OBJECTIVE: Fetal scalp blood pH sampling (FBS) has been shown to reduce ... Of 238 fetuses with acidotic FBS values (pH. 7.2), 166. (70%) were delivered by ...
SMFM Abstracts 767
www.AJOG.org
SLEEP DISORDERED BREATHING-RELATIONSHIP TO PREECLAMPSIA FRANCESCA FACCO1, WILLIAM GROBMAN1, BRANDON LU1, KIM HO1, PHYLLIS ZEE1, 1Northwestern University, Chicago, Illinois OBJECTIVE: To determine if sleep-disordered breathing (SDB) is more prevalent among women with preeclampsia compared to normotensive controls STUDY DESIGN: Preeclamptic patients admitted for observation were recruited to complete the Berlin Questionnaire (BQ) for sleep apnea, and to participate in an overnight sleep evaluation with the Watch-PAT100 (WP), a wrist-mounted, ambulatory device designed to diagnose SDB. WP signals allowed for the determination of an apnea hypopnea index (AHI), oxygen desaturation index (ODI) and a respiratory disturbance index (RDI), all indicators of SDB. Gestational age (GA) matched controls were recruited among normotensive pregnant patients hospitalized for other obstetrical indications. This study had 80% power to detect a mean difference of 5 (SD ⫾ 4) in any SDB index. RESULTS: Ten preeclamptic patients and 11 controls were recruited. The GA at the time of the sleep study did not differ between the cases and controls (32.8 ⫾ 1.0 weeks vs. 31.6 ⫾ 0.7 weeks, p⫽ 0.3). Preeclamptic subjects had a higher mean BMI (37.7⫾ 3.3 vs. 29.2 ⫾ 1.2, p⫽.02). Seventy percent (7/10) of the preeclamptic subjects screened positive for sleep apnea on the BQ versus none (0/11) of the controls (p ⬍ .01). Preeclamptic subjects had higher mean AHI and RDI values and a higher prevalence of moderate to severe sleep apnea (AHI ⱖ 10). However, these differences did not reach statistical significance (Table). Preeclamptic subjects had a significantly higher mean ODI compared to controls (4.1 ⫾ 1.8 vs. 0.3 ⫾ 0.2, p ⫽.04). CONCLUSION: SDB is more prevalent among preeclamptic patients. Further research is needed to determine if SDB, independent of BMI, is a significant contributing factor to preeclampsia. Additionally, studies are needed to elucidate the relationship between chronic, nocturnal, oxygen desaturation and adverse pregnancy outcomes in preeclamptic women.
769
AHI, RDI and ODI Results
Mean AHI Mean RDI Mean ODI AHI ⱖ 10
Cases
Controls
p value
7.25 ⫾ 8.7 10.5 ⫾ 7.7 4.1 ⫾ 1.8 3/10 (30%)
2.5 ⫾ 3.2 5.7 ⫾ 3.4 0.3 ⫾ 0.2 0/11 (0%)
0.11 0.08 .04 0.09
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.798
768
THE ROLE OF URINARY ENDOGLIN IN DIAGNOSING SEVERE PREECLAMPSIA: A PROSPECTIVE COMPARISON WITH SOLUBLE FMS-LIKE TYROSINE KINASE (SFLT-1) TO PLACENTAL GROWTH FACTOR (PLGF) RATIO CATALIN S. BUHIMSCHI1, MARGARET A. BAUMBUSCH1, ANTONETTE T. DULAY1, SARAH LEE1, MARK WEHRUM1, GUOMAO ZHAO1, CHRISTIAN M. PETTKER1, MERT BAHTIYAR1, EDMUND FUNAI1, IRINA A. BUHIMSCHI1, 1Yale University, Ob/Gyn & Reprod Sci, New Haven, Connecticut OBJECTIVE: Preeclampsia (PE) is characterized by an imbalance of urinary angiogenic factors. Previous studies show that the urinary sFlt-1-to-PlGF ratio (uFP) carries significant diagnostic value. Endoglin, an anti-angiogenic glycoprotein expressed on endothelial cells, has been recently implicated in the etiology of PE. The purpose of our study was to determine the clinical utility of urinary endoglin, as compared to the uFP ratio, to discriminate among hypertensive disorders and identify women with PE. STUDY DESIGN: Free urinary levels of endoglin, sFlt-1 and PlGF were measured by immunoassay in 234 pregnant women enrolled prospectively in the following groups: healthy control (CRL n⫽63, GA: 33 [21-42] wks), chronic hypertension (cHTN n⫽27, GA: 33 [20-41] wks), mild PE (mPE n⫽38, GA: 37 [25-41] wks) and severe PE (sPE n⫽106, GA: 32 [22-44] wks). Levels of urinary analytes were normalized for creatinine. GA ⬎37 wks ⫽ term. RESULTS: 1) Endoglin was present in urine of CRLs (Fig); 2) Compared to CRLs women with cHTN, mPE and sPE had significantly elevated urinary endoglin levels preterm but not at term; 3) Urine endoglin did not discriminate sPE from cHTN or mPE preterm; 4) There was a significant correlation between urine endoglin and proteinuria that remained after GA correction (r⫽0.34, P⬍0.001); 5) Overall, the diagnostic performance of urinary endoglin in identifying sPE was significantly inferior to uFP (P⬍0.001) (Table); 6) Urinary endoglin did not add value to the clinical utility of uFP in diagnosing sPE either preterm or at term. CONCLUSION: We provide evidence that urinary endoglin is present and elevated in preterm sPE but cannot distinguish among hypertensive disorders during pregnancy. Compared to urinary endoglin, an elevated sFlt-1-to-PlGF ratio remains a better marker of disease presence and severity.
CONTINUING CONTRIBUTION OF FETAL BLOOD SAMPLING TO ASSESSMENT OF INTRAPARTUM FETAL WELLBEING MINNA GEISLER1, FIONNUALA MCAULIFFE2, COLM O’HERLIHY3, 1National Maternity Hospital, Dublin, Ireland, Obstetrics and Gynecology, Dublin, Dublin, Ireland, 2National Maternity Hospital, Dublin, Ireland, Dublin, Dublin, Ireland, 3National Maternity Hospital, Dublin, Ireland, Obstetrics and Gynecology, Dublin 2, Dublin, Ireland OBJECTIVE: Fetal scalp blood pH sampling (FBS) has been shown to reduce false positive interventions, specifically cesarean section (CS), for suspected intrapartum fetal hypoxia. Despite these data, FBS is not employed in a significant number of obstetric units internationally. We have analysed the role of FBS in our institution, where it forms part of routine labor care. STUDY DESIGN: We performed a retrospective analysis of singleton, cephalic, term ( ⱖ37 weeks) labors during 3 years, 2005-2007, correlating FBS results with obstetric and neonatal outcome. RESULTS: Of 20313 relevant deliveries, 3312 (16%) fetuses required FBS because of abnormal fetal heart rate patterns during labor, 516 (16%) of whom had ⱖ3 samples, 892 (27%) were subsequently delivered by CS, 1197 (36%) instrumentally and 1223 (37%) were delivered spontaneously. There were no intrapartum or neonatal deaths. Of 92 infants with a low Apgar score (⬍ 5@1, ⬍7@5), 23 (25%) had low pH FBS (⬍7.20). Of 238 fetuses with acidotic FBS values (pH ⬍ 7.2), 166 (70%) were delivered by CS, 19 (8%) had a low Apgar score and 42 (18%) required NICU admission. Overall 218 (6.6%) infants were admitted to NICU following intrapartum FBS. Of 7 infants diagnosed with hypoxic ischemic encephalopathy (HIE) following intrapartum FBS, 5 had acidotic values, whereas FBS pH was normal in 2 but sampling preceded delivery ⱖ80 minutes in each case. CONCLUSION: In our population a normal FBS value allowed continuation of labor with a high vaginal delivery rate and neonatal morbidity rates were low, suggesting that FBS accurately reflected fetal oxygenation. Intrapartum FBS should form an essential part of labor care to optimize perinatal outcome for mother and infant. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.800
770
ASSOCIATION BETWEEN AMNIOTIC AND CERVICAL FLUID HYALURONIC ACID LEVELS AT MID-TRIMESTER AND SPONTANEOUS PRETERM DELIVERY MIN-HYOUNG KIM1, SIN-YOUNG KIM2, JIN-HOON CHUNG3, JUNE-SEEK CHOI4, HYUN-KYONG AHN1, JUNG-YEOL HAN1, HYUN-MEE RYU1, MOON-YOUNG KIM1, JAE-HYUG YANG5, JONG-HWA KIM6, 1Cheil general hospital & Women’s healthcare center, Kwandong university college of medicine, Obstetrics and Gynecology, Seoul, Korea, South Korea, 2Cheil general hospital & Women’s healthcare center, Kwandong university college of medicine, Laboratory of medical genetics, Korea, 3Obstetrics and Gynecology, Cheil general hospital & Women’s healthcare center, Kwandong university college of medicine, Obstetrics and Gynecology, Seoul, Korea, South Korea, 4Cheil General Hospital and Women’s Healthcare Center, Kwandong University college of medicine, Obstetrics and Gynecology, Seoul, Korea, South Korea, 5Cheil Hospital and Women’s Healthcare Center, Kwandong University School of Medicine, Department of Obstetrics and Gynecology, Seoul, Korea, South Korea, 6Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Obstetrics and Gynecology, Seoul, Korea, South Korea OBJECTIVE: To evaluate whether hyaluronic acid levels in amniotic fluid (AF) and cervical fluid (CF) at mid-trimester were associated with spontaneous preterm delivery STUDY DESIGN: We conducted a nested case-control study that was based on cervical and amniotic fluid samples obtained at the time of amniocentesis from 474 singleton pregnant women. The study included 15 case subjects delivered spontaneously before 37 weeks of gestation (of them, 6 women delivered before 35 weeks of gestation) and matched 15 control subjects delivered at term. Hyaluronic acid levels in AF and CF were measured with enzyme-linked immunosorbent assay (ELISA). RESULTS: Hyaluronic acid levels in AF and CF at mid-trimester were not significantly higher in women delivered before 37 weeks of gestation (case subjects, 8,176 ng/mL vs control subjects, 7,957 ng/mL in AF; P⫽0.500, 1,621 ng/mL vs 1,179 ng/mL in CF; P⫽0.527). However, hyaluronic acid levels in AF not in CF were higher in women delivered before 35 weeks of gestation (8,890 ng/mL vs 7,861 ng/mL, P⫽0.048). There was no correlation between AF and CF hyaluronic acid levels. CONCLUSION: An elevated level of hyaluronic acid in AF at mid-trimester may be a predictor of the subsequent preterm delivery before 35 weeks of gestation. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.801
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.799
S218
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2008
