10^th International Conference on Gynecology and Obstetrics July 03-04, 2023 London, UK

Biography:

Wael Abdelkarim completed his MBBS from Khartoum University in 2015 and MRCOG part 1 in 2016. He is currently, an Obstetrics and Gynaecology trust grade SHO at Barts Heath NHS Trust, United Kingdom.

Abstract:

Background and objectives: Pregnant ladies with MG can have normal pregnancy and delivery, but the course is unpredictable, however, worsening of symptoms occurs more likely during the first trimester and puerperium. Our aim was to follow up pregnant women affected with Myasthenia Gravis (MG) to study the course of the disease, the extent of the disease sequelae and the effect of different treatment modalities on maternal and fetal outcomes.

Methods: We conducted a prospective observational study regarding treatment and follow-up for eighteen pregnant women with myasthenia gravis over a period of 20 years from 1999-2019 at the department of obstetrics and gynecology of a tertiary university medical city, in Saudi Arabia. The course of the disease, during pregnancy, mode of delivery, puerperium has been evaluated in addition to the state of the mother and the baby.

Results: 66% of females had spontaneous vaginal delivery. Three only experienced relapse during pregnancy (16.6%), one patient (5.5%) experienced relapse in the puerperium, no patients had myasthenia crises and six patients (33.3%) developed MG progression. One third of the patients were treated with cholinesterase inhibitors alone and the rest received corticosteroids. Fourteen patients (77.7%) had a thymectomy. Four babies (22.2%) had transient neonatal myasthenia gravis. Thymectomy in those females gave significantly different results, P=0.015.

Conclusion: Myasthenia gravis can be managed well during pregnancy with safe and effective therapies. Caesarian section is recommended only for obstetrical reasons. Forceps and vacuum delivery are sometimes required. Myasthenia gravis during pregnancy can lead to serious life threatening conditions. An interdisciplinary approach is required for managing pregnant women with myasthenia gravis.

Biography:

Grace Cheah is a fourth-year resident in the Singhealth Obstetrics & Gynecology programme in Singapore. She is passionate about obstetrics and gynecology and is looking for innovative ways to improve her acumen in clinical healthcare. Being placed in one of the largest OBGYN clusters in Singapore and the leading training centre in the field of O&G, she has had the opportunity to witness a myriad of clinical cases in both obstetrics and gynecology alike. The above case was written up with the intention of highlighting its rarity, clinical complexity and the management principles, which the authors found to be a noteworthy learning experience with multiple key takeaways.

Abstract:

A 17-year-old patient presented to the emergency department with an acute abdomen and elevated serum beta-human chorionic gonadotropin levels. She underwent a surgical laparoscopy for a suspected ruptured ectopic pregnancy. Intraoperatively, she was noted to have both a ruptured hemorrhagic corpus luteal cyst, as well as products of conception, arising from the same ovary. Histology confirmed an ovarian ectopic pregnancy with a concomitant ruptured corpus luteal cyst [Figure 1]. Her postoperative recovery was uneventful. Both hemorrhagic ovarian cysts, as well as ectopic pregnancies, are frequent causes of acute pelvic pain in women of childbearing age and their similarities in clinical signs and symptoms pose a diagnostic dilemma for any gynecologist. Additionally, ovarian pregnancies are a rare form of ectopic gestation that compounded the challenges in this patient’s diagnosis and management. In any woman presenting with acute abdominal pain, an adnexal mass and ultrasound features of hemoperitoneum, it is important to consider ruptured corpus luteal cysts, as well as ruptured ovarian ectopic pregnancies, as a rare but differential diagnosis.

Ultimately, the mainstay of diagnosis and treatment is a diagnostic laparoscopy, which has shown to be a reliable, safe and feasible management strategy without compromising on patient safety nor ovarian function in the long run.

Biography:

Avin Dehbokri is associated with the Epsom and St Helier University Hospitals NHS Trust in the UK.

Abstract:

This case study details the story of a previously fit and well 31-year-old woman who presented with progressive systemic and central nervous system symptoms. Initial investigations did not reveal any significant abnormalities, but she continued to deteriorate, developing seizures, and requiring ICU admission with intubation and ventilation. After weeks of diagnostic uncertainty and reviews by multiple specialties she was shown to have anti-NMDA encephalitis through antibody testing. She was treated with immunosuppression and recovered back to her normal baseline. As an outpatient she had follow-up investigations which revealed a very small right ovarian teratoma, thought to have been the source of the anti- NDMA antibodies, which were removed by the gynaecology team as a day case without complications. Subsequent histology report confirmed mature cystic teratoma with evidence of glial tissue. The case highlights that commonly used imaging can be unreliable when investigating for a causative ovarian teratoma in cases such as these, and details the further investigations that can be helpful when there is suspicion of a teratoma, such as PET/CT. The case also highlights how patients with this condition can improve significantly with targeted treatment. The condition is rare enough that most audience would likely be interested in about it, and the paper is written and will be presented in chronological order to allow the audience to think through what they may have done at each stepif they had been part of this woman’s medical team.

Biography:

Gilli is an author, trauma therapist and researcher with a particular interest in the reproductive cycle – sexuality, pregnancy, and birth - and how they affect health and wellbeing over a lifetime.Gilli’s first book Meditations & Positive Thoughts for Pregnancy and Birth was published almost 30 years ago, and the suggestions in the book have been adopted widely in ante-natal classes around the world. Her second book Miracle Baby Stories, details personal stories of heartbreak and hope from women going through fertility treatment. Her latest book, Becoming the Sexual Athlete was published 25th June 2023.

Abstract:

There are very good reasons we require clinical trials for all new innovations in healthcare: the drugs and techniques that are introduced have an impact not just today in the operating theatre, or this week in the hospital, but potentially for the lifetime of the patient. When the patient is a newborn baby, this consideration of treatment impact is especially essential. Yet clinical trials often last less than a year, and treatment impact may only surface, 5, 10 or even 30 years later.

Gilli takes a cautionary journey through the development of obstetric clinical practice in the last 120 years. There are many interventions which saved lives and were lauded at the time, but had catastrophic impacts on the babies later in life. Some of these practices were introduced for the benefit of the clinician and not the wellbeing of the infant and so may bear reassessment.

With the focus on live birth statistics to drive practices around infertility and birth it’s useful to remember that these interventions are not only in place to deliver a live birth today, but also a healthy child and adult tomorrow.  Exploring the development of routine birth interventions, revisiting the reasons why drugs are avoided in pregnancy, and discussing concerns in the development of neo-natal care through the 20th Century, this is a talk designed to inspire debate and discussion.This talk will offer thought provoking real world and real life examples, with the intention to remind clinicians of old practices that perhaps should not have been forgotten, discuss normalised practices that are perhaps not the best practices and inspire new thinking and new solutions in this critical field.

Biography:

Henrietta Gellen in a clinical laboratory researcher graduated in 2021. She is a second year PhD student at Pecs University, Faculty of Medicine Doctorate School of Medical Sciences; in addition, she is also involved in education by teaching the Modern Methods in Molecular Genetics course in the MSc program. She’s a member of the National Laboratory on Human Reproduction since 2021. Her research focuses on developing non-invasive molecular diagnostic techniques on embryonic culture media to improve implantation procedures and increase success rates.

Abstract:

Statement of the problem: The number of assisted reproductive techniques is increasing due to rising infertility rates in highly industrialized countries. Advanced maternal age increases the risk of fetal aneuploidy, reducing implantation and successful pregnancy chances. Non-invasive pre-implantation genetic testing for aneuploidy has potential, but its practical implementation in routine IVF centers is yet to begin. Our work group developed a clinically applicable NIPGT strategy using Spent Culture Media (SCM) for testing embryos, based on Next-Generation Sequencing (NGS) technology.

Methodology and theoretical orientation: For our proof-of concept study we sequenced cell-free embryonic DNA from SCM of Day 3 and Day 5 embryos fertilized with Intra Cytoplasmic Sperm Injection (ICSI) and the corresponding blank culture media as a background control. The MALBAC WGA method was used to amplify DNA from the culture media samples and the blank control media as well. Sequencing was performed on Illumina 6000 platform and embryonic chromosomal abnormalities were identified by an optimized bioinformatics pipeline applying a Copy Number Variation (CNV) detecting algorithm.

Findings: Analysis of DNA profiles of embryonic SCM demonstrated that higher gDNA copy number is associated with impaired intrauterine development and indicated miscarriage outcomes. We found some chromosomal abnormalities that occur only in a specific region of chromosome 18, where two important genes are located which are associated with congenital abnormalities and involved in various cellular processes and can be related to Edwards syndrome. In some cases, the chromosomal ploidy aberration was found to be multiple, which can be irreconcilable with healthy embryonic development and embryonic viability.

Conclusion: In the recent presentation we aim to demonstrate the comprehensive workflow covering both wet and dry-lab procedures supporting a clinically applicable strategy for NIPGT-A. The described integrated approach of non-invasive evaluation of embryonic DNA content of the culture media can potentially supplement existing pre-implantation genetic screening methods.

Biography:

Krisztina Futacs, a clinical laboratory researcher, graduated in 2022, works in the Molecular Genetics Laboratory of the University of Pecs, Hungary doing experimental and routine diagnostic work. In recent years, her work has focused on HPV infections and women's health. She has acquired a wide theoretical and practical knowledge of molecular diagnostic techniques, which is an important part of her lecturing activities. In her research work, she has also investigated miRNA targets in HPV+ cervical carcinoma FFPE tissues that can be correlated with EZH2 activity and therefore tumor progression.

Abstract:

Statement of the problem: Cervical cancer is one of the most common diseases affecting women Worldwide. In Hungary, the lethality is two to three times the European average. The aim of our studies was to determine the genotype of HPV infections using molecular genetic methods in the South-Transdanubian female population, who were diagnosed with HPV infection in our laboratory.

Methodology & theoretical orientation: Our study was performed at the Department of Laboratory Medicine of the University of Pecs, Hungary. During the study period 6389 HPV genotypes were identified using Linear® Array genotyping assay and AnyplexTM II HPV28 Detection real-time PCR [Figure 1]. Our statistical analysis was performed using SPSS version 20 and RStudio Version 1.4.1103.
 

Findings: The under-40 age group accounts for more than 50% of all cases. Most of the genotypes isolated are from the high-risk HPV group. The most predominant genotypes are HPV16 (12.6%), HPV42 (7.6%), HPV53 (6.4%), HPV31 (5.7%), HPV51 (5%). When genotypes are examined on a per-individual basis, it can be observed that in each study year some genotypes disappear while others appear in samples from the same individual. Our study underlines hypothesis generation of whether these genotype changes are in fact the evolutionary vanishing out of a genotype replaced by another or a genotype switch of the virus.

Conclusion: The HPV genotypes mostly from high-risk HPV group and most of them are multiple infections. The highest risk is within the younger populations the most prevalent HPV genotype is HPV16, which can be isolated in large numbers every year, but the percentage of it decreasing yearly, probably because of the ascendant vaccination. As a result of effective genotype screening in the region since 2014, the number of cervical carcinoma cases has now been significantly reduced.

Biography:

AI-powered applications have the potential to vastly improve medical care. The path to this revolution is still rather long and still has some obstacles. However, one of the areas of medicine that sees more and more progress with respect to application of AI is IVF. This follows as the IVF process offers unique, controllable and reputable conditions. These opportunities are further strengthened by the fact that over 10% of the human population will encounter reproduction problems, thus In Vitro Fertilization is becoming one of the fastest growing areas of healthcare. In this talk, I will present deep learning tools that support doctors in IVF treatment.

First, I will talk about how to automate ovarian ultrasound monitoring with deep learning computer vision algorithms. The calculating and measuring of follicles is of major importance for IVF, e.g., it helps estimate the ovarian reserve as well as the timing of the whole process.

Second, I will talk about an analytical and predictive system aiming for fully automated identification of the highest quality embryos based on a large collection of time-lapse images of human embryos.  Both AI-driven tools are designed for fertility clinics, diagnostic centers and hospitals and will respond to their well-identified needs. In this talk, I will describe the process of building these solutions and show the most important issues of applying deep learning in a medical context. Finally, I will talk about deployment of these tools in fertility clinics in Poland and worldwide.

Abstract:

Co-Founder and co-CEO at MIM Fertility, Polish best-in-class deeptech company specializing in AI solutions for IVF. Manager with over 15 years of experience in business and public sector. Economist, a graduate of the Warsaw School of Economics and University College Dublin. A scholarship holder of the Robert Bosch Foundation and the Irish Government. Winner of Businesswoman of the Year Award 2022. Awarded with Excellence in AI - Entrepreneur 2022. Under her leadership, MIM Fertility continues to deliver bespoke and innovative AI solutions crafted to different patients’ needs, and by collaborating closely with IVF clinics to standardize, optimize and automate clinical workflows.