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189 RISK FOR PUERPERAL ENDOMETRITIS: A MICROBIOLOGIC ANALYSIS. Charles J. Macri, CDR MC USN, Jeffrey S. Greenspoon, John G. Wilcoxx , Dept. OB/GYN, University of Southern California, School of Medicine, Los Angeles, CA 90033

We reviewed results of endometrial cultures obtained at the time of cesarean section (CS) to evaluate whether the presence of pathogenic bacteria predicted the development of post­cesarean section endometritis. Aerobic and anaerobic cultures of the lower uterine segment were obtained at the time of delivery in 43 patients undergoing CS. All patients received a single prophylactic dose of 2 grams of cefoxitin or cefotetan. Post-cesarean section endometritis developed in 7 (16%) patients; in 5 of 23 (22%) receiving cefoxitin and 2 of 20 (10%) receiving cefotetan, (p not significant). No organism or group of organisms was associated with the development of post­cesarean section endometritis. Specifically, group B Streptococcus, Enterococcus, gram­negative aerobic rods, anaerobes, or organisms associated with bacterial vaginosis were not associated with endometritis. Our results do not support the hypo<.hesis that the presence of pathogenic bacteria at the time of CS predicts the development of post-CS endometritis.

90 HISTOLOGIC AND NEONATAL CORRELATES OF CHORIOAMNION INFECTION. SL Hillierx, MA KrohnX, DA Eschenbachx: University of Washington, Seattle, W A

While bacterial infection of the chorioamnion is known to be assocIated with hIstologic chorioamnionltls, the specific microorganisms involved, and their association with prematurity and neonatal outcome have not been completely investigated. Chonoamnion cultures were obtained from 144 placentas deh vered at 22-34 weeks, and 219 placentas delivered at 35·40 weeks gestation. Facultative and/or anaerobic bacteria were recovered from 32% of placentas delivered at $34 weeks and from 17% of those delivered at >34 weeks gestation (Odds ratio = 3 .2, 95% confidence interval,C!, 1.4·7.9). The chorioamnion bacteria most related to both prematurity and chorioammOltis were group B streptococci (GBS), Bacteroides, Fusobactenum, and Peptostreptococcus. HistolOgiC chorioamnionitis was detected in 62% of placentas having bacterial infection of the chorioamnion and from 29% of those without infection (P<0.03). While chorioamnion infection by Ureaplasrna or Gardnerella was not related to preterm delivery, each was significantly related to histologic chonoamnionitis (p<0.05 for each). Of infants delivered at $34 weeks, bactenal Infection of the chorioamnion was related to an Increased risk of respiratory distress syndrome (relative risk = RR 1.9, 9S% cr, 0.7-S.I) and neonatal death (RR = 1.9, 9S% CI, 0.7-S.2), even after adjusting for gestational age at dehvery. Five (4S%) of II infants whose mothers had GBS or E. coli in the chorioamnion or ammotic fluid died compared to 7 (\ I %) of 62 infants born to mothers without infection (RR = 6.7, 95% CI, 1.3, 37). These data suggest that bacterial infection of the chorioammon is significantly related to preterm birth, chorioamniomtis and poor neonatal outcome.

SPO Abstracts 299

191 RISK OF EXPOSURE OF LABOR AND DELIV­ERY PERSONNEL TO PATIENTS' BLOOD DURING DELIVERY. L. Coultrip MD,C. Thrand­hard RN', S. VanDiver RN',P. Hoffman RN" L. Met70td RN', A.Khoury MD. Fairfax H.,Falis Church,VA.

This ongoing observational study aims to (1) deter­mine the risk of blood exposure to labor and delivery (L&D) personnel during delivery and (2) to identify influencing and modifying factors for such exposure. METHODS:lnformationconcerningbloodexposurehas been recorded in 200 delivery procedures. Personnel arc inspected and gloves examined (water test) for perf ora­tion according to a specified protocol. RESULTS:Blood exposure has been identified in 24% of procedures and is higher in vaginal delivery than csection (40% vs 20%). The most frequent exposure site is the face and neck. 7% of gloves had perforations.Blood splattering on glasses wa~ pre~ent in 9%. Exposure rate when HIV status was known and negative was 36%, when un­known, 19% .p < 0.05).CONCLUSIONS:L&Dstaff areat significant risk for intradelivery blood exposure. The risk is greater for vaginal delivery than csection.Our data supports the routine usc of goggles,f ace shields,double gloving ,boots,and waterproof gowns.Newborn nurse should be gowned as well as gloved. Knowledge of known negative HIV status may increase blood exposure risk .

192 USIlPUI.NIlSS OP AMNIOTIC PLUID GI.UCOSH MHASURHMHNT IN DHTHCTION OP INTRAAMNIOTIC INPIlCTION.L.Coultrip,N.Norril',B.Smilh',A.Khoury,J.H. Groll .. aD. Pairfa:a: H.,Pan, Cllllrdl, VA.

METHODS:161 amniotic fluid (A F) specimens were retrieved by amniocentesis in nondiabetic patients presenting in preterm labor (N = 129) or PPROM (N~32) and cultured for aerobic and anaerobic bacteria, mycoplasma and urea plasma. Gram stain was performed. AF was stored at -40 C until analysis utilizing a Beckman glucose analyzer.RESULTS:The prevalence of a positive AF culture was 18%. AF glucose was significantly lower in paticnts with a positive culture than in patients with a negative culture.(mean = 11.6mg/dl SD 12 vs. mean =30.6mg/dl SD 18, P < .001 )(median =8mg/dl,range 0-38 vs. 29.Smg/dl rangel-81,p<0.OOl) .Low AF glucose was more sensitive than the gram stain in detecting infection. A combination of low glucose and a positive gram stain improved positive predictive value. Dial:nostic Indices for a Positive AF Culture:

~ Rll&.uY .!'ifi GRAM STAINCGS) 62'lL 96'lL 77'lL 92'lL GI-U.s.l0 64'lL 84'lL 47'lL 91'lL GLU.s.1S 71'lL 78'lL 41'lL 92'lL GSQRGI.U.s.1S 81'lL 7S'lL 40'lL 9S'lL GSAGLU.s.1S SI'lL 98'lL 87'lL 91'lL CONCLUSION:AF glucose determination is a useful adjunct to our current armamentarium of rapid, inexpensive tests to deL::ct intraamniotic infection.