Evolution of OGASH by

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Evolution of OGASH by ERNST THEODOR RIPPMANN
30 MAY 2007 JW MARRIOTT (Mirage) Hotel, Cairo -
EGYPT
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BASICS OF EPH-GESTOSIS
EPH-Gestosis is the most important pregnancy
complication, killer No. 1 for babies and
mothers. It is important to know that the baby is
100 times more in danger than the mother.
EPH-Gestosis is not a disease. It is a syndrome.
The cardinal signs and symptoms edema (E),
proteinuria (P) and hypertension (H) may appear
simultaneously, or singly. The causes of E, P and
H are manyfold. Therefore it is illocigal and
even harmful to treat such a heterogeneous group
in just one way. The causes of the cardinal signs
and symptoms vary greatly according to population
group and its location. They should be discovered
before a next pregnancy. Over 100 names of this
syndrome, more than 50 classifications and
various techniques to assess the signs and
symptoms make it impossible to compare results
worldwide. Thir confusion prevents the science
from progress.
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BASICS OF EPH-GESTOSIS

• The OG has suggested a sensible nomenclature,
  classifications and definitions, which could
  overcome this barrier.
• Nomenclature EPH-Gestosis (EPH-Syndrome
  EPH-Complex)
• Pregnancy Gest...
• Complicated osis by Edema (E), Proteinuria (P),
  Hypertension (H)
• Classification
• Symptomatic Pathogenetic
• Mono EPH 1. Super imposed EPH-Gestosis
• Poly EP 2. Transient/essential EPH-Gestosis
• EH (no signs and symptoms after puerperium)
• PH 3. Concommitant diseases
• EPH 4. Unclassified EPH-Gestosis
• EI (Eclampsia imminent)
• EC (Eclampsia convulsiva)

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BASICS OF EPH-GESTOSIS

• Definitions
• Edema Excessive (inadequate) increase of
  body-weight during pregnancy,
• usually
• Due to fluid retention, i.e.
• More than 500g/week
• 2000g/month
• 13 kg/entire pregnancy
• Proteinuria Demonstrable pretibial edema are of
  gestosis origine, if they are still present
  after a nights's bedrest.
• More than trace in one specimen. Preferably
  dipstick
• Hypertension Last normal reading 135/85
• First pathological reading 140/90
• In Hypotension Increase of 30 mmHg systolic
• Increase of 15 mmHg diastolic

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BASICS OF EPH-GESTOSIS

• Since EPH-Gestosis is rampant in the developing
  countries with little or no facilities for
  prenatal care, the methods to detect E, P and H
  have to be simple and for everybody to be
  understood and to be carried out.
• EPH-Gestosis means high risk pregnancy. It might
  just mean that the pregnant patient has to be
  watched and monitored closely. Such EPH-Gestosis
  can be detected at a very early stage and treated
  adequately.
• It is mandatory to examine each patient
  thoroughly two to three months after delivery to
  exclude all conditions which could lead to
  EPH-Gestosis again in a future pregnancy.

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Originator of Project OGASH
34 years after the founding of the Organisation
Gestosis, i.e.2003 His Royal Highness Prince
Avtandil, Prof. A. R. Chkheidze started with his
spectacular idea. He was then already a welknown,
arrived scientist at the University of Tbilisi
Research Institute of Obstetrics and Gynaecology
in Georgia.
Since the early eighties he had been working on
the the problems of EPH - Gestosis. He also had
introduced the nomenclature, i.e. "Gestosis" in
the USSR. Together with V.V. Abramchenko from
Leningrad, now Petersburg again, he published
1988 No. 28 of the monographs of the Organisation
Gestosis Press, entitled
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Founding of OGASH
"The Pregnancy and Labor Management of Atypical
Forms of late Gestosis (EPH-Gestosis) He
recognized that the parameters of the OG needed
world wide spreading and application in every day
practice of Obstetrics. He therefore founded the

• Organisation
• Gestosis
• Affiliated and
• Sponsored
• Hospitals OGASH

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Creation of OGASH
He had come to the conclusion that without mutual
understanding, without the acceptance und
application of a common Name Classification Defini
ton i.e. a common language no comparison of
results of research in the fight against EPH -
Gestosis would be possible. Teaching starts as a
rule in hospitals and beside the university
Centers also in smaller hospitals where the young
doctors get their training. These hospitals,
University teaching and training centers would
agree to the obligation to apply the parameters
of the OG doing their work with pregnant patients
suffering from EPH - Gestosis in prenatal care in
the outpatient departments, in their delivery
rooms, laboratories and in their scientific
publications. To support these efforts the
Library of the Organisation Gestosis and all
books published by the Organisation Gestosis
Press were being transferred to the Medical
Library of the Republic of Georgia.
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Creation of OGASH, OG home page and logo of
OGASH
1. The World OGASH Board, An Intercontinental
OGASH presidency of the Academy of Medical -
Social Sciences The IAMSS correspondence and
collecting data of etiology prevention and
therapy by the best leaders of OGASH
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2. Promoting OGASH workshops world wide
3. Promoting and supporting Growth of Science and
Education Access to pertinent literature A Web
site bulletin of IAMSS Publishing "OGASH-Series"
Monographs
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4. Proposing guidelines and standards worked out
by International experts on diagnostics Methods
of pregnancy surveillance for everybody
concerned, including laboratories research
programs
5. Supporting national and regional EPH -
Gestosis centers e.g. International Center for
Study of Pathophysiology of pregnancy and fetus
(ICPPF) in Cairo, Egypt
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Creation of OG home page and logo of OGASH
6. With updating of the Home Page, created 2004
in Tbilisi, which includes all important details
of OGASH to spread the information more widely,
open for professional readers, collegues,
investors, sponsors and patients
(www.gestosis.ge). His Royal Highness also
created the logo of OGASH.
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Logos
In the Greek mythology HERA was the sister and
the wife of Zeus, the over all Lord of the Greek
Universe. She was the protector of marriages, of
the conjugal life, blessing the mothers during
birth and helper during pathology of
pregnancy. This ancient logo will be transferred
on an enamel shield and dedicated to OGASH
hospitals to be fixed to the main door of the
OGASH Academy, Hospital or of the OB/ GYN
Department. It also might be printed as stamp to
be fixed to every letter of this department, to
every publication which comes from this
department und nobody else would be permitted to
use these special stamps.
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Creation of Boards, Awards and the Academic Titles
To enforce these his ideas he created National
Boards. In Egypt it is The EGYPT OGASH Regional
Subcommittee and its Chairman is Prof. Mohammed
Nabegh El - Mahallawi, MD., PhD., FRCOG He also
has deserved the highest OGASH Award. He has been
honored by the title of an Honorary Academician
of OGASH
As corresponding members of the World OGASH Board
of Intercontinental Academy of Medical-Social
Sciences IAMSS here in Egypt have been
named Prof. Hany Helal Prof. Mahmoud
El-Tayed Prof. Hatem El-Gabaly Prof. Mounir M.F.
El-Hao Prof. Ali El-Abd Ass. Prof. Khaled
Saiid Prof. Amr El-Shalakani
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B U L L E T I N "OGASH-Series" Collection of
scientific worksIntercontinental Academy of
Medical-Social Sciences (IAMSS)
Further plans concern a bulletin published by
OGASH, also Congresses realized by OGASH
Hospitals. They will discuss certain circumscript
problems. The result will be made available
through the OGASH Series. These books will cover
the many interrelationships in EPH - Gestosis. It
is being expected to make these information also
available on Compact Discs, easy to be
stored. OGASH owns no funds. Therefore no
financial support can be given. No monetary
awards are being offered. The support of the
cooperating hospitals consists in the
possibilities to obtain the information on the
running research programs and of the most
successful procedures in prophylaxis and therapy
in EPH - Gestosis There will also be a "Roll of
Honor" to underline the competence of the Member
hospitals of OGASH. And of course to be able to
fix the logo of OGASH to your hospital is a great
merit and honor. OGASH is a great effort to
foster mutual understanding in EPH - Gestosis It
aims at world wide progress in this field, at
reducing fetal and maternal morbidity and
mortality, creating a healthy population in every
country where hospitals are joining OGASH. It is
a worthy project which deserves world wide
recognition, acclaim and support. So urge your
hospitals to apply for membership of the OGASH.
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We have prepared a request form with which you
will get in touch with His Royal Highness Prince
Avtandil. Professor Avtandil Revaz Chkheidze
will get in touch with you and inform you about
the condition under which your hospital will be
accepted in this prestigeous association. CH-
Basel, May 12 2007