17-Hydroxyprogesterone Caproate Does Not Prevent Preterm Birth in Women with a Twin Pregnancy and a Prior Singleton Spontaneous Preterm Birth

INTRODUCTION: Prior spontaneous preterm birth (sPTB) is a risk factor for recurrent sPTB. Weekly 17-hydroxyprogesterone caproate (17P) is used to prevent sPTB in singletons, but there is insufficient evidence on its benefit in twin pregnancies. OBJECTIVE: We hypothesized that 17P weekly injections would reduce the likelihood of sPTB in women carrying a twin pregnancy with a history of singleton sPTB. METHODS: We performed a retrospective case control study of women with a twin gestation and prior singleton sPTB between 2005 and 2016. The study group consisted of women with a twin gestation that received weekly 17P starting at 16 to 20 weeks versus those who did not. The primary outcome was twin sPTB discharge. RESULTS: Of 79 patients included, 27 women received weekly 17P and 52 did not. There were no statistically significant differences in maternal demographics (except maternal age) or in the rate of sPTB controls. There was no statistically significant difference in the rate of sPTB weeks, mean birth weight, or mode of delivery between study and control groups. Composite neonatal morbidity occurred in 20 neonates (74%) in the study group and in 41 control pregnancies (79%). DISCUSSION: Weekly 17P injections do not appear to decrease the incidence of sPTB or neonatal complications in twin pregnancies with a history of prior singleton sPTB. This study will therefore guide future patient management on this common obstetric dilemma

Stepwise Implementation of Vaginal Cleansing and Azithromycin at Cesarean Delivery to Decrease Postoperative Infections; A Quality Improvement Study

Aims for Improvement We aimed to decrease our SSI rate by 30% by sequential implementation of vaginal cleaning1,2 and azithromycin3 for women who underwent a CD after having labored or experienced rupture of membranes

The Effect of Transvaginal Ultrasound, Vaginal Examination, or Coitus on Fetal Fibronectin Results: A Systematic Review

Cervical manipulation via transvaginal ultrasound or sterile vaginal examination does not significantly affect fetal fibronectin results; therefore its use after these exposures is clinically acceptable. Conversely, fFN use in the setting of recent coitus should continue to be discouraged.https://jdc.jefferson.edu/obgynposters/1011/thumbnail.jp

Short cervix on ultrasound: does indomethacin prevent preterm birth?

OBJECTIVE: Our aim was to estimate if indomethacin therapy prevents preterm birth (PTB) in women with a short cervical length (CL) on transvaginal ultrasound (TVU). STUDY DESIGN: Individual-level data from all randomized trials including asymptomatic women with a short CL on TVU were analyzed for use of indomethacin at the time of the short CL. The trials eligible would be ones that randomized women with a short CLmm, identified between 14 and 27 weeks. The eligible trials randomized such women to receive either cerclage or no cerclage. Only women who did NOT receive cerclage were analyzed. Exclusion criteria were major fetal anomaly and cerclage. We compared demographics, risk factors, and outcomes in women who, at the time of the short CL, received indomethacin or not. Primary outcome was PTBweeks. RESULTS: Three of the 4 randomized trials identified had databases which recorded indomethacin use at the time of the short CL. A total of 139 women with a short CLwomen, 99 (71.2%) received indomethacin, and 40 (28.8%) did not. Demographics and risk factors, including previous PTB (45.5% vs 62.5%; P = .11), were similar in the 2 groups. The primary outcome of PTB29.3% (29/99) of women who received indomethacin, and 42.5% (17/40) of women who did not receive indomethacin (RR 0.69, 95% CI 0.44-1.13). PTB1.0% (1/99) versus 7.5% (3/40), respectively (RR 0.14; 95% CI 0.02-0.92). Incidence of perinatal death was similar in the 2 groups (6% vs 10%; RR 0.61, 95% CI 0.19-1.95). CONCLUSION: Indomethacin therapy for asymptomatic women who have a short CLweeks, but did prevent PTBtherapy

Improving Utilization of Aspirin for Prevention of Preeclampsia in a High Risk Urban Cohort

High risk women without a history of preeclampsia were less likely to be recommended aspirin for preeclampsia prevention. A simple screening tool at 1st trimester ultrasound can significantly improve aspirin utilization for preeclampsia preventionhttps://jdc.jefferson.edu/obgynposters/1009/thumbnail.jp

Hypertensive Disorders of Pregnancy (HDP) and Infertility Treatment: A Population-Based Survey Among U.S. Women

Objective To explore associations between infertility treatment and hypertensive disorders of pregnancy using a nationally representative sample of womenhttps://jdc.jefferson.edu/obgynposters/1005/thumbnail.jp