Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396 S133

Conclusions: The PASS Stillbirth Classification incorporates

mechanism of demise and etiology to address pathophysiology of

stillbirth. In these 21 stillbirths, 25% were due to fetal disorders,

50% to placental etiologies, and 25% were of unknown cause. 43%

of cases were due placental perfusion failure with an a priori risk

for recurrence. This schema will be applied to stillbirths from

Phase II pregnancies (n = 12,000) in the PASS Research Network.

We hypothesize effects of prenatal alcohol and smoking exposure

on pregnancy may modify case stratification and/or demonstrate a

concentrated effect in certain stillbirth subsets.

O140

Alternatives to routine ultrasound for eligibility assessment

prior to early medical abortion

H. Bracken1, W. Clark1, J. Tanenhaus2, S. Schweikert3,

S. Lichtenberg4, B. Winikoff1. 1Gynuity Health Projects, USA, 2Planned

Parenthood of New York City, USA, 3Planned Parenthood of San Diego

Riverside, USA, 4Family Planning Associates Medical Group, Chicago,

USA

Objective: To test the feasibility and efficacy of an approach

to medical abortion that foregoes routine use of ultrasound for

determination of eligibility for medical abortion.

Methods: The prospective multi-center trial enrolled 4484 women

seeking medical abortion at ten family planning clinics in the United

States. Women provided estimates of date of last menstrual period.

Women also underwent an ultrasound and clinical exam. We

compared estimates using the three methods, calculating the

proportion of women less than or equal to 9 weeks gestation

by woman or provider estimate and greater than 9 weeks by

ultrasound.

Results: Relying on women’s report of last menstrual period alone,

only 3.3% of women would have been offered treatment despite

being beyond 9 weeks gestation, the traditional cutoff for early

medical abortion protocols. Relying on women’s report of LMP

along with physical examination to determine eligibility for medical

abortion would result in only 1.6% of women being offered medical

abortion treatment at an “inappropriate” gestational age. However,

any woman inappropriately offered treatment would have been at

a gestational age when medical abortion treatment would still be

extremely likely to be successful.

Conclusion: It is possible safely to forego routine pre-abortion

sonography in order to determine women’s eligibility for medical

abortion.

O141

Alternatives to a routine follow-up visit for early medical

abortion

W. Clark1, H. Bracken1, J. Tanenhaus2, L. Lang3, S. Lichtenberg4,

B. Winikoff1. 1Gynuity Health Projects, 2Planned Parenthood of

New York City, 3Planned Parenthood of San Diego Riverside, 4Family

Planning Associates Medical Group

Background: Typical protocols for early medical abortion with

mifepristone and misoprostol require women to return to the

clinic 7–14 days after the administration of mifepristone. Many

practitioners employ trans-vaginal ultrasonic imaging at the follow-

up visit to verify the abortion is complete. This study evaluated

the ability of women and their providers to assess the need for

additional care without the routine use of ultrasound or a follow-

up clinic visit.

Methods: The prospective multi-center trial enrolled 4484 women

seeking medical abortion at ten family planning clinics in

the United States. Data were collected on women’s socio-

demographic characteristics; abortion outcomes and receipt of

additional treatment (including ongoing pregnancy, curettage,

treatment for infection, or receipt of additional uterotonics); and

clinical, laboratory and ultrasound assessments associated with the

procedure.

Results: Of the 3377 treated women not lost to follow-up who

received treatment at or after the follow-up visit, 22 women (0.7%)

were diagnosed with an ongoing pregnancy. Thirty-three women

(1.4%) received curettage or treatment for a suspected infection and

55 women (2.6%) received additional uterotonics or other medical

abortion-related care. A screening algorithm based on two patient-

observed outcomes, a urine test, and non-sonographic clinical

evaluation performed as well as sonography, identifying at least

as large a percentage of women with ongoing pregnancies or who

received curettage or treatment for infection at the follow-up visit.

Data also suggest that a safe, effective algorithm relying on woman-

observed parameters alone might be developed which could spare

many patients the necessity of returning for a follow-up visit.

Conclusion: Relying on women’s observations, a low-sensitivity

pregnancy test, and clinical examination, women and their

providers can accurately assess whether a woman requires

further follow-up care after medical abortion with mifepristone-

misoprostol without ultrasound.

O142

Expression of the cell-cycle regulators p21, p16 and p53 in

cervical intraepithelial neoplasia

J. Braganca, S. Derchain, D. Pitta, A. Maito, J. Vassallo, G. Pinto,

L. Andrade, L. Sarian. Faculdade de Ciencias Medicas, Universidade

Estadual de Campinas UNICAMP

Objective: To assess the expression of the cell-cycle regulators p21,

p16 and p53 in cervical intraepithelial neoplasia grades I to III.

Materials and Methods: In this cross-sectional study, we examined

histological samples from 102 women who underwent cervical

conization between March 2003 and November 2007. The

expression of the cell-cycle regulators was determined with

immunohistochemistry. Analysis of covariance (CANOVA) was used

to determine the differences in expression of each of the cell-cycle

regulators in different grades of CIN, controlled for relevant clinical

features of the women. Paired t-tests and Pearson’s correlation

coefficients were used to determine the association between the

expressions of the cell-cycle regulators.

Results: Pathological assessment disclosed 79 (77.4%) cases of CIN3,

12 (11.8%) of CIN2 and 11 (10.8%) CIN1. The expression of p21

and p53 were not associated with CIN grade (p =0.09 and p=0.89,

respectively), whereas that of p16 increased in parallel with disease

severity (p < 0.01). The expression of p16 and p21 showed no

statistical correlation (p =0.64, cor = 0.04), as neither that of p21 and

p53 (p =0.10, cor = 0.17) nor of p16 and p53 (p =0.87, cor = 0.02).

Conclusions: The expressions of the cell-cycle regulators p21, p53

and p16 were not associated to each other in CIN, and p16 was the

only marker that had its expression associated with CIN grade.

O143

The effectiveness of the SOS Bakri Balloon in controlling post

partum hemorrhage unresponsive to medical therapy in a

community hospital in Edmonton, Alberta

G. Brassard, T. Corbett. University of Alberta, Edmonton, Canada

Objective: To examine the effectiveness of the SOS Bakri balloon

in controlling post partum hemorrhage (PPH) refractory to medical

treatment.

Methods: A retrospective case review of 19 events of post partum

hemorrhage that failed to respond to medical therapy in a

community based hospital in Edmonton, Canada.

Charts were selected by convenience sampling if they met the ICD-

10-CA codes of uterine packing and control or excision of bleeding

uterus and surrounding structures. Exclusion criteria included

women who delivered at less than 24 weeks of gestational age

and charts with incomplete data.

Results: The SOS Bakri balloon was successful in stopping

hemorrhage in 16/19 cases. Average patient age was 28 and average

parity was 1. There were three sets of twins and 16 singletons. The