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Objective The objective of the study was to examine maternal and neonatal outcomes in obese nulliparous women with an unfavorable cervix undergoing elective induction of labor compared with expectant management after 39.0 weeks. Study Design This was a retrospective analysis of a cohort of nulliparous women with a vertex singleton gestation who delivered at MedStar Washington Hospital Center from 2007 to 2012. Patients with unfavorable cervix between 38.0 and 38.9 weeks (modified Bishop 2 or greater at the time of delivery were included. Women undergoing elective induction between 39.0 and 40.9 weeks' gestation were compared with those who were expectantly managed beyond 39.0 weeks. Outcomes were analyzed using χ 2 , Student t , or Wilcoxon rank sum tests as appropriate with a significance set at P Results Sixty patients meeting inclusion criteria underwent elective induction of labor and were compared with 410 patients expectantly managed beyond 39.0 weeks. The rate of cesarean delivery was significantly higher in the electively induced group (40.0% vs 25.9%, respectively, P = .022). Other maternal outcomes, including operative vaginal delivery, rate of third- or fourth-degree lacerations, chorioamnionitis, postpartum hemorrhage, and a need for a blood transfusion were similar. The neonatal intensive care unit admission rate was higher in the electively induced group (18.3% vs 6.3%, P = .001). Birthweight, umbilical artery pH less than 7.0, and Apgar less than 7 at 5 minutes were similar. Conclusion Elective labor induction at term in obese nulliparous parturients carries an increased risk of cesarean delivery and higher neonatal intensive care unit admission rate as compared with expectant management.

Objective The objective of the study was to determine the relationships between maternal race and obstetric outcomes in twin gestations by planned mode of delivery. Study Design We performed a secondary analysis of the Consortium on Safe Labor data. Patients with twin gestations in vertex-vertex presentation greater than 32 weeks' gestational age were grouped according to race. Demographic information and neonatal and maternal outcomes were analyzed according to planned mode of delivery: elective cesarean or trial of labor (with subsequent vaginal delivery, unplanned cesarean, or combined delivery). The primary outcome was unplanned cesarean. Secondary outcomes included maternal and neonatal outcomes. Results One thousand nine vertex-vertex twin pregnancies were identified. There were no significant differences across ethnicities in the rate of unplanned cesarean delivery, which occurred in 233 of patients undergoing trial of labor (27%). Elective cesarean occurred in 151 patients (15%). African American women were less likely to have an elective cesarean compared with whites (odds ratio, 0.5; 95% confidence interval, 0.3–0.8), and Asian women were more likely to have an elective cesarean compared with whites (odds ratio, 2.0; 95% confidence interval, 1.2–3.4. Combined delivery occurred in 67 patients (8%) and did not differ among the groups. Subgroup analysis did not reveal any significant differences in neonatal outcomes. Adverse maternal outcomes were rare across ethnicities. Conclusion Unplanned cesarean delivery rates are similar in twin pregnancies, regardless of race. Maternal and neonatal outcomes in twin gestations are similar across ethnicities, regardless of mode of delivery.

Objective: To investigate feasibility of identifying the number of vessels in umbilical cord during nuchal translucency screening. Methods: We performed a prospective study in patients undergoing nuchal translucency screening at 11.0-13.9 weeks’ from 2011-2012. An oblique transverse view of fetal abdomen utilizing Doppler flow and a cross section view of free loop of umbilical cord were obtained. Maternal characteristics, technical aspects of first trimester ultrasound, and number of umbilical cord vessels identified in the second trimester were collected. McNemar’s test and kappa analysis were used to compare quantification of umbilical cord vessels in the first vs. second trimesters. Results: Total of 123 women were included. The number of umbilical cord vessels was successfully visualized in 95.9% of patients utilizing the bladder view, and 65.0% of patients on cross sectional cord views. Three-vessel cord was correctly identified in 99.2% of patients; one case was incorrectly diagnosed with a two two-vessel cord. McNemar’s test indicated that overall, first and second trimester ultrasounds have the same propensity to detect umbilical cord vessels (p=0.414), with moderate agreement (kappa=0.226). Conclusions: Identification of umbilical cord vasculature is possible in the first trimester and can be used as an adjunct to early fetal anatomy evaluation.

140 Effects of low pre-pregnancy body mass index and gestational weight gain on neonatal outcomes Milana Berguig, Julia Timofeev, Helain Landy MedStar Georgetown University Hospital, Obstetrics and Gynecology, Washington, DC, MedStar Washington Hospital Center, Obstetrics and Gynecology, Washington, DC OBJECTIVE: To evaluate the effect of low pre-pregnancy body mass index (BMI) and low gestational weight gain on neonatal outcomes as compared to parturients with normal BMI and normal or excessive weight gain. STUDY DESIGN: A retrospective review of a multicenter cohort of deidentified data in the Consortium on Safe Labor (NICHD). This database includes information on 233,844 births from 228,668 deliveries from 2002-2008. Maternal factors and neonatal outcomes were analyzed by BMI (low BMI 18.5 kg/m, normal 18.5-24.9 kg/m) and weight gain during gestation as recommended by the Institute of Medicine 2009 guidelines (normal weight gain of 28-40lbs for women with low BMI, and 25-35lbs for women with normal BMI). Chi square and Fisher’s exact tests were used for statistical analysis, with significance determined at two-tailed 0.05. RESULTS: Low pre-pregnancy BMI showed statistically significant increases in the risk of small for gestational age (SGA) infants (OR 1.96, CI 1.93 2.00), NICU admission (OR 1.24, CI 1.21 1.26), and neonatal death (OR 1.62, CI 1.47 1.79). No statistically significant differences were seen in gestational age at delivery or need for newborn resuscitation. When considering recommended weight gain, women who gained less weight ( 28 lbs for low BMI, and 25 lbs for normal BMI) had higher risks of poor pregnancy outcomes (SGA, 5-minute Apgar score 7, NICU admission, antepartum and intrapartum stillbirth (Table). CONCLUSION: Pregnancy outcomes are influenced by both pre-pregnancy BMI and weight gain during pregnancy. These findings suggest that women can minimize their risk of neonatal morbidity and mortality by optimizing their weight prior to conception and gaining the recommended weight amount throughout the pregnancy.