Poster Session V ajog.org

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PDC-E2 and P2Y2 associate with VEGFR2 in humanplacentas near termShannon Ho1, Stanley Stevens2, Christina Teefey1, Maja Okuka1,Thora Steffensen3, Valerie Whiteman1, John Tsibris11University of South Florida, Ob-Gyn, Tampa, FL, 2University of SouthFlorida, Cell Biology, Microbiology, and Molecular Biology, Tampa, FL,3Tampa General Hospital, Pathology, Tampa, FLOBJECTIVE: To study in normal and preeclamptic placentas the as-sociation of VEGFR2 with pyruvate dehydrogenase component E2(PDC-E2) and purinergic receptor P2Y2. VEGFR2 synthesizesdiuridine tetraphosphate Up4A that, like ATP, could stimulate P2Y2.These proteins may synergize in the vasculature and placentalmetabolism to support fetal growth and possibly labor.STUDY DESIGN:Homogenized samples from the fetal compartment ofplacentas (n¼20) provided soluble (S) and membrane (M) proteins.Immunoprecipitation (IP) with the corresponding antibodiesselected proteins and proteomics identified them. Western blots(WB) determined protein levels and immunohistochemistry con-firmed protein co-localizations.RESULTS: VEGFR2 is confined to endothelial cells at term. We hadreported that in VEGFR2-IP, PDC-E2, P2Y2, immunoglobulins andperoxiredoxin did coIP. PDC-E2 resides predominantly in tropho-blasts. PDC-E2 IP of trophoblast PDC-E2, not retained by VEGFR2-IP, revealed coIP of a 50kD PDC-E2 variant that was also lysineacetylated (K-Ac). In VEGFR2-IP of normotensive vs. preeclampticpatient samples, different intensities of native (60kD) and 43kDP2Y2 bands were seen; very large, lipid-raft, P2Y2 complexes wereseen in WB of S and M proteins, but not in maternal or cord blood.P2Y2-IP of S or M revealed IP of a K-Ac 50kD protein. VEGFR2 isK-Ac by p300 (Zecchin A et al, 2014). HDAC inhibitors (trichostatinA, panobinostat) added recently to homogenizations seem to affectproteolytic degradation.CONCLUSION: We found protein associations, not predicted fromknown signal transaction pathways, which will enrich the latter as weexplore catalytic interactions. We propose that PDC-E2 and/or its50kDa variant are acetyltransferases supplying acetyl-CoA toVEGFR2, assuming that PDC-E2 “leaks” out of mitochondria, as inprimary biliary cirrhosis. Correlations of patient data with proteinexpression in placenta, maternal and cord blood will provide newinsights on placental metabolism and labor.

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Immunologic response to vaccine challenge in PTPN22gene variants in pregnancyShelly Tien3, Juliet Crabtree2, Heather Gray3, Erik Peterson11University of Minnesota, Rheumatic and Autoimmune Diseases,Minneapolis, MN, 2University of Minnesota, Center for Immunology,Minneapolis, MN, 3University of Minnesota, Maternal-Fetal Medicine,Minneapolis, MNOBJECTIVE: A polymorphism in the PTPN22 gene imparts risk forinfection and autoimmune disease. In the PTPN22 gene variantmurine model, there is dampened immunologic activity to influenzavaccine challenge. We sought to quantify the humoral and cell-mediated immunologic response to the inactivated influenza vaccineamong healthy pregnant women who are wild type (non-carriers)and variant (carriers) for the PTPN22 gene.STUDY DESIGN: We recruited 114 healthy pregnant women prior toreceiving the influenza vaccine from September to November 2013.A venipuncture was performed on consenting subjects for geno-typing and pre vaccine serum. Genotyping for carrier or non-carrierstatus was performed on all women. All gene variant subjects (n¼17)and a group of wild type subjects (n¼33) were selected to completethe study. Selected participants had additional blood draws 9-15 daysand 15-30 days post vaccine for cellular and antibody response,respectively. Hemagglutination-inhibition assays for influenza sub-types were performed to quantify neutralizing antibodies. Evaluationof CD 4 T cell response through cell stimulation and flow cytometry

S416 American Journal of Obstetrics & Gynecology Supplement to JANUARY

is in process. From prior human PTPN22 gene carrier data, a samplesize of 15 subjects within each group was calculated to detect asignificant difference in immunologic response between gene car-riers and non-carriers.RESULTS: There was no significant difference in age, parity, BMI,ethnicity, gestational age at time of vaccine, and history of priorinfluenza vaccination between the two groups. 23.5% of gene car-riers compared to 51.5% of gene non-carriers demonstrated sero-conversion to the H1N1 influenza serotype, trending towardsignificance (p¼0.06). CD 4 T cell evaluation is on-going.CONCLUSION: Among healthy pregnant women, PTPN22 gene carriersubjects have a decreased immunoglobulin response to the inacti-vated influenza vaccine compared to gene non-carriers.

Hemagglutination inhibition antibody results.

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Adverse pregnancy outcomes in twin pregnanciesreduced to singleton pregnancies and ongoing twinpregnanciesSimi Gupta1, Jessica Feinberg2, Nathan Fox1, Chad Klauser1,Andrei Rebarber11Mount Sinai School of Medicine, New York, NY, 2Carnegie Imaging forWomen, New York, NYOBJECTIVE: Multifetal pregnancy reduction has been shown toimprove outcomes in triplet and higher order multiple pregnancies.The data for fetal reduction of twin pregnancies is limited. Thepurpose of this study was to compare adverse pregnancy outcomesin ongoing twin pregnancies compared to twin pregnancies reducedto singletons.STUDY DESIGN: This is a retrospective cohort study of dichorionic-diamniotic twin pregnancies, comparing ongoing twin pregnancieswith twin pregnancies reduced to singleton gestations between 11-24weeks gestation in a single Maternal Fetal Medicine practice over a 9year period. Adverse pregnancy outcomes >24 weeks werecompared with p<0.05 used for significance.

2015

ajog.org Poster Session V

RESULTS: 501 ongoing twin pregnancies and 63 twin pregnanciesreduced to singletons were included. Patients with reductions tosingletons had a significantly lower risk of preterm delivery before 37weeks gestation (10% vs. 43%, p<0.001) but no difference in therisk of preterm delivery before 34 weeks (5% vs. 12%) or 28 weeksgestation (2% vs. 3%). Patients with reductions to singletons alsohad a lower risk of infant birth weight less than the 10th percentilefor gestational age (23% vs. 49%, p<0.001), but no difference in therisk of infant birth weigh less than the 5th percentile (16% vs. 28%,p¼0.079). There was no difference in the risk of fetal demise after 24weeks gestation.CONCLUSION: Fetal reduction of twin pregnancies decreases the riskof late preterm birth and birth weight less than the 10th percentilebut not the risks of more severe complications such as early pretermbirth or birth weight less than the 5th percentile.

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Evaluating postpartum readmission rate as an OBquality metricSindhu Srinivas1, April Romanos11Maternal and Child Health Research Program, Perelman School of Medicineat the University of Pennsylvania, Obstetrics and Gynecology, Philadelphia,PAOBJECTIVE: Decreasing readmission rates within 7 and 30 days is anational focus aimed at improving patient care. Obstetrics (OB)accounts for a large volume of annual hospital admissions nationally.We sought to examine the postpartum readmission rate, assess eti-ology, preventability and ultimately, determine if readmission rate isa viable OB quality metric.STUDY DESIGN: We performed a cohort study of all patients whodelivered and were subsequently readmitted within 7 and 30 days ofdischarge at a single urban teaching institution between August 2013and June 2014. A comprehensive chart review was performed for allOB readmissions. Reason for readmission was categorized. Cate-gorical variables were compared using chi square analyses.RESULTS: A total of 3762 deliveries occurred during the 11 months;30.8% were by cesarean; 84% were term; 11% had a hypertensivedisorder of pregnancy. Fifty-two women (1.4%) were readmittedwithin 30 days of discharge from delivery admission, 42 (80.7%) ofwhich were within the first 7 days. Of the 52 readmitted patients,75% (39) were for hypertension or fever/infection (table). Cesareandelivery was significantly associated with readmission (2% vs. 1%,p¼0.016). Of the 19 with fever, 21% (4) had a fever during the initialadmission. Of the 20 readmitted with hypertension, 60% (12) had adiagnosis of hypertensive disorder of pregnancy on initial deliveryadmission. Readmissions due to hypertension were significantlyassociated with an earlier postpartum readmission (p¼0.04).CONCLUSION: Readmissions are an important hospital quality metric.While they represent a small volume in OB, they provide importantinsight into the quality of care and follow-up at discharge. Hyper-tension was the largest contributor to postpartum readmissions ac-counting for nearly half of readmissions in the first 7 days postdischarge. Hypertension is a leading cause of maternal mortality.This suggests that optimal management and surveillance of post-partum hypertension is critical.

Reasons for readmission

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Prior full term birth does not decrease the risk ofrecurrent preterm birthStephanie Purisch1, Michal Elovitz1, Amy Turitz2, Lisa Levine11University of Pennsylvania Perelman School of Medicine, Maternal andChild Health Research Program, Department of OBGYN, Philadelphia, PA,2Columbia University Medical Center, Obstetrics and Gynecology, New York,NYOBJECTIVE:While it is known that a prior spontaneous preterm birth(sPTB) significantly increases the risk for recurrent sPTB, it remainsunknown whether a prior full term birth (FTB) modifies that risk.Our objective was to determine the impact of a prior FTB onrecurrent sPTB risk.STUDY DESIGN: Retrospective cohort study of patients with priorsingleton sPTB from 24-36 6/7 weeks, who were counseled in ourPrematurity Prevention Program and delivered a singleton gestationat our institution from 2010-2014. The exposed group was womenwith a prior FTB; the unexposed group was women with no priorFTB. The primary outcome was recurrent sPTB (24-36 6/7 weeks).Data were collected via chart abstraction. As standard practice at ourinstitution, patients were offered 17-OHP for prior sPTB <37 weeks,as well as cervical length screening/cerclage for prior sPTB <34weeks. Categorical and continuous variables were compared usingchi square and Mann Whitney U tests, as appropriate.RESULTS: 137 women met inclusion criteria. The overall rate of sPTBin the cohort was 34.3%. There was no difference in the baselinecharacteristics of the exposed (n¼64) and unexposed (n¼73) groups,including age, race, tobacco use, median gestational age (GA) of priorPTB, 17-OHP use, and cerclage placement. The rate of recurrent sPTBbetween the exposed and unexposed groups was similar even whenstratifying by number of prior sPTB (table). While prior FTB did notimpact the rate of recurrent sPTB, the sPTB rate did increase with>1prior sPTB compared to 1 prior sPTB (56% vs. 27%, p¼0.002). Themedian GA at delivery of the current pregnancy (37 4/7 weeks) wasthe same for exposed and unexposed groups (p¼0.6).CONCLUSION: The risk of recurrent sPTB is not decreased by a historyof prior FTB. The number of prior sPTBs remains the driving forcebehind the risk of recurrent sPTB; therefore, a history of prior FTBshould not alter counseling or preclude offering interventions toprevent recurrent sPTB.

Rate of recurrent sPTB 24-36 6/7 weeks

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Short cervical length remains a risk factor for pretermbirth in multiparous womenStephanie Purisch1, Nadav Schwartz1, Julie Romero1,Michal Elovitz1, Lisa Levine11University of Pennsylvania Perelman School of Medicine, Maternal andChild Health Research Program, Department of OBGYN, Philadelphia, PAOBJECTIVE: Although SMFM guidelines state that universal trans-vaginal cervical length (UCL) screening is a reasonable strategy toidentify women at risk of spontaneous preterm birth (sPTB), his-torical data questions the utility of this strategy in parous women.We sought to describe sPTB rates, stratified by parity, in acontemporary population undergoing UCL screening.STUDY DESIGN: Retrospective cohort study of patients who under-went UCL screening at 18 to 23 6/7 weeks gestation from Jan 2012 toMar 2014 and delivered at our institution. Patients were not offeredscreening if they had a multiple gestation, cerclage already in place,or were using 17-OHPC. Patients with a short CL (�20mm) were

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