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Poster Session V Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging www.AJOG.org

701 Maternal supine recumbency leads to brainuto-regulation in the fetus and elicit the brainparing effect in low risk pregnancies

Nizar Khatib1, Shoshana Haberman2, Ron Belooseski1,ana Vitner1, Zeev Weiner3, Israel Thaler3

1Rambam Medical Center, Haifa, 2Maimonides Medical Center, Brooklyn,NY, 3Rambam Medical Center, Technion Israel Institue of Technology, HaifaOBJECTIVE: The brain sparing phenomena in the fetus is a protective

echanism aimed at maintaining sufficient blood flow towards therain during chronic or acute fetal stress such as that caused by hy-oxemia or utero-placental insufficiency. In this study we investigatedhether the brain sparing effect can be also elicited by a physiological

tress associated with maternal posture.STUDY DESIGN: Eighteen low-risk pregnant women participated in thestudy. Gestational age ranged from 36 to 40 weeks gestation. Dopplerflow velocity waveforms were obtained from the fetal middle cerebralartery and the umbilical artery in the supine and the left lateral decu-bitus positons. Resistance indices and peak systolic velocities weremeasured. The paired t-test was employed. Results are expressed asthe mean �SEM.RESULTS: The pulsatilty index in the middle cerebral artery decreasedrom 1.8 � 0.06 in the left lateral decubitus position to 1.25�0.04 inupine recumbency (p�0.0001). Peak systolic velocity decreasedrom 45.8�1.8 cm/sec to 39.6�1.8 cm/sec respectively (p�0.001).he pulsatility index in the umbilical artery declined from 0.89�0.033

n the left lateral position to 0.74�0.026 in the supine positionp�0.0001).

CONCLUSIONS: This study demonstrates that supine recumbency inate pregnancy causing aortic and vena-caval compression, a decreasen cardiac output and in systemic blood pressure, leads to brain auto-egulation that activates the brain sparing effect in the fetus. Thisrotective mechanism, shown here for the first time to be linked to ahysiological stress, may provide the basis for a novel approach in thessessment of fetal well being.

702 Risk factors for intrauterine fetal death (1988-2009)Oded Ohana1, Gershon Holcberg2,

uslan Sergienko3, Eyal Sheiner2

1Soroka University Medical Center, Ben-Gurion University of theegev, Be’er-sheva, Israel, 2Soroka University Medical Center,eer Sheva, 3Ben-Gurion University of the Negev, Beer Sheva

OBJECTIVE: To determine risk factors for intrauterine fetal deathIUFD).

STUDY DESIGN: A retrospective population based study, of all singletoneliveries between the years 1988-2009, was conducted. Intrapartumeaths, postpartum death and multiple gestations were excluded. Aultiple logistic regression model was used to determine independent

isk factors while controlling for confounding variables.RESULTS: During the study period, out of 228,239 singleton births,

694 IUFD cases were recorded (7.4 per 1000 births). The followingndependent risk factors were identified in the multiple logistic regres-ion model: amniotic fluid disturbances including oligohydramniosOR 2.6, 95% CI 2.1-3.2, P�0.001) and polyhydramnios (OR 1.8 95%I 1.4-2.2, P�0.001), previous adverse perinatal outcome (OR 1.7,5% CI 1.5-2.1, P�0.001), congenital malformations (OR 2.0, 95%I 1.8-2.3, P�0.001), true knot of cord (OR 3.7, 95% CI 2.8-4.9,�0.001), meconium stained amniotic fluid (OR 2.7, 95% CI 2.3-3.0,�0.001), placental abruption (OR 2.9, 95% CI 2.4-3.5, P�0.001),dvanced maternal age (OR 1.03, 95% CI 1.02-1.04, P�0.001, forvery year), and hypertensive disorders (OR 1.24, 95% CI 1.0-1.4,�0.026). Gestational diabetes mellitus (GDM, OR 0.7, 95% CI 0.5-.8, P� 0.001), previous cesarean delivery (OR 0.8, 95% CI 0.7-0.97,� 0.019) and recurrent abortions (OR 0.8, 95% CI 0.6-0.9, P�

.011) were negatively associated with IUFD. f

S278 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

CONCLUSIONS: Several independent risk factors were identified, sug-esting a possible cause of death. Other pathologic conditions thatacilitate tighter pregnancy surveillance and active management wereound protective (such as GDM), pointing the benefit of such man-gement approaches in high-risk pregnancies.

703 Variable prenatal stress: aat model of prenatal behavior

Patricia Scott1, April Ronca2, Christina Tulbert2, Jonathanorgan2, Jasmine Feimster2, Glenn Winn2

1Wake Forest University, Nashville, TN, 2Wakeorest University, Winston Salem, NC

OBJECTIVE: Prenatal behavior is often used to predict fetal health. Inumans, in-utero movements such as kick-counts and ultrasound as-

sessment of fetal movement are routinely performed for fetal reassur-ance. Physical stress such as umbilical cord occlusion has direct effectsupon fetal behavior and health. Little is known about prenatal expo-sure to environmental stressors and effects on fetal behavior. Fetalprogramming of neurologic responses may be influenced by eventsoccurring during prenatal life. We developed a method to representchronic, intermittent environmental stress in a rat model with the useof ultrasound as a non-invasive method for observation of fetal be-havior.STUDY DESIGN: Female Sprague-Dawley rats were time mated thenallocated to the variable stress (VPS) or control (CNTL) group.Throughout gestation, VPS dams were exposed daily to 3 differentstressors: (1) white noise, (2) strobe light, and (3) tube restraint pre-sented in 3 separate episodes at varying times and durations. CNTLdams were handled daily to match handling of the VPS dams. On day20, spinal anesthesia was administered and ultrasound of prenatalmovement using high-resolution ultrasound was performed (Visual-Sonics Vevo 770). Comparison was made to CNTL group (total 10minutes). At completion all pups were delivered via cesarean sectionfor pup and placental weights.RESULTS: Comparison of upper limb movements, lower limb move-

ents, total time in movement and total time at rest were made withndings of increased time in movement for the pups of the VPS dams,ith more time in movement by hind legs.

CONCLUSIONS: Differences in prenatal movement could indicate pre-atal neurological damage or alteration due to external environmen-

al stressors and provide insight into the foundation of developmentalnd/or behavioral disabilities in children. Variable prenatal stress maympact fetal health and behavior which may be seen prenatally vialterations in fetal movement patterns seen via ultrasonography.hese behaviors may represent predictors of neurologic influenceshich later may manifest as disabilities in children.

704 Obstetric outcomes in casesf first trimester cystic hygroma

Roa Al Ammari1, Jeremy Kaplan1, Adam Wolfberg1, Cassandreanner1, Chitra Iyer1, Asha Heard1, Jaclyn Coletta2, Brittaanda3, Jessica Scholl4, Michael House1, Sabrina Craigo1

1Tufts Medical Center, Boston, MA, 2Columbia University Medicalenter, New York, NY, 3Massachusetts General Hospital, Boston,

MA, 4Dartmouth Hitchcock Medical Center, Lebanon, NHOBJECTIVE: To determine obstetric outcomes in pregnancies diag-

osed with a cystic hygroma in the first trimester.STUDY DESIGN: A multi-center retrospective study of 1,975 records of

atients with increased NT (�2.5mm) and/or cystic hygroma thatresented between 2000 and 2010 yielded 631 patients with cysticygroma. Patients had ultrasound examinations between 10 weeks 3ays and 13 weeks 6 days. Cystic hygroma was defined as “an enlargedypoechoic space at the back of the fetal neck, extending along the

ength of the fetal back, and in which septations were clearly visible.”RESULTS: Obstetric outcome data were available for 453 of the 631

etuses diagnosed with cystic hygroma. 276 (60%) underwent elective

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