Differences In Maternal Demographics Research Articles

A randomized trial assessing the impact of educational podcasts on personal control and satisfaction during childbirth

Childbirth education can help pregnant individuals feel in control, relieve anxiety and fear, and decrease pain perception. However, many barriers exist that impede patients from obtaining adequate childbirth education, especially in the era of the COVID-19 pandemic. Advances in technology, such as podcasts, can allow for asynchronous patient education. This study aimed to assess the effect of a labor education podcast on personal perception of control and patient satisfaction during childbirth. This was a randomized controlled trial that included nulliparous, low-risk women with singleton gestations who reached 36 weeks' gestation at 2 academic hospitals in Philadelphia, Pennsylvania. Participants were randomized at 28 weeks and 0 days of gestation to usual education (control) or podcast education (intervention), which included links to 7 labor-related podcast episodes on patient-suggested topics that were available on widely-used podcatchers. Primary outcomes were assessed with a 3-question birth satisfaction survey and the Labour Agentry Scale to evaluate personal perception of control during childbirth. Secondary outcomes included the Edinburgh Postnatal Depression Scale score. Analyses were performed as intention-to-treat. Parametric and nonparametric data were compared using the Student t-test or Wilcoxon rank-sum test, as appropriate. A total of 201 women were randomized, and 153 were included in the final analysis (78 in podcast and 75 in control group). There were no significant differences in maternal demographics. Patients in the podcast group had higher median birth satisfaction scores compared with the control group (20 [18-21] vs 18 [16-21]; P=.002), without a significant difference in median Labour Agentry Scale scores (57 [50-63] vs 54 [47-62]; P=.12). When restricting analysis to patients who underwent induction, Labour Agentry Scale scores were significantly higher in the podcast group (58 [53-64] vs 54 [47-61]; P=.045), representing an increased perception of control. However, birth satisfaction score was not different between the groups (P=.06). The most downloaded podcasts were on induction and labor anesthesia. More than 95% of participants would recommend the podcasts to family and friends. An educational podcast on labor topics was well-received, increased patient satisfaction overall, and increased labor agentry among those who were induced. Podcasts are a promising educational modality to improve patient experience during childbirth, and warrant further exploration.

Effect of preoperative low-normal cervical length on perinatal outcome after laparotomy-assisted fetoscopic spina bifida repair.

To determine if preoperative cervical length in the low-normal range increases the risk of adverse perinatal outcome in patients undergoing fetoscopic spina bifida repair. This was a retrospective cohort study of patients who underwent fetal spina bifida repair between September 2014 and May 2022 at a single center. Cervical length was measured on transvaginal ultrasound during the week before surgery. Eligibility for laparotomy-assisted fetoscopic spina bifida repair was as per the criteria of the Management of Myelomeningocele Study, although maternal body mass index (BMI) up to 40 kg/m2 was allowed. Laparotomy-assisted fetoscopic spina bifida repair was performed, with carbon dioxide insufflation via two 12-French ports in the exteriorized uterus. All patients received the same peri- and postoperative tocolysis regimen, including magnesium sulfate, nifedipine and indomethacin. Postoperative follow-up ultrasound scans were performed either weekly (< 32 weeks' gestation) or twice a week (≥ 32 weeks). Perinatal outcome was compared between patients with a preoperative cervical length of 25-30 mm vs those with a cervical length > 30 mm. Logistic regression analyses and generalized linear mixed regression analyses were used to predict delivery at less than 30, 34 and 37 weeks' gestation. The study included 99 patients with a preoperative cervical length > 30 mm and 12 patients with a cervix 25-30 mm in length. One further case which underwent spina bifida repair was excluded because cervical length was measured > 1 week before surgery. No differences in maternal demographics, gestational age (GA) at surgery, duration of surgery or duration of carbon dioxide uterine insufflation were observed between groups. Cases with low-normal cervical length had an earlier GA at delivery (median (range), 35.2 (25.1-39.7) weeks vs 38.2 (26.0-40.9) weeks; P = 0.01), higher rates of delivery at < 34 weeks (41.7% vs 10.2%; P = 0.01) and < 30 weeks (25.0% vs 1.0%; P < 0.01) and a higher rate of preterm prelabor rupture of membranes (PPROM) (58.3% vs 26.3%; P = 0.04) at an earlier GA (mean ± SD, 29.3 ± 4.0 weeks vs 33.0 ± 2.4 weeks; P = 0.05) compared to those with a normal cervical length. Neonates of cases with low-normal cervical length had a longer stay in the neonatal intensive care unit (20 (7-162) days vs 9 (3-253) days; P = 0.02) and higher rates of respiratory distress syndrome (50.0% vs 14.4%; P < 0.01), sepsis (16.7% vs 1.0%; P = 0.03), necrotizing enterocolitis (16.7% vs 0%; P = 0.01) and retinopathy (33.3% vs 1.0%; P < 0.01). There was an association between preoperative cervical length and risk of delivery at < 30 weeks which was significant only for patients with a maternal BMI < 25 kg/m2 (odds ratio, 0.37 (95% CI, 0.07-0.81); P = 0.02). Low-normal cervical length (25-30 mm) as measured before in-utero laparotomy-assisted fetoscopic spina bifida repair may increase the risk of adverse perinatal outcomes, including PPROM and preterm birth, leading to higher rates of neonatal complications. These data warrant further research and are of critical relevance for clinical teams considering the eligibility of patients for in-utero spina bifida repair. Based on this evidence, patients with a low-normal cervical length should be aware of their increased risk for adverse perinatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Intramuscular progesterone in women with twins and a prior singleton spontaneous preterm birth

Although the use of 17-alpha-hydroxyprogesterone caproate is one of the most commonly used strategies to reduce the risk of preterm birth since its approval by the Food and Drug Administration in 2011, there has been controversy recently that there may be no benefit associated with its use in singleton pregnancies in women with a prior history of spontaneous preterm birth. However, very few of these investigations evaluated the use of intramuscular progesterone in twin pregnancies. A few studies that used 17-alpha-hydroxyprogesterone caproate in twin pregnancies had mainly included unselected twin pregnancies. Although a twin pregnancy is independently associated with an increased likelihood of preterm birth, the primary indication for the use of supplemental progesterone in pregnancy is prior history of spontaneous preterm birth. Therefore, our investigation of weekly intramuscular progesterone in twin pregnancies with this birth history best addresses this question using a selected cohort. To assess whether weekly 17-alpha-hydroxyprogesterone caproate prevents recurrent preterm birth in women with a current twin pregnancy and a prior singleton spontaneous preterm birth. This was a retrospective cohort study of women with twin pregnancy and a prior singleton spontaneous preterm birth in 2 institutions between January 2005 and December 2016. One group (intervention group) consisted of women who received weekly 17-alpha-hydroxyprogesterone caproate, whereas the other (control group) did not. The primary outcome was twin spontaneous preterm birth <34 weeks compared with odds ratio and adjusted odds ratio, adjusting for potential confounders. Secondary outcomes included composite neonatal morbidity such as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, admission to the neonatal intensive care nursery, and fetal or neonatal death before hospital discharge. A total of 79 patients were included; 27 women received weekly 17-alpha-hydroxyprogesterone caproate and 52 did not. There were no statistically significant differences in maternal demographics except for age. Spontaneous preterm birth <34 weeks occurred in 16 patients (59%) in the intervention group vs 24 (46%) in the control group (odds ratio, 1.69; 95% confidence interval, 0.68-4.54). Composite neonatal morbidity occurred in 20 pregnancies (74%) in the intervention group and 41 pregnancies (79%) in the control group (odds ratio, 0.76; 95% confidence interval, 0.27-2.12). There remained no differences in outcomes after adjusting for potential confounders. In our study, weekly 17-alpha-hydroxyprogesterone caproate did not prevent spontaneous preterm birth or neonatal morbidity in women with twins and a prior singleton spontaneous preterm birth; however, further research with larger numbers and prospective design is needed.

Pregnancy outcomes in association with placental histopathology in pregnancies complicated by macrosomia in diabetic vs. non-diabetic women

ObjectiveWe aimed to compare pregnancy outcomes in association with placental pathology in pregnancies complicated by macrosomia in diabetic vs. non-diabetic women. Study designPregnancies complicated by macrosomia (≥4000gr) were included. Pregnancy and delivery characteristics, neonatal outcomes and placental histopathology reports were compared between macrosomia in diabetic [pre-gestational or Gestational Diabetes Mellitus (GDM)] women (diabetic-macrosomia group) vs. non-diabetic women (non-diabetic macrosomia group). Adverse neonatal outcome was defined as ≥1 neonatal complications. Multivariate analysis was used to identify independent associations with adverse neonatal outcome. ResultsThe diabetic macrosomia group (n = 160) was characterized by higher maternal age (p = 0.002), Body Mass Index (BMI) (p < 0.001), and smoking (p = 0.03), and lower gestational age at delivery (p = 0.001). The diabetic-macrosomia group had higher rates of scheduled Cesarean deliveries (CDs) (58.9 % vs23.7 %,p < 0.001) while the non-diabetic macrosomia group (n = 214) had higher rates of emergent CDs (76.3 % vs.40.7 %,p < 0.001), perineal tears (p = 0.027) and Post Partum Hemorrhage (PPH) (p = 0.006). Placentas from the non-diabetic macrosomia group were characterized by higher rates of maternal and fetal inflammatory response lesions (p < 0.001). Except for higher jaundice rate in the diabetic macrosomia group (p < 0.001), none of the other neonatal outcomes including shoulder dystocia differed between the groups. In multivariate analysis GA < 37 weeks (aOR = 1.4,95 %,CI-1.2–3.9), and emergent CDs (aOR = 1.7,95 %,CI-1.4–4.1) but not diabetes (aOR = 1.1,95 %,CI-0.7–3.9) were associated with adverse neonatal outcome. ConclusionsDespite major differences in maternal demographics, mode of delivery, maternal morbidity, and placental characteristics- adverse neonatal outcome did not differ between macrosomia in diabetic vs. non-diabetic women and was high in both groups. Clinicians should be aware of the high rate of adverse neonatal outcome in macrosomic fetuses, even in the absence of diabetes mellitus.

The impact of baseline proteinuria in pregnant women with pregestational diabetes mellitus

The incidence of diabetes in pregnancy has increased dramatically with the rising rates of obesity. Because there are a number of recognized adverse maternal and fetal outcomes associated with diabetes, there have been several attempts to classify this disorder for perinatal risk stratification. One of the first classification systems for pregnancy was developed by White nearly 70 years ago. More recently, efforts to stratify diabetic disease severity according to vasculopathy have been adopted. Regardless of classification system, vasculopathy-associated effects have been associated with worsening pregnancy outcomes. Defining vasculopathy within an organ system, however, has not been consistent. For example, definitions of diabetic kidney disease differ from the previously used threshold of ≥500 mg/d by White for pregnancy to varying thresholds of albuminuria by the American Diabetes Association. To evaluate a proteinuria threshold that was a relevant determinant of perinatal risk in a cohort of women with type 2 diabetes. This was a retrospective cohort study of women with pregestational diabetes delivered of nonanomalous, singleton, liveborn infants. All women were assessed for baseline maternal disease burden with a 24-hour proteinuria quantification performed before 20 weeks' gestation. Women with <500 mg/d on 24-hour urine collections were included. Perinatal outcomes were analyzed according to the following protein excretion values: 50-100, 101-200, 201-300, and 301-499 mg/d. Based on trends noted in these results and using the prior definition of the American Diabetes Association of 300 mg/d of albumin for diabetic kidney disease, women were then analyzed according to 24-hour urine collections of ≤300 or >300 mg/d. Between 2009 and 2016, a total of 594 women with pregestational diabetes were found to meet study criteria. When analyzed according to protein excretion values 50-100, 101-200, 201-300, and 301-499 mg/d, there were no differences in maternal demographics. The rate of preeclampsia with severe features (P for trend= .02), preterm birth at <37 weeks (P for trend <.001), and birthweight <10th percentile (P for trend= .02) were significantly associated with increasing proteinuria excretion, with the highest rates in the >300 mg/d group. Perinatal outcomes were then examined in the context of 24-hour urine protein excretion values of ≤300 or >300 mg/d, with no differences in maternal demographics. Protein excretion values >300 mg/d were significantly associated with preterm birth <37 weeks (P= .003), preeclampsia with severe features (P= .002), and birthweight <10th percentile (P= .048). White's classification in 1949 was developed to stratify perinatal risks based on maternal disease burden, and it was found that urinary protein excretion of >500 mg/d was associated with adverse pregnancy outcomes. In a contemporary cohort of pregnant women, proteinuria >300 mg/d was associated with preterm birth, preeclampsia with severe features, and birthweight <10th percentile.

When is the right time to remove staples after an elective cesarean delivery?: a randomized control trial

Objective: To determine if there are differences in scar healing and cosmetic outcome between early and late metal staples removal after cesarean delivery.Study design: Randomized controlled trial, in which patients undergoing a scheduled nonemergent cesarean delivery were randomly assigned to early staples removal versus late staples removal. Outcome assessors were blinded to group allocation. Scars were evaluated 8 weeks after cesarean delivery. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) scores. Secondary outcome measures included surgical site infection, wound disruption, hematoma, or seroma.Results: During the study period, 104 patients were randomized. There were no between-group differences in maternal demographics. Both groups had similar indications for cesarean delivery and similar rate of previous one or more cesarean delivery. Patient and Observer Scar Assessment Scale were similar for patients (p = .932) and for physician observer (p = .529). No significant differences were demonstrated between the groups in the rate of surgical site infection or wound disruption.Conclusions: Removal of stainless steel staples on postoperative 4 versus postoperative 8 after cesarean delivery showed similar outcome without significant effect on incision healing. Therefore, timing of removal staples after cesarean delivery could be performed based on patients and surgeon preference.

911: Fetal growth restriction in smaller twin of monochorionic diamniotic pair with discordant estimated fetal weights

To identify predictors of selective fetal growth restriction (sFGR) in the smaller twin of a monochorionic diamniotic (MCDA) pair complicated by estimated fetal weight discordance (EFWD) of at least 20%. This was a retrospective cohort study of all MCDA twin pregnancies evaluated at a single institution from 2008 to 2018. Inclusion criteria were EFWD ≥ 20% before 27 weeks and adequate ultrasound (US) information to assess for interval growth until delivery, defined as last US within 5 weeks of delivery. We excluded those with major structural anomalies, pregnancies that were terminated, those that developed twin-twin transfusion syndrome, and those that developed polyhydramnios. The primary outcome was development of sFGR in the smaller twin, defined as estimated fetal weight ≤ 10th percentile for gestational age (GA). Predictors included maternal demographics (age, nulliparity, and use of assisted reproductive technology), US findings (cord insertion of smaller twin and presence of arterio-arterial anastomosis), and details at time of EFWD diagnosis (GA at diagnosis and degree of EFWD). The Kruskal-Wallis test generated median values for non-parametric continuous variables, and Fisher’s exact tests compared proportions between categorical variables. A total of 38 MCDA pairs met the inclusion criteria, with 26 (68%) developing sFGR at a median GA of 23.9 weeks (20.7-35.1). There were no statistically significant differences in maternal demographics, US findings, or GA at time of EFWD diagnosis comparing those who developed sFGR and those who did not. The sFGR group had a greater degree of EFWD at initial diagnosis, which approached but did not reach statistical significance (median EFWD 32.8% vs 29.2%, p = 0.055). The relative risk of developing sFGR with initial EFWD ≥ 30% was 1.3 (95% CI 0.8-2.1). The majority of MCDA twins with EFWD ≥ 20% ultimately develop sFGR in the smaller twin. While a statistically significant difference was not reached, we did observe a trend toward a greater degree of EFWD being associated with subsequent development of sFGR. Larger studies are required to further evaluate this finding and to enable providers to risk-stratify MCDA pairs with EFWD.

531: Neonatal outcomes following administration of antenatal corticosteroids in the late preterm period

The objective of this study was to determine the incidence of neonatal respiratory morbidity in infants born at 34-36 weeks gestation since the implementation of late preterm corticosteroid administration. A retrospective cohort study was performed on patients who delivered between 1/1/2015 and 4/24/2018 at a single institution. The study group included women who received 2 doses of 12 mg IM betamethasone 24 hours apart between 34/0 and 36/6 weeks. A historical cohort consisted of patients who delivered between 34/0 and 36/6 who did not receive betamethasone. Primary outcomes included a composite of respiratory treatment (rates of neonates requiring respiratory support in first 72 hours after delivery including continuous positive airway pressure (CPAP) or nasal cannula for at least 2 hours, supplemental oxygen with fraction of inspired oxygen of at least 0.30 for at least 4 hours, mechanical ventilation) and the rates of neonatal hypoglycemia (<44 mg/dL). A total of 376 patients were included – 121 patients who received late preterm steroids and 255 patients who served as a historical control. Preliminary data demonstrates no statistically significant differences in maternal demographics. A statistically significant difference in birthweight was initially noted between the groups (p < 0.001) however when controlled for there was no difference (p = 0.206). Initially, there was no statistically significant difference between the groups of neonates requiring respiratory treatment in the first 72 hours (p = 0.069), however, results became statistically significant when birthweight was controlled (p = 0.045). Neonates within the betamethasone group had higher rates of hypoglycemia compared to the control group (p = 0.012). The significance was retained even after controlling for the birthweight (p = 0.007). Administration of late preterm antenatal steroids was associated with lower rates of neonatal respiratory treatment. Exposed neonates had higher rates of hypoglycemia and need for supplemental treatment, in addition, the percentage observed were substantially higher than previous reports. Our results support past investigations.

Does Pregnancy Weight Gain Increase the Risk of Metformin Failure in the Treatment of Gestational Diabetes? [35D

INTRODUCTION: To determine if maternal weight gain is associated with a higher risk of metformin failure in women with gestational diabetes (GDM). METHODS: A retrospective cohort study of women with GDM was conducted from 2013-2016. Included in the study were women with GDM started on metformin after a failed trial of diet therapy. Excluded from the study were women with pre-existing diabetes mellitus. Women were categorized as having adequate glycemic control on metformin (metformin success) or requiring the addition of or transition to an insulin regimen (metformin failure). Metformin failure was defined as the inability to obtain glycemic control despite utilization of the maximum metformin dosage, or provider discretion. Maternal demographics and weight parameters were collected from the medical records and compared between the 2 groups. Parametric and nonparametric statistical analyses were performed with a p value of &lt; 0.05 as statistically significant. RESULTS: A total of 146 women with GDM were identified, of which 21 women (14%) failed metformin therapy. There were no differences in maternal demographics. Although the overall weight gain in pregnancy was not statistically significant between the 2 groups, mothers who failed metformin therapy had significantly less weight gain from pre-pregnancy to GDM diagnosis and higher weight gain from GDM diagnosis to delivery compared to those who did not fail metformin therapy. CONCLUSION: Women who were successfully treated with metformin, gained less weight after GDM diagnosis. Providers should consider weight gain in pregnancy in counseling women regarding their risk of metformin failure in the treatment of GDM.

Can the 2-hour Glucose Tolerance Test (GTT) Values Predict Metformin Failure in Women with Gestational Diabetes? [14E

INTRODUCTION: To determine if the GTT values have utility in predicting metformin failure in women with gestational diabetes (GDM). METHODS: A retrospective cohort study of women with GDM was conducted from 2013-2016. Included in the study were women with GDM started on metformin after a failed trial of diet therapy. Excluded from the study were women with pre-existing DM, or were started on glyburide or insulin therapy initially. Women were categorized as having adequate glycemic control on metformin (metformin success) or requiring the addition of or transition to an insulin regimen (metformin failure). Maternal demographics and GTT values were collected. The sensitivity and the specificity of the GTT values as a screening test for metformin failure were analyzed and the corresponding ROC curves were plotted to assess the performance of the test. Parametric and nonparametric statistical analyses were performed with a p value of &lt;0.05 as significant. RESULTS: A total of 118 gestational diabetics were identified, 19 (16.1%) women failed metformin therapy. There were no significant differences in maternal demographics between groups. A ROC curve of the fasting GTT value revealed that a value of 103mg/dL was best predictive of metformin failure (AUC 0.653; p 0.04, with a sensitivity and specificity of 42% and 90% respectively. The ROC curves of the 1 hour value and 2 hour value on the GTT were not statistically significant (AUC 0.578, p 0.28; and AUC 0.579, p0.28 respectively). CONCLUSION: An elevated fasting GTT value may help predict metformin failure in women with GDM.

Can Initial Glycemic Control Predict Metformin Failure in Women with Gestational Diabetes? [38B

INTRODUCTION: To determine if glycemic control prior to medication initiation predicts metformin failure in women with gestational diabetes (GDM). METHODS: A retrospective cohort study of women with GDM was conducted from 2013-2016. Included in the study were women with GDM started on metformin after a failed trial of diet therapy. Excluded from the study were women with pre-existing DM. Women were advised to take fasting and 1-hour postprandial finger sticks. Women were categorized as having adequate glycemic control on metformin (metformin success) or requiring the addition of or transition to an insulin regimen (metformin failure). Maternal demographics and average blood glucose (BG) values were collected. The sensitivity and the specificity of BG values as a screening test for metformin failure were analyzed and the corresponding ROC curves were plotted to assess the performance of the test. Parametric and nonparametric statistical analyses were performed with a p value of &lt;0.05 as significant. RESULTS: A total of 118 gestational diabetics were identified, 19 (16.1%) women failed metformin therapy. There were no significant differences in maternal demographics in the groups. Compared to the metformin success group, those in the metformin failure group had significantly higher fasting BG values prior to medical management. Postprandial BG values were not different between groups. A ROC curve of the average fasting BGs revealed that a value of 90mg/dl was best predictive of metformin failure (AUC 0.74; p 0.002), with a sensitivity and specificity of 90% and 79% respectively. CONCLUSION: Elevated fasting BG values may predict metformin failure in women with GDM.

Abstract P290: Maternal Aerobic Exercise Intervention Improves Fetal Heart and Growth Measures

Introduction: Self-reported maternal exercise is associated with improved heart and body size measures in the fetus. Currently, there is a gap in understanding how regular maternal aerobic exercise at recommended levels (150 min/wk) for pregnancy influence heart and body size in utero. Hypothesis: We assessed the hypothesis that offspring of women randomized to aerobic exercise will have lower heart rate (HR), higher ejection fractions (EF), and lighter fetal weight than offspring of women in the control group. Methods: Healthy pregnant women were randomly assigned to aerobic exercise or no intervention. Women performed aerobic activity at a moderate intensity for 150 min/wk from 16 weeks until delivery. Maternal demographics (age, pre-pregnancy BMI) as well as other activities were self-reported. Based on type and intensity, activities were converted to METs and then combined to yield METmin per week (METs X frequency per week X duration in minutes). A sonographer blinded to group assignment recorded fetal ultrasound. Data from 27 pregnancies (16 exercise, 11 control) were analyzed. To compare differences between groups (Active only=A; Quiet only=Q) independent t -tests were performed while regression analysis was conducted to determine predictors of fetal HR, our primary outcome. Results: Of the 16 exercisers, 6 were excluded (compliance 51-74%); the remaining 10 had &gt;80% compliance. There were no group differences in maternal demographics, i.e., age and pre-pregnancy BMI. All values were in the normal range for fetal heart and body size measures. While not statistically significant, there was trend for fetal HR to be lower in exercisers (p=0.14) while aortic (p=0.05) and pulmonary (p=0.22) diameter, right ventricular (RV) EF (p=0.17), and left ventricular (LV) EF (p=0.18) were slightly higher compared to controls. In the A state , the female HR of exercisers were lower (p=0.05), while male left ventricular (LV) EF (p=0.006), and all fetuses right ventricular (RV) EF (p=0.07) were increased relative to same gender controls. In the Q state , female aortic diameter (p=0.11) and all fetuses’ pulmonary diameter (p=0.04) were increased in exercisers relative to same gender controls. Exercise level during pregnancy was a significant predictor of fetal HR (R 2 =0.10; p=0.01). Fetal head to abdominal circumference ratio was appropriate in exercisers (1.0±0.1) relative to control (0.985±0.1) fetuses (p=0.09). The fetuses of exercisers were slightly lighter relative to fetuses of controls (p=0.20). Conclusion: These preliminary data support the positive influence of aerobic exercise at recommended levels on fetal health outcomes during pregnancy.

Racial/ethnic differences in preterm perinatal outcomes

Racial disparities in preterm birth and infant death have been well documented. Less is known about racial disparities in neonatal morbidities among infants who are born at <37 weeks of gestation. The purpose of this study was to determine whether the risk for morbidity and death among infants who are born preterm differs by maternal race. A retrospective cohort design included medical records from preterm deliveries of 19,325 black, Hispanic, and white women in the Consortium on Safe Labor. Sequentially adjusted Poisson models with generalized estimating equations estimated racial differences in the risk for neonatal morbidities and death, controlling for maternal demographics, health behaviors, and medical history. Sex differences between and within race were examined. Black preterm infants had an elevated risk for perinatal death, but there was no difference in risk for neonatal death across racial groups. Relative to white infants, black infants were significantly more likely to experience sepsis (9.1% vs 13.6%), peri- or intraventricular hemorrhage (2.6% vs 3.3%), intracranial hemorrhage (0.6% vs 1.8%), and retinopathy of prematurity (1.0% vs 2.6%). Hispanic and white preterm neonates had similar risk profiles. In general, female infants had lower risk relative to male infants, with white female infants having the lowest prevalence of a composite indicator of perinatal death or any morbidity across all races (30.9%). Differences in maternal demographics, health behaviors, and medical history did little to influence these associations, which were robust to sensitivity analyses of pregnancy complications as potential underlying mechanisms. Preterm infants were at similar risk for neonatal death, regardless of race; however, there were notable racial disparities and sex differences in rare, but serious, adverse neonatal morbidities.

Oligohydramnios and growth restriction do not portend worse prognosis in gastroschisis pregnancies

Objectives: Gastroschisis is a common abdominal wall defect. While most neonates have an excellent prognosis, complications do occur. Several risk factors for adverse neonatal outcomes have been identified, however, the impact of intrauterine growth restriction (IUGR) and oligohydramnios on neonatal morbidity and mortality has not been fully elucidated. Methods: In this retrospective cohort study of pregnancies complicated by gastroschisis at two tertiary-care centers during an eight-year period, maternal, fetal and neonatal data were analyzed to estimate the impact of IUGR and oligohydramnios upon neonatal outcomes. Adverse outcomes were defined as five-minute Apgar score <7, umbilical cord pH <7.12, neonatal sepsis, prolonged ventilator support, prolonged total parenteral nutrition, extended NICU stay, death and a composite of the above. Results: Among the 179 cases of gastroschisis, there were no differences in maternal demographics between cases with and without IUGR or oligohydramnios. Fetuses with oligohydramnios demonstrated a trend toward lower birthweight (p = 0.06). Small for gestational age infants showed a trend toward prolonged ventilator support (p = 0.06). Oligohydramnios and IUGR were otherwise not associated with adverse neonatal outcomes. Conclusions: While risk factors for adverse neonatal outcomes have been identified in pregnancies complicated by gastroschisis, IUGR and oligohydramnios do not appear to be among them.

The Effect on Latency Beyond 24 Weeks of Gestation Based on Cerclage Indication

INTRODUCTION: Cervical insufficiency is characterized by recurrent painless cervical dilation and spontaneous midtrimester delivery. Diagnosis is clinical and retrospective, often ending in poor obstetric outcomes. Management involves cerclage, which is placed based on history of recurrent spontaneous preterm birth or midtrimester loss. Other indications are evidence of cervical shortening and midtrimester dilation determined by sonographic or physical examination. Although previous studies demonstrate the benefits of history-indicated cerclages, there are few studies defining outcomes of ultrasound examination–indicated and physical examination–indicated cerclages as compared with history-indicated cerclages. METHODS: We reviewed records of patients undergoing cerclage at a single center between January 1, 2008 and January 1, 2013. Cases consisted of women with ultrasound examination–indicated or physical examination–indicated cerclages and women in a control group compromised women with history-indicated cerclages. The primary outcome measured was latency beyond 24 weeks of gestation. Statistical analysis was done using commercially available software. Categorical variables were analyzed using χ2 test and continuous variables were analyzed using Student's t test or Fisher's exact test where appropriate. P=.05 was considered significant. RESULTS: Sixty patients were included. There were no differences in maternal demographics among the women in the case group and those in the control group. The women in the control group were more likely to have had a cerclage in a prior pregnancy. Mean latency beyond 24 weeks of gestation in women in the case group and those in the control group was 7 and 8 weeks, respectively (P=.49). CONCLUSIONS: In pregnancies that reach 24 weeks of gestation, there is no difference in latency between those with history-indicated cerclages and ultrasound examination–indicated or physical examination–indicated cerclages. This information can be used to better counsel women with cervical insufficiency on expected outcomes.

Increasing Parity Is Associated with Cumulative Effects on Memory

The purpose of this investigation was to determine if reproductive experience is associated with cumulative effects on human memory performance during pregnancy and if these effects persist into the postpartum period. Verbal recall memory performance was assessed in 254 women four times during pregnancy and at 3 months postpartum. The relation between parity and memory function was evaluated with hierarchical linear modeling and analysis of covariance (ANCOVA). The data indicate that the previously documented adverse effects of pregnancy on memory performance are compounded with successive pregnancies. During gestation and postpartum, multiparity was associated with poorer memory function, and these effects did not appear to be due to differences in maternal demographics, depressive symptoms, or sleep quality. Animal models demonstrate that the effects of reproduction on brain structure and function are both cumulative and enduring. However, little is known about the influence of reproductive experience on the human female brain. These findings provide evidence that in humans, reproduction is associated with striking and perhaps persisting changes in cognitive function.

SNIPPV vs NIPPV: does synchronization matter?

BackgroundUse of nasal intermittent positive pressure ventilation (NIPPV) in the neonatal intensive care unit (NICU) has shown promise with better clinical outcomes in premature neonates. It is not known if synchronization makes a significant clinical impact when using this technique.ObjectiveTo compare clinical outcomes of premature infants on synchronized NIPPV (SNIPPV) vs. NIPPV in the NICU.Design/MethodsRetrospective data were obtained (1/04 to 12/09) of infants who received NIPPV anytime in the NICU. SNIPPV (Infant Star with StarSync) was utilized from 2004–06, while NIPPV (Bear Cub) was used from 2007–09. BPD was defined using the NIH consensus definition. Unadjusted associations between potential risk factors and BPD/death were assessed using the chi-square or Wilcoxon Rank Sum test. Adjusted analyses were performed using generalized linear mixed models, taking into account correlation among infants of multiple gestation.ResultsThere was no significant difference in the mean gestational age and birth weight in the 2 groups: SNIPPV (n=172; 27.0w; 1016g), NIPPV (n=238; 27.7w; 1117g). There were no significant differences in maternal demographics, use of antenatal steroids, gender, multiple births, SGA, or Apgar scores in the 2 groups. More infants in the NIPPV group were given resuscitation in the delivery room (SNIPPV vs. NIPPV: 44.2% vs. 63%, p<0.001). Surfactant use (84.4% vs. 70.2%; p<0.001) was significantly higher in the SNIPPV group. There were no differences in the rate of PDA, IVH, PVL, ROP, and NEC in the 2 groups. After adjusting for the significant variables, use of NIPPV vs. SNIPPV (OR 0.74; 95%CI: 0.42, 1.30) was not associated with BPD/death.ConclusionsThese data suggest that use of SNIPPV vs. NIPPV is not significantly associated with a differential impact on clinical outcomes.

Pregnancy Outcomes in Women With Thyroid Peroxidase Antibodies

To estimate the prevalence of antithyroid peroxidase antibodies in the general obstetric population and to compare pregnancy outcomes in women who are antithyroid peroxidase-antibody positive with those who are antithyroid peroxidase-antibody negative. Between November 2000 and April 2003, all women who presented for prenatal care underwent thyroid screening. Serum samples from women without clinical hypothyroidism who had been screened in the first 20 weeks of gestation and delivered a singleton newborn weighing 500 g or more were analyzed for concentrations of antithyroid peroxidase antibodies. Serum thyroid peroxidase antibody levels were determined using a chemiluminescent immunoassay. Pregnancy outcomes in women with positive antithyroid peroxidase antibodies (more than 50 international units/mL) were compared with those with negative levels. Serum samples from 17,298 women were tested. Of these, 1,012 (6%) women were identified with positive antithyroid peroxidase antibodies. Women who were antithyroid peroxidase-antibody positive were older, heavier, and more often parous than women with negative antithyroid peroxidase antibodies. Rate of placental abruption was threefold higher in women with antithyroid peroxidase antibodies (1.0% compared with 0.3%, odds ratio 3.4, 95% confidence interval 1.7-6.7) after adjustment for differences in maternal demographics. Seven of the 10 abruptions associated with antithyroid peroxidase antibody occurred in women with normal thyroid-stimulating hormone and free thyroxine levels. Antithyroid peroxidase antibodies are present in 6% of the general obstetric population and are associated with a threefold increase in the rate of placental abruption. However, this increase in placental abruption does not currently warrant routine antithyroid antibody screening during pregnancy. II.

The Apparently Stillborn Infant: Risk Factors, Incidence, and Neonatal Outcome

We evaluated neonatal outcomes of apparently stillborn infants. The apparently stillborn neonate is born with an unexpected Apgar score of 0 at 1 minute and is subsequently successfully resuscitated. A retrospective cohort study was performed using electronic medical records for neonates >24 weeks' gestation born between 2002 and 2007. Adverse outcome was defined by the presence of seizures, encephalopathy, or death prior to hospital discharge. Differences in maternal demographics and clinical characteristics were compared between neonates with and without adverse outcomes at varying hospital settings. Ninety-three neonates were identified as apparently stillborn. Adverse outcomes occurred in 31.2% of neonates; 83.9% survived from birth to hospital discharge. Neonates with a 5-minute Apgar score <4 were significantly more likely to suffer an adverse outcome. Survival of the apparent stillborn is likely. In this cohort, neither mode of delivery nor hospital acuity level predicted outcome.

Magnesium sulfate (MGS04) tocolysis versus no tocolysis in women with preterm labor between 32 0/7 and 34 6/7 weeks of gestation: A randomized controlled trial

WITH PRETERM LABOR BETWEEN 32 0/7 AND 34 6/7 WEEKS OF GESTATION: A RANDOMIZED CONTROLLED TRIAL HELEN HOW, LELA ZAFARANCHI, CAROLINE STELLA, KATHERINE RECHT, ROSEMAXWELL, BAHA SIBAI, JOSEPH SPINNATO II, University of Cincinnati, Obstetrics & Gynecology, Cincinnati, Ohio OBJECTIVE: To determine whether MgSO4 tocolysis in women with preterm labor between 32 0/7 and 34 6/7 weeks reduces neonatal hospital stay. STUDY DESIGN: Study subjects included 52 women between 32 0/7 and 34 6/7 weeks gestation presenting in preterm labor (regular uterine contactions R 6/hour with cervical change or dilation of R2 cm and 80% effaced) who were randomized to receive either MgSO4 tocolysis (n=28) or no tocolysis (n=24). All women received celestone 12mg IM 24 hrs apart and IV antibiotics. Tocolysis group received MgSO4 6g IV load followed by 2-5g/hr to achieve uterine quiescence followed by oral nifedepine 10-20 mg every 4-6 hrs until 36 6/7 weeks or delivery. The primary outcome was total days of neonatal hospital stay. Data were analyzed using Chi-square and T-test. RESULTS: There were no differences in maternal demographics (age, race, parity, previous preterm delivery, cervical dilation at enrollment, mean GA at enrollment, 33G0.8) and maternal outcomes (pregnancy prolongation, total hospital stay, % triage visit, % readmission). There was no difference in the primary outcome (Table), and no neonatal deaths, RDS, IVH or NEC in either group. Other neonatal outcomes are presented in the Table.