Fetal heart rate patterns associated with amniotic fluid embolism.

Two cases with recorded fetal heart rate response during maternal amniotic fluid embolus are reported. Fetal heart rate abnormalities can be associated with the development of amniotic fluid embolus or occur during the acute events of amniotic fluid embolus. Attention to the management of amniotic fluid embolus in the mother must not neglect the fetus. Improvement of maternal oxygenation and perfusion can effect intrauterine resuscitation; however, when this is not successful early delivery of the fetus may be necessary for its survival.

Proliferation of group B streptococci in human amniotic fluid in vitro.

The group B Streptococcus is one of the most virulent organisms causing perinatal infection. Human amniotic fluid from the second and third trimesters was pooled and analyzed for electrolytes, protein, albumin, zinc, inorganic phosphorus, ferritin, lysozyme, and immunoglobulins. We inoculated replicates of specimens with known virulent strains of group B streptococci (893, 891, and 878) and Escherichia coli (C5) with Todd-Hewitt broth and normal saline solution used as controls. Group B streptococci strains 893 and 891 proliferated rapidly at rates similar to their rates in Todd-Hewitt Broth. Strain 878 grew at a rate slower than that of strains 893 and 891. The amniotic fluid specimens were similar with respect to factors reported as inhibitory to bacterial proliferation. Second- and third-trimester amniotic fluid supports the growth of group B streptococci as well as a culture medium optimized for bacterial growth. Strain-specific variance in group B streptococci growth rates in amniotic fluid may have clinical significance for those at risk for group B streptococci infection.

Leukocyte esterase activity in the rapid detection of urinary tract and lower genital tract infections in obstetric patients.

Infections of the vagina and urinary tract are important problems for the obstetrician. Examination of the vaginal discharge and urine for the presence of leukocytes is an important part of the evaluation for vaginitis and urinary tract infections. Neutrophils contain several esterases that are not present in serum, urine, or vaginal secretions. These esterases are not influenced by bacteria, commonly used drugs, or variable compositions of urine or vaginal secretions. A prospective study was performed to assess the sensitivity and specificity of leukocyte esterase activity as measured by dipstick (Chemstrip 9, Biodynamics) for the prediction of vaginitis and urinary tract infections during pregnancy. Results were compared with those obtained from potassium hydroxide smears, wet preps, and urine cultures. The vaginal discharge and urine of 65 patients was tested for leukocyte esterase activity on their initial OB visit. Leukocyte esterase was 100% sensitive and 100% specific for detecting urinary tract infections. It was 100% sensitive and 90% specific for predicting vaginal infections. Trichomonas infections accounted for the positive leukocyte esterase results when the urine culture was negative. On the basis of this study we believe that leukocyte esterase activity is sufficiently sensitive and specific to permit use of this test as a rapid and inexpensive screening procedure for vaginitis and urinary tract infections.