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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 / Milner, 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, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

9 Issues per year


IMPACT FACTOR 2016: 1.577
5-year IMPACT FACTOR: 1.705

CiteScore 2016: 1.49

SCImago Journal Rank (SJR) 2016: 0.602
Source Normalized Impact per Paper (SNIP) 2016: 0.832

Online
ISSN
1619-3997
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Volume 34, Issue 1 (Feb 2006)

Issues

A sonographic short cervix as the only clinical manifestation of intra-amniotic infection

Sonia Hassan
  • Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
/ Roberto Romero
  • Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
/ Israel Hendler
  • Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
/ Ricardo Gomez
  • Center for Perinatal Diagnosis and Research (CEDIP), Sótero del Río Hospital, P. Universidad Católica de Chile, Puente Alto, Chile
/ Nahla Khalek
  • Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
/ Jimmy Espinoza
  • Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan, USA and Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
/ Jyh Kae Nien
  • Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
/ Stanley M. Berry
  • William Beaumont Hospital, Department of Obstetrics and Gynecology, Royal Oak, Michigan, USA
/ Emmanuel Bujold
  • Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
/ Natalia Camacho
  • Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
/ Yoram Sorokin
  • Wayne State University, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
Published Online: 2006-01-11 | DOI: https://doi.org/10.1515/JPM.2006.002

Abstract

Objective: A sonographically short cervix is a powerful predictor of spontaneous preterm delivery. However, the etiology and optimal management of a patient with a short cervix in the mid-trimester of pregnancy remain uncertain. Microbial invasion of the amniotic cavity (MIAC) and intra-amniotic inflammation are frequently present in patients with spontaneous preterm labor or acute cervical insufficiency. This study was conducted to determine the rate of MIAC and intra-amniotic inflammation in patients with a cervical length <25 mm in the mid-trimester.

Study design: A retrospective cohort study was conducted of patients referred to our high risk clinic because of a sonographic short cervix or a history of a previous preterm birth. Amniocenteses were performed for the evaluation of MIAC and for karyotype analysis in patients with a short cervix. Fluid was cultured for aerobic and anaerobic bacteria, as well as genital mycoplasmas. Patients with MIAC were treated with antibiotics selected by their physician.

Results: Of 152 patients with a short cervix at 14–24 weeks, 57 had amniotic fluid analysis. The prevalence of MIAC was 9% (5/57). Among these patients, the rate of preterm delivery (<32 weeks) was 40% (2/5). Microorganisms isolated from amniotic fluid included Ureaplasma urealyticum (n=4) and Fusobacterium nucleatum (n=1). Patients with a positive culture for Ureaplasma urealyticum received intravenous Azithromycin. Three patients with Ureaplasma urealyticum had a sterile amniotic fluid culture after treatment, and subsequently delivered at term. The patient with Fusobacterium nucleatum developed clinical chorioamnionitis and was induced.

Conclusion: (1) Sub-clinical MIAC was detected in 9% of patients with a sonographically short cervix (<25 mm); and (2) maternal parenteral treatment with antibiotics can eradicate MIAC caused by Ureaplasma urealyticum. This was associated with delivery at term in the three patients whose successful treatment was documented by microbiologic studies.

Keywords: Cervical insufficiency; cervical length; chorioamnionitis; intra-amniotic infection; microbial invasion of the amniotic cavity; preterm delivery; short cervix; ultrasound

About the article

Corresponding author: Sonia S. Hassan, MD Hutzel Women's Hospital/Wayne State University Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology 3990 John R 7 Brush North, MFM-Mail Drawer #163 Detroit, MI 48201 Tel.: +(313) 993-1368 Fax: +(313) 993-4100


Received: September 21, 2005

Accepted: October 28, 2005

Published Online: 2006-01-11

Published in Print: 2006-02-01


Citation Information: Journal of Perinatal Medicine, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/JPM.2006.002.

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