- Email: [email protected]
673: Effect of Asian race on adverse neonatal outcomes after elective repeat cesarean delivery
www.AJOG.org Operative Obstetrics, Clinical Obstetrics, Intrapartum, Medical-Surgical
Poster Session IV
RESULTS: 6515 samples of amniotic fluid was collected. The median AFL-value was 7.9 mmol/l (0.5-20). Every second delivery (1421) arrested according to the partogram. 71% (1009) of them had a low AFL-level just before delivery. After stimulation with oxytocin, the rate of spontaneous vaginal delivery in the low AFL- group was 69%. In 16% (220) a high AFL-value was analyzed. After optimal stimulation with oxytocin, the spontaneous vaginal delivery rate in the high AFL-group was 14%. In 192 cases a last AFL sample was missing. One maternal death occurred. A Tanzanian woman had an extended labor. She was vaginal delivered with an AFL-value of 18 mmol/l just before delivery. She died in a postpartum hemorrhage. CONCLUSION: Low levels of AFL in arrested labors correlate well to a successful vaginal delivery after use of oxytocin. High levels of AFL correlates well to risk of operative intervention and post partum complications. We speculate that AFL-test can be a useful test in clinical management in the future.
673 Effect of Asian race on adverse neonatal outcomes after elective repeat cesarean delivery Gustavo Vilchez1, Elaine Brantley1, Jocelyn Leon-Peters1, Anushka Chelliah1, Michael Kruger1, Ray Bahado-Singh1
Adjusted ORs of prematurity-related outcomes after ERCD in Asians (N¼42,131)
1
Wayne State University/Detroit Medical Center, Department of Obstetrics & Gynecology, Detroit, MI
OBJECTIVE: The current recommendation for the overall population
is to delay the elective repeat cesarean delivery (ERCD) S 39 wks in order to decrease the risks of prematurity. Prior studies suggest accelerated maturity of Asian American fetuses. Our objective was to determine whether ERCD prior to 39 wks compared to 40wks was associated with increased rates of prematurity-related neonatal complications. STUDY DESIGN: The U.S. Natality Database for U.S. from 2004-2008 was reviewed. Inclusion criteria were: singleton deliveries, repeat cesarean delivery, gestational age from 36-40wks, Asian race. Exclusion criteria were: attempted trial of labor, fetal anomalies, diabetes/hypertensive disorders including eclampsia. Logistic regression analysis was used to calculate the odds ratios (OR) of prematurity-related outcomes (low Apgar scores, assisted ventilation, NICU admission, surfactant use, and antibiotic use, neonatal seizures. Standard confounders were used to calculate the adjusted OR (95% CI) based on gestational age. Cases delivered from 36-40 weeks were studied with 40 weeks as the reference group. RESULTS: A total of 42,131 ERCDs were performed in Asians between 2004-2008. The ORs of adverse neonatal outcomes are shown in table 1. In Asians, the risk of prematurity-related outcomes were not significantly increased at 38 weeks of gestation compared to 40 wks (figure). CONCLUSION: In a USA population, there appears to be not further benefits on delaying the ERCD further than 38 weeks in AsianAmericans. This is consistent with prior reports of accelerated maturity in asian fetuses. Differences in race may be considered in patient counseling regarding timing of ERCD, which can benefit more mothers and fetuses. Studies focusing on minorities are warranted.
*Adjusted for maternal age, live birth order, newborn gender, year of delivery.
674 Is severe ovarian hyperstimulation syndrome associated with adverse pregnancy outcome? Evidence from a large case-control study Jigal Haas1, Yoav Yinon1, Katya Meridor1, Anat Hershko-Klement2, Raoul Orvieto1, Eyal Schiff1, Shali Mazaki-Tovi1 1
Sheba Medical Center, Tel-Aviv University, Obstetrics and Gynecology, TelHashomer, Israel, 2Meir Medical Center, Tel-Aviv University, Obstetrics and Gynecology, Kfar-Saba, Israel
OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is a life-
threatening condition characterized by haemodynamic instability, haemoconcentration and hypoxia. The impact of this complication on pregnancy outcome is controversial. . The aim of this study was to determine the obstetric outcome of women hospitalized for severe OHSS. STUDY DESIGN: A case control study including 125 women (78 singletons and 47 twins) who were hospitalized at early gestation due to severe OHSS and whose pregnancies continued beyond the first trimester (study group), and a control group, consisting of 157 women (79 singletons and 78 twins) matched by age, who conceived via IVF treatment and didn’t develop OHSS. Pregnancy outcome measures including preterm delivery, gestational hypertension, gestational diabetes and IUGR were compared between the two groups.
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S329
Poster Session IV
RESULTS: 6515 samples of amniotic fluid was collected. The median AFL-value was 7.9 mmol/l (0.5-20). Every second delivery (1421) arrested according to the partogram. 71% (1009) of them had a low AFL-level just before delivery. After stimulation with oxytocin, the rate of spontaneous vaginal delivery in the low AFL- group was 69%. In 16% (220) a high AFL-value was analyzed. After optimal stimulation with oxytocin, the spontaneous vaginal delivery rate in the high AFL-group was 14%. In 192 cases a last AFL sample was missing. One maternal death occurred. A Tanzanian woman had an extended labor. She was vaginal delivered with an AFL-value of 18 mmol/l just before delivery. She died in a postpartum hemorrhage. CONCLUSION: Low levels of AFL in arrested labors correlate well to a successful vaginal delivery after use of oxytocin. High levels of AFL correlates well to risk of operative intervention and post partum complications. We speculate that AFL-test can be a useful test in clinical management in the future.
673 Effect of Asian race on adverse neonatal outcomes after elective repeat cesarean delivery Gustavo Vilchez1, Elaine Brantley1, Jocelyn Leon-Peters1, Anushka Chelliah1, Michael Kruger1, Ray Bahado-Singh1
Adjusted ORs of prematurity-related outcomes after ERCD in Asians (N¼42,131)
1
Wayne State University/Detroit Medical Center, Department of Obstetrics & Gynecology, Detroit, MI
OBJECTIVE: The current recommendation for the overall population
is to delay the elective repeat cesarean delivery (ERCD) S 39 wks in order to decrease the risks of prematurity. Prior studies suggest accelerated maturity of Asian American fetuses. Our objective was to determine whether ERCD prior to 39 wks compared to 40wks was associated with increased rates of prematurity-related neonatal complications. STUDY DESIGN: The U.S. Natality Database for U.S. from 2004-2008 was reviewed. Inclusion criteria were: singleton deliveries, repeat cesarean delivery, gestational age from 36-40wks, Asian race. Exclusion criteria were: attempted trial of labor, fetal anomalies, diabetes/hypertensive disorders including eclampsia. Logistic regression analysis was used to calculate the odds ratios (OR) of prematurity-related outcomes (low Apgar scores, assisted ventilation, NICU admission, surfactant use, and antibiotic use, neonatal seizures. Standard confounders were used to calculate the adjusted OR (95% CI) based on gestational age. Cases delivered from 36-40 weeks were studied with 40 weeks as the reference group. RESULTS: A total of 42,131 ERCDs were performed in Asians between 2004-2008. The ORs of adverse neonatal outcomes are shown in table 1. In Asians, the risk of prematurity-related outcomes were not significantly increased at 38 weeks of gestation compared to 40 wks (figure). CONCLUSION: In a USA population, there appears to be not further benefits on delaying the ERCD further than 38 weeks in AsianAmericans. This is consistent with prior reports of accelerated maturity in asian fetuses. Differences in race may be considered in patient counseling regarding timing of ERCD, which can benefit more mothers and fetuses. Studies focusing on minorities are warranted.
*Adjusted for maternal age, live birth order, newborn gender, year of delivery.
674 Is severe ovarian hyperstimulation syndrome associated with adverse pregnancy outcome? Evidence from a large case-control study Jigal Haas1, Yoav Yinon1, Katya Meridor1, Anat Hershko-Klement2, Raoul Orvieto1, Eyal Schiff1, Shali Mazaki-Tovi1 1
Sheba Medical Center, Tel-Aviv University, Obstetrics and Gynecology, TelHashomer, Israel, 2Meir Medical Center, Tel-Aviv University, Obstetrics and Gynecology, Kfar-Saba, Israel
OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is a life-
threatening condition characterized by haemodynamic instability, haemoconcentration and hypoxia. The impact of this complication on pregnancy outcome is controversial. . The aim of this study was to determine the obstetric outcome of women hospitalized for severe OHSS. STUDY DESIGN: A case control study including 125 women (78 singletons and 47 twins) who were hospitalized at early gestation due to severe OHSS and whose pregnancies continued beyond the first trimester (study group), and a control group, consisting of 157 women (79 singletons and 78 twins) matched by age, who conceived via IVF treatment and didn’t develop OHSS. Pregnancy outcome measures including preterm delivery, gestational hypertension, gestational diabetes and IUGR were compared between the two groups.
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S329