- Email: [email protected]
Maternal work hours and work stress: Impact on pregnancy outcomes
S48 SMFM Abstracts 119 MATERNAL WORK HOURS AND WORK STRESS: IMPACT ON PREGNANCY OUTCOMES LORI DAY1, AMY SPARKS1, SHANNA SWAN2, 1University of Iowa, Obstetrics and Gynecology, Iowa City, Iowa, 2University of Missouri-Columbia, Family & Community Medicine, Columbia, Missouri OBJECTIVE: To examine how maternal work hours (MWH) and workrelated stress (WRS) affect gestational age at delivery and birth weight. STUDY DESIGN: Between 1999-2005, pregnancy and delivery information in spontaneously conceived pregnancies was obtained. This data was collected for the Study for Future Families, a prospective cohort study conducted at four US centers (Los Angeles, Minneapolis, Iowa City and Columbia, MO). Women reported the average weekly number of work hours and rated their WRS on a 4-increment scale. The influence of MWH and WRS on gestational age and birth weight was evaluated by analysis of variance. Covariates included maternal age, race, nulliparity, tobacco use, educational level and infant gender. Twin gestations (14 infants) and infants !2500 g (15 infants) were excluded. A value of p!.05 was considered to be statistically significant. RESULTS: The 371 mothers included in the analysis were predominantly Caucasian (83%), college-educated (90%), employed (84%), !35 years old (81%), and parous (62%). Only fourteen infants were preterm (3.8%). Average gestational age at delivery was 39.3 G .1 weeks (mean G se). Gestational age at delivery decreased as MWH increased. Women working O40 hours/week delivered at 38.9 G .2 weeks compared to women working !40 hours/week who delivered at 39.5 G .1 weeks (p=0.04). Gestational age at delivery decreased as WRS increased (p=0.028). WRS was not associated with MWH. Average birth weight was 3561 g G 27.2 g. Birth weight of these O2500 g infants did not differ based on MWH. However, the average birth weight was lowest for women with the highest WRS (3409 g G 97 g) versus lowest WRS (3577 g G 66 g) (p = 0.2). CONCLUSION: Women who work longer hours tend to deliver at an earlier gestation. However, self-reported work-stress has a greater impact on gestational age and birth weight than absolute number of hours worked.
121 TRANSABDOMINAL CERCLAGE IN PREGNANCY AFTER HISTORY OF TWO OR MORE FAILED VAGINAL CERCLAGES ROBERT DEBBS1, STEPHANIE PEARSON2, GUILLERMO DE LA VEGA2, JACK LUDMIR1, 1Pennsylvania Hospital, University of Pennsylvania Health System, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Philadelphia, Pennsylvania, 2Pennsylvania Hospital, University of Pennsylvania Health System, Obstetrics and Gynecology, Philadelphia, Pennsylvania OBJECTIVE: To assess the outcome of patients who underwent transabdominal cerclage (TAC) placement during pregnancy who had previously failed 2 or more vaginally placed cerclages. STUDY DESIGN: Outcome data for all patients who underwent TAC at our institution from 1994 through 2006 was collected. All patients had failed two or more transvaginal cerclages. All patients had pre-conceptual workup to exclude thrombophilia’s, uterine cavity and chromosomal abnormalities. RESULTS: 75 women underwent TAC procedures. The mean gestational age at the time of cerclage placement was 13.4 weeks (range 12-19 weeks). The mean gestational age at delivery was 36.6 weeks (range 19-39 weeks). There were 72 viable deliveries and 3 non-viable deliveries. One pregnancy ended at 19 weeks secondary to PPROM, one terminated at 22 weeks secondary to severe preeclampsia with an intra-uterine fetal demise and one had PROM and IUFD within 24 hours of procedure secondary to cord prolapse. The fetal salvage rate following TAC was 96%. CONCLUSION: The management of the patient with history of two failed vaginal cerclages is controversial. Data regarding the value of further surgical intervention is limited. Our findings suggest that in patients with a history of two or more failed transvaginal cerclages, transabdominal cerclage is a safe and effective procedure. Further randomized prospective studies comparing different interventions are necessary to determine the true value of this intervention. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.137
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.135
120 A COMPARISON OF SINGLETON AND TWIN PREGNANCIES WHO UNDERGO EMERGENT CERCLAGE KARA DEAVER1, WILLIAM GROBMAN1, 1Northwestern University, Department of Obstetrics and Gynecology, Chicago, Illinois OBJECTIVE: To compare women with singleton and twin gestations who undergo emergency cerclage (EC) placement with regard to presentation characteristics and pregnancy outcomes. STUDY DESIGN: A cohort study was performed of all women with singleton and twin gestations who received an EC between 16 and 23 6/7 weeks gestation at a tertiary care hospital over a 25 year period. Only included were women who received cerclages due to documented cervical dilatation or effacement on digital examination. RESULTS: OF the 218 women who underwent EC, 172 (78.9%) had singletons and 46 (21.1%) had twins. There were no significant differences between groups with regard to demographic factors, cervical exam findings at EC placement or perioperative technique. In terms of pregnancy outcome, there was no difference between singletons and twins in their mean GA at delivery (30.9 G 7.1 vs. 29.5 G 5.7 weeks, P = 0.16). Similar proportions of women in the two groups delivered previably, although women with twins were more likely to deliver between 32 and 36 weeks (table). No difference in median time until delivery after EC placement was noted (72 versus 65 days, P = 0.29). However, pregnancy prolongation, as assessed by survival analysis, was significantly shorter in twin gestations due to a separation of survival curves at approximately 32 weeks (P = 0.04).
122 A SHORT INTERPREGNANCY INTERVAL INCREASES THE RISK FOR EXTREME PREMATURITY EMILY DEFRANCO1, ZACHARY KISTKA2, SARAH BOSLAUGH2, GILAD GROSS1, LOUIS J. MUGLIA2, 1Washington University in St. Louis, Obstetrics and Gynecology, St. Louis, Missouri, 2Washington University in St. Louis, Pediatrics, St. Louis, Missouri OBJECTIVE: A short interval between pregnancies is associated with preterm birth (PTB) and low birthweight (LBW) infants. This study was undertaken to test the hypothesis that a short interpregnancy interval increases the risk for extremes of prematurity and LBW. STUDY DESIGN: Retrospective cohort study of the Missouri Dpt. of Health’s database of births and fetal deaths from 1989-1997. A subgroup of women who had two consecutive singleton live births was evaluated. Bivariate and multivariate regression analyses assessed the association between the interpregnancy interval and outcome of the second pregnancy. RESULTS: Of the 156,377 women in the study, 15,204 had an interpregnancy interval of !6 months and 141,173 had an interval of O6 months. An interval of !6 months was associated with PTB and LBW, even when controlling for confounding factors. The relative risk of PTB increased at earlier gestational ages (see Table). A short interpregnancy interval also increased the risk for delivery of very low birthweight (VLBW) and extremely low birthweight (ELBW) infants. CONCLUSION: A short interval between pregnancies increases the risk of extreme PTB and delivery of an extremely LBW infant. These findings highlight the importance of counseling women to plan at least a six 6 month interval between delivery and subsequent conception. Pregnancy Outcomes !6 mo
O6 mo
OR (95% CI)
Adj OR (95% CI)
PTB!35wk 1042 (6.9%) 4790 (3.4%) 2.09 (1.95-2.24) 1.53 (1.42-1.65) 32-35wk 613 (4.0%) 3005 (2.1%) 1.92 (1.75-2.10) 1.11 (0.75-1.63) 28-32wk 287 (1.9%) 1202 (0.9%) 2.22 (1.95-2.53) 1.43 (1.14-1.80) 24-28wk 103 (0.7%) 430 (0.3%) 2.21 (1.78-2.74) 1.61 (1.40-1.84) 20-24wk 39 (0.3%) 154 (0.1%) 2.35 (1.66-3.35) 1.54 (1.40-1.69) All LBW (gm) 1320 (8.7%) 6842 (4.8%) 1.87 (1.76-1.98) 1.39 (1.30-1.48) LBW (1500-2500) 1073 (7.1%) 5735 (4.1%) 1.81 (1.69-1.94) 1.38 (1.29-1.48) VLBW (500-1000) 142 (0.9%) 610 (0.4%) 2.25 (1.87-2.71) 1.61 (1.33-1.96) ELBW (!500) 105 (0.7%) 497 (0.4%) 2.04 (1.65-2.52) 1.21 (0.96-1.52) EGA at delivery stratified by plurality CONCLUSION: Women with singletons and twins who underwent EC placement had similar characteristics; categorical analysis demonstrated that twins delivered at earlier GA’s and less time after EC placement, although only later in gestation (i.e. O 32 weeks). 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.136
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.138
121 TRANSABDOMINAL CERCLAGE IN PREGNANCY AFTER HISTORY OF TWO OR MORE FAILED VAGINAL CERCLAGES ROBERT DEBBS1, STEPHANIE PEARSON2, GUILLERMO DE LA VEGA2, JACK LUDMIR1, 1Pennsylvania Hospital, University of Pennsylvania Health System, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Philadelphia, Pennsylvania, 2Pennsylvania Hospital, University of Pennsylvania Health System, Obstetrics and Gynecology, Philadelphia, Pennsylvania OBJECTIVE: To assess the outcome of patients who underwent transabdominal cerclage (TAC) placement during pregnancy who had previously failed 2 or more vaginally placed cerclages. STUDY DESIGN: Outcome data for all patients who underwent TAC at our institution from 1994 through 2006 was collected. All patients had failed two or more transvaginal cerclages. All patients had pre-conceptual workup to exclude thrombophilia’s, uterine cavity and chromosomal abnormalities. RESULTS: 75 women underwent TAC procedures. The mean gestational age at the time of cerclage placement was 13.4 weeks (range 12-19 weeks). The mean gestational age at delivery was 36.6 weeks (range 19-39 weeks). There were 72 viable deliveries and 3 non-viable deliveries. One pregnancy ended at 19 weeks secondary to PPROM, one terminated at 22 weeks secondary to severe preeclampsia with an intra-uterine fetal demise and one had PROM and IUFD within 24 hours of procedure secondary to cord prolapse. The fetal salvage rate following TAC was 96%. CONCLUSION: The management of the patient with history of two failed vaginal cerclages is controversial. Data regarding the value of further surgical intervention is limited. Our findings suggest that in patients with a history of two or more failed transvaginal cerclages, transabdominal cerclage is a safe and effective procedure. Further randomized prospective studies comparing different interventions are necessary to determine the true value of this intervention. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.137
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.135
120 A COMPARISON OF SINGLETON AND TWIN PREGNANCIES WHO UNDERGO EMERGENT CERCLAGE KARA DEAVER1, WILLIAM GROBMAN1, 1Northwestern University, Department of Obstetrics and Gynecology, Chicago, Illinois OBJECTIVE: To compare women with singleton and twin gestations who undergo emergency cerclage (EC) placement with regard to presentation characteristics and pregnancy outcomes. STUDY DESIGN: A cohort study was performed of all women with singleton and twin gestations who received an EC between 16 and 23 6/7 weeks gestation at a tertiary care hospital over a 25 year period. Only included were women who received cerclages due to documented cervical dilatation or effacement on digital examination. RESULTS: OF the 218 women who underwent EC, 172 (78.9%) had singletons and 46 (21.1%) had twins. There were no significant differences between groups with regard to demographic factors, cervical exam findings at EC placement or perioperative technique. In terms of pregnancy outcome, there was no difference between singletons and twins in their mean GA at delivery (30.9 G 7.1 vs. 29.5 G 5.7 weeks, P = 0.16). Similar proportions of women in the two groups delivered previably, although women with twins were more likely to deliver between 32 and 36 weeks (table). No difference in median time until delivery after EC placement was noted (72 versus 65 days, P = 0.29). However, pregnancy prolongation, as assessed by survival analysis, was significantly shorter in twin gestations due to a separation of survival curves at approximately 32 weeks (P = 0.04).
122 A SHORT INTERPREGNANCY INTERVAL INCREASES THE RISK FOR EXTREME PREMATURITY EMILY DEFRANCO1, ZACHARY KISTKA2, SARAH BOSLAUGH2, GILAD GROSS1, LOUIS J. MUGLIA2, 1Washington University in St. Louis, Obstetrics and Gynecology, St. Louis, Missouri, 2Washington University in St. Louis, Pediatrics, St. Louis, Missouri OBJECTIVE: A short interval between pregnancies is associated with preterm birth (PTB) and low birthweight (LBW) infants. This study was undertaken to test the hypothesis that a short interpregnancy interval increases the risk for extremes of prematurity and LBW. STUDY DESIGN: Retrospective cohort study of the Missouri Dpt. of Health’s database of births and fetal deaths from 1989-1997. A subgroup of women who had two consecutive singleton live births was evaluated. Bivariate and multivariate regression analyses assessed the association between the interpregnancy interval and outcome of the second pregnancy. RESULTS: Of the 156,377 women in the study, 15,204 had an interpregnancy interval of !6 months and 141,173 had an interval of O6 months. An interval of !6 months was associated with PTB and LBW, even when controlling for confounding factors. The relative risk of PTB increased at earlier gestational ages (see Table). A short interpregnancy interval also increased the risk for delivery of very low birthweight (VLBW) and extremely low birthweight (ELBW) infants. CONCLUSION: A short interval between pregnancies increases the risk of extreme PTB and delivery of an extremely LBW infant. These findings highlight the importance of counseling women to plan at least a six 6 month interval between delivery and subsequent conception. Pregnancy Outcomes !6 mo
O6 mo
OR (95% CI)
Adj OR (95% CI)
PTB!35wk 1042 (6.9%) 4790 (3.4%) 2.09 (1.95-2.24) 1.53 (1.42-1.65) 32-35wk 613 (4.0%) 3005 (2.1%) 1.92 (1.75-2.10) 1.11 (0.75-1.63) 28-32wk 287 (1.9%) 1202 (0.9%) 2.22 (1.95-2.53) 1.43 (1.14-1.80) 24-28wk 103 (0.7%) 430 (0.3%) 2.21 (1.78-2.74) 1.61 (1.40-1.84) 20-24wk 39 (0.3%) 154 (0.1%) 2.35 (1.66-3.35) 1.54 (1.40-1.69) All LBW (gm) 1320 (8.7%) 6842 (4.8%) 1.87 (1.76-1.98) 1.39 (1.30-1.48) LBW (1500-2500) 1073 (7.1%) 5735 (4.1%) 1.81 (1.69-1.94) 1.38 (1.29-1.48) VLBW (500-1000) 142 (0.9%) 610 (0.4%) 2.25 (1.87-2.71) 1.61 (1.33-1.96) ELBW (!500) 105 (0.7%) 497 (0.4%) 2.04 (1.65-2.52) 1.21 (0.96-1.52) EGA at delivery stratified by plurality CONCLUSION: Women with singletons and twins who underwent EC placement had similar characteristics; categorical analysis demonstrated that twins delivered at earlier GA’s and less time after EC placement, although only later in gestation (i.e. O 32 weeks). 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.136
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.138