Yair Daykan1, Zvi Klein1, Rona Bugin1, Dana Yossefi1,. Tal Biron-Shental1, Ron Schonman1 ... Meir medical center. All women with ovarian or adnexal torsion.
Poster Session III STUDY DESIGN: A retrospective cohort study from the Consortium on Safe Labor was performed. Triplet pregnancies with delivery at a gestational age (GA) ¼ 28 weeks were identified. Women with a prior CD and pregnancies with anomalies, TTTS, or a fetal demise were excluded. The aVD group included spontaneous or induced labor and excluded pre-labor CD, elective CD, or CD for malpresentation. The primary outcomes were maternal morbidity or composite neonatal morbidity, defined as: birth injury, 5-minute Apgar < 4, arterial pH < 7.0 or base excess < -12.0, neonatal asphyxia, or neonatal death. Multivariate Poisson regression was performed with clustering to account for correlation between triplets within a pregnancy. To assess the validity of aVD exposure, repeat analysis was performed after restricting the aVD group to women with documented induction/augmentation of labor or GA¼ 34 weeks (“strict”). RESULTS: Of 188 triplet sets 80 sets met inclusion criteria and 24 had aVD. The rate of successful aVD was 16.7% (4 triplet sets). No woman had a combined mode of delivery. Women with aVD were more likely to have preterm labor and receive steroids. aVD was associated with a higher risk of maternal transfusion (20.8% vs 3.6%, p¼0.023) [Table 1]. The risk of neonatal mechanical ventilation was higher with aVD, however there were no differences in asphyxia or composite neonatal morbidity [Table 2]. 47 triplet sets met “strict” criteria of whom 18 had aVD with a success rate of 22.2%. In the “strict” subcohort, the risk of maternal transfusion was no longer significant (22.2% vs 3.5%, p¼0.06) but aVD was associated with an increased risk of composite neonatal morbidity (aIRR 12.44, 95%CI 1.22-127.20). CONCLUSION: aVD of triplets is associated with higher risks of maternal transfusion and neonatal morbidity. The low probability of successful VD raises questions regarding the utility of aVD in triplet gestations.
ajog.org 502 The effects of chronic unpredictable stress on maternal behavior and fetal brain development in a mouse model Yen Chan1, Juan Velasquez2, Alexandre Bonnin2 1 University of Southern California, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Los Angeles, CA, 2Zilkha Neurogenetic Institute and Department of Cell and Neurobiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
OBJECTIVE: To evaluate the effects of unpredictable stressors on
maternal antenatal behavior and their impact on fetal growth and neurodevelopment in mice. STUDY DESIGN: Pregnant CD-1 mice were subjected to chronic unpredictable stress (CUS) from embryonic day (E)8 through E17. CUS was defined as a daily randomly selected physical or psychosocial stressor. On E17, mice were assessed for depression- and anxiety-like behaviors using Forced Swim (FST) and Open Field (OFT) tests, respectively. Age-matched, unexposed controls underwent only behavioral testing. Fetal brains were harvested on E17 after the last behavioral test. Fetal brain biogenic amine concentrations, normalized to total fetal brain protein concentrations, were measured by high performance liquid chromatography (HPLC). Immunohistochemistry (IHC) was utilized assess fetal serotonergic and thalamocortical circuit formation. RESULTS: Compared to controls (n¼9), CUS exposed pregnant mice (n¼12) exhibited signs of depression and anxiety, as demonstrated by increased immobility in the FST (p¼0.0153) and decreased time spent in the center of the arena in the OFT (p¼0.0009). CUS exposed mice gained less weight during their pregnancy (p¼0.017). In addition, maternal CUS exposure negatively impacted fetal weight measured at E17 (p¼0.002). Mice exposed to CUS demonstrated a significant increase in fetal forebrain serotonin concentrations compared to unexposed controls (p
