ajog.
org
predict hemorrhage outcomes and need for transfusion (p<0.0001,
Figure 1).
CONCLUSION: Different risk factors exist predisposing women to non-
severe and severe PPH among this large cohort who required ce-
sarean section. Using our data, we were able to create a risk calcu-
lator for a prediction model of postpartum hemorrhage requiring a
blood transfusion.
717 Vasa previa and extreme prematurity
Amanda Yeaton-Massey, Anna I. Girsen, Jonathan Mayo,
Yair J. Blumenfeld, Yasser Y. El-Sayed, Gary M. Shaw, March of
Dimes Prematurity Research Center at Stanford University School
of Medicine
Stanford University, Stanford, CA
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
Poster Session IV
OBJECTIVE: Vasa previa is associated with high rates of fetal morbidity
and mortality secondary to rupture of fetal vessels and rapid exsan-
guination. To avoid the increased risk of vessel rupture with labor,
pregnancies complicated by vasa previa are often delivered preterm.
We sought to determine the population-based risks of preterm birth
(PTB), particularly extreme and very PTB, associated with vasa previa.
STUDY DESIGN: Retrospective cohort study using maternally-linked
hospital discharge data and birth certificate records for California
singleton livebirths between 2007-2011. Births delivered by cesarean
with and without vasa previa were included for analyses. Vasa previa
was identified as maternal diagnosis ICD-9-CM code 663.5. PTB was
grouped as delivery at 24-27 (extreme PTB), 28-31 (very PTB) and 32-
36 weeks gestation (preterm). Adjusted and unadjusted odds ratios
(ORs) of PTB were estimated using logistic regression modeling.
RESULTS: Our population included a total of 799,114 cesarean de-
liveries (CD) of which 464 were complicated by vasa previa (0.06%).
Among these births, 279 (60%) of those with vasa previa were deliv-
ered <37 weeks compared with 77,934 (10%) of those without. Births
via CD with vasa previa were more likely to have PTB at <37 weeks in
both unadjusted and adjusted models (Table). Among births with CD,
odds of extreme and very PTB were substantially higher for preg-
nancies complicated by vasa previa even after controlling for co-
morbidities known to contribute to prematurity, with ORs of 3.95
(95%CI: 1.3,12.4) and 13.5 (95%CI: 8.2,22.4), respectively.
CONCLUSION: Vasa previa is a risk factor for iatrogenic prematurity
with CD recommended between 34-37 weeks. Based on our data,
most patients with vasa previa are delivered between 32-36 weeks
gestation, however, a clinically significant portion of these deliveries
are <32 weeks. These data are helpful in counseling patients
regarding the expected gestational age of delivery in pregnancies
complicated by vasa previa.
718 California births, 2009-2011: postpartum
emergency department care utilization
Priya Batra1, Moshe Fridman2, Mei Leng3, Kimberly D. Gregory4
1
University of California, Riverside, Riverside, CA, 2AMF Consulting, Los
Angeles, CA, 3University of California, Los Angeles, Los Angeles, CA,
4
Cedars-Sinai Medical Center, Los Angeles, CA
OBJECTIVE: U.S. maternal morbidity and mortality are increasing;
most maternal deaths and significant morbidity occur in the weeks
following delivery. Despite this, few studies have investigated emer-
gency department (ED) care after delivery. This study evaluated
patterns and predictors of postpartum ED utilization.
STUDY DESIGN: This retrospective cross-sectional study analyzed
linked maternal inpatient discharge and ED encounter data for all
California births from 2009-2011. The primary outcome of interest
was maternal use of ED care within 90 days of delivery discharge.
Independent variables included demographics (age, race/ethnicity,
payer, income) and clinical characteristics (antepartum complica-
tions, mode of delivery, severe maternal morbidity - SMM - at
S419