The cervical mucus plug inhibits, but does not block, the passage of ascending bacteria from the vagina during pregnancy

Hansen, Lulu Anne; Becher, Naja; Bastholm, Sara Kjær; Glavind, Julie; Ramsing, Mette; Kim, Chong J.; Romero, Roberto; Jensen, Jørgen Skov; Uldbjerg, Niels

doi:10.1111/aogs.12296

Cited by 72 publications

(60 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients with a CL 15 mm had a higher rate of positive AF culture [26% (15/57)] than patients with a CL !15 mm [3.8% (13/344)] [220]. It is unclear if a short cervix leads to compromised innate immunity following the loss of the anti-microbial properties of the cervical mucus plug [224][225][226][227][228][229] and predisposes to ascending intra-amniotic infection, or alternatively, if intra-amniotic infection leads to a short cervix.…”

Section: Discussionmentioning

confidence: 99%

Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance

Romero

Miranda

Chaiworapongsa

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

Self Cite

156

122

View full text Add to dashboard Cite

Objective To determine the frequency and clinical significance of sterile- and microbial-associated intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix. Methods Amniotic fluid (AF) samples obtained by transabdominal amniocentesis from 231 asymptomatic women with a sonographic short cervix [cervical length (CL) ≤25 mm] were analyzed using cultivation techniques (for aerobic and anaerobic as well as genital mycoplasmas) and broad-range polymerase chain reaction (PCR) coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). The frequency and magnitude of intra-amniotic inflammation [defined as an AF interleukin (IL)-6 concentration ≥2.6 ng/mL], acute histologic placental inflammation, spontaneous preterm delivery, and the amniocentesis-to-delivery interval were examined according to the results of AF cultures, PCR/ESI-MS and AF IL-6 concentrations. Results Ten percent (24/231) of patients with a sonographic short cervix had sterile intra-amniotic inflammation (an elevated AF IL-6 concentration without evidence of microorganisms using cultivation and molecular methods). Sterile intra-amniotic inflammation was significantly more frequent than microbial-associated intra-amniotic inflammation [10.4% (24/231) vs. 2.2% (5/231); p<0.001]. Patients with sterile intra-amniotic inflammation had a significantly higher rate of spontaneous preterm delivery <34 weeks of gestation [70.8% (17/24) vs. 31.6% (55/174); p<0.001] and a significantly shorter amniocentesis-to-delivery interval than patients without intra-amniotic inflammation [median 35, (IQR: 10 – 70) vs. median 71, (IQR: 47 – 98) days, (p<0.0001)]. Conclusion Sterile intra-amniotic inflammation is more common than microbial-associated intra-amniotic inflammation in asymptomatic women with a sonographic short cervix, and is associated with increased risk of spontaneous preterm delivery (<34 weeks). Further investigation is required to determine the causes of sterile intra-amniotic inflammation and the mechanisms whereby this condition is associated with a short cervix and spontaneous preterm delivery.

show abstract

Section: Discussionmentioning

confidence: 99%

Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance

Romero

Miranda

Chaiworapongsa

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

Self Cite

156

122

View full text Add to dashboard Cite

show abstract

“…While all pregnant women have microorganisms in the lower genital tract, most do not have intra-amniotic infection. The mucus plug represents an anatomical and functional barrier to ascending infection during pregnancy 69-75 . In the non-pregnant state, the endometrial cavity is not sterile 76-78 , but the decidua is thought to be sterile during pregnancy.…”

Section: Pathways Of Microbial Invasion Of the Amniotic Cavitymentioning

confidence: 99%

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

Kim

Romero

Chaemsaithong

et al. 2015

American Journal of Obstetrics and Gynecology

Self Cite

724

652

View full text Add to dashboard Cite

Acute inflammatory lesions of the placenta consist of diffuse infiltration of neutrophils at different sites in the organ. These lesions include acute chorioamnionitis, funisitis, and chorionic vasculitis, and represent a host response (maternal or fetal) to a chemotactic gradient in the amniotic cavity. While acute chorioamnionitis is evidence of a maternal host response, funisitis and chorionic vasculitis represent fetal inflammatory responses. Intra-amniotic infection has been generally considered to be the cause of acute histologic chorioamnionitis and funisitis; however, recent evidence indicates that “sterile” intra-amniotic inflammation, which occurs in the absence of demonstrable microorganisms but can be induced by “danger signals”, is frequently associated with these lesions. In the context of intra-amniotic infection, chemokines (such as interleukin-8 and granulocyte chemotactic protein) establish a gradient favoring the migration of neutrophils from maternal or fetal circulation into the chorioamniotic membranes or umbilical cord, respectively. Danger signals released during the course of cellular stress or cell death can also induce the release of neutrophil chemokines. The prevalence of chorioamnionitis is a function of gestational age at birth, and is present in 3-5% of placentas delivered at term, but in 94% of placentas delivered between 21-24 weeks of gestation. The frequency is higher in patients with spontaneous labor, preterm labor, clinical chorioamnionitis (preterm or term), or ruptured membranes. Funisitis and chorionic vasculitis are the hallmarks for the fetal inflammatory response syndrome, a condition characterized by an elevation in fetal plasma concentrations of interleukin-6, associated with the impending onset of preterm labor, a higher rate of neonatal morbidity (after adjustment for gestational age), and multi-organ fetal involvement. This syndrome is the counterpart of the systemic inflammatory response syndrome in adults; however, in fetuses, it is a risk factor for short- and long-term complications (i.e. neonatal sepsis, bronchopulmonary dysplasia, periventricular leukomalacia, and cerebral palsy). This article reviews the definition, pathogenesis, grading and staging, and clinical significance of the most common lesions in placental pathology. Illustrations of the lesions and diagrams of the mechanisms of disease are provided.

show abstract

“…However, this hypothesis was refuted, and recent research has shown microorganisms detected even in the endometrial cavity of healthy asymptomatic women . Furthermore, the uterine mucus plug has been shown to incompletely block bacterial ascension by vaginal bacteria . Additionally, particles can translocate from the vagina to the uterus through the cervical canal within minutes by the function of the uterine peristaltic pump .…”

Section: Etiologymentioning

confidence: 99%

“…[22][23][24][25] Furthermore, the uterine mucus plug has been shown to incompletely block bacterial ascension by vaginal bacteria. 26,27 Additionally, particles can translocate from the vagina to the uterus through the cervical canal within minutes by the function of the uterine peristaltic pump. 27,28 Thus, the existence of microorganisms in the uterus has come to be accepted, and they are thought to be a main cause of CE, since antibiotic treatment has been reported to be an effective therapy for CE.…”

Section: Concept Of Cementioning

confidence: 99%

Review: Chronic endometritis and its effect on reproduction

Kimura

Takebayashi

Ishida

et al. 2019

J of Obstet and Gynaecol

196

144

View full text Add to dashboard Cite

Aim Chronic endometritis (CE) is a disease of continuous and subtle inflammation characterized by the infiltration of plasma cells in the endometrial stromal area. Although the clinical significance of CE has been thought in clinical practice for a long time because it is either asymptomatic or presents with subtle symptoms, recent studies have shown the potential adverse effects of CE on fertility. In the present review, we focus on the concept, diagnosis, etiology, pathophysiology, diagnosis, impact on reproduction and treatment for it to understand CE. Methods The published articles were reviewed. Results The prevalence of CE has been found to be 2.8–56.8% in infertile women, 14–67.5% in women with recurrent implantation failure (RIF), and 9.3–67.6% in women with recurrent pregnancy loss. Microorganisms are thought to be a main cause of CE, since antibiotic treatment has been reported to be an effective therapy for CE. Common bacteria are frequently detected in the uterine cavity of CE patients by microbial culture. In CE endometrium, the prevalence of immune cells and decidualization has been reported to be modified, and these modifications are thought to adversely affect fertility. The gold standard for the diagnosis of CE is the histological detection of plasma cells in the stromal area of the endometrium in endometrial specimens, although universally accepted criteria for the diagnosis of CE have not been determined. The treatment currently thought to be most effective for the recovery of fertility in CE is administration of oral antibiotics. Patients whose CE has been cured have been reported to have a higher ongoing pregnancy rate, clinical pregnancy rate, and implantation rate compared with patients with persistent CE. Conclusion CE greatly affects implantation and impairs fertility. Antibiotic administration is an effective therapeutic option. Pregnancy rate in in vitro fertilization is improved when CE is cured by antibiotic.

show abstract

The cervical mucus plug inhibits, but does not block, the passage of ascending bacteria from the vagina during pregnancy

Cited by 72 publications

References 27 publications

Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance

Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

Review: Chronic endometritis and its effect on reproduction

Contact Info

Product

Resources

About