346: Combination of first-trimester placental protein 13(PP13), 3D placental volume, vascular indices and maternal characteristics for prediction of adverse pregnancy outcomes

13(PP13), 3D placental volume, vascular indices and maternal characteristics for prediction of adverse pregnancy outcomes Jeanine Carbone, Katherine Goetzinger, Julie Liebsch, Roxane Rampersad, George Macones, Anthony Odibo Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO OBJECTIVE: PP13 and placental parameters may be valuable early predictors of adverse pregnancy outcomes. We tested the hypothesis that a combination of first-trimester PP13, 3D placental volume, and vascular indices would improve the prediction of adverse pregnancy outcomes. STUDY DESIGN: We performed a prospective cohort study of 422 singleton pregnancies presenting to our prenatal ultrasound unit between 11 and 14 weeks gestation. Placental volume (PV) was obtained by 3D ultrasound using the VOCAL technique. Placental quotient (PQ) was determined by taking the ratio of PV to fetal crown-rump length. Vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were obtained from 3D power Doppler histograms. PP13 levels were measured, and the values were converted to multiples of the median (MoM) for gestational age. Adverse outcomes evaluated included preeclamspis (PE), gestational hypertestion (GHTN) and small for gestational age (SGA birthweight, 10th percentile). Comparisons of PP13, 3D PV, PQ, vascular indices, and maternal characteristics between women who developed any of the adverse pregnancy outcomes and those with normal outcomes were performed using the Wilcoxon rank sum test. Logistic regression analysis was used to identify the final prediction model and receiver-operating characteristics (ROC) curves used to evaluate the predictive ability of each or combination of variables, using area under the curve (AUC). RESULTS: PE was diagnosed in 42(10%), GHTN in 39 (9.2%), and SGA in 32(7.6%) of the women included. PP13 MoM was significantly lower in women diagnosed with preeclampsia (0.67;p 0.001) and PQ was significantly lower in pregnancies complicated by SGA (0.61; p 0.1). The area under the ROC curve for the prediction of SGA with the combination of PP13 with VI and PQ was 0.71. However, combination of these first-trimester parameters did not improve the prediction of preeclampsia or GHTN. Results summary in the table. CONCLUSION: PP13, VI, and PQ have modest ability to predict SGA individually. Combination of these parameters do not further improve the prediction of preeclampsia or GHTN nor SGA. 347 Hydramnios in twin gestations Jennifer S. Hernandez, Diane M. Twickler, Donald D. McIntire, Jodi S. Dashe The University of Texas Southwestern Medical Center, Obstetrics and Gynecology, Dallas, TX, The University of Texas Southwestern Medical Center, Radiology, Dallas, TX OBJECTIVE: To evaluate the effect of hydramnios on pregnancy outcomes in dichorionic (DC) and monochorionic (MC) twins. STUDY DESIGN: This is a retrospective cohort study of all twin pregnancies that received prenatal ultrasound evaluation between August 1997 and December 2010 and delivered live-born infants 24 weeks of gestation. Chorionicity was assessed sonographically. Sonography was routinely performed every 4 to 6 weeks. Hydramnios was defined as a single deepest pocket of amniotic fluid 8 cm, and further qualified as mild (8-9.9 cm), moderate (10-11.9 cm), and severe ( 12 cm). The greatest degree of hydramnios identified during pregnancy was used for analysis. Monoamniotic pregnancies and pregnancies complicated by twin-twin transfusion syndrome were excluded. Infants with major structural anomalies were analyzed separately. RESULTS: There were 1919 twin pregnancies meeting inclusion criteria, of which 1301 (68%) were DC and 618 (32%) MC. Hydramnios was identified in 323 pregnancies (17%), with no differences in prevalence or severity according to chorionicity. Outcomes are presented in the table below. The prevalence of major structural anomalies increased significantly with the degree of hydramnios in both DC and MC pregnancies. The remainder of the analyses excluded anomalous infants. In DC pregnancies, there was a significant association between degree of hydramnios and infant birthweight; however, this relationship was not present in MC pregnancies. Hydramnios was not associated with preterm birth, birthweight discordance, or neonatal death. CONCLUSION: Hydramnios is common in twin gestations and is associated with an increased risk for fetal anomalies. In the absence of malformations, we did not identify an increased risk for adverse pregnancy outcomes. www.AJOG.org Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging Poster Session II