308 SPO Abstracts

225 A RANDOMIZED TRIAL OF PROSTAGLANDIN E2 IN A CONTROLLED RELEASE VAGINAL PESSARY FOR CERVICAL RIPENING AT TERM. FR Witter, M.D., L Rocco, RN, MSx, TRB Johnson, M.D., The Johns Hopkins School of Medicine, Baltimore, Maryland

This double blind randomized, placebo controlled study of prostaglandin E2 in a controlled release va.ginal pessary for cervical ripening at term included 70 patients (37 on active agent). Pessary was inserted for 12 hours. Change in Bishop score differed significantly between active agent and placebo (3.89 vs. 1.25 p=0.00003). Time from pessary insertion to onset of active labor and to delivery were significantly shorter for patients rece~v~ng

active agent (6.51 vs. 16.78 hrs. p=0.00024 and 18.26 vs. 26.28 hrs. p=0.0155) Duration of first and second stages of labor did not differ between groups. Hyperstimulation with active agent occurred only after onset of active labor. Conclusions about the agent: 1) effective for cervical ripening. 2) shortens the latent phase of labor without effecting the active phase. 3) should be used only under continuous monitoring and be removed at the onset of the active phase of labor.

226 ROUTINE INTRAPARTUM DRUG SCREENING IN A MIXED OBSTETRICAL POPULATION. T. Feng,X T.R.B. Johnson, The Johns Hopkins Medical Institutions, Baltimore, Maryland

Routine urine drug screening was instituted to identify the incidence of substance abuse at the time of delivery and permit pediatric and maternal interventions. A specific urine drug screen was developed for the obstetrical service which would screen for opiates, cocaine, THC, and barbiturates on admission to labor. Results were available in 24 hours. The incidence of drug abuse in the overall population was 11.2%. The house staff clinic accounted for 68% of the positive urine screens, 18% were from an HMO, and 14% were from private patients. Active intervention from a multidisciplinary team was started prior to discharge. Conclusion: Recent drug use is a significant problem in our obstetric population. Biases about demographic an;:! social risk factors for drug abuse may be misleading. Intrapartum screening allowed us to identify patients in need of drug abuse intervention and to begin an integrated intervention plan involving pediatric, obstetrics, social work and substance abuse services.

January 1991 Am J Obstet Gynecol

227 TERM HUMAN PARTURITION IS ASSOCIATED WITH SYS· TEMIC AND LOCAL CHANGES IN CORTISOL AND ESTROGIN CONCEN}'RATIONS. Mos~e Mazor, Arnon Wiznitz12.rJ Joseph Levy, Marek Glezerman, Roberto Romero. Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel and Yale University School of Medicine, New Haven, cr.

The purpose of this study was to determine whether term human parturition is assocIated with changes in cortisol, estradiol, dehydrqepiandroter~ne s)Jlfate (DHEA-S), proges­terone and prolactm concentratIOns m maternal plasma and am­niotic fluid. The samples were obtained from 31 women with term gestations (11 in active labor and 20 not in labor). Hor­monal concentrations were measured in maternal plasma and amniotic fluid with sensitive and specific radioimmunoassa),s. Plasma cortisol concentrations were significantly higher in women in labor than in women not in labor (median 35 mg/dL [range 1~ to 74] vs. 25 mg/dL [9 to 41]; [p = 0.02]) .. No significant changes m maternal plasma normonaI levels (medIan ano range) were noted between women in labor and not in labor (estradlOf: 15.3 n~m1 [8.5 to 23.3] vs. 14.4 n~ml [5.5 to 28.5]; DHEA-S: 7(fJ ng/ml 439 to 1625] vs. 500 ng/ml 150 to 1750]; progesterone: 125 ng/m1 74 to 302] vs. 148 ng/ml 44 to 3(fJ]. and prolactin: 109 ng/m1 3 to 448] vs. 198 ng/ml [7 to 550]). in contrast, amniotic fluid concentrafions of Doth cortisol and estradiol were sig­nificantly increased in laboring women when compared to non­laboring women (4 mg/dL [1.3 to 7] vs. 2.1 mg/dL [1.0 to 4.0) [p = 0.0003) and 2.7 ng/mr [0.7 to 9.2] vs. 1.6 ng/m1 [0.9 to 5.4[ [p = 0.0491J. No significant differences in the amniotic fluiil con­centrations of progesterone, DHEA-S and prolactin were found in the two grO~S (progesterone: 15.5 ng/ml 111 to 87] vs. 23.5 ng/ml [14 to 23. ; DHEA.-S: 33.4 ng/m1 rT8 to 250] vs.1IJ7 ng/m1

163 to lOOO]: an prolactin: 634 ng(m1 [!50 to 10781 vs. 506 ng/m1 170 to 1618]). rn conclusion, term human labor is associated

with systemic changes in cortisol levels and with local changes in cortisol and estradIol concentrations in anmiotic fluid.