125: Adverse outcomes of teenage pregnancies

Abstract

Jessica McPherson, Methodius Tuuli, Kimberly Roehl, Qiuhong Zhao, Anthony Odibo, Alison Cahill Washington University in St. Louis, Obstetrics and Gynecology, St. Louis, MO OBJECTIVE: Data on pregnancy outcomes of teenage women who deliver are limited. Given pelvic immaturity, there is concern for adverse events. The objective of this study was to compare pregnancy outcomes of women 18 years of age to those 18 years of age. STUDY DESIGN: This was a retrospective cohort study of all consecutive women who underwent labor between 2004 and 2008. Pregnancy outcomes including vaginal laceration, postpartum hemorrhage (PPH), shoulder dystocia, umbilical cord gas pH 7.2 or 7.05, and neonatal intensive care unit (NICU) admission in women 18 years of age were compared to women 18. A second analysis comparing only term deliveries was performed. Exclusion criteria included multiple gestations and congenital anomalies. Univariable and multivariable analyses were performed; logistic regression analyses were used to adjust for confounders. RESULTS: Of 8,390 women, 663 were 18 years of age. After adjusting for nulliparity, African American race, gestational hypertension, prior cesarean, and birthweight 4000 grams teen women were at an increased risk of vaginal laceration (aOR 1.59, CI 1.33-1.89), but there was no difference in postpartum hemorrhage, shoulder dystocia, umbilical cord gas pH 7.2 or pH 7.05, or NICU admission. There were 5,386 women who delivered at term, 500 were teenage women. After adjusting for nulliparity, African American race, gestational hypertension, gestational diabetes, prior cesarean, or birthweight 4000 grams there was no difference in laceration, postpartum hemorrhage, shoulder dystocia, umbilical cord gas pH 7.20 or pH 7.05. CONCLUSION: Our results suggest, while the teenage pelvis may not be mature, risks of postpartum hemorrhage, shoulder dystocia, abnormal umbilical cord gases, or NICU admission are similar when comparing women 18 years of age and those 18 years of age. There is, however, an increased risk of vaginal laceration in teenage women. 126 The impact of cervical length on the cost-effectiveness of vaginal progesterone as a preterm birth intervention Jessica Page, Jenna Emerson, Alison Cahill, Allison Allen, Jessica Fowler, Leonardo Pereira, Aaron Caughey Oregon Health & Science University, Obstetrics & Gynecology, Portland, OR, Washington University in St. Louis, Obstetrics & Gynecology, St. Louis, MO OBJECTIVE: To determine the cost-effectiveness of vaginal progesterone treatment for the prevention of preterm birth (PTB) over a wide range of short cervical length (CL) measurements. STUDY DESIGN: Decision-analytic models were built using TreeAge software comparing vaginal progesterone to no intervention at four different CL ranges (10-14mm, 15-19mm, 20-24mm, 25-29mm) measured once at 20-24 wks. Baseline preterm birth probabilities were adjusted to reflect the relative risk associated with each CL range as well as the relative risk reduction with vaginal progesterone treatment as estimated from the literature. The primary outcome was preterm birth at 37wks, with secondary outcomes of preterm birth 28wks and 35wks as well as neonatal death and cerebral palsy. The costeffectiveness threshold was set at $100,000/QALY (quality-adjusted life years). RESULTS: Vaginal progesterone was found to be an effective and inexpensive intervention for preterm birth. The greatest reduction in PTB was observed in the 10-14mm CL group with a cost difference of $9,136 ($17,136 vs. $26,272). Vaginal progesterone remained dominant in all cervical length ranges with lower costs and fewer PTBs (15-19mm $13,846 vs. $20,660, 20-24mm $10,063 vs. $14,209, 2529mm $7,702 vs. $10,183). Correspondingly, with the reduction in PTB, rates of cerebral palsy and neonatal death were decreased in the treatment arm. CONCLUSION: Vaginal progesterone is an effective and relatively noninvasive treatment strategy for women with CL measurements of 10-30mm. Outcomes of teenage pregnancies: all deliveries