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Poster Session III Doppler Assessment, Fetus, Neonatology, Prematurity www.AJOG.org

6/7 weeks exposed to ACS �34 weeks (2003-2008). Case status wasdefined by adverse respiratory outcomes including need for CPAP orventilator prior to discharge (RESP). Pertinent maternal informationand neonatal outcomes were recorded. Significant associations be-tween dichotomous maternal variables and RESP were determinedwith chi-square analyses. MVLR was performed to estimate the oddsof RESP controlling for confounders.RESULTS: We enrolled 148 infants (black: 84.5%, non-black: 15.5%).

on-black race was associated with RESP (p�0.04) independent ofedical co-morbidities, age, insurance, prenatal care, chorioamnio-

itis, delivery type, and infant gender. Controlling for gestational aget delivery, time between ACS and delivery, and birth weight, non-lack infants had 3.4-fold (95%CI 1.2-9.6) greater odds of RESP and.1-fold (95%CI 1.2-53.0) greater odds of ventilator use than blacknfants.

CONCLUSIONS: Despite ACS, the prevalence of RESP in late PTB re-ains high with non-black infants at significantly greater risk. Some

tudies have shown that non-black infants have decreased surfactantynthesis compared to black infants. Whether this biological differ-nce is responsible for increased respiratory complications is notnown. It is plausible that non-black infants have a less potent re-ponse to ACS or that genetic and/or environmental factors modifyesponse to ACS in non-black women and fetuses. Understandinghese racial differences may lead to modifications in ACS therapy andmproved outcomes.

493 Cerclage retention versus removal in the setting ofreterm premature rupture of membranes: a systematiceview and meta-analysis of neonatal sepsis and mortality

Joel Larma1, Cynthia Shellhaas2

1The Ohio State University, Department of Obstetrics & Gynecology,ivision of Maternal Fetal Medicine, Columbus, OH,

2The Ohio State University, Columbus, OHOBJECTIVE: When PPROM occurs in patients with a cerclage, there is

o consensus regarding its removal or retention. The objective of thistudy was to perform a meta-analysis of the neonatal effects associatedith cerclage retention versus removal in the setting of PPROM.

STUDY DESIGN: PubMed was indexed for cerclage, premature, rupturend membranes to identify studies for inclusion. A QUOROM meth-dology was employed & only comparative studies were included. Theifference in neonatal sepsis between groups was the primary out-ome. Secondary outcomes involved neonatal mortality and birth-eight. A Bayesian inference utilizing Markov chain Monte Carloodeling was used to perform a random effects meta-analysis modelith the WinBugs 1.4.3 program. Continuous variables were com-ared using Cohen’s d and dichotomous variables were comparedsing log OR. Each outcome was reported as a standardized effect. Ane-way exclusion sensitivity analysis was performed to assess theffect on final outcomes. Publication bias was assessed using a stan-ard funnel plot, heterogeneity with the Q statistic and graphical out-ut was done with MIX 1.7. An alpha of 0.05 indicated a statisticallyignificant result.

RESULTS: Five studies were included in the final analysis. Values oftandardized effects greater than zero indicate an outcome (i.e. sepsis)as increased in the retained-cerclage group while values less than

ero indicate the outcome was increased in the group where the cer-lage was removed. Values in parentheses indicate a 95% CI. Theverall effect for sepsis was 1.22 (0.45, 1.99), p � 0.01. The difference

n mortality was 0.79 (�0.90, 2.49), p � 0.36 and for birthweight was0.05 (�0.26, 0.35), p � 0.75. The sensitivity analysis did not alter anyoutcome and the funnel plot revealed no evidence of publication bias.Heterogeneity was not seen.CONCLUSIONS: Retention of a cerclage in the setting of PPROM signif-cantly increases the risk for neonatal sepsis with no significant differ-nce in neonatal mortality or birthweight.

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S198 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

Figure 1 – Forest plot of neonatal sepsiswith and without cerclage removal

494 Scheduled timing of and patient complianceith longitudinal sonographic cervical length (CL)easurement in a multicenter randomized

rial of ultrasound-indicated cerclageJohn Owen1, Jeff Szychowski1, for the

aginal Ultrasound Trial Consortium2

1University of Alabama at Birmingham, Birmingham, AL, 2MulticenterOBJECTIVE: To assess the timing of CL measurement and compliance

ith scheduled visits in women at high risk for recurrent pretermirth (PTB).

STUDY DESIGN: Women with �1 prior spontaneous PTB 17-336/7 wksad an initial scan at 16-21 wks. Unless randomization occurred at the

nitial scan, follow-up visits were scheduled biweekly if CL �30 mm,ncreased to weekly if 25-29 mm. Women were randomized: cerclager no-cerclage if CL�25 mm. The final scan was scheduled by 226/7

wks. Birth in the prescribed scanning window 16-226/7 wks and ges-tational age (GA) at birth were evaluated.RESULTS: Of 674 non-randomized women, only 11 (1.6%) deliveredn the GA window �23 wks. The rate of birth �23 wks was 1.6% in 379omen with perfect compliance and 1.7% in 295 women who were

ither late for any visit or who missed their final scan (p�1.00). 18327.2%) did not present for their final scan � 23 wks, and these non-ompliant women delivered at a mean (SD) GA of 37.0 (4.0) as com-ared to 37.2 (3.8) wks for those who were compliant (p�0.66).omen who missed their final 1-week follow-up (last observed CL

5-29 mm), delivered at 36.4 (4.4) wks compared to 37.1 (3.9) wks inhose whose missed scan was a 2-week follow-up (last observed CL

30 mm; p�0.55). Of 189 women randomized after the initial scan,1 were assigned to cerclage and 98 to no-cerclage. In the cerclageroup the rates of birth �23 weeks were 4% in 78 with perfect com-liance and 0 (0%) in 13 who missed �1 scheduled visit (p�1.00). Inhe no-cerclage group the rates of birth �23 weeks were 7.5% in 80ith perfect compliance and 0 (0%) in 18 who were non-compliant

p�0.59).CONCLUSIONS: Women at high-risk for recurrent PTB followed witherial CL measurement using a defined scanning interval based on CL,ith an intent for ultrasound-indicated cerclage, have a low, 1.8% riskf birth �23 wks. The effect of non compliance with scheduled scansas null. For non-randomized women who missed their final scan,ean birth GA did not depend on whether the last observed CL was

5-29 vs. �30 mm.

495 Can the optimal cervical length for placingltrasound-indicated cerclage be identified?

John Owen1, Jeff Szychowski1, for theaginal Ultrasound Trial Consortium2

1University of Alabama at Birmingham, Birmingham, AL, 2MulticenterOBJECTIVE: To define an optimal cervical length (CL) for cerclage in

omen with prior spontaneous preterm birth (PTB) and short cervix

25 mm.

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