[Prognostic and therapeutic value of biologic signs of infection in the management of preterm labor (amniocentesis excepted)].
During threatened preterm delivery, both general and local signs of infection increase the risks of amniotic infection, premature rupture of membranes, preterm delivery, and neonatal and/or maternal morbidity of infectious origin. Nonetheless, as antibiotics have not been sufficiently studied to be proved of benefit in chorioamnionitis with intact membranes, search for these general (C Reactive Protein, hyperleucocytosis) or cervical/vaginal (Group B Streptococcus, Escherichia Coli, bacterial vaginosis) signs of infection have not been proved to be really necessary. We have to except Group B Streptococcus, which have to be searched during weeks that precede delivery: in those cases where it is shown to be present in the cervix or the vagina, antibiotics must be prescribed during delivery (ANAES recommendation). Finally, it must be emphasized that these recommendations are mainly based on the absence of studies specifically done to prove the benefits or risks of antenatal antibiotics - or fetal extraction - in case of chorioamnionitis with intact membranes. Systematic vaginal and blood samples (CRP, leukocytes, vaginal micro-organisms) would be helpful in determining the appropriate option in those situations.
Subtil
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Clinique de Gynécologie, Obstétrique et Néonatalogie, Hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille Cedex, France. d-subtil@chru-lille.fr
D000649:Amniocentesis; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D002821:Chorioamnionitis / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005602:France; D006801:Humans; D007964:Leukocytosis / Q000209:etiology; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy; D011379:Prognosis; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D013292:Streptococcus agalactiae / Q000302:isolation & purification; D016585:Vaginosis, Bacterial / Q000175:diagnosis / Q000382:microbiology
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002097:C-Reactive Protein