327: Maternal outcome in twin compared to singleton gestation
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327 MATERNAL OUTCOME IN TWIN COMPARED TO SINGLETON GESTATION NGOC PHAN 1 , YVONNE CHENG 1 , TIM BRUCKNER 2 , DANNY W. WU 1 , AARON B. CAUGHEY 1 , 1 University of California, San Francisco, San Francisco, California, 2 University of California, Berkeley,, California OBJECTIVE: To estimate the risk of maternal complications in twin pregnancies compared to singletons. STUDY DESIGN: This is a retrospective cohort study of non-anomalous term births in 2003 in the U.S. Maternal outcomes of twin gestations were compared to that of singletons. Statistical comparison was made using Chi-square test and mul- tivariable logistic analysis was used to control for confounders; singleton gestation was designated as the referent. RESULTS: There were 2,714,815 (98.6%) singleton and 39,790 (1.4%) twin term (37-41 weeks) births meeting study criteria. Women with twins had higher risk of complications compared to singletons, except for febrile morbidity and meconium stained amniotic fluid (see Table). CONCLUSION: Women with twin gestation are generally at higher risk of ma- ternal complication compared to singleton gestation. Thus, women undergoing assisted reproductive technology should be counseled regarding these risks. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.355 328 THE IMPACT OF PRE-PREGNANCY BODY MASS INDEX ON PREGNANCY OUTCOMES IN TRIPLET GESTATIONS ZOI RUSSELL 1 , HAMISU SALIHU 1 , ONEIL LYNCH 1 , VICTORIA BELOGOLOVKIN 1 , 1 University of South Florida, Obstetrics and Gynecology, Tampa, Florida OBJECTIVE: To investigate the effect of pre-pregnancy maternal body mass in- dex on the outcome of triplet gestations. STUDY DESIGN: Triplet births in the State of Missouri from 1989 through 1997 were analyzed. Obesity was defined as maternal pre-pregnancy body mass index (BMI) higher than or equal to 30. We assessed the association between obesity and the following outcomes: stillbirth, preeclampsia, very preterm, small for gestational age (SGA) and a composite adverse birth outcome. RESULTS: As compared to normal weight mothers, the likelihood of stillbirth and pre-eclampsia was about four-fold (OR 3.70; 95% CI 1.37-9.97) and three-fold (OR 3.02; 95% CI 1.69-5.40) respectively among obese mothers. Obese mothers were also about twice as likely to experience at least one of the adverse birth outcomes considered. CONCLUSION: Obesity increases the risk for adverse perinatal outcomes in trip- let gestations. This observation could assist in the counseling of women considering the use of assisted reproductive technology (ART). Body mass index sub-categories and association with adverse pregnancy outcomes among triplets with normal BMI as the referent group. Missouri, 1989- 1997 Adverse outcome Under weight (Adjusted OR and 95% CI) Over weight (Adjusted OR and 95% CI) Obese (Adjusted OR and 95% CI) Stillbirth 1.30 (0.16-10.85) 0.49 (0.06-3.93) 3.70 (1.37-9.97) Pre eclampsia 0.71 (0.32-1.55) 2.54 (1.46-4.42) 3.02 (1.69-5.40) Preterm delivery 1.03 (0.58-1.81) 0.64 (0.38-1.07) 0.85 (0.51-1.41) SGA 1.01 (0.38-2.67) 1.12 (0.49-2.56) 1.52 (0.71-3.23) Compo site 0.82 (0.46-1.44) 1.05 (0.65-1.69) 1.88 (1.12-3.13) 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.356 329 UTERINE DUPLICATION ANOMALIES AND OBSTETRIC OUTCOMES STEPHEN T. CHASEN 1 , YELENA HAVRYLIUK 1 , ROBERT TROIANO 2 , 1 Weill Medical College of Cornell University, Obstetrics and Gynecology, New York, New York, 2 Weill Medical Col- lege of Cornell University, Radiology, New York, New York OBJECTIVE: Uterine anomalies have been associated with high rates of poor OB outcomes.Studies are limited by the fact that diagnosis often follows poor out- comes, while women with no history of complications are less likely to be identi- fied.Our objective was to evaluate pregnancy outcomes in women with uterine anomalies identified in our regular obstetric population. STUDY DESIGN: Review of OB ultrasound records identified women with evi- dence of duplication anomalies, including bicornuate, didelphic, and septate uteri. A duplicate cervix was documented in all those with uterine didelphys. OB out- comes were obtained from record review. Spontaneous abortions (SAB) due to aneuploidy were excluded. Women with a history of surgical repair were excluded. Chi-Square analysis was used for statistical comparison. RESULTS: 48 women with duplication anomalies (22 bicornuate, 12 septate, 14 didelphys) were identified, in whom 115 pregnancies were documented. Mean maternal age was 31.15.6 years. A cerclage was placed in 6 pregnancies in 2 women with bicornuate uterus. SAB occurred in 26 pregnancies (22.6%), with only one at 12 weeks. There was one IUFD. There were 68 term births (59.1%), and 20 preterm births (17.4%). Most preterm births occurred at 34-36 weeks, with only 3 occurring at 34 weeks. Malpresentation complicated 39.3% of live births, and 17.6% of all neonates were small for gestational age (SGA). Similar rates of SAB, preterm birth, and SGA were seen in the 3 groups of duplication anomalies. Mal- presentation was significantly less common with septate uterus compared to bicor- nuate or didelphys uteri (12.5% vs. 42.9% and 52.6%; p.04). In women with a prior SAB, preterm birth occurred more frequently than in those with no history of SAB (37.9% vs. 15.8%; p.03). CONCLUSION: In our population, most women with duplication anomalies de- livered at or near term, with malpresentation occurring commonly. In women with no history of poor outcome, surgical repair or prophylactic cerclage is not indi- cated. Prior miscarriage might identify those at higher risk of preterm birth. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.357 330 OUTCOME OF HYPOGASTRIC ARTERY EMBOLIZATION FOR PLACENTA ACCRETA CLARISSA BONANNO 1 , KARIN FUCHS 1 , FADI MIRZA 1 , KIRSTEN CLEARY 1 , SREEDAR GADDIPATI 1 , JASON WRIGHT 1 , PATRICIA DEVINE 1 , 1 Columbia University, New York, New York OBJECTIVE: To compare outcomes of patients with placenta accreta undergo- ing hypogastric artery embolization (HAE) at cesarean hysterectomy versus those undergoing hysterectomy alone. STUDY DESIGN: This was a retrospective cohort study of patients with a prena- tal diagnosis of placenta accreta from January of 2000 to June 2008. Placenta accreta was confirmed for all patients by pathological review of hysterectomy specimens. Patients with preoperative placement of hypogastric artery catheters and intraop- erative embolization were compared to patients who underwent hysterectomy alone. Records were reviewed to determine EBL, transfusion requirements, rate of ICU admission, need for reoperation, and postoperative length of stay. RESULTS: Of 30 patients with a preoperative diagnosis of placenta accreta, 7 underwent hysterectomy with intraoperative embolization and 23 underwent hys- terectomy alone. Patients who underwent HAE had significantly higher estimated blood loss (mean 9700 and range 1800-16000 vs. mean 5600 and range 1500- 20000), transfusion requirements, rates of ICU admission, and longer postopera- tive hospitalizations. One patient undergoing HAE developed extensive arterial thrombi requiring thrombectomy. CONCLUSION: Hypogastric artery embolization at cesarean hysterectomy did not improve surgical outcomes and does not prevent massive hemorrhage. How- ever, studies of this nature are inherently influenced by selection bias and a ran- domized controlled trial is needed to determine the utility of embolization in these at-risk patients. Table 1: Outcomes of patients treated with hysterectomy and embolization versus hysterectomy alone for prenatally diagnosed placenta accreta With HAE (n7) Without HAE (n23) p Mean EBL (cc) 9700 5600 0.05 Total Blood Products (units) 64 23 0.002 PRBC (units) 20.7 9.7 0.006 ICU 100% 39% 0.004 Reop 0% 8.7% NS Postop LOS 7.4 5.8 0.02 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.358 SMFM Abstracts www.AJOG.org S102 American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2008
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27 MATERNAL OUTCOME IN TWIN COMPARED TO SINGLETON GESTATION NGOC PHAN1,YVONNE CHENG1, TIM BRUCKNER2, DANNY W. WU1, AARON B. CAUGHEY1, 1University ofCalifornia, San Francisco, San Francisco, California, 2University of California,Berkeley,, California
OBJECTIVE: To estimate the risk of maternal complications in twin pregnanciescompared to singletons.
STUDY DESIGN: This is a retrospective cohort study of non-anomalous termbirths in 2003 in the U.S. Maternal outcomes of twin gestations were compared tothat of singletons. Statistical comparison was made using Chi-square test and mul-tivariable logistic analysis was used to control for confounders; singleton gestationwas designated as the referent.
RESULTS: There were 2,714,815 (98.6%) singleton and 39,790 (1.4%) twinterm (37-41 weeks) births meeting study criteria. Women with twins had higherrisk of complications compared to singletons, except for febrile morbidity andmeconium stained amniotic fluid (see Table).
CONCLUSION: Women with twin gestation are generally at higher risk of ma-ternal complication compared to singleton gestation. Thus, women undergoingassisted reproductive technology should be counseled regarding these risks.
0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.355
28 THE IMPACT OF PRE-PREGNANCY BODY MASS INDEX ON PREGNANCY OUTCOMES INTRIPLET GESTATIONS ZOI RUSSELL1, HAMISU SALIHU1, ONEIL LYNCH1, VICTORIABELOGOLOVKIN1, 1University of South Florida, Obstetrics and Gynecology, Tampa,Florida
OBJECTIVE: To investigate the effect of pre-pregnancy maternal body mass in-dex on the outcome of triplet gestations.
STUDY DESIGN: Triplet births in the State of Missouri from 1989 through 1997were analyzed. Obesity was defined as maternal pre-pregnancy body mass index(BMI) higher than or equal to 30. We assessed the association between obesity andthe following outcomes: stillbirth, preeclampsia, very preterm, small for gestationalage (SGA) and a composite adverse birth outcome.
RESULTS: As compared to normal weight mothers, the likelihood of stillbirthand pre-eclampsia was about four-fold (OR � 3.70; 95% CI � 1.37-9.97) andthree-fold (OR � 3.02; 95% CI � 1.69-5.40) respectively among obese mothers.Obese mothers were also about twice as likely to experience at least one of theadverse birth outcomes considered.
CONCLUSION: Obesity increases the risk for adverse perinatal outcomes in trip-let gestations. This observation could assist in the counseling of women consideringthe use of assisted reproductive technology (ART).
Body mass index sub-categories and association with adverse pregnancyoutcomes among triplets with normal BMI as the referent group. Missouri, 1989-1997
Adverse outcome
Under weight(Adjusted ORand 95% CI)
Over weight(Adjusted ORand 95% CI)
Obese(Adjusted ORand 95% CI)
Stillbirth 1.30 (0.16-10.85) 0.49 (0.06-3.93) 3.70 (1.37-9.97)Pre eclampsia 0.71 (0.32-1.55) 2.54 (1.46-4.42) 3.02 (1.69-5.40)Preterm delivery 1.03 (0.58-1.81) 0.64 (0.38-1.07) 0.85 (0.51-1.41)SGA 1.01 (0.38-2.67) 1.12 (0.49-2.56) 1.52 (0.71-3.23)Compo site 0.82 (0.46-1.44) 1.05 (0.65-1.69) 1.88 (1.12-3.13)
0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.356
102 American Journal of Obstetrics & Gynecology Supplement to DECEMBER
29 UTERINE DUPLICATION ANOMALIES AND OBSTETRIC OUTCOMES STEPHEN T.CHASEN1, YELENA HAVRYLIUK1, ROBERT TROIANO2, 1Weill Medical College of CornellUniversity, Obstetrics and Gynecology, New York, New York, 2Weill Medical Col-lege of Cornell University, Radiology, New York, New York
OBJECTIVE: Uterine anomalies have been associated with high rates of poor OBoutcomes.Studies are limited by the fact that diagnosis often follows poor out-comes, while women with no history of complications are less likely to be identi-fied.Our objective was to evaluate pregnancy outcomes in women with uterineanomalies identified in our regular obstetric population.
STUDY DESIGN: Review of OB ultrasound records identified women with evi-dence of duplication anomalies, including bicornuate, didelphic, and septate uteri.A duplicate cervix was documented in all those with uterine didelphys. OB out-comes were obtained from record review. Spontaneous abortions (SAB) due toaneuploidy were excluded. Women with a history of surgical repair were excluded.Chi-Square analysis was used for statistical comparison.
RESULTS: 48 women with duplication anomalies (22 bicornuate, 12 septate, 14didelphys) were identified, in whom 115 pregnancies were documented. Meanmaternal age was 31.1�5.6 years. A cerclage was placed in 6 pregnancies in 2 womenwith bicornuate uterus. SAB occurred in 26 pregnancies (22.6%), with only one at�12 weeks. There was one IUFD. There were 68 term births (59.1%), and 20preterm births (17.4%). Most preterm births occurred at 34-36 weeks, with only 3occurring at �34 weeks. Malpresentation complicated 39.3% of live births, and17.6% of all neonates were small for gestational age (SGA). Similar rates of SAB,preterm birth, and SGA were seen in the 3 groups of duplication anomalies. Mal-presentation was significantly less common with septate uterus compared to bicor-nuate or didelphys uteri (12.5% vs. 42.9% and 52.6%; p�.04). In women with aprior SAB, preterm birth occurred more frequently than in those with no history ofSAB (37.9% vs. 15.8%; p�.03).
CONCLUSION: In our population, most women with duplication anomalies de-livered at or near term, with malpresentation occurring commonly. In women withno history of poor outcome, surgical repair or prophylactic cerclage is not indi-cated. Prior miscarriage might identify those at higher risk of preterm birth.
0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.357
30 OUTCOME OF HYPOGASTRIC ARTERY EMBOLIZATION FOR PLACENTAACCRETA CLARISSA BONANNO1, KARIN FUCHS1, FADI MIRZA1, KIRSTEN CLEARY1,SREEDAR GADDIPATI1, JASON WRIGHT1, PATRICIA DEVINE1, 1Columbia University, NewYork, New York
OBJECTIVE: To compare outcomes of patients with placenta accreta undergo-ing hypogastric artery embolization (HAE) at cesarean hysterectomy versus thoseundergoing hysterectomy alone.
STUDY DESIGN: This was a retrospective cohort study of patients with a prena-tal diagnosis of placenta accreta from January of 2000 to June 2008. Placenta accretawas confirmed for all patients by pathological review of hysterectomy specimens.Patients with preoperative placement of hypogastric artery catheters and intraop-erative embolization were compared to patients who underwent hysterectomyalone. Records were reviewed to determine EBL, transfusion requirements, rate ofICU admission, need for reoperation, and postoperative length of stay.
RESULTS: Of 30 patients with a preoperative diagnosis of placenta accreta, 7underwent hysterectomy with intraoperative embolization and 23 underwent hys-terectomy alone. Patients who underwent HAE had significantly higher estimatedblood loss (mean 9700 and range 1800-16000 vs. mean 5600 and range 1500-20000), transfusion requirements, rates of ICU admission, and longer postopera-tive hospitalizations. One patient undergoing HAE developed extensive arterialthrombi requiring thrombectomy.
CONCLUSION: Hypogastric artery embolization at cesarean hysterectomy didnot improve surgical outcomes and does not prevent massive hemorrhage. How-ever, studies of this nature are inherently influenced by selection bias and a ran-domized controlled trial is needed to determine the utility of embolization in theseat-risk patients.
Table 1: Outcomes of patients treated with hysterectomy and embolization versushysterectomy alone for prenatally diagnosed placenta accreta
With HAE(n�7)
Without HAE(n�23) p
Mean EBL (cc) 9700 5600 0.05Total Blood Products (units) 64 23 0.002PRBC (units) 20.7 9.7 0.006ICU 100% 39% 0.004Reop 0% 8.7% NSPostop LOS 7.4 5.8 0.02
0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.358
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