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176: Conformity with treatment standards and pregnancy outcomes in patients receiving 17 alpha-hydroxyprogesterone caproate (17p) for preterm birth prophylaxis
www.AJOG.org Clinical Obstetrics, Neonatology, Physiology-Endocrinology CONCLUSIONS: Overall while receiving 17P, women with one prior SPTB due to PPROM were less likely to experience RSPTB than patients with a prior SPTB due to PTL with intact membranes. No differences in rates of RSPTB were observed between those with prior PTL or PPROM if the GA of the first SPTB occurred between 28-33.9 weeks’ gestation. 17P prophylaxis should be offered to all women with history of SPTB. Prior GA SPTB
20-27.9w
28-33.9w
34-36.9w
RSPTB ⬍37w
.................................................................................................................................................................................
PTL group 30.8% 29.7% 29.0% ................................................................................................................................................................................. PPROM group 15.4%* 30.3% 17.6%* ..........................................................................................................................................................................................
Poster Session I
SPTB <37w 17P start 16-20.9w (n⫽5058)
26.3%
SPTB <35w 10.8%
SPTB <32w 4.5%
..........................................................................................................................................................................................
17P start 21-24.9w (n⫽1488) 27.0% 11.9% 4.8% .......................................................................................................................................................................................... p-value 0.600 0.252 0.547 .......................................................................................................................................................................................... Interval ⱕ10d (n⫽6449) 26.3% 10.9% 4.4% .......................................................................................................................................................................................... Interval ⬎10d (n⫽60) 33.3% 20.0% 6.7% .......................................................................................................................................................................................... p-value 0.222 0.025 0.341 .......................................................................................................................................................................................... No Early DC (n⫽ 5561) 24.9% 10.2% 4.1% .......................................................................................................................................................................................... Early DC ⬍34w (n⫽985) 35.2% 16.1% 7.2% .......................................................................................................................................................................................... p-value ⬍0.001 ⬍0.001 ⬍0.001 ..........................................................................................................................................................................................
RSPTB ⬍35w ................................................................................................................................................................................. PTL group 21.4% 14.4% 9.9% ................................................................................................................................................................................. PPROM group
10.3%*
12.8%
4.3%*
..........................................................................................................................................................................................
RPTB................................................................................................................................................................................. ⬍32w
177 Amniotic fluid sludge in the presence of cervical cerclage is associated with poor obstetric outcomes
PTL group 13.1% 5.8% 2.3% .................................................................................................................................................................................
Vikas Sachar1, M Ismail2, L DiGiovanni2, O Rust3, Julie Moldenhauer4
PPROM group
1
6.4%
4.6%
0.5%
..........................................................................................................................................................................................
* ⫽p⬍0.05 vs. PTL group
176 Conformity with treatment standards and pregnancy outcomes in patients receiving 17 alpha-hydroxyprogesterone caproate (17p) for preterm birth prophylaxis Victor Hugo Gonzalez-Quintero1, Niki Istwan2, Felipe Jose Tudela1, Debbie Rhea2, Leticia Maria Romary1, Yvette C. Cordova1, Fabienne Achille1, Cheryl Desch2, Gary Stanziano2 1
University of Miami , Miami, FL, 2Alere Health, Atlanta, GA
OBJECTIVE: 17P is recommended for women with a history of spontaneous preterm birth (SPTB) to reduce the risk for SPTB recurrence, though patient compliance with timely initiation of treatment, injection interval and completion of therapy are clinical challenges. We sought to examine rates of compliance and recurrent SPTB in women enrolled for outpatient 17P administration services. STUDY DESIGN: Identified from a database were women enrolled in an outpatient 17P administration program of education and weekly home visits with nurse administered 17P injections. Included were women with prior SPTB, current singleton pregnancy, and no cerclage, enrolled at ⬍25 weeks’ gestation (N⫽6546). We examined rates of recurrent SPTB at ⬍37, ⬍35 and ⬍32 weeks by timing of 17P initiation (16-20.9 weeks vs. 21-24.9 weeks), mean injection interval for those having ⬎1 injection (within 10 days vs. ⬎10 day interval), and timing of 17P discontinuation (DC) (elective DC prior to 34 weeks vs. DC due to preterm birth or after 34 completed weeks). RESULTS: Overall, within the outpatient program of weekly nurse visits 77.3% of women initiated 17P at 16-20.9 weeks and 98.5% had a mean injection interval within 10 days. Only 0.5% of patients electively discontinued 17P after 1 injection. Early DC at ⬍34 weeks which was elective and not due to preterm birth occurred in 15.0% of patients. SPTB outcomes presented in table. CONCLUSIONS: High rates of compliance with timing of 17P prophylaxis initiation and recommended injection interval are observed for women enrolled in an outpatient 17P administration program of patient education and weekly home nursing visits. Elective early DC of 17P at ⬍34 weeks’ gestation is associated with increased rates of recurrent SPTB.
St. Francis Medical Center, Beverly Hills, CA, 2University of Chicago, Chicago, IL, 3Grand View Hospital, Sellersville, PA, 4The Children’s Hospital of Philadelphia, Philadelphia, PA
OBJECTIVE: To determine if the prenatal ultrasound finding of amniotic fluid sludge in patients with cervical cerclage is associated with adverse pregnancy outcome. STUDY DESIGN: Retrospective review of patients receiving cervical cerclage and subsequent delivery at one institution over a five year period. Maternal demographics, operative cerclage details, obstetric and neonatal outcome data were collected through chart review. Ultrasound images were retrospectively reviewed for the presence or absence of amniotic fluid sludge and cervical sonographic characteristics. Primary outcomes measured were preterm delivery ⬍ 32 weeks and composite neonatal morbidity, including grade III-IV intraventricular hemorrhage, bronchopulmonary dysplasia, respiratory distress syndrome, necrotizing enterocolitis, culture proven sepsis and death, in the presence of amniotic fluid sludge. RESULTS: A total of 105 patients were included in the study. Of those, 66 had sonographic evidence of sludge and 39 did not. Delivery at ⬍32 weeks (34.8% vs 5.1%, p⬍0.0001) and ⬍28 weeks (29% vs 5.1%, p⫽0.005) was significantly increased in the sludge present group vs the sludge absent group. There was no difference in composite neonatal morbidity between the two groups (p⫽0.056). The interval from cerclage to delivery was significantly less in the group with sludge present (114.6 ⫹/- 56.1 days) compared to the group with no sludge (148.4 ⫹/- 32 days, p⫽0.0008). Gestational age at delivery was significantly less in the sludge present group compared to the sludge absent group (33.3 ⫹/- 6.7 weeks vs. 36.9⫹/-3.3 weeks; p⫽0.0025). CONCLUSIONS: In women undergoing cerclage placement, the presence of amniotic fluid sludge increases the risk for delivery at less than 32 weeks. The interval from cerclage placement to delivery is also shortened in women with amniotic fluid sludge.
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S81
20-27.9w
28-33.9w
34-36.9w
RSPTB ⬍37w
.................................................................................................................................................................................
PTL group 30.8% 29.7% 29.0% ................................................................................................................................................................................. PPROM group 15.4%* 30.3% 17.6%* ..........................................................................................................................................................................................
Poster Session I
SPTB <37w 17P start 16-20.9w (n⫽5058)
26.3%
SPTB <35w 10.8%
SPTB <32w 4.5%
..........................................................................................................................................................................................
17P start 21-24.9w (n⫽1488) 27.0% 11.9% 4.8% .......................................................................................................................................................................................... p-value 0.600 0.252 0.547 .......................................................................................................................................................................................... Interval ⱕ10d (n⫽6449) 26.3% 10.9% 4.4% .......................................................................................................................................................................................... Interval ⬎10d (n⫽60) 33.3% 20.0% 6.7% .......................................................................................................................................................................................... p-value 0.222 0.025 0.341 .......................................................................................................................................................................................... No Early DC (n⫽ 5561) 24.9% 10.2% 4.1% .......................................................................................................................................................................................... Early DC ⬍34w (n⫽985) 35.2% 16.1% 7.2% .......................................................................................................................................................................................... p-value ⬍0.001 ⬍0.001 ⬍0.001 ..........................................................................................................................................................................................
RSPTB ⬍35w ................................................................................................................................................................................. PTL group 21.4% 14.4% 9.9% ................................................................................................................................................................................. PPROM group
10.3%*
12.8%
4.3%*
..........................................................................................................................................................................................
RPTB................................................................................................................................................................................. ⬍32w
177 Amniotic fluid sludge in the presence of cervical cerclage is associated with poor obstetric outcomes
PTL group 13.1% 5.8% 2.3% .................................................................................................................................................................................
Vikas Sachar1, M Ismail2, L DiGiovanni2, O Rust3, Julie Moldenhauer4
PPROM group
1
6.4%
4.6%
0.5%
..........................................................................................................................................................................................
* ⫽p⬍0.05 vs. PTL group
176 Conformity with treatment standards and pregnancy outcomes in patients receiving 17 alpha-hydroxyprogesterone caproate (17p) for preterm birth prophylaxis Victor Hugo Gonzalez-Quintero1, Niki Istwan2, Felipe Jose Tudela1, Debbie Rhea2, Leticia Maria Romary1, Yvette C. Cordova1, Fabienne Achille1, Cheryl Desch2, Gary Stanziano2 1
University of Miami , Miami, FL, 2Alere Health, Atlanta, GA
OBJECTIVE: 17P is recommended for women with a history of spontaneous preterm birth (SPTB) to reduce the risk for SPTB recurrence, though patient compliance with timely initiation of treatment, injection interval and completion of therapy are clinical challenges. We sought to examine rates of compliance and recurrent SPTB in women enrolled for outpatient 17P administration services. STUDY DESIGN: Identified from a database were women enrolled in an outpatient 17P administration program of education and weekly home visits with nurse administered 17P injections. Included were women with prior SPTB, current singleton pregnancy, and no cerclage, enrolled at ⬍25 weeks’ gestation (N⫽6546). We examined rates of recurrent SPTB at ⬍37, ⬍35 and ⬍32 weeks by timing of 17P initiation (16-20.9 weeks vs. 21-24.9 weeks), mean injection interval for those having ⬎1 injection (within 10 days vs. ⬎10 day interval), and timing of 17P discontinuation (DC) (elective DC prior to 34 weeks vs. DC due to preterm birth or after 34 completed weeks). RESULTS: Overall, within the outpatient program of weekly nurse visits 77.3% of women initiated 17P at 16-20.9 weeks and 98.5% had a mean injection interval within 10 days. Only 0.5% of patients electively discontinued 17P after 1 injection. Early DC at ⬍34 weeks which was elective and not due to preterm birth occurred in 15.0% of patients. SPTB outcomes presented in table. CONCLUSIONS: High rates of compliance with timing of 17P prophylaxis initiation and recommended injection interval are observed for women enrolled in an outpatient 17P administration program of patient education and weekly home nursing visits. Elective early DC of 17P at ⬍34 weeks’ gestation is associated with increased rates of recurrent SPTB.
St. Francis Medical Center, Beverly Hills, CA, 2University of Chicago, Chicago, IL, 3Grand View Hospital, Sellersville, PA, 4The Children’s Hospital of Philadelphia, Philadelphia, PA
OBJECTIVE: To determine if the prenatal ultrasound finding of amniotic fluid sludge in patients with cervical cerclage is associated with adverse pregnancy outcome. STUDY DESIGN: Retrospective review of patients receiving cervical cerclage and subsequent delivery at one institution over a five year period. Maternal demographics, operative cerclage details, obstetric and neonatal outcome data were collected through chart review. Ultrasound images were retrospectively reviewed for the presence or absence of amniotic fluid sludge and cervical sonographic characteristics. Primary outcomes measured were preterm delivery ⬍ 32 weeks and composite neonatal morbidity, including grade III-IV intraventricular hemorrhage, bronchopulmonary dysplasia, respiratory distress syndrome, necrotizing enterocolitis, culture proven sepsis and death, in the presence of amniotic fluid sludge. RESULTS: A total of 105 patients were included in the study. Of those, 66 had sonographic evidence of sludge and 39 did not. Delivery at ⬍32 weeks (34.8% vs 5.1%, p⬍0.0001) and ⬍28 weeks (29% vs 5.1%, p⫽0.005) was significantly increased in the sludge present group vs the sludge absent group. There was no difference in composite neonatal morbidity between the two groups (p⫽0.056). The interval from cerclage to delivery was significantly less in the group with sludge present (114.6 ⫹/- 56.1 days) compared to the group with no sludge (148.4 ⫹/- 32 days, p⫽0.0008). Gestational age at delivery was significantly less in the sludge present group compared to the sludge absent group (33.3 ⫹/- 6.7 weeks vs. 36.9⫹/-3.3 weeks; p⫽0.0025). CONCLUSIONS: In women undergoing cerclage placement, the presence of amniotic fluid sludge increases the risk for delivery at less than 32 weeks. The interval from cerclage placement to delivery is also shortened in women with amniotic fluid sludge.
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S81