INTERLEUKIN-6 (IL-6) LEVELS IN PRETERM FETO-NEONATES BRIAN ... collected in endotoxin-free glass tubes containing (EDTA) ((Becton, Dickinson).
SMFM Abstracts 640
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FIRST TRIMESTER INTEGRATED SCREENING FOR FETAL GROWTH RESTRICTION AHMET BASCHAT1, LAN ADAMS1, OZHAN TURAN1, JEROME KOPELMAN1, CHUKA JENKINS2, ROBERT ATLAS1, MIRIAM BLITZER1, CHRISTOPHER HARMAN1, 1University of Maryland at Baltimore, Baltimore, Maryland, 2Harbor Hospital Medical Center, Baltimore, Maryland OBJECTIVE: Fetal growth restriction (FGR) is a high risk condition with considerable morbidity and mortality. Early prediction offers the possibility for prevention. It was the aim of our study to develop a first trimester predictive algorithm for FGR. STUDY DESIGN: Prospectively enrolled patients at 11-14 weeks had measurement of body mass index (BMI), mean arterial blood pressure (MAP), CrownRump length (CRL), mean uterine (Ut) and umbilical artery (UA) pulsatility index MOM, pregnancy associated protein-A (PAPP-A) and free beta HCG MOM. Results were related to birthweight percentile (BW%) to derive a predictive algorithm for FGR (BW%ile⬍10). RESULTS: In 489 patients 43 delivered a neonate with a BW⬍10%, (26 before 34 weeks). Of all first trimester parameters only gravidity and Ut PI MOM correlated with BW % (Pearsons 0.09 and ⫺0.1, all p⬍0.05). The distribution of PAPP-A and Ut PI MOM was significantly different for FGR cases, (Mann Whitney p⫽0.01 and 0.008 respectively). Receiver operator curve statistics showed 49% sensitivity 74% specificity for a Ut PI MOM ⬎0.35 and 71 % sensitivity 58% specificity for a PAPP-A MOM ⬍0.92. Logistic regression did not define any additional co-factors. In the final integrated model Ut PI and PAPPA MOM predicted FGR with 90% sensitivity 20% specificity (PPV:17, NPV 92, OR: 2.4 [1.1-5.2] and p⫽0.04). CONCLUSION: First trimester screening using uterine artery Doppler and PAPP-A identifies a higher proportion of pregnancies at risk for FGR than previously reported for second trimester screening. The low specificity indicates the need to evaluate additional biomarkers or a two-stage screening approach.
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0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.670
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DOES VELAMENTOUS CORD INSERTION AFFECT OUTCOMES AFTER LASER THERAPY FOR TWIN-TWIN TRANSFUSION SYNDROME? RAMEN CHMAIT1, KURT BENIRSCHKE2, 1 University of Southern California, Keck School of Medicine, Los Angeles, California, 2University of California, San Diego, Reproductive Medicine, La Jolla, California OBJECTIVE: Velamentous cord insertion (VCI) is associated with smaller placental territory in diamniotic-monochorionic twins. Obliteration of vascular communications after laser therapy for twin-twin transfusion syndrome (TTTS) may result in further reduction of placental territory. We sought to determine if fetuses with VCI had worse perinatal outcomes compared to those without VCI after laser treatment for TTTS. STUDY DESIGN: Retrospective review of placental pathology reports from patients that underwent laser therapy for TTTS from March 2006 through March 2008 was performed. Cases were grouped according to VCI status and compared in regards to demographic and perinatal outcomes. Statistical analysis was conducted using Fisher=s exact and Pearson chi-square tests with significance defined as p⬍0.05. RESULTS: 99 patients underwent laser ablation for TTTS, of which 73 had placental pathology available. The overall rate of VCI per fetus in this cohort was 18%. VCI was significantly higher in the donors compared to the recipients (34% vs. 1%, p⬍0.0001). Donors with (25) and without (48) VCI had no difference in Quintero Stage, preoperative umbilical or middle cerebral artery Dopplers, gestational age at surgery, estimated fetal weight at surgery, gestational age at delivery, and birth weight. 30-day donor survival rate was 80% (20/25) in the VCI group and 77.1% (37/48) in the non-VCI group, which was not statistically different (p⫽1.0). CONCLUSION: No detectable differences in perinatal outcomes were identified in fetuses with and without velamentous cord insertion that underwent laser surgery for TTTS. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.672
RELATIONSHIPS BETWEEN CONCURRENT UMBILICAL CORD ARTERIAL BLOOD PH AND INTERLEUKIN-6 (IL-6) LEVELS IN PRETERM FETO-NEONATES BRIAN STAFEIL1, RENATA WILCZEK1, PETER G. PRYDE2, ROBERT MITTENDORF3, 1Loyola University Medical Center, Division of Maternal-Fetal Medicine, Maywood, Illinois, 2University of Wisconsin Medical School, Madison, Wisconsin, 3Loyola University Medical Center, Departments of Obstetrics and Gynecology, and of Pediatrics, Maywood, Illinois OBJECTIVE: In the guinea pig, even in the absence of infection, chronic hypoxemia can induce an inflammatory response (AJOG 2007;197:S41). We investigated whether, in the human, lower umbilical cord blood arterial pH (pHa) levels might be associated with fetal inflammation (defined as increased levels of IL-6). STUDY DESIGN: We did a secondary analysis of prospective data from the Magnesium and Neurologic Endpoints Trial (MagNET) ((AJOG 2002;186:1111). In brief, among other biological parameters, umbilical cord blood sera were obtained and processed locally for pHa. Concurrent aliquots of cord blood plasma were collected in endotoxin-free glass tubes containing (EDTA) ((Becton, Dickinson) and aprotinin (A6279, Sigma Chemical) for IL-6 levels (assays done at Madigan U.S. Army Hospital, Tacoma, WA). RESULTS: Matched cord blood sera pHa and plasma IL-6 levels were available for 84 feto-neonates (pHa range, 7.09 to 7.43; IL-6, ⬍10 to 8,660 pg/ml). By univariate analyses, babies with higher IL-6 (25 pg/ml) were more likely to have: a) earlier gestational ages (GA) ((P⬍.001), b) more positive bacterial cultures from the chorioamnion space (NEJM 1988;319:972) ((P⫽.01), and c) quite unexpectedly, higher--not lower--pHa ⬍7.28 (7.28, median pH in our data) ((P⫽.049). Using multivariate logistic regression (LogXact) to control for confounding, earlier GA and positive cultures remained significant, whereas pHa became non-significant albeit maintaining its unexpected trend (Table). CONCLUSION: In our data, contrary to the initial hypothesis, lower pHa levels were not associated with higher levels of IL-6. Although the severity of hypoxemia in our data set (worst case, pH 7.09) may have been insufficient to induce an inflammatory response, the possibility that the response in humans differs from that of guinea pigs is considered.
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A RETROSPECTIVE COMPARISON OF COMPLICATION RATES BETWEEN TRANSCERVICAL AND TRANSABDOMINAL CVS KENNETH LIM1, BENNY LEE2, PETER VON DADELZSEN2, 1University of British Columbia, Vancouver, British Columbia, Canada, 2University of British Columbia,, British Columbia, Canada OBJECTIVE: To examine the complications rates between transabdominal (TA) and transcervical (TC) [biopsy forceps] CVS performed in our institution STUDY DESIGN: Retrospective cohort: Our ultrasound database was searched for all CVS performed between Jan 1, 2004 and Dec 31, 2006 where only a single technique was applied to a singleton pregnancy and performed between 10 and 13⫹2 weeks gestation. Database and chart review was conducted to obtain followup of those pregnancies. Losses were defined as a pregnancy loss for any reason within 28 days of the procedure, and at 20 weeks gestation. Significant bleeding was defined as reported bleeding and/or persistent hematoma on ultrasound for more than 28 days post procedure. Standard descriptive statistics and comparative statistics were used where appropriate. RESULTS: There were 291 CVS performed in singleton pregnancies, and followup was obtained in 186 cases (64%). The proportion of TA vs TC was the same in those with and without followup. No significant differences were seen in gravida, abortions, maternal age, gestational age at procedure or % of cases considered difficult between TA and TC groups. There were 118 TC procedures vs 68 TA procedures with complete followup for analysis. There was significantly greater reported vaginal bleeding post procedure (21 vs 1) in the TC vs TA groups (p ⬍ 0.001), but there was no significant differences in loss rates prior to 28 days post procedure (14 vs 11) and prior to 20 weeks gestation (21 vs 12) respectively. There was no statistical difference in significant bleeding (4 vs 0). CONCLUSION: Although TC cvs is associated with significantly more bleeding post procedure compared to TA cvs, there appears to be no significant difference in loss rates. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.673
Table: Multivariate logistic regression with IL-6 levels as the outcome variable Predictor
Adj OR:
95% CI:
P-value:
Positive culture GA ⬍28 weeks pHa ⬍7.28
6.8 15.8 .34
1.4 to 67 2.2 to ⬁ .07 to 1.3
.01 .003 .15
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.671
S184
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2008
