653 THE PROLONGED USE OF PROPHYLACTIC INTRAVENOUS (IV) ANTIBIOTICS FORPRETERM PREMATURE RUPTURE OF THE MEMBRANES (PPROM) DOES NOT APPEARTO ENHANCE STERILIZATION OF THE CHORIOAMNION SPACE KRISTINABELL MIXER1, ROBERT ABRAMS1, RICHARD BESINGER1, JOHN GIANOPOULOS1,MARK SANTILLAN1, ROBERT MITTENDORF1, 1Loyola University Medical Center,Department of Obstetrics and Gynecology, Maywood, Illinois

OBJECTIVE: Given that IV antibiotics are almost always used for prophy-laxis in PPROM, determine if prolonged usage leads to more negative bacterialcultures from the chorioamnion space at delivery.

STUDY DESIGN: During the Magnesium and Neurologic Endpoints Trial,an Epidemiologic Data File (EDF) of biological variables was collected. Itincludes a precise recording (drug and dosage) of antibiotic prophylaxis usedin PPROM, as well as subsequent results of placental bacteriology. The latterwere obtained at delivery by aseptically dissecting the chorion from theamnion and obtaining cultures (aerobes, anaerobes, Ureaplasma, Myco-plasma, and Chlamydia) from their interior (Hillier method, N Engl J Med1988;319:972-8).

RESULTS: In the EDF, 94 mothers with PPROM received IV antibioticprophylaxis and had bacterial cultures taken at delivery (59 positive; 35negative [see J Perinatol 2001;21:3-8 for the various species]). The medianexposure to prophylaxis was 13 total doses. We found that 84 of 94 (89%)women received IV ampicillin (2 g each dose); 76% got erythromycin (500 mgeach); 63% got both ampicillin and erythromycin prophylaxis; 9%, cefazolin(2 g each); 12%, gentamicin (120 mg each); and, 5%, clindamycin (600 mgeach dose). Using the Cochran Armitage Trend Test (Table; StatXact), nosignificant trend was found between increased exposure to IV antibiotics andenhanced sterilization of the chorioamnion space (P=.16).

CONCLUSION: In our data, there is no evidence to support the hypothesisthat prolonged exposure to prophylactic antibiotics decreases the prevalence ofbacteria cultured from reproductive tissues. The clinical implications of suchknowledge should be considered.

Relationships between total numbers of prophylactic IV antibiotic doses andpositive bacterial cultures in the chorioamnion space

Chorio-amnion culture0 to 5doses 6 to 11 doses

12 to 17doses

18 to 23doses

O23doses

Negative 15 5 3 4 8Positive 11 10 18 6 14Percent

negative15 of 26(57.7%)

5 of 15(33.3%)

3 of 21(14.3%)

4 of 10(40%)

8/22(36.4%)

654 HEPATITIS C IN PREGNANT WOMEN: RISK FACTORS FOR CHRONIC AND ACTIVEDISEASE JAMES AIROLDI (F)1, STACY MCCROSSON1, SUDHA MOOLA1, ATHITACHANTHASENANONT2, VINCENZO BERGHELLA1, 1Thomas Jefferson University,Obstetrics and Gynecology, Philadelphia, Pennsylvania, 2Thammasat Univer-sity, Obstetrics and Gynecology, Pathum-Thani, Thailand

OBJECTIVE: To evaluate which risk factors are significantly associated withworsening maternal disease, focusing on chronic and active hepatitis C.

STUDY DESIGN: A retrospective review was completed for hepatitis Cpregnant women from 2000-2003. Chronic hepatitis C is defined as hepatitis Cviral RNA in the serum, while chronic active hepatitis C is defined as hepatitisC viral RNA plus abnormal liver function tests (LFT’s).

RESULTS: Of 76 pregnant women with known hepatitis c viral titers, 63women had positive viral titers (chronic infection rate 83%). Within thechronic infection group with known LFT’s, 33 had abnormal LFT’s (52%).Smoking and previous drug use were significantly associated with chronichepatits C. (Table)

CONCLUSION: Smoking and previous drug use were significantly associatedwith chronic hepatits C. There were no significant risk factors when comparingnon-active versus active hepatitis C.

Non-viremichep C

Chronhep C (viremic) p value

Chron non-activehep C

Chronactive hep C p value

N 13 63 29 33

Age (mean) 28.0 29.6 0.49 29.0 29.9 0.48Duration (years) 4.1 2.6 0.41 3.1 2.2 0.30HIV viral load 1813.3 3156.8 0.60 3510.7 2941.5 0.88Methadone

dose (mg)113.7 95.1 0.60 91.3 98.6 0.55

HIV pos 2 (15%) 8 (13%) 0.79 2 (7%) 6 (18%) 0.18Hep B pos 5 (38%) 12 (19%) 0.12 7 (24%) 5 (15%) 0.37Smoke 10 (77%) 60 (95%) 0.02 29 (100%) 30 (91%) 0.09Prev drug use 8 (62%) 63 (100%) 0.00 29 (100%) 33 (100%) d

655 CYTOMEGALOVIRUS (CMV) AND THE REGULATION OF TRAIL IN THE PLACENTAJANET ANDREWS (F)1, THOMAS GRIFFITH2, TROY KEMP2, JEFFERY MEIER3, 1Uni-versity of Iowa, Obstetrics and Gynecology, Iowa City, Iowa, 2University ofIowa, Urology, Iowa City, Iowa, 3University of Iowa, Internal Medicine,Iowa City, Iowa

OBJECTIVE: Cytomegalovirus has been shown to upregulate tumor necrosisfactor-related apoptosis-inducing ligand (TRAIL) in dendritic cells resulting inthe deletion of activated T cells. Our objective was to evaluate CMV’s effect onregulation of TRAIL in human placental cells.

STUDY DESIGN: Primary cytotrophoblasts (CTB), placental and foreskinfibroblasts, and interferon (IFN)-null cells were cultured in the presence orabsence of CMV. RNA and protein were harvested at various time points.Quantitative real time RT-PCR and ELISAs were performed. To furtherassess the confounding effect of viral mediated release of IFN, fibroblasts wereco-cultured with IFN antibodies and Type 1 IFN receptor blocking antibodies.

RESULTS: Compared with controls, TRAIL mRNA and protein expressionwere up-regulated over 100-fold in CMV-infected placental fibroblasts andCTBs. The up-regulation of TRAIL mRNA expression was partially blockedby the addition of antibodies against IFN-alpha and -beta or Type 1 IFNreceptor, but this effect could not be completely abrogated by addingincreasing concentrations of these antibodies. Moreover, CMV increasedTRAIL mRNA expression by O100-fold in IFN-null cells compared touninfected controls. Non-infectious (UV-inactivated) CMV increased TRAILmRNA abundance to even a greater extent than infectious CMV. TRAILmRNA was down regulated later in the course of infection by a viral mediatedmechanism.

CONCLUSION: CMV increases TRAIL mRNA and protein expression inplacental fibroblasts and cytotrophoblasts. However, later during infection,TRAIL expression decreases via an unknown viral mediated mechanism.While CMV-induced type I IFN may contribute to TRAIL expression, wehave demonstrated that CMV also directly up-regulates TRAIL expressionindependent of IFN release.

656 ASSOCIATION BETWEEN BACTERIAL VAGINOSIS (BV) AND UPPER GENITAL TRACTMICROBIAL COLONIZATION AND INFLAMMATION WILLIAM ANDREWS1, JOHNHAUTH1, SUZANNE CLIVER1, ROBERT GOLDENBERG1, MICHAEL CONNER2, ALICEGOEPFERT1, 1University of Alabama at Birmingham, Obstetrics/Gynecology,Birmingham, Alabama, 2University of Alabama at Birmingham, Pathology,Birmingham, Alabama

OBJECTIVE: To determine the association between BV and endometrialmicrobial colonization and inflammation in non-pregnant women.

STUDY DESIGN: Microbial cultures (n=820) and histopathology (n=506)were performed on endometrial specimens from women with a recent pretermor term delivery (83G17 days). Endometritis was defined as the presence ofplasma cells. BV was defined using Nugent’s and Amsel’s criteria.

RESULTS: The study population was 71% black, 29% white, 69% unmar-ried and 32% had !12 years of education. 82% had endometrial culturespositive for at least one organism. 39% had plasma cell endometritis. Analysisof paired cervical/endometrial cultures estimated endometrial microbial con-tamination to be only 4.1 to 7.5%. Compared to BV-negative women, positiveendometrial cultures were significantly more common with Nugent-BV (89%vs. 79%, p=.001) but not Amsel-BV (89% vs. 83%, p=.096). Logisticregression analysis confirmed these results. Endometrial BV-associated bacte-ria were significantly more common among women with Amsel- or Nugent-BVregardless of how these bacteria were defined or grouped (any anaerobe,anaerobic Gram-negative rods, anaerobic Gram-negative cocci, M. hominis,G. vaginalis, Mobiluncus species; p%.002 in all cases). Neither Amsel-BV(39% vs. 41%, p=.758) nor Nugent-BV (40% vs. 39%, p=.904) wereassociated with a higher rate of endometritis. In women with Amsel-BV,only amine odor (89% vs. 83%, p=.034) and elevated pH (pHO4.5;86%vs.76%, p=.006) were associated with a higher rate of positive endometrialcultures. In women with Nugent-BV, Mobiluncus (89% vs. 82%, p=.050) andGardnerella/Bacteroides (86% vs. 76%, p=.0005), but not Lactibacillus (86%vs. 82%, p=.141) score were associated with a higher rate of positiveendometrial cultures.

CONCLUSION: In recently post-partum women, BV is associated with amodest but statistically significant increased risk of endometrial microbialcolonization but not plasma cell endometritis. Amine odor, elevated vaginalpH and increased BV-associated bacterial morphotypes are more predictive ofendometrial colonization.

SMFM Abstracts S185