958: The harvesting, transplant, and tracking of stem cell sheets for the prevention of uterine scarring

Abstract

graduation in OB/GYN. Herein, we aimed to examine factors associated with the chosen route of operative delivery (abdominal vs. vaginal) in the second stage of labor for appropriate clinical indications, and to consider the potential impact of mid-cavity/rotational OVD skills on overall CD rates. STUDY DESIGN: Case-control study of patients delivered by OVD compared with second-stage CD over a 4-year period (2012-15) in a tertiary academic center. Multiple pregnancies, trial of labor after CD and intrauterine fetal deaths were excluded. Demographics and outcome data were collected retrospectively by interrogation of the OBNET database and individual chart review. Groups were compared using Student's t, Mann-Whitney U and chi-square tests as appropriate. IRB approval was granted (19-0017). RESULTS: In 2012-15, a total of 591 patients with unscarred uteri and singleton live fetuses required second stage operative intervention (5.7e7.1 % of births per annum). There were no differences between CD and OVD groups in age, gestation or labor onset. Women undergoing trial of OVD (68.4%) were more likely to be parous (21.6% vs. 12.0%, p¼0.022) with lower body mass index (24.9 AE 5.85 vs. 28.3 AE 1.56, p¼0.031). There were no differences in Apgars scores or umbilical arterial (UA) or venous pH, but UA base deficit was higher after OVD (5.5 AE 3.4 vs. 3.9 AE 0.3, p<0.001). Patients undergoing primary CD had a higher estimated fetal weight (3610 AE 37.2 vs. 3354 AE 25.8 g, p<0.001), station (+1 AE 0.1 vs. +3 AE 0.1, p<0.001) and actual birthweight (3507 AE 43.3 vs. 3352 AE 23.1 g, p¼0.002), however 88.8% were below the level of the ischial spines (0 to +2) and hence potentially eligible for mid-cavity OVD; only 12.5% were persistently OT and in need of manual rotation or rotational OVD. CONCLUSION: Factors associated with decision for primary CD in the second stage were largely predictable clinically. However, a substantial proportion may be preventable if providers adequately trained/experienced in mid-cavity/rotational OVD are available.