The common vaginal commensal bacterium Ureaplasma parvum is associated with chorioamnionitis in extreme preterm labor

Abstract

Objective: To assess the association of vaginal commensal and low grade pathogenic bacteria including Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Group B Streptococcus (GBS), and Gardnerella vaginalis, in women who delivered preterm at less than 37 weeks gestation in the presence or absence of inflammation of the chorioamnionitic membranes.Methods: A case control study involving women who delivered before 37 weeks gestation with and without inflammation of chorioamnionitic membranes.A total of 57 placental samples were histologically examined for polymorphonuclear leukocyte infiltration of placental tissue for evidence of chorioamnionitis, and by type-specific nucleic acid amplification for evidence of infection with one or more of the target bacteria. Demographic data was collected for each mother.Results: Amongst the 57 placental samples, 42.1% had chorioamnionitis and 24.6% delivered in the second trimester of pregnancy; U. parvum, U. urealyticum, G. vaginalis and GBS were all detected in the study with respective prevalence of 19.3%, 3.5%, 17.5% and 15.8%; M.genitalium and M. hominis were not detected. U. parvum was significantly associated with chorioamnionitis (p value = 0.02; OR 5.0; (95% CI 1.2-21.5) and was more common in women who delivered in the second (35.7%) compared to the third trimester of pregnancy (13.9%). None of the other bacteria were associated with chorioamnionitis or earlier delivery and all G.vaginalis positive women delivered in the third trimester of pregnancy (p value 0.04).Conclusions: The detection of U. parvum in placental tissue was significantly associated with acute chorioamnionitis in women presenting in extreme preterm labour. Just Accepted by The Journal of Maternal-Fetal & Neonatal Medicine© 2016 Taylor & Francis. This provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon.DISCLAIMER: The ideas and opinions expressed in the journal's Just Accepted articles do not necessarily reflect those of Taylor & Francis (the Publisher), the Editors or the journal. The Publisher does not assume any responsibility for any injury and/or damage to persons or property arising from or related to any use of the material contained in these articles. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each drug to be administered to verify the dosages, the method and duration of administration, and contraindications. It is the responsibility of the treating physician or other health care professional, relying on his or her independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient. Just Accepted articles have undergone full scientific review but none of the additional editorial preparation, such as copyediting, typesetting, and proofreading, as have articles published in the traditional manner. There may, the...

Inflammasome activation during spontaneous preterm labor with intra‐amniotic infection or sterile intra‐amniotic inflammation

“…Herein, we showed that women who underwent spontaneous preterm labor with IAI had the highest amniotic fluid concentrations of extracellular ASC, which coincides with most elevated concentrations of IL-6 (ie, intra-amniotic inflammation). These results are consistent with previous studies, which demonstrated that amniotic fluid concentrations of caspase-1 33 (the predominant inflammasomeactivated caspase 46 ), IL-1β, 26 and IL-18 106 35,37,117 and that Ureaplasma species (genital mycoplasmas are the most common microorganisms found in women with IAI 12,16,[118][119][120][121][122][123] ) are capable of activating the inflammasome pathway in murine macrophages. 124 Together, these findings indicate that the inflammasome is involved in the mechanisms that lead to microbialassociated preterm labor and birth.…”

Current understanding and treatment of intra‐amniotic infection with Ureaplasma spp.

“…The presence of U. parvum in the placental tissue was found to be significantly associated with chorioamnionitis in a case–control study on women with preterm birth. It is also more prevalent among women who underwent delivery in their second trimester of pregnancy than in those who underwent delivery in their third trimester . A placenta infected with U. urealyticum also showed an association with a higher prevalence of preterm labor and pPROM …”

The Human Ureaplasma Species as Causative Agents of Chorioamnionitis

“…Of the microorganisms associated with chorioamnionitis, the human Ureaplasma spp. are consistently identified as the most common microorganisms within the amniotic fluid and placentae of women with chorioamnionitis (1,62,123,133,134), funisitis (120,135,136), and preterm birth (1,137).…”