644

645

442 SPO Abstracts

UTILITY OF BLOOD CULTURES IN POSTPARTUM ENDOMYO­METRITIS. ~. P. Characha:J. Repke, Depts. Gyn/Obs and Infect. Dis., The Johns Hopkins Univ. Sch. of Med., Balto., Md. 21205

This study was undertaken in an effort to evaluate the utility of blood culture information in the management of patients with postpartum endomyometritis. An 18 month pariod was evaluated during which positive blood culturfl results were reviewed. Variables included assessment of the appropriateness of antibiotic treatment before and after blood culture results were available, effect of blood culture results on antibiotic selection, and effect of blood culture results on duration of use of antibiotics. During this period of time, 16 confirmed positive blood cultures were reported, while an estimated total of 288 sets of blood cultures were obtained. Positive blood cultures, therefore, were present in 5.5% of patients with postpartum endomyometritis. Among these patients, there were no cases identified where additional antibiotics were necessary after blood culture identification and sensitivities were made available. There were eight cases where an antibiotic was judged to be superfluous based on blood culture results. In conclusion, given the high incidence of postpartum endomyometritis, the low incidence of blood culture positivity, and the broad spectrum antibiotics used in treatment, and given the cost of blood cultures ($28 per set), Wfl recommend a reevaluation of the effectiveness of blood cultures, as currently utilized, in the management of postpartum endomyometritis in otherwise uncompromised healthy obstetric patients.

MUL TICOMPAATMENT MOLECULAR IN UTERO EVALUATION FOR CONGENITAL HERPES SIMPLEX VIRUS (HSV) AND CYTOMEGALOVIRUS (CMV) INFECTIONS BY CHORIONIC VILLUS SAMPLING (CVS) AND POLYMERASE CHAIN REACTION (PeR). t:lB. .I.&ada., MP Johnsonx, SM Berry, R WMleyX, W Brittx, W Holzgreve, MI Evans. Ctr for Fetal Diagn & Ther, Hutzel Hosp, Wayne St U, Detroit, Mi., Institute fOr Humangenetik, MOnster, FRG & Div Ped Infect Dis, Dept Peds, U Alabama, Birmingham.

Congen~al infections are difficult to evaluate prenatally. CMV is associated with IUGR and CNS defects. Primary HSV may be teratogenic. PCR is a recently idescribed molecular genetic technique which amplifies minute amounts of genetic material. We used a multicompartment evaluation to assess ali possible routes and sites of infection. Viral cu~ures, histology and viral-specific PCR were used to analyze the CVS sample. Viral cuttures and PCR were used to analyze the amniotic fluid (AF). Cordocentesis for CBC, immune globulins and liver enzymes were performed. We evaluated two gravidas for congen~al infections. Patient 1 developed primary HSV with meningoencephalitis in thje first trimester. She had a negative evaluation that included CVS, amniocentesis and cordocentesis. Nested PCR primers encompassing HSV glycoprotein B region were used to analyze the CVS tissue. She delivered vaginally at term elsewhere and developed gen~al HSV 12 hours postpartum. The neonate developed HSV & required IV acyclovir. Concerns have been raised regarding time of acquisition of infection. Patient 2 was a heatth-care worker seropos~ive for CMV IgM. She had positive PCR in CVS and AF samples using primers from the conserved region of the gB gene. Shell vial cuttures from CVS, amniocentesis and cordocentesis were neg. PCR on WBCs from cordocentesis was neg. She delivered at 37wks a 6 Ib healthy male infant. We conclude that mutti-compartment evaluation can be useful in excluding in utero infection and that the presence of viral genetic material does not necessarily indicate fetal morbidity.

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January 1992 Am J Obstet Gyneco1

GROUP B STREPTOCOCCUS DETECTION: COMPARISON OF RAPID

IMMUNOASSAY AND CULTURE. Jeffrey S Greenspoon, M MorganX , Stuart

G Smithx, Regta L Greenspoonx, Malcolm L MargolinX DeptJ. Ob-Gyn and

Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles,

California

The reliability of an immunoassay, ICON Strep B TestR (Hybridtech, Sao

Diego, CA), was assessed by comparison with the standard culture for Group B

Streptococcus (GBS). A simple, rapid means to identify GBS colonized patients

has been sought in order to pennit selective and expeditious administration of

chemoprophylaxis to the colonized patients and to avoid unnecessary treatment of

those not colonized. At the time of evaluation for preterm or term labor,

premature rupture of membranes, or antepartum surveillance, two vaginal swabs

were simultaneously obtained from 174 patients. One swab was cultured using

standard techniques for identification ofGBS. Colonization was defined as light

(1 + growth on culture plate), moderate (2+ or 3+), or heavy (4+). The second

swab was used to perform the rapid test according to the manufacturer's

recommendations. The prevalence of any GBS vaginal colonization was 10 of

174 (5.7%, 95% CI, 2.8% to 10.3%). Five of 174 (2.9%, 95% CI, 0.9% to

6.6%) had moderate or heavy colonization. Five of the 6 patients with false

negative rapid tests had fewer than 20 colonies per plate.

Rapid test

Positive

Negative

Culture

Positive Negative

163

Sen •. 40% PPV 80%

Spec.99.3% NPV 96.4%

Previous reports whose study design distinguished parturients with light growth on

culture from those with heavy growth noted that the infants of mothers with light

colonization were less likely to develop EOGBS, although the risk was not zero.

This test will be especially useful for identifying patients heavily colonized with

GBS who are likely to benefit from timely chemoprophylaxis.

IMMATURE LECITIlIN/SPHINGOMYELIN (US) RATIOS AND PERINATAL OUTCOME IN HIGH RISK PREGNANCIES. MA Haroer, Dept. Ob/Gyn, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC

Nine hundred thirty-seven US ratios (single-dimension thin-layer chromatography) were reviewed from the three year period preceding the initiation of surfactant therapy in premature neonates in our institution. Six hundred eight were less than 2.5 with no phosphatidylglycerol. Of these, 104 singletons without congenital anomalies delivered within 72 hours from the collection of fluid [amniocentesis (n=42) or vaginal fluid (n=62») for US determination and are the data set for this analysis. The values of the immature US ratios correlated significantly with length of hospital stay (r=-.41, p=.OO(1), total days on supplemental O2 (r=-.25, p=.OO9), total days ventilated (r=-.29, p=.OO3). Seventy-one percent of babies with a US less than 1.0 required some respiratory support (02,

CPAP, ventilator) compared to 28% of babies with a US between 2.0 and 2.5. Conclusion: The absolute value of an immature US ratio can be helpful in predicting perinatal outcome in high risk pregnancies and therefore is of benefit in timing of delivery in these patients.