RESUMEN
PURPOSE: To assess the prevalence, microbial profile, and clinical risk factors of maternal bacteremia associated with intrapartum fever (IPF). METHODS: A retrospective cohort study, in a single tertiary university-affiliated medical center between 2012 and 2018. Demographic and labor characteristics of women, who delivered at term (37+0/7-41+6/7) and developed bacteremia following IPF were compared to a control group of women with IPF but without bacteremia. RESULTS: During the study period there were 86,590 deliveries in our center. Of them, 2074 women (2.4%) were diagnosed with IPF, of them, for 2052 women (98.93%) the blood maternal cultures were available. In 26 patients (1.25%) maternal bacteremia was diagnosed. A lower rate of epidural anesthesia (84.6% vs 95.9%, p = 0.02) and a higher rate of antibiotics prophylaxis treatment prior to the onset of fever (30.8%.vs 12.1%, p = 0.006) were observed in patients who developed maternal bacteremia in comparison to those who have not. Maternal hyperpyrexia developed after initiation of antibiotics or without epidural anesthesia remained significantly associated with maternal bacteremia after applying a multivariate analysis, (Odds Ratio 3.14 95% CI 1.27-7.14, p = 0.009; 4.76 95% CI 1.35-12.5, p = 0.006; respectively). CONCLUSION: Maternal fever developing after initiation of antibiotics or without epidural is associated with maternal bacteremia.
Asunto(s)
Bacteriemia , Fiebre , Humanos , Femenino , Bacteriemia/epidemiología , Bacteriemia/microbiología , Embarazo , Estudios Retrospectivos , Adulto , Factores de Riesgo , Fiebre/epidemiología , Fiebre/microbiología , Fiebre/etiología , Prevalencia , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/microbiología , Anestesia Epidural/efectos adversos , Profilaxis Antibiótica , Antibacterianos/uso terapéutico , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones del Trabajo de Parto/microbiologíaRESUMEN
OBJECTIVE: To determine the difference in rate of weight gain from birth to 5 years based on exposure to maternal group B streptococcal (GBS) intrapartum antibiotic prophylaxis (IAP). DESIGN: Retrospective cohort study of 13 804 infants. SETTING: Two perinatal centres and a primary paediatric care network in Philadelphia. PARTICIPANTS: Term infants born 2007-2012, followed longitudinally from birth to 5 years of age. EXPOSURES: GBS IAP defined as penicillin, ampicillin, cefazolin, clindamycin or vancomycin administered ≥4 hours prior to delivery to the mother. Reference infants were defined as born to mothers without (vaginal delivery) or with other (caesarean delivery) intrapartum antibiotic exposure. OUTCOMES: Difference in rate of weight change from birth to 5 years was assessed using longitudinal rate regression. Analysis was a priori stratified by delivery mode and adjusted for relevant covariates. RESULTS: GBS IAP was administered to mothers of 2444/13 804 (17.7%) children. GBS IAP-exposed children had a significantly elevated rate of weight gain in the first 5 years among vaginally-born (adjusted rate difference 1.44% (95% CI 0.3% to 2.6%)) and caesarean-born (3.52% (95% CI 1.9% to 5.2%)) children. At 5 years, the rate differences equated to an additional 0.24 kg among vaginally-born children and 0.60 kg among caesarean-born children. CONCLUSION: GBS-specific IAP was associated with a modest increase in rate of early childhood weight gain. GBS IAP is an effective intervention to prevent perinatal GBS disease-associated morbidity and mortality. However, these findings highlight the need to better understand effects of intrapartum antibiotic exposure on childhood growth and support efforts to develop alternate prevention strategies.
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Antibacterianos , Desarrollo Infantil/efectos de los fármacos , Parto Obstétrico , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones del Trabajo de Parto , Obesidad Infantil , Infecciones Estreptocócicas/prevención & control , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Antibacterianos/clasificación , Profilaxis Antibiótica/efectos adversos , Profilaxis Antibiótica/métodos , Preescolar , Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estadística & datos numéricos , Femenino , Humanos , Recién Nacido , Estudios Longitudinales , Masculino , Exposición Materna/efectos adversos , Complicaciones del Trabajo de Parto/microbiología , Complicaciones del Trabajo de Parto/prevención & control , Obesidad Infantil/diagnóstico , Obesidad Infantil/etiología , Obesidad Infantil/prevención & control , Embarazo , Aumento de Peso/efectos de los fármacosRESUMEN
We sought to determine whether pre-eclampsia, spontaneous preterm birth or the delivery of infants who are small for gestational age were associated with the presence of bacterial DNA in the human placenta. Here we show that there was no evidence for the presence of bacteria in the large majority of placental samples, from both complicated and uncomplicated pregnancies. Almost all signals were related either to the acquisition of bacteria during labour and delivery, or to contamination of laboratory reagents with bacterial DNA. The exception was Streptococcus agalactiae (group B Streptococcus), for which non-contaminant signals were detected in approximately 5% of samples collected before the onset of labour. We conclude that bacterial infection of the placenta is not a common cause of adverse pregnancy outcome and that the human placenta does not have a microbiome, but it does represent a potential site of perinatal acquisition of S. agalactiae, a major cause of neonatal sepsis.
Asunto(s)
Parto Obstétrico , Complicaciones del Trabajo de Parto/microbiología , Placenta/microbiología , Complicaciones Infecciosas del Embarazo/microbiología , Sepsis/congénito , Sepsis/microbiología , Streptococcus agalactiae/aislamiento & purificación , Streptococcus agalactiae/patogenicidad , Biopsia , Estudios de Cohortes , Contaminación de ADN , ADN Bacteriano/análisis , ADN Bacteriano/genética , ADN Bacteriano/aislamiento & purificación , Femenino , Humanos , Recién Nacido , Masculino , Metagenómica , Embarazo , Resultado del Embarazo , ARN Ribosómico 16S/análisis , ARN Ribosómico 16S/genética , Reproducibilidad de los Resultados , Análisis de Secuencia de ADNRESUMEN
BACKGROUND: In January 2011, there was an outbreak of Panton-Valentine Leukocidin-positive methicillin-sensitive Staphylococcus aureus (PVL-MSSA) infection in a neonatal unit (NNU). We describe the investigation and control of an outbreak of PVL-MSSA infection in neonates. SETTING: Neonatal unit in West London. METHODS: We performed descriptive and analytical (case-control study) epidemiological investigations. Microbiological investigations including screening of MSSA isolates by PCR for the presence of the luk-PV, mecA and mecC genes and comparison of isolate with Pulsed field gel electrophoresis (PFGE). Control measures were also introduced. RESULTS: Sixteen babies were infected/colonised with the outbreak strain. Of these, one baby developed blood stream infection, 12 developed skin pustules and four babies were colonised. Four mothers developed breast abscesses. Eighty-seven babies in the unit were screened and 16 were found to have same PVL-MSSA strain (spa type t005, belonging to MLST clonal complex 22). Multivariate analysis showed gestational age was significantly lower in cases compared to controls (mean gestational age: 31.7 weeks v 35.6 weeks; P = 0.006). Length of stay was significantly greater for cases, with a median of 25 days, compared to only 6 days for controls (P = 0.01). Most (88%) cases were born through caesarean section, compared to less than half of controls. (P = 0.002). No healthcare worker carriers and environmental source was identified. The outbreak was controlled by stopping new admissions to unit and reinforcing infection control precautions. The outbreak lasted for seven weeks. No further cases were reported in the following year. CONCLUSIONS: Infection control teams have to be vigilant for rising prevalence of particular S. aureus clones in their local community as they may cause outbreaks in vulnerable populations in healthcare settings such as NNUs.
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Toxinas Bacterianas/metabolismo , Exotoxinas/metabolismo , Enfermedades del Recién Nacido , Control de Infecciones/métodos , Leucocidinas/metabolismo , Complicaciones del Trabajo de Parto , Infecciones Estafilocócicas , Staphylococcus aureus , Adulto , Enfermedades de la Mama/epidemiología , Enfermedades de la Mama/microbiología , Enfermedades de la Mama/prevención & control , Lactancia Materna/estadística & datos numéricos , Estudios de Casos y Controles , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Brotes de Enfermedades , Femenino , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido/epidemiología , Enfermedades del Recién Nacido/microbiología , Enfermedades del Recién Nacido/prevención & control , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Londres/epidemiología , Masculino , Madres , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones del Trabajo de Parto/microbiología , Complicaciones del Trabajo de Parto/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/microbiología , Complicaciones Infecciosas del Embarazo/prevención & control , Prevalencia , Infecciones Estafilocócicas/congénito , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/prevención & control , Staphylococcus aureus/aislamiento & purificación , Staphylococcus aureus/metabolismoRESUMEN
Cervicovaginal microbiota play a critical role in women's health and reproductive outcomes. Despite being one of the simplest commensal bacterial communities in the human body, we are only beginning to appreciate its complex dynamic nature and important role in host immune modulation. In this review, we discuss the "optimal" cervicovaginal bacterial community composition, the impact of microbiota on gynecologic and obstetric outcomes, and the hurdles to developing a deeper mechanistic understanding of the function of the cervicovaginal microbiome. We then describe efforts to durably alter microbial composition in this compartment by promotion of Lactobacillus colonization with probiotics, modulation of vaginal pH, hormonal administration, and the eradication of pathogenic bacteria with antibiotics. Finally, we draw on lessons learned from the deeply investigated gut microbiome to suggest future avenues of research into host-pathogen interactions in the female genital tract.
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Lactobacillus/crecimiento & desarrollo , Microbiota/fisiología , Complicaciones del Trabajo de Parto/microbiología , Vagina/microbiología , Vaginosis Bacteriana/microbiología , Población Negra , Femenino , Humanos , Embarazo , Probióticos , Salud Reproductiva , Vaginosis Bacteriana/terapia , Población BlancaRESUMEN
OBJECTIVES: To evaluate data on outpatient antibiotic use in women post-labour as a potential method of monitoring infections in this group of patients. METHODS: Demographic and antibiotic prescription data originated from the registries of the National Health Fund (pol. Narodowy Fundusz Zdrowia). The measure of antibiotic use in this study was the percentage of women who purchased the drugs from prescriptions and DDDs. RESULTS: Among 67917 females who gave birth in the years 2013-14, 5050 (7.4%) purchased antibiotics prescribed by the obstetrician only. The average number of antibiotics bought per person was equivalent to â¼14 DDDs; in most cases (95.7%) these were ß-lactams. Antibiotic use occurred significantly more frequently among younger patients (11.5% patients <18 years of age), those living in rural areas (8.2%) and those who underwent Caesarean section (8.1%). No significant differences were found between the reported day of labour and the post-partum use of antibiotics. CONCLUSIONS: Antibiotic prescribing data can be used to verify/complement the information originating from hospital infection registries to monitor rates of infection in obstetric patients.
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Antibacterianos/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Control de Infecciones/métodos , Complicaciones del Trabajo de Parto/tratamiento farmacológico , Complicaciones del Trabajo de Parto/epidemiología , Adolescente , Adulto , Cesárea/efectos adversos , Prescripciones de Medicamentos/estadística & datos numéricos , Endometritis/tratamiento farmacológico , Endometritis/epidemiología , Femenino , Humanos , Mastitis/tratamiento farmacológico , Mastitis/epidemiología , Complicaciones del Trabajo de Parto/microbiología , Pacientes Ambulatorios , Polonia/epidemiología , Periodo Posparto , Pautas de la Práctica en Medicina , Embarazo , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/epidemiología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To evaluate risk factors associated with maternal bacteremia in febrile peripartum women. METHODS: We performed a case-control study of women with fevers occurring between 7 days before and up to 42 days after delivery of viable neonates at two academic hospitals. Women with positive blood cultures were matched with the next two febrile women meeting inclusion criteria with negative blood cultures in the microbiology data without other matching parameters. We compared maternal and neonatal characteristics and outcomes between women in the case group and those in the control group with univariate analysis. We then used logistic regression to examine the association between clinical characteristics and maternal bacteremia. RESULTS: After excluding blood cultures positive only for contaminants, we compared 115 women in the case group with 285 in the control group. Bacteremic women were more likely to experience their initial fever during labor (40.9% compared with 22.8%, P<.01) and more likely to have fever at or above 102°F (62.6% compared with 31.6%, P<.01). These associations persisted in the adjusted analysis: multiparity (adjusted odds ratio [OR] 1.75, 95% CI 1.07-2.87), initial fever during labor (adjusted OR 2.82, 95% CI 1.70-4.70), and fever at or above 102°F (adjusted OR 3.83, 95% CI 2.37-6.19). In an analysis restricted to neonates whose mothers had initial fevers before or in the immediate 24 hours after delivery, neonates born to women in the case group had higher rates of bacteremia compared with those born to women in the control group (9.0% compared with 1.3%, P<.01). Eight of the nine bacteremic neonates born to bacteremic mothers (89%) grew the same organism as his or her mother in blood culture. CONCLUSION: Maternal bacteremia is associated with multiparity, initial fever during labor, and fever at or above 102°F; however, 37.5% of cases of bacteremia occurred in women with maximum fevers below this threshold. Obstetricians should maintain a heightened suspicion for an infectious source of fever in women with these clinical characteristics.
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Bacteriemia/microbiología , Fiebre/microbiología , Complicaciones del Trabajo de Parto/microbiología , Periodo Periparto , Infección Puerperal/microbiología , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Modelos Logísticos , Sepsis Neonatal/microbiología , Oportunidad Relativa , Embarazo , Factores de RiesgoRESUMEN
BACKGROUND: Congenital tuberculosis is a rare manifestation of tuberculosis. The diagnosis is often delayed, especially in preterm neonates because of the non-specific clinical presentation and the lack of awareness of maternal disease prior to pregnancy. CASE PRESENTATION: We report a case of congenital tuberculosis in an infant born at 24 weeks of gestation to a mother who presented with uncontrolled seizures during preterm labor. Maternal diagnosis was initially made by placental pathology, and later confirmed by isolation of Mycobacterium tuberculosis in urine, gastric aspirates and sputum. Full screening was performed on the newborn infant, and both mother and infant were successfully treated for tuberculosis with a four drug regimen. CONCLUSION: Pregnancy can exacerbate latent tuberculosis and women originating from endemic areas are especially susceptible. The best way to prevent congenital tuberculosis is to have a high index of suspicion and identify and treat tuberculosis in pregnant women.
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Fertilización In Vitro , Recien Nacido Extremadamente Prematuro , Complicaciones del Trabajo de Parto/microbiología , Convulsiones/microbiología , Tuberculosis/congénito , Adulto , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Masculino , Embarazo , Tuberculosis/transmisión , Tuberculosis de los Genitales Femeninos/diagnóstico , Tuberculosis de los Genitales Femeninos/microbiología , Tuberculosis Miliar/congénito , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/transmisiónAsunto(s)
Países en Desarrollo , Instituciones de Salud/normas , Servicios de Salud Materna/normas , Complicaciones del Trabajo de Parto/prevención & control , Parto , Complicaciones Infecciosas del Embarazo/prevención & control , Adulto , Femenino , Humanos , Recién Nacido , Masculino , Servicios de Salud Materna/tendencias , Evaluación de Necesidades , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones del Trabajo de Parto/microbiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/microbiología , Garantía de la Calidad de Atención de SaludRESUMEN
Vaginal Escherichia coli colonization is related to obstetric infections and the consequent development of infections in newborns. Ampicillin resistance among E. coli strains is increasing, which is the main choice for treating empirically many obstetric and neonatal infections. Vaginal E. coli strains are very similar to extraintestinal pathogenic E. coli with regards to the virulence factors and the belonging to phylogroup B2. We studied the antimicrobial resistance and the genetic virulence profile of 82 E. coli isolates from 638 vaginal samples and 63 isolated from endometrial aspirate, placental and amniotic fluid samples from pregnant women with obstetric infections. The prevalence of E. coli in the vaginal samples was 13%, which was significant among women with associated risk factors during pregnancy, especially premature preterm rupture of membranes (p<0.0001). Sixty-five percent of the strains were ampicillin-resistant. The E. coli isolates causing obstetric infections showed higher resistance levels than vaginal isolates, particularly for gentamicin (p = 0.001). The most prevalent virulence factor genes were those related to the iron uptake systems revealing clear targets for interventions. More than 50% of the isolates belonged to the virulent B2 group possessing the highest number of virulence factor genes. The ampicillin-resistant isolates had high number of virulence factors primarily related to pathogenicity islands, and the remarkable gentamicin resistance in E. coli isolates from women presenting obstetric infections, the choice of the most appropriate empiric treatment and clinical management of pregnant women and neonates should be carefully made. Taking into account host-susceptibility, the heterogeneity of E. coli due to evolution over time and the geographical area, characterization of E. coli isolates colonizing the vagina and causing obstetric infections in different regions may help to develop interventions and avoid the aetiological link between maternal carriage and obstetric and subsequent puerperal infections.
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Farmacorresistencia Microbiana , Infecciones por Escherichia coli/epidemiología , Escherichia coli , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Vagina/microbiología , Factores de Virulencia/genética , Antiinfecciosos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Farmacorresistencia Microbiana/genética , Escherichia coli/clasificación , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Femenino , Humanos , Recién Nacido , Marruecos/epidemiología , Mozambique/epidemiología , Complicaciones del Trabajo de Parto/tratamiento farmacológico , Complicaciones del Trabajo de Parto/microbiología , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/microbiologíaAsunto(s)
Parto Domiciliario/enfermería , Partería/organización & administración , Rol de la Enfermera , Complicaciones del Trabajo de Parto/prevención & control , Infecciones Estreptocócicas/prevención & control , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones del Trabajo de Parto/microbiología , Complicaciones del Trabajo de Parto/enfermería , Embarazo , Infecciones Estreptocócicas/enfermería , Streptococcus agalactiaeRESUMEN
OBJECTIVE: To assess whether the lack of water or the lack of sanitation facilities in either the home or in health facilities is associated with an increased risk of maternal mortality and to quantify the effect sizes. METHODS: Systematic review of published literature in Medline, Embase, Popline and Africa Wide EBSCO 1980. RESULTS: Fourteen articles were found. Four of five ecological studies that considered sanitation found that poor sanitation was associated with higher maternal mortality. Meta-analysis of adjusted estimates in individual-level studies indicated that women in households with poor sanitation had 3.07 (95% CI 1.72-5.49) higher odds of maternal mortality. Four of six ecological studies assessing water environment found that poor water environment was associated with higher maternal mortality. The only individual-level study looking at the adjusted effect of water showed a significant association with maternal mortality (OR = 1.50, 95% CI 1.10-2.10). Two ecological and one facility-based study found an association between a combined measure of water and sanitation environment and maternal mortality. CONCLUSIONS: There is evidence of association between sanitation and maternal mortality and between water and maternal mortality. Both associations are of substantial magnitude and are maintained after adjusting for confounders. However, these conclusions are based on a very small number of studies, few of which set out to examine sanitation or water as risk factors, and only some of which adjusted for potential confounders. Nevertheless, there are plausible pathways through which such associations may operate.
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Mortalidad Materna , Complicaciones Infecciosas del Embarazo/mortalidad , Saneamiento/estadística & datos numéricos , Sepsis/mortalidad , Abastecimiento de Agua/estadística & datos numéricos , África/epidemiología , Bases de Datos Bibliográficas , Femenino , Humanos , Complicaciones del Trabajo de Parto/microbiología , Complicaciones del Trabajo de Parto/mortalidad , Embarazo , Complicaciones Infecciosas del Embarazo/etiología , Complicaciones Infecciosas del Embarazo/microbiología , Sepsis/complicaciones , Sepsis/etiología , Aguas del Alcantarillado/efectos adversos , Aguas del Alcantarillado/microbiología , Microbiología del Agua , Contaminantes del Agua/efectos adversosRESUMEN
OBJECTIVE: To evaluate the positive predictive value (PPV) of group B Streptococcus (GBS) cultures at 35-37 weeks of gestation relative to GBS colonization status at delivery. METHODS: Rectovaginal swabs from 221 women at labor in four Lisbon hospitals were collected for GBS screening according to the CDC guidelines. RESULTS: The PPV was 24.4%. IAP was administered to 100% of prenatally GBS positive women. There was no case of early onset GBS disease (EOD). CONCLUSIONS: Poor accuracy of prenatal cultures in identifying true candidates for IAP highlights the need for Portuguese clinical and laboratory guidelines to prevent EOD and antibiotic overtreatment of pregnant women.
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Técnicas Bacteriológicas/métodos , Transmisión Vertical de Enfermedad Infecciosa , Complicaciones del Trabajo de Parto/diagnóstico , Complicaciones del Trabajo de Parto/microbiología , Complicaciones Infecciosas del Embarazo/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Parto , Valor Predictivo de las Pruebas , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Recto/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus agalactiae/crecimiento & desarrollo , Streptococcus agalactiae/aislamiento & purificación , Vagina/microbiología , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to estimate the impact of internal monitors (fetal scalp electrode [FSE] and intrauterine pressure catheter [IUPC]) on maternal and neonatal outcomes. STUDY DESIGN: The study comprised a retrospective cohort of all women who were admitted for labor from 2004-2008. Women with internal monitors (FSE, IUPC, or both) were compared with women without internal monitors. Maternal outcomes were maternal fever and cesarean delivery. Neonatal outcomes were a composite of 5-minute Apgar score of ≤3, cord pH <7.1, cord base excess ≤-12, or admission to level 3 nursery. Logistic regression was performed to estimate the impact of internal monitors with adjustment for confounding variables, including time in labor. RESULTS: Of 6445 subjects, 3944 women (61.2%) had internal monitors. Women with internal monitors were more likely to have a fever than women without internal monitors (11.7% vs 4.5%; adjusted odds ratio [AOR], 2.0; 95% confidence interval [CI], 1.6-2.5). FSE alone was not associated with an increased risk of fever (AOR, 1.5; 95% CI, 1.0-2.1), but IUPC alone was (AOR, 2.4; 95% CI, 1.8-3.2). The risk of cesarean delivery was higher in women with internal monitors (18.6% vs 9.7%; AOR, 1.3; 95% CI, 1.0-1.5). Risk of cesarean delivery was lower in women with an FSE alone (AOR, 0.5; 95% CI, 0.4-0.7) but higher in women with both an FSE and an IUPC (AOR, 1.6; 95% CI, 1.4-2.0). Risk of the composite neonatal outcome was not higher in women with internal monitors (3.3% vs 3.6%; AOR, 0.8; 95% CI, 0.6-1.1). CONCLUSION: Routine use of an IUPC in laboring patients should be avoided because of an increased risk of maternal fever.
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Cesárea/estadística & datos numéricos , Monitoreo Fetal/instrumentación , Fiebre/etiología , Trabajo de Parto/fisiología , Complicaciones del Trabajo de Parto/etiología , Adulto , Puntaje de Apgar , Femenino , Monitoreo Fetal/efectos adversos , Monitoreo Fetal/métodos , Humanos , Recién Nacido , Modelos Logísticos , Persona de Mediana Edad , Complicaciones del Trabajo de Parto/diagnóstico , Complicaciones del Trabajo de Parto/microbiología , Oportunidad Relativa , Embarazo , Estudios Retrospectivos , Medición de Riesgo , Infecciones Estreptocócicas/etiología , Streptococcus agalactiae/patogenicidadAsunto(s)
Seguridad de la Sangre , Recolección de Muestras de Sangre/normas , Cesárea , Sangre Fetal , Trabajo de Parto/fisiología , Adulto , Bancos de Sangre/normas , Bancos de Sangre/estadística & datos numéricos , Recolección de Muestras de Sangre/efectos adversos , Recolección de Muestras de Sangre/métodos , Cesárea/efectos adversos , Femenino , Humanos , Recién Nacido , Masculino , Complicaciones del Trabajo de Parto/sangre , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones del Trabajo de Parto/microbiología , Embarazo , Control de Calidad , VaginaRESUMEN
INTRODUCTION: Chlamydia trachomatis is the most common agent of sexually transmitted infections. In pregnant women it can cause premature delivery. In newborns the clinical manifestation are pneumonia and conjunctivitis. AIM: The aim of the study was to estimate the perinatal transmission of Chlamydia trachomatis and the prevalence of neonatal complications. MATERIAL AND METHODS: The study included 82 mothers with delivery < 34 weeks of gestation and 100 of their newborns. All patients were hospitalized at the Poznan University of Medical Sciences Gynecology and Obstetrics Hospital between 2004 and 2009. Polymerase chain reaction (PCR) method in AMPLICOR CT/NG test was used for the detection of Chlamydia trachomatis infection. RESULTS: Chlamydia trachomatis was identified in 8 pregnant women among 82 tested patients (10%) and in 6 neonates. Perinatal transmission was 75%. All infected infants developed respiratory disorders. Five of them needed respiratory support such as nCPAP or mechanical ventilation. Three newborns presented apneic spells. CONCLUSIONS: Asymptomatic chlamydial infection is frequently detected in women with preterm delivery. There is high risk of perinatal transmission of the infection from the mother to the newborn, which leads to perinatal complications such as neonatal pneumonia which in preterm infants can develop just after the delivery and give rise to life-threatening respiratory disorders.
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Infecciones por Chlamydia/transmisión , Chlamydia trachomatis/aislamiento & purificación , Recien Nacido Prematuro , Transmisión Vertical de Enfermedad Infecciosa , Complicaciones del Trabajo de Parto/microbiología , Complicaciones Infecciosas del Embarazo , Adulto , Infecciones por Chlamydia/diagnóstico , Femenino , Humanos , Recién Nacido , Complicaciones del Trabajo de Parto/epidemiología , Embarazo , Resultado del Embarazo , Atención Prenatal , Salud de la Mujer , Adulto JovenRESUMEN
OBJECTIVES: To investigate the association between clinical characteristics and placental histopathology in women with intrapartum fever (IPF) at term. METHODS: Maternal characteristics, intrapartum parameters, neonatal outcome and placental pathology were compared between 120 patients with IPF (≥ 380C) and a control group matched for mode of delivery. Placental lesions were classified as consistent with maternal circulation abnormalities or fetal thrombo-occlusive disease or inflammatory responses of maternal (MIR) or fetal (FIR) origin. RESULTS: Compared to controls the study group was characterized by significantly higher rates of nulliparity, extra-amniotic balloon induction of labor, and epidural anesthesia, higher gestational age, higher white blood cell count, and more vaginal examinations. On multivariate logistic regression analysis, multiple vaginal examinations were independently associated with IPF. MIR was detected in 71% of the study group compared to 21% of controls (p < 0.001), and FIR, in 32.5% and 7.5%, respectively (p < 0.001). IPF was independently associated with inflammation of maternal origin (adjusted odds ratio (OR) 8.0, 95% CI 4.2-15.2, p < 0.001) and fetal origin (adjusted OR 5.2, 95% CI 2.07-13.4, p < 0.001). Neonatal outcome was similar in the two groups. CONCLUSIONS: Multiple vaginal examinations are a significant risk factor for the development of IPF. IPF at term is independently associated with placental inflammatory lesions.
Asunto(s)
Fiebre/etiología , Fiebre/patología , Parto/fisiología , Placenta/patología , Nacimiento a Término/fisiología , Adulto , Estudios de Casos y Controles , Femenino , Fiebre/microbiología , Humanos , Complicaciones del Trabajo de Parto/etiología , Complicaciones del Trabajo de Parto/microbiología , Complicaciones del Trabajo de Parto/patología , Placenta/microbiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/patología , Resultado del Embarazo/epidemiología , Factores de Riesgo , Síndrome de Respuesta Inflamatoria Sistémica/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/patología , Adulto JovenAsunto(s)
Complicaciones del Trabajo de Parto/microbiología , Infecciones Neumocócicas/complicaciones , Sepsis/etiología , Streptococcus pneumoniae/aislamiento & purificación , Resultado Fatal , Femenino , Humanos , Recién Nacido , Masculino , Infecciones Neumocócicas/congénito , Infecciones Neumocócicas/microbiología , Embarazo , Sepsis/congénito , Streptococcus pneumoniae/patogenicidadRESUMEN
Campylobacter fetus subspecies fetus is a cause of different obstetric-gynecological diseases. It is a first time when rate of infection with Campylobacter was studied and connection between the infection and development of chronic gynecologic diseases and pathology of labor was established. Bacteria were isolated and identified in 36.0% +/- 0.7 of studied women admitted to inpatient clinics. It was established that Campylobacter fetus subspecies fetus can cause abnormalities in placenta functions as well as different inflammatory processes during pregnancy.
Asunto(s)
Infecciones por Campylobacter/microbiología , Campylobacter fetus/aislamiento & purificación , Enfermedades de los Genitales Femeninos/microbiología , Complicaciones del Trabajo de Parto/microbiología , Complicaciones Infecciosas del Embarazo/microbiología , Infecciones por Campylobacter/complicaciones , Infecciones por Campylobacter/prevención & control , Campylobacter fetus/clasificación , Cuello del Útero/microbiología , Endometrio/microbiología , Femenino , Humanos , Placenta/microbiología , Embarazo , Factores de RiesgoRESUMEN
OBJECTIVE: The amniotic cavity is normally sterile for bacteria. However, experimental evidence indicates that regular uterine contractions exert a suction-like effect whereby vaginal fluid ascends into the uterine cavity with contractions (demonstrated by sonohysterography contrast media). Consequently, this study was conducted to determine whether the presence and progress of labor are associated with an increased risk of microbial invasion of the amniotic cavity (MIAC), intraamniotic inflammation, and histologic chorioamnionitis in women with term pregnancies with intact membranes. STUDY DESIGN: Amniotic fluid (AF) was obtained from term singleton pregnant women with intact membranes at the time of cesarean delivery. AF was cultured for aerobic and anaerobic bacteria and genital mycoplasmas, and white blood cell (WBC) count was determined. Patients were divided into 3 groups according to the presence or absence of labor and the progress of labor. Nonparametric statistics were used for analysis. RESULTS: Results included: (1) a total of 884 pregnant women were enrolled and divided into 3 groups: group 1, not in labor (n = 775); group 2, in early labor (cervical dilatation less than 4 cm) (n = 86); and group 3, in active labor (cervical dilatation 4 cm or greater) (n = 23); (2) the frequency of MIAC was 1% (6 of 775) in women not in labor, 3.5% (3 of 86) in patients with early labor, and 13% (3 of 23) in patients with active labor; and (3) the median AF WBC count and the frequency of histologic chorioamnionitis were also higher in the presence of labor than in the absence of labor. CONCLUSION: We came to the following conclusions: (1) labor is associated with an increased risk of MIAC, a higher median AF WBC count, and histologic chorioamnionitis in term pregnancy with intact membranes; (2) the more advanced the cervical dilatation, the greater the risk of MIAC, a higher median AF WBC count, and histologic chorioamnionitis; and (3) in contrast, fetal inflammation (funisitis) did not increase with the presence of labor or as a function of cervical dilatation. We propose that labor predisposes to MIAC, a higher median AF WBC count, and histologic chorioamnionitis.