484: cervilenz and ultrasound evaluation of cervimetry: a comparative study

(positive hemosiderin staining) in 67.9%, with 16.7% having no spe-cific histologic findings (“negative”). None of the histologic featureswere associated with differences in SPTB recurrence except for vasc-ulitis or funisitis and the risk of early SPTB �34 weeks (OR 2.8,p�0.037). Several histologic features were significantly associatedwith reductions in gestational age-adjusted birthweight in the subse-quent pregnancies (Table) with adjustment for clinical confoundersof maternal BMI, race and tobacco use, though trends toward LBWand SGA per se did not reach significance.CONCLUSION: Histologic evidence of inflammation or hemorrhage inSPTB is associated with a decrease in birthweight in subsequent preg-nancies even when there is no association with the recurrent SPTB riskitself. Thus abnormal placental histology may have consequences in asubsequent pregnancy beyond SPTB itself. Funded by WRHR K-12:HD001332-09.

483 Pregnancy outcome of subsequent pregnancy after ahistory of preterm birth with and without PPROMDavid van der Ham1, Ben Mol3, Jelle Schaaf2,Brenda Kazemier2, Anita Ravelli2

1Martini Hospital, Obstetrics and Gynecology, Groningen, Netherlands,2Academic Medical Centre, Medical Informatics, Amsterdam, Netherlands,3Academic Medical Centre, Obstetrics and Gynecology, Amsterdam,NetherlandsOBJECTIVE: Preterm prelabor rupture of membranes (PPROM) as wellas preterm delivery without PPROM are associated with high mortal-ity and morbidity rate. Especially when gestational age at deliverydecreases. The decision for couples to pursuit a subsequent pregnancyis difficult. In this retrospective study we analyzed the risk of recurrentpreterm labor in women who had PPROM and preterm labor in theirinitial pregnancy.STUDY DESIGN: Data were obtained from the Dutch Perinatal Registry(PRN) from 2000-2007. Women with two subsequent singleton preg-nancies and without hypertensive disorders or congenital abnormal-ities were selected. This cohort was divided in three subgroups;women with preterm labor without PPROM, women with PPROM(�24h ROM �37 week), and women with term labor (controls). Weassessed the risk of preterm delivery in a subsequent pregnancy, de-pending on PPROM in the first pregnancy for the whole populationand subgroups.RESULTS: Between 2000-2007, we identified 227,747 women in whomthe pregnancy outcome was known of their first two singleton preg-nancies, of which 13,821 (6,1%) women delivered preterm withoutPPROM, 1,182 (0.5%) had PPROM � 37 weeks and 212,744 (93,4%)had a term delivery in their first pregnancy. The risk of PPROM in thesecond pregnancy after PPROM in the index pregnancy was 0.7%versus 0.4% after preterm birth and 0.2% after initial term delivery RR4.0 (95% CI 1.9 to 8.0) and 2.3 (95% CI 1.8 to 3.1). The risk of pretermdelivery after initial preterm delivery with and without PPROM was13% and 17%, strongly increased as compared to the 2.6% pretermbirth risk after initial term delivery (RR 4.8 (95% CI 4.1 to 5.6) and 6.6(95% CI 6.3 to 6.9). These risks were significantly higher in the � 32week subgroups.

CONCLUSION: In women with a history of PPROM, the risk of recur-rent PPROM is low. However, the risk of preterm delivery is stronglyincreased.

484 Cervilenz and ultrasound evaluation ofcervimetry: a comparative studyFrancesca Ferrari1, Fabio Facchinetti1, Giuseppina Porcaro2,Francesca Monari1, Graziano Clerici2, Gian Carlo Di Renzo2

1Obstetrics & Gynaecology, University of Modena and Reggio Emilia,Mother-Infant Department, Modena, Italy, 2Centre for Perinatal andReproductive Medicine, University of Perugia, Obstetrics & Gynaecology,Perugia, ItalyOBJECTIVE: The Cervilenz device is a mechanical measurement systemapplied during a speculum examination and provides an alternative,cheaper method of measuring cervical length (CL). Our objective wasto determine whether CL measured by Cervilenz is an effective screen-ing tool for the prediction of preterm delivery (PTD) compared totransvaginal ultrasound (TVU) evaluation in both women presentingwith symptoms of PTD and in asymptomatic women.STUDY DESIGN: Forty-nine symptomatic women at 24-34 weeks and 50asymptomatic patients at 21-24 weeks underwent CL measurementsby both Cervilenz and TVU, in blinded fashion. Pearson’s correlationcoefficient, Paired t-test, the sensitivity, specificity, positive and neg-ative predictive values (PPV and NPV) were used to compare Cer-vilenz and TVU measurements.RESULTS: Ninety-nine patients were evaluated, 63.6% were primi-gravidae and 36.4% were multigravidae. Overall, mean Cervilenz CLwas not significantly different from TVU (29.8 � 6.3 vs 30.9 � 8.4mm, p�0.16). Cervilenz measurements were highly correlated withTVU evaluations both in symptomatic (r�0.79, P�0.001) andasymptomatic women (r�0.94, P�0.001). Correlation remained sig-nificant either in short and long cervix, and were unaffected by ap-praisal curves. According to TVU, 14 women had a CL � 25 mm.Cervilenz had a PPV�55% and NPV�97% compared to TVU, withsensitivity�0.86 and specificity�0.88.CONCLUSION: Measurements of CL with Cervilenz appear to be equiv-alent to TVU evaluations both in symptomatic and asymptomaticwomen. Given cost and turnaround time with TVU evaluation, Cer-vilenz represents a first-line clinical tool to screen women not requir-ing further investigation with TVU.

485 Cervicovaginal swabs in preterm birth: are they useful?Federica Accordino1, Sara Consonni1, Agnese Pizzardi1, TizianaFedeli2, Francesca Moltrasio3, Antonietta Scian1, Anna Locatelli1

1MBBM Foundation, University of Milano- Bicocca, Obstetrics andGynecology, Monza, Italy, 2MBBM Foundation, University of Milano-Bicocca, Neonatalogy, Monza, Italy, 3San Gerardo Hospital, University ofMilano- Bicocca, Pathology, Monza, ItalyOBJECTIVE: We evaluated the role of cervicovaginal swabs (sw) in pre-dicting infective and infant outcomes in preterm birth.STUDY DESIGN: We studied a retrospective cohort of pregnancies com-plicated by pPROM and preterm labor (PTL) delivering at 24 0/7 to 330/6 weeks of gestation from 1/2006 to 12/2010. Excluded were indi-cated preterm deliveries, stillbirths and congenital anomalies. In allwomen diagnosed with pPROM or PTL, sw for aerobic and anaerobiccultures, Trichomonas, Ureaplasma-Mycoplasma, and vaginorectalswab for GBS were performed at admission and repeated every 2weeks during expectant management. pPROM received antibioticprophylaxis for a week, while it was not routinely administered forPTL. In case of positive results, targeted antibiotic therapy was admin-istered. Follow-up for at least 12 months was available in all neonatesfulfilling the inclusion criteria. Statistical analysis included Chi-square, ANOVA and logistic regression, with P�0.05 or OR with 95%CI considered significant.RESULTS: 223 women fulfilled the study criteria. Sw were performed in103/114 (90%) pPROM and in 98/109 (90%) PTL. Results were pos-itive in 40/103 (39%) and 27/98 (27%), respectively (p�0.24). The

Linear regression of birthweight in pregnanciessubsequent to a prior spontaneous pretermbirth adjusted for gestational age andclinical confounders

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