Preterm prelabor rupture of membranes without microbial invasion of the amniotic cavity and intra-amniotic inflammation: a heterogeneous group with differences in adverse outcomes

AbstractTo determine the IgGFc-binding protein (FcgammaBP) concentration in amniotic and cervical fluids in preterm prelabor rupture of membranes (PPROM) and preterm labor with intact membranes (PTL) and to assess the diagnostic indices of FcgammaBP to predict intra-amniotic infection (the presence of both microbial invasion of the amniotic cavity and intra-amniotic inflammation). In this study, we included 170 and 79 women with PPROM and PTL, respectively. Paired cervical and amniotic fluid samples were obtained using a Dacron polyester swab and transabdominal amniocentesis, respectively. The FcgammaBP concentrations in the samples were assessed using an enzyme-linked immunosorbent assay. The presence of intra-amniotic infection was associated with elevated FcgammaBP concentrations in pregnancies with PPROM and PTL [PPROM—presence: 86 ng/mL vs. absence: 13 ng/mL, p < 0.0001, area under receiver operating characteristic curve (AUC) = 0.94; PTL—presence: 140 ng/mL vs. absence: 22 ng/mL, p < 0.0001, AUC = 0.86]. In cervical fluid, the concentrations of FcgammaBP were elevated in the presence of intra-amniotic infection in pregnancies with PPROM only (presence: 345 ng/mL vs. absence: 60 ng/mL, p < 0.0001, AUC = 0.93). FcgammaBP in amniotic fluid might be a marker of intra-amniotic infection in women with both PPROM and PTL However, in cervical fluid, it is only observed in women with PPROM.

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Maternal white blood cell count cannot identify the presence of microbial invasion of the amniotic cavity or intra-amniotic inflammation in women with preterm prelabor rupture of membranes

PLoS ONE ◽

10.1371/journal.pone.0189394 ◽

2017 ◽

Vol 12 (12) ◽

pp. e0189394 ◽

Cited By ~ 9

Author(s):

Ivana Musilova ◽

Lenka Pliskova ◽

Romana Gerychova ◽

Petr Janku ◽

Ondrej Simetka ◽

...

Keyword(s):

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Blood Cell Count ◽

Amniotic Cavity ◽

Microbial Invasion ◽

Prelabor Rupture Of Membranes

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Cervical Gardnerella vaginalis in women with preterm prelabor rupture of membranes

PLoS ONE ◽

10.1371/journal.pone.0245937 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245937

Author(s):

Marian Kacerovsky ◽

Lenka Pliskova ◽

Radka Bolehovska ◽

Daniel Lesko ◽

Romana Gerychova ◽

...

Keyword(s):

Amniotic Fluid ◽

Quantitative Pcr ◽

Interleukin 6 ◽

Gardnerella Vaginalis ◽

Amniotic Cavity ◽

Bacterial Dna ◽

Microbial Invasion ◽

Prelabor Rupture Of Membranes ◽

Time Of Admission ◽

Singleton Pregnancies

Objective To determine the association between microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI) and the cervical prevalence of Gardnerella vaginalis DNA in pregnancies with preterm prelabor rupture of membrane (PPROM). Method In total, 405 women with singleton pregnancies complicated with PPROM were included. Cervical fluid and amniotic fluid samples were collected at the time of admission. Bacterial and G. vaginalis DNA were assessed in the cervical fluid samples using quantitative PCR technique. Concentrations of interleukin-6 and MIAC were evaluated in the amniotic fluid samples. Loads of G. vaginalis DNA ≥ 1% of the total cervical bacterial DNA were used to define the cervical prevalence of G. vaginalis as abundant. Based on the MIAC and IAI, women were categorized into four groups: with intra-amniotic infection (both MIAC and IAI), with sterile IAI (IAI without MIAC), with MIAC without IAI, and without either MIAC or IAI. Results The presence of the abundant cervical G. vaginalis was related to MIAC (with: 65% vs. without: 44%; p = 0.0004) but not IAI (with: 52% vs. without: 48%; p = 0.70). Women with MIAC without IAI had the highest load of the cervical G. vaginalis DNA (median 2.0 × 104 copies DNA/mL) and the highest presence of abundant cervical G. vaginalis (73%). Conclusions In women with PPROM, the presence of cervical G. vaginalis was associated with MIAC, mainly without the concurrent presence of IAI.

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Faculty Opinions recommendation of Impact of microbial invasion of amniotic cavity and the type of microorganisms on short-term neonatal outcome in women with preterm labor and intact membranes.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727216655.793534045 ◽

2017 ◽

Author(s):

Jeff Keelan

Keyword(s):

Preterm Labor ◽

Neonatal Outcome ◽

Short Term ◽

Amniotic Cavity ◽

Microbial Invasion

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A short cervix in women with preterm labor and intact membranes: A risk factor for microbial invasion of the amniotic cavity

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2005.07.029 ◽

2006 ◽

Vol 194 (3) ◽

pp. 901-902

Author(s):

Aaron B. Caughey

Keyword(s):

Risk Factor ◽

Preterm Labor ◽

Short Cervix ◽

Amniotic Cavity ◽

Microbial Invasion

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Two thirds of human fetuses with microbial invasion of the amniotic cavity have a detectable systemic cyto-kine response before birth

American Journal of Obstetrics and Gynecology ◽

10.1016/s0002-9378(97)80102-0 ◽

1997 ◽

Vol 176 (1) ◽

pp. S14 ◽

Cited By ~ 24

Author(s):

R. Gomez ◽

F. Ghezzi ◽

R. Romero ◽

B.H. Yoon ◽

M. Mazor ◽

...

Keyword(s):

Human Fetuses ◽

Amniotic Cavity ◽

Microbial Invasion

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Placental inflammatory changes and their association with the vaginal microbiota before delivery

Journal of obstetrics and women s diseases ◽

10.17816/jowd52962 ◽

2021 ◽

Vol 70 (1) ◽

pp. 59-68

Author(s):

Dzhamilya G. Dadayeva ◽

Alexandra K. Sosnina ◽

Tatyana G. Tral ◽

Gulrukhsor Kh. Tolibova ◽

Olga V. Budilovskaya ◽

...

Keyword(s):

Histological Examination ◽

Vaginal Discharge ◽

Vaginal Microbiota ◽

Amniotic Cavity ◽

Membrane Rupture ◽

Opportunistic Bacteria ◽

Prolonged Labor ◽

Adverse Pregnancy ◽

Prelabor Rupture Of Membranes ◽

Inflammatory Changes

Hypothesis/aims of study: Infection of the amniotic cavity and placenta is one of the leading causes of adverse pregnancy outcomes. In the majority of cases, intra-amniotic infection is associated with the normal microbiota of the lower urogenital tract. The aim of the study was to explore the relationships between the placental inflammatory changes, vaginal microbiota and labor course. Study design, materials and methods: We examined 124 women at 37-41 weeks of gestation. The vaginal discharge at admission was taken for microbiological evaluation, with the delivered placenta sent for histological examination. Results: In 17.7% of cases, histological examination of the placenta revealed inflammatory changes. A statistically significant correlation was noted between the placental inflammatory changes and Staphylocossus spp. presence in the vaginal discharge at admission (р = 0.0004). The placental inflammatory changes were associated with the membrane rupture to delivery interval more than 6 hours (р = 0.01) and the labor duration more than 7 hours (р = 0.0004). Prelabor rupture of membranes did not significantly affect the placental inflammatory changes (p = 1.0). Conclusion: Predisposing factors for the development of ascending bacterial infection of the placenta are an abnormal vaginal microbiota with the presence of opportunistic bacteria before delivery, a long membrane rupture to delivery interval, and a prolonged labor.

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Amniotic Fluid Infection in Preterm Pregnancies with Intact Membranes

Disease Markers ◽

10.1155/2017/8167276 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 8

Author(s):

Tarja Myntti ◽

Leena Rahkonen ◽

Irmeli Nupponen ◽

Anu Pätäri-Sampo ◽

Minna Tikkanen ◽

...

Keyword(s):

Amniotic Fluid ◽

Preterm Labor ◽

Molar Ratio ◽

Amniotic Cavity ◽

Culture Techniques ◽

Reactive Protein ◽

Molecular Microbiology ◽

Microbial Invasion ◽

Proteolytic Cascade ◽

Singleton Pregnancies

Introduction. Intra-amniotic infection (IAI) is a major cause of preterm labor and adverse neonatal outcome. We evaluated amniotic fluid (AF) proteolytic cascade forming biomarkers in relation to microbial invasion of the amniotic cavity (MIAC) and IAI in preterm pregnancies with intact membranes. Material and Methods. Amniocentesis was made to 73 women with singleton pregnancies; 27 with suspected IAI; and 46 controls. AF biomarkers were divided into three cascades: Cascade 1: matrix metalloproteinase-8 (MMP-8), MMP-9, myeloperoxidase (MPO), and interleukin-6; Cascade 2: neutrophil elastase (HNE), elafin, and MMP-9; Cascade 3: MMP-2, tissue inhibitor of matrix metalloproteinases-1 (TIMP-1), MMP-8/TIMP-1 molar ratio, and C-reactive protein (CRP). MMP-8 was measured by an immunoenzymometric assay and the others were measured by ELISA. Standard biochemical methods, molecular microbiology, and culture techniques were used. Results. MMP-8, MMP-9, MPO, elafin, and TIMP-1 concentrations were higher in IAI suspected cases compared to controls and also in IAI suspected cases with MIAC compared to those without MIAC when adjusted by gestational age at amniocentesis. All biomarkers except elafin and MMP-2 had the sensitivity of 100% with thresholds based on ROC-curve. Odd ratios of biomarkers for MIAC were 1.2-38 and 95% confidential intervals 1.0-353.6. Conclusions. Neutrophil based AF biomarkers were associated with IAI and MIAC.

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