Diagnosis Of Intrauterine Infection Research Articles

Прогнозирование внутриутробной инфекции при несвоевременном излитии околоплодных вод и преждевременных родах

Objective. To study significant risk factors for predicting intrauterine infection (IUI) in patients with prelabor upture of membranes (PROM) and threatened preterm birth (PB). Patients and methods. A retrospective study was conducted, including the analysis of prenatal records, labor and delivery records, and neonatal development (n = 125). Labor and delivery records were selected considering the diagnoses of preterm birth” and “prelabor rupture of membranes”. Two patient groups were identified: group 1 (n = 59) consisted of patients diagnosed with IUI, group 2 (n = 66) – patients without diagnosis of IUI. Medical records of pregnant women and the results of clinical, laboratory, and instrumental examinations during pregnancy and at the time of hospitalization were analyzed. A comparative assessment of perinatal outcomes was performed. Results. Statistically significant risk factors for IUI regardless of gestational age included hereditary thrombophilia (OR: 2.837; 95% CI: 1.057–7.618), history of ≥2 pregnancies (OR: 2.494; 95% CI: 1.093–5.690), PB, and recurrent miscarriage (OR: 2.392; 95% CI: 1.019–5.615). Among pregnancy and delivery complications, the following were important in predicting IUI: the presence of isthmic-cervical insufficiency (ICI) (OR: 2.698; 95% CI: 1.058–6.878), the duration of waterless period (p = 0.037), gestational age at the onset of membrane rupture (p < 0.001) and delivery (p < 0.001). Conclusion. In case of expectant management, the prognostic model should be used to predict IUI in patients at risk of PB and PROM. Based on the calculation of the adjusted odds ratio, we identified the factors that have a statistically significant effect on IUI development, irrespective of other predictors, with a sensitivity of 86.7% and specificity of 92.6%. Key words: vaginal microbiota, intrauterine infection, intrauterine pneumonia, intraamniotic infection, prelabor rupture of membranes, preterm birth, chorioamnionitis

Microbiological diagnostics of inneriotrobic infections.

Intrauterine infections - infectious diseases in which infection of the fetus occurred in the ante- or intrapartum period, accompanied by clinical manifestations. The purpose of this study was to study the information content and diagnostic significance of the microbiological research method for the etiological diagnosis of intrauterine infections of a bacterial nature. A retrospective (2011-2014) and prospective (2015-2019) analysis of the results of microbiological studies of biomaterials from puerperas and their newborns was carried out in 63 cases of early neonatal mortality with established diagnoses of intrauterine infections. In the study of the separated cervical canal, placenta samples, and amniotic fluid, seeding of coagulase-negative staphylococci was most frequently observed, among which the species Staphylococcus epidermidis dominated, Staphylococcus hominis, Staphylococcus haemolyticus, Staphylococcus warneri also met. Frequent isolation of group B streptococci from the placenta and amniotic fluid was revealed in comparison with the material from the cervical canal.The information content of the microbiological study of materials from the puerpera and the newborn in terms of confirmation of the pathogen and the fact of its transmission from mother to fetus/newborn does not exceed 30%. Even with high contamination of the genital tract of the puerpera, placenta or amniotic fluid, examination of the materials from the newborn immediately after birth often does not allow to identify the causative agent, probably due to the low degree of contamination at the initial stage of development of the infectious process. An increase in the diagnostic value of microbiological research can be facilitated by an increase in the frequency of examinations, the number of samples taken; the use of techniques to increase the sensitivity of cultural research at the stage of analysis; the use of molecular genetic methods, especially in the study of materials from newborns.

Forensic medical evaluation of the role of the formation of ascending amniotic infection in the event of intrauterine fetal death

The analysis of expert practice and scientific research conducted during the last decade show that the greatest number of claims to the correctness of the provision of medical care are made by doctors of surgical specialties, including obstetrician-gynecologists, and, at the same time, inspections for “medical cases”, including profile “obstetrics and gynecology” are complex and time-consuming. The article considers the problem of the unfavorable outcome of medical care in obstetric practice. The questions of etiology, pathogenesis, diagnosis of intrauterine infection (VUI), which largely determines the frequency of perinatal morbidity and mortality, are also analyzed and analyzed questions of the prescription of the pathological process in the amniotic membranes, its role in the formation of fetal death. On a concrete example, expert practice shows how the forensic medical commission, taking into account the data of medical documents, as well as the results of macroscopic and microscopic studies, solves the problem of the immediate cause of antenatal death and establishes the role of intrauterine infection in the death of the fetus, the timing and causes of its formation. The information that is relevant to the practice of forensic medical examinations is presented, which allows us to formulate objective and scientifically substantiated conclusions about the existence of cause-effect relationships between the defects in the provision of medical care and the onset of an unfavorable outcome of medical care in similar cases.

Current approaches to the diagnosis of intrauterine infections

Current approaches to the diagnosis of intrauterine infections

T-Cell Subpopulations αβ and γδ in Cord Blood of Very Preterm Infants: the Influence of Intrauterine Infection

Preterm infants are very susceptible to infections. Immune response mechanisms in this group of patients and factors that influence cord blood mononuclear cell populations remain poorly understood and are considered insufficient. However, competent immune functions of the cord blood mononuclear cells are also described. The aim of this work was to evaluate the T-cell population (CD3+) with its subpopulations bearing T-cell receptor (TCR) αβ or TCR γδ in the cord blood of preterm infants born before 32 weeks of gestation by mothers with or without an intrauterine infection. Being a pilot study, it also aimed at feasibility check and assessment of an expected effect size. The cord blood samples of 46 infants age were subjected to direct immunofluorescent staining with monoclonal antibodies and then analyzed by flow cytometry. The percentage of CD3+ cells in neonates born by mothers with diagnosis of intrauterine infection was significantly lower than in neonates born by mothers without infection (p = 0.005; Mann–Whitney U test). The number of cells did not differ between groups. Infection present in the mother did not have an influence on the TCR αβ or TCR γδ subpopulations. Our study contributes to a better understanding of preterm infants’ immune mechanisms, and sets the stage for further investigations.

Influence of maternal age, gestational age and fetal gender on expression of immune mediators in amniotic fluid

BackgroundVariations in cytokine and immune mediator expression patterns in amniotic fluid due to gestational age, maternal age and fetal gender were investigated.FindingsAmniotic fluid samples were obtained from 192 women, 82 with a mid-trimester amniocentesis (median gestational age 17 weeks) and 110 with a caesarean section not in labor (median gestational age 39 weeks). Amniotic fluid was screened by commercial ELISAs for the TH1/TH2/TH17 cytokines and immune mediators IL-1 beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, TNF alpha, GRO-alpha, MIP1alpha, MIP1beta, Histone, and IP10. Analysis was by Bonferroni correction for multiple comparisons. None of the 15 examined cytokines revealed any differences in expression patterns regarding fetal gender. Significant differences were found in IL-4, IL-10, IL-12, TNF- alpha, GRO-alpha and MIP1-beta with respect to gestational age and in GRO-alpha regarding maternal age.ConclusionCytokines utilized as biomarkers in the diagnosis of intrauterine infections are not influenced in their expression pattern by fetal gender but may vary with respect to maternal age and gestational age.

Evaluation of Placental Membrane Swabs in the Diagnosis of Intrauterine Infections

Aims: To evaluate the performance of bacterial culture of placental swabs for the diagnosis of intrauterine infections in preterm and term infants. Methods: A total of 1438 placentas were examined after preterm and term deliveries and the results were compared with neonatal surface swabs and blood cultures, with respect to the diagnosis of perinatal infection. Swabs were inserted between the cotyledones into the space between placenta and amnion, or obtained from the membranes after separation of the amnion from the chorion. Results: Sixty-one of 1438 (4.2%) cultures of placental swabs were positive including 21 Bacteroides species, 13 Eschericia coli (E. coli), 11 group B streptococcus (GBS), 4 Enterococcus faecalis, and 12 other species. Seventeen of the 61 neonates with positive placental cultures showed clinical signs of infection or sepsis (5 E. coli, 6 GBS, 2 Enterococcus faecalis, 1 Klebsiella pneumoniae, 1 Staphylococcus aureus, 1 Candida albicans, 1 Gardnerella vaginalis), but only 4 of these neonates had a positive blood culture. 123 of 1438 (8.6%) placental swabs were contaminated. Sensitivity and positive predictive value of placental swabs for the diagnosis of neonatal infection were 62.5% and 38.5% for E. coli and 60% and 54.5% for GBS, respectively. Conclusion: Placental swabs appear to be helpful for the retrospective identification of the causative bacteria in case of chorioamnionitis with or without neonatal infection. However, the performance of placental swabs should be improved by developing a standardized technique.

The diagnosis of intrauterine infection in women with preterm premature rupture of the membranes (PPROM).

The diagnosis of intrauterine infection in women with preterm premature rupture of the membranes (PPROM).

Congenital infection

The past year has shed much new light on congenital infection. A key development has been the application of polymerase chain reaction technology to the diagnosis of intrauterine infection. This technique appears to be the diagnostic tool of choice for toxoplasmosis and cytomegalovirus. Pharmacologic treatment appears to reduce the sequellae of toxoplasmosis when treated either in utero or postnatally. Obstetric interventions may reduce vertical transmission. Education has been shown to reduce the incidence of seroconversion for toxoplasmosis, and HIV-positive women treated with zidovudine have a dramatically reduced rate of transmission to their offspring.

Fetal haematological response to intra-uterine infection in preterm prelabour amniorrhexis.

The value of fetal haematological indices in the prediction of intra-uterine infection in 91 cases of preterm prelabour amniorrhexis was examined. Cordocentesis and amniocentesis were performed for the diagnosis of intra-uterine infection. The patients were subsequently divided into three groups, depending on the results of fetal blood and amniotic fluid cultures. In group 1 there were 53 patients with negative fetal blood and amniotic fluid cultures, group 2 consisted of 22 patients with negative fetal blood, but positive amniotic fluid cultures, and in group 3 there were 16 patients with positive fetal blood cultures. The mean leucocyte and neutrophil counts in all three groups were significantly higher than normal, and in group 3 the values were significantly higher than in group 1. The leucocyte and neutrophil counts were above the 95th centile of the normal range in 58% (22 cases) and 66% (25 cases), respectively, of the 38 cases with positive fetal blood and/or amniotic fluid cultures and in only 15% (8 cases) and 13% (7 cases), respectively, of the 53 patients with no infection. There were no significant differences between the groups, between the patients with amniorrhexis or for normal haemoglobin concentration, platelet count, or lymphocyte count. In the majority of the cases with positive fetal blood and/or amniotic fluid cultures, there is fetal leucocytosis. Since the results of the fetal leucocyte and neutrophil counts are available within a few minutes after cordocentesis, it would be reasonable to give antibiotics to all patients with a fetal leucocyte count above the 95th centile.

Diagnosis of Intrauterine Infection by Demonstration of Antibody-Coated Bacteria in the Amniotic Fluid

Departments of Obstetrics and Gynecology, Aalborg Sygehus and Aarhus Kommunehospital; and Institute of Pathology, University of Aarhus, Aarhus, Denmark

Diagnosis of intrauterine infection by demonstration of antibody-coated bacteria in the amniotic fluid.

Immunofluorescence examination of amniotic fluid for the occurrence of antibody-coated bacteria was carried out in 72 consecutive women with premature rupture of the fetal membranes to assess this method in the diagnosis of intrauterine infection. Antibody-coated bacteria were demonstrated in 11 women with clinical signs of intrauterine infection, histological amnionitis and heavy growth of one bacterial species. The presence of intrauterine infection was considered possible in another 14 women. One patient had no clinical signs of infection, but positive histological and bacteriological evidence; antibody-coated bacteria were demonstrated in this patient, but not in the remaining 13 women. In 47 women clinical, histological and bacteriological signs of intrauterine infection were absent, and examinations for antibody-coated bacteria were negative in all of them. It is concluded that the demonstration of antibody-coated bacteria in amniotic fluid indicates the presence of intrauterine infection, and the examination may in some cases be positive before the appearance of clinical signs of infection.

Immunoglobulin Levels in Non-Aborted and Aborted Fetuses from Danish Herds of Cattle

The applicability of serological tests in the diagnosis of intrauterine infections in Danish cattle was investigated. Fetuses from slaughter animals, experimentally infected and spontaneously aborted fetuses, premature and stillborn calves, were subjected to necropsy and histological studies, and to microbiological and serological examinations. The latter comprised rocket immunoelectrophoresis and radial immunodiffusion. In sera of the fetuses from slaughter animals, immunoglobulins were either not detectable or only present in very small quantities, whereas sera of fetuses and calves with pathological changes and/or verified infection contained considerable amounts of IgM and IgG. IgA was also detected in the latter group. The results corroborate the diagnostic importance of immunoglobulin determination in aborted fetuses and stillborn calves.

Early diagnosis of intrauterine infection by staphylococcal protein A adsorption of neonatal serum

Early diagnosis of intrauterine infection by staphylococcal protein A adsorption of neonatal serum

Detectability and pattern of immunoglobulins in normal amniotic fluid throughout gestation

Immunoglobulin (Ig) M, IgA, and IgD class and IgA1 and IgA2 subclass levels were detected in normal amniotic fluid throughout gestation with a hemagglutination-inhibition assay: IgG was measured by single radial immunodiffusion. In 161 tested samples, IgA, IgA1, IgA2, and IgG were measurable in all cases; IgM was measurable in 99.4 per cent and IgD, in 90.6 per cent of the fluids. IgA, IgG, and IgD concentrations increased toward midpregnancy and thereafter decreased to term in a pattern similar to that for amniotic fluid total protein. IgM, on the other hand, remained relatively constant through week 35 of gestation; thereafter, it increased to term. There was no correlation in this normal group between amniotic fluid and cord blood levels of Ig class or subclass at term. Mean IgA values were 2.2 times higher in amniotic fluid than in cord serum. This was in sharp contrast to IgM, which was 16 times higher, IgG, which was 66 times higher, and IgD, which was 2.4 times higher in cord serum than in amniotic fluid. The inverse data for IgA as compared to other Ig classes suggest that amniotic fluid IgA may be partially derived from IgA in fetal gastrointestinal and pulmonary secretions. Determination of the concentration of the different Ig classes (and eventually subclasses) in amniotic fluid may be useful in diagnosis of intrauterine infections, malformations, and immunodeficiencies.

Elevated cord macroglobulins in the diagnosis of intrauterine infections.

INFECTION in utero can result in stillbirth, prematurity, malformation, growth failure and mental retardation.1 2 3 4 5 Rubella virus, cytomegalovirus, Treponema pallidum and toxoplasma are known causes of intrauterine infections that lead to fetal damage. Other agents, including mumps, influenza, Coxsackie, ECHO and vaccinia viruses, may be implicated.1 2 3 The incidence and etiology of these infections cannot be determined with any degree of accuracy by a retrospective study of illness during pregnancy, primarily because it is difficult to recollect trivial or short lasting symptoms or to establish an exact microbiologic diagnosis six months later. A clinical survey of newborn infants is also unsatisfactory since . . .