Maternal Leukocytosis Research Articles

Predictive factors for perinatal bacterial transmission from colonized mothers to delivered very-low-birth-weight infants: a retrospective cohort study

This study investigated the predictive factors for perinatal bacterial transmission in very-low-birth-weight infants (VLBWIs) born to mothers with a history of intrapartum colonization. We retrospectively reviewed the medical records of 173 VLBWIs, wherein pathogens were confirmed in maternal cultures obtained from the blood, urine, and vagina during the intrapartum period from 2013 to 2020. Newborns were categorized based on microbiological tests, including gastric aspirates, endotracheal aspirates, blood, and skin/nasal swab cultures collected immediately after birth. Infants whose cultures matched their maternal pathogens were categorized into the “transmission group” (n = 45), while those who tested negative were assigned to the “control group” (n = 128). The predominant maternal-colonizing pathogen observed was Escherichia coli (30.6%), which also emerged as the primary colonizing pathogen in neonates (35.6%). Transmission group had higher incidences of maternal leukocytosis, chorioamnionitis, and cervical cerclage. Regarding neonatal characteristics, the transmission group demonstrated lower initial base excesses (− 6.3 ± 3.9 vs. − 9.2 ± 4.9, P < 0.05) and higher C-reactive protein levels (0.1 ± 0.3 vs. 0.4 ± 0.8, P < 0.05). Notably, regarding major neonatal outcomes, transmission group had higher mortality rates and incidences of severe intraventricular hemorrhage. These findings may be useful for making decisions when considering antibiotic treatment for infants with a history of maternal colonization.

Antibiotic treatment of women with isolated intrapartum fever vs clinical chorioamnionitis: maternal and neonatal outcomes

Clinical chorioamnionitis refers to the presence of maternal fever (≥38°C) and at least 2 clinical signs: (1) maternal tachycardia (>100 bpm), (2) fetal tachycardia (>160 bpm), (3) maternal leukocytosis >15,000/mm2, (4) purulent vaginal discharge, and (5) uterine tenderness. Few data exist to guide the appropriate management of women with isolated intrapartum fever in the absence of other clinical signs suggesting chorioamnionitis. This study compared maternal and neonatal infectious outcomes and microbiological outcomes between women with isolated intrapartum fever and women with clinical chorioamnionitis. This 10-year retrospective study included all the laboring women at our institution, at ≥34 weeks of gestation, with a singleton pregnancy and body temperature of ≥38.0°C, with or without other evidences of infection. According to our department protocol, women with isolated intrapartum fever received intravenous ampicillin, whereas women with clinical chorioamnionitis received intravenous ampicillin plus gentamicin. The primary outcome was puerperal endometritis, compared between women with isolated intrapartum fever (treated with ampicillin) and women with clinical chorioamnionitis (treated with ampicillin plus gentamicin). The secondary maternal outcomes consisted of (1) maternal clinical outcomes, such as cesarean delivery, surgical site infection, postpartum hemorrhage, and postpartum length of stay, and (2) microbiological studies, including positive chorioamniotic membrane swabs and blood culture. Among the secondary neonatal outcomes were early-onset sepsis, neonatal intensive care unit admission, and length of stay. Of note, 2 multivariate logistic regression models were created. A model aimed to predict puerperal endometritis controlled for gestational age of >41 weeks, diabetes mellitus, obesity, positive group B streptococcus status, rupture of membrane ≥18 hours, meconium staining, positive chorioamniotic membrane swabs, cesarean delivery, and empiric postdelivery antibiotic administration. A model aimed to predict neonatal early-onset sepsis controlled for gestational age of 34 to 37 weeks, positive group B streptococcus status, rupture of membrane ≥18 hours, and positive chorioamniotic membrane swabs. Overall, 458 women met the inclusion criteria. Compared with women with clinical chorioamnionitis (n=231), women with isolated intrapartum fever (n=227) had higher rates of puerperal endometritis (3.9% vs 8.8%; P=.03), early-onset sepsis (0.4% vs 4.4%; P=.005), positive chorioamniotic membrane swabs (46.3% vs 63.9%; P<.001), and ampicillin-resistant Escherichia coli (35.5% vs 48.9%; P=.033). The rate of group B streptococcus-positive chorioamniotic membrane swabs was similar between the groups. In a subanalysis of women with negative or unknown group B streptococcus status, the puerperal endometritis and neonatal early-onset sepsis rates were higher among women with isolated intrapartum fever than women with suspected chorioamnionitis (8.7% vs 3.3% [P=.041] and 4.1% vs 0% [P<.001], respectively). In 2 multivariate analysis models, among women with isolated intrapartum fever treated with ampicillin compared with those with clinical chorioamnionitis treated with ampicillin and gentamicin, the odds ratio of antibiotic treatment of endometritis was 2.65 (95% confidence interval, 1.06-6.62; P=.036), and the odds ratio of neonatal early-onset sepsis was 8.33 (95% confidence interval, 1.04-60.60; P=.045). Women with intrapartum fever, with or without other signs of infection, were at increased risk of maternal and neonatal complications. The use of ampicillin as a sole agent in isolated intrapartum fever might promote ampicillin-resistant E coli growth in the chorioamniotic membranes and consequently lead to puerperal endometritis and early-onset sepsis. In this context, a broad-range antibiotic should be considered.

Scoring model to predict early-onset bacterial sepsis at Dr. Mohammad Hoesin Hospital, Palembang

Background Early-onset bacterial neonatal sepsis (bacterial EONS) is one of the most common causes of death and illness in newborns. Assessment of risk factors is important to identify infants who are more susceptible to bacterial EONS. A scoring model based on maternal and infant risk factors would be useful for predicting bacterial EONS.&#x0D; Objective To develop a scoring model to predict bacterial EONS by examining maternal and neonatal risk factors.&#x0D; Methods This diagnostic test study was conducted at Mohammad Hoesin Hospital, Palembang between January-September 2021 using various maternal and infant risk factors. Subjects were newborns suspected of having early-onset bacterial sepsis with birth weight &gt;1000 grams. The potential risk factors evaluated consisted of premature rupture of membranes &gt;18 hours, greenish-thick-and-foul-smelling amniotic fluid, maternal body temperature &gt;38°C, maternal leukocytosis &gt;15.000/?L, gestational of &lt;37 weeks, birth weight of &lt;2500 grams, and APGAR score of &lt;7 at 1 minute. One hundred sixty-two subjects were selected consecutively. Analyses included odds ratio, logistic regression test, and ROC curve to assess sensitivity and specificity of each risk factor.&#x0D; Results Premature rupture of membranes &gt;18 hours, greenish-thick-and-foul-smelling amniotic fluid, male sex, and gestation of &lt;37 weeks were risk factors for bacterial EONS. In the multivariate analysis, premature rupture of membranes &gt;18 hours had an OR of 5.94 (95%CI 1.69 to 20.86, P=0.005), greenish-thick-and-foul-smelling amniotic fluid had an OR of 3.74(95%CI 1.16 to 12.02, P=0,027), male sex had an OR of 4.28 (95%CI 1.14 to 16.02, P=0.031), and gestation of &lt;37 weeks had an OR of 3.1 (95%CI 0.82 to 11.72, P=0.094). In the scoring model, each of these four risk factors were assigned a score of 2 (for maternal risk factors) and 1 (for neonatal risk factors). Using a cut-off score of 2.5 to predict bacterial EONS, the scoring system had a sensitivity of 80% and specificity of 47%.&#x0D; Conclusion Our scoring model of maternal and infant risk factors can be used to screen for possible bacterial EONS at an earlier stage of illness, although with limited specificity.

Risk Factors Associated with Early Onset Group B Streptococcal Disease and Newborn Outcomes in a Tertiary Care Center in Pakistan

Background: To assess the risk factors associated with early onset group B streptococcal disease and newborn outcomes in a tertiary care center in Pakistan. Methods: A prospective cohort study design was implemented in the postnatal wards and neonatal intensive care unit of Aga Khan Hospital between 15 December 2021 – 15 June 2022. The exposed group included all pregnancies with risk of GBS infection, the un-exposed group included all pregnancies with no risk factors for GBS. All births were followed for outcomes during admission and after discharge for 28 days of life. Information about the mother and baby dyad was retrieved from the medical records. A second proforma was filled out at the time of discharge (2 to 5 days of life for healthy babies and at 10 to 15 days of life for babies admitted for NICU). These were the average length of stay of healthy and ill newborns at our facility.) The final follow up was at 28 days of life which was at the clinic or telephonic. Data on morbidities such as sepsis, use of antibiotics and hospitalization breast feeding practices was captured at the day 28 follow up. Results: A total of 78 patients were included, with a mean maternal age of 30.82 ± 4.65 years and gestational age of 37.26 ± 2.1 weeks. GBS colonization was positive in high vaginal swab in 23 (29.5%) patients, in urine culture in 16 (20.2%) patients, and 1 (1.3%) patient who delivered a previous baby with GBS infection. Two patients suffered from pneumonia among them one patient also had sepsis and 77 patients were stable at 28 days. In 16 (41%) cases of GBS colonization, high vaginal swab yielded a negative result. Similarly, in 23 (59%) patients with GBS colonization, urine culture was also negative. Only one patient with GBS colonization had a history of a previous infant with GBS infection. Approximately 70% of GBS positive had PROM. Maternal Leukocytosis and tachycardia were significantly higher in patients with GBS (p&lt;0.0001). Uterine tenderness was found in 14 (35.9%) mothers with GBS colonization (p&lt;0.0001). Intrapartum fever was significantly more common in mothers with GBS colonization (p=0.011). Tachycardia was significantly higher in neonates of mothers with GBS colonization (p=0.01). Need of oxygen was significantly higher in neonates with mothers having GBS colonization (p=0.002). Conclusion: In hindsight, GBS colonization and the early onset of Group B streptococcus infection is a public health issue in Pakistan that requires attention. Recommended antenatal screening measures should be implemented, as well as the necessary steps, such as an antibiotics treatment regimen following a positive GBS colonization report, to protect newborns from this disease. Keywords: colonization, maternal risk factors, group B streptococcal, early onset group B streptococcal disease, GBS, PROM

Comparison between Foley Catheter plus Oxytocin and Oxytocin Only For Induction of Labour after Membrane Rupture

Premature Rupture of Membranes (PROM) at term is defined as rupture of membrane at least 1 hour before the onset of uterine contractions at a gestational age of 37 weeks or more, it complicates 8% of all pregnancies [1]. It is associated with a risk of chorioamnionitis, which increases with duration of PROM, latency beyond 24 hours increases the incidence of chorioamnionitis and neonatal sepsis [2,3]. Spontaneous labour occurs in 60%–67% of these patients within 24 hours [2,4]. If no labour occurs, labour induction must be the best management for women with PROM at term. Labour induction is usually performed when the risks of continuing a pregnancy are more than the benefits of delivery as in PROM. Cervical ripening is an important factor for a successful induction. Unripe cervix with a lower Bishop score is associated with an increased risk of induction failure, while a favorable cervix significantly predicts a timely delivery [5]. Different methods are used for labour induction but none of the available methods of induction of labour is free of associated medical risks; therefore, labour should only be induced when there is a risk of the continuation of pregnancy. The agents used for induction should simulate spontaneous labour without causing excessive uterine activity. The most common methods of labour induction involve Pharmacological methods which include many agents, such as Prostaglandins (PGs (E2 orE1), progesterone receptor antagonists (mifepristone), oxytocin, and Nitric Oxide (NO) donors, but the most commonly used are PG and oxytocin) [6], and mechanical methods as Intracervical Foley catheter which is the most common mechanical method that was first described by Embrey and Mollison in 1967, where a Foley is inserted into the cervical canal and inflated just past the internal os with mild traction outward dilating the cervix directly, as well as indirectly stimulating (PGs) and oxytocin secretion [7-11]. The American College of Obstetricians and Gynecologists (2009) recommended using oxytocin for induction of labour in case of PROM at term, even if the cervix is unfavorable [12]. Several studies have evaluated the combination of oxytocin and mechanical devices, as oxytocin alone has not been shown to affect the risk of chorioamnionitis [13-15]. Induction of labour by mechanical device is accepted in cases with intact membrane, although mechanical treatment does not show any advantage over vaginal PGs regarding rates of chorioamnionitis, endometritis and neonatal infection [16]. In PROM, a concern with mechanical cervical ripening is increased risk of intraamniotic infection and other infection morbidity, which is not increased when membranes are intact [13]. Although the Foley catheter has been established as safe and effective in women with intact membranes, its efficacy has not been established in women with PROM. Chorioamnionitis was defined as temperature 38°C or greater with at least two of the following: uterine tenderness, maternal tachycardia, fetal tachycardia, foul odor of the amniotic fluid, or maternal leukocytosis (greater than 15,000 cells/mL3) [17].

Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes

Background Chorioamnionitis is a risk factor for fetal and neonatal outcomes. Therefore, predicting histological chorioamnionitis (HCA) and neonatal outcomes using clinical parameters could be helpful in management and preventing morbidities. Objective To determine if parameters of clinical chorioamnionitis (CCA) would be associated with HCA and neonatal outcomes. Study design In this cohort study using a retrospective design, we analyzed the performance of signs of CCA in predicting HCA, and neonatal outcomes. Data were extracted from the electronic health record for all neonates with documented CCA delivered at our institution from 2011 to 2016. We compared our findings based on the old ACOG definition of CCA and the new definition released in 2017 – maternal fever plus any of fetal tachycardia, maternal leukocytosis, and purulent vaginal discharge. Maternal tachycardia and uterine tenderness were removed from the new criteria. Neonatal laboratory samples on admission, 12 h and 24 h were used to define the three time points of neonatal suspected sepsis. Results There were 530 mothers-infant dyads with chorioamnionitis. Seventy-three were preterm, and 457 were term. Eighty-eight percent of the preterm mothers had CCA, and HCA was present in 62.5% of 72 preterm placentas. Preterm infants with placental HCA significantly had lower birth weight, gestational age, placental weight, and more infants with lower 5-minute Apgar scores, compared to those with no HCA. In preterm infants, maternal urinary tract infection was significantly associated with decreased odds for HCA (OR 0.22, CI 0.10 − 0.71). More preterm babies with suspected sepsis criteria at the 3 time points had HCA (all p ≤ .01). In the term cohort, 95.4% and 65.6% had CCA and HCA, respectively. In term infants (n = 457), maternal leukocytosis (p = .002) and prolonged rupture of membranes (PROM; p = 002) were associated with HCA. Suspected sepsis was associated with PROM (p = .04), HCA (p = .0001), and maternal leukocytosis (p ≤ .05) in at least 1 of the 3 time points. Conclusion Though maternal leukocytosis was significantly associated with the presence of HCA in the term cohort, there were no CCA criteria that accurately predicted presence of HCA in either the preterm or the term infants.

Risk factors for surgical site infection following cesarean section.

Introduction: Post caesarean section (CS) wound infections represents a considerable load for health system; therefore, preventive measures should be a health care priority in developing world.1 The rate of surgical site infection (SSI) after caesarean section is reported between 3% -15%.&#x0D; Objective: To determine risk factors responsible for surgical site infection following caesarean section.&#x0D; Methodology: This cross-sectional study was conducted at Department of Obstetrics and Gynecology Unit II Civil Hospital Karachi during January 2017 to June 2017. Total 163 women with post cesarean wound infection, irrespective of any age and parity, were included in the study. Post-surgery, final assessment was made after 30 days. Informed consent was taken and patients were inquired about history of trial of labor from Dai or lady health visitor (LHV), history of leaking of amniotic fluid, presence of maternal fever ≥100 for 24 hours, maternal leukocytosis &gt;15000/mm3, uterine tenderness, foul odor of amniotic fluid and decreased Hemoglobin level. Women with history of diabetes and gestational diabetes, cesarean section performed in other settings and had undergone cesarean section via midline vertical incision were excluded. Findings were recorded in a self-designed questionnaire. SPSS Version 20 used to analyze the data.&#x0D; Results: Mean age of women was 27.88±4.55 years. Most common factor for surgical site infection was personal hygiene (58.9%) followed by obesity (23.3%), history of LHV/Dai handling (20.2%), PROM (17.8%), anemia (13.5%) and chorioamnionitis (10.4%).&#x0D; Conclusion: For surgical site infection, personal hygiene is more common risk factor.&#x0D; Keywords: Risk actors, Surgical Site Infection (SSI), Caesarean Section.&#x0D;

Vaginal Group B Streptococcal Colonization Not Associated With Chorioamnionitis In Laboring Patients

Multiple studies have reported increased rates of chorioamnionitis associated with group B streptococcal (GBS) colonization. We sought to estimate the risk of chorioamnionitis associated with GBS positive status in term laboring patients. This is a retrospective cohort study of term (≥37 weeks), singleton pregnancies who labored at our tertiary care center from 2005 to 2018. The primary outcome of chorioamnionitis was defined as maternal intrapartum fever (single oral temperature of >39°C or 38–38.9°C for 30 minutes) and one or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. The primary exposure was GBS colonization in the medical record. Cox proportional hazard regression was used to model the effect of GBS on the risk of chorioamnionitis while adjusting for number of cervical exams, epidural use, meconium, smoking, parity, BMI, duration of rupture, labor induction and cesarean section. 19,688 individuals met inclusion criteria and 981 (5%) patients met criteria for clinical chorioamnionitis. Of the subjects diagnosed with chorioamnionitis, 188 (19.2%) were GBS positive compared to 25.2% in those not diagnosed with infection (p < 0.001). GBS colonization was not associated with an increased rate of chorioamnionitis after adjusting for potential confounders (hazard ratio [HR] 0.6, 95% confidence interval [CI] 0.5-0.7; p= < 0.001). GBS colonization rates were higher among patients undergoing unplanned cesarean delivery (Vaginal: 12.0% vs Cesarean: 13.4%, p=0.01). Meconium rates were similar between the two groups (GBS positive: 19.0% vs GBS negative: 19.4%, p=0.06). In contrast to previous reports, GBS colonization in laboring patient did not increase the risk of chorioamnionitis. Individuals with positive GBS status should not be counseled on increased risk of chorioamnionitis.

Fever after Preterm Prelabor Rupture of Membranes.

Fever after Preterm Prelabor Rupture of Membranes.

Incremental risk of clinical chorioamnionitis associated with cervical examination

Clinical chorioamnionitis is associated with significant maternal and neonatal morbidity, yet there is no clear evidence on the association between cervical examinations and infection. We sought to assess the association between the number of cervical examinations performed during term labor management and the risk of clinical chorioamnionitis. This is a retrospective cohort study of term (≥37 weeks of gestation), singleton pregnancies who labored at our tertiary care center from 2014 to 2018. The primary outcome of clinical chorioamnionitis was defined as maternal intrapartum fever (single oral temperature of >39°C or 38°C-38.9°C for 30 minutes) and 1 or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. The primary exposure was the number of digital cervical exams documented in the medical record. Log-binomial regression was used to model the effect of cervical examinations on the risk of clinical chorioamnionitis while adjusting for potential confounders. A total of 20,029 individuals met the inclusion criteria and 1028 (5%) patients experienced clinical chorioamnionitis. The number of cervical exams was associated with increased risk of developing infection after adjusting for potential confounders. Individuals with ≥8 cervical exams had 1.7 times the risk of developing clinical chorioamnionitis compared with those with 1 to 3 exams. Prolonged rupture time, nulliparity, Black race, Medicaid insurance, higher gestational age, and higher body mass index were associated with increased risk of clinical chorioamnionitis, whereas smoking and group B Streptococcus colonization were associated with a lower risk. Our study found that the number of cervical exams performed during labor is an independent risk factor for developing clinical chorioamnionitis. Unnecessary cervical exams should be avoided during labor management at term.

MATERNAL LEUKOCYTOSIS AS DIAGNOSTIC MARKERS IN SPONTANEOUSLY DECLARED PRETERM BIRTH

Spontaneous preterm birth is the basic problem of perinatal mortality in Bulgaria. Pregnancy is characterized by physiological leukocytosis - determined by twice increased neutrophils levels, unchanged monocyte levels, and a reduction in the levels of lymphocytes, eosinophils, and basophils. The leukocytosis is particularly pronounced in the last trimester, due to physiological stress during pregnancy, and it is a result of the increased inflammatory response, a consequence of selective immune tolerance, immunosuppression, and fetus-immunomodulation.&#x0D; The objective of this study was to investigate and to appreciate maternal leukocytosis as potential diagnostic markers in spontaneously declared preterm birth and term birth declared cases.&#x0D; Methods: The case–control study was performed in UMBAL-City Hospital, Stara Zagora during 2017–2020. The study involved 200 patients, split into two groups: G1- the healthy pregnant women, n1=100 with а registered singleton pregnancy, at gestational age 37-39+6, gave birth on the term (TB); G2- the PTB patients, n2=100, confirmed clinically by cardiotocography for gestation &gt;32 weeks. The highly sensitive Leuko-TIC-ELISA-WBC (upper limit of the normal number of Leuc during pregnancy - 15x109 per L) test was used for investigation. Blood samples were taken by puncture of the v.cubitalis in an anticoagulant at the time of hospitalization and examined within 1 hrs. Patients with systemic chronic illness and infections were excluded from the study.&#x0D; The results showed statistically significant Leuc reduction in SPTB patients (14.31±2.66×109/L, p&gt;0.03), compared to the increased (14.67±3.21×109/L) (in normal-15x109L) Leuc values in the TB group.In conclusion, the results of the Leuc value confirm the presence of a systemic leukocytosis/oxidative inflammatory reaction at the time of declaring SPTB and TB.

Management of Clinical Chorioamnionitis: An Evidence-based Approach

(Am J Obstet Gynecol. 2020;223:848–869) Clinical chorioamnionitis affects 1% to 6% of US pregnancies and is a risk factor for postpartum hemorrhage, neonatal sepsis, neonatal intensive care unit admission, neonatal death, and other adverse outcomes. Clinical chorioamnionitis has typically been diagnosed by maternal fever combined with at least 2 other symptoms: maternal tachycardia, fetal tachycardia, uterine tenderness, purulent or foul-smelling amniotic fluid or vaginal discharge, or maternal leukocytosis. This condition is usually treated with antibiotics and antipyretic agents, along with expedited delivery, though management regimens vary widely in terms of types of antibiotic and timing of treatment. This review aimed to examine evidence on the treatment of clinical chorioamnionitis to develop an evidence-based management approach. A literature search was conducted using MEDLINE, EMBASE, POPLINE, LILACS, CINAHL, the Cochrane Central Register of Controlled Trials, clinical trial registries, and Google Scholar.

Treatment Outcomes and Determinants of Eclampsia and Severe Preeclampsia Among Pregnant Women Admitted to Selected Tertiary Hospitals in Ethiopia: A Cohort Study.

BackgroundEclampsia contributes to 12% of all maternal deaths worldwide during pregnancy. Again, women with severe preeclampsia and eclampsia had a three to 25-fold increased risk of severe complications. Therefore, this study was aimed to determine treatment outcomes and determinants of eclampsia and severe preeclampsia among pregnant women admitted to selected tertiary hospitals.MethodsA prospective cohort study was conducted on 217 women with eclampsia or severe preeclampsia from April 1 to October 30, 2019. Data were collected from patients’ chart, questionnaire-based interviews at baseline and telephone interviews during follow-up. Then, the collected data were entered into EpiData 3.1 and exported to SPSS 21.0 for final analysis. Kaplan–Meier (log rank test) and Cox regression were employed to compare baseline survival experience and to adjust for the predictors of clinical outcomes, respectively.ResultsOf 217 women, 80.2% of them developed maternal complications, while nine (4.2%) women died. Determinant factors of maternal complications were linked with eclampsia case (AHR: 1.98; 95%CI: 1.28–3.06; P=0.002), lack of ANC follow-up (AHR: 1.75; 95%CI: 1.22–2.51; P=0.002), presence of maternal leukocytosis (AHR: 1.53; 95%CI: 1.12–2.09; P=0.008), elevated serum creatinine (AHR: 1.51; 95%CI: 1.05–2.17; P=0.02), and maternal age of 20–35 years (AHR: 0.61; 95%CI: 0.41–0.90; P=0.01).ConclusionDespite improved survival of women with preeclampsia/eclampsia, different complications that they experienced remained serious problems. We suggest strategies that comprise frequent ANC follow-up and check-up for women with leukocytosis and kidney impairment so as to optimally prevent and treat eclampsia and preeclampsia during pregnancy.

Role of umbilical interleukin-6, procalcitonin and C-reactive protein measurement in the diagnosis of fetal inflammatory response syndrome.

Fetal Inflammatory Response Syndrome (FIRS) is aserious complication accompanied by increased neonatal mortality and morbidity. Early dia-gnosis of FIRS is essential to detect high risk infants. The aim of the study was to evaluate the correlation between interleukin-6(IL-6), procalcitonin (PCT), C-reactive protein (CRP) in cord blood and histologically proven funisitis;chorioamnionitis in high-risk infants after preterm birth. Blood sampling for the measurement of inflammatory bio-markers was performed immediately after placental delivery and umbilical cutting. Umbilical and placental inflammatory changes were assessed using arecently released scoring system (Amsterdam Placental Workshop Group Consensus). One hundred preterm infants (30.5 ± 2.5 gestational week, birth weight 1,443 ± 566 grams) and 21 health term infants were analyzed. Histologic chorioamnionitis was confirmed in 19% cases and chorioamnionitis with funisitis in 7% cases. Thirty-three infants (33%) fulfilled criteria of FIRS (funistis and/ or umbilical IL-6 > 11 ng/ L). The presence of FIRS correlated significantly with maternal leukocytosis (P < 0.001), preterm premature rupture of membrane (P < 0.001) and preterm uterine contraction (P < 0.0001). In comparison to preterm and healthy term infants we found statistically significant higher levels of umbilical inflammatory bio­markers (IL-6, PCT, CRP) in FIRS group (P < 0.0001). Composite mortality and morbidity (bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leukomalacia) was higher in FIRS group (28.1 vs 22.4% in preterm group). However, the difference was not statistically significant (P = 0.53). Our study confirmed the correlation of umbilical inflammatory bio­markers levels (IL-6, PCT, CRP) and the presence of FIRS. We did not find significant adverse impact of FIRS on neonatal mortality and morbidity. Nevertheless, our results could be influenced by the size of study group and strict inclusion criteria (only cases after C-section were analyzed).

A History of Preterm Delivery Is Associated with Aberrant Postpartal MicroRNA Expression Profiles in Mothers with an Absence of Other Pregnancy-Related Complications.

This prospective cross-sectional case-control study investigated the postpartal gene expression of microRNAs associated with diabetes/cardiovascular/cerebrovascular diseases in the peripheral white blood cells of women with anamnesis of preterm prelabor rupture of membranes (n = 58), spontaneous preterm birth (n = 55), and term delivery (n = 89) by a quantitative reverse transcription polymerase chain reaction. After pregnancies complicated by preterm prelabor rupture of membranes or spontaneous preterm birth, mothers showed diverse expression profiles for 25 out of 29 tested microRNAs (miR-1-3p, miR-16-5p, miR-17-5p, miR-20a-5p, miR-20b-5p, miR-21-5p, miR-23a-3p, miR-24-3p, miR-26a-5p, miR-29a-3p, miR-100-5p, miR-103a-3p, miR-125b-5p, miR-126-3p, miR-130b-3p, miR-133a-3p, miR-143-3p, miR-145-5p, miR-146a-5p, miR-181a-5p, miR-195-5p, miR-199a-5p, miR-221-3p, miR-499a-5p, and miR-574-3p). The earliest gestational ages at delivery and the lowest birth weights of newborns were associated with the highest postpartal levels of the previously mentioned microRNAs in maternal peripheral white blood cells. Administration of tocolytic drugs in order to prolong pregnancy, used in order to administer and complete a full course of antenatal corticosteroids, was associated with alterations in postpartal microRNA expression profiles to a lesser extent than in women with imminent delivery, where there was insufficient time for administration of tocolytics and antenatal corticosteroids. Overall, mothers who did not receive tocolytic therapy (miR-24-3p and miR-146a-5p) and mothers who did not receive corticosteroid therapy (miR-1-3p, miR-100-5p, and miR-143-3p) had increased or showed a trend toward increased postpartal microRNA expression when compared with mothers given tocolytic and corticosteroid therapy. In addition, mothers with serum C-reactive protein levels above 20 mg/L, who experienced preterm labour, showed a trend toward increased postpartal expression profiles of miR-143-3p and miR-199a-5p when compared with mothers with normal serum C-reactive protein levels. On the other hand, the occurrence of maternal leukocytosis, the presence of intra-amniotic inflammation (higher levels of interleukin 6 in the amniotic fluid), and the administration of antibiotics at the time of preterm delivery had no impact on postpartal microRNA expression profiles in mothers with a history of preterm delivery. Likewise, the condition of the newborns at the moment of birth, determined by Apgar scores at 5 and 10 min and the pH of cord arterial blood, had no influence on the postpartal expression profiles of mothers with a history of preterm delivery. These findings may contribute to explaining the increased cardiovascular risk in mothers with anamnesis of preterm delivery, and the greater increase of maternal cardiovascular risk with the decrease of gestational age at delivery. Women with preterm delivery in their anamnesis represent a high-risk group with special needs on a long-term basis, with a need to apply preventive and therapeutic interventions as early as possible.

830 Risk of chorioamnionitis following intrauterine pressure catheter placement in laboring patients

Intrauterine Pressure Catheters (IUPC) are thought to create a pathway for contamination and ascending infections. We sought to estimate the risk of chorioamnionitis associated with IUPC use in term labor. This is a retrospective cohort study of term (≥37 weeks), singleton pregnancies who labored at our tertiary care center from 2005 to 2018. The primary outcome of chorioamnionitis was defined as maternal intrapartum fever (single oral temperature of >39°C or 38–38.9°C for 30 minutes) and one or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. The primary exposure was the presence of an IUPC documented in the medical record. Cox proportional hazard regression was used to model the effect of cervical examinations on the risk of chorioamnionitis while adjusting for adjusted for number of cervical exams, epidural use, meconium, smoking, GBS, parity, BMI, duration of rupture, labor induction and cesarean section. 20,579 women met inclusion criteria and1,039 (5%) women were diagnosed with chorioamnionitis. Of the subjects diagnosed with chorioamnionitis, 185 (17.8%) had IUPCs compared to 22.5% in women not diagnosed with infection (p<0.001). IUPCs were not associated with increased rate of chorioamnionitis after adjusting for potential confounders (hazard ratio [HR] 0.6, 95% confidence interval [CI] 0.5-0.7; p=<0.001). Presence of IUPCs was higher in women undergoing unplanned cesarean delivery (30.6% versus 21.1% in women undergoing vaginal delivery, p=<0.001). Meconium rates were not higher in women with IUPCs (IUPC 20.0% versus no IUPC18.8 p=0.06) In contrast to prior work, routine use of internal monitoring in laboring patient did not increase the risk of chorioamnionitis. Internal monitors should not be avoided during term labor management.

177 Incremental risk of chorioamnionitis associated with cervical examination

Intra-amniotic infection is associated with significant neonatal morbidity and mortality. We sought to assess the association between number of cervical examinations and the risk of chorioamnionitis in term labor. This is a retrospective cohort study of term (≥37 weeks), singleton pregnancies who labored at our tertiary care center from 2005 to 2018. The primary outcome of chorioamnionitis was defined as maternal intrapartum fever (single oral temperature of >39°C or 38–38.9°C for 30 minutes) and one or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. The primary exposure was the number of digital cervical exams documented in the medical record. Cox proportional hazard regression was used to model the effect of cervical examinations on the risk of chorioamnionitis while adjusting for internal monitoring, epidural use, meconium, maternal smoking, GBS, parity, BMI, duration of membrane rupture, labor induction and cesarean section. 20,579 women met inclusion criteria and1,039 (5%) women were diagnosed with chorioamnionitis. The number of cervical exams was associated with an increased rate of chorioamnionitis after adjusting for potential confounders (hazard ratio [HR] 1.1, 95% confidence interval [CI] 1.04-1.1; p=<0.001). Each additional cervical exam confers an incremental risk of infection (OR=1.06 per exam, p<0.001). Women with greater than 7 cervical exams were 2.3 times more likely to develop chorioamnionitis (relative risk [RR] 2.3, 95% CI 1.3-4.0; p=<0.001). Duration of membrane rupture, labor induction, epidural placement, presence of meconium and cesarean delivery were all associated with chorioamnionitis after adjusting for confounders. In contrast to prior work, our study found that the number of cervical exams in term labor is an independent risk factor for developing chorioamnionitis after adjusting for confounders. Unnecessary cervical exams should be avoided during term labor management.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

255 Chorioamnionitis rates in private versus resident-managed labor in term pregnancies

Intra-amniotic infection is associated with maternal and neonatal morbidity. We sought to determine if chorioamnionitis rates among private verses resident- managed services were different. This is a retrospective cohort study of women who labored at ≥37 weeks gestation from 2005 to 2018 at a single academic center. Women were identified as part of a “resident service” if their labor was primarily managed by OB/Gyn residents; “private service” patients were managed without resident involvement. The primary outcome of suspected chorioamnionitis was defined as maternal intrapartum fever (single oral temperature of >39°C or 38–38.9°C for 30 minutes) and one or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. Rates of chorioamnionitis were analyzed using multivariate regression models while adjusting for potential confounders. 20,579 women were included: 3897 (18.9%) were managed by a resident service and 16681 (81%) were managed by a private service. Chorioamnionitis rates were higher among resident-managed patients after adjusting for confounders (relative risk [RR] 1.4, 95% confidence interval [CI] 1.2-1.6; p<0.001). Rates of chorioamnionitis remained higher after adjusting for public insurance and black race (RR 1.3, 95% CI 1.1-1.5; p<0.001). Duration of membrane rupture was significantly shorter among resident services (private service: 6hrs vs. resident service: 5hrs, p<0.001). There was no difference in the rates of unscheduled cesarean deliveries, length of labor, meconium or the number of cervical exams between the two services. This is the largest cohort comparing the rates of chorioamnionitis among women managed by a resident care model versus a private physician model. Women managed by a resident service were 30% more likely to develop chorioamnionitis despite shorter ruptured time and similar cervical exams. The etiology of infectious morbidity among resident services necessitates further investigation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

145 To determine if Vitamin D prophylaxis decreases the incidence of maternal and neonatal infection

To determine if Vitamin D prophylaxis decreases the incidence of maternal and neonatal infection. A secondary analysis assessing maternal and neonatal infection was performed on a RCT in which pregnant women received Vitamin D3 3000 IU daily or no supplement. Women with a confirmed intrauterine pregnancy 12-16 weeks without a history of Vitamin D use or malabsorption disorder were included. Maternal 25-hydroxyvitamin D (25(OH)D) levels were assessed at the time of enrollment and admission for delivery. Neonatal 25(OH)D level was assessed via cord blood. Outcomes collected included clinical chorioamnionitis (temperature > 38.0°C + maternal leukocytosis, purulent cervical discharge, or fetal tachycardia), endometritis (temperature > 38.0°C + uterine tenderness on exam), neonatal infection (as documented by NICU staff), neonatal sepsis (+ blood culture) and histologic chorioamnionitis (polymorphonucleocytes in the placental amnion and chorion). Parametric and nonparametric statistics were used to compare groups. A P value of <0.05 was statistically significant. Of the 412 women enrolled, 392 (95.1%) had completed pregnancies for analysis. Demographic characteristics, including baseline 25(OH)D levels, were similar between groups. Table 1. Compared to women who did not receive Vitamin D prophylaxis, those who did had a significantly higher 25(OH)D delivery (29.18 +/- 11.87 ng/mL vs. 23.79 +/- 9.29 ng/mL; P<0.001) and cord blood levels (33.73 +/- 13.68 ng/mL vs. 26.06 +/- 9.72 ng/mL; P<0.001). Vitamin D prophylaxis did not decrease the incidence of clinical chorioamnionitis, endometritis, neonatal infection, and neonatal sepsis. Table 2. Stratification by Vitamin D deficiency status revealed a higher incidence of clinical chorioamnionitis in those who did not receive intervention and remained Vitamin D deficient at delivery (9.7% vs. 1.6%; RR 5.9 95% CI 1.3-21.7; P=0.010). Vitamin D prophylaxis does not decrease the incidence of maternal or neonatal infection. Persistent Vitamin D deficiency in pregnancy may be associated with a risk for clinical chorioamnionitis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Intra-amniotic Infection

Intra-amniotic Infection