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818: Activity restriction does not slow the rate of cervical shortening in pregnancy
Poster Session V
Prematurity, Physiology
yMedian and range, pg/mL.
817 Prenatal prediction of neonatal intraventricular hemorrhage based on amniotic fluid markers Jose Bartha1, Rocio Revello1, Marı´a Alcaide2, Daniel Abehsera1, Sara Lopez-Magallon1, Beatriz Herreros1 1 University Hospital La Paz, Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Madrid, Spain, 2University Hospital La Paz, Clinical Chemistry, Madrid, Spain
OBJECTIVE: To assess the predictive capability of some biological markers in the amniotic fluid of fetuses at high risk of neonatal intraventricular hemorrhage (IVH). STUDY DESIGN: Forty women at risk of very preterm delivery due to PPROM (n ¼ 29, 72.5%) or preterm labor with intact membranes and cervical length < 15 mm (n ¼ 11, 27.5%) were studied. Gestational age at study (diagnosis of the primary condition) was 26.91 2.59 weeks. Amniocentesis, universal and specific PCR and microbiological cultures were performed. Amniotic fluid IL18, IL 2, IL4, IL6, IL10, IL12, TNF-alpha, IFN-g and MMP-8 were measured by Multiplex method. Amniotic fluid glucose and leukocyte count were also measured by standard methods. Gestational age at study was also considered in the predictive models. Placental detailed histological studies were performed. Mann Whitney U test and forward stepwise binary logistic regression were used. RESULTS: In total 8 cases developed IVH (20%). Amniotic fluid concentrations of IL6, IL12, IL8, MMP-8 and leukocyte were significantly higher in those cases that develop IVH while gestational age at study was significantly lower. Binary logistic regression found 4 predictive models for IVH. The best of them (R2 ¼ 0.69, p ¼ 0.0001) included in the model measurements of amniotic fluid IL6, IL12 and IL8 as well as gestational age at study. CONCLUSION: Clinical and biochemical markers of inflammation, specifically measurements of amniotic fluid IL6, IL12, IL8 and MMP-8, may predict the development of postnatal IVH in cases at high risk of this condition.
818 Activity restriction does not slow the rate of cervical shortening in pregnancy M. Camille Hoffman1, Lizbeth McCarthy1, Gretchen Heinrichs1, Jennifer Hyer1, J. Chris Carey1 1 Denver Health Medical Center, University of Colorado Obstetrics & Gynecology, Denver, CO
OBJECTIVE: Despite being prescribed commonly in prenatal care, activity restriction (AR) has not been demonstrated to reduce the rate of preterm birth. The objective of our study was to determine if there is a difference in cervical length shortening in women prescribed AR during pregnancy when compared with women reporting normal and increased activity (IA). STUDY DESIGN: This was a secondary analysis of data from the Maternal-Fetal Medicine Unit Network Preterm Prediction Study. Participants reported on their level of activity and the recommendation for AR at 2 study visits beginning at 22 weeks gestation. We defined subjects as having IA if they reported participating in 2/7 activities considered more strenuous than normal. Subjects were then categorized into 3 groups: AR, normal activity, and IA. We
www.AJOG.org
compared cervical lengths (CL) measured by ultrasound at approximately 24 and 28 weeks gestation between the 3 groups. We also compared activity group with preterm or term delivery. RESULTS: Information was available regarding activity and CL for 2740 subjects. Of these, 354 (13%) reported AR at some point during pregnancy, 776 (28%) were considered IA and 1610 (59%) reported normal activity. Of subjects prescribed AR, 22% delivered preterm and 78% delivered at term. Subjects prescribed AR had significantly greater change in CL between the 2 visits compared with the normal and IA groups (2.80.4mm v 1.4 0.1mm, p¼0.0004, and 1.30.2mm, p¼0.0005), respectively (Figure). When stratified by preterm versus term deliveries, the group reporting AR who delivered at term had the greatest change in cervical length (3.67.8mm, p¼0.008) when compared with other groups. CONCLUSION: Activity restriction did not slow the rate of CL change. Increased activity did not speed the rate of CL change. The greatest change in CL was noted in the AR group who subsequently delivered at term. These data provide further support to stop prescribing AR for the prevention of preterm birth.
819 Fetal adrenal gland size and risk of preterm birth Elizabeth Langen1, Amy Judy2, Mary Norton2 1
University of Michigan, Obstetrics and Gynecology, Ann Arbor, MI, Stanford University School of Medicine, Obstetrics and Gynecology, Stanford, CA 2
OBJECTIVE: Identifying markers of increased risk for preterm birth such as shortened cervical length is a priority in caring for pregnant women and improving new born health. Enlarged fetal adrenal gland size identified at the time of threatened preterm birth in the third trimester has been associated with increased risk for progression to preterm delivery. The purpose of this study is to investigate if enlarged fetal adrenal gland size in either the first or second trimester is a marker for increased risk of preterm birth. STUDY DESIGN: We conducted a prospective observational trial. IRB approval was obtained. Women presenting for either routine first trimester screening or anatomic survey at an academic medical center were enrolled. Women with fetal anomalies and newly diagnosed fetal demises were excluded. The superior-inferior adrenal gland length was measured on both the left and right when feasible. The largest measured length was used for statistical analysis. The adrenal gland length was plotted against gestational age at time of measurement and the best fit line was created. RESULTS: 518 patients were enrolled between 2011 and 2012. We excluded 73 patients who were lost to follow up, 1 patient who had a
S398 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014
Prematurity, Physiology
yMedian and range, pg/mL.
817 Prenatal prediction of neonatal intraventricular hemorrhage based on amniotic fluid markers Jose Bartha1, Rocio Revello1, Marı´a Alcaide2, Daniel Abehsera1, Sara Lopez-Magallon1, Beatriz Herreros1 1 University Hospital La Paz, Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Madrid, Spain, 2University Hospital La Paz, Clinical Chemistry, Madrid, Spain
OBJECTIVE: To assess the predictive capability of some biological markers in the amniotic fluid of fetuses at high risk of neonatal intraventricular hemorrhage (IVH). STUDY DESIGN: Forty women at risk of very preterm delivery due to PPROM (n ¼ 29, 72.5%) or preterm labor with intact membranes and cervical length < 15 mm (n ¼ 11, 27.5%) were studied. Gestational age at study (diagnosis of the primary condition) was 26.91 2.59 weeks. Amniocentesis, universal and specific PCR and microbiological cultures were performed. Amniotic fluid IL18, IL 2, IL4, IL6, IL10, IL12, TNF-alpha, IFN-g and MMP-8 were measured by Multiplex method. Amniotic fluid glucose and leukocyte count were also measured by standard methods. Gestational age at study was also considered in the predictive models. Placental detailed histological studies were performed. Mann Whitney U test and forward stepwise binary logistic regression were used. RESULTS: In total 8 cases developed IVH (20%). Amniotic fluid concentrations of IL6, IL12, IL8, MMP-8 and leukocyte were significantly higher in those cases that develop IVH while gestational age at study was significantly lower. Binary logistic regression found 4 predictive models for IVH. The best of them (R2 ¼ 0.69, p ¼ 0.0001) included in the model measurements of amniotic fluid IL6, IL12 and IL8 as well as gestational age at study. CONCLUSION: Clinical and biochemical markers of inflammation, specifically measurements of amniotic fluid IL6, IL12, IL8 and MMP-8, may predict the development of postnatal IVH in cases at high risk of this condition.
818 Activity restriction does not slow the rate of cervical shortening in pregnancy M. Camille Hoffman1, Lizbeth McCarthy1, Gretchen Heinrichs1, Jennifer Hyer1, J. Chris Carey1 1 Denver Health Medical Center, University of Colorado Obstetrics & Gynecology, Denver, CO
OBJECTIVE: Despite being prescribed commonly in prenatal care, activity restriction (AR) has not been demonstrated to reduce the rate of preterm birth. The objective of our study was to determine if there is a difference in cervical length shortening in women prescribed AR during pregnancy when compared with women reporting normal and increased activity (IA). STUDY DESIGN: This was a secondary analysis of data from the Maternal-Fetal Medicine Unit Network Preterm Prediction Study. Participants reported on their level of activity and the recommendation for AR at 2 study visits beginning at 22 weeks gestation. We defined subjects as having IA if they reported participating in 2/7 activities considered more strenuous than normal. Subjects were then categorized into 3 groups: AR, normal activity, and IA. We
www.AJOG.org
compared cervical lengths (CL) measured by ultrasound at approximately 24 and 28 weeks gestation between the 3 groups. We also compared activity group with preterm or term delivery. RESULTS: Information was available regarding activity and CL for 2740 subjects. Of these, 354 (13%) reported AR at some point during pregnancy, 776 (28%) were considered IA and 1610 (59%) reported normal activity. Of subjects prescribed AR, 22% delivered preterm and 78% delivered at term. Subjects prescribed AR had significantly greater change in CL between the 2 visits compared with the normal and IA groups (2.80.4mm v 1.4 0.1mm, p¼0.0004, and 1.30.2mm, p¼0.0005), respectively (Figure). When stratified by preterm versus term deliveries, the group reporting AR who delivered at term had the greatest change in cervical length (3.67.8mm, p¼0.008) when compared with other groups. CONCLUSION: Activity restriction did not slow the rate of CL change. Increased activity did not speed the rate of CL change. The greatest change in CL was noted in the AR group who subsequently delivered at term. These data provide further support to stop prescribing AR for the prevention of preterm birth.
819 Fetal adrenal gland size and risk of preterm birth Elizabeth Langen1, Amy Judy2, Mary Norton2 1
University of Michigan, Obstetrics and Gynecology, Ann Arbor, MI, Stanford University School of Medicine, Obstetrics and Gynecology, Stanford, CA 2
OBJECTIVE: Identifying markers of increased risk for preterm birth such as shortened cervical length is a priority in caring for pregnant women and improving new born health. Enlarged fetal adrenal gland size identified at the time of threatened preterm birth in the third trimester has been associated with increased risk for progression to preterm delivery. The purpose of this study is to investigate if enlarged fetal adrenal gland size in either the first or second trimester is a marker for increased risk of preterm birth. STUDY DESIGN: We conducted a prospective observational trial. IRB approval was obtained. Women presenting for either routine first trimester screening or anatomic survey at an academic medical center were enrolled. Women with fetal anomalies and newly diagnosed fetal demises were excluded. The superior-inferior adrenal gland length was measured on both the left and right when feasible. The largest measured length was used for statistical analysis. The adrenal gland length was plotted against gestational age at time of measurement and the best fit line was created. RESULTS: 518 patients were enrolled between 2011 and 2012. We excluded 73 patients who were lost to follow up, 1 patient who had a
S398 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014