SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018 - 145A

Scientific Abstracts

T-107
Should Diagnostic Laparoscopies Be Deferred in Young Women
Presenting with Pelvic Pain and a Normal Pelvic Ultrasound Scan?
Nicola Tempest†, 1 Katerina Efstathiou†, 2 Zena Petros†, 2 Dharani
Hapangama*.1 1Liverpool Women's Hospital, Liverpool, United Kingdom;
2
University of Liverpool, Liverpool, United Kingdom.
INTRODUCTION: Chronic Pelvic pain (CPP) is a common reason for
gynaecology clinic (GOPD) referrals. The incidence of CPP is increasing
in young people and on attendance, they expect a definitive diagnosis
and curative or effective treatment to alleviate pain, unfortunately this is
not usually achievable. Despite a normal pelvic ultrasound scan (USS)
and examination, many young women undergo diagnostic laparoscopy
in an attempt to diagnose the existence/absence of causative factors such
as endometriosis, yet empirical treatment can be started without this.
Hypothesis: Diagnostic laparoscopy is a beneficial investigation in most
young women presenting to GOPD with CPP and a normal USS.
METHODS: All laparoscopies undertaken to investigate women aged
16-30 years with CPP, a normal USS, and no previous laparoscopy, from
December 2014 to December 2016, were retrospectively audited using
a proforma.
RESULTS: The 151 consecutive women (mean age 25 years and BMI 25),
had a prevalence of 11% anxiety, 11% depression and 13% IBS. A normal
pelvis was found at laparoscopy in 110 (72.8%) women. In the remaining
41 women (27.2%), there were 25 (16.6%) stage 1 endometriosis, 2
(1.3%) stage 2 endometriosis, 2 (1.3%) stage 3 endometriosis, 1 (0.7%)
stage 4 endometriosis, 9 (6%) with filmy adhesions, 1 (0.7%) with thick
adhesions and 1 (0.7%) with a simple cyst.
CONCLUSION: Laparoscopies confirmed normal findings in most young
women with CPP and a normal pelvic USS and examination, with only 3
women (2%) diagnosed with stage 3/4 endometriosis, who were offered
further surgical intervention. ESHRE guidelines recommend that in the
absence of signs of deep infiltrating or ovarian endometriosis in clinical
examination and imaging, a laparoscopy should not be performed purely
to find/ treat peritoneal disease, especially in adolescents and young
adults. Available evidence suggests limited benefit of surgical treatment
in mild endometriosis or filmy adhesions, thus we propose empirical
medical treatment, reassurance, education and supported self-management
strategies are particularly important as a first line approach in managing
younger women, over invasive investigations.

T-108
NSAID-Resistant Menstrual Pain is Due to Low Serum Levels
of NSAIDs. Folabomi Oladosu, Ellen Garrison, Kevin M Hellman*.
NorthShore University HealthSystem, Evanston, IL, United States.
INTRODUCTION: Non-steroidal anti-inflammatory drugs are
commonly to treat dysmenorrhea. A subset of women with dysmenorrhea,
however, do not benefit from non-steroidal anti-inflammatory drug

145A

treatment. Since the pharmacological basis of treatment resistance in
refractory menstrual has not been characterized, we sought to determine
if there was an association between menstrual pain relief and serum
naproxen levels.
METHODS: Women with either primary or secondary dysmenorrhea
(n=18) and healthy controls (n=9) were recruited to participate in an IRB
approved study. While on their menses, participants answered a battery
of self-report questionnaires examining their menstrual pain including
a numerical rating scale (0-10) of severity. After the questionnaires,
participants squeezed a bulb (with analog-digital signal capture into a
BIOPAC) to grade cramping events in real-time for 10 minutes. Following
baseline assessments, participants received 440mg of naproxen sodium.
Ninety minutes after receiving naproxen, participants reported their
overall level of pain relief with the numerical rating score and repeated
the real-time bulb measure of cramping. Afterwards, blood was collected
to detect and quantify naproxen serum levels with high-performance
liquid chromatography and tandem mass spectroscopy. Hypothesized
correlations and ANOVA and regression for assessing group differences
were performed in STATA.
RESULTS: High-performance liquid chromatography combined with
tandem mass spectroscopy reliably measured naproxen across a range of
standards in a controlled experiment (R2=0.998). There was no difference
in unbound naproxen serum levels between healthy controls and women
with dysmenorrhea (p=0.46). However, there was a range of detected
concentrations, suggesting pharmacokinetics may have contributed to
NSAID ineffectiveness. The effectiveness of naproxen, reported as relative
change in numerical scale rating, was positively correlated to unbound
naproxen serum levels (R2=0.38, p=0.0084). Similarly, a reduction in
total time cramping was negatively correlated with unbound naproxen
serum levels (R2=0.45, p=0.0088).
CONCLUSION: NSAID-resist menstrual pain may be due to insufficient
levels of absorbed naproxen. Increased consumption of analgesic
medications could be a causative factor. Additional research with a larger
sample size in needed to confirm the associations between serum naproxen
concentrations and key characteristics.
*Figure(s) will be available online.

T-109
Is Bilateral Salpingectomy Associated with Higher Rate of Surgical
Complications during Cesarean Delivery? Jose R Duncan†, Heather
L Jones†, Michael M Aziz†, Stefanie O Hoffer†, Giancarlo Mari*.
University of Tennessee Health Science Center, Memphis, TN, United
States.
INTRODUCTION: Bilateral total salpingectomy has been recommended
by the American Congress of Obstetricians and Gynecologists and the
Society for Gynecologic Oncology in order to reduce the risk of ovarian
cancer. Surgical outcomes in patients undergoing bilateral salpingectomy
and those who had traditional methods of sterilization during cesarean
delivery were compared.
METHODS: Patient who underwent sterilization during cesarean delivery
at our institution from July 2015 to November 2016 were included in this
study. Surgical outcomes including total operative time (TOP), hematocrit
(Hct) difference (Hct before surgery- Hct after surgery), estimated
blood loss, internal organ injury, hospital readmission, and the need
for transfusion were compared between salpingectomy and traditional
sterilization groups. Parametric and non-parametric statistical analysis
was utilized when appropriate. A P < .05 indicated statistical significance.
RESULTS: One hundred sixty five patients underwent sterilization during
cesarean delivery. Bilateral salpingectomy was attempted in 41 cases and
traditional sterilizations were performed in 124 women. Age, diabetes
and chorioamnioitis were all higher in the salpingectomy group (Table
1). The median total operative time was longer in the salpingectomy
group than the control group (62, IQR 54, 71 vs 57, IQR 46, 70.8; P=
.01). Other surgical complications were not statistical different among
our study groups. (Table 2)
CONCLUSION: Bilateral salpingectomy during cesarean delivery for
sterilization was associated with a minimal increase in operative time
when compared to traditional methods. Other complications rates were

Thursday Posters

Encycloped1ia of Genes and Genomes) and GO(Gene Ontology)
Consortium annotations, was used to identify global biological trends in
the gene expression data.
RESULTS: The expression levels of the SMC-specific contractile proteins
α-SMA and calponin were dramatically increased after treatment with
TGF-β1. Immunofluorescece staining showed that the TGF-β1- treated
MDSCs were positive for α-SMA. We identified 486 genes that were
diffentially expressed between the MDSCs and TGF-β1-treated MDSCs.
260 of which were up-regulated and 226 of which were down-regulated.
Twenty-one genes exhibited a greater than ten-fold change, 13 of which
were up-regulated and 8 of which were down-regulated. TGF-β1 treatment
up-regulated both the SMAD and MAPK signaling pathways during the
differentiation of these sheep cells. The PPAR and Wnt signaling pathways
were also found to be involved in the differentiation process.
CONCLUSION: TGF-β1 can successfully induce the differentiation
of sheep MDSCs into SMCs. For the first time, we analyzed the gene
expression profiles associated with this differentiation process, and the
results showed that both the SMAD and MAPK signaling pathways are
involved. This study indicated that multiple signaling networks coordinate
the development and differentiation of MDSCs into SMCs.

Reproductive Sciences Vol. 25, Supplement 1, March 2018
Table of Contents for the Digital Edition of SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018
