- Email: [email protected]
O227 Factors influencing contraceptive effectiveness of oral contraceptives: US results from the INAS-OC study
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
communication skills to enable them to more effectively sensitize others when they return to their home communities. Results: Anecdotal reports indicate that fistula survivors who have participated in the social immersion program demonstrate improved confidence, self-esteem and emotional health. The reintegration approach has improved links between the fistula repair facility and the surrounding community. With empowerment from the social immersion program fistula survivors have actively advocated for those without a voice. Conclusions: An effective fistula care program should go beyond urinary continence to address emotional and psychosocial ‘continence’ and smooth patients’ reentry to their home communities. O224 Gestational diabetes (GD). Ten years using ALAD guidelines V. Diego, V. Joaquin, O. Enrique The current study describes the experience in the screening of gestational diabetes under the ALAD guidelines, to 12.285 pregnancies receiving medical care at the Military Healthcare, in the period from December 1, 1997 through November 30, 2007. It’s a retrospective, descriptive, transversal study, based on the analysis of clinical charts and SIP data. The prevalence was 4.5%. Diagnostic was made by oral glucose tolerance test over 92% of de cases and the rest by hyperglycemia. The most frequently found risk factor was obesity. 62% of diabetic patients were older than 30 years. The prevalence of pregnant hypertension in diabetics is 18.4%. 83% of patient achieved good metabolic control with diet and exercise and 14% required insulin. The caesarean ratio in diabetic patients was 47.9%. We found a 5.27% neonatal depression and 8.13% fetal macrosomy in diabetic patients. 66% of the patients were reclassified and 8% persisted as diabetics. Conclusions: The utilization of ALAD guidelines leads to an increase in diagnostic of gestational diabetes. Diabetes duplicates the risk of gestational hypertension and decreases the risk of premature rupture of membranes and placenta previa; increases the caesarean and fetal macrosomy ratio. O225 Severe acute maternal morbidity and mode of delivery in The Netherlands J. Dillen1 , J. Zwart1 , J. Schutte2 , K. Bloemenkamp1 , J. Roosmalen1 . 1 Leiden Univerity Medical Centre, 2 Isala Klinieken, Postbus 10400, 8000 GK Zwolle, The Netherlands Objective: Globally, 10–15% of all births are delivered by cesarean section (CS). Maternal morbidity and mortality rates are higher in CS in comparison to vaginal delivery (VD). Elective CS cause less morbidity to the mother but more to the neonate as compared with emergency CS. However, most studies on this subject have major limitations. Firstly most studies about maternal mortality have not been recently published. Secondly due to the rarity of the event, underpowerment is likely to be present. Thirdly, due to absence of an universal classification system for urgency, it is not possible to relate differences in CS-associated maternal morbidity and mortality with the degree of urgency of the procedure. Finally, the role of bias by indication often remains unclear as morbidity related to CS may rather be a result from pre-existing disease that leads to the decision to perform CS than from the procedure itself. A recent nationwide prospective cohort study identified that severe acute maternal morbidity (SAMM) complicates at least 7.1 per 1000 pregnancies in the Netherlands. To overcome above described bias and shortcomings we used this cohort to evaluate the risk of SAMM related to mode of delivery in the Netherlands. Methods: In a two year period, all cases of SAMM were prospectively enrolled in a nationwide population based cohort study called LEMMoN. Incidence of SAMM in vaginal delivery (VD) compared to cesarean section (CS) was calculated. Additionally, all
S157
cases where SAMM was not clearly related to the mode of delivery were excluded. Results: During the two year period 355,841 deliveries were registered of which 53,152 (14.9%) were CS (24,580 primary CS, 28,572 secondary CS). A total of 2552 women with SAMM were included in the LEMMoN database, 1479 (58.0%) with VD and 1073 (42.0%) delivered by CS: 565 primary CS and 508 secondary CS. In total 1049 cases were identified were SAMM was possibly related to VD and 400 cases where SAMM was possibly related to CS, 158 primary CS and 242 secondary CS. The incidence of SAMM possibly related to primary CS was 6.4 per 1000 compared to 3.9 per 1000 attempted VD (OR 1.7: 95% CI 1.4–2.0). Women with CS in obstetric history are at risk for SAMM in the present pregnancy (OR 3.0: 95% CI 2.7–3.3). Conclusion: CS increases the risk of SAMM compared with VD, also after excluding those cases where SAMM is not clearly related to mode of delivery. Furthermore, cesarean section in previous pregnancy carries a threefold increased risk for SAMM in the present pregnancy. Finally, for improving comparison of morbidity and mortality related to mode of delivery, standardisation of classification systems for SAMM and urgency of CS is indicated. O226 Leptin and cortisol concentrations in maternal and fetal blood during normal vaginal delivery and caesarean section K. Dimopoulos1 , K. Dafopoulos1 , H. Skentou1 , S. Milingos2 , A. Antsaklis2 , I. Messinis1 . 1 Department of Obstetrics and Gynaecology, University of Thessalia, Larissa, Greece, 2 Department of Obstetrics and Gynaecology, University of Athens, Greece Objectives: The aim of the study was to investigate leptin and cortisol concentrations in maternal and fetal blood during the various stages of vaginal delivery and caesarean section (CS). Materials and Methods: One hundred and sixty pregnant women at term were included. Eighty delivered by CS (40 under general anaesthesia, group 1, and 40 with epidural anaesthesia, group 2) and 80 vaginally (40 primigravidas, group 3 and 40 para >1, group 4). In groups 1 and 2 blood samples were obtained before and during the operation while in groups 3 and 4 before and during the various stages of delivery. In all groups, blood from the umbilical vein was obtained at delivery. Cortisol and leptin levels were measured. Results: In all groups, maternal leptin levels were similar before the onset of anaesthesia for CS or before the onset of labour and remained stable until umbilical cord clamping. In all types of delivery, cortisol levels were higher in maternal compared to fetal blood (p < 0.05), while leptin levels were similar. There was significant correlation between maternal and fetal cortisol levels (p < 0.001), but not between maternal and fetal leptin levels. Conclusions: Maternal leptin levels do not change significantly during labour and are not affected by the type of delivery or the maternal or fetal stress. Maternal stress affects fetal stress irrespectively of type of delivery. Leptin secretion in mother and fetus is independent of cortisol and is not affected by the type of delivery. O227 Factors influencing contraceptive effectiveness of oral contraceptives: US results from the INAS-OC study J. Dinger, K. Voigt, A. Assmann. ZEG – Berlin Center for Epidemiology and Health Research, Germany Objectives: To assess factors (e.g., age, BMI, parity, OC regimen) that influence use-effectiveness of oral contraceptives (OCs). Materials and Methods: Prospective, controlled, non-interventional cohort study conducted in the US and Europe. New users of an OC (starters or switchers) are recruited by a network of gynecologists. A 3 to 5-year follow-up of more than 80,000 women will be sufficient to document more than 150,000 womenyears. Baseline and follow-up information are collected via self-
S158
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
administered questionnaires. Reports of unintended pregnancies are validated by study physicians. A multifaceted follow-up procedure ensures low loss to follow-up. Inferential statistics are based on Cox regression models. Results: As of end of 2008 a total of 879 unintended pregnancies that occurred during OC use had been reported by US participants. The Pearl indices were in the range of 1.3 (24-day regimen of a DRSP containing OC) and 2.2 (21-day regimen of OCs without DRSP). Parity (HR, 2.2), high educational level (HR, 0.5), age 35+y (HR, 0.2), BMI 35+ (HR, 1.5) and the use of the 24-day regimen of DRSP (HR, 0.6) had a statistical significant impact on contraceptive effectiveness. Conclusions: Results as of end of 2008 indicate that a 24day regimen of a progestin with a long half-life has very high contraceptive effectiveness under routine medical conditions. Contraceptive failure rates increase with parity, grade II obesity and decrease with high educational level and age. O228 Rapid versus slow intravenous iron sucrose administration in pregnant women with iron deficiency anemia in a rural setting in India H. Divakar1 , N. Kumar2 , I. Manyonda3 . 1 Obgyn Divakars Hospital, 2 Public Health, MS ramaiya Medical College, 3 Obgyn St. Georges University of London Objectives: To compare the efficacy, safety and cost of two methods of administering intravenous iron sucrose, the conventional slow intravenous infusion versus the rapid “bolus-push” technique. Patient and Methods: 125 women attending a rural antenatal clinic in India between november 2008 and feb. 2009 were randomized to receive two doses of intravenous iron sucrose by one or other of the two methods under comparison. Haemoglobin (Hb) was measured prior to treatment, and again at 4 weeks post treatment. All participants received the same total dose of iron sucrose of 400 mg divided into two equal doses administered 2–4 days apart at 20–24 weeks gestation. 58 women were randomized to Group A and received their iron sucrose by the slow infusion technique, while 67 women were randomized to Group B and iron sucrose was administered via the rapid bolus-push technique. Any adverse reactions to the drug administration were recorded, after the first injection Per unit additional costs incurred were calculated for each method. Results: There were no differences in patient demographics or pretreatment Hb between the two groups. Both groups recorded a statistically significant increase in the mean Hb level in response to treatment (p < 0.001), but there were no differences between the two groups. No woman experienced major adverse reactions, but minor reactions occurred in 5 (8.6%) women in Group A and 13 (19.4%) women in Group B (p value). Only two women experiencing minor reactions required intravenous hydrocortisone, and symptoms resolved within 20 minutes in both. Cost analysis revealed that the slow infusion was seven times more expensive than the bolus push technique (Rs 143 INR versus Rs 19 INR). Conclusions: In the administration of iron sucrose, the bolus-push technique has similar efficacy and safety profile compared to the conventional slow infusion technique, but is 7 times cheaper. In evaluating the feasibility of the use of iron sucrose in the mass eradication of IDA in pregnancy in a developing world setting, the bolus-push technique might have major cost-saving advantages. O229 Hematocolpos in double vagina associated with uterus didelphus and ipsilateral renal agenesis N. Dominguez Palicio1 , O. Giler Cantos, R. Almirall. 1 Department of Gynecology, PASSIR Eixample ICS Barcelona Objective: The malformative syndrome of double vagina in association with uterus didelphus and ipsilateral renal agenesis
is a rare condition, and usually presents after menarche with progressive pelvic pain during menses due to hematocolpos, but also could be low symptomatic. Materials and Methods: We describe two cases with the different clinic presentation. Results: The main finding is the different symptomatology between patients carriers of mullerian anomalies, from practically assymptomatic to pain and infertility. Conclusions: Ultrasound and MRI have significantly improve the management and diagnosis of this anomalies, often misdiagnosed. O230 Vaginal flora changes on Pap smears after insertion of intrauterine levonorgestrel releasing device (Mirena® ) G. Donders1 , J. Berger2 , H. Heuninckx2 , G. Bellen3 , A. Cornelis4 . 1 Femicare vzw, clinical research for women, Tienen, Belgium, Departments of Obstetrics and Gynaecology, of the 2) Heilig Hart Ziekenhuis Tienen and 3) Gasthuisberg University Hospital Leuven, Belgium., 2 Department of Obstetrics and Gynaecology of the Heilig Hart Ziekenhuis Tienen, Belgium, 3 Femicare clinical Research For Women, Tienen, Belgium, 4 Department of Pathology of the Heilig Hart Ziekenhuis Tienen, Belgium Introduction: Mirena® users combine the insertion of a foreign body in the uterus and the continuous release of low dose levonorgestrel. The influence of this combination on the rate of vulvovaginal infections and flora disturbance is insufficiently known, but important for contraceptive advice in women with recurrent vaginosis or vulvo-vaginitis. Aim: Study vaginal microflora in retrospective cohort of women being equipped with Mirena, in order to enable construction and design of a prospective study. Material and Methods: Pap smear slides of 286 women who had Mirena inserted (n = 424) and had Pap smear taken before and 1 to 2 years after placement were blindly reviewed for the presence of abnormal vaginal flora (AVF), bacterial vaginosis (BV), aerobic vaginitis (AV) and Candida vaginitis (CV). Results: Before insertion, there were no differences in vaginal flora abnormalities between women not using contraception, oral contraceptive pill users, former Mirena® users or women using other methods of contraception. After insertion, Mirena® users did not have a different rate of abnormal vaginal flora, bacterial vaginosis, or aerobic vaginitis, but there was a non-significant trend of diminished colonisation with Candida. Conclusion: Insertion of Mirena® caused no major bacterial or mycological changes in vaginal flora. Also the presence and amount of uterine bleeding or amenorrhea after insertion did not seem to predict a different type of flora, which was unexpected. Prospective studies with better diagnostic techniques are needed. O231 The effects of air sac combined with nitrous oxide and Doula companying delivery in vaginal delivery X. Dong, H. Qi, L. Hu, X. Luo, Y. Zhu, J. Cai Objective: To study the effects of air sac combined with nitrous oxide and Doula companying delivery in vaginal delivery. Methods: 60 primiparas were randomly chosen in control and study group respectively. Air sac combined with nitrous oxide and Doula companying was given in study group. Only observation was given in control group. The time and mode of delivery, the volume of bleeding and complications in postpartum, neonate asphyxia, CST and character of amnionic fluid were compared between these two groups. Results: The time of total stage in study group was (5.6±2.8) hours, active phase was (104.2±43.1) minutes and the second stage was (34.3±8.4) minutes, which were shorter than in control group (p < 0.05). Cervical and perineum laceration, the rate of Cesarean section and character of amnionic fluid were lower in study group
communication skills to enable them to more effectively sensitize others when they return to their home communities. Results: Anecdotal reports indicate that fistula survivors who have participated in the social immersion program demonstrate improved confidence, self-esteem and emotional health. The reintegration approach has improved links between the fistula repair facility and the surrounding community. With empowerment from the social immersion program fistula survivors have actively advocated for those without a voice. Conclusions: An effective fistula care program should go beyond urinary continence to address emotional and psychosocial ‘continence’ and smooth patients’ reentry to their home communities. O224 Gestational diabetes (GD). Ten years using ALAD guidelines V. Diego, V. Joaquin, O. Enrique The current study describes the experience in the screening of gestational diabetes under the ALAD guidelines, to 12.285 pregnancies receiving medical care at the Military Healthcare, in the period from December 1, 1997 through November 30, 2007. It’s a retrospective, descriptive, transversal study, based on the analysis of clinical charts and SIP data. The prevalence was 4.5%. Diagnostic was made by oral glucose tolerance test over 92% of de cases and the rest by hyperglycemia. The most frequently found risk factor was obesity. 62% of diabetic patients were older than 30 years. The prevalence of pregnant hypertension in diabetics is 18.4%. 83% of patient achieved good metabolic control with diet and exercise and 14% required insulin. The caesarean ratio in diabetic patients was 47.9%. We found a 5.27% neonatal depression and 8.13% fetal macrosomy in diabetic patients. 66% of the patients were reclassified and 8% persisted as diabetics. Conclusions: The utilization of ALAD guidelines leads to an increase in diagnostic of gestational diabetes. Diabetes duplicates the risk of gestational hypertension and decreases the risk of premature rupture of membranes and placenta previa; increases the caesarean and fetal macrosomy ratio. O225 Severe acute maternal morbidity and mode of delivery in The Netherlands J. Dillen1 , J. Zwart1 , J. Schutte2 , K. Bloemenkamp1 , J. Roosmalen1 . 1 Leiden Univerity Medical Centre, 2 Isala Klinieken, Postbus 10400, 8000 GK Zwolle, The Netherlands Objective: Globally, 10–15% of all births are delivered by cesarean section (CS). Maternal morbidity and mortality rates are higher in CS in comparison to vaginal delivery (VD). Elective CS cause less morbidity to the mother but more to the neonate as compared with emergency CS. However, most studies on this subject have major limitations. Firstly most studies about maternal mortality have not been recently published. Secondly due to the rarity of the event, underpowerment is likely to be present. Thirdly, due to absence of an universal classification system for urgency, it is not possible to relate differences in CS-associated maternal morbidity and mortality with the degree of urgency of the procedure. Finally, the role of bias by indication often remains unclear as morbidity related to CS may rather be a result from pre-existing disease that leads to the decision to perform CS than from the procedure itself. A recent nationwide prospective cohort study identified that severe acute maternal morbidity (SAMM) complicates at least 7.1 per 1000 pregnancies in the Netherlands. To overcome above described bias and shortcomings we used this cohort to evaluate the risk of SAMM related to mode of delivery in the Netherlands. Methods: In a two year period, all cases of SAMM were prospectively enrolled in a nationwide population based cohort study called LEMMoN. Incidence of SAMM in vaginal delivery (VD) compared to cesarean section (CS) was calculated. Additionally, all
S157
cases where SAMM was not clearly related to the mode of delivery were excluded. Results: During the two year period 355,841 deliveries were registered of which 53,152 (14.9%) were CS (24,580 primary CS, 28,572 secondary CS). A total of 2552 women with SAMM were included in the LEMMoN database, 1479 (58.0%) with VD and 1073 (42.0%) delivered by CS: 565 primary CS and 508 secondary CS. In total 1049 cases were identified were SAMM was possibly related to VD and 400 cases where SAMM was possibly related to CS, 158 primary CS and 242 secondary CS. The incidence of SAMM possibly related to primary CS was 6.4 per 1000 compared to 3.9 per 1000 attempted VD (OR 1.7: 95% CI 1.4–2.0). Women with CS in obstetric history are at risk for SAMM in the present pregnancy (OR 3.0: 95% CI 2.7–3.3). Conclusion: CS increases the risk of SAMM compared with VD, also after excluding those cases where SAMM is not clearly related to mode of delivery. Furthermore, cesarean section in previous pregnancy carries a threefold increased risk for SAMM in the present pregnancy. Finally, for improving comparison of morbidity and mortality related to mode of delivery, standardisation of classification systems for SAMM and urgency of CS is indicated. O226 Leptin and cortisol concentrations in maternal and fetal blood during normal vaginal delivery and caesarean section K. Dimopoulos1 , K. Dafopoulos1 , H. Skentou1 , S. Milingos2 , A. Antsaklis2 , I. Messinis1 . 1 Department of Obstetrics and Gynaecology, University of Thessalia, Larissa, Greece, 2 Department of Obstetrics and Gynaecology, University of Athens, Greece Objectives: The aim of the study was to investigate leptin and cortisol concentrations in maternal and fetal blood during the various stages of vaginal delivery and caesarean section (CS). Materials and Methods: One hundred and sixty pregnant women at term were included. Eighty delivered by CS (40 under general anaesthesia, group 1, and 40 with epidural anaesthesia, group 2) and 80 vaginally (40 primigravidas, group 3 and 40 para >1, group 4). In groups 1 and 2 blood samples were obtained before and during the operation while in groups 3 and 4 before and during the various stages of delivery. In all groups, blood from the umbilical vein was obtained at delivery. Cortisol and leptin levels were measured. Results: In all groups, maternal leptin levels were similar before the onset of anaesthesia for CS or before the onset of labour and remained stable until umbilical cord clamping. In all types of delivery, cortisol levels were higher in maternal compared to fetal blood (p < 0.05), while leptin levels were similar. There was significant correlation between maternal and fetal cortisol levels (p < 0.001), but not between maternal and fetal leptin levels. Conclusions: Maternal leptin levels do not change significantly during labour and are not affected by the type of delivery or the maternal or fetal stress. Maternal stress affects fetal stress irrespectively of type of delivery. Leptin secretion in mother and fetus is independent of cortisol and is not affected by the type of delivery. O227 Factors influencing contraceptive effectiveness of oral contraceptives: US results from the INAS-OC study J. Dinger, K. Voigt, A. Assmann. ZEG – Berlin Center for Epidemiology and Health Research, Germany Objectives: To assess factors (e.g., age, BMI, parity, OC regimen) that influence use-effectiveness of oral contraceptives (OCs). Materials and Methods: Prospective, controlled, non-interventional cohort study conducted in the US and Europe. New users of an OC (starters or switchers) are recruited by a network of gynecologists. A 3 to 5-year follow-up of more than 80,000 women will be sufficient to document more than 150,000 womenyears. Baseline and follow-up information are collected via self-
S158
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
administered questionnaires. Reports of unintended pregnancies are validated by study physicians. A multifaceted follow-up procedure ensures low loss to follow-up. Inferential statistics are based on Cox regression models. Results: As of end of 2008 a total of 879 unintended pregnancies that occurred during OC use had been reported by US participants. The Pearl indices were in the range of 1.3 (24-day regimen of a DRSP containing OC) and 2.2 (21-day regimen of OCs without DRSP). Parity (HR, 2.2), high educational level (HR, 0.5), age 35+y (HR, 0.2), BMI 35+ (HR, 1.5) and the use of the 24-day regimen of DRSP (HR, 0.6) had a statistical significant impact on contraceptive effectiveness. Conclusions: Results as of end of 2008 indicate that a 24day regimen of a progestin with a long half-life has very high contraceptive effectiveness under routine medical conditions. Contraceptive failure rates increase with parity, grade II obesity and decrease with high educational level and age. O228 Rapid versus slow intravenous iron sucrose administration in pregnant women with iron deficiency anemia in a rural setting in India H. Divakar1 , N. Kumar2 , I. Manyonda3 . 1 Obgyn Divakars Hospital, 2 Public Health, MS ramaiya Medical College, 3 Obgyn St. Georges University of London Objectives: To compare the efficacy, safety and cost of two methods of administering intravenous iron sucrose, the conventional slow intravenous infusion versus the rapid “bolus-push” technique. Patient and Methods: 125 women attending a rural antenatal clinic in India between november 2008 and feb. 2009 were randomized to receive two doses of intravenous iron sucrose by one or other of the two methods under comparison. Haemoglobin (Hb) was measured prior to treatment, and again at 4 weeks post treatment. All participants received the same total dose of iron sucrose of 400 mg divided into two equal doses administered 2–4 days apart at 20–24 weeks gestation. 58 women were randomized to Group A and received their iron sucrose by the slow infusion technique, while 67 women were randomized to Group B and iron sucrose was administered via the rapid bolus-push technique. Any adverse reactions to the drug administration were recorded, after the first injection Per unit additional costs incurred were calculated for each method. Results: There were no differences in patient demographics or pretreatment Hb between the two groups. Both groups recorded a statistically significant increase in the mean Hb level in response to treatment (p < 0.001), but there were no differences between the two groups. No woman experienced major adverse reactions, but minor reactions occurred in 5 (8.6%) women in Group A and 13 (19.4%) women in Group B (p value). Only two women experiencing minor reactions required intravenous hydrocortisone, and symptoms resolved within 20 minutes in both. Cost analysis revealed that the slow infusion was seven times more expensive than the bolus push technique (Rs 143 INR versus Rs 19 INR). Conclusions: In the administration of iron sucrose, the bolus-push technique has similar efficacy and safety profile compared to the conventional slow infusion technique, but is 7 times cheaper. In evaluating the feasibility of the use of iron sucrose in the mass eradication of IDA in pregnancy in a developing world setting, the bolus-push technique might have major cost-saving advantages. O229 Hematocolpos in double vagina associated with uterus didelphus and ipsilateral renal agenesis N. Dominguez Palicio1 , O. Giler Cantos, R. Almirall. 1 Department of Gynecology, PASSIR Eixample ICS Barcelona Objective: The malformative syndrome of double vagina in association with uterus didelphus and ipsilateral renal agenesis
is a rare condition, and usually presents after menarche with progressive pelvic pain during menses due to hematocolpos, but also could be low symptomatic. Materials and Methods: We describe two cases with the different clinic presentation. Results: The main finding is the different symptomatology between patients carriers of mullerian anomalies, from practically assymptomatic to pain and infertility. Conclusions: Ultrasound and MRI have significantly improve the management and diagnosis of this anomalies, often misdiagnosed. O230 Vaginal flora changes on Pap smears after insertion of intrauterine levonorgestrel releasing device (Mirena® ) G. Donders1 , J. Berger2 , H. Heuninckx2 , G. Bellen3 , A. Cornelis4 . 1 Femicare vzw, clinical research for women, Tienen, Belgium, Departments of Obstetrics and Gynaecology, of the 2) Heilig Hart Ziekenhuis Tienen and 3) Gasthuisberg University Hospital Leuven, Belgium., 2 Department of Obstetrics and Gynaecology of the Heilig Hart Ziekenhuis Tienen, Belgium, 3 Femicare clinical Research For Women, Tienen, Belgium, 4 Department of Pathology of the Heilig Hart Ziekenhuis Tienen, Belgium Introduction: Mirena® users combine the insertion of a foreign body in the uterus and the continuous release of low dose levonorgestrel. The influence of this combination on the rate of vulvovaginal infections and flora disturbance is insufficiently known, but important for contraceptive advice in women with recurrent vaginosis or vulvo-vaginitis. Aim: Study vaginal microflora in retrospective cohort of women being equipped with Mirena, in order to enable construction and design of a prospective study. Material and Methods: Pap smear slides of 286 women who had Mirena inserted (n = 424) and had Pap smear taken before and 1 to 2 years after placement were blindly reviewed for the presence of abnormal vaginal flora (AVF), bacterial vaginosis (BV), aerobic vaginitis (AV) and Candida vaginitis (CV). Results: Before insertion, there were no differences in vaginal flora abnormalities between women not using contraception, oral contraceptive pill users, former Mirena® users or women using other methods of contraception. After insertion, Mirena® users did not have a different rate of abnormal vaginal flora, bacterial vaginosis, or aerobic vaginitis, but there was a non-significant trend of diminished colonisation with Candida. Conclusion: Insertion of Mirena® caused no major bacterial or mycological changes in vaginal flora. Also the presence and amount of uterine bleeding or amenorrhea after insertion did not seem to predict a different type of flora, which was unexpected. Prospective studies with better diagnostic techniques are needed. O231 The effects of air sac combined with nitrous oxide and Doula companying delivery in vaginal delivery X. Dong, H. Qi, L. Hu, X. Luo, Y. Zhu, J. Cai Objective: To study the effects of air sac combined with nitrous oxide and Doula companying delivery in vaginal delivery. Methods: 60 primiparas were randomly chosen in control and study group respectively. Air sac combined with nitrous oxide and Doula companying was given in study group. Only observation was given in control group. The time and mode of delivery, the volume of bleeding and complications in postpartum, neonate asphyxia, CST and character of amnionic fluid were compared between these two groups. Results: The time of total stage in study group was (5.6±2.8) hours, active phase was (104.2±43.1) minutes and the second stage was (34.3±8.4) minutes, which were shorter than in control group (p < 0.05). Cervical and perineum laceration, the rate of Cesarean section and character of amnionic fluid were lower in study group