Do preterm mothers deliver preterm babies?

163 DO PRETERM MOTHERS DELIVER PRETERM BABIES? BRIAN MERCER1,CYNTHIA MILLUZZI1, JOHN MOORE2, 1CASE-MetroHealth Medical Center,Reproductive Biology, Maternal-Fetal Medicine, Cleveland, Ohio, 2CASE-MetroHealth Medical Center, Reproductive Biology, Pediatrics, Cleveland,Ohio

OBJECTIVE: It has been reported that low infant birth-weight (bBWT) ismore likely if maternal BWT (mBWT) was also low. It is not known if thisreflects increased preterm birth (PTB) or low-BWT (LBW) at term in thesemothers and babies. We sought to determine if women born preterm are morelikely to deliver preterm, or if the tendency to repeat LBW across generationsreflects LBW at term.

STUDY DESIGN: From our electronic perinatal database (1974-2004) weidentified women who were born and delivered at our institution. Only thoseborn of and delivering a singleton gestation O=20 weeks were included. Onlythe 1st delivery for each was analyzed. Maternal gestational age (mEGA) andmBWT were correlated to their babys EGA (bEGA) and bBWT. Thelikelihood of delivering bPTB (!37 weeks) and bLBW (!2,500 grams) basedon a history of mPTB or mLBW were calculated. Sub-analysis regarding LBWwas performed for those born and delivering at term only. p!0.05 wasconsidered significant.

RESULTS: 3,331 women, born and delivered at our institution, metinclusion criteria. They were 52% Afr. American, 35% Caucasian, 10%Hispanic. Pregnancy complications were; 4.7% preeclampsia, 4.6% pretermlabor, and 2.3% PROM. While bEGA increased with increasing mEGA(p=0.002) the correlation was poor (R2=0.003). Those with mPTB did nothave more frequent bPTBs (13.7 vs11.1%, p=0.13) or bPTB!32 weeks (3.8vs 3.2%, p=0.49) than those born at term. bBWT increased with mBWT(p!0.0001, R2=0.04). LBW mothers delivered more LBW babies (19.7 vs10.6%, p!0.0001) than those born O2500 gms. For those born and deliveringat term, LBW mothers also had more LBW babies (8.1 vs 3.9%, p=0.009).ANOVA revealed bLBW to be associated with bPTB (p!0.0001), andmLBW (p=0.036), but not mPTB (p=0.89). bPTB was not associated withmPTB (p=0.79) after controlling mLBW (p=0.034).

CONCLUSION: For singleton pregnancies, women born preterm are NOTmore likely to deliver preterm. Infant LBW is associated with PTB andmaternal LBW, but not with maternal PTB. Maternal LBW at term ISassociated with LBW in their term offspring.

164 CHARACTERIZATION OF PROGESTERONE RECEPTOR ISOFORM EXPRESSION INFETAL MEMBRANES ALYSSA MILLS1, BRYAN YONISH1, LIPING FENG1,AMY MURTHA (F)1, 1Duke University, Division of Maternal-Fetal Medicine,Durham, North Carolina

OBJECTIVE: To quantify the levels of expression of progesterone receptor(PR) isoforms A and B in amnion, chorion, and decidua, and to determinewhether expression changes in cell culture.

STUDY DESIGN: After IRB approval, placentas from term gestationsdelivered by cesarean section without labor were collected. Layers of amnion,chorion, and decidua were separated manually and then digested. Cell layerswere further separated using Opti-prep (Sigma Aldrich) density gradient.Purity of cell separation was confirmed using immunocytochemistry. RNAwas immediately extracted from an aliquot of cells from each cell layer and theremainder was cultured for 48 hours. RNA was then extracted for quantitativeRT-PCR using primers specific for PR isoforms A and B, as well as for b-2microglobulin (b2M), a constituitively expressed gene used to normalizequantification across tissue samples. Standard curves were generated fromknown concentrations of each transcript. Data were analyzed using t-test andMann Whitney U.

RESULTS: PR isoforms A and B were identified in the chorion and deciduabut were below the lower limits of detection of our assay in the amnion. Forboth isoforms, decidual expression was higher than expression in the chorion(PR-A/b2M 0.006 vs. 0.001, p=0.02; PR-B/b2M 0.005 vs. 0.0004, p=0.02).Ratios of PR-A to PR-B were similar in both decidua and chorion. When freshcells were compared to cultured cells there was no significant difference in PRexpression.

CONCLUSION: PR isoforms A and B are present in chorion and decidua,with the highest concentrations found in the maternally-derived decidua. PRisoforms appear to be equally expressed in cultured and fresh cells. Thesefindings will aid in our understanding of how progesterone contributes to thepathogenesis of preterm delivery.

165 CANDIDA PLACENTAL INFECTION IN WOMEN WITH PRETERM PREMATURERUPTURE OF MEMBRANES: AN EMERGING CONCERN? DAVID MINER1, ONAFAYE-PETERSEN1, PATRICK RAMSEY1, 1University of Alabama at Birmingham,Obstetrics/Gynecology, Birmingham, Alabama

OBJECTIVE: To characterize the prevalence and implications of Candidaplacental infection in pregnancies complicated by PPROM.

STUDY DESIGN: We reviewed all cases of women with pregnancies compli-cated by PPROM !32 weeks at our institution between 1998-2000. Casesinvolving multifetal gestations, fetal anomalies, gestational hypertension, orpreeclampsia were excluded. All PPROM cases were managed using astandardized protocol consisting of antenatal steroid administration andantibiotic therapy (azithromycin/amoxicillin x 10 days). No tocolytic therapywas utilized. Women reaching 34 weeks gestation were induced. Placentalpathology reports from this cohort of women were reviewed for evidence ofCandida infection (characteristic microabscesses, hyphae, and/or a positiveGomori methenamine silver stain).

RESULTS: Of 161cases of PPROM which occurred over the study interval,107 (66%) had pathology reports available. Of these 107 cases, 8 had placentalevidence of Candida infection (8%). The mean gestational age at PPROM(28 G 2 vs 28 G 2 wks, p=0.7), latency (8 G 7 vs 7 G 2 days, p=0.34), anddelivery gestational age (29 G 2 vs 29 G 2 wks, p=0.9) were similar betweenthe group of women with placental Candida infection and the group without,respectively. Use of prophylactic corticosteroids (88 vs 87%, p=1.0) andantibiotics (88 vs 85%, p=1.0) were also similar between those with placentalCandida and those without. The incidence of clinical chorioamnionitis (13 vs25%, p=0.7) and postpartum endometritis (38% vs 13%, p=0.1) were alsostatistically similar between those with placental Candida infection and thosewithout. The incidence of major neonatal morbidity was also similar in theinfants born to women with placenta Candida infection vs those without (50 vs58%, p=0.7).

CONCLUSION: Candida placental infection was noted in 8% of women withPPROM in our series. Alterations in our management of women with PPROMto include use of both prophylactic antibiotics and antenatal corticosteroidsmay alter vaginal flora and predispose to development of this otherwiseuncommon infection.

166 HOME MANAGEMENT OF PRETERM PREMATURE RUPTURE OF MEMBRANESSARAH ELLESTAD (F)1, GEETA SWAMY1, PHILLIP HEINE1, AMY MURTHA1, 1DukeUniversity, Division of Maternal-Fetal Medicine, Durham, North Carolina

OBJECTIVE: To determine outcomes among women with preterm prema-ture rupture of membranes (PPROM) by retrospectively applying criteria forhome management originally described by Carlan (Obstet Gynecol, 1993).

STUDY DESIGN: After IRB approval, a retrospective case-control study ofpatients admitted to Duke University Medical Center with PPROM between22 and 34 weeks gestation was performed. This is a secondary analysis ofsubjects previously enrolled in a prospective cohort study. Demographic andclinical information were collected. The time of the sentinel event leading todelivery was determined by chart review. Criteria described by Carlan wereapplied and included no labor within 72 hours of rupture, singleton gestation,no evidence of infection, cephalic presentation, amniotic fluid index O2cm,and cervix !4cm dilated. For this investigation, all subjects were assumed tolive locally. Subjects were divided into those that delivered !2hours (h) orR2h from the sentinel event for comparison and statistical analysis.

RESULTS: Of the 138 subjects enrolled between 10/97 and 3/04, 65 (47%)met inclusion criteria; 12 (18%) delivered !2h from the sentinel event and 53(82%) delivered R2h. There was no difference in maternal age, race, maritalstatus, insurance, latency, or history of prematurity between the groups. Allsubjects who delivered !2h were multiparous vs. 28% of those who deliveredR2h (p!.05). Of the 12 deliveries occurring !2h from the sentinel event,5 had acute chorioamnionitis, 2 had cord prolapses, 4 had precipitous labor,3 had abruptions and 4 had fetal distress (some subjects had more than oneevent). In addition, subjects who delivered in !2h were less likely to delivervaginally (25% vs. 75%, p!.002), had smaller infants (1234g vs. 1970g,p!.01), had Apgar scores !7 (58% vs. 26%, p!.05) and delivered at anearlier gestational age (27.9wks vs. 30.9wks, p!.004) compared to subjectswho delivered R2h.

CONCLUSION: This study suggests that all patients with preterm PROM ata viable gestational age should be managed as inpatients in a tertiary carefacility.

SMFM Abstracts S57