SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018 - 143A

Scientific Abstracts

Is Electronic Patient Portal Use during Pregnancy Associated with
Better Maternal and Neonatal Outcomes? Erinma P Ukoha†,2 Joseph
M Feinglass,1 Lynn M Yee*.1 1Northwestern University Feinberg School
of Medicine, Chicago, IL, United States; 2University of California, San
Francisco, San Francisco, CA, United States.
INTRODUCTION: Use of an electronic patient portal, in particular
secure messaging, has been found to have a positive impact in management
of chronic disease and health care utilization outside of pregnancy. Our
objective was to determine if the use of an electronic portal during
pregnancy is associated with better maternal and neonatal outcomes and
less health care utilization.
METHODS: This is a retrospective cohort study of women who received
prenatal care at a large academic medical center (2014-16). Clinical
records were reviewed for portal use and patient data. Patients were
considered to be enrolled in the electronic patient portal if they had an
account at the time of delivery; enrollees were compared to non-enrollees.
Enrollees were categorized by the number of secure messages sent during
pregnancy as active (≥1) versus inactive (0) users. Multivariable Poisson
regression was used to assess the association of portal use with maternal
outcomes (preeclampsia, gestational diabetes mellitus [GDM], cesarean
delivery, excess gestational weight gain), neonatal outcomes (preterm
birth [PTB], birthweight <1000g, 5-minute Apgar <7, NICU admission,
fetal death), and utilization outcomes (obstetrical triage visit, emergency
department visit, antepartum admission).
RESULTS: 2350 (68%) of 3450 women eligible for inclusion were
enrolled in the portal. Women enrolled in the patient portal were more
likely to be non-Hispanic white, privately insured, and nulliparous. In
unadjusted analyses, portal enrollees were less likely to develop GDM,
preeclampsia, or have a cesarean delivery. However, these differences did
not persist in adjusted analyses (Table). Neonates of portal enrollees were
at statistically significant decreased risk of PTB and NICU admission.
Active portal use was not associated with differences in maternal or
neonatal outcomes. In regard to health care utilization, portal enrollees
and active users were less likely to be admitted to the antepartum unit
during pregnancy.
CONCLUSION: Unlike in the non-pregnant population, portal use was
not associated with improved maternal outcomes, but was associated with
neonatal outcomes and decreased likelihood of antepartum admission.
These findings suggest portal use may lead to better outcomes through
enhanced patient-provider communication and facilitation of patient
self-management, but further investigation is needed to understand the
potential impact in pregnancy.
*Figure(s) will be available online.

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External Cephalic Version at 35 Weeks' Gestation versus 37 Weeks'
Gestation: Retrospective Cohort Study. Anat Lavie, Lee Reicher, Ronit
Almog, Yariv Yogev, Sharon Maslovitz. Tel Aviv Sourasky Medical Center
and Sackler School of Medicine, Tel Aviv, Israel.
INTRODUCTION: We aim to determine whether performance of
external cephalic version (ECV) at 35 weeks of gestation is associated with
increased success and lowers the rate of non-cephalic presentation at birth.
METHODS: A retrospective cohort study at a single university affiliated
tertiary hospital between 2015 and 2017. All participants were healthy
primiparous women at 34-38 weeks of gestation with fetal breech
presentation who were routinely offered an ECV attempt. Women who
underwent ECV between 35-36 weeks' gestation (study group) were
compared to those who underwent ECV between 37-38 weeks' gestation
(control group). Group assignment was according to the wishes of the
mother and the availability of a physician and not based on clinical
considerations.Primary outcome was rate of non-cephalic presentations at
birth. Secondary outcomes were CS and vaginal delivery rate, presentation
after first and last ECV and a composite of serious fetal complication
(defined as one or more of the following: preterm birth or preterm rupture
of the membranes at <37 weeks, placental abruption requiring obstetrical
intervention or abnormalities in the fetal heart rate requiring obstetric
intervention).

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RESULTS: 1. Overall, 54 women were enrolled in the study group
and 106 in the control group. 2. The groups were similar with regard to
demographic and clinical characteristics (Table 1), except for estimated
fetal weight which was higher in the control group (2927+196 g vs.
2634+212 g, p<0.05). 3. The study group had a higher incidence of more
than two ECV attempts (18.5% vs. 5.6% for control group, p<0.05). 4.
Women in the study group had a higher incidence of cephalic presentation
after first ECV in comparison to the control group (72.2% vs. 66%
p<0.05), with no significant difference in presentation at delivery (Table
2). 5. Women in the study group had a trend toward a higher incidence
of cephalic spontaneous and operative deliveries compared control group
(46.2% vs. 44.3% and 3.7% vs. 1.8%, respectively, p=0.09 and p=0.07).
No difference was found in cesarean section rate between the groups. 6.
Other outcome measures were similar for both groups.
CONCLUSION: Initiating ECV at 35-36 weeks of gestation in
primiparous women increases the chances for a cephalic presentation
immediately after ECV. However, it has no effect on presentation at
delivery or the CS rate.
*Figure(s) will be available online.

T-102A
Cervical Length Alone versus Cervical Length Plus Distance to Fetus:
Which is a Better Predictor of Preterm Delivery? Natalie Porat†, Olivia
Grubman†, Dyese Taylor†, Melissa Chu Lam†, Lois Brustman*, Barak
Rosenn*. Mount Sinai West, New York, NY, United States.
INTRODUCTION: The purpose of this study is test the hypothesis that
shortened cervical length plus distance to fetus is a better predictor of
preterm delivery than shortened cervix alone.
METHODS: This is a retrospective cohort study of patients who had
cervical length (CL) measured between 16-32 weeks gestation for various
indications between 10/2012 and 6/2017 and were found to have a CL
<2.5 cm. We reviewed all CL studies and measured the distance from the
fetal part closest to the cervix to the internal cervical os (FD). If there
was more than one CL study, the last study prior to delivery was used
up to 32 weeks gestation. We then added that distance to the CL alone
(Image 1). Our primary outcome was delivery <37 weeks' gestation.
Secondary outcomes included delivery <34 weeks and delivery within 2
weeks from ultrasound. We also collected demographic data regarding
age, race, BMI, smoking history, history of prior preterm delivery (PTD),
and history of cervical surgery. Statistical analysis was performed using
logistic regression models to assess the effect of CL alone or CL+FD on
each of the outcomes.
RESULTS: Sonograms of 135 patients with CL <2.5 cm were reviewed.
The odds of having a preterm delivery at <37 weeks are 76% less (OR 0.24,
95% CI: 0.13, 0.47) for each cm increase in CL alone, p = <0.001 (Table
1). This did not hold true regarding CL+FD (OR 1.02, 95% CI: 0.71, 1.47),
p=0.904. CL alone was also found to be significantly associated with PTD
<34 weeks (p=<0.001) and delivery within two weeks (p=0.035). There
was no statistically significant association between CL+FD and PTD <34
weeks (p=0.185) or delivery within two weeks (p=0.864).
CONCLUSION: While shortened CL is associated with preterm delivery
and delivery within 14 days, adding the distance to the fetus does not
enhance the ability to predict preterm delivery.
*Figure(s) will be available online.

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Hippo/YAP Mechanical Signaling in Uterine Fibroid. Sinnie SM
Ng*,1 Szu-chi Su*,1 Minnie Malik*,2 James H Segars*.1 1Johns Hopkins
Medicine, Baltimore, MD, United States; 2Uniformed Services University
of the Health Sciences, Bethesda, MD, United States.
INTRODUCTION: Uterine fibroids are stiff tumors characterized by
the presence of excessive and disorganized extracellular matrix. Prior
studies showed that mechanical homeostasis was altered in fibroids
compared with adjacent myometrium. In vitro culture of primary fibroid
cells also showed an abnormal response to substrate stiffness and cyclic
stretching. The Hippo pathway coactivator YAP responds to changes
in cell density, and mechanical stress. For cells plated at high density,
YAP is phosphorylated and sequestered outside the nucleus, leading

Thursday Posters

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Reproductive Sciences Vol. 25, Supplement 1, March 2018
Table of Contents for the Digital Edition of SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018
