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474 Placental “Lakes” and Anticartiolipin Antibodies (ACA)
SPO Abstracts
Volume 166 Number 1, Part 2
472
THE FAILURE OF ROUTINE AMNIOINFUSION IN PATIENTS WITH THICK MECONIUM TO ELIMINATE THE OCCURRENCE OF MECONIUM ASPIRATION SYNDRCJIIE.
M. T.
Parsons,
A.K.
Parsons, x
and
J.L.
Angel.
University of South Florida College of Medicine, Tan..,a, FLorida. The use of arrnioinfusion in patients with thick meconiun stained amiotic fluid (MSAF) to reduce c"""l ications of meconilJll to the fetus was first reported in 1988. The practice has become widespread but no data have been reported of a beneficial effect of routine use in a large patient population. We cOff1'8red the incidence and c~L ications of MSAF in 1987 (before BftI'lioinfusion was used) to Jan.-Sept. 1990, (when arrnioinfusion was routine for patients with thick. meconiun stained amniotic fluid). Patients l and babies' charts were reviewed for cOlT1'Lications during labor, abnormal fetal heart rate tracings, use of arrnioinfusion, and infant outcome, especially meconilln aspiration syndrome. Resul ts: The incidence of MSAF was 16.1" (1012 of 6275 del iveries) in 1987 c"",,"red to 16.9% (937 of 5537 del iveries) in 1990 (NS). Thirty-two infants were aanitted to the NICU with meconiun aspiration syndrome in 1987 which represented 3.2% of patients with MSAF, cOfI1)8red to 31 infants adnitted to the NICU with meconh.n aspiration syndrome in 1990, 3.4% of patients with MSAF (NS). The mean stay in NICU in 1987 was 9.3 days and in 1990 8.8 days (NS). Of the 31 patients whose infants had meconiun aspiration syndrome in 1990, only 6 had anI'lioinfusion performed and all 6 of these had abnormal fetal heart rate tracings. The reasons that the other 25 patients whose infants had meconiun aspiration syndrome did not have anrlioinfusion included: no suspicion of thick meconilJll (20), advanced labor (2), fetal distress necessitating delivery (2), and other (1). We conclude that routine amioinfusion for suspected thick meconiln does not el iminate meconiun aspiration syndrome. I""rovements may be made by 1) accurate and continued observation for the presence of thick. meconiun stained fluid, and 2) not falsely assuning anI'lioinfusion wi II always protect the fetus with thick meconilln and an abnormal heart rate tracing.
473
CHANGES IN SUBSTANCE ABUSE OVER SUCCESSIVE PREGNANCIES: A LONGITUDINAL ANALYSIS. R.J. Sokol. S.S. Martier: J.W. Ager, Dept. Ob/Gyn, Wayne State Univ.lHutzel Hosp .• Detroit. MI Though substance abuse is well recognized as a major pregnancy risk, there have been no longitudinal studies of maternal substance abuse in successive pregnancies. In this longitudinal study, prenatal risk factors were observed in two consecutive pregnancies for 888 black patients in an inner city prenatal clinic. Of particular interest were changes over time in substance abuse. For this sample, the age at the first pregnancy was 21.9 and mean inter-pregnancy interval was 23 months. Mean gestational age at first visit was about 22 weeks for both pregnancies. Differences between means for successive pregnancies were assessed using the matched t test for continuous measures and the McNemar significance of change test for the dichotomous outcomes in both cases using alpha == .01. Of the substance abuse factors, cigarette smoking showed a significant increase, (p < .001) whereas use of cocaine, cannabis and narcotics (n == 306) showed no difference for the two pregnancies. For alcohol use, results depended on the period assessed. Periconceptional drinking, 8S measured by ounces of absolute alcohol per day (aad), amount per drinking day (aadd) and proportion drinking days (ppdl, did not differ for the two pregnancies. However, for drinking at time of initial visit, the same three measures-aad, aadd and pdd-showed large and significant increases for the second pregnancy. A measure of alcohol-related life problems, the Michigan Alcohol Screening Test (MAST) score of ~ 6 showed no differences between pregnancies (about 10% in each). Results reinforce the need for post-partum interventions designed to reduce maternal drinking before and during subsequent pregnancies.
474 PLACEllTAL "LAKES" AIID AllTlCARDIOLIPIIf AllTlOODIES (ACA). ~ Hatjis, J. GrahaJIx , S. libeeler", J. Gadd x , K. Reed", Div. IIaternal/Fetal lied., Dept. OB/GY\I, Riverside Jlethodist Hospitals, Colllllbus, Obio ACA and lupus anticoagulant (LA) have been associated with significant obstetrical colPlications. ~: Does the sonographic detection of placental "lakes" correlate with the presence of ACA or LA in laternal blood? ~: Placental lakes were seen in 23 pregnant WOJIel\ exuined by ultrasolDld in the 2nd triJester. Transplacental lakes (TPL) spanned the entire width or a significant portion of the placenta and aeasured at least 2 CI in diaaeter. Subchorionic lakes (SCL) were located near the subchorionic plate. ACA and LA were aeasured by established aethods. ~: 13 of 14 patients with TPL were positive for ACA (5/13 aedillJ positive, 8/13 low positive): 1/13 was also positive for LA. In patients with SCL only 2/9 bad low-positive ACA (p < 0.001). 10/14 patients with TPL, but only 3/9 with SCL had pregnancy related colPlications (p < 0.06). conclusions: TIle presence of TPL stronqly correlates with a positi ve laternal ACA panel and lay serve as a aarker for pregnancies at risk for cOlPlications. Intensive surveillance of patients with TPL and positive ACA is reco_neled.
475
PREVIOUS VERTICAL CESAREAN SECTION; UTERINE RUPTURE RATE
Jacquin P. Matthews X , Jeffrey J. Knickerbocker x • Mark A. Morgan, Dept. Ob/Gyn, Univ. Oklahoma Health Sciences Center, Oklahoma City, OK and Dept. Ob/Gyn, Univ. of California, Irvine Medical Center. Orange, CA Although the uterine rupture in patients undergoing a labor trial
with a previous low transverse cesarean section is reported to be acceptably low. uterine rupture in patients with a previous vertical cesarean section is believed to be unacceptably high. However. studies of patients with previous vertical cesarean section lahor trials have not represented all of these patients having a labor trial. The purpose of this study was to determine the frequency of clinically significant uterine ruptures in all baboons with previous vertical cesarean section. The reproductive histories of baboons from our colony between 1966 and 1991 were reviewed and those animals (n~29) who had undergone at least one labor trial after vertical cesarean section (VBAC) comprised the study group. A total of 188 deliveries occurred, 75 vertical cesarean sections, 104 VBAC (gestational age at least >100 days at delivery, term 175 days) and 9 uterine ruptures. The overall frequency of uterine rupture in these animals all having had a labor trial was 8.0% (9/113). The uterine rupture frequency increased with the number of previous vertical cesarean sections: one. 5.2% (3/58); two. 11.4% (4/35); three or more. 10.0% (2/20). The maternal mortality associated with uterine rupture was 38% (3/8) and the perinatal mortality 100%. Interestingly, the baboons in whom uterine rupture occurred tended to be older. Based on these experimental animal data, the frequency of uterine ruptures in nonhuman primates with a previous vertical scar having all had a labor trial is unacceptably high. Therefore, we would not recommend a labor trial for a patient with a previous vertical cesarean section.
405
Volume 166 Number 1, Part 2
472
THE FAILURE OF ROUTINE AMNIOINFUSION IN PATIENTS WITH THICK MECONIUM TO ELIMINATE THE OCCURRENCE OF MECONIUM ASPIRATION SYNDRCJIIE.
M. T.
Parsons,
A.K.
Parsons, x
and
J.L.
Angel.
University of South Florida College of Medicine, Tan..,a, FLorida. The use of arrnioinfusion in patients with thick meconiun stained amiotic fluid (MSAF) to reduce c"""l ications of meconilJll to the fetus was first reported in 1988. The practice has become widespread but no data have been reported of a beneficial effect of routine use in a large patient population. We cOff1'8red the incidence and c~L ications of MSAF in 1987 (before BftI'lioinfusion was used) to Jan.-Sept. 1990, (when arrnioinfusion was routine for patients with thick. meconiun stained amniotic fluid). Patients l and babies' charts were reviewed for cOlT1'Lications during labor, abnormal fetal heart rate tracings, use of arrnioinfusion, and infant outcome, especially meconilln aspiration syndrome. Resul ts: The incidence of MSAF was 16.1" (1012 of 6275 del iveries) in 1987 c"",,"red to 16.9% (937 of 5537 del iveries) in 1990 (NS). Thirty-two infants were aanitted to the NICU with meconiun aspiration syndrome in 1987 which represented 3.2% of patients with MSAF, cOfI1)8red to 31 infants adnitted to the NICU with meconh.n aspiration syndrome in 1990, 3.4% of patients with MSAF (NS). The mean stay in NICU in 1987 was 9.3 days and in 1990 8.8 days (NS). Of the 31 patients whose infants had meconiun aspiration syndrome in 1990, only 6 had anI'lioinfusion performed and all 6 of these had abnormal fetal heart rate tracings. The reasons that the other 25 patients whose infants had meconiun aspiration syndrome did not have anrlioinfusion included: no suspicion of thick meconilJll (20), advanced labor (2), fetal distress necessitating delivery (2), and other (1). We conclude that routine amioinfusion for suspected thick meconiln does not el iminate meconiun aspiration syndrome. I""rovements may be made by 1) accurate and continued observation for the presence of thick. meconiun stained fluid, and 2) not falsely assuning anI'lioinfusion wi II always protect the fetus with thick meconilln and an abnormal heart rate tracing.
473
CHANGES IN SUBSTANCE ABUSE OVER SUCCESSIVE PREGNANCIES: A LONGITUDINAL ANALYSIS. R.J. Sokol. S.S. Martier: J.W. Ager, Dept. Ob/Gyn, Wayne State Univ.lHutzel Hosp .• Detroit. MI Though substance abuse is well recognized as a major pregnancy risk, there have been no longitudinal studies of maternal substance abuse in successive pregnancies. In this longitudinal study, prenatal risk factors were observed in two consecutive pregnancies for 888 black patients in an inner city prenatal clinic. Of particular interest were changes over time in substance abuse. For this sample, the age at the first pregnancy was 21.9 and mean inter-pregnancy interval was 23 months. Mean gestational age at first visit was about 22 weeks for both pregnancies. Differences between means for successive pregnancies were assessed using the matched t test for continuous measures and the McNemar significance of change test for the dichotomous outcomes in both cases using alpha == .01. Of the substance abuse factors, cigarette smoking showed a significant increase, (p < .001) whereas use of cocaine, cannabis and narcotics (n == 306) showed no difference for the two pregnancies. For alcohol use, results depended on the period assessed. Periconceptional drinking, 8S measured by ounces of absolute alcohol per day (aad), amount per drinking day (aadd) and proportion drinking days (ppdl, did not differ for the two pregnancies. However, for drinking at time of initial visit, the same three measures-aad, aadd and pdd-showed large and significant increases for the second pregnancy. A measure of alcohol-related life problems, the Michigan Alcohol Screening Test (MAST) score of ~ 6 showed no differences between pregnancies (about 10% in each). Results reinforce the need for post-partum interventions designed to reduce maternal drinking before and during subsequent pregnancies.
474 PLACEllTAL "LAKES" AIID AllTlCARDIOLIPIIf AllTlOODIES (ACA). ~ Hatjis, J. GrahaJIx , S. libeeler", J. Gadd x , K. Reed", Div. IIaternal/Fetal lied., Dept. OB/GY\I, Riverside Jlethodist Hospitals, Colllllbus, Obio ACA and lupus anticoagulant (LA) have been associated with significant obstetrical colPlications. ~: Does the sonographic detection of placental "lakes" correlate with the presence of ACA or LA in laternal blood? ~: Placental lakes were seen in 23 pregnant WOJIel\ exuined by ultrasolDld in the 2nd triJester. Transplacental lakes (TPL) spanned the entire width or a significant portion of the placenta and aeasured at least 2 CI in diaaeter. Subchorionic lakes (SCL) were located near the subchorionic plate. ACA and LA were aeasured by established aethods. ~: 13 of 14 patients with TPL were positive for ACA (5/13 aedillJ positive, 8/13 low positive): 1/13 was also positive for LA. In patients with SCL only 2/9 bad low-positive ACA (p < 0.001). 10/14 patients with TPL, but only 3/9 with SCL had pregnancy related colPlications (p < 0.06). conclusions: TIle presence of TPL stronqly correlates with a positi ve laternal ACA panel and lay serve as a aarker for pregnancies at risk for cOlPlications. Intensive surveillance of patients with TPL and positive ACA is reco_neled.
475
PREVIOUS VERTICAL CESAREAN SECTION; UTERINE RUPTURE RATE
Jacquin P. Matthews X , Jeffrey J. Knickerbocker x • Mark A. Morgan, Dept. Ob/Gyn, Univ. Oklahoma Health Sciences Center, Oklahoma City, OK and Dept. Ob/Gyn, Univ. of California, Irvine Medical Center. Orange, CA Although the uterine rupture in patients undergoing a labor trial
with a previous low transverse cesarean section is reported to be acceptably low. uterine rupture in patients with a previous vertical cesarean section is believed to be unacceptably high. However. studies of patients with previous vertical cesarean section lahor trials have not represented all of these patients having a labor trial. The purpose of this study was to determine the frequency of clinically significant uterine ruptures in all baboons with previous vertical cesarean section. The reproductive histories of baboons from our colony between 1966 and 1991 were reviewed and those animals (n~29) who had undergone at least one labor trial after vertical cesarean section (VBAC) comprised the study group. A total of 188 deliveries occurred, 75 vertical cesarean sections, 104 VBAC (gestational age at least >100 days at delivery, term 175 days) and 9 uterine ruptures. The overall frequency of uterine rupture in these animals all having had a labor trial was 8.0% (9/113). The uterine rupture frequency increased with the number of previous vertical cesarean sections: one. 5.2% (3/58); two. 11.4% (4/35); three or more. 10.0% (2/20). The maternal mortality associated with uterine rupture was 38% (3/8) and the perinatal mortality 100%. Interestingly, the baboons in whom uterine rupture occurred tended to be older. Based on these experimental animal data, the frequency of uterine ruptures in nonhuman primates with a previous vertical scar having all had a labor trial is unacceptably high. Therefore, we would not recommend a labor trial for a patient with a previous vertical cesarean section.
405