Antibiotic administration in patients with preterm premature rupture of membranes reduces the rate of histological chorioamnionitis: a prospective, randomized, controlled study.

OBJECTIVE: To determine whether antibiotic administration in patients with preterm premature rupture of membranes is associated with a reduction in the rate of histological chorioamnionitis and funisitis. METHODS: One hundred consecutive patients with preterm premature rupture of membranes and no labor between 24 and 34 weeks were invited to participate in this study. Eligible patients randomly received either clindamycin-gentamicin for 7 days or placebo, and were managed expectantly until 35 weeks unless fetal or maternal indications developed. Microbial invasion of the amniotic cavity was defined as the presence of a positive amniotic fluid culture obtained by transabdominal amniocentesis. Cervicovaginal infection was diagnosed when bacterial vaginosis or a positive culture for cervicovaginal pathogens or facultative bacteria associated with a significant increase in the white blood cell count were found. Histological chorioamnionitis was based on the observation of polymorphonuclear leukocyte infiltration of the chorionic plate or the extraplacental fetal membranes. Funisitis was diagnosed in the presence of polymorphonuclear leukocyte infiltration into the umbilical vessel walls or Wharton jelly. Statistics were performed using contingency tables. RESULTS: Seventy-one patients with available histological study of the placenta were included. Thirty-five women received antibiotics and 36 were given placebo. Patients who received antibiotics had a significantly lower rate of histological chorioamnionitis than patients who received placebo (46% (16/35) vs. 69% (25/36), respectively; p < 0.05). This effect was more pronounced among women with microbial invasion of the amniotic cavity and/or cervicovaginal infection (58% vs. 89%, respectively; p < 0.01). Antibiotic therapy was associated with an increase in the frequency of placentas without histological abnormalities (29% vs. 6%; p < 0.01). The frequency of funisitis was not different between groups. CONCLUSION: Administration of antibiotics in patients with preterm premature rupture of membranes is associated with a significant reduction in the incidence of histological chorioamnionitis but it does not modify the frequency of funisitis.

[Complete molar abortion induced with prostaglandin F2 alpha]. / Aborto molar completo inducido con prostaglandina F2 alfa

PIP: Prostaglandins (PGs) are unsaturated fatty acids with 20 carbon atoms; they are to be found in most human and animal tissues. There are 13 known PGs divided into 4 groups, E, F, A, and B. This article describes the use of PGF2alpha in a case of missed abortion. The patient, aged 22, was 9 months pregnant according to the date of last menstruation; the abdominal examination revealed uterine size corresponding to a 3 months' pregnancy; no fetal cardiac sign was present. Intravenous infusion of PGF2alpha was started with a dose of 25 mcg/minute for the first 30 minutes, then at a dose of 50 mcg/minute. Contractions started 1 hour 35 minutes after infusion, and continued irregularly. The patient aborted suddenly and completely at 10 hours 25 minutes after beginning of infusion; total quantity of PGF2alpha used was of 35 mg. A series of unpleasant side effects accompanied the procedure, starting at about 2 hours 10 minutes after starting PG infusion, precardial pain, nausea and vomiting; there was no diarrhea. The mechanism of PGs in inducing abortion is still unknown; administration can be intrauterine, besides intravenous, and, apparently, PGE1 is much more powerful than PGF2alpha.^ieng