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The frequency of microbial invasion of the amniotic cavity and histologic chorioamnionitis in women at term with intact membranes in the presence or absence of labor

Cited 94 time in Web of Science Cited 104 time in Scopus
Authors
Seong, Hyo Suk; Lee, Si Eun; Kang, Ji Hyun; Romero, Roberto; Yoon, Bo Hyun
Issue Date
2008-10-22
Publisher
Elsevier
Citation
Am J Obstet Gynecol. 2008;199(4):375.e1-375.e5
Keywords
AdolescentAdultAmnion/*microbiologyAmniotic Fluid/*microbiologyChorioamnionitis/*epidemiologyFemaleGestational AgeHumansMiddle AgedObstetric Labor Complications/*microbiologyPregnancyRetrospective Studies
Abstract
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.
ISSN
1097-6868 (Electronic)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18928978

http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6W9P-4TP3799-C-1&_cdi=6688&_user=168665&_orig=search&_coverDate=10%2F31%2F2008&_sk=998009995&view=c&wchp=dGLzVtb-zSkWb&md5=079d0db44b230df4a676a445a379e375&ie=/sdarticle.pdf

https://hdl.handle.net/10371/68101
DOI
https://doi.org/10.1016/j.ajog.2008.06.040
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College of Medicine/School of Medicine (의과대학/대학원)Obstetrics & Gynecology (산부인과전공)Journal Papers (저널논문_산부인과학전공)
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