Volume 164 Number 1, Part 2

SPO Abstracts 413

610 THE CLINICAL SIGNIFICANCE OF REVERSE UMBILICAL 612 ARTERY FLOW VELOCITY WAVEFORMS IN PRETERM GROWTH RETARDED FETUSES.

UMBILICAL ARTERY DOPPLER FLOW VELOCITY WAVE FORMS IN PREGNANCIES WITH SLE OR POSITIVE ANA. K. Muise

x, J.C. Veille, Dept. Repro. BioI.,

University MacDonald Womens Hospital, Case Western Reserve University, Cleveland, Ohio

Hamid A. Hadi, M.D., Julius Q. Mallette, M.D.,x and Diana Strickland, R.T.,x RDMS. East Carolina University School of Medicine, Section of Maternal-Fetal Medicine, Greenville, North Carolina.

Reversed diastolic flow waveform is the most extreme placental vascular resistance associated with high perinatal morbidity and mortality. To examine the significance of this finding, we reviewed our experience with 1100 high risk patients with umbilical artery velocity waveforms. We observed 22 fetuses (GA 23-29 wks.) who had reverse end-diastolic flow. Two groups of fetuses were identified; group I (No~10) who were managed conservatively and all resulted in intrauterine fetal demise between 2 to 10 days. Group II (No~12) who were managed aggressively and were delivered. In this group, 9 fetuses survived and only three died of consequences of severe prematurity. Associated risk factors were IUGR, oligohydramnios, hypertension, etc. These findings suggest that reverse end-diastolic flow waveform represent severe fetal compromise and impending death unless aggressive management and delivery is contemplated.

611 INTRAPARTUM EPIDURAL ANESTHESIA: EFFECTS ON UMB ILICAL ARTERY BLOOD FLOW. Dahna G. Brecker, M.D.,x John T. Repke, M.D., The Johns Hopkins Medical Institutions, Baltimore, Maryland, 21205.

The effect of epidural anesthesia on umbilical artery flow was studied using continuous wave Doppler ultrasound in 19 laboring women. Baseline SiD ratios as well as pre-epidural, 15 minute post-epidural, and 30 minute post-epidural were obtained. Each patient received at least 1 liter RL for preblock hydration. Anesthesia was achieved with 5-10 cc of bupivicaine, marcaine, or lidocaine with epinephrine after a 2 cc test dose. Maternal pulse, blood pressure, and fetal heart rate remained constant in all but one case. Paired T test analysis showed that the SiD ratio significantly decreased 15 minutes post induction of epidural anesthesia (p<0.02). This study suggests that achievement of epidural analgesia can provide a transient decrease in umbilical artery vascular resistance.

Many clinical manifestations of systemic lupus erythematosus (SLE) and positive anti­nuclear antibody (ANA) syndromes are a result of inflammatory processes on the microvas­culature. Microvascular changes in the pla­centa may be responsible for poor outcome in affected pregnancies. Umbilical artery Doppler flow velocity wave forms (UADFVW) indirectly reflec t placental vascular resistance. If SLE and +ANA result in increased placental resis­tance, these changes may result in an increased systolic/diastolic (S/D) ratio of the UADFVW. Fifty-four UADFVW were obtained on 28 patients with SLE or +ANA and compared with 54 UADFVW on 36 patients with normal pregnancies. Study patients were matched with controls for gesta­tional age. Mean EGA at time of study was 29.2 + 5.6 weeks in both groups. The SiD ratios in SLE or +ANA patients were significantly higher than those found in normal pregnancies (mean ~ SiD 4.31 ~ 3.68 vs. 2.74 ~ 0.75 P<O.OOl). These results suggest that placental resistance is increased early in pregnancies complicated by SLE or +ANA and the UADFVW should be in­cluded in the antepartum evaluation.

613 DOPPLER VELOCIMETRY AS A PREDICTOR OF CHORIOAKNIONITIS IN PREMATURE RUPTURE OF MEMBRANES Mauro V. Leo. M. D. Vij aya Ganesh, M.D., Joseph Apuzzio, M.D., UKDNJ­N.J. Medical School, Newark, N.J.

Following the in-vitro experimental model of bacterially induced umbilical vein spasm by Hyde et al., continuous doppler flow studies were performed daily in 50 patients with premature rupture of the membranes, from 22 to 38 weeks of gestation. We hypothesize that chorioamnionitis and funisitis may cause spasm of the umbilical artery as shown by an increased SID ratio.

Chorio No Chorio Normal Donnler 7 30

Abnormal Donnler 3 10 p-ns

Conclusion: In PROM, doppler velocimetry of the umbilical artery does not show vasospasm. Therefore, it does not appear to be useful as a predictor of chorioamnionitis. Further studies are warranted.