intraamniotic infection Dotaz Zobrazit nápovědu
- MeSH
- cytokiny fyziologie krev MeSH
- infekce komplikace mikrobiologie patologie MeSH
- interferon alfa fyziologie krev MeSH
- nemoci novorozenců etiologie patologie MeSH
- nemoci plodu etiologie patologie MeSH
- periventrikulární leukomalacie patologie prevence a kontrola ultrasonografie MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Excisional treatment of cervical intraepithelial neoplasia or very early stages of cervical cancer increases the risk of preterm prelabor rupture of membranes in subsequent pregnancies. The risk increases with the length of the excised cone. The subset of cases with preterm prelabor rupture of membranes and a history of cervical excisional treatment could also be at higher risk of intraamniotic infection/inflammation. However, there is a paucity of relevant information on this subject. OBJECTIVE: This study aimed to assess the differences in the rates of intraamniotic infection/inflammation and early-onset neonatal sepsis between singleton preterm prelabor rupture of membranes pregnancies without and with a history of cervical excisional treatment, and to investigate the association between these complications of preterm prelabor rupture of membranes and the excised cone length. STUDY DESIGN: This retrospective cohort study included 770 preterm prelabor rupture of membranes pregnancies in which transabdominal amniocentesis was performed as part of standard clinical management to assess the intraamniotic environment. The maternal and perinatal medical records of all included women were reviewed to obtain information on the absence or presence of history of cervical excisional treatment and neonatal outcomes. Women whose records contained any information on history of cervical excisional treatment were contacted by phone and in writing to inform them of the study and request permission to collect relevant information from their medical records. Women were divided into 4 subgroups according to the presence of microorganisms and/or their nucleic acids (through culturing and molecular biology methods) in amniotic fluid and/or intraamniotic inflammation (through amniotic fluid interleukin-6 concentration evaluation): intraamniotic infection (presence of both), sterile intraamniotic inflammation (intraamniotic inflammation alone), microbial invasion of the amniotic cavity without inflammation (presence of microorganisms and/or their nucleic acids in amniotic fluid alone), and negative amniotic fluid for infection/inflammation (absence of both). RESULTS: A history of cervical excisional treatment was found in 10% (76/765) of the women. Of these, 82% (62/76) had a history of only 1 treatment, and information on cone length was available for 97% (60/62) of them. Women with a history of cervical excisional treatment had higher rates of intraamniotic infection (with, 25% [19/76] vs without, 12% [85/689]; adjusted odds ratio, 2.5; adjusted P=.004), microbial invasion of the amniotic cavity without inflammation (with, 25% [19/76] vs without, 11% [74/689]; adjusted odds ratio, 3.1; adjusted P<.0001), and early-onset neonatal sepsis (with, 8% [11/76] vs without, 3% [23/689]; adjusted odds ratio, 2.9; adjusted P=.02) compared with those without such history. Quartiles of cone length (range: 3-32 mm) were used to categorize the women into 4 quartile subgroups (first: 3-8 mm; second: 9-12 mm; third: 13-17 mm; and fourth: 18-32 mm). Cone length of ≥18 mm was associated with higher rates of intraamniotic infection (with, 29% [5/15] vs without, 12% [85/689]; adjusted odds ratio, 3.0; adjusted P=.05), microbial invasion of the amniotic cavity without inflammation (with, 40% [6/15] vs without, 11% [74/689]; adjusted odds ratio, 6.1; adjusted P=.003), and early-onset neonatal sepsis (with, 20% [3/15] vs without, 3% [23/689]; adjusted odds ratio, 5.7; adjusted P=.02). CONCLUSION: History of cervical excisional treatment increases risks of intraamniotic infection, microbial invasion of the amniotic cavity without inflammation, and development of early-onset neonatal sepsis in a subsequent pregnancy complicated by preterm prelabor rupture of membranes.
- MeSH
- chorioamnionitida * epidemiologie etiologie MeSH
- lidé MeSH
- novorozenec MeSH
- novorozenecká sepse * MeSH
- plodová voda MeSH
- předčasný odtok plodové vody * epidemiologie MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- zánět komplikace MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- amnion imunologie mikrobiologie MeSH
- cytokiny analýza MeSH
- Escherichia coli patogenita MeSH
- finanční podpora výzkumu jako téma MeSH
- fluorescenční protilátková technika metody MeSH
- imunohistochemie metody MeSH
- infekce vyvolané Escherichia coli imunologie MeSH
- těhotenství MeSH
- zánět diagnóza imunologie MeSH
- zvířata MeSH
- Check Tag
- těhotenství MeSH
- zvířata MeSH
BACKGROUND: Preterm prelabor rupture of the membranes (PPROM) is frequently complicated by intraamniotic inflammatory processes such as intraamniotic infection and sterile intraamniotic inflammation. Antibiotic therapy is recommended to patients with PPROM to prolong the interval between this complication and delivery (latency period), reduce the risk of clinical chorioamnionitis, and improve neonatal outcome. However, there is a lack of information regarding whether the administration of antibiotics can reduce the intensity of the intraamniotic inflammatory response or eradicate microorganisms in patients with PPROM. OBJECTIVE: The first aim of the study was to determine whether antimicrobial agents can reduce the magnitude of the intraamniotic inflammatory response in patients with PPROM by assessing the concentrations of interleukin-6 in amniotic fluid before and after antibiotic treatment. The second aim was to determine whether treatment with intravenous clarithromycin changes the microbial load of Ureaplasma spp DNA in amniotic fluid. STUDY DESIGN: A retrospective cohort study included patients who had (1) a singleton gestation, (2) PPROM between 24+0 and 33+6 weeks, (3) a transabdominal amniocentesis at the time of admission, and (4) intravenous antibiotic treatment (clarithromycin for patients with intraamniotic inflammation and benzylpenicillin/clindamycin in the cases of allergy in patients without intraamniotic inflammation) for 7 days. Follow-up amniocenteses (7th day after admission) were performed in the subset of patients with a latency period lasting longer than 7 days. Concentrations of interleukin-6 were measured in the samples of amniotic fluid with a bedside test, and the presence of microbial invasion of the amniotic cavity was assessed with culture and molecular microbiological methods. Intraamniotic inflammation was defined as a bedside interleukin-6 concentration ≥745 pg/mL in the samples of amniotic fluid. Intraamniotic infection was defined as the presence of both microbial invasion of the amniotic cavity and intraamniotic inflammation; sterile intraamniotic inflammation was defined as the presence of intraamniotic inflammation without microbial invasion of the amniotic cavity. RESULTS: A total of 270 patients with PPROM were included in this study: 207 patients delivered within 7 days and 63 patients delivered after 7 days of admission. Of the 63 patients who delivered after 7 days following the initial amniocentesis, 40 underwent a follow-up amniocentesis. Patients with intraamniotic infection (n = 7) and sterile intraamniotic inflammation (n = 7) were treated with intravenous clarithromycin. Patients without either microbial invasion of the amniotic cavity or intraamniotic inflammation (n = 26) were treated with benzylpenicillin or clindamycin. Treatment with clarithromycin decreased the interleukin-6 concentration in amniotic fluid at the follow-up amniocentesis compared to the initial amniocentesis in patients with intraamniotic infection (follow-up: median, 295 pg/mL, interquartile range [IQR], 72-673 vs initial: median, 2973 pg/mL, IQR, 1750-6296; P = .02) and in those with sterile intraamniotic inflammation (follow-up: median, 221 pg/mL, IQR 118-366 pg/mL vs initial: median, 1446 pg/mL, IQR, 1300-2941; P = .02). Samples of amniotic fluid with Ureaplasma spp DNA had a lower microbial load at the time of follow-up amniocentesis compared to the initial amniocentesis (follow-up: median, 1.8 × 104 copies DNA/mL, 2.9 × 104 to 6.7 × 108 vs initial: median, 4.7 × 107 copies DNA/mL, interquartile range, 2.9 × 103 to 3.6 × 107; P = .03). CONCLUSION: Intravenous therapy with clarithromycin was associated with a reduction in the intensity of the intraamniotic inflammatory response in patients with PPROM with either intraamniotic infection or sterile intraamniotic inflammation. Moreover, treatment with clarithromycin was related to a reduction in the load of Ureaplasma spp DNA in the amniotic fluid of patients with PPROM <34 weeks of gestation.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- bakteriální infekce etiologie prevence a kontrola MeSH
- chorioamnionitida etiologie prevence a kontrola MeSH
- DNA bakterií analýza MeSH
- dospělí MeSH
- interleukin-6 analýza MeSH
- klarithromycin terapeutické užití MeSH
- klindamycin terapeutické užití MeSH
- kohortové studie MeSH
- lidé MeSH
- penicilin G terapeutické užití MeSH
- plodová voda chemie MeSH
- předčasný odtok plodové vody * MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- Ureaplasma genetika MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Research Support, N.I.H., Extramural MeSH
- MeSH
- amnion patologie MeSH
- bakteriální infekce mikrobiologie MeSH
- cytokiny biosyntéza MeSH
- mediátory zánětu fyziologie MeSH
- Publikační typ
- přehledy MeSH
To give an overview about the role of the innate immunity in pathogenesis of intraamniotic inflammation in pregnancies complicated by preterm premature rupture of membranes. DESIGN: Review article. SETTING: Department of Clinical Immunology and Allergy, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University in Prague. METHOD: An overview of recent published data. CONCLUSION: Immune system has an indisplaceable function throughout the successful pregnancy. Spontaneous labor is the result of many factors in which innate immunity playes a major role. The increased concentrations of proinflammatory markers (interleukin (IL)-1beta, IL-6, tumour necrosis factor alfa a IL-8) were found in amniotic fluid both in term and in preterm spontaneous delivery. These markers could be used for an early diagnosis of intraamnial infection/inflammation, which is the most common cause of preterm delivery (PTD) and preterm premature rupture of membranes (PPROM). The elevation of these markers could also better determine the patients with enhanced probability of PTD and PPROM.
- Klíčová slova
- amniochorion, intraamniální zánět, prozánětové markery,
- MeSH
- chorioamnionitida imunologie MeSH
- lidé MeSH
- předčasná porodní činnost imunologie MeSH
- předčasný odtok plodové vody imunologie MeSH
- přirozená imunita MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
OBJECTIVE: We sought to determine the influence of microbial invasion of the amniotic cavity (MIAC) and acute histologic chorioamnionitis (HCA) on the intensity of the intraamniotic inflammatory response and neonatal morbidity in preterm prelabor rupture of membranes (PPROM) between 34-37 weeks. STUDY DESIGN: This study included 99 women with singleton pregnancies complicated by PPROM between the gestational ages of 34-37 weeks. Amniocenteses were performed at the time of admission, and MIAC and amniotic fluid interleukin-6 concentrations were determined. After delivery, the placenta was evaluated for the presence of HCA. RESULTS: Women with both MIAC and HCA had the highest intraamniotic inflammatory response, which was mediated by interleukin-6 concentrations (both MIAC and HCA: median 2164.0 pg/mL; HCA alone: median 654.8 pg/mL; MIAC alone: median 784.1 pg/mL; neither MIAC nor HCA: median 383.0 pg/mL; P < .0001) and the highest incidence of newborns with early-onset sepsis (P = .02). CONCLUSION: Both MIAC and HCA affect the intensity of the intraamniotic inflammatory response and the incidence of early-onset sepsis following PPROM between 34-37 weeks. The intensity of the intraamniotic inflammatory response should be considered in the clinical management of PPROM between 34-37 weeks.
- MeSH
- amniocentéza MeSH
- chorioamnionitida patologie MeSH
- dospělí MeSH
- gestační stáří MeSH
- interleukin-6 analýza MeSH
- lidé MeSH
- mladý dospělý MeSH
- nemoci novorozenců diagnóza epidemiologie MeSH
- novorozenec MeSH
- plodová voda chemie mikrobiologie MeSH
- předčasný odtok plodové vody * MeSH
- prediktivní hodnota testů MeSH
- prospektivní studie MeSH
- senzitivita a specificita MeSH
- sepse diagnóza epidemiologie MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVE: The objective of the study was to determine whether the bacterial load of genital mycoplasmas and gestation age are related to intraamniotic inflammatory response using the amniotic fluid levels of 18 inflammatory mediators. STUDY DESIGN: A prospective study of 145 women with singleton pregnancies complicated by preterm prelabor rupture of membranes between 24(0/7) and 36(6/7) weeks was conducted. Amniotic fluid was obtained from all women by transabdominal amniocentesis. The amounts of genital mycoplasma deoxyribonucleic acid were determined using the threshold cycle value and relative and absolute quantification techniques. A panel of multiple proteins was analyzed simultaneously using multiplex technology. RESULTS: Twenty-four women with the presence of genital mycoplasmas in amniotic fluid were included in the final analyses. The concentrations of 9 of the 18 evaluated proteins in the amniotic fluid correlated with bacterial load of genital mycoplasmas independent of the quantification technique used. CONCLUSION: The intensity of intraamniotic inflammatory response to genital mycoplasmas decreased with gestational age.
- MeSH
- amniocentéza MeSH
- bakteriální nálož MeSH
- chorioamnionitida diagnóza mikrobiologie MeSH
- DNA bakterií analýza MeSH
- dospělí MeSH
- gestační stáří MeSH
- infekční komplikace v těhotenství diagnóza mikrobiologie MeSH
- lidé MeSH
- mediátory zánětu analýza MeSH
- mladý dospělý MeSH
- mykoplazmové infekce diagnóza MeSH
- plodová voda chemie mikrobiologie MeSH
- předčasný odtok plodové vody mikrobiologie MeSH
- prospektivní studie MeSH
- stupeň závažnosti nemoci MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
