- Email: [email protected]
581: Second and third trimester weight gain and perinatal outcome among twin pregnancies
Poster Session IV
Operative Obstetrics, Clinical Obstetrics, Intrapartum, Medical-Surgical www.AJOG.org
Rate of non-focal placenta accreta associated with index uterine surgery
A
Of accreta delivery; BTime period includes July 1996 - December 2011. The other four time periods are each three calendar years; CIncludes myomectomy, septum resection, lysis of uterine adhesions, endometrial ablation, and polypectomy.
580 Potassium levels in the highest quartile of the normal range during pregnancy are associated with an increased risk for long-term maternal atherosclerotic morbidity Talya Wolak1, Eyal Sheiner3, Ilana Shoham-Vardi2, Ruslan Sergienko2 1 Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Hypertension Unit, Beer Sheva, Israel, 2Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion University of the Negev, Epidemiology and Health Services Evaluation, Beer Sheva, Israel, 3Faculty of Health Sciences, Soroka University Medical Center, BenGurion University of the Negev, Department of Obstetrics and Gynecology, Beer Sheva, Israel
OBJECTIVE: The present study was aimed to examine the association between potassium level during pregnancy and the development of future long-term maternal atherosclerotic morbidity. STUDY DESIGN: A case-control study was conducted including women who delivered between the years 2000-2012 and subsequently develop cardiovascular, cerebrovascular and renal morbidity (n¼653); controls were matched for age and year of delivery (n¼4171). The hospitalized group was further divided to major event (cardiovascular, cerebrovascular disease, chronic renal failure), and cardiac procedures (such as coronary angiography, coronary computed tomography, etc.).The mean follow-up duration was 6.2 years. Kaplan-Meier survival curves were used to estimate cumulative incidence of cardiovascular, cerbrovascular and renal hospitalizations. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) for hospitalizations. RESULTS: A significant linear association was documented between potassium during pregnancy and the long-term maternal atherosclerotic morbidity (Table). Using a Kaplan-Meier survival curve, K 4.0 mEq/L had a significantly higher cumulative incidence of hospitalizations (Figure). Cox proportional hazard model, adjusted for confounders such as preeclampsia, diabetes mellitus, and obesity, showed that potassium level 4.0 mEq/L during pregnancy remained independently associated with atherosclerotic hospitalizations (adjusted HR, 1.56; 95% CI, 1.29-1.89; P<0.001). CONCLUSION: Potassium level at the higher normal range during pregnancy may predict atherosclerotic morbidity later in nonpregnant life.
581 Second and third trimester weight gain and perinatal outcome among twin pregnancies Tulin Ozcan1, Stephen Bacak1, Paula Paula Zozzaro-Smith1, Neil Seligman1, Christopher Glantz1 1
University of Rochester, OB/GYN, Rochester, NY
OBJECTIVE: The aim of this study is to estimate the impact of body
mass index (BMI) specific weight gain recommendations by the Institute of Medicine (IOM) on pregnancy outcome in twin pregnancies. STUDY DESIGN: Twin pregnancies with two live births between January 1, 2004 and December 31, 2012 delivered 24 weeks were included. Exclusion criteria were incomplete documentation, major congenital anomaly and pre-pregnancy BMI<18.5. Subjects were classified into three groups: Group 1 normal (BMI 18.5-24.9), Group 2 overweight (BMI 25-29.9) and Group 3 obese (BMI 30). Expected total weight gain in the second and third trimester in each BMI group was calculated as the product of expected weekly weight gain per IOM recommendations in the second and third trimester x (gestational week at delivery -13). Estimated total weight gain in the second and third trimester was defined as low, expected, or excessive as compared to IOM recommendations. Primary outcomes were gestational diabetes, preeclampsia, preterm delivery <32 weeks and <35 weeks, birth weight of the larger twin <10th percentile, birth weight of the smaller twin <10th percentile, NICU admission, and 5-minute Apgar score<7. Logistic regression was used to derive adjusted odds ratios for low and extensive weight in each BMI group using expected weight gain as reference.
S286 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014
www.AJOG.org Operative Obstetrics, Clinical Obstetrics, Intrapartum, Medical-Surgical RESULTS: In Group 1, NICU admissions increased with low or excessive weight gain. In Group 2, the risk of preterm delivery increased with low weight gain. In Group 3, perinatal outcomes were not affected by weight gain. (Table) CONCLUSION: Low or extensive weight gain was not associated with adverse perinatal outcome in obese patients with twins. Low or extensive weight gain did not appear to impact perinatal outcomes such as gestational diabetes, preeclampsia, birth weight of either twin < 10%,or five minute Apgar scores among twin pregnancies.
The association between the Institute of Medicine pregnancy weight gain recommendations and perinatal outcomes by body mass index among twin gestations, January 2004-December 2012
Poster Session IV
accounting for gestational age, maternal age, parity, BMI, dilatation during amniotomy, use of oxytocin in labor and contraction power prior to amniotomy was preformed (Table). 3) In a forward stepwise likelihood ratio analysis only the power of contraction while membranes were intact remained an independent predictor of contraction augmentation. Patients with initial hypotonic contractions (<3.5 mWS) were augmented following membrane rupture (p¼0.01). CONCLUSION: Patients most likely to benefit from AROM in the active phase of labor are those with initial hypotonic spontaneous uterine contractions. EUM provides means for noninvasive measurement of contraction power allowing identification these patients.
Logistic regression model predicting an increase of more than 55 in EUM measurement following AROM
583 Predictors of successful external cephalic version and assessment of success for vaginal delivery AOR- Adjusted odds ratio. (Confounding factors: maternal age, race, tobacco use, college degree, chronic hypertension, and pregestational diabetes); 95% CI- 95% Confidence interval. *P<0.05.
582 Can electrical uterine myography predict who will benefit from artificial rupture of membranes (AROM)? Hadar Rosen2, Liran Hiersch1, Oded Raban1, Amir Aviram1, Liat Salzer1, Nir Melamed1, Avi Ben-Haroush1, Yariv Yogev1 1 Helen Schneider Hospital for Women, Obstetrics and Gynecology, Petach Tiqva, Israel, 2Shaare Zedek Medical Center, Obstetrics and Gynecology, Jerusalem, Israel
OBJECTIVE: The impact of AROM on augmenting labor is contro-
versial. We aimed to determine which patient will benefit from AROM during active phase by using Electrical Uterine Myography (EUM). STUDY DESIGN: 41 women at term with singleton pregnancies during the active phase of labor. EUM measures myometrial electrical activity. Results are reported using a scoring index of 1-5 mWS (microWatt-Second) based on: 1) period between contractions (seconds); 2) power of contraction peaks (root mean square) 3) movement of the center of electrical activity (mm). Uterine activity was compared 30 min. prior to and following rupture of membranes for each patient. Augmentation of uterine contractions was defined as ratio of more than 1.05 average mWS before and after membrane rupture (representing a 5% increase in contraction power). Patients were stratified into 2 groups based on power of contraction measured in the half hour prior to rupture of membranes (¼3.5mWS). RESULTS: 1) Mean EUM measurements before and after amniotomy for the entire cohort were 3.400.46 mWS and 3.610.43 mWS respectively, representing significantly enhanced contractions following membrane rupture by paired student t-test (p<0.001). 2) A multivariant logistic regression Enter model p<0.001, R2¼0.662
Liat Salzer1, Ran Nagar1, Rony Chen1, Arnon Wiznitzer1, Moshe Hod1, Nir Melamed1, Yariv Yogev1 1 Helen Schneider Hospital for Women, Obstetrics and Gynecology, Petach Tiqva, Israel
OBJECTIVE: To identify predictors of successful external cephalic
version (ECV) and to compare delivery outcome between women who had a successful ECV and women with spontaneous vertex presentation. STUDY DESIGN: A retrospective cohort study of all women who underwent ECV in a single tertiary medical center between 2008-2012. Patient’s characteristics were compared between women who had a successful vs. failed ECV. Delivery outcome was compared between women who underwent a trial of vaginal delivery following successful ECV with that of a control group of women with spontaneous vertex presentation matched by maternal age, parity, birthweight, need for induction, and use of epidural analgesia in a 2:1 ratio. Multivariate analysis was used to identify predictors of successful ECV and to determine whether a successful ECV is an independent risk factor cesarean delivery (CS) and operative vaginal delivery (OVD). RESULTS: 1) Overall 299 women underwent ECV during the study period, of whom 287 were eligible for the study group. Of these 130 (45.3%) had a successful ECV, and in 157 (54.7%) the ECV failed. 2) Polyhydramnios was the strongest factor associated with successful ECV (OR¼3.1, 95%-CI 1.4-7.2), followed by transverse lie (vs. breech presentation, OR¼2.6, 95%-CI 1.2-6.7) and a posterior placenta (OR¼1.7, 95%-CI 1.1-3.9), while nulliparity was associated with a lower likelihood of successful ECV (OR¼0.4, 95%-CI 0.20.6). 3) Women who had a successful ECV and underwent a trial of labor were more likely to deliver by operative vaginal delivery (OR¼1.8, 95%-CI 1.2-3.6), mainly due to a higher rate of prolonged 2nd, but were not at an increased risk for CS (OR¼0.9, 95%-CI 0.4-2.4).
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S287
Operative Obstetrics, Clinical Obstetrics, Intrapartum, Medical-Surgical www.AJOG.org
Rate of non-focal placenta accreta associated with index uterine surgery
A
Of accreta delivery; BTime period includes July 1996 - December 2011. The other four time periods are each three calendar years; CIncludes myomectomy, septum resection, lysis of uterine adhesions, endometrial ablation, and polypectomy.
580 Potassium levels in the highest quartile of the normal range during pregnancy are associated with an increased risk for long-term maternal atherosclerotic morbidity Talya Wolak1, Eyal Sheiner3, Ilana Shoham-Vardi2, Ruslan Sergienko2 1 Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Hypertension Unit, Beer Sheva, Israel, 2Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion University of the Negev, Epidemiology and Health Services Evaluation, Beer Sheva, Israel, 3Faculty of Health Sciences, Soroka University Medical Center, BenGurion University of the Negev, Department of Obstetrics and Gynecology, Beer Sheva, Israel
OBJECTIVE: The present study was aimed to examine the association between potassium level during pregnancy and the development of future long-term maternal atherosclerotic morbidity. STUDY DESIGN: A case-control study was conducted including women who delivered between the years 2000-2012 and subsequently develop cardiovascular, cerebrovascular and renal morbidity (n¼653); controls were matched for age and year of delivery (n¼4171). The hospitalized group was further divided to major event (cardiovascular, cerebrovascular disease, chronic renal failure), and cardiac procedures (such as coronary angiography, coronary computed tomography, etc.).The mean follow-up duration was 6.2 years. Kaplan-Meier survival curves were used to estimate cumulative incidence of cardiovascular, cerbrovascular and renal hospitalizations. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) for hospitalizations. RESULTS: A significant linear association was documented between potassium during pregnancy and the long-term maternal atherosclerotic morbidity (Table). Using a Kaplan-Meier survival curve, K 4.0 mEq/L had a significantly higher cumulative incidence of hospitalizations (Figure). Cox proportional hazard model, adjusted for confounders such as preeclampsia, diabetes mellitus, and obesity, showed that potassium level 4.0 mEq/L during pregnancy remained independently associated with atherosclerotic hospitalizations (adjusted HR, 1.56; 95% CI, 1.29-1.89; P<0.001). CONCLUSION: Potassium level at the higher normal range during pregnancy may predict atherosclerotic morbidity later in nonpregnant life.
581 Second and third trimester weight gain and perinatal outcome among twin pregnancies Tulin Ozcan1, Stephen Bacak1, Paula Paula Zozzaro-Smith1, Neil Seligman1, Christopher Glantz1 1
University of Rochester, OB/GYN, Rochester, NY
OBJECTIVE: The aim of this study is to estimate the impact of body
mass index (BMI) specific weight gain recommendations by the Institute of Medicine (IOM) on pregnancy outcome in twin pregnancies. STUDY DESIGN: Twin pregnancies with two live births between January 1, 2004 and December 31, 2012 delivered 24 weeks were included. Exclusion criteria were incomplete documentation, major congenital anomaly and pre-pregnancy BMI<18.5. Subjects were classified into three groups: Group 1 normal (BMI 18.5-24.9), Group 2 overweight (BMI 25-29.9) and Group 3 obese (BMI 30). Expected total weight gain in the second and third trimester in each BMI group was calculated as the product of expected weekly weight gain per IOM recommendations in the second and third trimester x (gestational week at delivery -13). Estimated total weight gain in the second and third trimester was defined as low, expected, or excessive as compared to IOM recommendations. Primary outcomes were gestational diabetes, preeclampsia, preterm delivery <32 weeks and <35 weeks, birth weight of the larger twin <10th percentile, birth weight of the smaller twin <10th percentile, NICU admission, and 5-minute Apgar score<7. Logistic regression was used to derive adjusted odds ratios for low and extensive weight in each BMI group using expected weight gain as reference.
S286 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014
www.AJOG.org Operative Obstetrics, Clinical Obstetrics, Intrapartum, Medical-Surgical RESULTS: In Group 1, NICU admissions increased with low or excessive weight gain. In Group 2, the risk of preterm delivery increased with low weight gain. In Group 3, perinatal outcomes were not affected by weight gain. (Table) CONCLUSION: Low or extensive weight gain was not associated with adverse perinatal outcome in obese patients with twins. Low or extensive weight gain did not appear to impact perinatal outcomes such as gestational diabetes, preeclampsia, birth weight of either twin < 10%,or five minute Apgar scores among twin pregnancies.
The association between the Institute of Medicine pregnancy weight gain recommendations and perinatal outcomes by body mass index among twin gestations, January 2004-December 2012
Poster Session IV
accounting for gestational age, maternal age, parity, BMI, dilatation during amniotomy, use of oxytocin in labor and contraction power prior to amniotomy was preformed (Table). 3) In a forward stepwise likelihood ratio analysis only the power of contraction while membranes were intact remained an independent predictor of contraction augmentation. Patients with initial hypotonic contractions (<3.5 mWS) were augmented following membrane rupture (p¼0.01). CONCLUSION: Patients most likely to benefit from AROM in the active phase of labor are those with initial hypotonic spontaneous uterine contractions. EUM provides means for noninvasive measurement of contraction power allowing identification these patients.
Logistic regression model predicting an increase of more than 55 in EUM measurement following AROM
583 Predictors of successful external cephalic version and assessment of success for vaginal delivery AOR- Adjusted odds ratio. (Confounding factors: maternal age, race, tobacco use, college degree, chronic hypertension, and pregestational diabetes); 95% CI- 95% Confidence interval. *P<0.05.
582 Can electrical uterine myography predict who will benefit from artificial rupture of membranes (AROM)? Hadar Rosen2, Liran Hiersch1, Oded Raban1, Amir Aviram1, Liat Salzer1, Nir Melamed1, Avi Ben-Haroush1, Yariv Yogev1 1 Helen Schneider Hospital for Women, Obstetrics and Gynecology, Petach Tiqva, Israel, 2Shaare Zedek Medical Center, Obstetrics and Gynecology, Jerusalem, Israel
OBJECTIVE: The impact of AROM on augmenting labor is contro-
versial. We aimed to determine which patient will benefit from AROM during active phase by using Electrical Uterine Myography (EUM). STUDY DESIGN: 41 women at term with singleton pregnancies during the active phase of labor. EUM measures myometrial electrical activity. Results are reported using a scoring index of 1-5 mWS (microWatt-Second) based on: 1) period between contractions (seconds); 2) power of contraction peaks (root mean square) 3) movement of the center of electrical activity (mm). Uterine activity was compared 30 min. prior to and following rupture of membranes for each patient. Augmentation of uterine contractions was defined as ratio of more than 1.05 average mWS before and after membrane rupture (representing a 5% increase in contraction power). Patients were stratified into 2 groups based on power of contraction measured in the half hour prior to rupture of membranes (
Liat Salzer1, Ran Nagar1, Rony Chen1, Arnon Wiznitzer1, Moshe Hod1, Nir Melamed1, Yariv Yogev1 1 Helen Schneider Hospital for Women, Obstetrics and Gynecology, Petach Tiqva, Israel
OBJECTIVE: To identify predictors of successful external cephalic
version (ECV) and to compare delivery outcome between women who had a successful ECV and women with spontaneous vertex presentation. STUDY DESIGN: A retrospective cohort study of all women who underwent ECV in a single tertiary medical center between 2008-2012. Patient’s characteristics were compared between women who had a successful vs. failed ECV. Delivery outcome was compared between women who underwent a trial of vaginal delivery following successful ECV with that of a control group of women with spontaneous vertex presentation matched by maternal age, parity, birthweight, need for induction, and use of epidural analgesia in a 2:1 ratio. Multivariate analysis was used to identify predictors of successful ECV and to determine whether a successful ECV is an independent risk factor cesarean delivery (CS) and operative vaginal delivery (OVD). RESULTS: 1) Overall 299 women underwent ECV during the study period, of whom 287 were eligible for the study group. Of these 130 (45.3%) had a successful ECV, and in 157 (54.7%) the ECV failed. 2) Polyhydramnios was the strongest factor associated with successful ECV (OR¼3.1, 95%-CI 1.4-7.2), followed by transverse lie (vs. breech presentation, OR¼2.6, 95%-CI 1.2-6.7) and a posterior placenta (OR¼1.7, 95%-CI 1.1-3.9), while nulliparity was associated with a lower likelihood of successful ECV (OR¼0.4, 95%-CI 0.20.6). 3) Women who had a successful ECV and underwent a trial of labor were more likely to deliver by operative vaginal delivery (OR¼1.8, 95%-CI 1.2-3.6), mainly due to a higher rate of prolonged 2nd, but were not at an increased risk for CS (OR¼0.9, 95%-CI 0.4-2.4).
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S287