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the choriodecidual space
between the maternal tissues and the fetal membranes
the fe- tal membranes
amnion and chorion
Infection of the fetal membranes, as documented by histologic find- ings or culture, is called
chorioamniitis
infection of the umbilical cord is called
funisitis
bacterial infection within the placenta is called
villitis
Infection is rare in late preterm deliveries @
34-36
The relation between infection and preterm deliv- ery is not consistent throughout gestation. Infection is rare in late preterm deliveries (at 34 to 36 weeks) but is present in most cases in which birth occurs @
less than 30 weeks
Bacteria may invade the uterus by
migration from the abdominal cavity through the fallopian tubes, in- advertent needle contamination at the time of am- niocentesis or chorionic-villus sampling, hematoge- nous spread through the placenta, or passage through the cervix from the vagina
In women in spontaneous preterm labor with in- tact membranes, the most commonly identified bac- teria are
Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis, peptostreptococci, and bacteroi- des species — all vaginal organisms of relatively low virulence.20-2
Vaginal organisms appear to ascend first into
the choriodecidual space, in some women they then cross the intact chorioamniotic membranes into the amniotic fluid, and some of the fetuses ultimate- ly become infected.28
Women who have bacterial vaginosis, defined as a decrease in the
normally occurring lactobacillus spe- cies and a massive increase in other organisms, includ- ing G. vaginalis, bacteroides species, mobiluncus spe- cies, U. urealyticum, and M. hominis, have a doubled risk of spontaneous preterm delivery
Women who have bacterial vaginosis, defined as a decrease in the
normally occurring lactobacillus spe- cies and a massive increase in other organisms, includ- ing G. vaginalis, bacteroides species, mobiluncus spe- cies, U. urealyticum, and M. hominis, have a doubled risk of spontaneous preterm delivery
Amsel’s criteria
(homogeneous vag- inal discharge, white cells ringed by bacteria, an amine odor when vaginal fluid is combined with potassi- um hydroxide, and pH above 4.5),7. are associated with intrauterine infection and predict preterm deliv- ery.37-41
is the best predictor of spontaneous preterm delivery, but also is strongly associated with subsequent chorioamnionitis and neo- natal sepsis.
a positive result on the test of vaginal or cervical secretions for fibronectin,
Vaginal organisms appear to ascend first into
the choriodecidual space, in some women they then cross the intact chorioamniotic membranes into the amniotic fluid, and some of the fetuses ultimate- ly become infected.28
Women who have bacterial vaginosis, defined as a decrease in the
normally occurring lactobacillus spe- cies and a massive increase in other organisms, includ- ing G. vaginalis, bacteroides species, mobiluncus spe- cies, U. urealyticum, and M. hominis, have a doubled risk of spontaneous preterm delivery
Women who have bacterial vaginosis, defined as a decrease in the
normally occurring lactobacillus spe- cies and a massive increase in other organisms, includ- ing G. vaginalis, bacteroides species, mobiluncus spe- cies, U. urealyticum, and M. hominis, have a doubled risk of spontaneous preterm delivery
Amsel’s criteria
(homogeneous vag- inal discharge, white cells ringed by bacteria, an amine odor when vaginal fluid is combined with potassi- um hydroxide, and pH above 4.5),7. are associated with intrauterine infection and predict preterm deliv- ery.37-41
is the best predictor of spontaneous preterm delivery, but also is strongly associated with subsequent chorioamnionitis and neo- natal sepsis.
a positive result on the test of vaginal or cervical secretions for fibronectin,
A short cervix, as determined by ultrasonography, correlates with
several markers of infection and chor- ioamnionitis.77,78 Although a short cervix might facil- itate the ascension of bacteria into the uterus, it is also likely that in some women, the cervix shortens in response to an upper genital tract infection that has already occurred.
double within a week after membrane rupture, probably indicating progressive intrauterine infec- tion.
Serum ferritin concentrations
It should be noted that ureaplasma is part of the vaginal microflora in many women, and its presence in the lower genital tract, unlike its presence in the upper genital tract,
has not been associated with an increased risk of spontaneous preterm delivery.8
overall results suggest that in women with a previous preterm delivery and with bacterial vagino- sis diagnosed in the second trimester,
treatment for one week or more with oral metronidazole, and per- haps with erythromycin, results in a significant re- duction in the incidence of preterm delivery.89
overall results suggest that in women with a previous preterm delivery and with bacterial vagino- sis diagnosed in the second trimester,
treatment for one week or more with oral metronidazole, and per- haps with erythromycin, results in a significant re- duction in the incidence of preterm delivery.89