Poster Session I
org
characteristics and outcomes were collected. Quantitative and
qualitative variables were compared by Wilcox, t-test or Fisher test
respectively.
RESULTS: Among 3068 women (1497 nullipara and 1571 para), 208
(6.8%) had a second stage > 2 hours. OP position was diagnosed in
76 (36.5%) of these women. Vaginal delivery occurred in 74.1% (43/
58) and 83.3% (15/18) of nulliparous and parous women, respectively,
when the second stage of labor was extended. Length of second stage
was longer in nulliparous women with a fetus in an OP position than
in nulliparous women with a fetus in an occiput anterior position.
However, perineal tears of 3rd and 4th degree, postpartum hemorrhage
and neonatal outcomes were similar (Table 1).
CONCLUSION: Extending the second stage of labor with a fetus
in an OP position is safe and reduce the risk of CD whatever the
parity.
175 Does malpresentation affect latency and other
perinatal outcomes among PPROM cases?
Saila S. Moni, Lizelle Comfort, Xiaonan Xue, Peter Bernstein,
Pamela Troppper
Albert Einstein/Montefiore Medical Center, Bronx, NY
OBJECTIVE: PPROM is estimated to complicate 3% of all births and is
associated with up to 40% all preterm births. PPROM is an
important cause for perinatal mortality and morbidity and there are
improved outcomes with longer latency. There is limited literature
on whether fetal presentation affects latency among PPROM cases.
S120 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2018
ajog.
Our objective was to determine whether fetal presentation at the
diagnosis of PPROM has an effect on the latency period and other
perinatal outcomes.
STUDY DESIGN: All cases of PPROM after 20 weeks of gestation
delivered at our institution from January 2014 though May 2017.
Inclusion criteria: singleton gestations. Exclusion criteria: PPROM at
less than 20 wks gestational age (GA), multiple gestations and fetal
anomalies. The analysis was stratified based on GA at time of
rupture: 20 - 26 wks, 26 wks+1d - 28 wks, 28 wks+1d - 30 wks, 30
wks+1d - 32 wks and 32 wks+1d - 36 wks+6d. We calculated that 20
women with noncephalic and 80 with cephalic presentations would
give the study 80% power to detect HR of 1.3 for latency measured
in days.
RESULTS: 120 cases of PPROM were reviewed: 100 were cephalic
and 20 noncephalic at presentation. There were no differences in
maternal age, race, smoking status, infection on admission,
bleeding in pregnancy, history of preterm delivery or the use of
latency antibiotics between fetal presentation. There was no dif-
ference noted in latency period based on fetal presentation (HR ¼
1.17, CI: 0.66, 2.07). Noncephalic presentation at PPROM was
associated with delivery for nonreassuring fetal status, lower
Apgar scores at 1 and 5 minutes and fetal anemia. A fetal/
neonatal composite morbidity composite variable consisting of
sepsis, IUFD, RDS and neonatal demise showed a trend toward
worse outcomes for fetuses in noncephalic presentation however
it did not reach statistical significance (OR ¼ 4.62, CI 0.94, 22.71,
P¼0.06).
CONCLUSION: Fetal presentation at the time of PPROM does not
appear to affect the length of the latency period. However, there may
be increased maternal and fetal/neonatal morbidity associated with
fetal malpresentation and closer fetal monitoring may be warranted
for non-vertex presenting fetuses in cases of PPROM.
ajog.org
176 Are maternal and neonatal complications
associated with the number of pop-offs during
vacuum-assisted vaginal delivery (VAVD)?
Saila S. Moni1, Georgios Doulaveris1, Donna Somerville2,
Rodney McLaren3, Keith Eddleman4, Karen Beckerman5,
Barak Rosen6, Peter Bernstein1
1
Albert Einstein/Montefiore Medical Center, Bronx, NY, 2Hospitals Insurance
Company, New York, NY, 3Maimonides Medical Center, Brooklyn, NY,
4
Mount Sinai, New York, NY, 5Bronx Lebanon Hospital Center, Bronx, NY,
6
Mount Sinai West, New York, NY
OBJECTIVE: VAVDs account for approximately 4% of vaginal births
in the US and the incidence of serious neonatal complications
with VAVD is approximately 5%. There is limited literature on the
maternal and neonatal outcomes associated with the number of
involuntary detachments (pop-offs) of the cup during VAVDs.
Most experts recommend limiting pop-offs to three before
abandoning the procedure, however, there are no standard
guidelines. Our objective was to evaluate outcomes among suc-
cessful VAVDs in relation to the number of pop-offs during the
deliveries.
STUDY DESIGN: This was a retrospective cohort analysis of patients
undergoing successful VAVD in seven New York hospitals from
January 2015 to December 2016. Data was abstracted from a de-
identified database maintained by the risk management advisor/
malpractice insurer for these institutions, which performs quarterly
chart audits of all VAVD deliveries. Inclusion criteria: single gesta-
tions in cephalic presentation at >34 weeks of gestation. Maternal
and neonatal outcomes were analyzed using standard univariate
analyses.
RESULTS: 611 cases of VAVDs were reviewed. Number of pop-offs are
as follows: Zero among 398 (65.1%) cases, one among 147 (24.1%)
cases, two among 57 (9.3%) cases and three among 9 (1.5%) cases.
When comparing VAVDs with any pop-off (1) to those with zero
pop-offs, there was significantly higher risk of NICU admission
(11.3% vs. 6.5%, p¼0.04), Apgar <7 at 1 minute (10.8% vs. 5%,
p¼0.01), need for neonatal intubation (2.3% vs. 0.3%, p¼0.02) or
any neonatal resuscitation (10.3% vs. 4.5%, p¼0.009). When
comparing VAVD with  2 pop-offs to those with <2 pop-offs, there
was significantly higher risk of major head trauma (subgaleal hem-
orrhage, skull fracture and intracranial hemorrhage) (4.5% vs. 0.7%,
p¼0.03) and need for neonatal intubation (4.5% vs. 0.5%, p¼0.01).
Supplement to JANUARY 2018 American Journal of Obstetrics & Gynecology
Poster Session I
There was no difference in both analyses with regards to maternal
complications, including PPH, blood transfusion and 3rd or 4th
degree perineal lacerations.
CONCLUSION: There is significant neonatal morbidity associated with
increasing number of pop-offs during VAVD. Clinicians should
counsel and manage patients undergoing VAVD accordingly.
177 The risk of amniotic fluid embolism
reoccurrence in subsequent pregnancy
Irene Stafford1, Presley S. Parkes1, Amir Moaddab1,
Miranda Klassen2, Steven L. Clark1, Michael A. Belfort1,
Gary A. Dildy1
1
Baylor College of Medicine, Houston, TX, 2Amniotic Fluid Embolism
Foundation, Vista, CA
OBJECTIVE: Amniotic fluid embolism (AFE) is a rare and catastrophic
complication of pregnancy presenting as a complex sequence of
events resulting in cardiopulmonary and coagulation compromise
during the intrapartum period. Mortality is high. Consequently,
women who have suffered an AFE and survive commonly refrain
from further child bearing despite a lack of evidence suggesting a risk
of reoccurrence (Moaddab 2017 EJOGRB). The aim of this study
was to determine AFE reoccurrence rates using data from the in-
ternational AFE Registry established at Baylor College of Medicine
and AFE Foundation, along with published reports of pregnancies
following AFE.
STUDY DESIGN: Patients enrolled in the AFE Registry between 2013-
2017 and classified as having had a classic AFE (Clark 2016 AJOG)
were interviewed about pregnancy before and after AFE. PubMed
and OVID search engines were used to identify cases of pregnancy
reported in the literature after AFE.
RESULTS: Fifty-four women with classic AFE were identified in the
Registry. Of these, 5 died, leaving 49 women available for interview.
Seven women had subsequent pregnancies, 1 miscarried and the
other 6 had uncomplicated pregnancies and delivered at term. Nine
cases of pregnancy following AFE were found in the literature, all
without reoccurrence bringing the total reported cases of pregnancy
following AFE to 16. Therefore the documented rate of reoccurrence
for AFE is 0% (0/16) with 95% CI ¼ 0-20% (Hanley & Lippman-
Hand 1983 JAMA).
CONCLUSION: These data represent the largest existing series of
pregnancy outcome following AFE, almost double the existing re-
ported experience. Although the numbers remain small, there exists
no documented case of AFE recurrence in the literature. These data,
along with the appropriate CI may prove helpful in counseling AFE
survivors considering pregnancy.
178 The effect of antenatal corticosteroid
administration on neonatal biometrics administered
after 34 weeks gestation
Irene Stafford, Angela Burgess, Haleh Sangi-Haghpeykar,
Kjersti M. Aagard
Baylor College of Medicine, Houston, TX
OBJECTIVE: Whereas evidence suggests that the administration of
repetitive doses of antenatal corticosteroids to mothers at risk for
preterm birth reduces newborn cephalic biometric measures, a single
course followed by a rescue regimen before 34 0/7 weeks gestation
has not demonstrated this effect and has proven to be beneficial for
the fetus at risk for preterm birth. Currently, there are no studies that
have evaluated the effects of antenatal corticosteroid on newborn
biometric measurements given after 34 0/7 weeks gestation for
women at risk for late-preterm birth.
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