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The MFMU cesarean registry: Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery
SMFM Abstracts S223 749 CLINICAL CHARACTERISTICS OF WOMEN PRESCRIBED 17 ALPHAHYDROXYPROGESTERONE CAPROATE IN THE COMMUNITY SETTING CHARLES RITTENBERG1, SCOTT SULLIVAN1, NIKI ISTWAN2, DEBBIE RHEA2, GARY STANZIANO2, ROGER NEWMAN1, 1Medical University of South Carolina, Obstetrics and Gynecology, Charleston, South Carolina, 2Matria Healthcare, Clinical Research, Marietta, Georgia OBJECTIVE: ACOG has recommended that 17 alpha-hydroxyprogesterone caproate (17P) weekly injections be used only for women with a history of spontaneous preterm delivery (PTD) pending further studies. However, a recent survey disclosed that 38% of prescribing MFMs recommend 17P for other indications. The purpose of this study is to describe clinical characteristics and pregnancy outcomes of women actually prescribed 17P for the prevention of PTD in a community setting. STUDY DESIGN: A retrospective review of data collected from patients enrolled for outpatient administration of weekly 17P injections and nursing assessment between April 2004 and January 2006 was conducted. Of 2159 women prescribed 17P, pregnancy outcome data were available for 1979 (91.7%). Pregnancy history, reason for referral, labor/delivery onset (spontaneous or indicated) and gestational duration were identified. RESULTS: Data were analyzed for 1979 women who received 17P. 59 patients (3.0%) discontinued 17P for reasons other than delivery after a single injection. The majority of women (1258/1979, 63.6%) were singleton gestations with a history of PTD without cerclage. For these women, initiation of 17P occurred at !21 weeks for 56.5% (711/1258) while 43.5% (547/1258) were R21 weeks. The remaining 721/1979 (36.4%) women initiated 17P for other indications: multiple gestation, cerclage, current PTL, history of spontaneous abortion or PTL. Overall, 37.3% of patients experienced recurrent spontaneous PTD; 22.1% delivered !35 weeks; 9.0% !32 weeks. 26.9% of women discontinued 17P prior to 34 weeks or delivery. CONCLUSION: In current clinical practice, over one-third of patients receiving 17P do not meet accepted indications confirming a recent MFM practice questionnaire. Additionally, early initiation and adherence to completion of therapy are greater problems than reported in clinical trials. Clinical trials evaluating these expanded indications are urgently needed.
congenital anomalies in our cohort of ART children is similar to the general population. Outcomes Outcome Placenta praevia HELLP APH PET/PIH PTD singletons PTD twins LBW singletons LBW twins Major congenital anomalies
ART group (n=1105) General Population p 1.8% 2.1% 3.2% 5.9% 9.2% 46.2% 7.4% 37.2% 2.26%
0.5% !0.6% 3% 5-7% 4.3% 43.3% 3.8% 46.5% 2.19%
!0.05 !0.05 ns ns !0.01 0.425 !0.01 !0.01 ns
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.812
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.811 751 THE MFMU CESAREAN REGISTRY: RISK OF UTERINE RUPTURE AND ADVERSE PERINATAL OUTCOME AT TERM AFTER CESAREAN DELIVERY CATHERINE Y. SPONG1, 1 for the NICHD MFMU Network, Bethesda, Maryland OBJECTIVE: Current information on the risk of uterine rupture after cesarean delivery(CD) has compared the risk after trial of labor(TOL) to that occurring with an elective CD without labor. However, antepartum counseling cannot account for whether a woman will develop an indication requiring a repeat CD, some will labor before CD can be performed and some desiring a TOL will develop a medical indication requiring CD. Our goal was to provide clinically useful information regarding the risks of uterine rupture and adverse perinatal outcome for women with a prior CD at term. STUDY DESIGN: Women with a singleton gestation at term and prior CD were studied from 1999-2002 at 19 centers. Five groups were studied:TOL, elective repeat with no labor, elective repeat with labor (women presenting in early labor who subsequently underwent CD), indicated repeat with labor and indicated repeat without labor.Cases of uterine rupture were reviewed centrally. RESULTS: 39,117 women were studied. The uterine rupture risk for indicated repeat CD (laborCno labor) was 7/6080(0.12%);the risk for elective repeat CD (laborCno labor) was 4/17,714(0.02%); an indication increased the risk of uterine rupture by a factor of 5 [OR 5.1, 95%CI 1.49-17.44]. The presence of labor also increased the risk of uterine rupture [4/2721(0.15%) vs 0/14,993, P!0.01]. The overall risk for adverse perinatal outcome (stillbirth,HIE,neonatal death) was 106/39,049(0.27%).
750 OUTCOMES OF PREGNANCIES FOLLOWING ASSISTED REPRODUCTION CATHY ALLEN1, ROBERT F. HARRISON1, WILLIAM REARDON2, 1Human Assisted Reproduction Ireland, Dublin, Ireland, 2National Centre for Medical Genetics, Dublin, Ireland OBJECTIVE: To determine whether pregnancies conceived following assisted reproduction technology (ART) are associated with obstetric complications or neonatal morbidity. STUDY DESIGN: A survey was undertaken of 1065 patients who had delivered 1771 children following ART between 1989 and 2002. Data regarding conception, pregnancy, and neonatal outcomes were compared to historic data from the general population. Statistical analyses used were Chi-square tests. RESULTS: The survey response rate was 68% giving data on 841 pregnancies and 1105 children. Placenta praevia and HELLP syndrome rates were higher in the ART group; antepartum haemorrhage and hypertensive disorder rates were similar to the general population (Table). ART singletons had a higher rate of PTD and LBW; ART twins had a similar rate of PTD but a lower rate of LBW. The rate of major congenital anomalies in the ART group was similar to the general population. CONCLUSION: ART pregnancies are at increased risk of placenta praevia and HELLP syndrome. ART singletons are at increased risk of PTD and LBW. ART twins have a lower risk of LBW and a similar risk of PTD compared to twins in the general Irish population. The incidence of major
CONCLUSION: At term, the risk of uterine rupture and adverse perinatal outcome for women with a singleton and prior CD is low, occurring in 3 per 1,000 women. The risk of uterine rupture occurs mainly in the setting of TOL. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.813
congenital anomalies in our cohort of ART children is similar to the general population. Outcomes Outcome Placenta praevia HELLP APH PET/PIH PTD singletons PTD twins LBW singletons LBW twins Major congenital anomalies
ART group (n=1105) General Population p 1.8% 2.1% 3.2% 5.9% 9.2% 46.2% 7.4% 37.2% 2.26%
0.5% !0.6% 3% 5-7% 4.3% 43.3% 3.8% 46.5% 2.19%
!0.05 !0.05 ns ns !0.01 0.425 !0.01 !0.01 ns
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.812
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.811 751 THE MFMU CESAREAN REGISTRY: RISK OF UTERINE RUPTURE AND ADVERSE PERINATAL OUTCOME AT TERM AFTER CESAREAN DELIVERY CATHERINE Y. SPONG1, 1 for the NICHD MFMU Network, Bethesda, Maryland OBJECTIVE: Current information on the risk of uterine rupture after cesarean delivery(CD) has compared the risk after trial of labor(TOL) to that occurring with an elective CD without labor. However, antepartum counseling cannot account for whether a woman will develop an indication requiring a repeat CD, some will labor before CD can be performed and some desiring a TOL will develop a medical indication requiring CD. Our goal was to provide clinically useful information regarding the risks of uterine rupture and adverse perinatal outcome for women with a prior CD at term. STUDY DESIGN: Women with a singleton gestation at term and prior CD were studied from 1999-2002 at 19 centers. Five groups were studied:TOL, elective repeat with no labor, elective repeat with labor (women presenting in early labor who subsequently underwent CD), indicated repeat with labor and indicated repeat without labor.Cases of uterine rupture were reviewed centrally. RESULTS: 39,117 women were studied. The uterine rupture risk for indicated repeat CD (laborCno labor) was 7/6080(0.12%);the risk for elective repeat CD (laborCno labor) was 4/17,714(0.02%); an indication increased the risk of uterine rupture by a factor of 5 [OR 5.1, 95%CI 1.49-17.44]. The presence of labor also increased the risk of uterine rupture [4/2721(0.15%) vs 0/14,993, P!0.01]. The overall risk for adverse perinatal outcome (stillbirth,HIE,neonatal death) was 106/39,049(0.27%).
750 OUTCOMES OF PREGNANCIES FOLLOWING ASSISTED REPRODUCTION CATHY ALLEN1, ROBERT F. HARRISON1, WILLIAM REARDON2, 1Human Assisted Reproduction Ireland, Dublin, Ireland, 2National Centre for Medical Genetics, Dublin, Ireland OBJECTIVE: To determine whether pregnancies conceived following assisted reproduction technology (ART) are associated with obstetric complications or neonatal morbidity. STUDY DESIGN: A survey was undertaken of 1065 patients who had delivered 1771 children following ART between 1989 and 2002. Data regarding conception, pregnancy, and neonatal outcomes were compared to historic data from the general population. Statistical analyses used were Chi-square tests. RESULTS: The survey response rate was 68% giving data on 841 pregnancies and 1105 children. Placenta praevia and HELLP syndrome rates were higher in the ART group; antepartum haemorrhage and hypertensive disorder rates were similar to the general population (Table). ART singletons had a higher rate of PTD and LBW; ART twins had a similar rate of PTD but a lower rate of LBW. The rate of major congenital anomalies in the ART group was similar to the general population. CONCLUSION: ART pregnancies are at increased risk of placenta praevia and HELLP syndrome. ART singletons are at increased risk of PTD and LBW. ART twins have a lower risk of LBW and a similar risk of PTD compared to twins in the general Irish population. The incidence of major
CONCLUSION: At term, the risk of uterine rupture and adverse perinatal outcome for women with a singleton and prior CD is low, occurring in 3 per 1,000 women. The risk of uterine rupture occurs mainly in the setting of TOL. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.813