- Email: [email protected]
464 Chorioamnion Colonization: Correlation with Gestational Age in Women Delivered Following Spontaneous Labor Versus Indicated Delivery
SPO Abstracts
Volume 168 Number I, Part 2
463
TREATMENT OF CHORIOAMNIONITIS WITH CEFOTETAN VERSUS AMPICILUN AND GENTAMICIN. E Graham. I. Forouzan, A. Cohen. Dept. of Ob/Gyn, Univ. of Pcru\., Philadelphia, PA. OBJECTIVE: The null hypo!hesis is !hat 2nd generation cephalosporins (ccfotetan) are equally as efficacious in treating chorioamnionitis as the more traditionally used antibiotics ampicillin and gentamicin (A + G). STUDY DESIGN: A retrospective analysis of 97 cases of chorioamnionitis over !he previous 2 yean; was conducted. All cases involved viable, liveborn infants at 23 or more weeks gestation. ~
465
DECREASING AMNIOTIC FLUID SOLUBLE INTERLEUKIN-2 RECEPTOR DURING NORMAL GESTATION, P Cherouny, DPJ Barton", G Pankuch', S Tabibzadeh~. The Dept. of OB/GYN, Penn State Univ, Hershey, PA and Depts. of OB/GYN 1 and pathology', Moffitt Cancer Center, Tampa, FL. OBJECTIVE: The concentration of soluble interleukin-2 receptor (sIL-2R), a potential inhibitor of IL-2 activity, in amniotic fluid from second and third trimester pregnancies was evaluated. STUDY DESIGN: Amniotic fluid from second trimester (normal genetic studies) and term pregnancies (mature fetal pulmonary studies) were evaluated for sIL-2R by ELISA (T Cell Diagnostics, Inc., Cambridge, MA). RESULTS: A significant reduction in the immunoreactive sIL-2R in amniotic fluid was noted at term (mean gest. age 38.lwks,n;6) when compared with amniotic fluid from the second trimester (mean gest. age l6.8wks,n;5) (89.6±16.1 vs. 518.7±82.0 U/ml; p
466
BLOOD CONTACTS DURING OBSTETRICAL PROCEDURES, L RUDNICK" M. CHAMBERLAND, A. PANLILIO, D. BELL, and the OB Cooperative Study Group. Hospital Infections Program, Centers for Disease Control, Atlanta, GA. OBJECTIVE: To detennine the nature and frequency of occupational blood contact (BC) among obstetrical personnel (OBP) during deliveries, and to identify how such contact might be prevented, as BC puts OBP at risk for infeetion wi!h human immunodeficiency virus (HIV) and hepatitis B virlll. STUDY DESIGN: Beginning in March 1992, trained observers monitored vaginal and cesarian deliveries at three U.S. urban hospitals where HIV oeroprevalence of child-bearing women exceeded 1%. Observers recorded infonnation about the delivery, participating OBP, use of protective equipment, and the frequency and circumstances of BC, defmed as percutaneous injuries (PIs) or skin or mucous membrane contacts. RESULTS: During !he first three mon!hs of data collection, one or more OBP had a BC during 64 (15%) of 437 vaginal and 20 (22%) of91 cesarian deliveries. Of 97 BCs, 8 (8%) were Pis 87 (90%) were skin contacts, and 2 (2%) were mucous membrane contacts. The rates of BC per 100 penon procedures varied by occupation: 13.8 for resident physicians; 8.5 for attending physicians; 7.7 for midwives; and 3.0 for medical students. Of!he 8 Pis, 3 were inflicted by ano!her team member, (2 while passing a scalpel and I while suturing); 3 occurred during phlebotomy or injection of medication; 1 occurred during needle recapping; and I occurred while an internal clip was removed from an infant's head. Of the 89 skin and mucous membrane contacts, 45 (51 %) might have been prevented by use of an appropriate barrier: 18 by an impenneable gown, 20 by any gown, I by a mask, 3 by eye protection, and 3 by gloves. The remaining 44 contacts occurred ei!her because of a glove lear (N =31), or because of contact to unprotected areas e.l:" feet, neck (N = 13). CONCLUSIONS: OOP Mft .. AfJIIft'Ciabk . - of ac dwiAg deliveries; many of IIoeoe ac. are ...-;.By JWWentable.
~
Cesarean 30 (40.0%) 9 (42.9%) Vaginal 45 (60.0%) 12 (57.1%) + 21 (2!.9%);96patients T(YfAL 75(78.1%) Everyone receiving A + G who delivered by cesarean had flagyl added postpartum. Of !he 30 patients receiving cefotetan who delivered by cesarean, 3 (10%) remained febrile and had to be switched to triples. There were no cases of pelvic abcesses or pelvic vein Ihrombophlebitis. One case complicated by hemorrhage requiring cesarean hysterectomy was excluded. RESULTS: Bo!h treatment groups were similiar in terms of gestational age (36.7 ± 4.3 vs. 33.6 ± 6.0 weeks), bir!h weight (2739 ± 929 vs. 2263 ± 1034 grams), and microbiologic results. Comparing patients who delivered vaginally, !here was no difference between !hose treated wi!h cefotetan versus A + G in terms of length of postpartum stay (2.8 ± 1.2 vs. 2.3 ± 0.5 days), number of febrile days (1.4 ± 0.9 vs. 1.0 ± 0.3 days), and peak postpartum temperature (100.4 ± 0.9 vs. 100.3 ± 1.2 OF). The patients who delivered by cesarean in !he 2 treatment groups were also similar in terms of leng!h of postpartum stay (5.8 ± 2.2 vs. 6.7 ± 2.4 days), number of febrile days (3.8 ± 2.3 vs. 4.9 ± 2.1 days), and peak postpartum temperature (101.9 ± 0.9 vs. 102.3 ± 1.2 0 F). CONCLUSION: Cefotetan is equa!!y as effective in treating chorioamnionitis as A + G. A cost analysis at !his institution showed that by treating wi!h cefotetan ra!her !han A + G, and adding flagyl if delivery is by cesarean, !here is a savings of $34.73/patient. These data suggest !hat a randomized prospective trial should be conducted.
464 CHORIOAMNION COLONIZATION: CORRELATION WITH GESTATIONAL AGE IN WOMEN DELIVERED FOLLOWING SPONTANEOUS LABOR VERSUS INDICATED DELIVERY. G. Cassell: .L.J::lau1!J., W. Andrews, G. Cutter: R. Goldenberg. Departments of Microbiology and OB/GYN, University of Alabama at Birmingham, Birmingham, AL. HYPOTHESES: Chorioamnion colonization is increased and inversely proportional to gestational age in women with intact membranes who have a spontaneous onset of labor versus women delivered for medical or obstetrical indications. STUDY DESIGN: At cesarean delivery, amniotic fluid and the chorioamnion interface were cultured for aerobes, anaerobes, ureaplasma and mycoplasma species in 609 women with intact membranes and singleton gestation. RESULTS: Sixty-four (40%) of 162 women with spontaneous labor and 57 of 447 (13%) with an indicated delivery had a positive chorioamnion culture (p
i
425
Volume 168 Number I, Part 2
463
TREATMENT OF CHORIOAMNIONITIS WITH CEFOTETAN VERSUS AMPICILUN AND GENTAMICIN. E Graham. I. Forouzan, A. Cohen. Dept. of Ob/Gyn, Univ. of Pcru\., Philadelphia, PA. OBJECTIVE: The null hypo!hesis is !hat 2nd generation cephalosporins (ccfotetan) are equally as efficacious in treating chorioamnionitis as the more traditionally used antibiotics ampicillin and gentamicin (A + G). STUDY DESIGN: A retrospective analysis of 97 cases of chorioamnionitis over !he previous 2 yean; was conducted. All cases involved viable, liveborn infants at 23 or more weeks gestation. ~
465
DECREASING AMNIOTIC FLUID SOLUBLE INTERLEUKIN-2 RECEPTOR DURING NORMAL GESTATION, P Cherouny, DPJ Barton", G Pankuch', S Tabibzadeh~. The Dept. of OB/GYN, Penn State Univ, Hershey, PA and Depts. of OB/GYN 1 and pathology', Moffitt Cancer Center, Tampa, FL. OBJECTIVE: The concentration of soluble interleukin-2 receptor (sIL-2R), a potential inhibitor of IL-2 activity, in amniotic fluid from second and third trimester pregnancies was evaluated. STUDY DESIGN: Amniotic fluid from second trimester (normal genetic studies) and term pregnancies (mature fetal pulmonary studies) were evaluated for sIL-2R by ELISA (T Cell Diagnostics, Inc., Cambridge, MA). RESULTS: A significant reduction in the immunoreactive sIL-2R in amniotic fluid was noted at term (mean gest. age 38.lwks,n;6) when compared with amniotic fluid from the second trimester (mean gest. age l6.8wks,n;5) (89.6±16.1 vs. 518.7±82.0 U/ml; p
466
BLOOD CONTACTS DURING OBSTETRICAL PROCEDURES, L RUDNICK" M. CHAMBERLAND, A. PANLILIO, D. BELL, and the OB Cooperative Study Group. Hospital Infections Program, Centers for Disease Control, Atlanta, GA. OBJECTIVE: To detennine the nature and frequency of occupational blood contact (BC) among obstetrical personnel (OBP) during deliveries, and to identify how such contact might be prevented, as BC puts OBP at risk for infeetion wi!h human immunodeficiency virus (HIV) and hepatitis B virlll. STUDY DESIGN: Beginning in March 1992, trained observers monitored vaginal and cesarian deliveries at three U.S. urban hospitals where HIV oeroprevalence of child-bearing women exceeded 1%. Observers recorded infonnation about the delivery, participating OBP, use of protective equipment, and the frequency and circumstances of BC, defmed as percutaneous injuries (PIs) or skin or mucous membrane contacts. RESULTS: During !he first three mon!hs of data collection, one or more OBP had a BC during 64 (15%) of 437 vaginal and 20 (22%) of91 cesarian deliveries. Of 97 BCs, 8 (8%) were Pis 87 (90%) were skin contacts, and 2 (2%) were mucous membrane contacts. The rates of BC per 100 penon procedures varied by occupation: 13.8 for resident physicians; 8.5 for attending physicians; 7.7 for midwives; and 3.0 for medical students. Of!he 8 Pis, 3 were inflicted by ano!her team member, (2 while passing a scalpel and I while suturing); 3 occurred during phlebotomy or injection of medication; 1 occurred during needle recapping; and I occurred while an internal clip was removed from an infant's head. Of the 89 skin and mucous membrane contacts, 45 (51 %) might have been prevented by use of an appropriate barrier: 18 by an impenneable gown, 20 by any gown, I by a mask, 3 by eye protection, and 3 by gloves. The remaining 44 contacts occurred ei!her because of a glove lear (N =31), or because of contact to unprotected areas e.l:" feet, neck (N = 13). CONCLUSIONS: OOP Mft .. AfJIIft'Ciabk . - of ac dwiAg deliveries; many of IIoeoe ac. are ...-;.By JWWentable.
~
Cesarean 30 (40.0%) 9 (42.9%) Vaginal 45 (60.0%) 12 (57.1%) + 21 (2!.9%);96patients T(YfAL 75(78.1%) Everyone receiving A + G who delivered by cesarean had flagyl added postpartum. Of !he 30 patients receiving cefotetan who delivered by cesarean, 3 (10%) remained febrile and had to be switched to triples. There were no cases of pelvic abcesses or pelvic vein Ihrombophlebitis. One case complicated by hemorrhage requiring cesarean hysterectomy was excluded. RESULTS: Bo!h treatment groups were similiar in terms of gestational age (36.7 ± 4.3 vs. 33.6 ± 6.0 weeks), bir!h weight (2739 ± 929 vs. 2263 ± 1034 grams), and microbiologic results. Comparing patients who delivered vaginally, !here was no difference between !hose treated wi!h cefotetan versus A + G in terms of length of postpartum stay (2.8 ± 1.2 vs. 2.3 ± 0.5 days), number of febrile days (1.4 ± 0.9 vs. 1.0 ± 0.3 days), and peak postpartum temperature (100.4 ± 0.9 vs. 100.3 ± 1.2 OF). The patients who delivered by cesarean in !he 2 treatment groups were also similar in terms of leng!h of postpartum stay (5.8 ± 2.2 vs. 6.7 ± 2.4 days), number of febrile days (3.8 ± 2.3 vs. 4.9 ± 2.1 days), and peak postpartum temperature (101.9 ± 0.9 vs. 102.3 ± 1.2 0 F). CONCLUSION: Cefotetan is equa!!y as effective in treating chorioamnionitis as A + G. A cost analysis at !his institution showed that by treating wi!h cefotetan ra!her !han A + G, and adding flagyl if delivery is by cesarean, !here is a savings of $34.73/patient. These data suggest !hat a randomized prospective trial should be conducted.
464 CHORIOAMNION COLONIZATION: CORRELATION WITH GESTATIONAL AGE IN WOMEN DELIVERED FOLLOWING SPONTANEOUS LABOR VERSUS INDICATED DELIVERY. G. Cassell: .L.J::lau1!J., W. Andrews, G. Cutter: R. Goldenberg. Departments of Microbiology and OB/GYN, University of Alabama at Birmingham, Birmingham, AL. HYPOTHESES: Chorioamnion colonization is increased and inversely proportional to gestational age in women with intact membranes who have a spontaneous onset of labor versus women delivered for medical or obstetrical indications. STUDY DESIGN: At cesarean delivery, amniotic fluid and the chorioamnion interface were cultured for aerobes, anaerobes, ureaplasma and mycoplasma species in 609 women with intact membranes and singleton gestation. RESULTS: Sixty-four (40%) of 162 women with spontaneous labor and 57 of 447 (13%) with an indicated delivery had a positive chorioamnion culture (p
i
425