Poster Session V
org
923 Successful tolac in a population with a high
success rate - what are the differences?
Amir Aviram1,2, Eran Hadar1, Rinat Gabbay-Benziv1,
Anat Shmueli1, Liran Hiersch1,2, Eran Ashwal1,2,
Arnon Wiznitzer1, Yariv Yogev1,2
1
Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva,
Israel, 2Lis Maternity & Women’s Hospital, Tel-Aviv Sourasky Medical Center,
Tel-Aviv, Israel
OBJECTIVE: To determine cofactors influencing success or failure of
trial of labor after a cesarean delivery (TOLAC) in a population with
high success rate.
STUDY DESIGN: A retrospective cohort study during 2007-2014,
including all women carrying a single, non-anomalous fetus, at term
(37+0-42+0 weeks of gestation), in TOLAC. All women underwent
previous single cesarean delivery (CD). Women with previous
multiple CD were excluded. We compared women who delivered
vaginally with women who delivered by intrapartum CD. Logistic
regression analysis was performed in order to account for con-
founders and evaluate the independent contribution of different
cofactors to the success or failure of TOLAC.
RESULTS: Out of 62,102 deliveries, 2,889 (4.7%) were TOLAC’s.
Overall, 2,611 (90.4%) women delivered vaginally, and the rest
unerwent CD. Our main results were (p<0.001 unless stated
otherwise): 1. Women in the CD group were less parous (2.5
1.0
vs. 3.1
1.3), had lower rate of previous vaginal delivery (25.5%
vs. 58.5%) and higher rates of chronic hypertension (2.2% vs.
0.7%, p¼0.007) and mild preeclampsia (1.8% vs. 0.6%, p¼0.02).
2. Additionally, they had lower rate of regional analgesia use
(56.8% vs. 71.9%) and the rate of cervical ripening higher (14.0%
vs. 7.4%). 3. In a multivariate logistic regression model,
S526 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017
ajog.
accounting for cofactors (Table), risk factors for CD were chronic
hypertension, polyhydramnios and cervical ripening, while previ-
ous vaginal delivery and regional analgesia used were protective
factors (Table).
CONCLUSION: In a cohort with high TOLAC success rate (>90%),
previous vaginal delivery and regional analgesia use are associated
with TOLAC’s success, and cervical ripening, polyhydramnios and
chronic hypertension are associated with TOLAC’s failure.
924 Risks and consequences of puerperal uterine
inversion in the United States, 2004-2013
Sarah Coad, Leanne Dahlgren, Jennifer A. Hutcheon
University of British Columbia, Vancouver, BC, Canada
OBJECTIVE: Puerperal uterine inversion is a rare, potentially life-
threatening obstetrical emergency. The current literature consists of
small case series and a single nationwide study from Europe with
only 15 cases. We aimed to define the incidence, temporal trends and
outcomes in women with uterine inversion using a nationally
representative United States (US) cohort.
STUDY DESIGN: We used the Nationwide Inpatient Sample, a 20%
sample of US hospital admissions, to identify all deliveries from 2004
to 2013. ICD-9 diagnosis codes were used to identify cases of uterine
inversion and associated adverse outcomes (maternal death, blood
transfusion, maternal shock, need for surgical correction and length
of hospital stay). The incidence of uterine inversion overall and for
each year of the study period was calculated with 95% confidence
intervals (CI). The case fatality and incidence of other adverse
outcomes among women with a uterine inversion were also
estimated.
RESULTS: Among 8,294,279 deliveries in 2004-2013, there were 2427
cases of puerperal uterine inversion, corresponding to an incidence
of 2.9 per 10,000 deliveries (95% CI: 2.8-3.0). There was one
maternal death in our cohort (4.1 per 10,000 events). No change in
the incidence of uterine inversion over the study period was detected
(Figure 1). Among women with a uterine inversion, 37.7% (95% CI:
35.8%-39.6%) had an associated postpartum hemorrhage, 22.4%
(95% CI: 20.7%-24.0%) received a blood transfusion and 6.0%
(95% CI: 5.1%-7.0%) required surgical management. Only 2.8%
(95% CI: 2.1%-3.5%) underwent a hysterectomy. The median length
of hospital stay was 3 days.
CONCLUSION: The present study provides the largest population-
based results on puerperal uterine inversion to date and highlights
the high likelihood of adverse maternal outcomes associated with the
condition. The results inform the optimization of clinical manage-
ment, by preparing for possible postpartum hemorrhage, need for
blood products and surgical management in the rare event of uterine
inversion.
ajog.org Poster Session V

925 Impact of metabolic dysfunction on

breastfeeding outcomes in gestational diabetes
mellitus
Angelica V. Glover, Diane C. Berry, Todd A. Schwartz,
Alison M. Stuebe
University of North Carolina at Chapel Hill, Chapel Hill, NC
OBJECTIVE: Previous studies have noted an association between
metabolic risk factors and breastfeeding outcome. We sought to
assess the relationship between prenatal metabolic markers and
breastfeeding (BF) duration in women with gestational diabetes
mellitus (GDM).
STUDY DESIGN: Secondary analysis of a prospective randomized trial
on a lifestyle intervention to improve metabolic health among
women with GDM. Women were enrolled in the third trimester and
were followed through 10 months postpartum. Metabolic and
clinical measures were collected at enrollment, including oral glucose
tolerance test results, insulin level, HOMA-IR, glycated hemoglobin
(A1c), lipid panel, blood pressure, body mass index (BMI), and
triceps and subscapular skinfold (SS) thickness. Women reported on
postpartum questionnaires when they stopped BF and whether they
breastfed as long as desired. We quantified differences in BF duration
by tertiles of metabolic measures using Cox proportional hazards
models, adjusting for BF intention, randomized treatment group, 926 Placentophagy: comparison of plausible
Black race, and study site. We further categorized undesired weaning biologically active compounds that might support
prevalence by tertile, using Mantel-Haenszel chi square tests to test this practice
association with metabolic measure tertile. P <.05 was statistically Tessa Schwering, M. Camille Hoffman, Mark L. Laudenslager,
significant. Anita Kramer, Carrie Hankins, Theresa L. Powell
RESULTS: 100 women were enrolled: 52% were non-Hispanic Black, University of Colorado, Anschutz Medical Campus, Aurora, CO
31% non-Hispanic White, 9% American Indian or Alaskan Native, OBJECTIVE: Proponents of placentophagy claim that consumption of
and 8% more than one race. BF outcome data were available for 82 encapsulated human placenta improves maternal postpartum mood,
women. We found associations between fasting glucose, A1c, BMI, energy, and milk supply. The objective of our study was to determine
SS thickness, and hazard ratio for BF cessation (Wald chi square p the amount of biologically active compounds in encapsulated
<.05 for log(hazard ratio), Table). Women with higher fasting placental tissue that may make these claims plausible, and to
glucose, BMI, or SS thickness were at higher risk of reporting not determine if the process of encapsulation impacts the concentrations
having breastfed as long as they desired (Table). We did not find of these compounds.
associations with other metabolic markers. STUDY DESIGN: Placentas from 10 healthy pregnancies were collected
CONCLUSION: In women with GDM, higher fasting glucose, A1c, immediately after caesarean delivery. Placental tissue was washed and
BMI, and SS thickness were associated with shorter BF duration. immediately frozen at -80 C or processed for encapsulation within
These mothers warrant closer postpartum follow-up and support to 48 hrs by: steaming (30 min, 75 C), dehydrating (18-24 hours,
help them achieve their BF goals. 60 C), grinding in a food mill, and encapsulating in gelatin capsules.

Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology S527