George M. Ryan

Chlamydia trachomatis infection in pregnancy and effect of treatment on outcome.

The effect of Chlamydia trachomatis on pregnancy outcome and the effect of treatment of positive cervical cultures was studied by culturing 11,544 women for chlamydia at their first prenatal visit. Chlamydia culture was positive in 2433 (21.08%) and prevalence was related to age and race. Of the positive cultures, 1110 were classified as untreated. The untreated group demonstrated a significant increase in the incidence of premature rupture of the membranes and low birth weight and a decrease in survival when compared with either those with positive cultures who received treatment (N = 1323) or those with negative cultures (N = 9111). Screening of populations at high risk of chlamydia is recommended and treatment of chlamydia-positive patients may improve pregnancy outcome.

Attitudes of adolescents toward pregnancy and contraception

Teenage pregnancy rates are increasing, particularly among the younger age groups. The causes of this increase are varied. While many people assume that most adolescent pregnancies are unwanted and result from a lack of contraceptive knowledge and/or availability, our findings were quite to the contrary. In-depth interviews with 87 pregnant teenagers in a large Southern city revealed that almost all had knowledge of contraception and that most were happy about being pregnant. Multidisciplinary programs have been organized throughout the country to address the adolescent pregnancy problem. Our study emphasizes the fact that to be effective, such programs must be tailored to the individual target group and that concentrating on the increased dissemination of contraceptive knowledge and methods may not be the most effective approach in some groups.

The efficacy of x-ray pelvimetry

Comparison is made of x-ray pelvimetry use on a public and private service in 1974 with experience in 1979, when the clinic service did no x-ray pelvimetry while the private service continued as before. It is concluded that the use of x-ray pelvimetry is inadequate as a predictor of cesarean section because of cephalopelvic disproportion, does not improve neonatal mortality, and poses potential hazards to the mother and fetus. Its use in the management of breech presentations is not currently established by our data. Guidelines are presented for the management of patients in labor without using x-ray pelvimetry.

Pituitary gonadotropins during long-term enovid therapy

4 patients receiving the oral contraceptive Enovid, 5 mg tablets Day 5-24 of the treatment cycle, were studied for 7 cycles after therapy for a minimum of 12 and a maximum of 31 (mean duration of 25) consecutive months of therapy. In addition 1 patient was studied for a control cycle before receiving medication and a second cycle while on medication. Total gonadotropins and luteinizing hormone (LH) were determined on 24 hour specimens. There was a slight depression of total gonadotropins in the patients receiving long-term cyclic therapy. The results of the LH excretion studies showed no evidence of a midcycle peak in the patients on medication. It was suggested that the loss of the midcycle LH peak and generally diminished total gonadotropin levels might be adequate explanation for ovulation suppression by Enovid.

Gonorrhea during the intrapartum period

Go~o~~~~~isacommunicable,endemicdisease transmitted almost exclusively through sexual exposure to an infected partner. Infection confers no immunity and repeated infections are, therefore, not uncommon. Depending on the population screened, prevalence rates of 2.75% to 7.5% have been reported among pregnant patients.’ Treatment of prenatal patients with positive screening tests is mandatory. Despite this, or because of this, the prevalence of gonorrhea during the intrapartum periods remains unknown. In order to test the hypothesis that a significant prevalence of gonococcal infection persists during the intrapartum period despite screening and treatment during the early antenatal period, a l-month surveillance for gonorrhea among pregnant patients during the intrapartum period was undertaken in a large city-county

Treatment of Chlamydial Infections of the Cervix during Pregnancy

Chlamydia trachomatis infections in pregnancy are associated with a high rate of transmission to the newborn and may be associated with poor obstetrical outcome including low birth weight, premature delivery, stillbirth and neonatal death. This prospective study of 99 chlamydia infected women assessed the clinical efficacy of treating chlamydial infections diagnosed at the initial obstetrical visit. Twelve women had concomitant gonococcal and/or urinary tract infections. Seven day regimens of erythromycin 1 gm per day and erythromycin 2 gm per day appear to be equally effective (95.1% and 92.3% respectively) in the treatment of chlamydial infections in pregnancy. Successive therapy did not vary with gestational age when treated. Four of 91 erythromycin treated women discontinued therapy due to gastrointestinal distress. Eight women received sulfisoxazole 4 gm per day and all responded to therapy. Additional controlled studies are needed to determine the most efficacious treatment for chlamydial infections in pregnancy.