INFECTION AND HISTOPATHOLOGY IN PRETERM LABOR

有证据表明，无发热的妇女在早产， 感染了 10%的孕妇羊水中存在微生物， 早产的妇女 微生物可以从 在60%的分娩妇女的绒毛膜和羊膜之间 早产，相比之下，只有20%的妇女在 term. 本研究的主要目的是确定微生物学 和组织病理学的妇女在早产和治疗 早产的妇女用抗生素 具体目标 是：1）定义阴道/宫颈，羊水和胎盘 早产妇女的微生物学，2）选定的研究 与感染相关的微生物因素，3）证明 给早产的妇女使用抗生素 与安慰剂治疗的女性相比，早产，4） 表明胎盘和蜕膜炎症是高度 与感染和早产相关，以及5） 评估防御机制， 感染 我们计划进行一项病例对照研究， 无发热的胎膜完整的早产妇女 接受阴道/宫颈和经腹羊水 cultures. 这些女性将被随机分配到一个双- 静脉注射美洛西林和口服红霉素的盲法试验 生理盐水安慰剂。 对照组将分为女性 在怀孕34-37周和超过37周时分娩。 分娩后，绒毛膜-羊膜培养和组织学检查， 将进行胎盘和子宫内膜检查。 评价 感染对怀孕的影响 阴道/宫颈、子宫内膜、胎盘膜和羊膜 将对450个生物体和/或炎症进行比较 原因和450控制妇女。 我们将评估高有机体浓度或 微生物毒力与感染呈正相关， 所选微生物是否对羊水细菌有抑制作用 因子和血清抗体与 感染 希望这些研究的结果将证明， 微生物学和病理生理学 早产和抗生素治疗会降低 早产的风险

There is evidence that afebrile women in premature labor can be infected. Organisms are present in the amniotic fluid of 10% of the women in premature labor. Organisms can be isolated from between the chorion and amnion of 60% of the women who deliver prematurely, in contrast to only 20% of women who deliver at term. The major objective of this study is to define the microbiology and histopathology of women in premature labor and to treat the women in premature labor with antibiotics. The specific aims are: 1) define the vaginal/cervical, amniotic fluid and placental microbiology of women in premature labor, 2) study selected microbiologic factors associated with infection, 3) demonstrate that antibiotics given to women in premature labor will reduce premature deliveries compared to placebo treated women, 4) demonstrate that placental and decidual inflammation is highly correlated with both infection and preterm delivery, and 5) evaluate defense mechanisms which may protect against infection. We plan to conduct a case-control study in which cases consisting of afebrile women in premature labor with intact membranes will undergo vaginal/cervical and trans-abdominal amniotic fluid cultures. These women will be placed in a randomized double- blinded trial of intravenous mezlocillin and oral erythromycin or saline placebo. The control group will be stratified into women who deliver at 34-37 and greater than 37 weeks of pregnancy. After delivery, cultures of the chorion-amnion and histology of the placental and endometrium will be performed. To evaluate the effect of infection on pregnancy the presence of vaginal/cervical, endometrial, placental membrane and amniotic organisms and/or inflammation will be compared among 450 causes and 450 control women. We will evaluate whether high organism concentration or organism virulence will positively correlate with infection and whether selected organisms, amniotic fluid bacterial inhibitory factors and serum antibody will negatively correlate with infection. It is hoped that the result of these studies will demonstrate the microbiology and pathophysiology of infection among women in premature labor and that antibiotic therapy will reduce the rate of premature births.