355 BIRTH EXPERIENCE IN HIGH-RISK VERSUS NORMAL PREGNANCY KIER VAN
, JUAN E. VARGAS
, ALVARO INSUNZA
, RICARDO GOMEZ
, AARON B. CAUGHEY
University of California, San Francisco,
Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California,
Clinica Alemana de Santiago, Hospital Padre Hurtado, Universidad del De-
sarrollo, Santiago, Chile,
CEDIP, Sotero del Rio Hospital, Puente Alto, Chile
OBJECTIVE: The literature has shown that women perceive their birth
experience very diﬀerently depending on mode of delivery, prenatal care, and
the amount of education they receive prior to delivery. Here we investigate
how complications in prior pregnancies or a current high-risk pregnancy might
inﬂuence birth experience as well.
STUDY DESIGN: Pregnant women were surveyed in regular and high-risk
prenatal clinics in Santiago, Chile over a six month period. They were
interviewed regarding prior deliveries and outcomes, their anticpated birth
experience during the upcoming delivery, and the maximum amount of pain
they expected to feel. Dimensions of birth experience were assessed by
Salmon’s item list and measured using a 10 point Likert scale.
RESULTS: Of the 643 women surveyed, 152 (23.6%) were patients with
high-risk pregnancies and 491 (76.4%) had normal pregnancies. When
comparing women with a history of prior complications to those with a
history of normal pregnancies, there was no signiﬁcant diﬀerence in the
amount of satisfaction or pain anticipated. They did, however, expect to be
more anxious (8.08 versus 6.89, p=0.039). Patients with current high-risk
pregnancies did not expect more pain, but they anticipated more anxiety (7.62
versus 6.63, p=0.021) and more satisfaction (9.13 versus 8.74, p=0.009).
CONCLUSION: Patient’s with a current high-risk pregnancy or a history of
complications during a prior pregnancy do not anticipate more pain during
delivery, but they do feel more anxious. Interestingly, patients with current
high-risk pregnancies also expect more satisfaction with their delivery. These
data suggest that women with high-risk pregnancies may actually have more
fulﬁlling birth experiences than women with normal pregnancies.
Anticipation of birth experience (satistically signiﬁcant values only)
Satisﬁed dd8.74 9.13
Anxious 6.89 8.08 6.63 7.62
356 HEALTH LITERACY AND PATIENT UNDERSTANDING OF FIRST AND SECOND
TRIMESTER SCREENING FOR ANEUPLOIDY AND NEURAL TUBE DEFECTS
, BETH PLUNKETT
, MICHAEL WOLF
, CHARLA SIMON
Northwestern University, Obstetrics and Gynecology,
Northwestern University, Institute for Health Services Re-
search and Policy Studies, Chicago, Illinois
OBJECTIVE: To determine whether low health literacy is associated with a
patient’s understanding of ﬁrst and second trimester screening tests for fetal
aneuploidy and neural tube defects.
STUDY DESIGN: We performed a prospective observational study on a
cohort of English speaking patients receiving prenatal care in two resident-
staﬀed ambulatory clinics. Health literacy was measured using the Rapid
Estimate of Adult Literacy in Medicine-7 (REALM-7), and low health literacy
was deﬁned as a REALM-7 score of !7. Understanding of the ﬁrst and
second trimester screening tests was assessed using the modiﬁed Maternal
Serum Screening Knowledge Questionnaire (MSSKQ), and inadequate un-
derstanding was deﬁned as an MSSKQ score of !0.5.
RESULTS: Over an eight month period, of the 125 patients who were
approached to participate, 101 (81%) subjects consented to the study. Thirty-
eight (38%) women demonstrated low health literacy. Patients with low health
literacy were signiﬁcantly more likely to demonstrate inadequate understand-
ing of the ﬁrst and second trimester screening tests when compared to patients
with adequate health literacy (97 vs. 11%, p!.001). Similarly, patients with a
12th grade education or less were more likely to have inadequate understand-
ing of the ﬁrst and second trimester screening tests when compared to patients
with more than a 12th grade education (53 vs. 30%, p!.05). The sensitivity
and speciﬁcity of health literacy screening were signiﬁcantly higher than the
sensitivity and speciﬁcity of level of education to detect inadequate knowledge
of the ﬁrst and second trimester screening tests (84 vs. 70%, p!.05; and 98 vs
47%, p!.05, respectively).
CONCLUSION: Detection of low health literacy with a literacy screening tool
is signiﬁcantly associated with inadequate understanding of ﬁrst and second
trimester screening tests. This tool is also more likely to identify women with a
lack of understanding than assessment of educational level alone.
357 C-REACTIVE PROTEIN (CRP) AND OUTCOME OF EMERGENCY CERCLAGE
, BARBARA PARILLA
Advocate Lutheran General Hospi-
tal, Park Ridge, Illinois,
Advocate Lutheran General Hospital, Obstetrics &
Gynecology, Park Ridge, Illinois
OBJECTIVE: C-reactive protein (CRP) is a major acute-phase protein that is
produced in large quantities by the liver in response to IL-1 and IL-6 during
the innate immune response to infection and tissue injury. We hypothesize that
an abnormal CRP at the time of emergent cerclage placement is associated
with a higher incidence of preterm delivery.
STUDY DESIGN: The medical records of patients who received a cervical
cerclage or had the diagnosis of cervical incompetence were reviewed from
January 2000 to December 2004. Prophylactic cerclages were excluded. Forty
patients out of 329 charts reviewed met criteria for this study. All patients
undergoing emergency cerclage placement are tested for CRP.
RESULTS: Of the 40 patients who underwent emergent cerclage placement,
22 had an abnormal CRP value (O 0.8, mean 1.85 G 1.5). The table below
outlines the demographic and outcome data based on CRP results. A multiple
logistic regression analysis was performed with the independent variable being
delivery !30 wks. The dependant variables analyzed were CRP, cervical
dilation, prolapsed membranes, and GA at cerclage placement. Only GA at
placement was signiﬁcantly associated with delivery !30 weeks (OR 0.75,
CI .558-.999). Signiﬁcantly more women delivered at !30 weeks if they re-
ceived the cerclage earlier (mean 19.74 G 2.7 wks versus 21.93 G 3.2 for
delivery O30 wks, p=.028).
CONCLUSION: An elevated CRP level at the time of emergency cerclage
placement was not associated with a higher incidence of delivery prior to 30 wks.
CRP!0.8 (n=18) CRPO0.8 (n=22) p value
GA at cerclage 21.4 G 2.2 20.53 G 3.7 0.36
Cervical dilation 1.33 G 1.0 1.6 G 1.3 0.57
Cervical length 1.9 G 0.8 1.8 G 0.9 0.42
Prolapsed membranes 8 11 0.63
GA at delivery 31.0 G 830.7G 8.1 0.95
358 TIMING IN GESTATION OF RECURRENT PREGNANCY LOSS JESS DALTON
, WARE BRANCH
, T. PORTER
, MELISSA ECKMAN
of Utah, Obstetrics and Gynecology, Salt Lake City, Utah
OBJECTIVE: Recurrent pregnancy loss occurs in approximately one percent
of couples.Despite the frequency of the condition, medical science has made
surprisingly modest progress in identifying causes and developing treatments.
Pregnancy losses prior to twenty weeks gestation have all traditionally been
deﬁned as being spontaneous abortions. However, causes of pregnancy loss
may diﬀer during the pre-embryonic, embryonic, and fetal periods. Thus, our
purpose was to compare the timing in gestation of pregnancy losses in a cohort
of women with recurrent pregnancy loss.
STUDY DESIGN: We used a cohort study design to compare subsequent
pregnancy outcomes in women with idiopathic recurrent pregnancy loss who
had 1) a pregnancy loss with clear documentation of gestational age at the time
of loss and 2) subsequent pregnancies. Subsequent pregnancy outcomes were
compared between women with anembryonic (Group I; !6 weeks), embryonic
(Group II; 6 - 10 weeks), or fetal (Group III; O10 weeks) losses during their
ﬁrst well characterized pregnancy loss.
RESULTS: 498 women met criteria for inclusion and had 1,052 subsequent
pregnancies (Table I).
CONCLUSION: In a population of women with recurrent miscarriage, those
with one type of pregnancy loss are more likely to suﬀer similar types of
pregnancy loss in subsequent pregnancies. This observation implies that etiol-
ogies for pregnancy loss may diﬀer at diﬀerent times in gestation and should
guide further investigation into etiologies of pregnancy loss.
Subsequent pregnancy outcome
Live Birth 6 weeks* 6 - 10 weeks* O 10 weeks* Loss weeks?
Group I (N=130) 61 (23%) 74 (37%) 47 (23%) 35 (17%) 47 (23%)
Group II (N=208) 74 (22%) 47 (18%) 102 (39%) 33 (13%) 83 (31%)
Group III (N=160) 106 (31%) 41 (17%) 62 (26%) 80 (34%) 56 (23%)
P ! 0.001
S108 SMFM Abstracts