Maternal Infection and Adverse Fetal and Neonatal Outcomes

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Abstract

Adverse pregnancy outcomes can follow direct placental, fetal, or neonatal infection, or preterm birth associated with vaginal, cervical, intrauterine, or even nonpelvic infections. These latter infections appear to be associated with the majority of very early preterm births, and may explain some of the long-term neurologic damage associated with preterm birth. Bacterial vaginosis and its associated intrauterine infections likely contribute far more to the overall burden of adverse pregnancy outcomes than the more classical perinatal infections such as rubella and syphilis.

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Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations.

R Amsel, P Totten, C A Spiegel … (1983)

Numerous previous studies of nonspecific vaginitis have yielded contradictory results regarding its cause and clinical manifestations, due to a lack of uniform case definition and laboratory methods. We studied 397 consecutive unselected female university students and applied sets of well defined criteria to distinguish nonspecific vaginitis from other forms of vaginitis and from normal findings. Using such criteria, we diagnosed nonspecific vaginitis in up to 25 percent of our study population; asymptomatic disease was recognized in more than 50 percent of those with nonspecific vaginitis. A clinical diagnosis of nonspecific vaginitis, based on simple office procedures, was correlated with both the presence and the concentration of Gardnerella vaginalis (Hemophilus vaginalis) in vaginal discharge, and with characteristic biochemical findings in vaginal discharge. Nonspecific vaginitis was also correlated with a history of sexual activity, a history of previous trichomoniasis, current use of nonbarrier contraceptive methods, and, particularly, use of an intrauterine device. G. vaginalis was isolated from 51.3 percent of the total population using a highly selective medium that detected the organism in lower concentration in vaginal discharge than did previously used media. Practical diagnostic criteria for standard clinical use are proposed. Application of such criteria should assist in clinical management of nonspecific vaginitis and in further study of the microbiologic and biochemical correlates and the pathogenesis of this mild but quite prevalent disease.

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Chorioamnionitis as a risk factor for cerebral palsy: A meta-analysis.

Y. Wu, J Colford (2000)

Chorioamnionitis has been implicated in the pathogenesis of cerebral palsy, but most studies have not reported a significant association. Cystic periventricular leukomalacia (cPVL) is believed to be a precursor of cerebral palsy in preterm infants. To determine whether chorioamnionitis is associated with cerebral palsy or cPVL and to examine factors that may explain differences in study results. Searches of MEDLINE (1966-1999), Index Medicus (1960-1965), Doctoral Dissertation Abstracts On-Line (1861-1999), bibliographies, and online conference proceedings (1999) were performed for English-language studies with titles or abstracts that discussed prenatal risk factors for cerebral palsy or cPVL. Of 229 initially identified publications, meta-analyses were performed on studies that addressed the association between clinical (n = 19) or histologic (n = 7) chorioamnionitis and cerebral palsy or cPVL in both preterm and full-term infants. Inclusion criteria were: presence of appropriate exposure and outcome measures, case-control or cohort study design, and provision of sufficient data to calculate relative risks (RRs) or odds ratios with 95% confidence intervals (CIs). Studies evaluating risk of cerebral palsy following maternal fever, urinary tract infection, or other maternal infection were collected, but not included in the meta-analysis. Information from individual studies was abstracted using standardized forms by 2 independent observers blinded to authors' names, journal titles, and funding sources. Using a random effects model, clinical chorioamnionitis was significantly associated with both cerebral palsy (RR, 1.9; 95% CI, 1.4-2.5) and cPVL (RR, 3.0; 95% CI, 2.2-4.0) in preterm infants. The RR of histologic chorioamnionitis and cerebral palsy was 1.6 (95% CI, 0.9-2.7) in preterm infants, and histologic chorioamnionitis was significantly associated with cPVL (RR, 2.1; 95% CI, 1.5-2.9). Among full-term infants, a positive association was found between clinical chorioamnionitis and cerebral palsy (RR, 4.7; 95% CI, 1.3-16.2). Factors explaining differences in study results included varying definitions of clinical chorioamnionitis, extent of blinding in determining exposure status, and whether individual studies adjusted for potential confounders. Our meta-analysis indicates that chorioamnionitis is a risk factor for both cerebral palsy and cPVL. JAMA. 2000;284:1417-1424.

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Prevention of premature birth.

R L Goldenberg, D Rouse (1998)

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Robert L. Goldenberg

Journal

Journal ID (nlm-ta): Clin Perinatol

Journal ID (iso-abbrev): Clin Perinatol

Title: Clinics in Perinatology

Publisher: Elsevier Inc.

ISSN (Print): 0095-5108

ISSN (Electronic): 1557-9840

Publication date PMC-release: 5 August 2005

Publication date (Print): September 2005

Publication date (Electronic): 5 August 2005

Volume: 32

Issue: 3

Pages: 523-559

Affiliations

[a ]Center for Obstetric Research, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, 1500 6th Avenue South, Birmingham, AL 35233, USA

[b ]Department of Obstetrics and Gynecology, Drexel University College of Medicine, 245 North 15th Street, MS#495, 17th Floor, Philadelphia, PA 19102, USA

Author notes

[* ]Corresponding author rlg@ 123456uab.edu

Article

Publisher ID: S0095-5108(05)00034-5

DOI: 10.1016/j.clp.2005.04.006

PMC ID: 7119141

PubMed ID: 16085019

SO-VID: 2326435e-cf69-405c-8f2b-dc98d7401056

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Maternal Infection and Adverse Fetal and Neonatal Outcomes

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Abstract

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Decoding Infection and Transmission

Most cited references 136

Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations.

Chorioamnionitis as a risk factor for cerebral palsy: A meta-analysis.

Prevention of premature birth.

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