key: cord-0907348-9t2kuxyy authors: Mok, Thalia; Mei, Jenny Y.; Cambou, Mary C.; Fuller, Trevon; Fajardo, Viviana M.; Kerin, Tara; Han, Christina S.; Nielsen-Saines, Karin; Rao, Rashmi title: Association of prenatal ultrasonographic findings with neonatal outcomes in pregnant women with SARS-CoV-2 infection date: 2022-01-31 journal: American Journal of Obstetrics and Gynecology DOI: 10.1016/j.ajog.2021.11.325 sha: 800d01af6ed28207d9d94b80159e11d67a2e2a1c doc_id: 907348 cord_uid: 9t2kuxyy nan OBJECTIVE: Twins are considered high-risk pregnancies owing to increased risk of complications and mainly preterm birth. Lower birthweight and other obstetrical issues unique to second-born twins may put them at even higher risk of adverse neonatal outcomes. Scarce data exists regarding the long-term health outcomes of twin pairs, stratified for birth order. Thus, we sought to determine whether twins born second are at an increased risk for long-term morbidity. STUDY DESIGN: A population-based cohort study was performed including dichorionic diamniotic twin deliveries occurring between the years 1991-2021 at a tertiary referral hospital. Incidence of hospitalizations due to selected categories of morbidity up to age of 18 years was compared between second versus firstborn twins. Kaplan Meier survival curves compared cumulative morbidity. Cox proportional hazards models were used to control for baseline selected confounders. RESULTS: During the study period, 11,014 offspring of dichorionic twins met the inclusion criteria, evenly distributed between first and second-born groups. Offspring of twin deliveries experienced notable morbidity due to infectious (23.8-24.1%), respiratory (10.5-10.9%) and neurological morbidity (7.0-7.8%) during childhood, that was not affected by birth order. Hospitalization due to other conditions was similar as well (TABLE) . Likewise, Kaplan-Meier survival curves revealed no difference in the cumulative incidence of hospitalizations among offspring of both groups (FIGURE). Cox proportional hazards models showed comparable rates of morbidity among second-versus first twin after controlling for birthweight and mode of delivery. CONCLUSION: As opposed to the neonatal period, birth order itself does not predict excess risk for morbidity during childhood. 274 Association of prenatal ultrasonographic findings with neonatal outcomes in pregnant women with SARS-CoV-2 infection OBJECTIVE: To describe the sonographic characteristics of pregnancies after confirmed SARS-CoV-2 infection and assess the association of prenatal ultrasound (US) findings with adverse neonatal outcomes. STUDY DESIGN: This is a prospective cohort study conducted at a single tertiary care center of women diagnosed during pregnancy with SARS-CoV-2 by reverse-transcription polymerase chain reaction between March 2020 and May 2021. All patients underwent prenatal US following the diagnosis of infection. Standard fetal biometric measurements, umbilical artery and middle cerebral artery Dopplers, placental thickness, and amniotic fluid volume were collected. An anatomic evaluation for infection-associated findings was also performed. The primary outcome was a composite adverse neonatal outcome. Prenatal US findings were compared by neonatal outcomes with Chi-squared (or Fisher's exact) and t-tests. RESULTS: Of 103 mother-infant pairs, 45 (43.7%) had normal results and 58 (56.3%) had abnormal results on prenatal US examination. The most common abnormal US findings were placentomegaly (34.1%) and fetal growth restriction (9.7%). There were no significant differences in baseline characteristics, trimester of infection, or disease severity by US findings (p > 0.05). 93 pregnancies had known neonatal outcomes. Of these, 30 (32%) had a composite adverse neonatal outcome. Having any abnormal US finding was not significantly associated with development of a composite adverse neonatal outcome (p ΒΌ 0.19), but pregnancies that developed fetal growth restriction following SARS-CoV-2 infection had a significantly higher rate of a composite adverse neonatal outcome (p < 0.001). CONCLUSION: Abnormal US findings occurred in over half of the pregnancies with confirmed SARS-CoV-2 infection, but an abnormal US overall is not associated with development of an adverse neonatal outcome. However, SARS-CoV-2 affected pregnancies that develop fetal growth restriction may be at an increased risk for adverse neonatal outcomes and require close surveillance. 275 Maternal obstetrical risk factors for severe chorioamniotic membrane separation after laparotomy-assisted fetoscopic spina bifida repair Children's Pavilion for Women OBJECTIVE: Chorioamniotic membrane separation (CAS) after laparotomy-assisted fetoscopic spina bifida repair is one of the main known risk factors for developing PPROM and preterm birth. Gaining insight into the factors that increase the risk for CAS could be of great clinical relevance. We hypothesized that having an obstetrical history of uterine overdistension could increase the likelihood of developing severe CAS after surgery STUDY DESIGN: Prospective observational study of 101 patients that underwent fetal spina bifida repair between 09/2014 and 07/2021 in a single center. Surgery was performed by laparotomy-assisted fetoscopic spina bifda repair using the same eligibility criteria as reported by MOMS trial, including maternal BMI up to 40kg/m 2 . After surgery, ultrasound scans were performed weekly ( < 32 weeks) or twice a week ( 32 weeks). Severe CAS was defined if >50% of membranes in the uterine cavity were detached. Perinatal outcomes and maternal demographics were compared between cases with severe CAS and the rest of the cohort. Logistic regression analyses were performed to identify the factors that would increase the risk for severe CAS.