$240

585

SMFM Abstracts

MATERNAL SERUM A C T M N - A AND INTACT HCG IN PREGNANCIES COMPLICATED BY FETAL G R O W T H RESTRICTION ANDREA FICK 1, MARY MCASEY 2, ROBERT FRASER II1; tUniversity of Missouri, Depar tment of Obstetrics and Gynecology, Columbia, MO; 2Soutbern Illinois University, Depar tment of Obstetrics and Gynecology, Springfield, IL

OBJECTIVE: To examine second trimester maternal serum Activin-A and intact h u m a n Chorionic Gonadot ropin (hCG) in pregnancies complicated by in t rau ter ine growth restr ict ion (IUGR) as compared to pregnancies with appropriately grown infants.

STUDY DESIGN: 46 cases of IUGR and 73 control subjects were selected f rom our maternal serum bank of second t r imester specimens. IUGR was defined as both birthweight and Ponderal Index less than the tenth percentile for gestational age, or either birthweight or Ponderal index below the tenth percentile for patients with pregnancy-induced hypertension (PIH). Activin-A and intact hCG were measured by solid phase enzyme-linked immunosorben t assay. Concentrat ions of Activin-A and hCG were compared using the Mann- Whitney test.

RESULTS: Activin-A was elevated in the IUGR patients as compared to controls (2.81 vs. 1.65 n g / m L , P < .05). Likewise, intact hCG was elevated in the 1UGR patients as compared to controls (26,600 vs. 19,200 ra IU/mL, P < .05). When the subgroup of IUGR patients without PIH were considered (n = 23), a similar elevation of Activin-A was again observed (2.92 vs. 1.65 n g / m L , P < .05). However, intact hCG in the subgroup of IUGR patients without PIH was comparable to controls (19,100 vs. 19,200 m l U / m L ) .

CONCLUSION: Second tr imester maternal serum Activin-A and intact hCG are elevated in pregnanc ies compl ica ted by IUGR. However, in normotensive patients with IUGR, an elevation of intact hCG is not observed.

587

December 2001 Pun J Obstet Gynecol

INDICATIONS FOR DELIVERY AFTER INTRAUTERINE REPAIR OF SPINA BIFIDAJOY D U O N G t , J O S E P H BRUNER l, ARCHIE HEDDINGS2, GEORGE REED s, LAURA STONEI; ]Vanderbil t University, Obstetrics & Gynecology, Nashville, TN; 2University of Kansas, Surgery, Nashville, TN; SUniversity of Massachusetts, Preventive and Behavioral Medicine, Nashville, TN

OBJECTIVE: To relate indications for delivery after intrauterine repair of myelomeningocele to selected maternal-fetal outcome measures.

STUDY DESIGN: A retrospective cohor t study of 102 women who unde rwen t in t rau ter ine repai r of fetal myelomeningocele was pe r fo rmed . Medical records were reviewed to determine the indication(s) for delivery. Categories of delivery indicat ions were compared to various measures of maternal-fetal outcome.

RESULTS: O f the 102 cases reviewed, 96 satisfied diagnostic criteria tbr a recognized indication for delivery. The most common indication tor delivery was premature rupture of membranes (PROM), which accounted for 29% of the deliveries. The second most common cause of delivery was pre-term labor (PTL) (26%), followed by scheduled cesarean section (C/S) (14%), chorio- amnionit is (11%), abrup t ion (7%), o l igohydramnios (5%), nonreassur ing fetal status (3%), and preeclampsia (2%). Mean gestational age (EGA) at delivery was greatest for women when C /S was scheduled (35 6 / 7 weeks, P < .02). The earliest mean age at delivery was in the chorioanmionit is g roup (30 0 / 7 weeks, P< .02). The mean EGA at delivery for PTL and PROM was 34 5 / 7 and 32 5 / 7 weeks, respectively (P < .02). There was no relationship between EGA at surgery and EGA at delivery and no apparent way to predict EGA at delivery. There was no way to predict women who would deliver by scheduled C/S. However, younger mothers tended to have a higher incidence of PTL (26.2 years vs 29.7 years for all other categories, P = .003).

CONCLUSION: In this study, women who delivered by scheduled C/S after intrauterine repair of spiua bifida had the greatest mean EGA at delivery, while those with chorioamnionit is had the lowest mean EGA at delivery. We could find no appa ren t predic tor that might identify these patients before establishment of a diagnosis, Changes in perioperative and postoperative care may reduce the number of patients who develop chorioamnionitis.

586 THE EFFECTS OF FETAL ARTERIAL HYPOXIA AND ACIDEMIA ON PLA- CENTAL PRODUCTION OF MATRIX METALLOPROTEINASE 9 BRIAN PIERCE t, LISA PIERCE 1, PETER NAPOLITANO t, ELIZABETH HANCOCK 1, RODERICK HUME JR. l, BYRON CALHOUN 1, lMadigan Army Medical Center, Tacoma, WA

OBJECTIVE: Matrix metalloproteinases have recently been shown to be one of the most sensitive predic tors for the subsequent deve lopment of cerebral palsy. We have previously demonstra ted inflammatory cytokines from h u m a n placentas to be elevated unde r hyperoxic, but not acidemic, placental condit ions. In an a t tempt to fu r the r identify placenta l cont r ibutors and predictors of fetal morbidity our goal is to determine whether the conditions of placental arterial hypoxia or placental arterial acidemia result in altered matrix metalloproteinase 9 (MMP-9) concentrations.

STUDY DESIGN: In two separate experiments, the maternal and fetal circulation of two cotyledons from five h u m a n placentas were perfused for four hours. PART I: The fetal circulation of one cotyledon was perfused with hypoxic (pO2 < 25 mm Hg) Hanks Balanced Salt Solution (HBSS) while the circulation of the other cotyledon was perfused with hyperoxic (pO2 > 600 mm Hg) HBSS. PART II: The fetal circulation of one cotyledon was perfused with acidemic (pH = 6.90) HBSS while the circulation of the other cotyledon was per fused with physiologic (pH = 7.35) HBSS. Fetal vein effluents were collected hourly and MMP-9 concentrat ions were determined by ELISA.

RESULTS: Fetal artery acidemia resulted in lower placental venous MMP-9 concent ra t ions c o m p a r e d to the physiologic arterial p H with a significant difference no ted at 4 hours (P < .05). There was no difference in MMP-9 concentrat ion when compar ing hypoxic conditions to hyperoxic conditions (P > .05). There was no significant change over time for MMP-9 concentrat ions from baseline values for any of the conditions studied (P> .05).

CONCLUSION: Unlike the inf lammatory cytokines IL-6 a n d TNF-0t, placental product ion of MMP-9 is not altered by fetal arterial oxygen content and not increased by fetal acidemia. These findings indicate that placental p roduc t ion of MMP-9 may be d e p e n d e n t on a l ternate pathophysiologic conditions.

588 INTRAUTERINE REPAIR OF MYELOMENINGOCFJ~ VS MYELOSCHISIS KRISTINA STORCK 1, JOY DUONG 1, JOSEPH BRUNER 1, GEORGE DAVIS 1, LAURA STONE 1, GEORGE REED2; 1Vanderbilt University, Obstetr ics & Gynecology, Nashville, TN; 2University of Massachusetts, Preventive & Behavioral Medicine, Nashville, TN

OBJECTIVE: To compare obstetrical and neonata l outcomes of preg- nancies after intrauterine repair of myelomeningocele (MMC) or myeloschisis (MS).

STUDY DESIGN: All maternal-infant pairs > 12 months after delivery were studied.

RESULTS: Sixty (60) maternal-infant pairs with a child ~ 12 months old were studied. No significant difference between groups was found in maternal age, gravidity, pe r i concep tua l folate supp lementa t ion or EGA at surgery. Women carrying a fetus with MS were more likely to have delivered a previous infant with a NTD (44.4% vs 14.3%, P = ,02). Although repair of MS required more dissection and a longer operat ing time than MMC (113.5 vs 90.0 min, P = .03), the postoperative length of hospital stay, incidence of pre term labor, rup tured membranes, chorioamnionit is and other obstetrical complications, as well as EGA at delivery were not different between groups. There was no difference in sex distribution, lesion level, indication for delivery, Apgar scores, cord blood gases or need for neonatal resuscitation between groups. Neuro- logic outcomes, as measured by need for ventriculoperi toneal shunt, lower extremity, bladder and bowel function were not different.

CONCLUSION: Although int rauter ine repair of MS requires a longer operat ing time than MMC, due to the need to mobilize bidedicular skin flaps, this does not affect the incidence of postoperative obstetrical complications. The neurologic outcome of babies with MMC vs MS is not different.