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385 ETIOLOGY AND MANAGEMENT OF ACUTE PULMONARY EDEMA IN PREGNANCY-
POSTPARTUM: ROLE OF ECHOCARDIOGRAPHY MOUNIRA HABLI1, ANNETTE BOMBRYS1,
JOHN R. BARTON2, HELEN HOW1, BAHA SIBAI1, 1University of Cincinnati, Cincinnati,
Ohio, 2Central Baptist Hospital, Lexington, Kentucky
OBJECTIVE: To evaluate the role of echocardiography (ECHO)in the etiology
and management of acute pulmonary edema in pregnancy.
STUDY DESIGN: 59 pregnant women with acute pulmonary edema were eval-
uated with ECHO between 2000-2006.Women with known functional or structural
heart disease were excluded. Maternal outcomes are: ECHO parameters(left ven-
tricular end diastolic[LVED] and systolic dimension[LVES],ejection fraction[EF],
% shortening and evidence of systolicdiastolic dysfunction), risk factors, acute
and discharge medications and major morbidities. 47(80%) patients had a follow
up of 1-5 years. Data were analyzed using T-test, Chi square and Fisher exact test.
RESULTS: Based on ECHO findings, patients(pts) were classified as having car-
diogenic (n36) or non-cardiogenic (n23) etiology. There were no differences
between groups regarding race, age, rate of hypertensive disorders (67% vs 58%)
and admission with preterm labor (11%vs 17%). Mean gestational age at delivery
was 36.43.25 wks. Among the cardiogenic group, 21 (58%) had peripartum car-
diomyopathy, 6 (17%) had isolated systolic dysfunction, 8 (22%) had newly diag-
nosed valvular disease and one had pulmonary hypertension. These pts had signif-
icant impairment in left ventricular performance as compared to non-cardiogenic
group (table). All pts received diuretics and oxygen.There was a difference in use of
antihypertensive medications(66%,cardiogenic vs 39%,p0.04). At discharge 28
(77%) women in the cardiogenic group received targeted medications based on
ECHO findings as compared to none in the non-cardiogenic group. There were no
maternal deaths.
CONCLUSION: Echocardiography should be an integral part of the initial eval-
uation of the etiology and management of acute pulmonary edema in pregnancy.
Information obtained by ECHO will assist in improvement of short and long term
maternal outcomes.
ECHO findings and maternal morbidities
Group 1 (n 36) Group 2 (n 23)
% EF 29.5 13.9 55.7 10.2***
LVED-mm 58.9 8.0 48.1 7.5***
LVES-mm 47.4 10.1 31.9 7.9***
% Shortening 20.1 9.6 33.0 16.1**
Mechanical ventilation-n(%) 5 (22) 6 (17)
*Data mean SD, **P 0.01, ***P 0.001
0002-9378/$ - see front matter
doi:10.1016/j.ajog.2007.10.403
386 MATERNAL OUTCOMES OF 126 PREGNANCIES WITH ACUTE PULMONARY
EDEMA MOUNIRA HABLI1, TAMMY RADOMILE1, ANNETTE BOMBRYS1, JOHN R.
BARTON2, HELEN HOW1, BAHA SIBAI1, 1University of Cincinnati, Cincinnati, Ohio,
2
Central Baptist Hospital, Perinatal Diagnostic Center, Lexington, Kentucky
OBJECTIVE: To determine risk factors and evaluate maternal outcomes in acute
pulmonary edema during pregnancy.
STUDY DESIGN: A retrospective study of 126 pregnant -postpartum women
diagnosed with acute pulmonary edema between 2000-2006. Data analyzed were:
risk factors (preterm labor requiring tocolysis, hypertensive disorders), manage-
ment during acute episode, % ICU admission and major maternal morbidities
RESULTS: Among 126 patients,22 (17.5%) had multifetal pregnancy (6 triplets,
16 twins). Patients were young (mean age 27.27.7 years) and obese (mean BMI
33.7129.9). 64(51%) had hypertensive disorder,and 28(22%) had preterm labor
requiring tocolysis. Magnesium sulfate was the most commonly used medication.
Patients were treated with diuretics and antihypertensive medications as needed.
Mean gestational age (GA) at delivery was 33.85.7 weeks. 59 of 126 (47%) had
antepartum pulmonary edema and 67(53%) had postpartum onset.Antepartum
diagnosis of acute pulmonary edema was associated with a significantly higher rate
of multifetal pregnancy, preterm labor, and tocolysis and ICU admission as com-
pared to postpartum period (Table).Most cases of postpartum pulmonary edema
was associated with ceserean delivery(Table). Overall, there was one maternal death
and 23(18%) required intubation but none had residual injury. The perinatal loss
was 3.3 %( n5).
CONCLUSION: Postpartum pulmonary edema was mostly associated with ceserean
delivery. High order pregnancy and preterm labor patients on tocolysis are more likely
to have pulmonary edema before delivery. This favourable maternal outcome is attrib-
uted to early diagnosis and aggressive therapy with diuretics and intubation.
Antepartum (n 59) Postpartum (n 67)
BMI 30.6 8.5 36.7 11.7
GA at delivery(wks) 29.5 5.3 35.9 5.3***
Multifetal pregnancy -n (%) 17 (29.0) 5 (7.4)*
Tocolysis -n (%) 21 (35.5) 7 (10.3)***
Hypertensive disorder-n (%) 25 (42.4) 40 (58.8)
Cesarean rate-n (%) 29 (49) 39 (58)
ICU admission--n (%) 11 (25.6) 34 (50.7)
*Data mean SD, **P 0.05, ***P 0.001
387 RACIAL AND ETHNIC DIFFERENCES IN THE INCIDENCE OF ASTHMA EXACERBATIONS
DURING PREGNANCY CORNELIA GRAVES1, GWINNETT LADSON2, DARRYL JORDAN3,
DEBORAH NARRIGAN2, JAMES SHELLER4, JOHN MURRAY3, 1Baptist Hospital, Maternal-
Fetal Medicine, Nashville, Tennessee, 2Meharry Medical College, Obstetrics and
Gynecology, Nashville, Tennessee, 3Meharry Medical College, Internal Medicine,
Nashville, Tennessee, 4Vanderbilt University, Nashville, Tennessee
OBJECTIVE: Studies have suggested increased perinatal morbidity in African-
American patients with asthma. The purpose of this study is to evaluate the inci-
dence of asthma exacerbations in African-Americans when compared to other eth-
nic groups.
STUDY DESIGN: Study was approved by the Institutional Review Board at each
site. Criteria were all pregnant patients with English or Spanish as the primary
language who were less than 30 weeks gestation presenting to clinics associated with
the county, university or private hospital. Results were obtained from a self admin-
istered screening questionnaire (in English or Spanish) used to determine eligibility
for a study designed to examine the impact of the interventions on asthma out-
comes during pregnancy. 1500 questionnaires were completed divided among
groups including Caucasians, African Americans and Hispanics. Questions identi-
fied whether the respondent had a diagnosis of asthma and allergies, took asthma
medications, the type and frequency of asthma symptoms, and smoking history.
Analyses were done using the software package SPSS. Comparisons of the responses
between the three groups were analyzed by ANOVA and Students t-tests. (p0.05
was considered significant). Study funded by NIH grant U01 HL072471-05.
RESULTS: Compared to Hispanics and Caucasians who were identified as asth-
matics, African Americans were more likely have been diagnosed as asthmatic by a
provider(p0.013), 60.4% reported having asthma medications(p0.002) com-
pared to 37.6% of Caucasians and 2.0% of Hispanics. However,African Americans
were twice was likely to have had an asthma exacerbation in the last 12
months(p0.001). Exacerbations were more likely to occur in the first trimester or
second trimester, although this did not reach statistical significance.
CONCLUSION: African-American women are at increased risk for asthma exac-
erbations during pregnancy despite being diagnosed and receiving medical therapy
more often than Hispanics and Caucasians. Further investigation is needed to de-
termine additional interventions to decrease morbidity in this population
0002-9378/$ - see front matter
doi:10.1016/j.ajog.2007.10.405
388 PSYCHIATRIC ILLNESS AND ADVERSE PERINATAL OUTCOME NAOMI SCHNEID-
KOFMAN1, EYAL SHEINER1, AMALIA LEVY2, 1Soroka University Medical Center, Ob-
stetrics and Gynecology, Beer-Sheva, Israel, 2Ben-Gurion University, Epidemiol-
ogy, Beer-Sheva, Israel
OBJECTIVE: The present study was aimed to portray the psychiatric pregnant
patient as a high-risk pregnancy patient, and to describe the effect of psychiatric
illness upon pregnancy outcome.
STUDY DESIGN: A retrospective population-based study of all deliveries during
1988-2005 was performed, comparing pregnancy outcome of patients with and
without psychiatric illness. Stratified analysis was performed using a multiple lo-
gistic regression model.
RESULTS: Of 181,479 deliveries, 607 (0.3%) had psychiatric disorders. The psy-
chiatric group consisted basically of depressive and anxiety disorders (39%),
schizophrenia (11%) or other psychiatric illness (50%). Psychiatric illness signifi-
cantly increased adverse perinatal outcome (Table). Using two different multiva-
riable logistic regression models, with perinatal mortality and congenital malfor-
mations as the outcome variables, psychiatric illness during pregnancy was
documented as an independent risk factor for perinatal mortality (OR 2.4, 95 CI
1.5-3.7; P0.001) and congenital malformations (OR 1.4, 95 CI 1.01-1.9;
P0.003).
CONCLUSION: Psychiatric illness is an independent risk factor for congenital
malformations and perinatal mortality. A high-risk pregnancy should be expected
with psychiatric patients, and prenatal care should be adjusted accordingly.
Adverse pregnancy outcome of patients with and without psychiatric disorder
Psychiatric group Comparison group
(n 607) (n 181479) P-value
Congenital malformations 7.1% 4.9% 0.015
Apgar score 7 at 1 7.3% 4.3% 0.001
minute
Apgar score 7 at 5 1.4% 0.6% 0.017
minutes
Birth weight 2500 gr 15.8% 9.6% 0.001
Perinatal mortality 35/1000 14/1000 0.001
0002-9378/$ - see front matter
doi:10.1016/j.ajog.2007.10.406

0002-9378/$ - see front matter

doi:10.1016/j.ajog.2007.10.404

Supplement to DECEMBER 2007 American Journal of Obstetrics & Gynecology S117