21st European Congress of Obstetrics and Gynaecology

Abstract

The 21st European Congress of Obstetrics and Gynaecology took place in Antwerp 5–8 May 2010. The congress provided the participants with an overview of recent scientific and clinical developments throughout the field of obstetrics and gynaecology, and these are summarized in this article.

21st European Congress of Obstetrics and Gynaecology 5-8 May 2010, Antwerp, Belgium

The 21st European Congress of Obstetrics and Gynaecology was organized by the European Board and College of Obstetrics and Gynaecology (EBCOG) and took place in Antwerp, Belgium on 5–8 May 2010. The congress attracted 1000 participants from all over the world. Congress presidents were Peter Hornnes from EBCOG, Johan Van Wiemeersch from the Flemish Speaking Belgian Obstetricians and Gynaecologists and Jean-Pierre Schaaps from the French Speaking Belgian Obstetricians and Gynaecologists. The congress was intended to give a general update throughout obstetrics and gynecology. The program included courses and sessions organized in cooperation with the four subspecialty societies: European Association of Perinatal Medicine (EAPM), European Society of Gynaecological Oncology (ESGO), European Urogynaecology Association (EUGA), and European Society of Human Reproduction and Embryology (ESHRE). Furthermore, a number of other societies contributed with sessions. A selection of presentations will be mentioned here.

One session was dedicated to the most critical challenges for obstetrics and gynecology at present. Gamal Serour, the Egyptian president of the International Federation of Gynaecology and Obstetrics (FIGO), presented the global view, while American College of Obstetricians and Gynecologists president Gerald J Joseph Jr from the USA gave the American view and EBCOG president Peter Hornnes from Denmark presented the European view. In all cases, health disparities and reproductive rights were underlined. Education and training should be harmonized and much more attention should be given to continuing medical education/continuing professional development. The significance of litigation is increasing throughout the world. This issue has, in many parts of the world, caused the number of practicing obstetricians to decline with the effect that pregnant women in these parts of the world might find themselves unable to find an obstetrician, leaving the field of obstetrics to less skilled birth attendants. This is a major problem that cannot be solved by the medical professions alone.

Obstetrics

Monitoring the progression of delivery is traditionally carried out by external and internal examinations that can sometimes be unpleasant for the mother and might also increase the risk of infection. Therefore, increasingly intrapartum ultrasound examination is being evaluated. With ultrasound the angle between the pubic bone and the fetal head can be determined, and also the distance from the fetal head to the perineum may be directly measured. Both methods appear to be useful, the latter possibly more easily learned.

With an increasing number of deliveries by elective cesarean section in most European countries, special attention must be given to the timing of these deliveries. It was clearly documented that elective cesarean delivery prior to week 39 yields an increased risk of respiratory problems for the newborn, and therefore it was emphasized that elective cesareans should be deferred to week 39 or later whenever possible.

Obesity is increasingly prevalent in the pregnant population in Europe. Several studies were reported showing increases in the risk of hypertensive disorders, induction of labor, cesarean section and fetal macrosomia and malformations with increasing BMI.

The European Midwifes Association (EMA) chaired a session. One topic was alcohol intake in pregnancy. Advice differs somewhat from country to country in Europe: in some countries any alcohol intake in pregnancy is discouraged; in others, one or two drinks per week might be allowed. Fetal alcohol syndrome is recognized everywhere, and no lower limit has been established. Another topic was the EMA survey of antenatal care, which again highlighted differences in antenatal care among European countries.

Prenatal diagnostic possibilities evolve rapidly. Several reports were given concerning the detection of fetal DNA in maternal blood. In some countries, fetal rhesus typing in maternal blood towards the end of the second trimester forms the basis for rhesus antibody treatment during pregnancy. A future where detection of fetal conditions in early pregnancy maternal blood samples is an everyday possibility might be just around the corner.

Gynecology

Much focus was given to operative techniques, both in traditional podium sessions, in courses and in a session offering live transmission of operations from operating theatres in hospitals in Leuven and in Genk, Belgium. Laparoscopic techniques are constantly being improved, but also robotic surgery is increasingly being used in operations for benign conditions, costly as the robots might be.

The European Association of Paediatric and Adolescent Gynaecology held sessions where treatment of Müllerian anomalies, surgical or nonsurgical, was discussed. In another session, new techniques for operation on vaginal aplasia were described.

Hormone replacement therapy (HRT) was another important topic. Usage of HRT has declined considerably since studies restated the increased risk of breast cancer following HRT usage. At this conference, it was advocated that individual considerations should be made in every single patient and individual advice might be necessary, as the balance between benefits and risks might differ from patient to patient.

Urogynecology

Increasingly, urinary stress incontinence is being treated with sling operations. In addition, operations with insertion of various meshes are being performed. At the EBCOG Congress, many complications to the mesh operations were presented. It was concluded that the first line of treatment of stress incontinence could be a sling operation. However, there is still a role for the colporrhaphia operations, and meshes should be reserved for second-line treatment. Conservative treatments employing pelvic floor exercises remain a pivotal first-line treatment.

Gynecological oncology

Human papillomavirus vaccination remains a very important topic in gynecological oncology. The vaccination is being included in an increasing number of national vaccination programs in young girls before the onset of sexual activity. Although a number of studies also indicate beneficial effects in women already sexually active and in boys, the cost–benefit balance in these groups remains an issue.

More and more surgery for gynecological–oncological conditions is being performed by surgical robots. This was documented in podium sessions and also very convincingly in live transmissions from the operating theatres. In several conditions, the sentinel node detection plays an important role, and it was documented how neoadjuvant chemotherapy yields better results in stage 3–4 ovarian cancer compared with primary surgery.

Human reproduction

The European Society of Human Reproduction and Embryology had for its plenary session chosen the topic of ovarian failure. The clinical presentation was described showing only small differences in phenotypic presentation between familial and sporadic cases of ovarian failure. The condition itself is treated with HRT, whereas oocyte donation remains the best option when pregnancy is desired.

Conclusion

It was evident that there are continuing scientific and clinical developments in every field of obstetrics and gynaecology. On 9–12 May 2012, the congress participants may again be updated at the 22nd European Congress of Obstetrics and Gynaecology taking place in Tallinn, Estonia.