Search

OBJECTIVE: In women with a triplet pregnancy, there is debate on the preferred mode of delivery. We performed a nationwide cohort study to assess the impact of mode of delivery on perinatal outcome in women with a triplet pregnancy.METHODS: Nationwide cohort study on women with a triplet pregnancy who delivered between 26 + 0 and 40 + 0 weeks of gestation in the years 1999-2008. We compared perinatal outcomes according to the intended mode of delivery and the actual mode of delivery. Outcome measures were perinatal mortality and neonatal morbidity. Perinatal outcomes were analyzed taking into account the dependency between the children of the same triplet pregnancy ("any mortality" and "any morbidity") and were also analyzed separately per child.RESULTS: We identified 386 women with a triplet pregnancy in the study period. Mean gestational age at delivery was 33.1 weeks (SD 2.5 weeks; range 26.0-40.0 weeks). Perinatal mortality was 2.3% for women with a planned caesarean section and 2.4% in women with a planned vaginal delivery (aOR 0.37; 95% confidence interval (CI) 0.09-1.5) and neonatal morbidity was 26.0% versus 36.0%, (aOR 0.88; 95% CI 0.51-1.4) respectively. In the subgroup analyses according to gestational age and in the analysis of perinatal outcomes per child separately, there were also no large differences in perinatal outcomes. The same applied for perinatal outcomes according to the actual mode of delivery.CONCLUSION: In this large cohort study among women with a triplet pregnancy, caesarean delivery is not associated with reduced perinatal mortality and morbidity.

OBJECTIVE: To develop a multivariable prognostic model for the risk of preterm delivery in women with multiple pregnancy that includes cervical length measurement at 16 to 21 weeks' gestation and other variables.METHODS: We used data from a previous randomized trial. We assessed the association between maternal and pregnancy characteristics including cervical length measurement at 16 to 21 weeks' gestation and time to delivery using multivariable Cox regression modelling. Performance of the final model was assessed for the outcomes of preterm and very preterm delivery using calibration and discrimination measures.RESULTS: We studied 507 women, of whom 270 (53%) delivered < 37 weeks (preterm) and 66 (13%) < 32 weeks (very preterm). Women with cervical length < 30 mm delivered more often preterm (hazard ratio 1.9; 95% CI 0.7 to 4.8). Other independently contributing predictors were previous preterm delivery, monochorionicity, smoking, educational level, and triplet pregnancy. Prediction models for preterm and very preterm delivery had a c-index of 0.68 (95% CI 0.63 to 0.72) and 0.68 (95% CI 0.62 to 0.75), respectively, and showed good calibration.CONCLUSION: In women with a multiple pregnancy, the risk of preterm delivery can be assessed with a multivariable model incorporating cervical length and other predictors.

Item does not contain fulltext OBJECTIVE: The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins. STUDY DESIGN: This was a nationwide retrospective cohort study. We compared the time to delivery and perinatal mortality in trichorionic triplet pregnancies electively reduced to twins with ongoing trichorionic triplets and primary dichorionic twins. RESULTS: We identified 86 women with reduced trichorionic triplet pregnancies, 44 with ongoing trichorionic triplets, and 824 with primary twins. Reduced triplets had a median gestational age at delivery of 36.1 weeks (interquartile range [IQR], 33.3-37.5 weeks) vs 33.3 (IQR, 28.1-35.2) weeks for ongoing triplets and 37.1 (IQR, 35.3-38.1) weeks for primary twins (P < .001). The total number of surviving children in the reduced group was 155 (90%) vs 114 (86%) in the ongoing triplet group. After reduction, 75 of women (87%) had all their fetuses surviving, compared with 36 (82%) (relative risk [RR], 1.3; 95% confidence interval [CI], 0.72-2.3) for ongoing triplets and 770 (93%) (RR, 0.91; 95% CI, 0.82-1) for primary twins. There were 6 women without any surviving children (7%) after reduction vs 5 (11.4%) (RR, 0.81; 95% CI, 0.47-1.4) among women with ongoing triplets and 32 (3.9%) (RR, 1.7; 95% CI, 0.8-3.7) in women with primary twins. CONCLUSION: In women with a triplet pregnancy, fetal reduction increases gestational age at birth with 3 weeks as compared with ongoing triplets. However, there the impact on neonatal survival is limited.

We present a normotensive, pregnant woman with severe haemolytic anaemia in the third trimester of pregnancy. Owing to normal platelet count diagnoses other than HELLP syndrome were considered and investigated. The patient was treated with nitrofurantoin 3 weeks before presentation and she turned out to have a deficiency of glucose-6-phosphate dehydrogenase. After treatment with blood transfusion, vitamin B12 and folic acid the patient recovered completely. Caesarean delivery was performed because of maternal hypertension and fetal distress at 33 weeks' gestation.

Lidewij van de Mheen, Anita Ravelli, Maria van Pampus, Christianne de Groot, Eva Pajkrt, Ben Willem Mol Onze Lieve Vrouwe Gasthuis Amsterdam, Obestetrics and Gynaecology, Amterdam, Netherlands, Academic Medical Center, Medical Informatics, Amsterdam, Netherlands, Onze Lieve Vrouwe Gasthuis, Obestetrics and Gynaecology, Amsterdam, Netherlands, VU Medical Centre, Obstetrics and Gynaecology, Amsterdam, Netherlands, Academic Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands, Dutch consortium AMPHIA trial, ., ., Netherlands OBJECTIVE: Some clinicians advise prophylactic administration of antenatal steroids for fetal lung ripening in women with a triplet pregnancy, irrespective of the development of signs and symptoms that announce preterm delivery. The aim of this study was to assess the natural course of triplet pregnancies by calculating the risk of delivery in a particular time frame during gestation. STUDY DESIGN: We collected data on all triplet pregnancies in the Netherlands from 1999-2007 from the Dutch Perinatal Registration (PRN). From these data, we constructed a Kaplan Meier curve for time to delivery, and calculated the risk of delivery within two weeks for different gestational ages. RESULTS: Between 1999 and 2007, there were 575 triplet pregnancies in the Netherlands, of which 367 after artificial reproductive techniques and 208 after spontaneous conception. The mean gestational age at delivery was 32.8 weeks (SD 3.8 weeks) (figure 1), Artificially conceived triplets were on average 0.4 weeks longer pregnant (data not shown). There were 22 pregnancies (4%) that ended before 24 weeks. At a gestational age of 24 weeks, the change to deliver within the next two weeks was 2%. For 26, 28, 30 and 32 weeks these risks were 5%, 6%,13% and 31%, respectively (table 1). The probability to continue the pregnancy until a gestational age of 37 weeks was approximately 7%. CONCLUSION: Mean gestational age for triplet pregnancies in The Netherlands was 32.8 weeks. Before 32 weeks of gestation, prophylactic administration of steroids is not indicated. At a gestational age of 32 weeks, prophylactic antenatal corticosteroids could be considered in a triplet pregnancy. 506 Midtrimester Vitamin D status is not associated with spontaneous preterm birth prior to 35 weeks Luisa Wetta, Joseph Biggio, Suzanne Cliver, Adi Abramovici, Stephen Barnes, Alan Tita University of Alabama at Birmingham, Obstetrics & Gynecology, Birmingham, AL, University of Alabama at Birmingham, Department of Pharmacology and Toxicology, Birmingham, AL OBJECTIVE: Preterm birth (PTB) has been associated with deficient maternal vitamin D status in some studies. Measurement methodologies, patient populations, and seasonal variation may all affect results. We evaluated whether midtrimester serum vitamin D levels are associated with spontaneous(S) PTB prior to 35 weeks gestation. STUDY DESIGN: We conducted a nested case-control study of 100 women with SPTB prior to 35 weeks gestation (cases) and 200 healthy women who delivered at 39-40 weeks (controls). Stored remnant serum specimens from a midtrimester sample drawn between 15-21 weeks gestation for multiple marker screening were tested for total 25-hydroxy vitamin D levels (25-OH D) using a validated liquid chromatography-tandem mass spectrometry method considered the gold standard for 25-OH D quantitation. We compared mean 25-OH D levels as well as prevalence of vitamin D insufficiency (25-OH D level 30 ng/mL) and vitamin D deficiency (25-OH D 15 ng/mL). Logistic regression was used for multivariable adjustments. RESULTS: A total of 90 SPTB cases and 177 controls had remnant specimens with valid measurements. Data are provided in the Table. African Americans were more likely to be vitamin D deficient than other races (24.5% versus 3.7%, p 0.0001) as were women with specimens drawn between Oct and Apr (20.9% versus 9.2%, p 0.011). Mean midtrimester 25-OH D levels were similar between cases and controls. After adjusting for age, race, parity, weight, and season of specimen collection, neither vitamin D insufficiency (Adjusted OR: 0.8; 0.4-1.4) www.AJOG.org Doppler Assessment, Fetus, Prematurity Poster Session III