Transcervical amnioinfusion of antibiotics: A basic study for managing premature rupture of membranes

Citations from the Literahrre ifomia Medical Center. Of these patients, 2708 (8.2%) had undergone a prior cesarean birth, and 17% women (66%) underwent a trial of labor. A total of 1465 (81070)of them achieved a vaginal delivery. Successful vaginal delivery by the number of prior cesarean sections were as follows: one, 82%; two, 72%; three, 90%. When contrasted with the group without a trial of labor, the group with a trial of labor had significantly less maternal morbidity. In a comparison of the groups with and without a trial of labor, the incidence of uterine dehiscence (1 .Q% versus 1.9%) and rupture (0.3% versus 0.5%) was similar. With the application of attempted vaginal delivery in our patients with a previous cesarean birth, we were able to reduce our cesarean delivery rate for this population alone by 54%. In summary, the benefits associated with a trial of labor in the patient with a prior cesarean bii far outweigh the risks. The policy of ‘once a cesarean section, always a cesarean section’ should be abandoned. Addkted mothers and preterm babies: A disastrous outcome Verloove-Vanhorick SP; Van Zeben-Van der Aa TM; Verwey RA POPS Secretarial Office, Neonatal Centre, Department of Paediatrics, University Hospital, 2300 RC Leiden, NetherIan& LANCET; l/8582 (421422)/1988/ The discussion of drug and alcohol addiction during pregnancy has focused on fetal growth and development, follow-up studies are scare. The baby born to an addicted mother faces an uncertain future, especially when the baby is born preterm. We took the opportunity offered by the Project on Preterm and Small-for-gestational-age Infants in The Netherlands 1983 (POPS), of a virtually complete cohort of liveborn infants with gestational age under 32 weeks and/or birthweight below 1500 g, to evaluate the outcome of these problem pregnancies. We conclude that, in contrast to the generally favourable prognosis of VLBW infants, the outlook for VLBW babies born to an addicted mother is very gloomy (infant mortality rate 50% and major handicap rate 21% of livebom, infants vs 30% and 4%, respectively, in the total POPS cohort. We suggest that serious consideration be given to placing very preterm and/or VLBW children of addicted mothers to temporarily or permanently into the care of the social services and discharging them, not to the home of the parent(s), but to a foster home. Is C-reactive protein really useful in preterm premature rapture of the membranes? Fisk NM; Fysh J; Child AG; et al Department of Obstetrics and Gynaecology, King George’s V Hospital, Sydney, Australia BR. J OBSTET. GYNAECOL.; 94/12(1159-1164)/1987/ In a prospective blind study 380 daily serum samples from 55 women with preterm premature rupture of the membranes were analysed for C-reactive protein (CRP). Although the last CRP before delivery was higher in patients with histological chorioamnionitis (P = 0.007), considerable overlap between infected and non-infected pregnancies occurred, precluding the use of CRP as a diagnostic test if published normal levels were used. When upper limits were set at 30, 35, or 40 mg/l, the last

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CRP before delivery proved 90,95 and 100% specific and 88, 92 and 100% positively predictive of infection in singleton pregnancies. Such high specificities are needed to prevent inappropriate intervention based on false positive results. We therefore propose upper limits for single estimations of 30, 35, or 40 mg/l depending on the relative risks of preterm delivery versus infection at various gestational ages. In addition, consecutive values >2Omg/l appeared highly predictive of infection. Tmnscervicai amnioinfusion of antibiotics: A basic study for managing premature rupture of membranes Ogita S; Imanaka M; Matsumoto M; et al Department of Obstetrics and Gynecology, Osaka City Perinatal Center, Osaka 557. Japan. AM. J. OBSTET. GYNECOL.; 158/l (23-27)/1988/ To determine the best method of preventing ascending infection in the management of premature rupture of membranes, antibiotics such as latamoxef sodium, cefoperazone sodium, and cefotaxime sodium were infused directly into the amniotic cavity in 64 patients undergoing induction of labor at term. A single infusion of 100 or 500 mg of each drug resulted in a concentration of 200 to 1000 mug/ml immediately after infusion, and the concentration remained above 10 mug/ml for about 24 hours without significant increase in fetal or maternal blood levels. Consequently, a daily single dose of 100 mg or more is probably effective prophylaxis in cases of premature rupture of membranes. When intrauterine infection is suspected, the dose can be increased to 500 mg or more, and transplacental administration may be added to achieve a higher concentration in fetal blood. The present study simulates well premature rupture of membranes, and an aminofusion of antibodies will be reliable and effective in managing premature rupture of membranes. The grandmultipara: Is she still a risk? Eidelman AI; Kamar R; Schimmel MS; Bar-On E Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, NY, USA AM. J. OBSTET. GYNECOL.; 158/2 (389-392)/1988/ Grandmultiparity is reported to increase both maternal and perinatal mortality and morbidity. Unique religious and demographic factors in Jerusalem allowed us to analyze a population wherein parity could be dissociated from socioeconomic status. A total of 7785 mothers was studied, 889 (11.5wo) of whom were grandmultiparas. Comparison of grandmultiparous mothers with all others revealed no increase in the incidence of hypertension, diabetes, uterine atonia, antenatal or postnatal hemorrhage, cesarean sections, stillbinh rate, or congenital malformations. The grandmuhipara had significantly lower neonatal mortality and low birth weight rates and a significantly higher incidence of multiple births and trisomy 21 (p < 0.01). These results strongly suggest that grandmultiparity in and of itself in a healthy, economically stable population afforded modem medical care is not a major risk factor and that previous reports primarily reflected social class factors and not parity per se. Int J Gynecol Obstet 27