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286 Prematurity, Intraamniotic Infection and Fetal Biophysical Profile
SPO Abstracts
Volume 168 Number 1, Part 2
284
285
SYSTEMIC AND LOCAL CYTOKINE PROFILE IN ENDOTOXIN INDUCED PRETERM BIRTH, R, Romero. P. Baumann', P. Fidel', M. Ramirez', H. Araneda', D.B. Cotton. Dept. of Ob/Gyn, Wayne State Univ., Detroit, MI; and the Perinatology Branch, NICHD, Bethesda, MD. BACKGROUND: The mechanisms responsible for preterm labor in the setting of maternal systemic febrile illnesses (i.e. pyelonephritis, pneumonia) have not been elucidated. A likely mechanism i. the release of cytokines by monocytes/macrophages in response to bacterial endotoxin. Cytokines, in turn, stimulate prostaglandin production and may lead to preterm parturition. OBJECTIVE: To 1) determine if systemic administration of bacterial endotoxin (LPS) can induce pretlitrm labor and delivery; and 2) describe the temporal relationship betwliten LPS administration, systemic and local changes of cytokine concentrations and preterm delivery. STUDY DESIGN: C3H/HEN pregnant mice at 16 days of gestation (70% gestation) were randomized to receive a systemic injection of LPS (doses of 12.6, 20, 26, 36, 60 and 100 jig/animal) or phosphate buffer saline (PBS) (n = 96). The dose of LPS which caused consistent preterm birth without maternal death was determined. Another set of animals was then randomized to receive that dose of LPS or PBS (n = 39). Mice were sacrificed at 1, 4 and 10 h, and blood and amniotic fluid was obtained. Interleukin·la (lL·la), tumor necrosis factor a (TNFa) and interleukin·6 (lL·6) were determined with sensitive and specific ELiSAs for murine cytokines. RESULTS: 1) Systemic administration of LPS induced consistent preterm delivery at a dose of 60 jlg/animal without maternal death. 2) LPS treated animals delivered at a median of 16.6 h (range: 10·37 h) as compared to the median of 89 h of PBS treated animals (range: 81·106 h, p
286
mlcr 01 KlfROIIDAIOLI II mum IIfH HISrORY 01 pmlRl BIRrH 110 BACTERIAL YAGIIOSIS. A PUCBBO COIfROL DOUBLE BLIID STUDt. N.J. Horales, S.J. Schorr, J. Alhritton Dept. Ob/Gyn; Orlando Regional Hedical Center OBJICfIfI. To deteraine whether the treatlent with letronidazole of hacterial vaginosis (BV) in patients with prior pretera deliveries frol pretera lahor or PROM reduces the risk of hospital adlission and pretera birth. STUDY DISIGI. frol January, 1989 to June, 1992, patients with singleton gestation and history of pretera birth were referred to high risk clinics before 20 weeks. Those with diagnosis of BV were randolized by randol nUlher tahles to receive aetronidazole (H) 250 Ig tid I 10d, or placebo (P) in a double blind deSign after signing IRB consent fori. Patients were re·cultured when adlitted to the hospital. RBSULTS. Of 94 eligible patients, 80 enrolled in the study of which 44 received H. Both groups were cOlparable in terls of a nUlber of entry variables. COlpared to the P group, the M group had significantly less hospital adlissions, episodes of pretera labor as well as pretera birth; 18 vs 391 and hirth of infants <2500 g, 14 vs m. COICLUSIOI. Treatlent with H was effective in reducing preterl birth in patients with history of prelaturity and BV.
287
377
PREMATURITY, INTRAAMNIOTIC INFECTION AND FETAL BIOPHYSICAL PROfiLE P. Roussis, B. Campbell, K. Knoxx , S. Cox. Dept Ob/Oyn, Univenity of Kentucky, Lexington, Kentucky. INTRODUCTION: There i. a growing body of evidence that pretenn labor and pretenn premature rupture of the fetal membrane. is callUally related to subclinical intrumniotic infection. Recently. antenatal testa to predict chorioamnioniti •• nd fetal aepai. have been evaluated in pregnancie. complicated by pretenn PROM. OBJECTIVE: The purpoae of thi. lIIudy WII to prospectively determine the incidence of 1AI in prcgnancie. complicated by pretenn labor or premabJre rupture of the fetal membranes. Additionally, we sought to dctenninc if absent fctal breathing movement or fctal body movement on admi••ion to the labor hall could ICrvC I. an indicator of subaequent infection. STUDY DESIGN: On admission to the labor unit a fetal biophysical profile was performed and amniotic fluid was retrieved by transabdominal .mniocentesi. from 30 women with PPROM and 72 pregnancies complicated by pretenn labor. Fluid WI. cultured for aerobic and anaerobic microorganisms. Endotoxin wal determined by the limulus amoebocyte lysate test. RESULTS: The relUits are .ummarized in the following table. PROM
IAI
+
n=
5 4 (80%) 2 (40%)
culture po.itive LPS po.itive dilCha..,e undelivered mean time to delivery (day.)
+
FBM
·FBM - Fetal movement
25 0 0 o 3 6.4 8.6 5 (100%) 19 (76%) o 6 (24%) 1(20%) 0
+
PTL
2 0 2 (100%) I (50%) 3 1(50%) 112 0
70 0 70 (0%) 29 (41 %) 17.7 45 (80%) 11 (20%) 0
CONCLUSION. From the .. data we conclude that biophYlical parameten (ie. Fetal Breathing and Fetal Body Movement) on admission to labor hall do not correlate with IAI. The incidence of IAI in thOle preglll.ncie. delivered within 48 boun of admillion (n=23) was 26% and FBM was absent in two of the six (33%) but fetal body movementa were present in all.
THE AMNIOTIC FLUID INDEX AND PRETERM PREMA lURE RUPTURE OF THE MEMBRANES. CORRELATES WITH OUTCOME. R.B. Kurzel and F. Mazdisnianx , Dept. OB/GYN, Olive View/UCLA Medical Center, Sylmar, CA. OBJECTIVE: To detennine the clinical consequences of oligohydramnios seen in pretenn premature rupture of the membrane. (pPROM), by degree of severity as quantitated by the amniotic fluid index (AFI). STUDY DESIGN: 51 patienll with PPROM, co_rvatively managed, had daily AFI. perfonned, and continuous fetal heart rate (FHR) recording. All patientJ were given tocolysis. antibiotic. until 8-5trep. cultures were available. and .teroids if leIS than 34 wka. Frequency of FHR decelerations were noted, not a.lOCiated with accelerations or contractions, and were studied relative to AFI. Other parameteR studied were incidence of cord accidents, contracture anomalie., ms, and latency period. Significance was AlIO noted wa. the temporal studied by the Student'. paired t-Test. variation in API. RESULTS. The mean gestational age (G.A.) at PPROM was 32.0 wks (<1 = 3.0). The mean AFI in this study wa. 6.5 (<1 = 3.3). ComparilODI were made between two groups, patients with AFI < 6.5, and those with. AFI:!:: 6.5. Patients with low API had a significant association with lower G.A.s (AFI < 6.5: X = 31.3 wk., <1 = 3.5; AFI ~ 6.5: X = 33.0 wks, <1 = 1.6; p = 0.020). There were no cord accidents. Of 5 neolll.tal death., none were related to AFI (1 sepsis, & 4 ICvere prematurity). All modente-lCvere cases ofRDS were in G .A. ::!: 29 wks, which coincidentally corresponded to low AFIs (8/9 with AFI < 6.5). No relation wa. found between degree of oligohydramnios and 5 min. Apgar, variable deceleration frequency, or severity of variable decelerations (p> >0.25). Correcting for G.A. at PPROM, still a weak correlation wa. found for incrcllled latency with AFI < 6.5 (p=0.1O). Not infrequently, the temporal pattern of AFI in a patient with. vertex presentation may be sinusoidal (ball-valve effect). CONCLUSIONS. Barring maternal or fetal indicatioDl, there i. 110 reason to alter conservative management ofpatienll with PPROM, solely because oflow AFI. Low API is not asaociated with increased -deceleration frequency or severity due to cord compression.
Volume 168 Number 1, Part 2
284
285
SYSTEMIC AND LOCAL CYTOKINE PROFILE IN ENDOTOXIN INDUCED PRETERM BIRTH, R, Romero. P. Baumann', P. Fidel', M. Ramirez', H. Araneda', D.B. Cotton. Dept. of Ob/Gyn, Wayne State Univ., Detroit, MI; and the Perinatology Branch, NICHD, Bethesda, MD. BACKGROUND: The mechanisms responsible for preterm labor in the setting of maternal systemic febrile illnesses (i.e. pyelonephritis, pneumonia) have not been elucidated. A likely mechanism i. the release of cytokines by monocytes/macrophages in response to bacterial endotoxin. Cytokines, in turn, stimulate prostaglandin production and may lead to preterm parturition. OBJECTIVE: To 1) determine if systemic administration of bacterial endotoxin (LPS) can induce pretlitrm labor and delivery; and 2) describe the temporal relationship betwliten LPS administration, systemic and local changes of cytokine concentrations and preterm delivery. STUDY DESIGN: C3H/HEN pregnant mice at 16 days of gestation (70% gestation) were randomized to receive a systemic injection of LPS (doses of 12.6, 20, 26, 36, 60 and 100 jig/animal) or phosphate buffer saline (PBS) (n = 96). The dose of LPS which caused consistent preterm birth without maternal death was determined. Another set of animals was then randomized to receive that dose of LPS or PBS (n = 39). Mice were sacrificed at 1, 4 and 10 h, and blood and amniotic fluid was obtained. Interleukin·la (lL·la), tumor necrosis factor a (TNFa) and interleukin·6 (lL·6) were determined with sensitive and specific ELiSAs for murine cytokines. RESULTS: 1) Systemic administration of LPS induced consistent preterm delivery at a dose of 60 jlg/animal without maternal death. 2) LPS treated animals delivered at a median of 16.6 h (range: 10·37 h) as compared to the median of 89 h of PBS treated animals (range: 81·106 h, p
286
mlcr 01 KlfROIIDAIOLI II mum IIfH HISrORY 01 pmlRl BIRrH 110 BACTERIAL YAGIIOSIS. A PUCBBO COIfROL DOUBLE BLIID STUDt. N.J. Horales, S.J. Schorr, J. Alhritton Dept. Ob/Gyn; Orlando Regional Hedical Center OBJICfIfI. To deteraine whether the treatlent with letronidazole of hacterial vaginosis (BV) in patients with prior pretera deliveries frol pretera lahor or PROM reduces the risk of hospital adlission and pretera birth. STUDY DISIGI. frol January, 1989 to June, 1992, patients with singleton gestation and history of pretera birth were referred to high risk clinics before 20 weeks. Those with diagnosis of BV were randolized by randol nUlher tahles to receive aetronidazole (H) 250 Ig tid I 10d, or placebo (P) in a double blind deSign after signing IRB consent fori. Patients were re·cultured when adlitted to the hospital. RBSULTS. Of 94 eligible patients, 80 enrolled in the study of which 44 received H. Both groups were cOlparable in terls of a nUlber of entry variables. COlpared to the P group, the M group had significantly less hospital adlissions, episodes of pretera labor as well as pretera birth; 18 vs 391 and hirth of infants <2500 g, 14 vs m. COICLUSIOI. Treatlent with H was effective in reducing preterl birth in patients with history of prelaturity and BV.
287
377
PREMATURITY, INTRAAMNIOTIC INFECTION AND FETAL BIOPHYSICAL PROfiLE P. Roussis, B. Campbell, K. Knoxx , S. Cox. Dept Ob/Oyn, Univenity of Kentucky, Lexington, Kentucky. INTRODUCTION: There i. a growing body of evidence that pretenn labor and pretenn premature rupture of the fetal membrane. is callUally related to subclinical intrumniotic infection. Recently. antenatal testa to predict chorioamnioniti •• nd fetal aepai. have been evaluated in pregnancie. complicated by pretenn PROM. OBJECTIVE: The purpoae of thi. lIIudy WII to prospectively determine the incidence of 1AI in prcgnancie. complicated by pretenn labor or premabJre rupture of the fetal membranes. Additionally, we sought to dctenninc if absent fctal breathing movement or fctal body movement on admi••ion to the labor hall could ICrvC I. an indicator of subaequent infection. STUDY DESIGN: On admission to the labor unit a fetal biophysical profile was performed and amniotic fluid was retrieved by transabdominal .mniocentesi. from 30 women with PPROM and 72 pregnancies complicated by pretenn labor. Fluid WI. cultured for aerobic and anaerobic microorganisms. Endotoxin wal determined by the limulus amoebocyte lysate test. RESULTS: The relUits are .ummarized in the following table. PROM
IAI
+
n=
5 4 (80%) 2 (40%)
culture po.itive LPS po.itive dilCha..,e undelivered mean time to delivery (day.)
+
FBM
·FBM - Fetal movement
25 0 0 o 3 6.4 8.6 5 (100%) 19 (76%) o 6 (24%) 1(20%) 0
+
PTL
2 0 2 (100%) I (50%) 3 1(50%) 112 0
70 0 70 (0%) 29 (41 %) 17.7 45 (80%) 11 (20%) 0
CONCLUSION. From the .. data we conclude that biophYlical parameten (ie. Fetal Breathing and Fetal Body Movement) on admission to labor hall do not correlate with IAI. The incidence of IAI in thOle preglll.ncie. delivered within 48 boun of admillion (n=23) was 26% and FBM was absent in two of the six (33%) but fetal body movementa were present in all.
THE AMNIOTIC FLUID INDEX AND PRETERM PREMA lURE RUPTURE OF THE MEMBRANES. CORRELATES WITH OUTCOME. R.B. Kurzel and F. Mazdisnianx , Dept. OB/GYN, Olive View/UCLA Medical Center, Sylmar, CA. OBJECTIVE: To detennine the clinical consequences of oligohydramnios seen in pretenn premature rupture of the membrane. (pPROM), by degree of severity as quantitated by the amniotic fluid index (AFI). STUDY DESIGN: 51 patienll with PPROM, co_rvatively managed, had daily AFI. perfonned, and continuous fetal heart rate (FHR) recording. All patientJ were given tocolysis. antibiotic. until 8-5trep. cultures were available. and .teroids if leIS than 34 wka. Frequency of FHR decelerations were noted, not a.lOCiated with accelerations or contractions, and were studied relative to AFI. Other parameteR studied were incidence of cord accidents, contracture anomalie., ms, and latency period. Significance was AlIO noted wa. the temporal studied by the Student'. paired t-Test. variation in API. RESULTS. The mean gestational age (G.A.) at PPROM was 32.0 wks (<1 = 3.0). The mean AFI in this study wa. 6.5 (<1 = 3.3). ComparilODI were made between two groups, patients with AFI < 6.5, and those with. AFI:!:: 6.5. Patients with low API had a significant association with lower G.A.s (AFI < 6.5: X = 31.3 wk., <1 = 3.5; AFI ~ 6.5: X = 33.0 wks, <1 = 1.6; p = 0.020). There were no cord accidents. Of 5 neolll.tal death., none were related to AFI (1 sepsis, & 4 ICvere prematurity). All modente-lCvere cases ofRDS were in G .A. ::!: 29 wks, which coincidentally corresponded to low AFIs (8/9 with AFI < 6.5). No relation wa. found between degree of oligohydramnios and 5 min. Apgar, variable deceleration frequency, or severity of variable decelerations (p> >0.25). Correcting for G.A. at PPROM, still a weak correlation wa. found for incrcllled latency with AFI < 6.5 (p=0.1O). Not infrequently, the temporal pattern of AFI in a patient with. vertex presentation may be sinusoidal (ball-valve effect). CONCLUSIONS. Barring maternal or fetal indicatioDl, there i. 110 reason to alter conservative management ofpatienll with PPROM, solely because oflow AFI. Low API is not asaociated with increased -deceleration frequency or severity due to cord compression.