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Amniotic fluid index and clinical oligohydramnios as predictors of neonatal outcome in patients with prolonged pregnancy
S42
SPO Abstracts
January 1997 A m J Obstet Gyneeol
109
PERSISTENCE OF BENZATHINE PENICILLIN IN PREGNANT GROUP B STREP CARRIERS. j Weeks, S Myers~, L LasheG J Goldsmithx, C Vr ~,J Spinnato, S Gall Depts. of OB/GYN mad Pharmacology, Univ. of Louisville, Louisville, KY. OBJECTIVE: To determine if streptococcicidal levels of benzathine penicillin can be detected in the maternal serum for four weeks after treatment with 4.8 million units. The study hypothesis was that 4.8 million units of intramuscular benzathine penicillin would result in maternal sermn levels of at least 0.12 wg/ml (twice the minimal inhibitory concentration for Group B Streptococcus) at 4 weeks post-injection. METHODS: Twenty-seven pregnant patients with positive Group B strep vaginal or urine cultures were given 4.8 million units of benzathine penicillin. Maternal blood samples were collected serially for 6 weeks post injection and at delivmy. Penicillin levels were determined by high pressure liquid chromatography. RESULTS: The patients were an average of 186 lbs (range 113 to 337). None of the patients bad penicillin levels of less than 0.20 v.g/ml at forty days after treatment. Cord blood levels were approximately 50 percent lower than maternal penicillin levels. At delivmy maternal and fetal levels were significantly greater than 0.12 ~ g / m l (p < .01), indicating that adequate drug levels would be expected if this therapy were used in the general population. In all but one subject, cord blood levels were above 0.06 p~g/ml (the minimal inhibitolT concentration for Group B strep). The one exception was a patient whose cord blood level was 0.05 p~g/ml at 108 days after treatment. CONCLUSIONS: In pregnant patients, henzathine penicillin levels are high enough to inhibit the growth of Group B Strep for over 4 weeks after injection with 4.8 million units. Further studies are needed to evaluate whether this regimen can replace intrapartum prophylaxis for GBS carriers.
111
AMNIOTIC FLUID INDEX AND CLINICAL OLIGOHYDRAMNIOS AS PREDICTORS OF NEONATAL OUTCOME IN PATIENTS WITH PROLONGED PREGNANCY. C O'Rcill~-Green, M.Y. Divon. Dept. of Ob/Gyn, Albert Einstein College of Medicine, Bronx, Nu OBJECTIVE: To evaluate the role of amniotic fluid index (AFI) and clinical oligohydranmios as predictors of neonatal outcome. STUDY DESIGN: 657 patients with prolonged pregnancies ,~tro had AFI measurements --<5 days before admission and a clinician's note of the amount of fluid at rupture of membranes (ROM) were evaluated for neonatal outcome. Variables included 1 & 5 minute Apgar scores < 7 & 8 respectively (1 MIN --< 7, 5 MIN -< 8), neonatal intensive care unit admission (NICU), neonatal hospitalization > 4 days (>4 DAYS), and any serious neonatal complication, including resuscitation (COMPLIC). Odds ratios were calculated from chi-square analysis of 2 • 2 tables, taking an AFI --< 5 cin (AFI < 5) and absent or decreased fluid at rupture of membranes (OLIGO) as abnormal. (POS - positive; NEG - negadve; SENS sensitiviw; SPEC specificity; CI - confidence interval) RESULTS: True False True False Odds
(95% cI) 1 MIN -< 7 5 M1N < 8 COMPLIC NICU > 4 DAYS
AFI -< 5 OLIGO AFI < 5 OL1GO AFI < 5 OLIGO AFI < 5 OLIGO AFI < 5 OLIGO
20 30 14 17 16 27 7 16 15 31
104 112 110 125 107 115 116 125 39 60
456 448 501 486 483 475 507 498 337 316
76 66 31 28 47 36 23 14 104 88
.21 .31 .31 .38 .25 .43 .23 .53 .13 .26
.81 .80 .82 .80 .82 .81 .81 .80 .90 .84
1.15 1.82 2.06 2.36 1.54 3.10 1.33 4.55 1.25 1.86
(0.65, (t.09, (0.98, (1.17, (0.80, 0.75, (0.47, (2.04, (0.74, (1.10,
2.03) 3.01) 4.14) 4.62) 2.92) 5.49) 3.30) 10.17) 1.87) 3.13)
AFI < 5 did not predict these outconms (95% CI included 1.0). OLIGO is a useful CONCLUSION: OLIGO had significant odds ratios for predicting 1 minute Apgars < 7, 5 minute Apgar < 8, any serious neonatal complication, NICU admission, and neonatal stay > 4 day's, predictor of neonatal outcome. OLIGO may he directly related to the actual anmunt of amniotic fluid present at the tinm of ROM. Decreased amniotic fluid at the time of ROM may predispose to labor abnormalities which result in infection or asphyxia, or may reflect an already compromised fetus. AFI -< 5 may not predict neonatal outcome because it was used as an indication for delivery.
110
FETAL GROWTH RATES IN PATIENTS WITH PRETERM PROLONGED RUPTURE OF MEMBRANES. V~ Block, Jr. x, .,~C Veille. Dept. of Ob/Gyn, Bowman Gray School of Medicine, Winston-Salem, NC. OBJECTIVE: To evaluate fetal biornetric parameters by serial ultrasounds in an effort to prove the hypothesis that fetal growth occurs at a lesser rate in preterm prolonged rupture of membranes (PPROM)~ STUDY DESIGN: A retrospective review of ultrasound data from our institution was performed to isolate patients with PPROM of greater than 14 days duration and serial ultrasound measurements of fetal biometry. Twenty-one patients were identified and comparisons made to a similar number of controls, matched for gravidity, gestational age, and intmwal between ultrasounds, in an effort to determine any significant difference in growth rate of isolated parameters. Analysis of each parameter included rate of growth per day of subjects and controls with subsequent performance of an unpaired t-test to determine significance. RESULTS: The rates of growth for biparietal diameter, head circmnference, abdominal circumference, fenmr length, and fetal weight demonstrated no significant differences between patients with PPROM and matched controls with p values of 0.34, 0.76, 0.38, 0.93, and 0.60 respectively. CONCLUSIONS: Our data and analysis do not support the hypothesis that fetal growth is diminished in these patients. The rate of growth in the face of PPROM is similar to that of controls.
112
MECONIUM ASPIRATION SYNDROME: PLACENTAL PATHOLOGY AND RESPIRATORY DISEASE. Salafia CMx, Holzman 1x. Departments of Pathology and Pediatrics, Mount Sinai Medical Center, New York, NY. OBJECTIVE: To evaluate whether placental features, especially those related to lneconiuln passage and acute infection, are associated with severity of meconimn aspiration syndrome. STUDY DESIGN: Thirty-three consecutive cases admitted to the NICU between 3/94 and 6/96 with a diagnosis of nmconimn aspiration. All cases had placentas submitted for histologic examination. Birthweight, gestational age, Apgar scores, and days for which oxygen support was required were extracted from a data base, and placental slides were reviewed blinded to clinical data. Placental weight, lesions associated with meconium passage (e.g., extent of meconimn histiocytosis in amnion, chorion, decidua and mnbilical cord, integrity of mnbilical and anmiodc epithelium, proximity of meconimn histiocytes to umbilical and chorionie vessels, and mnbilical and chorionic myocyte necrosis), and extent of histologic evidence of acute ascending infection were recorded. Nonparametric analyses used p < 0.05 as significant. RESULTS: Mean birth weight of the 33 cases was 3355 -+ 641 gm, mean gestational age at delivep/39.9 -+ 1.6 wk., and mean Apgar score at 1 and 5 minutes 6.4 -+ 2 and 8.0 -+ 1.5. Histologic evidence of acute ascending infection was seen in 85% (28/33) of cases. Acute anmionitis was seen in 8 (25%) and umbilical/chorionic vasculitis in 9 (28%), both of which were significantly more than in uncomplicated term deliveries (each < 1%, Obstet Gynecol 73: 383-9, 1989, p < 0.001). Severity of acute inflammation was directly related to lower 1 minute Apgar score (p - 0.04). More severe respiratmy disease, as reflected by more days of oxygen support, was related to lower birthweight and decreasing fetoplacental weight ratio (each p < 0.01), but not to any features of meconimn histology or acute ascending infection. CONCLUSIONS: Infants who are diagnosed with lneconium aspiration syndrome are more likely to have inspired amniotic fluid contaminated with both meconium and bacteria/bacterial by-products. More severe meconiuln aspiration syndrome, measured by days of oxygen support, is directly related to lower birthweight (but not gestational age) and larger placental weights (decreasing fetoplacental weight ratio), suggesting that chronic fetoplacental pathology may predispose to more severe neonatal meconium aspiration syndrome.
SPO Abstracts
January 1997 A m J Obstet Gyneeol
109
PERSISTENCE OF BENZATHINE PENICILLIN IN PREGNANT GROUP B STREP CARRIERS. j Weeks, S Myers~, L LasheG J Goldsmithx, C Vr ~,J Spinnato, S Gall Depts. of OB/GYN mad Pharmacology, Univ. of Louisville, Louisville, KY. OBJECTIVE: To determine if streptococcicidal levels of benzathine penicillin can be detected in the maternal serum for four weeks after treatment with 4.8 million units. The study hypothesis was that 4.8 million units of intramuscular benzathine penicillin would result in maternal sermn levels of at least 0.12 wg/ml (twice the minimal inhibitory concentration for Group B Streptococcus) at 4 weeks post-injection. METHODS: Twenty-seven pregnant patients with positive Group B strep vaginal or urine cultures were given 4.8 million units of benzathine penicillin. Maternal blood samples were collected serially for 6 weeks post injection and at delivmy. Penicillin levels were determined by high pressure liquid chromatography. RESULTS: The patients were an average of 186 lbs (range 113 to 337). None of the patients bad penicillin levels of less than 0.20 v.g/ml at forty days after treatment. Cord blood levels were approximately 50 percent lower than maternal penicillin levels. At delivmy maternal and fetal levels were significantly greater than 0.12 ~ g / m l (p < .01), indicating that adequate drug levels would be expected if this therapy were used in the general population. In all but one subject, cord blood levels were above 0.06 p~g/ml (the minimal inhibitolT concentration for Group B strep). The one exception was a patient whose cord blood level was 0.05 p~g/ml at 108 days after treatment. CONCLUSIONS: In pregnant patients, henzathine penicillin levels are high enough to inhibit the growth of Group B Strep for over 4 weeks after injection with 4.8 million units. Further studies are needed to evaluate whether this regimen can replace intrapartum prophylaxis for GBS carriers.
111
AMNIOTIC FLUID INDEX AND CLINICAL OLIGOHYDRAMNIOS AS PREDICTORS OF NEONATAL OUTCOME IN PATIENTS WITH PROLONGED PREGNANCY. C O'Rcill~-Green, M.Y. Divon. Dept. of Ob/Gyn, Albert Einstein College of Medicine, Bronx, Nu OBJECTIVE: To evaluate the role of amniotic fluid index (AFI) and clinical oligohydranmios as predictors of neonatal outcome. STUDY DESIGN: 657 patients with prolonged pregnancies ,~tro had AFI measurements --<5 days before admission and a clinician's note of the amount of fluid at rupture of membranes (ROM) were evaluated for neonatal outcome. Variables included 1 & 5 minute Apgar scores < 7 & 8 respectively (1 MIN --< 7, 5 MIN -< 8), neonatal intensive care unit admission (NICU), neonatal hospitalization > 4 days (>4 DAYS), and any serious neonatal complication, including resuscitation (COMPLIC). Odds ratios were calculated from chi-square analysis of 2 • 2 tables, taking an AFI --< 5 cin (AFI < 5) and absent or decreased fluid at rupture of membranes (OLIGO) as abnormal. (POS - positive; NEG - negadve; SENS sensitiviw; SPEC specificity; CI - confidence interval) RESULTS: True False True False Odds
(95% cI) 1 MIN -< 7 5 M1N < 8 COMPLIC NICU > 4 DAYS
AFI -< 5 OLIGO AFI < 5 OL1GO AFI < 5 OLIGO AFI < 5 OLIGO AFI < 5 OLIGO
20 30 14 17 16 27 7 16 15 31
104 112 110 125 107 115 116 125 39 60
456 448 501 486 483 475 507 498 337 316
76 66 31 28 47 36 23 14 104 88
.21 .31 .31 .38 .25 .43 .23 .53 .13 .26
.81 .80 .82 .80 .82 .81 .81 .80 .90 .84
1.15 1.82 2.06 2.36 1.54 3.10 1.33 4.55 1.25 1.86
(0.65, (t.09, (0.98, (1.17, (0.80, 0.75, (0.47, (2.04, (0.74, (1.10,
2.03) 3.01) 4.14) 4.62) 2.92) 5.49) 3.30) 10.17) 1.87) 3.13)
AFI < 5 did not predict these outconms (95% CI included 1.0). OLIGO is a useful CONCLUSION: OLIGO had significant odds ratios for predicting 1 minute Apgars < 7, 5 minute Apgar < 8, any serious neonatal complication, NICU admission, and neonatal stay > 4 day's, predictor of neonatal outcome. OLIGO may he directly related to the actual anmunt of amniotic fluid present at the tinm of ROM. Decreased amniotic fluid at the time of ROM may predispose to labor abnormalities which result in infection or asphyxia, or may reflect an already compromised fetus. AFI -< 5 may not predict neonatal outcome because it was used as an indication for delivery.
110
FETAL GROWTH RATES IN PATIENTS WITH PRETERM PROLONGED RUPTURE OF MEMBRANES. V~ Block, Jr. x, .,~C Veille. Dept. of Ob/Gyn, Bowman Gray School of Medicine, Winston-Salem, NC. OBJECTIVE: To evaluate fetal biornetric parameters by serial ultrasounds in an effort to prove the hypothesis that fetal growth occurs at a lesser rate in preterm prolonged rupture of membranes (PPROM)~ STUDY DESIGN: A retrospective review of ultrasound data from our institution was performed to isolate patients with PPROM of greater than 14 days duration and serial ultrasound measurements of fetal biometry. Twenty-one patients were identified and comparisons made to a similar number of controls, matched for gravidity, gestational age, and intmwal between ultrasounds, in an effort to determine any significant difference in growth rate of isolated parameters. Analysis of each parameter included rate of growth per day of subjects and controls with subsequent performance of an unpaired t-test to determine significance. RESULTS: The rates of growth for biparietal diameter, head circmnference, abdominal circumference, fenmr length, and fetal weight demonstrated no significant differences between patients with PPROM and matched controls with p values of 0.34, 0.76, 0.38, 0.93, and 0.60 respectively. CONCLUSIONS: Our data and analysis do not support the hypothesis that fetal growth is diminished in these patients. The rate of growth in the face of PPROM is similar to that of controls.
112
MECONIUM ASPIRATION SYNDROME: PLACENTAL PATHOLOGY AND RESPIRATORY DISEASE. Salafia CMx, Holzman 1x. Departments of Pathology and Pediatrics, Mount Sinai Medical Center, New York, NY. OBJECTIVE: To evaluate whether placental features, especially those related to lneconiuln passage and acute infection, are associated with severity of meconimn aspiration syndrome. STUDY DESIGN: Thirty-three consecutive cases admitted to the NICU between 3/94 and 6/96 with a diagnosis of nmconimn aspiration. All cases had placentas submitted for histologic examination. Birthweight, gestational age, Apgar scores, and days for which oxygen support was required were extracted from a data base, and placental slides were reviewed blinded to clinical data. Placental weight, lesions associated with meconium passage (e.g., extent of meconimn histiocytosis in amnion, chorion, decidua and mnbilical cord, integrity of mnbilical and anmiodc epithelium, proximity of meconimn histiocytes to umbilical and chorionie vessels, and mnbilical and chorionic myocyte necrosis), and extent of histologic evidence of acute ascending infection were recorded. Nonparametric analyses used p < 0.05 as significant. RESULTS: Mean birth weight of the 33 cases was 3355 -+ 641 gm, mean gestational age at delivep/39.9 -+ 1.6 wk., and mean Apgar score at 1 and 5 minutes 6.4 -+ 2 and 8.0 -+ 1.5. Histologic evidence of acute ascending infection was seen in 85% (28/33) of cases. Acute anmionitis was seen in 8 (25%) and umbilical/chorionic vasculitis in 9 (28%), both of which were significantly more than in uncomplicated term deliveries (each < 1%, Obstet Gynecol 73: 383-9, 1989, p < 0.001). Severity of acute inflammation was directly related to lower 1 minute Apgar score (p - 0.04). More severe respiratmy disease, as reflected by more days of oxygen support, was related to lower birthweight and decreasing fetoplacental weight ratio (each p < 0.01), but not to any features of meconimn histology or acute ascending infection. CONCLUSIONS: Infants who are diagnosed with lneconium aspiration syndrome are more likely to have inspired amniotic fluid contaminated with both meconium and bacteria/bacterial by-products. More severe meconiuln aspiration syndrome, measured by days of oxygen support, is directly related to lower birthweight (but not gestational age) and larger placental weights (decreasing fetoplacental weight ratio), suggesting that chronic fetoplacental pathology may predispose to more severe neonatal meconium aspiration syndrome.