I334 RADIATION THERAPY FOR GYNECOLOGICAL CANCERS IN RESOURCE POOR COUNTRIES

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<ul><li><p>S244 Invited presentations and presentations by organisations and societies / International Journal of Gynecology &amp; Obstetrics 119S3 (2012) S161S260</p><p>I331</p><p>CROSS BORDER REPRODUCTIVE CARE (CBRC): ETHICAL ISSUES</p><p>F. Shenfield</p><p>The term CBRC refers to patients or other collaborators (such as</p><p>gametes donors or potential surrogates) who cross national borders</p><p>in order to obtain fertility treatment. The reasons vary, from law</p><p>avoidance to access limitations and long waiting lists nationally, to</p><p>seeking better quality or cheaper treatment abroad.</p><p>CBRC enhances patients choice and autonomy, but also raises</p><p>concerns of potential harmful outcomes for them, the collaborators</p><p>and the future child(ren).</p><p>There may be complications, sometimes born by the home</p><p>country, where the patient may return with hyperstimulation or</p><p>a multiple pregnancy. Others are born by the receiving country,</p><p>especially if there is diversion of scarce local physician skills. Also,</p><p>economic incentives for egg donors or surrogates may lead to the</p><p>commodification of vulnerable women.</p><p>Access to evidence based reproductive care locally in a fair and</p><p>equitable manner should be encouraged, without discrimination.</p><p>Furthermore good clinical practice should be promoted across</p><p>borders as well as nationally, so that all patients and participants get</p><p>safe and evidence based care wherever they go. Ethical standards,</p><p>including the welfare of the future child, should be respected.</p><p>Finally CBRC implies the exchange of full information about care of</p><p>patients and collaborators.</p><p>Reference(s)</p><p>FIGO Ethics committee report, Cross-border reproductive services (2010)</p><p>Int J of Gyn and Obs111:190191.</p><p>Pennings, G., de Wert, G., Shenfield, F., Cohen, J., Tarlatzis, B. and Devroey,</p><p>P. (2008). ESHRE task force on ethics and law 15: cross-border</p><p>reproductive care. Hum Reprod. 23: 21822184.</p><p>I332</p><p>FROM EVIDENCE TO ACTION: NEPALS PROGRESS IN</p><p>ADDRESSING PPH</p><p>M. Sherpa. Nepal</p><p>Mt Everest and the Himalayas are the pride of Nepal but</p><p>contributor to maternal mortality by limiting access to health</p><p>services including safe delivery. In 2001, 11% of women delivered</p><p>with skilled assistance, and PPH causing 47% of maternal</p><p>deaths (FHD/1998). Nepal then launched several initiatives:</p><p>increasing facility deliveries; training skilled birth attendants</p><p>(SBAs); upgrading facilities and scaling up PPH prevention at home</p><p>births.</p><p>Overarching idea was to promote AMSTL in facilities and use of</p><p>Misoprostol at home births. An important finding in the pilot</p><p>was that health facility deliveries increased increasing overall</p><p>utertonic coverage. The USAID-funded Nepal Family Health Program</p><p>(NFHP) and Jhpiego supported the Family Health Division to pilot</p><p>community-based misoprostol distribution in Banke district in</p><p>2005. It was designed to be closely monitored to facilitate learning</p><p>lessons and a refined approach for greater impact and ease of</p><p>implementation. It was done as part of birth preparedness package</p><p>using FCHVs. To avoid misuse of the drug, it was packaged and</p><p>branded as Mother Safety Pills.</p><p>After the successful pilot, scaling up was planned. There was some</p><p>resistance, partly due to a lack of WHO global recommendations</p><p>misoprostol for PPH prevention. The MoHP approved community-</p><p>based distribution of misoprostol for PPH prevention for nationwide</p><p>expansion. 21 of 75 districts now implementing. Misoprostol is</p><p>also included in national Essential Drugs List and government</p><p>will procure misoprostol. Commitment and ownership by the</p><p>government and strong partnership is considered the most</p><p>important factor in Nepals success.</p><p>I333</p><p>SURROGACY</p><p>L. Shrikhande. India</p><p>Commercial surrogacy has been legal in India since 2002. Recently</p><p>there has been a sharp increase in the frequency of commercial</p><p>surrogacy arrangement in India. Considering the growing number</p><p>of Surrogacy cases in India and the challenges that the Surrogacy</p><p>would face in the future, the Government of India decided to come</p><p>up with a law which would govern the Surrogacy and ART in India.</p><p>Some of the features of the proposed bill are:</p><p> Constitution of an authority at National level and State level to</p><p>register and regulate the IVF clinics and ART centers.</p><p> Creation of a forum to file complaints for grievances against</p><p>clinics and ART centers.</p><p> Imposing duties and responsibilities on the clinics and ART</p><p>centers.</p><p> Regulations for sourcing, storage, handling, record keeping of</p><p>Gametes, Embryos and other human reproductive materials.</p><p> Placing rights and duties on Surrogate and IPs.</p><p> Imposing stringent penalties for breach of the duties and</p><p>regulations under the Act.</p><p>The above features are dynamic in nature and will go a long way</p><p>in making the entire surrogacy procedure transparent and fair. The</p><p>chances of any exploitation of the Intended Parents and Surrogate</p><p>will be eliminated all together.</p><p>Even though, there is no law or legislation to regulate surrogacy in</p><p>India at present, the entire surrogacy process is carried out in ethical</p><p>and transparent manner keeping in mind National Guidelines for</p><p>accreditation, supervision and regulation of ART clinics in India by</p><p>Indian Council of Medical research and the proposed new law.</p><p>I334</p><p>RADIATION THERAPY FOR GYNECOLOGICAL CANCERS IN</p><p>RESOURCE POOR COUNTRIES</p><p>S.K. Shrivastava, U. Mahantshetty, R. Engineer, S. Chopra.</p><p>Department of Radiation Oncology, Tata Memorial Hospital, Mumbai,</p><p>India</p><p>The radiation therapy is the mainstay of treatment for</p><p>Gynaecological malignancies consisting of combination of external-</p><p>beam pelvic irradiation followed by intracavitary irradiation. The</p><p>aim is to deliver a dose equivalent of 80Gy. Under fluoroscopy</p><p>guidance, bony landmarks are used to mark the radiation portals.</p><p>Brachytherapy plays extremely important role. A good intracavitary</p><p>insertion delivers radiation dose to target without exceeding the</p><p>radiation tolerance doses to the rectum and bladder. Also the</p><p>phase III trials have shown an absolute benefit in overall and</p><p>progression free survival with chemo-radiotherapy.</p><p>There is shortage of equipments and personnel in resource poor</p><p>countries. Several countries have only telecobalt machines or low</p><p>energy linear Accelerators without multileaf collimators. It has</p><p>been noticed that even with basic machines execution of treatment</p><p>with proper planning for radiotherapy can give acceptable results.</p><p>The low resource countries/institutions should be trained to use</p><p>available equipments optimally to deliver radiation to save normal</p><p>tissues as much as possible.</p><p>In the past few years, there has been a rapid progress in radiation</p><p>delivery techniques. Newer external radiation techniques like IMRT,</p><p>IGRT, PET-CT Guided Radiation etc. have also been explored in</p><p>cervical cancers. However, these need further validation and since</p><p>there is no convincing evidence. Over the last two decades, various</p><p>imaging modalities like Ultrasound, CT, MRI and PET have been</p><p>explored in radiotherapy. The potential of USG as an alternate</p><p>imaging modality in cervical cancer is also being explored.</p></li></ul>