O-OBS-PhD-108 Factors Obstetricians, Family Physicians and Midwives Consider When Counselling Pregnant Women with a Previous Cesarean Section (CS) on Delivery Method

Study Methods: A retrospective chart review was conducted on patients who underwent a hysterectomy subsequent to a NovaSure ablation over a four year time frame in one community based hospital. Detailed analysis was performed on 203 charts. Results: Of the 1994 women who underwent NovaSure ablation 226 (11%) subsequently had a hysterectomy. The Novasure procedure was unable to be performed in 23 patients and those charts were excluded. The primary indication for hysterectomy was bleeding in 117 (58%). Other indications include pain in 31 (15%), pain and bleeding in 45 (22%), and other, prolapse, and cancer 10 (5%). New onset pain was reported in 45 (22%) patients following NovaSure and 16 (8%) underwent a hysterectomy solely due to new onset pain. Of the 164 pathology reports that commented on the endometrium, 88 (54%) showed active endometrium, 10 (6%) inactive or atrophic, 52(32%) fibrosis, scarring, or “postablative changes”. 14 (9%) had both scarring and residual active endometrium. Conclusion: Bleeding is the most common reason for Novasure failure. However, new onset pain following the NovaSure procedure is a significant burden for 22% of patients. The finding of post ablative scarring and fibrosis was not found universally in those with new onset pain, nor was it consistently noted in those patients with a bleeding component, making it difficult to attribute it as a consistent or common cause of the pain. O-OBS-PhD-108 FACTORS OBSTETRICIANS, FAMILY PHYSICIANS AND MIDWIVES CONSIDER WHEN COUNSELLING PREGNANT WOMENWITH A PREVIOUS CESAREAN SECTION (CS) ON DELIVERY METHOD C. Kurtz Landy York University, 4700 Keele St., HNES 312A, Toronto, Ontario, M3J 1P3, Canada W. Sword, S. McDonald, A. Biringer, J. Cramp, J. Dawdy, P. Angle, C. Cunningham, M. Heaman, M. Morris, H. McDonald, H. Shannon, J. Blake Objectives: Repeat CSs are major contributors to the high rate of CS in Canada. Maternity care providers have a strong influence on women’s decision to have a planned repeat CS or trial of labour (TOL), yet little is known about factors providers consider when counselling women. This study examined factors maternity care providers consider when counselling pregnant women with a previous CS, eligible for a TOL, on delivery method. Study Methods: We used a qualitative descriptive approach and conducted in-depth telephone interviews with 39 maternity care providers in Ontario. A semi-structured interview schedule guided the interviews. Data was analyzed using qualitative content analysis. Results: Maternity care providers considered systems, clinical, and personal factors when counselling women. System factors of concern to obstetricians included the availability of anesthesiologists and time needed to mount emergency CSs; and oncall providers’ support for TOL. All providers identified clinical factors, i.e. women’s characteristics that increased or decreased the likelihood of successful TOL(e.g., BMI); as well as women’s risk tolerance related to both modes of delivery. All providers considered women’s preferences. Women’s preferences were particularly important to the midwives. Midwives described that some women sought their care for a TOL believing midwives could make vaginal delivery possible when physicians couldn’t, or when obstetricians refused to support a TOL. Providers’ negative clinical experiences 490 l MAY JOGC MAI 2016 also influenced their counselling. Convenience of delivery method was considered by some. Conclusion: Effectively addressing systems, clinical and personal factors providers consider when counselling women on delivery methods may assist in decreasing non medically indicated elective repeat CS rates. O-OBS-MFM-MD-113 CORRELATION OF ESTIMATED FETAL WEIGHT WITH NEONATAL BIRTH WEIGHT AT BORDERLINE VIABILITY N. Ladhani Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada S. Hughes, J. Nguyen, J. Barrett Objectives:We sought to determine the correlation between estimated fetal weight and neonatal birth weight in live-birth deliveries between 23+0 and 25+6 weeks gestational age at a major Canadian tertiary care centre. Predicting the likelihood of morbidity and mortality in neonates delivered at the extreme of prematurity, namely 23+0 to 25+6 weeks gestational age, is an important part of counseling in this population. Physicians rely on a number of sonographic markers to establish an estimated fetal weight (EFW) composite which they use as a surrogate marker to predict true birth weight. Study Methods: A retrospective cohort study was conducted at Sunnybrook Health Sciences Centre. We sampled patients retrospectively through records of all patients delivering singleton pregnancies at gestational ages of 23+0 to 25+6 weeks between January 2003 and December 2013 inclusive, who had an ultrasound scan less than 2 weeks prior to delivery. We collected information regarding maternal demographics, ultrasound parameters, and neonatal characteristics. Results: Two hundred and forty-seven deliveries, with an average birth weight of 679g, were includded. Median maternal age was 32 years (16-46years); median gravidity was 2. The mean interval between ultrasound (measuring fetal biometry) and birth was 3.24 days. Estimated fetal weight was moderately correlated with live birth weight (r1⁄40.63). Conclusion: Estimates of fetal weight correlate moderately with live birth weight in neonates born at 23+0 to 25+6 weeks. Developing a better understanding of the utility of EFW in assessing extremely premature neonates will help guide physicians’ and families’ decision-making during this difficult periviable period W-GYN-JM-094 THE MIND-BODY CONNECTION AFTER SURGERY FOR PELVIC FLOOR DISORDERS: FACT OR FICTION? M. Larouche Providence Health St. Paul’s Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada L. Brotto, N.A. Koenig, T. Lee, G.W. Cundiff, R. Geoffrion Objectives: To determine the association between depression and anxiety symptoms, and patient-centered outcomes after surgical treatment for pelvic floor disorders (PFD). Study Methods: Prospective cohort of 50 women undergoing inpatient surgery for PFDs at a single tertiary care center. Preoperative validated questionnaires included Beck’s Depression Inventory-II (BDI-II), Beck’s Anxiety Inventory (BAI), Pelvic Floor Impact Questionnaire (PFIQ-7), and Pelvic Floor Distress Inventory (PFDI20). Women were asked about their post-surgical goals at baseline. All questionnaires were readministered at 6 weeks postoperatively,