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PubMed1999

[Study of relation between ureaplasma urealyticum and fetal intrauterine growth retardation].

OBJECTIVE: To study the influences of Ureaplasma Urealyticum (UU) infection to fetal intrauterine growth. METHODS: Polymerase Chain Reaction was used to detect UU in samples of cervical secretions, umbilical blood and placenta. The study group included 50 women with neonatal birth weight below 2,500 g, 50 women with newborns birth weight above 2,500 g served as control group. RESULTS: Positive rate of UU in samples of cord blood and placenta and placental chorioamnionitis in study group were higher than that in the control group (P < 0.005 and P < 0.05). There was no significant difference of UU positive rate in cervical samples between two groups. The positive rate of UU in cases with chorioamnionitis was higher than that of cases with negative UU infection (P < 0.05). CONCLUSION: UU may interfere fetal intrauterine growth through infecting umbilical blood and placenta.

Adult↗

PubMed2000

[Prophylaxis of group B beta-hemolytic streptococcal infections].

Group B streptococcus is a possible cause of chorioamnionitis, endometritis and urinary tract infections in pregnant woman. Maternal risk factors and the vertical transmission of GBS and neonatal GBS infection occur through the following fever during labor, the rupturing of membranes more than 18 hours before delivery, prematurity and chorioamnionitis. GBS can induce early-onset neonatal disease (sepsis, meningitis or pneumonia) during the first week of life and late-onset neonatal infection (leptomeningitis) within the first 12 weeks of life. Numerous strategies for preventing neonatal group B streptococcal infection were investigated: 1) the treatment of GBS-colonized women during the third trimester of pregnancy did not prove to be effective because it does not reduce maternal colonizzation rates at delivery; 2) the neonatal universal post-partum prophylaxis with penicillin G was ineffective and increased neonatal mortality due to penicillin-resistant bacterial infection; 3) the intrapartum maternal chemoprophylaxis with penicillin G or ampicillin in GBS-colonized women, in women with risk factors, or in women with both GBS colonization and risk factors. The latter strategy proved to be the most effective because it reduces the risk of early-onset GBS infection by 75% and 95% when associated with post-neonatal prophylaxis. To date, there are no guidelines on the management of the asymptomatic neonate whose mothers have been treated with chemopropylaxis intra-partum.

Humans↗

PubMed2001

An immunohistochemical study of the secretory immune system in human fetal endocrine glands and their precursors.

We examined the presence and distribution of components of the secretory immune system (SIS) in fetal endocrine organs and their embryonic precursors. Specimens from 16 embryos (4 to 8 weeks of development) and 32 fetuses (9 to 38 weeks) were divided into those that had not been exposed to massive foreign antigenic effects (Group I, n=28) and those that had suffered from chorioamnionitis (Group II, n=20). An immunohistochemical study was performed using antibodies against the secretory component (SC), joining (J) chain, IgA, IgM, IgG, subsets of T and B lymphocytes, and macrophages. Positive immunostaining for SIS components in the precursors of endocrine organs was seen from 4 to 6 weeks of development, and was present thereafter in the pituitary body, thyroid, pancreatic islets and adrenals. J chain and immunoglobulins were found in all endocrine cells throughout intrauterine development, but the massive antigenic influence caused by chorioamnionitis decreased the latters immunoreactivity. The presence of SC in the precursors of adenohypophysis and pancreatic islet cells decreased significantly after their transformation into definitive endocrine organs. In the thyroidal follicular epithelium and the pars intermedia of the pituitary body cells, SC was present during the entire period of pregnancy. In adrenals, SC was not found. Maternal immunoglobulins, together with SC and J chain, are accumulated in endocrine gland cells from the early stages of intrauterine life. They are the major mechanism of endocrine cell defense during the early prenatal period when the common immune system is still structurally and functionally incompetent.

B-Lymphocytes↗

PubMed2002

Neonatal sepsis: evaluation and management.

Bacterial antigenic challenge presents a difficult fight for the neonatal immune system, and they have a smaller arsenal of weapons to fight bacterial infections than adults and older children. The baby's own systemic inflammatory response may have detrimental effects on several organs and longer lasting effects on the developing brain. Neurodevelopmental outcomes after maternal chorioamnionitis are worse than neonates without a contaminated intrauterine environment, regardless of gestation age and the baby's culture results. Successes with intrapartum antibiotic prophylaxis decreasing rates of GBS sepsis and maternal chorioamnionitis, have heartened care providers and parents. These results demonstrate the advances possible when specific diseases are made a national health priority, and good clinical trial work is applied to clinical practice.

Humans↗

PubMed2005

Elevated maternal glucose concentrations and placental infection in twin pregnancies.

OBJECTIVE: To evaluate the association between maternal screening glucose concentration and placental infection in nondiabetic twin pregnancies. STUDY DESIGN: One thousand sixty-one nondiabetic twin pregnancies at > or =28 weeks' gestation were divided into 3 groups based on the screening 50-g fasting glucose concentration at 24-28 weeks: lowest quartile (< 96 mg/dL), middle 2 quartiles (96-128 mg/dL) and upper quartile (> 128 mg/dL). Outcomes were modeled using general linear and multinomial logistic regression, controlling for confounding factors. RESULTS: The middle and highest glucose groups were associated with increased risks for clinical chorioamnionitis (adjusted OR [AOR] 3.18, 95% CI 1.34, 7.54; AOR 6.80, CI 1.89, 24.53, respectively). Birth at <32 weeks and histologic diagnosis of placental infection (chorioamnionitis, funisitis, necrosis, vasculitis or villitis) were significantly associated only with the highest glucose group (AOR 1.79, CI 1.02, 3.13; AOR 6.95, CI 1.10, 8.68, respectively). CONCLUSION: Elevated screening glucose in nondiabetic twin pregnancies may be a marker of placental inflammation and infection.

Adult↗

PubMed1992

A retrospective review of the efficacy and safety of prostaglandin E2 with premature rupture of the membranes at term.

OBJECTIVE: The purpose of this study was to assess rates of endometritis, clinical chorioamnionitis, cesarean delivery, and neonatal sepsis from the records of patients with premature rupture of the membranes (PROM) and an unfavorable cervix treated with vaginal prostaglandin (PG) E2 in comparison with those in the literature. METHODS: Using a computer data base at Denver General Hospital, we identified 146 women with PROM and cervical dilatation of 2 cm or less at term who were treated with PGE2 gel or suppositories. The records were reviewed to identify rates of maternal and neonatal infection and complications, as well as cesarean delivery. RESULTS: The cesarean rate was 12%. Chorioamnionitis developed in 6.8% of the study group and endometritis in 2%. Neonatal complications were limited to two with low Apgar scores (less than 7 at 5 minutes), one with microbiologically confirmed sepsis, and two with positive urine counterimmunoelectrophoresis for group B streptococcus. The only instance of neonatal sepsis occurred in a patient with rupture of membranes longer than 24 hours. CONCLUSIONS: The use of vaginal PGE2 suppositories for induction of labor and cervical ripening in term patients with PROM was accompanied by a high rate of vaginal delivery and a low rate of maternal and neonatal complications in a city hospital setting.

Administration, Intravaginal↗

PubMed1992

Pediatric AIDS and perinatal HIV infection in Zaire: epidemiologic and pathologic findings.

HIV infection in women and children is a special problem in Zaire and in other countries where heterosexual transmission is predominant. Nearly half of the cases of HIV infection are in women 15 to 30 years old and as many as seven infected infants may be born each year. Whether or not infected at birth, these children have mothers, and often fathers, who are infected and likely to die while they are still very young. Such orphaned children, as well as those whose families cannot provide adequate food and health care, add to the problematic economies of developing countries. The problems of children of HIV-infected mothers in developing countries may be compounded further by factors directly related to their mother's disease. Infected mothers who are sick may produce insufficient levels of antibodies and be unable to provide their children with adequate natural passive immunity before birth. Their infants may also receive inadequate levels of breast-milk-derived antibodies possibly enhancing their already increased susceptibility to perinatal infections, and lastly, the volume of breast milk produced by these mothers may be inadequate for the nutrition of these infants. All these factors may further compromise the already difficult task of distinguishing those infants of HIV-infected mothers who are ill because they are infected from those who are ill because of their mother's disease. Regardless of the mechanisms accounting for the increased vulnerability of infants of HIV--seropositive and AIDS-afflicted mothers to perinatal infections, infant mortality can be expected to increase significantly as a direct consequence of the progression of the HIV pandemic throughout Africa and possibly other developing countries; this in populations already with a total under five-years-of-age mortality rate exceeding 15%. The association of chorioamnionitis with HIV seropositivity and with the clinical status of the mother seems to suggest that impaired maternal immunity increases the risk of premature birth, its consequent lower birth weight, and to HIV or other perinatally acquired infections. The identification of women at higher risk of chorioamnionitis and their treatment might provide a means to decrease the risk of premature delivery and possibly reduce the rate of HIV transmission to their infants. The pathologic changes in organs of infants and children with HIV infection require in-depth, systematic study to better define the natural history of perinatal HIV disease and infection.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗

PubMed2006

Term delivery of the second twin after miscarriage of the first: a case report.

BACKGROUND: Term delivery of the second twin after miscarriage of the first twin is rare. There is always a risk of preterm delivery as well as infection leading to chorioamnionitis. CASE: The second twin was delivered at term after miscarriage of the first twin at 17 weeks'gestation. The pregnancy was carefully monitored for prevention and early detection of chorioamnionitis. Delivery was delayed to 30 weeks after the miscarriage of the first twin, with a good outcome. CONCLUSION: Delayed delivery of the second twin with conservative management clearly is of benefit.

Abortion, Incomplete↗

PubMedDate not supplied

Mycoplasma hominis: a placental pathogen?

Current information on the role played by Mycoplasma hominis in placental inflammation was reviewed. M. hominis is associated with chorioamnionitis and funisitis, but the clinical significance of this association in not clear. Further research on the role of the organism in perinatal disease is needed. Meanwhile, in a gravely ill infant with a history of prolonged rupture of the placental membranes, chorioamnionitis, and funisitis, M. hominis should probably be considered a potential pathogen, cultures for this organism should be performed, and therapy with an antibiotic regimen effective against M. hominis should be instituted.

Amnion↗

PubMed1983

The clinical significance of placental villous edema.

A study was undertaken to determine why there is such variability in morbidity and mortality in neonates exposed to antenatal chorioamnionitis. Villous edema provides a clue. It was present in 72/83 placentas with chorioamnionitis. The extent and severity of the edema had a strong, positive correlation with cord arterial blood pH values, low Apgar scores, the need to resuscitate vigorously at birth, the subsequent need for assisted ventilation, the frequency of hyaline membrane disease, and neonatal mortality. Most of the difference in morbidity and mortality between preterm and full-term infants was related to the greater severity and extent of villous edema in those born prematurely.

Amnion↗

PubMed1983

C-reactive protein with premature rupture of membranes and premature labor.

C-reactive protein (CRP) was determined serially in 31 patients with premature rupture of the membranes, 41 patients in premature labor, and 18 pregnant patients with a variety of high-risk conditions. Elevated levels of CRP were not predictive of clinical amnionitis, histologic chorioamnionitis, or neonatal sepsis. No discernible relationship was found between serum CRP and peripheral white blood cell count. CRP was not elevated (false negative) in two patients in the premature labor group with culture-proved bacterial amnionitis. Elevated CRP in the absence of infection (false positive) likewise occurred. The results suggest that CRP be used in conjunction with other signs and symptoms suggestive of chorioamnionitis, rather than as a pathognomonic test.

C-Reactive Protein↗

PubMed1981

Bacteremia in obstetrics: clinical course.

The authors reviewed all documented cases of bacteremia in obstetric patients between 1975 and 1979, with emphasis on the clinical course. The incidence of bacteremia was 7.5:1000 obstetric admissions and 9.7% of those patients sampled. One hundred seventy-six bacteremic obstetric patients had the following diagnoses: endoparametritis (123), pyelonephritis (29), chorioamnionitis (14), and other (10). No deaths, clinical evidence of septic shock, or cases of postinfection endocarditis were found. The most common bloodstream isolates were Escherichia coli (57), group B streptococcus (28), and Bacteroides sp (26). The patients with endoparametritis had a fever index of 86.2 +/- 47.1F-hours, an average hospital stay of 6.5 +/- 3.1 days, a 7.3% rate of complications, and a 19.5% rate of failure of primary antibiotics. The patients with chorioamnionitis had a fever index of 32.7 +/- 48.9F-hours and an average hospital stay of 4.8 +/- 2.3 days. These clinical measures are comparable with those in the general population with the same diagnoses at the authors' hospital. In this obstetric population, prompt, vigorous treatment rendered the clinical course of bacteremic patients with genital infections remarkably similar to that of nonbacteremic patients with the same kinds of infection.

Adolescent↗

PubMed1994

Neonatal group B streptococcal sepsis during 2 years of a universal screening program.

OBJECTIVE: To assess the feasibility and efficacy of a protocol for universal screening for group B streptococci combined with selective intrapartum prophylaxis at a teaching hospital. METHODS: This is a descriptive study of experience with a standardized protocol in which patients were screened at 26-28 weeks with a rectal and genital culture placed directly in selective media. As risk factors, we used clinical chorioamnionitis, preterm birth, and rupture of the membranes greater than 12 hours. Participants were all women receiving prenatal care at our hospital. Major outcomes were compliance and neonatal sepsis due to group B streptococci. RESULTS: The prevalence of rectal and genital group B streptococci was 18.5% of 3721 screened women. Of culture-positive women, 35% developed risk factors (9% chorioamnionitis, 13% preterm birth, and 13% membrane rupture greater than 12 hours at term). With strict application of criteria, the compliance rate in administering indicated prophylaxis was 80.3%. Of women receiving prophylaxis, 42% had the first dose for 4 hours or less before delivery. There were five cases of group B streptococcal neonatal sepsis, resulting from either protocol violations, protocol failures, or both. Compared to the historic rate of group B streptococcal sepsis of 1.5 per 1000 births at our hospital, the rate in these 2 years was 1.0 per 1000 (1.6 per 1000 in the first year and 0.5 per 1000 in the second). CONCLUSIONS: It is feasible to conduct such a protocol, but compliance is only moderately good because the algorithm is complex. The protocol is not foolproof in preventing neonatal group B streptococcal sepsis, as there are protocol failures and violations.

Adult↗

PubMed1993

Effects of digital cervical examinations on duration of latency period, maternal and neonatal outcome in preterm premature rupture of membranes.

The medical records of 115 singleton pregnancies by preterm PROM from Chulalongkorn Hospital that met the criteria for expectant treatment from January 1987 to December 1991 were reviewed. All cases were divided into 2 groups. Fifty cases had a digital cervical examination to assess cervical status and sixty-five cases had a sterile speculum examination only. Latency period, maternal and neonatal outcome of both groups were compared. There was no statistically significant difference between the latency period of both groups (34.19 +/- 78.35 versus 54.6 +/- 127.01 hours). This was consistent for all gestational age groups. There was statistically significant increased incidence of chorioamnionitis in patients receiving digital cervical examinations. A nonsignificant trend toward an increased incidence of endometritis was also noted in patients receiving digital cervical examinations. There was no statistically significant differences in the average time of delivery, mode of delivery and postpartum hospitalization between both groups. No maternal mortality and stillbirth was noted in this study. There were no statistically significant differences in Apgar score at 1 minute and 5 minute, NICU admittance, neonatal hospitalization and percentage of neonatal deaths, livebirths, and neonatal morbidity between both groups. The results of this study suggest that digital cervical examinations in patients with preterm PROM should be avoided until the clinician is convinced that the patient is clearly in labor because digital cervical examinations increase the incidence of chorioamnionitis and endometritis but have no effect on latency period.

Adult↗

PubMed1993

[A study on cervical cerclage for a dilated cervix or bulging membranes without rupture of membranes].

During the period January 1, 1989 through December 31, 1991, one hundred thirty-six pregnant women with an effaced and widely dilated cervix or with bulging membranes were treated by emergent cervical cerclage. Suturing was carried out in 16 women before 20 weeks gestation, in 86 women between 20 and 28 weeks and in 34 women after 28 weeks. 16 patients in group A were those whose pregnancy was terminated with 3 days after operation and their tocolysis index was significantly higher than that of 69 patients in group D, whose pregnancy was prolonged move than two weeks. Clinical chorioamnionitis (WBC > 15,000/mm3 and CRP > 2mg/dl) was occurring in 43.7% of patients in group A, compared with 8.7% in group D at the time of operation. Vaginal delivery was accomplished in 38 patients at between 24 and 36 weeks gestation in our hospital, while 41 cesarean sections were performed. On the basis of these results, we conclude that the emergency cerclage operation may improve the outcome of pregnancy but we have to pay special attention to premature rupture of membranes and chorioamnionitis.

Abortion, Threatened↗

PubMed1996

The contribution of pathological examination of the placenta in the investigation of the causes of foetal mortality.

The purpose of this study was to evaluate the significance of histological examination of the placenta during routine post-mortem examination of foetal, perinatal and early neonatal deaths with particular reference to the cause of death. Three hundred (300) placentas were examinated over a period of three years (1988-1991). The clinical history, autopsy examination and placental histological examination were taken into account to determine the cause of death. Autopsy findings revealed the cause of death in only 33 cases (12.9%). In contrast, placental examination allowed us to determine the cause of death in 123 cases (48.4%) especially in abortions (54.4%). The most frequent abnormalities found were vascular insufficiency in intrauterine deaths (16.47%) and acute chorioamnionitis with foetal involvement in abortions (31.4%). Fifty six (56) cases with diagnoses of acute chorioamnionitis, chronic villitis of unknown aetiology and erythroblastosis were classified in the highrisk group for a subsequent pregnancy. Routine histological examination of the placenta following a perinatal death constitutes a necessary complement to autopsy examination, as it provides essential information for the cause of death and therefore helps in planning and more effective prenatal monitoring of a future pregnancy.

Abortion, Spontaneous↗

PubMedDate not supplied

Role of the placenta in perinatal pathology (revisited).

This article on the placenta includes considerations of chorioamnionitis, villitis, preeclampsia, and other low placental blood flow states and aspects of the circulating lupus anticoagulant syndrome. The author explains that, although gross and microscopic placental findings document placental features at one point in time, they also reflect ongoing pathophysiologic changes. Pathogenetic relationships between placental pathology, fetal hypoxia, intrauterine growth retardation, and cerebral palsy are discussed. The reader will learn that low placental blood flow states and chorioamnionitis are important means by which endothelins may eventually participate in the production of placental and fetal vasoconstriction and critical hypoperfusion. The author explains means by which reduced umbilical, placental, and fetal blood flow can result from chronic fetal exposure to meconium, meconium-induced vasoactivity, and ultimate vascular necrosis. Clinically important complications therein may include anoxic-ischemic neuronal necrosis in the brain, necrotizing enterocolitis, and ischemic lesions in the fetal heart, lungs, kidneys, and liver. The article includes a review of nucleated red blood cells that most often signify chronic fetal hypoxia rather than infrequent acute intrapartum asphyxia. The reader will also find information on chorangiosis (placental villous capillary hypervascularity), an important sign of placental malperfusion and very long-standing fetal hypoxia.

Female↗

PubMed1997

Antecedents of cerebral palsy in a multicenter trial of indomethacin for intraventricular hemorrhage.

OBJECTIVES: To determine if cerebral palsy (CP) rates were lower in the active treatment group compared with the control group, as improved survival rates of very low-birth-weight infants are postulated to be the cause of the increased incidence of CP in preterm infants, to evaluate relationships between multiple prenatal, perinatal, and postnatal variables and CP to understand better its antecedents in very low-birth-weight infants in the era of surfactant replacement therapy, and to determine the usefulness of a cranial ultrasonographic (US) scan in predicting CP. DESIGN: Inception cohort follow-up study as part of a randomized controlled trial of low-dose indomethacin sodium for the prevention of intraventricular hemorrhage. SETTING: Neonatal intensive care units at 3 medical centers. PATIENTS: Infants with birth weights between 600 and 1250 g were eligible, and 505 infants were enrolled in the original study. Of these infants, 440 (87%) survived; neurologic examinations were completed on 381 infants (86%) at 36 months corrected age. MAIN OUTCOME MEASURES: Statistical analyses were performed to identify the antecedents of CP, including the results of frequent cranial US scans obtained throughout the newborn period. RESULTS: Cerebral palsy was found in 36 (9.5%) of 381 infants at 36 months corrected age (range, 33-39 months corrected age). Univariate analysis identified chorioamnionitis, treatment with surfactant, bronchopulmonary dysplasia, and abnormal cranial US findings as antecedents of CP. Periventricular leukomalacia and ventriculomegaly were associated with the highest detection rates for CP (37% and 30%, respectively) with acceptable false-positive rates. Multivariate analysis identified bronchopulmonary dysplasia and an abnormal cranial US scan showing grade 3 to 4 intraventricular hemorrhage, periventricular leukomalacia, or ventriculomegaly as independent predictors of CP. Odds ratios for the detection of CP using cranial US findings tabulated by hospital day were in the range of 7 to 26 beginning on day 2. CONCLUSION: The results suggest that cranial US findings are useful predictors of CP during a patient's stay in the hospital.

Cerebral Hemorrhage↗