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80: Increased risk of intrauterine fetal death in women with fibroids at routine second trimester ultrasound
Oral Concurrent Session 8 Saturday, February 6, 2010 • 8:00 am – 10:00 am • International Ballroom South, Hilton Chicago CLINICAL OB/LABOR/ACADEMIC ISSUES
Abstracts 79 – 86 Moderators: Deborah Wing, MD; Jeff Kuller, MD 79 Perinatal safety initiative to reduce adverse obstetric events Brian Wagner1, Natalie Meirowitz1, Phyllis Cohen1, Leah Kaufman1, Jalpa Shah1, Deepak Nanda1, Lori Reggio1, Karen Britt1, Adiel Fleischer1 1
Long Island Jewish Medical Center, Obstetrics and Gynecology, New Hyde Park, New York
OBJECTIVE: To assess the benefit of a comprehensive perinatal safety initiative to reduce adverse obstetrical outcomes and improve patient safety. STUDY DESIGN: An interventional trial was developed where we incrementally introduced multiple perinatal safety initiatives from August 2007 through July 2009 at a large community medical center. The safety initiative included formalized team training with an emphasis on communication, standardizing EFM terminology with required documentation of competence, introduction of evidence-based protocols and integration of educational programs among all care providers. 11 adverse outcome measures were followed prospectively and the adverse outcome index was analyzed for a trend. RESULTS: At the beginning of the safety initiative the adverse outcome index, defined as the number of deliveries with one or more adverse outcomes as a proportion of total deliveries, was approximately 2%. Within the first year, the AOI had decreased to 0.6 percent and has been maintained throughout year two (P⬍0.05). Additionally, employee and patient perceptions of teamwork and safety improved, 28% and 11%, respectively. CONCLUSION: A comprehensive perinatal safety initiative can offer a significant improvement in preventing adverse obstetric outcomes, improving patient safety and enhancing staff and patient experiences.
STUDY DESIGN: A retrospective cohort study of all consecutive women with singleton pregnancies that underwent routine second trimester ultrasound fetal anatomic survey between 16-22 weeks at a large, tertiary care center. Data were extracted on maternal sociodemographics, medical history, and obstetric outcomes. Pregnancies with any fetal anomalies were excluded. Women with at least 1 fibroid detected at the time of fetal anatomic survey were compared to women without fibroids. The primary outcome was IUFD after 20 weeks gestation, and by presence or absence of growth restriction. Univariate and multiple logistic regression analyses were used to estimate the risk of IUFD in women with fibroids. RESULTS: Of 64,047 women, the incidence of fibroids was 3.2% (n⫽2,058). The incidence of IUFD was significantly higher in the fibroid group than in the no-fibroid group (1.6% v. 0.7%, aOR 1.8, 95%CI 1.3-2.7) even after adjusting for black race, tobacco exposure, chronic hypertension, and pregestational diabetes. The risk relationship between fibroids and IUFD was significant only within the IUGR subgroup.
CONCLUSION: Women with fibroids appear to be at increased risk of
IUFD via a growth restriction pathway, making a clinical approach of serial growth scans reasonable. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.095
81 The effect of uterine tachysystole (TS) on intrapartum fetal heart rate tracings (FHRTS) Tracy Manuck1, Erick Henry1, Marc Jackson1, Michael Varner1, Sean Esplin1 1
Intermountain Healthcare, Salt Lake City, Utah
OBJECTIVE: To determine the effect of TS on intrapartum FHRTs and
clinical outcomes. STUDY DESIGN: Intrapartum electronic FHRTs for all term singletons
Adverse Outcome Index 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.094
80 Increased risk of intrauterine fetal death in women with fibroids at routine second trimester ultrasound Molly Stout1, Anthony Odibo1, George Macones1, Alison Cahill1 1
Washington University in St. Louis, St. Louis, Missouri
OBJECTIVE: To estimate the risk of intrauterine fetal death (IUFD) in
women with fibroids detected at routine second trimester ultrasound anatomic survey.
in 5 regional hospitals in October 2008 were retrospectively evaluated. Maternal demographics, intrapartum data, and neonatal outcomes were collected. Data from the last 2 hrs of labor were analyzed. TS was defined as an average of ⬎5 contractions/10 minutes over the last 2 hrs of monitoring. Analysis was by chi-square and t-test. RESULTS: 1069 women were included; 104 (9.7%) had TS during the last 2 hours of labor. Women with TS were more likely nulliparous (53% vs. 37%, p⫽0.002), but otherwise were similar to those without TS. Mean oxytocin dose did not vary between women with and without TS (10.6 vs. 9.3 mU, p⫽0.28). Table 1 lists intrapartum characteristics and neonatal outcomes. CONCLUSION: TS affects 9-10% of term singletons in the last 2 hours of labor and is more common in nulliparas. Women with TS during the last 2 hours of labor are more likely to have increased FHR baseline and marked variability, although their fetuses spend a similar percentage of time in Category II. Women with TS are more likely to have an operative vaginal delivery. Initial neonatal outcomes are comparable regardless of contraction frequency.
Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology
S45
Abstracts 79 – 86 Moderators: Deborah Wing, MD; Jeff Kuller, MD 79 Perinatal safety initiative to reduce adverse obstetric events Brian Wagner1, Natalie Meirowitz1, Phyllis Cohen1, Leah Kaufman1, Jalpa Shah1, Deepak Nanda1, Lori Reggio1, Karen Britt1, Adiel Fleischer1 1
Long Island Jewish Medical Center, Obstetrics and Gynecology, New Hyde Park, New York
OBJECTIVE: To assess the benefit of a comprehensive perinatal safety initiative to reduce adverse obstetrical outcomes and improve patient safety. STUDY DESIGN: An interventional trial was developed where we incrementally introduced multiple perinatal safety initiatives from August 2007 through July 2009 at a large community medical center. The safety initiative included formalized team training with an emphasis on communication, standardizing EFM terminology with required documentation of competence, introduction of evidence-based protocols and integration of educational programs among all care providers. 11 adverse outcome measures were followed prospectively and the adverse outcome index was analyzed for a trend. RESULTS: At the beginning of the safety initiative the adverse outcome index, defined as the number of deliveries with one or more adverse outcomes as a proportion of total deliveries, was approximately 2%. Within the first year, the AOI had decreased to 0.6 percent and has been maintained throughout year two (P⬍0.05). Additionally, employee and patient perceptions of teamwork and safety improved, 28% and 11%, respectively. CONCLUSION: A comprehensive perinatal safety initiative can offer a significant improvement in preventing adverse obstetric outcomes, improving patient safety and enhancing staff and patient experiences.
STUDY DESIGN: A retrospective cohort study of all consecutive women with singleton pregnancies that underwent routine second trimester ultrasound fetal anatomic survey between 16-22 weeks at a large, tertiary care center. Data were extracted on maternal sociodemographics, medical history, and obstetric outcomes. Pregnancies with any fetal anomalies were excluded. Women with at least 1 fibroid detected at the time of fetal anatomic survey were compared to women without fibroids. The primary outcome was IUFD after 20 weeks gestation, and by presence or absence of growth restriction. Univariate and multiple logistic regression analyses were used to estimate the risk of IUFD in women with fibroids. RESULTS: Of 64,047 women, the incidence of fibroids was 3.2% (n⫽2,058). The incidence of IUFD was significantly higher in the fibroid group than in the no-fibroid group (1.6% v. 0.7%, aOR 1.8, 95%CI 1.3-2.7) even after adjusting for black race, tobacco exposure, chronic hypertension, and pregestational diabetes. The risk relationship between fibroids and IUFD was significant only within the IUGR subgroup.
CONCLUSION: Women with fibroids appear to be at increased risk of
IUFD via a growth restriction pathway, making a clinical approach of serial growth scans reasonable. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.095
81 The effect of uterine tachysystole (TS) on intrapartum fetal heart rate tracings (FHRTS) Tracy Manuck1, Erick Henry1, Marc Jackson1, Michael Varner1, Sean Esplin1 1
Intermountain Healthcare, Salt Lake City, Utah
OBJECTIVE: To determine the effect of TS on intrapartum FHRTs and
clinical outcomes. STUDY DESIGN: Intrapartum electronic FHRTs for all term singletons
Adverse Outcome Index 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.094
80 Increased risk of intrauterine fetal death in women with fibroids at routine second trimester ultrasound Molly Stout1, Anthony Odibo1, George Macones1, Alison Cahill1 1
Washington University in St. Louis, St. Louis, Missouri
OBJECTIVE: To estimate the risk of intrauterine fetal death (IUFD) in
women with fibroids detected at routine second trimester ultrasound anatomic survey.
in 5 regional hospitals in October 2008 were retrospectively evaluated. Maternal demographics, intrapartum data, and neonatal outcomes were collected. Data from the last 2 hrs of labor were analyzed. TS was defined as an average of ⬎5 contractions/10 minutes over the last 2 hrs of monitoring. Analysis was by chi-square and t-test. RESULTS: 1069 women were included; 104 (9.7%) had TS during the last 2 hours of labor. Women with TS were more likely nulliparous (53% vs. 37%, p⫽0.002), but otherwise were similar to those without TS. Mean oxytocin dose did not vary between women with and without TS (10.6 vs. 9.3 mU, p⫽0.28). Table 1 lists intrapartum characteristics and neonatal outcomes. CONCLUSION: TS affects 9-10% of term singletons in the last 2 hours of labor and is more common in nulliparas. Women with TS during the last 2 hours of labor are more likely to have increased FHR baseline and marked variability, although their fetuses spend a similar percentage of time in Category II. Women with TS are more likely to have an operative vaginal delivery. Initial neonatal outcomes are comparable regardless of contraction frequency.
Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology
S45