- Email: [email protected]
587: The effect of oocyte donation on pregnancy outcomes in IVF twin gestations
www.AJOG.org Operative Obstetrics, Clinical Obstetrics, Intrapartum, Medical-Surgical
Poster Session IV
RESULTS: 112 patients were included, 56 with oocyte donors and 56
586 Severe maternal morbidity and management of major obstetric haemorrhage in Ireland Edel Manning1, Richard Greene1, Jennifer Lutomski1, Leanne O’Connor1, Paul Corcoran1 1 University College, National Perinatal Epidemiology Centre, Department of Obstetrics & Gynaecology, Cork, Ireland
OBJECTIVE: Severe maternal morbidity is an indicator of quality of care in the maternity services. For this reason, the National Perinatal Epidemiology Centre established the first national clinical audit of severe maternal morbidity in Ireland. STUDY DESIGN: Cases that occurred in 2011 in 19 of the country’s 20 maternity units were reported. Fifteen categories of maternal morbidity were used in the case-definition criteria. Major obstetric haemorrhage (MOH) events and their management was also assessed (MOH was defined as blood loss>2,500ml, transfusion 5 units of blood or documented treatment for coagulopathy). RESULTS: Overall, 260 women experienced severe maternal morbidity, a national rate of 3.8 cases per 1,000 maternities. MOH was the most frequent type of morbidity (61.2% of cases) followed by ICU admission (42.7%). Previous Caesarean section, placenta praevia and/or morbidly adherent placenta were associated with MOH. The onset of haemorrhage usually occurred postpartum (63.9%), uterine atony was the commonest identified cause (42.8%) and Caesarean section was the mode of delivery in 67.1% of cases. The maternity units deemed the care they provided to be appropriate for the vast majority of cases (85.8%). Nearly all units (94.7%) had a protocol for the management of MOH and management was in accordance with the local protocol in 94.8% of cases. CONCLUSION: The incidence of severe maternal morbidity in Ireland is similar or lower than comparable internationally figures. The good practice and learning points identified in the assessment of MOH cases may be useful on a national level to improve clinical care.
587 The effect of oocyte donation on pregnancy outcomes in IVF twin gestations Lucky Sekhon1, Rachel Gerber2, Andrei Rebarber3, Daniel Saltzman3, Chad Klauser3, Simi Gupta3, Nathan Fox3 1 Icahn School of Medicine at Mount Sinai, Obstetrics, Gynecology, and Reproductive Science, New York, NY, 2Weill Cornell Medical College, Obstetrics and Gynecology, New York, NY, 3Maternal Fetal Medicine Associates, PLLC, New York, NY
OBJECTIVE: To estimate the effect of oocyte donation on pregnancy
outcomes in patients with twin pregnancies conceived via IVF. STUDY DESIGN: Cohort study of patients with IVF twin pregnancies
delivered by one maternal-fetal medicine practice from 2005-2013. We compared outcomes between patients who had oocyte donation to age-matched controls using autologous oocytes. We excluded women over 50 years old as there were no age-matched controls over 50 using autologous oocytes.
with autologous oocytes. The baseline characteristics were similar between the groups, including maternal age, race, parity, chorionicity, and comorbidities. The mean age was 43.0 +/- 6.0 vs. 41.9 +/1.7 years (p¼0.181). Pregnancy outcomes are shown in Table 1. There were no differences in outcomes between the groups in regards to preterm birth, birthweight or gestational diabetes. There was a greater incidence of gestational hypertension (32.1% vs. 13.0%, P¼0.018) and preeclampsia (28.3% vs. 13.0%, P¼0.05) in the group that underwent IVF with donor oocytes. CONCLUSION: In patients who conceive twin pregnancies using IVF, oocyte donation increases the risk of gestational hypertension and preeclampsia. However, this did not translate into increased rates of preterm birth or low birth weight. Patients who require oocyte donation should be carefully counseled regarding the increased risk for preeclampsia and gestational hypertension, but should be reassured that oocyte donation does not appear to lead to other adverse outcomes.
Pregnancy outcomes in patients with IVF twin pregnancies, patients with donated oocytes vs. age-matched controls
588 Gestational weight gain targets are safely modified in obese women Rachael Overcash1, Andrew Hull1, Thomas Moore1, Yvette LaCoursiere1 1
University of California San Diego, Reproductive Medicine, San Diego, CA
OBJECTIVE: During pregnancy, obese women are advised to gain
between 11-20 pounds, regardless of degree of obesity. We assessed gestational weight gain (GWG) in women with BMI 35 to determine an inflection point that identifies women at risk of excess GWG. STUDY DESIGN: A prospective cohort study was performed on pregnancies managed through the UC San Diego Maternal Weight and Wellness Program from 2011-2013. The independent variable was GWG category: inadequate (<11 lbs), adequate (11-20 lbs), and excessive (>20 lbs) weight gain based on IOM recommendations. Anthropometric, maternal, and neonatal factors were analyzed by ANOVA. RESULTS: 71 patients were included with a mean pre-pregnancy BMI of 41.9 8.9, and total GWG of 21.9 19 lbs. GWG in the first trimester was -0.1 6.4 lbs (0 lbs/wk), second trimester was 11.1 11.6 lbs (0.74 lbs/wk), and third trimester was 12.2 7.9 lbs (1.1 lbs/wk). The primary cesarean delivery rate was 27.8%. Regarding GWG, 29.6% had inadequate, 19.7% had adequate, and 50.7% had excessive weight gains.
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S289
Poster Session IV
RESULTS: 112 patients were included, 56 with oocyte donors and 56
586 Severe maternal morbidity and management of major obstetric haemorrhage in Ireland Edel Manning1, Richard Greene1, Jennifer Lutomski1, Leanne O’Connor1, Paul Corcoran1 1 University College, National Perinatal Epidemiology Centre, Department of Obstetrics & Gynaecology, Cork, Ireland
OBJECTIVE: Severe maternal morbidity is an indicator of quality of care in the maternity services. For this reason, the National Perinatal Epidemiology Centre established the first national clinical audit of severe maternal morbidity in Ireland. STUDY DESIGN: Cases that occurred in 2011 in 19 of the country’s 20 maternity units were reported. Fifteen categories of maternal morbidity were used in the case-definition criteria. Major obstetric haemorrhage (MOH) events and their management was also assessed (MOH was defined as blood loss>2,500ml, transfusion 5 units of blood or documented treatment for coagulopathy). RESULTS: Overall, 260 women experienced severe maternal morbidity, a national rate of 3.8 cases per 1,000 maternities. MOH was the most frequent type of morbidity (61.2% of cases) followed by ICU admission (42.7%). Previous Caesarean section, placenta praevia and/or morbidly adherent placenta were associated with MOH. The onset of haemorrhage usually occurred postpartum (63.9%), uterine atony was the commonest identified cause (42.8%) and Caesarean section was the mode of delivery in 67.1% of cases. The maternity units deemed the care they provided to be appropriate for the vast majority of cases (85.8%). Nearly all units (94.7%) had a protocol for the management of MOH and management was in accordance with the local protocol in 94.8% of cases. CONCLUSION: The incidence of severe maternal morbidity in Ireland is similar or lower than comparable internationally figures. The good practice and learning points identified in the assessment of MOH cases may be useful on a national level to improve clinical care.
587 The effect of oocyte donation on pregnancy outcomes in IVF twin gestations Lucky Sekhon1, Rachel Gerber2, Andrei Rebarber3, Daniel Saltzman3, Chad Klauser3, Simi Gupta3, Nathan Fox3 1 Icahn School of Medicine at Mount Sinai, Obstetrics, Gynecology, and Reproductive Science, New York, NY, 2Weill Cornell Medical College, Obstetrics and Gynecology, New York, NY, 3Maternal Fetal Medicine Associates, PLLC, New York, NY
OBJECTIVE: To estimate the effect of oocyte donation on pregnancy
outcomes in patients with twin pregnancies conceived via IVF. STUDY DESIGN: Cohort study of patients with IVF twin pregnancies
delivered by one maternal-fetal medicine practice from 2005-2013. We compared outcomes between patients who had oocyte donation to age-matched controls using autologous oocytes. We excluded women over 50 years old as there were no age-matched controls over 50 using autologous oocytes.
with autologous oocytes. The baseline characteristics were similar between the groups, including maternal age, race, parity, chorionicity, and comorbidities. The mean age was 43.0 +/- 6.0 vs. 41.9 +/1.7 years (p¼0.181). Pregnancy outcomes are shown in Table 1. There were no differences in outcomes between the groups in regards to preterm birth, birthweight or gestational diabetes. There was a greater incidence of gestational hypertension (32.1% vs. 13.0%, P¼0.018) and preeclampsia (28.3% vs. 13.0%, P¼0.05) in the group that underwent IVF with donor oocytes. CONCLUSION: In patients who conceive twin pregnancies using IVF, oocyte donation increases the risk of gestational hypertension and preeclampsia. However, this did not translate into increased rates of preterm birth or low birth weight. Patients who require oocyte donation should be carefully counseled regarding the increased risk for preeclampsia and gestational hypertension, but should be reassured that oocyte donation does not appear to lead to other adverse outcomes.
Pregnancy outcomes in patients with IVF twin pregnancies, patients with donated oocytes vs. age-matched controls
588 Gestational weight gain targets are safely modified in obese women Rachael Overcash1, Andrew Hull1, Thomas Moore1, Yvette LaCoursiere1 1
University of California San Diego, Reproductive Medicine, San Diego, CA
OBJECTIVE: During pregnancy, obese women are advised to gain
between 11-20 pounds, regardless of degree of obesity. We assessed gestational weight gain (GWG) in women with BMI 35 to determine an inflection point that identifies women at risk of excess GWG. STUDY DESIGN: A prospective cohort study was performed on pregnancies managed through the UC San Diego Maternal Weight and Wellness Program from 2011-2013. The independent variable was GWG category: inadequate (<11 lbs), adequate (11-20 lbs), and excessive (>20 lbs) weight gain based on IOM recommendations. Anthropometric, maternal, and neonatal factors were analyzed by ANOVA. RESULTS: 71 patients were included with a mean pre-pregnancy BMI of 41.9 8.9, and total GWG of 21.9 19 lbs. GWG in the first trimester was -0.1 6.4 lbs (0 lbs/wk), second trimester was 11.1 11.6 lbs (0.74 lbs/wk), and third trimester was 12.2 7.9 lbs (1.1 lbs/wk). The primary cesarean delivery rate was 27.8%. Regarding GWG, 29.6% had inadequate, 19.7% had adequate, and 50.7% had excessive weight gains.
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S289