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PubMed1998

Perinatal events and the risk of intraparenchymal echodensity in very-low-birthweight neonates.

A case-control study was performed to identify perinatal events associated with intraparenchymal echodensity on cranial ultrasonography--an important antecedent of cerebral palsy in very-low-birthweight infants. Forty-eight infants with birthweight < 1500 g and intraparenchymal echodensity on cranial ultrasound examination and 90 controls with normal cranial ultrasounds were identified within a cohort of 1791 consecutive very-low-birthweight infants born at a regional obstetric referral centre. Data about potential risk factors were obtained from medical records of cases and controls. Among prenatal factors, chorioamnionitis (odds ratio[OR]: 3.2; 95% confidence interval: 1.3, 8.1) and placental abruption (OR 2.6 [1.0, 6.6]) were associated most strongly with an increased risk of intraparenchymal echodensity and pre-eclampsia (OR 0.3 [0.1, 0.8]) was associated most strongly with a decreased risk. When controlling for gestational age, multiple gestation was also associated with an increased risk (OR 2.7 [1.0, 7.5]). Neonatal factors independently associated with an increased risk included low systolic blood pressure (< 33 mmHg in the first 12 h of life; odds ratio 8.0 [2.0, 31.3]), receipt of a fluid bolus in the first 12 h of life (OR 19.7 [4.6, 84.3]), need for cardiopulmonary resuscitation in the first 72 h (OR 6.9 [1.5, 31.3]) and pneumothorax in the first 72 h of life (OR 27.0 [4.3, 167.2]). When analyses were restricted to infants who were not given a fluid bolus, the associations with chorioamnionitis and placental abruption were attenuated. When excluding infants who had a pneumothorax, the associations with placental abruption and multiple gestation were attenuated. Restriction of infants with systolic blood pressure < 33 mmHg resulted in attenuation of associations with pre-eclampsia and multiple gestation. These analyses suggest the possibility that potentially modifiable postnatal events may be involved as intervening factors linking chorioamnionitis, placental abruption and multiple gestation with subsequent intraparenchymal echodensity.

Abruptio Placentae↗

PubMed2000

Infection and preterm birth: evidence of a common causal relationship with bronchopulmonary dysplasia and cerebral palsy.

Subclinical genital tract infection has been clearly established as a significant cause of spontaneous preterm birth, particularly in early gestations. Bacterial vaginosis organisms rank highly among the pathogens involved in preterm labour and there is considerable beneficial evidence from the use of prophylactic antibiotics for women at high risk of preterm birth. The pathogenesis involves activation of macrophages and the generation of pro-inflammatory cytokines. Bronchopulmonary dysplasia is seen in the most immature of survivors and appears to be secondary to interruption of normal development and maturation of the lungs. The link between chorioamnionitis and lung injury in utero and subsequent development of bronchopulmonary dysplasia has now been substantiated. Exposure to pro-inflammatory cytokines is implicated in the impairment of the fetal lung. A significant body of evidence supports the association between chorioamnionitis, periventricular leukomalacia and cerebral palsy. Biological mechanisms that explain the association between chorioamnionitis and fetal brain injury involve pro-inflammatory cytokines. Similarity in the pattern of expression of cytokines suggests a common pathway for the initiation of preterm labour and also injury to the lung and the central nervous system of the fetus.

Bronchopulmonary Dysplasia↗

PubMed1997

Residual amniotic fluid volume in preterm rupture of membranes: association with fetal presentation and incidence of clinical and histologic evidence of infection.

The objective of this study was assess whether residual amniotic fluid volume (AFV) following premature rupture of the membranes (PROM) is associated with fetal presentation, or the prevalence of either clinical or histologic infection in patients delivering below 32 weeks' gestation. From an established database of 465 deliveries below 32 weeks' gestation, patients with singleton, nonanomalous fetuses with AFV assessment within 24 hours of delivery were studied (n = 146). Fetal presentation was confirmed by ultrasound identifying 46 breech and 100 vertex-presenting fetuses. Premature rupture of the membranes was diagnosed by sterile speculum examination. Clinical chorioamnionitis was diagnosed by previously published criteria. Histopathology examination of the extraplacental amnion and the umbilical cord were performed by a single pathologist blinded to clinical data. Outcome variables evaluated: rupture-to-delivery interval, gestational age at delivery, neonatal morbidity parameters (1- and 5-min Apgar scores < 5 and 7, respectively; incidence of respiratory distress syndrome; bronchopulmonary dysplasia; retinopathy of prematurity; neonatal sepsis; intraventricular hemorrhage; days of ventilation; and hospitalization), and placental histologic parameters of maternal and/or fetal acute inflammation. Statistical analysis included contingency tables and analysis of variance with p < .05 considered significant, after corrections for multiple comparisons when appropriate. Residual AF volume following PROM was significantly lower in breech compared with vertex presentation (AFV = 0 in 20 vs. 34; AFV = 1 in 19 vs. 27; AFV = 2 in 7 vs. 39, respectively, p = .014). No significant difference was noted in the rupture-to-delivery interval, gestational age at delivery, neonatal morbidity parameters, or histologic evidence of maternal and/or fetal acute inflammation (50% vs. 42%, p > .2) between gestations with breech or vertex presentations. The incidence of clinical chorioamnionitis was significantly lower in breech compared with vertex presentation (40% vs. 60%, p < .05). We conclude that following PROM below 32 weeks' gestation, in breech-presenting fetuses, the residual AFV and incidence of clinical chorioamnionitis are significantly decreased compared with vertex-presenting fetuses.

Acute Disease↗

PubMedDate not supplied

Significance of positive cervical cultures for Chlamydia trachomatis in patients with preterm premature rupture of membranes.

We tested the hypothesis that in patients with preterm premature rupture of membranes the presence of Chlamydia trachomatis in the cervix shortens the latent period (time from rupture of membranes to delivery) and increases the incidence of chorioamnionitis and early endometritis. A total of 178 conservatively managed patients with PROM between 22 and 35 weeks' gestation had cervical cultures for chlamydia, group B Streptococcus (GBS) and Neisseria gonorrhoeae performed at the time of rupture. Patients with GBS and gonorrhea were treated at the time the culture results were available and excluded from analysis. The remaining patients were divided into group 1: 26 patients (14.6%) positive for only chlamydia (and not treated until discharge from the hospital); group 2: 120 patients (67.4%) negative for all three organisms. The two groups did not differ in cesarean rate, duration of conservative management, hospital stay, or birthweight. Furthermore, the rates of chorioamnionitis (30.8% group 1; 38.3% group 2) or early endometritis (11.5% group 1; 20.8% group 2) were similar. We conclude that in patients with preterm premature rupture of membranes, the presence of chlamydia in the cervix appears to neither decrease the latent period nor increase the incidence of chorioamnionitis and early endometritis.

Adult↗

PubMed1987

Placental pathology is not predictive for sudden infant death syndrome (SIDS).

A previous report has suggested an increased incidence of chorioamnionitis in the placentae of sudden infant death syndrome (SIDS) victims. To further evaluate placental pathology in SIDS, 27 cases were identified from coroner's records and matched to two control groups. Both control groups were matched for birthweight, gestational age, and season, with the second also matched for maternal race, infant sex, blood type B, and maternal parity. No significant increase in chorioamnionitis or other placental abnormalities were found in SIDS victims when controlling for prematurity, which is a factor related to chorioamnionitis. An increased incidence of vaginal bleeding (P less than 0.04) and possibly substance abuse or anemia at delivery was found in SIDS mothers. There were more premature and black infants found in the SIDS group compared with the general birth population, and also lower five-minute Apgar scores (P less than 0.02) compared to matched controls. Analysis of the second control group match, including infant Apgar scores, maternal hematocrit, maternal age, and complications of pregnancy and delivery, did not influence any of our conclusions. The data suggests that matching for prematurity may be important in identifying the strength of additional risk factors for SIDS, since the risk factors for SIDS and premature delivery are similar.

Adult↗

PubMed1988

[Genital infections and the course of pregnancy: a prospective study].

The reported study investigates the relationship of genital infections, pathobiochemical findings and demographic data to preterm labor, premature rupture of membranes (PROM) and premature delivery. The predictability of chorioamnionitis, puerperal and neonatal infections by these parameters was evaluated concurrently. 301 patients were included in this study between July 1985 and June 1986. 147 of these patients were studied longitudinally during pregnancy, delivery and puerperium (longitudinal group). A second group consisted of 154 women who presented themselves on start of labor to the labor and delivery unit of our Department (peripartal group). The incidence of preterm labor and of PROM was 26%. The incidence of premature delivery, chorioamnionitis, puerperal and neonatal infection was 11.4%, 5.5%, 7.6% and 3% respectively. Cervical colonization with Mycoplasma hominis correlated positively with PROM (relative risk 2.2), premature delivery (3.9) and neonatal infection (6.9). Chorioamnionitis, premature delivery and puerperal infection were also significantly increased in patients with positive vaginal Ureaplasma urealyticum cultures during pregnancy and delivery. Premature delivery (2.8) and puerperal infection (4.0) were associated with a vaginal group B-Streptococci (GBS) colonization during pregnancy, as was a positive GBS culture during delivery associated with puerperal infection. Bacterial vaginosis also correlated positively with premature delivery (5.6) and puerperal infection. Preterm labor correlated negatively with the socioeconomic level, PROM correlated negatively with the marital status, positively with age, a history of cervical cerclage, conization or PROM during former pregnancies. Sexual intercourse more often than once weekly during the last month of pregnancy was also associated with an increased number of PROM. Gardnerella vaginalis, Candida and Trichomoniasis during pregnancy and delivery were associated with preterm labor and puerperal infections. Levels of maternal plasma fibrinogen concentrations in patients with PROM were elevated 48 hours after delivery in accordance to the characteristics of acute phase proteins. In contrast, the maternal PMN-granulocyte-elastase concentration was significantly elevated at time of delivery and 24 hours thereafter in those patients who developed puerperal infections. The derived positive predictive value was 26%, the negative 94.7%, respectively. The overall accuracy of the prediction was 83.1%. Six out of seven mothers with neonates treated because of neonatal infection showed significantly elevated plasma concentration of PMN-granulocyte-elastase.(ABSTRACT TRUNCATED AT 400 WORDS)

Bacterial Infections↗

PubMed2002

The effect of elective cesarean delivery and intrapartum infection on fetal lymphocyte activation and susceptibility to HIV infection.

OBJECTIVE: Mother-to-child transmission of the human immunodeficiency virus may be reduced with elective cesarean delivery before labor. Because immune activation enhances the human immunodeficiency virus infection, we hypothesized that fetal lymphocytes that are obtained at elective cesarean delivery may be less activated, therefore less susceptible to human immunodeficiency virus infection than cells that are obtained after normal spontaneous vaginal delivery at term. A second hypothesis was that intrapartum infection correlates with increased lymphocyte activation and susceptibility to human immunodeficiency virus infection. STUDY DESIGN: Samples were obtained after normal spontaneous vaginal delivery (n = 13), elective cesarean delivery (n = 12), chorioamnionitis (n = 5), and preterm labor (n = 6). Activation markers were measured by flow cytometry, and cord blood mononuclear cells were infected with the human immunodeficiency virus. RESULTS: Cell activation was comparable within the normal spontaneous vaginal delivery and elective cesarean delivery groups; there was no difference in susceptibility to in vitro human immunodeficiency virus infection. Intrapartum infection (chorioamnionitis, preterm labor) was associated with increased cell activation. Chorioamnionitis/preterm labor also tended to increase cord blood mononuclear cell susceptibility to human immunodeficiency virus infection. CONCLUSION: Labor did not activate fetal lymphocytes or alter susceptibility to human immunodeficiency virus infection compared with elective cesarean delivery. Intrapartum infection was associated with cell activation, and there was a trend toward increased susceptibility to human immunodeficiency virus infection. These data suggest that fetal lymphocyte activation correlates with susceptibility to human immunodeficiency virus infection and may account for the increased mother-to-child transmission of the human immunodeficiency virus that has been seen in association with chorioamnionitis and preterm labor.

Cesarean Section↗

PubMed2003

Duration of antibiotic therapy after preterm premature rupture of fetal membranes.

OBJECTIVE: This study was undertaken to compare the efficacy of 3 days versus 7 days of ampicillin in prolonging gestation for at least 7 days in women with preterm premature rupture of membranes (PPROM). STUDY DESIGN: We performed a randomized clinical trial comparing 3 days of ampicillin with 7 days ampicillin in patients with PPROM. Our primary outcome was the prolongation of pregnancy for at least 7 days. Secondary outcomes included rates of chorioamnionitis, postpartum endometritis, and neonatal morbidity and mortality. RESULTS: Forty-eight patients were randomly selected. There was no statistically significant difference in the ability to achieve a 7-day latency (relative risk 0.83, 95% CI 0.51-1.38). In addition, there was no statistically significant difference in the rates of chorioamnionitis, endometritis, and our composite neonatal morbidity. CONCLUSION: In patients with PPROM, length of antibiotic therapy does not change the rate of a 7-day latency or affect the rate of chorioamnionitis, postpartum endometritis, or neonatal morbidity.

Adult↗

PubMed2003

Prolonged latency after preterm premature rupture of membranes: an evaluation of histologic condition and intracranial ultrasonic abnormality in the neonate born at <28 weeks of gestation.

OBJECTIVE: The purpose of this study was to evaluate whether infants who were delivered at <28 weeks of gestation after prolonged latency in pregnancies that were complicated by preterm premature rupture of membranes are at increased risk of histologic chorioamnionitis and intracranial ultrasound abnormalities. STUDY DESIGN: A retrospective cohort analysis of 430 singleton infants born at <28 weeks of gestation in five hospitals (January 1991 through December 1993) with at least one of three protocol cranial scans read by a consensus committee and with placental pathologic evidence. Outcome variables were placental (histologic chorioamnionitis, fetal vasculitis) and neonatal (intraventricular hemorrhage, echolucencies, ventriculomegaly). Latency was divided into five intervals, and outcomes in the longer four intervals were compared with those in infants who were delivered at <1 hour after membrane rupture. Each outcome-latency relationship was evaluated in a logistic model that was controlled for confounders. RESULTS: Odds ratios and CIs for each latency interval that was controlled for confounders that included gestational age, maternal race, antenatal steroid and antibiotic administration, and delivery mode show a statistically significant increase in the risk of histologic chorioamnionitis and fetal vasculitis. Models for intraventricular hemorrhage, ventriculomegaly, and echolucencies failed to demonstrate significant differences with increasing latency. CONCLUSIONS: Ascending transcervical infection after preterm premature rupture of membranes is documented by the increasing odds ratios of placental inflammation. The odds of ultrasonically detectable brain abnormalities, however, did not increase with increasing latency.

Adult↗

PubMed2003

Pulmonary fluorodeoxyglucose uptake in infants of very low birth weight with and without intrauterine inflammation.

OBJECTIVE: We compared early pulmonary (18)fluorodeoxyglucose ((18)FDG) uptake in infants who had very low birth weight with and without exposure to intrauterine inflammation by using positron emission tomography (PET). A secondary goal was to correlate (18)FDG uptake with later death or bronchopulmonary dysplasia. METHODS: Within 72 hours of birth, 22 singleton infants between 25 and 30 weeks of gestation had a thoracic PET scan after intravenous (18)FDG. Influx constants (K(i)) for (18)FDG were determined. Placental histology assessed exposure to intrauterine inflammation. RESULTS: Chorioamnionitis was found in 13 infants. Seven of these infants also had evidence of funisitis. No inflammation was detected in the remaining nine infants. Median (minimum, maximum) thoracic K(I) was 0.008 (0.006, 0.011) mL/min/mL in infants with funisitis, 0.006 (0.002, 0.008) in infants with chorioamnionitis only, and 0.006 (0.001, 0.015) in infants with no evidence of intrauterine inflammation (P=.16). No relation was found between K(i) and later death or bronchopulmonary dysplasia. Cord blood interleukin-6 was elevated in newborns with placental inflammation (P=.014). CONCLUSION: Early thoracic PET scanning for metabolically active inflammatory cells does not differ between infants with and without exposure to intrauterine inflammation. Evidence of early intrapulmonary sequestration of inflammatory cells in some infants without chorioamnionitis points to the complex etiology of postnatal inflammation.

Bronchopulmonary Dysplasia↗

PubMed2003

Maternal and fetal inflammatory responses in unexplained fetal death.

OBJECTIVE: The role of intra-amniotic infection in the etiology of fetal death has been proposed. This study was conducted to determine the prevalence of microbial invasion of the amniotic cavity (MIAC) and the frequency of maternal and/or fetal inflammation in patients presenting with a fetal death. METHODS: A prospective study was conducted in patients with a fetal death. Amniocenteses were performed for clinical indications (karyotype), as well as to assess the microbiological and cytological state of the amniotic cavity. Fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas. An amniotic fluid white blood cell count and glucose determinations were also performed. Histological examination of the placenta was conducted to identify a maternal inflammatory response (acute chorioamnionitis) or a fetal inflammatory response (funisitis). RESULTS: This study included 44 patients with intrauterine fetal death. The median gestational age at diagnosis was 30.1 weeks (range 16.3-40.4 weeks). One patient had documented MIAC (1/44). Acute histological chorioamnionitis was found in 20.9% (9/43), but a fetal inflammatory response was observed in only 2.3% (1/43) of cases. One patient had a positive amniotic fluid culture for Streptococcus agalactiae (group B streptococcus). CONCLUSION: Histological chorioamnionitis was present in 20.9% of cases, but MIAC could be demonstrated with conventional microbiological techniques in only one case. A fetal inflammatory response was nine times less frequent than a maternal inflammatory response (maternal 20.9% vs. fetal 2.3%, p = 0.008) in cases of fetal death.

Adult↗

PubMed1998

Prenatal events and the risk of cerebral palsy in very low birth weight infants.

The purpose of this study was to analyze associations between prenatal factors and cerebral palsy in a geographically based cohort of very low birth weight infants. Cases (n = 80) and controls had birth weights of 500-1,500 g and were born in 1978-1989, to a resident of one of 17 counties in northwest North Carolina. Medical records were reviewed for data about prenatal and neonatal factors. Associations were analyzed separately for three clinical forms of spastic cerebral palsy (hemiplegia, diplegia, and quadriplegia) and for cerebral palsy with and without antecedent major cranial ultrasound abnormalities. The following factors were associated most strongly with an increased risk of cerebral palsy: multiple gestation, chorioamnionitis, maternal antibiotics, antepartum vaginal bleeding, and labor lasting less than 4 hours. Preeclampsia and delivery without labor were associated with a decreased risk. Evidence of confounding was found for each of these associations, except for those with chorioamnionitis and labor lasting less than 4 hours. The association with chorioamnionitis was stronger for diplegia (compared with hemiplegia and quadriplegia) and for cerebral palsy without major cranial ultrasound abnormalities. Associations with antepartum vaginal bleeding (increased risk) and preeclampsia (decreased risk) were stronger for cerebral palsy occurring with major cranial ultrasound abnormality.

Anti-Bacterial Agents↗

PubMed1992

Human placenta constitutively produces interleukin-8 during pregnancy and enhances its production in intrauterine infection.

Interleukin-8 (IL-8) exerts unique chemotactic and activating activity on neutrophils. To address the significance of IL-8 in the fetoplacental unit during pregnancy, we cultured human placental explants that had been obtained by vaginal delivery, Caesarean section, or artificial abortion and then measured the IL-8 titer in the culture supernatants by enzyme immunoassay (EIA). Chorionic tissue from the first trimester produced a significant amount of IL-8 (2.2 +/- 0.4 ng/ml/10 mg, n = 5), while placentae in the second trimester (8.3 +/- 1.6 ng/ml/10 mg, n = 7) or at term (9.2 +/- 0.7 ng/ml/10 mg, n = 29) produced significantly higher amounts of IL-8. The presence or absence of labor did not affect the amount of placental IL-8 production. However, placentae with chorioamnionitis (25.2 +/- 1.6 ng/ml/10 mg, n = 9) showed significantly higher IL-8 production than those without chorioamnionitis (p less than 0.0001). Northern blot analysis of IL-8 mRNA expression demonstrated a constant level during pregnancy with or without chorioamnionitis, indicating the possibility that the major site of regulation of IL-8 synthesis in the placenta is posttranscriptional. Immunohistochemical analysis of first and third trimester placental tissues with rabbit anti-IL-8 antibody revealed the IL-8 producing cells to be trophoblasts and macrophage-like cells. IL-8 produced by the placental cells might contribute to potentiation of the immunocompetence of placental cells against bacteria invading the fetoplacental unit.

Blotting, Northern↗

PubMed1996

Race, perinatal outcome, and amniotic infection.

Racial differences in rates of amniotic infection were examined through a review of the literature. Following a computerized and manual search of the literature from 1966 to 1994, studies were selected that reported the prevalence by race of presumed markers of amniotic infection. These markers included: amniotic infection syndrome, histologic chorioamnionitis, clinical chorioamnionitis, premature rupture of the membranes, and early neonatal mortality from sepsis. With the exception of overall rates of histologic chorioamnionitis, black women showed higher rates of the all the conditions examined. Insofar as amniotic infection is a risk factor for poor perinatal outcomes, the finding of higher rates of markers of amniotic infection among black women suggests that such infections may contribute to racial disparities in perinatal outcome.

Black or African American↗

PubMed2005

Clinical characteristics of chronic lung disease without preceding respiratory distress syndrome in preterm infants.

BACKGROUND: Recently, the incidence of atypical presentation of chronic lung disease (CLD) that develops in infants without a history of preceding respiratory distress syndrome (RDS) is increasing. Therefore, the clinical characteristics of CLD without RDS in comparison with CLD with RDS were assessed. METHODS: Prospective cohort analysis was done from 117 very low-birthweight infants who were born in Seoul National University Hospital and survived more than 36 weeks postmenstrual age (PMA). RESULTS: Of the 117 infants analyzed, CLD developed in 44 infants (38%). Among these 44 infants, CLD with RDS developed in 27 infants (23%) and CLD without RDS developed in 17 infants (15%). Each type of CLD was subgrouped according to the presence of chorioamnionitis (CA): RDS(+)CA(+) CLD (n = 8) and RDS(+)CA(-) CLD (n = 19); and RDS(-)CA(+) CLD (n = 12) and RDS(-)CA(-) CLD (n = 5). There were no significant differences in the demographic characteristics between CLD with RDS and CLD without RDS. Chorioamnionitis was significantly more common in CLD without RDS, while patent ductus arteriosus was more common in CLD with RDS. Although the severity of initial respiratory failure was not greater than that of CLD with RDS, CLD without RDS showed a gradually increasing chronic oxygen requirement pattern. Chronic oxygen requirement pattern showed that infants with RDS(+)CA(+)CLD required the highest concentrations of oxygen not only initially but also thereafter until the 28th day of life and 36 weeks PMA. CONCLUSIONS: Although CLD without RDS was still less common than CLD with RDS, it comprised over a third of all cases of CLD in our study. Clinical characteristics and chronic oxygen requirement pattern of CLD without RDS seems to be less severe than those of CLD with RDS. Our data suggest that CLD without RDS may be developed by causes other than initial acute lung injury. Chorioamnionitis may be one of antecedents of CLD without RDS.

Case-Control Studies↗

PubMed1985

Prepartal infection of the placenta with Neisseria gonorrhoeae.

Placentas from 191 consecutive deliveries were cultured for Neisseria gonorrhoeae and other bacteria before being examined histologically. N gonorrhoeae was seen on direct microscopical examination and cultured from two placentas, one of which had chorioamnionitis and the other had a granulocytic invasion of the membranes. In both patients, rupture of the membranes had occurred two hours or less before delivery, and thus after infection. A third patient was also found to have light gonococcal infection of the placenta. Six infections with group B streptococci were identified, but only one correlated with chorioamnionitis. Chorioamnionitis was observed in 16 (8.4%) and granulocytic infiltration of the membranes in 18 (9.4%) of the deliveries.

Adolescent↗

PubMed2003

Minimal lung and systemic responses to TNF-alpha in preterm sheep.

TNF-alpha has been associated with chorioamnionitis and the subsequent development of bronchopulmonary dysplasia in preterm infants. We asked whether bioactive recombinant ovine TNF-alpha could induce chorioamnionitis, lung inflammation, lung maturation, and systemic effects in fetal sheep. We compared the responses to IL-1alpha, a cytokine known to induce these responses in preterm sheep. Intra-amniotic TNF-alpha caused no chorioamnionitis, no lung maturation, and a very small increase in inflammatory cells in the fetal lung after 5 h, 2 days (d), and 7 d. In contrast, IL-1alpha induced inflammation and lung maturation. TNF-alpha given into the airways at birth increased granulocytes in the bronchoalveolar lavage fluid of ventilated preterm lungs and decreased the mRNA for surfactant protein C but did not adversely effect postnatal lung function. An intravascular injection of IL-1alpha caused a systemic inflammatory response in fetal sheep, whereas there was no fetal response to intravascular TNF-alpha. Fetal and newborn preterm sheep are minimally responsive to TNF-alpha. Therefore, the presence of a mediator such as TNF-alpha in a developing animal does not necessarily mean that it is causing the responses anticipated from previous results in adult animals.

Amniotic Fluid↗

PubMed2000

Intrauterine infection and spontaneous midgestation abortion: is the spectrum of microorganisms similar to that in preterm labor?

OBJECTIVE: To determine whether microorganisms associated with intrauterine infection and preterm labor play a contributing role in midgestation abortion. METHODS: A 4 year retrospective review of spontaneous midgestation abortions for which autopsy and microbiological cultures of placental and fetal tissue were performed was conducted for a tertiary obstetrics hospital, which included a regional referral service for perinatal and fetal pathology. One hundred twenty-nine spontaneously delivered, nonmacerated, midgestation fetuses or stillbirths (of between 16 and 26 weeks' gestation) and placentas were examined and cultured for aerobic and anaerobic bacteria, yeasts, and genital mycoplasmas. RESULTS: Microorganisms were recovered in 85 (66%) cases (57% placentas, 49% fetuses). Among the culture positive cases, 81% had histological chorioamnionitis, 28% fetal pneumonitis, 38% clinical signs of infection, and 62% ruptured membranes at the time of miscarriage. These differed significantly from culture-negative cases (44%, 5%, 13%, and 34%, respectively). Group B streptococcus (GBS) was the most significant pathogen, recovered in 21 cases, 13 as the sole isolate, 94% with chorioamnionitis, and 47% in women with intact membranes. Escherichia coli and Ureaplasma urealyticum (22 and 24 cases, respectively) occurred mostly as mixed infections, with ruptured membranes. GBS, MU urealyticum, and Streptococcus anginosus group were individually associated with chorioamnionitis, Bacteroides/Prevotella and S. anginosus with fetal pneumonitis. The spectrum of microorganisms was similar to that in preterm labor at later gestations; however, GBS appeared to be the most significant pathogen in midgestation miscarriage, especially with intact membranes. CONCLUSIONS: Unsuspected intrauterine infection underlies many spontaneous midgestation abortions. GBS is a key pathogen in this setting.

Abortion, Spontaneous↗