Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530 S309

Methods: All nulliparous women presented to the Obstetric

clinics at first trimester were invited to join the study. Three-

dimensional perineal USG was performed for them during rest,

valsalva maneuver (VM) and pelvic floor muscle contraction (PFMC)

at first trimester (10–12 week), second trimester (26–28 week) and

third trimester (35–38 week). Their pelvic floor symptoms of stress

urinary incontinence and dragging sensation were obtained at each

trimester. Offline analysis of the USG volumes were performed to

assess the pelvic floor biometry and the operator was blinded to

the symptoms of the women. Paired t-test and independent sample

t-test were used.

Results: In all, 44 sets of data were analysed and reported. The mean

age of the women was 29.9 (SD 3.9) years and mean body mass

index was 20.5 (2.4) kg/m2 at recruitment. There were significant

bladder neck displacement, descent of all three compartments and

enlargement of hiatal area during rest as the pregnancy advanced;

however, the same trend was only observed from first to second

trimester of pregnancy during VM. And no changes were found

during PFMC. At third trimester, 20% of women had stress urinary

incontinence but there was no association with the bladder neck

mobility; 70% of them reported symptoms of dragging sensation

and it was associated with a larger hiatal area (16.6±2.4 cm2 vs

14.1±2.7 cm2, P = 0.01).

Conclusions: There were significant changes of pelvic floor

biometries with increase in bladder neck displacement and

descent of three compartments at rest and at valsalva maneuver

during pregnancy. Stress urinary incontinence was common during

pregnancy but it was not associated with bladder neck mobility.

Dragging sensation was common and it was associated with a larger

hiatal area.

O138

‘PATHOLOGICAL’ DECELERATIONS’ ON CTG: TIME FOR FPS OR

FBS?

E. Chandraharan1, V. Lowe1, S. Arulkumaran1. 1St George’s

Healthcare NHS Trust, London, United Kingdom

Objectives: To assess the role of a fetal physiological score (FPS)

that is based on fetal response to hypoxic stress during labour

to understand fetal wellbeing, when pathological decelerations are

observed on CTG Trace.

Materials: 48 CTG traces showing pathological (late or atypical

variable) decelerations during the last 30 minutes prior to delivery,

for which neonatal outcome data were available, were selected.

Fetal Physiological Score (FPS) was calculated by comparing the

last 30 minutes of the Trace with the features of CTG trace at

commencement of fetal monitoring.

Methods: Percentage increase in Baseline Heart Rate, changes in

Baseline Variability, the sum of Inter-deceleration interval for 30

minutes, and the sum of Inter-contraction Interval for 30 minutes,

were determined and the Fetal Physiological Score (FPS) was

calculated (see table).

Results: 41/48 (85.4%) of CTGs with pathological decelerations

during the last 30 minutes of labour had a Fetal Physiological Score

(FPS) of >7/10. Only one neonate (2%) had APGAR score of <7 and all

newborn had cord arterial pH of >7.05 and Base excess <-12mmol/l,

when the FPS was >7/10. A poor FPS (<4) was associated with

APGAR Score <6 (75%) and abnormal cord gases (50%). Sum of

inter-contraction and inter-deceleration intervals of <10 minutes

during the last 30 minutes were associated with lower cord arterial

pH (75%) and poor FPS Scores (60%). An increase in baseline fetal

heart rate >20% was not associated with a poor outcome, if the

sum of inter-contraction and inter-deceleration intervals during the

last 30 minutes prior to birth are >10 minutes. Saltatory pattern

persisting for over 20 minutes was associated with poor umbilical

cord gases (80%).

Conclusions: Fetal Physiological Score (FPS) appears to be a useful

tool to assess fetal compensatory response to intrapartum hypoxia,

when pathological decelerations are observed on the CTG Trace. In

our series, FPS of >7 is associated with normal APGAR Scores (98%)

and umbilical cord gases (100%). Hence, presence of pathological

decelerations alone does not indicate a poor perinatal outcome and

clinicians should aim to improve the inter-contraction and inter-

deceleration intervals by interventions such as reducing or stopping

oxytocin infusion when FPS of <5 is observed, to improve utero-

placental circulation, prior to considering Fetal Blood Sampling

(FBS). We hope our pilot attempt to develop a tool based on

fetal physiology will stimulate a larger study to determine clinical

applicability.

Table: Fetal Physiological Score (FPS)

Features of CTG with pathological decelerations during the last 30min Score

0 1 2

Increase in baseline heart rate (compared with CTG at onset of labour) >20% 10–20% <10%Baseline variability <5 bpm (following decelerations and/or rise inbaseline heart rate)

>20min 10–19min <10min

Total duration of saltatory pattern at baseline for 30min >20min 10–19min <10minSum of Inter-deceleration interval for 30min <20min 10–19min >20minSum of Inter-contraction interval for 30min <20min 10–19min >20min

O139

LOW DOSE INTRAVENOUS VERSUS ORAL IRON FOR IRON

DEFICIENCY ANEMIA STARTING LATE IN PREGNANCY: A

RANDOMIZED CONTROLLED TRIAL

P. Chanprapaph1, P. Ruangvutilert1, V. Titapant1, P. Chuenwattana1.1Faculty of Medicine, Siriraj Hospital, Mahdiol University, Bangkok,

Bangkok, Thailand

Objectives: To compare the efficacy of intravenous iron

administered weekly and daily oral iron starting late in pregnancy

at 3 weeks after medication and at delivery.

Materials: Eighty pregnant women who received antenatal care at

Siriraj Hospital, Mahidol University, Thailand with iron deficiency

anemia found at 32 weeks of gestation were enrolled into this

randomized controlled trial.

Methods: They were allocated into two groups: oral group (O-

group) and intravenous group (IV-group). At gestation age of 33

weeks, women in the O-group were given three 67-mg oral iron

tablets per day until delivery while those in the IV-group received

200 mg iron sucrose weekly to a total dose of 500 mg. Hemoglobin

(Hb) and serum ferritin levels at 3 weeks after the start of treatment

and at delivery were measured. Infant birth weight data were also

collected. The statistical comparisons between the two groups were

analyzed by Mann–Whitney U test.

Results: There were 39 women and 41 participants in the O-group

and the IV-group, respectively. The mean baseline levels of Hb

and ferritin in both groups were similar (9.55, 9.68 g/dL and 7.19,

7.37 g/L, respectively). After 3 weeks of medication, the Hb levels

were 10.17, 10.57 g/dL and ferritin levels were 26.20, 123.80 g/L

in the O-group and the IV-group, correspondingly. At delivery, Hb

levels were comparable between two groups (11.18, 11.40 g/dL) but

the difference in ferritin levels remained significant (29.55 in the

O-group, 63 g/L in the IV-group). Infant birth weights were 3,049

g in both groups.

Conclusions: Low dose intravenous iron divided into weekly doses

can raise Hb levels at the same rate as oral iron up to delivery with

the same pregnancy outcomes and with a higher body iron store

which is reflected by serum ferritin levels.

O140

WHY DO OBSTETRIC PATIENTS GO TO ICU? – A 3 YEAR STUDY

S. Chawla1, M. Nakra2. 1INHS Asvini, Mumbai, Maharashtra, India;2Base Hospital, Delhi, Delhi, India

Objectives: To determine the current spectrum of diseases in an

obstetric population resulting in admission to the intensive care

unit (ICU) at a tertiary care hospital.

Materials: A 900 bedded hospital with 80 beds in the Department

of Obstetrics & Gynaecology. The hospital has a 18 bedded

multidisciplinary ICU for medical, surgical, cardiac and obstetric