S382 Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530

Methods: The risk of caesarean section was calculated for births

with induced onset using births with spontaneous onsets as

reference. Births with elective caesarean section were not included.

Inductions with amniotomy and cervical ripening were studied

separately. The risks were calculated as odds ratio (OR) and adjusted

for parity, maternal age, gestational length, infant’s weight, use of

epidural anesthesia and year of birth.

Results: In the cohort 346/8167 (4%) births had an elective

induction of labour. Compared with labours with a spontaneous

onset, induced labours had a more than twofold increased risk of

caesarean section, OR 2.5 (95%CI 1.4–4.2). The risk was especially

high if cervical ripening was required, OR 3.6 (95%CI 1.7–7.6).

Conclusions: In parous women without prior caesarean section

elective induction of labour increases the risk of caesarean section.

The risk is influenced by requirement of cervical ripening agents.

Women need to be counseled about the increased risk.

O345

ETIOLOGICAL ROLE OF INSULIN-LIKE GROWTH FACTOR 1 (IGF-1);

INSULIN-LIKE GROWTH FACTOR 2 (IGF-2) AND INSULIN-LIKE

GROWTH FACTOR BINDING PROTEIN 3 (IGFBP-3) GENE IN THE

BACKGROUND OF INTRAUTERINE RESTRICTION; ANALYSIS OF

PLACENTAL GENE EXPRESSION PATTERN

J.G. Joo1, B. Borzsonyi2, C. Demendi2, Z. Nagy3, I. Szentpeteri4,

A. Pajor2, J. Rigo1. 1Semmelweis University 1st. Department of Ob/Gyn,

Budapest, Hungary; 2Semmelweis University 2nd. Department of

Ob/Gyn, Budapest, Hungary; 3Nagy Gene Diagnostics and Reasearch

Ltd., Budapest, Hungary; 4Clinical Research Units Hungary Ltd.,

Szikszo, Hungary

Objectives: In this study, we compared IGF-gene expression

patterns and characteristics of glucose and insulin metabolism in

human placenta from pregnancies with or without intrauterine

growth restriction (IUGR).

Materials: We examined 101 human placentas from intrauterine

growth restriction pregnancies diagnosed at our clinics in the time

period between January 1, 2010 and January 1, 2011.

Methods: Clinical characteristics were also assessed and compared

between the IUGR and normal pregnancy groups.

Results: Between ages 17–24 and 35–44 IUGR was found to be

significantly more common than in other age groups. In pregnancies

without IUGR, umbilical cord glucose and insulin levels were

significantly higher than in pregnancies with IUGR. In placentas

from pregnancies with IUGR an overexpression of the IGF-2 and

the IGFBP-3 genes were found (IGF-2 gene:1.67-fold expression,

p = 0.04; IGFBP-3 gene:1.55-fold expression, p = 0.03). In placentas

from pregnancies with IUGR there was no significant gender

difference in the gene expression of either IGF-1 or IGFBP-3.

However, in placentas from pregnancies with male fetal gender

we found a significant overexpression of the IGF-2 gene (1.02-fold

expression, p = 0.03).

Conclusions: Intrauterine growth restriction appears to be more

common in younger (age <20 years) and older (age >35 years)

mothers. Gestational weight gain and BMI increase seem to predict

the development of IUGR. Insulin and carbohydrate metabolism are

also impaired in IUGR fetuses. In the placentas from pregnancies

with IUGR, IGF-2 is overexpressed reflecting its physiological role

in optimizing energy distribution in a low-energy environment.

O346

IS NINTENDO WII™ A MORE SUITABLE VIDEO GAME PLATFORM

THAN PLAYSTATION2™ FOR ENHANCING LAPAROSCOPY SKILLS?

R. Ju1, P.L. Chang2, K.C. Wang3, A. Buckley2. 1OB-GYN, University of

North Carolina at Chapel Hill, Chapel Hill, NC, United States; 2Beth

Israel Medical Center, New York, NY, United States; 3Brigham and

Women’s Hospital, Boston, MA, United States

Objectives: To evaluate if Nintendo (Wii) BoomBlox™ is a better

training tool than Playstation2 (PS2) Time Crisis2™ for enhancing

laparoscopy skills.

Materials: Laparoscopy box trainer, Nintendo Wii™, BoomBlox™,

Playstation 2™, Time Crisis2™Methods: 42 medical students,

residents, and attending physicians were recruited for this study.

These subjects underwent a laparoscopy box trainer with bead and

suturing pretest, followed by 30 minutes of video game play and

concluded with a similar post-test.

Results: For both the novice and expert groups, there were no

significant differences in their characteristics or improved LSC

scores using either Wii or PS2. However, subjects assigned to Wii

showed significant improvement in bead transfer scores (pre-test

129.23+18.04 vs. post-test 190.86+9.34, p < 0.001). PS2 subjects also

showed significant improvement in bead transfer scores (pre-test

138.65+16.79 vs. post-test 178.15+13.5, p < 0.05). Neither Wii nor

PS2 subjects showed any improvement in suturing scores.

Conclusions: Studies have demonstrated a positive association

between traditional video game (e.g. PS2) playing and improved

laparoscopy skills. Wii has a different platform that involves the

use of hand movements that more closely mimic laparoscopy

movements. This pilot study demonstrated that both Wii and

PS2 significantly improved laparoscopy skills in bead transfer

and may serve as a low cost alternative training tool to

expensive simulators. While no significant differences were

observed between the two systems with the current number

of subjects, this pilot study successfully proved feasibility of

our design. Further powered studies are needed and are in

development.

Table: Mean change in test score by system

Task Wii

Mean (SD)

Playstation 2

Mean (SD)

p value

Beads 62 (67) 40 (63) 0.28

Suture 0.14 (0.89) 0.10 (0.79) 0.81

O347

A SURVEY OF POSTGRADUATE TRAINING IN INDIGENOUS

WOMEN’S HEALTH IN OBSTETRICS AND GYNAECOLOGY

N.A. Jumah1, R. Shah1, D. Wilson2. 1University of Toronto, Toronto,

ON, Canada; 2University of British Columbia, Vancouver, BC, Canada

Objectives: In 2005, the Royal College of Physicians and Surgeons

Canada made improving the health of Canada’s indigenous peoples

a strategic priority. It mandated the introduction of indigenous

health education into the postgraduate curriculum. Residents in

Obstetrics and Gynaecology routinely care for aboriginal patients

and therefore would benefit from formal teaching in: First Nations,

Inuit, and Metis culture and history; the determinants of health

among Canada’s indigenous peoples; cultural safety training; and

accessing resources available to this population. The purpose of

this study is to assess the background knowledge of Obstetrics and

Gynaecology residents across the country in indigenous women’s

health with respect to this specialty. Concurrently we aim to

assess the resources and programming in place in Obstetrics and

Gynaecology departments across the country at an administrative

level by surveying program directors.

Materials: A 20-question multiple choice survey for residents was

develeoped to assess baseline knowledge in aboriginal women’s

health in Obstetrics and Gynaecology in four key areas: general

knowledge regarding Canada’s indigenous peoples; the impact of

the Residential School system; clinical experience in aboriginal

women’s health; and a self-assessment of competency in aboriginal

women’s health. A second multiple choice survey for program

directors was developed to assess the curriculum content and the

resources available to support this curriculum.

Methods: Surveys were distributed to 495 residents and 19 program

directors in accredited Obstetrics and Gynaecology programs at

Canadian universities. The data was analyzed using an SPSS

database.