in the third trimester. This may have important implications for theinterpretation of twin fetal growth patterns.

372 Ureaplasma parvum intra-amniotic infection(IAI) is associated with fetal cardiovascularand regional hemodynamic alterationsVictoria Roberts1, Peta Grigsby1, Juha Rasanen2,Antonio Frias3, Kimberly Newman1

1Oregon Health & Science University, Reproductive & DevelopmentalSciences, Beaverton, OR, 2Oregon Health & Science University, MaternalFetal Medicine, Portland, OR, 3Oregon Health and Science University,Department of Obstetrics and Gynecology, Portland, OROBJECTIVE: Intra-amniotic infection (IAI) by U.parvum is a predom-inant cause of early preterm birth (�30wks) and manifests a robustfetal inflammatory response syndrome (FIRS). The fetal myocardiumis a potential target organ during the FIRS. The objective of this studywas to assess whether the severity of the FIRS is reflected in fetal he-modynamics and cardiovascular function.STUDY DESIGN: At 127-132dGA (term 168 days) long-term catheter-ized Rhesus monkeys received intra-amniotic inoculation with U.pa-rvum (107 CFU/ml; n�6), while age-matched control animals re-ceived sterile media (n�6). Image-directed pulsed and color Dopplerultrasonography was utilized to obtain serial fetal hemodynamic mea-surements prior to and during U.parvum IAI. Non-parametric statis-tics were used for comparisons; p�0.05 was considered significant.RESULTS: Right ventricular cardiac output (RVCO) was significantlyreduced following short duration IAI (4-9d), contributing to a shiftfrom right to left ventricular output. However, prolonged U.parvumexposure (11-15d) resulted in restored RVCO to control levels. Infetuses exposed to U.parvum, myocardial performance index was sig-nificantly increased suggesting global cardiac functional compromise.Holosystolic mitral valve regurgitation was evident in one fetus after15d U.parvum IAI, suggestive of myocarditis. Prolonged U.parvumIAI increased placental vascular impedance and decreased vascularimpedance in the middle cerebral artery. Left hepatic vein pulsatilityindices were significantly increased after U. parvum IAI.CONCLUSION: Our findings indicate that U.parvum IAI is associated withfetal cardiac dysfunction and hemodynamic alterations. Although somerestoration of fetal hemodynamic status after prolonged U.parvum IAIwas observed, the long-term consequences of exposing the fetal myocar-dium to the effects of U.parvum IAI remain to be elucidated.

373 Is an abdominal circumference >90% in thesecond trimester a risk factor for macrosomia?Rachelle Schwartz1, Lena Hachem1, Barak Rosenn1

1St. Luke’s-Roosevelt Hospital Center, Obstetricsand Gynecology, New York, NYOBJECTIVE: To determine if a fetal abdominal circumference (AC)�90%, measured in the second trimester, is a risk factor for macro-somia.

STUDY DESIGN: A case-control study was conducted on all women witha fetal AC�90%, as determined by ultrasound between 18-24 weeksgestation, from 2008-2010. Control subjects (patients with an AC be-tween 10th -89th %, determined within the same gestational age pe-riod), were randomly selected in a 1:1 ratio. Additional inclusion cri-teria included: singleton pregnancy, well defined estimated date ofconfinement, documented birth weight, and delivery at �37 weeksgestation. Macrosomia was defined as birth weight �4000g. The sen-sitivity, specificity, positive and negative predictive values, and likeli-hood ratio of an AC �90%, for the development of macrosomia, werecalculated. Statistical analysis was performed using Chi square andStudent’s t-test.RESULTS: 372 cases and 372 controls were analyzed. Cases were signif-icantly different then controls in regard to birth weight (3670�/�454g vs 3367�/�452g, p�0.001), mean AC (93�/�2.5% vs 43�/�19.7%, p�0.001) and multiparity (45%vs 67%, p�0.001),respectively. There were no differences in gestational age at birth(39.4�/�1.1wks vs 39.3�/�1.2wks, p�0.2) or gestational diabetes(8.6% vs 7.3%, p�0.3). The crude and adjusted (for multiparity,GDM and post-EDC) odds ratios for the occurrence of macrosomia infetuses with an AC �90%, in the second trimester, are listed in Table1. The ability of a fetal AC�90%, in the second trimester, to predictmacrosomia was as follows, sensitivity 74%, specificity 54%, positivepredictive value 23%, negative predictive value 92%, and likelihoodratio 1.6.CONCLUSION: A fetal AC �90%, in the second trimester, is an inde-pendent risk factor for the development of macrosomia.

374 The impact of the introduction of the 20weeks fetal anomaly scan on prenatal diagnosisof fetal cleft lip with or without cleft palateSabine Ensing1, Emily Kleinrouweler1, Saskia Maas2,Katia Bilardo3, Chantal van der Horst4, Eva Pajkrt1

1Academic Medical Center, Department of Obstetrics and Gynaecology,Amsterdam, Netherlands, 2Academic Medical Center, Department ofClinical Genetics, Amsterdam, Netherlands, 3University Medical CenterGroningen, Department of Obstetrics and Gynaecology, Groningen,Netherlands, 4Academic Medical Center, Departmentof Plastic Surgery, Amsterdam, NetherlandsOBJECTIVE: In the Netherlands, the 20 weeks fetal anomaly scan wasintroduced in 2007. We investigated the trends in prenatal diagnosisand termination of pregnancy in cases of fetal facial clefting over aperiod of 10 years, before and after the introduction of the 20 weeksscan. In addition, we assessed the sensitivity and specificity of the scanfor the diagnosis of facial clefts.STUDY DESIGN: Historical cohort study of consecutive cases of fetalcleft lip with or without cleft palate diagnosed in 2001-2010 in thereferral region of the Academic Medical Center. Prenatally diagnosedcases were identified from the hospital owned prenatal database. In-formation on chromosomal and associated structural anomalies, andpregnancy and neonatal outcome was obtained. These data were com-pared with all cases managed by the multidisciplinary cleft team,which services the same region. In addition, we collected data on thetotal number of anomaly scans performed in our region in 2007-2010.

Poster Session II Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging www.AJOG.org

S174 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2012