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ANALYSIS OSCAR SADAN, MOSHE LESHNO, AHUVA GOTTREICH, MICHAL DISHI, ABRAHAM GOLAN, SAMUEL LURIE, Sackler University, Holon, Israel, Sackler Faculty of Medicine, Tel-Aviv, Faculty of Management, Tel Aviv, Israel, Tel-Aviv University, Holon, Israel, Wolfson Medical Center, Sackler University, Obstetrics & Gynecology, Holon, Israel, E. Wolfson Medical Center, Tel Aviv University, Obstetrics and Gynecology, Holon, Israel, Tel-Aviv University, Obstetrics & Gynecology, Holon, Israel OBJECTIVE: A previous decision analysis models for two strategic choices for trial of labor or repeated cesarean section after a prior cesarean concluded that the degree of wish for an additional future pregnancy appeared to be a major determinant for the choice between the two strategic options. We had extended the analysis model to stillbirth and hypoxic-ischemic encephalopathy in addition to placental complications while updating most of the outcomes in the decision tree. STUDY DESIGN: A model was formulated using a decision tree based on reported probabilities for various outcomes and estimated utilities. The question asked was should a trial of labor or repeated cesarean section be performed after a prior cesarean, with a varying desire for an additional pregnancy. RESULTS: Our model favors repeated elective cesarean section (0.9947) over trial of labor (0.9917) after a previous cesarean and is the preferred approach. This approach was preferable irrespective of the probability of additional pregnancy. CONCLUSION: In contrary to previous models, when taking into account occurrence of a live infant birth, birth of an infant with hypoxic-ischemic encephalopathy stillbirth, neonatal death, abnormal placental implantation, hysterectomy, and maternal death the preferred approach for women with previous cesarean section is an elective repeated cesarean section rather then trial of vaginal delivery.

NEUROTOXITICITY ROBIN ROBERSON, IRENE CAMERONI, LAURA TOSO, DANIEL ABEBE, STEPHANIE BISSELL, CATHERINE SPONG, National Institutes of Health (NIH), Unit on Perinatal and Develomental Neurobiology, NICHD&NIAAA, Bethesda, Maryland, University of Milano-Bicocca, Obstetrics and Gynecology, Monza, Milan, Italy OBJECTIVE: Fetal alcohol syndrome (FAS) is the leading cause of a spectrum of preventable non-genetic learning disorders. In the adult, neurogenesis occurs in the hippocampal dentate gyrus, which is thought to be important for learning and memory. Previously we have shown alterations in the NMDA receptor underlie some of the learning abnormalities in FAS. NMDA exerts it action through CREB. CREB is a transcription factor that controls gene expression via phosphorylation promoting neuronal survival. Using a model for FAS, we measured P-CREB levels in hippocampal subregions to evaluate if alterations in P-CREB underlie the FAS learning abnormalities after in utero alcohol exposure. STUDY DESIGN: Pregnant C57Bl6/J mice were treated on gestational day 8 with alcohol, n = 10 or control (saline) n = 5. Adult males were assessed in the Morris water maze for learning on days 50-56. On day 57, 5 males/ treatment were perfused for immunohistochemistry, and stained with SER 144 P-CREB antibody with relative densities of staining assessed using NIH Image software. Statistical analysis ANOVA, P!.05 significant. RESULTS: The hippocampal areas CA1, dentate and CA3 were quantitated. In the control, P-CREB staining was greatest in dentate granule cells and lowest in CA1. In all of the hippocampal subregions, alcohol exposure in utero resulted in significant downregulation of P-CREB (P!.001).

Objective To assess the role of uterine artery (UtA) Doppler to predict superimposed preeclampsia in women with chronic hypertension. Methods In a cohort of 182 women with chronic hypertension, UtA Doppler studies were performed before 25 weeks (mean 19.7 ± 2.1 weeks) and repeated later in pregnancy (mean 28.5 ± 3.7 weeks). Results The incidence of preeclampsia was 13% (24/182). Rates of preeclampsia increased with advancing gestation of abnormal UtA Doppler: 7% when UtA Doppler were normal at early exam, 18% when abnormal at early exam, and 28% when abnormal at late exam (Chi-square for trend: P < 0.001). The rate of preeclampsia among 40 women with abnormal early but normal late UtA Doppler was similar to that of women with normal findings at early exam (8 vs 7%; P = 1.00). Logistic regression analysis showed that the ability of UtA Doppler to predict preeclampsia was independent from other variables [Odds Ratio (OR) 7.1, 95% Confidence Interval (CI) 2.6–18.9). Receiver operating characteristic (ROC) curve identified a UtA value of 0.58 as the optimal threshold for the prediction of preeclampsia. Conclusion The later in pregnancy the abnormal UtA Doppler findings are observed, the greater the risk of preeclampsia. Normalization of UtA Doppler after 25 weeks reduces the risk of preeclampsia to 8%. Copyright © 2008 John Wiley & Sons, Ltd.