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The role of infection in the etiology of preterm birth
198
Citations from the Literature
The role of infection in the etiology of preterm birth
Toth M; Witkin SS; Ledger W; Thaler H Department of Obstetrics and Gynecolocy, New York Hospital-Cornell University Medical Center, New York, NY 10021, USA OBSTET. GYNECOL.; 71/S (723-726)/1988/ The hypothesis that infection induces or is a precursor to preterm birth or premature rupture of the membranes was examined in a prospective study of 193 randomly selected pregnant women. We investigated the prognostic significance of factors that suggest infection of the uterine cavity before pregnancy, such as a history of pelvic inflammatory disease, a history of intrauterine contraceptive device (IUD) used, multiple sex partners, and the presence of antisperm antibodies, in relation to premature rupture of the membranes and preterm birth. Sexual activity, a potential vehicle for bacterial exchange, was also charted throughout pregnancy via monthly interviews. We performed immunologic tests on each patient and obtained cultures of the cervix for aerobic and anaerobic bacteria and chlamydia at the first visit, occurring at six to 14 weeks’ gestation, and again at 36 weeks. The results suggest that infection may indeed play a causative role in premature rupture of the membranes or preterm birth. A strong correlation was found between preterm birth and both a history of pelvic inflammatory disease (P = .004) and a history of IUD use (P = .0015). Amnionitis was associated with the presence of immunoglobulin GT (IgG) antisperm antibodies (P = .02), as well as with a history of pelvic inflammation disease (P = .0006). There was also a correlation between premature rupture of the membranes and a history of multiple sex partners (P = .02). This collective evidence implicates preexisting infection of the uterine cavity as a predisposing factor in premature rupture of the membranes, preterm delivery, and amnionits. Typhoid fever in pregnancy
Seoud M; Saade G; Uwaydah M; Azoury R Department of Obstetrics and Gynecology, American Univeristy of Beirut Medical Center, Beirut, Lebanon OBSTET. GYNECOL.; 71/S (711-714)/1988/ Fourteen cases of typhoid fever complicating pregnancy are presented. The diagnosis was confirmed by blood cultures in 13 patients and by a rising Widal titer in one. Stool cultures were positive in only two out of five patients; urine cultures in 12 patients and cervical cultures in five patients were all negative. The clinical presentation was similar to the description in older reports, except for the absence of relative bradycardia. Hypothermic response to antipyretics was frequently observed. Patients were treated with either chloramphenicol, ampicillin, or amoxicillin, with satisfactory response. Typhoid fever diagnosed in the latter part of the second trimester and third trimester and treated early did not seem to alter the neonatal outcome. Management of urolithissis during pregnancy
Rodriguez PN; Klein AS Division of Urology, University of W&on&, Madison, WI, USA SURG. GYNECOL. OBSTET.; 166/2 (103-106)/1988/ Int J Gynecol Obstet 28
Renal calculus disease is an infrequent, but not insignificant, occurrence during pregnancy. Fortunately, the majority of symptomatic calculi that present during pregnancy pass spontaneously. However, 20 to 30 per cent of patients do require intervention for stones, posing a diagnostic and therapeutic challenge. Delay in treatment may jeopardize the pregnancy. Traditional methods of intervention for renal calculus disease have been supplanted by advanced, less invasive techniques; however, their application for the pregnant patient has not been addressed adequately. The varied presentation of urolithiasis during gestation and the use of newer methods of the treatment in each is discussed. Antenatal screening for thahssemia
minor
Gehlbach DL; Morgenstern IL Department of Obstetrics/Gynecology, William Beaumont Army Medical Center, El Paso, TX, USA OBSTET. GYNECOL.; 71/5 (801-803)/1988/ This report describes the findings of a screening program of 918 obstetric patients for thalassemia minor. Patients with erythrocyte mean corpuscular volume (MCV) less than 80 fL on initial complete blood count were evaluated with serum iron, total iron binding capacity, guantitative hemoglobin electrophoresis, and trial of iron replacement. A diagnosis of thalassemia minor was made when microcytosis persisted after exclusion of iron deficiency or other causes of erythrocyte microcytosis. Twenty-six women (2.8% of those screened) had an initial MCV less than 80 fL. Three cases of previously unsuspected thalassemia minor were detected (one alpha-thalassemia, two beta-thalassemia). Of 17 well-documented cases of iron deficiency, 16 had a hemoglobin level above 11 q/dL on initial complete blood count and would not have been otherwise detected until much later in gestation. A simple screening program can effectively identify pregnant women with unrecognized thalassemia minor and can also detect patients with iron deficiency before they become anemic. Maternal fatness and viability of preterm infants Lucas A; Morley R; Cole TJ; et al
MRC Dunn Nutrition Unit, Cambridge CB4 IZJ. UK BR. MED. J.; 2%/6635 (1495-1497)/1988/ To investigate the effect of maternal fatness on the mortality of infants born preterm up to the corrected age of 18 months 795 mother-infant pairs were studied. Maternal fatness was defined by Quetelet’s index (weight/(height3) and all infants weight less than 1850 g at birth. In 771 mother-infant pairs maternal age, complications of pregnancy, mode of delivery, parity, social class, and the baby’s sex and gestation were analysed by a logistic regression model for associations with infant mortality (but deaths from severe congenital abnormalities and those occurring during the first 48 hours after birth were excluded). In a subgroup of 284 mother-infant pairs all infants deaths except those from severe congenital abnormalities were analysed in association with the infant’s birth weight and gestation and the mother’s height and weight; this second analysis included another 24 infants who had died within 48 hours after birth. In the first analysis mortality overall was 7070
Citations from the Literature
The role of infection in the etiology of preterm birth
Toth M; Witkin SS; Ledger W; Thaler H Department of Obstetrics and Gynecolocy, New York Hospital-Cornell University Medical Center, New York, NY 10021, USA OBSTET. GYNECOL.; 71/S (723-726)/1988/ The hypothesis that infection induces or is a precursor to preterm birth or premature rupture of the membranes was examined in a prospective study of 193 randomly selected pregnant women. We investigated the prognostic significance of factors that suggest infection of the uterine cavity before pregnancy, such as a history of pelvic inflammatory disease, a history of intrauterine contraceptive device (IUD) used, multiple sex partners, and the presence of antisperm antibodies, in relation to premature rupture of the membranes and preterm birth. Sexual activity, a potential vehicle for bacterial exchange, was also charted throughout pregnancy via monthly interviews. We performed immunologic tests on each patient and obtained cultures of the cervix for aerobic and anaerobic bacteria and chlamydia at the first visit, occurring at six to 14 weeks’ gestation, and again at 36 weeks. The results suggest that infection may indeed play a causative role in premature rupture of the membranes or preterm birth. A strong correlation was found between preterm birth and both a history of pelvic inflammatory disease (P = .004) and a history of IUD use (P = .0015). Amnionitis was associated with the presence of immunoglobulin GT (IgG) antisperm antibodies (P = .02), as well as with a history of pelvic inflammation disease (P = .0006). There was also a correlation between premature rupture of the membranes and a history of multiple sex partners (P = .02). This collective evidence implicates preexisting infection of the uterine cavity as a predisposing factor in premature rupture of the membranes, preterm delivery, and amnionits. Typhoid fever in pregnancy
Seoud M; Saade G; Uwaydah M; Azoury R Department of Obstetrics and Gynecology, American Univeristy of Beirut Medical Center, Beirut, Lebanon OBSTET. GYNECOL.; 71/S (711-714)/1988/ Fourteen cases of typhoid fever complicating pregnancy are presented. The diagnosis was confirmed by blood cultures in 13 patients and by a rising Widal titer in one. Stool cultures were positive in only two out of five patients; urine cultures in 12 patients and cervical cultures in five patients were all negative. The clinical presentation was similar to the description in older reports, except for the absence of relative bradycardia. Hypothermic response to antipyretics was frequently observed. Patients were treated with either chloramphenicol, ampicillin, or amoxicillin, with satisfactory response. Typhoid fever diagnosed in the latter part of the second trimester and third trimester and treated early did not seem to alter the neonatal outcome. Management of urolithissis during pregnancy
Rodriguez PN; Klein AS Division of Urology, University of W&on&, Madison, WI, USA SURG. GYNECOL. OBSTET.; 166/2 (103-106)/1988/ Int J Gynecol Obstet 28
Renal calculus disease is an infrequent, but not insignificant, occurrence during pregnancy. Fortunately, the majority of symptomatic calculi that present during pregnancy pass spontaneously. However, 20 to 30 per cent of patients do require intervention for stones, posing a diagnostic and therapeutic challenge. Delay in treatment may jeopardize the pregnancy. Traditional methods of intervention for renal calculus disease have been supplanted by advanced, less invasive techniques; however, their application for the pregnant patient has not been addressed adequately. The varied presentation of urolithiasis during gestation and the use of newer methods of the treatment in each is discussed. Antenatal screening for thahssemia
minor
Gehlbach DL; Morgenstern IL Department of Obstetrics/Gynecology, William Beaumont Army Medical Center, El Paso, TX, USA OBSTET. GYNECOL.; 71/5 (801-803)/1988/ This report describes the findings of a screening program of 918 obstetric patients for thalassemia minor. Patients with erythrocyte mean corpuscular volume (MCV) less than 80 fL on initial complete blood count were evaluated with serum iron, total iron binding capacity, guantitative hemoglobin electrophoresis, and trial of iron replacement. A diagnosis of thalassemia minor was made when microcytosis persisted after exclusion of iron deficiency or other causes of erythrocyte microcytosis. Twenty-six women (2.8% of those screened) had an initial MCV less than 80 fL. Three cases of previously unsuspected thalassemia minor were detected (one alpha-thalassemia, two beta-thalassemia). Of 17 well-documented cases of iron deficiency, 16 had a hemoglobin level above 11 q/dL on initial complete blood count and would not have been otherwise detected until much later in gestation. A simple screening program can effectively identify pregnant women with unrecognized thalassemia minor and can also detect patients with iron deficiency before they become anemic. Maternal fatness and viability of preterm infants Lucas A; Morley R; Cole TJ; et al
MRC Dunn Nutrition Unit, Cambridge CB4 IZJ. UK BR. MED. J.; 2%/6635 (1495-1497)/1988/ To investigate the effect of maternal fatness on the mortality of infants born preterm up to the corrected age of 18 months 795 mother-infant pairs were studied. Maternal fatness was defined by Quetelet’s index (weight/(height3) and all infants weight less than 1850 g at birth. In 771 mother-infant pairs maternal age, complications of pregnancy, mode of delivery, parity, social class, and the baby’s sex and gestation were analysed by a logistic regression model for associations with infant mortality (but deaths from severe congenital abnormalities and those occurring during the first 48 hours after birth were excluded). In a subgroup of 284 mother-infant pairs all infants deaths except those from severe congenital abnormalities were analysed in association with the infant’s birth weight and gestation and the mother’s height and weight; this second analysis included another 24 infants who had died within 48 hours after birth. In the first analysis mortality overall was 7070