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Acid base profiles of newborns with umbilical cord prolapse
407 ⫾ 393 minutes, PF ⫽ 624 ⫾ 300 minutes; P ⬍ .05). There was no difference in the number of patients managed with artificial rupture of membranes. There was no difference in maternal age, parity, weight, height, race, or indication for induction of labor. There was also no difference in cesarean delivery rate, antepartum fever, Apgar scores, birth weight, or cord pH.
Active Expectant Management of Second-Trimester Preterm Premature Rupture of Membranes
CONCLUSIONS: In patients who respond to a single sustained release dinoprostone insert, intracervical placement decreases time to delivery without increasing cesarean delivery rate, infectious morbidity, or other complications of labor.
Lee Yang, DO
Acid Base Profiles of Newborns With Umbilical Cord Prolapse Susan M. Ramin, MD University of Texas Health Science Center at Houston, Houston, TX
Joan M. Mastrobattista, MD, Edward Yeomans, MD, Mary-Clare Day, RN, Alfred Sosa, MD, and Larry C. Gilstrap, MD OBJECTIVE: To determine acid base profiles and differences between umbilical artery (Ua) and umbilical vein (Uv) values in newborns with umbilical cord prolapse (UCP). STUDY DESIGN: Babies with UCP were identified from our database (January 1, 2000 –June 30, 2002). Of 13,324 deliveries, there were 18 (0.14%) cases of UCP. Maternal charts and acid base profiles were reviewed. RESULTS: Sixteen of 18 newborns had both Ua and Uv samples, one had only the Ua sample, and one had no sample. Mean GA was 36.5 weeks. Eleven fetuses (61%) were vertex, four (22%) breech, two (11%) transverse, and one (6%) compound. Mean birth weight was 3086 ⫾ 1051 g. Seventeen infants (94%) were delivered abdominally. Five (28%) of the 18 babies had 5-minute Apgar score of less than 7. Seven newborns (39%) were admitted to the neonatal intensive care unit. Mean Ua pH was 7.16 ⫾ 0.11. Mean Uv pH was 7.30 ⫾ 0.06. Eight infants (44%) had Ua pH of 7.15 or less, five had Ua pH of 7.10 or less, and two had Ua pH of 7.00 or less. One infant with Ua pH of 6.97 had low normal Uv pH (7.27), and one had Ua pH of 6.96 with a very low Uv pH of 7.13. Ten of 16 infants with both Ua and Uv samples had a 0.10 or more pH unit Ua-Uv difference. Five of 16 (31%) had a Ua-Uv difference of 24 or more mm Hg in PCO2. CONCLUSIONS: UCP may affect the Ua values to a greater degree than Uv values. Ua pH may be very low (less than 7.00), whereas Uv pH remains in the normal range. With prompt diagnosis and delivery the outcome is good.
36S
MONDAY POSTERS
Rockford Regional Perinatal Center, Rockford, IL
Susan K. Hendricks, MD, Donald R. Taylor, DO, Roderick F. Hume, Jr, MD, Byron C. Calhoun, MD, and Howard K. Kaufman, DO OBJECTIVE: To define the impact of active expectant management of preterm PROM on fetal or neonatal outcome parameters and maternal health. METHODS: Retrospective case analysis of 44 consecutive pregnancies with PPROM. INCLUSION CRITERIA: Singleton gestation with PPROM less than 27 weeks’ gestation; no evidence of chorioamnionitis, active labor, or maternal or fetal contraindications to prolongation of pregnancy. Groups were stratified by gestational age. Management included tocolysis, steroid administration when 24 weeks’ gestation or greater, GBS prophylaxis, and appropriate fetal surveillance. Delivery was effected for intraamniotic infection, nonreassuring maternal or fetal status, active labor, or 34 weeks’ completed gestation. RESULTS: Mean GA at onset of ROM was 22.9 weeks (range 16 –26.8). The mean latent period was 20.5 days (2– 83) and was inversely related to gestational age at ROM. The mean GA at delivery was 25.8 weeks (17–28.8). The risk of pulmonary hypoplasia was inversely associated with GA at ROM onset. Endomyometritis (6.8%) was without long-lasting sequela. Immediate neonatal morbidity and mortality, stratified by gestational age at amniorrhexis, is summarized in Table 1.
Table 1. GA at PROM
Stillborn Neonatal Pulmonary fetoses death hypoplasia N (%) (%) (%) (%)
⬍23 wk 15 (34.1) 6 (40.4) 23–23 13 (29.5) 1 (7.7) 6/7 wk 24–26 wk 16 (36.4) 0
5 (33.3) 4 (30.8)
6 (40.0) 1 (7.7)
0
0
BPD (%)
Survival (%)
4 (26.7) 4 (26.7) 6 (46.1) 8 (61.5) 10 (62.5) 16 (100)
CONCLUSIONS: This study suggests that active expectant management improves perinatal outcome without increasing maternal morbidity and mortality. Survival for neonates with PPROM before 23 weeks remains bleak.
OBSTETRICS & GYNECOLOGY
Active Expectant Management of Second-Trimester Preterm Premature Rupture of Membranes
CONCLUSIONS: In patients who respond to a single sustained release dinoprostone insert, intracervical placement decreases time to delivery without increasing cesarean delivery rate, infectious morbidity, or other complications of labor.
Lee Yang, DO
Acid Base Profiles of Newborns With Umbilical Cord Prolapse Susan M. Ramin, MD University of Texas Health Science Center at Houston, Houston, TX
Joan M. Mastrobattista, MD, Edward Yeomans, MD, Mary-Clare Day, RN, Alfred Sosa, MD, and Larry C. Gilstrap, MD OBJECTIVE: To determine acid base profiles and differences between umbilical artery (Ua) and umbilical vein (Uv) values in newborns with umbilical cord prolapse (UCP). STUDY DESIGN: Babies with UCP were identified from our database (January 1, 2000 –June 30, 2002). Of 13,324 deliveries, there were 18 (0.14%) cases of UCP. Maternal charts and acid base profiles were reviewed. RESULTS: Sixteen of 18 newborns had both Ua and Uv samples, one had only the Ua sample, and one had no sample. Mean GA was 36.5 weeks. Eleven fetuses (61%) were vertex, four (22%) breech, two (11%) transverse, and one (6%) compound. Mean birth weight was 3086 ⫾ 1051 g. Seventeen infants (94%) were delivered abdominally. Five (28%) of the 18 babies had 5-minute Apgar score of less than 7. Seven newborns (39%) were admitted to the neonatal intensive care unit. Mean Ua pH was 7.16 ⫾ 0.11. Mean Uv pH was 7.30 ⫾ 0.06. Eight infants (44%) had Ua pH of 7.15 or less, five had Ua pH of 7.10 or less, and two had Ua pH of 7.00 or less. One infant with Ua pH of 6.97 had low normal Uv pH (7.27), and one had Ua pH of 6.96 with a very low Uv pH of 7.13. Ten of 16 infants with both Ua and Uv samples had a 0.10 or more pH unit Ua-Uv difference. Five of 16 (31%) had a Ua-Uv difference of 24 or more mm Hg in PCO2. CONCLUSIONS: UCP may affect the Ua values to a greater degree than Uv values. Ua pH may be very low (less than 7.00), whereas Uv pH remains in the normal range. With prompt diagnosis and delivery the outcome is good.
36S
MONDAY POSTERS
Rockford Regional Perinatal Center, Rockford, IL
Susan K. Hendricks, MD, Donald R. Taylor, DO, Roderick F. Hume, Jr, MD, Byron C. Calhoun, MD, and Howard K. Kaufman, DO OBJECTIVE: To define the impact of active expectant management of preterm PROM on fetal or neonatal outcome parameters and maternal health. METHODS: Retrospective case analysis of 44 consecutive pregnancies with PPROM. INCLUSION CRITERIA: Singleton gestation with PPROM less than 27 weeks’ gestation; no evidence of chorioamnionitis, active labor, or maternal or fetal contraindications to prolongation of pregnancy. Groups were stratified by gestational age. Management included tocolysis, steroid administration when 24 weeks’ gestation or greater, GBS prophylaxis, and appropriate fetal surveillance. Delivery was effected for intraamniotic infection, nonreassuring maternal or fetal status, active labor, or 34 weeks’ completed gestation. RESULTS: Mean GA at onset of ROM was 22.9 weeks (range 16 –26.8). The mean latent period was 20.5 days (2– 83) and was inversely related to gestational age at ROM. The mean GA at delivery was 25.8 weeks (17–28.8). The risk of pulmonary hypoplasia was inversely associated with GA at ROM onset. Endomyometritis (6.8%) was without long-lasting sequela. Immediate neonatal morbidity and mortality, stratified by gestational age at amniorrhexis, is summarized in Table 1.
Table 1. GA at PROM
Stillborn Neonatal Pulmonary fetoses death hypoplasia N (%) (%) (%) (%)
⬍23 wk 15 (34.1) 6 (40.4) 23–23 13 (29.5) 1 (7.7) 6/7 wk 24–26 wk 16 (36.4) 0
5 (33.3) 4 (30.8)
6 (40.0) 1 (7.7)
0
0
BPD (%)
Survival (%)
4 (26.7) 4 (26.7) 6 (46.1) 8 (61.5) 10 (62.5) 16 (100)
CONCLUSIONS: This study suggests that active expectant management improves perinatal outcome without increasing maternal morbidity and mortality. Survival for neonates with PPROM before 23 weeks remains bleak.
OBSTETRICS & GYNECOLOGY