802: Oral labetalol alone is as effective as combined IV and oral labetalol in the management of hypertension in preeclampsia

Poster Session V

Fetus Diabetes, etc

in the mode of delivery or in cesarean section rates for both groups was identified (P⫽0.3084). CONCLUSION: Gestational Prehypertension could be defined as an early pregnancy condition whose timely recognition will lead to an improved pregnancy outcome through early intervention and close monitoring of the patient during her prenatal care and delivery. We are expanding to a larger scale study in order to evaluate and confirm these findings in a greater pregnant population. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.818

802 Oral labetalol alone is as effective as combined IV and oral labetalol in the management of hypertension in preeclampsia Teelkien R Van Veen1, Michael A Belfort2, Shalece Kofford3 1

University Medical Center, Groningen, Netherlands, 2HCA, St. Mark‘s Hospital, and University of Utah School of Medicine, Salt Lake City, Utah, 3St. Mark‘s Hospital, Salt Lake City, Utah

OBJECTIVE: ACOG guidelines currently only recommend IV labetalol

and hydralazine as options for the management of severe hypertension in preeclampsia. We studied the antihypertensive efficacy of oral labetalol alone (LAB-PO) as an alternative to IV labetalol followed by oral labetalol (LAB-IV/PO). STUDY DESIGN: Nested case-control study within an RCT. Compared mean arterial pressure (MAP) response to LAB-PO (200 mg PO q 6hrs ) versus LAB-IV/PO (20mg IV then 200mg PO q 6 hrs).⌬MAP ⫽ difference at each timepoint versus baseline MAP. All patients had preeclampsia (ACOG criteria) and none received MgSO4. Significance: p ⬍ 0.05. RESULTS: 44 LAB-PO and 174 LAB-IV/PO. There were no significant differences in admission MAP (112⫾11 vs 116⫾14 mmHg) or maternal demographic factors (gestational age, gravidity, parity, weight). There was no significant difference in efficacy of BP control (Table) or need for additional antihypertensive medication (n⫽4 LAB-PO/n⫽7 LAB-IV/PO). Maternal and neonatal outcomes were similar. (Apgar 5: 8 ⫾ 1 vs 8 ⫾1) CONCLUSION: Oral labetalol alone is as effective as LAB-IV/PO for BP control in preeclampsia, and may be a useful addition to our emergency armamentarium especially in severely preeclamptic patients without an IV line.

www.AJOG.org as cesarean delivery. Clincians may use this information in counseling women at risk of late preterm delivery. Etiolohy of Late preterm birth and outcomes

Jaundice

PreE

Other

aOR CI

43.4%

25.5%

1.5 1.3-1.6

..........................................................................................................................................................................................

Sepsis 5.6% 2.9% 0.9 0.8-1.1 .......................................................................................................................................................................................... RDS 5.5% 2.8% 1.0 0.8-1.1 .......................................................................................................................................................................................... CS 63.3% 41.3% 2.6 2.4-2.8 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.820

804 Neonatal outcomes of early preeclampsia differ from other etiologies of preterm delivery Angie Jelin1, Yvonne Cheng1, Aaron Caughey1 1

University of California, San Francisco, San Francisco, California

OBJECTIVE: To evaluate the neonatal outcomes of infants delivered

between 24 and 28 weeks to mothers with preeclampsia. STUDY DESIGN: This is a retrospective cohort of 1,364 infants delivered

preterm between 24 0/7 and 28 0/7 weeks gestation in California. Neonatal outcomes of 165 infants delivered due to preeclampsia were compared with 1,199 infants delivered due to other etiologies. Primary outcomes examined included: jaundice, cesarean delivery, chorioamnionitis (chorio), neonatal death (NND), and infant death. Multivariable logistic regression was used to analyze the association between preeclampsia and the neonatal outcomes, controlling for potential confounders. RESULTS: Infants of women with preeclampsia were more likely to have jaundice and be delivered by cesarean. They were less likely to suffer a neonatal death (see Table 1). CONCLUSION: Compared to neonates delivered prematurely due to other etiologies, neonates born to preeclamptic mothers were more likely to have a decrease in mortality. This may be a reflection of the differences in the underlying pathophysiology behind indicated preterm birth due to preeclampsia and can be used to counsel women delivering at 24-28 weeks gestation. Table: Perinatal Outcomes in Preeclampsia at 24-28 Weeks’ Gestation

Change in MAP compared with admission MAP Drug (n)

⌬MAP 1 hr

⌬MAP 2 hrs

⌬MAP 3 hrs

⌬MAP 4 hrs

Preeclampsia

Other Preterm Delivery

Adjusted OR (95%CI)

37.0%

21.4%

2.0 (1.4-2.7)

LAB-PO (44) ⫺10⫾12 (⫺8.5%) ⫺14⫾13 (⫺3.8%) ⫺12⫾11 (⫺2.6%) ⫺12⫾12 (⫺0.3%)

Jaundice

IV⫹PO(174) ⫺11⫾15 (⫺9.1%) ⫺14⫾14 (⫺1.5%) ⫺15⫾15 (⫺0.1%) ⫺15⫾15 (0.8%)

Cesarean 81.2% 45.9% 8.4 (5.5-13.0) ..........................................................................................................................................................................................

0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.819

Neonatal Death 9.5% 20.3% 0.06 (0.02-0.2) ..........................................................................................................................................................................................

........................................................................................................................................................................................................... ...........................................................................................................................................................................................................

..........................................................................................................................................................................................

0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.821

803 Late pretem deliveries: preeclampsia and neonatal outcomes Angie Jelin1, Yvonne Cheng1, Aaron Caughey1 1

University of California, San Francisco, San Francisco, California

OBJECTIVE: To evaluate the contribution of preeclampsia to neonatal

morbidity and mortality in late preterm infants by comparing neonatal outcomes of infants born to mothers with and without preeclampsia. STUDY DESIGN: This is a retrospective cohort study of neonatal outcomes of 39,180 infants delivered between 33 and 36 weeks gestation in California. Infants delivered to mothers with preeclampsia were compared to those delivered secondary to other etiologies using chi square and multivariable logisic regression analyses. RESULTS: Neonates delivered to mothers with preeclampsia were more likely to have jaundice, RDS and sepsis and be deliverd via cesarean (Table). These findings reminaed significant after controlling for potential confounders. CONCLUSION: Late preterm deliveries in the setting of preeclampsia were had higher associated rates of several neonatal morbidities as well

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805 Serum and plasma determination of angiogenic and anti-angiogenic factors yield different results: the need for standardization in clinical practice Giovanna Ogge1, Roberto Romero1, Juan Pedro Kusanovic2, Tinnakorn Chaiworapongsa2, Zhong Dong1, Pooja Mittal2, Edi Vaisbuch2, Shali MazakiTovi2, Juan Gonzalez2, Lami Yeo2, Sonia S. Hassan2 1 Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, 2Wayne State University School of Medicine, Detroit, Michigan

OBJECTIVE: The importance of an anti-angiogenic state as a mecha-

nism of disease in preeclampsia is now recognized. Assays for the determination of concentrations of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF) and soluble endoglin (sEng) have been developed for research and clinical laboratories. A key question is whether these factors should be measured in plasma or serum. This issue has been addressed when determining glucose concentration and establishing thresholds for the diagnosis of glucose intoler-

American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009