367: Uterine synechiae are associated with an increased risk of preterm premature rupture of membranes and abruption

367 Uterine synechiae are associated with an increased risk of preterm premature rupture of membranes and abruption Methodius Tuuli, Anthony Shanks, Lisa Bernhard, Anthony Odibo, George Macones, Alison Cahill Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO OBJECTIVE: Uterine synechiae have generally been considered benign findings in pregnancy. We used a large perinatal database to test the hypothesis that uterine synechiae are associated with pregnancy complications. STUDY DESIGN: We performed a retrospective cohort study of women with singleton pregnancies presenting for routine ultrasound examinations at 17 to 22 weeks from 1990 to 2009. Pregnancies with multiple fetuses, amniotic bands, fibroids and congenital uterine anomalies were excluded. We compared pregnancy outcomes between women with and without uterine synechiae. Multivariable logistic regression was used to adjust for confounders. RESULTS: Of 65, 518 pregnancies meeting inclusion criteria 296 (0.45%) were diagnosed with uterine synechiae. Women with uterine synechiae were significantly more likely to have preterm premature rupture of membranes (PPROM) (5.5% vs 2.3%, aOR 2.51 [95% CI 1.51,4.18]), placental abruption (2.1% vs 0.6%, aOR 3.25 [95% CI 1.43, 7.36]) and cesarean delivery for breech presentation (5.1% vs 3.0%, OR 1.75 [95% CI 1.04, 2.94]) (Table). In contrast, the risks of placenta previa, fetal growth restriction, stillbirth and preterm delivery were not significantly increased. CONCLUSION: Uterine synechiae are associated with a significant increase in the risk of PPROM and placental abruption. Therefore, the concept of uterine synechiae as benign findings in pregnancy should be re-considered. 368 Cardiovascular profile in recipient and donor twins and relationship with survival following fetoscopic laser occlusion (FLOC) Michael Atlas, Ozhan Turan, Sifa Turan, Christopher Harman, Ahmet Baschat University of Maryland School of Medicine, Obstetrics, Gynecology and Reproductive Sciences, Baltimore, MD, University of maryland, Obstetrics, Gynecology and Reproductive Sciences, Baltimore, MD OBJECTIVE: Compare cardiovascular profiles in Twin to Twin Transfusion Syndrome (TTTS) recipient and donors and relate these to post-FLOC survival. STUDY DESIGN: Retrospective cohort study of 54 TTTS cases receiving umbilical artery (UA), ductus venosus (DV), left and right ventricular Doppler, UA and DV pulsatility index (PI), phasic indices of the DV (S,v,D,a), umbilical vein (UV) volume flow (VF), mitral and tricuspid E/A ratios, and Tei index were compared between recipient (R) and donor (D) and related to survival after FLOC. RESULTS: Recipient twins had significantly higher UVVF, DV-PI, E/A ratios, and left ventricular Tei indices than donors. In recipients, DV-PI correlated with UA-PI and UVVF (Pearson 0.39 and 0.31, p .005). 47% of the increase of the DV-PIV was due to decreased end systolic relaxation (p 0.001). Recipient Tei indices and E/A ratios were unrelated to preload or afterload. The donor DV-PI correlated with UVVF and the UVVF in turn to UA-PI (Pearson 0.33 and 0.42, p 0.001). 34% of the Tei index increase was due to placental blood flow resistance (p 0.05). After FLOC, 93% had at least one survivor, and 76% had two survivors. In recipients, the distribution of cardiovascular parameters was unrelated to subsequent stillbirth (FDIU) after FLOC, while in donors, FDIU cases had higher UA and DV-PI (p .002 for all). While recipient death was predicted by Quintero stage severity (7/9 FDIU’s in stages III/IV, p 0.05), donors death was not predicted by Quintero staging. CONCLUSION: TTTS recipients receive a higher UV volume flow, ultimately precipitating abnormal diastolic and systolic cardiac performance. Donors experience hypovolemia confounded by placental dysfunction. Despite significant differences in cardiac preload and afterload between the twins, Quintero staging is a better predictor of recipient survival than the cardiovascular profile. Poster Session II Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging www.AJOG.org