401 DECIDUAL LEUKOCYTES IN HUMAN PREGNANCY ASSOCIATED WITH INTRAUTERINEGROWTH RESTRICTION WITH AND WITHOUT PREECLAMPSIA SICCO SCHERJON1,ALIANA SINDRAM2, DAVE ROELEN3, FRANS CLAAS3, HUMPHREY KANHAI1, 1LeidenUniversity, Obstetrics, Leiden, Netherlands, 2DukeUniversity, Durham, NorthCarolina, 3Leiden University, Leiden, Netherlands

OBJECTIVE: The aim of this study was to determine the potential role ofdecidual leukocytes in intrauterine growth restriction (IUGR) and preeclamp-sia by quantifying the percentage of leukocytes in decidua basalis andparietalis associated with IUGR with and without preeclampsia in relationto the situation in normal pregnancy.

STUDY DESIGN: Paired decidua basalis and parietalis samples wereobtained from pregnancy with IUGR alone (n= 10), with preeclampsia andIUGR (n=11), and normal term pregnancy (n=30). All women weredelivered biy elective caesarean. Following mechanical isolation and staining,percentages of leukocytes were determined by flow cytometry.

RESULTS: The percentage of TCRgdCCD3C and CD4CCD25C cellswas lower in decidua basalis and parietalis associated with IUGR with andwithout preeclampsia compared to normal pregnancy (see figure 1a, 1b). Thedifferences can not be explained because of differences in gestational agebetween the groups (data not shown).

CONCLUSION: Significant differences in decidual leukocytes exist betweenIUGR with and without preeclampsia, compared to normal control pregnan-cies, suggestive for an aberrant immunoregulation of both diseases. Both thelower percentage of TCRgdCCD3C and of CD4CCD25C cells indicate arelative absence of immuno regulatory cells in IUGR G PE.

SMFM Abstracts S119

399 AMNIOTIC FLUID LACTATE DEHYDROGENASE (AF LDH) AS A PREDICTOR OFEARLY DELIVERY IN IDIOPATHIC CERVICAL INCOMPETENCE WITH EMERGENTCERCLAGE PLACEMENT SCOTT REYNOLDS1, STEPHANIE LADOWSKI1, COLEGREVES1, DAVID GLIDDEN2, STEPHEN CARLAN1, RACHEL HUMPHREY1, 1OrlandoRegional Healthcare System, Obstetrics and Gynecology, Orlando, Florida,2University of California, San Francisco, Epidemiology and Biostatistics,San Francisco, California

OBJECTIVE: Lactate dehydrogenase is a non-specific marker of inflamma-tion that can be quantified in amniotic fluid. We evaluated the utility of AFLDH for prediction of latency between emergent cerclage placement anddelivery.

STUDY DESIGN: Women who had an amniocentesis with assessment of AFLDH prior to emergent cerclage placement and who delivered at our institu-tion from 1999-2003 were included. Incompetent cervix was diagnosed bycervical dilation or effacement in the absence of contractions between 18 and24 weeks gestation. The cohort was divided into two groups: those with lowAF LDH (LDH !90 IU/L) and those with elevated AF LDH (LDH R90IU/L). Significance was determined by calculating the correlation coefficientand by logistic regression where appropriate.

RESULTS: A total of 18 patients met inclusion criteria. There were 10 patientsin the low AF LDH group (mean AF LDH value: 71C 17 IU/L) and 8 patientsin the elevated AF LDH group (mean AF LDH value 137 C 25 IU/L).The latency between cerclage placement and delivery (Lat to del) was greater inthe low AF LDH group as was gestational age at delivery (GA at del). Thelength of neonatal hospitalization (Baby LOS) was shorter in the low AF LDHgroup. There was a significant association between AF LDH levels and theincidence of neonatal respiratory distress syndrome (RDS) and chorioamnio-nitis on placental microscopic examination. There were no differences betweenthe groups in terms of gestational age, cervical length or dilatation at placement;or amniotic fluid glucose, WBC or RBC values.

CONCLUSION: AF LDH can be used to predict latency after emergentcerclage placement. This readily-available test improves identification ofpatients at risk for early delivery and neonatal complications.

LDH and pregnancy outcomes

AF LDH ! 90 AF LDH R 90 P-value

Lat to del (days) 113 45 .0001GA at del (wks) 37 28 .0001Baby LOS (days) 8 50 .0004RDS (%) 10 75 .001Chorio on Path (%) 0 63 !.0001

400 SYMPHYSIS-FUNDAL HEIGHT MEASUREMENTS AND MATERNAL WEIGHT GAIN AREMORE ACCURATE THAN ULTRASOUND IN PREDICTING NEONATAL MACROSOMIAIN MORBIDLY OBESE WOMEN ASHA RIJHSINGHANI1, RAVI BHATIA1, 1Universityof Iowa, Obstetrics and Gynecology, Iowa City, Iowa

OBJECTIVE: Fetal growth determination is difficult in morbidly obesewomen. Ultrasound examinations have limitations. We compared the accuracyof ultrasound with symphysis-fundal height (SFH) measurement to determinewhich of the two more accurately estimated the neonatal weight.

STUDY DESIGN: We reviewed antenatal records of morbidly obese patientswith BMI O 40 at the time of delivery. Maternal weight at registration,weight gain, SFH measurements and delivery data were analyzed. These werecorrelated with neonatal birth weight that was O90th percentile and O4500grams.

RESULTS: Forty-six morbidly obese women were seen through the antepartum clinic. Thirty patients with complete data were delivered at ourhospital. SFH measurements were obtained on all patients. Maternal weightgain, mean SFH measurement at term, and ultrasound based estimated fetalweight were compared with neonatal weight. The average BMI at registrationwas 50.76 (G 7.75) and 54.69 (G 7.48) at delivery. In mothers whose with theSFH -GA measured R7cm and weight gain was O30 lbs, 88.9% deliveredneonates O 90 percentile weight, all neonates O 4500 g belong to this group.

CONCLUSION: In the morbidly obese pregnant woman, when SFH - GA isR7, and maternal weight gain is O30 pounds at delivery, the possibility of theneonatal weight beingO90th percentile andO4500 g is significantly increased.The SFH and maternal weight gain are better predictors of fetal and neonatalmacrosomia when compared to ultrasound estimated fetal weight.

Neonatal birth weight in comparison to maternal weight gain and SFH

Birth Wt!90%

Birth WtO90% p

Birth Wt!4500grams

Birth WtO4500grams p

SFH - GAR7

25% 73.3 0.004 40% 100% 0.02

Mat WtGain(lbs)

23.08G16.5 32.61G14.8 0.05 24.34G15.4 43.42G9.7 0.007

SFH - GAR7& Mat WtGainO30

6.3% 57.1% 0.003 16% 100% 0.001

Decidual Leukocytes subpopulation in IUGR with and withoutpre-eclampsia compared to controls

402 PREGNANCY OUTCOME IN THE 5TH TO 7TH DECADES MICHAL SIMCHEN1,YOAV YINON1, EYAL SCHIFF1, EYAL SIVAN1, 1Tel Aviv University, Sheba MedicalCenter, obstetrics and gynecology, Ramat-Gan, Israel

OBJECTIVE: To describe pregnancy complications in the peri-menopausal/menopausal pregnant population.

STUDY DESIGN: Medical records of women aged 45 years or older who gavebirth at our center were collected and reviewed. Pregnancy and neonataloutcomes were compared between women aged 45-49 yrs (Group 1) andwomen aged 50 yrs or more (Group 2).

RESULTS: During 5 years 123 women agedR45 years gave birth, represent-ing 0.2%of total deliveries; 99 inGroup 1 (median age 46: range 45-49), and 24 inGroup 2 (median age: 52; range: 50-64). Overall, 67 women (54.5%) werenulliparous; 50/99 (50%) inGroup 1 and 17/24 (71%) inGroup 2 (p=0.07). 43/99women inGroup 1 conceived via IVF, 13with oocyte donation (OD),while allwomen (100%) in Group 2 conceived via IVF with OD. Overall, meangestational age at delivery (GA) was 37.6G2.6 weeks, with mean birth weight(BW) 2684G754 gr. The overall incidenceofmultifetal pregnancies, diabetes andhypertension was 23%, 21% and 28.4%, respectively, similar between groups1 and 2. Nonetheless, older women were more likely to be hospitalized duringpregnancy (22% vs. 62.5%, respectively, p = 0.0001). Neonatal outcome wasgood except for 1 intrauterine death of a severely growth restricted twin. GA andBW were both significantly lower for singletons, as well as multiples, in group 2