Objectives: To examine clinical and demographic characteristics associated with availability of self-reported and measured pre-pregnancy weight, differences in these parameters, and characteristics associated with self-report accuracy. Methods: Retrospective cohort of 7483 women who delivered at a large academic medical center between 2011 and 2014. Measured pre-pregnancy weights recorded within a year of conception and self-reported pre-pregnancy weights reported anytime during pregnancy were abstracted from electronic medical records. Difference in weights was calculated as self-reported minus measured pre-pregnancy weight. Logistic and linear regression models estimated associations between demographic and clinical characteristics, and presence of self-reported and measured weights, and weight differences. Results: 42.2% of women had both self-reported and measured pre-pregnancy weight, 49.7% had only self-reported, and 2.8% had only measured. Compared to white women, black women and women of other races/ethnicities were less likely to have self-reported weight, and black, Asian, and Hispanic women, and women of other races/ethnicities were less likely to have measured weights. For 85%, pre-pregnancy BMI categorized by self-reported and measured weights were concordant. Primiparas and multiparas were more likely to underreport their weight compared to nulliparas (b = -1.32 lbs, 95% CI -2.24 to -0.41 lbs and b = -2.74 lbs, 95% CI -3.82 to -1.67 lbs, respectively). Discussion: Utilization of self-reported or measured pre-pregnancy weight for pre-pregnancy BMI classification results in identical categorization for the majority of women. Providers may wish to account for underreporting for patients with a BMI close to category cutoff by recommending a range of gestational weight gain that falls within recommendations for both categories where feasible

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INTRODUCTION: Obstetric Anal Sphincter Injuries (OASIS) occur in 2 to 19% of vaginal deliveries in the United States. Neonatal measurements such as birthweight above 4000g or neonatal head circumference above 37cm are known risk factors for 3rd and 4th degree perineal laceration. Unfortunately, these predictors are identified after the delivery and therefore have very limited practical impact. We hypothesized that fetal Head Circumference (HC) size assessed by ultrasound in pregnancy can aid in predicting Obstetric Anal Sphincter Injuries (OASIS). METHODS: Secondary analysis of a retrospective cohort study assessing pregnancies with OASIS between 2005 and 2016. Inclusion criteria for this secondary analysis were third trimester ultrasound head circumference measurements. Antenatal ultrasound Head Circumference (HC) assessment, maternal demographics and labor and delivery data were documented and compared. P less than .05 was considered statistically significant. RESULTS: Of 2057 patients that had head circumference assessment, 121 (5.8%) had OASIS. In the unadjusted continuous analysis of the head circumference, an increase of 10% in the HC were associated with OASIS OR 1.12 (1.02-1.23) p=0.015. Although not statistically significant HC above the 90% appears to be associated with OASIS OR 3.37 (0.89-12.74) p=0.073. CONCLUSION: In our cohort, fetal head circumference percentile is associated with OASIS, specifically the larger the head circumference percentile, the greater the risk. Severe perineal lacerations significantly impact short and long term health outcomes such as perineal pain, dyspareunia, urinary and fecal incontinence. This piece of information might help clinicians antenatally during counseling of patients about the risk of OASIS and future implications of the injury.

INTRODUCTION: Up to 75% of babies born growth restricted were undiagnosed prior to delivery. Certain placental changes have associated with growth restriction. Our objective is to determine if these changes are increased in cases with ultrasound estimated fetal weight (EFW) 10-20%. METHODS: Retrospective analysis on singleton placentas from 2011 to 2016. Exclusion criteria were less than 24 weeks’ gestation or EFW <10%, multiple anomalies, known aneuploidy. Primary outcome was decreased placental weight. Secondary outcomes were infarcts, villitis, fibrin deposition, calcium deposition and a composite of outcomes. Pathology reports, ultrasound reports, and the electronic medical records were reviewed. Chi square was used for categorical variables and logistic regression for adjusted analyses. RESULTS: 1748 ultrasounds had with EFW >10th%. Pregnancies with EFW 10-20% were more likely in women who were younger, nulliparous, had lower BMI, less gestational weight gain, and delivered less than a week earlier (p<0.05). Rates of SGA at birth were also increased (69.2% vs 8.7%, p<0.001). Placental pathology was sent in 35 (37%) of EFW 10-20% pregnancies and 281 (17%) those with EFW>20%. There were more placentas with decreased placental weight in the EFW 10-20% group (p<0.005). There was a trend toward increase in the incidence of infarcts, villitis, no differences in any of the other secondary outcomes, except decreased placental weight and one other placental finding (p=0.005). CONCLUSION: Placentas from pregnancies with EFW 10-20% had higher rates of decreased placental weight. No difference found in secondary outcomes, but with small numbers, further research is needed to assess these outcomes.