Premature rupture of the membranes and ascending infection

Abstract

The association of premature rupture of the membranes (PROM) and ascending infection was investigated in 15 women. Bacteriological, histological and immunofluorescence methods were used to study infection at various levels in the birth canal. In most of the women the membranes as well as the placentae showed heavy bacterial invasion. Bacterial distribution within the membranes showed a choriodecidual preponderance. Ascending infection appears to follow the choriodecidual route and may be a primary pathogenetic event in many instances of PROM. The anaerobe Bacteroides fragilis, which is very infrequently isolated in normal pregnant women, was found in five out of 15 women. Two infants had congenital pneumonia caused by group B streptococci and Huemophilus influenrue respectively. The neonatal outcome with PROM may be influenced by the efficiency of the individual defence mechanisms including the antimicrobial capacity of amniotic fluid.

Morbidade Materna e Morbimortalidade Perinatal Associada à Infecção Ascendente na Rotura Prematura das Membranas

“…As principais repercussões maternas incluem aumento na taxa de cesárea, corioamnionite clínica e infecção pós-parto, ao passo que o risco perinatal inclui, entre outros, prematuridade, infecção, sepse neonatal e óbito fetal e neonatal [1][2][3][4][5] . Com a finalidade de obter maturidade pulmonar fetal a conduta expectante, com ou sem a utilização de corticosteróides, tem sido freqüen-temente adotada, obviamente diante dos casos bem selecionados e na ausência de contra-indicações para tal medida.…”

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IntroduçãoApesar dos avanços científicos e tecnológicos na vigência do terceiro milênio, a rotura prematura das membranas (RPM) continua sendo um desafio para o obstetra e certamente o será para aqueles que irão militar na especialidade no sé-culo XXI.As principais repercussões maternas incluem aumento na taxa de cesárea, corioamnionite clínica e infecção pós-parto, ao passo que o risco perinatal inclui, entre outros, prematuridade, infecção, sepse neonatal e óbito fetal e neonatal [1][2][3][4][5] . Com a finalidade de obter maturidade pulmonar fetal a conduta expectante, com ou sem a

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Is the Collagen Content Reduced when the Fetal Membranes Rupture?

“…However, the mechanism by which the as cending infection finally results in a PROM still remains obscure. Apart from triggering uterine contractions with resulting increase of intraamniotic pressure and membrane stress application [5,7], the ascending in fection has been claimed to damage locally the membranes adjacent to the internal os [9]. The result of our previous study [7] did not demonstrate such a local defect to be a frequent cause of PROM.…”

“…Apart from triggering uterine contractions with resulting increase of intraamniotic pressure and membrane stress application [5,7], the ascending in fection has been claimed to damage locally the membranes adjacent to the internal os [9]. The result of our previous study [7] did not demonstrate such a local defect to be a frequent cause of PROM. Neither do the findings of the present investigation indi cate PROM to be caused by any local change of the connective tissue collagen component following ascending infection.…”

“…In a previous study [7] an ascending in fection was demonstrated as a possible etio logical factor of PROM. A similar mecha nism has been suggested by Ledger [8], who considered some instances of PROM pre ceded by occult intrauterine infection re sulting in an increased uterine motility.…”