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Chiamydia trachomatis and premature contractions
1254 Correspondence
hom's after birth and before discharge from the neonatal department. We distinguished seven types of hymenal shapes and orifices: smooth with central orifice, folded with central orifice, folded with eccentric orifice, anterior opening, posterior opening, hymenal band, and almost in perforate hymen. The incidence of these various hymenal shapes was also calculated. Another two very rare types of hymenal shapes were later observed in our newborn population-cribriform and complete inperforate hymen. In his classic textbook of childhood gynecolog), Huffman' described various types of hymenal shapes that are similar to our findings. The differences between hymenal shapes in our newborn infants and those in the prepubertal population examined by S. F. Pokorny are noteworthy. (We emphasize her particular selection of children with known or suspected genital problems.) This fact raises a question about the possible changes in hymenal configuration during childhood as a result of aging. Therefore, a prospective cross-sectional study of a large pediatric population from birth to puberty is necessary to answer this question. Naomi Mor, MD Paul Merlob, MD Neonatal Department Beilinson Medical Center and Sackler School of Medicine Tel Aviv Umversity 49100 Petah Tiqva, Ismel REFERENCES 1. Mor N, Merlob P, Reisner SH. Types of hymen in the newborn infant. Eur J Obstet Gynecol Reprod Bioi 1986; 22:225-8. 2. Mor N. Merlob P. ReisnerSH. Tags and bands of the female external genitalia in the newborn infant. Clin PedIatr 1983;22:122-4. 3. Huffman JW. Dewhurst CJ. Capraro VJ. The gynecology of childhood and adolescence. 2nd ed. Philadelphia: WB Saunders. 1981: 154-6.
Chlamydia trachoma tis and premature contractions To the Editors: I read with interest the article by Cohen et al. (Serumspecific antibodies for Chlamydia tmchomatis in premature contractions. AM J OSSTET GYl\ECOL 1988; 158: 579-82). The authors measured immunoglobulin G (lgG) and IgA antichlamydial antibody levels in women with premature contractions and compared these results with those of women who were healthy and not in labor. IgG antibody titers were similar in both groups and IgA antibody levels were actually lower in the women with contractions than in the control group.
Am J
May 1989
Obstet Gynecol
The authors concluded that chlamydia has no role in preterm contractions. Although the authors obviously invested a good deal of time and effort to this study, I have some major reservations about its design. For one thing, the patients in-the idiopathic contractions group were carefully selected to be women with a minimal chance of having chlamydia. Women with urinary tract infections (often associated with chlamydia), "other maternal disease" (type not specified), and history of pelvic inflammatory disease (often associated with chlamydia) were excluded. The only women included were those who had premature contractions of unknown cause. Presumably premature rupture of the membranes and amnionitis were excluding conditions, both of which are associated to some extent with chlamydia. Previous abnormal obstetric history (prematurity because of infection?) also was exclusionary. The authors stated that the control group was picked only because of a lack of previous pelvic inflammatory disease. It would appear that women with preterm contractions who were carefully screened not to have chlamydial infection were compared with a control group that was screened only for a negative history of pelvic inflammatory disease. One can conclude from these facts that women with a low risk of previous or current chlamydial infection have fewer IgA antibodies than does a relatively cross-sectional sam pie of women. This is not surprising, nor is it relevant to the subject of preterm contractions. A second problem is the use of antibody levels as a diagnostic test for chlamydia. The authors point out that the manufacturers of their test kits recommend IgG values :;;.1: 128 and IgA values :;;.1: 16 as indications of active chlamydial infection. However, active upper tract chlamydial infection may not be as reasonable a target as cervical involvement with more local effects on the lower uterine decidua and membranes. In effect, the authors are trying to use a small sample of women to try to differentiate effects of chlamydial infection versus chlamydial colonization. Of course, no cultures were done so this cannot be carried any further with the above discussion in mind. I find it difficult to accept the authors' conclusion that their findings do not support the assumption that C. tmchomatis has a role in premature contractions. I agree, however, that in women previously screened to be at low risk for chlamydial exposure, testing with a method that may not reveal the correct endpoint may indeed yield negative results. joseph C. Pastorek II, MD Sections of Infectious Disease and Maternal-Fetal Medicine School of Medicine in New Orleans Louisiana State University Medical Center 1542 Tulane Avenue New Orleans, LA 70112-2822
hom's after birth and before discharge from the neonatal department. We distinguished seven types of hymenal shapes and orifices: smooth with central orifice, folded with central orifice, folded with eccentric orifice, anterior opening, posterior opening, hymenal band, and almost in perforate hymen. The incidence of these various hymenal shapes was also calculated. Another two very rare types of hymenal shapes were later observed in our newborn population-cribriform and complete inperforate hymen. In his classic textbook of childhood gynecolog), Huffman' described various types of hymenal shapes that are similar to our findings. The differences between hymenal shapes in our newborn infants and those in the prepubertal population examined by S. F. Pokorny are noteworthy. (We emphasize her particular selection of children with known or suspected genital problems.) This fact raises a question about the possible changes in hymenal configuration during childhood as a result of aging. Therefore, a prospective cross-sectional study of a large pediatric population from birth to puberty is necessary to answer this question. Naomi Mor, MD Paul Merlob, MD Neonatal Department Beilinson Medical Center and Sackler School of Medicine Tel Aviv Umversity 49100 Petah Tiqva, Ismel REFERENCES 1. Mor N, Merlob P, Reisner SH. Types of hymen in the newborn infant. Eur J Obstet Gynecol Reprod Bioi 1986; 22:225-8. 2. Mor N. Merlob P. ReisnerSH. Tags and bands of the female external genitalia in the newborn infant. Clin PedIatr 1983;22:122-4. 3. Huffman JW. Dewhurst CJ. Capraro VJ. The gynecology of childhood and adolescence. 2nd ed. Philadelphia: WB Saunders. 1981: 154-6.
Chlamydia trachoma tis and premature contractions To the Editors: I read with interest the article by Cohen et al. (Serumspecific antibodies for Chlamydia tmchomatis in premature contractions. AM J OSSTET GYl\ECOL 1988; 158: 579-82). The authors measured immunoglobulin G (lgG) and IgA antichlamydial antibody levels in women with premature contractions and compared these results with those of women who were healthy and not in labor. IgG antibody titers were similar in both groups and IgA antibody levels were actually lower in the women with contractions than in the control group.
Am J
May 1989
Obstet Gynecol
The authors concluded that chlamydia has no role in preterm contractions. Although the authors obviously invested a good deal of time and effort to this study, I have some major reservations about its design. For one thing, the patients in-the idiopathic contractions group were carefully selected to be women with a minimal chance of having chlamydia. Women with urinary tract infections (often associated with chlamydia), "other maternal disease" (type not specified), and history of pelvic inflammatory disease (often associated with chlamydia) were excluded. The only women included were those who had premature contractions of unknown cause. Presumably premature rupture of the membranes and amnionitis were excluding conditions, both of which are associated to some extent with chlamydia. Previous abnormal obstetric history (prematurity because of infection?) also was exclusionary. The authors stated that the control group was picked only because of a lack of previous pelvic inflammatory disease. It would appear that women with preterm contractions who were carefully screened not to have chlamydial infection were compared with a control group that was screened only for a negative history of pelvic inflammatory disease. One can conclude from these facts that women with a low risk of previous or current chlamydial infection have fewer IgA antibodies than does a relatively cross-sectional sam pie of women. This is not surprising, nor is it relevant to the subject of preterm contractions. A second problem is the use of antibody levels as a diagnostic test for chlamydia. The authors point out that the manufacturers of their test kits recommend IgG values :;;.1: 128 and IgA values :;;.1: 16 as indications of active chlamydial infection. However, active upper tract chlamydial infection may not be as reasonable a target as cervical involvement with more local effects on the lower uterine decidua and membranes. In effect, the authors are trying to use a small sample of women to try to differentiate effects of chlamydial infection versus chlamydial colonization. Of course, no cultures were done so this cannot be carried any further with the above discussion in mind. I find it difficult to accept the authors' conclusion that their findings do not support the assumption that C. tmchomatis has a role in premature contractions. I agree, however, that in women previously screened to be at low risk for chlamydial exposure, testing with a method that may not reveal the correct endpoint may indeed yield negative results. joseph C. Pastorek II, MD Sections of Infectious Disease and Maternal-Fetal Medicine School of Medicine in New Orleans Louisiana State University Medical Center 1542 Tulane Avenue New Orleans, LA 70112-2822