Should severely obese women complete childbearing prior to undergoing bariatric surgery?

SMFM Abstracts S93 277 SHOULD SEVERELY OBESE WOMEN COMPLETE CHILDBEARING PRIOR TO UNDERGOING BARIATRIC SURGERY? ELLEN LANDSBERGER1, YVONNE ANKRAH1, CJ SEGAL-ISAACSON2, EDITH GUREWITSCH3, LISA LEVINE1, FRANCINE EINSTEIN1, CYNTHIA CHAZOTTE1, 1Albert Einstein College of Medicine, Obstetrics & Gynecology and Women’s Health, Bronx, New York, 2Albert Einstein College of Medicine, Department of Epidemiology & Population Health, Bronx, New York, 3 Johns Hopkins University, Gynecology and Obstetrics, Baltimore, Maryland OBJECTIVE: Gastric bypass surgery (GBP) has become increasingly popular to treat severe obesity. 80% of patients having GBP are women. This study compares pregnancy outcomes of severely obese women who have undergone GBP with similar patients matched to their preoperative and postoperative body mass index (BMI). STUDY DESIGN: A retrospective comparison study utilizing 3 groups of 19 patients each: Group 1=patients who had GBP, Group 2=1 patients matched to preoperative BMI, Group 3=patients matched to postoperative BMI. Patients delivered from 2004-2006. Data were analyzed utilizing Chi-Square and analysis of variance. RESULTS: Even with significant weight loss, most GBP patients remained obese. Mean BMI=37.1 (SDG7.7), mean BMI of Group 2=47.6 (G7.3), mean BMI group 3=36.4 (G7.1) There were no significant differences in the pregnancy outcomes among the three groups. There was a trend toward preeclampsia in the GBP group (p=.051); but no difference in chronic hypertension. Although the pre-op BMI group 2 had the heaviest babies (3454G764gms), the mean birthweights were similar (GBP=3002G609gms, Grp 3=3093G590gms); the incidence of IUGR and macrosomia was not different. Although there was not a significant difference in gestational diabetes (GDM) alone, the incidence of GDM and pregestational diabetes was lower in the GBP group (3/19,15.8%) than in group 2 (8/19,42.1%) or group 3 (4/ 19,21.1%). There was 1 second trimester loss in the GBP and group 2. There were no differences in mode of delivery, preterm delivery, anemia, or perinatal complications among the groups. CONCLUSION: Many women who have had GBP remain obese despite significant weight loss. Although significant differences in pregnancy outcomes were not observed, the higher rate of preeclampsia in the GBP group deserves further study. Our data suggest that GBP may safely be performed in women prior to completion of childbearing.

There was a small increase in uterine rupture at community hospitals compared to university hospitals, but the overall risk remained low (see Table). CONCLUSION: Hospital setting does not influence VBAC outcomes. VBAC Outcomes Hospital Type

No OR OR Residency Residency (95% CI) University Community (95% CI)

VBAC Attempt

10206, 56.1%

3492, 51.3%

Failed VBAC

2481, 24.3%

884, 25.3%

Uter. Rupture

96, 0.9%

32, 0.9%

Blood 70, Transfusion 0.7%

27, 0.8%

Comp. Adv. 226, Outcome 2.2%

74, 2.1%

0.88 (0.820.95) 1.03 (0.921.15) 0.93 (0.601.45) 1.19 (0.761.86) 0.89 (0.661.21)

6234, 61%

7464, 50.5%

1503, 24.1%

1862, 24.9%

40, 0.6%

88, 1.2%

46, 0.7%

51, 0.7%

136, 2.2%

164, 2.2%

0.68 (0.640.72) 0.98 (0.901.07) 1.6 (1.082.36) 0.93 (0.621.39) 0.98 (0.761.26)

0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.304

0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.303

278 DO VBAC OUTCOMES DIFFER BASED ON HOSPITAL SETTING? EMILY DEFRANCO1, ROXANE RAMPERSAD1, KRISTIN ATKINS1, ANTHONY ODIBO1, DAVID STAMILIO1, GEORGE MACONES1, 1Washington University in St. Louis, Obstetrics and Gynecology, St. Louis, Missouri OBJECTIVE: There is concern that complications from vaginal birth after cesarean (VBAC) differ based on the type of hospital where the VBAC attempt occurs. This study compares VBAC outcomes in hospitals with and without OB/GYN residency programs and in university vs community hospitals. STUDY DESIGN: Retrospective cohort study of women who were offered VBAC in 17 hospitals from 1996-2000. VBAC attempts occurring at hospitals with an OB-GYN residency (n=13) were compared to those at hospitals without (n=4). Similarly, outcomes at university (n=6) and community (n=11) hospitals were compared. Bivariate and multivariate logistic regression analyses were performed to assess the association between hospital type and VBAC outcomes. RESULTS: There were 25,065 women with R1 prior cesarean in this study (13,698 VBAC attempts, 11,367 elective repeat cesareans). There were 10,206 VBAC attempts at hospitals with OB-GYN residencies, 3492 at hospitals without, 6234 at university hospitals and 7464 at community hospitals. VBACs are attempted more commonly in university hospitals and hospitals with residency programs. There were no differences in the occurrence of failed VBAC, blood transfusion, or composite adverse outcome by hospital setting.

279 THE PATIENT WITH ASYMPTOMATIC SHORTENED CERVIX AT 23–28 WEEKS: IS DELIVERY IMMINENT? FADI MIRZA1, MICHAEL HOUSE1, SABRINA CRAIGO1, ADAM URATO1, 1Tufts-New England Medical Center, Maternal Fetal Medicine, Boston, Massachusetts OBJECTIVE: To compare the incidence of preterm delivery within 2 weeks in patients with premature cervical shortening (cervical length less than 1.5 cm) on routine ultrasound and symptoms of preterm labor versus asymptomatic patients with the incidental finding of a shortened cervix less than 1.5 cm. STUDY DESIGN: A retrospective cohort study was performed. The cohort included patients from 23 to 28 weeks’ gestation with shortened cervix (cervical length less than 1.5 cm) on routine ultrasound. Two groups were defined: patients with no evidence of preterm labor were compared to patients with symptoms of preterm labor (abdominal tightness, contractions, and vaginal spotting). The incidence of delivery within 2 weeks was determined for both groups. The groups were compared with the Fisher exact test. RESULTS: A total of 36 patients with cervical length (CL) !1.5 cm were identified from an ultrasound database. 23 patients had CL !1.5 cm and no symptoms. Of these, none delivered within 2 weeks. 13 patients had a CL !1.5 cm and symptoms of preterm labor. Of these, 4 (30.8%) delivered within 2 weeks, a statistically significant increase (p=.01). CONCLUSION: Premature cervical shortening (CL!1.5 cm) at 23 to 28 weeks, in the absence of symptoms of preterm labor, is not often associated with preterm delivery within 2 weeks. Following those patients clinically may prevent prolonged hospitalization and allow steroid administration close to the date of delivery. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.305