442

443

368 SPO Abstracts

v:rJ.R.:lACXXJSITC STIMUIATION (VAS) FOR ABNORMAL 444 BIOPHYSICAL rnoFIIE (BPP) RErug(S OBSTEIRICAL INl'ERVENI'ION. Druzin M, Bord AL , Adams D, wagner W. New York Hosp.-COrnell Med.ctr, NYC

'!he effect of VAS on BPP .:$ 6 (N=81) was ~ to 20 cx:>ntrols (no VAS after BPP .:$ 6). BPP was perfonred at 28-42 weeks gestation with NST included; BPP = 6 was equivoc:al, BPP < 6 abnonnal. VAS was awlied CNer the fetal vertex for 3 sec:orxjs. All patients delivered within 7 days of BPP. Results: 67/81 cases (83%) with VAS showed illprCNed score ~ 6 (% illprCNem:mt similar at all gestational ages) ani were ~ to 14/81 who had no charge with VAS ani to 20 controls (no VAS). '!here was no difference in labor CCIlplications ani neonatal outcane between all 3 groups. Conclusion: 1). VAS for equivoc:al/abnonnal BPP resulted in illprCNed score ~ 6 in 83% cases. 2) .'!his may prevent intervention for false abnonw.l BPP.

VAS + VAS + roNTROIS * P NS mANGE NO ClIANGE

N=67 N=14 N=20 CIS 28 (42%) * 7 (50%) * 12 (34%) CIS FD 10 (36%) * 4 (57%) * 6 (50%) ~ FETUS 6 (9%) * 2 (14%) * 4 (20%) MECONIUM 15 (22%) * 3 (21%) * 2 (10%) A8NL CORD 15 (22%) * 1 (7%) * 4 (20%) mM 15/1000 * 0 * 0

LACK OF ASSOCIATION OF SPONTANEOUS FETAL HEART RATE 445 DECELERATIONS DURING ANTEPARTUM NON-STRESS TESTING WITH FETAl COMPROMISE. DJ Gloeb. J Whitty' and MY Divan. The Albert Einstein College of Medicine. Weller Hospltal. Bronx. New York.

Background. Non-stress testlng (NST) lS used ln the antepartum assessment of fetal well-bel ng 1 n hi gh-rl sk pregnancl es. The significance of spontaneous fetal heart rate (FHR) deceleratlOns is comp 1 i cated by thei r rel at i ve severi ty. The purpose of thl s study was to examine the impact of the degree of severity of antepartum FHR decelerations on perinatal outcome. Methods. A prospective study of 866 NSTs was carried out in a cohort of high-risk pregnant patients. FHR decelerations were deflned as a decrease of at least 10 BPM below baseline lasting for at least 10 seconds (i .e .• 10x10). The lmpact of decelerations that were 20x20 and 30x30 on perl nata 1 outcome was also assessed . All patlents were undergOlng non-stress testlng for a varlety of lndications and were placed in the left lateral positlOn. and a Corometri cs fetal monitor-l45 was used. Abnormal perl nata 1 outcome was defl ned by the presence of at 1 east one of the following: meconium. NICU admission and IUGR. Results. The incldence of spontaneous FHR deceleratlons was 18.4%; 84.4% of these tracl ngs were conSl dered to be reactl ve USl ng standard Crlterla. The two most common lndications for testing were hypertensi ve di sease of pregnancy and gestat lOna 1 di abetes mellitus (30.2% each). Perinatal morbid outcomes lncluded the presence of mecomum ln 26.0%. NICU admlsslons ln 6.1% and IUGR in 5.1%. PREDICTION OF PERINATAL MORBIDITY BY SIZE OF FHR DECELERATION

Sens ~ +PV -PV

~20 BPMx20 sec 67 34 26 75 ~30 BPMx30 sec 33 64 29 69 Conclusion. The predlctlVe value of FHR decelerations ln elther reactive or non-reactive NSTs lS llmlted.

Januaq 1991 Am J Ob,tet G}necol

COMPARISON OF CONTRACTIONS DURING BST & OCT STRENGTH & UTERINE FLOW: D.Nanda~ L. FeinkindX

, H. Minkoff, F. MorganoX;

SUNY-HSC at Brooklyn, NY Doppler was used to quantify uterine

contraction strength during CSTs.8 patients had internal toco placed extra ovularly 3" above the os. Baseline uterine pressure & Doppler readings were obtained. Patients had BST; uterine pressures & coincident doppler readings were taken. After contractions subsided, similar readings were obtained with pitocin.188 BST & 170 OCT Doppler readings were evaluated with Pearson correlation co-eff. & t test. Results: Linear correlation of t in contraction strength with changes in SD ratios & PI was seen in patients undergoing BST as well as OCT. Mean t in contraction with BST was 11.01±9.3mm & with OCT it was 14.91±16.03mm (pO.006). PI values for the OCT group were significantly higher than BST group (1.4± 1.68 vs.1.21±.71; P<0.009), but SD ratios were not different (P<0.09) Conclusions: A linear relation exists between the uterine contraction strength & doppler flow; contractions produced by BST are less intense than those by OCT.

A COMPARISON BETWEEN VISUAL AND COMPUTER ANALYSIS OF FETAL HEART RATE (FHR) TRACINGS. R.Gagnon, K.CampbeW, C.HunseX, J.Patrickx.Lawson Res.lnst.,Dept OB/GYN & Epidemiol.,UWO, London,Ont.

The purpose of this study was to determine whether a role exists for computerized analysis of human FHR recordin~s. We collected 100 antepartum FHR tracings of 30 min. duration and good quality (average signal loss of 1.5%). The 100 recordings were coded and examined randomly by 5 observers on 3 occasions during a 12-month period. Kappa coefficients reflecting intraobserver agreement revealed good agreement for the assessment of baseline FHR (0.53-0.82) but poor agreement for the assessment of long-term FHR variability (0.03-0.58). The interobserver agreement was better for baseline FHR (0.44) than long-term FHR variability (0.18). The interobserver agreement in making deCision to continue recording (non-reactive NST) or to the question "are you concerned about this tracing" was poor (0.39 and 0.26, respectively). When compared to the computer (Dawes and Redman), the 5 observers agreed with the baseline FHR (+ 5 bpm), 81% of the time. If the computer detectea 0-1 FHR acceleration ~15 bpm X ~15 sec, observers agreed 64% of the time. Observers missed more than 95% of FHR decelerations of >15 bpm X >60 sec detected by the computer. We conClude that:1)Visual assessment of the baseline FHR is accurate but not of long-term FHR variability, and 2) when observers were compared to the computer, an unacceptably high level of inaccuracy existed to confirm the absence of accelerations and the presence of decelerations, both considered ominous signs in antepartum FHR testing. A standardized computer method should be used to analyze human FHR traces.