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Infection and Preterm Birth

Infection and Preterm Birth. Joogn Shin Park, MD, PhD Department of Obstetrics & Gynecology Seoul National University Hospital Seoul, Korea. Survival of Preterm Liveborn Infants. (Lemons JA et al. Pediatrics 2001). Neonatal morbidities of preterm birth. Neonatal Sepsis

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Infection and Preterm Birth

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  1. Infection and Preterm Birth Joogn Shin Park, MD, PhD Department of Obstetrics & Gynecology Seoul National University Hospital Seoul, Korea

  2. Survival of Preterm Liveborn Infants (Lemons JA et al. Pediatrics 2001)

  3. Neonatal morbidities of preterm birth • Neonatal Sepsis • Respiratory Distress Syndrome • Bronchopulmonary Dysplasia • Intraventricular Hemorrhage • Necrotizing Enterocolitis • Patent Ductus Arteriosus • Retinopathy of Prematuriy • Developmental Delay • Cerebral Palsy

  4. Causes of Preterm Birth PTL PPROM Maternal Fetal

  5. Intrauterine infection • 10% culture positive in PTL with intact membranes (Yoon BH et al. AJOG 2001)

  6. Microorganisms in AF of PTL Ureaplasmaurealyticum (67%) – most common Staphylococcus aureus Enterococcusspp Acinetobacterspp Lactobacillus spp Candida albicans Porphyromonasasaccharolytica (Yoon BH et al. AJOG 2001)

  7. Intrauterine infection • 25-40% culture positive in PPROM (Romero R et al. AJOG, 1988)

  8. Microorganisms obtained from AF Non-genital mycoplasmas E coli (n=19) Group B Streptococcus (n=28) G vaginalis (n=17) Candida sp. (n=14) Bacteroidessp. (n=18) K pneumonia (n=5) B cepacia (n=2) A baumannii (n=2) Peptostreptococcus sp. (n=8) Staphylococcus aureus (n=4) Group D Streptococcus (n=1) Lactobacillus sp. (n=1) Coagulase-negative Staphylococcus (CoNS, n=4) Genital mycoplasmas Ureaplasmaurealyticum Ureaplasmaparvum Mycoplasmahominis (n=183) (From 12 studies including 995 patients with preterm PROM)

  9. Funisitis and neonatal sepsis

  10. Elevated cord IL-6: risk factor for funisitis • AF infection and clinical chorioamnionitis: association with funisitis • Funisitis: risk factor for neonatal sepsis

  11. Association between AF MMP-8 and funisitis • Cutoff for identification of intra-amniotic inflammation: AF MMP-8 > 23 ng/mL

  12. FIRS (fetal inflammatory response syndrome)

  13. Prediction of spontaneous preterm delivery

  14. MMP-8 PTD CheckTM

  15. Oligohydramnios in women with PPROM is associated with an inflammatory response in the fetal and maternal compartment

  16. Oligohydramnios in PPROM and interval to delivery AFI > 5 AFI ≤ 5

  17. Infection and Cerebral palsy

  18. Medico-Legal Issue related to Cerebral Palsy • Obstetric malpractice? • Incidence of CP remains unchanged even with the tremendous improvements in obstetric and neonatal care • Only about 10% of neonatal encephalopathy is due to hypoxia

  19. Fetal Hypoxia & Cerebral Palsy ? Rate of Perinatal Mortality and CP (1967 to 1985) • Did the improved • obstetric and neonatal • care decrease the rate • of cerebral palsy ? • Major obstetric • improvements aimed at • reducing fetal hypoxia Stanley & Watson BMJ 1992;304:1658 Stillbirths Early neonatal deaths Cerebral palsy

  20. Intra-amniotic inflammation and funisitis: independent risk factors for cerebral palsy

  21. An elevated cord IL-6 • Associated with FIRS • Risk factor for BPD

  22. FIRS and BPD

  23. Intrauterine Infection Chorioamnionitis Fetal Inflammatory Response Prematurity Neurologic & Respiratory Sequelae

  24. 제목

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