Listeriosis is a rare foodborne infection caused by Listeria monocytogenes. It is 12–20 times more prevalent in pregnant women compared to the general population, with a 20–40% mortality rate in neonates. Early treatment with appropriate antimicrobial agents is critical for pregnancy outcomes; however, the infection is difficult to control because the nonspecific clinical manifestations and rarity of the disease often preclude early diagnosis. We encountered 2 cases of pregnancy-associated listeriosis that occurred at 29 and 37 weeks of gestation. Both neonates were delivered by emergent cesarean section due to fetal condition, and one of the preterm infants died immediately after birth. Pregnancy-associated listeriosis should be considered in the management of unexplained fever or inflammatory conditions in pregnant women.
Anti-Infective Agents ; Cesarean Section ; Chorioamnionitis* ; Early Diagnosis ; Female ; Fever ; Humans ; Infant, Newborn ; Infant, Premature ; Listeria monocytogenes ; Listeriosis* ; Mortality ; Parturition ; Pregnancy ; Pregnancy Outcome ; Pregnant Women

Bronchopulmonary dysplasia (BPD) is the most common morbidity of prematurity. BPD is a chronic respiratory disease related to lung-injury during the primary course of critical lung disease such as respiratory distress syndrome or when abnormal development of the preterm lung occurs. Abnormal lung development not only results from primary lung injury in the first days after birth, but also secondary injury through abnormal repair resulting in arrested and abnormal alveolarization, fibrosis and pulmonary vascular dysgenesis. Chorioamnionitis is a risk factor that plays an important role in the development of BPD. Ureaplasma subspecies (spp.) are the most common isolated organisms from chorioamniotic tissue after premature births. Therefore Ureaplasma spp. appear to play an important role in the development of BPD, and treatment or prophylactic treatment of these infections or colonization may reduce the incidence, morbidity and mortality of BPD. Ureaplasma spp. infections are challenging not only to treat, but also to diagnosis in a timely manner. This review summarizes the current state of treatment and new developments in the treatment of Ureaplasma exposure in premature infants.
Azithromycin ; Bronchopulmonary Dysplasia* ; Chorioamnionitis ; Colon ; Diagnosis ; Female ; Fibrosis ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Lung ; Lung Diseases ; Lung Injury ; Mortality ; Parturition ; Pregnancy ; Premature Birth ; Risk Factors ; Ultrasonography ; Ureaplasma*

PURPOSE: We report a rare case of bilateral macular infarction as an ocular presenting sign of primary antiphospholipid syndrome. CASE SUMMARY: A 29-year-old woman who had undergone a cesarean section for chorioamnionitis in the department of Obsterics was referred to the department of ophthalmology for bilateral visual loss. At examination, best-corrected visual acuity (BCVA) of the right eye was counting fingers, and for the left was 0.05. Fundus examination revealed extensive macular edema and cotton-wool spots in both eyes. We performed hematologic tests including thrombophilia examination. Antinuclear antibody and rheumatoid factor were negative but lupus anticoagulant presented high titers on two occasions 12 weeks apart. She was administered sub-Tenon's injections of triamcinolone acetonide 50 mg/week in both eyes under the diagnosis of bilateral macular arteriolar occlusion in primary antiphospholipid syndrome. Her BCVA remained 0.025 in her right eye and improved to 0.125 in her left eye. CONCLUSIONS: Macular infarction is an uncommon but severe complication of antiphospholipid syndrome. Early and regular fundus exam in patients with antiphospholipid syndrome is necessary to avoid progression of severe ocular complications.
Adult ; Antibodies, Antinuclear ; Antiphospholipid Syndrome* ; Cesarean Section ; Chorioamnionitis ; Diagnosis ; Female ; Fingers ; Hematologic Tests ; Humans ; Infarction* ; Lupus Coagulation Inhibitor ; Macular Edema ; Ophthalmology ; Pregnancy ; Rheumatoid Factor ; Thrombophilia ; Triamcinolone Acetonide ; Visual Acuity

PURPOSE: To develop a model based on non-invasive clinical and ultrasonographic parameters for predicting the likelihood of subsequent histologic chorioamnionitis in women with preterm premature rupture of membranes (PPROM) and to determine whether the inclusion of invasive test results improves the predictive value of the model. MATERIALS AND METHODS: This retrospective cohort study included 146 consecutive women presenting with PPROM (20-33 weeks). Transvaginal ultrasonographic assessment of cervical length was performed. Maternal serum C-reactive protein (CRP) levels and white blood cell (WBC) counts were measured after amniocentesis. Amniotic fluid (AF) obtained by amniocentesis was cultured, and interleukin-6 (IL-6) levels and WBC counts were determined. The primary outcome measure was histologic chorioamnionitis. RESULTS: Risk scores based on serum CRP concentrations and gestational age (model 1) were calculated for each patient. The model was shown to have adequate goodness of fit and an area under the receiver operating characteristic curve (AUC) of 0.742. When including AF test results (e.g., AF IL-6 levels) in model 1, serum CRP concentrations were found to be insignificant, and thus, were excluded from model 2, comprising AF IL-6 levels and gestational age. No significant difference in AUC was found between models 1 and 2. CONCLUSION: For women with PPROM, the newly developed model incorporating non-invasive parameters (serum CRP and gestational age) was moderately predictive of histologic chorioamnionitis. The inclusion of invasive test results added no predictive information to the model in this setting.
Adult ; *Amniocentesis ; Amniotic Fluid/*cytology/microbiology ; C-Reactive Protein/*metabolism ; Chorioamnionitis/blood/*diagnosis/metabolism ; Cohort Studies ; Female ; Fetal Membranes, Premature Rupture/*blood ; *Gestational Age ; Humans ; Infant, Newborn ; Interleukin-6/blood ; Leukocyte Count ; Predictive Value of Tests ; Pregnancy ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: To evaluate the diagnostic performance of maternal inflammatory marker: C-reactive protein (CRP) in predicting early onset neonatal sepsis (that occurring within 72 hours after birth). MATERIALS AND METHODS: 126 low birth weight newborns (gestation 32+/-3.2 wk, birth weight 1887+/-623 g) and their mothers were included. Neonates were divided into sepsis group (n=51) including both proven (positive blood culture) and suspected (negative blood culture but with more than 3 abnormal clinical signs), and controls (n=75). Mothers were subgrouped into CRP positive > or =1.22 mg/dL (n=48) and CRP negative <1.22 mg/dL (n=78) group, determined by Receiver Operating Characteristic curves, and odds ratio was calculated for neonatal sepsis according to maternal condition. RESULTS: Maternal CRP was significantly higher in neonatal sepsis group than in control (3.55+/-2.69 vs. 0.48+/-0.31 mg/dL, p=0.0001). Maternal CRP (cutoff value >1.22 mg/dL) had sensitivity 71% and specificity 84% for predicting neonatal sepsis. Maternal CRP positive group had more neonatal sepsis than CRP negative group (71% vs. 29%, p<0.001). Odds ratio of neonatal sepsis in maternal CRP positive group versus CRP negative group was 10.68 (95% confidence interval: 4.313-26.428, p<0.001). CONCLUSION: The risk of early onset neonatal sepsis significantly increased in the case of positive maternal CRP (> or =1.22 mg/dL). In newborn of CRP positive mother, the clinician may be alerted to earlier evaluation for possible neonatal infection prior to development of sepsis.
C-Reactive Protein/*metabolism ; Chorioamnionitis/metabolism ; Female ; Humans ; Infant, Newborn ; Male ; Mothers ; Pregnancy ; Sepsis/diagnosis/*metabolism

The aim of this study was to determine whether maternal serum C-reactive protein (CRP) is of value in predicting funisitis and early-onset neonatal sepsis (EONS) in women with preterm labor or preterm premature rupture of membranes (PROM). This retrospective cohort study included 306 consecutive women with preterm labor or preterm PROM who delivered preterm singleton neonates (23-35 weeks gestation) within 72 hr of CRP measurement. The CRP level was measured with a highly sensitive immunoassay. The sensitivity, specificity, positive predictive value, and negative predictive value of an elevated serum CRP level (> or = 8 mg/L) were 74.1%, 67.5%, 32.8%, and 92.4% for funisitis, and 67.7%, 63.3%, 17.2%, and 94.6% for EONS, respectively. Logistic regression analysis demonstrated that elevated levels of serum CRP were significantly associated with funisitis and EONS, even after adjusting gestational age. The maternal serum CRP level obtained up to 72 hr before delivery is an independent predictor of funisitis and EONS in women with preterm labor or preterm PROM. A low serum CRP level (< 8 mg/L) has good negative predictive value in excluding funisitis and EONS, and may therefore be used as a non-invasive adjunct to clinical judgment to identify low-risk patients.
Adult ; Age of Onset ; Area Under Curve ; Biological Markers/blood ; C-Reactive Protein/*analysis ; Chorioamnionitis/blood/*diagnosis ; Cohort Studies ; Female ; Fetal Membranes, Premature Rupture/blood ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/blood/*diagnosis ; *Predictive Value of Tests ; Pregnancy ; Premature Birth/blood ; ROC Curve ; Retrospective Studies ; Sepsis/blood/*diagnosis

OBJECTIVETo study the relationship between microbial gene 16SrRNA and intrauterine infection.

METHODSThirty cases of single preterm birth were enrolled, including 16 cases due to premature rupture of membranes (PROM) (rupture time>18 hrs), 6 cases due to spontaneous preterm birth and 8 cases due to iatrogenic preterm birth. Ten cases of single term birth were used as the control group. Fetal membrane and placenta samples were obtained. Amniotic fluid, blood from cord or newborn babies as well as gastric fluid and tracheal secretions from infants with mechanical ventilation were also obtained. The histological features of placenta and fetal membranes were observed. Polymerase chain reaction (PCR) was used to detect the presence of microbial 16SrRNA and ureaplasma urealyticum (UU) in placenta, fetal membranes and other samples.

RESULTSTwenty-one (70%) cases were diagnosed as chorioamnionitis, characterized by neutrophil infiltration in fetal membrane and placenta tissues, especially in fetal membranes. Chorioamnionitis was most frequent in babies whose gestational age less than 32 weeks or birth weight lower than 1 500 g. Positive 16SrRNA gene was found in 12 cases, and positive UU gene in 10 cases in the preterm birth group. Neither 16SrRNA nor UU gene was detected in the control group. The PROM preterm babies developed more frequent infection than the babies premature born due to other causes, but there were no statistically significant differences in the incidence of infection.

CONCLUSIONSChorioamnionitis may be the major cause of PROM and premature birth. The detection of microbial genes is valuable in identification of intrauterine infection.

Chorioamnionitis ; diagnosis ; Female ; Fetal Membranes, Premature Rupture ; etiology ; Humans ; Infant, Newborn ; Infant, Premature ; Placenta ; microbiology ; pathology ; Pregnancy ; RNA, Ribosomal, 16S ; genetics ; Ureaplasma urealyticum ; genetics ; isolation & purification

Umbilical cord cyst is correlated with the fetal chromosomal defects or its structural abnormality; therefore, the follow-up evaluations on fetal growth, lesion size, and concomitant congenital malformation are essential. Thus, when a prenatal ultrasonogram suspects an umbilical cord cyst, karyotyping is strongly recommended to rule out any chromosomal abnormality. The pathologic findings of necrotizing funisitis are paraumbilical exudates due to inflammatory changes, the secondary calcification change of the exudates, thrombosis, and sometimes edema of the umbilical cord. Even though incidence of umbilical cord cyst is rare, it must be differentiated from a cord edema caused by necrotizing funisitis. We have encountered a patient with a suspicious umbilical cord cyst in the third trimester of her pregnancy but the postpartum diagnosis turned out to be an umbilical cord edema by necrotizing funisitis, so we investigated the case with brief comparison to other literature.
Chorioamnionitis* ; Chromosome Aberrations ; Diagnosis ; Edema* ; Exudates and Transudates ; Female ; Fetal Development ; Follow-Up Studies ; Humans ; Incidence ; Karyotyping ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, Third ; Thrombosis ; Ultrasonography* ; Umbilical Cord*

Umbilical cord cyst is correlated with the fetal chromosomal defects or its structural abnormality; therefore, the follow-up evaluations on fetal growth, lesion size, and concomitant congenital malformation are essential. Thus, when a prenatal ultrasonogram suspects an umbilical cord cyst, karyotyping is strongly recommended to rule out any chromosomal abnormality. The pathologic findings of necrotizing funisitis are paraumbilical exudates due to inflammatory changes, the secondary calcification change of the exudates, thrombosis, and sometimes edema of the umbilical cord. Even though incidence of umbilical cord cyst is rare, it must be differentiated from a cord edema caused by necrotizing funisitis. We have encountered a patient with a suspicious umbilical cord cyst in the third trimester of her pregnancy but the postpartum diagnosis turned out to be an umbilical cord edema by necrotizing funisitis, so we investigated the case with brief comparison to other literature.
Chorioamnionitis* ; Chromosome Aberrations ; Diagnosis ; Edema* ; Exudates and Transudates ; Female ; Fetal Development ; Follow-Up Studies ; Humans ; Incidence ; Karyotyping ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, Third ; Thrombosis ; Ultrasonography* ; Umbilical Cord*

This study evaluated the risk of brain damage in neonates delivered at < 34 weeks following a prolonged latency after preterm premature rupture of membranes (pPROM). The medical records of 77 singletons delivered at < 34 weeks with pPROM and 66 singletons delivered at < 34 weeks with preterm labor and intact membranes were reviewed. Latency was divided into four intervals: < or = 24, > 24- < or = 72, > 72- < or = 168 hr, and > 1 week. Outcomes in the longer three intervals were compared with those in neonates delivered at < or = 24 hr after pPROM. The documented outcomes were placental (histologic chorioamnionitis, vasculitis, funnisitis) and neonatal (intraventricular hemorrhage, ventriculomegaly, germinal matrix hemorrhage, periventricular leukomalacia). Odds ratios and 95% CI for the risk of histologic chorioamnionitis according to the respective latency intervals were 4.8 (1.0-22.9), 7.0 (1.1-43.1), 7.4 (2.1-42.3) in patients with pPROM. The risks of intracranial ultrasonic abnormalities, however, did not increased with prolonged latency. In the patients with preterm labor and intact membranes, the both risks did not increased with increasing latency. Therefore, this study was suggested that the risk of histologic chorioamnionitis increased with increasing latency, but there was no relationship between neonatal brain damage and latency interval after pPROM.
Ultrasonography, Prenatal/methods ; Sepsis ; Risk ; Pregnancy ; Odds Ratio ; Obstetric Labor, Premature ; Models, Statistical ; Intracranial Hemorrhages/pathology ; Humans ; Fetal Membranes, Premature Rupture/*pathology ; Female ; Extraembryonic Membranes/pathology ; Chorioamnionitis ; Brain Injuries/*diagnosis/*etiology ; Adult