Objective: The maternal cardiovascular system undergoes significant adaptation during pregnancy. We aimed to examine the changes in arterial stiffness parameters during normal pregnancy and establish reference ranges for the general population. Methods:We performed a prospective cross-sectional observational study at the University Hospitals of Leicester. We included low-risk healthy pregnant women with singleton and viable pregnancies with no evidence of foetal abnormality or aneuploidy. Smokers, women with preexisting or gestational hypertensive disorders and diabetes, booking BMI at least 30, on medication that could affect cardiac function and/or those who delivered before 37 completed weeks of gestation, and/or a neonate with birthweight less than 10th centile were excluded. Brachial (BrAIx) and aortic augmentation indices (AoAIx), and pulse wave velocity (PWV) were assessed using the Arteriograph. Data were analysed using a linear mixed model. Results:We analysed a total of 571 readings from 259 women across different gestational ages and present the 10th, 25th, 50th, 75th and 90th centiles for BrAIx, AoAIx and PWV from 12 þ0 to 42 þ0 weeks' gestation. All haemodynamic variables were significantly associated with maternal heart rate. BrAIx, AoAIx and PWV demonstrated significant change with gestation, with all reaching their lowest value in the second trimester. Conclusion:The current study presents reference ranges for BrAIx, AoAIx and PWV in low-risk singleton pregnancies. Further work is required to establish if women in whom measures of arterial stiffness lie above the 90th centile could be at increased risk of adverse pregnancy outcomes and to identify the optimum time for screening.

The thumb is pivotal to many functions of the hand. Loss or absence of the thumb can be catastrophic to a patient’s functioning. Different methods can be employed to surgically fashion a new thumb. This case report aims to demonstrate one patient’s 34-year experience, reporting objective measures for a toe to thumb transfer, and documenting aesthetic outcomes. A semi-structured interview was conducted to gain insight into the patient's personal experiences. Validated assessment tools were used to assess range of movement and power, including Kapandji test, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Cochin Hand Function Scale, Qingfeng Hand Dynamometer, Self-Administered Foot Evaluation Questionnaire (SAFE-Q). A physical examination on the neothumb was performed, along with photography to document aesthetic outcome. A 55-year-old white British male injured his right thumb whilst on a placement year in a sugar refinery in the Netherlands. The thumb was traumatically amputated proximal to the metacarpophalangeal joint. The patient lived for a year without a thumb on his dominant hand, which had a huge effect on his functioning, with extensive input from physiotherapists to help increase his handgrip strength. He then underwent a transfer operation, with the removal of the second toe which was transferred to create a right neothumb. The patient has high physical functioning of his neothumb, however, he is still mildly limited due to pain 34 years post-operation. The objective assessment tools demonstrate a high functioning of the neothumb, with only mild deficits in the dexterity and the physical functioning of the right hand. He experiences mild pain and reduced function of the donor foot. Light touch was found to be absent on the right thumb, but present on the left. Two-point discrimination was 7 mm on the right thumb, and 0.5 mm on the left. In this case, we present a toe to thumb transfer that had very good outcomes after 34 years with few complications. This case demonstrates that great adaptation can occur over long periods of time, restoring near-normal function. Measures of functional outcomes were generally high, with main deficiencies in fine motor skills such as picking up a penny from a flat surface and undoing small buttons. Additionally, there can be good long term outcomes from toe to thumb transfer despite moderate impairment of function. There is hope that this can be used to encourage and reassure patients and surgeons alike that the neothumb is likely to give good outcomes both functionally and aesthetically for many years.

Virtual poster abstracts Methods: This was a prospective, longitudinal study of maternal hemodynamics, assessed by a bioreactance method, measured at 11 to 14, 19 to 24, 30 to 34, and 35 to 37 weeks' gestation in 3 groups of women. Group 1 ws composed of parous women without a history of pre-eclampsia and/or small for gestational age (n = 632), group 2 was composed of nulliparous women (n = 829), and group 3 was composed of parous women with a history of pre-eclampsia and/or small for gestational age (n = 113). A multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables controlling for maternal characteristics, medical history, and development of pre-eclampsia or small for gestational age in the current pregnancy. Results: In groups 1 and 2, cardiac output increased with gestational age to a peak at 32 weeks and peripheral vascular resistance showed a reversed pattern with its nadir at 32 weeks; in group 1, compared with group 2, there was better cardiac adaptation, reflected in higher cardiac output and lower peripheral vascular resistance. In group 3 there was a hyperdynamic profile of higher cardiac output and lower peripheral vascular resistance at the first trimester followed by an earlier sharp decline of cardiac output and increase of peripheral vascular resistance from mid-gestation. The incidence of pre-eclampsia and small for gestational age was highest in group 3 and lowest in group 1. Conclusions: There are parity-specific differences in maternal cardiac adaptation in pregnancy. VP48.08 The effect of race on longitudinal maternal central hemodynamics

Objectives: Maternal overweight and obesity, defined as BMI ≥25 kg/m 2 and BMI ≥30.0 kg/m 2 respectively, represent a significant public health burden globally, and rates are rapidly increasing across developed nations. Very little is known about fetal growth and fetal growth trajectories in this high risk population. We aimed to examine the effect of increasing maternal BMI, across the BMI spectrum, on fetal growth and adiposity measures and their trajectories, among a prospectively recruited, contemporary cohort of Australian women. We also aimed to characterise the nature of the relationship between maternal BMI and fetal growth and adiposity measures. Methods: This was a secondary analysis of results from two contemporary randomised controlled trials, the LIMIT and Optimise randomised trials. Participants were pregnant women with a BMI of >/= 18.5kg/m 2 , and a singleton gestation between 10 +0 and 20 +0 weeks. Data were obtained from research ultrasounds, performed at 28 and 36 weeks of gestation, of participants randomised to the Standard Care groups of these trials. Results: The total sample size consisted of 1,377 women who underwent one or more fetal ultrasounds over the course of their pregnancy. Maternal BMI ranged from 18.5-24.9 kg/m 2 (n = 317 women; 23/02%) up to >/= 40 kg/m 2 (n = 122 women; 8.86%). Assessment of the relationship between maternal BMI and fetal growth measures did not provide any evidence of nonlinear relationships, and indicated that linear regression models were optimal. For all fetal biometry measures except for fetal femur length, we found statistically significant positive associations with increasing maternal BMI at each timepoint. At 36 weeks of gestation, we found a statistically significant association with increasing maternal BMI and increasing fetal adiposity measures of mid-thigh fat mass, abdominal fat mass, abdominal area, and subscapular fat mass. Conclusions: We show a positive linear relationship between maternal BMI, across the BMI spectrum, and fetal growth and adiposity. VP34.03Is there an association between the size of the decline in maternal cardiac output in the third trimester and offspring birthweight?

Oral communication abstractsbut there was a significant relationship with age (OR 1.07 95% CI 1.01 to 1.14, P 0.01). Conclusions: This is the first U.K. prospective study looking at the impact of fibroids and risk of miscarriage in the population of women attending an EPU. There was no significant relationship between fibroids and risk of miscarriage. Although 418 women were included in this study, a larger scale study may be conducted in the future to power for and detect any relationship between fibroid location and miscarriage risk. OC06.07Pre-treatment 48-hour β-hCG ratio to predict success of medical and expectant management of ectopic pregnancy