- Email: [email protected]
W-OBS-JM-091 I Can Push
ABSTRACTS
- O-OBS-MFM-MD-117 .............................................................. CAESAREAN SECTION VERSUS INDUCTION OF LABOUR FOR TWIN PREGNANCY: A SECONDARY ANALYSIS OF THE TWIN BIRTH STUDY E. Mei-Dan Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada N. Melamed, E. Asztalos, A. Willan, J. Barrett Objectives: To compare neonatal and maternal outcomes in women with twins who undergo induction of labour (IOL) versus caesarean section (CS) before the onset of spontaneous labour. Study Methods: In the primary analysis of the Twin Birth Study, it was found that women, between 32+0 to 38+6 weeks of gestation and the first twin in the cephalic presentation, who were randomized to planned vaginal delivery or planned CS had similar neonatal and maternal outcomes. In this secondary analysis we assessed pregnancy outcomes in those women who required IOL or CS before the onset of spontaneous labour. Results: A total of 1345 women required delivery before the onset of spontaneous labour, 409 had an IOL and 938 had a CS. The rate of CS in the IOL group was 41.3%. There were no significant differences between the two groups in respect to neonatal outcomes. A composite of maternal death or serious morbidity was found to be significantly lower with CS in comparison with IOL (7.25% vs. 11.25%, respectively; P¼0.01; OR 0.61; 95% CI, 0.410.91). Women in the CS group had significantly lower rate of haemorrhage and a need for dilatation and curettage after delivery than women in the IOL group. These results were similar in a subanalysis of women who required delivery solely for the indication of post-date. Conclusion: In twin pregnancies between 32+0 to 38+6 weeks of gestation, when an indication for delivery exists before the onset of spontaneous labour, delivery by CS may be superior to IOL in respect to maternal outcome.
- P-OBS-MFM-MD-116 ............................................................... CESAREAN VERSUS VAGINAL DELIVERY FOR WOMEN IN SPONTANEOUS LABOR OF TWIN PREGNANCY: A SECONDARY ANALYSIS OF THE TWIN BIRTH STUDY E. Mei-Dan Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada N. Melamed, E. Asztalos, A. Willan, J. Barrett Objectives: In the primary analysis of the Twin Birth Study (TBS), it was found that women with twins who were randomized to planned vaginal delivery or planned cesarean section had similar neonatal and maternal outcomes. Our objective was to compare neonatal and maternal outcomes in women with twins who presented in active labor and underwent urgent cesarean section or vaginal delivery. Study Methods: In the TBS, women between 32+0 to 38+6 weeks of gestation, with the first twin in cephalic presentation, were randomly assigned to either planned vaginal delivery or planned cesarean section. This secondary analysis is comparing pregnancy outcomes in the subgroup of women who presented in spontaneous labor based on the randomization group. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Results: A total of 823 (59%) women from the planned vaginal delivery group and 612 (44%) women from the planned cesarean section group presented in spontaneous labor. The rate of cesarean section
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was 31.4% in the planned vaginal delivery group vs. 82.4% in the planned cesarean section group (p < 0.0001). There was no difference in the rate of composite primary outcome between the two groups (1.8% vs. 2.7%, respectively; P¼0.16; OR 1.49; 95% CI, 0.87-2.55). Similarly, the rate of the individual neonatal and maternal outcomes were similar between the two groups. Conclusion: In women with twins between 32+0 to 38+6 weeks of gestation, who present in active labor, both vaginal and urgent cesarean section result in similar neonatal and maternal outcomes.
- O-OBS/GYN-S-066 .................................................................. THE ROLE OF ETHNICITY IN THE TREATMENT OF UTERINE FIBROIDS WITH ULIPRISTAL ACETATE A. Murji Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada R. Crosier, T. Chow, J. Shapiro, W. Wolfman Objectives: Ulipristal Acetate (UPA) is a selective progesterone receptor modulator for the treatment of uterine fibroids. Participants from the pivotal randomized trials consisted primarily of white Eastern European women. Our objective was to evaluate if there is a difference between Black and White women with respect to fibroid symptomatology at baseline and treatment effect following 3 months of UPA. Study Methods: This was a single-center prospective cohort study of women initiated on UPA for symptoms from uterine fibroids. Patients completed a survey at baseline and 3 months consisting of demographics, Aberdeen Bleeding Scale, Uterine Fibroid Symptom and Health Related Quality of Life Questionnaire (UFS-QoL). Ultrasound measurements were recorded. Patients were asked identify their ‘ethnic/cultural’ origin based on Statistics Canada predefined options. Results: At baseline, Black women were younger (39 vs 45, p<0.05) and had greater median uterine volumes, compared to white counterparts (598 vs 321 cm3, p<0.05). There were no baseline differences in median bleeding scores (40 vs 45), symptom severity scores (47 vs 55) or fibroid volume (138 cm3 vs 82 cm3). After three months, both groups experienced a reduction of symptom severity, with no significant difference between groups. More White women were amenorrheic at the end of treatment (40% vs 83%, p<0.05). There was no significant change in fibroid volume between groups. Conclusion: Although Black women are younger and have larger uteri at baseline, both ethnicities experience similar symptom severity. Black and White women have comparable improvements in quality of life and fibroid shrinkage following UPA treatment.
- W-OBS-JM-091 ........................................................................... I CAN PUSH O. Murnaghan The University of Ottawa and the Ottawa Hospital Research Institute, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada J. Dy Objectives: Elective repeat Cesarean sections (ERCS) account for approximately 30% of all Cesarean sections being performed. Recent research supports VBAC as a safe and reasonable option for the majority of women with a prior C/S. Mothers who have a successful VBAC have a quicker recovery, shorter hospital stay, and achieve earlier bonding with their newborns. Both short and long term maternal and neonatal morbidity associated with CS are also reduced in women who have a VBAC. The Ottawa Hospital has
ABSTRACTS
one of the highest CS rates and lowest VBAC rates among academic hospitals in Ontario. The goal of this database review will be to analyze data from the Better Outcomes Registry & Network (BORN) Information System to identify the number of women who were eligible for a VBAC, the proportion who attempted a VBAC, the number who had a successful VBAC, overall CS rate, maternal morbidity and neonatal morbidity composite scores. Study Methods: A retrospective database review of the BORN database will be completed to collect information on women attempting VBAC from April 2012-March 2014 at the Ottawa Hospital. We have identified 1500 patient who meet our study eligibility criteria. The data will be analyzed to assess The Ottawa Hospital’s trial of labour rate and successful VBAC rate. Maternal outcomes including uterine rupture, hysterectomy, transfusion rates and death will be reported. Additionally neonatal outcomes including apgars <7 at 5 min, pH <7.1, base excess >-12, admission to NICU/Special care Nursery, hypoxic ischemic encephalopathy and death will be analyzed. Results: Pending Conclusion: Pending
- P-OBS-PhD-036 ......................................................................... MENTAL HEALTH AND POSTPARTUM DEPRESSION INDICATORS AMONG PREGNANT ABORIGINAL WOMEN IN CANADA: RESULTS FROM THE MATERNITY EXPERIENCES SURVEY (MES) C. Nelson Public Health Agency of Canada, 785 Carling Ave, Ottawa, ON, K1A 0K9, Canada Objectives: To examine the prevalence of mental health indicators including pre-and postpartum depression among Aboriginal women in Canada Study Methods: The MES, which was developed by the Public Health Agency of Canada, is a national survey of 6,421 Canadian women’s experiences and practices prior to conception, up to the early months of parenthood. The MES was a stratified random sample of birth mothers >15 years of age who had a singleton live birth during a three-month period preceding the 2006 Census and who lived with their infant at the time of data collection. The analysis were conducted among women who self-identified as Aboriginal (Inuit, Metis or First Nation living off-reserve). Results: Metis and First Nations women reported a higher prevalence of pre-existing depression than non-Aboriginal women (28.8%, 22.1% versus 17.8%), while Inuit women reported the lowest prevalence with 9.4%. Overall, Inuit, Metis and First Nations women had a higher prevalence of postpartum depression than nonAboriginal women, with 10.6%, 9.1%, 12.9% reporting symptoms of depression as indicated by the EDPS compared to 5.6%. A disproportionally higher number of Aboriginal women reported experiencing abuse, as compared to non-Aboriginal women. Women reported that most days in the past year were somewhat stressful (44%) and very stressful (15%), and over half reported having social support available to them (56%). Conclusion: The data suggest that Aboriginal women experience a high prevalence of abuse/violence, and stressful events during the pregnancy period. Further, these indicators may be contributing to the prevalence of postpartum depression. This information can be used to further increase awareness of mental health indicators among Aboriginal women.
- O-GYN-MD-110 ........................................................................ CONTRACEPTION METHOD AT ABORTION IS DIRECTLY RELATED TO RATE OF RECURRENT PREGNANCY: RESULTS FROM RCTs LINKED TO PROVINCIAL HEALTH ADMINISTRATIVE DATA W.V. Norman University of British Columbia, Dpt Family Practice, 320-5950 University Boulevard, Vancouver, British Columbi, V6T 1Z3, Canada S. Samiedaluie, R. Brant, J. Kaczorowski, S. Bryan Objectives: Recurrent unintended pregnancy is common in Canada: 40% of women seeking abortion have had a prior abortion. Free contraception during abortion services could mitigate these high rates. Clinical follow up of abortion patients is typically rare. In Canada, provincial health administrative data offers a mechanism to understand iterative reproductive experiences Study Methods: We enrolled 1031 women in two post-abortion contraception RCTs recruiting at all surgical abortion clinics in BC, May 2010- September 2012. Participants wished to avoid a subsequent pregnancy for at least one year, consented to use administrative data on outcomes for 5 years. We analyzed health system costs and outcomes within two years following an index abortion by cohorts of contraceptive method chosen at abortion, when available free. Using Markov modelling we projected system level outcomes and costs for health policy options. Results: Two year follow-up is complete for > 95% of participants. Within 2yrs of index abortion, among each hundred women using the method, those who did not use LARC or hormonal contraceptive methods had 47.5 pregnancy outcomes, those using short acting hormonal methods: 33.5, copper IUD 13.6, and LNG-IUS-20mg: 5.3. Modelling indicated BC could save 20% in health system costs and incur 51% fewer subsequent unintended pregnancies within two years following each index abortion, if all women seeking abortion were offered free LARC or hormonal contraceptive methods. Conclusion: Provision of cost-free highly effective contraception at the time of abortion is a cost-saving measure from the health system perspective, and is associated with significant improvement in pregnancy prevention.
- O-OBS-PhD-001 ........................................................................ PRENATAL HEALTHCARE PROVIDER PERCEPTIONS OF EFFECTIVE CARE FOR FIRST NATIONS WOMEN: FINDINGS FROM THE ENRICH STUDY R. Oster University of Alberta, 8308 114 Street, Edmonton, Alberta, T6G 2V2, Canada G. Bruno, M. Montour, M. Roasting, R. Lightning, P. Rain, B. Graham, M. Mayan, E. Toth, R. Bell Objectives: Pregnant Indigenous women suffer a disproportionate burden of risk and adverse outcomes relative to non-Indigenous women. Although there has been a call for improved prenatal care, examples are scarce. Therefore, we sought to learn from prenatal healthcare providers (HCPs) in addressing the following research question: How can effective care for pregnant First Nations women be practically achieved? Study Methods: We conducted an ethnographic community-based study in collaboration with a large Cree community. We carried out semi-structured interviews with 12 prenatal HCPs serving members
MAY JOGC MAI 2016
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495
- O-OBS-MFM-MD-117 .............................................................. CAESAREAN SECTION VERSUS INDUCTION OF LABOUR FOR TWIN PREGNANCY: A SECONDARY ANALYSIS OF THE TWIN BIRTH STUDY E. Mei-Dan Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada N. Melamed, E. Asztalos, A. Willan, J. Barrett Objectives: To compare neonatal and maternal outcomes in women with twins who undergo induction of labour (IOL) versus caesarean section (CS) before the onset of spontaneous labour. Study Methods: In the primary analysis of the Twin Birth Study, it was found that women, between 32+0 to 38+6 weeks of gestation and the first twin in the cephalic presentation, who were randomized to planned vaginal delivery or planned CS had similar neonatal and maternal outcomes. In this secondary analysis we assessed pregnancy outcomes in those women who required IOL or CS before the onset of spontaneous labour. Results: A total of 1345 women required delivery before the onset of spontaneous labour, 409 had an IOL and 938 had a CS. The rate of CS in the IOL group was 41.3%. There were no significant differences between the two groups in respect to neonatal outcomes. A composite of maternal death or serious morbidity was found to be significantly lower with CS in comparison with IOL (7.25% vs. 11.25%, respectively; P¼0.01; OR 0.61; 95% CI, 0.410.91). Women in the CS group had significantly lower rate of haemorrhage and a need for dilatation and curettage after delivery than women in the IOL group. These results were similar in a subanalysis of women who required delivery solely for the indication of post-date. Conclusion: In twin pregnancies between 32+0 to 38+6 weeks of gestation, when an indication for delivery exists before the onset of spontaneous labour, delivery by CS may be superior to IOL in respect to maternal outcome.
- P-OBS-MFM-MD-116 ............................................................... CESAREAN VERSUS VAGINAL DELIVERY FOR WOMEN IN SPONTANEOUS LABOR OF TWIN PREGNANCY: A SECONDARY ANALYSIS OF THE TWIN BIRTH STUDY E. Mei-Dan Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada N. Melamed, E. Asztalos, A. Willan, J. Barrett Objectives: In the primary analysis of the Twin Birth Study (TBS), it was found that women with twins who were randomized to planned vaginal delivery or planned cesarean section had similar neonatal and maternal outcomes. Our objective was to compare neonatal and maternal outcomes in women with twins who presented in active labor and underwent urgent cesarean section or vaginal delivery. Study Methods: In the TBS, women between 32+0 to 38+6 weeks of gestation, with the first twin in cephalic presentation, were randomly assigned to either planned vaginal delivery or planned cesarean section. This secondary analysis is comparing pregnancy outcomes in the subgroup of women who presented in spontaneous labor based on the randomization group. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Results: A total of 823 (59%) women from the planned vaginal delivery group and 612 (44%) women from the planned cesarean section group presented in spontaneous labor. The rate of cesarean section
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was 31.4% in the planned vaginal delivery group vs. 82.4% in the planned cesarean section group (p < 0.0001). There was no difference in the rate of composite primary outcome between the two groups (1.8% vs. 2.7%, respectively; P¼0.16; OR 1.49; 95% CI, 0.87-2.55). Similarly, the rate of the individual neonatal and maternal outcomes were similar between the two groups. Conclusion: In women with twins between 32+0 to 38+6 weeks of gestation, who present in active labor, both vaginal and urgent cesarean section result in similar neonatal and maternal outcomes.
- O-OBS/GYN-S-066 .................................................................. THE ROLE OF ETHNICITY IN THE TREATMENT OF UTERINE FIBROIDS WITH ULIPRISTAL ACETATE A. Murji Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada R. Crosier, T. Chow, J. Shapiro, W. Wolfman Objectives: Ulipristal Acetate (UPA) is a selective progesterone receptor modulator for the treatment of uterine fibroids. Participants from the pivotal randomized trials consisted primarily of white Eastern European women. Our objective was to evaluate if there is a difference between Black and White women with respect to fibroid symptomatology at baseline and treatment effect following 3 months of UPA. Study Methods: This was a single-center prospective cohort study of women initiated on UPA for symptoms from uterine fibroids. Patients completed a survey at baseline and 3 months consisting of demographics, Aberdeen Bleeding Scale, Uterine Fibroid Symptom and Health Related Quality of Life Questionnaire (UFS-QoL). Ultrasound measurements were recorded. Patients were asked identify their ‘ethnic/cultural’ origin based on Statistics Canada predefined options. Results: At baseline, Black women were younger (39 vs 45, p<0.05) and had greater median uterine volumes, compared to white counterparts (598 vs 321 cm3, p<0.05). There were no baseline differences in median bleeding scores (40 vs 45), symptom severity scores (47 vs 55) or fibroid volume (138 cm3 vs 82 cm3). After three months, both groups experienced a reduction of symptom severity, with no significant difference between groups. More White women were amenorrheic at the end of treatment (40% vs 83%, p<0.05). There was no significant change in fibroid volume between groups. Conclusion: Although Black women are younger and have larger uteri at baseline, both ethnicities experience similar symptom severity. Black and White women have comparable improvements in quality of life and fibroid shrinkage following UPA treatment.
- W-OBS-JM-091 ........................................................................... I CAN PUSH O. Murnaghan The University of Ottawa and the Ottawa Hospital Research Institute, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada J. Dy Objectives: Elective repeat Cesarean sections (ERCS) account for approximately 30% of all Cesarean sections being performed. Recent research supports VBAC as a safe and reasonable option for the majority of women with a prior C/S. Mothers who have a successful VBAC have a quicker recovery, shorter hospital stay, and achieve earlier bonding with their newborns. Both short and long term maternal and neonatal morbidity associated with CS are also reduced in women who have a VBAC. The Ottawa Hospital has
ABSTRACTS
one of the highest CS rates and lowest VBAC rates among academic hospitals in Ontario. The goal of this database review will be to analyze data from the Better Outcomes Registry & Network (BORN) Information System to identify the number of women who were eligible for a VBAC, the proportion who attempted a VBAC, the number who had a successful VBAC, overall CS rate, maternal morbidity and neonatal morbidity composite scores. Study Methods: A retrospective database review of the BORN database will be completed to collect information on women attempting VBAC from April 2012-March 2014 at the Ottawa Hospital. We have identified 1500 patient who meet our study eligibility criteria. The data will be analyzed to assess The Ottawa Hospital’s trial of labour rate and successful VBAC rate. Maternal outcomes including uterine rupture, hysterectomy, transfusion rates and death will be reported. Additionally neonatal outcomes including apgars <7 at 5 min, pH <7.1, base excess >-12, admission to NICU/Special care Nursery, hypoxic ischemic encephalopathy and death will be analyzed. Results: Pending Conclusion: Pending
- P-OBS-PhD-036 ......................................................................... MENTAL HEALTH AND POSTPARTUM DEPRESSION INDICATORS AMONG PREGNANT ABORIGINAL WOMEN IN CANADA: RESULTS FROM THE MATERNITY EXPERIENCES SURVEY (MES) C. Nelson Public Health Agency of Canada, 785 Carling Ave, Ottawa, ON, K1A 0K9, Canada Objectives: To examine the prevalence of mental health indicators including pre-and postpartum depression among Aboriginal women in Canada Study Methods: The MES, which was developed by the Public Health Agency of Canada, is a national survey of 6,421 Canadian women’s experiences and practices prior to conception, up to the early months of parenthood. The MES was a stratified random sample of birth mothers >15 years of age who had a singleton live birth during a three-month period preceding the 2006 Census and who lived with their infant at the time of data collection. The analysis were conducted among women who self-identified as Aboriginal (Inuit, Metis or First Nation living off-reserve). Results: Metis and First Nations women reported a higher prevalence of pre-existing depression than non-Aboriginal women (28.8%, 22.1% versus 17.8%), while Inuit women reported the lowest prevalence with 9.4%. Overall, Inuit, Metis and First Nations women had a higher prevalence of postpartum depression than nonAboriginal women, with 10.6%, 9.1%, 12.9% reporting symptoms of depression as indicated by the EDPS compared to 5.6%. A disproportionally higher number of Aboriginal women reported experiencing abuse, as compared to non-Aboriginal women. Women reported that most days in the past year were somewhat stressful (44%) and very stressful (15%), and over half reported having social support available to them (56%). Conclusion: The data suggest that Aboriginal women experience a high prevalence of abuse/violence, and stressful events during the pregnancy period. Further, these indicators may be contributing to the prevalence of postpartum depression. This information can be used to further increase awareness of mental health indicators among Aboriginal women.
- O-GYN-MD-110 ........................................................................ CONTRACEPTION METHOD AT ABORTION IS DIRECTLY RELATED TO RATE OF RECURRENT PREGNANCY: RESULTS FROM RCTs LINKED TO PROVINCIAL HEALTH ADMINISTRATIVE DATA W.V. Norman University of British Columbia, Dpt Family Practice, 320-5950 University Boulevard, Vancouver, British Columbi, V6T 1Z3, Canada S. Samiedaluie, R. Brant, J. Kaczorowski, S. Bryan Objectives: Recurrent unintended pregnancy is common in Canada: 40% of women seeking abortion have had a prior abortion. Free contraception during abortion services could mitigate these high rates. Clinical follow up of abortion patients is typically rare. In Canada, provincial health administrative data offers a mechanism to understand iterative reproductive experiences Study Methods: We enrolled 1031 women in two post-abortion contraception RCTs recruiting at all surgical abortion clinics in BC, May 2010- September 2012. Participants wished to avoid a subsequent pregnancy for at least one year, consented to use administrative data on outcomes for 5 years. We analyzed health system costs and outcomes within two years following an index abortion by cohorts of contraceptive method chosen at abortion, when available free. Using Markov modelling we projected system level outcomes and costs for health policy options. Results: Two year follow-up is complete for > 95% of participants. Within 2yrs of index abortion, among each hundred women using the method, those who did not use LARC or hormonal contraceptive methods had 47.5 pregnancy outcomes, those using short acting hormonal methods: 33.5, copper IUD 13.6, and LNG-IUS-20mg: 5.3. Modelling indicated BC could save 20% in health system costs and incur 51% fewer subsequent unintended pregnancies within two years following each index abortion, if all women seeking abortion were offered free LARC or hormonal contraceptive methods. Conclusion: Provision of cost-free highly effective contraception at the time of abortion is a cost-saving measure from the health system perspective, and is associated with significant improvement in pregnancy prevention.
- O-OBS-PhD-001 ........................................................................ PRENATAL HEALTHCARE PROVIDER PERCEPTIONS OF EFFECTIVE CARE FOR FIRST NATIONS WOMEN: FINDINGS FROM THE ENRICH STUDY R. Oster University of Alberta, 8308 114 Street, Edmonton, Alberta, T6G 2V2, Canada G. Bruno, M. Montour, M. Roasting, R. Lightning, P. Rain, B. Graham, M. Mayan, E. Toth, R. Bell Objectives: Pregnant Indigenous women suffer a disproportionate burden of risk and adverse outcomes relative to non-Indigenous women. Although there has been a call for improved prenatal care, examples are scarce. Therefore, we sought to learn from prenatal healthcare providers (HCPs) in addressing the following research question: How can effective care for pregnant First Nations women be practically achieved? Study Methods: We conducted an ethnographic community-based study in collaboration with a large Cree community. We carried out semi-structured interviews with 12 prenatal HCPs serving members
MAY JOGC MAI 2016
l
495