RCOG

1. An International Journal of
Obstetrics and Gynaecology
Top Scoring Abstracts of the RCOG World
Congress 2023
Reporting the best research in women’s health since 1902
ISSN 1470-0328/1471-0528 (Online) Volume 130 Supplement 2 June 2023
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2. BJOG
An International Journal of
Obstetrics and Gynaecology
Volume 130, Supplement 2, June 2023
Top Scoring Abstracts of the RCOG World Congress 2023
Disclaimer
This supplement has been produced using author-supplied copy. Editing has been restricted to some corrections
of spelling and style where appropriate. No responsibility is assumed for any claims, instruction, methods or
drugs dosages contained in the abstracts: it is recommended that these should be verified independently.
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3. Category – Abortion Care 3–5
Category – Adolescent Gynaecology 5–10
Category – Advances In Prenatal Diagnosis 10–12
Category – Benign Gynaecology 12–21
Category – Early Pregnancy Complications and Gynaecology 21–27
Category – Endometriosis and Uterine Disorders 27–30
Category – Fetal Medicine 30–43
Category – Gynae Oncology 43–47
Category – High Risk Pregnancy 48–76
Category – Hot Topics (Emerging research/issues) in Gynaecology 76–78
Category – Hot Topics (Emerging research/issues) in Obstetrics 79–97
Category – Imaging in Gynaecology 97–98
Category – Imaging in Obstetrics 98–101
Category – Innovation 101–109
Category – Labour Ward Management 109–121
Category – Lifestyle Medicine in Woman's Health 121–124
Category – Maternal Medicine 124–140
Category – Medical Education 140–157
Category – Obesity 157–164
Category – Pandemic and impact of Covid/Infectious Diseases 164–168
Category – Post Reproductive Health 169–173
Category – Quality Improvement 173–201
Category – Reproductive Medicine/Assisted Reproduction 201–209
Category – Risk Management 209–210
Category – Sexual Health and Contraception 210–215
Category – Telemedicine 215–217
Category – Urogynaecology/Pelvic Floor 217–219
Category – Women’s Health and Policies 219–228
Author Index 229–234
BJOG
An International Journal of
Obstetrics and Gynaecology
Volume 130, Supplement 2, June 2023
Contents
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4. | 121
A​BST​RACTS
Extension of the uterotomy was more common in the pres-
ence of IFH (28% v 4%) as was requirement for blood trans-
fusion (7% v 2%). Where artery pH was available, pH was
<7.1 in 18% with IFH and 3% no IFH. Apgar scores of ≤7 at
5 min recorded in 1% following IFH and 2% without IFH.
NNU admissions were 7% following IFH and 5% without
IFH. There were no cases of neonatal trauma or HIE.
Conclusion: IFH is commonly encountered in EMCS, in-
cluding 1st stage EMCS. In our unit, Consultant or ST7 pres-
ence is mandated at all EMCS in the second stage of labour
which may account for the absence of neonatal trauma. The
unpredictability of encountering IFH justifies the develop-
ment of a standardised approach to the management of IFH
since access to a senior obstetrician may entail delay in a
time critical situation.
LIFESTYLE MEDICINE IN WOMAN'S
HEALTH
OP.0028 | Prenatal substance exposures and mental
health trajectories
Jocelynn Cook1,2
; Nicole Roberts3
1
The Society of Obstetricians and Gynaecologists of Canada,
Ottawa, Canada; 2
The University of Ottawa, Ottawa,
Canada; 3
BORN Ontario, Ottawa, Canada
Objective: In utero experiences are important determinants
of health. This study identifies relationships between prena-
tal exposures to substances and mental health across ages. It
is hypothesized that prenatal exposure to substances is asso-
ciated with increased prevalence of mental health disorders,
beginning in preschool.
Design: A cross sectional survey was used to determine
characteristics of individuals undergoing neurodevelop-
mental assessment and diagnosis.
Method: The Canadian National Fetal Alcohol Spectrum
Disorder (FASD) Database contains data on individu-
als (N=4,200) assessed in Canadian clinics (N=30). The
Database contains information about demographics, refer-
rals, family history, prenatal exposures, early life adversity,
physical and mental health co-­
morbidities, functional chal-
lenges, and daily living difficulties. Descriptive statistics,
chi-­
square tests and logistic regression compared patterns
between groups, examined predictive factors, and explored
associations.
Results: FASD was associated with increased prevalence
of mental health issues beginning in preschool. By adult-
hood, individuals with FASD were twice as likely to experi-
ence mental health issues when compared to the Canadian
population; during adolescence they were 82× more likely
to attempt suicide and 7× more likely to be experiencing a
mental health issue. New data show sex-­
related differences
in mental health and adverse experiences in individuals with
prenatal exposures.
36% of cases have confirmed prenatal exposure to at least
three substances; alcohol (92%), nicotine (41.5%) and canna-
bis (30.7%) were the most common. Results show significant
brain domain impairment associated with prenatal alco-
hol exposure (PAE); half experience a mental health issue,
and prevalence increases across ages reaching 78% in adults
Prenatal exposure to cannabis and alcohol increased preva-
lence of anxiety and mood disorders, PTSD, and substance
use (ps<0.05); prenatal exposure to nicotine and alcohol de-
creased prevalence of impairments in the academic and mem-
ory brain domains, and substance use (ps <0.05).
Prevalence of neurobehavioural, physical and mental health
issues were influenced by the number of prenatal substance
exposures.
Conclusions: The National database provides evidence about
effects of prenatal substance exposures and the developmen-
tal origins of health and disease. Understanding how in utero
experiences impact long term neurodevelopment, including
mental health, and age and sex-­specific trajectories, will iden-
tify permissive and protective factors that optimize develop-
mental outcomes. Early age of onset of mental health issues
has been shown to be associated with a longer duration of un-
treated illness and poorer clinical and functional outcomes
and results of this study will help to anticipate early interven-
tions and supports that can mitigate adverse outcomes and
provide a foundation for healthier trajectories.
OP.0029 | Lifestyle interventions to prevent
gestational diabetes mellitus (GDM): Individual
participant data meta-­
analysis
Dyuti Coomar1
; Richard Riley2
; John Allotey1
; Shakila
Thangaratinam1
; The I-­
WIP Group1
1
Institute of Metabolism and Systems Research, University of
Birmingham, Birmingham, UK; 2
Institute of Applied Health
Research, University of Birmingham, Birmingham, UK
Objective: GDM increases the risk of pregnancy-­
related
complications and the risk of developing type-­
2 diabetes
postpartum. Many trials have been conducted to study the
effect of lifestyle interventions on GDM, but due to varying
populations and different definitions of interventions and
outcomes, their results have not been translated into clinical
practice. Our aim is to assess the effect of diet and physical
activity-­
based interventions in preventing GDM by aggre-
gating the existing literature into a single body of evidence.
Design: Systematic review followed by an Individual partici-
pant data (IPD) meta-­
analysis.
Method: A systematic review was carried out to identify tri-
als up to March 2022. Authors were then contacted to pro-
vide IPD. We analysed the IPD using both one-­
stage and
two-­
stage approaches to obtain the summary intervention
effects and the 95% confidence intervals (CI). We studied
the heterogeneity by obtaining the I2
and tau2
statistics along
with 95% prediction intervals (PI). The models were adjusted
for age, baseline BMI and clustering. We used different

5. 122 | ABSTR​ACTS​
definitions of GDM (author's definition, National Institute
for Health and Care Excellence (NICE), International
Association of the Diabetes and Pregnancy Study Groups
(IADPSG) and modified IADPSG). We evaluated the over-
all effect of lifestyle interventions and also each intervention
separately: ‘Diet’, ‘Physical activity’, and ‘Mixed approach’,
which incorporated diet and physical activity components
underpinned by behavioural approach.
Results: We identified 8,580 citations, of which 145 trials
met the inclusion criteria. We obtained IPD from 55 studies
composing of 24,150 women. The summary effect estimates
favoured the intervention when we used the author's defi-
nition, odds ratio (OR): 0.903, (95% CI: 0.802–­
1.017), (95%
PI: 0.59–­1.37), I2
=25.5%, tau2
=0.0401 (95% CI: 0.0053–­
0.1307). We observed similar effect estimates for IADPSG
and modified IADPSG definitions and they favoured the
intervention. However, we did not observe any effect for the
NICE definition. While evaluating the effect estimates for
each intervention separately, we found that ‘Diet’ (OR: 0.804,
95% CI: 0.679–­
0.953) and ‘Physical Activity’ (OR: 0.603,
95% CI: 0.454–­
0.801) prevented the development of GDM,
while ‘Mixed Approach’ had no effect (OR: 1.065, 95% CI:
0.947–­1.197).
Conclusion: Lifestyle interventions during pregnancy re-
duces the odds of developing GDM. Results were consistent
for different definitions of GDM, except the NICE defini-
tion. ‘Physical activity’ based interventions and ‘Diet’ based
interventions both reduced the odds of developing GDM.
EP.0081 | Self-­
care behaviors in menopausal women
attended in a public hospital, Peru
Juan Matzumura-­Kasano1
; Hugo Gutiérrez-­
Crespo2
1
Principal Professor of the Faculty of Medicine, Universidad
Nacional Mayor de San Marcos., Lima, Peru; 2
Obstetrician.
Associate Professor of the Faculty of Medicine, Universidad
Nacional Mayor de San Marcos. Master in Teaching and
Research in Health, Lima, Peru
Introduction: The progress of the demographic transition is
affecting several countries in Latin America. In Peru, during
the last year, some health conditions have improved and this
has resulted in an increase in life expectancy among women.
Objective: To describe self-­
care behaviors in menopausal
women who were attended in a public hospital in Lima-­
Peru
during the year 2021.
Design: non experimental, descriptive cross sectional study.
Methods: Women between 40 and 59years of age attended
in gynecology outpatient clinics participated. A simple ran-
dom probability sample of 263 women was used. A question-
naire made up of 30 questions with dichotomous answers
(absent and present) was used, divided into four dimensions;
somatic, psychological, cognitive and sexual. It was consid-
ered as effective if it performed ≥50% of the activities for
each dimension and for the overall score. It has a content
validity according to Kappa index of 0.79 and a reliability of
0.638 according to Kuder Richardson coefficient.
Results: The mean age was 47.7 ±5.4. 46% were between 47
and 53years old, 79.5% had a stable partner, 43% performed
household activities. Somatic dimension: 90.5% performed
healthy activities, 52.9% avoided hot and crowded places,
while 97.3% did not use menopausal hormone therapy and
90.9% did not perform pelvic muscle control exercises.
Psychological dimension; 78.7% showed self-­
esteem, 52.9%
accepted the climacteric stage positively, while 87.5% did
not seek psychological support, 71.5% did not prepare for
the climacteric stage and 70.3% did not identify climacteric
changes and symptoms. Cognitive dimension; 66.9% stated
that they plan their activities, 57% engage in distraction
activities, 87.5% do not engage in extra-­
occupational ac-
tivities. Sexual dimension; 65.8% maintain an active sexual
life, 57.8% perform self-­
care activities for the prevention of
genital tract infections, 93.2% do not seek information on
changes in sexuality and 91.6% do not perform self-­
care ac-
tivities to improve their sexual life.
Conclusion: The somatic dimension obtained higher scores
as ineffective, while the cognitive dimension obtained fa-
vorable results, all dimensions were considered ineffective.
The overall result showed that self-­
care behaviors were inef-
fective in 90.5%.
Key words: Climacteric, self-­
care, menopause, menopause,
climacteric.
EP.1675 | Breastfeeding behaviour and cardiovascular
risk in later reproductive age women
Catherine McNestry1
; Patrick Twomey2
; Rachel Crowley3
;
Fionnuala McAuliffe1
1
UCD Perinatal Research Centre, Dublin, Ireland;
2
Department of Clinical Pathology, St. Vincents University
Hospital, Dublin, Ireland; 3
Department of Endocrinology, St.
Vincent's University Hospital, Dublin, Ireland
Introduction: Cardiovascular disease is the leading cause of
death in women worldwide. There is a growing body of data
supporting breastfeeding as a risk-­
reducing behaviour for
women's later cardiovascular health. In this study we exam-
ined whether lifetime breastfeeding behaviour was related
to future cardiovascular risk in a cohort of later reproduc-
tive age women, as calculated by three commonly used risk
scores.
Design: This is a prospective longitudinal cohort study of
168 women from the ROLO Preteen study.
Methods: Demographics and health behaviour data were
collected via questionnaires. Anthropomorphic meas-
urements, blood samples and total body DEXA scan were
collected at the study visit. Official online calculators for
SCORE-­
2, QRISK-­
3 and ASCVD were used to calculate risk
for each participant. Univariate analysis was used to test
relationships.
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6. | 123
A​BST​RACTS
Results: Mean age was 42.53 (95% CI 41.91–­
43.62) and me-
dian BMI was 26.3 (IQR 5.9). Mean total cholesterol was
4.87 (95% CI 4.72–­
5.01) and mean HDL was 1.22 (95% CI
1.15–­
1.29). Median visceral adipose tissue volume was 494
cm3
(IQR 636). 72.6% (N=122) reported ever breastfeeding.
Median lifetime exclusive breastfeeding was 5weeks (IQR
35; range 0–­
130) and median lifetime any breastfeeding was
30weeks (IQR 84.5; range 0–­
488). 37.5% (N=63) breastfed
for 12 months or greater. Breastfeeding >/=12 months was
associated with lower QRISK-­
3 risk ratio (p=0.01), and life-
time any breastfeeding duration correlated with a lower BMI
(r(df) = −0.241, p=0.002), lower visceral adipose tissue vol-
ume (r(df) = −0.249, p=0.002), higher HDL (r(df) =0.157,
p=0.042), lower total cholesterol:HDL (r(df) = −0.177,
p=0.021). Lifetime exclusive breastfeeding correlated with
lower total cholesterol: HDL (r(df) = −0.159, p=0.041) and
lower BMI r(df) = −0.279 p = <0.001.
Conclusion: Although we did not find a significant
relationship between lifetime breastfeeding behaviour and
cardiovascular risk scores, our findings support the growing
evidence that breastfeeding for longer is beneficial for
future cardiovascular health in women. Any and exclusive
lifetime breastfeeding duration both showed a positive
dose-­
response effect on body composition and lipid profile.
Lifetime breastfeeding for >/=12 months was associated
reduced risk ratio for cardiovascular disease and stroke
compared to healthy matched controls. Long-­
term maternal
health benefits are another reason to support best practice in
breastfeeding.
EP.0169 | Sexuality after breast cancer treatment: An
additional burden
Hadir Laamiri1
; Hatem Frikha1
; Haithem Aloui1
; Khaoula
Magdoud2
; Rami Hammami1
; Rahma Bouhmida1
; Meriem
Ouederni1
; Amal Chermiti1
; Mohamed Badis Channoufi1
;
Saber Hassine Abouda1
1
Maternity and Neonatology Centre of Tunis Department C,
Tunis, Tunisia; 2
Maternity and Neonatology Centre of Tunis
Emergency Department, Tunis, Tunisia
Objective: The aim of our study was to evaluate the im-
pact of breast cancer treatment on Tunisian women's sexual
function.
Design: This was a prospective, observational, and
monocentric study.
Method: Our study was carried out in our Gynecology de-
partment, over a period of one year. It included patients who
received surgical treatment for breast cancer and agreed
to answer our questionnaire. We used the Female Sexual
Function Index (FSFI) and the Female Sexual Distress Scale-­
Revised (FSDS-­R).
Results: We included 210 patients. The average age was
45years. Most of them were married (90%) and 76% of them
were sexually active. Among these patients, 68% had radical
treatment.
We found that 62% of the patients reported a negative impact
of their condition on their sexual life. Half of them declared
that this impact was intensified after surgery. Absence of
sexual intercourse for the past month was reported by 19%
of the women.
Hypoactive sexual desire disorder was found in 47% of the
cases and sexual arousal disorder in 34% of them. The preva-
lence of dyspareunia was 32%.
The main reasons for sexual dysfunction were body image
disruption in 81% of the cases, followed by chronic fatigue in
62% and iatrogenic menopause in 9% of the cases.
Only 13% of the patients consulted a psycho-­
sexologist or a
psychiatrist and 17% of them had divorce.
Conclusions: Sexuality is often disrupted over the course of
a breast cancer patient's life. This dysfunction can be inten-
sified after treatment due to physical changes and surgery
side effects. Early multi-­
disciplinary care should be offered
to these women in distress.
EP.0185 | Clinical efficacy of low-­
intensity focused
ultrasound to treat primary dysmenorrhea
Tao Xu1
; Ling Xia2
; Hongzhen Liu2
; Guoyin He2
; Jing Li2
;
Qiang Shi2
1
Xi'an Jiaotong University Global Health Institute, Xi'an,
China; 2
Pelvic Floor Rehabilitation Center, the Second
Affiliated Hospital of Shandong First Medical University,
Tai'an, China
Objective: This study aimed to investigate the effect of low-­
intensity focused ultrasound on primary dysmenorrhea.
Methods: 80 patients with primary dysmenorrhea were se-
lected for the study. They were selected as the research ob-
jects and randomly divided into the observation group and
the control group, Patients in the observation group were
treated with low-­
intensity focused ultrasound, while pa-
tients in the control group were treated with oral ibuprofen.
Results: After 3 menstrual cycles of treatment, CMSS,
VAS, and serological index PGF2α decreased in the 1st,
2nd, and 3rd cycles and PGE2 increased in the 1st, 2nd,
and 3rd cycles in both the observation and control groups,
and the changes were more significant in the observation
group than in the control group (p < 0.05). By studying the
relationship between disease duration and treatment ef-
fect, each year increase in disease duration decreased the
treatment effect (OR = 0.29) and by studying the relation-
ship between treatment modality and treatment effect,
low-­
intensity focused ultrasound increased the treatment
effect compared to oral ibuprofen (OR = 3.75). The cure
rate and total effective rate were 32.50% and 87.50% in the
observation group and 10.00% and 72.50% in the control
group.
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7. 124 | ABSTR​ACTS​
Conclusion: Low-­
intensity focused ultrasound can effec-
tively treat symptoms and change serological indicators in
patients with primary dysmenorrhea without side effects,
and can be promoted.
EP.0273 | Audit on weight management during
pregnancy
Ayotunde Opeyemi Ojo1
; Talar Amin2
1
Carmarthen, Carmarthen, UK; 2
Glanwili Hospital,
Carmarthen, UK
Introduction: Achieving and maintaining a healthy
weight in pregnancy helps to determine the best pregnancy
outcomes for mothers and their babies. According to
the recommendation outlined by the ACOG for healthy
gestational weight gain to the BMI calculated at booking
includes the expected weight gain for the following.
BMI >18.5 gain 13–­
18 kg
BMI 18.5–­
24.9 gain 11.5–­
16 kg
BMI 25–­
29.9 gain 7–­
11 kg
BMI >30 gain 5–­
9 kg
Aims: To assess the weighing of pregnant women @ 28weeks
and @ 36weeks is performed according to and monitor
trends of weight gain during pregnancy.
To assess if the amount of weight gain in pregnancy con-
forms to the current guidelines recommended by the ACOG.
To assess mode of delivery and fetal weight at delivery.
Methods: The physical notes were retrieved for this audit
for 65 maternal mothers in August 2022 with BMI 25 and
above and they were categorised into three groups based on
the BMI at booking.
The weight measured at 28weeks and 36weeks gestation
were recorded and the difference in weight whether gained
or lost were calculated and inputted.
Mothers who developed pregnancy related conditions and
complications arising antepartum/postpartum (e.g. GDM,
RFM, PIH, PE, fetal distress, etc) were also recorded.
Fetal weight at delivery were also recorded.
Results: Out of the 65 mothers, 29.2% (19) fell under BMI
25–­
29.9, 33.8% (22) fell under BMI 30–­
34.9 and 37% (24) had
a BMI >35.
Discussion: It is important to consider the impact of mater-
nal weight greatly affect the immediate and future health of
a woman and her infant. No only is weight an important de-
terminate of how pregnancy progress but it also influences
the mode of birth of infant and the health of infant.
Authors and Affiliations
Talar Amin –­Consultant
Sarah Burton –­Public Health Midwife
Yemi Ojo –­ST1 O&G Trainee
EP.0281 | Impact of surgery for stress urinary
incontinence on sexuality
Amal Chermiti; Hatem Frikha; Haithem Aloui; Rami
Hammami; Nawraz Dakhli; Zeineb Ben Dhief; Hadir
Laamiri; Mehdi Binous; Mohamed Badis Channoufi; Saber
Hassine Abouda
Maternity and Neonatology Center of Tunis Department C,
Tunis, Tunisia
Objective: To evaluate the women sexuality after surgical
treatment of stress urinary incontinence (SUI) and analyze
the satisfaction of these patients.
Design: A prospective descriptive and analytic study.
Methods: We proceeded by a monocentric prospective study
including women who were operated in our department for
SUI with sub urethral slings by the trans obturator approach
with evaluation 6 months after surgery. Global satisfaction
was evaluated using patient global impression and improve-
ment (PGI-­
I), urinary symptoms were assessed using the
ICIQ-­
FLUTS and sexuality was appreciated by Lemack and
Ziemmern survey and ICIQ FLUTSsex.
Results: We received 20 responses (85.4% of women). The
average age was 57years old (+-­
11).
After the surgery, the PGI-­
I revealed that 17 women felt better
(85%ofcases),10%hadnotnoticedanychangeand5%feltworse.
Amongthe18womensexuallyactive,7(38.9%)noticedimprove-
ment in their sexual life while 2 patients had no more sexual life.
The 7 women sexually satisfied reported that intercourse in-
continence decreased in 60.2% of cases while the two unsat-
isfied complained of dyspareunia.
The global improvement after surgery was not only concern-
ing incontinence (RR 0.93) but also in sexuality (RR 13.85).
Conclusion: Among women operated for SUI using sub
urethral slings one third reported an improvement of their
sexuality and life quality.
MATERNAL MEDICINE
OP.0001 | Increased incidence of eclampsia in
adolescents in low and middle income settings
Laura van der Krogt1
; Alexandra Ridout2
; Paul Seed2
;
Nicola Vousden2
; Hannah Nathan2
; Andrew Shennan2
1
Royal London Hospital, Barts Health Trust, London, UK;
2
Division of Women's Health, Women's Health Academic
Centre, Kings College London, London, UK
Objective: 810 women die every day from preventable ma-
ternal causes; the majority (94%) occur in low and lower
middle-­income countries.1
Hypertensive disorders of preg-
nancy are a leading cause of maternal death. Teenagers face
a disproportionately high risk of dying.1
We report on hypertensive complications of pregnancy
across 10 low-­and middle-­
income geographical regions in
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