Downloaded from http://journals.lww.com/greenjournal by BhDMf5ePHKbH4TTImqenVBZZxeh5YHRL8YFMZ9NvDGs6zeWcEWc5oGMEw3FoZtoYcerJC5BKqwk= on 06/30/2020 founding variables more appropriately than previous studies, likely increasing the reliability of the findings. Financial Disclosure: The authors did not report any potential conflicts of interest. Effects of Delayed Cord Clamping on Neonatal Outcomes in Pregestational Diabetes at Term [13O] Carrie Bennett, MD Cleveland Clinic Foundation, Cleveland, OH Jessian Louis Munoz, MD, PhD, Meng Yao, and Katherine Singh, MD INTRODUCTION: Placental blood transfusion via delayed cord clamping can increase infant blood volume 10–20%. Hyperbilirubine- mia is a well-known sequelae of infants born to diabetic mothers. Our study sought to evaluate the effects of delayed cord clamping on neo- natal hyperbilirubinemia in a population prone to this phenomenon. METHODS: In January 2016, our institution implemented a thirty- second delayed cord clamping policy for provider-deemed eligible patients. This retrospective cohort study represents infants of pre- gestational diabetics who delivered before and after implementation. 72 patients were selected for each arm to achieve 80% power to detect a 15% difference between groups. Term singleton gestations were included. Study period was October 2014 to August 2017. Primary outcome was neonatal transcutaneous bilirubin. Secondary outcomes included serum bilirubin, jaundice requiring phototherapy, hypoglycemia, polycythemia, neonatal respiratory distress, and NICU admission. Subgroup analysis for outcomes in Type I diabetes and Type II diabetes was also performed. RESULTS: 145 patients were included in the final analysis. Trans- cutaneous bilirubin was 10.1 6 3.4 for immediate cord clamping and 9.5 6 3.4 for delayed cord clamping (P5.25). There were no statistically significant differences between groups in jaundice requiring phototherapy, hypoglycemia, polycythemia, neonatal respiratory distress, or NICU admission. No differences were observed in neonatal outcome by sub- group analysis of Type I versus Type II pre-gestational diabetes. CONCLUSION: In our study, there was no statistically significant increase in transcutaneous bilirubin in term infants of mothers with pre- gestational diabetes after undergoing 30 seconds of delayed cord clamping. Further research is needed to ascertain long-term neonatal effects. Financial Disclosure: The authors did not report any potential conflicts of interest. Explaining the (Over)Use of Electronic Fetal Monitoring: Evidence From a Study of Work Flow on the Unit [14O] Lisa Kane Low, RN, CNM, PhD University of Michigan, Ann Arbor, MI Meagan Chuey, CNM, PhD, Samia Abdelnabi, CNM, MA, RN, and Raymond De Vries, PhD INTRODUCTION: Guidelines from ACOG, AWHONN, and ACNM recommend against the routine use of electronic fetal monitoring (EFM) for low risk, healthy labors, recognizing the limited evidence of improved outcomes and its contribution to cesarean births. Yet the vast majority of healthy labors continue to be monitored with EFM rather than intermittent auscultation (IA). We explore the reasons for this disjuncture, going beyond the untested assumption that liability concerns drive EFM use to examine the place of EFM in the workflow of maternity care units. METHODS: A mixed methods study, at a large medical center, using 1) observations on the unit (121 hours), 2) interviews and focus groups with nurses, midwives, obstetricians, and administrators (n547), 3) chart review, and 4) a short survey of care providers (n5140). RESULTS: Four areas favor EFM use: The work environment (incorrect assumptions about what others on the care team want; EFM as default order; economic and time efficiency); Patients (limited knowledge of monitoring options); Technology (emphasis on EFM training over other approaches); Fear (of missing something, of blame from colleagues, of litigation). CONCLUSION: In light of the recognition – by ACOG and other professional societies – of the role of EFM in the overuse of cesarean sections – it is imperative that we understand continued reliance on this technology. Our study – the first of its kind – points to practical steps needed to reduce this reliance, including open communication among maternity care team members, change in EHR order sets, training in use of IA, and patient education. Financial Disclosure: Lisa Kane Low: Ferring (Speaker/Honoraria includes speakers bureau, symposia, and expert witness). The other authors did not report any potential conflicts of interest. Fetal Bradycardia in Response to Maternal Hypothermia [15O] Benjamin Spires, MD, Captain USAF University of Tennessee Medical Center, Knoxville, Knoxville, TN Craig V. Towers, MD INTRODUCTION: Fetal bradycardia, especially if it develops abruptly in the setting of a normal fetal heart (FHR) tracing, is most often associated with fetal compromise. The differential diagnosis may include numerous maternal, placental, and fetal conditions that would prompt emergent delivery. These causes are usually associated with an absence of FHR accelerations and decreased or absent variability. On the other end of the spectrum, fetal tachycardia also has numerous causes, one of which is maternal fever (or hyperthermia). Therefore, it is plausible that the opposite effect of a low maternal temperature or hypothermia might produce fetal bradycardia. The purpose of this case series is to demonstrate this finding. METHODS: 6 cases of fetal bradycardia associated with maternal hypothermia were collected. Data collection included gestational age at presentation, maternal medical condition, maternal temperature, FHR baseline, presence and/or absence of FHR variability and accelera- tions, and pregnancy outcome. RESULTS: All 6 cases demonstrated FHR baselines in the 80–90s in the setting of maternal hypothermia. Maternal temperatures ranged from 92.1– 96.9 0F. All had moderate variability with the presence of accelerations. All FHR baselines returned to normal with correction of maternal temperature. No adverse outcomes were seen in the 6 neonates post-delivery. CONCLUSION: These cases demonstrated fetal bradycardia can be seen in the presence of maternal hypothermia. The appearance of the FHR tracing is reassuring, except for the baseline. Therefore, emergent delivery is not indicated. The FHR baseline returns to normal with correction of maternal temperature. The overall clinical picture should be taken into consideration before proceeding with delivery. Financial Disclosure: The authors did not report any potential conflicts of interest. Identification of Newborns With Birth Weight of 4,500 Grams or More: The Impact of Obesity [16O] Bonnie Blackburn, MD Houston Methodist, Houston, TX Matthew Bicocca, MD, Tran Le, MD, Caroline Zhang, BS, Baha M. Sibai, MD, and Suneet P. Chauhan, MD, HonDSc INTRODUCTION: Obesity is a known risk factor for fetal macro- somia (birth weight [BW] greater than or equal to 4,500g), but prior studies examining its effect on sonographic estimated fetal weight (SEFW) have been equivocal. Our objective was to determine the impact of obesity on sonographic detection of macrosomia. METHODS: We performed a multicenter retrospective cohort study of all non-anomalous singletons with SEFW greater than or equal to 4,000g. All SEFWs were performed by Registered Diagnostic Medical Sonographers within 14 days of delivery and were calculated using a Hadlock equation. Patients were grouped according to body mass index (kg/m 2 ) at delivery (,30.0 [non-obese], 30.0–39.9 [obese], and $ 40.0 [morbidly obese]). The primary outcome was the detection rate (DR) of macrosomic newborns. Secondary outcomes were false posi- tive rate (FPR) and area under the receiver operator curve (AUC). RESULTS: Of the 330 women included, 83 (25.2%) were non-obese, 145 (43.9%) were obese, and 102 (30.9%) were morbidly obese. Overall there were 51 (15.5%) macrosomic newborns and its preva- lence varied: 8.4% among non-obese, 14.5% among obese, and 22.5% © 2020 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 160S SUNDAY POSTERS OBSTETRICS & GYNECOLOGY