Romero R, Shamma F, Avila C, Jimenez C, Callahan R, Nores J, Mazor M, Brekus C A, Hobbins J C
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06510.
Am J Obstet Gynecol. 1990 Sep;163(3):757-61. doi: 10.1016/0002-9378(90)91063-i.
The purpose of this study was to establish the prevalence, microbiology, and outcome of microbial invasion of the amniotic cavity in twin gestation presenting with preterm labor and intact membranes. Amniocenteses were performed on both sacs of 46 women with twin gestations, preterm labor, and intact membranes. Indigo carmine was injected to ensure sampling of both amniotic sacs. Amniotic fluid was cultured for aerobic and anaerobic bacteria, Mycoplasma hominis, and Ureaplasma urealyticum. A positive amniotic fluid culture of at least one sac was noted in 10.8% (5/46) of patients admitted in preterm labor and in 11.9% (5/42) of women delivered of preterm neonates. Of the five patients with microbial invasion of the amniotic cavity, three had microorganisms isolated from both sacs. The presenting sac was involved in all cases, supporting an ascending route for microbial invasion of the amniotic cavity in twin gestation. Polymicrobial infection was found in three of the eight amniotic sacs with positive cultures. In two cases different organisms were isolated from each sac. All patients with positive amniotic fluid cultures were delivered of preterm infants within 48 hours of amniocentesis. Patients with positive amniotic fluid cultures presented with preterm labor at an earlier gestational age and with more advanced cervical dilatation than did women with negative amniotic fluid cultures. Clinical evidence of chorioamnionitis subsequently developed in two of five women with positive amniotic fluid cultures. The interval between amniocentesis and delivery was shorter in women with positive amniotic fluid cultures than in women with negative amniotic fluid cultures (median: 3.5 vs 168 hours, p less than 0.0001). Infants born to women with microbial invasion of the amniotic cavity had a lower median birth weight and a higher incidence of respiratory distress syndrome than those born to women with negative amniotic fluid cultures (birth weight: 1085 vs 1975 gm, p = 0.024; respiratory distress syndrome: 37.5% vs 8.3%, p = 0.04).
本研究的目的是确定双胎妊娠胎膜完整早产时羊膜腔微生物入侵的发生率、微生物学特征及结局。对46例双胎妊娠、胎膜完整早产的孕妇的两个羊膜囊进行了羊水穿刺。注入靛胭脂以确保对两个羊膜囊进行采样。对羊水进行需氧菌、厌氧菌、人型支原体和解脲脲原体培养。在胎膜完整早产入院的患者中，10.8%（5/46）的患者至少一个羊膜囊羊水培养阳性，在早产新生儿分娩的女性中，11.9%（5/42）的女性羊水培养阳性。在5例羊膜腔微生物入侵的患者中，3例两个羊膜囊均分离出微生物。所有病例中先露羊膜囊均受累，支持双胎妊娠羊膜腔微生物入侵的上行途径。在8例培养阳性的羊膜囊中，3例发现多微生物感染。在2例中，每个羊膜囊分离出不同的微生物。所有羊水培养阳性的患者在羊水穿刺后48小时内分娩早产婴儿。羊水培养阳性的患者比羊水培养阴性的女性早产孕周更早，宫颈扩张更明显。5例羊水培养阳性的女性中有2例随后出现绒毛膜羊膜炎的临床证据。羊水培养阳性的女性羊水穿刺与分娩之间的间隔比羊水培养阴性的女性短（中位数：3.5小时对168小时，p<0.0001）。羊膜腔微生物入侵的女性所生婴儿的出生体重中位数低于羊水培养阴性的女性所生婴儿，呼吸窘迫综合征的发生率更高（出生体重：1085克对1975克，p = 0.024；呼吸窘迫综合征：37.5%对8.3%，p = 0.04）。
