672 ALTERATIONS IN UTERINE SODIUM PUMP ABUNDANCE MAY CONTRIBUTE TO THEONSET 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 uterinecontractile activity. We described a reduction in uterine SPa3 isoform inpregnant women in active labor, however those studies could not determinewhether the change occurred before or resulted from labor. To determinewhether the mouse might serve as a model for human pregnancy in terms of theSP and to determine whether changes in SP anticipate (and hence potentiallyincrease uterine contractility) or follow labor, we studied pregnant mice overtheir nal trimester.

STUDY DESIGN: Pregnant C57Bl6 mice were sacriced (n = 4) at 14, 16 and18 days gestation, during birth (wday 19) and 1 day post partum, uterusharvested and RNA isolated for rtPCR. cDNA was obtained by reversetranscriptase. Samples were amplied and quantied using an ABI 7900HTinstrument using mouse SPa3 primers. Western Blot analysis using a SPa3isoform specic monoclonal antibody was also done. Data were analyzed byANOVA with post hoc Newman-Keuls pair-wise comparisons.

RESULTS: SPa3 isoform mRNA was most abundant on day 14 (9.4G 0.3!10-7 units), was lower day 16 (8.0 G 1.1 ! 10-7 units) and signicantly lowerday 18 (4.5G 0.6! 10-7 units) and at birth (wday 19, 3.7G 0.1! 10-7 units).SPa3 rose signicantly post delivery (7.5G 1.7! 10-7 units). The overall trendwas signicant (P= .004). Western blot analysis demonstrated a similar butdelayed pattern.

CONCLUSION: Mouse uterine SPa3 isoform protein expression fell prior tolabor and appeared to be mediated by reductions in mRNA. These reductionsparallel changes observed in term pregnant women. Such reductions increase

SMFM Abstracts S187670 MISOPROSTOL CONTROLLED-RELEASE VAGINAL INSERT FOR CERVICAL RIPENINGAND INDUCTION OF LABOR IN NULLIPAROUS WOMEN CARLOS SANTANA-CASTENEDA1, JUAN CARLOS IZQUIERDO-PUENTE2, RAUL ANTONIO LEON-OCHOA3,TERRY PLASSE4, WILLIAM RAYBURN5, 1Clinical Materno Infantil Alfredo delMazo ISSEMYM, Toluca, Edo de Mexico, Mexico, 2Hospital de Gineco-Obstetricia, Luis Castelazo Ayala #4 IMSS, Mexico DF, Mexico, 3HospitalRegional 1 * de Octubre ISSSTE, Mexico DF, Mexico, 4CytokinePharmaSciences, Inc, King of Prussia, Pennsylvania, 5University of NewMexico, Obstetrics and Gynecology, Albuquerque, New Mexico

OBJECTIVE: To assess the maximum tolerated dose, ecacy and safety ofmisoprostol incorporated into a controlled release hydrogel polymer.

STUDY DESIGN: Nulliparous women at or postterm were treated withmisoprostol administered intravaginally in a retrievable hydrogel polymerdesigned to deliver drug in a controlled manner for 24 hours. The productwas similar to controlled release dinoprostone (Cervidil) but containedmisoprostol 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 reservoirresulted in a shorter time to delivery as well as a more rapid increase in modiedBishop scores. Adverse uterine and fetal heart rate eects from misoprostol werenoted 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 forevents unrelated to misoprostol; while two cesareans using the 200 mg and thoseat 300 mg doses were for events related to misoprostol.

CONCLUSION: Misoprostol administered as a 100 mg dose in a sustainedrelease hydrogel with a retrieval system resulted in rapid cervical ripening andvaginal delivery with a good safety prole.Dose (mg) N

Vaginal delivery

within 24 h

Median time to vaginal

delivery, h (range) Cesarean delivery

25 6 0 43.3 (27.5-59.2) 4

50 6 1 29.0 (21.2-54.6) 1

100 6 5 14.2 (12.9-17.2) 1

200 7 3 11.1 (10.8-21.1) 4

300 6 4 13.8 (12.3-20.1) 2

671 OBSTETRIC RISK FACTORS AND OUTCOME OF PREGNANCIES COMPLICATED WITHPOSTPARTUM HEMORRHAGE EYAL SHEINER1, LIAT SARID2, AMALIA LEVY3, DANIELS. SEIDMAN4, MORDECHAI HALLAK5, 1Soroka University Medical Center, Beer-Sheva, Israel, 2Soroka Medical Center, Beer-Sheva, Israel, 3Ben GurionUniversity of the Negev, Epidemiology and Health Services Evaluation, Beer-Sheva, Israel, 4Tel Hashomer and Sackler Faculty of Medicine, Tel-Aviv, Israel,5Ben Gurion University Soroka Medical Center, Beer Sheva, Israel

OBJECTIVE: The study aimed to identify obstetric risk factors for post partumhemorrhage (PPH), and to determine pregnancy outcome.

STUDY DESIGN: A comparison between consecutive singleton deliveries withand without PPH was performed. Deliveries occurred during the years 1988-2002 in a tertiary medical center. A multiple logistic regression model wasconstructed in order to dene independent risk factors for PPH.

RESULTS: Postpartum hemorrhage complicated 0.4% (n = 666) of alldeliveries enrolled in the study (n = 154,312). Signicant risk factors for PPH,using a multivariable analysis, were failure to progress during the second stage oflabor (OR = 3.4, 95% CI = 2.4-4.7), instrumental delivery (OR = 2.3, 95% CI1.6-3.4), 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, usingthe Mantel-Haenszel technique, between the severity of bleeding and thefollowing risk factors: vacuum extraction, oxytocin augmentation of labor andhypertensive disorders (P ! .001 for all variables).

CONCLUSION: Hypertensive disorder, failure of progress during the secondstage of labor, oxytocin augmentation, vacuum extraction and LGA were foundto be major risk factors for severe PPH. Special attention should be given afterbirth to hypertensive patients, to patients who underwent induction of labor orinstrumental delivery, as well as to those delivering a LGA newborn.

uterine contractile activity and may be a fundamental mechanism in mouse andhuman labor.

673 GLYCEMIC PROFILE CHARACTERISTICS DURING ACTIVE LABOR AND DELIVERY INNON 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 ofObstetrics and Gynecology, Petach-Tikva, Israel, Israel

OBJECTIVE: There is scarcity of data regarding the physiology of glycemicprole during labor. We studied the characteristics of the glycemic prole duringlabor and early post-partum period in non-diabetic subjects using a novelapproach with the use of the Continuous Glucose Monitoring System (CGMS).

STUDY DESIGN: In an on-going prospective study, 32 non-diabetic gravidsubjects were evaluated using Continuous Glucose Monitoring System-CGMS.CGMS measures glucose levels every 5 minutes for a total of 288 measurementsdaily. The evaluation timeframe was from the latent phase until 24-h postpartum. Eligibility was limited to healthy non-diabetic women >37 weeksgestation with a singleton pregnancy, with no chronic diseases, who did notreceive drugs known to have an eect on carbohydrate metabolism (ie, steroidsand b-sympathomimetics). All participants did not receive uids containingglucose during labor and had spontaneous vaginal d.

RESULTS: (1) Mean maternal age was 27.3 G 3.1 years; gestational age atdelivery was 39.2 G 1.1 weeks and BMI of 24.4 G 2.6. (2) Overall, 14,586glucose determinations were obtained during the study period; the mean time ofevaluation was 38 G 11 hours and the mean blood glucose determinations foreach subject were 452 G 64. (3) No signicant dierence was found in meanblood glucose (MBG) during latent and active phase (82G 19 and 79G 21 mg/dL, respectively P= .23). (4) During the second stage of labor, signicant lowerMBG was recorded (71 G 14 mg/dL) P= .001, and 9/32 of the women hadhypoglycemic events (blood glucose !40 mg/dL for more than 10 consecutiveminutes) with no alteration in fetal heart rate. (5) MBG during the 24-hpostprandial was signicantly higher in comparison to labor and delivery (89G17 mg/dL, P= .02).

CONCLUSION: During normal labor, there is a gradual physiological decreasein glucose levels which is pronounced during the second stage.