566

567

402 spa Abstracts

INFLUENCE OF ANTEPARTUM RISK FACTORS ON THE x

DEVELOPME~T OF NEONATAL SEPSIS. D Skupski MD, R Chan MD , and Chang Lee MD. Hurley Med1cal Center , Fl 1nt, Mich1gan

The neonate at risk for seps1s 1S often treated w1th ant1b1ot1CS until cultures have r eturned. This retrospect1ve reV1ew was a1meu at answer1ng two questions: 1) Accord1ng to antepartum r1sk factors, whi c h neonates are most llkely to benefit from 1mmeulate antl­b1ot1C coverage, and 2)Do intrapartum ant1-b1ot1CS decrease neonatal Sepsls? A chart review over a 13 month per10d 1dentif1ed all lnfants at rlsk for sepsis , 1nclud1ng all neonatal deaths. Results: I)Sepsis , deflned as growth of vlrulent bacterla fr om the blood, was fo und in 17 of 290 neonates, 2)Fetal tachycard1a was the only antepartum risk fac­tor slgnlf1cantly associated wl th neonatal seps l s, suggestlng that antepartum fetal mon-1tor1 ng 1n the sett1ng of pret erm or prolonged rupture of membranes (ROM) may be beneficial in detecting those lnfants at greatest rlsk of seps is, 3)In the settlngs of either preterm or prolonged ROM or term Chorl0amn1onitis, 1nLra­partum antibiotic treatment was not seen to lnfluence the development of neonatal seps1s, ln thlS retrospeclive reVlew.

HYCOPLASHA HOt1INIS INFECTION AND PRETERH LABOR. JL Davis. MD. LC Castro. MD. 0 Rascon, MTx. RL Avina. MDx. & C Otto. MD. Cedars-Sinai Medical Center, Los Angeles, CA

The significance of Mycoplasma hominis (M. hominis) infection in obstetrics remains controversial in this study we investigated the role of M. hominis in preterm labor . Cervical cultures were prospectively obtamed for M. hominis. Chlamydia trachomatis. gonococcus. and group B streptococcus in women presenting to rule out preterm labor. Perinatal outcomes were compared between patients with isolated positive M hominis cultures and those with negalive cultures. Unpaired Studenl's l lesl and Chi-Square were used for statistical analysis. There were no statislically significanl differences belween the sludy and conlrol groups with respect lo maternal age, prior preterm delivery, gestational age (GA) at presentation, delivery mode, or Apgars. Statistically significant differences were seen between the groups with respect to second trimester losses, preterm labor and delivery, and birthweight. M. hominis infections are associated with pre term labor and delivery and second trimester loss and thereby may be a preventable cause of these problems.

Results Pos . cultures (55) Neg. cultures (44) P

GA at presentation (wks) 29.1:1:5 .3 30.4:1:4.6 NS GA at delivery 34.6:1:5 .9 37.7:1:2.2 p< .OI Birthweighl (gms) 2520:1: 1 029 3079:1:597 p<.O 1 2nd trimester loss 11 ~ (6/55) O~ p<.02 Pre term labor 73~ (40/55) 43~ (19/44) p<.OI

Janu<.r\ 1991 Am J Ob,tet G~necol

568 GROUP B STREPTOCOCCUS COLONIZATION IN THE PREGNANT DIABETIC PATIENT Karen Raimer, M.D.x , Mary J. O'Sullivan, M.D., University of Miami, Miami, Florida

Group B Streptococcus (GBS) has been implicated in preterm labor, preterm premature rupture of the membranes and neonatal sepsis. Considering the known higher incidence of infection and bacterial colonization in diabetics and possibly pregnant diabetic women, along with the possible complications of GBS, it is the aim of this study to determine if the incidence of GBS colonization is greater in pregnant diabetic& compared to nondiabetic pregnant women. Twenty-six pregnant diabetics (Class B or », 28-40 weeks gestational age, controlled with matched pregnant nondiabetics were cultured (vaginal introitus) for GBS.

Diabetics Nondiabet ics

GBS+ 6 (23%) 2 (7.7%)

GBS-20 24

Total 26 26

Preliminary data shows diabetics to have a three-fold higher r ate of colonization than non-diabetics. Fifty patients in each group will be needed to satisfy a p value of (0 .05 and a power of 80%.

570 MASSIVE SEPTIC PELVIC THROMBOPHLEBITIS: A CASE REPORT. K.P. Magee*, J.M. Graham*, J.D. Blanco. Dept of Ob, Gyn, & Repro sci, The U.T.H.S.C. Houston, Tx

We report the clinical presentation, radiologic findings, and management of a puerperal patient with extensive septic pelvic thrombophlebitis. The patient developed postpartum endometritis, and was treated with Mezlocillin 4 gm IV q6h. After 4 days with no response, gentamicin, clindamycin, and ampicillin were started. She continued to be febrile and symptomatic. CT scan revealed a venous clot occluding the right ovarian vein extending into the inferior vena cava up to the level of the pancreas, including the right and left renal veins. Inferiorly, the clot extended into the femoral veins, bilaterally, to the level of the mid-thigh. She was begun on heparin and maintained fully anticoagulated for 2 weeks. She defervesced and became asymptomatic 2 days after the initiation of heparin therapy. Four months later, a repeat CT study revealed total recanalization of the venous system.