The autumn meeting of the Society took place on Saturday 15th October 2011 at the Potters Leisure Resort. The meeting was thoroughly enjoyed by all who attended, thanks to Medhat Hassanaien and his colleagues who put a brilliant scientific meeting which was well planned and organised. The venue and content were excellent and even the weather was brilliant. At the meeting, the society presidency transition took place and David Horwell handed over the presidential chain of office to EAOGS new president Miss Jane Preston. We are grateful to David for his good leadership and hard work during which much has been achieved in raising the society’s profile.
The president, Mr David Horwell, chaired the meeting and welcomed the members to the meeting
Andrew Leather, Edward Morris, Sarah Reynolds, Andrew Prentice, Gerry Hacket, David Rees, Elizabeth Devonald, John Latimer, Peter Brinsden, Simon Crocker, Gareth Thomas, Stafford Patient, Robin Crawford, Katharine Stanley, Owen Owens, Malcolm Griffiths, Susie Elneil, Gordon Smith, Mahmood Shafi, Geoff Budden, Robin Venn, Frances de Boer, Alison Wilson, John Chalmers, Thomas Mathews, Christopher Lees, Mark Slack and Martin Lamb.
3. Minutes of previous meeting:
The minutes of the spring meeting with BMOGS held in May 2011 were accepted as a true record.
4. Matters arising: Election for the post of president
David Horwell has completed his 3-years term of office as president. There was only one application for the post from Dr Jane Preston, consultant obstetrician & Gynaecologist , James Paget Hospital. Jane was duly elected and the meeting wishes her a successful presidency.
5. Secretary’s Report – Hamed Al-Taher
On behalf of the society, Hamed thanked David for his relentless efforts to improve communication with membership and raising the society’s profile. The membership is now about 230 and to maintain and increase this number we have all to encourage new consultants as well as trainees to join the Society. Membership and bursary application forms are available at the website www.eaogs.org.uk . Members are encouraged to send any suggestions to the President or secretary with regards to the website or any other issues related to the society. The secretary announced that he has completed his term of office and interested members are invited to contact him for further information.
6. Treasurer’s Report
The treasurer, Chris Goodfellow, was unable to attend the meeting but sent the summary of the society’s accounts. The society’s bank account was noted to be in a very healthy condition and at the end of the financial year 2010/11 the total balance is £9,527.35.
7. Bursary applications
There was one application from Melinda Bird, specialist midwife James Paget’s hospital but no applications for the trainees’ bursary
8. Future Meetings:
a. Spring meeting – 2012: Norwich
b. Future meetings – Nothing has been agreed yet; members were encouraged to consider hosting future meetings.
9. Any other business: Installation of new President
David Horwell handed over the Presidential chain of office to the society’s new president Miss Jane Preston. Jane gave a brief talk on developing the society further and in particular the website.
Welcome by Mr John Hemming, Chairman, James Paget University Hospital
Mr Hemming welcomed the members to Great Yarmouth. He described some of the specific problems that James Paget hospital faces including, summer peaks, obesity, teen age pregnancies and older population.
First Morning Session:
Chair Mr Roger Giles, Consultant O&G, West Suffolk Hospital
“Pelvic Organ Prolapse: To mesh or not to mesh”
Elizabeth Adams, Consultant Urogynaecologist, Liverpool Women’s Hospital
Asymptomatic prolapse requires no treatment and conservative management should be tried first before surgery. Different vaginal and abdominal surgical procedures, with and without mesh, were discussed. In view of the high failure rate of conventional prolapse surgery, mesh was introduced and different mesh kits were developed. Liz described how the total vaginal mesh kit “TVM” developed in 2000 in France to provide instrumentation that will help achieve complete anatomic repair of pelvic floor defects in a standardized way. Complications include bladder perforation 1.6%, rectal perforation 1.1%, vascular injury 0.7%, buttock pain 5.2%, erosion 10%, USI 4.8% and dyspareunia 4.5%. Recurrence rate with mesh compared to fascial repair was 13.8% and 30% for anterior and 13% and 6.5% for post repairs. Liz described the Liverpool experience 2006-2010 of 28 cases, where the functional results were less satisfying with subjective rates of recurrent organ prolapse & incontinence of 28% & 36% respectively and the mesh erosion rates are low at 7% .
“Induction of Labour for Intrauterine Death”
Hilary Turnbull, ST3 O&G, Norfolk & Norwich University Hospital, Norwich
IUD represents about 5.2 per 1000 births UK and a previous NNUH audit 2004 revealed variable practice using Prostin, gemeprost or mife/miso with poor documentation & planning. The audit standards were drawn from FIGO recommendation 2007 and included in a care bundle using mife 200mg followed by misoprostol after 27 weeks 50 mcg 4hourly (increase to 100mcg if no contractions to maximum of 600mcg/24 hrs). Oxytocin can be given 4 hours after misoprostol. The introduction of the care bundle resulted safer practice and improvement in planning.
Second Morning Session:
“Female Genital Mutilation”
Georgina Sosa, Governance Midwife, FMG Specialist Midwife, James Paget Hospital, Gt Yarmouth
Gina explained the definitions of FGM (partial or total removal of the external female genitalia) and classification (type I-IV according to severity). FMG is practiced in 26 African countries and in the UK, is often seen among immigrants from Somalia, Eritrea, Mali, Sudan and Ethiopia. The 1985 Prohibition of Female Circumcision Act made it an offence to carry out, aid, abet, or procure any form of female genital mutilation in the United Kingdom. The 2003She described short, long term complications and the difficulties encountered during pregnancy and labour. the protocols required to care for women with FGM and the procedure of de-infibulation.
“The Right Procedure for SUI”
Ash Monga, Princess Anne University Hospital, Southampton
The aim of surgery in the treatment of SUI is to restore anatomy and function, with no deleterious effects, good long term success rates with low complication rates and more important a beneficial effect on quality of life. Urethral bulking with Macroplastique gives 30% cure rates at 2 years 68% improvement. Colposuspension and sling operations were discussed although for the last 10 years, mid urethral tapes have become the standard procedures. Randomised studies of TVT versus colposuspension revealed similar Subjective success rates – 89% and 85% as well as Objective success rates – 68 and 66% with much lower morbidity. Several studies compared TVT and TVT-O with similar success rates but more bladder injury in the TVT and more thigh/hip pain in the TVT-O group. Single incision tapes however have less success rates.
“The Long and Winding Road, The journey towards becoming Obstetrician/Gynaecologist”
Dr Eibhe Whelan, SHO, James Paget University Hospital, Gt Yarmouth
Eibhe described why and how she joined the O&G training programme She described her Obstetrics experience during the elective period in Vanuatu. She put O&G as her 1st choice in the FY rotation programme and this helped her to decide whether she wanted to apply for the ST posts, and if so to use this time to take advantage of opportunities to improve her CV. She was concerned about RCOG survey that showed 82% of trainees to believe that the EWTD had reduced training opportunities with an increased focus upon service delivery, discontinuity in patient care and training, a move towards working more unsocial hours (including filling rota gaps. Despite this, Eibhe believes that her initial instincts were right and that she had fantastic experiences along the way so far and she is hoping her ST application to be successful to join the specialty.
“Getting alife – You, Work and the college”
Mr Ric Warren, RCOG Hon. Secretary 2004-2011
Ric, having stepped down recently from the post of RCOG Hon. secretary, described how much college work can have significant impact on personal life. As the college secretary 2004-11, he has done an excellent job and contributed to several college initiatives and reports. He explained some of the current College issues highlighting that the RCOG is primarily a charity to improve women health not necessary the membership. The RCOG had significant influence on the Health bill discussion and continue to address the manpower problem resulted from overtraining and increase feminisation and possible bulge of retirement. For work/life balance Ric eluded to the recent RCOG working party report and recommended the website www.isma.org.uk which include the “top ten stress-busting tips”
First Afternoon Session:
Chair Mr Andy Pozyczka, Consultant O&G, James Paget Hospital
“Investigating Women with Postmenopausal Vaginal Bleeding”
N Burbos, Subspecialty Fellow in Gynaecological Oncology, Norfolk & Norwich University Hospital, Norwich
5% of gynaecological appointments are related to PMB half of these are due to atrophic changes. Diagnosis depends mainly on transvaginal ultraound, endometrial biopsy and hysteroscopy. The specificity of endometrial thickness of 4mm and 5mm in diagnosing cancer is 53% and 61% respectively while both have sensetivity of 96%. Pipelle biopsy detection rate is 99. 6% with a probability of endometrial cancer after a negative biopsy is 0.9 % . Further improvements of PMB diagnostic strategies can be achieved by individualise the probability of cancer, streamline referral pathway, computerising the predictive models and incorporation of serum biomarkers
“Training in Obstetrics and Gynaecology in the Eastern Region”
Jane MacDougall, Head of Postgraduate School of Obstetrics & Gynaecology, East of England Deanery
Jane explained the current system of run through training programme based on national recruitment and regional appointments. The system relies on robust annual assessment to allow progression. The Postgraduate school (responsible to both RCOG and Deanery) has a board (chaired by Head of School) and Specialist Training Committee (chaired by Training Programme Director). The current issues facing the Eastern region include, managing trainees with difficulty, undermining trainees, work place assessments, training educational supervisors and manpower issues to reduce number of trainees. Undermining in particular is of great concern as O&G in the eastern region is reported to be the worst. Several options were discussed on how to tackle this issue.
“The Future of O&G Education”
Wendy Reid, Vice President, Education, RCOG
Miss Reid addressed 3 areas in her talk; National policy on education and workforce, Strategic direction and developments, Curriculum – design, content and deliverability, Support of trainees and training the trainers. She discussed what is good about the Health Bill’s proposals? With regards to workforce issues, the RCOG is concerned about quality, training numbers expansion over past decade, future role of the consultant, new ways of working. The challenges are; Feminisation of workforce, Increased part time working in training and at consultant level, Generalists vs specialists, Care moving from hospital base to community, Work patterns changing – EWTR, consultants 24/7 and Autonomy for some hospitals (Foundation), may not follow national/regional workforce plans. Wendy then discussed Faculty development to improve quality of trainers.
Second Afternoon Session:
“Experiences in a new midwife-led birthing unit (MLBU)”
Helen Smith, Lead midwife, The Dolphin Suite, James Paget hospital, Gt Yarmouth
The place of birth and supporting women’s choices has been a common theme through successive government policies since Changing Childbirth in 1993. The aim of MLBU is to provide additional choice of place for birth in line with current policy, to promote normality and reduce medical interventions, ensure best use of professional skills and resources and increase satisfaction rates for women and families. Helen described the development of the Dolphin Suite re- configuring existing space within the Delivery Suite: to include 3 birth rooms, small kitchen, midwives station and new store room to be shared with Delivery Suite. There are no beds to encourage women to move around and using mats and beanbags on the floor to get into positions to promote active birth. The Dolphin suite has air conditioning and there will be a chair bed in each room. Women are “booked” for birth on Dolphin thru use of a proforma: for most women this is completed at the visit by the community midwife to discuss birth plans; currently there are around 50 proformas received/ month. The No. of Deliveries 21-34/month, transfer rate 17-30%, and water births 38-70% with 1:1 care in all cases.
“Operative Vaginal delivery OVD Reaudit and Patient Satisfaction Questionnaire”
R Padmagirison, Southend University Hospital, Southend
The incidence of OVD is 10-15% and there has been recently increasing awareness of short term and long term morbidity on pelvic floor following OVD. Rates of second-stage caesarean section are increasing, while rates of successful instrumental delivery are decreasing. A reduction in training hours, lack of senior supervision and fear of litigation have made it difficult to achieve the level of experience required for proficiency. A prospective reaudit of OVD over 2 months and the audit Standards derived from RCOG Guideline revised in Jan 2011. The Re-audit has shown significant improvements in documentation of Procedure details, Verbal consent and Bladder care and debriefing after procedure. Maternal complication rates were slightly higher, however this may be an isolated event. Results from the patient satisfaction questionnaire were excellent in terms of service delivery. Audit has identified the need for Perineal clinic post delivery to follow up patients who have undergone difficult instrumental delivery or complications.
“Colpocleisis-Is it a good choice..!”
Omaema Al-Baghdadi, Mr Harnek Rai. Peterborough Hospital
Colpocleisis entails closure of the vagina, which is suitable for frail women who do not want to retain sexual function. For some decades colpectomy and colpocleisis have been considered obsolete and considered associated with a high incidence of de novo stress urinary incontinence. However, in recent years these operations have been re-evaluated and are again being performed by gynaecological surgeons. Colpocleisis was found to be effective in resolving prolapse and pelvic symptoms and was associated with high patient satisfaction. There are two basic approaches to the repair of vaginal vault prolapse: obliterative and reconstructive. Although reconstructive approaches recreate a functional vagina, obliterative procedures reach nearly 100% success rates in curing prolapse.
Colpocleisis is a safe and effective procedure that can be considered for those women who do not wish to retain sexual function. It has a short operating time, Rapid recovery with very little downtime Can be coupled with sling (incontinence) procedures low incidence of complications. As the population ages, This procedure stands to become an increasingly popular treatment option.
Close of the Meeting
The President drew the meeting to a close by thanking the speakers and members.
Special thanks were also given to the Pharmaceutical companies for their generous contributions in providing sponsorship for the scientific meeting.
To conclude the day, the Society Dinner was held at the resort Restaurant