The frequency of microbial invasion of the amniotic cavity and histologic chorioamnionitis in women at term with intact membranes in the presence or absence of labor

Abstract

Objective The amniotic cavity is normally sterile for bacteria. However, experimental evidence indicates that regular uterine contractions exert a suction-like effect whereby vaginal fluid ascends into the uterine cavity with contractions (demonstrated by sonohysterography contrast media). Consequently, this study was conducted to determine whether the presence and progress of labor are associated with an increased risk of microbial invasion of the amniotic cavity (MIAC), intraamniotic inflammation, and histologic chorioamnionitis in women with term pregnancies with intact membranes. Study Design Amniotic fluid (AF) was obtained from term singleton pregnant women with intact membranes at the time of cesarean delivery. AF was cultured for aerobic and anaerobic bacteria and genital mycoplasma, and white blood cell (WBC) count was determined. Patients were divided into 3 groups according to the presence or absence of labor and the progress of labor. Nonparametric statistics were used for analysis. Results Results included: (1) a total of 884 pregnant women were enrolled and divided into 3 groups: group 1, not in labor (n = 775); group 2, in early labor (cervical dilatation less than 3 cm) (n = 86); and group 3, in active labor (Cervical dilatation 4 cm or greater) (n = 23); (2) the frequency of MIAC was 1% (6 of 775) in women not in labor, 3.5% (3 of 86) in patients with early labor, and 13% (3 of 23) in patients with active labor; and (3) the median AF WBC count and the frequency of histologic chorioamnionitis were also higher in the presence of labor than in the absence of labor. Conclusion We came to the following conclusions: (1) labor is associated with an increased risk of MIAC, a higher median AF WBC count, and histologic chorioamnionitis in term pregnancy with intact membranes; (2) the more advanced the cervical dilatation, the greater the risk of MIAC, a higher median AF WBC count, and histologic chorioamnionitis; and (3) in contrast, fetal inflammation (funisitis) did not increase with the presence of labor or as a function of cervical dilatation. We propose that labor predisposes to MIAC, a higher median AF WBC count, and histologic chorioamnionitis.

The Human Ureaplasma Species as Causative Agents of Chorioamnionitis

“…More recently, Stoll et al (30) demonstrated that histological chorioamnionitis was present in 70% (295/421) of pregnancies that delivered at 22 weeks of gestation. The frequency of histological chorioamnionitis was significantly higher in women who delivered after the spontaneous onset of labor than in those who had induction of labor at term or delivered via Caesarean section in the absence of labor (33,34). Furthermore, the frequency of histological chorioamnionitis increases in patients with prolonged duration of labor (35) and premature rupture of membranes (36).…”

First molecular evidence of intrauterine and surgical-site infections caused by Streptococcus dysgalactiae subsp. equisimilis

“…Additionally, the molecular characteristics and AST results of the isolates from different specimens revealed 100% consistency, and the three isolates belonged to a new sequence typing. Furthermore, in our case, the fetal membrane was found intact before Csection, which might be explained by the ability of the microorganism to cross the intact membranes [13][14][15]. Despite the fact that SDSE has been rarely documented either to colonize the vaginal tract or as a cause of maternal infections [19], this case suggests that SDSE colonized in the lower genital tract may be a potential, if rare, cause of maternal IAI via the ascending route during pregnancy.…”

“…The organisms frequently found in IAI and SSI after cesarean section are those normally present in the lower genital tract, indicating that the lower genital tract is the most likely reservoir for causative microorganisms for maternal infections via the ascending pathway under the appropriate circumstances [13][14][15][16]. SDSE, increasingly recognized as an important human pathogen, is a group C or G pyogenic β-hemolytic streptococcus sharing similar virulence factors and disease spectrum with GAS [17].…”

Avaliação clínica e microbiológica em puérperas com doença periodontal e a sua relação com desfecho reprodutivo ruim.

“…Diante disso, tem sido ressaltada a existência de uma relação positiva entre a vaginose bacteriana e o parto prematuro, alertando para a necessidade do tratamento dessa doença tanto na presença de vaginose sintomática quanto na presença de vaginose sem sintomas (Chaim et al,1997 (Seong et al, 2008).…”

“…Inflamação intra-amniótica é encontrada em aproximadamente 40% dos pacientes com PPROM e é um fator de risco para parto prematuro e gestação e desfecho neonatal adversos, com a comprovação ou não da infecção microbiana do líquido amniótico através de técnicas de cultura (Lee et al, 2007;Park et al, 2009Seong et al, 2008. O ataque microbiano ao feto tem lugar em aproximadamente 10% das gestações com infecção intra-aminótica, e o feto humano é capaz de deflagrar uma resposta inflamatória (celular e humoral) no trimestre médio da gestação (Romero et al, 2007a).…”