Volume 166 Number I, Part 2

572 THE EFFECTS OF VIBROACOUSTIC STIMULATION (VAS) ON BIOPHYSICAL PROFILE TESTING (BPP). Thomas N. Balaskas, M.D., Jooeph A. SpinDato, M.D., Univenity of Louisville School of Medicine, Deputmoal of Obolelrics and Gyneco1ogy, Louisville, Kentucky.

Vibroooou.tic slimulalion (VAS) of the felus has been shown to mIuce the Dumber of falsely Don-reactive oonslress tests while shortening IeIIinc lime. The objective of this study was 10 investigate whether VAS ..,.ulll in improvemenl of aboonnaI BPP scores and reduces the latency period fer oppoonnce of scoring puameters. M.IIttHIs: One hundred four (104) biP-riIk obolelrica1 patients between 2842 weeks geslation with BPP ICClRS S 6 were randomized 10 VAS (n=51) versus no VAS (n=53). U111uound evaluation was continued for an additiona115 minute time period 10 ...... for iJJ¥ovemenl of score and the time of appearance of scoring parameten. R.,IIII&: Of 51 patients who received VAS, 26 (50.1%) showed in¥<>vemenl of BPP score wbile 21 (39.6%) of the 53 patients J'IIIIdonUed 10 00 VAS showed improvemenl in score (P=NS). TIme 10 appearance of BPP puamelen (minules ± SD) in both VAS and no VAS groupo revea1ed:

VAS NOVAS P Total Score (n-30) (n-25)

5.66±S.08 1O.8±4.0 <.05 Breathing (n=9) (n-12)

8. 11±6.6 IJ.6±4.4 NS Tone (n-l1) (n=9)

6.18±S.1 IOB.5 NS G ..... body (n-IO) (n=4) Movement 4.4±3.5 10±4.1 <.05

C.llt:huiDu: Although nolslalislica1Jy significan~ VAS applied after BPP testing in palienll with scores of S6 appears 10 resull in improvement of scores ",hen compared 10 no VAS. VAS signifu-.anlly reduced the latency period fcr """""",,ce of scoring puamelen C<lI'D,~ 10 no VAS. The .. data suggest Ibot VAS may potenlially he uliJizJed 10 shorten testing times and 10 reduce equivocal or falsely aboorma1 results.

574 UMBILICAL ARTERY DOPPLER VELOCIMETRY DOES NOT IDENTIFY PERINATAL RISK IN CASES OF OLIGOHYDRAMNIOS, J.R. Wax.' L. Paina.' N.A. Callan. C. Gagor.· T.R.B. Johnson. Dapt. GynlOb. The Johns Hopkins Hospital. Baltimora. MD.

Background: Since oligohydramnios and abnormal umbilical artery doppler systolic/diastolic (SID) ratios are felt to reflect uteroplacental insufficiency, we sought 8 correlation between these two parameters. Since the minority of patients with oligohydramnios suffer perinatal morbidity. we compared the SID ratio to the non·stress test (NST) as a means of stratifying perinatal risk in cases of third trimester oligohydramnios. Methods: One hundred eighty ttvee structurally normal high risk fetuses underwent simultaneous NST. SID ratio. and amniotic fluid index (AFIl within seven days of delivery. Data collected on each newborn were: birth weight, ponderal index, hematocrit, l­and 6- Apgar scores. arterial cord pH and base excess. need for resuscitation or intensive care admission, delivery for distress, and meconium staining. Reaulta: No significant correlation was found between the SID ratio and AFI. In 64 patients with oligohydramnios. the sensitivity of the NST was significantly greater than that of the SID ratio for detecting risk for low birth weight (p< .061. abnormal hematocrit (p< .061. arterial cord pH < 7.20 (p< .06). delivery for fatal distress (p<.OOOl). and pondaral index s10% for gestational age (p<.02). In 119 patients with normal AFI. the NST was significantly more sensitive than the SID ratio in detecting risk for abnormal hematocrit (p<.06). arterial cord pH <7.20 (p<.06), ponderal index s10% for gestational age (p<.06), and meconium staining (p<.02). Conclusions: The SID ratio does not correlate with the AFI in a group of high risk pregnancies. The NST is superior to the SID ratio in identifying risk for perinatal morbidity by a variaty of outcomes in our high risk population.

spa Abstracts 429

576 USE OF OXYTOCIN IN PATIENTS WITH PREVIOUS CESAREAN SECTION. B.Gross, A.F1eischer, Dept. Ob/Gyn Albert Einstein College of 'fedicine, Bronx, N.Y.

This is a retrospective study concerning the efficacy of oxytocin in patients with a pre­vious cesarean section. During the period evaluated, 362 patients with prior cesarean sections were identified 248 of which had a trial of labor, The remainin8 114 patients had an elective repeat cesarean section. Oxytocin was used for the usual obstetric indications in 70 patients (28%) irrespective of the reasons for the primary cesarean section. In the absence of oxytocin 124 patients (50%) had a vaginal delivery. An additional 46 women delivered vaginally following oxytocin augmen­tation, bringing the total rate to 67% (P<.05). Hith this approach, the va8ina1 delivery rate among patients with CPD as the reason for their primary cesarean section was similar to those with other indications for their primary pro­cedure. Among patients with a primary cesarean section for CPD, 57% delivered a 1ar8er baby vaginally. There was no increase in maternal or fetal morbidity in the trial of labor 8roups compared to elective repeat cesarean sections, nor was there increased morbidity associated with the use of oxytocin among patients delivered by the same route.

577 COMPARISON OF MORBIDITY IN CESAREAN-TUBAL VS. CESAREAN HYSTERECTOMY. Mohammed A Bey, Joseph M Miller, Jr., Joseph G Pastorek, II and Harvey A Gabert, LSU Medical Center, New Orleans, LA.

Cesarean hysterectomy (C-Hyst), often an emergency procedure, is an alternative to ce­sarean with tubal ligation (C-BTL). Patients undergoing scheduled repeat C-BTL (n=45) were compared to scheduled C-Hyst (n=48). Outcome parameters were compared by t-test, chi square or Fisher exact tests as appropriate.

C-BTL C-Hyst P Blood Transfusion 8/45 12/48 .397 Post Op Comp 0/45 1/48 1.000 Febrile Morbidity 13/45 9/48 .250 Est rl100d Loss (cc) 690±259 1l01±450 .0001 Pre-Op Hct (%) 34.7±4.5 35.7±3.4 .2373 Post-Op Hct (%) 3l.2±3.6 30.9±5.2 .7495 /':, Hct (%) 3.8±2.8 3.6±2.4 .5983 Op Time (min) 75±21 111±28 .0001 Hosp Stay (d) 4.9±l.4 5.2±2.4 .4566 Patient Age (yr) 26.9±5.1 30.9±5.7 .0007 Gest Age (wk) 38.8±l.7 38. 4±l. 6 .2471 Parity 3.3±l.5 2.7±l.5 .0577 Operating time and estimated blood loss are in­creased, but the incidence of blood transfusion and post operative febrile morbidity and other complications were not more common. Elective C-Hyst is a reasonable alternative to C-BTL.