Operative Vaginal Delivery District 1 ACOG Medical Student Teaching Module 2011.
275 Re-examination of operative vaginal delivery for the 90's
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Volume Ib4 N umber I. Part 2 272 A POSITIVE URINE DRUG SCREEN IN PREGNANCY: CORRELATED TO ADVERSE PREGNANCY OUTCOME, BUT NOT PATIENT HISTORY. GalY Lipscomb!, Diana Devall x , Brian Mercer x , Baha Sibai. University of Tennessee: Memphis The issue of drug abuse in pregnancy is of increasing concern. The purpose of this study was to assess the incidence of drug usage in our high risk patient population and correlate these findings to patient history, prenatal risk factors and pregnancy complications. Methods: Over a two month period (April-May 1990), patients admitted to our Labor Unit were assessed. Medical records were reviewed for risk factors including: absent/poor prenatal care, cutture proven STD's, and previous emergehcy room visits or hospitalization. After full history and physical evaluation, consenting women underwent urinalysis for cocaine and THC metabolites. Care givers were blinded to urinalysis results. Patients were followed prospectively until delivery. Adverse perinatal outcomes, including: preterm premature rupture of the membranes (pPROM), abruptio placentae, fetal demise, and low birth birth weight were documented. Results: A total of 466 drug screens were performed. Just two women refused analysis. Cocaine and THC metabolite screens were positive in 45 (9.6%) and 17 (3.6%) women respectively (4 with both). Interestingly, 68% of women (40/59) with positive tests denied drug abuse prior to screening and 41% had no prenatal care. Positive THC screens were not associated with any prenatal risk factor or adverse pregnancy outcome. Cocaine abuse was associated with no prenatal care (p<0.0001), less than 4 prenatal visits (p<0.0001), positive cervical cultures in pregnancy for Neisseria Gonorrhea (p<0.0001), treated syphilis in pregnancy (p<0.OO07), pPROM (p=0.027), abruptio placenta (p=0.01), and fetal demise (p=0.07). Low birth weight was highly correlated to cocaine abuse: < 2,500 grams (p<0.0001), and <2,000 grams (p=0.004). Conclusions: Cocaine abuse in pregnancy is highly correlated to poor prenatal care, sexually transmitted disease and adverse pregnancy outcome. Unfortunately, maternal history is not a reliable predictor of drug abuse. Further, as 41% of these patients had no prenatal care, an early screening program could not have attered their pregnancy outcomes. 273 CLINICAL CHARACTERISTICS AND SIGNIFICANCE OF NUCHAL CORD. Anthony M. Vintzileos, James F X, Egan John F. Rodis, Winston A. Campbell, Edward J. Wolf, James Balducci. University of Connecticut Health Center, Farmington, CT Mhough the frequency and complications of nuchal cord at birth have been described, most of these reports Involve full term infants born vaginally. The clinical characteristics and significance of nuchal cord in preterm gestations has not been studied. The objective of this study was to study the clinical characteristics and significance of nuchal cord at birth in preterm as well as term gestations. The obstetrical records of 520 patients were retrospectively reViewed (gestational age ranged from 24 to 42 weeks) The overall frequency of nuchal cord at birth was 16.7% (87 of 520). The frequency of nuchal cord was less in preterm versus term gestations (56 of 379 or 14.7% versus 31 of 141 or 22%, Factors associated with Increased Incidence of nuchal cord at birth were' vertex presentation and vaginal birth at term. When the data were analyzed according to route of delivery and gestational age, it was found that the group of neonates born vaginally at term had the highest incidence of nuchal cord (17 of 51 or 33%, p<.05) as compared to infants born at term by cesarean section (14 or 90 or 15.5%), preterm born vaginally (24 of 140 or 17.1%) and preterm born by cesarean section (32 of 239 or 13.3%). No differences In gravidity, parity, prior obstetrical history, type of anesthesia, complicatlons·such as premature rupture of the membranes, preterm labor, abruption, pregnancy Induced hypertension, intrautenne growth retardation, meconium, anomalies, perinatal deaths, and fetal distress were found between fetuses with or without nuchal cord. A lower cord artery pH, higher PC02 and greater number of acidotic fetuses (cord artenal pH<7.20) were noted among fetuses with nuchal cord born vaginally, but not among fetuses with nuchal cord born by cesarean section. Regardless of the route of delivery there were no differences in fetal distress, Apgar scores or perinatal deaths between fetuses With and without nuchal cord at birth spa Abstracts 32 274 RETINAL HEMORRHAGE: MARKER FOR CNS TRAUMA? M. Berkus x , P. O'Connor x , E. Xenakis,x O. Langer, Department of OB/GYN and Ophthalmology, The University of Texas Health SCience Center at San Antonio, TX. The prognostic significance of retinal hemorrhage (RH) remains an open question, and its association with subclinical alterations in the CNS has not been established. In this prospective, longitudinal study, we sought to assess the relationship between the incidence and grade of RH, and neurological function at birth, using Sarnat's encephalopathy staging and Scanlon's early neonatal neurobehavioral scale, and to determine visual acuity in babies with macular hemorrhage. 332 term infants were examined as a cohort of successive instrumental deliveries with SVD and CIS controls. The 34% with varying grades of RH examined at 6 weeks of age exhibited total resolution. The 9% with macular hemorrhage were followed periodically over 6 years and exhibited no evidence of visual impairment. The study further revealed a significant association (p < .02) between RH and 1) length of 2nd stage, 2) station of instrumental delivery, 3) # of applications and pulls of the instrument, 4) combined vacuum and forceps delivery, 5) neonatal adverse outcome. There was also a significant correlation (r=.21; p<.003) between grade of RH and neurological assessment, including non-visual habituation items. Conclusion: 1) Macular hemorrhage was not associated with amblyopia on long-term follow-up; 2) RH associated with a decreased neurological score at birth that may reflect subtle eNS injury. 275 REEXAMINATION OF OPERATIVE VAGINAL DELIVERY FOR THE 90'S, M Berkus', R Ramamurthyx, E. Xenakis x , O. Langer. Departments of OB/GYN & Pediatrics, The Umversity of Texas Health Science Center at San Antonio, TX. Although operative vaginal deliveries (OVO> have tradition- ally been associated With increased perinatal morbidity and mortality, the majority of studies investigating this area have been retrospective andlor have predated modern OB care. In this prospective study, we sought to investigate whether OVD usmg modem 8electlve critena and care would result in less adverse outcome, as assessed by standard morbidity measures and neurological testing (Sarnat's encephalopathy staging and Scanlon's early neonatal neurobehavlOral scale l. 350 term deliveries were exammed as a cohort of successive OVD with SVD and CIS controls The aS8ociatIOn between type of OVD and adverse outcome, controlling for indication and anestheSia, is summarized below: Maternal Complications-(%) Controls OVD SVD (19) Outlet (18)' CIS (56)* LOW (32) MID 131) Neonatal Comphcations-(%) Controls OVD SVD(26) Outlet(28) CIS (33) LOW (33) MID (38) Maternal complicatIOns were associated with station '(X2=22,P<.01) and increased by CIS Neonatal complicatIOns, mcludmg Sarnat and Scanlon, were not Significantly effected by OVD, nor associated with. 1) Length of 2nd stage; 2) #, or failure of applications or pul1s With mstrument, 3) rotation; 4) mldpelvic delivery by "old" or "new" ACOG claSSifications. ConclUSiOn: 1) OVD m modern perinatal medicine yields Similar outcome for outlet VB SVD; :i) mldpelvlc dehvery does not result In slgmfi- cantly increased adverse outcome compared to CIS controls
Transcript of 275 Re-examination of operative vaginal delivery for the 90's
Volume Ib4 N umber I. Part 2
272 A POSITIVE URINE DRUG SCREEN IN PREGNANCY: CORRELATED TO ADVERSE PREGNANCY OUTCOME, BUT NOT PATIENT HISTORY.
GalY Lipscomb!, Diana Devallx, Brian Mercerx, Baha Sibai. University of Tennessee: Memphis
The issue of drug abuse in pregnancy is of increasing concern. The purpose of this study was to assess the incidence of drug usage in our high risk patient population and correlate these findings to patient history, prenatal risk factors and pregnancy complications. Methods: Over a two month period (April-May 1990), patients admitted to our Labor Unit were assessed. Medical records were reviewed for risk factors including: absent/poor prenatal care, cutture proven STD's, and previous emergehcy room visits or hospitalization. After full history and physical evaluation, consenting women underwent urinalysis for cocaine and THC metabolites. Care givers were blinded to urinalysis results. Patients were followed prospectively until delivery. Adverse perinatal outcomes, including: preterm premature rupture of the membranes (pPROM), abruptio placentae, fetal demise, and low birth birth weight were documented. Results: A total of 466 drug screens were performed. Just two women refused analysis. Cocaine and THC metabolite screens were positive in 45 (9.6%) and 17 (3.6%) women respectively (4 with both). Interestingly, 68% of women (40/59) with positive tests denied drug abuse prior to screening and 41% had no prenatal care. Positive THC screens were not associated with any prenatal risk factor or adverse pregnancy outcome. Cocaine abuse was associated with no prenatal care (p<0.0001), less than 4 prenatal visits (p<0.0001), positive cervical cultures in pregnancy for Neisseria Gonorrhea (p<0.0001), treated syphilis in pregnancy (p<0.OO07), pPROM (p=0.027), abruptio placenta (p=0.01), and fetal demise (p=0.07). Low birth weight was highly correlated to cocaine abuse: < 2,500 grams (p<0.0001), and <2,000 grams (p=0.004). Conclusions: Cocaine abuse in pregnancy is highly correlated to poor prenatal care, sexually transmitted disease and adverse pregnancy outcome. Unfortunately, maternal history is not a reliable predictor of drug abuse. Further, as 41% of these patients had no prenatal care, an early screening program could not have attered their pregnancy outcomes.
273 CLINICAL CHARACTERISTICS AND SIGNIFICANCE OF NUCHAL CORD. Anthony M. Vintzileos, James F X, Egan John F. Rodis, Winston A. Campbell, Edward J. Wolf, James Balducci. University of Connecticut Health Center, Farmington, CT
Mhough the frequency and complications of nuchal cord at birth have been described, most of these reports Involve full term infants born vaginally. The clinical characteristics and significance of nuchal cord in preterm gestations has not been studied. The objective of this study was to study the clinical characteristics and significance of nuchal cord at birth in preterm as well as term gestations. The obstetrical records of 520 patients were retrospectively reViewed (gestational age ranged from 24 to 42 weeks) The overall frequency of nuchal cord at birth was 16.7% (87 of 520). The frequency of nuchal cord was less in preterm versus term gestations (56 of 379 or 14.7% versus 31 of 141 or 22%, p~.05). Factors associated with Increased Incidence of nuchal cord at birth were' vertex presentation and vaginal birth at term. When the data were analyzed according to route of delivery and gestational age, it was found that the group of neonates born vaginally at term had the highest incidence of nuchal cord (17 of 51 or 33%, p<.05) as compared to infants born at term by cesarean section (14 or 90 or 15.5%), preterm born vaginally (24 of 140 or 17.1%) and preterm born by cesarean section (32 of 239 or 13.3%). No differences In gravidity, parity, prior obstetrical history, type of anesthesia, complicatlons·such as premature rupture of the membranes, preterm labor, abruption, pregnancy Induced hypertension, intrautenne growth retardation, meconium, anomalies, perinatal deaths, and fetal distress were found between fetuses with or without nuchal cord. A lower cord artery pH, higher PC02 and greater number of acidotic fetuses (cord artenal pH<7.20) were noted among fetuses with nuchal cord born vaginally, but not among fetuses with nuchal cord born by cesarean section. Regardless of the route of delivery there were no differences in fetal distress, Apgar scores or perinatal deaths between fetuses With and without nuchal cord at birth
spa Abstracts 32
274 RETINAL HEMORRHAGE: MARKER FOR CNS TRAUMA? M. Berkusx, P. O'Connorx, E. Xenakis,x O. Langer, Department of OB/GYN and Ophthalmology, The University of Texas Health SCience Center at San Antonio, TX.
The prognostic significance of retinal hemorrhage (RH) remains an open question, and its association with subclinical alterations in the CNS has not been established. In this prospective, longitudinal study, we sought to assess the relationship between the incidence and grade of RH, and neurological function at birth, using Sarnat's encephalopathy staging and Scanlon's early neonatal neurobehavioral scale, and to determine visual acuity in babies with macular hemorrhage. 332 term infants were examined as a cohort of successive instrumental deliveries with SVD and CIS controls. The 34% with varying grades of RH examined at 6 weeks of age exhibited total resolution. The 9% with macular hemorrhage were followed periodically over 6 years and exhibited no evidence of visual impairment. The study further revealed a significant association (p < .02) between RH and 1) length of 2nd stage, 2) station of instrumental delivery, 3) # of applications and pulls of the instrument, 4) combined vacuum and forceps delivery, 5) neonatal adverse outcome. There was also a significant correlation (r=.21; p<.003) between grade of RH and neurological assessment, including non-visual habituation items. Conclusion: 1) Macular hemorrhage was not associated with amblyopia on long-term follow-up; 2) RH ~ associated with a decreased neurological score at birth that may reflect subtle eNS injury.
275 REEXAMINATION OF OPERATIVE VAGINAL DELIVERY FOR THE 90'S, M Berkus', R Ramamurthyx, E. Xenakisx,
O. Langer. Departments of OB/GYN & Pediatrics, The Umversity of Texas Health Science Center at San Antonio, TX.
Although operative vaginal deliveries (OVO> have traditionally been associated With increased perinatal morbidity and mortality, the majority of studies investigating this area have been retrospective andlor have predated modern OB care. In this prospective study, we sought to investigate whether OVD usmg modem 8electlve critena and care would result in less adverse outcome, as assessed by standard morbidity measures and neurological testing (Sarnat's encephalopathy staging and Scanlon's early neonatal neurobehavlOral scale l. 350 term deliveries were exammed as a cohort of successive OVD with SVD and CIS controls The aS8ociatIOn between type of OVD and adverse outcome, controlling for indication and anestheSia, is summarized below: Maternal Complications-(%)
Controls OVD SVD (19) Outlet (18)' CIS (56)* LOW (32)
MID 131)
Neonatal Comphcations-(%) Controls OVD
SVD(26) Outlet(28) CIS (33) LOW (33)
MID (38) Maternal complicatIOns were associated with station '(X2=22,P<.01) and increased by CIS Neonatal complicatIOns, mcludmg Sarnat and Scanlon, were not Significantly effected by OVD, nor associated with. 1) Length of 2nd stage; 2) #, or failure of applications or pul1s With mstrument, 3) rotation; 4) mldpelvic delivery by "old" or "new" ACOG claSSifications. ConclUSiOn: 1) OVD m modern perinatal medicine yields Similar outcome for outlet VB SVD; :i) mldpelvlc dehvery does not result In slgmficantly increased adverse outcome compared to CIS controls
