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519: Outcomes of subsequent pregnancies in women with peripartum cardiomyopathy
Poster Session III
ajog.org CONCLUSION: Women who recover normal LVEF after a pregnancy complicated by PPCM do not appear to experience recurrent left ventricular dysfunction in subsequent pregnancies.
520 Does baseline change influence neonatal outcomes?
Michael Yang1, Molly Stout1, Ryan Colvin1, George Macones1, Alison Cahill1 1
Washington University in St. Louis School of Medicine, Saint Louis, MO
OBJECTIVE: Abnormalities of the fetal baseline heart rate, though
Figure. In situ flourescence probing with the universal 16S bacterial rDNA genome (EUB338) reveals the observable presence of bacteria in placentae. These findings support our recent metegenomic characterization of a low biomass placental microbiome, and significantly expands decades of work by other investigators on culturable bacteria. With the FISH approach, we are able to estimate the typical cluster abundance at 0.2-0.9 bacteria/mm3 in the absence of chorioamnionitis.
519 Outcomes of subsequent pregnancies in women with peripartum cardiomyopathy Maya Remington2, Michael Fassett1, Darios Getahun3
1 Kaiser Permanente West Los Angeles Medical Center, Maternal-Fetal Medicine, Los Angeles, CA, 2Kaiser Permanente Los Angeles Medical Center, Obstetrics and Gynecology, Los Angeles, CA, 3Kaiser Permanente Southern California, Research and Evaluation, Pasadena, CA
rare, have been associated with adverse outcomes. More commonly, fetal heart rate (FHR) baseline fluctuates within the normal range, though with presently unknown meaning. We aimed to estimate the association between changes in normal baseline FHR with acidemia and neonatal outcomes. STUDY DESIGN: Within an ongoing prospective cohort study of all consecutive singleton, nonanomalous, term pregnancies, we included all women with continuous EFM in the last 2 hours of labor. To examine normal baselines, we excluded fetuses with any bradycardia or tachycardia. EFM patterns were extracted using NICHD criteria by trained obstetric research nurses blind to clinical and outcome data. As the NICHD defines change as 15 bpm for 10 minutes, we divided the last 2 hours into 10 minute periods and assigned a baseline FHR value to each. Increase or decrease of 20 bpm from one period to any later period was considered baseline change. Change 30 bpm was also assessed. Risk of acidemia (umbilical cord arterial pH 7.10) and NICU admission in infants with baseline change was estimated with GEE adjusting for nulliparity, obesity, fever, delivery mode, and within patient change. RESULTS: Of 3,021 women with continuous EFM and normal baseline throughout the last 2 hours of labor, 272 (9.0%) had change 30 bpm, and 1267 (41.9%) 20 bpm. Baseline change was not associated with acidemia at 20 bpm or 30 bpm in any direction. NICU admission was not significantly more likely with baseline increase 20 bpm or change in any direction 30 bpm. Decrease 20 bpm (adjusted odds ratio [aOR] 2.98; 95% confidence [CI] 1.21-7.33) and any change 20 bpm (aOR 4.19; 95% CI 1.52-11.56) were associated with NICU admission, but poor predictors of outcome (respectively, sensitivity 40%, 75%; specificity 18%, 42%; positive predictive value 1.4%, 1.2%; negative predictive value 0.4%, 0.2%). CONCLUSION: Changes of normal baseline heart rate are common in term labor and are poor predictors of morbidity, regardless of direction or magnitude.
Relationship between baseline change and outcome
OBJECTIVE: To examine the outcomes of subsequent pregnancies in
women with peripartum cardiomyopathy (PPCM). STUDY DESIGN: We identified women with PPCM (ICD-9 674.5)
within 9 months before or 6 months after any pregnancy. Medical records were reviewed to confirm diagnosis of PPCM and ascertain the outcomes of any subsequent pregnancies. RESULTS: We identified 85 women with PPCM. Left ventricular ejection fraction (LVEF) returned to normal in 72 women (84.7%). No woman with persistent left ventricular dysfunction had a subsequent pregnancy. 16 women with recovered LVEF (mean 55.3% 6.9%) had 30 subsequent pregnancies. 12 women had one subsequent pregnancy, and 6 women had two or more subsequent pregnancies. Among these 30 pregnancies there were: 7 elective terminations (mean LVEF 62.3% 6.3%), 7 spontaneous abortions (mean LVEF 58% 4.5%), and 13 liveborn infants (mean LVEF 57.7% 4,4%). None of these 16 women experienced recurrent left ventricular dysfunction in a subsequent pregnancy.
*Fisher’s exact test
S260 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015
ajog.org CONCLUSION: Women who recover normal LVEF after a pregnancy complicated by PPCM do not appear to experience recurrent left ventricular dysfunction in subsequent pregnancies.
520 Does baseline change influence neonatal outcomes?
Michael Yang1, Molly Stout1, Ryan Colvin1, George Macones1, Alison Cahill1 1
Washington University in St. Louis School of Medicine, Saint Louis, MO
OBJECTIVE: Abnormalities of the fetal baseline heart rate, though
Figure. In situ flourescence probing with the universal 16S bacterial rDNA genome (EUB338) reveals the observable presence of bacteria in placentae. These findings support our recent metegenomic characterization of a low biomass placental microbiome, and significantly expands decades of work by other investigators on culturable bacteria. With the FISH approach, we are able to estimate the typical cluster abundance at 0.2-0.9 bacteria/mm3 in the absence of chorioamnionitis.
519 Outcomes of subsequent pregnancies in women with peripartum cardiomyopathy Maya Remington2, Michael Fassett1, Darios Getahun3
1 Kaiser Permanente West Los Angeles Medical Center, Maternal-Fetal Medicine, Los Angeles, CA, 2Kaiser Permanente Los Angeles Medical Center, Obstetrics and Gynecology, Los Angeles, CA, 3Kaiser Permanente Southern California, Research and Evaluation, Pasadena, CA
rare, have been associated with adverse outcomes. More commonly, fetal heart rate (FHR) baseline fluctuates within the normal range, though with presently unknown meaning. We aimed to estimate the association between changes in normal baseline FHR with acidemia and neonatal outcomes. STUDY DESIGN: Within an ongoing prospective cohort study of all consecutive singleton, nonanomalous, term pregnancies, we included all women with continuous EFM in the last 2 hours of labor. To examine normal baselines, we excluded fetuses with any bradycardia or tachycardia. EFM patterns were extracted using NICHD criteria by trained obstetric research nurses blind to clinical and outcome data. As the NICHD defines change as 15 bpm for 10 minutes, we divided the last 2 hours into 10 minute periods and assigned a baseline FHR value to each. Increase or decrease of 20 bpm from one period to any later period was considered baseline change. Change 30 bpm was also assessed. Risk of acidemia (umbilical cord arterial pH 7.10) and NICU admission in infants with baseline change was estimated with GEE adjusting for nulliparity, obesity, fever, delivery mode, and within patient change. RESULTS: Of 3,021 women with continuous EFM and normal baseline throughout the last 2 hours of labor, 272 (9.0%) had change 30 bpm, and 1267 (41.9%) 20 bpm. Baseline change was not associated with acidemia at 20 bpm or 30 bpm in any direction. NICU admission was not significantly more likely with baseline increase 20 bpm or change in any direction 30 bpm. Decrease 20 bpm (adjusted odds ratio [aOR] 2.98; 95% confidence [CI] 1.21-7.33) and any change 20 bpm (aOR 4.19; 95% CI 1.52-11.56) were associated with NICU admission, but poor predictors of outcome (respectively, sensitivity 40%, 75%; specificity 18%, 42%; positive predictive value 1.4%, 1.2%; negative predictive value 0.4%, 0.2%). CONCLUSION: Changes of normal baseline heart rate are common in term labor and are poor predictors of morbidity, regardless of direction or magnitude.
Relationship between baseline change and outcome
OBJECTIVE: To examine the outcomes of subsequent pregnancies in
women with peripartum cardiomyopathy (PPCM). STUDY DESIGN: We identified women with PPCM (ICD-9 674.5)
within 9 months before or 6 months after any pregnancy. Medical records were reviewed to confirm diagnosis of PPCM and ascertain the outcomes of any subsequent pregnancies. RESULTS: We identified 85 women with PPCM. Left ventricular ejection fraction (LVEF) returned to normal in 72 women (84.7%). No woman with persistent left ventricular dysfunction had a subsequent pregnancy. 16 women with recovered LVEF (mean 55.3% 6.9%) had 30 subsequent pregnancies. 12 women had one subsequent pregnancy, and 6 women had two or more subsequent pregnancies. Among these 30 pregnancies there were: 7 elective terminations (mean LVEF 62.3% 6.3%), 7 spontaneous abortions (mean LVEF 58% 4.5%), and 13 liveborn infants (mean LVEF 57.7% 4,4%). None of these 16 women experienced recurrent left ventricular dysfunction in a subsequent pregnancy.
*Fisher’s exact test
S260 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015