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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, M.J.M.C. / Kurjak M.D., Asim / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, MD, PhD, HonD, Istvan / Vetter, Klaus / Winn, MD, Hung N. / Young, Bruce K. / Zimmermann, Roland

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Microbial invasion of the amniotic cavity in pregnancies with small-for-gestational-age fetuses

Daniel B. DiGiulio1, 2 / Maria Teresa Gervasi3 / Roberto Romero4–6, , / Edi Vaisbuch4, 6 / Shali Mazaki-Tovi4, 6 / Juan Pedro Kusanovic4, 6 / Kimberley S. Seok2 / Ricardo Gómez7, 8 / Pooja Mittal4, 6 / Francesca Gotsch4 / Tinnakorn Chaiworapongsa4, 6 / Enrique Oyarzún8 / Chong Jai Kim4, 9 / David A. Relman1, 2, 10

1Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

2Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

3Department of Obstetrics and Gynecology, Azienda Ospedaliera of Padova, Padova, Italy

4Perinatology Research Branch, NICHD, NIH, Bethesda, MD, and Detroit, MI, USA

5Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Hutzel Women's Hospital, Detroit Medical Center, Detroit, MI, USA

6Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA

7CEDIP (Center for Perinatal Diagnosis and Research), Department of Obstetrics and Gynecology, Sotero del Rio Hospital, Santiago, Chile

8Department of Obstetrics and Gynecology, P. Universidad Católica de Chile, Santiago, Chile

9Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA

10Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA

Corresponding author: Roberto Romero, MD Perinatology Research Branch Intramural Division NICHD/NIH/DHHS Hutzel Women's Hospital Box No. 4, 3990 John R, Detroit MI 48201 USA Tel.: +1 (313) 993-2700 Fax: +1 (313) 993-2694

Citation Information: Journal of Perinatal Medicine. Volume 38, Issue 5, Pages 495–502, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/jpm.2010.076, May 2010

Publication History

Received:
2010-03-05
Revised:
2010-03-26
Accepted:
2010-03-29
Published Online:
2010-05-20

Abstract

Objective: Microbial invasion of the amniotic cavity (MIAC) has been detected in women with preterm labor, preterm prelabor rupture of membranes (PROM), and in patients at term with PROM or in spontaneous labor. Intrauterine infection is recognized as a potential cause of fetal growth restriction; yet, the frequency of MIAC in pregnancies with small-for-gestational-age (SGA) fetuses is unknown. The aim of this study was to determine the frequency, diversity and relative abundance of microbes in amniotic fluid (AF) of women with an SGA neonate using a combination of culture and molecular methods.

Method: AF from 52 subjects with an SGA neonate was analyzed with both cultivation and molecular methods in a retrospective cohort study. Broad-range and group-specific PCR assays targeted small subunit rDNA, or other gene sequences, from bacteria, fungi and archaea. Results of microbiologic studies were correlated with indices of the host inflammatory response.

Results: 1) All AF samples (n=52) were negative for microorganisms based on cultivation techniques, whereas 6% (3/52) were positive based on PCR; and 2) intra-amniotic inflammation was detected in one of the three patients with a positive PCR result, as compared with three patients (6.1%) of the 49 with both a negative culture and a negative PCR (P=0.2).

Conclusion: MIAC is detected by PCR in some patients with an SGA fetus who were not in labor at the time of AF collection.

Keywords: 16S rRNA; chorioamnionitis; cytokines; FIRS; IL-6; intra-amniotic infection; intra-amniotic inflammation; molecular microbiology; PCR; pregnancy; SGA

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