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Misoprostol induction for pregnancy termination∗
lowers maternal and fetal heart rates. These changes in heart rate are too small to be clinically significant.
Detection of Abnormal Fetal Growths at Term With Abdominal Circumference Alone Christine E. Henrichs, MD Spartanburg Regional Medical Center, Spartanburg, SC
Everett F. Magann, MD, Kara L. Brantley, MD, J. Holt Crews, MD, Maureen Sanderson, PhD, and Suneet P. Chauhan, MD OBJECTIVE: To determine if abdominal circumference (AC) alone can identify fetal growth restriction (FGR, birth weight less than 2500 g) and macrosomia (at least 4000 g) at or beyond 37 weeks. METHODS: Prospectively, parturients at term admitted for delivery underwent sonographic mensuration of AC. Receiveroperating characteristic (ROC) curves were constructed to determine if AC can differentiate between normal (birth weight 2500 – 3999 g) and abnormal (FGR or macrosomia) conditions. Likelihood ratios were calculated. P ⬍ .05 was considered significant. RESULTS: The mean gestational age of the 256 subjects was 39.1 ⫹ 1.5 weeks,the prevalence of FGR was 6.2% (16 of 256), and the prevalence of macrosomia was 8.2% (21 of 256). The areas under the ROC curves (0.79 ⫹ 0.04 for macrosomia and 0.91 ⫹ 0.03 for fetal growth restriction) significantly differed from the area under the nondiagnostic line (P ⬍ .005). Likelihood ratios were 2.9 for AC to detect FGR and 3.8 for AC to detect macrosomia. Based on the proportion of abnormal growth in our population, we require over 1,000,000 newborns for macrosomia analysis and 800 infants for FGR analysis to have narrow confidence intervals around a clinically important likelihood ratio. CONCLUSIONS: Among term parturients, AC alone is slightly useful in detection of FGR or macrosomia.
to determine if it changes after intrauterine fetal demise (IUFD) or preterm rupture of the membranes (PPROM). STUDY DESIGN: We reviewed the charts for all patients who had a second trimester labor induction between January 2000 and December 2001. Data on maternal demographics, indication for induction, labor progress, and complications of labor and delivery were collected. Statistical analysis (Fisher exact, Student t, and Mann-Whitney tests) was performed using SPSS (SPSS Inc., Chicago, IL), with a P value of less than .05 considered significant. RESULTS: 124 patients were identified as having labor inductions in the second trimester. 24 did not receive transvaginal MISO, and 11 had missing charts, leaving 89 patients for analysis. The indications for induction included IUFD (12%), PPROM (19%), aneuploidy (24%), and congenital anomalies (39%). Although gestational age did not differ, induction time was significantly shorter and the use of MISO was decreased in patients with PPROM. There was no significant difference in the need for additional uterotonics, epidural anesthesia, or in the use of D&C for retained placenta. IUFD preceding induction did not shorten induction time (Table 1). Table 1.
EGA (wk) MISO no. (median) Indux time (median; hr) Epidural Additional agents D&C
PPROM (n ⫽ 18)
No PPROM (n ⫽ 71)
P
20.8 ⫾ 2.3 2 (1–8)
21.5 ⫾ 2.0 3 (1–8)
NS .004
9.2 (0.9–64.7)
18.3 (1.3–69.8)
⬍.0001
4 (22%) 1 (6%)
13 (18%) 9 (13%)
NS NS
3 (17%)
8 (11%)
NS
CONCLUSIONS: After PPROM, induction of labor is shorter and requires less MISO to achieve delivery, although D&C for retained placenta is often required.
Misoprostol Induction for Pregnancy Termination*
Do Obstetric Complications Differ by Race in the Obese Patient?
Mara J. Dinsmoor, MD
Ellen Yvonne Zamora, RN
Evanston Northwestern Healthcare, Evanston, IL
Kevin Madsen, MD, Marci Goldstein, and Courtney Lim OBJECTIVE: To determine the efficacy of second trimester pregnancy termination via misoprostol (MISO) induction, and
*This document includes a discussion of use of a product that is unapproved by the United States Food and Drug Administration.
VOL. 101, NO. 4 (SUPPLEMENT), APRIL 2003
Kelsey Research Foundation, Houston, TX
Frances A. Smith, MD, Patricia D. Dupras-Wilson, RNC, Anthony J. Greisinger, PhD, Oscar A. Wehmanen, MS, and Linda B. Russell OBJECTIVE: To determine whether obstetric complications in obese patients differ by race.
MONDAY POSTERS
43S
Detection of Abnormal Fetal Growths at Term With Abdominal Circumference Alone Christine E. Henrichs, MD Spartanburg Regional Medical Center, Spartanburg, SC
Everett F. Magann, MD, Kara L. Brantley, MD, J. Holt Crews, MD, Maureen Sanderson, PhD, and Suneet P. Chauhan, MD OBJECTIVE: To determine if abdominal circumference (AC) alone can identify fetal growth restriction (FGR, birth weight less than 2500 g) and macrosomia (at least 4000 g) at or beyond 37 weeks. METHODS: Prospectively, parturients at term admitted for delivery underwent sonographic mensuration of AC. Receiveroperating characteristic (ROC) curves were constructed to determine if AC can differentiate between normal (birth weight 2500 – 3999 g) and abnormal (FGR or macrosomia) conditions. Likelihood ratios were calculated. P ⬍ .05 was considered significant. RESULTS: The mean gestational age of the 256 subjects was 39.1 ⫹ 1.5 weeks,the prevalence of FGR was 6.2% (16 of 256), and the prevalence of macrosomia was 8.2% (21 of 256). The areas under the ROC curves (0.79 ⫹ 0.04 for macrosomia and 0.91 ⫹ 0.03 for fetal growth restriction) significantly differed from the area under the nondiagnostic line (P ⬍ .005). Likelihood ratios were 2.9 for AC to detect FGR and 3.8 for AC to detect macrosomia. Based on the proportion of abnormal growth in our population, we require over 1,000,000 newborns for macrosomia analysis and 800 infants for FGR analysis to have narrow confidence intervals around a clinically important likelihood ratio. CONCLUSIONS: Among term parturients, AC alone is slightly useful in detection of FGR or macrosomia.
to determine if it changes after intrauterine fetal demise (IUFD) or preterm rupture of the membranes (PPROM). STUDY DESIGN: We reviewed the charts for all patients who had a second trimester labor induction between January 2000 and December 2001. Data on maternal demographics, indication for induction, labor progress, and complications of labor and delivery were collected. Statistical analysis (Fisher exact, Student t, and Mann-Whitney tests) was performed using SPSS (SPSS Inc., Chicago, IL), with a P value of less than .05 considered significant. RESULTS: 124 patients were identified as having labor inductions in the second trimester. 24 did not receive transvaginal MISO, and 11 had missing charts, leaving 89 patients for analysis. The indications for induction included IUFD (12%), PPROM (19%), aneuploidy (24%), and congenital anomalies (39%). Although gestational age did not differ, induction time was significantly shorter and the use of MISO was decreased in patients with PPROM. There was no significant difference in the need for additional uterotonics, epidural anesthesia, or in the use of D&C for retained placenta. IUFD preceding induction did not shorten induction time (Table 1). Table 1.
EGA (wk) MISO no. (median) Indux time (median; hr) Epidural Additional agents D&C
PPROM (n ⫽ 18)
No PPROM (n ⫽ 71)
P
20.8 ⫾ 2.3 2 (1–8)
21.5 ⫾ 2.0 3 (1–8)
NS .004
9.2 (0.9–64.7)
18.3 (1.3–69.8)
⬍.0001
4 (22%) 1 (6%)
13 (18%) 9 (13%)
NS NS
3 (17%)
8 (11%)
NS
CONCLUSIONS: After PPROM, induction of labor is shorter and requires less MISO to achieve delivery, although D&C for retained placenta is often required.
Misoprostol Induction for Pregnancy Termination*
Do Obstetric Complications Differ by Race in the Obese Patient?
Mara J. Dinsmoor, MD
Ellen Yvonne Zamora, RN
Evanston Northwestern Healthcare, Evanston, IL
Kevin Madsen, MD, Marci Goldstein, and Courtney Lim OBJECTIVE: To determine the efficacy of second trimester pregnancy termination via misoprostol (MISO) induction, and
*This document includes a discussion of use of a product that is unapproved by the United States Food and Drug Administration.
VOL. 101, NO. 4 (SUPPLEMENT), APRIL 2003
Kelsey Research Foundation, Houston, TX
Frances A. Smith, MD, Patricia D. Dupras-Wilson, RNC, Anthony J. Greisinger, PhD, Oscar A. Wehmanen, MS, and Linda B. Russell OBJECTIVE: To determine whether obstetric complications in obese patients differ by race.
MONDAY POSTERS
43S