Hysterectomy is one of the most common major gynaecological operations performed in the UK and the USA. Its impact on sexual function is a major cause of preoperative anxiety. Unfortunately, this anxiety is seldom articulated by patients, nor recognized and discussed by clinicians. Reports about the impact of hysterectomy on sexual function have been conflicting, partly due to the use of different and often unsatisfactory parameters to assess sexual function. The aim of this review is to assess the current evidence about the effect of hysterectomy on sexual function. Female sexual function is governed by psychological, social and physiological factors. A new model of 'the sexual response cycle', comprising physical, emotional and cognitive feedback, helps explain the sexual difficulties that arise before and after hysterectomy. Evidence is lacking for sexual dysfunction caused by the disruption of local nerve and blood supply, or by changing anatomical relationships. Removal of the ovaries at hysterectomy is associated with no change or even an improvement in sexual function, particularly in women on hormone replacement therapy. Thus, overall, hysterectomy improves sexual function, regardless of surgical method or removal of the cervix. This is probably due to the amelioration of the symptoms that have previously had a negative effect on sexual function.

Adnexal torsion is an uncommon but important cause of emergency admission to the gynaecologist. Treatment of adnexal torsion has traditionally involved surgical excision of the affected structure, usually via laparotomy. A more conservative surgical approach of untwisting the torsion has been widely reported in paediatric cases. Despite reports of the successful treatment of torsion with this approach in the adult population, many UK surgeons remain reluctant to attempt ovarian conserving surgery, particularly via the laparoscopic route.We report six cases of conservative surgery for adnexal torsion. After initial success via laparotomy, the subsequent five cases were managed laparoscopically. We discuss the advantages and disadvantages of this management approach.

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The type IIb is the most difficult type to diagnose among isolated total anomalous pulmonary venous drainages (isolated TAPVD) in the fetal period. We retrospectively reviewed a missed diagnoses case of isolated TAPVD (IIb) using spatio-temporal image correlation (STIC). At the time of screening test the fetus had some abnormal echocardiographic findings, the apex of the heart pointing more to the left than normal with the angle of the septum almost 70 degrees to the midline, upper septum of mitral valve being whitish and dimness, and aorta being located slightly anterior right side in 3 vessels view. B-mode and color Doppler mode STIC volumes were acquired and stored during echocardiographic examination at 28 weeks of gestational age using Voluson E8. Postnatal echocardiography was performed at 5 days of age because pulse oximeteric reading was 85%, and TAPVD IIb with common pulmonary venous chamber (CPV) was diagnosed. All pulmonary venous flow were going into the right atrium via CPV. At 15 days of age, the cardiac surgery was performed successfully. The reason why we could not make a correct diagnosis were that we took CPV as the left atrium (LA). In fact the real position of the LA was extremely deviated to the left side and the LA itself was small. We analyzed STIC gray-mode image rendered with surface texture and gradient light modes. Reconstructed STIC render images clearly showed the position of CPV and LA than gray-mode. The small LA could be easily confirmed. On the basis of our findings, we conclude that 4D images with gradient light mode may be a useful tool, as an adjunct to 2D echocardiography for prenatal diagnoses of TAPVD IIb. P06: ANEUPLOIDY AND FETAL ANOMALIES: FIRST TRIMESTER P06.01 Impact of universal prenatal screening program for Down syndrome in a local obstetric unit in Hong KongK. Leung, B. Lau, C. Poon, K. Kou, T. Ma O&G, Queen Elizabeth Hospital, Hong KongObjectives: To evaluate the impact of a universal screening strategy in the first trimester (including nuchal translucency, PAPP-A and β-HCG), introduced in a local public hospital during second half of 2010. Before July 2010, a prenatal screening or invasive test for Down syndrome was offered to women of 35 or above only. Methods: This was a cohort study in an obstetric department with total annual deliveries of around 6,000. All the sonographers were trained, and the markers were assayed in a certified laboratory. An invasive test was offered to women with a screen positive result (1 in 250 or above). Results: From 1 July to 31 December, 2010, of 2034 eligible women, 82.5%, 14.1%, 1.0%, and 2.4% opted for first trimester combined screening, second trimester biochemical screening, screening by nuchal translucency measurement alone, and nothing respectively. The overall false positive rate was 6.0%. Of 126 women being screened positive, 68 (54.0%), 29 (23.0%), 29 (23.0%) underwent chorionic villus sampling, amniocentesis, and no invasive test respectively. Compared to 2009, there was a slight decrease in the total number of invasive...

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