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Intrauterine infection and prematurity
Luís F Gonçalves1, Tinnakorn Chaiworapongsa, Roberto Romero
1Perinatology Research Branch, NICHD, Hutzel Hospital, Department of Obstetrics and Gynecology, Detroit, Michigan 48201, USA.
Summary
Intrauterine infections significantly contribute to preterm birth, especially in early gestation. Early diagnosis and targeted antibiotic use, particularly in preterm premature rupture of membranes, can reduce complications.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Infectious Diseases
Background:
- Intrauterine infection is a primary driver of preterm labor, occurring in about 25% of preterm births, with incidence increasing at earlier gestational ages.
- Fetal exposure to microbial products can trigger an inflammatory response, leading to preterm labor and increased perinatal morbidity.
- Common causative agents include Ureaplasma urealyticum, Fusobacterium spp., and Mycoplasma hominis, while the roles of Chlamydia trachomatis and viruses are under investigation.
Purpose of the Study:
- To review the role of intrauterine infections in preterm labor.
- To discuss the impact of fetal inflammatory response syndrome on perinatal outcomes.
- To evaluate the efficacy of antibiotic interventions in managing intrauterine infections and preventing preterm birth.
Main Methods:
- Literature review of studies on intrauterine infections and preterm birth.
- Analysis of microbial agents implicated in intra-amniotic infections.
- Evaluation of antibiotic treatment strategies for various obstetric conditions.
Main Results:
- Antibiotic treatment for asymptomatic bacteriuria correlates with reduced preterm birth rates.
- Antibiotic administration in preterm premature rupture of membranes prolongs pregnancy and decreases chorioamnionitis and neonatal sepsis.
- Benefits of antibiotic therapy are not consistently demonstrated for bacterial vaginosis, or colonization with Streptococcus agalactia, Ureaplasma urealyticum, or Trichomonas vaginalis.
Conclusions:
- Intrauterine infections are critical in preterm labor, necessitating further research into causative factors and preventative strategies.
- Molecular microbiology may identify previously undiscovered microorganisms involved in these infections.
- Targeted antibiotic interventions show promise, particularly in cases of preterm premature rupture of membranes, but require further investigation for other conditions.