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BMFMS: Labour and Delivery

	PLD.01 COST COMPARISON OF CAESAREAN SECTION FOR ABNORMAL PLACENTATION WITH AND WITHOUT USE OF INTERVENTIONAL RADIOLOGY

TOP PLD.01 COST COMPARISON OF... PLD.02 CAN A NEW... PLD.03 CONTRACTILE PROPERTIES OF... PLD.04 THE ROLE OF... PLD.05 RANDOMISED CONTROLLED... PLD.06 A RANDOMISED TRIAL... PLD.07 CHILDBIRTH IN A... PLD.08 FETAL DISTRESS: A... PLD.09 UK SURVEY OF... PLD.10 THE LONGITUDINAL STUDY... PLD.11 OXYTOCIN-INDUCED... PLD.12 HIGH DEPENDENCY CARE... PLD.13 INTRAPARTUM STILLBIRTHS:... PLD.14 ASSESSING THE HUMAN... PLD.15 "SAFE" TRAINING TO... PLD.16 WITHDRAWN PLD.17 EPIDURAL ANALGESIA: THE... PLD.18 RISK OF LATE... PLD.19 PERINEAL TRAUMA IN... PLD.20 DIGIT PREFERENCE AND... PLD.21 OPERATIVE DELIVERY IN... PLD.22 PROSPECTIVE STUDY OF... PLD.23 CAESAREAN SECTION RATES... PLD.24 TRIAL OF LABOUR... PLD.25 NEONATAL OUTCOMES OF... PLD.26 THE PATERNAL PERSPECTIVE... PLD.27 PREDICTIVE MODEL FOR... PLD.28 OUTCOME FOLLOWING A... PLD.29 OUTCOME OF EXTERNAL... PLD.30 LIVING WITH STAN:... PLD.31 ASSESSING THE IMPACT... PLD.32 ANAESTHETIC... PLD.33 PREGNANCY IN WOMEN... PLD.34 FACILITATING PLACENTAL... PLD.35 A WEB-BASED INFORMATION... PLD.36 CHANGES IN MYOMETRIAL... PLD.37 DELAYED UMBILICAL CORD... PLD.38 ONE HUNDRED AND... PLD.39 FETAL FIBRONECTIN BEDSIDE... PLD.40 OBSTETRIC AND NEONATAL... PLD.41 CASE REPORT: PSOAS... PLD.42 DECISION TO INCISION:... PLD.43 POSTNATAL RE-ADMISSIONS:... PLD.44 CHORIOAMNIONITIS OR... PLD.45 THE INTRODUCTION OF... PLD.46 TRENDS AND MODE... PLD.47 MANAGEMENT OF INCIDENTAL... PLD.48 NEONATAL OUTCOME AFTER... PLD.49 CASE PRESENTATION-... PLD.50 EVALUATION OF OUTCOMES... PLD.51 AUDIT OF THE... PLD.52 INTRAVAGINAL... PLD.53 SURVEY ON MATERNITY... PLD.54 CAESAREAN RATES AMONG... PLD.55 EVALUATION OF HYOSCINE-N... PLD.56 TIME IS OF... PLD.57 A SURVEY OF... PLD.58 INDUCTION OF LABOUR... PLD.59 PERINEAL TRAUMA... PLD.60 A 3-YEAR STUDY... PLD.61 PREVALENCE AND OUTCOME... PLD.62 UNEXPECTED COMPLICATION... PLD.63 AUDIT OF PATIENTS... PLD.64 ACCURACY OF GRADING... PLD.65 CONSENT FOR CAESAREAN... PLD.66 VAGINAL BIRTH AFTER... PLD.67 ESCAPE FROM DEATH,... REFERENCES

Postpartum haemorrhage remains a significant cause of maternal morbidity and mortality. Fourteen deaths are attributed directly to haemorrhage in the most recent CEMACH report. At least two major surveys have shown that approximately two-thirds of all cases of severe maternal morbidity, so called "near misses", are related to severe haemorrhage. Of women requiring hysterectomy, 38% had a morbidly adherent placenta: placenta accreta, percreta or increta.

Interventional radiology can be used as a prophylactic measure to reduce blood loss when there is a known or suspected case of placenta accreta or placenta praevia associated with a previous Caesarean section scar.

Balloons are placed in the internal iliac or uterine arteries before delivery. The balloons can be inflated to occlude the vessels when required. Embolisation can be performed via the balloon catheters if bleeding continues despite inflation.

It has been reported that while blood loss during routine Caesarean section averages 1000 ml, haemorrhage during Caesarean hysterectomy for associated placental abnormalities may require up to 70 units of replacement blood products.

We have looked at the cost incurred by our trust when we do elective section along with interventional radiology (£2601) and compared this with similar cases in which elective section was associated with major postpartum haemorrhage (£4510). This is based on 12 cases in which we used interventional radiology and cost analysis included inpatient stay, total cost of procedure, blood products and uterotonics.

We recommend that interventional radiology is effective in achieving haemostasis during Caesarean section performed for placental abnormalities and is also cost effective.

	PLD.02 CAN A NEW OXYTOCIN ANALOGUE REDUCE THE NEED FOR ADDITIONAL OXYTOCICS AFTER CAESAREAN SECTION? THE RESULTS OF A DOUBLE-BLIND RANDOMISED TRIAL

TOP PLD.01 COST COMPARISON OF... PLD.02 CAN A NEW... PLD.03 CONTRACTILE PROPERTIES OF... PLD.04 THE ROLE OF... PLD.05 RANDOMISED CONTROLLED... PLD.06 A RANDOMISED TRIAL... PLD.07 CHILDBIRTH IN A... PLD.08 FETAL DISTRESS: A... PLD.09 UK SURVEY OF... PLD.10 THE LONGITUDINAL STUDY... PLD.11 OXYTOCIN-INDUCED... PLD.12 HIGH DEPENDENCY CARE... PLD.13 INTRAPARTUM STILLBIRTHS:... PLD.14 ASSESSING THE HUMAN... PLD.15 "SAFE" TRAINING TO... PLD.16 WITHDRAWN PLD.17 EPIDURAL ANALGESIA: THE... PLD.18 RISK OF LATE... PLD.19 PERINEAL TRAUMA IN... PLD.20 DIGIT PREFERENCE AND... PLD.21 OPERATIVE DELIVERY IN... PLD.22 PROSPECTIVE STUDY OF... PLD.23 CAESAREAN SECTION RATES... PLD.24 TRIAL OF LABOUR... PLD.25 NEONATAL OUTCOMES OF... PLD.26 THE PATERNAL PERSPECTIVE... PLD.27 PREDICTIVE MODEL FOR... PLD.28 OUTCOME FOLLOWING A... PLD.29 OUTCOME OF EXTERNAL... PLD.30 LIVING WITH STAN:... PLD.31 ASSESSING THE IMPACT... PLD.32 ANAESTHETIC... PLD.33 PREGNANCY IN WOMEN... PLD.34 FACILITATING PLACENTAL... PLD.35 A WEB-BASED INFORMATION... PLD.36 CHANGES IN MYOMETRIAL... PLD.37 DELAYED UMBILICAL CORD... PLD.38 ONE HUNDRED AND... PLD.39 FETAL FIBRONECTIN BEDSIDE... PLD.40 OBSTETRIC AND NEONATAL... PLD.41 CASE REPORT: PSOAS... PLD.42 DECISION TO INCISION:... PLD.43 POSTNATAL RE-ADMISSIONS:... PLD.44 CHORIOAMNIONITIS OR... PLD.45 THE INTRODUCTION OF... PLD.46 TRENDS AND MODE... PLD.47 MANAGEMENT OF INCIDENTAL... PLD.48 NEONATAL OUTCOME AFTER... PLD.49 CASE PRESENTATION-... PLD.50 EVALUATION OF OUTCOMES... PLD.51 AUDIT OF THE... PLD.52 INTRAVAGINAL... PLD.53 SURVEY ON MATERNITY... PLD.54 CAESAREAN RATES AMONG... PLD.55 EVALUATION OF HYOSCINE-N... PLD.56 TIME IS OF... PLD.57 A SURVEY OF... PLD.58 INDUCTION OF LABOUR... PLD.59 PERINEAL TRAUMA... PLD.60 A 3-YEAR STUDY... PLD.61 PREVALENCE AND OUTCOME... PLD.62 UNEXPECTED COMPLICATION... PLD.63 AUDIT OF PATIENTS... PLD.64 ACCURACY OF GRADING... PLD.65 CONSENT FOR CAESAREAN... PLD.66 VAGINAL BIRTH AFTER... PLD.67 ESCAPE FROM DEATH,... REFERENCES

 
G. Attilakos¹, D. Psaroudakis¹, J. Ash¹, R. Buchanan¹, C. Winter¹, F. Donald¹, L. Hunt², T. Draycott¹. ¹Southmead Hospital, North Bristol NHS Trust, Bristol, UK, ²University of Bristol, Bristol, UK

Introduction: NICE currently recommends 5 IU syntocinon to prevent postpartum haemorrhage (PPH) after Caesarean section. However, additional oxytocics may be required. Carbetocin is an oxytocin analogue, with a longer half life, which may reduce the requirement for additional treatment.

Methods: We conducted a double-blind randomised study of carbetocin versus syntocinon (1 : 1 ratio). The anaesthetist administered either the licensed dose (100 µg) of carbetocin intravenously after the delivery of the fetus or 5 IU syntocinon, from blinded ampoules. The surgeon was permitted to ask for additional oxytocics when required clinically. Elective and emergency Caesarean sections were included. We excluded women with multiple gestation, placenta praevia, placental abruption, gestation less than 37 weeks or undergoing general anaesthesia.

Results: 377 women were randomly assigned in the study. Both study groups had similar demographic and antenatal data. More women in the syntocinon arm needed additional oxytocic interventions (45.5% versus 33.5%, p = 0.02). A large proportion of women received a 4-h infusion of syntocinon (30.2% versus 22.3%, p = 0.1). There were no differences in the estimated blood loss, side-effect profile, intra and postoperative blood pressure and pulse readings or between pre and postoperative haemoglobin.

Conclusions: More than 40% of women required additional oxytocics following 5 IU syntocinon, but this was significantly reduced in the carbetocin arm. There was also a trend towards significance for a reduction in the use of a 4-h syntocinon infusion post-Caesarean section after carbetocin. This decrease in pharmacological intervention may reduce delay in transferring women to the postnatal wards postoperatively.

	PLD.03 CONTRACTILE PROPERTIES OF MYOMETRIUM IN TWIN PREGNANCIES

TOP PLD.01 COST COMPARISON OF... PLD.02 CAN A NEW... PLD.03 CONTRACTILE PROPERTIES OF... PLD.04 THE ROLE OF... PLD.05 RANDOMISED CONTROLLED... PLD.06 A RANDOMISED TRIAL... PLD.07 CHILDBIRTH IN A... PLD.08 FETAL DISTRESS: A... PLD.09 UK SURVEY OF... PLD.10 THE LONGITUDINAL STUDY... PLD.11 OXYTOCIN-INDUCED... PLD.12 HIGH DEPENDENCY CARE... PLD.13 INTRAPARTUM STILLBIRTHS:... PLD.14 ASSESSING THE HUMAN... PLD.15 "SAFE" TRAINING TO... PLD.16 WITHDRAWN PLD.17 EPIDURAL ANALGESIA: THE... PLD.18 RISK OF LATE... PLD.19 PERINEAL TRAUMA IN... PLD.20 DIGIT PREFERENCE AND... PLD.21 OPERATIVE DELIVERY IN... PLD.22 PROSPECTIVE STUDY OF... PLD.23 CAESAREAN SECTION RATES... PLD.24 TRIAL OF LABOUR... PLD.25 NEONATAL OUTCOMES OF... PLD.26 THE PATERNAL PERSPECTIVE... PLD.27 PREDICTIVE MODEL FOR... PLD.28 OUTCOME FOLLOWING A... PLD.29 OUTCOME OF EXTERNAL... PLD.30 LIVING WITH STAN:... PLD.31 ASSESSING THE IMPACT... PLD.32 ANAESTHETIC... PLD.33 PREGNANCY IN WOMEN... PLD.34 FACILITATING PLACENTAL... PLD.35 A WEB-BASED INFORMATION... PLD.36 CHANGES IN MYOMETRIAL... PLD.37 DELAYED UMBILICAL CORD... PLD.38 ONE HUNDRED AND... PLD.39 FETAL FIBRONECTIN BEDSIDE... PLD.40 OBSTETRIC AND NEONATAL... PLD.41 CASE REPORT: PSOAS... PLD.42 DECISION TO INCISION:... PLD.43 POSTNATAL RE-ADMISSIONS:... PLD.44 CHORIOAMNIONITIS OR... PLD.45 THE INTRODUCTION OF... PLD.46 TRENDS AND MODE... PLD.47 MANAGEMENT OF INCIDENTAL... PLD.48 NEONATAL OUTCOME AFTER... PLD.49 CASE PRESENTATION-... PLD.50 EVALUATION OF OUTCOMES... PLD.51 AUDIT OF THE... PLD.52 INTRAVAGINAL... PLD.53 SURVEY ON MATERNITY... PLD.54 CAESAREAN RATES AMONG... PLD.55 EVALUATION OF HYOSCINE-N... PLD.56 TIME IS OF... PLD.57 A SURVEY OF... PLD.58 INDUCTION OF LABOUR... PLD.59 PERINEAL TRAUMA... PLD.60 A 3-YEAR STUDY... PLD.61 PREVALENCE AND OUTCOME... PLD.62 UNEXPECTED COMPLICATION... PLD.63 AUDIT OF PATIENTS... PLD.64 ACCURACY OF GRADING... PLD.65 CONSENT FOR CAESAREAN... PLD.66 VAGINAL BIRTH AFTER... PLD.67 ESCAPE FROM DEATH,... REFERENCES

 
P. A. Turton¹, S. Wray¹, J. Neilson², S. Quenby². ¹School of Biomedical Sciences, University of Liverpool, Liverpool, UK, ²School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool, UK

Twin pregnancies present greater risks to both the mother and fetuses. The major clinical risk is that of preterm labour, with 40–70% of multiple pregnancies ending with preterm delivery (before 37 weeks).

Increased uterine stretch may play a role in this. There have, however, been no studies of the contractile properties of myometrium from multiple pregnancies and so we have investigated this and compared them with singleton pregnancies.

Following informed consent and ethical approval, myometrial biopsies were obtained at Caesarean section, from women having either singleton (n = 11) or twin (n = 7) pregnancies. Strips of myometrium were dissected, attached to a force transducer and mounted in a bath perfused with physiological solution. The force of contraction (relative to high-K depolarisation), duration and frequency of contractions were measured in both groups, as well as their response to 10 nmol oxytocin.

Myometrium from twin pregnancies contracted more frequently than singletons (p = 0.02), and there was a non-significant decrease in duration (p = 0.06), although when gestation was accounted for there was a significant decrease in duration (p = 0.05). Contractions from myometria of twin pregnancies were non-significantly more augmented by oxytocin (p = 0.07).

This first insight into the differences in myometria, showing increased contraction frequency in twin pregnancies, provides the basis for further work, such as oxytocin receptor and potassium channel expression, which may provide us with targets for tocolytics in pre-term multiple pregnancy.

Funding: This work has been supported by the Wolfson Foundation and the Jean Shanks Foundation.

	PLD.04 THE ROLE OF CERVICAL ELECTRICAL IMPEDANCE SPECTROSCOPY IN THE PREDICTION OF THE COURSE AND OUTCOME OF INDUCED LABOUR

TOP PLD.01 COST COMPARISON OF... PLD.02 CAN A NEW... PLD.03 CONTRACTILE PROPERTIES OF... PLD.04 THE ROLE OF... PLD.05 RANDOMISED CONTROLLED... PLD.06 A RANDOMISED TRIAL... PLD.07 CHILDBIRTH IN A... PLD.08 FETAL DISTRESS: A... PLD.09 UK SURVEY OF... PLD.10 THE LONGITUDINAL STUDY... PLD.11 OXYTOCIN-INDUCED... PLD.12 HIGH DEPENDENCY CARE... PLD.13 INTRAPARTUM STILLBIRTHS:... PLD.14 ASSESSING THE HUMAN... PLD.15 "SAFE" TRAINING TO... PLD.16 WITHDRAWN PLD.17 EPIDURAL ANALGESIA: THE... PLD.18 RISK OF LATE... PLD.19 PERINEAL TRAUMA IN... PLD.20 DIGIT PREFERENCE AND... PLD.21 OPERATIVE DELIVERY IN... PLD.22 PROSPECTIVE STUDY OF... PLD.23 CAESAREAN SECTION RATES... PLD.24 TRIAL OF LABOUR... PLD.25 NEONATAL OUTCOMES OF... PLD.26 THE PATERNAL PERSPECTIVE... PLD.27 PREDICTIVE MODEL FOR... PLD.28 OUTCOME FOLLOWING A... PLD.29 OUTCOME OF EXTERNAL... PLD.30 LIVING WITH STAN:... PLD.31 ASSESSING THE IMPACT... PLD.32 ANAESTHETIC... PLD.33 PREGNANCY IN WOMEN... PLD.34 FACILITATING PLACENTAL... PLD.35 A WEB-BASED INFORMATION... PLD.36 CHANGES IN MYOMETRIAL... PLD.37 DELAYED UMBILICAL CORD... PLD.38 ONE HUNDRED AND... PLD.39 FETAL FIBRONECTIN BEDSIDE... PLD.40 OBSTETRIC AND NEONATAL... PLD.41 CASE REPORT: PSOAS... PLD.42 DECISION TO INCISION:... PLD.43 POSTNATAL RE-ADMISSIONS:... PLD.44 CHORIOAMNIONITIS OR... PLD.45 THE INTRODUCTION OF... PLD.46 TRENDS AND MODE... PLD.47 MANAGEMENT OF INCIDENTAL... PLD.48 NEONATAL OUTCOME AFTER... PLD.49 CASE PRESENTATION-... PLD.50 EVALUATION OF OUTCOMES... PLD.51 AUDIT OF THE... PLD.52 INTRAVAGINAL... PLD.53 SURVEY ON MATERNITY... PLD.54 CAESAREAN RATES AMONG... PLD.55 EVALUATION OF HYOSCINE-N... PLD.56 TIME IS OF... PLD.57 A SURVEY OF... PLD.58 INDUCTION OF LABOUR... PLD.59 PERINEAL TRAUMA... PLD.60 A 3-YEAR STUDY... PLD.61 PREVALENCE AND OUTCOME... PLD.62 UNEXPECTED COMPLICATION... PLD.63 AUDIT OF PATIENTS... PLD.64 ACCURACY OF GRADING... PLD.65 CONSENT FOR CAESAREAN... PLD.66 VAGINAL BIRTH AFTER... PLD.67 ESCAPE FROM DEATH,... REFERENCES

 
R. P. Jokhi¹, B. H. Brown², D. O. C. Anumba¹. ¹Academic Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield, UK, ²Department of Medical Physics, University of Sheffield, Sheffield, UK

Background: We sought to compare the predictive value of cervical electrical impedance spectroscopy with clinical assessment by the Bishop Score (BS) for the course and outcome of induced labour.

Methods: 205 women undergoing indicated induction of labour were assessed by BS and cervical resistivity was measured using four probes of 3, 6, 9 and 12 mm diameter, before prostaglandin or amniotomy. The association of measured parameters with labour characteristics and outcomes (time to onset of labour, duration of labour, requirement for augmentation of labour and mode of delivery) were tested by correlation statistics, multilinear regression and receiver operator characteristic curve analysis.

Results: Compared with cervical resistivity the BS score better predicted time to onset of labour >12 h but neither correlated with the duration of labour nor predicted delivery by Caesarean section (CS). Conversely pre-induction cervical resistivity, measured with the 12 mm probe, between 19 and 156 kHz, better predicted labour duration and delivery by CS, being significantly increased in women who delivered by CS versus those who delivered vaginally and in labours >24 h. Prediction of CS was best at 78 kHz, with an optimal cut-off cervical resistivity of 2.24 .m (area under the curve (AUC) 0.66, sensitivity 71.0%, specificity 56.5%). Prediction of labour duration was best at 39 kHz, with an optimal cut-off of 2.25 .m (AUC 0.623, sensitivity 72.7%, specificity 55.4%).

Conclusions: Cervical electrical impedance spectroscopy predicts the duration and mode of delivery following induced labour better than the BS. Probe design may enhance the potential clinical utility of this technique.

	PLD.05 RANDOMISED CONTROLLED TRIAL TO COMPARE THE EFFECTIVENESS OF PROSTAGLANDIN GEL VERSUS TABLETS IN LABOUR INDUCTION AT TERM

TOP PLD.01 COST COMPARISON OF... PLD.02 CAN A NEW... PLD.03 CONTRACTILE PROPERTIES OF... PLD.04 THE ROLE OF... PLD.05 RANDOMISED CONTROLLED... PLD.06 A RANDOMISED TRIAL... PLD.07 CHILDBIRTH IN A... PLD.08 FETAL DISTRESS: A... PLD.09 UK SURVEY OF... PLD.10 THE LONGITUDINAL STUDY... PLD.11 OXYTOCIN-INDUCED... PLD.12 HIGH DEPENDENCY CARE... PLD.13 INTRAPARTUM STILLBIRTHS:... PLD.14 ASSESSING THE HUMAN... PLD.15 "SAFE" TRAINING TO... PLD.16 WITHDRAWN PLD.17 EPIDURAL ANALGESIA: THE... PLD.18 RISK OF LATE... PLD.19 PERINEAL TRAUMA IN... PLD.20 DIGIT PREFERENCE AND... PLD.21 OPERATIVE DELIVERY IN... PLD.22 PROSPECTIVE STUDY OF... PLD.23 CAESAREAN SECTION RATES... PLD.24 TRIAL OF LABOUR... PLD.25 NEONATAL OUTCOMES OF... PLD.26 THE PATERNAL PERSPECTIVE... PLD.27 PREDICTIVE MODEL FOR... PLD.28 OUTCOME FOLLOWING A... PLD.29 OUTCOME OF EXTERNAL... PLD.30 LIVING WITH STAN:... PLD.31 ASSESSING THE IMPACT... PLD.32 ANAESTHETIC... PLD.33 PREGNANCY IN WOMEN... PLD.34 FACILITATING PLACENTAL... PLD.35 A WEB-BASED INFORMATION... PLD.36 CHANGES IN MYOMETRIAL... PLD.37 DELAYED UMBILICAL CORD... PLD.38 ONE HUNDRED AND... PLD.39 FETAL FIBRONECTIN BEDSIDE... PLD.40 OBSTETRIC AND NEONATAL... PLD.41 CASE REPORT: PSOAS... PLD.42 DECISION TO INCISION:... PLD.43 POSTNATAL RE-ADMISSIONS:... PLD.44 CHORIOAMNIONITIS OR... PLD.45 THE INTRODUCTION OF... PLD.46 TRENDS AND MODE... PLD.47 MANAGEMENT OF INCIDENTAL... PLD.48 NEONATAL OUTCOME AFTER... PLD.49 CASE PRESENTATION-... PLD.50 EVALUATION OF OUTCOMES... PLD.51 AUDIT OF THE... PLD.52 INTRAVAGINAL... PLD.53 SURVEY ON MATERNITY... PLD.54 CAESAREAN RATES AMONG... PLD.55 EVALUATION OF HYOSCINE-N... PLD.56 TIME IS OF... PLD.57 A SURVEY OF... PLD.58 INDUCTION OF LABOUR... PLD.59 PERINEAL TRAUMA... PLD.60 A 3-YEAR STUDY... PLD.61 PREVALENCE AND OUTCOME... PLD.62 UNEXPECTED COMPLICATION... PLD.63 AUDIT OF PATIENTS... PLD.64 ACCURACY OF GRADING... PLD.65 CONSENT FOR CAESAREAN... PLD.66 VAGINAL BIRTH AFTER... PLD.67 ESCAPE FROM DEATH,... REFERENCES

 
S. Taher¹, J. Inder Riden², S. Soltan², J. Elihoo¹, V. Terzidou¹, P. Bennett¹. ¹Imperial College, London, UK, ²Queen Charlotte’s and Chelsea Hospital, London, UK

Objective: To compare the effectiveness of prostaglandin gel versus tablets in term labour induction.

Design: Prospective randomised controlled trial.

Setting: Patients attending for induction of labour at term.

Participants: 172 women aged 15–47 years (38–42 weeks of pregnancy).

Interventions: Women were randomly allocated to either prostin gel or tablets.

Main Outcome Measures: Time interval between induction to delivery. Other outcome measures: mode and indication of delivery, frequency of epidural usage, oxytocin used, epidural as analgesia, meconium staining in labour, uterine hyperstimulation, need for fetal blood sampling and admission to neonatal unit.

Results: 165 patients were randomly assigned, 83 to the gel arm and 82 to the tablet arm. Induction to delivery interval was significantly shorter in the gel group, 1400 versus 1868 minutes (p = 0.04).

Conclusions: Prostin gel is more effective and has cost-benefit compared with tablets.

	PLD.06 A RANDOMISED TRIAL OF EPIDURAL VERSUS SPINAL ANAESTHESIA FOR CAESAREAN SECTION IN THE POTENTIALLY COMPROMISED FETUS

TOP PLD.01 COST COMPARISON OF... PLD.02 CAN A NEW... PLD.03 CONTRACTILE PROPERTIES OF... PLD.04 THE ROLE OF... PLD.05 RANDOMISED CONTROLLED... PLD.06 A RANDOMISED TRIAL... PLD.07 CHILDBIRTH IN A... PLD.08 FETAL DISTRESS: A... PLD.09 UK SURVEY OF... PLD.10 THE LONGITUDINAL STUDY... PLD.11 OXYTOCIN-INDUCED... PLD.12 HIGH DEPENDENCY CARE... PLD.13 INTRAPARTUM STILLBIRTHS:... PLD.14 ASSESSING THE HUMAN... PLD.15 "SAFE" TRAINING TO... PLD.16 WITHDRAWN PLD.17 EPIDURAL ANALGESIA: THE... PLD.18 RISK OF LATE... PLD.19 PERINEAL TRAUMA IN... PLD.20 DIGIT PREFERENCE AND... PLD.21 OPERATIVE DELIVERY IN... PLD.22 PROSPECTIVE STUDY OF... PLD.23 CAESAREAN SECTION RATES... PLD.24 TRIAL OF LABOUR... PLD.25 NEONATAL OUTCOMES OF... PLD.26 THE PATERNAL PERSPECTIVE... PLD.27 PREDICTIVE MODEL FOR... PLD.28 OUTCOME FOLLOWING A... PLD.29 OUTCOME OF EXTERNAL... PLD.30 LIVING WITH STAN:... PLD.31 ASSESSING THE IMPACT... PLD.32 ANAESTHETIC... PLD.33 PREGNANCY IN WOMEN... PLD.34 FACILITATING PLACENTAL... PLD.35 A WEB-BASED INFORMATION... PLD.36 CHANGES IN MYOMETRIAL... PLD.37 DELAYED UMBILICAL CORD... PLD.38 ONE HUNDRED AND... PLD.39 FETAL FIBRONECTIN BEDSIDE... PLD.40 OBSTETRIC AND NEONATAL... PLD.41 CASE REPORT: PSOAS... PLD.42 DECISION TO INCISION:... PLD.43 POSTNATAL RE-ADMISSIONS:... PLD.44 CHORIOAMNIONITIS OR... PLD.45 THE INTRODUCTION OF... PLD.46 TRENDS AND MODE... PLD.47 MANAGEMENT OF INCIDENTAL... PLD.48 NEONATAL OUTCOME AFTER... PLD.49 CASE PRESENTATION-... PLD.50 EVALUATION OF OUTCOMES... PLD.51 AUDIT OF THE... PLD.52 INTRAVAGINAL... PLD.53 SURVEY ON MATERNITY... PLD.54 CAESAREAN RATES AMONG... PLD.55 EVALUATION OF HYOSCINE-N... PLD.56 TIME IS OF... PLD.57 A SURVEY OF... PLD.58 INDUCTION OF LABOUR... PLD.59 PERINEAL TRAUMA... PLD.60 A 3-YEAR STUDY... PLD.61 PREVALENCE AND OUTCOME... PLD.62 UNEXPECTED COMPLICATION... PLD.63 AUDIT OF PATIENTS... PLD.64 ACCURACY OF GRADING... PLD.65 CONSENT FOR CAESAREAN... PLD.66 VAGINAL BIRTH AFTER... PLD.67 ESCAPE FROM DEATH,... REFERENCES

 
V. Ashton, N. Steen, V. Bythell, S. Robson. Newcastle University, Newcastle upon Tyne, UK

Background: Spinal anaesthesia provides rapid and effective anaesthesia for elective Caesarean section. In healthy fetuses, spinal anaesthesia is associated with a statistically significant, but clinically irrelevant, reduction in umbilical arterial pH compared with epidural anaesthesia. We hypothesised that in the potentially compromised fetus, spinal anaesthesia would result in a clinically significant reduction in umbilical artery pH (defined as a fall of 0.05).

Methods: 60 women with severe pre-eclampsia, a small-for-gestational-age fetus or both were randomly assigned to spinal (SA: 12.5 mg bupivacaine 0.5% + 300 µg diamorphine) or epidural (EA: 50 mg bupivacaine 0.5% + 50 µg fentanyl) anaesthesia stratified by umbilical artery Doppler. An intravenous infusion of phenylephrine was used to prevent hypotension in all women. Haemodynamic measurements included maternal cardiac output (measured by Doppler and cross-sectional echocardiography) and umbilical artery pulsatility index.

Results: Three women were randomly assigned but not studied. Mean gestational age at randomisation was 33 weeks and mean (SD) umbilical artery pulsatility index was 1.86 (1.37). Baseline mean (SD) umbilical artery pH and base excess was similar in the two groups (SA 7.26 (0.07), –3.80 (2.94) versus EA 7.25 (0.11), –4.36 (4.39), respectively). Despite greater falls in systolic blood pressure (SA (23 (27) versus EA 14 (17) mm Hg, p = 0.004) and diastolic blood pressure (SA 14 (17) versus EA 5 (14) mm Hg, p = 0.02), there were no differences in cardiac output and umbilical artery Doppler after anaesthesia.

Conclusions: Spinal anaesthesia, with optimum hypotension prophylaxis, does not adversely affect acid base status in the potentially compromised fetus.

	PLD.07 CHILDBIRTH IN A STAND-ALONE MIDWIFE-LED UNIT: TRANSFERS AND OUTCOMES

TOP PLD.01 COST COMPARISON OF... PLD.02 CAN A NEW... PLD.03 CONTRACTILE PROPERTIES OF... PLD.04 THE ROLE OF... PLD.05 RANDOMISED CONTROLLED... PLD.06 A RANDOMISED TRIAL... PLD.07 CHILDBIRTH IN A... PLD.08 FETAL DISTRESS: A... PLD.09 UK SURVEY OF... PLD.10 THE LONGITUDINAL STUDY... PLD.11 OXYTOCIN-INDUCED... PLD.12 HIGH DEPENDENCY CARE... PLD.13 INTRAPARTUM STILLBIRTHS:... PLD.14 ASSESSING THE HUMAN... PLD.15 "SAFE" TRAINING TO... PLD.16 WITHDRAWN PLD.17 EPIDURAL ANALGESIA: THE... PLD.18 RISK OF LATE... PLD.19 PERINEAL TRAUMA IN... PLD.20 DIGIT PREFERENCE AND... PLD.21 OPERATIVE DELIVERY IN... PLD.22 PROSPECTIVE STUDY OF... PLD.23 CAESAREAN SECTION RATES... PLD.24 TRIAL OF LABOUR... PLD.25 NEONATAL OUTCOMES OF... PLD.26 THE PATERNAL PERSPECTIVE... PLD.27 PREDICTIVE MODEL FOR... PLD.28 OUTCOME FOLLOWING A... PLD.29 OUTCOME OF EXTERNAL... PLD.30 LIVING WITH STAN:... PLD.31 ASSESSING THE IMPACT... PLD.32 ANAESTHETIC... PLD.33 PREGNANCY IN WOMEN... PLD.34 FACILITATING PLACENTAL... PLD.35 A WEB-BASED INFORMATION... PLD.36 CHANGES IN MYOMETRIAL... PLD.37 DELAYED UMBILICAL CORD... PLD.38 ONE HUNDRED AND... PLD.39 FETAL FIBRONECTIN BEDSIDE... PLD.40 OBSTETRIC AND NEONATAL... PLD.41 CASE REPORT: PSOAS... PLD.42 DECISION TO INCISION:... PLD.43 POSTNATAL RE-ADMISSIONS:... PLD.44 CHORIOAMNIONITIS OR... PLD.45 THE INTRODUCTION OF... PLD.46 TRENDS AND MODE... PLD.47 MANAGEMENT OF INCIDENTAL... PLD.48 NEONATAL OUTCOME AFTER... PLD.49 CASE PRESENTATION-... PLD.50 EVALUATION OF OUTCOMES... PLD.51 AUDIT OF THE... PLD.52 INTRAVAGINAL... PLD.53 SURVEY ON MATERNITY... PLD.54 CAESAREAN RATES AMONG... PLD.55 EVALUATION OF HYOSCINE-N... PLD.56 TIME IS OF... PLD.57 A SURVEY OF... PLD.58 INDUCTION OF LABOUR... PLD.59 PERINEAL TRAUMA... PLD.60 A 3-YEAR STUDY... PLD.61 PREVALENCE AND OUTCOME... PLD.62 UNEXPECTED COMPLICATION... PLD.63 AUDIT OF PATIENTS... PLD.64 ACCURACY OF GRADING... PLD.65 CONSENT FOR CAESAREAN... PLD.66 VAGINAL BIRTH AFTER... PLD.67 ESCAPE FROM DEATH,... REFERENCES

 
A. S. Hammerton, P. Jacobs, P. K. Eedarapalli. The Royal Bournemouth Hospital, Bournemouth, UK

Background: The midwife-led maternity unit at the Royal Bournemouth Hospital (BMU) was opened in February 1992, the first in the United Kingdom. Patients requiring consultant care during labour have to be transferred to the consultant-led unit at Poole Hospital (PCU), 9 miles away. Despite the existence of midwife units in the United Kingdom for over 15 years, there remains a lack of good quality evidence on the safety of these units.

Objectives: To establish the incidence of intra and postpartum patient transfers between BMU and Poole Hospital and the reasons for transfer. To assess the time taken for interhospital transfers and potential problems. To determine the incidence of any maternal or neonatal adverse events.

Design: A retrospective, descriptive study of all patients transferred in labour or after delivery from BMU to PCU between 1 January 2007 and 30 June 2007.

Main Results: 238 women were admitted to BMU in labour. Of these, 31% (74) were transferred, of which 67% (60) were primigravidas. The mean time for transfer between the two units was 56 minutes. There were seven (9%) adverse neonatal events and 25 (20%) adverse maternal events, with an 8.4% emergency Caesarian section rate.

Conclusions: Midwife units are promoted as a way of offering choice to low-risk patients. However, patients should be made aware of their risk of transfer as well as possible adverse outcomes. This will only be possible if all units undergo continuous audit and participate in a national reporting system, which includes serious adverse maternal and neonatal events.

	PLD.08 FETAL DISTRESS: A MYOMETRIAL PERSPECTIVE

TOP PLD.01 COST COMPARISON OF... PLD.02 CAN A NEW... PLD.03 CONTRACTILE PROPERTIES OF... PLD.04 THE ROLE OF... PLD.05 RANDOMISED CONTROLLED... PLD.06 A RANDOMISED TRIAL... PLD.07 CHILDBIRTH IN A... PLD.08 FETAL DISTRESS: A... PLD.09 UK SURVEY OF... PLD.10 THE LONGITUDINAL STUDY... PLD.11 OXYTOCIN-INDUCED... PLD.12 HIGH DEPENDENCY CARE... PLD.13 INTRAPARTUM STILLBIRTHS:... PLD.14 ASSESSING THE HUMAN... PLD.15 "SAFE" TRAINING TO... PLD.16 WITHDRAWN PLD.17 EPIDURAL ANALGESIA: THE... PLD.18 RISK OF LATE... PLD.19 PERINEAL TRAUMA IN... PLD.20 DIGIT PREFERENCE AND... PLD.21 OPERATIVE DELIVERY IN... PLD.22 PROSPECTIVE STUDY OF... PLD.23 CAESAREAN SECTION RATES... PLD.24 TRIAL OF LABOUR... PLD.25 NEONATAL OUTCOMES OF... PLD.26 THE PATERNAL PERSPECTIVE... PLD.27 PREDICTIVE MODEL FOR... PLD.28 OUTCOME FOLLOWING A... PLD.29 OUTCOME OF EXTERNAL... PLD.30 LIVING WITH STAN:... PLD.31 ASSESSING THE IMPACT... PLD.32 ANAESTHETIC... PLD.33 PREGNANCY IN WOMEN... PLD.34 FACILITATING PLACENTAL... PLD.35 A WEB-BASED INFORMATION... PLD.36 CHANGES IN MYOMETRIAL... PLD.37 DELAYED UMBILICAL CORD... PLD.38 ONE HUNDRED AND... PLD.39 FETAL FIBRONECTIN BEDSIDE... PLD.40 OBSTETRIC AND NEONATAL... PLD.41 CASE REPORT: PSOAS... PLD.42 DECISION TO INCISION:... PLD.43 POSTNATAL RE-ADMISSIONS:... PLD.44 CHORIOAMNIONITIS OR... PLD.45 THE INTRODUCTION OF... PLD.46 TRENDS AND MODE... PLD.47 MANAGEMENT OF INCIDENTAL... PLD.48 NEONATAL OUTCOME AFTER... PLD.49 CASE PRESENTATION-... PLD.50 EVALUATION OF OUTCOMES... PLD.51 AUDIT OF THE... PLD.52 INTRAVAGINAL... PLD.53 SURVEY ON MATERNITY... PLD.54 CAESAREAN RATES AMONG... PLD.55 EVALUATION OF HYOSCINE-N... PLD.56 TIME IS OF... PLD.57 A SURVEY OF... PLD.58 INDUCTION OF LABOUR... PLD.59 PERINEAL TRAUMA... PLD.60 A 3-YEAR STUDY... PLD.61 PREVALENCE AND OUTCOME... PLD.62 UNEXPECTED COMPLICATION... PLD.63 AUDIT OF PATIENTS... PLD.64 ACCURACY OF GRADING... PLD.65 CONSENT FOR CAESAREAN... PLD.66 VAGINAL BIRTH AFTER... PLD.67 ESCAPE FROM DEATH,... REFERENCES

 
A. J. G. Matthew, S. Quenby, S. Wray. University of Liverpool, Liverpool, UK

Fetal distress (FD) occurs when the fetus is deprived of oxygen. During labour, the uterus contracts in order to expel the fetus. This contraction compresses the vasculature supplying the placenta with oxygenated blood and the supply of oxygenated blood to the uterus and fetus is reduced. The resultant decrease in blood supply gives rise to an accumulation of acidic carbon dioxide and lactate. This acidification inhibits uterine contraction, helps to relax the uterus and therefore protects the fetus. If this inhibitory feedback system is altered, then it may give rise to problems in labour and increase the risk of FD. We investigated whether patients with FD had altered uterine contractility and if they respond differently to uterine acidification.

Uterine biopsies were obtained with patients’ consent during Caesarean delivery. Contractility of uterine strips was measured at physiological and acidic pH (pH 7.5 and pH 7.3, respectively). Expression of lactate dehydrogenase was measured in biopsies by Western blot, and lactate dehydrogenase isoenzyme activity was assayed using the Helena Biosciences SAS-1plus electrophoresis system.

Contractility of uterine strips was significantly increased (p = 0.0002) in FD (6.726 ± 0.903 mN, n = 18) when compared with control labouring strips (2.878 ± 0.289 mN, n = 19). Upon acidification, the FD strips were significantly (p = 0.02) more inhibited by acidification to pH 7.3 compared with labouring control strips (1.524 ± 0.918 mN, n = 5 and 0.346 ± 0.257 mN, n = 5, respectively).

This study shows that FD is strongly associated with high uterine contractility. Also, uterine biopsies from patients with FD respond differently to changes in pH, suggesting an altered metabolic process.

	PLD.09 UK SURVEY OF ANTIBIOTIC TREATMENT OF WOMEN WITH SPONTANEOUS PRETERM LABOUR OR PRETERM RUPTURE OF THE MEMBRANES

TOP PLD.01 COST COMPARISON OF... PLD.02 CAN A NEW... PLD.03 CONTRACTILE PROPERTIES OF... PLD.04 THE ROLE OF... PLD.05 RANDOMISED CONTROLLED... PLD.06 A RANDOMISED TRIAL... PLD.07 CHILDBIRTH IN A... PLD.08 FETAL DISTRESS: A... PLD.09 UK SURVEY OF... PLD.10 THE LONGITUDINAL STUDY... PLD.11 OXYTOCIN-INDUCED... PLD.12 HIGH DEPENDENCY CARE... PLD.13 INTRAPARTUM STILLBIRTHS:... PLD.14 ASSESSING THE HUMAN... PLD.15 "SAFE" TRAINING TO... PLD.16 WITHDRAWN PLD.17 EPIDURAL ANALGESIA: THE... PLD.18 RISK OF LATE... PLD.19 PERINEAL TRAUMA IN... PLD.20 DIGIT PREFERENCE AND... PLD.21 OPERATIVE DELIVERY IN... PLD.22 PROSPECTIVE STUDY OF... PLD.23 CAESAREAN SECTION RATES... PLD.24 TRIAL OF LABOUR... PLD.25 NEONATAL OUTCOMES OF... PLD.26 THE PATERNAL PERSPECTIVE... PLD.27 PREDICTIVE MODEL FOR... PLD.28 OUTCOME FOLLOWING A... PLD.29 OUTCOME OF EXTERNAL... PLD.30 LIVING WITH STAN:... PLD.31 ASSESSING THE IMPACT... PLD.32 ANAESTHETIC... PLD.33 PREGNANCY IN WOMEN... PLD.34 FACILITATING PLACENTAL... PLD.35 A WEB-BASED INFORMATION... PLD.36 CHANGES IN MYOMETRIAL... PLD.37 DELAYED UMBILICAL CORD... PLD.38 ONE HUNDRED AND... PLD.39 FETAL FIBRONECTIN BEDSIDE... PLD.40 OBSTETRIC AND NEONATAL... PLD.41 CASE REPORT: PSOAS... PLD.42 DECISION TO INCISION:... PLD.43 POSTNATAL RE-ADMISSIONS:... PLD.44 CHORIOAMNIONITIS OR... PLD.45 THE INTRODUCTION OF... PLD.46 TRENDS AND MODE... PLD.47 MANAGEMENT OF INCIDENTAL... PLD.48 NEONATAL OUTCOME AFTER... PLD.49 CASE PRESENTATION-... PLD.50 EVALUATION OF OUTCOMES... PLD.51 AUDIT OF THE... PLD.52 INTRAVAGINAL... PLD.53 SURVEY ON MATERNITY... PLD.54 CAESAREAN RATES AMONG... PLD.55 EVALUATION OF HYOSCINE-N... PLD.56 TIME IS OF... PLD.57 A SURVEY OF... PLD.58 INDUCTION OF LABOUR... PLD.59 PERINEAL TRAUMA... PLD.60 A 3-YEAR STUDY... PLD.61 PREVALENCE AND OUTCOME... PLD.62 UNEXPECTED COMPLICATION... PLD.63 AUDIT OF PATIENTS... PLD.64 ACCURACY OF GRADING... PLD.65 CONSENT FOR CAESAREAN... PLD.66 VAGINAL BIRTH AFTER... PLD.67 ESCAPE FROM DEATH,... REFERENCES

 
S. Kenyon¹, D. Jones¹, P. Brocklehurst², N. Marlow³, A. Salt⁴, D. Taylor¹. ¹University of Leicester, Leicester, UK, ²University of Oxford, Oxford, UK, ³University of Nottingham, Nottingham, UK, ⁴Great Ormond Street Hospital for Sick Children, London, UK

Objective: To determine practice regarding antibiotic treatment of women with spontaneous preterm labour (SPL) or preterm rupture of the membranes (PROM) before publication of ORACLE Children Study (expected spring 2008).

Design: Questionnaire survey of practice in 2007.

Setting: All obstetric units.

Population: Clinical directors of obstetric units.

Methods: Questionnaire regarding practice of antibiotic treatment for women with either SPL or PROM. Reminders are sent after one month.

Main Outcome Measures: Number of obstetric units offering treatment based on Cochrane systematic reviews.

Results: Response rate of 76% (163/214). SPL 78.5% (128/163) reported they did not treat these women and the majority stated that the evidence of benefit was not conclusive 71% (72/101). 21.4% (35/163) stated they did treat these women, with erythromycin (16/35), penicillin (15/35), or ampicillin (2/35). Reasons given included Guillain-Barré syndrome prophylaxis (10/29) and evidence of benefit (9/29). PROM 97.5% (159/163) prescribe antibiotics for these women, with 97% (154/159) using erythromycin. The majority stated there was evidence of benefit 82% (93/113).

Conclusions: Evidence from the Cochrane reviews suggests that antibiotic treatment is of no benefit with SPL.¹ Whereas the majority (78.5%) of obstetric units stated they do not offer antibiotics, over 20% stated they did treat these women. Evidence suggests that antibiotic treatment (erythromycin) is of benefit with PROM;² the majority of UK women