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635: Factors increasing risk of hemorrhage in placenta previa
Poster Session IV
ajog.org
CONCLUSION: In this large contemporary cohort, the rate of maternal
operative complications and transfusion requirements were not affected by gestational age at delivery. However, the persistent high risk in all gestational age groups for antepartum bleeding likely warrants planned preterm delivery.
635 Factors increasing risk of hemorrhage in placenta previa Karen J. Gibbins1, Michael W. Varner1, Robert M. Silver1 1
University of Utah Health Sciences and Intermountain Healthcare, Salt Lake City, UT
OBJECTIVE: Placenta previa is associated with increased maternal hemorrhage, typically due to an atonic lower uterine segment. However, it is unclear why some women do and do not suffer hemorrhage. Our objective was to identify risk factors associated with hemorrhage in women with previa. STUDY DESIGN: Secondary case-control analysis of the prospective Maternal-Fetal Medicine Units Network Cesarean Registry including all women with cesarean delivery for previa. Cases are those who suffered hemorrhage, and controls are those who did not. Hemorrhage was defined as mortality, blood product transfusion, atony requiring uterotonics, uterine/hypogastric artery ligation, hysterectomy, coagulopathy, exploratory laparotomy, and ICU admission. Demographic, obstetric, and peripartum factors were compared by Wilcoxon rank sum test, chi-squared test, and odds ratios (ORs). Adjusted ORs were calculated using a logistic regression model determined by backwards-stepwise elimination of variables. RESULTS: 119/501 (24%) women had an emergent delivery, 102/119 (86%) of which were due to antenatal hemorrhage. 94/501 (19%) had an adverse hemorrhagic outcome and 407 did not. In univariate analysis, factors more common in women who ultimately had hemorrhage included anemia, thrombocytopenia, multifetal gestation, earlier gestational age at delivery, low birth weight, diabetes, hypertension, drug use, preterm labor, emergent delivery, bleeding as indication for cesarean, and general anesthesia (Table 1). After fitting the multivariable logistic regression model, anemia (aOR 2.49 [1.364.56]), thrombocytopenia (aOR 3.78 [1.20-11.86]), diabetes (aOR 3.47 [1.20-10.06]), magnesium (aOR 4.72 [1.33-16.7]), and general anesthesia (aOR 4.29 [2.25-8.16]) remained as risk factors for maternal morbidity. Magnesium was only given in the setting of preeclampsia in this group. CONCLUSION: Risk factors for hemorrhage after delivery for previa include pre-delivery anemia, thrombocytopenia, diabetes, magnesium administration, and general anesthesia.
636 Uropathogens and antibiotic resistance temporal trends among pregnant women: updated assessment and comparison from 2005-2014 Sanaa Suharwardy1, Katharine O’Malley1, Henry Lee1, Niaz Banaei1, Natali Aziz1 1
Stanford University, Stanford, CA
OBJECTIVE: Urinary tract infection (UTI) is the most common type
of bacterial infection among pregnant women. UTI, especially when untreated, is associated with numerous adverse pregnancy outcomes. Given the increase of antimicrobial resistance, we sought to describe more recent uropathogen and antibiotic resistance patterns among pregnant women. STUDY DESIGN: We conducted a retrospective study at a university medical center assessing urine cultures of women collected during pregnancy and postpartum from 2005-2014. All urine cultures with 100,000 cfu/mL, meeting formal criteria for UTI, were included in the analysis. The cultures were evaluated for uropathogen and antibiotic resistance. Uropathogen prevalence and resistance were compared between 2005-2009 and 2010-2014 time periods. RESULTS: Of 1492 urine cultures performed during the study period, 1105 met inclusion criteria and were used in final analysis; 594 cultures in 2005-2009 and 511 cultures in 2010-2014. Common uropathogens were not different between the two time periods (Table). Cumulative antibiotic resistance profiles between the two cohorts were also similar, with 44.8% (266) vs 45.4% (232) uropathogens pansensitive and 55.2% (328) vs 54.6% (279) resistant
S338 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016
ajog.org
CONCLUSION: In this large contemporary cohort, the rate of maternal
operative complications and transfusion requirements were not affected by gestational age at delivery. However, the persistent high risk in all gestational age groups for antepartum bleeding likely warrants planned preterm delivery.
635 Factors increasing risk of hemorrhage in placenta previa Karen J. Gibbins1, Michael W. Varner1, Robert M. Silver1 1
University of Utah Health Sciences and Intermountain Healthcare, Salt Lake City, UT
OBJECTIVE: Placenta previa is associated with increased maternal hemorrhage, typically due to an atonic lower uterine segment. However, it is unclear why some women do and do not suffer hemorrhage. Our objective was to identify risk factors associated with hemorrhage in women with previa. STUDY DESIGN: Secondary case-control analysis of the prospective Maternal-Fetal Medicine Units Network Cesarean Registry including all women with cesarean delivery for previa. Cases are those who suffered hemorrhage, and controls are those who did not. Hemorrhage was defined as mortality, blood product transfusion, atony requiring uterotonics, uterine/hypogastric artery ligation, hysterectomy, coagulopathy, exploratory laparotomy, and ICU admission. Demographic, obstetric, and peripartum factors were compared by Wilcoxon rank sum test, chi-squared test, and odds ratios (ORs). Adjusted ORs were calculated using a logistic regression model determined by backwards-stepwise elimination of variables. RESULTS: 119/501 (24%) women had an emergent delivery, 102/119 (86%) of which were due to antenatal hemorrhage. 94/501 (19%) had an adverse hemorrhagic outcome and 407 did not. In univariate analysis, factors more common in women who ultimately had hemorrhage included anemia, thrombocytopenia, multifetal gestation, earlier gestational age at delivery, low birth weight, diabetes, hypertension, drug use, preterm labor, emergent delivery, bleeding as indication for cesarean, and general anesthesia (Table 1). After fitting the multivariable logistic regression model, anemia (aOR 2.49 [1.364.56]), thrombocytopenia (aOR 3.78 [1.20-11.86]), diabetes (aOR 3.47 [1.20-10.06]), magnesium (aOR 4.72 [1.33-16.7]), and general anesthesia (aOR 4.29 [2.25-8.16]) remained as risk factors for maternal morbidity. Magnesium was only given in the setting of preeclampsia in this group. CONCLUSION: Risk factors for hemorrhage after delivery for previa include pre-delivery anemia, thrombocytopenia, diabetes, magnesium administration, and general anesthesia.
636 Uropathogens and antibiotic resistance temporal trends among pregnant women: updated assessment and comparison from 2005-2014 Sanaa Suharwardy1, Katharine O’Malley1, Henry Lee1, Niaz Banaei1, Natali Aziz1 1
Stanford University, Stanford, CA
OBJECTIVE: Urinary tract infection (UTI) is the most common type
of bacterial infection among pregnant women. UTI, especially when untreated, is associated with numerous adverse pregnancy outcomes. Given the increase of antimicrobial resistance, we sought to describe more recent uropathogen and antibiotic resistance patterns among pregnant women. STUDY DESIGN: We conducted a retrospective study at a university medical center assessing urine cultures of women collected during pregnancy and postpartum from 2005-2014. All urine cultures with 100,000 cfu/mL, meeting formal criteria for UTI, were included in the analysis. The cultures were evaluated for uropathogen and antibiotic resistance. Uropathogen prevalence and resistance were compared between 2005-2009 and 2010-2014 time periods. RESULTS: Of 1492 urine cultures performed during the study period, 1105 met inclusion criteria and were used in final analysis; 594 cultures in 2005-2009 and 511 cultures in 2010-2014. Common uropathogens were not different between the two time periods (Table). Cumulative antibiotic resistance profiles between the two cohorts were also similar, with 44.8% (266) vs 45.4% (232) uropathogens pansensitive and 55.2% (328) vs 54.6% (279) resistant
S338 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016