George Guirguis

Is preeclampsia an independent predictor of diastolic dysfunction? A retrospective cohort study.

OBJECTIVE To determine if preeclampsia is an independent predictor of diastolic dysfunction and what factors among patients with preeclampsia are associated with diastolic dysfunction. METHODS This is a retrospective cohort study of patients who delivered between 2008 and 2013 at a single institution who had a maternal echocardiogram during their pregnancy or within 5months of delivery. Patients with structural heart disease, ejection fraction less than 45%, pulmonary embolus, or age over 45years were excluded. Medical records were reviewed for medical and obstetric complications and echocardiogram findings. Demographic characteristics and rate of diastolic dysfunction were compared between patients with preeclampsia and without preeclampsia. Multivariate logistic regression was performed controlling for age, ethnicity, gestational age at delivery, diabetes, preeclampsia, intrauterine growth restriction (IUGR), antihypertensive use and magnesium sulfate administration. RESULTS Sixty-six patients were identified, of which 39 (59%) had preeclampsia. Past history of preeclampsia, IUGR in the current pregnancy, antihypertensive use and magnesium sulfate use were higher in the preeclampsia group. Fifteen patients (39%) in the preeclampsia group were African-American compared to 2 (3%) in the control group (p<0.01). Seventeen (44%) of the patients with preeclampsia were found to have diastolic dysfunction compared to 3 (11%) controls (OR=6.18, 95% CI 1.59,24.02; p=0.006). Logistic regression analysis did not reveal other independent predictors of diastolic dysfunction. In the patients with preeclampsia, history of preeclampsia with severe features and IUGR were not associated with diastolic dysfunction. CONCLUSIONS Our study supports previous findings that preeclampsia is associated with diastolic dysfunction.

Genital tract GBS and rate of histologic chorioamnionitis in patients with preterm premature rupture of membrane

Abstract Introduction: Histologic chorioamnionitis (HC) is a common finding in the placenta from patients with preterm premature rupture of membranes (PPROM). The purpose of this study is to determine if HC differs based on the Group B streptococcus (GBS) status in patients managed expectantly with PPROM <34 weeks gestation. Methods: A retrospective study was performed of patients admitted with PPROM between 23 0/7 and 33 6/7 weeks from 2003 to 2014 at one institution. Patients were excluded if in labor, evidence of clinical chorioamnionitis, nonreassuring fetal status, multifetal gestation, HIV positive, or if GBS specimens or placental histology were not available. Placental pathology results were compared using Fisher’s exact test. Results: One hundred eighty-one patients met inclusion criteria and 55 (30.3%) were GBS positive. The prevalence of HC did not differ between the GBS positive and GBS negative groups (69 versus 64.2%, respectively; p = .62). Clinical chorioamnionitis, endomyometritis, wound infection, maternal and neonatal sepsis did not differ between the two groups. Conclusions: Vaginal–rectal colonization with GBS on admission does not appear to affect the rate of HC nor neonatal outcome in patients managed conservatively with PPROM <34 weeks gestation.

Preoperative cystoscopy could determine the severity of placenta accreta spectrum disorders: An observational study: Cystoscopy to assess PAS severity

In the surgical treatment of placenta accreta spectrum disorders, cystoscopy for prophylactic stent placement is performed to protect the ureters from potential injury. Despite its frequent use, the use of cystoscopy in assessing the severity of these disorders has not been explored. Our objective was to find out if the abnormal findings documented during cystoscopy are associated with disease severity.

Duration of Latency Period and Histologic Chorioamnionitis in Patients With PPROM From 24 to 32 Weeks [24Q]

INTRODUCTION: The study objective was to determine if rates of histologic chorioamnionitis (HC) increased with longer latency periods. METHODS: This was a retrospective cohort study at a single institution from 1/1/2001 to 12/31/14 of patients admitted for conservative management with PPROM between 24 0/7 to 32 6/7 weeks. Patient were excluded if they were not a candidate for expectant management, multifetal gestation, HIV positive, delivered prior to hospital day 2 or did not have placental pathology results available. Patients were grouped by days from admission to delivery and rates of HC were compared. Mann-Whitney, Chi-square and Fishers exact tests were used. RESULTS: 143 patients were included, 97 (68%) had HC. Median gestational age at time of PPROM was lower in the HC group (28 compared to 30 weeks, P=.004). The median latency period with and without HC were 6 (range 2–36) and 9 days (range 2–53), respectively (P=.047). For the group with a latency of 2–7 days, the rate of HC was 75%, similar to those who delivered from 8–14 days (70%, P=.75). HC in patients who delivered after 14 days was 42%, lower than the day 2–7 group (P=.0045). Clinical chorioamnionitis was similar between the two groups (HC 17.4%; no HC 21.6%, P=.66). The latency period did not differ in patient with and without clinical chorioamnionitis. CONCLUSION: There was no increase in histologic chorioamnionitis as the latency period increased in this cohort. Although the overall rate is high, this data does not suggest a specific time point when delivery can be recommended.

Is Obesity Protective in Pyelonephritis in Pregnancy? [17J]

INTRODUCTION: Acute pyelonephritis is a major cause of infectious morbidity and ICU admissions in pregnancy. In the non-obstetric critical care literature, an “obesity paradox” has been described where increasing Body Mass Index (BMI) is associated with decreased mortality in septic patients admitted to the ICU. Here we study the association between BMI, pyelonephritis in pregnancy, and ICU admission. METHODS: A retrospective cohort study was performed on all pregnant patients admitted with pyelonephritis for the past 5 years. Data was collected on BMI at presentation, BMI postpartum, disease severity (SIRS, sepsis, or septic shock), and ICU admission. To define the distribution of BMI in our general obstetric population, BMI was recorded for all patients delivering at our institution over a one year period. Patients were grouped by BMI category: normal weight (18.5–24.99 kg/m2), overweight (25–29.99 kg/m2), or obese (greater than 30 kg/m2), and distributions compared by Chi-square test. RESULTS: The distribution of BMIs in patients with pyelonephritis (n=89) versus general obstetric patients (n=1,076) was significantly different (P<.0001) with 43% versus 11% normal weight, 34% versus 28% overweight, and 23% versus 61% obese, respectively. Postpartum BMIs in patients with pyelonephritis were increased but still significantly different from the general obstetric population (P=.0018). Among patients with pyelonephritis, the odds ratio for ICU admission/shock was 0.25 for obese versus normal/overweight (not significant at P=.2). CONCLUSION: In this obstetric population, obesity was associated with a decreased incidence of pyelonephritis and a trend towards decreased disease severity suggesting a role for the “obesity paradox” in pregnancy.

Is Preeclampsia an Independent Predictor of Diastolic Dysfunction?: A Retrospective Cohort Study [167].

INTRODUCTION: To determine whether preeclampsia is an independent predictor of diastolic dysfunction and what factors among patients with preeclampsia are associated with diastolic dysfunction. METHODS: This is a retrospective cohort study of patients who delivered between 2008 and 2013 at a single institution who had a maternal echocardiogram during their pregnancy or within 5 months of delivery. Patients with structural heart disease, ejection fraction less than 45%, pulmonary embolus, or age older than 45 years were excluded. Medical records were reviewed for medical and obstetric complications and echocardiogram findings. Demographic characteristics and rate of diastolic dysfunction were compared between patients with preeclampsia and without preeclampsia. Multivariate logistic regression was performed controlling for age, ethnicity, gestational age at delivery, diabetes, preeclampsia, intrauterine growth restriction (IUGR), antihypertensive use, and magnesium sulfate administration. RESULTS: Sixty-six patients were identified; 39 (59%) had preeclampsia. A history of preeclampsia, IUGR in the current pregnancy, antihypertensive use, and magnesium sulfate use was higher in the preeclampsia group. Fifteen (38.5%) in the preeclampsia group were African American compared with two (3%) in the control group (P<.01). Seventeen (44%) of the patients with preeclampsia were found to have diastolic dysfunction compared with three (11%) patients in a control group (odds ratio 6.18, 95% confidence interval 1.59–24.02; P=.006). Logistic regression analysis did not reveal other independent predictors of diastolic dysfunction. In the patients with preeclampsia, a history of preeclampsia, severe disease, and IUGR were not associated with diastolic dysfunction. CONCLUSION: Our study supports previous findings that preeclampsia is associated with diastolic dysfunction.

Does Histologic Chorioamnionitis in Patients With Preterm Premature Rupture of Membranes Depend on Group B Streptococcus Status? [118]

INTRODUCTION: Histologic chorioamnionitis is a common finding in patients with preterm premature rupture of membranes (PROM). The purpose of this study is to determine whether the rate of histologic chorioamnionitis differs based on group B streptococcus (GBS) carrier status in candidates for expectant management for preterm PROM at less than 34 weeks of gestation. METHODS: A retrospective study was performed of all pregnant women admitted with preterm PROM between 23 0/7 weeks and 33 6/7 days of gestation from January 1, 2005, to June 15, 2014, at our institution. Patients included were candidates for expectant management. Patients were excluded if there was evidence of chorioamnionitis, nonreassuring fetal status or labor at the time of admission, multifetal gestation, if they were human immunodeficiency virus–positive, if GBS cultures were not performed, or if histology was not available. Specimens for GBS analysis were obtained on admission from the lower third of the vagina and rectum. Placental pathology results were compared using Fishers exact test. RESULTS: One hundred sixty-five patients met inclusion criteria and 56 (33.9%) patients were GBS-positive. Prevalence of histologic chorioamnionitis did not differ between the GBS-positive and GBS-negative groups (66% compared with 63.3%, respectively; P=.86). Clinical chorioamnionitis, wound infection, and maternal and neonatal sepsis did not differ between the GBS-positive and GBS-negative groups, although the rate of endometritis trended higher in the GBS-negative group (13.8% compared with 3.6%, P=.057). CONCLUSION: Group B streptococcus genital tract colonization on admission does not appear to affect the rate of histologic chorioamnionitis in patients with preterm PROM managed conservatively at less than 34 weeks of gestation.