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Objective This study aimed to examine maternal outcomes of ongoing pregnancies complicated by fetal life-limiting conditions. Study design This was a retrospective matched cohort study of women with a diagnosis of fetal life-limiting condition between 2010 and 2018 in a single academic center. Cases were matched to controls (women who had normal fetal anatomic survey) according to year of delivery, body mass index, and parity in a 1:4 ratio. Bivariable and multivariable analyses were performed to compare the prevalence of the primary composite outcome, which included any one of the following: preeclampsia, gestational diabetes, cesarean delivery, third and fourth degree laceration, postpartum hemorrhage, blood transfusion, endometritis or wound infection, maternal intensive care unit admission, hysterectomy and maternal death, between cases and controls. Results During the study period, we found 101 cases that met inclusion criteria, matched to 404 controls. The rate of the composite maternal outcome did not differ between the two groups (39.6 vs. 38.9%, p = 0.948). For individual outcomes, women with diagnosis of fetal life-limiting condition had higher rates of blood transfusion (2.0 vs. 0%, p = 0.005) and longer length of the first stage of labor (median of 12 [6.8–22.0] hours vs. 6.6 [3.9–11.0] hours; p < 0.001). In a multivariable analysis, first stage of labor continued to be longer by an average of 6.48 hours among women with a diagnosis of fetal life-limiting condition compared with controls. Conclusion After controlling for confounding factors, except a longer first stage of labor, women diagnosed with fetal life-limiting conditions who continued the pregnancy did not have a higher rate of adverse maternal outcomes. Key Points

(NY). Subjects were screened during pregnancy or postpartum. Those who screened positive ('Red Flags' , >3-4 moderate risk factors, abnormal physical examination, persistent symptoms) underwent further testing. The primary outcome was screen positive rate. Secondary outcomes were true positive rate and the strength of each moderate factor in predicting CVD. Univariate logistic regression was used to analyze data. RESULTS: 846 women were screened. The overall screen positive rate was 8% (5% in CA vs 19% in NY). The sites differed in ethnicity, i.e. African American women (2.7% in CA vs 35% in NY, p< 0.01) and substance use (2.7% vs 5.6%, p< 0.04). The true positive rate was 1.5% at both sites, however several of the screen positive patients in NY did not complete follow up studies. CVD was confirmed in 30% with positive screens with complete follow up. Combinations of moderate factors were the main driver of screen positive rates in both populations. Table 1 illustrates predictive potential of the moderate risk factors. CONCLUSION: CVD is the leading cause of maternal mortality and 25% of these cases are preventable, highlighting the need for an effective screening tool. We report CVD screen positive and true positive rates at two academic tertiary care centers serving diverse populations. We identify the most predictive moderate factors that may help simplify the CVD toolkit algorithm. Our study is limited by lack of follow up studies in screen positive patients, however suggests a substantial rate of true CVD in screen positive patients. This is an initial attempt to test the CVD algorithm. Data may be used to design a larger investigation to validate the algorithm.

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