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www.AJOG.org Clinical Obstetrics, Neonatology, Physiology-Endocrinology Poster Session I

ions with cerclage is more than a function of cervical length alone.ompared with singleton gestations, twins manifest a unique risk in

he setting of short cervix and cerclage.

able 1

ariable Coef 95%CI p-value

win �5.2 (�6.0, �4.4) �0.0001.........................................................................................................................................................................................

vx length (cm) �2.2 (�2.0, �2.4) �0.0001.........................................................................................................................................................................................

win-Cvx length interaction �0.8 (�0.45, �1.2) �0.0001.........................................................................................................................................................................................

unneling �1.3 (�0.89, �1.7) �0.0001.........................................................................................................................................................................................

002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.132

118 ”The weekend syndrome”: higher ratesf suboptimal management and non-adherenceo protocols during the weekendsyal Sheiner1, Zahava Yohai1, Judy Rosen1, Michaelherf2, Pnina Schlaeffer2, Arnon Wiznitzer1

Soroka University Medical Center, Ben-Gurion Universityf the Negev, Department of Obstetrics and Gynecology,eer Sheva, Israel, 2Soroka University Medical Center,en-Gurion University of the Negev, Beer Sheva, IsraelBJECTIVE: To determine whether the weekend is a risk factor for sub-ptimal management, improper documentation and non-adherenceo protocols in adverse events and outcomes in obstetrics.TUDY DESIGN: During 2008, a comprehensive review of all adversevents in obstetrics was performed by a Patient Safety Committee,omposed of 2 midwives and 2 obstetricians (Patient Safety Officers).ll adverse events and outcomes (such as perinatal mortality, low 5inute Apgar scores, unexpected NICU admission etc.) were tracked

y the committee. The relevant files as well as the computerized data-ase and neonatal files were thoroughly reviewed. The committeeembers were blinded to the day of the week the delivery occurredhile summarizing the management of the staff.ESULTS: During 2008, 805 birth files were reviewed by the commit-ee; of these 62% (n�501) occurred during the week days and 38%n�304) during the weekends. Suboptimal management was signifi-antly more common during the weekend, as compared to week-daysOR�2.4; 95% CI 1.1-5.8; P�0.034). Likewise, higher rates of stricteviations from protocols used in the department were noted duringhe weekend, as compared to the week-days (OR�3.5 95%CI 1.5-8.0;�0.001). No significant differences were noted between weekendsnd week-days regarding improper documentations as well as in theumber of cases necessitating report to the insurance companyOR�1.3; 95% CI 0.7-2.3; P�0.328, and OR�1.5; 95% CI 0.9-2.4;�0.098, respectively).ONCLUSION: Higher rates of suboptimal management and non-ad-erence to protocols are noted during the weekends, as compared toeek-days. Accordingly, careful surveillance is warranted during theeekends.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.133

119 Neonatal outcome in discordant twins - is theredifference between AGA/AGA and AGA/SGA pairs?riel Many1, Yaron Haimovich1, Jessica Ascher Landsberg1,ror Mandel2, Sharon Maslovitz1, Yifat Ochshorn1,onit Almog2, Joseph Lessing2, Michael Kupferminc1

Lis Maternity Hospital, Tel Aviv, Israel,2Lis Maternity Hospital, Tel-Aviv, IsraelBJECTIVE: To estimate the influence of FGR on neonatal morbiditynd mortality among discordant premature twin pairs.TUDY DESIGN: Medical records of preterm twins born at 24-37 weeksetween 2000 and 2006, were reviewed. Discordancy was defined as aifference of �15% in birth weight. Small for gestational age (SGA)

as defined as birth weight �10th percentile, whereas appropriate for a

Suppleme

estational age (AGA) was defined as birth weight between the 10thnd 90th percentile, according to a twin-adjusted normogram. Oneroup (n�30) included discordant twins which are SGA/AGA pairsnd the other group (n�40) included AGA/AGA discordant twinairs. Neonatal parameters of morbidity and mortality were com-ared between the pairs of twins.ESULTS: Table 1 depicts the neonatal complications in the AGA/SGAroup. The incidence of hyperbilirubinemia, anemia and hypotensionere significantly higher among SGA neonates. The incidence of re-

piratory distress syndrome, apnea and the need for respiratory sup-ort was significantly higher among the AGA neonates in the SGA/GA group. There was no statistically significant difference between

he pairs in the incidence of IVH, NEC, sepsis, hyponatremia, hypo-lycemia, PDA,neonatal mortality, and length of hospitalization. Inhe AGA/AGA discordant group there was no difference in any of theeonatal complications between the pairs.ONCLUSION: FGR which leads to SGA among premature twin neo-ates is associated with significantly lower rates of respiratory mor-idity and higher incidence of anemia compared to their AGA sibling.f the discordancy does not lead to SGA, there are no differences be-ween siblings.

AGA SGA P value

DS 36.67% 16.67% 0.014.........................................................................................................................................................................................

TN 30% 3.3% 0.004.........................................................................................................................................................................................

esp mechan support 46.7% 16.6% 0.003.........................................................................................................................................................................................

yperbilirubin 40% 70% 0.002.........................................................................................................................................................................................

hototherapy 36.6% 66.6% 0.003.........................................................................................................................................................................................

rythropoietin 0% 23.3% 0.015.........................................................................................................................................................................................

002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.134

120 Maternal obesity is associated with placentomegalynd reduction of fetal oxygen margine of saftyadwah Tahir1

Royal College of Physicians and Surgeons of Canada,aternal Fetal Medicine, London, Ontario, Canada

BJECTIVE: To compare the fetal oxygen status and perinatal outcomet birth in obese vs. normal size pregnant women in all fetal weightategories.TUDY DESIGN: Computerized perinatal databases maintained by St.oseph=s Health Care, London, in which data for all singleton, liveorn between 24 - 40 completed weeks with no major anomaly, arentered by a dedicated research assistant. This is a retrospective cohortnalysis from January 1, 1999, to December 31, 2007(n� 24949).omparing pregnant women with BMI �30 kg/m2 to BMI from 18.5-4.9 kg/m2 divided into 5 birth weight category using fetal growthtandard.ESULTS: There were 24949 pregnant women who had singleton, withhe above criteria. 1433 underweight (BMI �18.5), 13780 normaleight (BMI�18.5-24.9), 5741 over weight (BMI� 25-29.9) and 3995bese (BMI 30). We found that, umbilical venous O2 saturation wastatistically significant lower among obese pregnant women in com-arison to the normal weight (the mean of 60.7 vs. 62 respectively)ith P value � 0.001 even after adjusted the fetal and maternal risks

hat could affect fetal oxygenation. Arterial fetal oxygen saturationas also statistically significant lower among over weight and obeseregnant women vs. normal weight (the mean of 25.1 & 24 vs. 26.0espectively) even after the risks adjustment. Furthermore, fractionalxygen extraction (as a measure of oxygen consumed) was foundtatistically significant higher among over weight and obese pregnantomen vs. normal weight (mean of 0.603 & 0.613 vs. 0.589 respec-

ively) P value of �0.001 these differences maintained even after risks

djustment, using linear regression analysis.

nt to DECEMBER 2009 American Journal of Obstetrics & Gynecology S59