[A new fetal death classification system]. / Método de clasificación de mortinatos según condición obstétrica relevante de la muerte fetal, en un hospital público de Chile (Método CORM).

BACKGROUND: Stillbirth is the mayor contributor to perinatal mortality. AIM: To report a system for classification of fetal deaths. MATERIAL AND METHODS: Retrospective cohort study of 29,916 births with 258 fetal deaths that occurred in a public hospital. Data were obtained from audit reports of stillbirths. The method for classification “obstetric condition relevant to the death” was applied, based on obstetric and placental pathological findings analyzed exclusively by a single obstetrician and a single pathologist. RESULTS: Ninety two percent of obstetric conditions causing fetal death were identified. The most commonly reported were ascending bacterial infection in 26%, congenital anomalies in 19%, arterial hypertension in 12% and placental pathology in 12%. Fetal growth restriction was identified in 50% of stillbirths. Ninety percent were secondary to a primary obstetric condition and 10% had an unexplained cause. Placental abruption as the final cause of fetal death was identified in 60% of cases with arterial hypertension, 43% of cases with placental pathology and 37% of ascending infections. Fetal deaths occurred during pregnancy in 82% of cases and during labor in 17%. Intrapartum asphyxia occurred in 0.8% of stillbirths and presented in term pregnancies. CONCLUSIONS: The “obstetric condition relevant to the death” method for classification of fetal death is effective to identify the originating obstetric cause of stillbirth and reduces the impact of fetal growth restriction and intrapartum asphyxia as the leading causes of death.

[Obesity, a risk factor for ascending bacterial infection during pregnancy]. / Obesidad, factor de riesgo de infección bacteriana ascendente durante el embarazo.

BACKGROUND: Obesity in pregnancy is associated with significantly higher rates of infection. AIM: To compare the infectious morbidity in pregnant women with normal and altered body mass index (BMI). MATERIAL AND METHODS: Cross sectional retrospective study of 6,150 patients who had delivery or second trimester abortion during 2012. The patients were classified according to BMI as underweight, normal weight, overweight and obese. We compared the frequency of pregnancy and perinatal complications related to ascending bacterial infection (ABI). The data was obtained from the hospital’s databases. RESULTS: Obese patients had higher rates of pregnancy and perinatal complications related to ABI compared to patients with normal weight. The odds ratios (OR) and 95% confidence intervals (CI) for second trimester abortion were 3.45 (1.63-7.31) p < 0.01, for preterm delivery 2.42 (1.51-3.87) p < 0.01, for labor and puerperium infections 3.42 (2.06-5.68) p < 0.01 and for early neonatal infectious and perinatal mortality 4.46 (1.75-11.37) p < 0.01. A logistic regression analysis revealed that obesity is an independent risk factor for second trimester abortion related to ABI with an OR of 3.18 (CI 95% 1.46-6.91), premature delivery related to ABI with an OR of 2.51 (CI 95% 1.54-4.09) and for delivery and postpartum infections with an OR of 4.44 (CI 95% 2.62 to 7.51). CONCLUSIONS: Obese pregnant women had a 2.5 to 4.5 times increased risk of infectious morbidity compared to normal weight patients. Obesity is an independent risk factor for second trimester abortion and preterm delivery related to ABI and delivery and postpartum infectious.

[Risk factors for preterm deliveries in a public hospital]. / Factores asociados con el parto prematuro entre 22 y 34 semanas en un hospital público de Santiago.

BACKGROUND: Preterm births are responsible for 75 to 80% of perinatal mortality. AIM: To determine the factors associated with preterm births, using maternal clinical data, laboratory results and pathological placental findings. PATIENTS AND METHODS: Retrospective study of 642 preterm single births at 22-34 weeks' gestation. Four hundred and seven cases with pathological placental studies were included. Births were subdivided into preterm births as a consequence of a medical indication and spontaneous births with or without premature rupture of membranes (PROM). Risk factors for preterm births were classified as maternal, fetal, placental, indeterminable and unclassifiable. RESULTS: The proportions of preterm births were spontaneous 69% (with PROM 27% and with intact membranes 42%) and medically indicated births 31%. A risk factor associated with prematurity was identified in 98 and 85% of medically indicated and spontaneous births, respectively. Ascending bacterial infection (ABI) was the most frequently associated factor with spontaneous preterm delivery in 51% of women (142/280, p < 0.01) and with preterm births of less than 30 weeks in 52% of women (82/157, p < 0.01). Vaginal or urinary infection with Group B Streptococcus, was the most common clinical condition associated with ABI related deliveries. Hypertension was present in 94 of 127 medically indicated preterm deliveries (preeclampsia in 62% and chronic hypertension in 12%), and in 29% (preeclampsia 24%) of preterm births of more than 30 weeks. Congenital anomalies were mainly associated with a maternal age over 35 years in 15% (14/92) of women. The frequency of placental diseases was higher in spontaneous preterm deliveries (14%) and in pregnancies of more than 30 weeks in (14%). CONCLUSIONS: ABI was the most common factor associated with spontaneous preterm births at 2234 weeks, while preeclampsia is the most common factor associated with medically indicated preterm births.

[Prevalence of sexually transmitted infections in pregnant women attending a public hospital in Chile]. / Prevalencia de infecciones de transmisión sexual en mujeres embarazadas atendidas en un hospital público de Chile.

INTRODUCTION: The epidemiologic rates of gonorrhea have declined steadily in Chile, while the incidence of infections with Trichomonas vaginalis and Chlamydia trachomatis is not well known. AIM: Since these sexually transmitted infections (STIs) are associated with adverse pregnancy outcomes and perinatal infections, this study aimed to update their prevalence in a public hospital in the Metropolitan Region of Chile. PATIENTS AND METHODS: Between April and October 2010 and April and October 2011, pregnant women attending the antenatal Service, Hospital San Borja Arriarán, were randomly selected for detection of T. vaginalis, N. gonorrhoeae and C. trachomatis by culture in modified Diamond's broth, Thayer-Martin agar, and by omp1 gene amplification by nested PCR, respectively. We excluded pregnant women who received antibiotics within the past 30 days. RESULTS: Two hundred and fifty five cervicovaginal samples were analyzed. C. trachomatis was detected in 15 (5.9%) and T. vaginalis in 6 (2.4%). N. gonorrhoeae was not found. CONCLUSION: The results show low prevalence of C. trachomatis and T. vaginalis and absence of N. gonorrhoeae. These rates have remained stable at this medical center since the 1990s, with a slight increase in C. trachomatis.

[Nugent and Spiegel criteria for the diagnosis of bacterial vaginosis. Analysis of discordant specimens by the Ison and Hay method]. / Comparación de los criterios de Nugent y Spiegel para el diagnóstico de vaginosis bacteriana y análisis de los resultados discordantes por el método de Ison y Hay.

BACKGROUND: Vaginal infection is the commonest cause of genital symptoms and has obstetric and gynecological implications. AIM: To compare the Nugent and Spiegel methods for the diagnosis of bacterial vaginosis (BV) and to analyze discordant specimens using Ison and Hay (Ison/Hay) criteria. MATERIAL AND METHODS: After discarding cases with Candidiasis, deficient specimens or those lacking bacteria, a total of 348 Gram-stained smears vaginal specimens received for the diagnosis of BV, were analyzed. RESULTS: Vaginal microbiota was classified as normal in 203 and 237 samples (58 and 68% of samples), according to Nugent and Spiegel criteria, respectively One hundred and five (30%) and 111 samples (32%), were classified as VB according to Nugent and Spiegel criteria, respectively. Both criteria were concordant in 308 samples (88.5%). The 40 (11.5%) discordant specimens were classified as intermediate microflora by the Nugent system and as normal or BV by Spiegel. Among these, the Ison/Hay procedure identified four categories of microbiota. Ten (25%) specimens were classified as grade II microbiota, confirming their categorization by Nugent as intermediate microbiota, six (15%) were classified in the III category, confirming the diagnosis of BV by Spiegel, 13 (32.5%) corresponded to the category III, that does not exist in the Nugent and Spiegel categorization systems. Finally, 11 specimens could not be assigned to one category due to microscopic limitations to distinguish bacterial morphotypes. CONCLUSIONS: The systems proposed by Spiegel, Nugent and Ison/Hay are comparable for the diagnosis of BV. However, we recommend the use of Ison/Hay procedure to evaluate vaginal microbiota, due to its wider range of categories, allowing a better discrimination of the vaginal microbiota.

[Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?] / ¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile?

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

Detection of Porphyromonas gingivalis in the amniotic fluid in pregnant women with a diagnosis of threatened premature labor.

BACKGROUND: Epidemiologic and randomized controlled studies have shown that periodontal diseases may be associated with preterm labor and delivery of infants with low birth weights. The purpose of the present study was to determine the presence of microbial invasion of the amniotic cavity by periodontopathic bacteria in pregnant women with a diagnosis of threatened premature labor. METHODS: A periodontal examination and collection of amniotic fluid and subgingival plaque samples were performed on women identified as having threatened premature labor (preterm premature rupture of membranes without clinical infection or labor and preterm labor with intact membranes) and a gestational age ranging between 24 and 34 weeks. Samples collected from amniotic fluid and from the four deepest periodontal pockets in each patient were pooled in prereduced transport fluid and cultured. Porphyromonas gingivalis was identified primarily by colony morphology under stereoscopic microscope and rapid biochemical tests. Amniotic fluid or plaque samples were homogenized, DNA was extracted, and polymerase chain reaction (PCR) amplification of 16S rRNA with specific and universal primers was carried out. RESULTS: Twenty-six women with threatened premature labor were included: eight with preterm premature rupture of membranes and 18 with preterm labor with intact membranes. Eight women presented with gingivitis, 12 with chronic periodontitis, and six without periodontal disease. Microbial invasion of the amniotic cavity as detected by P. gingivalis PCR was 30.8% (eight of 26 patients). In these eight patients, P. gingivalis was present in both the subgingival samples and the respective amniotic fluid sample. CONCLUSION: The presence of microbial invasion of the amniotic cavity by P. gingivalis could indicate a role for periodontal pathogenic bacteria in pregnant women with a diagnosis of threatened premature labor.

Antibiotic administration to patients with preterm labor and intact membranes: is there a beneficial effect in patients with endocervical inflammation?

OBJECTIVE: To determine whether broad-spectrum antibiotic administration to patients with preterm labor and intact membranes is associated with an improvement in neonatal and maternal outcomes, particularly in patients with microbial invasion of the amniotic cavity (MIAC) or endocervical inflammation (ECI). METHODS: A prospective clinical trial was conducted in which women in premature labor were alternately allocated to receive either antibiotics or placebo, and information about MIAC and ECI collected. Eighty-four pregnant women between 24 and 34 weeks of gestation with spontaneous preterm labor were enrolled. Exclusion criteria were cervical dilatation greater than 3 cm, clinical chorioamnionitis, abruption, rupture of membranes, vaginal bleeding, and several additional fetal and maternal conditions that may influence perinatal outcome. Amniocentesis was offered to all patients and the cervix and vagina were sampled for microbiological and cytological studies. Eligible patients were allocated to receive either clindamycin-gentamycin or placebo for 7 days. Corticosteroids and tocolysis with beta-adrenergic agents were used according to the standard management of our institution. MIAC was defined as the presence of a positive amniotic fluid culture obtained by trans-abdominal amniocentesis. ECI was diagnosed when a significant increase in the white blood cell count of the endocervical secretions was found. A composite neonatal morbidity/mortality outcome was created, including severe neonatal morbidity (respiratory distress syndrome, asphyxia, sepsis, pneumonia, intraventricular hemorrhage) and mortality. RESULTS: Thirty-nine women received antibiotics and 40 received placebo. The prevalence of ECI and MIAC in both groups was comparable (antibiotic group ECI 61.5% (24/39) and MIAC 20.5% (8/39); placebo group ECI 62.5% (25/40) and MIAC 20% (8/40); p > 0.05). Overall, there were no significant differences in maternal infections and composite neonatal outcomes between antibiotic and placebo groups. Women who received antibiotics had a lower rate of subsequent rupture of membranes compared to patients who received placebo (2.6% (1/39) vs. 25% (10/40), respectively; p = 0.007). A sub-analysis showed that among patients with ECI, antibiotic administration was associated with a lower rate of composite neonatal morbidity/mortality outcome compared to those who received placebo (4.2% (1/24) vs. 28% (7/25), respectively; p < 0.05). This association was also present in patients with ECI without MIAC (0% (0/16) vs. 27.8% (5/18); p < 0.05), but not in patients with ECI and MIAC (antibiotic group 12.5% (1/8) vs. placebo group 28.6% (2/7); p > 0.05). CONCLUSIONS: The combination of antibiotics used in this study did not improve maternal or perinatal outcome in patients with preterm labor and intact membranes. Further studies are required to determine if women with endocervicitis presenting with preterm labor and intact membranes may benefit from antibiotic administration.

Actinomicosis pélvica invasiva: un desafío para el ginecólogo / Invasive pelvic actinomycosis: a challenge for the gynecologist

Resumen La actinomicosis pélvica es una infección bacteriana supurativa crónica, producida por especies de Actinomyces, principalmente Actinomyces israelii, que afecta el aparato genital interno y las estructuras vecinas, asociada al uso prolongado de dispositivo intrauterino sin control en casi la totalidad de los casos descritos en mujeres. La actinomicosis pélvica suele presentarse como un absceso tubo-ovárico y con menor frecuencia como una actinomicosis pélvica invasiva (API). La API se propaga por contigüidad desde el aparato genital hacia las vísceras adyacentes, originando un tumor pélvico difuso, de consistencia leñosa, pseudotumoral, que a menudo se confunde con una neoplasia pélvica. La API representa un gran desafío para el ginecólogo por las dificultades en su diagnóstico y manejo. Se presentan dos casos de API y se revisan los procedimientos diagnósticos y terapéuticos recomendados actualmente para el enfrentamiento de esta patología.

Abstract Pelvic actinomycosis (PA) is a chronic suppurative bacterial infection, produced by Actinomyces, mainly Actinomyces israelii. It affects the internal genital tract, adjacent structures and is associated with a prolonged intrauterine device use with an inadequate control in almost all described cases in women. Pelvic actinomycosis usually presents as a tube ovarian abscess and less frequently as invasive pelvic actinomycosis (IPA). The IPA spreads contiguously from the genital tract to adjacent viscera, causing a diffuse, woody, pseudotumoral pelvic tumor that is frequently confused with a pelvic neoplasm. The IPA represents a great challenge for the gynecologist due to the difficulties in the diagnosis and management of this disease. Two cases of IPA are presented and the currently recommended diagnostic and therapeutic procedures for dealing with this pathology are reviewed.

Beneficios de los antibióticos en la rotura prematura de membranas de pretérmino y factores que intervienen en la eficacia del tratamiento: revisión narrativa / Benefits of antibiotics in preterm premature rupture of membranes and factors involved in the efficacy of the treatment: narrative review

Resumen El parto prematuro es la principal causa de morbilidad y de mortalidad perinatal, y hasta un tercio de los casos presentan rotura prematura de membranas. La infección intrauterina que asciende desde la vagina es su principal causa en un hospital público de Chile. Esta revisión narrativa mediante búsqueda en PubMed, Cochrane, Embase, Scielo, Science Direct y Wiley Online Library incluye estudios publicados sobre los diferentes factores infecciosos que intervienen en el resultado adverso perinatal y la eficacia de los antibióticos en la rotura prematura de membranas de pretérmino. Además, contiene recomendaciones de sociedades científicas sobre el uso de antibióticos en estos casos. Los ensayos concluyen que los antimicrobianos prolongan el embarazo, disminuyen la corioamnionitis clínica y reducen variadas morbilidades neonatales, pero no reducen la mortalidad perinatal ni las secuelas tardías en la infancia. Los resultados adversos obstétricos, especialmente los neonatales, y las secuelas dependen de la existencia de invasión microbiana de la cavidad amniótica o de infección cérvico-vaginal, de la virulencia de los microorganismos aislados, del compromiso inflamatorio/infeccioso de la placenta (corioamnionitis histológica, funisitis) y de la respuesta inflamatoria fetal. Para mejorar los resultados adversos obstétricos neonatales en la rotura prematura de membranas de pretérmino, los esquemas de antibióticos deben ser eficaces, cubriendo el amplio espectro microbiológico existente y actuando sobre los factores infecciosos implicados en la gravedad de la infección. Además, deben administrarse de manera intensiva y prolongada hasta el parto.

Abstract Preterm birth is the leading cause of perinatal morbidity and mortality, and up to a third of them have premature rupture of membranes. Intrauterine infection that rises from the vagina is its main cause in a public hospital in Chile. This narrative review by searching PubMed, Cochrane, Embase, Scielo, Science Direct and Wiley Online Library includes published studies of the different infectious factors involved in perinatal adverse outcome and of the efficacy of antibiotics in preterm premature rupture of membranes. It also contains recommendations from scientific societies on the use of antibiotics in these cases. These trials conclude that antimicrobials prolong pregnancy, decrease clinical chorioamnionitis, and reduce various neonatal morbidities, but do not reduce perinatal mortality or infant sequelae. Obstetric and especially neonatal adverse outcomes in these patients depend on the existence of microbial invasion of the amniotic cavity and/or cervicovaginal infection, of the virulence of the isolated microorganisms, of inflammatory/infectious involvement of the placenta (histological chorioamnionitis, funisitis) and fetal inflammatory response. To improve adverse neonatal obstetric outcomes in preterm premature rupture of membranes, antibiotic regimens must be effective, covering the wide existing microbiological spectrum and acting on infectious factors responsible for the severity of the infection. In addition, they must be administered aggressively and for a long time until delivery.

Chlamydia trachomatis genovars causing urogenital infections in Santiago, Chile.

BACKGROUND: Chlamydia trachomatis is a common sexually transmitted infection in Chile, but little is known about the genovar distribution in genital infections. Thus, the objective of this study was to determine the distribution of C. trachomatis genovars in such cases. METHODS: A total of 522 urogenital specimens, 403 from women and 119 from men, were analyzed for C. trachomatis by nested polymerase chain reaction (PCR) targeting of the ompA gene. Positive specimens were genotyped by DNA sequencing of the amplicons. RESULTS: Sixty-two (11.9%) specimens were positive. Of these, 43 (69.4%) were collected from men and 19 (30.6%) from women (p < 0.0001). Eight genovars were identified in men and seven in women. Genovar E was the most common in both men and women, followed by genovar Da in men, and F in women. Together these three genovars accounted for 84% of infections. Genovar D was the third most common genovar (n = 4). Genovar G was detected in two samples, and sequences of genovars Ba, H, and Ja were each found in single samples. One sample (1.6%) contained mixed sequences. No association was found between gender and specific genovars. Fifty-six (92%) sequences were identical to those reported for the respective reference genovars and the other two have been described in several regions. CONCLUSIONS: Our findings add to the results of most studies, which indicate that genovars E, F, and D/Da are the most frequent. No association was found between gender and specific genovars. Despite the heterogeneous population of genovars, most ompA sequences were conserved.

[Vaginal infections in a Family Health Clinic in the Metropolitan Region, Chile]. / Infecciones vaginales en un Centro de Salud Familiar de la Región Metropolitana, Chile.

BACKGROUND: Vaginal infections are a frequent cause for consultation, but their prevalence and etiology vary in different populations. OBJECTIVES: To determine the prevalence and etiologies of vaginal infection in women attending a family health center in the Metropolitan Region of Chile. METHODS: The microbiological diagnosis was made by wet mount and Gram stain. Diagnosis of trichomoniasis was performed by wet mount, culture and polymerase chain reaction. RESULTS: 101 women aged 15-54, not selected by signs or symptoms of vaginal infection, 46 of them pregnant were included. In 47 women (46.5%), vaginal infections were diagnosed. An association was observed between age and frequency of vaginal infection. The proportion of infections among pregnant and non-pregnant women was similar. The most frequent infections were bacterial vaginosis (16.8%), vulvovaginal candidiasis (11.9%) and co-infections (6.9%). We found 5.9% of intermediate microbiota cases, 3% of trichomoniasis and 2% of aerobic vaginitis. Symptoms of vaginal infection had poor agreement with microbiological findings. Otherwise physical signs had good agreement with the presence of infection, but low to moderate concordance with a specific etiology. CONCLUSIONS: We found a high prevalence of vaginal infections in the study population. It is necessary to improve the definitions and criteria of microbiological diagnosis of co-infections and intermediate microbiota, for them to be diagnosed in the clinical practice. More descriptive questionnaires are recommended to enhance the usefulness of clinical examination.

¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile? / Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?

Resumen El parto prematuro (PP) es el principal contribuyente de la morbilidad/mortalidad perinatal. A pesar del conocimiento de los factores de riesgo y de la introducción de intervenciones médicas destinadas a la prevención del nacimiento prematuro, su frecuencia ha aumentado. La infección bacteriana ascendente (IBA) es la condición obstétrica más frecuente asociada al PP ocasionando un importante resultado perinatal adverso en un hospital público de Chile. Esta revisión muestra la asociación entre PP e IBA, analiza la fisiopatología y la inmunología de las infecciones vaginales en la mujer embarazada susceptible, como asimismo la aplicación en este grupo de medidas con evidencia clínica que han demostrado ser eficientes, tales como la pesquisa rutinaria y el tratamiento de las infecciones genitourinarias (IGU), el cerclaje profiláctico o terapéutico, uso de probióticos, de progesterona vaginal, control metabólico de la diabetes mellitus y del peso de la obesa. El tratamiento de las IGU, conjuntamente con el uso de intervenciones que mejoran la inmunidad vaginal en la población de riesgo, permiten predecir una reducción del PP por IBA, de sus consecuencias inmediatas y de largo plazo y costos asociados elevados, con el consiguiente beneficio de la salud pública de Chile.

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

Meningitis neonatal precoz causada por transmisión vertical de Escherichia coli productora de beta-lactamasa de espectro extendido en parto prematuro con rotura prematura de membranas / Early neonatal meningitis caused by vertical transmission of extended-spectrum beta-lactamase-producing Escherichia coli in premature labor with premature rupture of membranes

Se comunica el caso de un recién nacido producto de un parto prematuro con rotura prematura de membranas, que desarrolló precozmente meningitis neonatal por Escherichia coli productora de beta-lactamasa de espectro extendido. Los cultivos en líquido céfalo raquídeo y sangre neonatal fueron tempranamente positivos para esta bacteria. No obstante no aislarse este microorganismo en la madre, los hallazgos de la biopsia placentaria y la precocidad de la infección neonatal son determinantes en señalar que se trató de infección intraamniótica con transmisión vertical al neonato. La meningitis neonatal fue tratada con meropenem y el niño se dio de alta en buenas condiciones después de 41 días de hospitalización. Las guías perinatales actuales, preconizan el tamizaje de muestras vaginales para la prevención del parto prematuro y de los resultados adversos asociados a infección bacteriana ascendente durante el embarazo.

We report the case of a newborn resultant of premature delivery with premature rupture of membranes, which developed early-onset neonatal meningitis caused by transmission of Escherichia coli producer of betalactamasa of spectrum extended. Cultures in cerebrospinal fluid and neonatal blood were early positive for this bacterium. Although this microorganism is not isolated in the mother, the findings of the placenta biopsy and the precocity of the neonatal infection are determinant in indicating that it was an intraamniotic infection with vertical transmission to the neonate. Neonatal meningitis was treated with meropenem and the child was discharged in good condition after 41 days of hospitalization. The current perinatal guidelines support the screening of vaginal samples for the prevention of preterm birth and the adverse outcomes associated with ascending bacterial infection during pregnancy.

Método de clasificación de mortinatos según condición obstétrica relevante de la muerte fetal, en un hospital público de Chile (Método CORM) / A new fetal death classification system

Background: Stillbirth is the mayor contributor to perinatal mortality. Aim: To report a system for classification of fetal deaths. Material and Methods: Retrospective cohort study of 29,916 births with 258 fetal deaths that occurred in a public hospital. Data were obtained from audit reports of stillbirths. The method for classification “obstetric condition relevant to the death” was applied, based on obstetric and placental pathological findings analyzed exclusively by a single obstetrician and a single pathologist. Results: Ninety two percent of obstetric conditions causing fetal death were identified. The most commonly reported were ascending bacterial infection in 26%, congenital anomalies in 19%, arterial hypertension in 12% and placental pathology in 12%. Fetal growth restriction was identified in 50% of stillbirths. Ninety percent were secondary to a primary obstetric condition and 10% had an unexplained cause. Placental abruption as the final cause of fetal death was identified in 60% of cases with arterial hypertension, 43% of cases with placental pathology and 37% of ascending infections. Fetal deaths occurred during pregnancy in 82% of cases and during labor in 17%. Intrapartum asphyxia occurred in 0.8% of stillbirths and presented in term pregnancies. Conclusions: The “obstetric condition relevant to the death” method for classification of fetal death is effective to identify the originating obstetric cause of stillbirth and reduces the impact of fetal growth restriction and intrapartum asphyxia as the leading causes of death.

Obesidad, factor de riesgo de infección bacteriana ascendente durante el embarazo / Obesity, a risk factor for ascending bacterial infection during pregnancy

Background: Obesity in pregnancy is associated with significantly higher rates of infection. Aim: To compare the infectious morbidity in pregnant women with normal and altered body mass index (BMI). Material and Methods: Cross sectional retrospective study of 6,150 patients who had delivery or second trimester abortion during 2012. The patients were classified according to BMI as underweight, normal weight, overweight and obese. We compared the frequency of pregnancy and perinatal complications related to ascending bacterial infection (ABI). The data was obtained from the hospital’s databases. Results: Obese patients had higher rates of pregnancy and perinatal complications related to ABI compared to patients with normal weight. The odds ratios (OR) and 95% confidence intervals (CI) for second trimester abortion were 3.45 (1.63-7.31) p < 0.01, for preterm delivery 2.42 (1.51-3.87) p < 0.01, for labor and puerperium infections 3.42 (2.06-5.68) p < 0.01 and for early neonatal infectious and perinatal mortality 4.46 (1.75-11.37) p < 0.01. A logistic regression analysis revealed that obesity is an independent risk factor for second trimester abortion related to ABI with an OR of 3.18 (CI 95% 1.46-6.91), premature delivery related to ABI with an OR of 2.51 (CI 95% 1.54-4.09) and for delivery and postpartum infections with an OR of 4.44 (CI 95% 2.62 to 7.51). Conclusions: Obese pregnant women had a 2.5 to 4.5 times increased risk of infectious morbidity compared to normal weight patients. Obesity is an independent risk factor for second trimester abortion and preterm delivery related to ABI and delivery and postpartum infectious.

Infecciones vaginales en un Centro de Salud Familiar de la Región Metropolitana, Chile / Vaginal infections in a Family Health Clinic in the Metropolitan Region, Chile

Background: Vaginal infections are a frequent cause for consultation, but their prevalence and etiology vary in different populations. Objectives: To determine the prevalence and etiologies of vaginal infection in women attending a family health center in the Metropolitan Region of Chile. Methods: The microbiological diagnosis was made by wet mount and Gram stain. Diagnosis of trichomoniasis was performed by wet mount, culture and polymerase chain reaction. Results: 101 women aged 15-54, not selected by signs or symptoms of vaginal infection, 46 of them pregnant were included. In 47 women (46.5%), vaginal infections were diagnosed. An association was observed between age and frequency of vaginal infection. The proportion of infections among pregnant and non-pregnant women was similar. The most frequent infections were bacterial vaginosis (16.8%), vulvovaginal candidiasis (11.9%) and co-infections (6.9%). We found 5.9% of intermediate microbiota cases, 3% of trichomoniasis and 2% of aerobic vaginitis. Symptoms of vaginal infection had poor agreement with microbiological findings. Otherwise physical signs had good agreement with the presence of infection, but low to moderate concordance with a specific etiology. Conclusions: We found a high prevalence of vaginal infections in the study population. It is necessary to improve the definitions and criteria of microbiological diagnosis of co-infections and intermediate microbiota, for them to be diagnosed in the clinical practice. More descriptive questionnaires are recommended to enhance the usefulness of clinical examination.

Introducción: Las infección vaginales constituyen un motivo frecuente de consulta, pero su prevalencia y etiología varían en distintas poblaciones. Objetivos: Determinar la prevalencia y tipos de infección vaginal en mujeres atendidas en un centro de salud familiar de la Región Metropolitana. Métodos: El diagnóstico microbiológico fue efectuado mediante examen microscópico al fresco y tinción de Gram y para tricomoniasis examen al fresco, cultivo y reacción de la polimerasa en cadena. Resultados: Se incluyeron 101 mujeres de 15-54 años, no seleccionadas por signos ó síntomas, 46 de ellas embarazadas. En 47 mujeres (46,5%) se diagnosticaron infecciones vaginales. Se observó asociación entre edad y frecuencia de infección vaginal. La proporción de infecciones entre gestantes y no gestantes fue similar. Las infecciones más frecuentes fueron vaginosis bacteriana (16,8%), candidiasis vulvo-vaginal (11,9%) y co-infecciones (6,9%). Se observó 5,9% casos de microbiota intermedia, 3% de tricomoniasis y 2% de vaginitis aeróbica. Los síntomas de infección vaginal tuvieron mala concordancia con los hallazgos microbiológicos. A su vez, los signos físicos tuvieron buena concordancia con la existencia de infección, pero escasa a moderada concordancia con una etiología específica. Conclusiones: Se encontró alta frecuencia de infecciones vaginales. Es necesario mejorar las definiciones y criterios de diagnóstico microbiológico de las co-infecciones y microbiota intermedia, para ser diagnosticadas en la práctica clínica. Se recomienda emplear cuestionarios más descriptivos para mejorar la utilidad del examen clínico.

[Fatal neonatal sepsis caused by vertical transmission of Morganella morganii. Report of one case]. / Sepsis neonatal precoz causada por transmisión vertical de Morganella morganii, en un embarazo de término.

We report a term neonate who developed early-onset sepsis due to Morganella morganii. The child was vaginally delivered after a short labor, and presented signs of perinatal asphyxia. Blood cultures taken soon after birth and from mother's lochia were positive for this microorganism. The infection was unresponsive to treatment with cefotaxime, to which the microorganism was susceptible, and the infant died at 17 days of age. M morganii is an opportunistic and uncommon pathogen, causing disease mainly in patients with underlying illness or after surgery. It is a rare perinatal pathogen, causing severe disease in premature infants, in association with maternal chorioamnionitis and premature rupture of the membranes.