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Evolving trends in 2,000 cases of multifetal pregnancy reduction
S184 SMFM Abstracts 605 EVOLVING TRENDS IN 2,000 CASES OF MULTIFETAL PREGNANCY REDUCTION: JOANNE STONE1, ANDREA MATHO2, RICHARD BERKOWITZ3, VICTORIA BELOGOLOVKIN4, KEITH EDDLEMAN5, 1Mount Sinai School of Medicine, Obstetrics or Gynecology, New York, New York, 2Mount Sinai School of Medicine, OBGYN, New York, New York, 3Columbia Presbyterian Medical Center, New York, New York, 4Mount Sinai School of Medicine, Obstetrics and Gynecology, New York, New York, 5Mount Sinai School of Medicine, Obstetrics, Gynecology and Reproductive Science, New York, New York OBJECTIVE: To examine changes in MPR procedure in 2,000 cases, and to evaluate evolving trends within the last 1,000 MPR’s. STUDY DESIGN: A computerized database was used to identify 2,000 consecutive patients undergoing MPR. Data was collected from the database and chart review. Comparisons were made between the first 1,000 (Group 1) and the 2nd 1,000 MPRs (Group 2). In addition, changing trends within Group 2 were also analyzed by dividing the patients into chronological groups of 200. Differences in proportions were evaluated by chi-square test and Fisher’s Exact as appropriate. RESULTS: There was a significant difference in starting and finishing numbers of fetuses between the 2 groups (p!0.0001) (Tables 1 and 2). A significant increase was seen in chorionic villus sampling (CVS) was seen in group 2 vs. Group 1 (43.7% vs. 1.5%, p! 0.0001). Within group 2, there was a significant trend toward an increasing number of patients undergoing CVS, with 25.5% of patients in the first group of 200 vs. 69.5% in the last group of 200 undergoing CVS pre-MPR, p!0.001.The incidence of monochorionic twins/triplets was significantly higher in Group 2 (5.7%) compared to group 1 (2.1%), p!0.001. Similarly, within Group 2, there was a significant increase in the incidence of monochorionicity (Table 3). CONCLUSION: Recent trends in MPR demonstrate significant increases in overall reductions to a singleton, reductions from twins to a singleton, utilization of CVS prior to MPR and presence of a monochorionic twin or triplet pair within a higher order multiple gestaion.
606 INCREASED UMBILICAL BLOOD NITRIC OXIDE CORRELATES WITH INCREASED PHOSPHO-ERK PROTEIN EXPRESSION IN AN OVINE MODEL OF FETAL GROWTH RESTRICITION JUAN A. ARROYO1, RUSSELL V. ANTHONY2, THOMAS PARKER2, GATES ROE2, HENRY L. GALAN1, 1University of Colorado Health Sciences Center, Obstetrics and Gynecology, Denver, Colorado, 2University of Colorado Health Sciences Center, Dept. of Pediatrics, Aurora, Colorado OBJECTIVE: Hypoxia and shear stress modulate the vasodilator nitric oxide (NO) and shear stress increases phosphorylation (p) of ERK and AKT proteins. In the hyperthermic (HT) ovine model of fetal growth restriction (FGR), characterized by fetal hypertension and reduced placental blood flow at term, we hypothesize that plasma NO, pERK and pAKT will be increased in the umbilical vessels and uterine artery of 95 day gestational age (dGA) animals. STUDY DESIGN: 4 ewes were exposed to HT conditions for 55 days beginning at 35dGA to induce FGR and 4 were used as controls in ambient conditions Blood was collected for NO quantification and blood gas analysis. Vessels were collected and frozen for Western blot analysis with an Ab against pERK, total ERK, pAKT and total AKT. Actin westerns on the same blots were used to account for inter-lane loading variation. Ratios of phosphorylated/total were calculated to determine level of phosphorylation of ERK and/ or AKT proteins. RESULTS: HT animals showed, 1) smaller placental (p!0.004), but not fetal weights, 2) decreased O2 sat (5.5G0.6% v 3.8¡G0.5% p!0.04) and pO2 levels (48.6G15.8 mmHg v 23.2G2.34 mmHg; p!0.02), 3) an increase in umbilical plasma [NO] (figure), but not uterine artery, 4) a 2.3-fold increase in umbilical vein pERK protein concentration (p!0.0002) for with no difference in pAKT, 5) a 1.2-fold increase in umbilical artery pERK protein (p!0.03) with no difference in pAKT, 6) no differences in pAKT or pERK for the uterine artery.
Starting number of fetuses Starting number
Group 1 (%)
Group 2 (%)
2 3 4 5 6C
4 54.9 29.4 8.6 3.1
15.6 60.8 17.6 3.3 2.5
Finishing number
Group 1 (%)
Group 2 (%)
4 3 2 1
0 1.8 86.4 11.8
0.3 0.3 67.6 31.8
Finishing number of fetuses
Incidence of Monochorionicity in Group 2 1-200
201-400
401-600
601-800
801-1000
2.5%
3.5%
3.5%
6.5%
12.5%
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.657
CONCLUSION: NO concentration and pERK are increased at mid-gestation and provide early evidence of underlying vascular changes in this FGR model with fetal hypertension and increased placental resistance at term.(Supported by NIH grant R01 HL071990-01A1). 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.658
606 INCREASED UMBILICAL BLOOD NITRIC OXIDE CORRELATES WITH INCREASED PHOSPHO-ERK PROTEIN EXPRESSION IN AN OVINE MODEL OF FETAL GROWTH RESTRICITION JUAN A. ARROYO1, RUSSELL V. ANTHONY2, THOMAS PARKER2, GATES ROE2, HENRY L. GALAN1, 1University of Colorado Health Sciences Center, Obstetrics and Gynecology, Denver, Colorado, 2University of Colorado Health Sciences Center, Dept. of Pediatrics, Aurora, Colorado OBJECTIVE: Hypoxia and shear stress modulate the vasodilator nitric oxide (NO) and shear stress increases phosphorylation (p) of ERK and AKT proteins. In the hyperthermic (HT) ovine model of fetal growth restriction (FGR), characterized by fetal hypertension and reduced placental blood flow at term, we hypothesize that plasma NO, pERK and pAKT will be increased in the umbilical vessels and uterine artery of 95 day gestational age (dGA) animals. STUDY DESIGN: 4 ewes were exposed to HT conditions for 55 days beginning at 35dGA to induce FGR and 4 were used as controls in ambient conditions Blood was collected for NO quantification and blood gas analysis. Vessels were collected and frozen for Western blot analysis with an Ab against pERK, total ERK, pAKT and total AKT. Actin westerns on the same blots were used to account for inter-lane loading variation. Ratios of phosphorylated/total were calculated to determine level of phosphorylation of ERK and/ or AKT proteins. RESULTS: HT animals showed, 1) smaller placental (p!0.004), but not fetal weights, 2) decreased O2 sat (5.5G0.6% v 3.8¡G0.5% p!0.04) and pO2 levels (48.6G15.8 mmHg v 23.2G2.34 mmHg; p!0.02), 3) an increase in umbilical plasma [NO] (figure), but not uterine artery, 4) a 2.3-fold increase in umbilical vein pERK protein concentration (p!0.0002) for with no difference in pAKT, 5) a 1.2-fold increase in umbilical artery pERK protein (p!0.03) with no difference in pAKT, 6) no differences in pAKT or pERK for the uterine artery.
Starting number of fetuses Starting number
Group 1 (%)
Group 2 (%)
2 3 4 5 6C
4 54.9 29.4 8.6 3.1
15.6 60.8 17.6 3.3 2.5
Finishing number
Group 1 (%)
Group 2 (%)
4 3 2 1
0 1.8 86.4 11.8
0.3 0.3 67.6 31.8
Finishing number of fetuses
Incidence of Monochorionicity in Group 2 1-200
201-400
401-600
601-800
801-1000
2.5%
3.5%
3.5%
6.5%
12.5%
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.657
CONCLUSION: NO concentration and pERK are increased at mid-gestation and provide early evidence of underlying vascular changes in this FGR model with fetal hypertension and increased placental resistance at term.(Supported by NIH grant R01 HL071990-01A1). 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.658