Volume 164 Number 1, Part 2

spa Abstracts 407

587 TEN YEARS EXPERIENCE WITH CESAREAN HYSTERECTOMY 589 01 Bergman,MQX, SA Ordorica,MD, FJ Frieden,MD,

DIGITAL VERSUS SPECULUM EXAM IN EVALUATING CERVICAL DILATION DURING LABOR, Steve Schlinkex, Mark Morgan, Dept. of OB/GYN, University of Oklahoma College of Medicine, Oklahoma City, OK

588

IA Hoskins,MD, BK Young,MD. NYU School of Medicine, New York, New York.

This study evaluated experience with Cesar­ean hysterectomy from 1980-1990. statistical analysis used t-test and Mann-Whitney analysis. There were 34 Cesarean hysterectomies (incidence 0.30%) with complete follow up on 29. Statisti­cally significant differences (p(.05) were fou­nd favoring the elective vs emergency cases. These were operative time (141. Ivs204. 5mins) , transfusion (2.22vs5.56units), and 1 minute Ap­gar (8.56vs7.57). Estimated blood loss (2,306vs 3,383cc), gestational age (38.1vs37.2wks), hos­pital stay (8.44vs9.80) , 5 minute Apgar (9.11vs 8.57) and antibiotics (11%vs20%) were not dif­ferent (p).05). The most common causes were ut­erine atony (38%), placenta previa (31%), and fibroids (25%). Average age for patients with fibroids was 37 vs 33 years (all others). All patients with placenta previa had previous ut­erine surgery. Thus, previous uterine surgery was associated with placenta previa and hyster­ectomy. Emergency Cesarean hysterectomy did not increase the morbidity or mortality. Placenta previa, fibroids, previous uterine surgery are risk factors for Cesarean hysterectomy which should forewarn the clinician.

TRANSVERSE UTERINE INCISION CLOSURE: ONE VERSUS TWO LAYERS

JC Hauth, J Owenx, RO Davis, T Lincolnx.

Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Alabama.

In 1926, Munro Kerr described the transverse lower uterine segment incision, recommending a two layer closure. However, a one layer closure should disrupt less tissue, lntroduce less foreign material, require less operatlve time, and perhaps achieve hemostasls more rapidly. We randomized 376 women to either a one (183) or two layer (193) closure. Both groups were similar for demographic and intrapartum risk factors. Outcome parameters were similar in both groups. In no outcome assessment was the two layer closure of benefit. Women who had a one layer closure had less operative time, 39 vs 47 min., (p=<.OOI) and a smaller hematocrit (Hct) decrease (p=.055). Women who had a one layer closure did not require more additional hemostatic sutures [x .64 (one) to .82 (two) p=.30j. We recommend that a transverse incision be placed in the true lower uterine segment and that a one layer closure be regularly used.

Sterile vaginal digital exams for cervical dilation are routinely utilized in laboring women. However, patients with ruptured membranes are at risk for subsequent intraamniotic infection. Visual cervical exams for dilation in outpatient nonlaboring women were recently deemed to clinically correlate with digital exams (r =

0,72). However, these exams were performed by the same examiner. Clinically we had not observed such a significant correlation. Our hypothesis was that visual cervical exams for dilation do not correlate with digital exams, The purpose of this study was to compare blinded visual with digital cervical exams for dilation in laboring women. Gravid women.2: 27 weeks' gestation, subjectively in labor were prospectively entered into the study. Cervical dilation was determined by two separate blinded examiners via digital and visual speculum exams within 10 minutes of each other. Three of the 50 patients were excluded due to difficulty in cervical visualization. Fifteen patients with ruptured (ROM) and 32 with intact (1M) membranes were utilized in the data analysis. The correlation coefficients between the two types of cervical exams were 0.80 (p<0.OO5) for ROM, 0.88 (p<0.OO5) for 1M and 0.88 (p<0.OO5) for all patients. Based on these data, our hypothesis was not supported. It appears that visual cervical exams for dilation correlate with digital exams in laboring women irrespective of their membrane status.

590 CONSERVATIVE MANAGEMENT OF PREGNANCY IN THE DIETHYLSTILBESTROL EXPOSED PATIENT Lev1ne, R.U.*, Berkow1tz, K.M.* Department of Obstetr1 cs and Gynecology , Col umb1 a Presby ten an Medi ca 1 Center, New York, N. Y .

Prophylactic cerclage 1n the d1ethylstilbestrol (DES) exposed pat i ent has been advocated to reduce the rate of preterm de 11 very We report on 120 pregnanc1 es 1 n 50 DES exposed patients managed w1thout prophylact1c cerclage. 68% of pat1ents had gross cerV1 ca 1 abnormal i t 1 es. One pat 1 ent had a h1 story of prlor second trlmester loss. In patlents whose pregnanCles reached V1 ab111 ty, subsequent pregnancy outcome was unchanged. Cerc 1 age was 11mi ted to 3 pat 1 ents W1 th pr10r second tnmester loss or progressi ve cerV1 ca 1 change. 41 pregnanci es (35%) terminated in the first trimester. 80% of the rema1n1ng pregnancies progressed to term. Of pregnanc1es reach1ng 24 weeks, 87% progressed to term. The mean gestat10nal age (GA) 1n pregnancies term1nat1ng after 16 weeks was 37.8:!: 3.9 weeks. The mean b1rthwe1ght (BW) was 2997:!: 555 gm. In pat1ents w1th gross cerv1cal abnormal1ties, 17% of pregnanc1es reach1ng 16 weeks progressed to term. The mean GA in th1 s subset was 37.0 + 4 4 weeks and the mean BW was 2813 .:!: 887 gm. There wa-; no signlficant difference 1n BW or GA between pat1ents w1th gross cerV1 ca 1 changes and those W1 th m1 croscopi c changes. The results of th,S study 1nd1cate that conservat,ve management produces a pregnancy outcome as favorable as that reported in previ ous stud1es of prophylactiC cerclage and suggest that the use of prophylactic cerclage is not 1nd1cated.