Obstetrics and Gynaecology - Research Publications

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    Role of genital mycoplasmas in bacteremia: should we be routinely culturing for these organisms?
    Garland, SM ; Kelly, VN (Hindawi Limited, 1996)
    OBJECTIVE: The purpose of this study was to examine the role of the genital mycoplasmas Mycoplasma hominis and Ureaplasma urealyticum as causes of bacteremia in a tertiary referral obstetrical, gynecological, and neonatal intensive care facility, over a period of 12 years from 1983 to 1994 inclusively. METHODS: All clinically significant blood cultures were reviewed and the percentage of septicemic episodes for genital mycoplasmas was compared to the total isolation rate, including conventional bacteria. RESULTS: The overall positivity rate for all pathogenic organisms isolated from the blood cultures of infants ranged from 4.5% to 7.7% per annum. U. urealyticum represented 0.8% of these positive isolates and M. hominis 0.4%. For adults, the overall positivity rate from blood cultures ranged from 6.5% to 13.5%, with U. urealyticum representing 9.6% of these positive isolates and M. hominis 9.9%. CONCLUSIONS: With M. hominis having an established role in such clinical entities as postabortal and postpartum fever and U. urealyticum strongly implicated with chronic lung disease in low birth weight infants, it is appropriate to examine blood cultures for genital mycoplasmas in an obstetric institution.
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    Do antepartum herpes simplex virus cultures predict intrapartum shedding for pregnant women with recurrent disease?
    Garland, SM ; Lee, TN ; Sacks, S (Wiley, 1999)
    OBJECTIVE: To examine antenatal screening as a predictor of intrapartum shedding of herpes simplex virus (HSV) and to determine its usefulness in guiding the appropriate route of delivery for patients with recurrent HSV in pregnancy. METHODS: A population of 198 pregnant women with a history of recurrent genital HSV were cultured in the last weeks of their pregnancy by specially-trained personnel and intrapartum by their delivering attendants. RESULTS: Of cultures from a total of 906 antenatal visits, 17% were culture positive, with an asymptomatic shedding rate of 3.4%. Asymptomatic shedding occurred in 12.6% of women. Over the 8-week antepartum period, viral culture-positivity rates for each visit ranged from 11% to 19.5%. This provided an expected delivery culture-positivity rate of 15.3%. However, actual intrapartum viral culture positivity occurred in only three of 191 women (1.5%; P < 0.001). Because previous studies have suggested antepartum culture positivity fails to predict intrapartum viral shedding, evaluations, including cultures, as well as predictive values for subsequent culture positivities, were determined under the supervision of an infectious disease specialist. Under these conditions, positive predictive values were 59% when the interval between visits was 2 days, but only 19% when days between visits were >2 (P < 0.0001). No cases of neonatal herpes were seen in this population, although cesarean deliveries were performed in 31% of the patient population, with genital herpes as the indication for 56% of those. CONCLUSIONS: Antepartum serial screening by viral culture is not predictive of an infant's risk of intrapartum viral exposure when conducted at weekly intervals. However, more frequent assessments of patients can be predictive of an infant's exposure risk to HSV; for patients with frequent recurrent disease near term or primary infection in pregnancy, frequent late antepartum screening may be appropriate.