Risk Of PTB Research Articles

Cervical Assessment by Transvaginal Ultrasound for Predicting Preterm Birth in Asymptomatic Women

Abstract Preterm birth (PTB) is defined as delivery before completing 37 weeks of gestation. It is the main cause of neonatal morbidity and mortality in the most countries. The inherent cervical length and strength are two main features of the cervix that determine whether or not a pregnant woman is at risk for PTB. Routine transvaginal cervical length screening was recommended for women with singleton pregnancy and history of prior spontaneous PTB, while the issue of universal cervical length screening and the screening in multiple gestations remain an object of debate. Strain sonoelastography and shear-wave sonoelastography have been used to evaluate the cervical stiffness in pregnant women, but the predictive value for PTB still requires further investigations. In this review, we will discuss the measurement methods of cervical length and cervical stiffness, and compare the value of cervical assessment by transvaginal ultrasound for predicting PTB in asymptomatic women.

Outcomes of ultrasound and physical-exam based cerclage: assessment of risk factors and the role of adjunctive progesterone in preventing preterm birth-a retrospective cohort study.

To assess outcomes of ultrasound and physical examination-based cerclage performed at mid to late second trimester and to assess the potential added value of progesterone treatment combined with cerclage for preventing preterm birth. A retrospective cohort study of women who underwent cerclage in a university-affiliated tertiary medical center (2012-2018). Inclusion criteria included only ultrasound-based cerclage and physical examination-based cerclage. Women who underwent history-based cerclage or multiple gestations were excluded. Study groups were stratified by previous PTB < 37weeks and other risk factors for PTB. Primary outcome was the incidence of preterm birth < 35weeks of gestation. Secondary outcomes included the potential added value of progesterone treatment and neonatal outcome. Sixty-nine women underwent cervical cerclage placement between 16-23weeks of gestation. All women had short cervix (cervical length of < 25mm) at presentation. Indications for cerclage placement included: 29% previous PTB, 32% prior cervical interventions (history of at least one D&C, hysteroscopy or cold-knife conization in the past), 22% had cervical dilatation > 1cm at presentation, 12% due to failure of progesterone treatment defined as continued cervical shortening after 14days of progesterone treatment, and 5% had other indications. Overall, 42 women (61%) gave birth at term. 27 women (39%) delivered prior to 37weeks of gestation, of them, 20 women (29%) gave birth prior to 35weeks. Overall median gestational age at delivery was 35 + 5 ± 4.7weeks. Cervical dilatation at presentation of > 1cm was associated with an increased risk for PTB < 35weeks (OR 3.57, CI 1.43-30.81, p = 0.036). Previous PTB, prior cervical interventions and extent of cervical shortening at presentation did not increase the risk of PTB. Progesterone treatment in addition to cerclage did not result in a decreased risk for PTB < 35weeks of gestation (OR 2.83, CI 0.58-13.89, p = 0.199). Late second trimester cerclage is a practical measure for preventing PTB in cases of asymptomatic cervical shortening. Our study did not find adjunctive benefit for progesterone treatment with physical or ultrasound-based cerclage in reducing the rate PTB.

Neighborhood-Level Mass Incarceration and Future Preterm Birth Risk among African American Women

While evidence for neighborhood effects on adverse birth outcomes is growing, no studies have examined whether living in a neighborhood impacted by mass incarceration is associated with preterm birth risk. We used modified Poisson regression to test whether residence in a neighborhood impacted by mass incarceration predicted future risk of preterm birth, among African American women. We linked data from the Justice Atlas of Sentencing and Corrections to survey and medical record data from the Life-course Influences on Fetal Environments study (n = 681). We also tested for effect modification by age and marital status. The association between prison admission expenditures and future risk of PTB varied by maternal age at birth, with younger women (< 35) having a modest increase in risk (relative risk (RR) 1.07; 95% confidence interval (CI) 0.99, 1.15), and older (35+ year old) women having lower risk (RR 0.86; 95% CI 0.69, 1.07). The association between the number of prison admissions due to new court cases and future risk of PTB varied by marital status, with evidence that married women may be protected (RR 0.75; 95% CI 0.61, 0.92), while little evidence of association was observed among unmarried women (RR 1.02; 95% CI 0.80, 1.30). The association between residence in an area impacted by mass incarceration and future risk of PTB among African American women may vary by age and marital status. Future research to identify the mechanisms of these associations is warranted.

The association between internal migration and pulmonary tuberculosis in China, 2005\u20132015: a spatial analysis

BackgroundInternal migration places individuals at high risk of contracting tuberculosis (TB). However, there is a scarcity of national-level spatial analyses regarding the association between TB and internal migration in China. In our research, we aimed to explore the spatial variation in cases of sputum smear-positive pulmonary TB (SS + PTB) in China; and the associations between SS + PTB, internal migration, socioeconomic factors, and demographic factors in the country between 2005 and 2015.MethodsReported cases of SS + PTB were obtained from the national PTB surveillance system database; cases were obtained at the provincial level. Internal migration data were extracted from the national population sampling survey and the census. Spatial autocorrelations were explored using the global Moran’s statistic and local indicators of spatial association. The spatial temporal analysis was performed using Kulldorff’s scan statistic. Fixed effects regression was used to explore the association between SS + PTB and internal migration.ResultsA total of 4 708 563 SS + PTB cases were reported in China between 2005 and 2015, of which 3 376 011 (71.7%) were male and 1 332 552 (28.3%) were female. There was a trend towards decreasing rates of SS + PTB notifications between 2005 and 2015. The result of global spatial autocorrelation indicated that there were significant spatial correlations between SS + PTB rate and internal migration each year (2005–2015). Spatial clustering of SS + PTB cases was mainly located in central and southern China and overlapped with the clusters of emigration. The proportions of emigrants and immigrants were significantly associated with SS + PTB. Per capita GDP and education level were negatively associated with SS + PTB. The internal migration flow maps indicated that migrants preferred neighboring provinces, with most migrating for work or business.ConclusionsThis study found a significant spatial autocorrelation between SS + PTB and internal migration. Both emigration and immigration were statistically associated with SS + PTB, and the association with emigration was stronger than that for immigration. Further, we found that SS + PTB clusters overlapped with emigration clusters, and the internal migration flow maps suggested that migrants from SS + PTB clusters may influence the TB epidemic characteristics of neighboring provinces. These findings can help stakeholders to implement effective PTB control strategies for areas at high risk of PTB and those with high rates of internal migrants.

Adverse birth outcomes and their clinical phenotypes in an urban Zambian cohort

Background: Few cohort studies of pregnancy in sub-Saharan Africa use rigorous gestational age dating and clinical phenotyping. As a result, incidence and risk factors of adverse birth outcomes are inadequately characterized. Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established to investigate adverse birth outcomes at a referral hospital in urban Lusaka. This report describes ZAPPS phase I, enrolled August 2015 to September 2017. Women were followed through pregnancy and 42 days postpartum. At delivery, study staff assessed neonatal vital status, birthweight, and sex, and assigned a delivery phenotype. Primary outcomes were: (1) preterm birth (PTB; delivery <37 weeks), (2) small-for-gestational-age (SGA; <10 th percentile weight-for-age at birth), and (3) stillbirth (SB; delivery of an infant without signs of life). Results: ZAPPS phase I enrolled 1450 women with median age 27 years (IQR 23–32). Most participants (68%) were multiparous, of whom 41% reported a prior PTB and 14% reported a prior stillbirth. Twins were present in 3% of pregnancies, 3% of women had short cervix (<25mm), 24% of women were HIV seropositive, and 5% were syphilis seropositive. Of 1216 (84%) retained at delivery, 15% were preterm, 18% small-for-gestational-age, and 4% stillborn. PTB risk was higher with prior PTB (aRR 1.88; 95%CI 1.32–2.68), short cervix (aRR 2.62; 95%CI 1.68–4.09), twins (aRR 5.22; 95%CI 3.67–7.43), and antenatal hypertension (aRR 2.04; 95%CI 1.43–2.91). SGA risk was higher with twins (aRR 2.75; 95%CI 1.81–4.18) and antenatal hypertension (aRR 1.62; 95%CI 1.16–2.26). SB risk was higher with short cervix (aRR 6.42; 95%CI 2.56–16.1). Conclusio ns: This study confirms high rates of PTB, SGA, and SB among pregnant women in Lusaka, Zambia. Accurate gestational age dating and careful ascertainment of delivery data are critical to understanding the scope of adverse birth outcomes in low-resource settings.

Time series analysis of total and direct associations between high temperatures and preterm births in Detroit, Michigan

ObjectivesPreterm births (PTBs) represent significant health risks, and several studies have found associations between high outdoor temperatures and PTB. We estimated both the total and natural direct effects (independent of...

Analysis of CTLA-4 (+49A/G) Gene Polymorphism and the Risk of Pulmonary Tuberculosis in Babylon province of Iraq

Background: Pulmonary tuberculosis (pTB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis (M. tuberculosis). It typically affects the lungs, but can also affect other sites (extra- pulmonary TB). The disease is spread when sick individuals expel bacteria into the air, for example by coughing.Aim of Study: To highlight the effect of CTLA-4 (+49A/G) gene polymorphism on the risk of pulmonary Tuberculosis (pTB).Patients and Methods: This case-controlled study used single specific primer-polymerase chain reaction (SSP-PCR) to analyze the CTLA-4 (+49A/G) gene polymorphism in 60 patients with pTB who were referred to consultant clinic for respiratory diseases in Hilla – Babylon province/ Iraq during the period from December 2017 to July 2018, and 60 healthy persons’ control. Blood samples were collected from both groups according to the standard methods.Results: Data analysis revealed that the frequencies of AA, AG and GG genotypes in patients were 73.33%, 23.33%, and 3.34% respectively. In controls, this frequency was 51.67%, 35%, and 13.33% respectively. Logistic regression test detected a significant difference in the frequency of the (GG genotype) mutant homozygous of this polymorphism between patients and controls (3.34% versus 13.33%), The GG genotype of CTLA-4(+49A/G) showed a significantly decreased risk of pulmonary tuberculosis disease (OR= 0.18, 95% CI= 0.04 – 0.88, P value = 0.035).Conclusion: The GG genotype of CTLA-4 may decrease the risk of pTB.

Adverse birth outcomes and their clinical phenotypes in an urban Zambian cohort.

Background: Few cohort studies of pregnancy in sub-Saharan Africa use rigorous gestational age dating and clinical phenotyping. As a result, incidence and risk factors of adverse birth outcomes are inadequately characterized. Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established to investigate adverse birth outcomes at a referral hospital in urban Lusaka. This report describes ZAPPS phase I, enrolled August 2015 to September 2017. Women were followed through pregnancy and 42 days postpartum. At delivery, study staff assessed neonatal vital status, birthweight, and sex, and assigned a delivery phenotype. Primary outcomes were: (1) preterm birth (PTB; delivery <37 weeks), (2) small-for-gestational-age (SGA; <10 th percentile weight-for-age at birth), and (3) stillbirth (SB; delivery of an infant without signs of life). Results: ZAPPS phase I enrolled 1450 women with median age 27 years (IQR 23-32). Most participants (68%) were multiparous, of whom 41% reported a prior PTB and 14% reported a prior stillbirth. Twins were present in 3% of pregnancies, 3% of women had short cervix (<25mm), 24% of women were HIV seropositive, and 5% were syphilis seropositive. Of 1216 (84%) retained at delivery, 15% were preterm, 18% small-for-gestational-age, and 4% stillborn. PTB risk was higher with prior PTB (aRR 1.88; 95%CI 1.32-2.68), short cervix (aRR 2.62; 95%CI 1.68-4.09), twins (aRR 5.22; 95%CI 3.67-7.43), and antenatal hypertension (aRR 2.04; 95%CI 1.43-2.91). SGA risk was higher with twins (aRR 2.75; 95%CI 1.81-4.18) and antenatal hypertension (aRR 1.62; 95%CI 1.16-2.26). SB risk was higher with short cervix (aRR 6.42; 95%CI 2.56-16.1). Conclusio ns: This study confirms high rates of PTB, SGA, and SB among pregnant women in Lusaka, Zambia. Accurate gestational age dating and careful ascertainment of delivery data are critical to understanding the scope of adverse birth outcomes in low-resource settings.

Cervical elastography using E-cervix for prediction of preterm birth in singleton pregnancies with threatened preterm labor

Objective E-Cervix™ (WS80A; Samsung, Seoul, Korea) elastography is a recent quantification tool to measure the stiffness of the cervix using strain elastography. The aim of this study was to evaluate the prediction performance of E-cervix for preterm birth in singleton gestation with threatened preterm labor (PTL). Methods This was a cohort study of singleton pregnancies without prior preterm birth presenting to obstetrics triage for threatened PTL between 23 0/7 and 33 6/7 week who received screening for PTL with transvaginal ultrasound cervical length (TVU CL) and cervical elastography with E-cervix at the time of triage. Cervical elastography parameters were examined and compared between women who delivered preterm and those who did not. The quantification of cervical strain was calculated by a data analysis system that directly analyses raw data from the region of interest (ROI) and described as hardness ratio (HR), mean strain level within 1 cm from internal os (IOS) and external os (EOS). Results Ninety-five singleton pregnancies without prior preterm birth and with threatened PTL between 23 0/7 and 33 6/7 week of gestation were included in the study. Forty-two (44.2%) had cervical length <25 mm, and were admitted for true PLT. Out of the 53 women with cervical length ≥25 mm, 40 (75.5%) were discharged, and 13 (24.5%) were admitted. Women with threatened PTL but without true PTL, had significantly higher HR compared to those with true PTL (49.0 ± 20.9% versus 34.8 ± 19.6%; p < .01), and significantly lower stiffness of cervical IOS and EOS. Women who delivered preterm had significantly lower HR compared to those who did not delivery preterm, in overall cohort, and in the subset of only women with true PTL. Incidences of HR < 50% and <35% were statistically significantly higher in women who delivered preterm compared to those who did not (p < .01). Conclusions Cervical elastography with E-cervix may be useful for the assessment of women presenting to obstetrics triage for threatened PTL. Women with low HR, especially with HR less than 50 or 35%, are at increased risk of PTB. Condensation Women who delivered preterm had significantly lower HR compared to those who did not delivery preterm and significantly lower IOS and EOS, in overall cohort, and in the subset of women with true PTL. Incidences of HR < 50% and <35% were statistically significantly higher in women who delivered preterm compared to those who did not (p < .01). Key message Cervical elastography with E-cervix may be useful for the assessment of women presenting to obstetrics triage for threatened PTL.

Risk factors for spontaneous miscarriage above 12\u2009weeks or premature delivery in patients undergoing cervical polypectomy during pregnancy

BackgroundIt currently remains unknown whether the resection of cervical polyps during pregnancy leads to miscarriage and/or preterm birth. This study evaluated the risk of spontaneous PTB below 34 or 37 weeks and miscarriage above 12 weeks in patients undergoing cervical polypectomy during pregnancy.MethodsThis was a retrospective monocentric cohort study of patients undergoing cervical polypectomy for clinical indication. Seventy-three pregnant women who underwent polypectomy were selected, and risk factors associated with miscarriage above 12 weeks or premature delivery below 34 or 37 weeks were investigated. A multivariable regression looking for predictors of spontaneous miscarriage > 12 weeks and PTB < 34 or 37 weeks were performed.ResultsSixteen patients (21.9%, 16/73) had spontaneous delivery at < 34 weeks or miscarriage above 12 weeks. A univariate analysis showed that bleeding before polypectomy [odds ratio (OR) 7.7, 95% confidence interval (CI) 1.6–37.3, p = 0.004], polyp width ≥ 12 mm (OR 4.0, 95% CI 1.2–13.1, p = 0.005), the proportion of decidual polyps (OR 8.1, 95% CI 1.00–65.9, p = 0.024), and polypectomy at ≤10 weeks (OR 5.2, 95% CI 1.3–20.3, p = 0.01) were significantly higher in delivery at < 34 weeks than at ≥34 weeks. A logistic regression analysis identified polyp width ≥ 12 mm (OR 11.8, 95% CI 2.8–77.5, p = 0.001), genital bleeding before polypectomy (OR 6.5, 95% CI 1.2–55.7, p = 0.025), and polypectomy at ≤10 weeks (OR 5.9, 95% CI 1.2–45.0, p = 0.028) as independent risk factors for predicting delivery at < 34 weeks. Polyp width ≥ 12 mm and bleeding before polypectomy are risk factors for PTB < 37 wks.ConclusionsOur cohort of patients undergoing polypectomy in pregnancy have high risks of miscarriage or spontaneous premature delivery. It is unclear whether these risks are given by the underlying disease, by surgical treatment or both. This study establishes clinically relevant predictors of PTB are polyp size> 12 mm, bleeding and first trimester polypectomy. PTB risks should be exposed to patients and extensively discussed with balancing against the benefits of intervention in pregnancy.

Papillomavirus infection and preterm birth. Chronicle of a broken relationship? case series and review of the literature

Human papillomavirus (HPV) infection is widespread. Approximately 40 HPV serotypes infect ano-genital area, but most infections are asymptomatic and can get cleared spontaneously. HPV clearance is modified during pregnancy. Many information have been published about HPV infection and preterm birth, unfortunately the results are often not corresponding. The aim of this study was to understand whether there is an association between HPV infection and preterm birth. In our study we reported results about 20 pregnant women admitted for preterm birth. We assessed if and how papillomavirus cervical infection affects pregnancy outcome. HPV prevalence in pregnant women in this case series was 45% (9/20), while 55% pregnant women were found HPV-negative (11/20). There was no difference between HPV positive group and HPV negative group in terms of gestational age at delivery, neonatal weight, Apgar score. Our data, even though from a very small series, confirm the absence of different outcomes due to HPV infection. It has been reported that women with H-SIL have a higher baseline risk for PTB than general population and treatment for H-SIL probably increase this risk further. The research on HPV and PTB should go straight to this direction.

800: Area deprivation index and adverse obstetric outcomes

Preterm birth and low birth weight continue to be vexing obstetric and pediatric problems, complicating many pregnancies, with few effective interventions, and troubling racial disparities. Our objective was to examine the associations between area deprivation index (ADI), race, and adverse obstetric outcomes to target populations at highest risk. This is a prospective cohort study enrolling pregnant women early in pregnancy and following them longitudinally at a tertiary care center in Missouri. ADI was calculated using the “Neighborhood Atlas” (University of Wisconsin), which uses census data to rank areas based on multiple measures of socioeconomic disadvantage such as income, education, employment, housing quality etc. ADI was calculated using Missouri state data based on the woman’s residential address at enrollment. Preterm birth < 37 weeks and low birth weight (birthweight < 2500 grams) were compared across ADI quartiles from the least (1st quartile) to the most (4th quartile) disadvantaged. The analysis was stratified by race to explore the effect of race on the relationship between deprivation and adverse obstetric outcomes. 848 pregnant women were included. Low birth weight significantly increased as ADI increased, from 7% in areas of lowest deprivation to 20% in areas of highest deprivation (Table). Preterm birth less than 37 weeks and less than 34 weeks increased as deprivation increased with a 2 times higher risk for PTB < 37 and and nearly 3 times the risk for PTB < 34 weeks at the highest quartile of neighborhood deprivation. Notable disparities exist with nonblack women even at the most highly disadvantaged ADI still having a lower risk for LBW (8.3%) than black women at low ADI (17.4%). Increasing ADI is associated with a significant increase in risk for LBW and to a smaller extent risk for preterm birth, with notable racial disparities. Future studies testing actionable screening and prevention interventions targeted specifically for populations living in high neighborhood disadvantage should be performed to minimize risk for LWB and PTB outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

307: Short femur length: A biomarker for spontaneous preterm birth?

Abnormal fetal growth patterns are associated with indicated preterm birth (iPTB). Recently, data has suggested that spontaneous preterm birth (sPTB) may also have sonographically detectable fetal growth characteristics, specifically the femur length (FL) component of fetal biometry. Our objective was to test the association of short FL at different gestational ages for the risk of PTB. This is a prospective cohort study of patients followed longitudinally across pregnancy at a tertiary care academic center with the primary aim of detecting novel markers of preterm birth. Fetal biometry measurements were collected from ultrasounds across pregnancy. sPTB was rupture of membranes or preterm labor resulting in delivery < 37 weeks (wks). iPTB was any maternal or fetal indication leading to delivery < 37 wks. Single FL measurements from growth assessments were tested for the association with PTB in four-week time windows (16 to 19+6 wks; 20-23+6 wks; 24-27+6 wks; 28-31+6 wks). ‘Short FL’ was defined < 25th percentile. Fischer’s exact tests were performed comparing the incidence of short FL between preterm versus term, and between sPTB versus iPTB. A time-to-event analysis, with delivery being the event, was performed to obtain hazard ratio for short FL and time to delivery. 125 patients with PTB were included; 58 sPTB and 67 iPTB. Short FL is significantly associated with the risk for PTB. The time windows of 16 to 20 weeks (p=0.01) and 28 to 32 weeks (p< 0.01) are of particular importance (Figure 1). Using survival analysis, there is a significantly decreased time to delivery amongst women with a short FL detected at 16-20 weeks and 28-32 weeks with fetuses with short FL three times more likely to deliver before those with normal FL (Figure 2) p< 0.001. There was no difference in risk for sPTB or iPTB with short FL < 25%ile. Short FL detected from 16-20 weeks and 28-32 weeks are associated with a significant increase in PTB. Further studies to examine whether short FL could be an important component of a clinical risk prediction and stratification for PTB.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Health Advantages and Disparities in Preterm Birth Among Immigrants Despite Disparate Sociodemographic, Behavioral, and Maternal Risk Factors in San Diego, California.

Reproductive health advantages have been reported among selected immigrants, but few studies have included new immigrants and refugees, nor simultaneously adjusted for socioeconomic, behavioral, and medical disparities. We examined the risk of preterm birth (PTB, < 37weeks' gestation) among singleton live births in San Diego County from 2007 to 2012. Multivariable regression was used to compare PTB (1) by nativity within racial/ethnic groups and (2) among immigrants compared to United States (US) born Whites, while adjusting for sociodemographic, behavioral, reproductive and medical variables. Among 230,878 singleton live births, overall PTB prevalence was highest among parturient women who were US-born Blacks (10.9%), Philippine (10.8%) and US-born Filipinas (10.7%), and US-born Asians (8.6%) despite differences in socioeconomic and maternal risk factors, and lowest among Somali (5.5%) migrants. Blacks born in Somalia or outside of the US, had significantly lower overall PTB prevalence compared to US-born Blacks (5.5% vs 7.6% vs 10.9%). Compared to US-born Whites, spontaneous PTB risk was significantly lower among Somali migrants (4.8% vs 3.7%, adjusted relative risk, aRR 0.7 [95% Confidence Intervals 0.5-0.9]), but higher among Philippine migrants (4.8% vs 7.7%, aRR 1.4 [1.3-1.6]). The strongest risk factor for overall PTB among nulliparous US-born Blacks was preexisting diabetes (aRR 3.81 [2.05-7.08]), and preexisting hypertension among Filipinas (aRR: 3.27 [2.36-4.54] and US-born Asians (aRR: 3.64 [1.61-8.24]). Black migrants had lower PTB prevalence compared to US-born Blacks, but this immigrant advantage was not observed in other racial/ethnic groups. Compared to US-born Whites, Somali migrants had significantly lower risk of spontaneous PTB while Filipinas had elevated risk.

Maternal prescribed opioid analgesic use during pregnancy and associations with adverse birth outcomes: A population-based study.

Published research on prescribed opioid analgesic (POA) use during pregnancy and birth outcomes is limited in scope and has not adequately adjusted for potential confounding factors. To help address these gaps, we estimated associations between maternal POAs during pregnancy and two adverse birth outcomes using a large population-based dataset, multiple definitions of POA exposure, and several methods to evaluate the influence of both measured and unmeasured confounding factors. We obtained data by linking information from several Swedish registers and conducted a retrospective cohort study on a population-based sample of 620,458 Swedish births occurring between 2007 and 2013 (48.6% female; 44.4% firstborn). We evaluated associations between prenatal POA exposure and risk for preterm birth (PTB; <37 gestational weeks) and small for gestational age (SGA; birth weight 2 standard deviations below the expected weight for gestational age or lower). We evaluated the influence of confounding by adjusting for a wide range of measured covariates while comparing exposed and unexposed infants. Additionally, we adjusted for unmeasured confounding factors by using several advanced epidemiological designs. Infants exposed to POAs anytime during pregnancy were at increased risk for PTB compared with unexposed infants (6.4% exposed versus 4.4% unexposed; adjusted odds ratio [OR] = 1.38, 95% confidence interval [CI] 1.31-1.45, p < 0.001). This association was attenuated when we compared POA-exposed infants with acetaminophen-exposed infants (OR = 1.18, 95% CI 1.07-1.30, p < 0.001), infants born to women who used POAs before pregnancy only (OR = 1.05, 95% CI 0.96-1.14, p = 0.27), and unexposed siblings (OR = 0.99, 95% CI 0.85-1.14, p = 0.92). We also evaluated associations with short-term versus persistent POA use during pregnancy and observed a similar pattern of results, although the magnitudes of associations with persistent exposure were larger than associations with any use or short-term use. Although short-term use was not associated with SGA (adjusted ORsingle-trimester = 0.95, 95% CI 0.87-1.04, p = 0.29), persistent use was associated with increased risk for SGA (adjusted ORmultiple-trimester = 1.40, 95% CI 1.17-1.67, p < 0.001) compared with unexposed infants. The association with persistent exposure was attenuated when we used alternative comparison groups (e.g., sibling comparison OR = 1.22, 95% CI 0.60-2.48, p = 0.58). Of note, our study had limitations, including potential bias from exposure misclassification, an inability to adjust for all sources of confounding, and uncertainty regarding generalizability to countries outside of Sweden. Our results suggested that observed associations between POA use during pregnancy and risk of PTB and SGA were largely due to unmeasured confounding factors, although we could not rule out small independent associations, particularly for persistent POA use during pregnancy.

Association between the number of oocytes retrieved and neonatal outcomes after freeze-all IVF cycles.

Is there any association between the number of oocytes retrieved and neonatal outcomes following IVF/ICSI treatment for patients using a freeze-all strategy? There was no increased risk of adverse neonatal outcomes in cycles with high number of oocytes retrieved (≥ 16) compared to those with 10-15 oocytes retrieved in freeze-all cycles. Recent studies have found that there is an increased risk of preterm birth (PTB, <37weeks gestation) and low birth weight (LBW, <2500g) following IVF in women with a high number (>20) of oocytes retrieved in fresh embryo transfer (ET) cycles. Other studies have found that there is an association between the number of oocytes retrieved and placenta praevia. However, the association between the number of oocytes retrieved and neonatal outcomes when using a freeze-all strategy is unknown. This retrospective cohort study included 14 170 women with singleton deliveries achieved by a freeze-all strategy performed between November 2006 and December 2017 in China. Only the first delivery from one episode of ovarian stimulation was included. Only cycles using a freeze-all strategy performed during the study period and resulting in singleton live births were included. Patients were categorized into five groups according to the number of oocytes retrieved: 1-3, 4-9, 10-15, 16-20 or >20 oocytes. In univariate and multivariate logistic regression analysis of the association between ovarian response and the outcomes of PTB, early PTB, LBW and other neonatal outcomes, the 10 to 15 oocyte category was used as a reference and other four groups were analysed as dummy variables. Multiple linear regression analysis was used to evaluate possible associations of birth weight z-scores and the number of oocytes retrieved (analysed as a continuous variable) with other confounding factors. After adjusted for confounding factors, no significant differences were observed in the risk of PTB (P= 0.837), LBW (P= 0.974), early PTB (P= 0.341), very LBW (P= 0.848), congenital malformation (P= 0.916) and other adverse neonatal outcome among patients with different number of oocytes retrieved. There was a higher risk of early PTB among women with a poor ovarian response (1-3 oocytes) compared with women with a normal response (10-15 oocytes) (1.5% vs 0.8%), crude odds ratio (OR): 2.001, 95% CI: 1.159-3.465, P= 0.013. However, the difference was not significant after adjusting for confounders, adjusted OR: 1.753, 95% CI: 0.997-3.081, P= 0.051. Data on some known confounders such as smoking and medical history of gestational diabetes mellitus and preeclampsia were lacking. As with any retrospective study, unknown confounders may affect outcomes. In the freeze-all cycles, there was no association between number of oocytes retrieved and adverse neonatal outcomes. This is a reassuring finding for both clinicians and patients who are planning to use freeze-all cycles for a variety of indications. Grants from the National Natural Science Foundation of China (NSFC) (31770989 to Y.W.) and the Shanghai Ninth People's Hospital Foundation of China (JYLJ030 to Y.W.). None of the authors have any conflicts of interest to declare.

CT FOR EARLY DIAGNOSIS OF SPUTUM-SMEAR NEGATIVE PULMONARY TB IN ENDEMIC POPULATIONS

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Early diagnosis of Tuberculosis (TB) is critical for prompt treatment and diagnostic dilemmas can delay appropriate treatment. We review 2 cases of sputum smear-negative pulmonary TB (SSN-pTB). CASE PRESENTATION: Case 1. A 57 year old Chinese man presented with haemoptysis. Radiology revealed a papillary thyroid carcinoma with severe extrinsic tracheal compression and infiltration. He received a total thyroidectomy. Although initial smear and molecular tests were negative on sputum, empiric TB treatment was started given tree-in-bud changes in the right upper lobe on CT. TB cultures from sputum and tracheal aspirates proved TB infection 6 weeks later. Case 2. A 34 year old Filipino pregnant lady presented with haemoptysis and near syncope. Ultrasound of calves were negative for deep venous thrombosis while CT pulmonary angiography revealed only left upper lobe tree in bud changes. Subsequent sputum studies were smear negative but molecular positive TB with culture conversion 2 months later. She was initiated on TB treatment with good outcomes. DISCUSSION: The diagnosis of pTB depends on clinical features and the decision to initiate treatment depends on the pre-test probability. Patients with sputum smear-negative pTB (SSN-pTB) pose as diagnostic dilemmas as they usually have mild symptoms or systemic manifestations. Culture conversion often requires 6-8 weeks to confirm the diagnosis hence losing valuable time for effective and early treatment. Although sputum TB smear and culture are the gold standards in diagnosing pTB, patients may not have sputum. While flexible fiberoptic bronchoscopy can increase the diagnostic yield of SSN-pTB this is invasive and bear risks of complications arising from anticipated difficult airways in both patients. Although empiric TB treatment can be initiated in younger patients with minimal adverse reactions as with the first patient, this cannot be similarly applied to the second patient given clear obstetric and gynaecological considerations to initiating TB treatment without diagnostic confirmation. Confirmation of pTB before initiating treatment is still ideal in either case. CT can be useful in the rapid diagnosis of pTB. Tree-in-bud appearance is the most significant association with active PTB in 24-33% of patients[1] with SSN-pTB. CT features suggestive of pTB reportedly have high sensitivity, specificity as well as positive- and negative- predictive values[2]. In particular, HRCT has been shown to predict the risk of PTB with good reproducibility [3]and is a good diagnostic tool to identify patients with high risk of pTB. CONCLUSIONS: It is important to consider and screen for TB in high risk patients especially if early diagnosis and subsequent treatment of TB is necessary. Tree-in-bud appearance on CT is highly suggestive of PTB in an endemic population and can be useful in the diagnosis of patients with SSN-pTB with difficulty expectorating sputum. Reference #1: Hatipoglu et al . Thorax 1996: 51: 397-402 Reference #2: JS park et al ERJ 2016 48 (60): PA3806 Reference #3: Nakanishi M et al. Eur J Radiol. 2010 Mar;73(3):545-50 DISCLOSURES: no disclosure on file for Kay See; No relevant relationships by Genevieve Tan, source=Web Response

Adverse birth outcomes and their clinical phenotypes in an urban Zambian cohort

Background: Few cohort studies of pregnancy in sub-Saharan Africa use rigorous gestational age dating and clinical phenotyping. As a result, incidence and risk factors of adverse birth outcomes are inadequately characterized. Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established to investigate adverse birth outcomes at a referral hospital in urban Lusaka. This report describes ZAPPS phase I, enrolled August 2015 to September 2017. Women were followed through pregnancy and 42 days postpartum. At delivery, study staff assessed neonatal vital status, birthweight, sex, and assigned a delivery phenotype. Primary outcomes were: (1) preterm birth (PTB; delivery &lt;37 weeks), (2) small-for-gestational-age (SGA; &lt;10th percentile weight-for-age at birth), and (3) stillbirth (SB; delivery of an infant without signs of life). Results: ZAPPS phase I enrolled 1450 women with median age 27 years (IQR 23–32). Most participants (68%) were multiparous, of whom 41% reported a prior PTB and 14% reported a prior stillbirth. Twins were present in 3% of pregnancies, 3% of women had short cervix (&lt;25mm), 24% of women were HIV seropositive, and 5% were syphilis seropositive. Of 1216 (84%) retained at delivery, 15% were preterm, 18% small-for-gestational-age, and 4% stillborn. PTB risk was higher with prior PTB (aRR 1.88; 95%CI 1.32–2.68), short cervix (aRR 2.62; 95%CI 1.68–4.09), twins (aRR 5.22; 95%CI 3.67–7.43), and antenatal hypertension (aRR 2.04; 95%CI 1.43–2.91). SGA risk was higher with twins (aRR 2.75; 95%CI 1.81–4.18) and antenatal hypertension (aRR 1.62; 95%CI 1.16–2.26). SB risk was higher with short cervix (aRR 6.42; 95%CI 2.56–16.1). Conclusions: This study confirms high rates of PTB, SGA, and SB among pregnant women in Lusaka, Zambia. Accurate gestational age dating and careful ascertainment of delivery data are critical to understanding the scope of adverse birth outcomes in low-resource settings.

Neonatal outcomes of singleton live births with vanishing twin syndrome following transfer of double embryos in assisted reproductive technology: a retrospective cohort study

To compare neonatal outcomes in singleton live births between groups with and without VTs following transfer of double embryos. Retrospective cohort study. Anonymised data on all cycles performed in the China were obtained from the Reproductive medicine department of the Third Affiliated Hospital of Zhengzhou University, involving 6220 singleton live births (2772 fresh embryos transfer (ET) cycles and 3448 frozen embryos transfer (FET) cycles). We analyzed the obstetric outcomes of gestation age, PTB, SGA (small for gestation age), birthweight, LBW, congenital malformation, pediatric admission and NICU admission in cycles of fresh ET and FET. Logistic regression analysis was performed adjusting for confounders, including age of women, BMI, value of AMH, infertile years, current cycle, antral follicles, cause of infertility, number of oocytes retrieved, endometrial thickness at the day of transplantation, number of high-quality embryos, embryo stage. In the fresh ET cycles, the birthweight and gestational age in the study group were lower than in the control group, (2962.4±563.1vs. 3104.9±498.5, p=0.000) and (262.8±8.4vs. 268.9±13.9, p=0.000), respectively. There was a significantly higher risk of PTB (adjusted odds ratio(aOR) 2.45,95%CI:1.98-3.03)) and LBW (aOR 2.11, 95%CI :1.67-2.65) in the study group than in the control group. And there was a higher risk of pediatric admission (aOR 2.55,95%CI2.07-3.13) and NICU admission (aOR 1.98,95%CI1.32-2.96) in the study group than in the control group, and In the FET cycles, the gestational age and birthweight in the study group were lower than in the control group, (263.0±15.7vs. 273.0±10.5, p=0.000) and (3099±662.1vs. 3352±671.5), respectively. There is a significantly higher risk of PTB (aOR2.45,95%CI: 2.23-3.43) and LBW (aOR 2.67, 95%CI :2.13-3.34) in the study group than in the control group. And there was a higher risk of pediatric admission (aOR2.62,95%CI2.14-3.21) and NICU admission (aOR 2.22,95%CI1.43,3.46) in the study group than in the control group. There was a higher risk of LBW, PTB, pediatric admission and NICU admission between the study groups and control groups in fresh ET and FET cycles. However, no increased risk of SGA and congenital malformation was observed in singleton live births in both fresh and frozen ART cycles following transferring double embryos.

Maternal and severe anaemia in delivering women is associated with risk of preterm and low birth weight: A cross sectional study from Jharkhand, India

Background and objectivesHaemoglobin content is the well accepted indicator for anaemia assessment. The high prevalence of anaemia, maternal health care issues and adverse delivery outcome in Jharkhand, we investigated whether delivering women with anaemia would present a modifiable risk of preterm (PTB) and low birth weight (LBW). MethodsA facility-based cross-sectional study involving pregnant women, with screening for pregnancy endpoints and haemoglobin assay, were conducted. Anaemia was classified according to World Health Organization's definition of anaemia in pregnancy. Confounding variables were adjusted in a logistic model. The adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used for analyzing the association among maternal anaemia, PTB and LBW. ResultsWe observed a high prevalence of anaemia (78.45%) in delivering women, whereas high prevalence of preterm birth (34.75%) and LBW (32.81%) in delivering women overall. In the adjusted analysis, overall anaemia in pregnancy was strongly associated with preterm birth (OR, 3.42; 95% CI, 1.98–5.88; P ≤ .0001) as compared to LBW (OR, 1.12; 95% CI, 0.65–1.61; P = .0003). The risk of PTB and LBW were dependent on the stratification of the anaemia group, as the strongest association was observed in severe (OR, 4.86) followed by mild (OR, 3.66) and moderate (OR, 3.18) anaemia in PTB; whereas risk of LBW was found in severe (OR, 2.5) followed by moderate (OR, 1.11) and mild (OR, 0.57) anaemia. The risk of PTB and LBW across six pregnancy haemoglobin groups were compared, haemoglobin of 10–10.9 g/dl (OR, 1.25) and ≤ 8 g/dl (OR, 1.03) have shown association with PTB and LBW, respectively. However, high haemoglobin concentration was not associated with either PTB or LBW. ConclusionsAnaemia in delivering women was associated with an elevated risk of PTB and LBW and the risk increased with the severity of anaemia in pregnant women.