- Email: [email protected]
870: Economic analysis of induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks (PPROMEXIL trial ISRCTN29313500)
Poster Session V
Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging
days) (OR 1.61 95%CI 0.98-2.67). This association was particularly evident among obese women. Obese participants who had long cycles had a 7.4-fold higher (95% CI 3.27-16.92) GDM risk compared with non-obese women who had normal cycle. In addition, we observed a significantly higher risk of GDM among participants with adult weight gain (ⱖ5 kg) and longer menstrual cycles compared with women who gained ⬍5 kg in adulthood and did not have long cycles (OR 4.62; 95%CI 2.65-8.07). CONCLUSIONS: Women with long cycles, particularly obese women or women who gained ⱖ5kg in adulthood, have increased risk for developing GDM. Menstrual history and characteristics may help to identify women with increased risk for developing GDM. Future studies to evaluate potential mechanisms of observed associations are needed.
868 The diagnostic utility of urinary protein to creatinine ratio (UPC) for the detection of significant proteinuria Molly Stout1, Christina Scifres2, David Stamilio1 1
Washington University in St. Louis, St. Louis, MO, 2University of Pittsburgh School of Medicine, Pittsburgh, PA
OBJECTIVE: To evaluate sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of various urinary protein to creatinine ratios (UPC) for the detection of significant proteinuria. STUDY DESIGN: This is a retrospective cohort study of 356 pregnant women from 2005-2007 in whom a UPC as well as a 24 hour urine collection were obtained in the initial evaluation for suspected preeclampsia. Baseline demographics, medical history, first 5 blood pressures at time of presentation, symptoms, laboratory data, and delivery information including final diagnosis of pre-eclampsia were obtained. UPC values were compared to 24 hour urine protein results to calculate sensitivity, specificity, positive and negative predictive values as well as positive and negative likelihood ratios for various UPC cutoffs. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of UPC. RESULTS: Of 356 women in the cohort, 40.5% (n⫽144) had proteinuria greater than 300 mg/24 hours. Compared to women without significant proteinuria, those with proteinuria did not differ with respect to maternal age, race, parity, diagnosis of chronic hypertension or body mass index. The area under the ROC curve for UPC is 0.82. Various UPC cutoffs were evaluated with regard to test characteristics and percent correctly classified (Table). CONCLUSIONS: UPC has a moderate ability to discriminate between those who will or will not have significant proteinuria on a 24-hour urine collection. Extremely low and high values of UPC may be helpful in deferring 24 hour urine collection to diagnose preeclampsia since a low value (⬍0.08) conveys a high negative predictive value ruling out disease and a high cutoff (⬎0.45) identifies disease with a low false positive rate.
UPC Cutoff (>)
Sensitivity Specificity (%) (%)
PPV (%)
NPV (%)
0.08
97
44
86
15
ⴙLR 1.14
ⴚLR
Percent Correctly Classified
0.23
48
..........................................................................................................................................................................................
0.12 90 39 50 86 1.48 0.25 60 .......................................................................................................................................................................................... 0.19 78 70 61 82 2.62 0.33 73 .......................................................................................................................................................................................... 0.40 50 93 80 74 7.08 0.53 76 .......................................................................................................................................................................................... 0.45 46 96 88 73 12.17 0.56 76 .......................................................................................................................................................................................... 1.19 31 ⬎99 96 85 64.9 0.70 72 ..........................................................................................................................................................................................
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www.AJOG.org
869 Creating a customized birth weight standard for Harris County’s Hispanic population Nikolaos Zacharias1, Sanaz Amini1, Haleh SangiHaghpeykar1, Andre Francis2, Jason Gardosi2 1 Baylor College of Medicine, Houston, TX, 2West Midlands Perinatal Institute, Birmingham
OBJECTIVE: To derive coefficients for developing a customized growth chart for the Hispanic population of Harris County. STUDY DESIGN: The Harris County screening prenatal ultrasound database was interrogated between September 2005 and December 2007. We included Hispanic women carrying singleton non-anomalous pregnancies dated by a sonogram before 24 weeks with ⱖ1 growth scan in the third trimester, and term delivery at Ben Taub General Hospital. Out of 8,620 sonograms, we reviewed 1,540 unselected studies and identified 490 pregnancies meeting all inclusion criteria. Information on significant physiologic variables affecting fetal growth was collected: maternal height, early pregnancy weight, parity, selfreported race/ethnicity and sonographically estimated delivery date (EDD). The delivery registry was reviewed to determine the delivery date, gender and birth weight for each infant. Coefficients were derived using backward stepwise multiple regression. Results are expressed in relation to the standard mother: first pregnancy, European descent, 163 cm tall, weighing 64 kg with neutral infant gender. RESULTS: This average maternal age was 28.3 years, height was 155.8 cm, early pregnancy weight was 67.2 kg and parity was 1.5; 51.1% of infants were male. The growth potential expressed as birth weight at 40 weeks was 3454.8g (standard error: 374.3g) – remarkably similar to findings in Europe and the United States. Significant physiologic variables influencing fetal growth included maternal early pregnancy weight from 64 kg (per kg: ⫹14.6 g), parity (1: ⫹107.8g, 2: ⫹128.5g, 3: ⫹128.5 g), male/female gender (⫹/⫺ 102.2g), BMI ⬎35 (⫺202.7g) and gestational age from 280 days (15.84g/day). Interestingly maternal height was not associated with birth weight. CONCLUSIONS: Our findings validate previous studies in other populations implicating physiological factors in fetal growth. The derived coefficients allow the determination of customized growth potential individually adjusted in the Hispanic population of Harris County, thus enhancing the clinician’s ability to detect aberrant fetal growth.
870 Economic analysis of induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks (PPROMEXIL trial ISRCTN29313500) Sylvia Vijgen1, David van der Ham2, Gerald Mantel3, Jan Molkenboer4, Twan Mulder2, Jan Nijhuis2, Paula Pernet5, Martina Porath6, Marc Spaanderman7, Martin Weinans8, Wim van Wijngaarden9, Hajo Wildschut10, Brent Opmeer1, Bertina Akerboom11, Marko Sikkema12, Ben Willem Mol1, Christine Willekes2, Denise Bijlenga1, Johannes van Beek13, Kitty Bloemenkamp14, Jan Derks15, Mariette Groenewout16, Michael Kars17, Simone Kuppens18 1 Academic Medical Center, Amsterdam, 2Maastricht University Medical Center, Maastricht, 3Isala, Zwolle, 4St. Anna Hospital, Geldrop, 5Kennemer Gasthuis, Haarlem, 6Maxima Medical Center, Veldhoven, 7University Medical Center St. Radboud, Nijmegen, 8Hospital Gelderse Vallei, Ede, 9 Bronovo Hospital, Den Haag, 10Erasmus Medical Center, Rotterdam, 11 Albert Schweitzer Hospital, Dordrecht, 12Twenteborg Hospital, Almelo, 13 VieCurie Hospital, Venlo, 14Leids University Medical Center, Leiden, 15 University Medical Center Utrecht, Utrecht, 16University Medical Center Groningen, Groningen, 17St. Antonius Hospital, Nieuwegein, 18Catharina Hospital, Eindhoven
OBJECTIVE: Preterm prelabor rupture of membranes (PPROM) is an important clinical problem. Awaiting spontaneous labor may lead to an increase in infectious disease for mother and child, whereas induction of labor leads to preterm birth with an increase in neonatal mor-
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011
www.AJOG.org
Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging
bidity. The Dutch nationwide preterm prelabor rupture of the membranestrial (Ppromexil trial) was initiated. Our aim was to perform an economic analysis alongside the trial. STUDY DESIGN: In the PPROMEXIL trial pregnant non-laboring women with PPROM for more than 24 hours at a gestational age from 34⫹0/7 week to 37⫹0/7 weeks were randomly allocated to either induction of labor or expectant management. We performed an economic analysis alongside the trial, using a bottom-up approach to estimate resource utilization, valued with unit-costs reflecting actual costs. Bootstrap analysis was used to estimate 95% confidence intervals around the mean costs and differences. All costs are presented in 2007 Euros. The economic analysis was performed from a health care provider perspective. RESULTS: A total of 536 women were randomized of which 268 were allocated to induction of labor and 268 to expectant management. Mean costs per patient were € 7.982 for induction and € 7.351 for expectant management (difference € 631; 95% CI - 579 to 1.991). This difference predominantly originated in the postpartum period: per patient € 5.756 for induction versus € 4.855 for expectant management due to longer duration of neonatal HC/MC admissions. Delivery costs were higher in patients allocated to induction than in patients allocated to expectant group (€1.599 versus €1.165 per patient), because of longer duration in the labor room or operation theatre. Antepartum costs in the expectant management group were higher because of longer antepartum maternal stays in hospital. CONCLUSIONS: Women with pregnancies complicated by PPROM near term, induction of labor and expectant management generate comparable costs.
871 Neonatal respiratory morbidity in twins vs singletons after elective preterm caesarean section Tullio Ghi1, Michela Nanni1, Federica Bellussi1, Elisa Maroni1, Aly Youssef 1, Elisabetta Tridapalli2, Gianluigi Pilu1, Giuseppe Pelusi1, Nicola Rizzo3 Department of Obstetrics, University of Bologna, Bologna, 2Department of Neonatology and Pediatrics, University of Bologna, Bologna, 3Departments of Obstetrics and Gynecology, Division of Prenatal Medicine, St. Orsola Malpighi General Hospital, University of Bologna, Bologna, Italy
Poster Session V
872 Risk factors for the development of chorioamnionitis in a teaching institution Zachary Bowman1, Gena Clark1, Leniel Cole1, Thomas Kelly1, Gladys Ramos1 1
University of California San Diego, San Diego, CA
OBJECTIVE: To examine risk factors associated with the development
of chorioamnionitis at a teaching hospital. STUDY DESIGN: A prospective cohort study of all term women presenting in labor from June to August 2008 and from June to August 2009. Intrapartum care was provided by housestaff and midwives under attending physician supervision. Exclusion criteria included patients with scheduled cesarean delivery, preterm premature rupture of membranes, preterm labor or who had evidence of chorioamnionitis prior to admission. Data abstracted included maternal demographics including Group B steptococcal carrier status, maternal diabetes and gestational age (GA) at delivery, the number of vaginal exams, hand hygeine practices, hours (hrs) from rupture of membranes (ROM) to delivery and epidural rate. Univariate and multivariate analyses were performed. RESULTS: 645 patients met inclusion criteria. The chorioamnionitis rate was 8.8%. Those who developed chorioamnionitis had a higher mean number of exams (7.8 ⫾ 3.8 vs. 5.3 ⫾ 2.7, p⬍0.001), examiners (3.5 ⫾ 1.7 vs. 2.6 ⫾ 1.4, p⬍0.001), and a longer time interval between ROM to delivery (11.8 ⫾ 8.3 hrs vs. 7.2 ⫾ 8.0 hrs, p⬍0.001). Multivariate analysis revealed the number of exams was the most important predictor for the development of chorioamnionitis (OR 1.237, 95%CI 1.125-1.359). CONCLUSIONS: Chorioamnionitis was associated with higher numbers of both vaginal exams and examiners as well as a longer length of time from ROM to delivery. When controlling for other factors, the most important predictor for the development of chorioamnionitis was the number of exams. Strategies to decrease number of exams may reduce chorioamnionitis rates.
1
OBJECTIVE: To compare the rate of neonatal respiratory morbidity in singletons versus twins delivered by prelabor Caesarean section. STUDY DESIGN: Singleton or dichorionic twin pregnancies delivered by a scheduled caesarean section at 34⫹0 to 37⫹6 weeks in our University Hospital in the period 2007 to 2009 were selected for the purpose of this study. Cases of preterm labor or PROM, fetal abnormality, SGA birthweight or maternal conditions such as haemorrhage, diabetes, hypertension or preeclampsia were excluded. Women previously exposed to betamethasone were also excluded. Neonatal morbidity including respiratory distress syndrome (RDS) and transient tachypnea (TTN) were compared in twins vs singletons. RESULTS: In the study period 388 neonates were selected, including 194 from singleton and 194 from twin pregnancies. Overall the rate of respiratory morbidity was slightly higher in singletons vs twins (20/ 194 or 10.3% vs 11/194 or 5.7%; OR: 1.91; 95% CI: 0.9-4.04; p⫽0.13), with a remarkably increased risk in the former group if elective delivery was performed prior to 37 weeks (11/37 or 29.7% vs 8/140 or 5.7%; OR: 5.20; 95% CI: 2-13.52; p ⬍.0001). CONCLUSIONS: Compared with singletons, twins delivered by elective caesarean section at 34-37 weeks of gestation seem to have a lower risk of respiratory morbidity.
873 The effect of serum from women with recurrent miscarriages and congenital thrombophilia with/without enoxaparin (Clexane) on JAR (trophoblast-like) cell line invasion and matrix metalloproteinase (MMP) secretion Zohar Nachum1, Elad Berkovich2, Noa Zafran2, Shiri Shatil2, Raed Salim1, Israel Gavish3, Shlomit Goldman4, Eliezer Shalev1 1 Ob&Gyn Dept, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa, 2Ob&Gyn Dept, Emek Medical Center, Afula, 3Hematology Unit, Emek Medical Center, Afula, 4Laboratory for Research in Reproductive Sciences, Emek Medical Center, Afula
OBJECTIVE: To study the invasion characteristics, including MMP2 and MMP9 secretion, of JAR human choriocarcinoma cells exposed to serum from women with recurrent miscarriages and congenital thrombophilia, and the effect of adding enoxaparin to these samples, all in comparison to the effect of serum from healthy controls. STUDY DESIGN: Blood was collected from 9 thrombophilic and 10 healthy non-pregnant women. Women with thrombophilia had at least 2 miscarriages and tested positive for the factor 2 or the factor V Leiden mutation. Controls were healthy women with a normal obstetric history and a negative thrombophilia workup. The JAR human choriocarcinoma cell line was cultured in the presence of 10% serum with 10 U/ml enoxaparin or without it. Cell invasion and MMP (2 and 9) secretion were measured using the Matrigel invasion assay and gel zymography, respectively. RESULTS: JAR invasion percentage and MMP2 optical density units were significantly lower in the thrombophilia group (50⫾10% and 393⫾64 units respectively) compared to controls (89⫾19% and 1022⫾99 units, P⬍0.0001 and P⬍0.05 respectively). No significant difference was documented between the two groups in MMP-9 secretion (359⫾149 study vs 637⫾84 controls). Enoxaparin increased cell invasion in the study group to 79⫾6% (P⬍0.001), similar to controls.
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S337
Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging
days) (OR 1.61 95%CI 0.98-2.67). This association was particularly evident among obese women. Obese participants who had long cycles had a 7.4-fold higher (95% CI 3.27-16.92) GDM risk compared with non-obese women who had normal cycle. In addition, we observed a significantly higher risk of GDM among participants with adult weight gain (ⱖ5 kg) and longer menstrual cycles compared with women who gained ⬍5 kg in adulthood and did not have long cycles (OR 4.62; 95%CI 2.65-8.07). CONCLUSIONS: Women with long cycles, particularly obese women or women who gained ⱖ5kg in adulthood, have increased risk for developing GDM. Menstrual history and characteristics may help to identify women with increased risk for developing GDM. Future studies to evaluate potential mechanisms of observed associations are needed.
868 The diagnostic utility of urinary protein to creatinine ratio (UPC) for the detection of significant proteinuria Molly Stout1, Christina Scifres2, David Stamilio1 1
Washington University in St. Louis, St. Louis, MO, 2University of Pittsburgh School of Medicine, Pittsburgh, PA
OBJECTIVE: To evaluate sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of various urinary protein to creatinine ratios (UPC) for the detection of significant proteinuria. STUDY DESIGN: This is a retrospective cohort study of 356 pregnant women from 2005-2007 in whom a UPC as well as a 24 hour urine collection were obtained in the initial evaluation for suspected preeclampsia. Baseline demographics, medical history, first 5 blood pressures at time of presentation, symptoms, laboratory data, and delivery information including final diagnosis of pre-eclampsia were obtained. UPC values were compared to 24 hour urine protein results to calculate sensitivity, specificity, positive and negative predictive values as well as positive and negative likelihood ratios for various UPC cutoffs. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of UPC. RESULTS: Of 356 women in the cohort, 40.5% (n⫽144) had proteinuria greater than 300 mg/24 hours. Compared to women without significant proteinuria, those with proteinuria did not differ with respect to maternal age, race, parity, diagnosis of chronic hypertension or body mass index. The area under the ROC curve for UPC is 0.82. Various UPC cutoffs were evaluated with regard to test characteristics and percent correctly classified (Table). CONCLUSIONS: UPC has a moderate ability to discriminate between those who will or will not have significant proteinuria on a 24-hour urine collection. Extremely low and high values of UPC may be helpful in deferring 24 hour urine collection to diagnose preeclampsia since a low value (⬍0.08) conveys a high negative predictive value ruling out disease and a high cutoff (⬎0.45) identifies disease with a low false positive rate.
UPC Cutoff (>)
Sensitivity Specificity (%) (%)
PPV (%)
NPV (%)
0.08
97
44
86
15
ⴙLR 1.14
ⴚLR
Percent Correctly Classified
0.23
48
..........................................................................................................................................................................................
0.12 90 39 50 86 1.48 0.25 60 .......................................................................................................................................................................................... 0.19 78 70 61 82 2.62 0.33 73 .......................................................................................................................................................................................... 0.40 50 93 80 74 7.08 0.53 76 .......................................................................................................................................................................................... 0.45 46 96 88 73 12.17 0.56 76 .......................................................................................................................................................................................... 1.19 31 ⬎99 96 85 64.9 0.70 72 ..........................................................................................................................................................................................
S336
www.AJOG.org
869 Creating a customized birth weight standard for Harris County’s Hispanic population Nikolaos Zacharias1, Sanaz Amini1, Haleh SangiHaghpeykar1, Andre Francis2, Jason Gardosi2 1 Baylor College of Medicine, Houston, TX, 2West Midlands Perinatal Institute, Birmingham
OBJECTIVE: To derive coefficients for developing a customized growth chart for the Hispanic population of Harris County. STUDY DESIGN: The Harris County screening prenatal ultrasound database was interrogated between September 2005 and December 2007. We included Hispanic women carrying singleton non-anomalous pregnancies dated by a sonogram before 24 weeks with ⱖ1 growth scan in the third trimester, and term delivery at Ben Taub General Hospital. Out of 8,620 sonograms, we reviewed 1,540 unselected studies and identified 490 pregnancies meeting all inclusion criteria. Information on significant physiologic variables affecting fetal growth was collected: maternal height, early pregnancy weight, parity, selfreported race/ethnicity and sonographically estimated delivery date (EDD). The delivery registry was reviewed to determine the delivery date, gender and birth weight for each infant. Coefficients were derived using backward stepwise multiple regression. Results are expressed in relation to the standard mother: first pregnancy, European descent, 163 cm tall, weighing 64 kg with neutral infant gender. RESULTS: This average maternal age was 28.3 years, height was 155.8 cm, early pregnancy weight was 67.2 kg and parity was 1.5; 51.1% of infants were male. The growth potential expressed as birth weight at 40 weeks was 3454.8g (standard error: 374.3g) – remarkably similar to findings in Europe and the United States. Significant physiologic variables influencing fetal growth included maternal early pregnancy weight from 64 kg (per kg: ⫹14.6 g), parity (1: ⫹107.8g, 2: ⫹128.5g, 3: ⫹128.5 g), male/female gender (⫹/⫺ 102.2g), BMI ⬎35 (⫺202.7g) and gestational age from 280 days (15.84g/day). Interestingly maternal height was not associated with birth weight. CONCLUSIONS: Our findings validate previous studies in other populations implicating physiological factors in fetal growth. The derived coefficients allow the determination of customized growth potential individually adjusted in the Hispanic population of Harris County, thus enhancing the clinician’s ability to detect aberrant fetal growth.
870 Economic analysis of induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks (PPROMEXIL trial ISRCTN29313500) Sylvia Vijgen1, David van der Ham2, Gerald Mantel3, Jan Molkenboer4, Twan Mulder2, Jan Nijhuis2, Paula Pernet5, Martina Porath6, Marc Spaanderman7, Martin Weinans8, Wim van Wijngaarden9, Hajo Wildschut10, Brent Opmeer1, Bertina Akerboom11, Marko Sikkema12, Ben Willem Mol1, Christine Willekes2, Denise Bijlenga1, Johannes van Beek13, Kitty Bloemenkamp14, Jan Derks15, Mariette Groenewout16, Michael Kars17, Simone Kuppens18 1 Academic Medical Center, Amsterdam, 2Maastricht University Medical Center, Maastricht, 3Isala, Zwolle, 4St. Anna Hospital, Geldrop, 5Kennemer Gasthuis, Haarlem, 6Maxima Medical Center, Veldhoven, 7University Medical Center St. Radboud, Nijmegen, 8Hospital Gelderse Vallei, Ede, 9 Bronovo Hospital, Den Haag, 10Erasmus Medical Center, Rotterdam, 11 Albert Schweitzer Hospital, Dordrecht, 12Twenteborg Hospital, Almelo, 13 VieCurie Hospital, Venlo, 14Leids University Medical Center, Leiden, 15 University Medical Center Utrecht, Utrecht, 16University Medical Center Groningen, Groningen, 17St. Antonius Hospital, Nieuwegein, 18Catharina Hospital, Eindhoven
OBJECTIVE: Preterm prelabor rupture of membranes (PPROM) is an important clinical problem. Awaiting spontaneous labor may lead to an increase in infectious disease for mother and child, whereas induction of labor leads to preterm birth with an increase in neonatal mor-
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011
www.AJOG.org
Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging
bidity. The Dutch nationwide preterm prelabor rupture of the membranestrial (Ppromexil trial) was initiated. Our aim was to perform an economic analysis alongside the trial. STUDY DESIGN: In the PPROMEXIL trial pregnant non-laboring women with PPROM for more than 24 hours at a gestational age from 34⫹0/7 week to 37⫹0/7 weeks were randomly allocated to either induction of labor or expectant management. We performed an economic analysis alongside the trial, using a bottom-up approach to estimate resource utilization, valued with unit-costs reflecting actual costs. Bootstrap analysis was used to estimate 95% confidence intervals around the mean costs and differences. All costs are presented in 2007 Euros. The economic analysis was performed from a health care provider perspective. RESULTS: A total of 536 women were randomized of which 268 were allocated to induction of labor and 268 to expectant management. Mean costs per patient were € 7.982 for induction and € 7.351 for expectant management (difference € 631; 95% CI - 579 to 1.991). This difference predominantly originated in the postpartum period: per patient € 5.756 for induction versus € 4.855 for expectant management due to longer duration of neonatal HC/MC admissions. Delivery costs were higher in patients allocated to induction than in patients allocated to expectant group (€1.599 versus €1.165 per patient), because of longer duration in the labor room or operation theatre. Antepartum costs in the expectant management group were higher because of longer antepartum maternal stays in hospital. CONCLUSIONS: Women with pregnancies complicated by PPROM near term, induction of labor and expectant management generate comparable costs.
871 Neonatal respiratory morbidity in twins vs singletons after elective preterm caesarean section Tullio Ghi1, Michela Nanni1, Federica Bellussi1, Elisa Maroni1, Aly Youssef 1, Elisabetta Tridapalli2, Gianluigi Pilu1, Giuseppe Pelusi1, Nicola Rizzo3 Department of Obstetrics, University of Bologna, Bologna, 2Department of Neonatology and Pediatrics, University of Bologna, Bologna, 3Departments of Obstetrics and Gynecology, Division of Prenatal Medicine, St. Orsola Malpighi General Hospital, University of Bologna, Bologna, Italy
Poster Session V
872 Risk factors for the development of chorioamnionitis in a teaching institution Zachary Bowman1, Gena Clark1, Leniel Cole1, Thomas Kelly1, Gladys Ramos1 1
University of California San Diego, San Diego, CA
OBJECTIVE: To examine risk factors associated with the development
of chorioamnionitis at a teaching hospital. STUDY DESIGN: A prospective cohort study of all term women presenting in labor from June to August 2008 and from June to August 2009. Intrapartum care was provided by housestaff and midwives under attending physician supervision. Exclusion criteria included patients with scheduled cesarean delivery, preterm premature rupture of membranes, preterm labor or who had evidence of chorioamnionitis prior to admission. Data abstracted included maternal demographics including Group B steptococcal carrier status, maternal diabetes and gestational age (GA) at delivery, the number of vaginal exams, hand hygeine practices, hours (hrs) from rupture of membranes (ROM) to delivery and epidural rate. Univariate and multivariate analyses were performed. RESULTS: 645 patients met inclusion criteria. The chorioamnionitis rate was 8.8%. Those who developed chorioamnionitis had a higher mean number of exams (7.8 ⫾ 3.8 vs. 5.3 ⫾ 2.7, p⬍0.001), examiners (3.5 ⫾ 1.7 vs. 2.6 ⫾ 1.4, p⬍0.001), and a longer time interval between ROM to delivery (11.8 ⫾ 8.3 hrs vs. 7.2 ⫾ 8.0 hrs, p⬍0.001). Multivariate analysis revealed the number of exams was the most important predictor for the development of chorioamnionitis (OR 1.237, 95%CI 1.125-1.359). CONCLUSIONS: Chorioamnionitis was associated with higher numbers of both vaginal exams and examiners as well as a longer length of time from ROM to delivery. When controlling for other factors, the most important predictor for the development of chorioamnionitis was the number of exams. Strategies to decrease number of exams may reduce chorioamnionitis rates.
1
OBJECTIVE: To compare the rate of neonatal respiratory morbidity in singletons versus twins delivered by prelabor Caesarean section. STUDY DESIGN: Singleton or dichorionic twin pregnancies delivered by a scheduled caesarean section at 34⫹0 to 37⫹6 weeks in our University Hospital in the period 2007 to 2009 were selected for the purpose of this study. Cases of preterm labor or PROM, fetal abnormality, SGA birthweight or maternal conditions such as haemorrhage, diabetes, hypertension or preeclampsia were excluded. Women previously exposed to betamethasone were also excluded. Neonatal morbidity including respiratory distress syndrome (RDS) and transient tachypnea (TTN) were compared in twins vs singletons. RESULTS: In the study period 388 neonates were selected, including 194 from singleton and 194 from twin pregnancies. Overall the rate of respiratory morbidity was slightly higher in singletons vs twins (20/ 194 or 10.3% vs 11/194 or 5.7%; OR: 1.91; 95% CI: 0.9-4.04; p⫽0.13), with a remarkably increased risk in the former group if elective delivery was performed prior to 37 weeks (11/37 or 29.7% vs 8/140 or 5.7%; OR: 5.20; 95% CI: 2-13.52; p ⬍.0001). CONCLUSIONS: Compared with singletons, twins delivered by elective caesarean section at 34-37 weeks of gestation seem to have a lower risk of respiratory morbidity.
873 The effect of serum from women with recurrent miscarriages and congenital thrombophilia with/without enoxaparin (Clexane) on JAR (trophoblast-like) cell line invasion and matrix metalloproteinase (MMP) secretion Zohar Nachum1, Elad Berkovich2, Noa Zafran2, Shiri Shatil2, Raed Salim1, Israel Gavish3, Shlomit Goldman4, Eliezer Shalev1 1 Ob&Gyn Dept, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa, 2Ob&Gyn Dept, Emek Medical Center, Afula, 3Hematology Unit, Emek Medical Center, Afula, 4Laboratory for Research in Reproductive Sciences, Emek Medical Center, Afula
OBJECTIVE: To study the invasion characteristics, including MMP2 and MMP9 secretion, of JAR human choriocarcinoma cells exposed to serum from women with recurrent miscarriages and congenital thrombophilia, and the effect of adding enoxaparin to these samples, all in comparison to the effect of serum from healthy controls. STUDY DESIGN: Blood was collected from 9 thrombophilic and 10 healthy non-pregnant women. Women with thrombophilia had at least 2 miscarriages and tested positive for the factor 2 or the factor V Leiden mutation. Controls were healthy women with a normal obstetric history and a negative thrombophilia workup. The JAR human choriocarcinoma cell line was cultured in the presence of 10% serum with 10 U/ml enoxaparin or without it. Cell invasion and MMP (2 and 9) secretion were measured using the Matrigel invasion assay and gel zymography, respectively. RESULTS: JAR invasion percentage and MMP2 optical density units were significantly lower in the thrombophilia group (50⫾10% and 393⫾64 units respectively) compared to controls (89⫾19% and 1022⫾99 units, P⬍0.0001 and P⬍0.05 respectively). No significant difference was documented between the two groups in MMP-9 secretion (359⫾149 study vs 637⫾84 controls). Enoxaparin increased cell invasion in the study group to 79⫾6% (P⬍0.001), similar to controls.
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S337