Comparison of irrigation and intravenous antibiotic prophylaxis at cesarean section.

Despite recent enthusiasm for antibiotic prophylaxis by uterine irrigation at the time of cesarean section, no data exists comparing the efficacy of this technique with standard intravenous antibiotic administration. Therefore, 124 patients about to undergo cesarean section were entered into a prospective, randomized, double-blind evaluation of uterine irrigation versus intravenous administration of either normal saline or cefoxitin. All women were considered to be at increased risk for postoperative infection because of the presence of labor or ruptured membranes. The incidence of endometritis and the fever index in patients receiving intravenous cefoxitin (3.2%, 4.6 degree hours) was significantly less than in patients receiving intravenous normal saline (21.2%, 22.3 degree hours). There was no significant difference between the use of intravenous normal saline and uterine irrigation with either cefoxitin (18.9%, 16.6 degree hours) or normal saline (17.4%, 24.6 degree hours). These results suggest that intravenous infusion is the most effective means of administering cefoxitin as a prophylactic antibiotic.

Legionnaire disease complicating pregnancy.

Although pneumonia complicating pregnancy remains an unusual occurrence, it can have serious consequences for both the mother and fetus. Although Streptococcus pneumoniae remains the most common bacterial pathogen, recent epidemics have emphasized the importance of considering Legionella pneumophila as the etiologic agent. Presented is the first case of Legionnaires disease to be diagnosed during pregnancy.

Abbreviated antibiotic therapy for the treatment of postpartum endometritis.

Standard antimicrobial therapy for postpartum endometritis usually consists of several days of intravenous antibiotics followed by up to ten days of oral therapy. In an effort to decrease the length of hospitalization and duration of antibiotic use, 54 patients were placed on an abbreviated antibiotic protocol. Therapy consisted of intravenous gentamicin and clindamycin until the patient's temperature remained lower than 99.5F for 24 hours, at which time intravenous antibiotics were discontinued and the patient was discharged immediately without oral medication. No morbidity secondary to the abbreviated regimen was observed. Further, the duration of hospitalization and antibiotic therapy of the study group were significantly shorter than similar data from a group of historic controls. These observations suggest that an abbreviated course of antibiotics, based upon the patient's "therapeutic response," may be a safe and cost-effective alternative to the currently practiced therapeutic regimen.

Acute pericarditis complicated by cardiac tamponade during pregnancy.

A case of acute pericarditis, complicated by pericardial effusion and cardiac tamponade, is described.

The use of nifedipine during the postpartum period in patients with severe preeclampsia.

Nifedipine is a calcium channel blocker that reduces blood pressure and increases renal blood flow. This double-blind investigation evaluated the effect of nifedipine in postpartum patients with severe preeclampsia. Thirty-one patients were randomized to receive either nifedipine (10 mg) or placebo every 4 hours beginning immediately after delivery. Data analysis revealed a significantly higher urine output in the nifedipine group during the first 24 hours after delivery (3834 versus 2057 ml; p less than 0.05). A significant reduction in mean arterial pressure was also noted in the nifedipine group between 18 and 24 hours postpartum (93.9 versus 100.2 mm Hg; p less than 0.05). There were no significant differences in the systolic or diastolic blood pressures, pulse, laboratory study results, or the need to administer hydralazine to control blood pressure. Nifedipine appears to have a beneficial effect on urinary output and mean arterial pressure during the first 24 hours post partum in patients with severe preeclampsia.

Increasing quantity of maternal immunoglobulin G in trophoblastic tissue before the onset of normal labor.

While levels of maternal immunoglobulin G (IgG) increase in the fetal circulation during the third trimester, actual trophoblastic concentrations have not been extensively studied. To investigate this process, placentas from 71 patients with gestational ages between 26 and 42 weeks were examined by means of a peroxidase-antiperoxidase immunostaining technique specific for IgG. Linear regression revealed a significant increase in antibody with advancing gestational age (r = 0.36, p less than 0.01). In addition, placentas from patients in spontaneous term labor revealed a significantly higher antibody level when compared with those of patients at term delivered electively before the onset of labor (mean +/- SEM 2.6 +/- 0.2 vs 1.7 +/- 0.3, p less than 0.02). Patients in premature labor failed to demonstrate this increase in antibody staining. One possible explanation for these findings is an enhanced recognition of the fetal trophoblastic tissue by the maternal immune system at term. It also suggests immunologic factors may play an important role in the initiation of normal labor.

Ritodrine inhibition of hypoxic pulmonary vasoconstriction.

The effect of ritodrine hydrochloride on hypoxic pulmonary vasoconstriction (HPV), the normal control mechanism for shunting blood flow away from nonventilated areas of the lung, was studied in nonpregnant dogs equipped with central monitors and electromagnetic flow probes. The systemic infusion of ritodrine at a dose of 4 micrograms/kg/min resulted in a 66.4% +/- 4.6% decrease in the HPV response, whether administered before or after the induction of isolated lobar hypoxia. These findings have significant implications for the patient who develops pulmonary edema during ritodrine therapy, in which inability to bypass nonventilated areas of the lung would serve to aggravate further the ventilation/perfusion inequalities that already exist.

Maternal cardiovascular response to caffeine infusion in the pregnant ewe.

The effect of maternal caffeine infusion on uterine blood flow and fetal oxygenation was studied in chronically catheterized pregnant sheep equipped with electromagnetic flow probes. The systemic administration of caffeine in doses of 8 and 24 mg/kg of body weight resulted in peak maternal serum levels of 16.7 +/- 0.9 and 38.5 +/- 2.1 micrograms/ml and fetal serum levels of 10.9 +/- 0.7 and 34.9 +/- 4.5 micrograms/ml, respectively. While no significant effects were noted at the 8 mg/kg dose, administration of 24 mg/kg was associated with a 5% reduction in uterine blood flow (p less than 0.05) and a 7% increase in mean arterial pressure (p less than 0.05). No significant alteration in maternal or fetal oxygenation occurred at either dose. These findings suggest that any adverse effects on fetal development attributed to caffeine are not likely exerted by influencing uterine blood flow.

Antenatal diagnosis of fetal seizure activity with use of real-time ultrasound.

Neonatal seizures have been observed as early as the first hour of life. It has been postulated that for certain central nervous system disorders, seizure activity may occur in utero. This report describes two cases of spontaneous fetal seizure activity diagnosed by real-time ultrasound.

Uterine blood flow and catecholamine response to repetitive nicotine exposure in the pregnant ewe.

In order to simulate human smoking, experiments were designed to determine what dose of nicotine in the pregnant sheep would produce those plasma nicotine concentrations observed in human smokers and to measure uterine blood flow and plasma catecholamines in response to repetitive exposure (every 30 minutes) to that nicotine dose. Utilizing seven chronically catheterized pregnant sheep equipped with electromagnetic flow probes around both uterine arteries, we observed that a nicotine dose of 0.2 mg/min for 5 minutes results in mean plasma nicotine concentrations of 23.1 +/- 1.1 ng/ml SEM (n = 17) immediately following infusion. This dose of nicotine was then infused every 30 minutes for 4 hours, and aliquots of blood were drawn immediately before and after nicotine infusion for determination of plasma catecholamines. No significant alterations in plasma epinephrine and norepinephrine were observed throughout the experiments (n = 8), and no significant changes in uterine blood flow occurred at any time during the experiment (n = 30). We conclude that there is a species difference between sheep and man with respect to the nicotinic threshold for catecholamine release.