Debbie Jacques

Does advanced maternal age affect pregnancy outcome in women with mild hypertension remote from term

OBJECTIVES Our purpose was to compare maternal and perinatal outcomes of mature women with those in younger women with pregnancies complicated by mild hypertension remote from term. STUDY DESIGN A matched cohort design was used. A total of 379 mature pregnant women (> or = 35 years old) with mild hypertension remote from term were matched for race, gestational age, and proteinuria status at enrollment with 379 adult controls aged 20 to 30 years also with mild hypertension remote from term. All were enrolled in an outpatient management program that included automated blood pressure measurements and daily assessment of weight, proteinuria, and fetal movement. RESULTS The mean gestational age at enrollment was 32.7 +/- 3.0 weeks for both groups (range 24 to 36 weeks). By matching 20.6% of patients in each group had > or = 1+ proteinuria on urinary dipstick at enrollment, and 77.3% of patients in each group were white. Chronic hypertension was more common in the mature group (22.4% vs 14.5%, p = 0.007). The mean gestational age at delivery (37.2 +/- 2.3 vs 37.2 +/- 2.2 weeks), the mean pregnancy prolongation (28.1 +/- 21.0 vs 28.4 +/- 22.0 days), and the mean birth weights (2864 +/- 770 vs 2906 +/- 788 gm) were similar between the mature and younger groups (all p > 0.05). There were no differences regarding abruptio placentae (2 vs 3 cases) or thrombocytopenia or HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome (7 vs 9 cases), and there were no cases of eclampsia. There were five stillbirths in the mature group and none in the younger group (p = 0.063). CONCLUSION Outpatient management of mild hypertension remote from term in the mature pregnant women was associated with similar maternal outcomes but with a nonstatistically higher stillbirth rate compared with the younger pregnant woman.

Clinical and Cost-Effectiveness of Continuous Subcutaneous Terbutaline Versus Oral Tocolytics for Treatment of Recurrent Preterm Labor in Twin Gestations

OBJECTIVE: To compare the clinical and cost-effectiveness of treating recurrent preterm labor with continuous subcutaneous terbutaline versus oral tocolytics in twin gestations.STUDY DESIGN: In a retrospective, matched-cohort design, twin pregnancies treated as outpatients with continuous subcutaneous terbutaline were identified from a perinatal database, then matched 1:1 by gestational age at recurrent preterm labor to those receiving oral tocolytics. There were 353 patients per treatment group. A cost model was used to compare antepartum hospital, nursery, and outpatient charges.RESULTS: Infants of the subcutaneous terbutaline group had greater gestational age at delivery, higher birth weights, and less frequent neonatal intensive care unit admission. Charges for antepartum hospitalization and nursery were significantly less in the subcutaneous terbutaline group, while charges for outpatient services were less for the oral group. Mean total estimated charges were US

A comparison of gestational days gained with oral terbutaline versus continuous subcutaneous terbutaline in women with twin gestations.

17,109 less for those receiving subcutaneous terbutaline.CONCLUSION: Improved clinical outcomes and decreased nursery utilization suggest cost-effectiveness of outpatient continuous subcutaneous terbutaline versus oral tocolytics for the treatment of recurrent preterm labor.

Monitored outpatient management of mild gestational hypertension remote from term in teenage pregnancies

OBJECTIVE: To compare gestational days gained with oral versus subcutaneous terbutaline for maintenance tocolysis.STUDY DESIGN: In retrospective fashion 386 women enrolled in an outpatient preterm labor identification program met the following criteria: twin gestation, development of threatened preterm labor resulting in treatment with oral terbutaline, and subsequent recurrence of threatened preterm labor resulting in treatment with continuous subcutaneous terbutaline. The primary outcome was gestational days gained with oral terbutaline versus gain with continuous subcutaneous terbutaline.RESULTS: There were significantly more days gained during subcutaneous treatment than during oral treatment (34.0±19.8 versus 19.3±15.3 days). Thirty-three percent of desired prolongation was achieved with oral terbutaline, whereas 79% of desired prolongation was achieved with subcutaneous terbutaline(p<0.001). Patients gained a mean of 53.4±21.4 days overall with outpatient tocolysis. The mean gestational age at delivery was 35.2±1.9 weeks.CONCLUSION: Continuous subcutaneous terbutaline was superior to oral terbutaline in prolonging gestation in women with twin gestations.

Clinical and economic outcomes of continuous subcutaneous tocolysis

OBJECTIVE Our purpose was to compare maternal and perinatal outcomes of teenage and adult pregnancies with mild gestational hypertension remote from term managed with an outpatient program. STUDY DESIGN A matched cohort design was used. Maternal and perinatal outcomes of 60 teenage pregnancies with mild gestational hypertension remote from term were compared with 120 adult controls 20 to 42 years old. The groups were matched for race, gestational age, and proteinuria status at enrollment. All were monitored on an outpatient basis with four times daily automated blood pressure measurement and daily assessment of weight, proteinuria, and fetal movement. RESULTS The mean gestational age at enrollment was 33.5 +/- 2.6 weeks for both groups (range 27 to 36 weeks). Only 60% of teenagers had a high school degree or equivalent compared with 76% of adults (p = 0.024). The teenagers were more likely than the adults to be of single marital status (75% vs 13%, p = 0.015). The mean gestational age at delivery (37.0 +/- 2.0 vs 37.0 +/- 2.2 weeks), mean pregnancy prolongation (23.5 +/- 19.0 vs 24.5 +/- 17.4 days), and mean birth weights (2915 +/- 669 vs 2879 +/- 678 gm) were not statistically different between the teenagers and adults (all p > 0.05). There were no stillbirths, neonatal deaths, or cases of eclampsia in either group. CONCLUSIONS In spite of a study population characterized by limited education, single marital status, and young age at enrollment, monitored outpatient management of mild gestational hypertension remote from term in teenage pregnancies is associated with maternal and perinatal outcomes similar to those observed in adults.

Mild gestational hypertension remote from term: Progression and outcome☆

Abstract Objective: To compare pregnancy and economic outcomes in women receiving inpatient (IP) versus outpatient (OP) tocolysis with subcutaneous terbutaline infusion (STI) following IP stabilization of preterm labor (PTL). Study design: The following inclusion criteria were applied to a database of women participating in a PTL identification program: 24–33.9 weeks gestational age (GA) and documented cervical exam (CX) at start of STI. Exclusion criteria were CX at the start of STI ≥ 3 cm or maternal or fetal instability requiring IP care or both. Inpatient STI patients were matched 1:1 to OP STI patients by CX, GA at the start of STI, and fetal number. Pregnancy and cost outcomes were examined with matched-pairs statistical analysis. Results: Ninety matched pairs (180 patients) were analyzed. Twin gestations accounted for 42.2%. Data are presented in the table; all P IP (n = 90) OP (n = 90) GA delivery (weeks) 34.1 ± 2.9 35.8 ± 1.9 Costs (

Impact of the fetal fibronectin assay on admissions for preterm labor

)—Antenatal IP days 1,162 ± 12,889 3,780 ± 4,690 —OP days 0 9,432 ± 4,761 Costs (

Demographic and obstetric factors influencing pregnancy outcome in twin gestations

)—NICU days 23,688 ± 33,836 8,884 ± 16,564 Total costs (

Pregnancy prolongation in triplet pregnancies. Oral vs. continuous subcutaneous terbutaline.

) per pregnancy 54,851 ± 48,720 25,279 ± 26,319 Conclusion: Women receiving OP STI had fewer preterm deliveries, fewer low-birth-weight and very-low-birth-weight infants, and significantly lower total costs than those receiving IP STI. Outpatient-administered STI appears to be a cost-effective and viable alternative in this select patient population.