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ASSESSMENT OF PARTICIPATION AND PERCEIVED BENEFITS AND BARRIERS TO PHYSICAL ACTIVITY IN LOW-RISK PREGNANCIES
Abstracts-SOGC ACSC 2019
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P-OBS/GYN-041......................................................................
POST-OPERATIVE ADJUNCTIVE TREATMENT OPTIONS IN PATIENTS WITH INTRAUTERINE ADHESIONS AND RECOMMENDATIONS FOR THE FUTURE: A SYSTEMATIC REVIEW Rea Konci, Natasha Caminsky, Michael Dahan, Togas Tulandi McGill University Health Centre, 1001 boulevard Decarie, Montre al, Que bec, Canada, H4A 3J1 Objectives: Intrauterine adhesions (IUAs) may lead to clinical sequelae such as miscarriage, infertility, and menstruation irregularities. Hysteroscopy is recognized as the gold standard in diagnosis and management, though the optimal course of treatment after surgical intervention remains unclear. The aim of our systematic review is to provide an update on the treatment options available post-hysteroscopic adhesiolysis and to facilitate clinical management of patients with IUAs. Methods: To avoid duplicating previous work, we focused only on studies which compared hormone therapy and other post-operative treatments. We reviewed the use of adjunctive treatments, such as hormone therapy, aspirin, intrauterine device, balloon catheter, hyaluronic acid gel, and amnion graft and limited our review to randomized controlled trials and cohort studies. Results: Of 548 studies published between 2013 and 2018, 15 papers fit our criteria that compared post-resection treatment options in women with IUAs. Meta-analysis of the use of Foley catheter or amnion graft as an adjunctive therapy post-adhesiolysis failed to show a statistical difference (OD 1.55; 95% CI 0.60-3.99). Meta-analysis could not be done for the 13 remaining studies due to extensive heterogeneity, bias, or non-comparable end points. Conclusions: The lack of a universal classification system for IUAs and the use of variable outcomes to measure the success of adjunctive treatment pose a challenge in generating standard treatment recommendations. We call for the development of a universal classification system and studies with consistent parameters and endpoints to allow for the generation of standard treatment guidelines. Currently, it is impossible to recommend any standardized treatment after hysteroscopic adhesiolysis. Key Words: Intrauterine Adhesions, Hysteroscopy, Infertility, Miscarriage, Treatment
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O-OBS-S-082 .............................................................................
ASSESSMENT OF PARTICIPATION AND PERCEIVED BENEFITS AND BARRIERS TO PHYSICAL ACTIVITY IN LOW-RISK PREGNANCIES Noor Ladhani, Kristen McFadyen Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada, M4N 3M5 Objectives: To investigate physical activity (PA) behaviours and to assess the perceived benefits and barriers to participation among women with low-risk pregnancies. Methods: Participants were recruited from low-risk, general obstetrics practices at a tertiary care centre; 100 women between 34-40 weeks gestational age completed the study. Participants were consented to complete a questionnaire comprised of three sections: (i) demographic information (ii) PA participation, and (iii) benefits and barriers to PA in their current pregnancy. Chi-square tests were used to analyze the data.
722
MAY JOGC MAI 2019
Results: The mean gestational age was 36.29 weeks (SD 1.50), and the mean pre-pregnancy BMI was 23.69 kg/m2 (SD 4.45). Approximately 66% met the criteria for regular PA (?15 min, ?3 sessions per week), and 40% of participants met the PA guidelines (?30 min, ?4 sessions per week). Among women who reported being physically active, walking was the most common activity (90%), followed by home exercises (43%). The barriers with the largest negative impact on PA were: fatigue, time, and back pain. Conversely, the barriers with the least negative impact were: cost and unaware of the PA recommendations. The factors with the greatest positive impact on PA were: mood, part of pre-pregnancy routine, and fetal benefits; the benefits with the lowest impact were: decreased risk of gestational diabetes and decreased back pain. Conclusions: Canadian guidelines recommend PA throughout pregnancy for all women without contraindications. Antenatal discussions on PA should include targeted counselling towards individually identified barriers and provide education on the benefits to maternal, fetal, and neonatal health. Key Words: Pregnancy, Physical activity, Maternal health, Obstetrics
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P-OBS-MFM-MD-020..............................................................
THE EFFECT OF ANTENATAL CORTICOSTEROIDS ON SURVIVAL IN EXTREME PREMATURITY Noor Ladhani, Mollie Sivaram, Julie Nguyen, Jon Barrett Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada, M4N 3M5 Objectives: The decision to administer antenatal corticosteroids (ACS) to women who present with threatened preterm birth prior to 25 weeks remains controversial. Recent studies suggest an improvement in survival with administration of ACS prior to 24 weeks, with marginal improvement in morbidities. As such, our objectives were to evaluate the effect of ACS on survival in extreme prematurity, and on morbidities associated with preterm birth. Methods: A retrospective chart review was conducted on patients who delivered after threatened preterm birth between gestational ages (GA) of 23-25 weeks at a large tertiary academic centre between Jan 1st 2003 and Dec 31st 2017. Multiple gestation pregnancies, terminations, and patients who declined neonatal resuscitation were excluded. Logistic regression was used to assess the effect of ACS treatment on neonatal mortality and morbidity, while controlling for maternal age, GA, and maternal complications. Results: A total of 435 singleton births met criteria, with 422 mothers receiving at least one dose of ACS and 13 receiving no ACS. Neonatal mortality was significantly lower for infants exposed to at least one dose of ACS (OR=0.225, 95% CI=0.067-0.762). Administration of ACS did not show any significant effect on morbidity, but did show a reduction in intraventricular hemorrhage (OR=0.599, 95% CI=0.130−2.758) and necrotizing enterocolitis (OR=0.872, 95% CI=0.147−5.163), and increased odds of chronic lung disease (OR=1.272, 95% CI=0.347−4.661) and pneumothorax (OR=1.124, 95% CI=0.113−11.128). Conclusions: Treatment with ACS for infants born at 23 to 25 weeks gestation was associated with a lower rate of neonatal mortality. No significant effect on morbidity was demonstrated. Key Words: Antenatal corticosteroids, premature birth, periviable birth
&
P-OBS/GYN-041......................................................................
POST-OPERATIVE ADJUNCTIVE TREATMENT OPTIONS IN PATIENTS WITH INTRAUTERINE ADHESIONS AND RECOMMENDATIONS FOR THE FUTURE: A SYSTEMATIC REVIEW Rea Konci, Natasha Caminsky, Michael Dahan, Togas Tulandi McGill University Health Centre, 1001 boulevard Decarie, Montre al, Que bec, Canada, H4A 3J1 Objectives: Intrauterine adhesions (IUAs) may lead to clinical sequelae such as miscarriage, infertility, and menstruation irregularities. Hysteroscopy is recognized as the gold standard in diagnosis and management, though the optimal course of treatment after surgical intervention remains unclear. The aim of our systematic review is to provide an update on the treatment options available post-hysteroscopic adhesiolysis and to facilitate clinical management of patients with IUAs. Methods: To avoid duplicating previous work, we focused only on studies which compared hormone therapy and other post-operative treatments. We reviewed the use of adjunctive treatments, such as hormone therapy, aspirin, intrauterine device, balloon catheter, hyaluronic acid gel, and amnion graft and limited our review to randomized controlled trials and cohort studies. Results: Of 548 studies published between 2013 and 2018, 15 papers fit our criteria that compared post-resection treatment options in women with IUAs. Meta-analysis of the use of Foley catheter or amnion graft as an adjunctive therapy post-adhesiolysis failed to show a statistical difference (OD 1.55; 95% CI 0.60-3.99). Meta-analysis could not be done for the 13 remaining studies due to extensive heterogeneity, bias, or non-comparable end points. Conclusions: The lack of a universal classification system for IUAs and the use of variable outcomes to measure the success of adjunctive treatment pose a challenge in generating standard treatment recommendations. We call for the development of a universal classification system and studies with consistent parameters and endpoints to allow for the generation of standard treatment guidelines. Currently, it is impossible to recommend any standardized treatment after hysteroscopic adhesiolysis. Key Words: Intrauterine Adhesions, Hysteroscopy, Infertility, Miscarriage, Treatment
&
O-OBS-S-082 .............................................................................
ASSESSMENT OF PARTICIPATION AND PERCEIVED BENEFITS AND BARRIERS TO PHYSICAL ACTIVITY IN LOW-RISK PREGNANCIES Noor Ladhani, Kristen McFadyen Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada, M4N 3M5 Objectives: To investigate physical activity (PA) behaviours and to assess the perceived benefits and barriers to participation among women with low-risk pregnancies. Methods: Participants were recruited from low-risk, general obstetrics practices at a tertiary care centre; 100 women between 34-40 weeks gestational age completed the study. Participants were consented to complete a questionnaire comprised of three sections: (i) demographic information (ii) PA participation, and (iii) benefits and barriers to PA in their current pregnancy. Chi-square tests were used to analyze the data.
722
MAY JOGC MAI 2019
Results: The mean gestational age was 36.29 weeks (SD 1.50), and the mean pre-pregnancy BMI was 23.69 kg/m2 (SD 4.45). Approximately 66% met the criteria for regular PA (?15 min, ?3 sessions per week), and 40% of participants met the PA guidelines (?30 min, ?4 sessions per week). Among women who reported being physically active, walking was the most common activity (90%), followed by home exercises (43%). The barriers with the largest negative impact on PA were: fatigue, time, and back pain. Conversely, the barriers with the least negative impact were: cost and unaware of the PA recommendations. The factors with the greatest positive impact on PA were: mood, part of pre-pregnancy routine, and fetal benefits; the benefits with the lowest impact were: decreased risk of gestational diabetes and decreased back pain. Conclusions: Canadian guidelines recommend PA throughout pregnancy for all women without contraindications. Antenatal discussions on PA should include targeted counselling towards individually identified barriers and provide education on the benefits to maternal, fetal, and neonatal health. Key Words: Pregnancy, Physical activity, Maternal health, Obstetrics
&
P-OBS-MFM-MD-020..............................................................
THE EFFECT OF ANTENATAL CORTICOSTEROIDS ON SURVIVAL IN EXTREME PREMATURITY Noor Ladhani, Mollie Sivaram, Julie Nguyen, Jon Barrett Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada, M4N 3M5 Objectives: The decision to administer antenatal corticosteroids (ACS) to women who present with threatened preterm birth prior to 25 weeks remains controversial. Recent studies suggest an improvement in survival with administration of ACS prior to 24 weeks, with marginal improvement in morbidities. As such, our objectives were to evaluate the effect of ACS on survival in extreme prematurity, and on morbidities associated with preterm birth. Methods: A retrospective chart review was conducted on patients who delivered after threatened preterm birth between gestational ages (GA) of 23-25 weeks at a large tertiary academic centre between Jan 1st 2003 and Dec 31st 2017. Multiple gestation pregnancies, terminations, and patients who declined neonatal resuscitation were excluded. Logistic regression was used to assess the effect of ACS treatment on neonatal mortality and morbidity, while controlling for maternal age, GA, and maternal complications. Results: A total of 435 singleton births met criteria, with 422 mothers receiving at least one dose of ACS and 13 receiving no ACS. Neonatal mortality was significantly lower for infants exposed to at least one dose of ACS (OR=0.225, 95% CI=0.067-0.762). Administration of ACS did not show any significant effect on morbidity, but did show a reduction in intraventricular hemorrhage (OR=0.599, 95% CI=0.130−2.758) and necrotizing enterocolitis (OR=0.872, 95% CI=0.147−5.163), and increased odds of chronic lung disease (OR=1.272, 95% CI=0.347−4.661) and pneumothorax (OR=1.124, 95% CI=0.113−11.128). Conclusions: Treatment with ACS for infants born at 23 to 25 weeks gestation was associated with a lower rate of neonatal mortality. No significant effect on morbidity was demonstrated. Key Words: Antenatal corticosteroids, premature birth, periviable birth