Niki K. Bergauer

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

Home Subcutaneous Metoclopramide Therapy for Hyperemesis Gravidarum

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.

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

OBJECTIVE:To describe the use of subcutaneous (s.c.) metoclopramide in the outpatient treatment of hyperemesis gravidarum.STUDY DESIGN:In a retrospective design, women who received continuous s.c. metoclopramide for treatment of hyperemesis gravidarum were identified from a national database. Data analysis included weight at start and stop of treatment, frequency of resolution of symptoms, and side effects of medication. In addition, data were collected on adjuvant therapies.RESULTS:Between January and December of 1997, there were 646 women with hyperemesis gravidarum who received continuous s.c. metoclopramide on an outpatient basis. A total of 413 patients (63.9%) had complete resolution of symptoms. Seventy-five percent of patients had received one or more antiemetic medications before initiation of s.c. metoclopramide. A total of 192 patients (30.5%) reported at least one side effect related to treatment. The majority of reported side effects were considered mild and did not require discontinuation of s.c. metoclopramide.CONCLUSION: S.c. metoclopramide appears to be a safe, effective treatment for hyperemesis gravidarum. Outpatient treatment may result in decreased costs compared with inpatient hospitalization.

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.

Is 34 weeks of gestation an acceptable goal for a complicated singleton pregnancy

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 assess the incidence of NICU admission, respiratory distress syndrome (RDS), and ventilator use in infants delivering between 34 and 36 weeks of gestation because of preterm labor (PTL). Study design: Singleton gestations with delivery at 34–36 weeks of gestation because of PTL were identified from a database of women completing an outpatient PTL identification program between May 1995 and March 2000. Inclusion criteria were PTL hospitalization leading to delivery without attempted tocolysis. Excluded were indicated deliveries. Statistics used included ANOVA, Kruskal-Wallis H and Pearson’s X 2 . Results: A total of 2,849 infants were identified. Risk of NICU admission decreases by 47.4% from weeks 34 to 35 and by 41.9% from weeks 35 to 36 (all P values below are 34 weeks n = 370 35 weeks n = 783 36 weeks n = 1,696 NICU 54.6% 28.7% 16.7% NICU days 9.5 ± 10.9 8.1 ± 9.1 7.7 ± 8.1 RDS 12.2% 9.1% 5.4% Ventilator use 9.2% 5.6% 3.1% Conclusion: Rates of NICU admission, RDS, and need for ventilatory assistance decrease significantly with each advancing week of gestation. These data indicate that benefit is derived in prolonging pregnancy beyond 34 weeks.