309 RESPIRATORY INSUFFICIENCY IN THE SETTING OF CHORIOAMNIONITIS CORNELIAGRAVES1, SARAH ALICE HOOD2, AUDREY KANG2, 1Vanderbilt University, Obstetrics/Gynecology, Nashville, Tennessee, 2Vanderbilt University, Obstetrics andGynecology, Nashville, Tennessee

OBJECTIVE: To describe and determine the incidence of respiratory in-sufficiency in patients with a diagnosis of chorioamnionitis.

STUDY DESIGN: In this retropective study, the records of all pregnant womencoded by ICD-9 with a discharge diagnosis of chorioamnionitis from October 1,1993 to March 30, 2003 were reviewed. Of the 443 patients discharged witha diagnosis of chorioamnionitis, 17 cases of respiratory insufficiency wereidentified. Exclusion criteria included the lack of placental pathology to confirmthe diagnosis of chorioamnionitis and the use of tocolytic therapy.

RESULTS: In the cases with chorionamnionitis confirmed by placentalpathology, there were 11 cases of respiratory insufficiency. The incidence(1/45) is similar to the incidence of respiratory insufficiency associated withpyelonephritis.

CONCLUSION: Acute respiratory distress syndrome (ARDS) and respiratoryinsufficiency have been described in association with pyelonephritis. This studydemonstrates that there is a similar phenomenon associated with chorioamnio-nitis. Early recognition may prevent maternal and fetal complications.

S92 SMFM Abstracts

307 PREDICTORS OF SUCCESSFUL SMOKING CESSATION DURING PREGNANCY MATTHEWHOFFMAN1, LINDA DANIEL1, 1Christiana Hospital, Newark, Delaware

OBJECTIVE: Tobacco use has been firmly linked to many poor perinataloutcomes. With this knowledge, many women are able to stop smoking on theirown. We sought to better understand what factors are associated with successfultobacco cessation by examining our own population.

STUDY DESIGN: From October 2001 to April of 2004, patients were identifiedas pregnant smokers as part of an ongoing quality assessment project. Eachtrimester they were contacted and their smoking status was reassessed along withother factors that might influence their smoking status. Our primary outcomemeasure was self-reported non-smoking status. Univariate analysis was used todetermine which factors predicted successful non-smokers. A P value of ! .05was viewed statistically significant.

RESULTS: A total or 718 women were recruited into the program. Thirty ninepercent of prior smokers were successful in not smoking during their pregnancy.Women who were successful non-smokers had a lower parity (0.40 vs.0/81;P ! .001), had smoked for a shorter duration( 8.1 years vs. 10.4- P ! .001),didnot have other smokers at home(37.5% vs. 20%; P ! .001), felt highlymotivated (87.7% vs. 26.5%; P ! .001). and felt highly self-confident (81.1%vs. 21.09%; P ! .001). Age and physician advice to quit smoking were notassociated with smoking status.

CONCLUSION: Successful smoking cessation is associated with lower parity,limited exposures to smokers, and feeling highly motivated and self-confident.Resources should target pregnant women who lack these qualities.

308 PREDICTORS OF MATERNAL AND FETAL OUTOME IN PREGNANCIES COMPLICATED BYSEPSIS CORNELIA GRAVES1, KANG AUDREY2, ERIN HARLEY-YU3, 1VanderbiltUniversity,Obstetrics/Gynecology, Nashville, Tennessee, 2Vanderbilt University, Ob/Gyn,Nashville, Tennessee, 3Vanderbilt University, Obstetrics and Gynecology,Nashville, Tennessee

OBJECTIVE: To compare characteristics of pregnant patients with septicshock and determine significant predictors of adverse outcome for both themother and the fetus.

STUDY DESIGN: In this retrospective case control study, records from 1992-2002 were reviewed for patients admitted to the obstetrical intensive care unitwith a diagnosis of septic shock. The criteria for diagnosis were sepsis-inducedhypotension unresponsive to adequate fluid resuscitation and requirement forvasopressors. 24 patients who met this criteria were identified. Maternalparameters evaluated included calculation of the Acute Physiology and ChronicHealth Evaluation (APACHE) score, temperature, PaO2, PaCO2, oxygendelivery, base excess, white blood cell count, hematocrit, creatinine, INR,SGOT,cardiac outout,left ventricular stroke work index (LVSWI) , pulmonarycapillary wedge pressure (PCWP), alveolar to arterial oxygen difference (a-ADO2) and systemic vascular resistance (SVR). Adverse maternal outcomeswere defined as requirement for mechanical ventilation, chronic renal failure anddeath. Adverse fetal outcomes included sepsis, perinatal death,hypoxic ischemicencephalopathy (HIE) and prolonged NICU admission. Data were analyzedusing the SAS system using the Wilcoxon two-sample test and multivariateanalysis.

RESULTS: Causes of shock were pneumonia (n = 11); pyelonephritis (n = 6);herpes hepatitis (n = 2); small bowel obstruction (n = 2), necrotic fiboids(n = 1); IV drug use (n = 1). There were 3 maternal deaths (12.5%), with anoverall adverse maternal outcome rate of 37.5%. Of 22 viable fetuses,there were3 fetal demises (13.6%) with an overall adverse fetal outcome rate of 40.9%.Predictors of poor maternal outcome were a mean APACHE score of 20(P = .01) and mean a-ADO2 of 485 (P = .02). The sole predictor for poor fetaloutcome in this study was a depressed LVSWI (P = .03).

CONCLUSION: Sepsis in pregnancy is a significant cause of maternal and fetalmordibity and mortality. Calculation of the APACHE score and the use of earlyinvasive parameters may be useful in predicting those at risk for a poor outcome.

310 RISK FACTORS FOR WOUND INFECTION FOLLOWING CESAREAN DELIVERIESEYAL SHEINER1, NAOMI SCHNEID-KOFMAN2, AMALIA LEVY3, GERSHON HOLCBERG4,1Soroka University Medical Center, Ben-Gurion University of the Negev,Obstetrics and Gynecology, Beer-Sheva, Israel, 2Soroka University MedicalCenter, Ben-Gurion University of the Negev, Obstetrics and Gynecology, Beer-Sheva, -, Israel, 3Faculty of Health Science, Ben-Gurion University of the Negev,Epidemiology, Beer-Sheva, Israel, 4Ben-Gurion University of the Negev, BeerSheva, Israel

OBJECTIVE: The study was aimed to identify risk factors for wound infectionfollowing cesarean deliveries (CD).

STUDY DESIGN: A cohort study of all cesarean deliveries occurred during theyears 1988-2002 was conducted. We compared patients with and without woundinfection was performed. A multiple logistic regression model, with backwardelimination, was performed to investigate independent risk factors for woundinfection following CD.

RESULTS: 19,416 cesarean deliveries occurred during the study period. Ofthese, 726 (3.7%) complicated with wound infection. Risk factors for woundinfection, using a univariate analysis (unadjusted odds ratio [OR]) anda multivariable logistic regression model (adjusted OR) are shown in the Table.Combining risk factors such as obesity and diabetes mellitus (gestational andpre-gestational) increased the risk for wound infection 9.3-fold (95% CI 4.5-19.2;P ! .001).

CONCLUSION: Independent risk factors for wound infection are obesity,diabetes mellitus, hypertensive disorders, premature rupture of membranes(PROM) and urgent CD. Information regarding higher rates of wound infectionshould be provided to obese patients undergoing cesarean delivery, specificallywhen diabetes, PROM, or hypertensive disorders coexist.

Risk factors for wound infection, using a univariate analysis (unadjusted OR)and a multivariable logistic regression model (adjusted OR)

Characteristics Unadjusted OR 95% CI Adjusted OR 95% CI

Obesity 2.0 1.4–2.7 2.2 1.6–3.1Hypertensive disorders 1.7 1.4–2.1 1.7 1.4–2.1PROM 1.5 1.2–1.9 1.5 1.2–1.9Diabetes mellitus 1.4 1.1–1.7 1.4 1.1–1.7Urgent CD 1.2 0.9–1.4 1.3 1.1–1.5