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www.AJOG.org Clinical Obstetrics, Neonatology, Physiology-Endocrinology Poster Session I

Figure 1. Characterization of human trophoblast progenitor cells(hTPCs) (A) Morphology of hTPCs in culture. (B) Western blot forHMGA2, N-cadherin, and Oct4. (C) Western blot for syncytin. (D)Gelatin zymography. Assay for presence of MMPs in growthmedium. H7 � human embryonic stem cell line (hESC); CTB �

primary human cytotrophoblasts; �-actin was used as a loadingontrol.

123 The active management of risk in pregnancyt term (amor-ipat) cost-effectiveness study

James Nicholson1, Lisa Kellar2, Abdulllah Dar1, Hariprakashadial1, Yvonne W. Cheng3, Aaron Caughey4

1University of Pennsylvania, Philadelphia, PA, 2Boonshoft Schoolof Medicine, Wright State University, Dayton, OH, 3Universityof California, San Francisco, San Francisco, CA, 4Oregon

ealth & Science University, Portland, OROBJECTIVE: Several recent publications have estimated the relativeosts of labor induction versus expectant management. These studiesave postulated that labor induction is more costly than expectantanagement. The objective of this study was to compare actual hos-

ital charges of a group of nulliparous parturients who were exposedo the Active Management of Risk in Pregnancy at Term (AMOR-PAT) - and its relatively high labor induction rate - to the actualospital charges of a group of nulliparous parturients who were ex-osed to usual care and its lower labor induction rate.

STUDY DESIGN: Within two similar previously published retrospectivetudies were 63 nulliparous parturients exposed to the Active Man-gement of Risk in Pregnancy at Term (AMOR-IPAT) and 241 nul-iparous parturients exposed to usual care. Detailed charge data werebtained for each parturient and her infant. Rates of common adverseutcomes, and the costs for maternal care, infants care, and combinedother/iinfant care, were determined and compared.

RESULTS: Parturients exposed to AMOR-IPAT had a higher labor in-uction rate (58.7% vs 27.4%, p�0.0001), a lower rate of cesareanelivery rate (11.1% vs 22.1%, p�0.04) and a trend towards a lowerICU admission rate (9.5% vs 14.5%, p�0.30). In addition, nullipa-

ous parturients exposed to AMOR-IPAT had lower costs for mater-al care, neonatal care and combined birthing costs (see table).

CONCLUSIONS: The use of the Active Management of Risk in Preg-ancy at Term, which includes a high labor induction rate, was asso-iated with improved clinical outcomes for first-time mothers andheir infants. In addition, the use of AMOR-IPAT in nulliparousomen was associated with reductions in the cost of care for bothothers and their infants. Accordingly, AMOR-IPAT may represent a

ominant therapy (i.e., better outcomes at less cost). Federal fundingor adequately-powered randomized clinical trials of AMOR-IPAT isot only ethical but imperative.

p

Supplem

Maternal Costs(mean)

Neonatal Costs(mean)

Combined Costs(mean)

Usual Care $12,869 $5,027 $17,901..........................................................................................................................................................................................

AMOR-IPAT $12,408 $4,776 $17,184..........................................................................................................................................................................................

Relative Reduction 3.6% 5.0% 4.6%..........................................................................................................................................................................................

124 Early-term preventive labor induction in gravidast increased risk for cesarean delivery–an associationetween 38-week preventive labor inductionnd improved birth outcomes

James Nicholson1, Steven Groves1, Sara Malik1, Javariaarwar1, Yvonne W. Cheng2, Aaron Caughey3

1University of Pennsylvania, Philadelphia, PA, 2Universityof California, San Francisco, San Francisco, CA, 3Oregon

ealth & Science University, Portland, OROBJECTIVE: The use of non-indicated labor induction in the early-erm period of pregnancy has been discouraged by a number of influ-ncial organizations over the past few years. However, high qualityata does not exist that supports this restriction. We wished to useata from several previously published studies to evaluate the specificssociations between risk-based labor induction in the 38th week ofestation and rates of common adverse birth outcomes.

STUDY DESIGN: Data from two previously published studies of the Ac-tive Management of Risk in Pregnancy at Term (AMOR-IPAT) werecombined. Parturients exposed to AMOR-IPAT who underwent pre-ventive labor induction in the 38th week of gestation were identified.The birth outcomes of these cases were then compared to the out-comes of births that occurred in the usual care group when pregnancylasted until or beyond 39 weeks 0 days of gestation.RESULTS: 62 parturients from the AMOR-IPAT exposed groups un-

erwent risk-based preventive labor induction in the 38th week ofestation. 539 parturients from the usual care groups delivered on orfter 39 weeks 0 days of gestation. Rates of cesarean delivery, majorerineal injury (3rd or 4th degree), NICU admission, and APGARcore at 5 minutes � 7 all trended lower in the 38-week labor induc-ion group (see table). The mean Adverse Outcome Index (AOI) scorelso trended lower in the 38-week preventive labor induction group5.24 vs 5.71, p�0.15).

CONCLUSIONS: In this retrospective study the overall pattern of birthutcomes that followed risk-based preventive labor induction withinhe 38th week of gestation appeared to be superior to that of expectant

anagement until or beyond 39 weeks 0 days of gestation. AMOR-PAT, with its regular use of risk-based 38-week labor induction , doesot appear to be harmful and should be definitively studied within theontext of adequately-powered randomized clinical trials.

CesareanDelivery

MajorPerinealInjury

NICUAdmission

APGAR @5min < 7

AMOR-IPAT (38 wk IOL) 6.4% 1.6% 6.4% 0%..........................................................................................................................................................................................

Expectant (� 39w 0d) 18.4% 9.3% 10.6% 1.5%..........................................................................................................................................................................................

p-value (adjusted) 0.06 0.11 0.31 0.33..........................................................................................................................................................................................

125 Leptin and leptin receptor single nucleotideolymorphisms and recurrent pregnancy loss

Jeanette Chin1, Cara Heuser1, Alexandraller1, D. Ware Branch1, Robert Silver1

1University of Utah, Salt Lake City, UTOBJECTIVE: Animal and human studies indicate that leptin signaling

lays an important role in embryo implantation and development.e sought to determine if the (-2548)G/A single nucleotide polymor-

hism (SNP) in the leptin (LEP) gene and/or the 223A/G SNP in theeptin receptor (LEPR) gene are associated with idiopathic recurrent

regnancy loss (iRPL). The LEP SNP occurs in the promoter region

ent to JANUARY 2011 American Journal of Obstetrics & Gynecology S63