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Páginas: 18 (4358 palabras) Publicado: 21 de septiembre de 2011
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J. Perinat. Med. 38 (2010) 275–279 • Copyright by Walter de Gruyter • Berlin • New York. DOI 10.1515/JPM.2010.001

The frequency and clinical significance of intra-amniotic infection and/or inflammation in women with placenta previa and vaginal bleeding: an unexpected observation

Ichchha Madan1,2, Roberto Romero1–3,*, Juan Pedro Kusanovic1,2, PoojaMittal1,2, Tinnakorn Chaiworapongsa1,2, Zhong Dong1, Shali MazakiTovi1,2, Edi Vaisbuch1,2, Zeynep Alpay Savasan1,2, Lami Yeo1,2, Chong Jai Kim1,4 and Sonia S. Hassan1,2
1

Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, MI, USA 2 Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA 3 Center for Molecular Medicine andGenetics, Wayne State University, Detroit, MI, USA 4 Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA

Results: 1) The prevalence of intra-amniotic infection was 5.7% (2/35), and that of IAI was 17.9% (5/28); 2) the gestational age at delivery was lower in patients with IAI than in those without IAI w29.4 weeks, interquartile range (IQR): 23.1–34.7 vs. 35.4 weeks,IQR: 33.9–36.9; Ps0.028x; and 3) patients with placenta previa and IAI had a higher rate of delivery within 48 h (80% (4/5) vs. 19% (4/21); Ps0.008) than those without IAI. Conclusions: Patients with placenta previa presenting with vaginal bleeding have intra-amniotic infection in 5.7% of the cases, and IAI in 17.9%. IAI in patients with placenta previa and vaginal bleeding is a risk factor forpreterm delivery within 48 h. Keywords: Chorioamnionitis; cytokines; deciduitis; idiopathic vaginal bleeding; intra-amniotic inflammation; IL-6; prematurity; preterm delivery; preterm labor.

Abstract
Objective: Idiopathic vaginal bleeding, a common complication of pregnancy, increases the risk of small-for-gestational age (SGA) neonate, preeclampsia and preterm delivery and can be the onlyclinical manifestation of intra-amniotic infection and/or inflammation (IAI). Placenta previa is thought to be protective against ascending intrauterine infection, yet an excess of histologic chorioamnionitis has been reported in this condition. The aim of this study was to determine the frequency and clinical significance of IAI in women with placenta previa and vaginal bleeding in the absence ofpreterm labor. Study design: A retrospective cohort study including 35 women with placenta previa and vaginal bleeding -37 weeks of gestation who underwent amniocentesis was undertaken. Patients with multiple gestations were excluded. Intra-amniotic infection was defined as a positive culture for microorganisms, and intra-amniotic inflammation as an elevated amniotic fluid interleukin (IL)-6concentration. IL-6 concentrations were determined by ELISA in 28 amniotic fluid samples available. Non-parametric statistics were used for analysis.
*Corresponding author: Roberto Romero, MD Perinatology Research Branch, NICHD, NIH, DHHS Wayne State University/Hutzel Women’s Hospital 3990 John R, Box 4 Detroit, MI 48201 USA Tel.: q1 (313) 993-2700 Fax: q1 (313) 993-2694 E-mail:prbchiefstaff@med.wayne.edu

Introduction
Placenta previa complicates 0.3–0.5% of pregnancies w23, 25x, and in ;70% of cases, women will experience at least one episode of vaginal bleeding during the second and third trimesters of pregnancy w25, 30x. Contractions associated with cervical change can cause partial detachment of the placenta and it has been proposed that this is the mechanism whereby vaginal bleedingoccurs in these cases w30x. However, patients with placenta previa can also present with an episode of vaginal bleeding in the absence of contractions. Idiopathic vaginal bleeding is a common complication of pregnancy and has been associated with adverse pregnancy outcome w18x, such as preeclampsia w29x, small-for-gestational age (SGA) neonate w1, 21, 44x and preterm delivery w1, 7, 17, 21, 26, 27,...
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