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525: Ethnic disparities among patients undergoing general anesthesia for cesarean delivery
www.AJOG.org
Epidemiology, Ob Quality, Operative Obstetrics, Public Health, Infectious Disease, Academic Issues
RESULTS: A total of 827 women were identified with a diagnosis of
spontaneous, missed, or incomplete abortion in the first trimester, of whom, 190 had a genital culture screen at diagnosis. Of the screened patients 10.5% (n¼20, 95% CI 6.9-15.7) were positive for Chlamydia and 5% (n¼5, 95% CI 1.1-6.0) positive for Gonorrhea. In the study group, positive cultures for Chlamydia were found in women aged 15 to 19, 22.2% (n¼8), women aged 20 to 24, 18.5% (n¼10) and women aged 25 to 30, 4.3% (n¼2). In comparison to the most recent 2011 CDC statistics regarding Chlamydia, our rate is significant for both age groups 15 to 19 (22.2% vs CDC 10.0%, p¼0.047) and 20 to 24 (18.5% vs CDC 7.0%, p¼0.008); the rate was not significant in women aged 25 to 30 (4.3% vs CDC 5.0%, p ¼ 0.761). The rate of Gonorrhea was 2.6% (n¼5) and in comparison to the CDC rate was not significantly different (2.6% vs CDC 1.1%, p¼0.120). CONCLUSION: Routine genital screening for Chlamydia and Gonorrhea may be justified at diagnosis of abortion especially in women ages 15-24 as the rate of Chlamydia is substantial in this population.
Comparison of C. trachomatis genital infection in first trimester abortion group vs. CDC data (2011) stratified by age
*p-value <0.05 significant.
525 Ethnic disparities among patients undergoing general anesthesia for cesarean delivery Alexander Butwick1, Yair Blumenfeld2, Kathleen Brookfield2, Carolyn Weiniger1 1
Stanford University School of Medicine, Department of Anesthesia, Stanford, CA, 2Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, CA
OBJECTIVE: Disparities in obstetric care exist between ethnic/racial groups. We examined data from an observational study to investigate whether disparities exist in mode of anesthesia: neuraxial anesthesia (NA) versus general anesthesia (GA) for cesarean delivery (CD). STUDY DESIGN: Patients undergoing CD were identified from a US (MFMU Network) registry of 19 academic centers (1999-2002). Race/ethnicity was recorded as: Caucasian, African-American, Hispanic, Other. Anesthesia was defined as neuraxial anesthesia (NA) (spinal, epidural or combined spinal-epidural anesthesia) or general anesthesia (GA). Emergency CD was classified by presence of at least one of the following: placenta previa with hemorrhage, cord prolapse, uterine rupture, failed forceps/vacuum, non-reassuring fetal heart trace. Multiple logistic regression analyses were performed using sequential sets of co-variates. RESULTS: Of 57,182 women undergoing CD; 92% received NA and 8% received GA. Rates of GA were: 5.7% for Caucasian, 12.2% for African American, 6.7% for Hispanic and 7.5% for Other groups. On univariate analyses, the odds for GA were significantly increased for all ethnic/racial groups compared to Caucasians (reference group), the greatest risk being for among African Americans (model 1). After adjustment for sociodemographic, medical and obstetric co-variates (models 2-4) the odds of GA moderately decreased for African-Americans (model 4) and increased for Hispanics and Other
Poster Session III
groups. In each model, the odds for GA was highest for AfricanAmericans compared to Caucasians. CONCLUSION: Non-Caucasian ethnic groups are at risk for GA for CD after adjustment for other co-variates.
a
Model 1: race/ethnicity; bModel 2: adjusted for maternal age, insurance class, BMI at delivery; cModel 3: adjusted for Model 2 co-variates plus chronic HTN, gestational age at delivery, singleton/multiple pregnancy, no.of prior CD, pregnancy-associated HTN, labor/attempted induction; dModel 4: Models 2 and 3 plus emergency indication for CD.
526 The rate of chorioamnionitis is higher, and rate of perinatally acquired sepsis is lower than CDC estimates: the 2010 Southern California Kaiser Region experience David Braun1, Darios Getahun3, Patricia Bromberger2, Ngoc Ho3 1
Kaiser Permanente Southern California, Neonatology, Pasadena, CA, 2Kaiser Permanente Southern California, Neonatology/Pediatrics, San Diego, CA, 3 Kaiser Permanente Southern California, Research and Evaluation, Pasadena, CA
OBJECTIVE: The objectives are: (1) to determine the incidence of intrapartum fever (IPF), chorioamnionits (CAM) the rates of culture positive early onset neonatal bacterial infection (CPEOI), culture negative early onset infection (CNEOI) in infants born to mothers with or without CAM and (2) to assess the inter-hospital variation in neonatal infection management. STUDY DESIGN: This retrospective cohort study includes mothers and their newborns who were delivered at 35 weeks gestation at Kaiser Permanente Southern California Hospitals in 2010 Electronic medical records and laboratory records were examined for GBS colonization, maternal temperature, intrapartum antibiotic treatment, and neonatal antibiotic treatment. Applying operational definitions, rates for IPF, CAM, CPEOI, and CNEOI were estimated. Relative risk for a hospital starting and continuing neonatal antibiotics were estimated using generalized estimating equation. RESULTS: 13 nurseries with 31,112 babies were studied. GBS colonization was 16.2% and 85% of the GBS positive mothers received intrapartum antibiotics. 48% of all mothers received intrapartum antibiotics. 9% of mothers had IPF and 7% had CAM. In infants with CAM, the CPEOI rate was 0.18% and the CNEOI rate was 2.79%. There was a 33-fold difference in relative risk for beginning antibiotics between the 13 nurseries [RR 32.9(CI 17.1-63.5)] and a 7-fold difference in relative risk for continuing antibiotics [RR 7.1 (CI 1.0-48.1)]. 5% of near-term and term infants were started on antibiotic treatment. CONCLUSION: The rate of CAM is much higher, and the rate of early onset neonatal infection much lower, than previously reported. There is large variation in initiation and continuation of neonatal antibiotic treatment. Better infection risk-assessment tools are needed to optimize management of these newborns.
527 The black-white disparity in congenital anomaly-related infant death and potential links to state Medicaid funding for pregnancy terminations Jennifer Hutcheon1, Lisa Bodnar2, Hyagriv Simhan3 1 University of British Columbia, Obstetrics & Gynaecology, Vancouver, BC, Canada, 2University of Pittsburgh, School of Public Health, Pittsburgh, PA, 3 University of Pittsburgh, Obstetrics & Gynecology, Pittsburgh, PA
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S259
Epidemiology, Ob Quality, Operative Obstetrics, Public Health, Infectious Disease, Academic Issues
RESULTS: A total of 827 women were identified with a diagnosis of
spontaneous, missed, or incomplete abortion in the first trimester, of whom, 190 had a genital culture screen at diagnosis. Of the screened patients 10.5% (n¼20, 95% CI 6.9-15.7) were positive for Chlamydia and 5% (n¼5, 95% CI 1.1-6.0) positive for Gonorrhea. In the study group, positive cultures for Chlamydia were found in women aged 15 to 19, 22.2% (n¼8), women aged 20 to 24, 18.5% (n¼10) and women aged 25 to 30, 4.3% (n¼2). In comparison to the most recent 2011 CDC statistics regarding Chlamydia, our rate is significant for both age groups 15 to 19 (22.2% vs CDC 10.0%, p¼0.047) and 20 to 24 (18.5% vs CDC 7.0%, p¼0.008); the rate was not significant in women aged 25 to 30 (4.3% vs CDC 5.0%, p ¼ 0.761). The rate of Gonorrhea was 2.6% (n¼5) and in comparison to the CDC rate was not significantly different (2.6% vs CDC 1.1%, p¼0.120). CONCLUSION: Routine genital screening for Chlamydia and Gonorrhea may be justified at diagnosis of abortion especially in women ages 15-24 as the rate of Chlamydia is substantial in this population.
Comparison of C. trachomatis genital infection in first trimester abortion group vs. CDC data (2011) stratified by age
*p-value <0.05 significant.
525 Ethnic disparities among patients undergoing general anesthesia for cesarean delivery Alexander Butwick1, Yair Blumenfeld2, Kathleen Brookfield2, Carolyn Weiniger1 1
Stanford University School of Medicine, Department of Anesthesia, Stanford, CA, 2Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, CA
OBJECTIVE: Disparities in obstetric care exist between ethnic/racial groups. We examined data from an observational study to investigate whether disparities exist in mode of anesthesia: neuraxial anesthesia (NA) versus general anesthesia (GA) for cesarean delivery (CD). STUDY DESIGN: Patients undergoing CD were identified from a US (MFMU Network) registry of 19 academic centers (1999-2002). Race/ethnicity was recorded as: Caucasian, African-American, Hispanic, Other. Anesthesia was defined as neuraxial anesthesia (NA) (spinal, epidural or combined spinal-epidural anesthesia) or general anesthesia (GA). Emergency CD was classified by presence of at least one of the following: placenta previa with hemorrhage, cord prolapse, uterine rupture, failed forceps/vacuum, non-reassuring fetal heart trace. Multiple logistic regression analyses were performed using sequential sets of co-variates. RESULTS: Of 57,182 women undergoing CD; 92% received NA and 8% received GA. Rates of GA were: 5.7% for Caucasian, 12.2% for African American, 6.7% for Hispanic and 7.5% for Other groups. On univariate analyses, the odds for GA were significantly increased for all ethnic/racial groups compared to Caucasians (reference group), the greatest risk being for among African Americans (model 1). After adjustment for sociodemographic, medical and obstetric co-variates (models 2-4) the odds of GA moderately decreased for African-Americans (model 4) and increased for Hispanics and Other
Poster Session III
groups. In each model, the odds for GA was highest for AfricanAmericans compared to Caucasians. CONCLUSION: Non-Caucasian ethnic groups are at risk for GA for CD after adjustment for other co-variates.
a
Model 1: race/ethnicity; bModel 2: adjusted for maternal age, insurance class, BMI at delivery; cModel 3: adjusted for Model 2 co-variates plus chronic HTN, gestational age at delivery, singleton/multiple pregnancy, no.of prior CD, pregnancy-associated HTN, labor/attempted induction; dModel 4: Models 2 and 3 plus emergency indication for CD.
526 The rate of chorioamnionitis is higher, and rate of perinatally acquired sepsis is lower than CDC estimates: the 2010 Southern California Kaiser Region experience David Braun1, Darios Getahun3, Patricia Bromberger2, Ngoc Ho3 1
Kaiser Permanente Southern California, Neonatology, Pasadena, CA, 2Kaiser Permanente Southern California, Neonatology/Pediatrics, San Diego, CA, 3 Kaiser Permanente Southern California, Research and Evaluation, Pasadena, CA
OBJECTIVE: The objectives are: (1) to determine the incidence of intrapartum fever (IPF), chorioamnionits (CAM) the rates of culture positive early onset neonatal bacterial infection (CPEOI), culture negative early onset infection (CNEOI) in infants born to mothers with or without CAM and (2) to assess the inter-hospital variation in neonatal infection management. STUDY DESIGN: This retrospective cohort study includes mothers and their newborns who were delivered at 35 weeks gestation at Kaiser Permanente Southern California Hospitals in 2010 Electronic medical records and laboratory records were examined for GBS colonization, maternal temperature, intrapartum antibiotic treatment, and neonatal antibiotic treatment. Applying operational definitions, rates for IPF, CAM, CPEOI, and CNEOI were estimated. Relative risk for a hospital starting and continuing neonatal antibiotics were estimated using generalized estimating equation. RESULTS: 13 nurseries with 31,112 babies were studied. GBS colonization was 16.2% and 85% of the GBS positive mothers received intrapartum antibiotics. 48% of all mothers received intrapartum antibiotics. 9% of mothers had IPF and 7% had CAM. In infants with CAM, the CPEOI rate was 0.18% and the CNEOI rate was 2.79%. There was a 33-fold difference in relative risk for beginning antibiotics between the 13 nurseries [RR 32.9(CI 17.1-63.5)] and a 7-fold difference in relative risk for continuing antibiotics [RR 7.1 (CI 1.0-48.1)]. 5% of near-term and term infants were started on antibiotic treatment. CONCLUSION: The rate of CAM is much higher, and the rate of early onset neonatal infection much lower, than previously reported. There is large variation in initiation and continuation of neonatal antibiotic treatment. Better infection risk-assessment tools are needed to optimize management of these newborns.
527 The black-white disparity in congenital anomaly-related infant death and potential links to state Medicaid funding for pregnancy terminations Jennifer Hutcheon1, Lisa Bodnar2, Hyagriv Simhan3 1 University of British Columbia, Obstetrics & Gynaecology, Vancouver, BC, Canada, 2University of Pittsburgh, School of Public Health, Pittsburgh, PA, 3 University of Pittsburgh, Obstetrics & Gynecology, Pittsburgh, PA
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S259