Microbiological characteristics and inflammatory cytokines associated with preterm labor (original) (raw)
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A case control study evaluating association of preterm Labor with vaginal infection
International journal of clinical obstetrics and gynaecology, 2020
Introduction: It is estimated that around 60-70% of preterm conveyances are likely because of subclinical infective or provocative causes. The current report was undertaken with an aim to study the role of vaginal infections in preterm labour. Methodology: This prospective observational study was conducted in OB&GY Department of Teerthanker Mahaveer Medical College and Research Center. A total of 137 subjects, 102 in the case group and 35 in the control group were enrolled. Subjects in case group were divided into three groups, group 1 (n=31) had preterm labor without preterm delivery, group 2 (n=37) had preterm labor and spontaneously progressed to labor while group 3 (n=34) had preterm labor and were medically induced into labor for various reasons. Result: In the present study most females were primigravida and were underweight belonged to lower socioeconomic strata. Majority had no history of abortion. Culture of vaginal discharge revealed that organisms were isolated in significantly higher proportion of subjects in PTL, S-PTB & M-PTB group as compared to control group. In the PTL, S-PTB, M-PTB and control group the commonest organisms were mixed microbes (27.27%), candida albicans (23.08%), Escherichia coli (22.22%) / Gardnerella vaginalis (22.22%) and Escherichia coli (25.00%) / Streptococcus agalactiae (25.00%), respectively. Most organisms were sensitive to the commonly used antibiotics. None of the organisms isolated was resistant to colistin. Conclusion: Vaginal infection is commonly associated with preterm labor.
Prevalence of Vaginal Infections in Preterm Labour
Pakistan Journal of Medical and Health Sciences, 2022
Objective: The purpose of this study is to determine the association of vaginal infection in preterm deliveries. Study Design: Retrospective/prospective study Place and Duration: Gynaecology and Obstetrics department of MSF Women's Hospital Peshawar and King Abdullah Teaching Hospital, Mansehra for the duration of six months form August 2021 to January 2022. Methods: Total 76 females with ages 18-(42) years were presented in this study. After receiving informed written consent, detailed demographic information about the enrolled patients, such as age, body mass index, domicile, and educational status, was recorded. Gravidity status and history of preterm deliveries were also assessed among all cases. Association of microorganisms was diagnosed by taking high vaginal swab and sent for test in bio lab. Prevalence of vaginal infections and risk factors were calculated. SPSS 23.0 was used to analyze all data. Results: Among all, 40 (52.6%) were ages between 18-28 years, 22 (28.9%) had age 29-38 years and 14 (18.4%) patients were aged between 39-48 years. Majority females 55 (72.4%) had BMI <25kg/m 2 and 21 (27.6%) had BMI >25kg/m 2. As per socioeconomic status, 44 (59.2%) cases had poor, 20 (26.3%) cases had middle and 12 (15.8%) patients were from upper class. There were 27 (35.5%) patients had history of preterm deliveries. Frequency of vaginal infections was found in 28 (36.8%) cases. UTI was found in 22 (28.9%) patients. Among HVS culture test, candida found in 25 (35.9%) patients. E.coli was the most common microorganism found in 10 (13.2%) patients. Conclusion: This study led us to the conclusion that vaginal infections greatly contribute to the unnecessary causes of premature labour. Screening for asymptomatic genitourinary infections in pregnant women is always a good idea. Early diagnosis and timely treatment of vaginal infections help reduce preterm labour and the related neonatal morbidity and mortality of premature newborns.
International Journal of Gynecology & Obstetrics, 2004
Objectives: To compare the usefulness of evaluating cervico-vaginal concentrations of proinflammatory cytokines (interleukin [IL]-1a a, IL-1h h, IL-6 and IL-8) and procalcitonin (PCT), as well as serum levels of C-reactive protein (CRP), leucocytosis and band form granulocytes in the prediction of preterm delivery (PTD). Methods: A total of 65 pregnant women experiencing preterm labor (PTL) were enrolled in the study. Concentrations of the studied markers in women who delivered prematurely and in women who, after treatment, delivered at term were compared. Receiver operator characteristic (ROC) curve analysis was used for all study parameters. Results: Cervico-vaginal IL-6 and procalcitonin as well as serum CRP concentrations were higher in women who delivered prematurely than in those who delivered near term. A cervico-vaginal IL-6 level greater than 660 pg/ml was the best predictive value of preterm delivery (sensitivity, 50%; specificity 90%; positive predictive value [PPV], 85%; NPV, 62%; likelihood ratio, 5.17). Moreover, the area under the ROC curve of 0.75 for cervico-vaginal IL-6 was greater than for other markers. Conclusion: Although cervico-vaginal concentrations of procalcitonin and serum concentration of CRP are higher in women who deliver prematurely, only cervico-vaginal concentration of IL-6 is a good predictor of preterm delivery.
Vaginal indicators of amniotic fluid infection in preterm labor
Obstetrics & Gynecology, 2001
To determine whether vaginal interleukin-6, interleukin-8, neutrophils, bacterial vaginosis, and selected vaginal bacteria are predictors of amniotic fluid (AF) infection among women in preterm labor. Methods: One hundred ninety-seven afebrile women in preterm labor with intact membranes had vaginal and AF samples collected for Gram stain, culture, and interleukin-8 and interleukin-6 determinations. Vaginal interleukin-6, interleukin-8, neutrophils, and vaginal flora were compared in women with positive and negative AF cultures. The negative AF culture group was subdivided according to AF interleukin-6 concentration. Logistic regression was used to examine the associations between vaginal cytokines and flora and AF infection or elevated AF interleukin-6. Results: The vaginal interleukin-8 concentration and neutrophil count were significantly higher with both AF infection and elevated concentrations of AF interleukin-6 and interleukin-8. The vaginal interleukin-6 concentration was not associated with AF infection or high concentration of AF cytokines. Amniotic fluid infection was associated with bacterial vaginosis or intermediate vaginal flora by Gram stain, absence of hydrogen peroxide-producing Lactobacillus, and presence of vaginal Bacteroides ureolyticus and Fusobacterium. Vaginal interleukin-8 levels greater than 30 ng/mL had 80% sensitivity and a positive predictive value of 35%, and an abnormal vaginal Gram stain (more than five neutrophils per 400؋ ؋ ؋ field, bacterial vaginosis species, or intermediate flora) had 90% sensitivity and a positive predictive value of 27% to detect AF infection or elevated AF interleukin-6. Conclusion: A high vaginal interleukin-8 concentration, abnormal vaginal Gram stain, absent hydrogen peroxideproducing Lactobacillus, and anaerobic vaginal flora were strongly associated with AF infection among women in preterm labor.
Preterm Labour: An insights into Vaginal Infections
Pakistan Journal of Medical and Health Sciences, 2022
Background: Preterm births result from preterm labour. The chief causes of newborn neurological morbidity and transience are prematurity and low birth weight. Vaginal infections are considered as a higher risk factor for pre term labour. Preterm labour is less common when proper antenatal examination, screening for lower urogenital tract infections, and early treatment are carried out. Methods: Group B streptococcus (GBS), Urea plasma urealyticum, Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum, bacterial vaginosis, herpes simplex virus (HSV) I and II, were all examined in vaginal swab samples from A control group of 81 expectant mothers underwent a GBS test. Tests for the antimicrobial propensities of GBS, U. urealyticum and M. hominis were conducted. Results: 8.70% of PTL-WO, 16.33% of S-PTB, 11.70% of M-PTB, and 17.29% of the control group had GBS. 13.04% of PTL-WO, 18.37% of S-PTB, and 17.65% of M-PTB had M. hominis. U. urealyticum was detected by PCR and culture in 52.17 percent of PTL-WO, 48.98 percent of S-PTB, and 55.88 percent of M-PTB. 17.39% of PTL-WO patients, 4.08% of S-PTB patients, and 5.88% of M-PTB patients had C. trachomatis. Monilia was found in 4.3% of PTL-WO, 6.12% of S-PTB, and 5.88% of M-PTB. This examination failed to discover N. gonorrhoeae, M. genitalium, HSV I, T. vaginalis, or T. pallidum; no additional bacteria or viruses were detected either. Conclusions: Lower urogenital tract infections in pregnant women should be tested for, especially in high-risk situations. When genitourinary infections are detected early and treated fast, prematurity-related infant morbidity and mortality are decreased, and preterm labour is less common.
The purpose of this study was to identify the relationship between the microbiological status of women and newborns, and the development of premature labor. Materials and Methods: The study included 227 pregnant women at gestational age between 28 and 36 weeks and 6 days. All women underwent an assessment of vaginal microcenosis and the quantitative and qualitative composition of the biotope of the cervical discharge; the newborns underwent bacteriological examination of the auricle, pharynx and anus. Results: Disturbances in the vaginal biotope were diagnosed in every second woman. We found that the shorter the gestation period, the higher the frequency of disturbances in the vaginal biotope, and the risk of premature birth at an earlier time correlates with the presence of infection in the mother. The risk of giving birth to an infected child is 4.2 times higher at birth from a mother who has disturbances in the biotope, compared to a woman with a normal biotope.(International Journal of Biomedicine. 2019;9(2):144-149.) Key Words: premature labor • vaginal biotope • vaginal infections • newborns Abbreviations PL, premature labor; BG, bacterial growth; GA, gestational age; PB, premature birth.
PLOS ONE
Multi-marker tests hold promise for identifying symptomatic women at risk of imminent preterm delivery (PTD, <37 week's gestation). This study sought to determine the relationship of inflammatory mediators and metabolites in cervicovaginal fluid (CVF) with spontaneous PTD (sPTD) and delivery within 14 days of presentation with symptoms of preterm labour (PTL). CVF samples from 94 (preterm = 19, term = 75) singleton women with symptoms of PTL studied between 19 +0-36 +6 weeks' gestation were analysed for cytokines/chemokines by multiplexed bead-based immunoassay, while metabolites were quantified by enzymebased spectrophotometry in a subset of 61 women (preterm = 16, term = 45). Prevalence of targeted vaginal bacterial species was determined for 70 women (preterm = 14, term = 66) by PCR. Overall, 10 women delivered within 14 days of sampling. Predictive capacities of individual biomarkers and cytokine-metabolite combinations for sPTD and delivery within 14 days of sampling were analysed by logistic regression models and area under the receiver operating characteristic curve. Fusobacterium sp., Mubiluncus mulieris and Mycoplasma hominis were detected in more preterm-delivered than term women (P<0.0001), while, M. curtisii was found in more term-delivered than preterm women (P<0.0001). RANTES (0.91, 0.65-1.0), IL-6 (0.79, 0.67-0.88), and Acetate/Glutamate ratio (0.74, 0.61-0.85) were associated with delivery within 14 days of sampling (AUC, 95% CI). There were significant correlations between cytokines and metabolites, and several cytokine-metabolite combinations were associated with sPTD or delivery within 14 days of sampling (e.g. L/D-lactate ratio +Acetate/Glutamate ratio+IL-6: 0.84, 0.67-0.94). Symptomatic women destined to deliver preterm and within 14 days of sampling express significantly higher pro-inflammatory mediators at mid to late gestation. In this cohort, IL-6, Acetate/Glutamate ratio and RANTES were associated with delivery within 14 days of sampling, consistent with their roles in modulating infection-inflammation-associated preterm labour in women presenting with symptoms of preterm birth. Replication of these observations in larger cohorts of women could show potential clinical utility.
Acta Obstetricia Et Gynecologica Scandinavica, 2003
Background. To find out whether preterm labor is associated with raised maternal serum concentrations of interleukin (IL)-6, IL-8, tumor necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ) and whether the measurement of these cytokines can be used to detect early intrauterine infection in preterm labor.Methods. Cross-sectional study: 77 women in preterm labor, 47 controls of healthy preterm women not in labor and 19 women in term labor. The serum cytokines levels were measured by enzyme-linked immunosorbent assay (ELISA). The newborns of women who were in labor were followed up for evidence of infection. Differences between groups were tested using analysis of variance, Student's t-test and χ2-test.Results. There was no significant difference in the concentration of all the cytokines measured between the different groups. No statistical difference was found in the concentration of the cytokines between women in preterm labor with ruptured membranes and those with intact membranes. There was also no difference found in the concentration of cytokines between women whose newborns had positive bacterial culture and those with negative culture. There was a positive correlation between the concentrations of IL-6, IL-8 and TNF-α.Conclusion. Serum levels of interleukin-6, interleukin-8 and tumor necrosis factor-α were not increased in preterm labor compared to normal control women. There is doubt regarding the usefulness of maternal serum measurement of these cytokines for the detection of early fetal infection in preterm labor, but this needs further evaluation.