\'olllme 166 :\fumber 1, Part 2

129 THE INCIDENCE AND NATURAL IIISTORY OF ASYMPTOMATIC

CHOLELlTIIIASIS IN PREGNANT PATIENTS, J. Williams m, R.

Willis-Hassanx, D. Aiken-HuntingX , B. Carox, 1.S. Greenspoon, The

Prenatal Diagnostic Center of So. CA & Dept. of Ob/Gyo, Cedars-Sinai

Med. Ctr, Beverly Hills & Los Angeles, CA

We prospectively evaluated 186 patients for cholethiasis to detennine the

incidence and natural history of cholelithiasis in women diagnosed during

pregnancy. Symptomatic gallstones diagnosed during pregnancy are

associated with a 15% rate of pregnancy complications. We hypothesized

that asymptomatic gallstones infrequently become symptomatic, and are

seldom associated with pregnancy or medical complications. A realtime

ultrasound examination of the biliary tract was perfonned at the time of an

indicated second trimester fetal evaluation. Patients included in the study

were referred for genetic or obstetrical indications. No patient was referred

for evaluation of biliary tract disease. The mean (SD) maternal age was

35,7 (4.5) years. The mean maternal weight was 68.2 (11.8) kilograms.

The mean maternal height 1.64 (0.06) meters. The mean body mass index

(BMI) was 25.3 (4.2), The gestational age at the time of the examinstion

was 16 to 24 weeks. An adequate examination of the biliary tract was

achieved in 176 (95%) of patients. An adequate exam was obtained as

frequently in overweight patients with a BMI2:,.27 as in patients with a

BMI < 27. Although 5 of 55 (9 %) patients with BMI2:.27 had inadequate

examinations compared to 5 of 131 (3 %) non-obese patients (BMI <27), the

difference was not statistically significant. Four of 176 (2 %) evaluable

patients had cholelithiasis. In retrospect, symptoms attributable to

cholelithiasis were elicited from one of the 4 patients with cholelithiasis.

None of the 4 patients has required therapy, although pregnancies are

ongoing. Further enrollment of consecutive patients is in progress to test

the hypothesis.

130 SEXUAL ASSAULT IN PREGNANCY: A SURVEY OF 2404 WOMEN. AJ Satin: J. Paicurich: S, Millman: G.D. Wendel, Dept. Ob/Gyn, U. Texas Southwestern Med Center., Dallas, TX

A women is sexually assaulted every 6 minutes in the U.S., however little data exists on the prevalence of and effect of rape on an obstetric population. In a previous retrospective study of assault victims we estimated an incidence of rape of 0.55/1000 pregnancies. The purpose of this investigation was to determine the prevalence of sexual assault in urban gravidas, characterize pregnancy complications and report pregnancy outcome of assault victims. Women (n=2404) were interviewed within 48 hours of delivery regarding forced sexual contact before or during Ihe current pregnancy. Reported pregnancy complications were confirmed by review of obstetric, medical & police reports. A history of sexual assault was elicited in 50:1000 (n= 120) women. The incidence of assault during the current gestation was 2:](XX) (n=5). Rape victims were more likely to be white (43v, 16%, P< .(01), employed (28v,19%, P < .(2), high school graduates (23v.14%, P < .OOS) and separated or divorced (13v.5%, P < ,(X)!), compared to non-victims. Rape viclims had a higher incidence of STD's (9v.4%, P<.OI), UTI's/vaginitis (32v.21%, P=.(2), drug usc (9v.2%, P<.OOl), and multiple h()spitalizations (15v,8%, p< .(1) during pregnancy. There were no differences in neonatal outcome renected by umbilical artery acidosis, EGA at delivery, or birthweight. Thus in our gravid population a history of sexual assault is common. Rape in pregnancy occurs four times more often than previously eSlimated. Assaull victims have more frequenl pregnancy complications, but achieve normal pregnancy outcome.

SPO Abstracts 315

131 3 HOtJ! GLUCOSE TOLERANCE TEST (GTT) RESULTS ARE UNRELATED TO OUTCOME IN A SELECTIVELY SCREENED POPULATION. Michael J. Lucas, Thomas W. lowe. Lisa Bowe. x Dona ld Me I nt i re.x Dept. Ob/Gyn, Univ. Texas Southwestern Medical Center, Dallas, TX

Selective GTT testing of a large cohort of antepartum clinic patients resulted in the identification of 126 class A diabetics and 139 gravidas with normal glucose tolerance based on a 100 gm, 3 hr GTl. These two groups were compared to evaluate the relationship of glucose intolerance to perinatal outcome. ,The Class Al diabetics received diet~ry counseling and had fastlng blood sugars checked at the tlme of antepartum clinic visits, but otherwise received routine obstetrlc care. There was no signiflCant difference between groups in average birthweight, EGA at delivery, stillbirths (one each), cesarean section delivery rate, meconium stalning of fluld, cord pH (or % < 7.2) or Apgar scores. There were very few small for gestatlonal age (SGA) neonates (2 in each group), ano although there were 36% large for gestat lona 1 age (LGA) neonates in the diabetlcs, this was not statistically different from the 31% LGA delivered ln the normal GTT group. There was no significant dlfference 1n the 3 hr GTT prof; les between mothers of LGA neonates and the others within each group. There was a 5% incldence of shoulder dystocia in the LGA neonates, and half of these had eVldence of injury. There was no apparent relation­ShlP between neonatal Slze and route of dellvery. Maternal welght, on the other hand, was slgnificantly higher in cesarean dellVerles and in LGA mothers, but was not Significantly different between the GTT result groups The high incidence of LGA neonates observed in both GTT groups suggest that elther the abnormal 50 gm result or the lndications for screening selected for this outcome. It should be noted that maternal obesity was not an indlcation for screening. Pnor delivery of a macrosomic infant was the indicat ion ln 22% of mothers screened yet contributed 44% of the LGA neonates. Whi le not surprislng that factors other than maternal glucose tolerance affect fetal Slze. the lack of association with GTT results indicates that targeting glycemic control in this population would not significantly reduce the incidence of LGA outcome.

132 CHARACTERISTICS AND OUTCOMES ACCORDING TO DIAGNOSTIC CRITERIA FOR GESTATIONAL DIABETES. Q. Berkowitzll., R. Lapinski', M. Alvare7 .. C. Lockwood, R. Berkowitz. Mount Sinai School of Medicine, New York, NY

The criteria endorsed by the National Diabetes Data Group (NDDG) for determining abnormal plasma glucose values were converted from O'Sullivan's original values based on whole blood without taking into account differences between whole blood and plasma values. C~nter and Coustan (I) have calculated lower thresholds hased on an adjustment for this difference. Our institution, which routinely screens all patients on the clinic service for diabetes. has adopted the lower thresholds. The aim of this study was to assess whether maternal characteristics and neonatal outcomes differ betwwen those who meet the NDDG criteria and those who only meet the criteria of Carpenter and Coustan. A total of 233 patients were diagnosed with gestational diabetes (GDM) based on the NDDG criteria and an additional 121 patients met the lower threshold criteria. The distributions of maternal age. race/ethnicily, body mass index, weekly maternal weight gain, a family history of diabetes, and a history of stillbirths or spontaneous abortions were very similar for the two groups. However, insulin use was more common in the NDDG group (p-==O.046) and there was a suggestion that a prior history of GDM was more frequent in this group (p=O.06). With regard to neonatal complications, there were no significant dirferences between the two groups although a hirth weight> 90th percentile for gestational age tended td"be more common in the NDIXJ group (p~O.06). SUMMARY: Although there was some suggestion L~at the patients fulfilling the NDDG criteria exhibit more sequelae of glucose intolerance than those who only meet the criteria proposed by Carpenter and Coustan, no clear distinctions were observed in terms of maternal characteristics or adverse neonatal outcomes between the two groups. (I) Carpenter M, Coustan D. Am J Obstet Gynecol 144:768, 1982.