312

Volume 166 Number I, Part 2

_IOIIIC FLUID INDEX AIID PREGIIAIICY OUTCOIE IN PATIENTS IIITH PREMATURE RUPTURE OF THE IlEMBRANES. M.Hussey·, N.Carlson, R. Besinger, J.Gianopoulos, loyola Univ. Med. Ctr., Maywood, ll.

Retrospective analysis of 127 singleton pregnancies with premature rupture of metTtlranes (PROM) between 25 and 35 weeks gestation was performed. Patients included presented within 72 hours of rupture and had no evidence of labor, infection, bleeding or fetal distress. Patients who received tocolysis or corticosteroids were excluded. Patients were divided into three groups based on th~ir four quadrant anniotic fluid index (AFl) at aanisssion. CoqJl ications and outcome (severe varhble decelerations (SVAR), armionitis, latency period, 1 and 5 minute Apgar scorus tess than 7) were corrpared. There was no difference in incidence of cesarean section (CIS), birth weight or perinatal mortal ity.

GROUP P GROUP 2 P GROUP 3 p (1,2) (2,3) (1,3)

AFI (CM) < 4 ~4,<8 ~ N 59 52 16 (X) (46.5) (40.9) (12.6) LATENCY 1.6±.16 ~.01 3.0±.58 ~.01 14.6± ~.01 (DAYS) 1.6 SVAR 23.7% ~.005 7.7% ~.005 0 ~.005

CIS 49.2X NS 32.7% NS 37.5% NS AMNION' ITIS 18.6% NS 11.5% <.01 <.01 1 MIN APGAR<7 52.5X ~.005 9.6X ~.005 0 ~.005 5 MIN APGAR<7 8.5% ~.005 ~.05 ~.005

Conclusion: Initial AFI in patients with preterm PROM is predictive of unfavorable pregnancy outcome as defined by shortened latency period, severe variable decelerations during labor, arrnfonftis, and low 1 and 5 minute Apgar scores. CIS rates were increased in all groups.

313 DOES "IDIOPATHIC PRETERM LABOR EXISn"~, A. Vintzileos, M. Albinix, M. Martinsx, C. Salafiax, J. Mead, Univ. of CT Hea~h Center, Farmington, CT.

Williams Obstetrics (18th Edition) states: "In the majority of instances, the precise cause or causes of labor before term are not known: In an effort to elucidate possible causes of preterm labor, we undertook a prospective study of all patients with a singleton pregnancy (23-36 weeks) admitted with preterm labor and intact membranes requiring tocolysis. A comprehensive evaluation plan was instituted including a detailed history and physical examination, targeted ultrasound, amniocentesis for gram stain, culture and glucose, laboratory analysis for infection (CBC, C-reactive protein, urinalysis, cervical, urine cu~ures) and for anti phospholipid antibody syndrome (ANA, LA, ACA), pathological examination of the placenta, urine toxicology screen and a 12 week postpartum hystero­salpingogram. Thirty consecutive patients who eventually had a preterm birth constitute the focus of this report. The mean gestational age at admission was 29.3 weeks and the mean cervical dilatation was 2.8 cms. The following possible causes of preterm labor were identified: intrauterine infection 14/30 (47%), faulty placentation (abruptio/previa) 12/30 (40%), immunological 10/30 (33%), uterine (uterine anomalies, hydramnios) 6/30 (?Oo/~), ce~ical incompetence 5/30 (17%), maternal (systemic Infection, preeclampsia, drug intoxication, etc.) 3/30 (10%), fetal anomalies 2/30 (7%). trauma/surgery 1/30 (3%) and idiopathic 1/30 (3%). Of the 30 patients, 17 (57%) had 2 or more possible causes, 12 (40%) had one cause and. only 1 (3%) had no cause identified. As compared to other causes, cervical incompetence and intrauterine infection were associated with a lower mean gestational age at admission and delivery (ANOVA, p<.05). Pregnancy prolongation, gestational age at admission and delivery, birthweight and Apgar scores were not different between patients having one vs. two or more possible causes. We suggest that an exhaustive evaluation can identify possible causes in the overwhelming majority of "idiopathic" preterm labor.

314

SPO Abstracts 363

IIEST LOS ANGELES PRETERM BIRTH PREVENTION PROJECT (LAPPP):

PROGRAM IMPACT. C.J. Hobel, M.G. Ross, R.L. Bemisx , J.R.

BragonierX , M. Bearx, B. Morix, Dept. Ob/Gyn, Cedars~Sinai Ked. Ctr. and Harbor-UCLA Med. Ctr., Los Angeles, CA.

The LAPPP is the fi rst prospective randomi zed controlled

triaL using a risk scoring system derived from the same population to test education (ED) plus selected interventions. Eight West LA cl inics were randomized to form 5 experimentaL (EXP) and 3 control (CTL) cl inics. From Sept. 1983 to Dec. 1988

2084 high-risk patients in the EXP cl lnics received a program of special ED and frequent visits and each were randomized to a selected intervention (bed rest, psychosocial counsel ing, oral Provera, a matched placebo and an internal control/special ED alone). There was an 18.8% reduction in preterm births «37 wks) in the EXP cl inics vs. CTL cl inics [7.38% vs. 9.09%

(p=O.063)]. None of the selected interventions had an effect greater than the internal control/special education alone. However, high-risk patients receiving bed rest had the lowest rates for very low preterm bi rths [<31 wks (p=0.074)1. ~e

bel ieve that the 18.8% reduction in preterm births is due to the overall program effect of special education, frequent visits and the greater attention given patients While applying the selected interventions. Even though the statistical evidence is borderl ine, the interpretation of these findings should be judged on cl inical and biological plausibil ity and cost

effectiveness (see Abstract: Ross, et. al.). Supported by State

of California Dept. Health Services, Maternal Child Health

Branch.

315 EFFICACY AND SAFETY OF RITODRINE WITH INTRAVENOUS OR INTRAMUSCULAR ADMINISTRATION. Steve N. Caritis. M.D .. Karen Leonhard, R.N.X, Peggy Cotroneo, R.N.', Jye Ping Chiao, M.S.x, University of Pittsburgh, Magee-Womens Hospital, Pittsburgh PA

Ritodrine is equally effective in treating preterm labor whether administered intravenously or intramuscularly (Gonik, et al AlOG 159:323, 1988). The two regimens, however, have not been specifically compared in regards to side effects particularly when the dcsing regimens are kinetically optimized. We compared these two regimens in 83 pregnant women in preterm labor. The dosing regimens were based on kinetic data in pregnant women. (AlOG 162, p. 429 and 1215, 1990) Significantly, fewer women experienced one or more side effect (SE) with the intramuscular regimen than with the intravenous regimen (p<O.OO4). Efficacy was comparable in the two groups

I.M. I.V.

SUBJECTS 44 39

With chest pain 2 7

With shortness of breath 5 2

With vomiting 3 6

With heart rate > 130 bpm 6 18

With diastolic BP <40mmHg 12 18

With 1 or > of above SEs 18 (41%) 29 (74%)'

With failed therapy 16 (36%) 16 (41%) l.M. admInistratIOn of ntoonne 0 ers advanta es over I. V. g