Antenatal microbiologic and maternal risk factors associated with prematurity

Article Abstract:

Labor that begins too early in gestation, leading to the delivery of premature infants, is the most important cause of death and complications associated with childbirth. Unfortunately, medical understanding of the physiologic processes that lead to prematurity is incomplete. Infections in the reproductive tract are associated with premature rupture of membranes (PROM; rupture of the membranes that surround the fetus) and with prematurity, but studies of the association have not found consistent relationships. To learn more about this issue, a prospective study was carried out of 196 pregnant women (approximately 24 weeks' gestation) at two prenatal clinics. Specimens were collected from the endocervix (within the cervical canal) and the vagina, and transferred to culture dishes to allow bacterial growth. Tests were also performed for bacterial vaginosis (inflammation due to Gardnerella vaginalis, a microorganism), Mobiluncus species, Trichomonas vaginalis, yeast, and vaginal pH (acidity). Just under 17 percent of the pregnancies (33 patients) among this low-income group of women resulted in preterm labor. Twenty underwent tocolytic therapy (drugs to inhibit uterine contractions), and nine ultimately delivered premature infants. No infants died near the time of delivery; three were born with minor birth defects. Risk factors for preterm labor included previous preterm birth (the strongest factor), medical problems (asthma, frequent urinary tract infections), or a history of three or more abortions. Bacterial vaginosis was associated with increased risk, and the risk for women with this condition and Mobiluncus species was still higher. Mycoplasma hominis and Staphylococcus aureus infection were also implicated. The presence of more than one infection increased the risk of preterm birth considerably. Finally, an increased concentration of proteases (proteins that are released by bacteria) in fluid washed through the vagina was associated with increased risk. Whether elimination of these common vaginal microorganisms can reduce the incidence of preterm birth remains to be determined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Physiological aspects, Vaginosis, Vagina

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Maternal deaths associated with Clostridium sordellii infection

Article Abstract:

Clostridium sordellii is a bacterium commonly found in the soil and in stomach and intestinal contents. Previous reports of C. sordellii infections rarely indicate toxic reactions. Some strains have recently been found to produce a deadly toxin. Three cases of lethal C. sordellii infections have been reported in pregnant women. A 28-year-old woman who had delivered five days prior was brought to the emergency room, experiencing fatigue, loss of appetite, vomiting, diarrhea and sweats. She stopped breathing, had no blood pressure and her heart had stopped (cardiac arrest). A vaginal pack placed in her vagina to treat an episiotomy, a surgical incision to help the passage of a fetus through the vaginal opening during delivery, was removed in the hospital. The patient died from toxins produced by C. sordellii. In another case, a 24-year-old woman had a swollen protrusion from the cervical opening of her uterus. A day after cesarean delivery the patient had the growth removed. The patient collapsed two days after removal of the growth, which upon laboratory analysis proved to be C. sordellii. The uterus was removed but the patient later had cardiac arrest and died. In a third case, following delivery of a normal infant, a 23-year-old had increased vaginal bleeding that was treated with drug therapy. On the second day after delivery she complained of fatigue, weakness, nausea and vomiting. A piece of tissue-like material thought to be remnants of the products of conception was removed from her vagina. After exhaustive efforts with antibiotic therapy, the patient's blood pressure dropped and she died. At no point did she ever have any fever. Laboratory cultures indicated C. sordellii infection. In all cases the patients had symptoms of fatigue, nausea and vomiting. The percentage of red blood cells was high, blood pressure was low and cultures were positive for C. sordellii bacteria. The three women may have had contamination of fecal material entering the reproductive tract during pregnancy. The bacterial toxins produced a lethal toxic shock-like syndrome. Earlier recognition of the syndrome may have been able to save lives.

Development and progression, Clostridium infections, Toxic shock syndrome, Puerperal fever, Puerperal infection

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Cervicovaginal microflora and pregnancy outcome: results of a double-blind, placebo-controlled trial of erythromycin treatment

Article Abstract:

Between 15 and 20 percent of infants born prematurely die as newborns; prevention of prematurity is therefore a highly desirable goal. Infections in the cervix and vagina (often associated with inflammation, or vaginitis) have been identified as possible causes of premature labor, premature delivery, and premature rupture of the amniotic membranes, which surround the fetus. Evidence exists that antibiotic treatment of women infected with certain organisms reduces the frequency of these complications. A group of 229 inner-city pregnant women with gestational ages between 26 and 30 weeks was studied. The rate of prematurity in such populations was known to be between 16 and 20 percent. After vaginal examination and evaluation of vaginal specimens confirmed the presence of microorganisms, the subjects were randomly assigned to receive either the antibiotic erythromycin (119 women) or a placebo (110 women). Subjects took these drugs three times daily for one week; their pregnancy outcomes were subsequently monitored. In addition, 75 women underwent follow-up examinations one month after the study began. Statistics concerning maternal health (vaginal bleeding, diabetes) are presented. No differences were found in the rates of premature labor, premature birth (all participants had a low rate of this complication), or low-birth-weight infants, as a function of antibiotic treatment. However, women who received placebo medication had a higher frequency (16 percent) of premature rupture of membranes than those who received erythromycin (6 percent). Many of the women failed to complete four or more days of their medication. An extensive discussion of the effects of vaginal infection is presented. Although erythromycin seemed to reduce the risk of premature rupture of membranes, its failure to be tolerated means it cannot be recommended at the present time for treating such a population. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Drug therapy, Erythromycin, Cervix diseases

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