Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729 S485

oral misoprostol was used for induction in 50microgram tablet

sublingually every four hours (2 to 3 times a day).

Results: There were recorded a total of 8338 live births in our

hospital during this period. Labor induction with misoprostol was

used in 7.17% of cases. The causes of induction were:pregnancy

after 41 weeks 54% (323), preeclampsia 26.7% (160), diabetes 3.8%

(23), intrahepatic cholestasis 3.3% (20) and other 12.2% (72). Labor

started after the first tablet in 43.3% of cases (259), after second

tablet in 41.9% (251). After the induction 35.6% (213) of parturients

needed oxytocin stimulation. Cesarean section rate was 23.6% (141).

The main reason of S-section was fetal hypoxia – 50% (71). Induction

failure was in 0.6% (4) of cases, hyperstimulation with fetal heart

rate changes was in 1.3% (8) of cases. Neonatal outcome was good,

Apgar below 7 was only in 23 cases – 3.8%.

Conclusion: Oral misoprostol in small regimens appears to

be effective and safe induction agent in obstetrics. Compared

to recommended vaginal PGE2 preparations misoprostol is

significantly cheaper and heat-stable.

P253

Caesarean section on request – A reality in Oman

S. Minocha, A. Zutshi

Objective: To study if the trend of caesarean section on patient

request is a contributory factor for increasing rates of caesarean

sections in a tertiary referral centre of Oman & its effect on perinatal

outcome.

Material and Methods: This was a retrospective study conducted

at Royal hospital over 8 years from 1999–2006. Computer data

& hospital records were utilised to collect information. Statistical

analysis was done through p value using SPSS.

Results: The number of deliveries revealed yearly rise along

with number of caesarean sections. The rate of caesarean section

increased from 11.07% in 1999 to 18.6% in 2006 which was

statistically significant. This was contributed by increase in almost

all indications but patient request showed significant rise after

2002. Only 0.5% of caesarean sections were planned elective

sections on request from 1999–2002 which increased to 2.8%

from 2003–2006 (p < 0.001). No change was noticed in perinatal

morbidity with liberalisation of caesarean sections which is in

consistence with the literature.

Conclusion: Although caesarean section on patient request has

become a reality in this part of the world but considering the social

requirement of multiparity, it should be after adequate informed

consent.

P254

6-year review of all anal sphincter injuries during vaginal

deliveries in a DGH and its management

S. Mittal, M. Das, M. O’neill

Objectives: To explore any recent trends in occurrence & risk

factors for obstetric anal sphincter injury (OASI) & ways to improve

outcome.

Materials and Methods: retrospective study of 150 patients with

OASI in 6 years (2003–2008). Data accessed & collected through

clinical audit on designed proformas.

Results: Overall occurrence was 1.4% of vaginal deliveries. Majority

were in age group of 25–35, normal BMI & nullipara. Postdate

pregnancy was a risk in two thirds, which could be indirectly

linked to factors such as induction/augmentation of labour etc.

Associated risk was 2% with induction of labour & epidural, 6%

with syntocinon augmentation, 3% with ventouse & over 8% with

forceps deliveries. Episiotomy was given in 12% spontaneous &

84% instrumental delivery in this group. Women with babies of

over 3.5 kg had 2.6% risk. Junior medical staff, perhaps competent,

repaired one third of injuries. 10% were symptomatic with faecal

urgency & incontinence. Extent of sphincter injury didn’t seem

to be co-related with symptoms. 50% reported improvement with

supervised pelvic floor exercises.

Conclusions: Association of nulliparity, prolonged second stage,

instrumental delivery, and big babies were confirmed. Medio-lateral

episiotomy appeared to be protective for both ventouse & forceps

deliveries and should be considered in nulliparous women and

others with increased risk. There is scope for more training, support

and competency assessment of Junior Medical staff undertaking

repair to improve outcome. Diverse factors ranging from maternal

age, previous bowel symptoms, and nutrition could be related to

subsequent symptoms and need further evaluation.

P255

The efficacy of wound infiltration with combination of

bupivacaine 0.5% and epinephrine in decreasing post-operative

pain in patients with transverse cesarean section

V. Modarres Nejad. Kerman University

Introduction: Post-operative pain has been always an important

surgical complication and surgeons have always been concerned

with this issue. Among various suggested techniques for post-

cesarean pain relief, use of narcotics or non-steroid anti-

inflammatory drugs are not accepted due to the problems

caused for breast-feeding and gynecologists prefer pre-operative

or post-incision analgesic techniques. In this study, the efficacy of

Bupivacaine-H combined with epinephrine in post-cesarean pain

relief was investigated.

Methods: In a randomized double-blind clinical trial in summer

and autumn 2004 in Afzalipour Hospital (Kerman/ Iran), 70 women

candidate of elective cesarean were randomly divided into case

and control groups (n =35). Inclusion criteria were 18–28 years

age, 60–80kg weight, no addiction, no accompanying surgical

operation, general anesthesia with the same type and amount of

medicines. Incision length was similar in all women and injection

of Bupivacaine (case group) and normal saline (control group) was

performed after fetus expulsion. Pain evaluation was performed in

0, 6, 12, 24 and 48 post-operative hours by using Visual Analogue

Scale. Data were analyzed through SPSS and using Mann-Whitney,

Wilcoxon Rank and repeated measure ANOVA tests. The power of

tests was analyzed by STATA’s Sampsi command.

Results: Mean age of subjects was 25.36±2.48 years and their age

range was 18–28 years. The educational level of about two third

of subjects was higher than secondary school. Previous history of

cesarean with the relative frequency of 38.5% was the most frequent

cause of cesarean candidacy. During the first 24 post-operative

hour pain was less severe in the control group as compared to the

control group (P<). After 24 hours two groups showed no significant

difference in pain severity (P>).

Discussion: The analgesic effect of Bupivacaine during the first 24

post-operative hours is significant and in whole, it is concluded

that wound infiltration with Bupivacaine in cesarean section is

an efficient way for post-operative pain management and has no

serious side effect.

P256

Controlled cord traction in active management of the third stage

(AMTSL) for the prevention of postpartum hemorrhage: FIGO

saving mothers and newborns project activities in Ukraine

I. Mogilevkina1, V. Chaika2, N. Morozova3, A. Shipunova4,

Y. Khaletskiy4, V. Senikas5, A. Lalonde5, L. Perron5. 1Donetsk

National Medical University, RNGO UMP, Ukraine, 2Donetsk National

Medical University, Donetsk ObsGyn Association, Ukraine, 3Donetsk

National Medical University, Ukraine, 4Donetsk Regional Center for

Mother and Child Care, Ukraine, 5SOGC, Canada

AMTSL properly performed helps to prevent postpartum

hemorrhage (PPH). This procedure although supported by Ministry

of Public Health, Ukraine still receives much opposition from health