Poster Session II ajog.

org

CONCLUSION: Differences in vaginal D- and L-lactic acid and TIMP 1

levels at mid-gestation are predictive of cervical length and L.
crispatus, L. iners or G. vaginalis dominance in the vaginal micro-
biome in G1P0 women.

446 Pregnancy complications among women

diagnosed with placenta previa and placental
abruption
445 Biomarkers in vaginal secretions predict short
Jennifer M. Hill1, Stacy Yadava2, Haylea S. Patrick3,
cervix and dominant bacterium in women at first Todd J. Rosen3, Meike Schuster4, Cande V. Ananth3
conception 1
Rutgers Robert Wood Johnson Medical School, Somerset, NJ, 2Gill OB/Gyn
Stephanno G. Sarmento1, Antonio F. Moron2, Larry Forney3, Valley Perinatal, Stockton, CA, 3Rutgers Robert Wood Johnson Medical
Alan R. Hatanaka2, Francisco H. Carvalho4, Marcelo S. França2, School, New Brunswick, NJ, 4Robert Wood Johnson University Hospital, New
Tatiana K. hamamoto2, Rosiane Mattar2, Iara M. Linhares5, Brunswick, NJ
Evelyn Minis6, Adriana Sañudo2, Ester C. Sabino5, OBJECTIVE: Placental abruption and placenta previa account for the
Marilza V. Rudge7, Steven S. Witkin8 majority of bleeding in the third trimester. We hypothesized that
1
Faculdade de Medicina de Jundiaí, Sao Paulo, Brazil, 2Federal University of women diagnosed with both previa and abruption in the same
Sao Paulo, Sao Paulo, Brazil, 3University of Idaho, Moscow, ID, 4Federal pregnancy would have higher rates of pregnancy complications
University of Ceara, Ceara, Brazil, 5University of Sao Paulo, Sao Paulo, Brazil, compared to women with either previa or abruption. We tested this
6
Weill Cornell MEdicine, New York, NY, 7UNESP-BOTUCATU, Sao Paulo, hypothesis in a large cohort of delivery hospitalizations in the US.
Brazil, 8Department of Obstetrics and Gynecology Weill Cornell Medicine,
STUDY DESIGN: We undertook a cross-sectional analysis using the US
New York, NY
National Hospital Survey data (1979-2010). Rates of pregnancy
OBJECTIVE: In women with a first pregnancy it is difficult to deter-
complications (postpartum hemorrhage, 3rd stage hemorrhage,
mine who is at increased risk for a preterm birth. We evaluated
transfusion, transfusion of PRBC, uterine rupture, velamentous cord
whether biomarkers in vaginal secretions could predict short cervical
insertion and DIC) were estimated for delivery-related hospitaliza-
length and dominant bacteria in the vaginal microbome in these
tions in relation to pregnancies diagnosed with previa only (deliv-
women.
ered by cesarean), abruption only, both previa and abruption.
STUDY DESIGN: 183 second trimester pregnant women with their first
Prevalence rate ratios (RR) and 95% confidence intervals (CI) were
conception (G1P0), evaluated at 18-24 weeks gestation, were
estimated from Poisson regression models with robust variance
assessed for cervical length by ultrasonography, vaginal microbiome
following adjustment for maternal age, insurance status, marital
composition by gene amplification of the V1-V3 region of the gene
status, race, hospital ownership and hospital bed size.
coding for bacterial 16S ribosomal RNA and for D- and L-lactic acid
RESULTS: Of a total of 125,259,569 delivery hospitalizations, the
and TIMP 1 in vaginal secretions by ELISA. Bacterial dominance was
prevalence rates of previa, abruption, and both previa and abruption
defined as >50% of the bacteria detected. A short cervix was defined
were 3.7, 9.6, and 0.3 per 1000. Rates of pregnancy complications in
as < 25 mm.
relation to previa and abruption are shown in the table. After ad-
RESULTS: Subjects’ had 19.7% short cervix. The vaginal D-lactic acid
justments for confounders, previa with abruption had the highest
concentration was >7.5 times higher (p¼0.0195), and the L-lactic
adjusted RRs for transfusion (RR 23.8, 95% CI 22.2, 25.6), trans-
acid level was 1.6 times higher (p¼0.0270), in women with a cervical
fusion of PRBC (RR 25.0, 95% CI 23.3, 26.9), hysterectomy (RR
length > 25 mm. Conversely, the TIMP 1 level was 1.5 times higher
47.0, 95% CI 44.2, 49.9) and cesarean hysterectomy (RR 25.2, 95%
(p >0.05) in women with a short cervix. The vaginal concentration
CI 23.7, 26.8; Figure). Previa alone had the highest adjusted RR for
of D-lactic acid was correlated with L. crispatus dominance (p<
postpartum hemorrhage (RR 3.7, 95% CI 3.6, 3.8) and 3rd stage
0.0001), a high L-lactic acid level and low D-lactic acid level corre-
hemorrhage (RR 4.4, 95% CI 4.2, 4.5).
lated with L. iners dominance (p< 0.0003) while a high TIMP 1
CONCLUSION: Placental abruption in the setting of previa has higher
concentration and low D- and L-lactic acid level correlated with G.
rates of pregnancy complications, which in turn, leads to higher rates
vaginalis dominance (p< 0.0020). By multivariate logistic regression,
of blood transfusion and hysterectomy. In the setting of both previa
controlling for maternal age and L. crispatus dominance, an
and abruption, providers might counsel patients on the associated
increased vaginal D-lactic acid concentration was independently
complications and the significant risk of need for blood transfusion
associated with a 33.2% decreased occurrence of a short cervix
and hysterectomy.
(p¼0.043). The D/L lactic acid concentrations were significant lower
(p¼ 0.027; p¼ 0.036 respectively) and TiMP-1 was higher (p¼0.322)
in women with a short cervix. SPTB occurred in 13.9% of women
with a short cervix and in 8.8% of those with a normal cervix
(p¼ 0.3570).

S292 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2020

ajog.org Poster Session II

OBJECTIVE: Delayed prenatal care (PNC) is associated with adverse

pregnancy outcomes. We seek to determine if advanced maternal age
(AMA) influences these outcomes.
STUDY DESIGN: A retrospective cohort study of non-anomalous,
singleton pregnancies with delayed PNC (>20-week gestational age)
comparing adverse maternal and neonatal outcomes between young
patients (age< 35) and AMA patients (age35) at OHSU from
2009-2013. Chi-square was used to compare rates of adverse out-
comes between young and AMA patients. Multivariate logistic
regression estimated the strength of association between race and
adverse outcomes among women with delayed PNC, adjusting for
biologically plausible and clinically relevant confounders.
RESULTS: After exclusions, 5927 (84.7%) women had early PNC and
1070 (15.3%) had delayed PNC. Young were more likely to delay
PNC (delayed 82.9% vs. early 76%, p< 0.001) compared to AMA
(delayed 17.1% vs. early 24%, p< 0.001). In delayed PNC, AMA
patients had significantly increased rates of cesarean section (CS)
(aOR, 1.84; 95% CI 1.22-2.78) and gestational diabetes (GDM)
(aOR, 1.85; 95% CI 1.09-3.13) when compared to young patients.
Among women who initiated PNC early, the strength of association
of GDM in AMA was higher than in delayed PNC (aOR, 2.34; 95%
CI 1.90-2.88). However, analyzing early vs. delayed PNC indepen-
dently demonstrates that delayed PNC in young patients is associated
with increased rates of GDM (aOR, 1.44; 95% CI 1.10-1.90) but not
in AMA patients (aOR, 1.19; 95% CI 0.76-1.87). There was no
significant age influence on pre-eclampsia, preterm birth, SGA/LGA,
or NICU admission with delayed PNC.
CONCLUSION: AMA pregnancies are associated with increased rates of
CS and GDM regardless of timing of PNC initiation. Delayed PNC
in younger patients impacts the risk of GDM significantly more than
in AMA patients who are a higher risk population in all points of
gestation. Our findings emphasize early education/intervention may
provide more opportunities to influence obstetric outcomes in all
age groups, but particularly women of younger age.

447 Maternal age impacts rates of gestational

diabetes and cesarean section with delayed PNC
Minhazur Sarker1, Hannah L. Bacheller2,
Aaron B. Caughey3, Amy M. Valent2
1
Icahn School of Medicine at Mount Sinai, New York, NY, 2Oregon Health &
Science University, Portland, OR, 3Department of Obstetrics & Gynecology,
Oregon Health & Science University, Portland, OR

Supplement to JANUARY 2020 American Journal of Obstetrics & Gynecology S293