390 SPO Abstracts

336 OBSERVER VARIABIUTV IN THE MEASUREMENT OF KOROTKOFF PHASES IV AND V IN PREGNANCY. A. Johennina~ T. Karrison~ W. Barron~ Dept. Medicine ami Ob/Gyn, Univ. of Chicago, Chicago, IL OBJECTIVE: To determine if inter-observer variability is greater in measuring Korotkoff IV or V in pregnancy. STUDY DESIGN: Three observers, trained to measure Korotkoff IV and V using tapes and practice sessions, used a Hawksley Random Zero Sphygmomanometer and a multi­head stethoscope to simultaneously measure Korotkoff I, IV and V on 98 pregnant women (two readings each). Data were analyzed by comparing rates of nondetectable phase IV and V values among observers and using Bland-Altman plots to assess the extent of variability in detectable Korotkoff IV or V values between pairs of observers. RESULTS: Rates of nondetectable Korotkoff IV (23.±.10%) and V (23.±.3%) values were not significantly different. When considering only detectable phase IV and V values, the percentage of measurements which differed between any two observers by more than 5mmHg was similar for Korotkoff IV (22%) and V (26%). CONCLUSIONS: Rates of undetectability for Korotkoff IV and V are substantial and of similar magnitude. When considering only detectable values, there is significant inter­observer variability which is of similar degree for Korotkoff IV and V.

337 ELEVATED MATERNAL SERUM INHIBIN IN PREECLAMPTIC PREGNANCIES WITH INTRAUTERINE GROWTH RETARDATION. B!JJJm. k Kaufmgnn MJJ.., Alrlam Khalil, M.D., Jacobo WOI1sman, M.d, ·Stephen Winters, M.D'., and Deborah Williams, M.nx, Departments of Obstetrics and Gynecology and Medicille, Southern illinois Ulliversity School of Medicille, Springfield, IL and ·Departmellt of Medicille, University of Pittsburgh, Pittsburgh, PA. OBJECTIVE: Serum inhibin is produced by the trophoblast and rises throughout pregnancy to decrease rapidly after delivery of the placenta. The objective of the present study was to evaluate whether the placental damage/dysfunction of preeclampsia alters matema1 serum inhibin concentrations.

STUDY DESIGN: Serum inhibin was measured in 12 women with preeclampsia and in 31 control women matched for maternsl and gestational ages. RESULTS: Among the control pregnancies, inhibin was significantly higher in mothers of female than male infants (1.94 ± 0.85 vs 1.27 ± 0.49 nglml; p<0.005). Serum inhibin concentrations of preeclamptic mothers were higher than control mothers after adjusting for neonatal gender (2.77 ± 1.89 nglml or 1.45 ± 0.67 nglml; p<O.OOI). Preeclamptic neonates had similar gestational ages as controls but had lower birthweights (1738 ± 775 vs 2668 ± 1017 gros; p<O.02). All preeclamptic mothers with small for

gestational age infants had elevated inhibin levels (> 95'" percentile of control), while preeclamptic mothers with infants appropriate for

gestational age had normal inhibin levels.

CONCLUSION: Fetal gender is a physiologically Significant modifier of maternsl inhibin concentrations; maternal serum inhibin may be a marker for intrauterine growth retardation secondary to placental

damage/dysfunction in preeclampsia.

January 1993 Am.J Obstet Gynecol

338 MONITORED OUTPATIENT MANAGEMENT OF MILD PREECLAMPSIA REMOTE FROM TERM IS NOT ASSOCIATED WITH INCREASED ADVERSE MATERNAL OR FETAL OUTCOME. J.R. Barton? M.L. 0lson,x B.M. Sibai. University of Tennessee, Memphis, and Healthdyne Perinatal Services, Marietta. Georgia. OBJECTIVES: To test the hypothesis that monitored ambulatory management of mild preeclampsia remote from term reduces the number of days of maternal hospitalization without adversely affecting maternal and fetal outcome. STUDY DESIGN: Five hundred and eighty-seven patients at 26 to 36 weeks' gestation with mild preeclampsia were monitored on an OUlpatient basis with four times daily blood pressure measurement and daily assessment of weight, proteinuria, and fetal movemenL Maternal and fetal outcome parameters were compared to previously published results from inpatient management of mild preeclampsia. RESULTS: The mean ± SD gestational age (GA) at enrollment was 32.5 ± 2.9 weeks. The mean GA at delivery was 36.6 ± 2.6 weeks with a mean pregnancy prolongation of 28.4 ± 20.9 days which is similar to previously reported inpatient studies (Table). The mean antepartum hospitalization for all patients during management was only 1.1 days. The mean birthweight was 2863 ± 730 grams with a birthweight of <!2500 grams and ~2000 grams achieved in 66% and 82% of managed patients, respectively. Eighty-five percent of infants required a newborn hospitalization of less than 7 days. The corrected perinatal mortality rate (PMR) was 3.4/1000 total births.

Parkland UT -Memphis Outpatient (1978) (1992) (current)

Patients (n) 545 200 587 GA Enrollment (mean) unk 33.1 wks 32.5 wks

<30wks' 4.8% 11.7% 17.7% 30.32 wks' 15.8% 22.8% 23.7% 33-36 wks' 47.9% 65.5% 58.6% 37 wks or > 31.5% none none

Hospitalization (mean) 24 days 12.4 days 4.8 days GA Delivery (mean) unk 36.7 wks 36.6 wks Birthweight (mean) 2824 gms 2509 gms 2863 gms Corrected PMR 9/1000 none 3.4/1000 CONCLUSIONS: Monitored ambulatory management of mild preeclampsia remote from term reduces the number of days of maternal hospitalization without increasing adverse maternal and fetal outcome.

339 FETAL GROIITH IN PREEClAMPTIC PATIENTS. M. Y. Divan, A. Rei ss", C. E. Henderson, Albert Einstein College of Medicine, Bronx, NY. OBJECTIVE: To evaluate preec 1 ampt i c pregnanci es for the incidence of intrauterine growth retardation (IUGR) and to determi ne the associ at i on between IUGR and mean arter; a 1 pressure (MAP), protei nuri a and umbi 1 i ca 1 artery Doppler velocimetry (UADV) in these patients. STUDY DESIGN: 76 consecutive preeclamptics were compared to 762 normotensive (low risk) patients. Patients with multiple gestat; on. di abetes or chroni c hypertens; on were excluded. Preeclampsia was defined according to ACDG criteria. IUGR and large for gestational age (LGA) were defined as birthweight (BW) <IOth% and >90th%, respectively. UADV was performed within one week of del i very and quant ifi ed with the use of systo 1 i c to diastol ic ratio (5/0). RESULTS:

CONTROL (N=762) PREECLAMPSIA (N=76)

* P< 0.001 vs. controls

IUGR

4.2% 38.7%*

AGA

80.8% 51. 6%

LGA

15.0',( 9.7%

Preeclampsia had an odds ratio of 14.3 for predicting IUGR (p< 0.001, 95% confidence interval 7.5, 27.1). The 5/0 ratio for preeclamptic patients and controls were 3.45 ± 1.37 and 2.21 ± 1.02, respectively (mean ± S.D., P < 0.01). The coefficients of carre 1 at i on between bi rthwei ght percent i 1 e and MAP, 5/0 and quantity of proteinuria were statistically significant but clinically irrelevant ( 0.32; 0.4; 0.29, respectively, with p values < 0.01). CONCLUSION: Approximately 40% of preeclamptic patients deliver IUGR infants. However, there is only a weak link between the incidence of lUGR and the severity of preeclampsia as measured by MAP, proteinuria and abnormal umbilical artery blood flow.