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455 Failure of E. Colt Lipopolysaccharide to Stimulate Labor
SPO Abstracts
Volume 168 Kumber 1, Part 2
455
FAILURE OF E. COLI LIPOPOLYSACCHARIDE TO STIMULATE' LABOR. E.R. Newton N.T. Field, K. Kagan-Hallet,' W. Pea irs.' Depts. of Ob/Gyn a;;d Pathology, Univ. of Texas Health Science Center, San Antonio, TX OBJECTIVE: Our purfose was to determine whether an intrauterine injection 0 E. coli lipopolysaccharide (LPS) causes preterm labor. STUDY DESIGN: Under hysteroscopic visualization, we injected each uterine horn of 33 pregnant (70% gestation) rabbits with 0.2 to 1 cc solution containing 10,50, 100,200 or 300]J!iI LPS. Control animals received 0.2 cc saline/horn (n = 22). Two anImals received 200 ]Jg intravenous LPS. The animals were sacrificed at 96 hours, or when preterm labor (PML) was noted. RESULTS: 32/33 LPS treated and 22/22 saline-treated animals had negative decidual cultures at sacrifice. Both pregnant animals that received 200 ]Jg intravenous LPS died. Treatment
N
Saline
22
0
3
0
10 ]Jg LPS/horn
Maternal death
25 ]Jg LPS/horn
2
0
50 ]Jg LPS/horn
3
a
100 ]Jg LPS/horn
2
0
200 ]Jg LPS/horn
15
0
300 ]Jg LPS/horn
8
457 BACTERIAL VAGINOSIS IN PREGNANT ADOLESCENTS:
PREVALENCE AND PERINATAL OUTCOME. ~,J. Hauth, M.K. OW, D. Ogden', L. Wallace', R. Bagby". Dept. of OB/GYN Univ. of Alabama at Birmingham, Birmingham, AL. OBJECTIVE: To assess the prevalence of bacterial vaginosis in pregnant adolescents at initiation of prenatal care and its association with pregnancy outcome. STUDY DESIGN: Bacterial vaginosis (BV) was prospectively assessed in 83 adolescents (ages 12-16) at their initial enrollment in a teen maternity clinic. The diagnosis of BV was based on standard clinical criteria and/or a vaginal gram stain. Other markers of altered flora obtained in vaginal secretions included: vaginal pH (nitrazine and meter) > 4.5; gas liquid chromatography (GLC) succinate/lactate ratio ~ 0.4; and the presence of other volatile organic acids on GLC testing. Preterm delivery (PTD) was defined as ::; 36 wks gestation. Patients with an indicated PTD and those who received antibiotics were excluded from the outcome analySis (n=10). RESULTS: The mean gestational age (GA) at culture was 19.6 wks, and the prevalence of BV was 55%. Trichomonas was present in 13.2%, chlamydia in 17.6%, gonorrhea in 12%, and other markers of altered vaginal flora in 73.7%. BV was present in 72% of those with other markers of altered vaginal flora. The mean GA at delivery was 39.3 wks and PTD occurred in 11 patients; 2 at ::; 34 wks. The prevalence of BV, er other markers of altered vaginal flora was similar between those who delivered preterm or at term. We found no correlation between the CONCLUSIONS: presence of BV or other markers of altered vaginal flora and the occurrence of PTD.
PML
o a a
2
CONCLUSION: Intrauterine injection of LPS several times that of the lethal intravenous dose dId not result in maternal death or preterm labor. Perhaps the decidua has intrinsic defense mechanisms against LPS.
456
ANAEROBES AKE ASSOCIATED WITH ELEVATED VAGINAL pH LEVELS IN THE ABSENCE OF BACTERIAL VAGINOSIS (BV). J.M. Ernest, R. Talley", L. Hendel'1lOnx, I. Fauconierx. Dept. Ob/Gyn, Bowman Gray School of Medicine, Winston-Salem, NC. OBJECTIVE: Previous studies have shown a significant association between elevated vaginal pH levels in the absence of BV and an increased risk of P-PROM. Hypothesis: Anaerobic hacteria in the absence of BV are associated with elevated vaginal pH levels. STUDY DESIGN: Twenty-one women at increased risk for preterm birth without gram stain evidence of BV were followed with 62 weekly vaginal pH measurements and semi-quantitative vaginal cultures for aerobic and anaerobic bacteria. Continuous variables were compared by t-test and categoric variables were compared by X2 analysis and two-tailed Fisher's exact test when appropriate RESULTS:
Vagi ••1 pH ~4.5
II aerobes/culture (mean)
2.89
>4.5 2.80
P NS
II anaerobes/culture (mean)
.096
.7
<0.05
II cultures with anaerobes identified
5152
5110
<0.007
CONCLUSIONS: Anaerobes are associated with elevated vaginal pH levels in the absence of BV_ Speculation: Anaerobes in the absence of BV may be associated with an increased risk of P-PROM.
458
RE·EMERGENCE OF ACTIVE SYMPTOMATIC TUBERCULOSIS IN PREGNANCY. F.Margono·, J.Mroueh~ D.Whit~H.~ink.?~. Department
of Obstetrics and Gynecology, State University of ew
or. rooklyn-NY.
OBJECTIVE: Recently an outbreak of tuberculosis(TB) in New York City
has caused obstetricians to reacquaint themselves with an enti~ rarely seen in 'hregnancy for the past generation. This time however TB in pregnancy,
r~:«t!~n ~i:hatflVe: ~e~1 ~w:~~~~!~n~nd~ :f~tUi;~dr~ fg:~~~ TB~
In order to determine the frequency of ~ in pregnancy during this epidemic, as well as to describe its course, the following study was unoertaken. STUDY DESIGN: We reviewed and analyzed the medical records of prlfnant women who were dil!gnosed with active TB between 1985 and 1992 ~JurT~ounty Hospita.l(KCH). Ten cases were found and reviewed. Ca..
A~
~~
I
•
~~
~c@ Dx i6'e
Symptoms bead ache
2
3
4
5
6
7
!I~
!l.£il
~T>
~rp>
~f)
!lel-
f/c/m
f/e/m
CD'
g~1
~~u
NSV
TOP
1380
200
D
•
~e
30e Ise
~
wre
Tl.!;day,
36
9
CompJ
oligo
37 3120
40 3020
Mise!
MRI
MRI
Delivery Gest age Weight
P<4 C
CD'
NSV
1l'Alab
CS
Dooe
NA Dooe
fev
D
PTL
NA pre-
lerm
3
fev
Y
~es
c +ppd
r~1
NSV
9
~rp>
~~
n
~re
IsS
19c 33c
fev
+PP
tIm
flmJc
TI<4 gul
~
•
NSV
NSV
nODe
none
3500
2200
2900
+Bx
!nil
+B,
+Cx
+HIV NA
8
D
H
~
PTL
H
-HIV lUGR
flmlc
D
flmlc fev
g:j'
~31
UD-
CS
M
~
1820
r!if fetal
ascit
f~ir
10
~
!W>
~6s
rIm
rt
+nxl
undel
PTL
died
+HIV
~ lUGR
B(II)=BIack(Hai.);B(U) = BJack(USA);O(C) = OrienW(Cbioa);F/C/M =raligue,coogb,maJa;,e: pul=pu1m~AP~eu=pleura;
med=mediastinum; cav=cavttary TB; fev=fever
1991
CONCLUSION: In the 6 years between 1985 and 1990 4 cases of active TB were reported at KCHC (.80 cases/year).ln the I 112 years from to mid 19926 cases were reported at the same mstitution(4 cases/year). Six women
underwent testing for HIV of whom four were p'ositive. Screening for TB with skin tests among HIV infected women may be complicated by relative anergy. In addition to the rapid increase In cases and new clinical complications related to coinfection with HIV. obstetrical problems
~~~tid~W~~r~soh!dtegr~~~Jr~ ~~r~~:~~tA;dhedeei~f~~~nfha~~e~~ew~~
emergence of TB as a pregnancy complication, along with old morbidities and new manifestations requires obstetricians to acquaint themselves with appropriate diagnostic and therapeutic approaches.
423
Volume 168 Kumber 1, Part 2
455
FAILURE OF E. COLI LIPOPOLYSACCHARIDE TO STIMULATE' LABOR. E.R. Newton N.T. Field, K. Kagan-Hallet,' W. Pea irs.' Depts. of Ob/Gyn a;;d Pathology, Univ. of Texas Health Science Center, San Antonio, TX OBJECTIVE: Our purfose was to determine whether an intrauterine injection 0 E. coli lipopolysaccharide (LPS) causes preterm labor. STUDY DESIGN: Under hysteroscopic visualization, we injected each uterine horn of 33 pregnant (70% gestation) rabbits with 0.2 to 1 cc solution containing 10,50, 100,200 or 300]J!iI LPS. Control animals received 0.2 cc saline/horn (n = 22). Two anImals received 200 ]Jg intravenous LPS. The animals were sacrificed at 96 hours, or when preterm labor (PML) was noted. RESULTS: 32/33 LPS treated and 22/22 saline-treated animals had negative decidual cultures at sacrifice. Both pregnant animals that received 200 ]Jg intravenous LPS died. Treatment
N
Saline
22
0
3
0
10 ]Jg LPS/horn
Maternal death
25 ]Jg LPS/horn
2
0
50 ]Jg LPS/horn
3
a
100 ]Jg LPS/horn
2
0
200 ]Jg LPS/horn
15
0
300 ]Jg LPS/horn
8
457 BACTERIAL VAGINOSIS IN PREGNANT ADOLESCENTS:
PREVALENCE AND PERINATAL OUTCOME. ~,J. Hauth, M.K. OW, D. Ogden', L. Wallace', R. Bagby". Dept. of OB/GYN Univ. of Alabama at Birmingham, Birmingham, AL. OBJECTIVE: To assess the prevalence of bacterial vaginosis in pregnant adolescents at initiation of prenatal care and its association with pregnancy outcome. STUDY DESIGN: Bacterial vaginosis (BV) was prospectively assessed in 83 adolescents (ages 12-16) at their initial enrollment in a teen maternity clinic. The diagnosis of BV was based on standard clinical criteria and/or a vaginal gram stain. Other markers of altered flora obtained in vaginal secretions included: vaginal pH (nitrazine and meter) > 4.5; gas liquid chromatography (GLC) succinate/lactate ratio ~ 0.4; and the presence of other volatile organic acids on GLC testing. Preterm delivery (PTD) was defined as ::; 36 wks gestation. Patients with an indicated PTD and those who received antibiotics were excluded from the outcome analySis (n=10). RESULTS: The mean gestational age (GA) at culture was 19.6 wks, and the prevalence of BV was 55%. Trichomonas was present in 13.2%, chlamydia in 17.6%, gonorrhea in 12%, and other markers of altered vaginal flora in 73.7%. BV was present in 72% of those with other markers of altered vaginal flora. The mean GA at delivery was 39.3 wks and PTD occurred in 11 patients; 2 at ::; 34 wks. The prevalence of BV, er other markers of altered vaginal flora was similar between those who delivered preterm or at term. We found no correlation between the CONCLUSIONS: presence of BV or other markers of altered vaginal flora and the occurrence of PTD.
PML
o a a
2
CONCLUSION: Intrauterine injection of LPS several times that of the lethal intravenous dose dId not result in maternal death or preterm labor. Perhaps the decidua has intrinsic defense mechanisms against LPS.
456
ANAEROBES AKE ASSOCIATED WITH ELEVATED VAGINAL pH LEVELS IN THE ABSENCE OF BACTERIAL VAGINOSIS (BV). J.M. Ernest, R. Talley", L. Hendel'1lOnx, I. Fauconierx. Dept. Ob/Gyn, Bowman Gray School of Medicine, Winston-Salem, NC. OBJECTIVE: Previous studies have shown a significant association between elevated vaginal pH levels in the absence of BV and an increased risk of P-PROM. Hypothesis: Anaerobic hacteria in the absence of BV are associated with elevated vaginal pH levels. STUDY DESIGN: Twenty-one women at increased risk for preterm birth without gram stain evidence of BV were followed with 62 weekly vaginal pH measurements and semi-quantitative vaginal cultures for aerobic and anaerobic bacteria. Continuous variables were compared by t-test and categoric variables were compared by X2 analysis and two-tailed Fisher's exact test when appropriate RESULTS:
Vagi ••1 pH ~4.5
II aerobes/culture (mean)
2.89
>4.5 2.80
P NS
II anaerobes/culture (mean)
.096
.7
<0.05
II cultures with anaerobes identified
5152
5110
<0.007
CONCLUSIONS: Anaerobes are associated with elevated vaginal pH levels in the absence of BV_ Speculation: Anaerobes in the absence of BV may be associated with an increased risk of P-PROM.
458
RE·EMERGENCE OF ACTIVE SYMPTOMATIC TUBERCULOSIS IN PREGNANCY. F.Margono·, J.Mroueh~ D.Whit~H.~ink.?~. Department
of Obstetrics and Gynecology, State University of ew
or. rooklyn-NY.
OBJECTIVE: Recently an outbreak of tuberculosis(TB) in New York City
has caused obstetricians to reacquaint themselves with an enti~ rarely seen in 'hregnancy for the past generation. This time however TB in pregnancy,
r~:«t!~n ~i:hatflVe: ~e~1 ~w:~~~~!~n~nd~ :f~tUi;~dr~ fg:~~~ TB~
In order to determine the frequency of ~ in pregnancy during this epidemic, as well as to describe its course, the following study was unoertaken. STUDY DESIGN: We reviewed and analyzed the medical records of prlfnant women who were dil!gnosed with active TB between 1985 and 1992 ~JurT~ounty Hospita.l(KCH). Ten cases were found and reviewed. Ca..
A~
~~
I
•
~~
~c@ Dx i6'e
Symptoms bead ache
2
3
4
5
6
7
!I~
!l.£il
~T>
~rp>
~f)
!lel-
f/c/m
f/e/m
CD'
g~1
~~u
NSV
TOP
1380
200
D
•
~e
30e Ise
~
wre
Tl.!;day,
36
9
CompJ
oligo
37 3120
40 3020
Mise!
MRI
MRI
Delivery Gest age Weight
P<4 C
CD'
NSV
1l'Alab
CS
Dooe
NA Dooe
fev
D
PTL
NA pre-
lerm
3
fev
Y
~es
c +ppd
r~1
NSV
9
~rp>
~~
n
~re
IsS
19c 33c
fev
+PP
tIm
flmJc
TI<4 gul
~
•
NSV
NSV
nODe
none
3500
2200
2900
+Bx
!nil
+B,
+Cx
+HIV NA
8
D
H
~
PTL
H
-HIV lUGR
flmlc
D
flmlc fev
g:j'
~31
UD-
CS
M
~
1820
r!if fetal
ascit
f~ir
10
~
!W>
~6s
rIm
rt
+nxl
undel
PTL
died
+HIV
~ lUGR
B(II)=BIack(Hai.);B(U) = BJack(USA);O(C) = OrienW(Cbioa);F/C/M =raligue,coogb,maJa;,e: pul=pu1m~AP~eu=pleura;
med=mediastinum; cav=cavttary TB; fev=fever
1991
CONCLUSION: In the 6 years between 1985 and 1990 4 cases of active TB were reported at KCHC (.80 cases/year).ln the I 112 years from to mid 19926 cases were reported at the same mstitution(4 cases/year). Six women
underwent testing for HIV of whom four were p'ositive. Screening for TB with skin tests among HIV infected women may be complicated by relative anergy. In addition to the rapid increase In cases and new clinical complications related to coinfection with HIV. obstetrical problems
~~~tid~W~~r~soh!dtegr~~~Jr~ ~~r~~:~~tA;dhedeei~f~~~nfha~~e~~ew~~
emergence of TB as a pregnancy complication, along with old morbidities and new manifestations requires obstetricians to acquaint themselves with appropriate diagnostic and therapeutic approaches.
423