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437 The relationships among umbilical artery velocimetry, fetal biophysical profile and placental inflammation in preterm PROM
366
SPO Abstracts
j.ltlll.ln 1991
Am
434 UNEXPLAINED ELEVATED MATERNAL SERUM ALPHAFETOPROTEIN (MSAFP) IS NOT NECESSARILY PREDICTIVE OF ADVERSE PERINATAL OUTCOME IN AN INDIGENT URBAN POPULATION. OP Phjlljps MD. JL SImpson MD. CD Morgan RNC MS. RN Anderson PhD, LP Shulman MD. CM Meyers MD. EA Tolley PhD. S Elias MD; University of Tennessee. Memphis. Increased frequencies of adverse perinalal outcome have been associaled with unexplamed elevaled MSAFP. It remains uncertam whether unexplamed values predict adverse perinatal outcome in an indIgent, urban obstetrIcal popUlation already IdentIfied to be at !ugh risk for adverse perinatal outcome. Study Design: Women WIth smgleton pregnancIes who underwent second trimester MSAFP screenmg (Abbott enzyme Immunoassay) and who receIved obstetrIcal care at our UniverSIty-based clinic were studied. An elevated MSAFP was defined as '" 2.5 MOM adjusted for weIght and race that was unexplained if, after correcting for gestatIOnal dating and multiple gestation. no fetal defects were detected by Ultrasonography. Subjects were stratIfied according to the presence or absence of medical risk factors as listed on the Hollister form. Patients with normal MSAFP values served as controls. matched for risk status. race. age and parity. Outcomes studied were congenital malformations. spontaneous abortIOn. premature labor. PROM. IUGR. fetal demIse. preeclampsia and abruptio placenta. Results: Among 8740 undergoing MSAFP screening. 85 had unexplained elevated MSAFP values; outcomes could not obtained for 9. In subjects with unexplained elevated MSAFP. 38 (50%) already had identIfIable risk factors. compared to 28.6% of populatIOn WIth normal MSAFP (p=O.OOI). Adverse perinatal outcome occurred in 32 (42.11 %) of the remaining 76 with elevated MSAFP, compared to 24 (31.58%) controls with normal MSAFP (p=0.25). No statIsbcal slgmficance was found when comparisons were made for any specific adverse perinatal outcome Comparison between SUbjects and controls after stratificabon of flsks factors showed no sigmficant difference III perinatal outcome. We conclude that in pabents from an indigent urban population already known to have mcreased risk for adverse perinatal outcome. unexplained elevated MSAFP prOVIdes no slgmflcant predictive information.
435
J Ob,tet GHlccol
436 HUMAN FETAL RESPONSE TO VIBROACOUSTIC STIMULATION AS A FUNCTION OF STIMULUS DURATION. Marcello PletrantoOl'. Jeffrey LAngel. MIchael T. Parsons, LInda McClaIn'. Hector Arango'. lilll,am N Spellacy, UOlv. of South FlorIda, Tampa, FlOrida The purpose of th, s study was to exam 1 ne the effects of varyIng stImulus duratIOns on the fetal heart rate acceleratIon Index and behaVIOral state. The actIvIty Index (AI = AmplItude bpm x duratIon sec) was deSIgned In an attempt to prOVIde obJectIve and quantItatIve assessment of the magOltude of the FHR acceleratIOn response follOWIng a SIngle v,broacoust,c stImulatIon (VAS) WIth duratIons of a (sham), 1. 3. or 5 seconds. Changes In baselIne FHR. variabIlIty. acceleratIons. and fetal body movements are normal to healthy fetuses These observatIOns are often related to the various fetal behaVIOral states as deSCribed by NlJhulS et al. These fetal behaVIoral states a re also known to be altered or 1 nduced by VAS There were 197 prospect 1 ve VAS tests among 4 groups; 49 rece1 ved a SIngle 1 second stImulus. 50 receIved a SIngle 3 second stImulus. 48 receIved a SIngle 5 second stImulus. and 50 receIVed a "sham" st 1 mu 1us (group "0··) and were cant ro 1s StatIstIcally slgOlflcant dIfferences were observed In the mean amplItude and duratIOn of acceleratIon of groups 3 sec and 5 sec when compared to groups and 1 at P < 05 In addItIon groups 3 and 5 demonstrated SIgnIfIcantly a greater change In the fetal behav lora 1 state from sleep to wakefu 1ness and a decrease 1 n NST test 1 ng tIme over groups a and 1 (P < . 0001) Our results suggest that the magnItude of the FHR acceleratIon response 1 s dependent on the durat IOn of the st 1 mu 1us Furthermore the mean AI of a 3-sec sound stImulus ImplIes an adequate dose-response for a change 1 n fetal behavIor to wakefulness.
a
AMNIOTIC FLUID INDEX AND ANTEPARTUM FETAL HEART RATE 437 THE RELATIONSHIPS AMONG UMBILICAL ARTERY VELOCIMETRY. FETAL BIOPHYSICAL PROFILE AND PLACENTAL INFLAMMATION PROLONGED DECELERATION IN PRETERM PROM. Alfred 0 Fleming MD. Carolyn M. Salafia. Mrt. Debra K Grubtt. Richard H Paul Anthony M. Vintzileos. MD. John F. Rodis. MD. Winston A. Campbell, Univ. of Southern Calnornia. LA. CA MD. Kimberly F. Bantham. B~ University of Connecticut Heanh Prolonged fetal heart rate (FHR) decelerations during antepartum Center. Farmington. CT testing have been associated with adverse fetal outcome. Decreased The relationships among umbilical artery velocimetry. fetal amount of amniotic fluid measured by various methods has been biophysical profile and placental inflammation in 44 consecutive associated With both FHR variable decelerations and adverse fetal patients with preterm PROM were determined. All patients were outcome. Antepartum FHR decelerations below 90 beats per minute followed with daily fetal biophysical profiles and systolicldiastolic (bpm) or at least 40 bpm below baseline for at least one minute were (SID) ratios as determined by continuous wave Doppler. After observed dUring antepartum testing in 98 pregnancies during the delivery. placental histologic examination resuned in the aSSignment period Jan. 1987-June 1990. Indications for and results of of 17 cases In Group 1 (no inflammation), and 22 in Group 2 (umbilical antepartum FHR testing, four quadrant amniotiC fluid index (AFI) at the vasculitis present). Five patients with choriodeciduitis/choriomtis time of testing. and pregnancy outcome were reviewed. In 77 were excluded. In Group 1. the last biophysical assessment Within 24 patients. delivery occurred In less than 24 hours, in 10 between 2 and hours prior to delivery was abnormal in 4 of 17 (24%). whereas in 5 days. and in 11 after 5 days. Cesarean section was performed in 35 Group 2 abnormal biophYSical assessment was present in 17 of 22 cases and vaginal delivery in 63 patients (9 With forceps). The (77%). (p<.05). The longitudinal trends of fetal biophysical profile average AFI in pregnancies which required intervention for fetal scores and SID ratios were analyzed for patients w~h and without distress (either forceps or cesarean section) was Significantly lower umbilical vasculitis. Analysis of the longitudinal trend during the than in pregnancies which did not require intervention In pregnancies period of two to seven days prior to delivery showed that there were in which the AFI was less than 5 centimeters at the time of the no differences of biophysical scores or SID ratios in either group. prolonged deceleration. 4 of 21 infants (19%) had a five minute Apgar However. in the last examination. within 24 hours of delivery. patients less than 7. compared to 2 of 53 (4%) In patients With an AFI greater with umbilical vasculitis had higher SID ratios and lower biophysical than 5. Patients with an AFlless than 5 cm had operative intervention profile scores as compared to previous examinations. In addition. the for fetal distress in 8 of 21 cases (38%). compared to 11 of 53 (21 %) In biophysical profile score of the last examination 24 hours prior to patients with AFI greater than 5 cm. These rates are both Increased In delivery in patients with umbilical vasculitis was found to be contrast to the approximately 3% rate of intervention for fetal distress significantly lower as compared to patients Without umbilical in patients with normal antepartum testing in thiS institution. These vasculitis (mean :t SO 6.6:t 2.3 v. 8.2:t 2.4, respectively). These data results imply that anhough fetuses with decreased amniotic fluid and a suggest that subclinical stages of infection are associated with prolonged FHR deceleration dUring antepartum testing have an biophYSical alterations of the fetoplacental unit; i.e .• simultaneous increased risk of fetal distress compared to fetuses With normal fluid, decreasing fetal biophysical activities and increasing SID ratios. prolonged fetal heart rate deceleration before the onset of labor Daily umbilical artery SID ratios. in conjunction with biophysical predicts a substantial risk of fetal distress dUring labor even In the profiles. may be proven useful in following patients with preterm presence of normal amniotic fluid. PROM.
SPO Abstracts
j.ltlll.ln 1991
Am
434 UNEXPLAINED ELEVATED MATERNAL SERUM ALPHAFETOPROTEIN (MSAFP) IS NOT NECESSARILY PREDICTIVE OF ADVERSE PERINATAL OUTCOME IN AN INDIGENT URBAN POPULATION. OP Phjlljps MD. JL SImpson MD. CD Morgan RNC MS. RN Anderson PhD, LP Shulman MD. CM Meyers MD. EA Tolley PhD. S Elias MD; University of Tennessee. Memphis. Increased frequencies of adverse perinalal outcome have been associaled with unexplamed elevaled MSAFP. It remains uncertam whether unexplamed values predict adverse perinatal outcome in an indIgent, urban obstetrIcal popUlation already IdentIfied to be at !ugh risk for adverse perinatal outcome. Study Design: Women WIth smgleton pregnancIes who underwent second trimester MSAFP screenmg (Abbott enzyme Immunoassay) and who receIved obstetrIcal care at our UniverSIty-based clinic were studied. An elevated MSAFP was defined as '" 2.5 MOM adjusted for weIght and race that was unexplained if, after correcting for gestatIOnal dating and multiple gestation. no fetal defects were detected by Ultrasonography. Subjects were stratIfied according to the presence or absence of medical risk factors as listed on the Hollister form. Patients with normal MSAFP values served as controls. matched for risk status. race. age and parity. Outcomes studied were congenital malformations. spontaneous abortIOn. premature labor. PROM. IUGR. fetal demIse. preeclampsia and abruptio placenta. Results: Among 8740 undergoing MSAFP screening. 85 had unexplained elevated MSAFP values; outcomes could not obtained for 9. In subjects with unexplained elevated MSAFP. 38 (50%) already had identIfIable risk factors. compared to 28.6% of populatIOn WIth normal MSAFP (p=O.OOI). Adverse perinatal outcome occurred in 32 (42.11 %) of the remaining 76 with elevated MSAFP, compared to 24 (31.58%) controls with normal MSAFP (p=0.25). No statIsbcal slgmficance was found when comparisons were made for any specific adverse perinatal outcome Comparison between SUbjects and controls after stratificabon of flsks factors showed no sigmficant difference III perinatal outcome. We conclude that in pabents from an indigent urban population already known to have mcreased risk for adverse perinatal outcome. unexplained elevated MSAFP prOVIdes no slgmflcant predictive information.
435
J Ob,tet GHlccol
436 HUMAN FETAL RESPONSE TO VIBROACOUSTIC STIMULATION AS A FUNCTION OF STIMULUS DURATION. Marcello PletrantoOl'. Jeffrey LAngel. MIchael T. Parsons, LInda McClaIn'. Hector Arango'. lilll,am N Spellacy, UOlv. of South FlorIda, Tampa, FlOrida The purpose of th, s study was to exam 1 ne the effects of varyIng stImulus duratIOns on the fetal heart rate acceleratIon Index and behaVIOral state. The actIvIty Index (AI = AmplItude bpm x duratIon sec) was deSIgned In an attempt to prOVIde obJectIve and quantItatIve assessment of the magOltude of the FHR acceleratIOn response follOWIng a SIngle v,broacoust,c stImulatIon (VAS) WIth duratIons of a (sham), 1. 3. or 5 seconds. Changes In baselIne FHR. variabIlIty. acceleratIons. and fetal body movements are normal to healthy fetuses These observatIOns are often related to the various fetal behaVIOral states as deSCribed by NlJhulS et al. These fetal behaVIoral states a re also known to be altered or 1 nduced by VAS There were 197 prospect 1 ve VAS tests among 4 groups; 49 rece1 ved a SIngle 1 second stImulus. 50 receIved a SIngle 3 second stImulus. 48 receIved a SIngle 5 second stImulus. and 50 receIVed a "sham" st 1 mu 1us (group "0··) and were cant ro 1s StatIstIcally slgOlflcant dIfferences were observed In the mean amplItude and duratIOn of acceleratIon of groups 3 sec and 5 sec when compared to groups and 1 at P < 05 In addItIon groups 3 and 5 demonstrated SIgnIfIcantly a greater change In the fetal behav lora 1 state from sleep to wakefu 1ness and a decrease 1 n NST test 1 ng tIme over groups a and 1 (P < . 0001) Our results suggest that the magnItude of the FHR acceleratIon response 1 s dependent on the durat IOn of the st 1 mu 1us Furthermore the mean AI of a 3-sec sound stImulus ImplIes an adequate dose-response for a change 1 n fetal behavIor to wakefulness.
a
AMNIOTIC FLUID INDEX AND ANTEPARTUM FETAL HEART RATE 437 THE RELATIONSHIPS AMONG UMBILICAL ARTERY VELOCIMETRY. FETAL BIOPHYSICAL PROFILE AND PLACENTAL INFLAMMATION PROLONGED DECELERATION IN PRETERM PROM. Alfred 0 Fleming MD. Carolyn M. Salafia. Mrt. Debra K Grubtt. Richard H Paul Anthony M. Vintzileos. MD. John F. Rodis. MD. Winston A. Campbell, Univ. of Southern Calnornia. LA. CA MD. Kimberly F. Bantham. B~ University of Connecticut Heanh Prolonged fetal heart rate (FHR) decelerations during antepartum Center. Farmington. CT testing have been associated with adverse fetal outcome. Decreased The relationships among umbilical artery velocimetry. fetal amount of amniotic fluid measured by various methods has been biophysical profile and placental inflammation in 44 consecutive associated With both FHR variable decelerations and adverse fetal patients with preterm PROM were determined. All patients were outcome. Antepartum FHR decelerations below 90 beats per minute followed with daily fetal biophysical profiles and systolicldiastolic (bpm) or at least 40 bpm below baseline for at least one minute were (SID) ratios as determined by continuous wave Doppler. After observed dUring antepartum testing in 98 pregnancies during the delivery. placental histologic examination resuned in the aSSignment period Jan. 1987-June 1990. Indications for and results of of 17 cases In Group 1 (no inflammation), and 22 in Group 2 (umbilical antepartum FHR testing, four quadrant amniotiC fluid index (AFI) at the vasculitis present). Five patients with choriodeciduitis/choriomtis time of testing. and pregnancy outcome were reviewed. In 77 were excluded. In Group 1. the last biophysical assessment Within 24 patients. delivery occurred In less than 24 hours, in 10 between 2 and hours prior to delivery was abnormal in 4 of 17 (24%). whereas in 5 days. and in 11 after 5 days. Cesarean section was performed in 35 Group 2 abnormal biophYSical assessment was present in 17 of 22 cases and vaginal delivery in 63 patients (9 With forceps). The (77%). (p<.05). The longitudinal trends of fetal biophysical profile average AFI in pregnancies which required intervention for fetal scores and SID ratios were analyzed for patients w~h and without distress (either forceps or cesarean section) was Significantly lower umbilical vasculitis. Analysis of the longitudinal trend during the than in pregnancies which did not require intervention In pregnancies period of two to seven days prior to delivery showed that there were in which the AFI was less than 5 centimeters at the time of the no differences of biophysical scores or SID ratios in either group. prolonged deceleration. 4 of 21 infants (19%) had a five minute Apgar However. in the last examination. within 24 hours of delivery. patients less than 7. compared to 2 of 53 (4%) In patients With an AFI greater with umbilical vasculitis had higher SID ratios and lower biophysical than 5. Patients with an AFlless than 5 cm had operative intervention profile scores as compared to previous examinations. In addition. the for fetal distress in 8 of 21 cases (38%). compared to 11 of 53 (21 %) In biophysical profile score of the last examination 24 hours prior to patients with AFI greater than 5 cm. These rates are both Increased In delivery in patients with umbilical vasculitis was found to be contrast to the approximately 3% rate of intervention for fetal distress significantly lower as compared to patients Without umbilical in patients with normal antepartum testing in thiS institution. These vasculitis (mean :t SO 6.6:t 2.3 v. 8.2:t 2.4, respectively). These data results imply that anhough fetuses with decreased amniotic fluid and a suggest that subclinical stages of infection are associated with prolonged FHR deceleration dUring antepartum testing have an biophYSical alterations of the fetoplacental unit; i.e .• simultaneous increased risk of fetal distress compared to fetuses With normal fluid, decreasing fetal biophysical activities and increasing SID ratios. prolonged fetal heart rate deceleration before the onset of labor Daily umbilical artery SID ratios. in conjunction with biophysical predicts a substantial risk of fetal distress dUring labor even In the profiles. may be proven useful in following patients with preterm presence of normal amniotic fluid. PROM.