568: The Chinese birth calendar for prediction of gender - fact or fiction?
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were slightly higher for early elective births, maternal and newborn lengths of stay and mean adjusted costs were similar. Maternal and newborn costs were lowest for spontaneous VBs and nearly double for CD births. Cost savings that might have been achieved in 2006 by delay of early births to term were primarily maternal, estimated at $6.3 million and $7.7 million for LPT and ET births respectively out of the nearly $2.2 billion expended on maternal care in California in 2006. CONCLUSION: The greatest cost savings can be had by reducing non-indi- cated primary cesarean deliveries. Repeat cesarean births contribute sub- stantially to avoidable early births had the greatest financial and adverse outcome costs. Interestingly, our data suggests that cost savings hinge on the performance of cesareans rather than specific GA at delivery. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.432 568 The Chinese birth calendar for prediction of gender - fact or fiction? Daniel Katz 1 , Blair Wylie 1 1 Massachusetts General Hospital, Boston, Massachusetts OBJECTIVE: To evaluate the accuracy of the Chinese birth calendar in predicting infant gender. STUDY DESIGN: We performed a retrospective database review of pre- natal and delivery records of all singleton deliveries at Massachusetts General Hospital between January 1st, 1995 and June 30th, 2008. Pregnancies complicated by multiple gestations and infants with am- biguous genitalia were excluded from analysis. Predicted infant gen- der based on month of conception and maternal age was compared to infant gender at birth in 38,394 delivery records. Gestational age was determined by last menstrual period if available or by first available ultrasound. Date of conception was assumed to be 14 days post the first day of the last menstrual period. Month of conception was cal- culated by subtracting gestational age in days at time of delivery from the date of delivery. Maternal age was calculated based on both the Chinese lunar calendar and the Gregorian calendar for comparison. RESULTS: Of the 38394 deliveries at MGH, 18683 (48.66%) were fe- males and 19711 (51.34%) were males. 19 infants had ambiguous genitalia and were excluded. Accurate prediction of fetal gender based on the mother’s Gregorian calendar age occurred in 19346/38394 (50.4%). Using the mother’s Chinese lunar age, accurate prediction of fetal gender occurred in 19406/38394 (50.2%). CONCLUSION: The Chinese birth calendar claims 93-99% accuracy in predicting infant gender based on month of conception and maternal age at delivery. In this large delivery dataset, accurate prediction of fetal gender based on the Chinese birth calendar was no better than a coin toss. Our study is limited by inclusion of pregnancies resulting from artificial reproductive technologies. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.433 569 Does hospital type influence the timing of preterm birth and neonatal morbidity? Candice Snyder 1 , Katherine Wolfe 1 , Ryan Loftin 1 , Sammy Tabbah 1 , David Lewis 1 , Emily DeFranco 1 1 University of Cincinnati, Cincinnati, Ohio OBJECTIVE: Despite heightened awareness of the morbidity of late pre- term birth, no studies have examined the effect of hospital setting on timing of preterm birth or neonatal outcomes. We compared rates of preterm delivery and neonatal outcomes in university (UNIV) versus community (COMM) hospitals and between those with and without OB-GYN residencies. STUDY DESIGN: Using the Ohio Department of Health’s birth certifi- cate database (2006-2007), we performed a population-based retro- spective cohort study of singleton live births. We compared the pri- mary outcomes of gestational age (GA) at delivery and composite neonatal morbidity by hospital setting. Logistic regression analyses estimated association between hospital type and neonatal outcomes, adjusting for significant covariates. RESULTS: Of 283,370 births, the population delivering in UNIV hos- pitals (N38616) versus COMM (N244754) and residency (N120508) versus not (162862) had significantly lower birthweight, GA, and socioeconomic status, less prenatal care and more medical comorbidities. Absolute rates of preterm delivery at 34-37 and 32-34 weeks were higher in UNIV and residency programs (12.6 vs 9.2%, p 0.001 and 6.0 vs 2.7%, p0.001 respectively). After adjusting for pop- ulation differences between hospital types, risk remained slightly in- creased, aOR 1.18 (1.14,1.23) and 1.25 (1.17,1.34), respectively. Inter- estingly, there was a 60-70% increased risk of birth injury in COMM and non-residency programs even with adjustment for birthweight and GA. However, overall neonatal morbidity did not differ between UNIV and COMM hospitals, and was only slightly higher in residency programs, aOR’s 1.24 (1.2-1.29), while absolute risk remained low. CONCLUSION: Despite an inherently higher risk population at UNIV and teaching facilities, neonatal morbidity does not differ significantly between these hospital types. Surprisingly, birth injury occurs 60-70% more frequently in COMM and non-teaching hospitals even after adjustment for birthweight and GA differences. This finding is pro- vocative and worthy of further investigation. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.434 570 Sepsis induced organ failure in obstetric patients: maternal outcomes in 20 cases Candice Snyder 1 , Mounira Habli 2 , Baha Sibai 1 1 University of Cincinnati, Cincinnati, Ohio, 2 Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio OBJECTIVE: Though sepsis is a leading cause of death, septic shock with resultant organ failure in pregnancy is a rare event and literature high- lighting maternal outcomes is scant. The objective is to report our experience with obstetric patients and septic shock with emphasis on organ failure and infectious etiology. STUDY DESIGN: Retrospective review of 20 antepartum/postpartum patients treated for septic shock at a university hospital. Maternal data included demographics, admit/discharge diagnoses, length of ICU stay, etiology, organisms isolated, laboratory and hemodynamic pro- files, presence of organ damage, and outcome. RESULTS: Of 186 obstetric patients admitted to the ICU, 20 (11%) were treated for septic shock (15 antepartum/5 postpartum). Causes of septic shock were pyelonephritis, uterine infection, epidural ab- scess, IV infection, ruptured appendix, pneumonia, and septic throm- bophlebitis. There were 2 maternal deaths (10%): one with pyelone- phritis, and one with multi-organ failure /acute fatty liver of pregnancy. Frequencies of end-organ damage are summarized in ta- ble. Isolated organisms included: Pyelonephritis: E.coli, Enterococ- cus, Acinebacter; Uterine Infection: E.coli, Bacteroides; Appendix: Klebsiella, Enterococcus, Pseudomonas; Pneumonia: Klebsiella, En- terococcus, MRSA, Pseudomonas; Other: Klebsiella, S.aureus. CONCLUSION: Pyelonephritis was the most frequent cause of sepsis, ac- counting for 40% of cases in our study and these patients had an 88% risk of ARDS, and 12.5% risk of mortality. E.coli was the most frequently isolated organism and accounted for 35% of cases of septic shock. Frequency of Organ Injury by Etiology N(%) ARDS DIC Renal Liver/GI Pyelo 8(40%) 7(88%) 3(38%) 3(38%) 4(50%) .......................................................................................................................................................................................... Uterine 5(25%) 4(80%) 3(60%) 1(20%) 1(20%) .......................................................................................................................................................................................... Appendix 2(10%) 1(50%) 0 0 1(50%) .......................................................................................................................................................................................... Pneumonia 2(10%) 2(100%) 1(50%) 1(50%) 1(50%) .......................................................................................................................................................................................... Other 3(15%) 1(33%) 0 2(66%) 2(66%) .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.435 www.AJOG.org Academic Issues, etc Poster Session IV Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology S211
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Transcript of 568: The Chinese birth calendar for prediction of gender - fact or fiction?
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www.AJOG.org Academic Issues, etc Poster Session IV
ere slightly higher for early elective births, maternal and newbornengths of stay and mean adjusted costs were similar. Maternal andewborn costs were lowest for spontaneous VBs and nearly double forD births. Cost savings that might have been achieved in 2006 byelay of early births to term were primarily maternal, estimated at $6.3illion and $7.7 million for LPT and ET births respectively out of the
early $2.2 billion expended on maternal care in California in 2006.ONCLUSION: The greatest cost savings can be had by reducing non-indi-ated primary cesarean deliveries. Repeat cesarean births contribute sub-tantially to avoidable early births had the greatest financial and adverseutcome costs. Interestingly, our data suggests that cost savings hinge onhe performance of cesareans rather than specific GA at delivery.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.432
568 The Chinese birth calendar for predictionf gender - fact or fiction?aniel Katz1, Blair Wylie1
Massachusetts General Hospital, Boston, MassachusettsBJECTIVE: To evaluate the accuracy of the Chinese birth calendar inredicting infant gender.TUDY DESIGN: We performed a retrospective database review of pre-atal and delivery records of all singleton deliveries at Massachusettseneral Hospital between January 1st, 1995 and June 30th, 2008.regnancies complicated by multiple gestations and infants with am-iguous genitalia were excluded from analysis. Predicted infant gen-er based on month of conception and maternal age was compared to
nfant gender at birth in 38,394 delivery records. Gestational age wasetermined by last menstrual period if available or by first availableltrasound. Date of conception was assumed to be 14 days post therst day of the last menstrual period. Month of conception was cal-ulated by subtracting gestational age in days at time of delivery fromhe date of delivery. Maternal age was calculated based on both thehinese lunar calendar and the Gregorian calendar for comparison.ESULTS: Of the 38394 deliveries at MGH, 18683 (48.66%) were fe-ales and 19711 (51.34%) were males. 19 infants had ambiguous
enitalia and were excluded. Accurate prediction of fetal gender basedn the mother’s Gregorian calendar age occurred in 19346/3839450.4%). Using the mother’s Chinese lunar age, accurate prediction ofetal gender occurred in 19406/38394 (50.2%).ONCLUSION: The Chinese birth calendar claims 93-99% accuracy inredicting infant gender based on month of conception and maternalge at delivery. In this large delivery dataset, accurate prediction ofetal gender based on the Chinese birth calendar was no better than aoin toss. Our study is limited by inclusion of pregnancies resultingrom artificial reproductive technologies.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.433
569 Does hospital type influence the timingf preterm birth and neonatal morbidity?andice Snyder1, Katherine Wolfe1, Ryan Loftin1,ammy Tabbah1, David Lewis1, Emily DeFranco1
University of Cincinnati, Cincinnati, OhioBJECTIVE: Despite heightened awareness of the morbidity of late pre-
erm birth, no studies have examined the effect of hospital setting oniming of preterm birth or neonatal outcomes. We compared rates ofreterm delivery and neonatal outcomes in university (UNIV) versusommunity (COMM) hospitals and between those with and withoutB-GYN residencies.
TUDY DESIGN: Using the Ohio Department of Health’s birth certifi-ate database (2006-2007), we performed a population-based retro-pective cohort study of singleton live births. We compared the pri-
ary outcomes of gestational age (GA) at delivery and compositeeonatal morbidity by hospital setting. Logistic regression analysesstimated association between hospital type and neonatal outcomes,djusting for significant covariates.ESULTS: Of 283,370 births, the population delivering in UNIV hos-
itals (N�38616) versus COMM (N�244754) and residencySupplemen
N�120508) versus not (162862) had significantly lower birthweight,A, and socioeconomic status, less prenatal care and more medical
omorbidities. Absolute rates of preterm delivery at 34-37 and 32-34eeks were higher in UNIV and residency programs (12.6 vs 9.2%, p�.001 and 6.0 vs 2.7%, p�0.001 respectively). After adjusting for pop-lation differences between hospital types, risk remained slightly in-reased, aOR 1.18 (1.14,1.23) and 1.25 (1.17,1.34), respectively. Inter-stingly, there was a 60-70% increased risk of birth injury in COMMnd non-residency programs even with adjustment for birthweightnd GA. However, overall neonatal morbidity did not differ betweenNIV and COMM hospitals, and was only slightly higher in residencyrograms, aOR’s 1.24 (1.2-1.29), while absolute risk remained low.ONCLUSION: Despite an inherently higher risk population at UNIVnd teaching facilities, neonatal morbidity does not differ significantlyetween these hospital types. Surprisingly, birth injury occurs 60-70%ore frequently in COMM and non-teaching hospitals even after
djustment for birthweight and GA differences. This finding is pro-ocative and worthy of further investigation.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.434
570 Sepsis induced organ failure in obstetricatients: maternal outcomes in 20 casesandice Snyder1, Mounira Habli2, Baha Sibai1
University of Cincinnati, Cincinnati, Ohio, 2Cincinnatihildren’s Hospital Medical Center, Cincinnati, OhioBJECTIVE: Though sepsis is a leading cause of death, septic shock withesultant organ failure in pregnancy is a rare event and literature high-ighting maternal outcomes is scant. The objective is to report ourxperience with obstetric patients and septic shock with emphasis onrgan failure and infectious etiology.TUDY DESIGN: Retrospective review of 20 antepartum/postpartumatients treated for septic shock at a university hospital. Maternal data
ncluded demographics, admit/discharge diagnoses, length of ICUtay, etiology, organisms isolated, laboratory and hemodynamic pro-les, presence of organ damage, and outcome.ESULTS: Of 186 obstetric patients admitted to the ICU, 20 (11%)ere treated for septic shock (15 antepartum/5 postpartum). Causesf septic shock were pyelonephritis, uterine infection, epidural ab-cess, IV infection, ruptured appendix, pneumonia, and septic throm-ophlebitis. There were 2 maternal deaths (10%): one with pyelone-hritis, and one with multi-organ failure /acute fatty liver ofregnancy. Frequencies of end-organ damage are summarized in ta-le. Isolated organisms included: Pyelonephritis: E.coli, Enterococ-us, Acinebacter; Uterine Infection: E.coli, Bacteroides; Appendix:lebsiella, Enterococcus, Pseudomonas; Pneumonia: Klebsiella, En-
erococcus, MRSA, Pseudomonas; Other: Klebsiella, S.aureus.ONCLUSION: Pyelonephritis was the most frequent cause of sepsis, ac-ounting for 40% of cases in our study and these patients had an 88% riskf ARDS, and 12.5% risk of mortality. E.coli was the most frequently
solated organism and accounted for 35% of cases of septic shock.
requency of Organ Injury by Etiology
(%) ARDS DIC Renal Liver/GI
yelo 8(40%) 7(88%) 3(38%) 3(38%) 4(50%).........................................................................................................................................................................................
terine 5(25%) 4(80%) 3(60%) 1(20%) 1(20%).........................................................................................................................................................................................
ppendix 2(10%) 1(50%) 0 0 1(50%).........................................................................................................................................................................................
neumonia 2(10%) 2(100%) 1(50%) 1(50%) 1(50%).........................................................................................................................................................................................
ther 3(15%) 1(33%) 0 2(66%) 2(66%).........................................................................................................................................................................................
002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.435
t to DECEMBER 2009 American Journal of Obstetrics & Gynecology S211
