www.AJOG.
org Prematurity, Physiology
759 Unexpected finding in vaginal microbiome assessment
in PPROM
Elizabeth Baldwin1, Marina Walther-Antonio2, Brian Brost1,
Arij Faksh1, Mari Charisse Trinidad1, Wendy White1,
Norman Davies1, Carl Rose1, Kristi Borowski1, Nicholas Chia2,
Douglas Creedon1
1
Mayo Clinic College of Medicine, Maternal Fetal Medicine, Rochester, MN,
2
Mayo Clinic College of Medicine, Department of Surgical Research,
Rochester, MN
OBJECTIVE: Altered vaginal microbial population and subclinical
infection have long been posited as major contributors to preterm
birth, the leading cause worldwide for infant morbidity and mor-
tality. We sought to describe the vaginal microbiome using high
throughput genomic technology in the setting of preterm premature
rupture of membranes (PPROM).
STUDY DESIGN: We recruited women diagnosed with PPROM be-
tween 23 and 34 weeks gestation. Antenatal care per standard pro-
tocol included 7 days of latency antibiotics. Serial posterior fornix
vaginal swabs were collected from diagnosis until delivery. 48 sam-
ples from 13 subjects were obtained every 3 days for 2 weeks, then
weekly until delivery. DNA was extracted using MoBio Powersoil.
Bacterial 16S rDNA was amplified using universal probes. When
bacterial DNA was identified, the microbial composition was profiled
using 16S rDNA hypervariable tag sequencing of the V3-V5 region
using the Illumina MiSeq platform.
RESULTS: Bacterial DNA was identified in 15 of 48 samples. Of the 13
subjects, only 5 were found to have bacterial DNA present at any
point following diagnosis of PPROM and initiation of antibiotics.
Only 1 subject was found to have quantifiable bacterial DNA at the
time of diagnosis and only 2 subjects had any positive samples
during the course of latency antibiotics.
CONCLUSION: Our study is the first to describe the vaginal microbial
pattern in PPROM using next generation sequencing techniques. In
addition, this study illustrates a novel finding in the absence of
bacterial DNA identifiable by non-culture dependent state of the art
metagenomic methods in vaginal samples from subjects with
PPROM. Prior work using similar methodology has not shown
undetectable levels of bacterial DNA from vaginal swabs in normal
pregnant women or women with symptoms of preterm labor; this
appears to be unique to PPROM. Further investigation is warranted
and ongoing but this preliminary finding was unexpected given the
conventional understanding of subclinical infection as a major
contributor in PPROM.
760 Interpregnancy interval length and risk of preterm birth,
a large US study
Bat zion Shachar1, Jonathan Mayo1, Deirdre Lyell2,
David Stevenson1, Gary Shaw1
1
Stanford University School Of Medicine, On behalf of the March of Dimes
prematurity center, Stanford, CA, 2Stanford University School Of Medicine,
Department of Obstetrics and Gynecology, Stanford, CA
OBJECTIVE: Short interpregnancy interval (IPI), time between end of
pregnancy and next conception, is associated with preterm birth
(PTB) in developing countries. Data from developed countries are
scant and outdated. US women often give birth at more advanced
age and subsequent births with shorter IPIs. However, they may be
less prone to suffer from underweight or maternal depletion syn-
drome, a possible underlying mechanism for the association between
short IPI and PTB. Our objective was to determine whether short IPI
is associated with PTB in the US.
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
Poster Session V
STUDY DESIGN: We analyzed approximately a million California
births 2007-10. Logistic regression was used to estimate odds ratios
(ORs) for risk of PTB, with an IPI of 18-23 months serving as the
reference interval. Risks for extreme (20-23 weeks), early (24-31
weeks) and medium to late PTB (32-36 weeks) were assessed. ORs
were adjusted for maternal age, race, medical insurance payment,
and education.
RESULTS: Women with an IPI of <6 months after a live birth had an
increased risk of PTB with adjusted ORs of 2.29, 2.12 and 1.71 for
extreme, early and late PTB, respectively. Similarly, women with an
IPI of 6-11 months had an increased risk of PTB with ORs of 1.45,
1.21 and 1.22, respectively. Long IPI of > 59 months was associated
with an increased risk for PTB with ORs of 1.53, 1.57 and 1.22 for
the above groups. Women with an IPI of <6 months after pregnancy
termination had a decreased risk for PTB, with ORs of 0.71 and 0.84
for early and late PTB, respectively. All noted ORs had 95% confi-
dence intervals that excluded one.
CONCLUSION: Short and long IPIs were associated with PTB in this
large US cohort. It is possible that etiologies other than maternal
depletion and maternal underweight may underlie the association of
PTB with shortened IPI. Given that IPI is potentially a modifiable
risk factor for PTB, more efforts toward elucidating the association
between IPI and risk could make substantial contribution to PTB
prevention.
761 Fetal and placental hemodynamic responses to acute
cardiac outflow tract occlusion in an experimental sheep
model
Juulia Junno1, Juha Räsänen5, Heikki Huhta1, Mervi Haapsamo1,
Tiina Erkinaro2, Roger Hohimer3, Lowell Davis3, Ganesh Acharya4
1
University of Oulu, Obstetrics and Gynecology, Oulu, Finland, 2University of
Oulu, Anesthesiology, Oulu, Finland, 3Oregon Health and Science University,
Obstetrics and Gynecology, Portland, OR, 4University Hospital of Northern
Norway, Obstetrics and Gynecology, Tromso, Norway, 5University of Eastern
Finland, Obstetrics and Gynecology, Kuopio, Finland
OBJECTIVE: In fetal circulation, right (RVCO) and left (LVCO) ven-
tricular cardiac outputs are arranged parallelly. Myocardial, brain
and upper body blood supply is provided by LVCO, and RVCO is
mainly responsible for lower body and placental circulation. We
investigated fetal sheep arterial and venous, as well as placental he-
modynamic responses to acute occlusion of ascending aorta (AAo)
and pulmonary artery (PA).
STUDY DESIGN: At 120-126 gestational days (term 145 days), 7 ewes
underwent surgery for the placement of a vascular occluder around
fetal PA and in 9 ewes a vascular occluder was placed around fetal
AAo. Fetal carotid artery and jugular vein were cannulated. After a 5-
day recovery, fetal systemic cardiac output (SCO), umbilical artery
(UA), descending aorta (DAo), ductus venosus (DV) and inferior
vena cava (IVC) pulsatility indices (PI) were obtained. Placental
volume blood flow (Qplac) was calculated from intraabdominal
umbilical vein. Data were collected at baseline, 15 and 60 minutes
after PA/AAo occlusion, and 15 minutes after release of PA/AAo
occlusion. Fetal mean arterial (mABP) and central venous (CVP)
pressures, and blood gas values were monitored.
RESULTS: PA occlusion decreased SCO about 50% (p<0.001) from
the baseline, while in the AAo occlusion group the corresponding
drop was about 16% (p<0.01). In both groups, UA and DAo PIs
were unaffected. However, PA occlusion decreased Qplac about 44%
from the baseline. In the AAo occlusion group Qplac remained
unchanged. PA occlusion increased (p<0.05) DV and IVC PIs, as
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