Infection and labor

Romero, Roberto; Shamma, Fayek N.; Avila, Cecilia; Jimenez, Carlos; Callahan, Robert; Nores, Jose; Mazor, Moshe; Brekus, Carol Ann; Hobbins, John C.

doi:10.1016/0002-9378(90)91063-i

Cited by 100 publications

(18 citation statements)

References 13 publications

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“…Interestingly, in all of the cases, Ureaplasma urealyticum was found in the amniotic cavity by conventional microbiological techniques or live/dead staining. This genital mycoplasma was either found to be alone or associated with Mycoplasma hominis , both of which are associated with spontaneous preterm labor and birth 32, 62, 63, 78, 79, 99-104 and/or clinical chorioamnionitis 73, 104 , both regarded as major clinical pregnancy complications 105-115 . Genital mycoplasmas can induce severe inflammatory responses in the amniotic cavity and surrounding tissues 116-120 , which may be characterized by the migration of maternal neutrophils into this compartment, as demonstrated herein.…”

Section: Discussionmentioning

confidence: 99%

Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?

Gomez‐Lopez

Romero

et al. 2017

American Journal of Obstetrics and Gynecology

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102

101

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Background Neutrophils are the most abundant white blood cells found in the amniotic cavity of women with intra-amniotic infection and/or inflammation. The current belief is that these neutrophils are of fetal origin. However, abundant neutrophils have been found in the amniotic fluid of women with a severe acute maternal inflammatory response but without a fetal inflammatory response in the placenta, suggesting that these innate immune cells can also be of maternal origin or a mixture of both fetal and maternal neutrophils. Objectives To investigate the origin of amniotic fluid neutrophils from women with intra-amniotic infection and/or inflammation, and to correlate these findings with acute histologic maternal and fetal inflammatory responses in the placenta. Study Design Amniotic fluid was collected from 15 women with suspected intra-amniotic infection and/or inflammation (positive microbiological cultures and/or interleukin (IL)-6 concentrations≥2.6 ng/mL). Amniotic fluid neutrophils were purified by fluorescence-activated cell sorting, DNA was extracted, and DNA fingerprinting was performed. DNA fingerprinting was also performed in the umbilical cord and maternal blood DNA. Fluorescence in situ hybridization (FISH) was assayed in women with male neonates. Blinded placental histopathological evaluations were conducted. Results 1) DNA fingerprinting revealed that 43% (6/14) of the women who underwent a single amniocentesis had mostly fetal neutrophils in the amniotic fluid; 2) DNA fingerprinting showed that 36% (5/14) of the women who underwent a single amniocentesis had predominantly maternal neutrophils in the amniotic fluid; 3) DNA fingerprinting indicated that 21% (3/14) of the women who underwent a single amniocentesis had an evident mixture of fetal and maternal neutrophils in the amniotic fluid; 4) DNA fingerprinting revealed that a woman who underwent two amniocenteses (patient #15) had fetal neutrophils first, and as infection progressed, abundant maternal neutrophils invaded the amniotic cavity ; 5) FISH confirmed DNA fingerprinting results by showing that both fetal and maternal neutrophils are present in the amniotic fluid; 6) Most of the women who had predominantly amniotic fluid neutrophils of fetal origin at the time of collection delivered extremely preterm neonates [71% (5/7)]; 7) All of the women who had predominantly amniotic fluid neutrophils of maternal origin at the time of collection delivered term or late preterm neonates [100% (6/6)]; 8) Two of the women who had an evident mixture of fetal and maternal neutrophils in the amniotic fluid at the time of collection delivered extremely preterm neonates [67% (2/3)], and the third woman delivered a term neonate [33% (1/3)]; and 9) Most of the women included in this study presented acute maternal and fetal inflammatory responses in the placenta [87 % (13/15)]. Conclusion Amniotic fluid neutrophils can be either predominantly of fetal or maternal origin, or a mixture of both fetal and maternal origin, in women with intra-amniotic inf...

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Section: Discussionmentioning

confidence: 99%

Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?

Gomez‐Lopez

Romero

et al. 2017

American Journal of Obstetrics and Gynecology

Self Cite

102

101

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“…They demonstrated a significant link between a short mid-trimester cervical length, and clinical chorioamnionitis, early onset sepsis and neonatal morbidity and mortality [25, 26]. Collectively, these findings suggest that a short mid-trimester cervical length may play an important role in the development of both fetal and maternal inflammatory responses, potentially through ascending infection [27, 28]. …”

Section: Discussionmentioning

confidence: 99%

Short cervical lengths initially detected in mid-trimester and early in the third trimester in asymptomatic twin gestations: Association with histologic chorioamnionitis and preterm birth

Park

Jung

et al. 2017

PLoS ONE

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ObjectiveTo determine whether short cervical lengths (≤20 mm) that were initially detected in mid-trimester and early in the third trimester are independently associated with increased risks of subsequent histologic chorioamnionitis and spontaneous preterm birth (SPTB, defined as a delivery before 34 weeks) in asymptomatic women with twin pregnancies.Material and methodsThis is a prospective study including 292 consecutive asymptomatic women with twin gestations. Cervical length measurements were carried out at 20 to 24 weeks’ gestation and at 28 to 32 weeks’ gestation. Both placentas of each twin pair were examined histologically after delivery. The generalized estimation equations models and logistic regression analysis were used for statistical analyses.ResultsMultivariable generalized estimation equations analysis revealed that short cervical length at mid-trimester was independently associated with an increased risk for subsequent histologic chorioamnionitis, whereas short cervical length initially detected early in the third trimester was not. By using the likelihood of SPTB as an outcome variable, multivariable logistic regression analysis indicated that short mid-trimester cervical length and histologic chorioamnionitis were independently associated with a greater risk for SPTB. Similarly, based on the multivariable analysis, a short third trimester cervical length was independently and significantly associated with a greater risk for SPTB.ConclusionsIn asymptomatic women with twin pregnancies, a short mid-trimester cervical length is independently associated with an increased risk of both subsequent histologic chorioamnionitis and SPTB, whereas a short cervical length initially detected early in the third trimester is independently associated with preterm delivery, but not subsequent histologic chorioamnionitis.

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“…A positive AF culture for bacteria has been reported in approximately 10% of patients with spontaneous PTL and intact membranes [14,15,21,130], 30–40% of patients with preterm PROM [37,41,127,201,202], 9% of patients with a short cervix [42–44], 51% of patients with acute cervical insufficiency [45–49], 10% of patients with PTL and twin gestations [50–52], and 14% of patients with idiopathic vaginal bleeding [53]. With the use of molecular microbiologic techniques, the frequency with which bacteria have been found in AF is even higher [19,21,22,66,203–214].…”

Section: Discussionmentioning

confidence: 99%

“…Microorganisms can gain access to the amniotic cavity in patients with preterm labor (PTL) and intact membranes [6–22], preterm prelabor rupture of membranes (PROM) [33–41], a short cervix [42–44], cervical insufficiency [45–49], PTL in twin gestations [50–52], vaginal bleeding in the third trimester [53], placenta previa [54,55] or in selected cases of fetal death [56–60]. …”

Section: Introductionmentioning

confidence: 99%

The diagnostic performance of the Mass Restricted (MR) score in the identification of microbial invasion of the amniotic cavity or intra-amniotic inflammation is not superior to amniotic fluid interleukin-6

Romero

Kadar

Miranda

et al. 2013

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective Intra-amniotic infection/inflammation are major causes of spontaneous preterm labor and delivery. However, diagnosis of intra-amniotic infection is challenging because most are subclinical and amniotic fluid (AF) cultures take several days before results are available. Several tests have been proposed for the rapid diagnosis of microbial invasion of the amniotic cavity (MIAC) or intra-amniotic inflammation. The aim of this study was to examine the diagnostic performance of the AF Mass Restricted (MR) score in comparison with interleukin-6 (IL-6) and matrix metalloproteinase-8 (MMP-8) for the identification of MIAC or inflammation. Methods AF samples were collected from patients with singleton gestations and symptoms of preterm labor (n = 100). Intra-amniotic inflammation was defined as >100 white blood cells/mm3 (WBCs) in AF; MIAC was defined as a positive AF culture. AF IL-6 and MMP-8 were determined using ELISA. The MR score was obtained using the Surface-Enhanced Laser Desorption Ionization Time of Flight (SELDI-TOF) mass spectrometry. Sensitivity and specificity were calculated and logistic regression models were fit to construct receiver-operating characteristic (ROC) curves for the identification of each outcome. The McNemar’s test and paired sample non-parametric statistical techniques were used to test for differences in diagnostic performance metrics. Results (1) The prevalence of MIAC and intra-amniotic inflammation was 34% (34/100) and 40% (40/100), respectively; (2) there were no significant differences in sensitivity of the three tests under study (MR score, IL-6 or MMP-8) in the identification of either MIAC or intra-amniotic inflammation (using the following cutoffs: MR score >2, IL-6 >11.4 ng/mL, and MMP-8 >23 ng/mL); (3) there was no significant difference in the sensitivity among the three tests for the same outcomes when the false positive rate was fixed at 15%; (4) the specificity for IL-6 was not significantly different from that of the MR score in identifying either MIAC or intra-amniotic inflammation when using previously reported thresholds; and (5) there were no significant differences in the area under the ROC curve when comparing the MR score, IL-6 or MMP-8 in the identification of these outcomes. Conclusions IL-6 and the MR score have equivalent diagnostic performance in the identification of MIAC or intra-amniotic inflammation. Selection from among these three tests (MR score, IL-6 and MMP-8) for diagnostic purposes should be based on factors such as availability, reproducibility, and cost. The MR score requires a protein chip and a SELDI-TOF instrument which are not widely available or considered “state of the art”. In contrast, immunoassays for IL-6 can be performed in the majority of clinical laboratories.

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Infection and labor

Cited by 100 publications

References 13 publications

Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?

Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?

Short cervical lengths initially detected in mid-trimester and early in the third trimester in asymptomatic twin gestations: Association with histologic chorioamnionitis and preterm birth

The diagnostic performance of the Mass Restricted (MR) score in the identification of microbial invasion of the amniotic cavity or intra-amniotic inflammation is not superior to amniotic fluid interleukin-6

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