338 SPO Abstracts

139 EFFECT OF PKETERM PREMAnJRE RUP11JRE OF MEMBRANES ON FETAL ACTIVITY. !UllI!a. J. Scardo'. S. Strarnm". R. Newman. Dept Ob/Gyn. Medical University of South Carolina. Charleston. SC. OBJECTIVE: Petal Activity (FA) was prospectively evaluated in patients with pretenn premature rupture of the membranes (PROM) to determine if this complication affects long-tenn fetal activity. STUDY DESIGN: Seventeen volunteers (29.6±2.5 weeks) with pretermPROM were monitored daily for one hour for FA with the doppler FA monitor (Toitu MT-320) prior to the onset of spontaneous labor. Volunteers who were moni­tored for at least three days before delivery were evaluated. Monitoring was performed in a quiet room at a consistent time for each volunteer ranging from II am to 4 pnL All 17 patients were monitored for three days with eight patients remaining for the entire seven days. FA was then expressed as the percentage of time the fetus was moving with respect to the total time monitored each day. RESULTS: Linear regression analysis of mean percent fela! activity over the seven days prior to the onset of spontaneous labarrevealed a significant (p=.006) trend \award decreasing activity as illustrated in Fig= 1. CONCLUSIONS: Preterm premature rupture of membranes i. associated 'With an overall decrease in long-tenn fela! activity during the week prior to spontane­ous labor.

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140 THE TIME COURSE OF APPEARANCE OF SAP-A ISOFORMS IN AMNIOTIC FLUID. R. Wiehle", T .Hutchins', P. Besch', A . Reiter, B. Kirshon. Dept. Ob/Gyn, Baylor Coli . of Medicine, Houston, TX. OBJECTIVE: The lecithin/sphingomyelin ratio (LSR) is often an inadequate indicator of fetal lung inunaturity but this need could be met by the analysis of isoforms of SAP-A if the variety of these proteins changed predictably during the third trimester. STUDY DESIGN: Pulmonary surfactant of lamellar bodies is composed of both phospholipids and surfactant-associated-proteins. Sequential samples of third trimester amniotic fluid from five women with the potential for Rh isoimmunization were investigated for the time course of the appearance of isoforms of SAP-A protein by 2D-PAGE. Samples of amniotic fluid from five women without this risk were also analyzed. lsoforms of SAP-A were recognized on the basis of size and charge properties. The LSR was also determined on each patient near term. RESULTS: Five groups of SAP-A isoforms were detected and each group had 3-4 subspecies. Both groups of patients exhibited a similar pattern of development but two groups of isoforms lagged in their temporal order of appearance. In 9 out of 10 cases, a complete set of SAP-A isoforms were found in the 33-36 week window but none of these proteins appeared before 31 weeks. LSRs did not predict this ontogeny since complete sets of SAP-As were found in cases of low (1.3) and high (3.7) LSRs. CONCLUSION: Isoforms of SAP-As appear in a specified order in lamellar bodies. These isoforms may have potential as markers of fetal lung maturity if their appearance is related to the development of physiologically active surfactant.

J anuary 1993 Am J O bstet Gyneco l

141 SERIAL MSAFP AND HCG IN PREGNANCIES COMPLICATED BY UNEXPLAINED, ELEVATED SECOND TRIMESTER MSAFP. T Cowles, A. BerkowitzX, I. Wilkins, P. Funnanx Dept. Ob/GynlRepro Sci Univ. Tx. School Medicine, Houslon, TIC OBJECTIVE: Unexplained, elevated second trimester maternal senun alphafetoprotein (MSAFP) has been associated with adverse pregnancy outcome. We examined whether elevations in serial human chorionic gonadotropin (HCG) and MSAFP could more accurately predict outcome. STIJDY DESIGN: Thirty patients having a second trimester MSAFP ~2 . 5 MOM and a normal ultrasound examination were prospectively followed. HCG and MSAFP levels were obtained at 24, 2S, 32 and 36 weeks of gestation. A normal third trimester MSAFP curve was constructed in our laboratory. Outcome variables included birthweight (BW), gestational age at delivery (EGA). and one-minute Apgar score (APG). Hypothesis testing was perfonned using two-way analysis of variance, t-testing and chi-square analysis. with Fisher's exact test when appropriate. RESULTS: HCG levels were consistently nonnal (::; 2SD) or elevated (~ 2SD) at all gestational ages examined. MSAFP levels either remained on the nonnal third trimester curve or were elevated (~ 2 MOM) during some or all of the gestational ages. The original second trimester MSAFP of ~ 3.0 MOM vs 2.5-2.99 MOM was correlated with BW (2709 vs 3327 g. p9).012), EGA (36.S vs 3S.9 weeks p9).014), and APG (4/13 vs 0/17 <7 p9).026). Elevated HCG levels were correlated with BW (2202 vs 3274 g. P <0.0005), EGA (35.6 vs 3S.6 weeks p9).004). and APG (3/6 vs 1124 < 7 p=O.OIS). Elevations in third trimester MSAFP were not significantly associated with outcome variables. Interaction between the original MSAFP, third trimester MSAFP and HCG was not demonstrated. CONCLUSION: Elevated HCG levels at 24 weeks were significantly associated with lower BW, prematurity and increase in APG <7; serial levels provided no additional information. Although unexplained, elevated second trimester MSAFP levels were also associated with poorer pregnancy outcome, third trimester MSAFP levels were not.

142 UNEXPLAINED ELEVATED SECOND TRIMESTER MATERNAL SERUM hCH IS NOT ASSOCIATED WITH ADVERSE PREGNANCY OUTCOME. K. MurohyX, M. Coxx, K. CoutterX, C. Le~chx, A. Cameron, D. Aitkenx, J. Crossleyx. The Queen Mother's Hospital, Glasgow, Scotland. OBJECTIVE: To determine the predictive value of an unexplained elevated second trimester maternal serum hCG (MShCG) for subsequent pregnancy complications. STUDY DESIGN: Between July 1988 and June 1990, 5297 pregnancies were screened with MSAFP/hCG. MShCG was >2.5 MOM in 204 singleton pregnancies with normally formed fetuses. 486 controls were selected randomly from the remaining pregnancies with MShCG <2.5 MOM. Pregnancy complications were compared between the two groups using the chi-squared test. RESULTS:

Elevated MShCG Controls x.2 (n-204) ( n-486)

Mean age (sd) 27.3 (2.3) 27.1 (2.7) ns Prematurity 98 (48%) 209 (43%) ns PTL « 37 wks) 13 ( 6%) 36 ( 7%) ns Invasive procedure 15 ( 7%) 32 ( 6%) ns Pregnancy loss 2 (1%) 5 ( 1%) ns Pre-eclampsia 7 (3%) 13 (3%) ns Birthweight <10th 15 (7%) 43 (goA.) ns MSAFP > 2.5 MOM 5 ( 3%) 9 ( 2%) ns CONCLUSIONS: Despite a recent report (1992 abstract No.494) suggesting an association between unexplained elevated second trimester MShCG and pregnancy complications, this study has found no evidence of such an association. This has obvious implications for patient counselling.