530: Reduced fetal urine production rate (FUPR) in preterm premature rupture of membranes (PPROM) predicts adverse neonatal outcome (ANO)

Abstract

preterm premature rupture of membranes (PPROM) predicts adverse neonatal outcome (ANO) Tehila Avitan, Ron Rabinovitz, Nurit Algor, Michal Kovo, Michael Schimmel, Letizia Schreiber, Arnon Samueloff, Sorina Grisaru-Granovsky Shaare Zedek Medical Center, Obstetrics and Gynecology, Jerusalem, Israel, Shaare Zedek MC, Biochemistry, Jerusalem, Israel, The Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Obstetrics & Gynecology, Holon, Israel, Shaare Zedek Medical Center, Neonatology, Jerusalem, Israel, The Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Pathology, Holon, Israel, Shaare Zedek MC, Affiliated to the Hebrew University Medical School, Obstetrics and Gynecology, Jerusalem, Israel OBJECTIVE: PPROM is associated with fetal inflammatory response syndrome and redistribution of blood away from the kidneys. This study aims to investigate the association between reduced FUPR and ANO in women with PPROM. STUDY DESIGN: Prospective observational study of consecutive cases of PPROM 24-35 wks, singleton, in a tertiary center (2009-11). Excluded: other maternal complications, birth within 24 hrs of PPROM and fetal malformations. Expectant management instituted until spontaneous labor, clinical chorioamnionitis or planned birth at 35 wks. FUPR determined after 24 hrs of PPROM (GA adjusted). ANO defined: severe prematurity (72hrs, reduced neonatal urine production ( 4ml/kg/h), early neonatal sepsis, IVH (I-IV), NEC and neonatal transfusion. Placenta inflammatory histology graded (Redline RW, Ped Res, 2000). Statistics: descriptive, correlations analyzed by MannWhitney, Kruskal-Wallis and Pearson coefficient(two-tailed). RESULTS: During the study period 20,753 births were attended. PPROM diagnosed in 145 patients. Thirty eight were eligible for the present study. Maternal and neonatal characteristics in Table. Spontaneous labor during the expectant period occurred in21 (55%), 2 (5.3%) showed signs of clinical chorioamnionitis and 10 (26%) reached planned birth. Six (16%) women were GBS carriers. FUPR (mean SD) was 20.8 12.9 ml/hour. Neonates that had an intrauterine reduced FUPR were at a significantly increased risk for severe prematurity (p 0.01), NICU 72 hours ( 0.5, p 0.01), NEC and IVH (p 0.008), blood products administration (p 0.004). Reduced FUPR was less associated with reduced neonatal urine production rate (p 0.06) and neonatal sepsis (p 0.06), while no significant association was found with low admission AFI ( 5cm), placental inflammatory grading and maternal GBS carrier state. CONCLUSION: In utero reduced FUPR in women with PPROM is associated with a significant increased risk of severe prematurity and severe neonatal morbidity. Future studies of this measure (FUPR) may provide additional insight into subtle intrauterine processes which impress on the neonatal outcome. 531 Prediction model of histological chorioamnionitis and funisitis in preterm premature rupture of membranes Teresa Cobo, Marian Kacerovsky, Montse Palacio, Helena Hornychova, David M. Hougaard, Kristin Skogstrand, Bo Jacobsson Hospital Clinic, Universitat Barcelona, IDIBAPS, Maternal Fetal Medicine Department, Barcelona, Spain, University Hospital Hradec Kralove, Department of Obstetrics and Gynecology, Hradec Kralove, Czech Republic, University Hospital Hradec Kralove, Fingerlands Department of Pathology, Hradec Kralove, Czech Republic, Statens Serum Institut, Department of Clinical Biochemistry and Immunology, DK-2300 Copenhagen S, Denmark, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden OBJECTIVE: To determine the best prediction model of histological chorioamnionitis (HCA) and funisitis in preterm premature rupture of membranes (PPROM) using selected proteins from a multiple immunoassay. STUDY DESIGN: Prospective cohort study performed at University Hospital Hradec Kralove in pregnant women with PPROM at 23.636.6 weeks gestational age. 27 proteins were assayed in amniotic fluid by a multiple sandwich immunoassay based on flowmetric Luminex x MAP technology, previously described. Induction of labor was performed within 24, 48 or 72 hours if gestational age at rupture of membranes was above 34, from 32-34 and from 28-31 weeks, respectively. The diagnosis of HCA was determined based on the degree of polymorphonuclear leukocyte infiltration, particularly grades 3-4 in chorion-decidua and/or 3-4 in chorionic plate and/or 1-4 in umbilical cord and/or 1-4 amnion Funisitis was diagnosed based on the presence of grades 1-4 in umbilical cord. Best predictive models to diagnose HCA and funisitis were calculated by logistic regression. RESULTS: 107 women with a diagnosis of PPROM were included. Best prediction models of HCA and funisitis depending on gestational age at membrane rupture are shown in the table below. CONCLUSION: Intra-amniotic inflammation is a predictor factor of HCA and funisitis. Some biochemical biomarkers alone or in combination are proposed as the best predictors of these adverse outcomes in PPROM. The results support further research to establish the potential contribution of these inflammatory biomarkers to the clinical management of patients with PPROM. Poster Session III Doppler Assessment, Fetus, Prematurity www.AJOG.org