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157 MATERNAL PLASMA CORTICOTROPIN RELEASING HORMONE

LEVELS IN LABOR. Sharon L. Patrickx, Wendy B. Warren,

Robin S. Golandx, Columbia Univ. Coil. of P&S, NY, NY. The placenta secretes large amounts of corticotropin

releasing hormone (CRH) into the maternal and fetal plasma. Maternal plasma CRH levels rise during the latter half of pregnancy with a sharp Increase 6 weeks prior to parturition. Placental CRH may playa role in mechanisms of labor, fetal maturation and adaptation to stress. There is evidence from i..n.:rilJ:.Q. studies that glucocorticoids and oxytocin stimulate placental CRH release. We investigated whether the stress of labor altered placental CRH secretIOn In addition, we characterized the effects of exogenous oxytocin infusion on maternal CRH. CRH was extracted from plasma and measured by RIA uSing an anti-human CRH antibody raised in our laboratory CRH was measured in 8 women in latent labor (cervical dilatation <3 cm) and active labor (>5 em). The mean maternal CRH concentration of 2243 ± 341 pg/ml in latent labor was not Significantly different from the levels In active labor, 2618 ± 486. CRH concentrations in an additional 3 women were unchanged after 3 hours of pllocin infusion (baseline, 1856 ± 378 pg/ml vs 2198 ± 526 after pitocln). In conclusion, we have shown that maternal plasma CRH does not rise during spontaneous labor. In addition, oxytocin administration in the dose and time period studied was not associated with a change in CRH levels Further study is thus needed to evaluate the in:YiYQ. regulation of placental CRH.

158 CA-125 LEVELS IN AMNIOTIC FLUID OF NORMAL VERSUS DIABETIC PREGNANCIES Robert Silverman, Shiraz Sunderji, Richard Oatesx • State University of New York Syracuse.

High levels of CA-125, a cytosolic glycoprotein, have been reported to exist in amniotic fluid. The amnion, chorion, and decidua are suggested to be the sites of production. At the subcellular level, cytosolic production predominates with a smaller contribution from the microsomal compartment. The present study is designed to investigate amniotic fluid levels of CA-125 in normal pregnancies versus pregnancies complicated by insulin requ~r~ng diabetes mellitus. Diabetes was selected as the study group since it presents a disturbed metabolic milieu. Amniotic fluid was obtained from transabdominal amniocentesis for standard clinical indications (n = 122). Assay was carried out using immunoradiometric methods. Results of the study indicate that the level of CA-125 was significantly lower (p < .05) in the diabetic versus the normal pregnancies, using an analysis of variance. The clinical utility of CA-125 levels in amniotic fluid awaits definition. However, in pregnancies where disorders of intracellular metabolism exist, this measurement may prove useful.

SPO Abstracts 29

159 ON-LINE COMPUTER SYSTEM FOR A FETAL ULTRASOUND UNIT Kirk JS, Blelman CJx, Turner DAx, Wlckenhiser LMx, Lee W, Comstock CH. DIV Fetal Imaging, Dept. OB-GYN & Dept. Inform Services, William Beaumont Hospital, Royal Oak, Michigan.

OBJECTIVE To develop a rapid on-line computer system for a fetal u~rasound Unit where 10,000 scans are performed annually METHODS' The system was deSigned by the ultrasound physicians together With a dedicated data processing team uSing software from Cognos corporation. Terminals were installed in each hospital exam room, In the phYSICian workrooms, in the scheduling office, and in satellite site exam rooms Personal computers (IBM and Macintosh) served as direct line terminals In physician and secretanal offices (The system can also be accessed by remote personal computer via modem.) USing data over voice lines, data was sent to a Hewlett Packard 3000 minicomputer RESULTS: Sonographers review patient Information entered by the scheduler, and they enter measurements and anatomy at time of exam Means and percentiles for gestational age are computed Other screens are available for amniocentesIs, echocardlography, long bones, etc. Help screens list findings that may be seen With teratogenic medicaliOns or infections At her/hiS terminal, the phYSICian reviews entnes by the scheduler and sonographer, enters comments, and prints a report Emergency patients have a report on the chart as they leave the unrt. Abnormal findings are marked by a database label for later retneval. There is on-line research ability to search by hiStOry, gestational age, measurements, anatomy, or database labels Graphics ability allows us to plot, for example, the estimated weights of qUintuplets over gestation The system tracks insurance, billing codes, and time spent on each exam An up to the minute pnntout can show number of dally charges, no shows, amniocentesIs, and referrals per attending. CONCLUSIONS' The multi-user, on-line computer system for fetal Imaging Integrates pallent care With research, scheduling, billing, and referral and time effiCiency analYSIS

160 STATE-WIDE COMPUTER-GENERATED RISK ASSESSMENT TO IDENTIFY PATIENTS FOR COORDINATED CARE. K. Johnsonx, C.J. Hobel, C.J.Kenne/, C. Dal, L. Chan Hox, J.E. Deaver", I.R.Merkatz. UCLA, Cedars-Sinai Medical Center, Los Angeles, CA, Albert Einstein College of Medicine, Bronx, NY, and Department of Health and Human Resources, Charleston, WV

The "Right From The Start" program in West Virginia coordinates the allocation of state resources for the care of 8,000 Medicaid-eligible pregnant women annually. The POPRAS III prenatal record had been adopted state-wide to uniformly collect patient information A prenatal information management system was then installed which included computerized risk assessment algorithms to implement the judgement of a clinical expert. The algorithms recognize the multi-factorial nature of risk and that its antecedents and outcomes are multi-dimensional. POPRAS intake data is entered in computer systems at eight regional sites. The algorithms determine initial risk based upon integration of the antecedent factors documented in the prenatal chart The computer generates a letter, in natural English format, to primary physicians detailing the relationships of these risk variables. Patients determined by the computer system to be at highest risk are referred to a care coord inator who plans services and longitudinal follow-up. A computerized data quality assurance program detects data inconsistencies and missing items. Future plans include longitudinal risk assessment, computer generated care plans, and linkage to state-wide outcome databases.