MANCUSO1, MERRI MADDOX PADEN2, JEFF SZYCHOWSKI3, JOHN OWEN1, 1The University ... Women with a prior singleton spontaneous PTB 34 weeks= ...
SMFM Abstracts
www.AJOG.org 755
DOES MID-TRIMESTER NUGENT SCORE OR VAGINAL PH PREDICT GESTATIONAL AGE AT DELIVERY IN WOMEN AT RISK FOR PRETERM BIRTH? DANA FIGUEROA1, MELISSA MANCUSO1, MERRI MADDOX PADEN2, JEFF SZYCHOWSKI3, JOHN OWEN1, 1The University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama, 2The University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, 3The University of Alabama at Birmingham, Department of Biostatistics, Birmingham, Alabama OBJECTIVE: Bacterial vaginosis (BV) has been associated with spontaneous preterm birth (PTB). Our aim was to determine if BV as defined by Gram stain Nugent score or high vaginal pH predicts gestational age at delivery in women at high risk for PTB. STUDY DESIGN: This is a secondary analysis of a randomized clinical trial of cerclage for PTB prevention. Women with a prior singleton spontaneous PTB ⬍34 weeks= gestational age (GA) underwent initial cervical length (CL) assessment at 16 0/7-21 6/7 weeks and serial scans until 22 6/7 weeks. Women whose CL shortened to ⬍25 mm were randomized to either cerclage or no cerclage. Patients in the cerclage group were not included in this analysis. Vaginal Gram stain and pH were collected just prior to the initial scan. Positive BV criteria included a Nugent score ⱖ 7 or vaginal pH ⱖ 5. Investigators and patients were blinded to Gram stain and pH results. Logistic regression was used to model the relationship between a BV diagnosis and PTB ⬍28, ⬍35, and ⬍37 weeks= GA. Maternal age, race, smoking, urinary tract infection (UTI), and GA and CL at the 1st ultrasound were also considered as possible confounders in the model. With a BV prevalence of 12% and a sample size of over 750 women, we had more than 80% power to detect an odds ratio for PTB of at least 2.0. RESULTS: 790 women had complete data. BV diagnosed by Nugent score ⱖ 7 or by high pH ⱖ 5 was not associated with PTB at ⬍28, ⬍35, and ⬍37 weeks= GA. This finding did not change when adjusted for possible confounders. Even when birth GA was modeled as a continuous variable in a linear regression model, there was no association with Nugent score or high pH. CONCLUSION: BV diagnosed by either Nugent score or vaginal pH did not predict GA at delivery in women at high risk for PTB.
757
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.788
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.786
756
MATERNAL WHITE BLOOD CELL SUBTYPES AS A PREDICTIVE MARKER OF TOCOLYTIC SUCCESS IN PRETERM LABOR PATIENTS SOO-JIN LEE1, SEUNG-CHUL LIM1, MARIA LEE1, GA-HYUN SON1, DONG WOOK KWAK1, JAYOUNG KWON1, YOUNG HAN KIM1, YONGWON PARK1, 1Yonsei University Health System, Obsterics and Gynecology, Seoul, Korea, South Korea OBJECTIVE: The peripheral circulating white cells are composed of polymorphonuclear and mononuclear cells and lymphocytes; each cell possesses unique biological functions and contributes to the inflammation and immune response. The purpose of this study was to evaluate whether maternal white blood cell (WBC) subtypes can predict the success of tocolysis in patients admitted for preterm labor occurring before 34 gestational weeks and compare it to the traditional markers of inflammation such as C-reactive protein (CRP) and highly sensitive C-reactive protein (hsCRP). STUDY DESIGN: We retrospectively reviewed the values of WBC subtypes, CRP and hsCRP in 283 singleton pregnancies complicated by preterm labor occurring before 34 gestational weeks. The predictive ability for tocolytic success of WBC subtypes, CRP, and hsCRP was evaluated using receiver operating characteristics (ROC) curve and area under the curve (AUC). Logistic regression procedures were used to calculate adjusted odds ration (OR) and 95% confidence interval (95% CI). RESULTS: Of the 283 singleton pregnancies complicated by preterm labor, 96 (33.9%) pregnancies were delivered within 48 hours from the initiation of tocolysis (failure group). WBC count (p⬍0.001), neutrophil-to-lymphocyte ratio (NLR) (p⬍0.001), CRP (p⫽0.003), and hsCRP (p⫽0.04) were significantly higher in the tocolysis failure group. However, there was no difference in the neutrophil, monocyte, eosinophil, and basophil count between the tocolysis success and failure group. In the prediction of tocolytic success, the AUCs of NLR, WBC count, CRP, and hsCRP were 0.79, 0.77, 0.63, and 0.66, respectively. The sensitivity and specificity of NLR in predicting tocolytic success was 75.0%, and 68.4%, respectively (cutoff value: 5.34), and the odds ratio was 5.34 (95% CI: 4.5-14.1, p⬍0.001). CONCLUSION: An elevated WBC profile, especially, neutrophil to lymphocyte ratio may be used as a marker to predict tocolytic success in patients with preterm labor occurring before 34 gestational weeks.
PLACENTAL HISTOPATHOLOGY IN MILD VERSUS SEVERE HYPERTENSIVE DISORDERS IN PREGNANCY: IMPLICATIONS FOR FETO-PLACENTAL PERFUSION JULIO MATEUS1, NIMA GOHARKHAY1, MONICA LONGO1, GEORGE R SAADE1, JOAN MOSS1, ELENA SBRANA1, 1The University of Texas Medical Branch, Obstetrics and Gynecology, Galveston, Texas OBJECTIVE: To determine whether the severity of placental vascular abnormalities in hypertensive disorders correlates with the severity of the condition. STUDY DESIGN: We retrospectively evaluated placental specimens from the surgical pathology repository at our institution. Inclusion criterion was hypertension in singleton gestation. We excluded cases that delivered at ⬍ 20 weeks of gestation, and those with a clinical diagnosis of chorioamnionitis. Hypertensive disorders were classified as mild or severe by ACOG criteria. Sections from the placentae were stained with hematoxylin & eosin and examined microscopically for relevant pathologic changes. Fisher=s exact test was used for statistical analysis (significance: P⬍0.05). RESULTS: 90 placentas were examined (25 from mild HTN and 65 from severe HTN). After adjusting for gestational age, placental weights were not significantly different between the 2 groups (P⫽0.91). The proportion of placental weights ⬍ 10%ile were similar between groups (2/25 and 10/65; P⫽0.49). Histological abnormalities were found in 22/25 (88.0%) of the mild HTN group and in 61/65 (93.8%) of the severe HTN group (P⫽0.39). The most common abnormality was placental infarction, which was found in 5/25 (20%) of the mild HTN group and in 30/65 (46.1%) of the severe HTN group (P⫽0.02). 2 (8%) in the mild HTN and 4 (6.1%) in the severe HTN had histological evidence of acute abruption (P⫽0.65). Decidual vasculopathy and ischemia were found in 17 (26.1%) cases of severe HTN and in 3 (12%) of the mild HTN (P⫽0.16). Advance villous maturation were found in 14 (21.3%) cases of severe HTN and in 3 (12%) of the mild HTN (P⫽0.75) CONCLUSION: Hypertensive disorders affecting pregnancy are associated with significant placental histopathology. Mild and severe hypertensive disorders lead to similar vascular abnormalities in the placenta. These abnormalities can significantly impair feto-placental perfusion equally between mild and severe conditions, resulting in fetal hypoxia or death.
758
MATERNAL LIPIDS AS PREDICTIVE FACTORS FOR LARGE FOR GESTATIONAL AGE NEWBORNS IN WOMEN WITH GESTATIONAL DIABETES MELLITUS GAHYUN SON1, SOO-JIN LEE1, DONG-WOOK KWAK1, YOUNG HAN KIM1, JA-YOUNG KWON1, YOUNG-WON PARK1, 1Yonsei University Health System, Obstetrics and Gynecology, Seoul, Korea, South Korea OBJECTIVE: To determine the contribution of maternal lipids in predicting large for gestational age newborns in women with gestational diabetes mellitus (GDM). STUDY DESIGN: A total of 105 women with GDM were included in the study. All subjects had singleton pregnancies and no other medical disease that may affect the fetal growth. Serum triglycerides (TG), cholesterol, high density cholesterol (HDL), and low density cholesterol (LDL) in the maternal serum were determined during the 3rd trimester. Maternal glucose values came from the oral glucose tolerance test. RESULTS: Maternal TG levels had significant correlation with newborn=s birthweight (p⫽0.009). Maternal TG levels were higher in mothers with LGA infants compared to those with AGA and SGA newborns. However, there were no significant correlations between newborn=s birthweight and maternal glucose values, cholesterol, HDL, and LDL. After adjustment for confounding variables such as prepregnancy BMI, weight gain during pregnancy, age, and parity, maternal TG during 3rd trimester remained as an independent parameter for identifying LGA newborns. CONCLUSION: In GDM pregnancies, maternal TG levels may help identify women with LGA newborns. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.789
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.787
Supplement to DECEMBER 2008 American Journal of Obstetrics & Gynecology
S215
