417

412 SPO Abstracts

PREGNANCY OUTCM AMONG 101 GRAVIDAS OVER 300 POUNDS. J.D. IsaacsX, E.F. Magann, R.W. Martin, S.P. ChauhanX, G.R. ReeksX, J.C. Morrison. Dept. Ob/Gyn, University of Mississippi Medical Center, Jackson, MS. OBJECTIVE: To examine the effects of maternal megobesity (> 300 lb) on pregnancy outcome, specifically its association with medical disorders, mode of delivery, postoperative complications, and neonatal outcome. STUDY DESIGN: In this retrospective, descriptive study, women weighing> 300 pounds delivering from January I, 1986 to November I, 1991 were matched for age, race, parity, and height with parturients who weighed < 200 pounds (160 + 21). These women were delivered during the same time i merva 1, by the same team of provi ders, and under similar medical circumstances. The groups were assessed for the medical complications of pregnancy, mode of delivery, indication for abdominal delivery including operative blood loss, length of labor, membrane rupture, incidence of postoperative wound infections, and neonatal outcome. RESULTS: Among megobese women there was a greater incidence of hypertension (p < 0.05) and diabetes mellitus (p < 0.05) compared to the control group. Mean birth weight was greater in the megobese group than controls at similar gestational ages (p < 0.05). Primary cesarean sections were more frequent (p < 0.05) as were the postoperative complications of endometritis and wound infection when megobese patients were compared to lean women (p < 0.05). The postpartum hospital stay was significantly longer in the study group than among control women (p < 0.05). There were no significant differences in the incidence of preeclampsia, urinary tract infection, preterm labor, and neonatal outcome between groups. CONCLUSIONS: The megobese parturient's gestation is more frequently complicated by hypertension and diabetes mellitus. Delivery is more likely to be by the abdominal route and thi s surgery is more frequently followed by endometritls as well as wound infection, resulting in a prolonged hospital stay.

418 FETAL SCALP PLATELET SAMPLING IN mE OBSTETRICAL MANAGEMENT OF IDIOPAmlC mROMBOCYTOPENlC PURPURA (lTP) PREGNANCIES S. Hunter, D. MerriU, C. Weiner. Dept. Ob/Oyn,

Univ. of lowI, Iowa City IA.

OBJECTIVE: Fetal .. alp platelet (FSp) .. mpli", i. commonly uood to predict

neonatal platelet countl (NPC) and to detennine the route of delivery (CIS for

FSP <50,(00) in pregnaneie. complicated by ITP. The objective ofthi. atudy

was to determine the predictive value of FSP with respect to the NPC and the

usefulnea. of this data in formulating obstetrical management.

STUDY DESIGN: 20 ITP complicated pregnaneie. were ineluded. FSP were

determined after rupture of membrane. in all CISCI. Route of delivery was

detcnnined based on FSP fCllUlta. NPC wa. determined immediately after birth.

RESULTS: Of the 20 FSP performed, 3 clotted, precludi", accunte

•• scoment. Of the remaining 17 casel, there was • significant but poor clinical

correlation between FSP and NPC (NPC = 574 (FSp) + 128952; P= .03, R2 = .23). However, there was no correlation betwccn FSP and NPC for those

with FSP < 50,000 (p= .11, R2 = .27). The positive predictive value of FSP

<50,000 in predicting NPC <50,000 was 50% (4 of 8). The negative

predictive value of a normal FSP (>50,000) to predict a "normal" NPC

(>50,000) WI. 100% (9 of 9). CIS was chooen as the route of delivery for

prelUmed DeOl1I.tal thrombocytopenia in 7 of 8 casci. CIS wal needlessly

performed in 4 pregnancies (57%). NPC ranged from 192,000 to 367,0000 in

these cales. No neonatal hemorrhagic complications occurred in the 20 calles.

Significant maternal morbidity occurred in two CIS caael requiring bilateral

hypogastric artery ligation and cesarean hysterectomy respectively.

CONCLUSIONS: I) FSP did not reliably predict neonatal thrombocytopenia 2)

CIS performed for presumed neonatal thrombocytopenia resulted in lignificant

maternal hemorrhagic morbidity.

419

January 1993 Am J Obstet Gynecol

DlsllnguIshIng ctvonlc RP From GesIaIIonaI RP In thrombocytopenic Pregnant Woman Lascgle K, Bussel, Jo', Eddleman, K .. Cines, Do', Samuels. P. The N_ York HospHal-Cornell MedICal center and The HospHal 01 The University ot Pennsylvania, New York, NY and Philadelphia, PA.

0bjec:IIvII: the oblectlve ot the study was to attempt to distinguish gestational ITP (G-ITP) from chronIC ITP (C-ITP) based on platelet anllbOdyassays In a collaborative experience as listed beloW. Study DesIgn: Sera from pallents wHh presumed G-ITP(n=l60) (asymptomallc. no prior history, platelets" lOOK) and C-ITP(n=90) were analyzed for platelef associated IgG (PA-lgG), platelet aSSOCiated IgM (PA-lgM). platelet associated C3 (PA-C3). and Indirect IgG(I-lgG). Resulb: PA-lgG PA-C3 PA-lgM HgG

Pallent

C-ITP 6.8 2.3 2.5 5.7 n=90 .12.5 .2.4 .4.0 .4.8

(n=80) (n=64) (n=56) (n=85)

G-ITP 5.3 4.2 4.0 3.4 n=160 .8.2 .7.2 .5.8 .4.6

(n=156) (n=103) (n=123) (n=129)

p value' .282 .576 .058 <.001 (*Kruskal-WaUls one-way analysis)

ConclusIonS: PA-lgM values approached stallstlCal slgnillcance and 1-lgG values were significantly different between the two groups. G-RP may be a resuH 01 platelel activation wHh nonspecHIC attachment of anllbOdy to the platelets. This explains the Increased levels of PA-lgM and the decreased levels of Indirect IgG In G-ITP.

420 A CASE-CONTROL STUDY OF LONG-TERM TERBUTALINE THERAPY AND PERIPARTUM CARDIOMYOPATHY. ..l Hibbard. Dept. Ob/Gyn, Univ. of Chicago, Chicago, IL OBJECTIVE: We have previously described 15 cases of peripartum cardiomyopathy documented by clinical and ECHO criteria, of whom 4 had received long-term terbutaline therapy. Therefore a case-control study was designed to further explore the significance of this observation: specifically is long-term terbutaline therapy for preterm labor positively associated with subsequent development of peripartum cardiomyopathy. STUDY DESIGN: Controls for the 15 patients with cardiomyopathy were chosen by computer generated random patient unit number selection from all deliveries occurring in the same time period (1985-91). Medical records were reviewed to determine exposure to terbutaline, other tocolytics, as well as potentially confounding factors. An odds ratio and 95% CI was calculated for terbutaline exposure; data was stratified and an adjusted odds ratio and 95% CI calculated for potentially confounding variables. RESULTS: While 4 (26.7%) of the original 15 cases had been on long-term terbutaline therapy, only 3 (5.0%) of 60 controls were, OR 6.91 [1.09-47.04] (p=0.026). The only confounding variable was smoking, OR 6.90 [1.15-90.07] (p=0.035), with more smokers in the cardiomyopathy group, but fewer smokers on long-term terbutaline in both groups. CONCLUSIONS: These data suggest that long-term terbutaline therapy may be associated with subsequent development of peripartum cardiomyopathy, and the need for further investigation of this complication.