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EFFECT OF MATERNAL COCAINE ABUSE ON RENAL ARTERIAL FLOW AND URINE OUTPUT OF THE FETUS. S.C.Mitra, U.B.Taylor, V.Ganesh, J.J.Apuzzio. Dept. OblGyn, UMDNJ·New Jersey Medical School, Newark, New Jersey. OBJECTIVE: To study the acute effect of maternal cocaine abuse on blood flow of the fetal kidney and urine output. STUDY DESIGN: 21 pregnant patients of varied gestational ages with a history of cocaine abuse were studied. The urine of the patient was positive for cocaine on the day of study. Patients were excluded if the urine was positive for any other vasoactive substances. Color and pulse wave Doppler were used to obtained flow velocity waveform (FVW) of the renal artery. The Resistance index (RI) was calculated from systolic and diastolic values of FVWs. Longitudinal, transverse and antero·posterior diameters of fetal urinary bladder were measured from transverse and coronal images of fetal bladder at their maximum diameters and bladder volume was calculated. Hourly urine output of the fetus was measured from the difference in the bladder volume at half hourly intervals. As controls, 95 normal pregnancies between 20 and 40 weeks were studied similarly for normal values. The RI of fetal renal artery and hourly fetal urine output of two groups were compared. RESULTS: The RI of normal fetal renal artery had no linear association with gestational age (Y=0.879·1.25E·03*X, p=.22). Cocaine exposed fetuses had significantly higher RI of the renal artery (p<O.OI) than the normal fetuses of corresponding gestational age. The normal mean hourly urine output increased from 2ml to 40ml between 20 and 40 weeks. A decrease in hourly urine output of cocaine exposed fetuSj!s was observed compared to the normal controls of corresponding gestational age (p<O.OI). CONCLUSION: The RI of fetal renal aretry and fetal urine output were affected due to maternal cocaine abuse.

EFFECTS Of mcAllIE lISE III FETAL BUIIIl FUJII II _lATELY _ FETUSES. P. Sh.lossman, G. Colmorgen, A. sciscioneX, M. Neerhof, F. Craparo, S. Weiner, Medical Center of Delaware, Newark, DEi Pemsylvania Hospital, Philadelphia, PA .... ECTIVE: OUr objective was to assess if maternal cocaine abuse resul ts in alterations in fetal blood flow c"",,ared to fetuses not exposed to cocaine. STUlY DESIGII: Patients at 26·37 weeks gestation, with docl.IIIented cocaine use in pregnancy ~erwent ultrasol.n:l examinations. Eighteen appropriately grown, cocaine exposed fetuses were examined. Color flow mapping was used to local ize, and flow velocity waveforms were obtained from, the middle cerebral artery (MCA), internal carotid artery (ICA), aorta, renal artery and umbil ical artery (UA). The resistance index was calculated for the intrafetal vessels and systol ic/diastol ic ratio (SID) for the UA. Fetuses not exposed to cocaine and matched for gestational age were used as controls. All fetuses had estimated weights appropriate for gestational age and appropriate head ci rCl.Inference to abdominal ci rCl.mference rat; as. Student t-test was used to analyze differences between groups. RESULTS: The resistance index was significantly higher in the cocaine exposed fetuses in the MCA (p=.005), ICA Cp<.001), and renal artery (p=.002). The resistance index was not significantly different between groups in the aorta (p=.170) or SID in the UA (p=.611). ClllCLUSIIIIS: Appropriately grown, cocaine exposed fetuses appear to demonstrate end organ vasoconstriction (as demonstrated by resistance index changes) in the MCA, ICA, and renal artery compared to nonexposed fetuses. There appeared to be no significant effect on aortic or umbil ical artery flow.

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SPO Abstracts 355

EFFECTS OF COCAINE EXPOSIIIE III FETAL BUIIII FUJII II SllALL FOR GESTATlIIIAL AGE FETUSES. P. Shlossman, G. Colmorgen, A. Sciscionex, M. Neerhof, F. Craparo, S. Weiner, Medical Center of Delaware, Newark, DE; Pemsylvania Hospital, Philadelphia, PA ORJECTIVE: OUr objective was to assess if cocaine exposure al tered fetal blood flow in small for gestational age (SGA) fetuses compared to nonexposed fetuses. STUlY DESIGII: Patients at 26·37 weeks gestation, with docl.IIIented coca i ne exposure dur i ng pregnancy underwent ultrasol6ld examinations. Ten SGA, cocaine exposed fetuses were examined. Color flow mapping was used to locate, and flow velocity waveforms were obtained from, the middle cerebral artery (MCA), internal carotid artery (leA), aorta, and renal artery (RA). Resistance index (RI) was calculated for each vessel. Cocaine exposed SGA fetuses were compared with 1. Appropriately grown (AGA) unexposed fetuses and 2. SGA unexposed fetuses, matched for gestational age. Student t·test was used to analyze differences between groups. RESULTS: The resistance index in the MCA, ICA, RA, and aorta were not significantly different between the SGA exposed group and AGA unexposed group Cp>.10). The resistance index was greater in the SGA exposed vs the SGA unexposed groups in the MCA (p=.OO1), ICA (p=.01), and aorta (p<.OD1). The RI was not significantly different in the RA between these groups (p=.127). The RI in the SGA vs AGA control groups was significantly lower in the MCA (p=.002), and leA Cp=.D02) and significantly higher in the aorta (p<.OO1) and RA (p=.038). COIICLUSIIII: The redistribution in blood flow, as demonstrated by changes in R I, that is seen in unexposed SGA fetuses was not seen in cocaine exposed SGA fetuses. The renal artery RI was similar between SGA groups, but the aorta RI was not. The cerebral vasculature did not appear to demonstrate evidence of vasodi letian in the cocaine exposed SGA fetuses.

IMPACT OF ROUTINE COLOR DOPPLER ON THE AMNIOTIC FLUID INDEX. L. Coultrip, L. SmithX, T. SmedstadX, S. Coulter", L. Hawksx • Dept. of Ob/Gyn, Hennepin County Medical Center, Minneapolis, MN . OBJECTIVE: Because the presence of increased or decreased amniotic fluid may identify fetuses at risk for increased morbidity, accurate assessment of abnormal amounts of amniotic fluid is critical. Color doppler, by virtue of cord identification and exclusion, may provide more accurate fluid volume estimations. Our aim was to determine (1) whether color doppler (CD) modifies the amniotic fluid index (AFI) and (2) if so, is this modification clinically significant? STUDY DESIGN: In this on going prospective study, 109 AFIs both with and without CD have been ascertained and compared. Maternal and neonatal outcome are reviewed in cases of abnormal AFI by CD only and compared to abnormal AFI without CD (Fisher exact test). RESULTS: The coefficient of variation between CD and no CD was 4% in all API but 16% in patients with an AFI .s. 8. The median difference was 0 and 1.4 cm, respectively (p=O.OI) CD AFI altered management in 5.6% (6/H17). CONCLUSIONS: Preliminary results suggest that CD may more accurately reflect amniotic fluid volume when AFI without CD is.s. 8 and in obese patients. Although no statistically significant difference in outcome was demonstrated in abnormal AFIs with and without CD, this may partially reflect the current small sample size.