SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018 - 122A

122A

Reproductive Sciences Vol. 25, Supplement 1, March 2018

RESULTS: Twenty one patients were included in the analysis. Average
age of twenty one subjects was 27.2 years, with range of 17 to 38.
Ethnicity in the group included three Caucasians, thirteen Hispanics, and
five African Americans. Gestational age ranged between 19 to 37 weeks,
with an average of 29.7 weeks. Six patients were in the second trimester
(29%) and fifteen patients in the third trimester (71%). Average Body
Mass Index was 36.14, range of 25-52. Three patients were overweight,
twelve obese and six morbidly obese. Four patients were nulliparous and
seventeen multiparous. Seven patients had cesarean sections for multiple
reasons (35%), thirteen had vaginal deliveries (65%). Average Amylase
was 265, with a range of 167 to 575. Average Lipase results were 524,
with a range of 279 to 1,375. Twenty patients had moderate elevation of
triglycerides and one had severe range elevation. Average elevation of
triglycerides was 735.1, range of 459 to 1,250. Three patients had family
history of dyslipidemia. Complications in this group of patients included:
Myocardial Infarction (1), Pancreatic Cyst (2), ARDS (2), Pre Term Labor
(7) and Severe Electrolyte Abnormalities (4).
CONCLUSION: Hypertriglyceridemia at moderate levels was associated
with complications in Acute Pancreatitis in Pregnancy (previous reports
had complications were only at severe levels). Patients with elevated BMI
appear to be at higher risk for hypertriglyceridemia. Sixty two percent
of our patients were Hispanics, this finding may indicate that Hispanics
are at greater risk for hypertriglyceridemia. Clinicians might consider
evaluating triglycerides in patients with Acute Pancreatitis in pregnancy
and risk factors such as elevated BMI, ethnic background, family history
of dyslipidemia. Hypertriglyceridemia and acute Pancreatitis in pregnancy
places patients at a higher risk for complications.

T-036
A Study to Compare the Clinical Efficacy of Antihypertensive Agents
during the Postpartum Period. Kendra R Sylvester†, Daniel Gibson*,
Erich Wyckoff*, Joaquin Santolaya-Forgas*, Sharon Byun*, Candace
Rouse*, Robert Egerman*. University of Florida College of Medicine,
Gainesville, FL, United States.
INTRODUCTION: The pathophysiology of postpartum hypertension
differs from antepartum hypertensive disorders. Reports on best
postpartum management of hypertension are limited, however. The
purpose of this study was to gain further insight into the clinical efficacy of
the most commonly used antihypertensive agents in the postpartum period.
METHODS: This was a retrospective study performed after IRB
approval. We compared the efficacies of various antihypertensive drugs
in terms of control of postpartum hypertension. All patients delivered at
our Hospital between 1/1/2011 and 9/30/2016. Patients were identified
using the Hospital ICD-9/-10 codes pertaining to hypertensive disorders
of pregnancy. Patients treated with antihypertensive agents during the
6 weeks postpartum period were then identified. Favorable clinical
control was defined when the systolic blood pressure was < 150 mm
Hg, whereas systolic blood pressure > 150 mm Hg were considered
uncontrolled. The time spent under 150 mm Hg between the dosages of
a given antihypertensive agent was used as the metric for clinical efficacy
and for comparisons among the antihypertensive agents (Figure 1a). Data
analysis was performed using one-way Analysis of Variance. Post hoc
analysis using Tukey's multiple comparison method was then performed
to validate the observations.
RESULTS: 1,269 patients were identified using the ICD codes and a
cohort of 338 met the inclusion criteria into the study. The blood pressure
control (below 150 mmHg) with Nifedipine, Furosemide, Metoprolol
and Diltiazem were better when compared to Methyldopa or Labetalol
(P<0.01). The degree of blood pressure control with Metoprolol was
significantly better p<0.05 when compared to all other antihypertensive
agents (Figure 1b).
CONCLUSION: These findings suggest that commonly used
antihypertensive agents provide a reasonable blood pressure control over
the postpartum period. Our novel observation is that Metoprolol appears to
be the most efficacious agent in terms of degree of blood pressure control.
Further studies are needed to confirm this finding.
*Figure(s) will be available online.

Scientific Abstracts

T-037
Low-Dose Betamethasone Exposure for 26 Hours Optimises Fetal
Exposure and Lung Maturation in a Sheep Model of Pregnancy.
Matt Kemp, 3 Haruo Usuda, 3 Masatoshi Saito, 3 Peter Eddershaw, 2
Augusto Schmidt,1 Alan Jobe.1 1CCHMC, Cincinnati, OH, United States;
2
GlaxoSmithKline, Stevenage, United Kingdom; 3University of Western
Australia, Perth, Australia.
INTRODUCTION: Antenatal steroids (ANS) are widely used to
functionally mature the preterm lung. ANS dosing remains unoptimized
despite human and animal data linking excess antenatal steroid exposure
with adverse changes in fetal development. Using a sheep model of
pregnancy, we show that ANS efficacy is independent of peak fetal
steroid exposure, but dependent on the duration of a low-amplitude fetal
plasma exposure.
METHODS: Following ethical review and approval, date-mated ewes
(120 ± 1 day gestation) were randomised to receive either: i) 2 x 0.25mg/
kg intramuscular injections of Celestone Chronodose (betamethasone
acetate and phosphate) spaced by 24h (total average steroid dose 29
mg; predicted fetal plasma betamethasone Cmax 10 ± 1 ng/mL; n=10)
representing current clinical ANS use; ii) an intravenous loading dose and
constant infusion designed to maintain a stable fetal plasma betamethasone
concentration of 1-4 ng/mL for 26 hours (total average steroid dose 7.9
mg; predicted fetal plasma betamethasone Cmax 3 ± 1 ng/mL; n=10); or
iii) 2 x intramuscular injections of saline spaced by 24h (n=17). After 48
hours, lambs were delivered, ventilated for 30 minutes, and euthanised.
Data were analysed with ANOVA according to distribution and variance,
with p values less than 0.05 taken as significant. Power calculations,
steroid dosing, and predicted plasma betamethasone Cmax values were
based on previous work (Kemp et al., Am J Obgyn 215(6) 2016).
RESULTS: Animals in the 26 h infusion group received approximately
a 70% lower dose of ANS than those in the Celestone Chronodose group.
After 30 minutes of ventilation there were no significant differences in
arterial blood pH, paO2, paCO2, peak inspiratory pressure, compliance,
heart rate, or ventilator efficiency index between the two steroid-treated
groups. Both steroid-treated groups were significantly different to saline
control with respect to all ventilation efficacy measures.
CONCLUSION: In preterm lambs, ANS efficacy depends on an extended
period of low-amplitude fetal steroid exposure, with additional dose
conferring no treatment benefit. These data suggest that current clinical
dosing regimens may be excessive. Dose optimisation based on lean
maternal weight may allow for a more efficacious and safer application
of ANS therapy.

T-038
Maternal Endotoxin Activity in Pregnancy and in Pregnancies
Complicated by Preterm Premature Rupture of Membranes: A
Case-Control Study. Stefania N Ronzoni*,3 Rohan D'Souza,2 Oksana
Shynlova,1 Stephen Lye,1 Kellie E Murphy.2 1Lunenfeld-Tanenbaum
Research Institute, Toronto, ON, Canada; 2Mount Sinai Hospital, Toronto,
ON, Canada; 3Sunnybrook Health Care Centre, Toronto, ON, Canada.
INTRODUCTION: To compare maternal peripheral blood endotoxin
activity (EA) in women with preterm premature rupture of membranes
(pPROM) at admission with gestational age (GA) matched controls; to
serially evaluate EA in pPROM and determine its correlation with latency
to delivery and chorioamnionitis.
METHODS: We followed singleton pregnancies between 23+1-35+6
weeks longitudinally from admission with pPROM until birth. Pregnancies
complicated with acute chorioamnionitis, prior uterine procedure,
preeclampsia, intrauterine growth restriction, elevated BMI, substance
abuse and chronic maternal disease were excluded. Uncomplicated,
GA-matched pregnancies without pPROM served as controls. Maternal
demographics, birth and neonatal outcomes were collected. EA (EAA™,
Spectral medical inc., Canada) was assessed in pPROM (<48 hours from
pPROM and weekly until birth), and in controls at study entry. EA levels
were compared using Student's t-test, p value <0.05 was considered
significant.
RESULTS: We recruited 20 cases of pPROM and 20 controls. Maternal
demographics were similar between groups. The mean GA of pPROM
Table of Contents for the Digital Edition of SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018
