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75: Twin birth study: incidence of caesarean delivery in induction of twin pregnancies
Oral Concurrent Session 7
Labor
75 Twin birth study: incidence of caesarean delivery in induction of twin pregnancies
Elad Mei-Dan1, Elizabeth Asztalos1, Andrew Willan2, Alexander Allen3, B. Anthony Armson4, Amiram Gafni5, Mary Hannah1, Eileen Hutton6, Ks Joseph7, Arne Ohlsson8, Susan Ross9, Jon Barrett1
1 Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 2Child Health Evaluative Sciences, HSC Research Institute, University of Toronto, Toronto, ON, Canada, 3Paediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada, 4Obstetrics and Gynecology, IWK Health Centre, Dalhousie University, Halifax, NS, Canada, 5Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada, 6Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada, 7Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada, 8Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 9Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
OBJECTIVE: The Twin Birth Study demonstrated that in a planned
vaginal birth between 32 and 38 weeks gestation in twin pregnancies where the first twin was a cephalic presentation, there was no difference in fetal and neonatal outcomes from a planned caesarean section. The Twin Birth Study necessitated an induction for women in the planned vaginal delivery group when completing 38 weeks of gestation. However, induction of labor can fail and lead to an unplanned caesarean delivery. The aim of this secondary analysis was to evaluate the incidence of factors which led to caesarean deliveries between the two approaches for induction, prostaglandin (PG) versus amniotomy and/or oxytocin (no PG). STUDY DESIGN: A total of 368 women were identified and included in the analysis. Of these women, 153 (41.5%) were induced by prostaglandins and 215 (58.5%) used amniotomy and/or oxytocin as an induction method. The following variables were evaluated between the two approaches: maternal age, parity, presentation of twin B, country’s perinatal mortality rate (PMR), start of active labor to full dilatation, start of active labour to delivery. Predictor variables were entered into a multiple logistic regress in a step-forward approach. RESULTS: In total, 149/368 (40%) women underwent a caesarean delivery after induction; the incidence in the two modes of induction was similar: 62/153 (40.5%) in the PG group and 87/215 (40.5%) in the no PG group. Of the variables listed above, the variables shown in the table were found to be highly significant. CONCLUSION: Nulliparous women and women over the age of 30 years were more likely to be unsuccessful with induction of labor and require an unplanned cesarean delivery. In addition, a cesarean delivery was more likely to occur in countries where the PMR is 10/ 1000. The method of induction (PG or no PG) nor the presentation of twin B (cephalic vs. non-cephalic) had no effect on the incidence of cesarean delivery.
* Odds ratios greater than one indicates that patients in the second category in parenthesis are more likely to experience a cesarean delivery
76 Obstetric outcome after oocyte donation (OD)
Ulla-Britt Wennerholm1, Sarah Nejdet1, Karin Ka¨llen2, Ann Thurin1
1 Clinical sciences, Sahlgrenska University Hospital, Obstetrics and gynecology, Gothenburg, Sweden, 2Tornblad institute, Institution of clinical sciences, Department of reproductive epidemiology, Lund, Sweden
OBJECTIVE: To describe the obstetric outcome after OD compared with IVF/ICSI and spontaneous conception. STUDY DESIGN: This population-based retrospective register study included all deliveries after OD in Sweden from 2002 to 2012. The IVF register was cross linked with the Medical Birth register. Deliveries after OD were compared with deliveries after IVF/ICSI and
ajog.org
deliveries after spontaneous conception (SC) in the general population. Outcomes were preeclampsia, gestational diabetes, placenta previa, placental abruption, preterm prelabour rupture of the membranes, pPROM, preterm birth (PTB < 28, 32 and 37 weeks), low birth weight (LBW < 1500 and 2500g), SGA, LGA, Apgar score < 75, perinatal death and caesarean section. Crude and adjusted odds ratio (AOR) with 95% CI were calculated. Adjustment was made for maternal age, parity, year of birth, smoking, BMI, years of infertility and multiplicity. RESULTS: There were 410 children born after OD, 23 610 after fresh IVF/ICSI and 1 118 647 after SC. As compared with the general population children born after OD had higher rate of PTB <32 (AOR 1.9; 95% CI 1.1-3.3) and 37 weeks (AOR 1.7; 95% CI 1.2-2.2), and LBW <2500g (AOR 1.5; 95% CI 1.03-2.1). The rate of caesarean section (AOR 2.4; 95% CI 1.9-2.9) and preeclampsia (AOR 2.8; 95% CI 2.1-3.8) was higher. As compared with IVF/ICSI, children born after OD had higher rates of PTB <37 weeks (AOR; 1.9; 95% CI 1.42.5), very low (AOR 2.0; 95% CI 1.1-3.7) and LBW (AOR 1.7; 95% CI 1.2-2.3). The rate of caesarean section and preeclampsia was higher (AOR 2.4; 95% CI 1.9-2.9 and AOR 3.0; 95% CI 2.3-4.1, respectively). CONCLUSION: Pregnancies after OD have a poorer perinatal outcome than those after IVF/ICSI and after SC mainly because of a high rate of preeclampsia.
Obstetric outcome in pregnancies after OD, IVF/ICSI and spontaneous conception
77 The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy stratified by gestational age
Anela Puljic1, Elissa Kim1, Jessica Page2, Tania Esakoff3, Brian Shaffer4, Daphne Lacoursiere1, Aaron Caughey4
1 University of California, San Diego, San Diego, CA, 2University of Utah, Salt Lake City, UT, 3Cedar Sinai Medical Center, Los Angeles, CA, 4Oregon Health & Science University, Portland, OR
OBJECTIVE: To characterize the risk of infant and fetal death by each
additional week of expectant management versus delivery in pregnancies complicated by cholestasis. STUDY DESIGN: This is a retrospective cohort study of 1,617,498 singleton, non-anomalous pregnancies of women between 33 to 40 weeks gestation with intrahepatic cholestasis of pregnancy (ICP) in the state of California during the years of 2005-2008. ICD-9 codes and linked hospital discharge and vital statistics data was utilized. For each week of gestation, the following outcomes were assessed per 10,000: the risk of stillbirth, the risk delivery (represented by the risk of infant death at given week of gestation), and the composite risk of expectant management for 1 additional week.
S52 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015
Labor
75 Twin birth study: incidence of caesarean delivery in induction of twin pregnancies
Elad Mei-Dan1, Elizabeth Asztalos1, Andrew Willan2, Alexander Allen3, B. Anthony Armson4, Amiram Gafni5, Mary Hannah1, Eileen Hutton6, Ks Joseph7, Arne Ohlsson8, Susan Ross9, Jon Barrett1
1 Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 2Child Health Evaluative Sciences, HSC Research Institute, University of Toronto, Toronto, ON, Canada, 3Paediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada, 4Obstetrics and Gynecology, IWK Health Centre, Dalhousie University, Halifax, NS, Canada, 5Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada, 6Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada, 7Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada, 8Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 9Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
OBJECTIVE: The Twin Birth Study demonstrated that in a planned
vaginal birth between 32 and 38 weeks gestation in twin pregnancies where the first twin was a cephalic presentation, there was no difference in fetal and neonatal outcomes from a planned caesarean section. The Twin Birth Study necessitated an induction for women in the planned vaginal delivery group when completing 38 weeks of gestation. However, induction of labor can fail and lead to an unplanned caesarean delivery. The aim of this secondary analysis was to evaluate the incidence of factors which led to caesarean deliveries between the two approaches for induction, prostaglandin (PG) versus amniotomy and/or oxytocin (no PG). STUDY DESIGN: A total of 368 women were identified and included in the analysis. Of these women, 153 (41.5%) were induced by prostaglandins and 215 (58.5%) used amniotomy and/or oxytocin as an induction method. The following variables were evaluated between the two approaches: maternal age, parity, presentation of twin B, country’s perinatal mortality rate (PMR), start of active labor to full dilatation, start of active labour to delivery. Predictor variables were entered into a multiple logistic regress in a step-forward approach. RESULTS: In total, 149/368 (40%) women underwent a caesarean delivery after induction; the incidence in the two modes of induction was similar: 62/153 (40.5%) in the PG group and 87/215 (40.5%) in the no PG group. Of the variables listed above, the variables shown in the table were found to be highly significant. CONCLUSION: Nulliparous women and women over the age of 30 years were more likely to be unsuccessful with induction of labor and require an unplanned cesarean delivery. In addition, a cesarean delivery was more likely to occur in countries where the PMR is 10/ 1000. The method of induction (PG or no PG) nor the presentation of twin B (cephalic vs. non-cephalic) had no effect on the incidence of cesarean delivery.
* Odds ratios greater than one indicates that patients in the second category in parenthesis are more likely to experience a cesarean delivery
76 Obstetric outcome after oocyte donation (OD)
Ulla-Britt Wennerholm1, Sarah Nejdet1, Karin Ka¨llen2, Ann Thurin1
1 Clinical sciences, Sahlgrenska University Hospital, Obstetrics and gynecology, Gothenburg, Sweden, 2Tornblad institute, Institution of clinical sciences, Department of reproductive epidemiology, Lund, Sweden
OBJECTIVE: To describe the obstetric outcome after OD compared with IVF/ICSI and spontaneous conception. STUDY DESIGN: This population-based retrospective register study included all deliveries after OD in Sweden from 2002 to 2012. The IVF register was cross linked with the Medical Birth register. Deliveries after OD were compared with deliveries after IVF/ICSI and
ajog.org
deliveries after spontaneous conception (SC) in the general population. Outcomes were preeclampsia, gestational diabetes, placenta previa, placental abruption, preterm prelabour rupture of the membranes, pPROM, preterm birth (PTB < 28, 32 and 37 weeks), low birth weight (LBW < 1500 and 2500g), SGA, LGA, Apgar score < 75, perinatal death and caesarean section. Crude and adjusted odds ratio (AOR) with 95% CI were calculated. Adjustment was made for maternal age, parity, year of birth, smoking, BMI, years of infertility and multiplicity. RESULTS: There were 410 children born after OD, 23 610 after fresh IVF/ICSI and 1 118 647 after SC. As compared with the general population children born after OD had higher rate of PTB <32 (AOR 1.9; 95% CI 1.1-3.3) and 37 weeks (AOR 1.7; 95% CI 1.2-2.2), and LBW <2500g (AOR 1.5; 95% CI 1.03-2.1). The rate of caesarean section (AOR 2.4; 95% CI 1.9-2.9) and preeclampsia (AOR 2.8; 95% CI 2.1-3.8) was higher. As compared with IVF/ICSI, children born after OD had higher rates of PTB <37 weeks (AOR; 1.9; 95% CI 1.42.5), very low (AOR 2.0; 95% CI 1.1-3.7) and LBW (AOR 1.7; 95% CI 1.2-2.3). The rate of caesarean section and preeclampsia was higher (AOR 2.4; 95% CI 1.9-2.9 and AOR 3.0; 95% CI 2.3-4.1, respectively). CONCLUSION: Pregnancies after OD have a poorer perinatal outcome than those after IVF/ICSI and after SC mainly because of a high rate of preeclampsia.
Obstetric outcome in pregnancies after OD, IVF/ICSI and spontaneous conception
77 The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy stratified by gestational age
Anela Puljic1, Elissa Kim1, Jessica Page2, Tania Esakoff3, Brian Shaffer4, Daphne Lacoursiere1, Aaron Caughey4
1 University of California, San Diego, San Diego, CA, 2University of Utah, Salt Lake City, UT, 3Cedar Sinai Medical Center, Los Angeles, CA, 4Oregon Health & Science University, Portland, OR
OBJECTIVE: To characterize the risk of infant and fetal death by each
additional week of expectant management versus delivery in pregnancies complicated by cholestasis. STUDY DESIGN: This is a retrospective cohort study of 1,617,498 singleton, non-anomalous pregnancies of women between 33 to 40 weeks gestation with intrahepatic cholestasis of pregnancy (ICP) in the state of California during the years of 2005-2008. ICD-9 codes and linked hospital discharge and vital statistics data was utilized. For each week of gestation, the following outcomes were assessed per 10,000: the risk of stillbirth, the risk delivery (represented by the risk of infant death at given week of gestation), and the composite risk of expectant management for 1 additional week.
S52 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015