Lena Kim

Racial and ethnic differences in the prevalence of placenta previa.

Objective:The objective of this study is to determine the prevalence of placenta previa among different racial and ethnic groups.Study Design:We conducted a retrospective cohort study to examine the prevalence of placenta previa among five major racial and ethnic groups: African American, Asian, Caucasian, Hispanic and Native American. We included all deliveries ⩾20 weeks gestation from a large northern Californian Health Maintenance Organization from 1995–2006. A multivariable logistic regression model was used to control for potential confounders.Result:Of the 394 083 deliveries in our cohort, 1580 (0.40%) were complicated by placenta previa. The prevalence of placenta previa was: Asian 0.64%, Native American 0.60%, African American 0.44%, Caucasian 0.36%, Hispanic 0.34% and unknown 0.31% (P<0.001). In our multivariable logistic regression model, only Asians (odds ratio (OR) 1.73, 95% confidence intervals (CI) 1.53–1.95) and African Americans (OR 1.43, 95% CI 1.19–1.72) were at increased risk for having placenta previa, compared with Caucasians.Conclusion:Asian women have the highest prevalence of placenta previa.

Maternal and neonatal outcomes among scheduled versus unscheduled deliveries in women with prenatally diagnosed, pathologically proven placenta accreta

Abstract Objective: To evaluate maternal and neonatal outcomes among scheduled versus unscheduled deliveries in cases of prenatally diagnosed, pathologically proven placenta accreta. Study design: Retrospective cohort of placenta accreta cases delivered in five University of California hospitals. Results: Of 151 cases of histopathologically proven placenta accreta, 82% were prenatally diagnosed. Sixty-seven percent of women underwent scheduled deliveries and 33% were unscheduled. There were no differences in demographics between groups except a higher rate of antepartum bleeding in the unscheduled delivery group (81 versus 53%; p = .003). Scheduled deliveries were associated with a later gestational age at delivery (34.6 versus 32.6 weeks; p = .001), lower blood loss (2.0 versus 2.5 l; p = .04), higher birth weight (2488 versus 2010 g; p < .001), shorter postpartum length of stay (4 versus 5 d; p = .03) and neonatal length of stay (12 versus 20 d; p = .005). Conclusion: Despite a prenatal diagnosis of placenta accreta, 1/3 of these cases require unscheduled delivery, portending poorer maternal and neonatal outcomes.

Low-dose aspirin for prevention of pre-eclampsia and its complications: a cost-effectiveness analysis

Objective The authors investigated whether low-dose aspirin (ASA) is a cost-effective means of reducing the risk of pre-eclampsia. Study Design A decision analytic model was designed comparing ASA prophylaxis vs no prophylaxis in a theoretical cohort of 100 000 pregnant women. Costs and prevalences were derived from existing randomised controlled trails. Utilities were applied to discounted life expectancy to generate quality-adjusted life years (QALYs), which were discounted at 3%. A cost-effectiveness threshold of

339: Racial and ethnic differences in the prevalence of placenta previa

100 000/QALY was utilised. Results ASA prophylaxis is the dominant strategy. It is both cheaper (

190: UC Fetal Consortium (UCfC) multidisciplinary team approach to invasive placenta: Management across a five institution consortium

18 720 vs

634: Maternal and neonatal outcomes of placenta accreta stratified by gestational age at delivery

18 804) and marginally more effective (26.7417 QALYs vs 26.7422 QALYs). Additionally, negative outcomes associated with pre-eclampsia were reduced in the intervention group, most notably fewer preterm births (10 312 vs 10 251). In sensitivity analysis, when the authors varied the efficacy of ASA prophylaxis, it remained cost-effective up to a relative risk of 0.91 for all nulliparous women and 0.98 for women with a 25% risk of pre-eclampsia. Conclusion Low-dose ASA appears to be a cost-effective prophylaxis for pre-eclampsia over a wide range of assumptions, particularly for women at elevated risk for pre-eclampsia. Abstract PM.42 Outcomes for 100,000 Nulliparous Pregnant Women NO ASA ASA Preeclampsia 5000 4150 Preterm Births 103120 10250.5 Neonatal Death 257.1 256.9 Maternal Deaths 13.8 13.1 Neurodevelopmental Disability 370.9 369.7 Costs 51,880,421,000 51,871,989,000 QALYs 2674174.1 2674224.