387 FACTORS INFLUENCING DECISION MAKING ABOUT THE TIMING OF ELECTIVEDELIVERY FOR PRETERM PROM SCOTT DEXTER1, ANDREW HEALY1, JEAN-CLAUDE VEILLE1, ANTHONY SCISCIONE2, HANI ABUSHOMAR3, LOUISE-ANNEMCNUTT4, 1Albany Medical College, Obstetrics and Gynecology, Albany, NewYork, 2Drexel University, Obstetrics and Gynecology, Philadelphia,Pennsylvania, 3State University of Albany, Department of Epidemiology,Rensselaer, New York, 4University at Albany, SUNY, Epidemiology, Albany,New York

OBJECTIVE: We sought to assess the relative importance of factors consideredin decision making regarding the gestational age of delivery for patients withpreterm PROM.

STUDY DESIGN: A three-page survey was mailed to members of the SMFM.Information solicited included demographic data, practice patterns for thetiming of delivery in patients with preterm PROM and factors that influencedthis decision. Comparisons were done using a chi-square test.

RESULTS: 717 questionnaires (40%) were completed. Table 1 depicts theranked importance of decision factors considered. The chosen gestational age ofdelivery (*), gender (#), and years of practice (C) were significantly associatedwith the ranked importance of a number of decision factors as depicted. Femalerepondants considered the issue of the infant being discharged home at the sametime as the mother to be more important than their male counterparts did(P = .007). Younger physicians ranked intraamniotic infection higher(P = .015) and financial costs lower (P = .007) than older respondants did.Full time faculty were the most likely to make clinical choices in line with recentexpert review articles compared with physicians in other types of practice(P = .037).

CONCLUSION: The risk of neonatal morbidity and risk of developingintraamniotic infection were ranked highest in importance when consideringthis clinical question. Respondant’s demographic characteristics appear to havesignificant influence upon the process of decision making for the timing ofdelivery in those with preterm PROM.

Importance of decision factors

SMFM Abstracts S113

385 IS INFLAMMATION A SIGNIFICANT CONTRIBUTOR TO SECOND TRIMESTER LOSS?SINDHU SRINIVAS1, MICHAL ELOVITZ1, 1University of Pennsylvania, Obstetrics andGynecology, Philadelphia, Pennsylvania

OBJECTIVE: Greater than 85% of preterm births at less than 28 wks gestationare associated with histological chorioamnionitis (HCA). Whether inflammationis associated with 2nd trimester loss has not yet been determined. Our aim was todetermine whether inflammation, as documented by the presence of HCA, wasa contributor to 2nd trimester loss as well as to ascertain whether maternaldemographics, obstetrical history and /or clinical presentatoin could predict thelikelihood of HCA.

STUDY DESIGN: A cohort study was performed on patients with a 2ndtrimester (15-23.6 wk) loss between 2002-04. Demographic information, obstet-rical history, clinical presentation and placental pathology were collected.Placental pathology was also collected on a cohort of patients undergoingelective 2nd trimester termination by labor induction. Chi square analysis wasused to examine the association between placental pathology and maternal age,obstetric history and gestational age of loss.

RESULTS: Of the 87 patients enrolled, 35 were primiparous and 52 weremultiparous. 39 patients had at least one prior full term delivery and 22 patientshad at least one prior preterm delivery (PTD). A total of 30 patients presentedwith preterm premature rupture of membranes (PPROM). Of all cases, HCAwas observed in 56 (64%) of the placentas while funisitis was reported in 20(23%) cases. HCA occurred significantly less (20%) in patients with elective 2ndtrimester abortions(P= .004). There were no significant associations foundbetween HCA or funisitis and obstetrical history, maternal age or PPROM.

CONCLUSION: This study is the largest to date that examines the relationshipbetween 2nd trimester loss and placental inflammation. The high prevalence ofHCA in this cohort of patients suggests that inflammation is a significantcontributor to 2nd trimester loss. However, this study also suggests thatobstetrical history and presentation do not accurately predict the presence ofHCA. More research is warranted to determine etiologies of late pregnancy lossand strategies for prevention.

386 ELEVATED FERRITIN LEVELS: A POSITIVE PREDICTOR OF PRETERM DELIVERYEYAL SHEINER1, MOSHE MAZOR2, ORIT PAAMONI-KEREN3, AHARON TEVET3,ARNON WIZNITZER1, 1Soroka University Medical Center, Beer-Sheva, Israel,2Soroka University Medical Center, Beer Sheva, Israel, 3Soroka UniversityMedical Center, Ob/Gyn, Beer-Sheva, Israel

OBJECTIVE: To investigate the relationship between maternal second tri-mester ferritin levels and the risk of preterm delivery.

STUDY DESIGN: A prospective observational study was performed in whichsecond trimester ferritin levels were measured among consecutive patientsadmitted to the Maternal-Fetal-Medicine Unit between November 2002 andFebruary 2003 due to preterm contractions. To test the statistical significance theFisher’s exact test was used to analyze categoric variables, and Student t test wasapplied for comparison of means.

RESULTS: Fifty women were enrolled to the study, among them 19 sub-sequently presented with preterm delivery (!36 weeks gestation), and 31delivered at term. Eight patients had second trimester ferritin levels above 30ng/dL. Among them, 75% (n = 6) subsequently presented with pretermdelivery. The odds ratio of preterm delivery among patients with secondtrimester ferritin levels above 30 ng/dL was 6.7 with 95% confidence intervalof 1.1-56.2, P = .04. Only 2 patients with elevated ferritin levels delivered atterm. However, 13 patients with second trimester ferritin levels below 30 ng/mLhad preterm delivery. No significant differences were found while comparingmean ferritin levels between patients who delivered preterm as compared to termdeliveries (mean 22.9C/-14.1 vs 15.9C/-9.2; P = .511).

CONCLUSION: Second trimester ferritin levels above 30 ng/mL are a positivepredictor of preterm delivery.

Factor% Ranked highlyimportant

Neonatal morbidity from prematurity 83Intraamniotic infection + 82Intruaterine fetal demise 46Neonatology input 42Financial cost for care * + 11Chance of neonate being discharged with mother * # 8

388 IS THERE A PREFERRED GESTATIONAL AGE THRESHOLD OF VIABILITY?: A SURVEYOF MATERNAL-FETAL MEDICINE PROVIDERS FRANCIS NUTHALAPATY1, PATRICKRAMSEY1, GEORGE LU2, SUSAN RAMIN3, KIRK RAMIN4, 1University of Alabama atBirmingham, Obstetrics/Gynecology, Birmingham, Alabama, 2ObstetrixMedical Group of Kansas & Missouri, Obstetrics/Gynecology, Kansas City,Missouri, 3University of Texas Health Science Center at Houston, Obstetrics/Gynecology, Houston, Texas, 4University of Minnesota, Obstetrics/Gynecology,Minneapolis, Minnesota

OBJECTIVE: To characterize the perceived gestational age for the threshold ofviability and factors associated with variation among maternal-fetal medicine(MFM) providers.

STUDY DESIGN: Supplemental data obtained from a survey of 1375 membersof the Society of Maternal-Fetal Medicine were analyzed to identify whatgestational age participants believed to be the threshold of viability. Compar-ative statistics were performed to identify various characteristics associated withthe perceived threshold of viability.

RESULTS: Five-hundred three providers (37%), representing all 50 states and13 countries, participated in the survey. Mean participant age was 45 G 9 yr.The majority of participants reported practicing in academic university basedsettings (53%). Survey respondents reported a wide range of gestational age forthe threshold of viability: 22 wks - 2.0%, 23 wks – 37.2%, 24 wks – 55.3%, 25wks – 3.4%, and 26 wks – 2.2%. No differences were noted in the reportedthreshold of viability with respect to practitioner age (!50 yo vs R50 yo:P = .42), nursery availability (Level III vs other: P= .46), and years in practice(!10 yr vs R10 yr: P = .86). Significantly more male practitioners reportedutilizing a lower gestational age threshold, as compared to females (P = .005,Table I). Significant differences were also noted among practitioners fromacademic vs private practice settings (P = .008, Table II).

Table 1 Threshold of viability preference by practitioner gender

22 wk 23 wk 24 wk 25 wk 26 wk

Female 0.5 29.4 65.0 3.6 1.6Male 2.9 42.2 49.0 3.2 2.6

Table 2 Threshold of viability preference by practitioner practice setting

22 wk 23 wk 24 wk 25 wk 26 wk

Academic 1.2 36.1 59.0 2.3 1.5Private Practice 3.9 39.7 46.8 5.8 3.9

CONCLUSION: The perceived gestational age for the threshold of viabilityvaries from 22-26 weeks among maternal fetal medicine providers. Male genderand private practice settings are associated with significantly lower thresholds.