Y"'"llle lli-i t\ umher 1, Part ~

486 PREDICTING PRETERM LABOR AND BIRTH

487

G. Ashmead. W. BUITowsX. M. KrewK, J. Ashmeadx , L. Mann. MetroHealth Medical Center, Cleveland, Ohio. An 8 year computer analysis found a 15% incidence of

preterm labor and birth (4,040/27,335). Mothers with 2 past preterm deliveries (20-37 weeks) had a 41 % incidence of a preterm delivery in a subsequent pregnancy. This study prospectively evaluated pregnant women with 2 past preterm deliveries but without uterine anomalies or medical problems. Creasy scores, cervical cultures, vaginal ultrasounds, weekly uterine activity monitoring, vaginal pH and cervical Bishop were obtained (20-37 weeks). Results were obtained from 92 weekly observations on six patients (2 preterm, 4 term). Preterm patients had 3 ± 1.4 contractions (mean ± standard deviation) initially and 6.5 ± 3.5 prior to delivery (within 1 week). The initial Bishop pelvic score was 4.5 ± 2.1 and 8 ± 0 prior to delivery. Full term patients had no contractions initially and 4.0 ± 3.2 prior to delivery. The initial Bishop score was l.8 ± .96 and 4.5 ± 2.6 prior to delivery. Linear and quadratic regression curves fitted to cumulative Bishop and contraction scores showed preterm patients had a linear curve with a 45° angle throughout the 2nd and 3rd trimester (quadratic term not significant). Term patients had flatter curves initially that exponentially increased prior to delivery (quadratic term Significant, p<.05). This study may eventually identify the best predictor for preterm labor and assist in the prevention of premature birth. Supported by NIH #RR 00210-26.

ENDOVAGINAL ULTRASOUND EVALUATION OF INCOMPETENT CERVIX H Frank Andersen, Robert H Hayashi. Clark E Nugent, Suzanne D WantY'o Department of Obstetrics and Gynecology, The University of Michigan, Ann Arbor, MI

Endovaginal ultrasound was used to evaluate 35 women with a clinical diagnosis of incompetent cervix (IC) prior to cerclage placement. The results were compared to 76 women without IC evaluated at comparable gestational ages (9 to 24 weeks EGA). Patients with an IC had a shorter mean cervical length than women who delivered at term (p < .01). but not significantly different than women who delivered pre term (Table). There was a large overlap of cervical lengths among the three groups. Significant funnelling of the internal cervical os was noted in 8 patients with IC and only in 1 without incompetence (p < .01). Serial examination of cervical anatomy by endovaginal ultrasound revealed developing evidence of IC in 6 patients whose history was unclear. A single assessment of cervical length is not predictive of Ie. The observation of significant funnelling of the internal os during second trimester is very suggestive of an Ie.

IC N 35

Cervix Length mean 35.8 mm S.D. 9.3

Pre term 10 36.7 mm 6.7

Term Delivery 66 42.7 mm

9.7

SPO Abstracts 379

488 ABRUPTIO PLACENTA AND PERINATAL MORTALITY

489

Raphae 1 N. Pollack'. R. H Usher', M. E. Boyd', S. Usher'. F Mclean' Departments of Obstetncs and Gynecology and Pedlatncs, Royal Vlctona HospItal, McGIll UniversIty, Montreal, Canada and The Albert EInsteIn College of MedICIne, Bronx, New York

38,850 consecut IVe dell ven es between January I, 1978 and March 31, 1989 were studIed to elUCIdate the contrlbutlOn of abruptIO placenta to perl nata 1 marta 11 ty. Abrupt 10 placenta camp 11 cated 439 pregnancI es, or 1.1% of all bJrths, and was assOCI ated WI th 79, (19%) of all pen natal deaths Ten (13%) of the perinatal deaths assOCIated with abruptlO were due to lethal anomalies. The frequency of 1 etha 1 anomalies was 22.8 per 1000 I n pat I ents WI th abrupt 10 placenta and 2 8 per 1000 I n controls Tn somy - 18, skeletal dysplaslas and hypoplastIC left heart were SIgnifIcantly assOCIated WIth abruptIO placenta The contnbutlon of abruptIO placenta to death rates, excludIng deaths due to malformatlOns was 39/169 (23.1%) of fetal deaths and 30/131 (22.9%) of all neonatal deaths. Once deaths due to anoma 11 es were excluded, the fetal death rate assocI ated WI th abrupt lOp 1 acenta was 90.9 per 1000, the neonatal death rate 76.9 per 1000. and pennatal mortalIty 157 2 per 1000. These rates were respectIVely 27 tImes, 32 tImes and 27 tImes the marta 11 ty rates for control pregnancI es. The maJon ty of fetal death occurred prlOr to term (72%) or pn or to hospltallzatlOn (73%) The 32 fold Increase In relatIVe nsk of neonatal mortalIty was largely explaIned by prematurIty. 22/30 (73.3%) of neonatal deaths follOWIng abruptlOn occurred In Infants born prior to 29 weeks gestatlOn. AsphYXIa and/or respJratory dIstress syndrome accounted for only 2 deaths In 340 llvebJrths de lIVered after 28 weeks gestat I on I n pat I ents WI th abrupt 10 placenta. Pn or to 33 weeks gestat lOn, neonatal marta 11 ty rates , n , nfants born fo 11 OWl ng abrupt; 0 placenta were not 1 ncreased over cant ro 1 S. Of the 343 pat I ents WI th abrupt lOp 1 acenta adml tted to the hospItal after 28 weeks gestatIon WIth a viable fetus only 10 (29%) suffered a pennatal death We conclude that abruptIO placenta contInues to be an Important contributor to pennatal marta 11 ty, and causes death by I nI tl at I ng preterm delivery, as well as by causIng fetal asphYXIa resultIng In stlllbJrth.

RECENT COCAINE USE AND COMPLICATIONS OF PREGNANCY .christmas.J'F;Peng, TC;Dinsmoor,MJ;Dawson,KSx; Keohane,NSx; VanDorsten,JP, Depts ofOB/GYN and Biostatistics, Medical College of Virginia Richmond, Virginia.

Cocaine use in pregnancy has been associated with preterm labor (PTL), premature rupture of the membranes (PROM), intrauterine growth retardation (IUGR), intrauterine fetal demise (IUFD), acute hypertension and placental abruption. The purpose of this study is to assess the relationship between these pregnancy complications and substance abuse. Beginning in July, 1990, all patients admitted to our hospital with PTL, PROM, IUGR, IUFD, hypertension without other signs of preeclampsia, placental abruption or a history of intravenous drug abuse (IVDA) had admission urine samples analyzed for illicit substances. In the first 2 months of this ongoing clinical investigation 125 patients were tested. 27 samples (20%) were positive for cocaine metabolites. This is higher than a recent study of unselected patients applying for prenatal care at our institution in whom the prevalence of positive urine cocaine toxicology was 7%. Indications for testing in order of frequency were PTL (50%), previous IVDA (22%), IUFD (13%), PROM (9%), abruption (2%), IUGR (2%), hypertension (2%). The number of patients in each group with positive urine toxicology was similar (19-24%). Of 63 patients admitted for evaluation of preterm labor, 12 (19%) had toxicology evidence of recent cocaine use and all delivered within 48 hours. In contrast, only 17 of 51 (33%) admitted with PTL and a negative urine toxicology delivered before 37 weeks gestation (p<.OOl). 41% of the "idiopathic" preterm deliveries (excluding maternal/fetal indications for delivery) occuring during the study period were associated with maternal cocaine use. These preliminary fmdings confirm a strong association between pregnancy complications and cocalne use in a tertiary care center and suggest that patients with PTL and positive urine toxicology for cocaine are at exceedingly high risk for preterm delivery.