- Email: [email protected]
The long-term outcome of twin-twin transfusion syndrome (TTTS)
SMFM Abstracts S157
Volume 189, Number 6 Am J Obstet Gynecol 348
COMPARISON OF POSTPARTUM QUALITY OF LIFE BETWEEN PATIENTS WITH REPEAT CESAREAN DELIVERY AND VAGINAL BIRTH AFTER CESAREAN SUSAN GERBER1, LISA SHARP2, CHERYL O’TOOLE2, 1 Northwestern University Medical School, Obstetrics and Gynecology, Chicago, IL 2Northwestern University Medical School, Family Medicine, Chicago, IL OBJECTIVE: To determine whether an association exists between route of delivery and postpartum quality of life (QOL) in women with a prior cesarean delivery. STUDY DESIGN: Sixty women with one prior cesarean delivery and no prior vaginal deliveries were recruited from outpatient settings during the third trimester of a subsequent pregnancy. Telephone interviews were performed at the time of recruitment, and then at 4 weeks and 3 months post partum. Maternal quality of life was assessed using the Postpartum Quality of Life Scale (PPQOL), a 1-10 QOL self-report scale (SRS), the Short Form-36 (SF-36), and the Edinburgh Postnatal Depression Scale (EPDS) for all subjects. Postpartum interviewers were blinded as to the route of delivery. Linear regression analysis was used to evaluate the association between route of delivery and postpartum QOL. RESULTS: Fifty-one women were interviewed at 4 weeks post partum. Thirtyfive women underwent repeat cesarean delivery (69%) and 16 (31%) had a vaginal birth after cesarean. Thirty-six of these women were also interviewed at 3 months post partum. Twenty-three of these women had a repeat cesarean delivery (64%). Linear regression analysis was performed, controlling for maternal age, race, income, insurance status, marital status, baseline QOL, interval since the prior delivery, and neonatal disposition. Repeat cesarean delivery was associated with higher QOL scores on both the PPQOL and the SRS at 4 weeks and at 3 months post partum (P < 0.05). Repeat cesarean delivery was also associated with higher scores on the Mental Health subscale of the SF-36 at 4 weeks (P < 0.01) and 3 months (P < 0.05), and with lower scores (lower risk of depression) on the EPDS at 4 weeks (P < 0.05) and 3 months (P = 0.07). CONCLUSION: In women with one prior cesarean delivery and no prior vaginal deliveries, repeat cesarean section is associated with superior maternal QOL in the first 3 months post partum.
350
THE LONG-TERM OUTCOME OF TWIN-TWIN TRANSFUSION SYNDROME (TTTS) ROBERT CINCOTTA1, PETER GRAY2, FUNG YEE CHAN1, GREG DUNCOMBE1, GLENN GARDENER1, BARBARA SOONG1, 1Mater Mother’s Hospital, Maternal Fetal Medicine, South Brisbane, Queensland, Australia 2Mater Mother’s Hospital, Neonatology, South Brisbane, Queensland, Australia OBJECTIVE: To assess the incidence of major handicap in survivors of TTTS treated without laser and to examine if there is a relationship with stage or severity of TTTS. STUDY DESIGN: A prospective cohort study. All cases of TTTS were identified form 1993 to 2002 at a single institution. Survivors of TTTS were followed up for 2 years and more in a multidisciplinary growth and development clinic. Detailed neurological examination developmental assessment was performed. Cerebral palsy (CP) was diagnosed according to standard criteria. A Griffiths developmental assessment was performed. A general quotient (GQ) more than 2 SD below the mean represented global developmental delay (GDD). The TTTS was staged according to the classification system of Quintero. RESULTS: There were 50 cases of TTTS managed at the Mater Mother’s Hospital from January 1994 until December 2002. There were 59 surviving infants (59%), 21 stillbirths (21%), and 20 NND (20%). The mean gestation of delivery was 28.5 ± 0.7 w (range 19-36 w). 66% of cases were treated with amnioreduction. Of the 59 survivors, detailed neurological assessment was available for 69% (41/59). Of those with complete assessment, 85% (35/41) were normal. 7%(3/41) of survivors had CP and 7% (3/41) had GDD. Of the 3 cases with CP, 1 had a co-twin that had an FDIU, 1 had a co-twin with GDD, and the other had a normal co-twin. The other 2 cases of GDD had normal co-twins. The incidences of handicap found in survivors of TTTS according to the worst stage achieved during pregnancy were 0%, 0%, 19%, 14%, and 25% for stages 1, 2, 3, 4, and 5. The incidence of CP and GDD in stages 2, 3, and 4 was 14% (6/44). CONCLUSION: Survivors of TTTS have a significant risk of major neurodevelopmental impairment such as cerebral palsy and global developmental delay. There is a trend towards major handicap being found in the more severe stages of TTTS. These results may support suggestions that laser treatment be reserved for more severe forms of TTTS.
349
MEDICATION PRESCRIBER ERRORS IN OBSTETRICS AND GYNECOLOGY: A HISTORICAL PERSPECTIVE CAMILLE KANAAN1, AMY MITCHELL1, CHELSEY CAREN1, MICHEAL PLEVYAK1, SCOTT DEXTER1, JEAN-CLAUDE VEILLE1, 1Albany Medical College, Ob Gyn, Albany, NY OBJECTIVE: To describe the nature and incidence of medication prescriber errors (MPE) occurring within an inpatient obstetrics and gynecology service (Ob/Gyn) over a 5-year time period. STUDY DESIGN: All entries for the Ob/Gyn service entered into the pharmacy prescriber error database between 1998 and 2002 were reviewed. Each entry had information concerning date, time, prescriber, problem description, result of problem, drug class, problem code, service and severity index. Severity index was defined as potentially ‘‘fatal or severe,’’ ‘‘serious,’’ or ‘‘significant’’ and scored by one senior pharmacist. Service was further divided into antepartum/ gyn, labor and delivery, and postpartum. Incidence was calculated as number of errors per 1000 patient-days. Statistics were done using ranked ANOVA with a Tukey correction for multiple comparison. RESULTS: A total of 245 detected errors were found over the last 5 years. Overall incidence was 3.2 per 1000 patient-days. A significantly higher number of errors were found on antepartum/gyn wards. Time of year did not significantly impact on the incidence. Wrong dose (49% overall) and allergy (23%) were consistently the most common type of error each year. Antibiotics (44% overall) and analgesics (16% overall) accounted for 60% of drugs involved for any given year. Although most MPEs were only ‘‘significant’’ (69% overall), 7% (17/245) MPEs were deemed potentially ‘‘fatal’’ or severe. CONCLUSION: (1) Antibiotics and analgesics were responsible for the majority of MPEs on a busy Ob/Gyn service. (2) Efforts focusing on antimicrobial and pain management are justifiable and should be implemented.
351
SUDDEN INFANT DEATH SYNDROME (SIDS) IN TWIN BIRTHS: UNITED STATES, 1995-98 DARIOS GETAHUN1, KITAW DEMISSIE2, SHOU-EN LU3, GEORGE RHOADS2, 1University of Medicine and Dentistry of New Jersey, Family Medicine, New Brunswick, NJ 2University of Medicine and Dentistry of New Jersey, Epidemiology, Piscataway, NJ 3University of Medicine and Dentistry of New Jersey, Biometrics, Piscataway, NJ OBJECTIVE: To study the incidence of Sudden Infant Death Syndrome (SIDS), to estimate the concordance of SIDS in twins, and to compare the risk factors for SIDS in twin and singleton births in the U.S. (1995-1998). STUDY DESIGN: The National Center for Health Statistics linked birth and infant death files were used for this purpose. ICD-9 code 798.0 was used to identify infants with SIDS. RESULTS: The incidence of SIDS was higher in twins (1.26/1000 live births) as compared to singletons (0.7 /1000 live births), with a relative risk of 1.82, 95% CI 1.66-1.99. Placenta previa (OR in twins = 1.41 [95% CI 0.35-5.31] and OR in singletons = 1.53 [95% CI 1.15-2.03]), abruptio placentae (OR in twins = 1.55 [95% CI 0.77-3.14] and OR in singletons = 1.30 [95% CI 1.07-1.59]), and smoking (OR in twins = 2.65 [95% CI 2.09-3.36] and OR in singletons = 2.98 [95% CI 2.84-3.13]) were risk factors for SIDS in both twins and singletons. The SIDS rate in twins was significantly higher than in singletons among term births (RR = 1.52, 95% CI 1.30-1.77). The probability of a 2nd twin dying of SIDS, given that at least one twin had died of SIDS, was P = 0.0062, 4.9 times higher than the overall risk of a twin dying of SIDS. This probability is even higher for black twins (RR = 6.5). CONCLUSION: Twins are at higher risk of SIDS than are singletons. The excess was especially prominent in term infants. There is higher rate of SIDS death in 2nd twin after co-twin had already died of SIDS.
Volume 189, Number 6 Am J Obstet Gynecol 348
COMPARISON OF POSTPARTUM QUALITY OF LIFE BETWEEN PATIENTS WITH REPEAT CESAREAN DELIVERY AND VAGINAL BIRTH AFTER CESAREAN SUSAN GERBER1, LISA SHARP2, CHERYL O’TOOLE2, 1 Northwestern University Medical School, Obstetrics and Gynecology, Chicago, IL 2Northwestern University Medical School, Family Medicine, Chicago, IL OBJECTIVE: To determine whether an association exists between route of delivery and postpartum quality of life (QOL) in women with a prior cesarean delivery. STUDY DESIGN: Sixty women with one prior cesarean delivery and no prior vaginal deliveries were recruited from outpatient settings during the third trimester of a subsequent pregnancy. Telephone interviews were performed at the time of recruitment, and then at 4 weeks and 3 months post partum. Maternal quality of life was assessed using the Postpartum Quality of Life Scale (PPQOL), a 1-10 QOL self-report scale (SRS), the Short Form-36 (SF-36), and the Edinburgh Postnatal Depression Scale (EPDS) for all subjects. Postpartum interviewers were blinded as to the route of delivery. Linear regression analysis was used to evaluate the association between route of delivery and postpartum QOL. RESULTS: Fifty-one women were interviewed at 4 weeks post partum. Thirtyfive women underwent repeat cesarean delivery (69%) and 16 (31%) had a vaginal birth after cesarean. Thirty-six of these women were also interviewed at 3 months post partum. Twenty-three of these women had a repeat cesarean delivery (64%). Linear regression analysis was performed, controlling for maternal age, race, income, insurance status, marital status, baseline QOL, interval since the prior delivery, and neonatal disposition. Repeat cesarean delivery was associated with higher QOL scores on both the PPQOL and the SRS at 4 weeks and at 3 months post partum (P < 0.05). Repeat cesarean delivery was also associated with higher scores on the Mental Health subscale of the SF-36 at 4 weeks (P < 0.01) and 3 months (P < 0.05), and with lower scores (lower risk of depression) on the EPDS at 4 weeks (P < 0.05) and 3 months (P = 0.07). CONCLUSION: In women with one prior cesarean delivery and no prior vaginal deliveries, repeat cesarean section is associated with superior maternal QOL in the first 3 months post partum.
350
THE LONG-TERM OUTCOME OF TWIN-TWIN TRANSFUSION SYNDROME (TTTS) ROBERT CINCOTTA1, PETER GRAY2, FUNG YEE CHAN1, GREG DUNCOMBE1, GLENN GARDENER1, BARBARA SOONG1, 1Mater Mother’s Hospital, Maternal Fetal Medicine, South Brisbane, Queensland, Australia 2Mater Mother’s Hospital, Neonatology, South Brisbane, Queensland, Australia OBJECTIVE: To assess the incidence of major handicap in survivors of TTTS treated without laser and to examine if there is a relationship with stage or severity of TTTS. STUDY DESIGN: A prospective cohort study. All cases of TTTS were identified form 1993 to 2002 at a single institution. Survivors of TTTS were followed up for 2 years and more in a multidisciplinary growth and development clinic. Detailed neurological examination developmental assessment was performed. Cerebral palsy (CP) was diagnosed according to standard criteria. A Griffiths developmental assessment was performed. A general quotient (GQ) more than 2 SD below the mean represented global developmental delay (GDD). The TTTS was staged according to the classification system of Quintero. RESULTS: There were 50 cases of TTTS managed at the Mater Mother’s Hospital from January 1994 until December 2002. There were 59 surviving infants (59%), 21 stillbirths (21%), and 20 NND (20%). The mean gestation of delivery was 28.5 ± 0.7 w (range 19-36 w). 66% of cases were treated with amnioreduction. Of the 59 survivors, detailed neurological assessment was available for 69% (41/59). Of those with complete assessment, 85% (35/41) were normal. 7%(3/41) of survivors had CP and 7% (3/41) had GDD. Of the 3 cases with CP, 1 had a co-twin that had an FDIU, 1 had a co-twin with GDD, and the other had a normal co-twin. The other 2 cases of GDD had normal co-twins. The incidences of handicap found in survivors of TTTS according to the worst stage achieved during pregnancy were 0%, 0%, 19%, 14%, and 25% for stages 1, 2, 3, 4, and 5. The incidence of CP and GDD in stages 2, 3, and 4 was 14% (6/44). CONCLUSION: Survivors of TTTS have a significant risk of major neurodevelopmental impairment such as cerebral palsy and global developmental delay. There is a trend towards major handicap being found in the more severe stages of TTTS. These results may support suggestions that laser treatment be reserved for more severe forms of TTTS.
349
MEDICATION PRESCRIBER ERRORS IN OBSTETRICS AND GYNECOLOGY: A HISTORICAL PERSPECTIVE CAMILLE KANAAN1, AMY MITCHELL1, CHELSEY CAREN1, MICHEAL PLEVYAK1, SCOTT DEXTER1, JEAN-CLAUDE VEILLE1, 1Albany Medical College, Ob Gyn, Albany, NY OBJECTIVE: To describe the nature and incidence of medication prescriber errors (MPE) occurring within an inpatient obstetrics and gynecology service (Ob/Gyn) over a 5-year time period. STUDY DESIGN: All entries for the Ob/Gyn service entered into the pharmacy prescriber error database between 1998 and 2002 were reviewed. Each entry had information concerning date, time, prescriber, problem description, result of problem, drug class, problem code, service and severity index. Severity index was defined as potentially ‘‘fatal or severe,’’ ‘‘serious,’’ or ‘‘significant’’ and scored by one senior pharmacist. Service was further divided into antepartum/ gyn, labor and delivery, and postpartum. Incidence was calculated as number of errors per 1000 patient-days. Statistics were done using ranked ANOVA with a Tukey correction for multiple comparison. RESULTS: A total of 245 detected errors were found over the last 5 years. Overall incidence was 3.2 per 1000 patient-days. A significantly higher number of errors were found on antepartum/gyn wards. Time of year did not significantly impact on the incidence. Wrong dose (49% overall) and allergy (23%) were consistently the most common type of error each year. Antibiotics (44% overall) and analgesics (16% overall) accounted for 60% of drugs involved for any given year. Although most MPEs were only ‘‘significant’’ (69% overall), 7% (17/245) MPEs were deemed potentially ‘‘fatal’’ or severe. CONCLUSION: (1) Antibiotics and analgesics were responsible for the majority of MPEs on a busy Ob/Gyn service. (2) Efforts focusing on antimicrobial and pain management are justifiable and should be implemented.
351
SUDDEN INFANT DEATH SYNDROME (SIDS) IN TWIN BIRTHS: UNITED STATES, 1995-98 DARIOS GETAHUN1, KITAW DEMISSIE2, SHOU-EN LU3, GEORGE RHOADS2, 1University of Medicine and Dentistry of New Jersey, Family Medicine, New Brunswick, NJ 2University of Medicine and Dentistry of New Jersey, Epidemiology, Piscataway, NJ 3University of Medicine and Dentistry of New Jersey, Biometrics, Piscataway, NJ OBJECTIVE: To study the incidence of Sudden Infant Death Syndrome (SIDS), to estimate the concordance of SIDS in twins, and to compare the risk factors for SIDS in twin and singleton births in the U.S. (1995-1998). STUDY DESIGN: The National Center for Health Statistics linked birth and infant death files were used for this purpose. ICD-9 code 798.0 was used to identify infants with SIDS. RESULTS: The incidence of SIDS was higher in twins (1.26/1000 live births) as compared to singletons (0.7 /1000 live births), with a relative risk of 1.82, 95% CI 1.66-1.99. Placenta previa (OR in twins = 1.41 [95% CI 0.35-5.31] and OR in singletons = 1.53 [95% CI 1.15-2.03]), abruptio placentae (OR in twins = 1.55 [95% CI 0.77-3.14] and OR in singletons = 1.30 [95% CI 1.07-1.59]), and smoking (OR in twins = 2.65 [95% CI 2.09-3.36] and OR in singletons = 2.98 [95% CI 2.84-3.13]) were risk factors for SIDS in both twins and singletons. The SIDS rate in twins was significantly higher than in singletons among term births (RR = 1.52, 95% CI 1.30-1.77). The probability of a 2nd twin dying of SIDS, given that at least one twin had died of SIDS, was P = 0.0062, 4.9 times higher than the overall risk of a twin dying of SIDS. This probability is even higher for black twins (RR = 6.5). CONCLUSION: Twins are at higher risk of SIDS than are singletons. The excess was especially prominent in term infants. There is higher rate of SIDS death in 2nd twin after co-twin had already died of SIDS.