S224 Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396

(n = 72). Statistical analysis was done with Chi-square test, Mann

Whitney and Students t-test wherever appropriate & p value <0.05

was taken as significant.

Results: Out of seventy two women with breech presentation

after previous cesarean, twenty three women (31.94%) were given

trial of labor (planned vaginal delivery) in comparison to forty

nine women who had repeat cesarean section. Trial of labor was

successful in eighty three percentage (19/23) of them. There were

more maternal complications in the repeat cesarean group than in

the group planned for vaginal delivery (22.4% vs. 13.04%); however,

one patient in the planned delivery had rupture uterus and was

diagnosed to have Ehler Danlos syndrome in the postpartum period.

Of the 72 babies, 3 (4.17%) were diagnosed to have intrauterine fetal

demise before labor. The birth weight and the gestation at delivery

were statistically comparable between the repeat cesarean section

group and the planned delivery group who had a successful trial

of labor (p < 0.05). The early neonatal morbidity in the form of

Apgar scores <7 at 1 min (43.8% vs 15.1%) & 5 min (12.5% vs 0%),

admissions to NICU (43.8% vs 7.6%) and neurological abnormality

(6.3% vs 0%) was slightly higher in the planned vaginal delivery

group (p < 0.05).

Conclusions: Trial of labor seems to be a reasonable alternative to

repeat cesarean in carefully selected cases of breech presentation

after a previous cesarean section.

O460

NICE guidelines and active management of the third stage

of labour: Are research results reproducible in practice?

B. Kemp, M. Mubarak, D. Eustace. Wycombe Hospital

Objectives: Following publication of the 2007 guidelines on

intrapartum care by the National Institute of Health and Clinical

Excellence (NICE), we replaced Syntometrine with Syntocinon (10

international units) in the active management of the third stage

of labour. The aim of this study is to assess the impact of this

change upon the incidence of post partum haemorrhage (PPH) and

associated sequelae.

Materials and Methods: Setting: UK District General Hospital

serving a multiethnic population with 2800 deliveries per annum.

Methods: A retrospective birth register and case notes analysis,

with pharmacy and transfusion database queries. Statistical analysis

performed using SPSS.

Subjects: Women achieving vaginal delivery (n =1100) from June

1st 2007 to November 30th 2007, using Syntometrine in the

third stage of labour, (group A) were compared with women

(n =1079) from the same period in 2008, when Syntocinon was

used (group B).

Outcome measures: Estimated blood loss at delivery, change in

haemoglobin, use of therapeutic uterotonics, blood transfusion and

intensive care admissions (ITU).

Results: The groups were comparable for age, parity, instrumental

delivery rate and retained placenta. In group B 33 women (3%) had

PPH greater than 1000ml versus 11 (1%) in group A (P =0.007, Odds

Ratio (OR) = 2.32); 27 women (2.45%) required blood transfusion

versus 5 (0.46%) (P = 0.001, OR=4.17); 100 ampoules of Carboprost

were used versus 50; and 1 woman was admitted to ITU versus

none.

Conclusions: These data imply that translating NICE guidance into

practice has generated a significant increase in the incidence of

post partum haemorrhage and blood transfusion. Could this be a

case of NICE on paper, but not quite so nice in practice?

O461

Novel early prediction of future spontaneous abortion or

preterm delivery among asymptomatic women

A. Kessler. SafePregnancy Ltd and Assaf Harofe Hospital

We still lack crucial understanding regarding the pathophysiology

leading to implantation failure as well as spontaneous abortion or

pre term delivery. Consequently, early prediction of the chances

of conceiving, or maintaining the pregnancy up to its 38th week

ending with uneventful delivery would today resemble science

fiction.

Based on our previous studies on specific brain circuits we

hypothesized a pivoting role of the hypothalamus in the

pathophysiology of spontaneous abortion. We developed a non-

invasive medical device (Pregnochrone) for monitoring the

hypothalamic chronobiology of women and domestic animals.

All experiments were performed under double blind experimental

design. Experiments 1–3 with 38, 36 and 42 dairy cows in

commercial herds located at two different geographical sites

were performed as a model of the working hypothesis. Correct

identification of past aborting cows from controls reached 58%, 71%

and 56% respectively.

Monitoring mares in breeding herds, Pregnochrone differentiated

past aborting mares from controls reaching 76% success rate

(Experiment 4).

Confident with our hypothesis we monitored pregnant women.

From a cohort of 34 women, 12 of 13 women presenting past

abortion were accurately identified yielding 92% sensitivity ratio.

To the best of our knowledge this is the first time that past abortion

has been detected by non-invasive means. The genetic load of this

disorder is analyzed thus opening it for early diagnosis of high risk

females prone to future abortion.

O462

A no-cost breast cancer screening program promotes cervical

cancer screening services to an underserved population of

women

D. Khabele1, M. Egger2, T. Campbell3, M. Dewey4, M. Overlock5,

D. Wujcik6. 1Vanderbilt University and Meharry Medical College,2Vanderbilt University, 3Metro Public Health Department, Breast and

Cervical Cancer Screening Program, 4Tennessee Department of Health,

TN Breast and Cervical Cancer Screening Program, 5Nashville General

Hospital at Meharry, 6Vanderbilt-Ingram Cancer Center

Background: The cervical cancer death rate among African-

American women in Tennessee remains disproportionately high and

the rate of Pap test screening remains below targeted numbers. The

Tennessee Breast and Cervical Cancer Screening Program (TBCSP)

provides free breast and cervical cancer screening to women

who are uninsured or underinsured. Mammograms in May (MIM)

offers no-cost screening mammograms at a county hospital in a

predominately African-American neighborhood. We hypothesized

that inquiring about recent Pap test screening during the MIM

visit would identify women who had not undergone recent cervical

cancer screening.

Materials and Methods: All women arriving for mammography

examinations through MIM were asked if they had received a Pap

test within the past 3 years. Women who had not were referred for

services and eligible women were enrolled in the TBCSP.

Results: Four hundred and twenty-nine screening mammograms

were performed through the MIM program. One hundred and

eighty-six (43%) women had not had a recent Pap test. Ninety-

three (22%) women were eligible for enrollment in the TBCSP and

57/93 (61%) Pap tests were completed.

Conclusion: Almost half of the women undergoing breast cancer

screening examinations had not had a recent Pap test. Over one-fifth

of the women were eligible for enrollment in the TBCSP, indicating

their status as uninsured or underinsured. The appointment show

rate was greater than 60% in this high risk population. These results

are preliminary, but suggest further study is warranted to explore

the approach of using breast cancer screening as a method of

entry to cervical cancer screening services in women who are

underserved.