ajog.
org
ventilation, seizures, sepsis, pH < 7.0, 5 min APGAR < 3, NICU
admission, length of stay of
5 days. These outcomes were
compared between women who had unlabored RCD at 36 vs 37
weeks. Multivariable analysis was used to control for possible con-
founders. We also compared a composite of adverse maternal out-
comes, including uterine rupture rates, between scheduled and
unscheduled cases.
RESULTS: 322 patients with scheduled CS as well as 115 unscheduled
cases were included in the analysis. Women who underwent
scheduled RCD at 36 (n¼116) vs 37 (n¼206) weeks had similar
baseline characteristics. Infants born at 36 weeks had significantly
greater odds of having RDS or TTN (aOR 2.48; 95% CI 1.22-5.05),
being admitted to NICU (aOR 1.918; 95% CI 1.12-3.23) and having
a prolonged hospitalization (aOR 2.483; 95% CI 1.35-4.59)
compared to those delivered at 37 weeks (Table 1). There was no
difference in the composite of adverse maternal outcomes (10% vs
7%, p¼0.455), uterine rupture (1% vs 0%, p¼0.590) or uterine
window (2% vs 2%, p¼0.749) in unscheduled (n¼115) compared to
scheduled RCD (n¼322) between 36-37 weeks (Table 2).
CONCLUSION: Scheduled 37-week CD for history of prior CCD was
associated with fewer adverse neonatal outcomes compared to
scheduled 36-week CD, with no associated increase in maternal
morbidity.
Supplement to JANUARY 2020 American Journal of Obstetrics & Gynecology
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Poster Session I
223 Risk factors for intrauterine fetal demise of the
co-twin following radiofrequency ablation in
multi-fetal gestations
Lauryn Gabby1, Andrew H. Chon1, Lisa M. Korst2, Arlyn Llanes1,
Ramen H. Chmait1
1
Keck School of Medicine, University of Southern California, Los Angeles,
CA, 2Childbirth Research Associates, Childbirth Research Associates, CA
OBJECTIVE: Radiofrequency ablation (RFA) is a common method of
umbilical cord occlusion (UCO) that is utilized to maximize out-
comes of the co-twin in multi-fetal monochorionic gestations.
Despite the ease of the RFA procedure, co-twin intrauterine fetal
demise (IUFD) is a topic of concern. We sought to determine risk
factors for co-twin fetal demise.
STUDY DESIGN: This is a retrospective study of women with multi-
fetal gestations who underwent RFA between 2012-2019. In-
dications for RFA included discordant anomalies, twin-twin
transfusion syndrome (TTTS), selective intrauterine growth re-
striction (SIUGR), and twin reversed arterial perfusion (TRAP)
sequence. The primary outcome was co-twin IUFD. Bivariate
analyses of patient characteristics with respect to co-twin IUFD
and multiple logistic regression modeling of identified risk factors
were conducted.
RESULTS: Thirty patients were studied. Surgical indications were:
discordant anomalies (8/30, 26.7%), SIUGR (6/30, 20.0%), TRAP
(14/30, 46.7%), and TTTS (2/30, 6.7%). Seven patients experi-
enced an IUFD of the co-twin (23.3%), and 5 (71.4%) of these
were within 24 hours after surgery. Patient characteristics
potentially associated (p< 0.10) with IUFD in bivariate analysis
were: estimated fetal weight percentile of the co-twin (median
[range] 8.2 [2.3-48.2] vs. 44.4 [1.0-98.9] percent, p¼0.0696); fetal
growth restriction (FGR) of the co-twin (4/7 [57.1%] vs. 4/23
[17.4%], p¼0.0596); and non-TRAP diagnosis (6/7 [85.7%] vs.
10/23 [43.5%], p¼0.0860). In logistic regression analysis, FGR of
the co-twin was associated with increased risk of IUFD (OR
12.93, 95% CI 1.12-149.29, p¼0.0403); although not statistically
significant, a preoperative TRAP diagnosis appeared protective
(OR 0.06, 95% CI 0.004-1.04, p¼0.0531).
CONCLUSION: The presence of co-twin FGR may increase risk of
postoperative co-twin demise following RFA. As compared to
the other indications for UCO, RFA cases for TRAP sequence
appeared to be associated with more favorable co-twin out-
comes.
224 Cesarean birth rates in pregestational diabetic
pregnancies
Kelsey Olerich1, Vivienne Souter2, Ian Painter2,
Kristin Sitcov2, Emily Fay1, Joseph Hwang1
1
University of Washington, Seattle, WA, 2Foundation for Health Care Quality,
Seattle, WA
OBJECTIVE: Pregestational diabetes (PGDM) is increasing in the US
and is associated with an increased risk of pregnancy complications,
including cesarean birth. However, there are limited data regarding
contributing factors to this increased CBR.
STUDY DESIGN: This retrospective cohort study included chart
abstracted data on births between 24+0-42+6 weeks’ estimated
gestational age (EGA) at 21 hospitals participating in a multi-center
quality collaborative between 01/2014 and 12/2018. Births
S155