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519: Induction of labor has an independent protective effect from cesarean section in women with late preterm PROM
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Doppler Assess, Fetus, Prematurity, U/S, Med-Surg-Diseases
518 Cervical colonization with genital mycoplasma, maternal serum anti-genital mycoplasma antibodies, and preterm parturition Offer Erez1, Ruthy Beer Weisel1, Sari Prutchi Sagiv4, Tal Rafaeli1, Ilan Levi3, Vered Klaitman1, Barak Aricha- Tamir1, Alona Kuzmina3, Limor Besser1, Orna Staretz-Chacham2, Iris Shoham1, Michela Quaranta5, Gershon Holcberg1, Moshe Mazor1 1 Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Department of Obstetrics and Gynecology, Beer Sheva, Israel, 2Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Department of Neonatology, Beer Sheva, Israel, 3Soroka University Medical Center, Promyco Diagnostics, Beer Sheva, Israel, 4Clalit Health Services, Mor Research Applications, Tel Aviv, Israel, 5Policlinico GB Rossi Azienda Ospedaliera, Obstetrics and Gynecology Departement, Verona, Italy
OBJECTIVE: Genital mycoplasmas (GM) are the most prevalent intraamniotic microorganism in women with preterm parturition. In contrast, the relationship between cervical colonization with these microorganisms and preterm parturition is not well established. The aim of this study was to determine the association between maternal serum concentrations of anti GM antibodies (AB) and spontaneous preterm delivery (PTD). STUDY DESIGN: a prospective observational study was conducted including women with preterm parturition (n⫽131) and patients in labor at term (n⫽22) as controls. Maternal serum AGM-AB were determined by the PROMYCO kit a novel immunoassay. RESULTS: There was a positive correlation between maternal serum AGM-AB during the episode of preterm parturition and at delivery (r⫽0.92, p⬍0.0001). Median maternal serum AGM-AB was higher in women with a positive GM cervical culture than in those with a negative one (p⫽0.001). There was no correlation between gestational age at sample collection and maternal serum AGM-AB concentrations. Women with preterm parturition who delivered preterm and a positive cervical GM culture had a higher rate of elevated AGM-AB (⬎75th percentile) than those with a sterile cervical culture (83.3% vs. 41.5%, p⫽0.012). Among women with preterm labor and a positive GM cervical culture, those who delivered preterm had a higher median AGM-AB than those who delivered at term (p⫽0.042). CONCLUSION: Maternal cervical colonization with GM is associated with elevated serum AGM-AB concentrations. In the presence of cervical colonization with genital mycoplasma, maternal serum concentrations of AGM-AB may assist in identifying those who will deliver preterm following an episode of preterm parturition. This is important, since our observation might contribute to a better identification of patients with cervical colonization with GM and preterm parturition that may benefit from antimicrobial treatment.
519 Induction of labor has an independent protective effect from cesarean section in women with late preterm PROM Gal Rodovsky3, Offer Erez1, Maayan Azran2, Moshe Mazor1, Ruthy Beer Weisel1, Daniella Landau4, Vered Klaitman1, Michela Quaranta5 1 Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Department of Obstetrics and Gynecology, Beer Sheva, Israel, 2School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Department of Epidemiology, Beer Sheva, Israel, 3Faculty of Health Sciences, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel, 4Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Neonatology, Beer Sheva, Israel, 5Policlinico GB Rossi Azienda Ospedaliera, Obstetrics and Gynecology Departement, Verona, Italy
OBJECTIVE: The management of late preterm prelabor rupture of membranes (PPROM), occurring from 34 to 36⫹6/7 weeks of gestation, is under debate. The aims of this study were to determine in a large population based study, the maternal and neonatal outcome
Poster Session III
resulting from induction of labor vs. expectant management in women with late PPROM. STUDY DESIGN: This retrospective population based cohort study included the following groups of women with late PPROM: 1) spontaneous delivery within 48 hours of admission (n⫽1237); 2) conservative management (n⫽408); and 3) induction of labor within 48 hours of admission (n⫽575). Maternal characteristics were collected from a computerized database including all the deliveries at our medical center during the study period. RESULTS: 1) women in the induction group had a lower mean maternal age, median gravidity, and rate of previous preterm birth than other study groups; 2) the median gestational age at delivery differ significantly among the groups and the cesarean section (CS) rate was the lowest in those who had induction(p⬍0.001); 3) women who were induced had a lower incidence of clinical chorioamnionitis than in the expectant group (p⫽0.001); 4) Induction by oxytocin was associated with a shorter median interval to delivery and hospitalization than in other methods (p⬍0.001 for both); 5) maternal parity (OR 2.5) was an independent risk factor for chorioamnionitis; 6) an interval of more than 1.5 days from PPROM to delivery had a sensitivity of 52.1% and a specificity of 72.7% for the development of chorioamnionitis (Area under the curve 0.641, p⫽⬍0.01); and 6) induction of labor had an independent protective effect against CS (OR 0.53) but not against chorioamnionitis. CONCLUSION: In women with late preterm PROM: 1) induction of labor reduces the risk for CS by 46% without affecting the risk for chorioamnionitis; and 2) parity increases the risk for chorioamnionitis regardless of whether these patients were managed actively or conservatively.
520 Severe and moderate thinness (prepregnancy body mass index <17) as risk factors for spontaneous preterm birth Ogechi Agwu1, Jan Hart2, Barbra Fisher2, Nancy West3, Ronald Gibbs2, Anne Lynch2 1
Case Western Reserve University, School of Medicine, Cleveland, OH, University of Colorado Denver, Obstetrics and Gynecology, Aurora, CO, University of Colorado Denver, Colorado School of Public Health, Aurora, CO 2 3
OBJECTIVE: The prepregnancy body mass index (BMI, kg/m2) is one of
the few modifiable risk factors for preterm birth (PTB). The objective of this study was to determine the relationship between WHO categories of BMI and spontaneous preterm birth (SPTB). STUDY DESIGN: From our perinatal database (2005 - 2010), we analyzed data on 11,967 women who delivered singleton births after excluding women who had a medically indicated PTB or delivered ⬍ 20 weeks. SPTB was defined as a PTB resulting from PPROM or spontaneous preterm labor. We used the WHO international classification of BMI (see figure). We analyzed the data using univariable and multivariable logistic regression analysis, adjusting for maternal age, race/ ethnicity, parity, cigarette smoking, history of PTB, chronic medical disease, uterine anomalies, cervical incompetence and infertility. RESULTS: SPTB accounted for 65% of all PTBs. The incidence of SPTB was highest among women who had severe or moderate thinness, 28% and 22%, respectively. Compared to women with normal range BMI, the categories significantly associated with an increased risk of SPTB were: severe thinness (AOR ⫽ 2.7, 95% CI ⫽ 1.3 to 5.8, P ⫽ 0.01) and moderate thinness (AOR ⫽ 2.1, 95% CI 1.3 to 3.5, P ⫽ 0.003). We also found that obese class I was associated with a decreased risk (AOR ⫽ 0.75, 95% CI ⫽ 0.60 to 0.93, P ⫽ 0.01). CONCLUSION: Women with BMI ⬍ 17 are more than twice as likely to have SPTB compared to women with normal range BMI. Because severe and moderate thinness prior to pregnancy is potentially modifiable, interventions for women in these categories to achieve a healthy preconception weight should be evaluated.
Supplement to JANUARY 2013 American Journal of Obstetrics & Gynecology
S223
Doppler Assess, Fetus, Prematurity, U/S, Med-Surg-Diseases
518 Cervical colonization with genital mycoplasma, maternal serum anti-genital mycoplasma antibodies, and preterm parturition Offer Erez1, Ruthy Beer Weisel1, Sari Prutchi Sagiv4, Tal Rafaeli1, Ilan Levi3, Vered Klaitman1, Barak Aricha- Tamir1, Alona Kuzmina3, Limor Besser1, Orna Staretz-Chacham2, Iris Shoham1, Michela Quaranta5, Gershon Holcberg1, Moshe Mazor1 1 Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Department of Obstetrics and Gynecology, Beer Sheva, Israel, 2Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Department of Neonatology, Beer Sheva, Israel, 3Soroka University Medical Center, Promyco Diagnostics, Beer Sheva, Israel, 4Clalit Health Services, Mor Research Applications, Tel Aviv, Israel, 5Policlinico GB Rossi Azienda Ospedaliera, Obstetrics and Gynecology Departement, Verona, Italy
OBJECTIVE: Genital mycoplasmas (GM) are the most prevalent intraamniotic microorganism in women with preterm parturition. In contrast, the relationship between cervical colonization with these microorganisms and preterm parturition is not well established. The aim of this study was to determine the association between maternal serum concentrations of anti GM antibodies (AB) and spontaneous preterm delivery (PTD). STUDY DESIGN: a prospective observational study was conducted including women with preterm parturition (n⫽131) and patients in labor at term (n⫽22) as controls. Maternal serum AGM-AB were determined by the PROMYCO kit a novel immunoassay. RESULTS: There was a positive correlation between maternal serum AGM-AB during the episode of preterm parturition and at delivery (r⫽0.92, p⬍0.0001). Median maternal serum AGM-AB was higher in women with a positive GM cervical culture than in those with a negative one (p⫽0.001). There was no correlation between gestational age at sample collection and maternal serum AGM-AB concentrations. Women with preterm parturition who delivered preterm and a positive cervical GM culture had a higher rate of elevated AGM-AB (⬎75th percentile) than those with a sterile cervical culture (83.3% vs. 41.5%, p⫽0.012). Among women with preterm labor and a positive GM cervical culture, those who delivered preterm had a higher median AGM-AB than those who delivered at term (p⫽0.042). CONCLUSION: Maternal cervical colonization with GM is associated with elevated serum AGM-AB concentrations. In the presence of cervical colonization with genital mycoplasma, maternal serum concentrations of AGM-AB may assist in identifying those who will deliver preterm following an episode of preterm parturition. This is important, since our observation might contribute to a better identification of patients with cervical colonization with GM and preterm parturition that may benefit from antimicrobial treatment.
519 Induction of labor has an independent protective effect from cesarean section in women with late preterm PROM Gal Rodovsky3, Offer Erez1, Maayan Azran2, Moshe Mazor1, Ruthy Beer Weisel1, Daniella Landau4, Vered Klaitman1, Michela Quaranta5 1 Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Department of Obstetrics and Gynecology, Beer Sheva, Israel, 2School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Department of Epidemiology, Beer Sheva, Israel, 3Faculty of Health Sciences, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel, 4Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Neonatology, Beer Sheva, Israel, 5Policlinico GB Rossi Azienda Ospedaliera, Obstetrics and Gynecology Departement, Verona, Italy
OBJECTIVE: The management of late preterm prelabor rupture of membranes (PPROM), occurring from 34 to 36⫹6/7 weeks of gestation, is under debate. The aims of this study were to determine in a large population based study, the maternal and neonatal outcome
Poster Session III
resulting from induction of labor vs. expectant management in women with late PPROM. STUDY DESIGN: This retrospective population based cohort study included the following groups of women with late PPROM: 1) spontaneous delivery within 48 hours of admission (n⫽1237); 2) conservative management (n⫽408); and 3) induction of labor within 48 hours of admission (n⫽575). Maternal characteristics were collected from a computerized database including all the deliveries at our medical center during the study period. RESULTS: 1) women in the induction group had a lower mean maternal age, median gravidity, and rate of previous preterm birth than other study groups; 2) the median gestational age at delivery differ significantly among the groups and the cesarean section (CS) rate was the lowest in those who had induction(p⬍0.001); 3) women who were induced had a lower incidence of clinical chorioamnionitis than in the expectant group (p⫽0.001); 4) Induction by oxytocin was associated with a shorter median interval to delivery and hospitalization than in other methods (p⬍0.001 for both); 5) maternal parity (OR 2.5) was an independent risk factor for chorioamnionitis; 6) an interval of more than 1.5 days from PPROM to delivery had a sensitivity of 52.1% and a specificity of 72.7% for the development of chorioamnionitis (Area under the curve 0.641, p⫽⬍0.01); and 6) induction of labor had an independent protective effect against CS (OR 0.53) but not against chorioamnionitis. CONCLUSION: In women with late preterm PROM: 1) induction of labor reduces the risk for CS by 46% without affecting the risk for chorioamnionitis; and 2) parity increases the risk for chorioamnionitis regardless of whether these patients were managed actively or conservatively.
520 Severe and moderate thinness (prepregnancy body mass index <17) as risk factors for spontaneous preterm birth Ogechi Agwu1, Jan Hart2, Barbra Fisher2, Nancy West3, Ronald Gibbs2, Anne Lynch2 1
Case Western Reserve University, School of Medicine, Cleveland, OH, University of Colorado Denver, Obstetrics and Gynecology, Aurora, CO, University of Colorado Denver, Colorado School of Public Health, Aurora, CO 2 3
OBJECTIVE: The prepregnancy body mass index (BMI, kg/m2) is one of
the few modifiable risk factors for preterm birth (PTB). The objective of this study was to determine the relationship between WHO categories of BMI and spontaneous preterm birth (SPTB). STUDY DESIGN: From our perinatal database (2005 - 2010), we analyzed data on 11,967 women who delivered singleton births after excluding women who had a medically indicated PTB or delivered ⬍ 20 weeks. SPTB was defined as a PTB resulting from PPROM or spontaneous preterm labor. We used the WHO international classification of BMI (see figure). We analyzed the data using univariable and multivariable logistic regression analysis, adjusting for maternal age, race/ ethnicity, parity, cigarette smoking, history of PTB, chronic medical disease, uterine anomalies, cervical incompetence and infertility. RESULTS: SPTB accounted for 65% of all PTBs. The incidence of SPTB was highest among women who had severe or moderate thinness, 28% and 22%, respectively. Compared to women with normal range BMI, the categories significantly associated with an increased risk of SPTB were: severe thinness (AOR ⫽ 2.7, 95% CI ⫽ 1.3 to 5.8, P ⫽ 0.01) and moderate thinness (AOR ⫽ 2.1, 95% CI 1.3 to 3.5, P ⫽ 0.003). We also found that obese class I was associated with a decreased risk (AOR ⫽ 0.75, 95% CI ⫽ 0.60 to 0.93, P ⫽ 0.01). CONCLUSION: Women with BMI ⬍ 17 are more than twice as likely to have SPTB compared to women with normal range BMI. Because severe and moderate thinness prior to pregnancy is potentially modifiable, interventions for women in these categories to achieve a healthy preconception weight should be evaluated.
Supplement to JANUARY 2013 American Journal of Obstetrics & Gynecology
S223