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152: Perinatal outcome of induction of labor compared with expectant management for term twin pregnancy
www.AJOG.org
Clinical Obstetrics, Medical-Surgical-Disease, Neonatology, Physiology-Endocrinology
Poster Session I
151 The accuracy of noninvasive hemoglobin assessment in an obstetric population Sharon Cooley1, Marie Bourke2, Roger McMorrow3, Fionnuala McAuliffe4 1
Rotunda Hospital, Obstetrics and Gynecology, Dublin, Ireland, National Maternity Hospital, UCD School of Medicine and Medical Sciences, Dublin 2, Ireland, 3National Maternity Hospital, Department of Anaesthesia, Dublin 2, Ireland, 4UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, Dublin, Ireland 2
OBJECTIVE: To validate continuous and non-invasive hemoglobin assessment in an obstetric setting, and to compare the values with traditional laboratory measurements of hemoglobin. STUDY DESIGN: Ethical approval was obtained and participants were recruited from the antenatal clinic of the National Maternity Hospital at the time of phlebotomy for their standard antenatal laboratory hemoglobin estimation. Hemoglobin was measured using the Sysmex XE-2100 automated haematology analyser (Sysmex Corporation, Sysmex Europe GmbH, Norderstedt, Germany). The SpHb Pulse CoOximeter was calibrated and the probe attached to the index finger of the patients hand. The mean of three non-invasive measurements of hemoglobin was recorded over 5 minutes. Maternal age, gestation, medical history, medications, body mass index and blood pressure were also recorded. Data analysis was undertaken using the Statistical Package for the Social Sciences (SPSS), Version 15.0. Bland Altman plots were used to determine acceptability of the new non-invasive test as a replacement for invasive testing in a clinical setting. RESULTS: In total 125 women were recruited and two women were excluded as their laboratory hemoglobin tests had to be repeated due to sampling error. The mean maternal age of the participants was 31.7 years. The mean gestation was 20.8 (8.6) weeks. Laboratory hemoglobin values ranged from 8.8 to 15.1 g/dL with a mean of 12.1 (1.0) g/dL. The range for the SpHb Pulse Co-Oximeter assessment was 9.1 to 15.8g/dL with a mean of 12.6 (1.3) g/dL. The Bland Altman plot for the two tests (Figure) illustrates the acceptable accuracy of haemoglobin assessment with the noninvasive method. CONCLUSION: Non-invasive hemoglobin measurement proved accurate compared to traditional hemoglobin testing and may offer a rapid cheap acceptable alternative to invasive testing in obstetric clinical scenarios.
152 Perinatal outcome of induction of labor compared with expectant management for term twin pregnancy Soo Hyeon Moon1, Eun-Na Kim2, Seung Chul Kim1, Jong Kwan Jun3 1 Pusan National University School of Medicine, Department of Obstetrics and Gynecology, Busan, Korea, 2Seoul National University College of Medicine, Obstetrics and Gynecology, Seoul, Korea, 3Seoul National University College of Medicine, Department of Obstetrics and Gynecology, Seoul, Korea
OBJECTIVE: It was reported that maternal complications such as cesarean section rate, chorioamnionitis, and uterine atony are increased in induction of labor in singleton pregnancies. The purpose of this study was to evaluate the risk of induction of labor in term twin pregnancy. STUDY DESIGN: We conducted a retrospective study of 479 term twin pregnancies between January 1999 and June 2011. Perinatal outcomes of induction of labor for term twin pregnancies (n⫽377) were compared with term twin pregnancies with spontaneous labor (n⫽102). Outcome criteria are cesarean section rate, chorioamnionitis, uterine atony, Apgar score at 5 minutes, umbilical artery pH ⬍7.2, and the rate of NICU admission. RESULTS: The average gestational age at delivery in the induction group was significantly later than that in the expectant management group (38.25 ⫹- 0.69, 37.94 ⫹- 0.72 weeks, p⫽0,001). There were no significant differences in maternal and neonatal outcome between the two groups (Table). CONCLUSION: In the term twin pregnancy, induction of labor does not increase the maternal and neonatal complication. For the term twin pregnant women suffering from overdistended uterus, induction of labor is a reasonable approach without additional maternal and neonatal risk.
Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology
S79
Poster Session I
Clinical Obstetrics, Medical-Surgical-Disease, Neonatology, Physiology-Endocrinology
153 The effect of twin-to-twin interval on neonatal outcome of the second twin Sophie Liem1, E. Schuit2, A.C. Lim3, Marielle van Pampus4, Kitty Bloemenkamp5, Hans Duvekot6, Tom Hasaart7, Piet Hummel8, Rob Bernardus9, Rolf Groenwold2, Michael Kars10, Charlotte van Oirschot11, Anneke Kwee3, Dimitri papatsonis12, Martina Porath13, Marc Spaanderman14, Christine Willekes15, Ben Mol1, Janine Wilpshaar16 1 Academic Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands, 2University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, 3Dutch Consortium AMPHIA trial, Netherlands, 4Onze Lieve Vrouwe Gasthuis, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands, 5 Leiden University Medical Center, Department of Obstetrics and Gynaecology, Leiden, Netherlands, 6Erasmus Medical Centre, Department of Obstetrics and Gynaecology, Rotterdam, Netherlands, 7Catharina Hospital, Department of Obstetrics and Gynaecology, Eindhoven, Netherlands, 8 Medical centre alkmaar, Department of Obstetrics and Gynaecology, alkmaar, Netherlands, 9Tergooi ziekenhuizen, Department of Obstetrics and Gynaecology, Blaricum, Netherlands, 10St. Antonius Hospital, Obstetrics & Gynecology, Nieuwegein, Netherlands, 11St. Elisabeth Hospital, Department of Obstetrics and Gynaecology, Tilburg, Netherlands, 12Amphia hospital, Department of Obstetrics and Gynaecology, Breda, Netherlands, 13Maxima Medical Center, Department of Obstetrics and Gynecology, Veldhoven, Netherlands, 14Sint Radboud University Medical Center, Obstetrics and Gynecology, Nijmegen, Netherlands, 15Academic Hospital Maastricht, Obstetrics and Gynecology, Maastricht, Netherlands, 16Nij Smellinghe Hospital, Obstetrics and Gynaecology, Drachten, Netherlands
S80
www.AJOG.org
OBJECTIVE: In vaginal delivery of twins, the optimal time interval between the delivery of the first and second twin is a controversial issue. To minimize the risk of hypoxia for the second twin, it has been suggested that the twin-to-twin delivery interval should be kept short. We studied the influences of twin-to-twin delivery interval on neonatal outcome of the second twin. STUDY DESIGN: We performed a secondary analysis of twin deliveries between 2007 and 2009 in the Netherlands in the AMPHIA trial (ISRCTN 40512715). We selected women that delivered after 34 weeks of gestation and who delivered first twin vaginally. Both twins had to be alive before the onset of labor and there had to be no twin-twin transfusion or fetal malformations. Twin-to-twin delivery interval was defined as the time interval between the delivery of the first twin and the second twin. The association between the twin-to-twin delivery interval and umbilical cord pH was evaluated by linear regression. Logistic regression was used to determine the association between delivery interval (categorized as 30 min) and arterial umbilical cord pH below 7.10, 5 minute Apgar score below 7 and NICU admission. RESULTS: We used data on 286 twin deliveries. The mean maternal age was 32.9 ( 4.5) years and 119 (41.6%) women were nulliparous. The mode of delivery for the second twin was a vaginal birth in 229 (80%), instrumental delivery in 39 (14%) and caesarean section in 18 (6%). The median twin-to-twin interval was 16 minutes (IQR: 9-29). Increasing twin-to-twin interval is related with a decline in arterial pH of 0.0013/min (p⫽30 min: OR 12.6 (95% CI 3.4-47.2)). After 30 minutes there were more low Apgar scores and NICU admissions (OR 2.5 (95% CI 0.8-7.6) and OR 2.0 (95% CI 0.5-8.4)). CONCLUSION: The risk of neonatal acidosis increases 10-fold when the twin-to-twin interval exceeds 15 minutes. These data suggest that in vaginal delivery of a twin, the twin-to-twin interval should be kept under 15 minutes if possible.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2012
Clinical Obstetrics, Medical-Surgical-Disease, Neonatology, Physiology-Endocrinology
Poster Session I
151 The accuracy of noninvasive hemoglobin assessment in an obstetric population Sharon Cooley1, Marie Bourke2, Roger McMorrow3, Fionnuala McAuliffe4 1
Rotunda Hospital, Obstetrics and Gynecology, Dublin, Ireland, National Maternity Hospital, UCD School of Medicine and Medical Sciences, Dublin 2, Ireland, 3National Maternity Hospital, Department of Anaesthesia, Dublin 2, Ireland, 4UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, Dublin, Ireland 2
OBJECTIVE: To validate continuous and non-invasive hemoglobin assessment in an obstetric setting, and to compare the values with traditional laboratory measurements of hemoglobin. STUDY DESIGN: Ethical approval was obtained and participants were recruited from the antenatal clinic of the National Maternity Hospital at the time of phlebotomy for their standard antenatal laboratory hemoglobin estimation. Hemoglobin was measured using the Sysmex XE-2100 automated haematology analyser (Sysmex Corporation, Sysmex Europe GmbH, Norderstedt, Germany). The SpHb Pulse CoOximeter was calibrated and the probe attached to the index finger of the patients hand. The mean of three non-invasive measurements of hemoglobin was recorded over 5 minutes. Maternal age, gestation, medical history, medications, body mass index and blood pressure were also recorded. Data analysis was undertaken using the Statistical Package for the Social Sciences (SPSS), Version 15.0. Bland Altman plots were used to determine acceptability of the new non-invasive test as a replacement for invasive testing in a clinical setting. RESULTS: In total 125 women were recruited and two women were excluded as their laboratory hemoglobin tests had to be repeated due to sampling error. The mean maternal age of the participants was 31.7 years. The mean gestation was 20.8 (8.6) weeks. Laboratory hemoglobin values ranged from 8.8 to 15.1 g/dL with a mean of 12.1 (1.0) g/dL. The range for the SpHb Pulse Co-Oximeter assessment was 9.1 to 15.8g/dL with a mean of 12.6 (1.3) g/dL. The Bland Altman plot for the two tests (Figure) illustrates the acceptable accuracy of haemoglobin assessment with the noninvasive method. CONCLUSION: Non-invasive hemoglobin measurement proved accurate compared to traditional hemoglobin testing and may offer a rapid cheap acceptable alternative to invasive testing in obstetric clinical scenarios.
152 Perinatal outcome of induction of labor compared with expectant management for term twin pregnancy Soo Hyeon Moon1, Eun-Na Kim2, Seung Chul Kim1, Jong Kwan Jun3 1 Pusan National University School of Medicine, Department of Obstetrics and Gynecology, Busan, Korea, 2Seoul National University College of Medicine, Obstetrics and Gynecology, Seoul, Korea, 3Seoul National University College of Medicine, Department of Obstetrics and Gynecology, Seoul, Korea
OBJECTIVE: It was reported that maternal complications such as cesarean section rate, chorioamnionitis, and uterine atony are increased in induction of labor in singleton pregnancies. The purpose of this study was to evaluate the risk of induction of labor in term twin pregnancy. STUDY DESIGN: We conducted a retrospective study of 479 term twin pregnancies between January 1999 and June 2011. Perinatal outcomes of induction of labor for term twin pregnancies (n⫽377) were compared with term twin pregnancies with spontaneous labor (n⫽102). Outcome criteria are cesarean section rate, chorioamnionitis, uterine atony, Apgar score at 5 minutes, umbilical artery pH ⬍7.2, and the rate of NICU admission. RESULTS: The average gestational age at delivery in the induction group was significantly later than that in the expectant management group (38.25 ⫹- 0.69, 37.94 ⫹- 0.72 weeks, p⫽0,001). There were no significant differences in maternal and neonatal outcome between the two groups (Table). CONCLUSION: In the term twin pregnancy, induction of labor does not increase the maternal and neonatal complication. For the term twin pregnant women suffering from overdistended uterus, induction of labor is a reasonable approach without additional maternal and neonatal risk.
Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology
S79
Poster Session I
Clinical Obstetrics, Medical-Surgical-Disease, Neonatology, Physiology-Endocrinology
153 The effect of twin-to-twin interval on neonatal outcome of the second twin Sophie Liem1, E. Schuit2, A.C. Lim3, Marielle van Pampus4, Kitty Bloemenkamp5, Hans Duvekot6, Tom Hasaart7, Piet Hummel8, Rob Bernardus9, Rolf Groenwold2, Michael Kars10, Charlotte van Oirschot11, Anneke Kwee3, Dimitri papatsonis12, Martina Porath13, Marc Spaanderman14, Christine Willekes15, Ben Mol1, Janine Wilpshaar16 1 Academic Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands, 2University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, 3Dutch Consortium AMPHIA trial, Netherlands, 4Onze Lieve Vrouwe Gasthuis, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands, 5 Leiden University Medical Center, Department of Obstetrics and Gynaecology, Leiden, Netherlands, 6Erasmus Medical Centre, Department of Obstetrics and Gynaecology, Rotterdam, Netherlands, 7Catharina Hospital, Department of Obstetrics and Gynaecology, Eindhoven, Netherlands, 8 Medical centre alkmaar, Department of Obstetrics and Gynaecology, alkmaar, Netherlands, 9Tergooi ziekenhuizen, Department of Obstetrics and Gynaecology, Blaricum, Netherlands, 10St. Antonius Hospital, Obstetrics & Gynecology, Nieuwegein, Netherlands, 11St. Elisabeth Hospital, Department of Obstetrics and Gynaecology, Tilburg, Netherlands, 12Amphia hospital, Department of Obstetrics and Gynaecology, Breda, Netherlands, 13Maxima Medical Center, Department of Obstetrics and Gynecology, Veldhoven, Netherlands, 14Sint Radboud University Medical Center, Obstetrics and Gynecology, Nijmegen, Netherlands, 15Academic Hospital Maastricht, Obstetrics and Gynecology, Maastricht, Netherlands, 16Nij Smellinghe Hospital, Obstetrics and Gynaecology, Drachten, Netherlands
S80
www.AJOG.org
OBJECTIVE: In vaginal delivery of twins, the optimal time interval between the delivery of the first and second twin is a controversial issue. To minimize the risk of hypoxia for the second twin, it has been suggested that the twin-to-twin delivery interval should be kept short. We studied the influences of twin-to-twin delivery interval on neonatal outcome of the second twin. STUDY DESIGN: We performed a secondary analysis of twin deliveries between 2007 and 2009 in the Netherlands in the AMPHIA trial (ISRCTN 40512715). We selected women that delivered after 34 weeks of gestation and who delivered first twin vaginally. Both twins had to be alive before the onset of labor and there had to be no twin-twin transfusion or fetal malformations. Twin-to-twin delivery interval was defined as the time interval between the delivery of the first twin and the second twin. The association between the twin-to-twin delivery interval and umbilical cord pH was evaluated by linear regression. Logistic regression was used to determine the association between delivery interval (categorized as 30 min) and arterial umbilical cord pH below 7.10, 5 minute Apgar score below 7 and NICU admission. RESULTS: We used data on 286 twin deliveries. The mean maternal age was 32.9 ( 4.5) years and 119 (41.6%) women were nulliparous. The mode of delivery for the second twin was a vaginal birth in 229 (80%), instrumental delivery in 39 (14%) and caesarean section in 18 (6%). The median twin-to-twin interval was 16 minutes (IQR: 9-29). Increasing twin-to-twin interval is related with a decline in arterial pH of 0.0013/min (p⫽30 min: OR 12.6 (95% CI 3.4-47.2)). After 30 minutes there were more low Apgar scores and NICU admissions (OR 2.5 (95% CI 0.8-7.6) and OR 2.0 (95% CI 0.5-8.4)). CONCLUSION: The risk of neonatal acidosis increases 10-fold when the twin-to-twin interval exceeds 15 minutes. These data suggest that in vaginal delivery of a twin, the twin-to-twin interval should be kept under 15 minutes if possible.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2012