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312: Cerclage for short cervix on ultrasound in singleton gestations without prior preterm birth: meta-analysis of trials
Poster Session II
ajog.org spontaneous labor with intact membranes, medically indicated). Risks were adjusted for maternal race/ethnicity, maternal age, MediCal (California’s Medicaid) coverage for delivery, mother’s education, parity, body mass index, mother’s place of birth, previous preterm birth, and interpregnancy interval. RESULTS: Spontaneous labor and PPROM were large contributors to preterm delivery among infants with gastroschisis, comprising 44.4% of all births (Figure). Additionally, these infants were at 10fold higher risk of being born before 34 weeks (8.9% of infants with gastroschisis versus 1.6% of infants without). Overall, 53% of infants with gastroschisis were born before 37 weeks compared with only 6.9% of infants without gastroschisis (aRR 15.4, 95% CI 13.8 to 17.1) (Table). CONCLUSION: Infants with gastroschisis are very likely to be born prematurely and are at particularly high risk of PPROM or spontaneous labor. Importantly, over 8% of infants with gastroschisis delivered before 34 weeks, indicating that these infants are at great risk for preterm birth morbidities in addition to the complications from the birth defect.
312 Cerclage for short cervix on ultrasound in singleton gestations without prior preterm birth: meta-analysis of trials Vincenzo Berghella1, Andrea Ciardulli1, Rupsa C. Boelig1, Orion A. Rust2, Kypros Nicolaides3, Katsufumi Otsuki4, Sietske Althuisius5, Gabriele Saccone6 1
Thomas Jefferson University, Philadelphia, PA, 2Lehigh Valley Hospital, Allentown, PA, 3King’s College, London, United Kingdom, 4Showa University, Tokyo, Japan, 5Horacio Oruber Hospitaal, Aruba, Aruba, 6 Universita’ Federico II, Napoli, Italy
OBJECTIVE: To evaluate if cerclage for short transvaginal ultrasound (TVU) cervical length (CL) prevents preterm birth (PTB) in singleton gestations without prior spontaneous PTB (SPTB) in a meta-analysis of randomized controlled trials (RCTs). STUDY DESIGN: MEDLINE, PUBMED, EMBASE, and the Cochrane Library were searched using the terms: “cerclage,” “short cervix,” “ultrasound,” “randomized trial.” Individual-patient level (all databases were obtained) meta-analysis was conducted on all RCTs of cerclage versus no cerclage in singleton gestations with TVU CL <¼25mm before 24 weeks and without prior SPTB. Primary outcome was PTB < 35 weeks. RESULTS: Five RCTs involving 463 singleton gestations with TVU CL <¼25mm before 24 week and without prior SPTB who were randomized to cerclage (n¼251) versus no cerclage (n¼212) met inclusion criteria. No RCT included use of any type of progestagen treatment. Cerclage was associated with a significant decrease in PTB < 35 weeks (27% vs 40%, RR 0.72, 95% CI 0.56-0.93) (Figure), and < 34 weeks (24% vs 28%, RR 0.89, 95% CI 0.55-0.97) (Table). CONCLUSION: In singleton gestations without prior SPTB and with TVU CL <¼25mm before 24 weeks, cerclage is associated with a significant reduction in PTB < 35 weeks.
313 Development of a first-trimester risk score to predict preterm birth for black women in California Rebecca J. Baer1,2, Scott P. Oltman2,3, Miriam Kuppermann2,4, Matthew Pantell5, Elizabeth E. Rogers5, Kelli K. Ryckman6, Marina Sirota7, Larry Rand2,4, Laura L. Jelliffe-Pawlowski2,3 1
Department of Pediatrics, University of California San Diego, La Jolla, CA, California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, 3Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, 4Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, 5Department of Pediatrics, University of 2
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S191
ajog.org spontaneous labor with intact membranes, medically indicated). Risks were adjusted for maternal race/ethnicity, maternal age, MediCal (California’s Medicaid) coverage for delivery, mother’s education, parity, body mass index, mother’s place of birth, previous preterm birth, and interpregnancy interval. RESULTS: Spontaneous labor and PPROM were large contributors to preterm delivery among infants with gastroschisis, comprising 44.4% of all births (Figure). Additionally, these infants were at 10fold higher risk of being born before 34 weeks (8.9% of infants with gastroschisis versus 1.6% of infants without). Overall, 53% of infants with gastroschisis were born before 37 weeks compared with only 6.9% of infants without gastroschisis (aRR 15.4, 95% CI 13.8 to 17.1) (Table). CONCLUSION: Infants with gastroschisis are very likely to be born prematurely and are at particularly high risk of PPROM or spontaneous labor. Importantly, over 8% of infants with gastroschisis delivered before 34 weeks, indicating that these infants are at great risk for preterm birth morbidities in addition to the complications from the birth defect.
312 Cerclage for short cervix on ultrasound in singleton gestations without prior preterm birth: meta-analysis of trials Vincenzo Berghella1, Andrea Ciardulli1, Rupsa C. Boelig1, Orion A. Rust2, Kypros Nicolaides3, Katsufumi Otsuki4, Sietske Althuisius5, Gabriele Saccone6 1
Thomas Jefferson University, Philadelphia, PA, 2Lehigh Valley Hospital, Allentown, PA, 3King’s College, London, United Kingdom, 4Showa University, Tokyo, Japan, 5Horacio Oruber Hospitaal, Aruba, Aruba, 6 Universita’ Federico II, Napoli, Italy
OBJECTIVE: To evaluate if cerclage for short transvaginal ultrasound (TVU) cervical length (CL) prevents preterm birth (PTB) in singleton gestations without prior spontaneous PTB (SPTB) in a meta-analysis of randomized controlled trials (RCTs). STUDY DESIGN: MEDLINE, PUBMED, EMBASE, and the Cochrane Library were searched using the terms: “cerclage,” “short cervix,” “ultrasound,” “randomized trial.” Individual-patient level (all databases were obtained) meta-analysis was conducted on all RCTs of cerclage versus no cerclage in singleton gestations with TVU CL <¼25mm before 24 weeks and without prior SPTB. Primary outcome was PTB < 35 weeks. RESULTS: Five RCTs involving 463 singleton gestations with TVU CL <¼25mm before 24 week and without prior SPTB who were randomized to cerclage (n¼251) versus no cerclage (n¼212) met inclusion criteria. No RCT included use of any type of progestagen treatment. Cerclage was associated with a significant decrease in PTB < 35 weeks (27% vs 40%, RR 0.72, 95% CI 0.56-0.93) (Figure), and < 34 weeks (24% vs 28%, RR 0.89, 95% CI 0.55-0.97) (Table). CONCLUSION: In singleton gestations without prior SPTB and with TVU CL <¼25mm before 24 weeks, cerclage is associated with a significant reduction in PTB < 35 weeks.
313 Development of a first-trimester risk score to predict preterm birth for black women in California Rebecca J. Baer1,2, Scott P. Oltman2,3, Miriam Kuppermann2,4, Matthew Pantell5, Elizabeth E. Rogers5, Kelli K. Ryckman6, Marina Sirota7, Larry Rand2,4, Laura L. Jelliffe-Pawlowski2,3 1
Department of Pediatrics, University of California San Diego, La Jolla, CA, California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, 3Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, 4Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, 5Department of Pediatrics, University of 2
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S191