396

Volume 166 Number 1, Part 2

PERINATAL EFFECTS OF GARDNERELIA VAG/NALlS DECIDUITIS IN THE RABBIT, N. Field,' E. Newton, K. Kagan-Hallet,' W. Peairs.' Dept. of Ob/Gyn, UTHSC, San Antonio, TX.

Gardnerella vaginalis in conjunction with anaerobic bacteria and !lenital mycoplasmas is associated with bacterial va~inosis and Infection-induced preterm birth. However, minimal attention has been paid to the pathologic role of Gardnerella vaginalis alone in preterm labor and perinatal morbidity. We studied the effects of intrauterine infection with Gardnerella vaginalis on pregnancy outcome and fetal development in the rabbit. Both uterine horns of rabbits at 70% gestation were inoculated hysteroscopically with either 0.2 ml of 105 - 107 cfu/ml of Gardnerella vaginalis or saline. The animals were observed daily for fever, bleeding, or labor. Animals were sacrificed on day 4 or earlier if premature delivery was recognized. Aerobic and anaerobic cultures of blood, decidua, and peritoneal and amniotic fluid were performed. Maternal and fetal histology was examined in a blinded fashion (KK-H) for evidence of infection and/or injury. Severe brain injury was defined as ;" 15% neuronal necrosis. Decidual and amniotic fluid cultures were positive for Gardnerella vagina lis in all ofthe study group ani mals.

Or!)anism (n) Fever

Gardnerella 3 vaginalis (17)

Placebo (14)

o

Live Preterm births

labor (%)

Brain Fetal wt. Placental injury (gm±SD) (gm±SD) (%)

86/108 12.8±3.31 6.2± 1.41 60' (80)*

o 80/84 16.8±3.1 8.3±2.0 o (95)

*p<0.03; tp<O.OOI

Ga;d~;;'~ji;;;agiiJiiis decid~itis did n';t unifor;"'ly result in maternal illness and/or preterm labor. However, intrauterine infection with Gardnerella vaginalis had significant detrimental fetal effects, including death, growth retardation, decreased placental weight, and brain injury.

397 SHOULD AN AMNIOCENTESIS BE PERFORMED BEFORE A CERClAGE OPERATION III PATIENTS PRESENTING WITH CERVICAL DILATATION IN THE MIOTRIMESTER OF PREGNANCY? R. Romero, R. Gonzalez: W. Sepulveda: F. Brandt: M. Ramirez: M. Mazor, Depts. of Ob/Gyn, Yale Univ, School of Medicine, New Haven, CT; Wayne State Univ., Detroit, MI

Cervical cerclage is a management option for patients presenting with cervical dilatation in the midtrimester of pregnancy, Post-cerclage rupture of membranes and clinical chorioamnionitis a(e common complications often attributec' to this procedure. However, these complications may result from a pre~xisting ascending intraamniotic infection rather than from the procedure per se. This study was designed to determine whether microbial invasion of the amniotiC cavity is present in patients presenting with cervical dilatation and effacement in the midtrimester of pregnancy. Materials and Methods: Amniocentesis was offered to patients presenting with cervical dilatation (>2 cm) in the midtrimester of pregnancy (gestational age..:'O,24 weeks) (n = 22). Amniotic fluid was cultured for aerobic, anaerobic bacteria and Mycoplasmas. ~ The prevalence of positive amniotic fluid cultures for microorganisms in women presenting with cervical dilatation and effacement was 59% (13/22). The most frequent isolates were Ureaplasma urealyticum (n = 3), Gardnerella vaginalis (n = 2) and Mycoplasma hominis. All patients who had an intraamniotic infection not detected by Gram stain and who underwent a cerclage operation had serious complications (rupture of membranes, chorioamnionitis or subsequentpreterm delivery/abortion). Conclusions: 1) Microbial invasion of the amniotic cavity is present in 59% of patients presenting with cervical dilatation in the midtrimester. 2) Patients who had a cervical cerclage in the presence of microbial invasion ruptured their membranes, developed clinical signs of chorioamnionitis or delivered a preterm neonate. 3) Amniocentesis for microbiologic evaluation should be considered before performing a cerclage operation in patients presenting with cervical dilatation in the midtrimester.

398

SPO Abstracts 385

IIITERLEUKIH-8: ASSOCIATION WITH AlllfIOTIC FLUID LEUKOTAXIS AIID CBORIOAIIIIIOHITIS. Peter H. Cherouny, Glenn A. Pankucbx, Roberto Roaero, John J. Botti, Peter C. Appelbaur. The Depts. of OB/GYH and Pathology, University Hospital, Penn state University, Hershey, PA and Dept of OB/GYH, Yale University School of lied, Hew Haven, CT. Supported by lIarcb of DileS Research Grant #6-548

InterleuJdn-8 (IL-8) is a leukoattractant cytokine that bas been shown to be elevated in miotic fluid (AF) of patients with intrauniotic infection, defined by a positive AF culture. IL-8 also produces neutrophil leukotaxis in the AF-Ieukotaxis assay (AF LelIA), previously shown as a IIOre accurate aarker for bistologic cborioaJllionitis than AF culture. The purpose of this study was to detemne if IL-8 is present in AF in which leukoattractants are detectable by the AF LelIA, AF collected frol 32 patients within 48 hours of delivery was evaluated by AF culture, AF LelIA, and illllllOasSaY for IL-8. Placentae were evaluated for bistologic cborioaJllionitis. 14 of 15 AFs negative for AF LelIA, culture and bistology bad IL-8 levels below the detection threshold of 1 11<1/11. All patients with detectable leukoattractants bad bistologic cboriomioni tis and detectable IL-8 and are grouped accordill<l to culture results. Conclusions: 1) IL-8 is present in AF with positive leukotaxis and, 2) IL-8 concentration increases signif icantl y with extension of the tissue infection into the miotic fluid. These data s ' t d tecti n of miotic fluid leuko- Groyp 2 (n=9) attractants, includill<l IL-8, AF Leu ( +) identifies intrauterine in- AF culture(-) AF culture(+) fection before there are detec,. Histology (+) t Histology (+) t table miotic fluid bacteria. y.-a (18.5,2-36) 1L-8(71.5,3-244)

<051- .'

399 1HE IMPACf OF AMNlOINFVSION ON MATERNAL AND NEONATAL MORBIDITY IN PREGNANCIES COMPLICATED BY PRETERM PREMATURE RUPI1JRE OF MEMBRANES AND AMNlONlTIS.

C A. Major. M. de Vecianax T. Asrat and M. P. Nageotte. University of California, Irvine and Memorial Medical Center of Long Beach.

We evaluated 65 pregnancies complicated by both pre term premature rupture of membranes (PPROM) and amnionitis between 24 and 34 weeks of gestation. All patients were induced after the clinical diagnosis of amnionitis was made. Twenty-seven patients received i.v. antibiotics followed by prophylactic amnioinfusion (AI group); 38 patients received i.v. antibiotics only ( non-AI group). Both groups were comparable for gestational age at ROM and at delivery, AFI on admission, latency periods from ROM until amnionitis developed, the time from the diagnosis of amnionitis to delivery and birthweight. In addition. there were similar incidences of variable decelerations and meconium staining in both groups. Only I of 27 patients in the AI group developed postpartum endometritis as compared to 18 of 38 patients in the non-AI group (P = 0.0003). The marked difference in the incidence of endometritis between the 2 groups was present regardless of the route of delivery (Vag. del. P = 0.018); (CIS P = 0.038). Delivery by CIS was necessary in only 5 of 27 in the AI group and 19 of 38 patients in the non-AI group (P = 0.0058). Although there was a trend towards an increased incidence of CIS for fetal distress in the non-AI group, this was not found to be statistically significant (P=0.079). No significant differences in perinatal depression/acidosis and neonatal sepsis were found between the 2 groups. Conclusion: In pregnancies complicated by both PPROM and amnionitis, prophylactic amnioinfusion may significantly decrease maternal morbidity by limiting postpartum infections and the cesarean section : ate. This study does not demonstrate improved neonatal outcome with amnioinfusion.