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Pregnancy Outcomes in Women With Primary Systemic Vasculitis [13C]

Conference Paper · May 2018

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4 authors, including:

Vanessa Nguyen Danielle Wuebbolt

Royal College of Surgeons in Ireland Royal College of Surgeons in Ireland
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Rohan D'Souza
Mount Sinai Hospital, Toronto
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 model had less positive reviews on transference to patient care, being
realistic, and instilling confidence in new skills.
CONCLUSION: Due to the small sample size of this study, the data
collected do not have the power to detect statistical significance in
differences between student reception of both models. While more
data need to be collected to determine statistical significance, this
instruction method is a promising development in medical education.
Financial Disclosure:: The authors did not report any potential conflicts of
interest.
OBSTETRICS
Anemia in Pregnancy and Risk of Blood Transfusion
[11C]
Rob Scholz, MD
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The University of Chicago, Chicago, IL
Danielle Young, MPH, Barbara Scavone, MD, Jennifer Hofer, MD,
and Maryam Siddiqui, MD
INTRODUCTION: A third of women have antepartum anemia,
potentially leading to maternal and neonatal morbidity and mortality.
Allogenic blood transfusion is often an appropriate treatment. Avail-
able evidence suggests antepartum correction may decrease post-
partum transfusion volumes. This retrospective cohort study
investigated the relationship between anemia at mid-trimester (24-28
weeks or third trimester) and estimated blood loss (EBL) and trans-
fusion at delivery.
METHODS: All deliveries between January 2014 and March 2015 at
our institution were eligible for inclusion. Exclusion criteria included
delivery ,24 weeks gestational age and unknown mid-trimester hemo-
globin. Anemia was defined as hemoglobin
RESULTS: 1071 patients were included. 473 (44.16%) were anemic at
mid-trimester and 36 (3.36%) required postpartum transfusion. Of
patients non-anemic at mid-trimester, 7% were anemic at delivery
compared to 57% of those who were anemic at mid-trimester
(p,0.001). Five (0.84%) non-anemic patients required transfusion com-
pared to 31 (6.55%) anemic patients (p5,0.001). Of transfused pa-
tients, EBL was higher in non-anemic compared to anemic patients
(mean EBL 2520.00+/-962.81ml vs. 1601.45+/-1464.38ml, p50.04).
Mean transfusion volume did not differ (not anemic 3.60+/-1.67 vs.
anemic 2.67+/-2.44, p50.011).
CONCLUSION: Patients with anemia at mid-trimester were signifi-
cantly more likely to be anemic at delivery. These patients had higher
rates of postpartum blood transfusion despite lower EBL than non-
anemic patients. The trend toward lower transfusion volume for
anemic patients suggests that these may be preventable. Treatment
of anemia at mid-trimester is essential.
Financial Disclosure:: The authors did not report any potential conflicts of
interest.
An Analysis of the Nulliparous, Term, Singleton,
Vertex Cesarean Rate in a High-Volume Community
Teaching Hospital [12C]
Tiffany Wang, MD
MedStar Georgetown University Hospital, MedStar Washington
Hospital Center, Virginia Hospital Center, Washington, DC
Tetsuya Kawakita, MD, Miguel A. Fernandez, MD, Eshetu Tefera, MS,
Stephen Fernandez, MPH, and Michael Moxley, MD
INTRODUCTION: In March 2014, the American College of Ob-
stetricians and Gynecologists (ACOG) published its Obstetric Care
Consensus guidelines on preventing the first cesarean birth. Virginia
Hospital Center (VHC) in Arlington, Virginia adopted these guidelines
to decrease its primary cesarean birth rate. The aim of the study was to
examine the effects of these initiatives on the nulliparous, term,
singleton, vertex (NTSV) cesarean birth rate at VHC.
METHODS: Interventions began in mid-2014 and included
department-wide review of the indications for scheduled and unsched-
uled primary cesarean birth. A retrospective cohort study of all
nulliparous women with singleton term pregnancies in the vertex
VOL. 131, NO. 5 (SUPPLEMENT), MAY 2018 Copyright ª by American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.
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presentation who delivered between 2014 and August 2017 was then
conducted. The NTSV cesarean birth rates were calculated across time.
Chi-square tests were used to determine whether NTSV cesarean birth
rates were statistically significant after adoption of ACOG’s Obstetric
Care Consensus guidelines.
RESULTS: There were 2,339 NTSV pregnancies in 2014, 2,090 in
2015, 1,673 in 2016, and 1,090 in 2017 (January through August).
During this time period, the NTSV cesarean birth rate significantly
decreased by 33.6% (31.8% in 2014, 27.7% in 2015, 22.0% in 2016, and
21.1% in 2017 (year to date) P,0.01).
CONCLUSION: Within two years of implementation of the guidelines
set forth by ACOG’s Obstetric Care Consensus, VHC significantly
decreased its NTSV rate to meet the HealthyPeople 2020 NSTV goal rate
of 23.9%. Further studies will examine provider and patient characteristics,
along with other quality metrics to identify factors which may have con-
tributed to the decreased NTSV cesarean birth rate.
Financial Disclosure:: The authors did not report any potential conflicts of
interest.
Pregnancy Outcomes in Women With Primary
Systemic Vasculitis [13C]
Vanessa Nguyen
Royal College of Surgeon in Ireland, Mount Sinai Hospital,
University of Toronto, Toronto, Canada
Danielle Wuebbolt, Christian Pagnoux, MD, MSc, and Rohan D’Souza, MD,
MSc, MRCOG
INTRODUCTION: This study analyzes pregnancy outcomes in
women with large, medium or small vessel vasculitis with the intent
of aiding pre-conceptional counselling and informing antepartum and
intrapartum care of these women.
METHODS: We conducted a retrospective study of women with
large-, medium- or small-vessel vasculitis and documented pregnancies
between 2001 and 2016, identified from the Special Pregnancy
Program Database at Mount Sinai Hospital, Toronto. We obtained
information from hospital records and analyzed maternal, fetal/neo-
natal and obstetric outcomes between the different vasculitides.
RESULTS: We identified 60 pregnancies in 50 women including 10
with large-vessel vasculitis (Takayasu’s arteritis), five with medium-
sized vessel vasculitis, 30 with small-vessel vasculitis (16 ANCA-
associated vasculitis, 14 with other such as IgA vasculitis), three with
central nervous system vasculitis and two with retinal vasculitis. Vas-
culitis flares occurred in women with large-vessel (3/12), small-vessel
(13/36) and retinal (2/3) vasculitis. Pregnancy complication rates were
low, with one case each of first-trimester miscarriage, congenital anom-
aly, stillbirth and gestational diabetes. Although seven (26.4%) viable
pregnancies resulted in preterm birth, the mean gestational age, regard-
less of the type of vasculitis, was over 35 weeks of gestation. Fetal
growth restriction only occurred with small-vessel vasculitis (10 new-
borns, 28.6%). Of the 44 deliveries, 22 (50%) were spontaneous vaginal
deliveries. All caesarean (18, 40.9%) and assisted vaginal (7, 15.9%)
deliveries were for obstetric indications.
CONCLUSION: With multidisciplinary management, women with
vasculitis can anticipate excellent maternal and fetal outcomes,
although they are at increased risk for late preterm birth.
Financial Disclosure:: The authors did not report any potential conflicts of
interest.
Obstetric and Delivery Characteristics Associated
with Gastroschisis [14C]
Robert Rossi, MD
Division of Maternal-Fetal Medicine, University of Cincinnati
College of Medicine, Cincinnati, OH
Emily DeFranco, DO, MS
INTRODUCTION: Gastroschisis is a congenital abdominal wall
defect associated with complications such as cesarean delivery (CD).
Previous studies have reported greater than 30% of these pregnancies
having fetal intolerance of labor (FIOL). We sought to characterize
obstetric factors associated with gastroschisis.
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