Obstetrics

SCOTTSDALE, ARIZ. — Researchers stopped a randomized, controlled trial comparing strategies to prevent postpartum hemorrhage when they found a 20-minute delay in delivery of the placenta to be much rarer than reported in the medical literature.

The investigators, who had expected 8% of women to take longer than 20 minutes, concluded that the third stage of labor exceeds this time frame in just 0.5% of pregnancies. Only 8 of the first 1,607 women recruited for the study took longer than 20 minutes to deliver the placenta, Everett F. Magann, M.D., reported in a poster at the annual meeting of the Central Association of Obstetricians and Gynecologists.

The multicenter trial was designed to determine whether 20 minutes would be a more optimal cutoff than 30 minutes for manually removing a placenta that had not delivered spontaneously. It also assessed risk factors for postpartum hemorrhage.

The investigators concluded that the new information from the aborted study “suggests that placental delivery should be considered earlier, perhaps at 10 minutes.”

Dr. Magann of the Naval Medical Center in Portsmouth, Va., said in an interview that they are redesigning the study to consider a cutoff of 10 minutes. “We think that is an appropriate place to look next,” he said.

Meanwhile, he and his colleagues stopped recruitment in the United States and Australia, as the original 7,300-woman goal could not produce statistically significant results on the study's primary end points with so few women reaching 20 or 30 minutes. “We saw we would need 110,000 women to get sample size,” he said.

Guidelines for manual delivery of the placenta are based on studies that are 15–20 years old, according to Dr. Magann. He noted that some practice guidelines are based on just one study, and others were never tested in clinical trials. He said, “I like to look at it again and say, 'Is that right?'”

When to intervene in the third stage of labor is an important issue in the Third World, he added. About 515,000 women die in childbirth each year, he said; the World Health Organization attributes a quarter of these deaths to postpartum hemorrhage.

More than half the women enrolled in the aborted study (56%) were Caucasian. Another 32% were African American. Their average age was 25.3 years, and their babies had reached a median gestational age of 39 weeks when delivered.

The median duration of labor was 7.2 hours for the first stage, 0.6 hours for the second stage, and 4 minutes for the third stage. A total of 1,431 placentas (89%) were delivered spontaneously within 10 minutes of birth. Another 168 placentas (10.5%) took 10–20 minutes for spontaneous delivery.

Older maternal age and duration of the second stage of labor beyond 2 hours were predictive of a prolonged third stage of labor.

Dr. Magann reported 42 women (3%) had postpartum hemorrhages. Duration of the third stage of labor beyond 10 minutes was a significant risk factor, with the odds ratios increasing from 2.68 for 10–15 minutes to 7.88 for durations longer than 15 minutes. Incidence of postpartum hemorrhage was 7% and 12%, respectively, in these time frames.

For women who delivered their placentas spontaneously within 5–10 minutes, however, the risk of postpartum hemorrhage was similar to the experience in women who delivered in less than 5 minutes (OR 1.16).

Chorioamnionitis at time of delivery was another significant simultaneous risk factor (OR 6.44) for postpartum hemorrhage within 24 hours of delivery. An overextended uterus also increased risk significantly (OR 2.85), whether due to a fetus weighing more than 4,000 g or to hydramnios.

Risk of postpartum hemorrhage was significantly less, however, in nulliparous women (OR 0.42).

SCOTTSDALE, ARIZ. — Researchers stopped a randomized, controlled trial comparing strategies to prevent postpartum hemorrhage when they found a 20-minute delay in delivery of the placenta to be much rarer than reported in the medical literature.

The investigators, who had expected 8% of women to take longer than 20 minutes, concluded that the third stage of labor exceeds this time frame in just 0.5% of pregnancies. Only 8 of the first 1,607 women recruited for the study took longer than 20 minutes to deliver the placenta, Everett F. Magann, M.D., reported in a poster at the annual meeting of the Central Association of Obstetricians and Gynecologists.

The multicenter trial was designed to determine whether 20 minutes would be a more optimal cutoff than 30 minutes for manually removing a placenta that had not delivered spontaneously. It also assessed risk factors for postpartum hemorrhage.

The investigators concluded that the new information from the aborted study “suggests that placental delivery should be considered earlier, perhaps at 10 minutes.”

Dr. Magann of the Naval Medical Center in Portsmouth, Va., said in an interview that they are redesigning the study to consider a cutoff of 10 minutes. “We think that is an appropriate place to look next,” he said.

Meanwhile, he and his colleagues stopped recruitment in the United States and Australia, as the original 7,300-woman goal could not produce statistically significant results on the study's primary end points with so few women reaching 20 or 30 minutes. “We saw we would need 110,000 women to get sample size,” he said.

Guidelines for manual delivery of the placenta are based on studies that are 15–20 years old, according to Dr. Magann. He noted that some practice guidelines are based on just one study, and others were never tested in clinical trials. He said, “I like to look at it again and say, 'Is that right?'”

When to intervene in the third stage of labor is an important issue in the Third World, he added. About 515,000 women die in childbirth each year, he said; the World Health Organization attributes a quarter of these deaths to postpartum hemorrhage.

More than half the women enrolled in the aborted study (56%) were Caucasian. Another 32% were African American. Their average age was 25.3 years, and their babies had reached a median gestational age of 39 weeks when delivered.

The median duration of labor was 7.2 hours for the first stage, 0.6 hours for the second stage, and 4 minutes for the third stage. A total of 1,431 placentas (89%) were delivered spontaneously within 10 minutes of birth. Another 168 placentas (10.5%) took 10–20 minutes for spontaneous delivery.

Older maternal age and duration of the second stage of labor beyond 2 hours were predictive of a prolonged third stage of labor.

Dr. Magann reported 42 women (3%) had postpartum hemorrhages. Duration of the third stage of labor beyond 10 minutes was a significant risk factor, with the odds ratios increasing from 2.68 for 10–15 minutes to 7.88 for durations longer than 15 minutes. Incidence of postpartum hemorrhage was 7% and 12%, respectively, in these time frames.

For women who delivered their placentas spontaneously within 5–10 minutes, however, the risk of postpartum hemorrhage was similar to the experience in women who delivered in less than 5 minutes (OR 1.16).

Chorioamnionitis at time of delivery was another significant simultaneous risk factor (OR 6.44) for postpartum hemorrhage within 24 hours of delivery. An overextended uterus also increased risk significantly (OR 2.85), whether due to a fetus weighing more than 4,000 g or to hydramnios.

Risk of postpartum hemorrhage was significantly less, however, in nulliparous women (OR 0.42).

SCOTTSDALE, ARIZ. — Researchers stopped a randomized, controlled trial comparing strategies to prevent postpartum hemorrhage when they found a 20-minute delay in delivery of the placenta to be much rarer than reported in the medical literature.

The investigators, who had expected 8% of women to take longer than 20 minutes, concluded that the third stage of labor exceeds this time frame in just 0.5% of pregnancies. Only 8 of the first 1,607 women recruited for the study took longer than 20 minutes to deliver the placenta, Everett F. Magann, M.D., reported in a poster at the annual meeting of the Central Association of Obstetricians and Gynecologists.

The multicenter trial was designed to determine whether 20 minutes would be a more optimal cutoff than 30 minutes for manually removing a placenta that had not delivered spontaneously. It also assessed risk factors for postpartum hemorrhage.

The investigators concluded that the new information from the aborted study “suggests that placental delivery should be considered earlier, perhaps at 10 minutes.”

Dr. Magann of the Naval Medical Center in Portsmouth, Va., said in an interview that they are redesigning the study to consider a cutoff of 10 minutes. “We think that is an appropriate place to look next,” he said.

Meanwhile, he and his colleagues stopped recruitment in the United States and Australia, as the original 7,300-woman goal could not produce statistically significant results on the study's primary end points with so few women reaching 20 or 30 minutes. “We saw we would need 110,000 women to get sample size,” he said.

Guidelines for manual delivery of the placenta are based on studies that are 15–20 years old, according to Dr. Magann. He noted that some practice guidelines are based on just one study, and others were never tested in clinical trials. He said, “I like to look at it again and say, 'Is that right?'”

When to intervene in the third stage of labor is an important issue in the Third World, he added. About 515,000 women die in childbirth each year, he said; the World Health Organization attributes a quarter of these deaths to postpartum hemorrhage.

More than half the women enrolled in the aborted study (56%) were Caucasian. Another 32% were African American. Their average age was 25.3 years, and their babies had reached a median gestational age of 39 weeks when delivered.

The median duration of labor was 7.2 hours for the first stage, 0.6 hours for the second stage, and 4 minutes for the third stage. A total of 1,431 placentas (89%) were delivered spontaneously within 10 minutes of birth. Another 168 placentas (10.5%) took 10–20 minutes for spontaneous delivery.

Older maternal age and duration of the second stage of labor beyond 2 hours were predictive of a prolonged third stage of labor.

Dr. Magann reported 42 women (3%) had postpartum hemorrhages. Duration of the third stage of labor beyond 10 minutes was a significant risk factor, with the odds ratios increasing from 2.68 for 10–15 minutes to 7.88 for durations longer than 15 minutes. Incidence of postpartum hemorrhage was 7% and 12%, respectively, in these time frames.

For women who delivered their placentas spontaneously within 5–10 minutes, however, the risk of postpartum hemorrhage was similar to the experience in women who delivered in less than 5 minutes (OR 1.16).

Chorioamnionitis at time of delivery was another significant simultaneous risk factor (OR 6.44) for postpartum hemorrhage within 24 hours of delivery. An overextended uterus also increased risk significantly (OR 2.85), whether due to a fetus weighing more than 4,000 g or to hydramnios.

Risk of postpartum hemorrhage was significantly less, however, in nulliparous women (OR 0.42).

KEVIN FOLEY, RESEARCH/JULIE KELLER, DESIGN

KEVIN FOLEY, RESEARCH/JULIE KELLER, DESIGN

KEVIN FOLEY, RESEARCH/JULIE KELLER, DESIGN

SCOTTSDALE, ARIZ. — Perineal repairs involving fast-absorbing polyglactin 910 sutures resulted in less pain and earlier resumption of sexual intercourse for new mothers in a randomized, controlled trial comparing the material with standard polyglactin 910 and chromic catgut.

Patients repaired with fast-absorbing polyglactin 910 sutures consumed fewer doses of analgesia and narcotics within 36–48 hours of giving birth. Two-thirds had resumed sexual intercourse at 6 weeks, and 48% had a pain-free experience, investigator Emmanuel Bujold, M.D., said at the annual meeting of the Central Association of Obstetricians and Gynecologists.

Only 42% of women repaired with chromic catgut sutures and 56% with standard polyglactin 910 resumed intercourse at 6 weeks. Just 27% in the chromic catgut cohort and 42% in the standard polyglactin 910 group said intercourse was pain free.

“The benefits of fast-absorbing polyglactin 910 include less short-term perineal pain and probably a shorter time to resumption of pain-free sexual intercourse,” said Dr. Bujold of Ste. Justine Hospital and the University of Montreal.

Dr. Bujold and coinvestigator Nathalie Leroux, M.D., also of the University of Montreal, undertook the study to see if the fast-absorbing form of polyglactin 910 could offer the benefits of a synthetic suture without the problems associated with delayed absorption of sutures.

He described suture-related discomfort as very common, with 85% of women suffering some form of perineal trauma in spontaneous vaginal birth. Medical literature reports as many as 69% require sutures, according to the investigators. Most patients suffer perineal pain after delivery, and about a fifth have long-term problems.

The study enrolled women with uncomplicated pregnancies early in labor. Those who had an uncomplicated median episiotomy or a second-degree perineal tear were randomized to sutures made with the three materials: 66 to chromic catgut, 60 to standard polyglactin 910, and 66 to fast-absorbing polyglactin 910.

The well-balanced groups contained women 30 years old on average. More than half of the standard polyglactin 910 cohort and two-thirds of the other cohorts were nulliparous. More than 40% in each group required an episiotomy. About one in four had dyspareunia before pregnancy.

Investigators used a standard analgesia protocol: 50 mg of immediate-release indomethacin and 500 mg of naproxen every 12 hours for 24 hours. As-needed doses were standardized at 500 mg of naproxen every 12 hours, 30 mg of codeine plus 325 mg of acetaminophen, and 1 mg of hydromorphone.

Nurses doing postpartum pain assessments were blinded to the sutures used. Neither pain questionnaire nor visual analog scale scores showed significant differences in evaluation of perineal pain 36–48 hours after the women had given birth.

The median number of analgesic doses was seven with chromic catgut, eight with standard polyglactin 910, and six with fast-absorbing polyglactin 910. Narcotic doses averaged one with chromic catgut and two with standard polyglactin 910 but zero with fast-absorbing polyglactin 910.

At 6 weeks, the number of women for whom data were available had fallen to 53 of the women treated with chromic catgut, 43 with standard polyglactin 910, and 58 with fast-absorbing polyglactin 910.

The data on return to sexual intercourse and pain-free sexual intercourse were significant only when chromic catgut and fast-absorbing polyglactin 910 were compared. At 3 months postpartum, fast-absorbing polyglactin 910 still showed a slight advantage but it was not significant.

Stephen H. Cruikshank, M.D., of Wright State University in Dayton, Ohio, praised the investigators for “a simple but most effective study,” which received the association's Central Prize Award. Dr. Cruikshank, the association's new president, said, “It just goes to show us sometimes the most effective study is the simplest.”

SCOTTSDALE, ARIZ. — Perineal repairs involving fast-absorbing polyglactin 910 sutures resulted in less pain and earlier resumption of sexual intercourse for new mothers in a randomized, controlled trial comparing the material with standard polyglactin 910 and chromic catgut.

Patients repaired with fast-absorbing polyglactin 910 sutures consumed fewer doses of analgesia and narcotics within 36–48 hours of giving birth. Two-thirds had resumed sexual intercourse at 6 weeks, and 48% had a pain-free experience, investigator Emmanuel Bujold, M.D., said at the annual meeting of the Central Association of Obstetricians and Gynecologists.

Only 42% of women repaired with chromic catgut sutures and 56% with standard polyglactin 910 resumed intercourse at 6 weeks. Just 27% in the chromic catgut cohort and 42% in the standard polyglactin 910 group said intercourse was pain free.

“The benefits of fast-absorbing polyglactin 910 include less short-term perineal pain and probably a shorter time to resumption of pain-free sexual intercourse,” said Dr. Bujold of Ste. Justine Hospital and the University of Montreal.

Dr. Bujold and coinvestigator Nathalie Leroux, M.D., also of the University of Montreal, undertook the study to see if the fast-absorbing form of polyglactin 910 could offer the benefits of a synthetic suture without the problems associated with delayed absorption of sutures.

He described suture-related discomfort as very common, with 85% of women suffering some form of perineal trauma in spontaneous vaginal birth. Medical literature reports as many as 69% require sutures, according to the investigators. Most patients suffer perineal pain after delivery, and about a fifth have long-term problems.

The study enrolled women with uncomplicated pregnancies early in labor. Those who had an uncomplicated median episiotomy or a second-degree perineal tear were randomized to sutures made with the three materials: 66 to chromic catgut, 60 to standard polyglactin 910, and 66 to fast-absorbing polyglactin 910.

The well-balanced groups contained women 30 years old on average. More than half of the standard polyglactin 910 cohort and two-thirds of the other cohorts were nulliparous. More than 40% in each group required an episiotomy. About one in four had dyspareunia before pregnancy.

Investigators used a standard analgesia protocol: 50 mg of immediate-release indomethacin and 500 mg of naproxen every 12 hours for 24 hours. As-needed doses were standardized at 500 mg of naproxen every 12 hours, 30 mg of codeine plus 325 mg of acetaminophen, and 1 mg of hydromorphone.

Nurses doing postpartum pain assessments were blinded to the sutures used. Neither pain questionnaire nor visual analog scale scores showed significant differences in evaluation of perineal pain 36–48 hours after the women had given birth.

The median number of analgesic doses was seven with chromic catgut, eight with standard polyglactin 910, and six with fast-absorbing polyglactin 910. Narcotic doses averaged one with chromic catgut and two with standard polyglactin 910 but zero with fast-absorbing polyglactin 910.

At 6 weeks, the number of women for whom data were available had fallen to 53 of the women treated with chromic catgut, 43 with standard polyglactin 910, and 58 with fast-absorbing polyglactin 910.

The data on return to sexual intercourse and pain-free sexual intercourse were significant only when chromic catgut and fast-absorbing polyglactin 910 were compared. At 3 months postpartum, fast-absorbing polyglactin 910 still showed a slight advantage but it was not significant.

Stephen H. Cruikshank, M.D., of Wright State University in Dayton, Ohio, praised the investigators for “a simple but most effective study,” which received the association's Central Prize Award. Dr. Cruikshank, the association's new president, said, “It just goes to show us sometimes the most effective study is the simplest.”

SCOTTSDALE, ARIZ. — Perineal repairs involving fast-absorbing polyglactin 910 sutures resulted in less pain and earlier resumption of sexual intercourse for new mothers in a randomized, controlled trial comparing the material with standard polyglactin 910 and chromic catgut.

Patients repaired with fast-absorbing polyglactin 910 sutures consumed fewer doses of analgesia and narcotics within 36–48 hours of giving birth. Two-thirds had resumed sexual intercourse at 6 weeks, and 48% had a pain-free experience, investigator Emmanuel Bujold, M.D., said at the annual meeting of the Central Association of Obstetricians and Gynecologists.

Only 42% of women repaired with chromic catgut sutures and 56% with standard polyglactin 910 resumed intercourse at 6 weeks. Just 27% in the chromic catgut cohort and 42% in the standard polyglactin 910 group said intercourse was pain free.

“The benefits of fast-absorbing polyglactin 910 include less short-term perineal pain and probably a shorter time to resumption of pain-free sexual intercourse,” said Dr. Bujold of Ste. Justine Hospital and the University of Montreal.

Dr. Bujold and coinvestigator Nathalie Leroux, M.D., also of the University of Montreal, undertook the study to see if the fast-absorbing form of polyglactin 910 could offer the benefits of a synthetic suture without the problems associated with delayed absorption of sutures.

He described suture-related discomfort as very common, with 85% of women suffering some form of perineal trauma in spontaneous vaginal birth. Medical literature reports as many as 69% require sutures, according to the investigators. Most patients suffer perineal pain after delivery, and about a fifth have long-term problems.

The study enrolled women with uncomplicated pregnancies early in labor. Those who had an uncomplicated median episiotomy or a second-degree perineal tear were randomized to sutures made with the three materials: 66 to chromic catgut, 60 to standard polyglactin 910, and 66 to fast-absorbing polyglactin 910.

The well-balanced groups contained women 30 years old on average. More than half of the standard polyglactin 910 cohort and two-thirds of the other cohorts were nulliparous. More than 40% in each group required an episiotomy. About one in four had dyspareunia before pregnancy.

Investigators used a standard analgesia protocol: 50 mg of immediate-release indomethacin and 500 mg of naproxen every 12 hours for 24 hours. As-needed doses were standardized at 500 mg of naproxen every 12 hours, 30 mg of codeine plus 325 mg of acetaminophen, and 1 mg of hydromorphone.

Nurses doing postpartum pain assessments were blinded to the sutures used. Neither pain questionnaire nor visual analog scale scores showed significant differences in evaluation of perineal pain 36–48 hours after the women had given birth.

The median number of analgesic doses was seven with chromic catgut, eight with standard polyglactin 910, and six with fast-absorbing polyglactin 910. Narcotic doses averaged one with chromic catgut and two with standard polyglactin 910 but zero with fast-absorbing polyglactin 910.

At 6 weeks, the number of women for whom data were available had fallen to 53 of the women treated with chromic catgut, 43 with standard polyglactin 910, and 58 with fast-absorbing polyglactin 910.

The data on return to sexual intercourse and pain-free sexual intercourse were significant only when chromic catgut and fast-absorbing polyglactin 910 were compared. At 3 months postpartum, fast-absorbing polyglactin 910 still showed a slight advantage but it was not significant.

Stephen H. Cruikshank, M.D., of Wright State University in Dayton, Ohio, praised the investigators for “a simple but most effective study,” which received the association's Central Prize Award. Dr. Cruikshank, the association's new president, said, “It just goes to show us sometimes the most effective study is the simplest.”

CHARLESTON, S.C. — Sexually transmitted diseases and bacterial vaginosis are known to be associated with elevated cervical proinflammatory cytokines in pregnancy, and interim results from an ongoing study suggest that vaginal flora that are opportunistic pathogens also have such an effect.

Candida albicans, Escherichia coli, and group B streptococci all were associated with elevations in specific cytokines in the 244 women enrolled in the study who were available for interim analysis, Marijane A. Krohn, Ph.D., reported at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“C. albicans, E. coli, and group B streptococci are very frequent colonizers in asymptomatic women—however, these microorganisms appear ready to start an inflammatory process, even when by local vaginal criteria they seem to be nonpathogenic at that time or quiescent,” Dr. Krohn said.

Given that these organisms are pathogenic to immunologically naive fetuses and neonates, and that they also can cause infection in women, it makes sense that they would show some pathogenic potential by being associated with elevated proinflammatory cytokines, she noted.

The women were sampled before 16 weeks' gestation, and some of them also were sampled later in pregnancy.

Cervical proinflammatory cytokines were considered elevated if they were at or above the 75th percentile on any sample, said Dr. Krohn of the University of Pittsburgh.

Of 80 patients who had C. albicans, 47% of them had elevated levels of interleukin (IL)-1α, and 51% of them had elevated levels of IL-1β.

The number of patients with IL-1α and IL-1β at these levels was significantly higher in the participants with C. albicans colonization, compared with those participants without C. albicans colonization. IL-6 was also significantly higher in the colonized group.

Similarly, of the 28 patients with E. coli, 54% had IL-1α at or above the 75th percentile, and significantly more of those with E. coli colonization had elevated IL-1α and IL-1βcompared with those without such colonization.

The researchers said only IL-6 was significantly elevated in the participants who had group B streptococci colonization, compared with the participants of the study without group B streptococci.

CHARLESTON, S.C. — Sexually transmitted diseases and bacterial vaginosis are known to be associated with elevated cervical proinflammatory cytokines in pregnancy, and interim results from an ongoing study suggest that vaginal flora that are opportunistic pathogens also have such an effect.

Candida albicans, Escherichia coli, and group B streptococci all were associated with elevations in specific cytokines in the 244 women enrolled in the study who were available for interim analysis, Marijane A. Krohn, Ph.D., reported at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“C. albicans, E. coli, and group B streptococci are very frequent colonizers in asymptomatic women—however, these microorganisms appear ready to start an inflammatory process, even when by local vaginal criteria they seem to be nonpathogenic at that time or quiescent,” Dr. Krohn said.

Given that these organisms are pathogenic to immunologically naive fetuses and neonates, and that they also can cause infection in women, it makes sense that they would show some pathogenic potential by being associated with elevated proinflammatory cytokines, she noted.

The women were sampled before 16 weeks' gestation, and some of them also were sampled later in pregnancy.

Cervical proinflammatory cytokines were considered elevated if they were at or above the 75th percentile on any sample, said Dr. Krohn of the University of Pittsburgh.

Of 80 patients who had C. albicans, 47% of them had elevated levels of interleukin (IL)-1α, and 51% of them had elevated levels of IL-1β.

The number of patients with IL-1α and IL-1β at these levels was significantly higher in the participants with C. albicans colonization, compared with those participants without C. albicans colonization. IL-6 was also significantly higher in the colonized group.

Similarly, of the 28 patients with E. coli, 54% had IL-1α at or above the 75th percentile, and significantly more of those with E. coli colonization had elevated IL-1α and IL-1βcompared with those without such colonization.

The researchers said only IL-6 was significantly elevated in the participants who had group B streptococci colonization, compared with the participants of the study without group B streptococci.

CHARLESTON, S.C. — Sexually transmitted diseases and bacterial vaginosis are known to be associated with elevated cervical proinflammatory cytokines in pregnancy, and interim results from an ongoing study suggest that vaginal flora that are opportunistic pathogens also have such an effect.

Candida albicans, Escherichia coli, and group B streptococci all were associated with elevations in specific cytokines in the 244 women enrolled in the study who were available for interim analysis, Marijane A. Krohn, Ph.D., reported at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“C. albicans, E. coli, and group B streptococci are very frequent colonizers in asymptomatic women—however, these microorganisms appear ready to start an inflammatory process, even when by local vaginal criteria they seem to be nonpathogenic at that time or quiescent,” Dr. Krohn said.

Given that these organisms are pathogenic to immunologically naive fetuses and neonates, and that they also can cause infection in women, it makes sense that they would show some pathogenic potential by being associated with elevated proinflammatory cytokines, she noted.

The women were sampled before 16 weeks' gestation, and some of them also were sampled later in pregnancy.

Cervical proinflammatory cytokines were considered elevated if they were at or above the 75th percentile on any sample, said Dr. Krohn of the University of Pittsburgh.

Of 80 patients who had C. albicans, 47% of them had elevated levels of interleukin (IL)-1α, and 51% of them had elevated levels of IL-1β.

The number of patients with IL-1α and IL-1β at these levels was significantly higher in the participants with C. albicans colonization, compared with those participants without C. albicans colonization. IL-6 was also significantly higher in the colonized group.

Similarly, of the 28 patients with E. coli, 54% had IL-1α at or above the 75th percentile, and significantly more of those with E. coli colonization had elevated IL-1α and IL-1βcompared with those without such colonization.

The researchers said only IL-6 was significantly elevated in the participants who had group B streptococci colonization, compared with the participants of the study without group B streptococci.

ST. LOUIS — There were no maternal or fetal deaths in a study of 13 pregnant women with hypertrophic cardiomyopathy.

Women with this condition can have successful pregnancies with minimal risk to themselves and their babies, and should not be discouraged from becoming pregnant, Neeru Kaushik, M.D., reported in a poster presented at the annual meeting of the Midwest Society for Pediatric Research.

“Our understanding of hypertrophic cardiomyopathy has changed,” Dr. Kaushik said in an interview. “Most women with HCM don't need invasive monitoring during delivery.”

Dr. Kaushik and her colleagues at Magee-Women's Hospital in Pittsburgh reviewed 13 women aged 17–36 years with 16 pregnancies who were seen in the department of maternal-fetal cardiology from 1989 to 2005.

The women had maternal echocardiograms at 20 and 30 weeks' gestation and at 6 weeks post partum and fetal echocardiograms between 18 and 30 weeks' gestation. Maternal echocardiograms showed a median septal wall thickness of 2.3 cm, and the median predicted Doppler gradient in the left ventricular outflow tract was 37 mm Hg.

All the women delivered in a perinatal special care unit. One woman had a cesarean delivery, and the rest had assisted vaginal deliveries with a shortened second stage of labor. The maternal heart rates remained in the range of 70–80 beats per minute, controlled with atenolol or verapamil in most cases.

Central venous pressure used was not necessary, the investigators said.

ST. LOUIS — There were no maternal or fetal deaths in a study of 13 pregnant women with hypertrophic cardiomyopathy.

Women with this condition can have successful pregnancies with minimal risk to themselves and their babies, and should not be discouraged from becoming pregnant, Neeru Kaushik, M.D., reported in a poster presented at the annual meeting of the Midwest Society for Pediatric Research.

“Our understanding of hypertrophic cardiomyopathy has changed,” Dr. Kaushik said in an interview. “Most women with HCM don't need invasive monitoring during delivery.”

Dr. Kaushik and her colleagues at Magee-Women's Hospital in Pittsburgh reviewed 13 women aged 17–36 years with 16 pregnancies who were seen in the department of maternal-fetal cardiology from 1989 to 2005.

The women had maternal echocardiograms at 20 and 30 weeks' gestation and at 6 weeks post partum and fetal echocardiograms between 18 and 30 weeks' gestation. Maternal echocardiograms showed a median septal wall thickness of 2.3 cm, and the median predicted Doppler gradient in the left ventricular outflow tract was 37 mm Hg.

All the women delivered in a perinatal special care unit. One woman had a cesarean delivery, and the rest had assisted vaginal deliveries with a shortened second stage of labor. The maternal heart rates remained in the range of 70–80 beats per minute, controlled with atenolol or verapamil in most cases.

Central venous pressure used was not necessary, the investigators said.

ST. LOUIS — There were no maternal or fetal deaths in a study of 13 pregnant women with hypertrophic cardiomyopathy.

Women with this condition can have successful pregnancies with minimal risk to themselves and their babies, and should not be discouraged from becoming pregnant, Neeru Kaushik, M.D., reported in a poster presented at the annual meeting of the Midwest Society for Pediatric Research.

“Our understanding of hypertrophic cardiomyopathy has changed,” Dr. Kaushik said in an interview. “Most women with HCM don't need invasive monitoring during delivery.”

Dr. Kaushik and her colleagues at Magee-Women's Hospital in Pittsburgh reviewed 13 women aged 17–36 years with 16 pregnancies who were seen in the department of maternal-fetal cardiology from 1989 to 2005.

The women had maternal echocardiograms at 20 and 30 weeks' gestation and at 6 weeks post partum and fetal echocardiograms between 18 and 30 weeks' gestation. Maternal echocardiograms showed a median septal wall thickness of 2.3 cm, and the median predicted Doppler gradient in the left ventricular outflow tract was 37 mm Hg.

All the women delivered in a perinatal special care unit. One woman had a cesarean delivery, and the rest had assisted vaginal deliveries with a shortened second stage of labor. The maternal heart rates remained in the range of 70–80 beats per minute, controlled with atenolol or verapamil in most cases.

Central venous pressure used was not necessary, the investigators said.

KEVIN FOLEY, RESEARCH

KEVIN FOLEY, RESEARCH

KEVIN FOLEY, RESEARCH

SAN FRANCISCO — Low levels of immunity to pertussis in adolescent Hispanic mothers and their newborns may help explain their overrepresentation in pertussis cases and in deaths from the disease, C. Mary Healy, M.D., said in a poster presentation at the annual meeting of the Infectious Diseases Society of America.

A study of pertussis toxin-specific IgG concentrations found low concentrations in umbilical cord blood from 220 consecutive term singletons born to Hispanic women, with the lowest geometric mean concentrations in infants born to adolescent mothers. The low antibody levels likely reflect waning of vaccine-induced or natural immunity, she said.

Dr. Healy of Baylor College of Medicine, Houston, and her associates also compared pertussis toxin-specific IgG concentrations in blood samples from 55 mothers and their infants and found a ratio indicating efficient transfer of antibodies across the placenta. That suggests that one reason infants may be so susceptible to acquiring life-threatening pertussis in the first 4 months of life is because their mothers supply them with few antibodies.

“If you have high levels in the mothers, for example through vaccination, then the likelihood is that the antibodies will transmit very efficiently to infants and, hopefully, protect them at that most vulnerable period in the first few months of life before they begin their primary series of immunizations,” she said in an interview at the meeting.

Currently there are no recommendations to vaccinate pregnant women against pertussis. Discussions are underway about whether to give pregnant women one of two relatively new acellular pertussis vaccines licensed for use in adolescents, Dr. Healy said.

“Hispanic women, especially adolescents, should be immunized with newly licensed acellular pertussis vaccine to prevent pertussis in themselves and life-threatening disease in their infants,” she concluded in her poster.

Pertussis incidence is increasing among infants younger than 4 months of age, too young to have completed the DTaP primary vaccination series at ages 2, 4, and 6 months. The annual incidence of pertussis in the United States increased fivefold since 1980 despite childhood immunization rates above 80%, mainly due to disease in the youngest infants, according to federal statistics.

Pertussis incidence was 74% higher in Hispanic infants than in infants of other ethnicities throughout the 1990s despite comparable childhood immunization rates. Pertussis was reported in 68/100,000 Hispanic infants, compared with 39/100,000 non-Hispanic infants. Among infant deaths from pertussis between 1990 and 2000, 36%–41% who died were Hispanic infants. In addition, Hispanics made up 19% of children in 2003, according to U.S. Census data. The reasons for this ethnic difference in pertussis are unclear and require further study, she said.

Mothers of the 220 infants in the study had a mean age of 26 years (ranging from 14 to 42 years), and they reported a mean of 8 years of education.

Thirty percent did not begin prenatal care until the second trimester and 28% had fewer than nine prenatal care visits, which the investigators considered to be delayed prenatal care and inadequate prenatal care, respectively.

For the 55 matched mother-infant pairs, investigators stratified them by age groups of Hispanic mothers in Texas: 10% aged 10–19 years, 30% aged 20–24 years, 30% aged 25–29 years, and 30% aged 30 years or older.

The investigators quantified pertussis antibody levels using enzyme-linked immunosorbent assay (ELISA). The geometric mean concentration of pertussis toxin-specific IgG was 8.45 ELISA U/mL for all infants and 4.63 ELISA U/mL for infants of adolescent mothers, which was a significant difference, Dr. Healy said.

SAN FRANCISCO — Low levels of immunity to pertussis in adolescent Hispanic mothers and their newborns may help explain their overrepresentation in pertussis cases and in deaths from the disease, C. Mary Healy, M.D., said in a poster presentation at the annual meeting of the Infectious Diseases Society of America.

A study of pertussis toxin-specific IgG concentrations found low concentrations in umbilical cord blood from 220 consecutive term singletons born to Hispanic women, with the lowest geometric mean concentrations in infants born to adolescent mothers. The low antibody levels likely reflect waning of vaccine-induced or natural immunity, she said.

Dr. Healy of Baylor College of Medicine, Houston, and her associates also compared pertussis toxin-specific IgG concentrations in blood samples from 55 mothers and their infants and found a ratio indicating efficient transfer of antibodies across the placenta. That suggests that one reason infants may be so susceptible to acquiring life-threatening pertussis in the first 4 months of life is because their mothers supply them with few antibodies.

“If you have high levels in the mothers, for example through vaccination, then the likelihood is that the antibodies will transmit very efficiently to infants and, hopefully, protect them at that most vulnerable period in the first few months of life before they begin their primary series of immunizations,” she said in an interview at the meeting.

Currently there are no recommendations to vaccinate pregnant women against pertussis. Discussions are underway about whether to give pregnant women one of two relatively new acellular pertussis vaccines licensed for use in adolescents, Dr. Healy said.

“Hispanic women, especially adolescents, should be immunized with newly licensed acellular pertussis vaccine to prevent pertussis in themselves and life-threatening disease in their infants,” she concluded in her poster.

Pertussis incidence is increasing among infants younger than 4 months of age, too young to have completed the DTaP primary vaccination series at ages 2, 4, and 6 months. The annual incidence of pertussis in the United States increased fivefold since 1980 despite childhood immunization rates above 80%, mainly due to disease in the youngest infants, according to federal statistics.

Pertussis incidence was 74% higher in Hispanic infants than in infants of other ethnicities throughout the 1990s despite comparable childhood immunization rates. Pertussis was reported in 68/100,000 Hispanic infants, compared with 39/100,000 non-Hispanic infants. Among infant deaths from pertussis between 1990 and 2000, 36%–41% who died were Hispanic infants. In addition, Hispanics made up 19% of children in 2003, according to U.S. Census data. The reasons for this ethnic difference in pertussis are unclear and require further study, she said.

Mothers of the 220 infants in the study had a mean age of 26 years (ranging from 14 to 42 years), and they reported a mean of 8 years of education.

Thirty percent did not begin prenatal care until the second trimester and 28% had fewer than nine prenatal care visits, which the investigators considered to be delayed prenatal care and inadequate prenatal care, respectively.

For the 55 matched mother-infant pairs, investigators stratified them by age groups of Hispanic mothers in Texas: 10% aged 10–19 years, 30% aged 20–24 years, 30% aged 25–29 years, and 30% aged 30 years or older.

The investigators quantified pertussis antibody levels using enzyme-linked immunosorbent assay (ELISA). The geometric mean concentration of pertussis toxin-specific IgG was 8.45 ELISA U/mL for all infants and 4.63 ELISA U/mL for infants of adolescent mothers, which was a significant difference, Dr. Healy said.

SAN FRANCISCO — Low levels of immunity to pertussis in adolescent Hispanic mothers and their newborns may help explain their overrepresentation in pertussis cases and in deaths from the disease, C. Mary Healy, M.D., said in a poster presentation at the annual meeting of the Infectious Diseases Society of America.

A study of pertussis toxin-specific IgG concentrations found low concentrations in umbilical cord blood from 220 consecutive term singletons born to Hispanic women, with the lowest geometric mean concentrations in infants born to adolescent mothers. The low antibody levels likely reflect waning of vaccine-induced or natural immunity, she said.

Dr. Healy of Baylor College of Medicine, Houston, and her associates also compared pertussis toxin-specific IgG concentrations in blood samples from 55 mothers and their infants and found a ratio indicating efficient transfer of antibodies across the placenta. That suggests that one reason infants may be so susceptible to acquiring life-threatening pertussis in the first 4 months of life is because their mothers supply them with few antibodies.

“If you have high levels in the mothers, for example through vaccination, then the likelihood is that the antibodies will transmit very efficiently to infants and, hopefully, protect them at that most vulnerable period in the first few months of life before they begin their primary series of immunizations,” she said in an interview at the meeting.

Currently there are no recommendations to vaccinate pregnant women against pertussis. Discussions are underway about whether to give pregnant women one of two relatively new acellular pertussis vaccines licensed for use in adolescents, Dr. Healy said.

“Hispanic women, especially adolescents, should be immunized with newly licensed acellular pertussis vaccine to prevent pertussis in themselves and life-threatening disease in their infants,” she concluded in her poster.

Pertussis incidence is increasing among infants younger than 4 months of age, too young to have completed the DTaP primary vaccination series at ages 2, 4, and 6 months. The annual incidence of pertussis in the United States increased fivefold since 1980 despite childhood immunization rates above 80%, mainly due to disease in the youngest infants, according to federal statistics.

Pertussis incidence was 74% higher in Hispanic infants than in infants of other ethnicities throughout the 1990s despite comparable childhood immunization rates. Pertussis was reported in 68/100,000 Hispanic infants, compared with 39/100,000 non-Hispanic infants. Among infant deaths from pertussis between 1990 and 2000, 36%–41% who died were Hispanic infants. In addition, Hispanics made up 19% of children in 2003, according to U.S. Census data. The reasons for this ethnic difference in pertussis are unclear and require further study, she said.

Mothers of the 220 infants in the study had a mean age of 26 years (ranging from 14 to 42 years), and they reported a mean of 8 years of education.

Thirty percent did not begin prenatal care until the second trimester and 28% had fewer than nine prenatal care visits, which the investigators considered to be delayed prenatal care and inadequate prenatal care, respectively.

For the 55 matched mother-infant pairs, investigators stratified them by age groups of Hispanic mothers in Texas: 10% aged 10–19 years, 30% aged 20–24 years, 30% aged 25–29 years, and 30% aged 30 years or older.

The investigators quantified pertussis antibody levels using enzyme-linked immunosorbent assay (ELISA). The geometric mean concentration of pertussis toxin-specific IgG was 8.45 ELISA U/mL for all infants and 4.63 ELISA U/mL for infants of adolescent mothers, which was a significant difference, Dr. Healy said.

STOCKHOLM — Marked maternal endothelial dysfunction remains present a full year after a preeclamptic pregnancy, Maria J. Eriksson, M.D., Ph.D., reported at the annual congress of the European Society of Cardiology.

One year post partum, women with a history of preeclampsia have significantly higher blood pressure and fasting insulin and blood glucose levels than healthy controls who had a normal pregnancy. These physiologic and metabolic abnormalities help explain the association between preeclampsia and increased risk of cardiovascular disease, said Dr. Eriksson of Karolinska University, Stockholm.

She presented a 1-year follow-up on 18 women who had moderate to severe preeclampsia in their first pregnancy and 17 age-matched controls with an uncomplicated pregnancy.

Brachial artery flow-mediated vasodilation as assessed by ultrasound—a standard noninvasive tool for the identification of endothelial dysfunction—was 2.5% in women with a history of preeclampsia, compared with 10.3% in controls. Flow-mediated dilation measured 1 year post pregnancy correlated directly with birth weight and gestational age, and inversely with maximum systolic blood pressure in pregnancy. But it is unclear whether this endothelial dysfunction was induced by the preeclamptic process or reflected a predisposition to it.

Twenty-four hour ambulatory blood pressure monitoring demonstrated that average daytime blood pressures in women 1 year post preeclampsia were 123/81 mm Hg, compared with 116/76 mm Hg in controls. Mean arterial pressure averaged 95 mm Hg in formerly preeclamptic subjects and 90 mm Hg in controls.

Fasting insulin and blood glucose was 4.6 mmol/L and 46 pmol/L, respectively, in women with a history of preeclampsia, compared with 4.4 mmol/L and 30 pmol/L in controls, suggesting insulin resistance as a therapeutic target for prevention of recurrent preeclampsia.

There were no significant differences between the two groups in terms of blood lipids. Nor did they differ in terms of levels of inflammatory markers or hemostatic factors.

STOCKHOLM — Marked maternal endothelial dysfunction remains present a full year after a preeclamptic pregnancy, Maria J. Eriksson, M.D., Ph.D., reported at the annual congress of the European Society of Cardiology.

One year post partum, women with a history of preeclampsia have significantly higher blood pressure and fasting insulin and blood glucose levels than healthy controls who had a normal pregnancy. These physiologic and metabolic abnormalities help explain the association between preeclampsia and increased risk of cardiovascular disease, said Dr. Eriksson of Karolinska University, Stockholm.

She presented a 1-year follow-up on 18 women who had moderate to severe preeclampsia in their first pregnancy and 17 age-matched controls with an uncomplicated pregnancy.

Brachial artery flow-mediated vasodilation as assessed by ultrasound—a standard noninvasive tool for the identification of endothelial dysfunction—was 2.5% in women with a history of preeclampsia, compared with 10.3% in controls. Flow-mediated dilation measured 1 year post pregnancy correlated directly with birth weight and gestational age, and inversely with maximum systolic blood pressure in pregnancy. But it is unclear whether this endothelial dysfunction was induced by the preeclamptic process or reflected a predisposition to it.

Twenty-four hour ambulatory blood pressure monitoring demonstrated that average daytime blood pressures in women 1 year post preeclampsia were 123/81 mm Hg, compared with 116/76 mm Hg in controls. Mean arterial pressure averaged 95 mm Hg in formerly preeclamptic subjects and 90 mm Hg in controls.

Fasting insulin and blood glucose was 4.6 mmol/L and 46 pmol/L, respectively, in women with a history of preeclampsia, compared with 4.4 mmol/L and 30 pmol/L in controls, suggesting insulin resistance as a therapeutic target for prevention of recurrent preeclampsia.

There were no significant differences between the two groups in terms of blood lipids. Nor did they differ in terms of levels of inflammatory markers or hemostatic factors.

STOCKHOLM — Marked maternal endothelial dysfunction remains present a full year after a preeclamptic pregnancy, Maria J. Eriksson, M.D., Ph.D., reported at the annual congress of the European Society of Cardiology.

One year post partum, women with a history of preeclampsia have significantly higher blood pressure and fasting insulin and blood glucose levels than healthy controls who had a normal pregnancy. These physiologic and metabolic abnormalities help explain the association between preeclampsia and increased risk of cardiovascular disease, said Dr. Eriksson of Karolinska University, Stockholm.

She presented a 1-year follow-up on 18 women who had moderate to severe preeclampsia in their first pregnancy and 17 age-matched controls with an uncomplicated pregnancy.

Brachial artery flow-mediated vasodilation as assessed by ultrasound—a standard noninvasive tool for the identification of endothelial dysfunction—was 2.5% in women with a history of preeclampsia, compared with 10.3% in controls. Flow-mediated dilation measured 1 year post pregnancy correlated directly with birth weight and gestational age, and inversely with maximum systolic blood pressure in pregnancy. But it is unclear whether this endothelial dysfunction was induced by the preeclamptic process or reflected a predisposition to it.

Twenty-four hour ambulatory blood pressure monitoring demonstrated that average daytime blood pressures in women 1 year post preeclampsia were 123/81 mm Hg, compared with 116/76 mm Hg in controls. Mean arterial pressure averaged 95 mm Hg in formerly preeclamptic subjects and 90 mm Hg in controls.

Fasting insulin and blood glucose was 4.6 mmol/L and 46 pmol/L, respectively, in women with a history of preeclampsia, compared with 4.4 mmol/L and 30 pmol/L in controls, suggesting insulin resistance as a therapeutic target for prevention of recurrent preeclampsia.

There were no significant differences between the two groups in terms of blood lipids. Nor did they differ in terms of levels of inflammatory markers or hemostatic factors.

KEVIN FOLEY, RESEARCH/SARAH L. GALLANT, DESIGN

KEVIN FOLEY, RESEARCH/SARAH L. GALLANT, DESIGN

KEVIN FOLEY, RESEARCH/SARAH L. GALLANT, DESIGN

CHARLESTON, S.C. — The development of chorioamnionitis in patients with preterm premature rupture of membranes is associated with an increased risk for adverse neonatal outcomes, Natali Aziz, M.D., reported at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

In a retrospective cohort study of 1,153 patients who gave birth between 1980 and 2001 with a diagnosis of preterm premature rupture of membranes (PPROM) made at 24 to 34 weeks' gestation, 29% were diagnosed with chorioamnionitis before delivery. Univariate outcomes on a variety of measures—such as Apgar scores and incidence of respiratory distress syndrome, intracerebral hemorrhage, and pneumonia—were significantly poorer in neonates born to mothers with chorioamnionitis, compared with those born to mothers without chorioamnionitis, said Dr. Aziz of the University of California, San Francisco.

“Management in this setting is better examined prospectively in a randomized, controlled trial, yet given these data, when managing a patient with preterm premature rupture of membranes we must weigh the risks of prematurity against those of expectant management with the ongoing possibility of development of chorioamnionitis,” she said.

Differences were noted in the rates of chorioamnionitis based on gestational age at the time of rupture of membranes (rate of 46% at gestational age of 24–25 weeks vs. 18% at 32 weeks or greater) and duration of latency (higher rates in those with latency greater than 48 hours). Subgroup analyses to adjust for these factors were performed. Many clinical differences remained, but statistical significance was lost due to smaller sample sizes.

In the subgroup analysis based on gestational age at time of rupture of membranes (grouped in 2-week intervals), nonnecrotizing enterocolitis was more common among those with chorioamnionitis in the 24− to 25-week subgroup, intracranial hemorrhage was more common among those with chorioamnionitis in the 30− to 31-week subgroup, and pneumonia was more common among those with chorioamnionitis in the 32-week or greater subgroup.

In a model adjusted for gestational age at the time of ruptured membranes, duration of latency, and use of betamethasone, the chorioamniotic group had significantly higher incidences of intracranial hemorrhage, pneumonia, hyperbilirubinemia, and a neonatal composite variable, including intracranial hemorrhage, pneumonia, and sepsis.

CHARLESTON, S.C. — The development of chorioamnionitis in patients with preterm premature rupture of membranes is associated with an increased risk for adverse neonatal outcomes, Natali Aziz, M.D., reported at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

In a retrospective cohort study of 1,153 patients who gave birth between 1980 and 2001 with a diagnosis of preterm premature rupture of membranes (PPROM) made at 24 to 34 weeks' gestation, 29% were diagnosed with chorioamnionitis before delivery. Univariate outcomes on a variety of measures—such as Apgar scores and incidence of respiratory distress syndrome, intracerebral hemorrhage, and pneumonia—were significantly poorer in neonates born to mothers with chorioamnionitis, compared with those born to mothers without chorioamnionitis, said Dr. Aziz of the University of California, San Francisco.

“Management in this setting is better examined prospectively in a randomized, controlled trial, yet given these data, when managing a patient with preterm premature rupture of membranes we must weigh the risks of prematurity against those of expectant management with the ongoing possibility of development of chorioamnionitis,” she said.

Differences were noted in the rates of chorioamnionitis based on gestational age at the time of rupture of membranes (rate of 46% at gestational age of 24–25 weeks vs. 18% at 32 weeks or greater) and duration of latency (higher rates in those with latency greater than 48 hours). Subgroup analyses to adjust for these factors were performed. Many clinical differences remained, but statistical significance was lost due to smaller sample sizes.

In the subgroup analysis based on gestational age at time of rupture of membranes (grouped in 2-week intervals), nonnecrotizing enterocolitis was more common among those with chorioamnionitis in the 24− to 25-week subgroup, intracranial hemorrhage was more common among those with chorioamnionitis in the 30− to 31-week subgroup, and pneumonia was more common among those with chorioamnionitis in the 32-week or greater subgroup.

In a model adjusted for gestational age at the time of ruptured membranes, duration of latency, and use of betamethasone, the chorioamniotic group had significantly higher incidences of intracranial hemorrhage, pneumonia, hyperbilirubinemia, and a neonatal composite variable, including intracranial hemorrhage, pneumonia, and sepsis.

CHARLESTON, S.C. — The development of chorioamnionitis in patients with preterm premature rupture of membranes is associated with an increased risk for adverse neonatal outcomes, Natali Aziz, M.D., reported at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

In a retrospective cohort study of 1,153 patients who gave birth between 1980 and 2001 with a diagnosis of preterm premature rupture of membranes (PPROM) made at 24 to 34 weeks' gestation, 29% were diagnosed with chorioamnionitis before delivery. Univariate outcomes on a variety of measures—such as Apgar scores and incidence of respiratory distress syndrome, intracerebral hemorrhage, and pneumonia—were significantly poorer in neonates born to mothers with chorioamnionitis, compared with those born to mothers without chorioamnionitis, said Dr. Aziz of the University of California, San Francisco.

“Management in this setting is better examined prospectively in a randomized, controlled trial, yet given these data, when managing a patient with preterm premature rupture of membranes we must weigh the risks of prematurity against those of expectant management with the ongoing possibility of development of chorioamnionitis,” she said.

Differences were noted in the rates of chorioamnionitis based on gestational age at the time of rupture of membranes (rate of 46% at gestational age of 24–25 weeks vs. 18% at 32 weeks or greater) and duration of latency (higher rates in those with latency greater than 48 hours). Subgroup analyses to adjust for these factors were performed. Many clinical differences remained, but statistical significance was lost due to smaller sample sizes.

In the subgroup analysis based on gestational age at time of rupture of membranes (grouped in 2-week intervals), nonnecrotizing enterocolitis was more common among those with chorioamnionitis in the 24− to 25-week subgroup, intracranial hemorrhage was more common among those with chorioamnionitis in the 30− to 31-week subgroup, and pneumonia was more common among those with chorioamnionitis in the 32-week or greater subgroup.

In a model adjusted for gestational age at the time of ruptured membranes, duration of latency, and use of betamethasone, the chorioamniotic group had significantly higher incidences of intracranial hemorrhage, pneumonia, hyperbilirubinemia, and a neonatal composite variable, including intracranial hemorrhage, pneumonia, and sepsis.