305 PERINATAL OUTCOMES OF WOMEN INVOLVED IN MOTOR VEHICLE ACCIDENTS DINAEL KADY1, GUIBO XING1, WILLIAM GILBERT1, 1University of California, Davis,OB/GYN, Sacramento, California

OBJECTIVE: To determine maternal, fetal, and neonatal outcomes ofpregnant women involved in motor vehicle accidents, as a function of thetiming of the delivery.

STUDY DESIGN: This is a population based retrospective cohort study ofmaternal/fetal/neonatal outcomes of pregnant women hospitalized secondary toa motor vehicle accident (MVA) in California from 1991-1999. ICD9-CM codeswere used to identify injuries secondary to the MVA as well as outcomesincluding PTL, PROM, abruption, uterine rupture, blood transfusions, in-fection, fetal distress, birth asphyxia, LBW, prematurity, and maternal, fetal andneonatal death. Outcomes are analyzed with Odds Ratios and 95% ConfidenceIntervals.

RESULTS: A total of 6086 women were hospitalized secondary to an MVA in4.3 million deliveries (1 in 706). Women hospitalized for an MVA and whodelivered had high rates of adverse outcomes including a 48 fold increased risk ofplacental abruption (CI 40,57), a 21 fold increase in blood transfusions (CI15,29), a 146 fold increase in uterine rupture (CI 68,311), a 25 fold increased rateof stillbirth (CI 19,33) and a 156 fold increased rate of maternal death (CI87,282). Adverse outcomes persisted for women discharged home undeliveredafter an MVA. These women had increased rates of PTL (OR 1.3, CI 1.2,1.4),placental abruption (OR 1.5, CI 1.2,1.8), C/S, hemorrhage (OR 8, CI 6.9,9.4)infection (OR 3.5, CI 3,4) and even maternal death (OR 5.2, CI 1.7,16).

CONCLUSION: Pregnant women discharged home after an MVA continue tohave increased risks of adverse outcomes at delivery, including maternal death.Therefore, these women should be followed closely during the remainder of thepregnancy in an attempt to prevent this morbidity and mortality.

SMFM Abstracts S91

303 PREVALENCE OF NEW ALLOANTIBODIES AFTER INTRAUTERINE TRANSFUSION FORSEVERE RH DISEASE WILLIAM WATSON1, JOSEPH WAX2, RICHARD MILLER3,BRIAN BROST1, 1Mayo Clinic, Maternal Fetal Medicine, Rochester, Minnesota,2Maine Medical Center, Maternal Fetal Medicine, Portland, Maine, 3SaintBarnabas Medical Center, Department of Obstetrics & Gynecology, Livingston,New Jersey

OBJECTIVE: Limited information is published on the frequency of newalloantibodies found in patients treated for isoimmunization. The purpose of thisstudy was to determine the prevalence of induction of additional red cellalloantibodies, found after the initiation of treatment for severe Rh disease.

STUDY DESIGN: A retrospective review from 1992-2004 of all patients at ourinstitutions with severe Rh disease was undertaken. Rh disease requiring intra-uterine blood transfusion was defined as severe. Gravidas with alloantibodies inaddition to Rh were included, but those without anti Rh antibodies wereexcluded. New alloantibodies were defined as antibodies absent in previouspregnancies, absent on initial pregnancy screening, found after the onset ofinvasive testing or treatment.

RESULTS: During this time period there were a total of 84 intra-uterine bloodtransfusions performed in 31 patients with severe Rh disease, an average of 2.7transfusion procedures per patient. Seventeen of 31 had alloantibodies inaddition to Rh known to be present in early pregnancy. Seven patients (23%)were found to develop additional red cell alloantibodies after treatment duringthe pregnancy.

Patient # Primary antibodies(s) New alloantibodies detected

1 D E,S2 D,C E3 D,C E4 D V5 D C6 D C,S7 D c,e,Jka

CONCLUSION: Induction of additional red cell alloantibodies after treatmentfor severe Rh disease is relatively common. This may have significantimplications for future pregnancies in this high-risk population.

304 BLUNT NEEDLES FOR PREVENTION OF PERCUTANEOUS INJURY DURING CESAREANDELIVERY BRIDGET WILLIAMSON1, DAVID SOPER1, ASHLEY WOODWARD2, 1MedicalUniversity of South Carolina, Department of Obstetrics and Gynecology,Charleston, South Carolina, 2Medical University of South Carolina, Collegeof Medicine, Charleston, South Carolina

OBJECTIVE: To evaluate the use of blunt needles during cesarean delivery forprevention of percutaneous injuries.

STUDY DESIGN: This prospective, randomized study enrolled patients un-dergoing cesarean delivery. Patients were randomized to blunt or sharp needles.The primary outcome of percutaneous injury was assessed by two methods: 1)questionnaire asking physicians to self-report injuries occurring during theprocedure, 2) water testing of gloves for discrete perforations as an indicator ofunrecognized percutaneous injury. Data collected from the operative recordincluded demographics, duration of the procedure, and estimated blood loss.Data was analyzed by the chi-square, Fisher’s exact, and student t-test.

RESULTS: A total of 150 patients completed the study; 73 with blunt needlesand 77 with sharp. There were no significant differences between the two groupswhen comparing demographic characteristics, duration of procedure, orestimated blood loss. Several physicians noted glove perforations duringprocedures; however, no percutaneous injuries were noted by any physician.Overall, discrete glove perforations noted by water testing were reduced whenusing blunt needles, however, this was not statistically significant (P = .22).When looking at the primary surgeon, there was no reduction in gloveperforation by using blunt needles (P = 1.0). Of interest, with the assistantsurgeon, there was a significant reduction in glove perforation with the bluntneedles (P = .03).

CONCLUSION: Blunt needles are protective against percutaneous injuryduring cesarean delivery, particularly with the assistant surgeon. These resultsimply that the mechanism of injury for assistant surgeons is different than theprimary surgeon. Using blunt needles for portions of, if not the entire cesareandelivery will significantly reduce the number of percutaneous injuries.

306 OUTCOMES OF MATERNAL FALLS DURING PREGNANCY DINA EL KADY1, GUIBO XING1,WILLIAM GILBERT1, 1University of California, Davis, Obstetrics & Gynecology,Sacramento, California

OBJECTIVE: To determine maternal, fetal and neonatal outcomes of womenhospitalized for falls during pregnancy.

STUDY DESIGN: This is a population based retrospective cohort study ofmaternal/fetal and neonatal outcomes of pregnant women hospitalized for fallsin California from 1991-9. Outcomes were analyzed for 2 groups of women;those who delivered at the fall hospitalization, and those who were discharged,delivering at a subsequent hospitalization. ICD 9-CM codes were used toidentify falls, injury types, and outcomes including PTL, PROM, abruption,uterine rupture, blood transfusions, infection, fetal distress, birth asphyxia,LBW, prematurity, and maternal, fetal and neonatal death. Outcomes areanalyzed with Odds Ratios and 95% Confidence Intervals.

RESULTS: A total of 3481 women were hospitalized during pregnancy fora fall, in a population of 4.3 million deliveries (1 in 1235). Of women who wereadmitted for a fall, 23% delivered at that hospitalization. Superficial injuries,contusions and crushing injuries were the most common injury in womendelivering at the fall hospitalization, where fractures, dislocations, sprains andstrains were more common in the women discharged undelivered. Womensustaining a fall leading to delivery had increased rates of PTL (OR 2.6, CI2.1,3.2), abruption (OR 5.2, CI 3.7,7.2), uterine rupture (OR 15.6, CI 2.2, 111),LBW (OR 2.1, CI 1.7,2.6), stillbirth (OR 4.1, CI 2.5, 6.7), and other adverseoutcomes. Women discharged undelivered continued to have increased risk ofadverse outcomes at delivery including PTL (1.6,CI 1.4,1.8), PTD (OR 1.3, CI1.2,1.5), LBW infants (OR 1.4, CI 1.3,1.6), C/S (OR 1.2, CI 1.1,1.3), hemorrage(OR 10, CI 8,12) and infectious complications of pregnancy (OR 4.8, CI 4, 5.6).

CONCLUSION: Women hospitalized for falls during pregnancy have high ratesof maternal and fetal morbidity and mortality, and should be monitored closelyfor adverse outcomes. Women discharged undelivered should also be followedclosely for many adverse events, including PTL and LBW.