Antepartum Complications Research Articles

Ectopic Kidney, a Challenging First Trimester Diagnosis—Case Report and Literature Review

(1) Background: Crossed fused renal ectopia is a rare migration and fusion renal anomaly, more frequently affecting males, with an incidence of between 1:2000 and 1:7500 observed at autopsy. (2) Case presentation: This paper presents the case of a 34-year-old woman, IIIG IIIP, who presented to our clinic for a first-trimester screening evaluation. The risk calculation was performed using the Fetal Medicine Foundation’s first-trimester screening software, version 2.8.1. The screening indicated a low risk for aneuploidies, but the ultrasound scan revealed an empty right renal fossa in the standard coronal section. A more detailed axial examination raised the suspicion of crossed fused renal ectopia. No other anomalies were detected. The morphological scans conducted in the second and third trimesters confirmed and upheld the diagnosis initially established in the first trimester. The fetus did not develop any potential antepartum complications. The patient gave birth via caesarean section at 36 weeks to a live female infant, weighing 3000 g, with an APGAR score of 9 at 1 min. Postnatally, the first trimester diagnosis of the renal malformation was confirmed. (3) Conclusions: Crossed fused renal ectopia, probably the rarest renal migration anomaly, can be diagnosed as early as the first trimester of pregnancy.

(127) TRAUMA INFORMED CARE TO REDUCE ANTEPARTUM COMPLICATIONS IN SURVIVORS OF TRAUMA

Abstract Introduction Life trauma permeates through society and across cultures. It impacts the individual, community, and society. Trauma may include but is not limited to adverse childhood experiences (ACEs), sexual assault and violence, domestic violence, and interpersonal violence (IPV). In the United States, 1 in 3 women experience physical IPV, 1 in 4 experience sexual assault, and 17% of adults have experienced 4 or more ACEs (CDC 2022, 2023). Experiencing trauma leads to a cascade of effects that infiltrate every aspect of life and causes higher levels of chronic stress. In those who are pregnant or giving birth, a history of trauma, particularly sexual assault, leads to adverse antepartum outcomes. Objective After this presentation, the learner will be able to: 1. Define trauma (ACEs, sexual assault, DV, IPV). 2. State the signs and symptoms of trauma. 3. Identify the antepartum complications associated with a history of trauma. 4. Explain the impact that a history of sexual assault has on the birth giver. 5. Define trauma informed care. 6. Identify the components of trauma informed care. 7. State the importance of using trauma informed care as a midwife and WHNP. Methods The methods used to address this topic include a literature review and podium style presentation of findings. Results Main findings include increased rates of miscarriage, preterm birth, post traumatic stress disorder, placental abruption, premature rupture of membranes, and low birth weight in pregnant survivors of past trauma. Additionally, the dynamic interplay between the Social Determinants of Health and violence experienced during pregnancy must be considered. Low household income, racism, lack of social support, as well as food and housing insecurity increased rates of intimate partner violence experienced during pregnancy. Trauma informed care has been shown to reduce psychological symptom severity and has been integrated into midwifery care to attempt to reduce these outcomes and prevent further traumatization of the client. Conclusions As pregnancy and childbirth are intimate and personal in nature, using a trauma informed model of care is crucial to identifying clients with trauma histories and caring for them in a manner that is cognizant of their lived experiences and potential antepartum outcomes. Future providers must receive adequate education and training regarding trauma informed care in an effort to prevent adverse outcomes and prevent re-traumatization of their clients. Disclosure No.

Epidemiology and factors associated with preterm births in multiple pregnancy: a retrospective cohort study

ObjectiveMultiple pregnancies carry an increased risk of maternal and perinatal complications, notably prematurity. Few studies have evaluated the risk factors for preterm births in multiple pregnancies within the Thai population. This study aims to ascertain maternal and perinatal outcomes and identify factors linked to preterm births in multiple pregnancies.MethodsThis study was carried out at Khon Kaen University, Faculty of Medicine, Department of Obstetrics and Gynecology in Thailand. We reviewed the medical records of women with multiple pregnancies who delivered at a gestational age of more than 20 weeks between January 1, 2012 and December 31, 2021. We excluded patients with incomplete data or those for whom data were missing.ResultsOut of 21,400 pregnancies, 427 were multiple pregnancies, constituting approximately 1.99%. Over the ten-year period, 269 multiple pregnancies (65.1%) resulted in preterm births. Of these, 173 (64.3%) were monochorionic twins, and 96 (35.7%) were dichorionic twins. Monochorionic twins had a notably higher rate of preterm delivery (AOR, 2.06; 95%CI 1.29—3.30). Vaginal delivery was observed in 7.9% of the cases, while cesarean sections were performed for both twins in 91.5% of cases. In 0.5% of the cases, only the second twin was delivered by cesarean section. In terms of neonatal outcomes, 160 infants (19.4%) weighed less than 1,500 g at birth, and there were 78 perinatal deaths (9.4%). Birth asphyxia was noted in 97 cases (20.2%) among monochorionic twins and in 28 cases (8.1%) for dichorionic twins.ConclusionThe prevalence of multiple pregnancies was 1.99%, with 65.1% resulting in preterm births. Neonatal complications were notably more frequent in monochorionic twins. Monochorionic placenta and antepartum complications emerged as significant risk factors for preterm birth.

Incidence and Perinatal Outcomes of Twin Pregnancy in Tertiary Healthcare Facility, Odisha, India

Background: Assisted reproductive technology has resulted in a progressive rise in the incidence of twin pregnancies, which affect both mother and child in terms of antepartum complications. Objective: To assess the perinatal outcomes of twin pregnancies and the influence of chorionicity on them in a tertiary healthcare facility. Methods: It is a hospital-based cross-sectional study that was carried out in the Obstetrics and Gynecology Department of S.C.B. Medical College Hospital, Cuttack, during the period from 2013 to 2015. All mothers having twin pregnancies (with 28 weeks of completed gestation) admitted to the antenatal (ANC) ward and labor room during this period were taken as a study group, and written informed consent was taken after explaining the details of the study. Results: A total of 150 cases are identified; among them, 98 cases (65.33%) are dichorionic diamniotic, 50 cases (33.33%) are monochorionic diamniotic, and 2 cases (1.33%) are monochorionic and monoamniotic pregnancies. The majority (66%) of the twin pregnancies were between 35-38 wks of gestational age at the onset of labor. It is also observed that macerated births, stillbirths, and neonatal deaths are higher in mono-chorionic twins as compared to dichorionic twins. Conclusions: Twin pregnancies carry a greater risk of adverse outcomes, especially perinatal mortality and neonatal morbidity, in monochorionic twins than dichorionic twins. Good antenatal care, early diagnosis of chorionicity, and antepartum assessment of placentation will prevent mortality and morbidity.

Maternal Group B Streptococcus Infection Correlates Inversely With Preeclampsia in Pregnant African American Women

Abstract Objective To determine whether an association exists between group B Streptococcus (GBS) colonization and preeclampsia among pregnant Black women. Methods This retrospective cross-sectional study involved Black women who gave birth at State University of New York Downstate Hospital between January 2010 and December 2017. Data were collected from the Obstetric Department, including delivery date, time, mode of delivery, age of the mother, weeks of gestation at delivery, and antepartum complications. The GBS test results were originally determined using the eSwab transport system. Preeclampsia was defined based on the American College of Obstetricians and Gynecologists criteria for the periods 2010–2012 and 2013–2017. The primary outcome was whether GBS was associated with the outcome of preeclampsia in the population of Black women. Covariates, including smoking status, gestational age, parity, body mass index, maternal age, and presence of herpes simplex virus (HSV) and human immunodeficiency virus (HIV) were examined as potential confounders. Chi-squared test and logistic regression model were used, presenting odds ratios with 95% confidence intervals (P < 0.050), analyzed with SAS on Demand for Academics (SAS Institute, Inc., NY). Results Among the 8,019 Black women included in this study, GBS-positive women (n = 977) had a 53% reduction in the likelihood of being diagnosed with preeclampsia compared to GBS-negative women (adjusted odds ratio, 0.47; 95% confidence interval, 0.32–0.70). We did not find evidence of differences in the distribution of smoking habits (P = 0.783) or maternal age (P = 0.107) between GBS-positive and GBS-negative women. However, the GBS-positive women tended to be less likely to have a preterm delivery (9.62% (94/977) vs. 24.24% (1707/7042), P < 0.001), less likely to be nulliparous (33.37% (326/977) vs. 37.87% (2667/7042), P = 0.006), and less likely to be obese (51.38% (502/977) vs. 55.30% (3894/7042), P < 0.001) compared with GBS-negative women. In contrast, GBS-positive women were more likely to have a comorbid infection than their counterparts: HSV (5.94% (58/977) vs. 2.63% (185/7042), P < 0.001) and HIV (1.54% (15/977) vs. 0.82% (58/7042), P = 0.028). Conclusion We found a reduced likelihood of preeclampsia among women who were positive for GBS at delivery. Given the cross-sectional nature of our study, more research is needed to further explore this association.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Evaluation of Preeclampsia Risk in Gestational Weight Gain

Background: The incidence of obesity worldwide has increased over the last 20 years. The increase in obesity in maternal pregnancy is causing a major challenge to obstetrics practices. The aimed study was to evaluate gestational weight gain as a risk for preeclampsia in pregnant women. Methods: This cross-sectional study was conducted on 2756 pregnant women with gestational age≥37 weeks. The selection of women was categorized into two groups, 1528 normal-weight women with BMI less than 25kg/m2 and 1228 pregnant women with a BMI of 25kg/m2 or more. SPSS software version 26.0 was used to analyze data. Multivariate logistic regression described the relation of weight change to pregnancy course and outcomes. Results: A comparison between study groups shows an increase in antepartum complications in obese women. Besides that, arterial hypertension, pre-eclampsia, and gestational diabetes were more frequent in overweight women compared to normal-weight women. The incidence of cesarean was highest in overweight and obese women with a statistically significant difference from normal weight women (p-value <0.005). In addition, maternal overweight and obese were at twice the risk for delivering infants with macrosomia (OR = 3.1, 95%CI = [1.09-5.8]). The difference in mean birth weight of the babies between normal and overweight women was statistically significant (p<0.05). Conclusion: The results of this study show that obesity during pregnancy is associated with pregnancy complications. To optimize all complications for the mother and fetus, weight gain during the pregnancy must be controlled and appropriate. Furthermore, studies are recommended to explore maternal obesity complications and risk factors for obesity to minimize the adverse effect of this risk.
 

Study of magnitude of grand multiparty and its perinatal outcome in a tertiary hospital of rural area in Maharashtra

Abstract Background: Grand multiparous pregnancies have been considered to be at higher risk of developing antenatal and perinatal complications like pre-eclampsia, gestational diabetes mellitus, anemia, antepartum hemorrhages, preterm labor, mal-presentation, mal-position and feto-pelvic disproportion This study was done to know the magnitude of grand multipara attending the tertiary care center with possible complications related to high parity. Objectives:To study the prevalence possible feto-maternal complications associated with grand multipara at rural setup. Methodology:Descriptive cross-sectional study conducted in medical college of rural area for 12 months. Grand multipara with 5 or more deliveries before current pregnancy coming for antenatal checkup and delivery were enrolled. Antenatal history was recorded till delivery and feto-maternal outcomes were noted. Results:Out of 1500 deliveries conducted during study period, 110 (7.5%) cases were grand multipara. Majority of them (79.5%) were Muslim and 80% were anaemic. 60% delivered with FTND, and 25.4% had emergency LSCS with one intrauterine death and a single breach delivery. Predominantly preeclampsia (23.6%) and malpresentation (14.5%) were diagnosed as antepartum complications. Almost one fifth of them had postpartum hemorrhage which was controlled with no mortality. 13 (11.8%) grand multipara women had still birth or early neonatal death, though fetal distress was observed in 37 cases. Conclusion: Grand multiparty is still a high-risk pregnancy associated with adverse maternal and fetal outcomes in our facility with multiple interrelated but mostly preventable causes.

Evaluation of Preeclampsia Risk in Gestational Weight Gain

Background: The incidence of obesity worldwide has increased over the last 20 years. The increase in obesity in maternal pregnancy is causing a major challenge to obstetrics practices. The aimed study was to evaluate gestational weight gain as a risk for preeclampsia in pregnant women. Methods: This cross-sectional study was conducted on 2756 pregnant women with gestational age≥37 weeks. The selection of women was categorized into two groups, 1528 normal-weight women with BMI less than 25kg/m2 and 1228 pregnant women with BMI over 25kg/m2. SPSS software version 26.0 was used to analyze data. Multivariate logistic regression described the relation of weight change to pregnancy course and outcomes. Results: A comparison between study groups appears an increase in antepartum complications in obese weight women. Besides that, arterial hypertension, pre-eclampsia, and gestational diabetes were more frequent in obese weight women compared to normal-weight women obese women. The incidence of cesarean was highest in obese women statistically significant difference from normal women with a p-value <0.005. In addition, maternal obese pregnancies were at twice the risk for delivery of infants who were macrosomia with higher odds (OR = 3.1, 95%CI = [1.09-5.8]). In perinatal outcomes, the difference in mean birth weight of the babies among normal and obese women was statistically significant (p<0.05). Conclusion: As we saw from the results of this study obesity during pregnancy was associated with pregnancy complications. To optimize all complications to maternal and fetus, weight gains during the pregnancy must be controlled and appropriate. Furthermore, studies are recommended to explore the maternal obesity complication and risk factors that influence obesity to minimize the adverse negative effect of this risk.

Is telephone follow-up reliable in maternal and neonatal outcomes surveys in in vitro fertilization?

Background Many studies that collect maternal and neonatal outcomes rely on patient self-report phone calls. It is unclear how reliable or accurate these phone call reports are.ObjectiveTo evaluate the reliability of telephone calls in information collection in IVF.Study designThe women were interviewed seven days after delivery by a nurse via telephone. The maternal and neonatal outcomes were recorded based on a self-report from one of the spouses. Meanwhile, the standardized electronic hospitalized discharge records were extracted from the hospital medical database. For each case, maternal and neonatal information obtained from telephone interviews and extracted from medical files were compared.ResultsAgreement was classified as “almost perfect, K = 0.81–1.00” for preterm birth, cesarean delivery, low birth weight baby, and macrosomia. The strength of agreement was classified as “moderate, K = 0.41–0.60” for some antepartum complications: gestational diabetes (K = 0.569); pregnancy-induced hypertension (K = 0.588); intrahepatic cholestasis of pregnancy (K = 0.597) and oligohydramnios (K = 0.432). The strength of agreement between telephone interviews and hospitalized discharge records can be classified as “slight (K = 0–0.20)” for some complications: thyroid diseases (K = 0.137), anemia (K = 0.047), postpartum hemorrhage (K = 0.016), and Fetal distress (K = 0.106).ConclusionSome variables (preterm birth, cesarean delivery, birth weight) information collected by telephone follow-up were reliable. However, other complications (thyroid diseases, anemia, postpartum hemorrhage, and fetal distress) collected via self-report was non-reliable. Compared with complications during labor, antepartum complications have higher agreement between different follow-up methods. IVF records and hospitalized discharge records should be matched and collected simultaneously when discussing maternal and neonatal outcomes of IVF.

Maternal Obesity & Feto-Maternal Outcomes

Obesity has become a “silent epidemic and its prevalence is increasing in pregnant women. Objective: This study aims to highlight the impact of maternal obesity on the fetal and maternal outcome. Methods: The study was conducted on 320 pregnant women in their first trimester with viable singleton pregnancy at Department of Gynecology & Obstetrics, Liaquat University of Medical & Health Sciences, Jamshoro. The obese group (BMI > 25) of 160 women, were compared for feto-maternal outcome, with parity matched 160 women in non-obese group (BMI < 25). Results: There was increased incidence of antepartum, intrapartum and fetal complications in obese group as compared to non-obese group. Preeclampsia was seen in 42.1% vs 14.1%, GDM in 14.5% vs 10.3%, induction of labor in 31.9% vs 13.3%, in obese as compared to non-obese respectively. Lower segment caesarean second (37.5% vs 13.8%), macrosomia (22.4% vs 1.3%), shoulder dystocia (18.4% vs 3.8%), birth asphyxia (11.8% vs 5.1%) and neonatal intensive care unit (NICU) admission (12.7% vs 6.6%) were more common in obese as compared to non-obese. Conclusion: Maternal obesity is a risk factor for many antepartum, intrapartum, postpartum and fetal complications. All attempts should be made to prevent obesity in women of childbearing age” and to encourage weight loss before pregnancy

Is Pakistan ready for the stillbirths count down 2030?

Worldwide, around 2 million births annually ended in stillbirths (1). Sub-Saharan Africa and South Asia are sharing 80% of the burden, with 44% of events being contributed by only six countries i.e., India, Pakistan, Nigeria, the Democratic Republic of the Congo, China, and Ethiopia (1). Considering the public health burden of significance, even now stillbirths are the most neglected in country-level attention and low priority is given to mitigate the risk factors of stillbirths. (2) The consequence of stillbirth is huge, both systemwide as well at the level of the household. The impact is grossly linked with both economic broadly and psychological and physical well-being at the individual level (3). Furthermore, at the individual level, the social and cultural taboo attached with stillbirth as an outcome is severe and hinders correct reporting at the country level (3). The problem of under or misreporting is grossly an issue in low-and middle-income countries (LMICs); socio-cultural barriers are most prevalent in these countries (3). Nearly 40% of stillbirths are attributable to preventable causes, usually happening during the intrapartum period, which can easily be averted through better health interventions and quality of care (1). Further, the rest of the leading causes are pertaining to antepartum complications (1) The distribution of causes of stillbirths are continuing to remain stagnant since last few years, and remedial interventions so far at the country level are not on track to gain the reduction in stillbirth rates as per criteria for the count down 2030 (4-5). --Continue

Placental location site and adverse antepartum pregnancy complications: a meta-analysis and review of the literature.

The purpose to the study was to determine the relationship, if any, between the placental location site and antepartum complications of pregnancy. A University research librarian conducted a comprehensive literature search using the search engines PubMed and Web of Science. The search terms were "placental location" AND "pregnancy complications" OR "perinatal complications. There were no limits put on the years of the search. The search identified 110 articles. After reviewing all the abstracts, relevant full articles, and references of full articles, there were 22 articles identified specific to antepartum complications. Central + fundal locations compared to all lateral were associated with a lower risk of hypertension during pregnancy RR = 0.47, 95% CI: 0.31-0.71]. Central location compared to all lateral was also associated with lower risk of hypertension during pregnancy [RR = 0.39, 95% CI: 0.26-0.59]. Placenta locations in the lower uterine segment were associated with greater risk of antepartum hemorrhage (APH) [RR = 2.99, 95% CI: 1.16-7.75] compared to above the lower uterine segment. No differences were observed in placental locations and gestational diabetes (GDM), preterm prelabor rupture of membranes (PPROM), preterm delivery (PTD) or on a placental abruption. Central and fundal location sites and central location alone decreased the risk of hypertension during pregnancy. Low uterine segment location sites increased the risk for APH. There were no effects of placenta location sites on the development of GDM, PPROM, PTD or abruption.

Preterm births in China between 2012 and 2018: an observational study of more than 9 million women

SummaryBackgroundPreterm birth rates have increased significantly worldwide over the past decade. Few epidemiological studies on the incidence of preterm birth and temporal trends are available in China. This study used national monitoring data from China's National Maternal Near Miss Surveillance System (NMNMSS) to estimate the rate of preterm birth and trends between 2012 and 2018 in China and to assess risk factors associated with preterm birth.MethodsIn this observational study, data were sourced from the NMNMSS between Jan 1, 2012, and Dec 31, 2018. Pregnancies with at least one livebirth, with the baby born at 28 weeks of gestation or more or 1000 g or more birthweight were included. We estimated the rates of overall preterm, very preterm (born between 28 and 31 weeks’ gestation), moderate preterm (born between 32 and 33 weeks’ gestation), and late preterm (born between 34 and 36 weeks’ gestation) births in singleton and multiple pregnancies and assessed their trends over time. We used logistic regression analysis to examine the associations between preterm birth and sociodemographic characteristics and obstetric complications, considering the sampling strategy and clustering of births within hospitals. Interrupted time series analysis was used to assess the changes in preterm birth rates during the period of the universal two child policy intervention.FindingsFrom Jan 1, 2012, to Dec 31, 2018, 9 645 646 women gave birth to at least one live baby, of whom 665 244 (6·1%) were born preterm. In all pregnancies, the overall preterm birth rate increased from 5·9% in 2012 to 6·4% in 2018 (8·8% increase; annual rate of increase [ARI] 1·3 [95% CI 0·6 to 2·1]). Late preterm births (8·8%; ARI 1·5% [0·9 to 2·2]) and very preterm births (13·3%; ARI 1·8% [0·5 to 3·0]) significantly increased from 2012 to 2018, whereas moderate preterm births did not (3·8%; ARI 0·3% [95% CI –0·9 to 1·5]). In singleton pregnancies, the overall preterm birth rate showed a small but significant 6·4% increase (ARI 1·0% [0·4 to 1·7]) over the 7 year period. In multiple pregnancies, the overall preterm birth rate significantly increased from 46·8% in 2012 to 52·7% in 2018 (12·4% increase; ARI 1·9% [1·2 to 2·6]). Compared with women who gave birth in 2012, those who gave birth in 2018 were more likely to be older (aged ≥35 years; 7·4% in 2012 vs 15·9% in 2018), have multiples (1·6% vs 1·9%), have seven or more antenatal visits (50·2% vs 70·7%), and have antepartum complications and medical disease (17·9% vs 35·1%), but they were less likely to deliver via caesarean section (47·5% vs 45·0%). Compared with the baseline period (January, 2012 to June, 2016), a higher increase in preterm birth was observed after the universal two child policy came into effect in July, 2016 (β=0·034; p=0·03).InterpretationAn increase in preterm births was noted for both singleton and multiple pregnancies between 2012 and 2018 in China. China's strategic investment in maternal and neonatal health has been crucial for the prevention of preterm birth. Due to rapid changes in sociodemographic and obstetric factors related to preterm birth—particularly within the context of the universal two child policy—such as advanced maternal age at delivery, maternal complications, and multiple pregnancies, greater efforts to reduce the burden of preterm birth are urgently needed.FundingNational Key R&D Program of China, National Health Commission of the People's Republic of China, China Medical Board, WHO, and UNICEF.

TO STUDY THE DIFFERENT COMPLICATIONS DURING ANTEPARTUM, INTRAPARTUM AND POSTPARTUM PERIODS WITH POSSIBLE MEASURES TO MANAGE TWIN PREGNANCY

Background: The present study of twins was done among the patients admitted in the department of Obstetrics and Gynecology at Sri Aurobindo Medical College and Post Graduate Institute, Indore.
 Method: Blood sample from the mother was collected for estimation of hemoglobin percentage to diagnose anemia, ABO & Rh typing for blood transfusion if necessary. Urine examination for albumin, sugar & acetone. Special investigations like USG done whenever possible. In maximum cases ultrasonography was done to detect or confirm presence of twins, their lie, maturity, gestational age, rule out congenital anomaly & to note any IUGR, Discordant growth. Amount of liquor also noted.
 Result: 143 (85.10%) babies were LBW. The main factors responsible for LBW were IUGR and prematurity. Intrauterine growth retardation affected 42 cases (24.41%) while prematurity affected 42 cases (24.41%) and 8 (9.3%) cases aborted.
 Intrauterine death was more common in first baby, because of malpresentations. Asphyxia was found to be slightly more in second baby in our study. Congenital anomalies were found in total 3 cases (1.78%). In one case, baby-2 was Anencephalic and in the other case baby-2 had fetal ascites. In one case baby-1 had multiple congenital anomalies with imperforate anus. Cord prolapse was present in one case. In one case (Case No. 17) first baby was presented by footling with cord prolapse LSCS was done, baby had SBA and died 1 day after birth. There were 8 abortions. All were second trimester abortions (12 weeks and 22 weeks).
 Conclusion: In the present study, incidence of various antepartum and intrapartum complications were less in booked cases, which shows that availability of antenatal care to more patients will further reduce their incidence and thus will decrease maternal morbidity.
 Keywords: Complications, Antepartum, Intrapartum & Postpartum.

Extended Perinatal Mortality Audit in a Rural Hospital in India.

The aim of the study is to describe the status of perinatal mortality (PM) in an Indian rural hospital. Retrospective analysis of data was compiled from PM meetings (April 2017 to December 2018) following "Making Every Baby Count: audit and review of stillbirths and neonatal deaths (ENAP or Every Newborn Action Plan)." The study includes 8,801 livebirths, 105 stillbirths (SBs); 74 antepartum stillbirths [ASBs], 22 intrapartum stillbirths [ISBs], and nine unknown timing stillbirths [USBs]), 39 neonatal deaths or NDs (perinatal death or PDs 144). The higher risks for ASBs were maternal age >34 years, previous history of death, and/or SBs. Almost half of the PDs could be related with antepartum complications. More than half of the ASB were related with preeclampsia/eclampsia and abruptio placentae; one-third of the ISB were related with preeclampsia/eclampsia and gestational hypertension, fetal growth restriction, and placental dysfunction. The main maternal conditions differed between PDs (p = 0.005). The main causes of the ND were infections, congenital malformations, complications of prematurity, intrapartum complications, and unknown. The stillbirth rate was 11.8/1,000 births, neonatal mortality rate 4.4/1,000 livebirths, and perinatal mortality rate 15.8/1,000 births. This is the first study of its kind in Andhra Pradesh being the first step for the analysis and prevention of PM. · Many conditions that lead to stillbirths are linked to neonatal deaths and PM has been outside of the global parameters from the last decades.. · This is the first study following International Classification of Disease perinatal mortality codes and the audit of ENAP in Andhra Pradesh.. · Extended PM and mortality are mainly caused by similar preventable and treatable conditions..

708 The relationship between toxicology-confirmed illicit drug use close to delivery and placental pathology

Illicit drug use continues to rise among women of reproductive age. Tobacco and alcohol demonstrated a strong association with placental insufficiency in prior studies. Less is known about the impact illicit drugs of abuse may have on the placenta. We aim to evaluate the association between toxicology-confirmed illicit drug use within 72 hours of delivery and placental pathology. This is a retrospective study of patients delivered between January 2016 and December 2019. Singleton pregnancies with urine drug screen performed within 72 hours of delivery and placenta sent to pathology at time of delivery were included. Current tobacco and alcohol users were excluded. Placental pathology (PP) findings (divided into vascular malperfusion and inflammation) and neonatal outcomes were compared between women that tested negative for drugs (NDS) and positive for one or more illicit drugs (IDU). Independent t-tests were used to calculate differences in demographics and outcomes. 466 NDS and 52 IDU patients were identified. IDU were likely to be younger (p=.024), white, non-Hispanic (p=.001) and to have a psychiatric history (p=.003). There was no difference in BMI, parity and preexisting conditions among the groups except for thrombophilia, which only occurred in NDS. Gestational age at delivery and antepartum complications were similar among the groups except for gestational diabetes, which only occurred in NDS. IDU were more likely to have placental inflammation (Table-1) however rates of vascular malperfusion were similar among the groups. IDU had lower birth weight (p=.006) and higher composite neonatal morbidity (p=.043) (Table-2). Rates of NICU admission (p=.026), Respiratory Distress Syndrome (p=.026) and Neonatal Abstinence Syndrome (p=.015) were higher among IDU. Vascular malperfusion was similar among the two groups, which may be accounted for by the higher rate of GDM and Thrombophilia in the NDS group. Inflammation was more frequent in the IDU group. Illicit drug use demonstrates a significant relationship with adverse PP and adverse neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

609 The association between toxicology-confirmed marijuana use close to delivery and neonatal outcomes and placental pathology

Marijuana use is increasing in women of reproductive age. Prior studies on marijuana's association with obstetric and neonatal outcomes were mainly based on self-reported use remote from delivery. We aim to evaluate the association between toxicology-confirmed marijuana use, within 72 hours of delivery and adverse neonatal outcomes. We also aim to examine placental pathology in women exposed to marijuana during pregnancy. This is a retrospective study of patients delivered between January 2016 and December 2019. Singleton pregnancies with urine drug screen performed within 72 hours of delivery and placenta sent to pathology at the time of delivery were included. Women who tested positive for polysubstance use and current tobacco and alcohol users were excluded. Neonatal outcomes and placental pathology (PP) findings were compared between the women that tested negative for drugs (NDS) and positive for marijuana use (MU). PP findings were categorized into vascular malperfusion and inflammatory findings. 466 patients (NDS) and 32 (MU) were identified. MU are likely to be younger (p=0.002), black and non- Hispanic (p=0.005) and have a psychiatric history (p= 0.01). There is no difference in BMI, parity and preexisting conditions among the groups. Gestational age at delivery and antepartum complications were similar among the groups except for gestational diabetes, which was higher in NDS group (p=0.01). The mean birth weight (BW) is lower in MU group. However, low BW, defined as <2500 grams, is similar among the groups (Table-1). NICU admissions and length of stay did not differ among the groups (Table 1). MU are likely to have higher composite neonatal morbidity (p=0.09). PP did not differ among the groups (Table 2). In contrast to prior studies, MU is not associated with increased risk of low BW, when smoking is excluded. This is also demonstrated in PP, as placental vascular insufficiency is similar in both the groups. Our study also showed increased risk of composite neonatal morbidity which has not been previously reported.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

COMPARISON OF OBSTETRICAL COMPLICATIONS IN MULTIPARA AND GRAND MULTIPARA

Pakistan is a low resource, developing country. (1) The incidence of grand multiparity is very high due to various reasons like lack of education, poor knowledge, and availability of family planning methods, various social and cultural reasons. Grand multiparity is mostly associated with increasing maternal age, which is an independent risk factor for various antepartum, intrapartum, and postpartum complications. (2)

Hepatitis C Seroprevalence Among Consecutive Labor and Delivery Admissions in Two New York City Hospitals.

BackgroundRates of hepatitis C virus (HCV) among women of childbearing age have increased as a result of the opioid epidemic, especially in the nonurban white population. Recently updated US Preventative Services Task Force and Centers for Disease Control and Prevention guidance have recommended universal HCV screening during pregnancy, but obstetrics societies have not yet endorsed this recommendation. We evaluated the seroprevalence of HCV among pregnant women in an inner-city population, compared rates with other sexually transmitted infections (STIs) screened for during pregnancy, and evaluated factors associated with HCV positivity.MethodsWe performed a prospective seroprevalence study of consecutive labor and delivery admissions (both antepartum complications and delivery admissions) by testing serum samples for HCV antibody over 9 months at 2 major hospital settings in New York City.ResultsFifty-six of 7373 (0.75%; 95% confidence interval [CI], 0.57–0.98) patients screened positive for HCV, with 28 of 4013 (0.70%; 95% CI, 0.46%–1.01%) and 28 of 3413 (0.82%; 95% CI, 0.55%–1.18%) at each hospital. Forty-one percent of HCV-positive patients had any reported HCV risk factors. Hepatitis C virus-positive patients were less likely to have private insurance and more likely to have a history of cannabis, cocaine, and injection drug use (P < .001). The HCV rates were higher among antepartum admissions compared with delivery admissions and higher than that of hepatitis B virus (0.65%; 95% CI, 0.48–0.86), human immunodeficiency virus (0.27%; 95% CI, 0.16–0.42), and syphilis (0.16%; 95% CI, 0.08–0.28).ConclusionsWe found a higher than expected HCV seroprevalence among pregnant women and higher than most other STIs routinely screened for in pregnancy. Most patients had no risk factors. These findings support universal screening for hepatitis C during pregnancy.