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based on the 2003 version of the Birth Certificate, it can be currently
used by any state.
749 How to manage isolated oligohydramnios at late
preterm? Lessons from a population based study
Offer Erez1, Noa Brzezinski Sinai1, Tal Rafaeli-Yehudai1,
Majdi Imterat1, Salvatore Andrea Mastrolia2,
Maayan Yitshak-Sade1, Moshe Stavsky1
1
Soroka University Medicial Center, Beer Sheva, Israel, 2Azienda Ospedaliero-
Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo
Moro”, Bari, Italy
OBJECTIVE: The management of isolated oligohydramnios occurring
at 34-36.6 weeks of gestation is under debate. The objective of this
study was to determine the maternal and neonatal outcome resulting
from induction of labor vs. expectant management in women with
isolated oligohydramnios at late preterm.
STUDY DESIGN: This retrospective population based cohort study
included 3 groups: 1) Conservative management-women with iso-
lated oligohydramnios that delivered spontaneously (n¼146); 2)
active management-women with isolated oligohydramnios who
underwent induction of labor (n¼ 114); 3) Control group-women
with normal amount of amniotic fluid who delivered at 34-36.6
weeks (n¼9,225).
RESULTS: The 9,485 women had 11,089 births divided into 146 in the
conservative management group, 115 in the active management
group, and 10828 in the control group. The rate of inducing labor
was higher in the oligohydramnios group compared to the control
group (75%, 32.6% respectively). The rate of caesarian sections was
higher in the conservative than the active management groups at 35
weeks (57.5% vs. 18.2%, p<0.001) and 36 weeks (52.0% vs. 3.0%, P
<0.001) of gestation. The main indication for caesarean section was
mal presentation of the fetus (60.6% vs 22.2%, p<0.001). Neonates
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
Poster Session V
in the active management group had a higher rate of fever of the
newborn after delivery than those in the conservative (15.2% vs
27.9%, p¼0.03).No difference in maternal and neonatal complica-
tions were documented between the study groups.
CONCLUSION: Women with isolated oligohydramnios had a higher
rate of induction of labor compared with women with normal
amount of amniotic fluid. There was a higher rate of caesarian
sections in the conservative management group compared to the
active management, especially because non-vertex presentation.
Although the active management of isolated oligohydramnios during
the late preterm was associated with a lower rate of cesarean de-
liveries, this is mainly attributed to the higher proportion of mal
presentation in this group that would have been delivered by ce-
sarean anyway. Moreover, induction of labor comes with a price of
increased neonatal fever, suggesting that the beneficial effect of in-
duction of labor in women with isolated oligohydramnios at the late
preterm period should be reconsidered.
750 The effects of maternal obesity on fetal and neonatal
outcomes among those born large for gestational age
Ruofan Yao1, Bo Y. Park2, Aaron B. Caughey3
1
University of Maryland Medical Center, Baltimore, MD, 2Johns Hopkins
University, School of Public Health, Baltimore, MD, 3Oregon Health &
Science University, Portland, OR
OBJECTIVE: It is unclear if the association between maternal obesity
and higher birth weight is physiological or pathological. The purpose
of this study is to determine the differences in fetal and neonatal
outcomes among large for gestational age(LGA) births in obese
women compared to normal weight women.
STUDY DESIGN: This was a retrospective cohort study of all non-
anomalous singleton neonates born in Texas from 2006-2011.
Analysis was limited to births between 34 and 42 weeks gestation
with birth weight above the 90th percentile among this cohort.
Results were stratified by maternal pre-pregnancy BMI, classified
according to WHO guideline. Neonatal and fetal outcomes of in-
terest included stillbirth, neonatal death, neonatal intensive care
unit(NICU) admission and low 5 minute APGAR scores. These
outcomes were analyzed for births above the 90th, 95th and 97th
percentile. Multivariable logistic regression analysis was performed
to estimate the association between maternal pre-pregnancy obesity
and fetal/neonatal outcomes compared to normal weight controls
controlling for potential confounding variables.
RESULTS: After exclusion, 236,017 births were analyzed. The preva-
lence of LGA births among obese women (15.6%) was higher than
normal weight controls (8.5%, p<0.001). The rates of stillbirth
among normal weight women for birth weight above 90th, 95th and
97th percentile were 4.8, 8.8 and 14.0 per 1,000 births respectively. In
comparison the rates among obese women were 5.2(OR:1.11
[.97,1.26]), 10.3(OR:.95[.83,1.09]) and 14.9(OR: .87[.76, .99]). The
rates of neonatal deaths among normal weight women were 3.3, 3.7,
and 3.6 per 1,000 births respectively. In comparison the rates among
obese women were 3.0(OR: .91[.76,1.08]), 2.8(OR: .74[.56, .94]),
and 2.9(OR: .81[.61,1.07]) respectively. The rates of NICU admis-
sion and low APGAR score were significantly higher among obese
pregnancies compared to normal weight controls (figure 1).
CONCLUSION: Maternal obesity is not associated with increased risks
of stillbirth or neonatal death among infants born LGA. Compared
to normal weight controls, maternal obesity is associated with a
reduction in stillbirth among neonates with birth weight greater than
97th percentile, and a reduction in neonatal death among neonates
with birth weight greater than 95th percentile.
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