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

Organized by:
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)
Course directors:
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
 
11:30 -14:00
SESSION 2
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
health
Risk factors for maternal and perinatal morbidity and mortality and how they link
to NCD
Gestational and pre gestational diabetes, diagnosis, management and prevention
Is screening and integrated care for GDM cost effective?
Panel Discussion
Developing an integrated program for MCH and NCDs in the developing world -
What does it take?
 
14:00-15:00
Lunch Break
 
15:00-17:30
SESSION 3
HOT TOPICS IN WOMEN'S HEALTH IN THE ASIAN PACIFIC REGION
Obesity and pregnancy
Type 1 and type 2 diabetes in young women - Worldwide challenges in developed
and developing countries
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
Panel Discussion


GYNECOLOGY

 
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?
Debate Endoscopic
            Uterine artery embolization
            Focus ultrasound
            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
osteoporosis and CVD
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:
China
India
Indonesia
Malaysia
Pakistan
Philippines
South Korea
Thailand
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
The progesterone hump
Medroxy progesterone acetate: The bad guy
The progestin connection to breast cancer
Different progestins and route of administration
Panel discussion:
Consensus on the route by which progestin is to be given, as well as the need for progestin
and the most appropriate progestin regimen
 
ROBOTIC SURGERY
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?
THE EXPERTS' OPINION
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
or obesity?
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
When to treat?
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
Before an abortion
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
treatment?

 
PERINATOLOGY
 
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
CONSENSUS
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
            of normal fetuses
Debate CVS or amniocentesis – What is better?
            For CVS
            For Amniocentesis
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?
The scientist
The clinician
The epidemiologist
 
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?
Thyroid dysfunction
Pre-existing diabetes
Hypertensive disorders
Anatomy scan
Do we need 3D in the first trimester?
Aneuploidy markers to all
Preterm labor
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
LECTURES
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?
            The case for MRI
            The case for sonography
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
Debate GDM Diagnosis
            Is gestational diabetes over diagnosed and over treated?
Debate GDM Treatment: Oral hypoglycemic agents - Can oral hypoglycemic agents be used
            throughout pregnancy?

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
MATERNAL FETAL MEDICINE
The controversies on the route of administration: What are the real differences and the
safety profiles?
Medically assisted pregnancy, in order to avoid:
Miscarriage and preterm labor
When to start
How long
How much
Recurrent abortion: Does progesterone play a key role?
Preterm birth prevention: When to start and how long to give progesterone? (European
Guidelines)

HOT TOPICS IN MATERNAL FETAL MEDICINE: THROMBOEMBOLISM & GROWTH
RESTRICTION
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
values to use?)
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
            business model

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 –
When to deliver
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,
postpartum
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?

PCOS II
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?
Patient friendly IVF
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?
Panel discussion:
Agonists vs. Antagonists
Can AMH help us in tailoring the optimal protocol?
How should we approach patients with PCOS?
Law dose gonadotropins
Metfoemin
Aromatase inhibitors
Minimal stimulation

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?
Debate Data bank
            RCT
            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

PGD
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

LOW RESPONDERS
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
stimulation protocol?
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

 
 
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