Preterm Premature Rupture of the Membranes and Genital Mycoplasmas

Abstract

Preterm delivery is one of the main causes of perinatal mortality and morbidity worldwide. It is an escalating problem in Czech Republic and has increased to 6 %. Premature rupture of the membranes is defined as fetal membranes rupture with leakage of amniotic fluid that precedes the onset of uterine contraction by at least 2 hours. It complicates 4-7 % of all births and is directly associated with a short length of gestation and an increased perinatal morbidity and mortality. There are predisposing conditions connected with the occurrence of premature rupture of the membranes such as local infections, cervical incompetence and low socio-economic condition (5, 13). Even so, the aetiology still remains unknown in the majority of cases. Increased biosynthesis of prostaglandins by intrauterine tissue is widely accepted as a key event in the initiation of parturition (8). Preterm labour after spontaneous rupture of the membranes is associated with a significant increase in amniotic fluid concentration of prostaglandins. A main reason of this elevation is probably infection. The purpose of this study was to evaluate the prevalence of cervical colonization by genital mycoplasmas (Ureaplasma urealyticum and/or Mycoplasma hominis) in patients with preterm premature rupture of the membranes (PPROM). The cervical detection rates of genital mycoplasmas were compared with a normal population of pregnant women in the Czech Republic. Patients and method Study populationThe study population involved 225 pregnant women with PPROM (gestation age between 24 and 36 weeks) who were admitted to the department of Obstetrics and Gynaecology in Most from January 2004 to February 2007. There were no differences in the demographic data of the groups studied and all groups were similar with regard to parity and gravidity. Their age at the time of diagnosis ranged from 19 to 38 years (median age 26). Women with multiple gestation or major fetal anomaly were excluded from the study. Written consent was obtained from each patient. Rupture of membranes was diagnosed by an examination with a sterile speculum and a combination of vaginal pooling of amniotic fluid and the nitrazine test or a positive result for insulin-like growth factor binding protein -1 (PROM test) in the vaginal fluid. Cervical swabs were obtained for detecting genital mycoplasmas and standard vaginal smears of bacterial culture were performed at the time of their admission. Sample of maternal blood was obtained for investigation of maternal CRP level. The control group comprised 225 otherwise healthy women in the mid trimester of pregnancy (gestation age between 24-28 weeks) from whom we obtained cervical swabs for genital mycoplasmas during routine prenatal examination. All these women delivered between 38th and 41st week of gestation without ad- Summary: Objective: The purpose of this study was to evaluate the prevalence of cervical colonization by genital mycoplasmas in patients with preterm premature rupture of the membranes (PPROM). Method: We studied 225 women between...

Epidemiologic Factors and Urogenital Infections Associated With Preterm Birth in a Midwestern U.S. Population

“…Conflicting associations between mollicutes and preterm birth have had a long history, not only related to population tested, but also to testing itself (culture vs PCR) (5,7,8,9,10,11,12,16,20,21,22,23,24,25,26). We used PCR probes that can separate M hominis , M genitalium , and U parvum from U urealyticum (18).…”

“…Some urogenital mollicutes ( Mycoplasma and Ureaplasma species, which are bacteria without cell walls) have been associated by culture with preterm birth in many (7,8,9,10), but not all (5,11,12), studies. Causality for preterm birth or labor is plausible because mollicutes possess adhesion molecules that interact with toll-like receptors and stimulate secretion of pro-inflammatory cytokines IL2, IL4, and IL6 (2,4,5,6,12,13,14).…”

Urogenital Mycoplasmosis and Pregnancy

“…As can be seen from Table 1, then prevalence varies considerably from study to study [1][2][3][4][5]. Prevalence of M. genitalium has been found to be between 0.3-1.2% [6,7].…”

“…Ureaplasma genital tract colonization has been associated with adverse pregnancy outcomes such as spontaneous abortion [10], premature rupture of membranes (PROM) [4], premature delivery [11], neonatal morbidity and perinatal death [12]. The methodology and samples vary considerably between studies, which makes combining and synthesizing the result difficult.…”

Molecular Study for Diagnosis of Ureaplasma parvum in Women with Recurrent Miscarriage

“…U. parvum are involved in a variety of infections in genitourinary tract infections of humans [10,16]. Identified U. parvum in 57% of healthy non pregnant women and the organism was far more prevalent than any of the other genital mycoplasmas, Chlamydia spp., or viruses [11,17]. The proposed mechanisms for infectious causes of recurrent abortion include: direct infection of the uterus, fetus, or placenta; placental insufficiency; chronic endometritis or endocervicitis; amnionitis; infected intrauterine device [18,19].…”