The effect of passive cigarette smoke on birthweight in pregnant women with asthma

Abstract

305 306 MATERNAL REPRODUCTIVE OUTCOME FOLLOWING FETAL SURGERY ROBERT WILSON, MARK JOHNSON, LORI HOWELL, ALAN FLAKE, TIM CROMBLEHOLM, HOLLY HEDRICK, SCOTT ADZICK, Children’s Hospital of Philadelphia, Pediatric Surgery, Philadelphia, PA OBJECTIVE: Retrospective database and maternal questionnaire information was used to determine the subsequent reproductive outcome for women following fetal surgery for non-life-threatening and emergency life -threatening fetal disease so that the information may be available for evidence-based presurgical counseling. STUDY DESIGN: The study was approved by the Committee for the Protection of Human Subjects IRB 2003-2-3200. Database review identified 83 women with fetal surgery from a single institution (1996-2002). These women were sent a consent to participate form and a questionnaire looking at postoperative problems, fertility, obstetrical outcomes, and psychosocial concerns . RESULTS: The surgery anomaly in the 83 probands was 52 MMC, 14 thoracic pathology, 13 CDH, and 4 SCT. Present return rate is 46 returned (55% with 2 consent refused), 7 lost to follow-up (8%), and 30 still to be returned. Subsequent pregnancy rate is 47% with 6to 72-month duration and 17% patients having more than one pregnancy. Pregnancy outcome was 33% SA, 6% preterm delivery, and 61% term delivery. Patients with no further pregnancies had sterilization 10% andwanting a further pregnancy in 25%. Complications in a subsequent pregnancy were reported in 5/41 (12%) with uterine rupture at 24 weeks (1), cesarean hysterectomy (1), antepartum hemorrhage requiring transfusion (1), preterm delivery (2) (twin pregnancy; singleton with heart disease). Psychosocial comments re depression and posttraumatic stress following a proband fetal or neonatal death were common in 9 cases returning the questionnaire following loss. CONCLUSION: (1) Spontaneous pregnancy loss is increased over ‘‘quoted’’ 15%-20% background rate. (2) Uterine rupture or dehiscence is similar to classical C section rate (4%-9%). (3) Psychosocial factors for families having fetal surgery need further study. (4) Subsequent pregnancies following fetal surgery have an increased risk for maternal health compared to normal obstetrical population. Volume 189, Number 6 Am J Obstet Gynecol SMFM Abstracts S145