Spontaneous Term Research Articles

The Realization of Casual Conversation Features of EFL Learners

This study was descriptive qualitative, which aimed at explaining the casual conversation features between two learners and its functions in terms of negotiation meaning, spontaneity, interpersonality, and interactivity. To obtained data, firstly, recording the conversation was done, continued by transcribing, coding, and the last was analyzing the findings. The findings showed this conversation was dominated by exchange information and idea between the speakers rather than exchanging feelings because logico-semantic appeared more dominant than interpersonal negotiation. In terms of spontaneity feature, it could be shown by the learners’ laughter during the conversation. Meanwhile, interpersonality features occurred were filled pauses, repetition, false start, and chunk. Then, interactivity features were turn-taking, back-channeling, and discourse markers. Also, those number of features and its functions implied in this casual conversation have an essential contribution. For instance, filled pauses can be used to take time to think of what is going to say. This study suggests that further research investigates how cultural and gender affect the speakers’ spoken features in monologue and dialogue speech, and also both formal and non-formal situations

Maternal stress, low cervicovaginal β-defensin, and spontaneous preterm birth

Spontaneous preterm birth (sPTB) is a major contributor to infant mortality and its etiology remains poorly understood. Host immunity and maternal stress may play a role in the pathogenesis of sPTB but mechanisms are poorly delineated. Antimicrobial proteins in the cervicovaginal space, such as beta defensins, modulate immune responses to bacteria and have been shown to modulate the risk of sPTB from non-optimal microbiota. While stress is known to induce immunological changes, no study has examined the interplay between maternal stress and the immune response in association with sPTB. Our objectives were to determine whether psychosocial stress was associated with a mediator of the immune system in the cervicovaginal space, beta defensin-2, and to examine the combined impact of high stress and low cervicovaginal beta defensin-2 levels on the odds of sPTB. From the Motherhood & Microbiome cohort study (n=2000), we performed a secondary, nested case-control study, frequency matched by race/ethnicity, of 519 pregnant women (110 sPTB and 409 term). Stress and cervicovaginal beta defensin-2 levels were measured at 16-20 weeks of gestation. Stress was dichotomized at a score of 30 on Cohen's Perceived Stress Scale (PSS-14). We measured cervicovaginal beta defensin-2 levels with ELISA and dichotomized at the median. We modeled associations of high stress and low cervicovaginal beta defensin-2 levels using multivariable logistic regression. We also compared the proportion of women with high stress and low cervicovaginal beta defensin-2 levels among women with spontaneous preterm and term births using Chi-Square tests. We modeled adjusted associations of stress and cervicovaginal beta defensin-2 levels with odds of sPTB using logistic regression. The majority of the study population was non-Hispanic black (72.8%), insured by Medicaid (51.1%), and had a PSS-14 score < 30 (80.2%). High stress was associated with reduced adjusted odds of low beta defensin-2 levels (aOR 0.63, 95% CI: 0.38 -0.99). In a model adjusted for race and smoking, both high stress (aOR 1.72, 95% CI: 1.03-2.90) and low beta defensin-2 (aOR 1.58, 95% CI: 1.004-2.49) were associated with increased odds of sPTB. We then built a model of the four possible combinations of low and high stress and low and high beta defensin-2 levels with the odds of sPTB. Women with either high stress (aOR 1.37, 95% CI: 0.68 - 2.78) or low beta defensin-2 (aOR 1.40, 95% CI: 0.83-2.34), had slightly elevated but not significantly increased odds of sPTB compared to women with neither exposure. However, women with both high stress and low beta defensin-2 had significantly elevated odds of sPTB compared to women with neither exposure (aOR 3.16, 95 % CI: 1.46 - 6.84). High perceived stress and low cervicovaginal beta defensin-2 levels are associated with higher odds of sPTB, and when present concurrently, they result in the highest odds of sPTB in a largely non-Hispanic black cohort. Our findings warrant further work to examine social determinants of health and the host cervicovaginal immune responses that may modulate the pathogenesis of sPTB.

387: The expression of heparanase in term and preterm human placentas

Heparanase is an endo-β-glucuronidase that cleaves side chains of heparan-sulfate proteoglycans, an integral constituent of the extra cellular matrix. The abundance of heparanase in placental trophoblast cells implies its role in the processes of placentation and trophoblast invasion. This study aims to explore the involvement of heparanase in parturition and preterm deliveries (PTD). Sixteen human placentas were collected following singleton spontaneous onset term vaginal deliveries (n=6), spontaneous onset preterm vaginal deliveries (n=7) and term elective cesarean sections (n=3). Placentas were excluded if any maternal chronic illness, pregnancy or delivery complications (hypertensive disorder, suspected amnionitis, placental abruption etc.). Placental tissue samples were dissected, homogenized and proteins were extracted. Additionally, cryosections were prepared from the placental tissues. Heparanase expression was evaluated utilizing western blot analysis and immunofluorescence staining using heparanse specific antibodies. Heparanase expression was compared between the study groups qualitatively and quantitatively by student t-test. P-value < 0.05 was considered significant. Western blot analysis results demonstrate increased expression of both pro-heparanase and heparanase in PTD placentas compared to term vaginal (TV) placentas (Figure 1). Accordingly, immunofluorescence staining shows elevated heparanase expression in PTD placentas compared to term vaginal placentas (5.1±0.92 vs. 1.2±0.18, p< 0.005). Contrarily, the expression level of heparanase was not altered in term cesarean section (TCS) placentas as compared to term vaginal deliveries placentas (1.8±0.39 vs. 1.2±0.18, p=0.06) (Figure 2). This study demonstrates for the first time that preterm vaginal deliveries are associated with over-expression of heparanase in placental tissue. This may imply a direct effect of heparanase on preterm labor. Further studies should evaluate the functional role by which heparanase influence preterm delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

392: Postpartum cervical length and the risk for preterm birth in the following pregnancy

We previously demonstrated that cervical length (CL) following preterm birth (PTB) during the first 2 postpartum days is significantly shorter compared with CL measured following term deliveries. In this study, we aim to examine the correlation between postpartum CL following PTB and the risk for recurrent PTB. In a prospective study conducted between 2016-2019, CL was measured transvaginally following PTB and term pregnancies at 8, 24, 48hrs & 6wks. Measurements were performed by a single operator (R.L) blinded to gestational age. Gestational age at delivery was presented as mean and range. Normal postpartum CL was determined following spontaneous term deliveries, presented as mean±SD. Abnormal CL was defined as 2SD below the mean. Of the 1348 patients that participated in the study, 247 delivered before 34wks. (e-PTB) and 141 women delivered between 34-37wks. (l-PTB). Women with PTB history were treated with progesterone. 77 women with e-PTB and 63 women with l-PTB delivered again during the study period. e-PTB: 54 women had abnormal CL at 8hrs. (0.86±0.13cm) and 48hrs. (1.78±0.19cm) postpartum. All delivered significantly earlier in the next pregnancy (30.3wks. (24-32.4)). All 23 women who had normal postpartum CL delivered at term (38.2wks (37.1-40.5)). l-PTB: 5 patients had abnormal CL at 8hrs. and 48hrs. postpartum [0.94±0.21cm and 1.95±0.11cm, respectively]. All, had e-PTB in the next pregnancy (31.6wks (30.3-33.5)). All 58 patients had normal postpartum CL delivered at term (38.6wks (37.6-40.2)). Sensitivity, specificity, NPV and PPV for prediction of future PTB were 83%, 85%, 94% and 62%, respectively, 8hrs postpartum, and 100% in all 4 parameters 48hrs postpartum. Postpartum CL measurement should be considered following PTB. Normal postpartum CL following PTB might call for preventive treatment with progesterone, while short postpartum CL may represent an extremely high-risk group that could benefit from close surveillance in the late 2nd trimester when intervention such as cerclage or pessary could be offered for shortening despite progesterone therapy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Plasma oxylipins and unesterified precursor fatty acids are altered by DHA supplementation in pregnancy: Can they help predict risk of preterm birth?

Oxidized lipids derived from omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids, collectively known as oxylipins, are bioactive signaling molecules that play diverse roles in human health and disease. Supplementation with n-3 docosahexaenoic acid (DHA) during pregnancy has been reported to decrease the risk of preterm birth in singleton pregnancies, which may be due to effects of DHA supplementation on oxylipins or their precursor n-6 and n-3 fatty acids. There is only limited understanding of the levels and trajectory of changes in plasma oxylipins during pregnancy, effects of DHA supplementation on oxylipins and unesterified fatty acids, and whether and how oxylipins and their unesterified precursor fatty acids influence preterm birth. In the present study we used liquid chromatography-tandem mass spectrometry to profile oxylipins and their precursor fatty acids in the unesterified pool using plasma samples collected from a subset of pregnant Australian women who participated in the ORIP (Omega-3 fats to Reduce the Incidence of Prematurity) study. ORIP is a large randomized controlled trial testing whether daily supplementation with n-3 DHA can reduce the incidence of early preterm birth compared to control. Plasma was collected at study entry (≈pregnancy week 14) and again at ≈week 24, in a subgroup of 48 ORIP participants—12 cases with spontaneous preterm (<37 weeks) birth and 36 matched controls with spontaneous term (≥40 weeks) birth. In the combined preterm and term pregnancies, we observed that in the control group without DHA supplementation unesterified AA and AA-derived oxylipins 12-HETE, 15-HETE and TXB2 declined between weeks 14–24 of pregnancy. Compared to control, DHA supplementation increased unesterified DHA, EPA, and AA, DHA-derived 4-HDHA, 10-HDHA and 19,20-EpDPA, and AA-derived 12-HETE at 24 weeks. In exploratory analysis independent of DHA supplementation, participants with concentrations above the median for 5-lipoxygenase derivatives of AA (5-HETE, Odds Ratio (OR) 8.2; p = 0.014) or DHA (4-HDHA, OR 8.0; p = 0.015) at 14 weeks, or unesterified AA (OR 5.1; p = 0.038) at 24 weeks had higher risk of spontaneous preterm birth. The hypothesis that 5-lipoxygenase-derived oxylipins and unesterified AA could serve as mechanism-based biomarkers predicting spontaneous preterm birth should be evaluated in larger, adequately powered studies.

Trajnost i promena. Abortusna kultura, liberalizacija propisa i pokušaji seksualne edukacije stanovništva Jugoslavije (1918–1991)

Prispevek preučuje ureditev in prakso načrtovanja družin v Jugoslaviji v 20. stoletju. Čeprav so se družbeno-gospodarske razmere v državi spreminjale, dvigal se je življenjski standard in kontracepcija je postala širše dostopna, je za večino parov v celotnem dvajsetem stoletju splav, najprej nezakonit, nato zakonit, ostal eden od osnovnih "metod" spontanega in nepremišljenega načrtovanja starševstva. Paradoksalno je, da je bil, kljub svobodnejši spolnosti in seksualni revoluciji, ki sta se zgodili po vojni, ter prizadevanjem za odpiranje svetovalnih centrov, širjenju kontracepcije in t. i. "humanizaciji odnosov med spoloma", eden temeljnih uspehov državne politike na področju načrtovanja družine dekriminaliziranje splava in njegova "selitev" v bolnišnice in ambulante. Na podlagi virov iz Arhiva Jugoslavije in relevantnih periodičnih publikacij ter literature bo avtorica skušala odgovoriti na vprašanje, zakaj je imela državna politika pri tem skromne rezultate, pa tudi, kakšni motivi so vplivali na pare, da so se odločali za družine z enim ali dvema otrokoma.

Investigation of triphenylamine-based sensitizer characteristics and adsorption behavior onto ZnTiO3 perovskite (1 0 1) surfaces for dye-sensitized solar cells using first-principle calculation

Four different Triphenylamine-based dyes, named as TPA-1, TPA-2, TPA-3 and TPA-4 as shown below, with substituents containing different linkages, earlier described inTiO2dye-sensitized solar cells (DSSCs), are described. The dyes are examined as potential dyes for perovskite ZnTiO3 based dye sensitized solar cells (DSSCs). The simulated characteristics include: Electronic absorption spectra, light harvesting efficiency, energy of dye adsorption to the semiconductor ZnTiO3 electrode, energy level alignment and spontaneity of charge transfer across the dye interfaces with ZnTiO3 and with solution redox couple. The characteristics have been comparatively investigated for all dyes. The absorption spectra for each dye, in its free and adsorbed forms, are discussed. Energy levels and electrochemical parameters are investigated to assess electron transfer efficiency between the excited dyes and the ZnTiO3 particles. Among the series, the dye TPA-3 shows superior behaviors, in terms of spontaneity of charge transfer with ZnTiO3 conduction band. The dye exhibits bidentate mode bonding with the semiconductor surface (1 0 1) as evidenced from its high adsorption energy. Such bonding enables stronger adherence between the dye and the semiconductor and enables more efficient charge transfer. The results encourage more theoretical and experimental study on TPA-3@ZnTiO3 DSSCs, with promising conversion efficiency and stability.

TNF-α effect on human delivery onset by CB1/TRPV1 crosstalk: new insights into endocannabinoid molecular signaling in preterm vs. term labor. Analysis of the EC/EV pathway and predictive biomarkers for early diagnosis of preterm delivery.

Endocannabinoids/endovanilloid (EC/EV) system and inflammation are recognized as key regulators of cell-signaling pathways in female reproduction. The knowledge of predictive biomarkers involved in preterm birth (PTB) represents an important goal to make an early diagnosis. The aim of the study was to investigate the role of EC/EV system and inflammation in human delivery, in placental samples from spontaneous deliveries. We examined the expression of genes encoding for the components of EC/EV system (CB1, CB2, TRPV1, MAGL, FAAH, DAGL, NAPE-PLD) and for inflammatory cytokines (IL-6, TNF-α) with qRT-PCR techniques, in human placental samples from preterm delivery (at 30 and at 34 weeks) compared to term delivery (40 weeks, control group). We found a marked increase of CB1, anandamide, and inflammatory cytokines, mainly TNF-α, together with TRPV1 down-regulation in term delivery group, compared to preterm groups (P<0.05). Our findings highlighted the emergent pivotal role of the EC/EV system and inflammation in spontaneous term delivery and provided the framework for future studies that investigate the CB1/TRPV1 crosstalk in preterm birth. Particularly, we found a link between the stimulation of CB1 receptors and the antagonism of TRPV1 channels, that could be used in PTB prevention, through selected molecules.

Vascular Function and Serum Lipids in Women with Spontaneous Preterm Delivery and Term Controls.

Background: Spontaneous preterm delivery (sPTD) is associated with a twofold increased risk of future maternal cardiovascular disease. We hypothesized that women with sPTD would demonstrate greater vascular dysfunction postpartum compared to women with term delivery. Materials and Methods: In a case-controlled, matched pilot study, we enrolled 20 women with sPTD (gestation ≤34 weeks), and 20 term control women (gestation ≥39 weeks) were matched for age (±5 years), parity, ethnicity, and route of delivery. Vascular function, serum lipids, C-reactive protein, and interleukin-6 were completed within 24-72 hours postpartum. Statistical analysis included paired t-tests based on match and mixed effects linear regression models and adjusted for potential confounders. Results: The mean age for sPTD and term controls was 33 ± 6 years and 32 ± 6 years, respectively. Women with sPTD had significantly lower augmentation index-75 (24.1% ± 16.1% vs. 39.9% ± 15.2%, p = 0.001) and central pulse pressure (29.1 ± 5.4 mmHg vs. 34.6 ± 4.7 mmHg, p = 0.004), but no difference in pulse wave velocity (5.1 ± 1.6 m/s vs. 5.6 ± 1.5 m/s, p = 0.12) compared to controls. Women with sPTD had significantly lower high-density lipoprotein cholesterol (59.4 ± 12.5 mg/dL vs. 67.6 ± 13.1 mg/dL, p = 0.035) compared to controls. Analysis of chorioamnionitis and magnesium sulfate did not alter the results. Conclusions: Women with sPTD have signs of lower smooth muscle tone in the early postpartum period compared to women with term delivery. Further research is required to understand mechanistic pathways in sPTD and future maternal cardiovascular disease risk.

Fetal adrenal gland size and the ability to predict spontaneous term labor

ObjectiveThe objective of this study was to evaluate whether ultrasound measured fetal adrenal gland size can be a predictor of spontaneous term labor. Study designThis study was a diagnostic test accuracy study using a prospective cohort design evaluating the ability of 2-dimensional ultrasound measurement of fetal adrenal gland total length, total width, fetal zone length and fetal zone width in women in the third trimester to predict the primary outcome of spontaneous term labor. Secondary outcomes were vaginal delivery, length of labor, and maternal and neonatal morbidities. ResultsOf 43 patients recruited, 3 were excluded. 11 (25.6%) presented in spontaneous labor and 29 (67.4%) underwent induction of labor. Patient demographics were similar for all included except for admission cervical exam and oxytocin use. A receiver operative curve was created to assess test predictability. Weighted width of fetal adrenal gland was the best predictor of spontaneous labor amongst variables measured with an area under the curve of 0.674, p = 0.93. w/W ≥ 0.41 had a sensitivity of 91.0%, specificity of 44.8%, positive predictive value of 38.5% and a negative predictive value of 92.3%. Maternal and neonatal morbidities were not different between the spontaneous labor group and the induction of labor group. ConclusionUltrasound measured fetal w/W was moderately predictive of spontaneous labor.

ANALYSIS OF CASUAL CONVERSATION IN SPONTANEITY, INTERACTIVITY, INTERPERSONALLY AND COHERENCE FEATURES

This study was carried out to respectively illustrate the casual conversation features in terms of spontaneity, interactivity, interpersonally, and coherence. The casual conversation analyzed was a conversation of two non-native English speakers who are an English teacher and a student at a convenient situation. The conversation lasted for eighteen minutes was transcribed. Results showed that S1 dominantly used features of spontaneity on the field of repetition, incomplete utterances, and chunks. On the features of interactivity, S2 is more cooperative than S1. In addition, on the feature of interpersonally, both speakers seemed to appeal more agreement. Thus, in terms of coherence, both speakers can run the conversation smoothly. The two speakers were still making conversation in line with the topic although they changed the topic three times.

Risk of spontaneous preterm birth and fetal growth associates with fetal SLIT2.

Spontaneous preterm birth (SPTB) is the leading cause of neonatal death and morbidity worldwide. Both maternal and fetal genetic factors likely contribute to SPTB. We performed a genome-wide association study (GWAS) on a population of Finnish origin that included 247 infants with SPTB (gestational age [GA] < 36 weeks) and 419 term controls (GA 38–41 weeks). The strongest signal came within the gene encoding slit guidance ligand 2 (SLIT2; rs116461311, minor allele frequency 0.05, p = 1.6×10−6). Pathway analysis revealed the top-ranking pathway was axon guidance, which includes SLIT2. In 172 very preterm-born infants (GA <32 weeks), rs116461311 was clearly overrepresented (odds ratio 4.06, p = 1.55×10−7). SLIT2 variants were associated with SPTB in another European population that comprised 260 very preterm infants and 9,630 controls. To gain functional insight, we used immunohistochemistry to visualize SLIT2 and its receptor ROBO1 in placentas from spontaneous preterm and term births. Both SLIT2 and ROBO1 were located in villous and decidual trophoblasts of embryonic origin. Based on qRT-PCR, the mRNA levels of SLIT2 and ROBO1 were higher in the basal plate of SPTB placentas compared to those from term or elective preterm deliveries. In addition, in spontaneous term and preterm births, placental SLIT2 expression was correlated with variations in fetal growth. Knockdown of ROBO1 in trophoblast-derived HTR8/SVneo cells by siRNA indicated that it regulate expression of several pregnancy-specific beta-1-glycoprotein (PSG) genes and genes involved in inflammation. Our results show that the fetal SLIT2 variant and both SLIT2 and ROBO1 expression in placenta and trophoblast cells may be correlated with susceptibility to SPTB. SLIT2-ROBO1 signaling was linked with regulation of genes involved in inflammation, PSG genes, decidualization and fetal growth. We propose that this receptor-ligand couple is a component of the signaling network that promotes SPTB.

Interpretable deep learning to map diagnostic texts to ICD-10 codes

BackgroundAutomatic extraction of morbid disease or conditions contained in Death Certificates is a critical process, useful for billing, epidemiological studies and comparison across countries. The fact that these clinical documents are written in regular natural language makes the automatic coding process difficult because, often, spontaneous terms diverge strongly from standard reference terminology such as the International Classification of Diseases (ICD). ObjectiveOur aim is to propose a general and multilingual approach to render Diagnostic Terms into the standard framework provided by the ICD. We have evaluated our proposal on a set of clinical texts written in French, Hungarian and Italian. MethodsICD-10 encoding is a multi-class classification problem with an extensive (thousands) number of classes. After considering several approaches, we tackle our objective as a sequence-to-sequence task. According to current trends, we opted to use neural networks. We tested different types of neural architectures on three datasets in which Diagnostic Terms (DTs) have their ICD-10 codes associated. Results and conclusionsOur results give a new state-of-the art on multilingual ICD-10 coding, outperforming several alternative approaches, and showing the feasibility of automatic ICD-10 prediction obtaining an F-measure of 0.838, 0.963 and 0.952 for French, Hungarian and Italian, respectively. Additionally, the results are interpretable, providing experts with supporting evidence when confronted with coding decisions, as the model is able to show the alignments between the original text and each output code.

The Effect of Video Education on Skin-to-Skin at the Time of Delivery [18T

INTRODUCTION: Skin-to-skin contact (SSC) is significantly associated with breastfeeding which continues to be below national goals. With a lack of research on how to overcome barriers to SSC, this trial examined the effect of video education upon admission for delivery on intent to, and actual participation in SSC. METHODS: Randomized control trial (June 2017-October 2017) of educational intervention in women (N=240) 18 or older admitted in anticipation of normal spontaneous term delivery. Alternate patients were randomized at the time of admission into video (N=120) and no video (N=120) groups. Both groups received a brief survey about SSC. The video group watched a patient education DVD and completed a post survey about SSC. IRB approval and patient informed consent were obtained. RESULTS: During the pre-intervention survey, 89.2% (107/120) of those in the video group compared to 83.3% (100/120) of those in the no video group indicated that they planned to use SSC (p=0.396). After the video, 98.3% (118/120) planned to do SSC after delivery (p<0.001). However, only 59.8% (55/92) started SSC within 5 minutes of delivery in the video group and only 49.4% (42/85) started SSC within 5 minutes of delivery in the no video group (p=0.17). CONCLUSION: Video education at the time of admission prior to delivery alters the intention of patients and trends towards preforming SSC within five minutes of delivery. Despite the plans for SSC there was no significant difference in rates of utilization between the two groups. These findings support that obstacles, other than prenatal education, may affect early SSC.

Ultrasound assisted batch operation for the adsorption of hexavalent chromium onto engineered nanobiocomposite

The study demonstrates the comparative retention characteristics of chromium from aqueous environment on iron(III) cellulose nanocomposite bead under conventional (C-ads) and ultrasound assisted (U-ads) batch adsorption operation. Optimization of process parameters was achieved varying pH, contact/sonication time, initial Cr(VI) concentration, adsorbent dose at fixed solution temperature. Equilibrium was achieved within 5 h and 30 min of contact time in C-ads and U-ads respectively. Langmuir isotherm is found suitable in C-ads while Temkin in U-ads. Both the operation is aided by change in negative free energy, positive enthalpy and entropy. Ultrasound assisted adsorption is much favorable in terms of efficiency, feasibility, spontaneity and randomness. Both the operations follow more the second order than the first order kinetic model. The pore diffusion prevails more in case of U-ads while the surface adsorption in C-ads.

The Robson 10‐group classification in Iceland: Obstetric interventions and outcomes

Rising cesarean rates call for studies on which subgroups of women contribute to the rising rates, both in countries with high and low rates. This study investigated the cesarean rates and contributing groups in Iceland using the Robson 10-group classification system. This study included all births in Iceland from 1997 to 2015, identified from the Icelandic Medical Birth Registry (81839). The Robson distribution, cesarean rate, and contribution of each Robson group were analyzed for each year, and the distribution of other outcomes was calculated for each Robson group. The overall cesarean rate in the population was 16.4%. Robson groups 1 (28.7%) and 3 (38.0%) (spontaneous term births) were the largest groups, and groups 2b (0.4%) and 4b (0.7%) (prelabor cesareans) were small. The cesarean rate in group 5 (prior cesarean) was 55.5%. Group 5 was the largest contributing group to the overall cesarean rate (31.2%), followed by groups 1 (17.1%) and 2a (11.0%). The size of groups 2a (RR1.04 [95% CI1.01-1.08]) and 4a (RR1.04 [95% CI1.01-1.07]) (induced labors) increased over time, whereas their cesarean rates were stable (group 2a: P=0.08) or decreased (group 4a: RR0.95 [95% CI0.91-0.98]). In comparison with countries with high cesarean rates, the prelabor cesarean groups (singleton term pregnancies) in Iceland were small, and in women with a previous cesarean, the cesarean rate was low. The size of the labor induction group increased, yet the cesarean rate in this group did not increase.

Incidence of pregnancy and disease-modifying therapy exposure trends in women with multiple sclerosis: A contemporary cohort study

BackgroundExposure to disease-modifying therapy (DMT) during early pregnancy in women with relapsing-remitting MS (RRMS) may be increasing. ObjectiveTo retrospectively determine incidence of pregnancy, DMT exposure and pregnancy outcomes in women with RRMS. MethodsWe identified all women with RRMS aged 15–45 years in the MSBase Registry between 2005–2016. Annualised pregnancy incidence rates were calculated using Poisson regression models. DMT exposures and pregnancy outcomes were assessed. ResultsOf 9,098 women meeting inclusion criteria, 1,178 (13%) women recorded 1,521 pregnancies. The annualised incidence rate of pregnancy was 0.042 (95% CI 0.040, 0.045). A total of 635 (42%) reported pregnancies were conceived on DMT, increasing from 27% in 2006 to 62% in 2016. The median duration of DMT exposure during pregnancy was 30 days (IQR: 9, 50). There were a higher number of induced abortions on FDA pregnancy class C/D drugs compared with pregnancy class B and no DMT (p = 0.010); but no differences in spontaneous abortions, term or preterm births. ConclusionsWe report low pregnancy incidence rates, with increasing number of pregnancies conceived on DMT over the past 12-years. The median duration of DMT exposure in pregnancy was relatively short at one month.

982: Arrest of descent- “The descent in cervical recovery postpartum after emergent C-Section”

Cervical recuperation postpartum remains a mystery. Cervical length (CL) returns to normal during the puerperium. Recent studies have demonstrated that emergent C-Section (CS) with full dilatation increases the risk for preterm birth in the following pregnancy. We aimed to investigate differences in cervical recuperation between spontaneous term vaginal deliveries and emergent CS at full dilatation. The study was conducted between 2016-2018. Following informed consent, CL measurements were performed for primipara women following emergent CS and spontaneous term deliveries. Women undergoing elective CS or emergent CS without full dilatation were excluded. All measurements were conducted trans-vaginally by a single observer (R.L) at 8, 24 and 48 hours postpartum. All relevant demographic and medical characteristics, were obtained from the patients’ medical records. Our cohort included 292 patients of whom, 38 patients underwent emergent CS at full dilatation. The indications for CS included arrest of descent (25 patients) and non-reassuring fetal heart rate (13 patients). The mean length of the 2nd stage of labor was 3.8±0.4 hrs and 1.3±0.5 hrs in the arrest of descent group and the non- reassuring fetal heart rate group, respectively. Significant pathological cervical recuperation was demonstrated following emergent CS due to arrest of descent compared to emergent CS due to non-reassuring fetal heart rate and spontaneous vaginal deliveries (27.4±2.5 mm vs. 30.4±1.6 mm vs. 35.2±3.5 mm P=0.018 respectively). (Fig 1). Emergent CS, especially due to prolonged 2nd stage, has a clear effect on cervical recuperation postpartum. Though the clinical significance of abnormal cervical recovery is yet unknown, it might imply for long term damage to the cervix. Our findings reinforce the results of recent studies which demonstrated a significant correlation between emergent CS and future preterm delivery.

460: Prior spontaneous preterm birth is not associated with maternal morbidity in subsequent pregnancies

Emerging data suggests that placental malperfusion and subsequent placental dysfunction may play a significant role in the pathophysiology of spontaneous preterm birth (PTB). The placental response to malperfusion is thought to lead to a pro-inflammatory state. We hypothesized that PTB patients with a history of prior spontaneous preterm birth (pSPB) may prone to recurrent placental dysfunction and in subsequent pregnancies and not only at increased risk of recurrent PTB but to maternal morbidity as well. This study aimed to determine if history of pSPB is associated with maternal morbidity in subsequent pregnancies. This was a retrospective cohort study of all women with two pregnancies at an academic tertiary care institution from 2004 to 2014. Pregnancy outcomes, and maternal morbidity rates were compared between women with a history of pSPB and with a history of prior spontaneous term birth. The primary outcome was composite morbidity, comprised of postpartum hemorrhage (PPH), transfusion, wound infection, fever, & endomyometritis. T-tests & Mann- Whitney U tests were used for continuous variables and chi-square/Fisher’s exact tests for categorical variables. 3,202 patients had at least two pregnancies in the study period, and 695 (21.7%) patients had a history of a prior spontaneous preterm birth. Patients with pSPB were more likely to be African-American, and develop a hypertensive disorder. The current pregnancies of patients with pSPB were more likely to result in vaginal delivery at earlier gestation, and have lower birth weights. The composite maternal morbidity rate, PPH, transfusion and infection rates were similar. In this study, patients with a pSPB do not appear to be at an increased risk of maternal morbidity in subsequent pregnancies. Further pursuit with a larger population evaluating not only maternal morbidity but neonatal outcomes as well may be helpful to determine the overall risk of morbidity in subsequent pregnancies of women with history of prior SPB.

Clinical chorioamnionitis at term IX: in vivo evidence of intra-amniotic inflammasome activation.

Background The inflammasome has been implicated in the mechanisms that lead to spontaneous labor at term. However, whether the inflammasome is activated in the amniotic cavity of women with clinical chorioamnionitis at term is unknown. Herein, by measuring extracellular ASC [apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain (CARD)], we investigated whether there is in vivo inflammasome activation in amniotic fluid of patients with clinical chorioamnionitis at term with sterile intra-amniotic inflammation and in those with intra-amniotic infection. Methods This was a retrospective cross-sectional study that included amniotic fluid samples collected from 76 women who delivered after spontaneous term labor with diagnosed clinical chorioamnionitis. Intra-amniotic inflammation was defined as an elevated amniotic fluid interleukin (IL)-6 concentration ≥2.6 ng/mL, and intra-amniotic infection was diagnosed by the presence of microbial invasion of the amniotic cavity (MIAC) accompanied by intra-amniotic inflammation. Patients were classified into the following groups: (1) women without intra-amniotic inflammation or infection (n=16); (2) women with MIAC but without intra-amniotic inflammation (n=5); (3) women with sterile intra-amniotic inflammation (n=15); and (4) women with intra-amniotic infection (n=40). As a readout of in vivo inflammasome activation, extracellular ASC was measured in amniotic fluid by enzyme-linked immunosorbent assay. Acute inflammatory responses in the amniotic fluid and placenta were also evaluated. Results In clinical chorioamnionitis at term: (1) amniotic fluid concentrations of ASC (extracellular ASC is indicative of in vivo inflammasome activation) and IL-6 were greater in women with intra-amniotic infection than in those without intra-amniotic inflammation, regardless of the presence of MIAC; (2) amniotic fluid concentrations of ASC and IL-6 were also higher in women with sterile intra-amniotic inflammation than in those without intra-amniotic inflammation, regardless of the presence of MIAC; (3) amniotic fluid concentrations of IL-6, but not ASC, were more elevated in women with intra-amniotic infection than in those with sterile intra-amniotic inflammation; (4) a positive and significant correlation was observed between amniotic fluid concentrations of ASC and IL-6; (5) no differences were observed in amniotic fluid ASC and IL-6 concentrations between women with and without MIAC in the absence of intra-amniotic inflammation; (6) women with intra-amniotic infection had elevated white blood cell counts and reduced glucose levels in amniotic fluid compared to the other three study groups; and (7) women with intra-amniotic infection presented higher frequencies of acute maternal and fetal inflammatory responses in the placenta than those with sterile intra-amniotic inflammation. Conclusion The intra-amniotic inflammatory response, either induced by alarmins or microbes, is characterized by the activation of the inflammasome - as evidenced by elevated amniotic fluid concentrations of extracellular ASC - in women with clinical chorioamnionitis at term. These findings provide insight into the intra-amniotic inflammatory response in women with clinical chorioamnionitis at term.