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476 Pregnancy Outcome in Grand Multiparous Women
428
475
476
SPO Abstracts
PREGNANCY OUTCOMES IN NORTHERN PLAINS INDIANS. Y....1.wl2. S. Fox·. Hennepin County Medical Center. Minneapolis. Minnesota OBJECTIVE: The poor health status of Native Americans has been previously documented but past studies have been primarily reservation-based. Pregnancy demographics and outcomes for Northern Plains Indians in the urban setting have not yet been addressed. This study of an urban population of Northern Plains Indians (approximately 213 Ojibwe and 1f3 Sioux tribes) was to determine whether these mothers had higher rates of pregnancy complications and adverse birth outcomes. STUDY DESIGN:For 205 Native Americans and 205 controls delivering at Hennepin County Medical Center in 1988 and 1989. all available prenatal and delivery records were reviewed; the control group consisted of the first Caucasian mother who delivered after each Native American. as identified by a delivery logbook. RESULTS: Native American mothers as a group tended to be single. had greater parity. had later onset of prenatal care as well as fewer vistts. had a higher incidence of anemia (hemoglobin <10) and gestational diabetes. had poorer weight gain. had greater tobacco. alcohol and iIIictt drug use. and a higher number of antepartum admissions. in addttion to a higher incidence of sexually transmttted diseases and more incidences of physical abuse during pregnancy. The incidence of low birthweight and prematurity was higher among Native Americans. as was the number of babies wtth congenital deformtties. Anhough more Caucasian babies were admitted to the Neonatal Intensive Care Untt. many of them had observation status and were transferred out to the newborn nursery sooner than were Native American babies. Fewer Native American women breastfed than Caucasian mothers (30% vs. 59%. p<.001). CONCLUSIONS: This urban population of Native American women is not obtaining adequate prenatal care. despite its availabiltty and poor pregnancy outcomes. including prematurtty. are observed. It is not clear whether these differences can be attributed to racial factors.
PREGNANCY OUTCOME IN GRAND MULTIPAROUS WOMEN. ~ P. Kapernick·. K. Daly· . Hennepin County Medical Center. Minneapolis. MN OBJECTIVE: GrandmuRiparity has long been considered an obstetrical risk. though tt has not been evaluated in an American population in the past decade. An analysis of obstetrical and perinatal outcome in an urban American population was undertaken. to assess the changing demographics and outcomes of such pregnancies. STUDY DESIGN:193 women delivering their sixth or greater pregnancy at Hennepin County Medical Center between Janaury 1. 1988. and December 31. 1989. were identified through a Labor and Delivery log book. The next woman delivering for the fifth or less time was taken as a control subject. All maternal charts were reviewed. RESULTS: Compared to control patients (C). grandmuRiparous women (GM) were older (32 vs. 24 years. P<.OO01). had fewer prenatal vistts (7 vs. 8.4. P<.002). and had later onset of prenatal care (22 wks vs. 18.6 wks). GM's were more likely to be Southeast Asian (38% vs. 11 %). or Native American (20% vs. 13%) and less likely to be whtte (9% vs. 40%) than control women. They were were more likely to be married (57% vs. 35%). and were no less likely to use alcohol or tobacco than control patients. No increase in anemia. treatment for preterm labor. gestational daibetes. or pre· eclampsia/eclampsia was seen between the two groups. Gestational age at delivery did not differ. Vaginal delivery was more likely (89% C vs. 95% GM) and episiotomy was much less likely (28% C vs. 3.6% GM). No increase in transfusion rates over controls was seen. There was a slight but non-significant increase in abnormal presentations. Breast feeding was more common in controls (35% vs. 18%). although this may reflect the very low rate of breast feeding in our Southeast Asian population. CONCLUSIONS: In a modern American obstetrics service. grandmuRiparity alone does not place a woman at higher risk of adverse pregnancy or birth outcome. Parity is highly correlated with race and as demographics change in parts of the country. the frequency of grandmuRipartty may change.
January 1993
Am J Obstet Gynecol
477
PREGNANCY OUTCOME AS A FUNcnON OF AGE IN NUWPAROUS WOMEN Pry..k M". Lorenz Rp>. Klaley AM"; Dopta. Ob/Gyn, 1)St. John Hospital, Detroit, MI and 2)WIIUam
a.aumont Hoapltal, Royal Oak. MI and
Wayne St. Unlv. OBJECTIVE: To compar. risk factors and presanancy outcome In nulllp..... ag. >34yrs. to tho.. aga 25--21iJ yr•.
STUDY DESIGN: M.ternol .nd newborn ho.pltol record. during 1986-1990 from 3 suburban hospitals for .n nulllpar.. age >34 yr .t delivery were r.vlewed. The control group wa. nullipar.. age 25-2g yr at delivery .trllUfied by hospital. Anillysis Included t-teat. Chi aquar.. Mann Whitney, and atepwl.. logistic regr•••lon; a p< -.OS wa. conaldereel r.trospectlwly
.Ignlfl""n\. RESULTS: Th. older group (nzIlll1) differed from tM younger (n=1063) In ant.partum facto ... (mor. prlvat. Insurance (97 v 85%). more unmarried (8
v 6%). 'ewor prlm.gr.vld•• (60 va71.7%). I••• welght g.ln (31.3 v 32.9 Ib).
mON ob.slty (6.9 v 3.1%), more chronic (2.7 v 0.8%) and acut. (14.4 v 8.3%)
hypertenalon. dl.bete. (7.5 v 3%) •••thm. (1.4 v 0.5%). lelmyom.t. (3.7 v 0.8%). third trimester bleeding (2.8 v 1.2%)); I.obor .nd delivery '.ctora (more d.nv.rl.. without Jabor (6.4 v 1.8%), condudlon anesthesl. (54 v
37%). oxytocin u.. (43 v 35%). 'ellli he.rt d_ler.tlona malpre.. ntatlon.
(10
Y
7%), c ...r.an birth (44 v 27.7%)];
(24 v 17%). and n.wborn
problem. [more preterm birth (12.6 v 6%). SGA (7 v 4.9%). LGA (17.4 v 16%). lo_r blrth_lght. (3277 y 3393 gm). NICU/SCN .dml••lon. (10.8 Y 7.1%)]. The perinatal death rate. were 1.7" vs.0.8%, not atati.tically differ.nt (power of.7 for obs.rved differ.nce). Stepwi.. r.gr.ssion showed .)chorloamnionltls, leiomyomata, and pret.rm I.bor with uteroplec.ntal Insufficiency •• f.do ... In perinatal mort.lity, but not age, b) age w.s not a
I.ctor In NICU/SCN .dml••lona. CONCLUSIONS: Although nulllp.... .ge >34 h.d algnlfl""ntly more antepartum risk f.do.... I.bor and delivery compllca110ns, and newborn complications than nullipara• •g.25-29 yr. age .Ione was not an Independent predictor of b.d outcome.
478
x PERINATAL NElWORK. M. Taslimi. A. Patel . A. Gonzalez. Dept. of OB/GYN. Univ. of Tenn .• Chattanooga. TN. OBJECTIVES: To ascertain the quality of prenatal care(PNC) provided to rural women by rural family physicians with guidance from a regional perinatal center(RPC). STUDY DESIGN: Six family physicians from rural towns within • fifty mile rlldius of our RPC were recruited to provide previously unavailable PNC to local women. Education. shared protocols. consultations for high-risk pregnancies. and all deliveries were provided by the perinatologists at our RPe. Data was retrieved from office and hospital racords. RESULTS: Between October 10.1989 and August 15.1992. 119 rural women entered the Perinatal Network; 38.7% in the first. 47.9% in the second. and 13.5% in the third trimesters of pregnancy. Fofty-one percent ware married and 39.5% were teenagers. Most(99.2%) of these rural patients were eligible for Medicaid or had other third party medical coverage. Seventy-one(59.7%) patients hlld pregnancy risk factors including fetal growth disorders(19.2%). diabetes mellitus(17.4%). preterm labor(17.1%). preterm delivery(13.7%). and twin gestation(4.2%). Fifty-six(47.1%) mothers ware referred to the RPC for consultation or management. Ninety-five patients have delivered 99 infants at the RPC. 15.8% by ceurean uction. Birth wieght (BW) mean(± SO) was 3118(± 658) gm; 2% were < 1.5 Kg. 16.2% ware 1.5-2.5 Kg. and 9.1 % were 4-4.5 Kg BW. All Apgar scores were ~ 3 and ~ 7 at 1 and 5 minutes. respectively. Eight(6.7%) newborns stayed in NICU from 2-24 days. No infants diad or hlld major congenital anomalies. CONCLUSIONS: Rural physicians. with guidance from our RPC provided routine PNC to local women. avoiding routine transportation of pregnant rural women. The success of the program relied heavily on ongoing comprehensive education of rural medical personnel. Use of shared protocols and a standard obstetric record keeping system assured timely detection and referral of high-risk patients. Delivery of all patients at the RPe provided sefe peripartum and newborn care. The program utilized the pre..xisting facilities and operated on medical service fees. Perinatal Network offers a safe. cost effective. and convenient means of providing PNC to rural women in settings similar to ours.
475
476
SPO Abstracts
PREGNANCY OUTCOMES IN NORTHERN PLAINS INDIANS. Y....1.wl2. S. Fox·. Hennepin County Medical Center. Minneapolis. Minnesota OBJECTIVE: The poor health status of Native Americans has been previously documented but past studies have been primarily reservation-based. Pregnancy demographics and outcomes for Northern Plains Indians in the urban setting have not yet been addressed. This study of an urban population of Northern Plains Indians (approximately 213 Ojibwe and 1f3 Sioux tribes) was to determine whether these mothers had higher rates of pregnancy complications and adverse birth outcomes. STUDY DESIGN:For 205 Native Americans and 205 controls delivering at Hennepin County Medical Center in 1988 and 1989. all available prenatal and delivery records were reviewed; the control group consisted of the first Caucasian mother who delivered after each Native American. as identified by a delivery logbook. RESULTS: Native American mothers as a group tended to be single. had greater parity. had later onset of prenatal care as well as fewer vistts. had a higher incidence of anemia (hemoglobin <10) and gestational diabetes. had poorer weight gain. had greater tobacco. alcohol and iIIictt drug use. and a higher number of antepartum admissions. in addttion to a higher incidence of sexually transmttted diseases and more incidences of physical abuse during pregnancy. The incidence of low birthweight and prematurity was higher among Native Americans. as was the number of babies wtth congenital deformtties. Anhough more Caucasian babies were admitted to the Neonatal Intensive Care Untt. many of them had observation status and were transferred out to the newborn nursery sooner than were Native American babies. Fewer Native American women breastfed than Caucasian mothers (30% vs. 59%. p<.001). CONCLUSIONS: This urban population of Native American women is not obtaining adequate prenatal care. despite its availabiltty and poor pregnancy outcomes. including prematurtty. are observed. It is not clear whether these differences can be attributed to racial factors.
PREGNANCY OUTCOME IN GRAND MULTIPAROUS WOMEN. ~ P. Kapernick·. K. Daly· . Hennepin County Medical Center. Minneapolis. MN OBJECTIVE: GrandmuRiparity has long been considered an obstetrical risk. though tt has not been evaluated in an American population in the past decade. An analysis of obstetrical and perinatal outcome in an urban American population was undertaken. to assess the changing demographics and outcomes of such pregnancies. STUDY DESIGN:193 women delivering their sixth or greater pregnancy at Hennepin County Medical Center between Janaury 1. 1988. and December 31. 1989. were identified through a Labor and Delivery log book. The next woman delivering for the fifth or less time was taken as a control subject. All maternal charts were reviewed. RESULTS: Compared to control patients (C). grandmuRiparous women (GM) were older (32 vs. 24 years. P<.OO01). had fewer prenatal vistts (7 vs. 8.4. P<.002). and had later onset of prenatal care (22 wks vs. 18.6 wks). GM's were more likely to be Southeast Asian (38% vs. 11 %). or Native American (20% vs. 13%) and less likely to be whtte (9% vs. 40%) than control women. They were were more likely to be married (57% vs. 35%). and were no less likely to use alcohol or tobacco than control patients. No increase in anemia. treatment for preterm labor. gestational daibetes. or pre· eclampsia/eclampsia was seen between the two groups. Gestational age at delivery did not differ. Vaginal delivery was more likely (89% C vs. 95% GM) and episiotomy was much less likely (28% C vs. 3.6% GM). No increase in transfusion rates over controls was seen. There was a slight but non-significant increase in abnormal presentations. Breast feeding was more common in controls (35% vs. 18%). although this may reflect the very low rate of breast feeding in our Southeast Asian population. CONCLUSIONS: In a modern American obstetrics service. grandmuRiparity alone does not place a woman at higher risk of adverse pregnancy or birth outcome. Parity is highly correlated with race and as demographics change in parts of the country. the frequency of grandmuRipartty may change.
January 1993
Am J Obstet Gynecol
477
PREGNANCY OUTCOME AS A FUNcnON OF AGE IN NUWPAROUS WOMEN Pry..k M". Lorenz Rp>. Klaley AM"; Dopta. Ob/Gyn, 1)St. John Hospital, Detroit, MI and 2)WIIUam
a.aumont Hoapltal, Royal Oak. MI and
Wayne St. Unlv. OBJECTIVE: To compar. risk factors and presanancy outcome In nulllp..... ag. >34yrs. to tho.. aga 25--21iJ yr•.
STUDY DESIGN: M.ternol .nd newborn ho.pltol record. during 1986-1990 from 3 suburban hospitals for .n nulllpar.. age >34 yr .t delivery were r.vlewed. The control group wa. nullipar.. age 25-2g yr at delivery .trllUfied by hospital. Anillysis Included t-teat. Chi aquar.. Mann Whitney, and atepwl.. logistic regr•••lon; a p< -.OS wa. conaldereel r.trospectlwly
.Ignlfl""n\. RESULTS: Th. older group (nzIlll1) differed from tM younger (n=1063) In ant.partum facto ... (mor. prlvat. Insurance (97 v 85%). more unmarried (8
v 6%). 'ewor prlm.gr.vld•• (60 va71.7%). I••• welght g.ln (31.3 v 32.9 Ib).
mON ob.slty (6.9 v 3.1%), more chronic (2.7 v 0.8%) and acut. (14.4 v 8.3%)
hypertenalon. dl.bete. (7.5 v 3%) •••thm. (1.4 v 0.5%). lelmyom.t. (3.7 v 0.8%). third trimester bleeding (2.8 v 1.2%)); I.obor .nd delivery '.ctora (more d.nv.rl.. without Jabor (6.4 v 1.8%), condudlon anesthesl. (54 v
37%). oxytocin u.. (43 v 35%). 'ellli he.rt d_ler.tlona malpre.. ntatlon.
(10
Y
7%), c ...r.an birth (44 v 27.7%)];
(24 v 17%). and n.wborn
problem. [more preterm birth (12.6 v 6%). SGA (7 v 4.9%). LGA (17.4 v 16%). lo_r blrth_lght. (3277 y 3393 gm). NICU/SCN .dml••lon. (10.8 Y 7.1%)]. The perinatal death rate. were 1.7" vs.0.8%, not atati.tically differ.nt (power of.7 for obs.rved differ.nce). Stepwi.. r.gr.ssion showed .)chorloamnionltls, leiomyomata, and pret.rm I.bor with uteroplec.ntal Insufficiency •• f.do ... In perinatal mort.lity, but not age, b) age w.s not a
I.ctor In NICU/SCN .dml••lona. CONCLUSIONS: Although nulllp.... .ge >34 h.d algnlfl""ntly more antepartum risk f.do.... I.bor and delivery compllca110ns, and newborn complications than nullipara• •g.25-29 yr. age .Ione was not an Independent predictor of b.d outcome.
478
x PERINATAL NElWORK. M. Taslimi. A. Patel . A. Gonzalez. Dept. of OB/GYN. Univ. of Tenn .• Chattanooga. TN. OBJECTIVES: To ascertain the quality of prenatal care(PNC) provided to rural women by rural family physicians with guidance from a regional perinatal center(RPC). STUDY DESIGN: Six family physicians from rural towns within • fifty mile rlldius of our RPC were recruited to provide previously unavailable PNC to local women. Education. shared protocols. consultations for high-risk pregnancies. and all deliveries were provided by the perinatologists at our RPe. Data was retrieved from office and hospital racords. RESULTS: Between October 10.1989 and August 15.1992. 119 rural women entered the Perinatal Network; 38.7% in the first. 47.9% in the second. and 13.5% in the third trimesters of pregnancy. Fofty-one percent ware married and 39.5% were teenagers. Most(99.2%) of these rural patients were eligible for Medicaid or had other third party medical coverage. Seventy-one(59.7%) patients hlld pregnancy risk factors including fetal growth disorders(19.2%). diabetes mellitus(17.4%). preterm labor(17.1%). preterm delivery(13.7%). and twin gestation(4.2%). Fifty-six(47.1%) mothers ware referred to the RPC for consultation or management. Ninety-five patients have delivered 99 infants at the RPC. 15.8% by ceurean uction. Birth wieght (BW) mean(± SO) was 3118(± 658) gm; 2% were < 1.5 Kg. 16.2% ware 1.5-2.5 Kg. and 9.1 % were 4-4.5 Kg BW. All Apgar scores were ~ 3 and ~ 7 at 1 and 5 minutes. respectively. Eight(6.7%) newborns stayed in NICU from 2-24 days. No infants diad or hlld major congenital anomalies. CONCLUSIONS: Rural physicians. with guidance from our RPC provided routine PNC to local women. avoiding routine transportation of pregnant rural women. The success of the program relied heavily on ongoing comprehensive education of rural medical personnel. Use of shared protocols and a standard obstetric record keeping system assured timely detection and referral of high-risk patients. Delivery of all patients at the RPe provided sefe peripartum and newborn care. The program utilized the pre..xisting facilities and operated on medical service fees. Perinatal Network offers a safe. cost effective. and convenient means of providing PNC to rural women in settings similar to ours.