601: Direction of prior scar and uterine defect: a systematic review

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Poster Session IV Epidemiology, Global Maternal-Fetal Public Health, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics www.AJOG.org

601 Direction of prior scar andterine defect: a systematic review

Nicole Marshall1, Jeanne-Marie Guise1

1Oregon Health & Science University, Portland, OROBJECTIVE: To determine the incidence of uterine rupture/dehiscence

y direction of prior uterine incision among women undergoing trialf labor after prior cesarean.

STUDY DESIGN: This study was performed as part of a systematic re-view conducted to inform the 2010 NIH Consensus DevelopmentConference on Vaginal Birth After Cesarean: New Insights. Publishedstudies were identified from searches of MEDLINE®, Cochrane Da-tabase of Systematic Reviews, National Centre for Reviews and Dis-semination (1980 to September 2009), reference lists, and nationalexperts. English language, general population studies of women fromdeveloped countries with one or more prior cesarean were included.Due to inconsistent definitions of uterine rupture and dehiscence,“uterine defect” is reported.RESULTS: 3,134 citations were identified, 963 full-text papers were re-iewed, and 203 met inclusion criteria and were quality rated. Tentudies provided information on impact of direction of prior uterinencision on uterine defect in subsequent pregnancies. The overallterine defect rate was 0.46%. 7 studies reported on 342 women withrior low vertical incisions and found 2 cases of uterine rupture and 1terine defect for a defect rate of 0.88%. 5 studies including 4808omen with an unknown scar reported 31 uterine defects for a defect

ate of 0.64%. Women with prior classical, T, or J incisions had aterine defect rate of 4.7%, which included 20 defects in 428 women

rom 6 studies.CONCLUSIONS: Women with an unknown scar have a similar risk of

terine defect compared to women with a prior low transverse cesar-an and are reasonable candidates for a trial of labor. Limited studiesuggest that women with a prior low vertical scar are at slight but notignificantly increased risk of uterine defect. Women with prior clas-ical incisions are at increased risk of uterine defects and should avoidabor.

602 Withdrawn

603 Amphetamine exposure and birth outcomes:systematic review and meta-analyses

Noor Ladhani1, Prakesh Shah2, Kellie Murphy3

1University of Toronto, Toronto, ON, 2Mount Sinai Hospital, Toronto,ON, 3Mount Sinai Hospital, University of Toronto, Toronto, ONOBJECTIVE: To systematically review the relationship between am-

hetamine use during pregnancy and birth outcomes including pre-erm birth (PTB), low birth weight (LBW) and small for gestationalge (SGA) births.

STUDY DESIGN: A comprehensive search of electronic databases waserformed to identify relevant studies. The MOOSE criteria were usednd risks of bias in included studies were assessed. Data were extractedy two reviewers. Meta-analyses on the results of these studies, usinghe random effects model, were performed to calculate pooled oddsatio (OR) and confidence intervals (CI).

RESULTS: Eight observational cohort studies providing unadjusted es-imates were included. The settings of these studies were tertiary careentres in a variety of geographic settings. Significant increases in un-djusted risks of PTB (OR 3.51, 95% CI 2.53, 4.87), LBW (OR 3.97,5% CI 2.45, 6.43), and SGA births (OR 6.14, 95% CI 1.73, 21.79)ere identified among women who used amphetamines in pregnancy.he mean birth weight was significantly lower among amphetamine-xposed pregnancies (mean difference �279g, 95% CI �485,�74).ensitivity analyses confirmed an increase in the unadjusted risks ofBW, PTB, and SGA for geographic region, year of publication, match

S240 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

CONCLUSIONS: Amphetamine use in pregnancy may be associated withdverse birth outcomes. As global rates of amphetamine use increases,hysicians should inquire about amphetamine exposure in pregnancynd encourage cessation to prevent these adverse outcomes. As well,ur knowledge of the effects associated with amphetamine exposureeeds to be expanded with further research and studies of adjustedutcomes.

604 Topiramate: a novel risk factor for IUGR and LBW?Robert Mittendorf 1, Sonia Hernandez-Diaz2, Lewis B. Holmes3

1Loyola University Health System, Maywood, IL, 2Harvardchool of Public Health, Boston, MA, 3Massachusettseneral Hospital for Children, Boston, MA

OBJECTIVE: Is topiramate a risk factor for intrauterine growth restric-ion (IUGR) and low birth weight (LBW, �2,500 g)?

STUDY DESIGN: We analyzed data from the North American AED (an-tiepileptic drug) Pregnancy Registry (MassGeneral for Children, Bos-ton). From Registry inception in 1997, through January 1, 2010, 6,684,women taking an AED and a reference group of 419 women not takingAEDs voluntarily enrolled. In this study, the exposed were defined asbabies whose mothers took topiramate monotherapy (no otherAEDs) during pregnancy. We collected maternal data on other drugusage (including vitamins and folate), demographics (such as ciga-rette smoking, level of education, and marital status), and presence ofmajor malformations in newborns, as well as their growth parameters(birth weight and length). Analyses were restricted to singleton, non-malformed liveborns who had complete follow-up.RESULTS: Data were available for 267 topiramate-exposed babies and

76 controls. Among the exposed, mean birth weights were 296 g lesshan controls (P�.001) ((see Table). LBW was also more common foropiramate-exposed (9% vs. 4%) ((P�.01). Gestational length for ex-osed (39.1 weeks) and controls (39.4 weeks) were similar and notignificantly different. In multivariate regression controlling formoking (aside from shorter gestational length, the most importantredictor of decreased birth weight), education and marital status,opiramate-exposed babies had a higher risk of LBW (Adjusted OR.2, 95% CI l.0 to 4.7). Length at birth was 2 cm less in topiramate-xposed babies than controls. Analyses for dose-response are pending.

CONCLUSIONS: Despite the limitations of observational studies, ournding of a substantial and clinically relevant (about 300 g) decrease

n mean birth weight among babies exposed to topiramate in uteroaises concern. Given that some adults taking topiramate lose weightObes Res 2003;11:556-62; Obes Res 2003;11:722-33; Int J Obes 2007;1:1140-7), is it possible that the decreased birth weights seen in ourtudy are mediated by a similar physiologic mechansim (Nutrition000;16:961-6)?

Birth weights and gestational ages:

Parameters:Topiramate:n�267 Controls: n�376 P.value:

Mean weight (sd) 3,168 g (527) 3,464 g (532) �.001..........................................................................................................................................................................................

LBW, n (%) 24 (9%) 15 (4%) .01..........................................................................................................................................................................................

Pregnancy length (sd) 39.1 wks (2.0) 39.4 wks (3.3) NS..........................................................................................................................................................................................

605 “In pain thou shalt bring forth boys”ale gender complicates term deliveries

Ronit Haimov-Kochman1, Eliana Ein Mor1, Benny Bar-Oz1,frat Esh-Broder1, David Mankuta1, Simcha Yagel1

1Hadassah Hebrew University Medical Center, Jerusalem, IsraelOBJECTIVE: To study whether the sex of the offspring is a risk factor fornstrumental or cesarean delivery and distress during labor.

STUDY DESIGN: A retrospective study of computerized 34410 singletonbirth records which took place at the birth centers of Hadassah He-brew University Medical Center in Jerusalem during the period of

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