- Email: [email protected]
824: Maternal cardiac arrest and perimortem cesarean delivery (PMCD): neonatal benefits
www.AJOG.org
Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical-Disease
823 Magnesium decreases inflammatory cytokine production: a novel innate immunomodulatory mechanism Helene Bernstein1, Jun Sugimoto2, Haruka Suzuki-Kakisaka2, Andrea Romani3 1 Case Western Reserve University, Reproductive Biology, Molecular Biology and Microbiology, Cleveland, OH, 2Case Western Reserve University, Reproductive Biology, Cleveland, OH, 3Case Western Reserve University, Physiology, Cleveland, OH
OBJECTIVE: To determine if magnesium sulfate (MgSO4) influences inflammatory cytokine production. STUDY DESIGN: MgSO4 exposure before preterm birth reduces the risk of cerebral palsy and major motor dysfunction. As neonatal inflammatory cytokine levels strongly correlate with neurologic outcome, we assessed the effect of MgSO4 on cytokine production within monocytic cell lines, cord blood mononuclear cells and maternal blood from women receiving parenteral magnesium sulfate for clinical indications. RESULTS: In vivo MgSO4 treatment substantially reduced maternal TNF-␣ and IL-6 production. THP-1 cells exposed to TLR4 ligand in the presence of a clinically-effective MgSO4 concentration (6mg/dl) demonstrated reduced IL-1, IL-6, IL-8 and TNF-␣ production. We next exposed term and preterm cord blood mononuclear cells to MgSO4 in vitro and found a significantly reduced frequency of neonatal monocytes producing cytokines under constitutive and TLRstimulated conditions, as measured by intracellular cytokine staining. Total cellular magnesium content rapidly increased upon MgSO4 exposure, and the immunomodulatory effect was mediated by magnesium and not the sulfate moiety of the compound. Decreased cytokine production was linked to lower cytokine and IB␣ gene expression and diminished NF-B activation. Reduced cytokine production was seen following exposure to different TLR ligands, suggesting that magnesium acts intracellularly, directly influencing NF-B or IB␣ activity. CONCLUSION: Our findings potentially elucidate the mechanism by which magnesium sulfate reduces the risk of cerebral palsy and establishes a new paradigm for innate immunoregulation, whereby magnesium plays a critical regulatory role in NF-B activation, cytokine production, and disease pathogenesis.
824 Maternal cardiac arrest and perimortem cesarean delivery (PMCD): neonatal benefits Hen Sela1, Sharon Einav2 1 Columbia University Medical Center, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York, NY, 2Shaare Zedek Medical Center, Jerusalem, Israel1, General Intensive Care Unit, Jerusalem, Israel
OBJECTIVE: AHA and RCOG suggest that PMCD be considered within 4 minutes of maternal collapse if there is no return of spontaneous circulation(ROSC), for neonatal and maternal benefit. This study examine whether such a recommendation is justified in terms of neonatal benefit STUDY DESIGN: We performed a systematic review of all reported maternal cardiac arrest cases (1980-2010). Cases were included if they provided clinical details regarding the event and maternal/neonatal outcome. Neonatal measures were: survival, Cerebral Performance Category (CPC) which is often used to assess brain damage after cardiac arrest and potential neonatal benefit from PMCD RESULTS: Of 1594 manuscripts screened, 156 underwent full review and 109 underwent data extraction. 95 cases met criteria. Maternal age was 30.56.5 years and gestational age (GA) at arrest 337 weeks. Common causes of arrest were trauma, preeclampsia and amniotic fluid embolism. Most arrests occurred in hospital (67.4%,n⫽64) and were witnessed (89.5%,n⫽85). PMCD was performed in 84% of viable pregnancies (76/90), Neonatal survival in singletons with reported outcome was 66.2% (43/65). Neurological outcomes of the surviving neonates were CPC1/2 or good in 34 cases (79%) and CPC3/4 in 9 cases (21%).Mean times between arrest and delivery were 1411 and 2213 minutes in survivors and non survivors (p⫽0.026). Time was 32
Poster Session V
weeks. In multivariate analysis (table) the variable associated with neonatal survival was in-hospital arrest (OR 13.035,95%CI2.566.8,P⫽0.002). Neonatal survival benefit attributed to PMCD was obvious in 40 cases (53%); we did not identify a single case of neonatal harm due to PMCD CONCLUSION: The 4 minute rule advocated for PMCD usually remains unmet, neonatal survival is still likely within 10 or even 15 minutes after the arrest. Neonatal benefit from PMCD is suggested in 53% of cases. Good neonatal outcome is associated with in-hospital maternal arrest. If cardiac arrest occurs, realistic, perhaps even evidence-based recommendations should include delivery within 10 minutes of arrest since there may well still be neonatal benefit from this procedure
825 Changes in maternal lipids from the 2nd to 3rd trimester differ by maternal pre-pregnancy BMI Jeanette Chin1, M. Sean Esplin2, Michael Varner3, Bob Silver4 1 University of Utah, Department of Obstetrics and Gynecology, Salt Lake City, UT, 2Intermountain Healthcare, Maternal-Fetal Medicine, Salt Lake City, UT, 3University of Utah Health Sciences Center, Obstetrics and Gynecology, Salt Lake City, UT, 4University of Utah Health Sciences Center and Intermountain Healthcare, Obstetrics and Gynecology, Salt Lake City, UT
OBJECTIVE: Lipid changes may contribute to adverse outcomes such as preeclampsia and fetal growth abnormalities. Relatively few studies have reported on lipid values across pregnancy (particularly from fasting blood draws), or how these values change with BMI. We sought to describe how changes in total cholesterol (TC), triglycerides (TG), HDL, LDL and non-HDL from the 2nd to 3rd trimester vary with maternal BMI. Non-HDL levels have not been the focus of previous studies in pregnancy, but are a stronger predictor of cardiovascular events than LDL in non-pregnant individuals. STUDY DESIGN: 72 women were enrolled in a prospective cohort study. Lipid panels were performed after overnight fasts at 22-26 weeks and 35-37 weeks gestation. ANOVA was used to determine whether lipid panel components differ by pre-pregnancy normal weight (NW) vs. overweight/obese (OW) status. ANCOVA was used to determine whether the change in lipid panel values from the 2nd to 3rd trimester differs by maternal weight category, while adjusting for the baseline value. RESULTS: Of the 72 women, 51 were NW (BMI⬍25 kg/m2, mean 21.2, SD 1.9) and 20 were OW (BMI ⱖ25 kg/m2, mean 30.2, SD 6.7). OW women had lower HDL levels as compared to NW women at the 2nd and 3rd trimester time points (68.1 mg/dL vs. 80.2 [p⫽0.03] and 61.4 vs. 71.0 [p⫽0.04], respectively). OW women had lower total cholesterol levels than NW women in the 3rd trimester (219 mg/dL vs. 246.7, p⫽0.009). OW women had a mean 2.3 mg/dL decrease in TC from the 2nd to 3rd trimester vs. a 13.2 mg/dL increase in TC for NW women (p⫽0.015). OW women had a mean 4.5 mg/dL increase in non-HDL cholesterol vs. a 21.5 mg/dL increase in NW women (p⫽0.009). OW women had a mean 9 mg/dL decrease in LDL vs. a 4 mg/dL increase in
Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology
S361
Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical-Disease
823 Magnesium decreases inflammatory cytokine production: a novel innate immunomodulatory mechanism Helene Bernstein1, Jun Sugimoto2, Haruka Suzuki-Kakisaka2, Andrea Romani3 1 Case Western Reserve University, Reproductive Biology, Molecular Biology and Microbiology, Cleveland, OH, 2Case Western Reserve University, Reproductive Biology, Cleveland, OH, 3Case Western Reserve University, Physiology, Cleveland, OH
OBJECTIVE: To determine if magnesium sulfate (MgSO4) influences inflammatory cytokine production. STUDY DESIGN: MgSO4 exposure before preterm birth reduces the risk of cerebral palsy and major motor dysfunction. As neonatal inflammatory cytokine levels strongly correlate with neurologic outcome, we assessed the effect of MgSO4 on cytokine production within monocytic cell lines, cord blood mononuclear cells and maternal blood from women receiving parenteral magnesium sulfate for clinical indications. RESULTS: In vivo MgSO4 treatment substantially reduced maternal TNF-␣ and IL-6 production. THP-1 cells exposed to TLR4 ligand in the presence of a clinically-effective MgSO4 concentration (6mg/dl) demonstrated reduced IL-1, IL-6, IL-8 and TNF-␣ production. We next exposed term and preterm cord blood mononuclear cells to MgSO4 in vitro and found a significantly reduced frequency of neonatal monocytes producing cytokines under constitutive and TLRstimulated conditions, as measured by intracellular cytokine staining. Total cellular magnesium content rapidly increased upon MgSO4 exposure, and the immunomodulatory effect was mediated by magnesium and not the sulfate moiety of the compound. Decreased cytokine production was linked to lower cytokine and IB␣ gene expression and diminished NF-B activation. Reduced cytokine production was seen following exposure to different TLR ligands, suggesting that magnesium acts intracellularly, directly influencing NF-B or IB␣ activity. CONCLUSION: Our findings potentially elucidate the mechanism by which magnesium sulfate reduces the risk of cerebral palsy and establishes a new paradigm for innate immunoregulation, whereby magnesium plays a critical regulatory role in NF-B activation, cytokine production, and disease pathogenesis.
824 Maternal cardiac arrest and perimortem cesarean delivery (PMCD): neonatal benefits Hen Sela1, Sharon Einav2 1 Columbia University Medical Center, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York, NY, 2Shaare Zedek Medical Center, Jerusalem, Israel1, General Intensive Care Unit, Jerusalem, Israel
OBJECTIVE: AHA and RCOG suggest that PMCD be considered within 4 minutes of maternal collapse if there is no return of spontaneous circulation(ROSC), for neonatal and maternal benefit. This study examine whether such a recommendation is justified in terms of neonatal benefit STUDY DESIGN: We performed a systematic review of all reported maternal cardiac arrest cases (1980-2010). Cases were included if they provided clinical details regarding the event and maternal/neonatal outcome. Neonatal measures were: survival, Cerebral Performance Category (CPC) which is often used to assess brain damage after cardiac arrest and potential neonatal benefit from PMCD RESULTS: Of 1594 manuscripts screened, 156 underwent full review and 109 underwent data extraction. 95 cases met criteria. Maternal age was 30.56.5 years and gestational age (GA) at arrest 337 weeks. Common causes of arrest were trauma, preeclampsia and amniotic fluid embolism. Most arrests occurred in hospital (67.4%,n⫽64) and were witnessed (89.5%,n⫽85). PMCD was performed in 84% of viable pregnancies (76/90), Neonatal survival in singletons with reported outcome was 66.2% (43/65). Neurological outcomes of the surviving neonates were CPC1/2 or good in 34 cases (79%) and CPC3/4 in 9 cases (21%).Mean times between arrest and delivery were 1411 and 2213 minutes in survivors and non survivors (p⫽0.026). Time was 32
Poster Session V
weeks. In multivariate analysis (table) the variable associated with neonatal survival was in-hospital arrest (OR 13.035,95%CI2.566.8,P⫽0.002). Neonatal survival benefit attributed to PMCD was obvious in 40 cases (53%); we did not identify a single case of neonatal harm due to PMCD CONCLUSION: The 4 minute rule advocated for PMCD usually remains unmet, neonatal survival is still likely within 10 or even 15 minutes after the arrest. Neonatal benefit from PMCD is suggested in 53% of cases. Good neonatal outcome is associated with in-hospital maternal arrest. If cardiac arrest occurs, realistic, perhaps even evidence-based recommendations should include delivery within 10 minutes of arrest since there may well still be neonatal benefit from this procedure
825 Changes in maternal lipids from the 2nd to 3rd trimester differ by maternal pre-pregnancy BMI Jeanette Chin1, M. Sean Esplin2, Michael Varner3, Bob Silver4 1 University of Utah, Department of Obstetrics and Gynecology, Salt Lake City, UT, 2Intermountain Healthcare, Maternal-Fetal Medicine, Salt Lake City, UT, 3University of Utah Health Sciences Center, Obstetrics and Gynecology, Salt Lake City, UT, 4University of Utah Health Sciences Center and Intermountain Healthcare, Obstetrics and Gynecology, Salt Lake City, UT
OBJECTIVE: Lipid changes may contribute to adverse outcomes such as preeclampsia and fetal growth abnormalities. Relatively few studies have reported on lipid values across pregnancy (particularly from fasting blood draws), or how these values change with BMI. We sought to describe how changes in total cholesterol (TC), triglycerides (TG), HDL, LDL and non-HDL from the 2nd to 3rd trimester vary with maternal BMI. Non-HDL levels have not been the focus of previous studies in pregnancy, but are a stronger predictor of cardiovascular events than LDL in non-pregnant individuals. STUDY DESIGN: 72 women were enrolled in a prospective cohort study. Lipid panels were performed after overnight fasts at 22-26 weeks and 35-37 weeks gestation. ANOVA was used to determine whether lipid panel components differ by pre-pregnancy normal weight (NW) vs. overweight/obese (OW) status. ANCOVA was used to determine whether the change in lipid panel values from the 2nd to 3rd trimester differs by maternal weight category, while adjusting for the baseline value. RESULTS: Of the 72 women, 51 were NW (BMI⬍25 kg/m2, mean 21.2, SD 1.9) and 20 were OW (BMI ⱖ25 kg/m2, mean 30.2, SD 6.7). OW women had lower HDL levels as compared to NW women at the 2nd and 3rd trimester time points (68.1 mg/dL vs. 80.2 [p⫽0.03] and 61.4 vs. 71.0 [p⫽0.04], respectively). OW women had lower total cholesterol levels than NW women in the 3rd trimester (219 mg/dL vs. 246.7, p⫽0.009). OW women had a mean 2.3 mg/dL decrease in TC from the 2nd to 3rd trimester vs. a 13.2 mg/dL increase in TC for NW women (p⫽0.015). OW women had a mean 4.5 mg/dL increase in non-HDL cholesterol vs. a 21.5 mg/dL increase in NW women (p⫽0.009). OW women had a mean 9 mg/dL decrease in LDL vs. a 4 mg/dL increase in
Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology
S361