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304 SPO Abstracts

TREATMENT EFFICACY OF SYPHILIS IN PREGNANCY Anita P. LaSala, M.D. Columbla University, College of Physicians and Surgeons, New York, N.Y.

The I nci dence of syphi 1 i SIn pregnancy has recently Increased dramatically. To evaluate the efficacy of treatment, we revIewed 100 consecutive patients treated in our Pennatal Infectious Disease c11mc for positIve syphIlIs serologIes between May 1989 and March 1990. 79% of the women were referred antepartum; 21% were recently post-partum . None of the patIents had pnmary syphilis, 5% had secondary syphIlIs, 18% had early latent, 74% had 1 ate 1 atent or di sease of unknown durat i on and 3% had false posItIve serologies. 71 (89.8%) of the antepartum patIents recei ved adequate therapy as out 11 ned by the CDC. However, In utero therapy of the fetus I s only cons1(iered adequate I fIt IS completed more than four weeks before delIvery and only 57 (72%) patIents fit those cnterl.. 16 (28%) of these women had documented rei nfect I on after comp 1 et i on of therapy and before delivery. Six more became reinfected in the year following de II very. Therefore, only 42 (53.2%) of regl stered pati ents were treated adequately for syph,l,s before delivery. 59 of the 79 neonatal records were avail ab 1 e and 52 . 5% of these babi es required therapy for syphll IS. ThIS review shows that despIte antepartum detection of syphi lis and referral to a speCIalIzed clinic, • large number of women did not receIve adequate therapy before de II very and a maJorl ty of these babl es reqUired treatment. The high rate of reInfectIOn plays a maJor role In thIS treatment failure. To successfully treat thIS disease, more efforts must be dl rected toward partner counsell ng and treatment.

RESPONSE OF PARTURIENTS AND GYNECOLOGICAL PATIENTS TO HUMAN IMMUNODEFICIENCY VIRUS INFECTION SCREENING. OJ G1oeb, C Henderson, J Youchah' and Ki t RusselL' The Albert Ei'iiSteiii College of Medicine. Bronx Mumclpa1 Hospital Center, Bronx, New York.

Purpose. To determine the effIcacy of HIV counseling and testing of hospitalized partunents and gynecological patients. Methods. HIV counseling and testing efforts were carrIed out usi ng three di fferent approaches. Init i ally, fl fty antepartum and post partum patients were referred (self and provider) for HIV counse11ng. Secondly, after the implementation of an HIV educat i on program. 562 antepartum and post partum pat i ents were approached for ri sk assessment and were routi ne 1 y offered voluntary screening. Lastly, 132 parturients and gynecological patients were approached at their bedside for risk assessment, counse II ng and testl ng. Results. All pati ents who were referred for HIV counseling consented to testing; 56% were antepartum patIents . The seropositivity rate was 22% . Daily HIV education classes were attended by 42 patients (7.5%) all of whom completed a risk assessment; 26 consented to testing and no HIV-antibody pOSItive patients were Identified. Of the 16 patIents who dec 1 i ned test i ng, 11 had at 1 east one ri sk factor for HIV infection exposure. Lastly, 120 patIents (91%) who were approached at their bedside consented to testing. Of the 32 seropositIve patients (27%), 6 were antepartum, 17 were post partum and 9 were gyneco 1 ogl ca 1 pati ents. Conc:IusJons. There are many obstacles to HIV rIsk assessment, counsel ing and testIng . InnovatIVe interventlonal efforts need to be developed to be maximally successful. Even self-identification of nsk as determi ned by a ri sk assessment quest lonna ire st ill dl d not ensure pat i ent acceptance of test i ng. A1 so, our data suggest that bedsIde patIent contact is most eff,cac,ous, but speaks for uni versa 1 part uri ent HIV counsel i ng and testing.

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January 199 1 Am.J Obstet Gynecol

GROUP B STREPTOCOCCUS SCREEN AND THE LOW BIRTHWEIGHT INFANT. CASSANDRA E. HENDERSON' DEBORAH N. PLATEK', DARLENE G. GIBBON' MICHAEL Y. DIVaN, CARLOS VEGA-RICH', GEORGE SZILAGYI', AND IRWIN R. MERKATZ. Albert Einstein College of Medicine, Bronx, New York.

Since 1978, a rapid screen for Group B Streptococcus (GBS) colonization had been employed on 31,688 consecutive prIVate obstetrical patIents. We undertook to evaluate the efficacy of such universal maternal screening in improving outcomes for at risk low birthweight neonates. In a three year study period , 1987-89, 341 infants were deli vered wei ghl ng ~2, 000 grams. Thirty-nine (11.4%) were born to mothers whose GBS screen was positive (Group I) while 302 were born to negatIve women (Group II). NICU admission was required for 74% and 81% of Group I and Group II neonates, respectIvely, p = NS . Six neonates in Group I developed GBS sepsis as defined by pOSItive blood or cerebral spinal flUId culture whIle only one infant In Group II was so dl agnosed. A 11 sept i c infants in Group I di ed WI thi n 24 hours despite aggressive treatment while the septic Group II infant responded to ant I blot I c therapy. The fo 11 owi ng is a summary of our results.

Mean GA (wks) Mean BW (gms) Neonatal GB

Sepsi s

Group I (n=39) 31.9 t 4 .8 1576 t 474.8 6

Group II (n=302) 31.4 t 5 . 27 1509 t 487.5 1

P NS NS p<O.OOI

Low bi rthwei ght infants weI ghl ng ~2, 000 grams and born to co 1 oni zed mothers had s i gni fi cant increased mortality. We conclude that knowledge of maternal colonization of Group B Streptococcus In pregnancy played no positive role In either preventing neonatal sepsis or ImprovIng survival. Despite the universal application of a rapid screen test for GBS, our perinatal mortality rate In this population due to GBS sepsIs rerna I ns simi 1 ar to that reported for non-tested pregnancI es.

A RABBIT MnL Frn BACIERIAL-JNIllE) F'REI'm1 Iffi<l: IDH::I' OF DElAY IN 1RFA'IMENT R,McDu£fiex, S,Blanton

X, R,Gibbs

Uni versi ty of Colorado Heal th Sci~ces{enter, Lenver, CO Hysteroscopic inoculation of 10 -10 cfu E, coli into

pregnant rabbits at 7or. gestation produces prompt pregnancy loss (&:;1 1939), We deronstrated significant reductl.On in loss when E. coli-inoculated rabblts \\ere treated with ampi cillin/ sulbactam pre-inoculation compared to no treatJrent (:rmx; 1m). The current hypothesis is that delay in treatJrent adversely affects pregnancy outcome. Animals at 7or. ge~tation were inoculated hysteroscopically with 0,2 ml of 10 cfu/ml E, coli. Ampicillin/sulbactam 1:0 mglkg/day LM, was begun at the t:iJre of inoculation (0'), 2', or 4' after i noculation and continued up to seven days. Animals \\ere observed for signs of delivery. Sacrifice was performed after delivery or after seven days, Aerobic and anaerobic cultures of blood, peritonetm1, armiotlC fluid and decidua \\ere done. Nunber of live fetuses was counted, OJtcames are listed by tinE of treatJrent after inoculation.

Lelay in TreatJrent OJtcome ,O'f _2_'_ 4' Leli very 3/1Y' 4/6 8/1or.-+ Culture 3/15* 1/6 6/10* Live Fe tus 15/ 15* 2/ 6 2 /10* tthese data reported i n part :rmx; 1m *p (.01 CThOlE1CN: Lelay in treatnEnt 4' after inoculation results in sigI!ificantly less fetal salvage than treatnEnt begun at or before the t:iJre of inoculation.