156: Antenatal vaginal bleeding and perinatal outcomes among women with suspected placenta accreta

Abstract

156 Antenatal vaginal bleeding and perinatal outcomes among women with suspected placenta accreta Marilee Simons, Tracy Manuck, Alexandra Eller, Bob Silver University of Utah Health Sciences Center and Intermountain Healthcare, Obstetrics and Gynecology, Salt Lake City, UT OBJECTIVE: Placenta accreta (PA) is associated with high rates of major maternal and neonatal morbidity and mortality. Delivery timing among women with suspected PA attempts to balance the risks of prematurity and maternal morbidity. We hypothesized that among pregnancies with suspected PA, those with antenatal vaginal bleeding (VB) would have increased morbidity. STUDY DESIGN: Retrospective cohort of women with a clinically suspected PA who delivered 1/2000-4/2011 in our tertiary hospital system. Women were identified by ICD-9 codes and delivery logs. Women with 1 episode of VB were compared to those without VB. Major maternal morbidity was defined as at least one of the following: coagulopathy, transfusion of 4 units pRBCs, reoperation, thromboembolism, ureter or bowel injury, ICU stay 24 hrs, or maternal death. Major neonatal morbidity was defined as at least one of the following: NEC, RDS, IVH, or neonatal death. Data were analyzed by Chi-square, Fishers exact, students t-test, and Kaplan-Meier. A pvalue 0.05 was considered significant. RESULTS: 60 women were included; all had 1 prior cesarean delivery. 38 (63%) had antenatal VB. Women with VB had a median of 2 VB episodes; 14 (23%) had more than 3 episodes of VB. Demographic characteristics and hospital courses were similar among women with and without VB, although those with VB were more likely to be transported, admitted antenatally, and receive betamethasone (Table). All women had a clinically confirmed PA at delivery and were delivered by cesarean hysterectomy. 40 (67%) had a pathologically confirmed PA. Women with VB were delivered earlier compared to those without VB (Figure). VB was highly correlated with delivery gestational age (r -0.31, p 0.012). CONCLUSION: Women with suspected PA who experience antenatal VB are more likely to be admitted to the hospital, receive betamethasone, and require blood transfusion at the time of delivery compared to women who do not experience VB. Despite delivering 2 weeks earlier than women without antenatal VB, initial maternal and neonatal outcomes are similar. 157 Rates of preterm delivery in women receiving nurse administered 17P in a home vs office setting Victor Hugo Gonzalez-Quintero, Felipe Jose Tudela, Yvette Cordova, Letty Romary, Debbie Rhea, Cheryl Desch, Niki Istwan Associates in Advanced Maternal Fetal Medicine, Maternal Fetal Medicine, Miami, FL, University of Miami School of Medicine, Obstetrics and Gynecology, Miami, FL, Alere Health, Department of Clinical Research, Atlanta, GA OBJECTIVE: To compare clinical characteristics and rates of preterm delivery (PTD) in women receiving 17P via a weekly home nurse visit vs. through their physician’s office. STUDY DESIGN: Study sample identified from a database of clinical information received from pregnant women enrolled for risk assessment-case management or outpatient perinatal nursing services. Included were records with a documented delivery date from women with singleton gestations prescribed 17P by their physician. PTD history and rates of recurrent spontaneous PTD (SPTD) were compared between those women enrolled in the 17P home administration program which included a weekly home nurse visit with compounded17P injection and maternal assessment vs. women receiving 17P injections through their physician’s office. A logistic regression model was used to assess the effect of significant univariate differences between the groups onto dependent outcome of SPTD. RESULTS: Of the 16,225 records identified, 15,533 (95.7%) were enrolled in the 17P home administration program and 692 (4.3%) received 17P at their physician’s office. Women enrolled for home administration services were more likely to have a history of PTD (90.0% vs. 62.0%, p 0.001), received a greater number of 17P injections (14.9 / 4.8 vs. 12.6 / 5.5, p 0.001), and had lower rates of SPTD (28.0% vs. 39.0%, p 0.001) than those women receiving 17P through their physician’s office. In only women with PTD history, Poster Session I Clinical Obstetrics, Medical-Surgical-Disease, Neonatology, Physiology-Endocrinology www.AJOG.org