Poster Session III ajog.org

to predict preterm birth. Our goal was to determine if the change inCL in the second trimester is a useful predictor of spontaneouspreterm birth in asymptomatic triplet pregnancies.STUDY DESIGN: A retrospective cohort study of all triplet pregnanciesmanaged at a single tertiary center from 1999 to 2013 was con-ducted. We analyzed the change in CL in the second trimester usingthe initial and final second trimester CL measurements in asymp-tomatic triplet pregnancies. Patients were placed in one of twogroups: change in CL �20% or change in CL <20%. Our primaryoutcome was the rate of spontaneous preterm birth in each group.RESULTS: Of the 53 women in our study, 33 had a change in their CL>20%, and 20 had a change <20%. There was a significantly higherrate of preterm birth between 28-34 weeks in those women witha change in CL >20% (RR 3.52, p¼0.021). Of the patients witha shortened cervix, 39.1% delivered at <34 weeks gestation(p¼0.025), 27.1% delivered at <32 weeks (p¼0.001), and 13.5%delivered at <30 weeks (p¼0.004). No patients in the stable CLgroup delivered before 32 weeks gestation, and only 3 deliveredbetween 32 and 34 weeks.CONCLUSION: In asymptomatic triplet pregnancies, a change in CL>20% in the second trimester is strongly associated with pretermbirth between 28-34 weeks. In our study population, when the CLwas stable in the second trimester, no patient delivered spontane-ously prior to 32 weeks gestation, and only 6.5% of these patientsexperienced a spontaneous preterm birth before 34 weeks. A changein CL <20% in the second trimester may be a useful predictor ofpreterm birth in triplet pregnancies, especially given its negativepredictive value.

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Effects of long-term indomethacin exposure on amnioticfluid volumeDana Block-Abraham1, Ozhan Turan1, Sarah Crimmins1,Garrett Fitzgerald1, Rinat Gabbay-Benziv1, Caroline Pancotti1,Chris Harman11University of Maryland, Obstetrics, Gynecology, and Reproductive Sciences,Baltimore, MDOBJECTIVE: Determine the effects of long-term indomethacin therapy(LIT) for prevention of preterm delivery on amniotic fluid volume(AFV).STUDY DESIGN: Retrospective cohort study of fetuses under thefollowing LIT protocol: women with progressive cervical shorteningof <25 mm before 24 weeks gestational age (GA) received a 100mgloading dose, then 50mg QID for up to 48 hours, then 25mg QIDmaintenance. Weekly ultrasound (US) monitoring was done for AFVand ductus arteriosus (DA) constriction. LIT was stopped at 32weeks GA, or earlier if complications arose. Control cases had cer-vical shortening but did not meet LIT criteria, and were followedwith weekly US. AFV change was calculated as: AFV at LIT onset

S234 American Journal of Obstetrics & Gynecology Supplement to JANUARY

minus AFV at LIT completion. For controls, AFV change was thedifference in AFV from the first to last US exam. Change in AFV perday was calculated. Non-parametric and Fisher’s exact tests wereused for comparisons; p<0.05 was significant.RESULTS: Of 225 women meeting study criteria, 164 took LTI for amedian of 41 days. The median between exams for 61 controls was28 days. LIT significantly lowered AFV (Table 1, p¼0.03), by amedian value of 2.8 cm total and 0.07 cm/day over the LIT interval.Women not taking LIT had a median fluid increase of 1.5 cm at amedian rate of 0.02 cm/day. This difference in median fluid changewas statistically significant (p<0.001) and the daily AFV changetrended toward significance (p¼0.05). Oligohydramnios (oligo, AFV<5cm) was diagnosed in 2 cases, 1 LIT and 1 control. The LIT casewith oligo received therapy from 24.6-26.5 weeks GA and deliveredat term. The control case had anhydramnios at 25.5 weeks GAand delivered 5 days later. In 3 other LIT cases, indomethacin wasreduced for borderline AFV of 8-10 cm. A total of 4 women (2.4%)had the LIT protocol altered for AFV changes. No LIT cases hadoligo by single pocket depth <2 cm.CONCLUSION: LIT significantly decreases AFV, but protocol infringe-ment is rare and oligohydramnios seldom occurs. Close surveillancewill detect changes in time to alter dosage.

Amniotic fluid volume comparisons betweenwomen exposed and not exposed to long-termindomethacin use

Data are presented as medians (ranges). AFV ¼ amniotic fluidvolume. LTI ¼ long-term (>72 hours) indomethacin use. N.S. ¼non-significant. Non-parametric tests were used for analysis, withp<0.05 considered significant.

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Is there a disparity in the rate of pregnancycomplications among patients diagnosed with cancersprevalent during child-bearing age? Evidence from a largepopulation-based cohort studyDaniel Lantsberg1, Yoav Yinon1, Mordechai Dulitzky1, Eyal Sivan1,Eyal Shif1, Shali Mazaki-Tovi11Sheba Medical Center, Obstetrics and Gynecology, Tel Aviv, IsraelOBJECTIVE: Pregnant women with a diagnosis of cancer are atincreased risk of major obstetric complications. However, dataregarding the prevalence of complications of pregnancy among sur-vivors of cancers prevalent during child-bearing age women aresparse. The aim of this study is to determine the prevalence of preg-nancy induced hypertension (PIH), eclampsia, gestational diabetesmellitus (GDM), fetal death (FD), and preterm birth (PTB) amongpatients diagnosed with carcinoma of breast, carcinoma of thyroid,Hodgkin’s lymphoma (HL) and non Hodgkin’s lymphoma (NHL).STUDY DESIGN: A population-based cohort study using data from the2006 NIS of the Healthcare Cost and Utilization Project. The rates ofPIH, eclampsia, GDM, FD, IUGR and PTB were determined andcompared among 3 groups of patients diagnosed with: 1. carcinoma ofbreast; 2. carcinoma of thyroid; and 3. HL. Comparison between ratesamong the groups was conducted by Chi-squared or Fisher’s exact test.RESULTS: 1. The rate of PTB was significantly different among the 4groups (p¼0.01). 2. The rate of PTB was significantly lower in pa-tients with carcinoma of thyroid compared to those with carcinomaof breast (p¼0.003), and HL (p¼0.003); and 3. There was no sig-nificant difference in the rate of PIH, eclampsia, GDM, or FD amongthe 3 groups.CONCLUSION: In contrast to other complications of pregnancy, thereis a cancer-specific disparity in the prevalence of PTB amongst

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ajog.org Poster Session III

cancer survivors of child-bearing age. This finding may reflect theproinflammatory response associated by the more aggressive cancersthat has been implicated in the pathophysiology of PTB. Such sys-temic response may be absent or attenuated in less aggressive andrelatively localized carcinoma of thyroid.

Pregnancy complications among patientsdiagnosed with cancers

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Communication skills in obstetrics: the impact onbereaved parentsDaniel Nuzum1, Sarah Meaney2, Keelin O’Donoghue11University College Cork, Department of Obstetrics & Gynaecology, Cork,Ireland, 2University College Cork, National Perinatal Epidemiology Centre,Cork, IrelandOBJECTIVE: Communicating bad news in an obstetric setting ischallenging for both clinicians and parents. How bad news iscommunicated can shape the overall experience of care for parents.This study explores the impact of how bad news was communicatedto parents diagnosed with stillbirth or fatal fetal abnormality whowere cared for in a tertiary maternity hospital (8,500 births perannum) where the perinatal mortality rate is 5.2/1000.STUDY DESIGN: Semi-structured qualitative interviews lasting 31-104minutes were conducted with 12 mothers and 5 fathers bereavedfollowing stillbirth. The participants were purposively sampled fromeach of the years 2008, 2010 and 2013. The data were transcribedverbatim and analysed in depth using Interpretative Phenomeno-logical Analysis.RESULTS: The diagnosis of a fatal fetal abnormality or confirmedstillbirth had a profound and enduring impact on each of theparents interviewed who described it as “life changing”. The datarevealed a detailed recollection of the context of how news wascommunicated by obstetricians. Diversionary techniques whileawaiting another opinion to confirm a diagnosis were identified byparents. These interactions resulted in a sense of mistrust when it wasfelt information was purposefully withheld. The remaining majorthemes were: language used, timing and sensitivity. How and wherebad news was communicated had a considerable impact on parents.CONCLUSION: How professionals communicate bad news to parents isremembered in painstaking detail, often revisited as parents seek tounderstand their loss. This study reveals in parents’ own words ex-amples of how and how not to break bad news. These findings are ofinterest to obstetricians as they continue to refine communicationskills in one of the most challenging areas of obstetric practice.

Themes

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Does vaginal bleeding increase the risk of developinga short cervix?Daphnie Drassinower1, Cande Ananth1,Cynthia Gyamfi-Bannerman1, Sarah Obican1, Heather Levin1,Joy Vink11Columbia University Medical Center, Department of Obstetrics andGynecology, New York, NYOBJECTIVE: While it is known that vaginal bleeding (VB) and a shortcervix are both independent risk factors for preterm birth (PTB),whether VB is a risk factor for short cervix has not been studied. Wehypothesized that VB is a risk factor for developing a short cervix.STUDY DESIGN: This is a secondary analysis of the Preterm PredictionStudy, where 3073 women receiving prenatal care between 1992 and1994 were studied to determine risk factors for PTB. Questionsabout VB were included in the standardized interview. Patients hadtransvaginal cervical length (CL) measurements obtained at 22-24and 26-28 weeks and were followed until delivery. For our study, theexposure of interest was VB in the first and/or second trimesters.The primary outcome was a short cervix < 25 mm at 22-24 weeks.Secondary outcomes were short cervix < 25 mm at 26-28 weeks,and the rate of cervical shortening between visits. Logistic regressionwas used to control for possible confounders.RESULTS: A total of 2998 patients with singleton pregnancies wereanalyzed, 2226 reported no VB, 496 had first trimester VB, 184 hadsecond trimester VB, and 92 had both first and second trimesterVB. VB in the first and/or second trimester was associated with PTBbut not cervical shortening (Table 1).CONCLUSION: Although VB was associated with an increased riskof PTB < 37 weeks, it was not a risk factor for developing a shortcervix <25 mm. The mechanism by which VB increases the risk ofPTB may be unrelated to cervical shortening.

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Maternal hematocrit and IQ at 4 years of ageDaphnie Drassinower1, Sarah Obi�can1, Heather Levin1,Cande Ananth11Columbia University Medical Center, Department of Obstetrics andGynecology, New York, NYOBJECTIVE: While it is known that maternal anemia is a risk factorfor mental retardation and adverse obstetric outcome, the relation-ship between maternal hematocrit and offspring IQ has not beenstudied. We hypothesized that there is a linear relationship betweenmaternal hematocrit and IQ at 4 years of age.STUDY DESIGN: This is a secondary analysis of the CollaborativePerinatal Project, a large, multicenter, prospective cohort study.For this secondary analysis we included singleton pregnancies,we excluded newborns with fetal anomalies, neonatal seizures, smallfor gestational age, mental retardation in either parent, maternalhypothyroidism, maternal hematocrit <21, and those missing

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