Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867 S799

not change either prior to or during sponta-neous term labor, as

was the case for the majority of biomarkers examined.

Conclusions: Serum levels of IL-6, WBCs, and CRP increased during

spontaneous term labor. As opposed to previous studies, we did

not find significant changes in IL-1b, IL-8, and TNF-a. The majority

of biomarkers did not change either prior to or during spontaneous

term labor.

W288

EPISIOTOMY AND PERINEAL LACERATIONS AND ITS

ASSOCIATION WITH MATERNAL AND INFANT CONDITIONS

A.M.P. Barbosa1, A.P.M. Almeida1, C.C. Arruda1, D.M. Lorenzo1,

M.U. Massoca1, G. Marini2, M.V.C. Rudge2. 1Special Education

Department of Physiotherapy, Faculty of Philosophy and Sciences of

the State University Paulista ‘Julio de Mesquita Filho’ – UNESP-Marilia,

SP, Brazil, Marıılia, Sao Paulo, Brazil; 2Botucatu Medical School-UNESP,

Botucatu, Sao Paulo, Brazil

Objectives: Verify the incidence of episiotomy and perineal

laceration and the association with maternal and child conditions.

Materials: Retrospective study conducted from July to August 2011

through manipulation of records on motherhood which serves low-

risk pregnant women. We conducted descriptive and univariate

analysis about the significance of the association of variables using

c2 test.

Methods: The study included 121 pregnant women between 18

and 35 years old, which progressed to vaginal delivery, without

comorbidities and with term delivery. The conditions involved

maternal parity, duration of labor, physiotherapy during labor

and delivery, dilation, the incidence of episiotomy, lacerations and

maternal complications. As fetal/infant conditions were considered

weight of newborn and fetal complications. In the association

between the variables, perineal outcome was the dependent

variable.

Results: 70.2% of pregnant women underwent episiotomy, 13.2%

had a first degree perineal laceration, 12.4% had perineal integrity,

2.5% had a second degree perineal tear, 1.7% had a third degree

perineal laceration and there was no incidence of vaginal delivery

using forceps. There was a significant association between the

variables episiotomy and primiparity (p < 0.05), however among

the other variables there was no significant association.

Conclusions: Episiotomy was performed in most of the mothers

and perineal outcome was associated with primiparity, and for

the other variables there was no significant association. The data

from this and other Brazilian studies got attention because they

have episiotomy rates higher than those recommended by the

World Health Organization, emphasizing the need to insist on

discussions about performing episiotomy, subject as relevant to

women’s health. Reinforce the need for thorough research and

training in physical therapy techniques and conducting the delivery

of midwifery professionals. Educational activities are suggested for

pregnant women regarding pregnancy, labor and delivery itself.

W289

PROPOSAL FOR HUMANIZED PHYSIOTHERAPEUTIC ATTENTION

DURING LABOR EVOLUTION AND DELIVERY

A.M.P. Barbosa1, A.P.M. Almeida1, C.C. Arruda1, G. Marini2, F. Piculo2,

M.V.C. Rudge2. 1Special Education Department of Physiotherapy,

Faculty of Philosophy and Sciences of the State University Paulista

’Julio de Mesquita Filho’ – UNESP-Marilia, SP, Brazil, Marıılia, Sao

Paulo, Brazil; 2Botucatu Medical School-UNESP, Botucatu, Sao Paulo,

Brazil

Objectives: The aim of this study is to evaluate the effect of

physiotherapy in the evolution of labor and delivery.

Materials: Data collection was performed at the Maternity Hospital,

with 87 mothers, where 43 received physiotherapy intervention

with kinesiotherapy and 44 had no intervention.

Methods: The protocol consisted of therapy ball exercise, squat and

walking; manual massage therapy in spine and lower abdomen, and

electrotherapy with analgesic purposes.

Results: This study demonstrated the effectiveness of physiotherapy

maneuvers on the length of labor (p = 0.0589), help in the dilation

(p =0.0253) showed a decrease in the number of caesarean

deliveries in pregnant women who underwent physiotherapy

intervention compared with those who didn’t, in relation to the

time difference of labor between primiparous and multiparous

average dilation and dilation among primigravid and multiparous

no significant difference in either group.

Conclusions: The physiotherapeutic protocol interfered with

decreased duration of labor and better development of dilatation.

These results reinforce the need for educational work for pregnant

women and for professional training in obstetrics since Brazil

had the highest cesarean ratesAppropriate interventions occurring

during labor and birth may interfere with the progress of these very

beneficial to both mother and child. Physical therapy may act in

these moments with manipulative therapy and Electrotherapeutic

resources.

W290

SHOULDER DYSTOCIA: A 2-YEAR RETROSPECTIVE AUDIT

ANALYSING MATERNAL RISK FACTORS AND MANAGEMENT

L. Sheikh1, A. Long2, F. O’Mahoney2. 1Keele University, Keele, United

Kingdom; 2University Hospital of North Staffordshire, Stoke on Trent,

United Kingdom

Objectives: The aims of this audit are to analyse the correlation

between maternal risk factors and outcomes of shoulder dystocia.

In addition, it evaluates the management of shoulder dystocia in an

attempt to improve maternal and fetal outcomes at the University

Hospital of North Staffordshire.

Methods: Cases of shoulder dystocia were identified between 1

August 2009 – 31 August 2011 using the birth register, DATIX forms

and RCOG Shoulder Dystocia audit forms. Data was collected from

96 patients at the University Hospital of North Staffordshire. This

included maternal demographic data, risk factors, management of

labour and maternal and fetal outcomes. The data was analysed

using Microsoft Excel to identify trends in risk factors and to

evaluate management.

Results: The audit found that fetal macrosomia and induction

of labour were major risk factors in the occurrence of shoulder

dystocia. However, minimal correlation was found between high

BMI, diabetes, previous shoulder dystocia, instrumental deliveries

and the occurrence of shoulder dystocia. Age, length of gestation

and nulliparity also had very little representation in the cohort.

Shoulder dystocia is managed extremely well by the staff at UHNS,

including midwives and doctors of all grades. A large proportion of

the women (40%) delivered successfully by McRoberts manoeuvre.

Of the 96 patients that experienced a shoulder dystocia, 12.5% of the

babies suffered birth injuries. 48% of women had perineal trauma

and 18% of women had a post-partum haemorrhage.

Conclusions: Due to the unpredictability of shoulder dystocia, it

is important to remain vigilant and seek out risk factors during

the antenatal period. Management of shoulder dystocia must be

maintained at high levels by continuing to train staff adequately.

The occurrence of post partum haemmorhage in women with a

shoulder dystocia at UHNS is higher than national statistics. This

has prompted a further audit to ascertain the possible causes of

this. A re-audit for shoulder dystocia is planned in July 2013.