Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women in preterm labor

Jacobsson, Bo; Mattsby‐Baltzer, Inger; Andersch, Björn; Bokström, Hans; Holst, Rose-Marie; Wennerholm, Ulla‐Britt; Hagberg, Henrik

doi:10.1034/j.1600-0412.2003.00047.x

Cited by 112 publications

(107 citation statements)

References 44 publications

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“…By confining the work to deliveries at earlier gestation, we increased the likelihood of including infection-related deliveries (34 -35). Although numerous studies have compared standard microbial culture techniques with histologic chorioamnionitis (14 -16,36), cytokines with culture techniques (37)(38)(39)(40)(41), and cytokines with histologic chorioamnionitis (42)(43)(44)(45)(46), none has compared all parameters and included both fetal and maternal tissues from all subclassifications of preterm delivery.…”

Section: Discussionmentioning

confidence: 99%

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Relationship between Antenatal Inflammation and Antenatal Infection Identified by Detection of Microbial Genes by Polymerase Chain Reaction

et al. 2005

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Although antenatal infection is thought to play an important role in the pathogenesis of preterm labor and neonatal diseases, the exact mechanisms are largely unknown. We sought to clarify the relationship between antenatal infection and intrauterine and neonatal inflammation. Samples were obtained from 41 preterm infants of Ͻ33 wk gestation delivered to 36 mothers and analyzed for the presence of 16s ribosomal RNA (16s rRNA) genes using PCR and for the proinflammatory cytokines IL-6 and IL-8. In 16 (44%) mother-baby pairings, at least one sample was found to be positive for the presence of 16s rRNA genes. All but one of the positive samples were from mothers presenting with preterm prelabor rupture of membranes (pPROM) or in spontaneous idiopathic preterm labor. A strong association was found between the presence of 16s rRNA genes and chorioamnionitis and with funisitis. A marked increase in IL-6 and IL-8 was noted in all tissues positive for 16s rRNA genes, including placenta, fetal membranes, cord blood serum, and, where samples were available, in bronchoalveolar lavage fluid (BAL) and in amniotic fluid. Interestingly, gastric fluid was always positive for 16s rRNA genes if any other intrauterine or BAL sample was positive, suggesting that this sample may provide an alternative to amniotic fluid to identify antenatal infection. In conclusion, we have found that microbial genes are particularly prevalent in pPROM and spontaneous preterm labor groups and that their presence is strongly associated with a marked intrauterine inflammatory response. (Pediatr Res 57: 570-577, 2005) Abbreviations BAL, bronchoalveolar lavage CLD, chronic lung disease pPROM, preterm prelabor rupture of membranes rRNA, ribosomal RNA Preterm birth is the most common cause of neonatal death (1) and is associated with increased neonatal morbidity and childhood disability (2,3). Evidence from studies over the past two decades suggests that subclinical infection and inflammation of the amnion/chorion/decidua is implicated in the pathogenesis of pPROM and "spontaneous" preterm labor (4,5). More recently, intrauterine infection/inflammation has been associated with neonatal morbidity, including white matter cerebral lesions (6 -8) and CLD (9 -11). It has been estimated that as many as 40% of spontaneous preterm births may be attributed to antenatal infection (12). Furthermore, because many infections are subclinical and the women have often been treated with antibiotics, culture results may underestimate the "true" infection rates.Many studies have used amniotic fluid to identify antenatal intrauterine infection. The organisms commonly identified are vaginal commensals, suggesting ascending infection as a route of entry to the uterine cavity (13). Few studies have investigated other components of the uterine cavity to accurately identify the presence of infection and the nature of the relationship between such infection and inflammation. A clear association has been demonstrated between chorioamnionitis and intrauterine infection (14 -16). Oft...

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Section: Discussionmentioning

confidence: 99%

“…More specifically, elevations in both IL-8 and IL-6 have been associated with microbial invasion of the amniotic cavity in both pPROM (40) and preterm labor (39). Increased IL-6 concentration in the fetus has suggested the presence of a fetal inflammatory response, and a role for the fetus in preterm labor (25).…”

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Relationship between Antenatal Inflammation and Antenatal Infection Identified by Detection of Microbial Genes by Polymerase Chain Reaction

et al. 2005

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“…MIAC is currently most commonly diagnosed by isolation of microorganisms in the amniotic fluid [5]. However, a MIAC diagnosis does not clarify whether or not IAI will result from the microbial invasion.…”

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confidence: 99%

“…IAI, with a prevalence of 30-50% in women with PTL [1-4], can occur without any clinical suspicion of chorioamnionitis and can develop in different ways. The most common, in 10-14% [5][6][7], is through microbial invasion of the amniotic cavity (MIAC). MIAC elicits an inflammatory response detectable in the amniotic fluid.…”

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confidence: 99%

Noninvasive Sampling of the Intrauterine Environment in Women with Preterm Labor and Intact Membranes

2017

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Spontaneous preterm birth has enormous consequences for newborns, children, and families. Intra-amniotic inflammation (IAI) is the leading cause of spontaneous preterm delivery, mainly at earlier gestational ages. Amniocentesis is the only method used to identify IAI in clinical practice. Although it is an invasive procedure with a very low risk of complications, many women and physicians are hesitant about amniocentesis on this indication. This has been an incentive to explore IAI and the intra-amniotic environment through noninvasive techniques, such as sampling cervical mucus, vaginal fluid, or maternal blood. With this overview, we aim to provide a concise update on the state of the art of the noninvasive sampling of the intrauterine environment in women with preterm labor and intact membranes. So far, it is unknown whether this screening helps improve our knowledge about the impact of IAI on the neonatal and long-term outcome, but we believe it merits this review.

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“…The presence of bacteria in the amniotic fluid or histologic chorioamnionitis is related to high cytokine levels in the amniotic fluid (1,5). Some women with signs of intra-amniotic inflammation, such as elevated concentrations of cytokines in their amniotic fluid, do not have documented intra-amniotic infection (6,7). Women with intraamniotic inflammation without detectable bacteria in the amniotic fluid are more likely to have bacteria detectable between the membranes than those without intra-amniotic inflammation (3,4).…”

mentioning

confidence: 99%

Intra-Amniotic Infection and Inflammation in Preterm Birth – is Bacteria Always the Connection?: Commentary on the article by Miralles et al. on page 570

Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women in preterm labor

Cited by 112 publications

References 44 publications

Relationship between Antenatal Inflammation and Antenatal Infection Identified by Detection of Microbial Genes by Polymerase Chain Reaction

Relationship between Antenatal Inflammation and Antenatal Infection Identified by Detection of Microbial Genes by Polymerase Chain Reaction

Noninvasive Sampling of the Intrauterine Environment in Women with Preterm Labor and Intact Membranes

Intra-Amniotic Infection and Inflammation in Preterm Birth – is Bacteria Always the Connection?: Commentary on the article by Miralles et al. on page 570

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