Vaginal group B streptococcus status during intrapartum antibiotic prophylaxis.

OBJECTIVE: To assess maternal group B streptococcus (GBS) colonization status and the pharmacokinetic profile of penicillin G in the umbilical cord and amniotic fluid compartment during 4 hours of intrapartum antibiotic prophylaxis (IAP). METHODS: In a prospective study at a hospital in Montevideo, Uruguay, 60 GBS carriers in active labor after a singleton pregnancy of 37 weeks or more were enrolled between April 1, 2011, and April 30, 2012. Intravenous penicillin G was administered via a standard regimen. Rectovaginal samples were obtained before IAP initiation, and 2 and 4 hours after the initial dose. Penicillin G concentrations were measured by high-performance liquid chromatography. Samples were obtained from fetal cord blood in all cases and from amniotic fluid obtained from patients who delivered by cesarean. RESULTS: Among the 60 participants, 43 (72%) had a positive rectovaginal sample before IAP initiation. Of these women, 23 (53%) had negative cultures after 2 hours; after 4 hours, only 5 (12%) remained positive for GBS. The penicillin G concentration in amniotic fluid and cord blood was above the minimum inhibitory concentration (0.12 µg/mL) in all cases. CONCLUSION: Four hours of IAP was needed to reduce the number of women with positive GBS cultures to 12%. Therefore, 4 hours of IAP might be necessary to achieve overall effectiveness from this treatment.

Lawrence D. Longo: from chronic fetal hypoxia to proteomic predictors of fetal distress syndrome - a life devoted to research and mentoring based on virtue-ethics.

The present chapter presents the experience of the author during his fellowship granted by the Fogarty Foundation of the NIH in the Division of Perinatal Biology, Loma Linda University, from 1989 to 1991. Experiments on maternal and fetal responses to long-term hypoxemia (including high-altitude) were performed successfully in pregnant sheep and their fetuses.Cardiovascular, hormonal and blood flow distribution responses were studied under a strict experimental protocol. As result of this research, four papers were accepted for publication in major scientific journals, and have served as basis for further research.Most of all, the leadership, virtue-based ethics, perseverance and continuous stimulus of Lawrence D. Longo is presented as an example to follow for future generations.

Effect of pethidine administered during the first stage of labor on the acid-base status at birth.

OBJECTIVE: To evaluate the association between the use of pethidine during the first stage of labor and the presence, type and timing of acidosis in the newborn at birth. STUDY DESIGN: Secondary data analysis of a randomized controlled trial, which included term singleton pregnancies diagnosed with dystocia and requiring active management of labor. Women were randomized to receive either 100 mg of pethidine or placebo. Statistical analyses were performed using chi(2) or Fisher's exact tests for proportions and multiple linear regression for continuous outcomes. RESULTS: Three hundred and eighty-three pregnant women with a valid arterial blood cord sample were included in the final analysis. Lower pH and bicarbonate levels, as well as higher pCO(2) levels were found in the pethidide group. A higher incidence of acidosis was found in the pethidine group (pH<7.12 OR: 8.59 95% C.I. 3.29, 22.46). The highest frequency of acidosis was encountered when pethidine-delivery interval was 5 h. CONCLUSION: Pethidine use during the first stage of labor was associated with an increased risk of acidosis at birth.

Effect of amoxicillin sulbactam in threatened preterm labour with intact membranes: a randomised controlled trial.

OBJECTIVE: To determine whether treatment with amoxicillin-sulbactam in women with threatened idiopathic preterm labour will prolong the gestation and reduce preterm birth rates in a Latin-American population. METHODS: A double-blind, placebo-controlled, randomized trial was conducted in 96 women who were hospitalized for preterm labour between 24 and 34 weeks of gestation at the Pereira Rossell Hospital, in Montevideo, Uruguay. The primary outcome measure was prematurity. The sample size was calculated a priori based on the hospital database. Statistical analyses were performed using the t-test, chi square, weighted mean difference (WMD) and relative risk (RR) with their confidence intervals (95% CI). Analysis by intention-to-treat. RESULTS: Out of 47 patients assigned for antibiotics, 43 completed the treatment. There were no significant statistical differences between antibiotics and placebo group in prematurity (RR:1.04, 95% CI: 0.59, 1.84), prolongation of pregnancy (WMD:0.23, 95% CI: -0.96, 1.42) and other perinatal outcomes. CONCLUSION: Antibiotics did not prove to have benefits in improving perinatal outcomes in this Latin American population.

Meperidine for dystocia during the first stage of labor: A randomized controlled trial.

OBJECTIVE: This study was undertaken to evaluate whether the administration of meperidine decreases the length of labor in patients with a diagnosis of dystocia during the first stage of labor. STUDY DESIGN: Women with term singleton pregnancies who received a diagnosis of dystocia and required an active management of labor were randomly assigned to receive either 100 mg of meperidine or placebo. The primary outcome measure was length of labor. RESULTS: Four hundred seven pregnant women were included. There were no significant statistical differences between meperidine and placebo groups in length of labor and operative delivery rates such as forceps and cesarean section by intention-to-treat analysis. Low Apgar scores, umbilical artery acidosis, and admission to neonatal care units were increased in the meperidine group. CONCLUSION: Because of the absence of any benefits in patients with dystocia in labor and the presence of harmful effects on neonatal outcomes, meperidine should not be used during labor for this specific indication.