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245 Maternal Transport Associated with Increased Survival of Very Low Birthweight Infants as Population-Based Study
SPO Abstracts
Volume 168 Number 1, Part 2
242
EVIDENCE OF TOPOGRAPHIC DIFFERENCES IN AMNIOTIC FLUID INTERLEUKIN-6 CONCENTRATIONS DURING SPONTANEOUS ACTIVE LABOR AT TERM. R. Romero. R. Gonzalez", Y. Sorokin, J.S. Kenney", M. Ramirez", P.B. Sehgal", E. Behnke, D.B. Cotton. Dept. of Ob/Gyn, Wayne State U(liv.lHutzel Hosp., Detroit, MI; The Hosp. Sotero Del Rio, Santiago, Chile; Syntex Research, Palo Alto, CA; Dept. of Microb. N.Y. Med. Coil., Valhalla, N.Y. OBJECTIVE: Determine whether there are differences in amniotic fluid (AF) concentrations of interleukin-6 UL-6) between AF retrieved transvaginally (TV) and transabdominally (TA). STUDY DESIGN: Paired samples of AF were obtained TV and TA from 50 women in labor at term. IL-6 determinations were performed with an enzyme·linked immunoassay. Comparisons between AF concentrations of IL-6 obtained .,,~ ... 0""TV and TA were performed using the Sign Rank Test. RESULT: IL-6 levels were i 1 significantly higher in samples obtained TV than in samples obtained TA (median = 6.08 ng/ml, range 1.6·63.9 vs median = 18.01 ng/ml, range 3.1 - 64.4 p < .0001. CONCLUSIONS: 1. During active labor concentrations of IL-6 are higher in AF obtained from the forebag than from the upper uterine compartment. 2. Concentrations of substances obtained TV may not reflect changes throughout the amniotic cavity. 3. Differences between AF compartments may result from increased production of IL-6 by fetal membranes of the forebag in response to microbial product normally present in vaginal secretions.
243 SECOND STAGE LABOR PATTERN FOR SECOND lWIN.
J.Gandhi, KWang,x S.Yeh. Dept.Ob/Gyn, Albert Einstein Medical Center,Phiiadelphia and Albert Einstein College of Medicine,New York. Objective:To evaluate second stage labor pattern for twin B and to assess effects of epidural anesthesia and oxytOCin augmentation on this pattern and on newborn status. Study Design: 84 spontaneous twin labors in vertex/vertex presentation culminating in vaginal delivery of both babies were studied. Length of all components of labor including time interval between two twins were analyzed with and without epidural and oxytocin. Statistical analysis included Chi Square. Results: Mean length of labor, first stage ,second stage for twin A(A2),and interval time between the two deliveries (B2) were, 487±277 ,522±966, 38±52 and 281"43 minutes respectively. In 32 patients with epidural, B2 was significantly longer (45j-65 vs. 191"21 minutes,P<.005).B2 was longer in oxytocin group (71,i77 vs 22j:32 minutes. P<.005). Twin B Apgar scores were not different with B2 of <30,30 to 60,60 to 120 minutes. One of the 3 twin B's delivered at 120 minutes had low Apgar score. Conclusion: Mean time interval between the two births was 28 minutes with a wide variation. Second stage for twin A was not altered by epidural anesthesia, while it was significantly longer for twin B. Interval time up to 120 minutes did not alter outcome in monitored twins. Oxytocin influence in normal twin labor could not be evaluated since it was used therapeutically in this study.
365
244 A TRUE NATIONAL STANDARD FOR BIRTH WEIGHT. KS Puder", CT Sloan, and SF Bottoms, Dept. of Ob/Gyn, Wayne State Univ., Hutzel and Beaumont Hospitals, Detroit, MI. OBJECTIVE: Previous birth weight curves have been based on data from referral centers or limited regions. We sought to develop national birth weight norms less subject to selection bias.
STUDY DESIGN: Birth weight percentiles for 24-44 gestational weeks were based on 1980 National Natality Survey data. The 9,941 live births in this dataset are a stratified, random sample of all 3.6 million births in the U.S. during 1980, with a 2: I over-sampling of low birth weight. Case weights provided by the National Center for Health Statistics were used to insure balance for age, race, marital status, parity, and birth weight. Multiple gestations and congenital malformations were excluded. RESULTS: 4000BIRTH 3S00WEIGHT 3000BY WEEK 25002000-
...... ........
90th percentile
.... .........
~ .. '
••••••
10th percentile
~I------r-I--~'-I----'I'-----~I
34 36 38 40 42 CONCLUSION: To the best of our knowledge, the data depicted above are the first to be derived using valid sampling techniques. They represent a true national standard for birth weight, supplanting previous studies.
245 MATERNAL TRANSPORT ASSOCIATED Wlm INCREASED
SURVIVAL OF VERY LOW BIRmwElGHT INFANTS: A POPULATION-BASED STUDY. 1.Jkl!&&', CA Combs, MJ Musial', U Kotogal', M Miodovnik, TA Siddiqi. University of Cincinnati, Cincinnati, Ohio
OBJECTIVE: To test the hypotbesis that delivery of a low birthweigbt infant after maternal transport to a tertiary care center (Level 3) is associated with increased neonatal survival compared to delivery at a non-tertiary center (Level 1 or 2). STUDY DESIGN: Population-based review of all live births oS. 2500 gms from 1988-91 in the southwest Ohio region, including six Levell, seven Level 2, and two Level 3 hospitals. Neonatal survival, stratified by birthweigbt, was compared between two groups whose mothers primarily received care at Level 1 and 2 hospitals. Maternal Transport Group: infants born at a Level 3 hospital after maternal transport. Outbom Group: infants born at a Level 1 or 2 hospital. To control for possible selection bias between tbese groups, we also reviewed survival in a third group. Tertiary Group: infants born to mothers who primarily received care at a Level 3 bospital and thus did not require transport to deliver there. Chi-square (* = P<.05, ** = P<.01). RESULTS: For infants 501-750 gms, survival was significantly lower in the Outborn group (23%, 14/61) than in the Maternal Transport group (57%,58/102**) or the Tertiary group (42%, 1i3/67*). For infants 7511000 grns, survival was also significantly lower in the Outborn group (65%,31/48) than either tbe Maternal Transport group (85%, 118/139") or the Tertiary group (85%, 59/69"). Above 1000 gms, there was no significant difference in survival rates between the three groups. There was no significant difference in survival between the Maternal Transport group or Tertiary group in any birthweigbt stratum. CONCLUSION: Neonatal survival of very low birthweigbt infants is markedly increased if the infant is delivered at a tertiary care center.
Volume 168 Number 1, Part 2
242
EVIDENCE OF TOPOGRAPHIC DIFFERENCES IN AMNIOTIC FLUID INTERLEUKIN-6 CONCENTRATIONS DURING SPONTANEOUS ACTIVE LABOR AT TERM. R. Romero. R. Gonzalez", Y. Sorokin, J.S. Kenney", M. Ramirez", P.B. Sehgal", E. Behnke, D.B. Cotton. Dept. of Ob/Gyn, Wayne State U(liv.lHutzel Hosp., Detroit, MI; The Hosp. Sotero Del Rio, Santiago, Chile; Syntex Research, Palo Alto, CA; Dept. of Microb. N.Y. Med. Coil., Valhalla, N.Y. OBJECTIVE: Determine whether there are differences in amniotic fluid (AF) concentrations of interleukin-6 UL-6) between AF retrieved transvaginally (TV) and transabdominally (TA). STUDY DESIGN: Paired samples of AF were obtained TV and TA from 50 women in labor at term. IL-6 determinations were performed with an enzyme·linked immunoassay. Comparisons between AF concentrations of IL-6 obtained .,,~ ... 0""TV and TA were performed using the Sign Rank Test. RESULT: IL-6 levels were i 1 significantly higher in samples obtained TV than in samples obtained TA (median = 6.08 ng/ml, range 1.6·63.9 vs median = 18.01 ng/ml, range 3.1 - 64.4 p < .0001. CONCLUSIONS: 1. During active labor concentrations of IL-6 are higher in AF obtained from the forebag than from the upper uterine compartment. 2. Concentrations of substances obtained TV may not reflect changes throughout the amniotic cavity. 3. Differences between AF compartments may result from increased production of IL-6 by fetal membranes of the forebag in response to microbial product normally present in vaginal secretions.
243 SECOND STAGE LABOR PATTERN FOR SECOND lWIN.
J.Gandhi, KWang,x S.Yeh. Dept.Ob/Gyn, Albert Einstein Medical Center,Phiiadelphia and Albert Einstein College of Medicine,New York. Objective:To evaluate second stage labor pattern for twin B and to assess effects of epidural anesthesia and oxytOCin augmentation on this pattern and on newborn status. Study Design: 84 spontaneous twin labors in vertex/vertex presentation culminating in vaginal delivery of both babies were studied. Length of all components of labor including time interval between two twins were analyzed with and without epidural and oxytocin. Statistical analysis included Chi Square. Results: Mean length of labor, first stage ,second stage for twin A(A2),and interval time between the two deliveries (B2) were, 487±277 ,522±966, 38±52 and 281"43 minutes respectively. In 32 patients with epidural, B2 was significantly longer (45j-65 vs. 191"21 minutes,P<.005).B2 was longer in oxytocin group (71,i77 vs 22j:32 minutes. P<.005). Twin B Apgar scores were not different with B2 of <30,30 to 60,60 to 120 minutes. One of the 3 twin B's delivered at 120 minutes had low Apgar score. Conclusion: Mean time interval between the two births was 28 minutes with a wide variation. Second stage for twin A was not altered by epidural anesthesia, while it was significantly longer for twin B. Interval time up to 120 minutes did not alter outcome in monitored twins. Oxytocin influence in normal twin labor could not be evaluated since it was used therapeutically in this study.
365
244 A TRUE NATIONAL STANDARD FOR BIRTH WEIGHT. KS Puder", CT Sloan, and SF Bottoms, Dept. of Ob/Gyn, Wayne State Univ., Hutzel and Beaumont Hospitals, Detroit, MI. OBJECTIVE: Previous birth weight curves have been based on data from referral centers or limited regions. We sought to develop national birth weight norms less subject to selection bias.
STUDY DESIGN: Birth weight percentiles for 24-44 gestational weeks were based on 1980 National Natality Survey data. The 9,941 live births in this dataset are a stratified, random sample of all 3.6 million births in the U.S. during 1980, with a 2: I over-sampling of low birth weight. Case weights provided by the National Center for Health Statistics were used to insure balance for age, race, marital status, parity, and birth weight. Multiple gestations and congenital malformations were excluded. RESULTS: 4000BIRTH 3S00WEIGHT 3000BY WEEK 25002000-
...... ........
90th percentile
.... .........
~ .. '
••••••
10th percentile
~I------r-I--~'-I----'I'-----~I
34 36 38 40 42 CONCLUSION: To the best of our knowledge, the data depicted above are the first to be derived using valid sampling techniques. They represent a true national standard for birth weight, supplanting previous studies.
245 MATERNAL TRANSPORT ASSOCIATED Wlm INCREASED
SURVIVAL OF VERY LOW BIRmwElGHT INFANTS: A POPULATION-BASED STUDY. 1.Jkl!&&', CA Combs, MJ Musial', U Kotogal', M Miodovnik, TA Siddiqi. University of Cincinnati, Cincinnati, Ohio
OBJECTIVE: To test the hypotbesis that delivery of a low birthweigbt infant after maternal transport to a tertiary care center (Level 3) is associated with increased neonatal survival compared to delivery at a non-tertiary center (Level 1 or 2). STUDY DESIGN: Population-based review of all live births oS. 2500 gms from 1988-91 in the southwest Ohio region, including six Levell, seven Level 2, and two Level 3 hospitals. Neonatal survival, stratified by birthweigbt, was compared between two groups whose mothers primarily received care at Level 1 and 2 hospitals. Maternal Transport Group: infants born at a Level 3 hospital after maternal transport. Outbom Group: infants born at a Level 1 or 2 hospital. To control for possible selection bias between tbese groups, we also reviewed survival in a third group. Tertiary Group: infants born to mothers who primarily received care at a Level 3 bospital and thus did not require transport to deliver there. Chi-square (* = P<.05, ** = P<.01). RESULTS: For infants 501-750 gms, survival was significantly lower in the Outborn group (23%, 14/61) than in the Maternal Transport group (57%,58/102**) or the Tertiary group (42%, 1i3/67*). For infants 7511000 grns, survival was also significantly lower in the Outborn group (65%,31/48) than either tbe Maternal Transport group (85%, 118/139") or the Tertiary group (85%, 59/69"). Above 1000 gms, there was no significant difference in survival rates between the three groups. There was no significant difference in survival between the Maternal Transport group or Tertiary group in any birthweigbt stratum. CONCLUSION: Neonatal survival of very low birthweigbt infants is markedly increased if the infant is delivered at a tertiary care center.