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Poster Session V Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging www.AJOG.org

850 Changing rates of antepartum death andttitudes to postmortem over a 10 year period

Hugh OConnor1, Mark Hehir1, Michael Robson2,am Coulter-Smith1, Fergal Malone3

1Rotunda Hospital, Dublin, 2National Maternity Hospital, HollesStreet, Dublin, 3Royal College of Surgeons in Ireland, DublinOBJECTIVE: Finding a cause of death in a fetus that has suffered anntepartum death (APD) is a vital part of understanding the clinicalcenario. A post-mortem is required to clarify the diagnosis. We setut to retrospectively examine the rates of APD in all fetuses over 500g

n 2 large tertiary hospitals over a 10 year period, and to measure theate of post-mortem in these cases of APD.

STUDY DESIGN: The study was carried out retrospectively looking atPDs over a 10 year period between 1999 and 2008 in two large ter-

iary hospitals serving a single urban population. Both hospitals are ofimilar size and serve a population with similar risk profile. Both haveomparable rates of perinatal morbidity and mortality. All cases ofPD are investigated with both maternal and fetal investigations andost-mortem is offered at the parent’s discretion. All APDs consid-red were unexpected with no known congenital abnormality and alletuses appeared structurally normal.

RESULTS: During the study period there were 150,574 deliveries be-ween the two hospitals - 69,741 in hospital A and 80,833 in hospital B.here were 669 APDs over the study period. The rate of APD was.5/1000 deliveries, this rate was 5.1/1000 from 1999-2003, and 3.9/000 from 2004-2008. There were a large number of unexplainedPDs over the study period however this decreased from 42.7% of allPDs in the first five years to 30.1% for the second five years. Ante-artum haemorrhage/Abruption (17.5%) was the leading docu-ented cause of APD. 34.8% of post-mortems were refused by par-

nts, between 1999-2003, this decreased to 29.2% between 2004-2008.CONCLUSIONS: This study shows that there is a decreasing rate of APD

ver the course of the study among the two institutions. This may beredited to improving standards of care and improvements in fetalssessment. The number of unexplained APDs has fallen over theourse of the study and this may be due in part to the improvingost-mortem rate.

851 Cell saver system eliminates cell free DNA fromaternal and fetal origin during cesarean section

Celine Osswald1, Irene Hoesli1, Olav Lapaire1, Thierryirard1, Marcus Schneider1, Corinne Rusterholz2

1University Hospital, Basel, 2Department of Obstetricsand Laboratory for Prenatal Medicine, BaselOBJECTIVE: Although cell-savers are widely used to avoid blood trans-usion their value in obstetrics remains controversial. To date, theirbility to extract cell-free-fetal DNA (cff-DNA) and total cell-freeNA (cf-DNA) has not been analyzed. The aim of this study was toetermine whether the cff-DNA and total cf-DNA were eliminated

rom the salvaged blood using a conventional cell-saver and a leu-odepletion filter during cesarean section (CS).

STUDY DESIGN: Blood samples were drawn pre- and 2 h postpartum. Inaddition, blood was collected from the surgical field and during thesequential steps of cell-salvage (pre-wash, post-wash and after leu-codepletion. DNA was extracted from plasma. Total cf-DNA and cff-DNA were quantified by real-time PCR amplification of the ubiqui-tous GAPDH sequence and the Y chromosome specific DYS14sequences, respectively.RESULTS: 17 patients undergoing elective CS, eight of them with maleetuses were recruited. Comparison of maternal blood samples pre-nd postpartum showed no alternation in GAPDH levels (n � 17),ut a significant decrease in DYS14 levels postpartum (n � 8). Theighest levels of cff-DNA and cf-DNA were found in samples takenirectly from the surgical field (A). Both molecules were still detected

n high amounts in the post-wash samples. Finally, leucofiltrationt

S330 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

resulted in a significant reduction in the concentration cf-DNA (G).Figure 1CONCLUSIONS: The study shows that maternal blood is initially con-aminated by large amounts of cf-DNA and cff-DNA. During theashing step of the cell-salvage procedure, cell lyses may lead to the

elease of extra loads of cf-DNA. However, a conventional cell-saverystem in conjunction with a leucocyte filter is capable of eliminatingell free DNA from both fetal and maternal origin.

852 Between center variation in perinatal and maternalutcomes of women presenting with very preterm labor

Joan Crane1, Peter von Dadelszen2, Emmanuel Bujold3,aura Magee4, Tang Lee4, Beth Payne4, for the Canadianerinatal Network (CPN) Collaborative Group2

1Memorial University, Eastern Health, St. John’s, NL, 2University of BritishColumbia, Vancouver, BC, 3Laval University, Quebec, QC, 4University of

ritish Columbia, Child and Family Research Institute, Vancouver, BCOBJECTIVE: To evaluate between center variation in perinatal and ma-ernal outcomes in women presenting with very preterm labor.

STUDY DESIGN: This prospective cohort study included women in theCanadian Perinatal Database, admitted Aug 2005–Aug 2009 with pre-term labor(PTL), between 22 0/7wks and 28 6/7wks gestation, to oneof 14 tertiary perinatal units. The primary outcome was perinatalmortality or serious morbidity, with the major secondary outcomebeing serious maternal complication(death, chorioamnionitis, bloodtransfusion, ICU admission or severe maternal morbidity). Betweencenter variation in the outcomes of interest was evaluated, controllingfor potential confounders(maternal age, parity, income, multiplepregnancy, smoking, alcohol, illicit drug use, previous PTB�34wks,gestational age on enrollment, congenital anomalies, severity of PTL,presence and severity of secondary conditions(short cervix withoutcontractions, prolapsing membranes, PPROM, IUGR, gestational hy-pertension or APH), latency, and interventions including Cesareandelivery, corticosteroid and tocolytic use.RESULTS: A total of 570 women and 557 infants were included. Ges-ational age at enrollment was 26.0�/�1.9 weeks, with PTB�28wksccurring in 55.6% of pregnancies. Perinatal mortality or seriousorbidity occurred in 52.2%(291/557) of infants(perinatal mor-

ality[150/557,26.9%], serious neonatal morbidity[172/522 liveorn infants,33.0%]). Serious maternal complication occurred in5.6%(146/570) of women. Significant between center variation wasound for perinatal morbidity and mortality, and serious maternalomplication, even after controlling for potential confounders, Ce-arean delivery, corticosteroid and tocolytic use.

CONCLUSIONS: Women admitted with very preterm labor are at highisk of perinatal morbidity/mortality and serious maternal complica-ion. Significant between center variation in these outcomes wasoted. It is important that future studies evaluate obstetric manage-ent at different centers, to identify those interventions and practices

hat are associated with improved perinatal and maternal outcomes.

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