Poster Session I
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210 Fetal growth patterns in hypertensive disorders
of pregnancy: the NICHD fetal growth studies
Julio Mateus1, Roger Newman1, Sungduk Kim2, Sarah J. Pugh2,
Hanyun Li3, Paul S. Albert2, Katherine L. Grantz2
1
Division of Maternal-Fetal Medicine, Medical University of South Carolina,
Charleston, SC, 2Division of Intramural Population Research, NICHD,
Bethesda, MD, 3Glotech, Inc., Bethesda, MD
OBJECTIVE: We lack an understanding of longitudinal patterns of fetal
growth in pregnancies that develop hypertensive disease. Our
objective was to compare longitudinal fetal growth trajectories be-
tween normotensive pregnancies and those complicated by preg-
nancy-induced hypertensive disorders.
STUDY DESIGN: This is a secondary analysis of a multicenter longi-
tudinal study of fetal growth. Dating was assured by ultrasound
between 8w0d and 13w6d and women had six targeted ultrasounds
across gestation. Women were grouped as mild or severe gestational
hypertension (mild-GHTN or severe-GHTN), mild or severe pre-
eclampsia (mild-PE or severe-PE), and no-hypertension (no-HTN)
based on the discharge diagnosis. Growth curves for estimated fetal
weight (EFW) and individual biometric parameters were created
using linear mixed models with cubic splines. Global and weekly
pair-wise comparisons were performed between groups to analyze
differences adjusting for confounding variables.
RESULTS: Of the 2,584 pregnancies analyzed, 2402 (92.9%) were
normotensive, 65 (2.5%) mild-GHTN, 58 (2.2%) mild-PE, and 34
(1.3%) severe-PE. Seven women with severe-GHTN were excluded
due to the small number. Compared to other groups, EFW was
reduced in the severe-PE group distinguishing itself from 21 weeks
onward (weekly pairwise P values <.05; Figure). Signicant re-
ductions were also noted in the abdominal circumference growth
between no-HTN and severe-PE groups from 21 to 38 weeks
gestation (weekly pairwise P values <.05), head circumference from
24 to 32 weeks, and some scattered differences in other parameters.
EFW and individual biometrics had scattered differences among
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mild-GHTN, mild-PE, and normotensive pregnancies, but the
magnitude of these differences was comparatively small.
CONCLUSION: Among hypertensive disorders of pregnancy, only
pregnancies destined to develop severe-PE had a signicant and
consistent adverse effect on fetal growth. Severe-PE is associated with
an early- onset fetal growth restriction.
211 Early fetal growth abnormalities and
development of severe preeclampsia: the NICHD fetal
growth studies
Julio Mateus1, Roger Newman1, Sungduk Kim2, Sarah J. Pugh2,
Hanyun Li3, Paul S. Albert2, Katherine L. Grantz2
1
Division of Maternal-Fetal Medicine, Medical University of South Carolina,
Charleston, SC, 2Division of Intramural Population Research, NICHD,
Bethesda, MD, 3Glotech, Inc., Bethesda, MD
OBJECTIVE: Preeclampsia is hypothesized to be associated with
abnormal vascular development of the placenta resulting in fetal
growth abnormalities. Our objective was to determine whether
abnormal fetal growth in the rst or second trimester was associated
with the later onset of severe preeclampsia.
STUDY DESIGN: In a secondary analysis of a multicenter longitudinal
study of fetal growth, women had six serial sonographic exams
across gestation. Pregnancies were classied as severe preeclampsia
(severe-PE) and normotensive based on discharge diagnosis. Crown
to rump length (CRL) measurements (mean
SEM) for the severe-
PE group were adjusted for gestational age between 8w0d and 13w6d
and compared to the normotensive group using non-parametric
tests. Estimated fetal weight (EFW), biparietal diameter (BPD), head
circumference, abdominal circumference, and femur length (mean

SEM) for the severe-PE group between 15-24 weeks gestation were
also compared in a similar fashion. Receiver operating characteristic
(ROC) curves were created whenever statistical difference in CRL
and biometric parameters was noted between the groups.
RESULTS: Of 2,436 pregnancies analyzed, 2402 (98.6%) were
normotensive and 34 (1.4%) had severe-PE. There were no differ-
ences in CRL measurements between the groups (p0.29). EFW
between 15 and 20 weeks of gestation were signicantly lower in
ajog.org Poster Session I

women who subsequently developed severe-PE compared to
normotensive women (Figure; p0.01). Similar ndings were noted
for all individual biometries (all p < 0.05) between 15 and 20 weeks,
except BPD (p0.052). Area under ROC curve was 0.685 for pre-
dicting subsequent severe PE based on abnormal EFW at 15-20
weeks gestation. No fetal growth differences were identied between
20 and 24 weeks of gestation for the severe-PE group compared to
normotensive patients.
CONCLUSION: Fetal undergrowth between 15 and 20 weeks gestation
anticipates and predicts the development of severe-PE. The later
development of severe-PE was not associated with rst trimester
differences in CRL.
Medison Sonoace R5/R7 ultrasound device. Sonographic evaluation
included fetal presentation and attitude, fetal biometry, placental
location and myometrial thickness. LUST was measured within 2cm
distance above the end an empty bladder while the women experi-
ence no contractions. Multiple measures were taken by up to three
different experienced sonographers.
RESULTS: A total of 64 women were recruited, of which 62 had
satisfactory measurements. A total of 28 (45.2%) women were
nuliparous and 34 (54.8%) multiparous, 35 (56.4%) were in latent
phase while 27 (43.6%) were in active labor (dened as 5cm dilation
or more). Of those in active labor, 10 (37%) women were fully
dilated when examined. Mean LUST was 3.2
0.8mm (ranging 6.1-
1.7mm). No correlation was found between the dilation and mean
LUST. Nuliparous women had signicant lower mean LUST when
compared with multiparous at all stages of labor.
CONCLUSION: We have found that LUST ranges from 1.7 to 6.1mm
during delivery with mean LUST of 3.2mm. Also, LUST may be
effected by parity. Further studies are required to estimate the exact
risk for uterine rupture according to lower uterine segment.

212 Intrapartum measurement of the lower uterine

segment thickness (LUST) - defining the normal
Daniel I. Nassie1,2, Zeev Efrat1,2, Kinneret Tenenbaum-Gavish1,2,
Amir Aviram2,3, Rony Chen1,2, Arnon Wiznitzer1,2,
Israel Meizner1,2, Ron Bardin1,2
1
Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tiqva,
Israel, 2Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel, 3Lis Maternity and
Womens Hospital, Sourasky Medical Center, Tel-Aviv, Israel
OBJECTIVE: Trial of labor after previous cesarean delivery (TOLAC)
may result in adverse outcomes such as uterine rupture. Although
not proved, a 2mm cutoff of the lower uterine segment thickness
(LUST) is often used when counseling pregnant women regarding
TOLAC. The aim of our study was to establish the normal range of
LUST in parturients with no previous cesarean delivery (CD).
STUDY DESIGN: A prospective study of parturients between 37 and 41
weeks of gestation with no past CD. All of the women had singleton
gestations in the cephalic presentation, an epidural anesthesia and a
urinary catheter. Measurements were performed using Samsungs

Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology S135