Lynnae Millar

To assess ceftriaxones effect on uterine contraction frequency and determine risk factors for subsequent preterm birth in women with pyelonephritis. Seventy-one women with pyelonephritis at greater than 24 weeks' gestation with continuous external tocodynamometry after antibiotic administration were studied. Patients received 2 doses of ceftriaxone 1 gram intramuscularly at 24-hour intervals. Temperatures, timing of antibiotic administration, and gestational age at delivery were recorded. Uterine contraction frequency was measured for the hour prior to antibiotic administration, as well as the six hours after. Uterine activity steadily and significantly decreased from a mean of 5.1 +/- 7.3 at presentation to 2.0 +/- 2.9 uterine contractions per hour (P = .04, student t-test) six hours after ceftriaxone administration. The maximal number of contractions per hour each woman experienced did not correlate with temperature (r = .02, linear regression analysis). Uterine contractility and recurrent urinary tract infection were both associated with subsequent preterm birth (P = .004 and .016 respectively using nominal logistic regression analysis). (1) A significant decrease in uterine activity from baseline occurs after ceftriaxone administration for acute pyelonephritis in pregnancy. (2) Temperature elevations are not associated with increased uterine activity. (3) Patients with significant uterine activity or recurrent urinary tract infection are at risk for preterm birth.

Objective: To determine the sensitivity, specificity, and positive and negative predictive values of an enzymatic urine screening test for diagnosing bacteriuria in pregnancy. Methods: Clean-catch midstream urine samples were collected from 383 women who had routine prenatal screening for bacteriuria. Sensitivity, specificity, and positive and negative predictive values for each screening test (enzyme activity, nitrites or leukocytes on dipstick, and bacteria or pyuria on microscopic examination) were estimated using urine culture as the criterion standard. Urine cultures were considered positive if they grew 10⁴ colony-forming units of a single uropathogen. Standard deviations used to calculate 95% confidence intervals were based on binomial distribution. A sample of 30 urine specimens was selected to evaluate interrater agreement using Cohen’s kappa statistic. Results: Five of 383 samples were contaminated, leaving 378 samples for evaluation. Thirty of 43 specimens with positive urine culture had positive enzyme activity. Of 335 samples with no growth, 150 had negative enzyme activity. Sensitivity, specificity, and positive and negative predictive values for the Uriscreen enzymatic screening test (Bard Patient Care Division, Murray Hill, NJ) were 70%, 45%, 14%, and 92%, respectively. Sensitivity of the Uriscreen was lower than that of bacteria alone. Interrater agreement for Uriscreen testing was high among the three testers (κ = .86). Conclusion: The Uriscreen enzymatic screening test had inadequate sensitivity for rapid screening for bacteriuria in pregnancy.