604A Maternal and neonatal complications in cases of dystocia

SPO Abstracts

Volume 164 Number 1, Part 2

411

604B SUBSTANCE ABUSE AND PERINATAL MORBIDITY & 603 OUTCOME OF TWIN GESTATIONS COMPLICATED MORTALITY BY ANTEPARTUM FETAL DEMISE, DJ Wong. MD. Copur H~ Khakoo H, Boafo A, Ayromlooi J. DS Kin MD. lIT Strassner MD. Rush Medical Center. New York Medical College, Lincoln Hospital N.Y. Chicago,IL. A retrospective study of 19,614 women who Antepartum fetal demise of one twin complicated 13 of 683 (1.9%) twin gestations dwiog a 10 year period. A delivered in an inner city hospital from Jan.l, retrospective review was performed to examine maternal 1985 to Dec.31, 1988 was conducted to ascertain and neonatal morbidity. Antepartum diagnosis of fetal the effect of cocaine, crack, heroin, methadone death was made in 8 of the 13 cases. Diagnosis to and marijuana over perinatal morbidity and still delivery interval ranged from 4 to 147 days. Antepartum birth rate. The findings are summarized in the complications included 7 with preterm labor. 2 with following table: premature rupture of membranes. 2 with polyhydramnios Complications Substance Control P value (preceding fetal demise) and 1 each with intrauterine abuser growth retardation. preeclampsia and gestational diabetes. (N=733) (N=18881) Eleven cesarean sections were performed (6 for 1.Preterm delivery 230 (31%) 2266(12%) 0.001 maipresentations. 3 for fetal distress. and 2 for repeat 2. Infants <' 2500gms 402(55%) 2870(15%) 0.001 cesarean sections). No coagulation problems were seen. 3.Abruptio p1ac. 25(3.4%) 30(.16%) 0.001 Five pregnancies were followed for >5 weeks following 4.PROM 61 (8.3%) 1397(7.4%) N.S. the demise. Neonatal outcomes included 10 of 13 (77%) 5.Low 1 min.Apgar 80 (11%) 774(4.1%) 0.001 surviving. Mean gestational age at delivery was 33 (less than 7) weeks. Mean birthweight for the surviving and 0.001 6.Low 5 min.Apgar 20(2.7%) 132(.7%) nonsurviving twin was 2775 and 745 grams respectively. 7. Stillbirth 32(4.4%) 181 (.96%) 0.001 Mean Apgar scores at 1 and 5 minutes were 5.5 and 7.7 respectively. There were 7 NICU admissions with 3 Conclusion: Substance abuse during pregnancy neonatal deaths (gestational ages 26-28 weeks). In results in significant increase in preterm summary. the morbidity for the surviving twin is delivery, low birth weight, abruptio placentae, primarily from prematurity whereas the morbidity for the stillbirth and low one and five minute Apgar mother is primarily from cesarean section.

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scores without any changes in the incidence of premature rupture of membranes (PROM) .

604A MATERNAL

AND NEONATAL COMPLICATIONS IN CASES OF DYSTOCIA, Rodriguez JX, Sarinoglu CX, Mercer BMx, Sibai BM, University of TN, Memphis, The development of shoulder dystocia is a medical-legal nightmare for the obstetrician, METHODS: We have reviewed maternal and neonatal complications in 149 cases of shoulder dystocia (between January, 1984 and November, 1988), Maternal data included presence of risk factors, use of instrumental delivery, and maternal complications. Neonatal data included Apgar scores, birth weight over 4 kilograms, umbilical cord gases and birth trauma. Long term outcome was obtained in survivors who had an average followup of 2.3 years (range, 0.5 to 5 years) RESULTS: Sixty lour women (43%) required instrumental delivery. Sixty eight (45%) had major perineal lacerations; one 01 which resulted in rectovaginal listula. Shoulder dystocia developed in eight pregnancies complicated by antepartum fetal demise and the remainder were live births. Seventy-eight infants (52%) had a birth weight greater than 4 kilograms, 22% had a cord pH <7.20, and only one infant had a 5 minute Apgar score less than 7. Neonatal birth trauma is summarized below. Erbs Palsy 221141 15.6% Fractured Clavicle 61141 4.3% 0.7% Facial Nerve Palsy 1/141 All six cases with fractured clavicles and the one case w~h facial nerve palsy healed spontaneously. Twenty of the 22 inlants w~h Erbs palsy had complete recovery within 8 weeks of delivery. The other two inlants suffered permanent motor delic~. CONCLUSION: Shoulder dystocia results in significant maternal and neonatal morbidity as rellected by neonatal acidosis and trauma. Most infants have a favorable long term outcome and will recover w~hin 8 weeks of delivery.

604C DRUG ABUSE AND STILLBIRTHS

AN ANALYSIS OF STILLBIRTHS AT A CITY HOSPITAL Hamida Khakoo, Alex T. Boafo, Huseyin Copurx Jahangir Ayromlooi Department of Obstetrics and Gynecology, New York Medical College, Lincoln Hospital,N.Y The records of all stillbirths occuring between Jan. 1984 and·~ec. 1989 were reviewed. Congenital anumalies as a cause of stillbirths were excluded from the analysis. During this period of time, there were a total of 28,306 deliveries and 315 stillbirths. The table below shows that drug use as a contributory factor to stillbirths dramatically increased from 14.5% in 1984 to 25% in 1989. The results suggest -that there is a continued need to expand drug education programs to minimize such derogatory effects on the normal but dead fetuses in pregnancy.

YEARS 1984 Total deliveries 4372 Stillbirths(SB) 60 Stillbirth rate% 1.4 Cong.Anomalies 4 Corrected(SB)rate%1.2 Drug Abusers with 8 stillbirths Drug related(SB)%14.S

1985 4619 43 0.93 2 0.88 5

1986 4932 44 0.89 4 0.81 5

1987 5258 54 1.02 2 0.96 9

1988 4775 61 1.27 3 1.23 16

1989 4320 53 1.20 1 1.20 13

11.1 12.6 17.6 26.6 25.0