Rates Of Pregnancy Complications Research Articles

Pregnancy outcomes among renal transplant recipients and patients with end-stage renal disease on dialysis.

The purpose of our study is to compare pregnancy outcomes between women with a functioning renal transplant and women with end-stage renal disease (ESRD). We carried out a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2006 to 2011. Logistic regression analysis was used to estimate the age-adjusted effect of functioning renal transplant vs. ESRD requiring dialysis on pregnancy outcomes. We identified 264 birth records to women with a functional renal transplant and 267 birth records to women with ESRD on dialysis among 5,245,452 births. As compared to women with ESRD on dialysis, renal transplant recipients were less likely to have placental abruption [odds ratio, OR 0.23 (95% confidence interval, CI 0.08-0.70)], to receive blood transfusions [OR 0.17 (95% CI 0.09-0.30)], and to have growth-restricted and small-for-gestational-age babies [OR 0.45 (95% CI 0.23-0.85)]. Renal transplant recipients were more likely to have an instrumental delivery [OR 15.38 (95% CI 1.92-123.3)]. Among renal transplant women, there was a trend towards delivery by cesarean section as compared to patients with ESRD [OR 1.31 (95% CI 0.93-1.85)]. However, these results were not statistically significant. Fetal deaths were less likely to occur in women with a renal transplant [OR 0.41 (95% CI 0.17-0.96)]. There were four maternal deaths among patients with ESRD on dialysis and no maternal deaths among renal transplant patients. Patients with a functional renal graft had an overall lower rate of morbidity and adverse pregnancy complications when compared to patients with ESRD on dialysis.

458: Is there a disparity in the rate of pregnancy complications among patients diagnosed with cancers prevalent during child-bearing age? Evidence from a large population-based cohort study

458: Is there a disparity in the rate of pregnancy complications among patients diagnosed with cancers prevalent during child-bearing age? Evidence from a large population-based cohort study

A possible role of polycystic ovary syndrome for pregnancy complications in women with psoriasis.

Psoriasis is a common, chronic, relapsing immune-mediated inflammatory disease (IMID) of the skin. IMIDs are multifactorial diseases characterized by common molecular pathways leading to a systemic inflammation. Patients with an IMID are also at higher risk of developing co-morbidities, such as adverse pregnancy outcomes, than the general population. A higher rate of pregnancy complications have been seen in inflammatory bowel disease and rheumatoid arthritis. The data for psoriasis are inconsistent but it appears that women with moderate-to-severe psoriasis may also have an increased risk of poor pregnancy outcomes. The cause of this association is unknown, although it may be related to elevated proinflammatory cytokines such as IL-6 and TNF-α, the high prevalence of comorbidities and other unhealthy behaviours, or the high prevalence of polycystic ovary syndrome (PCOS). In a recent study, PCOS prevalence in a psoriatic cohort (n = 51) was higher than in non-psoriatic women (n = 102) (47% versus 11%), and women with PCOS and psoriasis had a greater probability of insulin resistance, hyperinsulinaemia, and dyslipidaemia as well as a more severe skin condition, than those with psoriasis alone. Further studies are necessary to clarify the impact of psoriasis on pregnancy and in particular if these effects are mediated by concomitant PCOS.

Antibiotics prior to amniotomy for reducing infectious morbidity in mother and infant.

Amniotomy (the deliberate rupture of membranes) was described almost two centuries ago and since then has been used both for induction and augmentation of labour - which are common obstetric practices. Trends have shown a rise in the induction rates over the last decade and data suggest that the rate of labour inductions is increasing faster than the rate of pregnancy complications. Recent years have seen the emergence of a variety of other methods of induction of labour but amniotomy combined with oxytocin infusion remains the most commonly used method of augmentation of labour. The newer agents for induction are expensive and in resource-poor settings amniotomy is still the chosen method for both induction and augmentation.As with any invasive procedure amniotomy can lead to infection, ascending from the vagina into the uterine cavity and can contribute significantly to both maternal and neonatal infectious morbidity. The objective of this review was to evaluate the prophylactic use of antibiotics versus placebo or no treatment prior to amniotomy on maternal and neonatal infectious morbidity and mortality. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2014), the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (12 September 2014). Randomised controlled trials or cluster-randomised trials comparing antibiotics prior to amniotomy versus placebo (or no treatment) were eligible for inclusion in this review but none were identified. Quasi-randomised trials or cross-over trials were not eligible for inclusion. Two review authors independently assessed one trial report for inclusion. In future updates of this review, two review authors will independently assess risk of bias and carry out data extraction. Data will be checked for accuracy. We identified one trial report but this was excluded. No studies met the inclusion criteria for this review. High-quality trials are needed to justify or refute the routine use of antibiotics at amniotomy for prevention of infection in the mother and infant.Future studies should be conducted, especially in resource-constrained settings where amniotomy is still used as a means of induction of labour, in order to evaluate the routine use of antibiotics at amniotomy in these settings. Future research in this area should include important maternal and infant outcomes listed in this review and also consider cost effectiveness and side effects of antibiotic use, including the emergence of antibiotic-resistant strains.

The East Timorese: a high-risk ethnic minority in UK obstetrics: a cohort study

Objective: To observe the incidence of antenatal risk-factors and adverse maternal outcome in women of East Timorese origin within a UK population.Methods: This retrospective cohort study assessed a sample of women of East Timorese Origin (N = 42) attending UK maternity services from 01/2011 to 09/2012 compared to a control group of a standard UK maternity population (N = 7210). Data on the rate of pregnancy related risk-factors and complications were obtained from a computerized patient note database (NIMATS).Results: The East Timorese were at significant risk antenatally of anaemia (OR 19.5 (95% CI 10.2–37.2) (p < 0.001)), gestational diabetes (OR 10.6 (95% CI 4.6–24.4) (p < 0.001)) and hypertension in pregnancy (OR 4.6 (95% CI 1.4–15.3) (p < 0.01)) as well as late booking for care (OR 19.5 (95% CI 10.2–37.2) p < 0.001). In terms of post-partum complications there was a significant risk of admission to the intensive-care unit (OR 20.0 (95% CI 4.5–89.0) p < 0.001) and of postpartum hemorrhage (OR 15.9 (95% CI 7.7–33.0) p < 0.001). In 72 documented occasions an interpreter could not be obtained.Conclusions: Women from East Timor are a high-risk ethnic minority who, with added risk-factors of late booking and difficulty in obtaining interpreters are at greater risk of complications in pregnancy and the puerperium.

Surgical intervention versus expectant management for endometrial polyps in subfertile women.

Endometrial polyps, which are benign growths of the endometrium, may be a factor in female subfertility. Possible mechanisms include physical interference with gamete transport, alteration of the endometrial milieu and unresponsiveness to the cyclical global endometrial changes. As such polyps remain mostly asymptomatic, their diagnosis is often incidental during routine investigations prior to embarking on assisted reproductive treatment. Transvaginal sonography, hysterosalpingography and saline infusion sonography are the diagnostic tools most commonly employed. However, hysteroscopy remains the gold standard for diagnosis, as well as for treatment. Due to the possible effect of endometrial polyps on fertility, their removal prior to any subfertility treatment is widely practiced. To determine the effectiveness and safety of removal of endometrial polyps in subfertile women. Electronic databases were searched, including the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL and trial registers. The reference lists of identified articles were checked. The last search was performed on 30 July 2014. Only randomised controlled trials, reporting pregnancy or live birth rates and complication rates as primary or secondary outcomes, in which polyps were removed surgically prior to treatment of subfertility were eligible for inclusion. The diagnosis of endometrial polyps was required to be made by transvaginal ultrasound, hysterosalpingography, saline infusion, sono-hysterography or hysteroscopy. Any surgical technique of polyp removal was acceptable, with no intervention in the control groups. Two review authors independently screened the titles, abstracts and full articles to assess their suitability for inclusion in this review. Quality assessment was attempted independently by two authors with discrepancies being settled by consensus or consultation with a third review author.No data extraction was performed due to the absence of useable data in the one eligible study. If there had been data to include, two review authors would have independently extracted the data from the studies using a data extraction form designed and pilot tested by the authors. Any disagreements would have been resolved by discussion or by a third review author. Only one randomised controlled trial of endometrial polypectomy was identified for inclusion. However, a single set of data could not be extracted from this study due to internal inconsistencies of the results reported. Attempts to contact the authors to resolve the issue were unsuccessful, by phone, post and e-mail. Removal of endometrial polyps in subfertile women is commonly being performed in many countries with an aim to improve the reproductive outcome. We did not identify any analysable randomised trials which would allow us to reach any sound scientific conclusions on the efficacy of endometrial polypectomy in subfertile women. Well designed, methodologically sound, randomised controlled trials are urgently needed.

Does a Surgical Career Affect a Woman's Childbearing and Fertility? A Report on Pregnancy and Fertility Trends among Female Surgeons

Increases in pregnancy complication rates and use of assisted reproductive technology (ART) have been demonstrated in female urologists and orthopaedic surgeons when compared with the general US population. To determine if childbearing differences exist across specialties, we evaluated female surgeons in all fields, particularly with regard to fertility. An anonymous, 199-item survey was distributed via specialty female surgeon interest groups and word of mouth to general surgery, gynecology, neurosurgery, ophthalmology, orthopaedics, otolaryngology, plastic surgery, podiatry, and urology. The 1,021 responses were analyzed and compared with Centers for Disease Control National Survey for Family Growth and National Institute of Health data to identify differences between populations. Of women surgeons, 32% reported fertility difficulty; 84% of whom underwent infertility workup. Seventy-six percent of these women used ART to attempt pregnancy. In comparison, only 10.9% of women in the general US population report infertility, and 11% seek infertility services. Of all babies born to female surgeons, at least 13% were conceived using ART. Surgeons had 1.4 biological children, less than the national average. Age at first pregnancy was 33 years, compared with a national average of 23. If ART was implemented, surgeon age at first birth increased to 35.4 years. Highest rates of infertility existed in otolaryngology (29%), general surgery (22%), and orthopaedics (18%). Female surgeons have first pregnancies later in life, fewer children, and report more issues with infertility. Assisted reproductive technology is implemented more often by female surgeons than the general population. Differences in fertility exist between specialties and warrant additional study.

Metabolic effects of lifestyle intervention in obese pregnant women. Results from the randomized controlled trial 'Lifestyle in Pregnancy' (LiP).

The Lifestyle in Pregnancy intervention in obese pregnant women resulted in significantly lower gestational weight gain compared with the control group, but without improvement in rates of clinical pregnancy complications. The impact of the lifestyle intervention on metabolic measurements in the study participants is now reported. The Lifestyle in Pregnancy study was a randomized controlled trial among 360 obese women (BMI 30-45 kg/m²) who were allocated in early pregnancy to lifestyle interventions with diet counselling and physical activities or to the control group. Fasting blood samples, including plasma glucose, insulin, lipid profile and capillary blood glucose during a 2-h oral glucose tolerance test were carried out three times throughout pregnancy. Insulin resistance was estimated with the homeostasis model assessment of insulin resistance. Three hundred and four women (84%) were followed until delivery. Women in the intervention group had a significantly lower change in insulin resistance (HOMA-IR) from randomization to 28-30 weeks' gestation compared with control subjects (mean ± SD: 0.7 ± 1.3 vs. 1.0 ± 1.3, P = 0.02). Despite a significantly lower gestational weight gain in the intervention group, there was no difference between the groups with respect to total cholesterol, HDL, LDL or triglycerides. Lifestyle intervention in obese pregnant women resulted in attenuation of the physiologic pregnancy-induced insulin resistance. Despite restricted gestational weight gain, there were no changes in glucose or lipid metabolism between the groups.

PPO.32 Audit of management and outcomes of obstetric patients with pre-existing renal disease managed in a specialist obstetric clinic

ObjectiveTo audit a specialist antenatal clinic at St Mary’s hospital in managing obstetric patients with renal disease and evaluate pregnancy outcomes in those patients against set standards.MethodsData from patients with...

Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

Women with diabetes in pregnancy have high rates of pregnancy complications. Our aims were to explore trends in the incidence of diabetes in pregnancy and examine whether the risk of serious perinatal outcomes has changed. We performed a population-based cohort study of 1,109,605 women who delivered in Ontario, Canada, between 1 April 1996 and 31 March 2010. We categorized women as gestational diabetes (GDM) (n = 45,384), pregestational diabetes (pre-GDM) (n = 13,278), or no diabetes (n = 1,050,943). The annual age-adjusted rates of diabetes in pregnancy were calculated, and rates of serious perinatal outcomes were compared between groups and by year using Poisson regression. The age-adjusted rate of both GDM (2.7-5.6%, P < 0.001) and pre-GDM (0.7-1.5%, P < 0.001) doubled from 1996 to 2010. The rate of congenital anomalies declined by 23%, whereas the rate of perinatal mortality did not change significantly. However, compared with women with no diabetes, women with pre-GDM and GDM faced an increased risk of congenital anomalies (relative risk 1.86 [95% CI 1.49-2.33] and 1.26 [1.09-1.45], respectively), and perinatal mortality remained elevated in women with pre-GDM (2.33 [1.59-3.43]). The incidence of both GDM and pre-GDM in pregnancy has doubled over the last 14 years, and the overall burden of diabetes in pregnancy on society is growing. Although congenital anomaly rates have declined in women with diabetes, perinatal mortality rates remain unchanged, and the risk of both remains significantly elevated compared with nondiabetic women. Increased efforts are needed to reduce these adverse outcomes.

The effects of adipocytokines on the endocrino-metabolic features and obstetric outcome in pregnant obese women with polycystic ovary syndrome

To estimate the effects of adipocytokines on the metabolic and endocrine features, and the obstetric outcome in pregnant women with polycystic ovary syndrome (PCOS). Prospective cross sectional study. Main outcome measures: plasma concentration of adipocytokines, insulin resistance/hyperinsulinism (IR/HI), lipid profile, androgens and obstetric outcome. The study included hundred pregnant PCOS (PPCOS) women with android obesity (group 1), 100 pregnant non-PCOS women with android obesity (group 2), 100 PPCOS women with gynoid obesity (group 3), and 100 pregnant non-PCOS women with gynoid obesity (group 4). All patients in the four groups were primigravidae and women with PCOS (groups 1 and 3) became pregnant after treatment with clomiphene citrate and/or gonadotropins. Plasma concentrations of fasting glucose, fasting serum insulin, insulin sensitivity by quantitative insulin sensitivity check index (QUICKI), serum concentrations of triglycerides (TGs), total cholesterol (TC), high density lipoprotein cholesterol, (HDL-c), low density lipoprotein cholesterol (LDL-c); plasma adipocytokines: interleukin (IL)-10, adiponectin (both are insulin sensitizers and anti-inflammatory), pro-inflammatory cytokines: IL-6, prothrombin activator inhibitor-1(PAI-1), high sensitivity C-reactive protein (hsCRP); serum total testosterone (TT), sex-hormone binding globulin (SHBG), free androgen index (FAI) were estimated for the four groups between 22 and 24 weeks’ gestation Glucose loading test was done at 22–24 weeks’ gestation to check for gestational diabetes mellitus and if normal it was repeated at 30–34 weeks. Gestational hypertension (GH), preeclampsia (PE) and preterm labor (PTL) (delivery <37 weeks’ gestation) were recorded. Groups 1 and 2 with android obesity had IR/HI, (QUICKI < 0.331 ± 0.010). Groups 3 and 4 with gynoid obesity had normal insulin sensitivity (NIS), (QUICKI > 0.331 ± 0.010). Serum concentration of TGs, LDL-c, and plasma concentration of IL-6, PAI-1, hsCRP were significantly higher in groups 1 and 2 than groups 3 and 4. Serum HDL-c, plasma IL-10 and adiponectin were significantly higher in groups 3 and 4 than groups 1 and 2. Serum TT and FAI were significantly higher in groups 1 and 3 (cases of PPCOS) than their controls. There was no significant difference in the serum concentration of TC between the four groups. Incidence of spontaneous early miscarriage (SM) in groups 1, 2, 3, and 4 was 36%, 12%, 33%, and 11% respectively. Incidence of SM was significantly higher in PPCOS than non-PCOS pregnancy irrespective of the type of obesity. Rate of late pregnancy complications, GDM, GH, PE and PTL was significantly higher in groups 1 and 2 with android obesity than groups 3 and 4 with gynoid obesity. There was no significant difference in the rates of cesarean section (CS) between the 4 groups. The rates of neonatal complications and perinatal mortality were significantly higher in groups 1 and 2 (android obesity) than groups 3 and 4 (gynoid obesity). 1. TT and FAI were significantly higher in PPCOS with android obesity than PPCOS with gynoid obesity. 2. Incidence of early SM (9–12 weeks) was significantly higher in PPCOS than in non-PCOS pregnancy irrespective of the type of obesity. 3. Incidence of late-onset pregnancy complications, GDM, GH, PE and PTL was significantly higher in patients with android obesity than patients with gynoid obesity. PCOS per se seemed to be not related to the incidence of late-onset pregnancy complications. Pregnant patients with android obesity, (both PCOS and non-PCOS) with diminished serum concentration of anti-inflammatory cytokines, and increased serum concentration of pro-inflammatory cytokines had IR/HI and dyslipidemia. Pregnant patients with gynoid obesity, (both PCOS and non-PCOS) with normal serum concentration of anti- and pro-inflammatory cytokines had NIS and normal lipid profile. 4. In pregnancy with android obesity patients had reduced plasma concentration of IL-10 and increased concentration of IL-6 which may impair the development of the placenta with increased risk of PTL. 5. Neonatal complications and perinatal mortality were significantly higher in PPCOS with android obesity than PPCOS with gynoid obesity.

Study of outcome of pregnancy in patients with first-trimester bleeding per vaginum

Background: To assess pregnancy outcome in women with threatened miscarriage in the first trimester. To study various maternal complication and outcome of labor in pregnancy affected by first-trimester bleeding. Methods: This prospective study was carried out by institute from May 2013 to April 2014. 100 patients were included with a history of amenorrhea and urine pregnancy test positive with bleeding per vaginum in the first trimester. Results: In this case series, 100 cases of first-trimester bleeding were studied. Majority of patients were multigravida (66%). In the present study, 40 patient (40%) had a history of previous abortion out of these 16 (40%) had non-viable outcome and 24 (60%) continue with the pregnancy beyond 20 weeks. Majority of patients (68%) presented with spotting, among those 59 (86.7%) had a favorable outcome and only 9 (13.3%) out of 68 patients were aborted. All 10 patients of heavy bleeding category aborted. 5 out of 22 patients of bleeding of moderate category aborted. First-trimester bleeding associated with pain has a poor outcome. Conclusion: First-trimester bleeding is not only associated with miscarriage but also with a higher rate of pregnancy complications. First-trimester bleeding is associated with an increased risk of certain pregnancy-related complications namely placental abruption, preterm labor, delivery of low birth weight infants and preterm premature rupture of membrane.

Comparison of rates of and charges from pregnancy complications in users of extended and cyclic combined oral contraceptive (COC) regimens: a brief report

ObjectiveTo evaluate pregnancy complication rates and related charges in users of 84/7, 21/7 and 24/4 combined oral contraceptives (COCs). Study designData were obtained from the i3 InVision Data Mart™ retrospective claims database. Subjects were aged 15–40 years, first prescribed a COC between 1/1/2006 and 4/1/2011 and continuously insured for ≥1 year. 84/7 users were matched 1:1 to 21/7 and 24/4 users. ResultsPregnancy-related complication rates and associated charges were significantly lower with 84/7 vs. 21/7 and 24/4 regimens. ConclusionPreliminary data suggest 84/7 regimens may be associated with fewer pregnancy complications and lower related charges.

Venous Thromboembolism In Pregnant Women With Sickle Cell Disease

BackgroundThe risk of venous thromboembolism (VTE) is increased in pregnancy and sickle cell disease (SCD), yet the rates of pregnancy-related VTE are not firmly established in SCD, nor are other SCD-related complications, including pneumonia, vasooclusive crisis (VOC), and acute chest syndrome (ACS), which may be clinically indistinguishable from VTE. Moreover, the American College of Chest Physicians has made no recommendations regarding thromboprophylaxis in pregnant women with SCD. MethodsInpatient hospital discharge data for PE for the most recent 5-year period available, 2007-2011, were obtained from the Pennsylvania Health Care Cost Containment Council (PHC4). We compared VTE, pregnancy complications, medical co-morbidities, and mortality among pregnant women with and without SCD. Among pregnant SCD women with and without VTE, we also compared rates of pneumonia, vasooclusive crisis (VOC), and acute chest syndrome (ACS). All patient identifiers were removed. Diagnostic categories and co-morbidities were obtained using ICD-9 codes. Data from categorical variables were analyzed by chi-square or Fisher's exact test; and from continuous variables by two-sample Student t-test. ResultsThe prevalence of VTE was 2.8% among pregnant women with SCD. Among pregnant women with SCD and VTE, the rate of pneumonia, 28.6% vs. 4.4%, p=0.043, was significantly higher than in those without VTE. While somewhat higher, the rates of VOC, 57.1% vs. 24.7%, p=0.073, and ACS, 14.3% vs. 2.4%, p=0.177, were not significantly different between pregnant SCD VTE and non-VTE groups. Comparing VTE and non-VTE pregnant SCD women, the rate of pregnancy complications did not differ, p=0.999; nor did the rates of medical co-morbidity, other than diabetes, 28.6% vs. 3.6%, p=0.031. Among the subset of pregnant SCD with pneumonia, the prevalence of VOC, 80.0% vs. 36.1%, p=0.001; ACS, 35.0% vs. 2.9%, p<0.001; and length of stay, 12.5 vs. 4.6 days, p=0.030, were significantly greater than in those without pneumonia. Among the subset of SCD pregnancies with VOC, the prevalence of preeclampsia, 28.4% vs. 13.5%, p=0.003; pneumonia, 15.7% vs. 2.6%, p=0.001; ACS, 12.8% vs. 0.6%, p<0.001; and length of stay, 7.7 vs. 3.6 days, p<0.001, were significantly more common than in those without VOC. Among the subset of SCD pregnancies with ACS, the rates of intrauterine fetal death, 14.3% vs. 1.6%, p=0.036; postpartum infection, 28.6% vs. 6.6%, p=0.016; pneumonia, 50.0% vs. 5.3%, p<0.001; and VOC, 92.9% vs. 36.5%, p<0.001, were significantly higher than in those without ACS. Overall, the rate of VTE, among SCD women with pneumonia, VOC, and/or ACS, 6.6%, was significantly higher than among those without these conditions, 2.2%, p<0.001. DiscussionThe prevalence of pregnancy-related VTE in women with SCD, while low, 2.8%, appears to be at least 10-fold greater than the general 0.2% incidence of pregnancy-related VTE in the unaffected population. Further, the higher rates of VTE we observed among pregnant women with SCD-related complications, including pneumonia, VOC, or ACS, and the well-recognized potential clinical overlap with VTE, suggest that VTE may be missed in such women, and that VTE rates in pregnant women with SCD may be higher than herein reported or previously recognized. The presence of pneumonia, VOC, or ACS appears to be associated with VTE and may be a potential marker(s) of its occurrence. Prospective studies, however, are needed to determine the incidence of VTE in pregnant women with SCD with and without complicating pneumonia, VOC, and/or ACS. We conclude that pregnancy-related VTE may be more common than previously recognized in pregnant women with SCD and, if confirmed, such women might be candidates for thromboprophylaxis. Disclosures:No relevant conflicts of interest to declare.

Postpartum Hemorrhage In Women With Von Willebrand Disease and Other Bleeding Disorders

BackgroundPostpartum hemorrhage (PPH) is a cause of potentially serious morbidity and mortality in women of reproductive age. Prior data suggests that women with von Willebrand Disease (VWD) and other inherited bleeding disorders (OBD) experience PPH at a rate greater than the general population. Little published data exist regarding the incidence or predictors of PPH in women with VWD or OBD to guide obstetricians and hematologists in the management of these at-risk women. MethodsIn order to evaluate the incidence of PPH, clinical characteristics and obstetric outcomes of women with VWD and other inherited bleeding disorders we analyzed data from the Pennsylvania Health Care Cost Containment Council (PHC4) database between January 1, 2007 and December 31, 2011. The council collects data from over 4.5 million inpatient hospital discharges and ambulatory/outpatient procedure records each year from hospitals and freestanding ambulatory surgery centers in Pennsylvania. Data from all women with VWD and OBD (including factor XI deficiency, hemophilia A carriers, hemophilia B carriers) as well as all women who experienced PPH was extracted from the database. Data elements, in addition to demographic factors, were identified by ICD-9 codes, including medical comorbidities, hospital length of stay, obstetric complications, and birth outcomes. We compared data from women with VWD and OBD, specifically in those with and without PPH. Differences between groups were analyzed using chi-square or Fisher's exact tests for categorical variables and two-sample t-tests for continuous variables. ResultsBetween 2007 and 2011, there were a total of 1,234 women with bleeding disorders, including 506 with VWD and 728 with OBD, who underwent delivery. Of these, 54 (4.4%) experienced PPH, including 28 (5.5%) with VWD and 26 (3.6%) with OBD. Among women with VWD, those with PPH were younger, 25.4 vs. 27.8 years (p=0.034), and nearly 2-fold more likely to have anemia, 27.6% vs. 14.2% (p=0.059), but had no greater frequency of caesarean section delivery (p=0.234) or pregnancy complications (p=0.678), including antepartum bleeding, preeclampsia, placental abruption, gestational diabetes, fetal growth restriction, preterm labor, or intrauterine fetal death. There were no differences in live births or mortality (all p≥0.999), nor in medical comorbidities (p=0.300), including diabetes, hypertension, obesity, and hyperlipidemia. Among women with OBD, those with PPH were over 5-fold more likely to have anemia, 48.1% vs. 8.6% (p<0.001), but had no higher rates of caesarean section delivery (p=0.234) or pregnancy complications, mortality or lower rates of live births (all p≥0.999). DiscussionThe incidence of postpartum hemorrhage (PPH) in women with VWD is 5.5% and 3.6% in those with OBD. Importantly, anemia appears to be a marker of PPH in women with bleeding disorders as it is present in over one-fourth (27.6%) of women with VWD and PPH and in nearly one-half (48.1%) of those with OBD. These data suggest that screening hemoglobin, along with standard screening of factor levels in late pregnancy, may help identify those with VWD or OBD at risk for PPH. Future prospective studies will be needed to confirm this hypothesis. Disclosures:No relevant conflicts of interest to declare.

Pathogenesis of pregnancy complications in systemic lupus erythematosus

In spite of the advances made in the management of pregnancies in women with systemic lupus erythematosus (SLE), maternal complications and adverse fetal outcomes still exceed the rate of pregnancy complications in the general population. An intriguing question relates to the observation that pregnancy loss, intrauterine growth restriction (IUGR), preterm birth, and preeclampsia remain major complications in SLE pregnancies, not substantially altered by improved therapy and monitoring. From the review of the recent literature on the pathogenesis of pregnancy loss, IUGR, preeclampsia, and prematurity, it appears that clinical or subclinical inflammation, presence of autoantibodies, hormonal dysfunction, and immune alterations of lupus contribute to pregnancy complications. Impairment of early placenta development leads to poor vascularization, resulting in placental ischemia and subsequent endothelial damage. Depending on the extent of the pathological process, pregnancy loss, IUGR, and preeclampsia can develop. Early recognition of pregnancy complications is desirable in order to prevent their development or to prompt intervention that improves the outcomes. Several biomarkers have been investigated for their ability to predict complications at an early stage of pregnancy. However, up to date only lupus anticoagulant has emerged as a consistent predictor for adverse pregnancy outcomes.

Aromatase inhibitor co-treatment with gonadotropin reduces the dose of gonadotropn and peak estradiol level without compromising IVF outcomes in high responder patients

WITHDRAWN E2 (pg/ml) on hCG day 3850 765 4272 1508 1.5 ng/ml) or low (P4 3000 pg/ml on the hCG day). Patients were stimulated with daily doses of 100-150 UI of recombinant FSH (Puregon , MSD) starting on day 2-3; GnRH antagonist was added when the leading follicle reached a diameter of 14 mm (Cetrotide, 0.25 mg/day, Merck-Serono) and a single bolus of 250 mg of rhCG (Ovitrelle, Merck-Serono) was administered to induce oocyte maturation. FERTILITY & STERILITY Chi-squared test and ANOVA were applied to detect statistical differences; p<0.05 was considered statistically significant. RESULTS: Regarding the influence of progesterone concentration on clinical outcomes in presence of high estradiol levels, we did not find significant differences in any of the clinical variables analyzed. However, we observed statistical differences in E2 and P4 levels on the day of hCG between the two groups of the study. CONCLUSION: Our data suggest that in high responder women with estradiol levels over 3000 pg/ml, progesterone levels do not affect IVF results. We confirmed the close link between E2 and P4 as we observed that high E2 levels are significant correlated with high P4 levels. These results lead us to conclude that, regardless the progesterone levels attached during the cycle in high responders, clinical outcomes are not affected. O-358 Wednesday, October 16, 2013 04:45 PM COMPARING THE EFFICACYAND SAFETY OF GnRH AGONIST (LEUPROLIDE) WITH HCG TRIGGER VERSUS GnRH ANTAGONIST (GANIRELIX)WITHTRIPTORELIN TRIGGER IN PATIENTS OFPCODUNDERGOING IVFTREATMENT. R. Sharma, F. Rehman, N. Nakshtramalini. IVF and Reproductive Medicine, Max Hospital, New Delhi, India. OBJECTIVE: To determine the ideal protocol for PCOD patients undergoing IVF treatment. DESIGN: Retrospective analysisJan 2010 –Jan 2013. MATERIALS AND METHODS: 70 PCOS patients (according to Rotterdam criteria), who underwent IVF/IVF-ICSI cycles between Jan 2010 – Jan 2013 were evaluated retrospectively for the type of protocol used, amount and duration of gonadotrophin use, cost, no.of oocytes, fertilization rate, cleavage rate,embryo quality, clinical pregnancy rate and complication rate. RESULTS: The profiles of the patients in both groupswere comparable. Cost was almost same in both groups though there was reduction in the total amount of gonadotrophins used in the antagonist cycles. There was Reduction in the treatment days with analogue in the antagonist group (average 4.5 in antagonist versus 21 days in the agonist group). Duration of stimulation (9.5 versus 11.2 days) and total gonadotrophin required (1425 versus 1680 IU) were lower in the antagonist compared with agonist protocol. Mean no. of oocytes (COC’s) were less,(16.26 in the antagonist group versus 19.45 in the agonist group) therefore mean number of fertilized oocytes and consequent no. of embryos per patient were less in the antagonist group though fertilization rate(57.17%versus 58.09%) and cleavage rate(88.53%versus89.38%) were similar. There was no evidence of a statistically significant difference in clinical pregnancy rate between the two groups (36.66%in antagonist group versus 37.5%in the agonist group). There was significantly lower incidence of OHSS in the antagonist group. In agonist group, 3 patients had severeOHSS; due towhich embryo transfer had to be postponed .In antagonist group no patient had severe OHSS. In antagonist group one patient had empty follicles at the time of Oocyte retrieval with no embryos to transfer subsequently. CONCLUSION: The use of GnRH antagonists may be considered more advantageous because of more patient comfort and decreased risk of OHSS with good clinical outcome in high responder patients. O-359 Wednesday, October 16, 2013 05:00 PM THE FIRST SUCCESSFUL LIVE BIRTH FOLLOWING PREIMPLANTATION GENETIC DIAGNOSIS FOR TYPE I CITRULLINEMIA USING POLYMERASE CHAIN REACTION. C.-H. Kim, K.-H. Lee, J.-H. Cho, J.-M. Kim, G.-H. Kim, H.-W. Yoo. Obstetrics

Aberrant Pregnancy Adaptations in the Peripheral Immune Response in Type 1 Diabetes: A Rat Model

IntroductionDespite tight glycemic control, pregnancy complication rate in type 1 diabetes patients is higher than in normal pregnancy. Other etiological factors may be responsible for the development of adverse pregnancy outcome. Acceptance of the semi-allogeneic fetus is accompanied by adaptations in the maternal immune-response. Maladaptations of the immune-response has been shown to contribute to pregnancy complications. We hypothesized that type 1 diabetes, as an autoimmune disease, may be associated with maladaptations of the immune-response to pregnancy, possibly resulting in pregnancy complications.MethodsWe studied pregnancy outcome and pregnancy-induced immunological adaptations in a normoglycemic rat-model of type 1 diabetes, i.e. biobreeding diabetes-prone rats (BBDP; 5 non-pregnant rats, 7 pregnant day 10 rats and 6 pregnant day 18 rats) , versus non-diabetic control rats (i.e. congenic non-diabetic biobreeding diabetes-resistant (BBDR; 6 non-pregnant rats, 6 pregnant day 10 rats and 6 pregnant day 18 rats) and Wistar-rats (6 non-pregnant, 6 pregnant day 10 rats and 5 pregnant day 18 rats)).ResultsWe observed reduced litter size, lower fetal weight of viable fetuses and increased numbers of resorptions versus control rats. These complications are accompanied by various differences in the immune-response between BBDP and control rats in both pregnant and non-pregnant animals. The immune-response in non-pregnant BBDP-rats was characterized by decreased percentages of lymphocytes, increased percentages of effector T-cells, regulatory T-cells and natural killer cells, an increased Th1/Th2-ratio and activated monocytes versus Wistar and BBDR-rats. Furthermore, pregnancy-induced adaptations in BBDP-rats coincided with an increased Th1/Th2-ratio, a decreased mean fluorescence intensity CD161a/NKR-P1b ratio and no further activation of monocytes versus non-diabetic control rats.ConclusionThis study suggests that even in the face of strict normoglycemia, pregnancy complications still occur in type 1 diabetic pregnancies. This adverse pregnancy outcome may be related to the aberrant immunological adaptations to pregnancy in diabetic rats.

Community and Federal Collaboration to Assess Pregnancy Outcomes in Alaska Native Women, 1997–2005

The objectives are to report the estimated prevalence of pregnancy complications and adverse pregnancy outcomes in a defined population of Alaska Native women and also examine factors contributing to an intensive and successful collaboration between a tribal health center and the Centers for Disease Control and Prevention. Investigators abstracted medical record data from a random sample of singleton deliveries to residents of the study region occurring between 1997 and 2005. We used descriptive statistics to estimate the prevalence and 95% confidence intervals of selected pregnancy complications and adverse pregnancy outcomes. Records were examined for 505 pregnancies ending in a singleton delivery to 469 women. Pregnancy complication rates were 5.9% (95% CI 4.0, 8.4) for gestational diabetes mellitus, 6.1% (95% CI 4.2, 8.6%) for maternal chronic hypertension and 11.5% (95% CI 8.8, 14.6) for pregnancy associated hypertension, and 22.9% (95% CI 19.2-26.5 %) for anemia. The cesarean section rate was 5.5% (95% CI 3.5, 7.5) and 3.8% (95% CI 2.3, 5.8) of newborns weighed >4,500 g. Few previous studies reported pregnancy outcomes among Alaska Native women in a specific geographic region of Alaska and regarding the health needs in this population. We highlight components of our collaboration that contributed to the success of the study. Studies focusing on special populations such as Alaska Native women are feasible and can provide important information on health indicators at the local level.

Changes in risk factors for preterm birth in Western Australia 1984–2006

To characterise changing risk factors of preterm birth in Western Australia between 1984 and 2006. Population-based study. Western Australia. All non-Aboriginal women giving birth to live singleton infants between 1984 and 2006. Multinomial, multivariable regression models were used to assess antecedent profiles by preterm status and labour onset types (spontaneous, medically indicated, prelabour rupture of membranes [PROM]). Population attributable fraction (PAF) estimates characterized the contribution of individual antecedents as well as the overall contribution of two antecedent groups: pre-existing medical conditions (including previous obstetric history) and pregnancy complications. Antecedent relationships with preterm birth, stratified by labour onset type. Marked increases in maternal age and primiparous births were observed. A four-fold increase in the rates of pre-existing medical complications over time was observed. Rates of pregnancy complications remained stable. Multinomial regression showed differences in antecedent profiles across labour onset types. PAF estimates indicated that 50% of medically indicated preterm deliveries could be eliminated after removing six antecedents from the population; estimates for PROM and spontaneous preterm reduction were between 10 and 20%. Variables pertaining to previous and current obstetric complications (previous preterm birth, previous caesarean section, pre-eclampsia and antepartum haemorrhage) were the most influential predictors of preterm birth and adverse labour onset (PROM and medically indicated). Preterm antecedent profiles have changed markedly over the 23 years studied. Some changes may be attributable to true change, others to advances in surveillance and detection. Still others may signify change in clinical practice.