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she was allowed to deliver vaginally in the OR. Her baby’s Apgar lmin.=9/ 5min.=9). Conclusions: With FPO data consistently present 80% of the time, cesarean section was avoided in this group. Maternal and physician acceptance of the current smaller sensor was excellent. In these parturients sensor placement was easy, with little discomfort, and with no episodes of bleeding, chorioamnionitis, or rupture of membranes; we are encouraged to expand our studies. To date (n=153) parturients with normal FPO (Sat%= 45-80) have delivered normal infants. Four severely depressed babies in this cohort had extended (>3 minute) FPO epochs below 35%.

FC3.11.09 ANTENATAL FETAL ECG MONITORING - OUR HOSPITAL’S EXPERIENCE A Won% SW Seng, GSH Yeo. Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, 100 B&t Timah Road, Singapore 229899

Objectives: The aim of our study was to determine the efficacy of the non-invasive fetal ECG monitoring system in predicting an adverse pregnancy outcome in full-term low risk antenatal women. Study methods: 309 consecutive patients attending the Obstetric Day Care Center for cervical priming were recruited. The fetal ECG monitoring system was used to obtain an average ECG complex from an abdominal tracing. The mean and standard deviations of the ECG waveform was measured and calculated. Results: The occurrence of T wave inversion, ST elevation and T/QRS ratios was correlated against outcome measures such as the APGAR scores, neonatal special care and ICU admissions, and caesarean section or instrumental delivery for fetal distress. There was a statistically significant trend toward more neonatal special care admissions with poorer T/QRS scores. No significant difference was found in the occurrence of T wave inversion and ST elevation with neonatal outcomes. Conclusion: The fetal ECG provides a new avenue for research into antenatal fetal monitoring. Our study did not find the antenatal fetal ECG useful in predicting an adverse outcome in a low risk population. Further studies are needed to determine if it is a useful tool in the high-risk population.

FC3.12 PREGNANCY AND LABOR

FC3.12.01 FIVE YEAR REVIEW OF INDUCTION OF LABOR IN PATIENTS WITH A PREVIOUS LOWER SEGMENT CESAREAN SECTION A. Adoluh (l), L. Brydon (2), .I. Thiel(2) (1) Dept. OBIGYN, Royal University Hospital, Saskatoon, Saskatchewan, Canada. (2) Dept. OBIGYN, Regina General Hospital, Regina, Saskatchewan, Canada.

Objectives: The study reviews the safety of the use of vaginal prostaglandin (PGE,) gel for induction of labor with a previous lower segment cesarean section (LSCS). Study Methods: We conducted a retrospective review of 877 patients delivering at the Regina General Hospital between January 1992 and December 1997. Patients with a previous lower segment cesarean section on spontaneous labor were used as controls. Five groups were analyzed, Spontaneous labor, Spontaneous labor with augmentation, Syntocinon induction, PGE, induction, PGE, induction requiring Syntocinon augmentation. Primary outcome measures include uterine rupture and/or dehiscence. Secondary outcomes include cesarean section, instrumentation, length of first and second stage and neonatal outcome. Results: PGE, gel induction in patients with previous LSCS had statistically significant increase in uterine rupture and/or dehiscence (p<O.O2), as well as increased cesarean section rate (p<O.O4). Comparing PGE, gel with Syntocinon for induction of labor, there was an increased rate of ruptureidehiscence when PGE, was used, this was also statistically significant (cO.03). Conclusion: PGE, gel induction in patients with a previous LSCS is unsafe. PGE, gel compared with Syntocinon for induction also appears to be less safe. Syntocinon augmentation of spontaneous labor is less

likely to cause a rupture than Syntocinon augmentation after PGE, gel. If induction of labor is indicated, other methods should be considered.

FC3.12.02 MORE THAN ONE PREVIOUS CESAREAN SECTION DOES NOT EXCLUDE A TRIAL OF LABOR W.A. Suaans (l), L.M.E. van der Vliet (l), O.P. Bleker (l), E.A.M. RGell-Schorer (2), .I. van Roosmalen (2), (1) Dept. OBIGYN, Academic Medical Center, Amsterdam, The

Netherlands. (2) Dept. OB, Leiden University Medical Center, RC Leiden, The

Netherlands

Objectives: The aim of the study was to investigate pregnancy outcome of women with a history of multiple previous cesarean sections (MPCS). Study Methods: All medical records of women with a history of MPCS who gave birth during a 10 year period (1988.1997) in two large teaching hospitals in the Netherlands were studied. Results: During the study period 30, 132 women gave birth at the two centers, with a cesarean birth rate of 14.8%. there were 242 women with a history of MPCS: 188 (77.7%) delivered by elective repeat cesarean section, 54 (22.3%) had a trial of labor, of whom 45 (83.3%) had a vaginal birth. Women with recurring indication had less often a trial of labor than women with a non-recurring indication had less often a trial of labor than women with a non-recurring indication (OR 0.30; 95% CI 0.15-0.62). Three uterine ruptures occurred after previous lower segment cesarean sections without maternal or perinatal mortality; one during a trial of labor and a hysterectomy was necessary, one in a uterus bicornis planned for elective repeat cesarean, and one suddenly at 30 weeks pregnancy without any sign of labor. In the study group was no maternal mortality. Maternal morbidity did not differ between women with an elective repeat cesarean or a failed trial of labor. Women with a vaginal birth after cesarean needed less often a blood transfusion. Perinatal mortality was not related to the mode of delivery. Conclusion: An elective repeat cesarean section is not the only answer to a woman with more than one previous cesarean section. A trial of labor can be a safe option for a selected group of women.

FC3.12.03 IS THERE A RISK OF INTRA UTERINE FETAL DEATH IN UNCOMPLICATED SINGLETON POST TERM PREGNANCY? E.G. Tamale-Sali, Dept. OBIGYN, Ahmadi Hospital, Ahmadi, Kuwait.

Objectives: The purpose of this study was to examine the hypothesis that there is a risk of intrauterine fetal death in uncomplicated post term pregnancy. Study Methods: This was a retrospective study involving 283 patients with uncomplicated singleton pregnancy. Only patients with a prior ultrasound scan for dating before the 20th week of gestation were included. During the same period, a study of all cases of intrauterine fetal deaths on or after the 2gth week of gestation was also made. Results: In the post term group, the mean age was 27.1 (range 16.44), mean parity 2.9 (range O-11). The mean fetal weight was 3539.5 mg (range 2130-5170 mg). The mean post term gestation was 298.5 days (range 295-325). The cesarean section rate for fetal distress was 7.4%, that for instrumental delivery 4.6%. Meconium stained liquor incidence was 24.7% and the induction rate was 13%. There were neither intrauterine nor neonatal deaths in this group. All the 115 intrauterine deaths that occurred in the other group happened prior to the 290th day of gestation. The mean fetal weight was 2248 (range 670-5150 mg). Most of the pregnancies had an associated complication. Conclusion: Post term in uncomplicated singleton pregnancy appear to have little or no risk at all of intrauterine fetal death. Therefore induction of labor in these patients should be based on other factors other than post term provided a good follow up is assured or is in place.