Contraceptive Device Discovered to Have Broad Spectrum Application for Women’s Basic Unmet Needs

Introduction: The FemCap is an FDA, and CE mark approved barrier contraceptive device. To our surprise, it was found to apply to several basic unmet reproductive health needs for women. a) The FemCap is time tested hormone-free contraceptive device, b) It offers an alternative delivery system to the traditional vaginal applicator, c) It provides a safe and effective non-surgical treatment for stress urinary incontinence (SUI), d) It enhances the fertility awareness methods. Methodology: We conducted several pilot studies to explore the potential of the FemCap. We compared the retention and distribution of stained vaginal gel if inserted with the FemCap versus the same amount of gel when inserted by the vaginal applicator. We compared the safety and effectiveness of the FemCap with a vaginal pessary that treats stress urinary incontinence. We collected the fertile cervical mucous (Spinnbarkeit) with the FemCap to determine the time of ovulation to enhance the fertility awareness method. Results: The FemCap is a well-established, safe, and effective non-hormonal contraceptive. The retention and distribution of stained vaginal gel inserted with the FemCap is more efficient than the vaginal applicator. The FemCap’s unique storage groove for microbicides can potentially be utilized to treat sexually transmitted infections (STIs) topically. FemCap is also found to be substantially equivalent to the incontinence pessary in controlling stress urinary incontinence (SUI). The FemCap did also help to collect fertile cervical mucous (Spinnbarkeit) when using fertility awareness methods. Conclusion: The multipurpose FemCap would be an ideal tool for nurse practitioners, midwives, and physicians to provide women with safe and effective, hormone-free contraception. It also provides an efficient delivery system for spermicide/microbicides. It is much safer for non-surgical management of stress urinary incontinence. It is useful for the enhancement of fertility awareness methods. It is non-invasive and can be inserted and removed by the woman without professional help.

EP.WE.117Colovaginal fistula from neglected vaginal pessary; Fallouts from the COVID-19 pandemic

An 86 year old lady was admitted with a one week history of feeling unwell, polyuria, dysuria, urinary and faecal incontinence. She had previously been treated for recurrent UTIs by her GP. On examination she had suprapubic tenderness but no peritonism. Observations revealed tachycardia of 122bpm with a temperature of 36.3*C. Inflammatory markers were raised with a white cell count of 22.0x106/L and CRP 129 mg/L. Urine cultures grew Pseudomonas aeruginosa. She was managed for urosepsis with intravenous antibiotics. Past medical history included vaginal pessary for uterine prolapse, congestive cardiac failure, hypertension, polymyalgia and osteoporosis. She lived alone with no package of care. On admission she improved with intravenous antibiotics however she had a perineal examination due to ongoing faecal and urinary incontinence and was noticed to be passing faeces per vaginam. A colo-vaginal fistula was suspected and she was reviewed by the gynaecologist who noted her pessary had been in-situ for up to a year and her routine appointment to have it changed was cancelled due to the COVID-19 pandemic. An MRI Pelvic scan confirmed a 3x2cm rectovaginal fistula. She was reviewed by the general surgery team and the decision was made for her to be defunctioned to prevent her episodes of recurrent UTIs and improve her quality of life. She successfully had a laparoscopic end colostomy with an uneventful post-operative period. This case highlights the harms caused from the cancellation of appointments and demonstrates a rare cause of rectovaginal fistula.

719 Colovaginal Fistula from Neglected Vaginal Pessary; Fallouts from the COVID-19 Pandemic

An 86-year-old lady was admitted with a one-week history of feeling unwell, polyuria, dysuria, urinary and faecal incontinence. She had previously been treated for recurrent UTIs by her GP. On examination she had suprapubic tenderness but no peritonism. Observations revealed tachycardia of 122bpm with a temperature of 36.3*C. Inflammatory markers were raised with a white cell count of 22.0x106 /L and CRP 129 mg/L. Urine cultures grew Pseudomonas aeruginosa. She was managed for urosepsis with intravenous antibiotics. Past medical history included vaginal pessary for uterine prolapse, congestive cardiac failure, hypertension, polymyalgia and osteoporosis She lived alone with no package of care. On admission she improved with intravenous antibiotics however she had a perineal examination due to ongoing faecal and urinary incontinence and was noticed to be passing faeces per vaginam. A colo-vaginal fistula was suspected, and she was reviewed by the gynaecologist who noted her pessary had been in-situ for up to a year and her routine appointment to have it changed was cancelled due to the COVID-19 pandemic. An MRI Pelvic scan confirmed a 3x2cm rectovaginal fistula. She was reviewed by the general surgery team and the decision was made for her to be defunctioned to prevent her episodes of recurrent UTIs and improve her quality of life. She successfully had a laparoscopic end colostomy with an uneventful post-operative period. This case highlights the harms caused from the cancellation of appointments and demonstrates a rare cause of rectovaginal fistula.

RESCUE CERVICAL CERCLAGE WITH VAGINAL PESSARY SUPPORT AND ALTERNATIVE TOCOLYTICS IN CORONA POSITIVE , DCDA TWIN WITH HIGH LEAKING AND 16 WEEKS OF HOSPITALISATION LEADING TO SUCCESSFUL OUTCOME - A CASE REPORT

A twin gestation invariably leads to a certain extent of cervical length shortening . If this reduction is also associated with gradual dilatation of internal os and various biochemical , mechanical changes in cervical matrix , this can lead to mid trimester pregnancy loss or preterm labour. This is a case report on Dichorionic , Diamniotic twin pregnancy with cervical incompetence in which rescue cerclage was performed along with judicious use of tocolysis and vaginal pessary.