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390 SPQ Abstracts 416 ANTIRETROVIRAL THERAPY DURING PREGNANCY AND POSTPARTUM. U. Taylor and A. Bardeguez, Department of Obstetrics/Gynecology, UMDNJ-New Jersey Medical School, Newark, New Jersey. The number of AIDS cases reported worldwide in women is rapidly increasing. In 1987 AIDS was the 8th leading cause of death for women of reproductive age in the U.S.A. Zidovudine (AZT) therapy in HIV infected individuals is known to prolong survival in patients with AIDS and to delay the progression of disease in those with CD, counts <500/mm'. The major toxicity of AZT is myelosuppression. Other minor adverse effects are nausea, headache and transaminase elevation. The available information on the use of AZT in pregnancy has focused on the lack of adverse effects in the fetus. This report details our experience with the use of AZT during pregnancy and postpartum. As of August, 1991, we have managed 20 patients (10 antepartum and 10 postpartum) with antiretroviral therapy. The mean duration of therapy was 14.1 ±. 10 weeks. Ninety percent of our patients were black, 5% hispanic and 5% white. Seven patients were former IVDU's and 13 acquired the infection through heterosexual contact. There were 5 patients with AIDS; 6 with ARC and 9 asymptomatic patients. Mean maternal age was 26.1±. 5.6 years. The CD, counts ranged from 13-5OO/mm' with a mean value of 284.45 ±. 187.35/mm'. Laboratory data showed mean value of WBC 7.8 x 10' ±. 2.7, hemoglobin 8.9 ±. 1.6g/dl, hematocrit 27.6% ±. 3.2, GOT 35 ±. 11.2; and GPT 39 ±. 9.1 for that series. The obstetrical complications in the series were: preterm labor (3), PROM (1) and chorioamnionitis (1). Nineteen patients have delivered grossly normal infants with mean birth weight of 2299g. No fetal anomalies were noted. In patients with antepartum treatment, transaminase values were unchanged and CD, counts show an upward trend. We conclude that AZT has no immediate adverse effect on the pregnant woman or her neonate. Our findings support the use of AZT in pregnant women who are significantly immunocompromised or have advanced stage disease. 417 HIV-ASSOCIATED IMMUNE THROMBOCYTOPENIA IN PREGNANCY. U. Taylor, P. Gascon: J. Apuzzio and A. Bardeguez. Departments of Obstetrics/Gynecology and Hematology, UMDNJ-New Jersey Medical School, Newark, New Jersey. Immune thrombocytopenia purpura (lTP) while relatively uncommon during pregnancy «2%); occurs in 10 to 15% of asymptomatic HIV infected patients and is often the initial manifestation of the disease. Zidovudine (AZT) has been used effectively to treat HIV related thrombocytopenia. We sought to determine the prevalence of ITP in HIV infected pregnant women and to develop appropriate management guidelines for these cases. Between 1986 and 1990, we analyzed all HIV infected pregnant patients in our cohort with platelet counts <loo,OOO/mm'. We evaluated a total of 112 cases and identified nine cases (8%) with thrombocytopenia. The HIV risk factors for these 9 cases with thrombocytopenia were IVDA (4/9) and heterosexual contact (5/9). There was 1 patient with AIDS, 6 with ARC; and 2 others were HIV positive but asymptomatic. The mean maternal age was 30.3 ±. 3.9 years and the mean platelet count was 70,000 ±. 21,000. Four patients had positive antiplatelet antibody. The CD, counts in these patients were 287.7 ±. 106.7 /mm'. The two patients treated with AZT for an average of 12 weeks during pregnancy, showed an increase in platelet count of 26%. These pregnancies were delivered at term. No IVH or other bleeding diathesis were noted in the neonates. Late postpartum hemorrhage was a complication in 2 patients. Thrombocytopenia was a common manifestation of HIV infection in our series. We recommend the inclusion of HIV testing in the diagnostic evaluation of thrombocytopenia for women of reproductive age. When other diseases have been ruk'<l out intervention with antiretroviral therapy is beneficial to these patients. January 1992 Am J Obstet Gynecol 418 QUALITATIVB PHYSICAL AND CHBMlCAL CHANGES OF INPBCTBD AMNIOTIC FLUID - AN IN VITRO STUDY_ W. A. Vintzileos, Mt Sinai H08p., Univ. of CT Health Ctr, Farmington, CT It has been a clinical observation that patients with ruptured membranes and subsequent infection fail to demonstrate arborization on the fem test. The purpose of this study was to detennine if amniotic fluid inoculated with known pathogens differed in its arborization pattern and if qualitative chanaea (ilucoae, protein, nitrites, pH and leukocyte esterase) could be detected using a standard reagent strip. Sterile amniotic fluid was collected from 25 amniocenteses perfonoed in the 2 nd or 3 rd trimesters. Patients with ruptured membranes, premature labor or signs of intraamniotic infection were excluded. Each specimen was divided into 5 co aliquots consisting of a control and inoculated samples with either Group B strop, E. coli, or B. fTal/ilia. The investigators who analyzed the amniotic fluid were blinded. The fluid was incubated at 380C and examined at 48 and 96 hours for Gram stain, culture, and arborization and qualitative changes. Fifteen specimens were inoculated with each organism and compared to controls all of which had negative Gram stains and cultures. All inoculated samples had positive Gram stains and cultures. Inoculated specimens and controls demonstrated similar arborization patterns at 48 and 96 hours. No sample failed to "fern N All inoculated samples revealed 'negative' readings for glucose (sensitivity of the reagent, 74 mg%) while controls were trace positive (sensitivity of the reagent,100 mg%). There were no differences in protein (3+), nitrites (negative), pH (7.5 - 8.0), or leukocyte esterase (negative). The results were the same at 48 and 96 hours. This in vitro study continos the usefulness of the fern test to diagnoae ruptured membranes in the presence of infected amniotic fluid. This study also suggests that development of a reagent strip with high sensitivity for glucose may prove useful in the diagnosis of infected amniotic fluid. The qualitative analysis of other biochemical parameters did not seem to be useful at least in vitro. 419 COMPARISON OF GRAM STAIN, LEUKOCYTE ESTERASE, AND AMNIOTIC FLUID GLUCOSE IN PREDICTING CUL- TURE RESULTS IN PATIENTS WITH PREMATURE RUPTURE OF MEMBRANES. D. Gauthier,x W. Meyer,X A. Bieniarz. University of Illinois, Chicago,IL Gram stain(GS), leukocyte esterase activity (LE), and amniotic fluid glucose(AFG) have been described as rapid predictors of amniotic fluid culture results. METHODS. A prospective study was performed on 90 patients with PROM <34 weeks EGA and no clinical evidence of infectIon. Ae- robic, anaerobic, and mycoplasma cultures were done as well as GS, LE, and AFG on fluid ob- tained by amniocentesis. RESULTS. Cultures were positive in 47 patients(52%). The sensitivity, specificity, positive and negative predictive values of GS, LE 1+ or 2+, and AFG<16 mg/dl in predicting culture results are outlIned below: SENS SPEC PPV NPV Gram st. 38(49) 95(95) 90(90) 59(68) LE 1+/2+ 68(81)* 84(84) 82(81) 71(83) AFG 16 75(89)* 91(91) 90(89) 77(91)# ()=Exclusion of cultures + for Ureaplasma alone with no evidence of maternal/neonat. infection. In comparison to GS- * = p<.OI, 11= p<.05 CONCLUSION: AFG AND LE WERE SIGNIFICANTLY MORE SENSITIVE THAN GS IN DETECTING POSITIVE CULTURE RESULTS. OVERALL, AFG APPEARS TO BE THE MOST ACCURATE RAPID PREDICTOR OF CULTURE RESULTS.

417 HIV-Associated Immune Thrombocytopenia in Pregnancy

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390 SPQ Abstracts

416 ANTIRETROVIRAL THERAPY DURING PREGNANCY AND POSTPARTUM. U. Taylor and A. Bardeguez, Department of Obstetrics/Gynecology, UMDNJ-New Jersey Medical School, Newark, New Jersey.

The number of AIDS cases reported worldwide in women is rapidly increasing. In 1987 AIDS was the 8th leading cause of death for women of reproductive age in the U.S.A. Zidovudine (AZT) therapy in HIV infected individuals is known to prolong survival in patients with AIDS and to delay the progression of disease in those with CD, counts <500/mm'. The major toxicity of AZT is myelosuppression. Other minor adverse effects are nausea, headache and transaminase elevation. The available information on the use of AZT in pregnancy has focused on the lack of adverse effects in the fetus. This report details our experience with the use of AZT during pregnancy and postpartum. As of August, 1991, we have managed 20 patients (10 antepartum and 10 postpartum) with antiretroviral therapy. The mean duration of therapy was 14.1 ±. 10 weeks. Ninety percent of our patients were black, 5% hispanic and 5% white. Seven patients were former IVDU's and 13 acquired the infection through heterosexual contact. There were 5 patients with AIDS; 6 with ARC and 9 asymptomatic patients. Mean maternal age was 26.1±. 5.6 years. The CD, counts ranged from 13-5OO/mm' with a mean value of 284.45 ±. 187.35/mm'. Laboratory data showed mean value of WBC 7.8 x 10' ±. 2.7, hemoglobin 8.9 ±. 1.6g/dl, hematocrit 27.6% ±. 3.2, GOT 35 ±. 11.2; and GPT 39 ±. 9.1 for that series. The obstetrical complications in the series were: preterm labor (3), PROM (1) and chorioamnionitis (1). Nineteen patients have delivered grossly normal infants with mean birth weight of 2299g. No fetal anomalies were noted. In patients with antepartum treatment, transaminase values were unchanged and CD, counts show an upward trend. We conclude that AZT has no immediate adverse effect on the pregnant woman or her neonate. Our findings support the use of AZT in pregnant women who are significantly immunocompromised or have advanced stage disease.

417 HIV-ASSOCIATED IMMUNE THROMBOCYTOPENIA IN PREGNANCY. U. Taylor, P. Gascon: J. Apuzzio and A. Bardeguez. Departments of Obstetrics/Gynecology and Hematology, UMDNJ-New Jersey Medical School, Newark, New Jersey.

Immune thrombocytopenia purpura (lTP) while relatively uncommon during pregnancy «2%); occurs in 10 to 15% of asymptomatic HIV infected patients and is often the initial manifestation of the disease. Zidovudine (AZT) has been used effectively to treat HIV related thrombocytopenia. We sought to determine the prevalence of ITP in HIV infected pregnant women and to develop appropriate management guidelines for these cases. Between 1986 and 1990, we analyzed all HIV infected pregnant patients in our cohort with platelet counts <loo,OOO/mm'. We evaluated a total of 112 cases and identified nine cases (8%) with thrombocytopenia. The HIV risk factors for these 9 cases with thrombocytopenia were IVDA (4/9) and heterosexual contact (5/9). There was 1 patient with AIDS, 6 with ARC; and 2 others were HIV positive but asymptomatic. The mean maternal age was 30.3 ±. 3.9 years and the mean platelet count was 70,000 ±. 21,000. Four patients had positive antiplatelet antibody. The CD, counts in these patients were 287.7 ±. 106.7 /mm'. The two patients treated with AZT for an average of 12 weeks during pregnancy, showed an increase in platelet count of 26%. These pregnancies were delivered at term. No IVH or other bleeding diathesis were noted in the neonates. Late postpartum hemorrhage was a complication in 2 patients. Thrombocytopenia was a common manifestation of HIV infection in our series. We recommend the inclusion of HIV testing in the diagnostic evaluation of thrombocytopenia for women of reproductive age. When other diseases have been ruk'<l out intervention with antiretroviral therapy is beneficial to these patients.

January 1992 Am J Obstet Gynecol

418 QUALITATIVB PHYSICAL AND CHBMlCAL CHANGES OF INPBCTBD AMNIOTIC FLUID - AN IN VITRO STUDY_ W. Scorza,~, A. Vintzileos, Mt Sinai H08p., Univ. of CT Health Ctr, Farmington, CT

It has been a clinical observation that patients with ruptured membranes and subsequent infection fail to demonstrate arborization on the fem test. The purpose of this study was to detennine if amniotic fluid inoculated with known pathogens differed in its arborization pattern and if qualitative chanaea (ilucoae, protein, nitrites, pH and leukocyte esterase) could be detected using a standard reagent strip. Sterile amniotic fluid was collected from 25 amniocenteses perfonoed in the 2nd or 3rd trimesters. Patients with ruptured membranes, premature labor or signs of intraamniotic infection were excluded. Each specimen was divided into 5 co aliquots consisting of a control and inoculated samples with either Group B strop, E. coli, or B. fTal/ilia. The investigators who analyzed the amniotic fluid were blinded. The fluid was incubated at 380C and examined at 48 and 96 hours for Gram stain, culture, and arborization and qualitative changes. Fifteen specimens were inoculated with each organism and compared to controls all of which had negative Gram stains and cultures. All inoculated samples had positive Gram stains and cultures. Inoculated specimens and controls demonstrated similar arborization patterns at 48 and 96 hours. No sample failed to "fernN

• All inoculated samples revealed 'negative' readings for glucose (sensitivity of the reagent, 74 mg%) while controls were trace positive (sensitivity of the reagent,100 mg%). There were no differences in protein (3+), nitrites (negative), pH (7.5 - 8.0), or leukocyte esterase (negative). The results were the same at 48 and 96 hours. This in vitro study continos the usefulness of the fern test to diagnoae ruptured membranes in the presence of infected amniotic fluid. This study also suggests that development of a reagent strip with high sensitivity for glucose may prove useful in the diagnosis of infected amniotic fluid. The qualitative analysis of other biochemical parameters did not seem to be useful at least in vitro.

419 COMPARISON OF GRAM STAIN, LEUKOCYTE ESTERASE, AND AMNIOTIC FLUID GLUCOSE IN PREDICTING CUL­TURE RESULTS IN PATIENTS WITH PREMATURE RUPTURE OF MEMBRANES. D. Gauthier,x W. Meyer,X A. Bieniarz. University of Illinois, Chicago,IL

Gram stain(GS), leukocyte esterase activity (LE), and amniotic fluid glucose(AFG) have been described as rapid predictors of amniotic fluid culture results. METHODS. A prospective study was performed on 90 patients with PROM <34 weeks EGA and no clinical evidence of infectIon. Ae­robic, anaerobic, and mycoplasma cultures were done as well as GS, LE, and AFG on fluid ob­tained by amniocentesis. RESULTS. Cultures were positive in 47 patients(52%). The sensitivity, specificity, positive and negative predictive values of GS, LE 1+ or 2+, and AFG<16 mg/dl in predicting culture results are outlIned below:

SENS SPEC PPV NPV Gram st. 38(49) 95(95) 90(90) 59(68) LE 1+/2+ 68(81)* 84(84) 82(81) 71(83) AFG ~ 16 75(89)* 91(91) 90(89) 77(91)# ()=Exclusion of cultures + for Ureaplasma alone with no evidence of maternal/neonat. infection. In comparison to GS- * = p<.OI, 11= p<.05 CONCLUSION: AFG AND LE WERE SIGNIFICANTLY MORE SENSITIVE THAN GS IN DETECTING POSITIVE CULTURE RESULTS. OVERALL, AFG APPEARS TO BE THE MOST ACCURATE RAPID PREDICTOR OF CULTURE RESULTS.