bluuebunny/crossref_metadata_2025 huggingface dataset:
Subcutaneous Tissue: To Suture or Not to Suture at Cesarean Section
Authors: Bohman Van R. , Gilstrap Larry C. , Ramin Susan M. , Little Bertis B. , Santos-Ramos Rigoberto , Goldaber Kenneth G. , Dax Jody , Leveno Kenneth J.
Published: March 2007

Objective: The null hypothesis for this investigation was that there was
no difference in the frequency of wound disruption between women who had their
subcutaneous tissues approximated with suture and those who did not during cesarean
section.

Methods: During alternating months, consecutive women delivered by
cesarean section either did (N = 716) or did not (N = 693) have their subcutaneous tissues
closed with suture. All data were analyzed using chi square, Student′s t‐test, Fisher′s
exact probability test, analysis of variance, or logistic regression.

Results: A 32% decrease in the frequency of wound disruption was
observed when subcutaneous tissues were brought into apposition with suture at cesarean
section (P = 0.03).

Conclusions: Closure of Scarpa′s and Camper′s fascia with suture
during cesarean section significantly decreased the frequency of wound disruption in this
population.
Prevalence of Hepatitis C Virus Antibody in Patients With Sexually Transmitted Diseases Attending a Harrisburg, PA, STD Clinic
Authors: Sautter Robert L. , Jones Sharon , Weber Daniel I. , LeBar William D. , Heitjan Daniel F. , Kopreski Mary Magdalene C. , Curcio Frederick D.
Published: March 2007

Objective: The prevalence of hepatitis B and hepatitis C in a sexually
transmitted disease (STD) clinic population was studied, along with the prevalence of
various STD agents, in an attempt to identify possible STD markers for the hepatitis C
virus and help delineate the role of hepatitis C as an STD. The hepatitis C antibody rates
found in the STD clinic were also compared with those found among patients attending a
local OB/GYN clinic and those enrolled in a blood donor program, all from the same
geographical area.
Methods: A total of 150 women attending an STD clinc were examined
for each of the following agents: Chlamyadia trachomatis, Neisseria gonorrhoeae, syphilis,
hepatitis B surface antigen, hepatitis B core antibody, hepatitis B surface antibody,
and hepatitis C virus antibody. Additionally, several patients who signed informed
consent to be evaluated for human immunodeficiency virus (HIV) antibody were tested by
an enzyme immunoassay (EIA) screen method. The prevalence of each agent was then
compared with the other agents.
Results: The overall prevalence rates detected were as follows:
hepatitis B 16%, hepatitis C 4%, chlamydia 18.7%, gonorrhea 7.4%, syphilis 0.7%, and
HIV 0%. Hepatitis C antibody was detected in 4% of patients in the STD clinic, 0.76% of
volunteer blood donors from central Pennsylvania, and 0% of patiants studied from the
Harrisburg Hospital (Harrisburg, PA) prentatal population.
Conclusions: This screening study reveals an association between
attending a Harrisburg, PA, area STD clinic and having an increased prevalence of hepatitis
C antibody, but larger matched control studies will be needed to help clarify sexual
transmission as a mode of transmission for the hepatitis C virus.
In Vitro Study of Amniotic Fluid Gram Stain: Effect of Centrifugation
Authors: Gauthier Daniel W. , Torres Wilfredo , Meyer William J. , Lewis Barbara G. , Vernon Michael O. , Janda William M.
Published: March 2007

Objective: Gram stain of amniotic fluid (AF) is used to detect intraamniotic
infection. The purpose of this study was to determine if centrifugation improved the
ability of AF Gram stain to detect bacteria.

Methods: AF obtained by amniocentesis from patients with preterm
labor (PTL) or preterm premature rupture of membranes (PPROM) was pooled. Individual
AF samples as well as the pooled sample had a negative Gram stain for microorganisms
or white blood cells (WBCs) and negative cultures. With pure bacterial cultures, a suspension
equivalent to a 0.5 McFarland turbidity standard was prepared and then serially
diluted in the AF to either 106, 105, 104, or 103
colony forming units (cfu)/ml. Each sample
was divided into 2 equal portions, with 1 undergoing centrifugation. The Gram stains were
interpreted by technologists in the clinical microbiology laboratory in a blinded fashion.
Fisher′s exact test was used to compare the bacterial detection rate in centrifuged
vs. uncentrifuged AF samples at each concentration.

Results: Centrifugation of AF significantly improved the ability of the
Gram stain to detect bacteria at bacterial concentrations ≤104
cfu/ml (P < 0.01).
At concentrations ≥105
cfu/ml, centrifugation did not improve the ability of the Gram stain
to dtect bacteria.

Conclusions: At low bacterial concentrations, centrifugation of AF
increases the bacterial detection rate of AF Gram stain.
Ultrasound Guidance for Vaginal Drainage of Postoperative Pelvic Hematoma: A Case Report
Authors: Snyder Thomas E. , Faro Sebastian
Published: March 2007

Background: Postoperative pelvic fluid collection is almost a universal
consequence of gynecologic surgery. At one end of the spectrum are minimal collections
of peritoneal fluid or blood that are clinically inconsequential. At the other end are
hematomas and abscesses requiring active intervention for the patient to recover.

Case: This case report describes a symptomatic vaginal vault
hematoma occurring after vaginal hysterectomy. Ultrasonography was used to accurately
identify the hematoma and guide intraoperative drainage. The patient fully recovered
without complication.

Conclusion: Accurate visual guidance of instrumentation to
decompress postoperative retroperitoneal hematomas is a marked improvement
over non‐visual techniques utilizing palpation only. The hematoma cavity can be more
easily entered and the hematoma or abscess more completely drained, expediting the
recovery of the patient affected by this problem.
Induction of Tumor Necrosis Factor and Interleukin‐6 mRNA in Human Cytotrophoblast Cells Exposed to Lipopolysaccharide
Authors: Gonik Bernard , Rachmilewitz Jacob , Hochberg Avraham , Goshen Ran , de-Groot Nathan
Published: March 2007

Objective: The cytokines tumor necrosis factor (TNF) and interleukin‐6 (IL‐6) have previously been identified in
placental tissue and are known to be mediators of infection‐associated induction of the host immune system. This study
was undertaken to better characterize the in vitro regulation of these cytokines in cytotrophoblast cells when challenged
with the bacterial product lipopolysaccharide (LPS).

Methods: Term placentas were freshly collected, digested with trypsin/DNase, and subjected to Percoll gradient centrifugation to isolate cytotrophoblasts. Either immediately or after overnight incubation, LPS (1 μg/ml) or media alone was added to the cell cultures for 0, 1, 2, 4, 8, 24, 48, and 72 h. Total cellular RNA was isolated by the guanidinium thiocyanate/cesium chloride methodology. RNA samples were run on 1% agarose‐formaldehyde gels and subsequently transferred to nylon filters. Blots were hybridized with the appropriate P32‐radiolabeled probe.

Results: In non‐LPS‐treated cells, minimal amounts of TNF mRNA could be detected at zero time, or throughout the incubation periods. Conversely, LPS exposure resulted in detectable signal starting at 1 h and peaking at 2 h after the addition of LPS. Overnight incubation gave stronger TNF signals in the LPS stimulated cells, although the kinetics of this response remained similar to zero time exposure. IL‐6 was likewise minimally expressed at zero time, although non‐stimulated cell cultures demonstrated progressive increases in mRNA expression which was maximal at 16 h after plating. LPS further augmented the transcription of IL‐6 mRNA, with peak signals seen at 4 h after LPS stimulation. Again, overnight incubation of the cytotrophoblasts increased baseline and LPS‐induced IL‐6 mRNA responses. Long‐term constant exposure of cells to LPS did not demonstrate any evidence of prolonged signaling. LPS did not alter mRNA expression of the placental gene H19 or the oncogene FOS.

Conclusions: These data demonstrate the induction of TNF and IL‐6 mRNA in cytotrophoblast cells with LPS.
These transcriptional events are kinetically distinct and short term in nature. Overnight incubation accentuates the
TNF and IL‐6 mRNA signal and allows for an augmented response to LPS.
Spontaneous Occurrence of Gangrene Due to Clostridium septicum in a Patient With AdvancedEndometrial Carcinoma
Authors: Moore David H. , Ghosh Kris , Sutton Gregory P.
Published: March 2007

Background: We report the first known case of spontaneous, atraumatic Clostridium
septicum gangrene occurring in a patient with recurrent endometrial adenocarcinoma.

Case: A 63‐year‐old white female undergoing chemotherapy for recurrent endometrial adenocarcinoma presented with right “arthritis‐like” shoulder pain. She denied fever, chills, or shoulder trauma. The patient was afebrile and her
blood pressure was 100/50. Her right shoulder and upper extremity were remarkable for an area of dark blue
discoloration with crepitus. The white blood cell (WBC) count was 8,200/μl with left shift. Serum creatinine, platelet
count, and coagulation studies were normal. Computed tomography revealed gas in the right shoulder tissues. A Gram
stain of fluid aspirated from the shoulder demonstrated gram‐positive spore‐forming rods. She declined surgical
intervention and expired within hours of admission. Cultures of the right shoulder eventually grew Clostridium
septicum.

Conclusion: It is imperative to consider clostridial gangrene in the differential diagnosis for any
patient with cancer and a fever of unknown origin.
Preventive Antepartum Care
Authors: Ledger William J.
Published: March 2007

As the role of the obstetrician‐gynecologist evolves to include primary care, the obstetrician must assume greater
responsibility for providing prenatal preventive care, particularly regarding the STORCH5 pathogens.
Unresolved Crisis in Medical Education
Authors: Monif Gilles R.G. , Severin Matthew J.
Published: March 2007

A crisis exists in medical education. Changes in methodology have diverted attention from synthesis
to mass accumulation of factual data. The response to this crisis has been largely focused on a shell
game involving new pathways and curriculum changes without addressing the critical issue of what
constitutes education. The ultimate problem in medical education is a crisis of leadership. Until
education is given a priority status and the obligations to teach on the part of medical educators and
to learn on the part of students are translated into a creative policy by those who can lead, the wheels
of learning will continue to spin without significant progress.
Cytomegalovirus Infection in Pregnancy
Authors: Duff Patrick
Published: March 2007

Cytomegalovirus (CMV) infection is of great importance to obstetrician‐gynecologists because maternal infection
is relatively common and can result in severe injury to the fetus. The greatest risk to the fetus occurs when the mother
develops a primary CMV infection in the first trimester. Forty to 50% of infants delivered to mothers with primary
CMV infections will have congenital infections. Of these neonates, 5–18% will be overtly symptomatic at birth. Approximately 30% of severely infected infants die, and 80% have severe neurologic morbidity. Eighty‐five to 90% of infants will be asymptomatic, and 10–15% of these babies subsequently have sequelae such as visual and auditory defects. If the mother develops a recurrent or reactivated CMV infection during pregnancy, the risk of a severe congenital infection is very low. Perinatal infection, as opposed to congenital infection, may result from exposure to the virus during delivery or lactation and rarely leads to serious sequelae. Antimicrobial therapy and immunotherapy for CMV are, at present, unsatisfactory. Therefore, all patients, pregnant women in particular, must be educated about preventive measures.
Chorioamnionitis: Association of Nonreassuring Fetal Heart‐rate Patterns and Interval From Diagnosis toDelivery on Neonatal Outcome
Authors: Wendel Paul J. , Cox Susan M. , Roberts Scott W. , Dax Jody , Gilstrap Larry C.
Published: March 2007

Objective: The purpose of this study was to determine whether selected fetal heart‐rate (FHR)
patterns and the interval from diagnosis to delivery in pregnancies complicated by chorioamnionitis
could predict neonatal outcome.

Methods: During a 6‐month period, 217 consecutive patients with acute chorioamnionitis were
prospectively identified in labor. Following delivery, the fetal monitor strips and hospital courses
were reviewed for both the mother and neonate. Multiple logistic regression was used to analyze the
presence of a nonreassuring FHR pattern and the effect on neonatal outcome. Fisher exact tests
were used to analyze the time intervals from the diagnosis of chorioamnionitis to delivery and their
significance on neonatal outcome parameters.

Results: The overall incidence of chorioamnionitis in our population was 2.3%. None of the
independent variables analyzed following the diagnosis of chorioamnionitis until delivery were
significantly associated with an umbilical artery (Ua) pH < 7.20. There were no differences in cord
pH, Apgar scores, sepsis, admission to special‐care nursery, and oxygen requirements in neonates
based on the duration of time from the diagnosis of chorioamnionitis to delivery in our study. None of
the newborns had pathologic fetal acidemia (Ua pH < 7.00). None of the FHR patterns we
identified after the diagnosis of acute chorioamnionitis were significantly associated with neonates
with a Ua pH < 7.20.

Conclusions: An interval from diagnosis to delivery of up to 12 h plays little if any role in neonatal
outcome.
Human Papillomavirus DNA in LEEP Plume
Authors: Sood Anil K. , Bahrani-Mostafavi Zahra , Stoerker Jay , Stone I. Keith
Published: March 2007

Objective: This study was undertaken to determine the prevalence of human papillomavirus (HPV)
in loop electrosurgical excision procedure (LEEP) plumes.

Methods: Forty‐nine consecutive patients with colposcopic and cytologic evidence of cervical
intraepithelial neoplasia (CIN) were tested. Smoke plumes were collected through a filter placed in
the suction tubing. DNA was harvested by proteinase K digest of the filters and prepared for
polymerase chain reaction (PCR) by L1 consensus primers.

Results: Thirty‐nine (80%) tissue samples were positive for HPV, with types 6/11 in 4, 16/18 in 19,
31/33/35 in 2, and other types in 6 patients. The tissue sample was inadequate for typing in 8 patients.
HPV DNA was detected in 18 (37%) filters.

Conclusions: Although the consequences of HPV in LEEP plume are unknown, it would be
prudent to adopt stringent control procedures.
Salmonella typhi and Pregnancy: A Case Report
Authors: Gluck Brion , Ramin Kirk D. , Ramin Susan M.
Published: March 2007

Background: Salmonella typhi may be a cause of significant morbidity and mortality in both the
mother and fetus. Febrile illness during pregnancy, especially that associated with hemolysis, is
associated with chorioamnionitis, pyelonephritis, or viral syndrome. As such, S. typhi should be
considered when a patient presents with a fever and hemolysis. We present a case of S. typhi
complicating pregnancy.

Case: A primigravida at 26 weeks gestation presented with persistent spiking temperature and
severe hemolysis. Her presenting signs and symptoms included fever, vomiting, cough, earache,
jaundice, dark urine, and anemia. After 4 units of blood, her posttransfusion hematocrit was 29%.
Hemolysis was evident on a peripheral blood smear. Total bilirubin was 2.5 mg/dl and direct
bilirubin was 1.2 mg/dl. Gentamicin and clindamycin were administered empirically. Stool, blood,
and urine cultures were obtained. Blood cultures were positive for S. typhi. Antibiotic coverage was
changed to gentamicin and ceftriaxone. She defervesced on the 5th day and had no further problems.
A healthy male infant was delivered vaginally at term.

Conclusion: Typhoid fever is a serious infection, and special concern arises when S. typhi complicates
pregnancy. The diagnosis of S. typhi should be considered in a gravida presenting with fever
with prompt institution of antibiotic therapy. Appropriate cultures are essential for confirming the
diagnosis.
Randomized Prospective Study Comparing Erythromycin, Amoxicillin, and Clindamycin for theTreatment of Chlamydia trachomatis in Pregnancy
Authors: Turrentine Mark A. , Troyer Lisa , Gonik Bernard
Published: March 2007

Objective: The purpose of this study was to compare the efficacy and side effects of erythromycin,
amoxicillin, and clindamycin in eradicating Chlamydia trachomatis from the lower genital tract of
pregnant women.

Methods: A total of 174 women at <36 weeks gestation with positive cervical cultures for C.
trachomatis were enrolled. Patients were assigned in a randomized prospective fashion to either
erythromycin (500 mg q.i.d, for 7 days), amoxicillin (500 mg t.i.d, for 7 days), or clindamycin (600 mg
t.i.d, for 10 days). Six women elected not to participate and 8 patients were lost to follow‐up, leaving
53 patients in the erythromycin group, 55 patients in the amoxicillin group, and 52 patients in the
clindamycin group. All sexual partners of the enrolled women were offered doxycycline (100 mg
b.i.d. for 7 days) and patients were instructed to use barrier contraception until treatment was
complete.

Results: All 3 medications were effective agents for the treatment of antenatal C. trachomatis
infection with treatment efficacies of 96%, 94%, and 98% for the erythromycin, amoxicillin, and
clindamycin groups, respectively. When the antibiotic groups were compared, no statistically significant
differences were noted in intolerance. However, the differences in the incidence of gastrointestinal
symptoms between erythromycin and amoxicillin and/or clindamycin were significant
(P < 0.05).

Conclusions: These findings suggest that 1) all 3 antibiotic regimens are efficacious, 2) erythromycin
has a higher incidence of side effects, and 3) amoxicillin or clindamycin are reasonable alternatives
for the treatment of C. trachomatis in pregnant patients unable to tolerate erythromycin.
Repeated Recovery of Staphylococcus saprophyticus From the Urogenital Tracts of Women:Persistence Vs. Recurrence
Authors: Rupp M. E. , Han J. , Goering R. V.
Published: March 2007

Objective: The purpose of this study was to determine whether colonization was persistent or
recurrent in a small group of women who had repeated recovery of Staphylococcus saprophyticus from
their urogenital tracts.

Methods: Paired isolates of S. saprophyticus from each of the study subjects were genotypically
typed by plasmid fingerprinting and comparison of chromosomal‐DNA restriction fragment‐length
polymorphism patterns by field‐inversion gel electrophoresis (FIGE) and contour‐clamped homogenous
electric‐field (CHEF) electrophoresis.

Results: All isolates of S. saprophyticus from the study subjects were classified as genetically
unique by each of the typing methods.

Conclusions: The subjects experienced recurrent colonization with different isolates of S. saprophyticus.
These findings may have broader implications regarding the pathogenesis and recurrence
of S. saprophyticus urinary‐tract infection.
Evaluation of Two Commercially Available DNA Tests for Detection of Human Papillomavirus
Authors: Halstead Diane C. , Pfleger Sharon L. H. , Dupree William
Published: March 2007

Objective: This study was designed to compare the sensitivity, specificity, efficiency, positive and
negative predictive values, and ease of use for 2 commercially available hybridization kits for
detecting human papillomavirus (HPV) DNA: Oncor Southern blot (SB) (Oncor, Inc., Gaithersburg,
MD) and Digene ViraType dot blot (DB) (Digene Diagnostics, Inc., Silver Spring, MD).

Methods: A total of 179 specimens (172 cervical and 7 penile biopsies) were assessed for acceptability
based on the presence of epithelial cells and tested for HPV by DB and SB. The results were
evaluated based on Papanicolaou‐stained cervical specimens and selected risk factors.

Results: One hundred six (97.2%) of 109 results were concordant, i.e., 93 negative (85.3%) and 13
positive (11.9%). Using SB as the gold standard, we found the sensitivity, specificity, efficiency, and
positive and negative predictive values for the ViraType DB to be 100%, 96.9%, 97.3%, 81.3%, and
100%, respectively. Comparing the Papanicolaou smear to SB and DB, we found the sensitivity,
specificity, efficiency, and positive and negative predictive values to be 33.3% (SB) vs. 44.4% (DB),
89.5% vs. 87.6%, 87.3% vs. 84.2%, 11.8% vs. 23.5%, and 97.0% vs. 94.9%, respectively. The only
significant risk factor for predicting an HPV infection was the number of sexual partners.

Conclusions: Although SB has been considered the standard model, DB is an acceptable method
for detecting and identifying HPV infections.
Group B Streptococcus Meningitis Following Elective Termination of Pregnancy: Two Case Reports
Authors: Walker Mark A. , McNeeley S. Gene
Published: March 2007

Background: Although maternal group B streptococcus (GBS) infections are common, serious
infections are rare with prompt diagnosis and treatment. We present 2 cases of GBS meningitis
occurring 3 and 10 days after elective abortion. In the first patient, GBS meningitis was definitely
related to the elective termination. In the second patient, however, no evidence for a causal relationship
could be established and can only be presumed.

Case: The patients presented to the emergency department with headache, altered mental status,
and fever. Their physical examinations were consistent with meningitis and confirmed by cerebrospinal
fluid (CSF) analysis. One patient recovered completely and the other developed severe
bilateral hearing loss.

Conclusion: GBS meningitis is rare, occurring in men and women. When associated with pregnancy,
most cases present within 48–72 h of delivery or abortion.
In Vitro Ability of the Group B Streptococci to Inhibit Gram‐Positive and Gram‐Variable Constituents of theBacterial Flora of the Female Genital Tract
Authors: Chaisilwattana Pongsakdi , Monif Gilles R. G.
Published: March 2007

Objective: The purpose of this study was to analyze the ability of septicemic and nonsepticemic isolates of group B streptococci (GBS) to inhibit in vitro the principal bacterial groups found in the normal bacterial flora of the female genital tract.

Methods: The target groups were composed of 1) 10 strains each of the following: viridans
streptococci, nonhemolytic streptococci (not group B or D), group A streptococci, GBS, peptostreptococci, coagulase‐negative staphylococci, Staphylococcus aureus, and Gardnerella vaginalis; 2) 9 strains of enterococci; 3) 9 strains of group C or G streptococci; 4) 7 strains of lactobacilli; and 5) 7 strains of diphtheroids. All target groups were tested for inhibition by a test panel of either a group of 10 or 41 GBS isolates. If the GBS isolates failed to inhibit a target group, that group was tested for its ability to inhibit the GBS test panel.

Results: The GBS test panel did not inhibit the growth of coagulase‐negative staphylococci or S. aureus but uniformly inhibited groups A, B, C, and G streptococci, lactobacilli, and G. vaginalis. One of the 7 strains of diphtheroids was inhibited by 37 of the 41 GBS isolates; the other 6 strains of diphtheroids were uniformly inhibited. Variable inhibition by GBS was observed with viridans streptococci, nonhemolytic (not group B or D) streptococci, peptostreptococci, and enterococci; however, inhibition or noninhibition was uniform for a given target strain against the entire GBS test panel. The 23 GBS isolates obtained from septicemic neonates or adults did not differ from the 18 nonsepticemic isolates in their ability to inhibit other species of streptococci or other gram‐positive or gram‐variable constituents of the bacterial flora of the female genital tract. When converse testing was done, all 10 GBS isolates were uniformly inhibited by coagulase‐negative staphylococci and by the majority of enterococci, but were not inhibited by S. aureus.

Conclusions: These studies suggest that GBS may be significant regulators of other β‐hemolytic
streptococci, diphtheroids, lactobacilli, and G. vaginalis within the bacterial flora of the female genital tract. Moreover, the absence of GBS in the vaginal flora may be the result of mediation by coagulase‐negative staphylococci and selected strains of enterococci.
Mycobacterium chelonei Breast Abscess AssociatedWith Nipple Piercing
Authors: Pearlman Mark D.
Published: March 2007

Background: Breast abscesses are typically seen in the setting of complicated mastitis in lactating women. Abscesses resulting from foreign bodies are not commonly seen in the breast. Over the past few decades, body piercing has become increasingly common, yet the infectious morbidity resulting from it is not well recognized. A breast abscess associated with nipple piercing is described in this report.

Case: A 19‐year‐old woman developed a breast abscess approximately 10 weeks after the placement of a nipple ring. Multiple drainage procedures were performed before the infection was controlled. The cultures grew Mycobacterium chelonei, an organism not commonly causing soft‐tissue infection.

Conclusion: Body piercing may be associated with significant infections. The use of sterile equipment and techniques should be used to prevent these uncommon infections.
Modern Management of Clinical Chorioamnionitis
Authors: Westover Thomas , Knuppel Robert A.
Published: March 2007

Clinical chorioamnionitis continues to contribute to fetal and maternal morbidity and mortality. Significant advances have been made in the last 20 years in understanding the pathophysiologic processes leading to chorioamnionitis. This review addresses the history, incidence, pathophysiology, host defenses, risk factors, diagnosis, and maternal and neonatal management of clinically evident chorioamnionitis. After a detailed review of the physiologic processes leading to clinical chorioamnionitis and sepsis, we present a modern management scheme designed to optimize perinatal outcome for both mother and fetus.
Randomized, Double‐blinded, Placebo‐controlled Trial of Amoxicillin/Clavulanic Acid to Prevent PretermDelivery in Twin Gestation
Authors: Peters Mark T. , Brown Charles E. L. , Baum Audrey , Risser Rick
Published: March 2007

Objective: The objective of this study was to determine whether prophylactic treatment with oral broad‐spectrum antimicrobial therapy improves pregnancy outcomes in twin gestations.

Methods: Patients with twin gestations between 24 and 32 weeks were randomized to receive amoxicillin/clavulanic acid or placebo. Those patients randomized before 24 weeks received a 1‐week course at 24 and at 28 weeks gestation. Those patients entered later than 24 weeks received a 1‐week course either at 28 weeks or at enrollment (up to 32 weeks). Other than antibiotic use, the management of the groups was identical and unchanged from the routine care of twin gestations.

Results: Of 149 twin pregnancies enrolled, 76 were randomized to the drug group and 73 to the placebo group. There was no significant difference in mean gestational age at delivery (35.9 vs. 35.7 weeks), birth weight (2,358 vs. 2,344 g), mean neonatal nursery stay (9.9 vs. 11.7 days), or respiratory distress syndrome (6/76 vs. 4/73) in the drug vs. placebo group, respectively.

Conclusions: The addition of prophylactic oral broad‐spectrum antimicrobial therapy to the standard antepartum management of twin gestations had no demonstrable effect on the gestational age at delivery, birth weight, or neonatal complications. There did not appear to be any beneficial effect of the prophylactic use of amoxicillin/clavulanic acid in this clinical setting.
Cytomegalovirus Hepatitis During Pregnancy
Authors: Chan Ying , Kean-Chong Maria , Gonzalez David , Apuzzio Joseph
Published: March 2007

Background: Although cytomegalovirus (CMV) is an uncommon cause of viral hepatitis during pregnancy, a definitive diagnosis is important because of the potential for congenital CMV. In the case reported here, a diagnosis of hepatitis caused by CMV was made after the more common viral pathogens had been ruled out.

Case: A 17‐year‐old, 12‐week pregnant patient was evaluated for fever and right upper quadrant tenderness. A serologic evaluation revealed elevated liver function levels and a positive maternal serology for CMV IgM. A diagnosis of hepatitis caused by CMV was made after the more common viral pathogens and drug‐induced hepatitis had been ruled out. She was counseled about the potential effects of CMV on her fetus.

Conclusion: A step‐wise approach to the diagnosis of viral hepatitis during pregnancy is needed to determine the etiology because a potential teratogenic virus may be involved.
Erythema Nodosum Associated With Streptococcal Infection in Pregnancy
Authors: Richards W. Edward , Reedy Mark B. , Huddleston Kevin P. , Jundt Jeffrey W.
Published: March 2007

Background: Erythema nodosum (EN) is a condition characterized by the presence of painful erythematous nodules on the pretibial aspects of the lower extremities. EN is thought to be a local inflammatory, immune‐mediated reaction to a number of systemic antigenic stimuli. This condition is noted most often in women between menarche and menopause and is associated with certain drugs, infections, and pregnancy. However, no reports in the literature describe EN as a result of streptococcal infection during pregnancy.

Case: A 21‐year‐old, white woman, G3P0020, presented at 13 weeks gestation with a 2‐week history of erythematous, tender lesions on the pretibial aspects of both legs consistent with EN. The patient reported having had a “flu‐like” illness at the same time the lesions developed. The “flu” symptoms resolved within 10 days without medical intervention, but the lesions on her legs persisted. An initial antistreptolysin‐O (ASO) titer was elevated at 960 Todd units (normal values: preschool and adults <85; school‐age and young adults <170). Six days later, she presented to the emergency department with complaints consistent with a urinary‐tract infection. She was empirically treated with a 10‐day course of amoxicillin, 500 mg t.i.d. Although the patient was treated with amoxicillin for a presumed urinary‐tract infection (which was culture‐negative), the lesions resolved after her completion of the antibiotics. Twelve weeks later, a repeat ASO was within normal limits. The EN lesions did not recur.

Conclusion: Although many etiologic factors are identified as causes of EN, the condition is usually self‐limiting, requiring only minimal supportive measures until it resolves. A careful history should be obtained and a physical examination performed to exclude other causes. If a recent streptococcal infection is identified or presumed, a 10‐ to 14‐day course of antibiotics is warranted.
CMV Oophoritis in an AIDS Patient
Authors: Albert Michael S. , Amstey Marvin S.
Published: March 2007

Background: Disseminated cytomegalovirus (CMV) infection is relatively uncommon, occurring primarily in immunocompromised hosts and neonates. Patients with acquired immunodeficiency syndrome (AIDS) are the most common hosts, with symptoms secondary to lung and eye involvement. There have been no reports of symptomatic CMV infection of the pelvis in women.

Case report: This case is the first described of acute symptomatic CMV infection of the genital tract in a woman with AIDS. Her presenting symptoms were the result of acute CMV oophoritis. In addition, CMV was found in the endometrium and endosalpinx (an infected structure heretofore unreported).

Conclusion: The increasing prevalence and incidence of AIDS in women should make us aware of the possibility of opportunistic, symptomatic CMV pelvic infection.
Postpartum Endomyometritis
Authors: Williams Katherine L. , Pastorek Joseph G.
Published: March 2007

Endomyometritis following parturition is a major cause of maternal morbidity. It is most common following cesarean delivery, especially in certain high‐risk patient populations. The infection is usually caused by bacteria in the cervicovaginal tract that are inoculated into the uterus during labor and delivery. Both anaerobes and aerobes are thought to be involved in the disease process. A prompt diagnosis based on clinical suspicion, a thorough physical examination, and adjunctive laboratory measures is necessary to insure effective therapy and prompt resolution of the infection. The treatment consists of supportive care and broad‐spectrum antibiotic coverage either with single extended‐spectrum drugs or with combinations of antimicrobials. In cases appropriately treated, recovery without sequelae is the rule.
Cervical Antibodies to Herpes Simplex Virus Proteins in Pregnancy and Puerperium: A Pilot Study
Authors: Watts D. Heather , Guise Jeanne-Marie , Brown Zane , Corey Lawrence , Ashley Rhoda L.
Published: March 2007

Objective: This study was undertaken to evaluate the changes in total and anti‐herpes simplex virus
(HSV)‐specific cervical IgA and IgG antibody profiles during and after pregnancy.

Methods: Serum and cervical secretions were obtained from pregnant patients before 20 weeks
gestation, at 34–36 weeks gestation, and at 6 weeks postpartum and tested for total IgA and IgG
antibody and for IgA and IgG to HSV proteins by Western blot.

Results: Seven women were HSV seronegative, 14 HSV‐1 seropositive, and 14 HSV‐2 ± HSV‐1
seropositive. Minimal changes in the serum anti‐HSV profiles were seen over the 3 visits. The
total cervical IgA, IgG, and protein levels did not change between the 2 pregnancy visits but tended
to increase at the postpartum visit. No consistent change in cervical HSV‐specific IgA and IgG
was seen during pregnancy, but the levels increased markedly at the postpartum visit.

Conclusions: Lower cervical anti‐HSV antibody levels may be related to the previously reported
increased frequency of a reactivation of HSV during late pregnancy. Further evaluation is necessary
to confirm and quantify the changes in genital immunity during pregnancy and to evaluate whether
the increased levels at the postpartum visit are sustained.
Preincubation of Cervical Swabs in Lim Broth Improves Performance of ICON Rapid Test for Detection of Group B Streptococci
Authors: Altaie Sousan Sayahtaheri , Bridges James , Loghmanee Darius , Lele Amol , Kahn Kenneth R.
Published: March 2007

Objective: The purpose of this study was to determine whether an enrichment method would improve
the performance of an enzyme imunoassay test, the ICON Strep B, for detection of group B
streptococci (GBS) in vaginoperineal swabs.

Methods: The study was done in 3 phases. First, in 250 maternity patients, 2 swabs per patient
were tested simultaneously by an overnight selective broth culture method (Lim broth) and the
ICON assay. Forty‐five (18%) specimens were positive for GBS by culture. The ICON assay
detected only 2 (4%) of the positives. Second, in 391 maternity patients, a single swab was cultured
as above. However, during the overnight incubation of the Lim broth, 0.5 ml aliquots were removed
and tested by ICON assay at 4, 6, 8, 10, and 12 h post‐incubation. Seventy‐two specimens (18%)
were positive by culture. The ICON assay detected 20% of the positives at 4 h, 46% at 6 h, 70%
at 8 h, 94% at 10 h, and 100% at 12 h post‐incubation. Third, 97 high‐risk patients with the diagnosis
of preterm labor (PTL)/or preterm premature rupture of the membranes (PPROM) were sampled.
Three specimens per patient were obtained: a single swab that was cultured as before and 2 double
swabs, of which 1 was tested directly using the ICON test and the other was placed directly in
Lim broth and incubated overnight. The aliquots of broth were tested by the ICON assay at 2, 4,
6, and 8 h post‐incubation. Twenty‐four specimens were positive by culture.

Results: The direct ICON test detected only 4 (17%) of the positives. The ICON assay performed
on the enriched samples detected 4% of the positives at 2 h, 21% at 4 h, 58% at 6 h, and 100% at
8 h post‐incubation.

Conclusions: These data indicate that the ICON assay may be used with 100% sensitivity and
specificity to detect GBS‐colonized high‐risk mothers within 8 h if the initial sample size is doubled
and the enrichment broth is used in the performance of the ICON assay.
Trichomoniasis as Seen in a Chronic Vaginitis Clinic
Authors: Dan Michael , Sobel Jack D.
Published: March 2007

Objective: We sought to determine the clinical and laboratory features of trichomonas vaginitis (TV) in a
chronic vaginitis clinic.

Methods: We studied 45 women with symptomatic TV attending a specialty chronic vaginitis clinic.
These patients were older than the usual symptomatic patients with TV. They frequently described unusual
chronicity of symptoms, half being referred because of clinical resistance and the other half referred because
of chronic vaginitis of unknown etiology.

Results: In spite of the chronicity of infection, the signs and symptoms of florid inflammation were still
evident and high numbers of polymorphonuclear leukocytes and parasitic load were present.

Conclusions: A longstanding infection, especially if previously untreated, invariably responded to
conventional nitroimidazole therapy. In addition, the majority of patients seen with clinical resistance
to the conventional doses of metronidazole responded to high‐dose oral metronidazole therapy. Unsuspected
TV should always be considered in low‐risk patients with chronic vulvovaginal symptoms.
Immune Consequences of Chlamydia Infections in Pregnancy and In Vitro Fertilization Outcome
Authors: Askienazy-Elbhar M.
Published: March 2007

This review addresses the immune consequences of Chlamydial infections in pregnancy and in vitro fertilization (IVF) outcome. In pregnancy, many works have shown the risk for perterm labor, preterm birth, or miscarriage with current infection, and stress the need for screening and treatment early in pregnancy. IVF outcome needs to be studied in relation to specific markers like inflammatory cytokines and secretory antibodies to the 60 kD heat shock protein (hsp60) and to Chlamydia, to determine their ability to predict and influence pregnancy outcome.
Immune Recognition of the 60kD Heat Shock Protein: Implications for Subsequent Fertility
Authors: Witkin Steven S. , Jeremias Jan , Neuer Andreas , David Sami , Kligman Isaac , Toth Miklos , Willner Emily , Witkin Keren
Published: March 2007

The 60kD heat shock protein (hsp60) is a highly conserved protein and a dominant antigen of
most pathogenic bacteria. In some women, chronic or repeated upper genital tract infections with
Chlamydia trachomatis, and possibly with other microorganisms, induces immune sensitization to
epitopes of hsp60 that are present in both the microbial and human hsp60. Once a woman becomes
sensitized to these conserved epitpes, any subsequent induction of human or bacterial hsp60
expression will reactivate hsp60‐sensitized lymphocytes and initiate a pro‐inflammatory immune
response. Hsp60 is expressed during the early stages of pregnancy, by both the embryo and the
maternal decidua. We examined, therefore, whether women who were sensitized to hsp60 experienced
less successful pregnancy outcomes compared to women who were not sensitized to this
antigen. In women undergoing in vitro fertilization (IVF), the presence of cervical IgA antibodies
reactive with the C. trachomatis hsp60 correlated with implantation failure after embryo transfer.
Further analysis revealed that an immunodominant epitope for these IgA antibodies was an hsp60
epitope shared between C. trachomatis and man. In subsequent studies of women not undergoing
IVF, cervical IgA antibodies to the human hsp60 were identified in 13 of 91 reproductive age
women. This antibody was most prevalent in those women with a history of primary infertility
(p = 0.003). In addition, cervical anti‐hsp60 IgA correlated with the detection of the pro‐inflammatory
cytokines interferon‐γ (p = 0.001) and tumor necrosis factor‐α (p = 0.02) in the cervix.
Conversely, women with proven fertility had the highest prevalence of the anti‐inflammatory cytokine,
interleukin 10, in their cervices (p = 0.001). In an analysis of serum samples in a third study,
women with a history of two or more consecutive first trimester spontaneous abortions had a higher
prevalence (p = 0.01) of IgG antibodies to the human hsp60 (36.8%) than did age matched fertile
women (11.1%) or women with primary infertility (11.8%). Immune sensitization to epitopes expressed
by the human hsp60 may reduce the probability of a successful pregnancy outcome due to
reactivation of hsp60‐reactive lymphocytes, induction of a pro‐inflammatory cytokine response and
interference with early embryo development and/or implantation.
Treatment of Recurrent Eczema Herpeticum in Pregnancy With Acyclovir
Authors: Latta Richard A. , Baker David A.
Published: March 2007

Background:Eczema herpeticum is an uncommon manifestation of an infection with herpes simplex virus (HSV). The disease is primarily seen in patients with histories of atopic eczema. Eczema herpeticum may be a life-threatening illness, but the mortality is felt to be <10% with modern antiviral and antibacterial agents. The use of acyclovir for other viral infections secondary to herpesvirus in pregnancy has been well documented. The authors now present a case report of eczema herpeticum treated with acyclovir during pregnancy.

Case:A patient with a history of eczema herpeticum presented in pregnancy with a recurrence. She was successfully treated with intravenous (IV) acyclovir with good maternal and fetal outcome.

Conclusion:Acyclovir may be utilized in pregnancy for several manifestations of HSV including eczema herpeticum.
Significance of Genital Mycoplasmas in Pelvic Inflammatory Disease: Innocent Bystander!
Authors: Chatwani Ashwin , Harmanli Ozgur H. , Nyirjesy Paul , Reece E. Albert
Published: March 2007

Objective: Our objective was to determine the role of Mycoplasma hominis
and Ureaplasma urealyticum in pelvic inflammatory disease (PID).

Methods: The clinical and microbiologic variables in 114 patients with a clinical diagnosis of PID
were compared prospectively according to the isolation of M. hominis and U. urealyticum from their
endometrial cavities.

Results: The groups were epidemiologically well matched. Clinical parameters such as temperature,
leukocyte count, erythrocyte count, and C‐reactive protein on admission and length of hospital
stay were similar in the patients, regardless of their mycoplasma status. A significant percentage of
the patients either continued or started to harbor genital mycoplasmas after the resolution of PID
without any significant clinical sequelae.

Conclusions: The presence of genital mycoplasmas does not change the clinical presentation and
course of PID. Both M. hominis and U. urealyticum can persist or colonize the endometrium after
complete recovery from PID. Therefore, the genital mycoplasmas do not seem to have a dominant
pathogenic role in PID.
Randomized Clinical Trial of Antibiotic Therapy for Antenatal Pyelonephritis
Authors: Brost Brian C. , Campbell Barry , Stramm Sue , Eller Daniel , Newman Roger B.
Published: March 2007

Objective: The aim of this study was to prospectively evaluate the efficacy of a therapeutic course
of intravenous antibiotics followed by oral antibiotics vs. intravenous antibiotics alone to prevent
recurrent urinary tract infection.

Methods: Pyelonephritis was documented by strict criteria in 67 pregnant women who were then
treated with appropriate intravenous antibiotics until afebrile and asymptomatic for 48 h. Women
were then randomized to completion of a 10‐day course of oral nitrofurantoin 100 mg qid or no
further antibiotic therapy. Urine cultures (UC) were obtained 2 and 6 weeks after discharge, and
at delivery. A positive UC or readmission for pyelonephritis was considered endpoints for participation
in the study. Antibiotic suppression was not used.

Results: Readmission for pyelonephritis prior to the 2‐week follow‐up visit occurred in 2/36
(5.6%) women randomized to the oral therapy group compared to 4/31 (12.9%) in the no oral
treatment group (P = 0.29). At the 2‐week follow‐up visit, 6/31 (19.4%) women had a positive UC
in the oral therapy compared to 8/26 (30.1%) in the no oral treatment group but this difference was
not statistically significant (P = 0.31).

Conclusions: Completion of 10 days of antibiotic therapy with oral medication does not significantly
reduce the risk of recurrent pyelonephritis immediately post‐parenteral treatment. Women in
the no oral treatment group had a non‐significant increase in positive UC at the 2‐week follow‐up
visit. The high rates of recurrent urinary tract infection during pregnancy in both groups underscore
the need for regular UC and for the possible role of oral antibiotic suppression.
Cholecystitis in Pregnancy
Authors: Casey Brian M. , Cox Susan M.
Published: March 2007

Biliary tract disease is a relatively uncommon, heterogenous disease in pregnancy. Specifically,
acute cholecystitis can be especially difficult to recognize in pregnancy. However, once diagnosed,
the initial management plan should be conservative and include antibiotic therapy. Subsequent
management depends on the gestational age at diagnosis. Surgical therapy, when indicated,
should not be delayed and a planned intervention during the second trimester appears to offer a
better outcome than surgery performed under emergent conditions.
Role of Genital Mycoplasmas in Bacteremia: Should We Be Routinely Culturing for These Organisms?
Authors: Garland Suzanne M. , Kelly V. Nigel
Published: March 2007

Objective: The purpose of this study was to examine the role of the genital mycoplasmas
Mycoplasma hominis and Ureaplasma urealyticum as causes of bacteremia in a tertiary referral obstetrical, gynecological,
and neonatal intensive care facility, over a period of 12 years from 1983 to 1994 inclusively.

Methods: All clinically significant blood cultures were reviewed and the percentage of septicemic
episodes for genital mycoplasmas was compared to the total isolation rate, including conventional
bacteria.

Results: The overall positivity rate for all pathogenic organisms isolated from the blood cultures
of infants ranged from 4.5% to 7.7% per annum. U. urealyticum represented 0.8% of these positive
isolates and M. hominis 0.4%. For adults, the overall positivity rate from blood cultures ranged from
6.5% to 13.5%, with U. urealyticum representing 9.6% of these positive isolates and M. hominis 9.9%.

Conclusions: With M. hominis having an established role in such clinical entities as postabortal and
postpartum fever and U. urealyticum strongly implicated with chronic lung disease in low birth
weight infants, it is appropriate to examine blood cultures for genital mycoplasmas in an obstetric
institution.