ajog.
org
in FT rather than ET. Post-laser, RV and LV SDIs exhibited signi-
cantly less variation when compared to controls. Strong correlations
were demonstrated between the RV SDI and RV Tei index (r0.82)
and LV SDI and LV Tei index (r0.79) in all groups.
CONCLUSION: Twin fetuses aficted with TTTS cardiomyopathy
exhibit abnormal SDIs which subsequently normalize following
successful fetoscopic laser. Changes in SDI primarily result from
variations in lling time, suggesting compromised diastolic function
in recipient twins. SDI may be a feasible surrogate for Tei index and a
useful screening tool in TTTS cardiomyopathy.
409 Increased fetal adiposity is a risk factor for cesarean
delivery - Results of the national prospective Genesis Study
Mark P. Hehir1, Naomi Burke2, Gerard Burke3,
Fionnuala M. Breathnach2, Fionnuala M. McAuliffe4,
John J. Morrison5, Michael J. Turner6, Samina Dornan7,
John Higgins8, Amanda Cotter9, Michael P. Geary1, Fiona Cody1,
Peter McParland10, Cecelia Mulcahy10, Sean Daly11,
Patrick Dicker12, Elizabeth Tully2, Fergal D. Malone2
1
Rotunda Hospital, Dublin, Ireland, 2Royal College Of Surgeons In Ireland
(RCSI), Obstetrics and Gynaecology, Dublin, Ireland, 3Graduate Entry Medical
School, University of Limerick, Limerick, Limeirck, Ireland, 4UCD School of
Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland,
5
National University of Ireland, Galway, University Hospital Galway., Galway,
Ireland, 6UCD Centre for Human Reproduction Coombe Women and
Infants University Hospital, Dublin, Ireland, 7Royal Jubilee Maternity
Hospital, Belfast, Ireland, 8University College Cork, Cork, Ireland, 9Graduate
Entry Medical School, University of Limerick, Limerick, Limerick, Ireland,
10
National Maternity Hospital, Holles St, Dublin, Ireland, 11Coombe Women
and Infants University Hospital, Dublin, Ireland, 12Epidemiology & Public
Health, Royal College of Surgeons in Ireland, Dublin, Ireland, Dublin, Ireland
OBJECTIVE: Increased fetal size is associated with labor dystocia and
subsequent need for assisted delivery. The role of fetal adiposity in
the need for instrumental and cesarean delivery is unclear. We
sought to investigate if increased fetal adiposity diagnosed sono-
graphically was associated with increased risk of operative delivery.
STUDY DESIGN: The Genesis Study recruited 2,336 nulliparous pa-
tients with a vertex presentation in a prospective multicenter study
to examine prenatal and intra-partum predictors of cesarean de-
livery. Participants had ultrasound and clinical evaluation performed
between 39 0/7 and 40 6/7 weeks gestation. Data on fetal biometry
was not revealed either to patients or their managing clinicians. A
fetal adiposity composite of fetal thigh adiposity and fetal abdominal
thickness was compiled for each infant in order to clarify if fetal
adiposity >90th centile was associated with an increased risk of
cesarean or instrumental delivery.
RESULTS: Data was available for 2,336 patients, 42% (981/2,336) of
patients had a spontaneous vaginal delivery (SVD), 37% had an
operative vaginal delivery (864/2,336), while 21% (491/2,336)
required cesarean delivery. Fetuses with adiposity composite >90th
centile were more likely to require cesarean delivery than fetuses
with adiposity greater than the 90th centile (p0.0001, OR2.5,
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
Poster Session II
95% CI1.7-3.5). After adjusting for birthweight, maternal BMI,
and induction of labor, fetal adiposity >90th centile remained a risk
factor for cesarean delivery. Having a composite adiposity >90th
centile was not found to be associated with an increased likelihood of
operative vaginal delivery when compared with fetuses <90th centile
(p0.13, OR 1.3, 95% CI0.9-1.8).
CONCLUSION: In a large prospective cohort of nulliparous pregnan-
cies, fetuses with increased adipose deposition were more likely to
require cesarean delivery. Given that increased fetal adiposity is a risk
factor for cesarean delivery, consideration should be given to adding
fetal thigh and abdominal wall thickness to late pregnancy fetal as-
sessment.
410 Comparison between three methods for the detection of
macrosomia and growth restriction in patients presenting in
active labora prospective study
Eran Weiner1, Nataly Fainstein1, Yossi Mizrachi1, Osnat Elyashiv1,
Noa Mevorach-Zussman1, Jacob Bar1, Michal Kovo1
1
Wolfson Medical Center, Holon, Israel
OBJECTIVE: Patients presenting in active labor without a recent
estimation of fetal weight (EFW) pose a unique obstetric challenge.
We aimed to compare between sonographic, calculated and clinical
assessment methods of EFW to actual birth weight (ABW) for the
detection of macrosomia and fetal growth restriction (FGR) in pa-
tients presenting in active labor.
STUDY DESIGN: Patients >37 weeks, in active phase of labor, under-
went prospectively an assessment of fetal weight, by senior residents.
Three methods for EFW were used: sonographic assessment, using 5
formulas by Hadlock, clinical assessment, and calculated assessment
(extrapolating EFW from previous scan assuming the fetus retained
its growth %).Each performer was blinded to the EFW of the other
methods. Sensitivity and specicity were calculated for each method
for the detection ( 10%) of macrosomia (ABW  4000 gr) and
FGR (ABW <10th%). McNemars test was used to compare between
the methods.
RESULTS: During the study period (4/2014-6/2015) 405 patients were
recruited. Mean cervical dilatation at enrollment was 5.7 2.1 cm.
For the entire cohort, the coefcient of correlation between sono-
graphic, clinical, and calculated EFW to ABW were: 0.702
(p<0.001), 0.649 (p<0.001) and 0.623 (p<0.001), respectively. For
the detection of macrosomia (n60) sensitivity and specicity were:
44.1% and 75.6% (for sonographic EFW), 76.3% and 74.1% (for
clinical EFW), 65.5% and 72.1% (for calculated EFW) respective-
ly.Clinical EFW performed best (p0.03) compared to the other
methods. For the detection of FGR (n30) sensitivity and specicity
were: 86.2% and 69.7% (for sonographic EFW), 24.1% and 78.4%
(for clinical EFW), 20.7% and 75.1% (for calculated EFW) respec-
tively. Sonographic EFW performed best (p0.002) compared to the
other methods.
CONCLUSION: Sonographic, clinical and calculated EFW methods
performed during active labor correlate well with ABW. Clinical
EFW performed best for macrosomia detection while sonographic
EFW performed best for FGR detection. This information should be
used to detect fetuses in the extremes of fetal weight in patients
presenting in active labor.
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Sensitivity and Sprcificity for each method for macrosomoa and FGR detection
Sensitivity Specificity
Sonographic EFW 44.1% 75.6%
Macrosomia
Clinical EFW 76.3% 74.1%
(n=60)
Calculated EFW 65.5% 72.1%
Sonographic EFW 86.2% 69.7%
Fetal growth restriction (FGR) (n=30) Clinical EFW 24.1% 78.1%
Calculated EFW 20.7% 75.1%

411 Comparison of the pelvic floor before pregnancy and

6 weeks after delivery: an MRI study
Anne C. Cooper1, Audra Norris1, Terri Reichner1,
Amanda J. Holland1, Amy Thurmond1, William Thomas Gregory1
1
Oregon Health & Science University, Portland, OR
OBJECTIVE: To evaluate the change in pelvic oor biometry in a
cohort of nulliparous women, between pre-pregnancy &
postpartum.
STUDY DESIGN: This is a prospective cohort study of 73 nulliparous Bladder neck & levator hiatus biometry
Vaginal Delivery: Cesarean Delivery:
Pre Post Corresponding
Measurement Maneuver P-value Pre-post difference Pre-post difference P-value
women younger than 40 years of age who had pelvic MRI within 12 [cm(SD)] [cm{SD)]
[cm(SD)] [cm(SD)]
label on Fig. 1

months prior to & 6 (+/- 2) weeks after their rst pregnancies. Bladder neck
Bladder neck
Kegel
Rest
-2.5 (0.5)
-2.2 (0.5)
-2.2 (0.5)
-1.8 (0.6)
<0.0001 0.3 (0.5)
<0.0001 0.4 (0.4)
0.0 (0.4)
0.2 (0.4)
0.0096
0.035
B
B

Delivery data were also collected. The MRI included axial & sagittal Bladder neck Valsalva -0.6 (1.1) 0.2 (1.3) <0.0001 1.1 (1.0) -0.4 (1.1) <0.0001 B
Levator hiatus
Valsalva 5.7 (1.1) 6.3 (1.1) <0.0001 1.1 (0.9) -0.5 (0.9) <0.0001 C
sequences, both at rest & (for the sagittal scans) during Kegel & length
Levator hiatus
Valsalva 2.9 (1.1) 3.6 (1.2) <0.0001 1.0 (1.0) -0.1 (1.0) 0.0002 D
Valsalva maneuvers. A standardized set of biometry measurements of descent

the bony & soft tissue were made, including bladder neck (B) &
levator hiatus length (C) and descent (D) dimensions as shown in
Fig 1 (Mid-sagittal biometry measurements). The changes between
pre-pregnancy & 6-week post-partum data measurements were
compared using paired T test, & we compared the differences be-
tween vaginal delivery (VD) & cesarean delivery (CD) via non-
paired T test.
RESULTS: The 73 women averaged age 30.8 years (SD 3.9), BMI 24.1
kg/m2 (SD 3.5) & 84% were Caucasian. Fetal weight averaged 3387 g
(SD 572). There were no signicant differences in age, BMI, race, or
fetal weight between the CS & VD cohorts. There were 55 VD,
including 5 assisted vaginal deliveries, & 18 CD, including 5 done
before labor & 6 done during stage 2. Among VD subjects, there was
a signicant increase in laxity and lowering of the anterior
compartment, compared to CS subjects. The bladder neck was
signicantly lower postpartum among VD subjects, compared with a
non-signicant change among CS subjects. The length of pubor-
ectalis muscle, equivalent to the length of the levator hiatus, is also
signicantly longer postpartum among VD subjects compared with
CS subjects. New postpartum anatomic variation was minimized
during Kegel maneuvers, & exacerbated with Valsalva.
CONCLUSION: Among women who deliver by VD, there is a signicant
increase in laxity & mobility of the anterior compartment, as well as
lengthening and descent of the levator hiatus, compared with women
who delivered via CS. Inclusion of dynamic maneuvers is important
to fully assess the impact of pregnancy & childbirth on the pelvic
oor.
412 Comparison of neonatal outcomes among indicated and
spontaneous preterm births from the nuMoM2b study
Deborah Wing1
1
for the Eunice Kennedy Shriver NICHD nuMoM2b Network, Bethesda, MD
OBJECTIVE: To describe the frequency of preterm births within the
nuMoM2b cohort and compare neonatal outcomes of spontaneous
with indicated preterm births.
STUDY DESIGN: We studied preterm births occurring between 23 0/7
and 36 6/7 weeks gestation, among women enrolled in a large
prospective, observational cohort of nulliparous women. We
reviewed the primary reason listed in the chart for delivery of
indicated preterm births (iPTB), and compared neonatal outcomes
based on preterm birth type: spontaneous (sPTB, dened as delivery
occurring subsequent to spontaneous onset of preterm labor or
preterm premature rupture of the membranes) or iPTB.
RESULTS: Of 10,038 nulliparous women enrolled, outcome data were
available on 9428 births occurring at 23+ weeks gestation. There
were 783 (8.3%) women with preterm births; 310 (39.6%) iPTB and
473 (60.4%) sPTB. Hypertensive complications of pregnancy were
the most common delivery reasons for iPTB (180/310, 58.1%) fol-
lowed by abnormal fetal testing (37/310, 11.9%) and fetal growth
restriction (27/310, 8.7%). Demographic characteristics were similar
among groups except that women with iPTB were more likely to be
morbidly obese than women with sPTB, and less likely to have ever
used tobacco. iPTB infants were more likely to be admitted to the
NICU (208/309, 67% v. 241/452, 53%, p0.0001), have hypogly-
cemia (51/304, 17% v. 39/446, 9%, p0.0009) and have at least one
adverse neonatal outcome (227/307, 74% v. 277/447, 62%),
p0.0006. These differences persisted after adjustment for gesta-
tional age (Table 1).

S226 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016