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Background The Twin Birth Study randomized women with uncomplicated pregnancies, between 32 0/7 -38 6/7 weeks' gestation where the first twin was in cephalic presentation, to a policy of either a planned cesarean or planned vaginal delivery. The primary analysis showed that planned cesarean delivery did not increase or decrease the risk of fetal/neonatal death or serious neonatal morbidity as compared with planned vaginal delivery. Objective This study presents the secondary outcome of death or neurodevelopmental delay at 2 years of age. Study Design A total of 4603 children from the initial cohort of 5565 fetuses/infants (83%) contributed to the outcome of death or neurodevelopmental delay. Surviving children were screened using the Ages and Stages Questionnaire with abnormal scores validated by a clinical neurodevelopmental assessment. The effect of planned cesarean vs planned vaginal delivery on death or neurodevelopmental delay was quantified using a logistic model to control for stratification variables and using generalized estimating equations to account for the nonindependence of twin births. Results Baseline maternal, pregnancy, and infant characteristics were similar. Mean age at assessment was 26 months. There was no significant difference in the outcome of death or neurodevelopmental delay: 5.99% in the planned cesarean vs 5.83% in the planned vaginal delivery group (odds ratio, 1.04; 95% confidence interval, 0.77–1.41; P = .79). Conclusion A policy of planned cesarean delivery provides no benefit to children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32 0/7 -38 6/7 weeks' gestation where the first twin is in cephalic presentation.

Objective The purpose of this study was to determine whether planned cesarean delivery for the singleton fetus in breech presentation at term reduces the risk of death or neurodevelopmental delay at 2 years of age. Study design In selected centers in the Term Breech Trial, children were screened for abnormalities at ≥2 years of age with the Ages and Stages Questionnaire, followed by a neurodevelopmental assessment if the Ages and Stages Questionnaire score was abnormal. Results A total of 923 of 1159 children (79.6%) from 85 centers were followed to 2 years of age. The risk of death or neurodevelopmental delay was no different for the planned cesarean than for the planned vaginal birth groups (14 children [3.1%] vs 13 children [2.8%]; relative risk, 1.09; 95% CI, 0.52- 2.30; P =.85; risk difference, +0.3%; 95% CI, −1.9%, +2.4%). Conclusion Planned cesarean delivery is not associated with a reduction in risk of death or neurodevelopmental delay in children at 2 years of age.

The objective of the study was to assess whether recent data reporting survival of preterm infants introduce a bias from the use of varying denominators.We performed a systematic review of hospital survival of infants less than 1000 g or less than 28 weeks. Included publications specified the denominator used to calculate survival rates.Of 111 eligible publications only 51 (46%) specified the denominators used to calculate survival rates: 6 used all births, 25 used live births, and 20 used neonatal intensive care unit admissions. Overall rates of survival to hospital discharge ranged widely: from 26.5% to 87.8%. Mean survival varied significantly by denominator: 45.0% (±11.6) using a denominator of all births, 60.7% (±13.2) using live births, or 71.6% (±12.1) using used neonatal intensive care unit admissions (P ≤ .009 or less for each of 3 comparisons).Variations in reported rates of survival to discharge for extremely low-birthweight (1000 g) and extremely low-gestational-age (28 weeks) infants reflect in part a denominator bias that dramatically affects reported data.

Objective This study was undertaken to compare maternal outcomes at 2 years postpartum after planned cesarean section and planned vaginal birth for the singleton fetus in breech presentation at term. Study design In selected centers in the Term Breech Trial, mothers completed a structured questionnaire at 2 or more years postpartum to determine their health in the previous 3 to 6 months. Results A total of 917 of 1159 (79.1%) mothers from 85 centers completed a follow-up questionnaire at 2 years postpartum. There were no differences between groups in breast feeding, relationship with child or partner, pain, subsequent pregnancy, incontinence, depression, urinary, menstrual or sexual problems, fatigue, or distressing memories of the birth experience. Planned cesarean section was associated with a higher risk of constipation ( P =.02). Conclusion Maternal outcomes at 2 years postpartum are similar after planned cesarean section and planned vaginal birth for the singleton breech fetus at term.

or gestational age at birth? A secondary analysis from the multiple courses of antenatal corticosteroids for preterm birth study (MACS) Kellie Murphy, Andrew Willan, Mary Hannah, Arne Ohlsson, Edmond Kelly, Stephen Matthews, Saroj Saigal, Elizabeth Asztalos, Sue Ross, Marie-France Delisle, Kofi Amankwah, Patricia Guselle, Amiram Gafni, Shoo Lee, Anthony Armson Mount Sinai Hospital, University of Toronto, Maternal Fetal Medicine, Toronto, ON, Canada, SickKids Research Institute, Child Health Evaluative Sciences, Toronto, ON, Canada, University of Toronto, Department of Obstetrics and Gynecology, Toronto, ON, Canada, University of Toronto, Department of Paediatrics, Toronto, ON, Canada, Paediatrics, Mount Sinai Hospital, Paediatrics, Toronto, ON, Canada, University of Toronto, Physiology, Toronto, ON, Canada, McMaster University, Paediatrics, Hamilton, ON, Canada, Sunnybrook Health Sciences Centre, Paediatrics, Toronto, ON, Canada, Foothills Medical Centre, Obstetrics and Gynecology, Calgary, AB, Canada, Children’s & Women’s Health Centre of British Columbia, Obstetrics and Gynecology, Vancouver, BC, Canada, York Central Hospital, Obstetrics and Gynecology, Richmond Hill, ON, Canada, Sunnybrook Research Institute, Centre for Mother, Infant and Child Research, Toronto, ON, Canada, McMaster University, Clinical Epidemilogy and Biostatistics, Hamilton, ON, Canada, University of Toronto, Pediatrics, Obstetrics and Gynecology and Physiology, Toronto, ON, Canada, IWK Health Centre, Obstetrics and Gynaecology, Halifax, NS, Canada OBJECTIVE: Multiple courses of Antenatal Corticosteroids for preterm birth Study (MACS) was an international multi-centered doubleblind randomized controlled trial of single vs. multiple courses of antenatal corticosteroids (ACS). Infants exposed to ACS experienced similar composite morbidity and mortality as compared to placebo (12.9 % ACS vs. 12.5% placebo) OR 1.04 (CI 0.77-1.39 p 0.83). Infants in the ACS group were smaller. They weighed less (2216 g vs. 2330 g, p 0.0026), were shorter (44.5 cm vs. 45.4 cm, p 0.001) and had a smaller head circumference (31.1 cm vs. 31.7 cm, p 0.001) vs. placebo. The objective of these secondary analyses was to determine the effect of multiple courses of ACS on infant size, controlling for gestational age at birth and other confounders, and to determine if there was a dose response relationship between infant size and number of courses of ACS. STUDY DESIGN: All women (n 1858) and infants (n 2304) enrolled in MACS were included. The gestational age at birth was compared between randomized groups. Multiple linear regression analyses were undertaken to estimate differences (SE) in birth weight, length and head circumference, for the ACS vs. placebo groups, controlling for gestational age at birth and other confounders. RESULTS: Compared to placebo, infants exposed to ACS were born earlier (estimated difference [SE]: 0.43 weeks [0.17], p 0.0098). Controlling for gestational age at birth and other known confounders, multiple courses of ACS were associated with a decrease in birth weight (-33.5 g [SE 16.7] p 0.045), length (-0.3 cm [SE 0.14] p 0.0187) and head circumference (-0.3 cm [SE 0.08] p 0.0003). Lastly, for each additional course of ACS, there was a trend towards an incremental decrease in birth weight, length and head circumference. CONCLUSION: Infants exposed to multiple courses of ACS were born earlier and were smaller. In addition, a dose response was noted between the increasing number of courses of ACS and a decrease in birth weight, length and head circumference. Therefore, administration of multiple courses of ACS, every 14 days, is not recommended. 499 Respiratory outcomes of early term birth Kobina Ghartey, Jaclyn Coletta, Liza Lizarraga, Elizabeth Murphy, Cande V. Ananth, Cynthia Gyamfi Columbia Presbyterian, Maternal Fetal Medicine, New York, NY, Columbia University Medical Center, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York, NY, Columbia University Medical Center, Obstetrics and Gynecology, New York, NY, Columbia University Medical Center, Maternal Fetal Medicine, New York, NY, Columbia University Medical Center, OB/GYN, New York, NY OBJECTIVE: Respiratory morbidity at term is thought to decrease as gestational age approaches 39 weeks. However, the risk still persists. The purpose of this study was to evaluate the extent to which respiratory morbidity is higher for neonates delivered at 37-38 weeks gestation, defined as the early term period, in comparison to morbidity at 39 weeks gestation. STUDY DESIGN: We conducted a retrospective cohort study of term deliveries from 370/7 weeks to 396/7 weeks gestation from January to December 2010. Medical records were reviewed to determine baseline characteristics including maternal demographics, admission diagnosis, indication for delivery, mode of delivery, and prior antenatal corticosteroids. Neonatal outcomes were abstracted from infant charts. Our primary outcome was defined as a composite respiratory morbidity comprised of transient tachypnea of the newborn, respiratory distress syndrome, oxygen usage, CPAP, and intubation. RESULTS: Of 2,273 deliveries between 37-39 weeks, 51% (n 1,169) of women delivered in the early term period. There was a significant increase in adverse neonatal respiratory outcomes in those patients delivered in the early term period (Table). There was a significant decrease in the composite respiratory morbidity in those patients delivered at term as compared with the early term period (Figure). CONCLUSION: The two-fold increased risk of respiratory morbidity of infants in the early term period underscores the urgency for limiting non-indicated deliveries to 39 weeks gestation. Poster Session III Doppler Assessment, Fetus, Prematurity www.AJOG.org