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423

Volume lfi4 r\ulllber 1, Part 2

ARE lWINS WITH ELEVATED MSaFP VALUES AT RISK FOR PREGNANCY COMPLICATIONS AND POOR OUTCOME?

Wayne H. Persune, BS, RDMS', Michael T Weaver, PhD', Roger R. Lenke, MD, and M,chael Cardwell, MD

Medical College of Ohio, Toledo, OhIO

In addition to its utility in the detectIOn of the fetus WIth a structural defect, MSaFP screening is useful m the identIfIcatIOn of the singleton pregnancy at risk for perinatal complIcatIOns and poor outcome Cuckle et al recently suggested that, m order to aclueve the false posltlve ratc accepted in the singleton pregnancy (at >2.5 MoM) for the detectIOn of spmal bifida, the threshold for elevation in IWlns should be raIsed to 3-35 MoM To date, no association between elevated MS"FP and pregnancy complicatIOns in IWlns has been established We postulated that, utilizing the proposed cut-off for elevation in the IWln pregnancy (~3.5 MoM), MSAFP may be useful in identifymg a group of IWlns at increased risk for perinatal complications and poor outcome A retrospectIve study of 45 consecutive twin pregnancies was conducted Thrrteen of these patients (29%) had elevations in MS"FP ~3 5 MoM The mcidenee of low brrthweight (LBW), preterm delivery (PTD), birthweight discordancy (BD), and penpartum death (PO) were compared between the group of patients with normal values ( < 3 5 MoM) and the group with elevated values (~ 3.5 MoM). These data arc,

LBW «2.5kg) PTD «35 wks) BD (>20% dlff) PD

MSaFP(MoM) <3.5 (N=32) >3.5 (N=13) 61% (39/64) 83% (22/26) 43% (U/32) 70% (9/13) 17% (5/32) 46% (6/13) 15% (5/32) 31% (4/13)

CONCLUSION: We found that twin gestations with MS"FP values ~ 35 MoM seem to have a higher rate of LBW, PTD, BD, and PO, when compared with those who have lower values Therefore, these twin pregnancies may be considered to have an mcreased nsk for pennatal complications and poor pregnancy outcome.

DECREASED FETAL MOVEMENT AS AN INDICATION FOR ANTEPARTUM TESTING, Janlce E. Whitty. M.D.', David A. Garfinkel, M,D.', Mlchae1 Y. Divan, M.D., Albert Elnsteln College of Medicine, Bronx, NY.

Decreased fetal movement (FM) has tradltionally been used as an indlcatlon for fetal testlng. The purpose of thlS study was to evaluate: 1. the 1 nCl dence of abnormal test 1 ng requl rl ng lmmedl ate 1 ntervent lOn 2. the i nci dence of i nCl denta 1 sonographl c fl ndl ngs 3. the need for long term follow-up. Materi a 1 s & Methods' Of 4,727 patl ents evaluated in our antenatal test i ng center over a 4.5 year period, 292 (6.5%) presented wlth a primary comp1alnt of decreased FM (23% were <36 weeks). Inltlal testlng conslsted of an NST and ultrasound examination. 623 low-rlsk, non-tested patients served as a control population Results 2.4% of the study patlents had fetal demlse at the tlme of evaluation and 4.4% of fetuses wi th decreased FM requi red lmmedl ate dell very due to abnorma 1 FHR patterns/bi ophysi ca 1 profil e scan ng (the CIS rate for these patlents was 46%). In addition, 3% had abnormal FHR tracing requiring follow-up. 52% of patlents wlth a normal 1 nit i a 1 eva 1 uat ion recei ved addit i ana 1 test 1 ng. There were no Sl gnl fl cant dl fferences between these pati ents and pati ents recelvlng no addltiona1 testlng wlth regards to fetal dlstress ln labor, meCOnlum. low Apgar score or NICU admlsslon. The followlng 1 nci dental sonographi c fi ndl ngs were noted: JUGR-2. 7%, Macrosoml a-4 5%, Abnormal presentat ion-I. 7%, placenta preVl a-O. 3%. The lncldence of abnormal outcomes ln patlents with decreased FM and normal inltla1 eva1uatlon was not slgniflcant1y different from that of a low risk, non-tested popu1atlOn In conc1uslon, while 1 t 1 S prudent to evaluate all pat 1 ents who present with decreased FM, additional testing of patients wlth a normal lnltlal eva1uatlon lS not assoclated wlth lmproved pennata1 outcome.

SPO Abstracts 363

424 mEDICI'IVE RELIABILI'IY OF NORMAL BIOmYSICAL FR:lFIIE (BPP) FOLI.CMING VIBROACXXJSTIC STIMU­IATICN (VA'3) IS ~ 'ID NORMAL BPP WI'IH­~ VA'3. rmlis S , Dnlzin M, Wagner W, Bom A , 1Idams D, Kogut ~. New York Hospital­Cornell Medical Center, New York, NY

Neonatal ootcane of BPP scores ~ 6 (equivo­cal/abnonnal.) which inproved to ~ 8 (nonnal.) with VA'3 (n=41) was CC'IIpCil:'8d to BPP ~ 8 wi tl'lalt VA'3 (n=283). All patients were 28-42 weeks gestation am all delivered within seven days of the BPP. Results: There were no significant differences in labor CCIlplications or neonatal ootcane between the two groups. Conclusion: 1). Nonnal. BPP predicted good neonatal out:caoo. 2). VA'3 for abnonnal. BPP resulting in nonnal. score had the same predictive reliability as nonnal. BPP without VA'3. 3). VA'3 should be used for all abnonnal. BPP scores.

BPP + VA'3 BPP I NO VAS sa>RE ~ 8 SOORE ~ 8 n=41 -,:,n=c.=2""8,,,,3'-c-::-:-:-_

CIS 20 (49%) 131 (45%) CIS FEIAL DISTRESS 5/20 (25%) 59/131 (45%) SGA FElUS 3 (7%) 14 (5%) MEXXmUM 8 (20%) 56 (20%) ABNORMAL OORD 10 (24%) 81 (29%) OORREX:TED FNM -0- -0-P NS for all parameters

425 IS BIOPHYSICAL PROFILE (BPP) SCORE OF 4 [REACTIVE NON-STRESS TEST (NST) AND ADEQUATE AMNIOTIC FLUID VOLUME (AFV)] A RELIABLE INDICATOR OF FETAL WELL-BEING?

Sze-ya Yeh. M.D. and Carol Wilkerson, KN.x Department of Obstetrics & Gynecology, The Allentown Hospital -­Lehigh Valley Hospital Center, Allentown, Pennsylvania

BPP scores of 4 or less were considered a high probability of fetal asphyxia in utero, and immediate intervention was recommended. Recent studies indicated that a reactive NST with an adequate amniotic fluid volume is a reassuring sign of fetal well-being. During the 51 month period from April 1, 1986 to June 30, 1990 there were 2,270 BPP tests done in our institution. Among them,31 cases (1.4%) had scores of 4, and 11 of them had scores of 2 for reactive NST and 2 for adequate AFV. Indications for these tests were: 5 for hypertensive disorders, 4 for postdates, 1 for intrauterine growth retardation and 1 for suspected rupture of membranes. All tests were done between 36 to 42 weeks. The neonatal outcome of these patients was significantly better than that of other patients with scores of 4. Five patients had BPP repeated within 24 hours, and all of them had scores of 10 and subsequently delivered normal infants. Six patients delivered infants within 24 hours, none showed signs of fetal distress durmg labor. All except one had Apgar scores of 7 or greater. This patient had mild shoulder dystocia, and the infant's Apgar scores were 6 at one minute and 9 at five minutes. These data suggested that a reactive NST with an adequate AFV is a reliable sign of fetal well­being, and a complete BPP may not be necessary unless NST or AFV is abnormal.