Number Of Preterm Deliveries Research Articles

Determination of hand grip strength and its correlates during pregnancy: a cross-sectional study

BackgroundPregnancy results in many changes, including reduced hand grip strength (HGS). However, good HGS is required for physical functions such as carrying and breastfeeding the baby after birth. The aim of this study was to determine the factors that may predict HGS during pregnancy.MethodsThe study was a cross-sectional study approved by the Research Ethics Committees of Kano State Ministry of Health and Aminu Kano Teaching Hospital in Kano, north-west, Nigeria. Pregnant women at the designated hospitals were included in the study if they had no serious comorbidities or any known neurological condition that affects the hands and the neck. Demographic characteristics and independent (predictor) variables (age, weight, height, BMI, maternity leave status, number of full-term deliveries, number of preterm deliveries, number of live births, number of abortuses, gravidity, trimester, systolic blood pressure, diastolic blood pressure, inter arm systolic BP difference [IASBP], inter arm diastolic BP difference [IADBP], and heart rate) of each of the participants were recorded by experienced therapists. The data were analysed using descriptive statistics, t-test, Pearson correlation coefficient and standard multiple regression.ResultOne hundred and sixty-one pregnant women with mean age, 25.04 ± 4.83 years participated in the study. In the dominant hand, 120 participants (74.5%) had weak grip strength. In the non-dominant hand, 135 participants (83.9%) had weak grip strength. For the dominant hand, the total variance explained by the whole model was significant, 28.5%, F(11, 161) = 1.187, R2 = 0.081, p = 0.300 . In the final model, none of the variables significantly predicted HGS. However, systolic blood pressure contributed to the model more than any other variable (Beta = -0.155). For the non-dominant hand, the total variance explained by the whole model was not significant, 33.1%, F(11, 161) = 1.675, R2 = 0.111, p = 0.089 . In the final model, only systolic blood pressure (Beta = -0.254, p = 0.023) significantly predicted hand grip strength.ConclusionCardiovascular events or changes during pregnancy (such as change in systolic blood pressure) may be related to HGS in pregnant women. It is therefore, important for clinicians to pay attention to this, in planning rehabilitation strategies for pregnant women.

THU0144 DESCRIPTIVE ANALYSIS OF PREGNANCY, DELIVERY, AND LACTATION IN PATIENTS WITH RHEUMATOID ARTHRITIS FROM THE IORRA COHORT.

Background:Rheumatoid Arthritis (RA) is common in women with reproductive age. For this reason, RA treatment during pregnancy and lactation is very important. In recent years, the use of biologic disease-modifying antirheumatic drugs (bDMARDs) has become common in RA treatment (1), treatment during pregnancy and lactation has changed drastically (2,3).Objectives:To investigate the pregnancy, delivery and lactation status of RA patients and treatment during that period in daily practice.Methods:The IORRA cohort is a large, single institute-based, observational cohort of RA patients established at Institute of Rheumatology, Tokyo Women’s Medical University, in 2000. We identified female RA patients aged 20-49 years who answered ‘pregnant’ or ‘delivered’ in the IORRA survey in 2010-2016 and whose pregnancies were confirmed in the medical records. We examined the Disease Activity Score with 28 joint count (DAS28)-CRP, medication use situation, the outcome of pregnancy, and lactation in those patients.Results:A total of 101 patients and 143 pregnancies were confirmed, of which 136 outcomes of pregnancy could be confirmed in the medical records. Among 136 confirmed pregnancy cases, there were 106 births and 30 miscarriages. Among 106 births, 4 cases (3.8%) were birth defects that could be confirmed in the medical records. The average age at pregnancy was 34.2±3.7 years and 36.1±3.3 years in delivered and miscarried cases, respectively. Miscarried cases were significantly older pregnancies (p=0.01). Of the 106 births, 65 birth weeks were confirmed, with an average of 37.9±1.8 weeks. The number of preterm delivery was 11 cases (16.9%). The average birth weight of 59 babies whose birth weight could be confirmed was 2699±517 g. There were 21 cases (35.6%) of low birth weight infants. The proportion of patients in DAS28-CRP remission was 73.1% before pregnancy, 61.6% during pregnancy, and 68.0% 1 year after delivery. Drugs used before pregnancy were glucocorticoid (48.8%), non-steroidal anti-inflammatory drugs (14.2%), conventional synthetic DMARDs (24.8%), and bDMARDs (48.0%). Etanercept accounted for 90% of bDMARDs. Among taking bDMARDs patients, 73.8% were discontinued after the pregnancy, and 26.2% were continued during pregnancy. Among those patients who continued bDMARDs, lactating patients were 12/26 (46.2%) cases after delivery, 10/30 (33.3%) cases in six months after delivery, and 7/36 (19.4%) cases in 1 year after delivery, respectively.Conclusion:The actual situation of pregnancy, delivery, and lactation in RA patients was revealed. Especially, bDMARDs were used at relatively high rates in RA patients who wish to have a child.

Perinatal outcomes of African refugees after their integration into the Israeli health care system

ObjectiveEvaluate whether the incorporation of the refugees into the Israeli medical system resulted in improvements in perinatal outcomes, namely a reduction in the number of preterm deliveries and a decrease in NICU admissions. MethodsRetrospective cohort study. Electronic medical records of all African immigrants who delivered in our tertiary referral center between January 2018 and September 2019 were reviewed. African patients’ demographics, maternal and perinatal outcomes were compared to those of native Israeli population. In addition, the results were compared to the cohort from our previous study from 2010. ResultsA total of 20,796 deliveries took place at our labor and delivery department during the study period. Of these, 3% of all deliveries were of African refugees. Total rates of preterm deliveries <37 weeks was similar between groups, while rate of premature deliveries <34 week was higher among refugees. Rates of extreme prematurity <28 weeks were also similar between groups. Rate of meconium stained amniotic fluid, neonatal weight <2000 g as well as NICU admissions were significantly higher among refugees. ConclusionThough perinatal results have not substantially improved with the incorporation of a refugee population into a healthcare system, some progression has indeed been achieved in some perinatal parameters.

Особливості перебігу вагітності та пологів у жінок після застосування допоміжних репродуктивних технологій на тлі ожиріння (За даними ретроспективного аналізу)

The objective: to study the structure and frequency of complications of pregnancy, deliveries and perinatal outcomes in three groups of women: women with infertility and obesity, treated by application of in vitro fertilization (hereinafter IVF), pregnant women after IVF application with normal body weight, and pregnant women on the background of obesity which did not have an infertility in past history. Materials and methods. A retrospective analysis of 221 case histories of pregnancies and labors in women who were treated and gave birth in the Pregnancy and delivery pathology Department of SI «Institute of Pediatrics, Obstetrics and Gynecology named after Acad. O. M. Lukyanova of NAMS of Ukraine» for 2012 – 2016 years was carried out. Results. The overwhelming majority of pregnant women after IVF on the background of obesity are primaparas, who have a complicated obstetric history, hormonal changes in the form of progesterone deficiency predominantly and chronic inflammatory processes. Pregnancy with a combination of infertility, treated by the means of IVF application, and obesity, in most cases is accompanied by a long-term threat of termination of pregnancy (48.8%), threatening preterm deliveries (56%), placental dysfunction (41.5%), premature rupture of the amniotic membranes (41.5%), other problems during pregnancy, at the same time, every second woman (58.5%) had a combination of several complications, and required a long-term and repeated inpatient treatment (53.7%). The specific gravity of surgical delivery was 90%, and 16.2% of such deliveries were complicated by pathological blood loss. The number of preterm deliveries was 17.1%, with perinatal losses up to 11.3‰. Among full-term newborns 21.3% of newborns had malnutrition of the I degree and 17% of them had hypoxic-ischemic lesion of CNS. Conclusion. The course of pregnancy, delivery and the postpartum period in the studied contingent of women has a significant frequency of complications, mainly the coinciding ones, which affects on the consequences of perinatal outcomes and requires further study of this problem and the development of differentiated algorithms for antenatal observation. Key words: pregnancy, obesity, in vitro fertilization, complications, delivery, newborn.

Study of analgesics usage in third trimester of pregnancy and its ill effects on pregnancy course and outcome

Background: Pregnancy is a special physiological state. Pregnancy care is one of the greatest challenges in medicine as it demands a special care in the use of drugs because of altered physiology. At least 10 percent of birth defects are thought to result from maternal drug exposures. NSAIDS are one of the most commonly used medications during pregnancy (17%) to treat painful events during pregnancy.Methods: A prospective observational study was conducted after taking approval from the Institutional ethical committee and study was conducted for a period of one year. Antenatal clinics and inpatients wards of department of obstetrics and Gynaecology were visited and all the pregnant women with exposure to analgesics during third trimester and at the time of labour were included in the study. Information regarding the analgesics exposure either prescribed by the physician or self-medicated was collected.Results: Total 1520 pregnant women were included in the study over a period of one year. Analgesic exposure was seen in 77.1% of pregnant women during labour. Most common analgesic used to relieve labour pain was tramadol. 22.9% pregnant women were exposed to analgesics during third trimester, among them exposure to paracetamol was observed in 14% of pregnant women and to tramadol in 8.9%. Indications for usage of these analgesics during pregnancy were fever with myalgia (45.8%), false labour pain (37%), and headache (11.4%).Conclusions: Study showed that there is a positive association between analgesics exposure during third trimester of pregnancy particularly to paracetamol exposure and preterm delivery. Association between paracetamol exposure and low birth weight was also observed in this study but this finding could be due to more number of preterm deliveries which could not be ruled out in this study. Further studies have to be conducted to confirm the association since there are only limited numbers of studies done till now.

Investigating Parity as a Risk Factor for Developing Preeclampsia in Gestational Diabetes Mellitus [36F

INTRODUCTION: It is well established that patients with Gestational Diabetes Mellitus (GDM) are at a greater risk of developing preeclampsia than those not diagnosed with GDM. It has also been shown that nulliparous women are at an increased risk of developing preeclampsia compared to multiparous women. This study investigates the role of parity as a risk factor for preeclampsia in patients already diagnosed with GDM. METHODS: A retrospective chart review was conducted at SUNY Downstate Medical Center. Exact Mantel-Haenszel tests of trend were conducted for the outcome of preeclampsia (yes vs. no) from the following predictors: number of full-term deliveries, number of pre-term deliveries, and number of spontaneous/elective abortions. Step-down Bonferroni corrections to p-values were applied to correct for multiple testing. RESULTS: 636 patients with GDM and no prior history of diabetes were included. The population was composed of 30.3% nulliparous patients with a median age of 31 y/o and 37 weeks 2 days at delivery. The multipara (69.7%) population was similar with a median age of 32 y/o and 37 weeks 2 days at delivery. The results revealed that the frequency of developing preeclampsia in nulliparous women with GDM was more than twice that of multiparous women (8.81 to 4.06, p=0.086). CONCLUSION: As this value was approaching statistical significance, it warrants the necessity of further investigation of nulliparity as a risk factor for preeclampsia in GDM patients. This research was created in the effort to help physicians understand which patients are more at risk for preeclampsia thus aiding in counseling and management.

Elective cervical cerclage versus no treatment in women with the history of cervical insufficiency: retrospective analysis of pregnancy outcomes

Purpose of investigation: To evaluate the effectiveness of elective cervical cerclage (CC) on the pregnancy outcome of patients with cervical insufficiency. Material and Methods: A retrospective cohort study was conducted on women with an obstetric history of cervicalinsufficiency on whom CC was applied or not. The two groups were compared for the main measure outcomes of mean gestational age at delivery, birth weight, Apgar scores at five minutes, number of premature and preterm deliveries, rate of preterm premature ruptureof membranes, incidence of neonatal death, and admission to the neonatal intensive care unit (NICU). Results: A total of 183 women were eligible for the final analysis in the CC group and 183 were taken as the control group. There were significant differences in terms of the mean gestational age at delivery (37 &#x00B1; 4.0 vs. 34&#x00B1;5 weeks, p = 0.001), the mean birth weight (3,000 &#x00B1; 870 vs. 2,200 &#x00B1; 860 grams, p = 0.001), the number of preterm deliveries (vs. 63%, p = 0.001, OR: 0.4, 95% CI: 0.26–0.61) between CC and control groups, respectively. Median Apgar scores at five minutes were 9 in CC group and 8 in the control group (p = 0.001) and the percentages of admission to NICU were 14% in CC group and 34% in the control group (p = 0.001, OR: 0.30, 95% CI: 0.17– 0.52). Conclusion: The placement of elective CC seemed to be effective in patients with a history of mid-trimester abortion or preterm delivery due to cervical insufficiency.

Predicting the risk for preterm delivery in HIV-infected

Aim. To outline the risk factors for preterm delivery in HIV-positive women.Methods. Clinical histories of 146 pregnancies with a confirmed diagnosis of HIV infection were analyzed. All patients were allocated to 2 groups. The first group included 60 patients who had a preterm delivery prior to 37th week of pregnancy. The second group included 86 patients who delivered at term. To identify the risk factors for preterm delivery, odds ratios were calculated.Results. Risk factors for preterm birth include: infection duration less than 1 year (OR=2.6, 95% CI=1.04-6.49); 4A stage of HIV infection (OR=2.67, 95% CI=1.08-6.60); antiretroviral treatment started on 28th week of pregnancy (OR=5.12, 95% CI=2.37-11.02); oligohydramnios according to the results of second scheduled ultrasonography at 21-22th week of pregnancy (OR=29.0, 95% CI=3.73-158.8) and data for intrauterine growth restriction according to the results of third scheduled ultrasonography at 21-22th week of pregnancy (OR=16.84, 95% CI=5.46-51.93). CD4 count (OR=0.42, 95% CI=0.16-1.02) and viral load (OR=0.43, 95% CI=0.17-1.03) are indicators of patient’s immune status, but do not allow predict the risk of preterm birth.Conclusion. Factors that might be considered as preterm delivery predictors are outlined. Introducing the package of measures aimed at early treatment of HIV-positive pregnant women with the risk factors would allow to reduce the number of preterm deliveries in such patients.

Elastography for predicting preterm delivery in patients with short cervical length at 18-22 weeks of gestation: a prospective observational study.

The aim of the study was to estimate the potential value of elastographic evaluation of the internal cervical os at 18-22 weeks of pregnancy in patients with short cervical length for prediction of preterm delivery (PTD). This prospective observational study included 109 patients with cervical length of ≤ 25 mm at 18-22 weeks scan. Stiffness of the internal cervical os was assessed by elastography. Elastographic assessment of the internal os was performed using a color map: red (soft), yellow (medium soft), blue (medium hard), and purple (hard). If two colors were visible in the region of the internal os, the softer option was noted. The following outcome measures were analyzed: percentage of PTDs in various categories of elastographic cervical assessment, sensitivity specificity negative predictive value (NPV), and positive predictive value (PPV) of elastography in predicting PTDs. Additionally ROC curves were constructed for elastography and cervical length for predicting PTDs. Forty-five cases of PTDs (< 37 weeks of pregnancy) were found in the studied population. The number of PTDs was significantly higher in the red group, than in the blue and purple groups. The sensitivity specificity NPV and PPV for the assessment of both, red and yellow internal os for predicting preterm delivery were 82.2%, 75.0%, 84.0% and 72.5% respectively The cut-off value for elastography suggested inclusion of both, red and yellow (warm) colors as predictors of PTD. Elastographic evaluation of the internal cervical os at 18-22 weeks of pregnancy in patients with short cervical length may be useful in predicting PTD.

Relationship between pre-pregnancy maternal BMI with spontaneous preterm delivery and birth weight

The aim of the present study was to find the relationship between pre-pregnancy maternal body mass index (BMI) with spontaneous preterm delivery and birth weight. A prospective cohort study was performed on 576 pregnant women. Maternal BMI was determined at the first prenatal visit between 8–12 weeks’ gestation and considered as the pre-pregnancy maternal weight. The women were then monitored up to delivery. Out of 576 women, 396 completed the study. The demographics of the women in all BMI groups did not differ with regard to age, height, history of abortion and employment. A total of 21 women (5.3%) were underweight; 198 women (50%) were normal weight; 117 women (29.5%) were overweight and 60 (15.2%) were obese. There were no cases of morbidly obese (BMI > 40 kg/m2) women. Obesity in women had a positive correlation with higher gestational age at the time of delivery (r = 0.213, p = 0.015) and a heavier birth weight (r = 0.361, p = 0.008). Low birth weight had a correlation with low maternal BMI (r = 0.157, p = 0.041). Macrosomia was greater in obese women (p = 0.022) and BMI had a positive correlation with macrosomia (r = 0.224, p = 0.034). Preterm delivery showed a negative correlation with maternal BMI (r = –0.124, p = 0.004) and the women with a lower BMI had a greater number of preterm deliveries (p = 0.035).

Pros and cons of maternal cervical length screening to identify women at risk of spontaneous preterm delivery.

Large randomized controlled trials have demonstrated that universal maternal cervical length screening and treatment with daily vaginal progesterone in women with short cervical length reduces the risk of preterm birth, but large numbers of women must be screened to prevent a relatively small number of preterm deliveries. Issues that should be considered while implementing universal cervical length screening include: (1) the standards of quality and reproducibility for transvaginal ultrasound cervical length ascertainment; and (2) the implications of screening on the application of therapeutic strategies to populations not known to benefit (so-called "indication creep"). Optimal strategies to employ cervical ultrasound and progesterone treatment might be revealed by additional studies investigating cervical length cutoffs, frequency of screening, selective screening in higher-risk groups, and the use of transabdominal cervical length screening as a surrogate for transvaginal cervical length screening.

Elastography in predicting preterm delivery in asymptomatic, low-risk women: a prospective observational study.

BackgroundDespite the efforts to decrease the rate of preterm birth, preterm delivery is still the main cause of neonatal morbidity and mortality. Identifying patients threatened with preterm delivery remains one of the main obstetric challenges. The aim of this study was to estimate the potential value of elastographic evaluation of internal cervical os stiffness at 18-22 weeks of pregnancy in low risk, asymptomatic women in the prediction of spontaneous preterm delivery.MethodsThis prospective observational study included 333 low-risk, asymptomatic women presenting for the routine second trimester ultrasound scan according to the Polish Gynecological Society recommendation between 18-22 weeks of pregnancy. Ultrasound examinations of the cervix were performed transvaginally. The following data were recorded: elastographic color assessment of the internal os and ultrasound cervical length at 18-22 and 30 weeks of pregnancy; maternal age; obstetrical history; presence of cervical funneling at 30 weeks of pregnancy; gestational age at birth. Elastographic assessment of the internal os was performed using a color map: red (soft), yellow (medium soft), blue (medium hard) and purple (hard). If two colors were visible in the region of the internal os, the softer option was noted. Statistical analysis was performed using Statistica software (version 10, Statsoft Poland) using the following tests: chi square test to compare frequency of preterm deliveries in various categories of internal os assessment and Spearman correlation test to determine the correlation between elastographic assessment and cervical shortening. To determine the cut off category of internal os elastography assessment in selecting high preterm delivery risk patients we have calculated the sensivity, specifity, negative predictive value and positive predictive value.ResultsThe number of preterm deliveries (<37 weeks of pregnancy) was significantly higher in the red and yellow groups, than in the blue and purple groups. The sensivity, specifity, NPV and PPV for both red and yellow internal os assessment in predicting preterm delivery were 85.7%, 97.6%, 98.3% and 81.1% respectively.ConclusionsElastographic assessment of the internal cervical os at 18-22 weeks of pregnancy may identify patients with high risk of preterm delivery in low-risk, asymptomatic women.

Contemporary multidisciplinary treatment of pregnancy-associated breast cancer

Breast cancer diagnosed during pregnancy poses unique challenges. Application of standard treatment algorithms is limited by lack of level I evidence from randomized trials. This study describes contemporary multidisciplinary treatment of pregnancy-associated breast cancer (PABC) in an academic setting and explores early maternal and fetal outcomes. A search of the Dana-Farber/Harvard Cancer Center clinical databases was performed to identify PABC cases. Sociodemographic, disease, pregnancy, and treatment information, as well as data on short-term maternal and fetal outcomes, were collected through retrospective chart review. 74 patients were identified, the majority with early-stage breast cancer. Most (73.5%) underwent surgical resection during pregnancy, including 40% with sentinel lymph node biopsy and 32% with immediate reconstruction. A total of 36 patients received anthracycline-based chemotherapy during pregnancy; of those, almost 20% were on a dose-dense schedule and 8.3% also received paclitaxel. 68 patients delivered liveborn infants; over half were delivered preterm (< 37 weeks), most scheduled to allow further maternal cancer therapy. For the infants with available data, all had normal Apgar scores and over 90% had birth weight >10th percentile. The rate of fetal malformations (4.4%) was not different than expected population rate. Within a multidisciplinary academic setting, PABC treatment followed contemporary algorithms without apparent increase in maternal or fetal adverse outcomes. A considerable number of preterm deliveries were observed, the majority planned to facilitate cancer therapy. Continued attention to maternal and fetal outcomes after PABC is required to determine the benefit of this delivery strategy.

Low Dose Aspirin in Preeclampsia – History Revisited

Objectives: To study the role of low-dose aspirin in prevention of pre-eclampsia .and its effect on maternal & neonatal outcome. DESIGN: A prospective randomized double-blind placebo controlled study. METHODS: All the high risk antenatal women presenting between 12–24 weeks of gestation were randomized to receive either aspirin 75 mg/day or matching placebo. Both the groups were compared for pre-eclampsia, pregnancy duration, birthweight, adverse maternal or neonatal outcome. RESULTS: A total of 120 women were followed up. The incidence of pre-eclampsia in aspirin group was 0.83% ,whereas none of the patients developed preeclampsia in placebo group. There were no significant differences between both the groups in. number of preterm delivery 11.47% in aspirin group vs 22% in placebo group, of SGA babies 16.9% vs 17.2% in placebo group. Aspirin was also not associated with increased risk of maternal or fetal complications. CONCLUSIONS: : The results of present study do not support the use of low dose aspirin for prevention of pre-eclampsia or its complications in any category of high risk women as proven by results of previous large scale trials and further multicentric large trials are still required to assess the role.

Twin Pregnancies with Single Fetal Death: Analysis of 38 Cases

The objective of this study is to evaluate fetal and maternal outcomes of twin pregnancies with intrauterine single fetal death. In 13 cases, intrauterine death of one fetus was found during the first trimester; in 25 cases, it was found after the first trimester. Obstetric complications and fibrinogen levels were compared. There were no significant differences in the number of preterm delivery, preeclampsia, and intrauterine growth restriction and there were significant differences in gestational age at delivery and birth weight between groups. Coagulation disorders did not occur. The risk for adverse pregnancy outcomes with a single fetal death during and after the first trimester is similar.

P2-19-02: Multidisciplinary Treatment of Pregnancy-Associated Breast Cancer.

Abstract Background: Breast cancer complicates pregnancy in a significant minority of younger breast cancer (BC) patients (pts). Application of standard treatment algorithms is limited by the lack of randomized data to support safety and efficacy. A multidisciplinary approach attempts to maximize treatment efficacy for a pt while minimizing fetal toxicity. We sought to describe contemporary multidisciplinary BC treatment in an academic setting and explore early maternal and fetal outcomes. Methods: A search of the Dana-Farber/Harvard Cancer Center clinical database was performed to find BC pts self-identified as pregnant at presentation with &amp;gt;2 visits at our institution. Information available within the database along with complementary chart review provided sociodemographic, disease, staging, pregnancy and treatment information as well as short-term maternal and fetal outcomes. Results: 55 pts diagnosed between 1996–2011 were identified. The median age at diagnosis was 34 years. 25.5% were stage I, 49.1% stage II, 20% stage III, and 5.4% stage IV. 63.6% had hormone receptor positive disease, 36.3% HER2 positive, and 18.1% triple negative. 71% underwent testing for germline BRCA1/2 mutations, with 9% of all pts testing positive. 29% were diagnosed in the first trimester (T1), 29% in T2, and 42% in T3. 89% underwent ultrasound imaging for staging, 49% X-ray imaging, 16.3% MRI, and 0% CT. 67% underwent surgery during pregnancy: 43.2% mastectomy, 48.6% lumpectomy, and 8.1% lumpectomy with subsequent mastectomy during pregnancy. 18.9% underwent surgery in T1, 45.9% in T2, and 37.8% in T3. 27.2% underwent sentinel lymph node biopsy. 51% received chemotherapy (C) during pregnancy: of those, 100% received anthracycline/cyclophosphamide (2-4 cycles), 11% paclitaxel, and 0% trastuzumab. 28.5% received C on a dose-dense schedule, with 25% supported by growth factors (14.2% filgrastim, 10.8% pegfilgrastim). 28.5% received neoadjuvant C. C was initiated during T1 for 0%, T2 for 64.3%, and T3 for 35.7%. Two pts terminated pregnancy in T1, one spontaneously miscarried at 12 weeks (wks), and two are currently in the third trimester of pregnancy; therefore, a total of 50 pts had delivered at the time of this analysis. The median time of delivery was 36 wks. 50% delivered prior to 37 wks and were considered preterm; of those, 76% were inductions or Caesarian sections planned to facilitate cancer therapy. Only 12% delivered prior to 34 wks. For the 25 infants for whom Apgar scores were available, 76% had scores of ≥ 8 at delivery, and 100% had scores of ≥ 8 at 5 minutes. For the 25 infants for whom birth weights were available, the median birth weight was 6lbs 1oz. Only 4 were less than 5lbs at the time of delivery. A total of 4 fetal abnormalities were noted: cleft palate (2), club foot (1), and ventricular septal defect (1). Conclusions: Within a multidisciplinary academic center, treatment of pregnancy-associated BC using contemporary treatment algorithms, including taxane chemotherapy, growth factor support, and sentinel lymph node biopsy, has been pursued without significant adverse effect on fetal outcomes when compared to other published series. A considerable number of preterm deliveries have been observed. Further data collection is ongoing for confirmation of initial observations. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-19-02.

A Review of Prenatal Group Care Literature: The Need for a Structured Theoretical Framework and Systematic Evaluation

The purpose of this article is to systematically review the literature on group-based prenatal care related to patient participation, attendance, satisfaction, knowledge, pregnancy and birth outcomes, and program cost. MEDLINE, CINAHL, and PsycINFO sources were searched for English-language articles published any time prior to June 2010. Manual searches of bibliographies were conducted and experts were consulted to identify possible sources. Descriptive, cross-sectional, cohort, and randomized control studies that assessed group-based prenatal care were selected. Of the 15 articles reviewed, 11 studies met inclusion criteria for analysis of the study attributes and outcome data related to patient participation, attendance, satisfaction, knowledge, as well as breastfeeding, pregnancy and birth outcomes, and program cost. Results from the review show that group prenatal care may be associated with improved patient and birth outcomes including reduction in the number of preterm deliveries, higher patient participation and satisfaction, and increased initiation of breastfeeding. Prenatal group care research is limited by relatively few studies, most of which lack rigor. The current model of prenatal group care lacks a theoretical framework for describing and evaluating group processes as well as intermediary factors of prenatal and birth outcomes. Research on group care would benefit from additional randomized controlled trials that assess cost and sustainability and formally evaluate group process and intermediary factors thought to account for improved outcomes.

Management of Inflammatory Bowel Diseases during Pregnancy

Inflammatory bowel diseases (IBD) have a high prevalence in younger patients with child-bearing potential. Usually, pregnancies in women with IBD will develop normally, if the patient is in remission or has minor disease activity at the time of conception. In contrast, the frequency of normal pregnancies is significantly reduced and the frequency of adverse outcomes like preterm birth or miscarriage is increased, when conception occurs in phases with active IBD. Therefore, it is generally recommended to women with IBD to conceive at a time with minor disease activity or in remission. IBD patients who plan to become pregnant or are pregnant should be treated adequately. Currently, it is widely accepted that the treatment of IBD with corticosteroids and 5-ASA derivatives does not increase the risk of malformations or adverse outcomes in pregnant IBD patients. However, a slight increase in the number of pre-term deliveries or reduced birth weight is observed. More recently, it has also been appreciated that azathioprine and 6-MP and presumably also infliximab and other TNF-α blockers can be safely used during pregnancy in IBD, as no significant increase of malformations, miscarriages or adverse pregnancy outcomes is observed. Information on cyclosporine and tacrolimus during pregnancy is scarcer, but it may be continued or started in some situations if clinically needed. Methotrexate is contraindicated, as this drug is known to significantly increase the risk of malformations and spontaneous abortion. Patients, who wish to nurse their babies, may be treated with steroids and 5-ASA derivatives without a significantly increased risk for the newborn.

Vaccination against human papillomavirus – an impact on preterm delivery? Estimations based on literature review

Cervical cone excision increases the risk of preterm deliveries. Vaccination against human papillomavirus 16/18 (HPV16/18) will probably prevent development of high grade cervical intraepithelial neoplasia and thereby reduce the need for cervical cone excisions. An HPV16/18 vaccination programme may therefore also prevent some preterm deliveries. We identified the parameters influencing the effect of a HPV16/18 vaccination programme on preterm deliveries, and estimated a possible range of preventable deliveries before the 37th week of pregnancy. The number of preterm deliveries prevented by HPV16/18 vaccination programme would depend on the number of preterm deliveries related to cervical cone excision (extent of the health problem), and the proportion of this health problem that could be prevented by a vaccination programme. We obtained values on the parameters used in the estimations from the scientific literature. If 2% of childbearing women are treated with cervical cone excision, between 60 and 220 preterm deliveries/100 000 births may be related to such treatment. Close to 60% (between 35 and 128 preterm deliveries) could be prevented by an HPV16/18 vaccination programme, if the programme coverage was 90%. If 4% of women are treated with cone excision, between 70 and 257 preterm deliveries/100 000 births could be prevented. HPV16/18 vaccination programmes may reduce the number of preterm deliveries through reducing the need for cone excision.

Pregnancy outcome after exposure to oral contraceptives during the periconceptional period

To evaluate whether periconceptional exposure to oral contraceptives (OCs) increased adverse pregnancy outcomes, 136 pregnant women taking OCs within the periconceptional period were identified at the Korean Motherisk Program. Of them, 120 pregnant women accepted to participate in their study and were followed up until completion of the pregnancy. A control group of 240 age- and gravidity-matched pregnant women exposed to non-teratogen drugs for at least 1 month before pregnancy was also included. The median gestational age at delivery was 39.1 (27.0-41.0) weeks in the exposed group and 39.3 (27.4-42.0) weeks in the control group (P = 0.19). In the exposed group, 7.1% of babies were born with low birth weight versus 2.6% in the control group (P = 0.068). The number of preterm deliveries or babies born large for gestational age did not differ between the two groups. In the exposed group, the rate of birth defects was 3.2% (n = 3/99) versus 3.6% (n = 7/193) in the control group (P = 1.0). There were 15 women who took high doses of progesterone (emergency contraception) and no adverse fetal outcomes were observed. In conclusion, periconceptional exposure to OCs does not appear to increase the risk for adverse pregnancy outcomes.