Contribution of vaginal infection to preterm premature rupture of membrane and adverse pregnancy outcome

Background:Pretermpremature rupture of membranes (PPROM) is the cause of approximately one third of preterm deliveries. Objectives: assess the relation of vaginal infections and their antimicrobial profile with PPROM and pregnancy outcome. Methodology: Case control study of 320 females with PPROM (case) and 320 females with normal pregnancy (control) at 28- 37 weeks of gestation. Vaginal examination, vaginal pH assessment and Whiff test were done. Vaginal swabs were collected and examined microscopically for diagnosis of different vaginal infections. Swabs were cultivated, identification and antimicrobial susceptibility of revealed bacteria were done. Maternal and neonatal outcomes were assessed. Results: Bacterial vaginosis and aerobic vaginitis were identified in 29.1% and 17.3% of all participants respectively. There was statistically significant difference regarding prevalence of different vaginal infections in case and control groups (p < /em><0.001). Aerobic vaginitis and bacterial vaginosis were risk factors for PPROM. Streptococcus agalactiae was the most prevalent organism. Erythromycin and ampicillin were the least effective antibiotics against Gram positive and Gram-negative isolates respectively. There was significant increase of all maternal and fetal adverse outcomes in cases with aerobic vaginitis. Conclusion: Different vaginal infections carry risk of PPROM and adverse maternal and neonatal outcomes. The variation in prevalence of bacterial isolates in different studies and localities notify the lack of standardized treatment for infected mothers. Accurate diagnosis of vaginal infection, precise medical treatment during pregnancy is essential for maintenance of maternal and neonatal health

Effect of Aromatase Inhibitor Letrozole on the Placenta of Adult Albino Rats: A Histopathological, Immunohistochemical, and Biochemical Study

Background: Letrozole, an aromatase inhibitor, has recently been introduced as the preferred treatment option for ectopic pregnancy. To date, no study has investigated the effect of letrozole alone on placental tissue. The present study aimed to evaluate the effect of different doses of letrozole on the placenta of rats and to clarify the underlying mechanism. Methods: Sixty pregnant female rats were equally divided into three groups, namely the control group (GI), low-dose (0.5 mg/Kg/day) letrozole group (GII), which is equivalent to the human daily dose (HED) of 5 mg, and high-dose (1 mg/Kg/day) letrozole group (GIII), equivalent to the HED of 10 mg. Letrozole was administered by oral gavage daily from day 6 to 16 of gestation. Data were analyzed using a one-way analysis of variance followed by Tukey’s post hoc test and Chi square test. P<0.05 was considered statistically significant.Results: Compared to the GI and GII groups, high-dose letrozole significantly increased embryonic mortality with a high post-implantation loss rate (P<0.001) and significantly reduced the number of viable fetuses (P<0.001) and placental weight (P<0.001) of pregnant rats. Moreover, it significantly reduced placental estrogen receptor (ER) and progesterone receptor (PR) (P<0.001) and the expression of vascular endothelial growth factor (P<0.001), while increasing the apoptotic index of cleaved caspase-3 (P<0.001).Conclusion: Letrozole inhibited the expression of ER and PR in rat placenta. It interrupted stimulatory vascular signals causing significant apoptosis and placental vascular dysfunction. Letrozole in an equivalent human daily dose of 10 mg caused a high post-implantation loss rate without imposing severe side effects