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PubMed1987

Circadian incidence of labor onset hour in preterm birth and chorioamnionitis.

Normal labor begins most frequently between midnight and 2 AM, presumably because of an unidentified circadian labor-activating mechanism. We used records of the Collaborative Perinatal Project to determine whether such a circadian mechanism is present with intrauterine growth retardation (IUGR) or preterm birth, and whether chorioamnionitis is associated with alternative patterns. In the absence of chorioamnionitis, both preterm births and term births with IUGR demonstrated nocturnal labor onset distributions like those of control term deliveries, which had a peak incidence at 1:45 AM and an amplitude of 35%. With chorioamnionitis, in contrast, there was a different circadian distribution of term labor onset hour, with a peak at 7:45 PM and a 32% amplitude. A similar trend was found among preterm births. These data suggest the presence of the normal nocturnal labor-activating mechanism in both growth-retarded term deliveries and a defined subset of preterm deliveries. Chorioamnionitis appears to be associated with a prominent, unidentified alternative labor-activating mechanism that is maximal in the evening.

Chorioamnionitis↗

PubMed1994

[A clinical study on chemotherapies for chorioamnionitis].

Effects of imipenem/cilastatin (IPM/CS) therapy, flomoxef (FMOX) therapy and combined ceftazidime + aspoxicillin (CAZ/ASPC) therapy as initial therapies for chorioamnionitis were assessed clinically. 1. The subjects were 49 women with threatened abortion and 29 with premature rupture of membranes (PROM), complicated in all cases by chorioamnionitis. The inflammation was treated with IPM/CS in 19 patients, FMOX in 39, CAZ in 11, and CAZ/ASPC in 9. 2. The response rate to therapy for chorioamnionitis was 95.9% (47/49) in the threatened abortion group. Of the 49 patients in this group, 16 (32.7%) underwent premature labor. Of the therapies administered, IPM/CS tended to prevent premature labor more frequently than did any other therapy. The latent period (from rupture of membranes to delivery) was equal to or longer than 7 days in the PROM group. The percent prolongation of the latent period in these patients (55.5%) was significantly greater than that previously obtained with penicillin therapy. 3. The bacterial elimination rate was 50.9% (29/57). Of the 36 bacterial isolates, 66.7% were Gram-positive bacteria. The bacteriological efficacy rate was 89.7% (26/29). These results suggest that antibacterial agents effective against Gram-positive bacteria should be selected for treatment of chorioamnionitis, and that IPM/CS therapy is particularly useful considering the drug's good transfer into amniotic fluid and its antibacterial spectrum.

Amoxicillin↗

PubMed1996

Effect of chorioamnionitis on the levels of serum proteins in the cord blood of premature infants.

OBJECTIVE: To determine the relationships among complements, other serum proteins (including acute-phase reactant), and the cytokine interleukin-6. DESIGN: Prospective observational study. SETTING: A perinatal center, children's hospital, and research institute in Osaka, Japan. PATIENTS: Two hundred fifteen newborn infants ranging from 17 to 42 weeks in gestational age. MAIN OUTCOME MEASURES: We measured the serum levels of several proteins and complements in the cord blood of neonates with and without chorioamnionitis by immunological assays. RESULTS: The levels of C3d, haptoglobin, interleukin-6, IgM, C-reactive protein, and IgA were not influenced by gestational age, and levels of C5, C1q, C2, albumin, C9, and IgG were not influenced by chorioamnionitis status. The levels of C3, C4, CH50, factor B, and orosomucoid were influenced by both factors. CONCLUSIONS: Our investigation of the mutual relation of the data suggests that the increase of cytokine interleukin-6 affects each other component. We suggest that, compared with the serum levels of proteins in neonates with chorioamnionitis, levels in neonates without chorioamnionitis are more similar to those in the normal fetus.

Blood Proteins↗

PubMed1998

Methicillin resistant Staphylococcus aureus as a cause of chorioamnionitis.

BACKGROUND: Chorioamnionitis is a leading cause of morbidity and mortality in preterm infants. Only rarely is Staphylococcus aureus implicated. A case of methicillin resistant Staphylococcus aureus causing chorioamnionitis and endometritis is presented. CASE REPORT: A 39-year-old gravida 2 para 1 female, who previously worked as the unit clerk in the pediatric pulmonary unit of a children's hospital, was initially admitted at 22 weeks with a shortened cervix. The patient refused emergency cerclage. She was released from the hospital and returned at 25 4/7 weeks' estimated gestational age with possible spontaneous rupture of membranes. An amniocentesis was performed and revealed a gram stain positive for many gram positive cocci as well as a glucose of < 2 mg%. The patient was started on intravenous ampicillin and gentamicin and induction of labor with oxytocin was begun. Approximately 1 day after the patient's delivery, the culture from the amniocentesis was noted to have grown methicillin resistant Staphylococcus aureus, and the patient's (as well as the neonate's) regimen was switched to vancomycin. CONCLUSION: A Medline search revealed no cases of methicillin resistant Staphylococcus aureus causing chorioamnionitis. When chorioamnionitis or refractory endometritis is encountered in a patient who works in the health care industry, methicillin resistant staphylococcus aureus must be considered.

Adult↗

PubMed1983

Premature rupture of membranes: the role of C-reactive protein in the prediction of chorioamnionitis.

A group of 52 patients with premature rupture of the membranes (PROM) before 34 weeks' gestation were evaluated prospectively and managed expectantly. Of 42 patients who were delivered of their infants, 26 (61.9%) had significant chorioamnionitis on histopathology, and 18 had positive microbial cultures at delivery. However, only seven patients (16.7%) developed clinical signs of chorioamnionitis. There were no maternal deaths or perinatal deaths attributable to sepsis. Only two infants (less than 5%) had positive blood cultures. All patients were assessed daily for the development of chorioamnionitis. Amniocenteses were not routinely performed. White blood cell counts, band neutrophil counts, and erythrocyte sedimentation rate determinations were found to be unreliable. C-reactive protein determinations were found most reliable with a high sensitivity and specificity. Elevated C-reactive protein levels correlated better with pathologic confirmation of chorioamnionitis than with the clinical febrile morbidity. Clinical implications for the management of PROM are discussed.

Amnion↗

PubMedDate not supplied

The association of coagulase-negative staphylococci isolated from the chorioamnion at delivery and subsequent development of cerebral palsy.

OBJECTIVE: To find out whether there is an association between cultures positive for coagulase negative staphylococci (CONS) taken from babies in the Neonatal Intensive Care Unit (NICU) and a subsequent outcome of cerebral palsy. STUDY DESIGN: At delivery, we obtained cultures from the chorioamnion space and, when medically indicated, we obtained bacterial cultures from children in the NICU. Surviving neonates underwent final examination for cerebral palsy at age 18 months. RESULTS: Of six children in the Magnesium and Neurologic Endpoints Trial who had cerebral palsy, chorioamnion cultures had been obtained for five of six. Four of these five children (80%) had CONS-positive cultures, whereas 26 of 102 (25%) children without cerebral palsy were CONS positive (p = 0.02). In the NICU, of children with cerebral palsy, the prevalence of culture-proven CONS was 80% (4/5); for those without cerebral palsy, the prevalence was 17% (15/86) (p = 0.01). Using multivariable logistic regression to control for confounding, CONS in the chorioamnion remained significant (adjusted odds ratio [OR] 37.7, 95% confidence interval [CI] 3.0 to +infinity; p = 0.003). However, when controlled for extremely low birth weight, nonvertex presentation, and being on a ventilator > or = 20 days, the association between culture-proven CONS in the NICU and cerebral palsy became insignificant (adjusted OR 3.0, 95% CI 0.2 to +infinity; p = 0.42). CONCLUSION: CONS in the chorioamnion space are associated with cerebral palsy, but in these data, CONS in the NICU are not found to be associated with cerebral palsy.

Adult↗

PubMed1975

Chorioamnionitis and colonization of the newborn infant with genital mycoplasmas.

To study the role of Mycoplasma hominis and T-mycoplasmas (Ureaplasma urealyticum) in chorioamnionitis, we obtained culture from 249 puerperal women and their babies. The placentas were examined histologically. Infants whose placentas showed inflammation (chorioamnionitis) had cultures positive for T-mycoplasmas more frequently (37.5 per cent) than those with normal placentas (19.0 per cent) (P = 0.021). Colonization with M. hominis was found in 16.0 per cent of the babies and was not significantly associated with chorioamnionitis. Material colonization with mycoplasmas was more frequent (73.4 per cent) and was not correlated with placental inflammation. We conclude that a substantial proportion of cases of chorioamnionitis may be caused by prenatal infection with T-mycoplasmas. The fact that these organisms are not highly virulent could explain the frequent finding of inflammed placentas from otherwise normal pregnacies. No adverse clinical effects of the placental lesions or of mycoplasmal colonization could be detected in this small study.

Amnion↗

PubMed1997

A case control study of chorioamniotic infection and histological chorioamnionitis in stillbirth.

In order to elucidate the role and aetiology of chorioamnionitis in stillbirth a case referent study was carried out in 58 pregnant women with late foetal death (cases) and in 58 pregnant women at term with live foetus (referents) matched for age and parity in Maputo Mozambique. Samples from women, stillborns and liveborns, were collected for microbiological and histological assessment. Histological chorioamnionitis was diagnosed in 96% of the cases and in 67% of the referents (OR = 13.5; 95% CI: 2.9-123.9). Escherichia coli was the species most frequently isolated in stillborns; in 14/16 (88%) cases it was isolated from intracardiac fluid. E. coli was associated with chorioamnionitis in 28% of the stillborns as compared to 5% of the referents (OR = 6.9; 95% CI: 1.4-65.4). No group B streptococci were recovered from any placenta or newborn. Vasculitis was present in 12 (21%) cases and in 3 (5%) referents (OR = 4.8; 95%, CI: 1.2-27.7). Histological chorioamnionitis was thus associated with stillbirth. E. coli was common in stillborns. The presence of vasculitis in one fifth of the stillborns indicated that the foetus was alive at the onset of infection.

Age Factors↗

PubMed1990

The role of bacterial vaginosis as a cause of amniotic fluid infection, chorioamnionitis and prematurity--a review.

Antepartum bacterial vaginosis in pregnancy has been related to premature delivery, the recovery of microorganisms from amniotic fluid of women in premature labor with intact membranes, to histologic chorioamnionitis and to the recovery of microorganisms from the placenta or membranes. Microorganisms associated with bacterial vaginosis are commonly recovered from the amniotic fluid and chorioamnion of patients who deliver prematurely. In addition, bacterial vaginosis is associated with maternal infectious morbidity during labor and in the postpartum period. Very little is known of the pathophysiologic mechanisms by which bacterial vaginosis may cause preterm labor and/or premature rupture of the membranes. However, it is of interest to speculate on possible mechanisms. The high concentration of potentially pathogenic microorganisms in the vagina and cervix of pregnant women with bacterial vaginosis may increase the possibility of an ascending infection via the cervix, decidua, fetal membranes, maternal placenta, and amniotic fluid. Some of the bacteria associated with bacterial vaginosis such as Bacteroides sp. are particularly virulent. Certain bacteria produce enzymes that potentially could affect the fetal membranes or maternal deciduae. Bacteroides sp. and group B streptococcus produce proteases. Protease enzymes reduce the chorioamniotic membrane strength in vitro. It is even possible that a high concentration of bacteria in the lower genital tract could produce enough proteases to weaken the fetal membrane strength causing premature rupture of the membranes. Bacterial lipases could also produce tissue injury. Schwarz et al. demonstrated that lysosomes within fetal membrane cells contain phospholipase A2 in high concentrations. Phospholipase A2 is a precursor of prostaglandin synthesis and the destruction of lysosomes within deciduae or chorioamnion cells may induce prostaglandin synthesis resulting in uterine contractions. Bejar et al. found a high rate of phospholipase A2 production by Bacteroides sp., anaerobic streptococci, Fusobacterium sp., and G. vaginalis. Benett et al. demonstrated that bacterial products of group B streptococci, viridans streptococci, Escherichia coli and Bacteroides fragilis but not of Lactobacillus sp. increase the synthesis of prostaglandins in the membranes. Thus, selected bacteria, including some closely related to bacterial vaginosis may play a role in the initiation of uterine contractions by stimulating prostaglandin synthesis. In an alternative mechanism, either the release of prostaglandin in the membrane or uterine contraction could cause microbreaks of the membrane that allow bacterial colonization of the membrane.(ABSTRACT TRUNCATED AT 400 WORDS)

Amniotic Fluid↗

PubMed1989

Ceramide lactoside in amniotic fluid: high concentration in chorioamnionitis and in preterm labor.

The mechanisms responsible for the onset and progression of preterm labor are poorly understood. In the present study a total of 115 amniotic fluid specimens were analyzed for a lipid that has not previously been detected in amniotic fluid. This glycolipid was identified as ceramide lactoside. It was found in two-dimensional thin-layer chromatograms for evaluation of lung maturity and quantified by gas chromatography. Ceramide lactoside concentrations in amniotic fluid were low in spontaneous labor at term (1.7 +/- 0.7 nmol/ml) and in pregnancies that were not associated with spontaneous preterm labor (1.4 +/- 0.6 nmol/ml). The concentrations were high in chorioamnionitis with signs of infection (11.8 +/- 5.8 nmol/ml) and in preterm labor without clinical signs of chorioamnionitis (5.4 +/- 4.0 nmol/ml). A high ceramide lactoside (greater than or equal to 5 nmol/ml) predicted chorioamnionitis with signs of infection at a sensitivity and a specificity of 94% and 95%, respectively. A moderately high ceramide lactoside concentration (greater than or equal to 2.5 nmol/ml) predicted spontaneous preterm labor: sensitivity, 82%; specificity, 95%. Little, if any, ceramide lactoside was present in urine, vernix, normal fetal membranes, or lung effluent, whereas this glycolipid was present in large amounts in granulocytes and in inflamed fetal membranes. We propose that phagocytosing granulocytes release ceramide lactoside into amniotic fluid.

Amniocentesis↗

PubMed1989

Esterase activity in second- and third-trimester amniotic fluid: an indicator of chorioamnionitis.

Accurate and rapid diagnosis of chorioamnionitis poses a major diagnostic dilemma. We previously reported that leukocyte esterase activity in amniotic fluid, as measured by dipstick assay, could be used as an aid in the diagnosis of chorioamnionitis. This study examines the effectiveness of an in vitro spectrophotometric assay of esterase activity in amniotic fluid. We define baseline levels of esterase activity in uninfected amniotic fluid and demonstrate a quantitative increase when infection is present. Fifty-seven amniotic fluid samples obtained at second- and third-trimester amniocenteses were divided into three parts, one for culture and two for a comparison of esterase activities by the dipstick and spectrophotometric methods. In this study, the spectrophotometric assay, because of its higher specificity and sensitivity in the determination of elevated esterase activity, was shown to be more reliable for predicting chorioamnionitis than either the dipstick or culture method.

Amniocentesis↗

PubMed1996

Stillbirths and intrauterine infection, histologic chorioamnionitis and microbiological findings.

OBJECTIVE: To analyze whether placental inflammation is associated with stillbirth in Zimbabwe. METHOD: Placentas from 66 stillbirths (> 22 weeks' gestation; patients with congenital malformations, diabetes or preeclampsia were excluded) and 66 term live births were studied for the presence and severity of chorioamnionitis. The morphological results were compared with earlier presented microbiological findings in the same material. RESULTS: Chorioamnionitis was present in 79% of stillbirths and 30% of live births (O.R. 8.5, 95% C.I. 4.0-18). Nine percent of stillbirths but no live births presented vasculitis of the chorionic plate, which verified an inflammatory response from the infant (O.R. 14, 95% C.I. 2.8-72). The same types of microorganisms were isolated from stillbirths and liveborns, but Escherichia coli and group B streptococci were more frequent among stillbirths. CONCLUSIONS: Morphological chorioamnionitis occurred 2.6 times more often in women with stillbirths than in women with live births. In 9% of stillbirths the infant showed an inflammatory response. Thus the infant was alive when the infection occurred and it is therefore reasonable to assume that infection was the cause of death.

Cause of Death↗

PubMed2004

Development of a guinea pig model of chorioamnionitis and fetal brain injury.

OBJECTIVE: The purpose of this study was to develop a guinea pig model of chorioamnionitis to study the mechanisms that lead to fetal brain injury. Study design Pregnant guinea pigs at 70% gestation were inoculated intracervically with 1000 to 2500 colony-forming units of Escherichia coli. Guinea pigs were killed 2 to 3 days after bacterial inoculation. Maternal blood and fetal amniotic fluid samples were analyzed for proinflammatory cytokine tumor necrosis factor-alpha, interleukin-1beta, and interleukin-6 levels with the use of enzyme-linked immunosorbent assay kits. Fetal brains were stained for evidence of cell death with NeuroTacs stain. RESULTS: Of 34 maternal guinea pigs that were given an intracervical inoculation of E coli, 8 guinea pigs showed microbiologic evidence of chorioamnionitis in the amniotic fluid. Tumor necrosis factor-alpha and interleukin-6 were significantly higher (P<.05) in amniotic fluid samples that were obtained from sows that were subjected to intracervical inoculation with bacteria as compared with control animals (n=6 control maternal animals). These results were observed even if no bacteria were found subsequently on culture of the amniotic fluid from inoculated animals, which indicated that indirect exposure to infectious agents was sufficient to cause an elevated inflammatory response in the fetus. Levels of white matter injury were greater in fetuses that were exposed to bacterial infection in utero, as compared with control animals (P<.05). This result was found in the staining of periventricular and cortical white matter for the immunolabeling of activated caspase 3 and NeuroTacs staining for cells that exhibited evidence of apoptotic cell death (positive stain with evidence of karyorrhexis). CONCLUSION: Intracervical inoculation with E coli results in chorioamnionitis in guinea pigs that is associated with fetal brain injury.

Amniotic Fluid↗

PubMed2005

Chorioamnionitis and labor.

Chorioamnionitis is a puerperal infection that exists in histologic, clinical, and subclinical forms. This entity is believed to play a causative role in many cases of spontaneous preterm delivery. It also is associated with an increased risk of dysfunctional labor. This article focuses on the effects of chorioamnionitis on the progress of labor and the appropriate treatment of patients with clinical chorioamnionitis. The epidemiology, pathogenesis, and associated maternal and neonatal outcomes also are reviewed.

Chorioamnionitis↗

PubMed2004

Intraobserver and interobserver variability for the histologic diagnosis of chorioamnionitis.

OBJECTIVES: The interobserver and intraobserver variability for the histopathologic diagnosis of chorioamnionitis was examined. STUDY DESIGN: Two examiners independently reviewed archived slides from 250 placentas. They were blinded to the original diagnosis and details of the pregnancy. Definitions for two important diagnoses were made and a protocol for recording information used in trial before the study. Slides were examined under conditions reflecting normal working practice. RESULTS: A high level of agreement for the diagnosis of chorioamnionitis and umbilical vessel vasculitis (kappa range 0.78-0.81) between the examiners was found. Comparison of the agreement between each examiner and their original diagnosis was also excellent (kappa range 0.90-0.91). CONCLUSION: This study has audited the reliability of the diagnosis of chorioamnionitis, a common and important placental finding. The reproducible and reliable degree of agreement demonstrated permits further research to be undertaken relating this diagnosis to adverse postnatal outcomes.

Chorioamnionitis↗

PubMed1984

C-reactive protein as a predictor for chorioamnionitis in cases of premature rupture of the membranes.

We evaluated C-reactive protein for its ability to predict the occurrence of clinical chorioamnionitis in 51 patients with spontaneous premature rupture of the membranes at less than or equal to 34 weeks of gestational age. All the patients had determinations of C-reactive protein on admission, and then 25 patients were tested daily. Of the total 51 patients, 14 developed clinical signs compatible with a diagnosis of chorioamnionitis. An analysis was conducted to compare the use of C-reactive protein to that of white blood cell count in predicting febrile disease. Our study indicates that C-reactive protein is an accurate and early marker for predicting clinical chorioamnionitis. White blood cell and differential counts are less accurate in such prediction, especially after steroid treatment.

Adult↗

PubMed1998

Chorioamnionitis: is continuation of antibiotic therapy necessary after cesarean section?

OBJECTIVE: Our purpose was to determine whether the continuation of antibiotics postoperatively after cesarean section in patients whose labors were complicated by chorioamnionitis would reduce the incidence of endometritis. STUDY DESIGN: Patients with a clinical diagnosis of chorioamnionitis treated with ampicillin during labor and who required cesarean delivery for obstetric indications received preoperative intravenous clindamycin and gentamicin and were randomized into 2 groups. Group 1 received no scheduled postoperative antibiotics and group 2 continued to receive clindamycin 900 mg every 8 hours and gentamicin 1.5 mg/kg every 8 hours until afebrile for a minimum of 24 hours (temperature </=100 degreesF). RESULTS: Sixty-one patients were randomized to group 1 and 55 patients were randomized to group 2. The duration of labor, the duration of membrane rupture, and the number of intrapartum vaginal examinations were statistically insignificant between the 2 groups. The mean duration of maternal postoperative hospital stay was 4 days for both groups. There were no statistically significant differences in the rate of endometritis for group 1, 9 of 61 (14.8%), versus group 2, 12 of 55 (21.8%), P =.32. CONCLUSIONS: In patients whose labors were complicated by chorioamnionitis and who underwent cesarean section, the continuation of preoperative clindamycin and gentamicin in the postoperative period did not reduce the risk of endometritis compared with a single preoperative dose.

Adult↗

PubMed2001

Preventing recurrent second trimester group B streptococcus chorioamnionitis by intermittent prophylactic ampicillin.

BACKGROUND: Whereas carrying group B streptococcus during pregnancy is common, second trimester group B streptococcus chorioamnionitis with intact membranes is rare, and recurrence of the latter problem even more so. CASE: A 38-year-old multipara with a history of recurrent second trimester group B streptococcus chorioamnionitis resulting in pregnancy loss was treated, beginning at 14 weeks' gestation, with monthly prophylactic ampicillin therapy throughout pregnancy and delivered a healthy male infant at term. CONCLUSION: In women with recurrent pregnancy loss due to second trimester group B streptococcus chorioamnionitis, an intermittent prophylactic antibiotic regimen throughout pregnancy might increase the probability of successful pregnancy.

Adult↗