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BMFMS: Pregnancy Outcome

	PPO.01 STILLBIRTHS: HAVE THINGS CHANGED OVER A DECADE?

TOP PPO.01 STILLBIRTHS: HAVE THINGS... PPO.02 EARLY DETECTION OF... PPO.03 IS IT WORTH... PPO.04 CLINICAL ASSOCIATIONS OF... PPO.05 CHARACTERISTICS OF... PPO.06 MATERNAL SMOKING IN... PPO.07 INTRAUTERINE GROWTH... PPO.08 WITHDRAWN PPO.09 INTRAUTERINE GROWTH... PPO.10 PREGNANCY OUTCOME IN... PPO.11 CONFIDENTIAL ENQUIRY INTO... PPO.12 SEVERE PROTEINURIA AND... PPO.13 MATERNAL TYPE 2... PPO.14 TRENDS IN FETAL... PPO.15 VILLOUS DYSMATURITY: CAN... PPO.16 EXTERNAL CEPHALIC VERSION... PPO.17 IS STILLBIRTH PRECEDED... PPO.18 NEONATAL OUTCOMES OF... PPO.19 OUT-OF-HOSPITAL DELIVERY... PPO.20 PREGNANCY OUTCOME AFTER... PPO.21 THE CHARACTERISTICS OF... PPO.22 ARE THERE DIFFERENCES... PPO.23 DOSE REVERSED TYPE... PPO.24 NEONATAL ENCEPHALOPATHY:... PPO.25 TERM LOW BIRTHWEIGHT... PPO.26 STUDY ON ACCURACY... PPO.27 CERVICAL CERCLAGE AND... PPO.28 WITHDRAWN PPO.29 TIME TO TARGET... PPO.30 BODY MASS INDEX... PPO.31 ADMISSIONS TO AN... PPO.32 NEONATAL MORBIDITY AND... PPO.33 PRETERM PREMATURE RUPTURE... PPO.34 THE LINK CLINIC... PPO.35 PREGNANCY OUTCOMES WITH... PPO.36 A COMPARISON OF... PPO.37 SUBSTANCE ABUSE: CARE... PPO.38 AN AUDIT OF... PPO.39 DOES PROVISION OF... PPO.40 RETROSPECTIVE REVIEW OF... PPO.41 A QUESTIONNAIRE-BASED... PPO.42 TWIN PREGNANCIES MANAGED... PPO.43 PREGNANCY OUTCOMES WITH... PPO.44 TO ASSESS HBSAG... PPO.45 THE USE OF... PPO.46 FOLIC ACID... PPO.47 A RARE CAUSE... PPO.48 EXIGENCIES OF PRENATAL... PPO.49 WITHDRAWN PPO.50 WHY ARE PATIENTS... PPO.51 OUTCOMES OF PREGNANCY... PPO.52 SOCIAL RISKS: THE... REFERENCES

The stillbirth rate has remained stable nationally at 5/1000 births since the 1990s. We aimed to investigate in detail the causes and associations of stillbirths in two cohorts, 10 years apart to determine whether there has been any reduction in the prevalence of potentially preventable stillbirths.

Methods: Information on stillbirths occurring in Liverpool Women’s NHS Foundation Trust between 1995–7 and 2004–6 was collected from perinatal mortality reports, birth registers and an electronic database (Meditech). ReCoDe, placental histology and birthweight centiles were used to examine further the unexplained groups. Results were analyzed using Stats Direct.

Results: We investigated 269 stillbirths. Maternal age and proportion of primiparous women were similar in both cohorts. More than 50% of stillbirths in both groups are classified as unexplained by CEMACH. There is no significant change in the prevalence of fetal growth restriction babies in the unexplained groups over these years (see table).

	PPO.02 EARLY DETECTION OF ADVERSE TRENDS IN HEALTHCARE: A PROSPECTIVE PILOT STUDY EVALUATING THE UTILITY OF THE CUSUM CHART METHOD IN MONITORING QUALITY IN MATERNITY

TOP PPO.01 STILLBIRTHS: HAVE THINGS... PPO.02 EARLY DETECTION OF... PPO.03 IS IT WORTH... PPO.04 CLINICAL ASSOCIATIONS OF... PPO.05 CHARACTERISTICS OF... PPO.06 MATERNAL SMOKING IN... PPO.07 INTRAUTERINE GROWTH... PPO.08 WITHDRAWN PPO.09 INTRAUTERINE GROWTH... PPO.10 PREGNANCY OUTCOME IN... PPO.11 CONFIDENTIAL ENQUIRY INTO... PPO.12 SEVERE PROTEINURIA AND... PPO.13 MATERNAL TYPE 2... PPO.14 TRENDS IN FETAL... PPO.15 VILLOUS DYSMATURITY: CAN... PPO.16 EXTERNAL CEPHALIC VERSION... PPO.17 IS STILLBIRTH PRECEDED... PPO.18 NEONATAL OUTCOMES OF... PPO.19 OUT-OF-HOSPITAL DELIVERY... PPO.20 PREGNANCY OUTCOME AFTER... PPO.21 THE CHARACTERISTICS OF... PPO.22 ARE THERE DIFFERENCES... PPO.23 DOSE REVERSED TYPE... PPO.24 NEONATAL ENCEPHALOPATHY:... PPO.25 TERM LOW BIRTHWEIGHT... PPO.26 STUDY ON ACCURACY... PPO.27 CERVICAL CERCLAGE AND... PPO.28 WITHDRAWN PPO.29 TIME TO TARGET... PPO.30 BODY MASS INDEX... PPO.31 ADMISSIONS TO AN... PPO.32 NEONATAL MORBIDITY AND... PPO.33 PRETERM PREMATURE RUPTURE... PPO.34 THE LINK CLINIC... PPO.35 PREGNANCY OUTCOMES WITH... PPO.36 A COMPARISON OF... PPO.37 SUBSTANCE ABUSE: CARE... PPO.38 AN AUDIT OF... PPO.39 DOES PROVISION OF... PPO.40 RETROSPECTIVE REVIEW OF... PPO.41 A QUESTIONNAIRE-BASED... PPO.42 TWIN PREGNANCIES MANAGED... PPO.43 PREGNANCY OUTCOMES WITH... PPO.44 TO ASSESS HBSAG... PPO.45 THE USE OF... PPO.46 FOLIC ACID... PPO.47 A RARE CAUSE... PPO.48 EXIGENCIES OF PRENATAL... PPO.49 WITHDRAWN PPO.50 WHY ARE PATIENTS... PPO.51 OUTCOMES OF PREGNANCY... PPO.52 SOCIAL RISKS: THE... REFERENCES

 
T. Sibanda, T. Draycott. North Bristol NHS Trust, Bristol, UK

The need for robust systems for monitoring the quality and performance of maternity services has been highlighted.¹ The Cumulative SUM (CUSUM) chart method, proved as an effective tool for the early detection of faulty systems in industry,² could play a role. We conducted a prospective pilot study evaluating the applicability and value of the CUSUM in monitoring outcomes in maternity. Rates of low Apgar scores (5 minute Apgar score <7) in term, cephalic singletons (excluding elective Caesarean sections), delivered at Southmead Hospital were monitored over a 12-month period (2006). With the reference standard set at 0.44%,³ we regarded doubling of this rate as undesirable and set 0.66% as the rate at which a signal was to be raised by the monitoring system.

Results: We detected a significant rise in the rate of low Apgar scores during August 2006. Root cause analysis identified specific training needs that were corrected by an educational intervention. Subsequent monitoring showed a return to the baseline reference rate (0.44%), which was maintained during the rest of the year. The overall rate for the whole of 2006 was eventually 0.53%.

Discussion: Prospective monitoring of clinical outcomes using the CUSUM chart method is both feasible and effective. Early detection of adverse trends provides an opportunity for prompt remedial action and hence prevention of further harm. Wider application of this tool, monitoring key outcomes and quality indicators in maternity, has the potential of leading to overall improvements in the quality and performance of maternity units.

	PPO.03 IS IT WORTH REPEATING FETAL FIBRONECTIN TESTING IN ASYMPTOMATIC WOMEN AT RISK OF SPONTANEOUS PRETERM LABOUR?

TOP PPO.01 STILLBIRTHS: HAVE THINGS... PPO.02 EARLY DETECTION OF... PPO.03 IS IT WORTH... PPO.04 CLINICAL ASSOCIATIONS OF... PPO.05 CHARACTERISTICS OF... PPO.06 MATERNAL SMOKING IN... PPO.07 INTRAUTERINE GROWTH... PPO.08 WITHDRAWN PPO.09 INTRAUTERINE GROWTH... PPO.10 PREGNANCY OUTCOME IN... PPO.11 CONFIDENTIAL ENQUIRY INTO... PPO.12 SEVERE PROTEINURIA AND... PPO.13 MATERNAL TYPE 2... PPO.14 TRENDS IN FETAL... PPO.15 VILLOUS DYSMATURITY: CAN... PPO.16 EXTERNAL CEPHALIC VERSION... PPO.17 IS STILLBIRTH PRECEDED... PPO.18 NEONATAL OUTCOMES OF... PPO.19 OUT-OF-HOSPITAL DELIVERY... PPO.20 PREGNANCY OUTCOME AFTER... PPO.21 THE CHARACTERISTICS OF... PPO.22 ARE THERE DIFFERENCES... PPO.23 DOSE REVERSED TYPE... PPO.24 NEONATAL ENCEPHALOPATHY:... PPO.25 TERM LOW BIRTHWEIGHT... PPO.26 STUDY ON ACCURACY... PPO.27 CERVICAL CERCLAGE AND... PPO.28 WITHDRAWN PPO.29 TIME TO TARGET... PPO.30 BODY MASS INDEX... PPO.31 ADMISSIONS TO AN... PPO.32 NEONATAL MORBIDITY AND... PPO.33 PRETERM PREMATURE RUPTURE... PPO.34 THE LINK CLINIC... PPO.35 PREGNANCY OUTCOMES WITH... PPO.36 A COMPARISON OF... PPO.37 SUBSTANCE ABUSE: CARE... PPO.38 AN AUDIT OF... PPO.39 DOES PROVISION OF... PPO.40 RETROSPECTIVE REVIEW OF... PPO.41 A QUESTIONNAIRE-BASED... PPO.42 TWIN PREGNANCIES MANAGED... PPO.43 PREGNANCY OUTCOMES WITH... PPO.44 TO ASSESS HBSAG... PPO.45 THE USE OF... PPO.46 FOLIC ACID... PPO.47 A RARE CAUSE... PPO.48 EXIGENCIES OF PRENATAL... PPO.49 WITHDRAWN PPO.50 WHY ARE PATIENTS... PPO.51 OUTCOMES OF PREGNANCY... PPO.52 SOCIAL RISKS: THE... REFERENCES

 
M. Chandiramani, P. Seed, A. Briley, L. Poston, A. H. Shennan. King’s College, London, UK

Introduction: Fetal fibronectin (fFN) is a good predictor of spontaneous preterm birth (SPTB). The benefit of repeat testing in high-risk asymptomatic women is unclear.

Objective: To determine the value of repeat fibronectin testing performed at 24 and 27 weeks’ gestation in high-risk asymptomatic women for prediction of SPTB at <34 and <37 weeks’ gestation.

Study Design: We conducted a secondary analysis of a multicentre trial of 900 pregnancies, which underwent fFN testing at 24 and 27 weeks’ gestation. Included pregnancies had at least one previous risk factor for SPTB (mid-trimester loss/preterm delivery, uterine anomaly, cervical surgery or cerclage) and received placebo following positive testing. Those delivering by pre-labour Caesarean sections were excluded. Predictive values of repeat tests for SPTB at <34 and <37 weeks’ gestation were assessed.

Results: 625 women were analyzed for preterm delivery at <34 and <37 weeks’ gestation. The table shows the test performance when both tests are combined.

	PPO.04 CLINICAL ASSOCIATIONS OF PLACENTAL DELAYED VILLOUS MATURATION

TOP PPO.01 STILLBIRTHS: HAVE THINGS... PPO.02 EARLY DETECTION OF... PPO.03 IS IT WORTH... PPO.04 CLINICAL ASSOCIATIONS OF... PPO.05 CHARACTERISTICS OF... PPO.06 MATERNAL SMOKING IN... PPO.07 INTRAUTERINE GROWTH... PPO.08 WITHDRAWN PPO.09 INTRAUTERINE GROWTH... PPO.10 PREGNANCY OUTCOME IN... PPO.11 CONFIDENTIAL ENQUIRY INTO... PPO.12 SEVERE PROTEINURIA AND... PPO.13 MATERNAL TYPE 2... PPO.14 TRENDS IN FETAL... PPO.15 VILLOUS DYSMATURITY: CAN... PPO.16 EXTERNAL CEPHALIC VERSION... PPO.17 IS STILLBIRTH PRECEDED... PPO.18 NEONATAL OUTCOMES OF... PPO.19 OUT-OF-HOSPITAL DELIVERY... PPO.20 PREGNANCY OUTCOME AFTER... PPO.21 THE CHARACTERISTICS OF... PPO.22 ARE THERE DIFFERENCES... PPO.23 DOSE REVERSED TYPE... PPO.24 NEONATAL ENCEPHALOPATHY:... PPO.25 TERM LOW BIRTHWEIGHT... PPO.26 STUDY ON ACCURACY... PPO.27 CERVICAL CERCLAGE AND... PPO.28 WITHDRAWN PPO.29 TIME TO TARGET... PPO.30 BODY MASS INDEX... PPO.31 ADMISSIONS TO AN... PPO.32 NEONATAL MORBIDITY AND... PPO.33 PRETERM PREMATURE RUPTURE... PPO.34 THE LINK CLINIC... PPO.35 PREGNANCY OUTCOMES WITH... PPO.36 A COMPARISON OF... PPO.37 SUBSTANCE ABUSE: CARE... PPO.38 AN AUDIT OF... PPO.39 DOES PROVISION OF... PPO.40 RETROSPECTIVE REVIEW OF... PPO.41 A QUESTIONNAIRE-BASED... PPO.42 TWIN PREGNANCIES MANAGED... PPO.43 PREGNANCY OUTCOMES WITH... PPO.44 TO ASSESS HBSAG... PPO.45 THE USE OF... PPO.46 FOLIC ACID... PPO.47 A RARE CAUSE... PPO.48 EXIGENCIES OF PRENATAL... PPO.49 WITHDRAWN PPO.50 WHY ARE PATIENTS... PPO.51 OUTCOMES OF PREGNANCY... PPO.52 SOCIAL RISKS: THE... REFERENCES

 
M. F. Higgins, E. E. Mooney², F. M. McAuliffe. ¹University College Dublin, Dublin, Ireland, ²National Maternity Hospital, Dublin, Ireland

Aim: Delayed villous maturation (DVM) is a spectrum of disease with reduced vasculosyncytial membrane formation, decreased tertiary villous formation and increased large bullous villi in the more severe grades. There are few data on its significance, but in some series it is associated with an increased risk of stillbirth in the late third trimester. The aim of this study was to assess perinatal factors associated with, and the clinical significance of, the finding of DVM on placental histology.

Methods: A retrospective study investigating all pregnancies with DVM diagnosed on placental histology in a tertiary level unit from December 2000 to August 2006. Over 6 years 2915 placentas were triaged for histopathological assessment, representing 6.1% of all 48 054 deliveries in this time period. 190 (6.3%) of these selected cases showed DVM. Fifteen placentas <34 completed weeks’ gestation were excluded, leaving 175 for further analysis.

Results: When compared with controls matched for gestation and delivering within the same time period (n = 175), DVM was significantly associated with pre-gestational diabetes (8% versus 2.8%, p<0.05; relative risk (RR) 2.8, 95% CI 1.03 to 7.6), gestational diabetes (8.6% versus 3.4%, p<0.05; RR 2.5, 95% CI 0.99 to 6.3) and antenatal or intrapartum intrauterine death (8.6% versus 0%, p<0.05).

Conclusions: DVM is associated with diabetes mellitus and perinatal death. The association with diabetes may be mediated by hyperglycaemia. The relationship between diabetes and delayed villous maturation is being further investigated as part of an ongoing prospective study.

	PPO.05 CHARACTERISTICS OF PREGNANCIES OF WOMEN WITH DIABETES MELLITUS THAT RESULTED IN A BABY WITH CONGENITAL HEART DISEASE IN ENGLAND, WALES AND NORTHERN IRELAND

TOP PPO.01 STILLBIRTHS: HAVE THINGS... PPO.02 EARLY DETECTION OF... PPO.03 IS IT WORTH... PPO.04 CLINICAL ASSOCIATIONS OF... PPO.05 CHARACTERISTICS OF... PPO.06 MATERNAL SMOKING IN... PPO.07 INTRAUTERINE GROWTH... PPO.08 WITHDRAWN PPO.09 INTRAUTERINE GROWTH... PPO.10 PREGNANCY OUTCOME IN... PPO.11 CONFIDENTIAL ENQUIRY INTO... PPO.12 SEVERE PROTEINURIA AND... PPO.13 MATERNAL TYPE 2... PPO.14 TRENDS IN FETAL... PPO.15 VILLOUS DYSMATURITY: CAN... PPO.16 EXTERNAL CEPHALIC VERSION... PPO.17 IS STILLBIRTH PRECEDED... PPO.18 NEONATAL OUTCOMES OF... PPO.19 OUT-OF-HOSPITAL DELIVERY... PPO.20 PREGNANCY OUTCOME AFTER... PPO.21 THE CHARACTERISTICS OF... PPO.22 ARE THERE DIFFERENCES... PPO.23 DOSE REVERSED TYPE... PPO.24 NEONATAL ENCEPHALOPATHY:... PPO.25 TERM LOW BIRTHWEIGHT... PPO.26 STUDY ON ACCURACY... PPO.27 CERVICAL CERCLAGE AND... PPO.28 WITHDRAWN PPO.29 TIME TO TARGET... PPO.30 BODY MASS INDEX... PPO.31 ADMISSIONS TO AN... PPO.32 NEONATAL MORBIDITY AND... PPO.33 PRETERM PREMATURE RUPTURE... PPO.34 THE LINK CLINIC... PPO.35 PREGNANCY OUTCOMES WITH... PPO.36 A COMPARISON OF... PPO.37 SUBSTANCE ABUSE: CARE... PPO.38 AN AUDIT OF... PPO.39 DOES PROVISION OF... PPO.40 RETROSPECTIVE REVIEW OF... PPO.41 A QUESTIONNAIRE-BASED... PPO.42 TWIN PREGNANCIES MANAGED... PPO.43 PREGNANCY OUTCOMES WITH... PPO.44 TO ASSESS HBSAG... PPO.45 THE USE OF... PPO.46 FOLIC ACID... PPO.47 A RARE CAUSE... PPO.48 EXIGENCIES OF PRENATAL... PPO.49 WITHDRAWN PPO.50 WHY ARE PATIENTS... PPO.51 OUTCOMES OF PREGNANCY... PPO.52 SOCIAL RISKS: THE... REFERENCES

 
B. N. Ofoegbu¹, A. Subbarayan¹, A. M. Weindling². ¹Wythenshawe Hospital, Manchester, UK, ²University of Liverpool, Liverpool, UK

Aim: To characterise the pregnancies of women with pre-existing diabetes mellitus (DM) that resulted in a baby with congenital heart disease (CHD).

Methods: For a cohort of 3733 women (3808 pregnancies) with preconceptional diabetes who booked or delivered between 1 March 2002 and 28 February 2003, maternity units (n = 231) provided information on care of women and outcome of the pregnancy to the Confidential Enquiry into Maternal and Child Health (CEMACH) between March 2002 and February 2003.

Results: 54 babies were born with CHD. Information was available for 49 babies born to women with type 1 (n = 40) and type 2 (n = 9) diabetes, respectively. Irrespective of diabetes type, women did not apparently plan adequately for becoming pregnant: there was low folic acid use, high BMI and preconceptional haemoglobin A1C (HbA1C). Median (interquartile range) HbA1C remained high in the first 10 weeks of conception in women with type 1 and type 2 diabetes: 8.7 (5.3–13.8) versus 7.95 (7.2–10.7), respectively. All women had an 18–22-week anomaly scan. 18 women with apparently normal anomaly scan went on to have babies with varying severities of CHD. Three other women with normal anomaly scans had CHD identified in their babies when routinely referred for specialised cardiac scanning. The pre-termination prevalence rate of CHD was seven per 1000 pregnancies compared with a post-termination prevalence of five per 1000.

Conclusions: Glycaemic control (rather than type of diabetes) appeared to be a major factor in the aetiology of CHD. All women with diabetes should be referred for specialised antenatal cardiac scanning.

	PPO.06 MATERNAL SMOKING IN EARLY AND LATE PREGNANCY AND THE RISK OF FETAL GROWTH RESTRICTION

TOP PPO.01 STILLBIRTHS: HAVE THINGS... PPO.02 EARLY DETECTION OF... PPO.03 IS IT WORTH... PPO.04 CLINICAL ASSOCIATIONS OF... PPO.05 CHARACTERISTICS OF... PPO.06 MATERNAL SMOKING IN... PPO.07 INTRAUTERINE GROWTH... PPO.08 WITHDRAWN PPO.09 INTRAUTERINE GROWTH... PPO.10 PREGNANCY OUTCOME IN... PPO.11 CONFIDENTIAL ENQUIRY INTO... PPO.12 SEVERE PROTEINURIA AND... PPO.13 MATERNAL TYPE 2... PPO.14 TRENDS IN FETAL... PPO.15 VILLOUS DYSMATURITY: CAN... PPO.16 EXTERNAL CEPHALIC VERSION... PPO.17 IS STILLBIRTH PRECEDED... PPO.18 NEONATAL OUTCOMES OF... PPO.19 OUT-OF-HOSPITAL DELIVERY... PPO.20 PREGNANCY OUTCOME AFTER... PPO.21 THE CHARACTERISTICS OF... PPO.22 ARE THERE DIFFERENCES... PPO.23 DOSE REVERSED TYPE... PPO.24 NEONATAL ENCEPHALOPATHY:... PPO.25 TERM LOW BIRTHWEIGHT... PPO.26 STUDY ON ACCURACY... PPO.27 CERVICAL CERCLAGE AND... PPO.28 WITHDRAWN PPO.29 TIME TO TARGET... PPO.30 BODY MASS INDEX... PPO.31 ADMISSIONS TO AN... PPO.32 NEONATAL MORBIDITY AND... PPO.33 PRETERM PREMATURE RUPTURE... PPO.34 THE LINK CLINIC... PPO.35 PREGNANCY OUTCOMES WITH... PPO.36 A COMPARISON OF... PPO.37 SUBSTANCE ABUSE: CARE... PPO.38 AN AUDIT OF... PPO.39 DOES PROVISION OF... PPO.40 RETROSPECTIVE REVIEW OF... PPO.41 A QUESTIONNAIRE-BASED... PPO.42 TWIN PREGNANCIES MANAGED... PPO.43 PREGNANCY OUTCOMES WITH... PPO.44 TO ASSESS HBSAG... PPO.45 THE USE OF... PPO.46 FOLIC ACID... PPO.47 A RARE CAUSE... PPO.48 EXIGENCIES OF PRENATAL... PPO.49 WITHDRAWN PPO.50 WHY ARE PATIENTS... PPO.51 OUTCOMES OF PREGNANCY... PPO.52 SOCIAL RISKS: THE... REFERENCES

 
A. Williams, M. Sahota, J. Gardosi. Perinatal Institute, Birmingham, UK

Background: Smoking is known to be associated with fetal growth restriction, but little is known about the relative effects of smoking cessation during pregnancy and how that affects fetal growth.

Methods: Routine collection of maternity data was recently established in Birmingham and the Black Country maternity units. The data are extracted from the standard hand-held pregnancy notes and recorded electronically. The information includes smoking status at the beginning and end of pregnancy. Maternal height, weight, parity and ethnic origin were used to adjust for constitutional variation and calculate a customised birthweight centile. Growth restriction was defined as a birthweight below the tenth customised centile.

Results: The database included details of 9074 pregnancies, from a total of 9421 births delivered during 2007. The overall rate of smoking at booking was 18% and 15.8% still smoked at the end of pregnancy. The rate of fetal growth restriction was 16.5% in pregnancies when the mother did not smoke at any stage. Mothers who smoked throughout pregnancy had a significantly increased risk of having a growth restricted baby (29.3%, odds ratio (OR) 2.1, CI 1.8 to 2.4). In contrast, mothers who smoked in early pregnancy but subsequently stopped had a slightly elevated risk of a growth restricted baby that was not significantly different from non-smokers (19.2%, OR 1.2, CI 0.8 to 1.8).

Conclusions: Cessation of smoking during pregnancy appears to reduce the risk of fetal growth restriction. Larger databases will allow further analysis to assess confounders and interactions with other variables.

	PPO.07 INTRAUTERINE GROWTH RESTRICTION AS A RISK FACTOR FOR INFANT MORTALITY

TOP PPO.01 STILLBIRTHS: HAVE THINGS... PPO.02 EARLY DETECTION OF... PPO.03 IS IT WORTH... PPO.04 CLINICAL ASSOCIATIONS OF... PPO.05 CHARACTERISTICS OF... PPO.06 MATERNAL SMOKING IN... PPO.07 INTRAUTERINE GROWTH... PPO.08 WITHDRAWN PPO.09 INTRAUTERINE GROWTH... PPO.10 PREGNANCY OUTCOME IN... PPO.11 CONFIDENTIAL ENQUIRY INTO... PPO.12 SEVERE PROTEINURIA AND... PPO.13 MATERNAL TYPE 2... PPO.14 TRENDS IN FETAL... PPO.15 VILLOUS DYSMATURITY: CAN... PPO.16 EXTERNAL CEPHALIC VERSION... PPO.17 IS STILLBIRTH PRECEDED... PPO.18 NEONATAL OUTCOMES OF... PPO.19 OUT-OF-HOSPITAL DELIVERY... PPO.20 PREGNANCY OUTCOME AFTER... PPO.21 THE CHARACTERISTICS OF... PPO.22 ARE THERE DIFFERENCES... PPO.23 DOSE REVERSED TYPE... PPO.24 NEONATAL ENCEPHALOPATHY:... PPO.25 TERM LOW BIRTHWEIGHT... PPO.26 STUDY ON ACCURACY... PPO.27 CERVICAL CERCLAGE AND... PPO.28 WITHDRAWN PPO.29 TIME TO TARGET... PPO.30 BODY MASS INDEX... PPO.31 ADMISSIONS TO AN... PPO.32 NEONATAL MORBIDITY AND... PPO.33 PRETERM PREMATURE RUPTURE... PPO.34 THE LINK CLINIC... PPO.35 PREGNANCY OUTCOMES WITH... PPO.36 A COMPARISON OF... PPO.37 SUBSTANCE ABUSE: CARE... PPO.38 AN AUDIT OF... PPO.39 DOES PROVISION OF... PPO.40 RETROSPECTIVE REVIEW OF... PPO.41 A QUESTIONNAIRE-BASED... PPO.42 TWIN PREGNANCIES MANAGED... PPO.43 PREGNANCY OUTCOMES WITH... PPO.44 TO ASSESS HBSAG... PPO.45 THE USE OF... PPO.46 FOLIC ACID... PPO.47 A RARE CAUSE... PPO.48 EXIGENCIES OF PRENATAL... PPO.49 WITHDRAWN PPO.50 WHY ARE PATIENTS... PPO.51 OUTCOMES OF PREGNANCY... PPO.52 SOCIAL RISKS: THE... REFERENCES

 
N. Beamish, A. Francis, J. Gardosi. Perinatal Institute, Birmingham, UK

Background: Reduction of infant mortality is a key public health target, but government strategies have to date paid little attention to antecedent factors. We wanted to investigate the association between intrauterine growth restriction (IUGR) and subsequent infant death, in a 10-year database from Birmingham and the Black Country (B&BC).

Methods: The cohort consisted of all infant deaths notified from B&BC maternity units during 1997–2006. A classification system was devised that included neonatal categories as well as relevant antenatal conditions using ReCoDe,¹ including IUGR defined as <10th customised birthweight centile.

Results: There was a total of 2385 infant deaths over the 10-year period. Antenatal contributing conditions included infection, abruption and intrapartum asphyxia, but most frequently IUGR, which, after excluding congenital anomalies, was present in 42.3% of babies who subsequently died in infancy. Compared with surviving infants, those who died were overall more likely to have been born with IUGR (odds ratio (OR) 3.3, CI 2.9 to 3.7). This association was strongest for preterm births but present also for babies born at mature gestations. It applied in most infant death categories except infection and injury and was highest for extreme prematurity (OR 9.2, CI 7.2 to 11.6), gastrointestinal (4.8, 3.0 to 7.5), respiratory (3.0, 2.5 to 3.6) and neurological (2.7, 1.9 to 3.9) conditions as well as sudden unexpected death in infancy (2.8, 1.9 to 4.0).

Conclusions: IUGR is a frequent antecedent of infant death and may be an important factor contributing to the demise. A low weight at birth suggesting IUGR is a warning sign of an increased risk of death in infancy.

	PPO.08 WITHDRAWN

TOP PPO.01 STILLBIRTHS: HAVE THINGS... PPO.02 EARLY DETECTION OF... PPO.03 IS IT WORTH... PPO.04 CLINICAL ASSOCIATIONS OF... PPO.05 CHARACTERISTICS OF... PPO.06 MATERNAL SMOKING IN... PPO.07 INTRAUTERINE GROWTH... PPO.08 WITHDRAWN PPO.09 INTRAUTERINE GROWTH... PPO.10 PREGNANCY OUTCOME IN... PPO.11 CONFIDENTIAL ENQUIRY INTO... PPO.12 SEVERE PROTEINURIA AND... PPO.13 MATERNAL TYPE 2... PPO.14 TRENDS IN FETAL... PPO.15 VILLOUS DYSMATURITY: CAN... PPO.16 EXTERNAL CEPHALIC VERSION... PPO.17 IS STILLBIRTH PRECEDED... PPO.18 NEONATAL OUTCOMES OF... PPO.19 OUT-OF-HOSPITAL DELIVERY... PPO.20 PREGNANCY OUTCOME AFTER... PPO.21 THE CHARACTERISTICS OF... PPO.22 ARE THERE DIFFERENCES... PPO.23 DOSE REVERSED TYPE... PPO.24 NEONATAL ENCEPHALOPATHY:... PPO.25 TERM LOW BIRTHWEIGHT... PPO.26 STUDY ON ACCURACY... PPO.27 CERVICAL CERCLAGE AND... PPO.28 WITHDRAWN PPO.29 TIME TO TARGET... PPO.30 BODY MASS INDEX... PPO.31 ADMISSIONS TO AN... PPO.32 NEONATAL MORBIDITY AND... PPO.33 PRETERM PREMATURE RUPTURE... PPO.34 THE LINK CLINIC... PPO.35 PREGNANCY OUTCOMES WITH... PPO.36 A COMPARISON OF... PPO.37 SUBSTANCE ABUSE: CARE... PPO.38 AN AUDIT OF... PPO.39 DOES PROVISION OF... PPO.40 RETROSPECTIVE REVIEW OF... PPO.41 A QUESTIONNAIRE-BASED... PPO.42 TWIN PREGNANCIES MANAGED... PPO.43 PREGNANCY OUTCOMES WITH... PPO.44 TO ASSESS HBSAG... PPO.45 THE USE OF... PPO.46 FOLIC ACID... PPO.47 A RARE CAUSE... PPO.48 EXIGENCIES OF PRENATAL... PPO.49 WITHDRAWN PPO.50 WHY ARE PATIENTS... PPO.51 OUTCOMES OF PREGNANCY... PPO.52 SOCIAL RISKS: THE... REFERENCES

 

	PPO.09 INTRAUTERINE GROWTH RESTRICTION ASSOCIATED WITH MATERNAL SMOKING IN PREGNANCY: WHAT IS THE OPTIMAL TIMING OF SONOGRAPHY FOR FETAL GROWTH?

TOP PPO.01 STILLBIRTHS: HAVE THINGS... PPO.02 EARLY DETECTION OF... PPO.03 IS IT WORTH... PPO.04 CLINICAL ASSOCIATIONS OF... PPO.05 CHARACTERISTICS OF... PPO.06 MATERNAL SMOKING IN... PPO.07 INTRAUTERINE GROWTH... PPO.08 WITHDRAWN PPO.09 INTRAUTERINE GROWTH... PPO.10 PREGNANCY OUTCOME IN... PPO.11 CONFIDENTIAL ENQUIRY INTO... PPO.12 SEVERE PROTEINURIA AND... PPO.13 MATERNAL TYPE 2... PPO.14 TRENDS IN FETAL... PPO.15 VILLOUS DYSMATURITY: CAN... PPO.16 EXTERNAL CEPHALIC VERSION... PPO.17 IS STILLBIRTH PRECEDED... PPO.18 NEONATAL OUTCOMES OF... PPO.19 OUT-OF-HOSPITAL DELIVERY... PPO.20 PREGNANCY OUTCOME AFTER... PPO.21 THE CHARACTERISTICS OF... PPO.22 ARE THERE DIFFERENCES... PPO.23 DOSE REVERSED TYPE... PPO.24 NEONATAL ENCEPHALOPATHY:... PPO.25 TERM LOW BIRTHWEIGHT... PPO.26 STUDY ON ACCURACY... PPO.27 CERVICAL CERCLAGE AND... PPO.28 WITHDRAWN PPO.29 TIME TO TARGET... PPO.30 BODY MASS INDEX... PPO.31 ADMISSIONS TO AN... PPO.32 NEONATAL MORBIDITY AND... PPO.33 PRETERM PREMATURE RUPTURE... PPO.34 THE LINK CLINIC... PPO.35 PREGNANCY OUTCOMES WITH... PPO.36 A COMPARISON OF... PPO.37 SUBSTANCE ABUSE: CARE... PPO.38 AN AUDIT OF... PPO.39 DOES PROVISION OF... PPO.40 RETROSPECTIVE REVIEW OF... PPO.41 A QUESTIONNAIRE-BASED... PPO.42 TWIN PREGNANCIES MANAGED... PPO.43 PREGNANCY OUTCOMES WITH... PPO.44 TO ASSESS HBSAG... PPO.45 THE USE OF... PPO.46 FOLIC ACID... PPO.47 A RARE CAUSE... PPO.48 EXIGENCIES OF PRENATAL... PPO.49 WITHDRAWN PPO.50 WHY ARE PATIENTS... PPO.51 OUTCOMES OF PREGNANCY... PPO.52 SOCIAL RISKS: THE... REFERENCES

 
C. M. Lynch¹, R. O’Kelly¹, B. Stuart¹, R. Conroy², C. L. Regan¹. ¹Coombe Women’s and Infants’ University Hospital, Dublin, Ireland, ²Royal College of Surgeons in Ireland, Dublin, Ireland

Objectives: Smoking in pregnancy is a risk factor for fetal growth restriction. The optimal gestational age to detect this growth restriction by ultrasound examination of the fetus is uncertain.

Methods: A prospective study recruited women who were smoking (n = 71) and not smoking (n = 72) in pregnancy. Caucasian women with ultrasonographic determination of gestational age 14 weeks’ gestation were eligible. Exclusion criteria were recreational drug use, multiple pregnancy, insulin-dependent diabetes, development of gestational diabetes, maternal age <18 or >40 years. Serial ultrasounds for fetal growth were performed at 28, 32, and 36 weeks’ gestation. Smoking status was confirmed by immunoassay of the nicotine metabolite cotinine.

Results: The median cotinine level was 4208.0 ng/ml in the smoking group and 10.0 ng/ml in the non-smokers. The mean neonatal birthweight was lower in the smokers compared with the non-smokers, 3174 ± 490 g versus 3581 ± 486 g (p<0.05). The mean customised birthweight centile in the smokers was 23.0 versus 61.0. This significant difference in birthweight was identified by ultrasound biometry of abdominal circumference and estimated fetal weight at 32 and 36 weeks. The mean abdominal circumference in smokers at 32 weeks’ gestation was 27.85 ± 1.76 cm versus 28.94 ± 1.61 cm (p<0.05) in non-smokers. The estimated fetal weight at 32 weeks’ gestation was 1940.5 ± 326.9 g in the smokers compared with 2065.7 ± 287.4 g (p<0.05). This was not identified at 28 weeks. There was no significant difference in the amniotic fluid index or umbilical Doppler studies. Eight (13%) of the neonates born to the smoking group required admission to the neonatal unit compared with two (3.0%) in the non-smokers.

Conclusions: Smoking is associated with late-onset intrauterine growth restriction, which can be accurately detected by ultrasound at 32 weeks’ gestation.

	PPO.10 PREGNANCY OUTCOME IN WOMEN ON BUPRENORPHINE MAINTENANCE THERAPY: A COHORT STUDY OF 27 CASES

TOP PPO.01 STILLBIRTHS: HAVE THINGS... PPO.02 EARLY DETECTION OF... PPO.03 IS IT WORTH... PPO.04 CLINICAL ASSOCIATIONS OF... PPO.05 CHARACTERISTICS OF... PPO.06 MATERNAL SMOKING IN... PPO.07 INTRAUTERINE GROWTH... PPO.08 WITHDRAWN PPO.09 INTRAUTERINE GROWTH... PPO.10 PREGNANCY OUTCOME IN... PPO.11 CONFIDENTIAL ENQUIRY INTO... PPO.12 SEVERE PROTEINURIA AND... PPO.13 MATERNAL TYPE 2... PPO.14 TRENDS IN FETAL... PPO.15 VILLOUS DYSMATURITY: CAN... PPO.16 EXTERNAL CEPHALIC VERSION... PPO.17 IS STILLBIRTH PRECEDED... PPO.18 NEONATAL OUTCOMES OF... PPO.19 OUT-OF-HOSPITAL DELIVERY... PPO.20 PREGNANCY OUTCOME AFTER... PPO.21 THE CHARACTERISTICS OF... PPO.22 ARE THERE DIFFERENCES... PPO.23 DOSE REVERSED TYPE... PPO.24 NEONATAL ENCEPHALOPATHY:... PPO.25 TERM LOW BIRTHWEIGHT... PPO.26 STUDY ON ACCURACY... PPO.27 CERVICAL CERCLAGE AND... PPO.28 WITHDRAWN PPO.29 TIME TO TARGET... PPO.30 BODY MASS INDEX... PPO.31 ADMISSIONS TO AN... PPO.32 NEONATAL MORBIDITY AND... PPO.33 PRETERM PREMATURE RUPTURE... PPO.34 THE LINK CLINIC... PPO.35 PREGNANCY OUTCOMES WITH... PPO.36 A COMPARISON OF... PPO.37 SUBSTANCE ABUSE: CARE... PPO.38 AN AUDIT OF... PPO.39 DOES PROVISION OF... PPO.40 RETROSPECTIVE REVIEW OF... PPO.41 A QUESTIONNAIRE-BASED... PPO.42 TWIN PREGNANCIES MANAGED... PPO.43 PREGNANCY OUTCOMES WITH... PPO.44 TO ASSESS HBSAG... PPO.45 THE USE OF... PPO.46 FOLIC ACID... PPO.47 A RARE CAUSE... PPO.48 EXIGENCIES OF PRENATAL... PPO.49 WITHDRAWN PPO.50 WHY ARE PATIENTS... PPO.51 OUTCOMES OF PREGNANCY... PPO.52 SOCIAL RISKS: THE... REFERENCES

 
S. Mwenechanya, A. Walker, A. Whincup, L. Miall, J. Porter, A. Wright, J. Shillito, J. J. Walker. Leeds University Teaching Hospitals, Leeds, UK

Background: There is a paucity in the literature of robust data regarding maternal and neonatal outcomes in babies born to drug-using mothers who are maintained on buprenorphine (as opposed to methadone) through pregnancy.

Aims: To evaluate pregnancy outcome in opioid-dependent women who were maintained on buprenorphine through their pregnancy and to compare their outcome with matched women maintained on methadone.

Setting: Leeds University Teaching Hospitals, West Yorkshire, UK.

Methods: From March 2003 data for all pregnant women on buprenorphine maintenance therapy were collected prospectively. Pregnancy outcome of these women was compared with that of consecutive women with singleton pregnancies on methadone maintenance therapy over the same period.

Results: There were 34 women on buprenorphine maintenance therapy, seven women were co-using heroin or cocaine at the time of delivery and therefore were excluded from analysis. Preterm delivery rate was 7.7% in the buprenorphine group compared with 13% in the methadone group. Length of neonatal stay: 52% of the buprenorphine group were discharged after one week compared with 32% in the methadone group. 37% of the neonates in the methadone group were admitted for three or more weeks compared with only 16% in the buprenorphine group. Six of the 27 (22%) babies in the buprenorphine group needed treatment for neonatal abstinence syndrome compared with 22 of the 54 (44.7%) babies in the methadone group.

Conclusions: This cohort study has shown that babies born to women maintained on buprenorphine in pregnancy have less morbidity, compared with babies born to women on methadone maintenance therapy.

	PPO.11 CONFIDENTIAL ENQUIRY INTO STILLBIRTHS WITH FETAL GROWTH RESTRICTION

TOP PPO.01 STILLBIRTHS: HAVE THINGS... PPO.02 EARLY DETECTION OF... PPO.03 IS IT WORTH... PPO.04 CLINICAL ASSOCIATIONS OF... PPO.05 CHARACTERISTICS OF... PPO.06 MATERNAL SMOKING IN... PPO.07 INTRAUTERINE GROWTH... PPO.08 WITHDRAWN PPO.09 INTRAUTERINE GROWTH... PPO.10 PREGNANCY OUTCOME IN... PPO.11 CONFIDENTIAL ENQUIRY INTO... PPO.12 SEVERE PROTEINURIA AND... PPO.13 MATERNAL TYPE 2... PPO.14 TRENDS IN FETAL... PPO.15 VILLOUS DYSMATURITY: CAN... PPO.16 EXTERNAL CEPHALIC VERSION... PPO.17 IS STILLBIRTH PRECEDED... PPO.18 NEONATAL OUTCOMES OF... PPO.19 OUT-OF-HOSPITAL DELIVERY... PPO.20 PREGNANCY OUTCOME AFTER... PPO.21 THE CHARACTERISTICS OF... PPO.22 ARE THERE DIFFERENCES... PPO.23 DOSE REVERSED TYPE... PPO.24 NEONATAL ENCEPHALOPATHY:... PPO.25 TERM LOW BIRTHWEIGHT... PPO.26 STUDY ON ACCURACY... PPO.27 CERVICAL CERCLAGE AND... PPO.28 WITHDRAWN PPO.29 TIME TO TARGET... PPO.30 BODY MASS INDEX... PPO.31 ADMISSIONS TO AN... PPO.32 NEONATAL MORBIDITY AND... PPO.33 PRETERM PREMATURE RUPTURE... PPO.34 THE LINK CLINIC... PPO.35 PREGNANCY OUTCOMES WITH... PPO.36 A COMPARISON OF... PPO.37 SUBSTANCE ABUSE: CARE... PPO.38 AN AUDIT OF... PPO.39 DOES PROVISION OF... PPO.40 RETROSPECTIVE REVIEW OF... PPO.41 A QUESTIONNAIRE-BASED... PPO.42 TWIN PREGNANCIES MANAGED... PPO.43 PREGNANCY OUTCOMES WITH... PPO.44 TO ASSESS HBSAG... PPO.45 THE USE OF... PPO.46 FOLIC ACID... PPO.47 A RARE CAUSE... PPO.48 EXIGENCIES OF PRENATAL... PPO.49 WITHDRAWN PPO.50 WHY ARE PATIENTS... PPO.51 OUTCOMES OF PREGNANCY... PPO.52 SOCIAL RISKS: THE... REFERENCES

 
A. Williams, J. Gardosi. Perinatal Institute, Birmingham, UK

Background: Stillbirths are the main contributor to perinatal mortality and fetal growth restriction is the single largest category of conditions relevant to stillbirth.¹ This enquiry was part of an initiative including all Primary Care Trusts in Birmingham and the Black Country (B&BC), with the aim of improving our understanding of the underlying causes and associated factors.

Methods: Anonymised case notes of 28 consecutively notified stillbirths of 30+ weeks’ gestation with evidence of fetal growth restriction (diagnosed either during pregnancy, by postmortem, or by birthweight <10th customised percentile) were investigated for suboptimal care factors. Each panel included two obstetricians and two midwives from outside the area. Care was discussed and graded according to traditional CESDI criteria. After interim analysis, the project board determined that the enquiry should be terminated to allow urgent feedback of the results.

Results: 28 cases were assessed by seven panels of clinicians from outside the B&BC. In 24 cases (86%), panels considered that the death was potentially avoidable (grade 2, n = 16; or grade 3, n = 8)