Evaluation of Obstetric Telephone Triage: A Quality Improvement Project [14D] Michael Miller, MD Naval Medical Center San Diego, San Diego, CA Everett Magann, MD, Heather Moody, RN, Melissa Schmidt, RN, Patricia Butler, DNP, LCDR, USN, and Monica Lutgendorf, MD INTRODUCTION: Obstetric telephone triage is commonly used when patients call with questions or seek advice for various medical concerns. Prompt and accurate telephone triage is imperative to ensure high quality and accessible care while maintaining healthcare effi- ciency. We sought to determine the current accuracy of obstetric telephone triage on a labor and delivery unit compared to a standard- ized obstetric telephone triage call center. METHODS: This is an approved quality improvement project. We collected telephone triage logs for patients calling Labor and Delivery. Calls were reviewed by experienced nurses from the ANGELS call center at the University of Arkansas using standardized obstetric triage algorithms. Differences were categorized by concordant advice vs. discordant advice/less urgent and discordant advice/more urgent. RESULTS: We reviewed 101 calls over a 3 month period. 55% were .34 weeks, 27% were 20-34 weeks, and 2% were ,20 weeks gesta- tional age. Caller complaints included: contractions (38%), discharge/ bleeding (10%), leaking fluid (10%), decreased fetal movement (6%), fever/nausea/vomiting/diarrhea (4%), and other complaints (30%). Of these calls, 80% (n 5 81) were assessed with concordant advice. Of the discordant advice calls, 9% (n 5 9) were less urgent, and 8% (n 5 8) were more urgent. Three records (3%) were not marked with a dispo- sition in the telephone triage log book. CONCLUSION: In an L&D setting, 80% of documented telephone triage advice was concordant with standardized telephone triage pro- tocols. This presents opportunity for education and standardized obstetric telephone triage protocols to improve patient care. Financial Disclosure: The authors did not report any potential conflicts of interest. Management of Labor and Delivery after Fetoscopic Repair of Open Neural Tube Defect [15D] Jaden R. Kohn Baylor College of Medicine Vibha Rao, Allison A. Sellner, Dina Sharhan, Michael A. Belfort, MD, PhD, and Magdalena Sanz Cortes, MD, PhD INTRODUCTION: Fetal repair of open neural tube defect (NTD) improves motor/cognitive outcomes and decreases need for postnatal shunting. Cesarean delivery is mandated when this is done via hysterotomy. The fetoscopic approach has comparable neonatal benefits to the open hysterotomy approach, but allows for vaginal delivery. This study describes the outcomes for labor and delivery following fetoscopic repair. METHODS: Retrospective cohort study at a single institution from 2014-2017. RESULTS: 32 patients had fetoscopic repair followed by either vaginal delivery (n 5 16) or cesarean (n 5 16) at 38.1 (26-40.2) and 36.3 (25.5-40.5) weeks, respectively.There were three elective cesar- eans (one breech with severe IUGR, one prior cesarean, one macro- cephaly) at 39.0 (37.1-39.0) weeks. Thirteen cases were delivered by non-elective cesarean at 35.2 (25.5-40.5) weeks: five had urgent pre- labor indications (four abnormal FHTs, one breech with PPROM), and eight were indicated during labor (four abnormal FHTs, three suspected abruptions, one breech after labor onset).Of sixteen vaginal deliveries, three required instrumentation and one was a VBAC. Eight had a second-degree laceration.In total, 24 patients labored. Seven patients were induced at 39.0 (35.5-39.5) weeks; one required cervical ripening with dinoprostone while six were induced with oxytocin only. Two patients received labor augmentation with oxytocin. The most common oxytocin protocol started with 2 mU/min and increased 1-2 mU/min q45min; most cases received a maximum of 20 mU/min or less. The mean oxytocin exposure was 18.3+/-10.6 hours. No induc- tions failed. CONCLUSION: Induction of labor and vaginal delivery after feto- scopic NTD repair is safe with reduced maternal morbidity. Financial Disclosure: The authors did not report any potential conflicts of interest. Chemotherapy and Optimal Timing of Delivery for Women with Triple Negative Breast Cancer [16D] Kayli Senz, MD MacDonald Women’s Hospital Case Medical Center, Cleveland, OH Kelly Kuo, MD, and Aaron B. Caughey, MD, PhD INTRODUCTION: Data are limited regarding the optimal manage- ment of breast malignancy in pregnancy, particularly for the more aggressive subtype of triple negative breast cancer (TNBC). We sought to compare strategies for the management of TNBC and to determine the optimal gestational age for induction in regards to chemotherapy status and maternal-fetal outcomes. METHODS: A decision-analytic model was designed for women with TNBC at 20 weeks electing to continue their pregnancies, comparing 32 different strategies for scheduled delivery between 24-39 weeks gestation, with chemotherapy induction either at 24 weeks or delayed until after delivery. Baseline estimates of stage-specific mortality and the impact of delayed cancer treatment on 5-year survival rates were obtained from the literature. Outcomes factored into the model included the risk of intrauterine fetal demise, spontaneous delivery, respiratory distress syndrome, cerebral palsy, and neonatal demise at each gestational age. RESULTS: For women assigned to antepartum chemotherapy, over- all QALYs were maximized with delivery at term, with minimal additional benefit beyond 37 weeks. For women with TNBC deferring chemotherapy until the postpartum period, 5-year survival was maximized by immediate delivery, although maternal QALYs were maximized with delivery at 36 weeks for stage I, 31 weeks for stage II, and 26 weeks for stage III disease. Our model was heavily driven by the baseline probability of maternal death within 5 years, in addition to the expected progression of disease and decrease in survival rates with each week of non-treatment, and remained robust across reasonable ranges for all variables of interest. CONCLUSION: For women with TNBC diagnosed in early preg- nancy, initiation of chemotherapy and delivery at 37 weeks should be considered. Financial Disclosure: Aaron Caughey disclosed the following—Celmatix: Consultant/Advisory Board, Ownership Interest; Mindchild: Consultant/Advi- sory Board, Ownership Interest. The other authors did not report any potential conflicts of interest. Effects of Weight Gain on Delivery Outcomes in an Obese Pregnant Population [17D] Bani M. Ratan, MD Baylor College of Medicine, Houston, TX Allison A. Sellner, Abigail H. Garbarino, Di Miao, PhD, and Lisa M. Hollier, MD, MPH INTRODUCTION: The 2009 Institute of Medicine guidelines rec- ommend 11-20 pounds weight gain for all pregnant women with a BMI $30. This study examines the effect of weight gain/loss on delivery outcomes in relation to class of obesity. METHODS: A retrospective cohort of 1,440 women receiving care at a large Medicaid clinic from 2013-2016 with pre-gravid BMI $30 was reviewed. Eligible women were non-smokers with a singleton preg- nancy initiating care prior to 20 weeks. Multinomial logistic regression analysis compared gestational weight change to primary outcome of birth-weight percentile and secondary outcome of delivery type. RESULTS: Inclusion criteria were met by 889 women, with 485 in Class 1 (BMI 30-34.9), 218 in Class 2 (BMI 35-39.9), and 186 in Class 3 (BMI $40). Class 1 patients that lost weight were more likely to have a small-for-gestational-age (SGA) infant (P5.040) compared to Class 1 patients who had recommended weight gain. Class 2 and 3 patients had no statistically significant increase in SGA infants with weight loss or weight gain below recommendations. Class 2 patients that gained VOL. 131, NO. 5 (SUPPLEMENT), MAY 2018 FRIDAY POSTERS 45S Copyright ª by American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.