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126: Pregnancy in women 45 years old–risks and hazards
Poster Session I
Clinical Obstetrics, Neonatology, Physiology-Endocrinology
delivery, there were no differences among groups with regard to route of delivery, birthweight, Apgar scores, or intrapartum and postpartum epidural and analgesic use. CONCLUSION: Hypnobirthing was not more effective in improving perceived coping skills during labor than conventional childbirth classes.
www.AJOG.org
RESULTS: From the aforementioned predictors, only pre- and postcerclage CL and pre-cerclage exposure of the membranes to the vagina were significantly associated with SPTB ⬍32 weeks. Similar results were seen with SPTB ⬍ 24, 28, 34 and 37 weeks. The remaining predictors were not significant.
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.140
126 Pregnancy in women 45 years old–risks and hazards Ido Laskov1, Roee Birnbaum1, Sagy Amzallag1, Sharon Maslovitz1, Michael Kupferminc1, Joseph Lessing2, David Pauzner1, Ariel Many1 1
Lis Maternity Hospital, Tel Aviv, Israel, 2Tel Aviv University, Tel-Aviv, Israel
OBJECTIVE: The aim of this study was to assess the maternal and neo-
natal outcomes for women aged 45 years and over. STUDY DESIGN: We identified all women delivering at our institute from May 2000, to May 2009, at age 45 years and over. Data was collected regarding pregnancy complications and compared to a random control group reflecting the general parturient population. RESULTS: During the study period 312 women aged 45 years and older gave birth. Over 60% conceived with oocyte donation. The incidences of multifetal pregnancies (10.9% vs. 1.8%), diabetes 21% vs. 2.2% (OR 13.2, CI 95% 7.1-24.4), and hypertension 21% vs. 5.2% (OR 4.8, CI 95% 3.1-7.5) were significantly higher than the control group. The rate of preterm delivery (⬍ 32 weeks) and very low birth weight (⬍ 1,500 g) were very high in our study group 6.4% vs. 0.8% (OR 6.2, CI 95% 3.8-10.1) and 7% vs.1.1% (OR 8.2, CI 95% 3.5-19.2) respectively. This difference persisted even when singleton and multifetal pregnancies were analyzed separately. Singletons preterm birth rate was 5.4% vs. 1.1%, (OR 6.6, CI 95% 2.0-21) and Singleton Very low birth weight was 4% vs. 1.1% (OR 5.8, CI 95% 2-16.8). There were six (1.92%) maternal transfers to the intensive care unit as compared to 1.5/1000 in the general parturient population, (OR 6.2, CI 95% 2.1-14.7). For multifetal pregnancies the rate of maternal transfer to the intensive care unit was 8.8% (OR 64.5, CI 95% 17.1-234). CONCLUSION: Preterm birth and LBW are significant complications even when controlling for the effect of multifetal pregnancies. This group has high rates of maternal complications. The extremely high rate of maternal ICU admissions especially in multifetal pregnancies is disturbing. We suggest that women aged 45 years and over using ART should be advised to limit embryo transfer number, not only due to prematurity complications but also due to severe maternal complications. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.141
127 Factors predicting gestational age at delivery following ultrasound-indicated cervical cerclage Jolene Muscat1, Daniel Kiefer1, Michael Demishev1, Graham Ashmead2, Anthony Vintzileos2 1
Stony Brook-Winthrop University Hospitals, Long Island, New York, 2Winthrop University Hospital, Mineola, New York
OBJECTIVE: To determine which, if any, maternal, obstetrical and pregnancy characteristics predict gestational age (GA) at delivery following midtrimester ultrasound-indicated cervical cerclage. STUDY DESIGN: 63 patients with singleton gestations who underwent ultrasound-indicated cerclage placement between January 2007 and December 2008 were included. The following predictors were used: maternal age, gravidity, parity, ethnicity, obstetrical history, prior cervical surgery, prior D&C, pre- and post-cerclage cervical length (CL), amniocentesis utilization, pre-cerclage exposure of the membranes to the vagina and GA at cerclage placement. The primary outcome evaluated was spontaneous preterm birth (SPTB) at ⬍32 weeks. SPTB prior to 24, 28, 34 and 37 weeks were also evaluated as secondary outcomes. Statistical analysis was performed using the Wilcoxon Rank-sum or Fisher=s exact test when appropriate. Multivariable regression analysis was used to identify the independent effects of the predictors in determining GA at delivery.
S62
CONCLUSION: Pre- and post-cerclage cervical length and pre-cerclage
exposure of the membranes to the vagina are the most predictive variables for spontaneous preterm delivery after ultrasound-indicated cervical cerclage. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.142
128 Obesity among young adolescent mothers: who is the culprit – gestational weight gain or physiological change? Loral Patchen1, Erica Berggren2, Erin Conroy3 1 Medstar Research Institute, Washington Hospital Center, Obstetrics and Gynecology, Washington, District of Columbia, 2 University of North Carolina, Obstetrics & Gynecology, Women’s Primary Healthcare, Chapel Hill, North Carolina, 3 Georgetown University, Washington, District of Columbia
OBJECTIVE: Scant information is available regarding optimal weight
gain for young adolescents who experience the unique physiologic changes of early puberty concurrently with pregnancy. We hypothesize that young adolescents gain more weight during pregnancy and are more likely to retain weight after delivery than older adolescents. STUDY DESIGN: This is a secondary analysis of data for a prospective cohort of 183 pregnant adolescents aged 12 to 18 who enrolled in an adolescent parenting program. Data included: maternal demographics, self-reported pre-pregnancy weight, measured height, postpartum DepoProvera use, weight at last prenatal visit, and weight at 18 and 24 months after delivery. Adolescents were classified by age 15 (n⫽47) and 16 (n⫽136). Statistical analysis was performed using Student=s t-test, with p⬍0.05 considered significant. RESULTS: Younger adolescents gained significantly more weight than older adolescents, 37 and 31 pounds, respectively (p⫽0.01). Weight retention in younger adolescents was greater than older adolescents at 18 months, 27 and 7 pounds, respectively (p⫽0.01), and 24 months, 36 and 7 pounds, respectively (p⫽0.002). Groups were similar with respect to pre-pregnancy BMI (p⫽0.3), Black ethnicity (p⫽0.9), nulliparity (p⫽0.07), term delivery (p⫽0.21), and DepoProvera use (p⫽0.06). Younger adolescents had similar pre-pregnancy BMIs when compared to older adolescents, 23.7 vs. 24.6 (p⫽0.3). CONCLUSION: In our study, younger adolescents gained more weight during pregnancy and experienced more long-term weight retention than older adolescents. Additional studies are needed to determine whether gestational weight gain and long-term weight retention among younger adolescents is related primarily to gestational weight gain or is physiologic. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.143
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
Clinical Obstetrics, Neonatology, Physiology-Endocrinology
delivery, there were no differences among groups with regard to route of delivery, birthweight, Apgar scores, or intrapartum and postpartum epidural and analgesic use. CONCLUSION: Hypnobirthing was not more effective in improving perceived coping skills during labor than conventional childbirth classes.
www.AJOG.org
RESULTS: From the aforementioned predictors, only pre- and postcerclage CL and pre-cerclage exposure of the membranes to the vagina were significantly associated with SPTB ⬍32 weeks. Similar results were seen with SPTB ⬍ 24, 28, 34 and 37 weeks. The remaining predictors were not significant.
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.140
126 Pregnancy in women 45 years old–risks and hazards Ido Laskov1, Roee Birnbaum1, Sagy Amzallag1, Sharon Maslovitz1, Michael Kupferminc1, Joseph Lessing2, David Pauzner1, Ariel Many1 1
Lis Maternity Hospital, Tel Aviv, Israel, 2Tel Aviv University, Tel-Aviv, Israel
OBJECTIVE: The aim of this study was to assess the maternal and neo-
natal outcomes for women aged 45 years and over. STUDY DESIGN: We identified all women delivering at our institute from May 2000, to May 2009, at age 45 years and over. Data was collected regarding pregnancy complications and compared to a random control group reflecting the general parturient population. RESULTS: During the study period 312 women aged 45 years and older gave birth. Over 60% conceived with oocyte donation. The incidences of multifetal pregnancies (10.9% vs. 1.8%), diabetes 21% vs. 2.2% (OR 13.2, CI 95% 7.1-24.4), and hypertension 21% vs. 5.2% (OR 4.8, CI 95% 3.1-7.5) were significantly higher than the control group. The rate of preterm delivery (⬍ 32 weeks) and very low birth weight (⬍ 1,500 g) were very high in our study group 6.4% vs. 0.8% (OR 6.2, CI 95% 3.8-10.1) and 7% vs.1.1% (OR 8.2, CI 95% 3.5-19.2) respectively. This difference persisted even when singleton and multifetal pregnancies were analyzed separately. Singletons preterm birth rate was 5.4% vs. 1.1%, (OR 6.6, CI 95% 2.0-21) and Singleton Very low birth weight was 4% vs. 1.1% (OR 5.8, CI 95% 2-16.8). There were six (1.92%) maternal transfers to the intensive care unit as compared to 1.5/1000 in the general parturient population, (OR 6.2, CI 95% 2.1-14.7). For multifetal pregnancies the rate of maternal transfer to the intensive care unit was 8.8% (OR 64.5, CI 95% 17.1-234). CONCLUSION: Preterm birth and LBW are significant complications even when controlling for the effect of multifetal pregnancies. This group has high rates of maternal complications. The extremely high rate of maternal ICU admissions especially in multifetal pregnancies is disturbing. We suggest that women aged 45 years and over using ART should be advised to limit embryo transfer number, not only due to prematurity complications but also due to severe maternal complications. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.141
127 Factors predicting gestational age at delivery following ultrasound-indicated cervical cerclage Jolene Muscat1, Daniel Kiefer1, Michael Demishev1, Graham Ashmead2, Anthony Vintzileos2 1
Stony Brook-Winthrop University Hospitals, Long Island, New York, 2Winthrop University Hospital, Mineola, New York
OBJECTIVE: To determine which, if any, maternal, obstetrical and pregnancy characteristics predict gestational age (GA) at delivery following midtrimester ultrasound-indicated cervical cerclage. STUDY DESIGN: 63 patients with singleton gestations who underwent ultrasound-indicated cerclage placement between January 2007 and December 2008 were included. The following predictors were used: maternal age, gravidity, parity, ethnicity, obstetrical history, prior cervical surgery, prior D&C, pre- and post-cerclage cervical length (CL), amniocentesis utilization, pre-cerclage exposure of the membranes to the vagina and GA at cerclage placement. The primary outcome evaluated was spontaneous preterm birth (SPTB) at ⬍32 weeks. SPTB prior to 24, 28, 34 and 37 weeks were also evaluated as secondary outcomes. Statistical analysis was performed using the Wilcoxon Rank-sum or Fisher=s exact test when appropriate. Multivariable regression analysis was used to identify the independent effects of the predictors in determining GA at delivery.
S62
CONCLUSION: Pre- and post-cerclage cervical length and pre-cerclage
exposure of the membranes to the vagina are the most predictive variables for spontaneous preterm delivery after ultrasound-indicated cervical cerclage. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.142
128 Obesity among young adolescent mothers: who is the culprit – gestational weight gain or physiological change? Loral Patchen1, Erica Berggren2, Erin Conroy3 1 Medstar Research Institute, Washington Hospital Center, Obstetrics and Gynecology, Washington, District of Columbia, 2 University of North Carolina, Obstetrics & Gynecology, Women’s Primary Healthcare, Chapel Hill, North Carolina, 3 Georgetown University, Washington, District of Columbia
OBJECTIVE: Scant information is available regarding optimal weight
gain for young adolescents who experience the unique physiologic changes of early puberty concurrently with pregnancy. We hypothesize that young adolescents gain more weight during pregnancy and are more likely to retain weight after delivery than older adolescents. STUDY DESIGN: This is a secondary analysis of data for a prospective cohort of 183 pregnant adolescents aged 12 to 18 who enrolled in an adolescent parenting program. Data included: maternal demographics, self-reported pre-pregnancy weight, measured height, postpartum DepoProvera use, weight at last prenatal visit, and weight at 18 and 24 months after delivery. Adolescents were classified by age 15 (n⫽47) and 16 (n⫽136). Statistical analysis was performed using Student=s t-test, with p⬍0.05 considered significant. RESULTS: Younger adolescents gained significantly more weight than older adolescents, 37 and 31 pounds, respectively (p⫽0.01). Weight retention in younger adolescents was greater than older adolescents at 18 months, 27 and 7 pounds, respectively (p⫽0.01), and 24 months, 36 and 7 pounds, respectively (p⫽0.002). Groups were similar with respect to pre-pregnancy BMI (p⫽0.3), Black ethnicity (p⫽0.9), nulliparity (p⫽0.07), term delivery (p⫽0.21), and DepoProvera use (p⫽0.06). Younger adolescents had similar pre-pregnancy BMIs when compared to older adolescents, 23.7 vs. 24.6 (p⫽0.3). CONCLUSION: In our study, younger adolescents gained more weight during pregnancy and experienced more long-term weight retention than older adolescents. Additional studies are needed to determine whether gestational weight gain and long-term weight retention among younger adolescents is related primarily to gestational weight gain or is physiologic. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.143
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009