Preterm delivery: a risk factor for retained placenta

Article Abstract:

Retained placenta is a placenta that does not spontaneously separate from the uterus within 30 minutes after delivery of the infant. Retained placenta appears to occur at a higher rate in preterm deliveries (between 20 and 36 gestational weeks) than in term deliveries. Since approximately one-fifth of the women who deliver preterm infants also have microbiological evidence of bacteria in the amniotic fluid (in which the fetus floats), it is possible that retention of the placenta is associated with infection. To learn more about this, medical records were reviewed from 231 preterm vaginal deliveries and 561 term vaginal deliveries (the latter served as controls) at one medical facility. The preterm patients had undergone amniocentesis (removal of a sample of amniotic fluid) upon admission to the hospital for evaluation of possible microorganism content. One hundred twenty-five women had preterm labor with intact membranes (the membranes that surround the fetus) and 106 had premature rupture of membranes (PROM). Slightly more than 9 percent of the women with preterm vaginal delivery had retained placentas, compared with slightly more than 1 percent of the women with term deliveries, a statistically significant difference. No difference in the proportion of retained placentas was found between the PROM and non-PROM groups. The greater incidence of retained placenta in preterm births was not associated with either a positive result for microorganisms or with the presence of chorioamnionitis (inflammation of the amniotic membranes). The results show that preterm delivery is associated with retained placenta, but suggest that intrauterine infection and inflammation are not associated with retention. Other possible explanations are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Fetal membranes, Placenta

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Neutrophil attractant/activating peptide-1/interleukin-8 in term and preterm parturition

Article Abstract:

Neutrophils, a type of white blood cell, are known to move into the amniotic fluid to fight infection, but the mechanisms involved in this process have not been described. To learn more about changes in the concentration of one chemical factor that attracts neutrophils, neutrophil attractant/activating peptide-1/interleukin-8 (NAP-1/IL-8), a study of women during different stages of pregnancy was carried out. The subjects were in the mid-trimester of pregnancy (16 to 18 weeks gestation); at the end of pregnancy (38 to 39 weeks); in premature labor; or in labor after a term pregnancy (38 to 41 weeks). They underwent amniocentesis (sampling of the amniotic fluid) for reasons unrelated to this experiment. Most women studied during the mid-trimester of pregnancy and at term when they were not in labor did not have detectable levels of NAP-1/IL-8. Concentrations of the factor were higher in women in labor after term pregnancies than at earlier stages. When infection was present, the concentrations of the factor increased. Women in preterm labor who delivered had higher levels than women who began preterm labor but continued the pregnancies to term. The results indicate that NAP-1/IL-8 is part of the body's response to invasion of the amniotic cavity by bacteria and that the levels increase during delivery. More research is needed to determine the physiologic role of this factor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnancy, Neutrophils

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Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity

Article Abstract:

Meconium (the first feces of a newborn) staining of the amniotic fluid has been considered to be a sign of fetal hypoxia (lack of oxygen). However, it has recently been demonstrated that hypoxia is not usually present. The causes underlying meconium staining of amniotic fluid are not well-known, but infection may be involved in some cases. To better understand this, 707 women in premature labor were evaluated. Amniocentesis was performed to determine if infection, a cause of premature labor, was present. Amniotic fluid was stained with meconium in 30 cases. Infection was significantly more prevalent among women with meconium in the amniotic fluid; 10 of 30 women with meconium staining, and 75 of 677 women with clear fluid had infections. The most common bacteria found in women with meconium staining were Ureaplasma urealyticum, Listeria monocytogenes, and mixed bacterial strains. Therapy to halt labor failed more often and premature infants were more often delivered among women with meconium-stained fluid. The study indicates that meconium staining of amniotic fluid is associated with an increased risk for infection and premature delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnancy, Complications of, Pregnancy complications, Amniotic fluid, Amniotic sac, Amnion

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