- Email: [email protected]
O627 EFFECTIVENESS OF THE COMPONENTS OF ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR
S482
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
(P < 0.05), while there was a statistically significant difference between both groups in the treatment of dyspareunia (P ≥ 0.05). Conclusions: LUNA can be a last alternative option in well-selected patients for control of chronic pelvic pain without endometriosis; however, its effectiveness may not extend to other indications. Also, preliminary experience in the treatment of primary deep dyspareunia presents a promising perspective on the management of deep dyspareunia, especially if it will involve a team of social, psychological, and gynecological specialists. O626 RELATIONSHIP BETWEEN TIME TO PLACENTAL DELIVERY AND POST-PARTUM BLOOD LOSS W.R. Sheldon1,2 , J. Blum1 , J. Durocher1 , J. Trussell2,3 , B. Winikoff1 . 1 Gynuity Health Projects, New York, NY, United States; 2 Princeton University, Princeton, NJ, United States; 3 The Hull York Medical School, Hull, United Kingdom Objectives: Assess the relationship between time to placental delivery and post-partum blood loss among women with and without oxytocin prophylaxis. Materials: Secondary data analysis from two randomized controlled trials for the treatment of post-partum hemorrhage. Methods: The analysis involved a total of 39,110 women from four countries in two clinical regimens: one in which oxytocin prophylaxis was administered following birth of the baby; the other in which it was not. We used logistic regression to assess relationships between time to placental delivery and post-partum blood loss ≥700 mL. Results: In both clinical regimens, time to placental delivery was associated with increased risk of post-partum blood loss ≥700 mL. Among women with no oxytocin prophylaxis, the increased risk was greatest for third stage durations of 15 minutes or more, as compared with durations of 0 to 4 minutes. Among women with oxytocin prophylaxis, the increase in risk was significant for all third stage durations of 5 minutes or more, as compared with 0 to 4 minutes; however the change in risk remained relatively stable over time until third stage durations of 25 minutes or more. Conclusions: Time to placental delivery is a good predictor of postpartum blood loss, and particularly among those with no oxytocin prophylaxis. O627 EFFECTIVENESS OF THE COMPONENTS OF ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR W.R. Sheldon1,2 , J. Durocher1 , B. Winikoff1 , J. Blum1 , J. Trussell2,3 . 1 Gynuity Health Projects, New York, NY, United States; 2 Princeton University, Princeton, NJ, United States; 3 The Hull York Medical School, Hull, United Kingdom Objectives: Assess the independent and combined effectiveness of the interventions currently recommended for active management of the third stage of labour: oxytocin prophylaxis, controlled cord traction, and uterine massage. Materials: Secondary data analysis from two randomized controlled trials for the treatment of post-partum hemorrhage. Methods: The analysis involved a total of 39,202 women from four countries in two clinical regimens: one in which oxytocin prophylaxis was administered following birth of the baby; the other in which it was not. We used logistic regression to assess relationships between the active management components and post-partum blood loss ≥700 mL. Results: Among those with no oxytocin prophylaxis, provision of controlled cord traction reduced hemorrhage risk by nearly 50% as compared with expectant management (P < 0.001), while uterine massage was associated with increased hemorrhage risk. Among those with oxytocin prophylaxis, the additional provision of controlled cord traction reduced hemorrhage risk by 60% (P < 0.000) as compared with oxytocin alone; while the additional provision of
controlled cord traction plus uterine massage was no more effective than provision of oxytocin alone. Conclusions: Controlled cord traction is an important means for reducing post-partum hemorrhage risk among women with and without oxytocin prophylaxis, while the benefit of uterine massage is less clear. O628 THE IMPACT OF ORAL CONTRACEPTIVES, METFORMIN AND LIFESTYLE MODIFICATION ON THE METABOLISM DISORDER IN POLYCYSTIC OVARY SYNDROME WOMEN: A RANDOMIZED CONTROLLED TRIAL Q.Y. Wang1 , W. Huang1 , Y.S. Song1 , X. Li1 , L.L. Shen1 . 1 Obstetrics and Gynecology, West China Secong University Hospital of Sichuan University, Chengdu, Sichuan, China Objectives: To investigate the effect of COCs containing cyproterone acetate (CPA) or drospirenone (DRP) combined metformin and lifestyle modification on carbohydrate and lipid metabolism in PCOS patients with IR. Materials: 110 PCOS women diagnosed according to Rotterdam criteria were randomly separated into two groups: group DRP (n = 55) received 3mg DRP plus 30ug ethinyl estradiol and group CPA (n = 55) received 2mg CPA plus 35ug ethinyl estradiol, all participants took COCs continuously 21d with 7d internal for 6 cycles. Meantime, they received 1500mg/d metformin and lifestyle modification such as dietary and exercise. Methods: The body mass index (BMI), waist-to-lip ratio (WHR), blood pressure, score of GAGS and Ferriman-Gallwey were assessed at baseline and the 3th and the 6th treatment cycle. The biochemical profile as hormone profile, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), the insulin and glucose areas under the curve (AUC) by means of oral glucose tolerance tests (OGTT), and lipid profile {total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high- density lipoprotein cholesterol (HDL), triglyceride, and hemoglobin A1c (HbA1c)} were measured at baseline and in the 6th treatment cycle. Results: After six treatment cycle, the score of acne and hirsutism, and BMI decreased significantly in both groups. The systolic and diastolic blood pressure in group CPA increased than baseline and significantly higher than group DRP. In DRP-group, the fasting glucose decreased significantly; the glucose to insulin ratio and the AUC of plasma glucose upon OGTT statistically significantly increased; but the decrement of fasting insulin and the AUC of insulin had no significantly different; The lipid profiles were all statistically increased, while the ratio of LDL/HDL and TC/HDL decreased significantly). In CPA-group, The AUC of insulin decreased significantly than baseline; TC and HDL were significantly increased, LDL/HDL ratio decreased. Conclusions: The either DRP-COCs or CPA-COCs combined with metformin and lifestyle modification can significantly improve acne and BMI in PCOS women with metabolite disorder. Most importantly, both of them didn’t exaggerate the carbohydrate and lipid profile in these women; and DRP-COC has beneficial on blood pressure. O629 CERVICAL PRIMING WITH SUBLINGUAL MISOPROSTOL PRIOR TO OFFICE HYSTEROSCOPY: A RANDOMIZED CONTROLLED TRIAL A.M.El. Sherbiny1 , O.A. Shawki2 , W.S. Abd Elgaber2 . 1 Dr. Sherbiny Hospital, Damietta, Damietta, Egypt; 2 Kasr Al. Ainy Hospital, Cairo, Cairo, Egypt Objectives: To evaluate the effectiveness and possible adverse effects of sublingual misoprostol for cervical priming before office hysteroscopy in infertile, perimenopausal and postmenopausal women. Materials: A total of 60 women scheduled for diagnostic office hysteroscopy (using vaginoscopic technique) either due to infertility, perimenopausal or postmenopausal bleeding.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
(P < 0.05), while there was a statistically significant difference between both groups in the treatment of dyspareunia (P ≥ 0.05). Conclusions: LUNA can be a last alternative option in well-selected patients for control of chronic pelvic pain without endometriosis; however, its effectiveness may not extend to other indications. Also, preliminary experience in the treatment of primary deep dyspareunia presents a promising perspective on the management of deep dyspareunia, especially if it will involve a team of social, psychological, and gynecological specialists. O626 RELATIONSHIP BETWEEN TIME TO PLACENTAL DELIVERY AND POST-PARTUM BLOOD LOSS W.R. Sheldon1,2 , J. Blum1 , J. Durocher1 , J. Trussell2,3 , B. Winikoff1 . 1 Gynuity Health Projects, New York, NY, United States; 2 Princeton University, Princeton, NJ, United States; 3 The Hull York Medical School, Hull, United Kingdom Objectives: Assess the relationship between time to placental delivery and post-partum blood loss among women with and without oxytocin prophylaxis. Materials: Secondary data analysis from two randomized controlled trials for the treatment of post-partum hemorrhage. Methods: The analysis involved a total of 39,110 women from four countries in two clinical regimens: one in which oxytocin prophylaxis was administered following birth of the baby; the other in which it was not. We used logistic regression to assess relationships between time to placental delivery and post-partum blood loss ≥700 mL. Results: In both clinical regimens, time to placental delivery was associated with increased risk of post-partum blood loss ≥700 mL. Among women with no oxytocin prophylaxis, the increased risk was greatest for third stage durations of 15 minutes or more, as compared with durations of 0 to 4 minutes. Among women with oxytocin prophylaxis, the increase in risk was significant for all third stage durations of 5 minutes or more, as compared with 0 to 4 minutes; however the change in risk remained relatively stable over time until third stage durations of 25 minutes or more. Conclusions: Time to placental delivery is a good predictor of postpartum blood loss, and particularly among those with no oxytocin prophylaxis. O627 EFFECTIVENESS OF THE COMPONENTS OF ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR W.R. Sheldon1,2 , J. Durocher1 , B. Winikoff1 , J. Blum1 , J. Trussell2,3 . 1 Gynuity Health Projects, New York, NY, United States; 2 Princeton University, Princeton, NJ, United States; 3 The Hull York Medical School, Hull, United Kingdom Objectives: Assess the independent and combined effectiveness of the interventions currently recommended for active management of the third stage of labour: oxytocin prophylaxis, controlled cord traction, and uterine massage. Materials: Secondary data analysis from two randomized controlled trials for the treatment of post-partum hemorrhage. Methods: The analysis involved a total of 39,202 women from four countries in two clinical regimens: one in which oxytocin prophylaxis was administered following birth of the baby; the other in which it was not. We used logistic regression to assess relationships between the active management components and post-partum blood loss ≥700 mL. Results: Among those with no oxytocin prophylaxis, provision of controlled cord traction reduced hemorrhage risk by nearly 50% as compared with expectant management (P < 0.001), while uterine massage was associated with increased hemorrhage risk. Among those with oxytocin prophylaxis, the additional provision of controlled cord traction reduced hemorrhage risk by 60% (P < 0.000) as compared with oxytocin alone; while the additional provision of
controlled cord traction plus uterine massage was no more effective than provision of oxytocin alone. Conclusions: Controlled cord traction is an important means for reducing post-partum hemorrhage risk among women with and without oxytocin prophylaxis, while the benefit of uterine massage is less clear. O628 THE IMPACT OF ORAL CONTRACEPTIVES, METFORMIN AND LIFESTYLE MODIFICATION ON THE METABOLISM DISORDER IN POLYCYSTIC OVARY SYNDROME WOMEN: A RANDOMIZED CONTROLLED TRIAL Q.Y. Wang1 , W. Huang1 , Y.S. Song1 , X. Li1 , L.L. Shen1 . 1 Obstetrics and Gynecology, West China Secong University Hospital of Sichuan University, Chengdu, Sichuan, China Objectives: To investigate the effect of COCs containing cyproterone acetate (CPA) or drospirenone (DRP) combined metformin and lifestyle modification on carbohydrate and lipid metabolism in PCOS patients with IR. Materials: 110 PCOS women diagnosed according to Rotterdam criteria were randomly separated into two groups: group DRP (n = 55) received 3mg DRP plus 30ug ethinyl estradiol and group CPA (n = 55) received 2mg CPA plus 35ug ethinyl estradiol, all participants took COCs continuously 21d with 7d internal for 6 cycles. Meantime, they received 1500mg/d metformin and lifestyle modification such as dietary and exercise. Methods: The body mass index (BMI), waist-to-lip ratio (WHR), blood pressure, score of GAGS and Ferriman-Gallwey were assessed at baseline and the 3th and the 6th treatment cycle. The biochemical profile as hormone profile, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), the insulin and glucose areas under the curve (AUC) by means of oral glucose tolerance tests (OGTT), and lipid profile {total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high- density lipoprotein cholesterol (HDL), triglyceride, and hemoglobin A1c (HbA1c)} were measured at baseline and in the 6th treatment cycle. Results: After six treatment cycle, the score of acne and hirsutism, and BMI decreased significantly in both groups. The systolic and diastolic blood pressure in group CPA increased than baseline and significantly higher than group DRP. In DRP-group, the fasting glucose decreased significantly; the glucose to insulin ratio and the AUC of plasma glucose upon OGTT statistically significantly increased; but the decrement of fasting insulin and the AUC of insulin had no significantly different; The lipid profiles were all statistically increased, while the ratio of LDL/HDL and TC/HDL decreased significantly). In CPA-group, The AUC of insulin decreased significantly than baseline; TC and HDL were significantly increased, LDL/HDL ratio decreased. Conclusions: The either DRP-COCs or CPA-COCs combined with metformin and lifestyle modification can significantly improve acne and BMI in PCOS women with metabolite disorder. Most importantly, both of them didn’t exaggerate the carbohydrate and lipid profile in these women; and DRP-COC has beneficial on blood pressure. O629 CERVICAL PRIMING WITH SUBLINGUAL MISOPROSTOL PRIOR TO OFFICE HYSTEROSCOPY: A RANDOMIZED CONTROLLED TRIAL A.M.El. Sherbiny1 , O.A. Shawki2 , W.S. Abd Elgaber2 . 1 Dr. Sherbiny Hospital, Damietta, Damietta, Egypt; 2 Kasr Al. Ainy Hospital, Cairo, Cairo, Egypt Objectives: To evaluate the effectiveness and possible adverse effects of sublingual misoprostol for cervical priming before office hysteroscopy in infertile, perimenopausal and postmenopausal women. Materials: A total of 60 women scheduled for diagnostic office hysteroscopy (using vaginoscopic technique) either due to infertility, perimenopausal or postmenopausal bleeding.