Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI; Detroit Medical Center, Detroit, MI.
Am J Obstet Gynecol. 2022 Dec;227(6):895.e1-895.e13. doi: 10.1016/j.ajog.2022.07.007. Epub 2022 Jul 16.
The assessment and management of patients with threatened midtrimester miscarriage is a clinical challenge because the etiology of this condition is poorly understood.
This study aimed to examine the frequency of intraamniotic infection or inflammation and the effect of antibiotics in patients presenting with regular uterine contractions and intact membranes before 20 weeks of gestation.
This retrospective study comprised patients who met the following criteria: (1) singleton gestation, (2) gestational age before 20 weeks, (3) the presence of regular uterine contractions confirmed by a tocodynamometer (8 or more contractions in 60 minutes), (4) intact amniotic membranes, and (5) transabdominal amniocentesis performed for the evaluation of the microbiologic and inflammatory status of the amniotic cavity. Samples of amniotic fluid were cultured for aerobic and anaerobic bacteria and genital mycoplasmas, and polymerase chain reaction was performed to detect Ureaplasma species. Amniotic fluid was tested for white blood cell counts and matrix metalloproteinase-8 concentrations to diagnose intraamniotic inflammation. Patients with intraamniotic inflammation, or intraamniotic infection, were treated with antibiotics (a combination of ceftriaxone, clarithromycin, and metronidazole). Treatment success was defined as the resolution of intraamniotic infection/inflammation at the follow-up amniocentesis or delivery after 34 weeks of gestation.
The prevalence of intraamniotic inflammation in patients who presented with a threatened midtrimester miscarriage was 88% (15/17), and, in most cases, microorganisms could not be detected. Antibiotic treatment, administered to patients with intraamniotic inflammation, was associated with either objective resolution of intraamniotic inflammation or delivery after 34 weeks of gestation in 40% (6/15) of the cases.
对于有中期流产威胁的患者的评估和管理是一个临床挑战，因为这种情况的病因尚未完全了解。
本研究旨在检查在妊娠 20 周前出现有规律子宫收缩和胎膜完整的患者中，羊膜腔内感染或炎症的频率以及抗生素的作用。
本回顾性研究纳入了符合以下标准的患者：（1）单胎妊娠，（2）妊娠周数<20 周，（3）经宫缩监护仪证实有规律子宫收缩（60 分钟内 8 次或以上宫缩），（4）胎膜完整，（5）进行经腹羊膜腔穿刺术以评估羊膜腔的微生物学和炎症状态。采集羊水样本进行需氧菌和厌氧菌及生殖支原体培养，并进行聚合酶链反应检测解脲脲原体。检测羊水白细胞计数和基质金属蛋白酶-8 浓度以诊断羊膜腔内炎症。对有羊膜腔内炎症或感染的患者给予抗生素（头孢曲松、克拉霉素和甲硝唑联合用药）治疗。治疗成功定义为在随访羊膜腔穿刺术或妊娠 34 周后分娩时，羊膜腔内感染/炎症得到缓解。
1）17 例患者中 88%（15/17）存在羊膜腔内炎症，而仅 2 例可检测到感染；2）4 例行随访羊膜腔穿刺术的患者中，100%（4/4）显示羊膜腔内炎症客观缓解；3）30%（5/15）接受抗生素治疗的患者在妊娠 34 周后分娩（5 例患者中有 3 例随访羊膜腔穿刺术结果为阴性，2 例患者未行随访羊膜腔穿刺术）；4）抗生素总体治疗成功率为 40%（6/15；4 例羊膜腔内炎症客观缓解，5 例妊娠 34 周后分娩）。
在有中期流产威胁的患者中，羊膜腔内炎症的发生率为 88%（15/17），且大多数情况下无法检测到微生物。在有羊膜腔内炎症的患者中，给予抗生素治疗后，40%（6/15）的患者羊膜腔内炎症得到客观缓解或妊娠 34 周后分娩。
