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W324 ADVANCED MATERNAL AGE AND PREGNANCY OUTCOME
S810
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
Materials: Predesign spreadsheet. Methods: Retrospective observational study between 1/12/2011 and 31/1/2012. Location: public maternity ward of reference of Uruguay, at Pereira Rossell Hospital. Population: convenience sample that includes all patients who underwent pharmacological induction of labour during the study period (n = 203), 60 of which (29.5%) were due to PROM. Results: Among patients with PROM, in 98.3% of cases the induction mechanism was oxytocin and only in 1 case misoprostol (1.7%). While in the non-PROM population, misoprostol was used in 36% of cases (52/143). 13.3% of patients with PROM (8/60) had a caesarean section due to induction failure, which corresponded to 57% of all caesarean indications. Analysing Bishop score and parity as prognostic factors, 75% of patients were primiparous and 87% presented a Bishop score <6, with a RR of induction failure of 0.99 (95% CI 0.72–1.12) and 0.99 (95% CI 0.71–1.37) respectively. Analysing the time between the PROM and the beginning of induction, in 49.1% of cases the induction started within the first 6 hours and in 50.9%, after the first 6 hours. The average time in which the induction failure was diagnosed was 9.12 hours from the moment of the PROM, with an average time of 4.62 hours between the PROM and the beginning of the induction. Conclusions: In our population, oxytocin is the most used drug for pharmacological induction among women with PROM, while misoprostol is rarely used. In 13.3% of the inductions due to PROM, a caesarean section is performed for induction failure and there is a higher percentage of primiparous patients and with a lower Bishop score in comparision with successful inductions but these differences are not statistically significant. In our hospital, the average time in diagnosing failure of induction as well as the time in which pharmacological induction is started is alarmingly low in relation to international W324 ADVANCED MATERNAL AGE AND PREGNANCY OUTCOME G. Stratoudakis1 , C. Christodoulaki1 , K. Kastrinakis1 , A. Zisiou1 , H. Polyzou1 , M. Kalloniatou1 , M. Kampanieris1 , A. Tsopelas1 , G. Daskalakis1 . 1 Department of Obstetrics & Gynecology, Chania, Creta, Greece Objectives: To evaluate the effect of advanced maternal age on obstetric and perinatal outcomes in singleton gestations and in nulliparous. Materials: We analysed retrospectively the birth registry records of General Hospital of Chania, in Greece between January 2005 and December 2011 and we study all singleton pregnancies with the maternal age of 35 years or older and we compared the outomes with that in younger nulliparous. Methods: Information on their sociodemographic characteristics, antenatal history, maternal and labor complications (pre-eclampsia, gestational diabetes, antepartum haemorrhage, preterm delivery, delivery methods divided into normal vaginal delivery, vacuum delivery, caesarean delivery before labour and in labour, placental abruption, postpartum haemorrhage, breech presentation, abnormal cardiotocography and intrauterine foetal death), birth weight, Apgar scores and perinatal complications were extracted. Results: There were a total of 5567 parturients during the period under review and 234 of these were elderly nulliparous, while 1348 were young primigravid mothers. The prevalence of elderly nulliparous was 4.2% and the prevalence of young primigravid mothers was 24.2%. The mean age of elderly primigravidae was 36.8±1.9 years, while the mean age of young primigravidae was 26.6±3.7 years. 210 (89.7%) of the elderly nulliparous were married while, 1093 (81.1%) of young primigravidae were married. 215 (91.8%) of the elderly nulliparous were from Greece while 930 (68.9%) of young primigravidae were from Greece. 64.9% (152) of the elderly nulliparous had caesarean delivery as compared to 419 (31%) of the younger primigravidae. The main indications for the caesarean deliveries were severe pre-eclampsia with unfavorable
cervix, breech presentation, cephalopelvic disproportion, and placenta previa. The instrumental vaginal delivery rates were 10.9% (9) for the elderly nulliparous and 3.4% (32) for the young primigravidae. Twenty six (11.1%) of the babies delivered to the elderly nulliparous were low birth weight while 165 (12.2%) of the babies of the younger primigravidae were low birth weight. A larger proportion 38 (16.3%) of the elderly nulliparous had macrosomic babies compared to the younger primigravidae 91 (6.7%). Conclusions: The prevalence of elderly nulliparous in our centre is 4.2%. The elderly nulliparous are at increased risk for preterm birth, macrosomic newborns and caesarean deliveries compared to younger primigravid women. W325 MEDICAL MANAGEMENT OF LATE INTRAUTERINE DEATH USING A COMBINATION OF MIFEPRISTONE AND MISOPROSTOL L. Haque1 , F. Fatima1 , M. Mathur1 , P. Ashok1 . 1 Aberdeen Maternity Hospital, Aberdeen, United Kingdom Objectives: To assess the efficacy and safety of mifepristone in combination with misoprostol in the management of late fetal death. Methods: This is an Observational study done at Aberdeen Maternity Hospital, Aberdeen UK. 267 patients with IUD were identified over an 11 year period (from 1997–2008), but only 72 of these were over 24 weeks of gestation and included in the study. All patients received a single dose of 200 mg of mifepristone orally, followed by 100–800 micrograms of intra vaginal/oral misoprostol after 24–48 hours interval. Data was entered and analysed in SPSS version 16. Results: The mean age (+SD) of the study group was 28 (+5.12) with mean gestational age at which IUD occurred was 32week. Of these 30 (41.6%) were primigravida. Of the 42 (58.4%) multiparous women 5 (12%) had previous caesarean sections. Presentation of fetus at the time of IUD was cephalic in 79%, breech 19% and 2%oblique lie. The mean duration of mifepristone to misoprostol interval was 25.1 hrs (+18.3) and the mean duration between induction of labour and delivery was 14.9hrs (+14.9), mean number of misoprostol doses given was 3. The number of patient who required oral analgesia were 41 (78%) and 6 (4.5%) required parental analgesia. There was no complications in 66 (92%), with 4 (6%) required manual removal of placenta, 1 (1.5%) had ARM+augmentation with syntocinon and 1 (1.5%) had postpartum haemorrhage. Conclusions: This observational study illustrates the efficacy of the above regimen using mifepristone and a higher dose of misoprostol. Given the high success rate with the regimen with none of our patients requiring a CS for failed IOL we find no rationale in reducing the dose of misoprostol for IOL for late IUD. W326 BREECH PRESENTATION BEYOND 34 WEEKS – DOES THE TYPE OF LABOR INTERFERE WITH THE OUTCOME? A.I. Machado1 , N.F. Oliveira1 , L. Correia1 . 1 Maternity Dr. Alfredo da Costa, Lisbon, Portugal Objectives: The purpose of this study is to compare maternal and neonatal outcomes of breech presentation beyond 34 weeks of pregnancy between breech vaginal birth, elective cesarean and cesarean in labor. Materials: This is a retrospective study performed between 2005 and 2011. We defined three groups: 1 – vaginal birth, 2 – elective cesarean, 3 – cesarean in labor. All medical profiles belonging to single pregnancies with breech presentation who had vaginal birth beyond 34 weeks were reviewed and 2 elective cesarean to 1 cesarean in labor were randomly selected by each year. Methods: Demographic characteristics, conditions to vaginal birth, characteristics of labor, neonatal and maternal outcomes were analyzed. SPSS 20 and nonparametric tests were performed for statistic analysis.
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
Materials: Predesign spreadsheet. Methods: Retrospective observational study between 1/12/2011 and 31/1/2012. Location: public maternity ward of reference of Uruguay, at Pereira Rossell Hospital. Population: convenience sample that includes all patients who underwent pharmacological induction of labour during the study period (n = 203), 60 of which (29.5%) were due to PROM. Results: Among patients with PROM, in 98.3% of cases the induction mechanism was oxytocin and only in 1 case misoprostol (1.7%). While in the non-PROM population, misoprostol was used in 36% of cases (52/143). 13.3% of patients with PROM (8/60) had a caesarean section due to induction failure, which corresponded to 57% of all caesarean indications. Analysing Bishop score and parity as prognostic factors, 75% of patients were primiparous and 87% presented a Bishop score <6, with a RR of induction failure of 0.99 (95% CI 0.72–1.12) and 0.99 (95% CI 0.71–1.37) respectively. Analysing the time between the PROM and the beginning of induction, in 49.1% of cases the induction started within the first 6 hours and in 50.9%, after the first 6 hours. The average time in which the induction failure was diagnosed was 9.12 hours from the moment of the PROM, with an average time of 4.62 hours between the PROM and the beginning of the induction. Conclusions: In our population, oxytocin is the most used drug for pharmacological induction among women with PROM, while misoprostol is rarely used. In 13.3% of the inductions due to PROM, a caesarean section is performed for induction failure and there is a higher percentage of primiparous patients and with a lower Bishop score in comparision with successful inductions but these differences are not statistically significant. In our hospital, the average time in diagnosing failure of induction as well as the time in which pharmacological induction is started is alarmingly low in relation to international W324 ADVANCED MATERNAL AGE AND PREGNANCY OUTCOME G. Stratoudakis1 , C. Christodoulaki1 , K. Kastrinakis1 , A. Zisiou1 , H. Polyzou1 , M. Kalloniatou1 , M. Kampanieris1 , A. Tsopelas1 , G. Daskalakis1 . 1 Department of Obstetrics & Gynecology, Chania, Creta, Greece Objectives: To evaluate the effect of advanced maternal age on obstetric and perinatal outcomes in singleton gestations and in nulliparous. Materials: We analysed retrospectively the birth registry records of General Hospital of Chania, in Greece between January 2005 and December 2011 and we study all singleton pregnancies with the maternal age of 35 years or older and we compared the outomes with that in younger nulliparous. Methods: Information on their sociodemographic characteristics, antenatal history, maternal and labor complications (pre-eclampsia, gestational diabetes, antepartum haemorrhage, preterm delivery, delivery methods divided into normal vaginal delivery, vacuum delivery, caesarean delivery before labour and in labour, placental abruption, postpartum haemorrhage, breech presentation, abnormal cardiotocography and intrauterine foetal death), birth weight, Apgar scores and perinatal complications were extracted. Results: There were a total of 5567 parturients during the period under review and 234 of these were elderly nulliparous, while 1348 were young primigravid mothers. The prevalence of elderly nulliparous was 4.2% and the prevalence of young primigravid mothers was 24.2%. The mean age of elderly primigravidae was 36.8±1.9 years, while the mean age of young primigravidae was 26.6±3.7 years. 210 (89.7%) of the elderly nulliparous were married while, 1093 (81.1%) of young primigravidae were married. 215 (91.8%) of the elderly nulliparous were from Greece while 930 (68.9%) of young primigravidae were from Greece. 64.9% (152) of the elderly nulliparous had caesarean delivery as compared to 419 (31%) of the younger primigravidae. The main indications for the caesarean deliveries were severe pre-eclampsia with unfavorable
cervix, breech presentation, cephalopelvic disproportion, and placenta previa. The instrumental vaginal delivery rates were 10.9% (9) for the elderly nulliparous and 3.4% (32) for the young primigravidae. Twenty six (11.1%) of the babies delivered to the elderly nulliparous were low birth weight while 165 (12.2%) of the babies of the younger primigravidae were low birth weight. A larger proportion 38 (16.3%) of the elderly nulliparous had macrosomic babies compared to the younger primigravidae 91 (6.7%). Conclusions: The prevalence of elderly nulliparous in our centre is 4.2%. The elderly nulliparous are at increased risk for preterm birth, macrosomic newborns and caesarean deliveries compared to younger primigravid women. W325 MEDICAL MANAGEMENT OF LATE INTRAUTERINE DEATH USING A COMBINATION OF MIFEPRISTONE AND MISOPROSTOL L. Haque1 , F. Fatima1 , M. Mathur1 , P. Ashok1 . 1 Aberdeen Maternity Hospital, Aberdeen, United Kingdom Objectives: To assess the efficacy and safety of mifepristone in combination with misoprostol in the management of late fetal death. Methods: This is an Observational study done at Aberdeen Maternity Hospital, Aberdeen UK. 267 patients with IUD were identified over an 11 year period (from 1997–2008), but only 72 of these were over 24 weeks of gestation and included in the study. All patients received a single dose of 200 mg of mifepristone orally, followed by 100–800 micrograms of intra vaginal/oral misoprostol after 24–48 hours interval. Data was entered and analysed in SPSS version 16. Results: The mean age (+SD) of the study group was 28 (+5.12) with mean gestational age at which IUD occurred was 32week. Of these 30 (41.6%) were primigravida. Of the 42 (58.4%) multiparous women 5 (12%) had previous caesarean sections. Presentation of fetus at the time of IUD was cephalic in 79%, breech 19% and 2%oblique lie. The mean duration of mifepristone to misoprostol interval was 25.1 hrs (+18.3) and the mean duration between induction of labour and delivery was 14.9hrs (+14.9), mean number of misoprostol doses given was 3. The number of patient who required oral analgesia were 41 (78%) and 6 (4.5%) required parental analgesia. There was no complications in 66 (92%), with 4 (6%) required manual removal of placenta, 1 (1.5%) had ARM+augmentation with syntocinon and 1 (1.5%) had postpartum haemorrhage. Conclusions: This observational study illustrates the efficacy of the above regimen using mifepristone and a higher dose of misoprostol. Given the high success rate with the regimen with none of our patients requiring a CS for failed IOL we find no rationale in reducing the dose of misoprostol for IOL for late IUD. W326 BREECH PRESENTATION BEYOND 34 WEEKS – DOES THE TYPE OF LABOR INTERFERE WITH THE OUTCOME? A.I. Machado1 , N.F. Oliveira1 , L. Correia1 . 1 Maternity Dr. Alfredo da Costa, Lisbon, Portugal Objectives: The purpose of this study is to compare maternal and neonatal outcomes of breech presentation beyond 34 weeks of pregnancy between breech vaginal birth, elective cesarean and cesarean in labor. Materials: This is a retrospective study performed between 2005 and 2011. We defined three groups: 1 – vaginal birth, 2 – elective cesarean, 3 – cesarean in labor. All medical profiles belonging to single pregnancies with breech presentation who had vaginal birth beyond 34 weeks were reviewed and 2 elective cesarean to 1 cesarean in labor were randomly selected by each year. Methods: Demographic characteristics, conditions to vaginal birth, characteristics of labor, neonatal and maternal outcomes were analyzed. SPSS 20 and nonparametric tests were performed for statistic analysis.