670: Composite maternal and neonatal morbidity with trial of labor after cesarean: association with umbilical arterial acid-base analysis

Abstract

ObjectiveOne of the most cogent arguments for universal umbilical arterial acid-base analysis (UA ABA) is based on significantly higher reported neonatal mortality among those without an analysis vs. those with (Casey BM et al NEJM 2001). This study aimed to compare the composite maternal morbidity (CMM), neonatal morbidity (CNM) and mortality among women who underwent TOLAC and had UA ABA available vs. those who did not.Study DesignSecondary analysis of MFMU Cesarean Registry (CR) included women at ≥ 26 weeks gestation with a singleton, non-anomalous, live infant. CMM was defined as cystotomy, bowel injury, ureteral injury, intraoperative or postpartum transfusion, wound complication, wound evisceration, or cesarean hysterectomy. CNM included: sepsis, hypoxic ischemic encephalopathy, ventilation support within 24 hours among those ≥ 37 weeks, respiratory distress syndrome, renal failure, liver failure, pressor support, or confirmed seizures. Univariate and multivariate analyses were performed.ResultsOf the 17,291 TOLAC patients, 5,830 (34%) had UA ABA and 10,463 did not. The two groups differed significantly for maternal age, ethnicity, gestational age at delivery, preterm (< 37 wks) vs. term delivery, body mass index at delivery, hypertensive disease, and diabetes. CMM was significantly higher among those who had UA ABA (3.1%) than those who did not (1.6%). CNM was also significantly higher among those who had UA ABA (13.8% and 1.9/1000; Table). Adjusted odds ratio were not calculable for neonatal mortality due to its infrequent nature.ConclusionTabled 1Composite maternal and neonatal morbidity in the presence vs. absence of umbilical arterial acid-base analysis with trial of labor after cesarean delivery*Adjusted for maternal age, ethnicity, marital status, education, cigarette use, alcohol use, and newborn infant sex. Open table in a new tab ObjectiveOne of the most cogent arguments for universal umbilical arterial acid-base analysis (UA ABA) is based on significantly higher reported neonatal mortality among those without an analysis vs. those with (Casey BM et al NEJM 2001). This study aimed to compare the composite maternal morbidity (CMM), neonatal morbidity (CNM) and mortality among women who underwent TOLAC and had UA ABA available vs. those who did not. One of the most cogent arguments for universal umbilical arterial acid-base analysis (UA ABA) is based on significantly higher reported neonatal mortality among those without an analysis vs. those with (Casey BM et al NEJM 2001). This study aimed to compare the composite maternal morbidity (CMM), neonatal morbidity (CNM) and mortality among women who underwent TOLAC and had UA ABA available vs. those who did not. Study DesignSecondary analysis of MFMU Cesarean Registry (CR) included women at ≥ 26 weeks gestation with a singleton, non-anomalous, live infant. CMM was defined as cystotomy, bowel injury, ureteral injury, intraoperative or postpartum transfusion, wound complication, wound evisceration, or cesarean hysterectomy. CNM included: sepsis, hypoxic ischemic encephalopathy, ventilation support within 24 hours among those ≥ 37 weeks, respiratory distress syndrome, renal failure, liver failure, pressor support, or confirmed seizures. Univariate and multivariate analyses were performed. Secondary analysis of MFMU Cesarean Registry (CR) included women at ≥ 26 weeks gestation with a singleton, non-anomalous, live infant. CMM was defined as cystotomy, bowel injury, ureteral injury, intraoperative or postpartum transfusion, wound complication, wound evisceration, or cesarean hysterectomy. CNM included: sepsis, hypoxic ischemic encephalopathy, ventilation support within 24 hours among those ≥ 37 weeks, respiratory distress syndrome, renal failure, liver failure, pressor support, or confirmed seizures. Univariate and multivariate analyses were performed. ResultsOf the 17,291 TOLAC patients, 5,830 (34%) had UA ABA and 10,463 did not. The two groups differed significantly for maternal age, ethnicity, gestational age at delivery, preterm (< 37 wks) vs. term delivery, body mass index at delivery, hypertensive disease, and diabetes. CMM was significantly higher among those who had UA ABA (3.1%) than those who did not (1.6%). CNM was also significantly higher among those who had UA ABA (13.8% and 1.9/1000; Table). Adjusted odds ratio were not calculable for neonatal mortality due to its infrequent nature. Of the 17,291 TOLAC patients, 5,830 (34%) had UA ABA and 10,463 did not. The two groups differed significantly for maternal age, ethnicity, gestational age at delivery, preterm (< 37 wks) vs. term delivery, body mass index at delivery, hypertensive disease, and diabetes. CMM was significantly higher among those who had UA ABA (3.1%) than those who did not (1.6%). CNM was also significantly higher among those who had UA ABA (13.8% and 1.9/1000; Table). Adjusted odds ratio were not calculable for neonatal mortality due to its infrequent nature. ConclusionTabled 1Composite maternal and neonatal morbidity in the presence vs. absence of umbilical arterial acid-base analysis with trial of labor after cesarean delivery*Adjusted for maternal age, ethnicity, marital status, education, cigarette use, alcohol use, and newborn infant sex. Open table in a new tab *Adjusted for maternal age, ethnicity, marital status, education, cigarette use, alcohol use, and newborn infant sex.