91: Proteinuria in the uncomplicated twin pregnancy
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90 Impact of birthweight discordance and of non-vertex presentation of the second twin on successful vaginal birth – The Esprit Trial Fionnuala M Breathnach 1 , Stephen Carroll 2 , Fionnuala McAuliffe 3 , Michael Geary 4 , Sean Daly 5 , John R Higgins 6 , James Dornan 7 , John Morrison 8 , Gerard Burke 9 , Shane Higgins 10 , Fergal D. Malone 1 1 Royal College of Surgeons in Ireland, Dublin, Ireland, 2 National Maternity Hospital, Dublin, Ireland, 3 University College Dublin, Dublin, Ireland, 4 Rotunda Hospital, Dublin, Ireland, 5 Coombe Women and Infants University Hospital, Dublin, Ireland, 6 Cork University Maternity Hospital, Ireland, 7 Royal Victoria Maternity Hospital Belfast, Ireland, 8 National University of Ireland, Galway, Ireland, 9 Mid-Western Regional Maternity Hospital, Limerick, Ireland, 10 Our Lady of Lourdes Hospital, Drogheda, Ireland OBJECTIVE: To determine the impact of intratwin birthweight discor- dance and of non-vertex presentation of the second twin on successful vaginal delivery. STUDY DESIGN: The ESPRIT Trial is a national prospective population study of 642 consecutive twin pregnancies managed and delivered at 8 tertiary referral centers in one country. All pregnancies are followed using a uniform sonographic surveillance protocol. RESULTS: Vaginal or cesarean delivery (CD) was planned for 310 (48%) and 332 (52%) women, respectively. Birthweight discordance of 20% was documented in 12% (37/310) of patients who under- went a trial of labor. The sensitivity of ultrasound within 2 weeks of delivery for detection of this degree of discordance was 86%, specific- ity 61%. While the overall CD rate was 64% (411/642), intrapartum CD was needed in 29% (90/310) of cases where vaginal delivery was planned. Successful trial of labor did not correlate with advancing gestational age (logistic regression p-value 0.2409), vertex presenta- tion of the 2nd twin (p-value 0.3252), nor with concordant size (re- gression p-value 0.2988). CONCLUSION: Neither size discordance nor non-vertex presentation of the 2nd twin is predictive of CD. When the larger twin is not present- ing, successful vaginal delivery can still be anticipated in most cases. Twin birthweight discordance and successful trial of labor BW discordance Vaginal delivery of both twins (N220) Intrapartum CD (N 79) Combined vaginal-CD (N11) p-value 10% 55% 62% 55% - ........................................................................................................................................................................................................... 10% 45% 38% 45% 0.3510 ........................................................................................................................................................................................................... 20% 12% 12% 9% 0.9474 ........................................................................................................................................................................................................... 20% (smaller twin presenting) 6% 8% 9% 0.5797 ........................................................................................................................................................................................................... Non-vertex 2nd twin 27% 33% 0% 0.3252 ........................................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.105 91 Proteinuria in the uncomplicated twin pregnancy Nicole Smith 1 , Jennifer Lyons 1 , Thomas McElrath 1 1 Brigham and Women’s Hospital, Boston, Massachusetts OBJECTIVE: We have observed that women with twin pregnancies ap- pear to have higher rates of proteinuria without accompanying hyper- tension than do those with singletons. Protein to creatinine ratios (p:c ratio) in excess of 0.19 predict proteinuria greater than 300mg in a 24 hour collection. We compare rates of high p:c ratios in non-pre- eclamptic singleton and twin pregnancies in order to better under- stand normal protein excretion in twins. STUDY DESIGN: A sequential sample of 102 (51 twins, 51 singletons) healthy patients without preeclampsia, gestational diabetes, intrauter- ine growth restriction, history of premature delivery or other medical comorbidities were selected from the Predictors of Preeclampsia Study to compare protein-to-creatinine ratio by fetal number. Sam- ples were collected between 34 and 38 weeks gestation, and a clinically significant high p:c ratio was defined as greater than 0.19. Non-para- metric statistical comparisons and logistic regression were used for analysis. RESULTS: Women with twin pregnancies were significantly more likely to have protein to creatinine ratios greater than 0.19 (p0.003), and median p:c ratio was significantly higher in twins (p0.003). Median p:c ratio for singletons was 0.15, and for twins 0.2. Groups differed in maternal age (mean 31.3 vs 35.3 years, p0.0003) and gestational age at sample collection (35.6 vs 34.8 weeks, p0.001), and were similar in weight, BMI, race, and smoking status. Using multiple logistic regression to control for the confounders of maternal age and gestational age yielded an adjusted OR for p:c ratio greater than 0.19 of 4.23 (1.61, 11.06). CONCLUSION: Women with uncomplicated twin pregnancies have higher rates of elevated protein to creatinine ratios than do women with singletons, suggesting that normal protein excretion in this group is greater than that in singleton gestations. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.106 92 Time of initial pregnancy loss does not predict subsequent live birth in recurrent pregnancy loss Cara Heuser 1 , Jess Dalton 2 , Cora MacPherson 3 , D. Ware Branch 2 , Robert Silver 2 1 Society for Maternal-Fetal Medicine, Salt Lake city, Utah, 2 University of Utah, Salt Lake City, Utah, 3 Social and Scientific Systems, Inc., Maryland OBJECTIVE: To evaluate gestational age of initial pregnancy loss as a predictor of subsequent live birth in a cohort of women with recurrent pregnancy loss (RPL). We hypothesized that women who suffered a fetal loss would have fewer live births and be less likely to eventually have a live birth than women who suffered anembryonic or embry- onic losses. STUDY DESIGN: Retrospective cohort study of women with idiopathic RPL who had an initial loss with precise documentation of gestational age. Live birth in a subsequent pregnancy was compared between women with anembryonic ( 6 weeks), embryonic (6-10 weeks), or fetal (10 weeks) losses as their first loss. RESULTS: 454 women met inclusion criteria and had a total of 1,262 subsequent pregnancies. There was no significant difference in num- ber of subsequent pregnancies, number of live births, or percentage of women ultimately experiencing a live birth in any subsequent preg- nancy (Table). CONCLUSION: Timing of first pregnancy loss in patients with RPL is not predictive of number of subsequent pregnancies, number of live births, or number of women ultimately experiencing a live birth. Re- gardless of the timing of initial loss, patients had a 50% chance of ultimately having a live birth. Table Initial Loss n Number of subsequent pregnancies Mean (SD) Number of live births Mean (SD) Number of women experiencing a live birth in any subsequent pregnancy n (%) Anembryonic 149 3.5 (1.9) 0.8 (0.9) 78 (52.4) .......................................................................................................................................................................................... Embryonic 185 3.1 (1.9) 0.8 (0.9) 97 (52.4) .......................................................................................................................................................................................... Fetal 120 3.7 (2.6) 1.0 (1.2) 66 (55.0) .......................................................................................................................................................................................... p-value 0.12 0.37 0.89 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.107 Poster Session I Clinical Obstetrics, Neonatology, Physiology-Endocrinology www.AJOG.org S50 American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
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Transcript of 91: Proteinuria in the uncomplicated twin pregnancy
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Poster Session I Clinical Obstetrics, Neonatology, Physiology-Endocrinology www.AJOG.org
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90 Impact of birthweight discordance and of non-vertexresentation of the second twin on successfulaginal birth – The Esprit Trialionnuala M Breathnach1, Stephen Carroll2, FionnualacAuliffe3, Michael Geary4, Sean Daly5, John R Higgins6,
ames Dornan7, John Morrison8, Gerard Burke9,hane Higgins10, Fergal D. Malone1
Royal College of Surgeons in Ireland, Dublin, Ireland, 2National Maternityospital, Dublin, Ireland, 3University College Dublin, Dublin, Ireland,
Rotunda Hospital, Dublin, Ireland, 5Coombe Women and Infantsniversity Hospital, Dublin, Ireland, 6Cork University Maternityospital, Ireland, 7Royal Victoria Maternity Hospital Belfast,
reland, 8National University of Ireland, Galway, Ireland,9Mid-Western Regional Maternity Hospital, Limerick, Ireland,0Our Lady of Lourdes Hospital, Drogheda, IrelandBJECTIVE: To determine the impact of intratwin birthweight discor-ance and of non-vertex presentation of the second twin on successfulaginal delivery.TUDY DESIGN: The ESPRIT Trial is a national prospective populationtudy of 642 consecutive twin pregnancies managed and delivered at 8ertiary referral centers in one country. All pregnancies are followedsing a uniform sonographic surveillance protocol.ESULTS: Vaginal or cesarean delivery (CD) was planned for 31048%) and 332 (52%) women, respectively. Birthweight discordancef �20% was documented in 12% (37/310) of patients who under-ent a trial of labor. The sensitivity of ultrasound within 2 weeks ofelivery for detection of this degree of discordance was 86%, specific-
ty 61%. While the overall CD rate was 64% (411/642), intrapartumD was needed in 29% (90/310) of cases where vaginal delivery waslanned. Successful trial of labor did not correlate with advancingestational age (logistic regression p-value 0.2409), vertex presenta-ion of the 2nd twin (p-value 0.3252), nor with concordant size (re-ression p-value 0.2988).ONCLUSION: Neither size discordance nor non-vertex presentation ofhe 2nd twin is predictive of CD. When the larger twin is not present-ng, successful vaginal delivery can still be anticipated in most cases.
win birthweight discordance and successful trial of labor
W discordance
Vaginal deliveryof both twins(N�220)
Intrapartum CD(N � 79)
Combinedvaginal-CD(N�11) p-value
10% 55% 62% 55% -..........................................................................................................................................................................................................
10% 45% 38% 45% 0.3510..........................................................................................................................................................................................................
20% 12% 12% 9% 0.9474..........................................................................................................................................................................................................
20% (smaller twinpresenting)
6% 8% 9% 0.5797
..........................................................................................................................................................................................................
on-vertex 2nd twin 27% 33% 0% 0.3252..........................................................................................................................................................................................................
002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.105
91 Proteinuria in the uncomplicated twin pregnancyicole Smith1, Jennifer Lyons1, Thomas McElrath1
Brigham and Women’s Hospital, Boston, MassachusettsBJECTIVE: We have observed that women with twin pregnancies ap-ear to have higher rates of proteinuria without accompanying hyper-ension than do those with singletons. Protein to creatinine ratios (p:catio) in excess of 0.19 predict proteinuria greater than 300mg in a 24our collection. We compare rates of high p:c ratios in non-pre-clamptic singleton and twin pregnancies in order to better under-tand normal protein excretion in twins.TUDY DESIGN: A sequential sample of 102 (51 twins, 51 singletons)ealthy patients without preeclampsia, gestational diabetes, intrauter-
ne growth restriction, history of premature delivery or other medicalomorbidities were selected from the Predictors of Preeclampsia
tudy to compare protein-to-creatinine ratio by fetal number. Sam-50 American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2
les were collected between 34 and 38 weeks gestation, and a clinicallyignificant high p:c ratio was defined as greater than 0.19. Non-para-
etric statistical comparisons and logistic regression were used fornalysis.ESULTS: Women with twin pregnancies were significantly more
ikely to have protein to creatinine ratios greater than 0.19 (p�0.003),nd median p:c ratio was significantly higher in twins (p�0.003).edian p:c ratio for singletons was 0.15, and for twins 0.2. Groups
iffered in maternal age (mean 31.3 vs 35.3 years, p�0.0003) andestational age at sample collection (35.6 vs 34.8 weeks, p�0.001), andere similar in weight, BMI, race, and smoking status. Using multiple
ogistic regression to control for the confounders of maternal age andestational age yielded an adjusted OR for p:c ratio greater than 0.19 of.23 (1.61, 11.06).ONCLUSION: Women with uncomplicated twin pregnancies haveigher rates of elevated protein to creatinine ratios than do womenith singletons, suggesting that normal protein excretion in thisroup is greater than that in singleton gestations.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.106
92 Time of initial pregnancy loss does not predictubsequent live birth in recurrent pregnancy lossara Heuser1, Jess Dalton2, Cora MacPherson3,. Ware Branch2, Robert Silver2
Society for Maternal-Fetal Medicine, Salt Lake city, Utah, 2University oftah, Salt Lake City, Utah, 3Social and Scientific Systems, Inc., MarylandBJECTIVE: To evaluate gestational age of initial pregnancy loss as aredictor of subsequent live birth in a cohort of women with recurrentregnancy loss (RPL). We hypothesized that women who suffered a
etal loss would have fewer live births and be less likely to eventuallyave a live birth than women who suffered anembryonic or embry-nic losses.TUDY DESIGN: Retrospective cohort study of women with idiopathicPL who had an initial loss with precise documentation of gestationalge. Live birth in a subsequent pregnancy was compared betweenomen with anembryonic (� 6 weeks), embryonic (6-10 weeks), or
etal (�10 weeks) losses as their first loss.ESULTS: 454 women met inclusion criteria and had a total of 1,262ubsequent pregnancies. There was no significant difference in num-er of subsequent pregnancies, number of live births, or percentage ofomen ultimately experiencing a live birth in any subsequent preg-ancy (Table).ONCLUSION: Timing of first pregnancy loss in patients with RPL is notredictive of number of subsequent pregnancies, number of liveirths, or number of women ultimately experiencing a live birth. Re-ardless of the timing of initial loss, patients had a 50% chance ofltimately having a live birth.
able
nitial Loss n
Number ofsubsequentpregnanciesMean (SD)
Number oflive birthsMean (SD)
Number of womenexperiencing a live birthin any subsequentpregnancyn (%)
nembryonic 149 3.5 (1.9) 0.8 (0.9) 78 (52.4).........................................................................................................................................................................................
mbryonic 185 3.1 (1.9) 0.8 (0.9) 97 (52.4).........................................................................................................................................................................................
etal 120 3.7 (2.6) 1.0 (1.2) 66 (55.0).........................................................................................................................................................................................
-value 0.12 0.37 0.89.........................................................................................................................................................................................
002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.107
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