bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prematurity, Subclinical Intraamniotic Infection, and FetalBiophysical Parameters: Is There a Correlation?
Authors: Cox Susan M. , Roberts Scott , Roussis Percilis , Campbell Berry A. , Curry Thomas E. 
Published: March 2007

Objective: This prospective study was undertaken to examine the effects of subclinical intraamniotic
infection on fetal behavioral patterns.Methods: Amniotic fluid was obtained from four groups of patients (n = 99): group 1, patients
with preterm premature rupture of the fetal membranes (PPROM) without infection; group 2,
patients with PPROM and infection; group 3, patients with preterm labor (PTL) and without
infection; and group 4, patients with PTL and infection. Fetal biophysical profiles were obtained on
admission to the labor suite. Amniotic fluid was analyzed for the presence of microorganisms and
endotoxin to confirm intraamniotic infection; cytokines interleukin (IL)‐1β, IL‐6, and IL‐8 were
also assayed.Results: We found no association between low scores for biophysical parameters and subclinical
infection in patients with PPROM or PTL.Conclusions: We could not demonstrate that upon a patient′s admission to the labor hall absent
fetal breathing and absent fetal movement, as well as reactivity, correlate with subclinical intraamniotic
infection. Elevated cytokines, i.e. IL‐1β, IL‐6, and IL‐8 were associated with subclinical
chorioamnionitis.
Evaluation of Infectious Disease Knowledge in Obstetrics and Gynecology and the Effects of Varying Durations of Training
Authors: Martens Mark G. 
Published: March 2007

Objective: The amount, origin, and resources of infectious disease
knowledge in the field ofobstetrics and gynecology were investigated. If this knowledge is
lacking, the exact length of the specific infectious disease training during residency should
be defined to meet the ever‐increasing knowledge required in training.Methods: A 50‐question test was developed by one faculty member
utilizing questions that incorporated the basic sciences of microbiology and pharmacology
and clinical knowledge of infectious diseases in the area of obstetrics and gynecology.
Multiple choice and matching questions were structured so as to ascertain the source of the
knowledge, including medical school curriculum, recent journal articles, and clinical
experience.Results: The test was given yearly to all students and residents on the
Obstetric and Gynecology Service over a period of 2 year′s. The questions were the same for
each group, but were reshuffled each exam period. Three hundred and seven tests were
properly administered and recorded. There was no statistical improvement in any successive
year’s scores unless specific infectious disease training occurred. Increasing improvement in
scores was noted, with an increasing duration of infectious disease training specific for
obstetrics and gynecology, beginning at 2 weeks (22% improvement), 4 weeks (30%
improvement), and 6 weeks (31% improvement) (P = .05–.001). Basic science questions were
most frequently answered correctly by medical students and early residents, while correctly
answered clinical questions correlated with increasing clinical experience except in
the area of ambulatory care.Conclusions: The infectious disease knowledge of residents in
obstetrics and gynecology can be improved with 4 weeks of intensive training.
Re‐exposure to basic science knowledge and improved training in ambulatory care in this
resident group appear to be necessary. This test or similar tests can be helpful in defining
areas of deficiencies and their possible remedies.
Coccidioidal Placentitis With Normal Umbilical Artery Velocimetry
Authors: Nickisch Stephen A. , Izquierdo Luis , Vill Maggie A. , Curet Luis , Wolf Gordon C. 
Published: March 2007

Background: Disseminated coccidiomycosis during pregnancy can lead
to both maternal and neonatal mortality. Placentitis is an uncommon sequelae and its effect
on placental function remains speculative. The present report describes our management of
such a case and describes serial umbilical artery velocimetry of an affected placenta.Case: A pregnant woman with coccidioidal placentitis confirmed
histologically was treated with systemic and intrathecal amphotericin B starting at 28 weeks
gestation. Serial umbilical artery velocimetry revealed that all systolic/diastolic ratios
remained normal, and a normal infant was delivered at term.Conclusion: Coccidioidal placentitis was successfully treated with
amphotericin B; serial umbilical artery velocimetry monitoring exhibited no abnormalities
and, along with other reassuring fetal parameters, allowed continuation of the pregnancy to
term.
Amniotic Fluid Glucose Concentration: A Marker for Infection in Preterm Labor and Preterm Premature Rupture of Membranes
Authors: Dildy Gary A. , Pearlman Mark D. , Smith Leon G. , Tortolero-Luna Guillermo , Faro Sebastian , Cotton David B. 
Published: March 2007

Amniotic fluid Gram stain and culture have been utilized as laboratory tests of microbial
invasion of the amniotic cavity. The Gram stain of amniotic fluid has a low sensitivity in the
detection of clinical infection or microbial invasion of the amniotic cavity, and amniotic fluid
culture results are not immediately available for management decisions. Glucose
concentration is used to diagnose infection in other sites such as cerebrospinal fluid.Objective: The purpose of this study was to evaluate the usefulness
of amniotic fluid glucose concentration in detecting microbial invasion of the amniotic
cavity associated with preterm labor and preterm premature rupture of membranes.Methods: Amniocentesis was performed in 60 women with preterm labor
and/or preterm premature rupture of membranes. Gram stain and culture for Mycoplasma hominis,
Ureaplasma urealyticum, aerobic, and anaerobic bacteria were performed. Subjects
were studied prospectively for the development of positive amniotic fluid cultures and the
development of clinical chorioamnionitis.Results: The diagnosis of clinical chorioamnionitis was made in
25% (15/60) of women entered into the study. Low amniotic fluid glucose concentration
Was considered < 15 mg/dl. The sensitivity, specificity, and positive predictive value
of low amniotic, fluid glucose concentration to predict clinical chorioamnionitis were 73.3%,
88.1%, and 68.8% respectively, while positive amniotic fluid culture, hada sensitivity of
43.8%, specificity of 79.5%, and positive predictive value of 43.8%.Conclusions: Amniotic fluid glucose concentration was more sensitive
in predicting chorioamnionitis than either Gram stain or culture. Amniotic fluid glucose
concentration was better in predicting clinical chorioamnionitis than predicting positive
amniotic fluid culture results. Gestational age‐dependent normal ranges and pathologic
conditions that may alter amniotic fluid glucose concentrations should be considered
when interpreting amniotic fluid glucose values to diagnose microbial invasion of the
amniotic cavity.
Screening for Chlamydia trachomatis in Low‐Risk Obstetric Patients
Authors: Gribble Robert K. , Ricci-Goodman Jean M. , Berg Richard L. 
Published: March 2007

Objective: The purpose of this study was to evaluate the prevalence of
Chlamydia trachomatis in our rural obstetric population and assess the appropriateness
of selective vs. universal prenatal screening.Methods: Between April 1, 1991 and May 1, 1993, 1,587 patients were
screened at their first prenatal visit using a C. trachomatis antigen test. Patients who were
unmarried, younger than 20 years of age, or had a history of a previous sexually transmitted
disease (STD) were classified as being at high risk for C. trachomatis. All others were
considered low risk for C. trachomatis.Results: The overall prevalence of C. trachomatis was 2.0%.
There was a significant difference (P < 0.001) in the 1,128 patients
considered low risk [0.5%, 95% confidence interval (CI) 0.2–1.2] compared to the 459 patients
with one or more identifiable risk factors (5.7%, 95% CI 3.7–8.2).Conclusions: Routine prenatal screening for C. trachomatis in our
population is not appropriate for low‐risk patients.
Effect of Resident Physician Education Regarding Selective Chemoprophylaxis for the Prevention of Early Onset Group B Streptococcal Sepsis: An Outcome Study
Authors: Greenspoon Jeffrey S. , Rosen Doron J. D. , Sumen Anita P. 
Published: March 2007

Objective: The aim of this study was to evaluate the effect of a voluntary
protocol for selective intrapartum chemoprophylaxis on the incidence of early onset group
B streptococcal sepsis (GBS EOS).Methods: Cases of GBS EOS were defined as a positive GBS culture
from a normally sterile fluid obtained during the first 7 days of life. All cases of GBS EOS at an
urban, university‐affiliated community hospital were reviewed during 2 time periods.
The 2‐year period before instituting a resident education program to promote selective
chemoprophylaxis (1988–89) was retrospectively reviewed; the 2‐year period after the
education program was introduced (1990–91) was prospectively recorded. The outcome
measure was the incidence of GBS EOS.Results: The rate of GBS EOS was 7/14,335 deliveries (0.05%) before
and 9/13,999 (0.064%) after the introduction of the education program (observed
difference between proportions 0.016%, 95% confidence interval [CI] for the difference
between the proportions –0.071% to 0.04%, P = not significant [NS]). The rate of GBS EOS
in preterm infants was 5/1,331 (0.376%) before and 3/1,297 (0.23%) afterward (observed
difference between proportions 0.14%, 95% CI –0.28% to 0.56%, P = NS). The incidence
of GBS EOS did not decrease during the latter period due to failure of antepartum
cultures to predict intrapartum GBS colonization (2 cases); non‐compliance with voluntary
recommendations to administer chemoprophylaxis (2 cases); failure of chemoprophylaxis or
therapy for intraamniotic infection to prevent neonatal infection (3 cases); and occurrence
of GBS EOS in infants without risk factors (2 cases).Conclusions: An education program for resident physicians regarding
chemoprophylaxis for GBS EOS did not significantly reduce the absolute incidence
of disease. Alternative strategies are needed that redress the causes of failure inherent
in the current guidelines. Some cases of GBS EOS are not preventable because the parturient
does not have risk factors that indicate chemoprophylaxis.
Randomized Trial of Antibiotics in Addition to Tocolytic Therapy to Treat Preterm Labor
Authors: Watts D. Heather , Krohn Marijane A. , Hillier Sharon L. , Eschenbach David A. 
Published: March 2007

Objective: The objective of this study was to assess whether antibiotic
therapy plus tocolysis given to women in preterm labor would prolong pregnancy
compared with tocolysis alone.Methods: A randomized, double‐blind trial of intravenous
mezlocillin and oral erythromycin therapy vs. placebo was used in addition to
tocolysis among women in preterm labor ≤34 weeks gestation with intact
membranes. Amniocentesis was performed, and chorioamnionic membranes
were examined histologically and cultured for microorganisms after delivery.Results: Clinical characteristics including gestational age at
enrollment, frequency of contractions, cervical Bishop′s score, and white blood
cell count on admission were similar in the 2 groups. Antibiotic therapy was well tolerated.
No significant differences in the interval to delivery, birth weight, and neonatal outcomes
were observed between the 2 groups. Women in the antibiotic group had a significantly
lower incidence of postpartum infections compared with women in the placebo group.
Patients with evidence of upper genital tract infection in either group had a significantly
shorter interval to delivery, lower gestational age at delivery, lower mean birth weight,
and increased neonatal hospitalization time.Conclusions: Lack of an antibiotic effect on the gestational age
at delivery may be due to the low prevalence of upper genital tract infection among
unselected women in preterm labor, to advanced preterm labor unresponsive to antibiotic
therapy, or to an inability of antibiotics given alone to inhibit the cytokine response.
Further work is needed to identify markers of upper genital tract infection
among women in preterm labor and to evaluate other potential therapeutic interventions.
Ovarian Abscess Following Therapeutic Insemination
Authors: Kolb Bradford A. , Mercer Lane , Peters Albert J. , Kazer Ralph 
Published: March 2007

Background: Artificial insemination is a commonly performed
procedure for the treatment of various forms of infertility. Infectious complications have only
rarely been noted as a complication of intrauterine insemination (IUI).Case: In this presentation, we report the first case of an ovarian
abscess following IUI with the husband′s semen. Despite treatment with triple antibiotics,
an oophorectomy was required. Surgical as well as pathological evaluation confirmed the
diagnosis of an ovarian abscess. Following surgery, the patient responded well to antibiotic
therapy.Conclusion: Since pelvic infections are ascending processes, the
violation of the natural cervical barrier with IUI can theoretically place the patient at
increased risk for this complication. While few advocate routine cultures of semen
samples, the clinician must be acutely alert to potential infectious morbidity following
this procedure. Early diagnosis and intervention are necessary to minimize
morbidity and optimize treatment.
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.
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.
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.