Is midtrimester short cervix a sign of intraamniotic inflammation?

Kiefer, Daniel; Keeler, Sean; Rust, Orion A.; Wayock, Christopher; Vintzileos, Anthony M.; Hanna, Nazeeh

doi:10.1016/j.ajog.2009.01.047

Cited by 65 publications

(54 citation statements)

References 18 publications

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“…The AF IL-6 concentrations were used to assess the presence and magnitude of an inflammatory response based upon previous studies conducted by us and others [78–81,85, 90, 96, 163–172], which indicate that AF IL-6 concentrations correlate with the outcome of preterm labor [11,63, 79, 88, 173–179], preterm PROM [173, 180, 181], cervical insufficiency [182], placenta previa [89], and a short cervix [183–186]. The median AF IL-6 concentration in patients with clinical chorioamnionitis and microbial-associated intra-amniotic inflammation was 14 ng/mL, which was higher than that of patients with intra-amniotic inflammation without detectable microorganisms (4.7 ng/mL).…”

Section: Discussionmentioning

confidence: 87%

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

Romero¹,

Miranda²,

Kusanovic³

et al. 2015

Journal of Perinatal Medicine

212

216

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Introduction The objectives of this study were: 1) to determine the amniotic fluid (AF) microbiology of patients with the diagnosis of clinical chorioamnionitis at term using both cultivation and molecular techniques; and 2) to examine the relationship between intra-amniotic inflammation with and without microorganisms and placental lesions consistent with acute AF infection. Methods The AF samples obtained by transabdominal amniocentesis from 46 women with clinical signs of chorioamnionitis at term were analyzed using cultivation techniques (for aerobic and anerobic bacteria as well as genital mycoplasmas) and broad-range polymerase chain reaction (PCR) coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). The frequency of microbial invasion of the amniotic cavity (MIAC), intra-amniotic inflammation [defined as an AF interleukin 6 (IL-6) concentration ≥ 2.6ng/mL], and placental lesions consistent with acute AF infection (acute histologic chorioamnionitis and/or acute funisitis) were examined according to the results of AF cultivation and PCR/ESI-MS as well as AF IL-6 concentrations. Results 1) Culture identified bacteria in AF from 46% (21/46) of the participants, whereas PCR/ESI-MS was positive formicroorganisms in 59% (27/46) – combining these two tests, microorganisms were detected in 61% (28/46) of patients with clinical chorioamnionitis at term. Eight patients had discordant test results; one had a positive culture and negative PCR/ESI-MS result, whereas seven patients had positive PCR/ESI-MS results and negative cultures. 2) Ureaplasma urealyticum (n = 8) and Gardnerella vaginalis (n = 10) were the microorganisms most frequently identified by cultivation and PCR/ESI-MS, respectively. 3) When combining the results of AF culture, PCR/ESI-MS and AF IL-6 concentrations, 15% (7/46) of patients did not have intra-amniotic inflammation or infection, 6.5% (3/46) had only MIAC, 54% (25/46) had microbial-associated intra-amniotic inflammation, and 24% (11/46) had intra-amniotic inflammation without detectable microorganisms. 4) Placental lesions consistent with acute AF infection were significantly more frequent in patients with microbial-associated intra-amniotic inflammation than in those without intra-amniotic inflammation [70.8% (17/24) vs. 28.6% (2/7); P = 0.04]. Conclusion Microorganisms in the AF were identified in 61% of patients with clinical chorioamnionitis at term; 54% had microbial-associated intra-amniotic inflammation, whereas 24% had intra-amniotic inflammation without detectable microorganisms.

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Section: Discussionmentioning

confidence: 87%

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

Romero¹,

Miranda²,

Kusanovic³

et al. 2015

Journal of Perinatal Medicine

212

216

View full text Add to dashboard Cite

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“…Kiefer et al 109 reported an association between a cervical length ≤5 mm in the midtrimester and increased amniotic fluid concentrations of the chemokine monocyte chemotactic protein-1 (MCP-1) and the cytokine interleukin (IL)-6. These findings were subsequently confirmed in a study of 44 patients in the mid-trimester with a cervical length ≤25 mm, in which amniotic fluid MCP-1 concentration was predictive for spontaneous preterm delivery.…”

Section: Causes Of a Sonographic Short Cervixmentioning

confidence: 99%

A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix

Romero¹,

Yeo²,

Miranda

et al. 2013

Journal of Perinatal Medicine

184

103

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Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, and is the most important challenge to modern obstetrics. A major obstacle has been that preterm birth is treated (implicitly or explicitly) as a single condition. Two-thirds of preterm births occur after the spontaneous onset of labor, and the remaining one-third after “indicated” preterm birth; however, the causes of spontaneous preterm labor and “indicated” preterm birth are different. Spontaneous preterm birth is a syndrome caused by multiple etiologies, one of which is a decline in progesterone action, which induces cervical ripening. A sonographic short cervix (identified in the midtrimester) is a powerful predictor of spontaneous preterm delivery. Randomized clinical trials and individual patient meta-analyses have shown that vaginal progesterone reduces the rate of preterm delivery at <33 weeks of gestation by 44%, along with the rate of admission to the neonatal intensive care unit, respiratory distress syndrome, requirement for mechanical ventilation, and a composite score of neonatal morbidity/mortality. There is no evidence that 17-alpha-hydroxyprogesterone caproate can reduce the rate of preterm delivery in women with a short cervix, and therefore, the compound of choice is natural progesterone (not the synthetic progestin). Routine assessment of the risk of preterm birth with cervical ultrasound coupled with vaginal progesterone for women with a short cervix is cost-effective, and implementation of such a policy is urgently needed. Vaginal progesterone is as effective as cervical cerclage in reducing the rate of preterm delivery in women with a singleton gestation, history of preterm birth, and a short cervix (<25mm).

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“…Besides previous sPTB, short CL during pregnancy can be the consequence of several factors: congenital malformations [40,41], previous surgery of the uterine cervix [42][43][44], subclinical intra-amniotic infection and/or inflammation [45][46][47][48][49] and cervical insufficiency [50,51].…”

Section: Patient Obstetrical and Medical Historymentioning

confidence: 99%