pathologic findings in relation to causation of stillbirth and pretermlive birth.

108 Outcomes of triplet pregnanceis reduced to twinsversus triplet pregnancies in a single institutionDonna Brown1, Frank Craparo2

1Washington Hospital Center, Obstetrics and Gynecology, Washington, DC,2Abington Memorial Hospital, Obstetrics and Gynecology, Abington, PAOBJECTIVE: The purpose of this study was to examine the outcomes oftriplet pregnancies which were selectively reduced to twin pregnanciescompared with triplet pregnancies at a single institution.STUDY DESIGN: This study was a retrospective chart review. All adultwomen who presented to the Fetal Diagnostic Center between 1999-2009 who were found to have triplet pregnancies in the first trimester,received prenatal care, and then delivered at Abington Memorial Hos-pital were included in this study. All women with triplet pregnancieswere offered multifetal reduction. Included were women electing toexpectantly manage their triplet pregnancy or women electing to re-duce to a twin pregnancy. Data analysis was performed with SPPSversion 15 for Windows. Descriptive statistics were performed includ-ing means and frequencies. Inferential statistics were performed in-cluding chi square analysis and analysis of variance.RESULTS: 132 pregnancies were identified. The average gestational ageof delivery was longer in the reduction group (n�30) [34.63; 95%confidence interval (CI)�32.85-36.42 versus the triplet group [31.19weeks gestation; 95% CI 30.38-31.99, (P � �.0005)]. The days inhospital were also less [9.03; 95% CI 4.71-13.36, versus 26.71 days inhospital; 95% CI 21.37-32.04, (P � .001)]. A statistically significantreduction in incidence of gestational diabetes and preterm labor inreduced pregnancies versus expectantly managed [1 versus 23 patientswith gestational diabetes, (P � .015) in 2-sided chi-square analysis],and [62 versus 9 patients treated for preterm labor, (P � .004) in2-sided chi-square analysis] was also noted. A nonstatistically signif-icant trend towards increasing gestational age at delivery was noted insubgroup analysis. Rate of loss defined as delivery less than 24 weekswere similar [3.3% in reduced versus 4.9% in triplets].CONCLUSION: Patients electing to reduce a triplet pregnancy to twinshad higher gestational ages at delivery, lower rates of gestational dia-betes and preterm labor, and spent fewer days in hospital than patientselecting to expectantly manage triplet pregnancies.

109 Fertility and pregnancy outcomes followingextirpative treatment for placenta accretaDoron Kabiri1, Neta Shanwetter2, Moshe Simons1,Yael Hants1, Yuval Gielchinsky1, Yossef Ezra3

1Hadassah Hebrew University Medical Center, Ob/Gyn, Jerusalem,Israel, 2Tel-Aviv University, School of Public Health, Tel-Aviv,Israel, 3Hebrew University-Hadassah Medical Center, Departmentof Obstetrics and Gynecology, Jerusalem, IsraelOBJECTIVE: The aim of this study is to describe fertility and pregnancyoutcomes following extirpative treatment for placenta accreta.STUDY DESIGN: A retrospective cohort study included all women withhistory of extirpative treatment for placenta accreta at a tertiary uni-versity hospital between 1990 and 2000. Placenta accreta was diag-nosed according to clinical or histo-pathological criteria; extirpativetreatment was defined by placental removal with uterine preservation.Data regarding gynecological complications, reproductive function,fertility and subsequent pregnancies were retrieved from patients’medical records and telephone interviews on 2011.

RESULTS: Two hundred sixty-six women with a history of placentaaccreta were identified during the study period; 11 women underwentcesarean hysterectomy. Follow-up data were available for 144 of theremaining women and therefore were included in this analysis. Therewere 18 women who had irregular menses and one woman who be-came amenorrheic. Of the 113 women who attempted conception,106 women (93.8% [95% confidence interval (CI), 87.6-97.4%])achieved pregnancy with a total number of 359 pregnancies during thefollow-up period. Pregnancy outcomes were as follows: 11 pre-termdeliveries and 286 full-term deliveries; 3 ectopic pregnancies, 3 elec-tive abortions and 59 spontaneous miscarriages. Placenta accreta re-curred in 38 of 103 women [36.9% (95% CI, 27.6-46.4%)], whilepost-partum hemorrhage occurred in 19 women [18.5% (95% CI,11.5-27.3%)].CONCLUSION: Extirpative treatment for placenta accreta does not ap-pear to compromise the patients’ subsequent fertility or obstetricaloutcomes. Nevertheless, patients and physicians should be aware ofthe high risk that placenta accreta and post-partum hemorrhage mayrecur during future pregnancies.

110 Does fetal sex play a role in intrauterine fetal demise?Elizabeth Brass1, Yvonne W. Cheng2, JonathanSnowden1, Antonio Frias3, Aaron B. Caughey1

1Oregon Health & Science University, Department of Obstetricsand Gynecology, Portland, OR, 2University of California, SanFrancisco, Department of Obstetrics, Gynecology, and ReproductiveSciences, San Francisco, CA, 3Oregon Health & Sciences University,Department of Obstetrics and Gynecology, Portland, OROBJECTIVE: To examine gender differences in pregnancies compli-cated by intrauterine fetal demise (IUFD) after 20 weeks’ gestation.STUDY DESIGN: A retrospective cohort study was conducted of all preg-nancies who delivered in California in 2006 (n�483,816). IUFD after20 weeks’ gestation was stratified by gender. Obstetrical complicationsincluding pregnancy associated hypertension, chronic hypertension,and diabetes were assessed. Dichotomous outcomes were comparedusing chi-square test, and p�0.05 was used to indicate statistical sig-nificance.RESULTS: 1,526 pregnant women were diagnosed with IUFD after 20weeks’ gestation. There was no significant difference overall betweenmales and females who experienced IUFD (p�0.599). However, malefetuses were significantly more likely to experience IUFD in pregnan-cies complicated by pregnancy associated hypertension, chronic hy-pertension, gestational diabetes, and pre-existing diabetes (Table).Multivariable logistic regression was used to control for potential con-founders including race, age greater than 35, and college/educationwhere the association was consistent.CONCLUSION: While there was no overall difference in IUFD betweenmales and females, male fetuses have a statistically significant in-creased risk of fetal demise in the setting of maternal co-morbiditiescompared to females. This suggests that male pathophysiology may bedifferent than females. Further studies are needed in genetics andplacental physiology to confirm and further define this association.

111 Preterm delivery of triplets: spontaneous vs iatrogenicEllie Ragsdale1, Armin Razavi1, Stephen T. Chasen1

1Weill Medical College of Cornell University,Obstetrics and Gynecology, New York, NYOBJECTIVE: Prematurity is the largest source of perinatal mortality andmorbidity in triplet pregnancy. Though efforts to reduce prematurity

Poster Session I Clinical Obstetrics, Medical-Surgical-Disease, Neonatology, Physiology-Endocrinology www.AJOG.org

S62 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2012