Obstetrics

SAN FRANCISCO — Staphylococcus aureus was carried in the vaginal-rectal area in 11% of screened pregnant women at a Camden, N.J., hospital, according to a study presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The investigators took vaginal-rectal specimens collected from pregnant women being screened for group B streptococcus from June 2005 until March 2006 and cultured them for S. aureus.

Of 353 women screened, 39 (11%) were colonized with staphylococcus; 7 of the 39 (2%) were methicillin-resistant strains, said Dr. Henry Fraimow of Cooper University Hospital in Camden. Five of the seven MRSA isolates contained the Panton-Valentine leukocidin virulence gene.

All seven were susceptible to clindamycin and levofloxacin.

The study could help to explain why in Camden generally half of S. aureus abscesses occur below the waist, and why Camden nurseries have had outbreaks of neonatal S. aureus infections, Dr. Fraimow said at the conference, which was sponsored by the American Society for Microbiology.

“This is higher than reported rates of vaginal colonization with staph aureus, most [studies] of which were done in the 1980s during some of the toxic shock syndrome outbreaks,” he said. “There hasn't been a lot of good recent data.”

One other recent study that looked at vaginal colonization found a higher rate of carriage, 18%, but a lower rate of methicillin resistance, 0.5%, he added.

Dr. Fraimow and his colleagues also found much more carriage in the summer months than during the rest of the year. They found that 14% of the specimens collected between June and September were colonized, compared with only 7% of those collected between October and March.

“We also conclude that all reservoirs for this organism must be considered when looking at strategies such as decolonization to prevent recurrent infections,” Dr. Fraimow said.

SAN FRANCISCO — Staphylococcus aureus was carried in the vaginal-rectal area in 11% of screened pregnant women at a Camden, N.J., hospital, according to a study presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The investigators took vaginal-rectal specimens collected from pregnant women being screened for group B streptococcus from June 2005 until March 2006 and cultured them for S. aureus.

Of 353 women screened, 39 (11%) were colonized with staphylococcus; 7 of the 39 (2%) were methicillin-resistant strains, said Dr. Henry Fraimow of Cooper University Hospital in Camden. Five of the seven MRSA isolates contained the Panton-Valentine leukocidin virulence gene.

All seven were susceptible to clindamycin and levofloxacin.

The study could help to explain why in Camden generally half of S. aureus abscesses occur below the waist, and why Camden nurseries have had outbreaks of neonatal S. aureus infections, Dr. Fraimow said at the conference, which was sponsored by the American Society for Microbiology.

“This is higher than reported rates of vaginal colonization with staph aureus, most [studies] of which were done in the 1980s during some of the toxic shock syndrome outbreaks,” he said. “There hasn't been a lot of good recent data.”

One other recent study that looked at vaginal colonization found a higher rate of carriage, 18%, but a lower rate of methicillin resistance, 0.5%, he added.

Dr. Fraimow and his colleagues also found much more carriage in the summer months than during the rest of the year. They found that 14% of the specimens collected between June and September were colonized, compared with only 7% of those collected between October and March.

“We also conclude that all reservoirs for this organism must be considered when looking at strategies such as decolonization to prevent recurrent infections,” Dr. Fraimow said.

SAN FRANCISCO — Staphylococcus aureus was carried in the vaginal-rectal area in 11% of screened pregnant women at a Camden, N.J., hospital, according to a study presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The investigators took vaginal-rectal specimens collected from pregnant women being screened for group B streptococcus from June 2005 until March 2006 and cultured them for S. aureus.

Of 353 women screened, 39 (11%) were colonized with staphylococcus; 7 of the 39 (2%) were methicillin-resistant strains, said Dr. Henry Fraimow of Cooper University Hospital in Camden. Five of the seven MRSA isolates contained the Panton-Valentine leukocidin virulence gene.

All seven were susceptible to clindamycin and levofloxacin.

The study could help to explain why in Camden generally half of S. aureus abscesses occur below the waist, and why Camden nurseries have had outbreaks of neonatal S. aureus infections, Dr. Fraimow said at the conference, which was sponsored by the American Society for Microbiology.

“This is higher than reported rates of vaginal colonization with staph aureus, most [studies] of which were done in the 1980s during some of the toxic shock syndrome outbreaks,” he said. “There hasn't been a lot of good recent data.”

One other recent study that looked at vaginal colonization found a higher rate of carriage, 18%, but a lower rate of methicillin resistance, 0.5%, he added.

Dr. Fraimow and his colleagues also found much more carriage in the summer months than during the rest of the year. They found that 14% of the specimens collected between June and September were colonized, compared with only 7% of those collected between October and March.

“We also conclude that all reservoirs for this organism must be considered when looking at strategies such as decolonization to prevent recurrent infections,” Dr. Fraimow said.

LISBON — Malaria in pregnancy is the greatest challenge the disease poses, said Dr. Theonest K. Mutabingwa at the 12th International Congress on Infectious Diseases.

Each year, 50 million women become pregnant in malaria-endemic areas worldwide, including 30 million in sub-Saharan Africa. Those who are infected often develop placental parasitemia, a leading cause of low birth weight, infant mortality, and severe maternal anemia in tropical regions.

This is true even when the mother's infection is asymptomatic, as is typical in regions where malaria transmission is intense and many adults have developed immunity to the disease, explained Dr. Mutabingwa of the Seattle Biomedical Research Institute and the National Institute for Medical Research in Muheza, Tanzania. For this reason, it is recommended that malaria in pregnancy be diagnosed and treated. And that's where matters become so difficult. Microscopy, the standard diagnostic method in the developing world, isn't sufficiently sensitive to reliably detect asymptomatic infection in pregnant women who may have placental parasitemia despite having a negative peripheral blood smear. A rapid diagnostic test using a malaria-specific antigen that is suitable for rugged field use would be a major advance, he said.

Moreover, the resistance of malaria parasites to chloroquine and sulfadoxine-pyrimethamine has become so pervasive that the latest World Health Organization malaria guidelines, issued earlier this year, have demoted these agents from their longtime status as first-line therapy in favor of artemisinin-based combination therapies, except in pregnancy, where the older drugs' well-established safety record earned them a reprieve. The WHO guidelines call quinine—a drug with an inconveniently lengthy treatment course—the most effective antimalarial that's safe for use throughout pregnancy.

The big emerging problem as older antimalarials give way to artemisinin combination therapies and other drugs in the developmental pipeline is that pregnant women have been systematically excluded from participation in clinical trials of all newer agents. There is an urgent need to rectify this situation and begin evaluating the safety of antimalarial agents in pregnancy, Dr. Mutabingwa said at the congress sponsored by the International Society for Infectious Diseases.

Women in their first and second pregnancies are known to be particularly vulnerable to the deleterious effects of malaria. But in a recent study involving 453 infants, 69 of them born to mothers with placental malaria, Dr. Mutabingwa and colleagues discovered a surprising effect of gravidity on infant malaria. Babies born to mothers with placental malaria at delivery were 41% more likely to have parasitemia during infancy. No surprise there. But although parasitemia was more common in primigravid than multigravid women, the opposite was true in their infants. First-born infants of mothers with placental parasitemia were less likely to develop malaria in infancy than were babies born to multigravid women with placental malaria (PLos Med. 2005 December 2(12): e407; doi: 10.1371/journal.pmed.0020407).

Unfortunately, targeting malaria control measures specifically at women in their first two pregnancies as a means of improving mother-child health is rendered impractical in many areas because of the complicating factor of the HIV epidemic. HIV-infected women in malarial regions have a high prevalence and density of peripheral and placental parasitemia in all pregnancies, not just their first two.

For this reason, the most practical antimalarial strategy today in a region such as sub-Saharan Africa is to use intermittent preventive therapy and presumptively treat anemic pregnant women as having malaria. Historically, two or more antenatal doses of intermittent preventive therapy with sulfadoxine-pyrimethamine were known to be effective in reducing infection and parasite load, but drug resistance has greatly reduced the usefulness of this regimen.

LISBON — Malaria in pregnancy is the greatest challenge the disease poses, said Dr. Theonest K. Mutabingwa at the 12th International Congress on Infectious Diseases.

Each year, 50 million women become pregnant in malaria-endemic areas worldwide, including 30 million in sub-Saharan Africa. Those who are infected often develop placental parasitemia, a leading cause of low birth weight, infant mortality, and severe maternal anemia in tropical regions.

This is true even when the mother's infection is asymptomatic, as is typical in regions where malaria transmission is intense and many adults have developed immunity to the disease, explained Dr. Mutabingwa of the Seattle Biomedical Research Institute and the National Institute for Medical Research in Muheza, Tanzania. For this reason, it is recommended that malaria in pregnancy be diagnosed and treated. And that's where matters become so difficult. Microscopy, the standard diagnostic method in the developing world, isn't sufficiently sensitive to reliably detect asymptomatic infection in pregnant women who may have placental parasitemia despite having a negative peripheral blood smear. A rapid diagnostic test using a malaria-specific antigen that is suitable for rugged field use would be a major advance, he said.

Moreover, the resistance of malaria parasites to chloroquine and sulfadoxine-pyrimethamine has become so pervasive that the latest World Health Organization malaria guidelines, issued earlier this year, have demoted these agents from their longtime status as first-line therapy in favor of artemisinin-based combination therapies, except in pregnancy, where the older drugs' well-established safety record earned them a reprieve. The WHO guidelines call quinine—a drug with an inconveniently lengthy treatment course—the most effective antimalarial that's safe for use throughout pregnancy.

The big emerging problem as older antimalarials give way to artemisinin combination therapies and other drugs in the developmental pipeline is that pregnant women have been systematically excluded from participation in clinical trials of all newer agents. There is an urgent need to rectify this situation and begin evaluating the safety of antimalarial agents in pregnancy, Dr. Mutabingwa said at the congress sponsored by the International Society for Infectious Diseases.

Women in their first and second pregnancies are known to be particularly vulnerable to the deleterious effects of malaria. But in a recent study involving 453 infants, 69 of them born to mothers with placental malaria, Dr. Mutabingwa and colleagues discovered a surprising effect of gravidity on infant malaria. Babies born to mothers with placental malaria at delivery were 41% more likely to have parasitemia during infancy. No surprise there. But although parasitemia was more common in primigravid than multigravid women, the opposite was true in their infants. First-born infants of mothers with placental parasitemia were less likely to develop malaria in infancy than were babies born to multigravid women with placental malaria (PLos Med. 2005 December 2(12): e407; doi: 10.1371/journal.pmed.0020407).

Unfortunately, targeting malaria control measures specifically at women in their first two pregnancies as a means of improving mother-child health is rendered impractical in many areas because of the complicating factor of the HIV epidemic. HIV-infected women in malarial regions have a high prevalence and density of peripheral and placental parasitemia in all pregnancies, not just their first two.

For this reason, the most practical antimalarial strategy today in a region such as sub-Saharan Africa is to use intermittent preventive therapy and presumptively treat anemic pregnant women as having malaria. Historically, two or more antenatal doses of intermittent preventive therapy with sulfadoxine-pyrimethamine were known to be effective in reducing infection and parasite load, but drug resistance has greatly reduced the usefulness of this regimen.

LISBON — Malaria in pregnancy is the greatest challenge the disease poses, said Dr. Theonest K. Mutabingwa at the 12th International Congress on Infectious Diseases.

Each year, 50 million women become pregnant in malaria-endemic areas worldwide, including 30 million in sub-Saharan Africa. Those who are infected often develop placental parasitemia, a leading cause of low birth weight, infant mortality, and severe maternal anemia in tropical regions.

This is true even when the mother's infection is asymptomatic, as is typical in regions where malaria transmission is intense and many adults have developed immunity to the disease, explained Dr. Mutabingwa of the Seattle Biomedical Research Institute and the National Institute for Medical Research in Muheza, Tanzania. For this reason, it is recommended that malaria in pregnancy be diagnosed and treated. And that's where matters become so difficult. Microscopy, the standard diagnostic method in the developing world, isn't sufficiently sensitive to reliably detect asymptomatic infection in pregnant women who may have placental parasitemia despite having a negative peripheral blood smear. A rapid diagnostic test using a malaria-specific antigen that is suitable for rugged field use would be a major advance, he said.

Moreover, the resistance of malaria parasites to chloroquine and sulfadoxine-pyrimethamine has become so pervasive that the latest World Health Organization malaria guidelines, issued earlier this year, have demoted these agents from their longtime status as first-line therapy in favor of artemisinin-based combination therapies, except in pregnancy, where the older drugs' well-established safety record earned them a reprieve. The WHO guidelines call quinine—a drug with an inconveniently lengthy treatment course—the most effective antimalarial that's safe for use throughout pregnancy.

The big emerging problem as older antimalarials give way to artemisinin combination therapies and other drugs in the developmental pipeline is that pregnant women have been systematically excluded from participation in clinical trials of all newer agents. There is an urgent need to rectify this situation and begin evaluating the safety of antimalarial agents in pregnancy, Dr. Mutabingwa said at the congress sponsored by the International Society for Infectious Diseases.

Women in their first and second pregnancies are known to be particularly vulnerable to the deleterious effects of malaria. But in a recent study involving 453 infants, 69 of them born to mothers with placental malaria, Dr. Mutabingwa and colleagues discovered a surprising effect of gravidity on infant malaria. Babies born to mothers with placental malaria at delivery were 41% more likely to have parasitemia during infancy. No surprise there. But although parasitemia was more common in primigravid than multigravid women, the opposite was true in their infants. First-born infants of mothers with placental parasitemia were less likely to develop malaria in infancy than were babies born to multigravid women with placental malaria (PLos Med. 2005 December 2(12): e407; doi: 10.1371/journal.pmed.0020407).

Unfortunately, targeting malaria control measures specifically at women in their first two pregnancies as a means of improving mother-child health is rendered impractical in many areas because of the complicating factor of the HIV epidemic. HIV-infected women in malarial regions have a high prevalence and density of peripheral and placental parasitemia in all pregnancies, not just their first two.

For this reason, the most practical antimalarial strategy today in a region such as sub-Saharan Africa is to use intermittent preventive therapy and presumptively treat anemic pregnant women as having malaria. Historically, two or more antenatal doses of intermittent preventive therapy with sulfadoxine-pyrimethamine were known to be effective in reducing infection and parasite load, but drug resistance has greatly reduced the usefulness of this regimen.

The National Institutes of Health has announced the launch of a national consortium focused on transforming how clinical research is conducted in the hopes of providing patients with new treatments more quickly and effectively. Twelve institutions have received funding thus far, with the goal of having about 60 linked institutions by 2012. For more information, visit www.ncrr.nih.gov/clinicaldiscipline.asp

The National Institutes of Health has announced the launch of a national consortium focused on transforming how clinical research is conducted in the hopes of providing patients with new treatments more quickly and effectively. Twelve institutions have received funding thus far, with the goal of having about 60 linked institutions by 2012. For more information, visit www.ncrr.nih.gov/clinicaldiscipline.asp

The National Institutes of Health has announced the launch of a national consortium focused on transforming how clinical research is conducted in the hopes of providing patients with new treatments more quickly and effectively. Twelve institutions have received funding thus far, with the goal of having about 60 linked institutions by 2012. For more information, visit www.ncrr.nih.gov/clinicaldiscipline.asp

SAN FRANCISCO — Immunizing pregnant women with the trivalent inactivated influenza vaccine instead of the pneumococcal polysaccharide vaccine was associated with better outcomes in the women and their infants, based on preliminary results from a randomized, controlled trial presented in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Compared with women immunized with the pneumococcal polysaccharide vaccine, those given the trivalent inactivated vaccine had 28% fewer cases of respiratory illness with fever. Among their infants, those born to women given the trivalent vaccine had a 62% reduction in proven influenza illness and 38% fewer cases of respiratory illness with fever.

Influenza immunization of pregnant women in the third trimester is recommended in the United States; however, “there appears to be no prospective evaluation of this strategy and its effect on illness in women and their infants,” a group of researchers led by Dr. Mark C. Steinhoff wrote in their poster presentation.

As part of a study on maternal immunization practices in Dhaka, Bangladesh, Dr. Steinhoff and his associates at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, randomized 340 women in their third trimester to receive either trivalent inactivated influenza vaccine (Fluarix) or pneumococcal polysaccharide vaccine (Pneumovax) between August 2004 and March 2005. The researchers conducted weekly interviews with the mothers and followed the mothers and their infants for 6 months after birth to record illnesses. They also asked the mothers to bring infants with illness to a clinic for evaluation and treatment.

When acute febrile respiratory illnesses occurred, the researchers collected nasal swabs and conducted rapid testing for influenza A and B.

Throughout the study period, 25 of the 137 influenza tests were positive in the infants. Of these, 18 occurred in infants whose mothers received the pneumococcal polysaccharide vaccine and 7 were in those whose mothers got the trivalent inactivated influenza vaccine. This difference represented a 62% reduction in proven influenza illness for infants whose mothers received the influenza vaccine.

In the influenza vaccine group, 145 infants developed respiratory illness during the course of the study, compared with 232 infants in the pneumococcal polysaccharide vaccine group. The difference represented 38% fewer cases of respiratory illness with fever in infants whose mothers who took the influenza vaccine.

In addition, 83 mothers in the influenza vaccine group developed respiratory illness with fever during the course of the study, compared with 114 mothers in the pneumococcal polysaccharide vaccine group. This translated into 28% fewer cases of respiratory illness with fever in mothers who took the influenza vaccine.

Neither vaccine had a substantial clinical impact on diarrheal illnesses in the infants and mothers.

The researchers have not yet analyzed the serologic data collected for the study.

Dr. Steinhoff is a professor of pediatrics and international health at Johns Hopkins University School of Hygiene and Public Health.

SAN FRANCISCO — Immunizing pregnant women with the trivalent inactivated influenza vaccine instead of the pneumococcal polysaccharide vaccine was associated with better outcomes in the women and their infants, based on preliminary results from a randomized, controlled trial presented in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Compared with women immunized with the pneumococcal polysaccharide vaccine, those given the trivalent inactivated vaccine had 28% fewer cases of respiratory illness with fever. Among their infants, those born to women given the trivalent vaccine had a 62% reduction in proven influenza illness and 38% fewer cases of respiratory illness with fever.

Influenza immunization of pregnant women in the third trimester is recommended in the United States; however, “there appears to be no prospective evaluation of this strategy and its effect on illness in women and their infants,” a group of researchers led by Dr. Mark C. Steinhoff wrote in their poster presentation.

As part of a study on maternal immunization practices in Dhaka, Bangladesh, Dr. Steinhoff and his associates at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, randomized 340 women in their third trimester to receive either trivalent inactivated influenza vaccine (Fluarix) or pneumococcal polysaccharide vaccine (Pneumovax) between August 2004 and March 2005. The researchers conducted weekly interviews with the mothers and followed the mothers and their infants for 6 months after birth to record illnesses. They also asked the mothers to bring infants with illness to a clinic for evaluation and treatment.

When acute febrile respiratory illnesses occurred, the researchers collected nasal swabs and conducted rapid testing for influenza A and B.

Throughout the study period, 25 of the 137 influenza tests were positive in the infants. Of these, 18 occurred in infants whose mothers received the pneumococcal polysaccharide vaccine and 7 were in those whose mothers got the trivalent inactivated influenza vaccine. This difference represented a 62% reduction in proven influenza illness for infants whose mothers received the influenza vaccine.

In the influenza vaccine group, 145 infants developed respiratory illness during the course of the study, compared with 232 infants in the pneumococcal polysaccharide vaccine group. The difference represented 38% fewer cases of respiratory illness with fever in infants whose mothers who took the influenza vaccine.

In addition, 83 mothers in the influenza vaccine group developed respiratory illness with fever during the course of the study, compared with 114 mothers in the pneumococcal polysaccharide vaccine group. This translated into 28% fewer cases of respiratory illness with fever in mothers who took the influenza vaccine.

Neither vaccine had a substantial clinical impact on diarrheal illnesses in the infants and mothers.

The researchers have not yet analyzed the serologic data collected for the study.

Dr. Steinhoff is a professor of pediatrics and international health at Johns Hopkins University School of Hygiene and Public Health.

SAN FRANCISCO — Immunizing pregnant women with the trivalent inactivated influenza vaccine instead of the pneumococcal polysaccharide vaccine was associated with better outcomes in the women and their infants, based on preliminary results from a randomized, controlled trial presented in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Compared with women immunized with the pneumococcal polysaccharide vaccine, those given the trivalent inactivated vaccine had 28% fewer cases of respiratory illness with fever. Among their infants, those born to women given the trivalent vaccine had a 62% reduction in proven influenza illness and 38% fewer cases of respiratory illness with fever.

Influenza immunization of pregnant women in the third trimester is recommended in the United States; however, “there appears to be no prospective evaluation of this strategy and its effect on illness in women and their infants,” a group of researchers led by Dr. Mark C. Steinhoff wrote in their poster presentation.

As part of a study on maternal immunization practices in Dhaka, Bangladesh, Dr. Steinhoff and his associates at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, randomized 340 women in their third trimester to receive either trivalent inactivated influenza vaccine (Fluarix) or pneumococcal polysaccharide vaccine (Pneumovax) between August 2004 and March 2005. The researchers conducted weekly interviews with the mothers and followed the mothers and their infants for 6 months after birth to record illnesses. They also asked the mothers to bring infants with illness to a clinic for evaluation and treatment.

When acute febrile respiratory illnesses occurred, the researchers collected nasal swabs and conducted rapid testing for influenza A and B.

Throughout the study period, 25 of the 137 influenza tests were positive in the infants. Of these, 18 occurred in infants whose mothers received the pneumococcal polysaccharide vaccine and 7 were in those whose mothers got the trivalent inactivated influenza vaccine. This difference represented a 62% reduction in proven influenza illness for infants whose mothers received the influenza vaccine.

In the influenza vaccine group, 145 infants developed respiratory illness during the course of the study, compared with 232 infants in the pneumococcal polysaccharide vaccine group. The difference represented 38% fewer cases of respiratory illness with fever in infants whose mothers who took the influenza vaccine.

In addition, 83 mothers in the influenza vaccine group developed respiratory illness with fever during the course of the study, compared with 114 mothers in the pneumococcal polysaccharide vaccine group. This translated into 28% fewer cases of respiratory illness with fever in mothers who took the influenza vaccine.

Neither vaccine had a substantial clinical impact on diarrheal illnesses in the infants and mothers.

The researchers have not yet analyzed the serologic data collected for the study.

Dr. Steinhoff is a professor of pediatrics and international health at Johns Hopkins University School of Hygiene and Public Health.

MONTEREY, CALIF. — By itself, chorioamnionitis does not justify an operative delivery even if the first stage of labor is prolonged, a retrospective study of 1,810 deliveries suggests.

Longer first-stage labor in pregnancies with chorioamnionitis was associated with a 60% increased risk for cesarean delivery and a 30% increased risk for meconium-stained amniotic fluid, a multivariate analysis found. The results showed no increase in risk for meconium aspiration syndrome with prolonged first-stage labor in pregnancies with chorioamnionitis, Dr. Natali Aziz said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Chorioamnionitis in previous studies has been associated with significant adverse obstetric and neonatal outcomes including maternal blood loss and transfusions, endomyometritis, greater severity of lacerations, meconium aspiration syndrome, lower Apgar scores, neonatal sepsis, and other problems.

The current study found that the duration of first-stage labor in women with chorioamnionitis did not affect the risk of neonatal sequelae, “which was surprising to us,” said Dr. Aziz of the University of California, San Francisco.

The timing of delivery for patients with chorioamnionitis is controversial, she said. Her institution does not deliver based solely on the diagnosis of chorioamnionitis, but some other institutions do.

The investigators analyzed outcomes by comparing women with chorioamnionitis whose first stage of labor lasted less than 12 hours (39% of cases), 12–24 hours (48%), or 24 hours or longer (13%). The results “support continued efforts to achieve a vaginal delivery if other obstetrical indications permit, even in the setting of a prolonged course of labor and intraamniotic infection,” Dr. Aziz said. “Much of the maternal morbidity in our data was due to operative delivery in itself.”

An initial univariate analysis found that a longer first-stage labor was associated with worse maternal and obstetric outcomes, but “not as much as we expected,” she said. Risks for postpartum hemorrhage, C-section, endomyometritis, and operative vaginal delivery increased with longer labors.

Postpartum hemorrhage and endomyometritis, however, can be associated with cesarean delivery, so the investigators conducted a multivariate analysis that controlled for the effects of potential confounders, including cesarean delivery. That analysis found associations only between longer labor and increased risks for cesarean delivery or meconium-stained amniotic fluid.

They then conducted a second multivariate analysis that did not control for the effects of cesarean delivery. Some researchers have speculated that cesarean delivery may be a causal pathway that leads from chorioamnionitis to adverse perinatal outcomes, and so controlling for cesarean delivery might mask any effects of prolonged labor on chorioamnionitis and neonatal outcomes, Dr. Aziz and her associates reasoned.

In the analysis that did not control for cesarean delivery, the only other significant association with increased duration of first-stage labor was a 20% increased risk for postpartum hemorrhage. There was a trend toward greater need for blood transfusion with prolonged first-stage labor in pregnancies with chorioamnionitis. “We've demonstrated that the increasing duration of first-stage labor was associated with increased maternal morbidity, and in turn with operative delivery and thereby postpartum hemorrhage, but not with neonatal morbidity,” she said.

One physician in the audience commented, “I think these are very encouraging and reassuring data.”

Prolonged first-stage labor in pregnancies with chorioamnionitis also was associated with a significantly decreased risk for an umbilical artery base excess greater than 12 mmol/L, which puzzled the investigators. This may be due to fetal indications causing the delivery, Dr. Aziz said.

MONTEREY, CALIF. — By itself, chorioamnionitis does not justify an operative delivery even if the first stage of labor is prolonged, a retrospective study of 1,810 deliveries suggests.

Longer first-stage labor in pregnancies with chorioamnionitis was associated with a 60% increased risk for cesarean delivery and a 30% increased risk for meconium-stained amniotic fluid, a multivariate analysis found. The results showed no increase in risk for meconium aspiration syndrome with prolonged first-stage labor in pregnancies with chorioamnionitis, Dr. Natali Aziz said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Chorioamnionitis in previous studies has been associated with significant adverse obstetric and neonatal outcomes including maternal blood loss and transfusions, endomyometritis, greater severity of lacerations, meconium aspiration syndrome, lower Apgar scores, neonatal sepsis, and other problems.

The current study found that the duration of first-stage labor in women with chorioamnionitis did not affect the risk of neonatal sequelae, “which was surprising to us,” said Dr. Aziz of the University of California, San Francisco.

The timing of delivery for patients with chorioamnionitis is controversial, she said. Her institution does not deliver based solely on the diagnosis of chorioamnionitis, but some other institutions do.

The investigators analyzed outcomes by comparing women with chorioamnionitis whose first stage of labor lasted less than 12 hours (39% of cases), 12–24 hours (48%), or 24 hours or longer (13%). The results “support continued efforts to achieve a vaginal delivery if other obstetrical indications permit, even in the setting of a prolonged course of labor and intraamniotic infection,” Dr. Aziz said. “Much of the maternal morbidity in our data was due to operative delivery in itself.”

An initial univariate analysis found that a longer first-stage labor was associated with worse maternal and obstetric outcomes, but “not as much as we expected,” she said. Risks for postpartum hemorrhage, C-section, endomyometritis, and operative vaginal delivery increased with longer labors.

Postpartum hemorrhage and endomyometritis, however, can be associated with cesarean delivery, so the investigators conducted a multivariate analysis that controlled for the effects of potential confounders, including cesarean delivery. That analysis found associations only between longer labor and increased risks for cesarean delivery or meconium-stained amniotic fluid.

They then conducted a second multivariate analysis that did not control for the effects of cesarean delivery. Some researchers have speculated that cesarean delivery may be a causal pathway that leads from chorioamnionitis to adverse perinatal outcomes, and so controlling for cesarean delivery might mask any effects of prolonged labor on chorioamnionitis and neonatal outcomes, Dr. Aziz and her associates reasoned.

In the analysis that did not control for cesarean delivery, the only other significant association with increased duration of first-stage labor was a 20% increased risk for postpartum hemorrhage. There was a trend toward greater need for blood transfusion with prolonged first-stage labor in pregnancies with chorioamnionitis. “We've demonstrated that the increasing duration of first-stage labor was associated with increased maternal morbidity, and in turn with operative delivery and thereby postpartum hemorrhage, but not with neonatal morbidity,” she said.

One physician in the audience commented, “I think these are very encouraging and reassuring data.”

Prolonged first-stage labor in pregnancies with chorioamnionitis also was associated with a significantly decreased risk for an umbilical artery base excess greater than 12 mmol/L, which puzzled the investigators. This may be due to fetal indications causing the delivery, Dr. Aziz said.

MONTEREY, CALIF. — By itself, chorioamnionitis does not justify an operative delivery even if the first stage of labor is prolonged, a retrospective study of 1,810 deliveries suggests.

Longer first-stage labor in pregnancies with chorioamnionitis was associated with a 60% increased risk for cesarean delivery and a 30% increased risk for meconium-stained amniotic fluid, a multivariate analysis found. The results showed no increase in risk for meconium aspiration syndrome with prolonged first-stage labor in pregnancies with chorioamnionitis, Dr. Natali Aziz said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Chorioamnionitis in previous studies has been associated with significant adverse obstetric and neonatal outcomes including maternal blood loss and transfusions, endomyometritis, greater severity of lacerations, meconium aspiration syndrome, lower Apgar scores, neonatal sepsis, and other problems.

The current study found that the duration of first-stage labor in women with chorioamnionitis did not affect the risk of neonatal sequelae, “which was surprising to us,” said Dr. Aziz of the University of California, San Francisco.

The timing of delivery for patients with chorioamnionitis is controversial, she said. Her institution does not deliver based solely on the diagnosis of chorioamnionitis, but some other institutions do.

The investigators analyzed outcomes by comparing women with chorioamnionitis whose first stage of labor lasted less than 12 hours (39% of cases), 12–24 hours (48%), or 24 hours or longer (13%). The results “support continued efforts to achieve a vaginal delivery if other obstetrical indications permit, even in the setting of a prolonged course of labor and intraamniotic infection,” Dr. Aziz said. “Much of the maternal morbidity in our data was due to operative delivery in itself.”

An initial univariate analysis found that a longer first-stage labor was associated with worse maternal and obstetric outcomes, but “not as much as we expected,” she said. Risks for postpartum hemorrhage, C-section, endomyometritis, and operative vaginal delivery increased with longer labors.

Postpartum hemorrhage and endomyometritis, however, can be associated with cesarean delivery, so the investigators conducted a multivariate analysis that controlled for the effects of potential confounders, including cesarean delivery. That analysis found associations only between longer labor and increased risks for cesarean delivery or meconium-stained amniotic fluid.

They then conducted a second multivariate analysis that did not control for the effects of cesarean delivery. Some researchers have speculated that cesarean delivery may be a causal pathway that leads from chorioamnionitis to adverse perinatal outcomes, and so controlling for cesarean delivery might mask any effects of prolonged labor on chorioamnionitis and neonatal outcomes, Dr. Aziz and her associates reasoned.

In the analysis that did not control for cesarean delivery, the only other significant association with increased duration of first-stage labor was a 20% increased risk for postpartum hemorrhage. There was a trend toward greater need for blood transfusion with prolonged first-stage labor in pregnancies with chorioamnionitis. “We've demonstrated that the increasing duration of first-stage labor was associated with increased maternal morbidity, and in turn with operative delivery and thereby postpartum hemorrhage, but not with neonatal morbidity,” she said.

One physician in the audience commented, “I think these are very encouraging and reassuring data.”

Prolonged first-stage labor in pregnancies with chorioamnionitis also was associated with a significantly decreased risk for an umbilical artery base excess greater than 12 mmol/L, which puzzled the investigators. This may be due to fetal indications causing the delivery, Dr. Aziz said.

HOLLYWOOD, FLA. — A search of more than 100 Web sites that provide information about labor epidurals yielded very few with reliable information, Dr. Edgar M. Wayne reported in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Of 117 sites reviewed by two experienced obstetric anesthesiologists using two popular search engines and a Microsoft Accuracy rating tool that was shown to be reliable, only 33 were rated as accurate, and only 13 of those were deemed relevant and acceptable as educational tools for patients. An additional 36 sites were rated as inaccurate, and 33 were rated as misleading, reported Dr. Wayne of the University of Michigan Health System, Ann Arbor.

The remaining 15 were peer-reviewed articles only and were not included in the analysis.

Sites based on information from peer-reviewed sources such as textbooks or journals were significantly more likely to be accurate, relevant, and reliable; inaccurate Web sites were significantly more likely than the others to be based on nonscientific sources such as anecdotes or human interest stories. In addition, the inaccurate sites were more often written or sponsored by special interest groups.

Dr. Wayne emphasized that it is important to direct patients to Web sites that provide accurate, reliable information, because the Internet is widely and increasingly used by patients for medical information and the information they find there could influence them to decline safe and potentially beneficial labor pain management.

Interdisciplinary, hospital-based antepartum educational programs could help address the need for accurate patient education regarding neuraxial labor analgesia, he said.

HOLLYWOOD, FLA. — A search of more than 100 Web sites that provide information about labor epidurals yielded very few with reliable information, Dr. Edgar M. Wayne reported in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Of 117 sites reviewed by two experienced obstetric anesthesiologists using two popular search engines and a Microsoft Accuracy rating tool that was shown to be reliable, only 33 were rated as accurate, and only 13 of those were deemed relevant and acceptable as educational tools for patients. An additional 36 sites were rated as inaccurate, and 33 were rated as misleading, reported Dr. Wayne of the University of Michigan Health System, Ann Arbor.

The remaining 15 were peer-reviewed articles only and were not included in the analysis.

Sites based on information from peer-reviewed sources such as textbooks or journals were significantly more likely to be accurate, relevant, and reliable; inaccurate Web sites were significantly more likely than the others to be based on nonscientific sources such as anecdotes or human interest stories. In addition, the inaccurate sites were more often written or sponsored by special interest groups.

Dr. Wayne emphasized that it is important to direct patients to Web sites that provide accurate, reliable information, because the Internet is widely and increasingly used by patients for medical information and the information they find there could influence them to decline safe and potentially beneficial labor pain management.

Interdisciplinary, hospital-based antepartum educational programs could help address the need for accurate patient education regarding neuraxial labor analgesia, he said.

HOLLYWOOD, FLA. — A search of more than 100 Web sites that provide information about labor epidurals yielded very few with reliable information, Dr. Edgar M. Wayne reported in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Of 117 sites reviewed by two experienced obstetric anesthesiologists using two popular search engines and a Microsoft Accuracy rating tool that was shown to be reliable, only 33 were rated as accurate, and only 13 of those were deemed relevant and acceptable as educational tools for patients. An additional 36 sites were rated as inaccurate, and 33 were rated as misleading, reported Dr. Wayne of the University of Michigan Health System, Ann Arbor.

The remaining 15 were peer-reviewed articles only and were not included in the analysis.

Sites based on information from peer-reviewed sources such as textbooks or journals were significantly more likely to be accurate, relevant, and reliable; inaccurate Web sites were significantly more likely than the others to be based on nonscientific sources such as anecdotes or human interest stories. In addition, the inaccurate sites were more often written or sponsored by special interest groups.

Dr. Wayne emphasized that it is important to direct patients to Web sites that provide accurate, reliable information, because the Internet is widely and increasingly used by patients for medical information and the information they find there could influence them to decline safe and potentially beneficial labor pain management.

Interdisciplinary, hospital-based antepartum educational programs could help address the need for accurate patient education regarding neuraxial labor analgesia, he said.

MONTEREY, CALIF. — Multiple doses of tenofovir produced much higher drug concentrations in fetuses, compared with other antiretrovirals taken by pregnant women with HIV, Dr. Kim A. Boggess said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Few data exist on the fetal effects of antiretroviral regimens for HIV, and those few mostly look at single doses. The current study of eight HIV-infected women who had been on antiretrovirals for at least 26 weeks had them take their usual doses of antiretroviral medications on the day before and the day of a scheduled prelabor cesarean delivery. They also received intravenous zidovudine 4 hours before delivery to reduce the risk of vertical transmission.

Blood samples taken from the mother and mixed umbilical venous/arterial blood before administration of zidovudine and afterward (a mean of 16 hours after their last dose of usual antiretrovirals) found that tenofovir accumulates within the fetal compartment, said Dr. Boggess of the University of North Carolina, Chapel Hill, and her associates.

Results showed levels of tenofovir in umbilical cord blood were six times levels in maternal blood, nine times higher than reported following a single dose of tenofovir. Umbilical:maternal ratios for other antiretrovirals were similar to concentrations reported for single doses.

Three of the eight women were taking tenofovir (Viread), two women were on nelfinavir (Viracept), six were taking Kaletra (lopinavir/ritonavir), and all were exposed to Combivir (lamivudine/zidovudine) in their antiretroviral regimens.

Dr. Boggess has no affiliation with any of the companies that make these drugs.

The implications of tenofovir accumulating in the fetal compartment are unclear; it could be both helpful and harmful. Higher concentrations of an antiretroviral may help reduce the risk of vertical transmission of HIV from women who cannot undergo cesarean delivery, but also may cause more adverse side effects.

The infants are being followed, some with x-rays, to monitor potential bone changes from exposure to antiretrovirals, a concern raised by studies in monkeys.

Approximately 1,800 children are infected with HIV daily worldwide, usually via pregnancy or breast-feeding. Higher fetal antiretroviral concentrations might be especially useful in areas of the world where access to C-sections is limited, Dr. Boggess said.

MONTEREY, CALIF. — Multiple doses of tenofovir produced much higher drug concentrations in fetuses, compared with other antiretrovirals taken by pregnant women with HIV, Dr. Kim A. Boggess said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Few data exist on the fetal effects of antiretroviral regimens for HIV, and those few mostly look at single doses. The current study of eight HIV-infected women who had been on antiretrovirals for at least 26 weeks had them take their usual doses of antiretroviral medications on the day before and the day of a scheduled prelabor cesarean delivery. They also received intravenous zidovudine 4 hours before delivery to reduce the risk of vertical transmission.

Blood samples taken from the mother and mixed umbilical venous/arterial blood before administration of zidovudine and afterward (a mean of 16 hours after their last dose of usual antiretrovirals) found that tenofovir accumulates within the fetal compartment, said Dr. Boggess of the University of North Carolina, Chapel Hill, and her associates.

Results showed levels of tenofovir in umbilical cord blood were six times levels in maternal blood, nine times higher than reported following a single dose of tenofovir. Umbilical:maternal ratios for other antiretrovirals were similar to concentrations reported for single doses.

Three of the eight women were taking tenofovir (Viread), two women were on nelfinavir (Viracept), six were taking Kaletra (lopinavir/ritonavir), and all were exposed to Combivir (lamivudine/zidovudine) in their antiretroviral regimens.

Dr. Boggess has no affiliation with any of the companies that make these drugs.

The implications of tenofovir accumulating in the fetal compartment are unclear; it could be both helpful and harmful. Higher concentrations of an antiretroviral may help reduce the risk of vertical transmission of HIV from women who cannot undergo cesarean delivery, but also may cause more adverse side effects.

The infants are being followed, some with x-rays, to monitor potential bone changes from exposure to antiretrovirals, a concern raised by studies in monkeys.

Approximately 1,800 children are infected with HIV daily worldwide, usually via pregnancy or breast-feeding. Higher fetal antiretroviral concentrations might be especially useful in areas of the world where access to C-sections is limited, Dr. Boggess said.

MONTEREY, CALIF. — Multiple doses of tenofovir produced much higher drug concentrations in fetuses, compared with other antiretrovirals taken by pregnant women with HIV, Dr. Kim A. Boggess said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Few data exist on the fetal effects of antiretroviral regimens for HIV, and those few mostly look at single doses. The current study of eight HIV-infected women who had been on antiretrovirals for at least 26 weeks had them take their usual doses of antiretroviral medications on the day before and the day of a scheduled prelabor cesarean delivery. They also received intravenous zidovudine 4 hours before delivery to reduce the risk of vertical transmission.

Blood samples taken from the mother and mixed umbilical venous/arterial blood before administration of zidovudine and afterward (a mean of 16 hours after their last dose of usual antiretrovirals) found that tenofovir accumulates within the fetal compartment, said Dr. Boggess of the University of North Carolina, Chapel Hill, and her associates.

Results showed levels of tenofovir in umbilical cord blood were six times levels in maternal blood, nine times higher than reported following a single dose of tenofovir. Umbilical:maternal ratios for other antiretrovirals were similar to concentrations reported for single doses.

Three of the eight women were taking tenofovir (Viread), two women were on nelfinavir (Viracept), six were taking Kaletra (lopinavir/ritonavir), and all were exposed to Combivir (lamivudine/zidovudine) in their antiretroviral regimens.

Dr. Boggess has no affiliation with any of the companies that make these drugs.

The implications of tenofovir accumulating in the fetal compartment are unclear; it could be both helpful and harmful. Higher concentrations of an antiretroviral may help reduce the risk of vertical transmission of HIV from women who cannot undergo cesarean delivery, but also may cause more adverse side effects.

The infants are being followed, some with x-rays, to monitor potential bone changes from exposure to antiretrovirals, a concern raised by studies in monkeys.

Approximately 1,800 children are infected with HIV daily worldwide, usually via pregnancy or breast-feeding. Higher fetal antiretroviral concentrations might be especially useful in areas of the world where access to C-sections is limited, Dr. Boggess said.

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age and cultural subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Disadvantages outweighed advantages overall, but several subgroup trends emerged.

For example, 64 of 117 (55%) Hispanic teens said having a baby would enhance their connections with others, vs. 62 of 130 (48%) non-Hispanic teens. But most Hispanic and non-Hispanic teens (84% and 75%, respectively) identified changes in life plans as a significant disadvantage to pregnancy.

Additionally, 26 of 58 girls with intended pregnancies (45%) associated the pregnancy with positive changes, vs. 61 of 189 (32%) of girls whose pregnancies were unintended.

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age and cultural subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Disadvantages outweighed advantages overall, but several subgroup trends emerged.

For example, 64 of 117 (55%) Hispanic teens said having a baby would enhance their connections with others, vs. 62 of 130 (48%) non-Hispanic teens. But most Hispanic and non-Hispanic teens (84% and 75%, respectively) identified changes in life plans as a significant disadvantage to pregnancy.

Additionally, 26 of 58 girls with intended pregnancies (45%) associated the pregnancy with positive changes, vs. 61 of 189 (32%) of girls whose pregnancies were unintended.

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age and cultural subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Disadvantages outweighed advantages overall, but several subgroup trends emerged.

For example, 64 of 117 (55%) Hispanic teens said having a baby would enhance their connections with others, vs. 62 of 130 (48%) non-Hispanic teens. But most Hispanic and non-Hispanic teens (84% and 75%, respectively) identified changes in life plans as a significant disadvantage to pregnancy.

Additionally, 26 of 58 girls with intended pregnancies (45%) associated the pregnancy with positive changes, vs. 61 of 189 (32%) of girls whose pregnancies were unintended.

The relative risk of stillbirth following a preeclamptic pregnancy declined dramatically over the last 35 years in Norway, while the relative risk of neonatal death remained stable despite a substantial increase in preterm deliveries, reported Dr. Olga Basso and associates at the National Institute of Environmental Health Sciences and the University of Bergen, Norway.

Data on developed countries show an increasing trend toward managing preeclampsia by inducing deliveries preterm, even before 32 weeks. “Physicians face a real dilemma in balancing the risk of fetal/neonatal/maternal death due to preeclampsia against the increased risk of death associated with preterm delivery,” Dr. Basso and her colleagues wrote (JAMA 2006;296:1357–62).

To assess the effect of changing obstetric management of preeclampsia on fetal and infant survival, the investigators reviewed data from the Medical Birth Registry of Norway collected between 1967 and 2003. The analysis was restricted to singleton pregnancies lasting at least 24 weeks in nulliparous Norwegian-born mothers.

The investigators analyzed 804,448 births, including 33,835 pregnancies complicated by preeclampsia. Births were grouped into three roughly equal periods (1967–1978, 1979–1990, and 1991–2003). Logistic regression analysis was used to estimate preeclampsia-related odds ratios for fetal and infant death.

The incidence of stillbirth among preeclamptic pregnancies decreased sevenfold from the period 1967–1978 to the period 1991–2003.

Over the same time span, deliveries before 37 weeks due to medical intervention in preeclamptic pregnancies increased from 8% to almost 20%.

Notably, the relative risk of infant death following preeclamptic pregnancies remained stable, the investigators reported.

“Modern medical management of preeclampsia appears to have been effective in preventing fetal death without causing an increase in infant or maternal death,” Dr. Basso concluded.

The relative risk of stillbirth following a preeclamptic pregnancy declined dramatically over the last 35 years in Norway, while the relative risk of neonatal death remained stable despite a substantial increase in preterm deliveries, reported Dr. Olga Basso and associates at the National Institute of Environmental Health Sciences and the University of Bergen, Norway.

Data on developed countries show an increasing trend toward managing preeclampsia by inducing deliveries preterm, even before 32 weeks. “Physicians face a real dilemma in balancing the risk of fetal/neonatal/maternal death due to preeclampsia against the increased risk of death associated with preterm delivery,” Dr. Basso and her colleagues wrote (JAMA 2006;296:1357–62).

To assess the effect of changing obstetric management of preeclampsia on fetal and infant survival, the investigators reviewed data from the Medical Birth Registry of Norway collected between 1967 and 2003. The analysis was restricted to singleton pregnancies lasting at least 24 weeks in nulliparous Norwegian-born mothers.

The investigators analyzed 804,448 births, including 33,835 pregnancies complicated by preeclampsia. Births were grouped into three roughly equal periods (1967–1978, 1979–1990, and 1991–2003). Logistic regression analysis was used to estimate preeclampsia-related odds ratios for fetal and infant death.

The incidence of stillbirth among preeclamptic pregnancies decreased sevenfold from the period 1967–1978 to the period 1991–2003.

Over the same time span, deliveries before 37 weeks due to medical intervention in preeclamptic pregnancies increased from 8% to almost 20%.

Notably, the relative risk of infant death following preeclamptic pregnancies remained stable, the investigators reported.

“Modern medical management of preeclampsia appears to have been effective in preventing fetal death without causing an increase in infant or maternal death,” Dr. Basso concluded.

The relative risk of stillbirth following a preeclamptic pregnancy declined dramatically over the last 35 years in Norway, while the relative risk of neonatal death remained stable despite a substantial increase in preterm deliveries, reported Dr. Olga Basso and associates at the National Institute of Environmental Health Sciences and the University of Bergen, Norway.

Data on developed countries show an increasing trend toward managing preeclampsia by inducing deliveries preterm, even before 32 weeks. “Physicians face a real dilemma in balancing the risk of fetal/neonatal/maternal death due to preeclampsia against the increased risk of death associated with preterm delivery,” Dr. Basso and her colleagues wrote (JAMA 2006;296:1357–62).

To assess the effect of changing obstetric management of preeclampsia on fetal and infant survival, the investigators reviewed data from the Medical Birth Registry of Norway collected between 1967 and 2003. The analysis was restricted to singleton pregnancies lasting at least 24 weeks in nulliparous Norwegian-born mothers.

The investigators analyzed 804,448 births, including 33,835 pregnancies complicated by preeclampsia. Births were grouped into three roughly equal periods (1967–1978, 1979–1990, and 1991–2003). Logistic regression analysis was used to estimate preeclampsia-related odds ratios for fetal and infant death.

The incidence of stillbirth among preeclamptic pregnancies decreased sevenfold from the period 1967–1978 to the period 1991–2003.

Over the same time span, deliveries before 37 weeks due to medical intervention in preeclamptic pregnancies increased from 8% to almost 20%.

Notably, the relative risk of infant death following preeclamptic pregnancies remained stable, the investigators reported.

“Modern medical management of preeclampsia appears to have been effective in preventing fetal death without causing an increase in infant or maternal death,” Dr. Basso concluded.

MONTEREY, CALIF. — Two (2%) of 98 pregnant women being admitted for labor or a scheduled C-section were colonized with methicillin-resistant Staphylococcus aureus in a pilot study, Dr. Richard H. Beigi reported in a poster presentation at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

The results of the study are consistent with a 2%–4% colonization rate for methicillin-resistant S. aureus (MRSA) found in some populations, though higher rates have been seen in select populations. These are among the first data on MRSA in women entering labor and delivery wards, said Dr. Beigi, who performed the study at MetroHealth Medical Center, Cleveland, and now is at Magee-Women's Hospital, Pittsburgh.

“It emphasizes the fact that we need to have very good hand hygiene,” he said in an interview at the poster session. The study was funded by Steris Corp., which makes a hand hygiene product.

The 2% rate provides a baseline for comparisons as the incidence of MRSA is tracked in labor and delivery over time. Ongoing surveillance is warranted given the increasing rates of MRSA in other specialties and the limited number of effective drug treatments for complications of MRSA infection, said Dr. Beigi and his associates.

Of the 96 women, 21 (22%) had S. aureus detected in samples from the anterior nares. Two (10%) of the 21 with S. aureus had MRSA. One of the women with MRSA worked in a hospital, and the other had no contact with a hospital or hospital workers as a potential source for her MRSA colonization.

Eight (38%) of the 21 isolates with S. aureus demonstrated inducible clindamycin resistance, and one of these was a strain with MRSA. The clinical implications of this are unclear, but MRSA plus clindamycin resistance would further narrow choices for therapy.

In a subset of 28 women who also had cultures obtained from the outer third of the vagina, 23 (82%) had concordant findings, meaning that if they were positive or negative for S. aureus in one anatomical site, they had the same result at the other site.

Six postpartum infections potentially were attributable to S. aureus–two cases of mastitis and four wound infections after C-section. Postpartum infection rates were twice as high in women with S. aureus (10%), compared with uncolonized women (5%), but the difference was not statistically significant. A larger study might show a significant difference in infection rates, Dr. Beigi suggested.

MONTEREY, CALIF. — Two (2%) of 98 pregnant women being admitted for labor or a scheduled C-section were colonized with methicillin-resistant Staphylococcus aureus in a pilot study, Dr. Richard H. Beigi reported in a poster presentation at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

The results of the study are consistent with a 2%–4% colonization rate for methicillin-resistant S. aureus (MRSA) found in some populations, though higher rates have been seen in select populations. These are among the first data on MRSA in women entering labor and delivery wards, said Dr. Beigi, who performed the study at MetroHealth Medical Center, Cleveland, and now is at Magee-Women's Hospital, Pittsburgh.

“It emphasizes the fact that we need to have very good hand hygiene,” he said in an interview at the poster session. The study was funded by Steris Corp., which makes a hand hygiene product.

The 2% rate provides a baseline for comparisons as the incidence of MRSA is tracked in labor and delivery over time. Ongoing surveillance is warranted given the increasing rates of MRSA in other specialties and the limited number of effective drug treatments for complications of MRSA infection, said Dr. Beigi and his associates.

Of the 96 women, 21 (22%) had S. aureus detected in samples from the anterior nares. Two (10%) of the 21 with S. aureus had MRSA. One of the women with MRSA worked in a hospital, and the other had no contact with a hospital or hospital workers as a potential source for her MRSA colonization.

Eight (38%) of the 21 isolates with S. aureus demonstrated inducible clindamycin resistance, and one of these was a strain with MRSA. The clinical implications of this are unclear, but MRSA plus clindamycin resistance would further narrow choices for therapy.

In a subset of 28 women who also had cultures obtained from the outer third of the vagina, 23 (82%) had concordant findings, meaning that if they were positive or negative for S. aureus in one anatomical site, they had the same result at the other site.

Six postpartum infections potentially were attributable to S. aureus–two cases of mastitis and four wound infections after C-section. Postpartum infection rates were twice as high in women with S. aureus (10%), compared with uncolonized women (5%), but the difference was not statistically significant. A larger study might show a significant difference in infection rates, Dr. Beigi suggested.

MONTEREY, CALIF. — Two (2%) of 98 pregnant women being admitted for labor or a scheduled C-section were colonized with methicillin-resistant Staphylococcus aureus in a pilot study, Dr. Richard H. Beigi reported in a poster presentation at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

The results of the study are consistent with a 2%–4% colonization rate for methicillin-resistant S. aureus (MRSA) found in some populations, though higher rates have been seen in select populations. These are among the first data on MRSA in women entering labor and delivery wards, said Dr. Beigi, who performed the study at MetroHealth Medical Center, Cleveland, and now is at Magee-Women's Hospital, Pittsburgh.

“It emphasizes the fact that we need to have very good hand hygiene,” he said in an interview at the poster session. The study was funded by Steris Corp., which makes a hand hygiene product.

The 2% rate provides a baseline for comparisons as the incidence of MRSA is tracked in labor and delivery over time. Ongoing surveillance is warranted given the increasing rates of MRSA in other specialties and the limited number of effective drug treatments for complications of MRSA infection, said Dr. Beigi and his associates.

Of the 96 women, 21 (22%) had S. aureus detected in samples from the anterior nares. Two (10%) of the 21 with S. aureus had MRSA. One of the women with MRSA worked in a hospital, and the other had no contact with a hospital or hospital workers as a potential source for her MRSA colonization.

Eight (38%) of the 21 isolates with S. aureus demonstrated inducible clindamycin resistance, and one of these was a strain with MRSA. The clinical implications of this are unclear, but MRSA plus clindamycin resistance would further narrow choices for therapy.

In a subset of 28 women who also had cultures obtained from the outer third of the vagina, 23 (82%) had concordant findings, meaning that if they were positive or negative for S. aureus in one anatomical site, they had the same result at the other site.

Six postpartum infections potentially were attributable to S. aureus–two cases of mastitis and four wound infections after C-section. Postpartum infection rates were twice as high in women with S. aureus (10%), compared with uncolonized women (5%), but the difference was not statistically significant. A larger study might show a significant difference in infection rates, Dr. Beigi suggested.