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Occupational fatigue and preterm premature rupture of membranes
SPO Abstracts
Volume 176, N u m b e r 1, Part 2 A m J Obstet Gynecol
81
DETECTION OF G R O U P B STREPTOCOCCUS BY OPTICAL IMMUNOASSAY AND DIRECT AGAR PLATE CULTURE: COMPARISON TO B R O T H ENHANCED CULTURE. N,eu~en TM, Gauthicr 19, Vengalil SR, Schreckenberger U, Meyer W,, Myles 7"19, Nuwayhid BL Dept. of OB/GYN, University of Illinois, Chicago, IL. OBJECTIVE: To evaluate the diagnostic accuracy of a rapid optical inmmnoassay (STREP OIA, Biostar) and a non-selective medium (trypticase soy agar with 5% sheep blood [TSAr) for the detection of lower genital tract colonization by Group B Streptococcus (GBS) using a selective broth (Lirn broth) enhanced culture as the gold standard. S T U D Y DESIGN: GBS cultures from the lower genital tract were obtained in a prospective fashion using a dual swap transport system ti-om patients with risk factors thr perinatal GBS infection. One swab was used to inoculate the TSA and then placed in Lira broth. The other swab was used to perform the Strep OIA. RESULTS: 513 patients participated in the study. Lira broth cultures were positive for GBS in 86 samples (17%). The sensitivity (SENS), specificity (SPEC), positive predictive value (PPV), and negative predictive value (NPV) of the Strep OIA and the TSA compared to the Lira broth are outlined below:
STREP OIA TSA
SENS
SPEC
t'PV
NPV
48% (41/86) 59% (51/86)
96% (410/427)
71% (41/58)
90% (410/455)
99% (424/427)
94% (51/54)
92% (424/459)
$35
83
INTRAAMNIOTIC INFECTION OF TWIN PREGNANCIES W I T H PRETERM LABOR. B.H. Yoon, KH. ParU, j(N. Koo~,j(H. KwonX,j.K. Jun ~, H.C. Syn~, R. Romero. Seoul National University, Seoul, Korea. OBJECTIVE: Although preterm labor and delivery is common in twin gestation, the mechanisms responsible for this are poorly understood. One hypothesis is that the premature cmwical dilatation caused by overdistended uterus is a risk factor for ascending intrauterine infection and preterm labor and delivery. The purpose of this study was to examine if preterm labor in twin gestation is associated with higher rates of intraamniotic infection, preterm birth and significant perinatal morbidity. STUDY DESIGN: Transabdominal amniocentesis was perfornmd in 185 patients (20 cases with twin and 165 with singleton) with preterm labor and intact membranes. Amniotic fluid was cultured for aerobic and anaerobic bacteria and for rnycoplasmas. Significant neonatal morbidity was defined as congenital sepsis, intraventricular hemorrhage (grade --> II), respiratory distress syndrome, pneumonia, bronchopulnmnary dysplasia or necrotizing enterocolitis. RESULTS: Positive anmiotic fluid culture was more common in twin than in singleton pregnancies with preterm labor (35.0% (7/20) vs. 8.5% (14/165), p < 0.005]. Histologic chorioanmionitis was found in 67% (8/12) of patients with twin gestation. There was no significant difference in median gestational age at admission between the two groups of patients. However, patients with twin pregnancies had more advanced cervical dilatation at admission, lower gestational age at birth and higher rate of significant neonatal morbidity than patientx with singleton pregnancies. CONCLUSION: Patients with twin gestation presenting with preterm labor are at increased risk for sub-clinical intrauterine infection.
84
OCCUPATIONAL FATIGUE AND PRETERM PREMATURE RUPTURE OF MEMBRANES. R. Newman for the NICHD MFMU Network, Bethesda, MD. OBJECTIVE: To prospectively determine the relationship between occupational fatigue and low birth weight (LBW), spontaneous preterm delivery (SPTD), indicated preterm delivery (IPTD), preterm labor (PTL) and preterm premature rupture of membranes (pPROM). S T U D Y DESIGN: 2,929 singleton pregnancies at 2.3-24 weeks were enrolled in a multicentered (10 sites) Preterm Prediction Study. Patients reported the number of hours worked/week and answered specific questions designed to identify the 5 sources of occupational fatigue described by Mamelle: posture, work on industrial machines, physical exertion, mental, or environmental stress. Fatigue was quantified (0-5 index) based on the nmnber of sources positively reported. Simple and Mantel-Haenzel Chisquare tests were used to test the univariate association and the hypothesis of a linear trend between sources of occupational fatigue and hours worked and the outcomes of LBW, SPTD, IPTD, PTL, and pPROM <37 weeks gestation. Women who did not work were considered separately from those who worked but did not identify any source of occupational fatigue. RESULTS: Each source of occupational fatigue was associated with a significantly increased risk (p = 0.03) of pPROM among nuniparous but not multiparous women. There was a significant linear trend (p - 0.002) between the risk of pPROM and increasing number of sources of occupational fatigue: Not working 2.11%, working but no fatigue 3.70%, 1 source of fatigue 3A7%, 2 sources 5.23%, 3 sources 5.09%, or 4 sources 8.99%. Nulliparous women also bad a significant relationship (p - 0.01) between pPROM and increasing numbers of hours worked/week. Neither LBW, SPTD, IPTD, or PTL were associated with occupational fatigue or hours worked in either nulliparous or multiparous women. CONCLUSIONS: The occupational fatigue index of Mamelle prospectively identifies nulliparous women at increased risk for pPROM. The relationship between pPROM and occupational fatigue and hours worked provides guidelines by which nulliparous women and their employers can be advised.
The sensitivity of the Strep OIA to detect light GBS colonization and heavy GBS colonization, as determined by the TSA, was 54% (20/37) and 94% (16/17), respectively. CONCLUSION: The Strep OIA and direct agar plate culture appear to be of limited clinical value due to their poor sensitivity. This study also demonstrates the need to use a selective medium, such as Lira broth, when assessing for the GBS colonization of the lower genital tract.
82
RISKS A N D ETHICAL ISSUES ASSOCIATED W I T H T H E USE OF DIAGN O S T I C CORDOCENTESIS IN THE EVALUATION OF FETUSES W I T H PRETERM PROM. S.M. Bemr R. Romero, R. Gomezx, b~ Gtwzzix, 3/1. Mazo~; B.II. Yoon, j(E. Tolosa, D.B. Cotton. Wayne State University, Detroit, MI and the Perinatology Research Branch, NICHD, Bethesda, MD. OBJECTIVE: Neonatal sepsis has a case fatality- rate of 10% and survivors are at risk for significant handicap including mental retardation and cerebral palsy. Recently, fetal blood sampling has been proposed as a method for the prenatal detection of fetal sepsis (Am J Obstet Gynecol 1995:172;1427). Fetal bacteremia diagnosed by cordocentesis has been docunmnted in 30% of patients with a positive anmiotic fluid culture tor microorganisms (overall rate if preterm PROM: 31%). However, fetal blood sampling is an invasive procedure with potential risks. The purpose of this study was to assess the risks associated with cordocentesis in preterm PROM and the ethical issues pertinent to the use of this procedure in the diagnosis of tetal sepsis. S T U D Y DESIGN: A cohort study was conducted to compare the 6"equency of maternal and fetal complications in patients with preterin PROM managed with anmiocentesis vs. those managed with anmiocentesis + cordocentesis. Statistical analysis was conducted using contingency tables and smMval analysis. RESULTS: 116 patients with preterm PROM were eligible to be included in this stndy; 62 were managed with anmiocentesis and cordocentesis and 54 with anmiocentesis alone. Patients participating in this study did not diker in clinical or demographic characteristics at admission. No differences in neonatal or n'laternal outcomes were observed between patients managed with amniocentesis vs. those managed with amniocentesis + cordocentesis: 1) procedure to delivery interval: 27.5 vs. 34.5 hours; 2) gestational age at delivery: 32.3 vs. 31.5 weeks; 3) birtbweight: 1889 vs. 1685 gms; 4) mnbilical cord pH at deliveD,: 7.31 vs. 7.29; 5) rate of preterm delivmy within 24, 48, 72 hours or 7 days after the procedure (39% vs. 39%, 59% vs. 56%, 61% vs. 61% and 74% vs. 70%, respectively); 6) intrauterine fetal death: 3.7% vs. 0%; 7) C/section rate: 23% vs. 26%; 7) NICU admission rate and median neonatal hospital stay. The Office of Protection from Research Risks (OPRR) requires that research projects be conducted with IRB approval, informed consent and careful evaluation of risk and benefits. Several IRBs approved this study before its execution. Post-hoc ethical analysis found that this study complies with the regulations to protect human subjects fi-om research risks. CONCLUSION: No evidence of adverse perinatal a n d / o r maternal outcome attributable to cordocentesis could be demonstrated.
Volume 176, N u m b e r 1, Part 2 A m J Obstet Gynecol
81
DETECTION OF G R O U P B STREPTOCOCCUS BY OPTICAL IMMUNOASSAY AND DIRECT AGAR PLATE CULTURE: COMPARISON TO B R O T H ENHANCED CULTURE. N,eu~en TM, Gauthicr 19, Vengalil SR, Schreckenberger U, Meyer W,, Myles 7"19, Nuwayhid BL Dept. of OB/GYN, University of Illinois, Chicago, IL. OBJECTIVE: To evaluate the diagnostic accuracy of a rapid optical inmmnoassay (STREP OIA, Biostar) and a non-selective medium (trypticase soy agar with 5% sheep blood [TSAr) for the detection of lower genital tract colonization by Group B Streptococcus (GBS) using a selective broth (Lirn broth) enhanced culture as the gold standard. S T U D Y DESIGN: GBS cultures from the lower genital tract were obtained in a prospective fashion using a dual swap transport system ti-om patients with risk factors thr perinatal GBS infection. One swab was used to inoculate the TSA and then placed in Lira broth. The other swab was used to perform the Strep OIA. RESULTS: 513 patients participated in the study. Lira broth cultures were positive for GBS in 86 samples (17%). The sensitivity (SENS), specificity (SPEC), positive predictive value (PPV), and negative predictive value (NPV) of the Strep OIA and the TSA compared to the Lira broth are outlined below:
STREP OIA TSA
SENS
SPEC
t'PV
NPV
48% (41/86) 59% (51/86)
96% (410/427)
71% (41/58)
90% (410/455)
99% (424/427)
94% (51/54)
92% (424/459)
$35
83
INTRAAMNIOTIC INFECTION OF TWIN PREGNANCIES W I T H PRETERM LABOR. B.H. Yoon, KH. ParU, j(N. Koo~,j(H. KwonX,j.K. Jun ~, H.C. Syn~, R. Romero. Seoul National University, Seoul, Korea. OBJECTIVE: Although preterm labor and delivery is common in twin gestation, the mechanisms responsible for this are poorly understood. One hypothesis is that the premature cmwical dilatation caused by overdistended uterus is a risk factor for ascending intrauterine infection and preterm labor and delivery. The purpose of this study was to examine if preterm labor in twin gestation is associated with higher rates of intraamniotic infection, preterm birth and significant perinatal morbidity. STUDY DESIGN: Transabdominal amniocentesis was perfornmd in 185 patients (20 cases with twin and 165 with singleton) with preterm labor and intact membranes. Amniotic fluid was cultured for aerobic and anaerobic bacteria and for rnycoplasmas. Significant neonatal morbidity was defined as congenital sepsis, intraventricular hemorrhage (grade --> II), respiratory distress syndrome, pneumonia, bronchopulnmnary dysplasia or necrotizing enterocolitis. RESULTS: Positive anmiotic fluid culture was more common in twin than in singleton pregnancies with preterm labor (35.0% (7/20) vs. 8.5% (14/165), p < 0.005]. Histologic chorioanmionitis was found in 67% (8/12) of patients with twin gestation. There was no significant difference in median gestational age at admission between the two groups of patients. However, patients with twin pregnancies had more advanced cervical dilatation at admission, lower gestational age at birth and higher rate of significant neonatal morbidity than patientx with singleton pregnancies. CONCLUSION: Patients with twin gestation presenting with preterm labor are at increased risk for sub-clinical intrauterine infection.
84
OCCUPATIONAL FATIGUE AND PRETERM PREMATURE RUPTURE OF MEMBRANES. R. Newman for the NICHD MFMU Network, Bethesda, MD. OBJECTIVE: To prospectively determine the relationship between occupational fatigue and low birth weight (LBW), spontaneous preterm delivery (SPTD), indicated preterm delivery (IPTD), preterm labor (PTL) and preterm premature rupture of membranes (pPROM). S T U D Y DESIGN: 2,929 singleton pregnancies at 2.3-24 weeks were enrolled in a multicentered (10 sites) Preterm Prediction Study. Patients reported the number of hours worked/week and answered specific questions designed to identify the 5 sources of occupational fatigue described by Mamelle: posture, work on industrial machines, physical exertion, mental, or environmental stress. Fatigue was quantified (0-5 index) based on the nmnber of sources positively reported. Simple and Mantel-Haenzel Chisquare tests were used to test the univariate association and the hypothesis of a linear trend between sources of occupational fatigue and hours worked and the outcomes of LBW, SPTD, IPTD, PTL, and pPROM <37 weeks gestation. Women who did not work were considered separately from those who worked but did not identify any source of occupational fatigue. RESULTS: Each source of occupational fatigue was associated with a significantly increased risk (p = 0.03) of pPROM among nuniparous but not multiparous women. There was a significant linear trend (p - 0.002) between the risk of pPROM and increasing number of sources of occupational fatigue: Not working 2.11%, working but no fatigue 3.70%, 1 source of fatigue 3A7%, 2 sources 5.23%, 3 sources 5.09%, or 4 sources 8.99%. Nulliparous women also bad a significant relationship (p - 0.01) between pPROM and increasing numbers of hours worked/week. Neither LBW, SPTD, IPTD, or PTL were associated with occupational fatigue or hours worked in either nulliparous or multiparous women. CONCLUSIONS: The occupational fatigue index of Mamelle prospectively identifies nulliparous women at increased risk for pPROM. The relationship between pPROM and occupational fatigue and hours worked provides guidelines by which nulliparous women and their employers can be advised.
The sensitivity of the Strep OIA to detect light GBS colonization and heavy GBS colonization, as determined by the TSA, was 54% (20/37) and 94% (16/17), respectively. CONCLUSION: The Strep OIA and direct agar plate culture appear to be of limited clinical value due to their poor sensitivity. This study also demonstrates the need to use a selective medium, such as Lira broth, when assessing for the GBS colonization of the lower genital tract.
82
RISKS A N D ETHICAL ISSUES ASSOCIATED W I T H T H E USE OF DIAGN O S T I C CORDOCENTESIS IN THE EVALUATION OF FETUSES W I T H PRETERM PROM. S.M. Bemr R. Romero, R. Gomezx, b~ Gtwzzix, 3/1. Mazo~; B.II. Yoon, j(E. Tolosa, D.B. Cotton. Wayne State University, Detroit, MI and the Perinatology Research Branch, NICHD, Bethesda, MD. OBJECTIVE: Neonatal sepsis has a case fatality- rate of 10% and survivors are at risk for significant handicap including mental retardation and cerebral palsy. Recently, fetal blood sampling has been proposed as a method for the prenatal detection of fetal sepsis (Am J Obstet Gynecol 1995:172;1427). Fetal bacteremia diagnosed by cordocentesis has been docunmnted in 30% of patients with a positive anmiotic fluid culture tor microorganisms (overall rate if preterm PROM: 31%). However, fetal blood sampling is an invasive procedure with potential risks. The purpose of this study was to assess the risks associated with cordocentesis in preterm PROM and the ethical issues pertinent to the use of this procedure in the diagnosis of tetal sepsis. S T U D Y DESIGN: A cohort study was conducted to compare the 6"equency of maternal and fetal complications in patients with preterin PROM managed with anmiocentesis vs. those managed with anmiocentesis + cordocentesis. Statistical analysis was conducted using contingency tables and smMval analysis. RESULTS: 116 patients with preterm PROM were eligible to be included in this stndy; 62 were managed with anmiocentesis and cordocentesis and 54 with anmiocentesis alone. Patients participating in this study did not diker in clinical or demographic characteristics at admission. No differences in neonatal or n'laternal outcomes were observed between patients managed with amniocentesis vs. those managed with amniocentesis + cordocentesis: 1) procedure to delivery interval: 27.5 vs. 34.5 hours; 2) gestational age at delivery: 32.3 vs. 31.5 weeks; 3) birtbweight: 1889 vs. 1685 gms; 4) mnbilical cord pH at deliveD,: 7.31 vs. 7.29; 5) rate of preterm delivmy within 24, 48, 72 hours or 7 days after the procedure (39% vs. 39%, 59% vs. 56%, 61% vs. 61% and 74% vs. 70%, respectively); 6) intrauterine fetal death: 3.7% vs. 0%; 7) C/section rate: 23% vs. 26%; 7) NICU admission rate and median neonatal hospital stay. The Office of Protection from Research Risks (OPRR) requires that research projects be conducted with IRB approval, informed consent and careful evaluation of risk and benefits. Several IRBs approved this study before its execution. Post-hoc ethical analysis found that this study complies with the regulations to protect human subjects fi-om research risks. CONCLUSION: No evidence of adverse perinatal a n d / o r maternal outcome attributable to cordocentesis could be demonstrated.