Adverse Outcome in Pregnancy Following Amniotic Fluid Isolation of Ureaplasma urealyticum

Abstract

Infections in pregnancy with Ureaplasma urealyticum have been associated with a wide range of adverse outcomes, such as early abortion, stillbirth, prematurity, and neonatal morbidity and mortality. Causality has been difficult to demonstrate secondary to the high prevalence of asymptomatic lower genital tract (LGT) colonization and culture data from inaccessible or potentially contaminated sites.Between 1985 and 1989,2461 second-trimester genetic amniocenteses were evaluated at the cytogenetics section of the Children's Hospital Medical Center of Akron. All were cultured for the genital mycoplasmas: MycopZasma hominis and Ureaplasma ureafyticum. A total of nine patients were positive, all for Ureaplasma urealyticum, with one patient excluded because of subsequent therapeutic abortion. In addition, complete follow-up data, such as indication for amniocentesis, serum alpha-fetoprotein levels, gestational age at parturition, and outcome of pregnancy, were available on 86 Ureaplasma-negative (U -) patients during an approximate 2-year span within the time-frame of the study. This was in part due to physician response to a questionnaire sent after amniocentesis.Of the eight positive cultures, 100 per cent were associated with an adverse outcome, defined as fetal loss or premature delivery. This was significant compared with the Ugroup (P<O.OOl) with a more than eight times greater risk of adverse outcome. Six (75 per cent) resulted in spontaneous miscarriage within 4 weeks of amniocentesis and at less than 21 weeks' gestation. Two (25 per cent) delivered prematurely, with one (12.5 per cent) neonatal death at 24+ weeks. Histological examination of all eight placentae and the seven fetuses revealed a 100 per cent incidence of chorioamnionitis and pneumonia, respectively. In addition, in four of the five cases (80 per cent), cultures were positive for Ureaplasma urealyticum in pure culture from either placenta, fetal lung, or both tissues. The remaining case (20 per cent) was negative for aerobes, anaerobes, and mycoplasmas.The study demonstrates a significant association and supports a causal relationship between isolation of Ureaplasma from mid-trimester amniotic fluid with fetal wastage and premature birth.

Placental Features of Chorioamnionitis Colonized With Ureaplasma Species in Preterm Delivery

“…has been detected in some samples of amniotic fluid obtained in routine chromosomal analysis at 15-18 wk of gestation. In most of these women, delivery was around 24 wk (31)(32)(33). Meanwhile, Perni et al (34) reported that in 179 asymptomatic women who received amniocentesis at midtrimester, all women with preterm PROM (5/5) tested positive for either Ureaplasma spp.…”

543: Presenting twins are exposed to higher levels of inflammatory mediators than non-presenting twins as early as the mid-trimester of pregnancy

“…The AF concentrations of IL-8, MMP-8, and CRP were higher in the first twin, and this difference remained significant after adjustment for the fetal growth restriction at the time of birth and chorionicity. We included only twin pregnant women who delivered at term, because intra-amniotic infection and/or inflammation in midtrimester amniotic fluid itself is associated with an increased risk of preterm delivery [32][33][34][35][36].…”

Ureaplasma parvum as a Cause of Sternal Wound Infection

“…colonize the lower genitourinary tract in 40 to 80% of sexually active women (11). These organisms have been implicated as etiologic agents causing nongonococcal urethritis, stillbirth/premature delivery, postpartum bacteremia, and wound infection post-caesarean section (3,7,12,13). They have also been associated with the development of neonatal pneumonia, meningitis, and chronic lung disease (8, 11, 17).…”