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Pongchaikul P, Romero R, Mongkolsuk P, Vivithanaporn P, Wongsurawat T, Jenjaroenpun P, Nitayanon P, Thaipisuttikul I, Kamlungkuea T, Singsaneh A, Santanirand P, Chaemsaithong P. Genomic analysis of Enterococcus faecium strain RAOG174 associated with acute chorioamnionitis carried antibiotic resistance gene: is it time for precise microbiological identification for appropriate antibiotic use? BMC Genomics 2023; 24:405. [PMID: 37468842 DOI: 10.1186/s12864-023-09511-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Preterm labor syndrome is associated with high perinatal morbidity and mortality, and intra-amniotic infection is a cause of preterm labor. The standard identification of causative microorganisms is based on the use of biochemical phenotypes, together with broth dilution-based antibiotic susceptibility from organisms grown in culture. However, such methods could not provide an accurate epidemiological aspect and a genetic basis of antimicrobial resistance leading to an inappropriate antibiotic administration. Hybrid genome assembly is a combination of short- and long-read sequencing, which provides better genomic resolution and completeness for genotypic identification and characterization. Herein, we performed a hybrid whole genome assembly sequencing of a pathogen associated with acute histologic chorioamnionitis in women presenting with PPROM. RESULTS We identified Enterococcus faecium, namely E. faecium strain RAOG174, with several antibiotic resistance genes, including vancomycin and aminoglycoside. Virulence-associated genes and potential bacteriophage were also identified in this genome. CONCLUSION We report herein the first study demonstrating the use of hybrid genome assembly and genomic analysis to identify E. faecium ST17 as a pathogen associated with acute histologic chorioamnionitis. The analysis provided several antibiotic resistance-associated genes/mutations and mobile genetic elements. The occurrence of E. faecium ST17 raised the awareness of the colonization of clinically relevant E. faecium and the carrying of antibiotic resistance. This finding has brought the advantages of genomic approach in the identification of the bacterial species and antibiotic resistance gene for E. faecium for appropriate antibiotic use to improve maternal and neonatal care.
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Affiliation(s)
- Pisut Pongchaikul
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital Mahidol University, Samut Prakan, Thailand
- Integrative Computational BioScience Center, Mahidol University, Nakhon Pathom, Thailand
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Roberto Romero
- Pregnancy Research Branch (formerly The Perinatology Research Branch, NICHD/NIH/DHHS, in Detroit, Michigan, USA, has been renamed as the Pregnancy Research Branch, NICHD/NIH/DHHS), 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, United States Department of Health and Human Services, Bethesda, MD, USA
- 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, United States Department of Health and Human Services, Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Paninee Mongkolsuk
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital Mahidol University, Samut Prakan, Thailand
| | - Pornpun Vivithanaporn
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital Mahidol University, Samut Prakan, Thailand
| | - Thidathip Wongsurawat
- Division of Medical Bioinformatics, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piroon Jenjaroenpun
- Division of Medical Bioinformatics, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Perapon Nitayanon
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Iyarit Thaipisuttikul
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Threebhorn Kamlungkuea
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Arunee Singsaneh
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pitak Santanirand
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Urushiyama D, Ohnishi E, Suda W, Kurakazu M, Kiyoshima C, Hirakawa T, Miyata K, Yotsumoto F, Nabeshima K, Setoue T, Nagamitsu S, Hattori M, Hata K, Miyamoto S. Vaginal microbiome as a tool for prediction of chorioamnionitis in preterm labor: a pilot study. Sci Rep 2021; 11:18971. [PMID: 34556804 PMCID: PMC8460623 DOI: 10.1038/s41598-021-98587-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Intra-amniotic infection (IAI) is a major cause of preterm birth with a poor perinatal prognosis. We aimed to determine whether analyzing vaginal microbiota can evaluate the risk of chorioamnionitis (CAM) in preterm labor cases. Vaginal discharge samples were collected from 83 pregnant women admitted for preterm labor. Based on Blanc's classification, the participants were divided into CAM (stage ≥ II; n = 46) and non-CAM (stage ≤ I; n = 37) groups. The 16S rDNA amplicons (V1-V2) from vaginal samples were sequenced and analyzed. Using a random forest algorithm, the bacterial species associated with CAM were identified, and a predictive CAM (PCAM) scoring method was developed. The α diversity was significantly higher in the CAM than in the non-CAM group (P < 0.001). The area under the curve was 0.849 (95% confidence interval 0.765-0.934) using the PCAM score. Among patients at < 35 weeks of gestation, the PCAM group (n = 22) had a significantly shorter extended gestational period than the non-PCAM group (n = 25; P = 0.022). Multivariate analysis revealed a significant difference in the frequency of developmental disorders in 3-year-old infants (PCAM, 28%, non-PCAM, 4%; P = 0.022). Analyzing vaginal microbiota can evaluate the risk of IAI. Future studies should establish appropriate interventions for IAI high-risk patients to improve perinatal prognosis.
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Affiliation(s)
- Daichi Urushiyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Eriko Ohnishi
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, 157-8535, Japan
| | - Wataru Suda
- Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Yokohama, 230-0045, Japan
| | - Masamitsu Kurakazu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Chihiro Kiyoshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Toyofumi Hirakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kohei Miyata
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Fusanori Yotsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, 814-0180, Japan
| | - Takashi Setoue
- Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, 814-0180, Japan
| | - Shinichiro Nagamitsu
- Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Masahira Hattori
- Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Yokohama, 230-0045, Japan
- Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, 169-8555, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, 157-8535, Japan
| | - Shingo Miyamoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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Yadufashije C, Umugwaneza J, Muhimpundu L, Izere C, Munyeshyaka E, Mala A, Francois N, Mucumbitsi J, Sangano G, Ndayambaje M, Mwanzia L, Habyarimana T. Identification of Microorganisms associated with intraamniotic infection among women with preterm birth at Ruhengeri Referral Hospital, Rwanda: A case control study. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2021. [DOI: 10.4103/ijmbs.ijmbs_64_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yin F, Zhu Y, Wang H, Wang Y, Li D, Qin J. Microengineered hiPSC-Derived 3D Amnion Tissue Model to Probe Amniotic Inflammatory Responses under Bacterial Exposure. ACS Biomater Sci Eng 2020; 6:4644-4652. [PMID: 33455183 DOI: 10.1021/acsbiomaterials.0c00592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intra-amniotic infection is a common cause of preterm birth that can lead to adverse neonatal outcomes. Despite the basic and clinical significance, the study in normal and diseased human amnion is highly challenging due to the limited use of human primary tissues and the distinct divergence between animal models and human. Here, we established a microengineered hiPSC-derived amnion tissue model on a chip to investigate the inflammatory responses of amnion tissues to bacterial exposure. The microdevice consisted of two parallel channels with a middle matrix channel, creating a permissive microenvironment for amnion differentiation. Dissociated hiPSCs efficiently self-organized into cell cavity and finally differentiated into a polarized squamous amniotic epithelium on the chip under perfused 3D culture. When exposed to E. coli, amnion tissue exhibited significant functional impairments compared to the control, including induced cell apoptosis, disrupted cell junction integrity, and increased inflammatory factor secretion, recapitulating a series of characteristic clinical signs of intra-amniotic infection at an early stage. Together, this amnion-on-a-chip model provides a promising platform to investigate intrauterine inflammation in early gestation, indicating its potential applications in human embryology and reproductive medicine.
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Affiliation(s)
- Fangchao Yin
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023 China.,University of Chinese Academy of Sciences, Beijing 100049 China
| | - Yujuan Zhu
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023 China.,University of Chinese Academy of Sciences, Beijing 100049 China
| | - Hui Wang
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023 China.,University of Chinese Academy of Sciences, Beijing 100049 China
| | - Yaqing Wang
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023 China.,University of Chinese Academy of Sciences, Beijing 100049 China
| | - Dong Li
- Dalian Municipal Women and Children's Medical Center, Dalian 116037 China
| | - Jianhua Qin
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023 China.,Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing 100101 China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031 China.,University of Chinese Academy of Sciences, Beijing 100049 China
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Cimpoca B, Syngelaki A, Chi Mu A, Savvoulidou E, Nicolaides KH. Twin pregnancy with two live fetuses at 11-13 weeks: effect of one fetal death on pregnancy outcome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:482-488. [PMID: 31762144 DOI: 10.1002/uog.21925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES First, to compare the incidence of single and double fetal death between monochorionic (MC) and dichorionic (DC) twin pregnancies with two live fetuses at 11-13 weeks' gestation and no major abnormalities. Second, to investigate the relationship between gestational age at single fetal death and interval to delivery of the cotwin. Third, to determine the rate of early preterm birth in DC and MC twin pregnancies with two live fetuses and those with single fetal death. METHODS This was a retrospective analysis of prospectively collected data on twin pregnancies undergoing routine ultrasound examination at 11-13 weeks' gestation between 2002 and 2019. The outcome measures, which were stratified by chorionicity, were: first, death of both fetuses at presentation or death of one fetus followed by delivery of a live or dead cotwin within the subsequent 3 days at < 34 weeks' gestation; second, in pregnancies with single fetal death at < 34 weeks' gestation and a live cotwin ≥ 3 days later, the subsequent risk of fetal death and gestational-age distribution at birth of the cotwin; and, third, the gestational-age distribution at birth in pregnancies with two live fetuses. RESULTS The main findings of this study of 4896 DC and 1329 MC twin pregnancies with two live fetuses at 11-13 weeks' gestation were: first, the rate of death of both twins or death of one fetus and delivery of the live or dead cotwin within 3 days was higher in MC than in DC twin pregnancies; second, the rate of single fetal death with a live cotwin ≥ 3 days later was higher in MC than in DC twin pregnancies, but the rate of subsequent cotwin death in MC twin pregnancies was not significantly different from that in DC twin pregnancies; third, in pregnancies with two live fetuses, the rate of early preterm birth was significantly higher in MC than in DC twin pregnancies; fourth, the rate of early preterm birth in pregnancies with single fetal death and a live cotwin ≥ 3 days later was not significantly different between MC and DC twin pregnancies but the rates were substantially higher than in those with two live fetuses; and, fifth, in both MC and DC pregnancies with single fetal death and a live cotwin ≥ 3 days later, there was a significant inverse association between gestational age at death and interval to delivery (mean interval of 19 weeks for death at 15 weeks and mean interval of 2.5 weeks for death at 30 weeks). CONCLUSIONS First, in MC twin pregnancies, the risk of single or double fetal death is higher than in DC twins. Second, in both MC and DC twin pregnancies, the rate of early preterm birth is higher in those with one fetal death than in those with two live fetuses. Third, in both MC and DC twins with one fetal death, the interval to delivery is related inversely to gestational age at fetal death. These data should be useful in counseling parents as to the likely outcome of their pregnancy after single fetal death and in defining strategies for surveillance in the management of these types of twin pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- B Cimpoca
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Syngelaki
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Chi Mu
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - E Savvoulidou
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Recommendations on the diagnosis and the use of antibiotics for early-onset sepsis in preterm infant: consensus of the expert panel from Hunan Province. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22. [PMID: 31948515 PMCID: PMC7389710 DOI: 10.7499/j.issn.1008-8830.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Preterm infants are at higher risk of developing early-onset sepsis (EOS). Due to non-specific clinical manifestations and lack of laboratory tests for prompt diagnosis of EOS, inappropriate use of antibiotics is common in preterm infants. Prolonged exposure to antibiotics can lead to antibiotic resistance and significantly increases the risk of mortality and morbidity. Based on the latest progress in the diagnosis and treatment for EOS, both in China and overseas, and considering the current condition in Hunan Province, the expert panel of neonatologists in Hunan have reached this consensus after many discussions. This consensus clarifies the risk factors, proposes the diagnostic criteria, and recommends the antibiotic use strategies for EOS in preterm infants. It is emphasized that blood culture results and clinical manifestations are the main basis for the diagnosis of EOS and the duration of antibiotics use in preterm infants.
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湖南省新生儿医疗质量控制中心, 湖南省医学会围产医学专业委员会新生儿学组. Recommendations on the diagnosis and the use of antibiotics for early-onset sepsis in preterm infant: consensus of the expert panel from Hunan Province. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1-6. [PMID: 31948515 PMCID: PMC7389710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/09/2019] [Indexed: 08/01/2024]
Abstract
Preterm infants are at higher risk of developing early-onset sepsis (EOS). Due to non-specific clinical manifestations and lack of laboratory tests for prompt diagnosis of EOS, inappropriate use of antibiotics is common in preterm infants. Prolonged exposure to antibiotics can lead to antibiotic resistance and significantly increases the risk of mortality and morbidity. Based on the latest progress in the diagnosis and treatment for EOS, both in China and overseas, and considering the current condition in Hunan Province, the expert panel of neonatologists in Hunan have reached this consensus after many discussions. This consensus clarifies the risk factors, proposes the diagnostic criteria, and recommends the antibiotic use strategies for EOS in preterm infants. It is emphasized that blood culture results and clinical manifestations are the main basis for the diagnosis of EOS and the duration of antibiotics use in preterm infants.
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Puopolo KM, Benitz WE, Zaoutis TE, Cummings J, Juul S, Hand I, Eichenwald E, Poindexter B, Stewart DL, Aucott SW, Goldsmith JP, Watterberg K, Byington CL, Maldonado YA, Banerjee R, Barnett ED, Campbell JD, Gerber JS, Lynfield R, Munoz FM, Nolt D, Nyquist AC, O’Leary ST, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ. Management of Neonates Born at ≤34 6/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics 2018; 142:peds.2018-2896. [PMID: 30455344 DOI: 10.1542/peds.2018-2896] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Early-onset sepsis (EOS) remains a serious and often fatal illness among infants born preterm, particularly among newborn infants of the lowest gestational age. Currently, most preterm infants with very low birth weight are treated empirically with antibiotics for risk of EOS, often for prolonged periods, in the absence of a culture-confirmed infection. Retrospective studies have revealed that antibiotic exposures after birth are associated with multiple subsequent poor outcomes among preterm infants, making the risk/benefit balance of these antibiotic treatments uncertain. Gestational age is the strongest single predictor of EOS, and the majority of preterm births occur in the setting of other factors associated with risk of EOS, making it difficult to apply risk stratification strategies to preterm infants. Laboratory tests alone have a poor predictive value in preterm EOS. Delivery characteristics of extremely preterm infants present an opportunity to identify those with a lower risk of EOS and may inform decisions to initiate or extend antibiotic therapies. Our purpose for this clinical report is to provide a summary of the current epidemiology of preterm neonatal sepsis and provide guidance for the development of evidence-based approaches to sepsis risk assessment among preterm newborn infants.
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Affiliation(s)
- Karen M. Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia, and
| | - William E. Benitz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - Theoklis E. Zaoutis
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Roberts Center for Pediatric Research, Philadelphia, Pennsylvania; and
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9
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Urushiyama D, Suda W, Ohnishi E, Araki R, Kiyoshima C, Kurakazu M, Sanui A, Yotsumoto F, Murata M, Nabeshima K, Yasunaga S, Saito S, Nomiyama M, Hattori M, Miyamoto S, Hata K. Microbiome profile of the amniotic fluid as a predictive biomarker of perinatal outcome. Sci Rep 2017; 7:12171. [PMID: 28939908 PMCID: PMC5610236 DOI: 10.1038/s41598-017-11699-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022] Open
Abstract
Chorioamnionitis (CAM), an inflammation of the foetal membranes due to infection, is associated with preterm birth and poor perinatal prognosis. The present study aimed to determine whether CAM can be diagnosed prior to delivery based on the bacterial composition of the amniotic fluid (AF). AF samples from 79 patients were classified according to placental inflammation: Stage III (n = 32), CAM; Stage II (n = 27), chorionitis; Stage 0-I (n = 20), sub-chorionitis or no neutrophil infiltration; and normal AF in early pregnancy (n = 18). Absolute quantification and sequencing of 16S rDNA showed that in Stage III, the 16S rDNA copy number was significantly higher and the α-diversity index lower than those in the other groups. In principal coordinate analysis, Stage III formed a separate cluster from Stage 0-I, normal AF, and blank. Forty samples were classified as positive for microbiomic CAM (miCAM) defined by the presence of 11 bacterial species that were found to be significantly associated with CAM and some parameters of perinatal prognosis. The diagnostic accuracy for CAM according to miCAM was: sensitivity, approximately 94%, and specificity, 79-87%. Our findings indicate the possibility of predicting CAM prior to delivery based on the AF microbiome profile.
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Affiliation(s)
- Daichi Urushiyama
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, 157-8535, Japan.,Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Wataru Suda
- Department of Computational Biology, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, 277-8561, Japan.,Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, 160-0016, Japan
| | - Eriko Ohnishi
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, 157-8535, Japan
| | - Ryota Araki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Chihiro Kiyoshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Masamitsu Kurakazu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Ayako Sanui
- Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, 814-0180, Japan
| | - Fusanori Yotsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Masaharu Murata
- Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, 814-0180, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, 814-0180, Japan
| | - Shin'ichiro Yasunaga
- Department of Biochemistry, Faculty of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, 930-0194, Japan
| | - Makoto Nomiyama
- Department of Obstetrics and Gynecology, National Hospital Organization Saga Hospital, Saga, 849-8577, Japan
| | - Masahira Hattori
- Department of Computational Biology, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, 277-8561, Japan.,Cooperative Major in Advanced Health Science, Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, 169-8555, Japan
| | - Shingo Miyamoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, 157-8535, Japan.
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Romero R, Miranda J, Chaemsaithong P, Chaiworapongsa T, Kusanovic JP, Dong Z, Ahmed AI, Shaman M, Lannaman K, Yoon BH, Hassan SS, Kim CJ, Korzeniewski SJ, Yeo L, Kim YM. Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med 2015; 28:1394-409. [PMID: 25190175 PMCID: PMC5371030 DOI: 10.3109/14767058.2014.958463] [Citation(s) in RCA: 280] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/20/2014] [Accepted: 08/22/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objectives of this study were to: (1) determine the amniotic fluid (AF) microbiology of patients with preterm prelabor rupture of membranes (PROM); and (2) examine the relationship between intra-amniotic inflammation with and without microorganisms (sterile inflammation) and adverse pregnancy outcomes in patients with preterm PROM. METHODS AF samples obtained from 59 women with preterm PROM were analyzed using cultivation techniques (for aerobic and anaerobic bacteria as well as genital mycoplasmas) and with broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). AF concentration of interleukin-6 (IL-6) was determined using ELISA. Results of both tests were correlated with AF IL-6 concentrations and the occurrence of adverse obstetrical/perinatal outcomes. RESULTS (1) PCR/ESI-MS, AF culture, and the combination of these two tests each identified microorganisms in 36% (21/59), 24% (14/59) and 41% (24/59) of women with preterm PROM, respectively; (2) the most frequent microorganisms found in the amniotic cavity were Sneathia species and Ureaplasma urealyticum; (3) the frequency of microbial-associated and sterile intra-amniotic inflammation was overall similar [ 29% (17/59)]: however, the prevalence of each differed according to the gestational age when PROM occurred; (4) the earlier the gestational age at preterm PROM, the higher the frequency of both microbial-associated and sterile intra-amniotic inflammation; (5) the intensity of the intra-amniotic inflammatory response against microorganisms is stronger when preterm PROM occurs early in pregnancy; and (6) the frequency of acute placental inflammation (histologic chorioamnionitis and/or funisitis) was significantly higher in patients with microbial-associated intra-amniotic inflammation than in those without intra-amniotic inflammation [93.3% (14/15) versus 38% (6/16); p = 0.001]. CONCLUSIONS (1) The frequency of microorganisms in preterm PROM is 40% using both cultivation techniques and PCR/ESI-MS; (2) PCR/ESI-MS identified microorganisms in the AF of 50% more women with preterm PROM than AF culture; and (3) sterile intra-amniotic inflammation was present in 29% of these patients, and it was as or more common than microbial-associated intra-amniotic inflammation among those presenting after, but not before, 24 weeks of gestation.
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Affiliation(s)
- Roberto Romero
- 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
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Jezid Miranda
- 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
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Piya Chaemsaithong
- 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
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Tinnakorn Chaiworapongsa
- 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
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Juan P. Kusanovic
- 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
- Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile
- Department of Obstetrics and Gynecology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Zhong Dong
- 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
| | - Ahmed I. Ahmed
- 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
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Majid Shaman
- 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
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Kia Lannaman
- 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
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bo Hyun Yoon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Sonia S. Hassan
- 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
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Chong J. Kim
- 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
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Steven J. Korzeniewski
- 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
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Lami Yeo
- 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
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Yeon Mee Kim
- 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
- Department of Pathology, College of Medicine Inje University, Haeundae Paik Hospital, Seoul, Korea
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Tsimis ME, Abu Al-Hamayel N, Germaine H, Burd I. Prematurity: present and future. MINERVA GINECOLOGICA 2015; 67:35-46. [PMID: 25300768 PMCID: PMC4323881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The study of preterm labor and prematurity has undergone a major transformation in its approach from an inevitable part of obstetrics with few answers to one in which science has led to knowledge and clinical intervention. Despite these advancements, understanding of preterm labor and prevention of prematurity is still limited. In the current review, we begin the discussion with fetal viability, first from a historical perspective and then from the understanding of this issue from a prospective of various professional organizations. We then present the scope of the problem of preterm birth from various countries including the discrepancy between the US and Europe. We continue with updates on extreme prematurity and outcomes with two longitudinal studies from the past 2 years. We further review available interventions for prematurity and discuss the use of antenatal corticosteroids. First, we examine their use in the context of professional recommendations and then examine the trajectory of their continued use in the late preterm period. We focus on a European-based trial with preliminary results and an ongoing American counterpart. The current knowledge of molecular mechanisms behind preterm labor is presented with a focus on the multiple etiologies of preterm labor, both known and presumed, with updates in the basic science realm. Furthermore, we present up-to-date studies on prediction of preterm birth and prematurity-related morbidity.
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Affiliation(s)
- M E Tsimis
- Integrated Research Center for Fetal Medicine Division of Maternal‑Fetal Medicine Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine - Integrated Research Center for Fetal Medicine Division of Maternal‑Fetal Medicine Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine
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12
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Arora P, Bagga R, Kalra J, Kumar P, Radhika S, Gautam V. Mean gestation at delivery and histological chorioamnionitis correlates with early-onset neonatal sepsis following expectant management in pPROM. J OBSTET GYNAECOL 2014; 35:235-40. [PMID: 25244519 DOI: 10.3109/01443615.2014.958143] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This prospective observational study was carried out in India among 100 women with preterm pre-labour rupture of membranes (pPROM) between 26(0/7)-33(0/7) weeks on expectant management in order to correlate early-onset neonatal sepsis (EONS) with various features of chorioamnionitis. The incidence of pPROM during the study period of 1.5 years was 7%. The mean gestation at pPROM was 30(6/7) ± 1.8 weeks and at delivery was 32(1/7) ± 1 weeks. Features of chorioamnionitis in the form of clinical, microbiological, histological or a combination of these were observed in 70/100 women. Clinical chorioamnionitis was seen in 16%, bacterial isolates were present in 30% on cervical swab and in 39% on placental membrane culture and 19% had histological chorioamnionitis. EONS was present in 23/97 (24%). Clinical chorioamnionitis (p = 0.069), bacterial isolates on cervical swab (p = 0.56) or placental membranes (p = 0.39) were not found to predict EONS; whereas histological chorioamnionitis (p = 0.002) and lower gestation at delivery (p = 0.013) were significantly associated with EONS.
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Affiliation(s)
- P Arora
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research , Chandigarh , India
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13
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Abstract
Preterm birth is associated with 5 to 18% of pregnancies and is a leading cause of infant morbidity and mortality. Spontaneous preterm labor, a syndrome caused by multiple pathologic processes, leads to 70% of preterm births. The prevention and the treatment of preterm labor have been long-standing challenges. We summarize the current understanding of the mechanisms of disease implicated in this condition and review advances relevant to intra-amniotic infection, decidual senescence, and breakdown of maternal-fetal tolerance. The success of progestogen treatment to prevent preterm birth in a subset of patients at risk is a cause for optimism. Solving the mystery of preterm labor, which compromises the health of future generations, is a formidable scientific challenge worthy of investment.
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Affiliation(s)
- Roberto Romero
- 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), National Institutes of Health, Bethesda, MD, Wayne State University/the Detroit Medical Center, Detroit, MI, USA. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA. Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
| | - Sudhansu K Dey
- Division of Reproductive Sciences, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susan J Fisher
- Department of Obstetrics, Gynecology and Reproductive Sciences, Department of Anatomy, and Center for Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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14
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Kim SK, Romero R, Savasan ZA, Xu Y, Dong Z, Lee DC, Yeo L, Hassan SS, Chaiworapongsa T. Endoglin in amniotic fluid as a risk factor for the subsequent development of bronchopulmonary dysplasia. Am J Reprod Immunol 2012; 69:105-23. [PMID: 23279628 DOI: 10.1111/aji.12046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 10/23/2012] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Cross-talk between inflammation and angiogenesis pathways has been recently reported. The objectives of this study were to: (i) examine whether amniotic fluid (AF) concentrations of soluble endoglin (sEng), a protein with anti-angiogenic properties, change during pregnancy, parturition, or intra-amniotic infection and/or inflammation (IAI); (ii) determine whether an increase in sEng in the AF of patients with preterm labor (PTL) and preterm prelabor rupture of membranes (PROM) is associated with adverse neonatal outcomes; and (iii) investigate potential sources of sEng in AF. STUDY DESIGN A cross-sectional study was conducted to include patients in the following groups: (i) mid-trimester (n = 20); (ii) PTL with term delivery (n = 95); (iii) PTL leading to preterm delivery with (n = 40) and without IAI (n = 46); (iv) preterm PROM with (n = 37) and without IAI (n = 37); (v) term in labor (n = 48) and not in labor (n = 44). AF concentrations of sEng were determined by enzyme-linked immunosorbent assay. Chorioamniotic membranes, umbilical cord blood, and AF macrophages were examined for the expression of endoglin. RESULTS (i) Patients with IAI had a higher median AF concentration of sEng than those without IAI (P = 0.02 for PTL and 0.06 for preterm PROM); (ii) AF concentrations of sEng in the 3rd and 4th quartiles were associated with IAI (OR 2.5 and 7.9, respectively); (iii) an AF sEng concentration ≥779.5 pg/mL was associated with bronchopulmonary dysplasia (BPD) (OR 7.9); (iv) endoglin was co-localized with CD14+ macrophages in AF pellets of patients with IAI by immunofluorescence and flow cytometry; and (v) the concentration of sEng in the supernatant was significantly increased after the treatment of macrophages with endotoxin or TNF-α. CONCLUSIONS Soluble endoglin participates in the host response against IAI. Activated macrophages may be a source of sEng concentrations in the AF of patients with IAI. An increase of sEng in the AF is associated with BPD and adverse neonatal outcomes.
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Affiliation(s)
- Sun K Kim
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD and Detroit, MI 48201, USA
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15
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Gervasi MT, Romero R, Bracalente G, Chaiworapongsa T, Erez O, Dong Z, Hassan SS, Yeo L, Yoon BH, Mor G, Barzon L, Franchin E, Militello V, Palù G. Viral invasion of the amniotic cavity (VIAC) in the midtrimester of pregnancy. J Matern Fetal Neonatal Med 2012; 25:2002-13. [PMID: 22524157 PMCID: PMC3498469 DOI: 10.3109/14767058.2012.683899] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The prevalence of viral infections in the amniotic fluid (AF) has not yet been ascertained. The aim of this study was to determine the prevalence of specific viral nucleic acids in the AF and its relationship to pregnancy outcome. STUDY DESIGN From a cohort of 847 consecutive women undergoing midtrimester amniocentesis, 729 cases were included in this study after exclusion of documented fetal anomalies, chromosomal abnormalities, unavailability of AF specimens and clinical outcomes. AF specimens were tested by quantitative real-time PCR for the presence of genome sequences of the following viruses: adenoviruses, herpes simplex virus (HSV), varicella zoster virus (VZV), human herpesvirus 6 (HHV6), human cytomegalovirus (HCMV), Epstein-Barr virus (EBV), parvovirus B19 and enteroviruses. Viral nucleic acid testing was also performed in maternal blood and cord blood in the population of women in whom AF was positive for viruses and in a control group of 29 women with AF negative for viral nucleic acids. The relationship between the presence of viruses and pregnancy and neonatal outcome was examined. The correlation between the presence of nucleic acids of viruses in the AF and the concentration of the cytokine interleukin-6 (IL-6) and the T cell chemokine CXCL-10 (or IP-10) in AF and maternal blood were analyzed. RESULTS Viral genome sequences were found in 16 of 729 (2.2%) AF samples. HHV6 was the most commonly detected virus (7 cases, 1.0%), followed by HCMV (6 cases, 0.8%), parvovirus B19 (2 cases, 0.3%) and EBV (1 case, 0.1%), while HSV, VZV, enteroviruses and adenoviruses were not found in this cohort. Corresponding viral DNA was also detected in maternal blood of six out of seven women with HHV6-positive AF and in the umbilical cord plasma, which was available in one case. In contrast, viral DNA was not detected in maternal blood of women with AF positive for parvovirus B19, HCMV, EBV or of women with AF negative for viruses. HHV6 genome copy number in AF and maternal blood was consistent with genomic integration of viral DNA and genetic infection in all women. There was no significant difference in the AF concentration of IL-6 and IP-10 between patients with and without VIAC. However, for HCMV, there was a significant relationship between viral copy number and IP-10 concentration in maternal blood and AF. The group of women with AF positive for viral DNA delivered at term healthy neonates without complications in 14 out of 16 cases. In one case of HHV6 infection in the AF, the patient developed gestational hypertension at term, and in another case of HHV6 infection in the AF, the patient delivered at 33 weeks after preterm premature rupture of membranes (PPROM). CONCLUSION Viral nucleic acids are detectable in 2.2% of AF samples obtained from asymptomatic women in the midtrimester. HHV6 was the most frequently detected virus in AF. Adenoviruses were not detected. Vertical transmission of HHV6 was demonstrated in one case.
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Affiliation(s)
- Maria-Teresa Gervasi
- Ob/Gyn Unit, Department for Health of Mothers and Children, Azienda Ospedaliera, Padova, Italy
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA
| | - Gabriella Bracalente
- Ob/Gyn Unit, Department for Health of Mothers and Children, ASL 9 Treviso, Italy
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of The Negev, Beer Sheva, Israel
| | - Zhong Dong
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA
- Ob/Gyn Unit, Department for Health of Mothers and Children, ASL 9 Treviso, Italy
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA
- Ob/Gyn Unit, Department for Health of Mothers and Children, ASL 9 Treviso, Italy
| | - Bo Hyun Yoon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gil Mor
- Department of Obstetrics, Gynecology & Reproductive Sciences, Reproductive Immunology Unit, Yale University School of Medicine, New Haven, CT, USA
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Elisa Franchin
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Padova, Italy
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Abstract
Preterm delivery occurs in less than 10% of pregnancies but accounts for more than 60% of all neonatal deaths. Approximately one third of preterm deliveries are associated with preterm prelabour amniorrhexis and in a high proportion of such cases the underlying cause may be ascending infection from the lower genital tract. The causes of neonatal death in pregnancies with amniorrhexis are prematurity, pulmonary hypoplasia and sepsis. In the management of pregnancies with preterm prelabour amniorrhexis it is essential to distinguish between those with and without intrauterine infection. If there is no infection at presentation it is unlikely that this will develop and in such cases there is no benefit from hospitalisation, bed rest, prophylactic tocolytics or antibiotics. The group with evidence of intrauterine infection go into spontaneous labour within a few days of amniorrhexis; in this group the main determinant for the appropriate management is the gestation at amniorrhexis.
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17
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[Premature rupture of membranes before 32 weeks of gestation: prenatal prognosis factors]. ACTA ACUST UNITED AC 2008; 36:748-56. [PMID: 18603461 DOI: 10.1016/j.gyobfe.2008.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 04/18/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Premature preterm rupture of membranes (PPROM) accounts for a significant part of overall perinatal mortality and morbidity. This study aims to define potential prognostic factors for neonatal outcome. PATIENTS AND METHODS One hundred and thirty-one pregnancies complicated with PPROM at between 26 and 32 weeks were retrospectively reviewed over a three-year period. The influence of chorioamnionitis on perinatal morbidity and mortality was assessed using a composite outcome. RESULTS On admission, gestational age (GA) at diagnosis, fetal heart rate anomalies and increasing severity of clinical features of chorioamnionitis were significantly related with an adverse outcome. Significant factors associated with a favourable outcome were an administration of steroids for lung maturation, prophylactic antibiotics and tocolytic therapies. Stratifying according to GA at PPROM, the survival rates were 43 and 52% at before 22 weeks and between 22 and 26 weeks respectively. The prognosis dramatically improved after 26 weeks with an 84.6% rate of survival without impairment. Although this rate reached 97.5% after 30 weeks, there was no statistical evidence supporting any benefit to prolong pregnancies beyond this point. The complete expression of chorioamnionitis independently increased the mortality rate by 41% (OR=1.41; 95% CI [0.99-2.01]. Overall, the most relevant factor was GA at delivery, levelling the prognostic value of GA at diagnosis. DISCUSSION AND CONCLUSION If no consensus rules PPROM at the moment, the most efficient prognosis factor before 34 weeks is mostly determined by GA at delivery.
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Engemise S, Kalu E, Haque K. Successful outcome following pre-viability amniorrhexis. Arch Gynecol Obstet 2007; 276:87-9. [PMID: 17219157 DOI: 10.1007/s00404-006-0310-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 12/11/2006] [Indexed: 10/23/2022]
Abstract
A 34-years-old primigravida conceived following a fourth attempt at in vitro fertilization and embryo transfer for severe bilateral tubal disease and grade IV endometriosis. Pregnancy progressed well until 17 weeks gestation when she spontaneously ruptured her membranes. She elected to continue with the pregnancy despite the significant risks associated with prolonged rupture of membranes (PROM) and anhydramnion at extremes of viability. Pregnancy was carried to 28 weeks gestation, when delivery was necessitated by a major antepartum haemorrhage following abruption placentae. A male infant weighing 1,100 g was delivered by emergency caesarean section in good condition, and with no features oligohydramnion tetrad (Potter's features, skeletal deformities, intrauterine growth restriction, and pulmonary hypoplasia). This case adds to the small number of cases in the literature of successful outcome following prolonged pre-viability PROM. Counselling and psychological support to the parents in this situation is extremely important since the anxiety and uncertainty associated with expectant management of PROM does not end with the "successful" delivery of the baby but persists all through the neonatal period and for several years later.
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Affiliation(s)
- Samuel Engemise
- Department of Obstetrics and Gynaecology, St Helier Hospital, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK.
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Kagan KO, To M, Tsoi E, Nicolaides KH. Preterm birth: the value of sonographic measurement of cervical length. BJOG 2006; 113 Suppl 3:52-6. [PMID: 17206965 DOI: 10.1111/j.1471-0528.2006.01124.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Transvaginal ultrasound scanning of cervical length at approximately 20 weeks of gestation in women attending for routine antenatal care is useful for predicting the likelihood of spontaneous early preterm birth. The risk of early birth increases exponentially with decreasing cervical length in both singleton and multiple pregnancies. In such women, individualization of risk would lead to rationalisation of antenatal care, including frequency of visits, patient education in recognising and reporting symptoms of spontaneous preterm labour and timely administration of steroids. It is also possible that in women identified as being at high risk, the rate of preterm birth might be reduced by the prophylactic use of progesterone. In women presenting with threatened spontaneous preterm labour, transvaginal measurement of cervical length provides a useful distinction between those who are likely to deliver within the subsequent 7 days and those who are not. Since only 10-20% of such women are in true spontaneous preterm labour, the cervical length measurement in rational care can avoid the current practice of hospitalisation and administration of steroids and tocolytics to all. This article reviews the evidence in support of the clinical introduction of transvaginal sonography for both the prediction and management of spontaneous preterm labour.
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Affiliation(s)
- K O Kagan
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, UK
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20
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Tsoi E, Fuchs I, Henrich W, Dudenhausen JW, Nicolaides KH. Sonographic measurement of cervical length in preterm prelabor amniorrhexis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:550-553. [PMID: 15386608 DOI: 10.1002/uog.1122] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To determine whether sonographic measurement of cervical length in pregnancies complicated by preterm prelabor amniorrhexis helps distinguish between those women who deliver within 7 days and those who do not. METHODS In 101 women with singleton pregnancies presenting with preterm prelabor amniorrhexis at 24-36 (median, 32) weeks of gestation cervical length was measured by transvaginal ultrasound. Exclusion criteria were active labor defined by the presence of cervical dilatation of > or = 3 cm and iatrogenic delivery for fetal or maternal indication when not in active labor. The clinical management was determined by the attending obstetrician. The primary outcome of the study was delivery within 7 days of presentation. RESULTS Delivery within 7 days of presentation occurred in 58/101 (57%) pregnancies. Logistic regression analysis demonstrated that significant independent contribution in the prediction of delivery within 7 days was provided by cervical length (odds ratio (OR) = 0.91, 95% CI 0.86-0.96, P = 0.001), gestation at presentation (OR = 1.35, 95% CI 1.14-1.59, P = 0.001) and presence of contractions at presentation (OR = 3.07, 95% CI 1.05-8.92, P = 0.039) with no significant independent contribution from ethnic origin, maternal age, body mass index, parity, previous history of preterm delivery, cigarette smoking, vaginal bleeding or the administration of tocolytics, antibiotics or steroids. CONCLUSION In women with preterm prelabor amniorrhexis prediction of delivery within 7 days is provided by cervical length, gestation and presence of contractions at presentation.
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Affiliation(s)
- E Tsoi
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Yoon BH, Romero R, Shim JY, Shim SS, Kim CJ, Jun JK. C-reactive protein in umbilical cord blood: a simple and widely available clinical method to assess the risk of amniotic fluid infection and funisitis. J Matern Fetal Neonatal Med 2004; 14:85-90. [PMID: 14629087 DOI: 10.1080/jmf.14.2.85.90] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether concentrations of C-reactive protein (CRP) in umbilical cord plasma at birth were elevated in neonates with sepsis, an inflammatory lesion of the umbilical cord (funisitis) or who were born to mothers with microbial invasion of the amniotic cavity. METHODS Umbilical cord plasma was collected at birth from 313 singleton preterm neonates (20-35 weeks of gestation). The results of amniotic fluid culture performed within 5 days of birth, the occurrence of congenital neonatal sepsis and the presence of funisitis were assessed. Amniocentesis was performed in 152 patients within 5 days of birth. Amniotic fluid was cultured for aerobic and anaerobic bacteria and for mycoplasmas. The CRP concentration was measured with a highly sensitive immunoassay. RESULTS The median cord plasma CRP concentration was significantly higher in neonates with a positive amniotic fluid culture than in those with negative culture (median 245.9 (range 11.6-4885.5) ng/ml vs. median 44.3 (range 2.3-7401.8) ng/ml; p < 0.001), in those with congenital proven sepsis than in those without this complication (median 789.5 (range 20.4-2584.3) ng/ml vs. median 41.5 (range 1.3-7401.8) ng/ml; p < 0.005) and in neonates with funisitis than in those without funisitis (median 403.8 (range 4.9-10897.4) ng/ml vs. median 31.0 (range 1.3-7401.8) ng/ml; p < 0.001). The sensitivity of CRP in the identification of amniotic fluid infection, neonatal sepsis and funisitis was similar to that of interleukin-6 (> 17.5 pg/ml). However, the specificity of CRP in the identification of neonatal sepsis and funisitis was significantly higher than that of interleukin-6 (74% vs. 69%, p < 0.05; 83% vs. 76%, p < 0.01). CONCLUSION Umbilical cord plasma CRP concentrations were elevated in patients with amniotic fluid infection, congenital neonatal sepsis and funisitis.
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Affiliation(s)
- B H Yoon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Laboratory of Fetal Medicine Research, Clinical Research Institute, Seoul, Korea
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Gire C, Faggianelli P, Nicaise C, Shojai R, Fiori A, Chau C, Boubli L, D'Ercole C. Ultrasonographic evaluation of cervical length in pregnancies complicated by preterm premature rupture of membranes. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:565-569. [PMID: 12047535 DOI: 10.1046/j.1469-0705.2002.00666.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To evaluate the usefulness of transvaginal ultrasonography in the determination of the risk of preterm delivery and chorioamnionitis in pregnancies affected by preterm premature rupture of membranes preterm premature rupture of membranes. DESIGN One hundred and one singleton pregnancies with preterm premature rupture of membranes were included in this prospective study over a 3-year period. Patients underwent cervical length measurement by transvaginal ultrasonography at admission and thereafter, in the absence of chorioamnionitis, were managed expectantly. RESULTS The median time interval between admission and delivery (latency period) was 48 h. A cervical length of less than 20 mm was associated with a significant risk of early delivery (mean latency period was 59.44 +/- 159.93 h vs. 240.94 +/- 364.67; P < 0.05). There was no relation between cervical length and occurrence of chorioamnionitis or neonatal sepsis. CONCLUSIONS These data suggest that the use of transvaginal ultrasonography for cervical length measurement during preterm premature rupture of membranes may predict an early delivery but cannot anticipate the risk of chorioamnionitis or neonatal sepsis.
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Affiliation(s)
- C Gire
- Service de Pédiatrie, Hôpital Nord, Pavillon Mère-enfants, Marseille, France.
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Sebire NJ. Choriodecidual inflammatory syndrome (CoDIS) is the leading, and under recognised, cause of early preterm delivery and second trimester miscarriage. Med Hypotheses 2001; 56:497-500. [PMID: 11339855 DOI: 10.1054/mehy.2000.1204] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Severe preterm birth (delivery before 32 completed weeks of gestation), with or without preterm premature rupture of the membranes (PPROM), remains the leading cause of perinatal mortality. It is proposed that localized inflammation of the chorion and decidua in the membranes immediately above the internal cervical os, with or without amniotic cavity infection and inflammation, is the leading, but under recognised, cause of second trimester miscarriage and severe preterm delivery. The term 'CoDIS' (choriodecidual inflammatory syndrome), may provide a better understanding of the underlying pathophysiology than currently used terminology which over emphasizes the importance of overt intra-amniotic infection as opposed to localized extra-amniotic inflammation which stimulates uterine evacuation.
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Affiliation(s)
- N J Sebire
- Department of Histopathology, St Mary's Hospital, Paddington, London, UK
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24
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Heath VC, Daskalakis G, Zagaliki A, Carvalho M, Nicolaides KH. Cervicovaginal fibronectin and cervical length at 23 weeks of gestation: relative risk of early preterm delivery. BJOG 2000; 107:1276-81. [PMID: 11028581 DOI: 10.1111/j.1471-0528.2000.tb11620.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To establish the prevalence of cervicovaginal fetal fibronectin positivity at 23 weeks of gestation in a routine population of singleton pregnancies and determine the relative risk of spontaneous delivery before 33 weeks in women with a fibronectin positive result. DESIGN Prospective clinical study. SETTING Inner city antenatal clinic. POPULATION Singleton pregnancies attending for routine antenatal care. METHODS Cervicovaginal fetal fibronectin and cervical length were measured at 23 weeks of gestation. The distribution of fibronectin positivity within subgroups according to maternal characteristics was calculated and the relative risk of spontaneous delivery before 33 weeks was estimated. MAIN OUTCOME MEASURES Prevalence of a fibronectin positive result and its relation to cervical length measurement and spontaneous preterm delivery before 33 weeks. RESULTS Of 5,146 women participating in the study, 182 (3.5%) had a fibronectin positive result and 76 (1.5%) had a cervical length of < 15 mm. Fibronectin positive women were more likely to be Afro-Caribbean in origin, to have had a previous second trimester miscarriage and to have a short cervix. In the 5,068 women who were managed expectantly, the significantly independent relative risk of spontaneous delivery at < 33 weeks was 46.2 (95% CI 18.8-113.6), for cervical length of < or = 15 mm, 8.1 (95% CI 3.8-17.5) for a fibronectin positive result, and 4.4 (95% CI 2.2-9.1) for cigarette smoking. CONCLUSION Fibronectin positivity at 23 weeks of gestation provides useful prediction of pregnancies at risk of spontaneous preterm delivery before 33 weeks, with a relative risk that is twice as high as cigarette smoking, but is a sixth of that of cervical length.
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Affiliation(s)
- V C Heath
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, Denmark Hill, UK
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25
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Blackwell SC, Berry SM. Role of amniocentesis for the diagnosis of subclinical intra-amniotic infection in preterm premature rupture of the membranes. Curr Opin Obstet Gynecol 1999; 11:541-7. [PMID: 10674829 DOI: 10.1097/00001703-199912000-00001] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The clinical role of amniocentesis in the management of pregnancies that are complicated by preterm premature rupture of the membranes remains unclear. The indiscriminant use of expectant management, corticosteroids, and empiric antibiotic therapy without knowledge of the presence or absence of intra-amniotic infection poses underappreciated risks to the fetus. This clinical opinion presents the argument that amniocentesis should be an integral part of the management of patients with preterm premature rupture of the membranes. The technical aspects of amniocentesis, the associations between subclinical infection and neonatal morbidity, and the limitations of current interventions are reviewed, and suggestions for future studies that are sorely needed are offered.
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Affiliation(s)
- S C Blackwell
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan 48201, USA
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26
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Greig PC. The diagnosis of intrauterine infection in women with preterm premature rupture of the membranes (PPROM). Clin Obstet Gynecol 1998; 41:849-63. [PMID: 9917940 DOI: 10.1097/00003081-199812000-00009] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P C Greig
- Center for Women's Medicine, Greenville Hospital System, South Carolina, USA
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27
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Abstract
Preterm premature rupture of the fetal membranes is associated with 30-40% of premature births and is an important cause of perinatal morbidity and mortality. Although the major causes of neonatal death associated with PPROM include prematurity complications, infection, and pulmonary hypoplasia, rupture in a preterm gestation also is associated with an increase in morbidity, including cerebral palsy, other developmental delays, as well as chronic lung disease. When PPROM occurs, antibiotic prophylaxis has been shown to reduce the potential for complications and should be considered. Neonates treated intrapartum with antibiotics should have fewer complications, a longer latency period, and an improved long-term outlook compared with those without antepartum or intrapartum prophylaxis.
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Affiliation(s)
- J M Ernest
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Abstract
Recent technological advances have led to the development of several types of invasive procedures in the fetus principally for the diagnosis and management of fetal disorders. The risk of infection to the fetus related to these procedures needs evaluation. Although there are few reports of fetal infection, proper infection control procedures must be observed because the most common consequence of infection is fetal loss. Fetal blood sampling in the presence of chorioamnionitis is a risk factor that warrants prophylactic antibiotics. Conversely, clinical specimens taken from the fetus in the absence of chorioamnionitis are more likely to become contaminated with maternal skin flora, and a positive fetal blood culture is not necessarily significant. There is probably a small but finite risk of transmission of maternal viral infections such as human immunodeficiency virus, hepatitis B and C, cytomegalovirus and herpes simplex during invasive procedures. Obstetric departments undertaking invasive fetal diagnosis and treatment must have an adequate policy for infection control procedures.
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Affiliation(s)
- M R Workman
- Department of Medical Microbiology, Dulwich Public Health Laboratory, King's College School of Medicine and Dentistry, London, UK
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29
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Beazley D, Lewis R. The evaluation of infection and pulmonary maturity in women with premature rupture of the membranes. Semin Perinatol 1996; 20:409-17. [PMID: 8912995 DOI: 10.1016/s0146-0005(96)80008-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Although the etiology of PROM is multifactorial, increasing evidence regarding clinical risk factors, membrane histology, membrane culture, and amniotic fluid microbiology shows a strong association with infection. Recent studies suggest an association between genital tract infection, preterm labor (PTL), and preterm premature rupture of the membranes (pPROM). If correct, this information may be used to target areas for prevention, as well as to develop management protocols. This article reviews both the diagnostic tests for the causes associated with pPROM and the evaluation of intraamniotic infection and pulmonary maturity in patients with pPROM.
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Affiliation(s)
- D Beazley
- Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103, USA
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Carroll SG, Papaioannou S, Ntumazah IL, Philpott-Howard J, Nicolaides KH. Lower genital tract swabs in the prediction of intrauterine infection in preterm prelabour rupture of the membranes. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1996; 103:54-9. [PMID: 8608099 DOI: 10.1111/j.1471-0528.1996.tb09515.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To examine the genital tract flora in women with preterm prelabour rupture of the membranes and to determine the relationship of these microorganisms to those found in fetal blood and amniotic fluid. DESIGN Prospective study of 97 patients with preterm prelabour rupture of the membranes. SETTING Maternal-fetal medicine centre. METHODS High vaginal and endocervical swabs were taken for routine culture of aerobic and anaerobic bacteria and Ureaplasma urealyticum and Mycoplasma hominis. Cordocentesis and amniocentesis were performed and fetal blood and amniotic fluid were cultured for aerobic and anaerobic bacteria. Amniotic fluid was also cultured for Mycoplasma spp. The sensitivities and specificities of genital tract colonisation in the prediction of fetal blood and amniotic fluid infection were calculated. RESULTS Positive genital tract cultures for aerobic and anaerobic organisms predicted 40% of positive fetal blood and 53% of positive amniotic fluid cultures with false positive rates of 24% and 25%, respectively. The sensitivity and false positive rates for genital tract colonisation with Mycoplasma spp in the prediction of amniotic fluid infection with these organisms were 85% and 35%, respectively. CONCLUSIONS In preterm prelabour rupture of the membranes lower genital tract cultures provide poor prediction of intrauterine infection.
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Affiliation(s)
- S G Carroll
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London
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