298 SPO Abstracts

185 AMNIDnC fLUID GLUCOSE AS A PREDICfOR OF INfRAAMNIDnC INFECI10N IN PRETERM lABOR AND PRETERM RUPI1JRE OF MEMBRANES Gary A Pjldy, Mark D Pearlmanx, Leon G Smith,

Guillermo Tortolero-LunaX, Brian Kirshon, Sebastian Farox, David B Cotton. Dept of OB/GYN, Baylor College of Medicine, Houston, Texas.

Amniotic fluid (AF) culture is considered the gold standard for the diagnosis of intraamniotic infection (IAJ); however, results may take in excess of two days. Organisms are seen on Gram stain (GS) but only when ~1 05/ml are present. Low glucose concentration has been used as a marker for detecting infection In other sites such as cerebrospinal fluid The purpose of this study was to assess the validity of three laboratory tests (AF GS, AF culture, and AF glucose) in the diagnosis of V\I. MATERIALS AND METHODS: Amniocentesis was performed in 39 women with PTL (n;20) or PROM (n;19). AF was Gram stained and cultured for Mycoplasma, Ureaplasma, aerobic, and anaerobic bacteria. IAJ was diagnosed when maternal temperature was 2! l00.4°F in the presence of uterme tenderness and leukocytosis. Statistical significance was considered at p<0.05. RESULTS: Diagnosis of IAI was made in 31 % (12/39) of women. GS of the AF was positive for bacteria in 18% (2/11) of cases and positive for WBC in 64% (7/11) of cases. The AF culture was positive in 58% (7/12) and low «15 mg%) AF glucose was present m 75% (9/12) of infected patients. The sensitivity (S), specificity (Sp), and positive predictive value (PPY) for low AF glucose was 82%, 92%, and 82%, respectively. For presence of WBC on AF GS, a S of 70%, Sp of 88%, and PPY of 70% were found, while AF culture had a S of 64%, Sp of 83%, and PPY of 64%. Women who developed IAJ demonstrated significant differences in serum WBC (15.8±6.2 vs

11.4±3.3 xl03), gestational age at presentation (27.6:t4.3 vs 31.2±2.4 weeks), birthweight (1231:t413 vs 19l5±538 grams), and AF glucose (7.8±1.8 vs 28.7±1.9 mg%). CONCLUSIONS: Low «15 mg%) AF glucose demonstrated a higher S, Sp, and PPY among the three tests assessed in this study. Therefore AF glucose appears to be a rapid and suitable method to predict infection among women with PROM or PTL.

186 NEISSERIA GONORRHEA AND CHlAMYDIA TRACHOMATIS IN LABOR: PERINATAL OUTCOME AND RELATIONSHIP TO PRENATAL CULTURES. Brian Mercerx, Amanda Skollx, Vicki Bazelskix, George RyanX, Paul Gray x, Baha Sibai . U.T. Memphis.

The purpose of this study was to assess the prevalence of Neisseria Gonorrhea (NG) and Chlamydia trachomatis (CT) in our labor population, and identify adverse perinatal outcomes associated with their presence in labor. Secondarily we intended to correlate NG and CT cutures at the first prenatal visit to those in labor, and perinatal outcome. Methods' A total of 1,076 women admitted to the labor and delivery unit between September and December, 19S9 underwent cervical cultures for NG and CT. The indication for admission was noted and the perinatal course was followed prospectively for abruptio placenta, chorioamnionitis, postpartum infectious morbidity, birthweight <2,500 grams, and preterm delivery. Medical records were reviewed for the resutts and treatment of NG and CT cultures at the first prenatal visit. Patients recieving prenatal care at this institution are routinely cuttured for NG and CT, and treated as indicated, at the first prenatal visit. Results: The incidence of NG and CT in labor were 2.3% and 9.2% respectively. Positive cultures for NG or CT in labor were associated with an increased risk of preterm premature membrane rupture(PROM), (p=O.0017 & p=0.0007 respectively), birthweight <2,500 grams (p=0.025 & p=0.0006), and delivery before 37 weeks (p=0.02 & p<0.0006). The incidences of NG and CT at first prenatal visit were 4.5% and 1S.9%. A total of 70.3% of women with positive prenatal NG cuttures also had positive CT cuttures. Patients with positive NG on prenatal cultures had a two-fold increased in positive NG cuttures in labor ( ct. women with negative antenatal cultures (N.S.». A similar increase in CT was seen in labor among women with positive prenatal cultures (p=0.075). Positive cultures at the first prenatal visit were not associated with adverse perinatal outcome. Conclusions' In this population CT and NG in lalJor are associated with PROM, low birth weight and premature delivery. Repeat cuttures and treatment of NG and CT in the early third trimester may be useful in this population.

Januarv 199 I Am J Obstet Gvnecol

187 IMMUNOLOGICAL PARAMETERS IN PREGNANCY AND POST­PARTUM IN PAIRED HIV POSITIVE AND NEGATIVE CAUCASIAN AND BLACK WOMEN. Marc Boucher, N Lapointe', J Charest', J Samson', G Delage'. University of Montreal, Sainte-Justine Hospital, Montreal, Canada.

OUr goal was to assess immunological parame­ters of caucasian and black HIV- and HIV+ women during trimesters(T) of pregnancy and post-partum(PP). Lymphocyte subpopulations are measured by indirect IFA (CD2,3,4,S,20, Leu7 ,11). PHA,ConA,PWM mitogen responses are studied. NK cell activity is measured at cell ratios 5,10,20:1 and IgA/lgM/lgG by nephelometry. 145 studies were done in 19 HIV+/42 HIV- women. No differences were found between caucasian and black HIV- women. Immunosuppression was most profound during the 2nd/3rd T with return to normal values in PP in HIV- women. When HIV+/HIV- women were compared in the 2nd/3rd T, HIV+ women had lower CD4/CDS ratio due to increased CDS. PHA response was abnormal. IgG,Leu7 and CD20 were significantly increased.ln the 3rd T, NK activity was decreased. In PP, HIV+ women have a depressed CD4 count 35l±195/709±193 p=O.007. Mitogen responses remain decreased:PHA,PWM, ConA p<O.02. IgG is elevated while Leu7 and NK are normal. While HIV+ women are immunodeficient during pregnancy, the differences are more significant in PP.

188 ULTRASONOGRAPHIC ASSESSMENT OF FETAL GROWTH AND MORPHOLOGY IN HIV-l POSITIVE PREGNANT WOMEN. Marc Boucher, J Samson', G Delage', C Hankins', M Fauvel', N Lapointe', University of Montreal, Sainte-Justine Hospital, Montreal, Canada.

In light of the suggested existence of a syndrome combining growth failure and craniofacial dysmorphism in infants with HIV-1 infection we wanted to evaluate intrauterine growth and morphology of fetuses from HIV-l + pregnant women In our ongoing prospective study, 15 HIV-l + pregnant women had a total of 35 ultrasound examinations during their pregnancy. Biparietal diameter (BPD) , head circumference (HC), abdominal circumference (AC) , femur length (FL), transverse cerebellar diameter (TCD) and outer orbital distance (OOD) were measured. Not every measurement could be done on each patient at all times. Our results are:

BPD HC AC FL TCD OOD

Normal* 34 18 22 29 12 15 Decreased 0 1 4 4 4 3 No other fetal anomalies were noted. Our preliminary results suggest that in our population, growth retardation is not a prominent feature in fetuses from HIV-l + mothers and that growth is harmonious in those fetuses. Finally, dysmorphic growth of cranial structures does not seem to occur in utero. * ± 2 standard deviations for gestational age.