- Email: [email protected]
836: Physician perceptions of risk of radiographic imaging during pregnancy
Poster Session V
Fetus Diabetes, etc
increase: PTP: 3.1⫾2.6; DP 11.3⫾5.0 mg, p⫽0.001;). The dose at delivery was higher in PTP (PTP: 20.8⫾6.6; DP 16.8⫾5.1, p⫽0.03), but the proportion of neonates requiring treatment for abstinence symptoms was similar (PTP: 4/14 (28.6%); DP 4/29 (13.8%); p⫽0.40). The % of patients with a positive drug screen (opioids) was similar (PTP (%): 4/16 (25); DP: 6/29 (21); p⫽0.72). CONCLUSION: A majority of women required adjustment of buprenorphine during pregnancy, with the greatest increase and most frequent changes coincident with plasma volume expansion in the midtrimester. Dose Change by Trimester
Dose change(% pts): 0-12⫹6
PTP (nⴝ16)
DP (nⴝ29)
p
3/7 (43)
12/16 (75)
0.04
..........................................................................................................................................................................................
13-26⫹6 wks 9/14 (64) 23/26 (88) 0.10 .......................................................................................................................................................................................... 27-42⫹6 wks 8/16 (50) 24/29 (83) 0.04 .......................................................................................................................................................................................... Dose change (mg): 0-12⫹6 0.9⫾1.1 3.0⫾2.7 0.06 .......................................................................................................................................................................................... 13-26⫹6 wks 1.9⫾2.1 6.8⫾4.2 0.0002 .......................................................................................................................................................................................... 27-42⫹6 wks 1.1⫾1.2 3.6⫾3.0 0.003 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.850
834 Contribution of obesity to maternal hospitalization for non-obstetric complications Thaddeus Waters1, Judette Louis1, Jennifer Bailit1 1
MetroHealth Medical Center-Case Western Reserve University, Department of Obstetrics & Gynecology, Cleveland, Ohio
OBJECTIVE: To determine the association between obesity and mater-
nal hospitalizations for non-obstetric complications STUDY DESIGN: All maternal admissions in California and Florida hospitals from 2005 were identified from discharge data. Subjects were considered obese if any ICD-9 code for obesity was recorded. Primary discharge diagnoses were placed into mutually exclusive categories. The percent of each diagnosis associated with maternal obesity was determined. Adjusted OR were calculated controlling for maternal age and race. RESULTS: Of 821,811 maternal admissions, 10,567 (1.3%) were complicated by obesity (4.4% of Postpartum, 1.2% of Intrapartum, 1.4% of Antepartum admissions (p⬍0.0001). Adjusted odds ratios for all admissions showed a significant association between maternal complications and obesity (table). Only hyperemesis and pyelonephritis showed decreased odds with obesity. Postpartum adjusted odds ratios for appendicitis (OR:5.9 [1.228.2]), cardiac (OR:2.8 [1.8-4.4]) and pulmonary complications (OR:2.6 [1.3-5.3]) remained positively associated with maternal obesity. CONCLUSION: Obesity is significantly associated with non-obstetric morbidities. Correcting for race and maternal age, women who are hospitalized for cardiac and pulmonary complications are disproportionately obese. We speculate that obesity is differentially reported by diagnosis.
www.AJOG.org 835 Pouch function and gastrointestinal complications during pregnancy after ileal pouch-anal anastomis Neil Seligman1, Wingkan Sbar1, Vincenzo Berghella1 1
Thomas Jefferson University, Philadelphia, Pennsylvania
OBJECTIVE: To estimate the risk of gastrointestinal complications dur-
ing pregnancy and the effect of mode of delivery on pouch function in women treated with Ileal Pouch-Anal Anastomis (IPAA) for chronic ulcerative colitis and familial adenomatous polyposis. STUDY DESIGN: Pregnancies following IPAA were identified in our center, and in the literature through MEDLINE and PUBMED searches. The incidence of each gastrointestinal complications was calculated. Pouch function was compared during and after pregnancy, by mode of delivery, and between women who became pregnant versus those that did not. RESULTS: 386 pregnancies after IPAA were included in the analysis. The overall incidence of complications was 10.6%. Complications were minor and resolved without need for gastrointestinal resection. Complications included antepartum (2.1%) or the postpartum (4.7%) small bowel obstruction, pouchitis (1.3%), and perianal abscess (0.3%). Stool frequency and incontinence transiently worsened during pregnancy. There was no significant difference in pouch function by mode of delivery or between women who became pregnant versus those that did not. CONCLUSION: Pregnancy after IPAA is overall safe, associated with transient worsening of bowel function, and limited gastrointestinal complications. Vaginal delivery appears as safe as cesarean, but further research is needed to estimate the optimal mode of delivery. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.852
836 Physician perceptions of risk of radiographic imaging during pregnancy Jill Guelich1, Whitney You1, Linda Fonseca1 1
Northwestern University, Chicago, Illinois
OBJECTIVE: To determine how physicians in 3 different specialties per-
Pyelonephritis 0.4 0.3-0.6 ..........................................................................................................................................................................................
ceive the fetal risk of radiographic imaging during pregnancy, how these perceptions differ by specialty, and how these perceptions affect management. STUDY DESIGN: Practicing obstetricians, radiologists, and general surgeons were sent a request by email to complete a 30-question webbased survey. Perceived fetal risk of several common radiographic imaging procedures was assessed using multiple choice and Likert scale questions. Chi-square and Fisher exact tests were used to analyze categorical variables. Student t tests were used to analyze continuous variables. RESULTS: Six hundred thirty-nine physicians participated in the survey. General surgeons were more likely to attribute a CT scan with an increased risk of congenital anomaly as compared to radiologists and obstetricians (85.7%, 69.0%, and 36.1%, P ⬍.001). Perceived fetal risk associated with KUB and IVP demonstrated a similar trend (P ⬍ .001). For childhood leukemia, radiologists were significantly more likely to associate a higher level of risk than the other specialties. Obstetricians associated all imaging modalities with the lowest risk of congenital anomaly or childhood leukemia. All specialties agreed that CT has the highest sensitivity of any imaging modality in diagnosing appendicitis during pregnancy. However, obstetrics was the only specialty where the majority of respondents felt it would be acceptable to use CT as an initial imaging modality (P ⬍.001). CONCLUSION: Perception of risk associated with radiographic imaging studies during pregnancy varies significantly among specialties and this disparity may affect the care provided to pregnant women in the acute setting.
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.851
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.853
Diagnosis
OR
CI
Cardiac
6.7
4.7-9.4
..........................................................................................................................................................................................
Pulmonary 5.7 3.6-9.1 .......................................................................................................................................................................................... Diabetes 3.4 2.7-4.3 .......................................................................................................................................................................................... Hypertension 2.7 2.2-3.4 .......................................................................................................................................................................................... Gallbladder/ Pancreas 4.8 2.7-8.6 .......................................................................................................................................................................................... Appendicitis 5.2 2.4-11.2 .......................................................................................................................................................................................... Psychiatric 3.1 2.3-4.1 .......................................................................................................................................................................................... Hyperemesis 0.3 0.2-0.6 ..........................................................................................................................................................................................
S298
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
Fetus Diabetes, etc
increase: PTP: 3.1⫾2.6; DP 11.3⫾5.0 mg, p⫽0.001;). The dose at delivery was higher in PTP (PTP: 20.8⫾6.6; DP 16.8⫾5.1, p⫽0.03), but the proportion of neonates requiring treatment for abstinence symptoms was similar (PTP: 4/14 (28.6%); DP 4/29 (13.8%); p⫽0.40). The % of patients with a positive drug screen (opioids) was similar (PTP (%): 4/16 (25); DP: 6/29 (21); p⫽0.72). CONCLUSION: A majority of women required adjustment of buprenorphine during pregnancy, with the greatest increase and most frequent changes coincident with plasma volume expansion in the midtrimester. Dose Change by Trimester
Dose change(% pts): 0-12⫹6
PTP (nⴝ16)
DP (nⴝ29)
p
3/7 (43)
12/16 (75)
0.04
..........................................................................................................................................................................................
13-26⫹6 wks 9/14 (64) 23/26 (88) 0.10 .......................................................................................................................................................................................... 27-42⫹6 wks 8/16 (50) 24/29 (83) 0.04 .......................................................................................................................................................................................... Dose change (mg): 0-12⫹6 0.9⫾1.1 3.0⫾2.7 0.06 .......................................................................................................................................................................................... 13-26⫹6 wks 1.9⫾2.1 6.8⫾4.2 0.0002 .......................................................................................................................................................................................... 27-42⫹6 wks 1.1⫾1.2 3.6⫾3.0 0.003 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.850
834 Contribution of obesity to maternal hospitalization for non-obstetric complications Thaddeus Waters1, Judette Louis1, Jennifer Bailit1 1
MetroHealth Medical Center-Case Western Reserve University, Department of Obstetrics & Gynecology, Cleveland, Ohio
OBJECTIVE: To determine the association between obesity and mater-
nal hospitalizations for non-obstetric complications STUDY DESIGN: All maternal admissions in California and Florida hospitals from 2005 were identified from discharge data. Subjects were considered obese if any ICD-9 code for obesity was recorded. Primary discharge diagnoses were placed into mutually exclusive categories. The percent of each diagnosis associated with maternal obesity was determined. Adjusted OR were calculated controlling for maternal age and race. RESULTS: Of 821,811 maternal admissions, 10,567 (1.3%) were complicated by obesity (4.4% of Postpartum, 1.2% of Intrapartum, 1.4% of Antepartum admissions (p⬍0.0001). Adjusted odds ratios for all admissions showed a significant association between maternal complications and obesity (table). Only hyperemesis and pyelonephritis showed decreased odds with obesity. Postpartum adjusted odds ratios for appendicitis (OR:5.9 [1.228.2]), cardiac (OR:2.8 [1.8-4.4]) and pulmonary complications (OR:2.6 [1.3-5.3]) remained positively associated with maternal obesity. CONCLUSION: Obesity is significantly associated with non-obstetric morbidities. Correcting for race and maternal age, women who are hospitalized for cardiac and pulmonary complications are disproportionately obese. We speculate that obesity is differentially reported by diagnosis.
www.AJOG.org 835 Pouch function and gastrointestinal complications during pregnancy after ileal pouch-anal anastomis Neil Seligman1, Wingkan Sbar1, Vincenzo Berghella1 1
Thomas Jefferson University, Philadelphia, Pennsylvania
OBJECTIVE: To estimate the risk of gastrointestinal complications dur-
ing pregnancy and the effect of mode of delivery on pouch function in women treated with Ileal Pouch-Anal Anastomis (IPAA) for chronic ulcerative colitis and familial adenomatous polyposis. STUDY DESIGN: Pregnancies following IPAA were identified in our center, and in the literature through MEDLINE and PUBMED searches. The incidence of each gastrointestinal complications was calculated. Pouch function was compared during and after pregnancy, by mode of delivery, and between women who became pregnant versus those that did not. RESULTS: 386 pregnancies after IPAA were included in the analysis. The overall incidence of complications was 10.6%. Complications were minor and resolved without need for gastrointestinal resection. Complications included antepartum (2.1%) or the postpartum (4.7%) small bowel obstruction, pouchitis (1.3%), and perianal abscess (0.3%). Stool frequency and incontinence transiently worsened during pregnancy. There was no significant difference in pouch function by mode of delivery or between women who became pregnant versus those that did not. CONCLUSION: Pregnancy after IPAA is overall safe, associated with transient worsening of bowel function, and limited gastrointestinal complications. Vaginal delivery appears as safe as cesarean, but further research is needed to estimate the optimal mode of delivery. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.852
836 Physician perceptions of risk of radiographic imaging during pregnancy Jill Guelich1, Whitney You1, Linda Fonseca1 1
Northwestern University, Chicago, Illinois
OBJECTIVE: To determine how physicians in 3 different specialties per-
Pyelonephritis 0.4 0.3-0.6 ..........................................................................................................................................................................................
ceive the fetal risk of radiographic imaging during pregnancy, how these perceptions differ by specialty, and how these perceptions affect management. STUDY DESIGN: Practicing obstetricians, radiologists, and general surgeons were sent a request by email to complete a 30-question webbased survey. Perceived fetal risk of several common radiographic imaging procedures was assessed using multiple choice and Likert scale questions. Chi-square and Fisher exact tests were used to analyze categorical variables. Student t tests were used to analyze continuous variables. RESULTS: Six hundred thirty-nine physicians participated in the survey. General surgeons were more likely to attribute a CT scan with an increased risk of congenital anomaly as compared to radiologists and obstetricians (85.7%, 69.0%, and 36.1%, P ⬍.001). Perceived fetal risk associated with KUB and IVP demonstrated a similar trend (P ⬍ .001). For childhood leukemia, radiologists were significantly more likely to associate a higher level of risk than the other specialties. Obstetricians associated all imaging modalities with the lowest risk of congenital anomaly or childhood leukemia. All specialties agreed that CT has the highest sensitivity of any imaging modality in diagnosing appendicitis during pregnancy. However, obstetrics was the only specialty where the majority of respondents felt it would be acceptable to use CT as an initial imaging modality (P ⬍.001). CONCLUSION: Perception of risk associated with radiographic imaging studies during pregnancy varies significantly among specialties and this disparity may affect the care provided to pregnant women in the acute setting.
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.851
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.853
Diagnosis
OR
CI
Cardiac
6.7
4.7-9.4
..........................................................................................................................................................................................
Pulmonary 5.7 3.6-9.1 .......................................................................................................................................................................................... Diabetes 3.4 2.7-4.3 .......................................................................................................................................................................................... Hypertension 2.7 2.2-3.4 .......................................................................................................................................................................................... Gallbladder/ Pancreas 4.8 2.7-8.6 .......................................................................................................................................................................................... Appendicitis 5.2 2.4-11.2 .......................................................................................................................................................................................... Psychiatric 3.1 2.3-4.1 .......................................................................................................................................................................................... Hyperemesis 0.3 0.2-0.6 ..........................................................................................................................................................................................
S298
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009