114 Giant placental chorioangioma: techniquesin fetoscopic devascularization and outcomesFoong-Yen Lim1, William Polzin2, Ronald Jaekle3, MouniraHabli1, David Lewis4, James Van Hook5, Timothy Crombleholme1

1Cincinnati Children’s Hospital Medical Center, Fetal Care Center,Division of Pediatric General and Thoracic Surgery, Cincinnati, OH, 2GoodSamaritan Hospital, Obstetrics and Gynecology, Cincinnati, OH, 3Universityof Cincinnati, Obstetrics and Gynecology, Cincinnati, OH, 4University ofCincinnati, Obstetrics and Gynecology, Cincinnati, OH, 5University ofCincinnati, Obstetrics and Gynecology, Cincinnati, OHOBJECTIVE: To evaluate the intrauterine management and perinataloutcome of pregnancies complicated by giant placental chorioan-gioma (�4cm).STUDY DESIGN: Retrospective review of 8 cases of giant placental cho-rioangioma referred to a single center between May 2006 and Decem-ber 2010. Information on maternal demographics, prenatal imaging(ultrasound, fetal MRI, echocardiography), response to fetoscopictreatment for high cardiac output state or non-immune hydrops, ob-stetrical complications, and perinatal outcome were evaluated.RESULTS: All 8 cases were isolated, had an average tumor size of 8.3cm(range 5.1-12.5cm). Mean gestational age at evaluation and deliverywas 23.5 weeks and 35.5 weeks, respectively. Overall survival was 75%.Six (75%) cases were associated with obstetrical complications, in-cluding polyhydramnios (n � 6), non-immune hydrops (n � 3), highcardiac output state (n � 5). Five patients had fetoscopic devascular-ization of the chorioangiomas: all 5 were contiguous with the placen-tal cord insertion (PCI) at mean gestational age of 23.9 weeks with80% survival. The tumors were devascularized by bipolar coagulation(n�1), combination of bipolar and diode laser (n�2), bipolar andradiofrequency ablation (n�1), and surgical clip application (n�1).Post-operatively, hydrops resolved in 2 of 2 and cardiac output nor-malized in 4 of 4, and all were liveborn at mean gestational age of 35.4weeks. The three cases managed non-operatively had mild polyhy-dramnios persisted in one, and stillbirth occurred at 30 weeks gesta-tion in one, with 66% survival. Mean gestational age at delivery was35.6 weeks.CONCLUSION: Giant placental chorioangioma is associated with ob-stetrical complications particularly when contiguous with the PCI.Fetoscopic devascularization is indicated for high cardiac output ornon-immune hydrops, which may require multiple techniques in-cluding bipolar coagulation or clip application to interrupt arterialinflow and laser to coagulate surface collateral vessels.

115 The relationship between cause and timing of previousstillbirth and the risk of stillbirth in second pregnanciesGordon Smith1

1University of Cambridge, Obstetrics andGynaecology, Cambridge, United KingdomOBJECTIVE: To determine the relationship between the cause and tim-ing of antepartum stillbirth in a first pregnancy and the risk of ante-partum stillbirth in the second pregnancy.STUDY DESIGN: We linked Scottish registries of pregnancy and perina-tal death data. We analyzed records from 244,204 women with de-tailed information on their first and second births using logistic andcox regression. We exclude losses due to congenital anomaly. Unex-plained stillbirths were subdivided as birth weight small or appropri-ate for gestational age (�10th percentile; SGA or AGA, respectively).RESULTS: The risk of stillbirth in the second pregnancy was 2.7 per1,000 among 242,881 women whose first pregnancy ended in livebirthand 15.9 per 1,000 among 1,323 women whose first pregnancy was astillbirth (OR�5.9; 95% CI�3.8-9.2, P�0.001). The elevated risk inthe second pregnancy was similar for different causes of stillbirth inthe first pregnancy (pre-eclampsia, placental abruption, unexplained-SGA, unexplained-AGA). Adjustment for maternal characteristicshad a minimal effect (adjusted OR�5.8, 95% CI�3.7-9.0). The risk ofstillbirth in the second pregnancy was also similarly elevated compar-ing women whose previous loss occurred at 24-32 weeks (OR�7.4;

95% CI�3.9-13.9, P�0.001) and those whose previous loss occurredat 33-43 weeks (OR�5.0; 95% CI�2.7-9.1, P�0.001). However, theassociation between previous stillbirth and the risk of stillbirth in thesecond pregnancy significantly varied across the range 24-43 weeks(test of proportional hazards assumption P�0.01). The associationwas very strong at 24-28 weeks (OR�15.7; 95% CI�8.4-29.0), strongat 29-32 (OR�5.1; 95% CI�1.6-16.1) and 33-36 (OR�6.0; 95%CI�2.4-14.5) weeks, but there was no significant association at term(OR�1.7; 95% CI�0.4-6.8), probably due to routine elective deliveryat 37-38 weeks.CONCLUSION: Previous stillbirth is a strong risk factor for stillbirth insecond pregnancies. The risk is particularly high at extreme pretermgestational ages. However, an increased risk was still observed at 33-36weeks gestation.

116 Chlorhexidine-alcohol versus povidone-iodinefor surgical site antisepsis in cesarean deliveriesGulden Menderes1, Nina Ali1, Kjersti Aagaard2, LeighMeredith Klaus1, Yin Yiu1, Haleh Sangi-Haghpeykar1

1Baylor College of Medicine, Obstetrics and Gynecology,Houston, TX, 2Baylor College of Medicine, Obstetrics andGynecology–Division of Maternal-Fetal Medicine, Houston, TXOBJECTIVE: Recent reports have shown the utility of chlorhexidine-alcohol for surgical site antisepsis in nonobstetric cohorts. However,limited data is available concerning the optimal antisepsis among ob-stetrics patients who comprise of relatively young and healthy women.The aim of the current study was to compare the incidence of surgicalsite infection (SSI) with use of chlorhexidine-alcohol versus povi-done-iodine (a less expensive antisepsis) among women undergoingcaesarean deliveries (CD).STUDY DESIGN: A retrospective cohort review was completed amongsubjects having undergone CD over a 2 year interval. A total of 1000subjects were identified, 500 with preoperatively povidone-iodine and500 with chlorhexidine-alcohol. All subjects received perioperativeantibiotics. The primary outcome was any SSI within 30 days (CDCcriterion).RESULTS: Mean age and parity were equivalent (29.6�/�5.9 yrs; 2.6�/�1.4). Subjects were similar on baseline characteristics, includingSSI comorbidities (BMI, diabetes, smoking; p�0.05). Method of skinincision closure was different with 91% among povidine-iodine vs.80% in chlorhexidine employing staples (p�.0001). Of interest, al-though the duration of surgical time was higher among chlorhexidinesubjects (67.4 vs. 60.1 min., p�.0001), fewer subjects in the chlorhexi-dine group were classified as having undergone an urgent CD (26% vs.48% p�.0001). Despite these differences, the overall rate of SSI wasthe same in the two groups (5% [N�25] in chlorhexidine & 5.8%[N�29] povidone-iodine; p�.53). In multivariate analysis and aftercontrol for confounders, odds for SSI remained similar between thetwo groups (adjusted odds ratio [AOR] � 0.76; 95% CI, 0.42-1.30;p�.34). The single significant predictor of SSI was duration of CDwhereby every one min increase in duration of CD, increased the oddsfor infection by 1.5% (AOR�1.015, 95% CI�1.005-1.024, p�.002).CONCLUSION: The single significant predictor of SSI is operative time,and cleansing with povidone-iodine may be a cost effective and equiv-alent alternative to chlorhexidine-alcohol among women undergoingcaesarean deliveries.

117 The expression of CD36 inpreterm and term pregnanciesGyun-Ho Jeon1, Hyun Jin Cho1, Ji Yeon Kim2,Chong Jai Kim3, Roberto Romero3, Yeon Mee Kim2

1Haeundae Paik Hospital, Inje University, Obstetrics Gynecology, Busan, SouthKorea, 2Haeundae Paik Hospital, Inje University, Pathology, Busan, SouthKorea, 3NICHD, NIH, DHHS, Perinatology Research Branch, Detroit, MIOBJECTIVE: CD36 is a scavenger receptor for oxidized LDL which playsa key role in the pathogenesis of atherosclerosis. Typically, CD36 isexpressed on the cell surface of macrophages and this allows uptake of

Poster Session I Clinical Obstetrics, Medical-Surgical-Disease, Neonatology, Physiology-Endocrinology www.AJOG.org

S64 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2012