AGES XXIII Annual Scientific Meeting 2013 Abstracts & Program

The Pelvis in Pain
Endometriosis and Beyond
Free Communications 2 - Thursday 7 March
bowel surgery and the need for bowel surgery was
significantly associated with POD obliteration (p < 0.01).
CONCLUSION: This study helps to define the surgical
findings that may be encountered with POD obliteration
associated with endometriosis at laparoscopy. The presence
of uterine retroversion, endometriomata, and DIE involving
the rectosigmoid colon, anterior rectum, vagina and
rectovaginal septum were all significantly associated with
POD obliteration, as was the need for bowel surgery. The
ability to predict these markers for endometriosis preoperatively
may alert the clinician to the possibility of
difficult endometriosis surgery, and therefore further aid in
the surgical planning.
AUTHOR AFFILIATION: S. Reid 1,2 , C. Lu 3 , I. Casikar 4 , G.
Reid 5 , J. Abbott 6,7 , G. Cario 8 , D. Chou 8 , D. Kowalski 9 , M.
Cooper 9 , G. Condous 4 ; 1. University of Sydney, Sydney, New
South Wales, Australia. 2. Nepean Hospital, Penrith, New
South Wales, Australia. 3. Department of Computer Sciences,
University of Aberystwyth, United Kingdom. 4. Acute
Gynaecology, Early Pregnancy and Advanced Endosurgery
Unit, Nepean Medical School, Nepean Hospital, Penrith,
New South Wales, Australia. 5. Liverpool Public Hospital,
Liverpool, New South Wales, Australia. 6. University of
New South Wales, Kensington, New South Wales, Australia.
7. Prince of Wales Private Hospital, Randwick, New South
Wales, Australia. 8. St George Private Hospital, Kogarah,
New South Wales, Australia. 9. Royal Prince Alfred Hospital,
Department of Obstetrics and Gynaecology, University of
Sydney, Sydney, New South Wales, Australia.
SESSION 3 - Free COMMUNICATIONS II /
1430-1440
Evaluation of Code Critical Caesarean Sections at
Westmead Hospital
Kapurubandara S, Tse T, Anpalagan A, McGee T
INTRODUCTION: A code critical caesarean section
is a rapid response system developed to facilitate the
performance of an urgent caesarean section in situations that
threaten maternal or fetal wellbeing.
AIM: This clinical audit examined the code critical caesarean
sections in a 24 month period at a tertiary referral center. The
aim was to investigate the indications and appropriateness
of code criticals called, the decision to delivery time,
the type of anaesthesia used and the maternal and fetal
outcomes. Interim results were presented after 6 months at a
multidisciplinary meeting where guidelines were developed
for calling the code critical and an evaluation of the mode of
anaesthesia was performed.
RESULTS: 233 code critical caesarean sections were
conducted in the audit period, of which 169 (72%) cases
met criteria for an appropriate code critical. The most
common indications were non-reassuring CTG (34%) and
fetal scalp lactate >4.9mmol/L (22%). 150 (64%) cases were
performed under general anaesthetic with 73% resulting
in maternal complications. 136 (56%) neonates returned
to the ward and 63 (26%) required admission to neonatal
ICU with majority delivered under general anaesthetics.
Despite these admissions, there was no significant
difference between general and regional anaesthesia when
examining lactate, arterial pH, base excess and Apgars
at 5minutes as markers of neonatal outcome. The overall
decision to delivery time was 19.7 minutes with a difference
of 3 minutes between general anaesthetic (18.3mins) and
regional anaesthetics (21.7mins).
CONCLUSION: This clinical audit confirmed that a decision
to delivery time of less than thirty minutes, a widely accepted
audit standard 1 , is achievable in a tertiary level hospital with
either general or regional anaesthesia. The neonatal outcomes
between each anaesthetic were insignificant; however
maternal morbidity was significantly increased with general
anaesthesia. The implementation of guidelines at 6 months
led to a significant decrease of inappropriate code critical
caesarean sections, likely secondary to increased awareness
of criteria. There was also a decrease in rates of code critical
caesareans performed under general anaesthesia post
presentation of interim results. This decrease in inappropriate
calls potentially reduces inappropriate caesareans and
exposure to general anaesthetics.
REFERENCE:
1. NHS.Caesarean Section Clinical Guidelines.
NHS National Institute for Health and Clinical
Excellence,2004. http://www.nice.org.uk/nicemedia/pdf/
CG013NICEguideline.pdf
AUTHOR AFFILIATION: S. Kapurubandara, T. Tse, A.
Anpalagan, T. McGee; Westmead Hospital, Westemead, New
South Wales, Australia.
SESSION 3 - Free COMMUNICATIONS II /
1440-1450
Can we develop a model to predict Pouch of
Douglas obliteration in women with suspected
endometriosis
Reid S, Lu C, Casikar I, Condous G
OBJECTIVES: The aim was to develop a preliminary
model to predict pouch of Douglas (POD) obliteration in
women with suspected endometriosis who are scheduled for
laparoscopic surgery.
METHODS: Multi-centre prospective observational study
undertaken from January 2009 to November 2011. This study
included women with symptoms of chronic pelvic pain +/-
history of endometriosis, who were planned for laparoscopic
endometriosis surgery. All women underwent a standardized
history and detailed transvaginal ultrasound (TVS), including
assessment of the POD for obliteration using the TVS ‘sliding
sign’, prior to laparoscopy. More than 50 historical, clinical and
TVS end points were recorded for analysis. Variables for the
development of the preliminary model were determined using
stepwise logistic regression analysis.
RESULTS: 100 consecutive women with a history of
chronic pelvic pain underwent TVS and laparoscopy for
suspected endometriosis. POD obliteration was confirmed
in 30/100 (30%) of women at laparoscopy. Two models
for the prediction of POD obliteration at laparoscopy