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155: Outcomes of pregnancies with incidentally detected unicornuate uterus
www.AJOG.org
Clinical Obstetrics, Epidemiology, Fetus, Medical-Surgical Complications, Neonatology, Physiology/Endocrinology, Prematurity
outcomes showed a clinically relevant, although not statistically significant, improvement in birthweight ⬍2500 grams and preterm delivery in those women who successfully completed detoxification. CONCLUSION: Maternal opioid detoxification during pregnancy results in improved neonatal outcomes and decreased neonatal duration of hospitalization. The stability of our success rate and improvement in neonatal outcomes justifies continued maternal opioid detoxification in select patients.
154 Risk of intrauterine death in monochorionicdiamniotic (MCMD) twins Robin Kalish1, Gloria Felix1, Shane Wasden1 1
Weill Cornell Medical College, Obstetrics and Gynecology, New York, NY
OBJECTIVE: As MCMD pregnancies are at higher risk of perinatal mor-
bidity and death compared to singletons and dichorionic twins, the optimal gestational age of planned delivery is controversial. This study calculates the prospective gestational age specific risk of fetal death in MCDA twins. STUDY DESIGN: We performed a review of all MCDA twins who where followed antenatally and delivered ⱖ24 weeks gestation from 20002012 at our institution. Study subjects were identified from our ultrasound database. Maternal and neonatal charts were reviewed. The prospective risk of fetal demise was calculated for 2 week blocks starting at 24 weeks. Fisher’s exact and Mann-Whitney U tests were used for analysis of categorical and continuous variables. Binomial distribution 95% confidence intervals were calculated using standard statistical formulas. RESULTS: 147 pregnancies were included. Ten intrauterine deaths occurred in 147 pregnancies, giving a 3.4% fetal mortality rate. Twintwin transfusion syndrome (TTTS) was diagnosed in 13/147 pregnancies (8.8%).The risk of fetal death was higher in pregnancies complicated by TTTS (15.4% vs 3.0%, p⫽ .03).The prospective risk of fetal death was 4.1% at 24-25wks, 3.5% at 26-27wks, 2.2% at 2829wks, 2.2% at 30-31wks, 2.3% at 32-33wks, 1.8% at 34-35wks, and 1.4% at ⱖ36wks (see Table).Of 284 live newborns in our study there were 4 neonatal deaths from 3 pregnancies (1.4%).All 3 pregnancies were delivered severely prematurely at 24-25 weeks and 2 pregnancies were complicated by TTTS. The overall risk of perinatal death was 14 per 294 fetuses (4.8%). CONCLUSION: There is a high risk of intrauterine death in MCDA pregnancies. Elective pre-term delivery may reduce the perinatal mortality rate. However, planned delivery at ⬍36 weeks would likely increase the rate of neonatal complications associated with prematurity. The optimal age for delivery in MCDA pregnancies not complicated by TTTS remains controversial and warrants further investigation in prospective trials.
Prospective gestational age specific risk of fetal death
*95% CI is given in parenthesis.
Poster Session I
155 Outcomes of pregnancies with incidentally detected unicornuate uterus Sarah Anderson1, Stephen Chasen1 1 Weill Medical College of Cornell University, Obstetrics and Gynecology, New York, NY
OBJECTIVE: Unicornuate uterus is associated with high rates of cervical insufficiency and spontaneous preterm birth. A limitation of existing data is that imaging often is done for a history of poor OB outcomes, and those diagnosed with unicornuate uterus are at high risk based on history. Our objective was to evaluate OB outcomes in those with unicornuate uterus ascertained for reasons unrelated to poor OB history. STUDY DESIGN: Retrospective review of OB database from 2005-2012 identified women with unicornuate uterus at ⬎12 weeks. Diagnoses were confirmed by HSG and/or MRI. Cases in which imaging was performed due to history of midtrimester loss or preterm birth were excluded. Records were reviewed to identify outcomes. SGA was defined as birthweight ⬍10th%ile based on a US growth curve. MannWhitney U was used for statistical comparison. RESULTS: 27 patients with 37 pregnancies were included. Most diagnoses (85%) were made during infertility workup, with remaining cases diagnosed following findings at the time of OB ultrasound, cesarean delivery, or surgery for ectopic pregnancy. Prophylactic cerclage was placed in only 6 pregnancies (16%). Outcomes are listed in the Table. The midtrimester loss at 16 weeks was associated with vaginal bleeding, but not painless dilation. All spontaneous preterm births occurred at ⬎34 weeks. Indicated preterm births were for fetal indications (2), placenta previa (2), and vasa previa (1), and were at earlier gestational ages compared to spontaneous preterm births (median 34 vs. 36 weeks; p⫽.03). Cesarean delivery was performed in 27 cases (75%), with malpresentation the most common indication. CONCLUSION: In those with unicornuate uterus but no history of adverse OB outcome, rates of midtrimseter loss and spontaneous preterm birth were lower than described in published studies. Half the preterm births, including all at ⱕ34 weeks, were indicated. The relatively high rate of SGA newborns and placental abnormalities suggests that abnormal placentation may be a greater concern than spontaneous preterm birth.
Obstetric outcomes in women with incidentally detected unicornuate uterus
156 Time from LEEP to pregnancy: impact on adverse pregnancy outcomes Shayna Norman1, Alison Cahill1, Methodius Tuuli1, David Stamilio1, Anthony Odibo1, Kimberly Roehl1, George Macones1 1 Washington University in St. Louis, Obstetrics and Gynecology, St. Louis, MO
OBJECTIVE: Prior studies have shown conflicting results for pregnancy outcomes after loop electrode excision procedure (LEEP), however no study has evaluated pregnancy outcome with respect to time elapsed from LEEP to pregnancy. We investigated risk of spontaneous abortion (SAB) and preterm birth associated with time elapsed from a LEEP to pregnancy. STUDY DESIGN: A 7-year, multicenter cohort study of reproductiveaged women who underwent LEEP was performed between 2000 and 2006. Subjects were identified by review of pathology records at 9 tertiary and community hospitals. Trained research nurses conducted closed-ended phone interviews with all subjects to complete historical and medical data extraction unavailable in charts. Median time interSupplement to JANUARY 2013 American Journal of Obstetrics & Gynecology
S77
Clinical Obstetrics, Epidemiology, Fetus, Medical-Surgical Complications, Neonatology, Physiology/Endocrinology, Prematurity
outcomes showed a clinically relevant, although not statistically significant, improvement in birthweight ⬍2500 grams and preterm delivery in those women who successfully completed detoxification. CONCLUSION: Maternal opioid detoxification during pregnancy results in improved neonatal outcomes and decreased neonatal duration of hospitalization. The stability of our success rate and improvement in neonatal outcomes justifies continued maternal opioid detoxification in select patients.
154 Risk of intrauterine death in monochorionicdiamniotic (MCMD) twins Robin Kalish1, Gloria Felix1, Shane Wasden1 1
Weill Cornell Medical College, Obstetrics and Gynecology, New York, NY
OBJECTIVE: As MCMD pregnancies are at higher risk of perinatal mor-
bidity and death compared to singletons and dichorionic twins, the optimal gestational age of planned delivery is controversial. This study calculates the prospective gestational age specific risk of fetal death in MCDA twins. STUDY DESIGN: We performed a review of all MCDA twins who where followed antenatally and delivered ⱖ24 weeks gestation from 20002012 at our institution. Study subjects were identified from our ultrasound database. Maternal and neonatal charts were reviewed. The prospective risk of fetal demise was calculated for 2 week blocks starting at 24 weeks. Fisher’s exact and Mann-Whitney U tests were used for analysis of categorical and continuous variables. Binomial distribution 95% confidence intervals were calculated using standard statistical formulas. RESULTS: 147 pregnancies were included. Ten intrauterine deaths occurred in 147 pregnancies, giving a 3.4% fetal mortality rate. Twintwin transfusion syndrome (TTTS) was diagnosed in 13/147 pregnancies (8.8%).The risk of fetal death was higher in pregnancies complicated by TTTS (15.4% vs 3.0%, p⫽ .03).The prospective risk of fetal death was 4.1% at 24-25wks, 3.5% at 26-27wks, 2.2% at 2829wks, 2.2% at 30-31wks, 2.3% at 32-33wks, 1.8% at 34-35wks, and 1.4% at ⱖ36wks (see Table).Of 284 live newborns in our study there were 4 neonatal deaths from 3 pregnancies (1.4%).All 3 pregnancies were delivered severely prematurely at 24-25 weeks and 2 pregnancies were complicated by TTTS. The overall risk of perinatal death was 14 per 294 fetuses (4.8%). CONCLUSION: There is a high risk of intrauterine death in MCDA pregnancies. Elective pre-term delivery may reduce the perinatal mortality rate. However, planned delivery at ⬍36 weeks would likely increase the rate of neonatal complications associated with prematurity. The optimal age for delivery in MCDA pregnancies not complicated by TTTS remains controversial and warrants further investigation in prospective trials.
Prospective gestational age specific risk of fetal death
*95% CI is given in parenthesis.
Poster Session I
155 Outcomes of pregnancies with incidentally detected unicornuate uterus Sarah Anderson1, Stephen Chasen1 1 Weill Medical College of Cornell University, Obstetrics and Gynecology, New York, NY
OBJECTIVE: Unicornuate uterus is associated with high rates of cervical insufficiency and spontaneous preterm birth. A limitation of existing data is that imaging often is done for a history of poor OB outcomes, and those diagnosed with unicornuate uterus are at high risk based on history. Our objective was to evaluate OB outcomes in those with unicornuate uterus ascertained for reasons unrelated to poor OB history. STUDY DESIGN: Retrospective review of OB database from 2005-2012 identified women with unicornuate uterus at ⬎12 weeks. Diagnoses were confirmed by HSG and/or MRI. Cases in which imaging was performed due to history of midtrimester loss or preterm birth were excluded. Records were reviewed to identify outcomes. SGA was defined as birthweight ⬍10th%ile based on a US growth curve. MannWhitney U was used for statistical comparison. RESULTS: 27 patients with 37 pregnancies were included. Most diagnoses (85%) were made during infertility workup, with remaining cases diagnosed following findings at the time of OB ultrasound, cesarean delivery, or surgery for ectopic pregnancy. Prophylactic cerclage was placed in only 6 pregnancies (16%). Outcomes are listed in the Table. The midtrimester loss at 16 weeks was associated with vaginal bleeding, but not painless dilation. All spontaneous preterm births occurred at ⬎34 weeks. Indicated preterm births were for fetal indications (2), placenta previa (2), and vasa previa (1), and were at earlier gestational ages compared to spontaneous preterm births (median 34 vs. 36 weeks; p⫽.03). Cesarean delivery was performed in 27 cases (75%), with malpresentation the most common indication. CONCLUSION: In those with unicornuate uterus but no history of adverse OB outcome, rates of midtrimseter loss and spontaneous preterm birth were lower than described in published studies. Half the preterm births, including all at ⱕ34 weeks, were indicated. The relatively high rate of SGA newborns and placental abnormalities suggests that abnormal placentation may be a greater concern than spontaneous preterm birth.
Obstetric outcomes in women with incidentally detected unicornuate uterus
156 Time from LEEP to pregnancy: impact on adverse pregnancy outcomes Shayna Norman1, Alison Cahill1, Methodius Tuuli1, David Stamilio1, Anthony Odibo1, Kimberly Roehl1, George Macones1 1 Washington University in St. Louis, Obstetrics and Gynecology, St. Louis, MO
OBJECTIVE: Prior studies have shown conflicting results for pregnancy outcomes after loop electrode excision procedure (LEEP), however no study has evaluated pregnancy outcome with respect to time elapsed from LEEP to pregnancy. We investigated risk of spontaneous abortion (SAB) and preterm birth associated with time elapsed from a LEEP to pregnancy. STUDY DESIGN: A 7-year, multicenter cohort study of reproductiveaged women who underwent LEEP was performed between 2000 and 2006. Subjects were identified by review of pathology records at 9 tertiary and community hospitals. Trained research nurses conducted closed-ended phone interviews with all subjects to complete historical and medical data extraction unavailable in charts. Median time interSupplement to JANUARY 2013 American Journal of Obstetrics & Gynecology
S77