457 Correlation of amniotic fluid glucose with culture results
1
Volume I'\umber l, Part 2 454 PHARMACOLOGIC PULMONARY MATURATION IN PRETERM PREMATURE RUPTURE OF MEMBRANES SJ Carlan MD: M Parsons MD, IIF O'Bnen MD, J Kral1lT1er MD Unlversity of South Florlda Medlcal School, Tampa, Flonda Over a 1 year study penod, 44 patlents wlth documented ruptured membranes at 24-34 wks gestat lOna I age were prospec- tlVely randomlzed to recelve either 1) Betamethasone (12 mg 1M q24h x 2 doses), 2) Betamethasone and TRH (400 mcg IV q8h x 6 doses). or 3) nothlng for pulmonary maturatlOn The medlcatlon was repeated q wk unt i I de I 1 very or 34 wks gestat 1 on Fl ve patlents sealed and 2 patlents had documented pulmonary matunty leavlng 37 patlents for analysls. RESUL TS No TRH & Treatment Betamethasone Betamethasone E N=ll N=13 Age 22.7 21 1 23 5 NS EGA at ROM (wks) 30 31 30 NS Chorlo (%) 0 3 (27) 2 (15) NS Infant wt (gr) 1840 1864 1693 NS ROM -> del (hrs) 312.7 191. 7 226.8 NS RDS (%) 4 (30) 1 (9) 5 (38) NS Respl rator days 1.7 .27 2.8 NS NICU days 14.8 8.1 18 NS Neo hosp days 21.4 14.1 23.5 NS Neo charges ($) 19,013 13,378 24,537 NS CONCLUSIONS: There was no decrease ln the lncldence of RDS ln preterm PROM pat 1 ents that had recel ved TRH and Betamethasone or Betamethasone alone when compared to those patlents that recelved no treatment Comparlson of seventy of RDS among groups awa, t, ng more data. 455 THEEFFECf OF BEfAMETHASONE ON UTERINE CONTRACTION FREQUENCY Whitney Gonsoulin. ...MJ1.... ; MB Mauer, R.N.*. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine; Houston Texas. The purpose of the study was to determine if there is any change in the uterine contraction frequency of pregnant patients who receive betamethasone for fetal lung maturation. Using a double blind crossover protocol; six patients were studied following either betamethasone or placebo treatment. The treatment was administrated between the 27 and 31 weeks of gestation by multiple parameters. Tokos TM contraction monitor belts were used to collect data on frequency of contractions. The frequency of contractions following 12,5 milligrams of betamethasone intramuscular versus a saline placebo was compared using a Students's t test with a p value of < 0.05 considered significant. There was no significant difference between the frequency of contractions seen between the day before, the day of, and the day after betamethasone or placebo in our patients. Therefore we conclude that betamethasone does not increase uterine contraction frequency when adminsitered for lung maturation. SPO Abstracts 371 456 CARDIORESPIRATORY RESPONSE OF THE HYPOXEMIC OVINE FETUS TO FETAL NICARDIPINE ADMINISTRATION. R. Harold Holbrook Jr. M.D., Rebecca Peters x , and Joelle Osias x . Maternal-Fetal Medicine and Pediatric Cardiology, Stanford University, Stanford CA 94305. Maternal infusion of nicardipine and nifedipine in animals produces fetal acidosis and death in utero. We have shown that fetal administrauon in the normoxic state has no adverse effect on fetal cardiorespiratory variables. To assess the effect of nicardipine infusion in the hypoxemic state, we administered sodium nitrite to six chronic fetal sheep to attain a methemoglobin level of 30% and fetal hypoxemia. Nicardipine was then infused to the fetus to achieve fetal serum levels similar to those associated with asphyxia from maternal administration. There was no change in fetal arterial pressures, heart rate, pH, or blood gases after infusion of nicardipine. These results suggest that fetal compensatory vasoconstriction in response to hypoxemia is not reversed by nicardipine, and that membrane receptors for calcium antagonists may differ in the fetus, newborn, and adult. (Am Heart Assn 89-150: NICHD 22727 and 19190) 457 CORRELATION OF AMNIOTIC FLUID GLUCOSE WITH CULTURE RESULTS. Daniel Gauthier William Meyer Andre Bieniarz M.D., University of Illinois College of Medicine, Chicago, IL. The diagnosis of asymptomatic bacterial col- onization of amniotic fluid can be difficult. Gram stain may miss up to 50% of cases and cul- ture results may take 2 days or longer to be ob- tained. Amniotic fluid glucose(AFG) level has been suggested as a rapid and sensitive test for infection. METHODS: 149 patients with preterm labor (PL) or premature rupture of membranes (PROM) weeks EGA and no clinical evidence of infec- tion underwent amniocentesis. Amniotic fluid was sent for Gram stain, cultures (aerobic; anaerobic, mycoplasma), and glucose level. RESULTS: Cul- ture results were positive in 45 patients(30%). AFG levels were significantly lower in patients with positive cultures than in patients with neg- ative cultures(l2.3±10. 7 mg/dl vs 34. 7±16.0 mg/dl, p<O.OOOl). A glucose level of < 16 mg/dl had a sensitivity of 84%, specificityof 93%, positive predictive value of 84%, and negative predictive value of 93% in detecting positive culture re- sults. Glucose level< 16 mg/dl was much more sen- sitive than Gram in detecting positive cul- tures(84% vs 29%, p<O.OOOl). CONCLUSION: AFG is a useful indicator of asymptomatic bacterial colonization of amniotic fluid in PL or PROM .5.34 weeks EGA.
Transcript of 457 Correlation of amniotic fluid glucose with culture results
Volume 16~ I'\umber l, Part 2
454 PHARMACOLOGIC PULMONARY MATURATION IN PRETERM PREMATURE RUPTURE OF MEMBRANES SJ Carlan MD: M Parsons MD, IIF O'Bnen MD, J Kral1lT1er MD Unlversity of South Florlda Medlcal School, Tampa, Flonda
Over a 1 year study penod, 44 patlents wlth documented ruptured membranes at 24-34 wks gestat lOna I age were prospectlVely randomlzed to recelve either 1) Betamethasone (12 mg 1M q24h x 2 doses), 2) Betamethasone and TRH (400 mcg IV q8h x 6 doses). or 3) nothlng for pulmonary maturatlOn The medlcatlon was repeated q wk unt i I de I 1 very or 34 wks gestat 1 on Fl ve patlents sealed and 2 patlents had documented pulmonary matunty leavlng 37 patlents for analysls.
RESUL TS No TRH &
Treatment Betamethasone Betamethasone E ~ N=ll N=13
Age 22.7 21 1 23 5 NS EGA at ROM (wks) 30 31 30 NS Chorlo (%) 0 3 (27) 2 (15) NS Infant wt (gr) 1840 1864 1693 NS ROM -> del (hrs) 312.7 191. 7 226.8 NS RDS (%) 4 (30) 1 (9) 5 (38) NS Respl rator days 1.7 .27 2.8 NS NICU days 14.8 8.1 18 NS Neo hosp days 21.4 14.1 23.5 NS Neo charges ($) 19,013 13,378 24,537 NS
CONCLUSIONS: There was no decrease ln the lncldence of RDS ln preterm PROM pat 1 ents that had recel ved TRH and Betamethasone or Betamethasone alone when compared to those patlents that recelved no treatment Comparlson of seventy of RDS among groups awa, t, ng more data.
455 THEEFFECf OF BEfAMETHASONE ON UTERINE CONTRACTION FREQUENCY Whitney Gonsoulin. ...MJ1....; MB Mauer, R.N.*. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine; Houston Texas.
The purpose of the study was to determine if there is any change in the uterine contraction frequency of pregnant patients who receive betamethasone for fetal lung maturation. Using a double blind crossover protocol; six patients were studied following either betamethasone or placebo treatment. The treatment was administrated between the 27 and 31 weeks of gestation by multiple parameters. Tokos TM
contraction monitor belts were used to collect data on frequency of contractions. The frequency of contractions following 12,5 milligrams of betamethasone intramuscular versus a saline placebo was compared using a Students's t test with a p value of < 0.05 considered significant. There was no significant difference between the frequency of contractions seen between the day before, the day of, and the day after betamethasone or placebo in our patients. Therefore we conclude that betamethasone does not increase uterine contraction frequency when adminsitered for lung maturation.
SPO Abstracts 371
456 CARDIORESPIRATORY RESPONSE OF THE HYPOXEMIC OVINE FETUS TO FETAL NICARDIPINE ADMINISTRATION. R. Harold Holbrook Jr. M.D., Rebecca Petersx, and Joelle Osiasx. Maternal-Fetal Medicine and Pediatric Cardiology, Stanford University, Stanford CA 94305.
Maternal infusion of nicardipine and nifedipine in animals produces fetal acidosis and death in utero. We have shown that fetal administrauon in the normoxic state has no adverse effect on fetal cardiorespiratory variables. To assess the effect of nicardipine infusion in the hypoxemic state, we administered sodium nitrite to six chronic fetal sheep to attain a methemoglobin level of 30% and fetal hypoxemia. Nicardipine was then infused to the fetus to achieve fetal serum levels similar to those associated with asphyxia from maternal administration. There was no change in fetal arterial pressures, heart rate, pH, or blood gases after infusion of nicardipine. These results suggest that fetal compensatory vasoconstriction in response to hypoxemia is not reversed by nicardipine, and that membrane receptors for calcium antagonists may differ in the fetus, newborn, and adult. (Am Heart Assn 89-150: NICHD 22727 and 19190)
457 CORRELATION OF AMNIOTIC FLUID GLUCOSE WITH CULTURE RESULTS. Daniel Gauthier M.D~, William Meyer M.D~, Andre Bieniarz M.D., University of Illinois College of Medicine, Chicago, IL.
The diagnosis of asymptomatic bacterial colonization of amniotic fluid can be difficult. Gram stain may miss up to 50% of cases and culture results may take 2 days or longer to be obtained. Amniotic fluid glucose(AFG) level has been suggested as a rapid and sensitive test for infection. METHODS: 149 patients with preterm labor (PL) or premature rupture of membranes (PROM) ~34 weeks EGA and no clinical evidence of infection underwent amniocentesis. Amniotic fluid was sent for Gram stain, cultures (aerobic; anaerobic, mycoplasma), and glucose level. RESULTS: Culture results were positive in 45 patients(30%). AFG levels were significantly lower in patients with positive cultures than in patients with negative cultures(l2.3±10. 7 mg/dl vs 34. 7±16.0 mg/dl, p<O.OOOl). A glucose level of < 16 mg/dl had a sensitivity of 84%, specificityof 93%, positive predictive value of 84%, and negative predictive value of 93% in detecting positive culture results. Glucose level< 16 mg/dl was much more sensitive than Gram stai~ in detecting positive cultures(84% vs 29%, p<O.OOOl). CONCLUSION: AFG is a useful indicator of asymptomatic bacterial colonization of amniotic fluid in PL or PROM .5.34 weeks EGA.
