www.AJOG.org General Oral Plenary Session I

RESULTS: Between June 2009 and March 2013, 754 women wererandomized to either planned delivery (n¼353) or expectantmonitoring (n¼351).

Adverse maternal outcomes occurred in 0.9% of the women inthe delivery group and 2.8% in the expectant monitoring group (RR0.30; 95% CI 0.08-1.08, NNT 51). For women included withgestational hypertension, these rates were 0% vs. 1.9% (RR 0; NNT53) and for women with preeclampsia 1.5% vs. 3.4% (RR 0.44; 95%CI 0.11-1.67; NNT 53).

RDS was diagnosed in 6.0% of the infants in the delivery group,compared to 2.0% in the expectant monitoring group (RR 3.01; 95%CI 1.30-6.99; NNH 25). When stratified for gestational age at in-clusion, these rates were 13.0% vs. 5.6% (34+0-34+6 weeks), 5.9%vs. 1.5% (35+0-35+6 weeks) and 3.0% vs. 0.7% (36+0-36+6 weeks).CONCLUSION: In women with late preterm hypertensive disorders ofpregnancy, routine delivery did not decrease the risk of severeadverse maternal outcomes, while it increased the risk of neonatalrespiratory distress syndrome.

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Early clindamycin for bacterial vaginosis in low-riskpregnancy: the PREMEVA1 randomized, multicenter,double-blind, placebo-controlled trialDamien Subtil1, Gilles Brabant3, Emma Tilloy1, Julia Salleron2,Frederique Canis4, Annie Fruchart5, Marie-Christine Bissinger5,Jean-Charles Dugimont6, Nolf Catherine6, Jerome Chantrel1,Marielle Jousse7, David Desseauve7, Jean-Louis Plennevaux8,Delaeter Christine1, Sylvie Deghilage1, Anne Personne1,Joyez Emmanuelle1, Rodrigue Dessein5, Francois Goffinet91CHRU-University Lille Nord de France, Obstetrics Gynecology, Lille, France,2CHRU-University Lille Nord de France, EA 2694-Biostatistics, Lille, France,3St Vincent de Paul Hospital GHICL, Université Libre, Obstetrics Gynecology,Lille, France, 4Hospital of Valenciennes, Biology, Valenciennes, France,5CHRU-University Lille Nord de France, Biology Pathology Centre, Lille,France, 6Associaition des Biologistes Nord Picardie, Biology - QualityAssessment, Tourcoing, France, 7Poitiers University Hospital, ObstetricsGynecology, Poitiers, France, 8Poitiers University Hospital, ObstetricsGynecology, Arras, France, 9INSERM U953, Perinatal Epidemiology, Paris,France

OBJECTIVE: To reduce late abortion and very preterm spontaneousbirth associated with bacterial vaginosis in pregnancy. Recentmetaanalyses have suggested that a treatment with clindamycincould, if prescribed early in pregnancy, reduce these risks by 50%.STUDY DESIGN: This 2:1 randomized trial, which took place fromMay, 2006, through June 2011 in 35 French maternity wards,assigned 2869 low-risk women with Nugent scores � 7 to receiveoral clindamycin (n¼1904) or placebo (n¼956) before 15 weeks’gestation. In the clindamycin group, half received one four-daycourse of 600 mg oral clindamycin daily, and the other half 3 four-day courses of 600 mg daily one month apart. All three groups weredouble-blinded and placebo-controlled. The primary outcome waslate abortion or spontaneous very preterm birth (1-b¼0.8, a¼ 0.05,2-sided, to detect a reduction from 4% to 2% with clindamycin).RESULTS: In the placebo group, the late abortion/very pretermspontaneous delivery rate (12-32 weeks) was four times lower thanestimated (1%). It did not differ significantly between the clinda-mycin and placebo groups (22/1904 vs 10/956, 1.2 vs 1.0%, RR¼1.1[0.5-2.5], p¼0.82). Rates of spontaneous preterm delivery before 37weeks (4.8 vs 4.1, p¼0.40), total preterm delivery (6.7 vs 5.8%) andperinatal death (0.6 vs 0.5%, p¼0.72) were similarly low in bothgroups. Side effects were more common in the clindamycin group(3.0 vs 1.3, p¼0.003) but none was severe.

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CONCLUSION: Near identical results in the two groups of low-riskpregnant women with bacterial vaginosis during the first trimesterindicate that early treatment with oral clindamycin cannot reduce lateabortion or very preterm spontaneous birth, either preterm birth.

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Prevention of preterm delivery by17 alpha-hydroxyprogesterone caproate in high riskasymptomatic singleton gestations with a shortcervix: a randomized controlled trialNorbert Winer1, Philippe Deruelle2, Marie-Victoire Senat3,Patrick Rozenberg41Hôpital Mère-Enfant, Obstetrics and Gynecology, Nantes, France, 2HôpitalJeanne de Flandre, Obstetrics and Gynecology, Lille, France, 3Hopital Bicêtre,Hopital Antoine Béclère, AP-HP, Obstetrics and Gynecology, Paris, France,4Hopital Poissy Saint-Germain, Obstetrics and Gynecology, Poissy, France

OBJECTIVE: To evaluate the use of 17 alpha-hydroxyprogesteronecaproate (17OHPC) to reduce the risk of preterm delivery in highrisk asymptomatic singleton gestations with a short cervixSTUDY DESIGN: This open-label multicenter randomized controlled trialtook place at 10 university hospitals between June 2006 and January2010. Women older than 18 years with asymptomatic singletongestation were eligible between 24+0 through 31+6 weeks of gestation(WG) if they presented a history of preterm delivery, an uterine mal-formation or a prenatal exposition to diethylstilbestrol and a cervicallength less than 25 mm as measured by routine transvaginal ultrasoundand provided a written informed consent. Women were randomlyassigned in a 1:1 ratio to receive 17OHPC 500 mg IM weekly untildelivery or 36 WG, or to no treatment with 17OHPC (control group).The primary outcome was time from randomization to delivery.RESULTS: The trial was stopped for futility at the interim analysisafter inclusion of 105 patients. Maternal characteristics of the 51women in the 17OHPC group and the 54 women in the controlgroup were similar. The median [Q1-Q3] gestational age and cer-vical length at randomization were similar for the 17OHPC andcontrol groups : 24+6 [22+6-27+1] vs 25+4 [22+6-27+1] WG and19 [10-20] vs 17 [11-21] mm, respectively. Two patients were lost tofollow-up, one in each group. The intent-to-treat analysis showed nosignificant difference between the 17OHPC and control groups formedian [Q1-Q3] time to delivery (77 [54-103] and 74 [52-99] days,respectively; mean difference, 4; 95% CI, -9 to +17). After adjust-ment on the weeks of gestation at baseline, the mean increase in timeto delivery in 17OHPC group was 0 day (95% CI �7 to +8).CONCLUSION: Weekly injections of 17OHPC did not prolong preg-nancy significantly in high risk asymptomatic singleton gestationswith a short cervix.

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Rare chromosome abnormalities detected by currentprenatal screening compared to expected performance usingnon-invasive prenatal testing (NIPT)Mary Norton1, Robert Currier2, Laura Jelliffe-Pawlowski21University of California, San Francisco, Division of Maternal Fetal Medicine,Department of Obstetrics, Gynecology and Reproductive Sciences,San Francisco, CA, 2California Department of Public Health, Genetic DiseaseScreening Program, Richmond, CA

OBJECTIVE: To determine the range and number of chromosomeabnormalities detected in a large statewide prenatal screening pro-gram and to assess how many of these would be identified if currentscreening and invasive diagnostic testing strategies were replaced bynoninvasive prenatal testing (NIPT).STUDY DESIGN: All karyotype results of invasive prenatal testing insingleton pregnancies performed in response to a positive prenatal

ement to JANUARY 2014 American Journal of Obstetrics & Gynecology S3

Oral Plenary Session I General www.AJOG.org

screen through the California Prenatal Screening Program (PNS)from March 2009 through December 2012 were examined (n ¼26,059). Karyotypes were flagged as normal or abnormal; abnormalresults were categorized by type of abnormality and whether theabnormality is detectable by current NIPTmethods (e.g. non-mosaictrisomy 13, 18, or 21, or sex-chromosomal aneuploidy) or unlikelyto be detected by NIPT due to testing limitations (e.g. other raretrisomies, unbalanced structural rearrangements, or mosaicism).RESULTS: Over 1.3 million women had screening during the studyperiod (n ¼ 1,324,607), and 68,990 (5.2%) were screen positive fortrisomy 18 or 21. Of screen positive women, 26,059 (37.8%) un-derwent invasive diagnostic testing and 2993 had an abnormal result(11.5%). Of these, 2489 (83.2%) were predicted to be detectablewith current NIPT methods, and 504 (16.8%) were considered notcurrently detectable (Table 1). Trisomy 21 comprised 53.2% of theabnormal results (n¼1592).CONCLUSION: For women with a positive aneuploidy screening test,over 80% of chromosome abnormalities will be detected by NIPT,while approximately 17% will be missed. Undetected aneuploidiesrange from relatively mild to those associated with significantdisability. This is important information to be considered by patients,providers, and screening programs in evaluating the utility of tradi-tional screening and invasive prenatal diagnosis compared to NIPT.

Aneuploidies identified by current prenatalscreening and predicted detection by NIPT

NIPT, non-invasive prenatal testing.

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Resveratrol supplementation during pregnancy:maternal and placental benefits with a potential fetal riskAntonio Frias1, Victoria Roberts2, Lynley Pound2,Stephanie Thorn3, Melanie Gillingham4, Kent Thornburg5,Jacob Friedman3, Kevin Grove21Oregon Health & Science University, OB / GYN, Portland, OR, 2OregonNational Primate Research Center, Diabetes, Obesity, & Metabolism, Beaverton,OR, 3University of Colorado, Pediatrics, Denver, CO, 4Oregon Health & ScienceUniversity, Medical and Molecular Genetics, Portland, OR, 5Oregon Health &Science University, Knight Cardiovascular Institute, Portland, OR

OBJECTIVE: Dietary supplementation with resveratrol (RESV) hasreceived widespread attention as a potential therapy for obesity andmetabolic disease. We have previously shown in the nonhuman pri-mate (NHP) that consumption of a Western-style diet (WSD) duringpregnancy reduces uterine blood flow, increases placental inflamma-tion and stillbirth risk and leads to fetal hepatic steatosis, independentof obesity. We hypothesized that when administered to pregnant NHPs,RESV would mitigate the maternal and fetal complications of a WSD.STUDY DESIGN: Female Japanese Macaques were separated into 3 dietgroups: Control (n¼29, CON; 14% calories from fat), WSD (n¼33,35% calories from fat) and WSD/RESV (n¼6, WSD chow supple-mented with 0.37% RESV prior to and throughout pregnancy).Metabolic parameters weremeasured at regular intervals and Dopplerultrasound performed in a subset of animals at 120d (term; 175d)

S4 American Journal of Obstetrics & Gynecology Supplement to JANUARY 20

prior to C-section and fetal necropsy at 130d. Placental inflammationand liver triglycerides were assessed by immunoassay. Pancreas pro-liferation and islet mass were analyzed by immunofluorescence.RESULTS: RESV supplementation resulted in significant pre-preg-nancy maternal weight loss and improved insulin sensitivity(Table 1), restored uterine blood flow (Fig. 1) and reduced placentalinflammation (*p<0.05 for all, by one-way ANOVA). RESV crossedthe placenta, entered fetal circulation and decreased fetal liver lipiddeposition despite no effect on circulating free fatty acid levels. Fetalbody weight was unchanged with RESV vs. WSD and CON animalsyet pancreas mass was increased by 42% with significant prolifera-tion but no concomitant increase in islet mass.CONCLUSION: RESV dietary supplementation improved many of thedetrimental maternal and placental effects associated with WSDconsumption. However, the dramatic increase in fetal pancreas massand proliferation warrants further investigation and strongly cautionsagainst the clinical use of RESV in pregnant women at this time.

Maternal uterine artery blood flow

Maternal metabolic characteristics

Data are mean � sem; AUC: Area under curve (mU/L x 60 min);

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p<0.01 vs.

Baseline (Pre-RESV); *p<0.05 vs. 3rd Tri CON.

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Telomere shortening in stillbirth: a sign of prematureplacental senescenceFrancesca Ferrari1, Fabio Facchinetti1, Huaizhi Yin2,George Saade2, Ramkumar Menon21University of Modena and Reggio Emilia, Obstetrics and Gynecology,Mother-Infant Department, Modena, Italy, 2University of Texas MedicalBranch, Department of Obstetrics and Gynecology, Galveston, TX

OBJECTIVE: Although the direct pathogenic causes of stillbirth (SB)remain unknown, a substantial number of SBs are associated withabnormal placental development and functions. The objective of this

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