SMFM Abstracts S187

670

671

MISOPROSTOL CONTROLLED-RELEASE VAGINAL INSERT FOR CERVICAL RIPENING

AND INDUCTION OF LABOR IN NULLIPAROUS WOMEN CARLOS SANTANACASTENEDA1, JUAN CARLOS IZQUIERDO-PUENTE2, RAUL ANTONIO LEON-OCHOA3,
TERRY PLASSE4, WILLIAM RAYBURN5, 1Clinical Materno Infantil Alfredo del
Mazo ISSEMYM, Toluca, Edo de Mexico, Mexico, 2Hospital de GinecoObstetricia, Luis Castelazo Ayala #4 IMSS, Mexico DF, Mexico, 3Hospital
Regional 1 * de Octubre ISSSTE, Mexico DF, Mexico, 4Cytokine
PharmaSciences, Inc, King of Prussia, Pennsylvania, 5University of New
Mexico, Obstetrics and Gynecology, Albuquerque, New Mexico
OBJECTIVE: To assess the maximum tolerated dose, ecacy and safety of
misoprostol incorporated into a controlled release hydrogel polymer.
STUDY DESIGN: Nulliparous women at or postterm were treated with
misoprostol administered intravaginally in a retrievable hydrogel polymer
designed to deliver drug in a controlled manner for 24 hours. The product
was similar to controlled release dinoprostone (Cervidil) but contained
misoprostol rather than dinoprostone. The insert was removed at 24 hours,
upon the onset of active labor, or if treatment-related adverse events occurred.
Sequential cohorts were treated with reservoir doses from 25 through 300 mcg.
RESULTS: Treatment with increasing doses of misoprostol in the reservoir
resulted in a shorter time to delivery as well as a more rapid increase in modied
Bishop scores. Adverse uterine and fetal heart rate eects from misoprostol were
noted only at 200 or 300 mg. Two women at 300 mg, but none at lower doses,
developed hyperstimulation syndrome. Delivery outcomes are outlined below.
All cesarean deliveries using 25-100 mg doses and two at 200 mg doses were for
events unrelated to misoprostol; while two cesareans using the 200 mg and those
at 300 mg doses were for events related to misoprostol.
CONCLUSION: Misoprostol administered as a 100 mg dose in a sustained
release hydrogel with a retrieval system resulted in rapid cervical ripening and
vaginal delivery with a good safety prole.

Dose (mg)

Vaginal delivery
within 24 h

Median time to vaginal

delivery, h (range)

Cesarean delivery

25
50
100
200
300

6
6
6
7
6

0
1
5
3
4

43.3
29.0
14.2
11.1
13.8

4
1
1
4
2

(27.5-59.2)
(21.2-54.6)
(12.9-17.2)
(10.8-21.1)
(12.3-20.1)

OBSTETRIC RISK FACTORS AND OUTCOME OF PREGNANCIES COMPLICATED WITH

POSTPARTUM HEMORRHAGE EYAL SHEINER1, LIAT SARID2, AMALIA LEVY3, DANIEL
S. SEIDMAN4, MORDECHAI HALLAK5, 1Soroka University Medical Center, BeerSheva, Israel, 2Soroka Medical Center, Beer-Sheva, Israel, 3Ben Gurion
University of the Negev, Epidemiology and Health Services Evaluation, BeerSheva, Israel, 4Tel Hashomer and Sackler Faculty of Medicine, Tel-Aviv, Israel,
5
Ben Gurion University Soroka Medical Center, Beer Sheva, Israel
OBJECTIVE: The study aimed to identify obstetric risk factors for post partum
hemorrhage (PPH), and to determine pregnancy outcome.
STUDY DESIGN: A comparison between consecutive singleton deliveries with
and without PPH was performed. Deliveries occurred during the years 19882002 in a tertiary medical center. A multiple logistic regression model was
constructed in order to dene independent risk factors for PPH.
RESULTS: Postpartum hemorrhage complicated 0.4% (n = 666) of all
deliveries enrolled in the study (n = 154,312). Signicant risk factors for PPH,
using a multivariable analysis, were failure to progress during the second stage of
labor (OR = 3.4, 95% CI = 2.4-4.7), instrumental delivery (OR = 2.3, 95% CI
1.6-3.4), large for gestational age (LGA) newborn (OR = 1.9, 95% CI 1.6-2.4),
hypertensive disorders (OR = 1.7, 95% CI 1.2-2.1), induction of labor
(OR = 1.4 95% CI = 1.1-1.7) and augmentation of labor with oxytocin
(OR = 1.4 95% CI = 1.2-1.7). A signicant linear association was found, using
the Mantel-Haenszel technique, between the severity of bleeding and the
following risk factors: vacuum extraction, oxytocin augmentation of labor and
hypertensive disorders (P ! .001 for all variables).
CONCLUSION: Hypertensive disorder, failure of progress during the second
stage of labor, oxytocin augmentation, vacuum extraction and LGA were found
to be major risk factors for severe PPH. Special attention should be given after
birth to hypertensive patients, to patients who underwent induction of labor or
instrumental delivery, as well as to those delivering a LGA newborn.

672

ALTERATIONS IN UTERINE SODIUM PUMP ABUNDANCE MAY CONTRIBUTE TO THE

ONSET OF MOUSE LABOR CARLOS VANCE II1, STEVEN HAMBLIN2, MICHAEL ESPLIN2,
STEVEN GRAVES1, 1Brigham Young University, Chemistry and Biochemistry,
Provo, Utah, 2University of Utah, Obstetrics and Gynecology, Salt Lake City,
Utah
OBJECTIVE: Reductions in sodium pump (SP) abundance increase uterine
contractile activity. We described a reduction in uterine SPa3 isoform in
pregnant women in active labor, however those studies could not determine
whether the change occurred before or resulted from labor. To determine
whether the mouse might serve as a model for human pregnancy in terms of the
SP and to determine whether changes in SP anticipate (and hence potentially
increase uterine contractility) or follow labor, we studied pregnant mice over
their nal trimester.
STUDY DESIGN: Pregnant C57Bl6 mice were sacriced (n = 4) at 14, 16 and
18 days gestation, during birth (wday 19) and 1 day post partum, uterus
harvested and RNA isolated for rtPCR. cDNA was obtained by reverse
transcriptase. Samples were amplied and quantied using an ABI 7900HT
instrument using mouse SPa3 primers. Western Blot analysis using a SPa3
isoform specic monoclonal antibody was also done. Data were analyzed by
ANOVA with post hoc Newman-Keuls pair-wise comparisons.
RESULTS: SPa3 isoform mRNA was most abundant on day 14 (9.4 G 0.3 !
10-7 units), was lower day 16 (8.0 G 1.1 ! 10-7 units) and signicantly lower
day 18 (4.5 G 0.6 ! 10-7 units) and at birth (wday 19, 3.7 G 0.1 ! 10-7 units).
SPa3 rose signicantly post delivery (7.5 G 1.7 ! 10-7 units). The overall trend
was signicant (P = .004). Western blot analysis demonstrated a similar but
delayed pattern.
CONCLUSION: Mouse uterine SPa3 isoform protein expression fell prior to
labor and appeared to be mediated by reductions in mRNA. These reductions
parallel changes observed in term pregnant women. Such reductions increase
uterine contractile activity and may be a fundamental mechanism in mouse and
human labor.

673

GLYCEMIC PROFILE CHARACTERISTICS DURING ACTIVE LABOR AND DELIVERY IN

NON DIABETIC SUBJECTS YARIV YOGEV1, ODED LANGER1, AVI BEN HAROUSH2,
ORLI MOST1, RONY CHEN2, MOSHE HOD2, 1St. Lukes-Roosevelt Hospital Center,
University Hospital of Columbia University, Obstetrics and Gynecology, NY,
New York, 2Rabin Medical Center, Perinatal Division, Department of
Obstetrics and Gynecology, Petach-Tikva, Israel, Israel
OBJECTIVE: There is scarcity of data regarding the physiology of glycemic
prole during labor. We studied the characteristics of the glycemic prole during
labor and early post-partum period in non-diabetic subjects using a novel
approach with the use of the Continuous Glucose Monitoring System (CGMS).
STUDY DESIGN: In an on-going prospective study, 32 non-diabetic gravid
subjects were evaluated using Continuous Glucose Monitoring System-CGMS.
CGMS measures glucose levels every 5 minutes for a total of 288 measurements
daily. The evaluation timeframe was from the latent phase until 24-h post
partum. Eligibility was limited to healthy non-diabetic women >37 weeks
gestation with a singleton pregnancy, with no chronic diseases, who did not
receive drugs known to have an eect on carbohydrate metabolism (ie, steroids
and b-sympathomimetics). All participants did not receive uids containing
glucose during labor and had spontaneous vaginal d.
RESULTS: (1) Mean maternal age was 27.3 G 3.1 years; gestational age at
delivery was 39.2 G 1.1 weeks and BMI of 24.4 G 2.6. (2) Overall, 14,586
glucose determinations were obtained during the study period; the mean time of
evaluation was 38 G 11 hours and the mean blood glucose determinations for
each subject were 452 G 64. (3) No signicant dierence was found in mean
blood glucose (MBG) during latent and active phase (82 G 19 and 79 G 21 mg/
dL, respectively P = .23). (4) During the second stage of labor, signicant lower
MBG was recorded (71 G 14 mg/dL) P = .001, and 9/32 of the women had
hypoglycemic events (blood glucose !40 mg/dL for more than 10 consecutive
minutes) with no alteration in fetal heart rate. (5) MBG during the 24-h
postprandial was signicantly higher in comparison to labor and delivery (89 G
17 mg/dL, P = .02).
CONCLUSION: During normal labor, there is a gradual physiological decrease
in glucose levels which is pronounced during the second stage.