STUDY DESIGN: A retrospective study using the University of Kentucky Trauma ... locimetry (UAD) and pregnancy outcomes in patients with a history of ...
SMFM Abstracts
www.AJOG.org 529
ROLE OF HUMAN PLACENTAL UPD-GLUCURONOSYLTRANSFERASE IN LAMOTRIGINE METABOLISM DURING PREGNANCY YASUKO YAMAMURA1, RORY REMMEL1, 1University of Minnesota, Minneapolis, Minnesota OBJECTIVE: Determine if human placental UDP-glucuronosyltransferase (UGT) contributes to lamotrigine metabolism. STUDY DESIGN: A descriptive cross-sectional study was designed to evaluate metabolic activity of placental UGT. Placental tissue from term, uncomplicated pregnancies was collected. Human placental microsomes (HPM) were isolated from placental tissues by serial differential centrifugation. Ethoxyresorufin O-deethylase (EROD) activity was utilized to confirm metabolic activity of the HPM. Placental microsomes were incubated with lamotrigine in varying concentrations. Liquid chromatography-mass spectrometry (LCMS) was utilized to determine presence of lamotrigine metabolite, lamotrigine glucuronide (LTG-G), by comparison to known standard curve concentrations of LTG-G. RESULTS: Nine placentas were collected and processed; two from subjects with nicotine exposure during pregnancy. HPM of subjects exposed to nicotine exhibited induction of CYP1A enzyme by EROD activity, demonstrating presence of enzyme activity in HPM. In-vitro metabolism of lamotrigine to LTG-G by HPM was not detected by LCMS in either smokers or non-smokers. CONCLUSION: Human placental UGT does not contribute to lamotrigine metabolism at our defined level of detection. If a metabolic contribution from the placenta is present, it is likely not clinically significant. Levels of placental metabolism below our detection threshold should not account for the need for increased lamotrigine doseage requirements during gestation.
531
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.558
530
FACTORS ASSOCIATED WITH IMMEDIATE NEED FOR DELIVERY IN MATERNAL TRAUMA INCURRED FROM MOTOR VEHICLE CRASH KAREN SCHELL1, KRISTINE LAIN1, WENDY HANSEN1, 1University of Kentucky, lexington, Kentucky OBJECTIVE: To determine demographic, clinical and crash characteristics in maternal trauma that are associated with need for immediate delivery STUDY DESIGN: A retrospective study using the University of Kentucky Trauma Database from 1997-2006. Demographic data, clinical injury and crash characteristics were compared between women delivering prior to discharge (D) and those undelivered (UD) ⬎24 weeks gestation. Groups were compared using students t-test or Mann Whitney test for continuous variables and chi square for categorical variables. Logistic regression was used to control for confounders. ROC operator curve evaluated ISS for predictive characteristics RESULTS: 224 pregnant women were identified, 175 (78.2%) incurred a motor vehicle crash (MVC). Of the 97 (55.4%) women greater than 24 weeks, 31 (31.9%) were delivered prior to discharge. There were 2 maternal deaths. There was no difference between groups in maternal age, race or driver vs backseat position in vehicle. Significant differences were found between UD an D in gestational age 29.9⫾ 4.5 vs 33.6⫾4.8 wks, p 001; Injury Severity Scores (ISS) 4 (1,9) vs 14 (10,24) p⬍0.01; Unrestrained 18 (27.7%) vs18 (58.1%) [p.006, OR 3.6 CI (1.5-8.9)]; Core Injury: 5 (11%) vs 17 (68%) p00. ROC Area 0.90 (0.83,0.98) for an ISS⫽9.5 CONCLUSION: 32 % of pregnant women ⬎24 weeks gestation in a MVC meeting criteria for a trauma alert required delivery prior to discharge. Increased gestational age, ISS of 9.5 or greater, unrestrained, and injury to a core body part: abdomen or chest, were strongly associated with need for delivery. Despite the strong statistical associations, 3 women requiring delivery had ISS ⬍9.5 (ISS of 1/4/9). The data supports that when women incur severe injuries fetuses are often compromised, however a fetus can be compromised even when maternal injuries are mild. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.559
COMPLICATIONS OF CENTRAL VENOUS CATHETERS DURING PREGNANCY MARY BECK1, FRANCIS NUTHALAPATY2, BILL MABIE2, 1Greenville Hospital System University Medical Center, Greenville, South Carolina, 2University of South Carolina School of Medicine - Greenville, Greenville, South Carolina OBJECTIVE: To determine the incidence of central venous catheter related complications during pregnancy and to identify risk factors for complications. STUDY DESIGN: A retrospective case series of patients who were admitted for obstetric care at a tertiary care teaching hospital and had a central venous catheter placed between January 1, 2000 and July 10, 2006. Data regarding patient characteristics, the indication for admission and placement of venous catheter, as well as the associated complications were collected. Descriptive statistics and categorical comparisons were performed. RESULTS: We identified 85 patients who had a total of 97 central catheters placed during the study interval. Seventy-six percent of the catheters were placed antepartum at a mean gestational age of 24.7 ⫾ 10.7 weeks. Indications for catheter placement included: failed peripheral intravenous access (n⫽58, 61%), long term venous access (n⫽32, 34%) and other (n⫽5, 5%). The overall incidence of central venous catheter related complications was 25% (24/97). Complications included: culture-proven line infection 50% (12/24), mechanical failure 17% (4/24), presumed line infection 8% (2/24), superficial and deep venous thrombosis 8% (2/24), hematoma 8% (2/24), ventricular tachycardia 4% (1/24), and discomfort 4% (1/ 24). Caucasian race (P⫽.04), admission to the hospital for hyperemesis gravidarum (P⫽.03) and Crohn=s disease exacerbation (P⫽.01) were associated with an increased risk of central venous catheter complication. CONCLUSION: The incidence of central venous catheter related complication during pregnancy is comparable to that of the general medicine population. Admission to the hospital for hyperemesis gravidarum and Crohn disease exacerbation may predispose these patients to central catheter complication. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.560
532
UTERINE ARTERY DOPPLER VELOCIMETRY IN PATIENTS WITH A HISTORY OF THROMBOSIS OR THROMBOPHILIA TREATED WITH ENOXAPARIN CLAYTON FITZPATRICK1, TIMOTHY BEISWENGER1, BERNARD CANZONERI1, CHAD GROTEGUT1, GEETA SWAMY1, ANDRA JAMES1, 1Duke University, Durham, North Carolina OBJECTIVE: To assess the prevalence of abnormal uterine artery Doppler velocimetry (UAD) and pregnancy outcomes in patients with a history of thrombosis or thrombophilia and poor pregnancy outcome. STUDY DESIGN: Women with a history of thrombosis or thrombophilia and poor pregnancy outcome, who were being treated with enoxaparin and monitored with close fetal surveillance, underwent UAD measurements at the time of routine ultrasound (16 –20 weeks gestation). If the UAD resistance index (RI) was ⬎ 0.55 (the published 50th percentile), UAD measurements were repeated at 24-30 weeks gestation. A UAD RI of 0.58 was considered abnormal. RESULTS: Of the 23 subjects enrolled in the study, 9 had a history of thrombosis and 14 had a history of thrombophilia with poor pregnancy outcome. 21 subjects were found to have a RI ⬎ 0.55 at 16-20 weeks and were scheduled to undergo repeat measurements at 24-30 weeks. The subject with the highest RI (0.843) who had experienced a deep vein thrombosis and pulmonary embolism at 8 weeks gestation suffered a fetal demise at 20 weeks. 19/23 subjects (83%) were found to have abnormal uterine artery Doppler measurements (RI ⬎ 0.58) at 16-20 weeks. Of the 20 subjects, who underwent a second UAD measurement, 9 (45%) were found to have an abnormal UAD measurement. There were only 2 unplanned preterm births. The first, who delivered spontaneously at 35 weeks, had had 2 abnormal measurements. The second, who delivered after SROM at 36 weeks, had had normal UAD measurements. There were no cases of preeclampsia or fetal growth restriction, although at least 4 would have been expected among those with abnormal UAD measurements (P ⬍ 0.05). CONCLUSION: Despite a high prevalence of abnormal UAD measurements, this cohort of women with a history of thrombosis or thrombophilia with poor pregnancy outcome receiving enoxaparin and close fetal surveillance had better than expected pregnancy outcomes. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.561
Supplement to DECEMBER 2008 American Journal of Obstetrics & Gynecology
S155
