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778 Risk indicators for eclampsia in women withestational hypertension or mild preeclampsiat term: a case-control studyorine M Koopmans1, Joost J Zwart2, Henk Groen3,itty WM Bloemenkamp2, Ben Willem J Mol4,aria G Van Pampus1, Jos Van Roosmalen2

University Medical Center Groningen, Department of Obstetrics andynaecology, Groningen, Netherlands, 2Leiden University Medical Center,epartment of Obstetrics and Gynaecology, Leiden, Netherlands, 3Universityedical Center Groningen, Department of Epidemiology, Groningen,etherlands, 4Academic Medical Center, Amsterdam, Departmentf Obstetrics and Gynecology, Amsterdam, NetherlandsBJECTIVE: To evaluate whether eclampsia can be predicted in womenith gestational hypertension or mild preeclampsia at term.TUDY DESIGN: We performed a nationwide case-control study in theetherlands. Cases were women in whom pregnancy was complicatedy eclampsia, and selected from the LEMMoN study, a nationwideohort study on severe maternal morbidity (Zwart JJ et al. BJOG008). Controls were women who had a pregnancy complicated byestational hypertension or mild preeclampsia, but who did not de-elop eclampsia. These controls were collected from a multicentreandomized controlled trial (HYPITAT trial), in which we comparednduction of labor to expectant monitoring in women with gestationalypertension or mild preeclampsia at term (Koopmans CM et al. Lan-et 2009). Risk indicators studied included data from clinical charac-eristics and laboratory findings. Multivariable logistic regressionnalysis was performed to develop a model for the prediction ofclampsia. The predictive capacity of our model was assessed witheceiver-operating-characteristic (ROC) analysis.ESULTS: We compared 83 cases to 1153 controls. In the multivariablenalysis maternal age (OR 0.93 per year), ethnicity (OR 0.31 for Cau-asian ethnicity), systolic blood pressure (1.1 per mm Hg), protein-ria (OR 3.9 and 7.5 for 2� and 3� respectively), platelets (OR 0.99er unit), uric acid (OR 1.8 per unit), creatinin (OR 1.02 per unit),spartate aminotransferase (OR 1.03 per unit), lactate dehydrogenaseOR 1.01 per unit) and prophylactic use of magnesium sulphate (OR.30) showed a statistically significant association with the occurrencef eclampsia. Other variables included in the model were fetal loss inistory (OR 3.6) and miscarriage in history (OR 0.57). The area underhe ROC-curve of this model was 0.92.ONCLUSION: In women with gestational hypertension or mild pre-clampsia at term, eclampsia can be predicted. The identified predic-ors may provide physicians guidance to start prophylactic treatmentith magnesium sulphate or to induce labor without delay.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.795

779 Role of preeclampsia and BMIn determining baroreceptoreith Williams1, France Galerneau2, Linda Elgart3

Yale University, New Haven, Connecticut, 2Yale University Schoolf Medicine, OB/GYN, New Haven, Connecticut, 3Hospital oft Raphael, Women and Children, New Haven, ConnecticutBJECTIVE: Elevated sympathetic activity in pregnant patients mightontribute to vasoconstriction in preeclampsia (PET). Baroreflex sen-itivity (BRS) has become a powerful tool to assess autonomic nervousystem control in cardiac cases. We previously demonstrated that BRSs diminished in preeclampsia because of increased sympathetic activ-ty. We investigated whether Body Mass Index (BMI) and preeclamp-ia were independent risk factors for the changes in BRS.TUDY DESIGN: We measured continuously beat to beat outputs oflood pressure (pilot 9200) for 5 minutes. Time series of systolic beat-o-beat pressure values and RR intervals were extracted to analyze andssess BRS in forty pregnant patients at increased risk for PET. Weivided patients into two groups (BMI �35 and group two BMI �35).e measured BRS by the Linear Spontaneous Sequence Technique

ssessing spontaneous sequences of 3 cycles and calculating the linear m

280 American Journal of Obstetrics & Gynecology Supplement to DECEMBER

egression slope between BP and RR interval. Statistical significanceas at the (p � .05)ESULTS: We used a two-way ANOVA to evaluate the interaction be-ween BRS and the variables of PET and BMI. There was no interac-ion of PET and BMI (p�.05) on BRS. There was a significant mainffect of PET and BMI on BRS (p�.05). Seven women developed PET.RS was significantly reduced in the seven PET patients compared to

he group that remained normotensive (10.7 � 4 vs 4.4 �2) P�.05.ONCLUSION: A significant reduction in BRS is related to the develop-ent of PET and the degree of obesity. This indicates an altered au-

onomic nervous activity towards parasympathetic inhibition andympathetic activation. BRS analysis may provide a useful marker ofreeclampsia but has to be correlated with other factors includingbesity.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.796

780 D6 decoy receptor in preeclampsiaeum Joon Cho1, Min Jeong Oh1, Hyun Joo Seol2,yun Chul Jeong1, Young Sun Yoon1, Yu Chinaek1, Soon Cheol Hong1, Hai Joong Kim1

Department of Obstetrics and Gynecology, College of Medicine, Koreaniversity, Seoul, South Korea, 2Department of Obstetrics and Gynecology,ollege of Medicine, Kyunghee University, South KoreaBJECTIVE: Chemokines play a major role in the induction of inflam-atory reactions and development of an appropriate immune re-

ponse by coordinating leukocyte recruitment. D6 is a promiscuousecoy receptor defined as non-signalling receptor that can bind to thehemokines and target them to degradation resulting in inhibition ofnflammation. In placenta, D6 is strongly expressed by invading ex-ravillous trophoblast and on the apical side of syncytiotrophoblastells, at the very interface between maternal blood and fetus. It haseen reported that exposure of D6�/� mice to LPS resulted in in-reased levels of inflammatory chemokines and increased leukocytenfiltrate in placenta causing an increased rate of fetal loss. Preeclamp-ia is associated with a more vigorous systemic inflammatory responsehan normal pregnancy. The purpose of this study was to investigatehe expression of D6 decoy receptor in placentas from preeclampticregnancies and normal placentas.TUDY DESIGN: A study was carried out in 35 pregnant women (7atients with mild preeclampsia, 16 patients with severe preeclampsiand 12 healthy normotensive pregnant women) during the third tri-ester of pregnancy. The expression of D6 mRNA and protein was

etermined with real time RT-PCR and Western blotting, respectively.ESULTS: The mRNA and protein expression of D6 decoy receptorere detected in all of placentas from preeclamptic pregnancies andormal placentas. Placental D6 mRNA expression was significantly

ower in preeclampsia than in normal pregnancy. Western blot anal-sis revealed a decreased protein expression in preeclampsia.ONCLUSION: The expression of D6 decoy receptor in preeclampticlacenta was significantly lower than that of normal pregnancy. De-reased expression of D6 decoy receptor may involve an exaggerationf systemic inflammation in preeclampsia. Thus D6 decoy receptor

n placenta might play an important role in the pathogenesis ofreeclampsia.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.797

781 Severe preeclampsia is associated with abnormal tracelements concentrations in maternal and fetal bloodhad Katz1, Ofra Paz-Tal2, Tal Lazer1, Barak Aricha-Tamir1,oshe Mazor1, Arnon Wiznitzer1, Eyal Sheiner1

Soroka Uneversity Medical Center, Obstetrics and Gynecology,e’’er Sheva, Israel, 2Nuclear Research Center Negev, IsraelBJECTIVE: To compare trace elements concentrations in women withnd without severe preeclampsia (PET).TUDY DESIGN: A prospective case control study, comparing 42omen with PET and 80 healthy women and their newborns,

atched for gestational age. Inductively coupled plasma mass spec-

2009