Volume 166 Number I, Part 2

412 TREATED INTRAAMNIOTIC INFECTION AND OPERATIVE MORBIDITY. E.R. Newton, Dept. of Ob/Gyn, The Univ. of Tx. HSC, San Antonio, TX.

Surgical manipulation in an infected field is associated with intraoperative and postoperative complications. We studied whether or not intraamniotic infection (lAI), which was treated intrapartum, was associated with more operative complications than cesarean deliveries in patients without IAI. Treated IAI and operative complications were identified in 614 consecutive cesareans. Intraamniotic infection (lAI) was diagnosed by an intrapartum temperature «37.8· with 2 of S signs: maternal or fetal tachycardia, leukocytosis, tender uterus or foul lochia. Intrapartum ampicillin plus gentamicin was standard therapy at diagnosis of IAI. Clindamycin was added after the delivery of the fetus. The area under the fever curve (FEVER AREA) was calculated as the total CO - hours above 37' after delivery.

IAI NolAI Complications (n = 91) (n = 523)

Duration of surgery (min., range) 57 (111) 54(178)

Estimated blood loss «1500 cc 11 (12%)' 23(4%)

Uterine lacerations 4(4%)" 4(0.8%)

FEVER AREA ("C-hr, range) 42 (169) 43 (203)"

Wound infection 2(2%) 32(6%)

Septic pelvic thrombophlebitis 0 3

Pneumonia or urinary tract infection 0 7

Discharge from hospital «8 days 5(5%) 43(8%)

'P<0.05, "Endometritis (n = 129) only Cesarean section in the presence of treated IAI does not increase postoperative complications. Increased blood loss may be related to increased trauma andlor uterine atony associated with intramyometrial infecton.

413 DOES GROUP B STREP(GBS) COLONIZATION SHORTEN THE LATENCY PHASE OF PATIENTS WITH

'PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM)? Towers cy Lewis Dr., Asrat T, Haraguchi KX , Perlow IH, Memorial Women's Hospital, Long Beach, CA, University of California, hvine, CA.

A common premise in patients with PPROM is that GBS colonization will shorten the latency time (defmed as time of ruprure to time of delivery) when compared to patients who are not GBS colonized. Due to recent literarure which emphasizes the impact of digital vaginal exam (DYE) on the latency phase in patients with PPROM, we looked at GBS colonization controlling for incidence of DYE. Prom 1/86 to 6/91, 577 patients with PPROM between 24 and 35 weeks were evaluated. Patients with multiple gestations, cerclage, advanced lahor and indicated deliveries (i.e., pulmonary maturity, etc.) were excluded. This left 332 patients for analysis. No patients received tocolysis after PPROM. 43 patients were GBS positive and 289 were negative. No differences were found in gravity, parity, gestational age at PPROM, incidence of DYE and antepartum antibiotic usage between the two groups. The latency in days for GBS positive patients was 6.9± 10.6 and for GBS negative patients was 6.5 ± 10.3. Both groups were then subanalyzed, excluding cases with DYE as shown below.

Number Gravity Parity Gest.Age PPROM Antibiotics Latency (Days)

GBS Positive GBS Negative 26 151

3.5±2.4 2.9±1.7 1.3±1.4 1.0±1.0

29.2±2.6 29.6±3.0 7 21

9.6±12.3 1O.4±12.6

pYalue

0.12 0.19 0.21 0.16 0.76

CONCLUSIONS: GBS colonization, by itself, does not appear to affect the latency phase in patients with PPROM. These data further emphasize the significant shorterting of the latency period seen in patients with PPROM who experience a digital vaginal exam.

SPO Abstracts 389

414 ROUTINE SCREENING OF PREGNANT WOMEN FOR LYME DISEASE IN AN ENDEMIC AREA "IS IT WORTH IT". R. Figueroa, U. Verma, M. Aguero~ C. Smith~ N. Tejani. NY Med., CoIL, Valhalla, N Y.

Objective Screening for Lyme disease (LD) in pregnant women would detect asymptomatic women with the disease. Study design The sera of 485 asymptomatic pregnant women, who received pre­natal care at our institution, were tested for LD utilizing the ELISA method (Lyme Stat Test Kit). The test was reported as positive (POS), equivocal (EQUIV), or negative (NEG). The sera of the patients who tested POS or EQUIV was further tested by a Western Blot (WB) for confirmation. The WB was reported as positive (pos) or negative (neg) depending on the appearance of specific (41, 34,31,20) IgG and IgM bands. Results

WESTERN BLOT ELISA # (70) Pos Neg POS 38 (7.8) 1 (2.6) 37 (97.4) EQUIV 82 (16.9) 3 (3.6) 79 (96.4) NEG 365 (75,3) Ten patients who tested ELISA POS were found to have syphilis. One of these was the only pos WE. Conclusions 1) 25% of the patients had an ab­normal ELISA. Only 3.3% of these were true positive to LD (See Above)\2)Routine screening by the ELISA test for LD is not productive or cost effective. ($70 per ELISA, $100 per WB).

415 IMPACT OF ASYMPTOMATIC GARDNERELLA V AGINALIS CARRIAGE ON PREGNANCY OUTCOME. Jean Ricci GO?~man, Deidre Spelliscy Gifford" UCLA School of Medlcme, Los Angeles, California.

This prospective study was conducted to determine whether asymptomatic carriage of gardnerella vaginal is, a component of bacterial vaginosis, is associated with an increased risk of premature labor, preterm premature rupture of membranes (PPROM), low birth weight, andlor maternal infectious morbidity. 176 consecutive asymptomatic obstetric patients had cervico-vaginal cultures for gonorrhea chlamydia, urea~lasl!la, mycoplasma, group B streptococcus: gardnerella vagmalls, and other aerobic and anaerobic bacteria. The prevalence of asymptomatic gardnerella vagi~alis c~riage was 26.7% (47/176). All cultures were obtamed pnor to 24 weeks gestation (mean time of culture 14.~+ 1-4.00). Of the initial 176 patients, 32 were culture posItive for only gardnerella vaginalis (Group A) and 85 were c~lture negative for all organisms (Group B). A comparison between these two groups revealed no difference in mean birthweight (Group A 3170+1-851 kg; Group B 3308 + 1-638 kg) or mean gestational age at delivery (Group A 39.01:+-/:3.44 wks; Group B 39.37+1-3.04 wks). Nor was the mCldence of preterm labor, PPROM amnionitis endometritis, wound infection or episioto~y infectio~ significantly different between the two groups. We conclude that asymptomatic carriage of only gardnerella vaginalis is not associated with an increased risk of poor pregnancy outcome. Therefore treatment of obstetric patients who are asymptomatic carriers of gardner ella vaginalis is not warranted.