S204 Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260

the hospitals. Sexual and reproductive rights approaches were

emphasized and health administrators were introduced to an

abridged ALARM course. On the demand side, 40% of facility

deliveries were referred by community health workers and 85

community groups were mobilized to save money for health

emergencies. End of project evaluation, showed that over 300

pregnant women, over 9,000 men, women, and children had been

supported to meet health care costs.

Conclusion: This project demonstrates the pivotal role of

professional organizations in the implementation of low-cost

interventions to reduce maternal mortality and a model of

supervision that has contributed towards “up-skilling” of clinicians

in preventing and managing obstetric complications. Community

based savings schemes can support funding for emergencies.

I173

PRIMARY OVARIAN FAILURE

S. Kalantaridou. Obstetrics and Gynecology, University of Ioannina

Medical School, Ioannina, Greece

Organized by: Hellenic Society of PAG

Primary ovarian failure (POF) is a condition characterized by sex-

steroid deficiency, amenorrhea, and infertility in women younger

than 40 years. POF once was considered irreversible and was

described as “premature menopause”. POF is not an early natural

menopause and may present as primary or secondary amenorrhea.

Normal menopause results from ovarian follicle depletion, whereas

POF may occur as a result of either ovarian follicle dysfunction or

ovarian follicle depletion. The term “primary ovarian insufficiency”

may be a more accurate term to describe this condition. Women

with POF produce estrogen intermittently and may ovulate despite

the presence of high gonadotropin concentrations (intermittent

ovarian function). Pregnancies may occur in 5–10% of women after

the diagnosis of POF. There are no proven therapies to improve

ovarian function and increase fertility rates in these young women.

Women with POF sustain sex steroid deficiency for more years than

do naturally menopausal women. This deficiency can result in a

significantly higher risk for osteoporosis and cardiovascular disease.

Postmenopausal women who take hormone therapy prolong their

exposure to estrogen beyond the average age of completion of

their reproductive phase. In contrast, women with POF need

exogenous sex steroids to compensate for the decreased production

by their ovaries. The goal of therapy in young women with POF is

to provide a hormone replacement regimen that maintains sex

steroid status as effectively as the normal, functioning ovary. Thus,

premenopausal hormone therapy is required at least until these

women reach the age of “natural menopause.”

I174

FEMALE GENITAL MUTILATION/CUTTING IN THE GAMBIA:

RESEARCH FOR KNOWLEDGE TRANSFER

A. Kaplan1,2,3, I. Bonhoure2, S. Hechavarrıa4,5,6, M. Martın7, M. Uzet7,

M.R. Pous2,8. 1Catedra de Transferencia del Conocimiento/Parc de

Recerca UAB-Santander, Departamento de Antropologıa Social y

Cultural, Universitat Autonoma de Barcelona, Barcelona, Spain;2Grupo Interdisciplinar para la Prevencion y el Estudio de las Practicas

Tradicionales Perjudiciales (GIPE/PTP), Departamento de Antropologıa

Social y Cultural, Facultad de Letras y Psicologıa, Universitat

Autonoma de Barcelona, Barcelona, Spain; 3NGO Wassu Gambia

Kafo, Fajara F Section, Banjul, The Gambia; 4Cuban Medical Mission

in The Gambia, Banjul, The Gambia; 5Community Based Medical

Program, Ministry of Health and Social Welfare, Banjul, The Gambia;6Facultad de Ciencias Medicas Manuel Fajardo. Universidad Medica

de la Habana, La Habana, Cuba; 7Grups de Recerca d’America i Africa

Llatines (GRAAL), Unitat de Bioestadistıca. Facultat de Medicina,

Universitat Autonoma de Barcelona, Barcelona, Spain; 8Gynaecologist,

Institut Catala de la Salut, Barcelona, Spain

Objectives: In The Gambia, the prevalence of “Female Genital Mu-

tilation/Cutting” (FGM/C) is 78.3% (MICS 2006). The study consists

of two clinical surveys done in The Gambia in order to identify the

types practiced, the related health consequences of each type and

the problems associated during delivery with FGM/C.

Materials and Methods: For the first survey, nationwide, data

was collected from 871 female patients who consulted for any

problem requiring a medical gynaecologic examination and who

had undergone FGM/C. For the second clinical survey, data was

collected on 588 women who consulted for antenatal care or

delivery and that had undergone or not, FGM/C.

Results: The results show that FGM/C is still practiced in the six

regions of The Gambia, the most common form being type I (66.2%),

followed by type II (26.3%). All forms, including type I, produce sig-

nificantly high percentages of complications, especially infections.

The analysis of the consequences of FGM/C during delivery and

foetal suffering revealed a strong correlation between these factors

and that women with FGM/C are four times more likely to suffer

complications during delivery.

Conclusions: These results allowed the implementation of a

national training work plan for the health professionals and

students regarding the issue of FGM/C, directly based on knowledge

transfer as the training contents include the observed health

consequences in The Gambia. The results of the studies became

a powerful tool in order to do advocacy at other decision-making

levels, such as religious and political.

I175

ETHICS AND TRENDS IN PRENATAL DIAGNOSIS

S. Karchmer

The financial setting of most of Latin American countries is not

the most propitious; poverty and extreme poverty continue raising

as the purchasing power of the income goes down, not only as

absolute figures, but as it comes to the inflation. Therefore, the

repercussions for health and education are bigger every time.

On the other hand, the coverage of the reproductive event in Latin

American countries is generally difficult to determine, especially

about the evaluation of prenatal care quality. In most of Latin

American counties the gynecological and obstetric services lack the

appropriate resources to follow the guidelines and proceedings,

and there is an inexistent educational background for the patient’s

health. There are three reasons, which warrant the need of an

ethical consensus for prenatal diagnosis in the clinical practice.

First, the former guidelines need to be applied to the current issues

of moral decision-making. Most of the current problems of prenatal

diagnosis demand the ability to advise, and ethical sensitivity,

which outstand the demands of the daily clinical practice.

Second, even when the physicians of several counties agree about

some basic principles and practical approaches to moral issues,

their point of view becomes an “oral tradition,” instead of regulation

principles. Nevertheless, not establishing a consensus through writ-

ten guidelines reduces the relevance of a more important need.

Third, the future of the prenatal diagnosis and medical genetics is

going to be more ethically complex then ever. Physicians must a

wait for a trouble storm that will demand the participation of the

society and the establishment of public policies.

The ethical evolution of prenatal diagnosis then would go through

an early stage of oral tradition towards a more definitive in which

there will emerge guidelines with the greatest professional and

social support. It is not ethical for anyone to exert pressure in order

to influence on the couple to accept a determined choice.

I176

LESSONS LEARNED FROM NEPAL’S EXPERIENCE IN

ESTABLISHING SECOND-TRIMESTER ABORTION SERVICES

C. Karki. Institutional Development Committee, Nepal Society of

Obstetrics and Gynecology (NESOG), Nepal

This presentation will discuss Nepal’s expansion of comprehensive

abortion services to include abortions in the second trimester.