Postpartum voiding dysfunction - American Journal of Obstetrics ...

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Israel, 2Urology Service, Rabin Medical Center, Petah Tikva, Israel. OBJECTIVE: To investigate the contribution of labor to postpartum voiding dysfunction by ...
Poster Session IV RESULTS: 2137 and 3050 eligible patients pre- and post-guideline

were included for analysis. Baseline maternal characteristics did not differ between cohorts. Overall CD rate decreased from 15.2% to 12.8% (OR 0.82, 95% CI 0.7-0.96), with a significant decrease in CD for labor arrest from 10.5% to 8.5% (OR 0.79, 95% CI 0.65-0.95). The proportions of CD performed for arrest in latent, active, and second stage labor were not significantly different in the pre- and post-guideline groups (p¼0.89). There was no change in the rate of cesarean delivery for other indications. Multivariable logistic regression confirmed an independent contribution of post-guideline status to CD rate (aOR 0.73, 95% CI 0.613-0.869). CONCLUSION: Post-guideline the CD rate among eligible women attempting vaginal delivery was substantially reduced in an expanded cohort. These findings support previously published data on the impact of adoption of consensus recommendations at our institution.

681 Association of oral misoprostol with cesarean delivery Roxane C. Handal-Orefice1, Sujata Mulekar2, Joseph Politch1, Ronald E. Iverson1, Christina D. Yarrington1 1 Boston Medical Center, Boston, MA, 2Boston University School of Medicine, Boston, MA

OBJECTIVE: This study seeks to identify whether oral misoprostol

(OM) increases cesarean delivery risk and prolongs time to delivery compared to vaginal misoprostol (VM). STUDY DESIGN: We conducted a retrospective analysis comparing labor inductions that occurred during an institutional shift from VM to OM. We compared inductions initiated with misoprostol between 20132014 using VM to those between 2014-2015 using OM. The cohort was limited to the first 85 patients in each time period, with live singleton pregnancies >34 weeks gestation and an initial cervical dilation 1cm. Demographics, intrapartum outcomes, and labor outcomes were analyzed using unpaired t-test, chi-squared test, and ANOVA where appropriate. A multivariate analysis was performed using logistic regression including relevant covariates identified in our cohort. RESULTS: Demographics including maternal age, parity, BMI, gestational age, race, GBS status, and indications for labor induction were similar between two groups. Incidence of CS was higher in the OM compared to the VM groups (40% vs 18% p¼0.004). Women induced with OM had a 2-fold odds of cesarean section compared to women induced with VM that was attenuated but not eliminated when controlled for BMI >¼ 30kg/m. Indication for cesarean section in the OM group was predominantly failure to progress (67%), whereas non-reassuring fetal heart tracing was the majority indication in the VM group (56%). Time to delivery with OM was significantly longer than with VM (44.54  2.78 vs 36.2  2.4 p¼0.02, respectively). CONCLUSION: Although the increased odds of cesarean delivery with OM was modest, our data showed no decreased incidence of morbidity and an increase in time to delivery. These findings suggest that a categorical shift to OM instead of VM may result in increased cesarean delivery without benefit to mom or baby.

682 Can venous cord gas predict fetal acidemia? Kate Swanson1, Anna Whelan2, William A. Grobman1, Emily S. Miller1 1 2

Northwestern University Feinberg School of Medicine, Chicago, IL, University of Illinois at Chicago, Chicago, IL

ajog.org OBJECTIVE: Arterial cord gas values are used to diagnose fetal academia, however up to 20% of arterial cord segments are inadequate to allow measurements. Our objective was to assess whether venous cord gas values could be used to reliably predict fetal acidemia. STUDY DESIGN: This is an observational study of women with a singleton gestation at a single tertiary care hospital who delivered between September 2010 and September 2015 and had both arterial and venous cord gas values measured. Fetal acidemia was defined as either an umbilical cord arterial pH < 7.0 or base deficit  12 mmol/L. Receiver operating characteristic (ROC) curves for fetal acidemia were generated using venous cord gas values and the areas under the curves (AUCs) were calculated. Venous cord gas cutoffs associated with