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The risk of infection for mother and baby after spontaneous rupture of the membranes was evaluated in a prospective study of 24 patients with ruptured membranes before the 36th week of pregnancy. The mean length of pregnancy after rupture was 10 days and 2 hours. Only patients harboring Group B streptococci or E. coli in the urogenital tract were treated with antibiotics (during delivery). With the exception of 1 woman, all patients harbored one or more pathogens in the urogenital tract. Four mothers were infected but all recovered. One of 26 infants died from infection. The study did not confirm any association between prolonged rupture of the membranes and the frequency of idiopathic respiratory distress syndrome, nor did it contradict attempts to actively prolong pregnancy after rupture of the membranes.

AbstractA method has been developed for the detection in human sera of antibodies to surface antigens of group B streptococci (GBS), types Ia, Ib, or III. The sera were absorbed with GBS type II and then added to a suspension of GBS of the type against which antibodies were to be measured. After incubation and washing of the bacteria, the antibodies present on the surface of the cells were quantitated with radiolabelled protein A. Antibodies of IgG class were detected, probably specific for types Ia, Ib or III, with the exception that the Ib GBS suspension used could detect some antibodies to type Ia. With this method it was found that 67 mothers to infants with GBS septicemia had low levels of serum antibodies to the infant's type of GBS. Urogenital carriers of GBS, giving birth to neonatally healthy infants, had higher serum antibody levels against the colonizing type.

AbstractGroup B streptococci were isolated from the urogenital tract of 54 of 168 patients (32 ) examined at a gynecological outpatient department. 11 (7 ) of the patients were group B throat carriers. In contrast to the frequency of type III group B streptococci in the urogenital tract (41 of group B streptococcal carriers) only 1 of 11 strains isolated from the throat belonged to type III. Apart from 1 patient who carried type III streptococci in the urogenital tract, all patients who were both throat and urogenital tract carriers harboured the same type in both sites. Significantly more patients who were only throat carriers of group B streptococci or harboured another type in the throat than in the urogenital tract, harboured lactose-fermenting group B streptococci as compared to patients who were only carriers of group B streptococci in the urogenital tract. These results pointed out the possible existence of “throat-preferring” and “urogenital-preferring” group B streptococci.

AbstractSerum levels of type-specific antibodies against group B streptococci (GBS) were investigated in 53 pregnant urogenital carriers of GBS and in 20 pregnant non-carriers. The distribution of serotypes of GBS isolated from the urogenital tract of the 53 culture-positive patients was: type Ia, 20 patients (38), type II, 10 (19), and type III, 23 (43). Antibodies to GBS types Ia, Ib, II and III were quantitated by the use of radiolabelled protein A. It was found that the pregnant GBS carriers had in general higher levels of type-specific antibodies to GBS than non-carriers, irrespective of the type of GBS harboured in the urogenital tract. Furthermore, it was found that younger GBS carriers (20 to 29 yr of age) had higher serum levels of type-specific antibodies than older carriers (30 to 39 yr), a difference that did not occur among the non-carriers.

AbstractIn a kindergarten with 42 children and 17 female staff members, an epidemic of group B streptococcal carriage in the upper respiratory tract occurred. In the middle of February 1978, 6 children and 5 adults carried type I b streptococci in the throat while only 2 of these 11 were carriers 2 weeks later. Only one other streptococcus, belonging to type II, was found in the throat specimens. Five strains other than type I b were found in the urogenital tract of the staff. Three type I b throat carriers were also urogenital carriers of this type. The spread of type I b streptococci could have resulted from co-spreading with other upper respiratory tract pathogens found, including group A streptococci of type 12, Haemophilus influenzae, Branhamella catarrhalis and pneumococci. Estimation of antibodies with radiolabelled protein A indicated an immune response to type I b, but not to types I a, II or III group B streptococci in the staff compared with healthy blood donors.

The relationship between significant bacteriuria (SB), i.e. 2 subsequent voided urine specimens with ≥105colony forming units (CFU)ml, and the occurrence of bacteria in the urinary bladder detected by bladder punction, was investigated in asymptomatic pregnant women. From 30 (70) of the 43 women with SB studied, bacteria were isolated from the urinary bladder. The same bacteria were found in the bladders of all 21 women with Escherichia coli, the one with Klebsiella pneumoniae, and the one with Staphylococcus saprophyticus in midstream urine. Six of 10 patients with group B streptococci (GBS), 1 of 4 patients with Streptococcus faecalis, and none of 5 patients with Staphylococcus epidermidis in voided specimens had bacteria in the aspirated urine. Serotype III was isolated from 810 patients with SB caused by GBS. One child born to a woman with GBS SB but no bacteria in the urinary bladder, got early onset septicaemia. The poor predictive value of SB with GBS, S. faecalis and S. epidermidis necessitates the increased use of bladder puncture for diagnosis of true asymptomatic bacteriuria (AB), i.e. AB with bacteria in the urinary bladder. SB with GBS even without bacteria in the urinary bladder, may constitute a threat to the baby's health.

AbstractObstetrical and neonatal complications were studied among 143 urogenital carriers of group B streptococci (GBS) and their 144 infants and compared with complications occurring in a control group of 157 pregnant non-carriers and their 158 infants. All parturients had experienced uncomplicated pregnancies until week 36. 26 infants, 13 from each group, were transferred to the neonatal intensive care unit for treatment and observation within the first 7 days of life. Among these infants, 1113 infants of GBS carriers contracted pneumonia and pulmonary adaptation syndrome, in contrast to 313 infants of non-carriers (p<0.05). The GBS carrier infants transferred to the neonatal intensive care unit had higher birth weights and higher gestational ages. Within the group of infants born to GBS carriers, those with pulmonary diseases evidenced abnormal fetal heart rate changes during labour in a higher rate than in the controls. Puerperal endometritis occurred with a significantly higher frequency among the GBS carriers (7143) than among the non-carriers (0157). Maternal carriage of GBS is a high risk factor for both the mother and her newborn, also after an otherwise uncomplicated pregnancy.

AbstractSera from 3 groups of individuals were investigated for antibodies to group B streptococci (GBS) types Ia, Ib and III using radiolabelled protein A: 45 girls, aged 1 to 12 years; 123 non-pregnant gynecological outpatients, aged 15 to 42 years; and 96 female venereological disease (VD) clinic patients, aged 15 to 54 years. The two groups of adults had higher antibody levels against type Ia than the girls, while no difference was found between the two adult groups in this respect. On the other hand, the VD patients had higher levels of antibodies against type Ib than the girls and the gynecological patients; the gynecological patients did not differ from the girls as regards anti-lb antibodies. The antibody levels against type III were higher among the VD clinic patients than among the gynecological patients, who in turn had higher levels than the girls. Thus, the adults showed higher levels of antibodies against 2 of the 3 GBS types than did the girls. Furthermore, the VD clinic patients had higher levels against 2 of the 3 GBS types than the gynecological patients.

The effect on labor of administering ritodrine after a premature rupture of the membranes (PROM) was studied in a double-blind trial in 30 patients. The patients were selected according to the following criteria: 28 to 36 weeks' gestation, only 1 fetus, cervix dilated 4 cm or less, and absence of pyrexia or other signs of uterine infection. Fourteen patients received ritodrine and 16 received a placebo. The 2 groups were statistically comparable. None of the patients receiving ritodrine delivered within 24 hours. The difference between the 2 groups was statistically significant with respect to the number of patients delivered within 24 hours (P < 0.05). However, after 24 hours, there was no difference between the groups as regards the length of pregnancy. The infections registered in the mothers and infants were few and easily controlled. The incidence of idiopathic respiratory distress syndrome (IRDS) was low in the study and allows no conclusions concerning the benefit of proloning the pregnancy for more than 24 hours after PROM.

AbstractThe occurrence of group B streptococci was investigated in urethral and cervical specimens from the following groups of individuals: 219 females visiting a gynaecological department for screening for cervical carcinoma for the first time; 104 pregnant women visiting a mother-care department; 94 patients with previous or existing cytological changes in cervical smears; 153 patients with gonorrhoea and their 67 sexual contacts; and 42 male medical undergraduates. The women with gonorrhoea harboured group B streptococci more often than the women visiting the cancer screening department for the first time (36.9 and 18.3, respectively). Both groups harboured B streptococci more often than the pregnant women (7.7) who were living in a more rural district. The men with gonorrhoea harboured B streptococci more often than the male medical undergraduates (21.7 and 2.7, respectively). B streptococci were equally common among the sexual contacts as among the patients infected with gonococci, whether the contacts were infected with gonococci or not. The 219 women visiting the cervical cancer screening department were questioned regarding the use of contraceptives. Neither IUD nor contraceptive pills were found to influence the frequency of group B streptococci. On background of these results, sexual transmission of group B streptococci is discussed.

The relationship between significant bacteriuria (SB), i.e. 2 subsequent voided urine specimens with ≥105 colony forming units (CFU)/ml, and the occurrence of bacteria in the urinary bladder detected by bladder punction, was investigated in asymptomatic pregnant women. From 30 (70%) of the 43 women with SB studied, bacteria were isolated from the urinary bladder. The same bacteria were found in the bladders of all 21 women with Escherichia coli, the one with Klebsiella pneumoniae, and the one with Staphylococcus saprophyticus in midstream urine. Six of 10 patients with group B streptococci (GBS), 1 of 4 patients with Streptococcus faecalis, and none of 5 patients with Staphylococcus epidermidis in voided specimens had bacteria in the aspirated urine. Serotype III was isolated from 8/10 patients with SB caused by GBS. One child born to a woman with GBS SB but no bacteria in the urinary bladder, got early onset septicaemia. The poor predictive value of SB with GBS, S. faecalis and S. epidermidis necessitates the increased use of bladder puncture for diagnosis of true asymptomatic bacteriuria (AB), i.e. AB with bacteria in the urinary bladder. SB with GBS even without bacteria in the urinary bladder, may constitute a threat to the baby's health.

The rate of postoperative infections after cesarean section was studied in a prospective double-blind randomized study to compare cefuroxim with a placebo. Intravenous bolus injections were given at the beginning of, and 12h after the operation. Eighty patients received cefuroxim and 80 received placebo. Endometritis or wound infection, or both, was diagnosed in 2/80 (2.5%) patients receiving cefuroxim and in 23/80 (29%) patients receiving placebo. No side effects were demonstrated or reported by the patients. Thus, two bolus injections of 1.5 g of cefuroxim given peri-operatively significantly reduced postoperative infectious morbidity after emergency cesarean section.

A new commercially available method (UROBACT,1 AB Dermaci, Sweden) for detection of bacteriuria was compared to a conventional semiquantitative bacteriological method. The kit consisted of two tubes, which were inoculated with urine in two different dilutions. Positive tests were recorded as a colour change from red to yellow in both tubes, and the test was considered negative if one or both tubes remained red. When studying 556 urine samples, the test detected 153 of 163 samples with > 105 colony forming units (CFU) of bacteria per ml, i.e. the sensitivity was 93.9%. Among the samples containing less than 105 CFU/ml, 347 of 357 were recorded as negative, giving a specificity of 97.2%. Although relatively few urine samples containing Staphylococcus saprophyticus and Pseudomonas pyoceanea were tested the results indicated that the method was less reliable for these species. However, compared to dip-slides, which also give poor results with S. saprophyticus, the new test has several advantages, including a more simple interpretation, i.e. a distinct colour change.

During a 15-month period, all 34 infants delivered at the department of Obstetrics & Gynecology at University Hospital in Lund, Sweden, who died perinatally or neonatally were included in a prospective study of causes of death. Autopsies—including extensive culturing of specimens for bacteria, chlamydia, fungi, mycoplasmas, and viruses— were performed for all infants. Maternal sera obtained during pregnancy and after delivery were examined regarding titers against a number of microorganisms. During the study period, the perinatal mortality rate was 0.60 and the neonatal mortality rate 0.56. It was found that 37 of the deaths were caused by lethal malformations, 17 by idiopathic respiratory distress syndrome, and 9 by ablatio placentae. However, no less than 21 occurred as a direct consequence of infections, including 2 deaths caused by group 6 streptococci, 2 by Coxsackie B virus, and 3 deaths each by Hemophilus influenzac, Pseudomonas pyocyanea, and Candida albicans. A 6-month study of late abortions revealed another case of intrauterine group B streptococcal infection. The study has demonstrated that autopsy, including microbial examination, is recommended in all cases of perinatal and neonatal deaths.

AbstractUrethral, cervical and rectal specimens were taken from 92 females and urethral and rectal swabs from 46 males attending a venereological outpatient department. The frequencies of group B streptococci were, in the women: urethra 24 , cervix 14 and rectum 17 ; in the males: urethra 22 and rectum 7 . These findings, supported by the results of serotyping, clearly demonstrate that the human urethra is an important site of colonization and do not support the idea that the gastrointestinal canal is the primary site of acquisition.

AbstractTwo previously healthy men, aged 38 and 39 years, with meningitis due to group B streptococci are described. These patients are unique as only one or two adults with group B streptococcal meningitis without predisposing diseases have been reported previously.

AbstractA 23-year-old woman was delivered of twins 10 hours after rupture of the membranes. The infants appeared to be normal at birth. Very soon both developed a respiratory distress syndrome. Culture of CSF from both infants gave growth of beta-haemolytic streptococci group B. Both children died within a few days. Culture of vaginal smears from the mother 3 weeks after delivery also revealed growth of group B streptococci. As far as we know, this is the first time on record that both newborn twins developed fatal streptococcus group B meningitis.

AbstractA 35-year-old gravida 4 was admitted in pregnancy week 25 because of premature rupture of the fetal membranes. Two days later an intra-uterine infection developed. Treatment with clindamycin and ampicillin was started. However, she aborted within a few hours. The fetus was of normal size and without malformations. Mycoplasma hominis could be isolated from the placenta, cerebrospinal fluid and lungs of the fetus during sterile autopsy, and also from the genital tract of the patient, who had a high constant titre of indirect hemagglutination antibodies to M. hominis in sera collected during pregnancy and after the abortion. This case suggests that M. hominis can ascend to the uterine cavity after rupture of the membranes and infect the fetus.

Antibodies in human sera against surface antigens of Neisseria gonorrhoeae were detected with use of 125I-Iabeled protein A from Staphylococcus aureus. Serum was allowed to react with a suspension of whole gonococci, and the antibodies attached to the bacteria were quantitated with protein A, which reacts with the Fe fragment of IgG. Tests with five human sera with a gonococcoal complement-fixation titer of 1:30 revealed no difference between use of freshly isolated gonococci and use of strains subcultured daily on artificial medium for 10 years. Antibodies cross-reacting with N. gonorrhoeae and Neisseria meningitidis were found in human sera. The results of the test with labeled protein A varied with the serum titer of complementfixing antibody to N. gonorrhoeae. Acute and convalescent sera from six of seven patients, including one with disseminated gonococcal infection, showed significantly larger differences in antibodies to N. gonorrhoeae than did sera of women without evidence of genital infection. Complement-fixation titers changed significantly in only three of the six patients.