Transplacental passage of vancomycin during the second trimester of pregnancy

Article Abstract:

Vancomycin in an antibiotic that is effective in treating infections caused by Staphylococcus and Streptococcus bacteria. It is an expensive drug and has toxic side effects. It is generally used to treat patients who are allergic to penicillin antibiotics, or to treat infections that are resistant to penicillin. Vancomycin can cross the placenta and has thus been used to treat infections in the developing fetus. Since this drug is toxic to the kidneys and ears, the dose of the drug must be monitored carefully. This article describes the successful use of vancomycin for treating chorioamnionitis (an infection in the amniotic sac that encases the developing fetus) in a pregnant woman who was allergic to penicillin antibiotics. Chorioamnionitis can lead to premature rupture of the membranes and premature birth. Amniocentesis was performed at week 26 of pregnancy to obtain a sample of amniotic fluid for analysis. The sample contained Streptococcus agalactiae, a type of bacteria that can cause chorioamnionitis. The woman was treated with vancomycin (2,000 milligrams per day) and tobramycin (150 milligrams per day). The amount of vancomycin in the mother's blood and in the amniotic fluid (the fluid that surrounds the developing fetus) was monitored on a routine basis throughout the treatment period. Within three days of treatment the bacteria in the amniotic fluid had been killed. At week 28 of pregnancy the woman gave birth to a 3.2-pound baby. The mother had no toxic reactions to the treatment. Eleven months after delivery the infant was in good health and was developing normally. It is concluded that vancomycin can be used to treat infections in pregnant women, so long as the dose of the drug is monitored. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Infection, Vancomycin, Fetal membranes, Chorioamnionitis

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Controlled ovarian hyperstimulation as a risk factor for ectopic pregnancy

Article Abstract:

Although fertility drugs have been cited as a possible cause of ectopic pregnancy (pregnancy that implants in a site other than the uterus, often in the fallopian tube), few studies have tried to dissociate the effects of the drugs from the causes of infertility. The current study investigates the relation between ectopic pregnancy and controlled ovarian hyperstimulation accomplished with clomiphene citrate, human menopausal gonadotropin (hMG), or both. The possible contribution of in vitro fertilization (in which a fertilized embryo is implanted into the uterus) to ectopic pregnancy was also evaluated. One hundred thirty-five women with ectopic pregnancies (cases) and 244 women who delivered infants at the same medical center (controls) were assessed. Data were collected concerning sociodemographic variables, reproductive and sexual histories, birth control practices, surgical histories, and related variables. Results showed that a greater proportion of cases (8.9 percent) than controls (1.6 percent) had used ovarian hyperstimulation to become pregnant, and that the risk of ectopic pregnancy for women who had undergone hyperstimulation was 3.98 times that of women who had not taken these drugs. Women who underwent IVF (a total of seven in the study) did not appear to be at greater risk. These findings indicate that the risk of ectopic pregnancy does increase with ovarian hyperstimulation, most likely as a result of the hormone therapy itself rather than as a result of underlying disease of the fallopian tubes. More research is needed to fully evaluate these possible effects of fertility drugs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Fertility agents, Fertility drugs

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Fetal levels of tobramycin following maternal administration

Article Abstract:

The case report is presented of a woman with a heterotopic pregnancy (in an abnormal location) in the ovary, in addition to a normal uterine pregnancy. The patient was advised to undergo surgical termination of the ovarian pregnancy and consented to injection of a single dose of tobramycin, an antibiotic, so that its concentration in the removed fetal tissue could be assessed. This was of interest because tobramycin is often prescribed for certain infections, but its metabolism by the fetus is unknown. Results of measuring drug concentrations in different tissues are presented. Tobramycin crosses the placenta and enters the fetus, where it becomes concentrated in the spleen and kidneys. It is associated with damage to the kidneys and ear, particularly after repeated doses. The patient's uterine pregnancy resulted in the birth of a normal infant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Fetus, Surgery, Tobramycin

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