preeclampsia were included. Patients with hemorrhage, coagulopa-thy, coagulation disorders, preexisting thrombocytopenia, or antico-agulation were excluded. Subjects (n�100) were categorized into 4groups of preeclampsia severity: preeclampsia, severe preeclampsia,severe preeclampsia with thrombocytopenia or renal dysfunction,and HELLP syndrome. We compared the mean and median TEGparameters (R time, K, � angle, and MA) across strata of disease se-verity. Mean R values were compared with ANOVA. Median K, �angle, and MA values were compared with Kruskal-Wallis.RESULTS: Comparing TEG parameters, the mean R value, a measureof clotting time, was not different across severity strata. The median Kvalue, a measure clot strength, was different, with increasing time toachieve clot strengthening with increasing severity stratum. The me-dian � angle, a measure of rapidity of fibrin cross-linking, was differ-ent, with the slowest clot strengthening noted in patients with HELLPsyndrome. The median MA, or maximum clot strength, a measure ofplatelet function, was different, with decreasing platelet function withincreasing severity stratum.CONCLUSION: The K time, � angle, and MA differed with worseningpreeclampsia disease severity, indicating slower clot strengthening,and impaired fibrin cross-linking and clot strength with worseningpreeclampsia.
622 Outcomes of expectantly managed parturients afterbetamethasone for preeclampsiaChristopher Young1, Latasha Nelson2, Svena Julien2
1University of California, Irvine, Obstetrics and Gynecology, Orange, CA,2Northwestern University, Obstetrics and Gynecology, Chicago, ILOBJECTIVE: Describe the latency period for subjects who receive beta-methasone (BMZ) after diagnosis of preeclampsia.STUDY DESIGN: A retrospective cohort study of parturients who re-ceived BMZ for the diagnosis of preeclampsia was performed betweenJuly 2004 and June 2009 at a single, large, university-based practice.Rescue or repeat courses of BMZ were not administered. Mild pre-eclamptics were expectantly managed until 37 weeks gestationwhereas severe preeclamptics were managed until 34 weeks gestation.Subjects were grouped into intervals of two weeks based on gestationalage (GA) at diagnosis beginning with 24 weeks and ending with 34weeks. The primary outcome was the latency period between the GAat diagnosis and the GA at delivery. Neonatal intensive care unit(NICU) length of stay (LOS), eventual indication for delivery andpercentage of patients with latency periods greater than 14 days weresecondary outcomes. All data was analyzed with the Kruskal-Wallistest.RESULTS: 151 subjects received BMZ for preeclampsia and delivered173 infants. The median GA of BMZ administration, latency periodand NICU LOS were 220 days (IQR 20-29 days), 5 days (IQR 2-20days) and 5 days (IQR 2-21 days) respectively. There was no signifi-cant difference in latency (p�0.24) between GA groups. Infants bornto subjects diagnosed with PPROM between 28 and 29 6/7 weeks hada significantly different LOS (40 days, p�0.0002) compared to othergroups. The most common indications for delivery were worseningpreeclampsia (74%), nonreassuring fetal status (15%) and pretermlabor (3%). 4% of subjects were electively delivered at 34 or 37 weeksgestation based on preeclampsia severity. 29% of subjects had a la-tency period greater than 2 weeks.
CONCLUSION: Despite advances in obstetric care including BMZ, phar-macotherapy and close maternal and fetal monitoring, the majority ofpatients with preeclampsia will deliver within one week. Prolongingpregnancies complicated with preeclampsia remains a concern forobstetricians.
623 Alterations in protein secretion in preeclampsia as afunction of plurality–Clinical implicationsEran Zilberberg1, Eyal Sivan1, Yoav Yinon1, Eyal Schiff1, AnatKalter1, Israel Hendler1, Suzi Oberman-Farhi1, Shali Mazaki-Tovi1
1Sheba medical center, Obstetrics & Gynecology, Ramat Gan, IsraelOBJECTIVE: Physiological adaptations of pregnancy that may affectprotein secretion include increased intravascular volume, elevatedglomerular filtration rate and more. These changes are more promi-nent in twin gestation. The aims of this study were to determinewhether preeclampsia is associated with increased protein secretion intwins and to assess the association between proteinuria and clinicalindices of preeclampsia severity.STUDY DESIGN: This is a retrospective cohort study included pregnantwomen with twin or singleton gestation. Inclusion criteria included 1)diagnosis of preeclampsia, 2) gestational age between 24 and 40 weeks,3) 24 hours urine collection conducted during hospitalization. Exclu-sion criteria included: 1) chronic renal disease, 2) fetal death of one orboth fetuses. A total of 176 pregnant women met the criteria and wereclassified into two groups: singleton (n�56) and twins (n�120). Pro-tein secretion was determined in all patients, as well as the rate ofelevated SGOT, SGPT, creatinine, severe systolic and diastolic bloodpressure (BP), severe thrombocytopenia and proteinuria.RESULTS: The median 24-hours protein secretion was higher in twinthan singleton gestation (900 mg/24h IQR:450-1690 vs. 580 mg/24h,380-1570, p�0.026). There were no significant differences in the rateof elevated SGOT (twins: 38% vs. 30%, p�0.4), SGPT (35% vs. 21%,p�0.1) or creatinine (4% vs. 5%, p�0.7). Similarly, the rate of severediastolic (11% vs. 12%, p�0.8) or systolic (55% vs. 67%, p�0.9) BPwas comparable between groups. Twins and singletons did not differsignificantly in the rate of severe thrombocytopenia (twins: 15% vs.10%, p�0.5) or severe proteinuria (5% vs. 2%, p�0.4). Overall therate of severe preeclampsia was higher in singleton compared withtwins (37.5% vs. 20%, p�0.04).CONCLUSION: Elevated proteinuria in twin gestation is not accompa-nied by increased severity of preeclampsia. These findings may haveclinical implications for the management of twins gestations compli-cated by preeclampsia.
624 Utility of posterior and septal wall thickness inpredicting adverse pregnancy outcomes in patients withchronic hypertensionImelda Odibo1, Dimitry Zilberman1, Joseph Apuzzio1, ShaunaWilliams1
1UMDNJ-New Jersey Medical School, Obstetrics, Gynecology and Women’sHealth, Newark, NJOBJECTIVE: To determine if increased posterior wall thickness (PWT)and septal wall thickness(SWT) on echocardiogram in gravidas withchronic hypertension(CHTN) are associated with adverse pregnancyoutcomes(APO).
Significance p�0.05 is indicated in bold.
Latency period and NICU stay afterpreeclampsia diagnosis
www.AJOG.org Academic Issues, Antepartum Fetal, Clinical Ob, Fetus, Genetics, Hypertension, Med-Surg-Diseases, Operative Ob, U/S Poster Session IV
Supplement to JANUARY 2013 American Journal of Obstetrics & Gynecology S265
