316

332 SPO Abstracts

THE RELA TK>NSHIP BETWEEN UMBILICAL ARTERY DOPPLER VELOCIMETRY AND FETAL BIOMETRY. Wjlljam E Scorza MD,

Deborah Nardi, RT,RDMSx, Anthony M. Vintzileos, MD, Alfred D. Fleming, MD, John F. Rodis, MD, Winston A. Campbell, MD. University of Connecticut Health Center, Farmington, CT

The relationship between peak-systolic to end-diastolic (SID) ratio of the umbilical artery waveform and fetal biometry was studied in 127 uncomplicated pregnancies with certain dates between 20 and 40 weeks gestation. At each ultrasound examination fetal biometry included measurement of the biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). The SID ratio was measured by either a continuous or a pulsed-wave method. There were significant linear negative correlations between each biometric parameter, as well as the ultrasound estimated fetal weight (EFW) and SID ratio . A significant negative correlation was also found between gestation age and SID ratio. Of the individual ultrasound parameters the femur length (for gestations less than 30 weeks) and the AC (for gestations 30 weeks or greater) were found to be best correlated with the SID ratio. Regression curves including the tenth and the ninetieth percentile were developed between each biometriC parameter (BPD, HC, AC, and FL), as well as EFW, and SID ratIO. DUring the study penod, 25 IUGR fetuses were encountered (EFW <-2SD from the mean for gestational age); 23 of these 25 IUGR fetuses had present end diastolic velOCities. The sensitivity of detecting growth retardation by using the BPD vs SID nomogram was 35% (S of 23), head circumference vs SID 35% (S of 23), abdominal circumference vs SID 35% (S of 23), femur length vs SID 30% (7 of 23) and estimated fetal weight vs SID 4S% (11 of 23). The sensitivity by using the gestational age versus SID ratio nomogram was 52% (12 of 23). These nomograms should prove most useful in assessing downstream placental vascular resistance in high risk patients With unknown dates.

317 DOES FETAL DOPPLER FLOW STUDY HAVE AN EFFECT ON BIOPHYSICAL ACTIV lTY? Nanette B Okun, MD*, Susan McFaul, MD,' Carl Nimrod,MB. Division of Maternal Fetal Medicine, Ottawa General Hospital, University of Ottawa, Ottawa.

It had been informally observed in our unit that fetal activity appeared to increase after Doppler flow exams (DFE). Because of the possibility that this represented a possible bioeffect of this higher energy ultrasound, this hypothesis was formally tested. 45 patients between 32 and 42 weeks gestation,whose biophysical score was 8/8 and whose fetuses were appropriately grown consented to enter the study. A Seimens Sonoline SL-2 ultrasound unit with a 3.5 MHz. pulsed Doppler transducer was employed . Gross body movements were counted for an initial period of 15 minutes. DFE of I minute duration was performed on the descending aorta of 15 fetuses, and of 3 minutes duration on 30 fetuses. Gross body movements were then counted for 15 more minutes . All exams were videotaped and reviewed by the same examiner. There was no significant difference in number of gross body movements (two tailed t-test) in the 15 minute period before and after either a I or 3 minute DFE. Neither was there a difference when the immediate 5 minute window before and after the DFE was considered. This study demonstrates that fetal activity is not altered by doppler study.

318

Januan 1991 Am.J Obtet (;vneco l

EFFECT OF ASPIRIN AND PREDNISONE ON' UMBILICAL AND UTERINE ARTERY BLOOD FLOW IN

PATIENTS WITH ANTICARDIOLIPIN ANTIBODIES I FO[Quzan MOX, GM Jackson MD, AW Cohen MD, P Samuels MD

University of Pennsylvania Medical Center, Philadelphia PA

Anticardiolipin antibodies (ACA) are an alleged cause of poor pregnancy outcome and uteropfacental insufficiency. We studied 15 patients with a history of pregnancy loss and a positive plasma AC~ .who were treated with prednisone (15 to 40 mg/day) and asplnn (SO mg/day) thoughout pregnancy. Doppler velocimetry was performed at 2-3 week intervals from 20 weeks to delivery. At all gestational ages, the umbilical and uterine sy1olic/diastolic (SID) ratios of this group were not different from the SID ratios established in our normal control group (n-200). The correlations of umbilical and uterine SID ratios with gestational age were not sign~icantly different between our treated and control populations (Z.0.34, Fisher'S Z transformation).

~ 20-24 25-2B 29-32 33-36 37-40

ACA 1lml2ibI

3.S±.2 3.S±.2 3.2±.2 2.S±.2 2.2±.1

SID Treated

UWio.i 1.9±.1 1.8±.1 1.7±.2 1.6±.2 1.6±.1

Ratios Normals ~ lliIiM 3.9±.2 1.9±.2 3.B±.4 1.9±.3 3.1±.1 1.7±.2 2.7±.3 1.6±.2 2.1+.2 1.7±.2

Among these treated pregnancies, there were no adverse pregnancy outcomes. We conclude that patients with ACA and a previous pregnancy loss who are treated with prednisone and aspirin have umbilical and uterine SID ratios no different from a normal population. The contribution of each component of therapy requires further investigation.

319 DOPPLER VS. NST IN ANTEPARTUM fESTING Mark CainK MDa Trudy Pelusi RN BSN , Nawar Hatoum MD , A a Dwens BA MAX Dept. Ob-Gyn, Western Pennsylvania Hospital, Pittsburgh, PA

The role of doppler wave form analysis in antepartum testing is not well defined. In 288 pregnancies we 2ros~ectively compared the Non Stress Test (NST) w1th umbilical artery continuous wave doppler. Decision to deliver was not based on doppler results. A reactive NST was defined as 2 accelerations >15 BPM for 15 seconds. SiD ratio >3.0 was defined as abnormal. Mean delivery age was 37 wks, range 28-43 wks. The last test lNST <7 days and doppler <21 days from delivery)-was analyzed. Outcome parameters included were NICU admission >7 days (NICU), APGAR 5 min. <7 (APG<7), <5th and <10th percentile, fetal distress (FD), perinatal mortality. Sensitivity, specificity, positive predictive valve (PPV) ana negative ~redictive valve (NPV) were analyzea by Ch1 square. RESULTS: Doppler had better sensitivity for' <Sth% (40.37. vs 11.37.) P<.OOl, <lOth7. l33.7% vs 9.97.) P<.OOl, NICU (46.37. vs 20.87.) P<.Ol, FD (43.47. vs 15.17.) P<.Ol. NST had better PPV for APG<7 (207. vs 8.67.) P<.OS & NICU (737. vs 43.17.) P<.05. Specificity tended to be better for NST (95-987. vs 81-877.) and NPV was equal. CONCLUSION: Doppler is a better predictor of IUGR & can determine a greater proportion of compromised fetuses (sens). The abnormal NST is more accurate (PPV), but misses many compromised fetuses. The NST tends to be better in predicting health (spec), but both are reassuring when nl (NPV). We recommend the use of both antepartum tests.