Poster Session IV

Operative Obstetrics, Clinical Obstetrics, Intrapartum, Medical-Surgical www.AJOG.org

p0.04), and a higher rate of preterm delivery at less than 37 and 34
weeks (10.9% vs. 6.9%, p<0.001, and 4.7% vs. 1.6%, p<0.001,
respectively). 3) Neonates in the HEG group were characterized by a
lower birthweight (3074456g vs. 3248543g, p<0.001), a higher
rate of birthweight<10th percentile (12.7% vs. 6.8%, P<0.001), and
a higher rate of neonatal morbidity (8.7% vs. 3.8%, p<0.001). 4)
These associations persisted after adjustment for potential confounders, and were of most notable among women with HEG who
did not receive TPN support.
CONCLUSION: HEG is an independent risk factor for preterm delivery, fetal growth restriction, and short-term neonatal morbidity.
TPN support during early pregnancy is associated with a decreased
risk for these complications.

637 How useful is the FIGO classification in intrapartum fetal

assessment?
Malin Holzmann1, Stina Wretler1, Sven Cnattingius2,
Lennart Nordstrom1
1
Department of Womens and Childrens Health, Karolinska Institutet,
Stockholm, Sweden, 2Department of Medicine, Clinical Epidemiology Unit,
Karolinska Institutet, Stockholm, Sweden

OBJECTIVE: To evaluate the capacity of the FIGO classication of

Significant linear association between the number

of IUFD and future risk for cardiovascular
morbidity

636 Hyperemesis gravidarum and pregnancy outcomeea

possible beneficial impact of total parenetral nutrition
support
Liran Hiersch1, Nir Melamed1, Yoav Peled1, Joseph Pardo1,
Arnon Wiznitzer1, Yariv Yogev1
1
Helen Schneider Hospital for Women, Obstetrics and Gynecology, Petach
Tiqva, Israel

OBJECTIVE: To assess pregnancy outcome among women with

hyperemesis gravidarum (HEG) with and without total parenteral
nutrition (TPN) support.
STUDY DESIGN: A retrospective study of all pregnant women who
were hospitalized due to HEG between 1998 and 2012. Only those
women with singleton pregnancies who subsequently delivered in
our center were included in the analysis (N599). Pregnancy
outcome was compared with a control group consisting of women
with singleton pregnancies who gave birth immediately after each of
the index HEG deliveries, matched by maternal age and parity in a
3:1 ratio (N1,797).
RESULTS: 1) Overall 946 women were admitted during the study
period with the diagnosis of HEG, of which 599 had a singleton
pregnancy and subsequently delivered in our center. Of those, 122
(20.4%) received TPN support. 2) Women in the HEG group were
characterized by a higher rate of severe preeclampsia (1.3% vs. 0.5%,

cardiotocography tracings to predict intrapartum acidemia in fetal

scalp blood.
STUDY DESIGN: Observational cohort study of consecutive fetal blood
samplings (FBS) performed between February 2009 and February
2011 at Karolinska University Hospital, Stockholm. FBS with lactate
analysis was used if the attending obstetrician found the intrapartum
CTG tracing suspicious or abnormal. Lactate concentration was
measured bedside (Lactate Pro). If concentration exceeded 4.8
mmol/L, the fetus was regarded as acidemic and termination of labor
was recommended according to established guidelines. At a later
moment a senior obstetrician (LN) visually interpreted the CTG
tracings prior to each FBS, blinded to the lactate concentration at
FBS. We documented baseline fetal heart rate, variability, duration
from most recent acceleration, types of decelerations and frequency
of contractions. We categorized the CTG patterns according to the
FIGO classication.
RESULTS: During the study period, there were 9741 deliveries and
2132 FBSs performed on 1070 laboring women. Considering the
1st FBS during each labor, 94 fetuses (8.8%) had lactate >4.8
mmol/L at FBS. As compared with the normal group, where
acidemia occurred in 3.7% of the cases, the proportions with
increased lactate concentration in the different FIGO classication
groups were: intermediary 4.8% (NS), abnormal, 11.4% (p<0.02)
and preterminal 12.9% (NS). In tables 1 and 2, values for the 1st
FBS and corresponding values for the last FBS (active pushing prior
to sampling excluded) are displayed.
CONCLUSION: In the FIGO abnormal tracing group only one in ten
cases have acidemic values indicating termination of labor and most
cases with preterminal recordings are not acidemic. As lactate is an
early marker in the hypoxic process the use of FBS with lactate analysis
is a valuable complement to CTG in clinical management to prevent
birth acidemia and minimize operative intervention. The terminology
preterminal should be changed to absence of variability.

S312 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014