The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency

Lee, Si Eun; Romero, Roberto; Park, Chan-Wook; Jun, Jong Kwan; Yoon, Bo Hyun

doi:10.1016/j.ajog.2007.11.047

Cited by 180 publications

(163 citation statements)

References 35 publications

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“…Fetal inflammatory response syndrome, a condition associated with elevated levels of cytokines in the fetal circulation, is a risk factor for development of cerebral palsy and white matter damage (10). In a significant proportion of preterm deliveries complicated by histologic chorioamnionitis, amniotic fluid is sterile (11)(12)(13), and although there is no evidence of fetal infection, elevated concentrations of cytokines in amniotic fluid (9) and fetal plasma (14) have been reported. Under these circumstances, it is likely that detrimental fetal responses occur primarily in response to exposure to elevated cytokine concentrations, rather than to direct exposure to the pathogen (14,15).…”

mentioning

confidence: 99%

Prevention of Inflammatory Activation of Human Gestational Membranes in an Ex Vivo Model Using a Pharmacological NF-κB Inhibitor

Keelan

Khan²,

Yosaatmadja³

et al. 2009

The Journal of Immunology

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Intrauterine inflammation plays a major role in the etiology of preterm labor and birth. We established an ex vivo model employing perfused full-thickness term gestational membranes to study membrane transport, function, and inflammatory responses. Exposure of the maternal (decidual) face of the membranes to LPS (5 μg/ml) resulted in increased accumulation of proinflammatory cytokines in the maternal compartment within 4 h, followed by a response in the fetal (amniotic) compartment. Using cytokine arrays, exposure to LPS was found to result in increased secretion of a large number of cytokines and chemokines in both compartments, most notably IL-5, IL-6, IL-7, MDC (macrophage-derived chemokine), MIG (monokine induced by IFN-γ), TARC (thymus and activation-regulated chemokine), TGF-β, and TNF-α. PGE2 accumulation also increased in response to LPS, particularly in the fetal compartment. Cotreatment with sulfasalazine, which inhibited nuclear translocation of NF-κB p65, had a rapid and marked inhibitory effect on the rate of cytokine accumulation in the maternal compartment, with lesser but significant effects observed in the fetal compartment. While membrane integrity was not discernibly impaired with LPS or sulfasalazine exposure, rates of chorionic apoptosis after 20 h were doubled in sulfasalazine-treated tissues. We conclude that the system described provides a means of accurately modeling human gestational membrane functions and inflammatory activation ex vivo. Decidual LPS exposure was shown to elicit a robust inflammatory response in both the maternal and fetal compartments. Sulfasalazine was an effective antiinflammatory agent in this model, but also exerted proapoptotic effects that raise concerns regarding its placental effects when administered in pregnancy.

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mentioning

confidence: 99%

Prevention of Inflammatory Activation of Human Gestational Membranes in an Ex Vivo Model Using a Pharmacological NF-κB Inhibitor

Keelan

Khan²,

Yosaatmadja³

et al. 2009

The Journal of Immunology

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“…Indeed an elevated MMP-8 concentration (>23 ng/mL), is present in 81% of the cases with cervical insufficiency, while a positive microbial culture is found only in 8%. These results indicate that, regardless of the eventual microbial involvement, inflammation is a risk factor for impending preterm delivery (Lee et al, 2008). Overall, the evidences above speak in favour of a leading role of inflammation in the pathogenesis not only of premature birth, but also of ominous perinatal complications such as respiratory distress syndrome (RDS), cerebral haemorrhage and necrotizing enterocolitis (NEC).…”

Section: Need and Rules For Antibiotic And Glucocorticoid Therapy In mentioning

confidence: 82%

The Role of Glucocorticoids in Pregnancy: Four Decades Experience with Use of Betamethasone in the Prevention of Pregnancy Loss

Vesce¹,

Giugliano²,

Cagnazzo³

et al. 2012

Glucocorticoids - New Recognition of Our Familiar Friend

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“…(38). Otros factores asociados con el aumento de riesgo de parto prematuro son el tabaquismo y consumo de alcohol en exceso, así como la enfermedad periodontal (38), no evaluados en nuestro trabajo. La enfermedad periodontal, en especial la periodontitis apical crónica, se ha encontrado asociada al parto prematuro de muy bajo peso (39).…”

Section: Discussionunclassified

Epidemiología de la prematuridad y sus determinantes, en una población de mujeres adolescentes y adultas de Colombia

Tascón

Benítez

Ruíz

et al. 2016

Rev. chil. obstet. ginecol.

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RESUMENAntecedentes: La prematuridad es considerada actualmente una prioridad en salud pública para algunos países. Objetivo: Describir la prevalencia del parto prematuro y sus determinantes, en una población de gestantes adolescentes y adultas, que tuvieron su único o último parto en la Fundación Hospital San José de Buga, Colombia, entre los años 2010 a 2015. Métodos. Estudio de casos y controles realizado con 11.881 neonatos mujeres adolescentes y adultas. Los datos fueron analizados en Stata® 11.0, empleando para variables cuantitativas, mediana o promedio y sus medidas de dispersión, comparadas mediante pruebas t, Ranksum, ANOVA o Kruskal Wallis, de acuerdo a su distribución y para variables categóricas; medidas de frecuencia absolutas y relativas, comparadas mediante Pruebas de Chi2 o exacta de Fisher. Para estimar las asociaciones empleamos Odds Ratio con sus intervalos de confianza de 95% y para el análisis multivariado la regresión logística. La significancia estadística fue definida como un valor p<0,05. Resultados. La prevalencia de prematuridad fue 11,4%. Después del análisis multivariado, los determinantes asociados a prematuridad fueron etnia indígena-afrocolombiana o mulato, número de controles prenatales igual o inferior a 6, periodo intergenésico inferior a 2 años, embarazo múltiple, preeclampsia, oligohidramnios, restricción del crecimiento intrauterino y hemorragia del tercer trimestre (incluye desprendimiento prematuro de placenta). Conclusiones. La prematuridad es el resultado de una compleja red de determinantes individuales, sociales, culturales y gestacionales que interactúan, por lo que para su prevención se debe no sólo trabajar en medidas de salud, sino en elaboración de políticas y planes de acción integral.PALABRAS CLAVE: Prematuridad, determinantes de la salud, mujer adolescente, mujer adulta SUMMARY Background: Prematurity is currently considered a public health priority for some countries. Objective: To describe the prevalence of preterm birth and its determinants in a population of adolescent and adult mothers who had their sole or last delivery in the Fundación Hospital San José de Buga, Colombia, between 2010. Methods: Case-control study conducted with 11,881 infants adolescent and adult women. The data were analyzed in Stata 11.0, using quantitative, medium or average and dispersion measures variables compared using t tests, Ranksum, ANOVA or Kruskal Wallis, according to distribution and for categorical variables, frequency measurements absolute and relative, compared with Chi2 tests or Fisher exact. To estimate associations employ odds ratio with confidence intervals of 95% and multivariate analysis logistic regression. Statistical significance was defined as p <0.05. Results: Prematurity prevalence was 11.4%.

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The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency

Cited by 180 publications

References 35 publications

Prevention of Inflammatory Activation of Human Gestational Membranes in an Ex Vivo Model Using a Pharmacological NF-κB Inhibitor

Prevention of Inflammatory Activation of Human Gestational Membranes in an Ex Vivo Model Using a Pharmacological NF-κB Inhibitor

The Role of Glucocorticoids in Pregnancy: Four Decades Experience with Use of Betamethasone in the Prevention of Pregnancy Loss

Epidemiología de la prematuridad y sus determinantes, en una población de mujeres adolescentes y adultas de Colombia

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