Clinical chorioamnionitis is not predicted by umbilical artery Doppler velocimetry in patients with premature rupture of membranes.

Chorioamnionitis substantially increases fetal and neonatal morbidity. Infants born to women with chorioamnionitis have a fourfold increase in neonatal morbidity. If this condition could be predicted before the clinical manifestation and thereby treated earlier, an improved perinatal outcome might reasonably be expected. Based on the in vitro model of bacteria-induced vasoconstriction and pulmonary hypertension noted in sheep and lambs after exposure to the spent medium of a bacterial culture, we theorized that infected amniotic fluid may produce vasospasm of umbilical and placental vessels, reduce fetal perfusion, and increase perinatal asphyxia, morbidity, and mortality. Umbilical vessel vasospasm may be detected by measuring the systolic-diastolic ratio (S/D) of the umbilical artery. Continuous Doppler flow studies of the umbilical artery S/D were performed prospectively on 51 patients with premature rupture of membranes who were not in labor. The most recent test, done within 1 day of delivery, was compared with pregnancy outcome. Ten subjects developed clinical chorioamnionitis, of whom none had an abnormal S/D. Six of 41 women without clinical chorioamnionitis had abnormal S/Ds. These data do not support the use of Doppler measurement of the S/D as a predictor of clinical chorioamnionitis.

Prophylaxis with trimethoprim-sulfamethoxazole in abdominal, pelvic, and prostatic surgery.

The literature on use of trimethoprim-sulfamethoxazole (TMP-SMZ) for prophylaxis in abdominal, pelvic, and prostatic surgery is meager. There is some evidence that TMP-SMZ may be effective prophylactically in biliary surgery (in patients with functioning gall bladders). Further study is needed to clarify the mixed results seen in prostatic and pelvic surgery. An evaluation was made of the effectiveness of TMP-SMZ in the prevention of endomyometritis following cesarean section in 206 women who were comparable in terms of risk factors. Among patients given a placebo, a total of 44 infections (42%) occurred, whereas among those given TMP-SMZ prophylaxis, 22 infections (22%) occurred, a statistically significant difference (P = .037, chi 2). The rate of endomyometritis among placebo recipients was 33%, as contrasted with one of 19% in those given TMP-SMZ (P = .02, chi 2). Prophylactic treatment resulted in lower rates of endomyometritis in both high- and low-risk women, but the results reached statistical significance only among high-risk patients. In essence, prophylaxis changed high-risk patients into low-risk patients.

Fetal heart bradycardia associated with the vacuum extractor. A case report.

The vacuum extractor has been gaining acceptance in the United States. As a result, physicians are becoming aware of potential problems with its use. We treated a patient for fetal bradycardia attributable to the negative pressure of the vacuum apparatus. This type of fetal heart bradycardia can be distinguished from "true" fetal distress by disconnecting the vacuum apparatus and observing the fetal heart rate response. Bradycardia caused by the negative pressure of the vacuum apparatus returns to normal after instrument disconnection.

The effect of prophylactic antibiotics on risk factors for endomyometritis in adolescent patients undergoing cesarean section.

The efficacy of ticarcillin and its effect on the known risk factors for endomyometritis and the prevention of postcesarean infection was studied in adolescents. Patients were randomly given the antibiotic or a placebo. The patients who received prophylactic ticarcillin had one-half the endomyometritis rate as the placebo group. Four or more vaginal examinations during labor were associated with a high incidence of endomyometritis. This was reduced by 35% with prophylaxis. When membranes were ruptured for more than 8 hours before cesarean section, the endomyometritis rate was 86% in the placebo group, as compared to 28% in the prophylactic-treated group. A similar effect occurred in the high-risk length of labor group. Ticarcillin appears to be effective in reducing the incidence of postcesarean endomyometritis in adolescent patients. The critical risk factors, in order of importance, were the number of pelvic examinations performed during labor, the length of time between rupture of membranes and cesarean section, and the length of labor before cesarean section.

Spinal cord tumors during pregnancy.

The diagnosis of and therapy for spinal cord tumors occurring during pregnancy are discussed. A case of pilocytic astrocytoma, not reported previously in the literature, is presented.