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Objectives: To evaluate the utility of intrapartum amnioinfusion (AI) in reducing the infectious morbidity of patients with meconium-stained fluid (MSF). Previous studies have shown increased intraamniotic infection (IAI) and postpartum endometritis (PPE) rates in patients with MSF. Intraamniotic infection has been reduced with the prophylactic administration of ampicillinsulbactam in MSF. Intraamniotic infection and PPE have been reduced with the use of AI in patients with clear fluid. No investigators have specifically examined the efficacy ofAI in reducing meconium-stained, amniotic-fluid-associated infectious morbidity. Methods:A retrospective cohort study of all cases ofMSF was conducted and included patients who delivered at Louisiana State University Medical Center-Shreveport during the one-year period from January to December 1996. Patients were identified from the perinatal database by the diagnosis code ofMSF. The medical records were reviewed to determine the consistency ofMSF and the presence or absence of infectious morbidity. Patient demographics, labor characteristics, and various risk factors for infection were sought. The main outcome measures were the occurrence of clinical IAI or PPE. Statistical analysis included two-tailed unpaired t-test,X2, ANOVA, and Fisher exact test when appropriate. Results: Two hundred seventy-three medical records of patients with MSF were studied. One hundred twenty nine patients received AI, and 144 did not receive AI. No significant differences in demographics, labor characteristics, or outcome variables were noted between the two groups. The incidences of IAI were 18.6% and 24.3%, P 0.13, in the AI and non-AI groups, respectively. Postpartum endometritis occurred in 22.5% ofAI patients and 21.5% ofnon-AI patients, P 0.97. Conclusions: The use ofAI confers no benefit for the reduction ofinfectious morbidity in patients with MSF. Infect. Dis. Obstet. Gynecol. 5:366-369, 1997. (C) 1998 Wiley-Liss, Inc.

The objective of this retrospective study was to test the hypothesis that vacuum extraction of neonates with a birth weightor = 2000 gm is associated with an increased risk of periventricular-intraventricular hemorrhage (PV-IVH).One hundred sixty-eight neonates weighingor = 2000 gm were entered into this case control study. Fifty-six neonates delivered by silicone-rubber vacuum comprised the study group. For every infant born by vacuum-assisted delivery, two spontaneously delivered neonates served as controls (n = 112) and were matched for best obstetric gestational age (within 1 week), delivery date within 1 year, and birth weightor = 2000 gm. Maternal and neonatal medical records were reviewed for demographic variables, antenatal complications, indication for vacuum-assisted delivery, neonatal birth weight, Apgar scores, umbilical cord blood gas values, and neonatal morbidity including the incidence of PV-IVH. All perinatal outcome variables were compared between the vacuum-assisted and spontaneously delivered groups.Both groups were similar with regard to maternal age, parity, antepartum complications, gestational age at delivery, neonatal birth weight, and gender. Both groups were also similar with regard to the incidence of 1-minute Apgar score5, small for gestational age, cephalhematoma, birth trauma, respiratory distress syndrome, hyperbilirubinemia, and sepsis. There was a significant increased incidence of 5-minute Apgar scores7 in the vacuum-assisted group (p = 0.04). No significant difference was observed in the incidence of PV-IVH grades 1 through 4 (21.4% vacuum group vs 16.1% control group, odds ratio 1.42, 0.58 to 3.45).Indicated use of the silicone-rubber vacuum to assist vaginal delivery of neonates weighingor = 2000 gm does not appear to be associated with an increased risk of PV-IVH or other neonatal complications.

Two complete foeto-placental units were perfused at midgestation with 5.0 mCi of uniformly labelled 14C-sodium acetate plus 5.0 mCi of cholesterol-7α-3H and two isolated foetuses were perfused with 2.5 mCi of 14C-labelled sodium acetate plus 2.5 mCi of cholesterol-7α-3H. The perfusions were carried out at 35–36°C for 90 min. The foetal adrenals, livers, testes and perfusates were analyzed and various labelled steroids were isolated in a radiochemically homogeneous form. Major quantities of 14C- and 3H-labelled pregnenolone (3β-hydroxy-pregn-5-en-20-one) and dehydroepiandrosterone (3β-hydroxy-androst-5-en-17-one) were isolated from the foetal perfusates, livers and adrenals. Minor amounts of 14C- and 3H-labelled progesterone (pregn-4-ene-3,20-dione) were isolated from the perfusates and adrenals, and 17α-hydroxy-progesterone (17α-hydroxy-pregn-4-ene-3,20-dione) and androstenedione (androst-4-ene-3,17-dione) from the perfusates. Smaller amounts of exclusively 14C-labelled androstenedione were isolated also from the adrenals. No labelled progesterone, androstenedione or testosterone (17β-hydroxy-androst-4-en-3-one) was detected in the testes. Attempts to isolate 20α-dihydroprogesterone (20α-hydroxy-pregn-4-en-3-one) or 20β-dihydroprogesterone (20β-hydroxy-pregn-4-en-3-one) from the perfusates, adrenals and livers failed. No labelled cortisol (11β,17,21-trihydroxy-pregn-4-ene-3,20-dione) or corticosterone (11β,21-dihydroxy-pregn-4-ene-3,20-dione) was detected in the adrenals, and no testosterone, oestrone (3-hydroxy-oestra-1,3,5(10)-trien-17-one) or 16α-hydroxy-dehydroepiandrosterone (3β,16α-dihydroxy-androst-5-en-17-one) in the perfusates. Pregnenolone and dehydroepiandrosterone (which were present in approximately equal amounts) accounted for as much as 95% of all steroids isolated from all sources. The bulk of these two steroids was isolated from the perfusates. The 14C/3H ratio of the pregnenolone and dehydroepiandrosterone isolated from the conjugated fraction of the perfusates was much higher than that of the unconjugated compounds. It is concluded that the midgestation human foetus is capable per se of carrying out the de novo synthesis of major quantities of pregnenolone and dehydroepiandrosterone. It is suggested that in foetal steroidogenesis acetate is utilized predominantly via a conjugated pathway and circulating cholesterol mainly via an unconjugated pathway.