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114 Angiographic embolization as an alternative to surgery for the treatment of hemorrhagic complications of pregnancy
Volume 164 Numbe r I, Pa rt 2
SPO Abstracts
279
13 THE SAFETY OF HEPARIN USE DURING PREGNANCY 115 IS BHCG THE THYROID STIMULATOR OF HYPEREMESIS GRAVIDARUM? TM Goodwin, MD, J Hershman x , MD, M R. L. Perry M.D., R. Librizzi, D.O., M. Haut, M. Montoro x , MD, J Mestman X , MD, University of Southern D., M. Neerhof, D.O., J. Manley, M.D., J. Bell, California and West Los Angeles Veterans Administration, LA, M.D., N. Lorber, R.N., R. Bolognese, M.D. Pennsylvania Hospital, Philadelphia, PA CA Abnormal thyroid function has been observed in Hyperemesis Maternal osteoporosis, thrombocytopenia, hemorrhagic complications and allergic reactions as Gravidarum . The cause is not known but an effect of BhCG has well as an adverse fetal outcome of 30% have been postulated. BhCG and thyroid function were assessed in 53 been reported with heparin use in pregnancy. To gravidas with severe vomiting, ketonuria and weight evaluate the safety of heparin, 57 pregnancies loss(1l.2+4.7Ibs, mean+SD) at 9.9+1.9 weeks gestation and in 18 in 46 women were retrospectively reviewed. Indicontrols of equivalent gestational age. Hyperemesis patients cations for heparin use included: 1. Multiple pregnancy loss with abrupt ion, with or without were divided into 2 groups: Group A, n=33, ultrasensitive TSH a positive ACA (59.6%), 2. Previous thromboem<.4mcU/ml; Group B, n=20, TSH>.4 (normal range .4-5 .3). bolic event (35.1 %), and 3. miscellaneous (5.3%) Thyroid parameters were as follows: Group A - TSH 0.11+0.10, An average of 25,500 units of heparin subcutaneFree T4 (FT4, normal range .7-2.1ng/dl) 2.8+1.8, BhCG ous daily was given for an average of 20.3 weeks 115+53IU/ml. Group B - TSH 1.4+.67, FT4 1.7+.4, BhCG 86+58. to maintain the PTT at 1~ the baseline in most Controls - TSH 1.20+.60, FT4 1.5+.4, BhCG 40+25. FT4 and patients. There were no cases of clinically Free T4 Index (FT41) were increased in 25/53(47%) and significant osteoporosis or thrombocytopenia. 29/53(55%) patients respectively. FT31 was increased in only 4 Gross hematuria occured in 2 cases (3.5%), both patients, all in Group A. Overall, 37/53(70%) had at least one responded to a decrease in heparin dose. There indicator of thyroid stimulation which was transient (2-8 weeks) were no cases of excess blood loss at delivery. and required no specifIC therapy . FT4 and TSH differed Three allergic reactions occured (5.3%), heparin significantly between Group A and B (p<.OI), as did BHCG was discontinued in one of these. An adverse fetal outcome of 26.3% included 10 preterm deliv(p<.05). Group B did not differ significantly from controls with eries (~36 wks) and 5 fetal losses (first a nd respect to TSH and FT4 but BhCG was significantly lower in second trimester). Allpreterm infants were subcontrols (p<.OOI). BhCG correlated weakly with FT4 (r=.30, sequently discharged in go od health. Correcting p=.OI) and TSH (r=-.36, p=.003) over the whole population in this for the healthy prema ture infant, adverse fet a l the largest series of Hyperemesis subjects exarnined with respect outcome becomes only 8.7 % in this high ri s k popto thyroid function. Conclusion: thyroid stimulation is common in ulation. All 5 fetal losses did occur in women Hyperemesis Gravidarum. BHCG is elevated in hyperemesis and with comorbid conditions. It appears that hepmay be responsible for the thyroid stimulation seen in certain arin is a safe drug when used c au ti ously, for cases. both mother and fetus.
114 ANGIOGRAPHIC EMBOLIZATION AS AN ALTERNATIVE TO SURGERY FOR THE TREATMENT OF HEMORRHAGIC COMPLICATIONS OF PREGNANCY. William M. Gilbert. John DoemenyX, Josephine Von Herzenx, Thomas R. Moore. Division of Maternal Fetal Medicine, Department of Reproductive Medicine, University of California at San Diego and Department of Radiology and Obstetrics Mercy Hospital San Diego CA. Obstetrical hemorrhage continues to be a major cause of maternal mortality and morbidity. Recent developments in percutaneous angiographic embolization techniques have afforded the ability to control persistent bleeding from pelvic vessels while avoiding the morbidity of surgical exploration. We report the use of angiographic embolization for the treatment of 9 cases of pregnancy related hemorrhage: persistent post caesarean bleeding (3 cases), vaginal wall hematomas (3 cases), cervical ectopic pregnancies (2 cases), and postpartum bleeding secondary to fibroids (1 case). The embolization procedures were successful in all cases, thus, avoiding further surgical and anesthetic interventions. Eight of 9 patients experienced postprocedural fever which resolved on antibiotics alone. There were no procedural complications. Patients were discharged after an average post embolization hospital stay of 8 days (range of 3 to 13). These data indicate angiographic embolization is effective in treating hemorrhagic complications of pregnancy in hemodynamically stable patients when surgical exploration is undesirable.
116 INCIDENCE AND RISK FACTORS ASSOCIATED WITH ABNORMAL POST PARTUM GLUCOSE TOLERANCE IN WOMEN WITH GESTATIONAL DIABETES vargo K.M x. Amini, S .X, Bernstein, I.M .. Catalano. P.M. Case Western Reserve Univ., MetroHealth Medical Center, Dept. OB/GYN, Cleveland, OH 44109 It is recommended that women with gestational diabetes (GDM) have a glucose tolerance test (OGTn at the postpartum (PP) visit, because of their increased risk of diabetes mellitus. The purpose of this study was to 1) determine the Incidence of an abnormal PP OGTI and 2) the factors predictive of an abnormal result In women with GDM. 103 patients with GDM had a 2 hr 75 gm 0G1T 6 ±2 wks. (mean ±sd) PP. 22.3% (23/103) were abnormal - 13% (3/23) frank diabetes, 17.4% (4/23) Impaired and 69.6% (16/23) non-diagnostic. There was a significant dilTerence in graVidity (3 .7 ±2.4 vs 2.8 ± 1.9. p=.05). PP weight-kg (87.6 ±16.4 vs 73.7 ±15 .8, p=.OOO51. OGTI during pregnancy: fasting glucose (FBS - mg/dlj (117 ±26 vs 96 ±13, p=.OOOl) and 3hr glucose (155 ±56 vs 128 ±33. p=.OO7). weeks gestational age at diagnosis (22 ±8 vs 28 ±6. p=.OO091. insulin use in pregnancy (78% vs 40%, p=.OOI) in the abnormal vs normal group. FBS and gestational age at time of diagnOsis of GDM and parity were found to be most predictive of an abnormal PP OGIT. These results support the importance of PP OGTI testing In women with GDM. Supported by NIH #5 MOl RR-0021O-26.
SPO Abstracts
279
13 THE SAFETY OF HEPARIN USE DURING PREGNANCY 115 IS BHCG THE THYROID STIMULATOR OF HYPEREMESIS GRAVIDARUM? TM Goodwin, MD, J Hershman x , MD, M R. L. Perry M.D., R. Librizzi, D.O., M. Haut, M. Montoro x , MD, J Mestman X , MD, University of Southern D., M. Neerhof, D.O., J. Manley, M.D., J. Bell, California and West Los Angeles Veterans Administration, LA, M.D., N. Lorber, R.N., R. Bolognese, M.D. Pennsylvania Hospital, Philadelphia, PA CA Abnormal thyroid function has been observed in Hyperemesis Maternal osteoporosis, thrombocytopenia, hemorrhagic complications and allergic reactions as Gravidarum . The cause is not known but an effect of BhCG has well as an adverse fetal outcome of 30% have been postulated. BhCG and thyroid function were assessed in 53 been reported with heparin use in pregnancy. To gravidas with severe vomiting, ketonuria and weight evaluate the safety of heparin, 57 pregnancies loss(1l.2+4.7Ibs, mean+SD) at 9.9+1.9 weeks gestation and in 18 in 46 women were retrospectively reviewed. Indicontrols of equivalent gestational age. Hyperemesis patients cations for heparin use included: 1. Multiple pregnancy loss with abrupt ion, with or without were divided into 2 groups: Group A, n=33, ultrasensitive TSH a positive ACA (59.6%), 2. Previous thromboem<.4mcU/ml; Group B, n=20, TSH>.4 (normal range .4-5 .3). bolic event (35.1 %), and 3. miscellaneous (5.3%) Thyroid parameters were as follows: Group A - TSH 0.11+0.10, An average of 25,500 units of heparin subcutaneFree T4 (FT4, normal range .7-2.1ng/dl) 2.8+1.8, BhCG ous daily was given for an average of 20.3 weeks 115+53IU/ml. Group B - TSH 1.4+.67, FT4 1.7+.4, BhCG 86+58. to maintain the PTT at 1~ the baseline in most Controls - TSH 1.20+.60, FT4 1.5+.4, BhCG 40+25. FT4 and patients. There were no cases of clinically Free T4 Index (FT41) were increased in 25/53(47%) and significant osteoporosis or thrombocytopenia. 29/53(55%) patients respectively. FT31 was increased in only 4 Gross hematuria occured in 2 cases (3.5%), both patients, all in Group A. Overall, 37/53(70%) had at least one responded to a decrease in heparin dose. There indicator of thyroid stimulation which was transient (2-8 weeks) were no cases of excess blood loss at delivery. and required no specifIC therapy . FT4 and TSH differed Three allergic reactions occured (5.3%), heparin significantly between Group A and B (p<.OI), as did BHCG was discontinued in one of these. An adverse fetal outcome of 26.3% included 10 preterm deliv(p<.05). Group B did not differ significantly from controls with eries (~36 wks) and 5 fetal losses (first a nd respect to TSH and FT4 but BhCG was significantly lower in second trimester). Allpreterm infants were subcontrols (p<.OOI). BhCG correlated weakly with FT4 (r=.30, sequently discharged in go od health. Correcting p=.OI) and TSH (r=-.36, p=.003) over the whole population in this for the healthy prema ture infant, adverse fet a l the largest series of Hyperemesis subjects exarnined with respect outcome becomes only 8.7 % in this high ri s k popto thyroid function. Conclusion: thyroid stimulation is common in ulation. All 5 fetal losses did occur in women Hyperemesis Gravidarum. BHCG is elevated in hyperemesis and with comorbid conditions. It appears that hepmay be responsible for the thyroid stimulation seen in certain arin is a safe drug when used c au ti ously, for cases. both mother and fetus.
114 ANGIOGRAPHIC EMBOLIZATION AS AN ALTERNATIVE TO SURGERY FOR THE TREATMENT OF HEMORRHAGIC COMPLICATIONS OF PREGNANCY. William M. Gilbert. John DoemenyX, Josephine Von Herzenx, Thomas R. Moore. Division of Maternal Fetal Medicine, Department of Reproductive Medicine, University of California at San Diego and Department of Radiology and Obstetrics Mercy Hospital San Diego CA. Obstetrical hemorrhage continues to be a major cause of maternal mortality and morbidity. Recent developments in percutaneous angiographic embolization techniques have afforded the ability to control persistent bleeding from pelvic vessels while avoiding the morbidity of surgical exploration. We report the use of angiographic embolization for the treatment of 9 cases of pregnancy related hemorrhage: persistent post caesarean bleeding (3 cases), vaginal wall hematomas (3 cases), cervical ectopic pregnancies (2 cases), and postpartum bleeding secondary to fibroids (1 case). The embolization procedures were successful in all cases, thus, avoiding further surgical and anesthetic interventions. Eight of 9 patients experienced postprocedural fever which resolved on antibiotics alone. There were no procedural complications. Patients were discharged after an average post embolization hospital stay of 8 days (range of 3 to 13). These data indicate angiographic embolization is effective in treating hemorrhagic complications of pregnancy in hemodynamically stable patients when surgical exploration is undesirable.
116 INCIDENCE AND RISK FACTORS ASSOCIATED WITH ABNORMAL POST PARTUM GLUCOSE TOLERANCE IN WOMEN WITH GESTATIONAL DIABETES vargo K.M x. Amini, S .X, Bernstein, I.M .. Catalano. P.M. Case Western Reserve Univ., MetroHealth Medical Center, Dept. OB/GYN, Cleveland, OH 44109 It is recommended that women with gestational diabetes (GDM) have a glucose tolerance test (OGTn at the postpartum (PP) visit, because of their increased risk of diabetes mellitus. The purpose of this study was to 1) determine the Incidence of an abnormal PP OGTI and 2) the factors predictive of an abnormal result In women with GDM. 103 patients with GDM had a 2 hr 75 gm 0G1T 6 ±2 wks. (mean ±sd) PP. 22.3% (23/103) were abnormal - 13% (3/23) frank diabetes, 17.4% (4/23) Impaired and 69.6% (16/23) non-diagnostic. There was a significant dilTerence in graVidity (3 .7 ±2.4 vs 2.8 ± 1.9. p=.05). PP weight-kg (87.6 ±16.4 vs 73.7 ±15 .8, p=.OOO51. OGTI during pregnancy: fasting glucose (FBS - mg/dlj (117 ±26 vs 96 ±13, p=.OOOl) and 3hr glucose (155 ±56 vs 128 ±33. p=.OO7). weeks gestational age at diagnosis (22 ±8 vs 28 ±6. p=.OO091. insulin use in pregnancy (78% vs 40%, p=.OOI) in the abnormal vs normal group. FBS and gestational age at time of diagnOsis of GDM and parity were found to be most predictive of an abnormal PP OGIT. These results support the importance of PP OGTI testing In women with GDM. Supported by NIH #5 MOl RR-0021O-26.