709: Uterine artery doppler ultrasound predictor of adverse pregnancy outcomes

Poster Session IV

ajog.org

708 Risk factors for significant underestimation of blood loss during cesarean deliveries Ohad Gluck, Yossi Mizrachi, Michal Kovo, Jacob Bar, Eran Weiner Edith wolfson medical center, Holon, Israel

OBJECTIVE: The surgeon’s visual estimation is the fastest and most

widely used method for estimating blood loss (BL) while performing cesarean deliveries (CDs). Major BL underestimation may adversely influence obstetric decision-making, and result in delaying further interventions (such as blood products transfusion). Therefore, we aimed to identify independent predictors for major BL underestimation during CDs. STUDY DESIGN: The surgical files of all CDs performed between November 2008 and June 2016 were reviewed for surgeons’ reported estimated BL. Actual BL was calculated by multiplying the calculated maternal blood volume by the percent of hematocrit (HCT) decrease. Calculated maternal blood volume ¼ 0.75 * [(maternal height in inches * 50) + (maternal weight in pounds * 25)]. Percent of hematocrit decrease ¼ [(preoperative HCT - postoperative HCT)/ preoperative HCT]. Multivariate forward logistic regression was performed to identify independent risk factors for major BL underestimation (defined as actual BL- estimated BL  400 ml). Possible confounders included: maternal age, gestational age, BMI at delivery, multiple pregnancy, CD indication, number of previous CDs, intra-abdominal adhesions, CD duration, type of anesthesia (regional vs. general), manual/spontaneous placental separation, and surgeon’s experience (years). RESULTS: During the study period, 3655 CDs were analyzed, of which 420 met the criterion for major BL underestimation. Urgent surgery (aOR¼ 2.83), general anesthesia (aOR¼ 2.39), and higher surgeon experience (aOR¼ 1.03) were found to be independent risk factors for major BL underestimation. Previous CS decreased the risk of major BL underestimation (aOR¼0.47). Other cofounders were not found to be independently associated with major BL underestimation. CONCLUSION: Various factors can independently predict major underestimation of BL during CDs. Recognizing these factors can assist in the interpretation of estimated BL and improve obstetric decisionmaking.

Adjusted odds ratios and confidence intervals for major blood loss underestimation

Total

No.

Cases of major underestimation

3655

420 (11.5%)

p-value

Previous CS (≥1) No

2021

321 (15.9%)

Yes

1634

99 (6.1%)

<0.001 Surgeon experience (yr) ≤1

285

2-6

1994

16 (5.6%) 205 (10.3%)

≥7

1204

172 (14.3%)

<0.001

Type of surgery Elective

1656

84 (5.1%)

Urgent

995

189 (19.0%)

<0.001 Type of anesthesia Regional

2420

78 (3.2%)

General

335

213 (63.6%)

<0.001

709 Uterine artery doppler ultrasound predictor of adverse pregnancy outcomes Sedigheh Hantoushzadeh1, Shirin Torabi1, Mahdi Sheikh1, Farzaneh Fattahi Masrour1, Zhoobin H. Bateni2, Alireza A. Shamshirsaz2 1

Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of, Baylor College of Medicine, Houston, TX

2

OBJECTIVE: To assess whether increased pulsatility index (PI) and

resistance index (RI) have any predictive values for the occurrence of adverse pregnancy outcomes in women with previous cesarean delivery (CD). STUDY DESIGN: This prospective cohort study evaluated 400 gravida 2 pregnant women (200 with previous none medically indicated CD and 200 with previous normal vaginal deliveries (NVD)) who were referred for second trimester screening. The inclusion criteria were the following: single gestation; the absence of fetal growth restriction, stillbirth, hypertensive disorders, collagen vascular disorders, and diabetes during the previous pregnancy and (until enrollment) during the current pregnancy; a previous pregnancy resulting in a healthy, term infant through either NVD or none medically

S414 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017

Poster Session IV

ajog.org indicated CD; and the absence of treatment with aspirin, unfractionated heparin, or low-molecular-weight heparin. The exclusion criteria were smoking, opiate, or alcohol consumption during gestation, fetal structural or chromosomal anomalies. Uterine Artery Doppler (trans-abdominally) studies were performed for all participants between 18- 22 gestational weeks. The mean pulsatility index (PI), resistance index (RI), presence of a systolic notch and placental location were recorded. Mean uterine artery PIs and RIs >95th percentile was considered increased. Pearson correlation coefficients, chi-squared analyses, Logistic regression analyses, receiver operating characteristic (ROC) curves, likelihood ratios, and predictive values were used to analyze the correlations and relationships between variables. RESULTS: Compared with the women with prior NVD, women with prior CD had significantly higher rates of increased adverse pregnancy outcomes (23.5% vs. 4%, p¼0.01). Among the women with previous CD, all of the measured adverse outcomes were observed significantly more frequently in the women with abnormal uterine artery Doppler indices (p<0.001). (Table 1) Increased PI (sensitivity: 70.2%, specificity: 92.1%) and RI (sensitivity: 80.8%, specificity: 92.1%) were good predictors of adverse pregnancy outcomes in the women with previous CD. (Table 2) CONCLUSION: In the women with prior CD, increased PI and RI were very good predictors of adverse pregnancy outcomes and could be used as screening tools.

STUDY DESIGN: A case control study in a single tertiary medical center between 2014-2016. Inclusion criteria were tubal sterilizations performed at the time of cesarean sections. Patients who underwent bilateral salpingectomy were compared with those who underwent BTL using Pomeroy technique. Operative length, estimated blood loss, postpartum fever, wound infection, need for re-laparotomy, hospitalization length and blood transfusions were compared. RESULTS: 1. Overall 136 women were included. Forty four of them underwent bilateral salpingectomy and 92 underwent BTL in the course of the cesarean section. 2. Demographic, obstetrical and surgical characteristics were similar between the groups (Table 1). The mean maternal age was greater in women undergoing salpingectomy (p¼0.03), but the difference was not clinically significant. 3. Mean cesarean section duration was comparable for BTL and salpingectomy patients (44.2023.5 and 45.623.5 minutes; respectively). 4. In multivariate analysis, after controlling for factors that could affect bleeding volume, both blood product transfusion rate and hemoglobin decline after surgery were similar. Nevertheless, bilateral salpingectomy was associated with a significant increase of a clinical estimation of moderate blood loss (500-1,000 ml). 5. Complications were rare in both groups with no significant differences in rates of postpartum fever, wound infection, re-laparotomy, hospitalization length, blood loss and transfusions (Table 2). CONCLUSION: Short-term complications are rare and similar in patients undergoing BTL and bilateral salpingectomy, making bilateral salpingectomy a safe alternative to BTL.

710 Bilateral salpingectomy vs tubal ligation for permanent sterilization during a cesarean delivery Shiri Shinar, Eran Ashwal, Yair Blecher, Sharon Alpern, Uri Amikam, Ariel Many, Yariv Yogev, Liran Hiersch, Aviad Cohen Sourasky medical center, Tel Aviv, Israel

OBJECTIVE: Sterilization via bilateral salpingectomy is slowly replacing bilateral tubal ligation (BTL), as it is believed to decrease the incidence of ovarian cancer. Our objective was to compare shortterm complication rates of bilateral salpingectomy vs. BTL performed during the course of a cesarean section. Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology

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