Poster Session III Epidemiology, Ob Quality, Operative Obstetrics, Public Health, Infectious Disease, Academic Issues www.AJOG.org

method (national registries vs health surveys), gestational age (GA)determination (LMP, US, or clinical exam), and GA threshold dis-tinguishing PTB from “miscarriage”. Our aim was to perform apopulation-based estimation of PTB with active surveillance of ruraland urban villages, local health centers, and regional referralhospitals.STUDY DESIGN: We partnered with obstetrician specialists, commu-nity health workers, and local midwives and clinicians in a 50kmregion surrounding Lilongwe, Malawi. Actively engaging in com-munity-based antenatal care enabled data abstraction from local andregional/central labor wards, alongside home visits in surroundingvillages when a birth was heard to occur. Deidentified data weregathered and reposited on a secure web-based central repository;15% of all data were audited. Residing village and district de-mographics allowed for tracking of central hospital subjects fromtheir population cluster. For 1/3 of subjects both clinical and bestobstetrical GA estimates were compared by linear regression.RESULTS: Rates of PTB, stillbirth, and cesarean delivery are reported(Table). Over 6 months, we recorded 4585 live births and 1916 PTB(369 <34wks). There is significant concordance (r2 0.62, p<0.0001)between clinical and “best obstetrical” estimated GA. Indicative ofexpectation of survival, approximately 20% of PTB were delivered bycesarean (mean birthweight 1.77 kg).CONCLUSION: Working in partnership with our Malawian colleagues,we aimed to make every birth count from the village to the centralreferral hospital. We observed a clinically significant PTB rate of26.2% (26-34 weeks). These findings imply that further PTBresearch into underlying (notably genomic) causes, prevention, andintervention is warranted in this high-risk population.

523 The influence of pre-pregnancy antiretroviral therapy on

placental pathology in HIV infected pregnanciesRobert Stewart1, Elaine Duryea1, C. Edward Wells1,Vanessa Rogers1, Scott Roberts1, Donald McIntire1,Barbara McElwee1, Jeanne Sheffield11University of Texas Southwestern Medical Center, Obstetrics andGynecology, Dallas, TX

OBJECTIVE: To determine if pre-pregnancy antiretroviral therapy(ART) influences placental pathology findings in pregnanciescomplicated by maternal HIV infection.STUDY DESIGN: Women living with HIV who delivered at our insti-tution from January 1, 1984 until January 1, 2012 were identified.Records were obtained and reviewed for maternal data and placental

S258 American Journal of Obstetrics & Gynecology Supplement to JANUARY

pathology findings. The data was then divided into cohorts based onHIV status at presentation.RESULTS: During the study period, 715 deliveries of HIV infectedwomen with placental pathology were identified. Of these, 230(32%) were receiving ART prior to pregnancy, 178 (25%) had aknown diagnosis of HIV but were not receiving ART, and 307 (43%)were diagnosed with HIV during the pregnancy. Those women witha known diagnosis of HIV receiving ART prior to pregnancy wereless likely to have acute villitis on placental pathology as compared towomen not on ART or those diagnosed with HIV during pregnancy(p¼0.04). When all women not receiving ART prior to pregnancywere combined (those diagnosed during pregnancy and those with aknown diagnosis not on ART), women receiving ART prior topregnancy remained less likely to have acute villitis on placentalpathology (p¼0.01). When women diagnosed with HIV during thecurrent pregnancy, and therefore unable to receive ART prior topregnancy, were excluded, those who received ART prior to preg-nancy remained less likely to have acute villitis on placental pa-thology compared to women with a known diagnosis of HIV notreceiving ART (p¼0.02). When these findings were adjusted for CD4count <200 at presentation, they remained significant and inde-pendent of CD4 count.CONCLUSION: Pre-pregnancy ART use in HIV infected women isassociated with a decreased incidence of acute villitis on placentalpathology at delivery. As placental inflammation is known to beassociated with vertical transmission, this study indicates that pre-pregnancy ARTmay be beneficial to decrease maternal to child HIVtransmission.

Placental pathology findings of women living withHIV compared by ART at pregnancy initiation

Data presented as N (%) or median [Q1, Q3].

524

Routine screening for Chlamydia trachomatis andNeisseria gonorrhea in patients with first trimester abortionRyan Schlueter1, Cici Liu1, Sarah Crimmins2, Biren Patel1,James Shelton1, Majid Shaman11University of Buffalo, Obstetrics and Gynecology, Buffalo, NY, 2University ofMaryland, Obstetrics and Gynecology, Baltimore, MD

OBJECTIVE: No recommendation currently exists to collect genitalcultures at the diagnosis of abortion. The study aims to evaluate theprevalence of genital C. trachomatis and N. gonorrhea at diagnosisof abortion and compare the data to national statistics from theCenter for Disease Control (CDC).STUDY DESIGN: A retrospective cohort study was performed usingICD-9 codes to identify women with first trimester spontaneous,missed, or incomplete abortion from 2010 to 2012 at an inner-cityteaching institution. Only women with a genital culture at diagnosiswere included. Stratification by age and positive screen for C. tra-chomatis or N. gonorrhea was assessed as a rate n (%). The data wascompared with the most recent 2011 statistics from the CDC usingbinomial exact test.

2014