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PubMed2000

A case-referent study on fetal bacteremia and late fetal death of unknown etiology in Lithuania.

BACKGROUND: The objectives were to test the hypothesis that certain strains of microorganisms are present in fetal blood in a significant proportion of parturient women suffering unexplained third trimester fetal death, and to examine the correlation between fetal bacteremia and histologic chorioamnionitis and vasculitis. METHODS: A case-referent study was carried out on 58 pregnant women with fetal death of unknown etiology (cases) and 116 pregnant women at term (referents) with live fetuses. Cultures from maternal endocervix, amniotic fluid, placental homogenate, external ear and blood of newborns were performed in both groups. Histological examination of placentas and fetal membranes was carried out in order to identify chorioamnionitis and chorionic vasculitis. RESULTS: Intrauterine fetal bacteremia was observed in 36% of cases and in 0% of referents (p= 0.001). Escherichia coli was the most common strain, isolated in 21% of fetal blood samples in cases. Extensive histologic chorioamnionitis was observed in 50% of cases with the presence of Escherichia coli in blood of stillborns. Chorionic vasculitis was found in 67% of such cases. Positive significant correlations between isolation of the Escherichia coli from maternal endocervix, amniotic fluid, placenta, fetal ear and blood in stillborns and histological chorioamnionitis and chorionic vasculitis were observed. CONCLUSIONS: Escherichia coli bacteremia was detected in a significant proportion of stillborns suffering a third trimester prelabor death. Fetal bacteremia significantly correlated with histologic signs of inflammation in placenta and membranes. Ascending subclinical intrauterine infection may play an important role in the etiology of otherwise unexplained late prelabor fetal death.

Adult↗

PubMed1999

[The relationship between fetal fibronectin, bacteria vaginosis and chorioammionitis].

OBJECTIVE: To study the relationship of fetal fibronectin (FFN), Bacteria vaginosis (BV) and chorioamnionitis. To evaluate the diagnostic value of FFN for chorioamnionitis. METHODS: FFN was measured by enzyme-labelled immunosordent assay (ELISA) in samples of carvical secretion from 60 pregnant women with BV (study group) and 45 normal pregnant women at same gestational weeks (control group). Positive test was defined as a level of (FFN) > or = 50 ng/ml. RESULTS: Positive rate of FFN in pregnant women with BV was significantly higher than that in the normal control group. Incidence of chorioamnionitis and preterm labor in FFN positive cases was significantly higher than that of FFN negative cases. CONCLUSIONS: Fetal fibronectin is an important marker for diagnosis and prediction of chorioamnionitis perterm labor and Premature rupture of membranes.

Chorioamnionitis↗

PubMed1994

Peripartum infection associated with vaginal group B streptococcal colonization.

OBJECTIVE: To determine the frequency of peripartum infection in parturients colonized with group B streptococci. METHODS: We screened 915 obstetric patients for group B streptococcal colonization using selective broth media; 823 had vaginal cultures performed within 2 weeks preceding delivery and received complete follow-up. Vaginal group B streptococcal colonization and other risk factors for peripartum maternal infection were assessed using univariate and multivariate logistic modeling. RESULTS: Two hundred sixteen women (26%, 95% confidence interval [CI] 23-29) were colonized with group B streptococci. Chorioamnionitis or endometritis occurred in 45 of 216 colonized women (21%, 95% CI 15.6-26.4) and 72 of 607 women who were not colonized (12%, 95% CI 9-15; P < .01). When confounding variables were controlled in a multivariate analysis, the association between group B streptococcal colonization and chorioamnionitis, but not endometritis, was confirmed (odds ratio 3.6, 95% CI 2.1-6.2). The risk of chorioamnionitis increased in a stepwise fashion with light (odds ratio 1.9, 95% CI 1.0-3.7), moderate (odds ratio 2.6, 95% CI 1.3-5.2), and heavy (odds ratio 3.2, 95% CI 1.5-6.6) colonization. CONCLUSION: Intrapartum vaginal colonization with group B streptococci is an important independent risk factor for chorioamnionitis.

Chorioamnionitis↗

PubMed1998

[Placental histopathology in premature rupture of membranes. Its relationship with microbiological findings, maternal, and neonatal outcome].

BACKGROUND: There is a close relationship between premature membrane rupture, bacterial infections and premature labor. AIM: To study placental histological changes in patients with preterm membrane rupture. To establish a relationship between pathological findings, amniotic fluid and lower genital tract microbiological studies, maternal and neonatal outcome. PATIENTS AND METHODS: Patients with premature membrane rupture of membranes between 24 and 34 weeks of gestation participated in this study. On admission, patients had no evidence of clinical chorioamnionitis, labor or fetal distress. Microbiological studies of the amniotic fluid and cervicovaginal secretions were performed and the placenta was sent for pathological study. RESULTS: Seventy one placentas were available for the study. The main pathological findings were acute chorioamnionitis in 58%, trophoblastic proliferation in 38%, funisitis in 37%, villitis in 16%, fetal vascular lesions in 14% and no findings in 17%. Microbial invasion of amniotic cavity was present in 89% of acute chorioamnionitis. Sixty one percent of trophoblastic proliferation and all fetal vascular lesions were associated with negative amniotic and cervical cultures. Newborns with acute funisitis had a higher frequency of neonatal death (29%), severe asphyxia (42%) and neonatal infections (29%). CONCLUSIONS: Acute chorioamnionitis is the most frequent finding in patients with preterm membrane rupture and microbial invasion of amniotic cavity. In the absence of intra amniotic infection, proliferation of the trophoblast and the presence of fetal vascular lesions predominate. Acute funisitis is strongly associated with adverse fetal outcome.

Amniotic Fluid↗

PubMed1998

Placental lesions associated with neurologic impairment and cerebral palsy in very low-birth-weight infants.

OBJECTIVE: Systematic placental examination has the potential to shed light on poorly understood antenatal processes that may increase the risk of neurologic impairment and cerebral palsy. DESIGN: Using data from a retrospective case-control study, we analyzed placentas from 60 inborn, singleton, very low-birth-weight (<1.5 kg) infants delivered between 1983 and 1991 who had subsequent neurologic impairment at 20 months corrected age (42 with cerebral palsy and 18 with other neurologic abnormalities) and 59 control infants of comparable gestational age, birth weight, sex, and race. Three a priori hypotheses based on previous studies were that neurologic impairment would be increased with fetal vascular lesions with or without coexisting chorioamnionitis, decreased with chronic maternal vascular underperfusion, and increased when multiple placental abnormalities were seen in the same case. RESULTS AND CONCLUSIONS: We found 2 types of fetal placental vascular lesions to be associated with neurologic impairment, namely, recent nonocclusive thrombi of chorionic plate vessels (P < .04) and severe villous edema (P < .01). Chorionic plate thrombi were seen only with chorioamnionitis and accounted for the increased risk of neurologic impairment seen with chorioamnionitis. Maternal vascular lesions showed a biphasic relation to neurologic impairment in the subgroup of patients without chorioamnionitis. Mild lesions were increased in controls (inadequate vascular remodeling, P=.03, and accelerated maturation, P=.004). A more severe lesion, multiple villous infarcts, although not reaching significance, was increased in the neurologically impaired cases. Finally, in a test of 9 selected placental lesions, cases with cerebral palsy were more likely to have 2 or more lesions (P < .0001) and were less likely to have no lesions (P < .04) than control infants.

Case-Control Studies↗

PubMedDate not supplied

Management of asymptomatic neonates with prolonged rupture of membranes.

Guidelines for management of asymptomatic term and preterm neonates born to mothers with prolonged rupture of membranes (PROM) have not been clearly established. A survey was conducted to identify current management practice of neonatologists in midwestern states and to find if there is consensus among physicians with regard to management of PROM without chorioamnionitis, with chorioamnionitis but without treatment prior to delivery, and with intrapartum maternal antibiotic therapy prior to delivery. One hundred thirty seven responses to the questionnaire were received. Management of asymptomatic at risk neonates varied in different clinical scenarios. Preterm neonates were screened (94% vs 82%, p < 0.001) and treated (64% vs 41%, p < 0.001) more often than term babies. In the absence of maternal symptoms of chorioamnionitis, term neonates were usually observed or treated based on screening test results. With maternal symptoms, 94% of physicians ordered screening test. Prematurity and perceived severity of maternal illness significantly influenced the decision to treat routinely irrespective of screening test results. Physicians favour routine treatment of infants born to mothers who had received intrapartum antibiotic therapy; opinion was divided about management of term asymptomatic infant born to mothers with chorioamnionitis without intrapartum antibiotic therapy. Lumbar punctures were not routinely done for term or preterm neonates prior to antibiotic therapy. Further studies are needed to answer questions regarding the benefits and risks of routine therapy of high risk neonates vs routine clinical observation and selective therapy of only infants who develop symptoms.

Female↗

PubMed1981

Bacterial contamination of the cervix and premature rupture of membranes.

The endocervical flora was examined in 32 women with premature rupture of membranes (PROM). Sixty-six pregnant women served as controls. Ten patients with PROM who later developed chorioamnionitis were also included in the study. Samples for culturing were obtained from the endocervix on admission and at delivery and later from the fetal surface of the placenta. Blood for culturing was also taken in cases of chorioamnionitis. The total number of bacteria in the endocervix and placenta was higher in patients with PROM. Anaerobes were the most common, except for the fetal surface of the placenta, where aerobes were found in greater numbers. Cultures of blood from women with chorioamnionitis were positive in seven cases. These findings suggest that the high incidence of pathogenic or potentially pathogenic cervical bacteria in pregnancy is related to chorioamnionitis and PROM.

Amniotic Fluid↗

PubMed1984

Is conservative management of preterm rupture of membranes justified?

The management of preterm rupture of membranes (ROM) is controversial. Some advise immediate delivery and others advocate conservative approach in the hope of decreasing morbidity and mortality rates associated with prematurity. A retrospective review of 75 pregnancies with preterm ROM treated conservatively was performed to delineate the relative risk factors. All patients with preterm ROM were placed at bed rest until either labor or chorioamnionitis prompted delivery. Chorioamnionitis developed in 25% of the cases. The percentage of women developing chorioamnionitis increased with duration of ROM. Fetal morbidity and mortality was not increased in the group with chorioamnionitis. Hyaline membrane disease (HMD) and intra ventricular hemorrhage (IVH) were the major causes of neonatal death in the entire group of preterm ROM. There was a significant relationship between neonatal mortality and birth weight. The smaller the birth weight, the greater the risk of neonatal death. Our data support the conservative approach to preterm ROM especially in the very low birth weight group where extreme caution must be taken before a decision is made to terminate pregnancy.

Adult↗

PubMed2006

Chronic exposure to intra-amniotic lipopolysaccharide affects the ovine fetal brain.

OBJECTIVE: Fetal brain injury is associated with chorioamnionitis, which is often present without signs of overt infection or fetal compromise. We aimed to determine if prolonged exposure to intrauterine inflammation caused by intra-amniotic infusion of lipopolysaccharide (LPS) would affect the fetal brain. METHODS: At 80 days of pregnancy ewes bearing singletons had osmotic pumps implanted intra-amniotically to infuse Escherichia coli LPS (055:B5; n = 8) or saline (n = 7) for 28 days. At delivery (110 days), umbilical arterial blood and chorioamnion were assessed for inflammation; cytokine concentrations (interleukin [IL]-6 and IL-8) in amniotic fluid and fetal and maternal plasma were measured. The fetal cerebral hemispheres were examined for gross anatomical changes and the number of activated microglia/macrophages, astrocytes, and oligodendrocytes estimated after immunohistochemical staining. RESULTS: Intra-amniotic administration of LPS caused chorioamnionitis, fetal leucocytosis, and a moderate to extensive infiltration of activated microglia/macrophages in the subcortical white matter in six of eight fetuses; the remaining two fetuses were less affected. Within these focal regions of damage there was an attenuation of astrocytic processes, axonal injury, and a reduction in the number of 2',3'-cyclic nucleotide 3'-phosphodiesterase (CNPase) immunoreactive oligodendrocytes in areas of extensive focal damage. In control fetuses there was mild (3/7) or no infiltration of activated microglia/macrophages in the subcortical white matter. Overall the infiltration of activated microglia/macrophages in the white matter was significantly greater in LPS-exposed fetuses compared to controls. In regions devoid of injury, the number of oligodendrocytes and astrocytes was not different between groups, nor was there a difference in the volume of cerebral white matter or density of blood vessels within the white matter. Amniotic fluid IL-6 and IL-8, and maternal plasma IL-8 concentrations were significantly increased by LPS infusion. CONCLUSIONS: An increase in inflammatory cells and axonal disruption in the subcortical white matter of the fetal brain can accompany chorioamnionitis induced by intra-amniotic administration of LPS, but cystic lesions do not occur. Thus, the effect on the fetal brain is milder than that reported from animal models of acute fetal/intrauterine infection.

Amniotic Fluid↗

PubMed1981

Infectious complications of cervical cerclage.

A study of 115 gravid patients who required cervical cerclage indicated that the optimum time to perform the surgical procedure was between the fourteenth and eighteenth weeks. If the operation is delayed until later in the second trimester, the incidence of chorioamnionitis is increased 2.6-fold, and premature rupture of the membranes prior to the thirty-second week of gestation is trebled. Amniocentesis performed in nine patients with chorioamnionitis and intact membranes after cerclage demonstrated the polymicrobial nature of the amniotic fluid infection. The isolation of such organisms at Bacteroides bivius, Eubacterium lentum, and Staphylococcus epidermidis indicates their potential importance in chorioamnionitis. Early recourse to amniocentesis is recommended when chorioamnionitis is suspected, and, moreover, prophylactic antibiotics should be used when cerclage is performed after the eighteenth week of pregnancy.

Abortion, Habitual↗

PubMed1997

Lipopolysaccharide binding protein and soluble CD14 receptor protein in amniotic fluid and cord blood in patients at term.

OBJECTIVES: Our purpose was to examine whether lipopolysaccharide binding protein and soluble CD14 are present in amniotic fluid and to determine whether the lipopolysaccharide binding protein and soluble CD14 concentrations are associated with indicators of infection or labor at term. A lipopolysaccharide-lipopolysaccharide binding protein complex activates macrophages through soluble CD14 at lipopolysaccharide concentrations up to 100 times lower than required with lipopolysaccharide alone. Thus lipopolysaccharide binding protein and soluble CD14 in amniotic fluid could explain the high concentrations of cytokines found in amniotic fluid of culture-positive patients and may even explain the presence of cytokines in some culture-negative patients. STUDY DESIGN: Healthy women at term undergoing cesarean section had amniotic fluid, chorioamnion, decidua, and cord blood obtained. Lipopolysaccharide binding protein was measured by enzyme-linked immunosorbent assay. Amniotic fluid was cultured and assayed for cytokines, and the chorioamnion and decidua were cultured and examined histologically. RESULTS: Lipopolysaccharide binding protein and soluble CD14 were present in all amniotic fluids and fetal cord blood. An elevated level of lipopolysaccharide binding protein (270 ng/ml/mg of protein) was present in the amniotic fluid of 12 (36%) of the 33 patients. An elevated level was associated with microorganisms in the chorioamnion and decidua, cytokines (tumor necrosis factor-alpha, interleukin-6, and interleukin-8) in amniotic fluid, histologic chorioamnionitis, and labor. Among patients in labor, the concentration of lipopolysaccharide binding protein appeared independent of microorganisms in the amniotic fluid. CONCLUSIONS: Lipopolysaccharide binding protein and soluble CD14 are present in amniotic fluid, and concentrations of lipopolysaccharide binding protein are elevated in patients in labor with and without evidence of infection. Lipopolysaccharide binding protein and soluble CD14 may mediate intrauterine inflammatory responses at term.

Acute-Phase Proteins↗

PubMed1997

Obstetric antecedents of intraventricular hemorrhage and periventricular leukomalacia in the low-birth-weight neonate.

OBJECTIVE: Neonatal intraventricular hemorrhage and periventricular leukomalacia have a strong correlation with eventual neurologic deficit. Our objective was to correlate obstetric factors with the development of these lesions. STUDY DESIGN: Seven hundred forty-five consecutive inborn neonates with birth weights from 500 to 1750 gm were divided into three clinical groups: premature rupture of membranes, refractory preterm labor with intact membranes, and delivery initiated by the physician for maternal or fetal indications. Neonatal neurosonography was performed on days 3 and 7 of life and results were described as normal or abnormal. Abnormal scans included intraventricular hemorrhage seen within 3 days and echodense or echolucent periventricular leukomalacia seen within 7 days of life. Major abnormalities included intraventricular hemorrhage grades 3 and 4, intraventricular hemorrhage with periventricular leukomalacia, and echolucent periventricular leukomalacia. Abnormal scans were correlated with groups of origin and clinical and histologic chorioamnionitis. RESULTS: Abnormal scans occurred in 33% of cases of premature rupture of membranes and in 38.9% of cases of preterm labor compared with 17.7% of physician-initiated cases (p < 0.000001). Major lesions occurred in 17.6% of cases of premature rupture of membranes, 21.4% of cases of preterm labor, and 1.1% of physician-initiated cases (p < 0.0000001). Clinical chorioamnionitis occurred in 19.7% of cases of premature rupture of membranes, 11.9% of cases of preterm labor, and 1.1% of physician-initiated cases (p < 0.001) and was associated with a significant increase in the incidence (p < or = 0.005) and severity (p < or = 0.007) of these lesions. Histologic chorioamnionitis occurred in 59.9% of cases of premature rupture of membranes, 43.2% of cases of preterm labor, and 8% of physician-initiated cases and did not correlate significantly with the incidence or severity of abnormal scans. These findings were independent of gestational age. CONCLUSIONS: The incidence and severity of intraventricular hemorrhage and periventricular leukomalacia were significantly increased in premature rupture of membranes and preterm labor compared with the physician-initiated cases. Clinical chorioamnionitis increased the incidence and severity of these lesions.

Cerebral Hemorrhage↗

PubMed2004

Maternal admission characteristics as risk factors for preterm birth.

OBJECTIVE: The aim of this study is to identify a subset of women presenting with preterm labor not responding upon tocolytic therapy, eventually resulting in preterm birth. STUDY DESIGN: The maternal admission characteristics of 185 women with preterm labor receiving tocolysis were analysed for risk factors that could predict which women will deliver within 48 h after the start of tocolysis, or before 34 weeks gestation. Univariate analysis and multivariate logistic regression analysis was performed. RESULTS: Logistic regression analysis identified the following risk factors for delivery within 48 h after the start of tocolysis: cervical dilatation at admission (odds ratio (OR, cm(-1)) 1.47; 95% confidence interval (CI), 1.44-1.49), elevated leukocyte count at admission (per 10(3) leukocytes/mm(3)) (OR 1.27; 95% CI, 1.26-1.28), use of nifedipine (OR 0.49; 95% CI, 0.26-0.49), and developing signs suggestive of chorioamnionitis following admission (OR 2.12; 95% CI, 1.04-4.33). For delivery before 34 weeks of gestation the following risk factors were identified: use of steroids (OR 5.87; 95% CI, 2.34-14.7), use of nifedipine (OR 0.46; 95% CI, 0.27-0.85), developing signs suggestive of chorioamnionitis following admission (OR 10.6; 95% CI, 3.1-35.9), and preterm premature rupture of the membranes (OR 12; 95% CI, 4.1-35.2). CONCLUSIONS: Risk factors associated for delivery within 48 h after starting tocolysis are: cervical dilatation at admission, elevated leukocyte count at admission, and developing signs suggestive of chorioamnionitis following admission. Use of nifedipine was associated with a delay of delivery >48 h. Risk factors associated for delivery within 34 weeks gestation are: use of steroids, developing signs suggestive of chorioamnionitis following admission, and ruptured membranes. Use of nifedipine was associated with a delay >34 weeks.

Adult↗

PubMed2002

The effect of labor on maternal and fetal vitamins C and E.

OBJECTIVE: This study was conducted to compare maternal and fetal plasma, amniotic fluid, and chorioamnion levels of vitamins C and E in term (>38 weeks' gestation) subjects undergoing elective repeat cesarean section (CS) without labor with values of subjects of similar gestational age and dietary intake undergoing labor and vaginal delivery (VD). STUDY DESIGN: Healthy women undergoing elective repeat CS (n = 5) or uncomplicated VD (n = 5) at term (>38 weeks' gestation) were studied. For CS patients, maternal and fetal (cord) blood, amniotic fluid, and chorioamnion samples were collected at time of surgery. For VD patients, maternal blood and amniotic fluid were obtained at 5 cm cervical dilation and fetal cord blood and chorioamnion were collected at delivery. Each patient completed a nutritional questionnaire. Plasma and membrane vitamin E concentrations were determined by reversed-phase high-performance liquid chromatography and standardized to cholesterol or membrane protein, respectively. Vitamin C was determined with the use of the 2,4-DNPH method. RESULTS: Dietary intakes for vitamins C and E as well as maternal and fetal vitamin E plasma concentrations were similar for CS and VD patients. In both groups, maternal levels were higher than fetal levels(P <.05). Chorioamnion membrane vitamin E measurements in both groups were similar. Vitamin C concentrations in CS and VD patients were highest in amniotic fluid, lower in fetal plasma, and lowest in maternal plasma. However, mean vitamin C concentrations in maternal plasma, amniotic fluid, and fetal plasma of VD patients were significantly lower, being only 20% +/- 6%, 29% +/- 11%, and 22% +/- 2% of values obtained from CS patients. CONCLUSION: During labor in healthy women at term, uterine contractile activity may generate reactive oxygen species (ROS) through the process of repetitive ischemia and reperfusion. With the significant depletion of vitamin C during labor, we speculate that water-soluble vitamin C scavenges ROS in the aqueous phase and recycles lipid-soluble vitamin E to combat ROS-induced tissue damage.

Amnion↗

PubMed2002

Magnesium sulfate and neonatal outcomes of preterm neonates.

OBJECTIVE: To determine whether in utero exposure to magnesium sulfate was associated with increased neonatal morbidity and mortality among premature neonates, and secondarily to determine the relationship, if any, between duration of magnesium sulfate exposure and neonatal morbidity and mortality. METHODS: We studied 401 neonates at our institution who were born between 23 and 34 weeks' gestation following preterm labor or preterm premature rupture of membranes. The population was stratified by exposure to magnesium sulfate and compared by various neonatal outcome variables. Similarly, the magnesium-exposed population was stratified by duration of exposure and compared for various neonatal outcome variables. Student's t test, chi2 test, Fisher's exact test and logistic regression were used for analysis. RESULTS: A total of 190 neonates were exposed to magnesium sulfate, while 211 neonates were not. The magnesium-exposed neonates were delivered at a significantly lower gestational age compared to the unexposed neonates (28.2 +/- 3.0 vs. 29.3 +/- 3.1 weeks, p = 0.001). Univariate analysis revealed no differences between groups with regard to rates of respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosus, histological and clinical chorioamnionitis, neonatal sepsis or neonatal death. However, magnesium-exposed neonates were more likely to have received antibiotics (71.6% vs. 45.0%, p = 0.0001) and antenatal steroids (95.8% vs. 61.6%, p = 0.0001), factors known to affect perinatal morbidity and mortality. Controlling for antenatal confounding factors, magnesium sulfate use was not independently associated with neonatal mortality (odds ratio (OR) = 0.66; 95% confidence interval (CI) = 0.28, 1.54; p = 0.34). Seventy-nine neonates were exposed to magnesium sulfate therapy for more than 24 h, while 111 neonates were exposed for 24 h or less. There were no significant differences between groups with respect to neonatal outcomes, with the exception of an increased rate of clinical chorioamnionitis in the group exposed to magnesium for more than 24 h (22% vs. 8.2%, p = 0.005). After adjusting for gestational age at delivery, magnesium sulfate exposure for over 24 h was independently associated with a 2.8-fold increased rate of clinical chorioamnionitis (OR = 2.8, 95% CI = 1.14, 6.90; p = 0.02). CONCLUSION: Prenatal exposure to magnesium sulfate was not associated with increased neonatal morbidity or mortality. However, prolonged exposure to magnesium sulfate may be associated with an increased risk of clinical chorioamnionitis.

Adult↗

PubMed2004

Chorionic plate vessels as an origin of amniotic fluid neutrophils.

The present study was conducted to investigate the potential anatomical source of amniotic fluid neutrophils. Microdissection of neutrophils from the chorioamnion of the fetal membranes and the amnion of the chorionic plates of 10 preterm placentas with acute chorioamnionitis was performed and the genotypes of the neutrophils were compared with those of the mother and fetus using polymerase chain reaction of nine autosomal STR loci. In separate analyses, we reviewed eight cases of fetal autopsies with increased amniotic fluid neutrophils for the presence of neutrophils in the alveoli, and also analyzed the relationship between the amniotic fluid white blood cell (WBC) count and the histological pattern of placental inflammation. The genotypes of all of the neutrophils found in the chorioamnion of the fetal membrane matched those of the mother (n = 10). The genotypes of neutrophils found in the chorionic plate were of mixed maternal and fetal origin (n = 4). In the autopsy series of the fetuses with amniotic fluid WBC (n = 8), only five cases showed neutrophils in the alveolar space, while all the placentas had chorioamnionitis. There was no significant difference in amniotic fluid WBC count between the cases with or without acute membranitis, while among the cases with placental inflammation, those with inflammation of the chorionic plate had a significantly higher amniotic fluid WBC count than both the membranitis-only cases (P < 0.001) and the membranitis and funisitis cases (P < 0.05). These results imply that fetal vasculature at the chorionic plate is the main source of amniotic fluid neutrophils, especially in the cases without funisitis.

Adult↗

PubMed2006

Bacterial vaginosis in a cohort of Danish pregnant women: prevalence and relationship with preterm delivery, low birthweight and perinatal infections.

OBJECTIVE: To determine the prevalence of bacterial vaginosis (BV) in the second trimester of pregnancy in a Danish population using the Schmidt criteria and to examine whether BV was associated with subsequent preterm delivery, low birthweight or perinatal infections. DESIGN: Prospective cohort study. SETTING: Department of Obstetrics and Gynaecology at a University Hospital, Denmark. POPULATION: Three thousand five hundred and forty pregnant women aged 18 years or more. METHODS: A smear from the vagina was obtained from all women, air-dried and stored for subsequent diagnosis of BV. After rehydration with isotonic saline, the smear was examined in a phase-contrast microscope at 400x, and the numbers of lactobacilli morphotypes and small bacterial morphotypes were counted. A score for BV was calculated according to the method described by Schmidt. The outcome of pregnancy from 20 weeks of gestation was examined in the 3262 singleton pregnant women who were included in this study before 20 weeks of gestation. The relationship between BV and adverse outcome of pregnancy was examined by univariate and multivariate analyses. MAIN OUTCOME MEASURES: Prevalence of BV, preterm delivery (<37 weeks), low birthweight (<2500 g), preterm delivery of a low-birthweight infant and clinical chorioamnionitis. RESULTS: The prevalence of BV was 16%, and the rate of preterm delivery was 5.2% in the study population of 3262 singleton pregnant women who were included before 20 weeks of gestation. Mean birthweight was significantly lower in infants of women with BV than in infants of women without BV (3408 versus 3511 g, P < 0.01). Univariate analyses showed that BV was marginally associated with preterm delivery but significantly associated with low birthweight, preterm delivery of a low birthweight infant, indicated preterm delivery and clinical chorioamnionitis. Multivariate analyses, which adjusted for previous miscarriage, previous preterm delivery, previous conisation, smoking, gestational diabetes, fetal death and preterm premature rupture of membranes, showed that BV was significantly associated with low birthweight (OR 1.95, 95% CI 1.3-2.9), preterm delivery of a low-birthweight infant (OR 2.5, 95% CI 1.6-3.9), indicated preterm delivery (OR 2.4, 95% CI 1.4-4.1) and clinical chorioamnionitis (OR 2.7, 95% CI 1.4-5.1). CONCLUSIONS: The prevalence of BV determined using the Schmidt criteria in the early second trimester of pregnancy was similar to that found in similar studies. The presence of BV before 20 weeks of gestation was an independent risk factor for delivery of an infant with low birthweight, preterm delivery of a low-birthweight infant, indicated preterm delivery and clinical chorioamnionitis.

Cohort Studies↗

PubMed1998

Characterization of group B streptococcal invasion of human chorion and amnion epithelial cells In vitro.

Group B streptococci (GBS) have been cultured from the chorioamnionic membrane of pregnant women, usually in association with chorioamnionitis and premature labor (K. A. Boggess, D. H. Watts, S. L. Hillier, M. A. Krohn, T. J. Benedetti, and D. A. Eschenbach, Obstet. Gynecol. 87:779-784, 1996). Colonization and infection of placental membranes can be a prelude to neonatal GBS infections even in the presence of intact membranes (R. L. Naeye and E. C. Peters, Pediatrics 61:171-177, 1978), suggesting that GBS cause chorioamnionitis or establish amniotic fluid infections by partial or complete penetration of the placental membranes. We have isolated and grown cultures of primary chorion and amnion cells from human cesarean-section placentas. This has provided a biologically relevant model for investigating GBS adherence to and invasion of the two epithelial barriers of the placental membrane. GBS adhered to chorion cell monolayers to a high degree. Pretreatment of GBS with trypsin reduced adherence up to 10-fold, which suggested that the bacterial ligand(s) was a protein. GBS invaded chorion cells at a high rate in vitro, and invasion was dependent on cellular actin polymerization. GBS could be seen within intracellular vacuoles of chorion cells by transmission electron microscopy. We also demonstrated that GBS were capable of transcytosing through intact chorion cell monolayers without disruption of intracellular junctions. GBS also adhered to amnion cells; in contrast, however, these bacteria failed to invade amnion cells under a variety of assay conditions. GBS interactions with the chorion epithelial cell layer shown here correlate well with epidemiological and pathological studies of GBS chorioamnionitis. Our data also suggest that the amnion cell layer may provide an effective barrier against infection of the amniotic fluid.

Amnion↗