Neonatal Hypoglycemia in Women Controlled significant impact on immediate neonatal outcomes of infants with

spina bifida.
Intrapartum With Insulin Pump as Compared to
Financial Disclosure: The authors did not report any potential conflicts of
Subcutaneous Insulin & Drip [18R]
interest.
Shelly Soni
Northwell Hofstra School of Medicine, Manhasset, NY
Nikita Shah, Burt Rochelson, MD, and Lisa Simmonds, MD
INTRODUCTION: To evaluate the incidence of neonatal hypogly- Neonatal Outcomes of Infants at the Threshold of
cemia in women with diabetes whose intrapartum insulin management Viability in a Tertiary Care Center [20R]
is controlled with continuous insulin pump as compared with those Tiffany Tonismae
managed with subcutaneous insulin as well as drip.
Indiana University Health, Roanoke, VA
METHODS: Retrospective review of patients with pregestational Megan Lord, and Allison Durica
Type 1 and 2 diabetes. Primary outcome was neonatal hypoglycemia,
INTRODUCTION: The goal of this study is to analyze outcomes of
defined as neonatal blood glucose levels of , than 40 mg/dl in the first
periviable deliveries at a tertiary care center in Southwest Virginia
24 hrs. Patients were categorized into groups — those receiving intra-
from January 2010 to 2016 of those infants delivered from 22 to 25
partum subcutaneous insulin as well as drip and those with intrapartum
weeks.
insulin pumps. Elective cesarean sections were excluded.
METHODS: This is a retrospective case series of 76 infants delivered
RESULTS: 102 patients were included. 71 had type 2 diabetes and
between 22 0/7 and 24 6/7 weeks from 2010-2015. Infant and maternal
30.4% had type 1 diabetes. There was a greater rate of neonatal
charts were reviewed for data from admission until NICU discharge or
hypoglycemia in patients receiving subcutaneous/insulin drip, the
in hospital death. Outcomes included death prior to discharge and
difference was not statistically significant (28.6% vs 15.6%, p50.2).
major morbidities associated with prematurity.
There was no difference in the other perinatal outcomes; cesarean
deliveries, birth weights, NICU admissions and the need of neonatal RESULTS: Seventy-six patients were identified, with none less than
intravenous glucose. There were more patients with Type 1 diabetes in 23 0/7 weeks. Three patients were excluded due to life-limiting genetic
the pump group. Periconception HbA1C was similar. Though birth or anatomic abnormalities diagnosed antenatally. Mean gestational age
weights were higher in the pump group, the rate of hypoglycemia as at delivery was 24 0/7 weeks (22 6/7-24 6/7 weeks) with mean birth
well as the need of intravenous glucose was lower. Our data may have weight 610 g (342-907 g). Demographic information was obtained
been biased because of more Type 1 diabetics in the pump group. including maternal age/race, receipt of betamethasone and magnesium
sulfate, and causes for delivery. Placental pathology reports were also
CONCLUSION: We found no statistical difference in neonatal out-
reviewed. Overall survival was 63% (57% at 23 weeks, 70% at 24
comes of patients receiving intrapartum continuous subcutaneous
weeks), with a mean length of stay of 159 days (77-167 days). Seventy-
insulin infusion pump and those on subcutaneous insulin or drip.
four percent of survivors were diagnosed with major morbidity
Continuing these patients on pump is a reasonable option, especially
including: stage 3-4 retinopathy of prematurity (15%); late onset sepsis
with lower rates of neonatal hypoglycemia and need of intravenous
(28%); necrotizing enterocolitis (20%); grade 3-4 intraventricular
glucose.
hemorrhage (15%); periventricular leukomalacia (9%); and spontane-
Financial Disclosure: The authors did not report any potential conflicts of ous bowel perforation (22%). 70% of survivors were discharged with
interest. home oxygen requirements.
CONCLUSION: Our survival rate is above national benchmark data
for this gestational age. However, the majority of survivors experi-
Neonatal Outcomes by Attempted Mode of enced significant morbidity, which should be considered when making
decisions regarding resuscitation at the threshold of viability.
Delivery and Obstetric Intervention for Pregnancies
Financial Disclosure: The authors did not report any potential conflicts of
Affected by Spina Bifida [19R]
interest.
Michail Spiliopoulos, MD
MedStar Washington Hospital Center, Washington, DC
Sara Iqbal, MD, Uma Reddy, MD, MPH, Helain Landy, MD,
and Chun-Chih Huang, PhD, MSc
Neutophil to Lymphocyte Ratio: A Marker for
INTRODUCTION: To evaluate immediate neonatal outcomes of
pregnancies affected by spina bifida by attempted vaginal delivery vs. Preterm Labor? [21R]
cesarean section and spontaneous compared to induced labor. Melissa Chu Lam, MD
METHODS: This is a retrospective cohort study using data from the St Luke’s University Hospital, Bethlehem, PA
Consortium on Safe Labor study, including 228,562 deliveries from 19 Jonathan Hunt, and James Anasti, MD
hospitals across the U.S. from 2002 to 2008. All singleton pregnancies INTRODUCTION: Investigators have postulated that preterm labor
complicated by spina bifida that resulted in a live birth after 34 weeks may result from inflammation. Neutrophil/lymphocyte ratio (N/L) has
of gestation were evaluated. Breech deliveries were excluded from the been used as marker to determine sub-clinical inflammation and
analysis. Outcomes included NICU admission, respiratory morbidity, prognosis in several system disorders. The N/L is easy to obtain and
sepsis, birth trauma, asphyxia/seizures and mortality and were inexpensive, which would allow a widespread clinical use in the
evaluated according to attempted mode of delivery and spontaneous evaluation of patients. We therefore hypothesis that due to inflamma-
vs induced labor. Multivariable logistic regression was used to calculate tion, preterm patients would have higher N/L ratio compared to term
adjusted OR (aOR) and 95% confidence intervals controlling for controls.
gestational age and diabetes. METHODS: We randomly selected patients delivered before 37
RESULTS: We identified a total of 51 patients with spina bifida in the weeks (PT) and patients that delivered at term (T) during the last 10
database. Women undergoing attempted vaginal delivery were more years. Only patients in active labor were included. We compared their
likely to be nulliparous, less than 35 years of age, white and without N/L Ratio at the time of admission to Labor and Delivery. We
a history of previous cesarean delivery (CD) (p value , 0.05) com- excluded individuals with known infection, inflammatory diseases, and
pared to women undergoing planned CD. There was no statistically hematological disorders, as well all those that received steroids at least
significant difference in immediate neonatal outcomes between pa- 3 weeks prior to determining their N/L ratio.
tients attempting vaginal delivery and those scheduled for CD RESULTS: We compared 137 PT (32.4 6 4.1 wks) and 145 T (39.2 6
(p50.07 for NICU admission). No differences in neonatal outcomes 1.1 wks) patients of similar age. They differed by gravity (PT 2.8 6 1.9;
of pregnancies affected by spina bifida were identified between the T 2.0 6 1.4, p5 0.001), and parity (PT 0.8 6 1.1; T 1.2 6 0.8,
spontaneous labor and scheduled labor induction group. p50.001). Preterm patients had higher rates of BMI greater than 35
CONCLUSION: Neither mode of delivery (attempted vaginal vs (PT 13.8%; T 5.5%, p50.3), tobacco use (PT 24%, T 11%, p50.001)
scheduled CD) nor scheduled induction of labor had any statistically and hypothyroidism (PT 10.2%; T 2.7%, p50.001). N/L ratio was

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and Gynecologists. Published by Wolters Kluwer Health, Inc.
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significantly elevated in preterm patients compared to those delivered CONCLUSION: The NTSV cesarean delivery rate is influenced by
at term (PT 5.9 6 5.1; T 4.7 6 3.2, p50.007). many factors, and a wide variation in incidence can be seen across
CONCLUSION: N/L ratio appears to be elevated in preterm obstetric providers within the same hospital system. Further research
delivery. The clinical utility warrants further study. should be performed analyzing variations in obstetrical practices that
may contribute to this significant difference.
Financial Disclosure: The authors did not report any potential conflicts of
interest. Financial Disclosure: The authors did not report any potential conflicts of
interest.

Non-Invasive Hemoglobin Monitoring: A Method of

Obesity and Cell Free DNA Testing [24R]
Measuring Blood Loss in Cesarean Delivery? [22R]
Camila Cabrera
Amy Dermaco, MD University of South Florida, Tampa, FL
Stony Brook University Hospital, Stony Brook, NY Kathryn Dean, MD, Elizabeth Teal, MD, MPH,
Joseph Chappelle, MD and Stephanie T. Romero, MD, MSCI
INTRODUCTION: Obstetrical hemorrhage is a leading cause of INTRODUCTION: Cell free fetal DNA is first detected in maternal
maternal morbidity and mortality worldwide. Prompt and accurate serum at seven weeks gestation and the quantity increases during
estimation of blood loss (EBL) is necessary to expedite the diagnosis pregnancy. Non-invasive prenatal testing (NIPT) can be used as
and treatment of postpartum hemorrhage. The aim of this study is to a screening test to aid in prenatal diagnosis of fetal aneuploidy.
investigate the ability of the non-invasive hemoglobin measurement to Recommendations for use are limited to women at “high risk.” There
measure blood loss during a cesarean delivery (CD). are no current guidelines for use in special populations including obese
METHODS: Term, singleton patients undergoing scheduled CD were women, “low risk” women, or smokers. In obese women, the amount
consented for this prospective, non-blinded, observational study. The of maternal cfDNA is greater than in non-obese women. We
Masimo Radical-7 Pulse CO-oximeter recorded non-invasive hemoglo- hypothesize that obese women will have greater rates of “no result”
bin (SpHb) values at baseline, continuously during the CD, and for 8 than lean women.
hours postoperatively. Values were then compared with hemoglobin METHODS: A retrospective review was performed evaluating all
(Hb) measurements obtained preoperatively and on postoperative day 1. pregnant women at our institution who had NIPT drawn From 1/1/11-
RESULTS: Data were obtained from 13 women. Mean maternal age 1/1/15 (n5805). Women with BMI between 25.0-29.9 at initial pre-
was 32 (25-41) and mean gestational age was 38.9 (37.6-39.6). natal visit were excluded. Categorical variables were compared using
Indications were elective repeat (n55), repeat for . 1 prior (n56), chi square or Fisher’s exact test, continuous variables were assessed
primary elective (n52), and prior myomectomy (n51). Average EBL using a student t test.
was 938 (800-1500) and average decrease in Hb was 2.2 (0.6-3.0). EBL RESULTS: A total of 473 women met inclusion criteria (277 obese,
was not correlated to calculated blood loss (p50.37). Average preop- 196 normal weight). A larger proportion of obese women had “no
erative SpHb was 10.6 (9.2-12.2) and there was no difference in aver- result” than lean women but this was not statistically significant
age postoperative SpHb measurements at 0, 1, 4, and 8 hours (3.2% vs 1.5%, p50.24). The mean BMI in those with “no result”
postoperatively (p-0.9). There was no correlation between SpHb values was 36.2+/-13.0. One obese woman had a female result on NIPT
and blood loss. and male genitalia on ultrasound and confirmed at birth to be 46, XY.
CONCLUSION: This study demonstrates the inability of non- CONCLUSION: There was a trend toward more “no result” in obese
invasive techniques to measure blood loss during CD. SpHb showed vs lean women. A larger study is needed to further elucidate the differ-
poor accuracy and no trending ability compared to laboratory values. ences in performance of NIPT for lean vs obese women.
These findings are supported by prior studies showing poor perfor-
mance in conditions involving large changes in intravascular volume, Financial Disclosure: The authors did not report any potential conflicts of
especially during hemorrhage. interest.
Financial Disclosure: The authors did not report any potential conflicts of
interest.
Obesity Effect on Induction of Labor Duration [25R]
Garrett Fitzgerald, MD
University of Maryland Medical Center, Baltimore, MD
Nulliparous, Term, Singleton, Vertex (NTSV): Can
Sarah Crimmins, DO, Jerome Kopelman, MD, Chris Harman, MD,
We Predict Cesarean Delivery? [23R] and Ozhan Turan, MD, PhD
Shania Seibles, DO, JD INTRODUCTION: Obesity and associated morbidity significantly
MSUCOM - St Joseph Mercy Oakland Hospital, Pontiac, MI impacts obstetric management, including increased indication for
Baldwin Rikki, DO, George Kazzi, MD, and June Murphy, DO induction of labor (IOL). Retrospective studies report obesity prolong-
INTRODUCTION: The nulliparous, term, singleton, vertex (NTSV) ing labor course. We aim to investigate duration of IOL stratified by
cesarean delivery rate has become the obstetric quality measure, as it is body mass index (BMI). We hypothesize obesity prolongs IOL.
the most variable portion of the rise in cesarean delivery and represents METHODS: Prospective cohort study of singletons undergoing IOL.
low risk primary cesarean births. We hypothesize that analysis of Obstetric management was per provider’s discretion (vaginal miso-
previous nulliparous, term, singleton vertex (NTSV) deliveries will prostol, cervical balloon, intravenous oxytocin). The primary outcome
yield maternal, fetal, and/or obstetrical characteristics that are associ- was interval from starting IOL to latent labor. Secondary outcomes
ated with increased risk for cesarean delivery. include duration to active labor and delivery. Labor was considered
METHODS: Retrospective study of all NTSV births that occurred at prolonged if greater than 24 h to latent labor, and greater than 36 h to
St. Joseph Mercy Oakland Hospital during the year 2015, with the active labor. Patients were analyzed by BMI category (under 30,
purpose of identifying factors contributing to cesarean delivery. We between 30 and 39.9, over 40 kg/m2). Cesarean delivery outcomes
compared demographic, obstetrical, and neonatal data. The data were were excluded. Non-parametric and chi-square test were used for anal-
analyzed using SPSS-19 software, with categorical outcomes using the ysis.
chi square regression analysis and numerical outcomes using the t test. RESULTS: Total of 99 enrolled, 23 were delivered by cesarean,
RESULTS: A total of 475 cases of NTSV were included analysis. The leaving 76 analyzed. The median BMI was 36 kg/m2 (19-75); 17 BMI
overall NTSV cesarean delivery rate was 27.08%, with a range of under 30, 37 BMI between 30 and 39.9, 22 BMI over 40. The parity
12.9% to 39.1% amongst obstetrical providers. The most common and Bishop’s score were not significantly different. The BMI group
reasons for NTSV cesarean delivery were abnormal FHR tracing, median duration to latent labor (10.6 v 9.6 v 12.7 h, P5.5), to active
53.2%, and labor dystocia, 38.7%. The factors that were statistically labor (14.1 v 15.0 v 19.2 h, P5.5), and to delivery (18.5 v 17.8 v 20.6 h,
significant were diabetes (LHR 7.192, P , 0.004), hypertension (LHR P5.5) were not significantly different. The time to achieve active labor
14.9, P , 0.00), maternal race (LHR 5.42, P , 0.02), age in years (P trended longer with increasing BMI (P5.049).

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Unauthorized reproduction of this article is prohibited.