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599: Extreme morbid obesity and cesarean-related morbidities
www.AJOG.org Operative Obstetrics, Clinical Obstetrics, Intrapartum, Medical-Surgical acidemia (aOR 0.90, 95% CI 0.3 - 2.5), 5 minute Apgar score < 7 (aOR 1.2, 95% CI 0.76 - 2.0), cesarean delivery (aOR 0.81 95% CI 0.59 - 1.1) or postpartum hemorrhage (aOR 0.87, 95% CI 0.64 1.2). CONCLUSION: Nitrous oxide is a labor analgesic that is safe for the neonate and is not associated with adverse maternal outcomes. There is currently an FDA approved apparatus for its use in the US which may provide an attractive analgesic option for women who wish to avoid or who have contraindications to an epidural.
Poster Session IV
CD, whether elective or failed TOLAC, confers a higher ureteral injury risk than MO. It is imperative for the obstetrician to understand the risks associated with EMO when compared to MO for better patient counseling and surgical planning.
Cesarean related morbidities
Characteristics and outcomes of laboring women using nitrous oxide (N2O) analgesia
CD: cesarean delivery. ERCD: elective repeat CD. TOLAC: trial of labor after CD. Statistic significance as adjust odds ratio (95% confidence interval) adjusted for maternal age, race/ethnicity, smoking, general anesthesia, prior vaginal delivery, birth weight unless noted. *p-value, Fisher’s exact probability (event too rate to compute odds ratio).
600 Genetic factors associated with uterine rupture Tiffany Weber1, Calla Holmgren1, Tracy Manuck1 1 University of Utah and Intermountain Healthcare, Obstetrics and Gynecology, Salt Lake City, UT
599 Extreme morbid obesity and cesarean-related morbidities Matthew Garabedian1, Anita Sit1 1
Santa Clara Valley Medical Center, Obstetrics and Gynecology, San Jose, CA
OBJECTIVE: To better characterize surgical risks associated with ce-
sarean delivery among pregnant women with extreme morbid obesity (BMI of 50 kg/m2 or greater). STUDY DESIGN: This is a secondary analysis of the NICHD Maternal Fetal Medicine Units Network (MFMU) Cesarean Registry. The MFMU Cesarean Registry was a multi-center observation cohort that prospectively collected data on cesarean delivery (CD). Data were restricted to women with morbid obesity (MO: BMI 40 to 49) and extreme morbid obesity (EMO: BMI of at least 50). We compared demographic, obstetric, and surgical characteristics between these groups. Women underwent CD in 1 of 3 scenarios: primary CD (pCD), elective repeat CD(ERCD), of failed TOLAC. We further examined the CD-related surgical morbidity by classification of CD. RESULTS: From the MFMU Cesarean Registry, 7686 CD were available for analysis: 2824 pCD, 4133 ERCD, and 729 failed TOLAC. Women with EMO were more likely to be African American, have public insurance, and have diabetes, hypertension, asthma, or heart disease. Labor induction and emergent CD were more common among women with EMO. Surgical complications were greater among women with EMO than MO, including blood transfusion (3.1% v 1.7%, p ¼.001), pulmonary embolism (0.4% v. 0.2%, p¼.049), ICU admission (1.4% v. 0.8%, p¼0.21), urteral injury (0.3% v. 0%, p¼.001), and wound infection (2.0 v. 1.1, p¼.01). The pattern of risk was different by type of CD (Table). CONCLUSION: Extreme morbid obesity and morbid obesity increase the risks associated with cesarean delivery. Even within this high risk group, there are demonstrable increases in risk with increasing BMI. Morbid obesity cannot be treated as a homogeneous condition. Among EMO, risk profiles appear different by type of CD. Repeat
OBJECTIVE: Uterine rupture is a rare but dreaded pregnancy complication. A prior cesarean is the greatest risk factor, presumably because of suboptimal hysterotomy wound strength in some women. We hypothesize that uterine rupture occurs at least in part due to genetic variation. STUDY DESIGN: Prospective case-control genetic association study. Cases were prospectively-recruited women with a uterine rupture who delivered 2000-2013 at 2 perinatal referral centers. Controls were women with 1 term uncomplicated VBAC(s), identified from a prospectively collected obstetric database and matched 1:1 by maternal race/ethnicity. Outcomes for the uterine rupture pregnancy (cases) and for the most recent successful VBAC (controls) were compared. DNA was genotyped using the Illumina HumanExomeCore panel. Clinical data were analyzed by t-test, chi-square, and Fisher’s exact as appropriate using STATA(R) v12.1. Genetic data were analyzed by PLINK v1.07. As this was an exploratory study, we made an a priori decision to report the top 25 SNPs regardless of p-value. RESULTS: Sixty-nine women (39 cases, 30 controls) were included. Demographic and pregnancy characteristics were similar between groups. Controls had a mean of 2.3 successful term VBACs (range: 1-4). As expected, there was increased maternal morbidity among cases, including higher estimated blood loss at delivery (1.3 L vs. 0.4 L, p¼0.004). Case neonates were more likely to be admitted to the NICU (39% vs. 0%, p¼0.001), and 2 died (vs. 0 control neonates, p¼0.27). 538,448 SNP markers were genotyped; 233 were not in Hardy-Weinberg equilibrium (p<0.001), leaving 538,215 SNPs for analysis. Several markers in biologically plausible pathways were identified and are shown in the table (not all results shown due to space limitations). CONCLUSION: Uterine rupture is a rare but potentially catastrophic pregnancy complication. Identification of women at highest risk of rupture may decrease maternal and fetal morbidity and mortality.
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S295
Poster Session IV
CD, whether elective or failed TOLAC, confers a higher ureteral injury risk than MO. It is imperative for the obstetrician to understand the risks associated with EMO when compared to MO for better patient counseling and surgical planning.
Cesarean related morbidities
Characteristics and outcomes of laboring women using nitrous oxide (N2O) analgesia
CD: cesarean delivery. ERCD: elective repeat CD. TOLAC: trial of labor after CD. Statistic significance as adjust odds ratio (95% confidence interval) adjusted for maternal age, race/ethnicity, smoking, general anesthesia, prior vaginal delivery, birth weight unless noted. *p-value, Fisher’s exact probability (event too rate to compute odds ratio).
600 Genetic factors associated with uterine rupture Tiffany Weber1, Calla Holmgren1, Tracy Manuck1 1 University of Utah and Intermountain Healthcare, Obstetrics and Gynecology, Salt Lake City, UT
599 Extreme morbid obesity and cesarean-related morbidities Matthew Garabedian1, Anita Sit1 1
Santa Clara Valley Medical Center, Obstetrics and Gynecology, San Jose, CA
OBJECTIVE: To better characterize surgical risks associated with ce-
sarean delivery among pregnant women with extreme morbid obesity (BMI of 50 kg/m2 or greater). STUDY DESIGN: This is a secondary analysis of the NICHD Maternal Fetal Medicine Units Network (MFMU) Cesarean Registry. The MFMU Cesarean Registry was a multi-center observation cohort that prospectively collected data on cesarean delivery (CD). Data were restricted to women with morbid obesity (MO: BMI 40 to 49) and extreme morbid obesity (EMO: BMI of at least 50). We compared demographic, obstetric, and surgical characteristics between these groups. Women underwent CD in 1 of 3 scenarios: primary CD (pCD), elective repeat CD(ERCD), of failed TOLAC. We further examined the CD-related surgical morbidity by classification of CD. RESULTS: From the MFMU Cesarean Registry, 7686 CD were available for analysis: 2824 pCD, 4133 ERCD, and 729 failed TOLAC. Women with EMO were more likely to be African American, have public insurance, and have diabetes, hypertension, asthma, or heart disease. Labor induction and emergent CD were more common among women with EMO. Surgical complications were greater among women with EMO than MO, including blood transfusion (3.1% v 1.7%, p ¼.001), pulmonary embolism (0.4% v. 0.2%, p¼.049), ICU admission (1.4% v. 0.8%, p¼0.21), urteral injury (0.3% v. 0%, p¼.001), and wound infection (2.0 v. 1.1, p¼.01). The pattern of risk was different by type of CD (Table). CONCLUSION: Extreme morbid obesity and morbid obesity increase the risks associated with cesarean delivery. Even within this high risk group, there are demonstrable increases in risk with increasing BMI. Morbid obesity cannot be treated as a homogeneous condition. Among EMO, risk profiles appear different by type of CD. Repeat
OBJECTIVE: Uterine rupture is a rare but dreaded pregnancy complication. A prior cesarean is the greatest risk factor, presumably because of suboptimal hysterotomy wound strength in some women. We hypothesize that uterine rupture occurs at least in part due to genetic variation. STUDY DESIGN: Prospective case-control genetic association study. Cases were prospectively-recruited women with a uterine rupture who delivered 2000-2013 at 2 perinatal referral centers. Controls were women with 1 term uncomplicated VBAC(s), identified from a prospectively collected obstetric database and matched 1:1 by maternal race/ethnicity. Outcomes for the uterine rupture pregnancy (cases) and for the most recent successful VBAC (controls) were compared. DNA was genotyped using the Illumina HumanExomeCore panel. Clinical data were analyzed by t-test, chi-square, and Fisher’s exact as appropriate using STATA(R) v12.1. Genetic data were analyzed by PLINK v1.07. As this was an exploratory study, we made an a priori decision to report the top 25 SNPs regardless of p-value. RESULTS: Sixty-nine women (39 cases, 30 controls) were included. Demographic and pregnancy characteristics were similar between groups. Controls had a mean of 2.3 successful term VBACs (range: 1-4). As expected, there was increased maternal morbidity among cases, including higher estimated blood loss at delivery (1.3 L vs. 0.4 L, p¼0.004). Case neonates were more likely to be admitted to the NICU (39% vs. 0%, p¼0.001), and 2 died (vs. 0 control neonates, p¼0.27). 538,448 SNP markers were genotyped; 233 were not in Hardy-Weinberg equilibrium (p<0.001), leaving 538,215 SNPs for analysis. Several markers in biologically plausible pathways were identified and are shown in the table (not all results shown due to space limitations). CONCLUSION: Uterine rupture is a rare but potentially catastrophic pregnancy complication. Identification of women at highest risk of rupture may decrease maternal and fetal morbidity and mortality.
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S295