388 SPO Abstracts

408 THE UTILITY OF LUMBAR PUNCTURE IN THE EVALUATION AND TREATMENT OF SVPHlLIS.Brown.G",LaSala AP,Aoderson R',Tose D".Dept. of Ob/Gyn,Columbia University, New York, NY

409

Current recommendations for the evaluation of late latent syphilis or disease of unknown duration include cerebrospinal fluid (CSF) examination to rule out neurosyphilis. This assessment requires lumbar puncture (LP) which has the potential morbidity of meningitis and spinal headache. We examined the use of LP in a population of young pregnant women living in New York City. Ao evaluation of obstetrical patients with a positive rapid plasma reagin (RPR) screening test for syphilis was performed. Between Jan. I, 1989 and Aug. 23, 1991,253 of these women were followed at our center. They were evaluated for length of disease and given the appropriate therapy based on CDC guidelines. Twenty-three patients had disease present for less than 1 year and therefore did not require CSF examination. Two hundred-thirty women had disease of unknown duration or for greater than I year and were offered LP. Of this group, 12 tested positive for HIV. LP was performed in 70 women (30.4%), including 8 of the HIV positive group. One hundred fifty-five (67.4%) women refused LP, and 2 had unsuccessful taps. Four women came to the emergency room for treatment of spinal headache and several others reported milder headsche. Three women had CSF that was positive for syphilis. Each of these patients was also HIV positive. The patients with negative CSF and those who declined LP were treated for presumed late latent syphilis. AIl of the women were followed with monthly RPR tests and showed the decline in values consistent with successful treatment. It is our conclusion that the potential morbidity of LP outweighs its' benefit in the routine evaluation of our young pregnant popUlation with syphilis. AIl patients with syphilis should be offered HIV testing. CSF examination should be used for women with the additional risk factor of HIV infection which may hasten the progress of the disease. AIl treated women with syphilis should be followed with monthly RPR tests. Aoy evidence of persistent disease despite appropriate therapy may also warrant CSF examination.

FETAL SYPHILIS: CORRELATION OF SONOGRAPHIC FINDINGS AND RABBIT INFECTIVITY TESTING. L. Nathanx, D.M. Twicklerx, M. Petersx, P. Sanchezx, G.D. Wendel, Dept. Ob/Gyn, U. Texas Southwestern Med Center., Dallas, TX

Fetal syphi lis is the presumed diagnosiS when the sonographic findings of fetal hydrops are found in the presence of maternal syphilis infection. In the absence of fetal hydrops, the diagnosiS of fetal infection is problematic. Rabbit infectivity testing (RIT) is a specific, sensitive .ill vivo technique to identify Treponema pallidum in infected material. Amniocentesis and subsequent RIT to identify Treponema pallidum may be used to confirm amniotic fluid/fetal involvement. We sought to correlate antenatal sonographic findings from syphilitic gravidas with the results of amniotic fluid RIT. Twenty one gravidas with primary, secondary or early latent syphilis at 24 weeks or greater underwent rea 1 time sonography. inc luding corona 1 1 ;ver measurements. and amn ;ocentes is. Measurements which exceeded the 95th percent i Ie for gestat iona I age were cons idered abnorma 1. Fetal infection was confirmed by development of syphilis in rabbits after intratesticular inoculation of amniotic fluid. Eleven spechoons had positive RlTs and ten had negative RITS. The two groups were compared regarding sonographic findings:

Hepatomega ly

Posit ive RIT N=ll

P lacenth 1 Th i cken i ng Ascites En larged Abdomen Hydrops F eta 1 is

Negative RIT N=IO

<.01 NS NS NS NS

Conclusion: In over 50% of cases of maternal syphilis, fetal infection occurs. Sonographic hepatomegaly is significantly associated with amniot ic fluid/fetal infect ion detected by RlT. Sonography, prior to maternal syphilis therapy, may identify these affected fetuses who are at risk for treatment failure.

January 1992 Am J Obstet Gynecol

410 CORRELATION BETWEEN ltlE PRESENCE OF HIV-1 mRNA IN

ltllRD TRIMESTER PLACENTA AND NEONATAL INFECTION.

411

.I.. lSiltl.. C. Fox,X G. Eglinton, A. Firpo,X W. Meyer,X

J.T. Queenan, Dept. of Ob/Gyn, Georgetown University,

Washington, DC, and National Institutes of Health, Bethesda, MD

The purpose of this study was twofold: (1) to determine if 35S-mRNA

in situ hybridization (ISH) can identify HIV-1 in paraffin embedded

third trimester placentas from asymptomatic seropositive patients

and (2) to determine if the presence of HIV-1 viral mRNA in placental

tissue is associated with neonatal infection. The study population

was seropositive from 1 to 36 months before delivery, had no history

of opportunistic infection, depletion of CD4+ count or AZT exposure.

Placentas from 3 of 9 patients demonstrated positive ISH. One infant

is HIV-l infected at 5 months of age based on clinical and laboratory

findings. The other 2 infants have no evidence of HIV-l infection at 6

months. None of the 6 infants w~h negative placental ISH have

clinical or laboratory evidence of infection at 1 to 7 months after

delivery. We conclude that the sensitive technique of 35S-mRNA in

situ hybridization can successfully identify the presence of HIV-l in

paraffin embedded placental tissue, but the presence of viral mRNA

does not consistently predict neonatal infection within the first 6

months of life.

PREDICTORS OF CESAREAN WOUND DISRUPTIONIINFECTION. E.R. Newton, Dept. of Ob/Gyn, The University of Texas Health ScIence Center, San Antonio, Texas.

Parity, duration of internal monitor in!! and duration of ruptured membranes predict intraamniotic tnfection (lAO and endometritis (EN DO). We examined the relationship between labor and operative characteristics that predict cesarean wound disruption/infection (WOUND). Six hundred fourteen consecutive cesarean sections were reviewed during the postpartum hospitalization for demographic, obstetric and operative characteristics as predictors of WOUND. WOUND was defined as any intentional or unintentional wound opening in the first 6 weeks postpartum. Thirty-two (S.2%) wound infections occurred and eight (25%) were associated with IAI or ENDO. Stepwise logistiC regression was used to control for confounders and to identify the risk factors for WOUND. Possible predictors included concurrent infection, age, parity, labor duration, internal fetal monitoring, vaginal exams, duration of surgery, blood loss, weight, height, prophylactic antibiotics, gestational age, birthweight and diabetes.

Predictor Incidence

Smoker 8.1%

Obesity (;;;: 100 Kg) 17%

Adjusted Odds Ratio

6.67

2.64

9Sth CI

1.2 2.49

1.1 8.4

Unlike other obstetric infections, labor characteristics did not influence risk of WOUND. The etiology of wound infections after cesarean section appears to be similar to wound infections after gynecologic surgery.