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90 Impact of birthweight discordance and of non-vertexresentation of the second twin on successfulaginal birth – The Esprit Trialionnuala M Breathnach1, Stephen Carroll2, FionnualacAuliffe3, Michael Geary4, Sean Daly5, John R Higgins6,

ames Dornan7, John Morrison8, Gerard Burke9,hane Higgins10, Fergal D. Malone1

Royal College of Surgeons in Ireland, Dublin, Ireland, 2National Maternityospital, Dublin, Ireland, 3University College Dublin, Dublin, Ireland,

Rotunda Hospital, Dublin, Ireland, 5Coombe Women and Infantsniversity Hospital, Dublin, Ireland, 6Cork University Maternityospital, Ireland, 7Royal Victoria Maternity Hospital Belfast,

reland, 8National University of Ireland, Galway, Ireland,9Mid-Western Regional Maternity Hospital, Limerick, Ireland,0Our Lady of Lourdes Hospital, Drogheda, IrelandBJECTIVE: To determine the impact of intratwin birthweight discor-ance and of non-vertex presentation of the second twin on successfulaginal delivery.TUDY DESIGN: The ESPRIT Trial is a national prospective populationtudy of 642 consecutive twin pregnancies managed and delivered at 8ertiary referral centers in one country. All pregnancies are followedsing a uniform sonographic surveillance protocol.ESULTS: Vaginal or cesarean delivery (CD) was planned for 31048%) and 332 (52%) women, respectively. Birthweight discordancef �20% was documented in 12% (37/310) of patients who under-ent a trial of labor. The sensitivity of ultrasound within 2 weeks ofelivery for detection of this degree of discordance was 86%, specific-

ty 61%. While the overall CD rate was 64% (411/642), intrapartumD was needed in 29% (90/310) of cases where vaginal delivery waslanned. Successful trial of labor did not correlate with advancingestational age (logistic regression p-value 0.2409), vertex presenta-ion of the 2nd twin (p-value 0.3252), nor with concordant size (re-ression p-value 0.2988).ONCLUSION: Neither size discordance nor non-vertex presentation ofhe 2nd twin is predictive of CD. When the larger twin is not present-ng, successful vaginal delivery can still be anticipated in most cases.

win birthweight discordance and successful trial of labor

W discordance

Vaginal deliveryof both twins(N�220)

Intrapartum CD(N � 79)

Combinedvaginal-CD(N�11) p-value

10% 55% 62% 55% -..........................................................................................................................................................................................................

10% 45% 38% 45% 0.3510..........................................................................................................................................................................................................

20% 12% 12% 9% 0.9474..........................................................................................................................................................................................................

20% (smaller twinpresenting)

6% 8% 9% 0.5797

..........................................................................................................................................................................................................

on-vertex 2nd twin 27% 33% 0% 0.3252..........................................................................................................................................................................................................

002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.105

91 Proteinuria in the uncomplicated twin pregnancyicole Smith1, Jennifer Lyons1, Thomas McElrath1

Brigham and Women’s Hospital, Boston, MassachusettsBJECTIVE: We have observed that women with twin pregnancies ap-ear to have higher rates of proteinuria without accompanying hyper-ension than do those with singletons. Protein to creatinine ratios (p:catio) in excess of 0.19 predict proteinuria greater than 300mg in a 24our collection. We compare rates of high p:c ratios in non-pre-clamptic singleton and twin pregnancies in order to better under-tand normal protein excretion in twins.TUDY DESIGN: A sequential sample of 102 (51 twins, 51 singletons)ealthy patients without preeclampsia, gestational diabetes, intrauter-

ne growth restriction, history of premature delivery or other medicalomorbidities were selected from the Predictors of Preeclampsia

tudy to compare protein-to-creatinine ratio by fetal number. Sam-

50 American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2

les were collected between 34 and 38 weeks gestation, and a clinicallyignificant high p:c ratio was defined as greater than 0.19. Non-para-

etric statistical comparisons and logistic regression were used fornalysis.ESULTS: Women with twin pregnancies were significantly more

ikely to have protein to creatinine ratios greater than 0.19 (p�0.003),nd median p:c ratio was significantly higher in twins (p�0.003).edian p:c ratio for singletons was 0.15, and for twins 0.2. Groups

iffered in maternal age (mean 31.3 vs 35.3 years, p�0.0003) andestational age at sample collection (35.6 vs 34.8 weeks, p�0.001), andere similar in weight, BMI, race, and smoking status. Using multiple

ogistic regression to control for the confounders of maternal age andestational age yielded an adjusted OR for p:c ratio greater than 0.19 of.23 (1.61, 11.06).ONCLUSION: Women with uncomplicated twin pregnancies haveigher rates of elevated protein to creatinine ratios than do womenith singletons, suggesting that normal protein excretion in thisroup is greater than that in singleton gestations.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.106

92 Time of initial pregnancy loss does not predictubsequent live birth in recurrent pregnancy lossara Heuser1, Jess Dalton2, Cora MacPherson3,. Ware Branch2, Robert Silver2

Society for Maternal-Fetal Medicine, Salt Lake city, Utah, 2University oftah, Salt Lake City, Utah, 3Social and Scientific Systems, Inc., MarylandBJECTIVE: To evaluate gestational age of initial pregnancy loss as aredictor of subsequent live birth in a cohort of women with recurrentregnancy loss (RPL). We hypothesized that women who suffered a

etal loss would have fewer live births and be less likely to eventuallyave a live birth than women who suffered anembryonic or embry-nic losses.TUDY DESIGN: Retrospective cohort study of women with idiopathicPL who had an initial loss with precise documentation of gestationalge. Live birth in a subsequent pregnancy was compared betweenomen with anembryonic (� 6 weeks), embryonic (6-10 weeks), or

etal (�10 weeks) losses as their first loss.ESULTS: 454 women met inclusion criteria and had a total of 1,262ubsequent pregnancies. There was no significant difference in num-er of subsequent pregnancies, number of live births, or percentage ofomen ultimately experiencing a live birth in any subsequent preg-ancy (Table).ONCLUSION: Timing of first pregnancy loss in patients with RPL is notredictive of number of subsequent pregnancies, number of liveirths, or number of women ultimately experiencing a live birth. Re-ardless of the timing of initial loss, patients had a 50% chance ofltimately having a live birth.

able

nitial Loss n

Number ofsubsequentpregnanciesMean (SD)

Number oflive birthsMean (SD)

Number of womenexperiencing a live birthin any subsequentpregnancyn (%)

nembryonic 149 3.5 (1.9) 0.8 (0.9) 78 (52.4).........................................................................................................................................................................................

mbryonic 185 3.1 (1.9) 0.8 (0.9) 97 (52.4).........................................................................................................................................................................................

etal 120 3.7 (2.6) 1.0 (1.2) 66 (55.0).........................................................................................................................................................................................

-value 0.12 0.37 0.89.........................................................................................................................................................................................

002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.107

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