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PubMed1986

[Bacteriological and clinical studies of premature rupture of the membranes].

Cases of premature rupture of the membranes (PROM) were subjected to bacteriological examination of lower genital organs and their clinical courses were analyzed. The results obtained were summarized below. From lower genital organs of cases examined at the 24th-36th week of pregnancy, Gram-positive or Gram-negative aerobes were detected at a high rate in both the group without PROM (-) and the group with PROM (+). From patients in the group with PROM + chorioamnionitis (CAM) anaerobes as well as aerobes were detected at especially high rates. Many patients with PROM (+CAM) were administered with penicillin-antibiotics orally or parenterally. Clinical analysis showed effectiveness of these antibiotics which were especially effective when administered intravenously. The oral administration produced inferior results to the injection judging from clinical results. Patients with PROM and infection during the puerperal period were examined. They were found to include 15 cases of intrauterine infection and 6 cases of puerperal fever. Patients who started showing infectious symptoms at a later time than 8 hours after the onset of PROM tended to have a higher frequencies of infections. The rate of occurrence of cases requiring cesarean section was higher in this group than in the group where infectious symptoms started within 8 hours after PROM.

Cervix Uteri↗
PubMed1985

The stillborn fetus: placental histologic examination in determining a cause.

This investigation was undertaken to determine whether or not histologic examination of the placenta contributed to a better understanding of the cause for an intrauterine fetal death. The placentas of stillborn fetuses delivered after the 20th gestational week were examined during a 4.5-year period (January 1979 to June 1983). Adequate information about the clinical history, autopsy examination, and placental histological examination was available in 89 cases. Delivery was usually within the first week after the fetal death. Significant histologic aberrations in the placenta were found in 87 (98%) cases. The most frequent abnormalities were those of vascular insufficiency, hemorrhagic endovasculitis, retroplacental hematomata, acute chorioamnionitis with fetal involvement, and erythroblastosis/hydrops. Histologic abnormalities were supportive of prior impressions in 67 (77%) cases, contradictory to prior impressions in ten (11%) cases, or the sole contributors in explaining the cause of death in ten (11%) cases. Routine histologic examination of the placenta after a recent fetal death provides helpful information in counseling the parents and in planning any future childbearing.

Chorioamnionitis↗
PubMedDate not supplied

[Chorioamniotic infections following diagnostic amniocentesis in the 2d trimester].

Between 1978 and 1984 we performed 3 122 amniocentesis for prenatal diagnosis in second trimester. Based on a four week follow-up in more than 96% of all amniocentesis the percentage of fetal loss was 0.74% (n = 23). In 13 cases abortion was accompanied by chorioamnionitis. These cases were examined for various technical details and it could be concluded, that the incidence of febrile abortion is related to the early gestational age for amniocentesis. On the other hand, multiple insertions or the localisation of placenta both show no relation to the short-time febrile complications. To investigate the maternal-fetal transfer of mezlocillin, a single dose of 5 g mezlocillin was administered intravenously in 25 patients. In amniotic fluid mezlocillin levels exceeded 2 micrograms/ml nearly 120 minutes after administration. These pharmacokinetic data suggest, that a prophylactic regimen with antibiotics in the course of amniocentesis seems not to be beneficial for the prevention of chorio-amniotic infections.

Abortion, Septic↗
PubMedDate not supplied

[Premature rupture of membranes at term. Retrospective study of 88 cases].

A retrospective study enabled us to evaluate the "wait-and-see" attitude adopted in our department in case of premature rupture of the membranes at term. The series included 88 patients (9.74%) who delivered spontaneously or after induction. The following maternal parameters were studied:time between rupture and delivery, pyrexia and chorioamnionitis number of vaginal digital examinations, histology and placental bacteriology. Neonatal criteria were based upon an infection assessment. Our results showed that approximately 80% of patients were in labor within 24 hours following rupture. Cesarean section rate remained stable (13%) in comparison with the overall rate for the department. Neonatal infectious morbidity (5.7%) showed no increase. The incidence of chorioamniotitis did not vary (7 cases) but appeared to be related to the number of vaginal examinations before labor. In conclusion, our attitude of temporization did not result in any increase in the number of cesarean sections nor of neonatal infections in comparison with the general population in the department. Prostaglandins might be useful in unfavorable obstetric situations.

Adult↗
PubMed1995

Amnionitis and premature delivery with intact amniotic membranes involving Staphylococcus aureus. A case report.

Subclinical infection is suspected to be an important etiologic factor in the initiation of preterm labor in women with intact membranes. We present a case of acute clinical chorioamnionitis followed by preterm labor and fetal distress in a woman with intact membranes. The bacteriologic data on the mother and neonate clearly identified coagulase-positive Staphylococcus aureus as the etiologic factor.

Adult↗
PubMed1994

Preterm labor and congenital candidiasis. A case report.

Intrauterine infection with Candida is a rare complication of pregnancy. We report a case of preterm labor associated with Candida chorioamnionitis and the subsequent delivery of an infant with congenital Candida infection. We also discuss possible factors responsible for the increased invasiveness of this usually benign condition and management considerations once the diagnosis is made.

Adult↗
PubMed1994

[Evaluation of changes in IL-6 in gynecological infections].

We administered imipenem/cilastatin sodium (IPM/CS) to patients with gynecological infections as initial treatment and evaluated changes in blood interleukin 6 (IL-6) as an infection marker. 1. The subjects consisted of 7 patients with chorioamnionitis, 4 with intrauterine infections, and 1 with subcutaneous abscess. IPM/CS (1-2 g/day) was intravenously drip infused. This therapy was markedly effective in 1 patient and effective in 11; the response rate was 100%. 2. IL-6 generally began to decrease earlier than CRP. Before drug administration, correlations were observed between IL-6 and CRP (r = 0.946) between IL-6 and elastase (r = 0.355), and between elastase and CRP (r = 0.579). During the entire course, correlations were observed between IL-6 and CRP (r = 0.581), between IL-6 and elastase (r = 0.303), and between elastase and CRP (r = 0.776). These results suggest that blood IL-6 reflects early the pathologic state and treatment effects, and is a useful infection marker in gynecological infections.

Adult↗
PubMedDate not supplied

Haemophilus influenzae intra-amniotic infection with intact membranes.

BACKGROUND: Amnionitis rarely occurs with intact membranes. Haemophilus influenzae is a rare pathogen in intra-amniotic infection, but its importance and prevalence could be increasing, as reflected by the growing number of reported cases in the last 20 years. METHODS: Using the key words "amnionitis," "intra-amniotic infection," "chorioamnionitis," and "Haemophilus influenzae," we searched MEDLINE files from 1980 to the present. Articles dating before 1980 were accessed from cross-reference of the more recent studies. RESULTS AND CONCLUSIONS: H. influenzae, a nonmotile, aerobic, gram-negative rod-shaped bacteria, is primarily responsible for respiratory tract infections in children and neonatal meningitis; it has a low prevalence rate in genital tract cultures but a high attack rate of infection in mothers and neonates. With intact membranes, intra-amniotic infection occurs rarely and is thought to be caused by hematogenous transplacental seeding, direct invasion of the fetal membranes, or inoculation of the amniotic fluid during an invasive procedure. It can also be idiopathic. It occurs most often in the second and early third trimesters and can be definitively diagnosed by a positive amniotic fluid culture or positive maternal or neonatal blood cultures and clinical evidence of intra-amniotic infection. We present a case of intra-amniotic infection with intact membranes at 15 to 16 weeks in a patient with clinical evidence of intra-amniotic infection and positive blood cultures whose infection was treated successfully with antibiotics, prolonging her pregnancy by 16 weeks. Physicians caring for obstetric patients must be vigilant in diagnosing intra-amniotic infection, even with intact membranes, and this infection should be considered in the differential diagnoses for acute abdomen in pregnancy.

Adult↗
PubMed1994

[Recent status of group B streptococcal (GBS) infection of newborn in Japan].

Group B streptococcal (GBS) infections in neonates have been a leading cause of bacterial infections. In many cases the infected neonates and young infants died or sequelae remained. The trend of cases, risk factors and prognosis of this disease have been the subjects of questionnaires for the past 5 years in Japan. The number of cases has increased year by year. Risk factors including amniotic turbidity, chorioamnionitis, premature rupture of membrane and fever during labor were recognized in 58% of early onset (less than 7 days of age) and in 28% of late onset (7 days and more of age) infant disease. Cases of death and remaining sequelae were 63(20.8%) of 303 early onset, 27(39.1%) of 69 late onset and 90(24.2%) out of a total of 372 cases. These results suggested that strategies for the prevention of GBS infections in the newborn are necessary.

Chorioamnionitis↗
PubMed1993

Pregnancy outcome after expectant management of premature rupture of the membranes in the second trimester.

Because management of premature rupture of the membranes (PROM) at or before 26 weeks is controversial, we examined maternal and perinatal outcome after expectant management of 44 pregnancies complicated by this problem. Mean gestational age at preterm PROM was 23.9 +/- 1.7 (SD) weeks. The latency period between preterm PROM and delivery ranged from 1 to 68 days, with a medium of 6. Of the patients, 54.6% delivered within a week of PROM, and 79.5% delivered by four weeks; 77.2% developed chorioamnionitis, but despite this high incidence, there was no maternal sepsis or pelvic thrombophlebitis, and no maternal surgery was necessary. Perinatal outcome was 60.5% neonatal survival, 54.2% perinatal survival and a stillbirth rate of 10.4%. Respiratory distress syndrome, bronchopulmonary dysplasia, sepsis and intraventricular hemorrhage were common types of neonatal morbidity. There was no pulmonary hypoplasia, and limb deformity was seen in only two neonates. Costs of expectant management in pregnancies complicated by second-trimester PROM were estimated, and a strategy to reduce cost is suggested.

Adult↗
PubMed1993

[Congenital candida infections].

Congenital candida infection is a rare disease, although the incidence of candida vaginitis during pregnancy is high. We report on five cases each showing patterns considered typical for candida infection. The infective agent can cause chorioamnionitis even in the presence of intact fetal membranes. An intrauterine device (IUD) has been proved to be a risk factor for a congenital candida infection. The pathogenetic significance of contamination with candida for the fetus appears to depend largely on gestational age. A premature infant with a birth-weight less than 1500 g presented with bilateral candida endophthalmitis which was cured by intravenous Fluconazole therapy. Another premature infant weighing 800 g at birth developed a systemic candida infection. The other three more mature infants had milder symptoms, two of them presented with cutaneous candidiasis.

Adult↗
PubMed1993

[Clinical pharmacokinetics of ceftriaxone during the third trimester of pregnancy and study of its transplacental passage in two patients].

The purpose of this study was to determine ceftriaxone (CTX) pharmacokinetics during pregnancy. Six women (26 to 34 years of age) admitted for chorioamnionitis (n = 4) or pyelonephritis (n = 2) were included. Gestational age ranged from 29 1/7 to 40 5/7 weeks. Initial intravenous treatment was ceftriaxone (CTX) (2 g/d), tobramycin (3 mg/kd/d) and ornidazole (1 g/d). Blood specimens were collected during the first treatment day (D1) to determine the primary pharmacokinetic profile of CTX then at steady-state (D7) to look for systemic accumulation. In two patients, transplacental passage of CTX was evaluated by determining the ratio of fetal and maternal concentrations (F/M) at delivery. Plasma CTX levels were determined using high-performance liquid chromatography. A noncompartmental method was used for pharmacokinetic analysis. Each patient served as her own control. Data obtained on D1 and D7 were compared using Wilcoxon's test (values of p < or = 0.05 were considered significant). A group of healthy controls given a similar regimen was also used. 1) Tolerance was outstanding, recovery was achieved in every case, and there were no premature deliveries. 2) No evidence of accumulation of CTX was found and kinetic profiles on D1 and D7 were not significantly different. 3) Mean kinetic parameter values were closely similar to those found in healthy volunteers. 4) Residual levels of total CTX and free CTX determined after 24 hours were greater than the minimal inhibitory concentration (MICs) of susceptible organisms. 5) The usual recommended dosage of CTX (2 g/d) proved adequate during the third trimester of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Microbial invasion of the amniotic cavity during term labor. Prevalence and clinical significance.

The purpose of this study was to determine the prevalence and clinical significance of microbial invasion of the amniotic cavity during spontaneous parturition at term. Amniotic fluid was retrieved by transabdominal amniocentesis from 90 women in spontaneous term labor with intact membranes. Fluid was cultured for aerobic and anaerobic bacteria, including Mycoplasma. The prevalence of positive amniotic fluid cultures was 18.8% (17/90). The most common microbial isolates were Ureaplasma urealyticum, Streptococcus agalactiae, Lactobacillus species and Mycoplasma hominis. Clinical signs of chorioamnionitis were present in three patients, and only one of them had a positive amniotic fluid culture. Five patients (5.5%) had puerperal endometritis; three of them had an amniotic fluid culture positive for microorganisms. All neonates were free of clinical signs of infection. The data indicate that microbial invasion of the amniotic cavity occurs frequently during spontaneous labor at term, and it may be both the cause and the consequence of labor.

Adolescent↗
PubMed1993

[Value of perinatal characteristics for diagnosis of perinatal infections].

A retrospective case control study was performed in order to evaluate the diagnostic validity of clinical and paraclinical signs for early detection of neonatal sepsis. The perinatal data of 45 newborns with sepsis on day 1 or 2 (early perinatal sepsis) after birth were compared with those of 34 newborns with sepsis on day 3 and 4 (late perinatal sepsis) and with 87 newborns as controls. The groups were comparable in respect of birth weight (1,972-2,114 g), gestational age (33.3-33.5 weeks), gender (prevalence of male), frequency of prematures (82-91%) and mode of delivery. In cases of early perinatal sepsis a significant higher incidence of fetal tachycardia was found (heart rate > 160/min in 50% versus 5% in late perinatal sepsis and 8% in controls respectively), of reduced fetal heart oscillation (56% versus 14 and 38%) and of loss of acceleration (76% versus 56 and 20%) in the CTG ante partum. Therefore, these signs have proved to have a better diagnostic validity for infection than premature rupture of membranes, a prolonged rupture of membranes and the chorioamnionitis. Another predominant finding was the significant greater need for resuscitation due to asphyxia (48% in early sepsis versus 14 and 7%) despite missing differences in pH of blood in umbilical artery at birth (7.28 +/- 0.07). The occurrence of such signs supports a suspicion of a fetal sepsis.

Bacteremia↗
PubMed1993

[Significance of amniotic fluid cytokines measurement in threatened preterm labor and premature rupture of the membranes].

The purpose of this study was to elucidate the significance of measurements of cytokines in the amniotic fluid. Amniotic fluid was retrieved by transabdominal amniocentesis from 113 women in the following groups: Preterm labor (N = 58), PROM (N = 21) and term elective C/S (N = 34). Tumor necrosis factor alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta), were measured with a commercially available ELISA. Interleukin-6 (IL-6) was measured by bioassay and newly developed "luminescencer EIA". 1. Amniotic fluid concentrations of TNF-alpha, IL-1 beta and IL-6 in cases of term elective C/S were 22.8 +/- 19.2 pg/ml, 8.1 +/- 5.2 pg/ml and 166.8 +/- 126.1 pg/ml, respectively. 2. Significantly higher levels of TNF-alpha, IL-1 beta, IL-6 were found among the cases who failed to respond to tocolysis (i.e. delivery within 48 hrs of amniocentesis). In contrast, no significant difference in such conventional markers of infection as maternal serum CRP was noted. 3. According to the degree of histopathologic chorioamnionitis (Blanc), significantly higher concentrations of IL-1 beta, IL-6 were found among the of stage III cases than those in stage II irrespective of the rupture of the membranes (IL-1 beta: 1.36 +/- 0.41 ng/ml vs 76.6 +/- 20.1 pg/ml, IL-6: 31.98 +/- 4.55 ng/ml vs 5.22 +/- 0.92 ng/ml). Significant correlation was also found between the concentrations of IL-1 beta, IL-6 and the pathological degree of funitis (Nakayama, stage 0 < stage I, stage II < stage III).(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Threatened↗
PubMed1995

Amnioinfusion for preventing puerperal infection. A prospective study.

OBJECTIVE: To evaluate the hypothesis that irrigation of the uterine cavity by amnioinfusion in women with membranes ruptured for greater than six hours would decrease maternal puerperal infection. STUDY DESIGN: We designed a prospective study at three teaching institutions. Sixty-eight women were randomized to receive either amnioinfusion or routine care. Amnioinfusion was through preexisting internal uterine pressure catheters with a 300-500-mL bolus and a 125-150 mL/h constant drip. Chorioamnionitis and endometritis were evaluated as the outcome variables. RESULTS: Women from the amnioinfusion group, n = 36, and the control group, n = 32, had similar times in labor (mean 4 hours), times of ruptured membranes (mean 18 hours), vaginal examinations (mean 7), gestational age (mean 40 weeks), types of anesthesia and methods of delivery. Women who received amnioinfusion had significantly less puerperal infection, 9/36, as compared to women in the control group, 16/32 (P < .033, relative risk = .5, confidence interval .26-.94). There were no cases of neonatal sepsis in either group, and there were no complications from the amnioinfusions. CONCLUSION: In this study of women at high risk for puerperal infection, amnioinfusion was an inexpensive and safe technique for reducing the incidence of infection.

Adolescent↗
PubMed1996

Premature rupture of membranes in the second trimester.

Spontaneous rupture of membranes during the second trimester presents difficult medical and ethical questions for the patient and physician. Such pregnancies are at high risk for preterm birth, chorioamnionitis, and neonatal complications. Treatment can range from expectant management to pregnancy termination. This case presentation describes a patient with premature rupture of membranes at 21 weeks' gestation who gave birth at 35 weeks.

Adrenal Cortex Hormones↗