Early Term Period Research Articles

Optimal Timing of Delivery for Pregnant Individuals With Mild Chronic Hypertension.

To investigate the optimal gestational age to deliver pregnant people with chronic hypertension to improve perinatal outcomes. We conducted a planned secondary analysis of a randomized controlled trial of chronic hypertension treatment to different blood pressure goals. Participants with term, singleton gestations were included. Those with fetal anomalies and those with a diagnosis of preeclampsia before 37 weeks of gestation were excluded. The primary maternal composite outcome included death, serious morbidity (heart failure, stroke, encephalopathy, myocardial infarction, pulmonary edema, intensive care unit admission, intubation, renal failure), preeclampsia with severe features, hemorrhage requiring blood transfusion, or abruption. The primary neonatal outcome included fetal or neonatal death, respiratory support beyond oxygen mask, Apgar score less than 3 at 5 minutes, neonatal seizures, or suspected sepsis. Secondary outcomes included intrapartum cesarean birth, length of stay, neonatal intensive care unit admission, respiratory distress syndrome (RDS), transient tachypnea of the newborn, and hypoglycemia. Those with a planned delivery were compared with those expectantly managed at each gestational week. Adjusted odds ratios (aORs) with 95% CIs are reported. We included 1,417 participants with mild chronic hypertension; 305 (21.5%) with a new diagnosis in pregnancy and 1,112 (78.5%) with known preexisting hypertension. Groups differed by body mass index (BMI) and preexisting diabetes. In adjusted models, there was no association between planned delivery and the primary maternal or neonatal composite outcome in any gestational age week compared with expectant management. Planned delivery at 37 weeks of gestation was associated with RDS (7.9% vs 3.0%, aOR 2.70, 95% CI, 1.40-5.22), and planned delivery at 37 and 38 weeks was associated with neonatal hypoglycemia (19.4% vs 10.7%, aOR 1.97, 95% CI, 1.27-3.08 in week 37; 14.4% vs 7.7%, aOR 1.82, 95% CI, 1.06-3.10 in week 38). Planned delivery in the early-term period compared with expectant management was not associated with a reduction in adverse maternal outcomes. However, it was associated with increased odds of some neonatal complications. Delivery timing for individuals with mild chronic hypertension should weigh maternal and neonatal outcomes in each gestational week but may be optimized by delivery at 39 weeks.

Stress and anxiety during pregnancy and length of gestation: a federated study using data from five Canadian and European birth cohorts

While its etiology is not fully elucidated, preterm birth represents a major public health concern as it is the leading cause of child mortality and morbidity. Stress is one of the most common perinatal conditions and may increase the risk of preterm birth. In this paper we aimed to investigate the association of maternal perceived stress and anxiety with length of gestation. We used harmonized data from five birth cohorts from Canada, France, and Norway. A total of 5297 pregnancies of singletons were included in the analysis of perceived stress and gestational duration, and 55,775 pregnancies for anxiety. Federated analyses were performed through the DataSHIELD platform using Cox regression models within intervals of gestational age. The models were fit for each cohort separately, and the cohort-specific results were combined using random effects study-level meta-analysis. Moderate and high levels of perceived stress during pregnancy were associated with a shorter length of gestation in the very/moderately preterm interval [moderate: hazard ratio (HR) 1.92 (95%CI 0.83, 4.48); high: 2.04 (95%CI 0.77, 5.37)], albeit not statistically significant. No association was found for the other intervals. Anxiety was associated with gestational duration in the very/moderately preterm interval [1.66 (95%CI 1.32, 2.08)], and in the early term interval [1.15 (95%CI 1.08, 1.23)]. Our findings suggest that perceived stress and anxiety are associated with an increased risk of earlier birth, but only in the earliest gestational ages. We also found an association in the early term period for anxiety, but the result was only driven by the largest cohort, which collected information the latest in pregnancy. This raised a potential issue of reverse causality as anxiety later in pregnancy could be due to concerns about early signs of a possible preterm birth.

Misoprostol with balloon vs oxytocin with balloon in high-risk pregnancy induction: a randomized controlled trial

Pregnancies at high risk for maternal, fetal, or placental complications often necessitate induction of labor in the late preterm or early term period for delivery. Limited data exist on the safest method of induction to use in this specific patient population. This study aimed to compare the combination of oxytocin plus a Cook balloon vs misoprostol plus a Cook balloon for induction of labor in high-risk pregnancies. We conducted an open-label, randomized controlled trial at a single institution from July 2020 to May 2022. The study was approved by the institutional review board and registered with ClinicalTrials.gov (NCT04492072). Individuals with a high-risk pregnancy, at least ≥22 weeks' gestation, with a singleton in cephalic presentation, Bishop score ≤6, and intact membranes were offered enrollment. A high-risk pregnancy was defined as a pregnancy with any of the following complications: hypertensive disease of pregnancy, fetal growth restriction, oligohydramnios, suspected placental abruption requiring delivery, uncontrolled pregestational diabetes, or abnormal biophysical profile or nonstress test requiring delivery. The primary outcome was the rate of cesarean delivery. Secondary maternal outcomes included induction to delivery interval, number of vaginal deliveries within 24 hours, rates of uterine tachysystole, intraamniotic infection, operative vaginal delivery, and postpartum hemorrhage. Secondary fetal outcomes included fetal heart rate abnormalities, stillbirth, Apgar scores <7 at 5 minutes, admission to the neonatal intensive care unit, arterial umbilical blood pH <7.1, sepsis, and neonatal death. A subgroup analysis was planned for the primary outcome to assess the different indications for cesarean delivery. An intent-to-treat analysis was performed. During the 22 months of the trial, a total of 150 patients were randomized, and 73 (49%) of those were induced with oxytocin and a Cook balloon and 77 (51%) were induced with misoprostol and a Cook balloon. There was no significant difference in the overall rate of cesarean delivery between the study groups, (21.9% vs 31.1%; relative risk, 0.70; 95% confidence interval, 0.41-1.21), nor among those for which the cesarean delivery was performed for a specific indication. There were no differences in the secondary maternal and fetal or neonatal adverse outcomes. In high-risk pregnancies, the rate of cesarean delivery and adverse maternal and fetal outcomes were similar for induction of labor with oxytocin and a Cook balloon and for induction with misoprostol and a Cook balloon.

Impact on Neonatal Outcomes with Late Preterm and Early Term Delivery in Women with Diabetes.

Late preterm and early term deliveries are common in pregnancies complicated by diabetes due to higher rates of obstetric complications including increased stillbirth risk. However, early delivery is associated with multiple neonatal adverse outcomes, which may be further increased by maternal diabetes. We examined whether there is an additive effect on adverse neonatal outcomes in the setting of maternal diabetes in the late preterm and early term periods. This was a retrospective cohort study of women with a singleton, nonanomalous pregnancy delivering at a single academic medical center in the late preterm (340/7-366/7 weeks) or early term (370/7-386/7 weeks) period between 2010 and 2019. Women were categorized by diabetes status: no diabetes, type 1 (T1DM), type 2 (T2DM), or gestational diabetes (GDM). Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for risk of both mild and severe composite neonatal outcome with delivery in the late preterm or early term period using pregnancies without diabetes as the referent. A total of 8,072 pregnancies were included with T1DM, T2DM, and GDM complicating 1.8, 5.6, and 9.9% of pregnancies, respectively. Expected demographic differences were seen among groups including higher rates of non-Hispanic Black race, chronic hypertension, and higher body mass index in women with T2DM. The probability of severe composite adverse neonatal outcome was significantly increased in women with T1DM in the late preterm (aOR: 4.4; CI: 2.4-8.1) and early term (aOR: 1.6; CI: 1.1-2.3) periods, largely driven by the need for mechanical ventilation. The mild composite outcome was increased among all women with diabetes with early term delivery but highest in women with T1DM. Pregnancies complicated by diabetes, particularly T1DM, have higher rates of neonatal adverse outcomes independent of gestational age at delivery, which is an important consideration when late preterm or early term delivery is planned. · Diabetes in pregnancy increases risk of early delivery.. · Adverse neonatal outcomes are higher with diabetes, especially T1DM.. · Adverse neonatal outcomes are independent of gestational age..

A POPULATIONAL ANALYSIS OF THE INCIDENCE OF UTERINE RUPTURE AND PLACENTAL PATHOLOGY IN WOMEN WITH A HISTORY OF MYOMECTOMY

Controversy exists regarding obstetric outcomes such as uterine rupture and incidence of placental pathology following myomectomy. Many centers, therefore, out of an abundance of caution, recommend cesarean section (CS) in the late preterm or early term period for women with a prior myomectomy. This involves potential neonatal risks of earlier delivery and maternal surgical risks of CS.

Fetal Disseminated Malignant Rhabdoid Tumor.

Fetal Disseminated Malignant Rhabdoid Tumor.

Factors affecting breastfeeding in rural and urban population of Greece: Preliminary analysis of a prospective cohort study

Introduction: Breastfeeding is the unparalleled way to provide infants the ideal nutrients they need for their healthy growth. The World Health Organization (WHO) recommends exclusive breastfeeding until 6 months old, starting within 1 hour of birth. All infants should start receiving foods in addition to breast milk from 6 months onwards, while breastfeeding continues until 2 years old or more. Purpose: The purpose of this study is to investigate those factors that may influence the onset of breastfeeding in the first few days after birth and during the hospitalization in the maternity ward, as well as the establishment of breastfeeding 6 weeks after birth, along with studying the weight of the newborn. Material and Method: This was a prospective study with a convenience sample taking place in the General Hospital of Argolis and the Elena Venizelou maternity hospital in Athens. In the presented pilot study 75 women that delivered at full term completed the questionnaire. We chose to exclude women that delivered during the preterm period as well as those that delivered twins as these factors independently affect the possibility of discontinuing breastfeeding. A self-report questionnaire with closed and open-ended questions was used and was completed in two phases. Results: Overall, 75 women completed the questionnaire. Of those 3 women delivered within the early term period (37+0 – 38+6 weeks). The majority of women (74.67%) initiated breastfeeding within 2 hours from delivery. Rooming in was allowed within the first hour in a large proportion of participants (62.67%). Breastfeeding difficulties were encountered in approximately half of participants and the predominant reason was some form of breast pathology. Twenty-two mothers (29.3%) discontinued breastfeeding within the study period. Early rooming in significantly increased the possibility of continuing breastfeeding after the first month. Of all the factors that were investigated during the puerperal period only the amount of formula meals significantly affected the rates of continuous breastfeeding. Conclusion: Early rooming-in significantly increases breastfeeding practices. Unstructured educational activities from healthcare providers and accompanying brochures do not seem to enhance breastfeeding duration, indicating the need for adoption of specific programs that will be tested in forthcoming studies.

Hypertensive Disorders of Pregnancy.

Preeclampsia is a hypertensive disorder of pregnancy that is a leading cause of maternal and perinatal morbidity and mortality. The condition presents heterogeneously at varying gestational ages. Primary prevention for preeclampsia with low-dose aspirin is recommended for patients with clinical risk factors. Despite extensive research, there is no clearly defined pathophysiology for preeclampsia or treatment for preeclampsia besides delivery of the placenta. Delivery of patients with preeclampsia without severe features is indicated in the early term period at 37 weeks' gestation and sooner if the patient develops severe preeclampsia. Management of preterm preeclampsia is guided by close assessment of the status of the pregnant woman and fetus, blood pressure control, and surveillance for any clinical progression to a more severe form of preeclampsia that may require preterm delivery. In a preterm gestation affected by preeclampsia, expectant management is intended to provide neonatal benefit though it does assume some maternal risk. Future research will hopefully further delineate the pathophysiology of the condition with the ultimate goal of finding a treatment to avoid associated morbidity and preterm delivery.

Multifetal Gestations and Associated Perinatal Risks.

Along with the rise of assisted reproductive technology, multifetal gestations increased dramatically. Twin pregnancies account for 97% of multifetal pregnancies and 3% of all births in the United States. Twins and higher-order multiples carry increased risks of obstetric, perinatal, and maternal complications; these risks increase with increasing fetal number. Neonatal morbidity and mortality in multifetal gestations is driven primarily by prematurity. Both spontaneous and indicated preterm births are increased in multifetal gestations, and only a limited number of strategies are available to mitigate this risk. No single intervention has been shown to decrease the rate of spontaneous preterm birth in most twin pregnancies. Low-dose aspirin prophylaxis is recommended in all multifetal pregnancies to reduce the risk of preeclampsia and its associated complications. Antenatal management of multifetal gestations depends on chorionicity, which should be established using ultrasonography in the first trimester. Unlike dichorionic twin gestations, monochorionic pregnancies experience unique complications because of their shared vascular connections, and therefore, need frequent ultrasound surveillance. Even uncomplicated twin gestations have higher rates of unanticipated stillbirth compared with singletons. Delivery of twin pregnancies is generally indicated in the late preterm to early term period depending on chorionicity and other clinical factors. For most diamniotic twin pregnancies with a cephalic presenting fetus, vaginal delivery after 32 weeks' gestation is a safe and reasonable option with high rates of success and no increased risk of perinatal morbidity.

597 Impact on neonatal outcomes with late preterm and early term delivery in women with diabetes

Late preterm and early term deliveries are common in pregnancies complicated by diabetes because of higher rates of obstetric complications, as well as concerns of increased stillbirth risk. Early delivery is associated with multiple neonatal adverse outcomes. The aim of this study was to investigate the rates of adverse neonatal outcomes with delivery at late preterm and early term gestational ages in women with either pregestational or gestational diabetes (GDM). This was a retrospective cohort study of all women with a singleton, non-anomalous pregnancy delivering at a single academic medical center in the late preterm (34 0/7-36 6/7 weeks) or early term (37 0/7-38 6/7 weeks) period between 2010-2019. Women were categorized by diabetes status: no diabetes, type 1 (T1DM), type 2 (T2DM), or GDM. Multivariate logistic regression was used to calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for risk of both mild and severe composite neonatal outcome with delivery in the late preterm or early term period using pregnancies without diabetes as the referent. There were 8,072 pregnancies included in the analysis with T1DM, T2DM, and GDM complicating 1.8%, 5.6%, and 9.9% of pregnancies, respectively. Expected demographic differences were seen among groups such as higher rates of non-Hispanic Black race, chronic hypertension and higher BMI in women with T2DM (all p<.001, Table 1). The probability of severe composite adverse neonatal outcome was significantly increased with late preterm delivery in women with T1DM (aOR 3.2; CI 1.5-6.6) and GDM (aOR 1.0; CI 1.01-3.5), but this was largely driven by need for mechanical ventilation. The mild composite outcome was increased among all women with diabetes with early term delivery, but highest in women with T1DM (Table 2). Pregnancies complicated by diabetes, particularly those with T1DM, have higher rates of neonatal adverse outcomes independent of gestational age of delivery. These data are important to consider when late preterm and early term delivery is planned in these pregnancies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Optical coherence tomography of pseudophakic eyes after primary posterior capsulorhexis in pseudoexfoliation syndrome

Purpose to study vitreolenticular interface (VLI) and central retinal thickness after primary posterior capsulorhexis (PPC) in pseudoexfoliation syndrome (PEX).&#x0D; Material and methods. We conducted a dynamic OCT-evaluation of the macular morphology (47 cases) and of the VLI (39 cases) in patients with PEX in early and long term period after uncomplicated cataract surgery with PPC. In the long term period a comparative OCT-evaluation of the macula was performed in 129 patients with PEX (159 eyes) in different groups: after phacoemulsification with and without PPC, after Nd:YAG laser capsulotomy for secondary cataract, and in the control group of non-operated eyes.&#x0D; Results. The OCT-evaluation made it possible to visualize two significant features of VLI after PPC intact anterior hyaloid and restoration of the capsule barrier. It took 38 days for full adhesion. Secondary cataract in the PPC area was detected in one case in the long-term period. Dynamic OCT-evaluation of the macula in the main group revealed a statistically unreliable increase in the macular thickness (3.4%) in post-op period at 13 months with subsequent regression. Such changes were within the limits of physiological norm. In the remote period, comparative OCT-evaluation of the macula in different groups did not reveal statistically significant differences with the control group.&#x0D; Conclusion. OCT-evaluation at different post-op terms revealed the formation of stable vitreolenticular relationships and absence of clinically significant macular edema. Secondary cataract in the PPC area was detected only in one case.

Timing of Delivery in Women with Cardiac Disease.

Guidelines do not exist to determine timing of delivery for women with cardiovascular disease (CVD) in pregnancy. The neonatal benefit of a term delivery as compared with an early term delivery is well described. We sought to examine maternal outcomes in women with CVD who delivered in the early term period (370/7 through 386/7 weeks) compared with those who delivered later. This is a prospective cohort study examining cardiac and obstetric outcomes in women with CVD delivering between September 2011 and December 2016. The associations between gestational age at delivery and maternal, fetal, and obstetric characteristics were evaluated. Two-hundred twenty-five women with CVD were included, 83 (37%) delivered in the early term period and 142 (63%) delivered at term. While the early term group had significantly higher rates of any hypertension during pregnancy (18.1 vs. 7%, p = 0.01) and intrauterine growth restriction (22.9 vs. 2.8%, p < 0.001), there was no difference in high-risk cardiac or obstetric characteristics. No difference in composite cardiac morbidity was found (4.8 vs. 3.5%, p = 0.24). Women in the early term group were more likely to undergo cesarean delivery than women in the term group (43.4 vs. 24.7%, p = 0.004). There is no maternal benefit of an early term delivery in otherwise healthy women with CVD. Given the known fetal consequences of early term delivery, this study offers support to existing literature suggesting term delivery in these women. · Question of delivery timing in women with cardiac disease.. · No difference in cardiac morbidity, term versus early term.. · Term delivery in women with asymptomatic cardiac disease..

Management of isolated oligohydramnios in Korea: a questionnaire-based study of clinical practice patterns among the members of the Korean Society of Maternal Fetal Medicine.

ObjectiveThe aim of this survey was to investigate the recommendations and clinical practice patterns of the Korean Society of Maternal and Fetal Medicine (KSMFM) members, regarding management of isolated oligohydramnios (IO).MethodsFrom December 2018 to February 2019, questionnaires were e-mailed to the KSMFM members at 257 institutes that are listed by the Korean Statistical Information Services (KOSIS) as suitable labor premises. Responses to the seven questions on the management of IO, from diagnosis to treatment, were evaluated.ResultsA total of 72 KSMFM members responded to this survey. Nearly all participants (90.1%) used the amniotic fluid index (AFI) as the primary method for estimating amniotic fluid volume. The majority of the participants (73.6%) believed that IO was a risk factor for adverse pregnancy outcomes, including abnormal fetal heart rate (73.6%), need for cesarean delivery (58.3%), intrauterine fetal demise (52.8%), and meconium aspiration syndrome (50%). Almost 70% of the participants believed that induction of labor might decrease perinatal morbidities, and that late-preterm to early-term period (36–38 gestational weeks) was a suitable timeframe for delivery, if the fetus was sufficiently grown and antenatal testing revealed reassuring results. Less than half of the participants (47.2%) believed that maternal oral or intravenous hydration was a useful intervention for IO management.ConclusionsKSMFM members preferred labor induction at late-preterm to early-term, to decrease perinatal morbidity in cases of IO, although it was still uncertain whether labor induction improved the outcomes. Further prospective studies are needed regarding IO management.

Meta-analysis of Phase-Specific Survival After Endovascular Versus Surgical Repair of Abdominal Aortic Aneurysm From Randomized Controlled and Propensity Score-Matched Studies

Although endovascular aneurysm repair (EVAR) is the treatment of choice for abdominal aortic aneurysm (AAA), we have not concluded superiority between EVAR and open surgical repair (OSR) beyond the perioperative period. The aim of this study was to compare phase-specific survival after EVAR vs OSR. Embase and MEDLINE were searched up to November 2019 to identify randomized controlled trials and propensity score-matched studies that investigated ≥2-year all-cause mortality (primary outcome) after EVAR vs OSR for intact infrarenal AAA. For each study, the hazard ratio (HR) with 95% confidence interval (CI) of mortality for EVAR vs OSR was calculated using survival curves for the following specific phases: early term (0-2 years after repair), midterm (2-6 years after repair), long term (6-10 years after repair), and very long term (≥10 years after repair). The risk ratio (RR) in the perioperative (in-hospital or 30-day) period was also extracted. Phase-specific HRs or RRs were separately pooled using the random effects model. Sensitivity analyses were performed by removing one study at a time to confirm that our findings were not derived from any single study. Funnel plot asymmetry was also examined using the linear regression test. Our search identified four randomized controlled trials and seven propensity score-matched studies enrolling a total of 106,243 AAA patients assigned to EVAR (n = 53,123) or OSR (n = 53,120). The mortality after EVAR compared with OSR was significantly lower in the perioperative period (RR, 0.39; 95% CI, 0.29-0.51; P < .00001) and similar in the early-term period (HR, 0.93; 95% CI, 0.84-1.03; P = .16). Notably, significantly higher mortality was observed in the EVAR group compared with the OSR group in the midterm period (HR, 1.15; 95% CI, 1.03-1.29; P = .01). However, similar mortality was observed between the EVAR group and the OSR group in the long-term (HR, 1.06; 95% CI, 0.96-1.17; P = .27) and very-long-term (HR, 1.17; 95% CI, 0.93-1.47; P = .19) periods. In sensitivity analyses, the significant benefit of EVAR in the perioperative period and that of OSR in the midterm period was not changed. No funnel plot asymmetry was identified in all analyses. Compared with OSR, EVAR was associated with lower perioperative mortality and higher mortality in the midterm period for intact infrarenal AAA. The superiority of EVAR was absent in the early-term period, and the inferiority of EVAR in the midterm period disappeared in the long-term and very-long-term periods.

Management of pregnancy after fertility-sparing surgery for cervical cancer.

Cervical cancer is increasingly diagnosed in women who have not yet completed their reproductive plans. For women with early-stage disease (FIGO stage IA1-IB1), fertility-sparing procedures, such as conization, trachelectomy or radical trachelectomy, represent the treatments of choice. However, women who undergo repeated conization or trachelectomy represent a challenge for obstetricians because they are at increased risk of infertility, mid-trimester miscarriage, preterm premature rupture of membranes and preterm delivery. So far, the evidence-based guidance on the management of these pregnancies is limited. This article reviews the literature discussing pregnancy management in women after fertility-sparing surgery for early cervical cancer. Although the evidence is limited, certain measures are desirable, including screening and treatment of asymptomatic bacteriuria, screening for cervical incompetence and progressive cervical shortening by transvaginal ultrasonography, and fetal fibronectin testing. Vaginal progesterone supplementation should be primary prevention for all women after trachelectomy. Women with a history of preterm delivery or late miscarriage may benefit from cervical cerclage. Elective delivery by cesarean section in the early-term period is desirable.

Early and mid-term outcome of frozen elephant trunk using spinal cord protective perfusion strategy for acute type A aortic dissection

ObjectiveThis study aimed to evaluate the prevalence of spinal cord injury in total arch replacement with frozen elephant trunk for acute type A aortic dissection using our spinal cord protection technique.MethodsBetween January 2013 and December 2017, 33 patients underwent total arch replacement with frozen elephant trunk for acute type A aortic dissection (mean age 67.9 ± 13.3 years). Our spinal cord protection technique involved maintaining extracorporeal circulation through the left subclavian artery in all procedures, using aortic occlusion balloon during distal anastomosis, and inserting frozen elephant trunk above Th 8 with transesophageal echocardiographic guidance. Computed tomography was performed within 1–2 weeks, 12 months, and 36 months postoperatively. We compared the degree of thrombosis of the descending aorta between preoperation and early postoperative period by Fisher’s exact test. Moreover, we evaluated postoperative mortality and mobility (including spinal cord injury) at follow-up.ResultsThe operative mortality within 30 days was 6.1%. Neither paraplegia nor paraparesis was noted. We observed significant thrombosis of the false lumen at the distal arch and aortic valve level of the descending aorta in postoperative early term period (p < 0.01). At mid-term follow-up (mean 33.9 months), survival probability and 3-year freedom from reoperation rates were 93.9 ± 4.1% and 95.0 ± 4.9%, respectively.ConclusionsThe frozen elephant trunk technique with our spinal protection strategy provides good postoperative outcomes. Our strategy can maintain spinal cord perfusion without complete ischemia time even during lower body ischemia time. Implementation of our spinal protection strategy will help prevent spinal cord injury and dilated downstream aorta.

540: Early term delivery: Is there a difference in neonatal respiratory morbidity by diabetes sub-type?

Type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) have been linked to biochemical evidence of delayed fetal lung maturation and neonatal respiratory morbidity in the late preterm period. We sought to compare the impact of diabetes sub-types on neonatal respiratory outcomes in the early term period. We performed a retrospective cohort study of all pregnancies complicated by T2DM or GDM from 2009-2017 and delivered in the early term period (37 0/7-38 6/7 weeks gestation) at an academic tertiary care center. Those with multiple gestations, fetal anomalies, chorioamnionitis, and receipt of antenatal corticosteroids during were excluded. The primary outcome was composite neonatal respiratory morbidity, which included respiratory distress syndrome (RDS) and neonatal respiratory support. Univariable analyses were performed to compare maternal demographics between those with T2DM and GDM. A multivariable logistic regression analysis was performed to adjust for potential confounders, including maternal age, body mass index, chronic hypertension, and race. A total of 683 patients were included in the study, 382 (56%) with GDM and 301 (44%) with T2DM. Women with GDM and T2DM had similar demographic characteristics except those with T2DM were more likely to have chronic hypertension (59% vs. 31%; p< 0.01). Women with T2DM had a significantly increased risk of both composite neonatal respiratory morbidity (aRR 1.49; 95% confidence interval 1.17-1.89) and neonatal RDS alone (aRR 1.63; 95% CI 1.15-2.30) (Table 1). There is a 1.5-fold increased risk for neonatal respiratory morbidity among infants born to women with T2DM compared GDM in the early term period.

501: Antenatal Corticosteroids in Early Term Cesarean Sections (ACS ET CS)

Neonates born at term by Cesarean section (CS) are more likely to develop respiratory complications than those delivered vaginally. Risk of these complications is greater in the early term period, 37-39 weeks. Antenatal corticosteroids (ANCS) are given to mothers to reduce neonatal respiratory distress syndrome (NRDS) in preterm infants. Evidence suggests administration of betamethasone prior to CS at 37-39 weeks may similarly benefit fetal lung maturity. However, this is not standard practice in the United States. This study examines the effect of ANCS on the outcomes of early term neonates born by CS. A retrospective cohort study of patients who underwent planned early term CS at a single tertiary care center from 2016-19. Demographics, steroid administration, and neonatal outcomes were collected from the EMR. NRDS was the primary outcome. Data was separated by singleton vs. twin gestation, stratified by gestational age 37-37+6 vs. 38-38+6 weeks, and grouped by steroid vs. no steroid exposure. Categorical measures were compared using Chi-square or Fisher’s exact tests. Continuous measures were compared using Student’s T or Mann-Whitney U tests. 223 patients underwent planned early term CS for singleton pregnancy. 113 (50.7%) received ANCS, consisting of IM betamethasone 12mg x2 doses 24 hours apart. Baseline maternal demographics were comparable. In the 37-week subset, NRDS was less prevalent in babies who had received steroids (Table 1, p = 0.04). After adjusting for neonatal sex and birth weight, a trend for decreased NRDS with ANCS remained (Table 2, OR:0.22, 95% CI:0.05-1.01). No difference in NRDS was found in the 38-week subset. No other neonatal outcomes such as hypoglycemia, infection, and transient tachypnea of the newborn were significantly different regardless of gestational age. Data regarding twin pregnancies was gathered, but numbers were not sufficient to allow analysis. This study suggests ANCS may be an asset in reducing NRDS after planned CS at 37-37+6 weeks. Further study is required to determine long-term effects, and benefit to twin gestations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Impact of Gestational Age on Surgical Outcomes in Patients With Functionally Single Ventricle

Younger gestational age (GA) is known to be associated with worse outcomes after congenital cardiac surgery. We sought to determine the impact of GA on surgical outcomes of single-ventricle palliation. Among the 284 patients with functionally single ventricle who were born between January 2005 and December 2014, 50 neonates were born prematurely (GA < 37 weeks) and 113 neonates in the early term period (37 weeks ≤ GA < 39 weeks). Initial palliation was required in 251 patients, whereas 33 patients received primary bidirectional cavopulmonary anastomosis (BCPA). BCPA and the completion Fontan operation were performed in 200 and 169 patients, respectively. Overall survival at 5 years were 62.5% ± 2.9%. On Cox regression younger GA (hazard ratio, 1.14 per 1-week decrease; P= .007) was identified as a risk factor for increased interstage mortality (ISM) between initial palliation and BCPA. On subgroup analysis of the preterm or early-term patients with initial palliation (n= 145), younger postmenstrual age at initial palliation was associated with increased ISM before BCPA (hazard ratio, 1.18; P= .005). After BCPA, however, younger GA did not increase the risk of ISM between BCPA and the Fontan operation (P= .47). Younger GA is a risk factor for ISM between initial palliation and BCPA. Deferral of initial palliation may be beneficial to decrease the risk of ISM in patients who were born at preterm or early term. Adverse effects of younger GA on survival disappeared once BCPA was performed.

Mode of photoexcited C60 fullerene involvement in potentiating cisplatin toxicity against drug-resistant L1210 cells.

Introduction: C60 fullerene has received great attention as a candidate for biomedical applications. Due to unique structure and properties, C60 fullerene nanoparticles are supposed to be useful in drug delivery, photodynamic therapy (PDT) of cancer, and reversion of tumor cells’ multidrug resistance. The aim of this study was to elucidate the possible molecular mechanisms involved in photoexcited C60 fullerene-dependent enhancement of cisplatin toxicity against leukemic cells resistant to cisplatin. Methods: Stable homogeneous pristine C60 fullerene aqueous colloid solution (10-4 М, purity 99.5%) was used in the study. The photoactivation of C60 fullerene accumulated by L1210R cells was done by irradiation in microplates with light-emitting diode lamp (420-700 nm light, 100 mW·cm-2). Cells were further incubated with the addition of Cis-Pt to a final concentration of 1 μg/mL. Activation of p38 MAPK was visualized by Western blot analysis. Flow cytometry was used for the estimation of cells distribution on cell cycle. Mitochondrial membrane potential (Δψm) was estimated with the use of fluorescent potential-sensitive probe TMRE (Tetramethylrhodamine Ethyl Ester). Results: Cis-Pt applied alone at 1 μg/mL concentration failed to affect mitochondrial membrane potential in L1210R cells or cell cycle distribution as compared with untreated cells. Activation of ROS-sensitive proapoptotic p38 kinase and enhanced content of cells in subG1 phase were detected after irradiation of L1210R cells treated with 10-5M C60 fullerene. Combined treatment with photoexcited C60 fullerene and Cis-Pt was followed by the dissipation of Δψm at early-term period, blockage of cell transition into S phase, and considerable accumulation of cells in proapoptotic subG1 phase at prolonged incubation. Conclusion: The effect of the synergic cytotoxic activity of both agents allowed to suppose that photoexcited C60 fullerene promoted Cis-Pt accumulation in leukemic cells resistant to Cis-Pt. The data obtained could be useful for the development of new approaches to overcome drug-resistance of leukemic cells.