Obstetric characteristics and neonatal outcome of unplanned out of hospital term deliveries

Abstract

HOSPITAL TERM DELIVERIES ALEX RABINOVICH, AMNON HADAR, EYAL SHEINER, DANIELA LANDAU, MORDECHAI HALLAK, MOSHE MAZOR, Soroka Medical Center, Beer-Sheva, Israel, Soroka University Medical Center, Ob & Gyn, Beer-Sheva, Israel, Ben-Gurion University of the Negev, Faculty of Health Sciences, Soroka University Medical Center, Obstetrics and Gynecology, Beer Sheva, Israel, Soroka University Medical Center, Neonate, Beer Sheva, Israel, Ben Gurion University Soroka Medical Center, Beer Sheva, Israel, Soroka University Medical Center, Beer Sheva, Israel OBJECTIVE: To describe the obstetric characteristics and neonatal outcome of unplanned out-of-hospital deliveries. STUDY DESIGN: The obstetric characteristics and neonatal outcome were compared between 151 consecutive parturients with unplanned out-of-hospital term deliveries and 151 hospital term deliveries. RESULTS: Women delivered out-of-hospital tended to be older (32 G 5.5 years olds Vs 28G 5.0 years olds P = .046) and less educated (4.4G 5.1 years vs 6.5 G 5.0 years P = .005) as compared to women delivered in-hospital. Unplanned out-of-hospital deliveries resulted in statistically significant higher rate of low birth weight newborns (!2500 g) (OR= 3.9, 95% CI 2.0-7.7; P ! .001) postpartum hemorrhage (OR = 8.4, 95% CI 1.1-181.1; P = .018) and trended for higher rate of revision of uterine cavity (4.0% vs 0%; P = .013). Higher rates of admission to the neonatal intensive care unit due to neonatal complications such as polycythemia (12.6% vs 0%; P ! .001), hypoglycemia (9.3% vs 0.6%; P = .001) and convulsions (3.3% vs 0%; P = .024), were noted among the out-of-hospital delivery group as compared to controls. CONCLUSION: Unplanned out-of-hospital birth is an important risk factor for complications such as postpartum hemorrhage, low birth weight and adverse neonatal outcome. 684 INDUCTION OF LABOUR WITH MISOPROSTOL IN WOMEN AT TERM WITH AN UNFAVORABLE CERVIX: A RANDOMIZED COMPARISON OF ORAL AND VAGINAL ADMINISTRATION BLAIR BUTLER, JOAN CRANE, TINA DELANEY, DONNA HUTCHENS, J. HARNETT, Memorial University of Newfoundland, Obstetrics and Gynaecology, St. John’s, Newfoundland, Canada, Memorial University of Newfoundland, Obstetrics and Gynecology, St. John’s, Newfoundland, Canada, Memorial University of Newfoundland, Obstretrics and Gynecology, St.John’s, Newfoundland, Canada, Memorial University of Newfoundland, Obsterics and Gynecology, St. John’s, Newfoundland, Canada, Memorial University of Newfoundland, Medicine, St. John’s, Newfoundland, Canada OBJECTIVE: To determine the best dose and route of misoprostol for the induction of labour in women at term with an unfavorable cervix (Bishop score ! 7) as measured by the induction to vaginal delivery time. STUDY DESIGN: Three hundred and thirty seven women after 37 completed weeks gestation who presented with an indication for induction were randomly assigned to receive either Prostin/Prepidil every 6 hours, misoprostol 25 mg vaginally every 6 hours, misoprostol 50 mg orally every 3 hours, or misoprostol 75 mg orally every 4 hours as needed to induce labour. The primary outcome measure was to determine the best dose and route of misoprostol for induction of labour in women at term with an unfavorable cervix as measured by time from induction to vaginal delivery. Sample size was calculated using a two-tailed a of 0.05 and power of 80%. RESULTS: Baseline demographic data including maternal age, parity, height, gestation, Bishop score, indication for induction, and birth weight were similar between groups. The mean time in minutes (G SD) to vaginal birth was 1278 (G 746) for Prostin/Prepidil , 1182 (G 1014) for misoprostol 25 mg vaginally every 6 hours, 1140 (G 485) for misoprostol 50 mcg. orally every 3 hours, and 1134 (G 590) for misoprostol 75 mg. orally every 4 hours (P = .69). There were no differences in maternal secondary outcomes, including caesarean birth, operative vaginal delivery, perineal trauma, manual placental removal, epidural use, postpartum hemorrhage, or gastrointestinal side effects. Neonatal outcomes including cord pH, Apgar scores, and admission to neonatal intensive care were not different. CONCLUSION: Misoprostol is as effective as Prostin/Prepidil for labour induction when given either orally or vaginally with no differences in maternal or neonatal outcomes. There is no difference in time from induction to vaginal birth with the doses, routes, or frequencies of administration used in this study. It is a safe, inexpensive, and effective alternative to standard induction methods in patients with low Bishop scores. S190 SMFM Abstracts