SMFM Abstracts S87

255 OPERATIVE VAGINAL DELIVERIES: WHAT IS THE ASSOCIATION BETWEEN STATION AND PERINATAL OUTCOMES? BRIAN L. SHAFFER1, YVONNE W. CHENG1, AARON B. CAUGHEY1, 1University of California, San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California OBJECTIVE: To compare maternal and neonatal morbidity by fetal station at time of operative vaginal delivery. STUDY DESIGN: We performed a retrospective cohort of all patients in the second stage of labor who had midpelvic, low, or outlet assisted operative vaginal deliveries. We examined fetal station at time of delivery as a predictor for maternal and neonatal morbidity. Statistical comparisons were made using the c2 test and Fishers exact test, and p!0.05 was used to indicate statistical signicance. RESULTS: Of the 3918 women meeting study criteria, 79 (2.0%) had midpelvic, 3396 (86.7%) low, and 443 (11.3%) outlet operative vaginal deliveries. There were no dierences in major neonatal or maternal morbidity between the comparison groups. We had 66% power to detect a 50% dierence in perineal lacerations or postpartum hemorrhage between midpelvic and low operative deliveries. We had greater than 90% power to detect a 50% dierence between low and outlet operative deliveries. CONCLUSION: We found no dierences in maternal or neonatal morbidity when comparing fetal station at time of operative vaginal delivery. In todays obstetric environment, midpelvic vaginal delivery is rare; however, in properly selected cases, it may confer similar perinatal morbidity when compared with low or outlet operative deliveries. Operative Vaginal Delivery: Perinatal Outcomes by Station Midpelvic n=(79) Shoulder dystocia Erbs palsy Cephalohematoma ICH Hemorrhage 3rd/4th degree lac 4.0% 0.0% 8.0% 0.0% 28.5% 30.0% Low n=(3396) 2.5% 0.5% 11.0% 0.4% 31.8% 32.5% Outlet n=(443) 2.8% 1.2% 10.7% 0.0% 27.2% 30.7% p-value 0.742 0.257 0.790 0.356 0.157 0.707 257 POLYMORPHISMS OF THE METHYLENETETRAHYDROFOLATE REDUCTASE GENE AND PLACENTAL ABRUPTION: THE NEW JERSEY-PLACENTAL ABRUPTION STUDY CANDE ANANTH1, MORGAN PELTIER1, CELESTE DEMARCO1, DARIOS GETAHUN1, RIMA ROZEN2, JOHN SMULIAN1, 1University of Medicine and Dentistry of New Jersey, Obstetrics, Gynecology and Reproductive Sciences, New Brunswick, New Jersey, 2McGill University, Human Genetics, Pediatrics and Biology, Montreal, Quebec, Canada OBJECTIVE: To examine associations between MTHFR 677C/T and 1298A/T polymorphisms and placental abruption. STUDY DESIGN: We examined 2 variants in MTHFR: 677C/T and 1298A/T in genomic DNA extracted from maternal blood. Subjects were recruited to the New Jersey-Placental Abruption Study, an ongoing, multicenter case-control study. We identied 168 women diagnosed with abruption (cases), and 162 controls. We assessed allele and genotype frequencies, and their associations with abruption risk. Plasma concentrations of total homocysteine, folate and vitamin B12 were also compared between cases and controls. RESULTS: The wild-type allele frequency of the 677C/T variant among cases and controls was 67.9% and 63.3%, respectively, and that of the 1298A/C variant was 74.9% and 78.0%, respectively. Among women with absence of the homozygous 677C/T mutation, mean homocysteine and vitamin B12 were elevated in cases than controls (P=0.041 and P=0.035, respectively). CONCLUSION: In this population, the MTHFR 677C/T and 1298A/T were not associated with abruption. Association between MTHFR genotypes and abruption Cases (n=168) MTHFR 677 C/T C/C C/T T/T MTHFR 1298 A/T A/A A/T T/T 50.0 35.7 14.3 59.5 32.1 8.3 Controls (n=162) 45.1 36.4 18.5 64.8 31.5 3.7 OR (95% CI) 1.0 (Ref) 0.9 (0.5, 1.6) 0.6 (0.3, 1.2) 1.0 (Ref) 1.1 (0.7, 1.9) 2.3 (0.8, 6.9)

0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.279

0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.281 258 RISK OF PLACENTAL ABRUPTION IN RELATION TO VARIANTS IN BETAINEHOMOCYSTEINE S-METHYLTRANSFERASE AND METHIONINE SYNTHASE REDUCTASE GENES: THE NEW JERSEY-PLACENTAL ABRUPTION STUDY CANDE ANANTH1, WENDY KINZLER1, MORGAN PELTIER1, DENISE ELSASSER1, DARIOS GETAHUN1, RIMA ROZEN2, 1University of Medicine and Dentistry of New Jersey, Obstetrics, Gynecology, and Reproductive Sciences, New Brunswick, New Jersey, 2 McGill University, Human Genetics, Montreal, Quebec, Canada OBJECTIVE: Hyperhomocystenemia is associated with adverse pregnancy outcomes and vascular disease. Betaine-homocysteine S-Methyltransferase (742G/A; BHMT) and Methionine Synthase Reductase (66A/G; MTRR) are 2 enzymes that regulate homocysteine (tHCY) metabolism. We assessed if mutations in BHMT and MTRR are associated with abruption. We further evaluated if tHCY diered between cases and controls for each BHMT and MTRR genotypes. STUDY DESIGN: Data were derived from the New Jersey Placental Abruption Study (NJ-PAS)dan ongoing, multicenter, case-control study conducted since August 2002. Women with a clinical or histologic diagnosis of abruption were recruited as incident cases (n=167), and controls (n=163) were matched to cases based on maternal race/ethnicity and parity. Total homocysteine concentrations were evaluated from maternal blood collected immediately following delivery, and DNA were genotyped for the BHMT and MTRR polymorphisms. RESULTS: Frequencies of the minor allele of BHMT were 35.3% and 29.8% in cases and controls, respectively (adjusted OR 2.7, 95% CI 1.2, 6.1), and that of the MTRR were 41.9% and 41.7% (OR 1.5, 95% CI 0.8, 2.8). The rate of homozygous recessive BHMT genotype was 2.7-fold (95% CI 1.1, 6.4) higher in cases than controls. Distributions for the mutant form of MTRR were similar between cases and controls (OR 1.4, 95% CI 0.7, 2.8), as were mean tHCY levels. CONCLUSION: In this population, women with homozygous recessive form of BHMT are at increased risk for abruption. Total homocysteine levels were higher in cases than controls among women carrying the G/G and G/A genotypes of BHMT. Plasma homocysteine concentrations among abruption cases and controls by BHMT (742G/A) genotype BHMT G/G G/A A/A Cases (n=134) 6.0G2.1 5.9G2.5 4.9G1.5 Controls (n=137) 5.6 G 2.4 5.5G1.7 5.7G2.1 P-value 0.031 !0.001 0.089

256 COMPARING MANUAL, FORCEPS, AND VACUUM ROTATIONS FOR OCCIPUT POSTERIOR AND TRANSVERSE POSITION BRIAN L. SHAFFER1, YVONNE W. CHENG1, JUAN E. VARGAS1, RUSSELL K. LAROS1, AARON B. CAUGHEY1, 1University of California, San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California OBJECTIVE: To evaluate the association of manual, forceps, and vacuum rotations and delivery mode with maternal and neonatal morbidity in persistent occiput posterior (OP) and transverse (OT) position. STUDY DESIGN: Retrospective cohort study of women with persistent OP/ OT position in the second stage of labor who had a trial of manual, forceps, or vacuum assisted rotation. We examined the association of type of rotation with delivery outcomes and maternal and neonatal morbidity. Comparisons were made using the c2 test and potential confounders were controlled for with multivariate regression. RESULTS: Of the 1715 women who met study criteria, 712 (41%) underwent manual, 737 (43%) had forceps, and 266 (16%) underwent a vacuum delivery with auto-rotation. Women who had forceps (OR 0.2, 95% CI: 0.1-0.5) and vacuum (OR 0.3, 0.1-0.7) rotations had a lower cesarean rate than those with a manual rotation. Postpartum hemorrhage was more common in women with forceps (OR 1.7, 1.2-2.3) than manual rotation. Severe perineal lacerations were associated with forceps (OR 2.0, 1.4-2.8) and vacuum (OR 1.7, 1.1-2.6) versus manual rotation. Compared with manual rotation, forceps (OR 4.7, 1.316) and vacuum (OR 4.6, 1.2-18) rotations were associated with higher rates of composite birth trauma (ICH, nerve palsies, and fractures). CONCLUSION: Manual rotation in persistent OP/OT position during the second stage is associated with less maternal morbidity and neonatal birth trauma but a higher rate of cesarean compared to rotation with forceps or vacuum. When considering delivery options in persistent OP/OT position, the success rate should be weighed against maternal and neonatal risks. Outcomes after Rotation of Fetal Occiput in OP/OT Manual n=712 (%) Cesarean Hemorrhage 3rd/4th Laceration Birth Trauma 7.6 22.0 14.6 1.1 Forceps n=737 (%) 2.3 33.7 30.7 2.8 Vacuum n=266 (%) 3.0 31.6 30.1 3.8 p-value !0.001 !0.001 !0.001 0.019

0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.280

0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.282