Supervisors info:
Νικόλαος Παπαντωνίου, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δημήτριος Κασσάνος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χαράλαμπος Συριστατίδης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Premature rupture of fetal membranes is a very serious cause of premature birth that contributes to adverse perinatal outcomes, such as maternal and fetal infection, umbilical
cord compression and prolapse, fetal loss, low apgar score, pulmonary hypertension, and
pulmonary hypertension. with significant neonatal mortality and mortality. The causes that
lead to premature rupture of fetal membrane are multifactorial and the exact cause is not
clear.
Female genital infections appear to be involved in the premature rupture of embryonic
membranes through the production of inflammatory cytokines that are implicated in the
weakening of the embryonic membranes and lead to their rupture. In the literature these
microorganisms that appear to be involved are Mycoplasma and Ureoplasma, Chlamydia
trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae and Streptococcus group B.
Genital mycoplasmas are often found in vaginal flora and have been shown to be involved in
undverse perinatal effects. Both Mycoplasma and Ureaplasma spp, in particular Ureoplasma
urealiticum and Mycoplasma Hominis, the most studied species, cause inflammation leading
to automatic premature birth and premature rupture of embryonic membranes. Macrolides
are the only medicines that can be safely used during pregnancy for treatment for
Mycoplasma spp and Ureoplasma spp. Azithromycin is still the drug of choice but the best
profile of josamycin and solithromycin can turn these drugs into preferred candidates in the
future.
Chlamydia trachomatis is considered the most widespread sexually transmitted disease
worldwide and is associated with adverse birth outcomes such as auto-abortion, intrauterine
infections, intrauterine death, endometritis, premature rupture and premature rupture. It is
recommended that C. Trachomatis be screened at the first prenatal visit in women <25 years
of age and those at increased risk for chlamydia (ie women who have a new sex partner or
multiple sex partners) and should subsequently be screened again. third trimester to avoid
maternal complications in pregnancy and chlamydial infection in infant. Based on the
available data, it seems therefore that a single dose of 1gr azithromycin or amoxycillin
500mg 1x3 for 7 days is the best available treatment for C. trachomatis during pregnancy
because they have the same efficacy as using erythromycin but fewer side effects and better
patient compliance with treatment.
Trichomonas vaginalis is a human parasite responsible for the most common non-viral
sexually transmitted disease in the world that has been associated with adverse pregnancy
outcomes, such as premature birth, low birth weight and premature rupture of membranes.
Screening for T.vaginalis in the first trimester is not recommended. A single dose of 2 mg
metronidazole provides parasitological treatment and has not been associated with any
teratogenic effects in pregnancy, even when administered in the first trimester.
Neisseria gonorrhoeae is the causative agent of gonorrhea, a sexually transmitted infection
that causes adverse effects on women such as pelvic inflammatory disease, infertility and
ectopic pregnancy, transmission of the disease from mother to offspring at birth. In the
literature, only one study has linked the disease to premature rupture of fetal membranes.
Screening for N. gonorrhoeae should be performed in all pregnant women under 25 years of
age and in older pregnant women at increased risk for infection. The treatment comprises a
dual regimen consisting of 250 mg of ceftriaxone in a single dose of IM and 1 g of
azithromycin orally in a single dose.
Streptococcus group B infection can cause serious bacterial infections, septicemia,
pneumonia and neonatal meningitis during the first week of life. Infection during pregnancy
can cause acute chorioamnonitis, endometritis and urinary tract infection. In several studies,
GBS infection has been associated with preterm birth and premature rupture of fetuses. For
the prevention of GBS, a screening based on universal screening with culture is
recommended to identify women who should undergo chemotherapy during childbirth.
Penicillin is the drug of choice.
Future research should be carried out to determine the inflammatory causal factors that
contribute to the premature rupture of fetal membranes so as to be able to create a model that
can predict high risk pregnancies for premature rupture. Analysis of the vaginal microbiome
needs to be done to determine the role of infection by different microorganisms during
pregnancy. In addition, newer methods such as PCR and quantification will allow accurate
measurement of the pathogenic microorganism load. These detection and quantification
capabilities can allow the distinction between colonization and infection and will allow the
focus of therapeutic efforts and improved results.
Keywords:
Preterm labor, Genital infections and pregnancy, Genital infections and prom, Vaginal micriobiota
