ajog.org Poster Session I

sPIF promotes neuroprotection in vitro. N2a cells were sub-jected to LPS and treated with sPIF or scrambled PIF (scrPIF). (A):sPIF increased PKA/PKC kinase activity in time dependent manner.(B): sPIF induced higher IL-10, BDNF, and GAP-43 and (C) lowerCASP-3, BAD, and TNF.a expression. (D): sPIF increased pGap-43/Gap-43 and (E) pBad/Bad ratio while decreasing Bad (E).***p<0.001

sPIF promotes neuroprotection in vitro. Unilateral brain injurywas induced by LPS, ligation of carotid artery and hypoxic period.(A): sPIF restored neuronal number (compare middle right pannelvs. lower right pannel). (B): sPIF decreased Iba-1 positive cells

Supplem

number (compare middle right pannel vs. lower right pannel) andchanged the morphology from predominantly amoeboid state(marked with red arrowheads) to ramified state (marked with bluearrowheads). (C): sPIF induced higher IL-10 expression and (D)increased phospho-Gap-43/Gap-43 ratio.

107

Counseling practices for fetal hypoplastic left heartsyndromeMichael Walsh1, George Verghese1, Eric Ferguson2,Nora Fitzgerald3, David Goldberg4, Sonal Owens5, Nelangi Pinto6,Sinai Zyblewski7, Michael Quartermain11Wake Forest School of Medicine, Pediatric Cardiology, Winston-Salem, NC,2Sibley Heart Center, Atlanta, GA, 3Wake Forest University School ofMedicine, Biostatistical Sciences, Winston-Salem, NC, 4Children’s Hospital ofPhiladelphia, Pediatric Cardiology, Philadelphia, PA, 5University of Michigan,Pediatric Cardiology, Ann Arbor, MI, 6University of Utah, PediatricCardiology, Salt Lake City, UT, 7Medical University of South Carolina,Pediatric Cardiology, Charleston, SCOBJECTIVE: In counseling parents of a fetus with newly diagnosedhypoplastic left heart syndrome (HLHS), pediatric cardiologists playa critical role in shaping a family’s expectations for the months andyears to come. However, guidelines for counseling do not exist andsignificant variation amongst physicians is likely present. Thisproject was undertaken to better define these practices.STUDY DESIGN: A Web-based survey of pediatric cardiologists thatperform fetal echocardiograms was performed.RESULTS: Two hundred one physicians responded (61% male, 81%from academic centers, 95% from the US), with an average of 12years’ experience. Most physicians counsel families alone (54%),while others counsel with a nurse (35%), social worker (12%), and/or maternal-fetal medicine colleague (15%). Most respondents(73%) typically receive initial referrals for HLHS between 20-24weeks gestation. Termination of pregnancy was discussed by 82% ofrespondents, although 15% didn’t know their state’s legal limit fortermination. While initial counseling sessions routinely describe theearlier ramifications of HLHS, many mid and long-term sequelae ofthe disease aren’t always discussed (Figure 1). Practice setting,experience, and fetal volume did not have a significant impact ondiscussion topics (P > 0.05). Common reasons given by providersfor not discussing certain sequelae were fear of overwhelming fam-ilies (75%), concern that families would not understand the infor-mation (30%), and/or feeling families did not need to worry aboutlong-term effects during the fetal period (31%).CONCLUSION: This is the first study of its kind to describe fetalcounseling practices for HLHS. Data suggests that earlier ramifica-tions of HLHS are discussed more frequently than long-term out-comes. Perceived barriers to a full discourse on long-term sequelaeof HLHS are common. Current counseling practices fail to coverimportant information in the majority of cases and may lead to adisconnect between reality and a family’s understanding of thenatural history of palliated HLHS.

ent to JANUARY 2015 American Journal of Obstetrics & Gynecology S71

Poster Session I ajog.org

Figure 1: The frequency (always, sometimes, or never) with whichsurvey respondents said they discussed certain sequelae of HLHSduring initial fetal counseling.

108

3D ultrasound: the best view of placenta accretaNora Doyle1, Jessica Pullen1, Mindy Holliday1, Michael Gardner11University of Oklahoma, OB/Gyn, Tulsa, OKOBJECTIVE:Morbidly adherent placenta (MAP)/Placenta accreta is anever increasing pregnancy complication associated with significantmaternal morbidity and mortality. The incidence continues to riseconcomitantly with increasing cesarean and repeat cesarean deliveryrates. Unrecognized MAP is associated with worsening maternal /fetal morbidity and higher rates of mortality. Optimal managementof women with placenta accreta requires accurate prenatal diagnosisto minimize these complications. We sought to compare 2D ultra-sound (US), 3D US/ Power Doppler, and MRI as effective screeningstrategies.STUDY DESIGN: IRB approved cohort study from a single institutionJanuary 2013 - June 2014. 25 Patients undergoing cesarean hyster-ectomy were identified and their pathology reports were examined toconfirm the MAP diagnosis. 2D US, 3D US and MRI findings werereviewed and compared to the pathology results to determinesensitivity, specificity, positive predictive and negative predictivevalues of each of the screening modalities.RESULTS: 25 cesarean hysterectomies performed in the study period.19 MAP cases were confirmed by pathology. See table.CONCLUSION: Ultrasound remains the superior screening tool forMAP. Use of 3D US increases the positive predictive value of thediagnosis without decreasing the sensitivity of screening for MAP.MRI is an inferior screening test due to higher costs and poorspecificity. We believe the addition of 3D ultrasound in the screeningfor MAP may prevent false positive diagnosis which could lead tounnecessary cesarean hysterectomy and iatrogenic pretermdeliveries.

S72 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

Screening results: 2D US, 3D US, MRI

109

Adolescent pregnancy e teenager’s perspectivePriya Prasad1, Julia Herdiman1, Ioana Livinti1, Robert Hecht1,Dabiri Tajudeen1, Carolyn Salafia1, Magdy Mikhail11Bronx Lebanon Hospital, Obstetrics and Gynecology, New York, NYOBJECTIVE: To evaluate teenager’s perspective on their pregnancy; itsimpact on their social and educational life, family involvement orsupport, awareness and willingness to use available contraceptivechoices.STUDY DESIGN: IRB approved questionnaire-based study. All ques-tionnaires were anonymous and were provided in either English orSpanish. Subjects included any pregnant adolescent above 24 weeksgestation seeking care at the Bronx Lebanon Hospital, New York.RESULTS: 156 questionnaires were completed. 77.6% (121) subjectswere Hispanic, 19.2% (30) were African-American and the rest wereof other races. 38.5% (60) were aged 19, 32.1% (50) were 18, 16%(25) were 17 and 13.5% (21) were less than 17 years old. 54.5% (85)of subjects were still in school, out of which 98.9% (84) believedtheir pregnancy will not impact their education. In 84.6% (132)cases, father of baby was involved in the relationship; while in 15.4%(24) they were not. 41.7% (65) of subjects were aware of all birthcontrol methods but did not want to use any, 7% (11) declined beingaware of any methods. 73.7% (115) subjects admitted talking to acare provider regarding the contraceptive choices available. 78.2%(122) of pregnancies were unplanned. Of these, 70.5% (84) subjectsdid not use any birth control, 28.6%(35) used short acting birthcontrol and 2.4% (3) used long acting birth control. Post delivery39.6% (61) subjects considered short acting birth control choices,while 27.9% (43) opted for long acting methods. Only 3.8% (6)subjects were planning on getting a job for financial support whilethe rest were dependent on others or government aid.CONCLUSION: Teenagers are aware of contraceptive choices but do notwant to use them. We need to formulate methods to increase theirappreciation of contraception and educate teens on the impact ofadolescent pregnancy on various aspects of adult life. This shouldinclude emphasis on financial independence instead of relying onothers for care of their baby.

110

Preterm premature rupture of membranes (PPROM) afterfetoscopic laser surgery (FLS) for twin-twin transfusionsyndrome (TTTS): risk factors and outcomesSaul Snowise1, Lovepreet Mann1, Kenneth Moise Jr.1,Anthony Johnson1, Michael Bebbington1, Noemi Boring1,Yisel Morales1, Erin Canon1, Genevieve Campbell1,Ramesha Papanna11UT Health- University of Texas Medical School at Houston, Fetal Center atChildren’s Memorial Herman Hospital, Houston, TXOBJECTIVE: FLS has increased perinatal survival for TTTS, butPPROM remains the main complication of the procedure. Thenatural history of PPROM after FLS and the associated factors haveyet to be studied. Our objective was to determine the risk factors andoutcomes of PPROM after FLS.

015