A sonographic short cervix as the only clinical manifestation of intra-amniotic infection.
OBJECTIVE
A sonographically short cervix is a powerful predictor of spontaneous preterm delivery. However, the etiology and optimal management of a patient with a short cervix in the mid-trimester of pregnancy remain uncertain. Microbial invasion of the amniotic cavity (MIAC) and intra-amniotic inflammation are frequently present in patients with spontaneous preterm labor or acute cervical insufficiency. This study was conducted to determine the rate of MIAC and intra-amniotic inflammation in patients with a cervical length < 25 mm in the mid-trimester.


METHODS
A retrospective cohort study was conducted of patients referred to our high risk clinic because of a sonographic short cervix or a history of a previous preterm birth. Amniocenteses were performed for the evaluation of MIAC and for karyotype analysis in patients with a short cervix. Fluid was cultured for aerobic and anaerobic bacteria, as well as genital mycoplasmas. Patients with MIAC were treated with antibiotics selected by their physician.


RESULTS
Of 152 patients with a short cervix at 14-24 weeks, 57 had amniotic fluid analysis. The prevalence of MIAC was 9% (5/57). Among these patients, the rate of preterm delivery (< 32 weeks) was 40% (2/5). Microorganisms isolated from amniotic fluid included Ureaplasma urealyticum (n=4) and Fusobacterium nucleatum (n=1). Patients with a positive culture for Ureaplasma urealyticum received intravenous Azithromycin. Three patients with Ureaplasma urealyticum had a sterile amniotic fluid culture after treatment, and subsequently delivered at term. The patient with Fusobacterium nucleatum developed clinical chorioamnionitis and was induced.


CONCLUSIONS
(1) Sub-clinical MIAC was detected in 9% of patients with a sonographically short cervix (< 25 mm); and (2) maternal parenteral treatment with antibiotics can eradicate MIAC caused by Ureaplasma urealyticum. This was associated with delivery at term in the three patients whose successful treatment was documented by microbiologic studies.
Hassan
Sonia
S
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Wayne State University, Hutzel Women's Hospital, 3990 John R., 7 Brush North, MFM-Mail Drawer #163, Detroit, MI 48201, USA. shassan@med.wayne.edu
Romero
Roberto
R
Hendler
Israel
I
Gomez
Ricardo
R
Khalek
Nahla
N
Espinoza
Jimmy
J
Nien
Jyh Kae
JK
Berry
Stanley M
SM
Bujold
Emmanuel
E
Camacho
Natalia
N
Sorokin
Yoram
Y
D000328:Adult; D000649:Amniocentesis; D000653:Amniotic Fluid / Q000737:chemistry / Q000382:microbiology*; D002584:Cervix Uteri / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D002821:Chorioamnionitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D005674:Fusobacterium Infections / Q000175:diagnosis; D016967:Fusobacterium nucleatum / Q000302:isolation & purification; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D016869:Ureaplasma Infections / Q000175:diagnosis / Q000188:drug therapy; D016990:Ureaplasma urealyticum / Q000302:isolation & purification; D014590:Uterine Contraction