Volume 164 1'\ umber I, Part 2

595 VAGINAL BIRTH AFTER CESAREAN: A ;;OLE FJ;; NURSE ~lIDWIFERY CARE L loeger, r" D. " I. Guyette, CNM, r~s" Ricrarci p. Porreca, ~1 D. PresbyterliJll/3c. L,"ke's PeeiniltiJl Program, "niv~rsity of Colorado He, 1 t h Sciences C~nter Denver, Co lorado

352 "omen .ho 1.,bored oftpr pr~vious cesarean births were cared for On three separate services: ,J cI'nic service with primary care by residenc physici.;n" 01 private service with primary care by dttending physiciilns, dnd ij nurse midwifery service with primary care by certified nurse midwives in 'l

collaborative arrongement with perinatologists. Apgar scores, macrosomic and under~rown infants. ,or,nnn ,c.lge labor lengths, use wf oxytocin augmentation and epidural iJna 1gesia were not different among the three groups AdrlitioniJ lly, indication for primar~ cesarean birth was similar .10l0ng the three groups. Vaginal births (V8AC) occurred sijnificantl; mo,'e often .,mOO9 pat i ents cared for on the c lin i c and nu rse mid~ifery servi ces (86.2% dnd 36.n respectlvely) when compared to the privdte service (71.0%). The clinic serVlce patients had significantly smaller infants thiln either of the other two services, though the nurse midwifery patients and private attendln~ patients were not different. Patlents whose first cesarean was for cephalopelvic disproQortion or failure to progress had significantly more vaginal births on the clinic and nurse midwifery service (79.7\ and 933% respectively) than on the priVilte service (53.;%). Overall, patients who delivered vaginillly on ilny of the three services bore infants significantly smaller than infants born by indicated repeat cesarean birth CONCLUSION: i) A collaborative physician/nurse midwifery model of obstetric care for patients with previous cesarean births appears to be at least as successful oS care directed by physicians,; lone 2) 8irthweights may explain in part some of the differences seen in V8AC between chnic and private patients, although nurse ~idwifery patients hod birthweig~ts identical to privilte p.;tients Jnd V8AC similar to clinic patients.

596 MATERNAL TRANSPORT IN MARYLAND. N. Callan, T. Gatto X , C. Bowenx , C. Bailey-Jones x , M. Pupkin, The Johns Hopkins University, and University of Maryland.

Our state maternal transport (MT) system consists of two primary university tertiary care centers, and four back up centers all in a single metropolitan area. Referrals are coordinated through the statewide emergency system. We reviewed the transport experience from 1984-1989 and compared it to neonatal transports (NT). The MT increased from 368 in 1984 to 643 in 1989, while NT remained constant. More than 40% of infants from MT and less than 25% of NT were < 1500 grams. The maj orily of NT were > 2500- grams. The most frequent indication for MT and NT was prematurity; however, surgical indications were common in NT. In both groups survival rates were significantly greater for infants >750 gm. The majority of MTs delivered in < 48 hours, yet 25% were discharged undelivered. Because MT and NT serve different patient populations, these systems should be viewed as complementary in providing optimal perinatal care for the region.

SPO Abstracts 409

597 A RETROSPECfIVE LOOK AT SINGLE LAYER U1ERlNE CLOSURE IN LOW TRANSVERSE CESAREAN SECTION. S. Paige Hertweck, M.D." J. A. Spinnato, M.D. University of Louisville, Louisville, KY

This study compares retrospectively single layer locking continuous closure for low transverse cesarean section with traditional two layer closure to assess the poSSible relationship of closure technique to uterine dehiscence or rupture with subsequent delivery. A computerized patient index was used to extract case records from 1985 to the present. Patients mcluded were those who had a low transverse cesarean section and a subsequent delivery. Three hundred nine patients were studied. 48% experienced labor and 29% accomplished vaginal delivery. Thirty-eight had a single layer closure at initial cesarean section. Two hundred seventy-one had other closures, either a single layer with multiple figure of eight hemostatic sutures or a traditional two layer closure. Of the thirty-eight patients in our Single layer closure group, all had either intact scars (26) at the time of second delivery or had no mention (12) of scar at second delivery. In the control group, there were two uterine dehiscences and one complex uterine rupture compared with no dehiscence or rupture in the study group. There was no staustical difference between the conventional closure and single layer closure with respect to scar disruption. If these prelimmary findings are validated with larger study popUlations, smgle layer closure is a suitable closure technique for cesarean section.

598 A COMPARISON OF EXTRA-AMNIONIC SALINE INFUSION WITH PROSTAGLANDIN E2 CERVICAL GEL FOR PRE­INDUCTION RIPENING OF THE UNFAVORABLE CERVIX, M Varner, M Koschnitzkex , B HurstX

, P JohnstonX , M Mi tchell x. Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah.

Fifty-four PGE2 cervical gel patients were compared to 18 extra-amnionic saline infusion EASI patients from October 1989 through August 1990. Although the choice of cervical pre­induction ripening procedure was selected by the attending physicians, there were no significant differences between the groups in indications for induction, pre- or post­procedure Bishop scores, gestational age, or maternal age and parity. There were no significant differences in method of delivery, five-minute Apgar scores, birthweight, cord blood gases, or induction-to-delivery time interval. CONCLUSIONS: 1. In these similar patient populations, no differences were noted in five minute Apgar scores, cord blood gases, method of delivery, or induction to delivery intervals. 2. A prospective randomized trial with adequate numbers should be performed before EASI can be considered a superior pre­induction cervical ripening technique.