Lindsay S. Alger

The association of Chlamydia trachomatis, Neisseria gonorrhoeae, and group B streptococci with preterm rupture of the membranes and pregnancy outcome

There is conflicting evidence regarding a possible causal role for Chlamydia trachomatis in the development of preterm premature rupture of the membranes. We investigated the relative prevalence of endocervical infection with C. trachomads and group B streptococci in patients with preterm premature rupture of membranes compared with a control group taken from the same obstetric population. C. trachomads was isolated from 23152 (44%) patients with preterm premature rupture of membranes versus 13184 (15%) women in the control group ( p Neisseria gonorrhoeae . Group B streptococci were isolated from 16% of the patients with preterm premature rupture of membranes versus 4% of the control population ( p C. trachomads and N. gonorrhoeae . Endocervical infection with C. trachomads did not significantly affect early maternal complication rates after delivery.

Codeine and the Breastfed Neonate

Codeine is an analgesic commonly used to relieve pain in the early post partum. Its metabolite, morphine, is probably responsible for its effectiveness in this use. However, morphine may also cause neonatal apnea. We studied free codeine and morphine levels inbreastmilk of 17 samples from seven mothers and neonatal plasma of 24 samples from 11 healthy, term neonates. Levels were determined by radioimmunoassay. Milk codeine levels ranged from 33.8 to 314 ng/ml 20 to 240 minutes after codeine; morphine levels ranged from 1.9 to 20.5 ng/ml. Infant plasma samples one to four hours after feeding had codeine levels ranging from <0.8 to 4.5 ng/ml; morphine ranged from <0.5 to 2.2 ng/ml. Low infant plasma levels are secondary to low excretion into milk and the small amounts of milk available in the first few days. Moderate codeine use during this time (

Incisional Negative Pressure Therapy to Prevent Wound Complications Following Cesarean Section in Morbidly Obese Women A Pilot Study

Objective. We sought to evaluate the efficacy of incisional negative pressure therapy in decreasing postoperative wound complications when placed prophylactically over clean, closed incisions following cesarean section in obese patients. Study design. This was a retrospective cohort study comparing rates of wound complications following cesarean sections in morbidly obese women prior to and following the institution of standard use of prophylactic incisional negative pressure therapy. All women with a body mass index greater than 45 kg/m2 undergoing cesarean section in a 2-year period in a single institution were included. The exposure was incisional negative pressure therapy, which began in September 2009, versus standard wound dressing used in the previous year. The main outcome was wound complication identified by ICD-9 codes. Demographic and wound outcomes were compared with χ2 and t tests. Stata version 11.0 was used for all analysis. Results. A total of 63 women met the inclusion criteria, 21 of whom received negative pressure wound therapy. The historical comparison and exposure groups were similar in all characteristics studied with the exceptions of length of surgery (64 vs 76 minutes, P = .03), length of labor (78 vs 261 minutes, P = .02), scheduled versus nonscheduled (77% vs 52%, P = .04), and mean age (29.5 vs 26.1 years, P = .04), respectively. There were 5 wound complications in the control group (10.4%) and none (0%) in the study group (P = .15). Conclusions. This pilot study suggests a decrease in wound complications in morbidly obese women receiving incisional negative pressure therapy following cesarean section.

TOXOPLASMOSIS AND PARVOVIRUS B19

Pregnant women might well improve their chances for a successful pregnancy outcome by following the advice of W. C. Fields: avoid contact with small children and animals whenever possible. Failing widespread acceptance of this philosophy, management of T. gondii and parvovirus B19 infections continues to be a challenge for the foreseeable future.

Predictors of fetal growth in maternal HIV disease

We sought to determine predictors of fetal growth restriction in maternal HIV disease. Pregnant HIV-positive women on antiretroviral therapy were monitored with serial viral load and CD4 counts. Individualized growth potential (GP) percentile was calculated for birth weight (BW). BW <10th GP percentile defined fetal growth restriction (FGR). Multiple medical and social factors, CD4 count, viral load, and antiretroviral therapy were tested for impact on fetal growth using chi-square and multiple regression analysis. Two hundred eleven women were studied. CD4 count <200 in the first trimester was strongly associated with FGR (odds ratio 8.75, 95% confidence interval 2.88 to 26.52). Maternal age ( P = 0.02) and smoking ( P = 0.03) were independent cofactors for FGR (Nagelkerke R(2) = 0.33). No other factors demonstrated an independent effect. Severity of maternal HIV disease as indicated by the CD4 count, rather than placental exposure to viral load, predicts FGR. Smoking has an independent detrimental effect on fetal growth.

Protease inhibitor therapy and fetal growth potential in HIV-positive women

Our objective was to test if protease inhibitors (PIs) increase the incidence of fetal growth restriction (FGR). Human immunodeficiency (HIV)-seropositive women were studied. At birth the neonatal weight percentile was assigned by predicted growth potential (GP), accounting for race, parity, weight, height, gestational age, birthweight, and gender (Gardosi, 1992). FGR was defined as GP < 10% percentile. Maternal age, CD4 count, viral load, weight gain, prenatal care, tobacco, alcohol, substance abuse, and PI use were related to FGR using chi-square and multiple regression analysis. Ninety-three of 191 women received PI. In these, FGR occurred in 27 (29%) compared with 15 (15.3%) in the non-PI group ( P = 0.02). Maternal CD4 count ( P < 0.0001) was the primary determinant, and smoking ( P = 0.037) was an independent cofactor for FGR (Nagelkerke r2 = 0.24). Twenty-six of 82 (31.7%) smokers had FGR, versus 16 of 109 (14.7%) of nonsmokers (odds ratio, 2.69; 95% confidence interval, 1.33 to 5.46; P = 0.005). After exclusion of the CD4 count, PI became a cofactor for FGR ( P = 0.021 and Nagelkerke r2 = 0.104). We concluded that maternal HIV status and smoking determine the risk for FGR. Although PIs increase the risk for FGR, this effect appears to depend on maternal disease severity.

The effect of fundal pressure maneuver on intrauterine pressure during the second stage of labor

Abstract Objective: Fundal pressure (FP) and Valsalva (V) are used alone and together to enhance uterine forces during the second stage of labor despite reported complications. We hypothesize that FP aids or complicates delivery by increasing intrauterine pressure (IP). Methods: We investigated the relationship between FP and IP during the second stage in 41 women with epidural analgesia. Intrauterine pressure was measured electronically. Fundal pressure was applied under standardized conditions across a pressure cuff connected to a manometer after the vertex reached +2. Interventions included V or FP during contraction (CTXV, CTXFP); FP during V during contraction (CTXVFP); and FP and V alone between contractions. Integral, amplitude, duration, and basal tone were calculated. Multiple regression was used to identify interactions between maternal, fetal, and labor characteristics, and the effect of FP on IP. Results: IP transiently increased by 92% after V and FP together. Fifty-six percent of the maximal force resulted from contraction, 27% from V, and 17% from FP. Applied over V, FP significantly enhanced IP (P Download : Download full-size image Conclusion: FP increases IP but to a lesser extent than V. Large increases in IP after standardized application of FP could help to predict relative cephalopelvic disproportion and thus prevent further delay of a needed operative delivery.