Adjunctive erythromycin treatment for idiopathic preterm labor: Results of a randomized, double-blinded, placebo-controlled trial

McGregor, James A.; French, Janice I.; Reller, L. Barth; Todd, James K.; Makowski, Edgar L.

doi:10.1016/0002-9378(86)90401-1

Cited by 123 publications

(44 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Tetracycline given to abacteriuric women led to reduced prematurity [40]. Studies by McGregor et al [41] and McCormack et al [42] showed a promising effect of erythromycin treatment given to patients with U. urealyticum in the reduction of prematurity. However, in a recent collaborative study, erythromycin administered to over 1000 patients with U.…”

Section: Discussionmentioning

confidence: 97%

The role of bacterial vaginosis as a cause of amniotic fluid infection, chorioamnionitis and prematurity — a review

Martius

Eschenbach

1990

Arch Gynecol Obstet

162

View full text Add to dashboard Cite

Antepartum bacterial vaginosis in pregnancy has been related to premature delivery, the recovery of microorganisms from amniotic fluid of women in premature labor with intact membranes, to histologic chorioamnionitis and to the recovery of microorganisms from the placenta or membranes. Microorganisms associated with bacterial vaginosis are commonly recovered from the amniotic fluid and chorioamnion of patients who deliver prematurely. In addition, bacterial vaginosis is associated with maternal infectious morbidity during labor and in the postpartum period. Very little is known of the pathophysiologic mechanisms by which bacterial vaginosis may cause preterm labor and/or premature rupture of the membranes. However, it is of interest to speculate on possible mechanisms. The high concentration of potentially pathogenic microorganisms in the vagina and cervix of pregnant women with bacterial vaginosis may increase the possibility of an ascending infection via the cervix, decidua, fetal membranes, maternal placenta, and amniotic fluid. Some of the bacteria associated with bacterial vaginosis such as Bacteroides sp. are particularly virulent. Certain bacteria produce enzymes that potentially could affect the fetal membranes or maternal deciduae. Bacteroides sp. and group B streptococcus produce proteases. Protease enzymes reduce the chorioamniotic membrane strength in vitro. It is even possible that a high concentration of bacteria in the lower genital tract could produce enough proteases to weaken the fetal membrane strength causing premature rupture of the membranes. Bacterial lipases could also produce tissue injury. Schwarz et al. demonstrated that lysosomes within fetal membrane cells contain phospholipase A2 in high concentrations. Phospholipase A2 is a precursor of prostaglandin synthesis and the destruction of lysosomes within deciduae or chorioamnion cells may induce prostaglandin synthesis resulting in uterine contractions. Bejar et al. found a high rate of phospholipase A2 production by Bacteroides sp., anaerobic streptococci, Fusobacterium sp., and G. vaginalis. Benett et al. demonstrated that bacterial products of group B streptococci, viridans streptococci, Escherichia coli and Bacteroides fragilis but not of Lactobacillus sp. increase the synthesis of prostaglandins in the membranes. Thus, selected bacteria, including some closely related to bacterial vaginosis may play a role in the initiation of uterine contractions by stimulating prostaglandin synthesis. In an alternative mechanism, either the release of prostaglandin in the membrane or uterine contraction could cause microbreaks of the membrane that allow bacterial colonization of the membrane.(ABSTRACT TRUNCATED AT 400 WORDS)

show abstract

Section: Discussionmentioning

confidence: 97%

The role of bacterial vaginosis as a cause of amniotic fluid infection, chorioamnionitis and prematurity — a review

Martius

Eschenbach

1990

Arch Gynecol Obstet

162

View full text Add to dashboard Cite

show abstract

“…Randomized clinical trials of antibiotic treatment of patients with bacterial vaginosis have contradictory results [McGregor et al, 1986;1995;Hauth et al, 1995;Mercer and Arheart, 1995;McDonald et al, 1997;KurkinenRaty et al, 2000;Kekki et al, 2001]. A beneficial effect has been demonstrated in patients with a history of preterm birth, bacterial vaginosis diagnosed in the second trimester and treated with oral metronidazol and, perhaps, erythromycin [McGregor et al, 1986;1995;Hauth et al, 1995;Mercer and Arheart, 1995].…”

Section: Do We Know Enough To Guide Management?mentioning

confidence: 92%

Intrauterine infection and prematurity

Gonçalves

Chaiworapongsa

Romero

2002

Ment. Retard. Dev. Disabil. Res. Rev.

537

380

View full text Add to dashboard Cite

Intrauterine infection is a major cause of premature labor with and without intact membranes. Intrauterine infection is present in approximately 25% of all preterm births and the earlier the gestational age at delivery, the higher the frequency of intra-amniotic infection. Microorganisms may also gain access to the fetus before delivery. A fetal inflammatory response syndrome elicited in response to microbial products is associated with the impending onset of preterm labor and also with multi-systemic organ involvement in the human fetus and a higher rate of perinatal morbidity. The most common microorganisms involved in intrauterine infections are Ureaplasma urealyticum, Fusobacterium species and Mycoplasma hominis. The role of Chlamydia trachomatis and viruses in preterm labor remain to be determined. Use of molecular microbiology techniques to diagnose intrauterine infection may uncover the role of fastidious microorganisms that have not yet been discovered. Antibiotic administration to patients with asymptomatic bacteriuria is associated with a significant reduction in the rate of preterm birth. However, such benefit has not been demonstrated for patients with bacterial vaginosis, or women who carry Streptococcus agalactia, Ureaplasma urealyticum or Trichomonas vaginalis. Antibiotic administration to patients with preterm premature rupture of membranes is associated with prolongation of pregnancy and a reduction in the rate of clinical chorioamnionitis and neonatal sepsis. The benefit has not been demonstrated in patients with preterm labor and intact membranes. Major efforts are required to determine why some women develop an ascending intrauterine infection and others do not and also what interventions may reduce the deleterious effect of systemic fetal inflammation.

show abstract

“…There is growing evidence that early treatment with adequate antibiotics is more convincing than the use of agressive tocolytics in preventing at least part of the otherwise intractable, so-called 'idiopathic' premature labor [1,3].…”

Section: Introductionmentioning

confidence: 99%

The Ecology of the Vaginal Flora at First Prenatal Visit is Associated with Preterm Delivery and Low Birth Weight

Donders¹,

Spitz²,

Vereecken³

et al. 2008

TOIDJ

View full text Add to dashboard Cite

Abstract:Objective: Can assessment of vaginal microbial flora at first prenatal visit predict the outcome of pregnancy?Material and methods: Pap smears and vaginal cultures were taken from 222 pregnant women at their first prenatal visit. Lactobacillary grades (LBG I-III) on Pap smears were used as a basis for the scoring. Points were added or subtracted according to the morphotypes of the lactobacilli, the presence of abnormal cellular morphology, increased vaginal leukocytosis, visible pathogens or red blood cells, or the finding of cytolysis of epithelial cells. The total score, reflecting the health of the vaginal microflora, was termed "Vaginal Ecology Score (VECO score)" and compared with pregnancy outcome.Results: A strong correlation was found between the vaginal eco-score (VECO) at first prenatal visit and the birth weight (r 2 0.85, p = 0.003), and between the VECO score and the number of days before term delivery took place (r 0.57, p = 0.048). This association persisted after multivariate analysis. After standardization for positive vaginal culture, a VECO score of 4 or more at first visit was associated with lower birth weight, earlier delivery and smaller fetal head circumference, but not with histological chorioamnionitis. Chorioamnionitis, on the other hand, was found more often in the group with positive vaginal cultures at first prenatal visit.Discussion: Vaginal micro-ecology can be scored at the first antenatal visit to predict delivery before 40 weeks and lowered birth weight, even in the absence of overt or detectable infectious disease. To assess prematurity below 37 weeks, larger studies are needed. This assessment of the vaginal ecology could also easily be applied on fresh wet mounts or gram stained specimens of vaginal fluid.

show abstract

Adjunctive erythromycin treatment for idiopathic preterm labor: Results of a randomized, double-blinded, placebo-controlled trial

Cited by 123 publications

References 14 publications

The role of bacterial vaginosis as a cause of amniotic fluid infection, chorioamnionitis and prematurity — a review

The role of bacterial vaginosis as a cause of amniotic fluid infection, chorioamnionitis and prematurity — a review

Intrauterine infection and prematurity

The Ecology of the Vaginal Flora at First Prenatal Visit is Associated with Preterm Delivery and Low Birth Weight

Contact Info

Product

Resources

About