Transplacental passage of vancomycin in the ex vivo human perfusion model.
OBJECTIVE
To determine maternal-fetal transplacental passage of vancomycin in the ex vivo human placental perfusion model.


METHODS
Six term placentas were collected immediately after delivery and perfused with physiologic medium using the single cotyledon perfusion system. Vancomycin was added to the maternal medium and perfused through the maternal circulation of the cotyledon. Over a 1-h period in an open system, samples of the perfusate were collected at defined intervals from the fetal venous catheter and from the maternal effluence to assess vancomycin transfer. Thereafter, the system was closed for 1-5 h to establish accumulation. Transport fraction and clearance indexes were calculated by perfusing antipyrine 14C (positive control). Vancomycin was estimated by high pressure liquid chromatography and antipyrine 14C concentration was determined by liquid scintillation.


RESULTS
Mean vancomycin maternal peak and trough concentrations ranged from 30.0 to 51.5 microg/ml and 7.7 to 16.4 microg/ml, respectively. Clearance indexes were minimal with a mean peak range of 0.000-0.080 and a mean trough range of 0.00-0.17. For each placenta, transport fraction for antipyrine 14C was > 1.85 with a single pass of > 40%. No accumulation of vancomycin was noted when the system was closed for 1-5 h. The mean peak clearance index was zero after perfusing the placenta for up to 5 h with 35.8 microg/ml of vancomycin.


CONCLUSIONS
Transplacental passage of vancomycin was minimal in the ex vivo human placental perfusion model, with no detectable accumulation.
Hnat
Michael D
MD
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas, Dallas, TX, USA. Michael.Hnat@UTSouthwestern.edu
Gainer
Julie
J
Bawdon
Roger E
RE
Wendel
George D
GD
D000900:Anti-Bacterial Agents / Q000032:analysis / Q000493:pharmacokinetics*; D000983:Antipyrine / Q000378:metabolism; D002250:Carbon Radioisotopes; D002851:Chromatography, High Pressure Liquid; D005260:Female; D005333:Fetus / Q000098:blood supply; D006801:Humans; D066298:In Vitro Techniques; D007700:Kinetics; D008431:Maternal-Fetal Exchange; D010477:Perfusion; D010920:Placenta / Q000098:blood supply / Q000378:metabolism*; D011247:Pregnancy; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014640:Vancomycin / Q000032:analysis / Q000493:pharmacokinetics*
D000900:Anti-Bacterial Agents; D002250:Carbon Radioisotopes; D014640:Vancomycin; D000983:Antipyrine
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