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107: Maternal morbidity in pregnancies complicated by abnormal placentation
www.AJOG.org Clinical Obstetrics, Neonatology, Physiology-Endocrinology 107 Maternal morbidity in pregnancies complicated by abnormal placentation Elizabeth Langen1, Henry Lee2, Michelle Park3, Yasser El-Sayed1, Maurice Druzin1 1 Stanford University School of Medicine/Lucile Salter Packard Children’s Hospital, Stanford, CA, 2University of California, San Francisco, San Francisco, CA, 3Stanford University, Palo Alto, CA
OBJECTIVE: To determine clinical factors associated with maternal morbidity in patients with placenta previa or invasive placentation. STUDY DESIGN: We reviewed pregnancies with a diagnosis of placenta previa, accreta, increta, and percreta delivered at our tertiary hospital between 7/2005 and 7/2009. The placentation abnormality was defined by pathological diagnosis when available and otherwise by clinical description at delivery. We defined maternal morbidity as a composite outcome of any of the following: Intensive Care Unit admission for ⬎ 24 hours, transfusion of ⱖ4 units of RBC, coagulopathy with an INR of ⱖ 1.2, ureteral injury, re-operation, or intra-abdominal infection. We conducted bivariate analysis on the relationship between risk factors and maternal morbidity, using chi square tests for categorical variables and student’s t-tests for continuous variables. We preformed stepwise multi-variable logistic regression to assess independent risk factors for maternal morbidity. The analysis was performed for the whole cohort and separately for patients with invasive placentation. RESULTS: Of 113 patients, 35 (31%) had maternal morbidity. Maternal morbidity was more common in women with invasive placentation (77.3% vs. 19.8%, p ⬍ 0.0001). We did not find significantly more morbidity among women who had bleeding episodes vs. those who did not (34.5% vs. 19.2%, p ⫽ 0.14). The use of tocolytics during pregnancy was also not associated with higher morbidity (34.6% vs. 27.6%, p ⫽ 0.42.) For the entire cohort, being delivered on a scheduled basis rather than for active bleeding did not significantly reduce morbidity (25.8% vs. 37.3%, p⫽0.19). In stepwise multi-variable logistic regression, only invasive placentation was associated with maternal morbidity (AOR 17, 95% CI 5, 58). When considering only those women with invasive placentation (n⫽22), being delivered at a scheduled time rather than for active bleeding was associated with decreased maternal morbidity (61.5% vs. 100%, p⫽0.03). CONCLUSIONS: For women with invasive placentation, delivery at a scheduled time may reduce maternal morbidity.
108 Neonatal morbidity in pregnancies complicated by abnormal placentation Elizabeth Langen1, Henry Lee2, Michelle Park3, Yasser El-Sayed1, Maurice Druzin1 1 Stanford University School of Medicine/Lucile Salter Packard Children’s Hospital, Stanford, CA, 2University of California, San Francisco, San Francisco, CA, 3Stanford University, Palo Alto, CA
Poster Session I
RESULTS: Of 110 pregnancies, 48 (44%) resulted in neonatal morbidity. While bivariate analysis showed several clinical predictors of neonatal morbidity, in stepwise logistic regression analysis, only GA was associated with neonatal morbidity (OR 0.29, 95% CI 0.18, 0.46 for one week increase in GA). For those pregnancies with invasive placentation (n⫽ 21), stepwise logistic regression results were similar with GA as the only predictor of morbidity (OR 0.29, 95% CI 0.10, 0.85 for one week increase in GA). Pregnancies ending in preterm delivery were more likely to be complicated by bleeding episodes (90.4% vs. 37.0%, p⬍0.0001) and had a higher mean number of bleeding episodes (2.4 vs. 0.8, p⬍0.0001). CONCLUSIONS: Neonatal morbidity in this cohort was largely due to preterm birth. Patients with more bleeding episodes were more likely to be delivered preterm.
109 Patient beliefs and mode of delivery preference Erin S. Hoppin1, Amanda Yeaton-Massey1, Teresa N. Sparks2, Stephanie J. Handler1, Jesus M. Granados1, Michelle R. Meyer1, Yvonne W. Cheng1, Aaron B. Caughey3 1
University of California, San Francisco, San Francisco, CA, Brigham and Women’s Hospital, Boston, MA, 3Oregon Health & Science University, Portland, OR 2
OBJECTIVE: To determine women’s attitudes regarding mode of delivery and the influence on preferences for mode of delivery. STUDY DESIGN: A cross-sectional survey of 719 women in outpatient clinics at our institution during the third trimester of pregnancy. Women were surveyed for demographics, obstetric history, and preference toward vaginal delivery (VD) vs. cesarean delivery (CD). The importance of various factors influencing a women’s choice of VD vs. CD were assessed using a 10-point Likert scale. Univariate analyses were conducted. RESULTS: The majority of women (85%) preferred VD, 8% preferred CD, and 7% had no preference. On a 10-point Likert scale (1⫽strongly agree and 10⫽strongly disagree), women preferring CD and those without a preference agreed that VD is more painful than CD (Table, P⬍0.01). Those preferring VD disagreed with the statement that CD is safer for the mother (P⬍0.01). Regardless of preferred mode of delivery, all three groups disagreed with the statement that their doctors had a preference for CD (P⫽0.45). CONCLUSIONS: Patient beliefs about vaginal and cesarean delivery influence their choice of preferred mode of delivery. Regardless of delivery preference, on average women did not feel that doctors preferred a cesarean section. Table. Mean Likert Scale Values for Patient Beliefs Regarding Mode of Delivery
OBJECTIVE: To determine clinical factors associated with neonatal
morbidity in patients born to mothers with placenta previa or invasive placentation. STUDY DESIGN: We reviewed pregnancies with a diagnosis of placenta previa, accreta, increta, and percreta delivered at our tertiary hospital between 7/2005 and 7/2009. The placentation abnormality was defined by pathological diagnosis when available and otherwise by clinical description at delivery. We defined neonatal morbidity by a composite outcome of any of the following: Neonatal Intensive Care Unit admission, respiratory distress syndrome requiring surfactant, intraventricular hemorrhage grade III or IV, need for transfusion, intrauterine fetal demise, or neonatal death. We looked for relationships between risk factors and neonatal morbidity, using chi square tests for categorical variables and student’s t-tests for continuous variables. Multi-variable logistic regression was performed to assess independent risk factors. Stepwise regression was performed using PROC LOGISTIC in SAS 9.2. Odds ratios were estimated with 95% confidence intervals. The analysis was performed for the whole cohort and for those patients with placental invasion.
Prefers VD, nⴝ577
Prefers CD, nⴝ53
No Preference, nⴝ51
“VD is more painful than CD”
5.25 (5.02-5.48)
3.92 (3.30-4.54)
4.30 (3.74-4.86)
P⬍0.01
“CD is safer for the mother”
7.52 (7.34-7.70)
6.15 (5.57-6.74)
5.90 (5.44-6.36)
P⬍0.01
“CD is more natural than VD”
9.10 (8.94-9.25)
8.57 (7.99-9.14)
7.86 (7.28-8.44)
P⬍0.01
“VD has more pain postpartum”
7.46 (7.24-7.67)
6.29 (5.49-7.08)
6.04 (5.44-6.65)
P⬍0.01
“CD has a longer recovery”
2.76 (2.53-2.99)
3.18 (2.40-3.96)
3.13 (2.56-3.69)
P⫽0.017
“VD is safer for the baby”
4.06 (3.86-4.26)
5.53 (4.90-6.15)
5.00 (4.48-5.52)
P⬍0.01
”Doctors prefer a CD”
6.52 (6.33-6.71)
6.50 (5.88-7.12)
6.16 (5.64-6.68)
P⫽0.45
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Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S57
OBJECTIVE: To determine clinical factors associated with maternal morbidity in patients with placenta previa or invasive placentation. STUDY DESIGN: We reviewed pregnancies with a diagnosis of placenta previa, accreta, increta, and percreta delivered at our tertiary hospital between 7/2005 and 7/2009. The placentation abnormality was defined by pathological diagnosis when available and otherwise by clinical description at delivery. We defined maternal morbidity as a composite outcome of any of the following: Intensive Care Unit admission for ⬎ 24 hours, transfusion of ⱖ4 units of RBC, coagulopathy with an INR of ⱖ 1.2, ureteral injury, re-operation, or intra-abdominal infection. We conducted bivariate analysis on the relationship between risk factors and maternal morbidity, using chi square tests for categorical variables and student’s t-tests for continuous variables. We preformed stepwise multi-variable logistic regression to assess independent risk factors for maternal morbidity. The analysis was performed for the whole cohort and separately for patients with invasive placentation. RESULTS: Of 113 patients, 35 (31%) had maternal morbidity. Maternal morbidity was more common in women with invasive placentation (77.3% vs. 19.8%, p ⬍ 0.0001). We did not find significantly more morbidity among women who had bleeding episodes vs. those who did not (34.5% vs. 19.2%, p ⫽ 0.14). The use of tocolytics during pregnancy was also not associated with higher morbidity (34.6% vs. 27.6%, p ⫽ 0.42.) For the entire cohort, being delivered on a scheduled basis rather than for active bleeding did not significantly reduce morbidity (25.8% vs. 37.3%, p⫽0.19). In stepwise multi-variable logistic regression, only invasive placentation was associated with maternal morbidity (AOR 17, 95% CI 5, 58). When considering only those women with invasive placentation (n⫽22), being delivered at a scheduled time rather than for active bleeding was associated with decreased maternal morbidity (61.5% vs. 100%, p⫽0.03). CONCLUSIONS: For women with invasive placentation, delivery at a scheduled time may reduce maternal morbidity.
108 Neonatal morbidity in pregnancies complicated by abnormal placentation Elizabeth Langen1, Henry Lee2, Michelle Park3, Yasser El-Sayed1, Maurice Druzin1 1 Stanford University School of Medicine/Lucile Salter Packard Children’s Hospital, Stanford, CA, 2University of California, San Francisco, San Francisco, CA, 3Stanford University, Palo Alto, CA
Poster Session I
RESULTS: Of 110 pregnancies, 48 (44%) resulted in neonatal morbidity. While bivariate analysis showed several clinical predictors of neonatal morbidity, in stepwise logistic regression analysis, only GA was associated with neonatal morbidity (OR 0.29, 95% CI 0.18, 0.46 for one week increase in GA). For those pregnancies with invasive placentation (n⫽ 21), stepwise logistic regression results were similar with GA as the only predictor of morbidity (OR 0.29, 95% CI 0.10, 0.85 for one week increase in GA). Pregnancies ending in preterm delivery were more likely to be complicated by bleeding episodes (90.4% vs. 37.0%, p⬍0.0001) and had a higher mean number of bleeding episodes (2.4 vs. 0.8, p⬍0.0001). CONCLUSIONS: Neonatal morbidity in this cohort was largely due to preterm birth. Patients with more bleeding episodes were more likely to be delivered preterm.
109 Patient beliefs and mode of delivery preference Erin S. Hoppin1, Amanda Yeaton-Massey1, Teresa N. Sparks2, Stephanie J. Handler1, Jesus M. Granados1, Michelle R. Meyer1, Yvonne W. Cheng1, Aaron B. Caughey3 1
University of California, San Francisco, San Francisco, CA, Brigham and Women’s Hospital, Boston, MA, 3Oregon Health & Science University, Portland, OR 2
OBJECTIVE: To determine women’s attitudes regarding mode of delivery and the influence on preferences for mode of delivery. STUDY DESIGN: A cross-sectional survey of 719 women in outpatient clinics at our institution during the third trimester of pregnancy. Women were surveyed for demographics, obstetric history, and preference toward vaginal delivery (VD) vs. cesarean delivery (CD). The importance of various factors influencing a women’s choice of VD vs. CD were assessed using a 10-point Likert scale. Univariate analyses were conducted. RESULTS: The majority of women (85%) preferred VD, 8% preferred CD, and 7% had no preference. On a 10-point Likert scale (1⫽strongly agree and 10⫽strongly disagree), women preferring CD and those without a preference agreed that VD is more painful than CD (Table, P⬍0.01). Those preferring VD disagreed with the statement that CD is safer for the mother (P⬍0.01). Regardless of preferred mode of delivery, all three groups disagreed with the statement that their doctors had a preference for CD (P⫽0.45). CONCLUSIONS: Patient beliefs about vaginal and cesarean delivery influence their choice of preferred mode of delivery. Regardless of delivery preference, on average women did not feel that doctors preferred a cesarean section. Table. Mean Likert Scale Values for Patient Beliefs Regarding Mode of Delivery
OBJECTIVE: To determine clinical factors associated with neonatal
morbidity in patients born to mothers with placenta previa or invasive placentation. STUDY DESIGN: We reviewed pregnancies with a diagnosis of placenta previa, accreta, increta, and percreta delivered at our tertiary hospital between 7/2005 and 7/2009. The placentation abnormality was defined by pathological diagnosis when available and otherwise by clinical description at delivery. We defined neonatal morbidity by a composite outcome of any of the following: Neonatal Intensive Care Unit admission, respiratory distress syndrome requiring surfactant, intraventricular hemorrhage grade III or IV, need for transfusion, intrauterine fetal demise, or neonatal death. We looked for relationships between risk factors and neonatal morbidity, using chi square tests for categorical variables and student’s t-tests for continuous variables. Multi-variable logistic regression was performed to assess independent risk factors. Stepwise regression was performed using PROC LOGISTIC in SAS 9.2. Odds ratios were estimated with 95% confidence intervals. The analysis was performed for the whole cohort and for those patients with placental invasion.
Prefers VD, nⴝ577
Prefers CD, nⴝ53
No Preference, nⴝ51
“VD is more painful than CD”
5.25 (5.02-5.48)
3.92 (3.30-4.54)
4.30 (3.74-4.86)
P⬍0.01
“CD is safer for the mother”
7.52 (7.34-7.70)
6.15 (5.57-6.74)
5.90 (5.44-6.36)
P⬍0.01
“CD is more natural than VD”
9.10 (8.94-9.25)
8.57 (7.99-9.14)
7.86 (7.28-8.44)
P⬍0.01
“VD has more pain postpartum”
7.46 (7.24-7.67)
6.29 (5.49-7.08)
6.04 (5.44-6.65)
P⬍0.01
“CD has a longer recovery”
2.76 (2.53-2.99)
3.18 (2.40-3.96)
3.13 (2.56-3.69)
P⫽0.017
“VD is safer for the baby”
4.06 (3.86-4.26)
5.53 (4.90-6.15)
5.00 (4.48-5.52)
P⬍0.01
”Doctors prefer a CD”
6.52 (6.33-6.71)
6.50 (5.88-7.12)
6.16 (5.64-6.68)
P⫽0.45
.......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... ..........................................................................................................................................................................................
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S57