|The 4th Asia Pacific Congress on Controversies in Obstetrics Gynecology and Infertility (COGI®):|
Building Consensus in Gynecology, Infertility and Perinatology (BCGIP)
in collaboration with The Royal Thai College of Obstetricians and Gynaecologists
Shangri-La Hotel, Bangkok, Thailand, November 24-27, 2011
|Preliminary Scientific Program|
|FIGO EDUCATIONAL SEMINAR|
NEW CHALLENGES IN MATERNAL HEALTH
Thursday, November 24, 2011
Capacity Building in Education and Training Committee (FIGO) The Royal Thai College of Obstetricians and Gynecologists World Diabetes Foundation (WDF) International Association of Diabetic Pregnancy Study Groups (IADPSG)
Luis Cabero Roura (CBETC – FIGO), Anil Kapur (WDF) and Moshe Hod (IADPSG)
09:00 -11:00 SESSION 1
PREGNANCY: MATERNAL MORBIDITY AND MORTALITY • FIGO a professional non-profit NGO • Maternal mortality in the world. Some good news • Anemia during pregnancy. A controlled risk of maternal mortality • Postpartum hemorrhage: Beyond brace sutures and blood • Obstetric fistulas. A hidden problem. The FIGO Project • Unsafe abortion. Health impact
11:00 -11:30 Coffee Break
FIGO - WDF WORKSHOP ON MATERNAL AND CHILD HEALTH AND NON COMMUNICABLE DISEASE (NCDS) • Relevance of maternal health to the NCD epidemic – The concept of early origins of health and foetal programming • Global burden of diabetes and related NCDs with particular relevance to women’s • Risk factors for maternal and perinatal morbidity and mortality and how they link • Gestational and pre gestational diabetes, diagnosis, management and prevention • Is screening and integrated care for GDM cost effective? • Developing an integrated program for MCH and NCDs in the developing world - HOT TOPICS IN WOMEN'S HEALTH IN THE ASIAN PACIFIC REGION • Type 1 and type 2 diabetes in young women - Worldwide challenges in developed • Diabetes and pregnancy and the drug dilemma – Insulin analogues • Diabetes and pregnancy and the drug dilemma – Oral hypoglycemic agents • HPV and cervical cancer prevention in low income countries • New challenges of hormonal contraception • Female genital mutilation ■ CURRENT TREATMENT OPTIONS FOR UTERINE FIBROIDS Capsule: Symptomatic uterine fibroids are still very common. How can we individualize treatment? • The multidisciplinary approach for the treatment of uterine fibroids. How do we select the patients for the proper procedure? Uterine artery embolization Pharmacological treatments • Should laparoscopic myomectomy be done for all sizes of fibroids? ■ BREAST CANCER AND HT – TRUE OR FALSE ACCUSATIONS? Organized and endorsed by IMS, EAMS and APMF Capsule: Beast cancer and HT: Fact or myth? • Estrogen therapy: Promotor or protector? • Epidemiology of breast cancer and risk factors in Asia. Postmenopausal HT and breast cancer – facts and misperceptions • HT use and breast cancer incidence since WHI. • Mammography screening: Better prognosis vs. over diagnosis ■ SPOTLIGHT ON MENOPAUSE - RELATED ISSUES Organized and endorsed by IMS, EAMS and APMF Capsule: No consensus exists concerning the first-line therapy and prevention of postmenopausal • Calcium supplementation for bone health: The upside and downside • Traditional medicines for menopausal symptoms: Is it effective? • The impact of lifestyle and nutrition on health • Overview on postmenopausal hormone use and CAD • Patient doctor interaction in Asia: The role of tradition, culture and religion ■ HOW TO CONSULT AND TREAT MENOPAUSAL WOMEN: FOLLOWING GUIDELINES WITH AN IND IVIDUAL APPROACH Panel discussion with delegate participation from national societies: • Clinical guidelines for physicians: Western and Asian perspectives • How to consult women on menopause issues in Asia ■ POSTMENOPAUSAL HORMONE THERAPY: THE PROGESTINS DILEMMA Capsule: It might be possible that the progesterone is responsible to the unexpected deleterious effect of HT, therefore choosing the progesterone is a key point in treatment • Medroxy progesterone acetate: The bad guy • The progestin connection to breast cancer • Different progestins and route of administration • Consensus on the route by which progestin is to be given, as well as the need for progestin and the most appropriate progestin regimen Capsule: The new technology using robotic surgery is slowly penetrating our practice. Is it justified? Are doctors being replaced by robots? Debate Robotic surgery for the treatment of uterine fibroids Robotic surgery vs. Simple laparoscopy • Cost of robotic surgery: Should this be considered as an issue? • Gynecology malignancy and robotic surgery: Is this improving prognosis?
■ WHAT IS NEW IN CONTRACEPTION? Organized and endorsed by APCOC Capsule: What more should we expect in this field? • The new estrogens and progestogens: Are they better? • The non-oral methods (implant, vaginal ring, transdermal, intrauterine system or device): Can they be better than OC for certain women? • The non-contraceptive benefits of medicated IUD: Where is the evidence? ■ CONTRACEPTION PILL: SHOULD IT BE AN OVER-THE-COUNTER DRUG? Organized and endorsed by APCOC Capsule: The currently-available combined low-dose contraceptive pill can be safely dispensed over the counter Debate Should the oral pill be prescribed over the counter? ■ WHAT ARE THE BURNING ISSUES RELATED TO THE USE OF CONTRACEPTION TODAY? Organized and endorsed by APCOC Capsule: Controversial issues arising from clinical practice Panel discussion on the following medical conditions: • How to select out “at risk women” from VTE? Is the choice of progestogens important? • Need for the thrombophilia screen? How useful is this? • Risk of breast cancer: Asian vs. Caucasian women • Use of low-dose in early stage survivors? • Protective effects of OC against ovarian/uterine cancer a good reason to continue to age 50 • How to deal with irregular/unacceptable bleeding in women using contraception – remove, treat & continue, investigate? • Can hormonal methods be used in women with mild/moderate hypertension or diabetes • Need to stop OC each month or is it safe to continue to avoid withdrawal bleeding? • What are the cultural barriers to use in countries in Asia-Pacific? • Differences in choice of methods between rural and urban communities – Why? ■ MAKING ABORTION SAFER, IS THIS FEASIBLE? Organized and endorsed by the WHRRFT Capsule: "Women are dying not because of diseases we cannot treat, they are dying because societies have yet to make the decision that their lives are worth saving" MF Fathalla, FIGO Past President • Making first trimester abortions safer • Cultural barriers to safe abortion: Where do doctors stand today? ■ ENDOMETRIOMA: THE DEBATE AROUND TREATMENT • Set the scene: The mysterious disease • Which surgical treatment should be given? • How does endometrioma affect fertility? • Should it be aspirated during the procedure? ■ RECURRENT ABORTION AND ENDOSCOPIC SURGERY • Uterine septum, when to remove • Hydrosalpinx - Aspirate, block the tube or remove? • Intrauterine fibroid, to remove or not and if so, when? • Mechanical endomeritomal irritation: Should it be done before or after failed infertility
■ NOVEL APPROACH TO PRENATAL GENETIC DIAGNOSIS
• Non-invasive prenatal diagnosis: Analysis of cell free fetal nucleic acids - Translating research into clinical practice • Non-invasive prenatal screening: Maternal cell-free DNA markers • Non-invasive prenatal screening for aneuploidy: The role of maternal biochemical markers • Non-invasive prenatal screening: The role of sonography • Prenatal CGH array – What are the indications for fetal testing • The Asian Pacific experience - Application of array comparative genomic hybridization in prenatal screening: Prospective experience from 3,187 cases
■ NOVEL APPROACH TO PRENATAL GENETIC DIAGNOSIS: CONTROVERSIES TO Debate Should invasive testing be offered to all? Yes: We should offer testing to everybody No: Chasing for Downs Syndrome does not decrease mental handicap it only leads to loss Debate CVS or amniocentesis – What is better? Debate Array CGH- Is the future already here? Array CGH - Should it replace conventional karyotyping and other technologies? Array CGH vs. Targeted BACs on beads Towards a consensus: Are we close to the ideal test? ■ NOVEL APPROACH TO THROMBOPHILIA AND PREGNANCY COMPLICATIONS Debate Setting the scene: When should evaluation for thrombophilia start? After 2 or 3 abortions, pre or post embryonic, late abortions, primary vs. secondary aborter
Debate Thrombophilia and early pregnancy complications (recurrent pregnancy loss):
To treat or not to treat?
Debate Thrombophilia and late pregnancy complications (PE, IUGR, placental abruption,
fetal loss): To treat or not to treat?
■ THE FIRST TRIMESTER: A WINDOW OF OPPORTUNITIES: SCREENING FOR ADVERSE PERINATAL OUTCOME? - ALL YOU CAN GET IN 10 MINUTES Should all women be screened and with which test? • Do we need 3D in the first trimester? • Aneuploidy markers to all • Can all screening be integrated into one test? • The ideal test: Which, when and to whom? • Are we close to the ideal test?
■ NOVEL APPROACH TO MULTIPLE PREGNANCIES: STATE OF THE ART LECTURES • MC twins: Should termination be offered? • Reduction from twins to singleton (MC and DC)? • How to reduce an anomalous fetus in a MC pregnancy?
• How and when to deliver MC and BC twins?
■ ADVANCES IN INFECTIOUS DISEASES DURING PREGNANCY - STATE OF THE ART • Preventing perinatal HIV transmission in the developing world • Is amniotic fluid analysis of value in the diagnosis of intrauterine infection? • Planning pregnancy: Is serologic screening necessary? Debate CMV infection in pregnancy: What's better for fetal evaluation? • Towards a consensus: Can all screening be integrated into one test? • The ideal test: Which, when and to whom? • Are we close to the ideal test? ■ NOVEL APPROACH TO GESTATIONAL DIABETES MELLITUS (GDM) • State of the art lecture: The consensus – Diagnosis and classification of GDM in pregnancy Is gestational diabetes over diagnosed and over treated? Debate GDM Treatment: Oral hypoglycemic agents - Can oral hypoglycemic agents be used ■ NOVEL APPROACH TO PRE-GESTATIONAL DIABETES MELLITUS (PRE-GDM) • State of the art lecture: The use of insulin analogues in diabetic pregnancy • State of the art lecture: The use of new technologies in diabetic pregnancy Debate Should we deliver all diabetic patients by CS? - Is there an estimated fetal weight cut off? Yes: Should we operate in all? No: Should we induce labor in all? ■ DIAGNOSIS OF FETAL CONGENITAL ANOMALIES Debate Are congenital anomalies preventable biochemically? Debate Routine fetal anomaly screening in the first, second and third trimesters of all pregnancies? Three anomaly scans are the ideal way to examine the fetus Debate Diagnosis of congenital anomalies: What is better MRI or sonography? ■ NATURAL PROGESTERONE: CONSENSUS ON PROGESTERONE UTILIZATION IN • The controversies on the route of administration: What are the real differences and the Medically assisted pregnancy, in order to avoid: • Miscarriage and preterm labor • Recurrent abortion: Does progesterone play a key role? • Preterm birth prevention: When to start and how long to give progesterone? (European ■ HOT TOPICS IN MATERNAL FETAL MEDICINE: THROMBOEMBOLISM & GROWTH • Peripartum management of a patient with severe thrombophilia (APLA), when medication should be stopped/ restarted? • The approach to pulmonary embolism in pregnancy – Diagnosis and management • The definition and diagnosis of FGR (population curves, customized curves, what cut-off • The genetic basis for normal and abnormal intrauterine growth (when karyotype should be evaluated? Confined placental musacism, epigenesis, fetal programming) • FGR remote from term/near term-delivery vs. expectant management Debate The role of umbilical blood banking - Public-private partnership in cord blood banking ■ OBESITY AND PREGNANCY - TIME FOR RECONSIDERATION? • Should obese patients aim to lose weight during pregnancy? If so, how much? • Is there a difference in pregnancy outcome for different classes of obesity? • Metabolic syndrome during pregnancy - An entity? ■ HYPERTENSIVE DISORDERS IN PREGNANCY Update: Management of pregnancy induced hypertension/preeclampsia – • Severe preeclampsia/HELLP remote from term - Delivery vs. expectant management • PIH/mild PET near term, to induce labor or not? • When Mg sulfate should be used? Impending eclampsia, severe PE, mild PE, PIH, peripartum, Debate Prediction and prevention of preeclampsia Yes: Prediction and prevention is possible No: Preeclampsia is unpredictable
REPRODUCTIVE MEDICINE AND ART
■ FERTILITY INVESTIGATION
Capsule: Can we define to what extent we need to do a surgical procedure to reach a diagnosis? • Is there a role for videolaparoscopy? Prevalence of abnormal peritoneal factors Debate Sonohysterography vs. Office hysteroscopy: What is the debate? • Is laparoscopy out-dated? ■ FERTILITY INVESTIGATION AND TREATMENT Capsule: Is traditional semen analysis relevant in the era of IVF/ICSI? • Semen analysis: what should be tested? • Should varicocelectomy be done in the era of IVF/ICSI? • What are the optimal conditions for performing IUI? • Who may benefit from IMSI? Is the likelihood of a healthy live birth really increased? • No improvement of pregnancy rate! ■ POLYCYSTIC OVARY SYNDROME (PCOS) Capsule: PCOS is a risk factor for insulin resistance: Are all PCOS patients at risk? • The Rotterdam Consensus PCOS criteria: Do they represent a basic screening level or the specialist's differentiating expertise of female androgenization? Debate Metformin improves ovarian response to stimulation and should be used in all PCOS patients • First line therapy for ovulation induction in PCOS - Should it be clomiphene citrate or gonadotropins? • PCOS management: "Adolescent to perimenopause" ■ PROGESTERONE LEVELS DURING CONTROLLED OVARIAN HYPERSTIMULATION
Capsule: How do we deal with increased progesterone levels during the follicular phase of COH?
Debate Increased follicular phase progesterone levels have no deleterious effects Does LH activity affect progesterone levels during the luteal phase Progesterone for luteal support and early pregnancy • Luteal support: What should we give and for how long? Capsule: PCOS patients are still at a greater risk for OHSS and multiple gestations. What should be the optimal approach for such patients? • Should ovarian drilling be performed first? A simple transvaginal procedure • Ten secrets of ovulation induction • Should IVM be the first line therapy for PCOS patients who need IVF? ■ MILD OVARIAN STIMULATION FOR IVF Capsule: Is it a matter of reduced drug administration, save on costs, prevent OHSS or get better results? After 10 years of experience: Should this procedure be applied to all cases? • Optimizing stimulation protocols • Stimulating in one country and aspirating in another one - Truism and reproduction • Traditional vs. Low cost IVF ■ EMBRYO CULTURE - DID WE HIT THE LIMIT? • What can be done to further improve the results? Debate New challenges in embryo culture: The embryologic perspective Is it influenced by the stimulation and aspiration technique? The physicians perspective When to transfer and freeze: Blastomer vs. blastocyst ■ SURVIVAL OF FROZEN IMMATURE EGGS FOLLOWING IVM Capsule: Despite many improvements, IVM is still experimental: Risk-benefit discussion and pitfalls clarification Debate IVM should be done in most cases saving costs and complications IVM should be done for a selected group of patients only Clinical results of IVM: Is it really so good?
■ CAN WE TAILOR THE BEST STIMULATION PROTOCOL FOR EACH PATIENT?
Capsule: Individualized methods of stimulation are becoming the treatment of choice. What are the options for such a treatment? • Agonists vs. Antagonists • Can AMH help us in tailoring the optimal protocol? • How should we approach patients with PCOS? ■ COLLECTING DATA ON IVF: HOW THIS SHOULD BE INTERPRETED? Capsule: Can large data bases help us in our daily work or RCTs and meta-analyses mandatory? Data gathered worldwide survey Debate on OHSS Should OHSS be treated or be prevented? When will you cancel a cycle? All cycles should be triggered by GnRH agonist and not by hCG Angiogenesis in reproduction: The role of OHSS ■ WHAT CAN WE DO TO IMPROVE IMPLANTATION? • The literature is overflowed with adjuvant therapy: What is the evidence? • The embryo transfer laboratory model • Can we improve implantation rate • Mechanical irritation of the endometrium? • The embryo-maternal dialogue for successful implantation
Capsule: The controversies on using PDG technology are not yet resolved
• What is the less detrimental stage of biopsy?
• How should we select the best embryo to replace? • Genomics? Proteomics? Embryo cleavage rate?
■ STEM CELLS FOR REPRODUCTION AND REGENERATIVE MEDICINE Capsule: What are the expectations? What is feasible? • How far are we now in understanding the possibilities behind this notion? • Can stem cells serve as a source of gametes? • Reprogramming as a new approach to obtain patient-specific stem cells Capsule: Decreased ovarian reserve remains a common and frustrating problem despite years of experience. Do we have novel evaluation tools and treatment modalities? • Is extensive ovarian reserve investigation warranted? Or: Nothing better than a generous • Assessment of ovarian reserve by measuring anti-mullerian hormone: Is this needed at all? • Should DHEA be used more widely? • Low responders: What is the evidence behind the various adjuvant therapies? • Natural cycle IVF in low responders
You are welcome to celebrate the Establishment of the
COGI Society with us at the COGI-BCGIP Congress!
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