Original Articles
Isolation of Ureaplasma urealyticum From the Amniotic Cavity and Adverse Outcome in Preterm Labor

https://doi.org/10.1016/S0029-7844(98)00122-7Get rights and content

Abstract

Objective: To determine the relationship between the presence of Ureaplasma urealyticum in the amniotic cavity and adverse maternal and perinatal outcome in women with preterm labor.

Methods: Amniocentesis was performed in 181 patients with preterm labor and intact membranes. Amniotic fluid (AF) was cultured for aerobic and anaerobic bacteria and mycoplasmas. Patients were divided into three groups according to the results of AF culture: those with negative AF cultures (n = 160), those with positive AF cultures and in whom the only microbial isolate was U urealyticum (n = 11), and those with positive cultures for non-ureaplasmas or mixed microorganisms (n = 10). Survival techniques were used for analysis.

Results: The prevalence of positive AF cultures in which the only microbial isolate was U urealyticum was 6.1% (11 of 181), and of positive cultures with non-ureaplasmas or mixed microorganisms was 5.5% (10 of 181). The amniocentesis-to-delivery interval was significantly shorter in patients with positive cultures limited to U urealyticum than in those with negative cultures (median 7 [range 0.1–149] hours versus median 264 [0.1–2659] hours, P < .001). Preterm delivery within 48 hours, 72 hours, and 7 days was more frequent in patients with U urealyticum in the AF than in those with sterile AF (48 hour: 91% versus 33%; 72 hour: 91% versus 36%; 7 days: 100% versus 45%, P < .001 for each). Patients with positive AF cultures limited to U urealyticum had a significantly higher rate of adverse perinatal outcome than those with negative culture. Adverse outcomes included low gestational age at birth, low birth weight, histologic chorioamnionitis, significant neonatal morbidity, and perinatal death.

Conclusion: Microbial invasion of the amniotic cavity with U urealyticum is a risk factor for impending preterm delivery and adverse perinatal outcome.

Section snippets

Materials and methods

The study population consisted of patients admitted with diagnosis of preterm labor with intact membranes and singleton gestation who underwent amniocentesis between January 1993 and October 1996 for assessment of the microbiologic status of the amniotic cavity. The study was carried out at Seoul National University Hospital of Seoul, Korea. All patients admitted with the diagnosis of preterm labor and intact membranes were offered amniocentesis for microbiologic assessment of the amniotic

Results

One hundred eighty-one patients were included in this study. The prevalence of positive AF culture was 11.6% (21 of 181). Microorganisms isolated from the amniotic cavity included U urealyticum (n = 13), Staphylococcus aureus (n = 2), Enterococcus sp. (n = 2), Lactobacillus sp. (n = 2), Acinetobacter sp. (n = 2), and one isolate each of Candida albicans, coagulase-negative Staphylococcus and Porphyromonas asaccharolytica. The coagulase-negative Staphylococcus was isolated from a woman with a

Discussion

This study was conducted to determine the clinical significance of microbial invasion of the amniotic cavity with U urealyticum. The relevance of this issue is underscored by data demonstrating that U urealyticum is the most frequent microbial isolate from AF in patients with preterm labor,2., 3., 4., 5., 9., 12. preterm premature rupture of membranes (PROM),6., 7. term PROM,23 and spontaneous labor at term.24 Yet, in many institutions, mycoplasma cultures are not part of the standard

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    Supported by grant No. 97-04-03-08-01-3 from the Korea Science and Engineering Foundation (KOSEF).

    1

    Dr. Romero has participated as a private citizen, not as an agent of the US government or of any of the universities to which he holds appointments.

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