Evidence that antibiotic administration is effective in the treatment of a subset of patients with intra-amniotic infection/inflammation presenting with cervical insufficiency

Abstract

BACKGROUND: Cervical insufficiency is a risk factor for spontaneous midtrimester abortion or early preterm birth. Intra-amniotic infection has been reported in 8-52% of such patients and intraamniotic inflammation in 81%. Some professional organizations have recommended perioperative antibiotic treatment when emergency cervical cerclage is performed. The use of prophylactic antibiotics is predicated largely on the basis that they reduce the rate of complications during the course of vaginal surgery. However, it is possible that antibiotic administration can also eradicate intra-amniotic infection/ inflammation and improve pregnancy outcome. OBJECTIVE: To describe the outcome of antibiotic treatment in patients with cervical insufficiency and intra-amniotic infection/inflammation. STUDY DESIGN: The study population consisted of 22 women who met the following criteria: (1) singleton pregnancy; (2) painless cervical dilatation of >1 cm between 16.0 and 27.9 weeks of gestation; (3) intact membranes and absence of uterine contractions; (4) transabdominal amniocentesis performed for the evaluation of the microbiologic and inflammatory status of the amniotic cavity; (5) presence of intra-amniotic infection/inflammation; and (6) antibiotic treatment (regimen consisted of ceftriaxone, clarithromycin, and metronidazole). Amniotic fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas, and polymerase chain reaction for Ureaplasma spp. was performed. Intraamniotic infection was defined as a positive amniotic fluid culture for microorganisms or a positive polymerase chain reaction for Ureaplasma spp., and intra-amniotic inflammation was suspected when there was an elevated amniotic fluid white blood cell count (!19 cells/mm 3 ) or a positive rapid test for metalloproteinase-8 (sensitivity 10 ng/mL). For the purpose of this study, the "gold standard" for diagnosis of intra-amniotic inflammation was an elevated interleukin-6 concentration (>2.6 ng/mL)

A Broad Spectrum Chemokine Inhibitor Prevents Preterm Labor but Not Microbial Invasion of the Amniotic Cavity or Neonatal Morbidity in a Non-human Primate Model

“…Our results strongly suggest that inhibition of PTL using a BSCI may be effective, but it is imperative for the obstetrician to rule out intra-amniotic infection for the safety of the fetus and the mother. Several new studies suggest that an intraamniotic infection, in some cases, can be treated successfully with antibiotics (94)(95)(96)(97)(98). Further research is needed to determine if antibiotic therapy with an immunomodulator, similar to the BSCI, can eradicate an intrauterine infection and prevent PTL.…”

The fetal inflammatory response syndrome: the origins of a concept, pathophysiology, diagnosis, and obstetrical implications

“…Therefore, the risks of prematurity and intra-amniotic infection/inflammation must be balanced. Antibiotic treatment can reduce the rate of intra-amniotic infection/inflammation, as well as funisitis in a subset of patients with spontaneous preterm delivery with intact membranes [342], cervical insufficiency [343], short cervix [344], and preterm PROM [345][346][347].…”

Cellular immune responses in amniotic fluid of women with preterm prelabor rupture of membranes

“…The traditional biomarker of intra-amniotic inflammation has been the amniotic fluid WBC count [27,61,65,109,110].…”