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645: How often do patients eligible for repeat antepartum corticosteroids receive them?
Poster Session IV
ajog.org
646 Platelet activation in preeclampsia: myth or fact
Heather Major1, Robert Campbell2, Andrew Weyrich2
645 How often do patients eligible for repeat antepartum corticosteroids receive them?
Heather Levin1, Cande Ananth1, Daphnie Drassinower1, Christian Benjamin-Boamah1, Alexander Friedman1
1 Columbia University Medical Center, Department of Obstetrics and Gynecology, New York, NY
OBJECTIVE: In current obstetrical practice, there has been a non-
standardized adoption of a repeat course of antenatal corticosteroids (ACS). The objective of this study was to determine the trends in administration and to evaluate optimal timing by indication for a repeat antenatal corticosteroid (ACS) in women who deliver preterm. STUDY DESIGN: This retrospective cohort study evaluated repeat ACS administration at a single tertiary care hospital from June 2006 through December 2011. This study included women with a singleton gestation delivering prior to 34 weeks. This study also evaluated the indication for repeat ACS administration, and whether or not administration was optimally timed (>48 hours but <7 days prior to delivery). RESULTS: Of 130 women that delivered at a single institution and were eligible for repeat ACS, 72.3% (n¼94) received repeat ACS prior to delivery. As illustrated in the graph, from 2006 to 2011 there was increasing use of repeat ACS administration. As shown in the table, of women that received a repeat ACS course, 29.8 % (n¼28) received it between 48 hours and 7 days prior to delivery. No single indication for repeat ACS administration was associated with optimal timing prior to delivery. CONCLUSION: Although there appears to be an increase in administration of a repeat course of antenatal corticosteroids over time, no single indication for repeat ACS was associated with optimal timing prior to delivery. Further research is needed to determine optimal timing for this intervention.
1 University of Utah, OB/GYN, Salt Lake City, UT, 2University of Utah, Molecular Medicine, Salt Lake City, UT
OBJECTIVE: Platelet activation has been demonstrated in women with preeclampsia through increased circulating platelet factor 4 (PF4), beta-thromboglobulin, and soluble CD40L. In contrast, other studies have shown decreased plasma thrombospondin, decreased platelet aggregation, and increased PFA-100 closure time. Few studies have examined markers of platelet activation in purified platelets, and platelet activation in preeclampsia remains controversial. STUDY DESIGN: Women with preeclampsia (PE) meeting ACOG criteria were matched by gestational age to women with normal pregnancies. Venous blood was centrifuged to collect platelet-rich plasma and subsequently centrifuged again to obtain platelet-poor plasma (PPP) and platelets. Platelets were purified by depleting leukocytes using magnetic immunoselection. Purified platelets were lysed at a known concentration in RIPA buffer. Plasma levels of RANTES and PF4, and levels of PF4, RANTES, and thrombospondin-1 in platelet lysates were determined by ELISA. RESULTS: Twenty-seven participants were recruited to each comparison group. There were no significant differences in plasma levels of RANTES or PF4 between groups. Levels of thrombospondin-1, PF4, and RANTES in platelet lysates also did not differ significantly between women with PE and those with normotensive pregnancies. When stratified by severity of disease (presence or absence of severe features) or by onset of clinical findings (<34 weeks compared to >34 weeks), again there were no significant differences between groups. CONCLUSION: There was no clear evidence of platelet activation in women with preeclampsia at the time of clinical evidence of disease. Plasma levels of PF4, and levels of PF4 and thombospondin-1 in platelet lysates were elevated in both groups compared to published normal ranges. This suggests that platelet activation may occur in normal pregnancy, thus complicating evaluation of platelet function in preeclampsia.
647 Chorioamnionitis without and with neonatal sepsis: newborn and infant outcomes
Hector Mendez-Figueroa1, Adi Abramovici1, Amy E O’Neil1, Joshua Dahlke2, Claudia Pedroza3, Suneet Chauhan1
1 UT Health - University of Texas Medical School at Houston, OB/GYN, Houston, TX, 2Nebraska Methodist Women’s Hospital and Perinatal Center, Omaha, NE, 3UT Health - University of Texas Medical School at Houston, Center for Clinical Research and Evidence-Based Medicine, Houston, TX
OBJECTIVE: The objective was to compare the differential rate of several neonatal and infant morbidities among women without chorioamnionitis (CAN) or neonatal sepsis (NS; control) with 3 groups: i) CAN, without NS ii) NS, without CAN and iii) CAN with NS. Our hypothesis was that neonatal morbidity would be higher with combination of CAN and NS than either one alone.
S318 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015
ajog.org
646 Platelet activation in preeclampsia: myth or fact
Heather Major1, Robert Campbell2, Andrew Weyrich2
645 How often do patients eligible for repeat antepartum corticosteroids receive them?
Heather Levin1, Cande Ananth1, Daphnie Drassinower1, Christian Benjamin-Boamah1, Alexander Friedman1
1 Columbia University Medical Center, Department of Obstetrics and Gynecology, New York, NY
OBJECTIVE: In current obstetrical practice, there has been a non-
standardized adoption of a repeat course of antenatal corticosteroids (ACS). The objective of this study was to determine the trends in administration and to evaluate optimal timing by indication for a repeat antenatal corticosteroid (ACS) in women who deliver preterm. STUDY DESIGN: This retrospective cohort study evaluated repeat ACS administration at a single tertiary care hospital from June 2006 through December 2011. This study included women with a singleton gestation delivering prior to 34 weeks. This study also evaluated the indication for repeat ACS administration, and whether or not administration was optimally timed (>48 hours but <7 days prior to delivery). RESULTS: Of 130 women that delivered at a single institution and were eligible for repeat ACS, 72.3% (n¼94) received repeat ACS prior to delivery. As illustrated in the graph, from 2006 to 2011 there was increasing use of repeat ACS administration. As shown in the table, of women that received a repeat ACS course, 29.8 % (n¼28) received it between 48 hours and 7 days prior to delivery. No single indication for repeat ACS administration was associated with optimal timing prior to delivery. CONCLUSION: Although there appears to be an increase in administration of a repeat course of antenatal corticosteroids over time, no single indication for repeat ACS was associated with optimal timing prior to delivery. Further research is needed to determine optimal timing for this intervention.
1 University of Utah, OB/GYN, Salt Lake City, UT, 2University of Utah, Molecular Medicine, Salt Lake City, UT
OBJECTIVE: Platelet activation has been demonstrated in women with preeclampsia through increased circulating platelet factor 4 (PF4), beta-thromboglobulin, and soluble CD40L. In contrast, other studies have shown decreased plasma thrombospondin, decreased platelet aggregation, and increased PFA-100 closure time. Few studies have examined markers of platelet activation in purified platelets, and platelet activation in preeclampsia remains controversial. STUDY DESIGN: Women with preeclampsia (PE) meeting ACOG criteria were matched by gestational age to women with normal pregnancies. Venous blood was centrifuged to collect platelet-rich plasma and subsequently centrifuged again to obtain platelet-poor plasma (PPP) and platelets. Platelets were purified by depleting leukocytes using magnetic immunoselection. Purified platelets were lysed at a known concentration in RIPA buffer. Plasma levels of RANTES and PF4, and levels of PF4, RANTES, and thrombospondin-1 in platelet lysates were determined by ELISA. RESULTS: Twenty-seven participants were recruited to each comparison group. There were no significant differences in plasma levels of RANTES or PF4 between groups. Levels of thrombospondin-1, PF4, and RANTES in platelet lysates also did not differ significantly between women with PE and those with normotensive pregnancies. When stratified by severity of disease (presence or absence of severe features) or by onset of clinical findings (<34 weeks compared to >34 weeks), again there were no significant differences between groups. CONCLUSION: There was no clear evidence of platelet activation in women with preeclampsia at the time of clinical evidence of disease. Plasma levels of PF4, and levels of PF4 and thombospondin-1 in platelet lysates were elevated in both groups compared to published normal ranges. This suggests that platelet activation may occur in normal pregnancy, thus complicating evaluation of platelet function in preeclampsia.
647 Chorioamnionitis without and with neonatal sepsis: newborn and infant outcomes
Hector Mendez-Figueroa1, Adi Abramovici1, Amy E O’Neil1, Joshua Dahlke2, Claudia Pedroza3, Suneet Chauhan1
1 UT Health - University of Texas Medical School at Houston, OB/GYN, Houston, TX, 2Nebraska Methodist Women’s Hospital and Perinatal Center, Omaha, NE, 3UT Health - University of Texas Medical School at Houston, Center for Clinical Research and Evidence-Based Medicine, Houston, TX
OBJECTIVE: The objective was to compare the differential rate of several neonatal and infant morbidities among women without chorioamnionitis (CAN) or neonatal sepsis (NS; control) with 3 groups: i) CAN, without NS ii) NS, without CAN and iii) CAN with NS. Our hypothesis was that neonatal morbidity would be higher with combination of CAN and NS than either one alone.
S318 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015