529: Bacteria are rapidly cleared from maternal bloodstream after delivery in pregnancies complicated by PPROM

  • Buhimschi C
  • Zhao G
  • Rood K
  • et al.
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Abstract

Objective: Preterm prelabor rupture of membranes (PPROM) is an integral part of preterm birth. When PPROM occurs prior to the onset of clinically recognizable uterine contractions, and fetus is stable, the patient is often admitted for observation. Yet, bacterial activity and progression of the inflammatory process continue silently. Birth occurs when microbial invasion of gestational sac, fetal membranes, placenta and myometrium reach a critical point. We sought to investigate if delivery of the placenta and powerful contraction of the uterus is associated with an outpouring of bacterial DNA and cytokines in the maternal circulation of women with PPROM. Study Design: 66 women (GA: 32+/-1 wks) had a confirmed diagnosis of PPROM. All women received antibiotics and steroids and were followed prospectively until delivery consistent with ACOG guidelines for management of PPROM. Maternal blood was retrieved via sterile venous puncture during the quiescent period and within 1 h post-partum (PP). At birth placental and fetal membrane tissues were collected and frozen in sterile fashion. A specific primer-probe was used for maternal blood and tissues bacterial quantification based on amplification of 16s rDNA by RT-PCR (data normalized to housekeeping gene GPI). Cord blood was collected and analyzed for haptoglobin (Hp) as a biomarker of antenatal exposure to inflammation. Maternal blood was analyzed for a panel of 10 cytokines by multiplex fluorescent immunoassay. Result(s): Albeit at low level, bacterial DNA was consistently identified in maternal blood both before and after birth. A significant decrease in maternal blood bacterial DNA was observed 1 h PP (dCt, before: 1.3x10-3 vs PP 0.9x10-3 fold change, P=.004). Conversely, levels of pro- (IL-6, IL-8, TNFa) and anti- (IL-10) inflammatory cytokines significantly increased (P<.05 for all) 1 h PP. In pregnancies where the fetus expressed Hp at birth the increase in maternal cytokine levels was more prominent (P<.001). The observed inverse relationship was prominent with increasing GA (P=.03) but independent of delivery mode or bacterial load of placenta or fetal membranes that harbored the highest bacterial burden (dCt, placenta: 4.0x10-3 vs membranes 16.1x10-3 fold change, P<.001). Conclusion(s): In PPROM, bacterial DNA is rapidly cleared from the maternal circulation in association with a significant surge in cytokine levels.Copyright © 2018

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Buhimschi, C. S., Zhao, G., Rood, K. M., Webster, S., Guessas, M., Hearne, S., … Buhimschi, I. A. (2019). 529: Bacteria are rapidly cleared from maternal bloodstream after delivery in pregnancies complicated by PPROM. American Journal of Obstetrics and Gynecology, 220(1), S355–S356. https://doi.org/10.1016/j.ajog.2018.11.551

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