615: Impact of intrapartum antihypertensives on electronic fetal heart rate (EFM) patterns in labor

Abstract

fetal heart rate (EFM) patterns in labor Alison Cahill, Anthony Odibo, Kimberly Roehl, George Macones Washington University in St. Louis, Obstetrics and Gynecology, St. Louis, MO OBJECTIVE: The effect of antihypertensive medications on EFM patterns has been poorly studied despite their frequent use. We aimed to estimate the impact of intravenous antihypertensive medications given in labor on EFM patterns in term infants STUDY DESIGN: We performed a retrospective cohort study of all term ( 37 weeks) deliveries from the second stage of labor. Known anomalies and multiple gestations were excluded. The 30 minutes of EFM prior to delivery was extracted by trained obstetric research nurses using the NICHD criteria, blind to clinic and outcome data. Detailed patient data was collected, including medical history, labor and delivery course, medication exposure, and outcomes. For this analysis, EFM patterns of women given intravenous hydralazine or labetalol (antiHTN) were compared to 2 comparison group: women with hypertensive disorders who did not receive any antihypertensives, and women without hypertensive disorders. Relative risks (RR) and attributable risks (AR) were calculated. Logistic regression was used to adjust for confounding factors including labor induction, race, epidural, and magnesium exposure RESULTS: Of 5,388 women, 4,945 had no hypertensive disorders, 408 had hypertension requiring no medications, and 35 received antiHTN. Attributable to their medication exposure, women who received antiHTN were 15% less likely to have accelerations compared to women without HTN (20.0 v. 35.2%, AR 0.15, 95%CI 0.29, 0.02), and 14% less likely compared to women with HTN who did not receive meds (20.0% v. 34.4%, AR 0.14, 95%CI 0.28, 0.02). There was no effect on EFM baseline, variability, or decelerations. CONCLUSION: Decreased frequency of accelerations is seen after exposure to hydralazine or labetalol, but there is no additional effect on other parameters of the fetal heart rate pattern. 616 Maternal plasma concentration of sST2 and angiogenic/ anti-angiogenic factors at the time of diagnosis of preeclampsia: a link between the immune system and angiogenesis Tamara Stampalija, Amol Malshe, Tinnakorn Chaiworapongsa, Piya Chaemsaithong, Steven Korzeniewski, Alyse Schwartz, Zhong Dong, Sonia Hassan, Roberto Romero NICHD/NIH/DHHS, Perinatology Research Branch, Detroit, MI, Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, MI OBJECTIVE: Angiogenic/anti-angiogenic factors have emerged as one of the most promising biomarkers for preeclampsia (PE). Since not all patients with PE can be identified by these biomarkers, the search for additional biomarkers continues. Recently, the soluble form of ST2 (sST2), a protein capable of binding to interleukin-33 and contributing to a Th1 biased immune response, has been reported to be increased in PE. The aims of this study were: 1) to determine if there is a difference in the maternal plasma concentration of sST2 between PE and normal pregnancy at the time of diagnosis of PE; and 2) to examine the relationships between sST2 and angiogenic/anti-angiogenic factors. STUDY DESIGN: This cross-sectional study included women with PE (n 106) and normal pregnant women (n 131). Plasma concentrations of sST2, soluble vascular endothelial growth factor receptor (sVEGFR)-1, soluble endoglin (sEng), and placental growth factor (PlGF) were determined by ELISA. RESULTS: 1) The mean plasma concentration of sST2 was higher in PE than in normal pregnancy (Figure; each p 0.05); 2) the area under receiver-operating characteristic curve (AUC) for sST2 for the identification of PE was 0.83; 3) each angiogenic/anti-angiogenic factor had a significantly larger AUC than sST2 (sVEGFR-1, 0.95, sEng 0.94, PlGF 0.92; compared to AUC of 0.83 for sST2; each p 0.001); and 4) there was a moderate correlation between sST2 and sVEFGR-1 or sEng (Spearman Rho 0.5 and 0.3, respectively; each p 0.005), but not between sST2 and PlGF (p 0.5). CONCLUSION: 1) Preeclampsia is associated with an elevation of plasma sST2 concentration; 2) there is a mild to moderate correlation between sST2 and anti-angiogenic factors; and 3) each angiogenic/antiangiogenic factor outperforms sST2 in the identification of preeclampsia. The diagnostic performance of sST2 combined with angiogenic/anti-angiogenic factors prior to the diagnosis of preeclampsia remains to be determined. Poster Session IV Academic Issues, Antepartum Fetal, Clinical Ob, Fetus, Genetics, Hypertension, Med-Surg-Diseases, Operative Ob, U/S www.AJOG.org