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303 The Effect of Physician Office Visits on Uterine Activity As Determined by Home Uterine Monitoring
360
300
301
SPO Abstracts
January 1992 Am J Obstet Gynecol
NEONATAL MORBIDITY BETWEEN 34-37 WEEKS' GESTATION. M.D. Fox,X J.F. McCaul, R.W. Martin, W.E. Roberts, B. McLaughlln,X J.C. Morrison, Dept. Ob/Gyn, Unlv. Mississippi Med. Ctr., Jackson, MS Obiectlve: To determine the risk of significant neona al morbidity between 34-37 weeks In women with preterm labor (PTL) who are not given tocolytlc therapy. Si~~y :slgn: Women between 34 and 37 weeks' gestation w cumented PTL and I ntact membranes were gl ven Informed consent and offered entry Into this prospective trial. Popul atlon: One hundred and one women met Inclusion/exclusion criteria; 90 gave Informed consent and were randoml zed. I ntervent Ion: Women were randomized by a disinterested third party (pharmacy) from a random number table to receive either Intravenous magnesium sulfate tocolysls followed by oral therapy using magnesium gluconate tocolysls (treatment group - T) or conservative management with hydration, sedation and observation (control group - C). Main Outcome Measured: The InCidence of maternal side effects from tocolysls, Interval from diagnosis of PH to del Ivery, birth weight, and neonatal outcome were noted. Results: Of the 90 women enterl ng the study, 45 In rancr-45 InC, two discontinued tocolytlc therapy because of gastroIntestinal side effects. There were no serious neonatal complications. In both T and C there were 3 who had TNN and 1 RDS In each grou~. GA at nterval Birth diagnosis to delivery weight GA at N (weeks) (days) (grams) del Ivery T 45 34.9 +.7 15.7 + 12.0 2741 + 496 36.5 + 1.7 C 45 35.1 +.7 15.4 + 13.6 2762 + 585 37.7 + 1.9 The gestational age on a
302
A COMPARISON OF FIVE MEmODS OF AMNIOTIC FLUID FETAL LUNG MATURITY TESTS: SENSITM1Y, SPECIFICITY, AND COST EFFECTIVENESS OF INDMDUAL VS. COMBINED TESTS. Chris T. Sloan, M.D~ Robert P. Loren". M.D~ Claire Michael, M.D."; Division or Maternal Fetal Medicine and Department or Clinical Pathology, William Beaumont Hospital, Royal Oak MI and, Wayne State Urllversity OBJECTIVES: 1) To compare the sensitivity and specificity of commerclaUy available rapid tests and chromatographic teats or retal maturity and 2) propose an algorithm ror east effective utilization or teats. MEmODS: A retrospective study or lecithin/sphingomyelin(US), phosphotidylglyeerol(% PG)(Gluek method), FLM"(AbboU TDx), Lumedex FSI"(Beekman), and Amrllostat"(Hana), and newborn outcome was performed. Direct costs were estimated ror materials and lahor. RESULTS: 153 pregnancies (35.7 +/- 2.6 weeks gestation) were analyzed, respiratory distress. syndrome occurred in 13 (8.5%). Diabetic pregnancies were analyzed separately. For nondiabeties (n=102), the number or studies, definition or maturity, sensitivity (ror the outcome or RDS), and specificity ror each test was: US n=80, 2.0, '2'Ai, 88'l1>; PG n=80, trace,7S'Ai, 7"l1>; FLM n='1, > =60,100%, 8S'lI>; FSI n=67, >47, 8O'lI>, 66'l1>; Amniastat n=39, ~ 0.5, "'Ai, 55%. For diabetics (n=S1): US n=48, 2.0, 100%, 94'l1>; PG n=48, trace, 100%, 92'l1>; FLM n=46, > =60, 100%, 87'l1>; FSI n=41, >47, 100%, 68'l1>; Amrllostat n=23, ~ O.5,(sens=??(no RDS), 61%. Testing sequences were compared ror sensitivity, specificity, and direct easts. CONCLUSIONS: This retrospective study suggests the least eastJy method is a first step using the FLM" (Abbott TDx), then an US and %PG orlly ror the 26% that are immature by FLM. This method has a sensitivity or 9O'lI> , a specificity or 92'Ai, and an average direct .-ost or $27.40 In our nondiabeties and should be prospectively studied.
PRETERM PREMATURE RUPTURED MEMBRANES IN THE TWIN GESTATION: A CASE CONTROL STUDY Montgomery DMx, Perlow mx, Asrat T, Morgan MA, Bahado-Singh RO, Garite TJ Long Beach Memorial Wornens Hospital, Long Beach, CA. University of California Irvine Med Center, Orange, California The natural history of premature preterm ruptured membranes (PPROM) in the twin gestation has not previously been described. Therefore, we sought to describe the clinical course of PPROM in the twin gestation, and to determine if perinatal outcomes are similar in twin and singleton pregnancies complicated by PPROM. Over the previous decade, 80 sets of twins between 25-36 weeks estimated gestational age (EGA) presented with PPROM (TProm) to our institution. A control group (n~80) consisting of singletons matched for EGA at time of PPROM (SProm) was selected and perinatal outcome between groups was analyzed. Maternal demographic characteristics were not significantly different between groups. During the study period, our general management protocol for PPROM was expectant and did not include use of tocolysis, antibiotics, or steroids.
303
THE EFFECT OF PHYSICIAN OFFICE VISITS ON UTERINE ACTIVITY AS DETERMINED BY HOME UTERINE MONITORING. T L Bennett M.D., P Winchester, M.D.x , B.E. Finley, M.D. , Humana Hosp~al of Overland Park, KS and University of Kansas Medical Center, Kansas City. KS Ue-style modifiC3tions, with limitation of both physical activity and mental-stress, are quite often an integral part 01 the management of the pregnant woman at risk for preterm delivery. Inoffice clinical evaluations necessitate that women at risk lor preterm labor leave the home environment with a curtailment of prescribed rest. To determine the elfect of physician office visits on uterine activity, home uterine monitoring records of 24 women at risk for preterm labor were retrospectively reviewed. The average activity was determined for the morning (AM) and the late afternoon (PM) for days with and without physician visits. No statistical difference was found between the AM uterine activity lor days with and without physician visits. A statistically significant rise in uterine activ~y the PM after a physician office visit was seen when compared to the average PM activity lor those days without such visits (paired t-test p<0.02). This increased activity tended to subside over the next 24 hours. In conclusjon uterine activity as recorded by home uterine monitoring, is increased subsequent to a prenatal office visit in those woman previously determined to be at risk for preterm delivery. The implications of this "white-coat labor" should be considered in protocols to evaluate and manage woman at risk for preterm events.
Outcome EGA at PPROM(Wk) Latency period <48 hr 49hr-7da. >7da. Chorioamnionitis Fetal distress RDS Neonatal infection
t:Il:!mlllill!l!alIh
Tl![Qm(%) 30.5 ± 4.5 70.0 16.3 13.8 18.8 0.05 35.0 18.8
II J
Smom!%) 30.3 ± 4.7
Pv!!lue NS
65.0 21.3 13.8 23.6 0.14 35.0 21.3
NS NS NS NS NS NS NS
138
AvERAGE UTERINE ACTlYITY (Contractjons jn One Hour)
NS
The natural history of PPROM in the twin gestation parallels that in the singleton pregnancy and suggests that similar antepartum management strategies are appropriate for both groups.
Mean SO
No Physician Visit PMIn=24) 3.19 3.06 1.53 1.96
AM (n=Z4l
Physician Visit AM (n-24) PMUEZll 3.84 5.75 2.54 3.74
300
301
SPO Abstracts
January 1992 Am J Obstet Gynecol
NEONATAL MORBIDITY BETWEEN 34-37 WEEKS' GESTATION. M.D. Fox,X J.F. McCaul, R.W. Martin, W.E. Roberts, B. McLaughlln,X J.C. Morrison, Dept. Ob/Gyn, Unlv. Mississippi Med. Ctr., Jackson, MS Obiectlve: To determine the risk of significant neona al morbidity between 34-37 weeks In women with preterm labor (PTL) who are not given tocolytlc therapy. Si~~y :slgn: Women between 34 and 37 weeks' gestation w cumented PTL and I ntact membranes were gl ven Informed consent and offered entry Into this prospective trial. Popul atlon: One hundred and one women met Inclusion/exclusion criteria; 90 gave Informed consent and were randoml zed. I ntervent Ion: Women were randomized by a disinterested third party (pharmacy) from a random number table to receive either Intravenous magnesium sulfate tocolysls followed by oral therapy using magnesium gluconate tocolysls (treatment group - T) or conservative management with hydration, sedation and observation (control group - C). Main Outcome Measured: The InCidence of maternal side effects from tocolysls, Interval from diagnosis of PH to del Ivery, birth weight, and neonatal outcome were noted. Results: Of the 90 women enterl ng the study, 45 In rancr-45 InC, two discontinued tocolytlc therapy because of gastroIntestinal side effects. There were no serious neonatal complications. In both T and C there were 3 who had TNN and 1 RDS In each grou~. GA at nterval Birth diagnosis to delivery weight GA at N (weeks) (days) (grams) del Ivery T 45 34.9 +.7 15.7 + 12.0 2741 + 496 36.5 + 1.7 C 45 35.1 +.7 15.4 + 13.6 2762 + 585 37.7 + 1.9 The gestational age on a
302
A COMPARISON OF FIVE MEmODS OF AMNIOTIC FLUID FETAL LUNG MATURITY TESTS: SENSITM1Y, SPECIFICITY, AND COST EFFECTIVENESS OF INDMDUAL VS. COMBINED TESTS. Chris T. Sloan, M.D~ Robert P. Loren". M.D~ Claire Michael, M.D."; Division or Maternal Fetal Medicine and Department or Clinical Pathology, William Beaumont Hospital, Royal Oak MI and, Wayne State Urllversity OBJECTIVES: 1) To compare the sensitivity and specificity of commerclaUy available rapid tests and chromatographic teats or retal maturity and 2) propose an algorithm ror east effective utilization or teats. MEmODS: A retrospective study or lecithin/sphingomyelin(US), phosphotidylglyeerol(% PG)(Gluek method), FLM"(AbboU TDx), Lumedex FSI"(Beekman), and Amrllostat"(Hana), and newborn outcome was performed. Direct costs were estimated ror materials and lahor. RESULTS: 153 pregnancies (35.7 +/- 2.6 weeks gestation) were analyzed, respiratory distress. syndrome occurred in 13 (8.5%). Diabetic pregnancies were analyzed separately. For nondiabeties (n=102), the number or studies, definition or maturity, sensitivity (ror the outcome or RDS), and specificity ror each test was: US n=80, 2.0, '2'Ai, 88'l1>; PG n=80, trace,7S'Ai, 7"l1>; FLM n='1, > =60,100%, 8S'lI>; FSI n=67, >47, 8O'lI>, 66'l1>; Amniastat n=39, ~ 0.5, "'Ai, 55%. For diabetics (n=S1): US n=48, 2.0, 100%, 94'l1>; PG n=48, trace, 100%, 92'l1>; FLM n=46, > =60, 100%, 87'l1>; FSI n=41, >47, 100%, 68'l1>; Amrllostat n=23, ~ O.5,(sens=??(no RDS), 61%. Testing sequences were compared ror sensitivity, specificity, and direct easts. CONCLUSIONS: This retrospective study suggests the least eastJy method is a first step using the FLM" (Abbott TDx), then an US and %PG orlly ror the 26% that are immature by FLM. This method has a sensitivity or 9O'lI> , a specificity or 92'Ai, and an average direct .-ost or $27.40 In our nondiabeties and should be prospectively studied.
PRETERM PREMATURE RUPTURED MEMBRANES IN THE TWIN GESTATION: A CASE CONTROL STUDY Montgomery DMx, Perlow mx, Asrat T, Morgan MA, Bahado-Singh RO, Garite TJ Long Beach Memorial Wornens Hospital, Long Beach, CA. University of California Irvine Med Center, Orange, California The natural history of premature preterm ruptured membranes (PPROM) in the twin gestation has not previously been described. Therefore, we sought to describe the clinical course of PPROM in the twin gestation, and to determine if perinatal outcomes are similar in twin and singleton pregnancies complicated by PPROM. Over the previous decade, 80 sets of twins between 25-36 weeks estimated gestational age (EGA) presented with PPROM (TProm) to our institution. A control group (n~80) consisting of singletons matched for EGA at time of PPROM (SProm) was selected and perinatal outcome between groups was analyzed. Maternal demographic characteristics were not significantly different between groups. During the study period, our general management protocol for PPROM was expectant and did not include use of tocolysis, antibiotics, or steroids.
303
THE EFFECT OF PHYSICIAN OFFICE VISITS ON UTERINE ACTIVITY AS DETERMINED BY HOME UTERINE MONITORING. T L Bennett M.D., P Winchester, M.D.x , B.E. Finley, M.D. , Humana Hosp~al of Overland Park, KS and University of Kansas Medical Center, Kansas City. KS Ue-style modifiC3tions, with limitation of both physical activity and mental-stress, are quite often an integral part 01 the management of the pregnant woman at risk for preterm delivery. Inoffice clinical evaluations necessitate that women at risk lor preterm labor leave the home environment with a curtailment of prescribed rest. To determine the elfect of physician office visits on uterine activity, home uterine monitoring records of 24 women at risk for preterm labor were retrospectively reviewed. The average activity was determined for the morning (AM) and the late afternoon (PM) for days with and without physician visits. No statistical difference was found between the AM uterine activity lor days with and without physician visits. A statistically significant rise in uterine activ~y the PM after a physician office visit was seen when compared to the average PM activity lor those days without such visits (paired t-test p<0.02). This increased activity tended to subside over the next 24 hours. In conclusjon uterine activity as recorded by home uterine monitoring, is increased subsequent to a prenatal office visit in those woman previously determined to be at risk for preterm delivery. The implications of this "white-coat labor" should be considered in protocols to evaluate and manage woman at risk for preterm events.
Outcome EGA at PPROM(Wk) Latency period <48 hr 49hr-7da. >7da. Chorioamnionitis Fetal distress RDS Neonatal infection
t:Il:!mlllill!l!alIh
Tl![Qm(%) 30.5 ± 4.5 70.0 16.3 13.8 18.8 0.05 35.0 18.8
II J
Smom!%) 30.3 ± 4.7
Pv!!lue NS
65.0 21.3 13.8 23.6 0.14 35.0 21.3
NS NS NS NS NS NS NS
138
AvERAGE UTERINE ACTlYITY (Contractjons jn One Hour)
NS
The natural history of PPROM in the twin gestation parallels that in the singleton pregnancy and suggests that similar antepartum management strategies are appropriate for both groups.
Mean SO
No Physician Visit PMIn=24) 3.19 3.06 1.53 1.96
AM (n=Z4l
Physician Visit AM (n-24) PMUEZll 3.84 5.75 2.54 3.74