Nancy L. Eriksen

A randomized trial of prophylactic doxycycline for curettage in incomplete abortion

Objective To determine whether prophylactic doxycycline at suction curettage for incomplete abortion decreases the rate of postoperative pelvic infection. Methods We randomized 240 patients to receive intravenous doxycycline or placebo at curettage. Cervical specimens for gonorrhea and chlamydia were obtained preoperatively. Two weeks post-procedure, we evaluated all patients for infectious morbidity and repeated gonorrhea and chlamydia cultures. Statistical analysis used Mann-Whitney U test, McNemar test, or Fisher exact test, as appropriate. Results There were no statistically significant differences in age, parity, gestational age, history of sexually transmitted disease, pelvic inflammatory disease, or multiple sex partners between the doxycycline and placebo groups. Preoperative gonorrhea or chlamydia isolates were positive in five (4.2%) and six (5%) of 120 doxycycline patients and four (3.3%) and eight (6.6%) of 120 controls (not significant). All preoperative gonorrhea isolates remained positive postoperatively. Seven (5.8%) controls had positive postoperative chlamydia isolates, as did one (0.8%) in the doxycycline group (P = .06). We diagnosed eight (6.6%) of 120 doxycycline patients and seven (5.8%) of 120 controls with infectious morbidity (not significant). Conclusion In our population of patients with incomplete abortion, the prevalence of gonorrhea and chlamydia was low, and prophylactic doxycycline did not decrease the rate of postoperative febrile morbidity.

Chlorhexidine versus sterile water vaginal wash during labor to prevent peripartum infection

OBJECTIVE Our purpose was to determine whether a dilute solution of chlorhexidine used as a one-time vaginal wash intrapartum can reduce the incidence of intraamniotic infection or endometritis in laboring pregnant women. STUDY DESIGN Term pregnant women in labor were prospectively randomized to receive either 20 ml of 0.4% chlorhexidine (n = 481) or 20 ml of sterile water (n = 466) placebo. All patients were monitored for risk factors associated with intraamniotic infection. Continuous variables were compared with the Mann-Whitney U test and discrete variables were compared with Fishers exact test. RESULTS No significant differences in infection were found between the chlorhexidine and placebo groups. During the study period 21 of 466 women (4.5%) had intraamniotic infection in the control group compared with 25 of 481 women (5.2%) receiving chlorhexidine (p = 0.65, 95% confidence interval 0.82 to 1.41). Nine women in the placebo group (1.9%) and 9 women in the chlorhexidine group (1.9%) had endometritis (p = 1.0, 95% confidence interval 0.62 to 1.56). CONCLUSIONS Our findings suggest that a one-time 0.4% chlorhexidine vaginal wash does not decrease the incidence of infectious morbidity in parturients, compared with the use of sterile water.

Endotoxin, interleukin-1β, interleukin-6, or tumor necrosis factor-α do not acutely stimulate isolated murine myometrial contractile activity

Objectives: Endotoxin, interleukin-1 β, interleukin-6, and tumor necrosis factor-α have been implicated in the pathogenesis of preterm labor, but their acute effect on myometrial contractile activity is unknown. The objective of this study was to determine their effect on isolated pregnant murine myometrial contractile activity. Study Design: Isometric contractions were measured in myometrium isolated from pregnancy day 18 Swiss-Webster mice. Frequency, duration, amplitude, and integrated area were compared before and after the addition of endotoxin (10 3 and 10 4 ng/ml) ( n = 6), interleukin-1β (10 and 10 ng/ml) ( n = 6), interleukin-6 (1 and 10 ng/ml) ( n = 6), and tumor necrosis factor-α (1 and 10 ng/ml) ( n = 6). Results were analyzed with the Wilcoxon rank-sum test. Results: The addition of endotoxin, interleukin-1β, interleukin-6, or tumor necrosis factor-α did not result in a change in the contractile activity of isolated pregnant murine myometrium compared with control. Conclusion: Endotoxin, interleukin-1 β, interleukin-6, and tumor necrosis factor-α do not acutely increase isolated murine myometrial contractile activity.

ZIDOVUDINE (ZDV) TREATMENT DURING PREGNANCY IN AN URBAN POPULATION. • 1003

Objective: To study the application of the ACTG 076 trial in an urban population in Houston. Methods: The maternal medical records of infants born between 3/1/94 and 10/31/95 who were referred to the pediatric human immunodeficiency (HIV) service were reviewed to determine prenatal ZDV treatment. Infection with HIV in infants was documented by both a positive polymerase chain reaction and a positive HIV culture on separate specimens.Results: One hundred and four infants were born to 103 HIV infected women between 3/1/94 and 10/31/95. Fifty-one (50%) mothers took prenatal ZDV, 8 (8%) had intrapartum ZDV only, and 44 (43%) mothers did not take ZDV. Eight(18%) refused ZDV, 16 (36%) had no prenatal care (PNC) and maternal HIV status was determined at birth, 11 (25%) had no PNC but were known to be HIV infected, 3 (7%) were not offered ZDV despite being HIV infected and having PNC, 3 (7%) had PNC but were not identified as infected until the birth, 2(5%) women had PNC but their HIV status was determined months after giving birth,and ZDV was contraindicated in 1 (2%)mother. Twelve (12%) infants were HIV infected, 2 (4%) were born to ZDV treated mothers and 10 (23%) were born to untreated mothers. Conclusions: Failure to access prenatal care was the most important impediment to prenatal treatment with ZDV. Prenatal ZDV treatment is as effective in preventing congenital HIV infection in general practice as it was in research setting.