Abstract
This article reviews the current trends in the evaluation and management of bacterial infection involving the uterus, placenta, membranes, amniotic fluid, and fetus occurring near the time of birth. The discussion includes information regarding risk, incidence, pathophysiology, bedside diagnosis, interventional options including antibiotics, corticosteroids, fetal monitoring, and delivery, and possible preventive measures which affect the outcome. The adequate evaluation and management of perinatal infection requires a team approach with obstetricians and pediatricians. Clinical screening is useful in developing the diagnosis, but amniotic fluid evaluation remains the proposed gold standard. The role of cytokines is becoming increasingly important, as is seen in the association of IL-6 with positive amniotic fluid cultures and periventricular leukomalacia. Prompt recognition and management of the pregnancy affected by infection can improve perinatal outcomes. A management protocol is presented to help structure the approach to suspected infection. Premature delivery due to perinatal infection may be preventable.
Similar content being viewed by others
References
Soper DE, Mayhall CG, Dalton HP. Risk factors for intraamniotic infection. A prospective epidemiologic study.Am J Obstet Gynecol 1989; 161: 562–568.
Newton ER, Prihoda TJ, Gibbs RS. Logistic regression analysis of risk factors for intra-amniotic infection.Obstet Gynecol 1989; 73: 571–575.
Hillier SL, Nugent RP, Eschenbach DA,et al. Association between bacterial vaginosis and preterm delivery of a lowbirth-weight infant.N Engl J Med 1995; 333: 1737–42.
Wen TS, Eriksen NL, Blanco JD, Graham JM, Oshiro BT, Prieto JA. Association of clinical intra-amniotic infection and meconium.Am J Perinatol 1993; 10: 438–440.
Watts DH, Krohn MA, Hillier SL, Eschenbach DA. The association of occult amniotic fluid infection with gestational age and neonatal outcome among women in preterm labour.Obstet Gynecol 1992; 79: 351–357.
Mueller-Heubach E, Rubinstein DN, Schwarz SS. Histologic chorioamnionitis and preterm delivery in different patient populations.Obstet Gynecol 1990; 75: 622–626.
Charles D, Edwards WR. Infections complications of cervical cerclage.Am J Obstet Gynecol 1981; 141:1065–71.
Romero R, Mazor M. Infection and preterm labour. Pathways for intrauterine infections.Clin Obstet Gynecol 1988; 31: 553–584.
Sperling RS, Newton E, Gibbs RS. Intraamniotic infection in low-birthweight infants.J Infect Dis 1988; 157:113–117.
Yoon BH, JK, Park KH, Syn HC, Gomez R, Romero R. Serum C reactive protein, white blood cell count, and amniotic fluid white blood cell count in women with preterm premature rupture of membranes.Obstet Gynecol 1996; 88: 1034–40.
Romero R, Yoon BH, Mazor M,et al.A comparative study of the diagnostic performance of amniotic fluid glucose, white blood cell count, interleukin-6, and Gram stain in the detection of microbial invasion in patients with preterm premature rupture of membranes.Am J Obstet Gynecol 1993; 169: 839–51.
Mercer B, Miodovnik M, Thumau G,et al. A multicentre randomized masked trial of antibiotic vs. placebo therapy after preterm premature rupture of the membranes.Am J Obstet Gynecol 1996; 174: 304.
National Institutes of Health Consensus Development Conference Statement. Effects of corticosteroids for fetal maturation on perinatal outcomes. February 28 to March 2, 1994.Am J Obstet Gynecol 1995; 173: 246.
Wendel PJ, Cox SM, Roberts SW, Dax J, Gilstrap LC. Chorioamnionitis. The association of nonreassuring fetal heart rate patterns and interval from diagnosis to delivery on neonatal outcome.Infect Dis Obstet Gynecol 1994; 2:162–66.
Yoon BH, Romero R, Jun JK,et al. Amniotic fluid concentrations of interieukin-6 identify fetuses at risk for the development of periventricular leukomalacia.Am J Obstet Gynecol 1996; 174: 330.
Grether JK, Nelson KB. Maternal infection and cerebral palsy in infants of normal birth weight.JAMA 1997; 278: 207–211.
Hillier SL, Krohn MA, Cassen E, Easterling TR, Rabe LK, Eschenbach DA. The role of bacterial vaginosis and vaginal bacteria in amniotic fluid infection in women in preterm labour with intact fetal membranes.Clin Infect Dis 1995; 20 (Suppl): 276–8.
Gravett MG, Hummel D, Eschenbach DA, Holmes KK. Preterm labour associated with subclinical amniotic fluid infection, and with bacterial vaginosis.Obstet Gynecol 1986; 67:229–37.
Hannah M, Ohlsson A, Farine D,et al. International termprom trial, a rct of induction of labour for prelabor rupture of membranes at term.Am J Obstet Gynecol 1996; 174: 303.
Madinger NE, Greenspoon JS, Ellrodt AG. Pneumonia during pregnancy. Has modern technology improved maternal or fetal outcome ?Am J Obstet Gynecol 1989; 161: 657–62.
Fan YD, Pastorek JG, Miller JM, Mulvey J. Acute pyelonephritis in pregnancy.Am J Perinat 1987; 4:324–6.
Offenbacher S, Katz V, Fertik G,et al. Periodontal infection as a possible risk factor for preterm low birth weight.J Periodontol 1996; 67:1103–1113.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yeagley, T.J., Tolosa, J.E. & Bhutani, V.K. Perinatal bacterial infection: An update. Indian J Pediatr 65, 841–848 (1998). https://doi.org/10.1007/BF02831344
Issue Date:
DOI: https://doi.org/10.1007/BF02831344