216 EVIDENCE FOR COMPLEMENT ACTIVATION IN PREMATURE LABOR ASSOCIATEDWITH INTRA-AMNIOTIC INFECTION ELEAZAR SOTO1, ROBERTO ROMERO2, KARINARICHANI1, TINNAKORN CHAIWORAPONGSA1, BO HYUN YOON3, JYH KAE NIEN2,SAM EDWIN2, JUAN PEDRO KUSANOVIC2, JIMMY ESPINOZA1, 1Wayne StateUniversity School of Medicine, Department of Obstetrics and Gynecology,Detroit, Michigan, 2Perinatology Research Branch, NICHD, NIH, DHHS,Detroit, Michigan, 3Seoul National University College of Medicine, Depart-ment of Obstetrics and Gynecology, Seoul, South Korea

OBJECTIVE: The complement system plays an important role in hostdefense against infection. Complement split product concentration or ana-phylatoxins (C3a, C4a and C5a) are indices of complement activation. Thepurpose of this study was to determine if term and preterm parturition isassociated with evidence of complement activation in the amniotic cavity.

STUDY DESIGN: AF samples were collected from 270 women in thefollowing groups: 1) normal pregnant women in midtrimester (n=70),2) term not in labor (n=23), 3) term in labor (n= 48), and 4) preterm labor(PTL) (n=129). PTL was categorized into: a) PTL without IAI and termdelivery (n=42), b) preterm delivery (PTD) without IAI (n=57), and c) PTDwith IAI (n=30). C5a, C4a and C3a concentrations were determined byELISA. Non-parametric tests were used for statistical analysis.

RESULTS: 1) AF C5a concentration was higher in women at term thanthose in the midtrimester (p=0.02); 2) Spontaneous labor at term was notassociated with changes in AF concentrations of anaphylatoxins (pO0.05);3) Among patients with PTL, those with IAI had higher AF C4a and C5aconcentrations than those without IAI (p!0.01). AF C3a concentration washigher in patients with PTD and IAI than those with PTL who delivered atterm (p=0.002). Patients with PTD without IAI had a higher median AF C4aconcentration than those with PTL who delivered at term (p=0.03).

CONCLUSION: 1) AF concentration of C5a increases as a function ofgestational age; 2) Intra-amniotic infection is associated with evidence ofcomplement activation (C5a and C4a); 3) Neither preterm parturition in theabsence of infection nor labor at term is associated with changes in AF C5a,the most potent anaphylatoxin.

S74 SMFM Abstracts

214 WHAT DO WE (END-USERS) KNOW REGARDING SAFETY OF ULTRASOUND DURINGPREGNANCY? EYAL SHEINER1, ILANA SHOHAM-VARDI2, JACQUES ABRAMOWICZ3,1Soroka University, Beer-Sheba, Israel, 2Ben-Gurion University of the Negev,Epidemiology and Health Services Evaluation Department, Faculty of HealthSciences, Beer-Sheva, Israel, 3Rush University Medical Center, Ob/Gyn,Chicago, Illinois

OBJECTIVE: The main goal of this study was to determine end-usersknowledge regarding safety aspects of diagnostic ultrasound (US) duringpregnancy. End-users’ attitudes towards the utilization of ultrasound in lowrisk pregnancies were also assessed.

STUDY DESIGN: A questionnaire was distributed to ultrasound end-users(physicians, sonographers, nurse practitioners) attending review courses andground-rounds between April-June 2006.

RESULTS: One hundred thirty end-users completed the questionnaires,(63% response rate). Sixty-three percent were physicians (n=84), the majorityof them, obstetricians (81.7%). Average number of US exams performed dailyranged from1-31, with a mean of 7.8G6.0. About 18% of participantsperformed Doppler during the 1st trimester routinely. Fifty percent of end-users thought there should be limitations regarding the number of ultrasoundexams in low-risk pregnancy, and believed this number should be 2-3(2.6G0.9). The other half did not think there should be any such limitation.Almost 70% disapproved of ‘‘keep-sake/entertainment’’ US. While 32.2% ofthe participants were familiar with the term thermal-index (TI), only 17.7%actually gave the correct answer on the nature of TI. About 22% were familiarwith the term mechanical index (MI), but only 3.8% described it properly.Almost 80% of end-users did not know where to find the acoustic indices, TIand MI. Only 20.8% were aware they are displayed on the US monitor duringthe exams. No significant differences were noted between physicians and otherend-users regarding their knowledge of safety issues.

CONCLUSION: Ultrasound end-users show poor knowledge regarding safetyissues during pregnancy. More than two thirds do not know the significance ofthe acoustic output indices nor where to find them when performing a scan.Further efforts in the realm of education and training are needed in order toincrease knowledge of end-users about the acoustic output of the machines andsafety issues.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2006.10.235

215 THE CLINICAL EFFICACY OF MMP-8 PTD CHECK FOR THE DIAGNOSIS OF AMNIOTICFLUID INFECTION JAE-YOON SHIM1, HYE-SUNG WON1, PIL RYANG LEE1, AHM KIM1,1University of Ulsan, College of Medicine, Asan Medical Center, Obstetrics &Gynecology, Seoul, South Korea

OBJECTIVE: To compare the value of amniotic fluid (AF) tests in thedetection of microbial invasion of the amniotic cavity.

STUDY DESIGN: From January 2005 to July 2006, Transabdominal amni-ocentesis was performed in 156 women with suspected or proven preterm laboror premature preterm rupture of membrane or maternal-fetal indications.AF analysis included white blood cell (WBC) count, glucose and MMP-8PTD check�. AF was cultured for aerobic and anaerobic bacteria and formycoplasmas.

RESULTS: The positive rate of AF culture was 18.6% (29/156). The medianAF WBC count and the positive rate of MMP-8 PTD check were significantlyhigher in women with a positive culture than in women with a negative culture(400 cells/mm3 vs 1 cells/mm3; p!0.001, 86.2% (25/29) vs 25.2% (32/127);p!0.001). The median AF glucose concentration was significantly lower inwomen with a positive culture than in women with a negative culture (15 mg/dL vs 33 mg/dL, p!0.01). In the context of diagnostic indices, the sensitivitiesof AF MMP-8 PTD check, AF WBC (O19 cells/mm3) and AF glucose (O15mg/dL) for the detection of AF infection were 86.2%, 75.9% and 48.3%respectively. The specificity of AF MMP-8 PTD check, AF WBC (O19 cells/mm3) and AF glucose (O15 mg/dL) for the detection of AF infection were74.8%, 80.3% and 80.3% respectively.

CONCLUSION: MMP-8 PTD check� is a rapidly and easily performedmethod and can be useful for the detection of AF infection. The diagnosticindex values of each test for amniotic fluid infection

Sensitivity Specificity PPV NPV OR (95% CI)

AF Glucose (!15mg/dl) 48.3% 80.3% 35.9% 87.2% 3.8 (1.6-8.9)AF WBC (O19/mm3) 75.9% 80.3% 46.8% 93.6% 12.8 (4.9-33.4)AF MMP-8 (O10ng/ml) 86.2% 74.8% 43.9% 96.0% 18.5 (6.0-57.4)

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2006.10.236

Table 1

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2006.10.237

217 THE MFMU CESAREAN REGISTRY: RISK FACTORS FOR NEONATAL SEPSIS AMONGWOMEN WITH CHORIOAMNIONITIS CATHERINE SPONG1, 1for the NICHDMFMU Network, PPB, Bethesda, Maryland

OBJECTIVE: Risk factors for neonatal sepsis include chorioamnionitis andcesarean delivery after labor. Delivery after chorioamnionitis typically resultsin a sepsis evaluation (blood work, spinal tap) for the infant, although at termthe yield is low. The objective of this study was to identify predictors ofneonatal sepsis in women at term who delivered by cesarean with chorioam-nionitis during labor.

STUDY DESIGN: Using a multicenter network of 19 sites, women with asingleton term gestation (R37wk) with information on chorioamnionitis andneonatal sepsis who delivered by cesarean were studied from 1999-2002. Chori-oamnionitis was diagnosed clinically, neonatal sepsis was proven by blood culture.

RESULTS: 2,749 women had chorioamnionitis and of these, 38 (1.4%) hadproven neonatal sepsis. Maternal demographics (age, nulliparity, GA delivery)were not related to the risk of neonatal sepsis. Intrapartum factors are inTable.

CONCLUSION: At term, infants born by cesarean with chorioamnionitis donot have identifiable risk factors for neonatal sepsis that would refine whichinfants should undergo a sepsis evaluation.

Sepsis No Sepsis P

GBS positive 2 (5%) 227 (8%) 0.8Labor or induction 38 (100%) 2675 (99%) 1.0Labor length (h) 21.6G8.9 21.3G11.2 0.3Duration ROM (h) 14.0G6.6 15.4G14.1 1.0IUPC 33 (87%) 2216 (82%) 0.4Persistent fetal tachycardia 27 (71%) 1470 (55%) 0.04Persistent mat tachycardia 22 (58%) 1152 (43%) 0.06Max maternal temp 101.2G1.1 100.9G0.8 0.2Maternal leukocytosis 3 (9%) 173 (7%) 0.7Malodorous discharge 3 (8%) 124 (5%) 0.4Uterine tenderness 6 (18%) 207 (8%) 0.055 min Apgar !3 2 (5%) 9 (0.3%) !.001

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2006.10.238