300 SHORT STATURE—AN INDEPENDENT RISK FACTOR FOR CESAREANDELIVERY EYAL SHEINER1, AMALIA LEVY2, MIRIAM KATZ1, MOSHEMAZOR1, 1Soroka University Medical Center, Ob/Gyn, Beer-Sheva, Israel2Faculty of Health Sciences, Ben-Gurion University of the Negev, Epidemi-ology and Health Services Evaluation, Beer-Sheva, Israel

OBJECTIVES: To investigate pregnancy outcome of patients with shortstature (height < 155 cm) and specifically to elucidate if patients with shortstature are at increased risk for cesarean section (CS), even after controlling forlabor dystocia.

STUDY DESIGN: A population-based study comparing pregnancy out-comes of patients with and without short stature was performed. Deliveriesoccurred during the years 1988-2002, in a tertiary medical center. Stratifiedanalysis, using the Mantel-Haenszel technique, was performed to control forconfounders.

RESULTS: 159,210 deliveries occurred during the study period. Of these,5822 (3.65%) were of patients with short stature. Patients with short stature hadstatistically significant higher rates of CS compared with patients above 155 cm(21.3% vs 11.9%, odds ratio [OR] = 2.0; 95% confidence interval [CI] 1.9-2.1;P < 0.001). These patients had higher rates of previous deliveries by CS (17.5% vs10.3%, OR = 1.8; 95%CI 1.7-2.0; P < 0.001), intrauterine growth restriction(IUGR) (3.2% vs 1.9%, OR = 1.7; 95% CI 1.4-1.9; P < 0.001), premature ruptureof membranes (PROM) (7.1% vs 5.6%, OR = 1.3; 95% CI 1.2-1.4; P < 0.001),failed induction (0.7% vs 0.4%, OR = 2.0; 95% CI 1.5-2.8; P < 0.001), labordystocia (6.1% vs 3.5%, OR = 1.8; 95% CI 1.6-2.0; P < 0.001), malpresentations(7.6% vs 6.1%, OR = 1.3; 95% CI 1.1-1.4; P < 0.001), and cephalopelvicdisproportion (CPD) (0.9% vs 0.3%, OR = 2.6; 95% CI 1.9-3.4; P < 0.001). Nosignificant differences were noted between the groups regarding perinatalcomplications such as low birth weight, meconium, perinatal mortality, and lowApgar scores at 5minutes. Controlling for possible confounders such as previousCS, IUGR, PROM, failed induction, labor dystocia, malpresentations, and CPDby using the Mantel-Haenszel technique did not change the significantassociation between short stature and CS.

CONCLUSION: Short stature is an independent risk factor for cesareandelivery.

301 BARIATRIC SURGERY IS NOT ASSOCIATED WITH ADVERSE PERINATALOUTCOME EYAL SHEINER1, AMALIA LEVY2, DANIEL SILVERBERG3,TEHILLAH MENES4, YIZHAK LEVY5, MIRIAM KATZ1, MOSHE MAZOR1,1Soroka University Medical Center, Ob/Gyn, Beer-Sheva, Israel 2Faculty ofHealth Science, Ben-Gurion University of the Negev, Epidemiology, Beer-Sheva, Israel 3Mount Sinai Hospital, Surgery, New York, NY 4Rabin MedicalCenter, Surgery B, Petach-Tikva, Israel 5Soroka University Medical Center,Surgery, Beer-Sheva, Israel

OBJECTIVE: To investigate pregnancy outcome of patients followingbariatric surgery.

STUDY DESIGN: A population-based study was performed comparing allpregnancies of patients with and without prior obesity operations, between theyears 1988 and 2002. Stratified analyses, using the Mantel-Haenszel technique,and a multiple logistic regression model were performed to control forconfounders.

RESULTS: 159,210 deliveries were performed during the study period. Ofthese, 298 were deliveries of patients following bariatric operations. Usinga multivariable analysis, the following conditions were significantly associatedwith a previous bariatric operation: previous cesarean section (CS) (odds ratios[OR] = 1.4; 95% confidence interval [CI] 1.1-2.0; P = .024), fertility treatments(OR = 2.3; 95% CI 1.6-3.8; P < .001), labor induction (OR = 2.1; 95% CI 1.6-2.7;P < .001), fetal macrosomia (birth weight > 4 kg; OR = 2.1; 95% CI 1.4-3.0;P < .001), and obesity (OR = 8.8; 95% CI 6.1-12.9; P < .001). No significantdifferences were noted between the groups regarding other pregnancycomplications such as placental abruption, placenta previa, labor dystocia, orperinatal complications such as meconium-stained amniotic fluid, perinatalmortality, congenital malformations, and low Apgar scores at 1 and 5 minutes.However, there were higher rates of CS among the bariatric operation group(25.2% vs 12.2%; OR = 2.4; 95% CI 1.9-3.1; P < .001). When controlling forpossible confounders such as previous CS, obesity, fertility treatments, laborinduction, diabetes mellitus, hypertensive disorders, and fetal macrosomia,using the Mantel-Haenszel technique, the correlation between previousbariatric surgery and CS remained significant.

CONCLUSION: Previous bariatric surgery, although an independent riskfactor for CS, is not associated with adverse perinatal outcome.

302

303

December 2003Am J Obstet Gynecol

S144 SMFM Abstracts

MATERNAL OBESITY AS AN INDEPENDENT RISK FACTOR FORCESAREAN DELIVERY EYAL SHEINER1, AMALIA LEVY2, TEHILLAHMENES3, DANIEL SILVERBERG4, MIRIAM KATZ1, MOSHE MAZOR1,1Soroka University Medical Center, Ob/Gyn, Beer-Sheva, Israel 2Ben GurionUniversity of the Negev, Epidemiology and Health Services Evaluation, Beer-Sheva, Israel 3Rabin Medical Center, Surgery B, Petach-Tikva, Israel 4MountSinai Hospital, Surgery, New York, NY

OBJECTIVE: To investigate the outcome of pregnancy among obesewomen, and specifically, the association between maternal obesity and cesareansection (CS) while controlling for confounders.

STUDY DESIGN: A population-based study was performed, comparing allpregnancies of obese (maternal pre-pregnancy BMI above 29.0 kg/m2) andnon-obese patients, between the years 1988 and 2002. Patients with hypertensivedisorders and diabetes mellitus, as well as patients lacking prenatal care, wereexcluded from the analysis. Stratified analyses, using the Mantel-Haenszeltechnique, and a multiple logistic regression model were performed to controlfor confounders.

RESULTS: During the study period there were 126,080 deliveries, of which1769 (1.4%) occurred in obese patients. Using a multivariate analysis, withbackward elimination, the following conditions were significantly associatedwith obesity: failure to progress during labor (OR = 3.1; 95%CI 2.5-3.8), fertilitytreatments (OR = 2.0; 95% CI 1.6-2.5), previous CS (OR = 1.7; 95% CI 1.5-1.9),malpresentations (OR = 1.4; 95% CI 1.2-1.6), recurrent abortions (OR = 1.4;95% CI 1.2-1.7), and fetal macrosomia (OR = 1.4; 95% CI 1.2-1.7). Higher ratesof cesarean deliveries were found among obese parturients (27.8% vs 10.8%;OR = 3.2; 95% CI 2.9-3.5; P < .001). When controlling for possible confounderssuch as failure to progress, previous CS, fertility treatments, malpresentations,recurrent abortions, fetal macrosomia, and labor induction, using the Mantel-Haenszel technique, the association betweenmaternal obesity and CS remainedsignificant. No significant differences were noted between the groups regardingperinatal complications such as perinatal mortality, congenital malformations,shoulder dystocia, and low Apgar scores.

CONCLUSION: Maternal obesity, although an independent risk factor forCS, is not associated with adverse perinatal outcome. Obstetricians should beencouraged to allow obese patients an adequate trial of labor, rather than tochoose the seemingly simpler mode of CS.

IS PERIPARTUM ANTICOAGULATION ASSOCIATED WITH AN UNAC-CEPTABLE RATE OF COMPLICATIONS? AMY ADELBERG1, THOMASTREVETT, JR1, TINA AYERS2, APRIL MILLER2, STEPHAN MOLL3,KENNETH MOISE4, 1University of North Carolina at Chapel Hill, ChapelHill, NC 2University of North Carolina at Chapel Hill, Pharmacology, ChapelHill, NC 3University of North Carolina at Chapel Hill, Hematology/Oncology, Chapel Hill, NC 4University of North Carolina at Chapel Hill,Obstetrics/Gynecology, Chapel Hill, NC

OBJECTIVE: To determine the rate of complications when an anti-coagulation protocol used in non-pregnant patients is utilized in the peripartumperiod.

STUDY DESIGN: After obtaining approval from the institutional reviewboard, we reviewed the medical records of all women who had receiveda standardized regimen of peripartum anticoagulation from January 2000through February 2003. We obtained data regarding indications for anti-coagulation and incidence of minor and major complications associated withanticoagulation. Major complications were defined as those that were life-threatening or required transfusion. Minor complications were defined asnotable alterations in clinical presentation that did not meet the above criteria.

RESULTS: Indications for anticoagulation included a history of venousthrombosis or pulmonary embolism in the current or previous pregnancy, septicpelvic thrombophlebitis, or a history of thrombophilic disorder. The rate of anycomplications was 12 of 32, or 37.5% (major complications: 13.5%, minorcomplications: 21%). Major complications included two severe delayedpostpartum hemorrhages, one of which required transfusion; one case ofsubarachnoid bleed; and a second case of intra-cranial posterior fossahemorrhage resulting in death. Minor complications included wound hema-toma, hematuria, and epistaxis.

CONCLUSION: The overall complication rate of 37.5% of a non-pregnantanticoagulation protocol used in the peripartum period is unacceptably high.An anticoagulation regimen specific to pregnancy should be sought.