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Poster Session IV Epidemiology, Global Maternal-Fetal Public Health, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics www.AJOG.org

be free of bacteria, including Mycoplasma and Ureaplasma. Cells weregrown to 90% confluence, infected with U. parvum, and assayed forquantitative adherence.RESULTS: Using the ureB qPCR assay, U. parvum strain 700970, a gen-tal isolate, had a mean adherence of 16.9% (� 3.7%) in culturedrimary chorion cells, similar to previously described adherence toultured amnion primary cells (15% � 0.6%). In contrast, culturedecidua primary cells demonstrated an adherence of only 4.7% (�.3%).

CONCLUSIONS: Ureaplasma parvum preferentially adheres to chorionnd amnion cells of fetal membranes. This suggests a method ofathogenesis in which the fetally derived cells are selectively targeted.uture work will elucidate the mechanism of adherence and inflam-atory consequences of these interactions.

629 Influenza-like illness during pandemic009 H1N1 in an obstetrics population

Catherine Eppes1, Abby Hornbogen1,atricia M. Garcia2, William A. Grobman2

1Northwestern Memorial Hospital, Chicago, IL, 2NorthwesternUniversity, Feinberg School of Medicine, Chicago, ILOBJECTIVE: At our institution, we developed a triage system for influ-nza-like illness (ILI) during the 2009 pandemic H1N1 influenza. Theurpose of this strategy was to maximize efficient resource utilizationnd optimize patient care. The purpose of this study is to assess theutcome related to the introduction of an ILI triage system.

STUDY DESIGN: Our triage system involved initial telephone screeningby a provider, followed by triage to either outpatient care or evalua-tion in our centralized evaluation unit. Triage decisions were based onseverity of symptoms as well as medical co-morbidities. Those whoreceived outpatient care were empirically treated if they had symp-toms consistent with ILI and re-contacted in 24 hours. Those seen inthe evaluation unit were tested for influenza and evaluated for theneed for inpatient admission. We prospectively collected informationon all patient triaged through this system from October 2009 to Jan-uary 2010.RESULTS: 303 patients were evaluated, of whom 151 were treated as

utpatients and 152 in the evaluation center. 16% of these womenere in the first trimester, 35% in the second, and 49% in the third. Of

hose treated as outpatients, 6% were eventually seen in the evaluationnit due to worsening symptoms; 4 of these women were admitted,lthough only one was for PCR-proven H1N1. All 4 women wereischarged within four days. Of the 152 patients initially seen in thevaluation unit, 63% were sent home and 36% were admitted. Forty-ight (32%) of those seen in evaluation tested positive for 2009 H1N1,for RSV, 8 for rhinovirus, 1 for adenovirus,1 for group A strep, 5 hadacterial pneumonia and 3 had pyelonephritis. Of those seen in thevaluation unit with PCR-proven H1N1 influenza, 24% were in therst trimester, 30% the second and 44% the third; 41% were admitted,nd the median hospital stay was 2 days. We had no maternal deathselated to 2009 H1N1.

CONCLUSIONS: This system that relied upon phone triage to determineutpatient empiric treatment versus in-person evaluation allowed anfficient use of resources without incurring apparent ILI morbidity.

630 Optimized amniotic fluid analysis in patientsuspected of intrauterine infection/inflammation

Catherine Ford1, Mehmet Genc1

1Brigham and Women’s Hospital, Boston, MAOBJECTIVE: To determine the performance characteristics of amniotic

uid (AF) analysis for diagnosis of intrauterine infection/inflamma-ion (IUI) in patients suspected of chorioamnionitis.

STUDY DESIGN: We studied 34 pregnant women who underwent am-niocentesis and AF analysis because of suspicion of IUI after 16 weeks’gestation between 1/1/2000 and 10/31/2009. The clinical suspicionwas raised by uterine tenderness, maternal fever, maternal tachycardia

and/or fetal tachycardia. IUI was confirmed by histopathological ev-

S250 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

idence of chorioamnionitis and/or positive bacterial cultures/Gramstain of AF. The regression relationship between IUI and AF tests wasexamined using a stepwise logistic regression. Sensitivity, specificity,positive and negative predictive values (PPV and NPV) were calcu-lated for individual and combined tests.RESULTS: Logistic regression revealed a significant relationship be-ween IUI and AF culture, gram stain, and glucose levels, but not whitelood count and lactate dehydrogenase. The most parsimoniousodel was obtained by culture and glucose (R2 adjusted � 0.50; p�

.001), followed by glucose alone (R2 adjusted � 0.49; p�0.001).Gram stain did not result in identification of cases that were not de-tected by culture or glucose testing. The combination of AF cultureand glucose had the best diagnostic performance profile (Table).CONCLUSIONS: The combination of AF culture and glucose offers the

est overall performance to predict IUI in patients with a clinicaluspicion of chorioamnionitis. AF glucose alone is also a reliable rapidest.

% (n/N)

F Test Sens Spec PPV NPV

ulture 40 (6/15) 100 (19/19) 100 (6/6) 68 (19/28)..........................................................................................................................................................................................

Gram stain 20 (3/15) 100 (19/19) 100 (3/3) 61 (19/31)..........................................................................................................................................................................................

Glucose (�15 mg/dL) 64 (9/14) 100 (19/19) 100 (9/9) 79 (19/24)..........................................................................................................................................................................................

Culture and/or Gramstain

40 (6/15) 100 (19/19) 100 (6/6) 68 (19/28)

..........................................................................................................................................................................................

Culture and/or glucose 71 (10/14) 100 (19/19) 100 (10/10) 83 (19/23)..........................................................................................................................................................................................

631 Recurrence of chorioamnionitis in subsequentregnancies: race/ethnicity disparities

Darios Getahun1, Michael J. Fassett2, Deborah. Wing3, Steven J. Jacobsen1

1Kaiser Permanente Southern California, Pasadena, CA, 2Kaiserermanente West Los Angeles Medical Center, Los Angeles,A, 3UC Irvine Medical Center, Orange, CA

OBJECTIVE: To assess the risk of recurrence of chorioamnionitis inuccessive pregnancies and to examine whether the risk is modified byace/ethnicity.

STUDY DESIGN: We conducted a retrospective cohort study of 1st twon�72,026) consecutive singleton pregnancies using the 1991-2009aiser Permanente Southern California longitudinally-linked birth

ertificate, inpatient, and outpatient encounter files. ICD-9 codes762.7 and 658.4x” identified chorioamnionitis (CA; infection andnflammation at the maternal-fetal interface).Adjusted relative risksRR) and their 95% confidence intervals quantified the risks.

RESULTS: The overall incidence of chorioamnionitis was 5.5%. Theace/ethnicity-specific risks of CA in the 2nd pregnancy and racialisparities in risk of recurrence are presented in the table. A stratifiednalysis by gestational age revealed that a history of CA is significantlyssociated with increased risk of recurrence in subsequent pregnan-ies at a preterm gestation across all racial/ethnic groups.

CONCLUSIONS: These results suggest that prior CA predicts an in-reased risk for a subsequent CA and risks are higher among non-hite racial/ethnic groups.

Maternalrace/ethnicity

1st BirthCA (%)

2nd BirthRecurrence riskas compared towhite women

2nd BirthCA (%)

Adjusted RR(95% CI)

hite 0.8 3.1 3.6 (2.5, 5.4) 1.0 (reference)..........................................................................................................................................................................................

African-Americans 1.4 4.6 3.2 (1.8, 5.6) 1.7 (1.3, 3.1)..........................................................................................................................................................................................

Hispanics 1.4 4.7 3.5 (2.8, 4.4) 1.6 (1.4, 1.9)..........................................................................................................................................................................................

Asian/Pacific Islanders 1.7 4.7 2.8 (1.9, 4.1) 1.9 (1.5, 2.3)..........................................................................................................................................................................................

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