Preterm birth is associated with increased risk of maternal and neonatal infection
Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver. Obstetrics and Gynecology
(Impact Factor: 5.18).
Much information suggests that maternal reproductive tract infections, both recognized and unrecognized, account for an important and possibly preventable portion of preterm births. If such infections do mediate instances of preterm labor and premature rupture of the membranes (PROM), then associated risks of subsequent maternal and neonatal infections would be increased, even after controlling for confounding variables. To evaluate possible associations between preterm birth and maternal and neonatal infections, we conducted a retrospective study of 9642 births at the University of Colorado Health Sciences Center between July 1980 and June 1985. Clinical chorioamnionitis occurred more frequently among women delivering before term with intact membranes at the onset of labor (5.8% preterm versus 1.7% term) and among women with PROM (26.5% preterm versus 6.7% term). Among the women delivered by cesarean, the incidence of postpartum endometritis was higher in those with preterm PROM than in those with term rupture of membranes. The incidence of neonatal infection increased significantly as the gestational age of the neonates decreased (P less than .01). The rate of culture-proven neonatal infection was significantly higher following PROM (P less than .01) than after birth without PROM. Both neonatal infection and perinatal mortality were increased in association with chorioamnionitis in both preterm and term pregnancies. These consistent observations complement and support suggestions that reproductive tract infection plays a possibly preventable role in the pathogenesis of preterm birth.
Available from: scirp.org
- "Although PROM (either preterm or ≥37 weeks' gestation) and duration of rupture of membranes ≥18 -24 hours are assumed to worsen the situation, premature labor in itself thus appears to be linked to neonatal sepsis. The latter might be linked to histological chorioamniotitis and microbial footprints in the amniotic cavity that were found in patients at risk of PROM   . Meanwhile, before much is known on the causative relationships between maternal exposure before PROM and neonatal condition, authors agree that efforts are to be orientated on prevalent risk factors according to different environments in order to properly base an antibiotic prophylaxis - . "
Available from: Ronald F Lamont
- "Concerns have been expressed that, if antibiotics are given late in pregnancy, without any objective evidence of abnormal fl ora, then in contrast to treating abnormal fl ora in early pregnancy, it is possible that normal fl ora is being altered detrimentally with subsequent adverse eff ects (Lamont et al. 1998, 2000, 2001). Th e earlier in pregnancy at which PTB occurs, the more likely it is to be due to infection (Seo et al. 1992; Shim et al. 2004) (Figure 2). Th e main cohort studies from Europe, North America and the Far East (Gravett et al. 1986; Kurki et al. 1992; Riduan et al. 1993; Hay et al. 1994; McGregor et al. 1994; Hillier et al. 1995; Meis et al. 1995; Gratacos et al. 1998) and three case – control studies from the USA, Sweden and Australia (Eschenbach et al. 1984; McDonald et al. 1992; Holst et al. 1994) have used diff erent methodologies to examine the association between abnormal genital tract fl ora, either in the form of BV or the presence of BV associated organisms, and adverse outcomes of pregnancy. "
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ABSTRACT: Spontaneous preterm labour and delivery is a syndrome comprising diverse pathological pathways that result in labour and delivery before term. It is recognised that multiple pathological processes are involved, and infection has been well studied and firmly established as a cause. Although the molecular mechanisms responsible for this process have been identified, there is a lack of consensus about effective antibiotic intervention. Systematic reviews of the few well conducted studies suggest that antibiotics active against bacterial vaginosis or related organisms (clindamycin) given to appropriate women (those with objective evidence of abnormal genital tract flora), and used early in pregnancy (< 22 completed weeks of gestation) before irreversible inflammatory damage occurs, can reduce the rate of preterm birth. There is a need for well constructed trials to understand the vaginal microbiome and how the different types of maternal immune response influences outcome.
Available from: Offer Erez
- "Esta enfermedad puede asociarse frecuentemente con la invasión microbiana de la cavidad amniótica. Seo et al  han comprobado un aumento de mortalidad neonatal en presencia de corioamnionitis en todas las edades gestacionales, por encima de las 28 semanas. Además, se asoció la RPM con el 30-40% de los partos pretérmino y también fue responsable de los problemas neonatales resultantes de la premadurez  . "
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