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ospital stay. These findings warrant delivery at a tertiary care centerith a NICU to care for the neonate with profound hypotonia.

ltrasound Findings and Neonatal outcome

Case 1 Case 2 Case 3 Case 4 Case 5

oly Yes Yes Yes Yes Yes.........................................................................................................................................................................................

A@Poly 31 wks 29 wks 33 wks 28 wks 28 wks.........................................................................................................................................................................................

C � 3% Y Y Y 4% Y.........................................................................................................................................................................................

etal Mvts 2 2 2 2 2.........................................................................................................................................................................................

wins N Y N Y Y.........................................................................................................................................................................................

A@Del 38 35 36 32 32.........................................................................................................................................................................................

ICU dys 23 27 45 102 75.........................................................................................................................................................................................

002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.753

737 Impact of smoking on first trimesterried blood free beta HCG and PAPP-Aerry Hallahan1, Kuang-Lin He1, Yuncen A. He1,

on Carmichael1, David Krantz1, John Sherwin1

NTD Labs/PerkinElmer, Melville, New YorkBJECTIVE: Previous studies conducted using maternal serum speci-ens indicated that smoking had a significant impact on PAPP-A

esults and only a small impact on free Beta hCG results. We sought tovaluate the impact of smoking on dried whole blood specimens.TUDY DESIGN: We evaluated a total of 7503 patient results. MedianoM value in free Beta hCG and PAPP-A was determined for each

roup. Statistical significance was determined using Wilcoxon testith P�0.05 deemed to be significant.ESULTS: In the group of 7503 patients, 358 (4.8%) were smokers.his percentage was significantly smaller (P�.001) than the 15% ofothers who are smokers according to birth certificate information

NCHS-2006). There was a statistically significant (P�0.001) 9.8%eduction in free Beta hCG median MoM for smokers compared toon-smokers. For PAPP-A there was an even larger 18.9% reductionP�0.001) in median MoM for smokers.ONCLUSION: An adjustment factor for smoking for PAPP-A and freeeta hCG is warranted in first trimester screening. However, moreducation is required to ensure that smokers are properly identifiedn laboratory requisition forms.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.754

738 Rapid DNA fingerprinting for zygosity determinationark Hughes1, Eugene Pergament2, Mark Evans3

Genesis Genetics, Detroit, Michigan, 2Northwestern University,hicago, Illinois, 3Comprehensive Genetics, New York, New YorkBJECTIVE: Structural congenital anomalies are increased in monozy-otic twins (MZ). However, shared circulation significantly changeselective termination options and statistics. Zygosity cannot always beetermined by ultrasound. Standard DNA fingerprinting techniquesn chorionic villi (CV) or amniotic fluid could be used but take far too

ong to be of clinical utility. We have adapted techniques used inreimplantation Genetic Diagnosis (PGD) to provide rapid zygosityetermination in such circumstances.TUDY DESIGN: In an ambiguous case, CV samples of both twins wereicrodissected to remove desidua, washed in a small amount of PBS

nd processed into clean DNA. Muliplex PCR was performed for sixighly polymorphic genomic loci followed by molecular genotypingn a conventional Applied Biosystems 3150 instrument. The ampli-ons (base pair length; different fluorescent dyes) were designed tollow all six markers to be analyzed simultaneously. Data comparisono cheek swab DNA from the parents simplifies the data interpretationut is not required given the high heterozygosity (polymorphic index)f the genomic markers. Molecular results are available seven hours

fter sample receipt. e

266 American Journal of Obstetrics & Gynecology Supplement to DECEMBER

ESULTS: Analysis of 6 markers was completed in � 24 hours from theime the CVS was completed, sent to the reference laboratory, micro-issected, and molecularly analyzed. Direct FISH chromosome test-

ng to evaluate for common aneuploidy can be performed simulta-eously. The data determine that the twins were genetically identicalto �99% MZ status) allowing appropriate clinical decisions to beade.

ONCLUSION: The shift from karyotyping to molecular methods forapid testing has allowed alteration in obstetrical management in sit-ations such as presumed T18 at term who otherwise would likelyeed CS or near GA limits for choice options. This technique nowllows rapid diagnosis of zygosity for which clinical decisions are re-uired in a time frame faster than routinely available currently andhould minimize mistakes in clinical management of such cases.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.755

739 Identification of 8 and 12 hour proteinurias a reliable method to diagnose preeclampsia.C. Otero-Pinto1, F. Latorre2, M. Rocha3, L. Reyes4

San Luis Clinic- HUS-UIS, Maternal Fetal Medicine Unit, Bucaramanga,olombia, 2Santander University Hospital-UIS, Maternal Fetaledicin Unit, Colombia, 3Santander University Hospital- UIS,

Cardiovascular Fundation of Santander, ColombiaBJECTIVE: Preeclampsia is defined as the development of hyperten-ion (�140/90 mm Hg) with 24-h proteinuria �300 mg/L after 20eek’s gestation. It would be important to know before the 24 hourroteinuria result which woman is at risk of developing preeclampsia

n order to take earlier therapeutic interventions. The aim of this studyas to determine whether 8 and 12 hour proteinuria could be used

nstead of 24 hour proteinuria to diagnose preeclampsia earlier inrder to avoid maternal and fetal complications.TUDY DESIGN: Sixty two women with clinical suspect of hypertensiveisorder of pregnancy were enrolled. A complete chart was recordednd a physical examination was performed in all women included.otal protein level was measured in aliquots of urine in the 8 and 12nd 24 hour samples. A ROC curve was made to determine the bestutoff point to diagnose preeclampsia in 8 and 12 hour proteinuria.ESULTS: The mean age of the patients was 29.7 �7 years. 9.9% of theatients had preeclampsia; their mean gestational age was 32.4 � 4.3.1.15% of the patients had history of hypertension and 19.67% re-orted to have preeclampsia in previous pregnancies. The ROC curve

dentified that a value of 55.8 mg/dl in the 8-hour sample has a sensi-ivity of 81.25 % and specificity of 86.96% to diagnose preeclampsiahen compared to the 24-hour proteinuria. This value also has aositive predictive value of 66.66 %, and negative predictive value of0.90 %. In the 12-hour proteinuiria, a value of 106.11 mg/dl has aensitivity of 93.75 %, a specificity of 89.13%, a positive predictivealue of 75 %, and negative predictive value of 97.61 % when com-ared to the 24-hour proteinuria.ONCLUSION: Based on the results of the study, it is suggested that 8nd 12 hour proteinuria can be used as a tool to perform and earlyiagnosis of preeclampsia. This important finding could help obste-ricians to implement an early therapeutic intervention to improvehe outcome for both mother and child. We propose that the best

ethod to diagnose preeclampsia is an 8-hour proteinuria �55.8 mg/dl.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.756

740 Prevention of preeclampsia with low-dose aspirinr vitamins C/E: a systematic review with metaanalysis. Cristina Rossi1, Vincenzo D’Addario2

IV Clinic of Obstetrics and Gynecology, University of Bari; Clinicf Obstetrics and Gynecology, “San Paolo” Hospital, Bari, Italy,

2IV Clinic of Obstetrics and Gynecology, University of Bari, ItalyBJECTIVE: To review randomized trials investigating the efficacy of

ow-dose aspirin (LDA) or vitamins C/E (VCE) in preventing pre-

clampsia (PE) in women at high or low risk.

2009