解脲支原体感染与早产及胎膜早破的关系

目的 探讨解脲支原体（ＵＵ）感染与早产及胎膜早破的相关性。方法 采用分离培养法,分别对４６例胎膜早破和７例早产患者（试验组）以及３２例正常妊娠（对照组）妇女的宫颈分泌物,胎膜和脐带进行了ＵＵ检测;对部分试验组和对照组的胎盘组织进行电镜观察,并与阳性培养物负染电镜观察结果引比较,结果 试验组宫颈分泌物,胎膜和脐带中ＵＵ检出率为均为７３．６％（３９／５３）,对照组宫颈,胎膜和脐带中的ＵＵ检出率分别为４     

Role of amnioseal in premature rupture of membranes

Objective

Interleukins (ILs) and matrix metalloproteinases actually target collagen IV in the amniochorion in premature rupture of membranes (PROM), IL-10 acts as a membrane protector. In order to counteract the immunological system involved in the pathogenesis, we have used a combination of proapoptotic bax gene P-53 inhibitor, myristoleate, with antimicrobial peptides, neutrophil defensins, and cytokine IL-10 enhancer.

Methods

A comparative prospective randomized study was conducted from July 2006 to January 2007 in patients (46 cases and 60 controls) attending the Gynecology and Obstetrics Emergency Department, Eden Medical College, Kolkata, complaining of leakage per vagina in their antenatal period between 24 and 36 weeks of gestation. Combination of bax gene inhibitor, antimicrobial peptides, neutrophil defensins, and IL-10 enhancer in scheduled protocol was prescribed and cases followed up as per fixed protocols.

Results

In the 24–30 weeks group, mean prolongation of gestational age was 6.16±3.21 as against 2.66±1.05 (significant), while in 31–36 weeks mean prolongation was 4.69±0.84 as against 4.6±0.632 (significant). In the first group mean birth weight in cases was 1.77±0.66 kg as against 1.2±0.43 kg (significant), while in the second it was 2.18±0.56 kg as against 1.76±0.45 kg (significant). Associated complications were less in cases.

Conclusion

Combination of bax gene inhibitor, antimicrobial peptides, neutrophil defensins, and IL-10 enhancer as per scheduled protocol can be advocated routinely in PROM barring a few situations with excellent fetal and maternal prognosis.     

Co-infection with vaginal Ureaplasma urealyticum and Mycoplasma hominis increases adverse pregnancy outcomes in patients with preterm labor or preterm premature rupture of membranes

Abstract

Objective: The purpose of this study was to determine the prevalence of Ureaplasma urealyticum (UU) and Mycoplasma hominis (MH) in patients with preterm labor or preterm premature rupture of membranes (PPROM) and to determine the effect of these organisms on pregnancy outcomes based on the density of colonization.

Methods: The study group consisted of 184 women with preterm labor or PPROM. Vaginal cultures for UU and MH were performed for all patients at admission, and the placentas were histologically evaluated after delivery.

Results: The prevalence of positive vaginal fluid cultures for genital mycoplasma was 62.5% (112/179). This group included 99 patients carrying only UU and 13 carrying both organisms. No patients were found to carry only MH. Compared to patients only positive for UU, patients with both organisms showed significantly decreased gestational age at birth and birth weight, and significant increases in the incidences of preterm birth, NICU admissions and histologic chorioamnionitis.

Conclusion: Vaginal MH tends to be detected with UU, and patients carrying both organisms simultaneously had more severe adverse pregnancy outcomes compared to patients in preterm labor or PPROM who were only positive for UU.     

Preterm premature rupture of the membranes

Preterm premature rupture of membranes (PROM) affects over 120,000 pregnancies annually in the United States and is associated with significant maternal, fetal, and neonatal risk. Management of PROM requires an accurate diagnosis as well as evaluation of the risks and benefits of continued pregnancy or expeditious delivery. An understanding of gestational age-dependent neonatal morbidity and mortality is important in determining the potential benefits of conservative management of preterm PROM at any gestation. Where possible, the treatment of pregnancies complicated by PROM remote from term should be directed towards conserving the pregnancy and reducing perinatal morbidity due to prematurity while monitoring closely for evidence of infection, placental abruption, labor, or fetal compromise due to umbilical cord compression. Current evidence suggests aggressive adjunctive antibiotic therapy to reduce gestational age-dependent and infectious infant morbidity. Similarly, review of evaluable data indicates that antenatal corticosteroid administration in this setting enhances neonatal outcome without increasing the risk of perinatal infection. It is not clear that tocolysis in the setting of preterm PROM remote from term reduces infant morbidity. When preterm PROM occurs near term, particularly if fetal pulmonary maturity is evident, the patient is generally best served by expeditious delivery.     

Nonintervention in premature rupture of the amniotic membranes

One hundred and forty-one instances of premature rupture of the amniotic membranes (PROM), between 25 and 36 weeks gestation and with duration of PROM greater than six hours, were managed by bedrest, observation and no obstetric intervention. Delivery was allowed if the patient had spontaneous labor develop, and delivery was initiated for chorioamnionitis or fetal distress. The perinatal mortality was 25 of 148 infants delivered (168 of 1,000 births). The majority of neonatal deaths (64 per cent) were attributable to complications of prematurity. Neonatal sepsis was uncommon as a cause of death (0.16 per cent). Results indicate that the natural history of PROM is associated with a low incidence of serious maternal and fetal infections and that prematurity is the most serious problem.     

Management of premature rupture of membranes

The management of patients with PROM, regardless of gestational age, remains controversial. Generally, when patients are in labor, have infection, or there is irreversible fetal distress, there are few options other than delivery. For those not in labor, especially in premature gestational ages, the complexities of the many combinations of decisions to be made regarding the best methods for evaluating patients, prolonging gestation, reducing complications of prematurity, and choosing the timing and route of delivery make studying and solving the problem of the best option for management difficult at best. The administration of corticosteroids and broad-spectrum antibiotics of those patients in the very early premature gestational age groups has now been shown clearly to improve outcome. Beyond that, the remainder of these problems are somewhat unresolved and several reasonable options often exist and are likely to remain so for some time to come.     

Continuous amnioinfusion in premature rupture of membranes

Results of premature rupture of membranes treatment including administration of continuous amnioinfusion procedure using amniotal catheter in 18 pregnancies between 23 and 28 weeks of gestation are presented in the study. Only a few early treatment complications and high rate of clinical success in the aspect of fetal surveillance were found. Clinical evidence of intra-amniotal infection after 2-6 weeks of therapy had become cesarean section cause in most cases of the study group. Authors have observed 17 live birth (one case of placental ablation excluded) with birth weight in the range of 950-2210 g (1540 +/- 230 g) with Apgar score 5-7. In the early neonatal period 7 cases of intensive care and 2 neonatal deaths were found.     

Fetal activity in premature rupture of membranes

Fetal movement (FM) counts by mothers with premature rupture of membranes (PROM) may be helpful in estimating fetal well being, provided FM assessment is not altered by the reduced amniotic fluid. It is possible that the decreased uterine volume restricts fetal movements, though the closer contact of the fetus to the uterine wall may enhance maternal perception of even weak FM. The present study compared maternally perceived FM in 41 cases of PROM to 120 uncomplicated pregnancies. No significant differences in FM counts were detected between the two groups at any of the gestational ages. Fetal movement counts by mothers with PROM, therefore, can assist fetal surveillance as is the case in pregnancies with intact membranes.     

基质金属蛋白酶2、9及其特异性组织抑制剂在自发性胎膜早破发病中的作用

目的　探讨基质金属蛋白酶 (MMP) 2、9及其特异性组织抑制剂 (TIMP)在自发性胎膜早破发病中的作用。方法　采用RT PCR方法对 8例自发性胎膜早破患者 (胎膜早破组 )、8例正常阴道分娩产妇 (阴道分娩组 )以及 8例择期剖宫产产妇 (剖宫产组 )的胎膜组织中MMP 2、MMP 9和TIMP 2、TIMP 1mRNA的表达进行检测。结果　 (1)MMP 2 :胎膜早破组为 0 84 9± 0 0 37,阴道分娩组为 0 32 7± 0 0 2 3,剖宫产组为 0 30 7± 0 0 2 8。胎膜早破组MMP 2表达水平明显高于阴道分娩组和剖宫产组 ,两组比较 ,差异有统计学意义 (P <0 0 5 ) ;阴道分娩组MMP 2表达水平与剖宫产组比较 ,差异均无统计学意义 (P >0 0 5 )。 (2 )MMP 9:胎膜早破组为 0 0 2 6± 0 0 0 4 ,阴道分娩组为 0 0 0 8± 0 0 0 1,剖宫产组无表达。胎膜早破组MMP 9表达水平明显高于阴道分娩组 ,两者比较 ,差异有统计学意义 (P <0 0 5 )。 (3)TIMP 2 :胎膜早破组为 0 4 2 0± 0 12 2 ,阴道分娩组为 0 730± 0 14 8,剖宫产组为 0 885± 0 0 6 5。胎膜早破组TIMP 2表达水平明显低于阴道分娩组和剖宫产组 ,两者比较 ,差异有统计学意义 (P <0 0 5 ) ;阴道分娩组TIMP 2表达水平明显低于剖宫产组 ,两组比较 ,差异有统计学意义 (P <0 0 5 )。 (4)TI     

Amniocentesis with premature rupture of membranes

Transabdominal amniocentesis was used in 73 consecutive, referred patients with premature rupture of membranes and no clinical signs of infection or labor. Positive Gram stain or positive culture of obtained amniotic fluid was used as an indication for delivery. The outcome of pregnancy in this group of patients was compared with the outcome of a historic control group of 73 patients managed conservatively without amniocentesis. Clinical amnionitis and low five-minute Apgar scores occurred significantly less often in the study than in the control group; however there was no difference in the frequency of neonatal infection, one-minute Apgar score, cord blood pH, or perinatal mortality between the two groups.