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641 Lewis Antigen Expression in Women with Preterm Labor or Preterm Prom
SPO Abstracts
Volume 166 Number I, Part 2
639
PLACENTAL ABRUPTION AND RENAL DYSFUNCTION
~', FL Gaudier, JC Hauth, SP Cliver. University of Alabama at Birmingham Placental abruption severe enough to cause fetal death can result in acute renal failure or transient dysfunction. Over a seven year period (January 1983-June 1990), 37 patients with placental abruption and fetal demise were managed at our institution. Six of the women had renal dysfunction (one required dialysis on 7 occasions over 10 days). defined as a maximum serum creatinine ~3.0 mg/dl. These women were compared to those whose creatinine remained <3.0 mg/dl (n=31). Both groups had a similar maternal age and parity, gestational age, and birth weight. Their admission hematologic and coagulation studies and mean units of blood, other blood products, or crystalloid given in the first 6 or 12 hours were similar. The diagnosis· to-transfusion or delivery intervals were similar in each group. Serum creatinine and urine output (UOP) values were: Maximum Maximum P Creatine Creatine Value Serurn Creatnines/Urine Output <3.0 mgJdl >3.0 mg/dl Admission creatinine (mg/dl) Discharge creatinine (mg/dl) Maximum creatinine (rng/dl) Urine output-first 6 hrs (cc/hr) Urine output-first 12 hrs (ce/hr)
0.9 0.9 1.1
53
65
1.5 2.2 6.6 21 33
641
LEWIS ANTIGEN EXPRESSION IN WOMEN WITH PRETERM LABOR OR PRETERM PROM, William F. O'Brien, German Leparc', Jodi Holbrook" Unlv of South Florida, Tampa, FL lewis sntlgens sre polysacharldes produced by a number of cell types which are transported In the circulation by adsorption to red cell membranes. The Inclusion of lewis antigens Into the cellular membrane Interferes with the attachment of gram negative bacterial pill to the cell resulting In a natural defense against colonization In Individuals who express the Lewis antigen. Expression of lewis antigens has been shown to be an Important risk factor In women with recurrent urinary tract Infection with a higher frequency of non-expression (a-b-) In women with recurrent Infection. In view of the Importance of genital tract Infection In preterm labor (PTL) preterm premature rupture of the membranes (PROM) we Investigated the possible association of these complications with lewis antigen phenotype as expressed on red blood cell membranes. White Black LEWIS PROM PTL Control PROM PTL Control a-b+ 18 (60) 15 (75) 38 (58) 15 (42) 15 (56) 21 (38) a+b7 (23) 3 (15) 16 (24) 6 (17) 3 (11) 9 (16) a-b5 (17) 2 (10) 12 (18) 15 (42) 9 (33) 26 (46) Although the Incidence of women who failed to express lewis antigens was significantly higher when compared to a non-pregnant population, when the resulta were adjusted for race there was no evidence of an excessive rate of a-bwomen In the PROM or PTL groups. It appears that lewis antigen expression and therefore bacterial attachment to vaginal epithelium Is not an Important component In the risk of PROM or PTL.
642
PREVALENCE OF SEXUALLY TRANSMITTED DISEASE IN HIV SEROPOSITIVE PREGNANT WOMEN. Sharon L. Patrick, M.D! and Harold E. Fox, M.D., Department of Obstetrics and Gynecology, Sloane Hospital for Women, Columbia Presbyterian Medical Center, New York, NY
.06 .04 .03 <.01 .01
All six women with a maximum serum creatinine of ~3 mg/dl had preeclampsia and thrombocytopenia «100,000 platelets/mm3) versus 19 (60%) of those whose maximum creatinine remained <3.0. Hypofibrinogenemia « t 50 mg/dl) was Similar in both groups. For both groups, the amount of crystalloid and blood infused was similar in the first 6 or 12 hours but the women with a subsequent creatinine of ~3 had a significantly lower UOP during this interval, and eventually received more blood therapy. An analysis of the 37 patients based on a maximum creatinine of <1.4 or ~1.4 mg/dl yielded similar results. We speculate that more prompt and adequate correction of intravascular volume may have ameliorated the renal dysfunction in these six women. However, we cannot be certain that the subsequent renal dysfunction had not been determined by events and tirning that occurred prior to admission since these six women trended toward a higher creatinine level on admission.
640 SINGLE DOSE ANTIBIOTIC THERAPY FOR CLINICAL CHORIOAMNIONITIS PRIOR TO VAGINAL DELIVERY_ C. Berr~_x, K.A. Hansen', J.F. McCaul, Dept of Ob!Gyn, Naval Hospital, Portsmouth, Virginia. Intrapartum antibiotics for clinical chorioamnionitis (CHOR) is well established treatment. Anecdotal and retrospective data suggest that vaginal delivery without postpartum antibiotics may be adequate therapy. We hypothesized that patients with CHOR who deliver vaginally do not benefit from postpartum antibiotics in the absence of persistent fever. 41 term laboring patients diagnosed with CHOR who subsequently delivered vaginally after a single dose of ampicillin and gentamicin were prospectively randomized_ 21 received continuous antibiotic therapy and 19 were assigned a placebo in a double-blinded fashion. One subject in each arm had continued postpartum febrility (p = 0.74, by Fischer's exact test). We conclude that patients with CHOR who deliver vaginally can safely be observed for signs of persistent infection without continuing postpartum IV antibiotics.
Pregnant women infected with the human immunodeficiency virus (HIV) are more likely to contract sexually transmined diseases (STDs); the magnitude of this problem varies among popUlations. We compared the prevalence of STDs in pregnant HIV seropositive (HIV +) women with pregnant HIV seronegative (HIV-) and non-pregnantHIV + individuals. In a retrospective case-controlled study, thirty-three pregnant women who were HIV + underwent routine prenatal screening for syphilis, hepatitis B surface antigen (HBsAg) and PAP smear analysis. These women were matched for age and socioeconomic status with both pregnant HIV- women and non-pregnant HIV + women. Results were analyzed using Chi square contingency table analysis. The HIV + gravidas had a syphilis prevalence of36% which was fourtimes higher than the pregnant HIV- women (p
441
Volume 166 Number I, Part 2
639
PLACENTAL ABRUPTION AND RENAL DYSFUNCTION
~', FL Gaudier, JC Hauth, SP Cliver. University of Alabama at Birmingham Placental abruption severe enough to cause fetal death can result in acute renal failure or transient dysfunction. Over a seven year period (January 1983-June 1990), 37 patients with placental abruption and fetal demise were managed at our institution. Six of the women had renal dysfunction (one required dialysis on 7 occasions over 10 days). defined as a maximum serum creatinine ~3.0 mg/dl. These women were compared to those whose creatinine remained <3.0 mg/dl (n=31). Both groups had a similar maternal age and parity, gestational age, and birth weight. Their admission hematologic and coagulation studies and mean units of blood, other blood products, or crystalloid given in the first 6 or 12 hours were similar. The diagnosis· to-transfusion or delivery intervals were similar in each group. Serum creatinine and urine output (UOP) values were: Maximum Maximum P Creatine Creatine Value Serurn Creatnines/Urine Output <3.0 mgJdl >3.0 mg/dl Admission creatinine (mg/dl) Discharge creatinine (mg/dl) Maximum creatinine (rng/dl) Urine output-first 6 hrs (cc/hr) Urine output-first 12 hrs (ce/hr)
0.9 0.9 1.1
53
65
1.5 2.2 6.6 21 33
641
LEWIS ANTIGEN EXPRESSION IN WOMEN WITH PRETERM LABOR OR PRETERM PROM, William F. O'Brien, German Leparc', Jodi Holbrook" Unlv of South Florida, Tampa, FL lewis sntlgens sre polysacharldes produced by a number of cell types which are transported In the circulation by adsorption to red cell membranes. The Inclusion of lewis antigens Into the cellular membrane Interferes with the attachment of gram negative bacterial pill to the cell resulting In a natural defense against colonization In Individuals who express the Lewis antigen. Expression of lewis antigens has been shown to be an Important risk factor In women with recurrent urinary tract Infection with a higher frequency of non-expression (a-b-) In women with recurrent Infection. In view of the Importance of genital tract Infection In preterm labor (PTL) preterm premature rupture of the membranes (PROM) we Investigated the possible association of these complications with lewis antigen phenotype as expressed on red blood cell membranes. White Black LEWIS PROM PTL Control PROM PTL Control a-b+ 18 (60) 15 (75) 38 (58) 15 (42) 15 (56) 21 (38) a+b7 (23) 3 (15) 16 (24) 6 (17) 3 (11) 9 (16) a-b5 (17) 2 (10) 12 (18) 15 (42) 9 (33) 26 (46) Although the Incidence of women who failed to express lewis antigens was significantly higher when compared to a non-pregnant population, when the resulta were adjusted for race there was no evidence of an excessive rate of a-bwomen In the PROM or PTL groups. It appears that lewis antigen expression and therefore bacterial attachment to vaginal epithelium Is not an Important component In the risk of PROM or PTL.
642
PREVALENCE OF SEXUALLY TRANSMITTED DISEASE IN HIV SEROPOSITIVE PREGNANT WOMEN. Sharon L. Patrick, M.D! and Harold E. Fox, M.D., Department of Obstetrics and Gynecology, Sloane Hospital for Women, Columbia Presbyterian Medical Center, New York, NY
.06 .04 .03 <.01 .01
All six women with a maximum serum creatinine of ~3 mg/dl had preeclampsia and thrombocytopenia «100,000 platelets/mm3) versus 19 (60%) of those whose maximum creatinine remained <3.0. Hypofibrinogenemia « t 50 mg/dl) was Similar in both groups. For both groups, the amount of crystalloid and blood infused was similar in the first 6 or 12 hours but the women with a subsequent creatinine of ~3 had a significantly lower UOP during this interval, and eventually received more blood therapy. An analysis of the 37 patients based on a maximum creatinine of <1.4 or ~1.4 mg/dl yielded similar results. We speculate that more prompt and adequate correction of intravascular volume may have ameliorated the renal dysfunction in these six women. However, we cannot be certain that the subsequent renal dysfunction had not been determined by events and tirning that occurred prior to admission since these six women trended toward a higher creatinine level on admission.
640 SINGLE DOSE ANTIBIOTIC THERAPY FOR CLINICAL CHORIOAMNIONITIS PRIOR TO VAGINAL DELIVERY_ C. Berr~_x, K.A. Hansen', J.F. McCaul, Dept of Ob!Gyn, Naval Hospital, Portsmouth, Virginia. Intrapartum antibiotics for clinical chorioamnionitis (CHOR) is well established treatment. Anecdotal and retrospective data suggest that vaginal delivery without postpartum antibiotics may be adequate therapy. We hypothesized that patients with CHOR who deliver vaginally do not benefit from postpartum antibiotics in the absence of persistent fever. 41 term laboring patients diagnosed with CHOR who subsequently delivered vaginally after a single dose of ampicillin and gentamicin were prospectively randomized_ 21 received continuous antibiotic therapy and 19 were assigned a placebo in a double-blinded fashion. One subject in each arm had continued postpartum febrility (p = 0.74, by Fischer's exact test). We conclude that patients with CHOR who deliver vaginally can safely be observed for signs of persistent infection without continuing postpartum IV antibiotics.
Pregnant women infected with the human immunodeficiency virus (HIV) are more likely to contract sexually transmined diseases (STDs); the magnitude of this problem varies among popUlations. We compared the prevalence of STDs in pregnant HIV seropositive (HIV +) women with pregnant HIV seronegative (HIV-) and non-pregnantHIV + individuals. In a retrospective case-controlled study, thirty-three pregnant women who were HIV + underwent routine prenatal screening for syphilis, hepatitis B surface antigen (HBsAg) and PAP smear analysis. These women were matched for age and socioeconomic status with both pregnant HIV- women and non-pregnant HIV + women. Results were analyzed using Chi square contingency table analysis. The HIV + gravidas had a syphilis prevalence of36% which was fourtimes higher than the pregnant HIV- women (p
441