www.AJOG.org Prematurity, Physiology Poster Session V

the relative risk for sPTB < 34 weeks was progressively increased ineach group, respectively: fFN 10-49 ng/mL RR 3.3 (95%CI 0.50-21.3), fFN 50-199 RR 8.2 (95%CI 1.0-66.6), fFN � 200 RR 16.3(95%CI 3.9-68.5). The PPVs for sPTB < 34 wks were 4.1% (fFN 0-9), 13.3% (fFN 10-49), 33.3% (fFN 50-199), and 66.7% (fFN �200). Similar trends were seen between groups for sPTB < 30 wksand < 36 wks. 6 pts delivered < 30 wks GA (5 spontaneously), andall 6 had fFN � 200 (sens 100%, spec 94.4% for sPTB < 30 wks).CONCLUSION: In asymptomatic patients with twin gestations, a singleqfFN screen at 22-27 6/7 wks GA effectively delineates the spectrumof risk of subsequent sPTB. Quantitative fFN may provide additionalinformation for prediction of sPTB compared to a standard quali-tative fFN screen (including enhanced PPV), particularly for iden-tifying patients at highest risk of early PTB.

Positive predictive value for sPTB (in wks) by fFNlevel (PPV, 95%CI)

791 Immunohistochemical distribution of toll-like receptors

in human fetal membranesJennifer Thompson1, Kimberly Fortner2, Brian Antczak1,Liping Feng1, Samantha Thomas3, Chad Grotegut1, Patrick Seed4,Amy Murtha11Duke University Medical Center, Obstetrics and Gynecology, Durham, NC,2Vanderbilt University, Obstetrics and Gynecology, Nashville, TN, 3DukeUniversity Medical Center, Biostatistics and Bioinformatics, Durham, NC,4Duke University Medical Center, Pediatrics, Durham, NC

OBJECTIVE: Activation of toll-like receptors (TLR) results in pro-duction of inflammatory cytokines and proteases and plays a criticalrole in the pathogenesis of preterm birth (PTB). The objective was todetermine if expression of TLR2, TLR4 and TLR6 in fetal mem-branes vary by clinical phenotype, infection status, and proximity torupture site.

Supplem

STUDY DESIGN: Paired membrane samples (rupture and distant) wereprospectively collected from: PPROM (9), preterm labor (PTL¼11),preterm no labor (PTNL¼10), term labor (TL¼10), and term nolabor (TNL¼10) subjects. With intact membranes, the area overlyingthe cervix was marked and a section collected. Samples were pre-pared and probed for TLR2, TLR4 and TLR6. Ten images wereobtained per slide and scored on a 4 point scale for degree of stainingby three independent blinded raters. Wilcoxon signed rank test,Wilcoxon-Mann-Whitney and Kruskal Wallis were used for statis-tical analysis.RESULTS: PPROM subjects had significantly less TLR4 expression atthe rupture site compared to distant (1.2 vs 1.8, p¼0.03) but nodifference in TLR2 or TLR6. PPROM subjects with chorioamnionitishad significantly less TLR2 expression than PPROM subjects withoutchorioamnionitis (0.4 vs 2.0, p¼0.04) but not TLR4 or TLR6. At therupture site, TLR6 expression was less in spontaneous PTB subjects(PPROM/PTL) than in PTNL (1.1 vs 1.7 p¼0.06).CONCLUSION: At the rupture site TLR4 expression was decreased inPPROM subjects and TLR2 expression was reduced in PPROMsubjects with chorioamnionitis. TLR6 expression was decreased inPPROM/PTL subjects. These findings suggest that increased bacte-rial concentration (rupture site, histologic chorioamnionitis andspontaneous PTB) leads to increased activation of receptors andsubsequent consumption. Additional work is required to betterunderstand the relationship of specific TLR signaling, bacterial in-vasion and histologic chorioamnionitis.

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793

Expression of cytochrome P450 2J2 (CYP2J2) andsoluble epoxide hydrolase (sEH) in labored versus non-labored human myometriumPaul Singh1, David Genochio2, Jianping Zhou2, Cristiano Jodicke1,Matthew Connell3, Mukut Sharma2, Dev Maulik11University of Missouri Kansas CIty School of Medicine, Obstetrics andGynecology, Division of Maternal Fetal Medicine, Kansas City, MO, 2KansasCity Veterans Administration Medical Center, Nephrology, Kansas City, MO,3University of Missouri Kansas City School of Medicine, Obstetrics andGynecology, Kansas City, MO

OBJECTIVE: Epoxyeicosatrienoic acids (EETs) have been shown toinduce relaxation of uterine vascular tone and diminish myometrialcontractility in vitro. Epoxyeicosanoids are thought to facilitateuterine quiescence in vivo. The synthesis and degradation of EETs isprincipally regulated by CYP 2J2, a cytochrome P450 epoxygenase,and soluble epoxide hydrolase (sEH) respectively. We hypothesizedthat human pregnant myometrium exposed to labor would exhibitdiminished expression of CYP 2J2 and increased expression of sEHcompared to non-labored controls.STUDY DESIGN: A prospective cohort study was conducted. Patientsundergoing a Cesarean delivery were offered enrollment. A 2 cmmyometrial biopsy specimen was excised from the adjacent lip of thehysterotomy incision immediately following the delivery of the in-fant and placenta. Specimens were washed in Krebs physiologicsolution and frozen in liquid nitrogen. Total RNA was analyzed forCYP 2J2 and sEH gene expression using real time RT-PCR. Foldchange in expression was calculated.RESULTS: Of the 22 patients enrolled, 9 patients underwent a Ce-sarean delivery after the initiation of labor (experimental group)while 12 patients underwent a scheduled repeat cesarean deliveryprior to the initiation of labor (control group). No significant

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Poster Session V Prematurity, Physiology www.AJOG.org

differences were found in the expression of either CYP 2J2 or sEHbetween the two groups. Results are summarized in Table 1.CONCLUSION: Prior in vitro experiments have suggested epox-yeicosanoids may eventually be utilized as a potential tocolytic agent.Presently, a trend towards diminished expression of CYP 2J2 andincreased expression of sEH in myometrium exposed to labor wasobserved although statistical significance was not achieved. Furtherstudies are needed in order to fully assess the impact of EET synthesisand metabolism upon myometrial contractility and to investigate thepossible role that epoxyeicosanoids may have in the transition fromuterine quiescence to active labor.

Fold change in expression of CYP 2J2 and sEH

794 Flattened diurnal cortisol slope correlates with

postpartum weight retentionHeather Straub1, Clarissa Simon2, Emma Adam2, Beth Plunkett1,Loraine Endres1, Chelsea McKinney3, Madeline Shalowitz for theCommunity Child Health Network31NorthShore University HealthSystem, Obstetrics and Gynecology, Evanston,IL, 2Northwestern University, School of Education and Social Policy,Evanston, IL, 3NorthShore University HealthSystem, Research Institute,Evanston, IL

OBJECTIVE: To assess the effect of cortisol slope, a biologic marker ofstress, on postpartum weight retention.STUDY DESIGN: 200 women with complete data were included fromthe Eunice Kennedy Shriver National Institute of Child Health andHuman Development (NICHD) Community Child Health Network(CCHN). CCHN was conducted using principles of community-based participatory research to study multi-level sources of parentalstress and resiliency on pregnancy outcomes. Included among stressmarkers was the rate of cortisol decline across the day (slope), withflatter slopes typically associated with poorer health and more stress.At 6 months postpartum patients completed standard scales ofperceived stress and depression, were weighed and returned threesaliva samples. Positively skewed cortisol data were transformed.Medical records provided pre-pregnancy weight and demographicdata. Pearson correlations were assessed between variables and hi-erarchical regression models were built.RESULTS: 44.2% of participants were white, 42.3% Hispanic (57%English, 42.5% Spanish speaking), 10.7% African-American and2.9% other race. 72.5% of women retained weight. Participants wereyoung, primiparous, and had a pre-pregnancy BMI of 26.3� 5.4, andretained <10 lbs. Cortisol slope was correlated with weight retention(r2¼0.174,p<0.01). Breastfeeding was modestly correlated withsteeper cortisol slopes (r2¼-0.162,p<0.05) while African-Americanrace and tobacco use were associated with flatter slopes(r2¼0.145,p<0.05 and r2¼0.148,p<0.05). There were no significantcorrelations between stress scores, cortisol slope and weight reten-tion. Multivariable analysis revealed no relationship between weightretention and demographic variables (Model 1,Table). Controllingfor smoking and breastfeeding status, (Model 2, Table), flattenedcortisol slope was weakly associated with weight retention(b ¼0.147,p<0.05,Table).

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CONCLUSION: A flattened diurnal cortisol slope appears to be asso-ciated with postpartum weight retention independent of standardstress scores.

Ordinary least squares regression correlation withweight retention

a Models controlled for breastfeeding and smoking status; bp<0.10;cp <0.05.

795

Clinical presentation of prior preterm delivery as a riskfactor for subsequent cervical shorteningSarah Obi�can1, Daphnie Drassinower1, Noelia Zork1, Cara Pessel1,Sara Brubaker1, Joy Vink1, Alexander Friedman11Columbia University Medical Center, Obstetrics and Gynecology, New York,NY

OBJECTIVE: While it is known that women with a prior spontaneouspreterm birth are at increased risk for short cervical length in asubsequent pregnancy, there is little evidence regarding whether aparticular clinical presentation during an index pregnancy - pre-mature rupture of membranes (PPROM), preterm labor, or painlesscervical dilatation in the absence of contractions - places women athigher or lower risk for short cervix in a subsequent pregnancy.STUDY DESIGN: Singleton pregnancies followed with serial cervicallength measurements from 2009 to 2012 due to a history of spon-taneous preterm delivery were identified using an ultrasound data-base. Demographic information, obstetric history, interventionsduring the pregnancy, cervical length measurements, and outcomedata were collected. Patients with fetal anomalies, medically indi-cated preterm delivery, missing outcome data, and those in whichthe clinical presentation of the prior preterm delivery could not bedetermined were excluded. Women were categorized based on theclinical presentation of their prior preterm delivery: painless cervicaldilation, PPROM, or preterm labor. We compared the shortestcervical length prior to 24 weeks and shortest cervical length prior to32 weeks amongst these groups using ANOVA.RESULTS: A total of 333 patients were included in this study. Theclinical presentations of the prior preterm deliveries were: 60 (18%)painless cervical dilation, 166 (50%) PPROM, and 107 (32%) pre-term labor. The mean cervical length prior to 24 and 32 weeks wassignificantly shorter in patients with a history of painless cervicaldilation (Figure 1).CONCLUSION: Patients with a history of painless cervical dilation areat an increased risk of having a shorter cervix in the subsequentpregnancy compared to those with a history of PPROM or pretermlabor. Notably, painless cervical dilation in a prior pregnancy wasassociated with average cervical length measurements 4 - 5 mmshorter than the other etiologies of preterm delivery.

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