Volume 164 Number 1, Part 2

603 OUTCOME OF TWIN GESTATIONS COMPLICATED BY ANTEPARTUM FETAL DEMISE, DJ Wong. MD. DS Kin MD. lIT Strassner MD. Rush Medical Center. Chicago,IL.

Antepartum fetal demise of one twin complicated 13 of 683 (1.9%) twin gestations dwiog a 10 year period. A retrospective review was performed to examine maternal and neonatal morbidity. Antepartum diagnosis of fetal death was made in 8 of the 13 cases. Diagnosis to delivery interval ranged from 4 to 147 days. Antepartum complications included 7 with preterm labor. 2 with premature rupture of membranes. 2 with polyhydramnios (preceding fetal demise) and 1 each with intrauterine growth retardation. preeclampsia and gestational diabetes. Eleven cesarean sections were performed (6 for maipresentations. 3 for fetal distress. and 2 for repeat cesarean sections). No coagulation problems were seen. Five pregnancies were followed for >5 weeks following the demise. Neonatal outcomes included 10 of 13 (77%) surviving. Mean gestational age at delivery was 33 weeks. Mean birthweight for the surviving and nonsurviving twin was 2775 and 745 grams respectively. Mean Apgar scores at 1 and 5 minutes were 5.5 and 7.7 respectively. There were 7 NICU admissions with 3 neonatal deaths (gestational ages 26-28 weeks). In summary. the morbidity for the surviving twin is primarily from prematurity whereas the morbidity for the mother is primarily from cesarean section.

604A MATERNAL AND NEONATAL COMPLICATIONS IN CASES OF DYSTOCIA, Rodriguez JX, Sarinoglu CX, Mercer BMx, Sibai BM, University of TN, Memphis,

The development of shoulder dystocia is a medical-legal nightmare for the obstetrician, METHODS: We have reviewed maternal and neonatal complications in 149 cases of shoulder dystocia (between January, 1984 and November, 1988), Maternal data included presence of risk factors, use of instrumental delivery, and maternal complications. Neonatal data included Apgar scores, birth weight over 4 kilograms, umbilical cord gases and birth trauma. Long term outcome was obtained in survivors who had an average followup of 2.3 years (range, 0.5 to 5 years) RESULTS: Sixty lour women (43%) required instrumental delivery. Sixty eight (45%) had major perineal lacerations; one 01 which resulted in rectovaginal listula. Shoulder dystocia developed in eight pregnancies complicated by antepartum fetal demise and the remainder were live births. Seventy-eight infants (52%) had a birth weight greater than 4 kilograms, 22% had a cord pH <7.20, and only one infant had a 5 minute Apgar score less than 7. Neonatal birth trauma is summarized below.

Erbs Palsy 221141 15.6% Fractured Clavicle 61141 4.3% Facial Nerve Palsy 1/141 0.7%

All six cases with fractured clavicles and the one case w~h facial nerve palsy healed spontaneously. Twenty of the 22 inlants w~h Erbs palsy had complete recovery within 8 weeks of delivery. The other two inlants suffered permanent motor delic~. CONCLUSION: Shoulder dystocia results in significant maternal and neonatal morbidity as rellected by neonatal acidosis and trauma. Most infants have a favorable long term outcome and will recover w~hin 8 weeks of delivery.

SPO Abstracts 411

604B SUBSTANCE ABUSE AND PERINATAL MORBIDITY & MORTALITY

Copur H~ Khakoo H, Boafo A, Ayromlooi J. New York Medical College, Lincoln Hospital N.Y.

A retrospective study of 19,614 women who delivered in an inner city hospital from Jan.l, 1985 to Dec.31, 1988 was conducted to ascertain the effect of cocaine, crack, heroin, methadone and marijuana over perinatal morbidity and still birth rate. The findings are summarized in the following table:

Complications Substance Control P value abuser (N=733) (N=18881) <

1.Preterm delivery 230 (31%) 2266(12%) 0.001 2. Infants <' 2500gms 402(55%) 2870(15%) 0.001 3.Abruptio p1ac. 25(3.4%) 30(.16%) 0.001 4.PROM 61 (8.3%) 1397(7.4%) N.S. 5.Low 1 min.Apgar 80 (11%) 774(4.1%) 0.001

(less than 7) 6.Low 5 min.Apgar 20(2.7%) 132(.7%) 0.001 7. Stillbirth 32(4.4%) 181 (.96%) 0.001

Conclusion: Substance abuse during pregnancy results in significant increase in preterm delivery, low birth weight, abruptio placentae, stillbirth and low one and five minute Apgar scores without any changes in the incidence of premature rupture of membranes (PROM) .

604C DRUG ABUSE AND STILLBIRTHS AN ANALYSIS OF STILLBIRTHS AT A CITY HOSPITAL Hamida Khakoo, Alex T. Boafo, Huseyin Copurx Jahangir Ayromlooi Department of Obstetrics and Gynecology, New York Medical College, Lincoln Hospital,N.Y

The records of all stillbirths occuring be­tween Jan. 1984 and·~ec. 1989 were reviewed. Congenital anumalies as a cause of stillbirths were excluded from the analysis. During this period of time, there were a total of 28,306 deliveries and 315 stillbirths. The table below shows that drug use as a contributory factor to stillbirths dramatically increased from 14.5% in 1984 to 25% in 1989. The results suggest -that there is a continued need to ex­pand drug education programs to minimize such derogatory effects on the normal but dead fetuses in pregnancy.

YEARS 1984 1985 1986 1987 1988 1989 Total deliveries 4372 4619 4932 5258 4775 4320 Stillbirths(SB) 60 43 44 54 61 53 Stillbirth rate% 1.4 0.93 0.89 1.02 1.27 1.20 Cong.Anomalies 4 2 4 2 3 1 Corrected(SB)rate%1.2 0.88 0.81 0.96 1.23 1.20 Drug Abusers with 8 5 5 9 16 13 stillbirths Drug related(SB)%14.S 11.1 12.6 17.6 26.6 25.0