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468 Prevalence and Clinical Significance of Fungal Invasion of the Amniotic Cavity in Preterm Labor and Preterm Prom
426
SPO Abstracts
January 1993 Am J Obstct C ynccol
467
IS C-REACTIVE PROTEIN OF CLINICAL VALUE IN THE DIAGNOSIS OF MICROBIAL INVASION OF THE AMNIOTIC CAVITY IN WOMEN WITH PRETERM PREMATURE RUPTURE OF MEMBRANES? M.Mazor, W .Chaim', R.Romero, S.Lazer', M .Glezerman'. Depts. OB/GYN, Soroka Med. Ctr., Ben-Gurion Univ. of the Negev, Beer-Sheva, Israel, Wayne State Univ., Detroit, MI; and the Perinatology Branch, NICHD, Bethesda, MD. BACKGROUND: C-Reactive Protein (CRP) determinations have been proposed to be of value in the identification of patients with subclinical chorioamnionitis. However, it is unknown whether this non· invasive test can replace amniocentesis for the diagnosis of microbial invasion of the amniotic cavity . OBJECTIVE: The purpose of this study was to determine the clinical value of CRP concentrations in the diagnosis of microbial invasion of the amniotic cavity in patients with preterm PROM. STUDY DESIGN: Amniocentesis for microbiologic studies and serum CRP determinations were performed in 42 consecutive patients with preterm PROM. Amniotic fluid (AF) was cultured for aerobic and anaerobic bacteria and Mycoplasmas. CRP concentrations were determined by a latex agglutination test and laser nephelometry. CRP results were scored as positive if the level was >0.8 mgldl. RESULTS: The prevalence of microbial invasion of the amniotic cavity was 36.4% (16/42) . Positive CRP was present in 40.5% (17/42) of patients . Only 7 of the 17 patients with a positive CRP (41.2%) had a positive AF culture. The diagnostic indices of CAP for the diagnosis of microbial invasion of the amniotic cavity were: sensitivity 43.7%, specificity 61.5%, positive predictive value 41.1 %, and negative predictive value 64% . CONCLUSION: We conclude that CAP is of limited value for the diagnosis of microbial invasion of the amniotic cavity in women with preterm PROM.
469
CYTOItIIIB rnrBrTrOIl wrTB PBJITOJ:rFYLLrilB FOR BACTBRrALLY rllDUCBD PReTBRX LABOR. D.WaltoD, D. Willis, O. Martinez X , R. Fojaco', M, O'Sullivan. Dept of Ob/Gyn, U. of Miami, Miami, FL OBJBCTrvz: This stUdy was designed to assess the impact of cytokine inhibition with pentoxifylline on rabbits with bacterially induced preterm labor. BTUDY DBBrGII: The study was a randomized, blinded,prospective trial. Twenty-seven rabbits underwent laparotomy, Five of these (shams) received an intrauterine injection of saline; 22 received an injection of 10· E. Coli into the lower uterine segment.The bacterially injected animals were treated postoperatively vith intramuscular injections of saline (control n=ll) or 20 mg/kg/ day of pentoxifylline (treatment n=ll) 3 times each day. Time until delivery, time until death, TNF~ levels and intrauterine pathology were evaluated. ReBULTB: All 5 sham rabbits delivered full term . There was no difference in the preterm delivery rate for the controls (8 of 11) versus the treatment group (7 of 11). There was a trend towards delay in time till death and a decrease in the TN~ levels in the treatment group. There was no difference in the pathology. COIiCLUBrOIl: cytokine inhibition with pentoxifylline does not delay bacterially induced preterm delivery in rabbits.
468
PREVALENCE AND CUNICAL SIGNIFICANCE OF FUNGAL INVASION OF THE AMNIOnC CAVITY IN PRETERM LABOR AND PRETERM PROM. M. Mozor W. Chaim', R. Romero, W. Sepulveda' , M . Glezerman'. Dept,;:" Ob/Gyn, Soroka Med. Ctr., Ben·Gurion Univ. of the Negey, Beer·Sheva, Israel, Wayne State Univ., Detroit, MI; and the Perinatology Branch, NICHD, Bethesda, MD. OBJECTIVE: The purpose of this study was to datermine the prevalence end clinical significance of fungi intr88mniotic infection in women with preterm labor (PTL) andlor preterm premature rupture of membranes (PPROM). STUDY DESIGN: Transabdominal amniocentesis was performed in 332
470
PYELONEPHRITIS IN PREGNANCY: ONCE- A-DAY VERSUS MULTIPLE DOSE THERAPY, Kenneth J McAlpine,X Luis Sanchez·Ramos, Department Obstetrics and Gynecology, University of Florida, Jacksonville, FL. OBJECTIVE: The purpose of this randomized, double-blind, placebo·controlled clinical trial was to compare the efficacy of once·a·day ceftriaxone to multiple daily doses of cefazolin in the treatment of acute pyelonephritis in pregnancy . STUDY DESIGN: Patients admitted to the hospital with signs and symptoms of acute pyelonephritis were randomly assigned (by table of random numbers) to one of two treatment groups. One group received ceftriaxo ne, 1 gram intravenously (IV) per day (second and third dose each day was placebo) and the second group received ce(azolin, 2 grams IV every 8 hours. Randomization was performed and maintained in the hospital pharmacy. Each patienl received antibiotic or placebo inlravenous solut io ns every 8 hours. Treatment was continued until the patien( was afebrile for at least 48 hours. Once afebrile, the patients were discharged on appropriate antib iotic oral antibiotics. Follow·up visit at one week with repeat ur ine cultures for test·of·cure was periormed. For an alpha of .05 and power of 80%, a sample size o( 148 patients was required. RESULTS: During the two year study period, 149 patients were enrolled in the study: 74 received cefazolin and 75 patients received ceftriaxone. Patient's age, race , parity, gestational age, and presenting signs and symptoms were similar in both groups. No difference was noted between groups in length of hospital stay, days febrile, or treatment failure s. CONCLUSIONS: These finding s support once·a·day therapy for pyelonephritis in pregnancy. This dose regimen may facilna(e monitored outpatient management resulling in significant cost savi ng s.
patients presented with PTL and intact membranes, and in 84 patients
with PPROM . Amniotic fluid (AF) was cultured for aerobic and anaerobic bacteria and Mycoplasmas.
RESULTS: The prevalence of positive AF cuttures for microorganisms
wa. 19.6% (811416); 49 patients (14.7%) with PTL and 32 patients (38°,.) with PPROM . Tho prevalence of posit ive AF cultures for Candida sp. was 7.4% (6/81) ; three patients from each group. Five out of the 6
pattent& had either an intrauterine contraceptive device in situ (n =4) or
cervical cerclage (n = 1). Two of the three patients with intrauterine infection with Candida sp. and intact membranes were treated with parental administration of antimycotic drugs to the mother. This approach was associated with prolongation of pregnancy with neonatal survival in two of them (see Table) : til
GA et amniocentesis
GA at deliv ery
Perinatal outcome
Case 1
23 .6 waeks
26.6 weeks
Alive end well
Casa 2
26 weeks
26 weeks
Alive and well
CONCLUSION: 1) Funga' invasion of the amniotic cavity accounts lor 7% of all cases of intr8amniotic infection; and 2) this condition is associated with tho presence of a foreign body (IUD or cerclage).
SPO Abstracts
January 1993 Am J Obstct C ynccol
467
IS C-REACTIVE PROTEIN OF CLINICAL VALUE IN THE DIAGNOSIS OF MICROBIAL INVASION OF THE AMNIOTIC CAVITY IN WOMEN WITH PRETERM PREMATURE RUPTURE OF MEMBRANES? M.Mazor, W .Chaim', R.Romero, S.Lazer', M .Glezerman'. Depts. OB/GYN, Soroka Med. Ctr., Ben-Gurion Univ. of the Negev, Beer-Sheva, Israel, Wayne State Univ., Detroit, MI; and the Perinatology Branch, NICHD, Bethesda, MD. BACKGROUND: C-Reactive Protein (CRP) determinations have been proposed to be of value in the identification of patients with subclinical chorioamnionitis. However, it is unknown whether this non· invasive test can replace amniocentesis for the diagnosis of microbial invasion of the amniotic cavity . OBJECTIVE: The purpose of this study was to determine the clinical value of CRP concentrations in the diagnosis of microbial invasion of the amniotic cavity in patients with preterm PROM. STUDY DESIGN: Amniocentesis for microbiologic studies and serum CRP determinations were performed in 42 consecutive patients with preterm PROM. Amniotic fluid (AF) was cultured for aerobic and anaerobic bacteria and Mycoplasmas. CRP concentrations were determined by a latex agglutination test and laser nephelometry. CRP results were scored as positive if the level was >0.8 mgldl. RESULTS: The prevalence of microbial invasion of the amniotic cavity was 36.4% (16/42) . Positive CRP was present in 40.5% (17/42) of patients . Only 7 of the 17 patients with a positive CRP (41.2%) had a positive AF culture. The diagnostic indices of CAP for the diagnosis of microbial invasion of the amniotic cavity were: sensitivity 43.7%, specificity 61.5%, positive predictive value 41.1 %, and negative predictive value 64% . CONCLUSION: We conclude that CAP is of limited value for the diagnosis of microbial invasion of the amniotic cavity in women with preterm PROM.
469
CYTOItIIIB rnrBrTrOIl wrTB PBJITOJ:rFYLLrilB FOR BACTBRrALLY rllDUCBD PReTBRX LABOR. D.WaltoD, D. Willis, O. Martinez X , R. Fojaco', M, O'Sullivan. Dept of Ob/Gyn, U. of Miami, Miami, FL OBJBCTrvz: This stUdy was designed to assess the impact of cytokine inhibition with pentoxifylline on rabbits with bacterially induced preterm labor. BTUDY DBBrGII: The study was a randomized, blinded,prospective trial. Twenty-seven rabbits underwent laparotomy, Five of these (shams) received an intrauterine injection of saline; 22 received an injection of 10· E. Coli into the lower uterine segment.The bacterially injected animals were treated postoperatively vith intramuscular injections of saline (control n=ll) or 20 mg/kg/ day of pentoxifylline (treatment n=ll) 3 times each day. Time until delivery, time until death, TNF~ levels and intrauterine pathology were evaluated. ReBULTB: All 5 sham rabbits delivered full term . There was no difference in the preterm delivery rate for the controls (8 of 11) versus the treatment group (7 of 11). There was a trend towards delay in time till death and a decrease in the TN~ levels in the treatment group. There was no difference in the pathology. COIiCLUBrOIl: cytokine inhibition with pentoxifylline does not delay bacterially induced preterm delivery in rabbits.
468
PREVALENCE AND CUNICAL SIGNIFICANCE OF FUNGAL INVASION OF THE AMNIOnC CAVITY IN PRETERM LABOR AND PRETERM PROM. M. Mozor W. Chaim', R. Romero, W. Sepulveda' , M . Glezerman'. Dept,;:" Ob/Gyn, Soroka Med. Ctr., Ben·Gurion Univ. of the Negey, Beer·Sheva, Israel, Wayne State Univ., Detroit, MI; and the Perinatology Branch, NICHD, Bethesda, MD. OBJECTIVE: The purpose of this study was to datermine the prevalence end clinical significance of fungi intr88mniotic infection in women with preterm labor (PTL) andlor preterm premature rupture of membranes (PPROM). STUDY DESIGN: Transabdominal amniocentesis was performed in 332
470
PYELONEPHRITIS IN PREGNANCY: ONCE- A-DAY VERSUS MULTIPLE DOSE THERAPY, Kenneth J McAlpine,X Luis Sanchez·Ramos, Department Obstetrics and Gynecology, University of Florida, Jacksonville, FL. OBJECTIVE: The purpose of this randomized, double-blind, placebo·controlled clinical trial was to compare the efficacy of once·a·day ceftriaxone to multiple daily doses of cefazolin in the treatment of acute pyelonephritis in pregnancy . STUDY DESIGN: Patients admitted to the hospital with signs and symptoms of acute pyelonephritis were randomly assigned (by table of random numbers) to one of two treatment groups. One group received ceftriaxo ne, 1 gram intravenously (IV) per day (second and third dose each day was placebo) and the second group received ce(azolin, 2 grams IV every 8 hours. Randomization was performed and maintained in the hospital pharmacy. Each patienl received antibiotic or placebo inlravenous solut io ns every 8 hours. Treatment was continued until the patien( was afebrile for at least 48 hours. Once afebrile, the patients were discharged on appropriate antib iotic oral antibiotics. Follow·up visit at one week with repeat ur ine cultures for test·of·cure was periormed. For an alpha of .05 and power of 80%, a sample size o( 148 patients was required. RESULTS: During the two year study period, 149 patients were enrolled in the study: 74 received cefazolin and 75 patients received ceftriaxone. Patient's age, race , parity, gestational age, and presenting signs and symptoms were similar in both groups. No difference was noted between groups in length of hospital stay, days febrile, or treatment failure s. CONCLUSIONS: These finding s support once·a·day therapy for pyelonephritis in pregnancy. This dose regimen may facilna(e monitored outpatient management resulling in significant cost savi ng s.
patients presented with PTL and intact membranes, and in 84 patients
with PPROM . Amniotic fluid (AF) was cultured for aerobic and anaerobic bacteria and Mycoplasmas.
RESULTS: The prevalence of positive AF cuttures for microorganisms
wa. 19.6% (811416); 49 patients (14.7%) with PTL and 32 patients (38°,.) with PPROM . Tho prevalence of posit ive AF cultures for Candida sp. was 7.4% (6/81) ; three patients from each group. Five out of the 6
pattent& had either an intrauterine contraceptive device in situ (n =4) or
cervical cerclage (n = 1). Two of the three patients with intrauterine infection with Candida sp. and intact membranes were treated with parental administration of antimycotic drugs to the mother. This approach was associated with prolongation of pregnancy with neonatal survival in two of them (see Table) : til
GA et amniocentesis
GA at deliv ery
Perinatal outcome
Case 1
23 .6 waeks
26.6 weeks
Alive end well
Casa 2
26 weeks
26 weeks
Alive and well
CONCLUSION: 1) Funga' invasion of the amniotic cavity accounts lor 7% of all cases of intr8amniotic infection; and 2) this condition is associated with tho presence of a foreign body (IUD or cerclage).