Volume 185, Number 6 AlnJ Obstet Gynecol

356 METHADONE T R O U G H LEVELS IN PREGNANCY VINCENZO BERG- HELLA 1, J O H N DROZDICK IlI 2, MARYKAY HILL 3, KAROL KALTENBACH4: 1Thomas Jefferson University, Obstetrics a~ad Gynecology, Philadelphia, PA; 2Moses Taylor Hospital, Obstetrics and Gynecology, Scranton, PA; 3Thomas Jefferson University, Obstetrics and Gynecology, Philadelphia, PA: 4Thomas Jefferson University, Pediatrics, Philadelphia, PA

OBJECTIVE: To deternr ine (1) the me thadone serum t rough level adequate to prevent withdrawal symptoms in hero in-addic ted p r e g n a n t women, and (2) if the methadone serum though level in symptomatic women with withdrawal symptoms differs from that of asymptomatic women. These levels have never before been studied in pregnancy.

STUDY DESIGN: P regnan t women addic ted to hero in were followed prospectively between 3 / 1 / 9 9 and 3 / 1 / 0 0 in a specialized federally-funded mult idiscipl inary m e t h a d o n e p r o g r a m after in-hospital stabilization. After counsel ing, women signing iRB-approved in fo rmed consent had their methadone sermn trough (20-24 hours after last dose) level (MethL) checked at regular intervals t h roughou t pregnancy. MethL were kept bl inded f rom clinicians. Me thadone doses were increased only accord ing to withdrawal symptoms. MethL of asymptomatic (without withdrawal symptoms) women were compared to MethL of symptomatic (with withdrawal symptoms) women.

RESULTS: Mean MethL was 0.295 + 0 .16mg/L in asytuptomatic women (n = 44) and 0.175 + 0 . 1 h n g / L in symptomatic (n = 58) women ( P - .0001). The mean methadone dose in asymptomatic patients was 101 -+ 42rag vs 114 -+ 43rag in symptomatic patients (P = .l). Despite these high doses, no patient had a toxic-range MethL (all <0.7rag/L). By receiver operator characteristic curve, the best dif ferent ia t ing MethL between asymptomat ic a n d symptomatic women was 0 . 2 4 m g / L These ditterences in MethL between asymptomatic and symptonlatic women were not influenced by cont inuing d rug abuse, maternal weight or gestational age when MethL was drawn.

CONCLUSION: Mean methadone serum trough level in asymptomatic pregnant women is approximately 0 .3mg/L, and levels of ->0.24mg/L should be considered adequate to prevent withdrawal symptoms in pregnancy. I, haowl- edge of these levels will help management of the frequently non-compliant heroin-addicted pregnant woman. Appropriate daily dosing to achieve these levels is usually between 50-150tug of methadone, with the occasional need for even higher doses in the third trimester.

358

SMFM Abstracts $179

INDICATIONS FOR ANTINUCLEAR ANTIBODY TESTING IN OBSTET- RICS AND GYNECOLOGY PATIENTS MATFHEW BORGMEYER l, ROBERT FRASER IIt , ANNA FRASER 1, 1University of Missouri, Department o f Obstet- rics and Gynecology, Columbia, MO

OBJECTIVE: To examine the relat ionship of f luorescent an t inuc lear antibody (FANA) titer and test indication in women evaluated by an Obstetrics and Gynecology referral service.

STUDY DESIGN: A FANA was per formed on 544 women by the University of Missouri Obstetrics and Gynecology service dur ing the per iod June 1994 th rough December 1997. Testing was per formed exclusively by the University of Missouri Antinuclear Antibody Laboratory. Patients were identified from the laboratory log using Obstetrics and Gynecology staff physicians as requestor. The FANA test indication was extracted from the medical record and coded to one of 17 categories. The proport ions of positive FANA for the 9 reproductive related indications were compared using Chi-Square or Fisher's Exact test as appropriate.

RESULTS: 49% (265/544) of women had a positive FANA with 10% (57/544) high positive (-> 1:320). O f the 344 women tested for reproductive related indications, 48% (166/344) had a positive FANA with 9% (32/344) high positive. The test indication Fetal Death was associated with a greater propor t ion of positive FANA (P< .05) but not high positive FANA.

CONCLUSION: A positive FANA is common in women who are evaluated by our Obstetrics and Gynecology service. No specific reproductive indication was associated with a greater propor t ion of high positive FANA.

Table

INDICATION N POS (%) HIGH POS (%)

Abort ion 100 51 (51) 7 (7) Preeclampsia 75 39 (52) 8 (11) Fetal death 41 26 (63) 5 (12) Decreased ainniotic fluid 37 14 (38) 2 (5) Fetal growth restriction 34 15 (44) 5 (15) Pretermn labor 23 9 (39) 2 (9) Abruption 19 7 (37) 2 (11) Neonatal death 8 2 (25) 0 Fetal abnormality 7 3 (43) 1 (14)

357 MANAGEMENT OF HYDRONF~HROSIS IN PREGNANCY OFER FAINARU ~, BENY ALMOG 1, RONI GAMZU 1, JOSEPH LESSING 1, MICHAEL KUPFER- MINC 1, ITel Aviv University, Obstetrics and Gynecology, Tel Aviv

OBJECTIVE: Hydronephrosis is physiologic in up to 90% of pregnancies. This condi t ion may become symptomatic and progress to an infection endange r ing m o t h e r and terns. We pe r fo rmed this study to evaluate the treatment measures for acute symptomatic hydronephrosis in pregnancy.

STUDY DESIGN: Of the 30,552 women delivering in our institution in the last 3.5 years, 56 women (0.2%) were admitted for symptomatic hydronephro- sis. They were treated conservatively by analgetics, hydration and antibiotics. Failure of these measures: nonresolving infection; de ter iora t ing renal function; absence of doppler evidence of ureteral flow; or intractable pain, led to ins t rumental dra inage. A double pigtail uretr ic stent was passed u n d e r cystoscopic vision and sonographic guidance.

RESULTS: Conservative t rea tment led to resolut ion in 5 2 / 5 6 pat ients (92.9%), whereas 4 /56 patients (7.1%) failed to respond and were treated successfully and without complications by pigtail insertion. Early induction of labor was unnecessary and good perinatal outcome was the rule.

CONCLUSION: Al though the vast majority of cases of symptomatic hydronephrosis in pregnancy may be treated conservatively, pigtail insertion is an efficient and safe modality for the rare patient with refractory symptoms. Table Patient data

CONSERVATIVE PIGTAIL:

TREATMENT 1 2 3 4

Age (yrs) 26 -- 5 29 20 30 30 Gest age (wks) 26.0 + 4.8 28 23 28 26 % prinfipara 68 prinfi primi pritui multi Hydronephrosis R-86.5%; L-13.5% R R bilat. R

side BUN (mg/dl) 5.8 + 2.2 26 7 30 10 Cr (mg/dl) 0.67 +_ 0.15 1.4 0.8 1.5 1.0 WBC 12.1 + 0.4 22 9 8.5 11.7 Hydronephrosis 73.2%; 19.2%; 7.6% 3 2 3 3

grade 1 / 2 / 3 Hospitalization 5.3 + 1.6 8 10 16 11

(days)

359 MOOD DISTURBANCE DURING PREGNANCY IS N O T ASSOCIATED WITH MODE OF DELIVERY JENNIFER WU 1, ADELE V1GUEIL~.2, LAURA RILEY 3, LEE COHEN 2, .JEFFREY ECKER4; 1Massachusetts General Hospital, Obstetrics and Gynecology, Brookline, MA; 2Massachusetts General Hospital, Perinatal and Reproductive Psychiatl T Program, Boston, MA; 3Massachusetts General Hospital, Ob/Gyn , Boston, MA; 4Harvard University, Maternal Fetal Medicine, Boston, MA

OBJECTIVE: In pr ior studies, mood disturbance has been associated with poor obstetric outcomes. The purpose of this study was to determine whether depression dur ing pregnancy is associated with a highe r frequency of cesarean or assisted vaginal delivery.

STUDY DESIGN: The s tandardized Center tb r Epidemiologic Studies Depression Scale (CES-D) survey was offered to all antenatal patients in their second trimester fi'om January 1996 to December 1999 at the Massachusetts General Hospital. Maternal demographics and pregnancy outcome data were collected from a computerized database on the 1067 patients who completed the CES-D surveys. A CES-D score -> 16 was considered to indicate significant depressive symptoms. Rates of cesarean section and assisted vaginal delivery in women with and without scores >16 were compared. Statistical analysis was perfor tued using Z 2 analysis.

RESULTS: 174 women (16.3%) of the study populat ion had CES-D scores >16. Among all subjects, the cesarean section rate was 23.4%, and the assisted vaginal delivery rate was 9.1%. There was no statistically significant difference between the rate of cesarean section (24.7% vs 23.2%) or assisted vaginal delivery (9.2% vs 9.0%) in women with and without elevated CES-D scores (P= .71). These f indings did not change when nul t iparous a n d mul t iparous patients were analyzed separately, when the definition of patients at risk for depression was expanded to include women who indicated current or past use of antidepressants, or when the cut-off CES-D score criteria was increased to 20 or 25. With our sample size, an c~ ~ .05 and a [3 = .2, we had the power to detect a 10% difference between our two groups.

CONCLUSION: Data f rom this study did no t suppor t a re la t ionship between mood disturbance and mode of delivery.