B.Denise Raynor

Preeclampsia and Chlamydia Pneumoniae: Is There a Link?

Several parallels exist between preeclampsia and atherosclerosis. Both are multifactorial diseases that share risk factors such as obesity, insulin resistance, lipid abnormalities, and elevated serum homocysteine. There are also similarities in the biochemical changes seen in both diseases, including elevated serum triglycerides, decreased HDL cholesterol and enhanced formation of small, dense LDL particles as well as vascular atherosclerotic lesions. Chronic infection with Chlamydia pneumoniae has been linked to coronary artery disease. This study evaluated a possible link between the incidence of preeclampsia and infection with C. pneumoniae by examining the rate of seropositivity in 81 women with preeclampsia, and 206 women with normal pregnancies. Although our data confirmed well‐known risk factors for preeclampsia such as obesity, diabetes, and hypertension, we found no difference in the rate of seropositivity between preeclampsia and normal pregnancy. On the contrary, the presence of chlamydial antibodies was lower in preeclampsia. Multiparous women with preeclampsia showed a significantly lower rate of seropositivity than multiparous normal women and nulliparous preeclamptics. In addition, women with a history of preeclampsia who developed preeclampsia in the current pregnancy also had a significantly lower rate of seropositivity.

The experience with vaginal birth after cesarean delivery in a small rural community practice

OBJECTIVE The purpose of this study was to determine if the success and safety of vaginal birth after cesarean delivery in a small, isolated, rural hospital compare with those seen in larger centers. STUDY DESIGN As part of a continuing study, the prenatal and hospital records of all patients with previous cesarean delivered by the Rural Health Group between October 1988 and January 1991 were reviewed. Patients were allowed a trial of labor with one or more previous cesarean sections, unknown scar, and breech presentation but not for other malpresentation or a vertical scar. RESULTS A total of 67 patients were studied; 76.1% of these had a trial of labor, and 60.8% of them were delivered vaginally, whereas 39.2% underwent repeat cesarean delivery. Of the 67 patients 11.9% were not candidates for vaginal birth after cesarean delivery, and the same percentage refused. Forty-nine percent received oxytocin; of these, 56% were delivered vaginally. Overall, maternal complications were similar between the groups. Two uterine ruptures occurred; neither was associated with labor. The major maternal complications occurred in the vaginal birth after cesarean delivery group, but all were associated with antepartum conditions and not related to labor and delivery. There were no maternal deaths. The only neonatal death resulted from a congenital anomaly. CONCLUSION We concluded that vaginal birth after cesarean delivery can be performed safely in an isolated small community hospital with success rates similar to those of larger centers and with no increased maternal or neonatal morbidity or mortality.

Penicillin and ampicillin

Abstract Penicillin was discovered by Alexander Fleming in 1928 and was first used in clinical trials in 1942. Addition of an amino group to the benzylpenicillin molecule resulted in the creation of ampicillin, a drug with a broadened spectrum of activity. Penicillin and ampicillin exert their bactericidal effect by inhibiting microbial cell wall synthesis. Penicillin is active against most gram-positive organisms and some gram-negative organisms such as Neisseria gonorrhoeae, Treponema pallidum , and Actinomyces species. Ampicillin has more extended activity against aerobic gram-negative bacilli than penicillin, but an increasing number of strains of coliforms have become resistant to the drug. Penicillin and ampicillin are effective in both oral and parenteral formulations, and they are very inexpensive. Their principal side effect is an allergic reaction. Ampicillin also may cause drug-induced diarrhea and candida vaginitis. The primary applications of penicillin and ampicillin in obstetrics and gynecology are treatment or prophylaxis for group B streptococcal infection (both), prevention of bacterial endocarditis (both), treatment of syphilis (penicillin), and treatment of enterococcal UTI (ampicillin).

Maternal Serum Vascular Cell Adhesion Molecule Concentration During Pregnancy

Objective: Vascular cell adhesion molecule (VCAM-1), a transmembrane glycoprotein known primarily as a mediator of white blood cell adhesion and extravasation from the intravascular space, is synthesized by vascular endothelial cells, macrophages, epithelial cells, and placental trophoblasts. Vascular cell adhesion molecule has also been identified as an angiogenic agent, and it appears to play an important role in early placental development. The expression of VCAM-1 is stimulated by cytokines, such as tumor necrosis factor, interleukin-1, and interferon gamma, as well as by oxidatively modified lipoproteins. Our objective was to determine the concentration of soluble VCAM-1 normally present throughout gestation. Methods: Maternal serum soluble VCAM-1 concentrations were measured by enzyme-linked immunosorbent assay in healthy pregnant women. Results: In 78 patients, soluble VCAM concentrations ranged from 128.02 to 728.6 ng/mL between 5 and 39 weeks of gestation. Maternal soluble VCAM concentrations showed a negative correlation with gestational age. The mean concentration (± standard deviation) was significantly higher before 20 weeks (406.76 ± 134.41 ng/mL) than at or after 20 weeks (346.04 ± 111.20 ng/mL). Conclusion: These findings are consistent with the hypothesis that VCAM-1 may play an important role in the normal process of placentation during early pregnancy.

Misoprostol in second trimester termination of pregnancy

Objective: The purpose of this study is to compare misoprostol to oxytocin and prostaglandin E(2) (PGE(2)) in second trimester termination of pregnancy.Methods: Patients between 14 and 24 weeks gestation scheduled for induction were asked to enroll in the study using misoprostol. Comparison was made with historical controls delivered over the last 3 years who received medical induction with (PGE(2)) suppositories or received high dose oxytocin. After pretreatment with acetaminophen, lomotil, and promethazine, a PGE(2) suppository (20 mg) was placed every 4 hours until passage of fetus or treatment failure. Oxytocin was given in dosages that were sequentially infused in 500 mL of D-5 LR over 3 hours each beginning at 50 units/500 mL and increasing an additional 50 units with each subsequent infusion until a maximum of 300 units. Each infusion was followed by 60 mL NS over 1 hour. Treatment failure was defined as undelivered after completion of the 24-hour infusion regimen. Misoprostol was placed into the posterior vaginal fornix every 8 hours until passage of fetus or treatment failure, which was defined as failure to pass fetus within 48 hours. Development of maternal signs or symptoms severe enough to preclude further treatment was also considered treatment failure. Data were collected on use of analgesia, induction to delivery interval, and adverse symptoms.Results: A total of 54 subjects were analyzed. Sixteen were given misoprostol, 21 high dose oxytocin, and 18 PGE(2). Mean induction to delivery times were 1374.2 +/- 1009.5 minutes, 609.2 +/- 515.6 minutes, and 933.6 +/- 1363.7 minutes, respectively. ANOVA with least square analysis showed no difference between groups. There were 3 misoprostol failures, 7 high dose oxytocin failures, and 1 prostin failure. chi(2) analysis of failure rates showed a difference between the 3 groups (P <.05), attributable to the difference between PGE(2) and oxytocin.Conclusions: Induction to delivery interval was not different between the three agents using intravaginal misoprostol of 200 µg every 8 hours. More treatment failures, however, occurred with oxytocin than prostaglandin. In view of lower cost and ease of storage and administration, misoprostol may be a more useful agent.

Umbilical Cord Vascular Cell Adhesion Molecule Concentration Following Labor

OBJECTIVE This study was designed to determine if VCAM concentrations are increased in serum from neonates delivered vaginally compared to those delivered by cesarean in the absence of labor at term. METHODS Serum was collected from umbilical cords immediately after delivery of term uncomplicated pregnancies either prior to onset of labor by scheduled cesarean or following labor. VCAM concentration was determined by commercial ELISA. RESULTS Mean VCAM concentration was significantly higher in the laboring (1,106.2 +/- 279 ng/ml) than the nonlaboring group (906.9 +/- 217 ng/ml, P = 0.01). CONCLUSIONS Increases in neonatal serum VCAM concentrations may represent a response to enhanced lipid peroxidation and oxidative stress during labor as well as a component of the normal fetal immune response.