S802

Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531S867

W297
AUDIT OF FETAL BLOOD SAMPLING IN LABOUR CORRELATION
WITH CORD BLOOD RESULTS AND FETAL OUTCOMES
N. Sharma1 , M. Philpott1 , N. Siraj1 . 1 Obstetrics & Gynaecology,
University Hospital North Staffordshire, Stoke-on-Trent, United
Kingdom
Objectives: Fetal blood sampling (FBS) is used commonly to conrm
suspected fetal compromise in labour. The usual indication is a
pathological cardiotocography. CNST (Clinical Negligence Scheme
for Trusts) has outlined certain standards for conducting FBS in
labour.
This audit was conducted to review our current practice of fetal
blood sampling (FBS) and to compare it with standards laid by
CNST.
Materials: This audit was conducted at University Hospital North
Staffordshire, UK. It is a retrospective audit conducted over a
one year period from 01/01/2011 to 31/12/2011. Five women who
underwent FBS were randomly selected from each month making
a total of 60 women.
Methods: A standard proforma was designed. Hospital notes of
the patients included in this study were reviewed to identify the
indication for FBS and the dilatation at which FBS was conducted
i.e. 3 cm classed as early labour or >3 cm classed as established
labour.
We assessed different parameters like analgesia in labour, mode of
delivery, fetal outcomes after FBS through apgar scores and paired
cord blood samples and any record of fetal scalp injury. These were
plotted in graphical analysis.
Results: It was interesting to see that some of our national
standards are not met. These are being addressed at our unit.
Conclusions: Criteria that are not met were highlighted and
presented in our monthly audit meeting. We need a larger cohort
and re-audit to identify whether there is a higher incidence of
delivery by caesarean section in women who undergo FBS in early
labour.
W298
LABOR INDUCTION USING SUB-LINGUAL MISOPROSTOL FOR
PRELABOR RUPTURE OF MEMBRANES AT TERM: A RANDOMIZED
CONTROLLED TRIAL
V.-T. Nguyen1 , D.V. Do2 , T.S. Tran1 , P.T. Nguyen1 . 1 Hung Vuong
Hospital, Ho Chi Minh City, Viet Nam; 2 University of Medicine and
Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
Objectives: To compare the effectiveness and safety of labor
induction between 50mcg sub-lingual misoprostol and intravenous
oxytocin drip of term prelabor rupture of the membranes (PROM).
Materials: Design: parallel randomized controlled trial Setting:
Hung Vuong hospital, a tertiary referral 900-bed maternity center
at Ho Chi Minh City, Vietnam. Participants: PROM women with
single, live and cephalic-presentation at completed 37 weeks of
gestation or more, without sign of chorioamnionitis.
Methods: A central, computer-generated, block-randomization
scheme was adopted. After giving a written informed consent, an
eligible participant was randomly assigned to receive either 50mcg
sublingual misoprostol or intravenous oxytocin drip. Misoprostol
was repeated, if necessary, four-hourly until total of 4 doses.
Oxytocin drip initiated at 2 mUI/minute was adjusted at twenty
minutes basis until favorable contractions were achieved. Labor was
managed using the standard treatment protocol. Labor induction
was considered failed unless labor achieved active phases 18 hours
post-interventionally. Main outcomes: Cesarean delivery, vaginal
delivery within 24 hours, excessive uterine activity.
Results: A total of 1208 participants were randomized from May
2008 to Nov 2011. Cesarean section rate was 18% (109/605) in
oxytocin group and 17.4% (105/603) in misoprostol group, yielding a
difference rate of 0.6% (95% CI: 3.7% to 4.9%). However, signicantly
more women receiving oxytocin underwent cesarean delivery

indicated for failed induction than misoprostol group (5.7% versus

2.6%) with an absolute difference of 3.1% (95% CI: 0.5% to 5.7%).
In contrast, rate of excessive uterine activity was higher if labor
was initiated by misoprostol with a difference of 9.9% (95% CI: 6.6%
to 13.3%). There were no signicant differences in rate of delivery
mode, interventions for fetal distress or neonatal outcomes between
the two groups.
Conclusions: 50 mcg sublingual misoprostol would be a promising
labor induction option for term PROM women. Misoprostol reduced
cesarean section indicated for failed labor induction, but was
associated with an increased risk of uterine tachysystole.
W299
RISK OF OBSTETRIC ANAL SPHINCTER LACERATIONS AMONG
OBESE WOMEN
E.S. Lindholm1 , D. Altman1 . 1 Obstetrics and gynaecology, Karolinska
Institute, Stockholm, Sweden
Objectives: The aim of this nationwide register-based study was to
assess the risk for obstetrical anal sphincter lacerations in relation
to maternal obesity among primiparous women in Sweden.
Materials: The study population consisted of 210,678 primiparous
women having vaginal delivery to a singleton pregnancy identied
from the Swedish Medical Birth Register from January 1, 2003 to
December 31, 2008.
Methods: BMI was categorized into four classes according to
World Health Organization guidelines: BMI <25, BMI 2530, BMI
3135, BMI >35. Diagnosis and classication of perineal lacerations
adhered to the International Classication of Diseases 10th revision:
grade I = labial tears; grade II = perineal and vaginal laceration but
no anal sphincter involvement; grade III = partial or complete anal
sphincter laceration; grade IV = complete anal sphincter laceration
including rectal mucosa. Information on age at delivery, operative
delivery, fetal birth weight, head circumference, and maternal
diabetes mellitus was derived from the register. Odds ratios (ORs)
with 95% Condence intervals (CIs) were used to estimate the risk
using multivariate logistic regression.
Results: In total, 8,958 (4.25%) cases of anal sphincter lacerations
(grade III-IV) occurred. In multivariate analyses, increasing BMI
showed a near dose-response type protective effect against grade
III-IV lacerations (i.e. anal sphincter injury) when compared to
women with BMI <25: 0.89 (0.850.95) BMI 25-<30; 0.84 (0.76
0.92) BMI 3035; and 0.70 (0.590.82) BMI >35. The greatest risk
for anal sphincter laceration was observed among women having
an instrumental delivery (OR 2.92, 95% CI 2.783.06).
Conclusions: This large-scale nationwide register-based study
suggest that overweight and obesity decreases the risk for
obstetrical anal sphincter lacerations among primiparous women
with singleton pregnancies.
W300
RETROSPECTIVE ANALYSIS OF PREVIOUS OBSTETRICAL FACTORS
WHICH AFFECT FUTURE UTERINE PROLAPSES
H. Hyodo1 , H. Hyodo2 , H. Hiraike1 , O. Hiraike2 , Y. Miyamoto2 ,
K. Aisaka1 . 1 OB/GYN, Hamada Hospital, Tokyo, Tokyo, Japan;
2
University of Tokyo, Tokyo, Tokyo, Japan
Objectives: There are many reports that the main causes of
the uterine prolapses are due to the muscular laceration or
distention of the pelvic oor during vaginal deliveries. We
performed the retrospective analysis to elucidate what kinds of
previous obstetrical factors affected the occurrences of the uterine
prolapses.
Materials: Two hundred and forty-three cases of the uterine
prolapses who were taken the operation for the uterine prolapses in
our hospital were subjected. All of the subjects had the experiences
of previous vaginal deliveries (Group A). Two hundred and fty
cases without uterine prolapses in the same clinical background
were selected for the control (Group B). There were no statistical