S234 Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260

should be excluded from the analysis. Maternal demographic

characteristics were reported in fewer than 10% of the cases. No

study demonstrated a comprehensive quality assurance strategy.

The INTERGROWTH-21st Fetal Growth Longitudinal Study (FGLS)

represents a unique opportunity to construct an international

equation to estimate gestational age based on CRL measures <14

weeks. We shall present the methodology, analytical strategy and

experience from our initial pilot exercise.

I287

QUANTITATIVE COMPARISON OF FETAL HEART VARIABILITY

IN FETUSES IN DIFFERENT STAGES OF LABOR USING ENTROPY

ANALYSIS

I.Y. Park, J.H. Kim

Objective: Recently, entropy analysis of fetal heart rate (FHR)

variability has been performed to assess fetal condition. To use

entropy indices for intrapartum fetal monitoring, it is essential to

understand the normal pattern of entropy indices of FHR variability

during labor. This study was conducted in order to see whether the

entropy indices of FHR are significantly different according to labor

progression.

Methods: Nonlinear analysis of fetal heart rate calculated from

cardiotocography performed half an hour before delivery.

Main outcomemeasures: Approximate entropy (ApEn) and sample

entropy (SampEn) for the final 2000 consecutive RR intervals.

Results: The vaginal delivery group had the smallest median

ApEn and SampEn, followed by the emergency cesarean group

and elective cesarean group for 2,000 RR intervals (P =0.0001,

P < 0.001, respectively). Also, in the vaginal delivery group, the

last 5 minutes of 2,000 RR intervals had a significantly lower

median ApEn (0.49 vs. 0.44, p = 0.0007) and lower median SampEn

(0.34 vs. 0.29, p < 0.0001) than the first 5 minutes of 2,000

RR intervals. No significant differences were detected between

different time segments for the elective cesarean and emergency

cesarean groups.

I288

CIRUGIA FETAL EN VENEZUELA Y SU PROYECCION PARA

AMERICA LATINA

J.A. Perez Wulff

El ambiente intrauterino y el feto han constituido un reto para la

medicina perinatal, sin embargo el advenimiento del ultrasonido y

el perfeccionamiento de estos equipos, nos ha permitido realizar

diagnosticos prenatales mas precisos y a su vez el desarrollar

pruebas de bienestar fetal, ası como la creacion de instrumentos y

tecnicas invasivas que permiten ingresar al ambiente intrauterino,

con cada vez menos complicaciones materno-fetales. El exito de

estas tecnicas mınimamente invasivas de cirugıa fetal requiere la

conjugacion de un buen equipo de ultrasonido, tener el material e

instrumental medico quirurgico y el conocimiento de la tecnica y

sus complicaciones.

En la actualidad en nuestro paıs contamos con un programa de

formacion Universitaria en Medicina Perinatal abierto a estudiantes

de America Latina y allı funciona una unidad procedimientos

invasivos obstetricos donde se realizan procedimientos de cirugıa

fetal mınimamente invasiva.

Se realizan procedimientos fetoscopicos complejos como la

Fotocoagulacion laser de vaso comunicantes en el Sındrome

de Transfusion Intergemelar, ligadura percutanea del cordon o

termocoagulacion de cordon umbilical en fetos discordantes y la

devascularizacion laser de tumores fetales como corioangiomas

y teratomas sacrococcıgeo, con sobrevida similar a la de otros

centros internacionales. Ademas realizamos procedimientos menos

complejos como la colocacion de derivaciones fetales en fetos con

patologıa pulmonar y obstrucciones del tracto urinario inferior y

tecnicas novedosas en tumores pulmonares solidos que consisten

en la esclerosis del mismo o sus vasos nutricios como en el

secuestro pulmonar, ademas (235) de las tradicionales tecnicas

diagnosticas como biopsia de vellosidades coriales, amniocentesis

y cordocentesis.

I289

IMPACT OF MENOPAUSE ON WOMEN’S HEALTH: A SURVEY

FROM DIFFERENT AREAS OF THE WORLD – CHILE

M. Parra. Chile

Chile is a country in demographical transition with 16.5 million

inhabitants – from which 8.4 million are women. From those, 25%

are aged more than 50. The “aging index” for 2010 is estimated to be

35 and life expectancy of women is 81 years old. Those indexes are

similar to those of developed countries with a maternal mortality

rate of 17/100.000 and a child mortality of 7.9/1000.

The median age at menopause in Chile is 49.5 years; using the

MRS scale to evaluate quality of life during the menopause in a

cohort of Chilean women 81% of the them have a score described

as moderate or severe.

Within the female population, the most frequent causes of

death are – in descendent order and approximate percentages –

cardiovascular diseases (29%), malign tumours (26%), respiratory

system diseases 10%, digestive system diseases (6%) and endocrine,

nutritional and/or metabolical diseases account for 5%. These five

large groups represent 76% of causes of female population’s deaths.

And what is more, breast cancer is demonstrated to be the first

cause of death in women aged more than 50.

In the same line, deaths caused by malign tumours and cardio-

vascular diseases contributed for more than half (53%) of the loss

of expectancy years (AEVP for its acronym in Spanish) estimated

for 2009.

The cardiovascular risk factors within the female population aged

over 50 are: Smoking 36%, Obesity 40%, arterial hypertension 40%

(for women over 65 this factor rises to 76%), Diabetes Mellitus 22%,

Hypercholesterolemia 58%, Sedentarism 93%, consumption of 5 or

more fruits/vegetables per day 18.4% and depression 30%.

Until 2002 Chile was the south-american country with the highest

rate of hormonal replacement therapy use with 13%. Today, this

figure doesn’t even reach 4%.

A year ago the Ministry of Health added, within the sanitary goals

for the 2010–2020 period, the health of women aged over 50.

Nowadays there are efforts in the development of sanitary rules

and clinical guidelines so that – as soon as possible – all women

within this lifespan (>50) can receive adequate treatment for their

vasomotor symptoms and handle their risk factors – notably breast

cancer.

I290

TASK-SHIFTING OF MAJOR OBSTETRIC SURGERY TO

NON-PHYSICIAN CLINICIANS IN MOZAMBIQUE

C. Pereira

Mozambican health system was further affected by human

resources last 35 years. War situation worsened the crisis and

Ministry for emergency obstetric care trained assistant medical

officers (Amos), midwives in special skills in surgery. The new

categories with surgical skills are known as surgical technicians (Tc)

and Midwives for surgery (MS).

Candidates came from each region in accord the local plan and

sets given by the Ministry of Heath. Prerequisite include three

years previous training as Amos, midwives or nurse, national

exam attended and approved, good recommendation from medical

regional office and scholarship from regional government.

80 Tcs and 50 MS have been trained and assigned to different

peripheral hospitals in the country, as teamwork of surgery. Outside

the three central hospitals serving 10% of the population, they

now constitute the backbone of emergency surgical care in rural

Mozambique.