Poster Session V
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856 Non-Invasive Cardiac Output Monitoring
(NICOM) can predict the evolution of uteroplacental
disease - results of the prospective handle study
Cathy Monteith1, Lisa McSweeney1, Lucy Shirren1, Anne Doherty1,
Colm R. Breathnach1, Elizabeth C. Tully1, Patrick Dicker1,
Fergal D. Malone1, Afif EL-Khuffash2, Etaoin Kent2
1
RCSI, Dublin, Ireland, 2Rotunda Hospital, Dublin, Ireland
OBJECTIVE: To assess the ability of Non-Invasive Cardiac Output
Monitoring (NICOM), a novel method of non-invasive maternal
hemodynamic assessment assessment using bioreactance, to predict
the evolution of pre-eclampsia (PEC), gestational hypertension
(GH) and intrauterine growth restriction (IUGR).
STUDY DESIGN: Low risk nulliparous women were enrolled in a single
center prospective study. NICOM assessment was performed at 14
weeks gestation and data was obtained on cardiac output (CO), total
peripheral resistance (TPR), systolic blood pressure (SBP) and dia-
stolic blood pressure (DBP). Indexed total peripheral resistance
(TRPi) indexed stroke volume (SVi) were calculated by adjusting for
participants body surface area. The hemodynamic prole of preg-
nancies subsequently complicated by GH, PEC IUGR were
compared a control group with normal pregnancy outcome. Logistic
regression was used to model GH, PEC and IUGR with NICOM
measurements as predictors. Linear, Non-linear and interaction
terms were assessed using the Akaike Information Criterion. Sta-
tistical signicance and area under the ROC curve are described.
RESULTS: The hemodynamic prole of 18 pregnancies complicated
by GH, six pregnancies complicated by PEC and 18 pregnancies
complicated by IUGR were compared to 282 healthy unaffected
pregnant controls. The best independent predictor for the evolution
of uteroplacental disease at 14 weeks gestation was TPR/ TPRi
(AUC 0.65 p0.007 and p0.005 respectively) in the prediction of Renal artery RI and PI were lower in PP (PP RI 0.580.03 vs TP
GH. Table 1 depicts the performance of independent hemodynamic
variables. The performance of multiple hemodynamic variables is
detailed in Table 2. We demonstrated that CO and TPR when
combined with BP were signicant predictors of pregnancies
complicated by IUGR (AUC 0.67, p0.02). In pregnancies
complicated by PEC, HR and SVi in combination with BP were also
statistically signicant predictors (AUC 0.77 p0.006 and p0.008 % PP2934 vs TP 6628%; p0.03), and more likely to be
respectively).
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CONCLUSION: NICOM derived maternal hemodynamic prole at 14
weeks gestation has the novel potential to discriminate pregnancies
which will ultimately develop uteroplacental disease. However, as a
result of a lower than anticipated PEC rate, larger studies are needed
to assess the performance of NICOM hemodynamic evaluation prior
to being employed into clinical practice.
857 Distinct phenotypes for preterm and term
preeclampsia
Carole McBride, Erin A. Morris, Gary J. Badger, Ira M. Bernstein
University of Vermont, Burlington, VT
OBJECTIVE: Preterm (PP) and term preeclampsia (TP) present
similarly, yet women who develop preterm disease are at the greatest
risk of developing future cardiovascular disease. We compared
women prior to, and during, pregnancy who subsequently developed
PP or TP to determine if there are physiologic differences between
the different presentations.
STUDY DESIGN: Ten women who developed PP and 7 who developed
TP were evaluated prior to pregnancy; 8 PP and 7 TP were reeval-
uated between 30 and 32 weeks of pregnancy prior to clinical disease
recognition. All observations were made following an overnight fast.
Prior to pregnancy, subjects were evaluated for body composition,
response to vascular volume challenge, and renal and uterine he-
modynamics. Plasma volume (PV), mean arterial pressure (MAP),
pulse wave velocity (PWV) and cardiac output (CO) were also
evaluated at both time points. Pregnancy outcome was determined
through chart review. Data are presented as meanSD.
RESULTS: Groups were of similar age (PP 312 vs TP 306
years; p0.9), BMI (PP 306 vs TP 278 m/kg2; p0.3), body
fat percentage (PP 455 vs TP 3911%; p0.2), and distribu-
tion of body fat (android/gynoid fat ratio PP0.490.12 vs TP
0.410.11; p0.18). Prior to pregnancy PP had higher MAP (PP
1029 vs TP 916mmHg; p<0.01), faster PWV (PP4.00.4 vs
TP3.60.3 m/sec; p0.05), had higher CO (PP 5.71.1 vs TP
4.40.8 L; p0.02), and an enhanced response to volume challenge
(PP area under the curve for CO 209 vs TP 811L; p0.03).
0.660.04; p<0.001; PP PI 0.970.07 vs TP 1.140.15;
p<0.001). Changes from pregnancy to 3rd trimester were enhanced
in TP when compared to PP (pulse change PP 512 vs TP 199
BPM; p0.03), (brachial PWV change PP -0.40.5 vs TP
0.20.5 m/sec; p0.03), (PV expansion PP 4121 vs TP
718%; p0.01). At delivery, PP infants were smaller (birth weight
growth restricted (PP50 vs TP 0%; p0.03).
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CONCLUSION: PP differs from TP demonstrating increased prepreg-
nancy blood pressure and CO, faster PWV, increased response to
volume loading, and lower renal vascular resistance. PP physiologic
adaptation to pregnancy appears limited while TP appears to be
associated with an enhanced cardiovascular response to pregnancy.
858 Effects of magnesium sulfate on maternal
cardiovascular function in preeclampsia without
severe features using non-invasive cardiac
monitoring
Antonio Saad, George Saade, Luis Pacheco
UTMB Galveston, Galveston, TX
OBJECTIVE: The ACOG task force on hypertension in pregnancy
suggests that magnesium sulfate (MgSO4) not be administered
universally to asymptomatic patients with preeclampsia without
severe features (PWOSF). However, one alleged benet is its po-
tential vasodilatory effect. Our objective was to determine the effect
of MgSO4 on cardiovascular function in women with PWOSF.
STUDY DESIGN: We rst validated a novel noninvasive bioreactance
approach by comparing it to a thermodilution catheter (gold stan-
dard). Women diagnosed with PWOSF at term were then included
in this prospective study. Diagnosis was based on the latest task force
report and reviewed in real-time. Using the bioreactance approach,
cardiac output (CO), cardiac index (CI), stroke volume (SV), cardiac
power (CP), systemic vascular resistances (SVR) and thoracic uid
content (TFC) were measured before start of MgSO4, during
MgSO4 load (6 gm over 30 minutes) and then after one hour while
patient was on maintenance (2 gm/hr). Data are reported as mean 
SEM. Repeated measures one-way ANOVA followed by post hoc
analysis were performed (signicance: P < 0.05).
RESULTS: Bioreactance correlated well with the thermodilution
catheter (CO PAC) (R squared 0.78; p<0.05) (Figure 1). CO, CI, SV,
SVI, CPI and CP decreased signicantly after the load and decreased
further during maintenance (Figure 2 A,B & C). This occurred
without signicant changes in SVR/SVRI (Figure 2 D).
CONCLUSION: MgSO4 depresses cardiac contractility with minimal
changes in peripheral vascular resistance in patients with PWOSF.
The negative inotropic effect, the lack of peripheral vascular benet,
and the previously reported high number needed to treat to prevent
one seizure in PWOSF argue against the use of MgSO4 in this low
risk patient population.
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
Poster Session V
859 Use of a Perceptual Adaptive Learning Module
Results in Improved Accuracy and Fluency of Fetal
Heart Rate Categorization by Medical Students
Melissa S. Wong1, Sally Krasne2
1
Cedars-Sinai Medical Center, Los Angeles, CA, 2University of California -
Los Angeles, Los Angeles, CA
OBJECTIVE: Despite its ubiquitous use in the United States, no
published studies have evaluated the best method of teaching Fetal
Heart Rate (FHR) interpretation. Our aim is to evaluate whether use
of a Perceptual Adaptive Learning Module (PALM) by medical stu-
dents would result in improved accuracy and uency (accuracy
and automaticity) of FHR categorization versus traditional lecture
methods. The PALM has been shown to improve learning in skills
requiring pattern recognition in multiple domains including der-
matopathology, ECG interpretation, and advanced imaging.
STUDY DESIGN: This is a prospective, non-randomized, controlled
trial of third-year medical students, divided into three groups. The
control group received an in-person lecture on the basics of FHR
physiology as well as a second lecture on the details of FHR cate-
gorization. The PALM group received an in-person lecture on the
basics of FHR physiology and then completed the PALM module.
Last, the Online group received a combination of the two: online
video instruction on both FHR physiology and categorization as well
as the PALM module.
All subjects took a pretest, an immediate posttest and a delayed
test ve weeks later as well as a survey on the content delivery
method.
RESULTS: From April 2015 to July 2016, 178 subjects participated: 86
were assigned to the control arm, 53 to the PALM arm and 39 to the
Online arm. Their accuracy and uency on tests of FHR categori-
zation are summarized in Tables 1 and 2.
All groups scored comparably in both accuracy and uency on the
pretest. Interventions involving the PALM (PALM group and Online
group) showed the largest improvements on the posttest. All
improved on the delayed test, but the interventions involving the
PALM (PALM group and Online group) showed larger improve-
ments compared to the control arm.
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