Antibiotic administration in patients with preterm premature rupture of membranes reduces the rate of histological chorioamnionitis: a prospective, randomized, controlled study

Ovalle, Alfredo; Martínez, María Angélica; Kakarieka, Elena; Gómez, Ricardo; Rubio, Rafael; Valderrama, O; Leyton, H.

doi:10.1080/jmf.12.1.35.41

Cited by 85 publications

(13 citation statements)

References 7 publications

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“… 24 25 Significant differences between PPROM and preterm labor with intact membranes in terms of cervical length and latency are probably related to the fact that systemic antibiotic therapy is routinely given to women with PPROM, while systemic antibiotic prophylaxis is not typically administered in cases of preterm labor. For patients with PPROM, administration of antibiotics, which has been shown to significantly reduce the incidence of histologic chorioamnionitis, prolong pregnancy, and improve neonatal outcomes, 26 27 may potentially prevent a possible ascending infection or ameliorate local damage to the placenta already experiencing acute inflammation.…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Prediction of Histologic Chorioamnionitis in Women with Preterm Premature Rupture of Membranes

2016

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PurposeTo develop a model based on non-invasive clinical and ultrasonographic parameters for predicting the likelihood of subsequent histologic chorioamnionitis in women with preterm premature rupture of membranes (PPROM) and to determine whether the inclusion of invasive test results improves the predictive value of the model.Materials and MethodsThis retrospective cohort study included 146 consecutive women presenting with PPROM (20–33 weeks). Transvaginal ultrasonographic assessment of cervical length was performed. Maternal serum C-reactive protein (CRP) levels and white blood cell (WBC) counts were measured after amniocentesis. Amniotic fluid (AF) obtained by amniocentesis was cultured, and interleukin-6 (IL-6) levels and WBC counts were determined. The primary outcome measure was histologic chorioamnionitis.ResultsRisk scores based on serum CRP concentrations and gestational age (model 1) were calculated for each patient. The model was shown to have adequate goodness of fit and an area under the receiver operating characteristic curve (AUC) of 0.742. When including AF test results (e.g., AF IL-6 levels) in model 1, serum CRP concentrations were found to be insignificant, and thus, were excluded from model 2, comprising AF IL-6 levels and gestational age. No significant difference in AUC was found between models 1 and 2.ConclusionFor women with PPROM, the newly developed model incorporating non-invasive parameters (serum CRP and gestational age) was moderately predictive of histologic chorioamnionitis. The inclusion of invasive test results added no predictive information to the model in this setting.

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Section: Discussionmentioning

confidence: 99%

Non-Invasive Prediction of Histologic Chorioamnionitis in Women with Preterm Premature Rupture of Membranes

2016

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“…The relationship between API and other forms of inflammation and infection is complex, hence the retirement of prior terminology including amniotic fluid infection (AFI), intrauterine infection (IUI), and ascending infection (11). Presumed pathogenic bacteria are identified in 72% (16), 89% (17), 38% (18), 61% (14), and 4% (19) of cases, depending on the clinical circumstances and methodology. In general, bacteria are more frequently identified in preterm delivery and when API and clinical chorioamnionitis are present.…”

Section: Api Acute Inflammation and Infectionmentioning

confidence: 99%

Maternal-Fetal Inflammation in the Placenta and the Developmental Origins of Health and Disease

et al. 2020

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“…It is possible that the methods to monitor maternal and fetal health may differ according to the pathologic process operative in cases of preterm PROM with and without infection, and also those without intra-amniotic inflammation. For example, the administration of antibiotics to patients with preterm PROM results in prolongation of the latency period and a reduction in the rate of clinical chorioamnionitis and neonatal sepsis [263][264][265][266][267][268][269][270][271][272][273]. However, studies in which amniocentesis has been performed at the time of admission and after the administration of antibiotics show that antimicrobial agents do not eradicate intra-amniotic infection present at admission, nor prevent subsequent microbial invasion [274].…”

Section: Future Directionsmentioning

confidence: 99%

Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes

Romero

Miranda

Chaemsaithong

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

355

294

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Objective The objectives of this study were to: 1) determine the amniotic fluid (AF) microbiology of patients with preterm prelabor rupture of membranes (PROM); and 2) examine the relationship between intra-amniotic inflammation with and without microorganisms (sterile inflammation) and adverse pregnancy outcomes in patients with preterm PROM. Methods AF samples obtained from 59 women with preterm PROM were analyzed using cultivation techniques (for aerobic and anaerobic bacteria as well as genital mycoplasmas) and with broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). AF concentration of interleukin-6 (IL-6) was determined using ELISA. Results of both tests were correlated with AF IL-6 concentrations, and the occurrence of adverse obstetrical/perinatal outcomes. Results 1) PCR/ESI-MS, AF culture, and the combination of these two tests, each identified microorganisms in 36% (21/59), 24% (14/59) and 41% (24/59) of women with preterm PROM, respectively; 2) the most frequent microorganisms found in the amniotic cavity were Sneathia species and Ureaplasma urealyticum; 3) the frequency of microbial-associated and sterile intra-amniotic inflammation was overall similar [ 29% (17/59)]: - however, the prevalence of each differed according to the gestational age when PROM occurred ; 4) the earlier the gestational age at preterm PROM, the higher the frequency of both microbial-associated and sterile intra-amniotic inflammation; 5) the intensity of the intra-amniotic inflammatory response against microorganisms is stronger when preterm PROM occurs early in pregnancy; and 6) the frequency of acute placental inflammation (histologic chorioamnionitis and/or funisitis) was significantly higher in patients with microbial-associated intra-amniotic inflammation than in those without intra-amniotic inflammation [93.3% (14/15) vs. 38% (6/16); p=0.001]. Conclusions 1) The frequency of microorganisms in preterm PROM is 40% using both cultivation and PCR/ESI-MS; 2) PCR/ESI-MS identified microorganisms in the AF of 50% more women with preterm PROM than did AF culture; and 3) sterile intra-amniotic inflammation was present in 29% of these patients, and it was as or more common than microbial-associated intra-amniotic inflammation among those presenting after, but not before, 24 weeks of gestation.

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Antibiotic administration in patients with preterm premature rupture of membranes reduces the rate of histological chorioamnionitis: a prospective, randomized, controlled study

Abstract: Administration of antibiotics in patients with preterm premature rupture of membranes is associated with a significant reduction in the incidence of histological chorioamnionitis but it does not modify the frequency of funisitis.

Cited by 85 publications

References 7 publications

Non-Invasive Prediction of Histologic Chorioamnionitis in Women with Preterm Premature Rupture of Membranes

Non-Invasive Prediction of Histologic Chorioamnionitis in Women with Preterm Premature Rupture of Membranes

Maternal-Fetal Inflammation in the Placenta and the Developmental Origins of Health and Disease

Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes

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