OB GYN Posters - 2019

OB GYN Posters - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1008/thumbnail.jp

EMBRYO BIOPSY AND MATERNAL AND NEONATAL OUTCOMES FOLLOWING CRYOPRESERVED-THAWED SINGLE EMBRYO TRANSFER

Background: Contemporary embryo biopsy in the United States involves removal of several cells from a blastocyst that would become the placenta for preimplantation genetic testing (PGT). Embryos are then cryopreserved while patients await biopsy results, with transfers occurring in a subsequent cycle as a single frozen-thawed embryo transfer, if euploid. Objective: We sought to determine if removal of these cells for PGT was associated with adverse obstetrical or neonatal outcomes following frozen-thawed single embryo transfer. Study design: We linked ART surveillance data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) to birth certificates and maternal and neonatal hospitalization discharge diagnoses in Massachusetts from 2014-2017, considering only singleton births following autologous frozen-thawed single embryo transfers. We compared outcomes of cycles having embryo biopsy (n=585) to those having no biopsy (n=2,191), using Chi-square for categorical and binary variables, and logistic regression for adjusted odds ratios (aOR\u27s) and 95% confidence intervals, adjusting for mother\u27s age, race, education, parity, BMI, birth year, insurance, and all infertility diagnoses. Results: Considering no biopsy as the reference, there were no differences between groups with respect to preeclampsia (aOR =0.82, 0.42-1.61, p=0.5685); pregnancy-induced hypertension (aOR = 0.85, 0.46-1.59, p=0.6146); placental disorders including abruption, previa, accreta, increta and percreta (aOR=1.16, 0.60-2.24, p=0.6675); preterm birth (aOR=1.22, p=0.73-2.03, p=0.4418); low birth weight (aOR=1.12, p=0.58-2.15, p=0.7355); cesarean section delivery (aOR=1.04, p=0.79-1.38, p=0.7762); or gestational diabetes mellitus (aOR=0.83, 0.50-1.38, p=0.4734). In addition, there were no differences between groups for prolonged hospital stay for mothers (aOR=1.23, 0.83-1.80, p=0.3014) or for infants (aOR=1.29, 0.72-2.29, p=0.3923). Conclusions: Embryo biopsy for preimplantation genetic testing does not increase the odds for diagnoses related to placentation (preeclampsia, pregnancy-related hypertension, placental disorders, preterm delivery, or low birth weight), maternal conditions (gestational diabetes), or maternal or infant length of stay following delivery

Azithromycin versus erythromycin for the management of preterm premature rupture of membranes

BACKGROUND: Preterm premature rupture of membranes (PPROM) complicates 2-3% of pregnancies. Many institutions have advocated for the use of azithromycin instead of erythromycin. This is secondary to national shortages of erythromycin, ease of administration, better side effect profile and decreased cost of azithromycin as compared to erythromycin. OBJECTIVE: To evaluate if there are differences in the latency from PPROM to delivery in patients treated with different dosing regimens of azithromycin vs. erythromycin. STUDY DESIGN: This is a multicenter, retrospective cohort of women with singleton pregnancies with confirmed rupture of membranes between 230 to 336 weeks from January 2010 to June 2015. Patients were excluded if there was a contraindication to expectant management of PPROM. Patients received one of four antibiotic regimens: 1) azithromycin 1000 mg PO once (azithromycin 1 day group), 2) azithromycin 500 mg PO once, followed by azithromycin 250 mg PO daily for 4 days (azithromycin 5 day group), 3) azithromycin 500 mg IV for 2 days, followed by azithromycin 500 mg PO daily for 5 days (azithromycin 7 day group), or 4) erythromycin IV for 2 days followed by erythromycin PO for 5 days (erythromycin group). The choice of macrolide was based on institutional policy and/or availability of antibiotics at the time of admission. In addition, all patients received ampicillin IV for 2 days followed by amoxicillin PO for 5 days. Primary outcome was latency from diagnosis of rupture of membranes to delivery. Secondary outcomes included clinical and histopathologic chorioamnionitis and neonatal outcomes. RESULTS: 453 patients were identified who met inclusion criteria. 78 patients received azithromycin for 1 day, 191 patients received azithromycin for 5 days, 52 patients received azithromycin for 7 days, and 132 patients received erythromycin. Women who received the 5 day regimen were younger and less likely to be non-African American, have hypertension, sexually transmitted infection or substance abuse. There was no statistical difference in median latency time of azithromycin 1 day (4.9 days, 95% CI 3.3-6.4), azithromycin 5 day (5.0, 95% CI 3.9-6.1), or azithromycin 7 days (4.9 days. 95% CI 2.8-7.0), when compared to erythromycin (5.1 days, 95% CI 3.9-6.4) after adjusting for demographic variables (p=0.99). Clinical chorioamnionitis was not different between groups in the adjusted model. Respiratory distress syndrome (RDS) was increased in the azithromycin 5 day group vs azithromycin 1 day vs, erythromycin (44% vs. 29% and 29%, p=.005, respectively). CONCLUSION: There was no difference in latency to delivery, incidence of chorioamnionitis, or neonatal outcomes when comparing different dosing regimens of the azithromycin with erythromycin, with exception of RDS being more common in the 5 day azithromycin group. Azithromycin could be considered as an alternative to erythromycin in the expectant management of PPROM if erythromycin is unavailable or contraindicated. There appears to be no additional benefit to an extended course of azithromycin beyond the single day dosing, but final recommendations on dosing strategies should rely on clinical trials