409: Membrane stripping in GBS carrier patients, is it safe? (STRIP-G Study)

www.AJOG.org Epidemiology, Ob Quality, Operative Obstetrics, Public Health, Infectious Disease, Academic Issues Poster Session III

STUDY DESIGN: We conducted a retrospective cohort study of allsingleton, vertex pregnancies at 39 weeks and beyond in the State ofCalifornia from 2005-2008. For each elective induction on aparticular day of gestation, we created a comparison group ofwomen who were undelivered at that gestational age, and whoexperienced labor at some future gestational age. We examinedoutcomes including cesarean delivery rate, NICU admissions, andperinatal mortality. Statistical comparisons were made using the chi-square test and multivariable logistic regression.RESULTS: In the nulliparous women induced at 39 weeks and 0 days,there was no statistically significant difference in the risk of cesareandelivery (24.5% vs. 26.2%, p¼0.21). This was also true at other daysof gestation between 39 0/7 and 40 6/7. Among multiparas, electiveinduction of labor at 39 0/7 weeks’ gestation was associated with areduction in the rate of cesarean delivery. This difference wasattenuated at 39 3/7 and there was no difference at 40 weeks andbeyond. Rates of NICU admissions were also examined.CONCLUSION: Our findings suggest that elective induction of labor at39 and 40 weeks of gestation demonstrates no difference in the rateof cesarean delivery in nulliparas. However, an elective induction oflabor at 39 weeks’ gestation was associated with a decrease in thecesarean delivery rate.

409 Membrane stripping in GBS carrier patients, is it safe?

OBJECTIVE: Membrane stripping is a widely utilized technique tohasten delivery. Although a Cochrane review affirmed that mem-brane stripping does not increase the risk of maternal and neonatalinfection, the relationship between Group B Streptococcus (GBS)disease and stripping of membranes is not known, and the issue ofwhether to perform stripping in GBS colonized patients is contro-versial. The aim of this study was to determine whether membranestripping in GBS carrier women negatively affects maternal orneonatal outcomes.STUDY DESIGN: A prospective observational cohort study was con-ducted between October 2011 and April 2013, comparing maternaland neonatal outcomes after membrane stripping among GBSpositive patients (exposed group) and GBS negative patients (un-exposed group). The primary outcome measure was neonatal sepsis,and secondary outcome measures were signs of maternal or neonatalinfection. Due to the rarity of GBS sepsis in the newborn, the NICEclinical indicators of early-onset neonatal infection were used as

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surrogate endpoints indicating neonatal compromise. Chi-squarewas used to assess the differences between the groups. A P-value of0.05 or less was considered statistically significant.RESULTS: During the study period 384 women underwent mem-brane stripping and were included in this analysis. Of these patients106 (27.6%) were GBS positive (Group 1) and 278 (72.4%) wereGBS negative (Group 2). There were no baseline differences inmaternal or fetal characteristics between the two groups (Table 1).There were no cases of neonatal sepsis in either group. The rates ofmaternal infection were 3.8% and 3.2% in Group 1 and 2 respec-tively (P¼0.8). Similarly the rates of compromised neonates werenot significantly different between the groups, with a rate of 5.7% inGroup 1 and 8.6% in Group 2 (P¼0.44).CONCLUSION: Membrane stripping in GBS carrier patients did notadversely affect maternal or neonatal outcomes, and appears to be asafe obstetrical procedure.

Comparison between exposed and unexposedgroup

NS ¼ Not Significant.

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OBJECTIVE: To identify antepartum and intrapartum risk factors forserious morbidity in term, non-anomalous neonates that might bemodifiable.STUDY DESIGN: We analyzed the first 4,997 subjects in an ongoingprospective cohort study of term (�37 weeks), consecutive non-anomalous births. The primary exposure was a composite of seriousneonatal morbidity, including one or more of: hypoxic ischemicencephalopathy, meconium aspiration, requirement of hypothermiatherapy, respiratory distress syndrome with requirement of ventilatoror oxygen support after 6 hours of life, seizures, sepsis or suspectedsepsis, or death. We calculated odds ratios for the compositemorbidity associated with antepartum and intrapartum factors.Multivariable logistic regression was used to estimate adjusted oddsratios.RESULTS: Of 4,997 term non-anomalous births, 393 (7.9%) had thecomposite morbidity. Significant risk factors for morbidity werenulliparity, presence of meconium, first stage of labor >95th

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