- Email: [email protected]
652: Induction of labor for gestational hypertension at term: a look at outcomes
Poster Session IV
ajog.org dominated by Lactobacillus, and most of these were dominated by L. iners. Sequences representing Megasphaera type 1 and Prevotella were detected in all vaginal samples (n¼70). Fourteen species of Prevotella were detected, as well as 15 other Prevotella-like sequences. Microbiome profiles at the time of membrane rupture did not cluster by GA at PPROM, latency duration, or chorioamnionitis. Composition of the vaginal microbiome was unstable over the latency period. Women who were PCR positive for Mollicutes (M. hominis, U. urealyticum, U. parvum) had significantly lower GA at delivery and correspondingly lower birth weight infants than PCR negative women. CONCLUSION: Women with PPROM had mixed, abnormal vaginal microbiota but the type of microbiome profile at PPROM did not correlate with latency duration. Prevotella spp. and Megasphaera type I were ubiquitous. The presence of Mollicutes in the vaginal microbiome was associated with lower GA at delivery. The microbiome was remarkably unstable during the latency period.
651 Selective serotonin reuptake inhibitor exposure and preterm birth: the effect of fetal sex Jeannie Kelly1, Adam Urato1 1
Tufts Medical Center, MFM, Boston, MA
OBJECTIVE: Selective serotonin reuptake inhibitor (SSRI) use during
pregnancy has been associated with preterm birth (PTB) in 3 metaanalyses. Previous studies have also suggested that SSRIs have differing effects on pregnancy outcomes depending on fetal sex. We sought to investigate the effect of fetal sex on PTB rates in SSRI users. STUDY DESIGN: A retrospective case-control study was conducted at a tertiary care center and community hospital. All patients using SSRIs at time of delivery between January 2010 and December 2013 were identified by hospital records. Multiple gestations were excluded. Patient demographics, pregnancy history, and delivery information were collected. Rates of PTB were compared between male and female fetuses, and the chi-squared test was used to test for statistical differences. RESULTS: 96 patients were eligible for inclusion. 55 (57.3%) were pregnant with male fetuses, and 41 (42.7%) with female fetuses. Significantly more pregnancies with male fetuses (41.8%) were complicated by PTB compared to pregnancies with female fetuses (22.0%) (OR 2.56, p¼0.04, 95% CI 1.03-6.37). There was no statistical difference between the two groups in terms age and medical history. Patients most commonly used sertraline (42.7%), and of these patients, those carrying male fetuses were significantly more likely to experience PTB (52.0%) compared to female fetuses (18.8%) (OR 4.69, p¼0.04, 95%CI 1.07-20.63). There was no statistical difference between fetal sex and PTB for the other SSRIs (Table 1). CONCLUSION: Patients on SSRIs carrying a male fetus are significantly more likely to deliver preterm compared with those with a female fetus. Sertraline, in particular, was strongly associated with PTB in women carrying males. Our study adds to the evidence that SSRIs may be associated with differential effects on pregnancy depending on the sex of the fetus.
652 Induction of labor for gestational hypertension at term: a look at outcomes
Jennifer Durst1, Akila Subramaniam1, Ying Tang1, Jeff Szychowski1, Sukhkamal Campbell1, Joseph Biggio1, Lorie Harper1 1
UAB, Obstetrics and Gynecology, Birmingham, AL
OBJECTIVE: Prior studies examining optimal timing of delivery for
women with gestational hypertension (GHTN) have included both multiparous and nulliparous women. Induction of labor (IOL) in nulliparous women at earlier gestational ages may be associated with increased cesarean delivery (CD); therefore we sought to compare maternal and neonatal outcomes of nulliparous women with GHTN undergoing IOL at term. STUDY DESIGN: Retrospective cohort from 2000-2013 of nulliparas with singletons diagnosed with GHTN undergoing IOL at 37 weeks. Outcomes were compared by week of delivery against women delivering in the 39th week or greater. Primary outcome was mode of delivery at each completed week of gestation. A secondary composite maternal outcome included need for antihypertensive medications, magnesium therapy, infectious morbidity, readmission, postpartum hemorrhage, or thromboembolic disease. Composite neonatal outcome included neonatal ICU admission, infant length of stay (LOS) 5 days, 5 minute APGAR 3, respiratory distress syndrome (RDS), or death. Groups were compared using the analysis of variance or X2 test for trend, as appropriate. Logistic regression was used to adjust for confounding variables. RESULTS: 323 nulliparous women with GHTN were included: 67 (21%) induced in the 37th week, 77 (24%) in the 38th, and 179 (55%) in the > 39th week. The rate of CD was not significantly different between groups (Figure). Composite maternal morbidity was lowest in women delivering at 38 weeks, whereas composite neonatal morbidity was similar across gestational ages. When compared to women delivering at > 39 weeks gestation, women delivered in the 38th week were less likely to experience any adverse maternal or neonatal outcome. CONCLUSION: Compared to induction of labor at 39 weeks, induction in the 37th and 38th week was not associated with an increased risk of CD in nulliparas and may be associated with a decreased risk of adverse perinatal outcomes in women with GHTN.
Selected maternal and neonatal outcomes.
SSRI exposure and preterm birth in male and female fetuses
Supplement to JANUARY 2015 American Journal of Obstetrics & Gynecology
S321
Poster Session IV
ajog.org 654 Rupture of the unscarred uterus
Jing Dai3, Gustavo Vilchez1, Navleen Gill1, Anushka Chelliah2, Luis Hoyos1, Robert Sokol3
1 Wayne State University/Detroit Medical Center, Detroit, MI, 2University of Florida, Gainesville, FL, 3Wayne State University, Detroit, MI
ˇ
Referent group 39.0; adjusted for race, BMI *Exact test( Cochran-Armitage Trend Test) TTN: Transient tachypnea of the newborn
653 Second trimester marginal previa: Is follow-up necessary? Jessica Parrott1, Marium Holland1
1 University of Kansas Medical Center, Obstetrics and Gynecology, Kansas City, MO
OBJECTIVE: Our goal was to determine if a marginal previa at 18-22 wga requires follow-up evaluation. To this end, we examined if marginal previas a) routinely resolve before delivery (i.e., are no longer marginal or low lying) and b) if diagnosis is associated with increased risk of adverse outcomes such as ante- or peripartum hemorrhage. STUDY DESIGN: A retrospective cohort study was conducted at a tertiary center from 1/2008 to 12/2013. Marginal previa cases at 1822 wga were identified using our ultrasound database. Placental location was confirmed by a board certified MFM. Multiple gestations were excluded. Data regarding ante- and peripartum course were abstracted including but not limited to gestational age at time of diagnosis, time of resolution, hemorrhage, delivery method and other complications. Excel statistical software was used for data analysis. RESULTS: 59 cases were initially identified, of which 53 had ultrasound data available. 41/53(77%) had complete resolution before delivery. 12(23%) resolved but remained low-lying at 28 wga; 3(6%) remained low-lying at delivery. Delivery information was available on 44/53 cases. 10(23%) delivered via cesarean at an average 38 3/7 wga (35 4/7-41 1/7) with average blood loss of 606mL(500ml-2000ml). 34(77%) delivered vaginally at an average 39 1/7 wga (35 5/7-41 4/7) with average blood loss of 200mL(200mL-2600mL). 3 cases in both the cesarean (30%) and vaginal (9%) delivery groups had postpartum hemorrhage. Of the 3 cases that remained low-lying at the time of delivery, 2 had delivery data available. The average gestational age at time of delivery was 35 6/7 weeks (35 6/7-36 0/7) with average blood loss of 1500mL(1000mL-2000mL). Ante- and peripartum bleeding complicated both cases. CONCLUSION: Of 53 marginal previa cases diagnosed at 18-22 wga 3(6%) remained low-lying. With the increased risk of hemorrhage associated with low-lying placentas, this suggests that women diagnosed with marginal previa at 18-22 wga should have repeat transvaginal ultrasound done before delivery.
OBJECTIVE: Rupture of the unscarred uterus is a very rare event suggesting that examining all cases nationally could be of value. Though risks such as parity & prolonged labor are thought to contribute, availability of evidence-based estimates of the main risk factors is limited. Our objective here was to identify significant preceding factors for uterine rupture in the unscarred uterus. STUDY DESIGN: Deliveries complicated by uterine rupture without a cesarean history were selected from the US Natality Database of all deliveries in 2011-12. Controls without uterine rupture matched by location & delivery date were selected. 24 variables (demographics, medical/obstetric history & labor complications) were analyzed using logistic regression with p< 0.05 considered significant. RESULTS: In 5,885,593 births without a prior cesarean, there were 1,059 uterine ruptures (1.8 per 10,000 births). Of the 24 variables, the model retained only seven, with multiple pregnancy, chronic hypertension and chorioamnionitis being the most significant predictors (Table 1). A high risk group with all three of these risks was estimated to have a uterine rupture rate of 10.7 per 1,000 births, which is 77 fold higher than a low risk group defined as age¼25, parity¼1 without other risk factors (Figure1). CONCLUSION: In the unscarred uterus, multiple pregnancy, chronic hypertension & chorioamnionitis are the most important preceding factors for uterine rupture. Multiparity, black race and advanced maternal age are also risks. Interestingly, oxytocin use does not appear to be a significant risk for rupture of the unscarred uterus. Despite being very rare, rupture in the unscarred uterus accounts nearly half of uterine ruptures in the US. When, due to the presence of multiple risk factors, the chance of uterine rupture is over one in a hundred, the possibility of this disastrous complication might be taken into account in physician/patient decision making.
Figure 1. Odds Ratios for Uterine Rupture in the Unscarred Uterus (N¼1,059).
Table 1 Odds ratios for uterine rupture in cases with no previous cesarean delivery (N¼1,059)
S322 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015
ajog.org dominated by Lactobacillus, and most of these were dominated by L. iners. Sequences representing Megasphaera type 1 and Prevotella were detected in all vaginal samples (n¼70). Fourteen species of Prevotella were detected, as well as 15 other Prevotella-like sequences. Microbiome profiles at the time of membrane rupture did not cluster by GA at PPROM, latency duration, or chorioamnionitis. Composition of the vaginal microbiome was unstable over the latency period. Women who were PCR positive for Mollicutes (M. hominis, U. urealyticum, U. parvum) had significantly lower GA at delivery and correspondingly lower birth weight infants than PCR negative women. CONCLUSION: Women with PPROM had mixed, abnormal vaginal microbiota but the type of microbiome profile at PPROM did not correlate with latency duration. Prevotella spp. and Megasphaera type I were ubiquitous. The presence of Mollicutes in the vaginal microbiome was associated with lower GA at delivery. The microbiome was remarkably unstable during the latency period.
651 Selective serotonin reuptake inhibitor exposure and preterm birth: the effect of fetal sex Jeannie Kelly1, Adam Urato1 1
Tufts Medical Center, MFM, Boston, MA
OBJECTIVE: Selective serotonin reuptake inhibitor (SSRI) use during
pregnancy has been associated with preterm birth (PTB) in 3 metaanalyses. Previous studies have also suggested that SSRIs have differing effects on pregnancy outcomes depending on fetal sex. We sought to investigate the effect of fetal sex on PTB rates in SSRI users. STUDY DESIGN: A retrospective case-control study was conducted at a tertiary care center and community hospital. All patients using SSRIs at time of delivery between January 2010 and December 2013 were identified by hospital records. Multiple gestations were excluded. Patient demographics, pregnancy history, and delivery information were collected. Rates of PTB were compared between male and female fetuses, and the chi-squared test was used to test for statistical differences. RESULTS: 96 patients were eligible for inclusion. 55 (57.3%) were pregnant with male fetuses, and 41 (42.7%) with female fetuses. Significantly more pregnancies with male fetuses (41.8%) were complicated by PTB compared to pregnancies with female fetuses (22.0%) (OR 2.56, p¼0.04, 95% CI 1.03-6.37). There was no statistical difference between the two groups in terms age and medical history. Patients most commonly used sertraline (42.7%), and of these patients, those carrying male fetuses were significantly more likely to experience PTB (52.0%) compared to female fetuses (18.8%) (OR 4.69, p¼0.04, 95%CI 1.07-20.63). There was no statistical difference between fetal sex and PTB for the other SSRIs (Table 1). CONCLUSION: Patients on SSRIs carrying a male fetus are significantly more likely to deliver preterm compared with those with a female fetus. Sertraline, in particular, was strongly associated with PTB in women carrying males. Our study adds to the evidence that SSRIs may be associated with differential effects on pregnancy depending on the sex of the fetus.
652 Induction of labor for gestational hypertension at term: a look at outcomes
Jennifer Durst1, Akila Subramaniam1, Ying Tang1, Jeff Szychowski1, Sukhkamal Campbell1, Joseph Biggio1, Lorie Harper1 1
UAB, Obstetrics and Gynecology, Birmingham, AL
OBJECTIVE: Prior studies examining optimal timing of delivery for
women with gestational hypertension (GHTN) have included both multiparous and nulliparous women. Induction of labor (IOL) in nulliparous women at earlier gestational ages may be associated with increased cesarean delivery (CD); therefore we sought to compare maternal and neonatal outcomes of nulliparous women with GHTN undergoing IOL at term. STUDY DESIGN: Retrospective cohort from 2000-2013 of nulliparas with singletons diagnosed with GHTN undergoing IOL at 37 weeks. Outcomes were compared by week of delivery against women delivering in the 39th week or greater. Primary outcome was mode of delivery at each completed week of gestation. A secondary composite maternal outcome included need for antihypertensive medications, magnesium therapy, infectious morbidity, readmission, postpartum hemorrhage, or thromboembolic disease. Composite neonatal outcome included neonatal ICU admission, infant length of stay (LOS) 5 days, 5 minute APGAR 3, respiratory distress syndrome (RDS), or death. Groups were compared using the analysis of variance or X2 test for trend, as appropriate. Logistic regression was used to adjust for confounding variables. RESULTS: 323 nulliparous women with GHTN were included: 67 (21%) induced in the 37th week, 77 (24%) in the 38th, and 179 (55%) in the > 39th week. The rate of CD was not significantly different between groups (Figure). Composite maternal morbidity was lowest in women delivering at 38 weeks, whereas composite neonatal morbidity was similar across gestational ages. When compared to women delivering at > 39 weeks gestation, women delivered in the 38th week were less likely to experience any adverse maternal or neonatal outcome. CONCLUSION: Compared to induction of labor at 39 weeks, induction in the 37th and 38th week was not associated with an increased risk of CD in nulliparas and may be associated with a decreased risk of adverse perinatal outcomes in women with GHTN.
Selected maternal and neonatal outcomes.
SSRI exposure and preterm birth in male and female fetuses
Supplement to JANUARY 2015 American Journal of Obstetrics & Gynecology
S321
Poster Session IV
ajog.org 654 Rupture of the unscarred uterus
Jing Dai3, Gustavo Vilchez1, Navleen Gill1, Anushka Chelliah2, Luis Hoyos1, Robert Sokol3
1 Wayne State University/Detroit Medical Center, Detroit, MI, 2University of Florida, Gainesville, FL, 3Wayne State University, Detroit, MI
ˇ
Referent group 39.0; adjusted for race, BMI *Exact test( Cochran-Armitage Trend Test) TTN: Transient tachypnea of the newborn
653 Second trimester marginal previa: Is follow-up necessary? Jessica Parrott1, Marium Holland1
1 University of Kansas Medical Center, Obstetrics and Gynecology, Kansas City, MO
OBJECTIVE: Our goal was to determine if a marginal previa at 18-22 wga requires follow-up evaluation. To this end, we examined if marginal previas a) routinely resolve before delivery (i.e., are no longer marginal or low lying) and b) if diagnosis is associated with increased risk of adverse outcomes such as ante- or peripartum hemorrhage. STUDY DESIGN: A retrospective cohort study was conducted at a tertiary center from 1/2008 to 12/2013. Marginal previa cases at 1822 wga were identified using our ultrasound database. Placental location was confirmed by a board certified MFM. Multiple gestations were excluded. Data regarding ante- and peripartum course were abstracted including but not limited to gestational age at time of diagnosis, time of resolution, hemorrhage, delivery method and other complications. Excel statistical software was used for data analysis. RESULTS: 59 cases were initially identified, of which 53 had ultrasound data available. 41/53(77%) had complete resolution before delivery. 12(23%) resolved but remained low-lying at 28 wga; 3(6%) remained low-lying at delivery. Delivery information was available on 44/53 cases. 10(23%) delivered via cesarean at an average 38 3/7 wga (35 4/7-41 1/7) with average blood loss of 606mL(500ml-2000ml). 34(77%) delivered vaginally at an average 39 1/7 wga (35 5/7-41 4/7) with average blood loss of 200mL(200mL-2600mL). 3 cases in both the cesarean (30%) and vaginal (9%) delivery groups had postpartum hemorrhage. Of the 3 cases that remained low-lying at the time of delivery, 2 had delivery data available. The average gestational age at time of delivery was 35 6/7 weeks (35 6/7-36 0/7) with average blood loss of 1500mL(1000mL-2000mL). Ante- and peripartum bleeding complicated both cases. CONCLUSION: Of 53 marginal previa cases diagnosed at 18-22 wga 3(6%) remained low-lying. With the increased risk of hemorrhage associated with low-lying placentas, this suggests that women diagnosed with marginal previa at 18-22 wga should have repeat transvaginal ultrasound done before delivery.
OBJECTIVE: Rupture of the unscarred uterus is a very rare event suggesting that examining all cases nationally could be of value. Though risks such as parity & prolonged labor are thought to contribute, availability of evidence-based estimates of the main risk factors is limited. Our objective here was to identify significant preceding factors for uterine rupture in the unscarred uterus. STUDY DESIGN: Deliveries complicated by uterine rupture without a cesarean history were selected from the US Natality Database of all deliveries in 2011-12. Controls without uterine rupture matched by location & delivery date were selected. 24 variables (demographics, medical/obstetric history & labor complications) were analyzed using logistic regression with p< 0.05 considered significant. RESULTS: In 5,885,593 births without a prior cesarean, there were 1,059 uterine ruptures (1.8 per 10,000 births). Of the 24 variables, the model retained only seven, with multiple pregnancy, chronic hypertension and chorioamnionitis being the most significant predictors (Table 1). A high risk group with all three of these risks was estimated to have a uterine rupture rate of 10.7 per 1,000 births, which is 77 fold higher than a low risk group defined as age¼25, parity¼1 without other risk factors (Figure1). CONCLUSION: In the unscarred uterus, multiple pregnancy, chronic hypertension & chorioamnionitis are the most important preceding factors for uterine rupture. Multiparity, black race and advanced maternal age are also risks. Interestingly, oxytocin use does not appear to be a significant risk for rupture of the unscarred uterus. Despite being very rare, rupture in the unscarred uterus accounts nearly half of uterine ruptures in the US. When, due to the presence of multiple risk factors, the chance of uterine rupture is over one in a hundred, the possibility of this disastrous complication might be taken into account in physician/patient decision making.
Figure 1. Odds Ratios for Uterine Rupture in the Unscarred Uterus (N¼1,059).
Table 1 Odds ratios for uterine rupture in cases with no previous cesarean delivery (N¼1,059)
S322 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015