Shulamith Horowitz

Intra-uterine infection in women with preterm premature rupture of membranes: maternal and neonatal characteristics

OBJECTIVE Our purpose was to determine the prevalence of intra-uterine infection in patients with preterm premature rupture of membranes and to evaluate the clinical characteristics of women and neonates according to the presence or absence of intrauterine infection. STUDY DESIGN Trans-abdominal amniocentesis was performed in 90 consecutive patients admitted with preterm premature rupture of membranes. Maternal clinical parameters evaluated included maternal age, origin, gravidity, parity, habitual abortion, previous perinatal death, previous preterm birth, urinary tract infection, fetal distress, abruptio placentae, gestational diabetes, admission-delivery interval and cesarean rate. Neonatal clinical parameters evaluated were gestational age at delivery, birth weight, Apgar score, neonatal gender, perinatal death and neonatal sepsis. RESULTS The prevalence of intra-uterine infection was 66.6% (60/90). No differences between patients with intra-uterine infection and those without intra-uterine infection were observed in maternal age, origin, gravidity, parity, habitual abortion, previous perinatal death, fetal distress, abruptio placentae, gestational diabetes, admission-delivery interval, cesarean section, neonates gender, Apgar score at 5 min and neonatal sepsis. On the other hand, gestational age at delivery, birth weight and Apgar score at 1 min were significantly different between the groups. CONCLUSION An intra-uterine infection was found in two thirds of women presenting with preterm premature rupture of membranes. Women presenting with preterm premature rupture of membranes and intra-uterine infection had a lower gestational age at delivery and consequently had a lower neonatal birth weight than those without intra-uterine infection.

Expression of IL-12, IL-10, PGE2, sIL-2R and sIL-6R in seminal plasma of fertile and infertile men

The involvement of cytokines and other immunoregulatory factors in male infertility is still unclear. In the present study we compared the levels of IL‐12, IL‐10, PGE2, sIL‐2R and sIL‐6R in the seminal plasma (SP) of fertile and infertile men. Four groups were included: fertile donors (FERT), infertile men with azoospermia (AZOO), and infertile men with either oligo‐terato‐asthenoazoospermia (OTA), or OTA with genital infection (OTA‐INF). Cytokines and cytokine‐soluble receptors in semen were evaluated by specific ELISA commercial kits. The levels of IL‐12, sIL‐2R and sIL‐6R were similar in SP of fertile and infertile men. The mean levels of IL‐10 in the SP of FERT, OTA and AZOO were 5.6±0.9, 4±2.8 and 8±3.5 pg ml−1, respectively, and did not differ significantly. The mean level of IL‐10 in SP from OTA‐INF (0.9±0.5 pg ml−1) was significantly lower than that for FERT (5.6±1.9 pg ml−1; P=0.02) and AZOO (8.2±3.4 pg ml−1; P=0.05), but not significantly different from that for OTA (3.7±2.1 pg ml−1). The mean SP level of PGE2 was significantly lower in SP of OTA‐INF than FERT (7.67±2.26 and 19.67±3.69 μg ml−1, respectively; P<0.02). In conclusion, the seminal plasma from fertile and infertile men contained similar levels of IL‐12, sIL‐2R and sIL‐6R. However, the levels of IL‐10 were significantly lower in SP from OTA‐INF compared to FERT and AZOO. Our results indicate that specific cytokines and their soluble receptors are involved in the male reproductive system.

Elevated concentrations of interleukin-6 in intra-amniotic infection with Ureaplasma urealyticum in asymptomatic women during

BACKGROUND Intra-amniotic infection is an important cause of preterm delivery and interleukin-6 (IL-6) determination was recently applied for identification of microbial invasion of the amniotic cavity. Our aim was to determine the levels of IL-6 in culture-positive amniotic fluids at genetic amniocentesis and to evaluate their significance in relation to pregnancy outcome. METHODS Seven culture-positive and 23 culture-negative amniotic fluids, obtained at 17-19 weeks of gestation, were analyzed for IL-6 levels by an immunoassay (ELISA). Pregnancy outcomes of all 30 women were obtained from the medical charts. RESULTS The mean level of IL-6 in the culture-negative amniotic fluids was 78+/-206 pg/ml. Among the seven culture-positive, high levels of IL-6 were found only in three amniotic fluids that were culture-positive for Ureaplasma urealyticum (1834, 1342 and 2832 pg/ml). Low levels of IL-6, ranging from zero to 60 pg/ml, were found in four AFs that were culture-positive for Staphylococcus epidermidis (n=3) and Bacillus Gram-positive (n= 1). Adverse pregnancy outcome occurred in the three women who had intra-amniotic infection with U. urealyticum accompanied by high levels of IL-6 (two fetal loss and one preterm delivery at 28 weeks of gestation). The four women with culture-positive but IL-6 negative amniotic fluids, had normal pregnancy outcome and term delivery. Two of the 23 women with culture-negative had preterm delivery, one with high (1000 pg/ml) and one with low (80 pg/ml) levels of IL-6. CONCLUSION High levels of IL-6 are suggestive of a genuine intra-amniotic infection with urea-plasmas resulting in adverse pregnancy outcome, while culture-positive amniotic fluids with normal IL-6 levels, may suggest a state of contamination.

Intraamniotic infection in patients with preterm labor and twin pregnancies

Background. Microbial invasion of the amniotic cavity plays a major role in the pathogenesis of preterm labor and delivery in singleton pregnancy. Nevertheless, this association is not well established among patients with multiple gestations. The purpose of our study was to explore the role of intraamniotic infection in the setting of twin pregnancies.

Production of interleukin-1–like molecules by human sperm cells

OBJECTIVE To characterize and localize interleukin (IL)-1alpha and IL-1beta in human sperm cells. DESIGN Prospective and comparative study. SETTING Andrology clinic of a university hospital. PATIENT(S) Two groups of normogonadotropic men: 17 fertile men (donors with proved fertility) and 8 oligoteratoasthenospermic infertile men. INTERVENTION(S) None. MAIN OTUCOME MEASURE(s): Evaluation of IL-1alpha and IL-1beta levels and expression in sperm cells by immunohistochemical staining, immunoassay, and Western blot analysis. RESULT(S) Both types of IL-1-like molecules (IL-1alpha and IL-1beta) were expressed in the tail, neck, and head of sperm cells of fertile men and patients with oligoteratoasthenospermia. Swim-up sperm cells from fertile men and patients with oligoteratoasthenospermia secreted similar levels of IL-1-like molecules. The levels of IL-1beta-like molecules were higher than those of IL-1alpha-like molecules in both groups. The expressed IL-1-like molecules were characterized by the presence a 60-kd protein for both IL-1alpha-like and IL-1beta-like molecules. In some samples of both fertile men and infertile men with oligoteratoasthenospermia, 17-kd, 33-kd, and 45-kd IL-1beta-like molecules were detected. Impairment of sperm function, such as decreased sperm count and motility and/or impaired morphology, was not related to the capacity of sperm cells to produce IL-1-like molecules. CONCLUSION(S) IL-1 molecules originating in sperm cells may play a role in the physiologic functions of sperm cells (autocrine effect) and/or in cell-cell interactions within the testis (paracrine effect).

Antibodies to ureaplasma urealyticum in women with intraamniotic infection and adverse pregnancy outcome

Objective. To determine the association between antibody response to Ureaplasma urealyticum and pregnancy outcome in women with ureaplasmal invasion of the amniotic cavity. Methods. A cross section study was performed in our high risk pregnancy unit. Three groups of pregnant women were identified: 1) 271 women at the midtrimester of pregnancy (16–20 weeks), who underwent transabdominal amniocentesis for genetic indications 2) 161 consecutive women admitted with preterm labor and intact membranes. 3) 118 consecutive patients with preterm premature rupture of membranes. Amniotic fluids were cultured for Ureaplasma urealyticum, Mycoplasma hominis and also for other aerobic and anaerobic bacteria. Serum antibodies to Uu were measured by a specific enzyme‐linked‐immunosorbent‐assay. Results. The prevalence of positive AF cultures with Uu in the 3 study groups was 2.9%, 4.3% and 17.8%, and the prevalence of antibodies to Uu in the AF‐colonized patients was 50%, 86% and 57%, respectively. Adverse pregnancy outcome (preterm birth, low birth weight or fetal death) among all AF colonized women, was significantly higher in patients with antibodies to Uu than in those without antibodies; preterm delivery 90% vs. 43%, and low birth weight infants or fetal death 85% vs. 28%, p=0.006 and 0.001 respectively. Conclusion. Women with intraamniotic infection with Uu and elevated levels of antibodies to Uu, had a higher rate of preterm delivery, and low birthweight infantdfetal death than those without antibody to Uu.

Involvement of serum and lipopolysaccharide in the production of interleukin-1- and interleukin-6-like molecules by human sperm cells.

PROBLEM: To examine the capacity of sperm cells from fertile and infertile men to secrete interleukin (IL)‐6, and the involvement of serum factors and lipopolysaccharide (LPS) in the regulation of IL‐6 and IL‐1 production by sperm cells. METHODS: Swim‐up sperm cells from fertile (donors) and oligoteratoasthenospermic (OTA)‐infertile men were incubated with or without 5% fetal calf serum (FCS) and LPS (10 μg/mL) for 2–24 hr. After incubation, IL‐6 and IL‐1 bioactivities were measured in supernatants and lysates by specific bioassays (B9 cell proliferation assay and 1A‐5 system, respectively). RESULTS: IL‐6‐ and IL‐1‐like activities were observed to be produced by swim‐up sperm cells from both study groups. Stimulation of swim‐up sperm cells with either LPS or FCS or both together did not affect their capacity to produce IL‐1. However, LPS, but not serum increased the secretion levels of IL‐6 by swim‐up sperm cells. CONCLUSIONS: Swim‐up sperm cells from both study groups constitutively produce IL‐6 and IL‐1, and serum components did not affect this capacity. However, LPS was shown to increase the capacity of swim‐up sperm cells of both study groups to secrete IL‐6, but not IL‐1. Cytokines may be involved in the physiology and pathophysiology of sperm functions and, thus, may affect male fertility.

Successful treatment of preterm labour by eradication of Ureaplasma urealyticum with erythromycin

SummaryUreaplasma urealyticum was detected in the amniotic cavity of a woman with premature contractions at 32 weeks of pregnancy. Treatment with Erythromycin base was instituted for a period of ten days. Amniotic fluid analysis performed 48 hours after discontinuation of antibiotic treatment revealed sterile amniotic fluid. The pregnancy continued uneventfully until 39 weeks.

Ureaplasma urealyticum cervical colonization as a marker for pregnancy complications

Objectives: To determine the clinical significance of cervical colonization with (Ureaplasma urealyticum (Uu) and its possible relationship to pregnancy outcome. Methods: Cervical cultures for Uu and serum antibodies to Uu were determined in four groups of pregnant women: (1) 117 women who underwent mid‐trimester amniocentesis; (2) 47 women with preterm labor and intact membranes; (3) 34 women with preterm premature rupture of membranes; and (4) a control group of 315 healthy women with normal pregnancies. Statistical methods used were the chi‐square and Fishers exact tests. Results: A significant increase in the cervical colonization rate with Uu was detected in all study groups (62%, 77% and 74%, respectively) when compared with the control group (42%). Women at mid‐trimester of pregnancy with a positive cervical culture and high levels of antibodies, had a higher rate of pregnancy complications than those with a negative culture and absence of antibodies (62 vs. 28%, respectively; P = 0.0006). Conclusion: Cervical colonization with Uu when associated with elevated titers of antibodies to Uu, may serve as a marker for the identification of a subpopulation of women who are at high risk for the development of pregnancy complications.

Ureaplasma urealyticum in the development of postpartum endometritis.

OBJECTIVE Investigation of the clinical significance of Ureaplasma urealyticum and its biovars in the development of postpartum endometritis. STUDY DESIGN Cervical swabs were cultured for U. urealyticum in women presenting endometritis. The positive U. urealyticum cultures (>10(5) cfu/ml) (study group) were compared with those from women without endometritis (control group). Anti-Ureaplasma antibodies were measured and U. urealyticum biovars were determined by polymerase chain reaction. RESULTS There was no difference between the prevalence of U. urealyticum in the cervical swabs of both groups, however, the number of cfu per culture, showed a significant difference between study and control groups. Out of the culture positive endometritis patients 39% (26/67) had >10(5) cfu/ml compared to 17% of control patients (5/30) P=0.03. No significant disparity between both the groups was found in the prevalence of the parvo biovar (77% versus 71.5%, respectively). The difference in anti-Ureaplasma antibodies reached no statistical significance (30% versus 18% in study and control groups, respectively). CONCLUSIONS The significant difference in U. urealyticum culture cfu between both groups suggests that U. urealyticum may play a role in the etiology of this infection. This involvement is dependent not only on the presence or absence of U. urealyticum in the culture, but on its colonization rate in the cervix (>10(5) cfu/ml).