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Clinical implications of fetal fibronectin testing in pregnancies complicated by cervical cerclage∗
Clinical Implications of Fetal Fibronectin Testing in Pregnancies Complicated by Cervical Cerclage* Danna C. Onaga, MD Good Samaritan Regional Medical Center, Phoenix, AZ
Jordan H. Perlow, MD OBJECTIVE: Given the absence of previously published literature regarding fetal fibronectin (fFN) testing in patients with cervical cerclage, we sought to study and report the sensitivity, specificity, and positive and negative predictive values for this group of patients. STUDY DESIGN: Retrospective review of pregnancies between 24 and 32 weeks with previously placed cervical cerclage that underwent fFN testing after symptoms of preterm labor and/or findings of diminished cervcial length on ultrasound examination from January 1998 to August 2002. RESULTS: Forty-four patients were identified who met inclusion criteria. Nineteen patients (43%) had an initial positive fFN test on admission, and 25 (57%) had a negative fFN test. For delivery within 14 days after admission, the negative predictive value (NPV) was 100%, the positive predictive value (PPV) was 11%, and the sensitivity and specificity were 100% and 59%, respectively. With respect to delivery at less than 32 weeks, the NPV was 96%, the PPV was 53%, and the sensitivity and specificity were 90% and 73%, respectively. CONCLUSIONS: Although fFN testing has not been recommended by the manufacturer for use in patients with cervical cerclage, we found that the negative predictive value was excellent and comparable with previously reported values for symptomatic patients without cervical cerclage.
Congenital Compartment Syndrome Ran Neiger, MD University of Tennessee at Knoxville, Knoxville, TN
Paige Kessler, MD OBJECTIVES: We present cases of fetal compartment syndrome diagnosed at birth, and discuss possible causes and preventive measures. METHOD: We describe the intrapartum and neonatal course of two newborns delivered at the University of Tennessee Medical Center with compartment syndrome requiring surgical exploration. RESULTS: The first affected newborn was a presenting twin, born at 36 weeks’gestation because of preterm labor. After artificial rupture of the membranes, a hand presentation was *This document includes a discussion of use of a product that is unapproved by the United States Food and Drug Administration.
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noted, and it could not be reduced. The twins were delivered by cesarean because of failure to dilate. At delivery, the newborn’s forearm was swollen and bruised, and within 24 hours he underwent fasciotomy, with subsequent debridement and wound closure. The second infant was delivered at 39 weeks. His chronically hypertensive mother was induced for oligohydramnios, and delivery was by cesarean because of repetitive decelerations. At delivery, the skin was sloughing from the newborn’s right bruised forearm. There was no evidence of an amniotic band. Within 24 hours a fasciotomy, thrombectomy, and angioplasty were performed. CONCLUSIONS: Congenital compartment syndrome is a rare complication associated with a combination of fetal malpresentation and oligohydramnios. When a nonreducible hand presentation is noticed during labor, a cesarean delivery should be considered when prolonged labor is anticipated.
Continuous Intravenous Propranolol Effects on Fetal Heart Rate Parameters and Maternal Cardiovascular Status in Labor* David S. Cole, MD Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
Ashlesha K. Dayal, MD, Cynthia Chazotte, MD, and Peter S. Bernstein, MD OBJECTIVE: To determine the effects of intravenous propranolol on fetal heart rate (FHR) variability, baseline FHR, and maternal cardiovascular status when used as an adjunct to oxytocin for labor induction. METHODS: Twenty women undergoing labor induction with oxytocin were given continuous intravenous propranolol. We included women with a vertex, singleton pregnancy greater than 37 weeks, EFW less than 4000 g, no fetal anomalies, and no chorioamnionitis. Propranolol was administered at 2 mg per hour as a continuous infusion for 10 hours. The FHR baseline and variability were evaluated at medication initiation, after 1 hour and 4 hours of propranolol administration. Variability was evaluated as absent, minimal (2–5 bpm), moderate (6 –25 bpm), or marked (more than 25 bpm). Accelerations and decelerations were noted. Maternal cardiovascular parameters evaluated included systolic and diastolic blood pressure and pulse before and 1 and 4 hours after the start of the propranolol infusion. RESULTS: The mean FHR baseline was significantly lower 4 hours after the start of the propranolol infusion relative to medication initiation (132 ⫾ 10.3 bpm versus 137 ⫾ 9.4 bpm, P ⫽ .04). Maternal pulse was also significantly lower 4 hours after the start of the infusion relative to baseline (77 ⫾ 11.2 versus 85 ⫾ 13.6, P ⫽ .004). No significant changes were noted in maternal systolic or diastolic blood pressure, FHR variability, or accelerations. CONCLUSIONS: Continuous intravenous propranolol administered as an adjunct during labor induction with oxytocin
OBSTETRICS & GYNECOLOGY
Jordan H. Perlow, MD OBJECTIVE: Given the absence of previously published literature regarding fetal fibronectin (fFN) testing in patients with cervical cerclage, we sought to study and report the sensitivity, specificity, and positive and negative predictive values for this group of patients. STUDY DESIGN: Retrospective review of pregnancies between 24 and 32 weeks with previously placed cervical cerclage that underwent fFN testing after symptoms of preterm labor and/or findings of diminished cervcial length on ultrasound examination from January 1998 to August 2002. RESULTS: Forty-four patients were identified who met inclusion criteria. Nineteen patients (43%) had an initial positive fFN test on admission, and 25 (57%) had a negative fFN test. For delivery within 14 days after admission, the negative predictive value (NPV) was 100%, the positive predictive value (PPV) was 11%, and the sensitivity and specificity were 100% and 59%, respectively. With respect to delivery at less than 32 weeks, the NPV was 96%, the PPV was 53%, and the sensitivity and specificity were 90% and 73%, respectively. CONCLUSIONS: Although fFN testing has not been recommended by the manufacturer for use in patients with cervical cerclage, we found that the negative predictive value was excellent and comparable with previously reported values for symptomatic patients without cervical cerclage.
Congenital Compartment Syndrome Ran Neiger, MD University of Tennessee at Knoxville, Knoxville, TN
Paige Kessler, MD OBJECTIVES: We present cases of fetal compartment syndrome diagnosed at birth, and discuss possible causes and preventive measures. METHOD: We describe the intrapartum and neonatal course of two newborns delivered at the University of Tennessee Medical Center with compartment syndrome requiring surgical exploration. RESULTS: The first affected newborn was a presenting twin, born at 36 weeks’gestation because of preterm labor. After artificial rupture of the membranes, a hand presentation was *This document includes a discussion of use of a product that is unapproved by the United States Food and Drug Administration.
42S
MONDAY POSTERS
noted, and it could not be reduced. The twins were delivered by cesarean because of failure to dilate. At delivery, the newborn’s forearm was swollen and bruised, and within 24 hours he underwent fasciotomy, with subsequent debridement and wound closure. The second infant was delivered at 39 weeks. His chronically hypertensive mother was induced for oligohydramnios, and delivery was by cesarean because of repetitive decelerations. At delivery, the skin was sloughing from the newborn’s right bruised forearm. There was no evidence of an amniotic band. Within 24 hours a fasciotomy, thrombectomy, and angioplasty were performed. CONCLUSIONS: Congenital compartment syndrome is a rare complication associated with a combination of fetal malpresentation and oligohydramnios. When a nonreducible hand presentation is noticed during labor, a cesarean delivery should be considered when prolonged labor is anticipated.
Continuous Intravenous Propranolol Effects on Fetal Heart Rate Parameters and Maternal Cardiovascular Status in Labor* David S. Cole, MD Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
Ashlesha K. Dayal, MD, Cynthia Chazotte, MD, and Peter S. Bernstein, MD OBJECTIVE: To determine the effects of intravenous propranolol on fetal heart rate (FHR) variability, baseline FHR, and maternal cardiovascular status when used as an adjunct to oxytocin for labor induction. METHODS: Twenty women undergoing labor induction with oxytocin were given continuous intravenous propranolol. We included women with a vertex, singleton pregnancy greater than 37 weeks, EFW less than 4000 g, no fetal anomalies, and no chorioamnionitis. Propranolol was administered at 2 mg per hour as a continuous infusion for 10 hours. The FHR baseline and variability were evaluated at medication initiation, after 1 hour and 4 hours of propranolol administration. Variability was evaluated as absent, minimal (2–5 bpm), moderate (6 –25 bpm), or marked (more than 25 bpm). Accelerations and decelerations were noted. Maternal cardiovascular parameters evaluated included systolic and diastolic blood pressure and pulse before and 1 and 4 hours after the start of the propranolol infusion. RESULTS: The mean FHR baseline was significantly lower 4 hours after the start of the propranolol infusion relative to medication initiation (132 ⫾ 10.3 bpm versus 137 ⫾ 9.4 bpm, P ⫽ .04). Maternal pulse was also significantly lower 4 hours after the start of the infusion relative to baseline (77 ⫾ 11.2 versus 85 ⫾ 13.6, P ⫽ .004). No significant changes were noted in maternal systolic or diastolic blood pressure, FHR variability, or accelerations. CONCLUSIONS: Continuous intravenous propranolol administered as an adjunct during labor induction with oxytocin
OBSTETRICS & GYNECOLOGY