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Resolution of hydramnios does not eliminate perinatal risk
The distribution
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of uterine rupture versus VBAC score is as
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OBSTETRICS
CAN A VBAC SCORING SYSTEM PREDICT UTERINE RUPTURE IN PATIENTS ATTEMPTING A TRIAL OF
Eight of nine uterine ruptures had a VBAC score of 4 or less: 8 of 273 (2.9%) versus 1 of 316 (0.3%); odds ratio = 9.51 (1.2<013<204.0); P
LABOR? Vito Alamia, Jr, MD, Bruce A. Meyer, MD, Olga Selioutski, and Nidhi Vohra, MD State University of New York at Stony Brook, Stony Brook, hQ’
Objective: The risks of trial of labor after a previous cesarean delivery have discouraged women and their physicians from attempting this procedure. The most serious complication is uterine rupture, resulting in morbidity and mortality. There is no systematic method to determine patients at increased risk for this complication. A system that could quantify this risk would be a valuable tool in managing and counseling patients undergoing trial of labor. Our study attempts to devise such a scoring system. Methods: All patients attempting a trial of labor between January 1995 and June 1997 were reviewed. Parameters significantly associated with outcome were used to construct our VBAC score. This score was then applied to all patients who had uterine rupture. Statistical analysis was performed using Epistat software and a P co.05 was considered significant. Results: Nine cases of uterine rupture occurred in 589 trials of labor. Two cases were discovered after VBAC and required laparotomy because of hemorrhage. Five cases resulted in significant fetal morbidity or mortality. Cesarean hysterectomy was required in 2 cases. The VBAC score applied to these patients consists of the following variables for total possible score of 10 points: 1) Previous vaginal delivery-2 points 2) Indications for previous cesarean delivery: Breech, fetal distress, previa, elective-2 points; FTP less than 5 cm-l point; FTP greater than 5 cm-0 points 3) Cervical dilation: Greater than 4 cm-2 points; Greater than 2.5 cm but less than 4 cm-l point; Less than 2.5 cm-0 points 4) Station below -2-2 points 5) Cervical length
64s
Wednesday Posters
RESOLUTION OF HYDRAMNIOS DOES NOT ELIMINATE PERINATAL RISK JosephR. Biggie, MD, Katharine D. Wenstrom,MD, May DuBard, MA, and Suzwme P. Cliver, BA University of Alabama at Birmingham, Birmingham, AL
Objective: To determine whether resolution of hydramnios eliminates the risk of adverse perinatal outcome. Methods: All computerized ultrasound and obstetric records from 1986 to 1997 were reviewed. Hydramnios was defined as an AFI of at least 25 cm, or subjectively. Hydramnios was classified as persistent if at least 2 scans before delivery or a single scan less than 14 days before delivery showed hydramnios, and was considered resolved if at least 1 scan confirming hydramnios was followed by at least 1 scan showing consistently normal fluid. Pregnancies with persistent and resolved hydramnios were compared to pregnancies with consistently normal fluid. Results: Hydranmios (1.4%)
Perinatal death Anomaly Aneuploid IUGR
Normal
Resolved
Persistent
(98.6%) (n = 31,807)
(n = 187, 41.5%)
(n = 264, 58.5%)
1.3% 1.2%
2.1% 10.7%* .5% 3.2%
6.8% 16.7%+ 0 5.3%
.&I% 6.6%
P
* Anomalies: 14 CNS, 14 GI, 10 CV, 1 GU, 1 skeletal, 5 Multiple. +Anomalies: 7 CNS, 6 GI, 4 CV, 1 GI, 2 Multiple. Conclusion: While hydramnios-associated risk is reduced if the hydramnios resolves spontaneously, the perinatal mortality is still twice the baseline and the incidence of anomalies is increased ninefold. Pregnancies with resolved hydramnios should undergo the same evaluation as persistent hydramnios.
Obstetrics b Gynecology
[[
of uterine rupture versus VBAC score is as
~~red;;;i;ii;;;r
OBSTETRICS
CAN A VBAC SCORING SYSTEM PREDICT UTERINE RUPTURE IN PATIENTS ATTEMPTING A TRIAL OF
Eight of nine uterine ruptures had a VBAC score of 4 or less: 8 of 273 (2.9%) versus 1 of 316 (0.3%); odds ratio = 9.51 (1.2<013<204.0); P
LABOR? Vito Alamia, Jr, MD, Bruce A. Meyer, MD, Olga Selioutski, and Nidhi Vohra, MD State University of New York at Stony Brook, Stony Brook, hQ’
Objective: The risks of trial of labor after a previous cesarean delivery have discouraged women and their physicians from attempting this procedure. The most serious complication is uterine rupture, resulting in morbidity and mortality. There is no systematic method to determine patients at increased risk for this complication. A system that could quantify this risk would be a valuable tool in managing and counseling patients undergoing trial of labor. Our study attempts to devise such a scoring system. Methods: All patients attempting a trial of labor between January 1995 and June 1997 were reviewed. Parameters significantly associated with outcome were used to construct our VBAC score. This score was then applied to all patients who had uterine rupture. Statistical analysis was performed using Epistat software and a P co.05 was considered significant. Results: Nine cases of uterine rupture occurred in 589 trials of labor. Two cases were discovered after VBAC and required laparotomy because of hemorrhage. Five cases resulted in significant fetal morbidity or mortality. Cesarean hysterectomy was required in 2 cases. The VBAC score applied to these patients consists of the following variables for total possible score of 10 points: 1) Previous vaginal delivery-2 points 2) Indications for previous cesarean delivery: Breech, fetal distress, previa, elective-2 points; FTP less than 5 cm-l point; FTP greater than 5 cm-0 points 3) Cervical dilation: Greater than 4 cm-2 points; Greater than 2.5 cm but less than 4 cm-l point; Less than 2.5 cm-0 points 4) Station below -2-2 points 5) Cervical length
64s
Wednesday Posters
RESOLUTION OF HYDRAMNIOS DOES NOT ELIMINATE PERINATAL RISK JosephR. Biggie, MD, Katharine D. Wenstrom,MD, May DuBard, MA, and Suzwme P. Cliver, BA University of Alabama at Birmingham, Birmingham, AL
Objective: To determine whether resolution of hydramnios eliminates the risk of adverse perinatal outcome. Methods: All computerized ultrasound and obstetric records from 1986 to 1997 were reviewed. Hydramnios was defined as an AFI of at least 25 cm, or subjectively. Hydramnios was classified as persistent if at least 2 scans before delivery or a single scan less than 14 days before delivery showed hydramnios, and was considered resolved if at least 1 scan confirming hydramnios was followed by at least 1 scan showing consistently normal fluid. Pregnancies with persistent and resolved hydramnios were compared to pregnancies with consistently normal fluid. Results: Hydranmios (1.4%)
Perinatal death Anomaly Aneuploid IUGR
Normal
Resolved
Persistent
(98.6%) (n = 31,807)
(n = 187, 41.5%)
(n = 264, 58.5%)
1.3% 1.2%
2.1% 10.7%* .5% 3.2%
6.8% 16.7%+ 0 5.3%
.&I% 6.6%
P
* Anomalies: 14 CNS, 14 GI, 10 CV, 1 GU, 1 skeletal, 5 Multiple. +Anomalies: 7 CNS, 6 GI, 4 CV, 1 GI, 2 Multiple. Conclusion: While hydramnios-associated risk is reduced if the hydramnios resolves spontaneously, the perinatal mortality is still twice the baseline and the incidence of anomalies is increased ninefold. Pregnancies with resolved hydramnios should undergo the same evaluation as persistent hydramnios.
Obstetrics b Gynecology