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753: Preeclampsia and intrauterine growth restriction with abnormal umbilical artery Dopplers: report of a new association
Fetus Diabetes, etc
www.AJOG.org 752 The impact of a history of previous preeclampsia (PE) on the risk of superimposed preeclampsia and adverse pregnancy outcome in patients with chronic hypertension (CHTN) Baha Sibai1, Matthew Koch2, Salvio Freire3, Joao Luiz Pinto E Silva4, Marilza Vieira Cunha Rudge5, Sérgio Martins-Costa6, Janet Moore2, Cleide De Barros Santos7, Jose Guilherme Cecatti8, Roberto Costa5, José Geraldo Ramos9, Nancy Moss10, Joseph Spinnato II1 1
University of Cincinnati, Cincinnati, Ohio, 2RTI International, North Carolina, 3Universidade Federal de Pernambuco, Obstetrics and Gynecology, Brazil, 4Universidade Estadual de Campinas, Obstetrics and Gynecology, Brazil, 5Universidade Estadual Paulista, Brazil, 6Universidade Federal do Rio Grande do Sul, Obstetrics and Gynecology, Brazil, 7Universidade Federal de Pernambuco, Brazil, 8Universidade Estadual de Campinas, Brazil, 9Universidade Federal do Rio Grande do Sul, Brazil, 10National Institute of Child Health and Human Development, Rockville, Maryland
OBJECTIVE: Normotensive women with previous PE are at increased risk of PE and adverse outcome in subsequent pregnancies (Hnat, 2001), and patients with CHTN are at high risk for superimposed PE. There are minimal data on the impact of previous PE on subsequent pregnancy outcome in women with CHTN. Our objective is to compare the rates of superimposed PE and adverse outcomes in women with CHTN with or without previous history of PE. STUDY DESIGN: Secondary analysis of 369 women with CHTN (104 with previous PE) enrolled at 12⫺19 weeks as part of a multisite trial of antioxidants to prevent PE (no reduction was found). Outcome measures were rates of superimposed PE and other adverse perinatal outcomes. Data were analyzed by CMH chi-square and ANOVA methods adjusted for clinical site. RESULTS: Prepregnancy BMI, maternal age, blood pressure, and smoking status at enrollment were similar between those with and without prior PE. Superimposed PE developed in 65 (17.6%). Table below compares outcomes for the two groups. CONCLUSION: In CHTN, previous history of PE does not increase rate of superimposed PE, but is assocated with an increased rate of delivery at ⬍37 weeks. NICHD U01HD40565, U01HD40636. Outcome
Prior PE (N ⴝ 104) n (%)
No prior PE (N ⴝ 265) n (%)
Sup PE
18 (17.3)
47 (17.7)
..........................................................................................................................................................................................
Abruptio 1 (1.0) 8 (3.1) .......................................................................................................................................................................................... Perinatal deaths 7 (6.7) 23 (8.7) .......................................................................................................................................................................................... PTD ⬍37 wk 38 (36.9)* 70 (27.1)* .......................................................................................................................................................................................... PTD ⬍34 wk 9 (8.7) 28 (10.9) .......................................................................................................................................................................................... SGA 19 (18.4) 34 (14.3) .......................................................................................................................................................................................... RDS 14 (13.6) 32 (12.4) .......................................................................................................................................................................................... *adj RR, 1.46 (1.05 - 2.03)
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.769
753 Preeclampsia and intrauterine growth restriction with abnormal umbilical artery Dopplers: report of a new association Fadi Mirza1, Josue Rivera1, Jeannie Chen2, William Strohsnitter2, Cynthia Gyamfi1 1
Columbia University Medical Center, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York, New York, 2Tufts Medical Center, Department of Obstetrics and Gynecology, Boston, Massachusetts
OBJECTIVE: The pathophysiology underlying unexplained intrauterine growth restriction (IUGR) remains poorly understood. Unexplained IUGR and preeclampsia are pregnancy-specific disorders that may share abnormal placental implantation as an underlying etiology. We conducted this study within a cohort of pregnancies complicated by unexplained IUGR to determine whether umbilical artery (UA)
Poster Session V
Dopplers can differentiate pregnancies further complicated by preeclampsia from those without evidence of preeclampsia. STUDY DESIGN: This was a retrospective cohort study of singleton pregnancies diagnosed with IUGR at a single center between 2005 and 2008. All cases with at least one ultrasound consistent with IUGR (estimated fetal weight ⬍10%) were retrieved. Exclusions included pregnancy termination, preexisting maternal disease, history of hypertensive disorders in prior pregnancies, congenital anomalies, congenital infections, aneuploidy, and loss to follow-up. Subjects were classified based on the presence or absence of abnormal UA Dopplers, defined as elevated S/D ratio or absent or reversed end-diastolic flow, on at least one ultrasound. The proportion of preeclampsia in the two groups was compared using the Mantel-Haenszel test. RESULTS: We identified 530 singleton pregnancies with IUGR, 230 of which were excluded. The remaining 300 cases included 74 cases with abnormal UA Dopplers. Of those, preeclampsia was diagnosed in 23 (31%) cases. In 226 cases with normal UA Dopplers, preeclampsia was diagnosed in 18 (8%) cases. After controlling for age and parity, patients with abnormal UA Dopplers were 3.4 times more likely to be diagnosed with preeclampsia. CONCLUSION: Patients with unexplained IUGR and abnormal UA Dopplers appear to be at increased risk of preeclampsia compared to those with normal UA Dopplers. Further evaluation of this possible association is warranted. Adjusted Relative Risk (RR) for development of preeclampsia
Abn. UA Dopplers
Adjusted RR
95% CI
P value
3.43
2.00-5.91
⬍ 0.0001
..........................................................................................................................................................................................
Multiparity 3.98 1.63-9.70 0.0005 .......................................................................................................................................................................................... Age ( 35 years) 1.34 0.72-2.50 0.3900 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.770
754 The relationship between elevated blood pressure in pregnancy and abruptio placentae Aldo D Khoury1, Douha Sabouni1, Kate Sullivan1, Muhamad Aly Rifai2, Lidia Kao3, Baha Sibai4 1 St. Joseph Regional Medical Center, Obstetrics and Gynecology, Paterson, New Jersey, 2Penn State University College of Medicine, Bethlehem, Pennsylvania, 3Applachain OB/GYN Associate, Kingsport, Tennessee, 4University of Cincinnati, Cincinnati, Ohio
OBJECTIVE: The complex etiology of placental abruption and its asso-
ciation with hypertensive disorders has been extensively examined. The purpose of this retrospective study is to further elucidate the connection between elevated blood pressure (BP) during pregnancy and abruption, as this association has not been clearly examined. We hypothesize that elevated BP would be the strongest factor associated with placental abruption. STUDY DESIGN: 540 consecutive cases of abruption were identified during an eight-year period (total deliveries N⫽ 47808) and reviewed with specific emphasis on the occurrence and severity of elevated blood pressures during pregnancy (systolic ⬎ 140 or diastolic ⬎ 90). We abstracted data on our control group, which were women with elevated BP but without abruption. Relevant clinical maternal and fetal variables were compared between the groups to assess the existence of any causal association. We utilized univariate and multivariate logistic regressions to examine temporal trends and the complex relationship between elevated BP and abruption. RESULTS: Among women with abruption, BP was elevated in 165 (165/540; 30.5%) compared with 5252 in our control group with elevated BP but without abruption (5252/47808; 10%). We controlled for maternal age, race, marital status, parity, and fetal gender. The association between placental abruption and elevated BP was statistically significant (p⬍ 0.0001). We used multivariate regression analysis to examine the association between elevated BP and abruption. Among the multivariate factors analyzed in relation to abruption,
Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology
S271
www.AJOG.org 752 The impact of a history of previous preeclampsia (PE) on the risk of superimposed preeclampsia and adverse pregnancy outcome in patients with chronic hypertension (CHTN) Baha Sibai1, Matthew Koch2, Salvio Freire3, Joao Luiz Pinto E Silva4, Marilza Vieira Cunha Rudge5, Sérgio Martins-Costa6, Janet Moore2, Cleide De Barros Santos7, Jose Guilherme Cecatti8, Roberto Costa5, José Geraldo Ramos9, Nancy Moss10, Joseph Spinnato II1 1
University of Cincinnati, Cincinnati, Ohio, 2RTI International, North Carolina, 3Universidade Federal de Pernambuco, Obstetrics and Gynecology, Brazil, 4Universidade Estadual de Campinas, Obstetrics and Gynecology, Brazil, 5Universidade Estadual Paulista, Brazil, 6Universidade Federal do Rio Grande do Sul, Obstetrics and Gynecology, Brazil, 7Universidade Federal de Pernambuco, Brazil, 8Universidade Estadual de Campinas, Brazil, 9Universidade Federal do Rio Grande do Sul, Brazil, 10National Institute of Child Health and Human Development, Rockville, Maryland
OBJECTIVE: Normotensive women with previous PE are at increased risk of PE and adverse outcome in subsequent pregnancies (Hnat, 2001), and patients with CHTN are at high risk for superimposed PE. There are minimal data on the impact of previous PE on subsequent pregnancy outcome in women with CHTN. Our objective is to compare the rates of superimposed PE and adverse outcomes in women with CHTN with or without previous history of PE. STUDY DESIGN: Secondary analysis of 369 women with CHTN (104 with previous PE) enrolled at 12⫺19 weeks as part of a multisite trial of antioxidants to prevent PE (no reduction was found). Outcome measures were rates of superimposed PE and other adverse perinatal outcomes. Data were analyzed by CMH chi-square and ANOVA methods adjusted for clinical site. RESULTS: Prepregnancy BMI, maternal age, blood pressure, and smoking status at enrollment were similar between those with and without prior PE. Superimposed PE developed in 65 (17.6%). Table below compares outcomes for the two groups. CONCLUSION: In CHTN, previous history of PE does not increase rate of superimposed PE, but is assocated with an increased rate of delivery at ⬍37 weeks. NICHD U01HD40565, U01HD40636. Outcome
Prior PE (N ⴝ 104) n (%)
No prior PE (N ⴝ 265) n (%)
Sup PE
18 (17.3)
47 (17.7)
..........................................................................................................................................................................................
Abruptio 1 (1.0) 8 (3.1) .......................................................................................................................................................................................... Perinatal deaths 7 (6.7) 23 (8.7) .......................................................................................................................................................................................... PTD ⬍37 wk 38 (36.9)* 70 (27.1)* .......................................................................................................................................................................................... PTD ⬍34 wk 9 (8.7) 28 (10.9) .......................................................................................................................................................................................... SGA 19 (18.4) 34 (14.3) .......................................................................................................................................................................................... RDS 14 (13.6) 32 (12.4) .......................................................................................................................................................................................... *adj RR, 1.46 (1.05 - 2.03)
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.769
753 Preeclampsia and intrauterine growth restriction with abnormal umbilical artery Dopplers: report of a new association Fadi Mirza1, Josue Rivera1, Jeannie Chen2, William Strohsnitter2, Cynthia Gyamfi1 1
Columbia University Medical Center, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York, New York, 2Tufts Medical Center, Department of Obstetrics and Gynecology, Boston, Massachusetts
OBJECTIVE: The pathophysiology underlying unexplained intrauterine growth restriction (IUGR) remains poorly understood. Unexplained IUGR and preeclampsia are pregnancy-specific disorders that may share abnormal placental implantation as an underlying etiology. We conducted this study within a cohort of pregnancies complicated by unexplained IUGR to determine whether umbilical artery (UA)
Poster Session V
Dopplers can differentiate pregnancies further complicated by preeclampsia from those without evidence of preeclampsia. STUDY DESIGN: This was a retrospective cohort study of singleton pregnancies diagnosed with IUGR at a single center between 2005 and 2008. All cases with at least one ultrasound consistent with IUGR (estimated fetal weight ⬍10%) were retrieved. Exclusions included pregnancy termination, preexisting maternal disease, history of hypertensive disorders in prior pregnancies, congenital anomalies, congenital infections, aneuploidy, and loss to follow-up. Subjects were classified based on the presence or absence of abnormal UA Dopplers, defined as elevated S/D ratio or absent or reversed end-diastolic flow, on at least one ultrasound. The proportion of preeclampsia in the two groups was compared using the Mantel-Haenszel test. RESULTS: We identified 530 singleton pregnancies with IUGR, 230 of which were excluded. The remaining 300 cases included 74 cases with abnormal UA Dopplers. Of those, preeclampsia was diagnosed in 23 (31%) cases. In 226 cases with normal UA Dopplers, preeclampsia was diagnosed in 18 (8%) cases. After controlling for age and parity, patients with abnormal UA Dopplers were 3.4 times more likely to be diagnosed with preeclampsia. CONCLUSION: Patients with unexplained IUGR and abnormal UA Dopplers appear to be at increased risk of preeclampsia compared to those with normal UA Dopplers. Further evaluation of this possible association is warranted. Adjusted Relative Risk (RR) for development of preeclampsia
Abn. UA Dopplers
Adjusted RR
95% CI
P value
3.43
2.00-5.91
⬍ 0.0001
..........................................................................................................................................................................................
Multiparity 3.98 1.63-9.70 0.0005 .......................................................................................................................................................................................... Age ( 35 years) 1.34 0.72-2.50 0.3900 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.770
754 The relationship between elevated blood pressure in pregnancy and abruptio placentae Aldo D Khoury1, Douha Sabouni1, Kate Sullivan1, Muhamad Aly Rifai2, Lidia Kao3, Baha Sibai4 1 St. Joseph Regional Medical Center, Obstetrics and Gynecology, Paterson, New Jersey, 2Penn State University College of Medicine, Bethlehem, Pennsylvania, 3Applachain OB/GYN Associate, Kingsport, Tennessee, 4University of Cincinnati, Cincinnati, Ohio
OBJECTIVE: The complex etiology of placental abruption and its asso-
ciation with hypertensive disorders has been extensively examined. The purpose of this retrospective study is to further elucidate the connection between elevated blood pressure (BP) during pregnancy and abruption, as this association has not been clearly examined. We hypothesize that elevated BP would be the strongest factor associated with placental abruption. STUDY DESIGN: 540 consecutive cases of abruption were identified during an eight-year period (total deliveries N⫽ 47808) and reviewed with specific emphasis on the occurrence and severity of elevated blood pressures during pregnancy (systolic ⬎ 140 or diastolic ⬎ 90). We abstracted data on our control group, which were women with elevated BP but without abruption. Relevant clinical maternal and fetal variables were compared between the groups to assess the existence of any causal association. We utilized univariate and multivariate logistic regressions to examine temporal trends and the complex relationship between elevated BP and abruption. RESULTS: Among women with abruption, BP was elevated in 165 (165/540; 30.5%) compared with 5252 in our control group with elevated BP but without abruption (5252/47808; 10%). We controlled for maternal age, race, marital status, parity, and fetal gender. The association between placental abruption and elevated BP was statistically significant (p⬍ 0.0001). We used multivariate regression analysis to examine the association between elevated BP and abruption. Among the multivariate factors analyzed in relation to abruption,
Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology
S271