Poster Presentations / Pregnancy Hypertension 1, Supplement 1 (2010) S43–S76 S59 (1) Persistence of aberrant CVD risk factors and an accelerated progression of IMT. (2) Lower levels of circulating endothelial markers and impaired numbers of circulating endothelial progenitor cells (EPCs), indicating endothelial cell dysfunction and impaired vascular repair. Methods: 18 formerly preeclamptic women and 16 controls were in- cluded in our follow-up (study 2). Ultrasound measurements of carotid and femoral arteries and various classical cardiovascular risk factors were recorded. Blood samples were taken and whole blood was stained using anti-CD34, anti-CD133 and anti-vascular growth factor receptor antibodies. Flow cytometry was used to quantify EPCs (triple positive cells). Circu- lating endothelial markers (von Willebrand factor (vWF), ICAM-1) and inflammatory markers (hsCRP) were measured in plasma using ELISA. Results: See Table 1. Conclusion: This study suggests a transient adaptive response of the vasculature to a preeclamptic pregnancy which normalizes within years. Otherwise, the presence and persistence of cardiovascular risk factors in formerly preeclamptic women emphasizes the need to follow up these high-risk women in future. P62 Renal oncocytoma and pregnancy – case report Rita Torres, Augusta Borges, Ana Campos. Maternity Dr. Alfredo da Costa, Lisbon, Portugal Introduction: Renal oncocytoma represents 5-7% of primary renal neo- plasms. It is usually diagnosed in asymptomatic patients and is char- acterized by a benign behavior without invasion of adjacent tissues or metastasis. The diagnosis during pregnancy is uncommon and to date there are only two cases reported in the literature. Case study: The authors present the case of a 32 years old nulliparous with uncontrolled chronic hypertension diagnosed at 7 weeks gestation. She was referred to our institution at 24 weeks with superimposed pre-eclampsia complicated by fetal growth restriction, stillbirth and acute pulmonary edema and hemodynamic instability requiring mechanical ventilatory sup- port. The etiological study of hypertensive disorder, ultrasound and MRI performed in postpartum period, was consistent with right renal tumor and the patient was submitted to ipsilateral nephrectomy. The anatomopatho- logical and immunohistochemical study revealed an oncocytoma. Conclusion: The clinical behavior of renal oncocytoma remains poorly characterized during pregnancy and may course with an adverse maternal and fetal outcome despite its theoretical benign behavior. It’s essential to exclude a possible secondary cause of hypertension in clinical pictures with difficult control. P63 Morbidity and mortality conference using ACGME competencies: a case study in eclampsia Ryan Summerall 1 , B. Denise Raynor 2 . 1 Danbury Hospital; 2 Emory University, GA, USA ACGME guidelines for residency training in the US dictate that 6 core competencies be integrated into clinical care. The core competencies en- compass all aspects of an exemplary physician. Medical Knowledge (MK): analytical application of knowledge to care, Patient Care (PC), Interper- sonal&Communication Skills (ICS): listening and information exchange; Professionalism (PF): commitment to ethical principles and accountabil- ity to patients and society; Practice-Based Learning&Improvement (PBLI): evaluation of care practices and assimilation of scientific evidence; System- Based Practice (SBP): using and responding to the larger healthcare system. M&M conferences can incorporate issues like healthcare utilization, reim- bursement, provider and system error. We present a conference discussion of patient with eclampsia, illustrative of the competency based approach. Methods: Medical records were reviewed for the multidisciplinary M&M conference that includes ob/gyn, neonatology, anesthesiology, pediatrics, pathology departments. Core competencies were applied to clinical man- agement, hospital procedures and best practices in the literature. Results: Case: 17 year old G1 at 35 weeks, unknown to the hospital, presented to ED with BP 170/106. She remained for more than 2 hours and was started on MgSO4. After transfer to Labor Suite, she became unrespon- sive. She underwent emergency cesarean, then MRI and was transferred to the ICU, diagnosed with posterior reversible encephalopathy syndrome (PRES). She was started on keppra. The next day she appeared recovered on labetalol, transferred to L&D. With subsequent hypertension, she was restarted on MgSO4, returned to the ICU for BP control with increased labetalol. She was discharged on keppra and labetolol on postoperative day 6. Errors in MK caused delayed diagnosis. ICS problems included poor com- munication between residents, attendings and consultants. SBP issues included failure to follow ED protocols, inappropriate coordination of care and transfer to ICU. Conclusion: Core competency based M&M reviews allow comprehensive evaluations of maternal morbidity that lead to procedural change and metrics for patient safety. P64 Changes of the level of total homocysteine, adrenomedullin and calcitonin gene-related peptide after antihypertensive treatment in preeclampsia Fei Xu 1 , Daozhen Chen 1 , Min Yang 1 , Junfeng Wang 1 , Jianping Xiao 1 , Qi Chen 2 . 1 Wuxi Maternity and Child Health Hospital Affiliated Nanjing Medical University, China; 2 The University of Auckland, Auckland, New Zealand Introduction: The combination of nifedipine and magnesium sulphate (MgSO 4 ) in antihypertensive treatment during preeclampsia is recently widely used. However the mechanism of nifedipine on antihypertensive treatment in preeclampsia is unknown. The plasma level of total ho- mocysteine (THcy) and adrenomedullin (AM) which are the risk factors for causing pregnant hypertension were found to be elevated, whereas the level of calcitonin gene-related peptide (CGRP) was decreased in preeclamptic women. Therefore this study was to investigate the changes of the plasma levels of THcy, AM and CGRP during preeclampsia treatment by Nifedipine. Methods: 16 pregnant women with severe preeclampsia (mean BP was 160/90, admission gestation age was 25-32 weeks) and 34 gestation matched normal pregnant women and 35 non pregnant women were included in this study. The severe preeclampsia group was treated with a combination of MgSO 4 and Nifedipine (10mg/d). The level of THcy or AM or CGRP in plasma of women with severe preeclampsia was measured before or after Nifedipine treatment. Results: The plasma levels of THcy and AM were significantly increased, while the CGRP level was significantly decreased in severe preeclampsia group before antihypertensive treatment (upon admission) compared to those in normal pregnant women and those in non pregnant women. After antihypertensive treatment of Nifedipine (1-6 weeks) the plasma level of THcy and AM were significantly decreased, and the CGRP level was increased to levels similar to those in the control groups. Conclusion: THcy, AM and CGRP play an important role in causing endothelial cell dysfunction seen in preeclampsia. Although the exact mechanism(s) of nifedipine on antihypertensive treatment in preeclampsia is unclear these data suggest it may act through the regulation of the level of THcy, AM or CGRP secretion from endothelial cells. P65 Severe obstructive sleep apnea in a 34 week pregnant woman Annette Robertson 1 , Pamela Johnson 2 , Kevin Chan 3 , Colin Sullivan 4 , Annemarie Hennessy 5 . 1 Campbelltown Hospital, University of Western Sydney, Australia; 2 Campbelltown Hospital, University of Sydney, Australia; 3 Campbelltown Hospital, Australia; 4 University of Sydney, Australia; 5 Campbelltown Hospital, University of Western Sydney, Australia Snoring is common during late pregnancy and is a symptom of obstructive sleep apnea/hypopnea syndrome (OSAHS). Maternal hypoxia is a known factor in intrauterine growth restriction and hypertension in pregnancy. A 37 year old, 32 week pregnant woman, complaining of loud snoring, excessive daytime sleepiness and falling asleep while driving, completed a questionnaire about the presence of snoring and daytime sleepiness. Domi- ciliary overnight sleep study and concurrent half hourly blood pressure measurements were performed. Results revealed severe obstructive sleep apnea/hypopnea syndrome (OS- AHS) with repetitive apneas and oxyhemoglobin desaturations to 66%. The apnea/hypopnea index was 98/hour. Overnight blood pressure demon- strated mean systolic 154mmHg (maximum 169mmHg) and diastolic 88mmHg (maximum 98mmHg). Daytime blood pressure was normal. Hospitalisation followed with commencement of methyldopa 125mgs at 18:00 and 24:00 hours. On night four of admission, positive airway pressure via nasal mask was commenced using an auto-adjusting machine (ResMed Autoset ® and on night five, continuous positive airway pressure (CPAP) was used at a