Volume 164 l\umher 1. Pdrt 2

5 TWIN TO TWIN TRANSFUSION SYNDROME: ROLE OF DOPPLER FLOW AND FETAL HYPERVISCOSITY IN PREDICTING OUTCOME. Abraham Ludomirski, Stuart Weiner, Frank Craparo, Vinod Bhutani. Section on Maternal-Fetal Medicine, Pennsylvania Hospital, Philadelphia, P A.

Twin to twin transfusion syndrome is a critical complication of monozygote multiple pregnancy and carried perinatal mortality rate up to 70%. 15 such pregnancies had been studied by fetal blood sampling of both fetuses, blood was analyzed for: hematocrit (Hct%), total serum protein, albumin (alb, g/dl), whole blood viscosity (Visc, Ct) and systolic/diastolic ratio of the umbilical artery blood flow. Immediate postnatal survival was evaluated - I: Paired (p: 5115), II: Donor (D: 12/15) and III: Recipient (R: 7/15). Mean values for donor and recipient are presented for each as survivor and non-survivor.

PAIRED Surv (D/R) Non (D/R)

GA 30 29 Hct 27/38 22/53 Alb 1.3/3.1 1.0/3.6 Visc 3.4/4.2 2.3/6.6 SID 3.414.2 3.7/4.6

DONOR Surv Non 29 29 25 11 1.1 0.7 2.8 4.4 3.6 4.2

RECIPIENT Surv

30 42 3.2 4.7 4.2

Non 28 52 3.6 6.6 4.4

Increased values of recipient viscosity are demonstrated in non­survival (p<O.OOI) when logistic regression model was used, survival rate was dependent on recipient viscosity rather than gestational age. Viscosity gradient of .::;.3 was predictive of paired survival (pos pred: 71 %, neg pred: 100%). Recipient survival was dependent on viscosity .::;.5.0 (pos pred: 86%, neg pred: 100%). Significant increased (p<O.OI) values of donor SID ratio are demonstrated in non-survival. These data emphasize the predictive value of fetal whole blood viscosity and SID ratio in evaluating twin to twin transfusion syndrome.

6 THE BIOPHYSICAL PROFILE IN PATIENTS UNDERGOING CERVICAL RIPENING BY PGE2 PRIOR TO INDUCTION OF

LABOR. Amon E Fossick KX, and Sibai BM. University of Tennessee, Memphis 38163.

The purpose of thiS study is to evaluate the biophYSical profile (BPP) components in patients undergoing 12 hours of cervical ripening with a controlled release vaginal pessary containing 10 mg of PGE2 designed to release drug at 0.8 to 1 mg per hr. The study group included 17 nulliparous women at ~38 wks. gestation, with a Bishop score of ";4, requiring a medically indicated induction of labor. The BPP was performed by the same sonographer at three intervals; prior to pessary IOsertlon, at 6 hr., and at 12 hr. None of these patients had membrane rupture or went into spontaneous labor during the npenlOg process. All patients subsequently required a formal Induction of labor with oxytocin. The proportion of patients receivlOg 2 points for individual BPP components durlOg the 12 hour period are summarized in the following table.

o hr. 6 hr.

12 hr.

Tone 100%

88% 88%

100% 65% 25%

Pf Breath 88% 59% 88% 6% 88% 0%

NST 100% 100%

94%

Conclusions: Fetal breathing movements and fetal body movements significantly decreased during cervical ripening with PGE2. However, the fetal heart rate panero remained reactive. The clinical significance and underlying pathogenesis of these findings require further evaluation.

spa Abstracts 243

7 CORONARY ARTERIAL FLOW RESERVE IN TH E SHEEP FETUS James

Heckman, Ph D.'. Linda Chan, M 0, Valan ... I'.tsleckl, B.S.'. Sharon

R Weil, M 0 x, Jeffrey Dunn. M 0' Departments of Surgery and Physiology, Temple Umverslty School of ~l ... dlcine, Department of Obstetncs and Gynecology. Jefferson Medlc.i1 College, Philadelphia, PA

The fetal heart has less functlOnJI re,erve lhan the adult heart This study was conducted to determme If ,limml,lied fetal coronary blood flow (CBF) reserve contTibutes to the dell edsed functional reserve Hearts from 7 sheep fetmes of mean gestallonal age 130 ± 0.8* days were studlCd (term 147 day') The eWL'S were ventilated with 1% halothane m oxygen. The fetal hearts werL' hemodynamically isolated and perfused via the proximal aorta With lll.ltcrnal blood A membrane oxygenator was used to eqUilibrate the blood with a 95% 02 and 5% C02 gas mixture Sodium bicarhonate wa:. gl\ l'll when needed to mamtam the pH between 7.30 and 7,,)0 Pharmacol"glealiy recruitable maximal CBF was determmed m 4 aOimais hy the InfUSIOn of adenosme (7-14 microgram<;/litcr/mmutc) Tht: maximum L:rrectlvc dose of adenosine was determined by mCrCd"Ing the mlu...,lOTI rate untIl no further mcrement m CBF occurred The percent mcrease above restmg CBF produced by adenosme W.IS 374 ± I g Il'~ .md the percent change In

coronary vasculdr re'I"ance WJ' -26 I ± 102% PhYSIOlogically recrUitahle maXImal CIlF wa, deleTiTIlnc'li m 3 ammals by a 60 second occlUSIOn of the aorta The maXlnlUfll CBF during the reactive hyperemia was measured The percenl change m CBF and coronary resistance dUTIng the hyperemic response were 106.1 ± 35.4% and -50.0 ± 87%, respectively. StudlCs of the adult heart have shown that maXImal recrUltable change, m CBF arc 400 to 500%. Our results show that both the maXImum pharmacologIC and phYSIOlogic recrUltable changes in CIl F are much less m the fetal heart The lower coronary flow reserve of the fetus may help e'plam lls lower cardIac functional reserve Supported, m part, by AHA crant # 900820 * All data reported as mean ± S.D.

8 USE OF COMPLEMENT SPLIT PRODUCTS TO DISTINGUISH ACTIVE SYSTEHIC LUPUS ERYTHEMATOSUS (SLE) FROM PREECLAMPSIA. S, A, Ordorjca*, J. Taaerius*, F. Frieden*, B.K. Young, S.A. Abrmon*, J.P. Bunyon*. Hospital for Joint Diseases and NYU Medical Center, N.Y. 10003,

To assess the activity of SLK during pregnancy and distinguish it frol preeclampsia, we prospectively leasured the cOlplimt split products (CSP), Ba, Bb, SC5b-9, and C(d during gestation in 14 SLK patients, in 10 wOlen with preeclalpsia, and in a control group of 11 nonal pregnant wOlen. Five of the H lupus patients had disease flares, 2 occurring in the 2nd tri.ester and 3 in the 3rd trimter. COlparison of the data for the active and inactive lupus patients revealed a lean value for Ba of 1.6 vs .6, pdt, Bb of 1.1 vs .3, p<,02, Sc5b-9 of 1.7 vs .5, p<.Ol. C( of 11 vs 21, KS, C3 98 vs 123, KS, cm 85 vs 179, pdt. In cOlparison, 3 of 10 wOlen with preec1alpsia had elevated levels of Ba, however in each case the cm was within or close to the nOIlal range. This was in sharp contrast to the findings observed in the 5 active lupus patients where high levels of Ba were always seen in association with low CH50. Furthenore, in all preeclaaptic men the ratio of cm to Sa was above 80, which is higher than the ratio obtained for all but one of the active lupus patients. These data suggests 1. cOlplmnt activation accolpanies lupus flares during pregnancy as leasured by increased alternative pathway products, Ba and Bb. 2. decreased values in conventional measureaents of cOlplelent, em, C3, and C4, are the result of ongoing conSUlption and reflect active disease in SLE pregnancies, and 3. there lay be complelent activation in sOle patients with preeclaapsia, however in contrast to the situation in SLK, the cm is in the nonal range or elevated, indistinguishable from healthy pregnancies.