Document Detail


A sonographic short cervix as the only clinical manifestation of intra-amniotic infection.
MedLine Citation:
PMID:  16489881     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: A sonographically short cervix is a powerful predictor of spontaneous preterm delivery. However, the etiology and optimal management of a patient with a short cervix in the mid-trimester of pregnancy remain uncertain. Microbial invasion of the amniotic cavity (MIAC) and intra-amniotic inflammation are frequently present in patients with spontaneous preterm labor or acute cervical insufficiency. This study was conducted to determine the rate of MIAC and intra-amniotic inflammation in patients with a cervical length < 25 mm in the mid-trimester. STUDY DESIGN: A retrospective cohort study was conducted of patients referred to our high risk clinic because of a sonographic short cervix or a history of a previous preterm birth. Amniocenteses were performed for the evaluation of MIAC and for karyotype analysis in patients with a short cervix. Fluid was cultured for aerobic and anaerobic bacteria, as well as genital mycoplasmas. Patients with MIAC were treated with antibiotics selected by their physician. RESULTS: Of 152 patients with a short cervix at 14-24 weeks, 57 had amniotic fluid analysis. The prevalence of MIAC was 9% (5/57). Among these patients, the rate of preterm delivery (< 32 weeks) was 40% (2/5). Microorganisms isolated from amniotic fluid included Ureaplasma urealyticum (n=4) and Fusobacterium nucleatum (n=1). Patients with a positive culture for Ureaplasma urealyticum received intravenous Azithromycin. Three patients with Ureaplasma urealyticum had a sterile amniotic fluid culture after treatment, and subsequently delivered at term. The patient with Fusobacterium nucleatum developed clinical chorioamnionitis and was induced. CONCLUSION: (1) Sub-clinical MIAC was detected in 9% of patients with a sonographically short cervix (< 25 mm); and (2) maternal parenteral treatment with antibiotics can eradicate MIAC caused by Ureaplasma urealyticum. This was associated with delivery at term in the three patients whose successful treatment was documented by microbiologic studies.
Authors:
Sonia Hassan; Roberto Romero; Israel Hendler; Ricardo Gomez; Nahla Khalek; Jimmy Espinoza; Jyh Kae Nien; Stanley M Berry; Emmanuel Bujold; Natalia Camacho; Yoram Sorokin
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, N.I.H., Intramural    
Journal Detail:
Title:  Journal of perinatal medicine     Volume:  34     ISSN:  0300-5577     ISO Abbreviation:  J Perinat Med     Publication Date:  2006  
Date Detail:
Created Date:  2006-02-21     Completed Date:  2007-01-09     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0361031     Medline TA:  J Perinat Med     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  13-9     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Wayne State University, Hutzel Women's Hospital, 3990 John R., 7 Brush North, MFM-Mail Drawer #163, Detroit, MI 48201, USA. shassan@med.wayne.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Amniocentesis
Amniotic Fluid / chemistry,  microbiology*
Cervix Uteri / anatomy & histology*,  ultrasonography*
Chorioamnionitis / diagnosis*,  drug therapy,  microbiology
Cohort Studies
Female
Fusobacterium Infections / diagnosis
Fusobacterium nucleatum / isolation & purification
Humans
Predictive Value of Tests
Pregnancy
Pregnancy Complications, Infectious / diagnosis*,  drug therapy
Pregnancy Trimester, Second
Premature Birth / microbiology,  prevention & control
Retrospective Studies
Ultrasonography, Prenatal
Ureaplasma Infections / diagnosis,  drug therapy
Ureaplasma urealyticum / isolation & purification
Uterine Contraction
Grant Support
ID/Acronym/Agency:
2K12 HD 01254-06/HD/NICHD NIH HHS; Z01 HD002400-14/HD/NICHD NIH HHS
Comments/Corrections
Comment In:
J Perinat Med. 2006;34(1):75-6   [PMID:  16502556 ]

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