Invited presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S1–S92 S87

I350

Stem cells in drug discovery and development

A. Trounson. California Institute for Regenerative Medicine, San

Francisco, CA, USA

The California Institute for Regenerative Medicine (CIRM) was

established by Proposition 71 in 2004 to fund pluripotential

stem cell and progenitor cell research and their applications in

regenerative medicine, in response to the Bush Administration’s

Presidential proclamation to restrict US federal funding of

embryonic stem cell research. CIRM is provided with $US3 billion

from the sale of state bonds for funding a program which calls for

research applications (RFAs) from Californian research institutions,

medical centers and companies. In the first 3 years of grant

and facilities funding CIRM has committed around $US800mill.

CIRM has also negotiated duel funding arrangements for scientific

collaborations with a number of international funding bodies

(including the State of Victoria Australia, the Canadian Cancer

Consortium, MRC UK, MICINN Spain, JST Japan and Junior Diabetes

Research Foundation) for funding collaborative research with

California scientists.

New discoveries are rapidly occurring in stem cell biology and

directed differentiation. New pluripotent cell types have been

created by transduction using specific transcription factors (induced

pluripotent stem cells – iPS cells) integrated by viral constructs

of human genes and by recombinant proteins. This is enabling

determination of disease heterogeneity, cause of diseases and

the identification of small molecule candidates for control of

phenotype. Embryonic stem cells are moving forward to clinical

trials and biotechnology companies are partnering with researchers

to derive the risk and effectiveness data needed for INDs

(registrations for clinical trial). CIRM is supporting the team

approach to IND with substantial funding (up to $US20 mill). There

are more than 30 new proposals invited for review for support

for disease teams who are confident of achieving an IND within

4 years. This includes embryonic stem cell, iPS cell projects and new

candidate drugs that have been discovered using high throughput

screening using stem cell assays.

Cancer stem cells are also an important area for CIRM support.

These cells relate to pluripotent stem cells but have lost the

key regulatory machinery to control differentiation, apoptosis and

senescence, and have upgraded proliferation as a key phenotype. It

is proposed that the cancer stem cell is maintained in a protective

quiescent niche that enables them to escape conventional cancer

therapies aimed at rapidly proliferating cells. Consequently, cancer

can be reseeded by the cancer stem cell, often years after chemo-

or radiotherapy, with consequent multiple metastases. Identifying

and targeting the putative cancer stem cell requires recognition

of stable cancer stem cell biomarkers and targeting strategies. The

targeting of inoperable gliomas using the tropism of transplanted

neural stem cells containing engineered lethal cell substrates that

can kill existing tumors, is an example of the approaching cell

therapeutics in this area.

(see www. cirm.ca.gov).

I351

Caesarean section on demand – A psychosomatic challenge?

S. Tschudin

Background: The percentage of deliveries by cesarean section (CS)

increased during the last decades and might be partly due to a

rising number of CS performed on demand of pregnant women.

With regard to somatic consequences of performing CS without

medical reasons evidence remains controversial, current knowledge

on psychological effects and sequelae is limited. The talk aims at

discussing the psychosomatic impact of CS on demand.

Material and Method: Literature findings on prevalence and

reasons for CS on demand will be discussed and results of a

survey will be presented. The cross-sectional survey consisted

of an anonymous structured questionnaire and assessed pregnant

women’s awareness of and attitudes towards CS on demand and

identified medical and psychological predictors pertaining to the

decision for CS on demand.

Results: According to the literature the percentage of CS on demand

varies between less than 3% and up to 20% of all CS. Besides

mainly rational considerations, such as prevention of incontinence,

emotions, such as fear of pain or loss of control, concerns about the

baby’s well-being or a traumatically experienced preceding birth

are associated with the demand for elective CS. In our study 10% of

pregnant women seriously considered delivering by CS on demand

and a negative previous birth experience and a preceding CS were

predictors for the wish to deliver by CS.

Conclusion: From a psychosomatic perspective specific supportive

care during first pregnancy could play a pivotal role in preventing

negative birth experience resulting in CS on demand.

I352

Emergency obstetric hysterectomy

M. Turner. UCD Professor of Obstetrics and Gynaecology, Coombe

Women & Infants University Hospital and St. Vincent’s University

Hospital, Ireland

Obstetric hysterectomy is an unusual but serious complication

of childbirth. It is associated with considerable morbidity and

occasional maternal mortality. It abruptly limits family size. The

incidence varies depending on the healthcare setting and on clinical

practice. Estimates of 1.0 per 1000 deliveries have been reported

(Shah and Wright, 2009).

In a large Irish university hospital we had 31 obstetric

hysterectomies in 114,698 women who delivered a baby weighing

500 g or more, between 1992 and 2007 giving a rate of 0.27

per 1000 (1 in 3670). This compares with an incidence of 1 in

5953 deliveries in the hospital in the previous decade 1982–91.

There were only two cases in 46,276 primigravidas (1 in 23,143)

compared with 29 cases in 68,422 multigravidas (1 in 2259). The

two cases of hysterectomy in primigravidas were associated with

surgical complications of caesarean section and not uterine atony.

Of the 29 cases in multigravidas, 27 were associated with caesarean

section or a history of a previous section.

Obstetric hysterectomy worldwide is evolving and there are

conflicting trends. The more effective use of pharmacological

therapies and the introduction of balloon tamponade decreases

hysterectomies for uterine atony. Increasing caesarean section rates

increase hysterectomies for both pathological placentation and

uterine rupture.

Hysterectomies for uterine atony are usually unpredictable and

present as an emergency. They may be subtotal, which is technically

easier to perform than total. Staff drills for unpredictable massive

haemorrhage should minimise hysterectomies for uterine atony.

Hysterectomy for placentation pathology needs to be total if there

is haemorrhage from the placental bed involving the cervix.

They are often elective but the surgery may be highly complex

leading to serious complications. Involvement of colleagues

specialising in gynaecological cancer surgery should minimise

morbidity for hysterectomies associated with pathological placental

localisation.

I353

Virtual reality or boxtrainer: Does the investment make a

difference?

K.M. Uv

There are numerous laparoscopic simulators commercially

available. Basically they can be divided into two different kinds,

Virtual Reality (VR) and BoxTrainers, in addition there are hybrid

simulators. They all have pros and cons. In favour of the

VR is the possibility to simulate operations like, Adnexectomy,

Tubectomy, Hysterectomy, Ectopic pregnancy, etc. In addition the