V/111Ventolini G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/43Vial Y. . . . . . . . . . . . . . . . . . . . . . FM-VI/61, P-III/33, P-V/57, P/145Viereck V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/22Villiger A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/60Vinante V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/13Viviano M. . . . . . . . . . . . . . . . . . . . . . FM-IV/40, FM-IV/41, P-IV/48von Harten R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/122von Hochstetter A. . . . . . . . . . . . . . . . . . . . . . . . . . P/108, P/120von Mandach U. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/24von Orelli S. . . . . . . . . . . . . . . . . . . . . P-VI/66, P/141, P/156, P/170von Perbandt E. . . . . . . . . . . . . . . . . . . . . . . FM-I/13, P-I/11, P-I/12von Wolff M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/101, P/117Vonzun L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/165Vo Quoc D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/134Vouga M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/30Vuichard D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/38Vulliemoz N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/51

W

Wäspi N.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/102, P/109Wavre T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/107Weber P.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/31Wedge S.R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-IV/44Wegener S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/109Weidlinger S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-I/13


➔

Weiss JM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/50Widmer A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/38Wiedemann N. . . . . . . . . . . . . . . . . . . . . . . . . P/150, P/155, P/159Wiedemann U. . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-V/53, P/124Wieser S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/44Willame A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/47Willing N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/164Winkelbach K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/115Winter K. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-I/17Wisser J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-VI/64Wüest A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V/104Wuillemin W. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/130

X

Xiao Ch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-IV/46

Z

Zammaretti A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/127Zanetti Dällenbach R.. . . . . . . . . . . . FM-II/21, P-IV/40, P-IV/41, P-VI/62Zbären S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/149Zbinden A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/124Zdanowicz J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-V/53Zech C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/158Zeitler I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-III/37Zimmermann R. . . . . . . . . FM-III/32, P-I/17, V/96, P/107, P/110, P/114,

P/119, P/140, P/165Zodan T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-VI/66Zollinger T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/167Züblin N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM-III/33Zulewski H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/156Zürcher L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-II/26


➔

Freie MitteilungenCommunications libresFM = Freie Mitteilung / Communication libre

➔

FM I/ 10

Measurement of fetal atrioventricular time intervals by tissue und pulsed Doppler

Author: 1) Mosimann B., 1) Amylidi-Mohr S., 1) Schmidt-Jakob A., 1) Spinelli M., 1) Surbek D., 2) Trelle S., 1) Raio L.Hospital: 1) Obstetrics and Gynecology, University Hospital Bern, University Bern, 2) CTU Bern

Objective: To evaluate the accuracy of pulsed Doppler (PD) and tissue Doppler imaging (TDI) derived fetal atrioventricular (AV) time interval measurements

Patients and measures: Echocardiography was performed on healthy fetuses between 16 and 40 weeks’ gestation. TDI-derived AV intervals were measured as the intervals from atrial contraction (Aa) to isovolumetric contraction at the right ventricular free wall. Pulsed Doppler-derived AV intervals were measured from the onset of the mitral A wave (atrial systole) to the beginning of the aortic pulsed Doppler tracing (ventricular systole). This represents the mechanical PR interval.

Results: During the study period 299 healthy pregnant women were enrolled. A signifi-cant, positive correlation was found between gestational age and both the TDI and PD-de-rived AV intervals (TDI: r=23, p<0.0001; PD: r=0.22; p=0.0001). Median AV time interval was 120ms (range 78-163ms) with PD and 129ms (76-173) with TDI. The medians were signifi-cantly different. The 97.5%ile in PD-derived AV-intervals reaches 150ms at 32 weeks gesta-tion, while TDI-derived already at 21 weeks gestation.

Conclusion: We have established gestational age specific reference ranges for the two most used techniques for the assessment of the mechanical AV time. This may be of value in particular in fetuses at risk for forms of heart block associated with maternal SSA/Ro-SSB/La antibodies. Of note, the AV time is dependent on gestational age and an AV time of 150ms, usually defined as AV block I, is normal in the second half of pregnancy in TDI-de-rived and after 32 weeks in PD-derived measurements. From a physiologic point of view this increase in AV time may in part be explained by the morphologic and biometric changes of the heart during development.

FM-I/10Jahreskongress / Congrès annuel gynécologie suisse 2016Freie Mitteilungen / Communications libres

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FM I/ 11

Role of uric acid and GLUT9 in pregnancy on neonatal development

Author: 1,2,3) Marini C., 1,2) Lüscher B.P., 1) Schneider P., 1,2) Baumann M., 1,2) Surbek D.Hospital: 1) Obstetrics and Gynecology, University Hospital Bern, 2) Clinical Research, 3) Graduate School for cellular and Biomedical Sciences (GCB)/ 2,3 University Bern

Introduction: High maternal uric acid serum levels are often associated with preeclamp-sia. The regulation of the placental uric acid transport system and its major uric acid trans-porter, glucose transporter 9 (GLUT9) are not fully understood yet. We hypothesized that the lack of GLUT9 in the placenta leads to exposure of high uric acid levels in the fetus. Using a systemic GLUT9 knockout mice model we aim to understand the effect of fetal hy-peruricemia on the growth of the pups and the development of their internal organs.

Methods: Six-week-old female GLUT9(+/-) mice, maintained on regular chow diet, are ma-ted with GLUT9(+/-) male mice. After the mating the diet is changed to regular chow diet plus inosine for the entire pregnancy period (21 days), which will lead to hyperuricemia in GLUT9(-/-) fetal mice, but not in the maternal mice. Starting from day 7 after birth the pups are daily weighted until day 70 after birth. At day 70 the pups are sacrificed and after perfusion organs (pancreas, liver and kidney) are weighted and used for tissue analysis to identify possible abnormal organ development.

Results: First of all we saw a significant difference in body weight between neonatal GLUT9(+/+) and GLUT9(-/-) female mice from day 12 till day 35. Neonatal GLUT9(-/-) female mice were smaller than GLUT9(+/+) female mice . Then when we compared kidneys from neonatal GLUT9(+/+) and GLUT9(-/-) female mice, we saw a decreased in size of 25±0.15% (n=7; p=0.007) in the left kidney and of 35±0.21% (n=7; p=0.011) in the right one. Hema-toxylin & eosin staining on kidney paraffin sections shows that the morphology of the kid-ney of GLUT9(+/+) mice is normal with normal kidney tubules with viable epithelial cells; while the morphology of the kidney of GLUT9(-/-) mice is typical of necrotic tissue. These kidneys are characterised by necrosis of epithelial cells, with loss of nuclei, fragmentation of cells, and leakage of contents.

Conclusions: The impaired development of neonatal GLUT9(-/-) mice may be due to hy-peruricemia. The understanding of the mechanism behind might underlie the possible link between hyperuricemia and altered placental function to metabolic fetal program-ming.


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FM I/ 12

Nomograms of sonographic measurements of the fetal sylvian fissure and insula lobe throughout gestation: a cross-sectional study

Author: 1) Spinelli M., 2) Di Meglio L., 1) Bolla D., 1) Mosimann B., 1) Surbek D., 1) Raio L.Hospital: 1) Obstetrics and Gynecology, University Hospital Bern, 2) Private Centre “Diagnostica Ecografica Prenatale Aniello Di Meglio Srl” Napoli

Objective: To provide 2D ultrasonographic (US) nomograms of the depth of the sylvian fissures (SF) and insula lobe (IL) throughout gestation in a large number of fetuses, as well as to evaluate the reproducibility of these measurements among differently-experienced operators.

Methods: This was a prospective cross- sectional study of 280 normal singleton pregnan-cies between 18 and 33 weeks. Measurement of the depth of the SF and IL in a standard trans ventricular axial plane of the fetal head was done trans-abdominally by a senior op-erator and in 38 cases also by a junior operator. SF and IL as a function of gestational age (GA) were expressed by regression equations. Inter-observer variability was assessed by interclass correlation coefficients (ICC).

Results: Satisfactory SF and IL measurements were obtained in all cases. SF (r=0.81, p<.0001) and IL (r=0.86, p<.0001) correlated linearly with GA. A high degree of consis-tency was observed between values obtained by different examiners (ICC=0.97 95% CI 0.94-0.98).

Conclusion: Prenatal 2D-US measurements of SF and IL may be feasible and reproducible using standard views of the fetal head. Since the nomograms increase with GA, they could be used to estimate brain development and may supply a tool for diagnosing, counselling and management of cases with malformations of cortical development.


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FM I/ 13

Active management of the third stage of labor: Does the application mode of oxytocin influence the outcome?

Author: Weidlinger S., von Perbandt E., Fischer T., Hornung R.Hospital: Obstetrics, Cantonal Hospital St. Gallen

Introduction: Postpartum hemorrhage is still the leading cause of maternal mortality worldwide. Prophy-lactic administration of uterotonics during the third stage of labor is a simple and well established interven-tion to significantly decrease the incidence of postpartum hemorrhage. In order to decrease cardiovascular adverse effects in 2010 doctors in Switzerland were notified by the manufacturer of Syntocinon® that Oxy-tocin, as a prophylactic uterotonic in the third stage of labor, should only be given as an intravenous short-term infusion (5 IE Oxytocin i.v. over a period of 5 minutes) or intramuscular (5-10 IE Oxytocin) and no longer as a rapid intravenous bolus (5 IE) as it was the standard before. The aim of this study was to compare the in-cidence of postpartum adverse outcome after this adjustment in therapy.

Material and methods: A retrospective cohort study was carried out in the Cantonal Hospital in St. Gal-len comparing outcomes of the third stage of labor before and after the change of the Oxytocin application mode. Two groups were classified, a bolus group (2005-2009) and an infusion group (2011- 2015). The study included only low-risk births of spontaneous delivered live singletons from 37 weeks of gestation without induction or previous cesarean.

Results: 4877 patients were included. We found significant differences with an increase in estimated blood loss (OR 2.42, p< 0.000), a decrease of complete detachment of placenta (OR 0.77, p 0.019), an increase in the manual removal of retained placenta (OR 1.8, p 0.002) and an increase in postpartum curettage (OR 3.1, p < 0.000).

Conclusion: As we reported earlier in 2011, our data showed considerable differences in all outcomes be-tween the two groups. The infusion group showed a significant increase of blood loss, incomplete detach-ment of placenta, manual removal of retained placenta and curettage directly after childbirth. In conclusion the intravenous short-term infusion is less effective than the bolus application in terms of successful man-agement of third stage of labor. Nevertheless in consideration of the severe maternal cardiovascular adverse effects, the application as a short-term infusion is justified.

Outcomes Bolus group n = 2486 (%)

Infusion group n = 2391 (%)

OR CI 95% p-value

Estimated blood loss > 500 ml = PPH

145 (5.8) 312 (13.0) 2.42 1.97-2.98 < 0.000

Complete de-tachment of placenta

2315 (93.1) 2183 (91.3) 0.77 0.63-0.96 0.019

Manual remo-val of retained placenta

42 (1.7) 72 (3.0) 1.80 1.23-2.66 0.002

Curettage di-rectly after childbirth

42 (1.7) 121 (5.1) 3.10 2.17-4.43 < 0.000


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FM I/ 14

Introducing a teaching video for caesarean sections: does it improve the outcome?

Author: Peric A., Hodel M., Günthert A.Hospital: Gynecology and Obstetrics, Cantonal Hospital Lucerne

Introduction: In surgery one main factor of outcome is the level of experience of the sur-geon. In order to achieve the needed skills repetitive practical experience and training un-der supervision is needed. It seems logical, that the learning curve is steeper if there is a uniform standard for the procedure and if it is always performed in the same way, irrespec-tive of the supervisor. This can be hindered since different supervising surgeons might ap-ply different techniques. Therefore a teaching video for performing a caesarean section was created in our department of gynaecology and obstetrics. After introducing this video all caesarean sections were performed accordingly to the standard provided therein. The aim of the present study was to evaluate the benefit of this video.

Material and methods: We performed a retrospective study in a tertiary obstetric unit. All caesarean sections performed during the year prior introducing the teaching video (n=509) as well as all caesarean sections performed during the year after introducing the teaching video (n=447) were analysed. The data was divided in four different groups relat-ing to the level of training of the surgeon. We also examined if there was any difference in primary, secondary or higher order caesarean section. The main outcome measures were total operative time, incision-to-delivery interval, operative blood loss and postoperative complication rates.

Results: Our results show a significant (p< 0,001) reduction of the total operative time from 49,5 ±11,54 minutes to 42,7 ± 10,78 minutes after introducing the video. The same effect could be observed in the examined subgroups, which related on the level of train-ing. Even though the operative time was shorter, there wasn`t any significant difference in the mean operative blood loss, nor in the postoperative complication rates. However, there was no difference concerning the incision-to-delivery interval.

Conclusion: This study shows that there is a significant effect on total operative time and hence in cost-effectiveness through the use of a teaching video. This effect is not only lim-ited to beginners but applies also to more experienced surgeons, like advanced residents or attendings.


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FM II/ 20

To pee or not to pee: What are the long-term sequelae after postpartum urinary retention?

Author: 1) Gobrecht U., 2) Mohr S., 2) Radan A-P., 2) Genoud S., 2) Mueller M.D., 2) Kuhn A.Hospital: 1) Obstetrics and Gynecology, University Hospital Basel, 2) Obstetrics and Gynecology, University Hospital Bern and University Bern

Introduction: Postpartum urinary retention (PUR) is a serious complication after child-birth, which can cause urogenital tract morbidity. In PUR, the inability to void (overt PUR) and an increased post void residual urine volume (PVRV) of more than 100-150 ml (covert PUR) are distinguished. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often played down. Aim of this study was to assess long-term development of PVRV after PUR.

Methods: All patients who were referred for PUR were asked to participate in this study be-tween January 2007 and December 2014. Demographic data, obstetric data, birth weight, type of anaesthetic and obstetric complications were noted. Post-void residual urine vol-ume (PVRV) was measured sonographically, and, if increased the patients were instructed to perform clean intermittent self-catherization. PVRV was measured every two days until day 15, then after six and twelve months. If retention persisted longer than the lactation period, multichannel urodynamics were performed.

Results: Sixty-two patients have been included in this study. The median residual volume postpartum normalized (i.e. went below 150 ml) at day seven. Long-term voiding disor-ders were found in 7.9% and in 4.8% of patients after one and three years, respectively. Multichannel urodynamics confirmed in all patients with persisting retention an acontrac-tile detrusor and de novo stress urinary incontinence in four cases.

Conclusion: In most cases PUR resolves early, but PUR also can persist and a significant number of patients complain of subjective voiding difficulties at follow-up after PUR. Per-sistent or chronic PUR is reported to range from 0.11 to 0.2%, while in this study up to 7.9% (cut-off 150 ml) of the patients show increased PVRV after 6 and 12 months, 6.3% after 24 months and 4.8% after three years. Routine measurement of the PVRV is not established as it is time consuming and costly. However, our data support the importance of early drain-age that may preclude lower urinary tract morbidity.

FM-II/20Jahreskongress / Congrès annuel gynécologie suisse 2016Freie Mitteilungen / Communications libres

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FM II/ 21

Ultrasound BI-RADS classification and real-time elastography Tsukuba score assessment of breast lesions: inter- and intraobserver agreement

Author: 1) Schwab F.D., 1) Redling K., 1) Siebert M., 2) Schötzau A., 3) Schoenenberger C-A., 1) Zanetti Dällenbach R.Hospital: 1) Gynecology and Obstetrics, 2) Statistics, Gynecology and Obstetrics, 3) Chemistry, University of Basel/ 1,2 University Hospital Basel

Introduction: Breast ultrasonography is a widely recognized diagnostic tool for evaluat-ing breast lesions. Based on the sonographic morphology, breast lesions are classified ac-cording to the Breast Imaging Reporting and Data System (BI-RADS,) in categories 2-5. On the other hand, real time elastography explores stiffness differences between breast lesions and the surrounding normal parenchyma at the macroscopic scale and is classi-fied in a Tsukuba elasticity score. Our aim was to prospectively evaluate inter-and intraob-server agreement of BI-RADS classification and Tsukuba elasticity score of breast lesions.

Material and methods: Women with a solid breast lesion who were scheduled for ultra-sound-guided invasive breast biopsy at the outpatient breast clinic of the Women’s Hos-pital of the University Hospital Basel, from August 2009 – December 2012 were recruited. Patient age ranged from 18 to 89 years with a mean of 50.3 years. The study included 164 breast lesions (63 malignant, 101 benign) from 156 patients. From each lesion, one repre-sentative B-mode image and 1 to 5 elastograms were recorded. Lesions were immediately assessed by US BI-RADS classification and Tsukuba elasticity score by the primary exam-iner who was aware of the clinical and, where available mammographic findings. Three ex-perienced reviewers who were blinded to the clinical findings as well as mammographic and histopathologic results, independently assessed the B-mode image and the elasto-grams and repeated the evaluation after 2 months.

Results: The analysis included 156 B-mode images and 613 elastograms. Weighted kappa values for interobserver agreement ranged from moderate to substantial for US BI-RADS classification (κ=0.585-0.738), and was substantial for Tsukuba elasticity score (κ=0.608-0.779). Intraobserver agreement was almost perfect for US BI-RADS (κ=0.847-0.872) and Tsukuba elasticity score (κ= 0.879-0.914). Overall, individual reviewers are highly self-con-sistent (almost perfect intraobserver agreement) with regard to US BI-RADS classification and Tsukuba elasticity score whereas interobserver agreement was moderate to substan-tial.

Conclusion: Our results indicate that a high diagnostic performance of breast US and Real time elasography can be achieved. Additional training and periodic performance evalua-tions may help to further improve interobserver agreement.


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FM II/ 22

Tumor characteristics and treatment of breast cancer in elderly patients

Author: Neumann S., Knabben L., Hecht C., Sager P., Mueller M.D.Hospital: Obstetrics and Gynecology, University Hospital Bern

Introduction: With the increasing expectation of life breast cancer in elderly women be-comes more common. Nevertheless older patients are underrepresented in breast can-cer research. The aim of our study was to analyze tumor characteristics and differences in treatment of patients ≥75y with breast cancer.

Material and methods: Retrospective analysis of data from patients with primary breast cancer treated at the university hospital of Berne between january 2013 and december 2015. Data regarding patients characteristics, histology, immunohistochemistry, tumor board recommendations for adjuvant treatment and received therapy were extracted from patients charts. Women aged ≥75y were compared to postmenopausal patients 50-74y. Statistical analysis was performed with GraphPad Prism 5. Statistical significance was considered at p < 0.05.

Results: In our cohort 47 (14.8%) patients were ≥75y (75-94) old. They were compared to 137 postmenopausal patients aged 50-74y. The older patients presented with locally more advanced stage (T3 and 4) at diagnosis (29.7% vs. 8%, p <0.001) and were more of-ten treated by mastectomy than the control group (53.2% vs. 24.1%, p <0.001). In contrast we didn’t find significant differences in histology, grading, receptor status, proliferation rate and molecular subtypes. When radiotherapy was administered elderly women were more likely to receive partial breast irradiation than whole breast irradiation (41.9% vs. 17.3%, p <0.001). Only few old women received chemotherapy; 9.3% vs. 25.4% in the con-trol group (p 0.03). In 12 (31.6%) of the elderly women treatment differed from the tumor board recommendations compared to 11 (11.6%) in the control group (p 0.01). Due to co-morbidities or patients request chemotherapy was omitted in 8 cases and radiotherapy in 5 women. In contrast recommendation for hormonal therapy was followed in most cases.

Conclusion: In 31.6% of our elderly patients with breast cancer tumor board recommen-dations were not followed into practice because of comorbidities. According to the litera-ture we found that old patients seem to be undertreated in terms of adjuvant therapy. Pro-spective studies with a focus on elderly patients with breast cancer should be conducted to define the optimum treatment for these patients.


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FM II/ 23

Impact of the new FIGO 2013 classification on prognosis of stage I epithelial ovarian cancers

Author: 1) Mirza U., 1) Montavon Sartorius C., 2) Schötzau A., 3) Fink D., 4) Hacker N., 1,2) Heinzelmann V.Hospital: 1) Gynecology and Gynecological Oncology, Hospital for Women, 2) Ovarian Can-cer Research Group, Department of Biomedicine, 3) Gynecology, University Hospital Zurich, 4) Gynecological Cancer Centre, Royal Hospital for Women, School of Women’s and Chil-dren’s Health, Randwick NSW, Australia/ 1,2 University Hospital Basel, University Basel

Introduction: FIGO stage is one of the strongest prognostic factors in epithelial ovarian cancer. Its classification has recently been revised: FIGO IC has now been subdivided in IC1 (intraoperative surgical spill), IC2 (capsule rupture before surgery or tumor on surface) and IC3 (positive peritoneal washing or ascites). Our aim is to compare the outcome of patients in the new FIGO I subgroups as this might influence adjuvant therapy desicion.

Materials and methods: Patient databases of three gynecological oncology centers were retrospectively analyzed. Patients with early FIGO stage I ovarian or tubal cancer were in-cluded, synchronous cancers with the endometrium were excluded. We restaged FIGO IC according to the revised FIGO staging system based on operation files and pathological reports and compared them to patient outcome data.

Results: In total, 208 patient datasets were analyzed (IA 59.1%; IB 7.2%; IC 33.6%, IC1 8.7%; IC2 7.7%; IC3 17.3%), from which 96.6% were ovarian cancers. In FIGO IA we found 11.5% recurrences and 4.3% deaths. In FIGO IC 23% of patients recurred and 3.8% died . When comparing IA to IC, time to recurrence was 190 vs 158 months (p = 0.061). Whithin all new subgroups of FIGO IC, there was no difference in time to recurrence ; 91.2 (IC1), 83.7 (IC2), and 78.2 (IC3) months (p= 0.68). There was also no difference in survial when FIGO IA was compared to FIGO IC in comparison to the new individual classifications (IA to IC or IA to IC1, 2 or 3, respectively ; p= 0.93, p= 0.66, p= 0.71, p= 0.64) or within the different sub-groups (p= 0.47). In 64.2% of all FIGO IC adjuvant chemotherapy was recommended. There was no difference in regards to the tumorboard when comparing FIGO IC1 and IC3.

Conclusion: In our retrospective analysis the new FIGO staging of IC ovarian cancers did predict prognosis nor change tumorboard decisions. However, larger numbers and indi-vidual histotype depending analyses may be warranted.


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FM II/ 24

Accuracy of sentinel lymph node mapping after previous hysterectomy in patientis with occult cervical cancer

Author: 1) Fink A., 2) Papadia A., 2) Imboden S., 3) Mueller M.D.Hospital: 1) Gynecology and Obstetrics, 2) Gynecology and Gyneco-Oncology, 3) Gynecology/ 1-3 University Hospital Bern

Introduction: In patients with a diagnosis of occult cervical cancer made on a hysterec-tomy specimen after surgery for a benign indication, lymph node assessment is crucial to determine treatment. We aimed to compare sentinel lymph node (SLN) mapping between patients with postoperative diagnosis of occult cervical carcinoma and patients with cer-vical cancer and uterus in situ.

Material and methods: A retrospective analysis of cervical cancer patients International Federation of Gynecology and Obstetrics (FIGO) stage IA-IIA disease ungerdoing laparo-scopic SLN mapping was performed. Patients were divided into two groups: those with a diagnosis of occult cervical cancer made on a hysterectomy specimen (group 1) and those with a diagnosis of cervical cancer and uterus in situ (group 2). Tracers used for SLN map-ping included technetium-99m, blue dye, and indocyanine green. After detection and ex-cision, the SLN was sent for frozen section analysis, and the planned surgical procedure was aborted in a case of metastatic disease in favor of a chemoradiotherapeutic treat-ment.

Results: Groups 1 and 2 included 9 and 62 patients, respectively. Clinicopathologic char-acteristics were similar among the two groups. Overall and bilateral detction rates were 66.6 and 33.3 and 95.1 and 87% in groups 1 and 2, respectively (p< 0.05). No false- nega-tive SLNs were identified in either group, with a negative predictive value of 100%.

Discussion: SLN mapping in occult cervical cancer patients has lower detection rates compared to patients with uterus in situ. In these patients, proper management of their desease has already failed before diagnosis, and additional mistakes may definitely com-promise attempts at cure.


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FM III/ 30

Simkania negevensis, an emerging pathogen with strong similarities to chlamydia trachomatis…

Author: 1,3) Vouga M., 2,3) Greub G., 1,3) Baud D.Hospital: 1) Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-enfant", Maternity, 2) Infectious Disease Service, 3) Center for Research on Intracellular Bacteria, Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne/ 1-3 University Hospital Lausanne

Introduction: Simkania negevensis is an emerging Chlamydia-related bacterium discov-ered in 1993 (1). Similarly to Chlamydia trachomatis, it is an obligate intracellular bacte-rium characterized by a biphasic developmental cycle. In the past decades various Chla-mydia-related bacteria have been discovered, such as Parachlamydia acanthamoebae (2) and Waddlia chondrophila (3). A growing interest has developed towards these bacteria as they represent potential emerging pathogens; W. chondrophila has been strongly asso-ciated with miscarriages (4–6). So far, little is known about the biology and pathogenesis of Simkania negevensis. Evidence of human exposition has been reported worldwide and current data suggest an association with pneumonia and bronchiolitis (7–10). Owing to its fastidious growth requirements, the clinical relevance of Simkania is probably underes-timated. In addition, its similarities with adverse pregnancy outcomes-related pathogens such as C. trachomatis and W. chondrophila make it a putative candidate for genital infec-tions, especially Pelvic Inflammatory Diseases (PIDs), and obstetrical complications, such as premature labor, stillbirths and miscarriages, for which growing evidence suggest a pu-tative causative role of poorly characterized infectious agents (11).

Methods: In this work, we characterized the growth cycle of Simkania in Vero cells, endo-metrial cells (Ishikawa cell line) and pneumocytes (A549 cell line) using (i) a specific quan-titative PCR, recently developed by our group, (ii) immunofluorescence and (iii) a mortal-ity assay, based on propidium iodide incorporation.

Results and conclusion: We demonstrated that Simkania efficiently replicates in those three cell lines within 6 days and new infective particles were released in the extracellular media starting from day 3. Infectivity was significantly higher in pneumocytes compared to the other cell lines. No cytopathic effects were observed in all cell lines tested, as shown by similar mortality levels in both infected and uninfected cells. This suggests that Sim-kania infection might persist for a prolonged time in pneumocytes or endometrial cells and induce chronic lung or endometrial infections, similarly to C. trachomatis. These data strongly support the role of Simkania as an agent of lower respiratory tract infections and suggest the urgent evaluation of its implication in genital tract infections.

FM-III/30Jahreskongress / Congrès annuel gynécologie suisse 2016Freie Mitteilungen / Communications libres

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FM III/ 31

Thyroid dysfunction in early pregnancy: An epidemiological study in the antenatal care unit of the University Hospital of Bern

Author: 1) Amylidi-Mohr S., 1) Hofstetter A., 1) Taghavi K., 1) Mosimann B., 1) Schlatter B., 1) Surbek D., 2) Christ E., 1) Raio L.Hospital: 1) Obstetrics, 2) Endocrinology/ 1,2 University Hospital Bern and University Bern

Introduction: Thyroid dysfunction in pregnancy has been associated with wide range of adverse maternal and fetal/infant outcomes. Questions have also been raised about in-creased risks of cognitive dysfunction and other adverse neurodevelopmental outcomes. Iodine deficiency is the most common cause of hypothyroidism worldwide, however, in io-dine replete areas, autoimmune disease is more dominant. The aim of our study was to as-sess the prevalence of thyroid dysfunction, in particular overt hypothyroidism in our preg-nant population and to stratify them demographically.

Methods: All women who had antenatal care in the University Hospital of Bern between January 2014 and October 2015 had a thyroid stimulating hormone (TSH) measurement in the first trimester of pregnancy. Women with normal serum free thyroxine (fT4) whose serum TSH level> 2.50 mU/L were diagnosed as subclinical hypothyroidism and measure-ment of thyroid antibodies followed. If antibodies were positive the women were treated with levothyroxine. Similarly, women with overt hypothyroidism (increased TSH levels with reduced fT4)received directly adequate treatment. Routine monitoring of ongoing thyroid function occurred for the remainder of the pregnancy for all women affected.

Results: A total of 1151 women underwent thyroid screening. Currently, we have analyzed the results of 425 women. Twenty-five women with preexisting thyroid dysfunction were excluded from the analysis. The mean gestational age at enrollment was 10.6±1.6 weeks. The mean TSH value was 1.37±1.2 mU/L. Thyroid dysfunction was diagnosed in 33 pa-tients (8%). Manifest hyperthyroidism had four of these pregnant women, with one being treated because of clinical symptoms. On the other hand, 28 (85%) of them had a subclin-ical hypothyroidism. Of those with subclinical hypothyroidism only five had positive thy-roid peroxidase antibodies (TPO-Ab) and received treatment. Eight out of these 28 women (28%) are Swiss. Additionally we had only one case of manifest hypothyroidism, an African woman. All the women who received treatment had a risk factor for thyroid dysfunction.

Conclusion: The prevalence of manifest hypothyroidism in our population is very low (0.25%). We also showed that that the incidence of an autoimmune thyroid dysfunction is higher among Swiss women, whereas in the group of subclinical hypothyroidism with negative antibodies 2/3 of the women were non-Swiss. This disproportion may be ex-plained due to iodine deficiency.


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FM III/ 32

Cervical softening occurs early in pregnancy: characterization of cervical stiffness using the aspiration technique

Author: 1,2) Badir S., 1) Quack Lötscher K., 1) Rohling K., 1) Zimmermann R., 2) Mazza E., 3) Scheiner D., 1) Bajka M.Hospital: 1) Obstetrics, 2) Institute for Mechanical Systems, ETH Zurich, 3) Gynecology/ 1,3 University Hospital Zurich

Introduction: Preterm birth is the leading cause of infant mortality and morbidity in de-veloped countries. The uterine cervix is firm and closed during pregnancy preventing the fetus from exiting before term. With the onset of labor, changes in consistency lead to ra-dial opening of the cervix allowing the passage of the child. The objective of our research is to quantitatively describe the changes in cervical stiffness and their relation to cervical length in normal pregnancy, and thus contribute to a better understanding and eventu-ally predict preterm ripening of the cervix that leads to cervical insufficiency.

Material and methods: A device has been developed at ETH Zurich to measure cervi-cal stiffness using the aspiration method. The pen-shaped probe is inserted into the va-gina and positioned on the uterine cervix. The device then applies a weak vacuum and measures the negative pressure necessary for a controlled, standardised displacement of the cervical tissue. This maximal negative pressure (pcl) is directly proportional to cervical stiffness. Cervical length was assessed by ultrasound according to the standard procedure.

Results: 448 aspiration and ultrasound measurements were carried out on pregnant women (n = 50) at each routine pregnancy consultation and on non-pregnant subjects (n = 50). Stiffness in the first trimester is significantly lower than for the non-pregnant group, by a factor >2 for the mean value. pcl continuously decreases during gestation, with signif-icant differences between first and second trimester. In contrast, cervical length is stable throughout the second trimester and only decreased in the third trimester. After delivery, consistency recovers to early pregnancy levels. In one case, pcl increased during gestation instead of decreasing. Interestingly, this cervix was unable to open at delivery leading to a caesarean section.

Conclusion: The aspiration method allows an objective description of the cervical con-sistency during pregnancy, indicating that the tissue softens already at the beginning of gestation, transforms continuously to lower consistency and recovers its stiffness after de-livery. The quantitative assessment of the mechanical properties of the cervix might thus provide information on the individual risk of preterm birth or efficacy of labor induction therapies. A clinical multi-center trial is currently ongoing in Switzerland and Belgium to determine the usefulness of the technique for prediction of the individual risk for preterm birth.


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FM III/ 33

Effects of early aspirin therapy on utero-placental hemodynamics of risk patients for preeclampsia

Author: Hofstaetter C., Züblin N., Raio L., Surbek D.Hospital: Obstetrics and Gynecology, University Hospital Bern, University Bern

Objectives: To evaluate the effects of early aspirin therapy on the mean pulsatility index of both uterine arteries (utA PI) at 1st and 2nd trimester in women at risk for preeclamp-sia (PE).

Methods: In a retrospective study of uterine artery (utA) Doppler in 315 women, 73 women with risk for PE and low dose aspirin treatment from 10 gestational weeks onwards, 124 with normal history and 118 women with present PE at admission. Data of the mean pul-satility index (PI) of both utA of the risk group and the normal group were compared at the 1st and 2nd trimester within and between the groups. Secondly the values at 2nd tri-mester were compared with the women with preeclampsia in their current pregnancy. To correlate the values of the groups, we calculated the O/E (observed and expected values) of utA PI in each patient.

Results: The mean utA PI in the aspirin group was significantly elevated at 1st trimes-ter compared to the control group (1.742 versus 1.468, p = 0.0117). At 2nd trimester the mean PI sank significantly in both groups from 1.742 to 1.156, (p < 0.0001) in the aspi-rin group and from 1.468 to 0.8961 (p < 0.0001) in the control group. The difference be-tween the groups was significant higher at 2nd trimester than at 1st trimester with 0.290 versus 0.274 (p < 0.001). The O/E ratio also sank significantly from 1.401 to 1.096 (p < 0.0001) in the aspirin group and from 1.182 to 0.783 in the control group (p < 0.0001). The difference was also significantly higher at 2nd trimester, 0.313 versus 0.219 respectively. 11 of 73 women (15.1%) in the aspirin group and 6 of 124 (4.7%) in the control group de-veloped preeclampsia, 4 early onset PE (<34.wks) and 7 late onset PE (>34.weeks), and 1 early and 5 late PE, respectively. Mean utA PI and the O/E ratio at 2nd trimester were in-creased in all PE groups, 1.454 /1.567 and 1.3270 /1.4710 in aspirin and 0.88 /1.048 and 0.8209 /0.9179 in normal group with no significant difference. However, the mean utA PI values were normal in 62 women in the aspirin group and 118 women in the control group withno PE. Whereas the mean utA PI was 1,374 and O/E-ratio was 1,286 in patients with PE at admission, significantly higher values in cases with early PE, 1.454 and 1.31 versus 1,070 and 1.024 in late PE.

Conclusions: Our study showed that early treatment with low dose aspirin was able to de-crease the elevated mean utA PI in risk patients for PE during 2nd stage of trophoblast in-vasion, reduced the recurrency of PE and prolonged the pregnancy in recurrent cases with PE.


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FM III/ 34

Validation of the Swiss Emergency Triage Scale for obstetrics and gynecology emergencies

Author: 1) Veit-Rubin N., 2) Brossard P., 1) Irion O., 3) Rutschmann O., 2) Martinez de Tejada B.Hospital: 1) Gynecology and Obstetrics, 2) Gynecology and Obstetrics, Hospital Yverdon-les-Bains, 3) Primary Care, Community and Emergency Medicine, Division of Emergency Medicine/ 1,3 University Hospital Geneva and Faculty of Medicine Geneva

Introduction: Triage is a well-established concept to cope with overcrowded emergency units. However, few available triage instruments have been sufficiently adapted to the specificities of obstetrics and gynecology (OBGYN) patients. We aimed to evaluate the re-liability of a Swiss Emergency Triage Scale (SETS) for OBGYN emergencies and to explore the factors associated with the correctness of the triage process.

Methods: We created 30 clinical vignettes with predefined emergency levels presenting the most frequent indications for OBGYN emergency consultation. These vignettes were submitted twice to nurses and midwives of the OBGYN emergency ward via a computer-ized triage simulator. Vignettes were evaluated twice to assess inter- (test phase) and in-tra-rater (re-test phase) reliability. Agreement was assessed using a two-way mixed effects intra class correlation (ICC) with its 95% confidence interval (CI). We also performed gener-alized linear mixed model with two non-nested random effects on the vignette and on the rater to evaluate the factors associated with the correct or incorrect triage.

Results: Twenty-two nurses and midwives participated in the study. Inter-rater reliabil-ity was good (ICC 0.748; 95%CI: 0.633-0.858) and intra-rater reliability almost perfect (ICC 0.812; 95%CI 0.726-0.889). We observed a wide variability in the triage process: the mean number of questions varied from 6.9 to 18.9 across individuals, and from 8.4 to 16.9 across vignettes in the test phase. Triage acuity was underestimated in 12.4%, and overestimated in 9.3% of cases. Under-triage occurred less frequently for gynecological compared to ob-stetrical vignettes (OR 0.45; IC95% 0.23-0.91, p=0.035) and decreased with the number of questions asked (OR 0.94; IC95% 0.88-0.99, p=0.047). Being certified in OBGYN emergen-cies management was an independent factor for avoiding under-triage (OR 0.35; IC95% 0.17-0.70, p=0.003).

Conclusions: Inter- and intra-rater agreement regarding the triage of obstetrics and gy-necology emergency cases using the 4-level SETS was good, suggesting that this scale is valid and could be used in routine. Reliable OBGYN triage assessment tools are needed in order to allow for an efficient triage process and for continuous training of implicated health care professionals to improve patient care and cost-control in emergency units.


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FM IV/ 40

Cervical cancer screening in sub-Saharan Africa: How many patients are eligible for cold coagulation therapy?

Author: 1) Viviano M., 2) Kenfack B., 1) Catarino R., 2) Temogne L., 2) Tincho E., 3) Tebeu P.M., 1) Meyer-Hamme U., 1,4) Benski A.C., 5) Vassilakos P., 1) Petignat P.Hospital: 1) Gynecology Division, Obstetrics and Gynecology, University Hospital Geneva, 2) Dschang District Hospital, Dschang, Cameroon, 3) Gynecology and Obstetrics, University Centre Hospital, Yaoundé, Cameroon, 4) Saint Damien Medical Center, Ambanja, Madagascar, 5) Geneva Foundation for Medical Education and Research, Geneva

Introduction: Cold coagulation has generated recent interest for the treatment of cervical intra-epithelial neoplasia (CIN) in low and medium-income countries (LMIC). The objec-tive of the present study was to determine what percentage of women having a positive screen for precancerous cervical lesions met criteria to undergo cold coagulation therapy.

Materials and methods: Between July and December 2015, women residing in the area of Dschang (Cameroon) aged between 30-49 years, were enrolled in a cervical cancer screen-ing study. HPV self-sampling was performed as a primary screening test and women who were either “HPV 16/18/45-positive” or “positive to HPV-other high-risk types and to VIA/VILI” were considered as having a positive screen, thus requiring further management. The primary outcome was to determine what percentage of patients with a positive screen met criteria for cold coagulation therapy. The secondary outcome was to evaluate the de-gree of patient discomfort, which was assessed immediately after the procedure and 1 month after it by using a pain visual analogue scale (VAS), as well as the occurrence of other self-reported symptoms.

Results: A total of 1013 women were recruited in the study period, of which 121 (12%) had had a positive screen requiring further therapy. The mean age of participants was 38.7 ± 5.3 years. Among screen-positive women, 110 (91%) were eligible and were treated by cold coagulation. No patients have discontinued treatment because of pain or others side effects. The median (range) VAS scores was 3/10 (1-8). No serious complications occurred during the procedure. Women having 1 or no children were more likely to report a higher pain score than those with more than 2 children (4.2±2.0 versus 2.9±1.5, respectively; p value=0.016). Vaginal discharge following treatment was reported in 112 (99.1%) patients, with a mean duration of 15.8 ± 8.5 days.

Conclusion: The majority of women having a positive screen met criteria for cold coagula-tion. The procedure is feasible and well-tolerated for the treatment of women with a posi-tive screen for precancerous cervical lesions in the sub-Saharan Africa context.

FM-IV/40Jahreskongress / Congrès annuel gynécologie suisse 2016Freie Mitteilungen / Communications libres

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FM IV/ 41

Performance of VIA versus VILI for triage of premalignant and malignant cervical lesions in HPV-positive women in sub-Saharan Africa

Author: 1) Urner E., 1) Delavy M., 1) Catarino R., 1) Viviano M., 2) Vassilakos P., 1) Meyer-Hamme U., 1) Benski A.C., 3) Jinoro J., 3) Heriniainasolo J., 4) De Vuyst H., 1) Petignat P.Hospital: 1) Division of Gynecology, Gynecology and Obstetrics, University Hospital Geneva, 2) Geneva Foundation for Medical Education and Research, Geneva, 3) Saint Damien Healthcare Centre, Ambanja, Madagascar, 4) International agency for Research on Cancer, WHO, Belgium

Background: Cervical cancer is one of the leading causes of women cancer-related death in low-resource countries essentially due to the lack of screening programs. The aim of our study was to compare the clinical performances of digital visual inspection with acetic acid (D-VIA) with visual inspection with Lugol’s iodine (D-VILI) for the diagnosis of prema-lignant and malignant cervical lesions.

Methods: From January to October 2015, human papillomavirus (HPV)-positive women recruited through a cervical cancer screening have had a digital cervicography as an ad-junct to VIA and VILI testing. Each woman had three images captured using a Smartphone, including native, VIA and VILI. The images were randomly coded and distributed on two different online databases (Google Forms). The D-VIA form included native&VIA images and the D-VILI form included native&VILI images. Pathological cases were defined as cer-vical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+). The prevalence of CIN2+ le-sions was 12%, corresponding to “real life” prevalence in an HPV-positive population. Phy-sicians rated the images as non-pathological or pathological. The order of the sequence (native&VIA or native&VILI) was randomly permuted. Sensitivity and specificity of D-VIA and D-VILI for each physician were calculated. The overall sensitivity and specificity were calculated by combining the results of all experts. Data were analyzed with a statistical software package (STATA 13).

Results: Five expert colposcopists (with more than 300 colposcopies performed and at least 10 years of experience) have assessed 240 digital images. Distribution of cervical dis-ease among the 120 patients was 3.3% cancer, 5.8% CIN3, 2.5% CIN2 and 3.3% CIN1. Sen-sitivity was better in the D-VIA interpretation, compared to D-VILI (SN D-VIA: 87,2 %, SN D-VILI : 66,3%, p 0.002), while specificity was higher for D-VILI (SP D-VIA : 60,4 %, SP D-VILI: 66,7 %, p 0.02). The inter-rater reliability calculated using Cohen’s Kappa with Light’s cor-rection for multiple raters was 0.36 for D-VIA and 0.25 for D-VILI.

Conclusion: Our study showed that for the triage of HPV-positive women, it was possible to detect 87% of precancerous and cancerous lesions with D-VIA, which was 20% more than with D-VILI, with a 7% lower specificity, respectively, using Smartphone images. The low Cohen’s Kappa value can be explained by the test’s high subjectivity, as well as by the presence of multiple raters.


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FM IV/ 42

Topical Botulinum-Toxin injections for provoked localized vestibulodynia: a randomized placebo-controlled trial

Author: 1) Diomande I., 2) Fehr M.K., 3) Gabriel N., 4) Kashiwagi M., 1) Ghisu G.-P., 1) Fink D., 1) Betschart C.Hospital: 1) Gynecology, University Hospital Zurich, 2) Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, 3) Obstetrics and Gynecology, Triemli Hospital Zurich, 4) Gynosense, Womens Health Center, Uster

Introduction: Provoked localized vestibulodynia (PVD) is a quality-of-life debilitating dis-order and often associated with unsatisfying treatment outcome. The use of botulinum toxin A (Botox®) for PVD has been reported previously in case studies and one random-ized trial with ambiguous results. Our aim was to evaluate two dosages of botulinum toxin A(50IE and 100IE) versus placebo injected subcutaneously in the vulvar vestibulum re-garding efficacy and safety.

Methods: Prospective, single-blind randomized, placebo-controlled study in a study pop-ulation of 32 patients using two different dosages of botulinum toxin (50 and 100 Units), or saline injection as placebo. On patients request injection of botulinum toxin A 100 units three months later was allowed (arm A, initially 50 units and 100 units at 3 months; arm B, initially 100units and 100 units at 3 months, arm C, placebo initially, 100 units botulinum toxin at 3 months and 100 units at 6 months).

Primary endpoints: evaluation of treatment efficacy by visual analogue score (VAS) at vulvar examination and pain threshold value identified by spring pressure device at base-line and at 3 month-, 6 month- or 9 month-visit as well as assessing longitudinal changes within the study arms. The secondary aims were changes in the Marinoff dyspareunia scale and patient satisfaction with the treatment.

Results: The groups did not differ significantly in baseline demographics. For the primary endpoints at three months, after having received botulinum toxin A 50 units, 100 units or placebo, groups did neither differ in the VAS at vulvar examination nor in the pain thresh-old value (p=0.899, p=0.265, respectively). The same was found at the 6-month-timepoint (p=0.485, p=0.177, respectively). The placebo arm improved significantly in the VAS at ex-amination following injection of 100 units botulinum toxin (p=0.031). For the secondary endpoints, the Marinoff dyspareunia scale at baseline, the 3- and 6 months visit didn’t dif-fer either (p=0.640, p=0.150, and p=0.362, respectively). The incidence of adverse events (AE) was similar in all three groups, no severe adverse events (SAE) occurred.

Conclusion: Our study did not reveal a significant positive effect for relatively high doses of subcutaneous botulinum toxin A injections in the treatment of PVD.


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FM IV/ 43

Obesity and recurrent vulvovaginal bacterial infections in reproductive age women

Author: Ventolini G., Hutton K., Lugo J., Mulkey A., Schlabritz-Loutsevitch N.Hospital: Obstetrics and Gynecology, Texas Tech University Health Sciences Center Permian Basin

Introduction: Obesity, the growing problem in the developed world, is associated with chronic inflammatory responses and recurrent infections. However, the data regarding the association between obesity and recurrent vulvovaginal bacterial infections (RVVBI) is sparse. The aim of this study was to fill this gap of knowledge and to determine if there any association between obesity and RVVBI among women of reproductive age.

Methods: The study was conducted at the gynecology clinics of Texas Tech University Health Sciences Center Permian Basin. Data base search was regarding patient’s BMI and history of RVVBI. Additionally, demographic and clinical data were inquired. The data base includes non-pregnant 18 to 40 years old who had history of RVVBI (n=55) and age-matched control (n=50).

Results: The BMI in the group with RVVBI history was higher than in the controls: 35±4 kg/m2 vs. 26±3kg/m2 (p<0.001). Multivariate regression analysis showed that obesity was as-sociated with RVVBI (odds ratio 4.00, 95% confidence interval 3.1-4.52 (p=0.001).

Conclusion: Obesity might be an independent risk factor of RVVBI.


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FM IV/ 44

Preclinical evaluation of the cyclin-dependent kinase 2 inhibitor NU6102 for the treatment of cyclin E1 amplified high-grade serous ovarian cancer

Author: 1,2) Lang F.M., 1) Au-Yeung G., 1) Mitchell C., 1) Azar W., 3) Wedge S.R., 3) Newell D.R., 1) Etemadmoghadam D., 1) Bowtell D.D.L.Hospital: 1) Peter MacCallum Cancer Centre, Melbourne, 2) Gynecology, University Hospital Zurich, 3) Northern Institute for Cancer Research, Newcastle University

Amplification of cyclin E1 (CCNE1) is a marker of primary treatment failure and poor overall survival in high-grade serous ovarian cancer (HGSC). Given that CCNE1 amplification and BRCA1/2 mutation are mutually exclusive and CCNE1 amplified tumours lack evidence of a HR defect, patients with these tumours are unlikely to respond to PARP inhibitors or stan-dard platinum-based therapy. It is therefore very important to identify new approaches to treat this group of patients. Therapeutically, CCNE1’s key partner protein, CDK2, emerges as one of the most promising targets due to its central role as regulator of cell division and its druggability. We have previously demonstrated that CDK2 inhibition, using an induc-ible shRNA system phenocopies CCNE1 knockdown and is selectively active in cells with CCNE1 amplification. Currently several small molecule CDK inhibitors are in preclinical and clinical development. Generally these compounds, however, have a broad-spectrum CDK inhibitory activity (incl. CDK7 and CDK9), which has been associated with significant dose-limiting toxicity in patients. We evaluate if a highly CDK2-selective small molecule inhibitor, NU6102, offers an increased therapeutic index over that seen with broad-spec-trum CDK inhibitors when targeting CCNE1-amplified HGSC.

Methods: We performed short-term proliferation (MTS) and long-term clonogenic sur-vival assays in vitro on three CCNE1 amplified and two non-amplified HGSC cell lines to ex-amine the relative sensitivity of these cell lines against NU6102 by their CCNE1 amplifica-tion status. Additionally, we assessed the effect of NU6102 on CDK2 downstream targets and on apoptosis via Western blot.

Results: We did not demonstrate any significant difference in CCNE1 amplicon-de-pendent sensitivity by MTS in vitro (CCNE1 amplified HGSC cell line mean IC50 value: 5.64±1.66µmol/L, non-amplified cell lines: 3.33±0.09µmol/L). The IC50 values were similar in the long-term clonogenic survival assays. To validate the on target effects of NU6102 we confirmed that treatment with NU6102 was associated with decreased phosphorylation of a CDK2 target, Rb, and apoptosis as assessed by PARP cleavage.

Conclusion: Although NU6102 shows cytotoxicity against the tested cells, we could not observe CCNE1 amplicon–dependent sensitivity in HGSC cell lines. Failure of NU6102 to replicate the results of knockdown of CDK2 expression may reflect off-target activity of NU6102 or kinase-independent activities of the CDK2/cyclinE1 complex in CCNE1 ampli-fied cells.


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FM V/ 50

Interferon-gamma response in human peripheral blood mononuclear cells upon stimulation with Waddlia chondrophila, an emerging bacterium associated with adverse pregnancy outcomes

Author: 1,2) Ammerdorffer A., 1,2) Gyger J., 1,2) Stojanov M., 1,2) Baud D.Hospital: 1) Materno-fetal and Obstetrics Research Unit, Department “Femme-Mère-enfant”, Maternity, 2) Institute of Microbiology, Faculty of Biology/ 1-2 University Hospital Lausanne

Introduction: Waddlia chondrophila, an emerging intracellular bacterium belonging to the order of Chlamydiales, is associated with miscarriages in woman as supported by the presence of anti- Waddlia antibodies. Moreover, Waddlia was identified by PCR and immu-nohistochemistry both in the genital tract and placenta of women with miscarriages. Re-cently, our group revealed that Waddlia induces systemic infection, organ pathology and elicits Th1-associated humoral immunity in a murine model of genital infection. So far, however, little is known how Waddlia infection spreads, elicits an immune response, and induces pathology in humans. With this current study, we investigated the ability of Wad-dlia to induce an interferon-gamma (IFN-γ) response in human peripheral blood mononu-clear cells (PBMCs).

Material and methods: PBMCs from healthy individuals were isolated from fresh EDTA blood and stimulated with medium only, live Waddlia (MOI of 1, 10 or 100), heat killed Waddlia (30 minutes at 56⁰C or 99⁰C) and PHA as positive control. Samples were incubated at 37⁰C for several time points (from 24h till 7 days) and the supernatant was used to mea-sure IFN-γ production by ELISA.

Results: The preliminary results show that PBMCs stimulated with live Waddlia show a proper IFN-γ response. A dose-response is observed, however, stimulation of PBMCs with a MOI of 10 already induced a good IFN-γ response. The time course revealed that after 24-48h of stimulation, IFN-γ production increased and reached its peak as well. Heat inactiva-tion of the bacterium led to lower IFN-γ production.

Conclusion: The current study shows that Waddlia elicits a Th1-associated immune re-sponse in human, as it induces an IFN-γ response in PBMCs. An interesting future question is whether pregnant women, in particular those with a positive Waddlia serology and mis-carriage, show the same immune response against Waddlia as pregnant women with term delivery or non pregnant women.

FM-V/50Jahreskongress / Congrès annuel gynécologie suisse 2016Freie Mitteilungen / Communications libres

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FM V/ 51

Vitamin D in early pregnancy – differences by skin color

Author: 1) Quack Lötscher K., 2) Richard A., 2) Rohrmann S.Hospital: 1) Obstetrics, University Hospital Zurich, 2) Epidemiology, Biostatistics and Prevention Institute, University Zurich

Introduction: The clinical consequences of vitamin D insufficiency in pregnancy range from negative influence on glucose tolerance, association with preeclampsia to improve-ment of birth weight by vitamin D supplementation in certain ethnic groups. The goal in this study was therefore to evaluate the prevalence of vitamin D deficiency (< 20 µg/l) in early pregnancy. The hypothesis was that women of darker skin color have a lower vitamin D level than women with a lighter skin.

Material and methods: Women in the Geburtshilfliche Poliklinik at the University Hos-pital Zurich were recruited for blood sampling between September 2014 and December 2015. Blood was taken at the first regular pregnancy visit for testing 25(OH) vitamin D and skin type was self-reported on the Fitzpatrick Scale (5-point scale). The Fitzpatrick Scale includes appearance and reaction to sun exposure. Mann-Whitney-U Test was performed comparing the difference in 25(OH) vitamin D levels by skin type.

Results: 205 women agreed to participate and the blood was collected between 6 and 14 weeks of pregnancy. The prevalence of 25(OH) vitamin D deficiency in all women was 63%. Comparing prevalence by skin type, 55% of women with light skin type (Fitzpatrick 1,2+3; n=152) had a vitamin D deficiency, whereas 83% of women with dark skin type (Fitzpatrick 4+5; n=52) had a vitamin D deficiency. The median level of 25(OH) vitamin D overall was 17.1 µg/l (Q1, Q3: 9.75-22.3 µg/l). Women with light colored skin had on average 18.4 µg/l (Q1, Q3: 10.8-24.0 µg/l) 25(OH) vitamin D, where as women with dark colored skin had 12.3 µg/l (Q1, Q3: 6.55-18.6 µg/l) (p<0.05).

Conclusion: Almost 2/3 of all women had a vitamin D deficiency. We found a difference in 25(OH) vitamin D levels and prevalence depending on maternal skin type emphasizing a consequent screening program for mothers with darker skin type.


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FM V/ 52

The induction of labor with balloon catheter after a previous caesarean section, a retrospective cohort study

Author: Radan A-P., Mueller M., Surbek D.Hospital: Obstetrics and Gynecology, University Hospital Bern

Introduction: Induction of labor on a scarred uterus is a challenge for obstetricians all over the world and requires both effective and safe methods.

Material and methods: We included in our retrospective study 190 women with a previ-ous cesarean section (CS). All pregnancies with lethal congenital anomalies, antepartum intrauterine fetal demise as well as patients with additional surgery of the uterus were ex-cluded. As a primary outcome we compared the rate of vaginal deliveries between the two groups. Furthermore we analyzed the impact of prior vaginal delivery on the delivery mode. As secondary outcomes we evaluated the rate of maternal complications as well as the fetal status defined through specific parameters (APGAR score after 5 minutes, arterial pH values, neonatal admission after birth).

Results: In our cohort, labor was induced by using a balloon catheter device in 59.47% (n=113) and by using oxytocin in 40.53% (n=77) of the cases. The vaginal delivery rate reached 38.93% (44/113) in the catheter group and a significantly higher 63.63% (49/77) in the oxytocin group. Successful vaginal delivery after previous vaginal delivery was also significantly higher in the oxytocin group vs the catheter group (86.36% (19/22) vs 50% (12/24), p< 0.05). We detected no difference between uterine rupture rates in both groups: the incomplete rupture rate reached 4.42% (5/113) in the catheter group and 0% (0/77) in the oxytocin group (p=0.06). The complete uterine rupture rate reached 0.88% (1/113) in the catheter group vs 1.29% (1/77) in the oxytocin group (p=0.07). Regarding the fetal out-come 27.43 % (31/113) of the newborns in the catheter group needed a neonatal admis-sion after birth vs. a significantly lower 14.28% (11/77) in the oxytocin group.

Conclusions: Induction of labor with oxytocin is a safe method for the scarred uterus and a good alternative to primary CS, when applied on a favorable cervix. Induction with balloon catheter is just as safe, though associated with lower rates of vaginal deliveries and higher rates of assisted vaginal deliveries. Prior vaginal delivery had no influence on the outcome of the current pregnancy when inducing with catheter, but increased the chances for a new vaginal delivery when using oxytocin. Neonatal admission after birth was significantly higher when inducing with catheter than with oxytocin. Given the risk of uterine rupture after CS adequate methods of detecting weak lower uterine segment prior to labor induction are desperately needed.


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FM V/ 53

Two years of first trimester preeclampsia screening: a single centre experience

Author: 1) Mosimann B., 1) Amylidi-Mohr S., 1) Zdanowicz J., 1) Baumann M., 2) Risch L., 1) Surbek D., 1) Raio L.Hospital: 1) Obstetrics and Gynecology, University Hospital Bern, 2) Labormedizinisches Zentrum Dr. Risch, Bern

Introduction: Universal preeclampsia (PE) screening and aspirin (ASS) prophylaxis is still a matter of debate. NICE (National Institute of clinical excellence) proposes a history based screening: high-risk criteria are chronic kidney disease, hypertension, diabetes type 1, SLE, APS or a history of PE; low risk criteria are primiparity, age >40 years, BMI >35, positive family history for PE and multiple pregnancies. ASS is indicated if one high-risk or two low-risk criteria are present. The Fetal Medicine Foundation (FMF) London introduced a screening between 11+0 to 13+6 weeks based on maternal history, mean arterial pressure (MAP), uterine artery Doppler (UtA-PI), and PAPP-A and PlGF. A risk of >1:50 for PE before 37 weeks is considered high risk. The aim of this study is to present our experience of the last two years of PE-screening and compare the two methods.

Material and methods: PE screening was offered to all women reaching our hospital for first trimester aneuploidy screening according to the FMF guidelines. UtA-PI was assessed by FMF-certified sonographers, MAP is assessed with UEBE Visiomat comfort in a stan-dardised way, PAPP-A and PlGF are measured on Kryptor from Brahms.

Results: 1020 women were screened and pregnancy outcome is available of 512 cases. Overall, 6 (0.6%) women had diabetes, 17 (1.7%) chronic hypertension, 31 (3.0%) a his-tory of PE, 6 (0.6%) SLE or APS and 12 (1.2%) a family history of PE. The median MAP-MoM is 1.002, the UtA-PI-MoM 0.953 and the PlGF-MoM is 0.979. 8 of 512 (1.6%) women devel-oped PE, 4 before 37 weeks. 59 of 512 (11.5%) women are at risk according to NICE, 3 of the 8 PE’s (all before 37 weeks) were detected by screening according to NICE. On the other hand 46 of 512 (9.0%) women had a risk of >1:50 before 37 weeks. Using the FMF algo-rhythm and considering a risk of >1:50 before 37 weeks, 4 of 4 preterm PE’s were detected as well as 1 of 4 term pregnancies.

Conclusion: Our data show that screening for PE at the first trimester is feasible and our results are in the expected range. Screening by FMF has a higher detection rate and a lower false-positive rate than screening according to NICE in our collective. The incidence of PE in our collective is low, probably as a result of prescribing low-dose aspirin to women at risk for PE according to NICE as well as FMF.


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FM V/ 54

Heterogeneity in testing practice for infectious diseases during pregnancy- National survey across Switzerland

Author: 1) Aebi-Popp K., 2) Kahlert C., 1) Rauch A., 3) Mosimann B., 4) Baud D., 5) Low N., 3) Surbek D.Hospital: 1) Infectious Diseases, University Hospital Bern, University of Bern, 2) Children’s Hospital of Eastern Switzerland, St. Gallen, 3) Obstetrics and Gynaecology, University Hospital Bern, 4) Obstetrics, University Hospital Lausanne, 5) Institute of Social and Preventive Medicine ISPM, University of Bern

Introduction: Detection and treatment of infections during pregnancy are important for both maternal and child health. The objective of this study was to describe testing practi-ces and adherence to national guidelines in Switzerland.

Methods: We invited all registered practicing obstetricians and gynecologists in Switzer-land to complete an anonymous web-based questionnaire about strategies for testing for 14 infections during pregnancy. We conducted a descriptive analysis according to demo-graphic characteristics.

Results: Of 1138 invited clinicians, 537 (47.2%) responded and 520 (45.6%) were currently caring for pregnant women. Only 94/515 (18.3%) of the respondents evaluated sexual his-tory of all their patients during antenatal care. Nearly all respondents tested all pregnant women for group B streptococcus (98.0%), hepatitis B (HBV) (96.5%) and human immuno-deficiency virus (HIV) (94.7%), in accordance with national guidelines. Although testing for toxoplasmosis is not recommended, 24.1% of respondents tested all women and 32.9% tested at the request of the patient. Hospital doctors were more likely not to test for toxo-plasmosis than doctors working in private practice (OR 2.52, 1.04-6.13 p=0.04). Only 80.4% of respondents tested all women for syphilis. There were regional differences in testing for some infections. The proportion of clinicians testing all women for HIV, HBV and syphilis, was lower in Eastern Switzerland and Zurich region (69.4% and 61.2% respectively) than in other regions (range 77.1% to 88.1%, p< 0.001). Most respondents (74.5%) said they would appreciate national guidelines about testing for infections during pregnancy.

Conclusions: Testing practices for infections in pregnant women vary widely in Switzer-land. National guidelines could improve consistency of testing practices.


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FM VI/ 60

How effective is Bulkamid in mixed urinary incontinence?

Author: 1) Villiger A., 1) Mohr S., 1) Marthaler C., 2) Monga A., 2) Soheil S., 1) Mueller M.D., 1) Kuhn A.Hospital: 1) Obstetrics and Gynecology, University Hospital Bern and University Bern, 2) Princess Anne Hospital, Southhampton, U.K.

Introduction: Mixed urinary incontinence is a difficult urogynaecologic entity with thor-ough therapeutic challenges. Aim of this prospective study is to determine efficacy and safety of Bulkamid in patients with mixed urinary incontinence. Short-term data were pre-sented at the SGGG 2015.

Patients and methods: Patients who suffered from mixed urinary incontinence within the ranges of 60:40 either side were included in this two-centre study. Ethical consent was obtained. Primary endpoint of this study was the domain “incontinence impact” of the King’s Health Questionnaire, a validated instrument to determine quality of life in in-continent patients. Secondary endpoint were the remaining domains of the King’s Health questionnaire general health, role limitations, physical and personal limitations, emotions, and sleep. Additionally, patients were asked to rate the bother caused by incontinence ap-plying the Visual analogue Scale (VAS) answering the question: ”How much bother does incontinence cause for you?” with 0 being the least bother and 10 the most imaginable bother. A pad test according to ICS regulations and multichannel urodynamics were per-formed. Side-effects were noted and follow-up took place after three and twelve months.

Results: Onehundredsixtynine patients were included aged between 43-91 years, me-dian 67 with a parity of two in median (range 0-5). After three months there was a sig-nificant improvement of the domains incontinence impact (<0.01), general health (0.01) and personal limitations (<0.01). VAS improved from 8.5 to 4.5 in median (<0.001) and Pad test improved significantly (<0.01). So far 81 patients were seen for 12 months follow-up when the improvements of incontinence impact, general health and personal limitations remained stable. Additionally, sleep did improve significantly (p<0.01). Side effects ap-peared as urinary tract infection (n=5), urinary retention lasting >36 hours (n=2) and pain (n=3).

Discussion: Bulkamid® appears to be an effective and safe implant for mixed urinary in-continence. The improvement of sleep at 12 months follow-up may be related to improv-ing urinary frequency and urgency resulting in an undisturbed sleep. The combination of patient reported outcomes using validated instruments and objective tests support ro-bust evidence of the validity of bulking in mixed urinary incontinence.

FM-VI/60Jahreskongress / Congrès annuel gynécologie suisse 2016Freie Mitteilungen / Communications libres

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FM VI/ 61

Intra-rectal pressure recordings during second phase of labor in primiparae: Is it useful for preventing post-delivery pelvic floor complaints?

Author: 1) Meyer S., 2) Baud D., 2) Hohfeld P., 2) Vial Y., 3) Salchli F., 1) Achtari C.Hospital: 1) Urogynecology, 2) Obstetric, 3) Micro-nanotechnology, HEIG, Yverdon/ 1,2 University Hospital Lausanne

Introduction: The aim of this research was to develop a technique for preventing the Birth Trauma effect using microsystems able to record intra-rectal pressure parameters during bearing efforts of the second phase of labor and to study their correlations with pelvic floor (PF) post-delivery complaints in a group of nulliparae women.

Methods: following parameters were measured in 60 nulliparae women (43 spontaneous deliveries, 17 outlet- forceps-assisted deliveries): duration of bearing efforts, surface area under pressure curve and peak pressure during bearing efforts (43 spontaneous deliver-ies, 17 outlet- forceps-assisted deliveries). PF functions complaints were assessed using ICS validated questionnaires, before delivery and 14 ± 6 months after delivery.

Results: 1.- Pelvic floor complaints are not significantly different when comparing sponta-neously delivered women to outlet forceps-assisted delivery women, 2.- Duration of first and second phase of labor are longer in the outlet-forceps group (first phase : 314± 112 vs 256 ± 107 min P:0.07, second phase : 52± 21 vs 39.9± 26 min, P:0.06), 2.- Duration, surface area under pressure curve and peak pressure during bearing efforts are not correlated with baby’s weight or mode of delivery. 3.- Duration of bearing efforts is significantly correlated with difficulties for voiding (R: 0.34, p: 0.03) and lower abdominal discomfort (R: 0.44, p: 0.004) in spontaneous delivered women only. 4.- Surface area under pressure curve is sig-nificantly correlated with feeling of urgency to void (R: 0,524, p: 031), urge incontinence (R: 0,482, p: 0,05) , drops escape (R: 0.54,P: 0 .025), frequency of orgasm (R: 0,526, p: 0.036) and difficulties for reaching orgasm (R: 0.613, p:0,012) in outlet-forceps-delivered women only. 5.- Peak pressures values show no significant correlations with PF dysfunctions,

Conclusions: intra-rectal pressures parameters recorded during second phase of labor in primiparae show no significant correlations with obstetrics parameters but significant correlations with some urinary and sexual pelvic floor complaints 14 months after sponta-neous and outlet- forceps-assisted deliveries. As there are no differences in PF complaints between spontaneous and outlet forceps-assisted deliveries, the highest number of sig-nificant correlations in the outlet-forceps group is probably due to the longer first and sec-ond phase of labor.


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FM VI/ 62

The association between joint hypermobility and pelvic organ prolapse in women: Situation in Switzerland and systematic review with meta-analysis

Author: 1,2) Veit-Rubin N., 1) Di Serio M., 2) Cartwright R., 2) Khullar V., 1) Mathevet P., 1) Achtari C.Hospital: 1) Urogynecology, University Hospital Lausanne, 2) Urogynecology, Imperial College London, United Kingdom

Introduction: Pelvic organ prolapse (POP) is a common problem affecting up to 50 % of parous women. Prevalence estimates of joint hypermobility (JHM) vary widely depending on the population and diagnostic criteria. In the largest available population representa-tive sample, the prevalence was 22%, but estimates have ranged from 0.5% to 43.5%. Ab-normalities of the common collagen proteins have been noted in individuals affected by POP and joint JHM, suggesting a common aetiology. We assessed the strength, consis-tency and potential for bias in pooled associations of the relationship between JHM and POP.

Methods: We searched Medline, EMBASE and CINAHL as well as ICS and IUGA annual meeting abstracts including reference lists without language restrictions. We included case-control and cohort studies and applied strict criteria to choose eligible studies. Meth-odologically trained reviewers independently screened abstracts and full texts to confirm eligibility. We extracted data on study and patient characteristics, clinical assessment tools and methodology. We assessed comparability and representativeness of source popula-tions, confidence in the assessment of JHM and POP and adjustment for confounding and missing data. Meta-analysis was performed using a random effects model.

Results: We retrieved 39 full texts of which 14 were included in a meta-analysis. The over-all pooled OR was 2.37 (95%CI 1.54-3.64, I2=77.0%). We did not identify significant factors in meta-regression. There was no evidence of publication bias and 6 studies were at high risk of bias with frequent differences in sampling frames, limited validity for clinical assess-ments and failure to match for important prognostic variables.

Conclusions: We found a strong association between POP and JHM, with an effect size that is clinically relevant. Our findings are limited by high heterogeneity and the potential for residual confounding. JHM is an important indicator for POP although future longitu-dinal studies should explore the shared aetiology.


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FM VI/ 63

Sexual function and clinical outcome after urethral diverticulum resection: Resection leads to satisfaction

Author: 1) Mohr S., 1) Taghavi K., 2) Nowakowski L., 1) Mueller M.D., 1) Brandner S., 1) Kuhn A.Hospital: 1) Obstetrics and Gynecology, University Hospital Bern and University Bern, 2) 2nd Department of Gynecology, Medical University, Poland

Introduction: Urethral diverticulae (UD) are a rare condition with an incidence of 20 per 1.000.000 women per year. The classical triad of symptoms are dysuria, dyspareunia and dribble and all three symptoms can be found in 23%, none of them in another 23% and dyspareunia in 56%. Further symptoms comprise urinary urgency and frequency in 60% and common findings are a tender anterior vaginal wall mass (88%) and urethral discharge (40%). Diagnosis is challenging and frequently delayed due to a wide spectre of symptoms and UD may mimic other pathologies. Imaging modalities comprise conventional voiding cystourethrography, (3D) sonography, computed tomography, CT voiding cystourethrog-raphy and particularly MRI which yields best diagnostic results. Surgical excision is the de-finitive treatment of UD. The aim of our study was to evaluate sexual function and clinical outcome in our UD patients.

Material and methods: All patients who were referred for suspected UD were asked to participate in this study between 2003 and 2014. Primary endpoint of the study was the domain “pain” of the FSFI, secondary endpoints the other domains of the FSFI, clinical out-come and continence status as well as urodynamic parameters. All patients had MRI im-aging to verify the preoperative diagnosis of UD. Hospitalization time, operating time and follow-up were determined. Multichannel urodynamic testing was performed pre- and postoperatively.

Results: Forty patients were included in this study. Preoperative symptoms were dribbling, infection, both dribbling and infection, dyspareunia, feeling of resid-ual, hematuria, spraying stream, and pain. The primary endpoint pain improved sig-nificantly (<0.01) after surgery, and overall sexual function improved as well. Postop-erative problems occurred in 10% and were as follows: stress urinary incontinence (n=1), urothelial carcinoma requiring pelvic exenteration (n=1), neuroendocrino-logic tumor requiring radio-chemotherapy (n=1), and stricture requiring dilation (n=1). MUCP deteriorated and residual urine significantly after surgery but without clinical sig-nificance. Sexual function globally improved postoperatively.

Discussion: Urethral diverticula are frequently diagnosed with delay while surgical treatment improves symptoms and sexual funciton. The rate of 5% malignant tumors in post-operative histology results warrants careful evaluation of each patient.


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FM VI/ 64

Accuracy of clinical diagnosis of anal sphincter defect: clinical evaluation vs 3D- transperineal ultrasound (3D-TPUS)

Author: Capanna F., Kimmich N., Haslinger C., Kreft M., Wisser J.Hospital: Obstetrics, University Hospital Zurich

Objective: Obstetric anal sphincter injury (OASIS) occurs in 0.4-7.5% of vaginal delivery and may predispose to the development of anal incontinence, whether in the immedi-ate postpartum period or later in life. Recognition of OASIS has resulted in the develop-ment and introduction into clinical practice of imaging techniques such as endoanal ultra-sonography, transvaginal two-dimensional ultrasonography and translabial/transperineal three-dimensional ultrasound (3DUS). The 3D-transperineal ultrasound (3D-TPUS) can be used to examine the pelvic floor anatomy after childbirth and has the advantage of exami-ning the undistended organ in the functional setting. The aim of this study was to evalu-ate and compare the accuracy of clinical diagnosed third degree sphincter tears with the ultrasound diagnosis.

Methods: This is a retrospective observational study. Between January 2010 and Decem-ber 2015, 8779 women delivered spontaneously. During this period 119 patients (1.4%) with third degree obstetric anal sphincter tears were diagnosed and treated. In 85 women, to ensure quality control, we evaluated the pelvic floor with 3D-transperineal ultrasound (3D-TPUS) within 3-7 days post-delivery.

Results: The mean age was 31 years, the gestational age was 40 +2 weeks and the ave-rage birth weight was 3526 g. In 16 patients with clinically diagnosed third-degree peri-neal tears Grade a and b, the ultrasound examination confirmed the lesion of the external anal sphincter (EAS) muscle, but in 9 patients (56% of the cases) we found a lesion of the internal anal sphincter (IAS) muscle, missed by clinical examination. In the remaining 69 patients with the third-degree perineal tears Grade c, the ultrasound examination confir-med both lesions (EAS and IAS muscles) in 56 women, but in 13 patients (19% of the cases) defects of the IAS muscle could not be confirmed by the ultrasound.

Conclusions: Recognition of intrapartum anal sphincter damage is difficult and crucial for the identification of candidates for surgical repair. The under classification of sphincter tears 3a/3b and the over classification of Grade 3c tears is due to the complex anatomy of anal sphincter structure. For visualizing this region, 3D-TPUS has emerged as a procedure that is relatively easy to perform, cost-effective and available in all the delivery rooms. There is no doubt that a combined use of clinical and ultrasound knowledge can improve the possibility to find a gold standard in the diagnosis of OASIS.


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Posterpräsentation und AusstellungPrésentation de poster et expositionP I – P VI = Posterpräsentation/ Présentation de poster

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P I/ 10

Multiple Intranasal Administration of Wharton’s Jelly Mesenchymal Stem Cells Is Neuroprotective in a Model of Preterm Brain Injury in Rats

Author: 1,2) Oppliger B., 1) Jörger-Messerli M., 1) Mueller M., 1) Reinhart U., 1) Schneider P., 1) Schoeberlein A., 1) Surbek D.Hospital: 1) Obstetrics and Gynecology and Clinical Research, 2) Graduate School for Cellular and Biomedical Sciences (GCB)/ 1,2 University Bern

Lately, there has been a significant increase in preterm-specific brain injuries that still re-main an unresolved clinical issue. The majority of the infants born preterm with brain in-juries develop non-csystic, diffuse white matter injury (WMI), characterized by an overall hypomyelination of the brain. Preterm brain injury is an important cause for long-term dis-ability. To date, no cure has been found to treat such lesions. Intranasal delivery of Whar-ton’s jelly mesenchymal stem cells (WJ-MSC) might be the ideal therapeutic approach to restore the damaged brain. Therefore our goal is to find an ideal treatment regimen of in-tranasal delivered WJ-MSC to achieve a maximum recovery after brain injury.

3 μl drops containing WJ-MSC (84’000 cells/μl) were delivered intranasally twice to each nostril making a total of 12 μl (1*106 cells) to Wistar rat pups that were previously brain-damaged. Rat pups received either one, two or three treatments, at two days inter-vals. Animals were sacrificed 7 days after the application of the cells. After fixation of the brains, several immunohistochemical analyses followed. Additionally, RNA was extracted to perform real-time PCR analysis.

Treatment with WJ-MSC increased myelination and decreased astro- and microgliosis. Re-peated intranasal delivery seemed not to be more effective than single treatment as as-sessed by immunohistochemistry. However, multiple administrations increased the ex-pression of brain-derived neurotrophic factor (Bdnf ) compared to single administration.

In conclusion, intranasal delivery of WJ-MSC to the newborn brain after preterm brain dam-age has a neuroregenerative potential probably mediated by a decreased astro and mi-crogliosis and an increased expression of important neurotrophic factors like Bdnf. Further studies should perform behavioral experiments to see how functional outcome might be improved by treatment with WJ-MSC. If the positive effect might be confirmed, intranasal delivery of stem cells to the brain may be the preferred method for stem cell treatment of perinatal brain damage.

Jahreskongress / Congrès annuel gynécologie suisse 2016 Posterpräsentationen / Présentation des poster P-I/10

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P I/ 11

Influence of pre-pregnancy BMI on gestational outcome: a retrospective study

Author: Ruf K., Fischer T., von Perbandt E., Hornung R.Hospital: Obstetrics, Cantonal Hospital St. Gallen

Introduction: Analyse the association between pre-pregnancy BMI and different items of gestational outcome.

Materials and methods: A retrospective study of 15’074 patients delivering at a Swiss pe-rinatal centre including 1’046 obese patients with a BMI >30.0 (8,6%) and 12’855 with a BMI between 18.5-29.9 from 2005 to 2015. Following items were analysed: mode of deli-very, gestational age, gestational weight and pregnancy complications.

Results: Pre-existing obesity has an impact on the mode of delivery. Especially obese pri-miparous have a higher risk for a secondary C-section than normal weight primiparous (OR 2.16). There is a higher risk for macrosomia (OR 1.84). Obese women have a higher risk of developing gestational diabetes (OR 4.87) and pregnancy induced hypertonia (OR 5.82). There is no difference in the rate of premature birth.

Conclusion: Both primiparous and multiparous should be motivated to attain a normal BMI before pregnancy. In addition to all other negative impacts of obesity young women should be informed of the risks associated with gestational outcomes. Pregnant women with a BMI > 30.0 should be motivated to prevent a gain of weight > 8kg.


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P I/ 12

Influenza Vaccination Coverage of Health Care Workers: A Cross-Sectional Study Based on Data from a Swiss Women’s Hospital

Author: von Perbandt E., Hornung R., Thanner M.Hospital: Obstetrics and Gynecology, Cantonal Hospital St. Gallen

Background: The vaccination has been recommended for healthcare workers (HCWs) as a strategy for preventing influenza for patients at risk. The aims of this study were to in-vestigate the influenza vaccination rate of HCWs, investigate possible motivations for and against the influenza vaccination in the minds of HCWs and describe possible strategies to promote the influenza vaccination in a non-mandatory setting.

Methods: In July 2015 a cross-sectional study was carried out to investigate the influenza vaccination rates of all staff members of a gynecological hospital in Switzerland (n=259). Socio-demographic characteristics of HCWs among those vaccinated and not vaccinated were compared using descriptive statistics.

Results: 200 questionnaires were included into the study (valid response rate 77%). 15% reported being vaccinated against influenza (n=29). Leading motivations of staff members to get vaccinated were the belief in protection of patients (82%), oneself (75%) or family (61%) through the influenza vaccination. 86% reported not being vaccinated against influ-enza (n=171). Main motivations for staff members not getting vaccinated included beliefs that the vaccine was not important (49%) or ineffective (44%). In the logistic regression analysis, the vaccination coverage among doctors (61% vaccinated) and nurses/midwives (4% vaccinated) was found different from that of the non-medical staff reference category (16% vaccinated; p=0.004, p=0.027), after controlling for the effect of other variables such as sex (p=0.807), age (p=0.438), full time employment (p=0.298).

Discussion: This study showed that doctors have a higher vaccination rate compared to other professions in this hospital, whereas nurses and midwives had very low vacci-nation rates. A sizeable proportion of nurses and midwives declined the influenza vacci-nation, which indicates a significant public health communication gap that needs to be addressed. In the present study, the following measures could be promising: improving accessibility and increasing awareness of the free offer of the influenza vaccination in this hospital; increasing vaccination knowledge tailored to the target professions (midwives, nurses and student/interns) and using the hospitals’ peer group-leaders to set an example to increase influenza vaccination coverage.


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P I/ 13

Changes in prenatal care after the introduction of insurance coverage for noninvasive prenatal testing (NIPT)

Author: Vinante V., Keller B., Hösli I., Lapaire O., Manegold-Brauer G.Hospital: Ultrasound Unit, Gynecology and Obstetrics, University Hospital Basel

Objectives: Prenatal care has been significantly influenced by the introduction of nonin-vasive prenatal testing (NIPT) for aneuploidies in 2012. In our previous study we observed a notable increase of prenatal testing after the implementation of NIPT. In Switzerland starting from July 15th 2015 the National insurance companies cover NIPT as a second line screening for women who are at an intermediate or high risk for fetal autosomal an-euploidies after the results of first trimester screening (FTS). The aim of this study was to describe the changes in prenatal testing after the integration of NIPT into national health care plans.

Methods: We performed a retrospective analysis including all women with singleton pregnancies who presented for FTS between July 2014 and December 2015. After FTS the women where categorized into three risk categories: low risk for aneuploidy (<1:1000), in-termediate risk (1:1000-1:100) and high risk (>1:100). All women had standardized prena-tal counselling before and after FTS. We assessed the decision on prenatal testing accord-ing to risk category. The year before, and 6 months after the introduction of insurance coverage were evaluated.

Results: In total 887 women were included. 573 FTS were carried out before the intro-duction of insurance coverage for NIPT (group 1) and 314 after (group 2). In group 1, 9% (53/573) had NIPT as compared to 22.9% (72/314) in group 2. Before insurance coverage, 25.0% of the women (7/28) in the high risk category, 20.5% (22/107) in the intermediate risk category and 5.4% (24/437) in the low risk category opted for NIPT. In group 2 NIPT was chosen by 52.3% (11/21) of the high risk patients, by 72.4% (42/58) of women with an intermediate risk and by 8.0% (19/235) of women with a low risk after FTS. Considering the high risk category, the number of invasive prenatal test decreased by 5,7%. 81,8% (9/11) of the women with a high risk who chose NIPT had a normal ultrasound exam. Within the high and intermediate risk category the number of NIPT test carried out by women with a public insurance increased by 29,8% and by 21,6%.

Discussion: We observed a notable increase of NIPT and a further decrease of invasive procedures after the introduction of insurance coverage for NIPT for women at interme-diate and high risk of aneuploidies after FTS. The greatest NIPT increase was within the in-termediate risk category. Invasive procedures are now are mostly chosen in the presence of abnormal ultrasound findings.


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P I/ 14

Influence of newborn head circumference and birth weight on the delivery modus of primipara: what is more important?

Author: Bartkute K., Balsyte D., Burkhardt T., Kurmanavicius J.Hospital: Obstetrics, University Hospital Zurich

Introduction: The elevated risk of operative vaginal delivery and unplanned Cesarean Section (CS) due to fetal macrosomia has been studied widely. However, it has been mostly focused on the estimated fetal and birth weight (BW) and only few studies analyzed the influence of the head circumference (HC) of the newborn. The aim of this study was to an-alyze the impact of neonatal HC alone and in combination with BW on the delivery mode of term, primiparous women.

Material and methods: In this retrospective study the data of 7708 primiparous women with delivery at term (37-42 weeks) were used to analyze the probability of an opera-tive vaginal delivery or unplanned CS regarding BW and HC. Based on these two param-eters four groups were created: HC<36 cm/BW<4000g, HC≥36cm/BW<4000g, HC<36cm/BW≥4000g, HC≥36 cm/BW≥4000g.

Results: The overall rate of operative vaginal delivery was 18.5% and unplanned CS 21.4%. The highest probability of an unplanned CS was in the group of HC≥36 cm/BW≥4000g; OR 2.06 (1.67-2.55, 95% CI). In the group HC<36 cm/BW≥4000g the probability of an un-planned CS was lower, OR 1.68 (1.20-2.34, 95% CI). The HC ≥36cm increases the probabil-ity of an operative vaginal delivery irrespective of birthweight ≥4000g or <4000g; OR 1.45 (1.28-1.65, 95% CI).

Conclusion: The risk for an operative vaginal delivery is increased due to HC ≥36cm, but not due to fetal macrosomia. The highest rate of unplanned CS was found in in pregnan-cies with a macrosomic infant (BW≥4000g) in combination with a HC≥36cm. It seems that not only macrosomia but also HC is an important factor for the prognosis of operative vag-inal delivery or CS in term pregnancies.


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P I/ 15

Bonding during elective c-section at term

Author: Knabenhans M., Spielmann C., Offel S., Todesco Bernasconi M.Hospital: Obstetrics and Perinatal Medicine, Cantonal Hospital Aarau

Introduction: An immediate skin-to-skin contact between mother and child after vag-inal delivery (bonding) is usual and known to be beneficial for both mother and child. Cardio-respiratory stability, better temperature and blood sugar regulation as well as de-creased susceptibility for asthma, diabetes, heart- and autoimmun-disease in future life are some of the advantages for the child. Concerning the mother bonding is associated with less mood-disturbances in the early post-partum period and with a positive effect on breastfeeding. It has been shown that after c-section however an average of 5-10 minutes passes by until the first contact between mother and child is established. In Switzerland more than a third of all children are delivered by c-section. Thus, an attempt to improve bonding after c-section is necessary.

Material and methods: Since January 2013 we use a bonding top at Kantonsspital Aarau to ameliorate bonding after elective c-section. The following is a descriptive report of our experience.

Results: Over the last 2 years we were able to experience that by using a bonding top during elective c-section an immediate skin-to-skin contact between mother and child can be achieved. Only a few steps have to be altered in the course of the c-section when the bondig top is applied. The medical staff (midwife, obstetrician, anaesthesiologist) ad-justed quickly to those changes and didn’t feel restricted or disturbed in their work. To op-timize cost-benefit ratio we chose to utilize the common mesh-underpants used in hos-pitals instead of the commercial product on the market. These can be easily adapted for the purpose. Naturally, it has to be ensured, that the primary adaptation of the newborn is without difficulty. The midwife is still in charge of monitoring the newborn for the first minutes of life.

Conclusion: The use of a bonding-top during elective c-section is an effective way to en-able an accelerated skin-to-skin contact between mother and child. So far the involved staff as well as newborns and mothers experienced only advantages when the bond-ing-top is applied. Taking into account the numerous benefits of an early bonding, the use of a bonding-top should be standard in elective c-section.


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P I/ 16

Placental alpha-microglobulin-1 for prediction of preterm birth

Author: 1,2) Mueller M., 1) Heverhagen A.M., 1) Polowy J.A., 1) Raio L., 1) Surbek D.Hospital: 1) Obstetrics and Gynecology, University Hospital Bern, 2) Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Introduction: Preterm birth is a major cause of neonatal morbidity and mortality in de-veloped countries. There is an urgent need for a test to accurately predict imminent deli-very to enable necessary interventions. The placental alpha-microglobulin-1 (PAMG-1) is a protein that can be found in high concentrations in the amniotic fluid and in lower con-centrations in the vaginal secretion in patients with signs of preterm labor without rup-ture of membranes. We aimed to evaluate PAMG-1 diagnostic kit PartoSure in the predic-tion of preterm birth.

Material and methods: We included 119 patients (between 24 0/7 and 36 6/7 gestational weeks) in this prospective observational trial. We included patients with symptoms of pre-term labor and gestational age-matched controls. We evaluated the sensitivity (SN), spe-cificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of PAMG-1 measurements compared to transvaginal cervical length (CL) measurements. The perfor-mance of the test was calculated within 48 hours, 7 days and 14 days. We performed a sub-group analysis in symptomatic patients with CL between 15 and 30mm.

Results: We detected superior SP and PPV in the PAMG-1 compared to CL group at all time points. SN was higher in the CL group and NPV was similar in both groups. PAMG-1 per-formance was confirmed within the subgroup (CL: 15-30 mm) of symptomatic patients, where CL measurements are at least accurate predicting preterm birth.

Conclusions: The novel PAMG-1 test has a high PPV and SP compared to other commer-cially available bed-side test such as fetal fibronectine or IGFBP-1. Our study suggests clini-cal usefulness of the PartoSure test, especially in addition to cervix length measurements. Its utilization may reduce unnecessary hospitalizations and overtreatment of patients at risk for preterm birth.


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P I/ 17

Peripartal blood loss and outcome of intrahepatic cholestasis of pregnancy

Author: 1) Furrer R., 2) Winter K. , 1) Zimmermann R., 3) Schäffer L., 1) Haslinger C.Hospital: 1) Obstetrics, University Hospital Zurich, 2) University Zurich, 3) Obstetrics, Cantonal Hospital Baden

Aim: Intrahepatic cholestasis of pregnancy (ICP) is associated with preterm birth, meco-nium staining and stillbirth. In addition, increased blood bile acids (BBA) may cause vita-min K malabsorption and hence influence blood coagulation with increased peripartal blood loss. Our goal was to evaluate feto-maternal outcome in women with ICP with at-tention to peripartal blood loss.

Methods: In a retrospective case-control study, 15083 deliveries including 345 women with ICP (2,3%) were analyzed from 2004-2014. To adjust differences in baseline charac-teristics a propensity analysis was performed and controls were matched to the ICP cases in a 5:1 ratio. Blood loss was analyzed by estimated blood loss (EBL) and delta hemoglo-bin (dHb: difference of pre-/postpartal Hb). A subgroup analysis regarding severity of ICP (mild (<40µmol/l BBA), moderate (40-100µmol/l BBA) and severe ICP (>100µmol/l BBA)) was performed. Differences in EBL, dHb and meconium staining between subgroups were analyzed. A spearman rank correlation was performed to evaluate the association of ICP and blood loss within subgroups.

Results: Baseline characteristics were comparable between study and control groups. EBL (mean 515ml vs 494ml, p=0,22), dHb (14,71 vs 13,63, p= 0,09), meconium staining (14,5 % vs 11,4 % , p=0,12) and number of stillbirths after the 26th week of gestation (0,6% vs 1,8 %, p=0,10) were not significantly different (study vs. control group, respectively). In severe ICP, meconium staining was observed significantly more often compared to controls (32,3 % vs 11,4%, p<0,001). There was no correlation between EBL or dHb and severity of ICP.

Conclusions: In our collective of women with ICP, who usually receive treatment with ur-sodeoxycholic acid and are induced at 38 weeks of gestation, no differences in peripartal blood loss, meconium staining and stillbirths were shown. However, severe ICP is associ-ated with meconium staining.


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P I/ 18

Iron deficiency and iron deficiency anemia in early pregnancy

Author: Hecht C., Christoph P., Surbek D.Hospital: Obstetrics and Gynecology, University Hospital Bern

Introduction: Iron deficiency (ID) is the most widespread nutritional deficiency in the world.1 2 It is the most common cause of anaemia during pregnancy (worldwide preva-lence in pregnant women: 38%). Iron deficiency anemia (IDA) in pregnancy may lead to maternal symptoms and to adverse pregnancy outcome, mainly intrauterine growth re-striction (IUGR) and preterm birth. Low haemoglobin and iron levels are important risk factors for the health and development of women and children.3 According to two recent meta-analysis, general iron supplementation in pregnancy has been shown to reduce the incidence of IUGR, to increase birth weight, and to reduce maternal postpartum anemia. ID is characterized by low serum ferritin, which leads to IDA. Because the need for iron steeply increases during gestation, low ferritin levels in the first trimester predict develop-ment of IDA later in pregnancy. The prevalence of anemia in pregnancy in Switzerland is low, according to the WHO anemia database . However, iron status of pregnant women is unknown. The aim of this study was therefore to determine the prevalence of ID and IDA in the first trimester of pregnancy.

Material and methods: In this observational study, we analysed the data of 914 pregnant women attending prenatal care at our outpatient’s clinic from 2011 – 2015. All of them were in the first trimester of pregnancy. Maternal blood was obtain for a red blood cell count, hemoglobin and ferritin levels.

Results: While IDA (Hb ≤ 110 g/l) was found in only 6.8% , ID (ferritin ≤ 30 ng/ml) was pres-ent in 29.8% of all 914 women. Among 852 women with normal hemoglobin levels, 27.1% had low ferritin levels.

Conclusions: Our results show that while only a small amount of the pregnant women in the first trimester have anemia in Switzerland, almost 1/3 of women have iron deficiency. Iron supplemetation should be offered to pregnant women with IDA and ID in early preg-nancy. In view of the potential gastrointestinal side effects of oral iron, a strategy of gen-eralised ferritin screening and focused treatment for ID in early pregnancy seems superior to general iron supplementation in Switzerland.


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P II/ 20

The pelvic floor hiatus: What changes over the life of a woman?

Author: 1) Meyer S., 2) Baud D., 2) Vial Y., 2) Rouiller S., 3) Prince E., 1) Achtari C., 4) Schmitter D., 5) Unser M.Hospital: 1) Gynecology and Obstetrics, Urogynecology Unit, 2) Gynecology and Obstetrics, Obstetrics Department, 3) Gynecology and Obstetrics, Urogynecology Unit, Morges, 4) Biomedical Imaging Group, 5) Biomedical Imaging Group, Urogynecology Unit/ 1-2 University Hospital Lausanne/ 4-5 EPFL, Lausanne

Introduction: to draw the shape of the pelvic floor hiatus (PFH) at rest and during pel-vic floor muscle contraction (PFMC) and then to stack the different shapes of these PFH. To compare PFH diameters and surface areas at rest and during PFMC in different groups, To determine correlations between PFH diameters and surface area with age, parity, ba-by’s weight, mode of delivery.

Methods: Ultrasound volume datasets were acquired in the supine position at rest, and during PFMC in 304 women (Group 1) divided in nulliparae women ( group 2, N : 61), cesar-ean section only-delivered (group 3, N : 23), nulliparae + cesarean section only-delivered (group 4, N : 84), primiparae (group 5, N :48), multiparae (Group 6, N :136) and forceps de-livered (Group 7, N :36). PFH structures assessment was realized calculating distance be-tween ano-rectal junction and inferior tip of the pubic symphysis (ARJ-PS) in mid-sagittal plane using a 2-D scanning. Diameters and surface area of PFH using the plane of min-imal hiatal dimensions were calculated using a 3-D scanning. The shape of PFH of each woman was drawn at rest and during PFMC: landmarks were manually placed on the con-tours at the PFH. Continuous 3D-curves where then reconstructed using spline interpola-tion based on exponential B-splines.

Results: – Compared to nulliparae women of Group 4, ARJ-PS distance and antero-poste-rior and transverse diameters were significantly greater in primiparae, multiparae and for-ceps-only delivered women at rest and during PFMC. – Significant correlations between PFH area during PFMC were also found with age and baby’s weight in women with sponta-neous and forceps-assisted deliveries delivered (Gr. 5, 6 and 7). – Frontal stacking pictures of PFH area at rest and during PFMC showed great variation within the same group with strong different shapes when comparing women with spontaneous/forceps-assisted vag-inal birth to nulliparae women

Conclusions: Ant-post and transverse diameters of PFH as well as PFH surface areas are significantly increased after spontaneous and forceps-assisted deliveries, when compared to nulliparae women.PFH surface areas at rest and during PFMC have significant correla-tions with aging process and vaginal deliveries.Stacking pictures of PFH show variations in the shape of the levator ani at rest and during PFMC.

Jahreskongress / Congrès annuel gynécologie suisse 2016 Posterpräsentationen / Présentation des poster P-II/20

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P II/ 21

Overactive bladder in Switzerland: What is the patient’s opinion?

Author: 1) Fink A., 2) Mohr S., 3) Adorjan P., 2) Kuhn A., 4) Mueller M.D.Hospital: 1) Gynecology and Obstetrics, 2) Urogynecology, 3) Astellas Pharma AG, Wallisellen, 4) Gynecology/ 1,2,4 University Hospital Bern

Introduction: Overactive bladder (OAB) is a symptom-oriented disease that describes a subjective state of urgency with (wet) and without (dry) incontinence.

Material and methods: In this Swiss nationwide study 430 patients were questioned or the voiding diary was used. The data was collected by Astellas. After the first visit, a medi-cal therapy treatement with Vesicare, an anticholinergic medication, was started.

Results: On average, symptoms persisted about 16.2 months until patients went to see a specialist. Most of the patients were looking for an appointment because of urgency (212 patients or 49%). 168 patients (39%) because of incontinence and 189 patients (43%) because of increased frequency of urinating. When first seeing a specialist, 169 patients (39%) already had a therapy: Either a medical treatement (88 patients, 53%), a non-medi-cal treatement (63, 37%) or both (19, 11%). 197 patients (46%) were diagnosed with OAB wet, 149 (35%) with OAB dry and 82 (19%) with OAB combined with stress urinary incon-tinence. 166 women (39%) received a non- medical treatment. 84% of these 166 had a bladder- training, 77% pelvic floor physiotherapy, 65% changed their lifestyle. Multiple answers were possible. Vesicare was given to all patients after the initial consultation. The most important reasons for discontinuation of medical treatment was mouth dryness, diz-ziness, constipation or combined complaints. However, only 35 patients (8%) discontin-ued medical treatment.

Discussion: The answer to the question, how the therapy of OAB changed the personal life, were clear. There was an increase in quality of life, e.g. increase in mobility and motility as well as more autonomy in daily business and even an increase of general health and a decrease of physical complaints. It is surprising, that only one third of patients were given a non-medical treatement. The data suggests a successful therapy upon medical treate-ment. Nevertheless, we always recommend a combined treatement of medication as well as bladder training and pelvic floor physiotherapy.


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P II/ 22

Sensory hyperinnervation distinguishes bladder pain syndrome/interstitial cystitis from overactive bladder syndrome

Author: 1) Gamper M., 2) Regauer S., 1) Fehr M.K., 1) Viereck V.Hospital: 1) Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, 2) Institute of Pathology, Medical University Graz

Introduction: Bladder pain syndrome/interstitial cystitis (BPS/IC) and overactive bladder syndrome (OAB) are defined by the leading symptoms ‘pain’ and ‘urgency’, respectively, but overlap occurs. Discriminating objective molecular markers are highly desired. In this work we tested if subepithelial sensory hyperinnervation is indicative for painful bladder diseases. We also assessed other histopathological markers, such as mast cell density and lymphocyte infiltration, urothelial integrity and nerve growth factor receptor (p75NTR) ex-pression. Furthermore, urinary nerve growth factor (NGF) was evaluated as a biomarker for bladder diseases.

Materials and methods: Bladder biopsies of 12 patients with BPS/IC with Hunner’s lesion, 19 patients with BPS/IC without Hunner’s lesion, 13 patients with OAB, and 12 healthy con-trols were analysed with hematoxylin and eosin stains and with immunohistochemistry with antibody to PGP9.5, p75NTR, mast cell tryptase and CD20. Patients were allocated to study groups by key bladder symptoms commonly used to define conditions (pain, major urgency). Urinary NGF was quantified by enzyme-linked immunosorbent assay.

Results: Subepithelial sensory hyperinnervation (97% sensitivity; 76% specificity), lym-phocytic infiltration (90% sensitivity; 80% specificity) and urothelial defects (97% sensitiv-ity; 76% specificity) associated with BPS/IC with and without Hunner’s lesion. These histo-pathological criteria allow the differentiation of BPS/IC with and without Hunner’s lesion from OAB and healthy controls. Increased sensory innervation was associated with sub-mucosal mast cell localization. Presence of p75NTR staining in basal urothelial cells was only found in BPS/IC with or without Hunner’s lesion. NGF protein was not detected in urine.

Conclusion: Sensory hyperinnervation and the presence of basal urothelial p75NTR stain-ing together with assessment of inflammatory lymphocytes and urothelial integrity al-low the differentiation of BPS/IC and OAB, even in the absence of Hunner’s lesion. Further-more, these histopathological criteria enable the identification of early disease stages or even asymptomatic cases, and permit appropriate treatment to prevent disease progress.


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P II/ 23

Validation of the French version of the Prolapse Quality of Life (P-QoL) questionnaire

Author: 1,2) Veit-Rubin N., 3) Chatziioannidou K., 3) Kaelin Gambirasio I., 2) Digesu A., 3) Dällenbach P., 3) Boulvain M.Hospital: 1) Urogynecology, Imperial College London, 2) Gynecology, University Hospital Lausanne, 3) Gynecology and Obstetrics, University Hospital Geneva

Introduction: Pelvic organ prolapse (POP) is a common condition affecting up to 50% of parous women. While POP is generally not life threatening, the symptoms have a signifi-cant impact on quality of life, leading to discomfort as well as physical, social, psycholog-ical, occupational, domestic and sexual limitations. The prolapse quality of life question-naire (P-QoL) is simple, reliable and easily comprehensible. The aim of our study was to provide evidence on validity, consistency and reliability of a French version of the P-QoL.

Materials and methods: The P-QoL was professionally translated into French and admin-istered to patients allocated to two groups depending on whether they were symptom-atic or asymptomatic for POP. The women had a vaginal exam in order to determine pro-lapse stage using Pelvic Organ prolapse quantification system (POP-Q). The reliability was assessed by calculating Cronbach’s alpha and by performing a test–retest analysis. The va-lidity was evaluated by comparing P-QoL scores between symptomatic and asymptom-atic women using Mann–Whitney U-test as well as by comparing symptom scores with prolapse stages using Cohen’s kappa and Spearman’s rho nonparametric correlation co-efficients.

Results: 25 symptomatic and 22 asymptomatic patients were included. Spearman’s non-parametric coefficients showed a statistically significant correlation between the P-QoL scores and the severity of the disease in symptomatic patients, except for the domain General Health perception. The total scores for each of the P-QoL domains were found to be significantly higher for symptomatic women compared to asymptomatic women (p < 0.001) except for the domain General Health perception. All items achieved a Cronbach’s alpha greater than 0.700, except for the questions addressing sleep, energy and severity measures. Cohen’s kappa displayed moderate agreement for 4 domains and strong agree-ment for 5 domains whereas Spearman’s rho nonparametric correlation coefficients were significant for all domains.

Conclusion: The French version of the P-QoL showed good psychometric properties. It is a reliable, valid, and easily comprehensible instrument to assess quality of life and symp-toms in women with POP. Like the original English questionnaire, it could be adopted to better identify those women in the need of treatment and could accurately evaluate ther-apeutic outcomes.


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Potential of Bryophyllum pinnatum as a detrusor relaxant: data with flavonoid aglycones in a porcine bladder model

Author: 1) Bachmann S., 2) Betschart C., 3) Eberli D., 3) Nötzli S., 4) Hamburger M., 1) Fürer K., 5) Mennet M., 4) Potterat O., 5) Schnelle M., 1) von Mandach U., 1) Simões-Wüst A.P.Hospital: 1) Obstetrics, 2) Gynecology, 3) Urology Clinic, 4) Pharmaceutical Biology, University Basel, 5) Weleda AG, Arlesheim/ 1-3 University Hospital Zurich

Introduction: Overactive bladder (OAB) is a syndrome characterized by urinary urgency with or without incontinence that affects ca. 500’000 people in Switzerland. Detrusor hy-peractivity is a major problem in OAB. Long-term adherence to standard medication with anticholinergic drugs is low. A beta3-agonist with proven clinical benefits was registered in Switzerland in 2014, but only limited data on long-term efficacy and safety are currently available. Bryophyllum pinnatum (BP) is an herbal medication used traditionally in anthro-posophic medicine. First promising clinical data on the OAB treatment with BP have been obtained in a pilot randomized double-blinded placebo-controlled trial. BP leaf press juice (BPJ) contains high amounts of flavonoid glycosides (FG) and could inhibit electrically stimulated detrusor contractions. Our goal was to investigate whether an aglycone mix-ture representative of the FG present in BPJ locally affects detrusor contractility.

Methods: The amounts of FG aglycones present in a BP extract were determined by HPLC-analysis and a mixture of pure aglycones at corresponding proportions was pre-pared. Porcine detrusor muscle strips were used for the experiments and their contraction was induced with KCl 124 mM. Effects of FG aglycones, a FG-enriched BP-fraction and BPJ were investigated and compared with those of isoprenaline, a non-specific beta agonist, and of BRL373344, a beta3 agonist.

Results: Treatment with the aglycone mixture led to a significant lowering of contraction force; at 0.075 and 0.22 mg/ml, the contraction force corresponded to 71% and 49% of ini-tial, respectively (n=4 each). A fraction enriched in FG increased the contraction force (at 1.5 mg/ml, 140% of initial; n=4). BPJ led to an increase in the contraction force (160% and 200% of initial at concentrations of 2.5% and 10%, respectively; n=12, n=5). Vehicle con-trols revealed moderate force increases (up to 120% of initial). As to be expected, both beta agonists led to a decrease in contraction force (1 microM isoprenaline: down to 76% of initial, n=10; 1 microM BRL373344: down to 94% of initial, n=5).

Conclusions: An aglycone mixture representative of BPJ-FG inhibits detrusor contractility in a concentration-dependent manner. Since such aglycones are likely to be among the BPJ constituents that enter the blood circulation upon absorption, they could provide an explanation for the results of the pilot study on the treatment of OAB with BP.


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Intra-, peri- and postoperative complications in elderly women undergoing surgery for pelvic organ prolapse

Author: Körnig M., Brühlmann E., Günthert A., Christmann C.Hospital: Urogynecology, Cantonal Hospital Lucerne

Introduction: Pelvic organ prolapse is a common problem among elderly women. Ad-vanced age is associated with a high prevalence of comorbidities that can lead to restric-tive use of surgical treatment due to fear of complications. With rising life expectancy and elderly women being the fastest growing group of the population, it is predicted that a surgical treatment in these women will be seen more frequently. Inconsistently there is a lack of clinical trials giving attention to geriatric women suffering from pelvic organ pro-lapse. Actually in many cases these patients have been excluded from studies. The aim of this study was to quantify the rate of complications in elderly women undergoing surgery for pelvic organ prolapse.

Materials and methods: We performed a retrospective study by reviewing the records of all patients aged ≥ 75 years who underwent urogynecological surgical procedures for pel-vic organ prolapse between January 2013 and December 2015. Demographics, comorbid-ities, intra-, peri- and postoperative complications were recorded. Moreover we compared the pre- and postoperative prevalence of symptoms linked to pelvic organ prolapse.

Results: Seventy-two patients were included in this study. The mean age was 81,5 years (SD ± 4,9, range 75-93). 4 (5,6%) of the patients had a major intra-, peri- or postoperative complication (2x bowel injuries, 1x bleeding requiring blood transfusion, 1x reanimation). An analysis with 2 subgroups (age <80 years vs. ≥ 80 years) showed no significant dif-ference concerning the presence of these complications between the groups (P = 1.00). There was a significant postoperative decrease in pelvic organ prolapse connected symp-toms, such as stress urinary incontinence (P = .013), voiding dysfunction (P < .001), recur-rent urinary tract infection (P = .001) and rectal outlet obstruction (P = .006).

Conclusion: Elderly women undergoing an operation for pelvic organ prolapse have a low risk of complication and benefit from surgery. Age alone should not be a contraindi-cation to surgery. Instead decision making should be individualised and more studies fo-cusing on this rising cohort of women are necessary to evaluate surgical procedures.


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Urinary incontinence and its association with physical and mental decline among female nursing home residents

Author: 1) Zürcher L., 2) Theill N., 1) Scheiner D., 1) Fink D., 2) Riese F., 1) Betschart C.Hospital: 1) Gynecology, University Hospital Zurich, 2) Division of Psychiatry Research and Psychogeriatric Medicine, Psychiatric University Hospital Zurich

Introduction: The prevalence of urinary incontinence (UI) increases dramatically with age. Despite its high prevalence and negative impact, the interrelation of physical and mental decline with UI is not fully eluci-dated yet. The aim of this study was to determine associations between UI and activities of daily living (ADL) performance, cognitive performance scale (CPS) and comorbid conditions in female nursing home residents at the time of admission.

Material and methods: Data sets from the Minimum Data Set (MDS) of the Resident Assessment Instru-ment 2.0 (RAI) of all females at nursing home admission (n = 44811; January 2005 to December 2014) in Swit-zerland examined in a cross-sectional analysis UI, the ADL hierarchy scale (0=independent, 6= totally depen-dent), the cognitive performance scale (CPS, 0=intact, 6=very severe impairment) and comorbid conditions. Statistical analysis was done by means of descriptive statistics (mean±SD, median, and range resp.) and lo-gistic regression analysis (odds ratio OR).

Results: At nursing home admission, the new entrants had a mean age (± SD) of 84.57 ± 6.87 years. UI was present in 54.7%. The mean ADL hierarchy scale (± SD) was 2.42 ± 3.26 (range = 0-6) and CPS (± SD) 1.95 ± 1.67 (range = 0-6), the median number of comor-bid conditions (± SD) was 2.94 ± 1.75 (range = 0-11). There was a gradual increase in the OR for being urinary incontinent depend-ing on the ADL hierarchy scale, also after correcting for the interaction between ADL and CPS as possible confounders (Table 1). For CPS, the range of OR from “borderline in-tact” to “very severe impairment” was 1.35 – 5.58. Of all comorbid conditions, only diabe-tes mellitus (OR 1.189), dementia (OR 1.097, and arthrosis / arthritis (OR 1.153) were sta-tistically significantly associated with incon-tinence.

Conclusion: Every second woman is affected by UI when admitted to a nursing home. Impairment in ADL performance is strongly associated with UI, stronger than comorbidities or CPS performance.


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How-to: In-bag morcellation of fibroids and large fibroid uterus using the MoreCellSafe device

Author: Mohr S., Nirgianakis K., Lanz S., Imboden S., Papadia A., Mueller M.D.Hospital: Obstetrics and Gynecology, University Hospital Bern and University Bern

Introduction: Minimally-invasive hysterectomy and myomectomy are beneficial in terms of pain control, infection risk, faster recovery and return to work compared with open procedures (Liu FW, AJOG 2015). However, laparoscopy necessitates morcellation to ext-ract the tissues from the abdomen. The inherent risk of morcellation is the spread of tis-sue parts in the abdominal cavity which can have devastating consequences if the tissue proves to be malignant. Since a preoperative assessment of malignancy can only be an ap-praisal (Parker W, JMIG 2016), surgical alternatives like laparotomy, mini-laparotomy, col-potomy, vaginal morcellation or morcellation in a bag have to be reviewed (Liu FW, AJOG 2015; Siedhoff MT, AJOG 2015). The risk of tissue spread has to be opposed to the risks of open surgery including increased morbidity and mortality (Siedhoff MT, AJOG 2015). Yet, combining laparoscopy with safe extraction procedures would be most optimal. This vi-deo shows morcellation in the MoreCellSafe bag (A.M.I., Austria) which prevents tissue spread.

Case and method: Case 1: The 34 year old patient presented with a rapidly growing mass in the posterior uterine wall auf 7 cm size. Her further history was uneventful. The video shows laparoscopic myomectomy with temporary clipping of the uterine arteries and morcellation in the MoreCellSafe. Histology results showed leiomyoma. Case 2: The 42 year old patient presented with a symptomatic fibroid uterus reaching the right costal arch. She was treated with Ullipristalacetate for 3 months preoperatively. Her further his-tory was uneventful and she desired no children. This video shows laparoscopic hysterec-tomy with bilateral salpingectomy and morcellation of the 830g uterus in the MoreCell-Safe. Histology showed multiple benign leiomyomata.

Conclusion: The video shows step-by-step use of the in-bag morcellation process using the MoreCellSafe device. It can not only effectively be used for spread-free morcellation of fibroids but even large uterus can be extracted safely.


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Endometriosis of the diaphragm: a pirouette or a traversale?

Author: Schwander A., Imboden S., Lanz S., Mueller M.D.Hospital: Obstetrics and Gynecology, University Hospital Bern, University Bern

Introduction: Endometriosis is a common condition with a wide scale of symptoms. En-dometrial lesion can be seen throughout the abdominal cavity and also in distant organs such as the lungs. In this study we analyzed the prevalence and characteristics of endome-triosis of the diaphragm.

Material and methods: Data from patients with endometriosis of the diaphragm were ex-tracted from the prospectively collected data base on endometriosis patients of the uni-versity hospital Berne, collected from January 1997 until July 2015. Symptoms, locations and therapy performed were documented in this database, the clinical charts and intraop-erative photo documentation were analyzed retrospectively.

Results: In a total of 1086 patients operated on endometriosis 21 patients (1.9%) were found with endometriosis of the diaphragm. In these patients 12 (57%) had an advanced stage of endometriosis (rAFS III° or IV°). In no case the endometriosis was isolated on the diaphragm alone. Consistent to the literature, the left lower pelvis was more frequently affected by endometriosis. On the contrary endometriosis of the diaphragm was present more frequently on the right side. 18/21 patients had an endometriosis of the diaphragm on the right side alone, three patients showed a bilateral involvement of the diaphragm. Only 6/21 (28.6%) had diaphragm specific symptoms: three with shoulder pain, three with upper abdominal pain and two also with dyspnea. Only 2/6 had isolated diaphragm symp-toms without any other discomfort. 16/21 (76.2%) had the classical symptoms of dysmen-orrhea, dyschezia, dysuria and/or dyspareunia. 5/21 (23.8%) were totally asymptomatic with no classic endometriosis symptoms. All patients were treated laparoscopically: 13/21 (61.9%) were excised, 4/21 (19.0%) evaporated with CO2 Laser, 2/21 (9.5%) were coagu-lated. In two cases the lesions were left as a second look therapy was planned.

Conclusion: Endometriosis of the diaphragm is rare and shows unspecific or even no symptoms at all. A careful inspection of the diaphragm is mandatory and the surgeon must be prepared to manage these cases. In our cohort most patients had a moderate to severe endometriosis on the left side and an endometriosis of the diaphragm on the right side. These findings suggest that endometriosis begins on the left side after menstrual re-flux of endometrial cells and that the circulating peritoneal fluid transports the endome-triosis cells to the right diaphragm, similar to a traversale in horse riding.


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P III/ 30

Prevalence and consequences of vitamin D deficiency in pregnant women in Bern

Author: Christoph P., Challande P., Raio L., Surbek D.Hospital: Obstetrics and Gynecology, University Hospital Bern

Introduction: Recently, the vitamin D metabolism in the general population and in par-ticular in pregnant women has gained importance. This is due to the fact, vitamin D defi-ciency has been associated with various adverse pregnancy outcomes such as gestational diabetes, gestational hypertension/preeclampsiea, bacterial vaginosis, preterm delivery, (recurrent) misscariage, cesarean section, and prolonged pregnancy. Moreover, adverse consequences for the newborn and his further development have also been observed. The aim of the present study is to assess the prevalence of vitamin D deficiency among pregnant women in Bern.

Methods: This is a retrospective, observational study of pregnant women attending our outpatient clinic for prenantal care from 2013 to 2015. The vitamin status was assessed at the first clinical visit. Vitamine D deficiency was defined as a Vitamine D level <50nmol/l and women usually received at least 1000 IE Vit D replacement therapy when the fulfilled the laboratory criteria for deficiency.

Results: During the study period 1382 women were included into this study. Only 26,8% (n=370) pregnant women showed a sufficient level of Vitamin D (>50 nmol/L), a mild defi-ciency (49-25 nmol/L) was present in 38,8% (n=538) pregnant women, a severe deficiency (<25 nmol/L) was present in 34,3% (n=474) women. In total more than 70% of our patients showed insufficient Vitamin D levels.

Conclusions: We are astonished that such a high number of pregnant women have a vi-tamin D deficiency and we wonder, if the cutoff used to define a vitamin D deficiency is appropriate for a pregnant population. Indeed, the 50nmol/l value has been estimated in a population at random, women and men at different ages. Future studies have to cor-rect for this problem analyzing at which vitamin D level pregnancy complications are in-creased and if supplementation the daily recommended amount of 600 IE is helpful in re-ducing complications.

Jahreskongress / Congrès annuel gynécologie suisse 2016 Posterpräsentationen / Présentation des poster P-III/30

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Clinical significance of borderline ventriculomegaly

Author: Tomic K., Schönberger H., Weber P., Lapaire O., Manegold-Brauer G.Hospital: Gynecology and Obstetric, University Hospital Basel

Introduction: Fetal ventriculomegaly (VM) is diagnosed with prenatal ultrasound and de-scribes a dilatation of the lateral ventricle of the fetal brain. It is one of the most commonly diagnosed brain abnormalities. But still, prenatal counselling remains challenging due to a variety of underlying causes and the broad spectrum in neurological development. Es-pecially little is known about the natural prenatal course and the long-term outcome of children with isolated borderline VM. The aim of this study was to assess cases with VM, describe the prenatal course and management, and assess short and long term develop-ment at the age of two years.

Material and methodics: We performed a Viewpoint data base search and included all children that were prenatally diagnosed with VM in our unit and had an estimated date of delivery between June 2008 and August 2013. The prenatal management as well as the postnatal outcome were evaluated. Additionally a questionnaire on the neurologic devel-opment at the age of two was sent out to the paediatricians in charge.

Results: 250 children were included. 79.2% (n=198) were diagnosed with borderline VM, 8.4% (n=21) with mild VM, 6.0% (n=15) with moderate VM, and 6.4% (n=16) with severe VM. 68.8% (n=172) of the affected children were boys. From all the children diagnosed with borderline VM 17.2% (n= 34/198) had serologic testing (TORCH), 9.1% (n=18/198) had an MRI, 6.1% (n = 12/198) had termination of pregnancy because of associated mal-formations and one child died after birth due to trisomy 18. 14.0% (n=25/ 178) who were live-born had associated anomalies. 110 children with isolated borderline VM had a com-plete follow-up after delivery. 1.8% (n= 2/110) were transferred to the neonatal unit due to the VM. 20.9% (n=23/110) had a postnatal brain ultrasound and 1.8% (n=2/110) showed abnormal findings. 1.8% (n=2/110) showed mild neurologic abnormalities after birth, but none of them were referred to or followed up by a neuropaediatrician.

Conclusion: In our collective the number of children with VM mainly are diagnosed with borderline VM. Based on our retrospective analysis, the vast majority of isolated border-line VM have a normal ultrasound after birth and show no neurological abnormalities and normal long term follow-up. Since associated abnormalities are relevant for counselling and for prognosis all cases of ventriculomegaly should be referred to a detailed ultrasound exam by a specialist to search for associated abnormalities.


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Exosomes from Wharton’s Jelly Mesenchymal Stem Cells: protect Neural cells from Oxygen-Glucose Deprivation and Reperfusion damage

Author: 1) Spinelli M., 1,2) Oppliger B., 1) Jörger-Messerli M., 1) Reinhart U.,1) Schoeberlein A., 1) Surbek D.Hospital: 1) Obstetrics and Gynecology, University Hospital Bern and Clinical Research, 2) Graduate School for Cellular and Biomedical Sciences (GCB)/ 1,2 University of Bern

Introduction: Mesenchymal stem cells (MSC)-derived exosomes have become a research focus in neuroscience during recent years, since they ought to contain beneficial factors to support a neuroregenerative environment in models of brain disease. However, to our knowledge, the role of MSC exosomes in perinatal hypoxic-ischemic brain injury has not yet been investigated. Therefore, the objective of this study was to: isolate and character-ize exosomes generated from Wharton’s Jelly (WJ)-MSC of normal term pregnancies; as-sess the effect of WJ-MSC exosomes in an in-vitro model of hypoxic-ischemic brain injury (Oxygen-Glucose Deprivation and Reperfusion, OGD-R), using the mouse N2a neuroblas-toma cell line as an analogue for neural progenitor cells.

Methods: WJ-MSC exosomes were isolated from culture supernatant by serial centrifu-gations and their identity was determined by membrane-based antibody array and elec-tron microscopy. Then, the content of exosomes was characterized by measuring the ex-pression of proteins and microRNAs by Western Blot and PCR array, respectively. After the OGD-R experiments, we assessed cell viability, apoptosis, and markers of proliferation and differentiation among treated and untreated N2a cells by TUNEL test, PrestoBlue assay and real-time PCR.

Results: WJ-MSC exosomes were positive for selected markers, including TSG101, ALIX, epCAM and mir133b and showed a typical morphology at electron microscopy. WJ-MSC exosomes protected N2a cells subjected to OGD-R injury by reducing apoptosis and in-creasing cell viability. These protective effects are associated with increases in the expres-sion of survival-related proteins, such as Ki-67 and TGFB-1 in injured cells compared with controls. WJ-MSC exosomes also reduced the expression of death-related proteins, such as cleaved caspase-3.

Conclusions: Our findings suggest that WJ-MSC exosomes are able to boost neuroprotec-tion and neuroregeneration in hypoxic-ischemic perinatal brain injury. Studies in animal models to confirm our results in vivo are currently ongoing.


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P III/ 33

Impact on labor induction of a new galenic form of misoprostol

Author: Robyr D., Bodenmann P., Lepigeon K., Baud D., Vial Y.Hospital: Obstetrics and Gynecology, University Hospital Lausanne

Introduction: In the last decade the use of misoprostol for labor induction has become common practice despite it’s off label status. Respectful of contraindications the use of this form of PGE1 application was the preferred method of induction at our site. A new a vaginal pessary with a constant release of 200 mcg of misoprostol per 24h has recently been introduced and approved by Swissmedic for induction of labor.

Aim: We propose to compare our observations and experience in terms of efficacy, rates of tachysytolia, fetal tolerance as well as mode of delivery, rates of emergency extractions, FHR tracings, fetal outcomes and post partum hemorrhage compared to the use of the off label vaginal tablet application.

Method: We collected and analyzed data from the induction, labor and delivery of 90 pa-tients over the course of 7 weeks at our site. The results will be compared to a group of 90 control patients who underwent induction of labor using the off label form of misoprostol immediately before the introduction of MISODEL®.

Preliminary results: Preliminary results show rates of tachysystolia, abnormal FHR trac-ings and emergency fetal extractions that subjectively seem significantly higher than that with the use of the off label tablets. These rates will be presented in comparison to those of the control cohort of patients which still has to be analyzed.

Conclusions: Definitive conclusions need to be withheld until the data of the control co-hort is extracted but we feel that, according to the instructions of the pharmaceutical company, the use of MIOSDEL® needs to be reserved for patients requiring rapid induction of labor. MISODEL® being the only Swissmedic approved form of PGE1 we observe that the only alternative would be the use of PGE2 for all other indications with possible longer du-rations and rates of induction failure.


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P III/ 34

Effect of lung maturation on fetal Doppler in intrauterine growth restricted fetuses

Author: Amylidi-Mohr S., Mosimann B., Schlatter B., Surbek D., Raio L.Hospital: Obstetrics, University Hospital Bern and University Bern

Introduction: Corticosteroids have become the basis of prophylactic treatment in preterm birth between 24 and 34 weeks of gestation to reduce neonatal complications. Although its effectiveness has not been demonstrated specifically in IUGR fetuses, steroids are widely established in these cases. Aim of our study was to investigate on the effects of an-tenatal glucocorticoids on the blood flow velocity waveform patterns of the middle cere-bral artery (MCA) und the umbilical artery (UA).

Methods: This was a retrospective, longitudinal study. Included were singleton fetuses born between 24 and 34 weeks of gestation with a birth weight below the 10th centile for gestational age, who received betamethasone (two doses of 12 mg intramuscularly, 24 hours apart) and were born at our institution. Fetuses with structural or chromosomal anomalies were excluded. Colour and pulsed-wave Doppler was used for the assessment of the fetal circulation. We compared the pulsatility index (PI) of UA and MCA before and 48 hours after the first application of steroids. In cases with absent or reversed end-dia-stolic flow velocity waveforms (AREDF) the returning of the diastole was used for statisti-cal purposes. A p<0.05 was considered statistically significant.

Results: Out of 180 cases seen between 2005 and 2015, 50 fulfilled the inclusion criteria. Mean gestational age at delivery was 29.4±2.2 weeks and birth weight was 856±295 g. 28 (56%) of the pregnancies were complicated by hypertensive disorders. Overall, mean UA-PI was 1.77±0.6 before steroids , and 1.69±0.6 after 48 hours (p=0.40). Fourteen cases were complicated by AREDF. A return of the end-diastolic blood flow velocity or disap-pearance of the reverse flow was noted in 8 (57%) cases. The UA-PI in these selected cases tend to be reduced after steroids but not significant from 2.49±1.06 to 1.92±0.25 (p=0.14). Moreover, the mean MCA-PI was 1.48±0.4 before steroid administration and 1.43±0.3 af-ter 48 hours (p=0.28). Thirteen (27%) of the cases showed a MCA-PI under the 5.percentile.

Conclusion: There were no significant changes in the blood flow waveform of the UA and the MCA following betamethasone administration. However betamethasone administra-tion is associated with a transient return of the end-diastolic blood flow in half of the preg-nancies complicated by IUGR and AREDF. This improvement in Doppler flow characteris-tics in a subclass of severe IUGR fetuses may be due to production of nitric oxide, a potent vasodilatator, induced by external steroids.


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P III/ 35

Misoprostol vaginal insert compared with Misoprostol oral for induction of labour

Author: 1) Redling K., 2) Schädeln S., 1) Hösli I.Hospital: 1) Obstetrics and Antenatal Care, 2) Clinical Trial/ 1,2 University Hospital Basel

Introduction: Misoprostol in an administration of 50µg orally is recommended for induc-tion of labor in women with an unfavourable cervix, although not licensed for this indica-tion. In September 2014 the 200µg Misoprostol vaginal insert (Misodel®) was launched in Switzerland and is licensed for induction. Our aim was to compare the efficacy and safety of misoprostol vaginal insert and oral misoprostol.

Material and methods: We retrospectively identified 100 patients who have been in-duced with Misodel® (VI) and compared them with 100 patients, induced with Misopros-tol oral (O) (50µg every 4-6 h, max. 200µg). Primary outcome were time until delivery, sec-ondary outcome the mode of delivery, occurrence of polysystoly, and neonatal adverse outcome. We included women with a singleton term pregnancy over 36+0 weeks of ges-tation, a Bishop Score ≤4 and a BMI ≤ 50kg/m2. The study has been approved by the eth-ics committee (EKNZ).

Results: Both groups were similar regarding age of the mother (VI 31.10y ± 5.56, O 31.16y ± 5.45), BMI (VI 30.39kg/m2 ± 5.41, O 30.12kg/m2 ± 5.92), gestational age at the beginning of the induction (VI 40.4w ±1.3w, O 40.4 w ± 1.07w). Time from the beginning of induction to delivery was significantly shorter in the VI group (20.86 h ± 19.93h) compared to the O group (49.91 h ± 41.6h, p<0.001). Mode of delivery overall was not significantly different, but more Cesarean sections for failure of induction were performed in the O group (15 vs 4). Polysystoly occurred significantly more often in the Misodel group (VI 22.4%, O 4.7%, p<0.001). APGAR score, umbilical cord blood pH, transfer to neonatal care unit were not statistically significant. We observed a lesser estimated blood loss in the Misoprostol orally group (VI 606ml ± 478ml, O 470ml ± 206ml, p<0.001).

Conclusion: In our selected cohort we could confirm the effectiveness of Misodel® vaginal insert for induction of labour. Time to delivery was reduced by more than half from 50h to 21h. There was a higher rate of polysystoly in the Misodel group without an adverse im-plication on the neonatal outcome. Larger observational trials are necessary to confirm these data. According to our experience the selection of patients is very important as well as proper surveillance during induction of labour in order to choose the right moment to remove the vaginal insert.


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P III/ 36

Epidemiology of active hepatitis B in pregnancy in Switzerland

Author: Mosimann B., Aebi-Popp K., Burkhard Staub V., Amylidi-Mohr S., Pfister S., Suter FM., Raio L., Surbek D.Hospital: Obstetrics and Gynecology, University Hospital Bern, University Bern

Introduction: Recently it has been shown that in active hepatitis B (HepB) with a high viral load there is frequent mother-to-child-transmission (MTCT) despite active and pas-sive vaccination of the newborn. Antiviral treatment with tenofovir or other antiviral com-pounds in the third trimester decreases the transmission significantly. The aim of this study is to obtain epidemiological information about the prevalence of HepB and about levels of viral load in order to decide on screening strategies and treatment recommenda-tion in Switzerland.

Material and methods: We searched our database of all HBsAg tests performed in preg-nant women in our outpatient obstetric clinic between 2005 and 2015. In all women who screened positive, we obtained further information about pregnancy outcome and viral load (if available) from the clinical data system.

Results: 12’030 pregnant women were tested. We identified 90 HBsAg positive pregnan-cies in 70 women (17 with repeat pregnancies), corresponding to a prevalence of 0.75%. Including multiple pregnancies (3 twins, 1 triplet), a total of 95 children were born to HB-sAg positive mothers. Viral load was tested in 50/90 (56%) of HBsAg positive women, and 9 of 50 (18%) showed a viral load of >1’000’000 cp/ml (1 women with a repeat pregnancy). 7 of 8 women are of Asiatic ethnicity while 1 woman is from eastern Europe. The outcome among the group with positive HBsAg showed a preterm birth rate of 16% in singleton pregnancies or 25% including multiple pregnancies and a SGA rate of 7%.

Conclusion: The prevalence of active HepB in pregnant women in Switzerland seems low. However, among HBsAg positive pregnant women there is a significant proportion of women with high viral load, qualifying for antiviral treatment in the third trimester ac-cording to current recommendations. We therefore conclude that HepB screening in preg-nancy should include HBsAg testing and viral load in those tested positive. As antiviral treatment during the third trimester reduces mother-to-child-transmission of HepB in women with high viral load, HepB screening should be performed before the third trimes-ter.


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P III/ 37

Antenatal screening for hemoglobinopathies – an interim analysis

Author: Amstad Bencaiova G., Quentin G., Zeitler I., Hösli I.Hospital: Obstetrics and Gynecology, University Hospital Basel

Background: Hemoglobinopathies are among the most common inherited disorders worldwide. As a result of the migration of people from countries with a high prevalence of hemoglobin disorders, laboratory diagnosis is of growing importance in North-West Eu-rope. Different policies for hemoglobinopathy screening have been adapted in Europe. The aim of the screening is early identification of women with hemoglobinopathies and so improvement of prenatal care.

Methods: Family origin questionnaire was used to screen pregnant women for the risk for hemoglobinopathies in the first trimester. Family origin questionnaire was adopted from the NHS Sickle Cell and Thalassemia Screening Programme in England. According to this questionnaire pregnant women were divided into two groups: women with high risk and women with low risk for hemoglobinopathies. In women with high risk red blood cell in-dices, iron status and chromatography was conducted. For women identified as carriers, their baby`s father was tested for hemoglobinopathy irrespective of family origin. In the case of a suspicion for alpha thalassemia based on hematological parameters, the mole-cular analysis was performed.

Results: There were 447 pregnant women on recruitment. Out of 447 women, 228 were identified as high risk group. Due to missing data in 32 pregnant women, the analysis was conducted in 196 women. The mean of hemoglobin was 120 ± 11.7 g/l and the median of ferritin 36.5 ug/l (4-210 ug/l). There were 36 anemic women (36/196; 18.4%); namely iron deficiency anemia was identified in 16 women (16/196; 8.2%) and anemia of other etio-logy in 20 women (20/196; 10.2%). There were 20 women with iron deficiency (20/196; 10.2%). The prevalence of hemoglobinopathies was 4.1% (8/196). There were two women with sickle cell anemia, five with alpha thalassemia and one with beta thalassemia. Only three women with hemoglobinopathy were simultaneously anemic (3/8; 37.5%).

Conclusion: Using the family origin questionnaire we identified a group of pregnant wo-men with hemoglobinopathies which we otherwise would have missed. The prevalence of 4.1% confirms an increasing significance of screening programme for hemoglobinopathy.


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P III/ 38

Comparison of GBS-Screening Methods in the Third Trimester of Pregnancy: Interim Results

Author: 1) Huang D., 2) Vuichard D., 2) Tschudin S., 1) Granado C., 1) Müller D., 2) Dangel M., 1) Pfister T., 3) Schötzau A., 2) Widmer A., 1) Hösli I.Hospital: 1) Obstetrics and Perinatal Medicine, 2) Infectious Diseases and Hospital Hygiene, 3) Statistics, Obstetrics and Gynecology/ 1-3 University Hospital of Basel

Introduction: Group B Streptococcus (Streptococcus agalactiae, GBS) infection in the newborn can result in significant morbidity and mortality, such as neonatal sepsis, pneu-monia and meningitis. 10-30% of pregnant women may be colonized with GBS in the gen-itourinary and/or gastrointestinal tracts and vertical transmission may occur during la-bor and delivery. The current CDC guidelines recommend obtaining a vaginal and rectal swab for GBS between 35-37 weeks gestation. However, small studies have shown that a vaginal-perineal specimen allows similar detection of GBS colonization with less patient discomfort. Nevertheless, the gold standard screening method remains the vaginal and rectal swab. At our hospital, GBS screening has been performed for many years using a combined vaginal-perineal swab, as recommended in the SGGG Expertenbrief. Our study goal was to determine whether the additional rectal swab improves the GBS detection rate in a prospective Swiss cohort study.

Methods: Vagino-perineal and rectal swabs for GBS were collected cross-sectionally from study participants between 35-37 weeks gestation. Accuracy of the vagino-perineal swab compared to the combined vagino-perineal/rectal swab was expressed as sensitivity and specificity along with the exact 95% confidence interval (CI). We applied Cohen’s kappa to measure agreement between the vagino-perineal swab and the reference standard. We calculated that at least 438 participants would provide 80% power to show a difference of 10% between both test results.

Results: To date, 119 women have been recruited for this study. Overall, 23 women (19.3%; 95% CI 11.8% to 25.5%) were GBS positive. Both the vagino-perineal and the rectal swab were positive in 20 of the 23 women (86.9%), whereas in two women only the rectal swab and in one woman only the vagino-perineal swab was positive. The sensitivity (95% CI) of the vagino-perineal swab for detecting GBS was lower at 91.3% (71.96 to 98.93) but speci-ficity (95% CI) was 100% (96.23 to 100.00). Agreement between the two methods was 0.94.

Discussion: Sensitivity of the vagino-perineal swab and rectal swab to detect GBS ap-pears to be higher compared to the vagino-perineal swab alone, although agreement be-tween the two methods was high. These results need to be confirmed after completion of the study.


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P IV/ 40

Clinical data as an adjunct to ultrasound minimizes the false-negative cancer rate in BI-RADS 3 breast lesions

Author: Ackermann S., Zanetti Dällenbach R.Hospital: Gynecology and Obstetrics, University Hospital Basel

Purpose: Ultrasound (US) is a well-established diagnostic procedure for breast examina-tion. We investigated the cancer rate in solid breast lesions according to their BI-RADS classification with a particular focus on false-negative BI-RADS 3 lesions. We examined whether patient history and clinical findings provide additional information that resolve further diagnostic evaluation of sonographic breast lesions.

Materials and methods: We conducted a retrospective study exploring US BI-RADS in 1469 breast lesions of 1201 patients who underwent minimal invasive breast biopsy (MIBB) from January 2002 to December 2011.

Results: The overall sensitivity and specificity of BI-RADS classification was 97.4% and 66.4%, respectively, with a positive (PPV) and negative predictive value (NPV) of 65% and 98%. In 506 BI-RADS 3 lesions, histology revealed 15 breast cancers equaling a false-ne-gative rate (FNR) of 2.65%. Clinical evaluation and patient request critically influenced further diagnostic procedure, thereby prevailing over the recommendation of BI-RADS 3 classification.

Conclusion: Clinical criteria including age, family and personal history, clinical examina-tion, mammography and patient choice ensure adequate diagnostic procedure in pati-ents with lesions classified as BI-RADS 3.

Jahreskongress / Congrès annuel gynécologie suisse 2016 Posterpräsentationen / Présentation des poster P-IV/40

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P IV/ 41

Elastography Complements Ultrasound as Principle Modality in the Assessment of Breast Lesions

Author: 1) Redling K., 1) Schwab F.D., 1) Siebert M., 2) Schötzau A., 1) Zanetti Dällenbach R.Hospital: 1) Gynecology and Obstetrics, 2) Statistics, Gynecology and Obstetrics/ 1,2 University Hospital Basel

Introduction: In recent years, real-time elastography (RTE) has received increasing atten-tion as a non-invasive diagnostic procedure. In RTE, the stiffness differences between the lesion and the surrounding tissue produce a color-coded image that is superimposed on the B-mode image of conventional US. The Tsukuba elasticity score (TS) provides a quali-tative (TS 1 or 2 benign, TS 3 probably benign, TS 4 or 5 malignant) and the strain ratio (SR) a quantitative (high SR malignant, low SR benign) assessment of breast lesions. The aim of our study was to evaluate the sensitivity and specificity of breast US, RTE and SR.

Materials and methods: We conducted a prospective study from August 2009 – Decem-ber 2012. Women who were scheduled for US-guided invasive breast biopsy at our outpa-tient breast clinic were asked to participate. They received a clinical breast examination, bilateral whole breast US, RTE of the lesion, and finally, an US-guided breast biopsy.

Results: 156 patients with 164 breast lesions were enrolled. Patient age ranged from 18 to 89 years with a mean of 50.3 years. Women with benign lesions had a mean age of 43.1 ye-ars and were significantly younger than those with breast cancer who had a mean age of 61.2 years. Histology revealed 61.6% benign lesions and 38.4% breast cancer. The final BI-RADS assessment was BI-RADS 3 in 51.8%, BI-RADS 4 in 26.8%, and BI-RADS 5 in 21.4%. Be-nign lesions had a mean TS of 2.05, which was significantly lower than the mean TS of 3.25 for malignant lesions. The SR for benign lesions was 1.83 and significantly smaller than for breast cancer with 4.83. BI-RADS classification showed a sensitivity of 95% and a specificity of 81%. The positive (PPV) and negative predictive value (NPV) was 76% and 96%. For the TS, the sensitivity and specificity were 39% and 94%, with a PPV and NPV of 82% and 71% when TS 1 to 3 was considered benign and 4 to 5 malignant. For the SR, the cut off was set at 2.5, resulting in a sensitivity of 83% and specificity of 57%, a PPV of 75% and a NPV of 68%. The combination of BI-RADS classification, TS and SR yielded a sensitivity of 85%, a specificity of 95%, a PPV of 97% and an NPV of 80%.

Conclusion: Our study corroborates the effective diagnostic performance of breast US. By combining BI-RADS classification with TS and SR, specificity and PPV increased, while sen-sitivity and NPV decreased. We conclude that RTE is a non-invasive procedure that com-plements US in the characterization of breast lesions.


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P IV/ 42

Multidisciplinary case conferences improve patient care: effects on decision making in the Breast Unit in Lucerne

Author: Masciocchi M., Brühlmann E., Bucher S., Günthert A., Schwedler K.Hospital: Breast Unit, Lucerne Cantonal Hospital

Introduction: Breast Cancer is a complex disease and it is well known that a multidisci-plinary approach is critical in optimizing patient care. Although regular multidisciplinary conferences are common in most major academic institutions, this approach is not univer-sal in common-base settings. The aim of this study is to access the impact of a multidisci-plinary conference in changing the management plan initially proposed by smaller net-work partners.

Material and methods: In the Breast Unit of Lucerne Cantonal Hospital a weekly multi-disciplinary case conference is scheduled. All breast cancer patients are presented and the management plan is discussed together with gynaecologists, oncologists, patholo-gists, radiologists, radiation-oncologists and breast care nurse. We reviewed more than 400 cases presented in 2015 by the 7 Network partners who participate to this case con-ference. Each reviewed case was assigned to 1 of 3 categories (concordant, discordant, no proposal) based on the concordance between the management plan initially proposed and finally established in the conference. Changes in management that were considered significant included different recommendations for surgery, oncological or radiation ther-apy or follow-up.

Results: Between January and December 2015 more than 400 cases were presented by network partners and discussed at the conference. Almost half of these cases had a signif-icant change in the management recommendations. This concerned particularly patients with challenging diagnostic or management issues. We classified the reasons for a change in the plan (radiology, pathology review or both); further we have analysed the manage-ment changes in detail (surgical plan, oncological therapy, radiation therapy or in the fol-low-up).

Conclusion: Our weekly multidisciplinary breast conference impacted patient manage-ment in a significant manner. These results support the need to incorporate a weekly mul-tidisciplinary breast case discussion into routine practice so that all breast cancer patients could be provided the same quality of care, both in district hospitals and in tertiary refer-ral institutions. Such a conference optimizes patient care by avoiding unnecessary surgical interventions and recommending the best treatment following the updated international guidelines personalized for each patient by a specialized multidisciplinary team.


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P IV/ 43

Concordance of immunohistochemistry in core needle biopsy and surgical specimen in invasive breast cancer

Author: Hecht C., Knabben L., Strahm K., Sager P., Mueller M.D.Hospital: Obstetrics and Gynecology, University Hospital Bern

Introduction: Recommendations for adjuvant treatment in breast cancer are mainly based on the biological features of the tumor according to the classification in molecular subtypes (St. Gallen 2011). Immunohistochemical (IHC) evaluation on core needle biopsy is essential to guide further treatment. Few studies analyzing concordance of biological characteristics in core needle biopsy (CNB) and surgical specimen (SS) exist but there is a lack of clear guidelines. The aim of our study was to determine the concordance of histol-ogy and IHC in CNB and SS in patients with invasive breast cancer.

Material and methods: Retrospective analysis of data from patients with primary diag-nosed breast cancer at the university hospital of Berne between 2013 and 2015. We in-cluded all patients with complete immunohistochemistry from CNB and SS. Patients with neoadjuvant treatment were excluded. Molecular subtypes were classified according to the St. Gallen breast cancer consensus of 2011. Statistical analysis was performed with GraphPad Prism 5. Concordance was analyzed using the kappa test.

Results: A total of 84 patients with a mean age of 60.3 years (32-91) were eligible for this study. Concordance analysis of receptor status revealed very good concordance for ER and PR expression with an observed agreement of 97.62% (κ 0.896) and 94.05% (κ 0.834), respectively. Less agreement but still good concordance was found for HER-2 receptor status (κ 0.783). Agreement of Ki67 was also very good (91.03%, κ 0.817). Regarding the molecular subtypes we found differences between CNB and SS in 15 (17.9%) patients. In 7 cases the tumor was reclassified from Luminal A in CNB to Luminal B in SS, in 5 cases from Luminal B to A, in one case from Luminal B to Her-2 positive, respectively from Her-2 positive to Luminal B and from triple negative to Luminal A. Overall agreement for molecular subtypes was 82.14% (κ 0.697). Comparing the subgroup of patients with a reclassification of molecular subtype in SS to those without, there was no difference in age, menopausal status, surgery, tumor size and lymph node status.

Conclusion: We found a good concordance of receptor status and Ki67 in CNB compared to SS. But in 17.9% of the patients reassessment of IHC on the SS lead to a reclassifica-tion of molecular subtype and thereby a possible change in adjuvant treatment. Although there are no guidelines on the topic, our study suggests that the immunohistochemical evaluation of the surgical specimen seems to be imperative.


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P IV/ 44

Ovarian cancer in Switzerland: Epidemiology, inpatient treatment and costs

Author: 1) Wieser S., 1) Schmidt M., 2) Heinzelmann V.Hospital: 1) Winterthur Institute of Health Economics, 2) Gynecology and Gyneco-Oncology, University Hospital Basel

Objective: To estimate the incidence of ovarian cancer (OC) in Switzerland, assess the trends in inpatient care of OC and calculate the corresponding costs.

Methods: We carried out a retrospective analysis of a hospital registry covering all inpa-tient care episodes in Switzerland between 1998 and 2012. The registry tracks patients over time and across hospitals. Incidence of OC was assessed by identifying patients with a first OC main diagnosis after an event-free period. Foreign residents were excluded from incidence calculation. We assessed the duration and costs of OC treatment sequences as well as the evolution of hospital patient volume over time.

Results: We found an average age-adjusted incidence rate of 14.6 per 100’000 women per year between 2004 and 2012. This incidence rate is substantially higher (+29.3%) than the corresponding rate published by the Swiss Cancer Registry. The average length of the treatment sequence was 134 days and the average costs were 22’246 Swiss Francs. Hos-pital patient volume was low in most hospitals with more than 40% of patients treated in hospitals with less than 20 cases per year. However, the share of patients treated in hospi-tals with more than 30 cases has increased substantially since 2009 and reached a share of nearly 50% in 2012.

Conclusions: We find a substantial difference between our OC incidence estimation and the corresponding estimate by the Swiss Cancer Registry. This difference is likely to be the result of an underestimation of the true OC incidence by the Cancer Registry as our esti-mate follows a conservative approach and is based on a hospital with virtually complete coverage. The low OC patient volume in many hospitals questions the adequacy of care in these hospitals. The recent increase of patient volume in specialised hospitals may be due to increased competition between hospitals driven by chances in hospital regulation and reimbursement regimens.


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P IV/ 45

Trophoblastic Disease Center: an activity report

Author: Undurraga Malinverno M., Meyer-Hamme U., Rosseel G., Petignat P.Hospital: Gynecology and Gyneco-Oncology, University Hospital Geneva

Introduction: Trophoblastic diseases are rare diseases, with 150 new cases per year in Switzerland. They are considered orphan diseases, which means that often their treat-ments do not meet the latest recommendations. In 2009, a Trophoblastic Disease Center (www.mole-chorio.ch) was created in the Geneva University Hospitals (HUG) in collabora-tion with the CHUV, Lausanne in order to optimize their management.

Materials and methods: The goal of the center is to help physicians optimize the diagno-sis, treatment and follow-up of patients with this pathology. Individual cases are reported on a voluntary basis by gynecologists or family doctors in French, Italian or German. The patient is followed by her physician and does not need to be referred to the center. Once patient consent is given, pathology is reviewed and a report with advice on treatment and follow up is sent to the physician.

Results: A total of 248 patients were registered in our database between January 2009 and October 2015. After pathological review, we confirmed the final diagnosis of tropho-blastic disease in 88% of cases with a change in diagnosis in 25% of cases (Fig.1). When pathological review established a change in diagnosis, a change in the therapeutic ap-proach was proposed in 72% of patients. A total of 34 cases trophoblastic neoplasia were diagnosed. Most registered cases originated from western Switzerland, where more than 80% of incident cases were announced (Fig 2).

Conclusions: In French-speaking Switzerland, we have created an efficient network of col-laboration, with inclusion of the majority of incident cases of trophoblastic disease in our database. Similar centers in the German and Italian-speaking cantons would provide a complete coverage of Switzerland thus improving management of this rare disease.


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P IV/ 46

Low MGAT3 expression is a marked finding in long-term survivors with high grade serous ovarian cancer

Author: 1) Kohler S., 1) Anugraham M., 1) Núñez López M., 1) Xiao Ch., 1) Schötzau A., 2) Hettich T., 2) Schlotterbeck G., 1) Fedier A., 1,3) Heinzelmann V., 1,4) Jacob F.Hospital: 1) Ovarian Cancer Research, Biomedicine, 2) School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, 3) Hospital for Women, Gynecology and Gynecological Oncology, 4) Glyco-Oncology Group, Ovarian Cancer Research, Biomedicine/ 1,3,4 University Hospital Basel, University Basel

Introduction: MGAT3 gene expression is implicated in oncogenic E-cadherin-, EGF-, Wnt-, and in-tegrin-signaling pathways. We have recently shown that its expression correlated with the pres-ence of bisecting GlcNAc on N-glycoproteins in ovarian cancer cells, as it is responsible for the enzymatic attachment of bisecting GlcNAc to N-glycoproteins. MGAT3 gene is encoded by two ex-ons, both flanked by high-density CpG islands. However, it is unknown (i) how MGAT3 expression is regulated, (ii) whether DNA methylation, MGAT3 expression, and bisecting GlcNAc presence are functionally linked, and (iii) whether MGAT3 expression has any predictive value.

Material and methods: DNA methylation at the transcription start site and MGAT3 expression were analyzed for different cancer types using the TCGA dataset. Bisecting GlcNAc on cancer cells was detected by mass spectrometry (UHPLC-ESI-MS/MS). Detailed CpG-island and regulatory ge-nomic region analysis was performed using four different web-based bioinformatic engines and MGAT3 reconstitution after DNA methyltransferase inhibition by 5-Aza was determined by RT-qPCR.

Results: Bioinformatical analysis of the TCGA dataset (n=6118 samples) revealed a longer over-all survival in cancer patients with reduced MGAT3 expression. This was particularly dramatic in a subgroup of high-grade serous ovarian cancers, thus identifying a set of long-term survivors. We also targeted a genomic region encompassing exon 1 and containing 37 CpGs (30 upstream and 7 downstream of the transcription start site (TSS). This anticipated key regulatory region is poorly methylated (=hypomethylated) in OVCAR3 and A2780 ovarian cancer cells associated with elevated MGAT3 expression but is highly methylated (=hypermethylated) in normal ovarian sur-face epithelial (HOSE) cells associated with absence of MGAT3 expression. 5-Aza treatment recon-stituted MGAT3 expression not only in HOSE cells, coinciding with reduced DNA methylation at MGAT3 TTS. It also reconstituted MGAT3 expression in hypermethylated OVCVAR8 cells and this, notably, coincided with re-expression of bisecting GlcNAc on N-glycoproteins. TCGA dataset con-firmed the regulatory impact of DNA methylation on MGAT3 expression in 18 different TCGA can-cer types.

Conclusion: Low MGAT3 expression is a predictive marker in all cancers but specifically for long-term survivors of ovarian cancer. This effect might be caused by epigenetic silencing of the MGAT3-bisecting GlcNAc axis, which could be used therapeutically.


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P IV/ 47

Myoma migration: An unexpected “effect” with ulipristal acetate treatment

Author: 1) Willame A., 1,2) Marci R., 1) Petignat P., 1) Dubuisson J.Hospital: 1) Gynecology and Obstetrics, University Hospital Geneva, 2) Department of Morphology, Surgery and Experimental Medicine, Section of Gynecology and Obstetrics, University of Ferrara, Italy

Introduction: Uterine myomas are one of the most common benign tumours, occurring in 20-40% of women of reproductive age. Ulipristal acetate (UPA) is a possible option for medical treatment of myomas. It induces amenorrhea and can reduce myoma volume be-fore surgical treatment. Since its introduction in our department, we uncovered an un-known effect: migration of myoma.

Clinical case reports: We describe three clinical case of myoma migration following three months UPA pre-operative treatment. The first woman presented with a FIGO 2 myoma, which migrated in FIGO 3. A previously planned hysteroscopy converted into a laparos-copy. The second woman also presented with a FIGO 2 myoma, which migrated in FIGO 3. Initially a hysteroscopy was planned, but ultimately surgery was no longer required. The third woman presented with a FIGO 2-5 myoma, which migrated in FIGO 1. The previously planned laparoscopy converted into a vaginal myomectomy.

Discussion: UPA induces a proapoptotic and anti proliferative effect of leiomyoma cells. It reduces expression of VEGF and reduces collagen deposition in the extracellular matrix. These mechanisms could induce migration of myoma.

Conclusion: UPA as pre-operative treatment can induce migration of myoma and there-fore can lead to perioperative conversion of surgery.


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P IV/ 48

Cervical cancer screening in Cameroon: Feasibility of a single-visit approach using rapid HPV-testing

Author: 1) Kunckler M., 1) Schumacher F., 2) Kenfack B., 1) Catarino R., 1) Viviano M., 3) Tincho E., 3) Tebeu P.M., 4) Bongoe A., 5) Vassilakos P., 1) Petignat P.Hospital: 1) Obstetrics and Gynecology, Gynecology Division, University Hospital Geneva, 2) Obstetrics and Gynecology, Hospital District of Dschang, Cameroon, 3) Faculty of Medicine and Biomedical Sciences and Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon, 4) Obstetrics and Gynecology, Hospital of Edea, Cameroon, 5) Geneva Foundation for Medical Education and Research

Background: Cervical cancer (CC) is the leading cause of cancer death among women in sub-Saharan Africa. Rapid human papillomavirus (HPV) tests offer the opportunity to screen and treat in a single visit. Our aim was to assess the feasibility and safety in prevent-ing CC by means of rapid HPV testing in a low resource context.

Methods: One thousand and twelve women aged 30 to 49 years were recruited through a cervical cancer screening campaign conducted in the District Hospital of Dschang, Camer-oon. Each woman performed a self-sample, which was tested for the presence of high-risk HPV (HR-HPV) DNA using a point-of-care HPV-test. All HPV-positive women were invited for visual inspection with acetic acid and lugol (VIA/VILI). Women positive for HPV 16, 18 or 45 and/or women with pathological VIA/VILI received cold-coagulation treatment. Quality control was assessed using histology of abnormal results, and a set of digital photographs of the cervix. Data were analyzed with a statistical analysis software package (STATA).

Results: The median age of the participants was 39.6 years (± 5.6). The average number of children and pregnancies per woman was 4.5±1.9 and 5.5±2.3, respectively. HR-HPV prevalence was 18.5% (n=187). Stratified by genotypes, 20 (10.6%) samples were posi-tive for HPV16, 42 (22.3%) for HPV18/45 and 140 (74.9%) for other HR-HPV types. A to-tal of 185 patients underwent VIA/VILI examination. Overall, 107 (57,8%) VIA were classi-fied as pathological and 78 (42,2%) as normal. When HPV16 infection was present, 85% of VIA examinations were classified as pathological. A total of 121 women were treated with cold-coagulation.

Conclusions: Our results support the great potential of a single-visit screen-and-treat ap-proach in low resource settings using point-of-care HPV testing. This strategy increases programme effectiveness and reduces loss of follow up.


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P V/ 50

Progesterone measurement before oocyte pick-up. Useful or not?

Author: Esber H., Peric A., Dhakal C., Weiss JM.Hospital: Cantonal Hospital Lucerne

Introduction: In stimulated cycles for assisted reproduction an elevated progesterone (>1.5 ng/ml) at the day of triggering the final oocyte maturation is increasingly used to postpone embryo transfer because of a potentially unfavourable effect on the endome-trium. Controversy exists whether this test is bene-ficial. Here we tested, whether in our setting progesterone tested prospectively at the trigger day is useful to decide for fresh or postponed frozen-thawed embryo transfer.

Material and methods: All stimulated cycles of 2015 with progesterone measured at the trigger day (n=165) were included in this analysis. Women were stimulated with 125-300 IE gonadotrophins in a fixed antagonist pro-tocol. Ovarian stimulation was monitored by ultrasound. Progesterone at the trigger day was de-termined by a electrochemilumines-cence immunoassay with a lower detection limit of 0.03 ng/ml. Progesterone levels above 1.5 ng/ml led to the recommendation to freeze all pronuclear stages.

Results: The mean progesterone level was 0.83 ng/ml (SD: 0.41 ng/ml). In only 4 cases (2.4%), progester-one levels were above 1.5 ng/ml. The highest progesterone of 3.4 ng/ml had a 45 year old women with 2 MII oocytes getting pregnant after fresh transfer. Since progesterone was higher than 1.5 ng/ml the patient chose fresh transfer against our rec-ommendation. Two times our pre-defined criterion for freezing all embryos (>19 follicles > 10 mm at the last ultrasound check-up) to avoid ovarian hyperstimulation syndrome was fulfilled. Progesterone levels were 2.2 ng/ml and 2.1 ng/ml, respectively. In only 1 case a progesterone of 2.4 ng/ml led to the decision to freeze all embryos. The number needed to diagnose was 165.

Conclusion: In our setting progesterone levels at the trigger day did not add any benefit to the question whether to perform a fresh or frozen-thawed embryo transfer. The mea-surement of progesterone at the trigger day can therefore be abandoned in our clinic. It is not clear whether this finding is general-izable to other clinics.

Jahreskongress / Congrès annuel gynécologie suisse 2016 Posterpräsentationen / Présentation des poster P-V/50

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P V/ 51

Waddlia chondrophila: a novel agent of male infertility?

Author: 1,2) Stojanov M., 1,2) Gyger J., 3) Castella V., 4) Vulliemoz N., 1,2) Baud D.Hospital: 1) Materno-fetal and Obstetrics Research Unit, Department “Femme-Mère-enfant”, Maternity, 2) Institute of Microbiology, Faculty of Biology, 3) University Center of Legal Medicine, 4) Reproductive Medicine Unit, Department “Femme-Mère-enfant”, Maternity/ 1-4 University Hospital Lausanne

Introduction: Intracellular bacteria, which fail to grow on media used routinely to iso-late human pathogens, could represent yet unrecognized agents of infertility and mis-carriages. Similarly to Chlamydia spp., Waddlia chondrophila is an emerging intracellular pathogen that has been associated to adverse pregnancy outcomes both in humans and animals. Our recent observations indicate that seroprevalence of anti-Waddlia antibodies is higher in male patients from couples with infertility problems, suggesting that this bac-terium might play impact reproduction in humans.

Material and methods: We established an in vitro model of infection of human sperma-tozoa, which were incubated with Waddlia at a multiplicity of infection of 10. Controls in-cluded filtrate of cell culture used to grow Waddlia (mock) and latex beads with similar size to bacteria (0.6 μm). Attachment to spermatozoa and internalization of Waddlia was mon-itored by confocal microscopy using a specific antibody. Viability of spermatozoa was as-sessed with flow cytometry using the LIVE/DEAD Sperm Viability Kit on previously fixed samples. The amount of bacteria was monitored with a specific quantitative RT-PCR.

Results: Using confocal microscopy we observed that, despite multiple washing steps, Waddlia was able to attach to spermatozoa. However, internalization and replication of bacteria were not observed. Presence of Waddlia decreased significantly viability of sper-matozoa, with almost a 2-fold increase compared to control at 72 h post-infection (32% versus 18%). Decrease of viability was not observed for spermatozoa incubated with mock or latex beads.

Conclusions: We showed in this study that Waddlia had a negative impact on spermato-zoa viability. Bacteria were observed in close contact with spermatozoa membrane, sug-gesting the presence of specific interactions. Internalization was not observed and is in agreement with the absence of bacterial replication (determined by Waddlia DNA quan-tification). Future analysis will focus on the impact of Waddlia on spermatozoa motility, a key parameter for the evaluation of sperm quality. Moreover, specificity of the Wad-dlia-spermatozoa interaction will be analysed at the molecular level, with the goal to de-termine specific receptors involved in the attachment process. Taken together, our data suggest that Waddlia might be associated with fertility impairment in men.


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P V/ 52

Prenatal screening for cardiac malformation in the referring area of the university hospital of Bern

Author: Nauwerk M., Rovina L., Pfammatter J.-P., Pavlovic M., Hofstaetter C., Kadner A., Raio L., Hutter D.Hospital: University Hospital Bern

Introduction: The prevalence of congenital cardiac malformation in Switzerland and worldwide is <1%. 25% are severe cardiac malformation (need an operative correction in the first year of live) and are responsible for 50% of neonatal mortality. The screening is based on prenatal diagnosis and postnatal post ductal pulse oximetry. The aim of our study is to assess the prevalence of cardiac malformation and the efficiency of the prena-tal diagnostic. Of note, ultrasound screening in Switzerland is almost universal.

Materials and methods: We analyzed the data retrospectively over a five years period (July 2009 to December 2014). We compare all children with a prenatal diagnosis of car-diac malformation with children that have had heart operation in the first year of live at the university hospital of Bern. Exclude were children with minor cardiac malformations like persistent ductus arteriosus, kinking of ductus arteriosus or transient tricuspid insuffi-ciency. We looked at the quality of prenatal screening.

Results: 339 children were included. 173 (51%) had a prenatal diagnosis of cardiac mal-formation, 166 were diagnosed postnatally. 106 children were diagnosed prenatally and treated postnatally at the university of Bern. Prenatal diagnosis was partially or totally cor-rect in 67 children (63.2%). In 39 cases the prenatal diagnosis was not correct. In this last group a majority of malformations concerned the aortic arch and the septum (like ven-tricle septum defect). Genetic testing was performed in 276 children. 185 with a normal karyotype and 91 with an aneuploidy.

Conclusion: We have a remarkably high detection rate for congenital cardiac malforma-tion compared with international data. The better quality of ultrasound machines ant the better formation of gynecologist could explain this result.


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P V/ 53

First trimester delta-Placental like growth factor (Δ-PlGF): a possible dynamic marker for preeclampsia

Author: Mosimann B., Amylidi-Mohr S., Wiedemann U., Risch L., Surbek D., Raio L.Hospital: Obstetrics and Gynecology, University Hospital Bern, University Bern

Introduction: PlGF is nowadays widely used in combination with maternal, biochemical and sonographic markers to screen for placental induced pregnancy complications such as preeclampsia (PE), and intrauterine growth restriction (IUGR) between 11 and 14 weeks of gestation. The aim of this study was to test whether PlGF assessed at an earlier gesta-tional age is similarly able to discriminate between normal and abnormal pregnancy out-come.

Material and method: Pregnant women with singleton pregnancies where PlGF was as-sessed between 8 and 14 weeks from January 2014 to December 2015 were included in this study. PlGF was measured with the Kryptor Immunoassay Analyzer (Brahms, Berlin, Germany). Absolute values were analysed using linear regression models. We used Graph Pad 5 for Window for statistical analysis.

Result: During the study period 1069 first trimester PlGF assessments have been per-formed. Of those, pregnancy outcome is available of 542 (50.7%) cases. Women with ges-tational diabetes (71), late miscarriage (6), preterm deliveries (32), and small for gesta-tional age neonates <5%ile (22) were excluded, leaving 402 uneventful pregnancies and 9 women who developed PE. PlGF increases significantly from 8 to 14 weeks gestation (r2=0.31; p<0.0001) while in pregnancies complicated by a latter PE no such dependency is detectable (r2=0.012, p=0.78). Of note, in 147/402 normal, and in 4/9 PE cases 2 first tri-mester measurements were available. Δ-PlGF value in PE and in those with uneventful pregnancies was 0.45pg/ml/d and 1.02pg/ml/d, respectively (p=0.09).

Conclusion: PlGF can be measured from 8 weeks onwards and in normal pregnancies in-creases steadily with gestational age. Its discriminatory capability between pregnancies with normal and adverse outcome is low before 11 weeks. However, although our results are based on a limited number of cases, Δ-PlGF as a dynamic marker may be of particular interest in first trimester PE-screening. Further studies will follow focusing on this finding.


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Absolute and relative indication for cerclage: is there a difference in the sonographic behaviour of the cervical length during pregnancy?

Author: Bolla D., Schöning A., Bärtschi C., Papadia A., Raio L.Hospital: Obstetrics and Gynecology, University Hospital Bern

Introduction: Randomized studies have shown that in properly selected patients a vagi-nal cerclage (VC) can reduce the risk of preterm delivery. Traditionally the indication for VC is based on a history of poor pregnancy outcome. However, the dogma “once a cerclage al-ways a cerclage” seems not be justified. Indeed, studies have shown that only a small part of women need a VC if the cervical length (CL) is monitored by transvaginal sonographic (TVS) in a subsequent pregnancy. The aim of our study is to evaluate the TVS behaviour of the CL after VC.

Methods: A retrospective study was conducted, including all women who had a VC with different indications between January 2010 and November 2015. This cohort was subdi-vided in two groups, absolute (A) and relative indication (B) for VC. Absolute indications consisted of cases with classical poor obstetrical history with and without shortening of the CL during pregnancy. All other indications were classified as relative. Exclusion crite-ria were twins or prolapsed membranes trough the cervical channel. The entire CL as well as the distance from the tape to the external cervical ostium was measured longitudinally. Data analysis was performed using Prism 5 for Mac OS X.

Results: During the study period 32 cases were included. Mean gestational age at VC was 18.3±3.5 weeks. Fourteen cases were included in group A, and 18 patients in group B. The CL before and after surgery did not show significant differences between the groups (be-fore: A 23.3±10.9 vs. B 26.43±10.9; p=NS/ after: A 27.3±11 vs. B 27.8±6.5; p=NS) as well as the position of the tape within the cervix (A: 11.89±3.4 vs. B: 12.12±3.19; p=NS). During the follow up a significant shortening of the CL starting from the isthmo-cervical area was ob-served in both groups. At the end of the follow up in group A the CL diminished until the tape while in group B the CL remained longer without reaching the cerclage (p=0.001).

Conclusions: The cervix of patients with a classically indicated VC is – in contrast to that seen in group B – characterized by a progressive cervical shortening until the tape. This different behaviour of the CL after cerclage may be useful in counselling patients and probably avoiding unnecessary surgeries in a subsequent pregnancy.


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Low-dose oral misoprostol for labour induction

Author: Vanetti A., Lipp von Wattenwyl B., Canonica C.Hospital: Gynecology and Obstetrics, Regional Hospital Bellinzona e Valli

Introduction: Off-label use of misoprostol for labour induction is known for its effective-ness, safety and low cost with different administration protocols. As suggested by the WHO owing to concerns about the risk of uterine hyperstimulation with vaginal misopros-tol, more recent trials have focused on the oral route for misoprostol administration. A re-duced risk of caesarean births and a lower risk of Apgar score below 7 at 5 minutes of life were observed. Therefore we switched from vaginal to oral application with a «low-dose» oral regimen.

Materials and methods: Retrospective cohort of induced deliveries between 37-41 weeks of gestation presenting with a Bishop score ≤6 using 25mcg misoprostol po four-hourly, maximal 8 dosages was analysed. A second cycle could be added in case of induction fail-ure. The primary outcome variable was induction to delivery time resp. to active labour. After reaching a Bishop score ≥8 patients continued labour spontaneously or with intra-venous oxytocin supply.

Results: 121 patients were included from 01.01.2014 to 30.06.2015. Mean time from in-duction to active labour or Bishop Score ≥8 was 30h, mean time to delivery 34h. 103 pa-tients (85%) had a clinical response within the first cycle with an average time of 20.2h until active labour and of 25h until delivery. 18 patients (14%) added a second cycle with resp. 86h and 89h. Induction failure rate was 6.6% and labour dystocia 6.4%. The overall caesarean section (CS) rate was 13% (8 in the first and 8 in the second cycle group). De-livery occurred within 48h in 79% of patients. Mean time to active labour was decreased for multiparous vs nulliparous women (22h versus 33h). Indication for induction (PROM, postterm pregnancy, IUGR oligohydramnios or preeclampsia) had a significant influence on time to active labour, whereas no difference could be found regarding gestational age at induction (32h <40weeks, 29h ≥40weeks). We didn’t observe any case of hyperstimula-tion.

Conclusions: Still unlicensed in Switzerland oral «low-dose» misoprostol is a safe, effec-tive and cheap method. We did not have any single case of hyperstimulation. 79% of all in-ductions achieved delivery within 48h corresponding to data from literature. In our data no benefit could be found regarding a second cycle of induction. The CS rate for failure of induction was below expectancy (13%). The oral route of administration shows greater ac-ceptability.


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Analysis of obstetrical factors among the hundred registered umbilical cord blood units with the highest stem cell count in the Cord Blood Bank Basel

Author: 1) Farina P., 1) Granado C., 1) Müller Borer D., 1) Hösli I., 2) Tsakiris D., 1) Manegold-Brauer G.Hospital: 1) Obstetrics and Gynecology, 2) Haematology/ 1,2 University Hospital Basel

Background: Umbilical cord blood (UCB) contains hematopoietic stem cells with ther-apeutic potential. Despite some crucial advantages of UCB compared to other stem cell sources only the minority of UCB donations actually contains sufficient hematopoietic stem cells to be valuable as a treatment to a patient. The most important HLA-indepen-dent factor for a hematopoietic stem cell transplantation (HSCT) is the total nucleated cell (TNC) number. It is known that some clinical parameters of the mother, the child and the delivery influence TNC count. Little is known about factors that lead to a TNC count above 250 x 10e 9/l (>99. percentile).

Study design and methods: We performed a retrospective data analysis including 2299 registered UCB units that were collected between 1997 and 2014. Differences in maternal, fetal and obstetrical factors were analyzed and compared between the 100 UCB units with the highest TNC count (Top100) and our previously published standardized general co-hort of 758 UCB units (cohort).

Results: The mean birth weight was 3748g (2750g-4630g) in the Top100 as compared to 3486g (4985g-2170g) in the general cohort. The mean gestational week at delivery was 40+3 weeks (36+4 SSW – 42+1 SSW) in the Top100 as compared to 40+0 weeks (33+2 SSW – 42+1 SSW) in the general cohort. The percentage of deliveries with a suspicious or pathological fetal heart rate tracing (CTG) was 65.7% (path. 27.3%, susp. 38.4%) in the Top100 as compared to 45.1% (path.17.0%, susp.18.1%) in the general cohort. As far as the mode of delivery is concerned in the Top100 37.0% had a spontaneous vaginal delivery, 52.0% had a vaginal-operative delivery, 1.0% had a primary Caesarean section and 10.0% had a secondary Caesarean section as compared to 61.1%, 24.1%, 8.7% and 6.1% in the general cohort. In the Top100 we found 41.0% with an umbilical artery pH <7.20 as com-pared to 22.7% in the general cohort.

Conclusions: Among the Top100 UCB units there is a trend towards higher TNC count in children with a higher birthweight, higher gestational week and lower umbilical artery pH. Fetal distress during labor, vaginal operative delivery and secondary Caesarean sections are favourable. However, it seems to be rather a combination of factors than one single factor leading to a TNC count above the 99th percentile.


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Audit of cesarean section rates using the 10-group classification system of robson in a university center

Author: Desseauve D., Baud D., Vial Y.Hospital: Obstetric, University Hospital Lausanne

Objective: Analysis the cesarean section (CS) rate using the 10-Group Classification Sys-tem (TGCS) as recommanded by WHO in order to identify the main contributors to the overall CS rate in a University Hospital in Switzerland and variations over time.

Study design: A descriptive retrospective study was conducted in an University hospital treating high risk pregnancies including all births that occured between 1 January 1997 and 31 december 2011. The data were collected from the hospital database. The CS rate were calculated and stratified according to the Robson classification. The system takes into consideration the following obstetrical characteristics : parity, gestationnal age, num-ber of fetuses (singleton or multiple), fœtal presentation, onset of labor and history of pre-vious CS. CS after induction of labor and elective cesarean are classified in separate sub-groups for group 2 and 4. The system of classification helps to identify the number of patients in each group and to determine the contribution of each group to the overall CS rate.

Results: A total of 32.368 births were collected over a period of 15 years. All deliveries above 24 weeks of gestation were included. The overall CS rate is 28.9%. There is a signif-icant increase in the CS rate from 21.3% in 1997 to 33% in 2011. According to TGCS, the main contributor to the overall rate is Group 5 (multiparous with previous cesarean scar and single cephalic pregnancy at term), followed by the Group 2 (all nulliparous with sin-gle cephalic pregnancy at term) and the Group 10 (all single cephalic premature pregnan-cies) , with respectively 6.1, 5.8 and 3.9% of the total of 28.9%. 4646 (47.5%) of all induced labor (9790) from the whole cohort was represented by nuliparous. Induction of labor on maternal request in nulliparous increased significantly the risk of CS by 10% compared to induction of labor in multiparous for same reason. Cesarean on maternal request was 1.7%.

Conclusion: The Robson classification as a simple tool for monitoring CS rates, is increas-ingly used by obstetric healthcare professionals worldwide. The main strategies for reduc-ing CS rates are through better selection of pregnant women with a history of previous CS for a trial labor and critical analysis of the indications of each case for induction of labor particularly in nulliparae.


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Tropical diseases like Zika, Ebola and Dengue in pregnancy: Does it matter in Switzerland?

Author: Gülmez H., Hösli I., Büchel J.Hospital: Obstetrics and Gynecology, University Hospital Basel

Introduction: Zika virus is a member of the Flaviviridae family, transmitted by mosquitoes and is currently a highly discussed topic in the media world. As fetal microcephaly cases are rising, particularly gynecologists are confronted with this disease. Beside Zika virus, professionals should not forget about the great variety of infectious diseases, which have become more important in our globalized world.

Material and methods: A 35 year old Indian woman GII PI presented at 28 gestational weeks with fever, headache, myalgia and shivering after a stay in Calcutta, East India. After a check-up, including a normal fetal ultrasound scan, the patient refused hospitalization. The following day she presented with a severe headache and fever, despite antipyretic medication. Abdominal ultrasound showed a mild splenomegaly. CTG and ultrasound scan were unsuspicious. The patient had a petechial rash on her chest, blood analysis re-vealed severe thrombocytopenia and elevated liver enzymes. According to the findings the most probable diagnosis appeared to be HELLP syndrome.

Results: Reassessment of the family history revealed new information about 4 cases of Dengue fever in their family in Calcutta that appeared shortly after the patient`s depar-ture. Dengue fever infection was then tested and confirmed in the pregnant woman. Symptomatic therapy of the hemorrhagic Dengue fever was continued, the fetal parame-ters were monitored with CTG and Doppler ultrasound. On day 3 the patient was apyretic, she left the hospital in a good condition on day 7.

Conclusion: The clinical outcome of Dengue infection can range from the mild form to a severe shock syndrome. The mortality rate for hemorrhagic Dengue Fever is about 5%. The initial phase is characterized by influenza-like symptoms. Treatment should include hydration and analgetic-antipyretic medication. The severity of the infection depends on hepatic transaminase levels and thrombocytopenia. In pregnant women the mimicry of HELLP Syndrome can lead to a misdiagnosis. Professionals should take into account tropi-cal Flaviviruses when a pregnant woman who has traveled to an endemic area suffers from influenza-like symptoms.


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Do mast cells and hyperinnervation contribute to symptoms in vulvovaginal lichen planus?

Author: 1) Regauer S., 2) Eberz B.Hospital: 1) Institute of Pathology, Medical University Graz, Austria, 2) General Gynecology Practice, Mürzzuschlag, Austria

Objectives: In contrast to lichen sclerosus, vulvovaginal manifestations of lichen planus (LP)are often extremely itchy and painful. Since mast cells (MC) and sensory hyperinner-vation / neuronal remodeling have been implicated in painful syndromes interstitial cysti-tis and vulvodynia, we were interested if increased MC and hyperinnervation are also fea-tures in vulvovaginal LP.

Methods: Formalin-fixed and paraffin-embedded biopsies of 46 patients with vulvovagi-nal LP were evaluated for MC with immunohistochemistry with antibodies to human mast cell tryptase, and for sensory innervation with antibodies to PGP 9.5.

Results: LP was classified on HE stained sections as highly active (10/48), advanced atro-phic or hypertrophic (32/48) and erosive (6/48). Mast cells in normal vulvar tissue and a control group of lichen sclerosus were typically below 15 MC/mm2. In 9/48 biopsies MC were identified at normal numbers <15 MC/mm2. Increased numbers with 16-50 MC/mm2 were identified in 23/48 biopsies and >50 (range 50-125) MC/mm2 in 16/48 biopsies. Ana-phylactic degranulation with most granules lying outside the cytoplasm of MC was iden-tified in 15/48 biopsies. Predominant piece-meal degranulation with most granules con-tained within the cell and only few granules outside the cytoplasm was identified in 33/48 biopsies. MC were common in areas of erosive LP, below the inflammatory lymphohistio-cytic infiltrate in active LP, and below the epithelium in advanced inactive disease. Biop-sies of patients with persistent complaints after a course of high potency corticosteroid therapy were devoid of lymphocytes but revealed increased MC counts. Increased sensory hyperinnervation was observed in 38 / 48 patients, which included increased density of subepithelial nerve fibers in 20/48 biopsies including the biopsies with erosive LP, intraep-ithelial nerve fiber extension in 18/48 patients, and abnormally thick subepithelial nerves in 8/48 biopsies.

Conclusion: Increased MC infiltrates and sensory hyperinnervation are common in biop-sies of vulvovaginal LP. MC contribute to nociceptive pain via cytokine secretion and direct stimulation of sensory nerves, but are involved also in promoting nerve proliferation, neu-ronal remodeling, and central pain processing resulting in so-called “neuropathic” pain. MC may therefore be alternative therapy targets in LP-patients with insufficient response to corticosteroid therapy. We therefore propose that LP patients with persistent symp-toms should be evaluated for MC and sensory hype.

Jahreskongress / Congrès annuel gynécologie suisse 2016 Posterpräsentationen / Présentation des poster P-VI/60

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P VI/ 61

The Role of Uterine Frozen Section in the Era of Sentinel Lymph Node Mapping in Low-Risk Endometrial Cancer

Author: Siegenthaler F., Papadia A., Imboden S., Mueller M.D.Hospital: Obstetrics and Gynecology, University Hospital Bern

Introduction: In endometrial cancer (EC), the most widespread method to tailor surgi-cal staging is intraoperative analysis of pathologic risk factors at frozen section (FS) of the uterus. Interest is shifting from this all-or-nothing approach to sentinel lymph node (SLN) mapping. Aim of the study is to evaluate the role of uterine FS in the era of SLN mapping.

Materials and methods: A retrospective analysis of all patients with complex atypical hy-perplasia (CAH) and low-risk EC undergoing SLN mapping at our institution between 2012 and 2016 with intraoperative bilateral SLN detection was performed. Patients underwent SLN mapping with cervical ICG injection followed by laparoscopic lymph node biopsy, to-tal hysterectomy (TLH) and bilateral salpingo-oophorectomy (BSO). FS of the SLNs was performed only in case of suspicion for metastasis. The uterus was sent to FS and based on identification of risk factors and clinical judgment, a laparoscopic pelvic (PLND) and/or paraaortic lymphadenectomy (PALND) was performed.

Results: Fifty-five patients were included in the study. For EC, preoperative grade was 1 and 2 in 16 and 35 cases respectively. Four patients had CAH. FIGO stage at final pathol-ogy was IA, IB, II, IIIC1 and IIIC2 in 37, 6, 2, 3 and 5 patients respectively. A TLH/BSO and SLN biopsy was performed on 33 patients, whereas 22 patients underwent the same surgical procedures followed by a PLND or PPALND. No intraoperative complications occurred. FS of the uterus was performed in 49 patients and was accurate in 29 of them. Eight patients had lymph node metastases and in all these cases SLN biopsy was positive. In 6 of these cases a FS of the lymph node was performed due to clinical suspicion. In the other two cases the SLNs looked normal and were not analyzed at FS. In both of these cases the FS of the uterus did not show risk factors suggesting a complete lymphadenectomy. In another case lymph node metastases were only recognized thanks to SLN biopsy, FS of the uterus and final pathology did not show any risk factors.

Conclusion: In the era of SLN mapping, FS analysis of the uterus may lose its importance. Ideally a full lymphadenectomy should be tailored based on lymph node status and not on risk factors of the uterus evaluated at FS. The back draught of omitting the intraopera-tive uterine evaluation is that a higher number of patients will need a second procedure, although this was not the case in our series. On the other hand, a larger number of full lymphadenectomies will be avoided.


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P VI/ 62

Cost benefit in robotic gynecologic surgery in a university hospital setting

Author: Kavvadias T., Egg R., Zanetti Dällenbach R., Heinzelmann V.Hospital: Gynecology and Gyneco-Oncology, University Hospital Basel

Introduction: Robotic surgery has been established for several years with 27 robotic sys-tems being placed throughout Switzerland. Although showing initially some benefit on blood loss and hospital stay, the acquisition and maintenance costs as well as the longer operating time have been its main points of criticism. Here we examined the extent of possible optimization in order to make this system potentially attractive for a university hospital setting.

Materials and methods: Since end of 2012 with the implementation of the robotic sur-gery in our gynaecological department we established a strict 6-step optimization pro-tocol in order to standardize robotic surgery. This included the assignment of a clearly defined dedicated interprofessional team, consisting of only 2 senior surgeons and 2 ex-perienced Da Vinci Nurses as well as the standardisation of every procedural step. We then performed a prospective observational study examining all robotic gynecological proce-dures, including docking time, operating time, hospital stay, complications and blood los-sand compared the data to conventional laparoscopic hysterectomies.

Results: The indication for robotic surgery in our hospital is: large fibroid uterus, heavily overweight patients and gynaecological cancers of the endometrium and cervix. During the period from February 2013 until October 2015 we performed a total of 180 robotic lap-aroscopical procedures. There was a reduction in docking time of 75% (from 59.5+/-28.0 minutes to 15.0 +/- 5.0 minutes) and in operating time of 29% (from 243.0 +/- 71.5 minutes to 171.4 +/- 65.2 minutes). The benefit of both times did not change when a third consul-tant was implemented into the surgical team. In patients who underwent hysterectomy for benign diagnoses, operative time was less with the robotic laparoscopy group: 135 minutes (range 75 to 370) versus 145 minutes (range 70 to 295); these patients also had a shorter hospital stay (3.6 vs. 4.1 days).

Conclusion: With our clear 6 step standardization and dedicated team protocol we achieved an impressive reduction of docking and operative time, which was also shorter, when compared to conventional laparoscopy despite the more complex clinical situation in these patients. This is an example for the possible reduction of the overall high costs of robotic procedures.


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Evaluation of uterine myomas using the leuven score (LS) as a predictor of sarcoma: a retrospective analysis

Author: Knipprath-Mészáros A.M., Manegold-Brauer G., Butenschön A., Heinzelmann V.Hospital: Gynecology and Oncology, University Hospital Basel

Introduction: Uterine fibroid is a very common feature, with 50% occurence for women at age 50. Despite new conservative options (hormone treatment, fibroid embolization), hys-terectomy remains the main therapy worldwide. The development of fibroid morcellation has enabled the removal of large uteri via minimal invasive surgery. However, the dramatic development of the disseminated disease in case of sarcoma morcellation, even if rare (1/352 hysterectomies for presumed leiomyomas), has led the FDA to no longer recom-mend it. In turn this leads to more invasive procedures with higher morbidity and costs. To date, there are no reliable criteria permitting the distinction between benign fibroid and sarcomas. This study aims to analyze whether the Leuven score (LS) permits a classification in high- and low risk clusters and helps in choosing the best surgical procedure.

Material and methods: In literature, the LS, involving 6 sonographic criteria of the fi-broids (past 3 months growth, high blood flow, atypical growth (postmenopause), irregu-lar lining, central necrosis and oval solitary lesion), has been considered. The evaluation of the criteria is binary, i.e. the score can range from 0 to 6. We retrospectively applied the LS for all uterine sarcoma with uterine fibroid from 2002-2015. For the control group, we an-alyzed all benign uterus myomatosus operated between 01/2013-06/2015. The LDH-Level was also assessed.

Results: The study included 7 patients with uterine sarcoma and 27 with benign myomas. About 50% of uterine sarcoma did not show fibroids, and were excluded from the study. 81% of the patients with leiomyomas showed a negative LS, and only one patient with sar-coma showed a negative score, which represents a NPV of 95.6%. The PPV was 54.5%. Nei-ther the size of the myoma or the uterus, nor the LDH-level was significantly different in both groups. 85% of the women with sarcomas were postmenopausal (vs 18.5% in con-trols) and only 50% of them showed bleeding, while 74% of premenopausal women with benign myomas had dysfunctional uterine bleeding.

Conclusion: The use of the LS could help to distinguish between benign uterus myomato-sus and sarcoma, with a high probability of a benign histology if the score is negative. Cau-tion is required when ≥ 1 criteria is present. In those cases, we do not recommend mor-cellation. We now use the LS routinely and will continue the analysis prospectively, while evaluating additional criteria which could improve the sensitivity and specificity of the score.


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P VI/ 64

Long-term Outcome of HER2-positive Metastatic Breast Cancer: A Retrospective Analysis

Author: 1) Bringolf L., 2) Pestalozzi B., 1) Fink D., 1) Dedes K.Hospital: 1) Gynecology, 2) Medical Oncology/ 1,2 University Hospital Zurich

Background: Trastuzumab has significantly improved survival of patients with HER2-pos-itive metastatic breast cancer (MBC). Some patients remain in remission for many years. However, there are no prognostic markers associated with long term survival for patients with HER2-positive MBC. This study aims at giving an overview of clinical practice on HER2-positive MBC and at deducting clinical prognostic factors of long-term benefit from trastuzumab-based treatments.

Patients and methods: 81 patients with HER2-positive MBC who received first-line treat-ment with trastuzumab between 2004 and 2014 at the University Hospital of Zurich were retrospectively analysed. OS and survival endpoints were determined using Kaplan-Meier curves and factors predicting long-term outcome were identified based on the log-rank test.

Results: The median overall survival for all patients was 5.9 years (95% CI: 1.7 – 2.2). 20 pa-tients (28.6%) remained in complete remission after 1 year, 11 (15.7%) after 2 years and 4 (5.7%) beyond 5 years. The median progression free survival was 13.6 months (95% CI: 9.0 – 18.3). The objective response rate (ORR) was 61.3% with 16 (20%) complete responses and 33 (41.3%) partial responses. 6 (7.4%) patients showed brain metastases as first site of relapse and they had a median OS of 1.9 years (95% CI: 1.7 – 2.2 years). 34 of all 81 patients (42%) had developed brain metastases by the time of death or last follow-up. Median OS after diagnosis of brain metastases was 14.1 months (range 1.2 – 123.1 months). Only pri-mary brain metastases was found to be a prognostic marker associated with worse sur-vival. Hormone-receptor status, presence of visceral metastases at primary diagnosis were not associated with prognosis. Only 4 patients (4.9%) developed some degree of left ven-tricular dysfunction under treatment with trastuzumab.

Conclusions: Anti-HER2-targeted treatment has improved the overall survival of patients with HER2-postive MBC with median OS exceeding 5 years. There are, however, no strong predictive markers for a long-term survival, except for the absence of primary brain me-tastases.


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P VI/ 65

Validation study of vaginal dry swabs using the Xpert HPV assay for human papillomavirus detection

Author: 1) Catarino R., 2) Vassilakos P., 1) Bilancioni A., 3) Bougel S., 1) Meyer-Hamme U., 1) Petignat P.Hospital: 1) Gynecology, Gynecology and Obstetrics, University Hospital Geneva, 2) Geneva Foundation for Medical Education and Research, Geneva, 3) Biopath Lab SA, Lausanne

Background: The Xpert HPV assay (Xpert) offers the opportunity of a point-of-care test to detect high-risk human papillomavirus (hrHPV) infection. This test is normally performed with specimen collected into a vial of PreservCyt transport medium. Our aim was to eval-uate the feasibility of vaginal self-sampling using dry swabs for hrHPV detection with the Xpert.

Methods: A total of 150 women aged at least 18 years old attending the colposcopy clinic in Geneva were recruited. Two vaginal specimens were collected for HPV testing and stored in different mediums for each woman. Women firstly self-collected a sample using a dry cotton swab (s-DRY) and then the physician would collect a pap specimen placed in PreservCyt (dr-WET). HPV analysis was performed by the Xpert. The remaining sample im-mersed in PreservCyt was tested for HPV DNA using the cobas test.

Results: HPV positivity was 49.1% for s-DRY, 41.8% for dr-WET and 46.2% for cobas. A good agreement was found between s-DRY and dr-WET samples (kappa=0.64), especially when LSIL+ was present (kappa=0.80). An excellent agreement was found between the two sam-ples for HPV16 detection in general (kappa=0.91) and among LSIL+ cases (kappa=1.00). The mean Ct-values were 30.5±5.0 for dr-WET samples and 25.1±14.3 for s-DRY samples (p<0.001). S-DRY and dr-WET showed similar sensitivity (79.2%, 78.8%), using cobas re-sults as gold standard. Sensitivities were 84.2% (s-DRY), 73.1% (dr-WET) and 77.8% (cobas) for CIN2+.

Conclusion: Dry cotton swabs are a feasible and equivalent method to collect and store vaginal specimens for testing with the Xpert HPV assay.

Key words: cervical cancer, dry swabs, human papillomavirus (HPV), self-sampling, Xpert HPV assay


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P VI/ 66

The influence of doctor-patient communication on patients‘ satisfaction

Author: Zodan T., von Orelli S.Hospital: Gynecology and Obstetrics, Triemli Hospital Zurich

Introduction: Confronted with daily medical work, a resident is usually advised to rely on hospital-intern guidelines, international guidelines, PubMed, Up-to-Date and Google. All these resources give directions on how to do something during a doctor-patient session, but none of them gives directions on what to say during a doctor-patient session. The hy-pothesis of this study was that patients’ satisfaction is not only dependent on what is done during an examination, but also on what is said.

Material und methods: The study was performed in two phases: in the first phase (first 115 days) the patients in the emergency admission of the Clinic for Gynecology and Ob-stetrics of the Triemli City hospital were examined and treated with no change in the doc-tor-patient communication. After each consultation a patient was given a questionnaire containing age of the patient, waiting time, short description of the diagnosis, PDRQ-9 (Patient-doctor relationship questionnaire, Version 9) and two questions concerning pa-tients’ satisfaction. After the first phase the residents were acquainted with the concept of planed communication during a doctor-patient session and were given clear commu-nication guidelines. In the next 115 (second phase) questionnaires were given out to the patients in the same way and the residents were advised to hold on to communication guidelines.

Results: There were 183 filled questionnaires in the first phase and 158 in the second phase of the study. There was no statistical difference in the PDRQ-9 questionnaire before and af-ter the change of communication. The patients presenting in emergency with diagnoses bearing strong psychological burden such as bleeding in early pregnancy, missed abor-tion and abdominal pain showed higher satisfaction after the implementation of commu-nication guidelines. Although generally assumed, there was no correlation between wait-ing-time and patients’ satisfaction neither before nor after the change in communication.

Conclusion: In patients presenting with diagnosis bearing substantial psychological bur-den, doctor-patient communication is very important. This finding is valuable for the teaching of medical residents in the field of professional communication.


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Survey among Swiss gynaecologists regarding frequency and management of symptomatic uterine fibroma in daily practice

Author: Siebert M., Merkel T., Schötzau A., Bitzer J., Heinzelmann V.Hospital: Gynecology and Gyneco-Oncology, University Hospital Basel

Introduction: Uterine fibromas present the most common benign proliferation of the myometrium (in 70% of women >50y). In 20-30% (up to 50%) fibromas are symptomatic (bleeding, pain, bladder symptoms). A new therapeutic principle (antiprogesterone drug treatment) is being introduced in Switzerland. For the moment there are no data available about the current practice in Switzerland regarding the treatment of symptomatic fibro-mas in different patient conditions (e.g. age, wish for child, pregnancy). This would be im-portant to see whether a new medical treatment offers advantages.

Material and methods: With an unrestricted grant by Gedeon Richter (producer of the new drug) a group of experts (lead JB) developed a questionnaire (German, French, En-glish) which was sent out with the support of Gynecologie Suisse to 1236 gynaecologists in the whole country. Participants were asked about the absolute frequency of therapeutic interventions in their everyday practice and about specific interventions in 7 typical cases of symptomatic uterine fibromas. Based on descriptive data the conformity and disparity of the frequency of interventions and the case specific decisions are analysed and the re-sults are put into context with international treatment guidelines.

Results: Of the 1236 questionnaires 309 (24.9%) have been sent back, results of 64 ques-tionnaires (20.7% of the sample) are analysed so far. The average age of gynaecologists was 48.6 years, they look back on 19.6 years of professional experience. The so far responding gynaecologists see their patients with symptomatic uterine fibromas because of bleeding disorders (64.7%), pain (16.8%) and the unfulfilled desire to have children (9.6%). Across the 7 representative cases the most frequently used therapeutic intervention is LNG IUD (21.5%) followed by endoscopic resection of fibromas (17,7%) or hysterectomy (13,4%). 7,0% prefer observation under symptomatic treatment. The highest disparity of treatment decisions was found in the case of bleeding disorders leading to anaemia in a 43y old para III who still considers another pregnancy.

Conclusions: Preliminary results of our survey show that the first treatment option of symptomatic uterine fibromas in patients without wish for a child is the LNG-IUD, followed by endoscopic resection and hysterectomy. The highest disparity in therapeutic approach is found in anaemic patients >40y still considering pregnancy. Final results will be pre-sented in context with international guidelines.


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P VI/ 68

Endometriosis associated neuro-proliferation – an important contributor to chronic pelvic pain?

Author: 1) Cindea-Drimus R., 1) Schneider M., 1) Samartzis E.P., 2) Dommann-Scherrer C., 1) Eberhard M.Hospital: 1) Gynecology and Obstetrics, Cantonal Hospital Schaffhausen, 2) Pathology, Cantonal Hospital Winterthur

Introduction: Multiple factors contribute to the development of pain in endometriosis, such as localization and activity of endometriotic lesions, synthesis of mediators related to inflammation and local invasion of nerve fibers. Endometriotic lesions secrete neuro-tropic agents and as a consequence a higher number of myelinisated as well as non mye-linisated nerve fibres are found in proximity of endometriotic lesions. In deep infiltrating endometriosis these fibers are spread even more densely than in peritoneal endometrio-sis. The number of nerve fibers in these lesion seems to correlate with the intensity of pain.

Case: We report the case of a 37–year-old patient with chronic therapy-resistent pelvic pain due to severe endometriosis rASRM grade IV with a 14 year long history of known endometriosis in which she underwent multiple laparoscopies. After the patient had ter-minated her family planning, she received medical treatment of the endometriosis with ovarian suppression by GnRH-analogues for several months. Due to persistence of symp-toms a total laparoscopic hysterectomy with ureterolysis and adhesiolysis was performed subsequently. During this surgical intervention, a considerable cicatrization of the retroo-varian peritoneum was found and this altered peritoneal area was excised. Histological ex-amination of the tissue revealed proliferation of multiple nerve fibres similar to the picture of a neurinoma. In the follow-up after surgical treatment the patient revealed to be com-pletely asymptomatic with no residual pain.

Conclusion: The presence of endometriosis-associated nerve fibers appear to be related to both pain and the concentration of peritoneal fluid cytokines in women with endomet-riosis. In the presented case, pain symptoms recurred despite medical treatment of endo-metriosis with several drugs including a long-time treatement GnRH-analogues. Histolo-gic analysis of the excised lesions revealed the growth of dense endometriosis-associated nerve fibres causing the severe pain symptoms. This clinical case demonstrates that surgi-cal exzision of endometriotic lesions and associated nerve fibres is an effective therapeu-tical option in patients with persistence or recurrence of pain associated to endometriosis.


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VideopräsentationenPrésentation des vidéosV = Videopräsentation / Présentation de vidéo

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V 96

Pentalogy of Cantrell: a case report

Author: 1) Bronz C., 1) Krähenmann F., 2) Valsangiacomo E., 3) Tutschek B., 1) Zimmermann R., 1) Ochsenbein-Kölble N.Hospital: 1) Obstetrics, University Hospital Zurich, 2) Division of Cardiology, University Children’s Hospital Zurich, 3) Pränatal Zurich

Background: Pentalogy of Cantrell (PC) is a complex malformation defined by an ompha-locele, an anterior diaphragmatic hernia, sternal cleft, ectopia cordis and intracardiac ab-normalities. Diagnosis is relatively simple, but the neonatal treatment is challenging and the prognosis is poor.

Material and methods: We describe a case of PC during pregnancy, its management at birth and the postnatal outcome.

Results: The first trimester ultrasound scan of a 33 years old 3P 3G showed an increased nuchal translucency of 3,4mm and the hallmarks of PC: structural heart disease with one large ventricle beating mostly outside the chest, an anterior diaphragmatic hernia and a sternal cleft. Amniocentesis at 15 gestational weeks (GW) showed normal karyotype and microarray. Additionally, a Blake’s pouch cyst was seen. After counseling, the parents de-cided to continue the pregnancy despite poor prognosis. Regular follow-up showed a normal fetal intrauterine growth. Fetal echocardiography showed normal left-sided heart structures with a large portion of the left ventricle (LV) displaced into the omphalocoele; a ventricular septal defect was suspected and the right ventricle (RV) poorly visualized, so that RV hypoplasia was postulated. No decompensation signs were seen. A planned C-Sec-tion was performed at 37 GW at the University Children’s Hospital to ensure optimal post-natal care. A girl was born with 3kg and an Apgar score of 6-7-5. Intubation was required because of neonatal bradycardia and hypoxia. Postnatal echocardiography showed a tri-cuspidal atresia with hypoplastic RV, a ventricular septal defect, ectopy of a large portion of the LV and mitral regurgitation. Contractility of the ectopic LV was moderately reduced. The girl presented additional malformations: bilateral choanal atresia, asplenia, and dys-morphic phenotype. Lung hypoplasia was suspected at chest-xray. In spite of successive escalation of intensive treatments, including prostaglandin, NO Ventilation and high dose catecholamine, adequate oxygenation levels could not be achieved and low cardiac out-put persisted. Considering the multiple morbidities and the single ventricle physiology, the options of surgical treatment with unclear outcome and long-term morbidities or pal-liative care were discussed with the parents who decided for palliative care. The baby died short after extubation.

Conclusion: An interdisciplinary expert team should be involved if diagnosis of PC is done, to ensure prenatal counseling and to plan optimal perinatal management.

Jahreskongress / Congrès annuel gynécologie suisse 2016Videopräsentationen / Présentation des vidéos V/96

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V 97

Transvaginal excision of an eroded sacrocolpopexy mesh with abscess formation by using the SILS minimally invasive equipment and rendez-vous technique

Author: Mohr S., Siegenthaler F., Imboden S., Kuhn A., Mueller M.D.Hospital: Obstetrics and Gynecology, University Hospital Bern and University Bern

Introduction: Frequently, pelvic organ prolapse can only be effectively treated if the sur-gical procedure comprises support of the central compartment. Laparoscopic sacrocol-popexy shows superior outcomes for this indication with success rates of up to 96%. How-ever, one of the rare side effects of laparoscopic sacrocolpopexy is mesh erosion occurring in 0-2.4% (Rosati M, Curr Opin Obstet Gynecol 2014). These erosions are usually treated laparoscopically (Chamsy D, JMIG 2014). In this video we show an alternative route for ex-cision of a symptomatic exposed mesh by using a transvaginal approach: The SILS trocar is used vaginally for abscess and mesh excision with minimally invasive instruments.

Case and method: The 68 year old patient was referred with a vaginal mesh erosion which resulted in abscess formation at the vaginal apex. The patient was symptomatic with an in-creasingly foul smelling vaginal discharge for about one year. She had a laparoscopic sac-rocolpopexy in a remote hospital 22 months before the current operation and she had a total abdominal hysterectomy 15 years ago. Except from that the patient’s history was un-eventful without dyspareunia, incontinence or voiding difficulties and she was otherwise content with the sacrocolpopexy result. For treatment of the abscess and the removal of exposed mesh the SILS trocar was placed vaginally and laparoscopic instruments were used. The abscess was incised, cleansed and irrigated, debrided, and the mesh excised. Laparoscopy was used to confirm that no intraabdominal lesion co-existed or occurred. Particularly, the area of the mesh excision was inspected with the rendez-vous technique (light source vaginally, laparoscopic view from abdominal cavity) to rule out sigma or rec-tum lesions. Postoperative course was without complications.

Conclusion: The SILS trocar used vaginally provides excellent overview of the vaginal walls and allows for precise use of microinvasive instruments in vaginal surgery. The ren-dez-vous technique allows for identification of intraabominal lesions.


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V 98

Pitfalls in laparoscopic sentinel node biopsy with ICG in endometrial and cervical cancer

Author: Imboden S., Papadia A., Siegenthaler S., Fink A., Mohr S., Mueller M.D.Hospital: Obstetrics and Gynecology, University Hospital Bern, University Bern

Introduction: Sentinel lymph node (SLN) biopsy in gynecological malignancies is becom-ing more and more important to allow minimal invasive staging and to tailor adjuvant treatment. After being accepted as standard in breast, vulvar and cervical cancer, also in endometrial cancer it has become an option in surgical treatment. However, to insure on-cological safety, the SLN procedures have to show high bilateral detection rates and low false negative rates. This is why a good operative technique is of great importance.

Materials and methods: Cuts from videos from patients with cervical or endometrial can-cer operated in the University Hospital of Berne with ICG as a tracer from 2012-2015 were viewed and summarized to a video.

Results: In this video, the technique of SLN detection with ICG is presented and patients with difficult situations such as metastatic lymph nodes, inflammatory tissue and untyp-ical SLN locations are shown.

Conclusion: With ICG good bilateral detection rates can be achieved also in difficult situ-ations with experience and awareness of possible pitfalls.


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V 99

Laparoscopic Sacrohysteropexy

Author: Magg H., Ledermann-Liu H., Schär G., Sarlos D.Hospital: Gynecology, Cantonal Hospital Aarau

Introduction: Traditionally most surgical techniques for treatment of pelvic organ pro-lapse (POP) include either total or supracervical hysterectomy. Due to increased patient awareness this has been questioned in the last years, an increasing number of uterus con-serving surgical techniques being described in the literature. There is no strong data sup-porting the fact that hysterectomy improves the outcome of prolapse repair. However, no high level evidence has been published for the laparoscopic approach, though some ret-rospective studies and case reports for different techniques do exist. Our video describes a uterine conserving technique of Laparoscopic Sacrohysteropexy (LSHP) which we use since 5 years in about 30 patients.

Methods: Patient positioning is steep Trendelenburg; placement of a 12mm optical trocar at the umbilicus, 3 6mm trocars in the lower Abdomen on both sides and in the midline. The dissection starts at the level of the promontory, exposing the longitudinal ligament. Care is taken to the left common iliac vein, which can cross quite far caudally. The perito-neum is incised superficially to avoid injury of the inferior hypogastric nerve. Dissection of the posterior compartment is done until the level of the pelvic floor. The anterior com-partment is dissected until the bladder neck. Fenestration of the broad ligament is per-formed at the level of the uterine isthmus, avoiding the uterine vessels, which should be visualized beforehand. A Y-shaped polypropylene mesh is attached to the anterior vaginal wall and the cervix using non-resorbable braided sutures. The two arms are passed around the uterus through the openings in the broad ligament and sewn to the posterior cervix, where they are united with the posterior mesh, which is sutured to the levator ani muscle. The posterior mesh is sutured to the longitudinal ligament without putting tension on it. Peritoneal coverage completes the procedure.

Conclusion: LSHP is a well feasible technique for treatment of POP, acknowledging the increasing demand for uterus conserving surgery. Current evidence, though low level, shows no significant disadvantages. It seems to be an interesting procedure, especially for younger women with symptomatic POP who want to preserve their fertility. Unfortu-nately, only few studies and no long term results are available. With this video, we want to focus on the surgical technique of LSHP, as it is currently investigated in a multicenter ran-domized controlled trial.


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V 100

Minimal invasive surgery for urinary tract endometriosis

Author: Lanz S., Imboden S., Mueller M.D.Hospital: Gynecology and Obstetrics, University Hospital Bern

Introduction: Urinary tract endometriosis includes the presence of endometrial glands and stroma in or around the urethra, bladder, ureters or kidney. We recently demonstrated that it can occur in up to 52% of women presenting with deep infiltrating endometriosis. However, the diagnosis and management of urinary tract endometriosis remain a chal-lenge. When diagnosis is delayed, ureteral involvement can lead to serious complications such as stenosis with hydroureter and hydronephrosis and finally loss of renal function. Surgery is considered to be the gold standard in treatment of patients with deep infiltrat-ing endometriosis. In the case of ureteral endometriosis, the aim of the treatment is to lib-erate the ureter from all endometriotic tissue to allow normal function and to avoid mor-bidity. Treatment of bladder endometriosis consists of complete surgical excision through partial cystectomy.

Materials and methods: We present a video with different cases of deep infiltrating en-dometriosis surrounding and compressing the ureter or infiltrating the bladder wall, all treated by minimal invasive surgery in our department between 2014 and 2016. Potential complications during surgery and appropriate treatments as well as postoperative results and follow ups are also described.

Results: All presented cases were treated successfully by laparoscopy. An intraoperative iatrogenic ureteral lesion was also managed by minimal invasive surgery.

Conclusion: Due to the likelihood of serious complications, like the loss of renal function, physicians must be aware of urogenital endometriosis and its management. Preoperative diagnosis may help to plan intraoperative management. In experienced hands most cases of endometriosis involving the urinary tract can be treated in a minimally invasive way with an excellent outcome.


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V 101

Laparoscopic vaginal cuff closure with extracorporeal knots – educational and training video

Author: 1) Oehler R., 2) Fellmann B.Hospital: 1) Gynecology, Hospital Solothurn, 2) Gynecology, University Hospital Basel

Introduction: Total laparoscopic hysterectomy is a common procedure which requires the skill to laparoscopically suture the vaginal cuff. Laparoscopic suturing in general is a task that requires practice, preferably in a dry lab pelvi trainer setup before attempting it in the operating theatre on a patient. In this educational video we demonstrate an easy to learn technique for laparoscopic vaginal cuff closure using extracorporeal knot tying.

Material and methods: A single person pelvi trainer with a fixed camera, a vaginal cuff model made of a composite of felt and silicone rubber, regular laparoscopic instruments and a 90cm length suture are used. The technique is broken down into the various steps such as introducing the needle into the abdomen, loading the needle, suturing the vagi-nal cuff, bending the needle before extraction and extracorporeal knot tying using a knot pusher. Visual cues are used to enhance the experience.

Results: A short educational and training video to review and learn a common method for vaginal cuff closure using extracorporeal knots was produced. Versions of this film are used for laparoscopic training workshops in Switzerland. This video is planned to be re-leased as open access.

Conclusion: Our experience as well as multiple studies have shown that dry lab exercises improve the manual dexterity and hand-eye coordination for complex tasks such as lapa-roscopic suturing. Video instructions can help guide the learning process even in absence of expert teaching. A single person pelvi trainer with standardized models, trocar posi-tions and regular instruments combined with training videos can facilitate the process of autodidactic learning and improve laparoscopic skills in the operating theatre.


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V 102

Laparoscopic Suturing: The Essentials about needle management and knot tying

Author: 1) Giannis G., 1) Favre D., 1) Samartzis E.P., 2) Filippakos F., 3) Ballabio N., 4) Oehler R., 1) Eberhard M.Hospital: 1) Gynecology, Hospital Schaffhausen, 2) Gynecology, Hospital Lugano, 3) Gynecology, Cantonal Hospital Lucerne, 4) Gynecology, Hospital Solothurn

Introduction: Laparoscopic surgery has outdated traditional surgery techniques in most of gynecological operations. Gynecologists contributed a lot in introducing minimal in-vasive surgery. Clarke published in 1972 the first laparoscopic ligation and resection. Kurt Semm, also a gynecologist, performed the first laparoscopic Appendectomy in 1983 and questioned the surgical dogma that great operators have great incisions. The minimal in-vasive surgery era was born. The secret of success of those pioneers is that they not only focused on surgical treatment but also introduced and developed new laparoscopic tech-niques. For future pioneers in laparoscopy it is therefore necessary to know the instru-ments and techniques they use before getting started.

Materials and methods: Our aim is to produce educational material about laparoscopic knot tying and needle management. The media is trilingual (german, italian, french) and consists of a video and download sheets. At the second stage of the project, the educa-tional media will be out handed to trainee doctors together with a feedback question-naire.

Discussion: Extracorporeal knot tying is easy to learn and can be applied to the majority of gynecological operations, for example when closing the vaginal vault after laparoscopic hysterectomy. Intracorporeal knot tying in contrast is an advanced skill in minimal inva-sive surgery. It is especially necessary when managing complications in laparoscopic sur-gery such as bladder, bowel, and vessel injury. Together with needle management these are the basic skills needed for laparoscopic suturing. Self-made simulators are cheap and allow basic laparoscopic skills to be practiced. Most laparoscopic instruments necessary for training are disposable and, after being properly sterilized, are suitable for training on non-in-vivo models. The only nondisposable instrument, the needle holder, can also be purchased from online auctions at a reasonable price.

Conclusion: Every gynecologist performing laparoscopy should be able to perform extra-corporeal and intracorporeal knots. Our educational Video on needle management and knot tying can be utilised for teaching the principles and techniques, before training these skills in laparoscopy simulators. As you can see in our teaching video, at the end it is not hard at all.


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V 103

Laparoscopic repair of a vesicovaginal fistula after laparoscopic hysterectomy – A video presentation

Author: Bousouni E., Ledermann-Liu H., Schär G., Sarlos D.Hospital: Gynecology and Gynecological Oncology, Cantonal Hospital Aarau

Formation of vesicovaginal fistula after gynecologic operations is a rare complication and difficult to repair. 75% of vesicovaginal fistulas in Europe occur for iatrogenic reasons fol-lowing surgery of the pelvis. Risk factors are previous operations, adhesions, endometrio-sis and bladder injury during initial surgery. Especially previous cesarean section seems to be a risk factor for intraoperative bladder injuries and in conclusion for fistula formation.

Fistula repair is a difficult procedure and has a quiet high rate of recurrence. The incidence of fistula recurrence depends on different factors like localization, time to diagnosis, previ-ous operations and other factors like diabetes or micro- or macroangiopathic conditions. The goal of fistula repair is not to compromise vascularization of the tissue therefore lapa-roscopic surgery with its minimal invasive approach seems to be an ideal tool.

This video shows a 49 years old patient who underwent a laparoscopic hysterectomy some weeks before. She presented with a severe vesicovaginal fistula in the midline of the blad-der about 2cm away from the the ureteric ostium.

After identification of the fistula, the vaginal and vesical margins of the fistula are excised to guarantee fresh and good vascularized tissue. The bladder is reconstructed with PDS 4-0 preplaced sutures which are tight extracorporealy. We usually place double J stents into the ureters for better identification of the ureter ostia and for prevention of an acci-dental suturing of the intravesical part of the ureter during bladder reconstruction.

The vagina is closed with Vicryl 0 laparoscopic sutures. After suturing the bladder is filled up with 250cc of saline to check for any leakage. The transurethral catheter remains for about 10 to 14 days.

With this technique we treated in our clinic in the last 5 years 9 cases of vesico-vaginal fistula with very encouraging results. 8 of these cases had a complete re-covery and one of them had a recurrences which needed a second intervention. The main advantages of laparoscopic approach to repair a fistula is the better view and the less tissue damage, compared to open surgery.

As gynecologic surgeons should be able to repair their complications by themselves this video could help younger colleagues and show them how treat fistulas by laparoscopy and by to improve their technique.


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V 104

Laparoscopic treatment of cesarean scar pregnancy remnants

Author: Mohr S., Wüest A., Schwander A., Lanz S., Imboden S., Mueller M.D.Hospital: Obstetrics and Gynecology, University Hospital Bern and University Bern

Introduction: Cesarean scar (ectopic) pregnancies (CSP) are rare but may have serious clinical manifestations due to massive hemorrhage. In this context the formation of arte-rio-venous malformations between the uterine arteries and myometrial venous plexus af-ter initial treatment of the CSP is feared. Doppler and 3D sonography and (Angio-)MRI are helpful in detecting such malformations and diagnosis is verified by histologic findings of trophoblast and atypically dilated vessels in the excised scar tissue. Management is con-troversial and guidelines are lacking. Systemic MTX and monitoring therapeutic success by serially determining HCG are favored. Hysterectomy is beneficial in patients who desire no further pregnancies. Embolization of the a.-v. malformations is an option, but the wide diameter of the vessels might lead to pulmonary embolism by the embolization agent. This video shows two patients with complete excision of CSP in rendez-vous technique af-ter temporary clipping of the uterine arteries and laparoscopic hysterectomy, respectively.

Cases and method: Case 1: The patient had two previous cesarean sections before a vi-tal CSP was determined sonographically in the 13 6/7 week of gestation. Fetocide was car-ried out with potassium chloride and MTX was applied subsequently i.m. HCG normalized after 124 days. 15 days after that the patient presented with vaginal bleeding. Sonogra-phy and MRI showed a highly vascularized 8 cm mass in the anterior uterine wall. Embo-lisation had to be abandoned because of systemic side effects. After this course of events and given the risk of hemorrhage the patient desired hysterectomy, which was unevent-ful. Case 2: The patient had one previous cesarean section and was diagnosed with an avi-tal CSP. Nevertheless, she had an outwards curettage with massive hemorrhage. After 10 weeks she was referred because of retained products of conception and vaginal bleeding. Sonography and MRI revealed a highly vascularized 6 cm mass in the right anterior uterine wall. HCG was undetectable. The tumor was excised laparoscopically in rendez-vous tech-nique after temporary clipping of the uterine arteries.

Conclusion: After CSP management it is important to keep in mind the formation of arte-rio-venous malformations with their inherent risk of major hemorrhage. Thus, normaliza-tion of HCG does not guarantee success of CSP therapy.


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V 105

Using a new dual access system for contained in-bag morcellation: Video-demonstration of the technique and pit-falls

Author: Freydanck M., Cindea-Drimus R., Breitling K., Samartzis E.P., Eberhard M.Hospital: Gynecology and Obstetrics, Cantonal Hospital Schaffhausen

Introduction: After the FDA (U.S. Food and Drug Administration) released a safety com-munication discouraging the use of power morcellators during laparoscopic hysterec-tomy and myomectomy, several reports have described contained power-morcellation in different types of bags to prevent dissemination of potentially malignant tissue caused by uncontained morcellation. Mostly these bags are designed for a single-incision laparo-scopic approach and need to be punctured to allow multiport in-bag morcellation, carry-ing the risk of leakage and microscopic dissemination of cells. In this video we present our experience using a recently designed dual access bag for two-port-in-bag morcellation af-ter laparoscopic hysterectomy.

Material and methods: After laparoscopic hysterectomy for an indication of leiomyomas or abnormal bleeding the bag (More-Cell-Safe®, A.M.I Austria) is introduced into the abdo-men and the specimen is positioned into the bag via its large opening. Afterwards both, the large mouth and the second tubular opening, have to be exteriorized. The optic is re-inserted through the tubular mouth. Hereon the bag is closed an inflated with CO2. The power morcellator is inserted through the wide opening and the specimen is morcellated under visual control. The everted tubular part is then closed by two knots outside the ab-domen and the bag is removed through the site above the pubic symphysis.

Results: Morcellation in a dual-access system enables safe morcellation without contami-nation of the abdominal cavity with potentially malignant tissue. However, some technical difficulties may be encountered and therefore the procedure may be time consuming. Po-tential problems are accidental perforation of the endobag and difficulties insufflating the system often caused by twisting. Beyond the learning curve the procedure was finished within an acceptable time and without any complications or lesions of the bag.

Conclusion: Morcellation in an insufflated bag is an important option to preserve the ben-efits of minimally invasive surgery while minimizing the risks of the open procedure such as unintended dissemination of uterine sarcomas or injury of internal organs. The new Dual-Access-System, in contrast to earlier described techniques, provides the possibility of safe insertion of two instruments without the need of puncturing the specimen-bag. The technique still needs further refinement but has the potential to become a standard in laparoscopic surgery.


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V 106

Mini-invasive surgical hysteroscopy using the Bettocchi endoscope

Author: Popescu S., DeOliveira S., Dubuisson J.Hospital: Gynecology, University Hospital Geneva

Introduction: Even though the mini-invasive surgical hysteroscopy exists since the 1990’s, it is rarely used in current practice. The classic surgical hysteroscopy that uses the resec-toscope and needs cervical dilation is still often preferred. We propose the technique of mini-invasive surgical hysteroscopy for treatment of uterine lesions in a video showing its advantages and ease of usability.

Materials and method: Video showing the use of the 5 mm Bettocchi hysteroscope for the treatment of endometrial polyps and uterine malformations in several different clini-cal cases ranging from nulliparous to menopausal women.

Results: The mini-invasive surgical hysteroscopy is an effective technique (with less than 5 % of relapse), feasible without cervical dilation or anesthesia, well tolerated in terms of pain and, most importantly, very useful in cases that present a cervical stenosis or contra-indications in terms of anesthesia.

Conclusions: The development of small diameter hysteroscopes and hysteroscopic in-struments allows not only the diagnostic but also the treatment of endo-uterine lesions in a variety of cases. The use of mini-invasive surgical hysteroscopy as an alternative for treat-ment should be more actively encouraged.


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V 107

Single-port laparoscopic hysterectomy using a new device: case reports and video

Author: Wavre T., Simonson C., Veit-Rubin N., Mathevet P.Hospital: Gynecology, University Hospital Lausanne

Introduction: Conventionally, laparoscopic surgery requires three or four ports for the treatment of benign disease. Attempts have been made to minimize the number of port sites required, without compromising surgical outcomes. Single-port laparoscopy utilizes a single, multichannel port in an attempt to decrease postoperative pain, while improving cosmetic outcome and minimizing the number of scars and the potential risks and mor-bidities. With our video, we aimed to demonstrate a total single-site laparoscopic hyster-ectomy with bilateral salpingo-oophorectomy using a new single-port device.

Material, methods and case: The patient was a 19-year-old genotypic female within the process of sex change to phenotypical male after medical and psychological counseling. He had no surgical nor medical history except a recent bilateral mastectomy. The device consists of an Alexis® retractor allowing a 2cm umbilical incision and the use either of three 5mm trocars or of a 10mm and two 5mm trocars for optics and instruments through a jelly membrane securing imperviousness for gases.

Results: A Hohl-uterine mobilizer was installed vaginally. We performed open laparos-copy consistent with the Hasson technique and inserted the device after a 2cm skin inci-sion. We created a pneumoperitoneum up to 15 mmHg. The hysterectomy was performed in a classic way alternating use of a bipolar clamp and scissors. The uterus and the adnexa were extracted and the vault was closed vaginally in order not to extend the operating time. Intervention time was 120 minutes; blood loss was less than 100 ml. The patient was able to walk the day of surgery without necessity of significant painkillers.

Conclusion: The installation of the new single-port-system was quick and easy. Its use for salpingo-oophorectomy and hysterectomy is feasible and safe. The main difficulty was the conflict of the instruments and the camera requiring work with a slightly lateralized vision of the operative field. Moreover, the instruments intersect at the abdominal wall. How-ever, the surgeons experienced a significant empirical learning curve, especially in terms of cross-over handling of the instruments, after having performed numerous sapling-oo-phorectomies previously. Operative times are reasonable and can be decreased with ex-perience. However additional costs for the device have to be balanced with the benefits.


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V 108

Laparascopic repair of a thermic lesion of the bladder

Author: Fähnle-Schiegg I., Salihi E., Christmann C.Hospital: Gynecology, Cantonal Hospital Lucerne

Introduction: Lesions of the bladder are typical complications of laparascopic hysterec-tomy. Frequently it is di-agnosed 3-7days postoperatively. Thus, the repair of vesical injury is an important skill for laparas-copic surgeons in gynecology. In this video we present the diagnosis of a vescial leak postoperati-vely by transvaginal ultrasound and subsequent laparascopic repair.

Material and methods: Case observation and report.

Case report: In this video we report the case of a 52 year old woman presenting four days after laparascopic hysterectomy of a large uterus with fibroids with abdominal pain and discomfort while urination. With a carefully performed transvaginal sonographic examina-tion a leak of the urinary bladder to the abdominal cavity could be clearly demonstrated. Subsequently laparascopy was performed, showing a thermal lesion of the urinary blad-der with a large necrotic area. The necrotic tissue was excised an the lesion was sewn with intraabdominal continuous suture.

Results: Transvaginal ultrasound can be a sufficient investigation without need for a com-puter tomography for detection of a leak of the urinary bladder. Furthermore, the lapara-scopic repair of a secondary thermal lesion of the urinary bladder can sa-fely and sucess-fully be performed laparascopically. Key point of the surgical repair is to completely excise the necrotic tissue with a remaining healthy margin.

Conclusion: Gynecologic surgeons performing laparascopic procedures need to be able to diagnose and ma-nage possible complications. Primary or secondary bladder lesion are typical complications of la-parascopic hysterectomies. Bladder lesions can be assumed or – as in this case – clearly be shown by transvaginal ultrasound. The repair can bei con-ducted laparascopically as well whereat necrotic tissue needs to be removed carefully. Ac-curate inspection of the operating field, test of thightness of the bladder after suture and examination of the urethers are indispensable.


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V 109

Successful hysterocospic treatment of a symptomatic isthmocele in a bicorporeal uterus: A case report with video

Author: Wegener S., Dubuisson J., Streuli I.Hospital: Gynecology, University Hospital Geneva

Background: Isthmocele is a little known complication of the Caesarean-section (CS) due to the absence of consensual anatomo-clinical and radiological definitions. Its prevalence has been increasing regularly for a decade. It can be the source of bleeding, dysmenor-rhea, cyclic pelvic pain or secondary infertility because of a reservoir-like pouch effect. The additional assessment systematically includes a pelvic ultrasound, supplemented by a hy-dro-sonography, a diagnostic hysteroscopy or a pelvic MRI.

Clinical case: We here report the case of a 36-year old patient, primigravida, with a uni-cer-vical bicorporeal uterus type. An isthmocele was diagnosed within a context of postmen-strual abnormal uterine bleeding and secondary infertility arising after CS. The hydro-so-nography confirmed the presence of a moderate scar defect, the myometrium next to the “niche” measuring 3 mm. Because of the symptomatology and the failure of multi-ple embryo transfer procedures, an operative hysteroscopy was performed to correct the anatomical defect and eliminate the symptoms. The patient was able to become sponta-neously pregnant and give birth by CS to a healthy child. She suffered no recurrence of ab-normal uterine bleeding with a follow-up of 16 months.

Conclusion: Minimally-invasive procedure using hysteroscopic resection of the fibrotic scar tissue is to be considered first given the existence of an isthmocele in a symptomatic and/or infertile woman, even in case of a uterine malformation. It is an effective and safe treatment option, but only in cases where the residual myometrium measures more than 3 mm next to the defect.


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V 110

Kurt Semm – Innovator and teacher of laparoscopic surgery

Author: 1) Oehler R., 2) Alkatout I., 2) Schliemann G., 2) Mettler L.Hospital: 1) Gynecology, Hospital Solothurn, 2) Gynecology, University of Kiel

Introduction: Many prominent researchers and surgeons enabled the development from diagnostic laparoscopy to laparoscopic surgery. Kelling, Veres, Hopkins, Storz, Palmer, Frangenheim and many others shaped the development. Kurt Semm was the most im-portant innovator who contributed in many ways to the advancement and proliferation of modern laparoscopy.

Material and methods: Literature study of academic and non-academic publications, image scans, video digitization of available materials and audio interviews were emplo-yed to assemble an overview of the achievements and methods of Prof. Kurt Semm.

Results: A short video was produced, sketching the achievements of Kurt Semm with an emphasis on the need to teach laparoscopic methods by means of courses and dry lab training. The alternative surgical approaches made possible through innovations in instru-ments, techniques and devices are described. Initial peer dissent, extensive research and educational efforts are discussed.

Conclusion: A historical review provides an interesting insight into issues still relevant to-day. The combination of medical research and industrial innovation enabled surgeons and gynecologists like Kurt Semm to transform laparoscopy from a diagnostic tool into the most widely used surgery of today. New methods will always be met with skepticism and it is necessary to provide research, courses and training to establish these methods.


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V 111

Uterus-preserving laparoscopic lateral suspension with mesh for pelvic organ prolapse: a patient-centred outcome report and video of a continuous series of 245 patients

Author: 1,2) Veit-Rubin N., 2) Dubuisson JB., 3) Lange S., 3) Eperon I., 3) Dubuisson J.Hospital: 1) Gynecology, University Hospital Lausanne, 2) Faculty of Medicine, University Geneva, 3) Gynecology and Obstetrics, University Hospital Geneva

Introduction: Changes in the psychological value of reproductive organs have led to a growing interest in uterine-preserving surgery for POP. Sacral hysteropexy is considered as gold standard, although dissection of the promontory may be challenging. We present a report on a series of 245 patients operated by laparoscopic lateral suspension with mesh as an alternative and demonstrate its different steps with a video.

Material and methods: The technique consists of a T-shaped synthetic mesh placed in the vesicovaginal septum and suspended bilaterally to the abdominal wall. Some patients were additionally treated with a mesh placed in the rectovaginal septum or with posterior colporrhaphy. Pre- and 1-year-postoperative clinical evaluation was assessed by the sim-plified Pelvic Organ Prolapse Quantification grading system (sPOP-Q). The main outcome measures were subjective and objective cure and patient satisfaction. Anatomic cure was defined as POP-Q sites Ba, C and Bp as less than −1 cm at any point in time during fol-low-up. Secondary outcomes were reoperation rate as well as mesh-related- and general complication rate. We used the Clavien Dindo scale and the validated complication classi-fication calculator. A telephone interview was conducted after 4 to 10 years to assess pa-tient satisfaction using the Patient Global Impression of Improvement Scale (PGI-I) and the visual analogue scale (VAS).

Results: We treated 245 patients between 2004 and 2011. All patients had significant stage 2 POP or greater. 59.6 % of patients had concomitant surgery for stress urinary in-continence (SUI). The posterior compartment was treated in 49.8 % of patients. At 1 year, the overall satisfaction rate was 92.3 %, and 82.7 % of patients were asymptomatic for pro-lapse. Anatomic success rates were 88.2 % for the anterior, 86.1 % for the apical and 80.8 % for the posterior compartment. In patients who had a posterior repair, the anatomic suc-cess rate was 83.6 %. 1.3 % had grade 3 complications, 1.2 %had vaginal mesh exposure. Total reoperation rate was 7.4 % for prolapse recurrence and 2.8 % for SUI recurrence. Me-dian VAS score was 9 out of 10, 82.9 % reported improvement of their condition.

Conclusion: Uterus-preserving LLS with mesh is a feasible and safe technique with prom-ising objective and subjective cure rates in highly satisfied patients. Complication rates are comparable with sacral hysteropexy which makes it an alternative to sacral for in a context of high morbidity and/or with difficult access to the promontory.


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Posterausstellung Exposition des posterP = Posterausstellung / Exposition des poster

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P 100

Neutrophil – trophoblast interactions in gestational diabetes mellitus: key role for neutrophil elastase

Author: 1,2) Grimolizzi F., 1) Stoikou M., 3) Hösli I., 3) Lapaire O., 1) Rossi S., 1,4) Giaglis S., 1) Hahn S.Hospital: 1) Biomedicine, University Hospital Basel, 2) Clinical Sciences, Polytechnic University Marche, Ancona, Italy, 3) Obstetrics, University Women’s Hospital Basel, 4) Rheumatology, Cantonal Hospital Aarau

Gestational diabetes mellitus (GDM) is a common complication of pregnancy character-ized by glucose intolerance with onset or first recognition during pregnancy. Maternal hy-perglycemia is the hallmark of GDM and may have profound effects on placental devel-opment and function. In both clinical and experimental conditions, hyperglycemia has been shown to alter many cellular parameters that predispose to an exaggerated inflam-matory response. Indeed, our data indicate that incubation of trophoblast BeWo cells in a high-glucose condition resulted in overt TNF-alpha production. This finding is pertinent, since aberrant expression of TNF-alpha in the placenta has been suspected to be import-ant contributor of chronic low-grade inflammation and fetal adiposity in GDM. In order to investigate whether there was a direct association between placental TNF-alpha and an inflammatory condition, we examined for the presence of neutrophil (PMN) infiltra-tion. We indeed observed a significant accumulation of PMN, as detected by immunohis-tochemistry for neutrophil elastase (NE) in the villous chorion of GDM placentas. Recent studies in cancer tissues and diabetes model systems have indicated that NE released by degranulation can be taken up by surrounding cells, where it can profoundly alter signal transducing cascade promoting insulin resistance via degradation of insulin receptor sub-strate 1 (IRS1). Our in-vitro data indicate that the direct addition of NE to trophoblast cell line BeWo causes degradation of IRS1 and suppresses GLUT4 expression, with consequent glucose uptake impairment. Additionally, we found that in co-culture system, direct cell-cell contacts between BeWo and PMN had a pro-inflammatory effect with increased ex-pression of TNF-alpha and IL8 mRNA in BeWo and PMN cells respectively. IL8 (CXCL8) is a potent chemokine, affecting neutrophil chemotaxis. Its inappropriate expression may thereby contribute to an inflammatory loop involved in PMN cell recruitment and activa-tion. PMN hyperactivation has been already showed in preeclamptic placentas and our new findings could explain why GDM women are more likely to develop similar hyper-tensive complications. Taken together, our data suggest that the structural and functional changes in the GDM placentas could be related with an abnormal infiltration of neutro-phils infiltration and NE release in the intervillous space.

Jahreskongress / Congrès annuel gynécologie suisse 2016Posterausstellung / Exposition des poster P/100

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P 101

Follicular flushing in Natural Cycle IVF neither affects the length of the luteal phase nor the luteal body hormone production – a prospective controlled study

Author: 1) Rohner S., 1) Fäh M., 1) Otti G., 1) Kohl Schwartz A., 1) Stute P., 2) Schürch R., 1) von Wolff M.Hospital: 1) Gynecologic Endocrinology and Reproductive Medicine, University Women’s Hospital Bern, 2) CTU Berne, Department of Clinical Research, and Institute of Social and Preventive Medicine (ISPM), University of Bern

Introduction: Natural Cycle IVF (NC-IVF) is favoured by many women due to lower treat-ment induced psychological stress and lower costs. In contrast to multifollicular IVF, follic-ular flushing increases the efficacy of monofollicular IVF such as NC-IVF by higher oocyte yield and higher transfer rates according to two retrospective studies. However, as follic-ular flushing causes loss of granulosa cells, follicular flushing might negatively affect the formation and endocrine function of the luteal body, requiring luteal phase support with progesterone and possibly also estrogen.

Study design, participants and methods: A prospective cohort phase II study was per-formed with 24 women undergoing NC-IVF in 2013 and 2015. Women (age 18-40y) with regular menstrual cycles (26-32days) and AMH-concentrations >5pmol/L were screened at a University based infertility center. Women first underwent a training cycle with HCG induced ovulation, followed by the analysis of the length of luteal phase and concentra-tions of progesterone and estradiol on day 2-3, 6-7 and 10-11 post ovulation. A second (NC-IVF) flushing cycle was identically performed but follicles were aspirated and flushed 3-5 times. Data were analysed using a paired Wilcoxon signed rank test with continuity correction for each time point separately.

Results: 49 women were screened, 46 were enrolled and 24 women finalized the study. The high drop out rate of 52% was due to 11/46 women who became pregnant during the first cycle and 11/46 women who preliminarily stopped the study due to other rea-sons. Data of luteal phase length was complete in 23/24 women. In 7 of these women lu-teal phase was shorter (29.2%), in 4 women luteal phase length was equal (16.7%) and in 12 women luteal phase was longer (50.0%) following flushing of the follicles. Overall, the difference in luteal phase length was not significant (p = 0.391). Median progesterone and estradiol concentrations did not differ significantly between training and flushing cycle (median difference in progesterone [pmol/L] in the flushing cycle compared to the train-ing cycle, early in cycle: -5.2; mid: 1.1; late: -1.2; median difference in estradiol [pmol/L], early: 65.0; mid: 31.1; late: -17.2; all p > 0.05).

Implication of the findings: The results of the study suggest that luteal phase support is not required in NC-IVF, even if the follicles are flushed, thereby allowing further treatment simplification by avoiding uncomfortable luteal phase support.


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P 102

Comparison of hematologic parameters of monochorionic twins with selective growth restriction to IUGR neonates of singleton pregnancies

Author: 1) In-Albon S., 1) Bolla D., 1) Raio L., 1) Wäspi N., 2) Nelle M., 1) Baumann M., 2) Gerull R.Hospital: 1) Obstetrics and Gynecology, 2) Neonatology/ 1,2 University Hospital Bern

Introduction: Fetal adaptive mechanism to placental insufficiency have also a profound influence on hematologic parameters at birth. We recently demonstrated that haemato-logical differences between MC twins with selective IUGR exists and are correlated to the birth order. The aim of the present study is to evaluate if the hematologic characteristics MC twins with sIUGR, and in particular of the smaller one, are similar to that of a growth restricted singleton neonate at birth compared.

Methods: Between January 2005 and November 2015 all cases of MC twins with sIUGR and singleton pregnancies with IUGR delivered at our hospital were included. sIUGR is is prenatally defined as abdominal circumference of the smaller foetus below the 10th per-centile with a weight discordancy of at least of 20%. Singleton IUGR were similarly defined with a umbilical artery PI > 95th percentile for gestational age. Cases with reversed or ab-sent end-diastolic flow were also included. We analyzed hemoglobin / hematocrit differ-ences at birth and on day 2 between the groups taking into account the gestational age at delivery and the order of birth of the twins. Moreover, for each twin pregnancy two sin-gleton cases matched for gestationa age (±1week) were included. Data analysis was per-formed using Prism 5 for Mac OS X.

Results: 105 cases fulfilled our inclusion criteria. Group 1 consisted of 35 twin pregnancies with sIUGR, and group 2 of 70 age matched IUGR neonates. Mean gestational age at de-livery in the two groups was 31.9±1.9 weeks. At birth, no significant difference in Hb were found between the two groups . A difference was found in HCT between the sIUGR twin and singleton IUGR (p<0.05). No hematologic differences were found at day 2. If the sIUGR delivered as first, a significant differences in Hb and HCT was found between group 1 and 2 (sIUGR vs IUGR p<0.05; Co-Twin vs IUGR p=NS). No differences with group 2 were found if the co-twin was delivered as first. In the Follow-up at 2 days a significant difference with group 2 was found only if the sIUGR was born first (sIUGR vs IUGR P=<0.05).

Conclusions: A little bit surprising is the fact that the so called “normal co-twin” shows sim-ilar hematologic parameters like a growth restricted singleton neonate while the growth restricted co-twin is similar to the age matched controls.


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P 103

Gestational diabetes mellitus is associated with increased neutrophil extracellular trap formation, which is induced by high glucose

Author: 1) Stoikou M., 1,2) Grimolizzi F., 3) Hösli I., 3) Lapaire O., 1) Rossi S., 1,4) Giaglis S., 1) Hahn S.Hospital: 1) Biomedicine, University Hospital Basel, 2) Clinical Sciences, Polytechnic University Marche, Ancona, Italy, 3) Obstetrics, University Women’s Hospital Basel, 4) Rheumatology, Cantonal Hospital Basel

During normal pregnancy insulin sensitivity declines with advancing gestation, while a compensatory increase in insulin maintains the normal glucose homeostasis. Gestational diabetes mellitus (GDM) is a condition of glucose intolerance first recognized during preg-nancy resulting in hyperglycemia of variable severity. GDM develops when the pancreatic beta cells are unable to regulate the increased insulin demand.

During pregnancy there is an increase in the number of circulating neutrophils, which exhibit an enhanced ability to produce extracellular traps (NETs). NETs contain genomic DNA, histones and granular proteins such as neutrophil elastase (NE) and myeloperoxi-dase (MPO), which are released in the extracellular environment to trap and kill patho-gens.

The aim of this study was to characterize and investigate the biological response of neu-trophils in cases with GDM. Neutrophils isolated from pregnant women with GDM were determined to be highly reactive and formed NETs more vigorously when compared to neutrophils isolated from normal healthy pregnant women, as observed by fluorimetry, immunocytochemistry and morphometric analysis. Moreover, serum and plasma analysis revealed higher levels of cell-free nucleosomes and MPO in GDM donors. Although neu-trophils isolated from normal blood donors exhibited an increased propensity towards NET formation under hyperglycemic conditions, this could not account for the excessive response observed in GDM. It is possible that the latter involves alterations in key compo-nents regulating NETosis, such as NE, where an imbalance in its inhibitor a1AT was noted. This could lead to overt NE activity, thereby promoting NETosis.

In an examination of blood samples from pregnant women taken during the O.G.T-Test, we observed that not only was NETosis enhanced in cases with GDM, but also the kinet-ics was altered when compared to those from normal pregnant women. More specifically, neutrophil activation and NETs release was greater after exposure to high glucose follow-ing a period of fasting.

In summary, our findings show that during GDM, peripheral blood neutrophils are more activated and prone to release NETs than neutrophils isolated during normal pregnancy. Therefore, the analysis of neutrophil activation and NET release could potentially serve as biomarkers for early detection of GDM development.


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P 104

24-h blood pressure variability in pregnant women with hypertensive disorders

Author: 1) Bessire A., 1) Bolla D., 2) Rimoldi S., 2) Cerny D., 1) Surbek D., 1) Spinelli M., 1) Baumann M., 1) Raio L.Hospital: 1) Obstetrics and Gynecology, 2) Cardiology/ 1,2 University Hospital Bern

Introduction: Recent studies performed in non-pregnant patients with chronic hyperten-sion have shown that an increased blood pressure variability (BPV), expressed as standard deviation (SD) of ambulatory 24h blood pressure monitoring (ABPM) is associated with a higher degree of end organ damage, and incidence of cardiovascular events. Studies eval-uating the BPV in the obstetric filed are lacking. The aim of the present study was to inves-tigate if BPV has a prognostic value in women with hypertensive disorders.

Methods: A retrospective study was conducted between January 2009 and April 2014, in-cluding pregnant women with hypertensive disorders who underwent ABPM during preg-nancy. From each ABPM recording we calculated the mean SD at day and night-time of the systolic-, diastolic- and mean arterial BP corrected according to the formula reported by Bilo et al (Journal of Hypertension 2007, 25:2058–2066). BPV was evaluated in cases with and without hypertensive complications at the time of ABPM. Moreover, our data’s were compared to published values (Bilo et al.) of a non-pregnant sex mixed population at high risk for cardiovascular disease, and end organ damage.

Results: A total of 52 patients were included in our study. Mean age and BMI of the co-hort was 33.6±6.3 years and 29.1±6.2 Kg/m2, respectively. Five (10%) women had a pre-eclampsia (PE) at ABPM and 7 (21.2%) developed it during the study period. No signifi-cant differences in systolic, diastolic, and mean arterial BPV SD were found between the groups. Similar BPV SD’s were found in women with PE and with chronic hypertension. Compared to the non-pregnant population in the study by Bilo et al. with a significantly higher mean age of 56.4±15.9 years but lower BMI (26±4.7 Kg/m2) the BPV SD (systolic BPV study group: 11.09±2.9 vs. BPV Boli et al. 11.1±3.1, p=0.9; diastolic BPV study group: 8.30±1.95 vs. BPV Boli et al. 8.3±1.9, p=0.9) was not different.

Conclusions: Our preliminary findings suggest that pregnant women with chronic hyper-tension and/or PE BPV SD’s are similar to those found in a much older population with hy-pertension.


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P 105

Anti-NMDA Receptor Encephalitis in a young patient with ovarian teratoma: A Case Report

Author: Matt L., Nussbaumer J., Heinzelmann V.Hospital: University Hospital for Women Basel

Introduction: Anti-N-methyl-D-aspartate receptor (anti-MMDAR) encephalitis is an im-mune-mediated disorder affecting mostly young, previously healthy women. As approxi-mately 60% of patients with signs of encephalitis and positive NMDAR-antibodies present with ovarian tumors, the anti-NMDAR encephalitis was initially classified as a paraneoplas-tic syndrome. Nowadays it is classified as autoimmune encephalitis: NMDAR antibodies have been present and confirmed in almost all cases of patients with acute onset of en-cephalitis and adnexal tumors. Clinical presentation generally includes psychiatric symp-toms with aggressive behavior, epileptic seizures, cognitive deficits, dyskinesia and de-creased level of consciousness with rapid deterioration.

Methods: This report is about a 29 year old, previously healthy woman. The patient was hospitalized in the medical intensive care unit after a 4 day history of headache, paresthe-sia, blurred vision, nausea, decreased level of consciousness and aggressive behavior. The initial routine laboratory results were normal, a CT and MRI brain scan showed no abnor-malities. An initiated therapy with zovirax for presumptive viral encephalitis was stopped after lumbar puncture showed negative results for herpes, varicella and borrelia. After ex-clusion of infective encephalitis, the patient was put on immunomodulating therapy in-cluding intravenous immunoglobulins and methylprednisolone. Her condition remained poor but stable.

Results: We strongly suspected anti-NMDAR encephalitis and performed a transvaginal bedside ultrasonography. It showed a right sided adnexal tumor of 8x5x5cm. All tumor markers (CA 125, CA 15-3, CA 72-4 and AMH) were normal. The patient received an opera-tion including washings and a right side ovarectomy which confirmed a teratoma contain-ing bone and brain structures.

Conclusion: The rare but severe immune-mediated anti-NMDAR encephalitis is mostly seen in young women and is associated with ovarian tumors. Therefore, early gynecolog-ical assessment including ultrasonography and ultimately removal of the tumor is war-ranted.


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P 106

Prospective evaluation of laparascopic sacrocolpopexy with concomitant laparoscopic as-sisted vaginal hysterectomy

Author: Christmann C., Fähnle-Schiegg I.Hospital: Urogynecology, Cantonal Hospital Lucerne

Introduction: We present a series of our first 20 cases of laparascopic sacrocolpopexy with concomitant laparo-scopic assisted vaginal hysterectomy (LAVH with SCP). To date the standard procedure in women with apical descent with a uterus present is a laparo-scopic SCP with a subtotal hysterectomy (SH) to avoid an increased risk of mesh erosion and to maintain the integrity of the vaginal canal. SH allows preserving the cervix which serves as a convenient possibility for fixation of the mesh and the integrity of the vaginal canal. Several disadvantages are linked to the remaing cervix, such as possible discharge and need for further PAP smears. Furthermore the uterine morcellation is controversially discussed which increases the risk of spillage of undetected uterine pathologies. Our pri-mary outcome was to evaluated mesh erosions rate. Secondary outcome was objective and functional outcome.

Material and methods: We prospectively evaluated 20 women who did not meet the cri-teria of a subtotal hysterectomy at the time of SCP. To remove the uterus in total, we per-formed SCP with a concomitant LAVH to avoid any thermic injuries on the vaginal cuff. Our surgical procedure contained a standardized laparascopic preparation of the uterus down to the uterine vessels, the dissection of the vesico-vaginal down to the level of the bladder neck and the recto-vaginal space down to the perineal body before completing the hys-terectomy vaginally. The vaginal cuff was then closed with continuous Vicryl 2-0 sutures. The SCP was completed the usual manner utilizing the EndoGYNious® mesh.

Results: In these 20 cases we found mesh erosion or symptomatic vaginal cuff hematoma (0/20) with a mean follow up of 4 months. Patients showed excellent anatomical and func-tional outcome compa-rable to women who had undergone laparoscopic SCP with con-comitant subtotal hysterectomy.

Conclusion: We could demonstrate that laparoscopic SCP with concomitant LAVH shows no increased risk of mesh erosion and high objective and functional outcomes. To our un-derstanding, if the total hys-terectomy is performed as LAVH to avoid any thermic injuries at the vaginal cuff vaginal cuff hema-toma and mesh erosion can be prevented. Thus, this procedure could become a standard for women with prolapse and indication for hysterec-tomy or contraindications for preservation of the cervix.


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P 107

„Uterus Wrapping“: A Novel Concept in the Management of Uterine Atony during Cesarean Delivery

Author: Kimmich N., Engel W., Kreft M., Zimmermann R.Hospital: Obstetrics, University Hospital Zurich

Introduction: Uterine atony during cesarean delivery is a serious cause of maternal mor-bidity and mortality. Management strategies include medical treatment, manual com-pression/massage of the uterus and interventional or surgical procedures. A novel tech-nique to compress the uterus by wrapping it with an elastic bandage is presented here as an alternative compressing procedure.

Materials and methods: Some cases of uterus wrapping during cesarean section are pre-sented, which we performed successfully in addition to medical treatment with uterotonic agents in the management of uterine atony. Therefore, the uterus was exteriorized and concentrically wrapped with a sterile elastic bandage from the fundus to the isthmocervi-cal segment, as far as possible without including the adnexa into the wrapping. The ban-dage was removed intraoperatively as soon as a sufficient tone of the uterus was achieved.

Results: In all of the cases, a sufficient tone of the uterus was obtained after 12-75 min-utes, so that the bandage could be removed and the cesarean could be terminated. By that, a hysterectomy could be avoided and fertility preserved in all cases. Blood loss was between 800 and 2000 ml, the postpartum hemoglobin between 13 and 28 g/l. All pa-tients could be discharged from hospital between three to seven days. Follow-up is un-eventful so far.

Conslusion: Our novel method of intermittent wrapping of the uterus during cesarean delivery seems to be a successful approach in the management of uterine atony and may be an alternative treatment option to other compressing procedures in order to avoid high blood loss and last but not least postpartum hysterectomy.


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P 108

Sentinel node biopsy (SNLB) pathologic Evalu-ation by frozen section and IMMUNHISTOCHEM-ical examination following paraffin Embed-ding, in 588 patients from a Breast Center – surgical and oncological implications

Author: Calvalcanti N., von Hochstetter A., Hilfiker P., Bättig B., Michael M., Landolt A., Schaub A., Obwegeser J., Köchli O.R.Hospital: BreastCenter Zurich-Bethanien

Introduction: In our Breast Center we continue to perform on a regular base the Sentinel Lymph Node Biopsy (SLNB) together with frozen section examination in node negative cancer patients. In spite of the results of the Z0011 study published by Giuliano in 2011, a positive finding of metas-tasis is followed up by full axillary dissection in the same setting, thus avoiding a delayed second operation. The aim of this study was to evaluate the pathological findings of SNLB and to under-stand better the surgical and oncological implications of this procedure.

Methods: We evaluated the charts of 588 consecutively operated node negative breast cancer pa-tients with SNLB and frozen sections over a six year period. Average tumor size was 1.73cm, 70.7% had a pT1 and 27.2% a pT2 tumor. All negative nodes were thoroughly screened by immunohisto-chemical means (IHC/Cytokeratin) subsequent to frozen section.

Results: Frozen sections of SLNB revealed metastatic deposits in 124/588 patients (20%). Of the patients with negative nodes on frozen section 80.8% remained negative with IHC (375/464), while 89 (19.2%) revealed cytokeratin-positive cells or cell groups: in 42 patients, these were isolated tu-mors cells only, in 47 patients cohesive cell groups. In these latter 47 patients, 29 were micrometa-stases (0.2-2mm) and 18 macrometastases (>2mm; pN1). The overall false-negative rate on frozen section was 19.2% (89/464 patients). Up-staging from pN0 to pN1 occurred in 10% (47/464): micro-metastases in 6% and macrometastases in 4%.

Evaluation of 588 node negative breast cancer patients: Frozen section positive patients: (=124): 20% Frozen section negative patients (=464): 80% After IHC still negative: (=375) 81% After IHC positive: pN0i+ (=89) 19% Up-staging to pN0i+ (=42/464) 9% Up-staging to pN1mi (=29/464) 6% Up-staging to pN1(=18/464) 4%

Conclusions: Performing a frozen section examination on the SLN is of value in helping to decrease the rate of delayed, second operations if patients with positive axillary sentinel lymph nodes are to undergo a full axillary dissection. Furthermore, the thorough evaluation of negative SLN by im-munohistochemical means (4% harbor macrometastases) has potential oncological implications.


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P 109

Birth order of monochorionic twins with selective intrauterine growth restriction and postnatal hematologic values

Author: 1) Kiechle K., 1) Bolla D., 1) Wäspi N., 1) Raio L., 2) Nelle M., 3) Baud D., 2) Gerull R.Hospital: 1) Obstetrics and Gynecology, 2) Neonatology, 3) Obstetrics and Gynecology, University Hospital Lausanne/ 1,2 University Hospital Bern

Introduction: The aim of our study is to compare in monochorionic (MC) diamniotic twins complicated by selective intrauterine growth restriction (sIUGR) hematologic parameters between both twins at birth and during the first 10 days after delivery.

Methods: A retrospective single cohort study was conducted between January 2005 and November 2015 including all MC pregnancies with sIUGR delivered in our hospital. sIUGR was defined as abdominal circumference of the smaller foetus below the 10th percentile for gestational age and a weight discordance between both foetuses of at least 25%. We compared haemoglobin (Hb) and haematocrit (HCT) between the twins at birth, on day 2 and 10 after delivery taking into account their birth order. Data analysis was performed using Prism 5 for Mac OS X.

Results: During the study period 44 MC twins with sIUGR were seen at our institution and 35 cases fulfilled the inclusion criteria. Mean gestational age at delivery was 31.9±2 weeks. At birth no significant Hb and HCT differences were found between the sIUWR and co-twin. Of the sIUGR group 7/35 (20%) needed a blood transfusion after birth. This pic-ture changed to 7/17 (41%) if the IUGR (17/35) twin was delivered as first (sIUGR Hb/HCT: 161.8±24.9/0.47±0.07 vs co-twin 184.2±20 / 0.53±0.04; p=0.03). During the follow up no significant haematological differences were found between the groups.

Conclusions: Growth restricted MC newborn present at birth a significant lower Hb/HCT value compared to their co-twin in particular when delivered as first child.


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P 110

Perinatal outcome after fetoscopic laser coagulation of placental anastomoses in twin-twin transfusion-syndrome (TTTS) at the University Hospital Zurich (USZ)

Author: Rüegg L., Hüsler M., Krähenmann F., Zimmermann R., Ochsenbein-Kölble N.Hospital: Obstetrics, University Hospital Zurich

Introduction: Without treatment, the risk of fetal demise of one or both fetuses in twin-twin transfusion-syndrome (TTTS) is above 90%. The selective laser coagulation of placen-tal anastomoses is the only causal therapy. The aim of our study was to analyze the perina-tal outcome after fetoscopic laser therapy at USZ.

Patients and methods: Between 2008– 2014 38 women were treated with fetoscopic la-ser procedures because of a TTTS. Outcomes observed were as follows: Gestational age (GA) at operation (OP), intrauterine fetal death (IUFD), preterm prelabour rupture of the membranes (PPROM) and birth; OP-time, postpartum survival of one child, two children and at least one child. The impact of a short cervix (<25mm) on the GA at delivery and sur-vival of the children was also evaluated. Data is presented as mean +/-SD.

Results: A Quintero stage I, II or III was diagnosed in 29%, 21% and 50%, respectively. Mean OP-time was 48+/-15 min and the mean GA at OP was 20.5+/-2.8 gestational weeks (GW). IUFD <7d after OP was diagnosed in 24%. PPROM <14d or <28d after OP occurred in 13% and 21% of all cases. Mean GA at birth in all cases was 30.2+/-5.8 GW. In 50% two children and in 29% only one child survived; in 79% the couple was able to bring home at least one child. If the cervix was preoperatively <25mm, the babies were born at a GA of 27.0 +/-4.7 GW with a survival rate of at least one child in 60%. In cases with a preoperative cervix >25mm the GA at delivery were 31.3 +/-5.8 GW. At least one child survived in 86%.

Conclusion: The presented perinatal outcome data after fetoscopic laser procedures at USZ are comparable to outcome data of international studies. A cervix >25mm is associ-ated with a better perinatal survival rate than a cervix <25mm.


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P 111

Removal of sFlt-1 by apheresis in very early-onset preeclampsia: A case report

Author: 1) Knabben L., 2) Mohaupt MG., 1) Raio L.Hospital: 1) Obstetrics and Gynecology, University Hospital Bern, 2) Nephrology, Hypertension and Clinical Pharmacology

Introduction: It has been suggested that an excess of placental derived antiangiogenic soluble fms-like tyrosine kinase-1 (sFlt-1) mediates the signs and symptoms of preeclamp-sia (PE). In previable, usually severe PE the management consists generally in termination of pregnancy due to the inherently high maternal morbidity and mortality. Recently, ther-apeutic apheresis of sFlt-1 and subsequently prolongation of pregnancy in women with early PE has been reported. We present our experience of apheresis in a patient with very early-onset PE.

Case report: A 36 years old gravida 2 para 0 was admitted at 22 2/7 weeks of gestation for suspicion of superimposed PE. Her medical history was marked by a focal segmental glo-merulosclerosis and chronic hypertension. Pregnancy had occurred after eight natural cy-cles IVF. At admission she presented severe PE with a blood pressure of 170/80 mmHg, a proteinuria of 8.9g/24h, and renal insufficiency (creatinine 310μmol/L). Serum sFlt-1 level was elevated (12 865 pg/ml) with a sFlt-1/PlGF ratio of 264. Hypertension was controlled with intravenous labetalol. Due to worsening renal function dialysis was necessary at 23 1/7 weeks. Acceptable fetal growth with normal umbilical hemodynamics but patholog-ical uterine artery doppler was found. After informed consent three apheresis sessions with removal of sFlt-1 were carried out. By the first treatment at 23 1/7 weeks circulating sFlt-1 level was lowered by 10.4% without adverse events. The second treatment was also well tolerated but sFlt-1 level increased by 2.9%. Fetal lung maturation was completed at 24 0/7 weeks of gestation. At 24 3/7 weeks a third apheresis was performed. The patient developed an anaphylactic shock due to the filter. Additionally laboratory findings were consistent with HELLP syndrome and cardiotocography showed fetal distress. Caesarean section was performed. A 600g neonate was admitted to the neonatal intensive care unit. The patient was discharged 6 days after delivery to ambulatory nephrologic care.

Conclusion: To the best of our knowledge we report the first experience of apheresis in treatment of early-onset PE in a patient with pre-existent renal disease. We could prolong pregnancy by 7 days and thereby achieve viability of the fetus. But in contrast to previous studies and case reports we observed a serious adverse event necessitating emergent de-livery. Apheresis might be a treatment option in previable PE but technical and safety as-pects have to be assessed in properly designed studies.


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P 112

Choledochal Cyst: The importance of prenatal diagnosis (Case Report)

Author: Taramarcaz T., Blindenbacher H., Schneider N.Hospital: Gynecology and Obstetrics, Valais Hospital, Sion

Introduction: The discovery of a prenatal abdominal cyst during an ultrasound allows to establish an early neonatal monitoring. This allows in turn to avoid severe complications such as cholestasis, pancreatitis, cholangitis, hepatic fibrosis and cholangiocarcinoma. The first step is to eliminate the diagnosis of biliary atresia, which requires surgical treatment that consists of a hepato-porto-enterostomy according to Kasai.

Case: The presented clinical case concerns a patient of 27 years, 3G2P, in which a cyst bil-iary tract is identified at 35 gestational age (GA) in the fetus. This patient has lost the first two children respectively 9 and 12 months of life because of a metabolic disease X with concomitant encephalopathy. The discovery of the cyst does not however seem to be re-lated to this history. With the cyst growing, a provocation to 37 2/7 GA was decided. The vaginal delivery took place without incidents with the birth of a daughter of 3170 grams (percentil 65), 50cm, arterial pH 7.33, not obtained venous pH, APGAR 9-10-10 and head circumference of 34.5cm . The child presented a neonatal jaundice without requiring pho-totherapy. Abdominal ultrasound, normal conjugated bilirubin and colored stools helped to diagnose the type of cyst bile 1. The choledochal cyst is a congenital malformation of the biliary tract in the form of one or more expansions connected together with possible damage to the hepatic ducts. The incidence in Western countries is 1 / 200,000. Currently the child is monitored by ultrasound and biologically so as to determine the best time to perform a Roux en Y hepatico-jejunostomy.

Conclusion: This presentation provides an understanding of postpartum care for antena-tal discoveries dilatation of the bile ducts, to better prepare the information given to pa-tients. It also highlights the usefulness of a multidisciplinary management (gynecologist, pediatrician, surgeon, geneticist) of those rare cases. Finally it reminds practitioners of some concepts necessary to the practice of ultrasound. Indeed, the doctor must know the possible genetic or environmental predisposition to the onset of biliary cysts and deformi-ties associated with them and which can be highlighted by prenatal ultrasounds (duode-nal atresia, atresia coli, anal atresia, hemifacial microsomia with extrafaciales defects, ven-tricular septal defect, aortic hypoplasia and polycystic kidney disease).


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P 113

Spontaneous third-trimester partial enucleation of a giant placental chorioangioma after mid-trimester lasertherapy: a case report

Author: 1) Kreklau A., 1) Pelikan S., 1) Hodel M., 2) Raio L., 3) Baud D., 1) Kohl J.Hospital: 1) Obstetrics and Gynecology, Cantonal Hospital Lucerne, 2) Obstetrics, University Hospital Bern, 3) Obstetrics, University Hospital Lausanne

Introduction: Chorioangioma are the most common benign tumors of the placenta with an estimated prevalence of 1%. The rare giant chorioangiomas (diameter > 4cm) bear a high perinatal death rate (30-40%) due to high cardiac output failure. Antenatal treatment includes fetoscopic laser coagulation of supplying vessels, laser ablation, chemosclerosis and endoscopic surgical devascularization. We report on a case of a sudden unexpected complication after fetoscopic laser therapy.

Material and methods: A 27-year-old Gravida II, Para 0 was referred to our department at 22+4 weeks’ gestation because of a placental mass. Ultrasound confirmed a viable single-ton pregnancy with polyhydramnios (AFI 27 cm), highly suspected fetal anemia and early signs of cardiac decompensation. A hypoechoic mass of 11x6x8 cm was found within the placenta, consistent with diagnosis of chorioangioma. Colour Flow demonstrated mas-sive feeding vessels running on the fetal side of the placenta connecting the tumor to the cord insertion site. Fetoscopic laser occlusion of the feeding vessel (1 cm diameter) was successfully performed one day later at the Department of Obstetrics, University of Bern. Follow up ultrasound revealed a devitalized mass. Size of the suspected chorioangioma remained stable while fetal cardiomegaly and signs of fetal anemia resolved. After inten-sive initial in-hospital observation, an outpatient management was scheduled.

Results: At 33+4 weeks’ gestation, ultrasound showed the devitalized mass to be highly mobile in its placental bed, the amniotic fluid was clearly hyperechoic. An urgent cesar-ean section was performed for suspicion of partial enucleation and intraamnial bleeding. A viable newborn was delivered, the sonographic findings could be confirmed. Except for neonatal anemia requiring transfusion of one unit of red cell concentrate, the baby`s adaptation and further neonatal period were uneventful. Pathological examination con-firmed the prenatal diagnosis of a chorioangioma.

Conclusion: Laser therapy allowed to prevent early intrauterine demise in regard of the chorioangioma`s size and the early fetal changes related to high cardiac output. However, this case of a rare complication reminds us the importance of close surveillance through-out the complete course of pregnancy.


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P 114

The Current Swiss Data for Prevention of Mother-To-Child Transmission of HIV

Author: Grawe C., Zimmermann R.Hospital: Obstetrics, University Hospital Zurich

The last published recommendations of Federal Office of Public Health (FOPH) from 26.01.2009 regarding the prevention of Mother-To-Child Transmission of HIV (MTCT) were released by HIV/AIDS Commission of experts for Clinic and Therapy. Currently, several new aspects concerning the antiviral therapy of the pregnant women, mode of delivery, post-exposure prophylaxis and breastfeeding have been discussed and submitted. Since 2009 in Switzerland there was no single Mother-To-Child Transmission of HIV registered. The study group consents that due to the antiviral therapy suppressed HIV-Virus load at the end of the 3. Trimester or before the delivery does not increase the risk of MTCT.

1) The antiviral therapy should be started as early as possible in the pregnancy or opti-mally before the conception. In case of the untreated HIV during the first trimester, an an-tiviral therapy must be indicated at the second trimester. Regarding the choice of an ac-tual antiviral therapy please consult the European AIDS Clinical Society Guidelines (EACS).

2) Under the assumption that the requirements are fulfilled the ordinary measures of ob-stetric care as well as spontaneous vaginal delivery can be provided. Zidovudin iv. during the vaginal delivery should not be administered. Hepatitis C and HIV Co-infection is no more an indication for the Cesarean Section.

3) The post-exposure prophylaxis of the newborn can be entirely avoided under the com-plete suppression of the viral load during the pregnancy.

4) The estimated risk of MTCT via mother’s milk is extremely low if the viral load is sup-pressed due to the sufficient antiviral therapy. However, there are several aspects as trans-fer of antivirals across the placenta and possible affection of the fetus or reactivation of the latent HIV in the mother’s milk and episodes of mastitis, which should be revised.

Breastfeeding- topic still needs an extensive research of the literature, before the elabora-tion of the final recommendations. The guidelines regarding topics 1-3 were published on 25.01.2016 by the Federal Office for Sexual Health (FOSH).


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P 115

Neolacto glycosphingolipids increase Doxorubicin and organoarsenic PENAO sensitivity and promote HIF-1a accumulation upon hypoxia in ovarian cancer cells

Author: 1) Fedier A., 1,2) Alam S., 1) Winkelbach K., 1) Kohler R., 1,3) Heinzelmann V., 1,2) Jacob F.Hospital: 1) Ovarian Cancer Research, Department of Biomedicine, 2) Glyco-Oncology, Ovarian Cancer Research, Department of Biomedicine, 3) Hospital for Women, Gynecology and Gynecological Oncology, / 1-3 University Hospital Basel, University Basel

Introduction: Drug resistance (intrinsic and acquired) and tumor hypoxia are two major obstacles in the treatment of cancer and many underlying key mechanisms and players have been identified in the past. Only recently possible functions of carbohydrate (glycan)-bearing ceramide lipids (gly-cosphingolipids, GSLs) located in the outer leaflet of cell membranes have been considered, not the least because GSLs have been shown to be critically implicated in the pathogenesis of various diseases and cancer. Here we investigate the unknown function of neolacto GSLs (P1 and nLc4) on drug sensitivity and response to hypoxia. To this aim we have generated from the parental IGROV1 ovarian cancer cell line a respective knockout subline disrupted in the B3GNT5 gene (B3GNT5-ko). B3GNT5 is the key enzyme in the biosynthesis of P1 and nLc4.

Material and methods: Gene disruption was achieved by CRISPR/Cas9 genome-editing of B3GNT5 and confirmed by genotyping and quantitative PCR. GSL expression was determined by flow cy-tometry. Drug sensitivity was determined by MTT-assay. Drug-induced apoptosis and hypoxia in-ducible factor (HIF-1a) accumulation in hypoxia-mimicking cobalt chloride-treated cells were de-termined by Western blotting.

Results: Parental IGROV1 cells expressed both neolacto P1 and nLc4, globosides Gb3 and SSAE3, and ganglioside GM1. In contrast and as anticipated, the B3GNT5-ko cells were depleted in P1 and nLC4 but still expressed Gb3, SSAE3, and GM1. These neolacto-depleted B3GNT5-ko cells exhib-ited a slower proliferation rate compared to the parental IGROV1. They were also 4-fold resistant to Doxorubicin and Epirubicin and presented with decreased apoptosis (PARP cleavage). This re-sistance resulted in elevated MDR1-expression and was reversed upon specific MDR1 inhibition by CP-100356. P1- and nLC4-depleted cells were also 2-fold resistant to recently developed orga-noarsenic PENAO, whereas no difference in sensitivity was found for Paclitaxel, Docetaxel, Carbo-platin, and Cisplatin. Interestingly, P1- and nLC4-depleted cells showed reduced HIF-1a accumula-tion in hypoxic compared to parental IGROV1 cells.

Conclusion: Neolacto P1 and nLc4 promote the cytotoxic effect of anthracyclines and organoarse-nic PENAO (but not taxanes and organic platinum compounds) and HIF-1a induction in IGROV1 cells. These data therefore demonstrate the importance of neolacto GSLs in drug and hypoxia re-sponses and expand on previous findings for Gb3 in conferring resistance to Cisplatin.


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P 116

Adolescent contraceptive continuation rates in the Canton of Vaud (Switzerland)

Author: 1) Diserens C., 2) Quach A., 1) Mathevet P., 1) Renteria S-C., 1) Ballabeni P., 1) Jacot-Guillarmod M.Hospital: 1) Gynecology-obstetric and Genetic, University Hospital Lausanne, 2) Profa Foundation, Family Planning, Vaud

Introduction: The objectives of this study, first of this kind in Switzerland, were to deter-mine the contraceptive continuation rates among adolescents in the Canton of Vaud, to identify the prescribed contraceptive methods, and to assess potential predictive factors of discontinuation.

Methods: A prospective observational study with an exploratory nature was performed on 12–19 year old girls recruited during consultations for new contraceptive prescriptions. Patients were interviewed one year later. Associations between continuation and poten-tial predictors were assessed using contingency tables and Fisher’s exact tests.

Results: 204 patients with a 17,28 years median age were included. Among the patients, 85.78% chose the oestroprogestative pill, 4.41% the progestative pill, 2, 45% the ring, 0,98% the patch, 3,43% the injection and 2.94% long-acting reversible contraception (LARC). 145 patients answered one year later (a high 71% response rate). The original con-traceptive continuation rate was 73.1%. Among these patients, 93.4% were satisfied with their contraceptive method. The factors statistically affecting the continuation rate were the contraceptive method, the place where the patient lived one year later, and sexual ac-tivity one year later. Age, nationality, smoking, occupation, the fact that the legal repre-sentative was informed about the contraception or not, had no influence on adherence. The continuation rates were: 100% for the LARC method, 75.2% for the oestroprogestative pill, 75% for injection, 60% for the progestative pill, and 0% for patch and ring. The main reasons given for discontinuation were absence of sexual intercourse followed by the side effects. Patients changing contraceptive method were considered as having discontinued the contraceptive method; they represented 22.86% of those who interrupted contracep-tion. Two patients became pregnant during the study.

Conclusion: The contraceptive continuation rate among adolescents in this canton was good. The only predictive factor of discontinuation identified upon prescription was the contraceptive method. The excellent rate of continuation and satisfaction with LARC methods strengthens the recommendation of prescription of these methods to adoles-cents. Care should be exercised when prescribing a patch or a ring as the continuation rate is very low. The significant impact of the contraceptive method on the continuation rate stresses the importance of individualized counselling.


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P 117

Lower cesarean section rate in singeltons born after gonadotropin-free in vitro fertilization (NC-IVF) compared to conventional IVF

Author: 1) Kohl Schwartz A., 1) Mitter, V., 1) Minger M., 1) Fasel P., 1) Eisenhut M., 2) Linoni C., 1) von Wolff M.Hospital: 1) Gynecologic Endocrinology and Reproductive Medicine, Bern University Woman’s Hospital, 2) University of Applied Sciences and Arts of Sourthern Switzerland, Lugano

Introduction: Cesarean section rate is known to be above average in an infertile popula-tion (Valenzuela-Alcaraz et al. 2016) because of multiple reasons. Differences in maternal characteristics such as age, parity or subfertility reasons are of importance. (Pelinck et al. 2010). Also ovarian stimulation may affect endometrial receptivity and lead to a poor im-plantation environment. In NC-IVF embryos showed a better quality (Papaleo et al. 2005) due to natural follicle selection. Implantation seems to be improved due to increased en-dometrium receptivity (Rackow et al. 2008, Bourgain et al. 2003). However little is known about the obstetrical outcomes in NC-IVF compared to conventional IVF (cIVF) conceived pregnancies.

Methods: Retrospective analysis of singelton pregnancies after IVF treatment with fresh embryo transfers at a single university centre between 2010 – 2014. All women (18-42 years) with regular cycles were offered both NC-IVF and cIVF. NC-IVF was performed with-out any gonadotropins but in 59% of cases modified with 25mg clomifen citrate per day to reduce the risk of premature ovulation. cIVF was performed as a short agonist (21%) or an-tagonist (78%) protocol. Obstetrical and delivery data were extracted from patient’s files and delivery reports.

Results: Complete data sets were identified for 62 NC-IVF and 41 cIVF singelton deliveries. Gestational age at delivery (NC-IVF mean 39.2 SSW vs. cIVF 38.8 SSW), prematurity (8% vs. 5% cases) and low birth weight (0% vs 4.8% cases) were not different. Mean birth weight of NC-IVF vs. cIVF children (3226g vs. 3148g) were not different either. In contrast, the pro-portion of women intending to deliver vaginally was significantly higher (85% vs. 67.5%, p= 0.035) after NC-IVF than after cIVF. Accordingly, cesarean section rate in pregnancies following NC-IVF were lower compared to cIVF (38.7 % vs. 53.7 %, p= 0.098).

Conclusion: Women choosing NC-IVF intended significantly more often to deliver sponta-neously. It remains to be examined if this difference is due to the attitude concerning vagi-nal or cesarean deliveries or if it is due to more tension and fear following cIVF, or if gonad-otropin affects the endometrial receptivity inducing changes in obstetrical and perinatal outcome. NC-IVF treatment has been shown to be less stressful for infertile couples possi-bly resulting in less fear concerning the delivery. In conclusion our study has shown that delivery parameters are in favour of NC-IVF, so this kind of treatment can be an alternative.


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P 118

Artery pseudoaneurysm after secondary caesarean section – a case report

Author: Schumacher C., Fehres O., Knüsel P., Fehr P.M., Biedermann K.Hospital: Gynecology and Obstetrics, Cantonal Hospital Graubuenden, Chur

Introduction: A pseudoaneurysm, or a false aneurysm, occurs when the wall of an artery is damaged with leakage into the blood vessel wall, without dilation of all the blood ves-sel wall layers, as seen in a true aneurysm. The leakage causes a hematoma, which lays in contact to the blood vessel. The surrounding tissue limits the expansion.

Case report: A 29-year old woman presented herself with dull abdominal pain, fever and vomiting for three weeks after a secondary caesarean section. At 40 + 2 gestational weeks in her second pregnancy, labor was induced, due to oligohydramnios. Her first phase of labor followed without complications after labor induction with 25 milligrams of miso-prostol, until she was dilated 8cm. At this stage the cardiotocography showed a fetal bra-dycardia, so the indication for a secondary caesarean section was made. During surgery the left side of the uterine incision tore farther into surrounding tissue with bleeding of the uterine artery. After suturing the left corner with three Z-sutures, the bleeding had apparently stopped. The patient was discharged without further complications after sev-eral days. As mentioned above, the patient presented herself again 3 weeks post-partum in the emergency. The clinical findings were tenderness of the lower left abdomen and brown, flesh-coloured vaginal discharge. The ultrasound examination showed an incon-spicuous uterus and a small 57x37mm hyperechoic tumour near the cervix on the left side behind the uterus, with a hypoechoic centre of 39x23mm and a positive flow in the dop-pler ultrasound. The CT-Scan confirmed the suspected diagnosis of an artery pseudoan-eurysm. The following embolization of the responsible branch of the uterine artery was successful, with an inconspicuous duplex sonography examination the next day. After 72 hours of observation she was discharged from hospital care in good condition. Sonogra-phy showed a remaining hematoma of only 78 x 69 x 52 mm.

Conclusion: Uterine artery pseudoaneurysm is a rare but serious complication of pelvic surgery and delivery, which can manifest as severe bleeding, symptoms associated with rupture and haemorrhage, can be asymptomatic, can thrombose, or can cause severe pain. Doppler ultrasound plays an important role in the differential diagnosis of the possi-ble causes of postpartum haemorrhage, and should guide us to this rare complication that can benefit from treatment by uterine artery angiographic embolization.


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P 119

Giving Birth in Switzerland: Comparing deliveries in hospitals from 2004 to 2011

Author: Konstantinidou E., Zimmermann R., Quack Lötscher K.Hospital: Obstetrics, University Hospital Zurich

Introduction: In 2007 Federal Office of Statistics published the results of an analysis con-cerning the numbers of pregnancies and deliveries as well as its complications in Swiss hospitals in 2004. We produced a similar statistical analysis of the 2011 data to investigate any changes in the numbers of pregnancy or and delivery complications.

Materials and methods: Statistical analysis of the data from 2011 from Medizinische Statistik der Krankenhäuser provided detailed information about the diagnosis (ICD10) and treatment (CHOP) of mothers hospitalized before, during and after delivery.

Results: In 2011 there were 78’487 deliveries in hospitals registered, of a total of 79’712 deliveries in Switzerland, compared to 69’952 hospital deliveries in 2004. Therefore 98,5% of deliveries took place in a hospital (in comparison to 97,5% in 2004). Regarding the deliv-ery mode we detected an increased rate of caesarean section from 29,2% in 2004 to 33,5 % in 2011. The rate of instrumental vaginal delivery was similar over time (11.8% in 2004 and 11,47% in 2011).The average age of mothers was 30 years in 2004 compared to 31.3 years in 2011.The rate of perineal tear in all vaginal deliveries showed an increase with 47,3% in 2011 compared to 33,1% in 2004. Especially by instrumental assisted deliveries the rate of perineal trauma was 38,6% compared to 23,8% in 2004. Concerning pregnancy com-plications we detected an increase in the rate of diabetes mellitus in pregnancy (includ-ing gestational diabetes, Typ I and Typ II) from 0.3% to 1,19%. The number of preeclamp-sia showed a decrease with 1322 cases (1,68%) compared to 1930 cases (2,75%) in 2004. Most women with preeclampsia in 2011 gave birth by caesarean section (70,8%) opposite to 2004 where only 48% with preeclampsia had a caesarean section.

Conclusion: The number of deliveries in Switzerland showed an increase in 2011 com-pared to 2004 and most women still give birth in hospitals. The international trend of in-creased rate of caesarean section can also be seen in Switzerland in 2011, maybe partly related to an increase of maternal age, with simultaneously stable rate of instrumental vaginal deliveries. Furthermore the complications of pregnancy showed an increase of cases of diabetes mellitus in pregnancy, most likely due to changes in screening programs in combination with the increased maternal age. On the opposite site there was a signifi-cant lower rate of preeclampsia and eclampsia in 2011.


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P 120

Results of 313 stereotactic breast biopsies from a breast center compared to the data from the Working Group of the Swiss Society of Senology: Minimal invasive breast biopsies (MIBB)

Author: Steinmann C., Michael M., Landolt A., von Hochstetter A., Köchli O.R.Hospital: BreastCenter Zurich-Bethanien

Introduction: Breast lesions which are neither palpable or seen on ultrasound but are de-tected with mammography due to the appearance of microcalcifications must be biop-sied with stereotactic biopsy if indicated (BI-RADS (III), IV und (V)). The Working Group of the Swiss Society of Senology keeps a mandatory national register for all Minimal Invasive Breast Biopsies (MIBB). The aim of this study was to analyse sterotactic breast biopsies per-formed in a single breast center and compare their histological distribution as well as the feasibility of the procedure with the national register.

Method: The prospectively established data base collected details of 313 cases over 10 years (2004-2014). Using the online tool provided by Adjumed, this data set was compared to the national bank for the following features: indication, malignancy, histological distri-bution and procedure related complication.

Result: BI-RADS IV-classification was the indication for the biopsy in 88% of cases within our data set compared to 83% in Switzerland. 23.2% of biopsies collected locally were ma-lignant compared to 25.6% nationally. The histological distribution of the biopsies was congruent with the Swiss data set. Evaluation of BI-RADS classification that was made prior to the biopsy and the histological result in our samples was as expected. No major complications occured and the incidence of minor complications was very low and com-parable to the whole collective.

Conclusion: The distribution of BI-RADS classification as well as the histological distribu-tion of the biopsies in our breast center was in range with the national data set of Switzer-land. This is evidence that the policies such as restrictive indication for biopsy and interdis-ciplinary preoperative case presentation at the over 10 years established Tumorboard and Mammacolloquium are valuable.


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P 121

Case report: “Neoadjuvant” Management of an aggressive Angiomyxoma with GnRH-Analoga

Author: Frei L., Sajjadi Maeder K., Eggemann C., Stähler K.Hospital: Gynecology, Hospital Centre Biel

Introduction: The agressiv Angiomyxoma (AAM) is a rare mesenchymal neoplasm aris-ing primarily in the soft tissue of the pelvis of premeopausal women. Dispite the fact that the tumor is characteristically positive for estrogen and progesterone and inclines to lo-cal recurrence, surgery is described in the literature as the treatment of choice. However treatment with GnRH-Agonists seems to be an elegant and efficient therapy option. Here we describe the case of a 38 years old woman with a big symptomatic aggressiv Angio-myxoma of the right ischiorectal fossa. We show the process over 9 months therapy under GnRH-Analoga with considerable reduction of the tumor as well as the improvement of her general condition in the context of a “neoadjuvant setting”.

Material and methods: Comparaison of the MRI of the pelvis befor and after Therapy (af-ter 3, 6 and 9 months) with Goserelin injection (Zoladex).

Results: Obvious regression oft he tumor volume (9,3 x 6 x 8 cm vs 5,5 x 4,0 x 7,0 cm) as well as subjective well-being under hormontherapy.

Conclusion: GnRH Therapy in context of a neoadjuvant setting decreases the complexity of the tumor resection. Furthermore there are reported cases of full remission under GnRH Analoga.


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P 122

Spontaneous complete uterine rupture in an early second-trimester uterus with placenta percreta – a case report

Author: von Harten R., Hagen D., Sekulowski M.Hospital: Hospital Uster

Introduction: Uterine rupture (UR) is a rare but serious obstetric complication that usually occurs in the third trimester during labor in patients with a history of prior cesaerean sec-tion (CS). It is associated with high maternal and fetal mortality. We present the rare case of uterine rupture as early as 14 weeks of gestation without a history of prior uterotomy.

Case: A 37-year old Caucasian, G3P1, at 14+0 weeks of gestation, presented with a sud-den onset of lower abdominal pain. She had a history of a vaginal delivery with postpar-tal curettage for retained products of conception with iatrogenic perforation of the uterus seven years ago. The current pregnancy had been uneventful so far. On admission, the vi-tal parameters were normal. Fetal ultrasound showed a vital intrauterine singleton fetus appropriate for gestational age. Abdominal ultrasound revealed free fluid in all four quad-rants. The patient developed tachycardia and hypotonia. Hemoglobin dropped to 6.3 g/dl. Emergency laparotomy was performed: the placenta and fetus in its intact amniotic mem-brane where floating in the abdominal cavity as there was a complete rupture of the uter-ine fundus. Abdominal hysterectomy was performed due to unstoppable bleeding. The patient was discharged home on postoperative day eight. The histopathologic results re-vealed the presence of placenta percreta.

Discussion: The median incidence for UR is 0.053 % with main risk factor previous CS. The incidence of rupture of the unscarred uterus is as low as 0.007 – 0.039 %. The average inci-dence of abnormal placentation is as low as 0.014 %. The main risk factor for UR in our case was placenta percreta and the additional risk factor perforation during curettage seven years prior. It is remarkable that the expulsion of the fetus into the abdominal cavity must have occurred after the initial ultrasound in our hospital. Diagnosis of UR early in preg-nancy is difficult and misdiagnosis frequent. Differential diagnoses include ectopic preg-nancy, appendicitis, endometriosis with erosion of utero-ovarian vessels, bleeding corpus luteum or molar pregnancies with invasion. Early surgical intervention is needed for suc-cessful diagnosis and reduction of maternal mortality.

Conclusion: Spontaneous uterine rupture in the second trimester is a rare condition, es-pecially if the patient did not have CS before. Nevertheless, clinicians should be aware of this rare diagnosis if a patient presents with abdominal pain at any time during pregnancy.


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P 123

Two embryos at one time, but no twins

Author: Silber P., Rittmann P., Harlacher S., Honegger Ch.Hospital: Gynecology and Obsterics, Cantonal Hospital Zug

Introduction: Heterotopic pregnancy is a very rare event in the general population. The incidence is approximately 1 in 30,000 in natural pregnancies, whereas it occurs in up to 1 in 100 pregnancies after in vitro fertilization. This report is about a case of a heterotopic spontaneous pregnancy diagnosed at 9 weeks of amenorrhea treated by laparoscopy. The synchronous intrauterine pregnancy continued with no further complications.

Materials and methods: A 33-year-old gravida 3 para 2 was seen in our emergency de-partment at 8 4/7 weeks of amenorrhea because of sudden onset of severe lower abdom-inal pain. Spontaneous conception and no relevant medical history in the past. Cervical movements were painless and there was no bleeding. Vital parameters, blood and urinary tests were all normal. Transvaginal ultrasound scan revealed the presence of a hetero-topic pregnancy with a vital intrauterine embryo and a vital tubal embryo on the left side, both with positive heartbeats. Besides, there was a cyst on the right ovary with the size of 68x59x63mm and a moderate amount of fluid in Douglas` space.

Results: We performed laparoscopy using low pneumoperitoneum pressure. There was a 250 ml hemoperitoneum and a complex adnexial mass in the middle of the left tube. Left salpingectomy and aspiration of the cyst of the right ovary and a peritoneal lavage were carried out. Histopathology of the resected specimen showed the presence of chorionic villi confirming a viable pregnancy. The postoperative course was uneventful and the pa-tient left the clinic 4 days after surgery with proper control of the intact intrauterine preg-nancy.

Conclusions: Heterotopic pregnancy can occur in the absence of any predisposing risk factors and the detection of an intrauterine pregnancy does not exclude the possibility of the simultaneous existence of an ectopic pregnancy. Hence a complete transvaginal ul-trasonography of the whole pelvis including adnexa should be done to rule out the pres-ence of a heterotopic pregnancy. A quick assessment and careful handling of the normal gestation can lead the patient to term with gratifying results. Because clinical features of a heterotopic pregnancy can vary widely, the correct and early diagnosis remains a chal-lenge for clinicians.


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P 124

Angiogeneic factors in pregnancies complicated by rheumatoid arthritis

Author: 1) Baumann M., 2) Risch L., 1) Raio L., 1) Surbek D., 3) Zbinden A., 2) Wiedemann U., 3) Förger F.Hospital: 1) Obstetrics and Gynecology, 2) Labormedizinisches Zentrum Dr. Risch, 3) Rheumatology/ 1,3 University Hospital Bern, University Bern

Introduction: Women with active rheumatoid arthritis (RA) during pregnancy deliver of-ten infants with reduced birth weight. We hypothesized that RA might have an impact on placental function and subsequently on the angiogenic profile. Therefore we investigated the pro- and anti-angiogenic factors such as placental growths factor (PLGF) and soluble fms-like tyrosine kinase-1 (sFlt-1), respectively, in patients with RA and healthy controls.

Patients and methods: PLGF and sFLT-1 serum levels of pregnant patients with RA (n=27) and gestational aged-matched healthy women (n=10) were analyzed once at each trimes-ter (gestational week 10-12, 20-22 and 30-32). Disease activity of all RA patients was mea-sured by DAS28-CRP and CRP. Neonatal birth weights and birth weight percentiles were correlated with PLGF and sFLT-1- levels.

Results: Median birth weight of the newborns from RA patients was 2890 g (range 1250-4000). Among all pregnancies of RA patients, the levels of PLGF and sFLT-1 were similar in active and inactive disease. At the third trimester of pregnancy, RA patients showed lower levels of the pro-angiogenic placental protein PLGF than healthy controls (p=0.02). In con-trast, levels of the anti-angiogenic protein sFLT-1 did not differ between RA patients and healthy women. The sFLT-1/PLGF ratio was lower in healthy women than in RA patients (p=0.021). Moreover the sFLT-1/PLGF ratio correlated negatively with the birth weight per-centile.

Conclusions: In RA the pro-angiogenic placental protein PLGF was lower than in healthy controls. This may reflect placental dysfunction which in turn leads to reduced birth weight in pregnancies compromised by RA.


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P 125

Lyme disease in pregnancy

Author: Hussung B., Frei J., Biedermann K., Fehr P.M.Hospital: Women’s Hospital Fontana, Cantonal Hospital Chur

Introduction: Lyme disease is the most frequently transmitted disease caused by ticks in the northern hemisphere. In Switzerland 5 – 30% of ticks are infected with the bacteria Borrelia burdorferi.

Case Report: A 35 years old 3. gravida 2. para was admitted in her 35th gestational week from a psychiatric clinic for further examination. The patient had suffered from loss of appetite with 7 kg weight loss over the past 8 weeks, loss of muscle strength and sleep deprivation. She was initially hospitalized in a smaller hospital. A MRI of the cervikal spine was without pathological finding. So she was diagnosed with depression and transferred to psychiatric clinic. An antidepressant therapy was introduced without any success. The symptoms progressed with additional back and neck pain and further detoriation.

Diagnostics and therapy: The patient’s initial symptoms comprised a ptosis of the left eye and a slower gate with short steps. A MRI of head and spine depicted a cervical mul-tisegment myelitis with focus on the posterior columns. The lumbar puncture showed a pleocytosis and a higher protein count. These results suit to a viral myelitis, however con-sidering the differential diagnosis of a bacterial myelitis due to borreliosis or listera. There-fore the initial therapy included aciclovir, ceftriaxon and ampicillin. After receiving the im-munological results showing positive specific antibodies for borreliosis in both serum and liquor the diagnosis neuroborreliosis was made. The therapy was adjusted to ceftriaxon for a 21-day intravenous application. The patient could not remember any history of tick bites. After completion of this therapy the patient was discharged, experiencing an almost total regression.

Conclusion: The Federal Office of Public Health estimates 10’000 of the Swiss population develop borreliosis each year. As such, we can expect this disease to complicate preg-nancy with increasing frequency. Lyme disease has a wide spectrum of symptoms. The nervous system will be affected in roughly 10-15%. In pregnant women with unspecific symptoms like e.g. loss of appetite, chronic fatigue, back- or neckpain without any success on symptomatic therapy a Lyme disease can be a possible differential diagnosis, especially if there is a cranial nerve palsy. Confirmed transplacental transmission of B. Burgdorferi has been documented in several cases; however the existence of a congenital borreliosis Syndrome, equivalent to that seen with syphilis, remains unproven.


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P 126

Primary neuroendocrine breast tumor: report of a rare triple negative case

Author: 1) Kanellos P., 2) Flury R., 1) Samartzis E.P., 1) Breitling K., 1) Eberhard M.Hospital: 1) Gynecology and Obstetrics, Canton Hospital Schaffhausen, 2) Pathology, Cantonal Hospital Winterthur

Introduction: Primary neuroendocrine breast cancer is a rare condition (fewer than 1% of breast tumors ), for which the formal diagnostic criteria have only been set since 2003 (WHO): 1. one or more neuroendocrine markers (enolase, chromogranin A, synaptophysin) are expressed in at least 50% of tumor cells, 2. other primary sites are ruled out, 3. the tu-mor must show histological evidence of a breast in situ component. The majority of these tumors are hormonal positive. Specific recommendations regarding surgical or cytostatic management do not exist. Patients are treated similarly to invasive ductal cancer. We now present a triple negative case that was diagnosed in our clinic.

Materials and methods: We report the case of an 89-year old patient who was assigned to an ultrasound and a mammography because of a painful right breast lump. These showed a possible malignant tumor so that a core biopsy was performed. The histological result revealed a cancer with neuroendocrine elements. Therefore a lumpectomy with a sentinel node biopsy was performed.

Result: The tissue-examination implied a primary well differentiated neuroendocrine breast cancer of 0.9cm with negative HER2, estrogen and progesterone receptors. Chro-mogranin A and synaptophysin were expressed, while the other neuroendocrine markers (i.e. enolase, CD56, somatostatin etc.) were negative. The proliferation index Ki-67 was less than 1%. One of the three sentinel lymph nodes was tumor-positive. These findings lead to a tumor-classification of pT1b, pN1a ( sn, 1/3 ), G1, R0. Because of the age of the patient, it was decided in an expert round that no cytostatic therapy shall be applied. Only a radia-tion therapy of the breast (and not of the lymph region) was recommended.

Conclusion: Neuroendocrine breast carcinomas are a rare entity of breast cancer and are usually hormone receptor positive. However, triple negative cases, as has been rarely de-scribed in the literature, are sporadically encountered. The adjuvant therapies are usually similar as in ductal breast cancer. However, due to its rarity, the pathogenesis, optimal ad-juvant therapy, and prognosis of this tumor entity are still not elucidated.


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P 127

Borderline brenner tumour of the ovary: A case report

Author: Bonollo M., Reina H., De Luca G., Zammaretti A., Canonica C.Hospital: Gynecology and Obstetrics, Regional Hospital Bellinzona e Valli

Introduction: Transitional cell tumours account for 1-2% of all ovarian tumours. Of these 3-5% are borderline Brenner tumours, distinguished by a benign Brenner tumour com-ponent, associated with variably atypical but non-invasive transitional epithelium. As for other epithelial tumors of the ovary, data suggest their origins in metaplasia of the tubal epithelial cells. To date, less than 40 cases of Brenner borderline tumours have been de-scribed in literature.

Materials and methods: Case report: A 72 year old woman presented with low abdomi-nal pain, hyperpyrexia and abdominal guarding. Laboratory findings showed an increased CRP 249 mg/L and WBC 12x109/L. CA 125 levels were normal (17.4 U/L). She first under-went an abdominal CT scan followed by a transvaginal ultrasound that showed a solid ovarian mass. We performed a bilateral laparoscopic salpingo-oophorectomy with ab-dominal washing after antibiotic therapy.

Results: Final histology revealed a 9 cm borderline Brenner tumor of the left ovary, stage IA, with expression of GATA3 and p63, negative abdominal washing for malignant cells but positive for inflammatory cells with infection of Escherichia coli and Lysinibacillus sphaeri-cus. The patient’s post-operative recovery was uneventful and no further treatment was required. The multidisciplinary proposal was a follow up after conservative surgery. There was no evidence of disease at one year follow-up visit.

Conclusions: Borderline Brenner tumors are very rare and generally asymptomatic. Among symptomatic patients, common symptoms include vaginal bleeding, a palpable pelvic mass and pelvic pain. There is a great deal of debate regarding the prognostic ben-efit of complete staging if macroscopic exploration is normal. Because only 15% of unilat-eral borderline tumors are associated with extraovarian disease, a complete staging with omentectomy, hysterectomy and appendectomy is probably not necessary for a unilateral ovarian tumor unless suspicious peritoneal lesions or micropapillary patterns are found. However, careful intraoperative exploration cannot be omitted. Furthermore a low rate of uterine involvement of about 2% was showed in literature among patients with BOTs who underwent hysterectomy in addition to bilateral adnexectomy. This case highlights the importance of including borderline tumors in the differential diagnosis of postmeno-pausal ovarian masses presenting with pelvic infection.


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P 128

Placental site trophoblastic tumor: a case report

Author: Radan A-P., Imboden S., Trippel M., Kostov P., Mueller M.D.Hospital: Gynecology and Obstetrics, University Hospital Bern

Introduction: Placental site trophoblastic tumor (PSTT) derives from intermediate tro-phoblastic cells and is the rarest form of gestational trophoblastic disease (GTD), with an incidence of 0.2% of all GTDs.

Case report: We present the case of a 30 year old gravida 1 para 1, who got admitted in our service 14 months after cesarean section. Clinical findings included 4 months of amen-orrhea and infrequent abdominal discomfort. In the lab work up a slightly elevated be-ta-hCG level (48 U/L) was noted and in the ultrasonography as well as in the MRI of the pelvis a 6x4 cm sized, intensively vascularized mass within the uterus wall was seen. Af-ter performing embolization of the uterine artery a hysteroscopy with biopsies was per-formed and the PSTT diagnosed. A laparoscopic hysterectomy with complete removal of the tumor was conducted 9 days later. Since all staging images were negative no adju-vant treatment was given. Weekly beta-hCG values were taken showing a steady decrease down to a normal range. However after 3 months an elevation to the value of 77 U/L was noted. In the therefore performed radiological images (thoracic, abdominal and head CT scan, abdominal MRI) a liver metastasis as well as enlarged retroperitoneal lymph nodules were detected. The patient is currently undergoing chemotherapy with the EMA-EP re-gime.

Conclusion: PSTT is little sensitive for chemotherapy and constitutes a real oncological challenge, the primary therapy is always surgical. The close follow-up of the patients and serial beta-hCG measurements are of great importance.


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P 129

Is soya healthy? – Case report of endometrial hyperplasia in a patient put on soy-rich diet

Author: Schneider M., Eberhard M.Hospital: Gynecology and Obstetrics, Cantonal Hospital Schaffhausen

Introduction: Soy beans contain phytoestrogens such as isoflavons. Phytoestrogens are nonsteroidal compounds that occur naturally in many plants, fruits and vegetables an have both estrogenic and antiestrogenic properties and therefore could have the poten-tial to induce also changes in endometrium such as hyperplasia or endometrial cancer.

Case report: We report a 30-year-old nulliparous women in which transvaginal ultrasound revealed a thickenend endometrium with fine cystic aspect, persistent after menstruation. Histologic examination of material achieved in subsequent hysteroscopia showed a sim-ple hyperplasia of the endometrium without atypia. Medical history about patients diet habits revealed that patient has had a high intake of soya for severel years (daily one glass of soy milk, tofu several times per week, occasionaly soy yoghurt) after being advised by her naturopath to maintain such a diet because of her blood group. The potential risk as-sociation of excessive soy intake and endometrial hyperplasia was discussed with patient who then decided to reduce her soy intake. Endometrial hyperplasia was treated with a le-vonorgestrel-IUD.

Conclusion: In literature, the effect of phytoestrogens on endometrial hyperplasia or can-cer risk is discussed controversially. Most studies including randomized trial have not con-firmed an increased risk of endometrial hyperplasia or cancer with phytoestrogen supple-ments or dietary intake. However, most randomized trials have had only 6 to 12 months of follow up. A potential increase in the risk of endometrial cancer under daily isoflavone supplements (150mg per day) was found in the a trial with the longest follow-up period of 5 years, as well as our patient had ad high soy intake for several years. In patient with diag-nosed endometrial hyperplasia and excessive soy intake the potential risk of phytoestro-gens regarding endometrium hyperplasia or carcinoma should be discussed.


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P 130

A rare differential diagnosis to postpartum HELLP-syndrome: Catastrophic antiphospholipid syn-drome (CAPS) in a Jehovah’s witness

Author: 1) Uerlings V., 2) Bosshard A., 2) Schmid J., 3) Wuillemin W., 4) Fischer A., 1) Kohl J.Hospital: 1) Obstetrics and Gynecology, 2) Intensive Care Center, 3) Haematology and Central Laboratory of Haematology, 4) Nephrology/ 1-4 Cantonal Hospital Lucerne

Introduction: We report on a patient with preeclampsia and a dramatic presentation of postpartum multiple organ dysfunction syndrome whose management was complicated by her religious beliefs.

Material and methods: A 22-year-old healthy primigravida was referred at 32 1/7 weeks of gestation with preeclampsia. Upon admission her blood pressure was 150/92 mmHg, creatinine, thrombocytes, liver enzymes and LDH were in normal range. Protein-to-creat-inine ratio in the spot urine sample showed an e-stimated proteinuria of 12 g / 24 h. After administration of a course of antenatal corticosteroids the patient showed generalised oe-dema and mild bilateral pleural effusion. Subsequently caesarean section was performed at 32 4/7 weeks of gestation, delivering a preterm but healthy neonate. On the 2nd day postpartum the patient’s condition worsened rapidly with tachycardia, tachypnea, acrocy-anosis and livedo reticularis. She became icteric, anuric and her consciousness level wor-sened. Within 24h the platelet count fell to 22 Giga/l with DIC. Liver enzymes remained moderately elevated. Haemodiafiltration was started on the 4th day postpartum. Kleb-siella oxytoca was detec-ted in one blood culture. The severe thrombocytopenia with a nadir of 7 G/l persisted for 4 days. A purpuric rash followed by large bullae on both arms and legs appeared. Haemoglobin decreased to a minimum value of 66 g/l. Transfusions of erythrocytes, platelets or fresh-frozen plasma were repeatedly refused.

Results: TTP/HUS was ruled out due to a preserved ADAMTS13 activity. A positive an-ti-beta 2-glycoprotein-Ig titer led instead to the diagnosis of a catastrophic antiphos-pholipid syndrome (CAPS). A skin biopsy corroborated the diagnosis. A treatment with iv methylprednisolone and iv immunoglobulins was started. The patient’s condition im-proved rapidly and she was eventually discharged from hospital on the 20th day postpar-tum. She recovered completely from all symp-toms.

Conclusion: CAPS is a rare but severe process resulting from microangiopathy in the pres-ence of anti-phospholipid-antibodies, which can be triggered by either delivery, bac-teriaemia or trauma. Peri-partum occurence is associated with high maternal and fetal mortality. Even if the patient’s religious belief restricted therapeutic options the definite diagnosis allowed appropriate management. If mistaken for HELLP-syndrome treatment options might be missed out.


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P 131

Conservative Management of a Scar Abscess formed in a Cesarean-induced Isthmocele

Author: Boukrid M., Dubuisson J.Hospital: Gynecology-Obstetrics, University Hospital Geneva

Introduction: The cesarean delivery rate is steadily increasing worldwide (1). Cesarean sections (CS) and resulting uterine scars are associated with obstetric complications such as cesarean scar pregnancies, uterine rupture, abnormal placental implantation and sec-ondary infertility (2). Surgical site infection after CS is rare and happens mostly within thirty days (3). The reported rate of abdominal wound infection under prophylactic anti-biotic coverage is usually around 0.52 % (4). Abscesses located in the caesarean-section induced isthmoceles are rarely encountered and are usually treated surgically, mostly by hysterectomy.

Materials and methods: We here report the case of a 40-year-old primiparous woman presenting a symptomatic abscess in the isthmocele 10 years after a caesarean section.

Results: She was treated by antibiotics and was closely monitored by clinical evaluation, ultrasonography and pelvic magnetic resonance imaging. This treatment led to complete resolution of symptoms and a disappearance of the abscess at imagery.

Conclusion: Our report shows that a conservative medical management of isthmocele abscesses can be an effective approach in women wishing to preserve their uterus.


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P 133

Cervical ectopic deciduosis: a case report

Author: Rotmistrovsky Valcarcel N., Moser N., Jacot-Guillarmod M.Hospital: Gynecology and Obstetrics, University Hospital Lausanne

Introduction: Ectopic deciduosis is a phenomenon that appears during pregnancy which implies the presence of decidual tissue out of the endometrium.

Material and method: Presentation of a case followed in our Department.

Results: A 31 years old patient, 3G1P, at 34 2/7 weeks of amenorrhea (WA) consults for her routine check-up. The speculum examination reveals a highlighting of a pregnant multip-arous cervix with a whitish, embossed lesion between seven and nine on the exocervix. A specialized colposcopic exam is performed. There is no abnormal vascularisation and par-ticular acidophilia but a lugol negative zone within the lesions. No severity criteria iden-tified. Anticoagulation treatement due to suspected pulmonary embolism we don’t per-form a biopsy. The PAP smear doesn’t show malignant cells. The colposcopic aspect of the lesion is compatible with an ectopic deciduosis but an epidermoïd carcinoma cannot for-mally be excluded. An elective C-section is planned at 38 WA because of her comorbidi-ties. During the colposcopic examen at four weeks after delivery, is observed a complete regression of the lesion.

Discussion: Ectopic cervical deciduosis is a benign lesion that occurs during pregnancy. It’s aspect can mimic a dysplastic lesion or cervical carcinoma. Cervical ectopic deciduo-sis is explained by the transformation of cellular islets who kept a differentiation potential and are stimulated by the hormonal stimulus of pregnancy. Usually, the patients are as-ymptomatic and this is an chance finding during a vaginal exam. Sometimes, there is vagi-nal discomfort or bleeding. Three forms are described : planar, nodular or tumoral. Cervical hypertrophy, hyperplasia of cervical glands and vascularisation of the cervical epithelium can complicate the colposcopic interpretation and mimic an invasive carcinoma. Differ-ential diagnosis includes dysplasia, carcinoma, polyp and infection. A biopsy is necessary when the diagnosis of ectopiy deciduosis is not clear. Evolution of ectopic cervical decid-uosis lesions are usually a complete regression in four to six weeks postpartum.

Conclusion: Ectopic cervical deciduosis is a benign cervical transformation which appears during pregnancy and regress spontaneously in postpartum. A quality colpocopic exam is the key for the diagnosis. A biopsy can confirm the diagnosis when the exam is not con-tributive. Expectation management is recommanded and a colposcopic control after de-livery show the regression.


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P 134

Paget’s disease and bilateral radical surgery: case report and review of the literature

Author: Dubar S., Khomsi F., Bouquet de la Jolinière J., Vo Quoc D., Ben Ali N., Guilon T., Vachette M., Fadhlaoui A., Feki A.Hospital: Gynecology-Obstetrics, Cantonal Hospital Fribourg

Introduction: Paget’s disease of the breast is a rare histological type of nipple-areola can-cer, representing 1-3% of female breast cancers. It appears as an isolated affection in 1.4-13% of cases and is associated with an in situ or invasive glandular carcinoma in 90-100% of cases. In situ histology is found in 1/3 cases. The average age of onset of disease is 56-year-old.The surgical treatment of Paget’s disease is controversial. Aim to discuss the clinical, histological and therapeutic aspects of the Paget’s disease.

Case report: A 43-year-old female patient, under oestroprogestative contraceptive with no family history of cancer was sent in by her gynecologist for a bloody discharge of the right breast. The examination revealed an eczematoid aspect of the right nipple suggest-ing Paget’s disease. Mammography showed a dense ovoid opacity of 14mm with irregular suspicious microcalcifications. A suspect galactophoric dilatation of the right supero-ex-ternal quadrant was seen by ultrasound. Biopsy concluded to a ductal multicentric carci-noma in situ, nuclear grade 2-3 of the external quadrants, HER2 positiv, ER and PRG neg-ativ, classification as B5a. Breast MRI revealed several multicentric tumoral lesions of the right breast with extension to the nipple-areola complex. Multidisciplinary meeting pro-posed a right mastectomy with sentinel lymph node biopsy technique. Bilateral radical surgery was performed without complications following the patient wish. Final histology concluded to a high grade DCIS of 40 mm with central foci extending to the main galac-tophoric and retromamillary ducts associated with a Paget’s disease. Sentinel node was negative.

Discussion: Mastectomy with or without axillary lymph node dissection has long been regarded as the standard therapy, however, a pamectomie with radiotherapy is increas-ingly chosen. Recent reviews have shown that conservative breast surgery combined with radiation therapy are a feasible alternative for patients with limited disease : long-term breast-conserving surgery would be equivalent to mastectomy in terms of overall dis-ease-free survival.

Conslusion: Paget’s disease of the breast is a rare cancer, this typical clinical case illus-trates the different epidemiological, clinical, histological, therapeutic and evolving as-pects of the disease.


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P 135

Breast metastases of ovarian cancer, a very rare diagnosis

Author: Barben C., Sager P., Knabben L., Mueller M.D.Hospital: Obstetrics and Gynecology, University Hospital Bern, University Bern

Material and method: Case report of a 46 years old woman with breast metastases of a known ovarian cancer FIGO IV.

Case: A 46 years old patient, with known serous, papillary ovarian cancer FIGO IV since April 2014 present with a new mass in the right breast after third line chemotherapy. The mammography showed no suspicious mass. The ultrasound showed several knots in both breasts and the metastasis of the ovarian cancer was confirming by core biopsy. Histolog-ical papillary tumour cells with WT-1 and PAX8 expression were showed. In her medical history she already got 3 cycles chemotherapy an abdominal staging surgery witch was macroscopically R0, followed with another 3 cycles chemotherapy. After this treatment a maintenance therapy with avastin was started. Intraabdominal recurrence and metasta-sis in liver, spleen and axillary lymph nodes occurred after 10 months. Second line chemo-therapy with carboplatin and caelyx was started. Two month later we changed to a third line chemotherapy with Taxol weekly and Carboplatin because of developing ascites. At this time, she develops paraneoplastic thrombophilie with multiple brain infarcts.

Discussion: Ovarian cancer usually spreads into abdominal cavity and to the loco-re-gional lymph nodes. Extra-abdominal metastases are less frequent and axillary metasta-ses or breast metastases are very rare. Only 0.5% to 2.0% of breast malignancies are me-tastasis of other origin.

Conclusion: Most of the patients with metastatic disease have a known history of ad-vanced stage ovarian or peritoneal carcinoma. Breast metastases of ovarian cancer are of-ten original of serous ovarian carcinoma. Breast or axillary LN involvement at initial pre-sentation is rare. Differentiation between metastatic and primary tumors is important because treatment and prognosis are significantly different. The presence of papillary ar-chitecture in histology, WT-1and PAX8 expression are useful for the correct diagnosis.


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P 136

The interdisciplinary perinatal management of a rare syndrome including arhinia, missing ocular bulbs, mandible hypoplasia and a missing acoustic meatus – Case Report

Author: 1) Kinkel J., 1) Putora K., 2) Malzacher A., 3) Krebs Th., 1) Fischer T., 1) Hornung R.Hospital: 1) Obstetrics, Cantonal Hospital St. Gallen, 2) Neonatology, 3) Pediatriac surgery/ 2,3 Children Hospital St. Gallen

A team consisting of radiologists, ENT physicians, anaesthesiologists, neonatologists, pa-ediatric surgeons and obstetricians was necessary to ensure a little boy´s chance at life.

A 30 year old Gravida X, Para IV was transferred to the cantonal hospital in St. Gallen in week 32+4 of her pregnancy because of suspected cheilognathouranoschisis. In an ultra-sonic exam midface dysmorphia including arhinia and missing ocular bulbs was detected. There were no signs of holoprosencephaly found. The following intrauterine MRI confir-med the ultrasonic diagnosis and in addition showed mandible hypoplasia and a missing acoustic meatus on the right side of the child´s head. Amniocentesis with consecutive mi-croarray analysis was carried out to rule out Trisomy 13 and other syndroms. It displayed a normal male karyotype. Fetal echocardiography also did not reveal any other malforma-tions. To date, only a few cases of this complex syndrome without mental retardation are known.

After multiple consultations with the parents a primary caesarean section was scheduled and performed earlier, in week 36+3, because of an increase of polyhydramnios. This chal-lenging procedure required two operating rooms to be working simultaneously with obs-tetricians, neonatologists, paediatric surgeons as wells as two teams of anaesthesiologists and operating room nurses. After delivery an unsuccessful intubation of the new-born called for emergency tracheotomy in order to stabilize the fetal circulation and its oxy-genation. Thanks to well planned and executed teamwork this highly intricate procedure could be completed and therefore ensured the uncomplicated development of the upco-ming treatments.

Even though the medical team mastered this challenge, it is somewhat overshadowed by the most difficult decision the parents had to face.


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P 138

ECTOPIC PREGNANCY IN THE NON COMMUNICATING TUBE OF A WOMAN WITH UNICORNUATE UTERUS

Author: Reina H., Lipp von Wattenwyl B., Canonica C.Hospital: Gynecology and Obstetrics, Cantonal Hospital Bellizona

Introduction: Congenital uterine anomalies have a prevalence of 3-4% and their origin in atresia of the paramesonephric ducts or their failure to fuse in the midline around the 9th gestational week p.c.. They are more closely associated with abortion and obstetrical com-plications than with infertility. Surgery to improve obstetric outcomes is controversial for most anomalies.

Material and methods: Case report : 32 year old II-gravida I-para in the 6th gestational week. She referred to our emergency room because of low abdominal pain mainly on her left since two days and light vaginal bleeding since day of admission. She reported about an uneventful pregnancy at 39+2 gestational weeks with vacuum extraction in 2012 (female, 3340g) and an otherwise empty medical history. We assessed minimal uter-ine bleeding at inspection and tenderness in the left adnexal region at bimanual palpa-tion. Abdomen was tender without rebound. Ultrasonography evidenced an empty uterus with endometrium thickness of 12mm, a normal right adnex, no free cul-de-sac fluid. The left adnex couldn’t be visualised. Serum hCG level was 2420 IU/L. Two days later the pa-tient developed strong pain at the entire left abdomen, especially in the left subcostal re-gion. Assessments showed a rise of hCG level to 3400 IU/L and the presence of 300ml cul-de-sac fluid. Through transabdominal ultrasonography the left ovary was detected at the left paracolic sulcus and close to it a 25mm mass suspect for an ectopic pregnancy.

Results: During diagnostic laparoscopy an unicornuate uterus with normal right ad-nex was diagnosed. The left ovary was macroscopically normal, but adherent to the left paracolic sulcus and partly to the paraepiploic appendices of the left colic flexure. At-tached to the ovary a 3cm long accessory salpinx could be recognised, where rupture of the ectopic pregnancy took place. There was no rudimentary noncommunicating left horn visible. Salpingectomy was performed. Histology confirmed tubal ectopic pregnancy.

Conclusions: In presence of an unicornuate uterus, literature shows that possible rudi-mentary horns (65% of cases) or tubes require a priori surgical excision on diagnosis to avoid complications. Assessments to rule out concomitant urological malformations (40% of cases), and medical history concerning in utero diethylstilbestrol exposure are also mandatory. Lastly, unicornuate uterus can be associated with an ectopic ovary, which can be identified using MRI.


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P 139

Cystic granulomatous mastitis non puerperalis, caused by corynebacterium kroppenstedtii, a different treatment is needed

Author: 1) Bärtschi C., 1) Sager P., 2) Rau T., 1) Knabben L., 1) Mueller M.D.Hospital: 1) Obstetrics and Gynecology, 2) Pathology/ 1,2 University Hospital Bern, University Bern

Introduction: Chronical non-puerperal mastitis is often recurrent and the treatment is dif-ficult. We report three cases with chronic mastitis and with the rare finding of Corynebac-terium Kroppenstedtii (CK).

Cases reports: A 31-year-old female presented with mastitis and symptoms since 3 months. In the last month she was treated with amoxicillin and clavulanacid for ten days, with some short recovery phases. Her risk factors were smoking and obesity. The clinical examination showed an abscess next to the nipple. Conservative treatment with needle aspiration and again amoxicillin and clavulanacid was started. After ten days the symp-toms were better, but didn’t completely disappear, we changed the antibiotics to cefurox-ime. First there was no bacteria growing on stain, and we thought about idiopathic gran-ulomatous mastitis. A biopsy was taken. The histology showed some cystic granuloma, no bacteria findings at that time. We started a therapy with prednisone 20mg a day. After a very long incubation CK was growing in the culture with no resistance to amoxicillin or cefuroxime. All conservative treatment failed, so we had to perform a surgical excision of the tissue involved. The secondary wound healing was supported with a V.A.C. therapy. As mentioned above, two other cases with similar histories and with a comparable long time of conservative therapy with different antibiotics and finally operation were treated in the last years in our clinic. One of the patients had elevated prolactin levels and a microprolac-tinoma was found at MRI, she was additionally treated with cabergolin.

Conclusions: CK was first described in 1998 by Collins et al. It stains poorly on gram stains and can fail to grow or grows slowly on routine media. The good development in breast tissue and the tendency for building cystic granulomas could be explained by the fact that CK is a lipophilic bacterium. Only Two papers showed recovering after treatment with tet-racycline. In our cases no conservative therapy was successful. We think that this specific bacterial infection is difficult to treat with antibiotics and a surgical excision is probably the better way to be successful. CK is rare, but it is important to ask for searching for this specific bacterium in the microbiological work out.


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P 140

Acute aortic dissection in pregnancy: managing the risks – a case report

Author: 1) Rüegger J., 1) Burkhardt T., 2) Mayer D., 1) Zimmermann R., 1) Kreft M.Hospital: 1) Obstetrics, 2) Cardiovascular Surgery/ 1,2 University Hospital Zurich

Case report: A primiparous woman with an uncomplicated pregnancy presented at 41 weeks of gestation at a secondary care centre with severe sharp pain between her shoul-der blades and arterial hypertension of 170/110mmHg. A CT-scan was performed imme-diately. It showed a Type B aortic dissection (TBAD) from the left subclavian artery down-wards. An antihypertensive treatment was started and the patient was referred to our tertiary care centre without delay. TBAD is preferred to be treated medically with anti-hypertensive and anticoagulation therapy. Surgical interventions become necessary only in case of complications such as aortic rupture or malperfusion. A multidisciplinary team made the decision to first perform an urgent cesarean section in the cardiac theatre under full anaesthesia after obtaining access to the right femoral artery with a team of cardio sur-geons ready to intervene, if necessary. Apart from a little delayed adaptation the female newborn presented no complications. A postoperative CT-scan showed dilated intestinal loops and narrowed visceral vessels. However, the resultant angiography with manometry showed normal perfusion of mesenterial and renal vessels. A postoperative atony of the uterus was initially under control by conservative treatment, but consistently was poorly contracted. Subsequently, an embolization of the uterine arteries was performed during the arteriography to minimize the risk of uterine bleeding before starting the anticoag-ulation treatment. Postoperative problems consisted of arterial hypertension, renal fail-ure, and respiratory distress. However these complications were all treated successfully. Several follow-up CT scans showed no progression of the AD. A Marfan syndrome is sus-pected to be the underlying cause as the patient fulfilled the diagnostic criteria (young age, dural ectasia, significant family history).

Conclusion: AD during pregnancy can have devastating consequences with a maternal mortality of up to 30% and fetal mortality as high as 50%. Correct interpretation of clinical symptoms, a rapid diagnostic investigation and initiation of an adequate treatment is life saving for both mother and child.


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P 141

Intrauterine pasteurella multocida: A cat bite with consequences

Author: 1) Somaini A., 1) Bernasconi I., 1) Passweg D., 2) Eich G., 1) von Orelli S.Hospital: 1) Gynecology and Obstetrics, 2) Infectious Diseases/ 1,2 Triemli Hospital Zurich

Introduction: The most common cause for an endometritis are ascending infections of the cervix. Descending infections of the adnexa or a haematogenic spread (e.g. tubercu-losis) are reported rarely. Predisposing factors ar abortions, childbirth, intrauterine inter-ventions, polyps, fibroids or intrauterine devices. The most frequent pathogens are chla-mydia, gonococcal infections, group A streptococcus and anaerobes. We report a case of endomyometritis due to Pasteurella multocida, a germ that ist frequently found in the res-ident oral flora of the cat, after a medically treated missed abortion.

Case report: A 40-year-old patient presented to our emergency room with right-sided ab-dominal pain with intermittent fever up to 40.0° C with no chills. Eleven days earlier a drug therapy of a missed abortion with two doses of Cytotec® was administered. Clinically, the patient was in poor general condition, febrile with a temperature up to 39.4°C though he-modynamically stable. The inflammatory markers were slightly increased (leukocytes 18.5 109/L, CRP 18.8 mg/L). On suspicion of a septic abortion, a high-dose intravenous antibi-otic therapy was initiated with Co-Amoxicillin (2.2g three times daily) and a curettage was performed the same day. Upon completion of the operation a bacteriological swab from the uterine cavity was taken, which showed a growth of Pasteurella multocida. Postopera-tively, there was a rapid clinical improvement and a regression of infection values. The an-tibiotic therapy was continued orally (Co-Amoxicillin® 625mg three times daily). The pa-tient was discharged the second day symptom-free.

Conclusions: Further investigation showed that the patient was bitten by her cat in the finger about two weeks prior her emergency room visit. Pasteurella multocida is known to cause short-term bacteraemia and soft tissue infections in humans. Our hypothesis sug-gests a hematogenously transmitted colonization of the not yet completely empty uter-ine cavity, even though the blood culture tests were negative. If the abortion was caused by the bacteraemia can only be speculated on, since the timeline could not be reproduced accurately. A review of literature allowed one case of a septic abortion due to Pasteurella multocida.


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P 142

You only see what you know! Interdisciplinary Marathon due to Underestimated Symptoms with Forgotten IUCD

Author: Epple G.P., Schorer A., Hebisch G., Rautenberg O., Fehr M.K.Hospital: Obstetrics and Gynecology, Cantonal Hospital Frauenfeld

Introduction: The morphology of intrauterine contraceptive devices (IUCDs) like Margu-lies coil or Dalcon shield used years ago is forgotten today. Especially young doctors might fail to recognize them. However, even initially inert coils may become symptomatic years later. Longstanding, cost intensive and superfluous consultations and diagnostic mea-sures might follow and correct diagnosis unneccessarily be postponed.

Material and methods: A 65-year old patient suffers from recurrent lower abdominal pain. After several consultations at her GP she attends at medical emergency. Gastritis is diagnosed and treated with proton pump inhibitors and analgesia. Infection screen is nor-mal; thus upper abdominal scan, ECG and chest Xray are performed. A week later she is seen as a gynaecological emergency. Vaginal exam is normal, on transvaginal ultrasound scan (TVUS) intrauterine calcifications are suspected. Since symptoms aren’t explained, referral to the surgical emergency. Abdominal CT is normal with IUCD which the patient initially had not remembered. Treatment is with analgesia and bowel regulation as co-prostasis is suspected. 2 months later surgical admission for 2 days due to persisting pain without infection signs. One month later self-referral to the gynaecological emergency for persisting pain. IUCD on TVUS, bacterial swabs normal.

Results: On repeat gynaecological examination 6 months after the first symptoms these are attributed to the unusual looking IUCD, equivalent to the CT image, for the first time. This was introduced some 25 years ago. Due to the long history of pain, hysteroscopic re-moval of the Margulies coil is performed. Intraoperatively, polypoid endometrium is rec-ognized and thus curetted. Besides polypoid endometrium, histology shows focal tubar metaplasia and prominent stroma without pathology. Postoperatively, the patient is as-ymptomatic immediately. Images of TVUS, Xray, CT and und intraoperative hysteroscopy are shown.

Conclusions: For a long time, this patient’s lower abdominal pain was not attributed to the ancient foreign body; thus correct therapy was postponed unnecessarily, since the form of the device was not recognized on scan and no thread was visible on colposcopy. Even in correct position, IUCDs may cause clinical symptoms after many years. Knowledge of the morphology of intrauterine devices used in former years and their potential pathol-ogy may facilitate diagnosis and therapy.


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P 143

The interdisciplinary management of a cystic lymphangioma of monochorionic-diamniotic Gemini – A case report

Author: 1) Hammerschmid N., 1) Malzacher A., 2) Krebs Th., 1) Fischer T., 1) Hornung R.Hospital: 1) Gynecology and Obstetrics, Cantonal Hospital St. Gallen, 2) Surgery, Children`s Hospital of Eastern Switzerland

A 35 year old primiparous with a spontaneous monochorionic-diamniotic twin pregnancy was referred to the Cantonal Hospital of St. Gallen in the 26+6 weeks of pregnancy with an unclear cervical tumor of fetus B. Until this point, the pregnancy was completely in-conspicuous with symmetrical growth of both fetuses. In the 26+3 weeks of pregnancy a cystic-septated tumor was sonographically diagnosed on the right side of the neck, sus-picious of a lymphangioma with an expansion up to the oropharynx of fetus B. Lymph-angiomata are frequently associated with chromosome aberration, but the parents re-fused karyotyping. In several interdisciplinary discussions the birth management was developed. Over the course of pregnancy the lymphangioma expanded to a total size of 58x82x54mm and progressively displaced the trachea to the left side. Repeated MRI scans were required to dedect a potential compression of the respiratory system at an early stage. In such a case, an ex utero intrapartum treatment (EXIT) would have been neces-sary. Corticosteroids for fetal lung maturation were applied. Despite the progression of the lymphangioma, it was possible to carry out the primary caesarean section at 34+0 weeks of pregnancy. Directly before the operation another MRI scan and an ultrasound-guided drainage of the complete lymphangioma were performed with aspiration of 130ml serous fluid. After the ceasarean section the neonatologists conducted a nasal intubation of fetus B without any difficulty. Pediatric anesthesiologists and surgeons, in case of a respiratory emergency for performance of fiberoptic intubation or tracheotomy, were not needed. The lymphangioma was resected at the Children`s Hospital of Eastern Switzerland the fol-lowing day.

Lymphangiomata are a rare benign malformation of lymphatic vessels. A lymph drainage disorder results from a lack of differentiation of the mesoderm between the fourth and eighth week of gestation. The risk of a prenatal occuring cervical lymphangioma is the possible postnatal compression of the respiratory system. To date, worldwide EXIT pro-cedures were performed mostly in singleton pregnancies. There are only few described cases where the EXIT procedure was carried out in a twin pregnancy. It was, however, never conducted successfully in a monochorionic pregnancy. It is therefore crucial to de-velop the EXIT procedure for risk pregnancies, such as described in the underlying case, al-though this procedure was fortunately not required.


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P 144

Uterine rupture in bicornuate uterus in second trimester: Case report and review of the literature

Author: Pace M., Valent E., Canonica C.Hospital: Maternity, Ospedale Regionale, Bellinzona

Introduction: Uterine rupture is an uncommon complication of pregnancy occurring mainly during labor at term in multigravida or women with previous uterine scar (i.e. cae-sarian section). It occurs very rarely in the first and second trimester and has high mortal-ity and morbidity rates.

Case report: A 25-year-old primigravida with previous normal controls was referred to our department at 17+6 weeks of gestation for sudden abdominal pain with no vaginal bleed-ing. Ultrasound revealed intrauterine fetus with absent fetal heart beat, biometry corre-sponding to gestational age, fundal placenta, no free fluid in the pelvis. Diagnosis of late miscarriage was done and the patient put on prostaglandins for induction of labor. Hemo-globin was 136 g/L. She was initially normotensive but later developed more serious pain with hypotension and drop of hemoglobin to 72 g/L. The abdomen was soft with diffuse tenderness and on ultrasound a hemoperitoneum was evident with free fluid up to Morri-son’s pouch. A uterine anomaly was not suspected. Urgent laparotomy showed a bicornu-ate uterus with rupture of the left horn with the fetus in abdomen. The horn was removed and the defect repaired. Histopatological exam revealed an accrete/increte placenta. The patient needed replacement of blood fractions. The post-operative period was unevent-full and the patient was discharged with a raccomandation of a one-year safe contracep-tion.

Discussion: Uterine rupture is very rare in first or second trimester, but it is more likely to happen in uterine malformations; the incidence of rupture of rudimentary horns is 1/40.000 pregnancies and usually diagnose becomes evident only during surgery. Previ-ous papers report a strong association with accrete placenta, as in our case probably due to morbid placentation in the hypoplastic horn. The treatment includes removal of the horn and suture of the remaining womb; pregnancy should be avoided for at least one year. Pregnancies in a rudimentary horn are at high risk for both mother and fetus; only 30% progress to term. Rupture occurs in 50% of cases. Some reported cases had a good neonatal outcome and, thanks to modern use of ultrasound, maternal mortality has also been decreasing.

Conclusion: This case highlights the difficulty of diagnosis for this rare uterine malforma-tion. It also can serve as reminder that in our clinical activity we have to be very careful in presence of abnormal symptoms when using prostaglandins for second trimester abor-tion.


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P 145

Septic complication after uterine artery embolization for postpartum hemorrhage: a case report and review of the literature

Author: 1) Junod R., 1) Bodenmann Gobin P., 2) Durand R., 1) Mathevet P., 1) Vial Y.Hospital: 1) Gynecology and Obstetrics, 2) Radiology/ 1,2 University Hospital Lausanne

Introduction: Uterine artery embolization in cases of postpartum hemorrhage is a sec-ond-line treatment when medical support is not efficient. Success rate is over 90%. Com-plications are about 7%. Potential complications are hematoma, vascular lesions, femoral vein thrombosis, endometritis, uterine, vaginal or intestinal necrosis, amenorrhea, endo-metrial atrophy and uterine synechiae.

Materials and methods: Case report and review of the literature in Pubmed database

Case report: A 38-year-old woman, gravida 1 para 1 presents a postpartum bleeding on retained placenta with uterine atony after vaginal delivery. Despite the use of uterotonic agents, bleeding persists with an estimated blood loss of 2000 mL and require uterine ar-tery embolization. The patient has initially well evolved. The patient is hospitalized 20 days after the delivery because she presents with fever and foul vaginal discharge. Ultrasounds show an accumulation of air in the uterine cavity and intra-myometrial. MRI confirms the presence of gas in the cavity with necrotizing aspect of intern part of the myometrium. We perform a suction curettage. The anatomopathological analysis of the material is consis-tent with myometrium necrosis.

Results: Uterine necrosis after embolization is an uncommon complication, as only 6 cases are reported in the literature. The type, but especially the size of particles of embo-lization seems to be a decisive element. Indeed, small size particles are more frequently responsible of uterine necrosis. The concomitant presence of endometritis probably in-creases ischemia. The diagnosis is to consider in case of abdominal pain and fever after uterine artery embolization. Exhaustive pelvic imaging with ultrasonographic examina-tion, computed tomography with injection and MRI are necessary. The diagnosis of uter-ine necrosis is suspected with the presence of air inside the endometrium or myometrium with absence of heightening of the latter. In case of adverse evolution, hysterectomy can be necessary.

Conclusion: Embolization remains currently the treatment of choice in case of postpar-tum bleeding refractory to medical support. It is important to be attentive to the type and size of particles used. Necrosis post-embolization remains nevertheless an uncom-mun complication.


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P 146

Cervicitis decidualis: Report of two cases

Author: Gyftomitrou A., Soave I., Irion O., Petignat P., Undurraga Malinverno M.Hospital: Obstetrics and Gynecology, University Hospital Geneva

Introduction: Cervical deciduosis can be found during pregnancy and represents a be-nign change in the columnar and squamous epithelium as well as the stroma of the cer-vix. It was first reported over 100 years ago and since then few cases have been reported.

We report two cases of cervical deciduosis.

Case 1: A 40-year-old woman, 2G1P, consulted at 15 weeks of gestation for vaginal bleed-ing. Her first pregnancy, 5 years earlier, ended in a spontaneous vaginal delivery with no complications. She had no history of abnormal cervical smears. The ultrasound confirmed a live singleton foetus with a total placenta praevia covering the cervical opening and no evidence of placental abruption. Speculum examination on the exam revealed a 2 cm cer-vical polyp actively bleeding occluding the cervical os. Five weeks later, colposcopic ex-amination showed an exophytic mass covering the whole cervix with multiple atypical vessels. Given the risk of a heavy bleeding and of previous transfusion, no biopsies were taken. A caesarean section was performed at 37 weeks with the delivery of a healthy baby. Colposcopy 8 weeks post partum showed a normal cervix, with no abnormalities found on the cervical smear.

Case 2: A 36-year-old woman, 2G1P at 27 weeks of gestation, presented with a history of a cervical polyp and a cervical smear positive for HSIL, HPV 18 positive. Her previous preg-nancy had ended in a spontaneous vaginal delivery with no complications. She had a his-tory of abnormal cervical smears since 2013. Colposcopic examination at 12 weeks gesta-tion revealed an important ectropion with an endocervical polyp. Colposcopy at 21 weeks showed cervical modifications with an exophytic lesion associated with abnormal vessels on the cervix. A biopsy on the lesion reported cervical deciduosis.. At 39 weeks she had a vaginal delivery without complications. Colposcopy 2 months post partum showed an ec-tropion without abnormal vascularisation. The cervical reported an ASC-H and the biopsy a CIN I dysplasia .She underwent a cervical conization two months later with a final diag-nosis of CIN III.

Discussion: Cervical deciduosis during pregnancy can be physiological, relating to reac-tion to progesterone. Due to its macroscopic similarity to neoplasia, lesion should be bi-opsied if possible. Cervical deciduosis normally regresses within 4-6 weeks after delivery.


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P 147

Urethral pyogenic granuloma formation: An unusual complication of sub urethral sling technique for urethral stress incontinence

Author: Mattenberger C., Prince-dit-Clottu E., Belhia F., Rouiller-Cornu S., Meyer S.Hospital: Gynecology and obstetrics, Hospital Morges

Objective: To describe an unusual complication of suburethral sling procedure for treat-ment of female stress urinary incontinence(SUI)

Materials and methods: 2 Case reports of two women investigated for urethral «tu-mor-like» masses.

1st case: A 60 year old woman, suffering from SUI, treated by TVT procedure in 2001 and by open Burch procedure in 2009 for recurrent SUI, was investigated in 2015 for chronic pain and bleeding during micturition.A vulvar examination showed a 2 cm proliferative red mass arising out from the anterior part of urethral meatus(fig 1).No other lesion was found in the vagina.A cystoscopy confirmed normal bladder and urethral mucosa.A total resection of the tumor was done.No erosion of the tape was noticed.The pathological ex-amination concluded to an urethral pyogenic granuloma, without any malignant sign. The post-opeative course was uneventflull.

2nd case: A 56 year old woman,suffering from SUI, was treated with a TVT procedure in 2004 with a complete recovery. In 2015, she experienced micturition problems with in-complete bladder emptying.A 3 cm proliferative mass arising out from mid-urethra sub-urethral part was found associated with a severe midurethral stenosis.A total excision of this mass associated with a section-removal of the sling was performed.The pathologi-cal examination concluded to a papilloma.The post-operative course was complicated by a persistent urethral stenosis requiring iterative urethral dilatations and to a 2nd opera-tion with resection of a 1cm new-appearing mass, with a pathological conclusion of a pyo-genic granuloma.

Results: TVT procedure complications represent 2 to 5% of cases.The most common com-plications are erosions,infections,hematomas and bladder injuries.Urethral or suburethral pyogenic granuloma and papilloma represent unusual complications who can appear many years after operation, and may lead to bleeding and chronic pain during miction.They are probably due to a local inflammatory reaction to the material of the mesh.They can have the appareance of malignancy.Surgical removal is the only treatment with fur-ther post-operative controls looking for local recurrence.Only case report was described in the litterature.

Conclusion: Granuloma pyogenic andpapilloma can be found generally in the mid su-buretral or uretral area, even many years after suburethral sling procedure.Local inflam-matory reaction to this “foreign body” can explain such tumor-like formation.Surgical re-moval is mendatory.


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P 148

Treatment-resistent vulval ulcers

Author: 1) Schwander A., 1) Marthaler C., 2) Beltraminelli H., 1) Mueller M.D.Hospital: 1) Obstetrics and Gynecology, 2) Histopathology/ 1,2 University Hospital Bern and University Bern

Introduction: Genital ulcers are a clinical challenge as the underlying etiology encom-passes a wide range of differential diagnoses. These may include sexually transmitted dis-eases (STD), other infections, inflammatory or multi-system diseases, exogenous or neo-plastic causes. An exact anamnesis, followed by a colposcopy and biopsy is imperative in obtaining a final diagnosis.

Material and methods: We present the case of a patient with a treatment-resistant vul-val ulcer.

Results: A 50-year-old patient was admitted with persistent ulcers on the right labium. Colposcopy revealed multiple lesions (5mm) on both sides of the vulva. Local lymph nodes were not enlarged. In 2014 the patient had undergone resection of a posterior pi-tuitary tumor of unknown etiology. We initially suspected Behçet’s disease and corticoste-roid therapy was initiated. Biopsy showed a chronic inflammation with infiltration of gran-ulocytes but no sign of Behçet’s. Local treatment was unsuccessful and resulted in further spreading of the ulcers with persistent vulvar pain. Repeat biopsy finally revealed Lang-erhans-cell histiocytosis (LCH), the patient’s immunohistochemical stains were consistent with the diagnosis. The pituitary tumor resected in 2014 was reanalyzed and showed that it was already a LCH at that time. A systemic treatment with prednisolone and vinblastine was startet. After the second dose of vinblastine the lesions cleared and the patient is now asymptomatic.

Conclusion: Isolated vulval LCH, also known as histiocytosis X, is uncommon but has the potential for disseminated disease. LCH may present with ulcers, nodules or erythematic plaques. The histology often remains inconclusive. The presence of a eosinophilic granu-loma should warrant clinical suspicion. Immunohistochemical stains specifically targeting antibodies against CD1a and S-100 protein or CD 207 are required. Clinical staging includ-ing whole-body-tomography should be initiated. Due to paucity in the medical literature, there is no standard treatment for LCH. Suggested regimens may include a combination of surgery, radiotherapy and chemotherapy combined with corticosteroids or topical treat-ment. In our case, vinblastine’s and corticosteroid therapy was found to be successful and the patient is now ulcer-free. Regular and long-term check-ups remain essential. In conclu-sion, rare conditions such as LCH require special attention in the evaluation and work-up of vulval lesions.


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P 149

Is the short-term variation (STV) in computerized CTG (cCTG) in monochorionic twins (MC) with selective intrauterine growth restriction (sIUGR) useful?

Author: 1) Bertrang Warncke A., 1) Zbären S., 1) Bolla D., 2) Baud D., 1) Raio L.Hospital: 1) Obstetrics and Gynecology, University Hospital Bern, 2) Feto-Maternal Medicine Unit, Obstetrics and Gynecology, University Hospital Lausanne

Introduction: the use of cCTG and Dopplers ultrasonography to assess the well-being of IUGR fetus in singleton pregnancies has been shown to reduce morbidity and mortality particularly ≤ 32 weeks of gestation. However, the ability of cCTG, especially STV, in MC pregnancies has not been properly investigated. The aim of the present study is to evalu-ate the value of cCTG in MC pregnancies complicated by sIUGR.

Method: all available cCTGs (Sonicaid FM800, Oxford Instruments) of MC twins compli-cated by sIUGR were retrospectively studied in regard to the behavior of the intertwin and single twin STV. For study purposes the cCTGs results at hospitalization and just before de-livery were used for analysis. sIUGR is defined as discordant fetal growth of at least 20% and abdominal circumference of the IUGR twin ≤ the 5th percentile. Cases were grouped by Gratacos in 3 types according to the umbilical artery (UA) blood flow of the smaller twin.

Results: during the study period 64 cases of MC twins with sIUGR were managed in our department. 32 cCTGs were available for analysis. Gestational age at study entry and at de-livery was 28.4±2.6 and 31.3±2.3 weeks, respectively with a median observational time of 2.3 weeks (range 0.14-9.3). 14/32 (43.8%) were classified as type III sIUGR (intermittently absent/reversed end diastolic flow in the UA). STV of the IUGR fetuses at entry and the last before delivery were 9.4±3.5ms and 8.3±2.4ms (p=0.08). Similarly, STV of the co-twin did not show significant changes during the observational period (9.2±2.9ms and 9.2±3ms; p=0.97). No differences were noted analyzing the intertwin variation of the STV at entry and at delivery (1.35 [0.1-8.4] and 2.25 [0-8.7]ms; p=0.48). Even analyzing STV of the most severe forms of sIUGR (type III), no significant inter and intratwin difference was found.

Conclusions: although the STV of the IUGR fetus tends to decrease gradual, this trend does not reach statistical significance. Moreover, between twins, STV is similar and also does not show a change over time. Neither in type III sIUGR cases the STV is able to distin-guish between the smaller and the bigger fetus. We speculate that although the placental territories are markedly different in MC twins with sIUGR, the placenta seems to work as a metabolically single one. cCTG seems to be less useful in MC twins at least at a gestational age between 28 and 32 weeks.


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P 150

Case report: a large fibroid uterus causing severe acute kidney failure

Author: De Zordo C., Wiedemann N., Markus A., Hornung R.Hospital: Gynecology and Obstetrics, Cantonal Hospital St. Gallen

Introduction: Uterine leiomyomas are the most common pelvic tumor in women (esti-mated prevalence in hysterectomy-specimens 77%). Myomas are clinically apparent in 12 - 25% of reproductive age women. The incidence is two- to three-fold greater in women of African origin than in white women. Women of African origin appear to have surgery at a younger age, have larger uteri and more severe anaemia. Leiomyomas can cause ob-structive renal impairment (8%), although the prognosis appears good.

Case report: The 33-year-old Congolese nulliparous woman was admitted at a psychiatric Hospital because of three suicide attempts. She was transferred to an ICU because of ab-dominal pain with increased creatinine (311umol/l) and bilateral hydronephrosis IV°. The patient had already undergone a myomectomy in 2013 with removal of 13 leiomyomas. An emergency check-up showed an acute obstructive renal failure (AKIN Stad.3, eGFR CKD-EPI 19ml/min/1.73m2) due to compression of the enlarged fibroid uterus. The placement of a JJ ureteral stent to relieve the obstruction was only possible in the left ureter. On the right side it was necessary to place a percutaneous nephrostomy. A kidney-scintigraphy showed a right Kidney with no function and a left kidney with reduced function. Because of a high risk of VTE (History of post-operative deep vein thrombosis after myomectomy in 2013) an inferior vena cava filter was placed before the operation and removed after three days. The antithrombotic therapy with unfractioned Heparin was started at thera-peutic dose. Due to severe renal impairment we were forced to carry out a total abdominal hysterectomy with bilateral salpingectomy via midline incision. The large uterus weighed 2529 g and was 27x13x10 cm big. The operation was complicated by adhesions to ureters, bladder, rectosigmoid colon and to omentum majus. After two month the patient is still at the psychiatric hospital. Creatinin values are persistent 240-260mmol/l, potassium and urea are in normal range. The patient has surprisingly no symptoms and a normal diuresis. The prognosis is severe but at the moment dialysis is not necessary.

Conclusion: Fibroids can cause severe complications because of the slow growth without causing severe disturbs to the patients. It’s important to check by ultrasound their pro-gression and also to check the kidneys because kidney injury due to compression has a good prognosis in early stage.


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P 152

Septic ovarian vein thrombosis: a rare complication of a copper IUD

Author: Keller N., Borcard A., Michael N., Lütolf Ch., Schmid S.Hospital: Gynecology and Obstetrics, Hospital Grabs

Introduction: Septic ovarian vein thrombosis (SOVT) is a rare complication in the postpar-tum period. The incidence is 1 in 3000 deliveries. But it can also be connected with abor-tion, surgery, gynaecological malignancy, pelvic inflammatory disease, sepsis or hyperco-agulable state. It occurs extremely rarely idiopathically. In most cases the patient suffers from fever, abdominal pain and an abdominal mass. The differential diagnoses are appen-dicitis, endometritis, pyelonephritis, pelvic abscess and sepsis. The pathogenesis is based on Virchow’s triad (blood stasis, hypercoagulability and epithelial injury). Dangerous com-plications are pulmonary embolism, sepsis with multiple organ failure, thrombosis of the inferior vena cava, the renal veins or the iliofemoral veins and ovarian infarction. The ther-apy consists of anticoagulation and antibiotics.

Case report: A 35-year-old woman reported lower abdominal pain and fever. When she came to the emergency room, she had been using a copper-intrauterine device for three months. Transvaginal ultrasound and blood tests primarily led to the suspicion of tu-boovarian abscess or ovary stalk rotation. An explorative laparoscopy showed no obvi-ous sign of infection in the abdomen but extraordinarily enlarged turgid ovarian vessels on the right side. Subsequently, an angio-CT-scan was performed confirming the ovarian vein thrombosis on the right. An antibiotic therapy and intravenous anticoagulation were started. The intrauterine device was removed. The smear test of the cervix and the intra-uterin device detected staphylococcus epidermidis and aureus. The antibiotic therapy was continued for 14 days. After 48 hours the iv anticoagulation was replaced by Rivaroxaban for six months.

Conclusion: A septic ovarian vein thrombosis affects mostly postpartum women. Nev-ertheless there are other rare cases of SOVT. When treating patients with nonspecific ab-dominal pain associated with a solid mass in the lower pelvis and laboratory abnormal-ities (high CRP and leucocytosis), SOVT should be considered as a differential diagnosis.


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P 153

Small bowel volvulus during pregnancy: a knotty surgical problem

Author: Sichitiu J., Ekatomati M., Capoccia Brugger R.Hospital: Obstetrics and Gynecology, Pourtalès Hospital, Neuchâtel

Introduction: Intestinal obstruction during pregnancy is a rare and complex condition. Midgut volvulus represents less than 3 % of all such cases. High fetal and maternal morbi-dity, as well as mortality, have been reported.

Case: We present a case of a 30-year-old primigravida at 27 5/7 weeks of gestation, diag-nosed with intestinal volvulus associated with malrotation. The patient was hospitalized after presenting with a 10 day history of vomiting and intermittent epigastric pain. Diag-nosis was established by MRI, which showed distension of the stomach and the two first parts of the duodenum, as well as the whirlpool sign. After multidisciplinary discussion, endoscopic management was planned, with placement of a naso-jejunal tube to provide enteral nutrition and a splinting mechanism to prevent recurrence of torsion, as success-fully described by Siwatch et al. (2011). Unfortunately, due to total obstruction of the in-testinal lumen at the Treitz angle, this approach failed, warranting surgical intervention. A naso-gastric tube was placed. Given early gestational age, the patient was transferred to a tertiary centre and pulmonary maturation prior to surgery was achieved. Laparosco-pic surgery was attempted with conversion to median laparotomy as a result of extensive adhesions and iatrogenic intestinal injury. Duodeno-jejunal volvulus was resolved during the procedure, and parietal fixation of the right colon was performed. No intestinal ische-mia was found. Post-operatively, a nosocomial pneumonia was treated by broad-spect-rum antibiotics. Fetal viability monitoring remained reassuring at all times. At term, the patient went into labor spontaneously, with delivery of a healthy male infant.

Conclusion: Intestinal malrotation is an uncommon congenital anomaly that results from inadequate rotation and fixation of the intestine during embryonic GI tract development. Volvulus secondary to malrotation is rare during adulthood, with the majority of patients being diagnosed during infancy. Pregnant patients with malrotation are at increased risk of developing volvulus as a result of bowel shift by the gravid uterus. Diagnosis in adults is challenging due to the rarity of the condition and its atypical clinical presentation. In this context, time to diagnosis is often delayed. Our case highlights the need for the obstetri-cian to be cognizant of surgical pathology during pregnancy and to retain a low threshold for ordering complementary imaging in such cases.


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P 154

Large epidermal cyst mimicking clitoral hypertrophy – a case report

Author: Kochanowski A., Ghisu G.-P., Fink D.Hospital: Gynecology and Obstetrics, University Hospital Zurich

Introduction: Epidermal inclusion cysts are slow-growing benign skin lesions that arise from obstructed or ruptured pilosebaceous follicles. Clitoral hypertrophy caused by epi-dermal cysts have been related in literature most commonly after a history of female gen-ital mutilation. Epidermal cysts of external genitalia are not unusual. These circumstances relate to the following case report: A painless, nontraumatic clitoral enlargement and a slowly tumor growth showed a 24-years-old woman – the case should be introduced be-cause of unusual picture and surgical challenge.

Material: A 24-years-old sexually active adolescent presented with a painless, since 7 years slowly growing clitoral enlargement. The patient denied urinary symptoms as well as history of prior genital surgery or trauma. Cohabitation was undisturbed.

Results: Clinical examination showed a 3 x 2 cm mobile, compressible clitoral mass emerg-ing from the superior apex of the glans, covered by the clitoral hood. External genita-lia were in normal accordance for her age with Tanner stage IV, no signs of virilization, hormonal evaluation excluded endocrinopathy. Pelvic ultrasound illustrated a hypoecho-genic, nonvascular, well-defined, homogeneous mass. The patient demanded surgical re-moval for cosmetic purposes and diagnostic security. Surgical intervention was taken by an inverted U-shaped incision over the superior apex of the mass, dissection in toto of the cyst from the neighboring tissue with preservation to neurovascular bundles of the cli-toris. Histopathology confirmed the diagnosis of an epidermal cyst. At 6-week follow-up clinical examination presented cosmetically pleasing results, sexual sensation was pre-served and tactile sensation confirmed with a Q-tip.

Conclusion: Clitoral hypertrophy is relatively rare and is secondary mostly documented to endocrinologic abnormalities involving a hyperandrogen state. The lesions can be clas-sified in being congenital, acquired, hormonal or nonhormonal and include benign and malignant varieties. Pelvic ultrasound may show characteristics of cyst content. MRI is common in visualization of anomalies of external genitalia, but poor resolution made it difficult to determine the neurovascular bundles of the clitoris and visualize destruction by a clitoral mass. Major goal of surgery involving clitoris include preservation of sexual sensation and restoration of female anatomy. In generally, a retained cyst wall will more often result in cyst recurrence and infections, in contrast to lipomas for instance.


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P 155

The interdisciplinary treatment of a 28 kg mucinous cystadenoma – A case report

Author: Jägli N., Markus A., Wiedemann N., Hornung R.Hospital: Gynecology and Obstetrics, Cantonal Hospital St. Gallen

Introduction: Ovarian mucinous cystadenomas represent approximately 15% of epithe-lial ovarian tumors. They can reach enormous size and seem to form the largest tumors in the human body.

Case report: The 57-year-old female introduced herself with a massive increase of her abdominal girth over the last two years. She presented no abdominal pain or dyspnea. Clinical examination showed a massively distended abdomen in an otherwise very skinny patient. Transabdominal ultrasound illustrated a giant adnex tumor with a rather benign aspect. The surgical intervention was planned in collaboration with the plastic surgeons, as the necessity of an abdominoplasty was predictable.

Gynecological intervention: Under general anesthesia, a laparotomy was performed via midline incision. Underneath the peritoneum, the giant cystic mass presented itself with a smooth surface and intact. Very careful dissection was necessary, as the tumor was adher-ent to the peritoneum of the anterior abdominal wall. At least cystic mass could be identi-fied to origin from the right ovary, and right salpingo-oophorectomy could be performed without intra-abdominal rupture of the tumor. In addition, left salpingo-oophorectomy was performed in the usual manner.

Plastic surgery: The gynecological procedure was followed by an abdominoplasty per-formed by the plastic surgeons. After removing 15 cm of skin on each side of the laparot-omy, they performed fascial duplication and a new navel was shaped out of some of the removed skin.

Anesthesiological challenge: Due to the altered central venous return after removal of the tumor, the patient was in need of catecholamines to stabilize circulation. Therefore, the initial postoperative surveillance took place in the intensive care unit, where further application of catecholamines was necessary during 48 hours. The further postoperative period was uncomplicated. Histological examination confirmed the diagnosis of a benign, mucinous cystadenoma. The tumor weight was 28 kg.

Discussion: Due to preventive gynecological checkups with routine ultrasound it is very rare to find such enormous tumors in highly developed countries. The surgeon should aim for intact removal of the tumor, even when the likelihood to encounter a malignant or bor-derline lesion is very small. The bigger the tumor, the more important it is to plan the sur-gical intervention interdisciplinary, as anesthesiological difficulties and the necessity of abdominoplasty are more likely.


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P 156

Graves disease in pregnancy: a multidisciplinary challenge

Author: Häberli B., Schrempf K., Zulewski H., Stocker G., Bass B., von Orelli S.Hospital: Gynecology and Obstetrics, Triemli Hospital Zurich

Introduction: Graves` disease is an autoimmune disorder causing hyperthyroidism due to activating TSH receptor antibodies. In pregnancy, the antibodies and antithyroid drugs pass the placenta and may thus affect the fetal thyroid gland. To prevent maternal com-plications associated with uncontrolled hyperthyroidism such as congestive heart failure, preeclampsia and placental abruption as well as fetal complications including growth re-tardation and accelerated bone maturation it is mandatory to ensure normal thyroid func-tion throughout the pregnancy.

Material und methodic: Case report of a patient with Graves disease detected in 2nd tri-mester of the pregnancy.

Results: We describe a case report of a 28 years old women with Graves` disease diag-nosed in the first control at week 20 + 5 of pregnancy. The routine TSH was <0.01 mU/l and she presented with a tachycardia of 140/min and increased nervousness. At clinical exam-ination we found a goitre and signs of orbitopathy with photophobia. The diagnosis of Grave`s disease was confirmed with increased autoantibodies to the thyrotropin receptor (TRAb) and thyroid peroxidase. Thyroid hormones were frankly elevated (fT4: 3 times up-per limit of normal, fT3 4 times upper limit of normal). The fetus so far showed no detect-able signs of hyperthyreodism like tachycardia or growth retardation. A therapy with Pro-pycil 4x50mg was started supplemented with Propanolol 4x20mg. The level of fT3 and fT 4 didn’t’ decrease substantially even after dose adjustement to 300 mg propycil and further change to carbimazole 50mg daily After ineffective medication we conducted the thyroid-ectomy. The surgery was performed by a very experienced surgeon without pre-surgical potassium iodide treatment, due to the unknown effects of iodine to fetal thyroid. Subse-quently she received thyroxine substitution and was closely followed by our endocrinolo-gists as well as the obstetricians. At the latest control 4 weeks after surgery we had no ev-idence for fetal hyperthyroidism with normal growth and normal heart rate.

Conclusion: In Grave’s disease during pregnancy first line therapies are antithyroid drugs to control the maternal and fetal thyroid function. In case of uncontrolled maternal hyper-thyroidism despite adequate treatment surgical therapy is an important option for pre-vention of severe maternal and fetal complication.


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P 157

Management of breech births – How to increase the number of vaginal births

Author: Frei L., Oehler R., Kohler L., Michaelis S.Hospital: Hospital Centre Biel

Introduction: About 4 % of all term babies are in breech position. In many swiss hospitals breech presentation is considered as an indication for an abdominal delivery. At our cen-tre Centre Hospital of Bienne, in order to reduce unnecessary cesarian sections, we offer external cephalic version, and , if unsuccsesfull or not desired, vaginal breech births. The latter is offered after carefull selection.

Material and methods: All term breech presentations between 01.03.2015 and 12.02.2016 were analyzed according intention to treat. Primary cesarian section vs primary attempted vaginal birth. Exclusion criteria included IUFD, Twin pregnancies as well as preterm deliv-eries.

Results: 41 breech presentations were included in our study. 23 of these opted for exter-nal cephalic version. 7 of these were successfull. 12 vaginal births occurred: 5 cephalic and 7 breech deliveries. There was a total of 29 abdominal deliveries.

Conclusion: External cephalic version is a usefull and low-risk as well as easily tought in-tervention to achieve vaginal deliveries in cephalic presentations. Our data show that in carefully selected cases successfull breech births can be achieved, thus lowering unnecas-sary cesarian deliveries. This however is only possible when skilled obstetric, pediatric as well as anesthesiologic personnel is available in order to manage possible complications. This management of breech presentations at our teaching hospital in Bienne has import-ant implications in teaching of junior staff in times when elective abdominal deliveries are increasing and obstetrical skilled are beeing lost.


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P 158

Peripartum complications with abnormal placentation and uterine arteriovenous malformations. A case report

Author: 1) Farina P., 1) Nussbaumer J., 1) Manegold-Brauer G., 2) Zech C., 3) Bruder E., 4) Erb S., 5) Girard T., 1) Hösli I.Hospital: 1) Obstetrics and Gynecology, 2) Radiology, 3) Pathology, 4) Infectiology, 5) Anaesthesiology/ 1-5 University Hospital Basel

Introduction: Morbidly adherent placenta (MAP) and uterine arteriovenous (AV) malfor-mations are rare conditions in primiparous women. Placenta accreta occurs in approxi-mately 1 of 2500 deliveries. Among women with placenta praevia, the incidence is nearly 10%. Risk factors are uterine surgery, maternal age (over 35), previous deliveries and infer-tility procedures. AV-malformations may be congenital or acquired. The congenital form is rare.

Study design and methods: This case is about a 33-year old primipara with placenta praevia totalis and a suspicion of MAP in prenatal ultrasound with extensive vasculariza-tion into the myometrium. The magnetic resonance imaging (MRI) revealed typical signs for MAP: focal interruptions of the myometrium, and the absence of flexibility between uterus and bladder. The patient had IVF treatment after laparoscopic therapy for severe endometriosis (rASRM Grad IV). She was referred to our hospital at 28 weeks because of vaginal bleeding. At 32 weeks she had premature preterm rupture of membranes and be-ginning contractions so that a Caesarean section with a longitudinal laparotomy and fun-dal hysterotomy was performed. Before removal of the placenta the uterine aretries were embolized bilaterally. After adhesiolysis between the bladder and the uterus removal of the placenta was without problems. 8 days post operatively septical fever occurred due to Enterobacteriaceae in urine culture and antibiotic therapy was started according to the antibiogram. At the 14th postoperative day, relaparotomy with hysterectomy was per-formed because of persistent signs of sepsis and the suspicion of an endomyometritis and partial necrosis with sonographical reduced myometric vascularisation.

Results: The histology confirmed a subtotal transmural necrosis of the myometrium with focal putrid- infection, which spread into the parametria. Moreover extensive transmural malformation of the complete myometrium was observed with partial thrombosis includ-ing the subserosa.

Conclusions: Retrospective the histological diagnosis of vascular malformations of the uterus matched to the MRI. The absence of flexibility between uterus and bladder was the result of the endometriosis. The embolization and the vascular malformations aggraveted the effect of a reduced uterine perfusion which explained the insufficient effect of the an-tibiotics. The hysterectomy was the only possibility to avoid a life threatening severe sep-sis.


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P 159

Spontaneous rupture of renal angiomyoplipoma in early pregnancy: A case report

Author: Ruf K., Fischer T., Wiedemann N., Hornung R.Hospital: Obstetrics, Cantonal Hospital St. Gallen

Introduction: Renal angiomyolipoma is a benign tumor composed of adipocytes, smooth muscle cells and blood vessels. There is little information about its association with preg-nancy but consequences can be occasionally fatal.

Case: A 38-year old multiparous presented herself with an episode of sudden and severe pain in the left flank in 11th weeks of pregnancy. She was diagnosed with an acute retro-peritoneal haemorrhagia from a ruptured renal angiomyolipoma with consecutive hemo-dynamically instability (hemoglobin 67g/l) She was treated successfully by angiographic embolization of two segment arteries of the left kidney. The further pregnancy was un-eventful although there were remaining tumors on both sides. She delivered vaginally a healthy baby boy after induction at 38th weeks.

Conclusion: Embolization of renal angiomyolipoma bleeding vessels during pregnancy can be an effective therapy to treat acute bleeding and to avoid surgery. The radiation ex-posure to the fetus should be well documented but it is no general indication for an abor-tion. Vaginal delivery is possibly under clinical conditions with close maternal and fetal monitoring.


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P 160

Adnexal mass of unkown dignity in an asymptomatic 34 year old woman – A case report

Author: Schneider N., Fehres O., Fehr P.M.Hospital: Gynecology and Obstetrics, Cantonal Hospital Graubuenden, Chur

Introduction: Tumors of the fallopian tube are rarely seen. In the majority of cases para-tubar cysts are detected, on rare occasions solid tumors are seen. Our case report depicts a solid tumor of the fallopian tube with the consequent diagnostic steps and clinical find-ings.

Case Report: A healthy 34 year old nulligravida presented herself for a routine gyneco-logical check-up. She reported having an irregular menstruation cycle as well as infertil-ity over the last 1½ years. The clinical investigation was inconspicuous. The ultrasound showed an incidental finding of an inhomogenous adnexal tumor 40mm diameter with a smooth surface and a positive doppler sign on the left side. The ovary was inconspicuous. The pregnancy test was negative. The sonographic follow up examination after 6 weeks revealed the same findings. A surgical intervention was indicated. The patient underwent hysteroscopy and diagnostic-therapeutic laparoscopy with chromopertubation. The lap-aroscopic situs showed a solid yellow transmural tumor with a smooth surface near the left fallopian tube. The mass was sent to pathology and histology results showed a hem-orrhagic pregnancy with highly degenerated immature villous placenta and circumflu-ent thrombotic blood vessels as well as fibrosis. There was no rupture or embryonal tissue identifiable. Also seen during surgery was a salpingitis isthmica nodosa on both sides. The chromopertubation revealed a delayed flow on the right and a hesitant flow of dye on the left side. After resection of the tumor and part of the left fallopian tube with reconstruc-tion a regular flow was noticed.

Discussion: In cases of solid tumors of unknown dignity of the fallopian tube presenting with a negative pregnancy test, an appropriate clinical investigation must be performed. As we have seen in our case, it is important to consider a regressive tubal pregnancy in the differential diagnosis.


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P 161

Chylous ascites after minimally invasive abdominal surgery with pelvic and paraaortic lymphadenectomy in treatment of endometrial cancer

Author: Machado S., Berlinger A., Schmid S.Hospital: Gynecology, Hospital Grabs

Introduction: Chylous ascites is defined as the accumulation of lymph fluid in the peri-toneal cavity. In the management of gynecologic cancer, it is a very rare complication (0.17 – 2%) subsequent to abdominal surgery including extensive retroperitoneal paraaor-tic lymphadenectomy. The risk of chylous ascites rises with the number of lymph nodes harvested. Existing data show best results with conservative treatment such as the use of total parenteral nutrition or a high protein, low-fat, medium chain triglyceride (MCT) based diet combined with somatostatin therapy, as well as paracentesis for symptomatic ascites. A surgical or interventional radiologic procedure should only be considered in ex-ceptional cases after failure of conservative management.

Case Report: We present the case of a 51-year-old stage IA, grade 3 endometrial can-cer patient, who underwent laparoscopic hysterectomy, adnexectomy and pelvic and paraaortic lymphadenectomy. One week after surgery the patient showed diffuse abdom-inal discomfort after getting back to a regular oral diet, daily emesis and high-volume vag-inal discharge of odorless fluid. Due to primarily suspected urinary-tract lesion a clinical, radiological and surgical exploration was performed which showed no lesion but mod-erate turbid ascites. Swabs taken from the abdominal cavity showed no bacterial growth and cytopathologic testing confirmed chylous ascites. Treatment with MCT diet and so-matostatin subcutaneously was started. The patient was discharged 3 days later pain-free in significantly improved condition without vaginal discharge or ascites. Treatment con-tinued for 2 weeks. The patient was asymptomatic at the 8-weeks follow-up.

Conclusion: Chylous ascites should be pondered in the differential diagnosis of any pa-tient who underwent paraaortic lymphadenectomy and develops symptomatic ascites and abdominal discomfort after starting a full oral diet. An abdominal drainage after sur-gery may be an effective diagnostic tool. Furthermore it allows additional laboratory tests of the drainage fluid to rule out other differential diagnosis such as an infection. In our case the keeping of an abdominal drainage until the patient was back to normal oral diet could have detected chylous ascites on an earlier stage allowing an earlier start of the rec-ommended treatment and preventing a surgical revision.


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P 162

A case report of struma ovarii presenting as pseudo-Meigs’ syndrome with highly elevated CA125 levels

Author: 1) Tran A., 2) Pfofe D., 1) Samartzis E.P., 1) Eberhard M.Hospital: 1) Gynecology and Obstetrics, Cantonal Hospital Schaffhausen, 2) Institute of Pathology, Cantonal Hospital Winterthur

Introduction: Struma ovarii is a rare form of ovarian mature teratoma composed predom-inantly of thyroid tissue. Although it is generally benign, it can undergo malignant trans-formation (in 5-37%). We report a rare case of benign struma ovarii with ascites, pleural ef-fusion, and elevation of CA125 and thereby mimicking ovarian cancer.

Case: A 60-year-old woman was referred to our clinic with high suspicion for ovarian can-cer. During a regular gynaecological check-up the ultrasound revealed a mass in the left adnexa and ascites. The CT scan revealed an 11cm complex cystic and solid mass in the left ovary, gross ascites, and left pleural effusion. CA125 was elevated to 1029U/ml. The patient’s only symptom was mild dyspnoea. Thoracocentesis yielded 1200ml of fluid that was found to be negative for malignant cells. The exploratory laparotomy revealed a left 10cm multicystic mass with no evidence for malignancy. The uterus and right ovary ap-peared normal and there was no evidence for intraperitoneal spread of disease. A total hysterectomy with bilateral salpingo-oophorectomy, omentectomy, appendectomy, and sampling of the paracolic peritoneum was undertaken. Histopathological results revealed a benign struma ovarii. On the 7th postoperative day CA125 was decreased to 684.7U/ml.

Conclusion: Meigs’ syndrome is defined as ovarian fibroma associated with ascites and pleural effusion that resolves after primary tumour resection. When other ovarian tumours are found with the same criteria, the term pseudo-Meigs’ syndrome is employed. The or-igin of ascites and pleural effusions remains obscure. Proposed explanations include irri-tation of the peritoneum, obstruction of the lymphatics, toxins and release of inflamma-tory products, hypoalbuminemia, and discrepancy between the arterial supply and the venous and lymphatic drainage. Pleural effusions seem to originate from the peritoneal fluid via mechanical transfer through diaphragmatic openings. CA125 is a classical tumour marker for epithelial ovarian cancer with a rather poor specificity. A possible explanation for the elevation of CA125 in (pseudo-) Meigs’ syndrome is the irritation and inflammation of pleura and peritoneum surface by the free fluid. In conclusion, a postmenopausal fe-male with a pelvic mass, ascites, pleural effusions, and elevated CA125 is highly suspicious for a malignant process. However, when the effusions show negative cytology, a benign ovarian tumour should be considered in the differential diagnosis.


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P 163

Enlarged axillary Lymphnodes – take a broad view !

Author: Devletlian S., Zivanovic I., Honegger Ch.Hospital: Women’s Clinic, Cantonal Hospital Zug

Backround: Evidence of tumor cells in axillary lymph nodes is usually identified as hav-ing primary carcinoma in the ipsilateral breast. Once a diagnosis of metastatic carcinoma on an axillary lymph node has been made in a female patient, there is a tendency to sub-ject the patient to an exhaustive senologic investigation including mammography, ultra-sound, breast MRI or biopsies. But the following cases show that sometimes clinical ap-pearance can be deceptive.

Methods: We report the case of three patients who presented with unilateral axillary lymphadenopathy during their first senologic consultation in our departement . Clinical, radiologic and pathologic examinations revealed in all three cases different malignant causes.

Results: Patient 1 complained about diffuse pain and a palpable node in the right ax-illa. Mammography identified a big sharply demarcated hyperechogenic tumor that sono-graphically appeared like a fibroadenoma. A punch biopsy was performed and showed a spindle like mesenchymal tumor, primarily according to soft tissue sarcoma or malignant phylloides tumor. Pathologic analysis after operative excision revealed a lymph node me-tastasis of a malignant melanoma with unknown primary. Patient 2 was admitted with edema and erythema of the left arm and breast which had been treated unsuccessfully with antibiotics for two weeks. On computed tomography imaging an inflammatoric mammary tumor with extended lymphatic metastatis was assumed to be the reason of lymphostatis. The results of punch biopsy approved a diffuse large B – cell non- Hodgkin’s lymphoma in the left axilla. Patient 3 consulted us with palpable nodes in the left breast and enlargement of lymph nodes in the left axilla. Results of a punch biopsy had been al-ready obtained and showed a poorly differentiated invasive ductal breast carcinoma.

Conclusion: All three patients presented themselves with axillary lymphadenopathy and similar clinical symptoms, although their underlying diseases were completely different. Core needle biopsy of enlarged axillary lymphnodes can be performed safely and usually reveals the true diagnosis of the enlarged nodes. So take a broad view, when faced with enlarged axillary lymphnodes.


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P 164

Case Study: Covered bleeding from left uterine artery after spontaneous delivery

Author: Willing N., Arnold E., Graf U.Hospital: Obstetrics and Gynecology, Hospital Uznach

Introduction: The uterine bloodflow at expected date of delivery measures approx. 500 ml/min. Intraparietal injuries of uterine artery get symptomatic after short time period and require a fast and adequate intervention, usual via laparotomy. We report a rare case of rupture of uterine artery, manifested with non-specific clinic in late state of puerperium.

Case: A 35 year old IV. Gravida, II. Para (condition after caesarean sectio) reporting diffuse pain in lower abdomen was seen on the 14th day after spontaneous delivery. The patient was in stable condition, haemoglobin was at 117 g/l. Despite a light pain, two-sided in the ovary region, a gynecologic examination showed no further findings . Transvaginal ultra-sound suspected a covered rupture of uterus posterior side with adjacent coagulum and a small quantity of hyperechoic liquid in pelvis minor. Within hours haemoglobin was sta-ble and patient reported to be free of symptoms. Decision to only observe patient. Further transvaginal ultrasounds showed an increased size of haematoma in Douglas. The sus-pected covered rupture was not confirmed. A diagnostic laparoscopy was conducted on the 23th postpartal day. Intraoperativly, a covered bleeding from left uterine artery with haemoperitoneum was found. The postoperative course was without any complications. In a control examination on the 17th postoperative day patient reported to be free of dis-comforts, a gynecologic examination was normal.

Conclusion: Postpartal bleedings from uterine artery do not necessarily correlate with a symptomology of an acute abdomen and anaemia with acute circulatory collapse. In-stead, a subclinic resp. unspecific course is possible. The shown symptomology might de-velop in a late time interval. For clarification diagnostic laparoscopy is recommended.


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P 165

Management of anti-colton alloimmunisation in pregnancy: A case report

Author: 1) Vonzun L., 2) Brand B., 3) Hustinx H., 4) Komarek A., 1) Zimmermann R., 1) Kimmich N.Hospital: 1) Obstetrics, 2) Haematology, 3) Immunohaematology, Interregional Blood Transfusion SRC Ldt., Switzerland, 4) Immunohaematology, Blood Transfusion Service SRK, Zurich/ 1,2 University Hospital Zurich

Background: Maternal alloimmunisation against red blood cell antigens can cause se-vere haemolytic disease in the foetus and neonate. This can lead to foetal anaemia with the risk of foetal death or severe hyperbilirubinaemia with kernicterus. Most cases of ma-ternal alloimmunisation are caused by anti-D antibodies, more rarely by other antibodies of the red blood cell system. There is scarce information about the frequency and severity of fetal or neonatal anaemia due to these antibodies. In regard to maternal alloimmunisa-tion against Coltonª (Coª) antigen during pregnancy, only five cases have been described so far, four in the 1970s and one in 2008, but diagnosis and management has changed in the meantime.

Material and methods: We describe a rare case of maternal alloimmunisation against Coª antigen during pregnancy, its management and favourable outcome without severe foe-tal anaemia.

Results: A 32-year-old woman (blood group 0RhD-, RhC-, Rhc+, RhE-, Rhe+, K-, Coª-) was admitted to our hospital at 20+3 gestational week (gw) with an alloimmunisation against blood group antigen Coª and increasing antibody titer. The foetus’ father was determined Coª homozygous. Monitoring of the foetus was performed every one to two weeks by MCA-PSV measurements with raising values above the 95th percentile between week 28 and 32. A cordocentesis was performed due to suspected foetal anaemia at 32+4 gw. Intra-operative haemoglobin and haematocrit were 123 g/l and 35.5% respectively, thus trans-fusion was stopped. MCA-PSV decreased to normal values within minutes and remained stable until delivery at 37+2 gw. Due to foetal hyperbilirubinaemia on the fifth day post-partum the neonate was treated with phototherapy for three days and discharged from hospital eight days postpartum.

Conclusion: Anti-Coª alloimmunisation during pregnancy is a challenging situation with the requirement of an interdisciplinary treatment approach. Both national and interna-tional blood donor registries are extremely helpful to identify compatible blood donors. Antibody testing can be performed by indirect antiglobulin testing, enzyme (papain) test-ing and a Monocyte Monolayer Assay. Despite increased antibody concentrations, MMA and MCA-PSV, this case did not develop foetal or neonatal anaemia and did not require ex-change transfusions after birth. Serologic methods can help to initiate foetal monitoring and doppler MCA-PSV measurements might be helpful to avoid serial cordocentesis, but can also be misleading in some cases.


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P 166

Non puerperal related ovarian vein thrombosis – A case report of a rare diagnosis

Author: Antonescu M., Seidler S., Bloch A.Hospital: Gynecology and obstetrics, Hôpital du Jura, Delémont

Ovarian vein thrombosis (OVT) is a rare diagnosis for abdominal pain, mainly in non preg-nant women, with a potentially lifethreatning outcome. Literature lacks evidence-based epidemiological, diagnostic and therapeutic data on this topic, nevertheless several case reports tend to show that the diagnosis may be easily mised. Suspicion should be raised in the presence of abdominal pain associated with pelvic inflamatory diseas, inflammatory bowel disease, post-operatory, malignancy or an underlying hypercoagulable state. Clin-ical manifestations include non specific abdominal pain especially in the right iliac fosa (OVT beeing more common at right), fever, nausea, vomiting and sometimes a palpable abdominal mass. Diagnosis is based on CT- scan. D-dimers and inflammatory markers can be helpful. Treatment remains empiric, anticoagulant therapy can vary from six weeks to three months. Complications include sepsis and pulmonary embolism. We therefore pres-ent our case of right ovarian vein thrombosis in a 27 years old woman known for acute colitis, underlying antilupic antibody disorder and a history of oestroprogestative pill in-duced pulmonary embolism without further diagnosis in the antecedents.


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P 167

Ewing’s sarcoma of the uterus in a 23-year-old female – A case report

Author: 1) Jägli N., 1) Markus A., 2) Rothermundt C., 3) Zollinger T., 3) Diener P.-A., 4) Dirksen U., 1) Hornung R.Hospital: 1) Gynecology and Obstetrics, 2) Oncology, 3) Pathology, 4) Pediatric Hematology and Oncology, University Hospital Münster/ 1-3 Cantonal Hospital St. Gallen

Introduction: Extraskeletal Ewing’s sarcoma of the uterus is very rare as less than 50 cases were published in English literature at the time of diagnosis.

Case report: A 23-year-old nulliparous female presented herself with an increased ab-dominal volume and lower abdominal pain. Gynecological examination revealed a large tumor in the uterine wall, interpreted as a myoma. The patient was treated with Esmya® for 3 months, in an attempt to reduce the myoma volume. The follow-up examination un-expectedly showed further growth of the tumor. An MRI revealed a 10 x 11 cm inhomoge-neous and contrast enhancing mass related to the anterior and side wall of the uterus. In a private hospital, a biopsy of the tumor was performed. Histological examination revealed an extraskeletal Ewing’s sarcoma/primitive neuroectodermal tumor (PNET) with a high proliferative MIB-1 index of 80%. The following PET-CT showed persistent, partly necrotic tumor of 11 cm in diameter, but no distant metastases. There is evidence for the impact of multidisciplinary and multimodal treatment of patients with Ewing’s sarcoma. The treat-ment approach was based on experience for Ewing’s sarcoma of the bone. Our patient un-derwent primary chemotherapy with six cycles of VIDE. The tumor showed regression with a residual tumor mass of 4 cm. We performed a median laparotomy with hysterectomy, bi-lateral salpingectomy and lateral transposition of the ovaries. On histology of the uterus the tumor showed 80% necrosis, however 20% vital tumor areas remained. After surgery, the patient received adjuvant treatment with radiotherapy of the pelvis (cumulative dose of 45 Gray) and chemotherapy with VAC. On follow-up the CT showed a complete remis-sion. The patient presented in a good general state of health. During the entire treatment, the GNRH agonist Zoladex® was applied to achieve ovarian suppression and to prevent chemotherapy-induced gonadotoxicity and premature ovarian failure.

Discussion: In spite of its rarity, Ewing’s sarcoma should be included in the differential di-agnosis of a growing uterine tumor, especially in adolescent and postmenopausal women, as most of the cases have been reported in those 2 age groups. There is no consensus on the adequate treatment, due to the lack of studies. Multidisciplinary management of this rare disease is key and multimodal therapy consisting of surgery, chemo- and radiother-apy improves the prognosis, which is still poor with an overall 5-year survival rate of 50%.


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P 168

Caudal regression syndrome: a case report

Author: Tan Z., Cubal-Pena R., Gaston G., Khomsi F., Fadhlaoui A., Bouquet de la Jolinière J., Feki A., Ben Ali N.Hospital: Gynecology and obstetrics, Cantonal Hospital Fribourg

Introduction: The caudal regression syndrome (CRS) refers to a group of congenital mal-formations involving the lower spinal segments with hypoplasia of the sacrum and lumbar spine. The gastrointestinal as well as urinary system can also be affected. Prevalence is es-timated at around 1/50,000 to 1/100,000 of pregnancies. Etiology is unclear but maternal diabetes; genetic susceptibility (HLBX9 mutation, expressed in pancreas) and vascular hy-poperfusion have been suggested as possible cause. CRS is 200 to 400-fold more likely to occur in pregnancies affected by diabetes than in the general population and almost 1% of children of diabetic mothers may be affected by this disorder.

We report a case of caudal regression syndrome diagnosed in utero at 21 weeks of gesta-tion in a patient without any risk factor.

Case report: A 29-year-old gravida 1, para 0, at 21 weeks of gestation was referred to our hospital for evaluation of fetal spine anomaly. No medical history was reported for the pa-tient and pregnancy follow-up was regular. Prenatal ultrasound examination revealed a masculine fetus with biometric measures within the normal range. US images of the fetal head demonstrated normal intracranial anatomy. We found a hypoplastic pelvis with a to-tal absence of the sacrum, hypoplastic iliac bones and a sudden interruption of the spine. These findings suggested diagnosis of caudal regression syndrome. After medical consul-tation the patient take a decision of medical termination of pregnancy. Administration of misoprostol after pre-treatment with mifepristone resulted in vaginal birth at 22 weeks of pregnancy. X-ray of the fetus confirmed the diagnosis observation gived by the 3-D mode ultrasound.

Discussion: Caudal regression syndrome is described by anomalies of in the development of the caudal vertebrae and limbs as well as neural tube, urogenital and digestive system. Infants affected by CRS have therefore a loss of bladder and bowel control combined with total neurologic deficit in the lower limbs. Treatment is only supportive because primary pathology is irreversible and that’s why management requires multidisciplinary assess-ment. Prognosis can be poor. Early neonatal death is observed in severe forms which are associated with cardiac, renal and respiratory problems.

Conclusion: The diagnosis is often made late in pregnancy, although prenatal ultrasono-graphic diagnosis of caudal regression syndrome is quite possible at morphology ultra-sound. The 3-D ultrasound is a tool for the comprehension of parents.


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P 170

Septic shock and multiple organ failure in a case of spontaneous septic abortion

Author: Brülhart L., Gahleitner E., Arbogast S., Passweg D., von Orelli S.Hospital: Gynecology and Obstetrics, Triemli Hospital Zurich

Introduction: Septic abortion leading to severe sepsis and septic shock are major causes of pregnancy related mortality, thus early diagnosis and management of septic shock es-sential. Septic abortion is more likely in unsafe, induced abortions, and rather exceptional in spontaneous abortion. Management includes ensuring hemodynamic stability, provid-ing systemic antibiotic treatment and evacuating retained pregnancy tissue preferably with suction evacuation as the perforation risk is high in infected, gravid uteri. Below, we report a case of septic shock resulting in multi organ failure with a rapid progressive clini-cal course in a case of spontaneous septic abortion.

Case report: A 38 year old primi gravida, pregnant without knowing, reporting menstrual irregularities for five months and was later admitted to the intensive care unit (ICU) with rapidly deteriorating septic shock symptoms. She developed multiple organ failure with disseminated intravascular coagulation and acute kidney failure. Toxic shock syndrome was suspected, blood cultures and vaginal swaps including rapid strep test were all neg-ative. Pregnancy test in urine was negative, but blood tests proved a beta-HCG level of 10 mlU/ml. Abdominal CT scan showed a mass of 5cm in the uterine cervix, highly suscepti-ble for abscess. A transvaginal ultrasound presented an anterior cervical mass of 3.5x4 cm with a negative doppler signal. Endometrial pipelle sampling was performed along with evacuation of bloody pus. ICU treatment included application of catecholamines, eryth-rocyte concentrates and systemic antibiotic treatment. After ensuring hemodynamic sta-bility, suction evacuation was performed which resulted in increased blood loss. For he-mostatic reasons a cook ballon was placed intrauterine. Histopathological findings proved the suspected diagnosis of a septic abortion. Rapid clinical improvement allowed for hos-pital discharge after 8 days.

Conclusions: Although septic abortions are rare in countries with liberal abortion law, complications can be life-threatening. Thus, differential diagnosis for septic abortion in women of reproductive age has to be considered. Increased awareness of symptoms may help with prevention of fatal complications.


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P 171

Prenatal ultrasonic findings of a child with congenital ichthyosis – Case report

Author: 1) Kinkel J., 2) Queisser M., 2) Malzacher A., 1) Fischer T., 1) Hornung R.Hospital: 1) Obstetrics, Cantonal Hospital St. Gallen, 2) Children Hospital, St. Gallen

Congenital ichthyosis is a rare skin disorder of keratinization or cornification due to auto-somal recessive or dominant mutation of certain genes (TGM 1, KRT 1, ALOXE 3, ABCA 12). The presence of dry surface scales is responsible for its naming as “collodion baby”. The probability for this disease is 1:300 000.

A 41 year-old Gravida V, Para II came to Cantonal Hospital in St. Gallen for the first time in 37+6 pregnancy weeks. Her previous births in 1999 and 2001 were uncomplicated. She had a normal pregnancy and came with premature rupture of membranes and con-tractions. Surprisingly the performed ultrasound showed numerous abnormalities. Poly-hydramnios was detected with an amnion fluid index of 22cm. Additionally the whole amniotic cavity except the placental site seemed to be detached from the myometrium. The amnion fluid surrounding all the foetal structures and umbilical cord showed exces-sive intra-amniotic debris. Interestingly there was a hypo-echoic liquid layer between the myometrium and this area. Furthermore the foetal skin was thickened with generalized oedema. In course of parturition a secondary caesarean section had to be performed be-cause of stagnation during dilation phase.

The primary cardiopulmonary adaptation of the new-born was normal. But the baby girl showed oedema all over her body especially on hands, feet, lips and genitalia. Her skin was swollen and taut, very dry and parchment-like with fine scaling. She could not close her eyes completely with bilateral ectropion and small eyelids. Furthermore she had everted lips, a reduced muscle tone in general and reduced joint movements. She was moved to the neonatal ward for closer observation and specific care with a high suspicion of con-genital ichthyosis.

Discussion: There are sonographic markers for congenital ichthyosis including polyhy-dramnios, thickened skin and intra-amniotic debris.


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ImpressumHerausgeberin:Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe, gynécologie suisse SGGG

Die Texte wurden von den Autorinnen, Autoren direkt übernommen. Die Herausgeberin nimmt weder orthografische noch inhaltliche Korrekturen/Änderungen vor.

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