Volume 168 Number 1, Part 2

19 INDUCTION VERSUS EXPECTANT MANAGEMENT IN PROM WITH MATURE AMNIOTIC FLUID AT 32-36 WEEKS: A RANDOMIZED TRIAL. B Mercerx, L Crockerx, N. Boex, B. Sibai. Univ. of Tenn., Memphis, TN. OBJECTIVE: To compare maternal and perinatal outcome between 2 management schemes for women with preterm PROM and documented fetal lung maturity. STUDY DESIGN: 93 women w~h documented PROM at 32·36 weeks' gestation (absent labor and amnion~is, documented mature amniotic fluid) were randomly assigned to e~her induction (n=46) or expectant management (nz47). Expectant management consisted of observation for labor and chorioamnionitis. Induction management included oxytocin and no digital exam until onset of active labor. Maternal & neonatal outcomes were assessed. Recurrent variable & late decelerations were considered abnormal. Suspected sepsis was diagnosed for suspicious clinical findings in the absence of a positive neonatal cu~ure. RESULTS: The 2 groups had similar par~y, cervical dilatation, and gestational age (induction 34.2 ± 1.2 vs. expectant 33.9 ± 1.4) at time of randomization. The incidences of prolonged oxygen requirement (4.4% vs. 2.1%) and cu~ure proven neonatal sepsis (6.8% vs. 4.4%) were similar. There were no perinatal deaths nor other major neonatal morbid~y in either group. Other outcome variables are summarized in the Table.

~~~ mean GA at delivery (wk) 34.1 ± 1.3 34.3 ± 1.2 N.S. mean birthweight(g) 2370 ± 388 2308 ± 441 N.S. mean randomization to delivery (d) 0.7 ± 0.4 2.2 ± 1.9 < 0.001 mean hosp~al stay (d) 2.8 ± 2.0 3.9 ± 1.9 0.006 chorioamnionitis # (%) 5 (11) 13 (28) 0.06 cesarean delivery (%) 4 (8.7) 3 (6.4) N.S. abnormal FHR antepartum # (%) 0 6 (13) 0.03 mean neonatal stay (d) 6.3 ± 4.4 8.8 ± 7.3 0.05 suspected neonatal sepsis # (%) 13 (30) 28 (61) 0.003

CONCLUSIONS: Induction in women with PROM and mature fluid at 32·36 weeks is associated with reduced hospitalization and infectious morbidity in both mother and infant w~hout an increase in cesarean section rate.

20 THE ACUTE EFFECT OF COCAINE EXPOSURE ON PREGNANT HUMAN MYOMETRIAL CONTRACTILE ACTIVITY. ~, N.W.Weisbrodt', R.LAndres, B.M.Sanborn'. Depts. Ob.Gyn.& Reprod. Sci., Physiol.& Cell BioI., Biochem.& Molec BioI., UTHSC,Houston, TX OBJECTIVE: Cocaine use has been associated with preterm labor and delivery, however the effect of cocaine on human myometrial contractions is unknown. This study was undertaken to test the hypothesis that cocaine increases spontaneous contractions in myometrium from term pregnant women. STUDY DESIGN: Myometrial samples were obtained from the lower uterine segment at elective cesarean section (from the upper edge of a transverse incision) from 5 women at term, and not in labor, who had no medical problems or history of drug abuse. Before and after addition of cocaine, (10·8M-l0,4Mj, isometric contractions were measured in myometrial strips suspended in buffer (mM: NaCII18.3; KCI4.7; CaCI2 2.5; MgSO. 1.18; NaHC03

25.0 and glucose 11.1) at 37°C and gassed with 95%O,l5%C02 •

Contraction duration, amplitude, frequency and integrated area were compared using ANOVA and Duncan's multiple range test. RESULTS: Duration (sec) and integrated area, expressed as a ratio to control, increased immediately after cocaine, with significant differences from control at all concentrations (area) and 1O,5M and 10 4M (duration) (p<O.OOI). COCAINE 1O,8M 10 5M 104 M DURATION 1.4±.05 2.0±.29 2.8±.64 AREA 1.6±.18 2.4±.16 3.5±.23 CONCLUSIONS: Cocaine, at concentrations similar to reported plasma and tissue levels following intravenous administration, acutely increases contractile activity in myometrium isolated from pregnant women. Sponsored in part by HD09618 (BMS)

SPO Abstracts 295

21 lCrnIE ~ CF IAB:R 1963 - 1993. P. Ebtlan, M. R±s::n,x P. M::: Rlrlard.x

N3.ticral Ml.ternity H::spital, Mlin. CBJEr:TIVE: 'Ihirty 'yffiTI3 a:p tlEre \\as a =x:ertEd effort to .inpro"e 1±E gBl.ity of care ext:En:E:i to all WJT81 in lal:or in 1±E N3.timal Ml.ternity H::spital. 8TI.Dl rESICN: In 1973 1±E results of a ~\e stLrly of 1000 m-E2CUti'£ rulliprrrus WJT81 \\ere pJ:Jl:istEd. W= anp3I"e 1±E lal:or Olta:rre of th::£e WJT81 with 1±E first 1000 m-E2CUti\e rulliprrrus WJT81 in 1992. ~: ~ va:Jiml dcli\el:Y rates \\ere 75% v.3 779c, va:Jiml q:erati \e dcli \el:Y rates 20% v.3 13% am ce3:ITE8I1

S'rtim rates 5% v.3 10%. I'pid.n:a.l rates in la1::ar:irg WJT81

\\ere 1% v.3 48%. Rriretal rrortality rates \\ere 25 v.3 12. In 1973, 7 dBth3 \\ere at:trihrte::l. to nalforrratim, 3 to bres::h prE'S31tatim, 11 ilI1ta13.tal dBth3, 2 rECTatal dBth3 l:s::aus= of prmabrity am 2 :inl:raj:Ertun dE.th3. In 1992 4 dBth3 \\ere lethl.l ~tal armaliEs, 4 \\ere lESS thm 25 VoEEks, 3 \\ere ilI1ta13.tal dE.th3 am tlEre \\as aE

rB:I13.tal dE.th dE to p18JTCC!Xl:'8l s=ptiCESTIia. Cer6Jral irritatim rates \\ere 0.4% v.3 0.3%. Ird:ctim rates \\ere

27% v.3 17%. Ckjt:o::in rates \\ere 55% v.3 50%. <INII.EIlli3r ld:.i\e ~ of lal:or cxnt.in.Es to pt:OJire a high ~ va:Jiml celi\el:Y rate with gx:d r:erirntal Olta:rre in rulliprrrus WJT81.

22 A RANDOIIIZED PROSPECTIVE COMPARISON OF OXYTOCIN DOSIIIIj. PROTOCOLS FOR LABOR AUGMENTATION IN NULLIPAROUS VOIIEN. ~ • E. Philipson. C. Ingardia, E. Kobetitsch and S. Curry. Dept. OB/GVN. Hartford Hospital, Hartford, CT. OBJECTIVE: The purpose of this study is to compare a 15 minute versus 40 minute low dose oxytocin protocol in augmentation of nulliparous patients. STUDY DESIGN: As part of an ongoing oxytocin study at Hartford Hospital. 264 term nUlliparous patients requiring labor augmentation were prospectively randomized into a 15 or 40 minute dOSing protocol. During labor, clinical data was recorded for each patient, and the presence of fetal distress and/or uterine hyperstimulation was recorded by the obstetrical nurse. After delivery the monitor traCings were blindly interpreted by two perinatologists for fetal distress or uterine hyperstimulation. RESULTS: The incidence of uterine hyperstimulation by tracing review was higher in the 15 minute dosing group (38.6 vs. 21.9%) (p < .01). The incidence of fetal distress was higher in the 15 minute dOSing group as interpreted by perinatologists (32 vs. 20%) (p < .05) and the obstetrical nurses (56.3 vs. 38.6%) (p < .01). The maximum dose of pitocin was lower in the 40 minute group (8.9

vs. 7.3 mu) (p < .05). There were no differences in the time to reach adequate contractions (2.5 vs. 2.4 hrs.), length of labor (6.8 vs. 7.1 hrs.) or incidence of cesarean sections (22.4 vs. 20.8%). CONCLUSION: Augmentation of nulliparous patients using a 40 minute dosing interval lowers the incidence of fetal distress, uterine hyperstimulation and the maximum dose of pitocin without affecting the length of labor or the rate of cesarean sections.