Impact of microbial invasion of amniotic cavity and the type of microorganisms on short-term neonatal outcome in women with preterm labor and intact membranes

INTRODUCTION

The objective of this study was to evaluate the impact of microbial invasion of the amniotic cavity and the type of microorganisms on pregnancy and short-term neonatal outcomes in women with preterm labor.

MATERIAL AND METHODS

Prospective observational cohort study including women with preterm labor from 22.0 to 36.0 weeks. Microbial invasion of the amniotic cavity was defined based on amniotic fluid aerobic/anaerobic/mycoplasma cultures, and intra-amniotic inflammation on amniotic fluid interleukin-6 levels. Demographic data and pregnancy outcomes were compared among women exposed to microbial invasion of the amniotic cavity by Ureaplasma spp., women with microbial invasion of the amniotic cavity by other microorganisms, and a No-microbial invasion of the amniotic cavity/No-intra-amniotic inflammation group. The short-term neonatal outcome was evaluated in women delivering after 24.0 weeks.

RESULTS

We included 228 women with preterm labor. Microbial invasion of the amniotic cavity occurred in 35% (80/228), 28% (22/80) being caused by Ureaplasma spp. Gestational age at admission and at delivery were significantly earlier and the rate of delivery at <24.0 weeks' gestation and of women who further developed clinical chorioamnionitis were significantly higher in women with microbial invasion of the amniotic cavity by microorganisms other than Ureaplasma spp. However, after 24 weeks, regardless of the microorganisms isolated, the short-term neonatal outcome was similar between women exposed to microbial invasion of the amniotic cavity and the No-microbial invasion of the amniotic cavity/No-intra-amniotic inflammation group when gestational age was considered.

CONCLUSIONS

Microbial invasion of the amniotic cavity by microorganisms other than Ureaplasma spp. was associated with earlier gestational age at admission and at delivery, and a higher rate of preterm delivery <24.0 weeks and of women who developed clinical chorioamnionitis. However, we did not find differences in the short-term neonatal outcome between women exposed to microbial invasion of the amniotic cavity and the no-microbial invasion of the amniotic cavity/no-intra-amniotic inflammation group delivering after 24.0 weeks' gestation when adjusted by gestational age at delivery.

Gestational age is more important for short-term neonatal outcome than microbial invasion of the amniotic cavity or intra-amniotic inflammation in preterm prelabor rupture of membranes

INTRODUCTION

The aim of this study was to evaluate, in women with preterm prelabor rupture of membranes (PPROM), the impact on short-term neonatal outcome of microbial invasion of the amniotic cavity (MIAC), intra-amniotic inflammation (IAI), and the microorganisms isolated in women with MIAC, when gestational age is taken into account.

MATERIAL AND METHODS

Prospective cohort study. We included women with PPROM (22.0-34.0 weeks of gestation) with available information about MIAC, IAI and short-term neonatal outcome. MIAC was defined as positive aerobic/anaerobic/genital Mycoplasma culture in amniotic fluid. Definition of IAI was based on interleukin-6 levels in amniotic fluid. Main outcome measures were Apgar score <7 at 5 min, umbilical artery pH ≤7.0, days in the neonatal intensive care unit, and composite neonatal morbidity, including any of the following: intraventricular hemorrhage grade III-IV, respiratory distress syndrome, early-onset neonatal sepsis, periventricular leukomalacia, necrotizing enterocolitis, and fetal or neonatal death. Labor was induced after 32.0 weeks if lung maturity was confirmed; and otherwise after 34.0 weeks.

RESULTS

MIAC and IAI were found in 38% (72/190) and 67% (111/165), respectively. After adjustment for gestational age at delivery, no differences in short-term neonatal outcome were found between women with either MIAC or IAI, compared with the non-infection/non-inflammation ("No-MIAC/No-IAI") group. Furthermore, short-term neonatal outcome did not differ between the MIAC caused by Ureaplasma spp. group, the MIAC caused by other microorganisms group and the "No-MIAC/No-IAI" group.

CONCLUSIONS

Gestational age at delivery seems to be more important for short-term neonatal outcome than MIAC or IAI in PPROM.

Atmospheric concentrations, occurrence and deposition of persistent organic pollutants (POPs) in a Mediterranean coastal site (Etang de Thau, France)

Atmospheric concentrations and deposition fluxes of PCDD/F and PCB have been evaluated over a 1-year period in a Mediterranean coastal lagoon (Etang de Thau, France). Indicative PBDE air concentrations in the hot season are also reported in this work. ∑2,3,7,8-PCDD/Fs and ∑18PCBs (gas+particulate) air concentrations ranged from 67 to 1700 fg m(-3) and from 13 to 95 pg m(-3), respectively whereas ∑8PBDEs (gas+particulate) summer time levels varied from 158 to 230 pg m(-3). The PCDD/F and PCB atmospheric occurrence over Thau lagoon and subsequent inputs to the surface waters are determined by an assemble of factors, being the seasonality of atmospheric concentration, the air mass origin and meteorological conditions important drivers. Total (wet+dry) ∑2,3,7,8-PCDD/Fs and ∑18PCBs deposition fluxes to Thau Lagoon waters are 117 and 715 pg m(-2)d(-1), respectively.

Assessment of the environmental and physiological processes determining the accumulation of organochlorine compounds in European mountain lake fish through multivariate analysis (PCA and PLS)

The presence of organochlorine compounds (OCs)-namely hexachlorobenzene (HCB), hexachlorocyclohexanes (HCH), polychlorobiphenyls (PCBs #28, 52, 101, 118, 138, 153 and 180), dichlorodiphenyltrichloroethane (DDT) and dichlorodiphenyldichloroethane (DDE)-was examined in various fish tissues (muscle and liver) sampled in 23 mountain lakes in Europe. The dependence of these organochlorine compounds on geographical parameters (altitude, longitude, latitude and temperature) and physiological parameters (lipid content, age, weight and size) was assessed. Principal components analysis (PCA) and partial least squares (PLS) models were used for the analyses. PCA results showed that organochlorine compound concentrations in fish tissues increased with increasing altitude and decreasing temperatures. This trend appeared to be more marked for the less volatile compounds. Some differences were found between the muscle and liver in the effects of the percentage of lipids on the accumulation of organochlorine compounds and the behaviour of HCB. Moreover, PCBs tended to accumulate more in liver rather than in muscle. PCA scores clearly differentiated samples according to the lake of origin. PLS models confirmed that temperature and altitude were the main factors influencing the accumulation of most organochlorine compounds in the lipids of the fish tissue.

[Anesthetic management of sacroiliac-vertebral echinococcosis]

Bone echinococcosis affects the spine and pelvis in 60% of cases. Bone lesions may be silent for between 10 and 20 years. The capsules progress aggressively through the medullary canal and replace the trabecular bone without forming cysts, as occurs in the organs, thus making anaplylaxis rare. The combination of chemotherapy and surgery facilitates anesthetic management and reduces the incidence of anaphylactic events and disease recurrence.

Age dependence of the accumulation of organochlorine pollutants in brown trout (Salmo trutta) from a remote high mountain lake (Redó, Pyrenees)

Polychlorobiphenyls (PCBs), hexachlorocyclohexanes (HCHs), hexachlorobenzene (HCB) and DDT were examined in the muscle of brown trout (Salmo trutta) from a high mountain lake located in the Pyrenees (Catalonia, Spain) that was used as a model of these lacustrine environments. Results indicate that fish age is the main factor of variability among specimens in this population that is subjected to atmospheric inputs of the organochlorine compounds (OC). Increases of 2- and 20-fold between fish aged 1 year and 15 years old are found. The observed pattern cannot be explained in terms of fish size, condition factor, or muscle lipid content. Higher molecular weight compounds (higher lipophilicity) are better correlated with fish age than low molecular weight compounds. A transformation from 4,4'-DDT to 4,4'-DDE occurs in fish after ingestion; this results in amplified age-dependent signals, especially in male specimens. In contrast, PCB congener #180 has lower age dependence than the general OC group, which could be due to its high hydrophobicity (log K(ow) > 7). In any case, selective accumulation of hydrophobic compounds is already observed among younger fish (age, 1 year). Due to this effect, the relative OC composition does not reflect the main OC pollutants in the lake waters.

Polycyclic aromatic hydrocarbons in fish from remote and high mountain lakes in Europe and Greenland

Polycyclic aromatic hydrocarbons (PAHs) were analysed in liver of fifty-seven individual trout distributed among seven high mountain lakes in Europe and one remote lake in Greenland. In all cases, very similar distributions were observed in which phenanthrene largely predominated and fluoranthene and pyrene were the second major compounds. These distributions were similar to those observed in the dissolved fraction of the waters studied in three of these lakes. The range of concentrations of PAH in fish liver show only a five-fold variation, which is considerably smaller than the range more than two orders of magnitude of sedimentary PAH concentrations of these lakes. No correlation between PAH content in sediments and fish liver has been found both at the level of total and individual compounds. However, lake site is the main statistically significant factor of variability between PAH concentrations in fish liver. Changes in fish species explain significant differences in liver content of some PAHs. Within lake, condition factor and liver concentration are inversely correlated. Female fish display lower average concentrations than male in all lakes but the differences are not statistically significant. No correspondence between fish age and PAH content has been observed.