276

322 SPO Abstracts

VITAMIN B6 FOR NAUSEAxAND VOMITING QF PREGNANCY. Sahakian, V. , Rouse! D.J. , Rose, N.B. x and N;ebyl~.R. Unlversity of Iowa Hospitals and Clinics, Iowa City, lA.

Fifty-nine women completed a randomized prospective double-blind placebo-controlled study of pyridoxine HCl [vitamin B6] in the treatment of nausea and vomiting of pregnan­cy. A visual analog scale for grading nausea on a scale of 1 to 10 and the number of patients with episodes of vomiting over a 72 hour period were used to evaluate response to therapy. Thirty-one patients received vita­min B6, 25 mg tablets, orally, every 8 hours for 72 hours and 28 patients received placebo in the same regimen. Patients were cate~o­rized as to whether they had vomiting epl­sodes, severe nausea [score> 7], or mild to moderate nausea [score ~ 7].

No. pts.

Mean score

Pre Post

B6 Placebo P value VomITing episodes - --

15 10 NS 8 15 < .05

Nausea severe Nz12 N=10

Pre 8.2 ± 0.8 8.7 ± 0.9 NS Post 4.3 ± 2.3 6.8 ± 2.0 <.01

The number of patients with vomiting episodes and the mean nausea score in patients with severe nausea were significantly reduced. In patients with mild to moderate nausea, no significant difference was observed.

277 MID-SECOND TRIMESTER LABOR INDUCTION: CONCEN­TRATED OXYTOCIN AS COMPARED TO PROSTAGLANDIN E2 VAGINAL SUPPOSITORIES Carey L. Winkler, M.D., Samuel E. Gray, M.D. x, John C. Hauth, M.D., John Owen, M.D. x

, J. Martin Tucker, M.D. University of Alabama at Birmingham School of Medicine and Hospitals, Birmingham, Alabama

A concentrated oxytocln infusion and prostaglandin E2 (PGE 2 ) vaginal suppositories were compared in a retrospective analysis for abortion in the mid-second trimester (17 to 24 weeks gestation). Eighty-one women underwent second trimester pregnancy termination, 59 by PGE 2 suppositories and 22 by concentrated oxytocin infusion. Prostaglandin E2 was successf ul in 93% (55 of 59) and oxytocin in 91% (20 of 22). The mean duration of labor was 13.1 hours with PGE 2 and 8.2 hours with oxytocin. The mean dose of PGE 2 was 65.2mg; of oxytocin, 200 units. Women who received PGE 2 experienced nausea (46%), vomiting (37%), fever (64%), and diarrhea (20%) despite appropriate prophylactic premedication. Essentially, no side effects occurred in the women treated with oxytocin. We conclude that concentrated oxytocin lnfusion seems to be a reasonable alternative to PGE 2 vaginal suppositories for the induction of labor in the mid-second trimest er.

JaIman 1991 Am J Obstct G)necnl

278 TERBUTALINE TOCOLYSIS AND MATERNAL GLUCOSE INTOLERANCE: ORAL VS. SUBCUTANEOUS ADMINISTRATION Anne C Re~enstein M 0, Karen Huntley, R.N.X, MiChael Katz, M.D., UCSF, San Francisco, CA

The chronic administration of oral terbutaline is associated with an increased incidence of maternal glucose intolerance. Whether the continuous subcutaneous infusion of terbutaline is associated with the same degree of glucose intolerance has not been addressed. An analysis of glucose testing on women receiving either, subcutaneous, oral or no terbutaline, was therefore undertaken. Patients with preconceptional diabetes, gestational diabetes, recent (within 72 hours) treatment with betamethasone or those receiving other beta-mimetic therapy were excluded. A significantly grealer maternal weight was observed among the control patients when compared to the subcutaneous treatment group. The frequency of a family history of diabetes was higher in the conlrols as compared to those receiving terbutaline orally. Gestational age at the time of test was less in the control group then either the oral or subcutaneous groups. Results of the one hour SOg glucose tolerance test (GlT) and 3 hour loog GTI are as follows:

Control Oral Subcut. N S9 22 21 Gest. Age (wks) 26.S· 28." 29" I br glucose IIS .9· 13S.6* 129.8 Abo' brGTI IS.3% 36.4% 33.3% Abo 3 brGTI S.2% IS.8% 10.0% As expected patients 00 oral terbutaline had higher glucose concentrations one hour after a SOg load as compared to controls (p<.05 by ANOVA with Scheffe F-test). The number of women WIth an abnormal one hour GTI on oral therapy approached significance (p=.068 by Chl­Square). The values for the subcutaneous group rell between the conltol group and 1he oral treatment group, but did suggest a trend toward glucose intolerance. Patients who exhibit glucose intolerance whIle receIving oral terbutaline may benefit from a switch to another tocolytic agent or the subcutaneous route of administration. At this juncture we recommend a GTI for patients receiving terbutaline chronically, Irrespective of the route of administration.

279 Rille FNAmS RE 9Il.I.DR IJYSIOCfA IN DIAJEITC mnwa. !1.u'k Blandon MD, Kian fuhOOkht MJ}r.', Michael Wa=*, Steven G Gabte MD. The Chio State l.hlver-si ty Hospitals, Columbus, ClIio.

The frequency of shoulder dystocia (SO) is believed to te increased in diabetic 1>UJ]ffi, although few studies haVE: exam:i.ne::I the tiS< factors for this ccmplication. We therefor-e reviPWed records of 183 diatet ic (IN) l.aI8l

who delivenrl vaginally aIId cCl!lJ:E1'ed them with 549 non-illatet i c patients rratched for birt:m.eighL. The incidence of SD was markedly increased in LM 24/183 (13%) vs non-IN 13/J49 (2%) p<.C01, orlds ratio 6.22. The r elative ris< f0r SO bec-aIIE signifi cantly greater for IN when birt.m-eight exceeded 3W g)11. The frequency of SD in IN >4ffi) g)11 was 45% canpared to 9% in non-IM (P<.COI, cdds ratio 8 .33). Two cases at bradri.al ple-'{tJs injury occurre::i in the LM group canpare::i to none in non-iliatetic patients. Instl1.illHltal dell very (cdds ratio 8.7) ann prolonge::i second stage (cdd ratio 4.2) significant.Ly increa:;e::i !'is< for SD in only non-diatetic (ELimts. SD occura:! i n 12/ 124 (9. 7%) LM vs 4/ 4?h (0.9) non-LM (ELi mts without t..hef'e ris< fac tors (p<.OJI). Conclusions: 1) Traditional risk factors (IfEcrosarri.a, insLl1.illHltal delivery, prolonged sff:ond stage) are far less predictive for shoulder dystrcia in di atetic pregnancy than in non-iliatetic v.aren. 2) Cesarean nelivery should be strongly considera:! for di abetic pat ient.s whm fetal \.eight is telieva:! to exceed 4rrf)

gm.