746: Does the neonatal impact of chorioamnionitis in the setting of PPROM vary depending on degree of prematurity?

Abstract

setting of PPROM vary depending on degree of prematurity? Shireen de Sam Lazaro, Yvonne Cheng, Jonathan Snowden, Leonardo Pereira, Natali Aziz, Aaron Caughey Oregon Health and Science University, Obstetrics and Gynecology, Portland, OR, University of California-San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, Stanford, Obstetrics and Gynecology, Palo Alto, CA OBJECTIVE: To examine if neonatal outcomes vary based on the diagnosis of chorioamnionitis in the setting of pregnancies complicated by preterm premature rupture of membranes, (PPROM) and whether this difference varies by gestational age. STUDY DESIGN: A retrospective cohort study was conducted of all pregnancies complicated by PPROM who delivered between 24 to 36 weeks and 6 days gestation in 2006 in California (n 5229). Pregnancies were grouped by gestational age, and patients who delivered with a diagnosis of chorioamnionitis were compared to patients without this diagnosis. Neonatal outcomes were assessed including necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and sepsis. Dichotomous outcomes were compared using Fisher’s exact test, with P 0.05 indicating statistical significance. RESULTS: 5,229 women were diagnosed with PPROM between 24 weeks to 36 weeks 6 days, and 306 (5.9 %) women were diagnosed with chorioamnionitis prior to delivery during the study period. Neonates born to mothers diagnosed with chorioamnionitis were noted to have significantly higher rates of sepsis across each gestational age (Table). Additionally, amongst the most premature infants, an association between chorioamnionitis and IVH was noted, though this did not reach statistical significance. Chorioamnionitis was not noted to affect the rate of necrotizing enterocolitis across the gestational ages. CONCLUSION: Patients who develop chorioamnionitis in the setting of PPROM are at an increased risk of neonatal sepsis. Additionally, the most premature infants delivered in the setting of chorioamnionitis may be an increased risk of intraventricular hemorrhage. No increased risk for necrotizing enterocolitis was noted amongst neonates delivered with chorioamnionitis compared to those without that diagnosis across all gestational ages. 747 Clinical significance of elevated high-sensitivity C-reactive protein in amniotic fluid obtained at emergency caesarean section Zbigniew Marchocki, Maurice O’Donoghue, Kevin Collins, Keelin O’Donoghue Cork University Maternity Hospital, University College Cork, Obstetrics & Gynaecology, Cork, Ireland, Cork University Maternity Hospital, University College Cork, Microbiology, Cork, Ireland OBJECTIVE: Delivery by caesarean section (CS) is the single most important factor associated with post-partum infection. Risk factors include obesity, prolonged operating time, poor surgical technique and emergency delivery. While the majority of infections are not life threatening they have implications on length of hospital stay, costs and re-admission rates. We examined high-sensitivity C-reactive protein (HS-CRP) levels in amniotic fluid (AF) and maternal serum at the time of CS and correlated results with risk factors for infection and postpartum infectious complications. STUDY DESIGN: This was a prospective observational study of women undergoing elective and emergency CS. AF for HS-CRP analysis was obtained at CS by direct needle aspiration from the intact amnion. Maternal serum HS-CRP was measured before and 3 days after CS. Results were correlated with maternal and neonatal outcomes. RESULTS: Seventy-four women had AF samples collected at CS; of these 53% (39/74) underwent emergency CS. There was a significant difference in HS-CRP in AF at emergency CS, with levels on average 10 fold higher (p 0.009). No difference in AF HS-CRP levels was noted in women with BMI 25 or between smokers. In the emergency CS group, AF HS-CRP levels were not affected by length of labour, fetal blood sampling or pyrexia in labour. However there was a significant difference in AF HS-CRP levels in women who had multiple ( 7) vaginal examinations in labour (p 0.003). Overall, 11% of women developed post-partum infectious complications, but there was no difference in AF HS-CRP levels. Six neonates were admitted to NICU with suspected infection; AF or serum HS-CRP levels were not significantly different. CONCLUSION: AF HS-CRP levels were significantly higher after emergency CS. Changes in AF HS-CRP levels were not associated with early post-partum infectious morbidity among mothers and babies, but our findings are limited by small sample size and further study may determine clinical significance.