ACOG 2014

CHICAGO – Women who have multiple children early in life are at increased risk for obesity early in adulthood, according to an analysis of National Health and Nutrition Examination Survey data.

The findings, from pooled 2001-2010 NHANES data, suggest that young multiparous women are a critical target group for obesity reduction efforts, Dr. Michelle H. Moniz of the University of Michigan, Ann Arbor, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The 4,979 women included in the study were aged 20-50 years at the time they were surveyed, and had a body mass index between 16.5 and 70 kg/m². They were not currently or recently pregnant.

After adjustment for race, ethnicity, income, and NHANES study wave, multiparous women aged 20-25 years were almost twice as likely as nulligravid women in that age group to be obese (odds ratio, 1.91). No significant differences were seen for other age groups or for primiparous vs. nulligravid women in any of the age groups, Dr. Moniz found.

Although limited by an inability to account for the effect of breast-feeding due to significant missing data and restriction on sample size, as well as by factors associated with its cross-sectional design – such as an inability to determine whether childbearing occurred before the onset of obesity – the study nevertheless highlights the importance of addressing the issue of obesity in young women, according to Dr. Moniz.

"Obesity affects more than a third of women in the United States and is a profound, persistent threat to health throughout the life course," she wrote, noting that studies have shown that once obesity is established, it is difficult to reverse.

Furthermore, childbearing increases the risk of obesity in women, and may be a particularly important risk factor in young mothers due to their increased risk of poverty, lower educational attainment, and endocrine parameters associated with physiologic growth during adolescence.

"Preventing unplanned pregnancies in adolescent and young adult women may be an important strategy to help reduce obesity prevalence and duration of exposure to obesity in women," Dr. Moniz concluded

Dr. Moniz reported having no relevant financial disclosures.

CHICAGO – Women who have multiple children early in life are at increased risk for obesity early in adulthood, according to an analysis of National Health and Nutrition Examination Survey data.

The findings, from pooled 2001-2010 NHANES data, suggest that young multiparous women are a critical target group for obesity reduction efforts, Dr. Michelle H. Moniz of the University of Michigan, Ann Arbor, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The 4,979 women included in the study were aged 20-50 years at the time they were surveyed, and had a body mass index between 16.5 and 70 kg/m². They were not currently or recently pregnant.

After adjustment for race, ethnicity, income, and NHANES study wave, multiparous women aged 20-25 years were almost twice as likely as nulligravid women in that age group to be obese (odds ratio, 1.91). No significant differences were seen for other age groups or for primiparous vs. nulligravid women in any of the age groups, Dr. Moniz found.

Although limited by an inability to account for the effect of breast-feeding due to significant missing data and restriction on sample size, as well as by factors associated with its cross-sectional design – such as an inability to determine whether childbearing occurred before the onset of obesity – the study nevertheless highlights the importance of addressing the issue of obesity in young women, according to Dr. Moniz.

"Obesity affects more than a third of women in the United States and is a profound, persistent threat to health throughout the life course," she wrote, noting that studies have shown that once obesity is established, it is difficult to reverse.

Furthermore, childbearing increases the risk of obesity in women, and may be a particularly important risk factor in young mothers due to their increased risk of poverty, lower educational attainment, and endocrine parameters associated with physiologic growth during adolescence.

"Preventing unplanned pregnancies in adolescent and young adult women may be an important strategy to help reduce obesity prevalence and duration of exposure to obesity in women," Dr. Moniz concluded

Dr. Moniz reported having no relevant financial disclosures.

CHICAGO – Women who have multiple children early in life are at increased risk for obesity early in adulthood, according to an analysis of National Health and Nutrition Examination Survey data.

The findings, from pooled 2001-2010 NHANES data, suggest that young multiparous women are a critical target group for obesity reduction efforts, Dr. Michelle H. Moniz of the University of Michigan, Ann Arbor, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The 4,979 women included in the study were aged 20-50 years at the time they were surveyed, and had a body mass index between 16.5 and 70 kg/m². They were not currently or recently pregnant.

After adjustment for race, ethnicity, income, and NHANES study wave, multiparous women aged 20-25 years were almost twice as likely as nulligravid women in that age group to be obese (odds ratio, 1.91). No significant differences were seen for other age groups or for primiparous vs. nulligravid women in any of the age groups, Dr. Moniz found.

Although limited by an inability to account for the effect of breast-feeding due to significant missing data and restriction on sample size, as well as by factors associated with its cross-sectional design – such as an inability to determine whether childbearing occurred before the onset of obesity – the study nevertheless highlights the importance of addressing the issue of obesity in young women, according to Dr. Moniz.

"Obesity affects more than a third of women in the United States and is a profound, persistent threat to health throughout the life course," she wrote, noting that studies have shown that once obesity is established, it is difficult to reverse.

Furthermore, childbearing increases the risk of obesity in women, and may be a particularly important risk factor in young mothers due to their increased risk of poverty, lower educational attainment, and endocrine parameters associated with physiologic growth during adolescence.

"Preventing unplanned pregnancies in adolescent and young adult women may be an important strategy to help reduce obesity prevalence and duration of exposure to obesity in women," Dr. Moniz concluded

Dr. Moniz reported having no relevant financial disclosures.

CHICAGO – Same-day intrauterine device placement is safe and effective, and should be considered for women seeking contraception, according to findings from two separate studies.

In one study, 272 women aged 15-44 years who visited an inner-city clinic for pregnancy testing or emergency contraception between Aug. 22, 2011, and May 30, 2013, were offered same-day copper IUD placement if they did not report unprotected intercourse within 8-14 days prior to the visit, and if they had no evidence of cervicitis on examination.

At 3 months’ follow-up, the rate of pelvic inflammatory disease (PID) was not significantly higher in 28 women who received the same-day IUD placement than in 17 who received an IUD within 3 months, Nan A. Wang of the University of Pittsburgh Medical Center reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Based on a chart review, 6.1% of those with same-day IUD placement and none of those with later placement reported a PID diagnosis, and 12.1% vs. 0% reported an STI diagnosis. Electronic medical record data showed that 6.5% of patients with same-day placement and 5.0% of patients without same-day placement had a PID diagnosis, and 48.4% and 37.5%, respectively, had pelvic pain.

Survey data at the initial visit and at 3 months’ follow-up showed that 50% vs. 43.8% of patients in the groups, respectively, had pelvic pain, and 57.1% and 52.9% were using condoms.

Furthermore, 88% of those who received same-day IUD placement reported ongoing IUD use at 3 months, and only 3% reported unintended pregnancy at 3 months, compared with 15% of patients who received ulipristal acetate pills and 9% who received levonorgestrel pills, Ms. Wang noted.

"Same-day IUD placement was not associated with higher rates of PID within 3 months, compared to women who did not receive same-day IUD placement," Ms. Wang wrote, adding that the absolute risk of PID following IUD placement in women who reported recent unprotected sex was less than 4%.

Same-day placement also did not reduce condom use, compared with other prescription contraceptives, and although pelvic pain was more common in those with same-day placement, it is not always a sign of infection, she wrote, concluding that concern for asymptomatic STI should not delay IUD placement, even among high-risk women.

In a separate study, Dr. Margaret Markham also found evidence favoring same-day IUD placement.

In 720 patients who presented for IUD placement and who were subject to a "two-visit protocol" for IUD insertion, with testing for gonorrhea and chlamydia at the first visit, the incidence of gonorrhea was 0.56% and the incidence of chlamydia was 2.5%, but only 69.74% of patients returned for the second visit for IUD placement, according to a chart review.

Those who tested positive for gonorrhea or chlamydia were less likely to return (odds ratio, 4.68), and the rate of pregnancy was significantly higher in those who did not return (32.4% vs. 1.9%), Dr. Markham of Baylor College of Medicine, Houston, reported in a poster at the meeting.

Women included in the study were predominantly Hispanic, multiparous, and married, with a low historical rate of STIs. The rate of follow-up for IUD placement was consistent with rates of 30%-71% reported in prior studies involving a two-visit protocol.

"Current ‘two-visit’ protocols should be amended to allow for immediate placement of IUDs in similar populations to prevent delay in contraceptive service and unintended pregnancy," Dr. Markham concluded.

Ms. Wang and Dr. Markham reported having no disclosures.

CHICAGO – Same-day intrauterine device placement is safe and effective, and should be considered for women seeking contraception, according to findings from two separate studies.

In one study, 272 women aged 15-44 years who visited an inner-city clinic for pregnancy testing or emergency contraception between Aug. 22, 2011, and May 30, 2013, were offered same-day copper IUD placement if they did not report unprotected intercourse within 8-14 days prior to the visit, and if they had no evidence of cervicitis on examination.

At 3 months’ follow-up, the rate of pelvic inflammatory disease (PID) was not significantly higher in 28 women who received the same-day IUD placement than in 17 who received an IUD within 3 months, Nan A. Wang of the University of Pittsburgh Medical Center reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Based on a chart review, 6.1% of those with same-day IUD placement and none of those with later placement reported a PID diagnosis, and 12.1% vs. 0% reported an STI diagnosis. Electronic medical record data showed that 6.5% of patients with same-day placement and 5.0% of patients without same-day placement had a PID diagnosis, and 48.4% and 37.5%, respectively, had pelvic pain.

Survey data at the initial visit and at 3 months’ follow-up showed that 50% vs. 43.8% of patients in the groups, respectively, had pelvic pain, and 57.1% and 52.9% were using condoms.

Furthermore, 88% of those who received same-day IUD placement reported ongoing IUD use at 3 months, and only 3% reported unintended pregnancy at 3 months, compared with 15% of patients who received ulipristal acetate pills and 9% who received levonorgestrel pills, Ms. Wang noted.

"Same-day IUD placement was not associated with higher rates of PID within 3 months, compared to women who did not receive same-day IUD placement," Ms. Wang wrote, adding that the absolute risk of PID following IUD placement in women who reported recent unprotected sex was less than 4%.

Same-day placement also did not reduce condom use, compared with other prescription contraceptives, and although pelvic pain was more common in those with same-day placement, it is not always a sign of infection, she wrote, concluding that concern for asymptomatic STI should not delay IUD placement, even among high-risk women.

In a separate study, Dr. Margaret Markham also found evidence favoring same-day IUD placement.

In 720 patients who presented for IUD placement and who were subject to a "two-visit protocol" for IUD insertion, with testing for gonorrhea and chlamydia at the first visit, the incidence of gonorrhea was 0.56% and the incidence of chlamydia was 2.5%, but only 69.74% of patients returned for the second visit for IUD placement, according to a chart review.

Those who tested positive for gonorrhea or chlamydia were less likely to return (odds ratio, 4.68), and the rate of pregnancy was significantly higher in those who did not return (32.4% vs. 1.9%), Dr. Markham of Baylor College of Medicine, Houston, reported in a poster at the meeting.

Women included in the study were predominantly Hispanic, multiparous, and married, with a low historical rate of STIs. The rate of follow-up for IUD placement was consistent with rates of 30%-71% reported in prior studies involving a two-visit protocol.

"Current ‘two-visit’ protocols should be amended to allow for immediate placement of IUDs in similar populations to prevent delay in contraceptive service and unintended pregnancy," Dr. Markham concluded.

Ms. Wang and Dr. Markham reported having no disclosures.

CHICAGO – Same-day intrauterine device placement is safe and effective, and should be considered for women seeking contraception, according to findings from two separate studies.

In one study, 272 women aged 15-44 years who visited an inner-city clinic for pregnancy testing or emergency contraception between Aug. 22, 2011, and May 30, 2013, were offered same-day copper IUD placement if they did not report unprotected intercourse within 8-14 days prior to the visit, and if they had no evidence of cervicitis on examination.

At 3 months’ follow-up, the rate of pelvic inflammatory disease (PID) was not significantly higher in 28 women who received the same-day IUD placement than in 17 who received an IUD within 3 months, Nan A. Wang of the University of Pittsburgh Medical Center reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Based on a chart review, 6.1% of those with same-day IUD placement and none of those with later placement reported a PID diagnosis, and 12.1% vs. 0% reported an STI diagnosis. Electronic medical record data showed that 6.5% of patients with same-day placement and 5.0% of patients without same-day placement had a PID diagnosis, and 48.4% and 37.5%, respectively, had pelvic pain.

Survey data at the initial visit and at 3 months’ follow-up showed that 50% vs. 43.8% of patients in the groups, respectively, had pelvic pain, and 57.1% and 52.9% were using condoms.

Furthermore, 88% of those who received same-day IUD placement reported ongoing IUD use at 3 months, and only 3% reported unintended pregnancy at 3 months, compared with 15% of patients who received ulipristal acetate pills and 9% who received levonorgestrel pills, Ms. Wang noted.

"Same-day IUD placement was not associated with higher rates of PID within 3 months, compared to women who did not receive same-day IUD placement," Ms. Wang wrote, adding that the absolute risk of PID following IUD placement in women who reported recent unprotected sex was less than 4%.

Same-day placement also did not reduce condom use, compared with other prescription contraceptives, and although pelvic pain was more common in those with same-day placement, it is not always a sign of infection, she wrote, concluding that concern for asymptomatic STI should not delay IUD placement, even among high-risk women.

In a separate study, Dr. Margaret Markham also found evidence favoring same-day IUD placement.

In 720 patients who presented for IUD placement and who were subject to a "two-visit protocol" for IUD insertion, with testing for gonorrhea and chlamydia at the first visit, the incidence of gonorrhea was 0.56% and the incidence of chlamydia was 2.5%, but only 69.74% of patients returned for the second visit for IUD placement, according to a chart review.

Those who tested positive for gonorrhea or chlamydia were less likely to return (odds ratio, 4.68), and the rate of pregnancy was significantly higher in those who did not return (32.4% vs. 1.9%), Dr. Markham of Baylor College of Medicine, Houston, reported in a poster at the meeting.

Women included in the study were predominantly Hispanic, multiparous, and married, with a low historical rate of STIs. The rate of follow-up for IUD placement was consistent with rates of 30%-71% reported in prior studies involving a two-visit protocol.

"Current ‘two-visit’ protocols should be amended to allow for immediate placement of IUDs in similar populations to prevent delay in contraceptive service and unintended pregnancy," Dr. Markham concluded.

Ms. Wang and Dr. Markham reported having no disclosures.

CHICAGO – The rate of total abdominal hysterectomy increased, and the rates of total vaginal hysterectomy and laparoscopic-assisted vaginal hysterectomy decreased in tandem with increasing body mass index among women included in the American College of Surgeons–National Surgical Quality Improvement Program database.

Of 18,810 women included in the database, 9,852 (52.38%) had total abdominal hysterectomy (TAH), 5,146 (27.36%) underwent total vaginal hysterectomy (TVH), 2,296 (12.21%) underwent laparoscopic-assisted vaginal hysterectomy (LAVH), and 1,516 (8.06%) had total laparoscopic hysterectomy (TLH).

The increases in TAH, and the decreases in TVH and LAVH, were statistically significant across four BMI categories (less than 25 kg/m², 24 to less than 30, 30 to less than 40, and 40 or greater); TLH rates did not change significantly based on BMI, Dr. Emad Mikhail of the University of South Florida, Tampa, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists

Operative time also increased in tandem with BMI. For example, operative times in the four BMI groups, respectively, were 90, 96, 106, and 125 minutes for TAH; 78, 87, 87, and 88.5 minutes for TVH; 103, 109, 117, and 136 minutes for LAVH; and 122, 135, 130, and 153 minutes for TLH.

Wound infection rates in the TAH group, but not in the other groups, also increased with increasing BMI, with 4, 6, 26, and 35 infections occurring in the groups, respectively, Dr. Mikhail noted.

Patients included in the database were women who underwent hysterectomy for benign indications between 2005 and 2011. The study was undertaken to determine whether obesity has any association with the recent trends with respect to routes chosen for hysterectomy for benign indications.

Obese patients are expected to benefit from minimally invasive procedures, including vaginal and laparoscopic hysterectomy, but these results suggest that obesity increases the likelihood of TAH, which increases morbidity, Dr. Mikhail concluded. Future studies should evaluate the effects of implementation of robotic-assisted TLH on these trends, especially for morbidly obese women, he added.

Dr. Mikhail reported having no relevant financial disclosures.

CHICAGO – The rate of total abdominal hysterectomy increased, and the rates of total vaginal hysterectomy and laparoscopic-assisted vaginal hysterectomy decreased in tandem with increasing body mass index among women included in the American College of Surgeons–National Surgical Quality Improvement Program database.

Of 18,810 women included in the database, 9,852 (52.38%) had total abdominal hysterectomy (TAH), 5,146 (27.36%) underwent total vaginal hysterectomy (TVH), 2,296 (12.21%) underwent laparoscopic-assisted vaginal hysterectomy (LAVH), and 1,516 (8.06%) had total laparoscopic hysterectomy (TLH).

The increases in TAH, and the decreases in TVH and LAVH, were statistically significant across four BMI categories (less than 25 kg/m², 24 to less than 30, 30 to less than 40, and 40 or greater); TLH rates did not change significantly based on BMI, Dr. Emad Mikhail of the University of South Florida, Tampa, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists

Operative time also increased in tandem with BMI. For example, operative times in the four BMI groups, respectively, were 90, 96, 106, and 125 minutes for TAH; 78, 87, 87, and 88.5 minutes for TVH; 103, 109, 117, and 136 minutes for LAVH; and 122, 135, 130, and 153 minutes for TLH.

Wound infection rates in the TAH group, but not in the other groups, also increased with increasing BMI, with 4, 6, 26, and 35 infections occurring in the groups, respectively, Dr. Mikhail noted.

Patients included in the database were women who underwent hysterectomy for benign indications between 2005 and 2011. The study was undertaken to determine whether obesity has any association with the recent trends with respect to routes chosen for hysterectomy for benign indications.

Obese patients are expected to benefit from minimally invasive procedures, including vaginal and laparoscopic hysterectomy, but these results suggest that obesity increases the likelihood of TAH, which increases morbidity, Dr. Mikhail concluded. Future studies should evaluate the effects of implementation of robotic-assisted TLH on these trends, especially for morbidly obese women, he added.

Dr. Mikhail reported having no relevant financial disclosures.

CHICAGO – The rate of total abdominal hysterectomy increased, and the rates of total vaginal hysterectomy and laparoscopic-assisted vaginal hysterectomy decreased in tandem with increasing body mass index among women included in the American College of Surgeons–National Surgical Quality Improvement Program database.

Of 18,810 women included in the database, 9,852 (52.38%) had total abdominal hysterectomy (TAH), 5,146 (27.36%) underwent total vaginal hysterectomy (TVH), 2,296 (12.21%) underwent laparoscopic-assisted vaginal hysterectomy (LAVH), and 1,516 (8.06%) had total laparoscopic hysterectomy (TLH).

The increases in TAH, and the decreases in TVH and LAVH, were statistically significant across four BMI categories (less than 25 kg/m², 24 to less than 30, 30 to less than 40, and 40 or greater); TLH rates did not change significantly based on BMI, Dr. Emad Mikhail of the University of South Florida, Tampa, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists

Operative time also increased in tandem with BMI. For example, operative times in the four BMI groups, respectively, were 90, 96, 106, and 125 minutes for TAH; 78, 87, 87, and 88.5 minutes for TVH; 103, 109, 117, and 136 minutes for LAVH; and 122, 135, 130, and 153 minutes for TLH.

Wound infection rates in the TAH group, but not in the other groups, also increased with increasing BMI, with 4, 6, 26, and 35 infections occurring in the groups, respectively, Dr. Mikhail noted.

Patients included in the database were women who underwent hysterectomy for benign indications between 2005 and 2011. The study was undertaken to determine whether obesity has any association with the recent trends with respect to routes chosen for hysterectomy for benign indications.

Obese patients are expected to benefit from minimally invasive procedures, including vaginal and laparoscopic hysterectomy, but these results suggest that obesity increases the likelihood of TAH, which increases morbidity, Dr. Mikhail concluded. Future studies should evaluate the effects of implementation of robotic-assisted TLH on these trends, especially for morbidly obese women, he added.

Dr. Mikhail reported having no relevant financial disclosures.

CHICAGO – Obesity was not associated with an increase in the risk of preterm birth among women with cerclage in a retrospective cohort study.

The rate of preterm births before 34 weeks’ gestation was similar in 103 nonobese women with cerclage and 93 obese women with cerclage (37.9% and 31.2%, respectively; odds ratio, 1.35) in a 2009-2011 study of patients, Dr. Lorene A. Temming and her colleagues reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In fact, there were no differences in the rate of preterm births between the two groups at any of the other time points evaluated, including 24, 28, 32, and 37 weeks’ gestation, and there also was no difference in the rate of term births between the groups, according to Dr. Temming of Carolinas Medical Center, Charlotte, N.C., and her associates.

The nonobese patients had a body mass index less than 30 kg/m², and the obese patients had a BMI of 30 or greater. The women all had singleton gestation, she noted.

The results of prior studies that investigated the effect of obesity on cerclage efficacy have conflicted. A secondary analysis of a large randomized trial of cerclage for short cervix showed no effect of obesity, but a smaller study showed that obesity was associated with increased risk of preterm birth prior to 35 weeks.

"Obesity increases risks of preeclampsia, gestational diabetes, and cesarean delivery, and is associated with increased operative morbidity with cesarean delivery. The role of obesity in preterm birth is less clear," Dr. Temming and her associates wrote.

Furthermore, although cerclage has been shown in multiple randomized, controlled trials and in a recent meta-analysis to reduce preterm birth in women with short cervical length, the effect of obesity on the efficacy of cerclage has also been unclear, they noted.

The current findings, which are derived from the second-largest data set available in the literature (although Dr. Temming listed sample size as a limiting factor in the study), are consistent with those from the larger of two prior studies, and suggest that obesity does not worsen outcomes in the setting of cerclage, she and her coauthors concluded.

Dr. Temming reported having no relevant financial disclosures.

CHICAGO – Obesity was not associated with an increase in the risk of preterm birth among women with cerclage in a retrospective cohort study.

The rate of preterm births before 34 weeks’ gestation was similar in 103 nonobese women with cerclage and 93 obese women with cerclage (37.9% and 31.2%, respectively; odds ratio, 1.35) in a 2009-2011 study of patients, Dr. Lorene A. Temming and her colleagues reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In fact, there were no differences in the rate of preterm births between the two groups at any of the other time points evaluated, including 24, 28, 32, and 37 weeks’ gestation, and there also was no difference in the rate of term births between the groups, according to Dr. Temming of Carolinas Medical Center, Charlotte, N.C., and her associates.

The nonobese patients had a body mass index less than 30 kg/m², and the obese patients had a BMI of 30 or greater. The women all had singleton gestation, she noted.

The results of prior studies that investigated the effect of obesity on cerclage efficacy have conflicted. A secondary analysis of a large randomized trial of cerclage for short cervix showed no effect of obesity, but a smaller study showed that obesity was associated with increased risk of preterm birth prior to 35 weeks.

"Obesity increases risks of preeclampsia, gestational diabetes, and cesarean delivery, and is associated with increased operative morbidity with cesarean delivery. The role of obesity in preterm birth is less clear," Dr. Temming and her associates wrote.

Furthermore, although cerclage has been shown in multiple randomized, controlled trials and in a recent meta-analysis to reduce preterm birth in women with short cervical length, the effect of obesity on the efficacy of cerclage has also been unclear, they noted.

The current findings, which are derived from the second-largest data set available in the literature (although Dr. Temming listed sample size as a limiting factor in the study), are consistent with those from the larger of two prior studies, and suggest that obesity does not worsen outcomes in the setting of cerclage, she and her coauthors concluded.

Dr. Temming reported having no relevant financial disclosures.

CHICAGO – Obesity was not associated with an increase in the risk of preterm birth among women with cerclage in a retrospective cohort study.

The rate of preterm births before 34 weeks’ gestation was similar in 103 nonobese women with cerclage and 93 obese women with cerclage (37.9% and 31.2%, respectively; odds ratio, 1.35) in a 2009-2011 study of patients, Dr. Lorene A. Temming and her colleagues reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In fact, there were no differences in the rate of preterm births between the two groups at any of the other time points evaluated, including 24, 28, 32, and 37 weeks’ gestation, and there also was no difference in the rate of term births between the groups, according to Dr. Temming of Carolinas Medical Center, Charlotte, N.C., and her associates.

The nonobese patients had a body mass index less than 30 kg/m², and the obese patients had a BMI of 30 or greater. The women all had singleton gestation, she noted.

The results of prior studies that investigated the effect of obesity on cerclage efficacy have conflicted. A secondary analysis of a large randomized trial of cerclage for short cervix showed no effect of obesity, but a smaller study showed that obesity was associated with increased risk of preterm birth prior to 35 weeks.

"Obesity increases risks of preeclampsia, gestational diabetes, and cesarean delivery, and is associated with increased operative morbidity with cesarean delivery. The role of obesity in preterm birth is less clear," Dr. Temming and her associates wrote.

Furthermore, although cerclage has been shown in multiple randomized, controlled trials and in a recent meta-analysis to reduce preterm birth in women with short cervical length, the effect of obesity on the efficacy of cerclage has also been unclear, they noted.

The current findings, which are derived from the second-largest data set available in the literature (although Dr. Temming listed sample size as a limiting factor in the study), are consistent with those from the larger of two prior studies, and suggest that obesity does not worsen outcomes in the setting of cerclage, she and her coauthors concluded.

Dr. Temming reported having no relevant financial disclosures.

CHICAGO – Many women who undergo a loop electrosurgical excision procedure for advanced cervical dysplasia are not screened for HIV and other sexually transmitted diseases, according to findings from a records review.

"While younger women were more likely to have been screened for HIV and other STIs than older women in this cohort, all women presenting for LEEP should be counseled and offered screening if indicated," investigators reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists. Ob.gyn. providers should not assume that screening is routinely offered in the primary care setting, they added.

Of 95 women who underwent LEEP at a large, urban university clinic between January 2010 and December 2012, 52 (55%) had no screening for HIV, syphilis, chlamydia, or gonorrhea within 12 months of the procedure or between their most recent Pap smear and the LEEP procedure, and 43 had at least one STI screening, Nicholas O. Jeffrey, a medical student at Florida State University, Tallahassee, and his associates reported.

Older women were less likely than younger women in this cohort to be screened; the mean age of women with no documented STI or HIV screening test was 43 years, compared with 33 years among those who were screened, Mr. Jeffrey found.

Those with no testing had at least two visits within the year prior to their LEEP procedure, they noted.

"Ob.gyn. providers have a unique opportunity to recommend and offer HIV and STI screening to women seeking treatment for abnormal cervical cytology, because these women often have more than one [gynecologic] visit during treatment," they wrote.

Based on these findings, the opportunity is often missed.

HIV and STI screening are important public health interventions because the incidence of HIV and STIs continues to rise, particularly among minority women in urban areas. In fact, the U.S. Preventive Services Task Force recommends HIV screening for those who have not been tested or who are at increased risk of HIV or other STIs.

Most invasive and preinvasive lesions of the cervix and vagina are caused by human papillomavirus types 16 and 18, and because HPV is transmitted through sexual contact, screening for other STIs is warranted in women who present with HPV infection.

Furthermore, having an STI increases the risk of acquiring HIV infection, Mr. Jeffrey and his colleagues noted, adding that as detection of HPV-related diseases advances, the number of women accessing the health care system for treatment will likely increase.

Mr. Jeffrey reported having no disclosures.

CHICAGO – Many women who undergo a loop electrosurgical excision procedure for advanced cervical dysplasia are not screened for HIV and other sexually transmitted diseases, according to findings from a records review.

"While younger women were more likely to have been screened for HIV and other STIs than older women in this cohort, all women presenting for LEEP should be counseled and offered screening if indicated," investigators reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists. Ob.gyn. providers should not assume that screening is routinely offered in the primary care setting, they added.

Of 95 women who underwent LEEP at a large, urban university clinic between January 2010 and December 2012, 52 (55%) had no screening for HIV, syphilis, chlamydia, or gonorrhea within 12 months of the procedure or between their most recent Pap smear and the LEEP procedure, and 43 had at least one STI screening, Nicholas O. Jeffrey, a medical student at Florida State University, Tallahassee, and his associates reported.

Older women were less likely than younger women in this cohort to be screened; the mean age of women with no documented STI or HIV screening test was 43 years, compared with 33 years among those who were screened, Mr. Jeffrey found.

Those with no testing had at least two visits within the year prior to their LEEP procedure, they noted.

"Ob.gyn. providers have a unique opportunity to recommend and offer HIV and STI screening to women seeking treatment for abnormal cervical cytology, because these women often have more than one [gynecologic] visit during treatment," they wrote.

Based on these findings, the opportunity is often missed.

HIV and STI screening are important public health interventions because the incidence of HIV and STIs continues to rise, particularly among minority women in urban areas. In fact, the U.S. Preventive Services Task Force recommends HIV screening for those who have not been tested or who are at increased risk of HIV or other STIs.

Most invasive and preinvasive lesions of the cervix and vagina are caused by human papillomavirus types 16 and 18, and because HPV is transmitted through sexual contact, screening for other STIs is warranted in women who present with HPV infection.

Furthermore, having an STI increases the risk of acquiring HIV infection, Mr. Jeffrey and his colleagues noted, adding that as detection of HPV-related diseases advances, the number of women accessing the health care system for treatment will likely increase.

Mr. Jeffrey reported having no disclosures.

CHICAGO – Many women who undergo a loop electrosurgical excision procedure for advanced cervical dysplasia are not screened for HIV and other sexually transmitted diseases, according to findings from a records review.

"While younger women were more likely to have been screened for HIV and other STIs than older women in this cohort, all women presenting for LEEP should be counseled and offered screening if indicated," investigators reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists. Ob.gyn. providers should not assume that screening is routinely offered in the primary care setting, they added.

Of 95 women who underwent LEEP at a large, urban university clinic between January 2010 and December 2012, 52 (55%) had no screening for HIV, syphilis, chlamydia, or gonorrhea within 12 months of the procedure or between their most recent Pap smear and the LEEP procedure, and 43 had at least one STI screening, Nicholas O. Jeffrey, a medical student at Florida State University, Tallahassee, and his associates reported.

Older women were less likely than younger women in this cohort to be screened; the mean age of women with no documented STI or HIV screening test was 43 years, compared with 33 years among those who were screened, Mr. Jeffrey found.

Those with no testing had at least two visits within the year prior to their LEEP procedure, they noted.

"Ob.gyn. providers have a unique opportunity to recommend and offer HIV and STI screening to women seeking treatment for abnormal cervical cytology, because these women often have more than one [gynecologic] visit during treatment," they wrote.

Based on these findings, the opportunity is often missed.

HIV and STI screening are important public health interventions because the incidence of HIV and STIs continues to rise, particularly among minority women in urban areas. In fact, the U.S. Preventive Services Task Force recommends HIV screening for those who have not been tested or who are at increased risk of HIV or other STIs.

Most invasive and preinvasive lesions of the cervix and vagina are caused by human papillomavirus types 16 and 18, and because HPV is transmitted through sexual contact, screening for other STIs is warranted in women who present with HPV infection.

Furthermore, having an STI increases the risk of acquiring HIV infection, Mr. Jeffrey and his colleagues noted, adding that as detection of HPV-related diseases advances, the number of women accessing the health care system for treatment will likely increase.

Mr. Jeffrey reported having no disclosures.

CHICAGO – Induction of labor is reasonable in cases involving fetal growth restriction, as most patients who are induced deliver vaginally rather than by cesarean section, according to findings from a retrospective cohort study.

Of 134 patients who underwent induction of labor for fetal growth restriction (FGR), 81% delivered vaginally, Dr. Kari Horowitz reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In those who delivered by C-section, the indication was nonreassuring fetal heart rate in 88% of cases, according to Dr. Horowitz, of the University of Connecticut, Farmington.

The cesarean delivery rates were highest in cases involving nulliparity, prematurity, hypertension, oligohydramnios, and use of prostaglandins. Logistic regression analysis showed that only prematurity was significantly associated with cesarean delivery (odds ratio, 3.81).

The findings are based on a chart review of all patients with singleton pregnancy, a non-anomalous fetus, and suspected FGR (estimated fetal weight and/or fetal abdominal circumference less than the 10th percentile, or no interval growth) who delivered between January 2008 and December 2012. Patients were excluded from the study if there was multiple gestation; fetal anomalies or aneuploidy; malpresentation; a history of prior cesarean delivery; or other contraindications to vaginal delivery.

Although FGR is associated with neonatal risks, including intrauterine demise, neonatal morbidity and mortality, and postnatal morbidity, it is not considered an indication for cesarean delivery. Affected fetuses, however, may be at risk for nonreassuring fetal heart rate tracing and fetal distress due to uteroplacental insufficiency. Delivery at 38 to 39 6/7 weeks is recommended in cases of isolated FGR, and delivery before 38 weeks is recommended in cases with additional risk factors for adverse outcomes.

"Prior studies have found increased risk of cesarean delivery in FGR neonates undergoing induction of labor as compared to spontaneous labor, and no difference in rates of cesarean delivery or adverse outcomes in patients undergoing induction of labor versus expectant management. Term FGR fetuses have been found to have significantly higher rates of cesarean delivery for nonreassuring fetal heart rate tracing," Dr. Horowitz noted.

"It is recommended that these patients undergo a trial of labor," Dr. Horowitz concluded, noting that preterm patients should be counseled about the increased risk of cesarean delivery for nonreassuring fetal heart tracing.

Dr. Horowitz reported having no disclosures.

CHICAGO – Induction of labor is reasonable in cases involving fetal growth restriction, as most patients who are induced deliver vaginally rather than by cesarean section, according to findings from a retrospective cohort study.

Of 134 patients who underwent induction of labor for fetal growth restriction (FGR), 81% delivered vaginally, Dr. Kari Horowitz reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In those who delivered by C-section, the indication was nonreassuring fetal heart rate in 88% of cases, according to Dr. Horowitz, of the University of Connecticut, Farmington.

The cesarean delivery rates were highest in cases involving nulliparity, prematurity, hypertension, oligohydramnios, and use of prostaglandins. Logistic regression analysis showed that only prematurity was significantly associated with cesarean delivery (odds ratio, 3.81).

The findings are based on a chart review of all patients with singleton pregnancy, a non-anomalous fetus, and suspected FGR (estimated fetal weight and/or fetal abdominal circumference less than the 10th percentile, or no interval growth) who delivered between January 2008 and December 2012. Patients were excluded from the study if there was multiple gestation; fetal anomalies or aneuploidy; malpresentation; a history of prior cesarean delivery; or other contraindications to vaginal delivery.

Although FGR is associated with neonatal risks, including intrauterine demise, neonatal morbidity and mortality, and postnatal morbidity, it is not considered an indication for cesarean delivery. Affected fetuses, however, may be at risk for nonreassuring fetal heart rate tracing and fetal distress due to uteroplacental insufficiency. Delivery at 38 to 39 6/7 weeks is recommended in cases of isolated FGR, and delivery before 38 weeks is recommended in cases with additional risk factors for adverse outcomes.

"Prior studies have found increased risk of cesarean delivery in FGR neonates undergoing induction of labor as compared to spontaneous labor, and no difference in rates of cesarean delivery or adverse outcomes in patients undergoing induction of labor versus expectant management. Term FGR fetuses have been found to have significantly higher rates of cesarean delivery for nonreassuring fetal heart rate tracing," Dr. Horowitz noted.

"It is recommended that these patients undergo a trial of labor," Dr. Horowitz concluded, noting that preterm patients should be counseled about the increased risk of cesarean delivery for nonreassuring fetal heart tracing.

Dr. Horowitz reported having no disclosures.

CHICAGO – Induction of labor is reasonable in cases involving fetal growth restriction, as most patients who are induced deliver vaginally rather than by cesarean section, according to findings from a retrospective cohort study.

Of 134 patients who underwent induction of labor for fetal growth restriction (FGR), 81% delivered vaginally, Dr. Kari Horowitz reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In those who delivered by C-section, the indication was nonreassuring fetal heart rate in 88% of cases, according to Dr. Horowitz, of the University of Connecticut, Farmington.

The cesarean delivery rates were highest in cases involving nulliparity, prematurity, hypertension, oligohydramnios, and use of prostaglandins. Logistic regression analysis showed that only prematurity was significantly associated with cesarean delivery (odds ratio, 3.81).

The findings are based on a chart review of all patients with singleton pregnancy, a non-anomalous fetus, and suspected FGR (estimated fetal weight and/or fetal abdominal circumference less than the 10th percentile, or no interval growth) who delivered between January 2008 and December 2012. Patients were excluded from the study if there was multiple gestation; fetal anomalies or aneuploidy; malpresentation; a history of prior cesarean delivery; or other contraindications to vaginal delivery.

Although FGR is associated with neonatal risks, including intrauterine demise, neonatal morbidity and mortality, and postnatal morbidity, it is not considered an indication for cesarean delivery. Affected fetuses, however, may be at risk for nonreassuring fetal heart rate tracing and fetal distress due to uteroplacental insufficiency. Delivery at 38 to 39 6/7 weeks is recommended in cases of isolated FGR, and delivery before 38 weeks is recommended in cases with additional risk factors for adverse outcomes.

"Prior studies have found increased risk of cesarean delivery in FGR neonates undergoing induction of labor as compared to spontaneous labor, and no difference in rates of cesarean delivery or adverse outcomes in patients undergoing induction of labor versus expectant management. Term FGR fetuses have been found to have significantly higher rates of cesarean delivery for nonreassuring fetal heart rate tracing," Dr. Horowitz noted.

"It is recommended that these patients undergo a trial of labor," Dr. Horowitz concluded, noting that preterm patients should be counseled about the increased risk of cesarean delivery for nonreassuring fetal heart tracing.

Dr. Horowitz reported having no disclosures.

CHICAGO – A four-item pregnancy-specific sleep disturbance scale proved valid as a screening tool for sleep-disordered breathing in pregnancy, and was associated with preeclampsia in a study of more than 1,100 women.

After adjustment for potential confounders – including sociodemographics, body mass index, and high blood pressure – a higher score on the short-form pregnancy-specific questionnaire (SF-SPQ) was significantly associated with an increase in the risk of preeclampsia (adjusted risk ratio, 1.54) Alpna Agrawal, Ph.D., of the University of Texas Health Science Center, Houston, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

"In a clinical setting, the short format and validity of SF-SPQ shown in this study suggests it may be a quick and effective method to screen women at risk for sleep-disordered breathing," Dr. Agrawal wrote.

The SF-SPQ was developed based on data collected from 1,153 pregnant women seen in three outpatient clinics between 2010 and 2013. Sleep patterns were assessed by the Berlin Questionnaire, Epworth Sleepiness Scale, and by questions regarding napping behavior. A confirmatory factor analysis (CFA) was performed to develop a sensitive and specific sleep scale derived from the findings. The scale ultimately included "snoring frequently," "bothersome snoring," "stopped breathing while sleeping," and "falling asleep while driving."

"These items were conceptually related to sleep-disordered breathing during pregnancy, statistically intercorrelated, and/or associated with adverse outcomes. CFA factor loadings were significant and model fit was good," Dr. Agrawal wrote.

In addition to higher score on the SF-SPQ, adjusted relative risks of adverse outcomes were associated with BMI greater than 30 (adjusted relative risk, 1.55), hypertension (adjusted RR, 5.07), and screening positive on the Berlin Questionnaire (adjusted RR, 2.45).

"These data suggest that comorbid conditions such as obesity and hypertension (which are themselves a part of the Berlin Questionnaire) drive association with pregnancy outcomes. However, preeclampsia was independently associated with the SF-SPQ," Dr. Agrawal noted.

Prior studies have demonstrated that sleep-disordered breathing during pregnancy is associated with adverse pregnancy outcomes, but an efficient and efficacious screening tool for sleep disorders has been lacking.

The findings are important, because in the United States, preeclampsia affects up to 6% of pregnancies and is linked with other morbidities such as intrauterine growth restriction, and because studies suggest that the use of continuous positive airway pressure (CPAP) can reduce the risk of preeclampsia in pregnant patients with sleep-disordered breathing.

Additional research is needed to evaluate the efficacy of the SF-SPQ for detecting women at risk, Dr. Agrawal concluded.

Dr. Agrawal reported having no disclosures.

CHICAGO – A four-item pregnancy-specific sleep disturbance scale proved valid as a screening tool for sleep-disordered breathing in pregnancy, and was associated with preeclampsia in a study of more than 1,100 women.

After adjustment for potential confounders – including sociodemographics, body mass index, and high blood pressure – a higher score on the short-form pregnancy-specific questionnaire (SF-SPQ) was significantly associated with an increase in the risk of preeclampsia (adjusted risk ratio, 1.54) Alpna Agrawal, Ph.D., of the University of Texas Health Science Center, Houston, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

"In a clinical setting, the short format and validity of SF-SPQ shown in this study suggests it may be a quick and effective method to screen women at risk for sleep-disordered breathing," Dr. Agrawal wrote.

The SF-SPQ was developed based on data collected from 1,153 pregnant women seen in three outpatient clinics between 2010 and 2013. Sleep patterns were assessed by the Berlin Questionnaire, Epworth Sleepiness Scale, and by questions regarding napping behavior. A confirmatory factor analysis (CFA) was performed to develop a sensitive and specific sleep scale derived from the findings. The scale ultimately included "snoring frequently," "bothersome snoring," "stopped breathing while sleeping," and "falling asleep while driving."

"These items were conceptually related to sleep-disordered breathing during pregnancy, statistically intercorrelated, and/or associated with adverse outcomes. CFA factor loadings were significant and model fit was good," Dr. Agrawal wrote.

In addition to higher score on the SF-SPQ, adjusted relative risks of adverse outcomes were associated with BMI greater than 30 (adjusted relative risk, 1.55), hypertension (adjusted RR, 5.07), and screening positive on the Berlin Questionnaire (adjusted RR, 2.45).

"These data suggest that comorbid conditions such as obesity and hypertension (which are themselves a part of the Berlin Questionnaire) drive association with pregnancy outcomes. However, preeclampsia was independently associated with the SF-SPQ," Dr. Agrawal noted.

Prior studies have demonstrated that sleep-disordered breathing during pregnancy is associated with adverse pregnancy outcomes, but an efficient and efficacious screening tool for sleep disorders has been lacking.

The findings are important, because in the United States, preeclampsia affects up to 6% of pregnancies and is linked with other morbidities such as intrauterine growth restriction, and because studies suggest that the use of continuous positive airway pressure (CPAP) can reduce the risk of preeclampsia in pregnant patients with sleep-disordered breathing.

Additional research is needed to evaluate the efficacy of the SF-SPQ for detecting women at risk, Dr. Agrawal concluded.

Dr. Agrawal reported having no disclosures.

CHICAGO – A four-item pregnancy-specific sleep disturbance scale proved valid as a screening tool for sleep-disordered breathing in pregnancy, and was associated with preeclampsia in a study of more than 1,100 women.

After adjustment for potential confounders – including sociodemographics, body mass index, and high blood pressure – a higher score on the short-form pregnancy-specific questionnaire (SF-SPQ) was significantly associated with an increase in the risk of preeclampsia (adjusted risk ratio, 1.54) Alpna Agrawal, Ph.D., of the University of Texas Health Science Center, Houston, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

"In a clinical setting, the short format and validity of SF-SPQ shown in this study suggests it may be a quick and effective method to screen women at risk for sleep-disordered breathing," Dr. Agrawal wrote.

The SF-SPQ was developed based on data collected from 1,153 pregnant women seen in three outpatient clinics between 2010 and 2013. Sleep patterns were assessed by the Berlin Questionnaire, Epworth Sleepiness Scale, and by questions regarding napping behavior. A confirmatory factor analysis (CFA) was performed to develop a sensitive and specific sleep scale derived from the findings. The scale ultimately included "snoring frequently," "bothersome snoring," "stopped breathing while sleeping," and "falling asleep while driving."

"These items were conceptually related to sleep-disordered breathing during pregnancy, statistically intercorrelated, and/or associated with adverse outcomes. CFA factor loadings were significant and model fit was good," Dr. Agrawal wrote.

In addition to higher score on the SF-SPQ, adjusted relative risks of adverse outcomes were associated with BMI greater than 30 (adjusted relative risk, 1.55), hypertension (adjusted RR, 5.07), and screening positive on the Berlin Questionnaire (adjusted RR, 2.45).

"These data suggest that comorbid conditions such as obesity and hypertension (which are themselves a part of the Berlin Questionnaire) drive association with pregnancy outcomes. However, preeclampsia was independently associated with the SF-SPQ," Dr. Agrawal noted.

Prior studies have demonstrated that sleep-disordered breathing during pregnancy is associated with adverse pregnancy outcomes, but an efficient and efficacious screening tool for sleep disorders has been lacking.

The findings are important, because in the United States, preeclampsia affects up to 6% of pregnancies and is linked with other morbidities such as intrauterine growth restriction, and because studies suggest that the use of continuous positive airway pressure (CPAP) can reduce the risk of preeclampsia in pregnant patients with sleep-disordered breathing.

Additional research is needed to evaluate the efficacy of the SF-SPQ for detecting women at risk, Dr. Agrawal concluded.

Dr. Agrawal reported having no disclosures.

CHICAGO – A novel composite prognostic index score helped predict the onset of labor in a retrospective cohort of patients with preterm premature rupture of membranes.

In a separate study, researchers identified three independent predictors of emergent outcomes in patients with preterm premature rupture of membranes (PPROM).

The findings of both studies were presented in posters at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The composite prognostic index score in the first study predicted the likelihood of labor within 12 hours while maintaining a significantly high negative predictive value in 78 patients between 24 and 34 weeks of gestation who were admitted with PPROM over a 2-year period, according to Dr. Yelena Feldman of Trihealth, Cincinnati.

In fact, differences in all variables included in the score were significant at 12 hours prior to labor, she noted.

Variables included as part of the score were deepest vertical pocket of amniotic fluid by ultrasound, fetal heart rate, changes in fetal heart rate variability, presence of decelerations, number of contractions, vaginal bleeding, and record of nursing concern. Each variable was scored at four time points prior to spontaneous labor onset (48, 36, 24, and 12 hours), and a model using the presence of dichotomous variables at 12 hours prior to labor onset was used to make the composite score.

A binary model with the outcome of 12 hours until labor onset had the best results (91.9% specificity; 51.25% sensitivity, 85% negative predictive value, and 67.8% positive predictive value).

Each variable was assigned a number of points based on its beta coefficient in the multivariate model, and the patient could be assigned a score based on the presence of these characteristics.

"The value would correspond to the risk of labor starting within 12 hours," she noted.

The cutoff score, determined by the receiver operating characteristic curves that signified the likelihood of starting labor in 12 hours, was 18, Dr. Feldman explained in the poster.

A score of 18 yielded a negative predictive value of 90.5%, a positive predictive value of 52%, and a sensitivity of 80.9%.

"This composite score may serve as a useful tool in clinical settings where patients admitted with PPROM need decisions regarding patient transfer, administering magnesium sulfate for neuroprotection, or administering a rescue dose of steroid," she concluded.

In the second study, Dr. Tripp Nelson of the Medical University of South Carolina, Charleston, found that malpresentation, bleeding, and sexually transmitted infection each predicted emergent outcomes in PPROM patients.

An admission test utilizing these three factors had 96.4% negative predictive value for emergent outcomes, 57.4% positive predictive value, 91% specificity, and 75.9% sensitivity. For the retrospective case-control study, Dr. Nelson and his colleagues identified 624 subjects, including 83 with at least one emergent outcome.

The emergent group had significantly higher rates of perinatal death and acidosis, and while bivariable comparison showed increased incidence of leukocytosis, urinary tract infection, sexually transmitted infection (STI), malpresentation, latency, vaginal bleeding, and fundal tenderness; only vaginal bleeding, STI, and malpresentation remained significant on logistic regression analysis.

Further randomized testing is needed for model validation, Dr. Nelson concluded.

The authors of both studies reported having no disclosures.

CHICAGO – A novel composite prognostic index score helped predict the onset of labor in a retrospective cohort of patients with preterm premature rupture of membranes.

In a separate study, researchers identified three independent predictors of emergent outcomes in patients with preterm premature rupture of membranes (PPROM).

The findings of both studies were presented in posters at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The composite prognostic index score in the first study predicted the likelihood of labor within 12 hours while maintaining a significantly high negative predictive value in 78 patients between 24 and 34 weeks of gestation who were admitted with PPROM over a 2-year period, according to Dr. Yelena Feldman of Trihealth, Cincinnati.

In fact, differences in all variables included in the score were significant at 12 hours prior to labor, she noted.

Variables included as part of the score were deepest vertical pocket of amniotic fluid by ultrasound, fetal heart rate, changes in fetal heart rate variability, presence of decelerations, number of contractions, vaginal bleeding, and record of nursing concern. Each variable was scored at four time points prior to spontaneous labor onset (48, 36, 24, and 12 hours), and a model using the presence of dichotomous variables at 12 hours prior to labor onset was used to make the composite score.

A binary model with the outcome of 12 hours until labor onset had the best results (91.9% specificity; 51.25% sensitivity, 85% negative predictive value, and 67.8% positive predictive value).

Each variable was assigned a number of points based on its beta coefficient in the multivariate model, and the patient could be assigned a score based on the presence of these characteristics.

"The value would correspond to the risk of labor starting within 12 hours," she noted.

The cutoff score, determined by the receiver operating characteristic curves that signified the likelihood of starting labor in 12 hours, was 18, Dr. Feldman explained in the poster.

A score of 18 yielded a negative predictive value of 90.5%, a positive predictive value of 52%, and a sensitivity of 80.9%.

"This composite score may serve as a useful tool in clinical settings where patients admitted with PPROM need decisions regarding patient transfer, administering magnesium sulfate for neuroprotection, or administering a rescue dose of steroid," she concluded.

In the second study, Dr. Tripp Nelson of the Medical University of South Carolina, Charleston, found that malpresentation, bleeding, and sexually transmitted infection each predicted emergent outcomes in PPROM patients.

An admission test utilizing these three factors had 96.4% negative predictive value for emergent outcomes, 57.4% positive predictive value, 91% specificity, and 75.9% sensitivity. For the retrospective case-control study, Dr. Nelson and his colleagues identified 624 subjects, including 83 with at least one emergent outcome.

The emergent group had significantly higher rates of perinatal death and acidosis, and while bivariable comparison showed increased incidence of leukocytosis, urinary tract infection, sexually transmitted infection (STI), malpresentation, latency, vaginal bleeding, and fundal tenderness; only vaginal bleeding, STI, and malpresentation remained significant on logistic regression analysis.

Further randomized testing is needed for model validation, Dr. Nelson concluded.

The authors of both studies reported having no disclosures.

CHICAGO – A novel composite prognostic index score helped predict the onset of labor in a retrospective cohort of patients with preterm premature rupture of membranes.

In a separate study, researchers identified three independent predictors of emergent outcomes in patients with preterm premature rupture of membranes (PPROM).

The findings of both studies were presented in posters at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The composite prognostic index score in the first study predicted the likelihood of labor within 12 hours while maintaining a significantly high negative predictive value in 78 patients between 24 and 34 weeks of gestation who were admitted with PPROM over a 2-year period, according to Dr. Yelena Feldman of Trihealth, Cincinnati.

In fact, differences in all variables included in the score were significant at 12 hours prior to labor, she noted.

Variables included as part of the score were deepest vertical pocket of amniotic fluid by ultrasound, fetal heart rate, changes in fetal heart rate variability, presence of decelerations, number of contractions, vaginal bleeding, and record of nursing concern. Each variable was scored at four time points prior to spontaneous labor onset (48, 36, 24, and 12 hours), and a model using the presence of dichotomous variables at 12 hours prior to labor onset was used to make the composite score.

A binary model with the outcome of 12 hours until labor onset had the best results (91.9% specificity; 51.25% sensitivity, 85% negative predictive value, and 67.8% positive predictive value).

Each variable was assigned a number of points based on its beta coefficient in the multivariate model, and the patient could be assigned a score based on the presence of these characteristics.

"The value would correspond to the risk of labor starting within 12 hours," she noted.

The cutoff score, determined by the receiver operating characteristic curves that signified the likelihood of starting labor in 12 hours, was 18, Dr. Feldman explained in the poster.

A score of 18 yielded a negative predictive value of 90.5%, a positive predictive value of 52%, and a sensitivity of 80.9%.

"This composite score may serve as a useful tool in clinical settings where patients admitted with PPROM need decisions regarding patient transfer, administering magnesium sulfate for neuroprotection, or administering a rescue dose of steroid," she concluded.

In the second study, Dr. Tripp Nelson of the Medical University of South Carolina, Charleston, found that malpresentation, bleeding, and sexually transmitted infection each predicted emergent outcomes in PPROM patients.

An admission test utilizing these three factors had 96.4% negative predictive value for emergent outcomes, 57.4% positive predictive value, 91% specificity, and 75.9% sensitivity. For the retrospective case-control study, Dr. Nelson and his colleagues identified 624 subjects, including 83 with at least one emergent outcome.

The emergent group had significantly higher rates of perinatal death and acidosis, and while bivariable comparison showed increased incidence of leukocytosis, urinary tract infection, sexually transmitted infection (STI), malpresentation, latency, vaginal bleeding, and fundal tenderness; only vaginal bleeding, STI, and malpresentation remained significant on logistic regression analysis.

Further randomized testing is needed for model validation, Dr. Nelson concluded.

The authors of both studies reported having no disclosures.

CHICAGO – Longer operative time is independently associated with perioperative morbidity after laparoscopic and robotic hysterectomy, according to a review of cases from the American College of Surgeons National Surgical Quality Improvement Program.

The overall complication rate in the 9,064 laparoscopic and robotic hysterectomies recorded in the database (ACS NSQIP) increased significantly and in tandem with increasing operative time, Dr. Tatiana L. Catanzarite reported in a blue ribbon poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

For example, the overall complication rate was 2.79% for operative time of 20-59 minutes and 18.75% for operative time greater than 360 minutes, according to Dr. Catanzarite of Northwestern University, Chicago.

Operative time of 240 minutes or longer was associated with increased overall complications, medical complications, surgical complications, reoperation, transfusion, urinary tract infection, and deep vein thrombosis/pulmonary embolism on both bivariate and multivariable regression analysis. Factors associated with operative time of 240 minutes or longer included age over 50 years, obesity, nonsmoking status, hypertension, history of stroke or transient ischemic attack, and American Anesthesiologists Society (ASA) class greater than 3, she noted.

Patients included in the database, which contains prospectively collected data for more than 240 variables from more than 460 participating institutions, underwent total or subtotal laparoscopic hysterectomy between 2006 and 2011. Patients with concomitant procedures, emergency surgery, gynecologic cancer, ASA class 5, or operative time less than 20 minutes were excluded from the analysis.

Similar findings have been reported for general surgery, but studies in gynecology have been conflicting, Dr. Catanzarite noted.

"Future research should aim to identify risk factors for excessive operative time in order to select appropriate candidates for minimally invasive approaches and maximize surgical efficiency," she wrote.

Dr. Catanzarite reported having no relevant financial disclosures.

CHICAGO – Longer operative time is independently associated with perioperative morbidity after laparoscopic and robotic hysterectomy, according to a review of cases from the American College of Surgeons National Surgical Quality Improvement Program.

The overall complication rate in the 9,064 laparoscopic and robotic hysterectomies recorded in the database (ACS NSQIP) increased significantly and in tandem with increasing operative time, Dr. Tatiana L. Catanzarite reported in a blue ribbon poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

For example, the overall complication rate was 2.79% for operative time of 20-59 minutes and 18.75% for operative time greater than 360 minutes, according to Dr. Catanzarite of Northwestern University, Chicago.

Operative time of 240 minutes or longer was associated with increased overall complications, medical complications, surgical complications, reoperation, transfusion, urinary tract infection, and deep vein thrombosis/pulmonary embolism on both bivariate and multivariable regression analysis. Factors associated with operative time of 240 minutes or longer included age over 50 years, obesity, nonsmoking status, hypertension, history of stroke or transient ischemic attack, and American Anesthesiologists Society (ASA) class greater than 3, she noted.

Patients included in the database, which contains prospectively collected data for more than 240 variables from more than 460 participating institutions, underwent total or subtotal laparoscopic hysterectomy between 2006 and 2011. Patients with concomitant procedures, emergency surgery, gynecologic cancer, ASA class 5, or operative time less than 20 minutes were excluded from the analysis.

Similar findings have been reported for general surgery, but studies in gynecology have been conflicting, Dr. Catanzarite noted.

"Future research should aim to identify risk factors for excessive operative time in order to select appropriate candidates for minimally invasive approaches and maximize surgical efficiency," she wrote.

Dr. Catanzarite reported having no relevant financial disclosures.

CHICAGO – Longer operative time is independently associated with perioperative morbidity after laparoscopic and robotic hysterectomy, according to a review of cases from the American College of Surgeons National Surgical Quality Improvement Program.

The overall complication rate in the 9,064 laparoscopic and robotic hysterectomies recorded in the database (ACS NSQIP) increased significantly and in tandem with increasing operative time, Dr. Tatiana L. Catanzarite reported in a blue ribbon poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

For example, the overall complication rate was 2.79% for operative time of 20-59 minutes and 18.75% for operative time greater than 360 minutes, according to Dr. Catanzarite of Northwestern University, Chicago.

Operative time of 240 minutes or longer was associated with increased overall complications, medical complications, surgical complications, reoperation, transfusion, urinary tract infection, and deep vein thrombosis/pulmonary embolism on both bivariate and multivariable regression analysis. Factors associated with operative time of 240 minutes or longer included age over 50 years, obesity, nonsmoking status, hypertension, history of stroke or transient ischemic attack, and American Anesthesiologists Society (ASA) class greater than 3, she noted.

Patients included in the database, which contains prospectively collected data for more than 240 variables from more than 460 participating institutions, underwent total or subtotal laparoscopic hysterectomy between 2006 and 2011. Patients with concomitant procedures, emergency surgery, gynecologic cancer, ASA class 5, or operative time less than 20 minutes were excluded from the analysis.

Similar findings have been reported for general surgery, but studies in gynecology have been conflicting, Dr. Catanzarite noted.

"Future research should aim to identify risk factors for excessive operative time in order to select appropriate candidates for minimally invasive approaches and maximize surgical efficiency," she wrote.

Dr. Catanzarite reported having no relevant financial disclosures.

CHICAGO – Obstetrician-gynecologists have a unique and largely unaddressed opportunity to improve cardiovascular disease prevention, clinical care, and outcomes in their patients, a survey suggests.

Of 641 patients aged 18-40 years who were surveyed, 65% said their ob.gyn. is the doctor with whom they feel most comfortable, 41% said their ob.gyn. is their "main doctor," and 50% said their ob.gyn. is the one doctor they prefer to see. Of 52 ob.gyns. surveyed, 60% said they consider themselves primary care physicians, yet only 35% of the patients said their ob.gyn. discusses heart health during annual visits, Dr. Mary L. Rosser of Montefiore Medical Center, New York, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Less than half (47%) of the physician respondents said they discuss risk factors for cardiovascular disease, and 16% educate patients about signs and symptoms of heart attack and stroke, Dr. Rosser found.

The findings are of concern because only 28% of the patients overall correctly identified heart disease as the "No. 1 killer of women," and only 21% of minority women and 22% of 18- to 40-year-olds did so, she noted.

Survey respondents were patients aged 18-40 years, as well as 356 women aged 40 or older, from five ob.gyn. offices affiliated with an ethnically diverse urban hospital in New York, and faculty respondents were affiliated with the same institution. Patients completed a 33-question survey that included items about which physician they prefer to see, and physicians completed a 19-question survey that addressed their perceptions of their primary care practices – and in particular, their cardiovascular disease practices.

The findings showed that cardiovascular disease awareness was low in this patient population, especially among young, nonwhite women, and that ob.gyns. do not appear to be providing education aimed at the prevention of cardiovascular disease, according to Dr. Rosser.

"The unique relationship between a woman and her ob.gyn., especially among 18- to 40-year-olds, provides an opportunity to influence change and empower patients to lead more healthful lives," she wrote, adding that educational strategies targeted to both women and their providers would improve awareness of chronic disease processes such as cardiovascular disease.

The American Congress of Obstetricians and Gynecologists and the American Heart Association have some basic information about heart disease in women on their websites.

Dr. Rosser reported having no relevant financial disclosures.

CHICAGO – Obstetrician-gynecologists have a unique and largely unaddressed opportunity to improve cardiovascular disease prevention, clinical care, and outcomes in their patients, a survey suggests.

Of 641 patients aged 18-40 years who were surveyed, 65% said their ob.gyn. is the doctor with whom they feel most comfortable, 41% said their ob.gyn. is their "main doctor," and 50% said their ob.gyn. is the one doctor they prefer to see. Of 52 ob.gyns. surveyed, 60% said they consider themselves primary care physicians, yet only 35% of the patients said their ob.gyn. discusses heart health during annual visits, Dr. Mary L. Rosser of Montefiore Medical Center, New York, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Less than half (47%) of the physician respondents said they discuss risk factors for cardiovascular disease, and 16% educate patients about signs and symptoms of heart attack and stroke, Dr. Rosser found.

The findings are of concern because only 28% of the patients overall correctly identified heart disease as the "No. 1 killer of women," and only 21% of minority women and 22% of 18- to 40-year-olds did so, she noted.

Survey respondents were patients aged 18-40 years, as well as 356 women aged 40 or older, from five ob.gyn. offices affiliated with an ethnically diverse urban hospital in New York, and faculty respondents were affiliated with the same institution. Patients completed a 33-question survey that included items about which physician they prefer to see, and physicians completed a 19-question survey that addressed their perceptions of their primary care practices – and in particular, their cardiovascular disease practices.

The findings showed that cardiovascular disease awareness was low in this patient population, especially among young, nonwhite women, and that ob.gyns. do not appear to be providing education aimed at the prevention of cardiovascular disease, according to Dr. Rosser.

"The unique relationship between a woman and her ob.gyn., especially among 18- to 40-year-olds, provides an opportunity to influence change and empower patients to lead more healthful lives," she wrote, adding that educational strategies targeted to both women and their providers would improve awareness of chronic disease processes such as cardiovascular disease.

The American Congress of Obstetricians and Gynecologists and the American Heart Association have some basic information about heart disease in women on their websites.

Dr. Rosser reported having no relevant financial disclosures.

CHICAGO – Obstetrician-gynecologists have a unique and largely unaddressed opportunity to improve cardiovascular disease prevention, clinical care, and outcomes in their patients, a survey suggests.

Of 641 patients aged 18-40 years who were surveyed, 65% said their ob.gyn. is the doctor with whom they feel most comfortable, 41% said their ob.gyn. is their "main doctor," and 50% said their ob.gyn. is the one doctor they prefer to see. Of 52 ob.gyns. surveyed, 60% said they consider themselves primary care physicians, yet only 35% of the patients said their ob.gyn. discusses heart health during annual visits, Dr. Mary L. Rosser of Montefiore Medical Center, New York, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Less than half (47%) of the physician respondents said they discuss risk factors for cardiovascular disease, and 16% educate patients about signs and symptoms of heart attack and stroke, Dr. Rosser found.

The findings are of concern because only 28% of the patients overall correctly identified heart disease as the "No. 1 killer of women," and only 21% of minority women and 22% of 18- to 40-year-olds did so, she noted.

Survey respondents were patients aged 18-40 years, as well as 356 women aged 40 or older, from five ob.gyn. offices affiliated with an ethnically diverse urban hospital in New York, and faculty respondents were affiliated with the same institution. Patients completed a 33-question survey that included items about which physician they prefer to see, and physicians completed a 19-question survey that addressed their perceptions of their primary care practices – and in particular, their cardiovascular disease practices.

The findings showed that cardiovascular disease awareness was low in this patient population, especially among young, nonwhite women, and that ob.gyns. do not appear to be providing education aimed at the prevention of cardiovascular disease, according to Dr. Rosser.

"The unique relationship between a woman and her ob.gyn., especially among 18- to 40-year-olds, provides an opportunity to influence change and empower patients to lead more healthful lives," she wrote, adding that educational strategies targeted to both women and their providers would improve awareness of chronic disease processes such as cardiovascular disease.

The American Congress of Obstetricians and Gynecologists and the American Heart Association have some basic information about heart disease in women on their websites.

Dr. Rosser reported having no relevant financial disclosures.