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288 spa Abstracts

EVALUATION OF DIFFERENT MODES OF DELIVERY IN 1WIN PREGNANCIES WITH DIFFERENT PRESENTATIONS. Phillip Greig; Jean-Claude Veille, Linda Henderson; Department of Ob/Gyn, Bowman Gray School of Medicine, Winston-Salem, North Carolina.

Four hundred and fifty-two twin deliveries occurred at Forsyth Memorial Hospital between January of 1985 and December of 1990. Thirty-two sets were excluded from analysis because of elective repeat cesarean section, extreme prematurity and prenatal fetal demise. We evaluated twins from 25 weeks to term. All deliveries had Apgar scores recorded and 214 sets had umbilical cord gases available for evaluation. The overall cesarean section rate was 45.2%. There were 225 sets of vertex/vertex twins, 68% delivered vaginally. There were 99 sets of vertex/breech presentations, 44% delivered vaginally. We analyzed the individual and joint effects of gestational age and mode of delivery in the different twin presentations using analysis of covariance. There were no statistically significant differences in fetal outcome when Apgar scores and umbilical cord gases were compared in the different age groups between those delivered vaginally and those by cesarean section for any given twin presentation. There were 16 sets of twins with a vertex presentation/transverse lie. In 6, vaginal delivery was attempted. Three required emergent cesarean section for twin B because of cord prolapse or persistent malpresentation. None of these fetuses showed lower Apgar scores or signifICantly different umbilical cord gases when compared to the first twin or twins undergoing elective cesarean delivery at the same gestational age and pOSition. Conclusion: Our data does not support routine abdominal delivery in vertex/non· vertex twin pregnancies for any gestational age..

THE EFFECT OF OPERATIVE VAGINAL DELIVERY 011 COGNITIVE DEVELOPMENT B. Wesley, 8. Van den Berg, E. A. Reece, TeqlLe 5ch. of Medicine, Phila., Pa. and Sch. of Public Health, Univ. of Calif. at Berkeley

Forceps deliveries have been il1l>l icated in the causation of bi rth trauna resulting in long term adverse outcomes. At though many of these studies were relatively smal L containing many con­founding variables including lack of control for socioeconomic status (SES) or non-ideal corrparison groups, e.g Cesarean sections, such data have led to a decl ine in forceps use. Despite the resultant change in obstetrical practice, there is no decrease in the prevalence of neurologic sequelae in school age chi ldren. The present project was a collaborative and retrospective study between the University of California at Berkeley (Kaiser Foundation Health Plan, San Francisco) and TetTl>le University School of Medicine in Phi ladelphia. From a database of 20,000 working women who received obstetrical care, 3,590 chi ldren were randomly selected for evaluation at age 5 by the Peabody Picture Vocabulary Test and the Raven Standard Progressive Matrices. Chi ldren were stratified according to mode of del ivery and the data of each subset were further divided into lengths of hours in active labor. The data were controlled for SES status. Children weighing less than 2500 grams or less than 37 week.s gestation, or those with congenital anomal ies were excluded. Of the 3590 chi ldren, 93% were tested: 1746 delivered vaginally, 1351 delivered by forceps (low and mid) and the remainder (breech and C-section del ivery) were excluded from analysis. Standardized IQ scores of chi ldren tak.ing these tests were 50 t 10 (mean t standard deviation). There was no significant difference in IQ scores between chi ldren del ivered spontaneously or by forceps. COIICLUSIOII: These data demonstrate in a relatively large study of school age children, that the method of delivery is not associated with significant alteration of intel­l1gence guotlent. In this Llght. the general assoclatlon of for­ceps deL ivery wi th adverse neonatal outcomes cannot be supported.

Mean Test Scores: Peaboc1Y and Raven (Maternal Education> High School)

- Low-Mid Mid Spontaneous Forceps Forceps

N X N X N ii PARITY 0 132 52.18 24 52.21 59 51.87

PARITY 1+ 807 51.05 17 52.27 29 51.09

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Jan uary 1992 Am J Obstet Gynecol

PERINATAL TRANSMISSION OF HEPATITIS C VIRUS E. Leikin, J . Reinus~ H. Al ter~ S. Piazza:r .Shih 'J)Jett~ Depts. Ob/Gyn and Peds, NY Med Call, Valhalla, NY Div. GI, Albert Einstein Coll of Med, Bronx, NY Dept. Transfusion Med, NIH, Bethesda, Md

Hepatitis C virus (HCV) infection is asymptom­atic in over 75% of cases, particularly in infants and young children. In about 40% of affected ind}­viduals the source of HCV infection is unknown; vertical transmission may be responsible for some of these cases. From 7/1/89 to 7/31/91 we prospec­tively studied vertical transmission of HCV, using an immunoassay (Ortho Diagnostics, Raritan, NJ) to test 743 mothers and their babies for anti­HCV antibody. Serum from anti-HCV+mothers and cord blood from their babies also was tested for HCV nucleic acid sequences by nested polymerase chain reac tion (PCR). Anti-HCV antibody was de­tected in serum from 30 mothers (4%) and cord blood of all but 1 of their 31 babies. 11 of 18 mothers tested to date and none of their babies were PCR+. 21 of 22 infants evaluated after dis­charge from the hospital became anti-HCV- by 33 wks; the remaining child was anti-HCV+ when lost to followup at 11 wks. None of the babies with long-term followup (mean 49 wks) has had reappear­ance of anti-HCV antibody, and PCR remains nega­tive. Although anti-HCV antibody appears to be transferred passively, vertical transmission of HCV is uncommon if it occurs.

SECOND TRIMESTER OBSTETRICAL ULTRASOUND IN THE PRENATAL DETECTION OF CONGENITAL HEART DISEASE. Janet N. Scheel.' Nancy A. Callan, Gail D. Pearson,. Jean S. Kan,· Catherine A. Neill. 1I

The Divisions of Maternal Fetal Medicine and Pediatric Cardiology. The Johns Hopkins Medical School, Baltimore, MD.

To determine the effectiveness of second trimester obstetrical ultrasound (STUS) in the prenatal diagnosis of congenital cardiac malformations tCCM), we reviewed referrals for fetal echocardiography (FE) after STUS using maternally reported data from a population based studv of all infants with CCM born in our geographic area (The Baltimore-Washington Infant Study). During 1987-89, 1063 infants were born with CCM. Of these 602 (56.7%) had STUS. A total of 69 of 1063 (6.5%) had FE, 47 after STUS and 22 without STUS. Of those with CCM. 52.2% (655 of t063) had STUS but not FE. The sensitivity of STUS in detecting critical CCM (CCM readily detectable by 4-chamber view) was 12.7%. The number of pregnancies with STUS and FE by critical lesion are shown:

Critical CCM !! STUS (%) FE 1% STUSI Endocardial Cushion 87 35 (40.2) 4 (11.4) Hypoplastic Left Heart 30 17 (56.7) 2 (11.8) Ebstein's Anomaly 14 8 (57.1) 2 (26.0) Single Ventricle 10 5 (50.0) 0 ( 0.0) Tricuspid Atresia 9 6 (66.7) 1 (16.7)

This suggests. that STUS as practiced during the study period when visualization of the four chamber view was recommended, detected only a small percentage of those with critical CCM. STUS with four chamber view has not been optimally practiced as 8 screening tool for CCM. Further education of those performing STUS is required to improve prenatal cardiac diagnosis.