Poster Session IV
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881 The optimal timing of induction of labor in
uncomplicated twin pregnancy
Su Jin Sung1, Seung Mi Lee1, Seung Hyun Bang1,
Young Im Kim1, Chan-Wook Park1, Joong Shin Park1,
Jong Kwan Jun1
1
Department of Obstetrics and Gynecology, Seoul National University
College of Medicine, Seoul, Republic of Korea
OBJECTIVE: Recent guidelines recommend the planned delivery in
twin pregnancy as 38 weeks for uncomplicated dichorionic twin
pregnancies and as 34-37+6 weeks for uncomplicated mono-
chorionic diamniotic twin pregnancies. However, the optimal timing
of induction of labor in twin pregnancies has not been well studied.
In the current study, we compared the pregnancy and neonatal
outcomes between women with induction at 37 weeks and those
who were nonintervention at 37 weeks and allowed the pregnancy to
progress after the time.
STUDY DESIGN: The study population consisted of 1228 term twin
pregnant women who were candidates for trial of labor. They were
divided into 2 groups: group 1, women who were planned as in-
duction of labor at 37-37+6 weeks (induction group, n¼488 in
dichorionic twin, 143 in monochorionic twin); group 2, women who
were nonintervention at 37 weeks and allowed the pregnancy to
progress after the time. (expectant management group, n¼384 in
dichorionic twin, 92 in monochorionic twin). The timing of in-
duction after 38 weeks in group 2 was at the discretion of the
attending physician. Women who delivered due to obstetric indica-
tion (ex. preeclampsia, oligohydramnios, fetal growth restriction)
and cases with fetal death in utero or fetal anomaly were excluded.
The primary outcome was cesarean section rate and perinatal out-
comes (Apgar scores, neonatal intensive care unit (NICU) admis-
sion, umbilical cord blood gases, neonatal morbidity).
RESULTS: No significant differences were observed in cesarean de-
livery rate between two groups regardless of chorionicity. In mon-
ochorionic twin pregnancies, neonates born to women in group 2
(expectant management group) had higher risk for admission to
NICU and lower pH in cord blood than neonates in group 1. In
dichorionic twin pregnancies, the perinatal outcomes were not
different between the two groups.
CONCLUSION: Induction of labor at 37 weeks resulted in reduced
adverse perinatal outcomes compared to expectant management in
monochorionic twin pregnancies. The optimal timing of induction
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of labor in dichorionic pregnancies beyond 38 weeks needs further
studies.
882 A comparison of quantified versus estimated
blood loss at the time of cesarean delivery
Keshia Torres1, David McKenna2, Samantha Wiegand2
1
Wright State University, Dept of ObGyn, Dayton, OH, 2Wright State
University, Dayton, OH
OBJECTIVE: To compare the diagnostic accuracy of visual estimation
of blood loss (EBL) versus quantified blood loss (QBL) for the tar-
geted outcomes of blood transfusion and hemoglobin (Hgb) drop 
3 gm/dL after cesarean delivery.
STUDY DESIGN: Comparison of EBL versus QBL in a cohort of
women being delivered in a tertiary care facility from July 1, 2017 e
July 31, 2018 via scheduled and unscheduled non-emergent cesarean
delivery. Maternal/neonatal demographics were collected along with
outcome measures to include pre-operative hemoglobin, post-
operative hemoglobin, and blood transfusion. EBL versus QBL for
identifying postpartum hemorrhage were compared utilizing the
area under the ROC curve for the targeted outcomes of blood
transfusion and hemoglobin decline of more than 3 grams/dL.
RESULTS: From July 1, 2017 e July 31, 2018 there were 994 deliveries
with complete data. There were 40 women (4.0%) who received red
cell transfusions and 132 (13.3%) who had a post-operative hemo-
globin drop of 3grams/dL. In the majority of cases (701/995,
70.5%), QBL exceeded EBL. In ROC curve analysis, the area under
the curve estimate was 0.67 for QBL vs 0.6 for EBL to predict the
need for blood transfusion; this was not statistically significant
(difference ¼ 0.074, 95% CI -0.023 - 0.171, p¼0.13). The area under
the curve estimate was 0.69 for QBL vs 0.646 for EBL to predict post-
partum hemoglobin drop of > 3 grams/dL; this was not statistically
significant (difference ¼ 0.044, 95% CI -0.011 - 0.100, p¼0.12).
CONCLUSION: QBL and EBL perform similarly in scheduled and non-
emergent cesarean deliveries for identifying hemorrhage utilizing the
target outcomes of blood transfusion and drop in Hgb  3 gm/dL.
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Costs and benefits should be considered further before imple-
menting QBL as a standard of care to predict postpartum
hemorrhage.
883 The association between personal weight gain
goals and appropriate gestational weight gain
Annie Dude1, Beth Plunkett2, Michelle Kominiarek3
1
University of Chicago, Chicago, IL, 2NorthShore University HealthSystem,
Evanston, IL, 3Northwestern Memorial Hospital, Chicago, IL
OBJECTIVE: To determine whether having the correct personal
gestational weight gain (GWG) goal was associated with appropriate
GWG.
STUDY DESIGN: In this prospective cohort of nulliparas with singleton
gestations, women were asked at visit 1 (6-13 weeks’ gestation)
whether they had a goal GWG, and what that goal was. Further, they
were asked whether their provider discussed GWG goals, and what
Supplement to JANUARY 2020 American Journal of Obstetrics & Gynecology
Poster Session IV
that goal was. Personal and provider recommended GWG goals were
classified as correct vs incorrect according to the 2009 Institute of
Medicine (IOM) guidelines by visit 1 body mass index (BMI)
category (underweight, normal weight, overweight, obese). The
primary outcome was GWG, defined as the difference between visit 1
weight and final weight prior to delivery, classified as inadequate,
appropriate, or excessive, based on the IOM guidelines. Student t
and chi square tests were used for bivariable analyses, and multi-
nomial logistic regression was performed to control for confounders.
RESULTS: Of 6,755 women, 3,821 (56.6% of all eligible women) had a
personal GWG, 2,596 (68.1%) of whom had the correct GWG goal.
2,210 (32.7% of all eligible women) recalled a discussion with their
provider regarding GWG goals, and 1,548 (70.7%) reported the
correct GWG goal. Having the correct personal GWG goal was
associated with age, race/ethnicity, education, insurance, smoking,
marital status, and BMI (Table 1). Having a GWG goal in general
was not associated with appropriate GWG. Having the correct GWG
goal was associated with a decreased risk of both excessive GWG
(adjusted relative risk ratio [aRRR] ¼ 0.76, 95% confidence interval
[CI] 0.64 e 0.91) and inadequate GWG (aRRR ¼ 0.68, 95% CI ¼
0.54 e 0.83, Table 2). Discussing GWG goals with a provider was not
associated with either inadequate (aRRR ¼ 0.99, 95% CI 0.85-1.15)
or excessive GWG (aRRR ¼ 0.91, 95% CI 0.81-1.03), even if the
provider’s recommendations for GWG were correct [aRRR ¼ 0.89,
95% CI 0.66 e 1.19 for inadequate; aRRR ¼ 0.91, 95% CI 0.72 e
1.16 for excessive GWG).
CONCLUSION: Nulliparas with the correct personal GWG goal were
more likely to have appropriate GWG.
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