Prediction of fetal lung maturity by amniotic fluid fluorescence polarization, L:S ratio, and phosphatidyl glycerol.

The relation of amniotic fluid fluorescence polarization (FP) to fetal lung maturity was examined in 186 pregnancies terminating within 48 hours of the fluid collection. Among the 9 babies who developed hyaline membrane disease (HMD), 8 were associated with FP values of 0.340 or more, and 1 had an FP value of 0.329. In 95 of these patients, the lecithin:sphingomyelin (L:S) ratio and the presence or absence of phosphatidyl glycerol (PG) were also determined. All 9 infants with HMD had L:S ratios less than 2.00 and no PG detectable in the amniotic fluid. Using an FP value of 0.325 or less, an L:S ratio of 2.00 or more, and the presence of PG as criteria for lung maturity, FP, L:S ratio, and PG did not differ significantly in the number of false predictions of HMD. Each test detected some mature infants who would have been incorrectly classified by at least 1 of the other tests. The status of all infants born at 33 weeks' gestation or later who did not develop HMD would have been correctly predicted by FP, L:S ratio, or both. These 3 tests, therefore, are complementary and can be used in combination to reduce the number of false predictions of HMD.

Treatment of vaginal discharge with yoghurt.

A preliminary trial was conducted, using yoghurt to assess its potential for the management of vaginal discharge. The results were encouraging in non-specific vaginal discharge and warrant further investigation. The treatment was ineffective in reducing Trichomonas vaginalis infestation, and in this condition no further investigation is warranted.

Management of septic chemical abortion with renal failure. Use of a conservative regimen.

The concept that hysterectomy is of value in the management of septic abortion induced by instillation of soap or phenolic antiseptics into the uterus is challenged. Nineteen out of 20 such cases with renal failure were managed with intensive antibiotic therapy, peritoneal dialysis and an absolute minimun of surgical intervention. Seventeen patients recovered, with normal renal function. Of the 11 known to be subsequently exposed to conception seven have achieved normal pregnancies.

PIP: 20 cases of septic abortion were reviewed, all of which had suffered septic shock and renal failure attributed to intrauterine instillation of soap or phenolic antiseptic solutions, which were treated at Hammersmith Hospital from 1965-1972 to determine proper management of such patients. 19 were managed conservatively, from a surgical point of view, with 13 not even having the products of conception removed from the uterus. Intensive antibiotic treatment and peritoneal dialysis were the principles of management. 17 of the 19 recovered; all 17 retain normal renal function. Of these 17 survivors, 7 have had normal pregnancies, but only 11 of the 17 have been exposed to conception.

The amniotic fluid foam test and fat cell count in malnourished and well-nourished fetuses.

A malnourished fetus has a higher concentration of pulmonary surfactant in the amniotic fluid than its well-nourished contemporary. The clinical value of this observation is discussed. Malnourished fetuses have higher "fat cell" counts in their amniotic fluid than well-nourished contemporaries. Well-nourished fetuses, at the same gestational age have high fat cell counts when the surfactant concentration is high, and low fat cell counts when the surfactant concentration is low. The relationship between surfactant concentration and the fat cell count is discussed.

Neonatal sepsis due to group G streptococci.

Two cases of neonatal septicaemia due to group G streptococci (Streptococcus canis) are described. In one patient, infection coexisted with transient neonatal hyperthyroidism, while, in the other, concomitant group G streptococcal septicaemia and endometritis in the mother was seen. Group G streptococci are rare causes of infection, especially in the paediatric age group. Bacteria were identified by serological and biochemical methods. Both neonates responded well to penicillin therapy, but the maternal infection required combination therapy with penicillin G, gentamicin, and chloramphenicol. The literature on systemic group G streptococcal infection is briefly reviewed. With increasing use of serotyping in the identification of beta-haemolytic streptococci, non-group A organisms will probably be identified more frequently from neonatal and other infections.

Studies on the growth-inhibiting property of amniotic fluids from two United States population groups.

This study attempted to determine if lack of antimicrobial activity in amniotic fluid is the reason United States blacks have more amniotic fluid bacterial infection than whites. No significant interracial differences were found in a study of 111 fluids from whites and 56 fluids from blacks. It has been claimed that the phosphate:zinc ratio in amniotic fluid is an accurate predictor of antimicrobial activity. The present study found this often to be untrue. Amniotic fluids that lacked antimicrobial activity gained such activity when zinc was added, but the in vitro zinc levels required were usually higher than observed physiologic concentrations. Previous studies have claimed that antimicrobial activity first appears in the amniotic fluid in the third trimester of gestation. We found such activity in the majority of fluids by the end of the first trimester, with a Staphylococcus aureus indicator; in contrast, with Escherichia coli and Streptococcus agalactiae as test organisms, greater inhibition was observed after 35 weeks.