630 Comparing international guidelines on hypertensive disorders in pregnancy Melanie Wiegerinck, Sigrid Huigen, Teus van Barneveld, Ben Willem Mol, Hans Duvekot Academic Medical Centre, Obstetrics and Gynaecology, Amsterdam, Netherlands, Erasmus Medical Center, Obstetrics and Gynaecology, Rotterdam, Netherlands, Netherlands Association of Medical specialists, Department of guideline development, Utrecht, Netherlands, Dutch consortium AMPHIA trial, Netherlands, Erasmus Medical Center, Department of Obstetrics and Gynaecology, Rotterdam, Netherlands OBJECTIVE: To compare international guidelines on Hypertensive disorders in pregnancy in order to assess the quality of guideline development in this field. STUDY DESIGN: We contacted the official Obstetric Societies of all European countries, the US, Canada and Australia, regarding the availability of a guideline on Hypertensive disorders in pregnancy. All retrieved guidelines were systematically reviewed on 7 topics that were identified as important by professionals: definitions of hypertensive disorders, methods for assessing proteinuria, top 3 antihypertensive agents, criteria for starting treatment (antihypertensive, anticonvulsive, termination of pregnancy), and target blood pressure after delivery. In addition, the methodologic quality of the guidelines was assessed using the Appraisal of Guidelines for Research & Evaluation (AGREE-II) Instrument. RESULTS: We approached professional societies in 41 European countries, and obtained guidelines from the US, Canada, and Australia (figure 1). Since 21 European countries did not reply and 4 had no guidelines, we analyzed a total of 19 guidelines. Nearly all countries had developed these guidelines themselves, and 17 dated from the last 4 years. Even though most guidelines refer to the same references, only 6 (32%) use the exact same definition for hypertension. All guidelines use the same cut-off values for proteinuria (0.3g/24 hours), but the accepted methods for assessing proteinuria differ (3 quantative 24 hour measure, 1 automated dipstick, 5 also accept protein/kreatinin ratio and visual dipstick, and in 10 it was not stated). Five guidelines agreed on initiation of antihypertensive treatment when the bloodpressure exceeds 160/110 mmHg, whereas 14 used other criteria. The remaining topics were comparable among the included guidelines. Methodological rigour and transparency of the guidelines also differed significantly. CONCLUSION: We found a wide variation in used definitions, clinical recommendations and methodology. This study emphasizes the need for international collaboration in the field of guideline development. 631 The impact of postpartum hemorrhage drill training at a single institution Noel Strong, Angela Bianco, Joanne Stone, Pozharny Zhenya, Luca Lambertini Mount Sinai Medical Center, Maternal Fetal Medicine, New York, NY, Mount Sinai School of Medicine, Maternal Fetal Medicine, New York, NY, North Shore-Long Island Jewish Health System, Maternal Fetal Medince, Manhasset, NY, Mount Sinai School of Medicine, Department of Preventive Medicine, New York, NY OBJECTIVE: To evaluate the impact of standardized postpartum hemorrhage drill training. STUDY DESIGN: In June of 2009 our institution mandated that all obstetrical providers participate in standardized postpartum hemorrhage training drills. The purpose of these drills was to improve recognition and management of post partum hemorrhage (PPH). Each drill consisted of a didactic session which emphasized accurate estimation of blood loss, early intervention, use of misoprostol as a first line agent and increased use of the Bakri Balloon and B-lynch suture. Each didactic session was followed by a simulated postpartum hemorrhage utilizing a female anthropomorphic robotic simulator. A retrospective chart review was preformed comparing all cases of PPH identified by the Labor & Delivery Quality Assurance Committee in the year preceding this mandate to all cases of PPH identified by the same committee in the year following this mandate. RESULTS: 160 patients with PPH were identified over the 2 year study period: 57 cases in the year preceding the PPH drills and 103 cases in the year following the PPH drills. The demographics of these two groups did not differ statistically, nor did their labor courses or etiologies of hemorrhage. In the first six months following the PPH training drills a trend toward increased use of misoprostol (26 %v 33% p 0.069) and Bakri Balloon (7% v 17% p 0.087) was noted. Although the rate of c-hysterectomy appeared to be reduced during this time period no trend toward significance was seen (19% v 8% p 0.220). At 6-12 months following the mandated drills these findings were no longer seen. No significant differences were noted in mean estimated blood loss, change in hemoglobin or rate of transfusion between any of the studied time periods. CONCLUSION: Training appears to improve recognition and reporting of PPH. While no statistically significant changes were noted, a trend towards increased use of misoprostol and Bakri Balloon was initially seen following the PPH training drills. This trend dissipated after 6 months. These findings seem to support a need for re-education.