The congruity between urine and cervical swab cultures in pregnant women with versus without amniotic fluid infection.

INTRODUCTION: We observed the congruity of bacteria found in urine and cervix of pregnant women with amniotic fluid infection (AFI) compared to healthy controls. PATIENTS AND METHODS: Over three years, we prospectively analysed urine and cervical swabs cultures in 120 pregnant women in gestational week 16-20. The patient population was divided in two groups: group I patients had clinical symptoms of AFI. The rest of the patients were designated as healthy controls (group II). Congruity between findings in both groups was observed. In patients with bacterial growth, antibiotic treatment was initiated as recommended and once ended - culture probes were repeated. RESULTS: The rates of nonsignificant and significant bacteriuria were doubled in group I. Fifty-five percent (n = 33) of patients in group I had identical bacteria cultured both from the urine sample and cervical swab, in contrast to only 13.3 % in group II. Congruity was most pronounced for Klebsiella species and E. coli, the later being single most dominant isolate in regards to both cultures. After antimicrobial treatment, microbial eradication occurred in 15 patients (45.5 %). The observed incidences of abortions and preterm deliveries were significantly lower in patients with microbial eradication versus patients with microbial persistence. CONCLUSION: Patients with clinical symptoms of AFI have high risk for bacteriuria identical to bacterial culture from cervical swab. Antimicrobial treatment was effective only partially where indicated. Screening for eradication is recommended and consensus on the most appropriate therapy is needed.

Pleomorphic vulvar leiomyoma with local invasive behavior.

A case of pleomorphic leiomyoma in Bartholin gland's area in a 26-year-old woman is reported. After diagnostic treatment, primary excision was done. A large, solid tumor 10 x 7.5 cm was extirpated. The tumor showed locally invasive behavior, which suggested a malignant tumor of Bartholin gland, because of it's localization and outlook. Pathohistological examination and immunohistochemical reactions proved that it was a mesenchymal tumor of smooth muscle origin with marked polymorphism, without mitosis, with a myxoid stroma and with biological aggressivity, and the possibility of local recurrence. Thus, a second more radical surgical procedure, was performed. In the excised tissue, no residual tumor was found and all lymph nodes were negative.

Nonspecific aerobic vaginitis and pregnancy.

During the period 1996-1998, cervical swabs of 50 pregnant women with subacute amniotic infection syndrome (AIS) and the semen of their consorts were bacteriologically analyzed. In the control group were 50 healthy pregnant women and their consorts too. Pathogenic bacteria (the most common were Escherichia coli, Staphylococcus haemolyticus, Chlamydia trachomatis and Ureaplasma urealyticum) were isolated from the cervical swab of 50 pregnant patients with AIS in 86.0% of them, while in the control group of healthy pregnant women in 28.0%. Pathogenic bacteria were present in 70.0% of semen of consorts pregnant women with AIS and only in 30.0% of semen of the control group. The congruity of pathogenic bacteria in the cervical swab and semen in the investigated group was 69.2%, while only 35.7% in the control group. Following erythromycin, cefuroxime and local tetracyclin treatment, the negativization of the cervical swab resulted in 30 pregnant patients with AIS, while the colonization persisted in 20 of them. The outcome of pregnancy was significantly better in cases with negativization of the cervical swab: perinatal loss was 6.7%, while in cases with persistent infection it was 55.0%. The authors presume the amniotic infection syndrome should be ascending manifestation of nonspecific vaginitis, which is maintained by the consort's urogenital infection. AIS should be classified as a 'sexually-transmitted disease'.

[Results of IVF treatment methods in Germany in 1998--the German IVF Registry]. / Rezultati lijecenja IVF metodama u Njemackoj 1998. godine--Njemacki IVF registar.

We used data in Germany IVF registar 1998 from 86 (94.6%) centers which take upon IVF procedures. The total documentary were treated 46730. The cultivated data were 45459. The visible is increase number of group which use IVF procedures and growth IVF/ICSI centers with options KRYO preservations. In Germany 1998, IVF ICSI, KRYO and GIFT procedures were treated 30,009 women, on an average 1,515 cycles per year. The endurance leaning of children was amoung 2 and 8 years for both procedures. In stimulated cycles on an average were taken 9.04 eggs (follicule punction). During IVF procedures it was 22.64% clinical pregnancy and ICSI procedures 23.53% clinical pregnancy. In most of the cases cycles were stimulated with long gonadotropine protocol, with GnRH-agonists, after suppression adenohypophysis. Considering pregnancies and abortions in addiction to chosen gonadothropine it was not possible to confirm significant difference neither for IVF of ICSI procedures. Results of therapy showed clear addiction to age of women and become worse after 39 the year of life and distintcly less after 49th year for both procedures. During transvaginal ultrasonography follicule punction reported is 253 (0.67%) complications. Severe cases such as ovarial hyperstimulation syndroms (OHSS III) were reported in 1.12% cases.

[Bacterial flora in the reproductive system in the intra-amniotic infection syndrome]. / Bakterijska flora reproduktivnog sustava kod sindroma intraamnijske infekcije.

By the bacteriological aerobic analysis of the cervical swabs of 64 pregnant women with a subacute syndrome of intraamniotic infection in the 16th and 28th gestation weeks, pathogenic bacteria were isolated in 59 women (92.2%) and out of the swabs of 30 young girls with less sexual experience, 8 (26.7%) showed the presence of pathogenic bacteria, the difference being statistically highly significant (X2 V 56.9, p less than 0.001). From the ejaculates of the husbands of the same pregnant women, pathogenic bacterial were isolated in 57 of them (89.1%) and from the ejaculates of the controlled groups of young adolescents, pathogenic bacteria were isolated in 5 of them (16.7%), the difference being again statistically highly significant (X2 = 62.2, p less than 0.001). Comparing bacteria from the swabs of pregnant women with the syndrome of intraamniotic infection with those from the semen of their husbands, it has been found that the bacteria were identical in 40.6% if only one kind of bacteria was isolated and in 68.7% if several kinds of bacteria were isolated from the swab or ejaculates. In the group of 30 young girls a statistically significant dependence of pathogenic bacteria on the number of partners in their sexual life was observed (X2 = 4.54, p less than 0.05); pathogenic bacteria were isolated only once from the swabs of girls with only one partner and 6 times from the swabs of girls with two or more sexual partners.

[Bacteriological analysis of the cervical canal in uterine cervix insufficiency]. / Bakterioloska analiza cervikalnog kanala kod insuficijencije grla maternice.

A bacteriological analysis was made of pyogenic agents from the cervical canal of 260 pregnant women with cervical incompetency, in whom the cerclage of the cervix was performed. Pyogenic agents were found in 139 (53.5%) pregnancies. The most frequently isolated pathogenic agent was Enterococcus--in 19.2% of all pregnant women and in 36.0% in those with a pathologic swab. E. coli was isolated in 16.5% of all pregnant women and in 30.9% of those with the pathologic swab. A significantly higher number of pathologic swabs were found in women with colpitis and the cleanliness 3 degree of the vaginal discharge and without colpitis (6.4%). In pregnant women with a pathologic swab, in spite of the cervical cerclage, spontaneous abortions and premature deliveries were significantly more frequent (8.2% and 16.4% respectively) than in pregnant women with a sterile swab (1.8% and 6.1% respectively).