Is There a Role for Placental Cultures in Cases of Clinical Chorioamnionitis Complicating Preterm Premature Rupture of Membranes?
30 October 2016
02 February 2017
08 March 2017 (eFirst)
Objective To assess the role of placental cultures in cases of preterm premature rupture of membranes (PPROM) complicated by chorioamnionitis and to determine the effect of positive cultures on short-term neonatal outcomes.
Design A retrospective single-center study. The medical records of all women with PPROM between January 1, 2011, and December 31, 2015, were reviewed. Cases were divided into placental culture positive (group A) and placental culture negative (group B) groups. Maternal and pregnancy characteristics as well as short-term neonatal outcomes were compared between groups.
Results During the 5-year study period, 61 cases of clinical chorioamnionitis complicating PPROM were diagnosed: 25 cases were culture positive (group A) and 36 were culture negative (group B). Neonatal outcome measures, including Apgar score at 5 minutes (p = 0.028; odds ratio [OR]: 5.27; confidence interval [CI]: 1.19–23.34), respiratory distress syndrome (p = 0.026; OR: 4.11; CI: 1.18–14.25), and neonatal infection (p < 0.0001; OR: 11.59; CI: 3.37–39.87) were significantly more common in group A newborns, regardless of gestational age at delivery as was the composite neonatal outcome (p = 0.017; OR: 7.35: CI: 1.42–37.79). Placental isolates were primarily Streptococci and Escherichia coli.
Conclusion Placental cultures may be an essential predictor of neonatal morbidity in PPROM and may contribute to the modification of neonatal treatment.
- 1 Mercer BM, Crocker LG, Pierce WF, Sibai BM. Clinical characteristics and outcome of twin gestation complicated by preterm premature rupture of the membranes. Am J Obstet Gynecol 1993; 168 (05) 1467-1473
- 2 Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005; 32 (03) 411-428
- 3 Soper DE, Mayhall CG, Dalton HP. Risk factors for intraamniotic infection: a prospective epidemiologic study. Am J Obstet Gynecol 1989; 161 (03) 562-566 , discussion 566–568
- 4 Musilova I, Kutová R, Pliskova L. , et al. Intraamniotic inflammation in women with preterm prelabor rupture of membranes. PLoS One 2015; 10 (07) e0133929 . Doi: 10.1371/journal.pone.0133929
- 5 Burke C, Chin EG. Chorioamnionitis at term: definition, diagnosis, and implications for practice. J Perinat Neonatal Nurs 2016; 30 (02) 106-114
- 6 Higgins RD, Saade G, Polin RA. , et al; Chorioamnionitis Workshop Participants Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol 2016; 127 (03) 426-436
- 7 Kacerovsky M, Pliskova L, Bolehovska R. , et al. The microbial load with genital mycoplasmas correlates with the degree of histologic chorioamnionitis in preterm PROM. Am J Obstet Gynecol 2011; 205 (03) 213.e1-213.e7
- 8 Kallapur SG, Presicce P, Rueda CM, Jobe AH, Chougnet CA. Fetal immune response to chorioamnionitis. Semin Reprod Med 2014; 32 (01) 56-67
- 9 Paumier A, Gras-Leguen C, Branger B. , et al. Premature rupture of membranes before 32 weeks of gestation: prenatal prognosis factors [in French]. Gynecol Obstet Fertil 2008; 36 (7-8): 748-756
- 10 Yamada N, Sato Y, Moriguchi-Goto S. , et al. Histological severity of fetal inflammation is useful in predicting neonatal outcome. Placenta 2015; 36 (12) 1490-1493
- 11 Ylijoki M, Lehtonen L, Lind A. , et al; PIPARI Study Group Chorioamnionitis and five-year neurodevelopmental outcome in preterm infants. Neonatology 2016; 110 (04) 286-295
- 12 Rodríguez-Trujillo A, Cobo T, Vives I. , et al. Gestational age is more important for short-term neonatal outcome than microbial invasion of the amniotic cavity or intra-amniotic inflammation in preterm prelabor rupture of membranes. Acta Obstet Gynecol Scand 2016; 95 (08) 926-933
- 13 Verani JR, McGee L, Schrag SJ. ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59 RR-10 1-36
- 14 Polin RA. ; Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics 2012; 129 (05) 1006-1015
- 15 Intrapartum Care: Care of Healthy Women and Their Babies during Childbirth. Clinical Guideline 190. London, UK: National Collaborating Centre for Women's and Children's Health; 2014
- 16 Kiser C, Nawab U, McKenna K, Aghai ZH. Role of guidelines on length of therapy in chorioamnionitis and neonatal sepsis. Pediatrics 2014; 133 (06) 992-998
- 17 Romero R, Yoon BH, Mazor M. , et al. A comparative study of the diagnostic performance of amniotic fluid glucose, white blood cell count, interleukin-6, and gram stain in the detection of microbial invasion in patients with preterm premature rupture of membranes. Am J Obstet Gynecol 1993; 169 (04) 839-851
- 18 Kim KW, Romero R, Park HS. , et al. A rapid matrix metalloproteinase-8 bedside test for the detection of intraamniotic inflammation in women with preterm premature rupture of membranes. Am J Obstet Gynecol 2007; 197 (03) 292.e1-292.e5
- 19 Hitti J, Lapidus JA, Lu X. , et al. Noninvasive diagnosis of intraamniotic infection: proteomic biomarkers in vaginal fluid. Am J Obstet Gynecol 2010; 203 (01) 32.e1-32.e8
- 20 Madan JC, Salari RC, Saxena D. , et al. Gut microbial colonization in premature neonates predicts neonatal sepsis. Ach Dis Child Fetal Neonatal Ed 2012; 97 (06) F456-F462
- 21 Bruch J-F, Bingen E, Fondacci C. , et al. The value of chorioamniotic plate smears in predicting intraamniotic infection. Placenta 1994; 15: 177-191