INFECTION AND HISTOPATHOLOGY IN PRETERM LABOR

有证据表明，早产中的发热妇女可能会 被感染了。10%的羊水中存在生物体 早产的妇女。生物体可以从 60%的产妇在绒毛膜和羊膜之间 早产，相比之下，只有20%的女性在 学期。 这项研究的主要目的是定义微生物学 和早产妇女的组织病理学，并治疗 使用抗生素的早产妇女。具体目标 1)定义阴道/宫颈、羊水和胎盘 早产妇女的微生物学，2)研究选择 与感染相关的微生物学因素，3)表明 给早产妇女服用抗生素会减少 早产与接受安慰剂治疗的妇女相比，4) 证明胎盘和蜕膜炎症是高度的 与感染和早产有关，以及5) 评估可能防御的防御机制 感染。 我们计划进行一项病例对照研究，其中病例包括 胎膜完好的早产无热症妇女将 接受经阴道/宫颈和经腹羊水 文化。这些女性将被随机分成两组- 静脉注射美洛西林与口服红霉素的双盲对照试验 生理盐水安慰剂。对照组将被分成女性 他们在34-37岁之间分娩，怀孕超过37周。 产后绒毛-羊膜培养及组织学观察 将进行胎盘和子宫内膜检查。评估 感染对妊娠的影响 阴道/宫颈、子宫内膜、胎盘膜和羊水 生物体和/或炎症将在450个 诱因和450名对照女性。 我们将评估高有机物浓度或 生物体的毒力将与感染和 选定的生物体、羊水是否抑菌 相关因素与血清抗体水平呈负相关 感染。 希望这些研究的结果将证明 女性感染的微生物学和病理生理学研究 早产和抗生素治疗将降低这一发生率 早产的症状。

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.