Intrauterine Infection and Spontaneous MidgestationAbortion: Is the Spectrum of Microorganisms Similarto That in Preterm Labor?

[摘要] Objective:To determine whether microorganisms associated with intrauterine infection and pretermlabor play a contributing role in midgestation abortion.Methods:A 4 year retrospective review of spontaneous midgestation abortions for which autopsyand microbiological cultures of placental and fetal tissue were performed was conducted for atertiary obstetrics hospital, which included a regional referral service for perinatal and fetal pathology.One hundred twenty-nine spontaneously delivered, nonmacerated, midgestation fetuses orstillbirths (of between 16 and 26 weeks' gestation) and placentas were examined and cultured foraerobic and anaerobic bacteria, yeasts, and genital mycoplasmas.Results:Microorganisms were recovered in 85 (66%) cases (57% placentas, 49% fetuses). Amongthe culture positive cases, 81% had histological chorioamnionitis, 28% fetal pneumonitis, 38% clinicalsigns of infection, and 62% ruptured membranes at the time of miscarriage. These differedsignificantly from culture-negative cases (44%, 5%, 13%, and 34%, respectively). Group B streptococcus(GBS) was the most significant pathogen, recovered in 21 cases, 13 as the sole isolate, 94%with chorioamnionitis, and 47% in women with intact membranes.Escherichia coliandUreaplasma urealyticum(22 and 24 cases, respectively) occurred mostly as mixed infections, with rupturedmembranes. GBS,U. urealyticum, andStreptococcus anginosusgroup were individually associatedwith chorioamnionitis,Bacteroides/PrevotellaandS. anginosuswith fetal pneumonitis. The spectrumof microorganisms was similar to that in preterm labor at later gestations; however, GBS appearedto be the most significant pathogen in midgestation miscarriage, especially with intact membranes.Conclusions:Unsuspected intrauterine infection underlies many spontaneous midgestation abortions.GBS is a key pathogen in this setting. Infect. Dis. Obstet. Gynecol. 8:220–227, 2000.

[学科分类] 妇产科学