- Email: [email protected]
594: Chorioamnionitis: a retrospective study analyzing the accuracy of clinical diagnosis in preterm pregnancies
Poster Session IV
Epidemiology, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics, Obstetric Quality & Safety, Public Health-Global Health
www.AJOG.org
RESULTS: We identified 457 HIV-positive mothers in a 5 year period. Seventy percent were diagnosed prior to pregnancy. 53% were American Black, followed by 21.6% were Haitian, and another 16.6% were Hispanic. 83.1% of patients were between the ages of 18-34 when they delivered. 59.8% of patients were on HAART without a PI and 38.8% were taking HAART with a PI. 40.2% had viral loads of less than 1,000 copies/ml at delivery. Only 15% had a CD4 count of ⬍200 at the end of pregnancy and 27% had AIDS. 33.4% had a vaginal delivery, while 66.6% had a Cesarean delivery. 18.5% were delivered preterm. The most common mode of transmission was heterosexual (93%). Most importantly, there were no cases of vertical HIV infection reported in the last 5 years at our institution. CONCLUSION: With the implementation of a tailored plan of care for HIV-positive pregnant women, a “zero” rate of vertical transmission of HIV is possible.
591 Rapid test for growth and determination of antibiotic sensitivity of Group B Streptococcus (GBS) in antepartum women 1
1
1
Jonathan Faro , Allan Katz , Mildred Ramirez , Mark Turrentine2, Karen Bishop1, Gerald Riddle1, Sebastian Faro1 1
UT Health Science Center at Houston, Obstetrics, Gynecology and Reproductive Sciences, Houston, TX, 2Kelsey Seybold, Obstetrics and Gynecology, Houston, TX
OBJECTIVE: We determined if a new method of rapidly growing GBS in 6 hours could also determine antibiotic sensitivities in a shorter period compared to standard cultures. STUDY DESIGN: Women were screened between 35 to 37 weeks gestation. Vaginal-rectal swabs were collected in Stuarts transport medium. Swabs were then inoculated on a nitrocellulose membrane (NCM) that had been coated previously with polyclonal rabbit antibody against GBS in the presence or absence of clindamycin. At six hours, the NCM was removed from the sheep blood agar medium, and horseradish-peroxidase conjugate polyclonal antibody against GBS was added. An additional swab from each patient was cultured by traditional methods for 48-72 hours and those positive for GBS were then tested for resistance/sensitivity to clindamycin. A final control consisted of sending a separate swab from each patient to a commercial lab. RESULTS: 124 patient samples were screened, of which 33 were positive for GBS by the rapid test (97.0% concordance with traditional culture). Of these 33 positive samples, 10 were resistant to clindamycin, which agreed 100% with traditional culture. Results of the both the rapid and traditional culture showed 100% concordance with sensitivity or resistance to clindamycin when compared with commercial lab results. CONCLUSION: This new NCM assay offers a rapid and unique method for both detection and determination of antibiotic sensitivities for GBS; thus improving the targeting of antibiotic prophylaxis for GBS colonization.
592 Can a zero perinatal transmission rate of HIV be achieved in the US? Kathleen Brookfield1, Lunthita Duthely2, Amanda Cotter3 1 University of Miami School of Medicine, Obstetrics and Gynecology, Miami, FL, 2Univ of Miami School of Medicine, Obstetrics & Gynecology, Miami, FL, 3University of Miami Miller School of Medicine, Obstetrics & Gynecology, Miami, FL
OBJECTIVE: Our institution treats one of the largest populations of HIV infected pregnant women in the United States. We sought to describe a single-center experience with treatment and pregnancy outcomes for this group of patients. STUDY DESIGN: We describe the prospective 5 year experience of our institution in a university setting between 2005-2010. Our institution utilizes a multi-disciplinary team of physicians, nurse practitioners, social workers, psychologists, and counselors in caring for these patients.
S268
593 Maternal self-report of oral health and hygiene, dental care, and pregnancy outcome Kim Boggess1, Erica Berggren2, Viktoria Koskenoja2, Diana Urlaub3, Merry K Moos4, Carol Lorenz3 1 University of North Carolina at Chapel Hill, Obstetrics and Gynecology, Chapel Hill, NC, 2University of North Carolina at Chapel Hill, Ob Gyn, Chapel Hill, NC, 3University of North Carolina at Chapel Hi, Center for Womens Health Research, Chapel Hill, NC, 4University of North Carolina at Chapel Hi, Ob Gyn, Chapel Hill, NC
OBJECTIVE: Periodontal disease in pregnancy is associated with PTB and preeclampsia. Our objective was to determine whether oral symptoms/problems, hygiene practices, or dental service utilization prior to or during pregnancy are associated with these outcomes. STUDY DESIGN: A written questionnaire was administered and outcomes ascertained by chart abstraction. Chi square test compared oral symptoms/problems, hygiene practices, and dental service utilization between women with spontaneous (s)PTB versus term birth, and severe preeclampsia versus others. Multivariable regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for outcomes. RESULTS: 48 (10%) of 470 women reported ⬎ 2 oral symptoms/problems in the 6 months prior to pregnancy and 77 (16%) since pregnancy. 51 (11%) reported prior periodontal treatment. Women who reported ⬎ 2 oral symptoms/problems in the 6 months prior to pregnancy were more likely to have sPTB ⬍ 37 weeks (aOR 4.7, 95%CI 1.4-8.7) or sPTB ⬍ 35 weeks (aOR 2.0, 95%CI 1.7-12.7). Women with a history of periodontal treatment were more likely to develop severe preeclampsia (aOR 3.8, 95%CI 1.4-9.8). However, oral health symptoms/problems, oral hygiene practices, or dental service utilization during pregnancy were not associated with pregnancy outcomes. CONCLUSION: Oral health symptoms/problems and periodontal treatment prior to pregnancy are more predictive of adverse outcomes than symptoms/problems during pregnancy. This may be one explanation for failure of periodontal treatment during pregnancy to reduce PTB. Preconception care to address oral symptoms/problems and prenatal questions to identify women with a history of periodontal treatment should be considered to identify women at risk for adverse pregnancy outcome and who may benefit from oral treatment prior to pregnancy.
594 Chorioamnionitis: a retrospective study analyzing the accuracy of clinical diagnosis in preterm pregnancies Leia Card1, Cecilia Avila1, Reinaldo Figueroa2 1 Stony Brook University, Obstetrics, Gynecology, and Reproductive Medicine, Stony Brook, NY, 2Stony Brook University, Obstetrics, Gynecology, and Reproductive Medicine, Stony Brook, NY
OBJECTIVE: Twelve percent of all births in the USA are premature, and 10% of these are diagnosed with clinical chorioamnionitis (CCA). CCA is associated with an increased risk of neonatal morbidity and mortality, and it has been defined as maternal fever (⬎37.8 C) associated with 2 or more of the following: maternal tachycardia (MaT)
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2012
www.AJOG.org
Epidemiology, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics, Obstetric Quality & Safety, Public Health-Global Health
(⬎100 bpm), fetal tachycardia (FeT) (⬎160 bpm), leukocytosis (⬎15,000/mm3), uterine tenderness (UtT), or malodorous vaginal discharge (VaD). The purpose of this study is to investigate the accuracy of the diagnostic criteria of CCA in preterm deliveries. STUDY DESIGN: A retrospective record review of maternal-infant pairs was conducted on 980 singleton pregnancies delivered between 24 and 36 6/7 weeks gestation at Stony Brook University Medical Center, from January 1, 2005 through December 31, 2008. Fetal deaths and neonates with structural or known chromosomal abnormalities were excluded. Maternal records were reviewed for a diagnosis of CCA and the criteria used to diagnose CCA. These were compared to the standard definition of CCA. Placental pathology reports were reviewed for evidence of histologic chorioamnionitis (HCA). RESULTS: One hundred sixty seven (17%) pregnancies were diagnosed with CCA, while 192 (19.6%) had HCA. One hundred six (63.5%) pregnancies with CCA also had HCA. Thirty (13.9%) pregnancies were diagnosed with CCA using the standard definition. The standard diagnostic criteria were only present in 27 (14%) pregnancies with HCA. Fever (59.4%) was the most common factor found in CCA, followed by MaT (45.4%), leukocytosis (44.5%), FeT (43.6%), UtT (13.5%), and VaD (3.2%) (P ⬍ 0.001). With the exception of leukocytosis (46.9%), the other factors were present less commonly in HCA (P⬍ 0.001). CONCLUSION: The standard definition of CCA was rarely used; yet, HCA was present in 63.5%. The standard criteria used to define CCA should be reevaluated.
595 Placental dysfunction and decreased trophoblast invasion induced by infection with Chlamydia pneumoniae is prevented by low-dose acetyl-salicylic acid Luis Gomez1, Sindhu Srinivas2, Michal Elovitz3, Samuel Parry3 1 University of Tennessee Health Science Center, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Memphis, TN, 2 University of Pennsylvania Perelman School of Medicine, Maternal and Child Research Program; Department of OBGYN, Philadelphia, PA, 3 University of Pennsylvania Perelman School of Medicine, Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Philadelphia, PA
OBJECTIVE: We demonstrated previously that acute Chlamydia pneumoniae (Cp) infection of the placenta impairs extravillous trophoblast (EVT) invasion and we detected Cp DNA in placentas from preeclampsia cases more frequently than controls. We also showed that chronic Cp infection induces a proinflammatory response in EVTs and that elevated IgG against Cp is associated with preeclampsia. We sought to determine if potential therapeutic interventions are protective of the effects of Cp in EVTs. STUDY DESIGN: Primary first-trimester EVTs were infected with active or inactivated (heat, UV light) Cp. We pretreated EVTs before Cp infection with low-dose acetyl-salicylic acid (ASA) 0.5mM/L, indomethacin 20uM/L, dexamethasone 1.2uM/L and heparin 5U/mL. Cell invasion assays were conducted 48h after infection and levels of interleukin 8, C-reactive protein, heat-shock protein 60 and tumor necrosis factor-alpha were measured in cell culture media from infected EVTs ⫹/⫺ pretreatment with pharmacologic agents. RESULTS: Active and inactive Cp reduced EVT invasion compared to uninfected controls (71-74% vs 94%; P⬍0.001). Reduced invasion was prevented in infected cells pre-treated with ASA (87-89%; P⫽NS compared to controls). Increased secretion of IL8, CRP, HSP60, and TNFa were detected in media from EVTs infected with active and inactive forms of Cp compared to uninfected cells (all P⬍0.0001). Pretreatment with low-dose ASA was associated with a significant reduction in cytokine secretion in cells infected with active and inactive forms of Cp compared to non-pretreated cells (all P⬍0.01). Pretreatment with indomethacin, dexamethasone and heparin had no major impact on the effects of Cp on invasion and cytokine secretion in EVTs.
Poster Session IV
CONCLUSION: Low-dose aspirin was protective of the adverse effects
induced by infection with active and inactive forms of Chlamydia pneumoniae in EVTs. The protective action of low-dose ASA may be secondary to anti-inflammatory activity through inhibition of cytokine release in infected trophoblasts. Investigation of additional mechanisms for the action of ASA on Cp infected trophoblasts is warranted.
596 Heterogeneity in diagnosis and treatment of chorioamnionitis Mara Greenberg1, Britta Anderson2, Jay Schulkin2, Mary Norton3, Natali Aziz3 1 Stanford University School of Medicine/Lucile Salter Packard Children’s Hospital, Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford, CA, 2American College of Obstetricians and Gynecologists, Research Department, Washington, DC, 3Stanford University School of Medicine/Lucile Salter Packard Children’s Hospital, Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford, CA
OBJECTIVE: Limited data exist regarding the consistency with which obstetricians manage intrapartum chorioamnionitis. We examined practice patterns for diagnosis and treatment of chorioamnionitis among members of the American College of Obstetricians and Gynecologists (ACOG). STUDY DESIGN: We surveyed a sample population of ACOG member obstetricians participating in the Collaborative Ambulatory Research Network. Surveys were mailed to participants. Providers not currently practicing obstetrics were excluded. We analyzed data using chisquare, student t-tests, and multivariable logistic regression. RESULTS: Of 500 surveys distributed, 269 (54%) were returned, of which 212 met study criteria and were analyzed. Men and women were equally represented across 4 US regions (West, Midwest, South, Northeast). The majority of respondents work in OBGYN group practice (90%), perform ⬎100 deliveries per year (59%), have been in practice ⬎10 years (77%), and work in a non-university setting (85.1%). A wide variety of diagnostic and treatment practice patterns were reported (Table). In total, over 25 primary antibiotic regimens were used. In univariable analyses, non-university providers were more likely to use single-agent antibiotic regimens than universitybased providers (32.6% vs. 13.8%, p⫽0.04), while use of a regimen with insufficient gram negative coverage was more commonly reported by both providers ⬎10 years in practice compared to ⬍10 years (18% vs. 2%, p⫽0.007) and non-university compared to university-based providers (16.6% vs. 0%, p⫽0.02). However, in multivariable analysis, no practitioner characteristic (duration, volume, region, or type of practice) was independently associated with diagnostic or therapeutic strategies. CONCLUSION: This study demonstrates wide variation in contemporary clinical practices for diagnosis and treatment of chorioamnionitis. This may represent a dearth of Level 1 evidence regarding management strategies. Future prospective clinical trials may provide more evidence-based practice recommendations for diagnosis and treatment of chorioamnionitis.
Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology
S269
Epidemiology, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics, Obstetric Quality & Safety, Public Health-Global Health
www.AJOG.org
RESULTS: We identified 457 HIV-positive mothers in a 5 year period. Seventy percent were diagnosed prior to pregnancy. 53% were American Black, followed by 21.6% were Haitian, and another 16.6% were Hispanic. 83.1% of patients were between the ages of 18-34 when they delivered. 59.8% of patients were on HAART without a PI and 38.8% were taking HAART with a PI. 40.2% had viral loads of less than 1,000 copies/ml at delivery. Only 15% had a CD4 count of ⬍200 at the end of pregnancy and 27% had AIDS. 33.4% had a vaginal delivery, while 66.6% had a Cesarean delivery. 18.5% were delivered preterm. The most common mode of transmission was heterosexual (93%). Most importantly, there were no cases of vertical HIV infection reported in the last 5 years at our institution. CONCLUSION: With the implementation of a tailored plan of care for HIV-positive pregnant women, a “zero” rate of vertical transmission of HIV is possible.
591 Rapid test for growth and determination of antibiotic sensitivity of Group B Streptococcus (GBS) in antepartum women 1
1
1
Jonathan Faro , Allan Katz , Mildred Ramirez , Mark Turrentine2, Karen Bishop1, Gerald Riddle1, Sebastian Faro1 1
UT Health Science Center at Houston, Obstetrics, Gynecology and Reproductive Sciences, Houston, TX, 2Kelsey Seybold, Obstetrics and Gynecology, Houston, TX
OBJECTIVE: We determined if a new method of rapidly growing GBS in 6 hours could also determine antibiotic sensitivities in a shorter period compared to standard cultures. STUDY DESIGN: Women were screened between 35 to 37 weeks gestation. Vaginal-rectal swabs were collected in Stuarts transport medium. Swabs were then inoculated on a nitrocellulose membrane (NCM) that had been coated previously with polyclonal rabbit antibody against GBS in the presence or absence of clindamycin. At six hours, the NCM was removed from the sheep blood agar medium, and horseradish-peroxidase conjugate polyclonal antibody against GBS was added. An additional swab from each patient was cultured by traditional methods for 48-72 hours and those positive for GBS were then tested for resistance/sensitivity to clindamycin. A final control consisted of sending a separate swab from each patient to a commercial lab. RESULTS: 124 patient samples were screened, of which 33 were positive for GBS by the rapid test (97.0% concordance with traditional culture). Of these 33 positive samples, 10 were resistant to clindamycin, which agreed 100% with traditional culture. Results of the both the rapid and traditional culture showed 100% concordance with sensitivity or resistance to clindamycin when compared with commercial lab results. CONCLUSION: This new NCM assay offers a rapid and unique method for both detection and determination of antibiotic sensitivities for GBS; thus improving the targeting of antibiotic prophylaxis for GBS colonization.
592 Can a zero perinatal transmission rate of HIV be achieved in the US? Kathleen Brookfield1, Lunthita Duthely2, Amanda Cotter3 1 University of Miami School of Medicine, Obstetrics and Gynecology, Miami, FL, 2Univ of Miami School of Medicine, Obstetrics & Gynecology, Miami, FL, 3University of Miami Miller School of Medicine, Obstetrics & Gynecology, Miami, FL
OBJECTIVE: Our institution treats one of the largest populations of HIV infected pregnant women in the United States. We sought to describe a single-center experience with treatment and pregnancy outcomes for this group of patients. STUDY DESIGN: We describe the prospective 5 year experience of our institution in a university setting between 2005-2010. Our institution utilizes a multi-disciplinary team of physicians, nurse practitioners, social workers, psychologists, and counselors in caring for these patients.
S268
593 Maternal self-report of oral health and hygiene, dental care, and pregnancy outcome Kim Boggess1, Erica Berggren2, Viktoria Koskenoja2, Diana Urlaub3, Merry K Moos4, Carol Lorenz3 1 University of North Carolina at Chapel Hill, Obstetrics and Gynecology, Chapel Hill, NC, 2University of North Carolina at Chapel Hill, Ob Gyn, Chapel Hill, NC, 3University of North Carolina at Chapel Hi, Center for Womens Health Research, Chapel Hill, NC, 4University of North Carolina at Chapel Hi, Ob Gyn, Chapel Hill, NC
OBJECTIVE: Periodontal disease in pregnancy is associated with PTB and preeclampsia. Our objective was to determine whether oral symptoms/problems, hygiene practices, or dental service utilization prior to or during pregnancy are associated with these outcomes. STUDY DESIGN: A written questionnaire was administered and outcomes ascertained by chart abstraction. Chi square test compared oral symptoms/problems, hygiene practices, and dental service utilization between women with spontaneous (s)PTB versus term birth, and severe preeclampsia versus others. Multivariable regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for outcomes. RESULTS: 48 (10%) of 470 women reported ⬎ 2 oral symptoms/problems in the 6 months prior to pregnancy and 77 (16%) since pregnancy. 51 (11%) reported prior periodontal treatment. Women who reported ⬎ 2 oral symptoms/problems in the 6 months prior to pregnancy were more likely to have sPTB ⬍ 37 weeks (aOR 4.7, 95%CI 1.4-8.7) or sPTB ⬍ 35 weeks (aOR 2.0, 95%CI 1.7-12.7). Women with a history of periodontal treatment were more likely to develop severe preeclampsia (aOR 3.8, 95%CI 1.4-9.8). However, oral health symptoms/problems, oral hygiene practices, or dental service utilization during pregnancy were not associated with pregnancy outcomes. CONCLUSION: Oral health symptoms/problems and periodontal treatment prior to pregnancy are more predictive of adverse outcomes than symptoms/problems during pregnancy. This may be one explanation for failure of periodontal treatment during pregnancy to reduce PTB. Preconception care to address oral symptoms/problems and prenatal questions to identify women with a history of periodontal treatment should be considered to identify women at risk for adverse pregnancy outcome and who may benefit from oral treatment prior to pregnancy.
594 Chorioamnionitis: a retrospective study analyzing the accuracy of clinical diagnosis in preterm pregnancies Leia Card1, Cecilia Avila1, Reinaldo Figueroa2 1 Stony Brook University, Obstetrics, Gynecology, and Reproductive Medicine, Stony Brook, NY, 2Stony Brook University, Obstetrics, Gynecology, and Reproductive Medicine, Stony Brook, NY
OBJECTIVE: Twelve percent of all births in the USA are premature, and 10% of these are diagnosed with clinical chorioamnionitis (CCA). CCA is associated with an increased risk of neonatal morbidity and mortality, and it has been defined as maternal fever (⬎37.8 C) associated with 2 or more of the following: maternal tachycardia (MaT)
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2012
www.AJOG.org
Epidemiology, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics, Obstetric Quality & Safety, Public Health-Global Health
(⬎100 bpm), fetal tachycardia (FeT) (⬎160 bpm), leukocytosis (⬎15,000/mm3), uterine tenderness (UtT), or malodorous vaginal discharge (VaD). The purpose of this study is to investigate the accuracy of the diagnostic criteria of CCA in preterm deliveries. STUDY DESIGN: A retrospective record review of maternal-infant pairs was conducted on 980 singleton pregnancies delivered between 24 and 36 6/7 weeks gestation at Stony Brook University Medical Center, from January 1, 2005 through December 31, 2008. Fetal deaths and neonates with structural or known chromosomal abnormalities were excluded. Maternal records were reviewed for a diagnosis of CCA and the criteria used to diagnose CCA. These were compared to the standard definition of CCA. Placental pathology reports were reviewed for evidence of histologic chorioamnionitis (HCA). RESULTS: One hundred sixty seven (17%) pregnancies were diagnosed with CCA, while 192 (19.6%) had HCA. One hundred six (63.5%) pregnancies with CCA also had HCA. Thirty (13.9%) pregnancies were diagnosed with CCA using the standard definition. The standard diagnostic criteria were only present in 27 (14%) pregnancies with HCA. Fever (59.4%) was the most common factor found in CCA, followed by MaT (45.4%), leukocytosis (44.5%), FeT (43.6%), UtT (13.5%), and VaD (3.2%) (P ⬍ 0.001). With the exception of leukocytosis (46.9%), the other factors were present less commonly in HCA (P⬍ 0.001). CONCLUSION: The standard definition of CCA was rarely used; yet, HCA was present in 63.5%. The standard criteria used to define CCA should be reevaluated.
595 Placental dysfunction and decreased trophoblast invasion induced by infection with Chlamydia pneumoniae is prevented by low-dose acetyl-salicylic acid Luis Gomez1, Sindhu Srinivas2, Michal Elovitz3, Samuel Parry3 1 University of Tennessee Health Science Center, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Memphis, TN, 2 University of Pennsylvania Perelman School of Medicine, Maternal and Child Research Program; Department of OBGYN, Philadelphia, PA, 3 University of Pennsylvania Perelman School of Medicine, Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Philadelphia, PA
OBJECTIVE: We demonstrated previously that acute Chlamydia pneumoniae (Cp) infection of the placenta impairs extravillous trophoblast (EVT) invasion and we detected Cp DNA in placentas from preeclampsia cases more frequently than controls. We also showed that chronic Cp infection induces a proinflammatory response in EVTs and that elevated IgG against Cp is associated with preeclampsia. We sought to determine if potential therapeutic interventions are protective of the effects of Cp in EVTs. STUDY DESIGN: Primary first-trimester EVTs were infected with active or inactivated (heat, UV light) Cp. We pretreated EVTs before Cp infection with low-dose acetyl-salicylic acid (ASA) 0.5mM/L, indomethacin 20uM/L, dexamethasone 1.2uM/L and heparin 5U/mL. Cell invasion assays were conducted 48h after infection and levels of interleukin 8, C-reactive protein, heat-shock protein 60 and tumor necrosis factor-alpha were measured in cell culture media from infected EVTs ⫹/⫺ pretreatment with pharmacologic agents. RESULTS: Active and inactive Cp reduced EVT invasion compared to uninfected controls (71-74% vs 94%; P⬍0.001). Reduced invasion was prevented in infected cells pre-treated with ASA (87-89%; P⫽NS compared to controls). Increased secretion of IL8, CRP, HSP60, and TNFa were detected in media from EVTs infected with active and inactive forms of Cp compared to uninfected cells (all P⬍0.0001). Pretreatment with low-dose ASA was associated with a significant reduction in cytokine secretion in cells infected with active and inactive forms of Cp compared to non-pretreated cells (all P⬍0.01). Pretreatment with indomethacin, dexamethasone and heparin had no major impact on the effects of Cp on invasion and cytokine secretion in EVTs.
Poster Session IV
CONCLUSION: Low-dose aspirin was protective of the adverse effects
induced by infection with active and inactive forms of Chlamydia pneumoniae in EVTs. The protective action of low-dose ASA may be secondary to anti-inflammatory activity through inhibition of cytokine release in infected trophoblasts. Investigation of additional mechanisms for the action of ASA on Cp infected trophoblasts is warranted.
596 Heterogeneity in diagnosis and treatment of chorioamnionitis Mara Greenberg1, Britta Anderson2, Jay Schulkin2, Mary Norton3, Natali Aziz3 1 Stanford University School of Medicine/Lucile Salter Packard Children’s Hospital, Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford, CA, 2American College of Obstetricians and Gynecologists, Research Department, Washington, DC, 3Stanford University School of Medicine/Lucile Salter Packard Children’s Hospital, Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford, CA
OBJECTIVE: Limited data exist regarding the consistency with which obstetricians manage intrapartum chorioamnionitis. We examined practice patterns for diagnosis and treatment of chorioamnionitis among members of the American College of Obstetricians and Gynecologists (ACOG). STUDY DESIGN: We surveyed a sample population of ACOG member obstetricians participating in the Collaborative Ambulatory Research Network. Surveys were mailed to participants. Providers not currently practicing obstetrics were excluded. We analyzed data using chisquare, student t-tests, and multivariable logistic regression. RESULTS: Of 500 surveys distributed, 269 (54%) were returned, of which 212 met study criteria and were analyzed. Men and women were equally represented across 4 US regions (West, Midwest, South, Northeast). The majority of respondents work in OBGYN group practice (90%), perform ⬎100 deliveries per year (59%), have been in practice ⬎10 years (77%), and work in a non-university setting (85.1%). A wide variety of diagnostic and treatment practice patterns were reported (Table). In total, over 25 primary antibiotic regimens were used. In univariable analyses, non-university providers were more likely to use single-agent antibiotic regimens than universitybased providers (32.6% vs. 13.8%, p⫽0.04), while use of a regimen with insufficient gram negative coverage was more commonly reported by both providers ⬎10 years in practice compared to ⬍10 years (18% vs. 2%, p⫽0.007) and non-university compared to university-based providers (16.6% vs. 0%, p⫽0.02). However, in multivariable analysis, no practitioner characteristic (duration, volume, region, or type of practice) was independently associated with diagnostic or therapeutic strategies. CONCLUSION: This study demonstrates wide variation in contemporary clinical practices for diagnosis and treatment of chorioamnionitis. This may represent a dearth of Level 1 evidence regarding management strategies. Future prospective clinical trials may provide more evidence-based practice recommendations for diagnosis and treatment of chorioamnionitis.
Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology
S269