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www.AJOG.org Academic Issues, etc Poster Session IV

002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.542

678 A methodology to improve myometrial healing afteresarean delivery: adjuvant grafting with a natural biologicohn O’Brien1, Daniel Whetham2, Tiffany Flick3,hristopher Fecteau4, John Jansen1, Michael Hiles4

Central Baptist Hospital, Lexington, Kentucky, 2Cook Medical Corporation,loomington, Indiana, 3University of Tennessee, Knoxville, Tennessee,

Cook Biotech Incorporated, West Lafayette, IndianaBJECTIVE: Defects in myometrial healing observed after hysterotomyepair are presumably due to intrinsic tissue properties, tissue devascu-arization, and the dynamics of the involuting uterus. Several obstetricalnd gynecologic complications result from inadequate tissue reapproxima-ion.Ourgoal is tocreateamethodologywhichimprovesmyometrial repair.TUDY DESIGN: Eight sheep (3 sets of twins) underwent cesarean deliveryt 138 �145 days gestation. Eleven hysterotomy sites were repaired withalf of each site reapproximated by a single layer running locking 0 Vicryluture and the remainder closed by the same closure with a juxtaposedraft consisting of 2-ply SIS (Cook, Bloomington, IN). At approximately0 days post-surgery, hysterotomy scar characteristics and tensile strengthesting were assessed Histologic examination was performed and graded.ESULTS: The difference in the mean hysterotomy closure time was onverage 1 minute 14 seconds longer for those undergoing graft place-ent. The mean scar thickness was 0.118 � 0.017 inches for controls

ersus 0.148 � 0.046 inches for the intervention group, P�.047. Tensiletrength testing demonstrated failure of the tested myometrial segment athe incision site in 13 of 17 (76.5%) evaluated sites for the control samplesersus 14 of 19 (73.7%) of the test segments, P�1.0. Tensile strengthesting did not demonstrate a significant difference between groups, Fail-re Plot analysis normalized by the width of specimen (censored for spec-

men widths �3mm), P�0.149 by Log Rank. Histologic examination ofhe myometrial scar showed no remarkable differences in inflammatoryeaction as evidenced by the presence of lymphocytes or abnormal tissueigration based on the frequency of endometrial inclusions.

ONCLUSION: Myometrial repair with a tissue graft of SIS increasedcar thickness in this animal model which may translate into fewer

yometrial defects post-cesarean delivery. This methodology did notncite a remarkable inflammatory reaction or enhance adenomyosis.

002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.543 8

Supplemen

679 Can failure of vacuum extractione predicted? A case-control studyorine J.M. Verhoeven1, Christel R.M. Janssen-olf2, S. Guid Oei2, Ben Willem Mol3

Máxima Medical Centre, Veldhoven, Netherlands, 2Máxima Medicalentre, Netherlands, 3Academic Medical Centre Amsterdam, NetherlandsBJECTIVE: A failed vacuum extraction is associated with adverse ma-ernal and fetal outcomes, and is a negative experience for the mother.nowledge of factors that predict failure of ventouse delivery can besed to improve clinical decision-making, but little systematic infor-ation on the subject is available. The objective of this case-control

tudy was to quantify potential predictors of failed vacuum extraction.TUDY DESIGN: We performed a retrospective case-control study in aerinatal centre in the south of The Netherlands. Cases were womenho had a failed ventouse delivery between 1993 and 2007. A failedacuum extraction was defined as a delivery that was started as vac-um extraction but was converted to a Cesarean section because of

ailure to progress. The study was limited to singleton pregnanciesbove 37 weeks. As controls we used data of two successful vacuumxtractions before the failed one. We recorded maternal age, height,ody mass index, parity, gestational age, induction of labour, need forpidural, reason for assisted vaginal delivery, position of the fetalead, descent of the fetal head and the number of tractions.ESULTS: Between 1993 and 2007, 2847 trials of vacuum extractionere performed of which 84 failed (3%). These 84 cases were com-ared to the data of 168 women who had a successful vacuum extrac-ion. The odds ratios for failed vacuum extraction were 1.7 (95% CI.3 to 2.2) for every traction more needed, 0.42 (95% CI 0.22 to 0.79)or fetal distress as indication for assisted vaginal delivery, and 0.1795% CI 0.09 to 0.33) for every 2 stations of fetal descent.ONCLUSION: Failed vacuum extraction can be predicted. Vacuum ex-raction for fetal distress and vacuum extraction when the fetal head iselow the level of �2 station is more likely to be successful. There is atrong need for prospective studies on the subject.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.544

680 Vacuum use during term cesareanelivery and rate of NICU admissioniane Timms1, Kathleen Smith1, Alireza Shamshirsaz1,arry Turner1, Winston Campbell1

University of Connecticut, Obstetrics andynecology, Farmington, ConnecticutBJECTIVE: Vacuum-assisted cesarean delivery (VACD) may permit amaller uterine incision to reduce the risk of lacerating the uterineessels. We sought to determine whether VACD increased the rate ofeonatal intensive care unit (NICU) admission.TUDY DESIGN: We used our database to identify all CD at 37 weekserformed at our institution from 1/2005-6/2009. Fetal anomaliesnd malpresentations were excluded. We abstracted maternal ageMA), gestational age (GA), mode of delivery, birthweight, Apgarcores at 1 and 5 minutes, and estimated blood loss (EBL) from theatabase. Operative reports were reviewed for vacuum use. We deter-ined NICU admissions by mode of delivery. Chi-square, t-test, andultivariate analysis of variance were used for data analysis.

ESULTS: There were 560 CD in the study. There was no difference inean MA, GA, birthweight, or APGAR scores �7 in the non-VACD

ersus VACD groups. A vacuum was used in 121 cases (21%). A totalf 52 infants (9.3%) were admitted to NICU. There was no difference

n NICU admission rate for VACD versus non-VACD. Similar resultsere obtained in subgroups of the 318 (56.8%) patients with primaryD or the 281 (50.2%) who had been in labor (see table). Reasons forICU admission in both groups included sepsis, respiratory compli-

ations, and hypoglycemia. There were no cranial hematomas or skullractures. There was no difference in EBL when the vacuum was usedp�0.77). Post-hoc power analysis confirms that this study had an

0% power to detect a 50% increase in NICU admission.

t to DECEMBER 2009 American Journal of Obstetrics & Gynecology S245