OBJECTIVE: To evaluate the safety of medical induction of labor (IOL) versus dilation and evacuation (D&E) at 14-24 weeks for fetal demise or termination of pregnancy. STUDY DESIGN: A retrospective cohort study of IOL and D&E cases was performed at our institution 2012-2015. A power calculation based on prior studies determined that 84 subjects would be needed. Data was collected by chart review. The composite adverse outcome was defined as the rate of uterine perforation, cervical laceration, transfusion, intrauterine infection, D&C for retained products, and/ or need for readmission. Student's t-test, chi-square, and the Mann-Whitney test were used for statistical analyses. RESULTS: There were 88 cases identified, 48 (55%) D&Es and 40 (45%) IOLs. There were no significant differences in maternal demographic characteristics between groups. Intrauterine demise and fetal anomalies were the indication for the majority of D&Es (85%) and IOLs (80%). D&E procedures were completed at a median gestational age of 16 weeks as compared to 20 weeks in the IOL cohort (p<0.01). The median EBL and rate of transfusion were similar in D&E and IOL cases (p>0.05). The rate of infection requiring IV antibiotics was higher in the IOL group (p¼0.02). While 28% of IOL patients required a D&C, there were no repeat procedures required in D&E patients. There were no uterine perforations in either group. The median length of stay was 2 days longer for IOL patients (p<0.01). The rate of the composite adverse outcome was significantly higher in the IOL patients as compared the D&E patients (43% vs. 10%; p<0.01). When examining a subgroup <20 weeks, these findings persisted with a composite complication rate of 50% for IOL and 9% for D&E patients. CONCLUSION: Second trimester fetal demise or termination of pregnancy is most safely managed with D&E as compared to IOL. The major complications of IOL include the failure of the procedure resulting in the need for a D&C and the increase in infectious morbidity.467 Epigenomic response of the fetal liver to maternal high-fat diet and resveratrol supplementation OBJECTIVE: The effects of an adverse gestational environment can persist postnatally, including an increased risk of adult metabolic diseases. In a non-human primate model of maternal high-fat diet (MHFD) we previously demonstrated signs of non-alcoholic fatty liver disease in the fetal livers of MHFD offspring. We further discovered an associated increase in histone H3K14 acetylation and decrease in histone deacetylase SIRT1 activity. To better understand the mechanism of the developmental origins of obesity, we aimed to establish the conserved alterations in the fetal hepatic epigenome in response to MHFD and determine the effect of SIRT1 activation on chromatin structure. STUDY DESIGN: Prior to and throughout pregnancy, Japanese macaques were placed on a control diet (CD) or MHFD with or without suplementation with resveratrol (480 mg/d). An additional cohort of dams previously exposed to HFD were fed CD to investigate the effects of diet...

INTRODUCTION: Preterm delivery is associated with a prolonged third stage of labor. Our objective was to evaluate the risk of maternal morbidity associated with duration of the third stage after midtrimester delivery. METHODS: We performed a retrospective cohort study examining vaginal deliveries between 14-24 weeks gestation. Univariate logistic regression was used for statistical analysis. A receiving operating characteristics (ROC) curve was generated to estimate sensitivity and specificity of the composite outcome (PPH, maternal infection, D&C) at 60 minutes. The proportion of undelivered placentas and risk of PPH or infection were plotted over length of third stage of labor. RESULTS: Of 131 participants, 38.2% had a third stage duration greater than or equal to 60 minutes. The risk of PPH was significantly higher among women with a third stage of labor greater than 60 minutes (OR=4.85, 95% CI: 2.11-11.11). This group was also more likely to undergo a post-delivery D&C (OR=18.6, 95% CI: 5.15-67.04). There was no difference in infection risk (OR=0.76, 95% CI: 0.17-3.30). The AUROC was 0.70 (sensitivity 67.0%, specificity 71.0%) for the composite outcome at 60 minutes. The proportion of undelivered placentas demonstrated exponential decay over time, while the risk of PPH and/or infection increased after 90 minutes. CONCLUSION: Maternal risk of PPH and need for post-delivery D&C at the time of midtrimester delivery increases with a third stage of labor greater than 60 minutes. Our data suggest that if the placenta is undelivered after 90 minutes, manual extraction or D&C is indicated to mitigate the increasing risk of maternal morbidity.