SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018 - 264A

264A

Reproductive Sciences Vol. 25, Supplement 1, March 2018

was 1727g (range 157-4529g), and mean operation time was 96minutes
(range 58-177minutes). Blood loss during operation and operation time
correlated with the fibrinogen levels in plasma. One case was needed
uterine artery ligation because of artery injury during caesarean section,
but other cases were not needed other surgical treatment. None of the
women developed complications related to the procedure.
CONCLUSION: Our uterine compression suture technique might be
very effective and safety treatment for severe PPH.
*Figure(s) will be available online.

S-032
Biomarkers for the Detection of Invasive Placentation: MicroRNA
in the Maternal Serum Can Be Used to Detect Placenta Accret. V M
Fratto†,2 S Srinivasan,2 C To,2 P DeHoff,2 V Tran,2 M Westermann,1 A
O'Leary,3 M E Norton,3 D A Wing,1 G A Ramos,2 L Laurent.2 1University
of California, Irvine, Irvine, CA, United States; 2University of California,
San Diego, San Diego, CA, United States; 3University of California, San
Francisco, San Francisco, CA, United States.
INTRODUCTION: Use of ultrasound and magnetic resonance imaging
to diagnose abnormally invasive placenta (AIP) is costly and imprecise.
We hypothesize that levels of cell-free microRNA (miRNA) in the
maternal blood will differ among women with AIP, placenta previa, and
normal placentation
METHODS: Women with suspected AIP, previa, or normal placentation
were prospectively recruited at three academic centers in the UC fetal
Consortium. AIP was confirmed by pathologic evaluation. Maternal serum
was collected, and total RNA was extracted and subjected to small RNA
sequencing. The percent abundance of miRNA, piRNA, and tRNA and
rRNA fragments, and levels of individual miRNAs were compared. Chi
square, Kruskal Wallis, Mann Whitney U, and Fishers Exact tests were
used as appropriate. Differential Rank Conservation was used to identify
pairs of miRNAs that were inversely correlated in normal placentation
and AIP.
RESULTS: 60 women were recruited: 17 AIP, 15 placenta previa, and
28 normal placentation. The median gestational age at sample collection
was 30w3d (IQR 28w - 33w), and did not differ among groups (p=0.13).
The abundance of total miRNA reads as a percentage of all reads in the
small RNA sequencing data was highest among women with AIP and
lowest in normal placentation (Figure 1). Differential Rank Conservation
analysis identified pairs of specific miRNAs that had inversely correlated
expression in the groups (example shown in Figure 2).
CONCLUSION: The percent total miRNA was significantly higher
in maternal serum in cases of AIP compared to normal placentation. In
addition, specific pairs of miRNAs that displayed inverse expression levels
in AIP and normal placentation were identified. Our results suggest that
maternal serum miRNAs have the potential to serve as biomarkers for
accurate antenatal diagnosis of AIP. Studies in larger cohorts for validation
of these results are needed.
*Figure(s) will be available online.

S-033
Impact of Resident Training Level on Clinical and Sonographic
EFW in Term Obese Women. B Adam Crosland†, Nisha Garg†, Robert
C Johnston†, Judith C Chung*. UC Irvine Health, Orange, CA, United
States.
INTRODUCTION: Accurate fetal weight estimation at term identifies
abnormal fetal growth and confirms the safety of a chosen delivery
mode. Fetal weight estimation is performed clinically using Leopold's
maneuver, or via ultrasound. However, both Leopold's and ultrasound
may under- or overestimate fetal weight by as much as 15 - 20%, or more
in obese women. Studies comparing clinical to ultrasound estimated fetal
weight (EFW) are sparse, and primarily retrospective. Whether clinician
experience impacts fetal weight estimation is unclear. This is a planned
sub-analysis assessing the impact of post-graduate training level on
clinical and sonographic fetal weight estimation in obese women at term.
METHODS: This was a prospective non-randomized study performed
between January and October, 2017. All women ≥ 18yo, with a singleton
fetus, ≥ 37 weeks' gestation and with a BMI of ≥ 30 who were admitted for

Scientific Abstracts

anticipated delivery were screened. Exclusion criteria included imminent
delivery or anatomical malformations precluding normal biometric
measurement. Fetal weight was estimated first by Leopold's maneuver,
followed by sonographic biometry, subcutaneous adiposity, and amniotic
fluid indices, and then compared to actual birthweight. All assessment
was limited to physicians in their second (PGY-2) year of training or
higher. One hundred seventy patients were enrolled to obtain a power of
80% and alpha of 0.05.
RESULTS: Compared to Leopold's maneuver, ultrasound was
significantly more accurate at estimating fetal weight. However, the mean
difference in grams between modalities was only 7.5 g, and therefore
of little clinical significance. Level of post-graduate training did not
impact accuracy of clinical, nor ultrasound EFW. Increasing BMI was
associated with less accurate EFW, both clinically and sonographically,
while subcutaneous adiposity, oligohydramnios, and anterior placental
location played no role.
CONCLUSION: We conclude that sufficient clinical experience is
obtained by PGY-2 year to affect a relatively accurate EFW via Leopold's
maneuver or ultrasound, even in the obese woman at term.
*Figure(s) will be available online.

S-034
Is Elective Cesarean Delivery for Elderly Primiparas Safer Than
Trial of Labor? Rani Haj Yahya, Michal Lipschuetz, Myriam Safrai,
Simcha Yagel, Doron Kabiri. Hadassa Medical Center , Ein Kerem,
Jerusalem, Israel.
INTRODUCTION: The aim of this study was to evaluate maternal and
neonatal outcomes following trial of labor for elderly primiparas at age
40 or older compared with elective cesarean delivery.
METHODS: This was a retrospective cohort study including all
primiparas women at age 40 or older, with singleton gestation who were
potential candidates for vaginal delivery and delivered in a tertiary center
between January 2003 and December 2015. We compared the incidence
of adverse maternal and neonatal outcomes between women with planned
vaginal delivery and women with planned elective caesarean section.
RESULTS: During the study period, 558 women met the inclusion
criteria. Two-hundred and eighty-six women (51.3%) had planned elective
cesarean delivery. Of the remaining 272 women who underwent trial of
labor, One-hundred and seventy-three delivered vaginally (success rate,
63.6%). There were no cases of maternal or perinatal deaths. Neonatal
outcomes were similar.
CONCLUSION: Maternal and neonatal outcomes are not better in elderly
primaparas aged 40 or older who choose to undergo elective cesarean
section. With a successful rate of approximately 65%, trial of labor is
reasonable also for the elderly primipara.
Selected maternal and neonatal outcomes.
Elective cesarean delivery
(N=286)

Trial of labor
(N=272)

P
value

Maternal age (years)

43.86 ± 1.75

41.41 ± 3.36

<0.001

Maternal death (n)

0 (0%)

0 (0%)

NA

Neonatal Birthweight
(gram)

3076 ± 402

3188 ± 419

<0.001

Apgar 5min <=7 (n)

2 (0.7%)

1 (0.36%)

0.591

PH<=7.1 (n)

2 (0.7%)

3 (1.1%)

0.152

NICU admission (n)

2 (0.7%)

3 (1.1%)

0.613

Fetal death (n)

0 (0%)

0 (0%)

NA

S-035
Mode of Delivery in Cases of Increased Fetal Head Circumference
and Fetal Ventriculomegaly. Benjamin K Kogutt†, Angie C Jelin*, Clark
T Johnson*. Johns Hopkins University, Baltimore, MD, United States.
INTRODUCTION: Is there a prenatal sonographic measurement of fetal
head circumference (HC) that can predict appropriate candidates for trial
of labor (TOL)? It is our objective to determine if there is a fetal head
circumference threshold for which TOL should be avoided.
Table of Contents for the Digital Edition of SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018
