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10 HOW RELIABLE IS DETERMINATION OF CERVICAL DILATATION? COMPARISON OFTRANSVAGINAL DIGITAL EXAMINATION WITH SPATIAL POSITION-TRACKINGRULER JACKY NIZARD1, SHOSHANA HABERMAN2, YOAV PALTIELI3, RON GONEN4,GONEN OHEL5, DIANE NICHOLSON2, YVES VILLE1, 1CHI Poissy-St-Germain-en-Laye,Poissy, France, 2Maimonides Medical Center, Brooklyn, New York, 3Bnai ZionMedical Center, Trig Medical Ltd, Haifa, Israel, 4Bnai Zion Medical Center, Tech-nion, Haifa, Israel, 5Bnai Zion Medical Center, Technion, Haifa, Haifa, Israel

OBJECTIVE: To compare digital assessment of cervical dilatation with simulta-neous measurements of the distance between two opposing cervical margins usinga finger mounted position sensor.

STUDY DESIGN: This prospective study conducted in Poissy, France; Brooklyn,USA; and Haifa, Israel, included 333 measurements performed in 188 women withterm, singleton vertex pregnancies, during the active stage of normal labor. Ninetymeasurements with clinical diagnosis of full dilatation were excluded from analysis.Measurements were performed using the LaborPro system, by attaching a smallposition snesor to the midwife=s index fingertip. Evaluations were done when cer-vical examinations were clinically indicated. Differences were calculated as Labor-Pro result – trans-vaginal result, with LaborPro as a reference. Center poolabilitywas assessed via a t-test.

RESULTS: Results were similar in all centers. Mean error was 10.2�8.4 mm,ranging from 7.5�7.3 mm when cervical dilatation was above 8 cm, to 12.5�8.7mm when cervical dilatation was between 6.1 and 8 cm. Proportion of subjects withan accuracy � 10mm shows the same patterns – the proportions of accurate resultsare similar for the 0 to 4.0 cm (68.3%), 4.1 to 6.0 cm (52.1%) and �8 cm (70.0%)sections, and significantly lower (p�0.0014) for the 6.1 to 8.0 cm section (38.8%).

CONCLUSION: This in situ evaluation of cervical assessment during vaginal ex-amination shows that clinical evaluation has limited precision. Clinical assessmentaccuracy was worst between 6.1 and 8 cm of dilatation.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.237

11 DETERMINING THE VALUE OF FORCE-FEEDBACK SIMULATION TRAINING FORSHOULDER DYSTOCIA JENNIFER KELLY1, JEANNE-MARIE GUISE2, PATRICIAOSTERWEIL3, HONG LI4, 1Oregon Health & Science University, Obstetrics and Gyne-cology, Portland, Oregon, 2Oregon Health and Science University, Maternal FetalMedicine, Portland, Oregon, 3Oregon Health and Science University, Portland,Oregon, 4Oregon Health & Science University, Portland, Oregon

OBJECTIVE: To discover if force feedback simulation training is useful to clini-cians in determining the maximum threshold of force to use during shoulder dys-tocia deliveries.

STUDY DESIGN: Obstetricians, family physicians and certified nurse midwivesthat deliver at OHSU were invited to participate in a study to determine the edu-cational value of obstetric simulation. The PROMPT™ birthing simulator was usedto simulate shoulder dystocia deliveries and to provide force-feedback training.Participants underwent a shoulder dystocia delivery simulation, teaching session,and then a post-teaching delivery simulation. Applied delivery forces were mea-sured for each delivery before and after training. The maximum force (in Newtons),number and percentage peak forces that were �100N were compared using thepaired t-test.

RESULTS: A total of 40 providers (28 OB, 6 Family Medicine, 6 CNMs) partic-ipated in force simulation training. Participants ranged from first year interns to 34years post training. Maximum peak forces, number of peaks �100N and percent-age of peaks �100N were all significantly reduced after training (P�0.0001 for all).Training was equally effective regardless of gender, training, or delivery experience.

CONCLUSION: Forces applied during simulated shoulder dystocia deliverieswere significantly reduced following force feedback training. Force-feedback is apotentially useful method for providers to self-train maximum force threshold inshoulder dystocia deliveries.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.238

70 American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2

12 NEONATAL ORGAN SYSTEM INJURY IS UNRELATED TO THE SEVERITY OF ACUTEBIRTH ASPHYXIA JEFFREY PHELAN1, LISA KORST2, GILBERT MARTIN3, 1Citrus ValleyMedical Center OB/Gyn, City of Industry, California, 2USC Keck School of Med-icine, OB/GYN, Los Angeles, California, 3Citrus Valley Medical Center, Neonatol-ogy, West Covina, California

OBJECTIVE: To examine the prevalence of major organ dysfunction amongneonates with and without catastrophic intrapartum asphyxia.

STUDY DESIGN: Fetuses with a sudden, rapid and sustained deterioration thatlasted until delivery from a previously reactive FHR pattern were identified in aregistry of singleton term brain-damaged neonates. Catastrophic intrapartum as-phyxia was defined as a uterine rupture with a partial or complete expulsion of thefetus and/or the placenta. Neonatal organ dysfunction was contrasted betweenthose fetuses with catastrophic asphyxia (Group 1), and those without catastrophicasphyxia but with and without a clinically recognizable sentinel hypoxic event suchas abruption or shoulder dystocia (Groups 2 and 3, respectively). Neonatal organinjury was defined as follows and did not include CNS injury: Renal-serum creat-inine �1.0 mg/dl or oliguria (�1.0 cc/kg/hr); Hepatic-Elevation of SGOT or SGPT�100 U/L or LDH �100 U/L or LDH 600 U/L; Cardiac-pressors for support orCPK �400 U/L or abnormal echocardiogram; Pulmonary- ventilator support; Gas-trointestinal- gasless abdomen on x-ray; and Hematologic- first NRBC �12%,NRBC Clearance time �80 hours, first platelet count �150,000 /mm3or a plateletcount �100,000 /mm3within 5 days of birth.

RESULTS: Of 111 eligible cases, 44 (40%) were classified in Group 1, 39 (35%)in Group 2, and 28 (25%) in Group 3. The prevalence of organ dysfunction for eachGroup respectively was: Hepatic 32% vs. 15% vs. 32% (P � 0.1657); Renal 91% vs.92% vs. 96% (P � 0.6701); Gastrointestinal 16% vs. 18% vs. 11% (0.7127); Pulmo-nary 80% vs. 72% vs. 86% (P � 0.3825); Cardiac 46% vs. 36% vs. 43% (P � 0.6673);and Hematologic 55% vs. 74% vs. 78% (P � 0.1566).

CONCLUSION: Among infants with permanent neonatal brain injury, cata-strophic intrapartum asphyxia did not appear to be associated with an increase inneonatal organ dysfunction.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.239

13 CAN WE PREDICT UNCOMPLICATED DELIVERY? A PROSPECTIVE OBSERVATIONALSTUDY JASMIN OZ1, ORLY SARID2, RONY PELEG3, EYAL SHEINER1, 1Soroka UniversityMedical Center, Ben-Gurion Universiy of he Negev, Department of Obstetrics andGynecology, Beer Sheva, Israel, 2Ben-Gurion Universiy of he Negev, Beer Sheva,Israel, 3Ben Gurion University of the Negev, Family Medicine, Faculty of HealhSciences, Beer-Sheva, -, Israel

OBJECTIVE: The present study aimed to investigate factors predicting uncom-plicated deliveries, and specifically whether a sense of coherence (SOC) and per-ceived stress can predict such deliveries.

STUDY DESIGN: A prospective observational study was conducted employingself-administered SOC and Perceived Stress Scale (PSS) questionnaires with preg-nant women attending the outpatient clinic for routine surveillance. Followingdelivery, data regarding maternal and fetal delivery complications were collectedfrom the participants’ medical records.

RESULTS: Of one-hundred and forty five women completing the study, 41.4%completed the delivery process without complications. Women experiencing de-livery complications, on average, had lower SOC scores (68�1.17 vs. 72�1.36, p �0.03). Maternal complications (as opposed to fetal complications) accounted forthis divergence and were related to lower SOC scores (67.74�1.19 vs. 72.18�1.32,p � 0.01). PSS was not associated with uncomplicated delivery (18.20�0.64 vs.18.63�0.58, p � 0.626). Nulliparity however, was associated with higher occur-rence of complicated delivery (31.9% of complicated vs. 13.2% of uncomplicateddeliveries, p � 0.01). Multivariable analysis demonstrated that SOC (OR�1.042;95% CI�1.004-1.08; p � 0.03) and nulliparity (OR�0.293; 95% CI� 0.113-0.758;p � 0.011) were both independent predictors of uncomplicated delivery, directlyand inversely, respectively.

CONCLUSION: Higher SOC scores are an independent protective factor for theprediction of uncomplicated delivery.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.240

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