SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018 - 215A

Scientific Abstracts

results of this study will provide a molecular basis to previous reports
that link genital use of talcum powder to increased risk of epithelial
ovarian cancer.

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F-100
Trends amongst Residency Programs Offering Trials of Labor after
Cesarean Delivery (TOLAC). Monica Basinger†, Jerasimos Ballas*,
Christina Davidson*. Baylor College of Medicine, Houston, TX, United
States.
INTRODUCTION: The National Institutes of Health recognizes that a
trial of labor after cesarean delivery (TOLAC) is a reasonable option for
many women with a prior cesarean delivery and called on organizations
to facilitate access to this birth option. However, the practice of offering
TOLAC varies widely throughout the United States. The purpose of
our study is to determine what trends exist in the attitudes and practices
of offering TOLAC between different levels of residents and Program
Directors, different types of U.S. OB/GYN Residency training programs,
and different regions of the country.
METHODS: A voluntary survey was sent electronically via publicly
acquired e-mail addresses of Program Directors to each current U.S. OB/
GYN ACGME accredited program with request to complete survey and
distribute amongst their residents.
RESULTS: We had 30% (80/249) response rate from program directors
and estimated 4.8% (243/5020) total resident responses, assuming every
resident was distributed the survey. The majority of responses were from
the Mid-Atlantic (20%) and South Atlantic (16-19%) regions. Program
types were divided into four categories with the majority of responses from
University based programs (60%) and Community hospital, universityaffiliated (27%) followed by community based (12%) and military
(1%). Both program directors and residents answered similarly in that
100% of both groups reported their program offered TOLAC to patients

215A

with one prior cesarean, 81% offer TOLAC with two prior cesareans
and 10% offer TOLAC in patients with three prior cesareans. Using
chi-squared analysis, there was no statistically significant difference in
offering TOLAC to different candidates in both the type of hospital and
the region of the county.
In general, both groups felt the attitude of hospital nursing staff towards
TOLAC was positive. The vast majority of program directors felt
comfortable with their residents managing and counseling patients
regarding TOLAC (99%). Likewise, most residents responded
affirmatively that they are comfortable with the intrapartum management
of a woman undergoing TOLAC (95%) and 82% agree that post-residency,
they will offer TOLAC to appropriate candidates regardless of indication
for cesarean.
CONCLUSION: Program directors and residents responded similarly in
the rates of offering TOLAC to certain patients depending on risk factors.
Both groups also felt confident in the ability of residents to manage these
patients in labor. There were no significant differences in programs who
offered TOLAC based on type of program or region of the country.
Specifically, the Mid-Atlantic region (NY, NJ, and PA) was not associated
with a decrease in the number of patients being offered TOLAC compared
to all other regions despite these states being reported as three of the top
five highest for medical malpractice payouts per capita in 2016.

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Assessment of Fetal Head Position and Primary Cesarean Delivery
Rate. Chelsea DeBolt†,2 Maya Craffey†,1 David O'Sullivan*,1 Jessica
Mullins*,1 Adam Borgida*.1 1Hartford Hospital, Hartford, CT, United
States; 2University of Connecticut, Farmington, CT, United States.
INTRODUCTION: Occiput posterior (OP) fetal head position is
associated with higher rates of cesarean delivery (CD), prolonged second
stage of labor, operative vaginal delivery (OVD) and third- and fourthdegree perineal lacerations. Despite national concern for higher than
recommended CD rate, few interventions have been shown to decrease
the CD rate overall. The objective of this study is to evaluate if assessment
of the fetal head position beyond 6 cm dilation but prior to the start of the
second stage of labor is associated with a decrease in primary CD rate.
METHODS: This retrospective cohort study included nulliparous,
term, singleton, vertex pregnancies delivered at Hartford Hospital from
August 2016 to April 2017. The exposure group consists of patients who
had assessment of fetal head position, while the control group consists
of patients who did not. The primary outcome was CD rate. Groups
were compared with respect to each maternal and neonatal variable and
differences between groups were evaluated with a Pearson chi square test.
A multivariate regression model was performed to evaluate the influence
of several variables on the outcome. All data was analyzed using an a
priori alpha level of 0.05.
RESULTS: 690 women met inclusion criteria for investigation, 379
women in the control group and 311 women in the exposure group. The
primary CD rate was 15.9% in the control group and 22.9% in the exposure
group, and this difference was not statistically significant (p=0.078, Table
1). Arrest of the second stage of labor was more likely to be the reason
for CD in the exposure group (53.4% vs. 19.2%, p<0.001, Table 1), and
within the second stage arrest group, persistent OP occurred in 58.1% of
deliveries. The OVD rate was also higher in the exposure group (10.0%
vs. 5.8%, p=0.041, Table 1). For those who underwent an intervention (i.e.
manual rotation, position changes) within the exposure group, the rate of
CD was significantly higher (42.5% vs. 22.1%, p<0.001).

Friday Posters

ERAP2(N) Induced Rapid Choriocarcinoma Clearance In Vivo. Eun D
Lee*,3 Michelle Warthan,2 Sonya Washington,3 Ronald Ramus,3 Efstratios
Stratikos,1 Jerome Strauss.3 1National Center for Scientific Research,
Demokritos, Greece; 2University of Virginia, Charlottesville, VA, United
States; 3Virginia Commonwealth University, Richmond, VA, United States.
INTRODUCTION: High as 50 percent of hydatidiform mole results in
life threatening gestational choriocarcinoma when the tumor metastases.
Half of the choriocarcinoma cell lines lack endoplasmic reticulum
aminopeptidase 2 (ERAP2) and have a unique HLA repertoire to study
the immune mechanism. ERAP2 enzyme trims amino acid residues prior
to presentation on HLA class I molecules. When the major T allele of
ERAP2 changes Lysine (K) to asparagine (N) near the catalytic center
of the enzyme it results in increased peptide trimming by up to 165-fold.
This alters the peptide and HLA repertoire affecting the immune response.
Interestingly, ERAP2(N) is not biologically detected in any population
studied. Therefore, we hypothesize that ERAP2(N) can induce fatal
immune response. Using an ERAP2(N) expressing choriocarcinoma
cell model, our preliminary data shows that ERAP2(N) expressing cells
are preferentially killed by activated NK cells in vitro. This observation
suggests that ERAP2(N) expression in cells is immunologically
unfavorable for survival.
METHODS: To further test the role of ERAP2(N) in vivo, we used NSG
mice model system to determine its contribution to the emergence and
clearance of solid tumors by adoptive transfer of immune cells compared
to the tumor that does not express ERAP2(N).
RESULTS: After the lymphocyte treatment, only ERAP2(N) tumor
displayed a rapid and significant decrease in tumor volume (P=0.046).
The DiR fluorescently labeled lymphocytes were specifically targeting
the tumor. The TdT Immunohistochemistry analysis of the tumor
confirmed the apoptotic death by the activated lymphocyte. Lastly, the
activated lymphocytes were elevated against ERAP2(N) expressing
choriocarcinoma cells.
CONCLUSION: Together, the data strongly suggest that ERAP2(N)
can be utilized as a potential cancer target molecule to specifically
eliminate tumor.

Reproductive Sciences Vol. 25, Supplement 1, March 2018

Table of Contents for the Digital Edition of SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018