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The 13th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Held jointly with The German Society of Obstetrics & Gynecology
Maritim Hotel, Berlin, Germany, November 4-7, 2010 |
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| Fetomaternal Medicine |
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Thursday, November 4, 2010
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| 17:30-19:00 |
Opening Session |
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Keynote Lectures - Leaders' prospective on the future Technology-based advances in obstetrics, gynecology and infertility facilitates earlier, less-invasive diagnosis: What does the future hold for our main subdisciplines? |
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Fetomaternal Medicine Genetic diagnosis on fetal cells in maternal blood: Will it ever become routine? |
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Gyn-Oncology Ovarian Cancer: Can new markers change the fate of the disease? |
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Reproductive Medicine
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| 19:00-20:30 |
Opening Cocktails |
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Friday - Sunday, November 5-7, 2010 |
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Session 1 |
Avoiding Invasive Prenatal Diagnosis |
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Capsule |
The race to achieve a complete, noninvasive prenatal genetic diagnosis remains, as yet, an unachieved goal of perinatology. Nevertheless, refinement of old tools and advances in new tests are indications of the future. What are the hurdles to achieve a noninvasive prenatal genetic diagnosis and how do ethical and patient choices affect this dilemma? |
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Only a few anomalies will escape detection with ultrasound and biomarkers: Should we be content with this combined tool? |
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Debate: Proposition: Chorionic villous sampling (CVS) is the next step after increased NT
Opposition: CVS should be performed only if detailed screening for anomalies is negative
Discussion |
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Objectives |
Upon completion of this session, the audience will learn: |
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* The advantages and limitations of current methods * Recognize all the added values of early ultrasound screening * Recognize the full constellation related to prenatal diagnosis |
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Session 2 |
Prematurity |
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Capsule |
Despite the high perinatal morbidity and mortality associated with preterm delivery, no existing tool is specific enough to diagnose premature labor, and no good and reliable intervention is available early enough to interrupt the vicious circle of labor. The question is: Can we really decrease prematurity? |
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Diagnosis of preterm labour (PTL) and prediction of premature delivery (PMD): Who to treat, and who not to treat? |
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Debate: Is Cervical Length Measurement Necessary over Biochemical Markers to Predict Preterm Birth?!
- Biochemical markers take priority over cervical length
- Ultrasound cervical length measurement is mandatory during preterm birth assessment
Discussion |
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What are tocolytics good or bad for? |
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Objectives |
Upon completion of this session, the audience will have learned: |
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* The pitfalls of diagnosis and treatment of PTL * Selecting who to treat * The place of late cerclage in the management of bulging membranes * Technique, indication, and contraindication of late cerclage |
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Session 3 |
Timing of Delivery and Intrapartum Complications |
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Capsule |
Despite the well-known perils of delivery, and notwithstanding the advanced methods and tools to diagnose those infrequent conditions that can negatively affect the results, we still have to ascertain that misjudgment and errors will not dominate the delivery room scene. What can we do to minimize the risk in this critical phase of human life?
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Can we prevent complications in high-risk pregnancies (previa, accreta, diabetes, IUGR, abnormal Doppler, olygohydramnios, PIH) by well-timed delivery? |
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Fetal resuscitation in labor: Is it feasible?
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Should elective inductions be performed in multiparous women, or multiparous with unfavorable cervix? Risks and benefits
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Objectives |
To acquire understanding of the following: |
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* How planned delivery can prevent complications * How in utero resuscitation can be achieved * When to induce, and when not to induce * The concept of acute tocolysis |
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Session 4 |
Ultrasound (US) Screening for Anomalies |
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Capsule |
Screening for anomalies with US is widely used. However, many elements of the examination remain controversial
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Hot Controversies |
Expert Opinions on: |
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Nasal bone: Fact or myth?
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Can "family album" assist in prenatal US screening?
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What can be gained by combining transvaginal screening (TVS) with transabdominal screening (TAS) in late (24 weeks) sonographic screening?
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Does intra-amniotic sludge predict preterm delivery?
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Can we agree on the definition of Dandy-Walker syndrome in ultrasonography?
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Early (14-16 weeks) or late (18-22 weeks) screening
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Amniotic band syndrome: Fact or myth
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Ultrasound: Its reliability in the diagnosis of placenta accreta and vasa previa
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Elective fetal reduction: In the early or late first trimester Folic acid: Can it prevent other conditions or only NTD? And at what dose?
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Elective fetal reduction: In the early or late first trimester |
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Session 5 |
Prediction of Hypertensive Disorders in Pregnancy |
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Capsule |
Hypertensive disorders of pregnancy, including pre-eclampsia, is associated with a syndrome of endothelial dysfunction and vasospasm leading to placental insufficiency and serious consequences to the mother and infant. Prediction of hypertension by various methods is being developed. This includes: medical history, arterial pressure, pulsatility index of the uterine artery, Pregnancy-Associated Plasma Protein-A, placental growth factor, Placental Protein 13 (PP13) and direct measurements of endothelial dysfunction. However, since the exact pathophysiologic mechanism leading to this condition is still poorly understood, it is hard to devise a prevention plan. Hence, the question is should we keep investing in prediction? |
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Debate: Should we Strive to Predict Pre-eclampsia?
Proposition: Prediction is Possible with newer methods and this is the First Step towards prevention!
Opposition: Investing in prediction of pre-eclampsia is futile, since there is no effective treatment
Discussion |
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Fetal DNA in the maternal circulation as a predictor of pre-eclampsia
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Prediction of hypertensive disorders in pregnancy |
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Objectives |
Upon completion of this session, the audience will have learned about:
* New research and tools to predict pre-eclampsia
* The role of PP-13 measurements
* The place of endothelial dysfunction
* The role of nucleated red blood cells in prediction of preeclampsia |
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Session 6 |
Progesterone to Prevent Premature Labor and Abortions |
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Capsule |
Progesterone support for early and late pregnancy has been used for over half a century. Recent publications on the safety of prophylactic administration of 17-alpha-hydroxy-progesterone caproate to reduce preterm labor, and the ever-growing list of indications, such as previous abortion, premature labor, PROM, dilatation of cervix, uterine anomalies, infertility, multiple pregnancy, postcerclage, and following various complications such as PIH and abruption, raises the question as to why not use it prophylactically for all pregnancies? |
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The diagnosis of premature labor |
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Debate: Should we use Progesterone (P) Prophylactically for all Pregnancies?
No: P, like every drug, should only be used when indicated, and in cases when its levels are expected to be low and in the right dosage Yes: P is safe, inexpensive and can help reduce preterm labour!
Discussion |
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Premature labor should not be stopped! |
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Objectives |
To acquire knowledge on the following: |
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* Premature labor: Diagnosis and treatment * Evidence of efficacy and safety of P * The indications for prophylactic P * The advantages of current compounds |
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Session 7 |
3-D and 4-D Ultrasound in Modern Perinatal Medicine and Neurobehavioral Assessment |
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Capsule |
3-D and 4-D Ultrasound represents the height of modern ultrasound technology, but the role of this technology remains controversial |
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Debate: Should 3-D and 4-D Ultrasound be Used in Every Pregnancy?
Pro / Con
Discussion |
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Are the current criteria valid for defining a causal relationship for cerebral palsy? |
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Potential of 3-D and 4-D Ultrasound for Neurobehavioral Assessment in Perinatal Medicine
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Objectives |
Upon completion of this session, the audience will have learned about: |
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* To establish whether 3/4-D Ultrasound indicated in every pregnancy? * To establish whether 3/4-D Ultrasound of value for neurobehavioral assessment in perinatal medicine? * To understand the relationship of Intrapartum events to cerebral palsy |
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Session 8 |
The Challenges of Perinatal Viability |
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Capsule |
Despite great advances in perinatal medicine, the challenges of the gestational period from 22 to 26 weeks are still poignant for the perinatologists |
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Outcome of the periviable infant: Have we reached the limit? |
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What is the best method to deliver the very premature babies? |
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Economic considerations in the management of the periviable infant |
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Ethical dimensions in obstetric and neonatal care of the periviable infant |
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Objectives |
Upon completion of this session, the audience will have learned about: |
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* To understand the burden of very premature delivery on medical, economical, societal and parental issues * To understand the risk of vaginal vs. Cesarean for periviable infants * To apply ethical principles to challenges evolving from perinatal management of the periviable infant |
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Session 9 |
Multiple Pregnancy |
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Capsule |
The management of multiple pregnancies remains a continuing High Risk challenge and most controversial topics in perinatal medicine |
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Elective preterm delivery for all Monochorionic (MC) twins? |
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Management of complicated MC twins |
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Outcome of multiple pregnancies - 2010: Spontaneous vs. iatrogenic |
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Are twins the preferred outcome in ART? |
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Objective |
* To understand hot controversies in the management of multiple pregnancies |
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Session 10 |
Uterine Contractility |
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Capsule |
Controlling uterine contractility to induce or prevent labor is the most important task of current obstetrics. What do we have in hand what are we striving for? |
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Should we use repeated courses of Atosiban? |
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What is the best method for induction of labor? |
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Carbetocin: A new player in the block? |
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Reducing the risk of premature labor by prophylactic progesterone is it feasible? |
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Objective |
To understand how different new approaches to induce or arrest uterine contractility might improve pregnancy outcomes in at risk cases |
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Session 11 |
Endless Cesarean Delivery Controversies |
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Capsule |
Cesarean delivery, the most common surgical procedure performed, continues to generate controversies that challenge all obstetricians |
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Can shoulder dystocia be prevented? |
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What is the ideal Cesarean delivery rate? |
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Patient choice - Cesarean: The role of evidence and ethics |
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Objectives |
To respect the impact of iatrogenic prematurity caused by Cesarean delivery: |
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* To identify methods for prevention of shoulder dystocia * To provide ethical appropriate strategies for dealing with patient-requested Cesarean delivery |
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Session 12 |
Prenatal Diagnosis and Therapy: State-of-the-Art |
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Capsule |
Implementing modern diagnosis and therapy continues to provoke controversies |
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Amniocentesis vs. CVS? |
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Controversies in the management of twin-to-twin transfusion syndrome |
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Fetal therapy |
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Objectives |
To appreciate the continuing improvements in obstetrical ultrasound: |
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* To understand current developments in the management of twin-to-twin transfusion syndrome * To appreciate new developments in invasive fetal therapy |
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Session 13 |
The Challenge of Membrane Rupture Diagnosis, Chorioamnionitis and Perinatal Infection |
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Capsule |
Chorioamnionitis and Perinatal Infection are major causes of perinatal morbidity and mortality |
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Advances in the diagnosis of premature rupture of the membrane |
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Controversies in the obstetric management of chorioamnionitis |
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Diagnosis and management of chorioamnionitis form the neonatal perspective |
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Can we safely avoid perinatal infections with appropriate vaccinations? |
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Objectives |
The accurate diagnosis of premature rupture of membranes |
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* To understand the impact of perinatal infection with and without chorioamnionitis * The present and future roles of vaccination during pregnancy |
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Session 14 |
When does Human Life Begin? |
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Capsule |
When does human life begin? This has challenged perinatal medicine for centuries |
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Controversies surrounding the questions: |
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When the fetus becomes a person? |
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When the fetus is a patient? |
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Cancer Treatment during pregnancy |
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Objective |
To appreciate different perspectives on when human life begins and when the physician has obligations to protect human life |
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