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Candida vaginitis develops in approximately one-fourth of women in their childbearing years. Conventional management consists of antifungal creams or tablets/suppositories administered intravaginally. Many patients have stated preferences for oral therapy. A randomized, double-blind placebo trial compared the efficacy of a single oral 200 mg dose of fluconazole with the application of terconazole 80 mg vaginal suppository daily for 3 days. Twenty-two patients (fluconazole = 12, terconazole = 10) were evaluated during a four-month period and favorable clinical responses were observed at both early and late evaluations. Mycologic cure was attained by 75% of the fluconazole group and 50% of the terconazole group at the early evaluation. At the late evaluation, mycologic cure was 75% and 100% respectively. The mean time to onset of symptom relief was 2.4 (1.7) days for the fluconazole group and 1.8 (1.8) days for the terconazole group. The mean time to complete relief of symptoms was 6.08 (2.84) and 6.6 (2.95) days respectively. A statistically significant difference did not exist for any of these measures. Seventy-three percent of the patients preferred oral therapy.

Patients hospitalized with acute pelvic inflammatory disease at University Medical Center of Jacksonville had a mean age of 26.8 years. Contraception use was minimal and mean gravidity was two. Hospitalized patients had a high incidence of peritonitis and tubo-ovarian abscess. N. gonorrhoeae was cultured in 50%. Mean temperature on admission was 100.5 degrees and mean white blood cell count 15,400. Mean hospitalization was 5.5 days. Two of nine patients tested for HIV were positive (22% of those tested, 2% of all patients reviewed).

Ninety members of the Jacksonville Obstetrical and Gynecological Society were surveyed as to their practice patterns; 55 responded. Due to fear of litigation, 34% had stopped delivering obstetrical care and 63% plan to discontinue perinatal care during the next ten year. At least one malpractice claim had been filed against 51%; 9% had two, and 11% three or more. Prenatal and intrapartum testing has increased primarily because of fear of litigation. Obstetric fees increased 44% during the last five years, according to the survey, compared to a Consumer Price Index rise of 20%. Mean malpractice premiums rose 42% during the same interval.

During one year, 646 women who delivered by cesarean section entered into a prospective randomized clinical trial to determine if a single intraoperative dose of cefazolin was as effective as cefotetan in the prevention of postoperative endomyometritis. Of 336 patients receiving 2 gm cefazolin intravenously at the time of clamping of the cord, endomyometritis developed in 30 (8.91%), and of 310 patients who received 2 gm cefotetan intravenously at the time of clamping of the cord, endomyometritis developed in 36 (11.6%). There was no statistically significant difference in the incidence of endomyometritis between the two groups (p = .269). We conclude that since the two drugs are equal in efficacy 2 gm of cefazolin is a cost effective method of prophylaxis for cesarean section.

Records were reviewed of all patients with premature rupture of the membranes (PROM) at or less than 34 weeks estimated gestational age (EGA) who delivered at University Hospital of Jacksonville, Florida, during 1987. That year 132 patients were identified, 3.1% of all deliveries. The mean time from membrane rupture to delivery was three days, and the duration of PROM seven or more days in 9% of cases. Chorioamnionitis was diagnosed in 20% of the mothers. Delivery was by cesarean section in 30% of cases, twice the primary rate at University Hospital for 1987. Sixty-five percent of infants were male, and 13 males and four females of the 132 infants died before or after birth, the majority due to prematurity. Respiratory distress syndrome (RDS) was found in 35 infants and in 80% of these cases the membrane ruptured at 30 weeks or less. Intraventricular hemorrhage (IVH) was diagnosed in 8% of cases. Neonatal sepsis was a common diagnosis (41% of deliveries) with incidence being similar at all gestational ages. The length of membrane rupture was not statistically significant when compared with neonatal sepsis (P = 0.39).