European Society for Infectious Diseases in Obstetrics and Gynecology

1. to present our preliminary experience in sixteen undergoing a prenatal evaluation to assess for fetal infection; 2. to esti- mate the reliability of CMV-specific IgM as an indicator of fetal infection using polymerase chain reaction (PCR) for amplification of DNA. Patients: Sixteen patients were referred for prenatal diagnosis of suspected fetal cytomegalovirus infection (CMV). Two women had documented positive IgG and IgM(one with IgA positive) immunoglobulin titres in the first trimester of pregnancy and two in the second trimester. Twelve patients were evaluated because of abnormal ultrasonographic examinations under suspicion of fetal infection. Methods: Mother’s serum was assayed for the presence of CMV-specific IgM by an enzyme-linked immunoabsorbent assay (ELISA). Four methods of fetal diagnosis were em- ployed involving a combination ofamniocentesis, fetal blood sampling, prenatal paracentesis and thoracentesis. Six fetuses underwent fetal intervention at a median gestational age (range 28 to 30 weeks). Five out of sixteen cases had bilat- eral pleural effusions and hydrops. DNA was extracted from cultures of mother’s blood and urine, amniotic fluid, fetal cord blood, pleural effusions and ascetic fluid. For the detection of CMV DNA in DNA preparations the nested-PCR test constructed in the Center of Microbiology and Virology PAS and PCR based TaKaRa (Japan) Human Cytomegalovirus infection was used. Results: Out of twelve patients evaluated because of abnormal ultrasonographic examinations suspective fetal CMV infection serological methods (positive IgG and negative IgM) in three cases DNA studies confirmed the presence of fetal CMV infection. Out of four patients with positive serological tests in one case with positive IgG, IgM and IgA DNA studies documented the presence of fetal infection and in three patients results suggested most likely a false-positive IgM. composition data shows significant differences in lymphocytic markers expression in both groups compared to controls. Amount of CD8+ lymphocytes increased in the high-risk HPV group and consequently CD4+/CD8+ ratio decreased. Marker CD69+ was detected (after in vitro cell stimulation) in 68.5% cells in group (1) at that time, in group (2)and control patients it was 55.4% and 53.6% cells respectively. The indexes of c-IFN decreased 4-6 times and those of y-IFN decreased 6-8 times in comparison to control group. A dramatic eleva-tion of serum and spontaneous IFN was found. Conclusion: Diseases of the lower genital system caused by HPV develop in the presence of suppression of immune and interferon systems, reliable decrease of gamma-interferon followed by an increase of serum interferon, and suppression of T-cellular chain activity which is ex-pressed by an increase of CD8+ leukocytes and a decrease in CD4+/CD8+ ratio. This study leads to an individual choice of immunocorrectors for a patient in accordance with individual therapeutic approach, based on the individual hyperactivity. Objectives: Is one injection of 2.4 million units ofbenzathine penicillin G sufficient treatment for early syphilis during pregnancy (CDC guidelines 1993)? analysed of benzathine penicillin G in of seronegative black Results: One hundred and eight women receivir/g two or three weekly intragluteal injections ofbenzathine penicillin G had a favourable pregnancy outcome. However, after only one injection, lower birth weight, increased immaturity, prematurity, and total preterm birth rate resulted. Treponemicidal coverage of 3 weeks or less resulted in decreased birth weight (2748 vs. 3130 g, P 0.004) when compared to treponemi- cidal coverage lasting longer than three weeks. Also the relative risk for prematurity (OR 8.5, c195 2.5-28). perinata! mortality (OR 20.5, c195 2.3-1 84) and congenital syphilis (RR 2.0, c 195;0.6-6.8) were increased when coverage was less then 3 weeks. These results were comparable to when no treatment was given. The majority of incompletely treated women delivered at less than 4 weeks after they received their injection. These also had the worst neonatal outcome. Impaired outcome due to short treatment clustered in early attainders of prenatal care and when the initial RPR titer was higher than 16. Conclusion: One intramuscular injection of 2.4 million units benzathine G or for of 2.4 million benzathine penicillin at least one week Condyloma acuminatum is a sexually transmitted disease with high recurrence rates. The aim of this study was to predict the recurrence of this disease before using two different treatment modalities by flow cytometric DNA analysis. Twenty-seven patients with vulvar condyloma acuminata were randomly divided into 2 groups. From these, 16 patients were treated with CO laser and 11 patients were treated with intralesional interferon. Before treatment, each patient was evaluated with flow cytometry to determine the presence of aneuploidy, DNA index, and S phase. The features of flow cytometry of the recurrent cases were analysed. The recurrence rate of patients treated with CO laser and interferon treatment were 25% (4/16) and 9% (1/11), respectively. Flow cytometric DNA analysis revealed 18.5% dip-loidy and 81% aneuploidy in 2 patient groups. The presence of aneuploidy, DNA index, and S phase were not statistically different in both treatment modalities and in recurrent and nonrecurrent patients. The results of study showed that the prediction of the recurrence of condyloma acuminata can not be possible with flow cytometric DNA analysis. Abstract: The objective ofthe study was to evaluate the correlation between clinical data and 50 characteristics of Candida strains isolated from two ontocenoses of pregnant diabetic women with different types of diabetes mellitus. The relationship between clinical symptoms and different fungal features was searched according to their own scheme. Data were collected in a special computer program. The fungal strains were isolated from 100 women with pregestational diabetes mellitus (PGDM) or gestational diabetes mellitus (GDM:GDM- 1,GDM-2). CIinical evaluation ofthe 10 signs and symptoms of candidosis was performed. The control group covered 100 pregnant women without diabetes melli- tus. The characteristics of axenic strains were assessed ow-ing to their own methods and unified tests (bioMerieux: API20 C, API20 AUX, API 20 ZYM). Correlation coeffi-cient (r) was used to measure the relationship between two variables. The prevalence of fungal strains in diabetic pregnant women was 30-50 percent. In the control group candidosis occured in 20 percent of women. The highest correlation coeffcient (r) related to bifocal infections of Candida. In the group of diabetic pregnant women there was a strong correlation between presence of fungi iia vagina (r from +0.45 5 to +0.720) and the symptoms, i. e., pruritus, swell-ing, redness, burning, abnormal discharge, and general diag- nosis of colpitis. There are differences in biochemical characteristics of fungal strains isolated from diabetic and non-diabetic women. The correlation for the clinical symptoms of genital infections refer mainly to the high activity of several hydrolases, i.e., esterase (e3), valine arylarnidase (e7), naphtol-AS-BI-phosphohydroIase (e 12), a-glucosidase (e 16). Additional studies are needed to define the relationship between clinical data and Candida strains isolated from different ontocenoses of pregnant women with diabetes. findings on wet mounts and results of vaginal culture, lactate and succinate content of the vagina and selected cytokinesis. Methods: From 631 women presenting at an obstetrics/ gynaecology outpatient clinic vaginal fluid was obtained for wet mount, pH measurement, culture and measurements of lactate, succinate, IL-1-beta, IL-8, leukemia inhibitory factor (LIF) and interleukin-1-receptor antagonist (IL-1-RA). Results: Increasing disturbance of the lactobacillary flora (lactobacillary grade (LBG) I, IIa, lib, III) was highly corre- lated with the presence of Garderella vaginalis, Trichomo-has vaginalis, enterococci, group B streptococci andEscheri- chia coli. Vaginal pH, IL-8 and ILl beta increased linearly with LBG, while lactate concentrations and the of epithelial cell lysis A similar pattern of associations with leukocyte count clear, The IL-1-betal/IL-1-RA when vaginal ferent the course concentrations associated with an LBG increase. Lactobacillus Spp. is miss-ing (67.4%), without or associated with GBS strains showed sensitivity to ampicillin and carbenicillin. Good sensitivity was found to cefazolin (92.4%) and to cefuroxim (94.2%). The strains showed 13.7% resistance to erythromicin and 4.1% to clindamycin. Ovarian pregnancy is a rare form of ectopic pregnancies. Among all the pregnancies that have attended in our outpatient clinic, the ectopic pregnancy ratio was 1/8000 with one ovarian case (1.25%) in a total of 80 ectopic pregnancies diagnosed. The differential diagnoses of owarian pregnancy is difficult, the symptoms and signs are like other ectopic pregnancies. C. luteum hematoma is seen frequently. The diagnosis is made mostly during laparotomy and even after the operation during the pathological investigation. In the medical history of this ovarian pregnancy case, 4 pregnancies, one delivery (6 years ago, cesarean section), right salphingectomy because of ectopic pregnancy 2 years previously, and a history of PID were seen. There was no usage of IUD. In the literature it is seen that, unlike tubal pregnancies, ovarian pregnancy usually does not have any relation to PID and infertility and the most important risk factor for ovarian pregnancy is IUD usage. In contrast, in our ovarian pregnancy case there was no usage of IUD but a history of PID was seen. Since ovarian pregnancy is a rare form of ectopic pregnancies, we aimed to present this ovarian pregnancy case seen in our clinic. in the third trimester. thyroid function results of T4, FT4 and TSH values were measured for all pregnant and nonpregnant women. trimester FT4 The aim of this study was to determine the bacterial flora of the vagina in healthy women (HW) and in women with bacterial vaginosis(BV). The vaginal samples of 100 HW and samples of 100 women that were determined to have BV by clinical symptoms shown in microscopic exams of their Gram-stained vaginal smears were studied. The facultative microorganisms and the anaerobic gain a better understanding of the composition of this system in our population. Objectives: Salpingitis has a complex etioiogy dominated by Chlamydia trachornatis (Ct) and by Neisseria gonorrhoeae (Ng), however, the particular pathogen is difficult to identify, even in laparoscopically obtained specimens, since re- sults from the lower genital tract do not always correlate with those from tubal swab samples. Several techniques have been described, including one invented in 1980 using a specially designed swab instrument directly inserted through the working channel of the laparoscope. Study design: The microbiological results of tubal swab specimens are compared with those from urethral and cervi- cal swabs of patients with laparoscopically diagnosed .salp-ingitis. Ct was identified by means of PCR and/or LCR, Ng(and other bacteria) by standard cultures. Results: Between 9/93 and 12/99 141 out of 321 patients with suspected PID were laparoscopically diagnosed to suf- fer of acute salpingitis due to the following bacteria: Besides the multitude of bacterial species in- volved, the difficulty in gaining access to the fallopian tubes Results: Up to 12/98, 73 of 381 women in the intervention group were identified with a pH > 4.4.58 were treated with lactobacilli, 24 additionally with clindamycin cream because of BV and 3 had no therapy. In this ongoing study the prematurity rate was 8.1% in the intervention group vs. 12.3% in controls (n=2.341; P < .05). 0.3 vs. 3.3% of the neonates were born at < 32 gestational weeks (P<0.01). was in 22.8% vs. 30.8% (P < 0.01) respectively. close intervals for 72 hours, the uterus and ovaries were thought to be the source of sepsis and total abdominal hysterectomy and bilateral salphingooopherectomy was performed. Four days after the operation, all the clinical and laboratory parameters were improved and on the postoperative tenth day she was discharged from hospital with oral antibiotic therapy and estrogen replacement therapy. were prepared according to the Kirby-Bauer diffusion method. The direct microscopy of was evaluated by saline and hydroxide Results: In four of 30 cases urine cultures were positive (13%). The bacteria in question were determined to be Klebsiella spp., Enterobacter spp., Coagulase negative staphylo- coccus and E. coli. Cases with positive cultures complained of inguinal pain. In only two of the cases dysuria and pollakuria were noted. There was no clinical complaint in five of 26 cases with negative cultures. In 14 of these cases inguinal pain, in 12 dysuria, in pollakuria and in 10 noc-turia were recorded. (ISH) the Estring group and either 36 weeks or until the first recurrence for the control group. The primary variable was analysed by survival analysis with the Kaplan-Meier method for estimating the survival density function. To compare the survival curves for the 2 treatment groups a log-rank test was performed for time until first recurrence. Results: The cumulative proportion of women remaining free of UTI was significantly higher in the Estring group than in the control group (P-0.008). After 36 weeks of study the cumulative likelihood of remaining free of disease was approximately 45% in the women with the vaginal ring compared with approximately 20% in the control group. Estring lowered vagi- nal pH, and the time to first recurrence was effectively prolonged by Estring treatment. Vaginal and, to a lesser extent, urethral mucosal cells were significantly more mature in the Estring group. No unexpected adverse events were found. Conclusion: Estring is useful to prolong the time to next recurrence among postmenopausal women with recurrent UTI and to decrease the number of recurrences per year. The sili-cone vaginal ring also has a clinically significant ability to alleviate other postmenopausal urogenital symptoms. Estring is safe and well tolerated. same menstrual period. cells are known to contain biological mediators and these may be responsible for local inflammatory reactions. These findings may be a factor in the pathogenesis of pelvic inflammatory disease and ectopic pregnancies that occur in IUCD. Objective: We aimed to investigate hepatitis B porters among pregnant women. Materials and Methods: Among 294 pregnant women who have attended to Iiili Etfal Hospital 3rd Obstetrics and Gynecology outpatient clinic, HBsAg, AntiHBs, and in HBsAg positive pregnant women, HBeAg were investigated by macro Elisa system. Results: Among 294 pregnant women HBsAg was positive in 22 women (7.48%), antiHBs was positive in 44 women (14.96%). In 22 pregnant women in whom HBsAg were positive, HBcAg was also found positive. Conclusion: Since hepatitis B virus can cause serious medi- cal problems, we aimed to point out the importance of hepatitis B screening for the health of the mother and newborn and so that it should not be forgotten during routine laboratory testing of pregnant women. Objective: Cervicitis is one ofthe most frequent genital in- fections among women of the reproductive age. The aim of this study was to evaluate microbial etiology and epidemiological features in Turkish women with cervicitis. Materials and Methods: 40 randomly selected women presenting with cervicitis to the Family Planning Clinic of HNSH were included in this study. Patients under 18 and over 50 years of age, women who had received antimicrobial drugs within the prior month, and menstruating women were excluded. Cervical smears, vaginal and endocervical specimens, and gram-stains were obtained from all patients. Results: The average age ofthe patients was 29.2 years (range However, IgM seropositivity does not always mean an acute toxoplasma infec- tion that started during pregnancy. In this case, the use of toxoplasma IgG avidity test has been suggested recently for differentiation of an acute infection during pregnancy. Objective: Bacterial vaginosis (BV) is characterized by the replacement of the vaginal flora which is normally domi- nated by lactobacillus species by Gardnerella vaginalis and anaerobic bacteria. BV is the most common vaginal complaint among women of reproductive age and is associated with serious complications. The objective of this study was to compare the efficacy of 2% clindamycin vaginal cream versus oral metronidazole in the treatment of BV. Materials and Methods: 60 patients diagnosed as BV with clinical criteria supported by gram-stain as described by Amsel and culture were divided randomly into two equal groups. One group received oral metronidazole 500 mg twice a day for 7 days and the second group 2% clindamycin vagi- nal cream 5 gm once a day for 7 days. Cure rates and side effects were evaluated by a return visit on the 15th day. Results: There was no significant difference (P>0.05) between the cure rate of oral metronidazole and clindamycin vaginal cream (86.7% and 83.3% respectively). Side effects were nausea (13.3%), metallic taste (6.7%), candidal vagini- tis (3.3%) for oral metronidazole and vaginal irritation (30%) and candidal vaginitis (13.3%) for clindamycin cream. Conclusion: Clindamycin vaginal cream (2%) is a safe and effective alternative to oral metronidazole for treatment of BV. in enzymes in 50 patients. correlated these events to peri- natal outcome. women in pregnancy at first trimester and gestation week 30-34. Vaginal taken for wet mount, Gram stain, pH measurement, enzymes such as sialidase, and microbiological test. Endocervical swab was sampled by using a cotton-tipped swab. Vagi- nal pH values were obtained by colorimetric strips carried by index finger of the special gloves. A cut-off point of pH 4.5 was selected. Results: In 1830 patients who have undergone microbiological test, we found 30% microbiological positivity. Among these, 52% developed threatening preterm labor. In 100 patients we detected a pH greater than 4.5 in 35% of all cases. Among microbiologically-positive patients (40%), vaginal fluid pH was positive especially in 74% cases ofBV. Sialidase activity in cervicovaginal fluid was associated with presence of ureaplasma, GBS, gardnerella and chlamydia. perinatal outcome preterm labor, and preterm Evaluation of risk factors, clinical features and of The 45(72.5%) 25.8% rupture and 35.4% generalized peritonitis. In our cases duration of hospitalization Objective: This survey has been planned to investigate the foreign (mainly Russian and Romanian) and local women in entertainment business, as possible loci of gonorrhea, syphillis, hepatitis ]3 & C, HIV, as well as trichomoniasis, candidiasis, bacterial vaginosis, ureaplasmosis and mycoplasmosis. Method: 74 women were sampled bacteriologically and se-rologically for the mentioned sexually transmitted disesases and have been asked to fill out a questionnaire. Results: No cases ofchlamydia, trichomonas, HIV, and hepa- titis C were identified. The incidences ofother infections were found as: candidiasis (5.4%), bacterial vaginosis (12.16%), ureaplasmosis(21.6%), mycoplasmosis(16.2%), gonorrhea (5.4%), syphillis (1.35%), and hepatitis B(2.7%). Conclusion: There has been an insidious increase in STD in Turkish population as stated and supported by various other Acute appendicitis in pregnancy is the most common nonobstetric complication laparotomy. The goal of this study is the evaluation of clinical manifestations, diagnosis and management of acute appendicitis

sonography, ***Center of Microbiology and Virology, Polish Academy of Sciences, Lodz, Poland Introduction: The objectives were: 1. to present our preliminary experience in sixteen pregnant women undergoing a prenatal evaluation to assess for fetal infection; 2. to estimate the reliability of CMV-specific IgM as an indicator of fetal infection using polymerase chain reaction (PCR) for amplification ofDNA. Patients: Sixteen patients were referred for prenatal diagnosis of suspected fetal cytomegalovirus infection (CMV). Two women had documented positive IgG and IgM(one with IgA positive) immunoglobulin titres in the first trimester of pregnancy and two in the second trimester. Twelve patients were evaluated because of abnormal ultrasonographic examinations under suspicion of fetal infection.
Methods: Mother's serum was assayed for the presence of CMV-specific IgM by an enzyme-linked immunoabsorbent assay (ELISA). Four methods of fetal diagnosis were employed involving a combination ofamniocentesis, fetal blood sampling, prenatal paracentesis and thoracentesis. Six fetuses underwent fetal intervention at a median gestational age (range 28 to 30 weeks). Five out of sixteen cases had bilateral pleural effusions and hydrops. DNA was extracted from cultures of mother's blood and urine, amniotic fluid, fetal cord blood, pleural effusions and ascetic fluid. For the detection of CMV DNA in DNA preparations the nested-PCR test constructed in the Center ofMicrobiology and Virology PAS and PCR based TaKaRa (Japan) Human Cytomegalovirus infection was used. Introduction: Human papillomavirus (HPV) 16 and 18 has the most frequent causal contribution to the origin of cervical cancer. Since development of most cancers connect with an incompetence of immune and interferon (IFS) systems, the objective of the study was investigation of immune and IFS systems in patients with various HPV types. Materials and Methods: We studied immune and IFS status in 117 patients with HPV detected by traditional and modem diagnostic technologies (PCR and DNA HPV Hy-brid Capture). The using ofDNA HPV Hybrid Capture let us separate the patients into two groups: high-risk HPV (1) and low-risk HPV (2). The third group (control) consisted of 43 women without HPV infection. We have detected lymphocytic subpopulations composition peripheral blood by cytofluorimety methods with using monoclonal antibodies (Beckton Dickinson, USA). Results: In the group with high-risk HPV the significant immune and IFN systems changes were detected in comparison to the group with low-risk HPV and among the controls. Statistic analysis of the lymphocytic subpopulations composition data shows significant differences in lymphocytic markers expression in both groups compared to controls. Amount of CD8+ lymphocytes increased in the high-risk HPV group and consequently CD4+/CD8+ ratio decreased. Marker CD69+ was detected (after in vitro cell stimulation) in 68.5% cells in group (1) at that time, in group (2)and control patients it was 55.4% and 53.6% cells respectively. The indexes of c-IFN decreased 4-6 times and those of y-IFN decreased 6-8 times in comparison to control group. A dramatic elevation of serum and spontaneous IFN was found. Conclusion: Diseases of the lower genital system caused by HPV develop in the presence of suppression of immune and interferon systems, reliable decrease of gammainterferon followed by an increase of serum interferon, and suppression of T-cellular chain activity which is expressed by an increase of CD8+ leukocytes and a decrease in CD4+/CD8+ ratio. This study leads to an individual choice of immunocorrectors for a patient in accordance with individual therapeutic approach, based on the individual hyperactivity. Apparent Failure of One Injection of Benzathine Penicillin G for Syphilis During Pregnancy in HIV Seronegative African Women Donders GGG,* Desmyter J.,* Hooft P,* Dewt GH** *Katholieke Universiteit, Leuven, Belgium; **Universiteit van Pretoria, South Africa Objectives: Is one injection of2.4 million units ofbenzathine penicillin G sufficient treatment for early syphilis during pregnancy (CDC guidelines 1993)?

Results
Study Design: Outcome of pregnancy was prospectively analysed after 0 to 3 weekly intramuscular injections of benzathine penicillin G in 180 of212 HIV seronegative black urban women with syphilis in Pretoria, South Africa. Results: One hundred and eight women receivir/g two or three weekly intragluteal injections ofbenzathine penicillin G had a favourable pregnancy outcome. However, after only one injection, lower birth weight, increased immaturity, prematurity, and total preterm birth rate resulted. Treponemicidal coverage of3 weeks or less resulted in decreased birth weight (2748 vs. 3130 g, P 0.004) when compared to treponemicidal coverage lasting longer than three weeks. Also the relative risk for prematurity (OR 8.5,c195 2.5-28). perinata! mortality (OR 20.5, c195 2.3-1 84) and congenital syphilis (RR 2.0, c 195;0.6-6.8) were increased when coverage was less then 3 weeks. These results were comparable to when no treatment was given. The majority ofincompletely treated women delivered at less than 4 weeks after they received their injection. These also had the worst neonatal outcome. Impaired outcome due to short treatment clustered in early attainders ofprenatal care and when the initial RPR titer was higher than 16. Conclusion: One intramuscular injection of 2.4 million units benzathine penicillin G or treponemicidal concentrations lasting 3 weeks or less are not sufficient therapy for pregnant women with syphilis. Two injections of 2.4 million units benzathine penicillin at least one week apart are recommended.
Cytometric DNA Analysis of Condyloma Acuminatum With Two Different Treatment Approaches Yorganci A,* Dtinder I,** Ortac F,** Tezcan S** *Ankara Numune Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey **Ankara University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey Condyloma acuminatum is a sexually transmitted disease with high recurrence rates. The aim of this study was to predict the recurrence ofthis disease before using two different treatment modalities by flow cytometric DNA analysis. Twenty-seven patients with vulvar condyloma acuminata were randomly divided into 2 groups. From these, 16 patients were treated with CO laser and 11 patients were treated with intralesional interferon. Before treatment, each patient was evaluated with flow cytometry to determine the presence of aneuploidy, DNA index, and S phase. The features of flow cytometry of the recurrent cases were analysed. The recurrence rate of patients treated with CO laser and interferon treatment were 25% (4/16) and 9% (1/11), respectively. Flow cytometric DNA analysis revealed 18.5% diploidy and 81% aneuploidy in 2 patient groups. The presence of aneuploidy, DNA index, and S phase were not statistically different in both treatment modalities and in recurrent and nonrecurrent patients.
The results of this study showed that the prediction of the recurrence of condyloma acuminata can not be possible with flow cytometric DNA analysis.
Analysis of the Selected Intraspecies and Species Features of Strains From Vaginal Ontocenosis ofWomen With Diabetes Mellitus D.Nowakowska,* J. Wilczynski,* A. Kurnatowska** *Institute Polish Mother's Memorial Hospital, **Chair of Medical Biology and Parasitology, Medical University of Lodz, Poland Introduction: The objective of the study was the analysis of the fermentation properties and the ability of carbon assimilation from 19 chemical compounds by fungi strains isolated from vaginal ontocenosis of women with diabetes mellitus. Materials and Methods: The fungal strains were isolated from vaginal ontocenosis of 72 women with diabetes mellitus whose mean glucose values did not exceeded 5.27mmol/ L (95 mg/dl). 30 morphological (macroscopic and microscopic) features of cultures (vegetative cells, blastospores, pseudohyphae), formation of ascospores (Gorodcov's medium) and biochemical features of each of 63 axenic strains were described for species identification. The strains were identified using API 20C and API 20C AUX tests according to the principle of numerical identification (Analytic Profile Index, bioMerieux, Lyon 1990). Results: Out of 63 fungal strains, 53 were presented by C.albicans, 4 by C.glabrata, 3 by C.tropicalis, by C.parapsilosis and 2 by S.cerevisae.There were 4 codes identified for C.albicans (2576174 76.6%, 657174 1.6%, 2776174 -4.8%, 2572174 2.7%), 2 codes for C.tropicalis (25763750-1.6%, 2576177-2.7%) and code separately for C.glabrata (2000040-6.4%), C.parapsilosis (6756135-1.6%) and S.cerevisae (2040070-2.7%). The chemical compounds showing taxonomic value for subspecific discrimination of species was glycerol, xylitol, 2-keto-a-gluconian and Lmethylo-D-glucoside. Conclusion study was to evaluate the correlation between clinical data and 50 characteristics of Candida strains isolated from two ontocenoses of pregnant diabetic women with different types of diabetes mellitus. The relationship between clinical symptoms and different fungal features was searched according to their own scheme. Data were collected in a special computer program. The fungal strains were isolated from 100 women with pregestational diabetes mellitus (PGDM) or gestational diabetes mellitus (GDM:GDM-1,GDM-2). CIinical evaluation ofthe 10 signs and symptoms of candidosis was performed. The control group covered 100 pregnant women without diabetes mellitus. The characteristics of axenic strains were assessed owing to their own methods and unified tests (bioMerieux: API20 C, API20 AUX, API 20 ZYM). Correlation coefficient (r) was used to measure the relationship between two variables. The prevalence of fungal strains in diabetic pregnant women was 30-50 percent. In the control group candidosis occured in 20 percent ofwomen. The highest correlation coeffcient (r) related to bifocal infections of Candida. In the group of diabetic pregnant women there was a strong correlation between presence offungi iia vagina (r from +0.45 5 to +0.720) and the symptoms, i. e., pruritus, swelling, redness, burning, abnormal discharge, and general diagnosis of colpitis. There are differences in biochemical characteristics of fungal strains isolated from diabetic and nondiabetic women. The correlation for the clinical symptoms of genital infections refer mainly to the high activity of several hydrolases, i.e., esterase (e3), valine arylarnidase (e7), naphtol-AS-BI-phosphohydroIase (e 12), a-glucosidase (e 16). Additional studies are needed to define the relationship between clinical data and Candida strains isolated from different ontocenoses of pregnant women with diabetes.
Results: Increasing disturbance of the lactobacillary flora (lactobacillary grade (LBG) I, IIa, lib, III) was highly correlated with the presence of Garderella vaginalis, Trichomohas vaginalis, enterococci, group B streptococci andEscherichia coli. Vaginal pH, IL-8 and ILl beta increased linearly with increasing LBG, while lactate concentrations and the presence of epithelial cell lysis decreased. A similar pattern of associations with increasing leukocyte count was clear, but, in addition, there was an increase in LIF concentration.
The IL-1-betal/IL-1-RA ratio remained stable, except when vaginal leukocytosis increased. In its severest form, with more than 10 leukocytes per epithelial cell present, a decompensation of the vaginal flora with collapsing IL-1-beta and IL-1-RA concentrations was seen, but with a concurrent sharp increase in LIF concentration. This pattern was completely different from the course of the cytokine concentrations associated with an LBG increase. Discussion: There was a remarkably linear increase in cytokines when either leukocytosis or LBG became more severe. When leukocytosis was extreme, IL-l-beta was no longer produced, but LIF became more severe. We speculate that in extreme inflammation the body tries to limit the damage that can be done by exaggerated cytokine production.
Peroxide Oxidation of Proteins (Oxidizing Modification of Protein) in Pregnancy Taking Its Physiological Course Ivanov II, Crimea State Medical University, named after S.I.Gergievsky (chair of Obstetrics and Gynaecology No:2,chief-assistance Professor Yu.P.Pasechnikov). The aim of the work was to study the state of peroxide oxidation of proteins in healthy pregnant women. 20 healthy pregnant women aged 18 to 25 within 34-40 weeks of gestation were under observation. As a result of investigations it has been established that in healthy pregnant women, compared to healthy nonpregnant women, there is observed lowering of the level of processes of protein oxidation, excluding the rate of oxidizing processes, i.e., the level of metabolic processes is increased. There is different opinion about antibiotic prophylaxis in obstetrics and gynaecology. Some doctors suggest the Metronidazole-infusion at caesarean sections, but many obstetricians use other preparations. We had tried Metronidazole infusion previously in the Postgraduate Medical School of Hungary, but in the past two years we began to give Unasyn for prophylaxis. There was given 2g Unasyn once before the operations. The results showed that the number of complications decreased from 12 to 7.8%. It is our opinion that Unasyn can be used with good results for prophylaxis. Sensitivity to Antibiotics of Group B Streptococcus Isolated From Vaginal Specimens of Pregnant Women Shopova E,* Markova M** Microbiological Laboratory, University Hospital of Obstetrics and Gynecology. **Chair ofClinical Laboratory and Immunology, Sofia, Bulgaria Over a period of 20 months we investigated 1366 vaginal specimens from pregnant women for GBS (group B streptococci carrier in three microscopic patterns, evaluated by Nugent score system). More frequently we isolated GBS in gr.I (4-6 score)-20.8%,(when Lactobacillus Spp. is missing (67.4%), without or associated with GBS strains showed sensitivity to ampicillin and carbenicillin. Good sensitivity was found to cefazolin (92.4%) and to cefuroxim (94.2%). Department ofObstetrics and Gynecology, Jagiellonian University Hospital, Cracow, Poland. Introduction: Although the frequency of premature labour in highly developed countries is established in only 6-8% of all labours, it is the cause of perinatal mortality in about 75%. It is known that the beginning of the labour is a very complicated process, involving both mother and fetus, but 296 INFECTIOUS DISEASES IN OBSTETRICS AND GYNECOLOGY one of the most important factors to be regarded is the infectious factor. Bacteria and their endotoxins induce increased prostaglandin synthesis, which stimulate uterine contracting activity. Materials, Methods andResults: Between 1997-01-01 and1999-07-31 in the Septic Ward ofthe Department of Obstetrics and Gynecology, Jagiellonian University Hospital in Cracow, 727 labours took place. 151 of all labours were premature (20.7%). Premature rupture of membranes was identified in 38 pregnant women (5.2%). At the time of admission on the ward the dilation of the external os was as follows: no dilatation in78 pregnant women (50.03%), less than lcm, 42 (27.81%) from to 3cm, 19(12.58%), from 3 to5cm, 8 (5.29%), and more than 5cm, 6 (3,97%). In spite oftocolitic management (Partutisten, magnesium sulphate), between 24 and 37 weeks of gestation, 151 women laboured., in which in 87 cases (57,61%) it was spontaneous labour, in 20 (13,24%), pharmocologically supported vaginal delivery, and manual fetal extraction procedure in case (0.0062%). 113 neonates was born alive (74.83%), in which 9 had congenital defects (5.96%) and 38 were stillborn (25.16%). The neonates' estimation byApgar scale was as follows: 8-10 points, 55 neonates (48,68%), 5-7 points, 24 (21,24%), less than 5 points, 34 (30.10%). Conclusion: Premature labour is associated with high rate of perinatal mortality and congenital defects.
Among all the pregnancies that have attended in our outpatient clinic, the ectopic pregnancy ratio was 1/8000 with one ovarian case (1.25%) in a total of 80 ectopic pregnancies diagnosed. The differential diagnoses of owarian pregnancy is difficult, the symptoms and signs are like other ectopic pregnancies. C. luteum hematoma is seen frequently. The diagnosis is made mostly during laparotomy and even after the operation during the pathological investigation. In the medical history of this ovarian pregnancy case, 4 pregnancies, one delivery (6 years ago, cesarean section), right salphingectomy because of ectopic pregnancy 2 years previously, and a history of PID were seen. There was no usage of IUD. In the literature it is seen that, unlike tubal pregnancies, ovarian pregnancy usually does not have any relation to PID and infertility and the most important risk factor for ovarian pregnancy is IUD usage. In contrast, in our ovarian pregnancy case there was no usage of IUD but a history of PID was seen. Since ovarian pregnancy is a rare form of ectopic pregnancies, we aimed to present this ovarian pregnancy case seen in our clinic.
Iiili Etfal Teaching and Research Hospital, Third Gynecology and Obstetric Clinic, Istanbul, Turkey Objective: In our study, held in Iiili Etfal Teaching and Research Hospital, Third Gynecology an.d Obstetric Clinic, we aimed to evaluate the thyroid functions in different periods of pregnancy, disorders of thyroid functions found during pregnancy and their effects on maternal-fetal morbidity and mortality. We also aimed to evaluate the goiter cases during pregnancy. Materials and Methods: We assessed 41 pregnant women in the first trimester and 118 in the third trimester. We also evaluated the thyroid function results of 150 women in reproductive period that applied to our hospital biochemistry department. Serum T3, T4, FT4 and TSH values were measured for all pregnant and nonpregnant women. Results: First trimester FT4 values were significantly higher than the values of third trimester and nonpregnant women (P<0.001). The progressive increase in T3 and T4 values during pregnancy were significant when compared with nonpregnant and first trimester values (P<0.001). When we evaluated the 105 women in active labor the incidence of complications (preeclampsia and IUGR) was significantly higher in women with disorder ofthyroid functions (P<0.05 and P<0.01 respectively). We found 33 goiter cases among 159 pregnant women. Conclusion: Changes in thyroid functions during pregnancy were consistent with the findings of other authors. We have also shown that the women with thyroid function disorders were under serious pregnancy risk (especially preeclampsia and IUGR) and under the risk ofpoor neonatal outcome. The frequency of thyroid enlargement-goiter cases probably indicates the deficiency of iodine intake that increases during pregnancy. Thus, it would be appropriate to evaluate all goiter cases before and during the pregnancy period and to start the necessary treatment and supplementation.
The Bacterial Flora of the Vagina in Healthy Turkish Women and in Turkish Women With Bacterial Vaginosis Mamal Torun M,* Bahar H,* (ger F.** Istanbul University, Medical Faculty ofCerrahpaia, *Department ofMicrobiology and Clinical Microbiology, **Department of Obstetrics and Gynecology, Istanbul, Turkey The aim of this study was to determine the bacterial flora of the vagina in healthy women (HW) and in women with bacterial vaginosis(BV). The vaginal samples of 100 HW and samples of 100 women that were determined to have BV by clinical symptoms shown in microscopic exams oftheir Gramstained vaginal smears were studied. The facultative microorganisms and the anaerobic microorganisms were isolated and identified. The results were confirmed by API and SCEPTOR panels. The number of each microorganism was evaluated and for hypothesis testing the Mantel Haenszel test for linear association of ordinal data was used. The value <0.05 was considered statistically significant. The isolation rate of facultative bacteria and anaerobic bacteria which grew in a high concentration and which show.ed a significant difference between the two flora (HW and BV) with a P value < 0.01 was as follows. Gardnerella vaginalis 75% in BV, 25% in HW, Mycoplasma hominis 71% in BV, 25% in HW, Ureaplasma urealyticum 84% in BV, 33% in HW, viridans streptococci 78% in BV 32% in HW and Lactobacillus sp 0% in BV, 53% in HW, Prevotella bivia 85% in BV, 8% in HW, Pdisiens 83% in BV, 5% in HW, Fusobacterium nucleatum 69% in BV, 0% in HW, Peptostreptococcus prevotii 68% in BV, 17% in HW, Pasaccharotyticus 66% in BV, 10% in HW, Pmagnus 79% in BV,0% in HW, Mobiluncus curtis6 14% in BV, 0% in HW, M.mulieri 11% in BV and 0% in HW. As a result we think that because of the recognized role of the endogenous vaginal flora in complications of pregnancy and infections of the upper genital tract it is important to gain a better understanding of the composition of this system in our population.
Laparoscopic Diagnosis and Therapy of Salpingitis Udo B. Hoyme, Ute Mahnert Department ofGynaecology and Obstetrics, Klinikum Erfurt, Germany Objectives: Salpingitis has a complex etioiogy dominated by Chlamydia trachornatis (Ct) and by Neisseria gonorrhoeae (Ng), however, the particular pathogen is difficult to identify, even in laparoscopically obtained specimens, since results from the lower genital tract do not always correlate with those from tubal swab samples. Several techniques have been described, including one invented in 1980 using a specially designed swab instrument directly inserted through the working channel of the laparoscope. Study design: The microbiological results of tubal swab specimens are compared with those from urethral and cervical swabs of patients with laparoscopically diagnosed .salpingitis. Ct was identified by means of PCR and/or LCR, Ng(and other  It increases from about 5% incidence in the reproductive age group to about 10% by the early postmenopausal years. UTI in the gynecological patient is also associated with medical, surgical and gynecological problems. The prevalence of infection is reported to be 15 to 25% in women with uterovaginal prolapse, 10 to 100% in patients with cervical carcinoma or 80 to 100% after surgery with catheterization and up to 30% without catheterization. The prevalence of postoperative bacteriuria is correlated with the procedure performed, with vaginal and periurethral traumatization as well as with duration of catheter placement. The spectrum of pathogens in UTI is Escherichia coli 76%, Proteus 2%, Pseudamonas 1%, Klebsiella 1%, Staphylococcus spp. 7%, Streptococcus/enterococcus spp 12%. For treatment, short-term and single-dose regimens are used in patients with uncomplicated or postoperative UTI since these infections involve only the superficial mucosal epithelium layers. The indications are as follows: Symptoms for less than one week, reproductive age women, women with iatrogenic infection, exclusion of predisposing disorders, no anatomical abnormalities, no diabetes, opportunity of clinical control, reliable patient. In our own prospectively randomized studies we treated women with postoperative UTI by nitrofurantoin, trimethoprim/sulfamethoxazole and ciprofloxacin for two days or by single dose in comparison to established conventional therapy regimen: The efficacy of single-dose administration of 480/2400 mg trimethoprim/sulfamethoxazole (85%, n=82 vs. 92%, n=83; n.s., 2-test) and 250 mg ciprofloxacin (94%, n=62 vs, 95%, n=65; n.s.) was as good as traditional policy. However, cure rates following two days of nitrofurantoin were demonstrated to be inferior (normal 69%, n=67 vs. 86%, n=65; P < 0,05; macrocrystals 73%, n=91 vs. 85%, n=99; P < 0.05), This is likely explained by the poor tissue penetration of this antimicrobial substance. In another prospectively randomized study, ciprofloxacin given to outpatients with uncomplicated UTI as 250 mg single dose versus 250 mg b.i.d, for 3 days led to cure rates of 18% and 91% (P <0.05). The high failure rate in the single dose group was mainly due to persistence of E. coli and reinfection with enterococci.
The benefits of short-term/single dose therapy of UTI are as follows: efficacy, excellent compliance, few side effects, low cost, limited emergence of resistant bacteria, identification of patients at risk by treatment failure.
Reduction of Prematurity by pH-Screening--The '98 State Udo B. Hoyme,* A. Grosch,* V.M. Roemer,** E. Saling*** *Department of Gynaecology and Obstetrics, Klinikum Erfurt, **Department of Gynaecology and Obstetrics, Klinikum Detmold, ***Institute of Perinatal Medicine, Berlin, Germany Objectives" Bacterial vaginosis (BV) increases the relative risk of prematurity. In these cases the preterm birth rate can be reduced by early intervention with antimicrobial substances such as clindamycin.
Study design: Women seeking prenatal care in one of 29 outpatient offices in the city beginning 10/96 were informed and requested to practice self-measurement of the vaginal pH every three days in order to screen for BV: Care Plan VpH gloves (Selfcare, Oberhachingen) were used in identifying patients at risk by means of a pH > 4.7. These women were instructed to see their physician immediately to have BV possibly confirmed and treated with clindamycin cream (Sobelin, Upjohn, Erlangen) i.vag, initiated, otherwise lactobacilli 107/estrioil 0.03mg (Gynoflor, Nourypharma, OberschleiBheim) were administered i.vag, for 6 days. Patients of 18 not participating local obstetricians and woman not consenting to participate in the study served as controls.
Results: Up to 12/98, 73 of 381 women in the intervention group were identified with a pH > 4.4.58 were treated with lactobacilli, 24 additionally with clindamycin cream because ofBV and 3 had no therapy. In this ongoing study the prematurity rate was 8.1% in the intervention group vs. 12.3% in controls (n=2.341; P < .05). 0.3 vs. 3.3% of the neonates were born at < 32 gestational weeks (P<0.01). PROM was registered in 22.8% vs. 30.8% (P < 0.01) respectively. Conclusion: Self-measurement of vaginal pH at close intervals according to Saling seems to identify women at risk for prematurity. Earliest possible intervention either with lactobacilii or in case of confirmed BV with clindamycin appears to result in a reduction of preterm birth and in particular of newborns less than 32 weeks. Septic shock is a life threatening disorder which can be associated with obstetric conditions. Successful management is of ultimate importance and depends on early identification and aggressive treatment. We report here a young woman who has developed septic shock after operative delivery in week 32 of pregnancy. Clinical features, treatment modalities, and prognosis of this high mortality rate disorder are presented and discussed.
Case Report: A 24-year-old woman, gravida 1, para 1, was referred to our clinic in a confused state and immediately admitted to our emergency service. She had eclampsia antenatally. Termination of pregnancy with induction of the labor following vacuum extraction had been applied in gestational week 32 of pregnancy. One day after delivery, her clinical and laboratory parameters worsened and she was referred to our clinic. After a thorough physical examination and laboratory evaluation, the patient was diagnosed with sepsis and disseminated intravascular coagulation.After blood and urine cultures were taken, aggressive management included volume repletion, antibiotics, and positive inotropic therapy. As she had persistent fever and unimproved laboratory values despite these therapies for 72 hours, the uterus and ovaries were thought to be the source of sepsis, total abdominal hysterectomy and bilateral salphingooopherectomy was performed. Neither clinical nor laboratory parameters improved and on the 16th postoperative day, the patient died of gram negative septicemia.

A Case of Septic Shock Developing Rapidly After Elective First Trimester Curettage
Baigtil Alin, Durmuioilu Fatih, Tufan Ergtin Marmara University Hospital, Department of Gynaecology and Obstetrics. Istanbul, Turkey Septic shock is a life threatening disorder that can be associated with obstetric conditions. Successful management is of ultimate importance and depends on early identification and aggressive treatment. We report here a young woman who developed septic shock rapidly after an elective first trimester abortion. Clinical features, treatment modalities, and prognosis of this high mortality rate disorder are presented and discussed.
Case Report: A 27-year-old woman, gravida 2, para 1, was admitted to our emergency service with the complaint of nausea, vomiting, and diarrhea which had started one to two hours after elective abortion that was performed earlier that day. She had fever of 38.5C, mild tacypnea and mild dyspnea. After a thorough physical examination and laboratory evaluation it was found that she had mild suprapubic tenderness, prolonged prothrombin time and elevated liver enzymes, fibrin degradation products and low platelet count. Her arterial blood gas measurement showed hypoxemia. The patient was diagnosed with sepsis and disseminated intravascular coagulation and admitted to the intensive care unit of our hospital. After blood and urine cultures were taken, aggressive management included volume repletion, antibiotics and positive inotropic therapy.
Since the patient had a persistent fever and unimproved laboratory values despite these therapies for 72 hours, the uterus and ovaries were thought to be the source of sepsis and total abdominal hysterectomy and bilateral salphingooopherectomy was performed. Four days after the operation, all the clinical and laboratory parameters were improved and on the postoperative tenth day she was discharged from hospital with oral antibiotic therapy and estrogen replacement therapy. Introduction: The objective of the study is to fortify subjective and clinical improvement of the condition in the patients with recidivant colpitis, after the treatment with Policresulen vaginal suppositories, and to fortify the influence of the therapy in the finding of "satisfactory but limited with inflammation" PAP, which is very frequent in such patients. Materials and Methods: Fifty-seven patients in the therapy group and 44 patients in the control group with symptoms and clinical findings of recidivant colpitis were included in this study. All patients were of reproductive age and HIV negative. Protocol for clinical assessment and questionnaire with "Discomfort score system" (0-3 Insignificant discomfort, 4-6 Moderate discomfort, 7-9 Hard discomfort) was used. Ten days treatment with Albothyl (Policresulen 90mg, BYC GULDEN), with control of symptoms and clinical picture after 3 weeks was performed. PAP was reviewed before and three months after the treatment. (0.5%)** *Anti-HBs titers equal or above 10 mIU/ml were accepted as positive for protection against HBV infection. Ofthese 93 anti-HBs (+) women, mean antibody titer was 235. 10 + 212.13 mIU/ml (minimum 12 mIU/ml, maximum 650 mIU/ ml). ** This patient was tested twice for anti-HIV antibody in our laboratory and both results were positive. According to legal regulations, patient was transferred to a governmental reference laboratory for confirmation by Western Blot; final result there was reported as "negative".  It is seen that in routine followup ofpregnant women usually only HBsAg among above markers was ordered. Thinking of the dramatic outcome of any possible HCV or HIV infection in pregnancy, we suggest that anti-HIV antibody and anti-HCV antibody tests should also be included to prevent any risk to the fetus; and that it would be better (from both an immunological and economical point of view) to test at first anti-HBc total antibody (both IgM and IgG against core antigen ofHBV), where it is available, rather than HBsAg alone or HBsAg and anti-HBs together to show any sign of exposure to HBV. If anti-HBc total is found to be negative; there will be no need for further tests; however, if it is found to be positive, then it would be better to investigate the whole serologic panel for HBV. then evaluated under the light microscope. Using a light microscope, a pronounced reduction of ciliated cells in the epithelium of fallopian tube, increased number of mast cells, and inflammatory cell infiltration were found in the lamina propia in IUCD users as compared to nonusers, in the same menstrual period. Mast cells are known to contain potent biological mediators and these may be responsible for local inflammatory reactions. These findings may be a factor in the pathogenesis of pelvic inflammatory disease and ectopic pregnancies that occur in IUCD.
ABSTRACTS 20-40). The average number of pregnancies was 4.1 (range 1-11) and the average number of living children was 2.7 (range 1-6). The most common complaints were leucorrhoea (82.5%), lower abdominal pain (42.5%), lombalgia (17.5%), postcoital bleeding (7.5%), dyspareunia (5%), urinary symptoms (2.5%) and pruritus (2.5%). 10% ofthe patients had no complaint. 39 ofthe smear results were normal (Class I), with one Class II result. 42.5% of the patients had an IUD, 27.5% practiced coitus interruptus, 15% used condoms, 5% oral contraceptives, and 7.5% used other methods. The microbial flora revealed Chlarnydia trachomatis (7.5%), Neisseria gonorrhoeae (7.5%), Ureaplasma urealyticum (35%), Mycoplasma hominis (17.5%), bacterial vaginosis (25%), Proteus mirabilis (5%), Trichomonas vaginalis (2.5%) and streptococci (12.5%) as etiological agents. All patients were married and had apparently just one sexual partner. Conclusion: Cervicitis is of importance especially because of its association with serious upper genital tract infections. Considering that all women apparently had only one sexual partner, the overall rate of microbial etiology capable of resulting in PID was higher than we expected. Medical Academy of Latvia, Riga, Latvia Introduction: Topicality of the problem of pelvic inflammatory disease (PID) is due to its high incidence in the countries of Eastern Europe. The combination of induced abortion with widely spread sexually transmitted diseases (STD) directly influences the reproductive health of the population and causes infertility. The goal of the study is to evaluate the factors influencing the incidence of PID, family planning practice in Latvia and the relation of different methods of contraception with PID. Materials and Methods: The results ofthe survey on reproductive health and sexual behaviour of the population of Latvia (2990 women were interviewed), the study ofthe role of intrauterine contraception (IUD) in the epidemiology of PID (127 hospitalized PID patients and 100 women in the control group), the study of the role of induced abortion in the epidemiology of PID (the analysis of the medical history of 126 hospitalized PID patients with tuboovarian abscesses) are included. Results: 26.6% ofwomen in Latvia have started their sexual activity prior to the age of 17, 24.5% ofsexually active women in the age group of 15-19 have had 4 or more sexual partners. The number of IUD users among the patients hospitalized due to PID was two times higher than among the control group (P<0.005). 40.48% of patients with tuboovarian abscesses stated that the first episode of PID was related to an induced abortion.
Conclusion: The early sexual activity of young people and lack of knowledge about safe sex increases the incidence of PID and is to be considered a serious health care hazard and an educational problem in Latvia. IUD should be recommended after the risk of STD has been evaluated, the screening of urogenital chlamydiosis is recommended. Patients under the age of 25 who come for an induced abortion are to be screened for urogenital chlamydiosis before the abortion or preventive doxocycline treatment is to be prescribed. Our results may be summarized as follows:  per 100,000 population.
In the Scandinavian countries the incidence is now below per 100,000. The question has thus been raised, ifthe obligatory prenatal screening program ought to be discontinued.
In Norway during the last 10 years, from 1989-1998, approximately 650,000 pregnancies have been screened and only 59 cases of syphilis have been identified. In 9 cases serology and history were suggestive of early infectious syphilis while in the remainder latent infections (>1 year) were identified. Approximately half of the cases were immigrants. All women were treated and delivered live born infants without stigmata ofcongenital syphilis. Taking into consideration a vertical transmission rate of 90% in early syphilis and 10% in late syphilis, 13 children were expected to be infected without a screening program. In addition, in this period 11 cases ofcongenital syphilis were detected, all were adopted or immigrant children from Asia or South Africa. Even in a country with a very low sero prevalence the antenatal screening program (using TPPA or TPHA which detect latent infections), is found to be cost effective. Thus, it is decided that routine screening should be continued. The antenatal screening is today the only syphilis surveillance in our country and is of importance since our neighbours in Russia and the Baltics at present experience a syphilis epidemic with a 100 fold increase. In these countries pregnant women should be tested twice, at the first antenatal visit and repeated at the end of pregnancy.
Chronic Toxoplasmosis and Its Treatment During Pregnancy Prof. Dr. Sevim Dinger CENGIZ,Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology Epidemiological evidence suggests that 25-50% of world's population have been infected by Toxoplasma gondii. The seropositivity can be as high as 90% especially in countries consuming raw meat such as Turkey. The cyst form is responsible for persistence of latent infection in multiple organs as brain, heart muscle, and skeletal muscle where they persist throughout the life of the host. In immunocompromisod carriers such as HIV patients, malignancy or in the absence of maternal immune response in pregnancy, reactivation of the infection may occur and parasitenva is seen. This leads to disruption of llssuc cysts and release of trophozites into the circulation. Fetal infection can be observed during the primary infection in pregnancy. The passage is usually seen in the last trimester but the damage caused by the infection is smaller. Fetal infection usually leads to fetal demise in the first trimester or may cause multiple organ defects. Reactivation of toxoplasmosis usually presents with habitual abortion, preterm labor and fetal demise. There is evidence that some chronically infected mothers have loci of Toxoplasma gondii in the uterus. In patients with above mentioned pathologies the possibility of a reactivation during pregnancy must be kept in mind. We have been studying chronic toxoplasmosis during pregnancy since 1975. After ruling out all reasons for the above mentioned pathologies, the treatment of patients with toxoplasmosis remarkably increased the rate of live births. In the beginning of this study, Sabin-Feldman dye test and indirect fluorescence antibody tests were utilized for the diagnosis of toxoplasmosis. Recently we have been using polymerase chain reaction (PCR) to detect the active infection. Due to reactivation of the CNS, toxoplasmosis in AIDS cases of chronic disease gained greater interest which led to discussion of new diagnostic tools such as PCR and new treatment modalities. Treatment is only indicated when a clear therapeutic benefit can be demonstrated. We have been using pyrimethamine since 1975 for the treatment of toxoplasmosis during pregnancy. Although it has teratogenic potential we have not observed any teratogenic effects of the therapy in our series. The success of the therapy depends on the timing of the treatment and the treatment must be initiated as early as weeks 7 or 8 of pregnancy. Due to the known side effects of high dose pyrimethamine therapy we developed our "attack" treatment. The schema of treatment (Dinger formula) is as follows 325 mg for first 3 days, 225 mg for the following three days and 25 mg for month. This drug is combined with folinic acid since pyrimethamine is a folic acid antagonist. The treatment was monitored with IgG titers at week 20 of pregnancy. If the titers were high then spiramycine was administrated as a new line of therapy.
Feminine Hygiene Practice Among Health Care Personel in Turkey Saracoglu OF, Yilmaz N, Eiilmez P, Akul H Numune Resarch and Training Hospital, Dept of Obstetrics and Gynecology, Ankara, Turkey Aim: Research in the area of feminine hygiene practice of Turkish women is limited. In the present study information related to feminine hygiene practices among nurses was searched.
Method: A descriptive research design was used to examine feminine hygiene practices among 250 nurses who were 20 years of age or older, working at the Ankara Numune Research and Training Hospital. A questionnaire containing 28 questions about feminine hygiene was developed after a literature review.
Results :All the participants were Muslim. 71% were married, 18% divorced and 11% single. 26% reported that they took a shower everyday, 62% took a bath every 2-3 days, whereas 1% used a tub for bathing and 98% used a handheld shower. 22% of the participants reported never douching vaginally whereas 29% douched sometitimes and only 49% always used an internal douche. 12.5% of the participants used panty liners during intermenstrual period, whereas most never used feminine hygiene spray (3%), deodorant vaginal tablets or suppositories. Wet wipes were used by 4% of the nurses and the practice of wiping from front to back was always done by 90% ofthem. Hands were always washed after urination/defecation by 92% ofthem. During menstruation 62% of the nurses used sanitary napkins and less than 1% of them used tampons. 50% of the responders washed their hands before and after changing their pads or tampons. When they used sanitary napkins 57% ofthem changed them at least every 2-4 hours, if they used tampons % of them changed it at every 2 hour interval. Conclusion Results ofthe study shows that even ifthe participants were health personnel it is important to teach women some correct feminine hygiene practices.
The Comparison of Piperacillin Use for Prophylaxis of Post Cesarean Section Infection Before andAfter Clamping Umblical Cord Gtil A, Zeteroilu I, Stirticti R Ytiziancti Yil University, Faculty of Medicine, Dept of Obstetrics and Gynecology, Van, Turkey Objective: We aimed to research efficacy ofpiperacillin use for prophylaxis of cesarean section infection before making incision and after clamping umblical cord. Material and Methods: A prospective randomized trial enrolled 57 pregnant women undergoing abdominal cesarean section due to any indication in our clinic during the period between February to September 1999. The sociodemographic status, complaints, and preoperative and postoperative physical findings, together with laboratory findings, indication for cesarean section, and duration of hospitalization of all patients were recorded onto previously prepared forms. Also the weight, sex, Apgar score and physical examination findings of all neonates were recorded and they were followed by us together with the neonatal care unit. 30 pregnant women were randomly assigned to receive gr piperacillin intravenously before making incision and to 27 other pregnant women, piperacillin was administered intravenously immediately after clamping umblical cord following delivery of fetus. Totally 3 doses of piperacillin were administered to women with 12 hours interval. Results: The findings ofmaternal and neonatal demographic status were similar in two groups. There was no significant difference between two groups by means ofpredisposing risk factors causing infection in postcesarean section period. The maternal diagnosis ofmaternal infection included occurrence of fever, high white blood cell count, endometritis, septic thrombophlebitis, pneumonia, urinary tract infection and opening or infection of the incision line. In first group that piperacillin was administered to before making incision, as a postoperative complication only induration was developed in 2(7.1%) patients. In other group that receiving piperacillin immediately after clamping umblical cord, induration, opening of incision line, and endometritis in cases of 1(3.8%), (3.8%) and (3.8%), respectively, were seen as postoperative complications. So, there was no significant difference between two groups by means of postoperative complication rate. In addition to that no neonatal infection developed in either group. Conclusion: Abdominal cesarean section is the most commonly applied operation in obstetric surgery. Widespreadly, for prophylaxis after ceserean section, antibiotic is given immediately after clamping umbilical cord. Although no significant difference was detected according to postoperative complications between two groups in this study, we believe that antibiotic for prophylaxis must be administered at preoperative period to reach effective blood dose levels during operation by obeying prophylaxis rules. In our opinion, better results may be obtained in maternal and neonatal morbidity.
Transvaginal Sonography in Detection of Pelvic Inflammatory Disease A. Kurjak, S. Kupesic, T. Zodan, I. Bekavac Department of Obstetrics and Gynecology, Medical School University of Zagreb, Sveti Duh Hospital, Zagreb, Croatia Objective: To assess the value of B-mode transvaginal sonography in the evaluation of the patients with laparoscopically proven pelvic inflammatory disease. Materials and Methods: Seventy-two patients with acute symptoms of pelvic inflammation, 11 patients with chronic pelvic pain and 19 patients with infertility suspected oftubal etiology were admitted to our department. Endometrial thickness and morphology were evaluated together with ovarian measurements and morphological appearance. The equipment used in the study was Aloka SSD 2000 with transvaginal transducer of 5 MHz. Results: Endometrial morphology suggestive of endometritis was demonstrated in 72 patients (70.6%). Free fluid in the cul-de-sac was demonstrated in 39 (38.2%) patients. Ovarian enlargement as the only finding was demonstrated in 6 (5.9%) patients, while 22 (21.6%) presented tubular adnexal structures. In 74 (72.5%) patients transvaginal sonography detected complex adnexal mass. Conclusions: Transvaginal sonography is a useful tool in detection of patients with pelvic inflammatory disease. In acute stages one can detect both uterine and adnexal findings (increased endometrial thickness and echogenicity, ovarian enlargement and/or complex adnexal mass). However, in chronic stages the most common finding is tubular adnexal structure presenting dilated tube without changes in uterine and ovarian morphology.

Prevalance of Bacterial Vaginosis in Patients With Various Gynecological Complaints
Petek Deniz Ugkan, Fadil Kara, Salim Erkaya, Serdar Hence, bacterial vaginosis is a curable disease; diagnosis and treatment are essential to prevent complications.

Pelvic Tuberculosis
Saracoglu OF, Tanzer F, Ttirkkani B Ankara Numune Research and Training Hospital, Dept Ob&Gyn, Ankara, Turkey Aim: Even if it is not common, pelvic tuberculosis is still a health problem in developing countries. In the present study our aim was to search the clinical and laboratory findings of these patients. Materials and Method: Retrospectively the files of the patients in which pelvic tuberculosis was diagnosed (n: 78 during the years 1979-1999 were analyzed. Results: Twenty-nine percent of the patients were over 40 years of age. The most common complaints were infertility (n:34, 43.5%), abdominal or pelvic pain (n:25, 32%) and abnormal uterine bleeding (n: 12, 15.3%). Only 2 patients had past or family history of pulmonary tuberculosis. The physical examination was normal in 31.6% of the patients.
The chest X-ray was normal in 81% of the patients. Blocked tubes were present in 32 of 34 patients who had hysterosalpingograms. Even ifthe diagnosis can be made from a histopathologic examination, hysterosalpingography is also a very useful aid in establishing a diagnosis. The most common site of infection was the tubes. Reconstructive surgery was performed in nine patients. Only one pregnancy was found in the present study without any medical or surgical treatment of pelvic tuberculosis. In one patient with habitual abortion endometrial tuberculosis was also found as a cause. Conclusion: Pelvic tuberculosis is a serious but rare disease in our population. However it must be in mind in infertile population. Although the diagnosis is made by endometrial biopsies in all the patients with infertility, in 94% of them tubes were found to be blocked. Therefore it is unnecessary to check them by HSG and they are candidates for IVF after medical treatment.  (BV), an imbalance in the vaginal ecosystem, is the most commonly diagnosed vaginal "infection" in the United States, although up to 50% of patients may be asymptomatic. It is important to screen and treat for this condition, as it has been associated with a number of adverse outcomes.

Serious Consequences of Bacterial Vaginosis
In nonpregnant women, those with BV frequently have evidence ofupper genital tract disease, including histologic evidence of endometritis. BV organisms are isolated in most cases of pelvic inflammatory disease, and patients with BV have an increased incidence of postabortal infection and of cuff cellulitis following hysterectomy. BV has also been associated with an increased risk of cervical dysplasia. Trials to study the efficacy of treatment in preventing these complications are lacking.
In the pregnant patient, the presence of BV or BV organisms has been linked to an increased risk of infectious complications, including intra-amniotic infection and postpartum endometritis. BV organisms are frequently isolated in these peripartum infections. The risk ofpreterm birth (PTB) is also increased 3 to 7 fold in the presence of BV. Treatment trials in pregnant women reveal that systemic treatment of BV decreases the risk of PTB in women who are at high risk for this complication. The benefit of BV treatment in women at low risk for PTB is less clear, as is the impact on the incidence of infectious complications. In conclusion, BV is a common condition with myriad consequences. Screening for and treatment ofbacterial vaginosis is an important part of gynecologic and obstetric care.
Genital Mycoplasmas Aydin D Department of Microbiology and Clinical Microbiology, Medical Faculty of Istanbul, (apa-Istanbul, Turkey Mycoplasmas are the smallest free-living organisms. They lack a rigid cell wall that renders them poorly stainable by Gram method, resistant to cell wall-acting antimicrobials (such as penicillins, cephalosporins, etc.) and display extreme pleomorphism. Of the mycoplasmal species that can be encountered in the normal human genital tract, Ureaplasma urealyticum, Mycoplasma hominis, and Mycoplasma genitalium are considered important.
Ureaplasma urealyticum and Mhominis can be isolated from healthy persons in high percentages; 40-50% of healthy females and 30-40% of healthy men include these microorganisms as part of their resident genital flora. Genital mycoplasmas constitute a smaller part of all female genital tract infections than is supposed. The association of genital mycoplasmas with female genital tract are categorized in three groups; cases in which genital mycoplasmas are proved to be as definitive causative agents, cases in which they are deemed to be probable causative agents, and cases in which it is shown that they are not the causative agents. Although there are considerable findings that U. urealyticum may play a role in repeated spontaneous abortion, stillbirth and Reiter syndrome, and M. hominis in abscess of Bartholin's gland, further studies are still needed to ascertain these findings. Genital mycoplasmas are not causes of vaginitis and cervicitis.
The most reliable and frequently used methods for diagnosis are culture for U. urealyticum and M. hominis, and PCR for M. genitalium. Doxycycline is the preferred drug in the treatment of NGU. In cases that are resistant to tetracyclines, macrolides or quinolones may be used.
The ABC's of Hepatitis in Pregnancy Dinsmoor, MJ. Associate Professor, Department of Obstetrics and Gynecology. Medical College of Virginia of Virginia Commonwealth University. Richmond, Virginia; USA Viral hepatitis is a frequent complication of pregnancy, usually in its chronic form. A review of the different types of viral hepatitis follows. The incidence and prognosis ofhepatitis A is not different in pregnancy. It is not teratogenic, and is very rarely vertically transmitted. A vaccine, which is safe in pregnancy, is currently available. Most pregnant patients with hepatitis B are chronic carriers.
Since most seropositive pregnant women have no risk factors for infection, routine screening for this infection is recommended for all pregnant women in the United States. Babies ofwomen with hepatitis B are given HBIG and hepatitis B vaccine at the time of birth, while babies of seronegative women are administered the vaccine alone. Breast feeding does not increase the risk of vertical transmission. The most seroprevalent form of viral hepatitis in pregnancy is hepatitis C, although 25-50% of infected women have no risk factors for infection. The risk of vertical transmission is not high (probably < 10%), although it is increased if the mother is also HIV-infected or has circulating HCV RNA. The long term neonatal outcome following perinatal hepatitis C infection is not known. Breast feeding does not appear to increase the risk of vertical transmission, although scant data are available.
Hepatitis D is present only in conjunction with acute or chronic hepatitis B infection. Measures to prevent spread of hepatitis B will also be effective in curtailing hepatitis D. Hepatitis E is usually diagnosed on clinical grounds, and causes a mild and self-limited illness in most cases. In developing countries, there appears to be a higher attack rate and higher case-fatality rate during pregnancy. Vertical transmission can occur, but it is not known how frequently.

Vaccination in Pregnancy
Dokuzoiuz, B. Ankara Numune Research and Training Hospital Dept. of Infectious Diseases and Clinical Microbiology, Ankara, Turkey As people realized that childhood vaccine program is insufficient to eliminate some vaccine preventable diseases, adolescent and adult vaccine scheme were found to be important. On the other hand, the beginning of childbearing age of women was accepted as about 15. Thus, the period of pregnancy and routine vaccination program may coincide. Vaccination ofwoman whose pregnancy is not known may cause serious problems. Also, pregnant women may need vaccination for epidemics, travel, occupational and environmental exposure, etc. Because of unknown but theoretical risk to the fetus, immunization of pregnant women is generally avoided. Tetanus vaccine has a special importance. To avoid puerperal and neonatal tetanus, all the pregnant women nonor inadequately immunized before have to be vaccinated by tetanus vaccine. Inactivated, recombinant, polysaccharide vaccines(hepatitis B, hepatitis A, influenzae, meningococcal vaccine, pneumococcal vaccine, rabies, inactivated polio vaccine) can be administered safely to pregnant women ifthere is a necessity. However, live vaccines (oral polio vaccine, measles, mumps, rubella, yellow fever, varicella vaccine) are certainly contraindicated for pregnant women. Although, oral polio vaccine and yellow fever vaccine are live vaccines, they may be applied to pregnant women in very exceptional situations. Immune globulins are safe for pregnant women.
Continued Decreased Vertical Transmission With Combination Antiretroviral Therapy in Pregnancy Hammill,. Hunter A; Shearer W; Hanson C; Polk R.: Baylor College of Medicine, Houston, Texas USA Objectives: To review our experience with regard to maternal safety and infant outcome in HIV-infected women treated with triple combination therapy during gestation. Design: Retrospective, single-center study. Methods: A chart review is being conducted of women who initiated triple therapy with combivir and nelfinavir or combivir and indinavir usually at 20 weeks gestation and who have delivered their infants. Virologic follow-up data on infant status is obtained from the Baylor College ofMedicine Pediatric Department ofAllergy and Immunology, as it becomes available.
Results: Data on 98 women who delivered between 21 July 97 and August 1999 are summarized. Treatment was well tolerated; there were no unusual symptoms reported, and no increased frequency of symptoms normally seen in this patient population. Early nausea was felt to be due to pregnancy and not drugs. All patients received intrapartum zidovudine, in cases prior to membrane rupture. Eighty-four (84) deliveries were vaginal, including delivery of 6 sets of twins; and fourteen (14) by cesarean section including one premature delivery of 29 weeks due to chronic hypertension and severe pregnancy-induced hypertension. Ninety-six patients had viral load determinations done during gestation at their initial prenatal visit, ranging between undetectable (Digne <25 copies/ml) and 189,923 copies/ml. All patients had CD4 levels done during gestation, ranging between 8 and 1,107 cells/ mm CD4 levels at delivery were done on patients and ranged between 11 and 964 cells/mm3. No fetal anomalies were observed at birth, suggesting that they will likely prove to be uninfected. Updated virologic data on infants delivered to date as well as clinical results for additional deliveries will be presented. At this time infant is positive. Conclusions: Triple combination therapy including combivir and nelfinavir or combivir and indinavir are well tolerated during pregnancy and was not associated with any fetal abnormalities in the small cohort described here. The transmission rate is less than 2% with combination therapy at the time of this abstract.
Cervicovaginal Microbiology, Enzymes, and Preterm Labor De Domenico P., Coata G., Pennacchi L., Taddei F., Gerli S., Di Renzo G.C. Centre of Perinatal Medicine, University of Perugia, Perugia, Italy Introduction: Lower reproductive tract infections, such as cervicitis or vaginitis, may play a major role in the pathogenesis of preterm labor, premature rupture of membranes and preterm birth. Objective: To investigate the relationship between cervicovaginal infections and related events as assessed by expression of bacterial enzymes and alterations in vaginal pH with preterm labor.
Materials and Methods: We identified cervicovaginal infections using three different diagnostic tools: 1) cervicovaginal microbiology in 1830 patients; 2) assessment of vaginal pH in 100 patients; 3) detection of bacterial enzymes in 50 patients. Then we correlated these events to perinatal outcome. We evaluated women in pregnancy at first trimester and during gestation week 30-34. Vaginal fluid was taken for wet mount, Gram stain, pH measurement, bacterial enzymes such as sialidase, and microbiological test. Endocervical swab was sampled by using a cotton-tipped swab. Vaginal pH values were obtained by colorimetric strips carried by index finger of the special gloves. A cut-off point of pH 4.5 was selected.
Results: In 1830 patients who have undergone microbiological test, we found 30% microbiological positivity. Among these, 52% developed threatening preterm labor. In 100 patients we detected a pH greater than 4.5 in 35% of all cases. Among microbiologically-positive patients (40%), vaginal fluid pH was positive especially in 74% cases ofBV. Sialidase activity in cervicovaginal fluid was associated with presence of ureaplasma, GBS, gardnerella and chlamydia.
Conclusion: Screening and treating cervicovaginal infections may be the best way to prevent adverse perinatal outcome such as preterm labor, PROM and preterm birth.

Chlamydia Infection and Perinatal Outcome
De Domenico P., Sensini A., Nicoli S., Cenci F., Di Renzo G.C. Centre of Perinatal Medicine, University of Perugia, Perugia, Italy Objective" We evaluated the importance of Chlamydia trachomatis infection in the etiopathogenesis ofadverse perinatal outcome such as preterm labor, premature rupture of membranes, and preterm birth. Materials and Methods: At first trimester and during gestation week 30-34, specimens were collected by inserting a sterile speculum into the vagina and wiping the vaginal discharge from the ectocervix. Endocervical material was sampled by using a cotton-tipped swab. Results: The C. trachomatis infection rate was 8.8%. PROM occurred in 35% of the cases; the frequency of threatening preterm labor was 10%, significantly higher in C. trachomatis-positive patients.
Conclusion: Every pregnant woman, and not only those at high risk, should be screened for C. trachomatis infection in order to prevent adverse perinatal outcome.
Inflammatory Reactions in Cervico-Vaginal Smears Tanzer F, Saragoilu OF Terminal Medical Center, Ankara, Turkey Aim: To investigate the rate ofinflammation in cervico-vaginal smears taken from asymptomatic women to screen against cervical cancer.
Methods: 390 cervico-vaginal smears taken from women without any complaints in 1998 were studied for inflammatory reactions in Terminal Medical Center. All cervico-vaginal smears prepared from cells removed from the posterior fornix of the vagina or from the squamous epithelium that lines the cervix and the portio of the cervix from the epithelial lining of the endocervical canal. Cervico-vaginal smear of collection of a vaginal pool and cervical surface sampled by brush. They were fixed by spray fixative. All smears were stained by Papanicolau staining technique. Pathological inflammator processes within the lower genital tract are bacterial, fungal, parasitic or viral origin.
Results: 238 (61.1%) cervico-vaginal smears showed normal cytologic findings. Inflammatory reactions were found in 152 (38.9%) of them. The cocci are the most common causative bacterial agents and found in 103 women (26.4%). Candida was the most common fungus associated with vaginitis and cervicitis found in 17 cases (4.3%). Trichomonas vaginalis was by far the most significant parasite found in 10 cases (2.6%). Gardneralla was found in 11 cases (2.8%). Viral agents herpes genitalis and human papilloma virus infections were the most important and found in 11 cases (2.8%). Objective: Group B Streptococcus (GBS) is a common cause of serious maternal and neonatal infections. The aim of this study was to identify the incidence ofrectovaginal colonization of GBS in pregnant women in our hospital and to evaluate the outcome ofculture positive patients who had received intrapartum antibiotic prophylaxis according to recommendations ofAmerican Academy of Pediatrics.
Methods: Pregnant women followed at Marmara University Hospital, Obstetrics and Gynecology outpatient clinic were screened at week 35-37 of gestation for GBS colonization. The rectovaginal samples were processed in a selective culture medium for GBS. The patients with positive culture results received intravenous ampicillin in the intrapartum period and both the patients and their newborns were evaluated for complications. Results: Out of 100 patients between 18-41 years of age, 57 patients (57%) were multipara and 43 patients (43%) were primipara. Ten patients (10%) (6 patients multipara, 4 patients primipara) had BGS growth in their rectovaginal cultures whereas patient had urinary tract infection secondary to GBS. The multipara patients had not had any infectious complications in their previous pregnancies. All but two patients with GBS colonization received intrapartum antibiotic prophylaxis as well as treatment of urinary tract infection when present. One of the GBS (+) patients had emergency cesarean section delivery for fetal distress and could not receive intrapartum antibiotic prophylaxis. The culture result of the other patient was not known during the labor so she could not receive intrapartum antibiotic prophylaxis as well.
None of the patients developed any infections or had any side effects secondary to antibiotics used for prophylaxis.
However, the newborn ofthe GBS (+) patient who could not receive intrapartum antibiotic prophylaxis developed sepsis. Conclusion: The incidence of rectovaginal GBS colonization was found to be 10% in pregnant women followed at our hospital. Routine screening for GBS colonization at week 35-37 of gestation and using the intrapartum antibiotic prophylaxis might decrease the incidence ofperinatal GBS infection. Design: A retrospective chart review of all neonates born during 1993-1997, with group B streptococcal colonization at any culture site.All rectovaginal cultures taken from group B streptococcus in parturients with preterm premature rupture ofmembranes and preterm labor during 1993-1997 were reviewed.

Intrapartum
Results: During the 10 study years, 45,968 neonates were evaluated, 12 neonates developed early onset group B streptococcal sepsis(0.26/1000). 8 neonates with a positive culture of group B streptococcus died, but only 2 of them had septicemia. 6 deaths, including the 2 with septicemia, could have been attributed to other factors. During the years 1993-1997, rectovaginal cultures unselective media were sent for group B streptococcus, for 259 parturients with preterm premature rupture ofmembranes or preterm labor. Only 18(7%) were positive, none of their babies developed early onset group B streptococcal sepsis.
Conclusion: The low carrier rate in our high risk patients and the low incidence of neonatal early onset group B streptococcal disease in our population lead us to reject the new guidelines from the CDC. researches. We tried to open a less clearly visible source of STD and highlighted some ofthe unknown risk factors present in entertainment business in Ankara region.
Evaluation of 62 Tubo-Ovarian Abscesses: Risk Factors, Clinical Features, and Treatment Atalay C., Saragoilu F., Uyar I. Gynecology and Obstetric Department of Ankara Numune Education and Research Hospital Objective: Evaluation of risk factors, clinical features and treatment in tubo-ovarian abscess which is one of the early complications of pelvic inflammatory disease with a prevalance as many as 34% of women with PID.
Material and Methods: 62 patients who were treated at the Obstetrics and Gynecology Department of Ankara Numune Education and Research Hospital between 1995 and 1999 were evaluated, retrospectively. Results: The patients ranged in age between and 20-54 with a mean of 36.16 + 8.36. All ofthe patients were married. The parities were between 0-5 with a mean of 2.06 + 1.54. In our study, the most important risk factor was IUD usage (58.06%). The most frequent symptom was abdominal pain (90.3), the other symptoms were foul smelling vaginal discharge (69.3%) and vaginal bleeding (29.03%). In pelvic examination bilateral adnexial masses were found in 16 (25.8%) of the patients, left adnexial mass was found in 28(45.16%), and right adnexial mass was found in 18(29.03%) of the patients. The fever was more than 38C in 38(61.3%) patients.
The mean leucocyte count was 15.793 + 5032.75. There was a correlation with ultrasound examination in 40 of62 (64.5%) patients. Clindamycin and gentamicin treatment was performed to all patients. After 48 hours 17(27.4%) patients responded to medical treatment. The other 45(72.5%) patients were treated with surgical methods. There was 25.8% rupture and 35.4% generalized peritonitis. In our cases we had no complications, mean duration ofhospitalization was 11.03 +5.1 days.
Sexually Transmitted Diseases Incidence In Entertainment Business In Ankara Karaiahin E., Saraoilu F., Balaban E., Gtivener E. Ankara Numune Hospital Dept. of Gynecology and Obstetrics, and Dept. of Microbiology Objective: This survey has been planned to investigate the foreign (mainly Russian and Romanian) and local women in entertainment business, as possible loci of gonorrhea, syphillis, hepatitis ]3 & C, HIV, as well as trichomoniasis, candidiasis, bacterial vaginosis, ureaplasmosis and mycoplasmosis. Method: 74 women were sampled bacteriologically and serologically for the mentioned sexually transmitted disesases and have been asked to fill out a questionnaire.
Results: No cases ofchlamydia, trichomonas, HIV, and hepatitis C were identified. The incidences ofother infections were found as: candidiasis (5.4%), bacterial vaginosis (12.16%), ureaplasmosis(21.6%), mycoplasmosis(16.2%), gonorrhea (5.4%), syphillis (1.35%), and hepatitis B(2.7%). Conclusion: There has been an insidious increase in STD in Turkish population as stated and supported by various other Acute Appendicitis in Pregnancy Atalay C., Saragoilu F., Ekici A. Gynecology Department of Ankara Numune Research and Education Hospital Objective: Acute appendicitis in pregnancy is the most common nonobstetric complication warranting emergency laparotomy. The goal of this study is the evaluation of clinical manifestations, diagnosis and management of acute appendicitis in pregnancy. Material and Methods: 25 pregnant patients to whom performed laparotomy for suspected acute appendicitis in Gynecology Department ofAnkara Numune Research and Education Hospital between 1995-1999 were evaluated retrospectively.
Results: In 15 (60%) cases, acute appendicitis was proven at laparotomy and by subsequent histopathology. In the confirmed cases, 3 (25%) in the first trimester,18 (72%) in the second and 4(16%) in the third trimester. Abdominal pain was the most common presenting symptom; the second was vomiting.Abdominal tenderness and rebound tenderness were the most common physical signs, although the latter was less marked in late pregnancy. There was a correlation with USG in 2 (8%) patients. Laparotomy was performed within the first 24 hours of onset of symptoms in all patients. Perforation of appendix was found in 1(4%) patient. There were 2(8%) preterm labors in the third trimester group (30 and 34 weeks) within the postoperative 48 hours, tocolitic therapy was performed and successful. In our study, there were no fetal and maternal deaths.
How Should We Treat Bacterial Vaginosis in the 1990s? Larsson, P-G. Departments of Obstetrics and Gynecology Karnsjukhuset, Skovde, Sweden. The treatment of anaerobic/bacterial vaginogis can sometimes be difficult. To calculate the true four-week cure rate, endpoint analysis should be carried out. The patients not cured after one or two weeks should be added to patients not cured after four weeks (many authors exclude patients not cured at one or two weeks). After a critical review of the literature of all blinded (single or double) studies the cure rate is much lower than expected and is no better than 60-75%.
An analysis shows that nonpublished treatments.tudies (used by the drug companies in registration files) have a much lower cure rate than the published studies. If the expected cure rate after 4-weeks is so low, how shall we increase the cure rate?
Women visiting for legal abortions will have benefit of preoperative treatment of BV with vaginal clindamycin cream the same as women with intermediate flora. However, women with normal lactobacilli will not have any increased risk of postoperative infection. This will point out that maybe even intermediate flora should be regarded as a pathological flora and should be regarded as pathological as BV and should be treated the same.