O636 The non-pneumatic anti-shock garment (NASG) for managing uterine atony and hypovolemic shock: Four Nigerian hospitals

S274 Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396 O635 MiniArc single incision sling: 1 year follow-up on a new minimally invasive treatment for female SUI R. Moore, J. Miklos. Atlanta Urogynecology Assoc, Northside Hospital, Atlanta, GA Introduction and Objective: The mid-urethral tension-free vaginal tape sling has emerged as the gold standard to treat female stress urinary incontinence (SUI). The transobturator approach was then developed to reduce risks of retropubic needle passage. Most recently, the mini-sling has been developed in attempts to place the sling without any needle passages through the abdomen or groin. The current study was conducted to report on the technique, safety and early efficacy of a single-incision mini-sling to treat female SUI. Methods: Women suffering from SUI were offered a single-incision approach to place a sub-urethral polypropylene mesh tape in a position similar to that of a transobturator sling without passage of needles through the groins. Retrospective data was collected on the first 61 patients that underwent the new MiniArc (American Medical Systems, Minnetonka, MN) single-incision sling at our specialty center in the United States. All patients had urodynamic proven SUI. Patient selection and concomitant procedures were determined by the senior authors at the center. The senior authors (RDM, JRM) were the primary surgeons in all cases. Procedures were completed under general, regional, or MAC anesthesia as determined by the surgeon. Results: Sixty-one patients underwent the Mini-arc single incision sling. 92% of patients had concomitant procedures for prolapse during the same setting. Average age was 58 years (range 26–84) and average LPP was 71.3. Average operative time for the sling procedure alone was short and average blood loss was 29 cc. There were no intra-operative complications. There was one postoperative adverse event secondary to urinary retention which was resolved by loosening of the sling under local anesthesia in an office setting. Significant urge symptoms were present in 55% of patients pre-operatively and only 14% post-operative (75% resolution of urge symtpoms). Overall cure rate at 12 months determined by physician and patient assessment in 58/61 patients was 91.4%. No patients suffered pain or dyspareunia secondary to the sling and no erosions or extrusions were reported. Conclusions: In this initial study, the MiniArc single-incision sling appears to be a safe approach to treat female SUI and the early clinical results are encouraging with 12 month cure at 91.4%. A multicenter US prospective trial is on-going. O636 The non-pneumatic anti-shock garment (NASG) for managing uterine atony and hypovolemic shock: Four Nigerian hospitals I. Morhason-Bello1 , O. Ojengbede1 , H. Galadanci2 , D. Nsima3 , B. Magaji4 , H. Martin5 , E. Butrick5 , S. Miller5 . 1 Department of Obstetrics & Gynaecology, University College Hospital, Ibadan, Nigeria, 2 Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria, 3 Katsina General Hospital, Katsina, Nigeria, 4 Pathfinder International, Kofar Goga, Katsina State, 5 Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, USA Objective: To demonstrate if there are differences in outcomes between women suffering obstetric hemorrhage due to uterine atony who are treated with the non-pneumatic anti-shock garment (NASG) and standard hemorrhage protocols vs. women treated with standard hemorrhage protocols only. Methods: The study took place at 4 tertiary level CEmOC facilities in Nigeria; the design was pre-intervention/intervention. There were 113 women, 41 in the Pre-intervention and 72 in the NASG intervention phase; all had a primary diagnosis of uterine atony. Outcomes were measured blood loss and a combined outcome, Extreme Adverse Outcomes (EAO), combining mortality and severe morbidity. Results: There were no differences between the women for age, parity, duration of pregnancy, estimated blood loss or MAP < 60 on study entry. There were no significant differences in treatment variables, few women in either group received a blood transfusion in the first hour and only around half received >=1500 mL IV fluids. There were significant differences in the mean measured blood loss during treatment, 447.8 mL pre, 50 mL NASG (p < 0.01). There was a 69% reduction in mortality, RR = 0.237, 95% CI = 0.047–1.187; while the EAO RR = 0.265, 95% CI = 0.082–0.856. Conclusion: Among women with obstetric hemorrhage and shock due to postpartum uterine atony, there was a significant reduction in Extreme Adverse Outcomes among women who received the NASG. O637 Introduction of human papilloma virus vaccine in a low resource setting: a survey of the views of Nigerian gynaecologists I.O. Morhason-Bello1 , A. Oladokun1 , B.O. Adedokun2 , O.A. Adesina1 , O.A. Awolude1 , C.O. Aimakhu1 , C.A. Okolo3 , B.O. Akinwunmi4 , I.F. Adewole1,4 . 1 Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria; 2 Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria; 3 Department of Pathology, College of Medicine, University of Ibadan /University College Hospital, Ibadan, Nigeria; 4 PEPFAR-APIN Plus Clinic, University College Hospital, Ibadan, Nigeria Objective: To determine knowledge and perception towards HPV vaccine use in Nigeria. Methods: A crossectional survey, conducted among gynaecologists – consultant and trainees, who attended the 42nd Society of Gynaecology and Obstetrics of Nigeria, held in Enugu, Nigeria from 19th to 22nd November, 2008. A self administered questionnaire was used to obtain information on sociodemographics, cervical cancer (CC) management experience, awareness and perception about HPV vaccine. Analysis was performed with SPSS 11.0 and statistical significance was 0.05%. Results: Of the 118 interviewed, consultants constituted 43.7% while others were senior residents (33.6%) and junior residents (22.7%). The ratio of male to female was 73.9% vs. 26.1%. All have been involved in CC management, while 37.9% had witnessed more than 20 mortalities. Although all knew that HPV can cause and its vaccine prevent CC but, only 44.5% knew the correct vaccine schedule. Concerning implementation strategies, 16.1% agreed that client should pay for the vaccine; 87.4% suggested its incorporation into the national immunization programme, and 34.5% agreed that vaccination should be a precondition for school enrollment. Consultants and senior residents were more likely to have adequate knowledge of HPV vaccine compared to junior residents (95% CI OR = 1.14–11.72 and 1.58–15.53 respectively), and the odds decreased by about 20% for each year spent in managing women with CC (95% CI OR = 0.75–0.92). Conclusion: Despite being involved in CC management, knowledge of eligibility and schedule of HPV vaccine is poor, and they are of the opinion that its implementation should not be clientele sponsored. O638 Cervarix® induces higher HPV-16/18-specific T cell responses compared to Gardasil ® in healthy women aged 18–45 years P. Moris, M. Janssens, G. Dubin, A. Schuind, M. Van Mechelen Objective: Two prophylactic HPV vaccines are licensed in many countries. A comparative trial in healthy women aged 18– 45 years evaluated the immune response after vaccination with HPV-16/18 AS04-adjuvanted vaccine (Cervarix® , GlaxoSmithKline) and a HPV-6, 11, 16, 18 vaccine (Gardasil® , Merck); in addition to