1
|
Xu L, Yang T, Wen M, Wen D, Jin C, An M, Wang L, Liu Y, Fan J. Frontiers in the Etiology and Treatment of Preterm Premature Rupture of Membrane: From Molecular Mechanisms to Innovative Therapeutic Strategies. Reprod Sci 2024; 31:917-931. [PMID: 37989803 DOI: 10.1007/s43032-023-01411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023]
Abstract
Preterm premature rupture of membranes (pPROM) poses a significant threat to fetal viability and increases the risk for newborn morbidities. The perinatal period of preterm infants affected by pPROM is often characterized by higher rates of mortality and morbidity, with associated risks of cerebral palsy, developmental delays, compromised immune function, respiratory diseases, and sensory impairments. pPROM is believed to result from a variety of causes, including but not limited to microbially induced infections, stretching of fetal membranes, oxidative stress, inflammatory responses, and age-related changes in the fetal-placental interface. Maternal stress, nutritional deficiencies, and medically induced procedures such as fetoscopy are also considered potential contributing factors to pPROM. This comprehensive review explores the potential etiologies leading to pPROM, delves into the intricate molecular mechanisms through which these etiologies cause membrane ruptures, and provides a concise overview of diagnostic and treatment approaches for pPROM. Based on available therapeutic options, this review proposes and explores the possibilities of utilizing a novel composite hydrogel composed of amniotic membrane particles for repairing ruptured fetal membranes, thereby holding promise for its clinical application.
Collapse
Affiliation(s)
- Ludan Xu
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Tiantian Yang
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Meiling Wen
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
- Research Center for Nanobiomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Dawei Wen
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Chaoyang Jin
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Meiwen An
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Li Wang
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China
| | - Yang Liu
- Institute of Biomedical Engineering, College of Biomedical Engineering, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi, China.
- Research Center for Nanobiomaterials & Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, Shanxi, China.
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Junmei Fan
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China.
| |
Collapse
|
2
|
Carter SWD, Neubronner S, Su LL, Dashraath P, Mattar C, Illanes SE, Choolani MA, Kemp MW. Chorioamnionitis: An Update on Diagnostic Evaluation. Biomedicines 2023; 11:2922. [PMID: 38001923 PMCID: PMC10669668 DOI: 10.3390/biomedicines11112922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Chorioamnionitis remains a major cause of preterm birth and maternal and neonatal morbidity. We reviewed the current evidence for the diagnostic tests of chorioamnionitis and how this relates to clinical practice today. A comprehensive literature search and review was conducted on chorioamnionitis and intra-uterine inflammation. Data from randomized control trials and systematic reviews were prioritized. This review highlights that sterile inflammation plays an important role in chorioamnionitis and that the current tests for chorioamnionitis including clinical criteria, maternal plasma and vaginal biomarkers lack diagnostic accuracy. Concerningly, these tests often rely on detecting an inflammatory response after damage has occurred to the fetus. Care should be taken when interpreting current investigations for the diagnosis of chorioamnionitis and how they guide obstetric/neonatal management. There is an urgent need for further validation of current diagnostic tests and the development of novel, accurate, minimally invasive tests that detect subclinical intra-uterine inflammation.
Collapse
Affiliation(s)
- Sean W D Carter
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Samantha Neubronner
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Lin Lin Su
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Pradip Dashraath
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Citra Mattar
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Sebastián E Illanes
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Center for Biomedical Research and Innovation, Reproductive Biology Program, Universidad de los Andes, Santiago 111711, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago 8331150, Chile
| | - Mahesh A Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Matthew W Kemp
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, WA 6008, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai 980-8574, Japan
| |
Collapse
|
3
|
Garg A, Jaiswal A. Evaluation and Management of Premature Rupture of Membranes: A Review Article. Cureus 2023; 15:e36615. [PMID: 37155446 PMCID: PMC10122752 DOI: 10.7759/cureus.36615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/24/2023] [Indexed: 05/10/2023] Open
Abstract
Premature rupture of membranes (PROM), now also referred to as "pre-labour rupture of membranes," is the rupture of gestational membranes after 37 weeks but before the process of labour begins. When membrane rupture occurs before 37 weeks of gestation, it is referred to as preterm PROM (PPROM). Prematurity is held accountable for the majority of newborn morbidity and mortality. PROM causes around one-third of all preterm deliveries and complicates 3% of pregnancies. Significant morbidity and mortality rates have been associated with PROM. Preterm (PROM) pregnancies are more difficult to manage. Pre-labour rupture of membranes is characterised by its short latency, higher intrauterine infection risk, and greater umbilical cord compression probability. Women with preterm PROM are more likely to develop chorioamnionitis and placental abruption. Various diagnostic modalities include sterile speculum examination, the nitrazine test, the ferning test, and the latest advances, which are the Amnisure test and the Actim test. Despite all these tests, there is still a need for newer, non-invasive, rapid, and accurate tests. Admission to a hospital, amniocentesis to rule out infection, and, if necessary, prenatal corticosteroids and broad-spectrum antibiotics are all alternatives for treatment. As a result, the clinician managing a pregnant woman whose pregnancy has been affected by PROM plays a crucial role in the management and must be well aware of probable complications and control measures to reduce risks and increase the likelihood of the required outcome. PROM's proclivity for recurrence in later pregnancies provides a chance for prevention. Furthermore, prenatal and neonatal care developments will continue to enhance the outcomes of women and their children. The purpose of this article is to summarise the concepts related to the evaluation and management of PROM.
Collapse
Affiliation(s)
- Aditi Garg
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Arpita Jaiswal
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| |
Collapse
|
4
|
Abebe TA, Nima DD, Mariye YF, Leminie AA. Determinants for perinatal adverse outcomes among pregnant women with preterm premature rupture of membrane: A prospective cohort study. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:1052827. [PMID: 36589699 PMCID: PMC9797823 DOI: 10.3389/frph.2022.1052827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022] Open
Abstract
Background One of the most critical functions of the fetal membranes is to remain intact until the onset of labor to maintain the protective intrauterine fluid environment. In most pregnancies, spontaneous rupture usually occurs near the end of the first stage of labor. Preterm premature membrane rupture (PROM) occurs when the fetal membrane ruptures before 37 weeks of pregnancy, and it contributes to adverse maternal, fetal, and neonatal outcomes. Therefore, this study aimed to determine the association of determinant factors with adverse perinatal outcomes. Methods A prospective cohort study was conducted on pregnant women with preterm premature membrane rupture (n = 160) attending the teaching hospitals at Addis Ababa University. Socio-demographic and obstetric risk factors with adverse perinatal outcomes include the 5th minute Apgar score, neonatal intensive care unit (NICU) admission, early-onset neonatal sepsis (EONS), respiratory distress syndrome (RDS), perinatal mortality, Chorioamnionitis, and placental abruption were assessed. SPSS version 24, t-test, χ 2 test, and logistic regression analysis were used. P-values <0.25 in the bivariate and p < 0.05 in the multiple logistic regression were considered statistically significant. Results The preterm (PROM) rate was 2.2% with perinatal mortality rate of 206/1,000. Gestational age (GA) at delivery was the determinate for low Apgar score at the 5th minute (AOR: 7.23; 95% CI, 1.10, 47.6; p = 0.04). Unable to use steroid (AOR: 8.23; 95% CI, 1.83, 37.0; p = 0.000), GA at membrane rupture (AOR: 4.61; 95% CI, 1.98, 31.8; p = 0.000) and delivery (AOR: 4.32; 95% CI, 1.99, 30.9; p = 0.000) were determinates for NICU admission. EONS was significantly affected by GA at membrane rupture (AOR: 5.9; 95% CI, 1.01, 37.0; p = 0.04). Placental abruption was significantly affected by GA at delivery (AOR: 7.52; 95% CI, 1.15, 48.96; p = 0.04). Conclusion GA at membrane rupture and delivery was the most critical predictors of adverse perinatal outcomes. Local guidelines on the approach and preterm PROM outcome management need to be prepared.
Collapse
Affiliation(s)
- Tariku Abewa Abebe
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dawit Desalegn Nima
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yitbarek Fantahun Mariye
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaye Aragaw Leminie
- Department of Medical Physiology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia,Correspondence: Abebaye Aragaw Leminie
| |
Collapse
|
5
|
Galectin-1 and Galectin-9 Concentration in Maternal Serum: Implications in Pregnancies Complicated with Preterm Prelabor Rupture of Membranes. J Clin Med 2022; 11:jcm11216330. [PMID: 36362558 PMCID: PMC9658671 DOI: 10.3390/jcm11216330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 11/30/2022] Open
Abstract
Preterm prelabor rupture of membranes (pPROM) accounts for nearly half of premature births. Although several risk factors have been identified, no markers allowing for effective prevention have been discovered. In this study, we investigated how the maternal serum levels of galectin-1 and galectin-9 change in patients with pPROM in comparison to uncomplicated pregnancies. A total of 75 patients were enrolled to both study and control group (37 vs. 38, respectively). The serum concentration of galectin-1 and galectin-9 were assayed in duplicate using an enzyme-linked immunoassay. All analyses were performed using PQ Stat v. 1.8.4 software. Galectin-1 levels were significantly higher in the controls (13.32 vs. 14.71 ng/mL, p = 0.02). Galectin-9 levels were similar in both groups (13.31 vs. 14.76 ng/mL, p = 0.30). Lower galectin levels were detected for early pPROM (before 32nd GW) in comparison to late pPROM and the controls (8.85 vs. 14.45 vs. 14.71 ng/mL, p = 0.0004). Similar trend was observed in galectin-9 levels, although no statistical significance was found (11.57 vs. 14.25 vs. 14.76 ng/mL, p = 0.26). Low galectin-1 maternal serum level is associated with the incidence of preterm prelabor rupture of membranes. Galectin-9 maternal serum levels were not significantly correlated with pPROM. However, in order to investigate gal-1 and gal-9 levels as potential, promising markers of pPROM, further clinical studies on larger groups are required.
Collapse
|
6
|
Chen M, Shi JL, Zheng ZM, Lin Z, Li MQ, Shao J. Galectins: Important Regulators in Normal and Pathologic Pregnancies. Int J Mol Sci 2022; 23:ijms231710110. [PMID: 36077508 PMCID: PMC9456357 DOI: 10.3390/ijms231710110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Galectins (Gal) are characterized by their affinity for galactoside structures on glycoconjugates. This relationship is mediated by carbohydrate recognition domains, which are multifunctional regulators of basic cellular biological processes with high structural similarity among family members. They participate in both innate and adaptive immune responses, as well as in reproductive immunology. Recently, the discovery that galectins are highly expressed at the maternal–fetal interface has garnerd the interest of experts in human reproduction. Galectins are involved in a variety of functions such as maternal–fetal immune tolerance, angiogenesis, trophoblast invasion and placental development and are considered to be important mediators of successful embryo implantation and during pregnancy. Dysregulation of these galectins is associated with abnormal and pathological pregnancies (e.g., preeclampsia, gestational diabetes mellitus, fetal growth restriction, preterm birth). Our work reviews the regulatory mechanisms of galectins in normal and pathological pregnancies and has implications for clinicians in the prevention, diagnosis and treatment of pregnancy-related diseases.
Collapse
Affiliation(s)
- Min Chen
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai 200080, China
| | - Jia-Lu Shi
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai 200080, China
| | - Zi-Meng Zheng
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai 200080, China
| | - Zhi Lin
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai 200080, China
| | - Ming-Qing Li
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai 200080, China
- NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Fudan University, Shanghai 201203, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, China
- Correspondence: (M.-Q.L.); (J.S.)
| | - Jun Shao
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai 200080, China
- Department of Obstetrics, Hospital of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai 200011, China
- Correspondence: (M.-Q.L.); (J.S.)
| |
Collapse
|
7
|
Talbert JA, Lu J, Spicer SK, Moore RE, Townsend SD, Gaddy JA. Ameliorating Adverse Perinatal Outcomes with Lactoferrin: An Intriguing Chemotherapeutic Intervention. Bioorg Med Chem 2022; 74:117037. [DOI: 10.1016/j.bmc.2022.117037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/26/2022]
|
8
|
Ölmez F, Oğlak SC, Can E. The Implication of Aquaporin-9 in the Pathogenesis of Preterm Premature Rupture of Membranes. Z Geburtshilfe Neonatol 2022; 226:233-239. [PMID: 35508193 DOI: 10.1055/a-1808-1614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to detect aquaporin-9 (AQP9) concentrations in the serum of patients with preterm premature rupture of membranes (PPROM) and compare them with the healthy control group with intact membranes. MATERIAL AND METHODS We conducted this prospective case-control study from January 2020 to June 2020. Of the 80 pregnant patients included in the study, we enrolled 42 singleton pregnant patients with PPROM as the study group and 43 healthy gestational age-, and body mass index (BMI)-matched healthy pregnant women with intact fetal membranes as the control group. We compared demographic and clinical characteristics, complete blood count and biochemical parameters, and serum AQP9 concentrations of the participants. We constructed an ROC curve to illustrate the sensitivity and specificity performance characteristics of AQP9 and calculated a cutoff value by using the Youden index. RESULTS Maternal serum AQP-9 concentrations were significantly higher in patients with PPROM (804.46±195.63 pg/mL) compared to the healthy pregnant women in the control group (505.97±68.89 pg/mL, p<0.001). When we examine the area under the ROC curve (AUC), the AQP-9 value can be reflected as a statistically significant parameter for diagnosing PPROM. According to the Youden index, a 654.78 pg/mL cut-off value of AQP-9 can be utilized to diagnose PPROM with 80.5% sensitivity and 100% specificity. CONCLUSION Maternal serum AQP9 concentrations were significantly higher in PPROM patients than healthy pregnant women with an intact membrane. We suggest that AQP9 might be an essential biomarker of the inflammatory process and energy homeostasis in PPROM.
Collapse
Affiliation(s)
- Fatma Ölmez
- Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Cemil Oğlak
- Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Esra Can
- Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Neonatal sepsis definitions from randomised clinical trials. Pediatr Res 2021; 93:1141-1148. [PMID: 34743180 PMCID: PMC10132965 DOI: 10.1038/s41390-021-01749-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Neonatal sepsis is a leading cause of infant mortality worldwide with non-specific and varied presentation. We aimed to catalogue the current definitions of neonatal sepsis in published randomised controlled trials (RCTs). METHOD A systematic search of the Embase and Cochrane databases was performed for RCTs which explicitly stated a definition for neonatal sepsis. Definitions were sub-divided into five primary criteria for infection (culture, laboratory findings, clinical signs, radiological evidence and risk factors) and stratified by qualifiers (early/late-onset and likelihood of sepsis). RESULTS Of 668 papers screened, 80 RCTs were included and 128 individual definitions identified. The single most common definition was neonatal sepsis defined by blood culture alone (n = 35), followed by culture and clinical signs (n = 29), and then laboratory tests/clinical signs (n = 25). Blood culture featured in 83 definitions, laboratory testing featured in 48 definitions while clinical signs and radiology featured in 80 and 8 definitions, respectively. DISCUSSION A diverse range of definitions of neonatal sepsis are used and based on microbiological culture, laboratory tests and clinical signs in contrast to adult and paediatric sepsis which use organ dysfunction. An international consensus-based definition of neonatal sepsis could allow meta-analysis and translate results to improve outcomes.
Collapse
|
10
|
Jiang H, Lu C, Zhou J, Zhang W. Cesarean section and pregnancy outcomes of preterm premature rupture of membranes under different fertility policies in China. Transl Pediatr 2021; 10:973-983. [PMID: 34012845 PMCID: PMC8107868 DOI: 10.21037/tp-21-144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The aim of the present study was to compare the outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) in China. METHODS The present study was a single-center retrospective study of women admitted to Beijing Obstetrics and Gynecology Hospital in 2012, 2014, and 2017. Deliveries at <24 and >37 weeks, fatal deformities, stillbirths, and multiple pregnancies were excluded. Pregnancies were divided into 24-27+6, 28-33+6, and 34-36+6 weeks according to weeks of gestation in each year. In total, 1,178 pregnancies complicated by PPROM were analyzed in terms of incidence rate, risk factors, delivery mode, and neonatal outcomes. RESULTS The rate of PPROM was 3.11% in 2012, 2.35% in 2014, and 2.4% in 2017; the difference was significant (P<0.001). Age [odds ratio (OR): 1.046, P<0.001], intrauterine infection (OR: 2.087, P=0.007), and vaginitis (OR: 1.812, P=0.039) were risk factors for PPROM. In all 3 years, patients with PPROM tended to choose vaginal delivery rather than cesarean section (CS) delivery (68.9% in 2012, P<0.001; 76.5% in 2014, P<0.001; 69.3% in 2017, P<0.001), and the rate of vaginal deliveries in 2014 was higher than that in 2012 and 2017 (P=0.027). Indications for PPROM at 34-36+6 weeks varied significantly among the 3 years (P<0.001). No significant difference was found in body weight, body length, and Apgar score at 1, 5, and 10 min; however, there was a significant difference in Apgar score after 1 min at 28-33+6 weeks (P=0.012). CONCLUSIONS The incidence rate of PPROM at our single center varied between 2012, 2014, and 2017. Risk factors for pregnancies complicated by PPROM include age, intrauterine infection, and vaginitis. The rate of CS delivery varied, and breech/transverse presentation was the major indication for patients with PPROM at 34-36+6 weeks.
Collapse
Affiliation(s)
- Haili Jiang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chang Lu
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jianxin Zhou
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Weiyuan Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
11
|
Saito-Abe M, Yamamoto-Hanada K, Pak K, Sato M, Irahara M, Mezawa H, Sasaki H, Nishizato M, Ishitsuka K, Konishi M, Yang L, Ohya Y, Suzuki K. Association of Maternal History of Allergic Features with Preterm Pregnancy Outcomes in the Japan Environment and Children's Study. Int Arch Allergy Immunol 2021; 182:650-662. [PMID: 33601376 DOI: 10.1159/000513749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/14/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Previous studies have reported that maternal asthma increases the risk of preterm birth. We hypothesized that inflammatory reactions caused by allergic diseases might affect the uterine environment and, subsequently, perinatal outcomes. The objective of this study was to examine the associations between allergic features among mothers and preterm pregnancy outcomes in a nationwide birth cohort. METHODS We analyzed data from pregnant women obtained from the Japanese Environment and Children's Study (JECS), a nationwide general birth cohort study. We used binomial and multinomial logistic regression models to examine the associations between maternal allergic features and preterm birth, threatened preterm labor (TPL), and preterm premature rupture of the membrane (PPROM). RESULTS A total of 97,683 pregnant women were included. Prevalence of preterm birth, TPL, and PPROM was 4.7, 19.6, and 1.2%, respectively. Maternal history of allergic diseases (asthma, allergic rhinitis, allergic conjunctivitis, food allergy, drug allergy, and contact dermatitis) increased the risk of TPL(adjusted odds ratio [aOR] = 1.11 [95% CI: 1.06-1.17], aOR = 1.12 [1.08-1.16], aOR = 1.10 [1.04-1.16], aOR = 1.17 [1.09-1.26], aOR = 1.35 [1.23-1.48], and aOR = 1.34 [1.20-1.49], respectively). Although some maternal allergic features showed a negative association with preterm birth, the variables affecting preterm birth differed according to the gestational age of the fetus (22-33 weeks vs. 34-36 weeks). There were no significant associations between maternal allergic features and PPROM. CONCLUSION Maternal allergic disease, except atopic dermatitis, may increase the risk of TPL. Comorbidity of maternal allergic disorders and perinatal adverse outcomes require further investigation.
Collapse
Affiliation(s)
- Mayko Saito-Abe
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan, .,Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan,
| | - Kiwako Yamamoto-Hanada
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kyongsun Pak
- Division of Biostatistics, Department of Data Management, Center for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan.,Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Makoto Irahara
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Hidetoshi Mezawa
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Hatoko Sasaki
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Minaho Nishizato
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kazue Ishitsuka
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Mizuho Konishi
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Limin Yang
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | | |
Collapse
|
12
|
Tanacan A, Uyanik E, Unal C, Beksac MS. A cut-off value for systemic immune-inflammation index in the prediction of adverse neonatal outcomes in preterm premature rupture of the membranes. J Obstet Gynaecol Res 2020; 46:1333-1341. [PMID: 32483902 DOI: 10.1111/jog.14320] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/09/2020] [Accepted: 05/08/2020] [Indexed: 01/30/2023]
Abstract
AIM To determine a cut-off value for systemic immune-inflammation index (SII)(neutrophil × platelet /lymphocyte) in the prediction of adverse neonatal outcomes in preterm premature rupture of the membranes (PPROM). METHODS This retrospective cohort study was conducted among singleton pregnancies with PPROM. Cases were divided into two main groups: Group 1) PPROM diagnosed at 24th-28th weeks of gestation and Group 2) PPROM diagnosed at >28th-34th weeks of gestation. Thereafter, main study groups were divided into two subgroups: Subgroup A: pregnancies with favorable neonatal outcomes and Subgroup B: pregnancies with composite adverse neonatal outcomes. Subgroups were compared in terms of demographic features, clinical characteristics, laboratory test results and SII values. Furthermore, cut-off values of SII for the prediction of composite adverse neonatal outcomes were determined for two main groups. A Mann-Whitney U test was conducted to compare the median values and the chi-square test was used to compare categorical variables among the groups. Receiver operating characteristic (ROC) curves were used to assess the performance of SII value in predicting composite adverse neonatal outcomes. RESULTS Significant differences were observed for median platelet and SII values between the subgroups (P < 0.001 for both in group 1 and P = 0.002 and P = 0.005, respectively, in group 2). Cut-off values of 1695.14 109 /L (83.3% sensitivity, 85.7% specificity) and 1430.90 × 109 /L (71.4% sensitivity, 75.7% specificity) for composite adverse neonatal outcomes were determined, respectively in group 1 and 2 according to the ROC curve analysis. CONCLUSION SII may be used as an additional indicator for the prediction of adverse neonatal outcomes in PPROM.
Collapse
Affiliation(s)
- Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Esra Uyanik
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| |
Collapse
|
13
|
Chatzakis C, Papatheodorou S, Sarafidis K, Dinas K, Makrydimas G, Sotiriadis A. Effect on perinatal outcome of prophylactic antibiotics in preterm prelabor rupture of membranes: network meta-analysis of randomized controlled trials. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:20-31. [PMID: 31633844 DOI: 10.1002/uog.21884] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Prophylactic antibiotics are recommended routinely for preterm prelabor rupture of membranes (PPROM), but there is an abundance of potential treatments and a paucity of comparative information. The aims of this network meta-analysis were to compare the efficiency of different antibiotic regimens on perinatal outcomes and to assess the quality of the current evidence. METHODS This was a network meta-analysis of randomized controlled trials comparing prophylactic antibiotics, or regimens of antibiotics, with each other or with placebo/no treatment, in women with PPROM. MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, US Registry of Clinical Trials ( www.ClinicalTrials.gov) and gray literature sources were searched. The primary outcomes were neonatal mortality and chorioamnionitis; secondary outcomes included other measures of perinatal morbidity. Relative effect sizes were estimated using risk ratios (RR) and the relative ranking of the interventions was obtained using cumulative ranking curves. The quality of evidence for the primary outcomes was assessed according to GRADE guidelines, adapted for network meta-analysis. RESULTS The analysis included 20 studies (7169 participants randomized to 15 therapeutic regimens). For the outcome of chorioamnionitis, clindamycin + gentamycin (network RR, 0.19 (95% CI, 0.05-0.83)), penicillin (RR, 0.31 (95% CI, 0.16-0.6)), ampicillin/sulbactam + amoxicillin/clavulanic acid (RR, 0.32 (95% CI, 0.12-0.92)), ampicillin (RR, 0.52 (95% CI, 0.34-0.81)) and erythromycin + ampicillin + amoxicillin (RR, 0.71 (95% CI, 0.55-0.92)) were superior to placebo/no treatment. Erythromycin was the only effective drug for neonatal sepsis (RR, 0.74 (95% CI, 0.56-0.97)). Clindamycin + gentamycin (RR, 0.32 (95% CI, 0.11-0.89)) and erythromycin + ampicillin + amoxicillin (RR, 0.83 (95% CI, 0.69-0.99)) were the only effective regimens for respiratory distress syndrome, whereas ampicillin (RR, 0.42 (95% CI, 0.20-0.92)) and penicillin (RR, 0.49 (95% CI, 0.25-0.96)) were effective in reducing the rates of Grade-3/4 intraventricular hemorrhage. None of the antibiotics appeared significantly more effective than placebo/no treatment in reducing the rates of neonatal death, perinatal death and necrotizing enterocolitis. No network RR could be estimated for neonatal intensive care unit admission. The overall quality of the evidence, according to GRADE guidelines, was moderate to very low, depending on the outcome and comparison. CONCLUSIONS Several antibiotics appear to be more effective than placebo/no treatment in reducing the rate of chorioamnionitis after PPROM. However, none of them is clearly and consistently superior compared to other antibiotics, and most are not superior to placebo/no treatment for other outcomes. The overall quality of the evidence is low and needs to be updated, as microbial resistance may have emerged for some antibiotics, while others are underrepresented in the existing evidence. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- C Chatzakis
- 2nd Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Papatheodorou
- Harvard TH Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - K Sarafidis
- 1st Department of Neonatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Dinas
- 2nd Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Makrydimas
- Department of Obstetrics and Gynaecology, University of Ioannina Medical School, Ioannina, Greece
| | - A Sotiriadis
- 2nd Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
14
|
Menon R, Moore JJ. Fetal Membranes, Not a Mere Appendage of the Placenta, but a Critical Part of the Fetal-Maternal Interface Controlling Parturition. Obstet Gynecol Clin North Am 2019; 47:147-162. [PMID: 32008665 DOI: 10.1016/j.ogc.2019.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Fetal membranes (FMs) play a role in pregnancy maintenance and promoting parturition at term. The FMs are not just part of the placenta, structurally or functionally. Although attached to the placenta, the amnion has a separate embryologic origin, and the chorion deviates from the placenta by the first month of pregnancy. Other than immune protection, these FM functions are not those of the placenta. FM dysfunction is associated with and may cause adverse pregnancy outcomes. Ongoing research may identify biomarkers for pending preterm premature rupture of the FMs as well as therapeutic agents, to prevent it and resulting preterm birth.
Collapse
Affiliation(s)
- Ramkumar Menon
- Department of Obstetrics and Gynecology, Perinatal Research Division, The University of Texas Medical Branch, MRB 11.138, 301 University Boulevard, Galveston, TX 77555, USA
| | - John J Moore
- Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
| |
Collapse
|
15
|
Janku P, Kacerovsky M, Zednikova B, Andrys C, Kolackova M, Drahosova M, Pliskova L, Zemlickova H, Gerychova R, Simetka O, Matlak P, Jacobsson B, Musilova I. Pentraxin 3 in Noninvasively Obtained Cervical Fluid Samples from Pregnancies Complicated by Preterm Prelabor Rupture of Membranes. Fetal Diagn Ther 2019; 46:402-410. [PMID: 31071711 DOI: 10.1159/000499482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/07/2019] [Indexed: 11/19/2022]
Abstract
PROBLEM To determine the changes of pentraxin 3 (PTX3) level in noninvasively obtained cervical fluid samples from women with preterm prelabor rupture of membranes (PPROM) based on the presence of microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI), and intra-amniotic infection (the presence of both MIAC and IAI). METHODS OF STUDY A total of 160 women with PPROM were included. Cervical fluid samples were obtained using a Dacron polyester swab and amniotic fluid samples were obtained by transabdominal amniocentesis. Cervical fluid PTX3 levels were assessed using enzyme-linked immunosorbent assay. RESULTS PTX3 was found in all the cervical fluid samples and its levels were higher in women with MIAC, IAI, and intra-amniotic infection than in women without these conditions. When the women were categorized into four subgroups based on the presence of MIAC and/or IAI, women with intra-amniotic infection had higher cervical fluid PTX3 levels than those with sterile IAI (IAI alone), colonization (MIAC alone), or no MIAC or IAI. A cervical fluid PTX3 level of 11 ng/mL was the best value for identifying the presence of intra-amniotic infection in women with PPROM. CONCLUSIONS PTX3 is a constituent of cervical fluid of women with PPROM. Cervical fluid PTX3 level reflects the situation in the intra-amniotic compartments of women with PPROM. Cervical fluid PTX3 is a potential marker for the noninvasive identification of intra-amniotic infection in PPROM.
Collapse
Affiliation(s)
- Petr Janku
- Department of Obstetrics and Gynecology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czechia
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czechia, .,Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czechia,
| | - Barbora Zednikova
- Department of Clinical Immunology and Allergy, Charles University Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | - Ctirad Andrys
- Department of Clinical Immunology and Allergy, Charles University Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | - Martina Kolackova
- Department of Clinical Immunology and Allergy, Charles University Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | - Marcela Drahosova
- Department of Clinical Immunology and Allergy, Charles University Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | - Lenka Pliskova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | - Helena Zemlickova
- Institute of Clinical Microbiology, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czechia
| | - Romana Gerychova
- Department of Obstetrics and Gynecology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czechia
| | - Ondrej Simetka
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Czechia
| | - Petr Matlak
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Czechia
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway
| | - Ivana Musilova
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czechia
| |
Collapse
|
16
|
Beucher G, Charlier C, Cazanave C. [Diagnosis and management of intra-uterine infection: CNGOF Preterm Premature Rupture of Membranes Guidelines]. ACTA ACUST UNITED AC 2018; 46:1054-1067. [PMID: 30389543 DOI: 10.1016/j.gofs.2018.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the diagnosis criteria and management of intra-uterine inflammation or infection (Triple I, III). METHODS PubMed and Cochrane Central databases search. RESULTS III is defined as an infection of the fetal membranes, and/or other components like the decidua, fetus, amniotic fluid or placenta. This word should be preferred to the word chorioamnionitis that is less precise (Professional consensus). III clinical signs exhibit poor limited sensibility and specificity (EL3). The diagnosis of III is retained in case of maternal fever (defined by a body temperature≥38°C) with no alternative cause identified and at least 2 signs among the following: fetal tachycardia>160 bpm for 10min or longer, uterine pain of labor, purulent fluid from the cervical canal (Professional consensus). Maternal hyperleukocytosis>20 giga/L in the absence of corticosteroids treatment or increased plasmatic C-reactive protein also argue for III, despite their limited sensibility and specificity (EL3). III requires prompt delivery (Grade A). III is not by itself an indication for cesarean delivery (Professional consensus). Antibiotic treatment should cover Streptococcus agalactiae and Escherichia coli. Antibiotics should be started immediately and maintained all over delivery, to reduce neonatal and maternal morbidity (Grade B). Treatment should rely on a combination of betalactamin and aminoglycoside (Grade B). After vaginal delivery, one single dose of antibiotic is required. Antibiotic duration should be longer in case of bacteremia. Longer duration could be considered in case of persistent fever or of cesarean delivery (Professional consensus).
Collapse
Affiliation(s)
- G Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - C Charlier
- Service des maladies infectieuses et tropicales, centre d'infectiologie Necker-Pasteur Institut IMAGINE, université Paris Descartes, hôpital Necker-Enfants-malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - C Cazanave
- Service des maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux, USC EA 3671, infections humaines à mycoplasmes et à chlamydiae, 33000 Bordeaux, France
| |
Collapse
|
17
|
Varrey A, Romero R, Panaitescu B, Miller D, Chaiworapongsa T, Patwardhan M, Faro J, Pacora P, Hassan SS, Hsu CD, Gomez-Lopez N. Human β-defensin-1: A natural antimicrobial peptide present in amniotic fluid that is increased in spontaneous preterm labor with intra-amniotic infection. Am J Reprod Immunol 2018; 80:e13031. [PMID: 30101464 DOI: 10.1111/aji.13031] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
PROBLEM Human β-defensins (HBDs) are antimicrobial peptides that participate in the soluble innate immune mechanisms against infection. Herein, we determined whether HBD-1 was present in amniotic fluid during normal pregnancy and whether its concentrations change with intra-amniotic inflammation and/or infection. METHOD OF STUDY Amniotic fluid was collected from 219 women in the following groups: (a) midtrimester who delivered at term (n = 35); (b) term with (n = 33) or without (n = 17) labor; (c) preterm labor with intact membranes who delivered at term (n = 29) or who delivered preterm with (n = 19) and without (n = 29) intra-amniotic inflammation and infection or with intra-amniotic inflammation but without infection (n = 21); and (d) preterm prelabor rupture of membranes (pPROM) with (n = 19) and without (n = 17) intra-amniotic inflammation/infection. Amniotic fluid HBD-1 concentrations were determined using a sensitive and specific ELISA kit. RESULTS (a) HBD-1 was detectable in all amniotic fluid samples; (b) amniotic fluid concentrations of HBD-1 were changed with gestational age (midtrimester vs term no labor), being higher in midtrimester; (c) amniotic fluid concentrations of HBD-1 were similar between women with and without spontaneous labor at term; (d) among patients with spontaneous preterm labor, amniotic fluid concentrations of HBD-1 in women with intra-amniotic inflammation/infection and in those with intra-amniotic inflammation without infection were greater than in women without intra-amniotic inflammation or infection who delivered preterm or at term; and (e) the presence of intra-amniotic inflammation and infection in patients with pPROM did not change amniotic fluid concentrations of HBD-1. CONCLUSION HBD-1 is a physiological constituent of amniotic fluid that is increased in midtrimester during normal pregnancy and in the presence of culturable microorganisms in the amniotic cavity. These findings provide insight into the soluble host defense mechanisms against intra-amniotic infection.
Collapse
Affiliation(s)
- Aneesha Varrey
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan.,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | - Bogdan Panaitescu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Derek Miller
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Manasi Patwardhan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Jonathan Faro
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Sonia S Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan.,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Chaur-Dong Hsu
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan.,Department of Immunology, Microbiology and Biochemistry, Wayne State University School of Medicine, Detroit, Michigan
| |
Collapse
|
18
|
Abstract
Preterm prelabor rupture of the membranes (pPROM) remains a significant obstetric problem that affects 3-4% of all pregnancies and precedes 40-50% of all preterm births. pPROM arises from complex, multifaceted pathways. In this review, we summarize some old concepts and introduce some novel theories related to pPROM pathophysiology. Specifically, we introduce the concept that pPROM is a disease of the fetal membranes where inflammation-oxidative stress axis plays a major role in producing pathways that can lead to membrane weakening through a variety of processes. In addition, we report microfractures in fetal membranes that are likely sites of tissue remodeling during gestation; however, increase in number and morphometry (width and depth) of these microfractures in pPROM membranes suggests reduced remodeling capacity of membranes. Microfractures can act as channels for amniotic fluid leak, and inflammatory cell and microbial migration. Further studies on senescence activation and microfracture formation and their role in maintaining membrane homeostasis are needed to fill the knowledge gaps in our understanding of pPROM as well as provide better screening (biomarker and imaging based) tools for predicting women at high risk for pPROM and subsequent preterm birth.
Collapse
Affiliation(s)
- Ramkumar Menon
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, 301 University Blvd, MRB, Room 11.138, Galveston, TX 77555-1062.
| | | |
Collapse
|
19
|
Kunze M, Klar M, Morfeld CA, Thorns B, Schild RL, Markfeld-Erol F, Rasenack R, Proempeler H, Hentschel R, Schaefer WR. Cytokines in noninvasively obtained amniotic fluid as predictors of fetal inflammatory response syndrome. Am J Obstet Gynecol 2016; 215:96.e1-8. [PMID: 26829512 DOI: 10.1016/j.ajog.2016.01.181] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/30/2015] [Accepted: 01/22/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND In patients with preterm premature rupture of membranes, intrauterine inflammation and/or infection is frequently present, can lead to fetal inflammatory response syndrome, and is associated with adverse neonatal outcome. Clinical decision making requires balancing the potential benefits of pregnancy prolongation against the risk of intrauterine infection. Diagnostic tests in maternal serum are of moderate prediction value and amniocentesis is an invasive procedure. Therefore, markers obtained noninvasively would be helpful in patients with expectant management. OBJECTIVES To determine the predictive values of amniotic fluid interleukin-6 and tumor necrosis factor-α in vaginal secretions for fetal inflammatory response syndrome and/or histologic funisitis and for adverse neonatal outcome in patients with preterm premature rupture of membranes. STUDY DESIGN In this prospective multicenter case-control study, vaginal secretions were sampled daily with a noninvasive method from 99 women with preterm premature rupture of membranes and expectant management. Amniotic fluid interleukin-6 and tumor necrosis factor-α were measured by 2 different immunoassays (an automated chemiluminescent enzyme immunoassay and a lateral flow immunoassay). After delivery, patients were divided into a control or a fetal inflammatory response syndrome group according to neonatal interleukin-6 in cord plasma and/or the presence of funisitis. Univariate and multivariate regression analyses were performed and prediction models were developed by calculating receiver operating characteristic curves. RESULTS Gestational age at delivery was lower and latency period was longer in the fetal inflammatory response syndrome group compared to the control group. The strongest risk factor for composite adverse neonatal outcome was fetal inflammatory response syndrome (odds ratio, 2.48; confidence interval, 1.40-4.38). The median concentrations of amniotic fluid interleukin-6 and tumor necrosis factor-α in vaginal secretions were significantly higher in the fetal inflammatory response group compared to the control group in both immunoassays (P < .001). The area under the curve of the clinical reference model (including common clinical parameters) was 0.66. Adding interleukin-6 and tumor necrosis factor-α into the model improved the area under the curve to 0.92 (in both assays, interleukin-6 IMMULITE and QuickLine); 0.87 (tumor necrosis factor-α IMMULITE) and 0.94 (tumor necrosis factor-α QuickLine), respectively. CONCLUSION The strongest risk factor for worse neonatal outcome (composite neonatal outcome) was fetal inflammatory response syndrome. Amniotic fluid interleukin-6 and tumor necrosis factor-α seem to be good predictors for fetal inflammatory response syndrome and for histologic funisitis and may improve the clinical management of patients with preterm premature rupture of membranes. The noninvasive technique of sampling amniotic fluid from vaginal secretions facilitates daily measurements and bedside assessment of cytokines and is in this respect preferable to invasive amniocentesis.
Collapse
Affiliation(s)
- Mirjam Kunze
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany.
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Christine A Morfeld
- Diakoniekrankenhaus Henriettenstiftung, Perinatalzentrum Hannover, Hannover, Germany
| | - Beena Thorns
- Diakoniekrankenhaus Henriettenstiftung, Perinatalzentrum Hannover, Hannover, Germany
| | - Ralf L Schild
- Diakoniekrankenhaus Henriettenstiftung, Perinatalzentrum Hannover, Hannover, Germany
| | - Filiz Markfeld-Erol
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Regina Rasenack
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Heinrich Proempeler
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Roland Hentschel
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Wolfgang R Schaefer
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany
| |
Collapse
|
20
|
Hallingström M, Lenco J, Vajrychova M, Link M, Tambor V, Liman V, Bullarbo M, Nilsson S, Tsiartas P, Cobo T, Kacerovsky M, Jacobsson B. Proteomic Analysis of Early Mid-Trimester Amniotic Fluid Does Not Predict Spontaneous Preterm Delivery. PLoS One 2016; 11:e0155164. [PMID: 27214132 PMCID: PMC4876998 DOI: 10.1371/journal.pone.0155164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 04/25/2016] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to identify early proteomic biomarkers of spontaneous preterm delivery (PTD) in mid-trimester amniotic fluid from asymptomatic women. Methods This is a case-cohort study. Amniotic fluid from mid-trimester genetic amniocentesis (14–19 weeks of gestation) was collected from 2008 to 2011. The analysis was conducted in 24 healthy women with subsequent spontaneous PTD (cases) and 40 randomly selected healthy women delivering at term (controls). An exploratory phase with proteomics analysis of pooled samples was followed by a verification phase with ELISA of individual case and control samples. Results The median (interquartile range (IQR: 25th; 75th percentiles) gestational age at delivery was 35+5 (33+6–36+6) weeks in women with spontaneous PTD and 40+0 (39+1–40+5) weeks in women who delivered at term. In the exploratory phase, the most pronounced differences were found in C-reactive protein (CRP) levels, that were approximately two-fold higher in the pooled case samples than in the pooled control samples. However, we could not verify these differences with ELISA. The median (25th; 75th IQR) CRP level was 95.2 ng/mL (64.3; 163.5) in women with spontaneous PTD and 86.0 ng/mL (51.2; 145.8) in women delivering at term (p = 0.37; t-test). Conclusions Proteomic analysis with mass spectrometry of mid-trimester amniotic fluid suggests CRP as a potential marker of spontaneous preterm delivery, but this prognostic potential was not verified with ELISA.
Collapse
Affiliation(s)
- Maria Hallingström
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Juraj Lenco
- Department of Molecular Pathology and Biology, Faculty of Military Health Sciences, University of Defense, Hradec Kralove, Czech Republic
| | - Marie Vajrychova
- Department of Molecular Pathology and Biology, Faculty of Military Health Sciences, University of Defense, Hradec Kralove, Czech Republic
| | - Marek Link
- Department of Molecular Pathology and Biology, Faculty of Military Health Sciences, University of Defense, Hradec Kralove, Czech Republic
| | - Vojtech Tambor
- Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Victor Liman
- Department of Neurochemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Bullarbo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Staffan Nilsson
- Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Panagiotis Tsiartas
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Teresa Cobo
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- BCNatal—Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, Institut d’Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centro de Investigaciones Biomedicas en Enfermedades Raras (CIBER-ER), Barcelona, Spain
| | - Marian Kacerovsky
- Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Area of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
| |
Collapse
|
21
|
Beneventi F, Locatelli E, De Amici M, Simonetta M, Cavagnoli C, Bellingeri C, Scancarello C, Ierullo A, Martinetti M, Spinillo A. Soluble HLA-G concentrations in maternal blood and cervical vaginal fluid of pregnant women with preterm premature rupture of membranes. J Reprod Immunol 2016; 116:76-80. [PMID: 27232355 DOI: 10.1016/j.jri.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/03/2016] [Accepted: 05/11/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate soluble HLA-G (sHLA-G) concentrations in maternal blood serum and cervical vaginal fluid in pregnancies complicated by preterm premature rupture of membranes (PPROM) compared to controls. STUDY DESIGN Case-control study of 24 women with PPROM and 40 controls. MAIN OUTCOME MEASURES Vaginal and serum sHLA-G and IL-6 concentrations. FINDINGS Women with PPROM had significantly higher serum and vaginal sHLA-G concentrations compared to controls (respectively median 31.48U\ml versus 13.9U\ml p<0.001 and 1.7U\ml versus 0.1U\ml p<0.001). Vaginal expression of IL-6 was higher in PPROM cases compared to controls (respectively, median 31.19pg\ml versus 6.67pg\ml; p<0.001). Higher serum and vaginal sHLA-G were associated with both a shorter length of pregnancy and histological chorioamnionitis in the PPROM group. CONCLUSIONS Higher vaginal and serum sHLA-G in PPROM cases may be a sign of local and systemic inflammation.
Collapse
Affiliation(s)
- Fausta Beneventi
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Elena Locatelli
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy.
| | - Mara De Amici
- Department of Pediatrics, University of Pavia, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Margherita Simonetta
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Camilla Bellingeri
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - AntonioMaria Ierullo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Miryam Martinetti
- Immunogenetics Laboratory, Immunohematology and Transfusion Center, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| |
Collapse
|
22
|
Chau A, Markley J, Juang J, Tsen L. Cytokines in the perinatal period – Part II. Int J Obstet Anesth 2016; 26:48-58. [DOI: 10.1016/j.ijoa.2015.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/28/2015] [Accepted: 12/22/2015] [Indexed: 11/29/2022]
|
23
|
Kim YD, Shim SS, Kang HS, Maeng YH. Clinical Significance of Newborn Gastric Inflammatory Mediators. NEONATAL MEDICINE 2016. [DOI: 10.5385/nm.2016.23.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Young Don Kim
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Soon Sup Shim
- Department of Obstetrics and Gynecology, Jeju National University School of Medicine, Jeju, Korea
| | - Hye Sim Kang
- Department of Obstetrics and Gynecology, Jeju National University School of Medicine, Jeju, Korea
| | - Young Hee Maeng
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
| |
Collapse
|
24
|
Lee J, Romero R, Kim SM, Chaemsaithong P, Yoon BH. A new antibiotic regimen treats and prevents intra-amniotic inflammation/infection in patients with preterm PROM. J Matern Fetal Neonatal Med 2015; 29:2727-37. [PMID: 26441216 DOI: 10.3109/14767058.2015.1103729] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To determine whether a new antibiotic regimen could reduce the frequency of intra-amniotic inflammation/infection in patients with preterm PROM. STUDY DESIGN This retrospective cohort study was conducted to evaluate the effect of antibiotics on the frequency of intra-amniotic inflammation/infection based on the results of follow-up transabdominal amniocenteses from 89 patients diagnosed with preterm PROM who underwent serial amniocenteses. From 1993-2003, ampicillin and/or cephalosporins or a combination was used ("regimen 1"). A new regimen (ceftriaxone, clarithromycin and metronidazole) was used from 2003-2012 ("regimen 2"). Amniotic fluid was cultured and matrix metalloproteinase-8 (MMP-8) concentrations were measured. RESULTS (1) The rates of intra-amniotic inflammation and intra-amniotic inflammation/infection in patients who received regimen 2 decreased during treatment from 68.8% to 52.1% and from 75% to 54.2%, respectively. In contrast, in patients who received regimen 1, the frequency of intra-amniotic inflammation and infection/inflammation increased during treatment (31.7% to 55% and 34.1% to 58.5%, respectively); and (2) intra-amniotic inflammation/infection was eradicated in 33.3% of patients who received regimen 2, but in none who received regimen 1. CONCLUSION The administration of ceftriaxone, clarithromycin and metronidazole was associated with a more successful eradication of intra-amniotic inflammation/infection and prevented secondary intra-amniotic inflammation/infection more frequently than an antibiotic regimen which included ampicillin and/or cephalosporins in patients with preterm PROM.
Collapse
Affiliation(s)
- JoonHo Lee
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Roberto Romero
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS , Bethesda, MD, and Detroit, MI , USA .,c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .,d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA .,e Center for Molecular Medicine and Genetics, Wayne State University , Detroit , MI , USA
| | - Sun Min Kim
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea .,f Department of Obstetrics and Gynecology , Seoul Metropolitan Government --Seoul National University Boramae Medical Center , Seoul , Republic of Korea , and
| | - Piya Chaemsaithong
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD/NIH/DHHS , Bethesda, MD, and Detroit, MI , USA .,g Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Bo Hyun Yoon
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea
| |
Collapse
|
25
|
Lee J, Romero R, Kim SM, Chaemsaithong P, Park CW, Park JS, Jun JK, Yoon BH. A new anti-microbial combination prolongs the latency period, reduces acute histologic chorioamnionitis as well as funisitis, and improves neonatal outcomes in preterm PROM. J Matern Fetal Neonatal Med 2015; 29:707-20. [PMID: 26373262 DOI: 10.3109/14767058.2015.1020293] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Antibiotic administration is a standard practice in preterm premature rupture of membranes (PROM). Specific anti-microbial agents often include ampicillin and/or erythromycin. Anaerobes and genital mycoplasmas are frequently involved in preterm PROM, but are not adequately covered by antibiotics routinely used in clinical practice. Our objective was to compare outcomes of PROM treated with standard antibiotic administration versus a new combination more effective against these bacteria. STUDY DESIGN A retrospective study compared perinatal outcomes in 314 patients with PROM <34 weeks receiving anti-microbial regimen 1 (ampicillin and/or cephalosporins; n = 195, 1993-2003) versus regimen 2 (ceftriaxone, clarithromycin and metronidazole; n = 119, 2003-2012). Intra-amniotic infection/inflammation was assessed by positive amniotic fluid culture and/or an elevated amniotic fluid MMP-8 concentration (>23 ng/mL). RESULTS (1) Patients treated with regimen 2 had a longer median antibiotic-to-delivery interval than those with regimen 1 [median (interquartile range) 23 d (10-51 d) versus 12 d (5-52 d), p < 0.01]; (2) patients who received regimen 2 had lower rates of acute histologic chorioamnionitis (50.5% versus 66.7%, p < 0.05) and funisitis (13.9% versus 42.9%, p < 0.001) than those who had received regimen 1; (3) the rates of intra-ventricular hemorrhage (IVH) and cerebral palsy (CP) were significantly lower in patients allocated to regimen 2 than regimen 1 (IVH: 2.1% versus 19.0%, p < 0.001 and CP: 0% versus 5.7%, p < 0.05); and (4) subgroup analysis showed that regimen 2 improved perinatal outcomes in pregnancies with intra-amniotic infection/inflammation, but not in those without intra-amniotic infection/inflammation (after adjusting for gestational age and antenatal corticosteroid administration). CONCLUSION A new antibiotic combination consisting of ceftriaxone, clarithromycin, and metronidazole prolonged the latency period, reduced acute histologic chorioamnionitis/funisitis, and improved neonatal outcomes in patients with preterm PROM. These findings suggest that the combination of anti-microbial agents (ceftriaxone, clarithromycin, and metronidazole) may improve perinatal outcome in preterm PROM.
Collapse
Affiliation(s)
- JoonHo Lee
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Roberto Romero
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development , NIH, Bethesda, MD and Detroit, MI , USA .,c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .,d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA .,e Center for Molecular Medicine and Genetics, Wayne State University , Detroit , MI , USA , and
| | - Sun Min Kim
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Piya Chaemsaithong
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development , NIH, Bethesda, MD and Detroit, MI , USA .,f Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Chan-Wook Park
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Joong Shin Park
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Jong Kwan Jun
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| | - Bo Hyun Yoon
- a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Korea
| |
Collapse
|
26
|
Identification of a gene in Mycoplasma hominis associated with preterm birth and microbial burden in intraamniotic infection. Am J Obstet Gynecol 2015; 212:779.e1-779.e13. [PMID: 25637842 DOI: 10.1016/j.ajog.2015.01.032] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/30/2014] [Accepted: 01/24/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Microbial invasion of the amniotic cavity is associated with spontaneous preterm labor and adverse pregnancy outcome, and Mycoplasma hominis often is present. However, the pathogenic process by which M hominis invades the amniotic cavity and gestational tissues, often resulting in chorioamnionitis and preterm birth, remains unknown. We hypothesized that strains of M hominis vary genetically with regards to their potential to invade and colonize the amniotic cavity and placenta. STUDY DESIGN We sequenced the entire genomes of 2 amniotic fluid isolates and a placental isolate of M hominis from pregnancies that resulted in preterm births and compared them with the previously sequenced genome of the type strain PG21. We identified genes that were specific to the amniotic fluid/placental isolates. We then determined the microbial burden and the presence of these genes in another set of subjects from whom samples of amniotic fluid had been collected and were positive for M hominis. RESULTS We identified 2 genes that encode surface-located membrane proteins (Lmp1 and Lmp-like) in the sequenced amniotic fluid/placental isolates that were truncated severely in PG21. We also identified, for the first time, a microbial gene of unknown function that is referred to in this study as gene of interest C that was associated significantly with bacterial burden in amniotic fluid and the risk of preterm delivery in patients with preterm labor. CONCLUSION A gene in M hominis was identified that is associated significantly with colonization and/or infection of the upper reproductive tract during pregnancy and with preterm birth.
Collapse
|
27
|
Le Ray I, Mace G, Sediki M, Lirussi F, Riethmuller D, Lentz N, Ramanah R, Hoyek T, Spagnolo G, Laurent N, Goirand F, Sagot P, Bardou M. Changes in maternal blood inflammatory markers as a predictor of chorioamnionitis: a prospective multicenter study. Am J Reprod Immunol 2014; 73:79-90. [PMID: 25263526 DOI: 10.1111/aji.12323] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/26/2014] [Indexed: 11/29/2022] Open
Abstract
PROBLEM To evaluate the inflammatory pattern in maternal circulation from women with preterm premature rupture of membranes (PPROM) considering the occurrence of histologically confirmed chorioamnionitis (HCA). METHOD OF STUDY A prospective study was conducted in 121 women with PPROM between 24 and 34 + 0 weeks of gestation. Association between white blood cells (WBC) count, plasma CRP, IL-6, MCP-1 and IP-10 levels, and HCA was assessed. RESULTS The rate of HCA was 44.7% (54/121). During the 5 days preceding delivery, median CRP, WBC, and IL-6 levels were significantly higher in the HCA than in no-HCA group (P < 0.001). Variations in IL-6, IP-10 levels, during the 24-72 hr before delivery, were predictors of the occurrence of HCA, but the diagnostic accuracy was low [Receiver Operating Characterictic (ROC) curve, area under the curve (AUC) = 0.56]. CONCLUSION An increase in IL-6, CRP, IP-10 maternal plasma levels was confirmed in PPROM women with HCA. Longitudinal follow-up of these markers did not add valuable information regarding HCA.
Collapse
Affiliation(s)
- Isabelle Le Ray
- Centre d'Investigations Cliniques 1432 (INSERM CIC 1432), CHU Dijon, Dijon Cedex, France; Université de Bourgogne, Dijon, France; Réseau National Gynécologie et Obstétrique des CIC de l'INSERM, GO-CIC
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Kamity R, Patel H, Younis S, Nasim M, Miller E, Ahmed M. Inhibition of Cxcr 1 and 2 Delays Preterm Delivery and Reduces Neonatal Mortality in a Mouse Model of Chorioamnionitis. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Intrauterine infection is one of the main etiologies associated with preterm delivery. Cytokines involved in chorioamnionitis, including IL-1, TNF-α, IL-6, IL-8, and MCP1, activate different pathways that lead to preterm delivery. Antileukinate (AL) is a potent selective IL-8 inhibitor that binds to CXC receptors 1&2 on neutrophils, thereby inhibiting IL-8-induced neutrophil chemotaxis and degranulation. Since CXC receptors 1&2 are critically involved in the pathology of chorioamnionitis, their inhibition with AL may have therapeutic potential. Four timed-pregnant C57BL6 mice groups were studied. LPS group received LPS intraperitoneally on gestational day (GD) 15. The AL group received LPS on GD15 followed immediately by intraperitoneal AL injection and repeated on GD16, and 17. Control groups received either saline, or no injections. In the LPS group, 90% delivered within 24 hours after LPS administration compared to 20% in the AL group. The LPS group had 85% stillborn compared to 15% in the AL group. Uterine histopathology AL group showed evidence of less inflammatory reaction compared to the LPS group. Uterine tissue and serum from the AL group had a significant reduction of inflammatory cytokines compared with the LPS group. Cytokine levels in brain and lung tissues from surviving pups were not significantly different between the AL and control groups. Our data show that antileukinate significantly delays preterm delivery in a mouse model of chorioamnionitis, and reduces neonatal mortality and morbidity.
Collapse
Affiliation(s)
- R. Kamity
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center of NY, New Hyde Park, NY, USA
- Lilling Family Neonatal Research Lab, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - H. Patel
- Lilling Family Neonatal Research Lab, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - S. Younis
- Lilling Family Neonatal Research Lab, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - M. Nasim
- Hofstra-North Shore LIJ School of Medicine, Hempstead, NY, USA
- Pathology Department, NS-LIJ, New Hyde Park, NY, USA
| | - E. Miller
- Hofstra-North Shore LIJ School of Medicine, Hempstead, NY, USA
- Center for Heart and Lung Research, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - M. Ahmed
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center of NY, New Hyde Park, NY, USA
- Lilling Family Neonatal Research Lab, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Hofstra-North Shore LIJ School of Medicine, Hempstead, NY, USA
- Center for Heart and Lung Research, Feinstein Institute for Medical Research, Manhasset, NY, USA
| |
Collapse
|
29
|
Impact of duration of rupture of membranes on outcomes of premature infants. J Perinatol 2014; 34:669-72. [PMID: 24762412 DOI: 10.1038/jp.2014.73] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/07/2014] [Accepted: 03/19/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The primary aim of the study was to determine how the risk of adverse outcomes was related to the duration of the latency period and gestational age at birth following preterm premature rupture of the fetal membranes (PPROM). STUDY DESIGN Retrospective review of infants discharged from 330 neonatal intensive care units. We defined four subgroups based on gestational age: 23 to 25, 26 to 28, 29 to 31 and 32 to 34 weeks. Each gestational age group was evaluated by duration of ROM: <24 h, 1 to 7 days, 8 to 14 days, 15 to 21 days, 21 to 28 days and >28 days and compared with a referent group (PPROM of >24 h but <7 days). RESULT In all, 239 808 non-anomalous infants 23 to 34 weeks' gestational age were identified; 37 233 (15.5%) had rupture of membranes (ROM) >24 h. Compared with a reference group (PPROM of >24 h but <7 days), the risk of mortality for PPROM of 8 to 14, 15 to 21 and 21 to 28 days varied depending on gestational age at birth. Only PPROM >28 days was consistently associated with increased mortality and decreased likelihood of survival without morbidity in all gestational age subgroups. CONCLUSION PPROM for >28 days is associated with an increased risk of death and morbidity.
Collapse
|
30
|
Abstract
OBJECTIVE To review the accuracy of the pediatric consensus definition of sepsis in term neonates and to determine the definition of neonatal sepsis used. STUDY SELECTION The review focused primarily on pediatric literature relevant to the topic of interest. CONCLUSIONS Neonatal sepsis is variably defined based on a number of clinical and laboratory criteria that make the study of this common and devastating condition very difficult. Diagnostic challenges and uncertain disease epidemiology necessarily result from a variable definition of disease. In 2005, intensivists caring for children recognized that as new drugs became available, children would be increasingly studied and thus, pediatric-specific consensus definitions were needed. Pediatric sepsis criteria are not accurate for term neonates and have not been examined in preterm neonates for whom the developmental stage influences aberrations associated with host immune response. Thus, specific consensus definitions for both term and preterm neonates are needed. Such definitions are critical for the interpretation of observational studies, future training of scientists and practitioners, and implementation of clinical trials in neonates.
Collapse
|
31
|
Menon R, Boldogh I, Hawkins HK, Woodson M, Polettini J, Syed TA, Fortunato SJ, Saade GR, Papaconstantinou J, Taylor RN. Histological evidence of oxidative stress and premature senescence in preterm premature rupture of the human fetal membranes recapitulated in vitro. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:1740-51. [PMID: 24832021 DOI: 10.1016/j.ajpath.2014.02.011] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/09/2014] [Accepted: 02/04/2014] [Indexed: 12/15/2022]
Abstract
Preterm prelabor rupture of the membranes (pPROM) may lead to preterm births (PTBs). We investigated premature senescence of fetal membranes in women with pPROM and spontaneous PTB with intact membranes (<34 weeks) and the inducibility fetal membrane senescence phenotype by oxidative stress in vitro. IHC was performed for p53, p21, and phospho (p)-p38 mitogen-activated protein kinase (MAPK) as markers of senescence phenotype in pPROM, PTBs, and term births. Term fetal membranes were exposed to cigarette smoke extract to induce oxidative stress. Western blots documented p-p53 and p-p38 MAPK. Transmission electron microscopy assessed cellular morphologic features in clinical and cigarette smoke extract-treated membranes. A total of 80% of pPROM cells and >60% of term cells were positive for all three senescence phenotype markers, and concentrations were higher than in PTBs (P < 0.05). p53 staining was comparable in membranes from PTB and term birth pregnancies, whereas only <30% and <45% of cells were positive for p21 and p38 MAPK, respectively. In vitro cigarette smoke extract exposure increased p-p38 MAPK without any detectable change in p-p53 MAPK. Enlargement of organelles consistent with senescence phenotype was evident in pPROM and term membranes in vivo and after cigarette smoke extract treatment in vitro but was less apparent in PTBs. Histologic and biochemical resemblance of pPROM and term membranes suggests premature senescence of the membranes is a mechanistic feature in pPROM, and this can be phenocopied in an in vitro model.
Collapse
Affiliation(s)
- Ramkumar Menon
- Division of Maternal-Fetal Medicine Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas.
| | - Istvan Boldogh
- Department of Microbiology and Immunology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Hal K Hawkins
- Department of Pathology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Michael Woodson
- Electron Microscopy Core Laboratory, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Jossimara Polettini
- Division of Maternal-Fetal Medicine Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Tariq Ali Syed
- Division of Maternal-Fetal Medicine Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - George R Saade
- Division of Maternal-Fetal Medicine Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - John Papaconstantinou
- Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Robert N Taylor
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
32
|
Abstract
BACKGROUND Premature birth carries substantial neonatal morbidity and mortality. Subclinical infection is associated with preterm rupture of membranes (PROM). Prophylactic maternal antibiotic therapy might lessen infectious morbidity and delay labour, but could suppress labour without treating underlying infection. OBJECTIVES To evaluate the immediate and long-term effects of administering antibiotics to women with PROM before 37 weeks, on maternal infectious morbidity, neonatal morbidity and mortality, and longer-term childhood development. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2013). SELECTION CRITERIA Randomised controlled trials comparing antibiotic administration with placebo that reported clinically relevant outcomes were included as were trials of different antibiotics. Trials in which no placebo was used were included for the outcome of perinatal death alone. DATA COLLECTION AND ANALYSIS We extracted data from each report without blinding of either the results or the treatments that women received. We sought unpublished data from a number of authors. MAIN RESULTS We included 22 trials, involving 6872 women and babies.The use of antibiotics following PROM is associated with statistically significant reductions in chorioamnionitis (average risk ratio (RR) 0.66, 95% confidence interval (CI) 0.46 to 0.96, and a reduction in the numbers of babies born within 48 hours (average RR 0.71, 95% CI 0.58 to 0.87) and seven days of randomisation (average RR 0.79, 95% CI 0.71 to 0.89). The following markers of neonatal morbidity were reduced: neonatal infection (RR 0.67, 95% CI 0.52 to 0.85), use of surfactant (RR 0.83, 95% CI 0.72 to 0.96), oxygen therapy (RR 0.88, 95% CI 0.81 to 0.96), and abnormal cerebral ultrasound scan prior to discharge from hospital (RR 0.81, 95% CI 0.68 to 0.98). Co-amoxiclav was associated with an increased risk of neonatal necrotising enterocolitis (RR 4.72, 95% CI 1.57 to 14.23).One study evaluated the children's health at seven years of age (ORACLE Children Study) and found antibiotics seemed to have little effect on the health of children. AUTHORS' CONCLUSIONS Routine prescription of antibiotics for women with preterm rupture of the membranes is associated with prolongation of pregnancy and improvements in a number of short-term neonatal morbidities, but no significant reduction in perinatal mortality. Despite lack of evidence of longer-term benefit in childhood, the advantages on short-term morbidities are such that we would recommend antibiotics are routinely prescribed. The antibiotic of choice is not clear but co-amoxiclav should be avoided in women due to increased risk of neonatal necrotising enterocolitis.
Collapse
Affiliation(s)
- Sara Kenyon
- School of Health and Population Sciences, University of Birmingham, Public Health Building, Edgbaston, UK, B15 2TT
| | | | | |
Collapse
|
33
|
Seelbach-Goebel B. Antibiotic Therapy for Premature Rupture of Membranes and Preterm Labor and Effect on Fetal Outcome. Geburtshilfe Frauenheilkd 2013; 73:1218-1227. [PMID: 24771902 PMCID: PMC3964356 DOI: 10.1055/s-0033-1360195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 11/19/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022] Open
Abstract
In Germany almost 10 % of children are born before the end of 37th week of gestation. In at least one quarter of these cases, ascending infection of the vagina plays a causative role, particularly during the early weeks of gestation. If, in addition to the decidua, the amniotic membrane, amniotic fluid and the umbilical cord are also affected, infection not only triggers uterine contractions and premature rupture of membranes but also initiates a systemic inflammatory reaction on the part of the fetus, which can increase neonatal morbidity. Numerous studies and meta-analyses have found that antibiotic therapy prolongs pregnancy and reduces neonatal morbidity. No general benefit of antibiotic treatment was found for premature uterine contractions. But it is conceivable that a subgroup of pregnant women would benefit from antibiotic treatment. It is important to identify this subgroup of women and offer them targeted treatment. This overview summarizes the current body of evidence on antibiotic treatment for impending preterm birth and the effect on neonatal outcomes.
Collapse
Affiliation(s)
- B. Seelbach-Goebel
- Krankenhaus der Barmherzigen Brüder – Klinik St. Hedwig, Lehrstuhl für
Frauenheilkunde und Geburtshilfe der Universität Regensburg,
Regensburg
| |
Collapse
|
34
|
Bibliography. Current world literature. Neonatology and perinatology. Curr Opin Pediatr 2013; 25:275-81. [PMID: 23481475 DOI: 10.1097/mop.0b013e32835f58ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Tambor V, Kacerovsky M, Lenco J, Bhat G, Menon R. Proteomics and bioinformatics analysis reveal underlying pathways of infection associated histologic chorioamnionitis in pPROM. Placenta 2013; 34:155-61. [DOI: 10.1016/j.placenta.2012.11.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/04/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
|