Library

Notes: Objective To investigate the incidence of post-operative infection after first trimester abortion in women treated with a long-acting cephalosporin (ceftriaxone) compared with low risk patients receiving no treatment and with high risk patients receiving our standard treatment of ampicillin/pivampicillin and metronidazole.Design A prospective, randomised controlled trial.Setting Department of Obstetrics and Gynaecology, Rigshospitalet, University of Copenhagen, Denmark.Subjects Nine hundred and ninety-six women, admitted on an outpatient basis for legal termination of pregnancy at 12 weeks or less of gestation, were included in the study after giving informed consent. The women were divided into high risk and low risk categories and allocated either to treatment with ceftriaxone or to standard treatment. For high risk patients the standard treatment was initiated by a peroperative injection of ampicillin and metronidazole, followed by oral doses of metronidazole and pivampicillin three times daily for four days. No prophylactic antibiotics were given to the women randomised to standard treatment in the low risk group.Interventions All women were kept under observation, and, between six and 14 days post-operatively, underwent pelvic examination. Clinical endpoints were noted.Main outcome measures Post-operative pelvic inflammatory disease in women applying for legal first trimester abortion.Results Seven hundred and eighty-six women fulfilled the criteria for evaluation. A tendency toward a prophylactic effect of ceftriaxone was observed in most clinical findings. A significant prophylactic effect of ceftriaxone was found in the low risk group.Conclusions This study demonstrated a significant reduction in post-operative pelvic inflammatory disease in low risk patients, who were applying for legal first trimester abortion, treated peroperatively with ceftriaxone. No significant difference was demonstrated between high risk patients treated with ceftriaxone or ampicillin/pivampicillin and metronidazole.

Notes: Objective To evaluate whether serum relaxin (S-relaxin) can predict spontaneous delivery before 34 weeks of gestation in high risk pregnancies.Design A prospective cohort study.Setting Calculated sample size was reached over a two-year period, during which 9507 women gave birth. Of these, 157 healthy women were eligible for the study as they were admitted with symptoms of delivery before 34 weeks of gestation. Ninety-three women were included. Overall participation rate was 59%.Population Healthy women with singleton pregnancies with symptoms of delivery before 34 weeks of gestation.Methods S-relaxin was measured using a standard sandwich ELISA.Main outcome measures End points were preterm delivery before 34 weeks of gestation and delivery within three days from initiation of symptoms. The best possible prediction of preterm delivery was established using logistic regression for risk factors individually associated with preterm delivery before 34 weeks of gestation. S-relaxin was dichotomised to obtain best possible fit and then entered into the model. The same analyses were done for delivery within three days.Results Median S-relaxin levels varied significantly in the women with preterm prelabour rupture of membranes (PPROM) (316 pg/mL), contractions (222 pg/mL) or ripe cervices (203 pg/mL) (P 〈 0.05). S-relaxin above the 80th centile (≥300 pg/mL) was associated with an increased risk of preterm delivery [crude OR = 4.8; (95% CI: 1.9–12)]. Likelihood ratio of a positive test is 2.6 (1.5–4.9) and S-relaxin resulted in a post-test probability of preterm delivery of 0.72, compared with a pre-test probability of 0.49. S-relaxin contributed to the identification of delivery within three days [adj. OR = 11 (95% CI: 1.8–64)].Conclusion S-relaxin may be a useful predictor in women with symptoms of delivery before 34 weeks of gestation.

Notes: Objective  To evaluate whether soluble CD163 (sCD163) and C-reactive protein (CRP) can predict spontaneous preterm delivery in women with symptoms of preterm delivery.Design  Prospective cohort study.Setting  Labour ward at a tertiary university hospital.Population  Ninety-three women with symptoms of preterm delivery before 34 weeks of gestation.Methods  sCD163 and CRP were individually examined as predictors of preterm delivery. A model for prediction of preterm delivery was established using exact logistic regression for risk factors individually associated with preterm delivery.Main outcome measures  Gestational age at delivery.Results  In women with symptoms of preterm delivery, median sCD163 and CRP levels were significantly higher statistically in women delivering preterm (3.4 mg/L, and 62 nmol/L) compared with the women delivering at term (2.7 mg/L, and 〈48 nmol/L, Mann–Whitney U test, P 〈 0.01 and P 〈 0.001) for sCD163 and CRP, respectively. sCD163 above 5 mg/L was associated with an increased risk of preterm delivery (crude OR = 10, [95% CI 1.3–466], adjusted OR = 27, [0.7–∞]). CRP above 47 mg/L was associated with an increased risk of preterm delivery (crude OR = 5 [1.8–14], adjusted OR = 5 [1.04–31]). Likelihood ratio of a positive test was 8.6 [2.8–14] and 2.8 [0–6.2] for sCD163 and CRP, respectively. The logistic regression model was able to predict 85% of preterm deliveries with 13% false positive, giving a likelihood ratio of 8 [2.2–13.5].Conclusion  High levels of sCD163 or CRP are associated with an increased risk of preterm delivery in women with symptoms of delivery. Good prediction of preterm delivery before 34 weeks of gestation was obtained by a combination of preterm prelabour rupture of membranes (PPROM), overweight, relaxin, CRP and sCD163.

Notes: Objectives To estimate the incidence of human parvovirus B19 among pregnant women before and during an epidemic, to elucidate possible sociodemographic and medical risk factors during pregnancy and to estimate the association between parvovirus B19 infection and negative pregnancy outcome.Design Prospective study among pregnant women followed from their first antenatal visit before 24 full weeks of gestation until delivery.Setting Department of Obstetrics and Gynaecology, Odense University Hospital, Denmark, November 1992 to February 1994.Methods 3596 pregnant women were invited to participate. The women were examined at first antenatal visit in the period from November 1992 to February 1994 and at delivery. The last delivery was in August 1994 and samples were thus collected before and during a large parvovirus B19 epidemic in Denmark January to September 1994. A blood sample for parvovirus B19 serology was taken at enrolment and from the umbilical cord at delivery. Three questionnaires were completed during 2nd and 3rd trimesters and a registration form at delivery. In total, 3174 (87.6%) were enrolled and 79.5% completed the study.Results The prevalence of B19 IgG seropositivity at the first antenatal visit before 24 full weeks of gestation was 66%. The cumulative prevalence proportion of acute parvovirus B19 infection during pregnancy among IgG negative women was found to be 10.3% (IgM seropositivity and/or IgG sero-conversion). The IgG seroconversion incidence increased significantly from 1.0% to 13.5% among 932 seronegative pregnant women before and during the epidemic, respectively (P 〈 0.001). Independent risk factors related to increased risk of B19 infection during pregnancy, adjusted for other sociodemographic and medical factors, were: children at home (adjusted OR 2.1, 95% CI 1.3–3.2); serious medical disease (adjusted OR 3.0, 95% CI 1.0–8.5); and a stressful job (adjusted OR 1.8, 95% CI 1.0–3.3). Parvovirus B19 IgM seropositivity was associated with events of late spontaneous abortions and stillbirths (crude OR 9.9; 95% CI 3.3–29.4).Conclusion Before and during an epidemic of acute B19 infection incidences were measured among pregnant women to be 1.0% and 13.5%, respectively. Three factors, significantly increasing the risk of acute B19, were identified as: having children at home; suffering from serious medical diseases; and having a stressful job. IgM positivity for parvovirus B19 was associated with negative outcome of pregnancy.

Notes: Mycoplasma hominis contains a variable adherence-associated (vaa) gene. To classify variants of the vaa genes, we examined 42 M. hominis isolates by PCR, DNA sequencing and immunoblotting. This uncovered the existence of five gene categories. Comparison of the gene types revealed a modular composition of the Vaa proteins. The proteins constituted a conserved N-terminal part followed by a varying number of interchangeable cassettes encoding approximately 110 amino acids with conserved sequence boxes flanking the cassettes. The interchangeable cassettes showed a high mutual homology and a conserved leucine zipper motif. The smallest product contained only one cassette and the largest five. Additionally, two types of stop mutations caused by substitutions resulting in the expression of truncated Vaa proteins were observed. Our results expand the known potential of the Vaa system in generating antigen variation.