449: The role of betamethasone and fetal lung maturity testing in late preterm cesarean deliveries
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449 The role of betamethasone and fetal lung maturity testing in late preterm cesarean deliveries Julie Phillips 1 , öDüL Amburgey 1 , Anna Benvenuto 1 , Marjorie Meyer 1 , Eleanor Capeless 1 1 University of Vermont, Obstetrics, Gynecology, and Reproductive Sciences, Burlington, Vermont OBJECTIVE: Respiratory morbidity (RM) remains a leading cause of neonatal intensive care (NICU) admissions in late preterm infants, especially those born by cesarean delivery (CD). Recent evidence sug- gests antenatal betamethasone (BMZ) may reduce RM in this group. Our objective was to evaluate the benefit of BMZ or assessment of fetal lung maturity (FLM) when planning CD in the late preterm infant. STUDY DESIGN: We performed a retrospective chart review of CD be- tween 350 and 366 weeks gestation between Jan 2005 and Mar 2009. Maternal and neonatal records were analyzed for demograph- ics, gestational age, delivery indications, amniocentesis, BMZ and neonatal outcomes. RM included need for oxygen, surfactant, intu- bation, or the diagnosis of TTN, PPHN, or RDS. Fisher’s exact and Wilcoxen rank tests were used for statistical analysis. RESULTS: 53 patients were identified. Indications for CD included pre- via, abnormal antenatal testing, abruption, rupture of membranes and malpresentation. The average GA at delivery was 36.1 weeks. 32.1% had RM. 21 (39.6%) underwent amniocentesis for FLM. 3% of those with a mature FLM had RM. 11 (52.4%) patients had an imma- ture FLM. 8 received BMZ; none of these infants had RM. 3 did not receive BMZ, 1 had RM. 32 patients were delivered without FLM testing. 11 empirically received BMZ with 45.5% RM. 21 did not re- ceive BMZ with 38.1% RM, p0.16. Those with an immature FLM were younger than those with a mature FLM (36.0 vs 36.4 weeks, p0.04). CONCLUSION: Those patients undergoing indicated cesarean delivery at 35 to 37 weeks had a high rate of neonatal RM. This persisted even in those with mature FLM testing. RM was low in those with an im- mature FLM who subsequently received BMZ. BMZ did not decrease rates of RM in patients without FLM testing. Routine use of BMZ in the late preterm infant does not appear to decrease overall RM. Rates of Respiratory Morbidity with use of FLM or BMZ Amnio - mat (10) Amnio - imm (11) p BMZ (11) BMZ (21) p GA wks 36.4 36.0 0.04 35.9 36.3 0.07 .......................................................................................................................................................................................... RM (%) 33.3 9.1 0.25 45.5 38.1 0.78 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.615 450 The effect of magnesium sulfate on activity of matrix metalloproteinase -9 in fetal cord plasma and human umbilical cord vein endothelial cells Brad M. Dolinsky 1 , Danielle L. Ippolito 1 , Deborah Tinnemore 1 , Craig M. Zelig 1 , Jonathan D. Stallings 1 , Peter G. Napolitano 1 1 Madigan Army Medical Center, Tacoma, Washington OBJECTIVE: Clinical epidiomologic evidence suggests that magnesium sulfate used for preterm labor may ameliorate the risks of fetal neu- rologic injury. The biologic plausibility of this is poorly understood. Matrix metalloproteinases are complex zinc dependent enzymes. Ma- trix metalloproteinase -9 (MMP9) levels are elevated in preterm labor patients and in patients with preterm amniorrhexis. There is evidence that MMP9 may break down the blood brain barrier in humans, lead- ing to a cytokine mediated cell injury. Our objective was to determine whether the addition of magnesium sulfate (MgSO4) attenuates ac- tivity of MMP9 in fetal cord plasma. STUDY DESIGN: We collected cord plasma in six normal, term, unla- bored patients. Using ELISA, we measured the activity of MMP9 with varying concentrations of magnesium sulfate added in vitro. We ver- ified our results by using a human umbilical cord vein endothelial cell (HUVEC) line that was induced with a phorbol ester. RESULTS: Levels of endogenously active MMP9 in fetal cord blood were approximately 10% of total MMP9. Addition of physiological doses of MgSO4 (0.07mg/ml) resulted in a 25% decrease in active MMP9 (p0.03) in cord blood specimens (n6). In a HUVEC line, overnight incubation of MgSO4 resulted in a 32% decrease in MMP9 activity (p0.02). CONCLUSION: The addition of MgSO4, at concentrations found in the cord blood of patients undergoing tocolysis, attenuated MMP9 activ- ity in fetal cord plasma.Similarly,MMP9 activity was also decreased using this dose of magnesium sulfate in the HUVEC line model. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.616 451 Prediction of spontaneous preterm birth in asymptomatic triplet pregnancies using fetal fibronectin and cervical length Nathan Fox 1 , Daniel Saltzman 2 , Chad K. Klauser 2 , Danielle Peress 1 , Donna Eckstein 1 , Andrei Rebarber 2 1 Mount Sinai School of Medicine, New York, New York, 2 Carnegie Hill Imaging for Women, New York, New York OBJECTIVE: To evaluate fetal fibronectin (fFN) and cervical length (CL) as predictors of preterm birth in triplet pregnancies. STUDY DESIGN: A historical cohort of 20 asymptomatic triplet preg- nancies with routine fFN and CL outpatient testing between 22-26 weeks gestation were identified from a single MFM practice. Short CL was defined as 25mm. Mann-Whitney-U, Pearson correlation, Fish- er’s exact test, one-way ANOVA and chi square for trend were used when appropriate. RESULTS: Three (15%) patients had a positive fFN. Compared to pa- tients with a negative fFN, patients with a positive fFN delivered at earlier gestational ages (Median GA 25.14 vs. 35.14, p0.013), and had higher rates of SPTB 28 weeks (66.7% vs. 0%, p0.016), 32 weeks (100% vs. 11.8%, p0.009), and 34 weeks (100% vs. 11.8%, p0.009). The CL measurement was significantly associated with ges- tational age at delivery (Pearson correlation 0.517, p0.020). We compared outcomes in three groups: patients with a positive fFN and a CL 25mm, patients with either test positive, and patients with both tests negative (Table). CONCLUSION: In asymptomatic triplet pregnancies, fFN at 22-26 weeks is a significant predictor of spontaneous preterm birth. The combina- tion of fFN and CL at 22-26 weeks outperforms either test alone. Outcomes in triplet pregnancies based on fFN and CL testing at 22-26 weeks fFN negative and CL>25mm Either fFN positive or CL </ 25mm fFN positive and CL </25mm p n 12 6 2 .......................................................................................................................................................................................... Mean GA at delivery 35.10 / 1.72 33.86 / 1.79 24.14 / 1.41 0.001 .......................................................................................................................................................................................... % Delivery <28 weeks 0 0 100 0.001 .......................................................................................................................................................................................... % Delivery <32 weeks 8.3 33.3 100 0.009 .......................................................................................................................................................................................... % Delivery <34 weeks 8.3 33.3 100 0.009 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.617 www.AJOG.org Fetus, Prematurity Poster Session III Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology S171
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Transcript of 449: The role of betamethasone and fetal lung maturity testing in late preterm cesarean deliveries
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www.AJOG.org Fetus, Prematurity Poster Session III
449 The role of betamethasone and fetal lung maturityesting in late preterm cesarean deliveriesulie Phillips1, öDüL Amburgey1, Anna Benvenuto1,
arjorie Meyer1, Eleanor Capeless1
University of Vermont, Obstetrics, Gynecology,nd Reproductive Sciences, Burlington, VermontBJECTIVE: Respiratory morbidity (RM) remains a leading cause ofeonatal intensive care (NICU) admissions in late preterm infants,specially those born by cesarean delivery (CD). Recent evidence sug-ests antenatal betamethasone (BMZ) may reduce RM in this group.ur objective was to evaluate the benefit of BMZ or assessment of fetal
ung maturity (FLM) when planning CD in the late preterm infant.TUDY DESIGN: We performed a retrospective chart review of CD be-ween 35�0 and 36�6 weeks gestation between Jan 2005 and Mar009. Maternal and neonatal records were analyzed for demograph-cs, gestational age, delivery indications, amniocentesis, BMZ andeonatal outcomes. RM included need for oxygen, surfactant, intu-ation, or the diagnosis of TTN, PPHN, or RDS. Fisher’s exact andilcoxen rank tests were used for statistical analysis.
ESULTS: 53 patients were identified. Indications for CD included pre-ia, abnormal antenatal testing, abruption, rupture of membranesnd malpresentation. The average GA at delivery was 36.1 weeks.2.1% had RM. 21 (39.6%) underwent amniocentesis for FLM. 3% ofhose with a mature FLM had RM. 11 (52.4%) patients had an imma-ure FLM. 8 received BMZ; none of these infants had RM. 3 did noteceive BMZ, 1 had RM. 32 patients were delivered without FLMesting. 11 empirically received BMZ with 45.5% RM. 21 did not re-eive BMZ with 38.1% RM, p�0.16. Those with an immature FLMere younger than those with a mature FLM (36.0 vs 36.4 weeks,�0.04).ONCLUSION: Those patients undergoing indicated cesarean deliveryt 35 to 37 weeks had a high rate of neonatal RM. This persisted evenn those with mature FLM testing. RM was low in those with an im-
ature FLM who subsequently received BMZ. BMZ did not decreaseates of RM in patients without FLM testing. Routine use of BMZ inhe late preterm infant does not appear to decrease overall RM.
ates of Respiratory Morbidity with use of FLM or BMZ
Amnio- mat(10)
Amnio- imm(11) p
�BMZ(11)
�BMZ(21) p
A wks 36.4 36.0 0.04 35.9 36.3 0.07.........................................................................................................................................................................................
M (%) 33.3 9.1 0.25 45.5 38.1 0.78.........................................................................................................................................................................................
002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.615
450 The effect of magnesium sulfate on activity of matrixetalloproteinase -9 in fetal cord plasma and human
mbilical cord vein endothelial cellsrad M. Dolinsky1, Danielle L. Ippolito1, Deborah Tinnemore1,raig M. Zelig1, Jonathan D. Stallings1, Peter G. Napolitano1
Madigan Army Medical Center, Tacoma, WashingtonBJECTIVE: Clinical epidiomologic evidence suggests that magnesiumulfate used for preterm labor may ameliorate the risks of fetal neu-ologic injury. The biologic plausibility of this is poorly understood.
atrix metalloproteinases are complex zinc dependent enzymes. Ma-rix metalloproteinase -9 (MMP9) levels are elevated in preterm laboratients and in patients with preterm amniorrhexis. There is evidencehat MMP9 may break down the blood brain barrier in humans, lead-ng to a cytokine mediated cell injury. Our objective was to determinehether the addition of magnesium sulfate (MgSO4) attenuates ac-
ivity of MMP9 in fetal cord plasma.TUDY DESIGN: We collected cord plasma in six normal, term, unla-ored patients. Using ELISA, we measured the activity of MMP9 with
arying concentrations of magnesium sulfate added in vitro. We ver-Supplemen
fied our results by using a human umbilical cord vein endothelial cellHUVEC) line that was induced with a phorbol ester.ESULTS: Levels of endogenously active MMP9 in fetal cord bloodere approximately 10% of total MMP9. Addition of physiologicaloses of MgSO4 (0.07mg/ml) resulted in a 25% decrease in activeMP9 (p�0.03) in cord blood specimens (n�6). In a HUVEC line,
vernight incubation of MgSO4 resulted in a 32% decrease in MMP9ctivity (p�0.02).ONCLUSION: The addition of MgSO4, at concentrations found in theord blood of patients undergoing tocolysis, attenuated MMP9 activ-ty in fetal cord plasma.Similarly,MMP9 activity was also decreasedsing this dose of magnesium sulfate in the HUVEC line model.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.616
451 Prediction of spontaneous preterm birthn asymptomatic triplet pregnancies usingetal fibronectin and cervical lengthathan Fox1, Daniel Saltzman2, Chad K. Klauser2, Danielleeress1, Donna Eckstein1, Andrei Rebarber2
Mount Sinai School of Medicine, New York, New York, 2Carnegieill Imaging for Women, New York, New YorkBJECTIVE: To evaluate fetal fibronectin (fFN) and cervical lengthCL) as predictors of preterm birth in triplet pregnancies.TUDY DESIGN: A historical cohort of 20 asymptomatic triplet preg-ancies with routine fFN and CL outpatient testing between 22-26eeks gestation were identified from a single MFM practice. Short CLas defined as 25mm. Mann-Whitney-U, Pearson correlation, Fish-
r’s exact test, one-way ANOVA and chi square for trend were usedhen appropriate.ESULTS: Three (15%) patients had a positive fFN. Compared to pa-ients with a negative fFN, patients with a positive fFN delivered atarlier gestational ages (Median GA 25.14 vs. 35.14, p�0.013), andad higher rates of SPTB �28 weeks (66.7% vs. 0%, p�0.016), �32eeks (100% vs. 11.8%, p�0.009), and �34 weeks (100% vs. 11.8%,�0.009). The CL measurement was significantly associated with ges-ational age at delivery (Pearson correlation � 0.517, p�0.020). Weompared outcomes in three groups: patients with a positive fFN andCL 25mm, patients with either test positive, and patients with both
ests negative (Table).ONCLUSION: In asymptomatic triplet pregnancies, fFN at 22-26 weeks
s a significant predictor of spontaneous preterm birth. The combina-ion of fFN and CL at 22-26 weeks outperforms either test alone.
utcomes in triplet pregnancies based on fFN and CL testing at 22-26 weeks
fFN negative andCL>25mm
Either fFN positiveor CL </� 25mm
fFN positive andCL </�25mm p
12 6 2.........................................................................................................................................................................................
ean GA atelivery
35.10 �/� 1.72 33.86 �/� 1.79 24.14 �/� 1.41 �0.001
.........................................................................................................................................................................................
Delivery28 weeks
0 0 100 0.001
.........................................................................................................................................................................................
Delivery32 weeks
8.3 33.3 100 0.009
.........................................................................................................................................................................................
Delivery34 weeks
8.3 33.3 100 0.009
.........................................................................................................................................................................................
002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.617
t to DECEMBER 2009 American Journal of Obstetrics & Gynecology S171
