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578: Twin Birth Study: neonatal and maternal outcomes in induction in twin pregnancies
www.AJOG.org Operative Obstetrics, Clinical Obstetrics, Intrapartum, Medical-Surgical
Neonatal outcomes and IOM guidelines for GWG compared with linear (birthweight, adjusted p-values) and logistic regression (low birthweight, NICU admissions; aOR, 95%CI)
Poster Session IV
RESULTS: The two groups were similar as outlined in the table. The incidence of an adverse neonatal outcome was 1/153 (0.7%) in the prostaglandin group and 5/215 (2. 3%), OR¼3.64 [95% CI: 0.42, 31.67], P ¼ 0.17. The incidence of an adverse maternal outcome was 16/153 (10.5%) in the prostaglandin group and 26/215 (12.1%), OR¼1.18 [95% CI: 0.61, 2.28], P ¼ 0.63. CONCLUSION: The incidence of an abnormal neonatal or maternal outcome is not affected by the method of induction, whether induction is initiated by prostaglandin or amniotomy and/or oxytocin.
*PMR¼ Perinatal Mortality Rate.
579 Placenta accreta in the setting of prior uterine surgery Adjusted for maternal age, parity, race, prepregnancy BMI and chronic hypertension.
578 Twin Birth Study: neonatal and maternal outcomes in induction in twin pregnancies Jon Barrett1, Elizabeth Asztalos1, Andrew Willan2, Elad Mei-Dan1, Alexander Allen3, B. Anthony Armson4, Amiram Gafni7, Mary Hannah1, Eileen Hutton5, K. Joseph6, Arne Ohlsson8, Susan Ross9 1
Sunnybrook Health Sciences Centre, University of Toronto, Women and Babies Program, Toronto, ON, Canada, 2SickKids Research Institute, University of Toronto, Child Health Evaluative Sciences, Toronto, ON, Canada, 3IWK Health Centre, Dalhousie University, Paediatrics, Halifax, NS, Canada, 4IWK Health Centre, Dalhousie University, Obstetrics and Gynecology, Halifax, NS, Canada, 5McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada, 6University of British Columbia, Obstetrics and Gynecology, Vancouver, BC, Canada, 7McMaster University, Clinical Epidemiology & Biostatistics, Hamilton, ON, Canada, 8Mount Sinai Hospital, University of Toronto, Paediatrics, Toronto, ON, Canada, 9University of Alberta, Obstetrics and Gynecology, Edmonton, AB, Canada
OBJECTIVE: The Twin Birth Study demonstrated that in a planned vaginal birth between 32 and 38 weeks gestation in twin pregnancies where the first twin was a cephalic presentation, there was no difference in fetal and neonatal outcomes from a planned caesarean section. Published data regarding optimal method for induction of twins is limited. The aim of this secondary analysis was to compare adverse neonatal and maternal outcomes between those pregnancies induced by prostaglandin and those induced with amniotomy and/or oxytocin when a planned vaginal birth for twins is made between 32 and 38 weeks gestation. STUDY DESIGN: A total of 368 women were identified; 153 (42%) underwent induction with the use of prostaglandin and 215 (58%) underwent induction with amniotomy and/or oxytocin. The following variables were evaluated: mean gestational age at induction/delivery, parity, perinatal mortality rate (PMR), chorionicity, presentation of twin B, time from active labor to full dilatation, time from delivery to discharge home.
Anne Cooper1, Mohak Mhatre2, Katherine Campbell2, Jessica Illuzzi2 1
Oregon Health & Science University, Obstetrics and Gynecology, Portland, OR, 2Yale School of Medicine, Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT
OBJECTIVE: We sought to analyze the association between exposure to prior uterine surgery and placenta accreta through analysis of pathologically confirmed cases of placenta accreta. STUDY DESIGN: The surgical pathology database was queried from July 1996 to December 2011 to identify all cases of placenta accreta. From the identified cases of abnormal placentation, patient characteristics included history of cesarean delivery (CD), history of dilation & curettage (D&C), and other uterine surgery (OUS) (e.g. myomectomy, septum resection, lysis of uterine adhesions, endometrial ablation, polypectomy). RESULTS: During the study period, 72,845 births and 100 cases of histologically proven non-focal accreta were identified. Of these, 63 were accreta vera (0.86/1,000 births), 23 were increta (0.32/1,000 births), and 14 were percreta (0.19/1,000 births). In women with non-focal accreta, the index exposure to uterine surgery was CD for 54 patients (54%), D&C for 17 (17%), and OUS for 13 patients (13%). Over the study period, the rate of placenta accreta with CD as index uterine surgery exposure increased from 0.41 to 0.65 per 1,000 births; the proportion of women with placenta accreta and D&C as index exposure decreased from 0.23 to 0.15 per 1,000 births; and the rate of accreta and OUS increased from 0.01 to 0.61 per 1,000 births. Among all births, the rate of CD as the index uterine surgery increased by 21.9% per 3-year period, while the rate of OUS as the index uterine surgery increased by 71.1% per 3-year period. The cumulative risk during this study period of having a placenta accreta after prior CD was 2.7 (95% CI 1.1-6.8), while the cumulative risk after OUS was 14.7 (95% CI 1.6 - 131) (see Table 1). CONCLUSION: The cumulative risk of a developing placenta accreta after exposure to various nonobstetrical uterine surgeries has increased significantly over time. Patient counseling and antepartum screening for abnormal placentation should be a routine part of prenatal care in women with prior uterine surgeries. Supported by Albert McKern Memorial Fund.
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S285
Neonatal outcomes and IOM guidelines for GWG compared with linear (birthweight, adjusted p-values) and logistic regression (low birthweight, NICU admissions; aOR, 95%CI)
Poster Session IV
RESULTS: The two groups were similar as outlined in the table. The incidence of an adverse neonatal outcome was 1/153 (0.7%) in the prostaglandin group and 5/215 (2. 3%), OR¼3.64 [95% CI: 0.42, 31.67], P ¼ 0.17. The incidence of an adverse maternal outcome was 16/153 (10.5%) in the prostaglandin group and 26/215 (12.1%), OR¼1.18 [95% CI: 0.61, 2.28], P ¼ 0.63. CONCLUSION: The incidence of an abnormal neonatal or maternal outcome is not affected by the method of induction, whether induction is initiated by prostaglandin or amniotomy and/or oxytocin.
*PMR¼ Perinatal Mortality Rate.
579 Placenta accreta in the setting of prior uterine surgery Adjusted for maternal age, parity, race, prepregnancy BMI and chronic hypertension.
578 Twin Birth Study: neonatal and maternal outcomes in induction in twin pregnancies Jon Barrett1, Elizabeth Asztalos1, Andrew Willan2, Elad Mei-Dan1, Alexander Allen3, B. Anthony Armson4, Amiram Gafni7, Mary Hannah1, Eileen Hutton5, K. Joseph6, Arne Ohlsson8, Susan Ross9 1
Sunnybrook Health Sciences Centre, University of Toronto, Women and Babies Program, Toronto, ON, Canada, 2SickKids Research Institute, University of Toronto, Child Health Evaluative Sciences, Toronto, ON, Canada, 3IWK Health Centre, Dalhousie University, Paediatrics, Halifax, NS, Canada, 4IWK Health Centre, Dalhousie University, Obstetrics and Gynecology, Halifax, NS, Canada, 5McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada, 6University of British Columbia, Obstetrics and Gynecology, Vancouver, BC, Canada, 7McMaster University, Clinical Epidemiology & Biostatistics, Hamilton, ON, Canada, 8Mount Sinai Hospital, University of Toronto, Paediatrics, Toronto, ON, Canada, 9University of Alberta, Obstetrics and Gynecology, Edmonton, AB, Canada
OBJECTIVE: The Twin Birth Study demonstrated that in a planned vaginal birth between 32 and 38 weeks gestation in twin pregnancies where the first twin was a cephalic presentation, there was no difference in fetal and neonatal outcomes from a planned caesarean section. Published data regarding optimal method for induction of twins is limited. The aim of this secondary analysis was to compare adverse neonatal and maternal outcomes between those pregnancies induced by prostaglandin and those induced with amniotomy and/or oxytocin when a planned vaginal birth for twins is made between 32 and 38 weeks gestation. STUDY DESIGN: A total of 368 women were identified; 153 (42%) underwent induction with the use of prostaglandin and 215 (58%) underwent induction with amniotomy and/or oxytocin. The following variables were evaluated: mean gestational age at induction/delivery, parity, perinatal mortality rate (PMR), chorionicity, presentation of twin B, time from active labor to full dilatation, time from delivery to discharge home.
Anne Cooper1, Mohak Mhatre2, Katherine Campbell2, Jessica Illuzzi2 1
Oregon Health & Science University, Obstetrics and Gynecology, Portland, OR, 2Yale School of Medicine, Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT
OBJECTIVE: We sought to analyze the association between exposure to prior uterine surgery and placenta accreta through analysis of pathologically confirmed cases of placenta accreta. STUDY DESIGN: The surgical pathology database was queried from July 1996 to December 2011 to identify all cases of placenta accreta. From the identified cases of abnormal placentation, patient characteristics included history of cesarean delivery (CD), history of dilation & curettage (D&C), and other uterine surgery (OUS) (e.g. myomectomy, septum resection, lysis of uterine adhesions, endometrial ablation, polypectomy). RESULTS: During the study period, 72,845 births and 100 cases of histologically proven non-focal accreta were identified. Of these, 63 were accreta vera (0.86/1,000 births), 23 were increta (0.32/1,000 births), and 14 were percreta (0.19/1,000 births). In women with non-focal accreta, the index exposure to uterine surgery was CD for 54 patients (54%), D&C for 17 (17%), and OUS for 13 patients (13%). Over the study period, the rate of placenta accreta with CD as index uterine surgery exposure increased from 0.41 to 0.65 per 1,000 births; the proportion of women with placenta accreta and D&C as index exposure decreased from 0.23 to 0.15 per 1,000 births; and the rate of accreta and OUS increased from 0.01 to 0.61 per 1,000 births. Among all births, the rate of CD as the index uterine surgery increased by 21.9% per 3-year period, while the rate of OUS as the index uterine surgery increased by 71.1% per 3-year period. The cumulative risk during this study period of having a placenta accreta after prior CD was 2.7 (95% CI 1.1-6.8), while the cumulative risk after OUS was 14.7 (95% CI 1.6 - 131) (see Table 1). CONCLUSION: The cumulative risk of a developing placenta accreta after exposure to various nonobstetrical uterine surgeries has increased significantly over time. Patient counseling and antepartum screening for abnormal placentation should be a routine part of prenatal care in women with prior uterine surgeries. Supported by Albert McKern Memorial Fund.
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S285