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782: Oligohydramnios in preterm preeclampsia is an independent risk factor for perinatal morbidity
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Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging
782 Oligohydramnios in preterm preeclampsia is an independent risk factor for perinatal morbidity Offer Erez1, Keren Holzman-Schweid2, Ilana Shoham-Vardi3, Moshe Mazor4 1 Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, 2Volfson Medical Center, Holon, 3Department of Epidemiology Faculty of Health Sciences Ben Gurion University of the Negev, Beer Sheva, 4 Soroka University Medical Center, Beer Sheva
OBJECTIVE: Preterm preeclampsia (PET) is associated with increased perinatal morbidity and mortality. Amniotic fluid index is a clinical tool for the assessment of fetal well-being. Indeed, the presence of oligohydramnios is associated with adverse perinatal outcome and is considered as a marker for reduced fetal perfusion. Therefore, the aim of this study is to determine the association between oligohydramnios and maternal and fetal outcome in patients with preterm PET. STUDY DESIGN: This retrospective follow-up study included women with singleton gestation and preterm PET that were divided into two groups: 1) women with oligohydramnios (n⫽81); and 2) women with a normal amount of amniotic fluid (n⫽81) that were matched according to gestational age at delivery, severity of PET and year of delivery. Composite maternal morbidity included: preeclampsia complications, admission to maternal special care unit, magnesium sulphate treatment post partum and admission to intensive care unit. Composite neonatal morbidity included one or more of the followings: low Apgar score, perinatal death, cord blood pH⬍7.1, fetal distress, neonatal anemia and hypoglycemia. RESULTS: 1) The prevalence of oligohydramnios among patients with PET who delivered preterm was 4.8% (81/1701). 2) Compared with women with preterm PET and normal amount of amniotic fluid, the study group had a significantly higher rate of intrauterine growth restriction (62.9% vs. 24.7%, P⬍0.01), and cesarean section (69.1% vs. 49.4%, P⫽0.01). 3) In a multiple logistic regression, oligohydramnios was an independent risk factor for increased neonatal morbidity (OR ⫽ 2.5). In contrast, the year of birth (OR⫽0.9) and gestational age at delivery (OR⫽0.4) had an independent protective effect against such morbidity. 4) The severity of PET was an independent risk factor for maternal morbidity (OR ⫽ 30.3). CONCLUSIONS: In patients with preterm PET, oligohydramnios is an independent risk factor for fetal and/or neonatal morbidity. However, oligohydramnios does not contribute to the maternal morbidity associated with preterm PET.
783 Vascular dysfunction in postpartum mothers with prepregnancy obesity and sFlt-1-induced preeclampsia Olaide Ashimi1, Anzicar Betancourt1, Esther Tamayo1, Phyllis Gamble1, Monica Longo1, George R. Saade1, Egle Bytautiene1 1
The University of Texas Medical Branch, Galveston, TX
OBJECTIVE: Both, obesity and preeclampsia, are associated with long
term cardiovascular morbidity. We hypothesize that this effect is the result of altered vascular dysfunction. Our objective was to determine vascular function 6 months after delivery in mice with prepregnancy obesity and/or preeclampsia-like syndrome induced by over-expression of sFlt-1. STUDY DESIGN: CD-1 female mice were placed on either standard fat (SF) or high fat diet (HF) for 3 months before they were mated. On day 8 of pregnancy, mice in both groups were injected with either adenovirus carrying sFlt1 (HF sFlt1 n⫽6, SF sFlt1 n⫽4) or adenovirus carrying mFc as virus control (HF mFc n⫽4, SF mFc n⫽7). Following the weaning, all dams were placed on standard fat diet. Six months after delivery, the animals were sacrificed and their right carotid arteries were extracted for in vitro contractility experiments. Responses to single doses of potassium chloride (KCL, 60 mmol/l), phenylephrine (PE, 10-4 M) and acetylcholine (Ach 10-5 M, after precontraction with PE) were obtained. One-way ANOVA with appropriate post-hoc tests were used (significance: P⬍0.05).
Poster Session V
RESULTS: Contractile responses to KCL were significantly increased in the HF sFlt1 group compared to the other three groups (figure). Addition of PE induced significantly higher responses in HF groups compared with SF dams with no differences within HF and SF diets groups. Relaxation to acetylcholine was lowest in both HF groups, followed by SF sFlt1 group, but the differences were not statistically significant. CONCLUSIONS: Prepregnancy obesity and sFlt1-induced preeclampsia result in long-term impairment of vascular function, with the combination having the biggest effect.
784 Preeclampsia is associated with fetal lipid wasting Paul Ogburn1, Jeffrey Hines2, Sheila Turner Hane3 1
Stony Brook - Winthrop University Hospitals, Stony Brook, NY, Southeastern Gynecologic Oncology, Riverdale, GA, 3Women and Infants Hospital of Rhode Island, Providence, RI 2
OBJECTIVE: Measure and compare total fatty acids in the umbilical arteries and veins of normal and preeclamptic pregnancies to elucidate mechanisms of fetal growth restriction and pathophysiology in preeclampsia. STUDY DESIGN: Ten women with preeclampsia (PE) and 10 controls (C) had arterial and venous blood drawn from the umbilical cord of the placenta after delivery in the third trimester. The patients with preeclampsia each had blood pressure elevations in excess of 140/90 mm/Hg on two occasions at rest. Proteinuria was at least 1 gm/liter in these patients. Patients with chronic hypertension, renal disease, or diabetes were excluded from the study. Plasma samples were frozen until lipid analysis was performed using thin layer and gas-liquid chromatography. Variations in total fatty acids were compared between venous and arterial samples and between PE and C groups. Statistical analysis utilized students t test and correlation analysis. Values are given as Mean ⫾ standard error of the mean. A p value ⱕ 0.05 is considered significant. RESULTS: Gestational age at delivery was 39.1 ⫾ 0.7 weeks for C and 34.9 ⫾1.4 weeks for PE (p ⬍ .05). PE arterial cord blood contained higher levels of total fatty acids (1261 ⫾ 90 mcg/ml) than C arterial cord blood (934 ⫾ 39 mcg/ml, p ⫽ 0.004) while venous cord blood values were similar in the two groups. Analysis of total fatty acid content of umbilical arteries (UA) and veins (UV) showed strong correlations between these values in each placenta. In controls, UA ⫽ .637 UV ⫹ 297 mcg/ml; and in preeclamptics, UA ⫽ 1.317 UV – 286 mcg/ml (p ⬍ .001 in both calculations). These results indicate a net loss of caloric lipids from the fetus in preeclampsia. CONCLUSIONS: PE is associated with increases in umbilical artery fatty acid levels that demonstrate a net loss of these lipids from the fetus. These results suggest that the mechanisms for fetal growth restriction and increased maternal serum triglycerides in PE could involve fetal production of fatty acids and transfer of these to the placenta through the umbilical artery.
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S307
Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging
782 Oligohydramnios in preterm preeclampsia is an independent risk factor for perinatal morbidity Offer Erez1, Keren Holzman-Schweid2, Ilana Shoham-Vardi3, Moshe Mazor4 1 Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, 2Volfson Medical Center, Holon, 3Department of Epidemiology Faculty of Health Sciences Ben Gurion University of the Negev, Beer Sheva, 4 Soroka University Medical Center, Beer Sheva
OBJECTIVE: Preterm preeclampsia (PET) is associated with increased perinatal morbidity and mortality. Amniotic fluid index is a clinical tool for the assessment of fetal well-being. Indeed, the presence of oligohydramnios is associated with adverse perinatal outcome and is considered as a marker for reduced fetal perfusion. Therefore, the aim of this study is to determine the association between oligohydramnios and maternal and fetal outcome in patients with preterm PET. STUDY DESIGN: This retrospective follow-up study included women with singleton gestation and preterm PET that were divided into two groups: 1) women with oligohydramnios (n⫽81); and 2) women with a normal amount of amniotic fluid (n⫽81) that were matched according to gestational age at delivery, severity of PET and year of delivery. Composite maternal morbidity included: preeclampsia complications, admission to maternal special care unit, magnesium sulphate treatment post partum and admission to intensive care unit. Composite neonatal morbidity included one or more of the followings: low Apgar score, perinatal death, cord blood pH⬍7.1, fetal distress, neonatal anemia and hypoglycemia. RESULTS: 1) The prevalence of oligohydramnios among patients with PET who delivered preterm was 4.8% (81/1701). 2) Compared with women with preterm PET and normal amount of amniotic fluid, the study group had a significantly higher rate of intrauterine growth restriction (62.9% vs. 24.7%, P⬍0.01), and cesarean section (69.1% vs. 49.4%, P⫽0.01). 3) In a multiple logistic regression, oligohydramnios was an independent risk factor for increased neonatal morbidity (OR ⫽ 2.5). In contrast, the year of birth (OR⫽0.9) and gestational age at delivery (OR⫽0.4) had an independent protective effect against such morbidity. 4) The severity of PET was an independent risk factor for maternal morbidity (OR ⫽ 30.3). CONCLUSIONS: In patients with preterm PET, oligohydramnios is an independent risk factor for fetal and/or neonatal morbidity. However, oligohydramnios does not contribute to the maternal morbidity associated with preterm PET.
783 Vascular dysfunction in postpartum mothers with prepregnancy obesity and sFlt-1-induced preeclampsia Olaide Ashimi1, Anzicar Betancourt1, Esther Tamayo1, Phyllis Gamble1, Monica Longo1, George R. Saade1, Egle Bytautiene1 1
The University of Texas Medical Branch, Galveston, TX
OBJECTIVE: Both, obesity and preeclampsia, are associated with long
term cardiovascular morbidity. We hypothesize that this effect is the result of altered vascular dysfunction. Our objective was to determine vascular function 6 months after delivery in mice with prepregnancy obesity and/or preeclampsia-like syndrome induced by over-expression of sFlt-1. STUDY DESIGN: CD-1 female mice were placed on either standard fat (SF) or high fat diet (HF) for 3 months before they were mated. On day 8 of pregnancy, mice in both groups were injected with either adenovirus carrying sFlt1 (HF sFlt1 n⫽6, SF sFlt1 n⫽4) or adenovirus carrying mFc as virus control (HF mFc n⫽4, SF mFc n⫽7). Following the weaning, all dams were placed on standard fat diet. Six months after delivery, the animals were sacrificed and their right carotid arteries were extracted for in vitro contractility experiments. Responses to single doses of potassium chloride (KCL, 60 mmol/l), phenylephrine (PE, 10-4 M) and acetylcholine (Ach 10-5 M, after precontraction with PE) were obtained. One-way ANOVA with appropriate post-hoc tests were used (significance: P⬍0.05).
Poster Session V
RESULTS: Contractile responses to KCL were significantly increased in the HF sFlt1 group compared to the other three groups (figure). Addition of PE induced significantly higher responses in HF groups compared with SF dams with no differences within HF and SF diets groups. Relaxation to acetylcholine was lowest in both HF groups, followed by SF sFlt1 group, but the differences were not statistically significant. CONCLUSIONS: Prepregnancy obesity and sFlt1-induced preeclampsia result in long-term impairment of vascular function, with the combination having the biggest effect.
784 Preeclampsia is associated with fetal lipid wasting Paul Ogburn1, Jeffrey Hines2, Sheila Turner Hane3 1
Stony Brook - Winthrop University Hospitals, Stony Brook, NY, Southeastern Gynecologic Oncology, Riverdale, GA, 3Women and Infants Hospital of Rhode Island, Providence, RI 2
OBJECTIVE: Measure and compare total fatty acids in the umbilical arteries and veins of normal and preeclamptic pregnancies to elucidate mechanisms of fetal growth restriction and pathophysiology in preeclampsia. STUDY DESIGN: Ten women with preeclampsia (PE) and 10 controls (C) had arterial and venous blood drawn from the umbilical cord of the placenta after delivery in the third trimester. The patients with preeclampsia each had blood pressure elevations in excess of 140/90 mm/Hg on two occasions at rest. Proteinuria was at least 1 gm/liter in these patients. Patients with chronic hypertension, renal disease, or diabetes were excluded from the study. Plasma samples were frozen until lipid analysis was performed using thin layer and gas-liquid chromatography. Variations in total fatty acids were compared between venous and arterial samples and between PE and C groups. Statistical analysis utilized students t test and correlation analysis. Values are given as Mean ⫾ standard error of the mean. A p value ⱕ 0.05 is considered significant. RESULTS: Gestational age at delivery was 39.1 ⫾ 0.7 weeks for C and 34.9 ⫾1.4 weeks for PE (p ⬍ .05). PE arterial cord blood contained higher levels of total fatty acids (1261 ⫾ 90 mcg/ml) than C arterial cord blood (934 ⫾ 39 mcg/ml, p ⫽ 0.004) while venous cord blood values were similar in the two groups. Analysis of total fatty acid content of umbilical arteries (UA) and veins (UV) showed strong correlations between these values in each placenta. In controls, UA ⫽ .637 UV ⫹ 297 mcg/ml; and in preeclamptics, UA ⫽ 1.317 UV – 286 mcg/ml (p ⬍ .001 in both calculations). These results indicate a net loss of caloric lipids from the fetus in preeclampsia. CONCLUSIONS: PE is associated with increases in umbilical artery fatty acid levels that demonstrate a net loss of these lipids from the fetus. These results suggest that the mechanisms for fetal growth restriction and increased maternal serum triglycerides in PE could involve fetal production of fatty acids and transfer of these to the placenta through the umbilical artery.
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S307