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  • S244 Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161S260



    F. Shenfield

    The term CBRC refers to patients or other collaborators (such as

    gametes donors or potential surrogates) who cross national borders

    in order to obtain fertility treatment. The reasons vary, from law

    avoidance to access limitations and long waiting lists nationally, to

    seeking better quality or cheaper treatment abroad.

    CBRC enhances patients choice and autonomy, but also raises

    concerns of potential harmful outcomes for them, the collaborators

    and the future child(ren).

    There may be complications, sometimes born by the home

    country, where the patient may return with hyperstimulation or

    a multiple pregnancy. Others are born by the receiving country,

    especially if there is diversion of scarce local physician skills. Also,

    economic incentives for egg donors or surrogates may lead to the

    commodification of vulnerable women.

    Access to evidence based reproductive care locally in a fair and

    equitable manner should be encouraged, without discrimination.

    Furthermore good clinical practice should be promoted across

    borders as well as nationally, so that all patients and participants get

    safe and evidence based care wherever they go. Ethical standards,

    including the welfare of the future child, should be respected.

    Finally CBRC implies the exchange of full information about care of

    patients and collaborators.


    FIGO Ethics committee report, Cross-border reproductive services (2010)

    Int J of Gyn and Obs111:190191.

    Pennings, G., de Wert, G., Shenfield, F., Cohen, J., Tarlatzis, B. and Devroey,

    P. (2008). ESHRE task force on ethics and law 15: cross-border

    reproductive care. Hum Reprod. 23: 21822184.




    M. Sherpa. Nepal

    Mt Everest and the Himalayas are the pride of Nepal but

    contributor to maternal mortality by limiting access to health

    services including safe delivery. In 2001, 11% of women delivered

    with skilled assistance, and PPH causing 47% of maternal

    deaths (FHD/1998). Nepal then launched several initiatives:

    increasing facility deliveries; training skilled birth attendants

    (SBAs); upgrading facilities and scaling up PPH prevention at home


    Overarching idea was to promote AMSTL in facilities and use of

    Misoprostol at home births. An important finding in the pilot

    was that health facility deliveries increased increasing overall

    utertonic coverage. The USAID-funded Nepal Family Health Program

    (NFHP) and Jhpiego supported the Family Health Division to pilot

    community-based misoprostol distribution in Banke district in

    2005. It was designed to be closely monitored to facilitate learning

    lessons and a refined approach for greater impact and ease of

    implementation. It was done as part of birth preparedness package

    using FCHVs. To avoid misuse of the drug, it was packaged and

    branded as Mother Safety Pills.

    After the successful pilot, scaling up was planned. There was some

    resistance, partly due to a lack of WHO global recommendations

    misoprostol for PPH prevention. The MoHP approved community-

    based distribution of misoprostol for PPH prevention for nationwide

    expansion. 21 of 75 districts now implementing. Misoprostol is

    also included in national Essential Drugs List and government

    will procure misoprostol. Commitment and ownership by the

    government and strong partnership is considered the most

    important factor in Nepals success.



    L. Shrikhande. India

    Commercial surrogacy has been legal in India since 2002. Recently

    there has been a sharp increase in the frequency of commercial

    surrogacy arrangement in India. Considering the growing number

    of Surrogacy cases in India and the challenges that the Surrogacy

    would face in the future, the Government of India decided to come

    up with a law which would govern the Surrogacy and ART in India.

    Some of the features of the proposed bill are:

    Constitution of an authority at National level and State level to

    register and regulate the IVF clinics and ART centers.

    Creation of a forum to file complaints for grievances against

    clinics and ART centers.

    Imposing duties and responsibilities on the clinics and ART


    Regulations for sourcing, storage, handling, record keeping of

    Gametes, Embryos and other human reproductive materials.

    Placing rights and duties on Surrogate and IPs.

    Imposing stringent penalties for breach of the duties and

    regulations under the Act.

    The above features are dynamic in nature and will go a long way

    in making the entire surrogacy procedure transparent and fair. The

    chances of any exploitation of the Intended Parents and Surrogate

    will be eliminated all together.

    Even though, there is no law or legislation to regulate surrogacy in

    India at present, the entire surrogacy process is carried out in ethical

    and transparent manner keeping in mind National Guidelines for

    accreditation, supervision and regulation of ART clinics in India by

    Indian Council of Medical research and the proposed new law.




    S.K. Shrivastava, U. Mahantshetty, R. Engineer, S. Chopra.

    Department of Radiation Oncology, Tata Memorial Hospital, Mumbai,


    The radiation therapy is the mainstay of treatment for

    Gynaecological malignancies consisting of combination of external-

    beam pelvic irradiation followed by intracavitary irradiation. The

    aim is to deliver a dose equivalent of 80Gy. Under fluoroscopy

    guidance, bony landmarks are used to mark the radiation portals.

    Brachytherapy plays extremely important role. A good intracavitary

    insertion delivers radiation dose to target without exceeding the

    radiation tolerance doses to the rectum and bladder. Also the

    phase III trials have shown an absolute benefit in overall and

    progression free survival with chemo-radiotherapy.

    There is shortage of equipments and personnel in resource poor

    countries. Several countries have only telecobalt machines or low

    energy linear Accelerators without multileaf collimators. It has

    been noticed that even with basic machines execution of treatment

    with proper planning for radiotherapy can give acceptable results.

    The low resource countries/institutions should be trained to use

    available equipments optimally to deliver radiation to save normal

    tissues as much as possible.

    In the past few years, there has been a rapid progress in radiation

    delivery techniques. Newer external radiation techniques like IMRT,

    IGRT, PET-CT Guided Radiation etc. have also been explored in

    cervical cancers. However, these need further validation and since

    there is no convincing evidence. Over the last two decades, various

    imaging modalities like Ultrasound, CT, MRI and PET have been

    explored in radiotherapy. The potential of USG as an alternate

    imaging modality in cervical cancer is also being explored.


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