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812: Risk factors for blood transfusion in patients undergoing high-order cesarean delivery
Poster Session IV
ajog.org (23%) underwent behavioral therapy, and 90 (19%) received pharmacologic treatment. Women with an elevated EDS were more likely to have a history of depression and drug use, and this was highest in those receiving pharmacologic treatment. There was a higher rate of preterm delivery <34 and <37 weeks, SGA, NICU admission, and APGAR <7 in the group with an elevated EDS (Table). The rates of these adverse outcomes were highest among women with an elevated EDS receiving pharmacologic therapy. CONCLUSION: 25% percent of women in this retrospective study had an elevated EDS and 42% received an intervention. The rate of depression, drug use and adverse pregnancy outcomes was high among those with elevated EDS. Contrary to our hypothesis, adverse pregnancy outcomes were highest among those requiring pharmacotherapy. It may be that women requiring pharmacotherapy have a higher a priori risk of adverse outcomes. Interventions to reduce these adverse outcomes in this subgroup of patients needs further study.
Primary Outcome Gestational age in completed weeks
Vaginal delivery
pvalue
Cesarean section
Live at Discharge
Demise
Percentage Survival
Live at Discharge
Demise
Percentage Survival
22
0
4
0%
0
1
0%
23
4
6
40%
0
1
0%
0.99
24
3
1
75%
9
3
75%
0.99
25
5
1
83.3%
22
2
91.6%
0.5
26
2
0
100%
23
1
95.8%
0.99
812 Risk factors for blood transfusion in patients undergoing high-order cesarean delivery Nathan S. Fox1,2, Jessica Spiegelman2, Mirella Mourad3, Simi Gupta1, Jennifer Lam-Rachlin1, Daniel H. Saltzman1, Andrei Rebarber1 1
Maternal Fetal Medicine Associates, PLLC, New York, NY, 2Icahn School of Medicine at Mount Sinai, New York, NY, 3Columbia University, New York, NY
811 A retrospective assessment of delivery methods for breech singleton 22 - 26 6/7 week gestation Nicole Albino, Clark T. Johnson, Ahizechukwu Eke, Linda Szymanski Johns Hopkins Hospital, Baltimore, MD
OBJECTIVE: To assess short-term neonatal and maternal outcomes of
breech singletons delivered between 22 0/7 and 26 6/7 weeks of gestation as affected by mode of delivery. STUDY DESIGN: This is a retrospective cohort study of all singleton births from the breech presentation between January of 2008 and June of 2016 limited to delivery between 22 0/7 weeks and 26 6/7 weeks of gestation. Primary outcome is neonatal death prior to discharge. Secondary outcomes include maternal blood loss, 5 minute Apgar score, and cord blood pH. We reviewed general morbidities from each case. RESULTS: A total of 88 cases met criteria for inclusion, including 26 vaginal deliveries and 62 cesarean deliveries. Neonatal death was not significantly different between the groups when stratified by gestational age. Average quantitative blood loss was significantly more for cesarean deliveries (1062 cc 95% CI 833-1260 vs 262 cc 95% CI 225340, p¼0.02) Cord blood pH was not significantly different between the groups (7.29 95% CI 7.21-7.35 vs 7.28 95% CI 7.25-7.31 p¼0.99). 5 minute APGAR score was significantly lower for vaginal deliveries overall, but not when we controlled for gestational age at delivery. CONCLUSION: In our population, neonatal outcome is not significantly improved in VLBW (very low birth weight) infants, particularly in lower gestational ages of periviability. Delivery of periviable singleton pregnancies in the breech presentation must weigh the potential maternal morbidities against unclear neonatal benefits when selecting a delivery method.
OBJECTIVE: To identify the risk factors independently associated with blood transfusion in patients undergoing high-order cesarean delivery. STUDY DESIGN: Retrospective cohort study of patients undergoing tertiary or higher-order cesarean delivery by a single Maternal-Fetal Medicine between 2005-2016. We compared risk factors between women who did and did not receive a blood transfusion during the operation or prior to discharge. Logistic regression analysis was used to identify those risk factors independently associated with blood transfusion, after controlling for placenta previa. RESULTS: 514 patients were included, 19 of whom (3.8%) received a blood transfusion. Placenta previa was the most significant risk factor for transfusion (57.9% of patients who received a transfusion vs. 1% of patients who did not, p<0.001). Patients with a placenta previa had a 68.5% likelihood of requiring blood transfusion. After controlling for placenta previa, other risk factors independently associated with blood transfusion were prophylactic anticoagulation during pregnancy (aOR 4.99, 95% CI 1.17-21.36) and having labored (aOR 6.65, 95% CI 1.58-27.93). Risk factors not associated with blood transfusion included the number of prior cesarean deliveries, gestational age, maternal age, and obesity. The incidence of transfusion in patients with no placenta previa, no anticoagulation during pregnancy and no labor was only 0.9% (95% CI 0.4%-2.4%), whereas the incidence of transfusion in patients with one of these risk factors was 15.6% (95% CI 9.7%-24.2%). CONCLUSION: In patients undergoing tertiary or higher-order cesarean delivery, only placenta previa, prophylactic anticoagulation during pregnancy, and having labored are independently associated with requiring a blood transfusion. This data should be used to guide physician ordering of prepared blood products preoperatively.
813 Prostaglandin use for cervical ripening and intrapartum fever Jonathan S. Hirshberg, Candice Woolfolk, Methodius G. Tuuli, George A. Macones, Alison G. Cahill, Molly J. Stout Washington University in St. Louis, Saint Louis, MO
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S465
ajog.org (23%) underwent behavioral therapy, and 90 (19%) received pharmacologic treatment. Women with an elevated EDS were more likely to have a history of depression and drug use, and this was highest in those receiving pharmacologic treatment. There was a higher rate of preterm delivery <34 and <37 weeks, SGA, NICU admission, and APGAR <7 in the group with an elevated EDS (Table). The rates of these adverse outcomes were highest among women with an elevated EDS receiving pharmacologic therapy. CONCLUSION: 25% percent of women in this retrospective study had an elevated EDS and 42% received an intervention. The rate of depression, drug use and adverse pregnancy outcomes was high among those with elevated EDS. Contrary to our hypothesis, adverse pregnancy outcomes were highest among those requiring pharmacotherapy. It may be that women requiring pharmacotherapy have a higher a priori risk of adverse outcomes. Interventions to reduce these adverse outcomes in this subgroup of patients needs further study.
Primary Outcome Gestational age in completed weeks
Vaginal delivery
pvalue
Cesarean section
Live at Discharge
Demise
Percentage Survival
Live at Discharge
Demise
Percentage Survival
22
0
4
0%
0
1
0%
23
4
6
40%
0
1
0%
0.99
24
3
1
75%
9
3
75%
0.99
25
5
1
83.3%
22
2
91.6%
0.5
26
2
0
100%
23
1
95.8%
0.99
812 Risk factors for blood transfusion in patients undergoing high-order cesarean delivery Nathan S. Fox1,2, Jessica Spiegelman2, Mirella Mourad3, Simi Gupta1, Jennifer Lam-Rachlin1, Daniel H. Saltzman1, Andrei Rebarber1 1
Maternal Fetal Medicine Associates, PLLC, New York, NY, 2Icahn School of Medicine at Mount Sinai, New York, NY, 3Columbia University, New York, NY
811 A retrospective assessment of delivery methods for breech singleton 22 - 26 6/7 week gestation Nicole Albino, Clark T. Johnson, Ahizechukwu Eke, Linda Szymanski Johns Hopkins Hospital, Baltimore, MD
OBJECTIVE: To assess short-term neonatal and maternal outcomes of
breech singletons delivered between 22 0/7 and 26 6/7 weeks of gestation as affected by mode of delivery. STUDY DESIGN: This is a retrospective cohort study of all singleton births from the breech presentation between January of 2008 and June of 2016 limited to delivery between 22 0/7 weeks and 26 6/7 weeks of gestation. Primary outcome is neonatal death prior to discharge. Secondary outcomes include maternal blood loss, 5 minute Apgar score, and cord blood pH. We reviewed general morbidities from each case. RESULTS: A total of 88 cases met criteria for inclusion, including 26 vaginal deliveries and 62 cesarean deliveries. Neonatal death was not significantly different between the groups when stratified by gestational age. Average quantitative blood loss was significantly more for cesarean deliveries (1062 cc 95% CI 833-1260 vs 262 cc 95% CI 225340, p¼0.02) Cord blood pH was not significantly different between the groups (7.29 95% CI 7.21-7.35 vs 7.28 95% CI 7.25-7.31 p¼0.99). 5 minute APGAR score was significantly lower for vaginal deliveries overall, but not when we controlled for gestational age at delivery. CONCLUSION: In our population, neonatal outcome is not significantly improved in VLBW (very low birth weight) infants, particularly in lower gestational ages of periviability. Delivery of periviable singleton pregnancies in the breech presentation must weigh the potential maternal morbidities against unclear neonatal benefits when selecting a delivery method.
OBJECTIVE: To identify the risk factors independently associated with blood transfusion in patients undergoing high-order cesarean delivery. STUDY DESIGN: Retrospective cohort study of patients undergoing tertiary or higher-order cesarean delivery by a single Maternal-Fetal Medicine between 2005-2016. We compared risk factors between women who did and did not receive a blood transfusion during the operation or prior to discharge. Logistic regression analysis was used to identify those risk factors independently associated with blood transfusion, after controlling for placenta previa. RESULTS: 514 patients were included, 19 of whom (3.8%) received a blood transfusion. Placenta previa was the most significant risk factor for transfusion (57.9% of patients who received a transfusion vs. 1% of patients who did not, p<0.001). Patients with a placenta previa had a 68.5% likelihood of requiring blood transfusion. After controlling for placenta previa, other risk factors independently associated with blood transfusion were prophylactic anticoagulation during pregnancy (aOR 4.99, 95% CI 1.17-21.36) and having labored (aOR 6.65, 95% CI 1.58-27.93). Risk factors not associated with blood transfusion included the number of prior cesarean deliveries, gestational age, maternal age, and obesity. The incidence of transfusion in patients with no placenta previa, no anticoagulation during pregnancy and no labor was only 0.9% (95% CI 0.4%-2.4%), whereas the incidence of transfusion in patients with one of these risk factors was 15.6% (95% CI 9.7%-24.2%). CONCLUSION: In patients undergoing tertiary or higher-order cesarean delivery, only placenta previa, prophylactic anticoagulation during pregnancy, and having labored are independently associated with requiring a blood transfusion. This data should be used to guide physician ordering of prepared blood products preoperatively.
813 Prostaglandin use for cervical ripening and intrapartum fever Jonathan S. Hirshberg, Candice Woolfolk, Methodius G. Tuuli, George A. Macones, Alison G. Cahill, Molly J. Stout Washington University in St. Louis, Saint Louis, MO
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S465