The grandmultipara in a modern setting

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rated the pain more severe than those, who tolerated crushed ice longer. Conclusions: Measured both by CF’I and VAS, women with extreme fear of labor pain seem to be more pain-sensitive than those without such fear, although beforehand the both groups estimated their pain tolerance quite similarly. Evidently, these finding reflect the need of individual pain relief during labor.

P2.02.03 LABOR AND DELIVERY FOLLOWING SUCCESFUL EXTERNAL CEPHALIC VERSION J. K. Sutula, T. Lerer, .I. Steinfeld, C. Ingardia, Dept. OB/GYN, Hartford Hospital, Hartford, CT, USA. Objective: To determine if successful external cephalic version is followed by an increased likelihood of prolonged labor or operative delivery. Study Methods: Women having a successful external cephalic version of a normal singleton fetus237 weeks gestation between l/1/97 and 12/31/98 were included. Each case was matched for gestational age at delivery (kl week), labor onset (spontaneous or induced), prior vaginal delivery (yes or no), and cervical dilation on admission for delivery (kl cm) to the next 3 patients delivering a naturally vertex term singleton. Maternal demographics, intrapartum variables, neonatal outcomes, and route of delivery were examined. Statistical comparisons were performed by the student t-test or Fisher exact test. Results: The 38 cases and 114 controls were similar by maternal age, race, gestational age at delivery, birth weight, and insurer. There were no differences in the frequency of epidural or oxytocin use, maternal genital tract lacerations, or blood loss at delivery. Neonatal outcomes, assessed by 1 and 5 minute Apgar score<7, or NICU admission did not differ between cases and controls. The labor length of patients undergoing successful version was similar to that of women laboring with naturally vertex fetuses (10.8*8.9 vs. 1O.hlO.l hours, p=O.4). The sample size provided 76% power to detect a 50% increase in labor duration from 10 hours to 1.5 hours following version. The frequencies of operative vaginal and cesarean delivery in cases did not differ from those of controls (3/38 vs. l/114, p= 0.56 and 4/38 vs. E/114, p=O.51, respectively). Conclusion: Labor duration and delivery route following successful external cephalic version do not differ from women with naturally vertex fetuses.

P2.02.04 DELIVERY UNDER WATER, SAFETY AND HOW DIFFERENT IS FROM CONVENTIONAL BIRTHS W.N. Rodrieocll, L. Brown (2), C. Williams(2), R.S.V. Carhnill(2), (1) Maternity Unit, New Cross Hospital, Wolverhampton, UK. (2) Good Hope Hospital, Birmingham, UK

IT

Objectives: To investigate the difference of characteristics of labor, analgesic requirements, maternal and perinatal outcome between the under water births and conventional births in uncomplicated primigravida. Study Methods: Case controlled retrospective study involving 150 primigravida in each group and the deliveries under water were matched for age, gestation and birth weights. Results: Cervical dilatation in the first stage of the labor (1.28 versus 1.35 cm/hour), duration of second stage of labor (52.5 vs. 56min) and duration of third stage (11.59 vs. 11.4min) were not statistically significantly different between two groups. Women who delivered under water mostly (85%) used entonox and 14.5% women did not use any analgesic. Unconventional births, 32% subjects used entonox, 38% pethidine and entonox, and 10.7% used epidural for analgesia. There were more second-degree perineal tears (39%), vaginal and labial tears among the women delivered under water. But there were more seconddegree perineal trauma in women who delivered conventionally when episiotomies and second-degree perineal tears were combined (53%). The apgar scores at one (8.23 vs. 8.35) and five (9.03 vs. 9.18) minutes were not statistically significantly different between two groups. There were more admissions for special baby care unit among babies delivered under water (odds ratio of 3.08). Conclusions: Duration of three stages of labor and perineal trauma was similar in both groups. Women who delivered under water had greatly reduced need for pain relief. The data also suggests that further research

is necessary morbidity.

to evaluate the safety of water births in respect to perinatal

P2.02.05 THE GRANDMULTIPARA IN A MODERN SETTING Buee GJ Atwal S Maresh M, St Mary’s Hospital, Manchester

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Objective: Our purpose was to compare the incidence of intrapartum complications among grand multiparous women with that of age-matched control multiparous women. Study design: A total of 397 grand multiparous women (para > or = 5) were compared with 397 age-matched control subjects (para 2 to 3), all delivering between April 1996 and December 1998. Intrapartum complications classically associated with grand multiparity (abruptioplacentae, dysfunctional labour, fetal malpresentation and postpartum haemorrhage) were compared. Antepartum complications and neonatal complications were also reviewed. Results: A high proportion of the grandmultiparous subjects were Jewish (21.2 % vs 1.8%). Both groups had comparable antepartum complications, neonatal complications and gestational ages at delivery. The overall incidence of intrapartum complications for grand multiparous women was 15.1% (60/397 patients), not significantly different from that of the control multiparous women, 16.7% (67/397) (odds ratio 0.87,95% CI 0.6-1.28). Grand multiparity was associated with an increased incidence of antenatal anaemia (22% vs 15.5%, odds ratio 1.6 95%CI 1.1-2.3) and a decreased incidence of elective caesarean section (6% vs ll%,odds ratio 0.52,95% CI 0.3-0.88). Instrumental vaginal delivery also had a decreased incidence in the grand multiparous group (0.7% vs 3%, odds ratio 0.24 95% CI 0.07. 0.86). Conclusions: Grand multiparous patients delivering at our hospital do not have an increased incidence of intrapartum complications and have a low incidence of operative deliveries.

P2.02.06 RELATIONSHIP OF ACID-BASE ANALYSIS OF FETAL SCALP BLOOD DURING LABOR TO UMBILICAL CORD BLOOD AT DELIVERY G. Morean (l), W. Wijngaarden (2), B. Strachan (3) (1) Dept. OB/GYN, Nottingham City Hospital, Newcastle-Upon-Tyne, UK. (2) Dept. OB/GYN, Academish Medish Centrum, Amsterdam, Netherlands. (3) Dept. OB/GYN, Queens Medical Centre, Nottingham, UK. Objectives: The sensitivity and specificity of electronic fetal monitoring can be improved with the use of fetal scalp sampling during labor. We wished to study the relationship of scalp sampling during labor with umbilical cord acid-base balance at delivery to identify the predicative ability of fetal blood sampling to predict a poor acid-base balance at delivery. Study Methods: Retrospective analysis was performed. Using the 1038 women randomized into the fetal ECG trial we identified 52 women where a fetal blood sample had been taken within one hour of delivery. The relationship of the scalp acid-base analysis to the umbilical cord gas analysis was studied. Results: The pH and base excess of the fetal scalp sample significantly correlated with both umbilical arterial and venous pH (?=0.23 p7.2, 8 (28%) were born with an arterial pH < 7.15 within an hour of sampling. Of 30 babies with a scalp BE <-8mmolfl3 (10%) were born with and arterial base excess of >-lOmmol/l within an hour of sampling. Conclusion: The pH and base excess of fetal scalp sampling correlate better with venous than arterial sampling. The base excess correlates better than the pH. This may be because of a different distribution of the microvessels in the scalp of the human fetus so that fetal scalp blood may be more related to venous cord blood.