stillbirth, abnormal BPS, oligohydramnios and abnormal NST as well as a composite variable “poor antenatal outcome” were related to CUR using ROC curve analysis. CUR was compared to CPR using Pearson correlation. RESULTS: 2700 patients who had appropriate third trimester testing were analyzed. Adverse outcome totaled 37 cases including 6 stillborn, 28 oligohydramnios, and 8 with biophysical abnormality. The higher the CUR, the more likely adverse outcome. CUR of 1.18 predicts ad- verse fetal antenatal outcome with 96% sensitivity and 67% specific- ity. CUR and CPR have a significant correlation and perform similarly in the prediction of adverse outcome, but abnormal CUR occurs more often in those with adverse outcome. CONCLUSIONS: Cerebrouterine ratio (CUR) predicts adverse outcome more often than CPR alone. Clinical studies using these complimen- tary tests are in order to evaluate the clinical impact of prediction of near-term compromise. 392 Isolated single umbilical artery - frequency of growth abnormality and antepartum fetal deterioration Sheveta Jain 1 , Tania Kasdaglis 1 , Kazumasa Hashimoto 1 , Catherine Sharoky 1 , Kristin Atkins 1 , Sifa Turan 1 , Jerome Kopelman 1 , Christopher Harman 1 , Ahmet Baschat 1 1 University of Maryland School of Medicine, Baltimore, MD OBJECTIVE: Pregnancies complicated by isolated single umbilical ar- tery (SUA) have previously been reported to be at increased risk for intrauterine growth restriction and unexpected stillbirth. Routine an- tepartum fetal surveillance is therefore frequently offered in these pregnancies. The aim of this study was to analyze the frequency of abnormal growth and abnormal antenatal outcomes. STUDY DESIGN: This is an IRB approved retrospective study of fetuses with isolated SUA that underwent third trimester surveillance. Growth abnormality was evaluated by the fetal weight  10th percen- tile (SGA) and/or head/abdomen ratio 1.14. Frequencies of bio- physical profile score (BPS)  8, low amniotic fluid index (AFI) [7cm for 28-32 weeks and 5cm for 32weeks], elevated umbilical artery pulsatility index (UmA PI) 1.4 and stillbirth was determined. RESULTS: Two hundred and ten fetuses with isolated single umbilical artery were followed with standardized weekly antenatal monitoring including BPS, UmA PI’s and serial growth ultrasounds every two weeKS Twenty one (10%) fetuses had growth asymmetry, but only 1.9% met criteria for SGA. BPS was normal in all the fetuses. 7 of 133 fetuses (0.05%) between 28-32 weeks had amniotic fluid index (AFI) 7 cm; 1 of 63 fetuses (0.01%) =32 weeks had AFI 5 cm. 9 of 180 (0.05%) fetuses had elevated UmA PI. The distribution of umbilical artery PI values was not significantly different from gestational refer- ence limits. No stillbirths were encountered. CONCLUSIONS: After exclusion of anomalies in fetuses with isolated single umbilical artery have a low rate of abnormal antenatal testing. In this large cohort managed with serial BPS and Doppler monitoring none of the patients had unanticipated adverse outcome and rates of placental dysfunction were lower than in the general population. 393 Intrauterine growth restriction in twin-twin transfusion syndrome treated with laser surgery Brendan Grubbs 1 , Kurt Benirschke 2 , Lisa M. Korst 1 , Arlyn Llanes 1 , Larisa Yedigarova 1 , Ramen Chmait 1 1 University of California, San Diego Medical Center, San Diego, CA, 2 University of California San Diego, San Diego, CA OBJECTIVE: The purpose of this study was to evaluate 30-day postnatal survival following treatment of twin-twin transfusion syndrome (TTTS) via preferential sequential selective laser photocoagulation of communicating vessels (SQLPCV) in the setting of coexistent intra- uterine growth restriction (IUGR). STUDY DESIGN: This was a retrospective analysis of 207 consecutive TTTS cases treated with SQLPCV. IUGR was defined as an estimated fetal weight  10th percentile for the given gestational age. All pla- centas were evaluated after delivery by one examiner (KB). Percentage weight placental share was calculated following division along the vascular equator, and was calculated only for fetuses born alive. Low donor placental share was defined as a placental share  30%. Survival was defined as alive at 30 days postpartum. RESULTS: Of the donors, 96/207 (46.4%) met criteria for IUGR; of these affected pregnancies, 6 also had affected recipients. There was no statistically significant difference in survival between those pregnan- cies that were and were not complicated by IUGR: dual survivors (69.1% vs. 70.9, p= 0.892), at least one survivor (91.8% vs. 93.6%, p=0.800), donor survival (74.2% vs. 77.3%, p=0.728) and recipient survival (86.6% vs. 87.3%, p=1.00). Placental share could be calcu- lated for 89 of 158 pregnancies (56.3%) where both fetuses were born alive. Pregnancies with donor IUGR were more likely than those with- out donor IUGR to have a low donor placental share (17/37[45.9%] vs. 10/52 [19.2%], Relative Risk 2.39 [95%CI 1.24-4.61], p = 0.014). CONCLUSIONS: The presence of donor IUGR at the time of laser sur- gery for TTTS did not appear to be associated with perinatal survival, in spite of evidence that IUGR pregnancies appeared more likely to have a low donor placental share. 394 Fetoscopic release of bands in amniotic band syndrome (ABS): outcomes in operative and non-operative candidates Candice Snyder 1 , Lana Lange 1 , David Lewis 1 , Mounira Habli 2 , Foong Yen Lim 2 , Timothy Crombleholme 2 1 University of Cincinnati, Cincinnati, OH, 2 Cincinnati Children’s Hospital Medical Center, Cincinnati, OH OBJECTIVE: When expectantly managed, ABS can result in loss of limb function, amputation, or IUFD in cases with cord involvement (CI). Fetoscopic release of bands is a new procedure with only 7 cases in the world’s literature. Our goal is to evaluate our experience with ABS, comparing patients who did and did not undergo surgery. STUDY DESIGN: Retrospective chart review of patients with ABS re- ferred to The Fetal Care Center of Cincinnati from 2006-10. Demo- graphics, imaging, basis of decision to proceed or not with surgery, operative findings, and peri/post-natal outcomes were evaluated. Sur- gical vs non-surgical cases were compared using Fisher-Exact or Mann-Whitney U tests. RESULTS: Of 24 cases, 10 had surgery, 10 non-lethal cases (13 fetuses) had no intervention, and 4 cases had lethal anomalies and were ex- cluded. Maternal age, parity, race, and diabetes did not differ between groups, but tobacco use was higher in surgical cases. Prenatally diag- nosed anomalies, distal deformity, lymphedema, and amputation did not differ, but abnormal vascular flow (5/10 vs 1/13) and CI (7/10 vs 2/13) was higher in the operative group (p=0.03, 0.01 respectively). Decision to proceed with fetoscopic release of bands was made in extremity ABS if there was lymphedema or abnormal flow, or if there was cord entanglement (CI-ABS). Surgery not recommended if bands did not involve fetus/cord, involved an encephalocele, or in twins where risk to other twin was high. Median interval to delivery after surgery was 5.5 (1-9) weeks. Median GA at delivery of livebirths was lower in the operative group [29 (25-34) vs 36 (25-39) weeks, p=0.03], but stillbirth/neonatal death did not differ. Survival in op- erative cases was 80% overall and 86% in those with CI-ABS. CONCLUSIONS: This is the largest reported series of ABS treated by fetoscopic release and first report of successful treatment of CI-ABS. GA at delivery was lower in surgical group, but may be explained by the inherent severity in cases where surgery was recommended. Ex- cellent survival can be achieved in CI-ABS in which the natural history is usually associated with IUFD. 395 Variation in physician approach to obstetrical management of life threatening fetal anomalies Cara Heuser 1 , Jan Byrne 1 , Nancy Rose 2 , Alexandra Eller 2 1 University of Utah, Salt Lake City, UT, 2 University of Utah and Intermountain Medical Center, Salt Lake City, UT OBJECTIVE: Standards of care regarding obstetrical management of life-threatening anomalies are not defined. We hypothesize that phy- Poster Session III Doppler Assessment, Fetus, Neonatology, Prematurity www.AJOG.org S160 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011