in the Fluid of Pregnancies by Preterm Premature Rupture ...
659 Estimation of Fetal Weight by Ultrasound in Preterm Pregnancies
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657 Volume 166 Number I, Part 2 CLINICAL CHARACTERISTICS AND OlITCOME OF PATIENTS WITH RESEALED, PRETERM, PREMATURE RUPTURE OF MEMBRANES.S.J. Carlan. W.F. O'Brien, J.L. Glock" U of S FI, Dept. OB/GYN, Tampa, FL. From March I, 1989to March I, 1991. a total of386 women (2.5% of total number of deliveries) with preterm, \',remature rupture of membranes (PPROM-rupture of membranes prior to la or before 37 weeks gestation) were admitted to Tampa General Hospital. Nineteen women electively terminated the pregnancy, and, of the remaining 349 patients, 14 (4%) resealed. All patients with rupture were documented with a positive history of a gush of fluid from the vagina, and either fern, nitrazine, pooling or a combination. All patients classified as • resealed· reported that the leaking stol.'ped and then were confirmed with amniocentesis and injection of indigo carmme. If no seepage of blue dye was noted from the vagina. they were classified as "resealed". There was no difference between the groups in racial makeup, GTPAL, or l'ositlve cervical cultures for Gc, Chlamydia, or GBBS. There were no multiple gestations in the resealed group and nme in the group that did not seal. CLINICAL CHARACTERISTICS OF RESEALED VS SEALED (t I SO) ReSealed Not Sealed llE:ffi" f weeks) 20.0 ± 3.6 23.9 ± 6.2 <.05 29.6 ± 4.6 31.7 ± 3.8 <.05 Hx previous PPROM (%) 14.3 10.1 NS Initial US deepest pocket (mean <.05 em) 4.6 ± 4.6 2.9 ± 1.6 ROM to delivery (mean d) 67.1 ± 37.6 5.3 ± 10.3 <.05 EGA at delivery (mean weeks) 38.6 ± 1.3 32.8 ± 3.7 <.05 C-Section (%) 14.3 16 NS Neonatal wt (mean grams) 3280 ± 454 1952 ± 683 <.05 Cord pH (mean) 7.28 ± .08 7.3 ± .08 (N=12) (N=280) NS NICU admissions (%) 0 52.8 <.05 Total neonatal days in hospital (mean) 2.4 ± 0.8 17.6 ± 23.1 < .05 We conclude that the that are more likely to reseal are younger and at an earlier gestational age and have larger pockets of amniotic fluid on initial ultrasound. After resealing the pregnanies apparently procede normally with no higher incidence of re-rupture. 658 PREVIOUS SPONTANEOUS AND INDICATED PRETERM BIRTH AS RISK FACTORS FOR PREMATURITY M.B. OuBard x , J.C. Hauth, R.L. Goldenberg, R.L. Copper x , R.O. Oavis, R. Creasy><, J. lams x The March of Oimes Multicenter Study Group University of Alabama Hospitals, Birmingham We reviewed the obstetric history of 33,430 women who were evaluated at the time of the March of Oimes Preterm Birth Prevention Project. As the number of prior PTOs (due to any etiology) rose from 0 to 1 to the rate of PTO 5.37 weeks rose from 10 to 21 to 31% (p5..0001). Similarly, the rate of PTO 5.34 weeks rose from 5 to 13 to 20% (P5..0001). We then evaluated the risk of PTO as related to the etiology of the prior PTO. As prior spontaneous preterm delivery (SPTO) (following labor or PROM) rose from 0 to 1 to the rate of SPTO 5.37 weeks in the current pregnancy rose from 7 to 17 to 26% (P5..0001) and the rate of SPTO 5.34 weeks rose from 4 to 10 to 17% (p5..0001). As the number of prior indicated PTO (IPTO) increased from 0 to 1 to .?2, the rate of IPTO in the current pregnancy 5.37 weeks rose from 2 to 11 to 28% (ps.0001) and the rate of IPTO 5.34 weeks rose from 2 to 7 to 24% (ps.0001). One or more prior IPTO did not predict SPTO. Of 445 women with twin gestations, 53% delivered 5.37 weeks and 35% delivered 5.34 weeks. However of women with twins and 1 or more prior SPTO, the rate of SPTO 5.37 weeks was 53% (NS) and 5.34 weeks was 44% (ps.03). This data will enable those planning studies of PTO intervention strategies to choose groups at highest risk for PTO and allow more precise power calculations. SPO Abstracts 445 659 ESTIMATION OF FETAL WEIGHT BY ULTRASOUND IN PRETERM PREGNANCIES D.K. Phillips MD", A.B. Knight MD, P.E. Maninez BS x , T.]. Kuehl PhD". Scott & White Memorial Hospital & Clinic, Texas A&M University College of Medicine, Temple, Texas. Estimation of fetal weight (EFW) or gestational age in the preterm pregnancy often directs management of high risk patients. Mode of delivery of preterm breech presentation is currently based on EFW; aggressive tocolysis may be limited by EFW and even, consideration of operative intervention requires an assessment of age or EFW. These difficult decisions are most often made in a labor and Delivery setting by physicians of varying expertise with ultrasound on patients with minimal histOrical information to allow gestational dating. This study determined the accuracy of fetal weights calculated from ultrasound measurements using the Shepard and 13 other formulas. 172 neonates whose birth weights were < 2000 gm were prospectively evaluated prior to delivery; all had ultrasound measurements (BPD, HC, AC, FL) within 7 days of delivery. The accuracy of each formula was assessed by a ratio of Estimated Fetal Weight(EFW) to Actual Birth Weight (ABW) and 95% Confidence Intervals. Only 3 formulas had 95% CIs that included 1.00, i.e. EFW not significantly different from ABWs; Hadlock #3, 1.004 ± 0.019; Hadlock #4, 1.010 ± 0.099; Woo #2, 0.992 ± 0.019. Errors tended to be exaggerated at ABWs < 500 gm. EFW significantly altered clinical management in a significant number of cases. 660 LONG-TERM INTRAVENOUS TOCOLYTIC THERAPY. J. Bruner, A. Bruner: A. Sarno, Dept. ofOB/GYN, Vanderbilt Univ. Medical Center, Nashville, Tennessee. Eighteen women in preterm labor who received continuous intravenous tocolytic therapy for greater than 48 hours (108.6 ± SD 156.9 hrs; range 48.5-729 hrs) were compared to a similar group of women treated for less than 48 hours (12.9 ± SD 6.7 hrs; range 4-38.5 hrs) in this retrospective case-controlstudy. The groupe were well-matched in regard to age, race, weight, gravidity, parity, marital status, social status, level of prenatal care, and prior medical and surgical diagnoses. The only identifiable risk factors for preterm labor significantly associated with an increased need for long-term intravenous tocolytic therapy were uterine and cervical anatomic defects (fibroids, prior conization, incompetent cervix) and multiple gestation. The mean gestational age at the time of diagnosis was 30 weeks for both groupe, and there were no significant differences in mean cervical dilatation or effacement on initiation of therapy. Tocolytic selection was similar in both groupe, although the dosage/hr was significantly greater with long-term therapy. The mean interval from initiation of therapy until delivery was 41 days in the study group, compared to 39 days among controls (NS). The mean gestational age at delivery was 37 weeks in both groupe. There was no significant difference in the incidence of fetal distress, mode of delivery, or neonatal Apgar scores. No statistically significant maternal or neonatal complications were noted in either group. These data demonstrate that long-term tocolytic therapy is a safe and efficacious means of prolonging gestation in those women who fail to respond to conventional treatment.
Transcript of 659 Estimation of Fetal Weight by Ultrasound in Preterm Pregnancies
657
Volume 166 Number I, Part 2
CLINICAL CHARACTERISTICS AND OlITCOME OF PATIENTS WITH RESEALED, PRETERM, PREMATURE RUPTURE OF MEMBRANES.S.J. Carlan. W.F. O'Brien, J.L. Glock" U of S FI, Dept. OB/GYN, Tampa, FL.
From March I, 1989to March I, 1991. a total of386 women (2.5% of total number of deliveries) with preterm, \',remature rupture of membranes (PPROM-rupture of membranes prior to la or before 37 weeks gestation) were admitted to Tampa General Hospital. Nineteen women electively terminated the pregnancy, and, of the remaining 349 patients, 14 (4%) resealed. All patients with rupture were documented with a positive history of a gush of fluid from the vagina, and either fern, nitrazine, pooling or a combination. All patients classified as • resealed· reported that the leaking stol.'ped and then were confirmed with amniocentesis and injection of indigo carmme. If no seepage of blue dye was noted from the vagina. they were classified as "resealed". There was no si~nificant difference between the groups in racial makeup, GTPAL, or l'ositlve cervical cultures for Gc, Chlamydia, or GBBS. There were no multiple gestations in the resealed group and nme in the group that did not seal. CLINICAL CHARACTERISTICS OF RESEALED VS SEALED (t I SO)
ReSealed Not Sealed llE:ffi" ~ f
~6"t. (:::RO~(::ean weeks) 20.0 ± 3.6 23.9 ± 6.2 <.05 29.6 ± 4.6 31.7 ± 3.8 <.05
Hx previous PPROM (%) 14.3 10.1 NS Initial US deepest pocket (mean
<.05 em) 4.6 ± 4.6 2.9 ± 1.6 ROM to delivery (mean d) 67.1 ± 37.6 5.3 ± 10.3 <.05
EGA at delivery (mean weeks) 38.6 ± 1.3 32.8 ± 3.7 <.05 C-Section (%) 14.3 16 NS Neonatal wt (mean grams) 3280 ± 454 1952 ± 683 <.05 Cord pH (mean) 7.28 ± .08 7.3 ± .08
(N=12) (N=280) NS NICU admissions (%) 0 52.8 <.05 Total neonatal days in hospital (mean) 2.4 ± 0.8 17.6 ± 23.1 < .05
We conclude that the pat~ents that are more likely to reseal are younger and at an earlier gestational age and have larger pockets of amniotic fluid on initial ultrasound. After resealing the pregnanies apparently procede normally with no higher incidence of re-rupture.
658 PREVIOUS SPONTANEOUS AND INDICATED PRETERM BIRTH AS RISK FACTORS FOR PREMATURITY
M.B. OuBardx, J.C. Hauth, R.L. Goldenberg, R.L. Copperx, R.O. Oavis, R. Creasy><, J. lamsx
The March of Oimes Multicenter Study Group University of Alabama Hospitals, Birmingham
We reviewed the obstetric history of 33,430 women who were evaluated at the time of the March of Oimes Preterm Birth Prevention Project. As the number of prior PTOs (due to any etiology) rose from 0 to 1 to ~2, the rate of PTO 5.37 weeks rose from 10 to 21 to 31% (p5..0001). Similarly, the rate of PTO 5.34 weeks rose from 5 to 13 to 20% (P5..0001). We then evaluated the risk of PTO as related to the etiology of the prior PTO. As prior spontaneous preterm delivery (SPTO) (following labor or PROM) rose from 0 to 1 to ~2, the rate of SPTO 5.37 weeks in the current pregnancy rose from 7 to 17 to 26% (P5..0001) and the rate of SPTO 5.34 weeks rose from 4 to 10 to 17% (p5..0001). As the number of prior indicated PTO (IPTO) increased from 0 to 1 to .?2, the rate of IPTO in the current pregnancy 5.37 weeks rose from 2 to 11 to 28% (ps.0001) and the rate of IPTO 5.34 weeks rose from 2 to 7 to 24% (ps.0001). One or more prior IPTO did not predict SPTO. Of 445 women with twin gestations, 53% delivered 5.37 weeks and 35% delivered 5.34 weeks. However of women with twins and 1 or more prior SPTO, the rate of SPTO 5.37 weeks was 53% (NS) and 5.34 weeks was 44% (ps.03). This data will enable those planning studies of PTO intervention strategies to choose groups at highest risk for PTO and allow more precise power calculations.
SPO Abstracts 445
659 ESTIMATION OF FETAL WEIGHT BY ULTRASOUND IN PRETERM PREGNANCIES
D.K. Phillips MD", A.B. Knight MD, P.E. Maninez BSx, T.]. Kuehl PhD". Scott & White Memorial Hospital & Clinic, Texas A&M University College of Medicine, Temple, Texas.
Estimation of fetal weight (EFW) or gestational age in the preterm pregnancy often directs management of high risk patients. Mode of delivery of preterm breech presentation is currently based on EFW; aggressive tocolysis may be limited by EFW and even, consideration of operative intervention requires an assessment of age or EFW. These difficult decisions are most often made in a labor and Delivery setting by physicians of varying expertise with ultrasound on patients with minimal histOrical information to allow gestational dating. This study determined the accuracy of fetal weights calculated from ultrasound measurements using the Shepard and 13 other formulas. 172 neonates whose birth weights were < 2000 gm were prospectively evaluated prior to delivery; all had ultrasound measurements (BPD, HC, AC, FL) within 7 days of delivery. The accuracy of each formula was assessed by a ratio of Estimated Fetal Weight(EFW) to Actual Birth Weight (ABW) and 95% Confidence Intervals. Only 3 formulas had 95% CIs that included 1.00, i.e. EFW not significantly different from ABWs; Hadlock #3, 1.004 ± 0.019; Hadlock #4, 1.010 ± 0.099; Woo #2, 0.992 ± 0.019. Errors tended to be exaggerated at ABWs < 500 gm. EFW significantly altered clinical management in a significant number of cases.
660 LONG-TERM INTRAVENOUS TOCOLYTIC THERAPY. J. Bruner, A. Bruner: A. Sarno, Dept. ofOB/GYN, Vanderbilt Univ. Medical Center, Nashville, Tennessee.
Eighteen women in preterm labor who received continuous intravenous tocolytic therapy for greater than 48 hours (108.6 ± SD 156.9 hrs; range 48.5-729 hrs) were compared to a similar group of women treated for less than 48 hours (12.9 ± SD 6.7 hrs; range 4-38.5 hrs) in this retrospective case-controlstudy. The groupe were well-matched in regard to age, race, weight, gravidity, parity, marital status, social status, level of prenatal care, and prior medical and surgical diagnoses. The only identifiable risk factors for preterm labor significantly associated with an increased need for long-term intravenous tocolytic therapy were uterine and cervical anatomic defects (fibroids, prior conization, incompetent cervix) and multiple gestation. The mean gestational age at the time of diagnosis was 30 weeks for both groupe, and there were no significant differences in mean cervical dilatation or effacement on initiation of therapy. Tocolytic selection was similar in both groupe, although the dosage/hr was significantly greater with long-term therapy. The mean interval from initiation of therapy until delivery was 41 days in the study group, compared to 39 days among controls (NS). The mean gestational age at delivery was 37 weeks in both groupe. There was no significant difference in the incidence of fetal distress, mode of delivery, or neonatal Apgar scores. No statistically significant maternal or neonatal complications were noted in either group. These data demonstrate that long-term tocolytic therapy is a safe and efficacious means of prolonging gestation in those women who fail to respond to conventional treatment.
