Lower Risk Of Preterm Delivery Research Articles

Clinical application of amino-terminal pro-brain natriuretic peptide concentration in amniotic fluid for the prediction of preterm birth in symptomatic women

BackgroundPreterm birth accounts for 60-80% of neonatal mortality. Approximately one-third of preterm births are caused by the spontaneous onset of preterm labor. Nevertheless, 70%-90% of women diagnosed with preterm labor will not deliver within seven days. Thus, many women will be unnecessarily treated by preterm labor with risk medications. Better tools are needed to categorize women in preterm labor into high or low risk of preterm delivery. ObjectiveTo evaluate the amino-terminal pro-brain natriuretic peptide concentration in the amniotic fluid as a prognostic test to predict the risk of delivery within 48 h or 7 days and before 34+0 or 37+0 weeks in women in preterm labor. Study Design102 pregnant women presenting signs and symptoms of spontaneous preterm birth (22+0 to 34+0 weeks of gestation) were included. Amniotic fluid was obtained by amniocentesis, and amino-terminal pro-brain natriuretic peptide concentration was measured. Below normal concentration was defined as < 0.5 multiples of the median of the standard curve according to gestational age. We estimated the risk of preterm delivery risk according to normal or lower-than-normal concentrations of amino-terminal pro-brain natriuretic peptide. The predictive capacity of the test (below normal concentration of amino-terminal pro-brain natriuretic peptide) was evaluated to identify spontaneous preterm birth at 48 h or 7 days from amniocentesis, and less than 34+0 or 37+0 weeks at delivery. ResultsFor the outcome delivery within 48 h, lower than normal amino-terminal pro-brain natriuretic peptide concentration had 94.6% sensitivity, 73.8% specificity, 96% negative predictive value, and positive and negative likelihood ratios 3.6 and 0.07, respectively. For the outcome delivery within 7 days, the test had 93.9% sensitivity, 88.7% specificity, 94% negative predictive value, and positive and negative likelihood ratios 8.3 and 0.07, respectively. For the outcome of spontaneous preterm birth before 34+0 and 37+0 weeks, below normal amino-terminal pro-brain natriuretic peptide had 80% sensitivity, 83% specificity, 78% negative predictive value, positive and negative likelihood ratio 4.7 and 0.24 and 64.1% sensitivity, 91.7% specificity, 44% negative predictive value, positive and negative likelihood ratio 7.7 and 0.39 respectively. ConclusionAmong patients in spontaneous preterm labor, the detection of lower-than-normal concentrations of amino-terminal pro-brain natriuretic peptide (< 0.5 multiples of the median) in amniotic fluid has an excellent predictive capacity to identify those patients at low risk of preterm delivery within 48 h or 7 days.

Differential DHA and EPA Levels in Women with Preterm and Term Births: A Tertiary Hospital Study in Indonesia.

BACKGROUND Preterm birth is one of the main causes of neonatal death worldwide. One strategy focused on preventing preterm birth is the administration of long chain polyunsaturated fatty acids (LCPUFAs) during pregnancy. Omega-3 LCPUFAs, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are essential in metabolic and physiological processes during embryonic and fetal development. This study aimed to compare DHA and EPA levels in 44 women with preterm births and 44 women with term births at a tertiary hospital in West Java Province, Indonesia, between November 2022 and March 2023. MATERIAL AND METHODS A total of 88 patients in this study consisted of 44 patients with term births (≥37 gestational weeks) and 44 patients with preterm births (<37 gestational weeks) at a tertiary hospital in West Java Province, Indonesia. This observational, cross-sectional study was conducted from November 2022 to March 2023. Using the enzyme-linked immunosorbent assay test, maternal DHA and EPA levels were investigated. IBM SPSS 24.0 was used to statistically measure outcomes. RESULTS Average maternal DHA and EPA levels in patients with preterm births were significantly lower than those in term births. Preterm labor risk was further increased by DHA levels of ≤5.70 µg/mL (OR=441.00, P=0.000) and EPA levels ≤3971.54 µg/mL (OR=441.00, P=0.000). CONCLUSIONS Since the average maternal DHA and EPA levels were significantly lower in patients with preterm births, adequate intake of omega-3 LCPUFA in early pregnancy and consistency with existing nutritional guidelines was associated with a lower risk of preterm delivery for pregnant women.

Randomized trial of screening for preterm birth in low-risk women - the preterm birth screening study

Preterm birth is a major cause of perinatal morbidity and mortality. It is unclear whether the introduction of a universal transvaginal ultrasound cervical length screening program in women at low risk for preterm delivery is associated with a reduction in the frequency of preterm birth. To test the hypothesis that the introduction of a midtrimester universal transvaginal ultrasound cervical length screening program in asymptomatic singleton pregnancies without prior preterm delivery would reduce the rate of preterm birth at <37 weeks of gestation. This study was a multicenter nonblinded randomized trial of screening of asymptomatic singleton pregnancies without prior spontaneous preterm birth, who were randomized to either cervical length screening program (ie, intervention group) or no screening (ie, control group). Participants were randomized at the time of their routine anatomy scan between 18 0/7 and 23 6/7 weeks of gestation. Women randomized in the screening group received cervical length measurement. Those who were found to have cervical length ≤25 mm were offered 200 mg vaginal progesterone daily along with cervical pessary. The primary outcome was preterm birth at <37 weeks. The risk of primary outcome was quantified by the relative risk with 95% confidence interval, and was based on the intention-to-screen principle. A total of 1334 asymptomatic women with singleton pregnancies and without prior preterm birth, were included in the trial. Out of the 675 women randomized in the transvaginal ultrasound cervical length screening group, 13 (1.9%) were found to have transvaginal ultrasound cervical length ≤25 mm during the screening. Preterm birth at <37 weeks of gestation occurred in 48 women in the transvaginal ultrasound cervical length screening group (7.5%), and 54 women in the control group (8.7%) (relative risk, 0.86; 95% confidence interval, 0.59-1.25). Women randomized in the transvaginal ultrasound cervical length screening group had no significant differences in the incidence of preterm birth at less than 34, 32, 30, 28, and 24 weeks of gestation. The introduction of a universal transvaginal ultrasound cervical length screening program at 18 0/6 to 23 6/7 weeks of gestation in singleton pregnancies without prior spontaneous preterm birth, with treatment for those with cervical length ≤25 mm, did not result in significant lower incidence of preterm delivery than the incidence without the screening program.

Preterm birth and its associated factors in coastal areas of eastern China: a multicenter retrospective study

Abstract Aim Preterm birth (PTB) is considered to be an important cause of neonatal mortality. However, most parts of China lack data or studies with large sample sizes to quantify the true burden of PTB. The current study aimed to determine the incidence of and factors associated with PTB in coastal areas of eastern China. Subject and methods This retrospective study included all eligible pregnant women who delivered in Lianyungang, Jiangsu Province, eastern China, between 1 July 2021 and 30 June 2022. Binary logistic regression was used to analyze the associated factors of PTB. Results A total of 29,807 pregnant women were included, and the incidence of PTB was found to be 5.1%. Multivariate regression analysis showed that pregnant women aged 18 years or younger (OR: 1.706, 95% CI: 1.207–2.409), who were 35 years or older (OR: 1.519, 95% CI: 1.312–1.760), or who had had a cesarean section delivery (OR: 1.542, 95% CI: 1.360–1.748), two or more perinatal births (OR: 14.557, 95% CI: 11.507–18.415), or four or more deliveries (OR: 1.614, 95% CI: 1.192–2.186) had a higher risk of PTB. Pregnant women with five or more prenatal visits (OR: 0.299, 95% CI: 0.241–0.372) had a lower risk of preterm delivery. In addition, pregnant women with hypertension (OR: 2.184, 95% CI: 1.666–2.863), preeclampsia (OR: 4.948, 95% CI: 3.014–8.124), gestational diabetes mellitus (OR: 1.610, 95% CI: 1.328–1.952), placenta previa (OR: 2.543, 95% CI: 1.836–3.523), or a history of PTB (OR: 9.028, 95% CI: 5.667–14.383) were more likely to have PTB. Conclusion The incidence of PTB was high and was affected by many factors. Early identification and management can reduce the incidence of PTB.

P-783 Obstetric and neonatal outcomes after single vitrified-thawed vs. fresh blastocyst transfer: a population-based linkage study

Abstract Study question Does the transfer of a single vitrified-thawed blastocyst optimise obstetric and neonatal outcomes compared to a single fresh blastocyst transfer? Summary answer A single vitrified-thawed blastocyst transfer is associated with a lower risk of preterm delivery and small-for-gestational-age babies but a higher risk of large-for-gestational-age babies. What is known already Several studies have been performed comparing the outcomes of ART pregnancies after fresh or frozen embryo transfers. Nevertheless, a closer examination of the available studies indicates a significant heterogeneity in terms of the clinical protocols they compare, predominantly in regards to the developmental stage of the embryos (cleavage vs. blastocyst), the number of embryos transferred (single vs. multiple) and the cryopreservation method used (slow-freezing vs. vitrification). The use of single blastocyst transfer and vitrification is currently considered the gold standard of care but relevant studies on the safety of these technologies regarding the obstetric and neonatal outcomes are lacking. Study design, size, duration Autologous ART cycles where a single Day 5/6 embryo was transferred were identified (n = 188,730) in the Australian ART registry (ANZARD) and these were linked with 20,214 birth records (deliveries &amp;gt;20 weeks of gestation or with a weight of &amp;gt; 400gr of the Perinatal Data Collection which had taken place in two Australian States between 1st of January of 2009 and 31st of December of 2016. Cycles including preimplantation genetic testing or assisted hatching were excluded. Participants/materials, setting, methods Two cohorts were formed, the Fresh group, containing 89,299 ART treatment cycles linked to 11,138 PDC birth records, and the Vitrified-Thawed (VT) group, containing 75,596 ART treatment cycles linked to 7,518 PDC birth records. Comparisons of obstetric and neonatal outcomes between these groups were performed using generalized estimating equations to account for the clustered nature of data while also accounting for multiple confounders. Significance level was set at 0.01 to correct for multiplicity of testing. Main results and the role of chance The risk of preterm delivery was significantly lower in the VT group compared to the fresh group (adjusted relative risk-aRR: 0.78, 99% CI 0.69-0.88). This persisted in a sensitivity analysis (accounting for the embryo ranking within each cohort) by comparing pregnancies occurring after the first vitrified-thawed embryo transfer following a freeze-all cycle (VTFA) with the fresh ET group (aRR: 0.71, 99% CI: 0.54-0.94). The probability of pregnancy-induced hypertension was not significantly different between the two groups (aRR: 1.15, 99% CI: 0.99-1.34). There was also no indication of an increased risk of PIH when the VTFA group was compared to the fresh ET group (aRR: 0.94, 99% CI: 0.68-1.30). The probability of SGA was 35% lower in the VT group compared to the fresh ET group (aRR: 0.65, 99% CI: 0.56-0.74). When only VTFA babies were compared with the fresh ET group, then the probability of SGA was 20% lower, but this was not statistically significant. For LGA babies, the risk was significantly higher (∼45%) in the VT group compared to the fresh ET group (aRR: 1.46, 99% CI: 1.30-1.65). The LGA risk remained significantly higher in the VTFA compared to the fresh ET group (aRR: 1.34, 99% CI: 1.04-1.72). Limitations, reasons for caution This is a population-based study using linked administrative datasets; therefore not all confounders could be accounted for. Furthermore, the smaller sample size of the sensitivity analysis combined with the strict level of significance adopted might have rendered some sensitivity analyses underpowered particularly for rare outcomes Wider implications of the findings This analysis shows the differences in obstetric and neonatal outcomes between fresh and frozen embryo transfers studying vitrification and single embryo transfer exclusively. For certain outcomes, it appears that the effects are modified when the embryo ranking within each cohort is accounted for. Trial registration number Not applicable

Distribution of uterocervical angles of pregnant women at 16+ 0 to 23+ 6 weeks gestation with low risk for preterm birth: first vietnamese cohort of women with singleton pregnancies

BackgroundCervical length (CL) measured by ultrasound in the second trimester is a predictor of spontaneous preterm birth (sPTB). The uterocervical angle (UCA) has recently been suggested as a predictor to identify women at risk of sPTB. The aim of this study was to investigate the UCAs’ distribution in singleton pregnant women at 16+ 0 − 23+ 6 weeks of gestation with low risk for sPTB.MethodsThis was a prospective cohort study of 1,051 pregnant women with singleton pregnancies at low risk for preterm delivery. Pregnant women with a viable singleton fetus at 16+ 0 − 23+ 6 weeks of gestation were enrolled in the study conducted at the Haiphong Hospital of Obstetrics and Gynecology, Vietnam, from 09/2019 to 09/2020. CL and the UCA were assessed using transvaginal ultrasonography (TVS) by a single sonographer. Subjects were followed-up until the end of pregnancy, and maternal and neonatal outcomes were recorded. The UCAs’ range and their relationship with gestational age were evaluated using regression analysis. P < 0.05 was considered statistically significant.ResultsThe normal range of the UCA (5th − 95th percentiles) was 46.47° (95% CI, 40.27°-51.81°) to 127.06° (95% CI, 123.02° − 130.71°). The UCAs in the preterm birth (< 37 weeks) and full-term groups were 117.86° ± 20.25° and 83.80° ± 24.18°, respectively (p < 0.001). Linear regression analysis showed a significant change in the UCA range from 16+ 0 to 23+ 6 weeks of gestation (2.51 degrees per week, p < 0.001). The linear function yielded the highest correlation coefficient in the variation rule of the UCA values (r = 0.22). A total of 42/63 (66.7%) patients with preterm birth < 37 weeks had a UCA above the 75th percentile. The majority of women with preterm birth had a UCA ≥ 95° compared with those with full-term delivery (88.9% vs. 31.3%, p < 0.001).ConclusionsThe results of this study present background information about the normal range of UCA values in singleton pregnant women at 16+ 0 to 23+ 6 weeks at low risk for sPTB in this Vietnamese cohort. In this study population at low risk for sPTB, pregnant women with a UCA value ≥ 95o were also considered at risk for preterm birth.

Maternal Health Literacy and Pregnancy Outcomes: Does any Association Exist?

Background & Objective: Social factors which are integrated with health status are considered crucial in pregnancy morbidity. Mothers with a developed level of health literacy (HL) experience a lower risk of preterm delivery. This study aimed to evaluate the relationship between maternal HL and prenatal care and pregnancy outcome.Materials & Methods: The research was a cohort study. A total of 323 participants were selected from prenatal clinics. The women were followed until delivery. Women who had gestational diabetes or preeclampsia or gestational hypertension during pregnancy were omitted. Data were collected with a survey.Results: The result found 34.1%, 33.1%, 23.8%, and 9% were categorized as having inadequate, problematic, sufficient, and excellent maternal HL. Women with sufficient and excellent literacy were meaningfully better in having earlier and more frequent antenatal care, earlier folic acid consumption, and exercise before and during pregnancy, pregnancy alarm sign awareness, neonatal birth weight, and breastfeeding.Conclusion: The results proposed that sufficient and excellent HL among women is related to good pregnancy outcomes and poor HL causes a poor chance to gain a positive pregnancy outcome. A cooperative work to grow maternal HL by considering HL levels, revision of educational materials into plain language, and provision of pregnant women with verbal and video instruction in addition to written materials are highly recommended.

Plant-Based Diets Improve Maternal-Fetal Outcomes in CKD Pregnancies.

Reducing protein intake in patients with chronic kidney disease (CKD) limits glomerular stress induced by hyperfiltration and can prevent the progression of kidney disease; data in pregnancy are limited. The aim of this study is to analyze the results obtained in CKD patients who followed a plant-based moderately protein-restricted diet during pregnancy in comparison with a propensity-score-matched cohort of CKD pregnancies on unrestricted diets. A total of 52 CKD pregnancies followed up with a protein-restricted plant-based diet (Torino, Italy) were matched with a propensity score based on kidney function and proteinuria with CKD pregnancies with unrestricted protein intake (Cagliari Italy). Outcomes included preterm (<37 weeks) and very preterm (<34 weeks) delivery and giving birth to a small-for-gestational-age baby. The median age in our cohort was 34 years, 63.46% of women were primiparous, and the median body mass index (BMI) was 23.15 kg/m2 with 13.46% of obese subjects. No statistical differences were found between women on a plant-based diet and women who were not in terms of age, parity, BMI, obesity, CKD stage, timing of referral, or cause of CKD. No differences were found between the two groups regarding the week of delivery. However, the combined negative outcome (birth before 37 completed gestational weeks or birth-weight centile <10) occurred less frequently in women following the diet than in women in the control group (61.54% versus 80.77%; p = 0.03). The lower risk was confirmed in a multivariable analysis adjusted for renal function and proteinuria (OR: 0.260 [Q1:0.093–Q3:0.724]; p = 0.010), in which the increase in proteinuria from the first to the last check-up before delivery was lower in patients on plant-based diets (median from 0.80 to 1.87 g/24 h; p: ns) than in controls (0.63 to 2.39 g/24 h p < 0.0001). Plant-based, moderately protein-restricted diets in pregnancy in patients with CKD are associated with a lower risk of preterm delivery and small-for-gestational-age babies; the effect may be mediated by better stabilization of proteinuria.

Obstetric and perinatal outcomes of teenage pregnant women: a retrospective study

Background: teenage pregnancy is a worldwide social problem. The aim of this study is to provide more data for a better understanding of the possible maternal and foetal risks associated with teenage pregnancies.&#x0D; Methods: the hospital records of all pregnant women, aged between 14 and 19, from the obstetric registers of the Policlinico Umberto I Hospital in Rome, between 2000 and 2010, have been completely reviewed (n=184). For each pregnant woman socio-demographic characteristics, obstetric history, pregnancy and birth outcomes were also determined. Our results were compared with a control group composed of 150 primigravida adult women aged 20-29 years who delivered at the Policlinico Umberto I Hospital in Rome in the same period.&#x0D; Results: the mean age ± SD of the study group was 17.9 ± 1.2, while that of the control group was 25.4 ± 2.4. The control group had a significantly lower risk of preterm delivery (p=0.000). The rate of low birth weight babies born to the young mothers was significantly higher than that of babies born to the adult mothers (p=0.036). The study group had a lower risk of instrumental delivery and a higher proportion of spontaneous delivery (p=0.000). Finally, we observed a statistically significant difference of the APGAR score at the fifth minute between the two groups (p=0.004).&#x0D; Conclusions: our results seemed to confirm the outcomes of previous studies for adolescent pregnant women, mainly regarding the increased risks of preterm deliveries and low birth weight babies, the higher incidence of spontaneous vaginal delivery and the lower incidence of instrumental delivery.

P-749 How do different uterine anomalies compare for pregnancy complications? An evaluation of a large American population database

Abstract Study question What type of uterine anomalies cause alterations in pregnancy complications, compared to other anomalies, based on analysis of the Healthcare-Cost and Utilization-Project-Nationwide Inpatient Sample(HCUP-NIS) database? Summary answer After controlling for confounders, bicornuate uteri had lower risks and arcuate uteri had increased risks of cesareans and mostly similar risks of other outcomes. What is known already Women with mullerian anomalies are known to have increased risks of adverse obstetrical outcomes. Comparison of different adverse obstetrics outcomes between women with different type of uterine anomalies has minimally been studied. Study design, size, duration This retrospective population-based cohort study utilized data from the HCUP-NIS from 2010-2014, inclusively. A cohort of all deliveries during the study period was created. Within this group, Six thousand and one hundred ninety-five deliveries were to women with bicornuate uteri, 798 were to women with arcuate uteri, 2255 were in women with didelphys uteri, 802 were from women with unicornuate uteri and 1404 were deliveries to women with septate uteri. Participants/materials, setting, methods HCUP-NIS is the largest inpatient sample database in the USA and is comprised of hospital stays throughout the country. It provides information relating to seven million inpatient stays yearly, includes 20% of admissions, and represents over 96% of the American population. Multivariate logistic regression was conducted to explore associations between uterine anomalies and delivery outcomes. According to the Tri-Council Policy Statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance After adjustment for confounders, women with bicornuate uteri had less risk for chorioamnionitis(aOR:0.6, 95%CI:0.5-0.8-P=0.003), were more likely to deliver vaginally or by operative vaginal delivery(aOR:1.4, 95%CI:1.1-1.9-P=0.01), and less likely to deliver by CD when compared to the other anomalies(aOR:0.6, 95%CI:0.5-0.6-P=0.0001). They had lower risk of SGA (small for gestational age)(aOR:0.8, 95%CI:0.7-0.9-P=0.03). Pregnant women with arcuate uterus had lower risk of preterm delivery compared to the other anomalies(aOR:0.6, 95%CI:0.5-0.8-P=0.0001), less chance of having delivered by an operative vaginal delivery(aOR:0.5, 95%CI:0.2-0.9-P=0.04), and were at higher risk of having a CD(aOR:1.6, 95%CI:1.4-2-P=0.0001). Pregnant women with didelphys uteri had higher risk of PPROM(aOR:1.6, 95%CI:1.3-1.9-P=0.0001), preterm delivery(aOR:1.5, 95%CI:1.3-1.6-P=0.0001), CD(aOR:1.4, 95%CI:1.2-1.5-P=0.0001) and wound complications(aOR:1.6, 95%CI:1.1-2.4-P=0.02) compared to the other anomalies. However, they had less risk for placenta abruptia(aOR:0.6, 95%CI:0.5-0.9-P=0.02). Pregnant women with unicornuate uteri had increased risks of preterm delivery(aOR:1.4, 95%CI:1.1-1.6-P=0.0001), CD(aOR:3.0, 95%%CI:1.6-2.5-P=0.0001) and SGA(aOR:1.8, 95%CI:1.4-2.3-P=0.0001) with lower risk of placenta abruptia(aOR:0.5, 95%CI:0.3-0.9-P=0.03). Pregnant women with septate uteri had higher risk of chorioamnionitis(aOR:1.5, 95%CI:1.1-2.1-P=0.048) and CD(aOR:1.4, 95%CI: 1.2-1.6-P=0.0001). Other pregnancy complications studied which included PPH, the need for hysterectomy, and IUFD had similar rates between the groups(p &amp;gt; 0.05 all). Limitations, reasons for caution This is a retrospective analysis utilizing an administrative database that relies on data coding accuracy and consistency Wider implications of the findings There are different risks for certain adverse pregnancy and neonatal outcomes in different uterine anomalies as compared to the other anomalies. Although, regarding many pregnancy complications, risks were similar with different anomalies. Arcuate uterus mostly responds in a similar manner in terms of pregnancy complications as other anomalies. Trial registration number NA

Precision in prescription: multiple micronutrient supplements in pregnancy

Precision in prescription: multiple micronutrient supplements in pregnancy

Open surgery for in utero repair of spina bifida: Microneurosurgery versus standard technique - A systematic review.

Prenatal myelomeningocele (MMC) repair has been shown to improve neurological outcomes. It has been suggested that decreases in the hysterotomy diameter during surgery can improve perinatal outcomes without altering neurologic outcomes. The objective of this study is to describe and compare the main maternal and fetal outcomes of fetuses undergoing open surgery for MMC repair, through the different modifications (standard-classical, mini-hysterotomy, and microneurosurgery). MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Ovid, SciELO, LILACS, PROSPERO. From a total of 112 studies, seven case series were selected including 399 fetuses with open fetal surgery, five studies using the classical technique (n=181), one with mini-hysterotomy (n=176), and one with the microneurosurgery technique (n=42). The mini-hysterotomy and microneurosurgery techniques presented a lower risk of preterm delivery (21.4% and 30%, respectively) compared to the classic technique (47.3%), premature rupture of membranes (78%, 62%, and 72.5 %, respectively), oligohydramnios (0% and 72.5%, respectively), dehiscence of hysterotomy, maintaining the same frequency of Chiari reversion (78%, 62%, and 72.5%, respectively), postnatal correction requirement (0%, 4.8%, and 5.8%, respectively), and lower frequency of requirement for a ventriculoperitoneal shunt placement (13.0%, 7.5%, and 29.1%, respectively). The least invasive techniques (minihysterotomy-microneurosurgery) are possible and reproduceable, as they are associated with better maternal and perinatal outcomes.

Single Uterine Access for Bilateral Pleuroamniotic Shunting in Fetuses with Severe Hydrothorax by an Internal Rotational Maneuver: Feasibility and Outcomes between Successful and Failed Procedures

Objective: The objective of this study was to describe the feasibility of single percutaneous uterine access for bilateral pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax by using an internal rotational maneuver and to compare perinatal outcomes between successful and failed procedures. Methods: A prospective cohort of 25 fetuses with isolated bilateral hydrothorax and hydrops were referred to our fetal surgery center in Queretaro, Mexico during an 8-year period. Bilateral PAS was first attempted through a percutaneous single uterine access by internal rotation of the fetus, which was achieved by using the blunt tip of the same cannula, and in case of a failed procedure, a second uterine port was used to place the second shunt. The perinatal outcomes between successful (single uterine port) and failed (2 uterine ports) fetal procedures were compared. Results: Placing of bilateral shunts through a percutaneous single uterine access was feasible in 15/25 (60%) cases. Overall, median GA at delivery was 35.2 weeks with a survival rate of 64.0% (16/25). Three cases were excluded due to shunt dislodgement, leaving a final population of 22 fetuses; 13/22 (59.1%) and 9/22 (40.9%) managed using 1 and 2 uterine ports, respectively. The group with bilateral PAS placement through a successful single uterine port showed a significantly higher GA at birth (36.5 vs. 32.8 weeks, p = 0.001), lower surgical time (11.0 vs. 19.0 min, p = 0.01), longer interval between fetal intervention and delivery (5.7 vs. 2.7 weeks, p = 0.01), lower risk of preterm delivery (46.2 vs. 100%, p < 0.01), and lower rate of perinatal death (15.4 vs. 55.6%, p < 0.05) than the failed procedures requiring 2 uterine ports. Conclusion: In fetuses with severe bilateral hydrothorax and hydrops, bilateral pleuroamniotic shunting through a successful single percutaneous uterine access is feasible in up to 60% of cases and is associated with better perinatal outcomes.

Effects of selenium supplementation on pregnancy outcomes and disease progression in HIV-infected pregnant women in Lagos: A randomized controlled trial.

To examine the effects of selenium supplementation on pregnancy outcomes and disease progression among HIV-infected pregnant women in Lagos. A randomized, placebo-controlled trial conducted among HIV-positive pregnant women between September 2018 and August 2019. At enrollment, 90 women were randomly assigned into each treatment arm to receive either a daily tablet of 200μg elemental selenium or a placebo. Relevant participants' sociodemographic and clinical data were collected at enrollment and delivery. Women in the selenium arm had a significantly lower risk of preterm delivery (relative risk [RR] 0.32, 95% confidence interval [CI] 0.11-0.96) and a non-significant reduction in the risk of delivering term neonates with a low delivery weight (RR 0.24, 95% CI 0.05-1.19). Supplemental selenium does not increase the risk of perinatal death and adverse drug events. The study reported a beneficial effect of prenatal selenium supplements on the risk of preterm delivery with no further reduction in risk among HIV-infected women who used the supplements for more than 14weeks. Pan African Clinical Trial Registry (PACTR201809756724274).

Maternal and Fetal Outcomes in Systemic Lupus Erythematosus Pregnancies

To describe the maternal and fetal outcomes in systemic lupus erythematosus (SLE) pregnancies followed-up in a single tertiary referral centre. We performed a retrospective cohort study of 75 SLE pregnancies who were followed up in Singapore General Hospital over a 16-year period from 2000 to 2016. Adverse fetal and maternal outcomes including preterm delivery, miscarriages, fetal growth restriction, congenital heart block, neonatal lupus, pre-eclampsia and SLE flares were obtained from the medical records. The mean age at conception was 32 years old (SD 3.8). The mean SLE disease duration was 5.9 years (SD 5.2). The majority (88%) had quiescent SLE disease activity at baseline. Most pregnancies resulted in a live birth (74.7%). The mean gestational age at birth was 37.4 weeks (SD 3.4). Adverse fetal outcomes occurred in 53.3%. Preterm delivery (33.9%), miscarriages (20%) and fetal growth restriction (17.3%) were the most frequent adverse fetal outcomes. There was 1 neonatal death and SLE flares occurred in a third (33%). In the subgroup of SLE pregnancies with antiphospholipid syndrome, there were higher SLE flare rates (40%) and adverse fetal outcomes occurred in 8 pregnancies (80%). There were no predictive factors identified for all adverse fetal and maternal outcomes. In the subgroup analysis of preterm delivery, anti-Ro (SS-A) antibody positivity and hydroxychloroquine treatment were associated with a lower risk of preterm delivery. Although the majority had quiescent SLE disease activity at baseline, SLE pregnancies were associated with high rates of adverse fetal and maternal outcomes.

Guideline No. 401: Sonographic Cervical Length in Singleton Pregnancies: Techniques and Clinical Applications.

• To assess the association between sonography-derived cervical length measurement and preterm birth. • To describe the various techniques to measure cervical length using sonography. • To review the natural history of the short cervix. • To review the clinical uses, predictive ability, and utility of sonography-measured short cervix. Reduction in rates of prematurity and/or better identification of those at risk, as well as possible prevention of unnecessary interventions. Clinicians involved in the obstetrical management or cervical imaging of patients at increased risk of a short cervix. Women at increased risk of a short cervix or at risk of preterm birth. Literature published up to June 2019 was retrieved through searches of PubMed and the Cochrane Library using appropriate controlled vocabulary and key words (preterm labour, ultrasound, cervix, cervical insufficiency, transvaginal, transperineal, cervical length, fibronectin). Results were restricted to general and systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. There were no date or language restrictions. Grey (unpublished) literature was identified through searching the websites of health technology assessment agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The evidence and this guideline were reviewed by the Diagnostic Imaging Committee of the Society of Obstetricians and Gynaecologists of Canada, and the recommendations were made and graded according to the rankings of the Canadian Task Force on Preventive Health Care (Online Appendix Table A1). Preterm birth is a leading cause of perinatal morbidity and mortality. Use of the sonographic technique reviewed in this guideline may help identify women at risk of preterm birth and, in some circumstances, lead to interventions that may reduce the rate of preterm birth. SUMMARY STATEMENTS (CANADIAN TASK FORCE ON PREVENTIVE HEALTH CARE GRADING IN PARENTHESES): RECOMMENDATIONS (CANADIAN TASK FORCE ON PREVENTIVE HEALTH CARE GRADING IN PARENTHESES).

The optimal cut-off point of vitamin D for pregnancy outcomes using a generalized additive model

Several studies consider vitamin D deficiency as a modifiable risk factor for adverse pregnancy outcomes. However, there is no specific cut-off point for the serum level of this prohormone to identify high-risk pregnant women. This study aimed to determine the thresholds for the circulating levels of 25-hydroxyvitamin D (25(OH)D), associated with adverse pregnancy outcomes, including preterm labor, preeclampsia (PE), and gestational diabetes mellitus (GDM), using a generalized additive model. This is a descriptive and analytical cross-sectional study carried out on the data collected from the Khuzestan Vitamin D Deficiency Screening Program in Pregnancy. Of 1800 pregnant women, referred to the health centers of Masjed-Soleyman and Shushtar (Khuzestan Province, Iran), we used the data of 1763 pregnant women, whose serum vitamin D status during the third trimester of pregnancy was available. The datasets were randomly divided into training (70%) and validation (30%) subsets. The cut-off levels of 25(OH)D were identified for the low, moderate, and high risk of adverse pregnancy outcomes, according to generalized additive models (GAM) with smooth functions in the training data set. Then Generalized Linear Model (GLM), with logit link function was applied in the validation dataset to explore the relationships between the optimal vitamin D classification and adverse pregnancy outcomes after adjusting for the potential confounders. The optimal cut-off levels of 25(OH)D for the high, moderate, and low risk of GDM were ≤16, 16-26, and >26ng/mL, respectively. Also, the optimal cut-off points of 25(OH)D for the high, moderate, and low risk of preterm delivery were ≤15, 15-21, and >21ng/mL, respectively. Finally, the corresponding values for the high, moderate, and low risk of PE were ≤15, 15-23, and >23ng/mL, respectively. The models were well-calibrated, based on the Hosmer-Lemeshow test. Results of the adjusted generalized linear model showed a significant increasing trend in the risk of pregnancy outcomes by decreasing 25(OH)D levels. In the preconception period, a 25(OH)D cut-off level of >15ng/mL is recommended for the prevention of adverse pregnancy outcomes.

Association between omega-3 fatty acid supplementation and lower risk of preterm delivery: a systematic review and meta-analysis

Objective To explore whether omega-3 fatty acid supplementation is associated with lower risk of preterm delivery. Methods Searching the RCTs which were compared preterm birth between women with omega-3 fatty acid supplementation and without before December 2019 on Medline, EMBASE and Cochrane’s Library, then performing a meta-analysis. Results 26 trials were identified, included 20124 women. There was almost no association between omega-3 fatty acid supplementation and lower risk of preterm delivery (risk ratio 0.92, 95% confidence interval 0.85 to 1.01, I 2 = 9%), gestational duration (0.30, −0.05 to 0.64, I 2 = 48%). In subgroup analyses, preterm delivery lower rate occurred in groups with mixed DHA and EPA supplementation not only DHA supplementation groups (P for interaction = 0.02); The dose of equivalent greater than 1 g made a higher reduction in preterm birth significantly. Conclusions Omega-3 fatty acid supplementation was not associated with reduced risk of preterm delivery compared with placebo or no treatment during pregnancy. Relationship between Omega-3 fatty acid supplementation and other pregnant outcomes need more evidence and clinical studies.

1348-P: Social Adaptability Index and Pregnancy Outcomes in Women with Diabetes during Pregnancy

Objective: The social adaptability index (SAI) is a composite indicator capturing an individual’s social adaptability within society and socioeconomic status in order to predict overall health outcomes. The objective of this analysis was to examine whether the SAI is an independent risk factor for adverse pregnancy outcomes in women whose pregnancy is complicated by diabetes. Methods: Data from the 2011-2017 National Survey of Family Growth were analyzed using cross-sectional methodology. Women with a singleton gestation age 18-44 were included. Maternal diabetes was defined as either presence of pre-gestational diabetes or diagnosis of gestational diabetes. The SAI was developed from the following maternal variables: education level, employment status, income, marital status and substance abuse. Higher score indicates lower risk. Multivariable logistic regression models were run to assess the association between SAI and pregnancy outcomes associated with diabetes, including cesarean delivery, macrosomia (birthweight &amp;gt;4000g) and preterm delivery (&amp;lt;37 weeks), stratified by maternal diabetes. All analyses were weighted. Results: A total of 18,304 women were included in the analysis, with 1,965 (10.7%) having diabetes during pregnancy. The SAI was lower in women with diabetes during pregnancy, compared to controls (6.7±0.2 vs. 7.2±0.1, p&amp;lt;0.001). In the univariable analysis, the SAI had a significant association with the outcomes of preterm delivery (OR=0.94, p&amp;lt;0.001) and was not significantly associated with cesarean delivery or macrosomia. In adjusted multivariable analysis, controlling for maternal race/ethnicity, insurance status, body mass index, age and partner support of the index pregnancy, SAI remained to be independently associated with preterm delivery among women with diabetes during pregnancy (aOR=0.83, 95% CI 0.77-0.94). Conclusion: Among women with diabetes during pregnancy, a higher SAI is independently associated with a lower risk of preterm delivery. Disclosure A. Palatnik: None. M.Y. Thakkar: None. R.J. Walker: None. L.E. Egede: None.

Pregnancy outcomes of dichorionic triamniotic triplet pregnancies after in vitro fertilization-embryo transfer: multifoetal pregnancy reduction versus expectant management

BackgroundTrichorionic triplet pregnancy reduction to twin pregnancy is associated with a lower risk of preterm delivery but not with a lower risk of miscarriage. However, data on dichorionic triamniotic (DCTA) triplet pregnancy outcomes are lacking. This study aimed to compare the pregnancy outcomes of DCTA triplets conceived via in vitro fertilization-embryo transfer (IVF-ET) managed expectantly or reduced to a monochorionic (MC) singleton or monochorionic diamniotic (MCDA) twins at 11–13+ 6 gestational weeks.MethodsTwo hundred ninety-eight patients with DCTA triplets conceived via IVF-ET between 2012 and 2016 were retrospectively analysed. DCTA triplets with three live foetuses were reduced to a MC singleton (group A) or MCDA twins (group B) or underwent expectant management (group C). Each multifoetal pregnancy reduction (MFPR) was performed at 11–13+ 6 gestational weeks. Pregnancy outcomes in the 3 groups were compared.ResultsEighty-four DCTA pregnancies were reduced to MC singleton pregnancies, 149 were reduced to MCDA pregnancies, and 65 were managed expectantly.There were no significant differences among groups A, B, and C in miscarriage rate (8.3 vs. 7.4 vs. 10.8%, respectively) and live birth rate (90.5 vs. 85.2 vs. 83.1%, respectively) (P > 0.05).Group A had significantly lower rates of preterm birth (8.3 vs. 84.6%; odds ratio (OR) 0.017, 95% confidence interval (CI) 0.006–0.046) and low birth weight (LBW; 9.2 vs. 93.2%; OR 0.007, 95% CI 0.003–0.020) than group C (P < 0.001).Group B had significantly lower preterm birth (47.0 vs. 84.6%; OR 0.161, 95% CI 0.076–0.340) and LBW rates (58.7 vs. 93.2%; OR 0.103, 95% CI 0.053–0.200) than group C (P < 0.001).Group A had significantly lower preterm birth (8.3 vs. 47.0%; OR 0.103, 95% CI 0.044–0.237; P < 0.001), LBW (9.2 vs. 58.7%; OR 0.071, 95% CI 0.032–0.162; P < 0.001) and perinatal death rates (1.3 vs. 9.1%; OR 0.132, 95% CI 0.018–0.991; P = 0.021) than group B.ConclusionThe MFPR of DCTA triplets to singleton or MCDA pregnancies was associated with better pregnancy outcomes compared to expectant management. DCTA triplets reduced to singleton pregnancies had better perinatal outcomes than DCTA triplets reduced to MCDA pregnancies.