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Aim The objective of this study was to compare neonatal and maternal outcomes among women with two previous cesarean deliveries who undergo trial of labor after two cesarean section (TOLA2C) versus elective repeat cesarean delivery (ERCD). Our primary outcome was neonatal intensive care unit (NICU) admission. Secondary outcomes included APGAR score <7 at 5 min, TOLA2C success rate, uterine rupture, postpartum hemorrhage, maternal blood transfusion, maternal bowel and bladder injury, immediate postpartum infection, and maternal mortality. Methods This retrospective cohort study was undertaken at a community medical center from January 1, 2008 to December 31, 2018. Inclusion criteria were women with a vertex singleton gestation at term and a history of two prior cesarean sections. Exclusion criteria included a previous successful TOLA2C, prior classical uterine incision or abdominal myomectomy, placenta previa or invasive placentation, multiple gestation, nonvertex presentation, history of uterine rupture or known fetal anomaly. Maternal and neonatal outcomes were assessed using Fisher exact test and Wilcoxon rank sum test. Results A total of 793 patients fulfilled study criteria. There were no differences in neonatal intensive care unit admissions or 5‐min APGAR scores <7 between the two groups. Sixty‐eight percent of women who underwent TOLAC ( N = 82) had a successful vaginal delivery. The uterine rupture rate was 1.16% ( N = 1) in the TOLA2C group with no case of uterine rupture in the ERCD group. No difference in maternal morbidity was noted between the two groups. No maternal or neonatal mortalities occurred in either group. Conclusions There was no difference in maternal or neonatal morbidity among patients in our study population with two previous cesarean sections who opted for TOLA2C versus ERCD.

Monozygotic twins with discordant karyotypes for trisomy 13 are rare. We report a case of a spontaneously conceived pregnancy who presented with first trimester ultrasound finding of umbilical cord cyst and increased nuchal translucency in Twin A and no abnormalities in Twin B. Amniocentesis revealed 47,XY,+13 karyotype in Twin A and 46,XY karyotype in Twin B. Selective fetal reduction was performed for Twin A. Twin B was delivered at 32 weeks gestation with normal phenotype. Peripheral blood karyotype revealed 15% mosaicism for trisomy 13 and skin fibroblast revealed 46,XY karyotype. The surviving twin will be monitored for potential complication of uniparental disomy 13 and mosaic trisomy 13. This case reinforces the need for early ultrasound and nuchal translucency measurements, especially in twin gestations.

review. Maternal baseline characteristics, co-morbidities and maternal and neonatal outcomes were collected. Women who have psychiatric conditions and SUD (Group 1, n¼111) were compared to women with SUD who do not have psychiatric conditions (Group 2, n¼372). Univariate analyses were performed using Chi-square, ttests, Mann-Whitney U tests as appropriate. Logistic regression modeling was then used to control for potential confounders identified in the univariate analyses. RESULTS: 23% of pregnant women with SUD also have psychiatric conditions in this cohort. Outcomes which were significantly different after univariate analyses are shown in Figure 1. After adjusting for potential confounders, women with co-occurrence of SUD and psychiatric conditions were more like to have chronic hypertension (aOR 3.25, 95% CI 1.15-9.32), and more likely to require antepartum admission (aOR 3.014, 95% CI 1.34-6.81) than women without psychiatric conditions. There was also a statistically significant, but not clinically significant difference in 5 minute Apgar score (Group 1: 8.76, Group 2: 8.55, p¼0.03). CONCLUSION: Co-occurrence of psychiatric disorder with SUD is common among pregnant women, and can impact outcomes for both mother and neonate. This data further supports the need for specialized care for this population, with integration of obstetrics, psychiatry, addiction medicine, and comprehensive social services.