OBJECTIVE: The objective of this study was to determine the maternal and fetal .... OBJECTIVE: Advanced maternal age is well recognized as a risk factor for ...
SMFM Abstracts
www.AJOG.org 649
WEST NILE VIRUS AND PREGNANCY OUTCOMES GABRIELLA PRIDJIAN1, DAWN WESSON1, SCOTT MCRAE1, KEN SWAN1, ALISON HINCKLEY2, XU XIONG1, PATRICIA KISSINGER1, PATRICIA SIROIS1, EDWARD HAYES2, SONJA RASMUSSEN3, STEPHANIE KUHN2, DAN O’LEARY2, MICHAEL HENSON4, PIERRE BUEKENS1, 1Tulane University, New Orleans, Louisiana, 2Centers for Disease Control and Prevention, Fort Collins, Colorado, 3Centers for Disease Control and Prevention, Atlanta, Georgia, 4Purdue University, Hammond, Indiana OBJECTIVE: The objective of this study was to determine the maternal and fetal effects of West Nile Virus (WNV) infection during pregnancy. STUDY DESIGN: Current enrollment for this investigation includes 15 cases retrospectively identified in 2003 and 2004 through a CDC registry and 21 cases prospectively identified in 2005 and 2006. Controls are being recruited for comparison to the prospective group. Maternal sera and cord blood on all participants is being tested for WNV-specific IgM and IgG antibodies, with confirmation of WNV through plaque reduction neutralization testing (PRNT). Information on maternal socioeconomic factors, prenatal history, birth history, newborn examinations and follow-up examinations are being collected. Ophthalmologic examinations and Bayley developmental assessments are also being performed on children up to 36 months of age. RESULTS: Thus far, pregnant women with a symptomatic WNV illness have presented with fever, rash, headache, meningitis, encephalitis, or flaccid paralysis. Of the 36 WNV cases, there were 7, 15, and 14 infections in the 1st, 2nd and 3rd trimesters, respectively. Four (11%) children were born with birth defects (aortic coarctation, cleft palate, umbilical hernia, torticollis). However, all mothers of these children were infected in the second and third trimester. WNV-specific IgM antibodies were detected in the sera of two newborns. One was born with aortic coarctation and a rash but is developing normally; the other was stillborn at 31 weeks to a mother infected 4 weeks earlier. No microcephaly or growth delay was observed among babies in the retrospective group. No chorioretinitis or cataracts were detected, and Bayley developmental assessments were at age level. Nearly all infected mothers delivered at term, and birth complications occurred at expected rates. CONCLUSION: Maternal WNV infection does not appear to increase pregnancy complications or adversely affect growth and developmental outcomes of their children. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.676
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REDUCED RATES OF DELIVERY-RELATED PERINATAL DEATH AT TERM IN SCOTLAND, 1985-2004 ARE DUE TO IMPROVED OBSTETRIC CARE. DHAMINTRA PASUPATHY1, ANGELA WOOD2, JILL PELL3, MICHAEL FLEMING4, GORDON SMITH5, 1University of Cambridge, Department of Obstetrics and Gynaecology, Cambridge, United Kingdom, 2 University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom, 3BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom, 4Common Services Agency, Information and Statistics Division, Edinburgh, United Kingdom, 5University of Cambridge, Cambridge, United Kingdom OBJECTIVE: Studies from a number of countries have indicated that rates of perinatal death (PND) related to delivery have declined in recent years. However, it is not clear whether this reflects improved obstetric care or improved resuscitation of asphyxiated infants. We sought to compare population trends in the decline of PND at term in relation to (1) the timing of death in relation to the time of delivery, (2) the number of asphyxiated liveborn infants. STUDY DESIGN: We studied 1,043,002 singleton births at term using Scottish registries of pregnancy outcome data (SMR2) and perinatal death data (SSBIDE) from 1985-2004. We excluded multiple pregnancy, preterm births, non-cephalic presentation, PNDs due to congenital anomaly and intrauterine fetal deaths prior to the onset of labor. The event was delivery-related PND (i.e. intra-uterine fetal death during labor or death of infant in the first four weeks of life), sub-divided according to intrapartum anoxia. Analysis was by multivariate logistic regression. RESULTS: The risk of all delivery-related PND declined over the period of study (36%, 95% CI 18-50%). This was wholly explained by a 51% (95% CI 32-64%) reduction in the risk of PNDs due to intrapartum anoxia. When anoxic deaths were analyzed by the time of death in relation to delivery, there was a greater reduction in intrapartum stillbirths (61%, 95% CI 36-76%) than neonatal deaths (41%, 95% CI 11-62%). There was a decline in the number of liveborn infants delivered with an Apgar score ⬍7 (52%, 95% CI 50-55%). When the risk of neonatal death due to anoxia was confined to liveborn infants with a low 5 minute Apgar score (⬍7), there was no significant decline in the risk of neonatal death (4%, 95% CI -53 to 40%) over the period of study. CONCLUSION: Reduced rates of delivery-related PND at term in Scotland from 1985-2004 appear to be due to improvements in obstetric rather than neonatal care.
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ADVANCED MATERNAL AGE IS ASSOCIATED WITH AN INCREASED RISK OF PERINATAL DEATH DUE TO INTRAPARTUM ANOXIA AT TERM DHAMINTRA PASUPATHY1, ANGELA WOOD2, JILL PELL3, MICHAEL FLEMING4, GORDON SMITH5, 1University of Cambridge, Department of Obstetrics and Gynaecology, Cambridge, United Kingdom, 2University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom, 3BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom, 4Common Services Agency, Information and Statistics Division, Edinburgh, United Kingdom, 5 University of Cambridge, Cambridge, United Kingdom OBJECTIVE: Advanced maternal age is well recognized as a risk factor for intrauterine fetal death prior to the onset of labor (antepartum stillbirth) but there is much less information on the risk of perinatal death (PND) due to delivery. We sought to compare the risk of delivery-related PND at term in relation to maternal age. STUDY DESIGN: We studied 1,043,002 singleton births at term using Scottish registries of pregnancy outcome data (SMR2) and perinatal death data (SSBIDE) from 1985-2004. We excluded multiple pregnancy, preterm births, non-cephalic presentation, perinatal deaths due to congenital anomaly and intrauterine fetal deaths prior to the onset of labor. The event was delivery-related PND (i.e. intrauterine fetal death during labor or death of infant in the first four weeks of life) attributed to intrapartum anoxia. Analysis was by multivariate logistic regression. RESULTS: There were 490 intrapartum stillbirths and neonatal deaths attributed to intrapartum anoxia (4.7 per 10,000). Women aged 40 and above had a greater than two-fold risk of perinatal death at term due to intrapartum anoxia (Table; * Adjusted for maternal height, parity, socioeconomic status, fetal weight, sex and gestational age, onset of labour, day of delivery and hospital throughput) CONCLUSION: Advanced maternal age is associated with a greater than two-fold risk of perinatal death during delivery at term. Maternal age and the risk of anoxic-related perinatal death
Age ⬍20 20-25 25-35 35-39 39
All cause PND
Intrapartum anoxia
Adjusted OR* (95% CI) 0.91 (0.70-1.19) 1.00 (0.84-1.19) 1.0 1.02 (0.79-1.32) 2.08 (1.35-3.22)
Adjusted OR* (95% CI) 0.72 (0.51-1.01) 0.73 (0.58-0.92) 1.0 1.02 (0.74-1.41) 2.52 (1.51-4.21)
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.678
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.677
Supplement to DECEMBER 2007 American Journal of Obstetrics & Gynecology
S187
