$190

399

SMFM Abstracts

MATERNAL VASCULAR/ENDOTHELIAL FUNCTION IN UNCOMPLI- CATED DIABETIC PREGNANCY MICHAEL MORETTI t, AHMED ABOUZEID l, JAMES PULLANO 1, STUART KATZ 2, ALESSANDRO GHI- DIN13, J O H N PEZZULLO 4, CAROLYN SALAFIAS; 1St Virlcent's Catholic Medical Center, Obstetrics, Staten Island, NY; 2Columbia University, Medicine, New York, NY; 3Georgetown University, Obstetrics and Gynecology, Washing- ton, DC; 1Georgetown University, Pharmacology, Washington, DC 5Columbia University, Epidemiology, Larchmont , NY

OBJECTIVE: Diabetes (DM) is character ized by systemic vascular dysfunction. DM pregnanc ies are more likely to develop preeclampsia , a pregnancy-limited endothelial dysfunction state. Systemlic vascular dysfunction was assessed in clinically uncomplicated DM pregnancies.

STUDY DESIGN: From 4-7/01, pat ients p resen t ing for care at the St Vincent 's Hospital OB Clinic were solicited for consent to participate, 11 DM (Class A-D) and 23 normal patients were assessed, in the fasting state, for large (C1) and small (C2) ar tery elasticity indices (CVProfilor®, Hyper tens ion Diagnostics, lnc) , and arterial resistance via forearm occlusive venous plethysmography. Maternal age (MA), BMI @exam, and gestational age (GA) were collected.

RESULTS: In DM patients, lower IVlA and h igher BMI were related to h igher min imum resistance (overall R = 0.99, P = .026). BMI was inversely related to peak b lood flow (R - 0.52, P = .03). Compared to 23 normal pregnant patients, DM status and higher BMI were related to reduced total excess blood flow (R - -.58, P= .01), after controll ing for MA and GA.

CONCLUSION: Subclinical endothel ia l dysfunct ion--ref lect ive of decreased endothel ia l NO product ior l - - i s present and measurable in uncomplicated Class A-D DM paderlts, and is inversely related to BMI. These tools may help risk mssessment of DM patients for later complications. Table Results

MEAN SD RANGE

Gestational age (wk) 26.6 8.5 13-38 Maternal age (yr) 31.5 6.4 2240 BMI 30.4 5.8 2140 Cl-Large artery elasticity index 13.2 4.9 8.2-25 C2-Small artery elasticity index 7.8 3.2 3.5-13 Total excess blood flow (~NO post-hypoxia) 89 30 51-137 Baseline resistance (pre-hypoxia) 15.3 8.5 1.3-24 Minimum resistance (post-hypoxia) 1.4 .09 1.03-2.12 Time to normalization (recovery time in secs) 115 38 35-151

401

December 2001 AmJ Obstet Gynecol

INTRAPARTUM ANTIBIOTIC PROPHYLAXIS WITH EITHER PENI- CILLIN O R AMP1CILLIN MAY INCREASE THE RATE OF NEONATAL SEP- SIS CAUSED BY AMPIC1LLIN-RESISTANT GRAM-NEGATIVE BACTERIA RODNEY EDWARDS 1, PENNY CLARK 1, PATRICK DUFF 1, ]University of Florida, Obstetrics and Gynecology, Gainesville, FL

OBJECTIVE: To determine if the antibiotic chosen for intrapartuin anti- biotic prophylaxis (IAP) affects the exposure of neonates to ampicillin- resistant Gram-negative bacteria.

STUDY DESIGN: We per formed a randomized trial of penicillin versus ampicil l in for IAP in women who were admit ted for labor at >-36 weeks gestational age. Women with a history of penicillin allergy received clinda- mycin (data not shown). Culture specimens from the lower vagina, per ineum, and perianal area were obtained at study erltry and 8-36 hours postpartum. Organisms of the Enterobacteriaceae family were isolated on MacConkey agar, identified, and tested for susceptibility to ampicillin by the Kirby-Bauer disk diftusion method. Data were analyzed using the chi-square test.

RESULTS: See Table for the "intent-to-treat" analysis. Results were sinfilar when considering only those women who received 2 or more doses of IAP and no additional antibiotics.

CONCLUSION: IAP with ei ther penicillin or ampicill in increases the i r l t rapar tum exposure of neonates to ampicillirl-resistant Gram-negative organisms.

Table

ANY RESISTANT ENTERO-

RESISTANT BACTERLACEAE E. COld ORGANISM

G R O U P ENTRY P O R T P V A L U E ENTRY P O R T P V A L U E

Penicillin 18% 32% .002 28% 51% <.001 (n = 177)

Ampicillin 21% 33% .01 34% 48% .006 (n = 175)

Pvalue .51 .91 - - ,22 .63 - -

400 CORRELATING ANTENATAL AND INTRAPARTUM COLONIZATION WITH GROUP B STREPTOCOCCI RODNEY EDWARDS 1, PENNY CLARK t, PATRICK DUFF t, tUniversity of Florida, Obstetrics and Gynecology, Gaines- ville, FL

OBJECTIVE: To determine the probability of group B streptococci (GBS) cartier status at the time of labor among women previously identified as GBS carriers.

STUDY DESIGN: We per formed a prospective cohort study of 377 women admitted for labor at >36 weeks gestation who previously were identified as carriers of GBS by: genital tract cultures dur ing the current pregnancy (group 1), ur ine cul tures for GBS dur ing the cu r ren t p r egnancy (group 2), or a history of a positive urine or genital tract culture in a previous p regnancy (group 3). Cultures for GBS were per formed by inoculating specimnens into selective broth for 18-24 hours and subculturing onto nonselective solid blood agm: For each group, the proport ions of women (95% confidence intervals (CI)) with positive intrapar tum cultures were calculated. All GBS isolates were tested for susceptibility to penicill in, ampicill in, cefazolin, vancomycin, clindamycirl, and erythromycin by the Kirby-Bauer disk diffusion method.

RESULTS: Of women in groups 1 (rl = 249), 2 (n = 69), and 3 (n = 59), respectively, 68% (95% C162, 73), 61% (95% C149, 72), and 48% (95% CI 36, 60) had positive GBS cultures at the time of labol: Of women in group 1 who were identified as carriers by cultures done <42 days prior to delivery (n = 218), 67% (95% CI 61, 73) b a d positive cul tures at the time of labor. The susceptibility of GBS isolates (n = 231) to penicillin, ampicillin, cefazolin, and vancomycin was 100% (95% CI 98, 100). Susceptibility to clindamycin and e~Tthromycin was 91% (95% C187, 94) and 79% (95% CI 73, 84), respectively.

CONCLUSION: Antenatal and intrapar tum genital tract cultures for GBS are less well correla ted than previously repor ted. This correla t ion did not improve when considering only short intervals between cultures. Susceptibility of GBS isolates to erythromycin is too low to justify, its use for prophylaxis against neonata l GBS infection.

402 DOES GBS CHEMOPROPHYLAXIS I N C ~ E THE RISK OF NON-GBS NEONATAL SEPSIS? PATRIZIA VERGANI t , ALESSANDRO GHID1NIZ, LUISA PATANE '1, CARLA COLOMBO 1, CESARINA BORRON1 l, ANTONI- ETTA SCIAN 1, GIUSEPPE GILTRP; tUrliversity of Milano-Bicocca, Obstetrics and Gynecology, Monza; 2Georgetown University, Obstetrics arid Gynecology, Washington. DC

OBJECTIVE: ln t rapar tum chemoprophylaxis for GBS based on risk factors or universal screening with cultures has decreased the incidence of neonatal early-onset GBS disease in the past decade. It is currently unknown, howevel, whether such policy results in an increase in the emergence of non-GBS microorganisms that are penicillin-resistant. We have compared the rates of non-GBS neonatal disease across 3 time periods in which diflerent strategies for GBS prophylaxis were adopted.

STUDY DESIGN: From 1/87 to 12/90 (historic controls) no organized approach tor GBS prophylaxis was used at our cerlte~: From 1/91 to 12/94, prophylaxis with ampicillin was given to wmnen with risk factors for neonatal GBS disease (preterm labor, prolonged rupture of membranes, maternal fever, maternal urinary infection with GBS dur ing pregnancy, or previous child with neonatal GBS disease). From 1/95 to 12/99 universal screening for GBS was introduced, and ampicillin was given to wmnen with positive cultures or risk factors. Neonatal managemen t did not change dur ing the 3 study periods. Comparison of n o n ~ B S early onset neonatal sepsis among the 3 time periods was per formed using Chi-square for trend, with a 2 tailed P < .05 considered significant.

RESULTS: The rate of early-onset GBS sepsis decreased significantly with in t roduct ion of GBS prophylaxis (P < .05). The rate of rlorl-GBS neonata l sepsis was 1.3/1000 (11/8573) dur ing the historic control period, 0.9/1000 (9/10,303) du r ing the risk-factors only per iod, and 0 .6 /1000 (9/13754) dur ing the universal screening period. The reduct ion in non-GBS neonatal disease was not significant (P~ .31).

CONCLUSION: Introduct ion of GBS prophylaxis does not increase tbe rate of non-GBS neonatal sepsis. In fact, a policy of GBS prophylaxis resulted in a non-significant decrease in such rate in our population.