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lucency ultrasound with evaluation of the fetal anatomy at 11-14weeks AND an early second trimester fetal anatomical survey between15 and 17 weeks. All cases of ONTD diagnosed in our unit were iden-tified using ICD-9 codes, and all MSAFP results over the same timeframe were queried. Groups were compared using Fisher Exact testwith p�0.05 as significance.RESULTS: Our unit performed 17,656 nuchal translucency ultra-ounds and 21,436 early anatomical surveys, and sent 11,809 speci-

ens for MSAFP during the study period. 11 ONTD were diagnosedy our unit during this time frame (incidence of 0.56 to 0.67 per 1000).1/11 ONTD (100%) were diagnosed by ultrasound; 0/11 (0%) wereetected after MSAFP screening (p�0.0001). 7/11 cases (64%) wereiagnosed during the first trimester; 4/11 (36%) were diagnosed at thearly second trimester anatomy scan. No cases of ONTD were diag-osed after 18 weeks’ gestation, and no cases of ONTD were missed byur unit (sensitivity 100%).

CONCLUSION: Ultrasound for fetal anatomical survey during the firstand early second trimester detected 100% of ONTD in our populationwith the majority identified in the first trimester. MSAFP was notuseful as a screening tool for neural tube defects in the setting of thisultrasound screening protocol.

360 Does first-trimester ultrasound predict obstetrical andeonatal outcomes in monochorionic diamnioticwin pregnancies?

Baraa Allaf1, Ali Ozhand2, Sina Haeri3, Joseph Wax4, Anthonyintzileos1, Adam Borgida5, Martin Chavez1, Sarah Davis6,amadeh Ravangard7, Melissa Spiel7, Rebecca Habenicht8, Glennarkenson9, Manisha Gandhi4, Amir Shamshirsaz10, Paulgburn10, Marjorie Meyer6, Jeff Johnson8, Allison Sadowski7,inston Campbell7, Alireza Shamshirsaz3

1Stony Brook-Winthrop University Hospitals, Obstetrics and Gynecology, Longsland, NY, 2University of Southern California, Department of Preventive

edicine, Los Angeles, CA, 3Baylor College of Medicine, Obstetrics andynecology, Houston, TX, 4Maine Medical Center, Obstetrics and

Gynecology, Portland, ME, 5Hartford Hospital, Obstetrics and Gynecology,artford, CT, 6University of Vermont College of Medicine, Obstetrics andynecology, Burlington, VT, 7University of Connecticut, Obstetrics

and Gynecology, Farmington, CT,, 8Dartmouth-Hitchcock, Obstetrics andynecology, Concord, NH, 9Baystate Medical Center, Obstetrics and

Gynecology, Springfield, MA, 10George Washington University, Obstetricsand Gynecology, Washington, DCOBJECTIVE: To determine the associations of discordant nuchal trans-ucency (NT) or crown-rump length (CRL) measurements at the timef aneuploidy screening with adverse obstetrical and neonatal out-omes.

STUDY DESIGN: A multicenter, retrospective cohort study in 9 regionalperinatal centers in the United States from 01/2006 to 06/2011. Allmonochorionic-diamniotic (MCDA) twin pregnancies with two livefetuses at the 11-14 week ultrasound examination and serial follow-upultrasonography until delivery were included. Pregnancies withknown chromosomal abnormalities or major malformations were ex-cluded. The NT and CRL discordances were calculated as the differ-ence between the two fetuses expressed as a percentage of the largermeasurement. Composite obstetrical outcome included any of thefollowing: IUFD, twin-to-twin transfusion syndrome (TTTS), intra-uterine fetal growth restriction (IUGR) or preterm birth � 28 weeks.Composite neonatal outcome included any of the following: Apgarscore � 7 at 5 minutes, respiratory distress syndrome, intraventricularhemorrhage, necrotizing enterocolitis, early onset sepsis, or neonataldemise. Receiver operating characteristic (ROC) curves of NT andCRL discordance cut-offs were developed for the prediction of com-posite obstetrical and neonatal outcomes.RESULTS: A total of 180 twin pregnancies met inclusion criteria. Mean�SD) gestational age at delivery was 33 � 3.4 weeks. A total of 26.1%nd 32% of pregnancies were found to have adverse composite ob-

tetrical and neonatal outcomes, respectively. Adverse obstetrical out- n

Supplem

come included: TTTS in 14 (7.7%), IUGR in 19 (10.5%), IUFD in 13(7.2%) and preterm birth (�28 weeks) in 14 (7.7%). Neither ROCcurve was discriminating between NT or CRL discordance and theprediction of adverse composite obstetrical or neonatal outcome (Fig-ure).CONCLUSION: In our population, NT or CRL discordance in monocho-rionic-diamniotic twin pregnancies were not predictive of adversecomposite obstetrical or neonatal outcome.

361 Prediction of perinatal outcomes in monochorioniciamniotic twin pregnancies by early secondrimester ultrasound

Alireza Shamshirsaz1, Baraa Allaf2, Sina Haeri1, Ali Ozhand4,elissa Spiel3, Samadeh Ravangard3, Anthony Vintzileos2, Adam

orgida5, Glenn Markenson6, Joseph Wax7, Sarah Davis8, Amirhamshirsaz9, Rebecca Habenicht10, Manisha Gandhi1, Jeffohnson10, Marjorie Meyer8, Allison Sadowski3, Paul Ogburn2,

artin Chavez2, Winston Campbell31Baylor College of Medicine, Obstetrics and Gynecology, Houston, TX,2Stony Brook-Winthrop University Hospitals, Obstetrics and Gynecology,

tony Brook, NY, 3University of Connecticut, Obstetrics and Gynecology,Farmington, CT, 4University of Southern California, Department of

reventive Medicine, Los Angeles, CA, 5Hartford Hospital, Obstetrics andGynecology, Hartford, CT, 6Baystate Medical Center, Obstetrics andGynecology, Springfield, MA, 7Maine Medical Center, Obstetricsand Gynecology, Portland, ME, 8University of Vermont College of Medicine,

bstetrics and Gynecology, Burlington, VT, 9George WashingtonUniversity, Obstetrics and Gynecology, Washington, DC, 10Dartmouth-

itchcock, Obstetrics and Gynecology, Concord, NHOBJECTIVE: To determine the association of discordant abdominal cir-umference (AC), femoral length (FL), head circumference (HC), orstimated fetal weight (EFW) at time of early second trimester ultra-ound with adverse perinatal outcomes.

STUDY DESIGN: A multicenter, retrospective cohort study in 9 perina-al centers in the United States from 01/2006 to 06/2011. All mono-horionic-diamniotic (MCDA) twin pregnancies with two live fetusest early second trimester (16-20 weeks) ultrasound, and serial fol-ow-up ultrasonography until delivery were included. Pregnanciesith known chromosomal abnormalities or major malformationsere excluded. The AC, FL, HC or EFW discordances were calculated

s the difference between the two fetuses expressed as a percentage ofhe larger measurement. Composite obstetrical outcome included:UFD, twin-to-twin transfusion syndrome (TTTS), intrauterine fetalrowth restriction (IUGR) or preterm birth � 28 weeks. Composite

eonatal outcome included: Apgar score � 7 at 5 minutes, respiratory

ent to JANUARY 2013 American Journal of Obstetrics & Gynecology S159

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distress syndrome, intraventricular hemorrhage, necrotizing entero-colitis, early onset sepsis, or neonatal demise. Receiver operating char-acteristic (ROC) curves of AC, FL, HC and EFW discordances cut-offswere developed for the prediction of composite perinatal outcomes.RESULTS: 180 twin pregnancies met inclusion criteria. Mean gesta-ional age at delivery was 33 � 3.4 weeks. 26.1% and 32% of pregnan-ies were found to have adverse composite obstetrical and neonatalutcomes, respectively. Adverse obstetrical outcome included: TTTS

n 14 (7.7%), IUGR in 19 (10.5%), IUFD in 13 (7.2%) and pretermirth (�28 weeks) in 14 (7.7%). Area under the ROC curve (AUC) ofC, FL, HC and EFW discordance for the prediction of compositebstetrical and neonatal outcomes are shown in the Table.

CONCLUSION: In our population, AC and EFW discordances in mono-chorionic-diamniotic twin pregnancies were fairly accurate in pre-dicting of adverse composite obstetrical outcome.

362 Intramuscular progesterone slows theate of cervical shortening

Cara Pessel1, Saila Moni1, Noelia Zork1, Sara Brubaker1,amantha Do1, Joy Vink1, Karin Fuchs1, Chia-Ling Nhan-Chang1,ande Ananth1, Cynthia Gyamfi1

1Columbia University Medical Center, Obstetrics and Gynecology, New York,Y

OBJECTIVE: To evaluate if 17-alpha-hydroxyprogesterone caproate (17-HPC) exposure is associated with the rate of cervical shortening.

STUDY DESIGN: Women with a history of spontaneous PTB (� 37 0/7eeks) who had serial cervical length (CL) measurements in 2011-12ere identified. 17-OHPC administration and outcome data were col-

ected. We excluded multiple gestations, patients lacking outcomeata, medically indicated PTBs, and pregnancies with major fetalnomalies, vaginal progesterone use, and abdominal or vaginal cer-lage. CL values from the 2nd and 3rd trimesters were recorded, andhe rate of cervical change was modeled based on 17-OHPC statussing methods for longitudinal analysis.

RESULTS: 103 patients were included, with a total of 555 CL values. 8582.5%) patients were exposed to 17-OHPC and 18 (17.5%) were not.estational age (GA) and number of previous PTBs, along with tim-

ng of CL exams, were similar between these 2 groups, althoughomen that did not receive 17-OHPC were more likely to have deliv-

red multiples in their previous PTB (27.8% vs 4.8%).CL was plotted against GA for every patient starting at 16 weeks.

omen were analyzed separately according to whether they deliveredt term or preterm. Rate of CL change in women that delivered pre-erm was modeled using linear terms for GA at CL assessment, whilehe rate in women that delivered at term was modeled using 2ndegree polynomials. There was no difference in the risk of spontane-us PTB according to 17-OHPC exposure, however among womenho delivered preterm the rate of CL shortening was slower in those

xposed to 17-OHPC (1mm/wk vs 4mm/wk).CONCLUSION: In women with previous PTB, cervical shortening oc-curs more gradually when exposed to 17-OHPC. Further studies mayevaluate how 17-OHPC influences the cervical remodeling that leads

Early second trimester ultrasound biometricdiscordance for the prediction of adversecomposite obstetrics and neonatal outcomes

to PTB.

S160 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

363 Universal transvaginal and transabdominalervical length screening for short cervix

Carmen Beamon1, Alison Stuebe1, Robert Strauss1

1University of North Carolina, Division of Maternal Fetal Medicine,epartment of Obstetrics and Gynecology, Chapel Hill, NC

OBJECTIVE: Universal transvaginal cervical length (TVCL) measure-ent has been recommended by some experts in light of recent evi-

ence supporting interventions to reduce preterm birth in asymp-omatic women with a shortened cervix. The sensitivity ofransabdominal cervical length (TACL) to detect a shortened cervixemains largely unknown. The purpose of this study was to assess thebility of TACL to detect a TVCL �25mm.

STUDY DESIGN: We performed a prospective evaluation of universalA and TVCL screening. During a three month period, all womenresenting for ultrasound at 16-24 weeks gestation at the UNC Pre-atal Diagnostics Unit received both TA and TV cervical length eval-ation. A standard protocol for acquisition of TA and TVCL was

nstituted that included measurement of TACL prior to TVCL. At thend of the three month period, all ultrasounds were reviewed. Thehortest TA and TV cervical lengths obtained were used for analysis.he additional time spent acquiring the TVCL was defined as theifference in time between the last TA image and the last TV image.

RESULTS: 686 of 1164 women (58.9%) underwent assessment of bothACL and TVCL. Median TACL and TVCL were 38 mm (IQR 33-32)nd 41 mm (IQR 36-47), respectively. Mean difference between TAnd TVCL was 3.5 mm (95% CI 2.8-4.1). In our sample, 15 women2.2%) had a TVCL �25 mm, among whom 7 (47%) had a TACL �25

mm (Table). 442 women had a TACL �40 mm. We found that aTACL �40 mm was 100% sensitive (95% CI 79.4-100%) for detectionof a transvaginal CL �25 mm, with a number needed to screen of 28.The median additional total time required to complete the TVCL was8.7 minutes (IQR 6.9-10.9). If all women with TACL �40mm under-went TVCL assessment, we estimated that it would require 4 hours ofadditional ultrasound time to detect an additional case of CL �25mm.CONCLUSION: TACL �40 mm detected all women with a TVCL �25

m in our population. TA evaluation of the cervix may reduce theumber of TV scans needed to detect a clinically significant shortervix.

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