ajog.
org
markers when compared to preterm. The co-culture had a more
prominent effect on the expression of glial markers compared to
CM.
CONCLUSION: WJ-MSC derived from term pregnancies have a
different secretome compared to preterm pregnancies. This was
demonstrated by mass spectroscopy as well as by in vitro experi-
ments. Moreover, cell contact may be necessary to induce neuroglial
differentiation on resident NPC. In conclusion, transplanting
WJ-MSC into damaged brains of neonatal infants may enhance
and support endogenous remyelination and neuroregeneration.
Financial support by Cryosave Switzerland and The Eagle Founda-
tion.
295 Unexpected consequences: impact of a conservative
fetal growth curve on near term delivery for growth restriction
Caroline Rouse1, Sarah Little1, Mark Clapp1, Nicole Smith1
1
Brigham and Women’s Hospital, OBGYN, Brookline, MA
OBJECTIVE: In 2011, our institution moved from a birthweight (BW)-
based fetal growth curve to an ultrasound (US) weight-based curve.
BW based curves overestimate growth centile in preterm fetuses,
potentially underdiagnosing fetal growth restriction (FGR). We
aimed to determine whether rates of near-term delivery (37-38+6
weeks) for the indication of FGR changed as a result of the change in
growth curve.
STUDY DESIGN: All 37-38+6 week inductions with the indication of
FGR in a 6 year period (2007-2010:BW curve, 2011-2012:US curve)
were reviewed. Maternal demographic data, ultrasound results,
neonatal outcomes and rates of delivery were compared using t-tests
and Chi squares. Term stillbirth rates over the same period were
reviewed.
RESULTS: The rate of near term delivery for the indication of FGR
increased from 0.3% (86/31319) to 0.8% (127/15075) (p<0.01) after
introduction of the US-based growth curve. There were no differ-
ences in maternal age, race, pregnancy complications, US indication,
provider group, NICU admission, Apgars, or rates of term stillbirths.
In the US-curve period, growth centiles were lower at first growth
scan (p<0.01), though mean GA at scan was similar. Fetuses were
diagnosed earlier with FGR (p<0.01), and growth centiles were
lower at diagnosis (p<0.01). There were no differences in oligohy-
dramnios or abnormal UA dopplers. Fetuses in the US-curve period
had more scans (p¼0.02), lower growth centiles (p<0.01), and were
heavier at birth (p<0.01).
CONCLUSION: Changing to an ultrasound-based growth curve more
than doubled near-term delivery for FGR without changing still-
birth rates, while average birthweight actually increased. The in-
crease in deliveries may be related to the lower growth percentiles
in the US curve causing earlier diagnosis of FGR or more patient
and provider anxiety. Further investigation is warranted to deter-
mine whether the potential benefits of a more conservative growth
curve in identifying early growth restriction outweigh the risks of
near-term birth.
Supplement to JANUARY 2015 American Journal of Obstetrics & Gynecology
Poster Session II
Characteristics of fetuses delivered near term for
growth restriction
a
GA¼ gestational age, US¼ultrasound, EFW¼estimated fetal
weight, FGR¼fetal growth restriction
b
Controlled for GA at delivery
296 Easy as ABC: the effect of an intervention to
subcategorize category II fetal heart rate tracings
Christina A. Penfield1, Connie Hong2, Samia El Haj Ibrahim1,
Sarah Kilpatrick1, Kimberly Gregory1
1
Cedars Sinai Medical Center, Los Angeles, CA, 2Kaiser Woodland Hills,
Woodland Hills, CA
OBJECTIVE: Category II (Cat II) fetal heart rate tracings (FHRT), as
outlined by the 2008 NICHD consensus guidelines, are criticized for
bundling both normal and pathologic FHRT variants in the same
category. As a result, communication between providers is often
inconsistent, leading to possible delays in care. We evaluated
communication and management using a system that divides Cat II
tracings into subcategories A, B and C (ABC system) based on the three
intermediate categories of the Parer-Ikeda system, where each sub-
catgory represents increased risk for fetal metabolic acidemia.
STUDY DESIGN: We surveyed L&D providers and attending physicians
to evaluate communication, agreement, and management using the
NICHD and ABC system. We collected data for 6 months using the
NICHD system followed by 9 months using the ABC system. Partici-
pants also completed surveys when a Cat II tracing prompted the L&D
team to alert an off-site attending during both time periods. Mode of
delivery and NICU admissions were abstracted by chart review.
RESULTS: Of 146 providers surveyed, most (69%) preferred the ABC
system to the NICHD system, and rated it as the more effective tool for
communicating “concerning” fetal status (80% vs. 43%, p<0.01). They
reported more agreement on FHRT interpretation when using the ABC
system (79% vs. 64%, p¼0.046). When the L&D team contacted an off-
site attending about a Cat II FHRT (n¼152), attendings were more likely
to arrive to L&D to manage the tracing on-site when using the ABC
system, (44% vs. 20%, p<0.01), particularly for a Cat IIC tracing (68.8%).
While using the ABC system, there were fewer NICU admissions (0 vs. 3,
p<0.01) and no difference in mode of delivery (NSVD 50% vs. 61%,
p¼0.5).
CONCLUSION: The ABC system intervention resulted in improved
team communication, more provider agreement, increased on-site
attending management, and decreased NICU admissions. Employing
standardized communication may offer a useful strategy for identi-
fying and expediting care for concerning Cat II FHRT.
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