Differences In Maternal Outcomes Research Articles

An Extra Hour

INTRODUCTION: ACOG recently recommended an increase of one hour in the maximum time spent laboring in the second stage in an effort to prevent primary cesarean deliveries. In nulliparous women with epidural analgesia, this indicated an increase in allowance of second-stage from 3 to 4 hours. This study examined the difference in maternal outcomes in the context of a longer second stage. METHODS: A decision-analytic model was created comparing outcomes associated with delivery at 3 hours in second stage versus expectant management until 4 hours in a theoretical cohort of 272,000 women. All probabilities and utilities were derived from the literature. Outcomes included mode of delivery, chorioamnionitis, post-partum hemorrhage, severe perineal lacerations and maternal deaths. RESULTS: Expectant management until 4 hours led to 55,488 fewer cesarean deliveries, 16,263 fewer cases of post-partum hemorrhage, and 1 fewer maternal deaths than immediate delivery at 3 hours. However, this strategy would lead to 7,906 more severe perineal lacerations. Ultimately, expectant management to 4 hours was the optimal strategy as it maximized total QALYs. Sensitivity analysis indicated that allowing 4 hours in second stage was optimal until the probability of cesarean delivery at 4 hours decreased to 44.2%, after which delivering at 3 hours was the preferred strategy. CONCLUSION: Expectant management of the second stage of labor until 4 hours is the optimal strategy to prevent primary cesarean deliveries and improve maternal outcomes, with the exception of severe lacerations. As practice evolves, outcomes related to changing practice deserve further research and additional consideration of neonatal outcomes.

Home Birth to Hospital Transfers

INTRODUCTION: Approximately 25,000 deliveries in the US last year were home births, and the risk of transport to a hospital during attempted home birth has been reported as 25–37%. We examined whether maternal and neonatal outcomes are affected by cervical dilation at time of transfer or by number of prenatal visits (PNV) with an obstetrician. METHODS: This was a retrospective cohort study over years 2012–2014 of women with singleton gestations at term who attempted a home birth and were transferred during labor to our university hospital. Multiple gestations and fetal anomalies were excluded. Number of PNV (<12 versus ≥12 visits as recommended by ACOG), cervical dilation at time of transfer, and several maternal and neonatal outcomes were extracted from an existing perinatal database. RESULTS: All women had attended at least 1 PNV. The overall cesarean rate for planned home births was 34.3%, and 10% of women transferred their care at 10 cm. Among women who were 0–5 cm, 6–9 cm, versus 10 cm at transfer, no significant difference in mode of delivery was found. No differences in maternal outcomes (blood transfusion, postpartum infection, hospital stay, readmission, and others) were observed comparing groups by cervical dilation at presentation or by number of PNV. Similarly, neonatal outcomes of Apgars, pH, resuscitation, and disposition did not differ significantly between groups. CONCLUSION: Cervical dilation and number of PNV did not affect maternal or neonatal outcomes. Further research is needed to guide prenatal and intra-partum care to improve outcomes for women transferring care to the hospital from an attempted home birth.

Murine Model for Preclinical Studies of Var2CSA-Mediated Pathology Associated with Malaria in Pregnancy.

Plasmodium falciparum infection during pregnancy leads to abortions, stillbirth, low birth weight, and maternal mortality. Infected erythrocytes (IEs) accumulate in the placenta by adhering to chondroitin sulfate A (CSA) via var2CSA protein exposed on the P. falciparum IE membrane. Plasmodium berghei IE infection in pregnant BALB/c mice is a model for severe placental malaria (PM). Here, we describe a transgenic P. berghei parasite expressing the full-length var2CSA extracellular region (domains DBL1X to DBL6ε) fused to a P. berghei exported protein (EMAP1) and characterize a var2CSA-based mouse model of PM. BALB/c mice were infected at midgestation with different doses of P. berghei-var2CSA (P. berghei-VAR) or P. berghei wild-type IEs. Infection with 10(4) P. berghei-VAR IEs induced a higher incidence of stillbirth and lower fetal weight than P. berghei At doses of 10(5) and 10(6) IEs, P. berghei-VAR-infected mice showed increased maternal mortality during pregnancy and fetal loss, respectively. Parasite loads in infected placentas were similar between parasite lines despite differences in maternal outcomes. Fetal weight loss normalized for parasitemia was higher in P. berghei-VAR-infected mice than in P. berghei-infected mice. In vitro assays showed that higher numbers of P. berghei-VAR IEs than P. berghei IEs adhered to placental tissue. Immunization of mice with P. berghei-VAR elicited IgG antibodies reactive to DBL1-6 recombinant protein, indicating that the topology of immunogenic epitopes is maintained between DBL1-6-EMAP1 on P. berghei-VAR and recombinant DBL1-6 (recDBL1-6). Our data suggested that impairments in pregnancy caused by P. berghei-VAR infection were attributable to var2CSA expression. This model provides a tool for preclinical evaluation of protection against PM induced by approaches that target var2CSA.

Comparison of Misoprostol and Dinoprostone Gel for Induction in Prelabor Rupture of Membranes at Term

Background: The aim of the study was to compare the safety and efficacy of vaginal misoprostol with dinoprostone gel for induction of labor in prelabor rupture of membranes at term pregnancy. Methods: This is a prospective study conducted in the Department of Obstetrics and Gynaecology, at Sri Devraj Urs Medical College from December 2010 to September 2012. One hundred patients were induced with either misoprostol or dinoprostone gel using computer-generated randomized table. The study had two groups. Group I had 50 cases of primigravida, where 25 cases were induced with misoprostol and another 25 were induced with dinoprostone gel. Group II had 50 cases of multigravida, where 25 cases were induced with misoprostol and the rest 25 were induced with dinoprostone gel. Twenty-five microgram misoprostol was inserted vaginally every sixth hourly for maximum of six doses and 0.5 mg dinoprostone gel was used intracervically every sixth hourly for maximum of three doses. The primary outcome measured was induction to delivery interval and the secondary outcomes included mode of delivery, and maternal and neonatal outcome. Results: Among the patients induced, both the groups were comparable with respect to age, parity, booking status, gestational age, and pre-induction Bishop’s score. There was no significant difference in induction to delivery interval between both the groups. The induction to delivery interval in misoprostol group was 6.65 hours and that in dinoprostone group was 6.89 hours. In primigravida, the induction to delivery interval in misoprostol group was 7.74 hours and 7.08 hours in dinoprostone group and in multigravida, the induction to delivery interval in misoprostol group was 5.55 hours and in dinoprostone group was 6.71 hours. In primigravida, dinoprostone has shorter induction to delivery interval compared to misoprostol. In multigravida, misoprostol has shorter induction to delivery interval compared to dinoprostone. There was no difference in mode of delivery in both the groups. There was no significant difference in maternal outcome and neonatal outcome among both the groups. Conclusion: Vaginal misoprostol is equally efficacious in labor induction and demonstrates a similar fetal and maternal safety profile when compared with dinoprostone gel. J Clin Gynecol Obstet. 2015;4(4):302-306 doi: http://dx.doi.org/10.14740/jcgo321w

The impact of chorionicity on maternal pregnancy outcomes

Women carrying twin pregnancies often receive similar counseling, regardless of chorionicity, with the notable exception of twin-twin transfusion syndrome (TTTS); however, little is known about whether the presence of 1 vs 2 placentas confers dissimilar maternal risks. We sought to determine differences in maternal and neonatal outcomes based on chorionicity. This was a retrospective cohort study of all twin pregnancies at our institution undergoing routine second-trimester ultrasound for anatomic survey from 1990 through 2010. Secondary outcomes included other adverse maternal and neonatal outcomes. Relative risks and adjusted odds ratios (aORs) were calculated. Cluster analysis was used to account for nonindependence of twin pairs. Of 2301 pregnancies, 1747 (75.9%) were dichorionic and 554 (24.1%) were monochorionic. Rates of preeclampsia, gestational diabetes, placental abruption, placenta previa, preterm labor, and preterm premature rupture of membranes (PPROM) were not significantly different in dichorionic vs monochorionic pregnancies. Early preterm delivery less than 34 weeks (aOR, 1.47; 95% confidence interval [CI], 1.17-1.86) and less than 28 weeks (aOR, 2.58; 95% CI, 1.58-4.20) were more likely in monochorionic twins, as was neonatal intensive care unit admission (aOR, 1.41; 95% CI, 1.12-1.78). Monochorionic twins delivered earlier at a mean gestational age of 34.2 weeks vs 35.0 weeks for dichorionic twins (P < .001). Hospital length of stay was significantly longer for monochorionic twins with a mean of 13.7 days vs 10.8 days for dichorionic twins (P = .01). There are no significant differences in maternal outcomes by chorionicity; however, monochorionicity is associated with increased fetal risks. This information may be helpful in guiding more targeted counseling to expectant parents of twins that, although the presence of an additional placenta does not confer additional maternal risks, monochorionic infants tend to deliver earlier and require longer hospital stays.

204-POS

Objectives Early onset pre-eclampsia (PE) is considered a worse disorder than later onset PE for the baby but differences in maternal outcomes are less certain. Aims To compare maternal and fetal outcomes amongst women with early onset PE (EOP) 37 weeks. Methods We retrospectively analysed outcomes of women with hypertension in pregnancy from our data that is collected during admission and validated by a physician at discharge. Between 1991 and 2011, 4657 pregnancies were complicated by hypertension; 2148 (45%) had pre-eclampsia. 1536 (72%) of these cases had complete data. Results 291 (19%) had EOP; 505 (33%) pre-term PE and 740 (48%) term PE. Maternal age was similar. Women with pre-term and term onset PE had similar maternal and fetal outcomes. Compared with term PE, women with EOP had similar rates of renal impairment (7% vs. 9%), proteinuria (76% vs. 81%), liver dysfunction (17% vs. 13%), thrombocytopenia (4.5% vs. 5%) and eclampsia (3 vs. 9/1000), but more episodes of severe hypertension (45% vs. 31%, p p p p p p Conclusions Women presenting with PE after 34 weeks have generally good maternal and fetal outcomes. Women with EOP are more likely to have severe hypertension and neurological symptoms but otherwise similar rates of other maternal complications as women with term PE. Outcomes for babies of women with EOP are significantly worse. These data highlight the fact that pre-eclampsia at any gestation poses fairly similar risks for the mother but EOP poses much greater risks for the baby. Disclosures F.M. Pettit: None. G.J. Mangos: None. G. Davis: None. A. Henry: None. M.A. Brown: None.

135-POS

Objectives To determine maternal and perinatal outcomes according to mode of delivery in normotensive and hypertensive pregnant women with term gestation, a live fetus, and undergoing induction of labor with misoprostol. Methods We conducted a retrospective cohort study from June 2004 to June 2011. The outcomes were tachysystole syndrome, uterine hyperstimulation, indications for cesarean section, severe maternal morbidity (uterine rupture and uterine atony), side effects, maternal death, Apgar scores at first and fifth minutes, neonatal death, need for admission at neonatal intensive care unit (NICU) and birth weight (grams). For statistical analysis we used the chi-square test or Fisher’s exact test, as appropriate, at a significance level of 5%. We also calculated the risk ratio (RR) and its confidence interval 95 % (95% CI). Results We evaluated 410 pregnant women submitted to induction of labor with misoprostol, 227 in normotensive, and 183 in hypertensive gestation. The main indication for induction of labor was hypertension (44.6%), followed by prolonged pregnancy (40.2%) and premature rupture of membranes (7.3%). Gestational hypertension was the most frequent (31.7%) cause, between hypertensive disorders. In both groups the failure of induction was the main indication for cesarean section, and there were no significant differences in maternal outcomes according to the mode of delivery. Among perinatal outcomes, only the Apgar below seven in the first minute occurred less frequently when the patient had a vaginal delivery in the group of normotensive women (RR 0.41, 95% CI 0.18–0.90). Conclusions Maternal and perinatal outcomes were similar in both normotensive and hypertensive pregnant women undergoing labor induction with misoprostol. Disclosures N.V. Leal: None. A.S. Souza: None. L. Katz: None. C. Noronha-Neto: None. S.B. Maia: None. A.H. Franca-Neto: None. M.M. Amorim: None.

Comparison of instrumental vaginal births by assisted birth practitioner midwives and medical practitioners

The role of the assisted birth practitioner (ABP) midwife is extending the traditional scope of midwifery practice to include instrumental vaginal births. A retrospective cohort study was carried out to examine the 6 months immediately after the introduction of ABP midwives into the middle-grade tier of a medical practitioner rota. Maternal and neonatal outcomes of births by ABP midwives were compared to those by medical practitioner. The results were analysed with a combination of independent (P&lt;0.05), Mann-Whitney U and chi-square tests as appropriate. Qualitative data were also collected. Of 57 instrumental vaginal births, 14 were performed by ABP midwives (25%) and 43 by medical practitioners (75%). Baseline demographic characteristics between the two groups were similar. There were no significant differences in maternal outcomes or in neonatal outcomes. Qualitative data were also very positive. These results provide reassurance to both service users and providers. ABP midwives are able to offer a valuable and safe extended role through instrumental births.

Rapid identification of group B streptococcus carriage by PCR to assist in the management of women with prelabour rupture of membranes in term pregnancy

Management of prelabour rupture of membranes at term (37weeks gestation or later) (TPROM) remains complicated in the absence of a rapid assay for group B streptococcus (GBS) colonisation. To evaluate the accuracy and clinical utility of a commercial PCR assay, compared with culture, for detection of GBS colonisation in pregnant women presenting with TPROM. A prospective study of women presenting with TPROM conducted in a large tertiary hospital (Westmead Hospital, Australia). Five hundred and seventy-four consecutive women with TPROM were enrolled between July 2006 and November 2007. Paired low vaginal and anal swabs were collected from women presenting with TPROM for PCR and culture on GBS selective agar following broth enrichment. Primary outcomes were sensitivity and specificity of PCR compared with GBS selective enrichment culture. Secondary analyses included comparison with a historical but otherwise similar cohort regarding clinical utility, maternal and neonatal outcomes. PCR sensitivity and specificity were 89.0% (95% CI - 82.8-93.6%) and 97.9% (95% CI - 96.0-99.0%), respectively, compared with culture. 72.3% of women were aware of their GBS PCR status within 3h of presentation. Compared with the historical cohort, PCR reduced the requirement for intrapartum antibiotics by 25.6% (P<0.001). There were no significant differences in maternal outcomes or combined rates of admissions to neonatal intensive care or special care nursery. Group B streptococcus PCR is an accurate, rapid, safe and practical alternative to culture for detection of GBS colonisation in pregnant women at the time of TPROM. This method has the potential advantage to reduce costs associated with length of hospital stay.

Influenza A/H1N1 MF59 adjuvanted vaccine in pregnant women and adverse perinatal outcomes: multicentre study

Objective To assess the risk of adverse perinatal events of vaccination of pregnant women with an MF59 adjuvanted vaccine.Design Cross sectional multicentre study.Setting 49 public hospitals in major cities in...

A Comparison of Buprenorphine + Naloxone to Buprenorphine and Methadone in the Treatment of Opioid Dependence during Pregnancy: Maternal and Neonatal Outcomes.

Given that buprenorphine + naloxone is prescribed for opioid-dependent pregnant women, it is important to examine the extent to which it differs from buprenorphine alone, methadone, or methadone-assisted withdrawal on neonatal and maternal outcomes. Summary statistics on maternal and neonatal outcomes were collected from 7 previously published studies examining treatment for opioid-dependent pregnant women that represented a range of research methodologies. Outcomes from these studies were compared to the same outcomes for 10 women treated with the combined buprenorphine + naloxone product. There were no significant differences in maternal outcomes for buprenorphine + naloxone compared to buprenorphine, methadone, or methadone-assisted withdrawal. Preliminary findings suggest no significant adverse maternal or neonatal outcomes related to the use of buprenorphine + naloxone for the treatment of opioid dependence during pregnancy. However, further research should examine possible differences between buprenorphine + naloxone and buprenorphine alone or methadone in fetal physical development.

A Focus on the Impact of Bariatric Surgery on Pregnancy Outcome: Effectiveness, Safety and Clinical Management

Due to the increase in obesity worldwide, nowadays about 1 in 5 women are obese when they conceive. Even if the International recommendations on weight gain during pregnancy recommend to treat obesity before a woman becomes pregnant, these suggestions often results fruitless due to the difficulty of losing weight, especially in cases of morbid obesity. On the contrary, bariatric surgery has proven to be the most effective long-term weight loss strategy in obese women in reproductive age. In this review we analyzed the more recent papers describing pregnancy outcome after bariatric surgery. In particular, we focused on weight loss procedures and their potential effects mainly on maternal complications, so to give a comprehensive view of the benefits and risks of post-surgery pregnancy. The present review is structured introducing the pros and cons associated with various surgical procedures, then analyzing the differences in maternal outcomes among pregnant women previously undergone bariatric surgery or not and finally concluding with a focus on the post-surgery clinical management aimed to reduce surgical complications, which may occur during future pregnancies. We concluded that outcome of pregnancy is favorable after bariatric surgery. However, the low number of patients in some studies and the fact that the vast majority of the observations have been performed retrospectively, resulting in errors in matching with the control groups, severely limits the reliability of the conclusions drawn. We highlighted the risks associated with various types of bariatric surgery, stressing the optimization of the screening procedures for nutritional deficiencies and counseling on correct weight gain and nutrition for a successful pregnancy. This aim needs to be achieved with the collaboration of a multidisciplinary team of specialists that work before, during and after delivery.

Heterogeneity of pregnancy outcomes and risk of LGA neonates in Caucasian females according to IADPSG criteria for gestational diabetes mellitus

ObjectiveThe International Association of Diabetes and Pregnancy Study Group (IADPSG) guidelines for gestational diabetes mellitus (GDM) diagnosis determines that fasting, 1-h and 2-h glucose values may contribute independently to adverse outcomes. However, given the different physiological bases of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), differences in pregnancy outcomes are to be expected. This study aimed to determine whether classification of GDM women according to glucose homoeostasis results in heterogeneity in maternal and/or fetal outcomes. Material and methodsOf the 75 pregnant women included after a 75-g 2-h OGTT performed between weeks 24–32 of gestation as per WHO criteria, 55 were classified as GDM (16 with IFG and 39 with IGT) according to IADSPG criteria. Their anthropometric and metabolic characteristics were compared with those of non-GDM women with IFG or IGT. Maternal and neonatal outcomes were prospectively recorded for each group. ResultsGDM women with IFG, including isolated IFG and combined IFG+IGT, were significantly heavier, had higher leptin values and were more frequently multiparous than GDM women with isolated IGT. HOMA-IR was significantly higher when fasting glucose was impaired. There were no significant differences in maternal outcomes according to metabolic status. In addition, large for gestational age (LGA) neonates were significantly seen more often in the IFG group. Fasting glucose was significantly associated with LGA independently of BMI and 2-h OGTT glucose. The>5.1mmol/L cut-off value for fasting glucose was highly predictive of delivery of LGA infants. ConclusionIFG in GDM women was associated with increases in BMI, fat mass and hepatic insulin resistance. Delivery of LGA neonates was more frequent when fasting glycaemia was increased during the third trimester of pregnancy, and was independent of BMI and 2-h OGTT glucose values.

Use of early transverse annular compression sutures for complete placenta previa during cesarean delivery

ObjectiveTo compare the difference in maternal outcomes between early and late use of transverse annular compression sutures (TACS) during cesarean delivery among women with complete placenta previa (CPP). MethodsA retrospective study of 36 women with CPP was conducted. Percentiles of blood loss before TACS were calculated. The transfusion rate, sensitivity, specificity, Youden index, positive predictive value, and negative predictive value were also estimated. Patients were assigned to either the early TACS group or the late TACS group based on the highest Youden index. Maternal outcomes of the 2 groups were compared. ResultsThe Youden index for transfusion rate was highest when blood loss before TACS reached 500mL. Blood loss before intervention in the late TACS group was significantly higher than in the early TACS group (735.0±123.7mL versus 396.9±76.3mL; P<0.001). More women in the late TACS group than in the early TACS group required blood transfusion (60.0% versus 12.5%; P=0.004) and the volume of blood transfused was significantly lower in the early TACS group than in the late TACS group (137.5±377.5mL versus 806.7±619.3mL; P=0.001). ConclusionEarly implementation of TACS could lead to improved maternal outcomes.

Characteristics of hypertensive disorders in twin versus singleton pregnancies

ObjectiveTo determine the characteristics of hypertensive disorders of pregnancy in twin compared with singleton pregnancies. Study designAnalysis of a prospectively recorded database of 4976 hypertensive pregnancies. Main outcome measuresComparison of progression to pre-eclampsia and maternal and neonatal outcomes. ResultsThere were 3942 singleton and 214 twin pregnancies. De novo hypertension in twin pregnancy was diagnosed earlier (p<0.001). In singleton pregnancies with de novo hypertension (n=3161), 60% had an initial diagnosis of gestational hypertension (GH) and 40% had pre-eclampsia (PE). In twin pregnancies with de novo hypertension (n=199), 35% of women were initially diagnosed with GH and 65% with PE (p<0.001). At delivery, 46% of the singletons had GH and 54% had PE, compared with twin pregnancies where 23% had GH and 77 % had PE (p<0.001). The progression from GH to PE for twins was twice that of singleton pregnancies (p<0.001).There were 781 singleton and 15 twin pregnancies with chronic hypertension (CH). Twin pregnancies complicated by CH were more likely to progress to PE than singletons (p<0.01). The gestation at delivery was earlier for twin pregnancies (p<0.001) and there were more twins that were smaller for gestational age (p<0.001). There were no differences in maternal outcomes. ConclusionWomen carrying twins with de novo hypertension are more likely to present earlier, have initial PE and to subsequently progress from GH to PE. Neonatal outcomes are worse in such pregnancies.

780: Utilization of echocardiogram in chronic hypertensive women who are pregnant

hypertensive women who are pregnant Karen Wilson, Scott Roberts, Donald McIntire, James M. Alexander University of Texas Southwestern Medical Center, Obstetrics and Gynecology, Dallas, TX OBJECTIVE: To determine if routinely obtained echocardiograms are indicated in chronic hypertensive women who are pregnant. STUDY DESIGN: All women with chronic hypertension requiring medication for blood pressure control are referred to a specialty clinic. We routinely obtain echocardiograms, in these women, as routine evaluation of their hypertensive disease when they initially present for prenatal care. For this analysis, we compared maternal and neonatal outcomes in women with and without cardiac findings on echocardiogram from January 2008 through December 2010. None of the women had evidence of heart disease at the time of echocardiogram other than their diagnosis of chronic hypertension. RESULTS: Outcomes were analyzed in 125 women with chronic hypertension and 88 women had normal echocardiograms while 37 women had abnormal echocardiograms. There was found to be no significant differences in maternal outcomes and the incidence of preeclampsia. CONCLUSION: Abnormal echocardiogram findings are common in women with chronic hypertension; however pregnancy outcomes are not impacted by these findings if they are otherwise asymptomatic.

Pregnancy outcome in immigrant women with gestational diabetes mellitus

Recent studies show adverse outcomes of pregnancy among immigrant women from countries with high diabetes rates. We compared maternal and fetal outcomes in immigrant and Italian women with gestational diabetes mellitus (GDM) followed up at our center. Maternal characteristics considered were age, pre-pregnancy body mass index (BMI), HbA1c, frequency of insulin treatment, timing and mode of delivery, and hypertensive disorders; and, for fetal outcome, infants large or small for gestational age, and fetal complications. Pre-pregnancy BMI and HbA1c were higher in immigrant GDM women than in Italians, and more of them were on insulin. No differences in maternal outcome emerged between the two groups. More large for gestational age (LGA) babies were born to immigrant women than to Italians, but no other differences emerged. Apart from newborn LGA, maternal and fetal outcomes were comparable in our immigrant and Italian GDM women. Immigrant GDM women have favourable outcomes if given access to health care and language and cultural barriers are removed.

Chlorhexidine Vaginal and Infant Wipes to Reduce Perinatal Mortality and Morbidity

To estimate the effects of chlorhexidine vaginal and baby wipes on fetal and neonatal mortality, respectively, and infection-related morbidity. We performed a placebo-controlled, randomized trial of chlorhexidine vaginal and neonatal wipes to reduce neonatal sepsis and mortality in three hospitals in Pakistan. The primary study outcome was a composite of neonatal sepsis or 7-day perinatal mortality. From 2005 to 2008, 5,008 laboring women and their neonates were randomly assigned to receive either chlorhexidine wipes (n=2,505) or wipes with a saline placebo (n=2,503). The primary outcome was similar in the chlorhexidine and control groups (3.1% compared with 3.4%; relative risk 0.91, 95% confidence interval 0.67-1.24) as was the composite rate of neonatal sepsis or 28-day perinatal mortality (3.8% compared with 3.9%, relative risk 0.96, 95% confidence interval 0.73-1.27). At day 7, the chlorhexidine group had a lower rate of neonatal skin infection (3.3% compared with 8.2%, P<.001). With the exception of less frequent 7-day hospitalization in the chlorhexidine group, there were no significant differences in maternal outcomes between the groups. Using maternal chlorhexidine vaginal wipes during labor and neonatal chlorhexidine wipes does not reduce maternal and perinatal mortality or neonatal sepsis. The finding of reduced superficial skin infections on day 7 without change in sepsis or mortality suggests that this difference, although statistically significant, may not be of major importance. I.

Using Matched Groups to Explore Child Behavior Problems and Maternal Well-Being in Children with Down Syndrome and Autism

Mothers of children with Down syndrome, autism, and mixed etiology intellectual disabilities, matched on child age, gender, and communication skills (n = 19 in each group) completed measures of their child's adaptive and problem behaviors, their own parenting stress, and positive perceptions of their child. Children with autism were rated as having more problem behaviors and lower levels of social competence than children with Down syndrome and mixed etiology intellectual disabilities. Mothers of children with autism scored lower on positive perceptions of their child, and higher on stress than the other two groups. After selecting closely matched groups, we found several group differences in child behavior but little evidence of group differences in maternal outcomes.

284: Maternal complications vary among different Asian-American subgroups

GROUPS LUCHIN WONG, AARON CAUGHEY, SANAE NAKAGAWA, ANJALI KAIMAL, SUSAN H. TRAN, YVONNE CHENG, Albert Einstein College of Medicine, Bronx, New York, University of California, San Francisco, San Francisco, California, University of California, San Francisco, , California OBJECTIVE: To investigate the differences in maternal outcomes between various Asian subgroups at a national level. STUDY DESIGN: This is a retrospective cohort study of all non-Hispanic Chinese, Japanese, Filipino, Asian Indian, Korean, Samoan, and Vietnamese women whose deliveries were recorded in U.S. birth certificates. Perinatal outcomes were compared between groups and potential confounders controlled for with multivariable logistic regression. RESULTS: The incidence of diabetes, pregnancy associated hypertension, and primary cesarean delivery was significantly different among the different subgroups of Asian-Americans (Table 1). These differences remained significant after adjusting for maternal age, Asian subgroup, gestational age at delivery, parity, residence status, marital status, and chronic hypertension. CONCLUSION: Our study demonstrates the presence of significant differences in diabetes, pregnancy associated hypertension, and primary cesarean section among Asian-American subgroups, affirming the importance of examining these subgroups separately.