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916: Ischemia-modified albumin in pregnancy
Poster Session V
ajog.org 916 Ischemia-modified albumin in pregnancy Alberto Rossi, Irene Romanello University of Udine, udine, Italy
OBJECTIVE: In normal pregnancies, a hypoxic intrauterine environment seems necessary for the early trophoblast development. In this context, mother’s serum levels of ischemia modified albumin (IMA) are elevated reflecting the oxidative stress associated with placental development. The aim of this study is to evaluate serum levels of IMA and Pregnancy Associated Plasma Protein A (PAPP-A) in mothers bearing small-for-gestational-age (SGA) fetuses compared to normal pregnancies. STUDY DESIGN: A prospective study was performed between June 2014 and May 2015. Serum total albumin, IMA and PAPP-A concentrations were determined in 101 pregnant women in 3 different periods: 1st trimester, 2nd trimester and in the post-partum. Two groups of subjects were identified: group 1) mothers bearing appropriate-for-gestational-age fetuses (AGA) and group 2) mothers bearing SGA fetuses. Serum total albumin and IMA concentrations were determined in 198 non-pregnant women as controls. RESULTS: Serum IMA concentrations increase during the gestation. IMA/Albumin serum levels in the 1st trimester were significantly higher in subjects of group 2 (p<0.05), whereas values of serum PAPP-A MoM were significantly lower (p<0.05). CONCLUSION: Elevated IMA serum levels together with low levels of PAPP-A were detected in the 1st trimester in mothers bearing SGA fetuses and that may reflect early placental changes occurring before clinical manifestation of SGA.
The median gestational age of fetal death in utero was 28.7 weeks (range: 23.0-30.4). Other obstetric and neonatal outcomes were not different between the two groups. The admission group showed significantly lower non-anomalous perinatal mortality rate (PMR) than the outpatient group (6.5% vs. 30.4%, p¼0.028). The presence of umbilical cord entanglement in antenatal ultrasound examination was 71.4% in the study population and the true umbilical cord entanglement at delivery was associated with low 5 minute Apgar score (Odds ratio 4.3, 95% Confidence interval 1.3-14.5) and low 5 minute Apgar score (Odds ratio 11.0, 95% Confidence interval 1.393.8), however other obstetric and neonatal outcomes did not show significant relationship with cord entanglement. CONCLUSION: Hospitalization of MCMA twin pregnancies for antenatal surveillance between 24 to 28 weeks of gestation significantly decreased PMR than observation through outpatient clinic followed by admission at later gestational period. This is a unique study for MCMA twin pregnancies comparing two different ways for prenatal care in a single center. Obstetric outcomes compared between outpatient group and protocol group Outpatient group
Protocol group p-value
(n=12)
(n=16)
Age (years)
31 (27-44)
31 (24-35)
NS
Nulliparity
66.7% (8/12)
68.8% (11/16)
NS
GA at first visit (weeks)
15.9 (9.6-30.7)
Umbilical cord entanglement in antenatal ultrasound examination 50.0% (3/6)
20.4 (10.0-26.7)
0.015
80.0% (12/15)
NS
GA at admission (weeks)
32.8 (23.0-37.1)
26.9 (25.1-28.1)
<0.001
Admission duration (days)
9 (5-27)
55 (11-67)
<0.001
Surveillance with continuous monitoring
33.3% (4/12)
6.3% (1/16)
0.013
Steroid administration
33.3% (4/12)
81.3% (13/16)
<0.001
Fetal death in utero
25.0% (6/24)
3.1% (1/32)
0.035
GA at delivery
34.4 (30.4-37.3)
34.3 (28.1-35.4)
NS
Birthweight
1935 (1440-2810)
1990 (1000-2540) NS
Emergency C/S
70.0% (7/10)
50.0% (8/16)
NS
Cord entanglement at delivery
53.8% (7/12)
62.5% (10/16)
NS
Expire at delivery room
5.6% (1/18)
0
NS
918 Safety and efficacy of oral probiotics in pregnant women Sunil K. Jain, Sangeeta Jain, George Saade University of Texas Medical Branch, Galveston, TX
OBJECTIVE: Preterm birth is a leading cause of neonatal morbidity
917 The optimal antenatal surveillance strategy for monochorionic monoamniotic twin pregnancies Jee Yoon Park1, Seung Mi Lee2, Chan-Wook Park2, Joong Shin Park2, Jong Kwan Jun2 1 Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of, 2Seoul National University Hospital, Seoul, Korea, Republic of
OBJECTIVE: To investigate perinatal outcomes in monochorionic
monoamniotic (MCMA) twin pregnancies. STUDY DESIGN: Medical records were retrospectively reviewed for 31
MCMA twin pregnancies from January 2001 to July 2016. Three cases who were diagnosed as intrauterine fetal death (FDIU) of both fetuses at the first visit or who underwent selective fetal reduction were excluded. Patients were divided into two groups: 1) patients who were admitted for fetal surveillance between 24 to 28 weeks of gestation (n¼16) and 2) those who were observed in outpatient clinic until any complication was found or were admitted after 29 weeks of gestation (n¼12). Once a patient was admitted, hospitalization proceeded until delivery with the setting of daily fetal heart rate monitoring. RESULTS: There was one intrauterine fetal demise in patients who were admitted between 24 to 28 weeks of gestation, while 6 fetal deaths were found in outpatient group (3.1% vs. 25.0%, p¼0.035).
and mortality. Bacterial vaginosis (BV) is known to cause preterm delivery by shifting normal vaginal flora to pathological bacteria. Probiotics are effective in the management of BV in non pregnant women. In this first FDA approved phase I study in the US, we evaluated the safety (maternal and neonatal outcomes up to 6 months after delivery) and efficacy (vaginal bacterial count, Amasal & Nugent scoring) of oral probiotics in pregnant women. STUDY DESIGN: In a randomized, placebo-controlled, double blind study (subjects and investigator were blinded) using oral Lactobacilli rhamnosus and Lactobacillus fermentum (109 viable colony-forming units) or placebo in pregnant women 18 wk for 60 days. Women with cervical cerclage, multi fetal pregnancy or known fetal anomalies were excluded. Study drug containing lactobacilli /placebo, one capsule taken daily. Vaginal swabs were taken before and after intervention and BV blue test, Amsel (score 1 - 4), Nugent’s (score 1 - 8) scoring and lactobacilli identification (quantitative PCR) were done. Maternal safety was measured by self reporting symptoms on dairy card (mild - event requiring minimal or no treatment to potentially life threatening - possible immediate risk of death) during the study and 6 months after delivery. Adherence to the protocol, occurrence of any side effects and neonatal outcomes (weight, ER admission or sepsis) were conducted by monthly telephone interview during study period and 6 months after the delivery.
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S523
ajog.org 916 Ischemia-modified albumin in pregnancy Alberto Rossi, Irene Romanello University of Udine, udine, Italy
OBJECTIVE: In normal pregnancies, a hypoxic intrauterine environment seems necessary for the early trophoblast development. In this context, mother’s serum levels of ischemia modified albumin (IMA) are elevated reflecting the oxidative stress associated with placental development. The aim of this study is to evaluate serum levels of IMA and Pregnancy Associated Plasma Protein A (PAPP-A) in mothers bearing small-for-gestational-age (SGA) fetuses compared to normal pregnancies. STUDY DESIGN: A prospective study was performed between June 2014 and May 2015. Serum total albumin, IMA and PAPP-A concentrations were determined in 101 pregnant women in 3 different periods: 1st trimester, 2nd trimester and in the post-partum. Two groups of subjects were identified: group 1) mothers bearing appropriate-for-gestational-age fetuses (AGA) and group 2) mothers bearing SGA fetuses. Serum total albumin and IMA concentrations were determined in 198 non-pregnant women as controls. RESULTS: Serum IMA concentrations increase during the gestation. IMA/Albumin serum levels in the 1st trimester were significantly higher in subjects of group 2 (p<0.05), whereas values of serum PAPP-A MoM were significantly lower (p<0.05). CONCLUSION: Elevated IMA serum levels together with low levels of PAPP-A were detected in the 1st trimester in mothers bearing SGA fetuses and that may reflect early placental changes occurring before clinical manifestation of SGA.
The median gestational age of fetal death in utero was 28.7 weeks (range: 23.0-30.4). Other obstetric and neonatal outcomes were not different between the two groups. The admission group showed significantly lower non-anomalous perinatal mortality rate (PMR) than the outpatient group (6.5% vs. 30.4%, p¼0.028). The presence of umbilical cord entanglement in antenatal ultrasound examination was 71.4% in the study population and the true umbilical cord entanglement at delivery was associated with low 5 minute Apgar score (Odds ratio 4.3, 95% Confidence interval 1.3-14.5) and low 5 minute Apgar score (Odds ratio 11.0, 95% Confidence interval 1.393.8), however other obstetric and neonatal outcomes did not show significant relationship with cord entanglement. CONCLUSION: Hospitalization of MCMA twin pregnancies for antenatal surveillance between 24 to 28 weeks of gestation significantly decreased PMR than observation through outpatient clinic followed by admission at later gestational period. This is a unique study for MCMA twin pregnancies comparing two different ways for prenatal care in a single center. Obstetric outcomes compared between outpatient group and protocol group Outpatient group
Protocol group p-value
(n=12)
(n=16)
Age (years)
31 (27-44)
31 (24-35)
NS
Nulliparity
66.7% (8/12)
68.8% (11/16)
NS
GA at first visit (weeks)
15.9 (9.6-30.7)
Umbilical cord entanglement in antenatal ultrasound examination 50.0% (3/6)
20.4 (10.0-26.7)
0.015
80.0% (12/15)
NS
GA at admission (weeks)
32.8 (23.0-37.1)
26.9 (25.1-28.1)
<0.001
Admission duration (days)
9 (5-27)
55 (11-67)
<0.001
Surveillance with continuous monitoring
33.3% (4/12)
6.3% (1/16)
0.013
Steroid administration
33.3% (4/12)
81.3% (13/16)
<0.001
Fetal death in utero
25.0% (6/24)
3.1% (1/32)
0.035
GA at delivery
34.4 (30.4-37.3)
34.3 (28.1-35.4)
NS
Birthweight
1935 (1440-2810)
1990 (1000-2540) NS
Emergency C/S
70.0% (7/10)
50.0% (8/16)
NS
Cord entanglement at delivery
53.8% (7/12)
62.5% (10/16)
NS
Expire at delivery room
5.6% (1/18)
0
NS
918 Safety and efficacy of oral probiotics in pregnant women Sunil K. Jain, Sangeeta Jain, George Saade University of Texas Medical Branch, Galveston, TX
OBJECTIVE: Preterm birth is a leading cause of neonatal morbidity
917 The optimal antenatal surveillance strategy for monochorionic monoamniotic twin pregnancies Jee Yoon Park1, Seung Mi Lee2, Chan-Wook Park2, Joong Shin Park2, Jong Kwan Jun2 1 Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of, 2Seoul National University Hospital, Seoul, Korea, Republic of
OBJECTIVE: To investigate perinatal outcomes in monochorionic
monoamniotic (MCMA) twin pregnancies. STUDY DESIGN: Medical records were retrospectively reviewed for 31
MCMA twin pregnancies from January 2001 to July 2016. Three cases who were diagnosed as intrauterine fetal death (FDIU) of both fetuses at the first visit or who underwent selective fetal reduction were excluded. Patients were divided into two groups: 1) patients who were admitted for fetal surveillance between 24 to 28 weeks of gestation (n¼16) and 2) those who were observed in outpatient clinic until any complication was found or were admitted after 29 weeks of gestation (n¼12). Once a patient was admitted, hospitalization proceeded until delivery with the setting of daily fetal heart rate monitoring. RESULTS: There was one intrauterine fetal demise in patients who were admitted between 24 to 28 weeks of gestation, while 6 fetal deaths were found in outpatient group (3.1% vs. 25.0%, p¼0.035).
and mortality. Bacterial vaginosis (BV) is known to cause preterm delivery by shifting normal vaginal flora to pathological bacteria. Probiotics are effective in the management of BV in non pregnant women. In this first FDA approved phase I study in the US, we evaluated the safety (maternal and neonatal outcomes up to 6 months after delivery) and efficacy (vaginal bacterial count, Amasal & Nugent scoring) of oral probiotics in pregnant women. STUDY DESIGN: In a randomized, placebo-controlled, double blind study (subjects and investigator were blinded) using oral Lactobacilli rhamnosus and Lactobacillus fermentum (109 viable colony-forming units) or placebo in pregnant women 18 wk for 60 days. Women with cervical cerclage, multi fetal pregnancy or known fetal anomalies were excluded. Study drug containing lactobacilli /placebo, one capsule taken daily. Vaginal swabs were taken before and after intervention and BV blue test, Amsel (score 1 - 4), Nugent’s (score 1 - 8) scoring and lactobacilli identification (quantitative PCR) were done. Maternal safety was measured by self reporting symptoms on dairy card (mild - event requiring minimal or no treatment to potentially life threatening - possible immediate risk of death) during the study and 6 months after delivery. Adherence to the protocol, occurrence of any side effects and neonatal outcomes (weight, ER admission or sepsis) were conducted by monthly telephone interview during study period and 6 months after the delivery.
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S523