A review of premature birth and subclinical infection

R. S. Gibbs, R. Romero, S. L. Hillier, D. A. Eschenbach, Richard L Sweet

Research output: Contribution to journalArticle

703 Citations (Scopus)

Abstract

Premature birth causes high rates of neonatal morbidity and mortality. There are multiple causes of preterm birth. This article reviews the evidence linking subclinical infection and premature birth. Although maternal genital tract colonization with specific organisms have been inconsistently associated with preterm birth and/or premature rupture of membranes, some infections have been consistently associated with preterm delivery. The association of histologic chorioamnionitis with prematurity is a consistent finding, but the mechanisms require further study. The relationship between histologic chorioamnionitis infection and the chorioamnionitis of prematurity requires additional research. A varying number of patients in "idiopathic" preterm labor have positive amniotic fluid cultures (0% to 30%), but it is not clear whether infection preceded labor or occurred as a result of labor. Evidence of subclinical infection as a cause of preterm labor is raised by finding elevated maternal serum C-reactive protein and abnormal amniotic fluid organic acid levels in some patients in preterm labor. Biochemical mechanisms for preterm labor in the setting of infection are suggested by both in vitro and in vivo studies of prostaglandins and their metabolites, endotoxin and cytokines. Some, but by no means all, antibiotic trials conducted to date have reported decreases in prematurity. These results supported the hypothesis that premature birth results in part from infection caused by genital tract bacteria. In the next few years, research efforts must be prioritized to determine the role of infection and the appropriate prevention of this cause of prematurity.

Original languageEnglish (US)
Pages (from-to)1515-1528
Number of pages14
JournalAmerican Journal of Obstetrics and Gynecology
Volume166
Issue number5
DOIs
StatePublished - 1992

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Asymptomatic Infections
Premature Birth
Premature Obstetric Labor
Chorioamnionitis
Infection
Amniotic Fluid
Mothers
Reproductive Tract Infections
Infant Mortality
Research
Endotoxins
C-Reactive Protein
Prostaglandins
Blood Proteins
Rupture
Cytokines
Anti-Bacterial Agents
Morbidity
Bacteria
Acids

Keywords

  • antibiotics
  • biochemical mechanisms
  • chorioamnionitis
  • Premature birth
  • subclinical infection

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

A review of premature birth and subclinical infection. / Gibbs, R. S.; Romero, R.; Hillier, S. L.; Eschenbach, D. A.; Sweet, Richard L.

In: American Journal of Obstetrics and Gynecology, Vol. 166, No. 5, 1992, p. 1515-1528.

Research output: Contribution to journalArticle

Gibbs, R. S. ; Romero, R. ; Hillier, S. L. ; Eschenbach, D. A. ; Sweet, Richard L. / A review of premature birth and subclinical infection. In: American Journal of Obstetrics and Gynecology. 1992 ; Vol. 166, No. 5. pp. 1515-1528.
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