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Chapter 4 : Prematurity: Premature Rupture of the Membranes and Preterm Labor

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Abstract:

Premature birth and low birth weight are the leading perinatal problems in the Western world. This chapter reviews the evidence supporting a linkage of subclinical infection and inflammation with preterm birth. Histologic chorioamnionitis is consistently associated with preterm birth. Examination of tissue reveals that for newborns greater than 2,500 g, approximately 20% of placentas had histologic lesions of chorioamnionitis, but for newborns less than 1,000 g, over 70% of placentas had chorioamnionitis. For births of premature infants, clinically evident infection in infants and mothers is increased. Associations have been made between some organisms or infections and subsequent preterm birth. More recent reports, summarized by Gibbs, have shown that the biochemical consequences of infection or inflammation can lead to preterm birth. Of greatest clinical interest are the antibiotic trials designed to prevent prematurity. These trials are of three different types, including trials conducted during prenatal care of women at high risk (generally greater than 10%) for preterm birth, trials involving women in preterm labor with intact membranes when the antibiotics are used concurrently with tocolytic drugs, and trials involving women with premature rupture of the membranes. Examples of such trials include prenatal treatment of or treatment of low-risk patients with bacterial vaginosis.

Citation: Gibbs R. 1999. Prematurity: Premature Rupture of the Membranes and Preterm Labor, p 61-68. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch4
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Figures

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Figure 1

Amniotic fluid cultures in patients in preterm labor. The asterisk indicates that although amniotic fluid cultures were negative, three neonates had evidence of infectious morbidity. Reprinted from ) with permission.

Citation: Gibbs R. 1999. Prematurity: Premature Rupture of the Membranes and Preterm Labor, p 61-68. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch4
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References

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1. Dombroski, R. A.,, D. S. Woodard,, M. J. K. Harper,, and R. S. Gibbs. 1990. A rabbit model for bacteria induced preterm pregnancy loss. Am. J. Obstet. Gynecol. 163: 1938 1943.
2. Egarter, C.,, H. Leitich,, H. Karas,, and F. Wieser. 1996. Antibiotic treatment in preterm premature rupture of membranes and neonatal morbidity: a meta-analysis. Am. J. Obstet. Gynecol. 174: 589 597.
3. Eschenbach, D. A.,, R. P. Nugent,, and A. V. Rao. 1991. A randomized placebocontrolled trial of erythromycin for the treatment of Ureaplasma urealyticum to prevent premature delivery. Am. J. Obstet. Gynecol. 164: 734 742.
4. Gibbs, R. S.,, and D. A. Eschenbach. 1997. Use of antibiotics to prevent preterm birth. Am. J. Obstet. Gynecol. 177: 375 380.
5. Gibbs, R. S.,, R. Romero,, S. L. Hillier,, D. A. Eschenbach,, and R. L. Sweet. 1992. A review of premature birth and subclinical infection. Am. J. Obstet. Gynecol. 166: 1515 1528.
6. Hauth, J. C.,, R. L. Goldenberg,, W. W. Andrews,, M. B. DuBard,, and R. L. Cooper. 1995. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N. Engl. J. Med. 333: 1732 1736.
7. Hillier, S. L.,, J. Martius,, and M. A. Krohn. 1988. A case controlled study of chorioamnionitis infection and histologic chorioamnionitis. N. Engl. J. Med. 319: 1972 1978.
8. Kirschbaum, T. 1993. Antibiotics in the treatment of preterm labor. Am. J. Obstet. Gynecol. 168: 1239 1246.
9. Klebanoff, M. A.,, J. A. Regan,, V. Rao,, R. P. Nugent,, W. C. Blackwelder,, D. A. Eschenbach,, J. G. Pastorek,, S. Williams,, and R. S. Gibbs. 1995. Outcome of the vaginal infections and prematurity study: results of a clinical trial of erythromycin among pregnant women colonized with group B streptococci. Am. J. Obstet. Gynecol. 172: 1540 1545.
10. McDuffie, R. S.,, and R. S. Gibbs. 1994. Animal models of ascending genital tract infection in pregnancy. Infect. Dis. Obstet. Gynecol. 2: 60 70.
11. McDuffie, R. S.,, M. P. Sherman,, and R. S. Gibbs. 1992. Amniotic fluid tumor necrosis factor- α and interleukin-1 in a rabbit model of bacterially induced preterm pregnancy loss. Am. J. Obstet. Gynecol. 167: 1583 1588.
12. McGregor, J. A.,, J. I. French,, R. Parker,, D. Draper,, and E. Patterson. 1995. Prevention of premature birth by screening and treatment for common genital tract infections: results of a prospective controlled evaluation. Am. J. Obstet. Gynecol. 173: 157 167.
13. Mercer, B. M.,, and K. L. Arheart. 1995. Antimicrobial therapy in expectant management of preterm premature rupture of the membranes. Lancet 346: 1271 1279.
14. Mercer, B. M.,, M. Miodovnik,, G. Thurnau,, R. L. Goldenberg,, A. Das,, R. D. Ramsey,, Y. A. Rabello,, P. J. Meis,, A. H. Moawad,, J. D. Iams,, J. P. Van Dorsten,, R. H. Paul,, S. F. Bottoms,, G. Merenstein,, E. A. Thom,, J. M. Roberts,, and D. McNellis. 1997. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. JAMA 278: 989 995.
15. Morales, W. J.,, S. Schorr,, and J. Albritton. 1994. Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebocontrolled, double-blind study. Am. J. Obstet. Gynecol. 171: 345 349.
16. Regan, J. A.,, M. A. Klebanoff,, R. P. Nugent,, D. A. Eschenbach,, W. C. Blackwelder,, Y. Lou,, and R. S. Gibbs. 1996. Colonization with group B streptococci in pregnancy and adverse outcome. Am. J. Obstet. Gynecol. 174: 1354 1360.
17. Romero, R.,, M. Sirtori,, E. Oyarzun,, and C. Avila. 1989. Infection and labor. Am. J. Obstet. Gynecol. 161: 817 824.
18. Romero, R.,, B. Sibai,, S. Caritis,, R. Paul,, and R. Depp. 1993. Antibiotic treatment of preterm labor with intact membranes: a multicenter, randomized, doubleblinded, placebo-controlled trial. Am. J. Obstet. Gynecol. 169: 764 774.
19. Ryan, G. M., Jr., T. N. Abdella, S. G. McNelly, V. S. Baselski, and D. E. Drummond. 1990. Chlamydia trachomatis infection in pregnancy and effect of treatment on outcome. Am. J. Obstet. Gynecol. 162: 34 39.
20. Seo, K.,, J. A. McGregor,, and J. I. French. 1992. Preterm birth is associated with increased risk of maternal and neonatal infection. Am. J. Obstet. Gynecol. 79: 75 80.
21. Sweet, R. L.,, D. V. Londres,, C. Walker, et al. 1987. Chlamydia trachomatis infection and pregnancy outcome. Am. J. Obstet. Gynecol. 156: 824

Tables

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Table 1

Preterm birth and neonatal infection based on diagnosis by culture

Citation: Gibbs R. 1999. Prematurity: Premature Rupture of the Membranes and Preterm Labor, p 61-68. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch4
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Table 2

Pregnancy outcome in a rabbit model

Citation: Gibbs R. 1999. Prematurity: Premature Rupture of the Membranes and Preterm Labor, p 61-68. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch4

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