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PubMed1994

Perinatal morbidity associated with violence experienced by pregnant women.

OBJECTIVE: We investigated whether physical assault is independently associated with an adverse obstetric outcome. STUDY DESIGN: We compared the perinatal outcomes of 32 indigent women who reported being physically abused during pregnancy with those of 352 control subjects who denied ever being assaulted. Patients were classified into the appropriate category on the basis of a structured interview. Logistic regression analyses were performed to estimate the relative risk of adverse outcome while adjusting for confounders. RESULTS: Women assaulted in the current pregnancy were twice as likely to have preterm labor as compared with those who denied assault. In addition, crude odds ratios showed a twofold increased risk of chorioamnionitis in assault victims. No difference between abused and nonabused women was noted in the prevalence of preterm delivery, pregnancy-induced hypertension, cesarean section, meconium staining, infant birth weight, Apgar scores, intrauterine growth retardation, fetal distress, fetal death, neonatal seizures, sepsis, or admission to the intensive care unit. CONCLUSIONS: This study demonstrates that physical assault during pregnancy is associated with preterm labor and chorioamnionitis. Screening for ongoing assault should be incorporated into routine prenatal care to identify women at risk of complications.

Adult↗

PubMed1996

Interleukin-6 concentrations in cervical secretions identify microbial invasion of the amniotic cavity in patients with preterm labor and intact membranes.

OBJECTIVE: The objectives of this study were to determine whether cytokine levels in cervical secretions were increased in the presence of microbial invasion of the amniotic cavity in patients with preterm labor and intact membranes and to relate concentrations to cytokine levels in amniotic fluid, cervicovaginal microflora, and the presence of chorioamnionitis. STUDY DESIGN: Cervical secretions were sampled immediately before amniocentesis in 92 patients admitted for preterm labor with singleton pregnancies and intact membranes. Amniotic fluid was cultured and the following cytokines were measured in amniotic fluid and cervical secretions: interleukin-1 beta, interleukin-1 receptor antagonist, tumor necrosis factor-alpha, and interleukin-6. The cervicovaginal microflora and placentas (n = 42) were also analyzed. RESULTS: A total of 19.56% (18/92) of the amniotic fluid cultures had positive results. All the cytokines tested showed significantly higher levels in cervical secretions in the presence of intraamniotic infection. There were significant relationships between the concentrations of interleukin-6 and interleukin-1 receptor antagonist in amniotic fluid and cervical secretions. A concentration of interleukin-6 in cervical secretions > 410 pg/ml had a sensitivity of 66.8% and a specificity of 90.5% and a relative risk of 7.7 for intraamniotic infection, higher than the other cytokines tested. There were no relationships between the presence of bacterial vaginosis and cervicovaginal pathogens and cervical cytokine levels. In the presence of chorioamnionitis, cervical concentrations of interleukin-6 and interleukin-1 receptor antagonist were significantly increased in spite of negative amniotic fluid culture results. CONCLUSION: The measurement of interleukin-6 in cervical secretions may help to noninvasively identify intraamniotic infection among pregnancies with preterm labor and intact membranes.

Adult↗

PubMed1997

Chlorhexidine vaginal irrigation for the prevention of peripartal infection: a placebo-controlled randomized clinical trial.

OBJECTIVE: Our purpose was to determine whether chlorhexidine vaginal irrigation prevents maternal peripartal infection. STUDY DESIGN: A double-blinded, placebo-controlled, randomized trial was performed. Single 200 ml irrigations of either 0.2% chlorhexidine solution or sterile water placebo were given in active labor or before planned cesarean delivery. The primary outcome measure was the combined rate of chorioamnionitis and endometritis (which were mutually exclusive diagnoses). RESULTS: A total of 1024 patients were enrolled: 508 in the chlorhexidine group and 516 in the placebo group. The two groups were generally well balanced on important clinical factors but differed (p < 0.05) in rates of nulliparity (chlorhexidine 42%, placebo 52%), intrauterine pressure catheter usage (chlorhexidine 65%, placebo 72%), and presence of meconium (chlorhexidine 17%, placebo 22%). There were no recognized adverse maternal or neonatal reactions to irrigation. Rates of infection (chorioamnionitis + endometritis) did not differ significantly between the groups, chlorhexidine 10% versus placebo 13% (relative risk 0.8, 95% confidence interval 0.5 to 1.1). Stratified and logistic regression analyses supported the primary univariate analysis. Neonatal outcomes, including sepsis rates of 0.4%, were equivalent for the groups. CONCLUSION: As used in this trial, chlorhexidine lacked efficacy in the prevention of maternal peripartal infection.

Adult↗

PubMed1998

International multicenter term PROM study: evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term. Premature Rupture of the Membranes.

OBJECTIVE: Our objective was to determine significant predictors for the development of neonatal infection in infants born to patients with premature rupture of membranes at term. STUDY DESIGN: Multivariate analysis was used to determine the significant predictors of neonatal infection in infants born to women with premature rupture of the membranes who were enrolled in the Term PROM Study. In a randomized, controlled trial, the Term PROM Study recently compared induction of labor with expectant management for premature rupture of membranes at term. RESULTS: The following variables were identified as independent predictors of neonatal infection: clinical chorioamnionitis (odds ratio 5.89, P < .0001), positive maternal group B streptococcal status (vs negative or unknown, odds ratio 3.08, P < .0001), 7 to 8 vaginal digital examinations (vs 0 to 2, odds ratio 2.37, P = .04), 24 to < 48 hours from membrane rupture to active labor (vs < 12 hours, odds ratio 1.97, P = .02), > or = 48 hours from membrane rupture to active labor (vs < 12 hours, odds ratio 2.25, P = .01), and maternal antibiotics before delivery (odds ratio 1.63, P = .05). CONCLUSIONS: Among infants born to patients with premature rupture of membranes at term, clinical chorioamnionitis and maternal colonization with group B streptococci are the most important predictors of subsequent neonatal infection.

Adult↗

PubMed1998

Microbial invasion of the amniotic cavity with Ureaplasma urealyticum is associated with a robust host response in fetal, amniotic, and maternal compartments.

OBJECTIVE: Ureaplasma urealyticum is the microorganism most frequently isolated from the amniotic fluid of women with preterm labor and preterm premature rupture of the membranes, yet the significance of amniotic fluid infection exclusively caused by this microorganism is unclear. This study was conducted to examine the presence and intensity of the inflammatory response in the fetal, amniotic, and maternal compartments in patients with preterm premature rupture of membranes and amniotic fluid infection with U urealyticum. STUDY DESIGN: One hundred twenty patients with preterm premature rupture of the membranes who delivered preterm neonates (gestational age </=36 weeks) within 5 days of amniocentesis were included. Amniotic fluid was cultured for aerobic and anaerobic bacterias and mycoplasmas. The intensity of the inflammatory response was evaluated by amniotic fluid concentrations of interleukin-6, tumor necrosis factor-alpha, interleukin-1beta, amniotic fluid white blood cell count, histologic chorioamnionitis, and interleukin-6 concentrations of umbilical cord plasma at birth. Cytokines were measured by sensitive and specific immunoassays. RESULTS: The prevalence of a positive amniotic fluid culture in which the only microbial isolate was U urealyticum was 21% (25/120) and that of positive cultures with other or mixed microorganisms was 9% (11/120). Intrauterine inflammatory response was significantly more intense in patients with positive amniotic fluid cultures limited to U urealyticum than in those with a negative culture (median and range of amniotic fluid interleukin-6, 13.4 [0.7-115.2] ng/mL vs 0.9 [0.001-137.2] ng/mL; median and range of amniotic fluid tumor necrosis factor-alpha, 85.5 [0.9-1600] pg/mL vs 2.4 [0-1142] pg/mL; median and range of amniotic fluid interleukin-1beta, 274.0 [0.3->80,000] pg/mL vs 3.4 [0-1449] pg/mL; median and range of amniotic fluid white blood cell count, 306 [0-19,764] cells/mm3 vs 3 [0-7956] cells/mm3; median and range of cord interleukin-6, 20.0 [2. 3-1199.6] pg/mL vs 6.7 [0-5550] pg/mL; histologic chorioamnionitis, 100% [22/22] vs 42% [30/72]; P <.01 for each) but was similar to values of patients with a positive amniotic fluid culture for other bacteria or mixed microorganisms. CONCLUSION: Patients with preterm premature rupture of membranes and microbial invasion of the amniotic cavity with U urealyticum are associated with a robust host inflammatory response in the fetal, amniotic, and maternal compartments.

Adult↗

PubMed1999

Maternal and neonatal infection rates with three different protocols for prevention of group B streptococcal disease.

OBJECTIVES: We compared maternal and neonatal infection rates under 3 different group B streptococcal prevention strategies and also evaluated reasons for each protocol's failures in preventing neonatal disease. STUDY DESIGN: Women who were delivered at our center from August 1, 1991, through April 30, 1998, were managed by 1 of 3 protocols for prevention of early-onset neonatal group B streptococcal infection: a selective screening protocol, The American College of Obstetricians and Gynecologists protocol, and the Centers for Disease Control and Prevention-recommended universal screening strategy. We compared maternal infection rates and neonatal group B streptococcal infection rates under each protocol. We also compared reasons for each protocol's failures in preventing neonatal infection. RESULTS: Clinical chorioamnionitis rates were 7.4% with selective screening, 7.7% under The American College of Obstetricians and Gynecologists' protocol, and 5.2% with universal screening (relative risk 0.7, 95% confidence interval 0.6-0.8). Endometritis rates were 4.0% with selective screening, 4.6% with The American College of Obstetricians and Gynecologists protocol, and 2. 8% with universal screening (relative risk 0.7, 95% confidence interval 0.6-0.8). Overall neonatal group B streptococcal infection rates were lower under the 2 more recent strategies, but not significantly so. Despite the ability of universal screening to find more women at risk for group B streptococcal transmission, half of the neonatal infections under this protocol occurred when the mothers were not considered candidates for prophylaxis. CONCLUSIONS: The Centers for Disease Control and Prevention-endorsed universal screening strategy for group B streptococcal infection prevention was associated with significantly lower rates of clinical chorioamnionitis and endometritis than were the other strategies. We were unable to document statistically significant improvement in neonatal outcome under the universal screening protocol.

Anti-Bacterial Agents↗

PubMed2003

Preterm premature rupture of membranes and neonatal outcome prior to 34 weeks of gestation.

OBJECTIVES: To investigate the impact of preterm premature rupture of membranes on neonatal outcome. METHODS: A retrospective study was conducted among singleton pregnancies with or without intact amniochorional membranes. The impact of maternal age, gestational age at birth, 1- and 5-min Apgar scores, birthweight, presence of meconium, use of tocolytics, corticosteroids and antibiotics, mode of delivery, umbilical artery pH, histologic presence of chorioamnionitis, and state of the membranes were analyzed in relation to neonatal outcome. Neonatal outcomes were categorized into: none, presence of respiratory distress syndrome, early neonatal sepsis, neonatal death, and days at neonatal intensive care unit. RESULTS: A total of 180 preterm deliveries with ruptured (n=80) and intact membranes (n=100) constituted the study group (group 1) and the control group (group 2), respectively. Compared with group 2, there were more cases in group 1 of maternal antibiotic use (P<0.001), short-term tocolysis (P=0.03), and histologic chorioamnionitis (P<0.001). Multiple logistic regression analysis showed that gestational age at delivery (P=0.009), 1-min Apgar score (P=0.013), and umbilical artery pH (P=0.05) were the independent factors affecting neonatal outcome. CONCLUSIONS: Neonatal outcome was mainly affected by prematurity rather than by preterm premature rupture of membranes.

Adult↗

PubMed2000

Expanded-spectrum antibiotics with preterm premature rupture of membranes.

OBJECTIVE: To compare maternal infection rates, neonatal sepsis rates, and bacterial resistance patterns in cases of neonatal sepsis for three antibiotic protocols for women with preterm premature rupture of membranes (PROM). METHODS: From January 1, 1988 to February 28, 1998, women with preterm PROM not requiring immediate delivery were treated according to one of three antibiotic protocols. During three distinct periods, patients received no antibiotics, intravenous ampicillin for 48 hours followed by oral amoxicillin, or intravenous ticarcillin-clavulanic acid for 48 hours followed by oral amoxicillin-clavulanic acid. Rates of chorioamnionitis, endometritis, and neonatal sepsis were compared, as were antimicrobial resistance patterns. Statistical analysis was done using chi(2) analysis, Fisher exact test, and the log-likelihood ratio test. The Bonferroni correction was used for multiple comparisons. RESULTS: During the three periods, preterm PROM was diagnosed in 1695 women. The incidence of endometritis was lower during the third (5.3%) compared with the first (15.1%, P <.001) and second (11.6%, P <.001) protocols. Chorioamnionitis rates were 13.6%, 12.7%, and 15.6% (P =.34) for the first, second, and third periods, respectively, and neonatal sepsis rates were 2.2%, 0.6%, and 1.1% (P =.08), respectively. Neonatal sepsis with gram-negative (P =.02) and ampicillin-resistant (P =.04) organisms was more likely when mothers received antepartum ampicillin or ticarcillin-clavulanic acid. CONCLUSION: Antibiotic therapy for patients with preterm PROM was associated with a decrease in the rate of endometritis and a trend toward less neonatal sepsis but an increase in the proportion of gram-negative and ampicillin-resistant organisms causing neonatal sepsis.

Adult↗

PubMed1998

Placental pathology in patients using cocaine: an observational study.

OBJECTIVE: Although retroplacental hemorrhage is a major cause of fetal death, its etiology often remains obscure. In some reports, cocaine use by pregnant women has been associated with retroplacental hemorrhage and clinical abruptio placentae. This study was designed to assess the occurrence of chorionic villus hemorrhage, an entity shown recently to be associated with retroplacental hemorrhage, in the placentas of cocaine users. METHODS: Twenty-nine placentas from cocaine users and 15 placentas from drug-free controls, as determined by questionnaire and urine toxicology screen, were examined prospectively, and pathological findings documented. The prevalence of retroplacental hemorrhage, chorionic villus hemorrhage, edema, chorioamnionitis, funisitis, infarction, fetal vessel thrombosis, and intervillus hemorrhage was examined in the two groups. RESULTS: Chorioamnionitis was the most frequent finding in both groups (58% of cocaine users, 66% of controls). Edema of moderate severity or greater was found only in the cocaine-using group (17%). The prevalence of chorionic villus hemorrhage among women using cocaine also was 17%. CONCLUSION: Cocaine use during pregnancy may be associated with chorionic villus hemorrhage and villus edema, even in the absence of clinical abruptio placentae. The relationship between abnormal placental morphology and adverse perinatal outcomes remains to be determined.

Adult↗

PubMed1995

Antimicrobial therapy in expectant management of preterm premature rupture of the membranes.

We review the impact of antimicrobial treatment on maternal and fetal outcome during expectant management of preterm premature rupture of the membranes. Relevant studies were retrieved from Medline (1966 to August, 1994) with the search term fetal-membrane-premature-rupture and antibiotics or antimicrobial, Excerpta Medica (1972 to August, 1994) with the search term premature fetus, membrane rupture, and antibiotic or antimicrobial therapy, and the Cochrane database of systemic reviews with the criterion antibiotics and prelabour rupture of membranes. We also obtained unpublished data from a randomised clinical trial of ceftizoxime versus placebo. The selected studies were randomised controlled trials of systemic antimicrobial therapy for prolongation of gestation in non-labouring women after preterm premature rupture of the membranes. Data extraction was done by a single reviewer. Studies were evaluated for post-randomisation exclusion and other confounding variables that might introduce analytical bias. Analysis was done with SAS statistical software by a blinded investigator. Antimicrobial therapy after preterm premature rupture of the membranes is associated with a reduced number of women delivering within 1 week (62 vs 76%; OR 0.51, 95% CI 0.41-0.68), and reduced diagnosis of maternal morbidity including chorioamnionitis (12 vs 23%; 0.45, 0.33-0.60) and postpartum infection (8 vs 12%; 0.63, 0.41-0.97). Fetal morbidity, including confirmed sepsis (5 vs 9%; 0.57, 0.36-0.88), pneumonia (1 vs 3%; 0.32, 0.11-0.96), and intraventricular haemorrhage (9 vs 14%; 0.65, 0.45-0.92) were less often diagnosed after antimicrobial therapy. Separate analysis of the six placebo-controlled trials revealed similar or improved odds of pregnancy prolongation, chorioamnionitis, neonatal sepsis, postpartum infection, positive infant blood cultures, and pneumonia. Antimicrobial therapy, when used in the expectant management of preterm premature rupture of the membranes is associated with prolongation of pregnancy and a reduction in the diagnosis of maternal and infant morbidity. Further study should be directed towards determination of optimal antimicrobial therapy, increasing pregnancy prolongation, and enhancement of corticosteroid therapy for induction of pulmonary maturity after preterm premature rupture of the membranes.

Anti-Bacterial Agents↗

PubMed1993

Biochemistry and physiology of preterm labour and delivery.

Human parturition is associated with profound changes in uterine connective tissue affecting mainly the cervix, but the endocrine control of cervical ripening remains obscure. Connective tissue changes are also implicated in premature rupture of the membranes, a problem often associated with preterm delivery, and it is believed that local inflammatory infiltration may play a role in both this condition and cervical ripening, but it is difficult to define which changes precede parturition and which are a consequence of the trauma of labour. Chorioamnionitis can cause preterm labour by provoking the release of inflammatory mediators in the decidua/fetal membranes area and it is likely that activation of prostaglandin release by decidual macrophages is involved in triggering labour. However, the role of macrophages and other bone marrow derived cells in normal labour and in labour associated with chorioamnionitis needs to be defined. It is likely that treatment with a combination of antibiotics and prostaglandin synthase inhibitors and/or other anti-inflammatory drugs is the most appropriate therapeutic approach. Idiopathic preterm labour and spontaneous labour at term are probably due to changes in the sensitivity of the myometrium to endogenous agonists. Recent progress in cell signalling pathways, such as the characterization of regulatory G proteins and the cloning of hormone receptors, should clarify the mechanism of action of relaxing and contracting agents on myometrial cells and should provide the means for the development of new therapeutic agents of high effectiveness and selectivity. This approach should result in better management of both term and preterm labour.

Cervix Uteri↗

PubMedDate not supplied

Production of oxytocin receptor and cytokines in primary uterine smooth muscle cells cultivated under inflammatory conditions.

OBJECTIVE: We studied the production of the oxytocin receptor and interleukins in human uterine smooth muscle cells cultured in vitro in the presence of cytokines that were shown to be elevated in gestational diseases such as intrauterine infections and chorioamnionitis. METHODS: Human uterine smooth muscle cells were cultured in the absence or presence of interleukin-1beta (IL-1beta), interleukin-6 (IL-6), tumor necrosis factor alpha (TNFalpha), or lipopolysaccharide (LPS). Additionally, cells were cultivated under hypoxic conditions (3.5% oxygen). After 6, 12, 24, and 48 hours of incubation, oxytocin receptor mRNA was measured from total RNA using quantitative, competitive reverse transcriptase-polymerase chain reaction. Secreted cytokines (IL-1beta, IL-6, or IL-8) were quantitated from supernatants after 6, 12, 24, and 48 hours of stimulation by commercially available enzyme-linked immunosorbent assay. RESULTS: In nonstimulated cultures basal secretion of IL-1beta, IL-6, and IL-8 was detectable. Supplementation of IL-1beta induced a statistically significant decrease in oxytocin receptor mRNA abundance, whereas IL-6, TNFalpha, LPS, or hypoxia did not significantly affect oxytocin receptor gene expression. The cytokines IL-1 and TNFalpha induced IL-6 and IL-8 release, whereas secretion of the two interleukins was not altered in the presence of LPS or hypoxia. Expression of IL-1beta was not significantly induced under inflammatory or hypoxic culture conditions. CONCLUSION: The constitutive and cytokine-inducible expression of interleukins from uterine smooth muscle cells suggests that the myometrium may contribute to the overall production of inflammatory mediators in the uterus that are thought to govern term- or infection-induced preterm labor. Down-regulation of the oxytocin receptor under IL-1beta in myometrial cells may indicate that initiation and maintenance of labor could be partially limited under severe inflammatory conditions such as chorioamnionitis.

Cells, Cultured↗

PubMed1995

Placental insights into neurodevelopmental and other childhood diseases.

Deficient information regarding placental pathology has compromised epidemiological investigations of cerebral palsy, mental retardation, and other diseases. This article reviews light microscopic signs of low placental blood flow, fetal nucleated red blood cells, villitis (villous inflammatory lesions), chorangiosis (placental villous capillary hypervascularity), meconium staining, and chorioamnionitis. These findings can be used with data of birth weight, head circumference, and length to document the duration of fetal disease. The article includes pathophysiological considerations; for example, chorioamnionitis and fetal meconium discharge may cause autacoids to produce fetal hypoperfusion of the fetal brain and other vital organs.

Anthropometry↗

PubMed2003

The association of placental abnormalities with maternal and neonatal clinical findings: a retrospective cohort study.

OBJECTIVES: (1) To determine the nature and extent of placental pathologic findings; (2) to associate placental pathologic findings with clinical indicators of infection; (3) to evaluate placental pathology in the context of the guidelines outlined by the College of American Pathologists (CAP). METHODS: A retrospective cohort study, through review of maternal and neonatal charts and placental pathology, of 100 sequential pregnancies in which placentas were submitted to pathology. Data were examined using descriptive statistics, and proportional differences were compared using the chi-square test and Fisher's exact test. RESULTS: Overall, 75% of placentas submitted for pathology review had pathologic abnormalities. Fifty percent had findings consistent with inflammation, 38% had findings consistent with vascular abnormalities, and 18% had findings consistent with meconium. Fetal clinical indicators of infection were associated with placental findings of chorioamnionitis (p < or = 0.01), while maternal clinical indicators were not. Similarly, fetal clinical indicators were associated with placental findings of fetal inflammation (p < or = 0.025), whereas maternal indicators were not associated with placental findings of maternal inflammation. A diagnosis of chorioamnionitis in labour by the attending physician was associated with pathologic findings (p < or = 0.05). A CAP indication was found in 75% of the placentas. There was no difference in incidence of placental pathology between those placentas submitted with and without a CAP indication. CONCLUSION: Placental findings of inflammation or infection were associated with fetal clinical indicators of infection, but not with maternal indicators. Placental pathology is very useful in identifying undiagnosed maternal infection or inflammation.

Adult↗

PubMed2005

Prevalence, management, and outcomes of preterm prelabour rupture of the membranes of women in Canada.

OBJECTIVES: To determine the prevalence of preterm prelabour rupture of the membranes (PPROM) at Canadian university-affiliated perinatal referral centres, to assess the different management strategies, and to review neonatal outcomes. METHODS: Twelve Canadian university-affiliated perinatal referral centres provided information on their management of PPROM, and 9 participated in data collection to determine prevalence. All women presenting with PPROM during a 2-week period were observed until delivery, and obstetric and neonatal outcome data were subsequently obtained. The total number of deliveries in each centre was recorded for the same time period. We also determined the incidence of PPROM and the neonatal outcome for all women presenting with PPROM at the Kingston General Hospital from January 1999 to December 2001 by retrospective chart review. RESULTS: In the 9 academic centres, 27 women (1 with a twin pregnancy) presented with PPROM during the 2-week period. There were 1168 deliveries during the same time period, giving a prevalence of PPROM of 2.3%. Overall, 53% of placentas submitted for histopathology after PPROM demonstrated evidence of chorioamnionitis. In the retrospective chart review, we found 153 cases of confirmed PPROM from January 1999 to December 2001,an incidence of 2.8%. Clinical management in all centres was similar for most women who presented with PPROM prior to 34 weeks' gestation. Management after 34 weeks' gestation varied among the 12 centres, ranging from immediate induction of labour to expectant management and induction at a greater gestational age (GA). CONCLUSIONS: The increased neonatal morbidity associated with PPROM appears to be inversely related to GA. Increased risk of chorioamnionitis is related to increased time from PPROM to delivery.

Canada↗

PubMed2003

An immunohistochemical study of the secretory immune system in human fetal membranes and decidua of the first trimester of pregnancy.

PROBLEM: We analyzed the presence and distribution of components of the secretory immune system (SIS) in human fetal membranes (amnion, yolk sac, chorion) and decidua from the first trimester of pregnancy. MATERIALS AND METHODS: Specimens from 17 embryos (4-8 weeks of pregnancy) and nine fetuses (9-12 weeks) were divided into those that had not been exposed to massive foreign antigenic effects (Group I, n = 18) and those that had suffered acute chorioamnionitis (Group II, n = 8). RESULTS: Positive immunostaining for secretory component (SC), joining (J) chain, IgG, IgA, and macrophages was seen from 4 to 5 weeks of development and then during the whole first trimester of pregnancy in the syncytio- and cytotrophoblasts, the amniotic epithelium, the yolk sac endoderm and decidual cells. Macrophages with J chain, IgG and IgA were found in embryonic tissues on week 4, whereas lymphocytes, including those synthesizing IgA and IgM, appeared only at the end of the first trimester of pregnancy. In the decidua, lymphocytes and macrophages were recognized during the whole period of study. In cases with chorioamnionitis (Group II), reactivity of IgG and IgA in the mentioned cells of fetuses decreased sharply while the rate of immunoreactivity of SC and J chain as well as the number of T and B lymphocytes did not change. In the decidua, the number of immune reactive cells sharply increased with the appearance of plasma cells. CONCLUSIONS: In the fetal membranes and decidua all the SIS components are present. We suggest that two SIS, maternal and fetal, participate in the formation of the barrier between a mother and the fetus. Both these systems have different origin and cellular content as well as different immune reactions.

B-Lymphocytes↗

PubMedDate not supplied

Fatal early onset infection in an extremely low birth weight infant due to Morganella morganii.

OBJECTIVE: This paper reports a case of chorioamnionitis due to Morganella morganii in a mother who presented with ruptured membranes at 24 weeks' gestation and was treated with dexamethasone and prophylactic ampicillin. Her premature infant developed severe early onset infection due to the same organism and expired. STUDY DESIGN: A clinical case report of M. morganii infection complicating preterm rupture of membranes is presented. Possible risk factors for maternal and neonatal infection with this organism as well as the therapy of neonatal M. morganii infection are discussed. RESULTS: Risk factors in the mother included having a cervical cerclage in place and treatment with dexamethasone and prophylactic ampicillin. The major risk factors in the infant were maternal chorioamnionitis and extreme prematurity. The mother responded to treatment with ampicillin, metronidazole, and gentamicin following delivery and had an uncomplicated recovery. Her infant developed severe early onset M. morganii infection complicated by neutropenia, thrombocytopenia, and severe acidosis and expired. Postmortem cultures of pleural fluid, peritoneal fluid, and blood were positive despite treatment with gentamicin, an antibiotic to which the organism was sensitive. CONCLUSION: M. morganii may cause serious infection in pregnancy and in the neonatal period. The use of dexamethasone and prophylactic ampicillin may have increased the risk of infection with this ampicillin-resistant organism. The failure of gentamicin to sterilize the infant's blood and body fluids emphasizes the necessity of treating such infections with a combination of an aminoglycoside and a third-generation cephalosporin, such as cefotaxime.

Adult↗

PubMed2003

Maternal epidural analgesia and rates of maternal antibiotic treatment in a low-risk nulliparous population.

BACKGROUND: Epidural analgesia is associated with an increased rate of fever in prospective randomized trials. While the evidence suggests that epidural fever is not infectious, epidural analgesia has been associated with increased rates of antibiotic use, the indications that prompt treatment have not been examined. METHODS: We analyzed 1235 nulliparous women with singleton term pregnancies presenting in labor with a temperature of < 99.5 degrees F. Antibiotic use during labor was categorized by indication. RESULTS: A total of 59.6% of women received epidural analgesia. The rate of antibiotic use was significantly higher in women receiving epidural analgesia (28 vs 10.8%). After adjusting for confounders using logistic regression, epidural analgesia was associated with a relative risk of 2.6 (95% CI 2.0, 3.4) for antibiotic treatment. The majority of the increased risk was due to significantly higher rates of antibiotic treatment for presumed chorioamnionitis (9.0 vs 0.4%) in the epidural analgesia group. CONCLUSION: Epidural-related fever results in excess maternal antibiotic treatment for presumed chorioamnionitis.

Adult↗