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PubMed1991

Eikenella corrodens chorioamnionitis.

Eikenella corrodens was once considered a microorganism of little clinical consequence. But over the past decade, there has been a marked increase in the number of reports of serious infections caused by this organism. We present a case of E corrodens chorioamnionitis in a patient with intact membranes. This is the second known case of its kind to be reported in the medical literature. The true incidence of obstetric and gynecologic infections may be much higher than reported because of the organism's susceptibility to routine antibiotic regimens and the failure of some strains to exhibit characteristic colony morphology on solid agar.

Adult↗

PubMed1991

Chronic chorioamnionitis: a clinicopathologic study of 17 cases.

The clinicopathologic features of 17 cases of an unusual variant of chorioamnionitis distinguished by a pure or predominantly chronic inflammatory infiltrate in the fetal membranes rather than the usual acute inflammatory reaction are reported. In six cases, there was an equal (one case) or minor (five cases) component of acute inflammation in the fetal membranes as well. Concomitant villitis, found in 11 cases, was almost uniformly lymphohistiocytic and destructive, but it varied greatly in severity. Immunoperoxidase stains for cytomegalovirus, herpes simplex I and II, and Toxoplasma gondii; Warthin-Starry, Gomori methenamine silver, Dieterle, Gram and acid fast stains; placental or amniotic fluid culture; and limited maternal serologic studies failed to identify a specific infectious etiology in any case. Seven women had experienced at least one previous spontaneous abortion, fetal death in utero, or preterm birth. No patient reported a history of fever, rash, or flu-like syndrome during pregnancy. Serious antenatal complications were numerous. Preterm birth occurred in 13 cases. Gestational age ranged from 25 to 42 weeks (mean 32 weeks) and birth weight ranged from 740 to 3,230 g (mean 2,100 g). When expressed as a percentile for gestational age, 47% of infants had a birth weight at or below the 25th percentile, and 76% were at or below the 50th percentile. Two infants were born with gross anomalies, and one infant died in the neonatal period.

Adolescent↗

PubMed1990

Streptococcus pneumoniae associated with second-trimester chorioamnionitis. A case report.

Streptococcus pneumoniae is found rarely in the normal vaginal flora but appeared to be the cause of chorioamnionitis and premature rupture of the membranes in a 16-week gestation. Both S pneumoniae and Ureaplasma urealyticum were recovered from cervical specimens, but only the Streptococcus grew from samples taken between the placental amnion and chorion.

Adult↗

PubMed1989

Acute chorioamnionitis.

In summary, acute intra-amniotic infection or chorioamnionitis is a relatively common complication of pregnancy and may be associated with significant maternal and neonatal morbidity. Maternal mortality is rare, as is mortality in term infants. Mortality in premature infants is probably related to prematurity itself rather than infection per se. Diagnosis is based primarily on the presence of maternal fever. Treatment consists of antibiotics and delivery. Antibiotics should be begun as soon as the diagnosis is made unless delivery is imminent (less than 1 hour). Cesarean section offers no specific advantage to the fetus and may carry increased risk to the mother.

Anti-Bacterial Agents↗

PubMed1989

First-trimester maternal Listeria monocytogenes sepsis and chorioamnionitis with normal neonatal outcome.

A secundigravida developed culture-proved Listeria monocytogenes sepsis with signs and symptoms of chorioamnionitis at 13 weeks' gestation. Pregnancy termination was refused, and she was treated with intravenous ampicillin and gentamicin followed by oral trimethoprim/sulfamethoxazol. Fifteen days after initiation of therapy, an amniotic fluid culture was negative, although uterine tenderness persisted for 7 weeks. A healthy, culture-negative infant was delivered at term.

Adult↗

PubMed1989

[Ureaplasma urealyticum and chorioamnionitis].

160 placentas from a clinical study group of women with pregnancy wastage and a control group were examined histologically and were cultured for Ureaplasma urealyticum. Recovery of Ureaplasma urealyticum was significantly higher in the pathologic group--43 p. cent--versus 21.6 p. cent in the control group, and was associated with chorioamnionitis.

Adolescent↗

PubMed1988

[The significance of C-reactive protein in the diagnosis of chorioamnionitis in cases of premature rupture of the membranes].

We have retrospectively studied the changes in the level of C-reactive protein (CRP) and of white blood cells in 82 patients who had premature rupture of the membranes between the 20th and the 36th week of pregnancy in order to estimate the possibility of prenatal screening for amnion infections in early rupture of the membranes. The level of CRP was shown to be quickly and significantly raised in cases of clinical or histological chorioamnionitis, whereas the change in maternal leucocytes alters little and later. The level of CRP can be worked out as an early biological marker which is sensitive and cheap in the clinical supervision of cases with early rupture of the membranes.

C-Reactive Protein↗

PubMed1987

[Bacteriologic studies in premature rupture of fetal membranes and correlation with the clinical aspects of chorioamnionitis and the amnion infection syndrome].

One of the major complications following premature rupture of the membranes (PROM) is ascending infection. In this aspect the bacteria of the vaginal flora play a major part. Bacterial spectra of a group with PROM and another control group with punctual rupture of the membranes are comparatively analysed. This analysis is based on swabs taken from vagina and newborns. Data are interpreted in correlation to clinical picture of chorioamnionitis and amnion infection syndrome (AIS). Twelve newborns clinical suspected to have a neonatal infection are retrospectively judged. In the group with pregnant women with PROM potential pathological germs such as group B streptococci and E. coli are found more often, whereas physiological flora, specially Lactobacillus species, are clearly reduced. In newborns with AIS even germs can be detected, which so far have seemed to be more apathogenic, such as Gardnerella vaginalis. Bacteriological findings are discussed in connection with clinical parameters, specially group B streptococci are looked at more precisely. In newborns with AIS microbiological results are demonstrated including course of pregnancy and delivery. For the management of PROM alternatives are shown and advice for prophylaxis is given.

Bacteria↗

PubMed1988

Antibiotic concentration in maternal blood, cord blood, and placental membranes in chorioamnionitis.

Levels of five antibiotics used in treating chorioamnionitis were measured in maternal and cord blood and placenta. Ampicillin provided the highest ratio of cord to maternal blood (0.71). Gentamicin was also relatively high in this respect and also had the highest placenta to maternal blood ratio (3.97). Based on these findings, the commonly used combination of ampicillin and gentamicin seems appropriate, although additional anaerobic coverage may be needed.

Acute Disease↗

PubMedDate not supplied

Chorioamnionitis: perinatal morbidity and mortality.

Chorioamnionitis is both a clinical and a histopathologic diagnosis. The latter may be clinically silent, but it commonly accompanies reproductive casualty and premature birth. Satisfactory delineation of its pathogenesis is elusive. Detailed histologic study indicates that endometrial inflammation usually precedes that of the membranes. Evidence is accumulated that Ureaplasma urealyticum is a major participant in this sequence and its grave clinical complications.

Chorioamnionitis↗

PubMed1995

Salmonella typhi chorioamnionitis in a human immunodeficiency virus-infected pregnant woman. A case report.

Opportunistic prenatal infection is a recognized problem in human immunodeficiency virus (HIV)-infected women from inner city communities. We report a case of intrapartum Salmonella typhi infection and discuss the possible route of infection. An HIV-infected pregnant woman was admitted for fever and ruptured membranes. Maternal blood, cervical and uterine cultures, and placental surface and intramembranous space cultures grew S typhi. The patient responded to antibiotic therapy, with no relapse. The infant did not show signs or symptoms of Salmonella sepsis. Salmonella infection should be treated aggressively in HIV-infected pregnancies with chorioamnionitis and postpartum endometritis.

Adult↗

PubMed1994

Chorioamnionitis and appendiceal abscess. A case report.

A rare case occurred of chorioamnionitis complicating a smoldering periappendiceal abscess. Neonatal death and maternal morbidity occurred. Direct spread of infection from the abscess to the fetal membranes is hypothesized.

Abscess↗

PubMed1994

[Significance of the glucose concentration in amniotic fluid for the prediction of chorioamnionitis in preterm labor].

For the rapid and accurate prediction of the presence of chorioamnionitis (CAM) in preterm labor, amniotic fluid analyses were performed in 46 women with preterm labor between 24 to 34 weeks' pregnancy. Ultrasound-guided transabdominal amniocentesis was performed on admission and the amniotic fluid was subjected to the measurement of cell count, glucose, protein and chlorine concentration according to cerebrospinal fluid and neutrophil esterase analysis. The data demonstrated that the amniotic fluid glucose concentration was significantly lower in women with preterm birth/CAM(+) than that with preterm birth/CAM(-) and term birth (19.0 +/- 9.1, 28.0 +/- 7.6, 51.6 +/- 14.5 mg/dl, respectively). All of the women with a glucose concentration of 20mg/dl or less showed signs of CAM. By setting up a cut off value of 25mg/dl, both high sensitivity (81.8%) and specificity (91.4%) for the prediction of CAM were obtained. Positive predictive values for CAM of a glucose concentration of 20mg/dl or less and 25mg/dl or less were 100% and 75% respectively. It was concluded that amniotic fluid glucose concentration measurement is useful for the prediction of CAM. The presence of CAM should be considered when the amniotic fluid glucose concentration is 25mg/dl or less.

Adult↗

PubMed1993

Chronic villitis, chronic chorioamnionitis, and maternal floor infarction.

Chronic inflammatory infiltrates in the human placenta are much less common than acute inflammation. Most often, chronic inflammation is found in the villi (villitis), but rarely it may involve the fetal membranes. Villitis is associated with many well-documented maternal infections. Reviewed herein are features of the villous inflammatory infiltrate and associated villous changes that may suggest a specific bacterial or protozoal etiology. However, the majority of villitides are of unknown etiology. These may be the result of an unrecognized pathogen or, alternatively, may reflect an abnormal immune reaction. Chronic chorioamnionitis is commonly associated with villitis and has accompanied some well-documented viral, bacterial, and protozoal infections, but a specific infectious etiology is not identified in many cases. Maternal floor infarction is not a true infarct; it is characterized by the deposition of fibrin in the decidua basalis and intervillous space where enveloped villi become avascular and sclerotic. Maternal floor infarction is associated with intrauterine growth retardation and fetal demise. It frequently recurs in successive pregnancies.

Chorioamnionitis↗

PubMed1993

Lysozyme in cervical mucus of patients with chorioamnionitis.

Lysozyme and lactoferrin, antimicrobial substances present in cervical mucus, play an important role in defense mechanisms against ascending infections in development of chorioamnionitis (CAM). In this study, we measured the concentration of lysozyme in cervical mucus, and studied its relationship with other factors, and obtained following results. The concentration of lysozyme in cervical mucus decreased more significantly in positive CAM in preterm labor than in negative CAM and control subjects (P < 0.001). A direct correlation between the concentrations of lysozyme and lactoferrin was observed (r = 0.709). In positive CAM, the concentration of elastase in cervical mucus reached a significantly high level (more than 8,000 micrograms/L), and a no correlation between the concentrations of elastase and lysozyme was observed. These findings suggest a reduction of the defense mechanism occurred because the concentrations of both lysozyme and lactoferrin in cervical mucus during preterm labor (positive CAM) decreased.

Cervix Mucus↗

PubMed1993

[Lactoferrin in cervical mucus of patients with chorioamnionitis].

The antimicrobial activity of cervical mucus is regarded as a local defense mechanism against ascending infections by the vaginal bacterial flora. In this study, the content of lactoferrin in cervical mucus of patients with chorioamnionitis (CAM) and its correlation with other indicators of infection were determined. The results obtained are summarized as follows: 1. The lactoferrin content in cervical mucous was higher in pregnant than in non-pregnant women. It was significantly lower in CAM(+) patients than in CAM(-) patients (P < 0.001) in preterm labor and was lower in preterm labor than in full-term control (P < 0.002). Elastase contents in cervical mucus of CAM(+) patients were significantly higher than full-term control levels (P < 0.001), and showed a negative correlation with lactoferrin contents. 2. With regard to other indicators of infection, CRP, ESR, and WBC were higher in CAM(+) patients and fibronectin was detected (> 50 ng/ml) in the cervical mucus of all CAM(+) patients.

Cervix Mucus↗

PubMed1982

Coitus and chorioamnionitis: a prospective study.

Amniotic fluid infections have been strongly associated with coitus during pregnancy. If the relationship is causal it may be possible to identify a time sequence between coitus, penetration of bacteria through the mucous plug in the cervix, the development of infection in the extraplacental membranes near the cervical os, spread of the infection to the amniotic fluid and complications of the infection. The present study looked for such a sequence in an analysis of 541 pregnancies. A peak frequency of chorioamnionitis limited to the extraplacental membranes was present when labor and delivery took place within two days of the last coitus. In the next two days the infection spread to the amniotic fluid as evidenced by a peak frequency of maternal neutrophils migrating through the placental plate toward the amniotic cavity. Premature delivery was 4 times more frequent when there had been recent coitus and an amniotic fluid infection was present than when either factor was absent (P less than 0.01). Spontaneous rupture of the fetal membranes before the onset of and the membranes were inflamed than when these factors were absent (P less than 0.01). This raises the possibility that orgasm further weakened or ruptured membranes that had already been weakened by infection.

Amnion↗

PubMed2003

Intrapartum chlorhexidine vaginal irrigation and chorioamnion and placental microbial colonization.

OBJECTIVES: To determine whether intrapartum chlorhexidine vaginal irrigation reduces microbial colonization of the chorioamnion or placenta. METHODS: Secondary analysis was made of a randomized trial. Cultures for aerobic and anaerobic bacteria, Mycoplasma species and Ureaplasma urealyticum were performed using standard isolation techniques. RESULTS: The placentas of 83 trial participants allocated to chlorhexidine and 93 allocated to placebo underwent evaluation. These two groups were statistically balanced for risk factors for infection. Aerobic bacteria were isolated from 47% of the chlorhexidine placentas vs. 51% of the placebo placentas (relative risk 0.9, 95% confidence interval 0.7-1.3), anaerobic bacteria from 30% and 35%, respectively (0.8, 0.5-1.3), group B streptococcus from 12% and 15% (0.8, 0.4-1.7), U. urealyticum from 18% and 29% (0.6, 0.4-1.1), Mycoplasma species from 6% and 11% (0.6, 0.2-1.6), and any organism from 57% and 67%, respectively (0.8, 0.7-1.1). CONCLUSIONS: Intrapartum chlorhexidine vaginal irrigation was associated with non-significant reductions in the rates of placental microbial isolation.

Administration, Intravaginal↗