Late Preterm Pregnancies Research Articles

Carbetocin versus oxytocin in prevention of postpartum hemorrhage in late preterm twin pregnancy following cesarean section: a prospective clinical study

Objective The objective of this study was to compare effectiveness and safety of carbetocin versus oxytocin infusion in prevention of postpartum hemorrhage (PPH) in women with late preterm twin pregnancy undergoing cesarean section. Patients and methods A prospective clinical study was conducted from June 2014 to August 2015 in Shibin El-Kom and Benha Teaching Hospitals in Egypt that enrolled 175 women with late preterm twin pregnancy undergoing cesarean section. Carbetocin group (n = 90) as a single intravenous bolus was compared with oxytocin (n = 85) 10 IU as six infusions as soon as the second twin was delivered, and the outcomes were compared. Results The mean blood loss during cesarean section was higher in oxytocin group as compared with carbetocin (685 ± 350 vs. 782.8 ± 370 ml, P > 0.05). The incident of primary PPH (>1000 ml) in cesarean delivery was lower in carbetocin group versus oxytocin group (3.33 vs. 11.76%, P 0.05). The need for another uterotonic agents in carbetocin was lower than in oxytocin (23.33 vs. 35.29%, P Conclusion This study found that carbetocin was an acceptable option with reduction of PPH compared with oxytocin in late preterm twin pregnancy undergoing cesarean section, and both had similar safety profile with minor hemodynamic effect.

263. Neonatal developmental and behavioral outcomes of immediate delivery versus expectant management in hypertensive disorders of pregnancy: 2-year outcomes of the HYPITAT II trial

Background In the management of hypertensive disorders(HD) in preterm pregnancy, maternal benefits of delivery need to be weighed against the neonatal consequences of preterm birth. We report 2-year child outcomes of the HYPITAT-II trial, which compared delivery versus expectant management(EM) in these women. Objective To compare effects of delivery versus EM in women with hypertension in late preterm pregnancy on neurodevelopmental and behavioral outcomes in their offspring at two years of age. Study design We studied children born in the HYPITAT-II trial, in which 704 women with a HD between 34 and 37 weeks of gestation were randomized to immediate delivery or EM. Participating women were asked to complete the Ages and Stages Questionnaire (ASQ) for developmental outcome and the Child Behavior Checklist (CBCL) for behavioral problems when their toddler was two years old. Outcomes were dichotomized and analyzed by logistic regression analysis. Results We approached 545 (77%) randomized women, of whom 344 (64%) participated. In the delivery group, 45/162 (28%) infants had an abnormal ASQ-score compared to 27/148 (18%) in the EM group (difference in percentage 9.6, CI 0.3 to 18.0); p = 0.045. An abnormal CBCL outcome was found in 31/175 (18%) in the delivery group versus 24/166 (15%) in the EM group (difference in percentage 3.2 (CI − 4.6 to 11.0). After correction for maternal education, management strategy remained an independent predictor of abnormal ASQ-score (OR 0.48, CI 0.24 −0.96, p = 0.03). In multivariable analyses, birth weight, maternal education and management policy were all significantly associated with an abnormal ASQ-score. Conclusions This study suggests that early delivery in women with late preterm HD results in poorer neurodevelopmental outcome at two years of age, indicating an increased risk of developmental delay compared to EM. This should be considered in the timing of delivery in women with a late preterm HD.

Twins versus singleton pregnancies: outcomes in small for gestational age late preterm deliveries

Background: Compared to singleton pregnancies, small for gestational age (SGA) and twin gestations experience adverse maternal and neonatal outcomes. Specific data regarding outcomes in late preterm SGA twin gestations are lacking.Objective: This study sought to compare pregnancy outcomes of late preterm (≥34 and <37 weeks) SGA twins versus singletons. In addition, we sought to stratify the comparisons by <10 and <5 percentile categories.Study design: In this retrospective cohort of 1.85 million pregnancies, we identified 10,646 nonanomalous, SGA, late preterm singleton and twin pregnancies. Births at gestational ages <34 and ≥37 weeks were excluded. Multivariate regression analyses and Chi-squared test were used for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.Results: After controlling for race, education, parity, prenatal care, diabetes, and hypertensive disease, twin pregnancies were less likely to experience neonatal death (aOR 0.14; 95% CI 0.03–0.63; p = .01) and intrauterine fetal demise (IUFD) (aOR 0.16; 95% CI 0.08–0.31; p < .001) compared to SGA <10 percentile singletons. Cesarean rates were higher in SGA <10 [percentile twin pregnancies (aOR 3.40; 95% CI 3.01–3.90; p < .001) as were postpartum hemorrhage (aOR 2.01; 95% CI 1.52–2.67; p < .001) and transfusion (aOR 1.54; 95% CI 1.52–2.67; p = .024).Conclusion: Late preterm SGA twin pregnancies were more like to be complicated by cesarean delivery, postpartum hemorrhage, and maternal transfusion compared to singleton pregnancies. However, neonatal death and IUFD were less common in SGA twin gestations.

Neonatal Effects of Maternal Magnesium Sulphate in Late Preterm and Term Pregnancies.

To compare the clinical, obstetric and neonatal parameters between patients with >34-week gestation having severe preeclampsia receiving magnesium sulphate and those with >34-week gestation with preeclampsia but not receiving magnesium sulphate. Single-centre prospective study studied 60 patients in each of the two groups. Magnesium sulphate was administered by Pritchard regimen as per standard protocol. Standard obstetric management was followed for both groups. In the severe preeclampsia/eclampsia group, maternal blood sample was analysed for serum magnesium levels. The duration of exposure, the amount of magnesium sulphate received and time elapsed between last dose of magnesium sulphate and delivery were all noted. Neonatal assessment was done. The various parameters including age, parity, blood pressure, mode of termination of pregnancy, NICU admission rate, incidence of hypotonia in the newborn and other neonatal parameters were tabulated and compared. The two groups were comparable with respect to age and parity. Need for induction of labour was higher in the group with severe preeclampsia/eclampsia. Rate of LSCS and birth weights were comparable between the two groups. NICU admission rate and incidence of hypotonia were higher in those who received magnesium sulphate. Amount of magnesium sulphate received and total duration of magnesium sulphate did not correlate with NICU admission rates. Neonatal morbidity, in terms of higher NICU admission rates and hypotonia, is higher in patients receiving magnesium sulphate.

Identifying Fetal Growth Disorders Using Ultrasonography in Women With Diabetes.

We evaluated the ability of third-trimester ultrasonography (US) to diagnose disorders of fetal growth among women with diabetes mellitus. This work was a retrospective cohort study of women with diabetes who delivered term singleton neonates at a single academic medical center and who had a US examination within 5 weeks of delivery. We characterized the sensitivity, specificity, positive predictive value, and negative predictive value of US to detect large-for-gestational age (LGA) and small-for-gestational age (SGA) infants. Large and small for gestational age were defined as a US estimated fetal weight of greater than 90% and less than 10%, respectively, based on the Hadlock formula (Radiology 1991; 181:129-133); US estimates of LGA or SGA were compared with postnatal findings of LGA or SGA based on gestational age-based weight percentiles. Test characteristics were analyzed for the total cohort and by the type of diabetes. We compared the areas under the curve for receiver operating characteristic curves for different types of diabetes. Of 521 women, 3 (0.6%) screened positive for SGA, and 64 (12.3%) delivered an SGA neonate. In contrast, 129 (24.8%) screened positive for LGA, and 61 (11.7%) delivered an LGA neonate. The receiver operating characteristic curves did not differ significantly for different types of diabetes (P = .68). Ultrasonography in women with diabetes and term or late preterm pregnancies has high specificity but poor sensitivity for SGA and a low positive predictive value for LGA. The diagnostic capability of US to detect fetal growth abnormalities did not differ significantly by the type of diabetes.

Perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios

Purpose: The purpose of this study is to determine the adverse perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios.Methods: A total of 430 pregnant women with an uncomplicated singleton pregnancy at a gestational age of 34 + 0–36 + 6 weeks were included. Borderline oligohydramnios was defined as an amniotic fluid index (AFI) of 5.1–8 cm, which was measured using the four-quadrant technique. Adverse perinatal outcomes were compared between the borderline and normal AFI groups.Results: Approximately 107 of the 430 pregnant women were borderline AFI, and 323 were normal AFI. The demographic and obstetric characteristics were similar in both groups. Delivery <37 weeks, cesarean delivery for non-reassuring fetal heart-rate testing, meconium-stained amniotic fluid, Apgar 5 min <7, transient tachypnea of the newborn, respiratory distress syndrome, neonatal intensive care unit, and hyperbilirubinemia were not statistically different between the groups (p = .054, p = .134, p = .749, p = 0.858, p = .703, p = .320, p = .185, and p = .996, respectively). Although gestational age was full-term, induction of labor rates were significantly higher in the borderline AFI group (p = .040). In addition, fetal renal artery pulsatility index pulsatility index (PI) was significantly lower in the borderline AFI group than in the normal AFI group (p = .014).Conclusion: Our results indicated that borderline AFI was not a risk for adverse perinatal outcomes in uncomplicated, late preterm pregnancies.

Assessing the potential impact of extending antenatal steroids to the late preterm period

In 2016, guidance statements were issued by the Society for Maternal-Fetal Medicine and the American Congress of Obstetricians and Gynecologists about extending antenatal steroid use to selected late preterm singleton pregnancies. We sought to review antenatal steroid use prior to the 2016 guidance statements and assess the potential impact of these. This cohort study used chart-abstracted data from singleton deliveries from Jan. 1, 2012, through March 31, 2016, at 12 centers participating in the Obstetrics Clinical Outcomes Assessment Program, a quality initiative in Washington State. Pregnancies with missing gestation at delivery, fetal anomalies, or antepartum demise were excluded. Antenatal steroid use prior to the 2016 guidance was evaluated based on the percentageof early preterm deliveries (23+0-33+6 weeks) and the percentage ofall pregnancies that received antenatal steroids. Newborn complication rates were calculated for late preterm deliveries (34+0+0-36+6 weeks), grouped by whether they would be potentially eligible or ineligible for antenatal steroids based on the 2016 guidance statements. The opportunity for antenatal steroids was missed in 21.8% (226/1034) of early preterm deliveries and of all those who received antenatal steroids, 32.2% (614/1908) delivered at term. Of preterm deliveries, 74% (n= 2942) were in the late preterm period. In all, 80% (n=2363) of late preterm deliveries were potentially eligible for antenatal steroids and 60% of these (n= 1411) delivered at 36 weeks. The rate of respiratory complications in newborns delivering at 34 and 35 weeks was higher in the group potentially eligible for late preterm antenatal steroids compared to those in the ineligible group. Of those delivering at 36 weeks, no differences were detected in prevalence of respiratory complications by potential eligibility for antenatal steroids; however, compared with the ineligible group, those potentially eligible had a lower risk of neonatal intensive care unit admission (P < .001). More than two thirds (69%; 171/248) ofnewborn respiratory complications among late preterm deliveries potentially eligible for antenatal steroids occurred in those delivering at 34-35 weeks. Thehighest rate of respiratory complications was in those ineligible for antenatal steroids due to prepregnancy diabetes or chorioamnionitis, regardless of gestational age at delivery. Careful consideration of which pregnancies should receive late preterm antenatal steroids and how to identify these pregnancies is important to optimize benefits and mitigate potential risks of this intervention.

Pregnancies complicated by both preeclampsia and growth restriction between 34 and 37 weeks’ gestation are associated with adverse perinatal outcomes

Objective: To determine whether adverse outcomes were more common in late preterm pregnancies complicated by preeclampsia and growth restriction compared to those affected by preeclampsia alone.Methods: This was a retrospective cohort study of 8927 singleton pregnancies with preeclampsia. Pregnancies with small for gestational age (SGA) neonates (birth weight <10th percentile) were compared to those appropriate for gestational age (AGA) neonates. Maternal outcomes included cesarean delivery (CD) rate, CD for fetal heart rate (FHR) abnormalities, abruption, postpartum hemorrhage (PPH), maternal transfusion, acute renal failure, and peripartum cardiomyopathy. Neonatal outcomes studied included respiratory distress syndrome (RDS), jaundice, hypoglycemia, seizure, asphyxia, neonatal death, and intrauterine fetal demise (IUFD).Results: Women with preeclampsia and SGA infants were more likely to experience abruption (5.3% versus 3.0%, p < 0.001), higher CD rate (66.5% versus 55.0%, p < 0.001), and higher likelihood of a CD for FHR abnormalities (21.7% versus 10.0%, p < 0.001). SGA infants were more likely to experience adverse neonatal outcomes including RDS (10.1% versus 4.9%, p < 0.001), jaundice (59.8% versus 39.2%, p < 0.001), hypoglycemia (8.9% versus 3.9%, p < 0.001), asphyxia (0.6% versus 0.2%, p = 0.015), and IUFD (1.5% versus 0.3%, p < 0.001).Conclusions: Preeclamptic women and their neonates were more likely to experience adverse perinatal outcomes when SGA pregnancies were compared to those with AGA neonates.

Preterm premature rupture of membrane assessment via transperineal ultrasonography: a diagnostic accuracy study

Objective: The objective of this study is to evaluate diagnostic accuracy of transperineal ultrasound assessment compared to speculum examination by using placental alfa-microglobulin (PAMG)-1 tests as reference.Methods: This was a prospective observational study conducted in Ankara University Hospital. Women with early and late preterm pregnancies with suspected rupture of membranes, i.e. women with a complaint of fluid leakage (105 in total) were enrolled. Prior to speculum examination, sagittal and transverse plane views of the fornices and cervix were obtained via transperineal ultrasonography and images were stored. Then the speculum examination for amniotic fluid pooling was performed. Definite diagnoses were made with PAGM-1 assays. After collection of the data, ultrasound images were analyzed by an observer blind to physical examination findings. Hypoechogenic fluid appearance around the cervix and in the fornices was considered positive for preterm premature rupture of membranes (PPROM). Results of physical and ultrasound examination were compared with PAMG-1 test as a reference method. The diagnostic performance of transperineal ultrasound was tested with accuracy parameters and receiver-operating characteristics (ROC) curves. Inter-rater reliability was analyzed with Cohen’s kappa.Results: In total, 103 pregnant women were evaluated. The prevalence of PPROM in our study population was 43.14%. At a 5 mm diagnostic threshold, the sensitivity and specificity values of transperineal assessment were 95.45% (95% CI: 84.50–99.31%) and 96.55% (95% CI: 88.07–99.48%), respectively, and they were comparable with speculum examination in a population of preterm pregnant women with suspected PPROM (p > 0.05). Interobserver reliability analysis with Cohen’s kappa has shown good very good agreement with the kappa value of 0.93 (95% CI 0.87–1.00).Conclusions: Transperineal ultrasonography is a novel method that can be used to assess vaginal pooling of amniotic fluid. Ultrasonography offers similar sensitivity and specificity compared with speculum examination and it is non-invasive.

Obstetrical Management of Late Preterm Pregnancy

Obstetrical Management of Late Preterm Pregnancy

Downregulation of notch signaling pathway in late preterm and term placentas from pregnancies complicated by preeclampsia.

Preeclampsia (PE) is a major cause of maternal mortality and morbidity, affecting 3–5% of all pregnancies. The Notch signaling pathway plays an important role during placental development, activating several target genes. Defects in the Notch pathway have adverse effect on placentation. The aim of this study was to investigate the expression of receptors NOTCH1,-2,-3,-4, ligands DLL1,-3,-4, JAG1,-2 and target genes HEY1,-2 in placental tissue samples from 20 late preterm or term pregnancies complicated by PE versus 20 normal pregnancies. mRNA levels of the studied molecules were measured by quantitative Real-Time PCR (qRT-PCR), while the protein expression of the intracellular domain of NOTCH2 (NICD2) and NOTCH3 (NICD3) was measured by Western Blot (WB). qRT-PCR analysis revealed that NOTCH1, NOTCH4 and DLL1 were not expressed in the placenta. On the contrary, NOTCH2, NOTCH3, DLL3, DLL4, JAG1, JAG2, HEY1 and HEY2 mRNA levels were downregulated in PE samples vs. controls (p<0.01). WB confirmed that NICD2 (p = 0.014) and NICD3 (p<0.001) protein levels were also lower in PE specimens. Statistical analysis revealed several significant associations: of NOTCH3 mRNA expression with smoking during pregnancy (p = 0.029), of NICD3 protein levels (p = 0.028) and DLL3 mRNA levels (p = 0.041) with birth weight centile, and of HEY2 transcript levels with parity (p = 0.034) and mode of delivery (p = 0.028). Our results suggest that Notch pathway downregulation is associated with PE. Further studies are required in order to determine the role of these molecules in PE pathogenesis and to evaluate their potential use for the early detection and treatment of PE.

Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial

There is little evidence to guide the management of women with hypertensive disorders in late preterm pregnancy. We investigated the effect of immediate delivery versus expectant monitoring on maternal and neonatal outcomes in such women. We did an open-label, randomised controlled trial, in seven academic hospitals and 44 non-academic hospitals in the Netherlands. Women with non-severe hypertensive disorders of pregnancy between 34 and 37 weeks of gestation were randomly allocated to either induction of labour or caesarean section within 24 h (immediate delivery) or a strategy aimed at prolonging pregnancy until 37 weeks of gestation (expectant monitoring). The primary outcomes were a composite of adverse maternal outcomes (thromboembolic disease, pulmonary oedema, eclampsia, HELLP syndrome, placental abruption, or maternal death), and neonatal respiratory distress syndrome, both analysed by intention-to-treat. This study is registered with the Netherlands Trial Register (NTR1792). Between March 1, 2009, and Feb 21, 2013, 897 women were invited to participate, of whom 703 were enrolled and randomly assigned to immediate delivery (n=352) or expectant monitoring (n=351). The composite adverse maternal outcome occurred in four (1·1%) of 352 women allocated to immediate delivery versus 11 (3·1%) of 351 women allocated to expectant monitoring (relative risk [RR] 0·36, 95% CI 0·12-1·11; p=0·069). Respiratory distress syndrome was diagnosed in 20 (5·7%) of 352 neonates in the immediate delivery group versus six (1·7%) of 351 neonates in the expectant monitoring group (RR 3·3, 95% CI 1·4-8·2; p=0·005). No maternal or perinatal deaths occurred. For women with non-severe hypertensive disorders at 34-37 weeks of gestation, immediate delivery might reduce the already small risk of adverse maternal outcomes. However, it significantly increases the risk of neonatal respiratory distress syndrome, therefore, routine immediate delivery does not seem justified and a strategy of expectant monitoring until the clinical situation deteriorates can be considered. ZonMw.

723: Outcomes of late preterm pregnancies complicated by gestational diabetes mellitus and polyhydramnios

723: Outcomes of late preterm pregnancies complicated by gestational diabetes mellitus and polyhydramnios

Small for gestational age newborns – does pre-recognition make a difference in pregnancy outcome?

Objective: We aimed to evaluate whether pre-recognition of small for gestational age (SGA) at late preterm or term pregnancies, has an impact on pregnancy outcome.Methods: Retrospective analysis of SGA newborns, stratified to those with suspected or unsuspected IUGR according the sonographic estimated fetal weight (EFW), below the 10th percentile for gestational age (n = 619), with fetuses not suspected as SGA (EFW ≥10th percentile) preformed up to 7 days prior to delivery (n = 1770).Results: SGA was correctly diagnosed prior to delivery in 26% of the fetuses. Women with suspected SGA were delivered earlier (37.9 ± 1.7 versus 38.8 ± 1.4 weeks, p < 0.001) and at a lower birth weight (2280 ± 321 versus 2454 ± 263 grams, p < 0.001). They also had higher rates of induction of labor (19.1% versus 6.2%, p < 0.001) and cesarean delivery (29.1% versus 19.8%, p < 0.001). Fetuses suspected for SGA had higher rate of neonatal adverse outcome, but on multivariate analysis suspected SGA (aOR 0.41, 95% CI 0.20–0.86), birthweight (aOR 0.67, 95% CI 0.5 to −0.77 for each additional 50 g), gestational age at delivery (aOR 0.63, 95% CI 0.56–0.71 for each additional week) and spontaneous vaginal delivery (aOR 0.88, 95% CI 0.19–3.89) were independently associated with an improved neonatal composite outcome.Conclusion: Identification of SGA may improve neonatal outcome. However, by itself, it is not an indication for intervention, which may lead to adverse outcome.

Clinical factors associated with failed trials of labor in late preterm and term twin pregnancies.

To evaluate the perinatal outcomes and clinical factors of unsuccessful trials of labor (TOLs) in late preterm and term twin pregnancies. We enrolled 896 consecutive twin pregnancies delivered between 1999 and 2012 in a single center, which met the following inclusion criteria: a vertex first twin, live twins, and attempted TOLs after 34 weeks. Obstetric characteristics and perinatal outcomes were compared between vaginal delivery and cesarean delivery groups. Successful TOLs were carried out in 81% (726/896). Failed TOLs occurred in 15% (37/247) of late preterm twins and 20% (133/649) of term twins. Comparisons of neonatal outcomes between the groups showed no significant differences in NICU admission, ventilator use, and composite morbidity. On univariable analysis, nulliparity, preeclampsia, induced labor, excessive weight gain, and intertwin weight discordance of >30% showed significant associations with failed TOLs. Multivariable analyses revealed nulliparity (adjusted odds ratio 9.89, 95% confidence interval 4.64-21.1) and preeclampsia (adjusted odds ratio 2.17, 95% confidence interval 1.30-3.63) as significantly associated with failed TOLs. In late preterm and term twins, trials of labor can be performed successfully without a significant increase in adverse neonatal outcomes. Nulliparity and preeclampsia are clinical factors associated with failed TOLs in twin pregnancies.

685: Clinical factors associated with failed trials of labor in late preterm and term twin pregnancies

685: Clinical factors associated with failed trials of labor in late preterm and term twin pregnancies

Comparison of placental pathology in preterm, late-preterm, near-term, and term births

The purpose of this study was to determine whether placental pathologic condition supports the recent suggestion of subcategorizing preterm and term births into smaller gestational age subgroups with different perinatal mortality and morbidity rates. Twenty-seven clinical and 43 placental phenotypes were retrospectively compared in 4617 third-trimester births: 1332 preterm pregnancies (28-33 weeks' gestation), 1066 late preterm pregnancies (34-36 weeks' gestation), 940 near-term pregnancies (37-38 weeks' gestation), and 1279 term pregnancies (≥39 weeks' gestation). Acute inflammatory pattern of placental injury was seen mostly at both gestational sides of the third trimester; the clinical conditions linked to in utero hypoxia (preeclampsia, diabetes mellitus, fetal growth restriction) and their placental associations (atherosis, membrane chorionic microcysts, chorangiosis, intervillous thrombi) were associated statistically significantly with mid third trimester. Acute fetal distress (abnormal fetal heart tracing and clinical and histologic meconium) were increasing with gestational age and were statistically significantly most common in full-term pregnancies. Differences in placental pathologic condition among the 4 subgroups of third-trimester pregnancy not only challenge the use of an arbitrary cutoff point of 37 weeks' gestation that separates the preterm birth and term birth but also further support separation of late preterm births from preterm births and term births from near-term births. Based on placental pathologic condition, chronic uteroplacental malperfusion is the dominating etiopathogenetic factor in the mid third trimester (late preterm and near-term births), and acute fetal distress is the factor in full-term births. This obscures relative frequencies of perinatal death and management modalities in the third trimester.

Which intrauterine growth restricted fetuses at term benefit from early labour induction? A secondary analysis of the DIGITAT randomised trial

ObjectiveThe Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT trial) showed that in women with suspected intrauterine growth restriction (IUGR) at term, there were no substantial outcome differences between induction of labour and expectant monitoring. The objective of the present analysis is to evaluate whether maternal or fetal markers could identify IUGR fetuses who would benefit from early labour induction. Study designThe DIGITAT trial was a multicenter, parallel and open-label randomised controlled trial in women who had a singleton pregnancy beyond 36+0 weeks’ gestation with suspected IUGR (n=650). Women had been randomly allocated to either labour induction or expectant monitoring. The primary outcome was a composite measure of adverse neonatal outcome, defined as neonatal death before hospital discharge, Apgar score <7, umbilical artery pH <7.05, or admission to neonatal intensive care. Using logistic regression modelling, we investigated associations between outcome and 17 markers, maternal characteristics and fetal sonographic and Doppler velocimetry measurements, all collected at study entry. Results17 (5.3%) infants in the induction group had an adverse neonatal outcome compared to 20 (6.1%) in the expectant monitoring group. The only potentially informative marker for inducing labour was maternal pre-pregnancy body mass index (BMI). Otherwise, we observed at best weak associations between a benefit from labour induction and maternal age, ethnicity, smoking, parity, pregnancy-induced hypertension or preeclampsia, Bishop score and gestational age, or fetal sonographic markers (gender, estimated fetal weight, body measurements, oligohydramnios, or umbilical artery pulsatility index and end diastolic flow). ConclusionIn late preterm and term pregnancies complicated by suspected intrauterine growth restriction, most of the known prognostic markers seem unlikely to be helpful in identifying women who could benefit from labour induction, except for maternal pre-pregnancy BMI.

OS011. Management of late preterm pregnancy complicated by mildpreeclampsia: A prospective randomized trial

In the absence of properly undertaken prospective randomized clinical trials, the optimal management of late preterm mild preeclampsia for best maternal and perinatal outcomes remains unclear for obstetricians worldwide. We desired to determine if immediate or expectant management of the late preterm mother presenting with mild preeclampsia was more beneficial to her without compromise to her newborn. This prospective randomized clinical trial of immediate versus expectant delivery for patients presenting with mild preeclampsia between the late preterm period of 34-0/7 to 36-6/7weeks gestation was undertaken using CONSORT guidelines. Patients were randomized to immediate delivery via induction of labor or cesarean delivery or inpatient expectant management with delivery at 37-0/7weeks gestation or earlier at onset of labor or progression to severe preeclampsia. The primary outcome was progression to severe preeclampsia; secondary outcomes were neonatal morbidity and mortality. Data were analyzed by appropriate tests for continuous or categorical outcomes with differences considered significant if p<0.05. One hundred and sixty nine patients during 2002-2008 satisfied and sustained protocol criteria in the immediate delivery (n=94) or inpatient expectant management (n=75) arms of the study. A third (33%) of expectantly managed patients developed severe preeclampsia during significantly longer hospitalization versus 3% in the immediately delivered patients (p=0.001). Cesarean delivery rates were similar. No significant neonatal morbidity differences were observed between groups; there were no maternal or neonatal deaths. The study was stopped in 2008 at 74% of the enrollment target when hospital policy changed to discourage inpatient hospitalization for uncomplicated mild preterm preeclampsia and in view of growing national concern for increased late preterm/early term neonatal morbidity and cost of care. Proceeding to delivery of the late preterm (⩾34weeks gestation) patient with mild preeclampsia lessens maternal risk without significantly increasing neonatal risk.

Is There an Association Between Fetal Scalp Electrode Application and Early-Onset Neonatal Sepsis in Term and Late Preterm Pregnancies? A Case–Control Study

ObjectiveEarly-onset neonatal sepsis (EONS), defined as neonatal sepsis occurring within the first week after birth, is a major cause of morbidity and mortality. Fetal scalp electrode application, used for fetal heart rate monitoring during labour, could potentially increase the risk of EONS. The objective of this study was to determine whether this practice is associated with a significant risk for EONS in term and late preterm pregnancies. MethodsThis case–control study enrolled subjects from three maternity hospitals in Edmonton. Cases were neonates with EONS who were born at ≥ 34 weeks between January 1, 2000, and March 1, 2011. Two control subjects were enrolled for each case identified. Control subjects were neonates of similar gestation (≥ 34 weeks), born at the same hospital site, who did not develop EONS. Maternal charts were accessed for information about fetal scalp electrode application and potential confounding variables. ResultsForty cases and 80 control subjects were identified. There was no difference in the rate of exposure to fetal scalp electrode in cases (6/40) and control subjects (10/80) (OR 1.24; 95% CI 0.42 to 3.68, P = 0.92). The association between fetal scalp electrode application and EONS remained non-significant despite adjustment for confounders. ConclusionWe did not detect an association between the use of fetal scalp electrode and EONS, but our study was powered to detect only a strong association between the exposure of interest and the disease outcome. We cannot rule out a weakly positive association that may still exist.