In our PPROM population Ureaplasma is isolated in nearly 30-40% of all cases. Its resistance to erythromycin is growing, and the benefits of the antibiotic regimen against Ureaplasma are not clear regarding latency period duration. Do you think it is a point for research?
Ureaplasma Urealyticum can elicit inflammatory cytokines and has been subjected to considerable attention over past decades for a role in PTB and PPROM. The key to its role in causation will probably reside in whether the organism elicits an inflammatory response in the mother and this will, in turn, probably depend upon genetic and epigenetic factors in the mother and fetes, and the associated vaginal flora. At term or late preterm, if any signs of clinical infection are present, or if there is dense infiltration of inflammatory cells on microscopy I treat. In preterm, Cochrane data states that in PPROM, especially before 34 weeks or when lung maturity is unknown, treatment with antibiotics prolongs pregnancy and improves outcomes so I also treat in these cases. Now the PROMPT trial outcomes have suggested we should be more conservative with late PPROM, I suspect we will also treat in these cases as well.
Hi Ernesto,
Pregnant women carrying both UU and Mycoplasma hominis had more severe adverse pregnancy outcomes compared to patients in preterm labor or PPROM who were only positive for UU (Please see http://www.ncbi.nlm.nih.gov/pubmed/23796000). However, the presence of these microorganisms in the vaginal flora might not be enough to cause pathological issues. Other co-morbid factors such as bacterial vaginosis and/or cervical incompetence may contribute to induce preterm birth. However, a multivariate analysis of confounding factors could provide ligth on the matter.
There are many issues on the topic that you may investigate if you a sufficient number of cases. A good study design would be needed to get good results.
Best wishes,
FRPL, UniZar
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