The efficacy of cefazolin plus macrolide (erythromycin or clarithromycin) versus cefazolin alone in neonatal morbidity and placental inflammation for women with preterm premature rupture of membranes.

INTRODUCTION: Although the use of broad-spectrum antibiotics in women with preterm premature rupture of membranes (PPROM) is recommended to prolong pregnancy and decrease short-term neonatal complications, the optimal regimen remains undetermined. The objective of this study was to compare the efficacy of cefazolin plus macrolide (erythromycin or clarithromycin) versus cefazolin alone in reducing neonatal morbidity and placental inflammation for women with PPROM. METHODS: This prospective study included singleton pregnancies with PPROM (23-33 weeks gestation). The primary outcome was neonatal composite morbidity and the secondary outcomes were the incidence of abnormal brain sonography and infant neurological outcome at one year of age. The presence and the stage of acute histological chorioamnionitis and funisitis were also reviewed blinded to all clinical information. RESULTS: 102 women were randomly assigned to cefazolin (n = 35), cefazolin plus erythromycin (n = 31), or cefazolin plus clarithromycin (n = 36). The neonatal composite morbidity, the incidence of abnormal brain sonography, and infant neurological outcome at one year of age were similar between the comparison treatments (combination of cefazolin plus erythromycin or clarithromycin) and cefazolin. However, the presence and stage of histological funisitis showed significant difference between cefazolin plus clarithromycin versus cefazolin alone (p = 0.023). DISCUSSION: This study is the first clinical trial of the use of cefazolin with either clarithromycin or erythromycin compared to cefazolin alone in the management of PPROM in which the primary and secondary analyses showed no difference among the three antibiotic regimens. The only noted difference was from a lesser degree of histological funisitis associated with clarithromycin exposure. CONCLUSION: Our data suggests that clarithromycin may be an alternative worth considering with potentially beneficial effects compared to erythromycin in PPROM.

Government-funding program on reversal of tubal sterilization.

Three hundred and sixty-one women were provided government-funded sterilization reversal services with the technique of microsurgery. A large majority of reasons (89.8%) for requesting reversal surgery was a loss of children, and the mean interval between sterilization and reversal was 28.7 months. Two hundred and seven (69.7%) of 297 follow-up cases have experienced term delivery or intra-uterine pregnancy and 5 cases were ectopic pregnancy. The largest number of reversal clients (63.3%) were sterilized by the laparoscopic unipolar coagulation technique and the next largest group (24.2%) was sterilized by the laparoscopic banding technique. The highest pregnancy rate (77.8%) was shown in clients who had undergone laparoscopic banding technique while the lowest (65.9%) was the group of laparoscopic unipolar coagulation. A more than 60% of the clients became pregnant within 6 months of their reversal surgery, with the shortest interval being 1 month, the longest 39 months, and the mean 7.6 months. A large majority of the successful cases, 81.6%, were pregnant within 1 year of their reversal surgery.

PIP: Physicians at 15 institutions in the Republic of Korea conducted microsurgery to reverse tubal sterilization in 361 22-38 year old women (mean 28.8 years) of parity 0-2 (mean 0.4) between 1980 and 1988. The government paid for the sterilization reversal services. The leading reason for regret and reversal of tubal sterilization was death of a child (89.8%). The researchers were able to follow up on 297 cases (18 months-8 years after reversal surgery). 69.7% (207) of the cases became pregnant after tubal sterilization. Most reversal clients (63.3%) had had laparoscopic unipolar coagulation followed by the laparoscopic banding technique (24.2%). The laparoscopic banding technique resulted in a more successful reversal rate (77.8%), however. Only 65.9% of clients who had had laparoscopic unipolar coagulation became pregnant. The most successful reversal by sterilization type was for clients who had had postpartum Pomeroy technique (90%). The most successful reversal by anastomosis site was isthmic-isthmic (80.9%) and the least successful was cornual-ampullary (64.9%). 61.8% became pregnant within 6 months after reversal and 81.6% within 1 year. The success rate was highest among the women who underwent their reversal 25-36 months after the sterilization (78.4%) and the lowest rate among those with an interval of 37-48 months (53.5%). The mean interval between reversal and conception was 7.6 months, the shortest interval being 1 month and the longest 39 months. As voluntary sterilization occurs more often at lower parity among younger women, Korea expects to continue to see more sterilization reversal requests.

Effects of combined oral contraceptive steroids on pituitary-ovarian function during the menstrual cycle of lactating women.

The object of this study was to investigate the effects of combined oral contraceptives on pituitary-ovarian function during the menstrual cycle of lactating women whose prolactin levels were usually elevated. Five of six lactating women studied were considered to have the normal menstrual cycle which was comparable to the presumptive ovulatory cycle of non-puerperal women. The patterns of serum LH and FSH as well as estradiol and progesterone during the menstrual cycle of lactating women were quantitatively and qualitatively, similar to those of non-puerperal women. Prolactin levels, however, were elevated throughout the cycle of lactating women as compared with those of non-puerperal women. Treatment with combined oral contraceptive steroids abolished a midcycle surge of LH and decreased ovarian steroids during the menstrual cycle of lactating women. Serum prolactin levels were also decreased throughout the cycle treated with contraceptives in lactating women.

Long term effects of IUD on the human endometrium. Histologic, histochemical and ultrastructural studies.

PIP: To evaluate the longterm effects of a IUD on the human endometrium and find the possible contraceptive mechanism of the IUD, histologic, histochemical, and ultrastructural studies of human endometrial biopsies from 44 normal contorls and 178 IUD wearers were made. Histologic findings included interstitial hemorrhage, inflammatory reaction, hyperplasia, atrohy, focal necrosis, and squamous metaplasia. However, all of these findings were either infrequent or insignificant except for inflammatory reaction. Histochemical, enzymatic, and ultrastructural findings were also unremarkable. The most significant finding was asynchronism between cyclic dating and endometrial histologic dating, showing delayed endometrial maturation in the majority of IUD users. In summary, IUD insertion results in mild histologic-alteration in the human endometrium but the inflammatory reaction and asynchronous endometrial maturation may play some role in the antifertility action of an IUD.^ieng

Menstrual pattern changes in laparoscopic sterilization patients whose last pregnancy was terminated by therapeutic abortion. A two-year follow-up study.

Women were used as their own controls in the comparison of presterilization and poststerilization menstrual patterns. Five parameters were studied: regularity of cycle length, duration and amount of flow and incidence of dysmenorrhea and intermenstrual bleeding. Three parameters in the electrocoagulation group (regularity of cycle length and duration and amount of flow) and one parameter in the tubal ring group(duration of flow) showed significant changes after sterilization. However, by controlling for the effect of previous contraceptive methods used, no significant menstrual pattern changes following sterilization were discerned in either technique group.

PIP: Between 1973 and 1975, 2501 women were sterilized by laparoscopy at the Yonsei University College of Medicine in Seoul, Korea. The women were used as their own controls in a follow-up study of the changes in menstrual patterns following sterilization. Tables present the results of the study. In the electrocoagulation group, twice as many patients changed from regular to irregular cycles than the other way; there was no such difference among the tubal occlusion group. More patients in both groups experienced a decline in menstrual flow. The aging of the patients and the fact that some had had therapeutic abortions prior to or concurrent with the sterilization procedure did not have any effect on the observed changes in menstrual cycles. Changes in menstrual cycle length, duration, and amount seemed to be associated with the type of contraceptive used previously. Controlling for prior contraceptive usage caused the observed differences in menstrual cycles to disappear.

Timing of laparoscopic sterilization in abortion patients.

A total of 1604 laparoscopic sterilization procedures with variable time intervals after first trimester therapeutic abortion were performed at the Severance Hospital of the Yonsei University College of Medicine, Seoul, Korea, from May 1973 to October 1975. Two hundred fourteen women were sterilized immediately at the time of abortion; 359 were sterilized between 1 and 42 days later; and the remaining 1031 women were sterilized 43 or more days after abortion. Electrocoagulation and tubal ring application were the tubal occlusion techniques used. The findings indicate that patients who underwent the combined abortion-sterilization procedure did not encounter higher rates of technical problems and/or complications than the other 2 groups. Only a few of these 1604 women studied had potentially serious complications that necessitated subsequent laparotomy, hospitalization after sterilization, and/or hospital readmission.