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www.AJOG.org Epidemiology, Global Maternal-Fetal Public Health, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics Poster Session IV

638 Termination of pregnancy amongIV-infected women in the era of HAART

Marta Lopez1, Anna Gonce1, Sandra Hernandez1,ontserrat Lonca2, Montse Palacio1, Francesc

igueras1, Oriol Coll3, Eduard Gratacos1

1Maternal Fetal Medicine Department. Hospital Clinic, Barcelona,2Infectious Diseases Department. Hospital Clinic. Fundacio

linic, Barcelona, 3Clinica Eugin, BarcelonaOBJECTIVE: To assess obstetric and virological characteristics of HIV-nfected women who underwent termination of pregnancy (TOP) inhe era of highly active antiretroviral pregnancy (HAART).

STUDY DESIGN: A retrospective cohort study was carried out among99 HIV-infected pregnant women who attended a single center froman 2000 until Dec 2009.

RESULTS: A total of 89 out of 399 HIV-infected pregnant women askedor a voluntary TOP during the study period (22.3%). Median mater-al age was 32 years old. A 37.5% (30/80) of women were HCV-co

nfected. Active or past injection drug use was reported in 21 cases27.3%). Cocaine use was declared in 6 cases. Most women had pre-ious pregnancies (78/85; 91.2%). In 30 cases (33.71%) a previousOP had been performed, including 13 women who underwent TOPore than once during the study period. According to HIV infection

arameters, sixty-five out of 89 women were taking HAART (73%).etectable viral load was present in 47.5% of HIV-pregnant women

29/61), though being 11 of them under HAART. Indications for ter-ination of pregnancy included exposure to teratogenic agents (13/

9; 14.6%), fetal abnormalities (4/89; 4.5%), maternal severe illness4/89; 4.5%), obstetric complications (2/89; 2.2%), and in 66 cases74.2%) there was no other reason apart from HIV infection for TOP.mong those women who considered HIV as a sufficient indication

or TOP, 21 of them did not need or did not use HAART (31.8%).edian gestational age at the procedure was 10 weeks (range 6.0 –

0.0). In 64 cases (71.9%) curettage was performed before 12 weeks.fter 12 weeks, medical termination of pregnancy was performed, and

n 8 cases curettage was also required.CONCLUSIONS: A 22.3% of HIV-infected pregnant women underwent

regnancy termination, not infrequently in the second trimester ofregnancy (25/89; 28.1%). There was no other reason for TOP apart

rom the HIV infection in 74.2% of cases. Two thirds of the studyopulation had previous TOP. Efforts should be made in family plan-ing policies to avoid unintended pregnancies among HIV-infectedomen.

639 Temporal trends in chorioamnionitis by maternalace/ethnicity and gestational age: 1991-2008

Michael Fassett1, Deborah A. Wing2, Darios Getahun3

1Kaiser Permanente West Los Angeles Medical Center, Losngeles, CA, 2UC Irvine Medical Center, Orange, CA,

3Kaiser Permanente Southern California, Pasadena, CAOBJECTIVE: To characterize trends in chorioamnionitis (CA) by ma-ernal race/ethnicity and gestational age.

STUDY DESIGN: We examined temporal trends in CA in women deliv-ring in Kaiser Permanente Southern California (KPSC) hospitals be-ween 1991-2008 (n � 516,820). Data were extracted from birth cer-ificate, inpatient, and outpatient encounter files. Relative increase%) and 95% confidence intervals (CI) were used to estimatediffer-nces in CA rates by race/ethnicity. Racial/ethnic disparities in CAere assessed by comparing the relative risks from multiple logistic

egression models. Preterm birth was defined as � 36 weeks gestation.RESULTS: Overall prevalence rates of CA increased from 3.3% in 1991-

992 to 4.4% in 2007-2008; relative increase 35.4% (95% confidencentervals [CI] 27.5%-43.7%). From 1991-1992 to 2007-2008, CA in-reased among whites (2.8% to 3.3%, relative increase 15.9% [95% CI.6%-31.2%]), Hispanics (3.3% to 4.5%, relative increase 34.4%95% CI 22.8%-46.8%]) and Asian/Pacific Islanders (4.43% to 7.12%,

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among African-Americans remained stable at about 2.9% during thesame period. Adjusted relative risk for change in CA from 1991-1992to 2007-2008 was 1.18 (1.04-1.34) for Caucasians [preterm 0.60 (0.38-0.99), term 1.24 (1.09-1.42)], 0.95 (0.77-1.17) for African-Americans[preterm 0.45 (0.27-0.76), term 1.11 (0.88-1.39)], 1.31 (1.19-1.45) forHispanics [preterm 0.62 (0.44-0.88), term 1.40 (1.26-1.55)], and 1.65(1.39-1.95) for Asian/Pacific Islanders [preterm 1.17 (0.60-2.27),term 1.70 (1.43-2.02)].CONCLUSIONS: This study shows the prevalence rate of chorioamnio-

itis has decreased for African-Americans, and increased for all otherace/ethnic groups. This appears to be due an increase in the rate ofhorioamnionitis in births � 37 weeks’ gestation.

640 In utero inflammation alters theardiovascular response of adult offspring

Michel Makhlouf1, Egle Bytautiene1, Esther Tamayo1,uaizhi Yin1, Talar Kechichian1, Phyllis Gamble1,onica Longo1, George R. Saade1

1The University of Texas Medical Branch, Galveston, TXOBJECTIVE: The effect of the uterine environment on adult vascularunction has been well documented. Our previous studies have shownhat exposure to significant inflammation at day 16 gestation in micelters the in vitro carotid artery vascular reactivity in the adult off-pring. Our objective in this study was to test the hypothesis thatxposure to inflammation in late gestation alters the adult offspring’slood pressure both during normal activity and in endotoxin-inducedhock.

STUDY DESIGN: CD-1 mice at day 16 of gestation were given 800 �g/kgf endotoxin (LPS) or saline (CON) intraperitoneally. The animalsere allowed to deliver and adult female offspring were implantedith intra-carotid blood pressure transducers allowing continuouslood pressure recordings during normal activity. On day 6 afterransducer implantation, endotoxic shock was induced by adminis-ration of endotoxin intraperitoneally. Blood pressure recordingsere continued for 22 hours afterwards. Blood pressure data were

nalyzed by the Student t test and analysis of variance. P�0.05 wasonsidered statistically significant.

RESULTS: There were no significant difference in systolic, diastolic,ulse pressure and heart rate during normal activity between the LPSnd CON group. Offspring from LPS exposed dams were bradycardicnd more hypotensive 30 minutes after endotoxin. Blood pressure inhe LPS group recovered faster 20 hours following endotoxin inducedhock compared to CON (Figure).

CONCLUSIONS: Exposure to inflammation at day 16 gestation in micelters on the vascular response to endotoxic shock in the adultffspring.

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