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hypertensive women who are pregnant Karen Wilson, Scott Roberts, Donald McIntire, James M. Alexander University of Texas Southwestern Medical Center, Obstetrics and Gynecology, Dallas, TX OBJECTIVE: To determine if routinely obtained echocardiograms are indicated in chronic hypertensive women who are pregnant. STUDY DESIGN: All women with chronic hypertension requiring medication for blood pressure control are referred to a specialty clinic. We routinely obtain echocardiograms, in these women, as routine evaluation of their hypertensive disease when they initially present for prenatal care. For this analysis, we compared maternal and neonatal outcomes in women with and without cardiac findings on echocardiogram from January 2008 through December 2010. None of the women had evidence of heart disease at the time of echocardiogram other than their diagnosis of chronic hypertension. RESULTS: Outcomes were analyzed in 125 women with chronic hypertension and 88 women had normal echocardiograms while 37 women had abnormal echocardiograms. There was found to be no significant differences in maternal outcomes and the incidence of preeclampsia. CONCLUSION: Abnormal echocardiogram findings are common in women with chronic hypertension; however pregnancy outcomes are not impacted by these findings if they are otherwise asymptomatic.

Objective: The purpose of this study was to determine whether selected fetal heart-rate (FHR) patterns and the interval from diagnosis to delivery in pregnancies complicated by chorioamnionitis could predict neonatal outcome.Methods: During a 6-month period, 217 consecutive patients with acute chorioamnionitis were prospectively identified in labor. Following delivery, the fetal monitor strips and hospital courses were reviewed for both the mother and neonate. Multiple logistic regression was used to analyze the presence of a nonreassuring FHR pattern and the effect on neonatal outcome. Fisher exact tests were used to analyze the time intervals from the diagnosis of chorioamnionitis to delivery and their significance on neonatal outcome parameters.Results: The overall incidence of chorioamnionitis in our population was 2.3%. None of the independent variables analyzed following the diagnosis of chorioamnionitis until delivery were significantly associated with an umbilical artery (Ua) pH < 7.20. There were no differences in cord pH, Apgar scores, sepsis, admission to special-care nursery, and oxygen requirements in neonates based on the duration of time from the diagnosis of chorioamnionitis to delivery in our study. None of the newborns had pathologic fetal acidemia (Ua pH < 7.00). None of the FHR patterns we identified after the diagnosis of acute chorioamnionitis were significantly associated with neonates with a Ua pH < 7.20.Conclusions: An interval from diagnosis to delivery of up to 12 h plays little if any role in neonatal outcome.

Objective:The purpose of this study was to determine if bacterial growth occurred in the amniotic fluid of laboring women. Twenty patients who required an intrauterine pressure catheter (IUPC) during labor were studied. Amniotic fluid samples were aspirated during labor and at the time of delivery.Methods:IUPCs were placed in laboring patients for a variety of reasons. Cervical cultures were taken prior to insertion of an IUPC. After the IUPC was placed, amniotic fluid cultures were taken both at the time of placement and 30 minutes prior to delivery. These cultures were sent for aerobic, anaerobic,Mycoplasma, andUreaplasmacultures.Results:The increase in bacterial concentration from the initial sample to the final sample was statistically significant (P< 0.01) for both aerobes and anaerobes. Amniotic fluid samples demonstrated a median of 0 bacterial species per patient on initial collection and 2 bacterial species per patient in final collection. The mean count of cfu for erobes in the initial amniotic samples was 3.5 ×104, compared to that of the second samples, which was 1.4 ×105. The mean count of cfu for anaerobes in the initial amniotic fluid samples,.was 4.1 ×102, compared to that of the second samples, which was 8.0 ×103. Only 3 of 20 patients developed chorioamnionitis, with only 1 patient having an increased number ofbacterial species significantly higher than the median. Although 80% of patients had a colony count ≥102cfu/cc, only 19% of this group developed chorioamnionitis.Conclusions:The number of bacterial species and colony counts increased significantly during labor, but this factor alone was not enough to cause chorioamnionitis in a significant number of patients.

205 THE EFFICACY AND SAFETY OF INFLUENZA VACCINATION IN PREGNANCY JEANNE SHEFFIELD, VANESSA LAIBL, SCOTT ROBERTS, MARY LORIMER, BRIAN CASEY, DON MCINTIRE, GEORGE D. WENDEL JR, University of Texas Southwestern Medical Center at Dallas, Obstetrics and Gynecology, Dallas, Texas OBJECTIVE: Limited data are available about the efficacy of influenza vaccination in pregnant women. We sought to measure the efficacy and safety of the inactivated influenza vaccine in pregnant women during the 2003-2004 influenza season. STUDY DESIGN: Pregnant women R20 weeks gestation from our prenatal clinics were offered the inactived influenza vaccine during the 2003-2004 influenza season. Data prospectively were collected on vaccinated women and a matched control group receiving prenatal care during the influenza season at the same gestational age who did not get vaccinated. Student t-test and chisquare analysis were performed to compare the two groups. RESULTS: During the 2003-2004 influenza season, 2889 pregnant women received the inactive influenza vaccine. To date, 2352 (81%) of these women have delivered, and the analysis is limited to this subset. The comparison group includes 1988 women. There were no significant differences in demographic characteristics between the 2 groups.The mean EGA at vaccination was 30.0 G 5.9 weeks. The vaccinated group was less likely to deliver an infant !36 weeks (3% versus 5%, P = .02) and less likely to have a newborn NICU admission (P = .04). All other obstetric and neonatal complications were similar in the 2 groups, including neonatal infection and malformation rates. Overall, 6 women (2.6 per 1000) in the vaccinated group developed laboratory confirmed influenza and 13 women (6.5 per 1000) developed infection in the non-vaccinated group (P = .047). When restricting the analysis to those women developing influenza >2 weeks after vaccination, the time required to develop immunity, there was 1 case (0.4 per 1000) of influenza (P ! .001: RR = 15.5 (2.02,118.4)). CONCLUSION: The influenza vaccine efficacy rate during the 2003-2004 season in our pregnant population was >99%. Significantly fewer women developed influenza after the vaccine, and it reduced the rate of influenza 15 fold when given over 2 weeks before exposure. The inactivated influenza vaccine is very effective and safe for women in the second half of prenancy. S66 SMFM Abstracts