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Section 4 - Problems Associated with Infection

Published online by Cambridge University Press:  15 November 2017

Edited by
David James ,
Philip Steer ,
Carl Weiner ,
Bernard Gonik  and
Stephen Robson
David James
Affiliation:
University of Nottingham
Philip Steer
Affiliation:
Imperial College London
Carl Weiner
Affiliation:
University of Kansas
Bernard Gonik
Affiliation:
Wayne State University, Detroit
Stephen Robson
Affiliation:
University of Newcastle
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Summary

Intra-amniotic infection/inflammation (IAI) is a frequent and important cause of spontaneous preterm labor and delivery. Indeed, it is the only pathologic process for which both a causal link with spontaneous preterm birth has been established and a molecular pathophysiology defined. Fetal infection/inflammation has been implicated in the genesis of fetal and neonatal injury leading to cerebral palsy (CP) and chronic lung disease. Pathologic intra-amniotic inflammation can occur in the absence of detectable microorganisms, upon analysis by cultivation and/or molecular microbiologic techniques. This condition is known as sterile intra-amniotic inflammation and has been observed in patients with preterm labor and intact membranes, preterm prelabor rupture of the membranes (PPROM), and a short cervix. A mild sterile inflammatory process also participates in spontaneous labor at term, but this is considered to be an example of physiologic inflammation similar to that implicated in other important events in reproductive physiology, such as ovulation and implantation.

Type
Chapter
Information
High-Risk Pregnancy
Management Options
 , pp. 579 - 602
Publisher: Cambridge University Press
First published in: 2017

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References

Further Reading

Conde-Agudelo, A, Romero, R. Antenatal magnesium sulfate for the prevention of cerebral palsy in preterm infants less than 34 weeks’ gestation: a systematic review and meta-analysis. Am J Obstet Gynecol 2009; 200: 595–609.CrossRefGoogle Scholar
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Dong, Y, Yu, Z, Sun, Y, et al. Chronic fetal hypoxia produces selective brain injury associated with altered nitric oxide synthases. Am J Obstet Gynecol 2011; 204: e16–28.CrossRefGoogle ScholarPubMed
Gomez, R, Romero, R, Ghezzi, F, et al. The fetal inflammatory response syndrome. Am J Obstet Gynecol 1998; 179: 194–202.CrossRefGoogle ScholarPubMed
Gomez, R, Romero, R, Nien, JK, et al. Antibiotic administration to patients with preterm premature rupture of membranes does not eradicate intra-amniotic infection. J Matern Fetal Neonatal Med 2007; 20: 167–73.CrossRefGoogle Scholar
Gomez-Lopez, N, Romero, R, Xu, Y, et al. A role for the inflammasome in spontaneous preterm labor with acute histologic chorioamnionitis. Reprod Sci 2017; 24: 1382–401.
Gonçalves, LF, Chaiworapongsa, T, Romero, R. Intrauterine infection and prematurity. Ment Retard Dev Disabil Res Rev 2002; 8: 3–13.CrossRefGoogle ScholarPubMed
Guo, R, Hou, W, Dong, Y, et al. Brain injury caused by chronic fetal hypoxemia is mediated by inflammatory cascade activation. Reprod Sci 2010; 17: 540–8.Google ScholarPubMed
Kenyon, SL, Taylor, DJ, Tarnow-Mordi, W. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. ORACLE Collaborative Group. Lancet 2001; 357: 979–88.Google ScholarPubMed
Kenyon, S, Pike, K, Jones, DR, et al. Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7-year follow-up of the ORACLE I trial. Lancet 2008; 372: 1310–18.Google ScholarPubMed
Kim, J, Choi, IY, Dong, Y, et al. Chronic fetal hypoxia affects axonal maturation in guinea pigs during development: A longitudinal diffusion tensor imaging and T2 mapping study. J Magn Reson Imaging 2015; 42: 658–65.CrossRefGoogle ScholarPubMed
Kim, CJ, Romero, R, Chaemsaithong, P, et al. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol 2015; 213 (4 Suppl): S29–52.
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Nien, JK, Yoon, BH, Espinoza, J, et al. A rapid MMP-8 bedside test for the detection of intra-amniotic inflammation identifies patients at risk for imminent preterm delivery. Am J Obstet Gynecol 2006; 195: 1025–30.CrossRefGoogle ScholarPubMed
Romero, R, Brody, DT, Oyarzun, E, et al. Infection and labor. III. Interleukin-1: A signal for the onset of parturition. Am J Obstet Gynecol 1989; 160: 1117–23.Google ScholarPubMed
Romero, R, Dey, SK, Fisher, SJ Preterm labor: one syndrome, many causes. Science 2014; 345: 760–5.
Romero, R, Miranda, J, Chaiworapongsa, T, et al. A novel molecular microbiologic technique for the rapid diagnosis of microbial invasion of the amniotic cavity and intra-amniotic infection in preterm labor with intact membranes. Am J Reprod Immunol 2014; 71: 330–58.
Romero, R, Miranda, J, Chaiworapongsa, T, et al. Prevalence and clinical significance of sterile intra-amniotic inflammation in patients with preterm labor and intact membranes. Am J Reprod Immunol 2014; 72: 458–74.
Romero, R, Xu, Y, Plazyo, O, et al. A role for the inflammasome in spontaneous labor at term. Am J Reprod Immunol 2018; 79: e12440.

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