1) A study evaluated pregnancy outcomes among 599 women with hyperemesis gravidarum (HEG), comparing 122 who received total parenteral nutrition (TPN) support to those who did not.
2) Women with HEG had higher rates of preeclampsia, preterm delivery, low birthweight, and neonatal morbidity compared to controls.
3) Receiving TPN support during early pregnancy was associated with decreased risks of these complications among women with HEG.
1) A study evaluated pregnancy outcomes among 599 women with hyperemesis gravidarum (HEG), comparing 122 who received total parenteral nutrition (TPN) support to those who did not.
2) Women with HEG had higher rates of preeclampsia, preterm delivery, low birthweight, and neonatal morbidity compared to controls.
3) Receiving TPN support during early pregnancy was associated with decreased risks of these complications among women with HEG.
1) A study evaluated pregnancy outcomes among 599 women with hyperemesis gravidarum (HEG), comparing 122 who received total parenteral nutrition (TPN) support to those who did not.
2) Women with HEG had higher rates of preeclampsia, preterm delivery, low birthweight, and neonatal morbidity compared to controls.
3) Receiving TPN support during early pregnancy was associated with decreased risks of these complications among women with HEG.
p0.04), and a higher rate of preterm delivery at less than 37 and 34 weeks (10.9% vs. 6.9%, p<0.001, and 4.7% vs. 1.6%, p<0.001, respectively). 3) Neonates in the HEG group were characterized by a lower birthweight (3074456g vs. 3248543g, p<0.001), a higher rate of birthweight<10th percentile (12.7% vs. 6.8%, P<0.001), and a higher rate of neonatal morbidity (8.7% vs. 3.8%, p<0.001). 4) These associations persisted after adjustment for potential confounders, and were of most notable among women with HEG who did not receive TPN support. CONCLUSION: HEG is an independent risk factor for preterm delivery, fetal growth restriction, and short-term neonatal morbidity. TPN support during early pregnancy is associated with a decreased risk for these complications.
637 How useful is the FIGO classification in intrapartum fetal
assessment? Malin Holzmann1, Stina Wretler1, Sven Cnattingius2, Lennart Nordstrom1 1 Department of Womens and Childrens Health, Karolinska Institutet, Stockholm, Sweden, 2Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
OBJECTIVE: To evaluate the capacity of the FIGO classication of
Significant linear association between the number
of IUFD and future risk for cardiovascular morbidity
636 Hyperemesis gravidarum and pregnancy outcomeea
possible beneficial impact of total parenetral nutrition support Liran Hiersch1, Nir Melamed1, Yoav Peled1, Joseph Pardo1, Arnon Wiznitzer1, Yariv Yogev1 1 Helen Schneider Hospital for Women, Obstetrics and Gynecology, Petach Tiqva, Israel
OBJECTIVE: To assess pregnancy outcome among women with
hyperemesis gravidarum (HEG) with and without total parenteral nutrition (TPN) support. STUDY DESIGN: A retrospective study of all pregnant women who were hospitalized due to HEG between 1998 and 2012. Only those women with singleton pregnancies who subsequently delivered in our center were included in the analysis (N599). Pregnancy outcome was compared with a control group consisting of women with singleton pregnancies who gave birth immediately after each of the index HEG deliveries, matched by maternal age and parity in a 3:1 ratio (N1,797). RESULTS: 1) Overall 946 women were admitted during the study period with the diagnosis of HEG, of which 599 had a singleton pregnancy and subsequently delivered in our center. Of those, 122 (20.4%) received TPN support. 2) Women in the HEG group were characterized by a higher rate of severe preeclampsia (1.3% vs. 0.5%,
cardiotocography tracings to predict intrapartum acidemia in fetal
scalp blood. STUDY DESIGN: Observational cohort study of consecutive fetal blood samplings (FBS) performed between February 2009 and February 2011 at Karolinska University Hospital, Stockholm. FBS with lactate analysis was used if the attending obstetrician found the intrapartum CTG tracing suspicious or abnormal. Lactate concentration was measured bedside (Lactate Pro). If concentration exceeded 4.8 mmol/L, the fetus was regarded as acidemic and termination of labor was recommended according to established guidelines. At a later moment a senior obstetrician (LN) visually interpreted the CTG tracings prior to each FBS, blinded to the lactate concentration at FBS. We documented baseline fetal heart rate, variability, duration from most recent acceleration, types of decelerations and frequency of contractions. We categorized the CTG patterns according to the FIGO classication. RESULTS: During the study period, there were 9741 deliveries and 2132 FBSs performed on 1070 laboring women. Considering the 1st FBS during each labor, 94 fetuses (8.8%) had lactate >4.8 mmol/L at FBS. As compared with the normal group, where acidemia occurred in 3.7% of the cases, the proportions with increased lactate concentration in the different FIGO classication groups were: intermediary 4.8% (NS), abnormal, 11.4% (p<0.02) and preterminal 12.9% (NS). In tables 1 and 2, values for the 1st FBS and corresponding values for the last FBS (active pushing prior to sampling excluded) are displayed. CONCLUSION: In the FIGO abnormal tracing group only one in ten cases have acidemic values indicating termination of labor and most cases with preterminal recordings are not acidemic. As lactate is an early marker in the hypoxic process the use of FBS with lactate analysis is a valuable complement to CTG in clinical management to prevent birth acidemia and minimize operative intervention. The terminology preterminal should be changed to absence of variability.
S312 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014