65: Neonatal outcomes associated with intended place of birth: birth centers and home birth compared to hospitals

Abstract

65 Neonatal outcomes associated with intended place of birth: birth centers and home birth compared to hospitals Yvonne W. Cheng, Jonathan Snowden, Aaron Caughey University of California, San Francisco, Obstetrics & Gynecology, San Francisco, CA, Oregon Health and Sciences University, Obstetrics and Gynecology, Portland, OR, Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR OBJECTIVE: To examine whether neonatal outcomes differ in women who intended home births, and births that occurred at birthing centers compared to hospitals. STUDY DESIGN: This was a retrospective cohort study of singleton live births that occurred in 2008 in the U.S. that had specified birthing facility information. Deliveries were categorized by location of occurrence: hospitals, birthing centers, or intended home births. Neonatal outcomes were compared using chi-square test and potential confounders adjusted for by multivariable logistic regression. RESULTS: There were 2,296,953 singleton, live, term births meeting study criteria; of these, 10,726 (0.47%) delivered at birthing centers and 12,433 (0.54%) had intended home births. While the risk of cesarean delivery was much lower for women who delivered/or intend to deliver outside of hospitals (0.02-4% vs. 24%, p 0.001), the odds of 5-minute Apgar score 7 and neonatal seizure was significantly higher for intended home births compared to hospital birth (see Table). CONCLUSION: The risk of cesarean delivery is significantly lower for women who had or intend to have births outside of hospitals; however, the risk of lower 5-minute Apgar score and neonatal seizure was higher for intended home births. This trade-off between maternal benefit and neonatal risk of deliveries outside of hospital should be weighed in the decision regarding birthing facility preferences. 66 Obstetric outcome in singletons after in-vitro fertilization with frozen-thawed embryos Ulla-Britt Wennerholm, Antonina Sazonova, Karin Kallen, Ann Thurin, Christina Bergh Sahlgrenska University Hospital, East, Obstetrics and Gynecology, Gothenburg, Sweden, Sahlgrenska University Hospital, Sahlgrenska, Obstetrics and Gynecology, Gothenburg, Sweden, Tornblad Institute, Reproduction Epidemiology, Lund, Sweden OBJECTIVE: Cryopreservation of embryos is an established method within assisted reproduction technique with satisfactory pregnancyand live birth rates. The increasing use of single embryo transfer (SET) results in more embryos available for freezing. For IVF children in general, also singletons, higher rate of preterm birth (PTB) and low birth weight (LBW) have been reported. The aim of this study was to compare obstetric outcome for singleton children born after cryopreservation of embryos with singletons born after fresh IVF and singletons born after spontaneous conception. STUDY DESIGN: This was a retrospective cohort study, including data from all IVF clinics in Sweden for IVF treatment during the years 2002-2006. All singletons from frozen/thawed IVF cycles (n 2348; 1533 SET and 815 double embryo transfers (DET)) and singletons from fresh IVF cycles (n 8944; 6047 SET and 2897 DET) were included. Data were cross-linked with the Swedish Medical Birth Registry and compared with all non-IVF singletons born during the same time period (n 571 914). Outcome measures were: PTB ( 28w, 32w, 37w), very LBW 1500g) and LBW ( 2500g), small for gestational age, peri/neonatal mortality, Apgar score, caesarean section, preeclampsia, gestational diabetes, placenta previa, placental abruption. Crude and adjusted OR were calculated. Adjustment was made for maternal age, parity, smoking, BMI, years of involuntary childlessness and year of birth. RESULTS: Singletons from frozen SET/DET had higher rates of PTB 28w and peri/neonatal mortality as compared with the general population (Table). Singletons from frozen SET/DET had lower rates of LBW (aOR 0.76; 95% CI 0.60-0.95) but higher rates of peri/neonatal mortality (aOR 1.90; 1.03-3.54) as compared with singletons from fresh SET/DET. Placenta previa was less common in pregnancies from frozen SET/DET as compared with pregnancies from fresh SET/DET. CONCLUSION: Singletons born after cryopreservation had increased peri/neonatal mortality as compared with singletons born after fresh IVF cycles and after spontaneous conception, however, the absolute risk was low (4.3/1000). Oral Concurrent Session 6 Intrapartum Fetal/Clinical Obstetrics www.AJOG.org