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PubMed1996

Ampicillin in the treatment of preterm labor: a randomised, placebo-controlled study.

This study was performed in order to assess whether the use of oral ampicillin vs. placebo therapy in women with latent-phase preterm labor delays delivery and improves pregnancy outcome. A prospective, randomised, double-blind, placebo-controlled study was performed of 110 women at 22-34 weeks of gestation. Patients received oral ampicillin 1 g (n = 59) or placebo (n = 51) every 8 h for 7 days. Outcome measures comprised gestational age at delivery, birth weight, Apgar score, perinatal death, neonatal infection, fetal growth restriction, histological chorioamnionitis and puerperal infection. In the ampicillin and placebo groups, respectively, the average gestational age at birth was 36.6 and 33.8 weeks (p < 0.05) and average birth weight 2,885 and 2,336 g (p < 0.05). Odds ratio (OR) for gestational age > 35 weeks and for birth weight > or = 2,500 g was 3.9 (95% CI 1.6-9.4). Neonatal infection (OR 15.5; 95% CI 4.6-65.7), intrauterine growth retardation (OR 9.6; 95% CI 2.8-41.3), histological chorioamnionitis (OR 13.0; 95% CI 3.4-72.2) and puerperal endometritis-myometritis (OR 65.3; 95% CI 9.3-2,715.7) occurred significantly less frequently among ampicillin-treated than among placebo-treated women. It is concluded that women in latent phase of preterm labor benefit from treatment with oral ampicillin, which prolongs the gestational age at delivery with ensuing increase in birth weight, reduction in the prevalence of histological chorioamnionitis and in neonatal and puerperal infectious morbidity.

Adult↗

PubMed1998

Perinatal correlates of cerebral palsy and other neurologic impairment among very low birth weight children.

BACKGROUND AND OBJECTIVE: The etiology of neurologic impairments among very low birth weight (VLBW, <1.5 kg) children is poorly understood. We sought to investigate the perinatal predictors of major neurologic impairment, including cerebral palsy, among VLBW children. METHODS: Antenatal, intrapartum, and neonatal events and therapies were compared between 72 singleton inborn VLBW children born between 1983 to 1991 who had neurologic impairment at 20 months corrected age (including 50 with cerebral palsy and 22 with other neurologic impairments) and 72 neurologically normal VLBW children matched by birth weight, gestational age, race, and sex via a retrospective case-control method. Multiple logistic regression was conducted, entering only those variables found to be significant at the bivariate level. RESULTS: There were no significant differences in the rates of pregnancy-induced hypertension, maternal tocolytic use including magnesium, or antenatal steroid therapy. Higher rates of clinical chorioamnionitis were found among the mothers of the neurologically impaired children as compared with controls (31% vs 11%), but not among the subgroup of mothers of children with cerebral palsy (22% vs 12%). Significant differences in neonatal factors among the total neurologically-impaired group (n = 72) versus controls included oxygen dependence at 36 weeks (31% vs 15%), septicemia (53% vs 31%), severe cranial ultrasound abnormality (50% vs 17%), and hypothyroxinemia (43% vs 25%). In the subgroup with cerebral palsy (n = 50), significant differences included days on the ventilator (23 vs 14 days), septicemia (54% vs 33%), and severe cranial ultrasound abnormality (52% vs 12%). Multivariate analysis controlling for birth weight, gestational age, race, sex, and the birth period (before 1990 versus 1990 and after) revealed direct and independent effects of clinical chorioamnionitis [odds ratio (OR), 3. 79; confidence interval (CI), 1.34-10.78], severe cranial ultrasound abnormality (OR, 9.97; CI, 3.84-25.87), and septicemia (OR, 2.46; CI, 1.10-5.52) on total neurologic impairment. Consideration of the 50 cases with cerebral palsy revealed direct and independent effects of severe cranial ultrasound abnormality only (OR, 15.01; CI, 4.34-51. 93). CONCLUSIONS: Both antenatal and neonatal risk factors contribute to the development of severe neurologic impairment, including cerebral palsy among VLBW children. Because prevention of chorioamnionitis may not be feasible in the near future, attempts to decrease neonatal risk factors such as severe cranial ultrasound abnormalities and sepsis may be most feasible at this time.

Birth Weight↗

PubMed1999

Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review.

OBJECTIVE: To identify and to establish the prevalence of ORs factors associated with increased risk for early-onset group B streptococcal (EOGBS) infection in neonates. streptococcal (EOGBS) infection in neonates. STUDY DESIGN: Literature review and reanalysis of published data. RESULTS: Risk factors for EOGBS infection include group B streptococcal (GBS)-positive vaginal culture at delivery (OR: 204), GBS-positive rectovaginal culture at 28 (OR: 9.64) or 36 weeks gestation (OR: 26. 7), vaginal Strep B OIA test positive at delivery (OR: 15.4), birth weight </= 2500 g (OR: 7.37), gestation <37 weeks (OR: 4.83), gestation <28 weeks (OR: 21.7), prolonged rupture of membranes (PROM) >18 hours (OR: 7.28), intrapartum fever >37.5 degrees C (OR: 4.05), intrapartum fever, PROM, or prematurity (OR: 9.74), intrapartum fever or PROM at term (OR: 11.5), chorioamnionitis (OR: 6.43). Chorioamnionitis is reported in most (88%) cases in which neonatal infection occurred despite intrapartum maternal antibiotic therapy. ORs could not be estimated for maternal GBS bacteriuria during pregnancy, with preterm premature rupture of membranes, or with a sibling or twin with invasive GBS disease, but these findings seem to be associated with a very high risk. Multiple gestation is not an independent risk factor for GBS infection. CONCLUSIONS: h Mothers with GBS bacteriuria during pregnancy, with another child with GBS disease, or with chorioamnionitis should receive empirical intrapartum antibiotic treatment. Their infants should have complete diagnostic evaluations and receive empirical treatment until infection is excluded by observation and negative cultures because of their particularly high risk for EOGBS infection. Either screening with cultures at 28 weeks gestation or identification of clinical risk factors, ie, PROM, intrapartum fever, or prematurity, may identify parturients whose infants include 65% of those with EOGBS infection. Intrapartum screening using the Strep B OIA rapid test identifies more at-risk infants (75%) than any other method. These risk identifiers may permit judicious selection of patients for prophylactic interventions.

Age of Onset↗

PubMed1999

Prophylaxis against early adrenal insufficiency to prevent chronic lung disease in premature infants.

UNLABELLED: BACKGROUND. Many extremely low birth weight infants (<1000 g) show biochemical evidence of adrenal insufficiency in the first week of life, correlating with subsequent development of chronic lung disease (CLD). METHODS: We conducted a randomized, double-masked, placebo-controlled pilot study to test whether early treatment with low-dose hydrocortisone for 12 days (1 mg/kg/day for 9 days followed by.5 mg/kg/day for 3 days), begun before 48 hours of life, would increase the likelihood of survival without CLD. RESULTS: Forty patients were enrolled at two centers. Birth weight and gestation were similar for treatment and placebo groups: 732 +/- 135 g versus 770 +/- 135 g and 25.2 +/- 1.3 weeks versus 25.4 +/- 1.5 weeks. More infants treated with hydrocortisone achieved study success, defined as survival without supplemental oxygen at 36 weeks' postconception (12/20 [60%] vs 7/20 [35%]). Lower birth weight, histologic chorioamnionitis, and preeclampsia were significant risk factors, whereas study center, prenatal steroids, sex, and ethnicity were not significant. Hydrocortisone treatment decreased days on >40% oxygen, days on >25% oxygen, days on ventilator, and oxygen at discharge. Among infants exposed to chorioamnionitis, hydrocortisone treatment also was associated with increased enteral intake during the first month of life and with increased weight at 36 weeks' postconception. Five treated infants and 6 placebo infants developed sepsis; 3 in each group died. CONCLUSIONS: First, early treatment with low-dose hydrocortisone in this population of extremely low birth weight infants increased the likelihood of survival without CLD. Second, the benefit was particularly apparent in infants with chorioamnionitis. Third, a larger multicenter trial is needed to verify the primary outcome and to better evaluate risks and benefits.

Adrenal Insufficiency↗

PubMed2000

Neonatal sepsis workups in infants >/=2000 grams at birth: A population-based study.

BACKGROUND: Few data are available on the outcome of neonatal sepsis evaluations in an era when intrapartum antibiotic therapy is common. METHODS: We identified all newborns weighing >/=2000 g at birth who were ever evaluated for suspected bacterial infection at 6 Kaiser Permanente hospitals between October 1995 and November 1996, reviewed their records and laboratory data, and tracked them to 1 week after discharge. We analyzed the relationship between key predictors and the presence of neonatal bacterial infection. RESULTS: Among 18 299 newborns >/=2000 g without major congenital anomalies, 2785 (15.2%) were evaluated for sepsis with a complete blood count and/or blood culture. A total of 62 (2.2%) met criteria for proven, probable, or possible bacterial infection: 22 (.8%) had positive cultures and 40 (1.4%) had clinical evidence of bacterial infection. We tracked all but 10 infants (.4%) to 7 days postdischarge. There were 67 rehospitalizations (2.4%; 2 for group B streptococcus bacteremia). Among 1568 infants who did not receive intrapartum antibiotics, initial asymptomatic status was associated with decreased risk of infection (adjusted odds ratio [AOR]:.26; 95% confidence interval [CI]:.11-.63), while chorioamnionitis (AOR: 2. 40; 95% CI: 1.15-5.00), low absolute neutrophil count (AOR: 2.84; 95% CI: 1.50-5.38), and meconium-stained amniotic fluid (AOR: 2.23; 95% CI: 1.18-4.21) were associated with increased risk. Results were similar among 1217 infants who were treated, except that maternal chorioamnionitis was not significantly associated with neonatal infection. CONCLUSIONS: The risk of bacterial infection in asymptomatic newborns is low. Evidence-based observation and treatment protocols could be defined based on a limited set of predictors: maternal fever, chorioamnionitis, initial neonatal examination, and absolute neutrophil count. Many missed opportunities for treating mothers and infants exist.

Ampicillin↗

PubMed2005

[Outcome of microbial invasion of amniotic cavity in the preterm premature rupture of membranes].

BACKGROUND: Microbial invasion of amniotic cavity occurs in 30 to 50% of patients with premature membrane rupture. AIM: To determine the outcomes associated with microbial invasion of the amniotic cavity (MIAC) in patients with preterm premature rupture of membrane (pPROM). PATIENTS AND METHODS: One hundred thirty four patients with preterm pPROM between 24 and 34 weeks of pregnancy, without clinical infection or labor, were studied. Cultures were obtained by transabdominal amniocentesis from the amniotic fluid and the lower genital tract. Four groups of MIAC were observed: MIAC1: due to S. agalactiae, F. nucleatum or H. influenzae as only etiologic agents, MIAC2: due to other bacteria, alone or mixed, MIAC3: due to U. urealyticum as only etiologic agent, MIAC0: No MIAC and no infection of the lower genital tract. Study patients received antibiotics and were managed expectantly until 35 weeks unless clinical chorioamnionitis developed or an amniotic fluid culture returned positive for S. agalactiae, F. nucleatum or H. influenzae. RESULTS: Ninety six patients were enrolled: MIAC1 (n=11), MIAC2 (n=30), MIAC3 (n=19) and MIAC0 (n=36). Clinical chorioamnionitis was more common in patients with MIAC1 than those with MIAC3 (p<0.01) and those without infection (p<0.001). The admission to delivery interval was shorter in patients with MIAC1 (2.8 days) than those with MIAC3 (10.1 days, p<0.05) and those without infection (18 days, p<0.001). Delivery within 48 h and within 7 days of admission were also more frequent in patients with MIAC1 than in patients with MIAC3 (p<0.05) or those without infection (p<0.001). Newborns to mothers with MIAC1 had a higher frequency of infection (36%), asphyxia (36%), admission to neonatal ICU (100%) and death (46%) than those of mothers with MIAC3 and those without infection. Birth weight was also significantly lower. Histological chorioamnionitis was more common in patients with MIAC1 than in patients with MIAC3 and those without infection. The rate of funisitis was higher in patients with MIAC1 than those without infection. CONCLUSIONS: In patients with preterm PROM, microbial invasion of the amniotic cavity by S. agalactiae, F. nucleatum or H. influenzae is associated with high frequency of adverse maternal and neonatal outcomes and neonatal death.

Adolescent↗

PubMed2000

Changes in cytokine (IL-8, IL-6 and TNF-alpha) levels in the amniotic fluid and maternal serum in patients with premature rupture of the membranes.

PURPOSE: To study the changes in interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) levels in patients with premature rupture of the membranes (PROM). METHODS: A total of 46 normal term pregnant women served as controls and 46 women with PROM were enrolled for study. Maternal serum and amniotic fluid IL-6, IL-8 and TNF-alpha levels were determined by enzyme-linked immunosorbent assay and a sensitive radioimmunoassay, respectively. RESULTS: The maternal serum IL-6 and IL-8 levels and amniotic fluid IL-6, IL-8 and TNF-alpha levels were higher than those of controls, and the differences were significant between the two groups (p < 0.05). Although the levels of TNF-alpha in maternal serum were higher than that of controls, the difference was not significant. There were significant relationships between the levels of IL-6, IL-8 and TNF-alpha and the duration of PROM. The longer the duration of PROM, the higher the levels of maternal serum and amniotic fluid IL-6, IL-8 and TNF-alpha were. There were 12 cases of clinical chorioamnionitis, and the levels of IL-6, IL-8 and TNF-alpha in the maternal and amniotic fluid were higher than that of those without chorioamnionitis (p < 0.05). CONCLUSION: Determining cytokines (IL-6, IL-8 and TNF-alpha) is a valuable clinical method for identifying chorioamnionitis in patients with PROM.

Adult↗

PubMed1999

[Serum concentration of interleukin-6 in maternal serum and its expression in amniochorionic membranes of preterm premature rupture of membrane].

OBJECTIVE: To investigate the relationship between interleukin-6 (IL-6) and preterm premature rupture of membranes (PPROM). METHODS: Serum IL-6 in 20 cases of normal pregnancy (control group) and 30 cases with PPROM in which 14 had moderate and severe chorioamnionitis (group 1), 16 had no chorioamnionitis (group 2) were measured by enzyme-linked immunosorbent assay (ELISA), and IL-6 protein in fetal membranes were determined by immunohistochemistry technique. RESULTS: The level of serum IL-6 in group 1 (155.17 ng/L) was significantly higher than that in group 2 (79.11 ng/L) and control group (70.15 ng/L) (P < 0.01). Expression of the IL-6 had more positive signs in chorion with chorioamnionitis, especially in infiltrating inflammatory cells. CONCLUSION: IL-6 associated with the onset of preterm labor caused by infection.

Extraembryonic Membranes↗

PubMed1982

Isolation of aerobic bacteria from the placenta.

Cultures for aerobic bacteria were prepared from 353 placentas. Specimens were taken from the chorion after removing the amnion. The specimens were immersed into Stuart transport medium. Microscopic examination of the placenta and cultures from the throat and ear of newborns were also done. The rate of positive bacterial cultures was 16%. Chorioamnionitis was found in 15%. The proportion of chorioamnionitis caused by aerobic bacteria was 44%. The rate of positive bacterial cultures from the placenta in the group of newborns with clinical signs of intrauterine infection was 63%. Bacteria can be present on the chorionic plate without any histological evidence of chorioamnionitis. Bacteriological examination of the placenta is therefore mandatory when amniotic fluid infection is suspected.

Amniotic Fluid↗

PubMed1982

Factors that predispose to premature rupture of the fetal membranes.

Causes of premature rupture of the fetal membranes were explored in a study of 10,460 pregnancies. Five risk factors were analyzed: Cigarette smoking, coitus, parity, prior surgery of the cervix, and chorioamnionitis. To minimize the effects of other influences the author compared the rates of premature rupture in successive pregnancies of the same mothers when the individual risk factors being analyzed were present in only 1 of the 2 pregnancies. Preterm delivery due to premature rupture of the membranes was 11 times more frequent when recent coitus was present in conjunction with chorioamnionitis than when both were absent. Such ruptures were increased only 3-fold when either recent coitus or chorioamnionitis was present without the other.

Amnion↗

PubMedDate not supplied

Expression of interleukin-10 in human gestational tissues.

OBJECTIVE: To determine production of interleukin-10 (IL-10) by interleukin-1 beta (IL-1 beta) in cultured decidual, chorion, and amnion cells and whether IL-10 is produced in gestational tissues under the setting of infection-associated preterm labor. METHODS: Decidual, chorion, and amnion cells were isolated from term placentas and grown in primary culture. The cells were incubated with various concentrations of IL-1 beta and then culture supernatants were assayed for IL-10 by enzyme-linked immunosorbent assay. In subsequent studies, gestational membranes were isolated from a normal-term pregnancy and a preterm pregnancy complicated by chorioamnionitis. Tissues were evaluated for IL-10 expression by immunohistology and in situ hybridization. Human gestational tissues were collected from 38 women experiencing: 1) term cesarean delivery without labor; 2) normal-term vaginal delivery; 3) preterm cesarean delivery without labor; 4) preterm vaginal delivery without chorioamnionitis; and 5) preterm vaginal delivery with concomitant chorioamnionitis. Amnion, chorion, and decidua were isolated, total RNA from each tissue was extracted, and the presence of IL-10 mRNA was determined by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: Decidual cells in culture produced IL-10 in response to IL-1 beta, but chorion and amnion cells produced no IL-10 protein. In vivo protein expression by immunohistology showed that most protein was detected within decidua while cells within amnion and chorion rarely had detectable IL-10 protein. In vivo RT-PCR samples demonstrated the strongest IL-10 mRNA signal from decidua samples, although IL-10 mRNA was also noted in chorion and amnion of placentas obtained after preterm labor. CONCLUSION: Maternal decidual cells can potentially produce IL-10, but fetal membranes (amnion and chorion) appear to have limited capabilities to produce IL-10. The relative inability of fetal tissues to produce IL-10 may play an important role in the pathophysiology of infection-associated preterm labor.

Amnion↗

PubMedDate not supplied

Preterm premature rupture of membranes: aggressive tocolysis versus expectant management.

The objective of our study is to determine whether aggressive tocolysis in patients with preterm premature rupture of membranes between 24 and 34 weeks gestation improves neonatal outcome. Patients with documented preterm premature rupture of membranes between 24 and 34 weeks gestation were prospectively randomized to group I, aggressive tocolysis with intravenous magnesium sulfate, or to group II, no tocolysis. The lecithin/sphingomyelin ratio was determined upon hospital admission and every 48-96 hours until delivery. Both groups received weekly steroids and antibiotics pending culture results and were promptly delivered when chorioamnionitis, fetal stress, or an Lecithin/sphingomyelin ratio of > or = 2.0 occurred. The study group involved 145 patients. No statistically significant differences between groups I (n = 78) and II (n = 67) were observed regarding demographic characteristics, gestational age at enrollment or at delivery, latency, development of clinical chorioamnionitis, birth weight, number of days in neonatal intensive care unit, days on oxygen or ventilatory support, frequency of hyaline membrane disease, necrotizing enterocolitis, intraventricular hemorrhage, neonatal sepsis, or neonatal mortality. Our data suggest that tocolysis in patients with preterm premature rupture of membranes does not significantly improve perinatal outcome.

Adult↗

PubMed2002

Infection markers and early signs of neonatal encephalopathy in the term infant.

Recent evidence points to an association between intrauterine infection and cerebral palsy (CP) in the preterm as well as the term infant. The mechanisms that link these two conditions are unclear. Chorioamnionitis is a common clinical problem complicating 5-10% of pregnancies, whereas the incidence of CP attributed to intrapartum asphyxia is rare. Chorioamnionitis may result in brain injury as a result of interruption of placental blood flow (asphyxia), or via fever and/ or the cytokine release associated with infection. This review will attempt to establish the link between perinatal infection and brain damage in term infants. The characteristics of the perinatal inflammatory response, the potential mechanisms of brain injury associated with infection, and the clinical characteristics of neonatal encephalopathy will be discussed.

Biomarkers↗

PubMed1998

The clinical value of assaying maternal serum and amniotic fluid intercellular adhesion molecule 1 (ICAM-1) in cases of premature rupture of membranes.

Intercellular adhesion molecule 1 (ICAM-1) expression and upregulation induced by pro-inflammatory cytokines may be of interest in defining human response to inflammation and infection. This study was initiated to determine the levels of ICAM-1 in sera and amniotic fluid of cases of premature rupture of membranes (PROM). Serum and amniotic fluid ICAM-1 levels were determined by ELISA in 33 cases of PROM and 10 cases of normal pregnancies of matched gestational age (controls). Both serum and amniotic fluid ICAM levels were significantly elevated in 76% and 85% of cases of PROM with mean fold increments of 3.13 and 3.95, respectively. This elevation was associated with intra-amniotic infection which was detected by microbiological culture and histopathological evidence of chorioamnionitis. Increased ICAM-1 in cases of PROM may be attributed to neutrophil activation and ICAM-1 expression on fetal membranes and mononuclear cells of amniotic fluid. These results demonstrate that determination of ICAM-1 may be a valuable biomarker for early detection of acute chorioamnionitis and the possibility of PROM.

Adult↗

PubMed1999

Cytokine release from placental endothelial cells, a process associated with preterm labour in the absence of intrauterine infection.

There is currently a great deal of interest in the role that cytokines may play in the processes mediating preterm as well as normal term labour. In case of preterm delivery a cause-effect relationship between infection, uncontrollable preterm labour, and increased uterine cytokine concentrations is widely accepted, but there is considerable information that increased uterine cytokine release is also a condition in normal term labour and preterm labour not due to infection. Thereby, the exact cellular sources of cytokine production have not yet been identified. In the present study, the authors used immunohistochemical analysis to localize interleukin 1beta (IL-1beta) interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-alpha) immunoreactivity within trophoblastic villi and fetal membranes. In the absence of chorioamnionitis, uncontrollable preterm labour, and also normal term labour was associated with strong immunoreactivity for IL-1beta and IL-6 in the endothelial cells within trophoblastic villi. In contrast, preterm delivery accompanied by histologically confirmed chorioamnionitis, was not associated with increased expression of cytokine antigens within endothelial cells of the fetal vascular system, but strong cytokine activity was found in polymorphonuclear cells infiltrating the amniochorionic membranes. Therefore, the data suggest two well-defined subgroups among patients delivering preterm. Thereby, increased uterine cytokine concentrations may be realized in both groups, but the cellular sources of cytokine production may be different.

Adult↗

PubMedDate not supplied

Vaginal Ureaplasma urealyticum colonization: influence on pregnancy outcome and neonatal morbidity.

The effects of Ureaplasma urealyticum colonization on pregnancy and neonatal outcome was prospectively studied in women with impending term or preterm delivery. One hundred and seventy women colonized with U. urealyticum as the only pathogenic microorganism and 83 women with negative cultures were enrolled for study. Compared to the controls, U. urealyticum colonization was associated with a significantly increased rate of amnionitis (2% vs 35%; p < 0.001), chorioamnionitis (0% vs 10%; p < 0.05), premature rupture of membranes (12% vs 35%; p < 0.001) and preterm delivery (10% vs 41%; p < 0.001). The rate of vertical transmission ranged from 38% in term infants to 95% in very low birth weight infants. U. urealyticum colonization at birth was associated with an increased risk for the development of respiratory distress syndrome (9% vs 51%), intraventricular hemorrhage (1% vs 7%) and bronchopulmonary dysplasia (4% vs 17%) in very low birth weight infants (< 1500 g). It is concluded that maternal U. urealyticum colonization is associated with amnionitis, chorioamnionitis and preterm delivery, and that tracheal colonization with U. urealyticum increases the risk for respiratory and neurological complications in very low birth weight infants.

Adult↗

PubMed2006

Neonatal morbidity and placental pathology.

OBJECTIVE: To investigate the association between gestational age, placental pathology and outcome among preterm births. METHODS: Medical records and placental pathology results of 165 preterm infants (gestational age pound 34 weeks) were used to analyze the development of intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and sepsis, in association with placental findings in the gestational age categories of 22-27 (n=71) and 28-33 (n=93) weeks. RESULTS: Significant differences were found in placental findings based on gestational age and neonatal morbidity. Lower gestational age was associated with increased infection-related lesions such as chorionic vasculitis (47.9%, P< 0.001) and acute chorioamnionitis (67.6%, P< 0.001). Placental lesions reflecting disturbances of fetal-placental blood flow (infarction, chorionic plate thrombi and basal perivillous fibrin) were predominantly seen in the 28-33 week gestational age category (P< 0.05-0.01). Despite the high prevalence of chorioamnionitis (38.8%), no significant association was found between this lesion and the tested preterm morbidity after controlling for gestational age. Only, villous edema and chorionic vasculitis were identified as independent predictors for the development of IVH (49.2%, ORA 2.57, 95% CI 1.01, 6.58 and 39.3%, ORA1.95, 95% CI 1.01, 4.21, respectively). CONCLUSION: Villous edema and chorionic vasculitis are significant risk factors for the development of the IVH among neonates born at gestational age pound 34 weeks.

Chorioamnionitis↗

PubMed2004

Chemoprophylactic and bactericidal efficacy of 80 mg gentamicin in a single and once-daily dosing.

OBJECTIVE: The objective was to examine the biodistribution, the chemoprophylactic, and the bactericide efficacy of 80-mg gentamicin single or once-daily dosing. STUDY DESIGN: Ninety-six patients who had had cesarean section or gynecological surgery received 80 mg gentamicin for chemoprophylaxis. A second group of 92 patients with Gram-negative infection received once-daily 80-mg gentamicin intramuscularly, combined with cefoxitin or ceforanide, for 5 days. Gentamicin serum and tissue concentration was determined 1 h after the first administration. RESULTS: The chemoprophylactic efficacy of gentamicin was 93.7%. The treatment efficacy was high in patients with chorioamnionitis and endometritis (92.9%), moderate in those with wound infection (69.5%), and less effective in those with septicemia (55.6%). Twenty-six percent of patients continued with antibiotics for infection control. The mean serum level was 4.48+/-0.49 and 5.56+/-0.66 microg/ml in obstetrical and gynecological patients respectively (p>0.05). Serum levels >4 microg/ml were achieved in 91% of patients. CONCLUSIONS: A single dose of 80 mg gentamicin offers chemoprophylaxis and achieves therapeutic serum-concentrations 1 h after administration. The 5-day combination of once-daily 80 mg gentamicin with a second-generation cephalosporin is effective in patients with chorioamnionitis and endometritis, but only moderately effective in those with wound infections and septicemia.

Adult↗