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457: Feasibility of implementing magnesium sulfate for neuroprotection in a tertiary obstetric unit
Poster Session III
Doppler Assessment, Fetus, Prematurity
457 Feasibility of implementing magnesium sulfate for neuroprotection in a tertiary obstetric unit Susan Walker1, Amber Kennedy2, Lin Li Ow1, Elizabeth McCarthy1 1 Mercy Hospital for Women, University Of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Australia, 2Mercy Hospital for Women, University of Melbourne Dept of Obstetrics and Gynaecology, Melbourne, Australia
OBJECTIVE: to determine whether research recommendations regarding magnesium sulfate for fetal neuroprotection can be successfully translated into clinical practice in a tertiary obstetric center. STUDY DESIGN: The clinical practice guideline Magnesium sulfate for prevention of cerebral palsy was developed and implemented at Mercy Hospital for Women in October 2009. The study population included all women admitted between 23 and 32 weeks gestation in the following 12 months to determine the number of women triaged to receive magnesium sulfate, the proportion of infants who received magnesium sulfate prior to delivery and the total number of doses (necessary and unnecessary) administered over the 12 month period. RESULTS: 330 women were admitted at a mean gestational age of 28.2 weeks. 132/330(40%) were prescribed Magnesium sulfate, of whom 123/132(93%) delivered. 142/191(73%) infants born at less than 32 weeks gestation received Magnesium sulfate prior to delivery, with no significant differences seen by plurality or gestational age. Of the 145 doses in 12 months, only 13 women received more than one dose, and only 9/145 (7%) doses proved to be unnecessary (delivery never eventuated prior to 32 weeks gestation). The median treatment duration was 3 hours 58 minutes. The infusion was discontinued due to side effects in only 2% of patients. CONCLUSION: Research recommendations regarding administration of Magnesium sulfate with neuroprotective intent can be successfully translated into clinical practice. Appropriate triaging of women at high risk of imminent preterm birth is feasible, enabling a high level of Magnesium sulfate coverage for infants that deliver prior to 32 weeks’ gestation, with minimal toxicity and a low rate of unnecessary maternal exposure.
www.AJOG.org
charge were prescribed daily telephonic assessment vs. weekly home nursing visits. STUDY DESIGN: Women with current singleton gestation and history of spontaneous PTD (SPTD), enrolled at 16-27.9 weeks in a weekly 17P home administration program were identified. The study sample consisted of women hospitalized for evaluation of PTL symptoms at ⬍34 weeks, who were subsequently discharged and continued to receive 17P (n⫽1081). Rates of recurrent SPTD, and estimated charges (for 17P program, daily assessment and nursery) were compared overall and by gestational age (GA) at 17P start (16-20.9 weeks or 21-27.9 weeks) for those women who continued 17P with weekly home nurse visits only to those that were prescribed daily telephonic assessment in addition to the weekly nurse visits. RESULTS: Overall 457 of 1081 women studied (42.3%) received additional daily assessment after hospitalization for PTL. Maternal characteristics: ⬎1 prior PTD, smoking, single parent, and presence of cerclage were similar between groups. Women prescribed daily assessment were more likely to have a cervical length ⬍25mm (10.5% vs. 6.1%, p⫽ 0.008). Initiation of 17P after 20.9 weeks occurred in 357 women (33%). Outcomes presented in table. Rates of PTD at ⬍34 and ⬍32 weeks and total estimated charges were significantly lower in the daily assessment group regardless if 17P was started at 16-20.9 weeks or 21-27.9 weeks. CONCLUSION: In women receiving 17P prophylaxis, initiation of daily nursing assessment following a hospitalization for evaluation of PTL symptoms resulted in lower rates of early PTD and was cost-effective through a reduction in nursery utilization. Ongoing patient education and frequent assessment of PTL symptoms may be beneficial in this population.
459 Racial differences in self-reported and biologic measures of chronic stress in pregnancy Ann Borders1, Kaitlin Wolfe2, Jie Peng3, KwangYoun Kim3, Jane Holl2, William Grobman1 1 Northwestern University Feinberg School of Medicine, Obstetrics and Gynecology, Chicago, IL, 2Northwestern University Feinberg School of Medicine, Institute for Healthcare Studies, Chicago, IL, 3Northwestern University Feinberg School of Medicine, Preventive Medicine, Chicago, IL
458 Recurrent preterm birth prevention in women receiving prophylactic 17P experiencing symptoms of preterm labor Andrei Rebarber1, Ashley Roman1, Nathan Fox1, Niki Istwan2, Debbie Rhea2, Cheryl Desch2, Daniel Saltzman1 1 Carnegie Imaging for Women, Obstetrics and Gynecology, New York, NY, 2Alere Health, Department of Clinical Research, Atlanta, GA
OBJECTIVE: Weekly injection of 17P is a prophylactic treatment that has been shown to reduce the risk for recurrent spontaneous preterm birth. The purpose of the present study was to compare rates of recurrent preterm delivery (PTD) in women that while receiving 17P had hospital evaluation for preterm labor (PTL) symptoms and upon dis-
S210
OBJECTIVE: Chronic stress has been associated with adverse pregnancy outcomes such as preterm birth. Elevated chronic stress in AfricanAmerican women may play a role in racial disparities in preterm birth; however, racial differences in maternal stress have not been consistently demonstrated. The objective of this study is to identify differences in self-reported and biologic measures of chronic stress between African-American and Caucasian pregnant women. STUDY DESIGN: African-American and Caucasian pregnant women were recruited at an urban university hospital between May 2008 and July 2009. Self-reported stress was measured from 14 to 22 weeks gestation. Blood samples, collected from 14 to 22 weeks and again
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2012
Doppler Assessment, Fetus, Prematurity
457 Feasibility of implementing magnesium sulfate for neuroprotection in a tertiary obstetric unit Susan Walker1, Amber Kennedy2, Lin Li Ow1, Elizabeth McCarthy1 1 Mercy Hospital for Women, University Of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Australia, 2Mercy Hospital for Women, University of Melbourne Dept of Obstetrics and Gynaecology, Melbourne, Australia
OBJECTIVE: to determine whether research recommendations regarding magnesium sulfate for fetal neuroprotection can be successfully translated into clinical practice in a tertiary obstetric center. STUDY DESIGN: The clinical practice guideline Magnesium sulfate for prevention of cerebral palsy was developed and implemented at Mercy Hospital for Women in October 2009. The study population included all women admitted between 23 and 32 weeks gestation in the following 12 months to determine the number of women triaged to receive magnesium sulfate, the proportion of infants who received magnesium sulfate prior to delivery and the total number of doses (necessary and unnecessary) administered over the 12 month period. RESULTS: 330 women were admitted at a mean gestational age of 28.2 weeks. 132/330(40%) were prescribed Magnesium sulfate, of whom 123/132(93%) delivered. 142/191(73%) infants born at less than 32 weeks gestation received Magnesium sulfate prior to delivery, with no significant differences seen by plurality or gestational age. Of the 145 doses in 12 months, only 13 women received more than one dose, and only 9/145 (7%) doses proved to be unnecessary (delivery never eventuated prior to 32 weeks gestation). The median treatment duration was 3 hours 58 minutes. The infusion was discontinued due to side effects in only 2% of patients. CONCLUSION: Research recommendations regarding administration of Magnesium sulfate with neuroprotective intent can be successfully translated into clinical practice. Appropriate triaging of women at high risk of imminent preterm birth is feasible, enabling a high level of Magnesium sulfate coverage for infants that deliver prior to 32 weeks’ gestation, with minimal toxicity and a low rate of unnecessary maternal exposure.
www.AJOG.org
charge were prescribed daily telephonic assessment vs. weekly home nursing visits. STUDY DESIGN: Women with current singleton gestation and history of spontaneous PTD (SPTD), enrolled at 16-27.9 weeks in a weekly 17P home administration program were identified. The study sample consisted of women hospitalized for evaluation of PTL symptoms at ⬍34 weeks, who were subsequently discharged and continued to receive 17P (n⫽1081). Rates of recurrent SPTD, and estimated charges (for 17P program, daily assessment and nursery) were compared overall and by gestational age (GA) at 17P start (16-20.9 weeks or 21-27.9 weeks) for those women who continued 17P with weekly home nurse visits only to those that were prescribed daily telephonic assessment in addition to the weekly nurse visits. RESULTS: Overall 457 of 1081 women studied (42.3%) received additional daily assessment after hospitalization for PTL. Maternal characteristics: ⬎1 prior PTD, smoking, single parent, and presence of cerclage were similar between groups. Women prescribed daily assessment were more likely to have a cervical length ⬍25mm (10.5% vs. 6.1%, p⫽ 0.008). Initiation of 17P after 20.9 weeks occurred in 357 women (33%). Outcomes presented in table. Rates of PTD at ⬍34 and ⬍32 weeks and total estimated charges were significantly lower in the daily assessment group regardless if 17P was started at 16-20.9 weeks or 21-27.9 weeks. CONCLUSION: In women receiving 17P prophylaxis, initiation of daily nursing assessment following a hospitalization for evaluation of PTL symptoms resulted in lower rates of early PTD and was cost-effective through a reduction in nursery utilization. Ongoing patient education and frequent assessment of PTL symptoms may be beneficial in this population.
459 Racial differences in self-reported and biologic measures of chronic stress in pregnancy Ann Borders1, Kaitlin Wolfe2, Jie Peng3, KwangYoun Kim3, Jane Holl2, William Grobman1 1 Northwestern University Feinberg School of Medicine, Obstetrics and Gynecology, Chicago, IL, 2Northwestern University Feinberg School of Medicine, Institute for Healthcare Studies, Chicago, IL, 3Northwestern University Feinberg School of Medicine, Preventive Medicine, Chicago, IL
458 Recurrent preterm birth prevention in women receiving prophylactic 17P experiencing symptoms of preterm labor Andrei Rebarber1, Ashley Roman1, Nathan Fox1, Niki Istwan2, Debbie Rhea2, Cheryl Desch2, Daniel Saltzman1 1 Carnegie Imaging for Women, Obstetrics and Gynecology, New York, NY, 2Alere Health, Department of Clinical Research, Atlanta, GA
OBJECTIVE: Weekly injection of 17P is a prophylactic treatment that has been shown to reduce the risk for recurrent spontaneous preterm birth. The purpose of the present study was to compare rates of recurrent preterm delivery (PTD) in women that while receiving 17P had hospital evaluation for preterm labor (PTL) symptoms and upon dis-
S210
OBJECTIVE: Chronic stress has been associated with adverse pregnancy outcomes such as preterm birth. Elevated chronic stress in AfricanAmerican women may play a role in racial disparities in preterm birth; however, racial differences in maternal stress have not been consistently demonstrated. The objective of this study is to identify differences in self-reported and biologic measures of chronic stress between African-American and Caucasian pregnant women. STUDY DESIGN: African-American and Caucasian pregnant women were recruited at an urban university hospital between May 2008 and July 2009. Self-reported stress was measured from 14 to 22 weeks gestation. Blood samples, collected from 14 to 22 weeks and again
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2012