$142

221

SMFM Abstracts

PRETERM RUPTURE OF MEMBRANES AT 24-32 WEEKS: RECENT VAGI- NAL BLEEDING AND PER/NATAL OUTCOME MICHAEL HNAT FOR THE N1CHD MFMU NETWORK]; 1NICHD, Bethesda, MD

OBJECTIVE: To compare per inatal outcomes in pre ter ln p rema tu re rap ture of membranes (PPROM) at 24-32 w e e ~ ' gestation in the presence or absence of vaginal bleeding.

STUDY DESIGN: Analysis of 582 singleton pregnancies who had PPROM with and wi thout vaginal b leeding in the week pr ior to admission or at presentation and who were enrolled in a MFMU Network nmlticenter trial. Main outcome was prolongat ion of pregnancy, _<48 hours and _<7 days. Other outcome variables were rates of abruptio placentae, chorioamnionitis, death, severe IVH, and RDS.

RESULTS: The table below describes outcomes in those with (n = 50) and without (n = 532) bleeding. Latency was not affected by presence or absence of bleeding. Bleeding was associated with a significantly h igher f requency of abruptio, perinatal death, IVH and RDS. Wmnen with bleeding were more likely to be white (52% vs 28%; P= .002) and have a lower mean gestational age at rap ture (27.6 vs 28.5: P = .02). After adjusting for race and gestational age, women with recent bleeding were at increased risk of having a neonate with RDS (OR - 3.1; 95% CI 1.5-6.7; P = .004) but not abruptio (OR = 2.6; 95% CI 0.9-7.4; P = .07).

CONCLUSION: Vaginal b leeding with PPROM is associated with increased rates of RDS. Interestingly, latency, abrupt io placentae and chorioanmionitis are not attected by the presence of bleeding with PPROM. Table

N O P ADJUSTED BLEEDING BLEEDING VALUE P V A L U E

Latency-<48 hours (%) 6 /50 (12.0) 94/529 (17.8) .30 .46 Latency-<7 days (%) 32/50 (64.0) 315/529 (59.6) .54 .26 Abruptio (%) 6 /50 (12.0) 18/522 (3.5) .01 .07 Chorioamnionitis (%) 15/50 (30.0) 151/528 (28.6) .83 .86 Perinatal death (%) 8 /50 (16.0) 26/529 (4.9) .006 .19 RDS (%) 34/49 (69.4) 214/530 (40.4) <.0001 .004 Grade 3-4 W H (%) 7/49 (14.3) 31/529 (5.9) .03 .24

223

December 2001 A m J Obstet Gyuecol

PERIODONTAL DISEASE DOES NOT CONFER ANY ADDITIONAL RISK OF PRETERM DELIVERY OVER THAT ESTABLISHED BY TNFA*2 CAR- RIAGE SUZANNE MOORE |, NIGEL SIMPSON2,JAN REID 2, MANJIT RAND- HAWA l, EMILY GOODLAD 2, JAMES WALKER'-', MARK IDE1; tGKT Dental Institute, Kings College, London , Dept. Periodontology, London; -gLeeds General Infirmary, University of Leeds, Dept. Obstetrics & Gyuaecology, Leeds

OBJECTIVE: The aim of this case control study was to investigate a putative relationship between the carriage of the allelic variant TNFA*2 at the codon -308 and pre tenn delive~ T (PTD) in a group of pos tpa r tum women, and to elucidate if the concurrent presence of periodontal disease increased the risk of PTD in this group.

STUDY DESIGN: Case sul~jects were defined as those who experienced a bir th at less than 37 weeks gestation. Control subjects gave bir th at term. Demograph ic data were collected and a pe r iodon ta l exmninat ion was per lormed. Blood samples were collected and analysed by restriction fragment length polymerase (RFLP) techniques for the presence of the allelic variant.

RESULTS: 48 case subjects and 82 cont ro l subjects were assessed. 23 (48%) of the case sul~jects and 24 (29%) of controls carried the TNFA*2 allelic variant (OR: 2.2; 95% CI: 1.0 - 5.0). In nonsmoking subjects, 52% of cases and 22% of controls carried this variant (OR: 3.9; CI: 1.4 - 11.0). There was no association between the carr iage of the TNFA*2 allele and the severity of periodontal disease. The combinat ion of periodontal disease and the allelic variant did not increase the risk of PTD.

CONCLUSION: In tiffs study populat ion, ttle presence of the TNFA*2 variant was associated with PTD and this association was s t ronger in nonsmokers , However there does not appear to be the gene-enviromnent in terac t ion with per iodonta l disease a n d PTD as has been r epo r t ed for bacterial vaginosis and PTD.

222 ANTIBIOTIC TREATMENT OF PATIENTS WITH PRETERM PROM DOES NO T ERADICATE INTRA-AMNIOTIC INFECTION O R PREVENT THE DEVELOPMENT OF INTRA-AMNIOTIC INFLAMMATION RICARDO GOMEZ 1, JYH KAE NIEN 1 , GONZALO SEPULVEDA 1 , MARIO CARSTENSI, LUIS MEDINA 1, ROGELIO GONZALEZ 1, 1VAN ROJAS 1, TINNAKORN CHA/WORAPONGSA MD2, ROBERTO ROMERO3; ICEDIP, Hosp. Sotero del Rio, Dept. Oh-Gin, P. Univers idad Catolica de Chile, Puente Alto, Stgo; 2National Institutes of Health, Perinatology Research Branch, Detroit, MI; aPerinatology Research Branch, Detroit, MI

OBJECTIVE: Antibiotic administrat ion to patients with pre term PROM has become par t of the s tandard of care. Yet, the natural history' of intrauterine in tecdon/ in f la tnmat ion dur ing antibiotic therapy is largely unknown. This study was conduc t ed to de te rmine if antibiotic adminis t ra t ion eradicates in t raamniot ic infection a n d / o r reduces the f requency of in t raamniot ic inflammation (1AI), a risk factor for impending pre term delNery and adverse neonatal outcome.

STUDY DESIGN: A subset of patients with pre term PROM admitted to our unit underwent an anmiocentesis before and after antibiotic administration to guide clinical management . Amniofic fluid (A1 r) analysis consisted of a Gram stain, AF white blood cell count (WBC) and AF cultures. IAI was defined as an AF WBC >100 /mm3 a n d / o r a positive AF culture. Antibiotics and steroids were administered from 24 weeks. Antibiotic t reatment consisted of ampicillin- erythromycin for 7 days to t patients without IAI and ceftriaxone-clindamycin- erythromycin for 10-14 days for patients with Lad.

RESULTS: Twenty patients with preterm PROM whose first anmiocentesis was p e r f o r m e d between 22-32 weeks (median 26.7) were included. The prevalence of IAI in the first amniocentesis was 35% (7/20) . Of these 7 patients, 3 had positive AF cultures. At the time of the second amniocentesis, all 3 patients with a positive AF culture had microorganisms. O f the remaining 4 patients, 2 showed no evidence of IAI after treatment, Among the 13 patients with no evidence of IAI at admission, 38% (n = 5) developed intlanmmtion despite therapy.

CONCLUSION: (1) Antibiotic adminis t ra t ion did no t eradicate intra- amniotic infection; (2) IAI developed in one third of patients who did not have IAI shortly after admission, despite antibiotic administration: (3) a subgroup of patients with documented inflammation of the amniotic cavity delnonstrated a decrease in the intensity of the inflamnmtoL'y process after antibiotic admini- stration.

224 THERE IS NO ASSOCIATION BETWEEN IL1B*2 CARRIAGE, PERIODON- TAL DISEASE AND PRETERM DELIVERY SUZANNE MOORE 1, NIGEL SIMPSON 2, J.MN REID 2, MANJIT RANDHAWA t, EMILY GOODLAD 2, JAMES WALKER 2, MARK IDE1; 1GKT Dental Institute, Kings College, London, Dept. Periodomology, London; 2Leeds General Infirmary, University of Leeds, Dept. Obstetrics & Gynaecology, Leeds

OBJECTIVE: The aim of this case cont ro l study was to investigate a putative relationship between the carriage of the allelic variant IL1B*2 at the codon +3953, periodontal disease and preterm delivery (PTD) in a g roup of post-partum women.

STUDY DESIGN: Case subjects were defined as those who experienced a bir th at less than 37 weeks gestation. Control subjects gave bi r th at term. Demograph ic data were collected via a ques t ionnai re and a per iodonta l examination was performed. Blood samples were collected and analysed by restriction f lagment length polymerase (RFLP) techniques for the presence ot the allelic variant.

RESULTS: 48 case subjects and 82 control subjects were assessed. There was no association between periodontal disease and PTD, 14 (29%) of case subjects and 15 (18%) of controls carried the IL1B*2 allelic variant, and this was no t statistically significant (OR: 1.8; CI: 0.7 - 4.9). There were no statistically significant differences in the carriage rate of the allelic variant in those subjects with periodontal disease.

CONCLUSION: Preterm delivery appears not to be associated with either the IL1B*2 variant or periodontal disease, either as two discrete entities or in combination.