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Background : A rare cause of hydrops fetalis, intrapericardial teratoma is invariably associated with a pericardial effusion. In fetal life, the effusion or mass effect may cause cardiac tamponade, hydrops, and death. After delivery, ventilation and cardiac output may be compromised. Case : One fetus of twins was diagnosed at 20 weeks' gestation with an intrapericardial teratoma. The affected twin underwent two intrauterine pericardiocenteses and had the tumor resected after delivery at 35 weeks' gestation. One year later, both twins are alive and well and have no evidence of tumor recurrence. Conclusion : Pericardiocentesis for tamponade secondary to a fetal intrapericardial teratoma, even when complicating a twin pregnancy, may prevent fetal death and allow delay of delivery until adequate fetal lung maturity has been achieved.

INTRO Binge eating disorder (BED) affects 3.5% of the population and is characterized by binge eating for at least 2 days a week for 6 months. Treatment options include cognitive behavioral therapy, interpersonal psychotherapy, and pharmacotherapy which are associated with varied success. Little is known about the biology of BED. Since there is evidence that the insulin like growth factor system is implicated in regulation of body weight, insulin sensitivity and feeding behavior, we speculated it may be involved in BED. METHODS A cross-sectional comparison was made between three groups of women: overweight with BED, overweight without BED and normal weight without BED. Women were assigned to Group Psychodynamic Interpersonal Psychotherapy. Blood was collected before therapy, at completion and at 6 months follow up for evaluation of IGF-II using Western blot. RESULTS 97 overweight women with BED contributed to the cross-sectional comparison. The two control groups comprised 53 overweight women without BED, and 50 age matched normal weight women without BED. Obese women had significantly lower Big IGF-II than normal weight women, p = .028; Overweight women with BED had higher Mature IGF-II than normal weight women, p

Zachary M Ferraro,1 Qing Qiu,2 Andrée Gruslin,3,4 Kristi B Adamo1,3,5 1Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada; 2The Ottawa Hospital Research Institute, Ottawa, ON, Canada; 3Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada; 4Departments of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada; 5Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada Background: Excessive gestational weight gain (GWG) increases risk of large for gestational age neonates and subsequent tracking of excess weight throughout the life course for both mother and child. Although the physiological mechanisms underlying these associations are incomplete, the insulin-like growth factor (IGF) axis has garnered attention for its role in fetal growth and development. Our purpose was to characterize the IGF axis protein expression patterns in mother–infant dyads in respect of excessive GWG. Methods: We obtained fasting serum samples and corresponding cord blood from eight controls (ADHERE group: ie, those who gained in accordance with 2009 Institute of Medicine GWG recommendations) and 13 exceeders (EXCEED group: ie, those who exceeded Institute of Medicine GWG recommendations). At study completion, we examined protein expression of IGF-I, IGF-II, IGF binding protein (IGFBP)-1, IGFBP-3, IGFBP-4, and hormone concentrations in both maternal and cord blood. Results: Between-group comparisons were made and revealed elevated maternal leptin (P ≤ 0.05) concentrations in gravidas who exceeded recommendations. There was a significantly higher number of obese women in the EXCEED group (P < 0.05). After adjustment, maternal leptin levels were positively correlated with maternal homeostasis model of assessment for insulin resistance score and excessive GWG (P ≤ 0.01). However, serum IGFBP-3 expression in the EXCEED mothers was greater than that in the ADHERE group (P ≤ 0.05). Conclusion: These findings provide preliminary evidence suggesting that small deviations in IGFBP-regulated IGF bioavailability arising from excessive GWG/positive energy balance may affect adipocyte differentiation through subclinical insulin resistance. Keywords: gestational weight gain, insulin-like growth factors, insulin-like growth factor binding protein-3, pregnancy, insulin sensitivity

s / Placenta 34 (2013) A1–A99 A41 Conclusion: Free HbF causes acute vasoconstriction of the fetoplacental vasculature by binding NO and disrupting placental endothelial morphology. HbF levels in fetal blood warrant further investigation in normal and pathological pregnancies. http://dx.doi.org/10.1016/j.placenta.2013.06.121 P1.85. ABSTRACT WITHDRAWN HTTP://DX.DOI.ORG/10.1016/J.PLACENTA.2013.06.122 P1.86. MATERNAL SERUM LEVELS OF FGL2 AS SCREENING TOOL FOR PREECLAMPSIA Julien Yockell-Lelievre , Barbara Vanderhyden , Andree Gruslin 1,3 Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Obstetrics and Gynecology, The Ottawa Hospital

s / Placenta 34 (2013) A1–A99 A15 Conclusion: Detailed placental measures collected by simple imaging methods illuminate placental functional efficiency, a key factor in gestational life that is likely important in fetal programming. PCA demonstrates the complex interactions between lateral expansion of the chorionic plate surface, branching growth of chorionic surface vessels, and arborisation of the fetal stem villi to create the placental surface exchange area that makes up disk thickness. Measurement of any single dimension can lead to misleading conclusions because in different combinations, specific measures may have opposite effects on beta. http://dx.doi.org/10.1016/j.placenta.2013.06.044 P1.8. POROUS MEDIA FLOW MODELS FOR MATERNAL PLACENTAL CIRCULATION Christopher Ball , David Grynspan , Andree Gruslin 3,4 Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Pathology and Laboratory Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Cellular Molecular Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada Introduction: It is reasonable to believe that the presence of abnormal flow patterns in the chorionic vessels is an earlier and more sensitive predictor of IUGR than altered end diastolic flow in the umbilical artery. It furthermore appears that the prediction of IUGR becomes increasingly sensitive as predictive flowmeasurements are taken increasingly distal (to the fetus) in the umbilical cord. This, we hypothesize, results from remodelling of the villous circulatory beddthe most proximate correlate of the factors that lead to IUGR. The effect of lacunar blood flow, the intimately connected maternal side of placental flow, cannot be ignored. Aim:Our aim is tomodel the fluidmechanics of the normalmaternal lacunar blood flows in order to assess its influence on flow within the measurable parts of the fetal arterial tree. In view of the placental structure, we aim to apply a model of flow through porous media to the maternal flow bed. Methods: Preliminary inquiry has lead us to suspect that this flowproblem is analogous to the problem of laminar flow through a porous medium (such as in models of fuel cells, ground water, etc.). Here we will illustrate application of this canonical flow model to that of the maternal placenta. Discussion: The problem of modelling EDFR provides an example where interdisciplinary collaboration between medicine and engineering hopefully will permit rapid progress through novel application to one field of established constructs from another. http://dx.doi.org/10.1016/j.placenta.2013.06.045 P1.9. ECHOCARDIOGRAPHIC ANALYSES OF PREGNANCIES IN THE PLACENTAL GROWTH FACTOR KNOCKOUT MOUSE Kristiina Aasa , Bruno Zavan , Philip Wong , Yat Tse , Stephen Pang , B. Anne Croy 1 Queen's University, Kingston, ON, Canada; UNIFAL-MG, Alfenas, Minas

s / Can J Diabetes 37 (2013) S217eS289 S267 rate variability; the ratio of lowto high-frequency power (LF/HF) reflects the balance between sympathetic and parasympathetic predominance. Participants completed questionnaires on food intake and physical activity. The associations between PEMCS and outcomes were tested with ANCOVA, including sex, age, height, maternal education, gestation length, breast-feeding and birthweight in the model as covariates. Results: Exposed (E; n1⁄4335) vs. non-exposed (NE) had greater visceraland subcutaneous-abdominal fat and total body fat (P1⁄40.01, 0.001 and 0.007, respectively). E vs. NE did not differ in physical activity, but had lower LF/HF (P1⁄40.009) and greater % fat dietary intake (P1⁄4 0.007). Discussion: In adolescence, PEMCS is associated with parasympathetic predominance and higher dietary fat intake. As parasympathetic predominance reduces energy expenditure and excess fat intake increases energy intake, these two factors may be mechanisms by which PEMCS contributes to increased adiposity.

Recent evidence indicates that CXCR2 signaling is crucial for cancer progression, and its antagonist SB225002 induces apoptosis in Wilms’ tumor cells. Here, we investigated the effect of SB225002 on cell cycle progression and apoptosis induction in vitro, using CDDP-sensitive and -resistant OVCA cell lines with different p53 status (wild type, mutant or null). Adenovirus infection of wild-type p53 or transfection of p53 siRNA was used to over-express or knock-down p53. Cell cycle and apoptosis were determined by flow cytometry or Hoechst staining and observation of nuclear morphology. Our data demonstrated that SB225002 induced apoptosis in both wild-type and p53-deficient ovarian cancer (OVCA) cells through alternative mechanisms. SB225002 promoted mitotic catastrophe, as evidenced by the accumulation of mitotic cells with spindle abnormalities, chromosome mis-segregation, multi-polar cell division, multiple nuclei, aneuploidy/polyploidy and subsequent extensive apoptosis. SB225002-induced mitotic catastrophe appeared to be mediated by down-regulation of checkpoint kinase Chk1 and Cdk1-cyclin B activation. In cells expressing wild-type p53 (OV2008 and C13*), SB225002 increased total and phospho-Ser p53 levels, and p53 knock-down decreased SB225002-induced apoptosis, without affecting premature mitosis. These results suggest that SB225002 induces p53-dependent apoptosis, and provokes mitotic catastrophe in p53-independent manner in p53 wild-type cells. Reconstitution with wild-type P53 in P53-null SKOV3 cell attenuated SB225002-induced mitotic catastrophe, suggesting p53 prevented mitotic catastrophe induced by SB225002 in p53-deficient OVCA cells. Finally, the effect of SB225002 could not be prevented by pretreatment with CXCR2 ligand or its neutralizing antibody. The present studies demonstrate for the first time that SB225002 has dual actions in OVCA cells, inducing classic apoptosis through p53 activation and provoking mitotic catastrophe in both p53 wild-type and deficient cells by Chk1 inhibition and Cdk activation. These findings raise the possibility of SB225002 as a new candidate molecule for OVCA therapy independent of the p53 status.

A Finnish-French group has proposed an imaging spectrometer- based instrument for the ENVISAT Earth observation satellite of ESA, which yields a global mapping of the vertical profile of ozone and other related atmospheric gases. The GOMOS instrument works by measuring the UV-visible spectrum of a star that is occulting behind the Earth's atmosphere. The prime contractor of GOMOS is Matra Marconi Space France. The focal plane optics are designed and manufactured by Spacebel Instrumentation S.A. and the holographic grating by Jobin-Yvon. VTT Automation, Measurement Technology has participated in the GOMOS studies since 1989 and is presently responsible for the verification tests of the imaging quality and opto-mechanical interfaces of the holographic imaging grating of GOMOS. The UVIS spectrometer of GOMOS consists of a holographic, aberration corrected grating and of a CCD detector. The alignment of the holographic grating needs as an input very accurate knowledge of the mechanical interfaces. VTT Automation has designed, built and tested a characterization system for the holographic grating. This system combines the accurate optical imaging measurements with the absolute knowledge of the geometrical parameters at the accuracy of plus or minus 10 micrometers which makes the system unique. The developed system has been used for two breadboard gratings and the qualification model grating. The imaging quality results and their analysis together with alignment procedure utilizing of the knowledge of mechanical interfaces is described.© (1996) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

A Finnish-French group has proposed an imaging spectrometer- based instrument for the ENVISAT Earth observation satellite of ESA, which yields a global mapping of the vertical profile of ozone and other related atmospheric gases. The GOMOS instrument works by measuring the UV-visible spectrum of a star that is occulting behind the Earth's atmosphere. The prime contractor of GOMOS is Matra Marconi Space France. The focal plane optics are designed and manufactured by Spacebel Instrumentation S.A. and the holographic grating by Jobin-Yvon. VTT Automation, Measurement Technology has participated in the GOMOS studies since 1989 and is presently responsible for the verification tests of the imaging quality and opto-mechanical interfaces of the holographic imaging grating of GOMOS. The UVIS spectrometer of GOMOS consists of a holographic, aberration corrected grating and of a CCD detector. The alignment of the holographic grating needs as an input very accurate knowledge of the mechanical interfaces. VTT Automation has designed, built and tested a characterization system for the holographic grating. This system combines the accurate optical imaging measurements with the absolute knowledge of the geometrical parameters at the accuracy of plus or minus 10 micrometers which makes the system unique. The developed system has been used for two breadboard gratings and the qualification model grating. The imaging quality results and their analysis together with alignment procedure utilizing of the knowledge of mechanical interfaces is described.

Objectives: To evaluate comparatively two management modalities in women with singleton pregnancies and with clinical risk factors for PTB (based on obstetric and gynecologic history): transvaginal ultrasound (TVU) surveillance of the cervical length and placement of CC indicated by cervical shortening (therapeutic cerclage, TC) versus prophylactic (elective) cerclage (PC). Methods: Data Sources and Study Selection: A search of entries in electronic databases (MEDLINE, EMBASE) was supplemented with references cited in original articles to identify randomized trials and case-control studies comparing pregnancy outcomes after cervical surveillance and TC versus PC in a high-risk population of pregnant women with singleton pregnancies. Case and control groups consisted of women with singleton pregnancies matched for obstetrical and gynecological risk factors for preterm birth. The outcomes assessed were preterm delivery before 35 weeks or prior to 24 weeks of gestation. Studies were excluded if there was no matched control group or if only the abstract was available. Results: Of 5 studies identified, 3 met the inclusion criteria. A total of 367 patients were evaluated, 215 in the cervical surveillance arm and 152 with PC. Compared to women with PC, those who were followed by cervical surveillance, had no increased risk of preterm delivery before 24 or 35 weeks, respectively (RR 1.41; 95%CI 0.58–3.41; RR 1.24; 95%CI 0.75–2.04, respectively). The conservative approach achieved a 62% reduction in the number of patients undergoing CC placement. Conclusions: Serial TVU of the cervix with ultrasound-indicated TC appears a safe alternative to traditional PC and it spares a significant number of pregnant women an intervention with potential inherent complications.

Maternal obesity results in a number of obstetrical and fetal complications with both immediate and long-term consequences. The increased prevalence of obesity has resulted in increasing numbers of women of reproductive age in this high-risk group. Since many of these obese women have been subjected to hypercaloric diets from early childhood we have developed a rodent model of life-long maternal obesity to more clearly understand the mechanisms that contribute to adverse pregnancy outcomes in obese women. Female Sprague Dawley rats were fed a control diet (CON - 16% of calories from fat) or high fat diet (HF - 45% of calories from fat) from 3 to 19 weeks of age. Prior to pregnancy HF-fed dams exhibited significant increases in body fat, serum leptin and triglycerides. A subset of dams was sacrificed at gestational day 15 to evaluate fetal and placental development. The remaining animals were allowed to deliver normally. HF-fed dams exhibited a more than 3-fold increase in fetal death and decreased neonatal survival. These outcomes were associated with altered vascular development in the placenta, as well as increased hypoxia in the labyrinth. We propose that the altered placental vasculature may result in reduced oxygenation of the fetal tissues contributing to premature demise and poor neonatal survival.

artery Doppler as predictors of placentallymediated pregnancy complications Chantal Mayer, Andree Gruslin, Camila Guan, Peter von Daldelszen, Blair Butler University of British Columbia, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Vancouver, BC, Canada, University of Ottawa, Ottawa Hospital Research Institute, Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Ottawa, ON, Canada OBJECTIVE: Pre-eclampsia(PE) and fetal growth restriction are late complications though abnormal placental perfusion is present from implantation. Umbilical artery (UA) Doppler does not provide early diagnosis as significant changes in the waveform do not appear until late in the process. Assessment of the intraplacental villous arteries (IPVA) is proposed to provide earlier diagnosis by detecting subtle early changes in the placental microvasculature. Preliminary results suggested a significant correlation between IPVA pulsatility index (PI) performed at 20, 28, 34 weeks gestational age (GA) and birth weight. The placenta of the fetus with impaired perfusion is also smaller than average. Preliminary data demonstrated a correlation between second trimester maximal placental length (MPL), thickness (MPT) and birth weight (BW). We sought to reproduce these results in a high risk population and hypothesized that both IPVA Doppler and placental biometry are predictive of a combined outcome of placentally-mediated complications. STUDY DESIGN: Patients with at least 1 risk factor for PE were recruited. Placental sonograms for biometry and IPVA Doppler were performed at 17-24 weeks and at 28-32 weeks GA. The Mann-Whitney test was used to correlate candidate predictors to the combined outcome. RESULTS: Seventy-three patients were recruited. Composite primary outcome consisting of BW 10%ile, PE, abruption, stillbirth, neonatal death, umbilical cord pH 7.0 or BE to 12mmo/l occurred in 16 (21.9%). Second trimester placental biometry and IPVA Doppler were not found to be significantly predictive of the primary outcome: MPL [p 0.61]; MPT [p 0.91]; IPVA PI [p 0.25]. Thirty-five patients underwent a third trimester examination, 7 of which had the composite outcome (20%). Third trimester placental biometry was not found to be predictive of outcome (MPL [p 0.49], MPT [p 0.12]),but IPVA PI was [p 0.03]. CONCLUSION: In a high risk population, second trimester placental biometry and IPVA Doppler were not predictive of a composite outcome of placentally-mediated complications but third trimester IPVA PI was. 390 The added value of second trimester uterine artery Doppler in the identification of nulliparous women at increased risk for preeclampsia: an individual patient data metaanalysis Emily Kleinrouweler, Patrick Bossuyt, Joris van der Post, Javier Arenas, Koen Deurloo, Abdalla Diab, Maureen Macleod, Akihide Ohkuchi, Basky Thilaganathan, Karlijn Vollebregt, Hans Wolf, Ben Mol, Eva Pajkrt Academic Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands, Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands, Hospital de Cabuenes, Department of Obstetrics and Gynaecology, Gijon, Spain, Free University Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands, Zagazig Faculty of Medicine, Department of Obstetrics and Gynaecology, Zagazig, Egypt, University of Dundee, Ninewells Hospital & Medical School, Department of Obstetrics and Gynaecology, Dundee, United Kingdom, Jichi Medical University School of Medicine, Department of Obstetrics and Gynecology, Tochigi, Japan, St Georges Hospital, Department of Obstetrics and Gynaecology, London, United Kingdom OBJECTIVE: Pre-eclampsia is a major obstetric problem. Screening pregnant women to identify those at risk of developing pre-eclampsia could substantially improve quality and focus of antenatal care, and thereby maternal and perinatal outcomes. We investigated the added value of second trimester uterine artery Doppler to patient characteristics in the identification of nulliparous women at risk for pre-eclampsia using individual patient data from previous studies. STUDY DESIGN: We performed a meta-analysis with individual patient data of cohort studies. We searched Medline and Embase to identify eligible articles. Datasets in which patient characteristics, second trimester Doppler ultrasound findings, and the occurrence of pre-eclampsia were available in nulliparous women were included. Authors were invited to share their original datasets. Shared data were checked for consistency, recoded to acquire uniformity, and merged into one dataset. Logistic regression models with a random intercept for study number were constructed for each of the patient and Doppler characteristics alone and in combinations. Performance of models was compared by the likelihood statistic. Discrimination of the models was assessed using the area under the ROC curve (AUC). RESULTS: Eight datasets containing 6708 nulliparous women were used, of which 302 (4.5%) developed pre-eclampsia. Doppler findings included higher, lower and mean Pulsatility Index (PI) and Resistance Index (RI), and any or bilateral notching. Of these, the best predictors were combinations of mean PI or RI and bilateral notching (AUC 0.676 [95% CI 0.618-0.734] and 0.688 [0.650-0.725]). Addition of patient characteristics BMI or blood pressure increased model performance (model with BMI, PI and notching: AUC 0.734 [0.682-0.785], model with BMI, RI and notching: 0.762 [0.725-0.799]). CONCLUSION: The addition of Doppler characteristics mean PI or RI and bilateral notching to patient characteristics blood pressure or BMI improves the identification of women at risk for pre-eclampsia. The combined model performes better than patient or Doppler characteristics alone. Poster Session III Doppler Assessment, Fetus, Prematurity www.AJOG.org