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Management of triplet pregnancies with prophylactic cerclage
Low Maternal Birth Weight Does Not Predict Diabetes in Pregnancy
Management of Triplet Pregnancies With Prophylactic Cerclage
Lauren A. Plante, MD
J. Milton Hutson, MD
MCP-Hahnemann University (Drexel University), Merion, PA
New York Weill Cornell Medical Center, New York, NY
Margaret Schmidt, MS, CRNP OBJECTIVE: To evaluate a previously described association between low maternal birth weight and diabetes in pregnancy, as a cohort aged. METHODS: All females born in Pennsylvania in 1974 who delivered live-born infants in 1999 –2002 were identified through review of state vital statistics. The year 1974 was chosen because that was the first year in which birth certificates required an estimate of gestational age. Exclusion criteria were prematurity, multiple gestation, race other than black or white, and incomplete information. Women born in 1974 were classified as small for gestational age (SGA) or adequate for gestational age (AGA) according to the Brenner curve, with SGA defined as less than tenth percentile. Their pregnancies in 1999 –2000 were coded for diabetes on the birth certificates generated at those deliveries. RESULTS: Of 10,412 females born in Pennsylvania in 1974 and matched with births of offspring from January 1, 1999 through December 21, 2000, a total of 7826 mother-infant pairs met criteria for inclusion. There was no difference in the rate of diabetes between SGA and AGA mothers (Table 1).
Terri G. Edersheim, MD, and Alan A. Kessler, MD OBJECTIVE: To determine the effect of prophylactic cerclage placement on the outcome of triplet pregnancy. STUDY DESIGN: 110 consecutive triplet pregnancies were managed between 1988 and 2002. Prophylactic McDonald cerclage was placed in all pregnancies at 13–16 weeks using Prolene suture. An additional management protocol included decreased patient activity, oral hydration, home uterine activity monitoring, and frequent office assessment. All pregnancies were conceived using assisted reproductive technology, and all dates were well established. All patients were delivered by cesarean at 36 weeks if not indicated earlier. RESULTS: One pregnancy was lost at 17 weeks and there were three stillborn fetuses, one remote from term. The mean gestational age at delivery was 34.3 weeks, with 50.3% being delivered at 35 to 36 weeks. The mean weight was 2017 g, but only 13% weighed less than 1500 g (Table 1).
Table 1. Table 1. No Risk of diabetes Diabetes diabetes AGA SGA
7077 521
213 15
3.01% 2.88%
RR (95% CI)
P
1.00 0.96 (0.57, 1.60) 0.89
CONCLUSIONS: A growing body of literature links small size at birth with health consequences in adulthood, including hypertension, coronary artery disease, and diabetes. A previous analysis of a cohort of Pennsylvania women born in 1974 who delivered live-born infants in 1995–1996 showed an RR of diabetes of 3.6 for the SGA group (4.19% versus 1.17%). The relationship was expected to persist or increase with increasing maternal age, but no confirmation was found in this study. Further investigation is planned as the maternal cohort ages.
68S
TUESDAY POSTERS
Weight (g)
#
Cumulative %
Gestational age (wk)
#
Cumulative %
⬍1000 ⬍1250 ⬍1500 ⬍2000 ⬍2500 ⬎2500
8 16 43 142 286 40
2 4 13 43 87 100
⬍28 ⬍30 ⬍32 ⬍34 ⬍35 36 36
2 5 23 37 52 81 28
1.8 4.6 11.0 33.9 47.7 74.3 100
CONCLUSIONS: This is one of the largest reported series of triplet pregnancies with prophylactic cerclage with resultant low prematurity rates and more than 50% delivering at 35 weeks or longer. These results may be compared to other protocols based on cervical length assessment.
OBSTETRICS & GYNECOLOGY
Management of Triplet Pregnancies With Prophylactic Cerclage
Lauren A. Plante, MD
J. Milton Hutson, MD
MCP-Hahnemann University (Drexel University), Merion, PA
New York Weill Cornell Medical Center, New York, NY
Margaret Schmidt, MS, CRNP OBJECTIVE: To evaluate a previously described association between low maternal birth weight and diabetes in pregnancy, as a cohort aged. METHODS: All females born in Pennsylvania in 1974 who delivered live-born infants in 1999 –2002 were identified through review of state vital statistics. The year 1974 was chosen because that was the first year in which birth certificates required an estimate of gestational age. Exclusion criteria were prematurity, multiple gestation, race other than black or white, and incomplete information. Women born in 1974 were classified as small for gestational age (SGA) or adequate for gestational age (AGA) according to the Brenner curve, with SGA defined as less than tenth percentile. Their pregnancies in 1999 –2000 were coded for diabetes on the birth certificates generated at those deliveries. RESULTS: Of 10,412 females born in Pennsylvania in 1974 and matched with births of offspring from January 1, 1999 through December 21, 2000, a total of 7826 mother-infant pairs met criteria for inclusion. There was no difference in the rate of diabetes between SGA and AGA mothers (Table 1).
Terri G. Edersheim, MD, and Alan A. Kessler, MD OBJECTIVE: To determine the effect of prophylactic cerclage placement on the outcome of triplet pregnancy. STUDY DESIGN: 110 consecutive triplet pregnancies were managed between 1988 and 2002. Prophylactic McDonald cerclage was placed in all pregnancies at 13–16 weeks using Prolene suture. An additional management protocol included decreased patient activity, oral hydration, home uterine activity monitoring, and frequent office assessment. All pregnancies were conceived using assisted reproductive technology, and all dates were well established. All patients were delivered by cesarean at 36 weeks if not indicated earlier. RESULTS: One pregnancy was lost at 17 weeks and there were three stillborn fetuses, one remote from term. The mean gestational age at delivery was 34.3 weeks, with 50.3% being delivered at 35 to 36 weeks. The mean weight was 2017 g, but only 13% weighed less than 1500 g (Table 1).
Table 1. Table 1. No Risk of diabetes Diabetes diabetes AGA SGA
7077 521
213 15
3.01% 2.88%
RR (95% CI)
P
1.00 0.96 (0.57, 1.60) 0.89
CONCLUSIONS: A growing body of literature links small size at birth with health consequences in adulthood, including hypertension, coronary artery disease, and diabetes. A previous analysis of a cohort of Pennsylvania women born in 1974 who delivered live-born infants in 1995–1996 showed an RR of diabetes of 3.6 for the SGA group (4.19% versus 1.17%). The relationship was expected to persist or increase with increasing maternal age, but no confirmation was found in this study. Further investigation is planned as the maternal cohort ages.
68S
TUESDAY POSTERS
Weight (g)
#
Cumulative %
Gestational age (wk)
#
Cumulative %
⬍1000 ⬍1250 ⬍1500 ⬍2000 ⬍2500 ⬎2500
8 16 43 142 286 40
2 4 13 43 87 100
⬍28 ⬍30 ⬍32 ⬍34 ⬍35 36 36
2 5 23 37 52 81 28
1.8 4.6 11.0 33.9 47.7 74.3 100
CONCLUSIONS: This is one of the largest reported series of triplet pregnancies with prophylactic cerclage with resultant low prematurity rates and more than 50% delivering at 35 weeks or longer. These results may be compared to other protocols based on cervical length assessment.
OBSTETRICS & GYNECOLOGY