Volume 164 1\ umber I, Part 2

494 PERINATAL MORTALIlY REVIEW: FOCUS ON PREVENTION MK Menard MD, WA Bowes MD, JA Hart UNC, Chapel Hill, NC

The four year cumulative experience with a Pennatal Mortality(PM) Review process at a regionalized perinatal care center IS reported, A team of perinatal and neonatal physicians, pathologists and support staff meet each month to review all perinatal deaths, Deaths are categorized by cause according to the scheme of Wigglesworth and colleagues and are classified as preventable(P), possibly preventable(PP) or nonpreventable(NP) by consensus opinion There were 254 perinatal deaths (86-89); a PM rate of 30,5/1000 live births 77% were classified as NP' 205% as PP and 2.5% as P. Cause Of Death NP(n=195) PP+P(n=55) Congenital anomalies 57 (29%) 2 (4%) Unexplained IUFO 45 (23%) 22 (40%) Intrapartum events 6 (3%) 2 (4%) Consequence of preterm birth 64 (33%) 21 (47%) Other specific causes 23 (12%) 10 08%) Maternal Factors NP (n=197) PP+P(n=57) Preterm premature ROM 43 (22%) 10 (18%) Pre term Labor 21 (11%) 13 (23%) Maternal/placental problem 68 (35%) 21 (42%) No maternal cause IO'd 64 (33%) 11 (19%) Medical management issues that might have improved out­come were identified In 60% of the PP deaths. Patient compliance or lack of PNC accounted for 40%. Only 23% of deaths were considered PP by current medical standards. Collective data is essential to setting research agenda and program pnontles for the prevention of pennatal deaths.

495 EFFECTS OF DIGITAL VAGINAL EXAMS ON LATENCY PERIOD IN PRETERM PREMATURE RUPTURE OF MEMBRANES, ~MaJor CA. Towers CV, Harding JA, Asrat T and Gante TJ, Unlv of Calif, IrVine Med Center and MemOrial Med Center of Long Beach, CA.

Preterm premature rupture of membranes (PPROM) conllnues to account for a slgDlflcant amount of pennatal morbidity and mortality Current standards include documentation of PPROM With a stenle speculum and aVOidance of digital vaglOal digital exam (DVE). little is known about the effects of DVE on PPROM. We prospectively collected 271 Singleton pregnanCies complicated by PPROM from Memonal Medical Center of Long Beach, Pennatal Outreach program, from January, 1986 to Apnl, 1990 , that met cntena for being treated expectantly Patients were not Included If they had multiple gestations, a cerclage, were In advanced labor, or had any Indication for delivery on admission, (i.e., mature lung profile, chorioamnionitls) All patients were maternal transports to our tertiary care facility and were managed similarly by our pennatal group. All DVE were performed pnor to transport. Effects on latency penod 10 days are listed below by gestational age.

SPO Abstracts 38'

496 PRETERM PREMATURE RUPTURE OF MEMBRANES AND PLACENTAL ABRUPTION: IS THERE AN ASSOCIATION BETWEEN THESE PREGNANCY COMPLICATIONS? Malor C A, Nageotle, M P., LeWIS, D.F., Asrat, T.,Hardlng,J A, Gante, T.J., UDiversity of CaliforDla, Irvine Medical Center and Memonal Medical Center of Long Beach, California.

We evaluated 756 pregnancies complicated by preterm premature rupture of membranes(PPROM) who were managed expectantly. The Incidence of abruptlon in thiS study group was 5%.(N;38). A control group,conslstlng of 11,240 pregnancies not complicated by PPROM and delivered over the same time period, was also evaluated The InCidence of abruptlon In thiS group was 86%(N;97). The difference In the inCidence of abruptlon between these groups was statistically Significant (p< 001) The PPROM group was divided IOtO 2 subgroups - an abruptiO group(AG) and a non-abruptiO group(NAG) The amniotic fluid volume on admiSSion in these 2 subgroups was evaluated and found to be Similar. 26 out of the 38(69%) patients In the AG had bleedlOg after rupture of membranes,whereas only 33 out of the 718(5%) patients 10 the NAG did (p< .0001). There also was a stallastlcally significant Increase In the InCidence of bleeding before ROM In the AG(6/38 ;15%)when compared to the NAG(8/718;I%)(p<.005). Further comparisons of the 2 subgroups are demonstrated below.

GA @ Del BW Latency Fetal Distress Amnionrtis AG(N;38) 312 wks 1694 g 13 days 18(46%) 15(39%) NAG(N;718) 304 wks 1563g 10 days 49(7%) 197(27%) p~ ~ ~ ~ ~ ~

CONCLUSIONS: (1) Placental abruptlon Is significantly more common In pregnancies complicated by PPROM, (2) Abruptlons In pregnancies complicated by PPROM are associated with a statistically significant increase in the Incidence of Intrapartum fetal distress, (3) There was no statistical difference in the latency period, blrthweight, GA or Incidence of armlonltis between the AG and NAG,

497 DOES TOCOLYSIS WITH INDOMETHACI:"I INCREASE THE INCIDENCE OF NECROTIZING ENTEROCOLITIS IN THE LOW BIRTHWEIGHT NEONATE? MaJor C.A. Lewis, D.F., Hardmg, J.A., Porto, M.A., Freeman, R.K., Garite, TJ., Untversity of California, Irvine and Long Beach Memorial Medical Center, California.

Early enthusiasm surrounding the use of mdomethacin (indocm) has been tempered due to the reports of adverse neonatal Side effects. This study examined the assOClal1on betwecn antenatal indomethacin and the development of necrotizmg entcrocolitis (NEC) in the low bJrthwelght neonate. Preterm neonates, who delivered wllhin I weck of maternal indomcthactn administration(N=S8)were compared to a control group of neonates(N=739) who had not had any antenatal indomethacm exposure. Within the 2 groups, the gcstaUonal age, birth weight, mode of delivery, MgS04 use, post dclivery treatment with indomethacin, incidencc of pennata! asphyxia, RDS and umbilical catheterization were compared and found to be Similar. The inCidence of NEC in the study group was 17% compared to the control group which was 6% (pd)OS). The incidence of NEe 10

neonates who dclivered within 24 hours of maternal indomethacm administration was 19%. Thi~ was also statistically different from the control group(p<.OO3). The interval between delivery and the development of NEC was similar in both groups and appeared to be related to the first enteral feedmg. Antenatal tndomethacin exposure, especially when It occurs within 24 hours of delivery, is associated with a significant mcrease in thc incidence of NEC in the low birth weight neonate. Group Number Cases of NEC % Indocin (Total) 58 10 17% Indocin «24 hrs.) 47 9 19% Control 739 49 6%