370 SPO Abstracts

450 TWIN DISCORDANCE: ULTRASOUND PREDICTORS AND PERINATAL OUTCOME. Maher JE Khoury AD', Moretti ML, Shaver DC. University of Tennessee, Memphis.

Early detection of discordant growth among twins is essential for identifying twins at risk for adverse perinatal outcome. The purpose of this report is to examine the relationship between the degree of twin discordance and perinatal outcome, and to analyze various biometric measures as predictors of discordance. Three hundred and sixty-six pregnancies were studied. Biometric measurement studied included: BPD, FL, AC, HC, and the estimated fetal weight using Shepard's formula. Perinatal data included: 5 minute Apgars scores, cord pH, delivery mode, stillbirth rate, neonatal death rate, and the incidence of RDS, IVH, NEC, and perinatal asphyxia. Discordance was defined as birthweight difference of 25%. Using stepwise linear regression, BPD and the estimated fetal weight formula were found to be the best predictors of discordance. Using an equation combining BPD and EFW, 61% of the variance in BW was predicted (p<O.OOOI). The mean gestational age of the discordant group was 32.8±5 compared to 34.3±4.3 in the concordant group (ns). In the discordant group, there was an increase in stillbirth rate, neonatal death rate, and the incidence of IVH as compared to the nondiscordant group (p<O.02). The larger twin of the discordant group had a signfficantly increase risk of HMD as compared to the smaller twin (p<O.02). This was also true for anemia and hypoglycemia (p<O.05). Conclusion: BPD and EFW (Shepard's formula) were found to be the best biometric parameters for predicting twin discordance. Discordance of this degree signfficantly increases the risk of neonatal death, stillbirth, IVH, and low 5 minute Apgars scores in both infants. An increase risk of HMD, anemia and hyperglycemia was found in greater frequency in the larger twin of the discordant pair.

451 THE VALUE OF DAILY MODIFIED BIOPHYSICAL PROFILE MONITORING IN PREDICTING INFECTION IN PREMATURE RUPTURE OF MEMBRANES (PROM) Richard L Rosemond, MD', Periclis Roussis, MD', Cheryl Glass, RN', Frank H Boehm, MD. Vanderbilt University, Nashville, Tennessee.

Accurate methods to predict infection in the presence of PROM are needed This prospective study was designed to determine the value of a modified biophysical profile(BPP)* in predicting infection in patients With PROM managed conservatively. Such patients were followed with daily nonstress tests (NST) and BPPs. Results from the last pre-delivery study were related to subsequent development of amnionitis or fetal sepsis. 99 patients were studied Table 1 shows biophYSical variables of the 16 infected cases. Table 2 shows efficacy of

TABLE 1 selected tests alone and in combination All but 1 case had "5T FB FH Ox absent fetal breathing(FB). but positive predictive value of thiS NR 0 0 A, S test alone was low (57%). When combined with nonreactive NR 0 0 A (NR) NST, pOSitive predictive value increased to 75%. When R 0 4 A both FB & fetal movement(FM) were absent and NST was NR, R 4 4 A all cases were infected and 3/4 (75%) had fetal sepsis. We NR 0 2 A conclude daily modified BPP & NST can accurately predict NR 0 4 A infection and propose immediate delivery of patients with BPP NR 0 4 A = 0/8 & NR NST. In patients >32 weeks with absent FB or NR 0 0 S BPP .:s,4/8 & NR NST delivery should be considered In those NR 0 0 S <32 weeks with absent FB or BPP< 4/8 and NR NST the risk NR 0 4 A Of infection should further be defined as NST reactivity was NR 0 4 A found to be gestational age dependent. NR 0 4 A TABLE 2 NR 0 4 A, S BP Var. Sens. Spec. + PV - PV Acc. NR 0 2 A NR NST 75. 0 66.3 30.0 93.2 67.7 R 0 4 A f/J F B 83. 8 86. 7 57. 7 98. 6 87. 9 R 0 4 A NR NST

& f/J FB 75. 0 95.2 75.0 95. 2 91. 9 BPP < 4/8 93.8 85. 5 55. 6 98. 6 86.9

A = Armi oni ti s NR NST & 5 = Neonatal BPP ~4/8 75.0 95.2 75.0 95.2 91. 9

sepsi s *FB score 0-4; FM score 0-4; maximum total = 8/8

Jamlan I~YI Am.J Ob.lel G),newl

452 UMBILICAL ARTERY OOPPLER WAVEFORM ANALYSIS: A RANDOMIZED STUDY ON EFFECT ON OUTCOME. ~ Gonsoulin. M,D .. From the Department of Obstetrics and Gynecology, Baylor College of Medicine; Houston, Texas

The purpose of this study was to determine if the addition of umbilical artery Doppler waveform analysis to our present methods of antepartum testing improved neonatal outcome. 147 patients were entered into this study and randomized into two groups:l) physicians aware of the Doppler findings; 2) blinded to the Doppler findings . The patients underwent umbi \ical artery Doppler waveform analysis for systolic/diastolic(S/D) ratios, in addition to routine nonstress testing and biophysical profiles. There were no significant differences between the two groups with regards to age, parity, abortions, gestational age at 1st Doppler examination, and first or last SID ratio. No significant differences were noted between the groups in relation to gestational age at delivery, 5 minute Apgar score, birth weight, mode of delivery, cesarean section rate. admission or length of stay in neonatal intensive care unit. There was a significantly lower incidence of intrauterine growth retardation in the Doppler available group as compared to the blinded group ( 4 versus 8 neonates). Aside from the decrease in the incidence of intrauterine growth retardation we were unable to demonstrate any benefit from the addition of umbilical artery Doppler waveform analysis to our antenatal testing regime.

453 THE EFFECT OF MAGNESIUM SULFATE ON THE FETAL BIOPHYSICAL PROFILE (BPP) OF NORMAL TERM FETUSES SJ Carlan MD,' WF O'Bnen MD, D Mastroglannl S MD, A Bhattey MS Unlversity of South Florida MedIcal School. Tampa, Flonda

MagneSIum sulfate has been shown to decrease the BPP score 1" preterm fetuses undergolng tOC01YS1S ThlS study was deSIgned to evaluate the effect of magnesIum sulfate on fetuses that had no condl tl on fe 1t to Independent 1 y I nfl uence the BPP score. Thl rty-four term breech gestat Ions adml tted for externa l cephal ic verSlOn recelVed a bIophYSIcal profl Ie pnar to any medicatIon or fluids. A loadIng dose of 5-6 gr of magnesIum su 1 fate was I nfused over 2D-3D ml nutes followed by a 1 hr rna i ntenance dose of 2-4 gr/hr. No other medl cat lOns were 91 ven A serum magnesium was drawn as the second blOphyslcal proflle wa s performed . The mean EGA was 387 wks (range 37-41) and the mean se rum magnesIum was 5.1 mg% (range 3.1-8.0) All newbor ns were normal at bIrth.

RESUL TS Mean Score

Parameter Pre Post P' -N-S-T-- 1.9 20 NS

Resp 1 4 .9 <. 05 Afv 2. a 2 D NS Movement 2 0 1 9 NS Tone 1 9 1.9 NS BPP 9.3 8.8 <. 05

• WIl coxon rank sum

CONCLUSIONS: (I) There was a statIstIcally s lgnlfl ca nt decrease In BPP In normal term fetuses after magnes Ium sulfate was Infused. (2) The change In BPP score wa s attnbuted solely t o a decrease In fetal breathIng actIvIty (no other BPP parameter changed) . (3) Serum magnes I urn 1 eve 1 was hI gher (but not statIstIcally signlflcant) In the fetuses that had loss of susta I ned resp>rat I on