A CASE STUDY ON 3 WEEKS PREMATURE RUPTURE OF MEMBRANES CAUSED BY OROPHARYNGEAL MICROBIOTA

Premature rupture of membrane (PROM) is produced when amniotic membranes tear before labor onset and is recorded in around 8 % of full-term gestations. Preterm PROMs (PPROMs) take place before the 37th week of gestation, with an incidence of 2–4 % of pregnancies, and it is associated with higher maternal and perinatal morbidity and mortality, mainly related to infectious processes and prematurity. Among maternal complications, which include postpartum infection, premature placental detachment, and maternal sepsis, we highlight clinical chorioamnionitis for its incidence and severity. Of decreasing frequency, perinatal complications include respiratory distress, neonatal sepsis, intraventricular hemorrhage, necrotizing enterocolitis, and neurological lesions. Full-term PROM frequently has a physiological cause and is a consequence of uterine contractions; however, PPROM usually has a multifactorial etiology that is often unknown, although the most frequently reported cause is an infection, observed in up to 60 % of cases. Therefore, the etiology of PPROM, although probably infectious, remains unknown in most cases. The obstetric approach varies as a function of gestational age, actively inducing the pregnancy in full-term PROM but performing an overall evaluation of maternal-fetal status in PPROM. In the latter situation, an assessment is made of the relative risks and benefits of a wait-and-see attitude versus pregnancy induction, considering signs of infection and/or prematurity, and ordering antibiotic treatment when PPROM is diagnosed . Multiple combinations of antimicrobial drugs have been proposed and better perinatal and maternal outcomes have been reported for the prophylactic administration of some new combinations. This study describes a case of PPROM caused by urinary tract infection

32-week premature rupture of membranes caused by oropharyngeal microbiota

Introduction. Preterm premature rupture of membranes (PPROM) usually has a multifactorial etiology that is often unknown, although the most frequently reported cause is infection by group B Streptococcus. Therefore, the etiology of PPROM, although probably infectious, remains unknown in most cases. This case describes a PPROM caused by infection from oropharyngeal microbiota. Case presentation. We report the case of a 26-yr-old pregnant woman. The gestational age was 32 weeks+5 days. Examinations in the emergency department revealed the release of clear amniotic fluid and a closed multiparous cervix with a length of 22 mm. Endocervical culture evidenced the growth of Staphylococcus aureus, serogroup B Neisseria meningitidis and Haemophilus influenzae. Conclusion. Preventive antibiotic therapy should consider: opportunistic infections by normal genital microbiota, infections due to sexual activity, opportunist microorganisms derived from oral sex, and the hematogenous spread of oral bacteria.S

New techniques to characterise the vaginal microbiome in pregnancy

Understanding of the vaginal microbiome in health and disease is essential to screen, detect and manage complications in pregnancy. One of the major complications of pregnancy is preterm birth, which is the leading world-wide cause of death and disability in children under five years of age. The aetiology of preterm birth is multifactorial, but a causal link has been established with infection. Despite the importance of understanding the vaginal microbiome in pregnancy in order to evaluate strategies to prevent and manage PTB, currently used culture based techniques provide limited information as not all pathogens are able to be cultured. The implementation of culture-independent high-throughput techniques and bioinformatics tools are advancing our understanding of the vaginal microbiome. New methods employing 16S rRNA and metagenomics analyses make possible a more comprehensive description of the bacteria of the human microbiome. Several studies on the vaginal microbiota of pregnant women have identified a large number of taxa. Studies also suggest reduced diversity of the microbiota in pregnancy compared to non-pregnant women, with a relative enrichment of the overall abundance of Lactobacillus species, and significant differences in the diversity of Lactobacillus spp. A number of advantages and disadvantages of these techniques are discussed briefly. The potential clinical importance of the new techniques is illustrated through recent reports where traditional culture-based techniques failed to identify pathogens in high risk complicated pregnancies whose presence subsequently was established using culture-independent, high-throughput analyses

Dental bacterial DNA are present in the amniotic cavity of healthy pregnant women at term

Aims: To determine if dental bacterial DNA are present in the amniotic cavity of healthy pregnant women undergoing an elective caesarean section at term utilising culture independent techniques. Methods: Pregnant Australian women undergoing an elective caesarean section were recruited. Women completed questionnaires addressing demographics, past and current pregnancies and medical history. One high vaginal swab and three amniotic cavity swabs (amniotic fluid, newborn axilla and placental) were collected under sterile conditions. Samples were analysed using culture-independent techniques to detect the presence of predefined pathogenic bacterial taxa of the oral microbiome. Taxa isolated from the amniotic cavity swabs were compared to those isolated from the vaginal swab. Results: DNA from taxa isolated from the amniotic cavity but not vagina included A. xylosoxidans, A. tumefaciens, B. subtilis, Bartonella sp, Bergeyella sp, C. concisus, C. curvus, C. durum, D. microaerophilus, G. haemolysans, G. morbillorum, G. adiacens, G. elegans, K. pneumoniae, L. casei, L. paracasei, L. fermentum, P. aeruginosa, P. fluorescens, P. pseudoalcaligenes, P. stutzeri, R. microluginosa, S. maltophilia, S. pneumoniae, S. salivarius, S. sanguinis, V. dispar, V. parvula and Xanthomonas sp. Conclusion: The DNA of many pathogenic oral bacteria can be identified in the amniotic cavity of healthy pregnant women at term when utilising culture-independent techniques. Given DNA is not always present in the vagina, the study findings fulfill one criterion necessary for oral haematogenous spread to the amniotic cavity