Poster Session V
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801 Effect of cesarean deliveries on the risk of hospital
admissions for small bowel obstruction
Haim Abenhaim1, Machelle Wilchesky2, Robert Platt2,
Maria Eberg2, Togas Tulandi1, Samy Suissa2, Kristian Filion2
1
Jewish General Hospital, Obstetrics, gynecology, Montreal, QC, Canada,
2
Jewish General Hospital, Centre for Clinical Epidemiology and Community
Studies, Montreal, QC, Canada
OBJECTIVE: Cesarean delivery (CD) rates have risen over the last
several decades, in large part, due to increasing safety of the pro-
cedure. Our aim was to examine the effects of CD on the risk of
small bowel obstruction (SBO).
STUDY DESIGN: We performed a population-based retrospective
cohort study using the United Kingdom Clinical Practice Research
Datalink and the Hospital Episode Statistics Databases on all women
with a first live birth and no history of SBO between 1998 and 2007,
with follow-up until 2012. Exposure was time-dependent and
defined as ever having a CD; outcome was defined as admission to
hospital for SBO. Marginal structural models were used to estimate
the effect of CD on hospital admission for SBO adjusting for time-
dependent confounders.
RESULTS: Our cohort consisted of 86,072 women, 26.3% of whom
had a first CD at cohort entry. Rates of primary CS increased during
the study period from 23.7% to 28.0%, p<0.01. There were 110
admissions for SBO observed over 523,802 person-years for an
overall incidence of 21 cases / 100,000 person-years. CD was asso-
ciated with an increased risk of admissions for SBO, OR 1.92 (1.30-
2.84). The risk of admission for SBO increased with increasing
number of CDs, OR 1.77 (1.35-2.34), with women who have had
multiple CDs being at particularly high risk, OR 3.49 (2.04-6.00).
CONCLUSION: CD is associated with an increased risk of admission to
hospital for SBO. Although this overall risk is small, its population
effect should be taken into consideration particularly given the rising
rates of CD.
802 Trends in timing of prenatal diagnosis and abortion for
fetal chromosomal abnormalities
Heather Hume1, Stephen Chasen1
1
Weill Medical College of Cornell University, New York, NY
OBJECTIVE: Major changes in risk assessment for chromosomal ab-
normalities include ACOG recommendations to offer first-trimester
risk assessment to all patients in 2007, and the availability of NIPT in
2012. Our objective was to evaluate changes in timing of prenatal
diagnosis and abortion for chromosomal abnormalities over the past
10-years.
STUDY DESIGN: We identified all singleton pregnancies with fetal
chromosomal abnormalities diagnosed from 2005-June 2014, and
included Down syndrome (DS), Trisomy 18 (T18) and Trisomy 13
(T13). Records were reviewed to determine timing of prenatal
diagnosis and abortion. The study period was divided into three
intervals to coincide with ACOG recommendations for first-
trimester screening and availability of NIPT: 2005-2006; 2007-2011;
and 2012-2014. Changes in median gestational age at diagnosis and
abortion over time were compared with Kruskal-Wallis Test. Cate-
goric variables were compared using chi-square. Continuous data are
presented as Median [Interquartile Range].
RESULTS: The 207 included cases included 136 DS (65.7%), 48 T18
(23.2%), and 23 T13 (11.1%). The median maternal age was 37 [34-
38], and did not differ over the three study periods. 194 women
(93.7%) chose to undergo abortion. The median gestational ages at
prenatal diagnosis and abortion for T18 or T13 were 12 weeks [12-
13] and 13 weeks [12-15.5] and did not change over the study
period. In contrast, gestational age at prenatal diagnosis and abor-
tion both decreased significantly for DS over time, while the rate of
prenatal diagnosis with CVS increased significantly (Table 1). During
the most recent study period (2012-2014), first-trimester NIPT was
the initial screen for chromosomal abnormalities in 26% of cases.
S388 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015
ajog.
CONCLUSION: Since 2005, the gestational ages at prenatal diagnsois
and abortion for Down syndrome have declined significantly, with
most diagnoses achieved with CVS in recent years. These changes are
likely attributable to the availability of first-trimester risk assessment
and NIPT leading to higher rates of CVS.
Prenatal diagnosis of down syndrome from 2005-
2014
CVS ¼ Chorionic Villus Sampling.
803 Withdrawn
804 When should postterm pregnancies be induced?
Comparison between two induction protocols: at 41 and at 42
weeks of gestation
Inna Bleicher1, Ron Gonen1
1
Bnai Zion Medical Center, Faculty of Medicine, Technion - Israel Institute of
Technology, Obstetrics and Gynecology, Haifa, Israel
OBJECTIVE: To compare the rate of cesarean deliveries (CD), maternal
complications and fetal morbidity and mortality between two in-
duction of labor protocols: at or shortly after 42 completed gesta-
tional weeks (“42 protocol”) or at or shortly after 41 completed
gestational weeks (“41 protocol”).
STUDY DESIGN: On January 2012, the management of postterm
pregnancies was changed in our department from “42 protocol” to
“41 protocol”. This is a retrospective analysis of data from a two years
period of each protocol. We collected data on the rate of inductions,
the mode of delivery, maternal and neonatal complications. Only
singleton gestations without contraindication for vaginal delivery
and without medical or other obstetrical indication for induction of
labor were included. Data were analyzed by intention to treat.
RESULTS: A total of 1935 women were included in the study, 967 in the
“42 protocol” and 968 in the “41 protocol”. Compared with the “42
protocol” during the “41 protocol” the induction rate was higher - 60.5%
vs 39.5% (p<0.0001), the rate of CD was lower 15.2% vs 19.5%
(p<0.0135) and neonatal readmission within 30 days was lower - 2.4% vs
4.2% (p¼0.043). There was no statistically significant differences in early
neonatal outcome parameters - admission to NICU, 5 minutes Apgar <7,
jaundice, polycythemia, hypoglycemia and meconium aspiration syn-
drome. Likewise, no significant differences were observed in maternal
outcomes - perineal tears, episiotomy and length of hospitalization. There
was only one case of fetal death at 41+4 weeks during the “42 protocol”.
CONCLUSION: As induction of labor at or shortly after 41 gestational
weeks prevents further fetal deaths with concomitant reduction in
the rate of CD and without any adverse maternal or neonatal out-
comes, such a policy seems to be superior to induction at or shortly
after 42 weeks of gestation.
805 Randomized, double-blinded trial of magnesium sulfate
tocolysis vs intravenous normal saline for nonsevere
placental abruption
Iris Colon1, Monica Berletti1, Matthew Garabedian1,
Nicole Wilcox1, Kristin Williams2, Jane Chueh2, Yasser El-Sayed2
1
Santa Clara Valley Medical Center, Obstetrics and Gynecology, San Jose, CA,
2
Stanford University, Obstetrics and Gynecology, Stanford, CA
OBJECTIVE: The purpose of this study was to evaluate the efficacy and
safety of intravenous magnesium sulfate in the resolution of vaginal
bleeding and contractions in nonsevere placental abruption.
STUDY DESIGN: Thirty women between 24-34 weeks of gestation
presenting with vaginal bleeding and uterine contractions and