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282 SPO Abstracts 125 MATERNAL HEMODYNAMIC RESPONSES TOCOLYSIS WITH SUBCUTANEOUS TERBUTALINE (TBT). M Alyarez, CJ Lockwood, RL Berkowitz; Mount Sinai School of Medicine, NY, NY Subcutaneous (sq) TBT has been proposed as an alternative to intravenous tocolysis because of its ease of administration and presumed safety. However, there is no data on maternal hemodynamic responses to such therapy. We evaluated 15 patients undergoing sq TBT therapy (O.25mg q 1hr x 5) followed by oral therapy (5mg q 4hr) with noninvasive hemodynamic monitoring prior to, during and following sq TBT therapy. Intravenous fluid therapy consisted of Lactated Ringer 125 mVhr. The groups mean maternal age was 26.9 (3.6) years, median parity was 2 and mean gestational age at admission was 30.3 (2.22) weeks. Hemodynamic parameters assessed included cardiac output (CO), thoracic fluid index (TFI), heart rate (HR), ejection velocity index (EVI), stroke volume (SV) and ventricular ejection lime (VET). RESULTS: -fBI.Q.B PUR I N G Af.li.R CO 9.03 (2.0) 12.9 (3.6) 10.9 (2.4) 0.001 TFI 19 (3.8) 20.3 (3.3) 19.4 (3.6) .022 HR 81.3 (11.7) 105.1 (7.7) 94.9 (11.0) 0.001 E V I 1.3 (0.2) 1.8 (0.6) 1.4 (0.4) .001 S V 114.4 (35) 125.3 (35.3) 116.2(25.2) 0.006 VET . 292 (.02) .281 (.02) .288 (.02) .35 • = Friedman's 2-way analysis of variance; ( ) = SD SUMMARY: The sq TBT therapy employed in this study has significant inotropic and chronotropic effects. However, sq TBT appears to have fewer maternal hemo- dynamic sequelae then intravenous beta mimetic therapy. 126 INCIDENTAL THROMBOCYTOPENIA DURING PREGNANCY: A BENIGN CONDITION. Jeffrey S Greenspoon MD, Sharon J Yee MDx, MD, Herman TYee MDx, Dept. OB/GYN, University of Southern California, Los Angeles, CA and Dept. of Pathology, Columbia University, New York. We report the outcome for 6S women with incidental thrombocytopenia during pregnancy. During a 4 year period beginning in 1984, 37 gravidas with mild thrombocytopenia (platelet counts between 100,000 and 149,000/mm 3 ) and 28 with moderate thrombocytopenia (7S,000 to 99,000/mm 3 ) were evaluated with this condition. Management was routine except for serial platelet counts. In 2 of 3 cases in which a falsely low scalp sample estimate «SO,000/mm 3 ) was obtained, an unnecessary cesarean section was performed. No infant had severe thrombocytopenia «SO,000/mm 3 ) at birth. One woman had a fetal demise at 22 weeks; the thrombocytopenia was the first sign of the anti-phospholipid antibody syndrome (APAS) • Gravidas with incidental thrombocytopenia are not at increased risk for fetal thrombocytopenia; however, thrombocytopenia may disclose the presence of APAS. Fetal scalp sampling may not be justified for incidental thrombocytopenia. Janudrv 1991 Am , Obstet G) newl 127 THE ROLE OF REPEAT GTT IN THE DIAGNOSIS OF GESTATIONAL DIABETES Ran Neiger MD Donald R. Coustan,MD, Brown University/Women & Infants' Hospital, Providence, Rhode Island. The diagnosis of gestational diabetes requires that two of the four oral glucose tolerance test values be elevated. We evaluated the utility of repeating the oral GTT in patients who had only one abnormal glucose determination mg/dl, 1 2 3 mg/dl). Our study population included 106 patients, average age 27.7±S.1 years, average gravidity 2.4±1.8, and parity 0.8±1.2. All patients had an abnormal screening test, performed at 27.±1.9 weeks, average value 148±14 mg/dl. On the initial GTT, performed at 30.3±2.S weeks, each had one abnormal value. We repeated the GTTs at 34.9±2.1 weeks. Thirty six patients (34%) had two abnormal glucose values on the repeat GTT and were classified as having gestational diabetes. Of the other 70 patients, 26 (37%) again had one abnormal value on their GTT,and the remainder 44 had all values normal. The ages, pre-pregnancy weights, diabetes screening test results, and the degree of abnormality of the first GTT of patients who were later diagnosed with gestational diabetes, were not statistically different from those who did not have two abnormal values on their repeat GTT. Our results indicate that the finding of one abnormal value on a glucose tolerance test denotes an increased risk for the development of gestational diabetes. 128 URINARY PROTEIN/CREATININE RATIO BEFORE AND DURING PREGNANCY IN WOMEN WITH DIABETES MELLITUS. C. Andrew Combs x , Bernadette Wheeler x , John L. Kitzmiller, University of California, San Francisco, California. Twenty-four hour urinary total protein excretion (24-hr TP) is routinely assessed in diabetes (DM) to detect nephropathy and preeclampsia. However, 24- hr collections are inconvenient and often incomplete. Urinary protein/creatinine ratio (PCR) in a single-voided specimen has been correlated with 24-hr TP, but this method has not been validated in pregnant women with DM. We analyzed the relation between 24-hr TP and PCR in 24-hr specimens from 123 class B-RF women with DM from before pregnancy (n=33), and 1st, 2nd and 3rd trimesters (n=99, 98, 70). PCR correlated well with 24-hr TP (r=0.981, p<O.OOOI); the regression line was: 24-hr TP = 1.17 x PCR + 0.02. The relation was not affected by trimester or by preeclampsia. The standard Cockroft formula 24-hr creatinine = (140-age)(weight)/5883 did not improve the correlation because daily creatinine excretion was only weakly correlated with body weight (r=.22) and not correlated with maternal age (r=.13). Previous studies have shown that 24-hr PCR is highly correlated with PCR in single-voided urine. Our data suggest that PCR may be used to estimate 24-hr TP in pregnant women with diabetes.

127 The role of repeat GTT in the diagnosis of gestational diabetes

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282 SPO Abstracts

125 MATERNAL HEMODYNAMIC RESPONSES TOCOLYSIS WITH SUBCUTANEOUS TERBUTALINE (TBT). M Alyarez, CJ Lockwood, RL Berkowitz; Mount Sinai School of Medicine, NY, NY

Subcutaneous (sq) TBT has been proposed as an alternative to intravenous tocolysis because of its ease of administration and presumed safety. However, there is no data on maternal hemodynamic responses to such therapy. We evaluated 15 patients undergoing sq TBT therapy (O.25mg q 1 hr x 5) followed by oral therapy (5mg q 4hr) with noninvasive hemodynamic monitoring prior to, during and following sq TBT therapy. Intravenous fluid therapy consisted of Lactated Ringer 125 mVhr. The groups mean maternal age was 26.9 (3.6) years, median parity was 2 and mean gestational age at admission was 30.3 (2.22) weeks. Hemodynamic parameters assessed included cardiac output (CO), thoracic fluid index (TFI), heart rate (HR), ejection velocity index (EVI), stroke volume (SV) and ventricular ejection lime (VET). RESULTS:

-fBI.Q.B PUR I N G Af.li.R ~ CO 9.03 (2.0) 12.9 (3.6) 10.9 (2.4) 0.001 TFI 19 (3.8) 20.3 (3.3) 19.4 (3.6) .022 HR 81.3 (11.7) 105.1 (7.7) 94.9 (11.0) 0.001 E V I 1.3 (0.2) 1.8 (0.6) 1.4 (0.4) .001 S V 114.4 (35) 125.3 (35.3) 116.2(25.2) 0.006 VET . 292 (.02) .281 (.02) .288 (.02) .35 • = Friedman's 2-way analysis of variance; ( ) = SD SUMMARY: The sq TBT therapy employed in this study has significant inotropic and chronotropic effects. However, sq TBT appears to have fewer maternal hemo­dynamic sequelae then intravenous beta mimetic therapy.

126 INCIDENTAL THROMBOCYTOPENIA DURING PREGNANCY: A BENIGN CONDITION. Jeffrey S Greenspoon MD, Sharon J Yee MDx, MD, Herman TYee MDx, Dept. OB/GYN, University of Southern California, Los Angeles, CA and Dept. of Pathology, Columbia University, New York.

We report the outcome for 6S women with incidental thrombocytopenia during pregnancy. During a 4 year period beginning in 1984, 37 gravidas with mild thrombocytopenia (platelet counts between 100,000 and 149,000/mm3 ) and 28 with moderate thrombocytopenia (7S,000 to 99,000/mm3 ) were evaluated with this condition. Management was routine except for serial platelet counts. In 2 of 3 cases in which a falsely low scalp sample estimate «SO,000/mm3 ) was obtained, an unnecessary cesarean section was performed. No infant had severe thrombocytopenia «SO,000/mm3 ) at birth. One woman had a fetal demise at 22 weeks; the thrombocytopenia was the first sign of the anti-phospholipid antibody syndrome (APAS) • Gravidas with incidental thrombocytopenia are not at increased risk for fetal thrombocytopenia; however, thrombocytopenia may disclose the presence of APAS. Fetal scalp sampling may not be justified for incidental thrombocytopenia.

Janudrv 1991 Am , Obstet G) newl

127 THE ROLE OF REPEAT GTT IN THE DIAGNOSIS OF GESTATIONAL DIABETES Ran Neiger MD Donald R. Coustan,MD, Brown University/Women & Infants' Hospital, Providence, Rhode Island.

The diagnosis of gestational diabetes requires that two of the four oral glucose tolerance test values be elevated. We evaluated the utility of repeating the oral GTT in patients who had only one abnormal glucose determination (Fasting~gS mg/dl, 1 hour~180, 2 hour~1SS, 3 hour~140 mg/dl). Our study population included 106 patients, average age 27.7±S.1 years, average gravidity 2.4±1.8, and parity 0.8±1.2. All patients had an abnormal screening test, performed at 27.±1.9 weeks, average value 148±14 mg/dl. On the initial GTT, performed at 30.3±2.S weeks, each had one abnormal value. We repeated the GTTs at 34.9±2.1 weeks. Thirty six patients (34%) had two abnormal glucose values on the repeat GTT and were classified as having gestational diabetes. Of the other 70 patients, 26 (37%) again had one abnormal value on their GTT,and the remainder 44 had all values normal. The ages, pre-pregnancy weights, diabetes screening test results, and the degree of abnormality of the first GTT of patients who were later diagnosed with gestational diabetes, were not statistically different from those who did not have two abnormal values on their repeat GTT. Our results indicate that the finding of one abnormal value on a glucose tolerance test denotes an increased risk for the development of gestational diabetes.

128 URINARY PROTEIN/CREATININE RATIO BEFORE AND DURING PREGNANCY IN WOMEN WITH DIABETES MELLITUS. C. Andrew Combsx, Bernadette Wheelerx, John L. Kitzmiller, University of California, San Francisco, California.

Twenty-four hour urinary total protein excretion (24-hr TP) is routinely assessed in diabetes (DM) to detect nephropathy and preeclampsia. However, 24-hr collections are inconvenient and often incomplete. Urinary protein/creatinine ratio (PCR) in a single-voided specimen has been correlated with 24-hr TP, but this method has not been validated in pregnant women with DM. We analyzed the relation between 24-hr TP and PCR in 24-hr specimens from 123 class B-RF women with DM from before pregnancy (n=33), and 1st, 2nd and 3rd trimesters (n=99, 98, 70). PCR correlated well with 24-hr TP (r=0.981, p<O.OOOI); the regression line was:

24-hr TP = 1.17 x PCR + 0.02. The relation was not affected by trimester or by preeclampsia. The standard Cockroft formula

24-hr creatinine = (140-age)(weight)/5883 did not improve the correlation because daily creatinine excretion was only weakly correlated with body weight (r=.22) and not correlated with maternal age (r=.13). Previous studies have shown that 24-hr PCR is highly correlated with PCR in single-voided urine. Our data suggest that PCR may be used to estimate 24-hr TP in pregnant women with diabetes.